Abomasal and small intestinal nematodes from captive gazelles in Spain

The abomasal and small intestinal helminth fauna of three species of captive gazelles (Gazella dama mhorr, G. cuvieri and G. dorcas neglecta) kept in captivity in Almería (southeast Spain) have been studied, and the following species were identified: Nematodirus spathiger, N. filicollis, N. helvetianus, Camelostrongylus mentulatus, Trichostrongylus vitrinus, T. probolurus, T. colubriformis, Ostertagia ostertagi, O. harrisi, Teladorsagia (Ostertagia) circumcincta, and T. (Ostertagia) davtiani. Camelostrongylus mentulatus and N. spathiger were the most prevalent and abundant parasites. Ostertagia ostertagi, O. harrisi, N. helvetianus, and T. (Ostertagia) davtiani were identified for the first time in the genus Gazella. In addition, O. harrisi and Trichostrongylus probolurus are new records for Spain.

Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding

BACKGROUND

After an episode of acute bleeding from esophageal varices, patients are at high risk for recurrent bleeding and death. We compared two treatments to prevent recurrent bleeding--endoscopic ligation and combined medical therapy with nadolol and isosorbide mononitrate.

METHODS

We randomly assigned 144 patients with cirrhosis who were hospitalized with esophageal variceal bleeding to receive treatment with endoscopic ligation (72 patients) or the combined medical therapy (72 patients). Sessions of ligation were repeated every two to three weeks until the varices were eradicated. The initial dose of nadolol was 80 mg orally once daily, with adjustment according to the resting heart rate; isosorbide mononitrate was given in increasing doses, beginning at 20 mg once a day at bed time and rising over the course of one week to 40 mg orally twice a day, unless side effects occurred. The primary end points were recurrent bleeding, complications, and death.

RESULTS

The median follow-up period was 21 months. A total of 35 patients in the ligation group and 24 in the medication group had recurrent bleeding. The probability of recurrence was lower in the medication group, both for all episodes related to portal hypertension (P=0.04) and for recurrent variceal bleeding (P=0.04). There were major complications in nine patients treated with ligation (seven had bleeding esophageal ulcers and two had aspiration pneumonia) and two treated with medication (both had bradycardia and dyspnea) (P=0.05). Thirty patients in the ligation group died, as did 23 patients in the medication group (P=0.52). The probability of recurrent bleeding was lower for patients with a hemodynamic response to therapy, defined as a decrease in the hepatic venous pressure gradient of more than 20 percent from the base-line value or to less than 12 mm Hg (18 percent, vs. 54 percent in patients with no hemodynamic response at one year; P<0.001), and the probability of survival was higher (94 percent vs. 78 percent at one year, P=0.02).

CONCLUSIONS

Combined therapy with nadolol and isosorbide mononitrate is more effective than endoscopic ligation for the prevention of recurrent bleeding and is associated with a lower rate of major complications. A hemodynamic response to treatment is associated with a better long-term prognosis.

Effect of different methods of administration of ivermectin on its efficacy against the shedding of gastrointestinal nematode eggs by gazelles

Seven different methods of administering ivermectin to gazelles were compared: subcutaneous injection, direct oral administration, administration in individual feeds, administration in a herd feed, direct oral administration of a second ivermectin formulation, administration in individual water supplies, and administration in the herd's water supply. The first five treatments were effective, as monitored by faecal egg count reduction tests, and administration in individual feeds or in a herd feed avoided the need to capture the animals, with the attendant risk of mortality. Of the factors associated with the recipients (species, sex, age and inbreeding coefficient) age was the only significant factor for the efficacy of the treatment. Oral or subcutaneous, individual or collective, and direct or indirect administrations were equally satisfactory for the treatment of all the parasite groups studied. Only when parasitic problems were due to Nematodirus species did direct administration to individual animals appear to be preferable.

Somatostatin treatment and risk stratification by continuous portal pressure monitoring during acute variceal bleeding

BACKGROUND AND AIMS

During acute variceal bleeding, several factors may lead to elevations of hepatic venous pressure gradient (HVPG), which may precipitate further hemorrhage. Whether somatostatin can suppress these increments is unknown. This study monitored somatostatin effects on HVPG during acute bleeding and assessed whether the changes affect outcome.

METHODS

In 40 patients with acute variceal bleeding treated with sclerotherapy, a catheter was placed into a main hepatic vein for 24-hour serial measurements of HVPG. After baseline measurements, patients received somatostatin (N = 25) or placebo (N = 15) under double blind conditions.

RESULTS

Somatostatin but not placebo produced a sustained decrease in HVPG (from 20.7 +/- 3.7 mm Hg to 17.7 +/- 2.7, P < 0.01). In patients receiving placebo, HVPG increased after a test meal (P = 0.018) and after blood transfusion (P = 0.034). Somatostatin completely prevented these increments. HVPG decreased significantly only in patients without further bleeding. One of 27 patients with HVPG <20 mm Hg at baseline or decreased >10% rebled vs. 9 of 13 who had neither of these 2 criteria (P < 0.0001). Both criteria had independent prognostic value for further bleeding.

CONCLUSIONS

During acute variceal bleeding, somatostatin produces a significant and sustained decrease in HVPG and prevents secondary elevations. Monitoring HVPG may stratify further bleeding risk and discriminate treatment response.

Oral administration of mebendazole failed to reduce nematode egg shedding in captive African gazelles

Idiosyncracies are observed in captive wild animals as regards the pharmacokinetics and efficacy of anthelmintics. This could be attributed to such factors as differences in host's metabolism, irregular distribution of anthelmintics due to the way they are administered and worm resistance to anthelmintics. Previously mebendazole was found to be poorly effective when administered in feed. An experiment was conducted to evaluate the efficacy of mebendazole when administered at the dosage rate of 15-20 mg/kg body weight to gastrointestinal nematodes in captive gazelles. Fifty-eight adult gazelles (Gazella cuvieri) were divided into four groups: T1 (animals dosed orally, directly into the mouth), T2 (treated orally, mixed in the water of a herd), T3 (treated orally, mixed in the water of one animal), and T4 (not treated). Individual faecal samples were taken before treatment, and 15 days thereafter. Mean percentages of reduction of egg shedding were calculated for Nematodirus spp., other trichostrongyles, total trichostrongylids, Trichuris spp. and total nematodes. No statistically significant differences were detected between the treatment groups and the control group or among the animals in the three treatment groups.

A prospective blinded evaluation of nerve conduction velocity versus Pressure-Specified Sensory Testing in carpal tunnel syndrome

The aim of this study was to compare the sensitivity, specificity, and pain associated with nerve conduction velocity testing and a new modality, the Pressure-Specified Sensory Device, in the diagnosis of carpal tunnel syndrome. The authors evaluated 79 patients, including 26 control subjects, and made the diagnosis of carpal tunnel syndrome based on the patient's history and physical examination. Both tests were then performed on each patient. The testers were blinded to the diagnosis and to any other test results. A 0 to 10-point visual analog pain scale was used to record the patient's reported testing discomfort. The sensitivity, specificity, and mean pain scale scores were calculated for each testing modality and compared. The nerve conduction velocity test had a sensitivity of 80% and a specificity of 77% whereas the sensitivity of the Pressure-Specified Sensory Device was 91% and the specificity was 82%. The difference between the tests was not significant. There was, however, a significant difference in the pain scores: nerve conduction velocity, 2.7 points; Pressure-Specified Sensory Device, 0.9 points (p < 0.001). This study shows that the Pressure-Specified Sensory Device is as sensitive and specific as nerve conduction velocity testing in the diagnosis of carpal tunnel syndrome, and is significantly less painful for the patient.

Acute necrotizing Meckel diverticulitis due to biliary enterolithiasis

BACKGROUND

Acute abdominal pain due to complicated Meckel's diverticulum is an unusual event. Even the presence of biliary enterolithiasis at the onset of inflamed congenital diverticulum has rarely been reported previously.

RESULTS

Despite this unusual presentation, an episode of gallstone passage through the biliary tract has not yet been described.

CONCLUSIONS

Whether the stones were primarily formed in the diverticulum as enterolithiasis, or secondary to gallstone passage is discussed. The complications of Meckel's diverticulum requiring surgical treatment are reviewed, focusing on the unusual finding of biliary stones in Meckel's diverticulum and the etiogenic mechanism of enterolithiasis.

Coherent high- and low-latitude climate variability during the holocene warm period

A faunal record of sea-surface temperature (SST) variations off West Africa documents a series of abrupt, millennial-scale cooling events, which punctuated the Holocene warm period. These events evidently resulted from increased southward advection of cooler temperate or subpolar waters to this subtropical location or from enhanced regional upwelling. The most recent of these events was the Little Ice Age, which occurred between 1300 to 1850 A.D., when subtropical SSTs were reduced by 3 degrees to 4 degrees C. These events were synchronous with Holocene changes in subpolar North Atlantic SSTs, documenting a strong, in-phase link between millennial-scale variations in high- and low-latitude climate during the Holocene.

Quantitative radioisotopic determination of histidine decarboxylase using high-performance liquid chromatography

We have developed a procedure for the accurate measurement of histidine decarboxylase in tissues expressing low levels of enzymatic activity. Briefly, histamine is enzymatically synthesized from [3H]-labeled histidine, followed by purification using high-performance liquid chromatography (HPLC) and quantitation by liquid scintillation counting. This method presents three advantages over previous techniques. First, prior to HPLC purification, excess precursor [3H]histidine is removed on an anion-exchange resin. Second, purification by HPLC is considerably more selective than that of classical cation-exchange gravity columns or organic solvent extractions. Finally, the accuracy of this method is improved by including non-radiolabeled histamine as internal standard, which is quantified by ultraviolet detection. This simple procedure allows highly sensitive and accurate determinations of histamine synthesis.

Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients

BACKGROUND/AIM

Cefotaxime is considered the first-choice antibiotic for empirical treatment in cirrhotic patients developing bacterial infections. It has been suggested that amoxicillin-clavulanic acid could be an alternative to cefotaxime, particularly in patients developing bacterial infections while on prophylactic norfloxacin. The aim of the present study was to compare amoxicillin-clavulanic acid with cefotaxime in the treatment of bacterial infections in cirrhosis.

METHODS

Ninety-six hospitalized cirrhotic patients with suspicion of bacterial infection were prospectively included and randomized into two groups: one group (n=48) received amoxicillin-clavulanic acid, first intravenously 1 g-0.2 g every 8 h, and then orally 500 mg-125 mg every 8 h, and the other group (n=48) received intravenous cefotaxime 1 g every 6 h. Patients were stratified for previous prophylaxis with norfloxacin and ascitic fluid infection.

RESULTS

Sixteen patients were excluded from the analysis because bacterial infection was not demonstrated or because of secondary peritonitis. Therefore, 38 patients from the amoxicillin-clavulanic acid group and 42 from the cefotaxime group were finally analyzed. There were 24 ascitic fluid infections in each group. Infection resolution (86.8% vs 88%, 95% CI: -0.15 to 0.13, p NS), spontaneous bacterial peritonitis resolution (87.5% vs 83.3%, 95% CI: -0.15 to 0.24, p NS), duration of treatment, incidence of complications, time of hospitalization and hospital mortality were similar in both groups. Considering patients on prophylactic norfloxacin, infection resolution was also similar (100% vs 83.3%, 95% CI: -0.04 to 0.37, p NS). No adverse events were observed in either of the two groups. The cost of antibiotics was statistically lower in the amoxicillin-clavulanic acid group (p<0.001).

CONCLUSIONS

Amoxicillin-clavulanic acid is as effective as cefotaxime in the treatment of bacterial infections in cirrhotic patients, but is less expensive and can be administered orally. These results suggest that amoxicillin-clavulanic acid is an effective alternative to cefotaxime for the empirical treatment of bacterial infections in cirrhosis.

Molecular basis of NMDA receptor-coupled ion channel modulation by S-nitrosylation

Several ion channels are thought to be directly modulated by nitric oxide (NO), but the molecular basis of this regulation is unclear. Here we show that the NMDA receptor (NMDAR)-associated ion channel was modulated not only by exogenous NO but also by endogenous NO. Site-directed mutagenesis identified a critical cysteine residue (Cys 399) on the NR2A subunit whose S-nitrosylation (NO+ transfer) under physiological conditions underlies this modulation. In cell systems expressing NMDARs with mutant NR2A subunits in which this single cysteine was replaced by an alanine, the effect of endogenous NO was lost. Thus endogenous S-nitrosylation can regulate ion channel activity.

Is preoperative selection of patients with cystic adnexal masses essential for laparoscopic treatment?

STUDY OBJECTIVE

To analyze indications for preoperative selection of patients with cystic adnexal masses to be treated by laparoscopic surgery.

DESIGN

Retrospective analysis (Canadian Task Force classification II-2).

SETTING

University and military hospitals.

PATIENTS

Three hundred sixteen women with adnexal masses.

INTERVENTION

Before laparoscopy, 214 patients underwent evaluation (size of adnexal mass, ultrasonographic image, CA 125, suspicious clinical diagnosis); in 102 women laparoscopies were performed without taking these factors into account.

MEASUREMENTS AND MAIN RESULTS

In the first center 99% of women were treated by laparoscopic surgery. One (0.4%) tumor of low malignant potential detected by deferred biopsy was operated on. In the second center 98% of cases were performed laparoscopically. In 3.9% of women carcinomas were detected intraoperatively and were treated by laparotomy (p = 0.04).

CONCLUSION

Laparoscopy is appropriate management of cystic adnexal masses, with a very low risk of unintentionally operating an ovarian carcinoma if a thorough preoperative evaluation is conducted. Only in centers where surgeons have enough training to cope with ovarian cancer may this evaluation be deferred, since conversion to laparotomy should be considered a second therapeutic step, and not an incorrect indication for laparoscopy. In centers where surgeons have no such training, strict preoperative selection of patients is mandatory

Double outlet right ventricle with anterior and left-sided aorta and subpulmonary ventricular septal defect

Double outlet right ventricle (DORV) is a heterogeneous group of abnormal ventriculoarterial connections where, by definition, both great arteries (pulmonary artery and aorta) arise primarily from the morphologically right ventricle. This condition affects 1-1.5% of the patients with congenital heart diseases, with a frequency of 1 in each 10,000 live births. We report the case of an 18-day-old infant with DORV and extremely rare anatomical features, such as anterior and left-sided aorta and subpulmonary ventricular septal defect (VSD). In addition to the anatomic features, the role of the echocardiogram for guiding the diagnosis and the surgical therapy of this congenital heart disease are discussed.

Somatostatin alone or combined with emergency sclerotherapy in the treatment of acute esophageal variceal bleeding: a prospective randomized trial

Recent trials have shown that somatostatin (SMT) is as effective as sclerotherapy in the treatment of acute variceal bleeding and that the combination of both treatments is more effective than sclerotherapy alone. To assess whether the addition of sclerotherapy improves the efficacy of SMT alone, all patients admitted to our unit with gastrointestinal bleeding and with suspected cirrhosis received a continuous infusion of SMT (250 micrograms/h). Endoscopy was performed between 1 and 5 hours later, and patients with esophageal variceal bleeding were randomized to receive or not to receive sclerotherapy. In both groups, SMT infusion was continued for 5 days. Fifty patient admissions were allocated to each group. Therapeutic failure occurred in 21 cases of the SMT group and in 7 cases of the combined-therapy group (P =.002). Failure to control the acute episode occurred in 24% vs. 8% (P =.03) and early rebleeding in 24% vs. 7% (P =.03), respectively. Transfusional requirements were significantly higher in the SMT group, while the incidence of complications was lower (8% vs. 24%; P =.029). In the multivariate analysis, the presence of shock at admission and active bleeding during endoscopy were the variables that better predicted the failure of therapy with SMT alone. Mortality at 6 weeks was similar. These data demonstrate that the addition of sclerotherapy significantly improves the efficacy of SMT alone for the treatment of acute variceal bleeding, although it also increases the rate of complications. Patients with shock and those with active bleeding are more likely to benefit from this combined therapy.

Risk of a first community-acquired spontaneous bacterial peritonitis in cirrhotics with low ascitic fluid protein levels

BACKGROUND & AIMS

Long-term primary antibiotic prophylaxis of spontaneous bacterial peritonitis has been suggested to be useful in cirrhotic patients with low ascitic fluid protein levels. However, it is unlikely that all such patients need prophylactic treatment. The aim of this study was to identify the group of cirrhotic patients with low ascitic fluid protein levels at high risk of developing a first episode of spontaneous bacterial peritonitis during outpatient follow-up.

METHODS

One hundred nine cirrhotic patients with low ascitic fluid protein levels and without previous episodes of spontaneous bacterial peritonitis were followed up in an outpatient clinic.

RESULTS

Twenty-eight patients developed a first spontaneous bacterial peritonitis episode. In the multivariate analysis, serum bilirubin level (>3.2 mg /dL) and platelet count (<98.000/mm(3)) independently correlated with the risk of developing the first spontaneous bacterial peritonitis (P < 0.01 and P < 0.05, respectively). According to the median relative risk coefficient, a low-risk group (relative risk <1.09) and a high-risk group (relative risk >1.09) were established. The probability of developing a first spontaneous bacterial peritonitis episode at 1-year follow-up was significantly higher in the high risk-group (low-risk group, 23.6%; high-risk group, 55%; P < 0.01) as a consequence of a higher probability of the first community-acquired episode (13.7% vs. 47.6%, respectively, P < 0.01). One-year probability of survival was significantly lower in the high-risk group (low-risk group, 57.6%; high-risk group, 38%, P < 0.05).

CONCLUSIONS

Cirrhotic patients with low ascitic fluid protein levels (</=1 g /dL) and high bilirubin level and/or low platelet count are at high risk of developing a first episode of spontaneous bacterial peritonitis during long-term follow-up.

Intelligent control of a planning system for astronaut training

This work intends to design, analyze and solve, from the systems control perspective, a complex, dynamic, and multiconstrained planning system for generating training plans for crew members of the NASA-led International Space Station. Various intelligent planning systems have been developed within the framework of artificial intelligence. These planning systems generally lack a rigorous mathematical formalism to allow a reliable and flexible methodology for their design, modeling, and performance analysis in a dynamical, time-critical, and multiconstrained environment. Formulating the planning problem in the domain of discrete-event systems under a unified framework such that it can be modeled, designed, and analyzed as a control system will provide a self-contained theory for such planning systems. This will also provide a means to certify various planning systems for operations in the dynamical and complex environments in space. The work presented here completes the design, development, and analysis of an intricate, large-scale, and representative mathematical formulation for intelligent control of a real planning system for Space Station crew training. This planning system has been tested and used at NASA-Johnson Space Center.

A putative protein complex consisting of Ctf19, Mcm21, and Okp1 represents a missing link in the budding yeast kinetochore

We have established a one-hybrid screen that allows the in vivo localization of proteins at a functional Saccharomyces cerevisiae centromere. Applying this screen we have identified three proteins-Ctf19, Mcm21, and the product of an unspecified open reading frame that we named Okp1-as components of the budding yeast centromere. Ctf19, Mcm21, and Okp1 most likely form a protein complex that links CBF3, a protein complex directly associated with the CDE III element of the centromere DNA, with further components of the budding yeast centromere, Cbf1, Mif2, and Cse4. We demonstrate that the CDE III element is essential and sufficient to localize the established protein network to the centromere and propose that the interaction of the CDE II element with the CDE III localized protein complex facilitates a protein-DNA conformation that evokes the active centromere.

Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients

Selective intestinal decontamination with norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk of infection. However, the emergence of infections caused by Escherichia coli resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic norfloxacin. Our aim is to determine the characteristics of the infections caused by E. coli resistant to norfloxacin in hospitalized cirrhotic patients. One hundred and six infections caused by E. coli in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I (n = 67), infections caused by E. coli sensitive to norfloxacin, and group II (n = 39), infections caused by E. coli resistant to norfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with norfloxacin was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P <.0001), as a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was similar in both groups. Infections were more frequently nosocomial-acquired in group II than in group I (17/67, 25.3% vs. 20/39, 51.2%, P =.01). The type of infections was similar in both groups: urinary tract infections 38 in group I and 24 in group II, spontaneous bacterial peritonitis 8 and 2, spontaneous bacteremia 4 and 4, and bacterascites 1 and 0, respectively (pNS). Mortality during hospitalization was similar in the two groups (4/67, 5.9% vs. 5/39, 12.8%, pNS). None of the E. coli resistant to norfloxacin were also resistant to cefotaxime and only one of them was resistant to amoxicillin-clavulanic acid. Prophylaxis with norfloxacin, usually continuous long-term prophylaxis, favors the development of infections caused by norfloxacin-resistant E. coli. Long-term antibiotic prophylaxis should therefore be restricted to highly selected groups of cirrhotic patients at high-risk of infection. Infections caused by E. coli resistant to norfloxacin show a severity similar to those caused by sensitive E. coli. No significant associated resistance between norfloxacin and the antibiotics most frequently used in the treatment of bacterial infections in cirrhotic patients has been observed.

Effect of atmospheric pollution on the respiratory system

Santiago de Chile has a high level of air pollution with ozone (O3), carbon monoxide (CO) and particles equal or smaller than 10 microns (PM10) usually exceeding the accepted standards. This situation should be noxious for the exposed population and particularly--in the case of O3 and PM10--for the respiratory system. However, such an effect is rather difficult to demonstrate and it depends on the type of population under study.