Severe gram positive bacterial infection in an ulcerative colitis patient treated with Infliximab

Tumour necrosis factor-alpha (TNF-α) inhibitors represent an important treatment advance for a number of inflammatory conditions, including inflammatory bowel disease. Since their introduction in 1999, it has become clear that some biological therapies may be associated with an increased risk for bacterial infections. Herein we present the first case of septic arthritis and spine empyema, caused by S. aureus, in a 63 year-old patient with ulcerative colitis, who was under treatment with Infliximab and with 40mg per day of prednisolone.

Evidence for a discrete evolutionary lineage within Equatorial Guinea suggests that the tsetse fly Glossina palpalis palpalis exists as a species complex

Tsetse flies of the palpalis group are major vectors of Human African Trypanosomiasis in Africa. Accurate knowledge of species identity is essential for vector control. Here, we combine ribosomal internal transcribed spacer 1 (ITS1), mitochondrial Cytochrome Oxidase 1 (COI) and microsatellites to determine the population structure and phylogenetic relations of Glossina p. palpalis in Equatorial Guinea. CO1 sequence data suggest that G. p. palpalis in Equatorial Guinea is a distinct subspecies from previously described G. p. palpalis in West Africa and Democratic Republic of Congo. Glossina p. palpalis in Equatorial Guinea and DRC share a common ancestor which diverged from West African G. p. palpalis around 1.9 Ma. Previous ITS1 length polymorphism data suggested the possible presence of hybrids in Equatorial Guinea. However, ITS1 showed incomplete lineage sorting compared with clearly defined COI groups, and data from 12 unlinked microsatellites provided no evidence of hybridization. Microsatellite data indicated moderate but significant differentiation between the populations analysed (Rio Campo, Mbini and Kogo). Moreover, unlike previous studies of G. p. palpalis, there was no evidence for heterozygote deficiency, presence of migrants or cryptic population structure. Variance effective population size at Rio Campo was estimated at 501-731 assuming eight generations per year. This study of the population genetics of G. p. palpalis in central Africa provides the first estimate of genetic differentiation between geographically separated G. p. palpalis populations.

High levels of hybridization between molecular forms of Anopheles gambiae from Guinea Bissau

In the malaria vector Anopheles gambiae Giles sensu stricto, two molecular forms denoted M and S are considered units of incipient speciation within this species. Very low hybrid frequencies and significant genetic differentiation have been found in sympatric M- and S-form populations. We studied the molecular form composition and the degree of genetic differentiation at 15 microsatellites in two samples of An. gambiae collected in two consecutive years from Bissau, Guinea Bissau. High frequencies of M/S hybrids (19-24%) were found in this area. Coincidently, very low levels of genetic differentiation were detected between forms when analysis involved microsatellites mapped at chromosome-3 (mean Fst, 0.000-0.002). The single exception was the X-linked AGXH678, for which high differentiation was measured (Fst, 0.158-0.301). This locus maps near the centromere of chromosome X, a low recombination region in which selection is likely to promote divergence between M and S forms. These results strongly suggest that the degree of isolation between M and S forms, considered the units of incipient speciation within An. gambiae, is not homogenous throughout the species distribution range.

Climate change and animal diseases in South America

Climate strongly affects agriculture and livestock production and influences animal diseases, vectors and pathogens, and their habitat. Global warming trends predicted in the 2007 Intergovernmental Panel on Climatic Change (IPCC) report for South America are likely to change the temporal and geographical distribution of infectious diseases, including those that are vector-borne such as bluetongue, West Nile fever, vesicular stomatitis and New World screwworm. Changes in distribution will be partially modulated by El Niño Southern Oscillation events, which will become more frequent and lead to a greater frequency of droughts and floods. Active disease surveillance for animal diseases in South America, particularly for vector-borne diseases, is very poor. Disease reporting is often lacking, which affects knowledge of disease distribution and impact, and preparedness for early response. Improved reporting for animal diseases that may be affected by climate change is needed for better prevention and intervention measures in susceptible livestock, wildlife and vectors in South America. This requires contributions from multidisciplinary experts, including meteorologists, epidemiologists, biologists and ecologists, and from local communities.

Tubes for pretransfusion testing should be collected by blood bank staff and hand labelled until the implementation of new technology for improved sample labelling. Results of a prospective study

BACKGROUND AND OBJECTIVES

The greatest risk in transfusion medicine is actually human error, resulting in the use of the incorrect blood component. The aim of our study was to identify and evaluate the risk factors involved in the collection and labelling of pretransfusion blood samples.

MATERIAL AND METHODS

We prospectively evaluated 6446 samples submitted to the blood bank for pretransfusion testing. Inappropriate samples were classified as 'mislabelled' or 'miscollected'. After 4 months of study, an educational approach was taken.

RESULTS

The frequency of inappropriately labelled samples was 6.45%. Such samples were associated with the use of addressograph labels (vs. hand-written labels) [23.4% vs. 1.4%, P < 0.0001], collection by clinical staff (vs. blood bank staff) [8.8% vs. 2.1%, P = 0.001] and emergency situations (vs. routine sampling) [10.1% vs. 6.1%, P = 0.005]. Following educational intervention, the percentage of inappropriately labelled samples decreased from 7.3% (pre-educational) to 5.8% (post-educational), P = 0.005.

CONCLUSION

Ongoing monitoring and analysis of labelling and collection should be mandatory in order to improve the safety of transfusion.

Ellis-van Creveld Syndrome (chondro-ectodermal dysplasia) in two siblings

Two male siblings aged 12 and 15 years (Figure 1) presented with growth retardation, limb abnormalities and, defective teeth and nail since childhood. There was no history of similar defects in other family members. On examination their height was 114 cm and 130 cm (expected height; 169 cm and 150 cm) respectively. There were hypoplastic and dystrophic nails, and microdontia and hypodontia on dental examination. There were post-axial polydactyly in both the hands and left foot. Skeletal survey revealed short forearms, legs & distal phalanges (Acromesomelia). Cardiac or other organ system defects were not noticed on clinical examination or echocardiogram. Clinical picture was suggestive of a diagnosis of Chondroectodermal dysplasia (Ellis van Creveld syndrome). These cases have been reported for their rarity and for the presence of some rare features of this syndrome.

A primer-introduced restriction analysis-polymerase chain reaction method to detect knockdown resistance mutations in Anopheles gambiae

In the major malaria vector Anopheles gambiae Giles, two point mutations at the voltage-gated sodium channel have been associated with knockdown resistance (kdr) to DDT and pyrethroid insecticides. Simple allele-specific polymerase chain reaction (PCR) assays to detect these single-nucleotide polymorphisms are prone to lack of specificity and therefore alternative techniques have been proposed. However, these may not be easily implemented in many laboratories from malaria endemic regions. Here, we describe a primer-introduced restriction analysis (PIRA)-PCR method to detect kdr mutations in An. gambiae. This method unambiguously identified all six genotypes for the kdr locus in a sample of 113 field-collected mosquitoes for which kdr genotypes had been confirmed by DNA sequencing. Co-occurrence of both kdr alleles was found in sites from Equatorial Guinea and Gabon and the L1014F mutation was detected in M-form individuals from Angola. The PIRA-PCR proved to be a reliable, robust, and simpler alternative for the detection of kdr mutations in this malaria vector.

Correction of failed fertilization despite intracytoplasmic sperm injection with oligoasthenoteratozoospermia but with acrosomes present by oocyte activation with calcium ionophore--case report

PURPOSE

To determine if fertilization and embryo cleavage can be achieved by artificial oocyte activation in circumstances of repeated failed fertilization with sperm that have an acrosome.

METHODS

A woman with three IVF cycles with intracytoplasmic sperm injection (ICSI) failed to fertilize any eggs. The sperm had severe oligoasthenoteratozoospermia with no sperm with normal morphology. In the fourth IVF cycle fertilization was evaluated by performing ICSI with the husband's sperm and egg activation with calcium ionophore, ICSI with the husband's sperm without artificial oocyte activation, and ICSI with donor sperm.

RESULTS

Five mature oocytes were retrieved. Of the four eggs having ICSI with the husband's sperm only one of the two activated by calcium ionophore fertilized and resulted in a cleaved day 3 embryo. Interestingly, the one egg fertilized by donor sperm did not fertilize.

CONCLUSIONS

The data could be consistent with conclusions that in some cases the failure to fertilize may be related to an oocyte activation factor/receptor problem in the oocyte that can be overcome by the use of calcium ionophore.

Improved pregnancy outcome for women with decreased ovarian oocyte reserve and advanced reproductive age by performing in vitro fertilization-embryo transfer

OBJECTIVE

To compare the pregnancy rates with IVF-ET vs non-assisted reproductive technology in women of more advanced reproductive age with decreased egg reserve as manifested by elevated day 3 serum FSH.

METHODS

A retrospective evaluation was made in women aged > or = 38 with a day 3 serum FSH of degrees 15 mIU/ml with > or = 1 year of infertility. Another inclusion criterion was three cycles (unless a pregnancy occurred before that time) of either IVF-ET or non-assisted reproductive therapy which as a minimum included luteal phase support with progesterone.

RESULTS

The clinical pregnancy rates in three cycles for non-IVF were 11.7% vs 27.2% for IVF. Delivery rates were 2.9% vs 15.1%. For ages 40-42 the clinical pregnancy rates were 37.5% vs 0.0% (p = .02).

CONCLUSIONS

Live deliveries are possible in women > or = age 38 with marked decreased egg reserve. In vitro fertilization is more effective than non-IVF when follicle stimulation with gonadotropins is mild.

A putative gene located at the MHC class I region around the D6S105 marker contributes to the setting of CD8+ T-lymphocyte numbers in humans

Significant associations between human leucocyte antigen (HLA)-A and -B alleles and CD8+ T-lymphocyte numbers have been reported in the literature in both healthy populations and in HFE-haemochromatosis patients. In order to address whether HLA alleles themselves or alleles at linked genes are responsible for these associations, several genetic markers at the MHC class I region were typed on a population of 147 apparently healthy unrelated subjects phenotypically characterized for their CD8+ and CD4+ T-lymphocyte numbers. By using a machine learning approach, a set of rules was generated that predict the number of CD8+ T-lymphocyte numbers on the basis of the information of the D6S105 microsatellite alleles only. We demonstrate that the previously reported associations with HLA-A and -B alleles are due to the presence of common long (up to 4 megabases long) haplotypes that increased in frequency recently due to positive selection and that encompass a region where a putative gene contributing to the setting of CD8+ T lymphocytes is located, in the neighbourhood of microsatellite locus D6S105, in the 6p21.3 region.

Advances in scrapie research

The bovine spongiform encephalopathy (BSE) crisis clearly demonstrated the need to keep animal transmissible spongiform encephalopathies (TSE) under control in order to protect animal and human health. Scrapie is the most widespread TSE of livestock in the world. For this reason, health authorities in different countries have elaborated plans that aim towards scrapie eradication. The unusual nature of the scrapie agent and the fragmented status of scientific knowledge about it, along with the limitations of currently available diagnostic tools, make it unlikely that the objective of eradication will be achieved in the near future. Scientific research is focused on acquiring the knowledge that will improve the efficiency of these efforts.

Assessment of inhalation exposures and potential health risks to the general population that resulted from the collapse of the World Trade Center towers

In the days following the collapse of the World Trade Center (WTC) towers on September 11, 2001 (9/11), the U.S. Environmental Protection Agency (EPA) initiated numerous air monitoring activities to better understand the ongoing impact of emissions from that disaster. Using these data, EPA conducted an inhalation exposure and human health risk assessment to the general population. This assessment does not address exposures and potential impacts that could have occurred to rescue workers, firefighters, and other site workers, nor does it address exposures that could have occurred in the indoor environment. Contaminants evaluated include particulate matter (PM), metals, polychlorinated biphenyls, dioxins, asbestos, volatile organic compounds, particle-bound polycyclic aromatic hydrocarbons, silica, and synthetic vitreous fibers (SVFs). This evaluation yielded three principal findings. (1) Persons exposed to extremely high levels of ambient PM and its components, SVFs, and other contaminants during the collapse of the WTC towers, and for several hours afterward, were likely to be at risk for acute and potentially chronic respiratory effects. (2) Available data suggest that contaminant concentrations within and near ground zero (GZ) remained significantly elevated above background levels for a few days after 9/11. Because only limited data on these critical few days were available, exposures and potential health impacts could not be evaluated with certainty for this time period. (3) Except for inhalation exposures that may have occurred on 9/11 and a few days afterward, the ambient air concentration data suggest that persons in the general population were unlikely to suffer short-term or long-term adverse health effects caused by inhalation exposures. While this analysis by EPA evaluated the potential for health impacts based on measured air concentrations, epidemiological studies conducted by organizations other than EPA have attempted to identify actual impacts. Such studies have identified respiratory effects in worker and general populations, and developmental effects in newborns whose mothers were near GZ on 9/11 or shortly thereafter. While researchers are not able to identify specific times and even exactly which contaminants are the cause of these effects, they have nonetheless concluded that exposure to WTC contaminants (and/or maternal stress, in the case of developmental effects) resulted in these effects, and have identified the time period including 9/11 itself and the days and few weeks afterward as a period of most concern based on high concentrations of key pollutants in the air and dust.

International organisations and their role in helping to protect the worldwide community against natural and intentional biological disasters

Preventing the spread of disease through international movements is one of the key objectives of the World Organisation for Animal Health (OIE). One of the ways it seeks to achieve this is by publishing international standards and guidelines aimed at, inter alia, preventing the importation of pathogens that are dangerous for animals and humans and strengthening Veterinary Services so that they can improve their surveillance and response systems. The OIE works in close partnership with the Food and Agriculture Organization of the United Nations (FAO), and together the two organisations have developed a joint initiative - the Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs). Member Countries of these organisations could increase their capacity to manage the risks of disease occurrences, whether natural or deliberately introduced, if they would all strictly implement existing OIE international standards. Compliance with these standards greatly depends on the political willingness of national policy-makers and on a successful transfer of resources to developing countries in support of good governance and appropriate policy implementation. A United Nations Resolution obliging its Member Countries to implement OIE standards could prove invaluable in this respect.

Human herpes virus 8 (HHV8): Detection in peripheral blood mononuclear cells (PBMC) from Venezuelan patients with human immunodeficienccy virus-1 (HIV-1) infection with/without Kaposi‘s sarcoma (KS)

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Background: The nucleic acid of HHV8 is present in the PBMCs of between 50% and 90% of KS patients,7% and 10% of HIV-1 infected patients without KS.We studied the prevalence of HHV8 in PBMCs from venezuelan patients with HIV-1 infection with/without KS. Methods: Seventy-six patients with HIV-1 infection without KS and 15 patients with KS associated with HIV-1 infection were included. Socioepidemiologic characteristics of HIV-1 infected patients were as follows: mean age (36 years, range 19–69 years); 79% of patients were male, 93% were heterosexuals, 9% were treated with antiherpetic drugs and 74% were on HAART; mean T-CD4 count was 362 cel/mm3. Socioepidemiologic characteristics of patients with KS associated with HIV-1 infection were as follows: mean age 39 years (range, 20- 69 years); 93% of patients were male, 87% were homosexuals, 93% belonged to a ‘high risk group‘, 7% were treated with antiherpetic drug and 80% were on HAART; mean T-CD4 count was 86 cel/mm3. PBMCs were isolated on a Fycoll Hypaque gradient and then stored at -70°C until processed. DNA was extracted from the samples by a standard phenol/chloroform extraction procedure.All DNA samples were confirmed to be amplifiable by PCR primers specific for a conserved region of the human beta-globin gen. Positive (DNA from KS biopsy) and negative controls were included. DNA was PCR amplified using the KS1 and KS2 primers specific for the HHV8 ORF 26. PCR reactions were considered positive only if the PCR products hybridized in the expected 233 bp region. Results: None of HIV-1 infected patients showed the presence of HHV8 in the PBMCs, and after a follow-up of two years, none has developed KS. HHV8 was detected in the PBMCs from 20 % of patients with KS. All patients belonged to a ‘high risk group‘, were male and homosexuals. None received blood transfusion. Conclusions: These preliminary data suggest that the prevalence of HHV8 in PBMCs from venezuelan HIV-1 infected patients with/without KS is probably low in comparison with patiens from USA and Europe.

No significant financial relationships to disclose.

[Retinal cholesterol embolization after coronary angiography]

CASE REPORT

We report a patient with multiple cholesterol retinal embolism in both eyes following coronary angiography. She also had associated renal, skin and cardiac manifestations of the Cholesterol Embolization Syndrome (CES) and died 10 weeks later. Autopsy revealed cholesterol crystal emboli in several organs.

DISCUSSION

Atheromatous plaques can be ruptured and displaced during a diagnostic catheterisation, and thus can be a potential source of these massive emboli. Retinal cholesterol crystals help to establish the diagnosis of the syndrome, particularly when other systemic manifestations exist. When this complication occurs, the prognosis can be devastating because of associated multiorgan failure.

PM source apportionment and health effects: 1. Intercomparison of source apportionment results

During the past three decades, receptor models have been used to identify and apportion ambient concentrations to sources. A number of groups are employing these methods to provide input into air quality management planning. A workshop has explored the use of resolved source contributions in health effects models. Multiple groups have analyzed particulate composition data sets from Washington, DC and Phoenix, AZ. Similar source profiles were extracted from these data sets by the investigators using different factor analysis methods. There was good agreement among the major resolved source types. Crustal (soil), sulfate, oil, and salt were the sources that were most unambiguously identified (generally highest correlation across the sites). Traffic and vegetative burning showed considerable variability among the results with variability in the ability of the methods to partition the motor vehicle contributions between gasoline and diesel vehicles. However, if the total motor vehicle contributions are estimated, good correspondence was obtained among the results. The source impacts were especially similar across various analyses for the larger mass contributors (e.g., in Washington, secondary sulfate SE=7% and 11% for traffic; in Phoenix, secondary sulfate SE=17% and 7% for traffic). Especially important for time-series health effects assessment, the source-specific impacts were found to be highly correlated across analysis methods/researchers for the major components (e.g., mean analysis to analysis correlation, r>0.9 for traffic and secondary sulfates in Phoenix and for traffic and secondary nitrates in Washington. The sulfate mean r value is >0.75 in Washington.). Overall, although these intercomparisons suggest areas where further research is needed (e.g., better division of traffic emissions between diesel and gasoline vehicles), they provide support the contention that PM(2.5) mass source apportionment results are consistent across users and methods, and that today's source apportionment methods are robust enough for application to PM(2.5) health effects assessments.

Co-occurrence of East and West African kdr mutations suggests high levels of resistance to pyrethroid insecticides in Anopheles gambiae from Libreville, Gabon

Point mutations in the voltage-gated sodium channel gene involved in knockdown resistance to DDT and pyrethroid insecticides have been described in several insect species. In the malaria vector Anopheles gambiae Giles sensu stricto (Diptera: Culicidae) two mutations have been identified. The first, consisting of a leucine-phenylalanine substitution at amino acid position 1014, is widespread in West Africa. The second, a leucine-serine substitution at the same position, has to date only been detected in western Kenya. Analysis of the kdr polymorphism in a sample of 106 An. gambiae s.s. of the rDNA S-form/Type I collected in Libreville (Gabon) surprisingly revealed the presence of both East and West African kdr mutations with frequencies of 63% and 37%, respectively. No wild-type alleles were detected and there was an excess of heterozygous genotypes (P = 0.04). In addition, an inconsistency was found during the kdr genotyping procedures by polymerase chain reaction, which could have lead to an underestimation of resistance alleles. The implications of these findings are discussed.

Workgroup report: workshop on source apportionment of particulate matter health effects--intercomparison of results and implications

Although the association between exposure to ambient fine particulate matter with aerodynamic diameter < 2.5 microm (PM2.5) and human mortality is well established, the most responsible particle types/sources are not yet certain. In May 2003, the U.S. Environmental Protection Agency's Particulate Matter Centers Program sponsored the Workshop on the Source Apportionment of PM Health Effects. The goal was to evaluate the consistency of the various source apportionment methods in assessing source contributions to daily PM2.5 mass-mortality associations. Seven research institutions, using varying methods, participated in the estimation of source apportionments of PM2.5 mass samples collected in Washington, DC, and Phoenix, Arizona, USA. Apportionments were evaluated for their respective associations with mortality using Poisson regressions, allowing a comparative assessment of the extent to which variations in the apportionments contributed to variability in the source-specific mortality results. The various research groups generally identified the same major source types, each with similar elemental makeups. Intergroup correlation analyses indicated that soil-, sulfate-, residual oil-, and salt-associated mass were most unambiguously identified by various methods, whereas vegetative burning and traffic were less consistent. Aggregate source-specific mortality relative risk (RR) estimate confidence intervals overlapped each other, but the sulfate-related PM2.5 component was most consistently significant across analyses in these cities. Analyses indicated that source types were a significant predictor of RR, whereas apportionment group differences were not. Variations in the source apportionments added only some 15% to the mortality regression uncertainties. These results provide supportive evidence that existing PM2.5 source apportionment methods can be used to derive reliable insights into the source components that contribute to PM2.5 health effects.