Geographic population structure of the African malaria vector Anopheles gambiae suggests a role for the forest-savannah biome transition as a barrier to gene flow

The primary Afrotropical malaria mosquito vector Anopheles gambiae sensu stricto has a complex population structure. In west Africa, this species is split into two molecular forms and displays local and regional variation in chromosomal arrangements and behaviors. To investigate patterns of macrogeographic population substructure, 25 An. gambiae samples from 12 African countries were genotyped at 13 microsatellite loci. This analysis detected the presence of additional population structuring, with the M-form being subdivided into distinct west, central, and southern African genetic clusters. These clusters are coincident with the central African rainforest belt and northern and southern savannah biomes, which suggests restrictions to gene flow associated with the transition between these biomes. By contrast, geographically patterned population substructure appears much weaker within the S-form.

[Early prediction of severity in acute pancreatitis]

OBJECTIVE

To identify the score that best predicts early severity in patients with acute pancreatitis.

MATERIALS AND METHODS

A prospective cohort study was performed from December 2009 to December 2011. Cases of pancreatitis were classified as mild or severe based on the organ failure criteria and/or local complications according to the Atlanta Symposium. APACHE-II, BISAP and urea were calculated using data from the first 24 hours. Ranson was calculated using data from the first 48 hours. Hemoconcentratión was assessed 24 hours from admission, after adequate hydration. To assess the predictive value of the different scores the area under the curve ROC was used.

RESULTS

329 patients with acute pancreatitis were included: 214 women (65%) and 115 males (35%). The most common etiology was biliary 245 (74.3%). Two hundred and forty were mild cases of pancreatitis (73%) and 89 were severe (27%). The areas under the curve ROC were: APACHE-II: 0.74; BISAP: 0.78; Ranson: 0.48; urea: 0.70; hemoconcentratión: 0.73. There were 10 deaths (mortality: 3%). There were no significant differences between BISAP and APACHE-II, urea or hemoconcentration, but a significant difference existed with Ranson score.

CONCLUSION

BISAP is a simple score that applied early in the emergency room identifies patients with severe pancreatitis with an efficacy similar to APACHE-II, urea and hemoconcentration, and

KEY WORDS

acute pancreatitis, BISAP, severity, prognostic scoring.

Frequency of PIK3CA mutations in HER2+ surgically resected breast cancers in a Hispanic cohort

e11066

Background: PI3K signaling pathway is responsible for balancing cell survival and apoptosis, and plays an important role in the pathogenesis and progression of human breast cancers. Alterations in this pathway could influence the response to targeted therapy. Our aim is to know the frequency of mutations in the PIK3CA gene in HER2+, operable breast tumors in an Andean population. Methods: We include a cohort of 59 patients with HER2+ surgically resected breast cancer that received adjuvant anti-HER2 targeted therapy at the Instituto Nacional de Enfermedades Neoplásicas. Genomic DNA was extracted from Paraffin embedded-formalin fixed tumor samples and mutational status of PIK3CA gene was using PCR-based DNA sequencing Results: At the current date, the median of follow-up in our cohort is 2.4 years and two recurrences have been registered. Four samples were not evaluable for molecular analysis. Mutation in PIK3CA gene was detected in 12 cases (20.3%). In cases where PIK3CA mutation was detected, eight cases (66.7%) had mutations in exon 9 (A1634C/E545A in 6 cases; G1624A/E542K in 1 case and G1633A/E545K in 1 case). Four cases (33.3%) had exon 20 mutated (A3140G/H1047R in all cases). There was not coexistence of mutations in both exons. One case of tumor recurrence had mutation in exon 9. Conclusions: We found similar rates of PIK3CA mutations as described previously to HER2+, breast tumors. A longest follow upwill show the prognostic value of PIK3CA status in our cohort treated with targeted anti-HER2 therapy. [Table: see text]

Meningism as a poor risk factor in breast cancer patients with relapse in central nervous system (CNS)

e11518

Background: CNS relapse in breast cancer patients is invariably defined as a poor prognosis feature with varied and bizarre clinical presentation. We describe the commonest signs and symptoms in CNS relapse and their relation with prognosis Methods: We evaluate retrospectively 2597 women with breast cancer treated at the Instituto Nacional de Enfermedades Neoplásicas (Lima-Perú) between 2000-2005. Phenotypes were determined by IHC and categorized in [HR+, HER2-], triple-negative (TN) [HR-, HER2-] and Her-2 [HR+/-, HER2 +]. Post-CNS recurrence survival was calculated by Kaplan Meier method. We use Chi-square, or exact Fisher test when appropriate, to evaluate correlations between categorical variables. Results: 157 pts (6.04%) had CNS relapse from which 19 had only leptomeningeal carcinomatosis (LMC), 124 only brain metastases and 14 both. In regard to phenotype, 43pts were [HR+, HER2-] (5 LMC), 68 were TN (13 LMC) and 51 were [HR+/-, HER2 +] (15 LMC). 152 pts had stages I-III (96.8% of all SNC relapses). There was no association between phenotypes and age at CNS relapse, ECOG PS, extracraneal metastases, control of primary tumor, number or volume of brain metastases. Significant association was found between phenotype and time from diagnosis to CNS relapse (≤8 months: 16.3% in TN, 7.3% in Her-2 and 0% for [HR+, HER2-], [P=0.017] ) and histological grade (grade III: 74.4% in TN, 55.% in Her-2 and 30% for [HR+, HER2-], [P=0.006]). Symptoms/signs frequently described in LMC patients were cephalea (72%), meningism (24%), nausea (24%), vomiting (20%), ataxia (20%), facial palsy (16%), somnolence (16%), paraparesia (12%), hiporeflexia (12%), apraxia (12%), arreflexia (12%), poor sphincter control (12%), hemiparesia (8%), seizures (8%), bradipsiquia (8%), neuropathic pain (4%). Fifty percent of TN pts with LMC had meningism. Post recurrence survival was shorter in TN patients (3.61mo vs 4.89mo to [HR+, HER2-] vs 5.95mo to [HR+/-, HER2 +; P=0.044] and in patients with meningism (1.38mo vs 5.26mo; P=0.02). Cox regression identify meningism as a risk factor for survival in patients relapsed with LMC (HR: 4.33; P=0.066). Conclusions: Meningism seems to be the only sign related to poor prognosis in patients relapsed with LMC.

Studies on the behaviour of peridomestic and endophagic M form Anopheles gambiae from a rice growing area of Ghana

The 'paddy paradox', the occurrence of large populations of vectors but low amounts of malaria transmission where irrigated rice is grown, was investigated in a village in Ghana where M form Anopheles gambiae are common. Peridomestic and indoor host-seeking mosquitoes were collected in tent traps and light traps over 21 consecutive nights at the start of the rainy season in June 2009 when the population increased exponentially from less than 100 per night to over 1000. Infection rates in the overall mosquito population were 0.3% and in the estimated parous population were 1.9%. Numbers of An. gambiae in the tent trap peaked between midnight and 02:40 am. The majority of insects were taking their first blood meal, as virgins or shortly after mating. More than expected were collected in the light trap during a rainstorm at the start of the rains but overall numbers were not affected. Fewer than expected were collected after a subsequent storm. Recruitment to the adult population decreased over the following days. It is hypothesised that the 'paddy paradox' is due to young pre-gravid insects dispersing more widely than gravid ones, not necessarily to low survival in the mosquito.

Characterization of backyard poultry production systems and disease risk in the central zone of Chile

Backyard poultry production systems (BPS) are an important and widespread form of poultry production. There is a common perception that biosecurity standards in BPS are generally poor and BPS are usually associated with animal diseases and zoonoses. In this study BPS were identified in the vicinity of six wetlands, having these a higher risk of presenting and introducing avian diseases such as HPAI and Newcastle disease, as defined by the national veterinary services, in to Chile's main poultry production area. BPS were characterized through a field questionnaire and the main areas covered by the survey were BPS structure, biosecurity and value chain. The BPS identified in this study share most characteristics on biosecurity, poultry management and product commercialization, but it was possible to identify a certain degree of variation within and among the study sites. BPS in Chile are similar to those in other regions, with a relatively small flock size (average 37 birds), a low level of biosecurity measures and lack of poultry disease management. Management findings include that most farmers used mixed/partial confinement, with low or no biosecurity and disease control measures in place. Eggs were the main output and were used mainly for home consumption or sale at local markets. Sick birds' treatment with drugs approved for other species or for human use could represent a risk to human health, owing to the possible presence of drug residues in poultry products. Despite the different structures of the poultry sector worldwide, BPS can play a major role in disease maintenance and spread because its management conditions characteristics and the lack of animal health services adapted to these production systems. This should be an alert message to the veterinary authorities to improve coverage of veterinary assistance and surveillance activities in backyard poultry production.

Efecto de tres dietas en el crecimiento de crías de cocodrilo americano Crocodylus acutus

Se estudió el efecto de tres dietas con sustitución de pescado marino (20 y 40%) por hígado de res en el crecimiento y supervivencia, así como el efecto de la temperatura en el consumo de alimento de crías de Crocodylus acutus. Los cocodrilos alimentados con la dieta de 40% de hígado tuvieron el mayor crecimiento y un 100% de supervivencia, con potencial de mayor tolerancia a condiciones invernales.

Hansen's disease mimicking a systemic vasculitis

Hansen's disease, caused by Mycobacterium leprae, classically presents with cutaneous and neurological manifestations. Rheumatologic manifestations present in 1 to 5% of the patients, and include arthritis, arthralgias, Charcot arthropathy, erythema nodosum and vasculitis. We report a case of a 86 year old woman with polyarthritis, subcutaneous nodules and leg ulcers whose differential diagnosis included primary vasculitis and diffuse connective tissue diseases and ended to be leprosy in a non endemic country.

Amyloidosis secondary to rheumatic diseases - 16 cases

INTRODUCTION

Secondary amyloidosis (SA) results of tissue deposition of an acute phase reactant protein produced by chronic inflammation. Its incidence appears to be declining, following the improvement of medical care to primary diseases. Our aim is to assess a group of Portuguese patients with amyloidosis secondary to inflammatory rheumatic diseases, and their evolution over the past 10 years.

METHODS

The study comprised 16 patients with SA confirmed by tissue biopsy, hospitalized in the Rheumatology Department of Hospital São João in Oporto in the last 10 years. We made a protocol on epidemiological, clinical and analytical data focusing the rheumatic disease and SA, and possible elements of connection between them.

RESULTS

Of the 16 patients, mainly women (81,2%), with mean age at entry of 56 years, 68,8% had rheumatoid arthritis. Amyloidosis was diagnosed in average at 13,5 years of primary rheumatic disease, and its main manifestation was kidney involvement, which together with infection and orthopaedic surgery or its complications, were the leading causes of hospitalization. In this time interval, 6 patients died. They were older, with longer duration and lower rate of treatment of the primary rheumatic disease, and had SA diagnosed 1,5 years before death (different of the 5 years of those that still alive). They had higher rate of gastrointestinal, neurological and serious kidney involvement, and hospitalizations.

CONCLUSIONS

Improving medical care in rheumatic inflammatory diseases has reduced the incidence of SA. Also, biotherapy appears to be achieving positive results in established amyloidosis, whatever the mechanisms involved. Our data, on Portuguese patients, seems to follow this trend.

The cold European winter of 2005-2006 assisted the spread and persistence of H5N1 influenza virus in wild birds

In January 2006, a major cold spell affected Europe, coinciding with an increase of H5N1 influenza virus detected in wild birds, mostly dead mute swans, starting along the River Danube and the Mediterranean coast line. Subsequently H5N1 detections in wild birds were concentrated in central and western parts of Europe, reaching a peak in mid February. We tested the hypothesis that the geographic distribution of these H5N1 infections was modulated by the long-term wintering line, the 0 °C isotherm marking the limit beyond which areas are largely unsuitable for wintering waterfowl. Given the particularly cold 2005-2006 European winter, we also considered the satellite-derived contemporary frost conditions. This brought us to select the long-term maximum rather than the mean January 0 °C isotherm as the best approximation for the 2005-2006 wintering line. Our analysis shows that H5N1 detection sites were closer to the wintering line than would be expected by chance, even when the geographic distribution of water bird wintering sites was accounted for. We argue that partial frost conditions in water bodies are conducive to bird congregation, and this may have enhanced H5N1 transmission and local spread. Because the environmental virus load also would build up in these hot spots, H5N1 virus may have readily persisted during the spring, at least in cooler areas. We conclude that H5N1 introduction, spread, and persistence in Europe may have been enhanced by the cold 2005-2006 winter.

Effect of hyperoxic resuscitation on propensity of germinal matrix haemorrhage and cerebral injury

AIMS

Intraventricular haemorrhage (IVH) and cerebral injury are major neurological disorders of premature infants. The effect of hyperoxic resuscitation on the occurrence of IVH and cerebral injury is elusive. Therefore, we asked whether hyperoxia during neonatal resuscitation increased the incidence and severity of IVH and cerebral injury in premature newborns.

METHODS

Premature rabbit pups, delivered by C-section, were sequentially assigned to receive 100%, 40% or 21% oxygen for 15 or 60 min at birth. The pups were treated with intraperitoneal glycerol at 24-h postnatal age to determine the incidence and severity of glycerol-induced IVH. Vascular endothelial growth factor and angiopoietin-2 genes and protein expression, endothelial proliferation as well as free radical levels and antioxidants were assessed in the germinal matrix, white matter and cortex of pups exposed to 100% oxygen and to 21% oxygen.

RESULTS

Exposure with 100% oxygen for 1 h did not adversely exacerbate the incidence of glycerol-induced IVH in premature rabbit pups. Compared with room air, 100% oxygen enhanced mRNA expression of both vascular endothelial growth factor and angiopoietin-2 as well as reactive oxygen species levels in the germinal matrix. Hyperoxia did not affect endothelial proliferation, apoptosis or neuronal degeneration in the forebrain.

CONCLUSION

Our data suggest that 100% oxygen exposure for 1 h does not increase the risk of IVH or cerebral injury in premature rabbit pups. Although extrapolating rabbit neural developmental data into humans has obvious limitations, we speculate that hyperoxia of short duration at birth in premature infants may not result in major neurological adverse effects.

[Anesthetic management in a pregnant woman with type 1 Gaucher disease]

Gaucher disease is a genetic disorder in which the enzyme activity of lysosomal acid beta-glucocerebrosidase is impaired, causing excessive lysosomal storage of glucocerebrosidase in monocytes and macrophages. Coagulation and multiorgan disorders can develop during pregnancy in women with this disorder, affecting anesthetic management. We report the case of a woman with type 1 Gaucher disease who was scheduled for cesarean section. The blood workup showed evidence of hepatosplenomegaly and thrombocytopenia, osteopenia, and gastroesophageal reflux. Epidural anesthesia-analgesia was provided. Surgical conditions and analgesia were both satisfactory and no complications developed after withdrawal of the epidural catheter. We conclude that the management of anesthesia for pregnant women with Gaucher disease will depend on the degree of systemic involvement. Regional anesthesia has been used in many such patients, but there is insufficient literature on which to base guidelines or protocols.