Detection of Shiga toxin-producing Escherichia coli in meat marketed in Casablanca (Morocco)

The contamination of meat and meat products with Shiga toxin-producing O157:H7 and non-O157 Escherichia coli (STEC), obtained from markets in Casablanca, Morocco, was investigated. A total of 460 meat and meat products were sampled between March 2004 and July 2006 analysed and 176 strains of E. coli were isolated from these samples. The presence of the stx1, stx2, eae and ehxA genes, recognized as major virulence factors of STEC, was tested in E. coli isolates by polymerase chain reaction (PCR). STEC was detected in 4 (0.9%) samples. The result of serotyping by molecular method showed that two of these STEC isolates corresponded to the serotype O157:H7. The others Shiga toxin-producing E. coli non-O157 corresponded to O6:H21 and O76:H19. The presence of O157:H7 and non-O157 STEC in meat and meat products marketed in Casablanca, Morocco, emphasizes the importance of implementing the Hazard Analysis and Critical Control Point (HACCP) system, as well as the need for implementing, evaluating, and validating antimicrobial interventions to reduce the presence of potential pathogenic microorganisms.

Evaluation framework for carotid bifurcation lumen segmentation and stenosis grading

This paper describes an evaluation framework that allows a standardized and objective quantitative comparison of carotid artery lumen segmentation and stenosis grading algorithms. We describe the data repository comprising 56 multi-center, multi-vendor CTA datasets, their acquisition, the creation of the reference standard and the evaluation measures. This framework has been introduced at the MICCAI 2009 workshop 3D Segmentation in the Clinic: A Grand Challenge III, and we compare the results of eight teams that participated. These results show that automated segmentation of the vessel lumen is possible with a precision that is comparable to manual annotation. The framework is open for new submissions through the website http://cls2009.bigr.nl.

Comparison of modified preadmission glucose-lowering regimen with basal/bolus regimen for glucose control on outcome in general medicine wards

BACKGROUND

It is undecided whether glucose control as advocated by the professional organisations and the glucose-lowering method by itself affects clinical outcome in patients with diabetes mellitus hospitalised in general medical wards. Our aim was to investigate whether a basal/bolus regimen and a modified prehospitalisation regimen have a different impact on the clinical diabetic patients in general medicine wards.

METHODS

Glucose control of patients with diabetes hospitalised in two different wards of internal medicine was achieved according to their wards' policy: a modified preadmission regimen (conventional regime) or a basal/bolus regimen (intensive regime). Death and any adverse event were determined during hospitalisation and within 6 months after discharge to assess clinical outcome.

RESULTS

Median fasting and daily glucose levels were similar in the conventional (n = 116) and intensive regime (n = 129) groups: 161 mg/dl (inter-quartile range: 138-201) and 176 mg/dl (152-215) vs. 155 mg/dl (133-208) and 173 mg/dl (146-208) respectively. Clinical outcome was not affected by the treatment modality. In the subgroup of patients hospitalised with infection, the median fasting glucose was significantly lower in the interventional compared with the conventional regime: 141 and 172 mg/dl respectively (p = 0.041). However, tighter control was associated with a significantly higher incidence of adverse events within 6 months after discharge: 48.9% and 21.4% respectively (p = 0.047).

CONCLUSION

In general medicine wards, modified prehospital hypoglycaemic regimens and a basal/bolus insulin regimen achieve similar glucose control. The clinical outcome was not affected by the modality of glucose control.

Anti-platelets in diabetes management

This study aimed to determine the prevalence of anti-platelet use, and the extent to which contraindications to anti-platelet therapy prevent its use, in 726 diabetic patients attending a private clinic. Among those who reported a history of cardiovascular disease (CVD), 87.1% were on anti-platelet therapy. Of those without prior CVD but with at least one CVD risk factor, 59.8% were not on anti-platelet therapy, but only 7.1% of these had a contraindication to anti-platelet therapy. This study showed that high usage of anti-platelet therapy in diabetic patients with prior CVD is achievable, and that contraindications did not explain low use in those without prior CVD.

TNRT profiles with the nucleus research platform 8 system

This study investigates the effect of the Nucleus CI24RE implant's neural response telemetry (NRT) system, which has less internal noise compared to its predecessor, the CI24M/R implant, on the NRT threshold (TNRT) profile across the array. CI24M/R measurements were simulated by ignoring CI24RE measurements with response amplitudes below 50 uV. Comparisons of the estimated TNRTs from the CI24RE measurements and the CI24M/R simulations suggest that, apart from a constant level difference, the TNRT profiles from the newer implant generally would not have differed very much from those of its predecessor. This view was also reflected by principal component analysis (PCA) results which revealed a 'shift' component similar to that reported by Smoorenburg et al (2002). On the whole, there is no indication that current practices of using the TNRT profiles for assisting with speech processor programming need to be revised for the CI24RE implant.

Magnesium administration may improve heart rate variability in patients with heart failure

BACKGROUND AND AIM

Intracellular magnesium (icMg) depletion may coexist with normomagnesemia. Mg deficiency (serum and/or intracellular) and decreased heart rate variability (HRV) are common in heart failure (HF). Since both are predictors of poor prognosis, it was of interest to evaluate the effect of Mg supplementation on HRV in patients with HF.

METHODS AND RESULTS

We investigated the effect of Mg administration on HRV in normomagnesemic patients with systolic HF. HRV, serum Mg and icMg were determined before and after 5-week 300 mg/day Mg citrate treatment in 16 patients (group 1). The control group included 16 Mg-non-treated HF patients (group 2). HRV was determined by a non-linear dynamics analysis, derived from the chaos theory, which calculates HRV-correlation dimension (HRV-CD). After 5 weeks, serum Mg (mmol/l) increased more significantly in group 1 (from 0.78+/-0.04 to 0.89+/-0.06, p<0.001), than in group 2 (from 0.79+/-0.07 to 0.84+/-0.06, p=0.042). IcMg and HRV-CD increased significantly only in group 1 (from 59+/-7 to 66+/-9 mmol/g cell protein, p=0.025, and from 3.47+/-0.42 to 3.94+/-0.36, p<0.001, respectively). In group 2, the differences in the respective parameters were 63+/-12 to 66+/-9 mmol/g cell protein (p=0.7) and 3.59+/-0.42 to 3.55+/-0.4 (p=0.8).

CONCLUSION

Mg administration to normomagnesemic patients with systolic HF increases serum Mg, icMg and HRV-CD. Increasing of HRV by Mg supplementation may prove beneficial to HF patients.

Hepatic safety of voriconazole after allogeneic hematopoietic stem cell transplantation

Voriconazole is increasingly used in allogeneic hematopoietic stem cell transplantation (HSCT) for prophylaxis and treatment of fungal infections. Hepatic dysfunction is common in patients undergoing HSCT and may have an impact on the clinical decision to institute voriconazole. We conducted a retrospective review of all adult and pediatric HSCT recipients who received >2 consecutive doses of voriconazole between January 2005 and February 2008. Clinical hepatotoxicity was defined as the subjective attribution of liver enzyme elevation (even a mild one) to hepatotoxicity because of voriconazole by the treating physician and leading to discontinuation of voriconazole. Biochemical hepatotoxicity was defined as an elevation in one or more liver enzymes to >3 times the upper limit of normal or >3 times the baseline value if abnormal at baseline. Liver enzymes assessed included aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total bilirubin. Simple and multiple logistic regressions were used to define the risks for hepatic dysfunction. The Wilcoxon signed-rank test was used to assess the differences in liver function test values before, during, and after the use of voriconazole. Sixty-eight of 200 patients (34%) developed hepatotoxicity while on voriconazole. The median duration of voriconazole therapy was 72 days (range, 1-804 days). Biochemical hepatotoxicity occurred in 51 patients (75%); clinical hepatotoxicity, in 17 patients (25%). Thirty-five (51%) of the patients with hepatotoxicity required discontinuation of therapy. In simple logistic regression, acute graft-versus-host disease (GVHD) was a risk factor for hepatotoxicity, and receipt of a T-cell depleted allograft was protective. In multiple logistic regression, acute GVHD (P = .002) remained significant. There were no cases of liver failure or death attributed to voriconazole. In this cohort of patients undergoing allogeneic HSCT, the rate of hepatotoxicity while on voriconazole was 34%. In general, the hepatic dysfunction was mild and reversible. Voriconazole therapy with monitoring appears to be reasonably safe for use in HSCT recipients at high risk for invasive fungal infections.

Power and Wavelength Dependence of Photoenhancement in (CdSe)ZnS-Dopamine in Aqueous Solution and Live Cells

CdSe(ZnS) quantum dots conjugated to the electron donor dopamine show enhancement of photoluminescence over a time course of seconds to minutes when exposed to ultraviolet or blue irradiation. This phenomenon is observed when the dots are in aqueous solution as well as after endocytosis by living cells. The rate of enhancement is directly related to the number of dopamine conjugates per quantum dot, and can be semi-quantitatively adjusted over a wide range. Uptake of the particles by cells is also dependent upon surface coverage, with moderate coverages proving ideal for both uptake and relative signal enhancement. The enhancement is strongly power-dependent and may also show dependence upon wavelength; however, direct excitation of the dopamine molecule is not necessary for the enhancement effect.

Molecular typing of Escherichia coli strains isolated from food in Casablanca (Morocco)

Serotyping of O- and H- antigens is regarded as the gold standard in classification of E. coli for taxonomic and epidemiological purposes similar to the Kaufmann-White scheme for Salmonella enterica. Molecular methods to replace or to support the serotyping were recently applied. Using the molecular polymorphism of the somatic (O- antigen) gene rfb cluster and flagella (H- antigen) gene fliC, 74 E. coli strains carrying the virulent genes isolated from food were characterised by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The results showed that 49 (66%) of the isolates revealed a reproducible and clear cut classification, with a very good correlation to the collection of reference strains, were found.

Rapid detection of Listeria monocytogenes in food by polymerase chain reaction

The standard conventional methods for the detection of Listeria monocytogenes in foods require high time 7 to 10 days to give ready results. To dissolve this problem we have evaluate a short method using Polymerase Chain Reaction (PCR) to analyze food samples. In parallel with this study, a comparison was made between PCR amplification from templates directly prepared from food and the official standard ISO procedure 11290-1. In this study we have used a Half Frazer broth as an enrichment medium; there were positive results of PCR detection of L. monocytogenes in different food sample analyzed (milk, cheese and meat) with approximately 1.5 10(1) Colony Forming Units /25 g in less than 36 h. This PCR procedure has proved to be rapid and sensitive method suitable for the routine analysis; firstly, because this assay required just a short pre-enrichment step before PCR. Secondly, this procedure is very simple and time-saving; it could take less than one working day to obtain results if initial microbiological load was very important.

Unrecognized major bleeding following thrombolysis for acute myocardial infarction presenting with syncope

Complete atrioventricular block and syncope sometimes are the presenting signs of acute myocardial infarction. In a presyncopal attempt to assume sitting position, the patient may fall and suffer consequent trauma. Once in hospital, this sequence of events may be overlooked by both the patient and admitting physicians. Moreover, physical examination initially may not be revealing. We report on two such patients who developed massive subcutaneous bleeding following thrombolytic and heparin treatment. We conclude that these patients constitute a specific group with a relatively high risk of trauma and bleeding at the gluteal region following thrombolytic therapy. Special attention must be given to these patients.

Conservative treatment for Brucella endocarditis

Endocarditis is the most devastating complication of brucellosis. The accepted treatment for Brucella endocarditis (BE) is a combination of valve replacement and antibiotics. Conservative antibiotic treatment alone is not recommended by most authors, as it is considered ineffective, risking fatality. We describe a patient with BE, in whom antibiotic treatment alone resulted in complete recovery. On reviewing the literature, we found 12 additional such cases. We compared this group of 13 patients with data from 49 published cases treated with a combination of surgery and antibiotics, with a favorable outcome. Absence of congestive heart failure or a prosthetic valve, relatively mild extravalvular cardiac involvement, and a somewhat shorter disease history until initiation of treatment were characteristic of the group treated conservatively in comparison with patients who underwent surgery. In selected patients with BE, conservative antibiotic treatment may be a valid alternative to surgery.

Metabolic and clinical effects of oral magnesium supplementation in furosemide-treated patients with severe congestive heart failure

BACKGROUND

Magnesium depletion and hypomagnesemia are common among furosemide-treated patients with chronic congestive heart failure.

HYPOTHESIS

This investigation evaluated clinical and metabolic effects of oral magnesium supplementation.

METHODS

Ten patients with severe congestive heart failure maintained on high dose furosemide (> or = 80 mg/day) received a supplement of oral magnesium citrate 300 mg/daily for 30 days. Clinical parameters were followed, and peripheral blood mononuclear cell magnesium and zinc content, serum and urine magnesium, potassium, zinc, calcium, phosphorus, and creatinine were assessed.

RESULTS

Peripheral blood mononuclear cell magnesium content and serum potassium rose significantly at the end of the study (2.09 +/- 1.89 to 3.99 +/- 2.26 micrograms/mg cell protein, p < 0.05, and 4.17 +/- 0.38 to 4.39 +/- 0.27 mEq/l, p < 0.05, respectively), while the other parameters remained unchanged.

CONCLUSION

In some of these patients, oral magnesium supplementation is effective in achieving substantial increments in intracellular magnesium and serum potassium which, in turn, may have cardioprotective effects.

Designing pharmacogenetic projects in industry: practical design perspectives from the Industry Pharmacogenomics Working Group

Pharmacogenetic association studies have the potential to identify variations in DNA sequence which impact drug response. Identifying these DNA variants can help to explain interindividual variability in drug response; this is the first step in personalizing dosing and treatment regimes to a patient's needs. There are many intricacies in the design and analysis of pharmacogenetic association studies, including having adequate power, selecting proper endpoints, detecting and correcting the effects of population stratification, modeling genetic and nongenetic covariates accurately, and validating the results. At this point there are no formal guidelines on the design and analysis of pharmacogenetic studies. The Industry Pharmacogenomics Working Group has initiated discussions regarding potential guidelines for pharmacogenetic study design and analyses (http://i-pwg.org) and the results from these discussions are presented in this paper.

Harmonization of strategies for the validation of quantitative analytical procedures: a SFSTP proposal part IV. Examples of application

A harmonized approach for the validation of analytical methods based on accuracy profile was introduced by a SFSTP commission on the validation of analytical procedure. This fourth and last document aims at illustrating this methodology and the statistics used. Therefore the validation of real case methods are proposed such as methods for the quality control of drugs, for the quantitation of impurities in drug substances, for bioanalysis or for the determination of nutriments. Furthermore, different types of analytical methods are used in order to demonstrate the applicability of the proposed approach to a wide range of methods such as liquid chromatography (LC-UV, LC-MS), spectrophotometry or ELISA.

Harmonization of strategies for the validation of quantitative analytical procedures

In the first two documents [Ph. Hubert, J.J. Nguyen-Huu, B. Boulanger, E. Chapuzet, P. Chiap, N. Cohen, P.A. Compagnon, W. Dewé, M. Feinberg, M. Lallier, M. Laurentie, N. Mercier, G. Muzard, C. Nivet, L. Valat, J. Pharm. Biomed. Anal. 36 (2004) 579-586; Ph. Hubert, J.J. Nguyen-Huu, B. Boulanger, E. Chapuzet, P. Chiap, N. Cohen, P.A. Compagnon, W. Dewé, M. Feinberg, M. Lallier, M. Laurentie, N. Mercier, G. Muzard, C. Nivet, L. Valat, E. Rozet, J. Pharm. Biomed. Anal., in press], a recent SFSTP Commission on the validation of analytical procedure has introduced a harmonized approach for the validation of analytical procedures. In order to complete this guide, the statistical methodology allowing to correctly conclude about the validity of a procedure is proposed in this third part of the guide. Indeed all the steps to obtain the decision tool namely the accuracy profile are described and illustrated step by step by a numerical example. This tool, based on the concept of total error (bias+standard deviation) build with a beta-expectation tolerance interval, allows to easily take the right decision and simultaneously minimizing the risk of the future use of the analytical procedure.

Evaluation of VEGF targeted therapy efficacy in mRCC after sorafenib failure or intolerance

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Background: Sorafenib, a multi kinase targeted agent with raf and VEGF receptor (VEGF-R) inhibitory properties, has been recently approved for the treatment of metastatic renal cell carcinoma (mRCC). Two other VEGF pathway targeted agents, sunitinib and bevacizumab, have documented efficacy in mRCC. It is not known whether these agents will exhibit biological or clinical activity after prior VEGF directed treatment. Methods: Eligibility applied to patients with mRCC treated with sorafenib within an expanded access program (EAP) at our institution that were later switched to either bevacizumab or sunitinib due to tumor progression or sorafenib intolerance. All patients had measurable disease. Patients were evaluated for response rates (RECIST), treatment duration and progression free survival (PFS). Results: 35 patients that participated in the EAP were identified. 10 patients fulfilled the entry criteria and all of them had clear cell histology. Median age was 66; sex distribution was 70% male-30% female. 6 (60%) received sunitinib and 4 (40%) received bevacizumab. Median treatment duration was 5.5 months (range: 1–15). Of the patients evaluable for response: 5 have SD (50%), 1(10%) had a PR and 1(10%) progressed. 3 are too early to be evaluated. Median PFS was 7 months. Conclusions: Despite the limitations of a small patient sample, the VEGF targeted therapies sunitinib and bevacizumab exhibited a median PFS and reponse rate similar to those reported by other authors as a first line anti-VEGF therapy. Second line anti-angiogenic activity appears to retain efficacy in clear cell mRCC priorly treated with the multi- kinase targeted agent sorafenib. This may provide hypothetical justification for sustained anti-angiogenic therapy after progression. Prospective evaluation of serial and combination approaches is ongoing.

No significant financial relationships to disclose.