An international investigation of an outbreak of Legionnaires disease among UK and French tourists

Five cases of legionnaires disease and one death were associated with four members of a tour group from the United Kingdom (UK) and one French tourist who all visited Spain in the spring of 1993. The UK group stayed at four hotels, one of which was also used by the French tourist. Phenotypic and genotypic comparison of isolates of Legionella pneumophila obtained from one of the UK cases and the French patient demonstrated that they were indistinguishable from each other and from environmental isolates obtained from the water supply of the hotel at which all five cases had stayed. A cohort study of the UK tour group was carried out to determine the extent of the outbreak and showed that three further members of the group had respiratory illness but were serologically negative to legionella infection. International participation in this investigation has highlighted the value of a European surveillance scheme and the benefit of microbiological collaboration between legionella reference laboratories in Europe.

Three-dimensional structure and stability of the KH domain: molecular insights into the fragile X syndrome

The KH module is a sequence motif found in a number of proteins that are known to be in close association with RNA. Experimental evidence suggests a direct involvement of KH in RNA binding. The human FMR1 protein, which has two KH domains, is associated with fragile X syndrome, the most common inherited cause of mental retardation. Here we present the three-dimensional solution structure of the KH module. The domain consists of a stable beta alpha alpha beta beta alpha fold. On the basis of our results, we suggest a potential surface for RNA binding centered on the loop between the first two helices. Substitution of a well-conserved hydrophobic residue located on the second helix destroys the KH fold; a mutation of this position in FMR1 leads to an aggravated fragile X phenotype.

An interdisciplinary mental health consultation team in a nursing home

The Mental Health Consultation Team (MHCT) at the Portland Veterans Affairs Medical Center nursing home is an interdisciplinary group of mental health professionals and primary care providers established to triage mental health consultations, improve communication between consultants and primary care providers, help staff translate consultants' recommendations into patient care, and furnish education in the management of mental health problems. The MHCT has decreased the demands for formal psychiatry and psychology consultations while increasing mental health services through innovative use of existing staff.

Secondary structure determination by NMR spectroscopy of an immunoglobulin-like domain from the giant muscle protein titin

We present the complete 15N and 1H NMR assignment and the secondary structure of an immunoglobulin-like domain from the giant muscle protein titin. The assignment was obtained using homonuclear and 15N heteronuclear 2D and 3D experiments. The complementarity of 3D TOCSY-NOESY and 3D 15N NOESY-HSQC experiments, using WATERGATE for water suppression, allowed an efficient assignment of otherwise ambiguous cross peaks and was helpful in overcoming poor TOCSY transfer for some amino acids. The secondary structure is derived from specific NOEs between backbone alpha- and amide protons, secondary chemical shifts of alpha-protons and chemical exchange for the backbone amide protons. It consists of eight beta-strands, forming two beta-sheets with four strands each, similar to the classical beta-sandwich of the immunoglobulin superfamily, as previously predicted by sequence analysis. Two of the beta-strands are connected by type II beta-turns; the first beta-strand forms a beta-bulge. The whole topology is very similar to the only intracellular immunoglobulin-like domain for which a structure has been determined so far, i.e., telokin.

The KH module has an alpha beta fold

The KH module has recently been identified in a number of RNA associated proteins including vigilin and FMR1, a protein implicated in the fragile X syndrome. In this work, NMR spectroscopy was used to determine the secondary structure in solution of a KH domain (repeat 5 from vigilin). Almost complete assignments were obtained for the 1H and 15N resonances using uniform 15N-labeling of the protein combined with homo-nuclear 2D 1HNMR and 3D 15N correlated 1H NMR. On the basis of NOE patterns, secondary chemical shifts and amide solvent exposure, the secondary structure consists of an antiparallel three stranded beta sheet connected by two helical regions. This domain may also be stabilized by an appended C-terminal helix which is common to many but not all members of the KH family.

Immunoglobulin-type domains of titin are stabilized by amino-terminal extension

We have recently suggested that similarly folded titin modules located at different sarcomeric regions have distinct molecular properties and stability. Could our selection of module boundaries have potentially influenced our conclusions? To address this question we expressed amino-terminally extended versions of the same modules and determined, with the use of CD and Fluorescence techniques, key thermodynamic parameters characterizing their stability. We present here our results which confirm our previous observations and show that, while amino-terminal extension has a profound effect on the stability of individual modules, it does not affect at all their folding pattern or their relative stabilities. Moreover, our data suggest that the selection of module boundaries can be of critical importance for the structural analysis of modular proteins in general, especially when a well-defined intron-exon topography is absent and proteolytic methods are inconclusive.

Scedosporium prolificans sclerokeratitis

BACKGROUND

The fungus Scedosporium prolificans was first described as a human pathogen in 1984, and has been associated with metastatic endophthalmitis and one previously reported case of sclerokeratitis.

METHODS

We report a case of S. prolificans sclerokeratitis in the setting of late scleral necrosis complicating pterygium surgery with adjunctive beta-irradiation.

RESULTS

A poor clinical response to topical natamycin and amphotericin B, and systemic itraconazole and ketoconazole was encountered. Enucleation was required, with subsequent microbiological cure. Pathological correlation is described.

CONCLUSIONS

S. prolificans infections often respond poorly to medical therapy. Early surgical intervention is indicated in culture-proven scleritis due to Scedosporium prolificans.

Alterations of auditory middle latency evoked potentials during yogic consciously regulated breathing and attentive state of mind

Middle latency auditory-evoked potentials (AEP-MLRs) of 10 healthy male subjects in the age range of 21-33 years, were assessed to determine whether yogic pranayamic practice would cause changes in them. The pranayama type assessed here is an exercise of consciously-controlled rhythmic breathing involving timed breath-holding in each cycle of breathing, while the subject holds utmost attention and experiences the touch of inhaled air in the nasal passage. The results revealed that the Na-wave amplitude increased and latency decreased during the period of pranayamic practice, whereas the Pa-wave was not significantly altered. The change is interpreted as an indication of a generalized alteration cause in information processing at the primary thalamo-cortical level during the concentrated mental exercise of inducing modifications in neural mechanisms regulating a different functional system (respiratory). Further researches are required to understand the operational significances of such changes.

Activation of the sphingomyelin signaling pathway in intact EL4 cells and in a cell-free system by IL-1 beta

The mechanism of interleukin-1 (IL-1) signaling is unknown. Tumor necrosis factor-alpha uses a signal transduction pathway that involves sphingomyelin hydrolysis to ceramide and stimulation of a ceramide-activated protein kinase. In intact EL4 thymoma cells, IL-1 beta similarly stimulated a rapid decrease of sphingomyelin and an elevation of ceramide, and enhanced ceramide-activated protein kinase activity. This cascade was also activated by IL-1 beta in a cell-free system, demonstrating tight coupling to the receptor. Exogenous sphingomyelinase, but not phospholipases A2, C, or D, in combination with phorbol ester replaced IL-1 beta to stimulate IL-2 secretion. Thus, IL-1 beta signals through the sphingomyelin pathway.

Routine laboratory assessment of nursing home patients

Little is known about protocols for routine laboratory testing in nursing homes. To determine what laboratory protocols are employed by community nursing homes, directors of nursing service in the 73 long-term-care facilities in Portland, Oregon were surveyed. One-hundred percent responded, and 56% reported having laboratory testing protocols. Ninety percent of protocols employed screening tests, and 88% employed monitoring tests, but content varied widely. Although physicians are ultimately responsible for ordering laboratory tests, protocols were derived from various sources including nursing staff, pharmacy and laboratory consultants, and Department of Health and Human Service guidelines. It is recommended that physicians take a leadership role in helping nursing homes develop clinically useful, cost-effective testing strategies.

Cryptosporidiosis in the Isle of Thanet; an outbreak associated with local drinking water

An outbreak of cryptosporidiosis occurred in the Isle of Thanet during December 1990 and January 1991. A total of 47 cases ranging in age from 2 months to 85 years were identified in residents from the Margate, Broadstairs and Ramsgate areas, with dates of onset of illness from 3 December to 14 January. A case-control study demonstrated a strong statistical association between illness and the consumption of unboiled tap water from a particular source, with evidence of a dose-response relationship. Although no cryptosporidial oocysts were identified in samples of untreated or treated water taken during the investigation, the results were consistent with the view that the source of infection was treated river water which was used to supplement borehole water.

Mechanism of benzylselenocyanate inhibition of azoxymethane-induced colon carcinogenesis in F344 rats

Benzylselenocyanate (BSC), a novel organoselenium compound, has been found to inhibit azoxymethane (AOM)-induced colon carcinogenesis in rats during initiation. To investigate its mechanism of action, we examined the effects of BSC feeding on the following parameters: (a) metabolism of [14C]AOM to 14CO2 in vivo; (b) metabolic activation of AOM to MAM and of MAM to formic acid and methanol by rat liver microsomes in vitro; and (c) AOM-induced DNA methylation in rat livers and colons. Five-week-old male F344 rats were fed modified (23% corn oil) AIN-76A diets containing 0 (control), 25, or 50 ppm of BSC or benzylthiocyanate (BTC), a sulfur analogue of BSC which does not inhibit the colon carcinogenicity of AOM. After 3 weeks, rats were either sacrificed for the isolation of liver microsomes or were given 15 mg/kg of [14C]AOM s.c. to determine the rate of carcinogen metabolism in vivo. No difference in [14C]AOM metabolism was found between rats fed the BTC diets and those fed the control diet. In contrast, the rate of [14C]AOM metabolism, as determined by exhaled radioactivity, was 2-3 times higher in rats fed the BSC diets. While liver microsomes from rats fed the BTC diets metabolized AOM and MAM at rates not significantly different from those obtained with control liver microsomes, the metabolic activation of AOM as well as of MAM was stimulated severalfold when assayed with liver microsomes from rats fed the BSC diets. An increase in total liver cytochrome P-450 was also observed in the BSC-fed rats. Following the administration of 15 mg/kg AOM, significantly less O6-methylguanine and 7-methylguanine was present in the colon DNA from rats consuming the BSC diets than in rats fed the BTC or control diets. The body weight gains of rats fed the 25- and 50-ppm BSC-containing diets for 3 weeks were less (27 and 43%, respectively) than those of rats fed either the control or BTC-containing diets. These results indicate that dietary BSC significantly induces the hydroxylation of AOM and the oxidation of MAM in rat liver. An increase in the rates of AOM and MAM metabolism in the liver due to enzyme induction by BSC will result in decreased delivery of MAM to the colon via the bloodstream. This will be reflected in decreased DNA alkylation, as observed, and is likely to be a major factor in the inhibition of AOM-induced colon carcinogenesis by BSC.

A review of outbreaks of infectious disease in schools in England and Wales 1979-88

In this review of 66 outbreaks of infectious disease in schools in England and Wales between 1979-88, 27 were reported from independent and 39 from maintained schools. Altogether, over 8000 children and nearly 500 adults were affected. Most of the outbreaks investigated were due to gastrointestinal infections which affected about 5000 children: respiratory infections affected a further 2000 children. Fifty-two children and seven adults were admitted to hospital and one child with measles died. Vaccination policies and use of immunoglobulin for control and prevention of outbreaks in schools have been discussed.

Two outbreaks of Legionnaires' disease in Bolton Health District

In 1988, there were two outbreaks of legionellosis in Bolton Health District. Altogether 37 cases of Legionnaires' disease and 23 cases of non-pneumonic legionellosis were identified. Twenty-five patients with Legionnaires' disease were associated with an engineering plant, 4 with Bolton town centre, and 8 with both the plant and town centre. Twenty-two people with non-pneumonic legionellosis were linked with the engineering plant and one with the plant and the town centre. A case-control study carried out among 37 employees with legionellosis and 109 control subjects at the plant showed that infection was associated with one of the 15 cooling towers on the site. Legionella pneumophila indistinguishable by serological and genetic typing methods was isolated from this cooling tower and from sputum samples from two patients. In the town centre, no one tower was linked with infection and L. pneumophila was not cultured from any of the nine towers identified. Control measures were implemented and to date there have been no further cases of legionellosis associated with Bolton Health District.

A large outbreak of Salmonella enteritidis phage type 4 associated with eggs from overseas

In February 1989 the largest reported outbreak to date in the United Kingdom of Salmonella enteritidis phage type 4 (PT4) infection occurred following a wedding reception at a hotel. One hundred and seventy-three people met the case definition of illness of whom 118 had the organism isolated from their stools. A further 17 were found to be S. enteritidis PT4 positive, but were asymptomatic. Lightly-cooked, egg-based sauces were the epidemiologically proven vehicles of infection. Investigations showed this outbreak to be the first to implicate imported European eggs as the source of infection. An unusual feature of this outbreak was a reported incubation period of less than 3 h for some of the confirmed cases of salmonellosis.

Evidence that v-src and v-fps gene products use a protein kinase C-mediated pathway to induce expression of a transformation-related gene

Induction of the transformation-related gene 9E3 by the v-src and v-fps gene products (v-Src and v-Fps) is blocked in chicken embryo fibroblasts depleted of protein kinase C (PKC). PKC agonists induce 9E3 gene expression. Protein kinase inhibitors block v-Src- and v-Fps-induced 9E3 gene expression with the same dose-response curves seen for PKC agonist-induced 9E3 gene expression. These data suggest that v-Src and v-Fps use a PKC-mediated signal-transduction pathway to induce expression of the transformation-related 9E3 gene. Consistent with this hypothesis, we find that both v-Src and v-Fps rapidly induce phosphorylation of a 67-kDa PKC substrate.

Preliminary findings on skin conductance measures in schizophrenics & normal individuals in India

Skin conductance measures were investigated during response paradigms, in 18 non medicated schizophrenics and 22 normal individuals. Basal, tonic and phasic skin conductance indices were studied in four experimental series consisting of auditory and visual stimuli differing in signal status. No differences were seen in skin conductance basal levels, tonic levels, phasic response or in the incidence of nonresponse in schizophrenics as compared to normal individuals.

EEG and autonomic arousal measures in schizophrenics

EEG and autonomic indices were measured in basal, tonic, and phasic conditions in order to delineate the nature of arousal dysfunction in schizophrenics as compared to normals. The experimental procedure involved six continuous recording sessions consisting of a basal recording before and after four experimental series. Sequentially, these were the visual nonsignal (VNS), the auditory nonsignal (ANS), the visual signal (VS), and the auditory signal (AS) series. The main findings indicated significant differences between the two groups in cardiovascular indices during the basal and tonic conditions and in the EEG and EMG indices of phasic response. These results suggest a dysfunction of basal and tonic autonomic arousal and a modulatory impairement of the central phasic arousal reaction. The findings are in accordance with the two arousal hypothesis postulated by Routtenberg (1968) and disconfirm the unitary concept of arousal for the explanation of psychophysiological abnormality in schizophrenia.

Psychological impact of home apnea monitoring: temporal effects, family resources, and maternal coping style

Mothers of 30 infants who had experienced an emergency apnea episode and were placed on a home apnea monitor were studied longitudinally, using measures of mood disturbance (anxiety, depression, hostility, fatigue, vigor and confusion). Mothers were assessed at the time of hospitalization immediately following the apnea episode, after approximately one month of home monitoring, and after three months of home monitoring. Measures of family resources, health locus of control, and coping style, involving preference for information under situations of threat, were obtained as predictor variables. A high level of mood disturbance was seen initially, but this was transient, diminishing significantly after the first month of monitoring. Level of family resources was highly predictive of mood disturbance throughout the study period, while health locus of control beliefs were predictive of changes in mood disturbance over time. These findings suggest a means for identifying families at higher risk for maladaptive responses, and in need of more intensive psychosocial support.