Small difference in international normalized ratio may yield a significant impact on prioritizing patients listed for liver transplantation

Priority for liver transplantation is currently based on the Model for End-stage Liver Disease (MELD) score. The aim of our study was to assess in detail the contribution of international normalized ratio (INR) differences for MELD scores because of interlaboratory variability. The samples from 92 cirrhotic patients were measured on different systems combining three coagulometers and three thromboplastin products to determine variations in INR and MELD score. The INR differences among the first four systems varied between 0 and 0.2, resulting in MELD differences of 0 to 2. The MELD scores of 92 patients changed only among 10 possible integers so that normally 2 to 10 patients shared the same MELD value. In some cases, one MELD score difference resulted in a 10 superpositioning on the waiting list. Including one more system (mechanical vs optical) into our investigations achieved a five MELD difference. Supposing an extreme situation where one patient competes with his or her lowest, all the other with their highest possible score (and visa versa), the difference may be even 20 positions, overturning the complete waiting list. In conclusion substantial interlaboratory differences in MELD score have profound clinical consequences.

Nail infection by Aspergillus ochraceopetaliformis

Aspergillus ochraceopetaliformis is a rare fungal species that has not yet been identified as a proven human pathogen. Here we report a case of a toenail infection in a healthy woman caused by this fungus. Species identification was performed by scrutinizing the phenotypic and genetic characteristics of distinct isolates obtained at different times during the course of the infection. Treatment with terbinafine plus ciclopiroxolamine was effective.

Grading of fermented and dried cocoa beans using fungal contamination, ergosterol index and ochratoxin a production

Sixty four samples of cocoa beans replicated in quadruplicates were collected from five warehouses from southwest Nigeria and examined for fungal loads, ergosterol and ochratoxin A The levels of all the variables obtained were further used as indices for cocoa grading into food quality, FoQ (erg < 5 mg/kg; OTA < 1 µg/kg), feed quality, FeQ (erg = 5~10 mg/kg; OTA in the range of 1.1~3.11 µg/kg), Screen for mycotoxin, SFM (erg = 10~20 mg/kg; OTA from 3.12 µg/kg and above) with fuel quality, FuQ having erg > 20 mg/kg and OTA > 6.12 µg/kg. Using these ergosterol indices, 18.75% of the cocoa beans examined was classified with the FoQ, 18.75% with the FuQ while 31.25% was classified with both the FeQ and the SFM, respectively. In conclusion, ergosterol can be used as a rapid index to grade fermented, dried cocoa beans meant for export.

A reappraisal of fungi producing aflatoxins

Aflatoxins are decaketide-derived secondary metabolites which are produced by a complex biosynthetic pathway. Aflatoxins are among the economically most important mycotoxins. Aflatoxin B1 exhibits hepatocarcinogenic and hepatotoxic properties, and is frequently referred to as the most potent naturally occurring carcinogen. Acute aflatoxicosis epidemics occur in several parts of Asia and Africa leading to the death of several hundred people. Aflatoxin production has incorrectly been claimed for a long list of Aspergillus species and also for species assigned to other fungal genera. Recent data indicate that aflatoxins are produced by 13 species assigned to three sections of the genus Aspergillus: section Flavi (A. flavus, A. pseudotamarii, A. parasiticus, A. nomius, A. bombycis, A. parvisclerotigenus, A. minisclerotigenes, A. arachidicola), section Nidulantes (Emericella astellata, E. venezuelensis, E. olivicola) and section Ochraceorosei (A. ochraceoroseus, A. rambellii). Several species claimed to produce aflatoxins have been synonymised with other aflatoxin producers, including A. toxicarius (=A. parasiticus), A. flavus var. columnaris (=A. flavus) or A. zhaoqingensis (=A. nomius). Compounds with related structures include sterigmatocystin, an intermediate of aflatoxin biosynthesis produced by several Aspergilli and species assigned to other genera, and dothistromin produced by a range of non-Aspergillus species. In this review, we wish to give an overview of aflatoxin production including the list of species incorrectly identified as aflatoxin producers, and provide short descriptions of the 'true' aflatoxin producing species.

Aspergillus acidus from Puerh tea and black tea does not produce ochratoxin A and fumonisin B2

Puerh tea is a unique Chinese fermented tea. Unlike other teas it is stored for a long period of time. Aspergillus niger is claimed to be the dominant microorganism in the Puerh tea manufacturing process and also to be common on tea in general. A. niger sensu stricto is known to produce the mycotoxins ochratoxin A, fumonisins B(2) and B(4). With this in mind, we performed a preliminary study to determine if production of these mycotoxins by black Aspergilli isolated from Puerh and black tea can occur. An examination of 47 isolates from Puerh tea and black tea showed that none of these was A. niger. A part of the calmodulin gene in 17 isolates were sequenced, and these 17 isolates were all identified as Aspergillus acidus (=A. foetidus var. acidus). The rest of the 47 isolates were also identified as A. acidus from their metabolite profile. Neither production of ochratoxin A nor fumonisins B(2) and B(4) by any of the 47 isolates were observed.

Development of a provisional core set of response measures for clinical trials of systemic sclerosis

OBJECTIVE

To develop a provisional core set of response measures for clinical trials of systemic sclerosis (SSc).

METHODS

The Scleroderma Clinical Trials Consortium (SCTC) conducted a structured, 3-round Delphi exercise to reach consensus on a core set of measures for clinical trials of SSc. Round 1 asked the SCTC investigators to list items in 11 pre-defined domains (skin, musculoskeletal, cardiac, pulmonary, cardio-pulmonary, gastrointestinal, renal, Raynaud phenomenon and digital ulcers, health-related quality of life and function, global health, and biomarkers) for SSc clinical trials. Round 2 asked respondents to rate the importance of the chosen items and was followed by a meeting, during which the Steering Committee discussed the feasibility, reliability, redundancy and validity of the items. Round 3 sought to obtain broader consensus on the core set measures. Members also voted on items that had data on feasibility but lacked data on reliability and validity, but may still be useful research outcome measures for future trials.

RESULTS

A total of 50 SCTC investigators participated in round 1, providing 212 unique items for the 11 domains. In all, 46 (92%) participants responded in round 2 and rated 177 items. The ratings of 177 items were reviewed by the Steering Committee and 31 items from the 11 domains were judged to be appropriate for inclusion in a 1-year multi-centre clinical trial. In total, 40 SCTC investigators completed round 3 and ranked 30 of 31 items as acceptable for inclusion in the core set. The Steering Committee also proposed 14 items for a research agenda.

CONCLUSION

Using a Delphi exercise, we have developed a provisional core set of measures for assessment of disease activity and severity in clinical trials of SSc.

Comparison of Sutured versus Non-Sutured Subcutaneous Fat Tissue in Abdominal Surgery

PURPOSE

The aim of this prospective randomized study was to investigate the necessity of suturing subcutaneous fat tissue in elective abdominal surgery.

METHODS

415 patients undergoing elective abdominal surgery were admitted to the trial. The patients were divided into two basic groups according to wound contamination: clean operations (n = 201) and clean-contaminated operation (n = 214). Subcutaneous suturing of the subcutaneous fat tissue was performed in half of the patients in each group, determined using the envelope method ('Suture Yes' or 'Suture No'). Wounds were checked on postoperative days 3, 7, 14, and 30. Infectious and non-infectious wound complications were charted in the records. Data were statistically analyzed. The percentages of complications in groups with and without subcutaneous suturing were statistically compared using Yates' corrected chi(2) two-tailed test.

RESULTS

There were no statistically significant group differences in infectious and non-infectious wound complications.

CONCLUSION

These results suggest that omission of subcutaneous fat tissue suturing does not increase the occurrence of infectious or non-infectious wound complications.

Acute Scrotal Pain in Children – Ten Years’ Experience

INTRODUCTION

Acute scrotal pain sometimes requires prompt surgical intervention and therefore accurate diagnosis of different etiologies of acute scrotal pain has great therapeutical and prognostic significance. The aim of this study was to analyze the incidence, symptomatology and results of treatment of acute scrotal pain in children.

MATERIAL AND METHOD

The study included patients hospitalized at the Pediatric Surgery Clinic with a diagnosis of acute scrotal pain. We retrospectively analyzed anamnestic data (age of patient and duration of anamnesis prior to admission), clinical parameters obtained during physical examination, mode of treatment (operative or medical), intraoperative findings and (postoperative) treatment.

RESULTS

The study included 256 patients with acute scrotal pain, aged from several hours up to 17 years of age (average 9.73 years). The average duration of symptoms prior to admission was 56.74 h. Acute epididymitis was diagnosed in 110 patients (43.0%), torsion of the testicular appendage in 104 patients (40.6%), torsion of the testis in 30 patients (11.7%) and other pathologies in another 12 patients. 166 patients (64.8%) underwent surgery, 42 patients with orchiepididymitis (38.2%), 92 patients with torsion of the testicular appendage (88.5%), and 16.6% of the patients with other pathologies. 22 patients with torsion of the testis underwent surgery (73.3%), while the rest of the 8 patients underwent manual detorquation of the testis.

CONCLUSION

Regardless of the etiology of the acute scrotal pain, it is of great importance that the patient seeks medical assistance promptly. It is therefore important to educate the parents and patients about the problems related to acute scrotal pain.

The current status of species recognition and identification in Aspergillus

The species recognition and identification of aspergilli and their teleomorphs is discussed. A historical overview of the taxonomic concepts starting with the monograph of Raper & Fennell (1965) is given. A list of taxa described since 2000 is provided. Physiological characters, particularly growth rates and the production of extrolites, often show differences that reflect phylogenetic species boundaries and greater emphasis should be placed on extrolite profiles and growth characteristics in species descriptions. Multilocus sequence-based phylogenetic analyses have emerged as the primary tool for inferring phylogenetic species boundaries and relationships within subgenera and sections. A four locus DNA sequence study covering all major lineages in Aspergillus using genealogical concordance theory resulted in a species recognition system that agrees in part with phenotypic studies and reveals the presence of many undescribed species not resolved by phenotype. The use of as much data from as many sources as possible in making taxonomic decisions is advocated. For species identification, DNA barcoding uses a short genetic marker in an organism"s DNA to quickly and easily identify it to a particular species. Partial cytochrome oxidase subunit 1 sequences, which are used for barcoding animal species, were found to have limited value for species identification among black aspergilli. The various possibilities are discussed and at present partial beta-tubulin or calmodulin are the most promising loci for Aspergillus identification. For characterising Aspergillus species one application would be to produce a multilocus phylogeny, with the goal of having a firm understanding of the evolutionary relationships among species across the entire genus. DNA chip technologies are discussed as possibilities for an accurate multilocus barcoding tool for the genus Aspergillus.