Effect of different therapeutic strategies on olfactory outcomes in patients with chronic rhinosinusitis with nasal polyps: a systematic review

INTRODUCTION

Olfactory impairment is one of the cardinal symptoms of chronic rhinosinusitis with nasal polyps (CRSwNP), yet the effect of the currently available therapeutic options on the recovery of the sense of smell is not well defined. The aim of this systematic review was to compile the evidence on the impact of medical, surgical, and biological therapies on the olfactory outcomes in patients with CRSwNP.

METHODS

This review was conducted by two reviewers, according to the Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) guidelines. The quality of evidence of all studies included in the qualitative synthesis was evaluated using the Critical Appraisal Skills Programme (CASP).

RESULTS

Forty-four studies were included in the qualitative synthesis (assessing sinonasal surgery [n = 23], biologics [n =15], and conventional medical treatment [n = 6]); most had moderate-to-high methodological quality. Overall, significant improvements in the sense of smell were detected with all analyzed interventions measured by either an objective or a subjective tool (or both). However, most studies used different outcome measurements, hindering comparisons between interventions, and data on clinically relevant changes were missing.

CONCLUSION

Oral corticosteroids, biologics and sinonasal surgery improve olfactory impairment associated with CRSwNP, but the high variability among existing studies does not allow accurate comparisons.

Mediastinitis secondary to invasive infection by group A Streptococcus in Spain

This study describes 5 mediastinitis cases secondary to invasive group A Streptococcus (iGAS) disease in a recent outbreak in Spain. Among 398 iGAS cases between January 2019-March 2023, 5 (1.3%) were mediastinitis, 4 occurring in December 2022, all secondary to pneumonia or deep neck infection. We outline the clinical outcome with a review of the scarce pediatric literature.  Conclusion: mediastinistis is a rare but severe complication of iGAS and a high level of suspicion is required to diagnose it. What is Known: • Group A Streptococcus can cause invasive and severe infections in children. • Mediastinitis is a severe complication from some bacterial infections, mainly secondary due to deep-neck abscesses. What is New: • Mediastinitis is an unrecognized complication due to an invasive group A Streptococcus (iGAS) infection. • In cases of a deep-neck abscess or complicated pneumonia a high clinical suspicion of iGAS mediastinitis is required, especially when the clinical course is not favorable.

Skin lesions by Scedosporium apiospermum and Nocardia pulmonary infection in an oncologic patient: a case report

BACKGROUND

Fungal infections, other than candidiasis and aspergillosis, are an uncommon entity. Despite this, emerging pathogens are a growing threat. In the following case report, we present the case of an immunocompromised patient suffering from two serious opportunistic infections in the same episode: the first of these, Nocardia multilobar pneumonia; and the second, skin infection by Scedosporium apiospermum. These required prolonged antibacterial and antifungal treatment.

CASE PRESENTATION

This case is a 71-year-old oncological patient admitted for recurrent pneumonias that was diagnosed for Nocardia pulmonary infection. Nervous system involvement was discarded and cotrimoxazole was started. Haemorrhagic skin ulcers in the lower limbs appeared after two weeks of hospital admission. We collected samples which were positive for Scedosporium apiospermum and we added voriconazole to the treatment. As a local complication, the patient presented a deep bruise that needed debridement. We completed 4 weeks of intravenous treatment with slow improvement and continued with oral treatment until the disappearance of the lesions occurs.

CONCLUSIONS

Opportunistic infections are a rising entity as the number of immunocompromised patients is growing due to more use of immunosuppressive therapies and transplants. Clinicians must have a high suspicion to diagnose and treat them. A fluid collaboration with Microbiology is necessary as antimicrobial resistance is frequent.

Pharmaceutical active compounds in sewage sludge: Degradation improvement and conversion into an organic amendment by bioaugmentation-composting processes

Around 143,000 chemicals find their fate in wastewater treatment plants in the European Union. Low efficiency on their removal at lab-based studies and even poorer performance at large scale experiments have been reported. Here, a coupled biological technology (bioaugmentation and composting) is proposed and proved for pharmaceutical active compounds degradation and toxicity reduction. The optimization was conducted through in situ inoculation of Penicillium oxalicum XD 3.1 and an enriched consortium (obtained from non-digested sewage sludge), into pilot scale piles of sewage sludge under real conditions. This bioaugmentation-composting system allowed a better performance of micropollutants degradation (21 % from the total pharmaceuticals detected at the beginning of the experiment) than a traditional composting process. Particularly, inoculation with P. oxalicum allowed the degradation of some recalcitrant compounds like carbamazepine, cotinine and methadone, and also produced better stabilization features in the mature compost (significant passivation of copper and zinc, higher macronutrients value, adequate physicochemical conditions for soil direct application and less toxic effect on germination) compared to the control and the enriched culture. These findings provide a feasible, alternative strategy to obtain a safer mature compost and a better removal of micropollutants performance at large scale.

Long-term acute infections during a bovine viral diarrhea virus (BVDV) outbreak in dairy farm from Galicia (NW Spain)

An observational study describes an outbreak of bovine viral diarrhea virus (BVDV) in a dairy herd in Spain. The herd was subjected to a voluntary control program. In a sampling carried out in June 2020, bulk tank milk antibody levels increased compared to the previous sampling. Additionally, serum samples from 4 young heifers also tested positive for antibodies. Since the results were consistent with a recent infection, we proceeded to detect possible persistently infected (PI) animals using antigen ELISA (on serum/ear-notch samples), following the program guidelines. From this moment on, 42 animals tested positive for BVDV antigen, of which 17 were under typical acute infection (AI), 13 were deemed as PI, and eight died early on the farm before having information to determine their status. The remaining 4 showed intriguing test results consistent with a long-term AI since they tested BVDV positive in at least two antigen tests more than 3 weeks apart. Thus, one animal was positive until 80 days of age in serum, and others even for longer periods in ear-notch samples, until they finally tested negative for BVDV. Based on these results, longer follow-up may be necessary in BVDV positive animals to accurately confirm persistent infection.

A reply to "Relevant factors in the eutrophication of the Uruguay River and the Río Negro"

A recent paper by Beretta-Blanco and Carrasco-Letelier (2021) claims that agricultural eutrophication is not one of the main causes for cyanobacterial blooms in rivers and artificial reservoirs. By combining rivers of markedly different hydrological characteristics e.g., presence/absence and number of dams, river discharge and geological setting, the study speculates about the role of nutrients for modulating phytoplankton chlorophyll-a. Here, we identified serious flaws, from erratic and inaccurate data manipulation. The study did not define how erroneous original dataset values were treated, how the variables below the detection/quantification limit were numerically introduced, lack of mandatory variables for river studies such as flow and rainfall, arbitrary removal of pH > 7.5 values (which were not outliers), and finally how extreme values of other environmental variables were included. In addition, we identified conceptual and procedural mistakes such as biased construction/evaluation of model prediction capability. The study trained the model using pooled data from a short restricted lotic section of the (large) Uruguay River and from both lotic and reservoir domains of the Negro River, but then tested predictability within the (small) Cuareim River. Besides these methodological considerations, the article shows misinterpretations of the statistical correlation of cause and effect neglecting basic limnological knowledge of the ecology of harmful algal blooms (HABs) and international research on land use effects on freshwater quality. The argument that pH is a predictor variable for HABs neglects overwhelming basic paradigms of carbon fluxes and change in pH because of primary productivity. As a result, the article introduces the notion that HABs formation are not related to agricultural land use and water residence time and generate a great risk for the management of surface waterbodies. This reply also emphasizes the need for good practices of open data management, especially for public databases in view of external reproducibility.

Recommendations for use of antigenic tests in the diagnosis of acute SARS-CoV-2 infection in the second pandemic wave: attitude in different clinical settings

The high transmissibility of SARS-CoV-2 before and shortly after the onset of symptoms suggests that only diagnosing and isolating symptomatic patients may not be sufficient to interrupt the spread of infection; therefore, public health measures such as personal distancing are also necessary. Additionally, it will be important to detect the newly infected individuals who remain asymptomatic, which may account for 50% or more of the cases. Molecular techniques are the "gold standard" for the diagnosis of SARS-CoV-2 infection. However, the massive use of these techniques has generated some problems. On the one hand, the scarcity of resources (analyzers, fungibles and reagents), and on the other the delay in the notification of results. These two facts translate into a lag in the application of isolation measures among cases and contacts, which favors the spread of the infection. Antigen detection tests are also direct diagnostic methods, with the advantage of obtaining the result in a few minutes and at the very "pointof-care". Furthermore, the simplicity and low cost of these tests allow them to be repeated on successive days in certain clinical settings. The sensitivity of antigen tests is generally lower than that of nucleic acid tests, although their specificity is comparable. Antigenic tests have been shown to be more valid in the days around the onset of symptoms, when the viral load in the nasopharynx is higher. Having a rapid and real-time viral detection assay such as the antigen test has been shown to be more useful to control the spread of the infection than more sensitive tests, but with greater cost and response time, such as in case of molecular tests. The main health institutions such as the WHO, the CDC and the Ministry of Health of the Government of Spain propose the use of antigenic tests in a wide variety of strategies to respond to the pandemic. This document aims to support physicians involved in the care of patients with suspected SC2 infection, in the context of a growing incidence in Spain since September 2020, which already represents the second pandemic wave of COVID-19.

Sewage sludge composting under semi-permeable film at full-scale: Evaluation of odour emissions and relationships between microbiological activities and physico-chemical variables

In the present study, physico-chemical characteristics, heavy metals content, odour emissions, microbial enumeration and enzymatic activities were analysed during industrial scale composting of sewage sludge partially pre-treated to evaluate the effect of a combined system of semi-permeable film and aeration on these parameters. The results related to physico-chemical parameters showed a decrease in total organic carbon (TOC), organic matter (OM), total carbon (TC) along the process. Volatile solids (VS) were also reduced, reaching 36% at 120 days, which is above the limit according to the current legislation. Similarly, metal content was found to be an important variable in the evolution of enzymatic activity, while lead (Pb), zinc (Zn), and nickel (Ni) were the most influential. Moreover, heavy metals were found below the limit of type B compost quality or European class 2 at the end of the process, which is suitable for agriculture soil. The odorous impact generated during the hydrolytic stage was reduced to an average value of 4 ou_E/s. This suggests that, covered stage with the semi-permeable film, could be a viable solution to mitigate odour emissions. The highest temperature was reached at 10 days and it was favoured by semi-permeable film. Temperature promoted the presence of thermophilic bacteria and fungi and indicated an early biodegradation process mediated by microorganisms. Statistical analyses revealed a high correlation of physico-chemical variables with microbial activity. Thus, samples from the first 14 days were highly correlated with enzymatic activities such as β-glucosidase (Ac-βGlu), protease (Ac-Pr), and dehydrogenase (Ac-De), which have usually been involved in the hydrolysis of organic matter.

Large-scale implementation of sustainable production practices in the Priorat-Montsant region

The Priorat and Montsant Appellations of Origin are considered to produce some of the finest wines in the Mediterranean area of Spain. Located in the south of Catalonia (North-East Spain), they account for close to 4000 ha cultivated by more than 1300 vine growers under severe Mediterranean climatic conditions and hence threatened by global warming. In this context, sustainable practices are needed for the optimal use of natural resources in order to ensure the durability of high-quality wine production in the region. In addition, these practices allow this region to maintain high levels of biodiversity, a major characteristic of Priorat and Montsant's agricultural landscape, which represents an important touristic attraction. The Project LIFE Priorant+Montsant, funded by the European Union, proposed the implementation of sustainable practices at a regional scale, in order to achieve remarkable reductions of resource consumption in three axes: 1) Irrigation water management, 2) vine fertilization and 3) synthetic pesticide use. Reductions are achieved by providing the necessary technical support to growers to adopt practices, developing optimized strategies and evaluating the viticulture and winery production processes. After the two first seasons of the project, 2017 and 2018, the objectives of reduction of resources consumption have been successfully achieved. A total of 53 vineyard plots, representing the main grape varieties in the region (Grenache, Carignan, Cabernet Sauvignon and Syrah) were classified in eight sub-areas and monitored for water consumption. From pea-size to harvest (phenological stages), weekly measurements of phenology, water potential and meteorological data were collected. Irrigation recommendations were then given to growers, to avoid water potential below − 1.4 MPa. Overall, more than 50 irrigation recommendations were emitted to growers. The water consumption with the optimized irrigation strategy ranged from 10 to 63 litres per ha, the recommended dose saved 20 to 87% of the irrigation water per year, according to previous general recommendations in this region. Regarding fertilization, soil samples were provided by growers and leave samples were taken from vineyards to assess nutrient levels and develop the corresponding recommendation of fertilization, depending on the analysis results. The analyzed soil samples from the different sub-areas were grouped by the Principal Component Analysis, in which the first and second principal components accounted for 31.6% and 11.8% of the variability and were related to soil texture and nutrient content of soils, respectively. Overall, the recommended doses of organic fertilizers saved more than 20% of the usual chemical fertilizer application in the region. The reduction of pesticide use will be achieved through three actions related to three main pests and diseases of grapevine: optimized formulations against powdery mildew, alternative products to reduce copper use against downy mildew and, increase of surface under mating disruption strategy against grape berry moth Lobesia botrana. Before implementing these actions, no vineyards were managed under mating disruption in the Montsant area and 207 ha have been monitored in 2018 after two years. In the Priorat area, more than 200 ha have also adopted this strategy during the project. This action has saved more than 500 application doses of synthetic insecticides in those vineyards. Within the same scope, several formulations will be proved in the following years in order to assess their effectiveness against powdery and downy mildew in further specific field trials. Candidate products will be introduced in Integrated Pest Management strategies to achieve the desired pesticide reduction levels. The results will represent specific regional strategies for irrigation, fertilization and plant protection, and are extensible to most of the vineyards in Priorat and Montsant, as well as to other vitivinicultural regions which similar conditions.

Keywords: Sustainable management, Irrigation, Fertilisation, Pesticides, Priorat-Montsant.

Septic pulmonary emboli detected by 18F-FDG PET/CT in children with S. aureus catheter-related bacteremia

PURPOSE

The role of ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET/CT) in the diagnosis of metastatic infectious foci in children with catheter-related blood stream infection has been hardly studied, although some authors have reported it benefit in the screening of metastatic foci in adult population. Septic pulmonary emboli are among the most difficult to identify, because many cases do not present pulmonary complaints or abnormal chest radiography. However, diagnosis of these foci has important therapeutic consequences. The purpose of this article is to describe the role of ¹⁸F-FDG PET/CT in the diagnosis of septic pulmonary embolism in children with S. aureus catheter-related bacteremia.

METHODS

We report 3 children with S. aureus catheter-related bacteremia and normal chest X-ray at admission, in whom ¹⁸F-FDG PET/CT led to the diagnosis of unsuspected septic pulmonary emboli, with an impact on clinical management.

RESULTS

All patients had hemophilia and implantable venous access ports and presented with fever and normal lung auscultation. Only 1 reported non-specific symptoms (undifferentiated left chest pain). All patients had normal chest X-ray on admission. Catheters were removed within 48 h after admission in 2 cases, and 5 days after admission in the last case, subsiding fever. In 2 children, paired blood cultures were not able to identify bacteremia. However, in all cases catheter tip and subcutaneous port cultures yielded S. aureus and PET/CT detected unsuspected pulmonary metastatic emboli.

CONCLUSIONS

¹⁸F-FDG PET/CT should be considered as a useful tool to diagnose septic pulmonary embolism in S. aureus catheter-related bacteremia, especially if conventional diagnostic imaging techniques have failed to reveal possible metastatic foci. Further studies are needed to clarify the usefulness of PET/CT performance in children with CRBSI.

Hydra: A web-based system for cardiovascular analysis, diagnosis and treatment

BACKGROUND AND OBJECTIVE

Cardiovascular (CV) risk stratification is a highly complex process involving an extensive set of clinical trials to support the clinical decision-making process. There are many clinical conditions (e.g. diabetes, obesity, stress, etc.) that can lead to the early diagnosis or establishment of cardiovascular disease. In order to determine all these clinical conditions, a complete set of clinical patient analyses is typically performed, including a physical examination, blood analysis, electrocardiogram, blood pressure (BP) analysis, etc. This article presents a web-based system, called Hydra, which integrates a full and detailed set of services and functionalities for clinical decision support in order to help and improve the work of clinicians in cardiovascular patient diagnosis, risk assessment, treatment and monitoring over time.

METHODS

Hydra integrates a number of different services: a service for inputting all the information gathered by specialists (physical examination, habits, BP, blood analysis, electrocardiogram, etc.); a tool to automatically determine the CV risk stratification, including well-known standard risk stratification tables; and, finally, various tools to incorporate, analyze and graphically present the records of the ambulatory BP monitoring that provides BP analysis over a given period of time (24 or 48 hours). In addition, the platform presents a set of reports derived from all the information gathered from the patient in order to support physicians in their clinical decisions.

RESULTS

Hydra was tested and validated in a real domain. In particular, internal medicine specialists at the Hypertension Unit of the Santiago de Compostela University Hospital (CHUS) validated the platform and used it in different clinical studies to demonstrate its utility. It was observed that the platform increased productivity and accuracy in the assessment of patient data yielding a cost reduction in clinical practice.

CONCLUSIONS

This paper proposes a complete platform that includes different services for cardiovascular clinical decision support. It was also run as a web-based application to facilitate its use by clinicians, who can access the platform from any remote computer with Internet access. Hydra also includes different automated methods to facilitate the physicians' work and avoid potential errors in the analysis of patient data.

Recurrent wheezing and asthma after bocavirus bronchiolitis

BACKGROUND

Human bocavirus (HBoV) was recently discovered and identified as an important cause of respiratory infection in young children. However, the relationship between HBoV-bronchiolitis and the development of recurrent wheezing has not yet been established.

OBJECTIVE

We designed this study in order to describe the mid-term outcome, regarding the development of recurrent wheezing and asthma of HBoV-bronchiolitis patients and to compare it with RSV-bronchiolitis infants.

METHODS

We studied 80 children (10 with HBoV and 70 with RSV infection), currently aged ≥4 years and previously hospitalised during the seasons 2004-2009 due to acute bronchiolitis. Epidemiological and clinical data were collected through structured clinical interviews at the follow-up visit. Spirometry and skin prick tests to common food and inhaled allergens were performed.

RESULTS

All HBoV-patients developed recurrent wheezing and half of them had asthma at age 5-7 years. Almost 30% required hospital admission for recurrent wheezing. Asthma (odds ratio (OR)=1.28) and current asthma (OR=2.18) were significantly more frequent in children with HBoV-bronchiolitis than in RSV-bronchiolitis. FEV1 values were 99.2±4.8 in HBoV-group vs. 103±11 in RSV-group, p: 0.09. No differences were found with respect to allergic rhinitis, atopic dermatitis, food allergy, proportion of positive prick tests, and family history of atopy or asthma.

CONCLUSIONS

Severe HBoV-bronchiolitis in infancy was strongly associated with asthma at 5-7 years.

Influence of Color on Perception of Sweetness and Fruit Flavor of Fruit Drinks

The objective of this work was to study the effects of color on the perception of both sweetness and fruit flavor of different fruit (peach, orange, kiwifruit and berries) beverages. Four samples of each fruit beverage were prepared by adding different colorants but maintaining the same composition. Color was measured using a Hunter Lab colorimeter. Samples of each of the different fruits were ranked for color, sweetness and typical fruit flavor by a group of assessors. Color was found to influence sweetness only in orange drinks but it affected intensity of typical flavor in all fruit drinks.

Hospital admission due to respiratory viral infections in moderate preterm, late preterm and term infants during their first year of life

Background

Respiratory viral infections are a major cause of hospitalisation in infants <1 year and might cause severe symptoms in preterm infants. Our aim was to analyse admissions due to respiratory infections in moderate, late and term infants, and to identify risk factors for hospitalisation in preterm versus term.

Methods

Prospective study in a cohort of moderate and late preterm, and term infants born between October/2011 and December/2012. Admissions due to respiratory infections during the first year of life were analysed and compared among moderate (32–33), late (34–36) and term infants. Sixteen respiratory viruses were detected by RT-PCR. Clinical data were collected.

Results

30 (20.9%) out of 143 preterm infants required admission for respiratory infection, versus 129 (6.9%) of 1858 term infants born in the same period (p < 0.0001, OR: 3.6 CI 2.0 to 5.0). Hospitalised children had a higher prevalence of hyaline membrane disease (HMD) at birth (p < 0.001, OR: 7.7 CI: 2.121 to 27.954) and needed more mechanical ventilation (p < 0.001, OR: 5.7 CI: 1.813 to 18.396). Virus was identified in 25/30 (83%) preterm babies, and in 110/129 (85%) term infants. The most frequent viruses in preterm infants were RSV (76%) rhinovirus (20%). Clinical and epidemiological characteristics among term and preterm infants were similar.

Conclusions

The risk of respiratory admissions during the first year of life is up to 3.6 times higher in moderate and late preterm. Once admitted, clinical features of respiratory episodes requiring hospitalisation are similar among term and preterm infants. Hyaline membrane disease and mechanical ventilation were also risk factors for respiratory admissions.

Viral respiratory tract infections in the neonatal intensive care unit

Introduction

Viral respiratory infections cause major morbidity and mortality in preterm infants. We have performed a prospective study in our neonatal intensive care unit (NICU) to determine the incidence of respiratory infections, their impact and the epidemiology and outcome in high risk neonates.

Patients and methods

From September 2011 to May 2013 a prospective study was conducted in all preterm infants <32 weeks gestational age and in all term newborns admitted to NICU for any pathology that was anticipated to have an admission exceeding two weeks. A nasopharyngeal aspirate (NPA) was collected the first day of life and weekly until discharge for virologic study with polymerase chain reaction. When these babies presented respiratory symptoms a new NPA was collected at this moment. A clinical form was filled by the physician.

Results

A total of 60 infants were analysed: 30 (50%) had a gestational age <32 weeks and 36 (60%) weighed less than 1500 g. We collected a total of 256 nasopharyngeal aspirate samples, 24 of them being positive (9.3%). These 24 positive samples corresponded to 13 infants in our cohort (21.6% of the patients). Of them, 9 were symptomatic and had 11 episodes of infection (2 patients had two different episodes with negative control between them). The most frequently identified virus was rhinovirus in (19) 79% of cases. The most frequent clinical data was the presence or increase in apneas (75%) and the need for oxygenotherapy.

Conclusions

HRV infections are prevalent in the NICU, and preterm infants have a high risk of infections with clinical relevance.

[SEIP-SERPE-SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis]

This is a Consensus Document of the Spanish Society of Paediatric Infectious Diseases (Sociedad Española de Infectología Pediatrica), Spanish Society of Paediatric Rheumatology (Sociedad Española de Reumatología Pediátrica) and the Spanish Society of Paediatric Orthopaedics (Sociedad Española de Ortopedia Pediátrica), on the treatment of uncomplicated acute osteomyelitis and septic arthritis. A review is presented on the medical and surgical treatment of acute osteoarticular infection, defined as a process with less than 14 days of symptomatology, uncomplicated and community-acquired. The different possible options are evaluated based on the best available scientific knowledge, and a number of evidence-based recommendations for clinical practice are provided.

[Viral respiratory tract infections in the Neonatal Intensive Care Unit]

INTRODUCTION

Viral respiratory infections cause major morbidity and mortality in preterm infants. We have performed a prospective study in our neonatal intensive care unit (NICU) to determine the incidence of respiratory infections, their impact and the epidemiology and outcome in high risk neonates.

PATIENTS AND METHODS

From September 2011 to May 2013 a prospective study was conducted in all preterm infants < 32 weeks gestational age and in all term newborns admitted to NICU for any pathology that are anticipated to have an income exceeding two weeks. A nasopharyngeal aspirate (NPA) was collected the first day of life and weekly until discharge for virologic study with polymerase chain reaction. When these babies presented respiratory symptoms a new NPA was collected in this moment. A clinical form was filled by the physician.

RESULTS

A total of 60 infants were analyzed: 30 (50%) had a gestational age < 32 weeks and 36 (60%) weighing less than 1500 grams. We collected a total of 256 nasopharyngeal aspirate samples, 24 of them being positive (9.3%). These 24 positive samples corresponded to 13 infants in our cohort (21.6% of the patients). Of them, 9 were symptomatic and had 11 episodes of infection (2 patients had two different episodes with negative control between them). The most frequently identified virus was rhinovirus in (19) 79% of cases. The most frequent clinical data was the presence or increased of apneas (75%) and the needed of oxygenotherapy.

CONCLUSIONS

HRV infections are prevalent in the NICU, and preterm infants have a high risk of infections with clinical relevance.

[Human parechovirus-3 infection in a neonate with fever and suspected sepsis]

The human parechovirus (HPeV) are viruses of the recently described Picornaviridae family and are causing several infections in young children. The pathology associated with these viruses is beginning to emerge. The HPeV type 3, has been described particularly in association with sepsis-like febrile syndromes, meningitis and encephalitis in very young infants and neonates. We report the case of a 14-day-old girl with a fever and clinical sepsis that required hospitalization and in which HPeV-3 was identified in the cerebrospinal fluid. The blood, urine and cerebrospinal fluid bacterial cultures were negative, and the patient improved. This case illustrates the usefulness of investigating parechovirus infection in neonates with fever or suspected sepsis.

Optimization of a Trap for Tuta absoluta Meyrick (Lepidoptera: Gelechiidae) and Trials to Determine the Effectiveness of Mass Trapping

Management of the South American tomato leafminer, Tuta absoluta Meyrick, with insecticides has led to the widespread development of insect resistance. Mass trapping using traps baited with the female-produced sex pheromone is an attractive alternative for the management of this pest. The current study evaluated several commercial trap designs for capture of T. absoluta. Based on its small size and ease of handling, the most effective trap is a small plastic container with entry windows cut on the sides filled with motor oil over water. These traps are most effective when placed near ground level. Tests of septa containing 0.1 or 0.2 mg of the pheromone (95:5) E4, Z8-14Ac/E4,Z8,Z11-14Ac were slightly more attractive than septa loaded with 0.5, 1.0, or 2 mg during the first week of use, but the latter three loadings were slightly more attractive than the first two loadings after 9 weeks. Ideal trap baits were loaded with 0.5 mg of pheromone. Higher numbers of T. absoluta were captured near upwind borders of tomato fields suggesting that treatments against T. absoluta should be concentrated near upwind parts of fields. Comparisons of conventional insecticide treatment versus mass trapping to manage T. absoluta damage in three different test sites showed that even when initial captures in monitoring traps were high (>35 males trap(-1) day(-1)), mass trapping at 48 traps/ha reduced leaf damage more efficiently than conventional insecticide treatment. Based on the typical insecticide recommendations against T. absoluta, mass trapping is an economically viable alternative.

[I-131 uptake in renal cyst: a false positive result]

We present the case of a 60-year old male with a follicular pattern of multifocal invasive papillary thyroid carcinoma who had undergone total thyroidectomy. During post-surgical follow-up with I-131 scan, a I-131 deposit was observed in the upper left hemiabdomen. Due to suspicion that it could be a metastasis, an ultrasound and CT scan were performed, with the subsequent diagnosis of a left simple serous renal cyst. Once confirmed, drainage was performed under ultrasound control, obtaining I-131 in the analysis of its content.

Reduced adipogenic gene expression in fibroblasts from a patient with type 2 congenital generalized lipodystrophy

AIMS

Beradinelli-Seip congenital generalized lipodystrophy is a rare autosomal recessive disorder characterized by near-complete absence of adipose tissue, Herculean appearance, insulin resistance, hypoleptinaemia and diabetes mellitus. The aim of this study was to investigate the in vitro effects of pioglitazone on the expression of genes involved in adipogenesis in fibroblasts from a patient with this condition due to a seipin mutation.

METHODS

Primary cultures of fibroblasts from the skin of the patient were obtained. Fibroblasts were treated with classic adipose differentiation medium, with and without pioglitazone. Several adipogenes were evaluated by real-time reverse transcriptase-polymerase chain reaction and western blotting. Intracellular localization of prelamin A was studied by immunofluorescence microscopy.

RESULTS

The expression of the adipogenic genes PPARG, LPL, LEP and SLC2A4 was reduced in lipodystrophic fibroblasts, while treatment with pioglitazone increased the expression of these genes. Moreover, and unexpectedly, we found an accumulation of farnesylated prelamin A in lipodystrophic fibroblasts.

CONCLUSIONS

The process of adipocyte differentiation is compromised in patients with Beradinelli-Seip congenital lipodystrophy owing to diminished expression of the regulatory genes involved, which pioglitazone treatment partially rescues. Prelamin A accumulation establishes a link with other types of familial lipodystrophies, as familial partial lipodystrophy.

Detection of new respiratory viruses in hospitalized infants with bronchiolitis: a three-year prospective study

AIM

We have designed a study with the objective of describing the clinical impact of other viruses different from the respiratory syncytial virus (RSV) in hospitalized infants with bronchiolitis.

METHODS

A 3 year prospective study was conducted on infants admitted to the Paediatrics Department of the Severo Ochoa Hospital (Spain). We studied the frequency of 16 respiratory viruses. Clinical characteristics of RSV-only infections were compared with other single agent viral infections.

RESULTS

Positive results were confirmed in 275 (86.5%) of the 318 children studied. A single virus was detected in 196 patients and 79 were dual or multiple viral infections. RSV was detected in 61.3% of total bronchiolitis. Rhinovirus (RV) was 17.4% of the identified virus, followed by human bocavirus (HBoV), adenovirus and metapneumovirus (hMPV). Only RV, HBoV and hMPV were significant as single infections. RSV patients were younger than HBoV (p > 0.0001) and hMPV (p = 0.025). Seasonality was clearly different between them. Children with RSV infection needed treatment in the intensive care unit more frequently than others.

CONCLUSIONS

In hospitalized infants, RSV was the most frequent agent in bronchiolitis in winter, but other viruses were present in 47% of the patients. RV, HBoV and hMPV had a significant proportion of single infections. Clinical characteristics were similar amongst them, but seasonality was clearly different.

Role of emerging respiratory viruses in children with severe acute wheezing

BACKGROUND

Acute wheezing episodes are frequently associated with respiratory viral infections in children. However, the role of the recently described respiratory viruses is not yet fully understood.

OBJECTIVE

The main objective of this study was to estimate the frequency of human metapneumovirus (HMPV), human bocavirus (HBoV), and 14 other respiratory viruses in hospitalized children with acute wheezing.

METHODS

A prospective study was conducted on children <14 years old, admitted with an acute expiratory wheezing episode from September 2005 to June 2008. Viruses were detected in nasopharyngeal aspirates by polymerase chain reaction. Clinical data were prospectively recorded.

RESULTS

A viral pathogen was identified in 444 (71%) out of 626 hospitalized acute wheezing episodes. Respiratory syncytial virus (RSV) was the most frequently detected (27%), followed by rhinovirus (24%), adenovirus (17.8%), HBoV (16%), and HMPV (4.7%). The rate of viral detection was significantly higher in infants (77.3%), than in older children (59.8%) (P < 0.001). RSV and HBoV were more prevalent in infants (P < 0.001) than in older children.

CONCLUSION

The most prevalent viruses found in severe acute wheezing episodes were RSV and rhinovirus not only in childhood, but also in infancy. However, other emerging viruses such as HBoV and metapneumovirus also play an important role in wheezing episodes.

Application of bioemulsifiers in soil oil bioremediation processes. Future prospects

Biodegradation is one of the primary mechanisms for elimination of petroleum and other hydrocarbon pollutants from the environment. It is considered an environmentally acceptable way of eliminating oils and fuel because the majority of hydrocarbons in crude oils and refined products are biodegradable. Petroleum hydrocarbon compounds bind to soil components and are difficult to remove and degrade. Bioemulsifiers can emulsify hydrocarbons enhancing their water solubility and increasing the displacement of oily substances from soil particles. For these reasons, inclusion of bioemulsifiers in a bioremediation treatment of a hydrocarbon polluted environment could be really advantageous. There is a useful diversity of bioemulsifiers due to the wide variety of producer microorganisms. Also their chemical compositions and functional properties can be strongly influenced by environmental conditions. The effectiveness of the bioemulsifiers as biostimulating agent in oil bioremediation processes has been demonstrated by several authors in different experimental assays. For example, they have shown to be really efficient in combination with other products frequently used in oil bioremediation such as they are inorganic fertilizer (NPK) and oleophilic fertilizer (i.e. S200C). On the other hand, the bioemulsifiers have shown to be more efficient in the treatment of soil with high percentage of clay. Finally, it has been proved their efficacy in other biotechnological processes such as in situ treatment and biopiles. This paper reviews literature concerning the application of bioemulsifiers in the bioremediation of soil polluted with hydrocarbons, and summarizes aspects of the current knowledge about their industrial application in bioremediation processes.

Interplay between human leukocyte antigen genes and the microbial colonization process of the newborn intestine

Coeliac disease (CD) development involves genetic (HLA-DQ2/DQ8) and environmental factors. Herein, the influence of the HLA-DQ genotype on the gut colonization process of breast-fed children was determined. A cohort of 20 newborns, with at least one first-degree relative with CD, were classified according to their HLA-DQ genotype into high, intermediate and low genetic risk groups, showing 24-28%, 7-8% and less than 1% probability to develop CD, respectively. Faecal microbiota was analysed at 7 days, 1 and 4 months of children's age by fluorescence in situ hybridization. When considering all data, Gram-negative bacteria and Bacteroides-Prevotella group proportions were higher (P<0.05) in the high than in the intermediate and low genetic risk groups. E. coli, Streptococcus-Lactococcus, E. rectale-C. coccoides, sulphate-reducing bacteria, C. lituseburense and C. histolyticum group proportions were also significantly higher (P<0.05) in the high than in the low genetic risk group. Correlations between these bacterial groups and the genetic risk were also detected (P<0.05). In addition, the number and type of CD relative seemed to influence (P<0.050) these bacterial proportions in children at CD risk. At 4 months of age, similar relationships were established between the high genetic risk to develop CD and the proportions of Streptococcus-Lactococcus (P<0.05), E. rectale-C. coccoides (P<0.05), C. lituseburense (P<0.05), C. histolyticum (P<0.05), Bacteroides-Prevotella (P<0.10) groups and total Gram-negative bacteria (P<0.05). The results suggest a relationship between HLA-DQ genes and the gut microbial colonization process that could lead to a change in the way this disorder is investigated.

The combination of amlodipine/valsartan 5/160 mg produces less peripheral oedema than amlodipine 10 mg in hypertensive patients not adequately controlled with amlodipine 5 mg

AIMS

To demonstrate the benefit of the combination amlodipine/valsartan 5/160 mg over amlodipine 10 mg, in producing a lower incidence of peripheral oedema for a comparable mean sitting systolic blood pressure (MSSBP) reduction.

METHODS

After a 4-week amlodipine 5 mg run-in phase, inadequately controlled hypertension patients (aged > or = 55 years, MSSBP > or = 130 and < or = 160 mmHg) were randomised to receive amlodipine/valsartan 5/160 mg or amlodipine 10 mg for 8 weeks, followed by amlodipine/valsartan 5/160 mg for 4 weeks for all patients. Primary variables were MSSBP change from baseline to week 8 and incidence of peripheral oedema reported as an AE. Resolution of peripheral oedema was assessed 4 weeks after switching patients from amlodipine 10 mg to amlodipine/ valsartan 5/160 mg.

RESULTS

At week 8, MSSBP showed greater reduction with amlodipine/valsartan 5/160 mg than amlodipine 10 mg (least square mean: -8.01 vs.-5.95 mmHg, p < 0.001 for non-inferiority and p = 0.002 for superiority). Systolic control, overall BP control and systolic response rate at week 8 were significantly higher with combination than amlodipine 10 mg (34 vs. 26%; 57 vs. 50%; 36.57 vs. 27.77%, respectively). Incidence of peripheral oedema was significantly lower with the combination than amlodipine 10 mg (6.6 vs. 31.1%, p < 0.001). Peripheral oedema resolved in 56% patients who switched from amlodipine 10 mg to the combination, without the loss of effect on BP reduction.

CONCLUSION

In non-responders to amlodipine 5 mg, treatment with amlodipine/valsartan 5/160 mg induced significantly less peripheral oedema than amlodipine 10 mg for similar BP reduction. Peripheral oedema resolved in > 50% patients switching from amlodipine 10 mg to the combination.