Influence of weather conditions and projected climate change scenarios on the suitability of Vitis vinifera cv. Carignan in Rioja DOCa, Spain

Grape development and its quality are highly dependent on soil and weather conditions. Under the progressive warming, which can affect the suitability of typical varieties grown in a given area, the knowledge of the vine response to changes in climate is essential to stablish strategies to maintain the viticulture sector. This research presents an analysis of phenology and grape composition of the Carignan cultivar, during a 13-year period, at two locations in Rioja DOCa. Based on the results obtained and the projected changes in climate under climate change scenarios (RC4.5 and RCP8.5), the response of this cultivar was evaluated. Differences in the phenological dates of up to 18, 29 and 40 days, for flowering, veraison and harvest, respectively, were observed between the warmest and the coolest years. An advance of up to 5, 8 and 11 days, respectively, for the mentioned stages, is projected under the RCP4.5 scenario by 2050, which could be near 1.5*times higher under the RCP8.5 scenario. These advances will be mainly driven by the temperatures recorded in the previous period. Grape acidity was mainly driven by water availability, in particular during ripening, which imply a slight projected reduction due to precipitation changes but not significant effect due to increasing temperatures. The phenolic composition could be positively affected by increasing temperatures and increasing water deficits, since this variety does not always reach a complete maturity at present. Thus, under the projected warming scenarios, the suitability of Carignan in Rioja DOCa was confirmed.

The Cost-Effectiveness of Subcutaneous Semaglutide Versus Empagliflozin in Type 2 Diabetes Uncontrolled on Metformin Alone in Denmark

INTRODUCTION

International and Danish guidelines recommend the use of glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 (SGLT-2) inhibitors already in second line in the management of type 2 diabetes (T2D). The objective of this study was to evaluate the long-term cost-effectiveness (CE) of subcutaneous (SC) semaglutide (GLP-1 RA) versus empagliflozin (SGLT-2 inhibitor) in individuals with T2D uncontrolled on metformin alone from a Danish payer's perspective.

METHODS

Cost-effectiveness analyses (CEA) were conducted from a Danish payer's perspective, using the IQVIA Core Diabetes model (CDM 9.5), with a time horizon of 50 years and an annual discount of 4% on costs and effects. Patients received either SC semaglutide or empagliflozin, in addition to metformin, until HbA1c threshold of 7.5% (58 mmol/mol) was reached, following which treatment intensification with insulin glargine in addition to empagliflozin or SC semaglutide plus metformin was considered. Baseline cohort characteristics and treatment effects were sourced from a published CEA. Utilities and cost of diabetes-related complications were also obtained from published sources. Treatment costs were derived from Danish official sources. Scenario analyses were also performed to test the accuracy of the base case results.

RESULTS

Individuals with T2D on SC semaglutide plus metformin gained 0.065 life-years (LYs) and 0.130 quality-adjusted LYs (QALYs), respectively, at an incremental cost of DKK 96,923 (€ 13,031) compared to empagliflozin plus metformin, resulting in an incremental cost-effectiveness ratio (ICER) of DKK 745,561(€ 100,239) per QALY gained. The probabilistic sensitivity analysis (PSA) results showed that the SC semaglutide plus metformin was cost-effective in 19% of simulations assuming a willingness-to-pay (WTP) threshold of DKK 357,100 (€ 48,011)/QALY gained. Duration of therapy with SC semaglutide seems the key driver of results.

CONCLUSION

The current analyses suggest that SC semaglutide plus metformin is not cost-effective compared to empagliflozin plus metformin from a Danish payer's perspective.

The cost-effectiveness of oral semaglutide versus empagliflozin in Type 2 diabetes in Denmark

Aim: To evaluate the cost-effectiveness of oral semaglutide+metformin versus empagliflozin+metformin in people with Type 2 diabetes uncontrolled on msetformin alone. Materials and methods: The IQVIA Core Diabetes Model was populated with efficacy data from a head-to-head study between oral semaglutide+metformin and empagliflozin+metformin. Danish costs and quality-of-life data were sourced from literature. Price per day was Danish Krone (DKK) 25.53 for oral semaglutide and DKK11.40 for empagliflozin. Discounting was fixed at 4%. Scenario and sensitivity analyses were performed. Results: Over a lifetime, Core Diabetes Model projected 8.78 and 8.75 quality-adjusted life-years and a total cost of DKK 447,633 and DKK 387,786, thereby generating an incremental cost-effectiveness ratio of DKK 1,930,548 for oral semaglutide+metformin versus empagliflozin+metformin. Scenario and sensitivity analyses showed the robustness of the outcomes. Duration of treatment with oral semaglutide is the key driver of the analyses. Conclusion: Oral semaglutide+metformin seems not cost effective versus empagliflozin+metformin in patients uncontrolled on metformin in Denmark.

First nationwide antimicrobial susceptibility surveillance for Neisseria gonorrhoeae in Brazil, 2015-16

Objectives

Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns globally. Enhanced AMR surveillance for gonococci is essential worldwide; however, recent quality-assured gonococcal AMR surveillance in Latin America, including Brazil, has been limited. Our aims were to (i) establish the first nationwide gonococcal AMR surveillance, quality assured according to WHO standards, in Brazil, and (ii) describe the antimicrobial susceptibility of clinical gonococcal isolates collected from 2015 to 2016 in all five main regions (seven sentinel sites) of Brazil.

Methods

Gonococcal isolates from 550 men with urethral discharge were examined for susceptibility to ceftriaxone, cefixime, azithromycin, ciprofloxacin, benzylpenicillin and tetracycline using the agar dilution method, according to CLSI recommendations and quality assured according to WHO standards.

Results

The levels of resistance (intermediate susceptibility) to tetracycline, ciprofloxacin, benzylpenicillin and azithromycin were 61.6% (34.2%), 55.6% (0.5%), 37.1% (60.4%) and 6.9% (8.9%), respectively. All isolates were susceptible to ceftriaxone and cefixime using the US CLSI breakpoints. However, according to the European EUCAST cefixime breakpoints, 0.2% (n = 1) of isolates were cefixime resistant and 6.9% (n = 38) of isolates had a cefixime MIC bordering on resistance.

Conclusions

This study describes the first national surveillance of gonococcal AMR in Brazil, which was quality assured according to WHO standards. The high resistance to ciprofloxacin (which promptly informed a revision of the Brazilian sexually transmitted infection treatment guideline), emerging resistance to azithromycin and decreasing susceptibility to extended-spectrum cephalosporins necessitate continuous surveillance of gonococcal AMR and ideally treatment failures, and increased awareness when prescribing treatment in Brazil.

Quantitative comparison of initial soil erosion processes and runoff generation in Spanish and German vineyards

The aim of this study was to enable a quantitative comparison of initial soil erosion processes in European vineyards using the same methodology and equipment. The study was conducted in four viticultural areas with different characteristics (Valencia and Málaga in Spain, Ruwer-Mosel valley and Saar-Mosel valley in Germany). Old and young vineyards, with conventional and ecological planting and management systems were compared. The same portable rainfall simulator with identical rainfall intensity (40mmh(-1)) and sampling intervals (30min of test duration, collecting the samples at 5-min-intervals) was used over a circular test plot with 0.28m(2). The results of 83 simulations have been analysed and correlation coefficients were calculated for each study area to identify the relationship between environmental plot characteristics, soil texture, soil erosion, runoff and infiltration. The results allow for identification of the main factors related to soil properties, topography and management, which control soil erosion processes in vineyards. The most important factors influencing soil erosion and runoff were the vegetation cover for the ecological German vineyards (with 97.6±8% infiltration coefficients) and stone cover, soil moisture and slope steepness for the conventional land uses.

Childhood tuberculosis and human immunodeficiency virus status in Brazil: a hierarchical analysis

SETTING

Human immunodeficiency virus (HIV) infection may impact tuberculosis (TB) diagnosis, clinical presentation and treatment outcomes in children as the signs and symptoms of both diseases overlap.

OBJECTIVE

To compare the sociodemographic and clinical profiles of childhood TB according to HIV status in Brazil.

METHODS

This was a cross-sectional study of data on subjects aged <15 years retrieved from the Brazilian National Electronic Disease Registry (Sistema de Informação de Agravos de Notificação) database on TB to compare TB-HIV coinfected patients and patients with TB only registered between 2007 and 2011. A hierarchical logistic regression model was applied.

RESULTS

Of 6091 cases analysed, 780 (12%) were TB-HIV patients, while 5311 (87%) presented with TB only. TB-HIV patients were more likely to be institutionalised (OR 2.22, 95%CI 1.43-3.46), to present with relapsed TB (OR 5.03, 95%CI 2.02-12.5) and be readmitted after treatment default (OR 16.7, 95%CI 4.34-64.46). They were also more likely to have unfavourable outcomes, including default (OR 2.85, 95%CI 1.81-4.49), death due to TB (OR 2.76, 95%CI 1.27-6.03) and death from other causes (OR 5.59, 95%CI 2.63-11.8).

CONCLUSION

Our study highlights the challenges of using national registers for research into childhood TB.

Spatial and temporal variability of cv. Tempranillo phenology and grape quality within the Ribera del Duero DO (Spain) and relationships with climate

The aim of this work was to analyze spatial phenology and grape quality variability related to the climatic characteristics within the Ribera del Duero Designation of Origin (DO). Twenty plots planted with cv. Tempranillo and distributed within the DO were analyzed for phenology from 2004 to 2013. Grape quality parameters at ripening (berry weight, sugar content, acidity and pH, and anthocyanins) were analyzed in 26 plots for the period 2003-2013. The relationships between phenology and grape parameters with different climatic variables were confirmed with a multivariate analysis. On average, bud break was April 27(th), bloom June 17(th), and veraison August 12th. However, phenology during the time period showed high variability, with differences between years of up to 21 days for a phenology stage. The earliest dates were observed in dry years (2005, 2006, and to a lesser degree in 2009) while the later phenology dates occurred in the wettest year of the period (2008). High correlations were found between veraison date and temperature variables as well as with precipitation-evapotranspiration recorded during the bloom-veraison period. These effects tended to be higher in the central part of the DO. Grape quality parameters also showed high variability among the dry and the wet years, and the influence of extreme temperatures on color development as well as the effect of available water on acidity were observed.

Survival of the biological control agent Candida sake CPA-1 on grapes under the influence of abiotic factors

AIMS

As reliability of preharvest applications of biological control agents (BCAs) to control fruit pathogens is highly dependent on the survival of the selected organism, this study aimed to describe the population dynamics of the yeast-BCA Candida sake (Saito & Ota) CPA-1 on grape berries under the effect of abiotic factors such as temperature, relative humidity, sunlight and rainfall.

METHODS AND RESULTS

Candida sake (5 × 10(7) CFU ml(-1)), combined with different concentrations of the food additive Fungicover(®), was applied on grape berry clusters. Treated clusters were then exposed to abiotic factors in field or laboratory conditions, recovering populations to describe C. sake population dynamics. The addition of Fungicover significantly increased C. sake multiplication under optimal growth conditions and improved survival under fluctuating abiotic factors. After field applications, significant differences in populations on grape bunches exposed or covered by fine foliage were detected. Simulated rainfall washed off C. sake populations by 0·6-0·9 log units after 20 mm of rain volume. Allowing populations to establish for 24 h or more, prior to a rain event, persistence on grape berries significantly increased and the effect of rain intensity was not observable.

CONCLUSIONS

Candida sake demonstrated high survival ability under unfavourable environmental conditions and persistence under intense rain. The study evidenced the importance of the first period just after application for C. sake survival on grape tissues and also the protective effect of the additive Fungicover.

SIGNIFICANCE AND IMPACT OF THE STUDY

This research provides new information on the survival of C. sake under field conditions and its practical implications for recommending timing of spray with this antagonist. Our results could be useful for other yeast antagonists applied before harvest. This work, for the first time, defines population dynamics of a yeast BCA using simulated rainfall.

Immunological evaluation of vaginal secretion in patients with high-grade cervical intraepithelial neoplasia treated with intralesional interferon alpha-2b

INTRODUCTION

Conservative treatment with intralesional interferon (IFN) is a therapeutic option for cervical intraepithelial neoplasia (CIN) patients of childbearing age.

MATERIALS AND METHODS

The study group was made up of patients diagnosed with a high-grade lesion and treated with intralesional human recombinant IFNalpha-2b. Vaginal secretion was collected during IFNalpha-2b treatment for analysis of cytokines and viral load.

RESULTS

The initial histology diagnostic was 62.5% (n = 5) with CIN 2 and 37.5% (n = 3) with CIN 3. In terms of clinical evaluation and anatomopathology, 6.5% (n = 5) had a good clinical response, while 37.5% (n = 3) had therapeutic failure. All the patients with therapeutic failure were smokers. Interleukin 6 and tumor necrosis factor-alpha concentrations were raised at the sixth application for the patient group who failed to respond to therapy compared to the responsive group (p = 0.0357). Patients with a good response exhibited a reduction in human papillomavirus viral load (p = 0.03).

CONCLUSIONS

Patients that had a good response had lower concentrations of inflammatory cytokines than did non-responders.

Expression of cytokines in cervical stroma in patients with high-grade cervical intraepithelial neoplasia after treatment with intralesional interferon alpha-2b

Conservative treatment with interferons (IFNs) has the advantage of preserving reproductive capacity in patients with grade 2 or 3 cervical intraepithelial neoplasia (CIN). The objective of this work was to study patients with high-grade CIN treated with intralesional IFN alpha-2b and to analyze the expression of Th1, Th2 and Th3 cytokines in cervical stroma. We observed that patients with a satisfactory response (60%) to treatment with IFN alpha-2b expressed more Th1 (IFN-gamma TNF-alpha, IL-2) cytokines, with a significant reduction in the viral load of high-risk human papillomavirus (p = 0.0313). All patients with therapeutic failure were smokers and had higher expression of cytokines Th2 (IL-4) or Th3 (TGF-beta2 and TGF-beta3).

The clinical use of type 1 interferon in gynecology

Interferons were initially described in terms of their role in blocking viral replication. They are important cytokines that act on various aspects of cell physiology. Importantly, they can affect cell proliferation or induce the differentiation of neoplastic cells. The exact way in which the interferon complex (IFN) acts on tumours is still unknown, although their use in clinical practice has been widely recommended, especially with tumours that are resistant to conventional treatments, or in situations where surgical removal might lead to a loss of organ function. IFN can be employed as a treatment for various chronic diseases, including tumours. Indeed interferon cytokines are the therapy of choice in certain situations. However, one of the difficulties yet to be overcome is the need for frequent administrations of the drug. We believe that the development of new formulations is needed to match the demand for its use in oncology treatment.

High-grade cervical intraepithelial neoplasia, human papillomavirus and factors connected with recurrence following surgical treatment

Although effective strategies for preventing cancer of the uterine cervix exist, this disease continues to be a serious health problem worldwide, especially in developing countries. Today, the role of human papillomavirus (HPV) as a causal factor for the emergence of cervical cancer and its precursor lesions is well established, and prevention programs against cervical cancer are based on detecting cervical intraepithelial neoplasia (CIN). HPV present immunological evasion mechanisms that inhibit detection of the virus by the host, which may result in persistent chronic infection and irrevocably comprise the host defenses. Conization is the surgical technique most used for treating high-grade CIN, since it makes it possible to exclude invasive neoplasia, evaluate resection margins and preserve fertility. However, several factors have been considered to be indicators for residual disease. This review had the aim of covering some factors relating to persistence and recurrence of high-grade CIN following conization.

Metals in vineyard soils of the Penedès area (NE Spain) after compost application

The application of organic wastes to improve soil physical characteristics in mechanized vineyards planted after land levelling is becoming a common practice in Mediterranean areas. It may be useful as an additional source of organic matter and nutrients, but these wastes could also have negative effects due to their metal content. The aim of the study was to evaluate the influence of compost application on soil metal contents in mechanized vineyard soils of the Spanish Mediterranean area, where this practice is repeated every three years. The study was carried out in a ten-year-old vineyard where the main soil type is Typic Calcixerept. Composted cattle manure was applied in alternate rows, at a rate of 40 Mgha(-1) dry-weight. Nine sampling points were located along the slopes of two plots: a levelled plot prepared for mechanization with large soil disturbance movements within the plot, and a plot of undisturbed soil. At each location, soil samples were taken in both treated and untreated soils. Total concentrations (digestion with aqua regia) and the extractable DTPA (Diethylene-triaminepentacetic)-CaCl2-TEA (Triethanolamine) fractions of Cu, Zn and Mn were analyzed in each sample. For Cu and Zn, the initial concentration was higher in the undisturbed plot. In both cases, total Cu and total Zn were positively affected by manure input and the concentration in treated soils was significantly higher than in untreated soil. For Mn, the initial concentration was higher in disturbed soils than in undisturbed ones, and although in both scenarios the concentrations increased with manure, no significant differences were found between treated and untreated soils. The extractable fraction also increased in treated versus untreated soils, although for Cu and Mn the extractable/total metal ratio was similar in treated and untreated soils. After one compost application, total metal contents increased significantly, particularly for Zn. Most of those metals are accumulated in the soil, due to the soil characteristics.

Effects of cattle manure on erosion rates and runoff water pollution by faecal coliforms

The large quantities of slurry and manure that are produced annually in many areas in which cattle are raised could be an important source of organic matter and nutrients for agriculture. However, the benefits of waste recycling may be partially offset by the risk of water pollution associated with runoff from the fields to which slurry or manure has been applied. In this paper, the effects of cattle manure application on soil erosion rates and runoff and on surface water pollution by faecal coliforms are analysed. Rainfall simulations at a rate of 70 mm h(-1) were conducted in a sandy loam soil packed into soil flumes (2.5m long x 1m wide) at a bulk density of 1400 kg m(-3), with and without cattle slurry manure applied on the surface. For each simulation, sediment and runoff rates were analysed and in those simulations with applied slurry, presumptive faecal coliform (PFC) concentrations in the runoff were evaluated. The application of slurry on the soil surface appeared to have a protective effect on the soils, reducing soil detachment by up to 70% but increasing runoff volume by up to 30%. This practice implies an important source of pollution for surface waters especially if rainfall takes place within a short period after application. The concentrations of micro-organisms (presumptive faecal coliforms (PFCs)) found in water runoff ranged from 1.9 x 10(4) to 1.1 x 10(6) PFC 100mL(-1), depending on the initial concentration in the slurry, and they were particularly high during the first phases of the rainfall event. The result indicates a strong relationship between the faecal coliforms transported by runoff and the organic matter in the sediment.

Prevalence of katG Ser315 substitution and rpoB mutations in isoniazid-resistant Mycobacterium tuberculosis isolates from Brazil

SETTING

Four hundred and sixty-eight isoniazid (INH) resistant Mycobacterium tuberculosis isolates recovered from a selected Brazilian population.

OBJECTIVE

To check for susceptibility to other chemotherapeutic drugs used in TB treatment, and to ascertain mutations involved in INH and rifampicin (RMP) resistance.

DESIGN

Antimicrobial susceptibility to RMP, streptomycin and ethambutol (EMB) was evaluated by the resistance ratio method and pyrazinamide (PZA) by activity assay. Single strand conformation polymorphism (SSCP) and sequence analysis were performed in samples from this panel to confirm mutations in codon 315 of the katG and in a 69-bp region of the rpoB gene.

RESULTS

Combined resistance to INH+RMP, INH+ PZA, INH+EMB, and INH+RMP+PZA was shown in respectively 272 (58.1%), 126 (26.9%), 47 (10%), 116 (24.8%) isolates. No katG mutation was found in 19 (39.6%) of 48 strains tested. Ser315Thr substitution was found in 29 (60.4%). All RMP-resistant strains tested (n = 25) showed rpoB mutations. S531L substitution was found in 15 (60%).

CONCLUSION

INH-resistant strains isolated from selected Brazilian populations frequently show resistance to other first-line anti-tuberculosis drugs. rpoB mutation was responsible for RMP resistance in all strains. Among INHr strains, katG mutations were shown in only 60.4%. Genetic approaches targeting the rpoB gene but not the katG gene have a high sensitivity to detect resistance among Brazilian M. tuberculosis strains.

IS1245 restriction fragment length polymorphism typing of Mycobacterium avium from patients admitted to a reference hospital in Campinas, Brazil

Mycobacterium avium is an important pathogen among immunodeficient patients, especially patients with AIDS. The natural history of this disease is unclear. Several environmental sources have been implicated as the origin of this infection. Polyclonal infection with this species is observed, challenging the understanding of its pathogenesis and treatment. In the present study 45 M. avium strains were recovered from 39 patients admitted to a reference hospital between 1996 and 1998. Species identification was performed using a species-specific nucleic acid hybridization test (AccuProbe) from Gen-Probe. Strains were genotyped using IS1245 restriction fragment length polymorphism typing. Blood was the main source of the organism. In one patient with disseminated disease, M. avium could be recovered more than once from potentially sterile sites. Strains isolated from this patient had different genotypes, indicating that the infection was polyclonal. Four patient clones were characterized in this population, the largest clone being detected in eight patients. This finding points to a common-source transmission of the organism.

PCR-based ribotyping of Staphylococcus aureus

Genotyping techniques are valuable tools for the epidemiologic study of Staphylococcus aureus infections in the hospital setting. Pulsed-field gel electrophoresis (PFGE) is the current method of choice for S. aureus strain typing. However, the method is laborious and requires expensive equipment. In the present study, we evaluated the natural polymorphism of the genomic 16S-23S rRNA region for genotyping purpose, by PCR-based ribotyping. Three primer pairs were tested to determine the size of amplicons produced and to obtain better discrimination with agar gel electrophoresis and ethidium bromide staining. The resolution of the typing system was determined using sets of bacteria obtained from clinical specimens from a large tertiary care hospital. These included DNA from three samples obtained from a bacteremic patient, six strains with known and diverse PGFE patterns, and 88 strains collected over a 3-month period in the same hospital. Amplification patterns obtained from samples from the same patient were identical, and PFGE from samples known to be different produced three genotypes. Amplification of DNA from 61 methicillin-resistant isolates produced only one pattern. Methicillin-sensitive strains yielded a diversity of patterns, pointing to a true polyclonal distribution throughout the hospital (22 unique patterns from 27 strains). Computer-based software can be used to differentiate among identifiable strains, given the low number of bands and good characterization of PCR products. PCR-based ribotyping can be a useful technique for genotyping methicillin-sensitive S. aureus strains, but is of limited value for methicillin-resistant strains.

Spotted fever in Brazil: a seroepidemiological study and description of clinical cases in an endemic area in the state of São Paulo

During 1985-1995, illnesses clinically and epidemiologically compatible with Brazilian spotted fever were identified in 17 patients in the county of Pedreira, in the state of São Paulo, Brazil. Spotted-fever group rickettsial infection was confirmed by serology and/or immunostaining of tissues in 10 of these patients. Immunostaining confirmed infection in a 37-year-old pregnant patient, although rickettsial antigens were not demonstrable in the tissues of the fetus. A serosurvey was conducted in four localities in the county to determine the prevalence of subclinical or asymptomatic infections with spotted fever group rickettsiae. Five hundred and twenty-five blood samples were tested by an indirect immunofluorescence assay for antibodies reactive with Rickettsia rickettsii. Twenty-two (4.2%) of these samples demonstrated titers > or = 1:64. The results indicate that Brazilian spotted fever is endemic within this region of Brazil.

Alzheimer's risk associated with human apolipoprotein E, alpha-2 macroglobulin and lipoprotein receptor related protein polymorphisms: absence of genetic interactions, and modulation by gender

Apolipoprotein E (apoE), the lipoprotein receptor related protein (LRP) and alpha-2 macroglobulin (alpha2M) have been proposed as a functional complex involved in amyloid clearance, a crucial event for Alzheimer's disease development. In this work, we present an epidemiological approach aimed to study the interactions among these genes, age and gender. This approach did not reveal significant associations between the genes; however, the present study indicated that the risk associated with APOE promoter and LRP gene polymorphisms is modulated by gender.

Widespread occurrence of the homologues of the early nodulin (ENOD) genes in Oryza species and related grasses

Eighty accessions representing 23 species from the genus Oryza were examined for the presence of homologues of early nodulin (ENOD) genes. Southern analyses indicated a widespread distribution of homologues of ENOD genes across all the genomes of rice as well as other monocots. The degree of cross-hybridization of the legume ENOD genes with sequences in the genomes of various species, as revealed by hybridization differentials measured in terms of signal intensities, however, suggests that the homologues of ENOD genes are conserved to varied extents in different Oryza species. The presence of homologues of ENOD genes in a wide variety of plant species denotes that the biological functions of early nodulins may be diverse, and not restricted to nodule organogenesis alone. The fact that ENOD gene homologues exist widely both in dicots and monocots provides evidence that these homologues have arisen from a common ancestral plant.

Usefulness of spoligotyping in molecular epidemiology of Mycobacterium bovis-related infections in South America

Two hundred twenty-four Mycobacterium bovis isolates, mainly from South American countries, were typed by spoligotyping, and 41 different spoligotypes were identified. A total of 202 M. bovis isolates (90%) were grouped into 19 different clusters. The largest cluster contained 96 isolates (42.8%) on the basis of the most frequently observed spoligotype, spoligotype 34. Nineteen M. bovis isolates from humans in Argentina had spoligotypes and polymorphic GC-rich repetitive sequence (PGRS) types that represented the most common types found among isolates from cattle. All five isolates from Uruguay and three of the six isolates from Paraguay had spoligotypes that were also detected for isolates from Argentina. The spoligotypes of isolates from Brazil, Costa Rica, and Mexico and of some of the isolates from Paraguay could not be found in Argentina. A total of 154 M. bovis isolates were selected in order to compare the discriminative power of spoligotyping and restriction fragment length polymorphism (RFLP) analysis with direct repeat (DR) and PGRS probes. By spoligotyping, 31 different types were found, while AluI-digested DR probe-associated RFLP analysis identified 42 types, and RFLP analysis with the PGRS probe also detected 42 types; these were partly independent of the DR types. By combining the results obtained by spoligotyping and by RFLP analysis with the DR and PGRS probes, 88 different types were obtained. Although the differentiation of M. bovis by spoligotyping was less discriminatory than differentiation by RFLP analysis with the DR and PGRS probes, spoligotyping is easier to perform and its results are easier to interpret. Therefore, for the purpose of typing of M. bovis isolates, spoligotyping could be performed first and the isolates could be grouped into clusters and then analyzed by RFLP analysis with the DR and PGRS probes.

Validation of national algorithms for the diagnosis of sexually transmitted diseases in Brazil: results from a multicentre study

OBJECTIVE

To validate STD flow charts for the management of genital discharge and genital ulcer currently recommended by the National STD Control Programme in Brazil.

METHODS

A study was conducted in five Brazilian STD clinics from January to June 1995. After an interview, a clinical examination was performed by a physician, who recorded a presumptive diagnosis, based on his/her clinical experience. This diagnosis was compared with a gold standard laboratory diagnosis in order to calculate sensitivity, specificity, and positive predictive value of the clinical diagnosis. The validity of the simulated national flow charts was assessed using the same method.

RESULTS

A total of 607 men and 348 women participated in the study. Gonorrhoea was the aetiology most frequently detected in men with urethral discharge. The sensitivity of the clinical diagnosis was far lower than the sensitivity fo the national flow chart, using the syndromic approach, for both gonococcal and chlamydial urethritis. Adding a simple laboratory test (Gram stain) to the national flow chart increased the specificity and positive predictive value for gonorrhoea. Among the women with vaginal discharge, a cervical infection was detected in 17%, a vaginal infection in 74%, and mixed infection in 9%. The sensitivity of the diagnosis for cervical infection increased from 16% (clinical aetiological approach) to 54% (when adding a syndromic approach) and to 68% when adding a risk assessment, as in the national flow charts. The cure or improved rate of genital ulcers was 96% after 1 week.

CONCLUSIONS

The results of the study will help to convince policy makers and those involved in training healthcare workers in Brazil of the public health advantages of the syndromic approach, as an essential part of STD/HIV control activities.

[The postantibiotic effect of amoxicillin/clavulanic acid on Streptococcus pneumoniae strains of different serotypes and penicillin sensitivity]

Amoxicillin and clavulanic acid, combined in a 4:1 ratio, caused a significant (longer than 0.5 hours) postantibiotic effect (PAE) for the S. pneumoniae stains tested. These strains were from a different serotype (3, 6 and 9) and also had different susceptibility to penicillin. The duration of the PAE depended both on the strain and the amoxicillin/clavulanic acid concentration used. It is significant that for the serotype 9 strain, which was both penicillin and amoxicillin resistant, the duration of the PAE was between 1.5 and 2.2 hours. These results agree with those observed by other authors as to the effectiveness of amoxicillin/clavulanic acid against S.pneumoniae.

The development and implementation of an integrated multidisciplinary clinical pathway

Clinical pathways, linear time-related representations of patient care processes, are widely encouraged as a mechanism to outline efficient, cost-effective, multidisciplinary care. The translation of pathways from concept to reality is, however, predictably difficult. All caregivers are dedicated to a common goal, but organizational, personal, and professional perspectives are barriers to development of a common tool. Moreover, the building process requires the discovery, articulation, and communication of previously tacit patient care processes. Although no prescription can work for all pathway development, some strategies can help ensure the best possible chance of pathway success. Participants must recognize that between-patient variability can be expected to decrease with pathway implementation, and educational processes must support that aim. "Stakeholder groups" must be identified and their investment must be assessed, with careful attention paid to acquiring the unconditional support of institutional leadership. Planning of precise building, implementation, and piloting processes, with provision for facilitation of building and implementation processes, is critical. Those charged with pathway development must commit to the establishment and explication of clear goals (economic and quality outcomes) and to careful integration of the pathway with planned and existing continuous quality improvement processes. These strategies are illustrated with actual experiences in implementing cystectomy and pressure ulcer pathways in one academic medical center.

Proliferating cell nuclear antigen (PCNA) as a marker of dysplasia in oral mucosa

The development of head and neck cancer has been proposed to be a multistep process, with accumulation of genetic and phenotypic alterations resulting from carcinogen exposure. Proliferating cell nuclear antigen (PCNA), also called cyclin, is a 36-KD auxiliary protein of DNA polymerase-delta, that has been found to be a useful marker in immunocytochemical studies of cell proliferation because its expression correlates with the proliferative state of the cell. PCNA expression was analyzed in 10 samples of normal mucosa, 23 benign oral lesions (18 hyperplasia and 5 oral lichen plani), 10 oral lesions with epithelial dysplasia, and 10 dysplastic epithelia adjacent to tumors. Immunocytochemical stained sections were scored for the presence or absence of suprabasal PCNA positivity regardless of location. The results indicate that the PCNA expression in the suprabasal layers increased with the degree of epithelia dysplasia and in the samples of histological dysplastic epithelium adjacent to the tumors, while the percentage of suprabasal PCNA expression was insignificant in the samples of normal oral mucosa and benign oral lesions. The authors conclude that suprabasal PCNA expression could be a marker of dysplasia in oral mucosa, indicating a special proliferative cellular state in those lesions.

Ampicillin-sulbactam is effective in prevention and therapy of experimental endocarditis caused by beta-lactamase-producing coagulase-negative staphylococci

Optimal strategies for the prophylaxis and therapy of endocarditis caused by oxacillin-resistant, coagulase-negative staphylococci in patients with native or prosthetic valvular heart disease are not well defined. We compared the in vivo efficacies of ampicillin-sulbactam-based regimens with those of vancomycin-based oxacillin-resistant, beta-lactamase-producing coagulase-negative staphylococcal isolate (Staphylococcus haemolyticus SE220). Ampicillin-sulbactam (100 and 20 mg/kg of body weight, respectively, given intramuscularly in a two-dose regimen) was equivalent to vancomycin (30 mg/kg given intravenously in a two-dose regimen) in its prophylactic efficacy against the coagulase-negative staphylococcal strain (93 and 80%, respectively). The combination of ampicillin-sulbactam plus either rifampin or vancomycin did not enhance the prophylactic efficacy compared with that of ampicillin-sulbactam or vancomycin alone. In the therapy of established aortic valve endocarditis in rabbits caused by this same coagulase-negative staphylococcal strain, animals received 7-day ampicillin-sulbactam-based or vancomycin-based regimens with or without rifampin. All treatment regimens were effective at lowering intravegetation coagulase-negative staphylococcal densities and rendering vegetations culture negative compared with the coagulase-negative staphylococcal densities and vegetations of untreated controls, with ampicillin-sulbactam in combination with rifampin or vancomycin being the most active regimen. However, only the regimen of ampicillin-sulbactam in combination with vancomycin effectively prevented relapse of endocarditis posttherapy after a 5-day antibiotic-free period. For animals receiving rifampin-containing regimens, relapses of endocarditis were associated with the in vivo development of rifampin resistance among coagulase-negative staphylococcal isolates in the vegetation. Ampicillin-sulbactam was highly effective in the prevention of experimental endocarditis caused by a beta-lactamase-producing, oxacillin-resistant coagulase-negative staphylococcal strain. Ampicillin-sulbactam was also efficacious for the therapy of coagulase-negative staphylococcal endocarditis, especially when it was combined with vancomycin to prevent posttherapeutic relapses.

Some histopathological and clinical correlations in oral squamous cell carcinoma

Oral squamous cell carcinoma (SCC) is an important health problem that causes high mortality and morbidity. Correlations between some clinical and histopathological parameters were studied in 37 oral SCC. Some interesting aspects in oral SCC arising from precancerous lesions were found such as smaller size and a lower TNM stage at the moment of diagnosis. Histological and clinical differences were also found between tumors invading deep tissues by little groups of dissociated malignant cells and those invading by big masses of malignant cells. The possible significance of the intensity of peritumoral eosinophilic infiltrate was also studied.

Mitral valve prolapse and its effects: a programme of inquiry within Orem's Self-Care Deficit Theory of Nursing

The optimum growth and scientific progress of nursing knowledge during the next century will depend upon the development and execution of focused programmes of clinical and theoretical research. The planning and design of such programmes must originate with the clear definition of nursing research questions. Nesting such questions within established theoretical frameworks provides a nursing context, lends precise language and suggests relevant variables for study. The development of a sequence of related studies exploring and describing the self-care needs of people with symptomatic mitral valve prolapse illustrates one such systematic research programme. Orem's Self-Care Deficit Theory of Nursing was used as a theoretical framework for four completed studies which describe one population's need for nursing assistance. The evolving nature of the research programme and plans for future research are discussed.

[Repetitive serum determinations of anticonvulsants in epileptic patients]

To evaluate complacence in chronic epileptic women we collected weekly 144 blood samples from 38 patients for antiepileptic drugs determination. All the patients were supposed to have uncontrolled seizures using phenobarbital, phenytoin or carbamazepine monotherapeutically. We found that 34% of the blood levels were below the standard normal range. Blood level with great weekly variations were interpreted as inadequate intake by the patient. We conclude that repetitive antiepileptic blood levels determination may elucidate if the patient has drug-resistant seizures or if the patient is not complacent to the drug therapy.

[Post-transfusional hepatitis in the city of Campinas, SP, Brazil. I. Incidence, etiological agents and clinico-epidemiological aspects of hepatitis C]

We have followed up 111 transfusion receptors in the ambulatory, for at least 180 days, in order to evaluate the occurrence of post-transfusional hepatitis and the etiological agents involved in the disease in the city of Campinas, state of São Paulo, Brazil. At the end of the study we have diagnosed this hepatitis in 18 (16.2%) subjects. Out of these 18 subjects, 16 (89%) were caused by hepatitis C virus, 1 (5.5%) caused by hepatitis B virus and 1 (5.5%) with undetermined etiology, 15 months after transfusion. The average incubation period of HCV was 71 days and 23% of the HCV positive receptors remained with increased AST/ALT for more than 6 months. Late serum conversion was observed for anti-HCV in 71.4% of the subjects, averaging 135 days after the transfusion. An ALT dosage and anti-HCV determination, 3 and 6 months after transfusion would diagnose, respectively, 71 and 93% of the cases which developed post-transfusional HCV.

Effects of alginase on the natural history and antibiotic therapy of experimental endocarditis caused by mucoid Pseudomonas aeruginosa

The exopolysaccharide (alginate) of mucoid strains of Pseudomonas aeruginosa is believed to be an important virulence factor. The ability of an alginate-deploymerizing enzyme (alginase) to modify the polymorphonuclear leukocyte (PMN)-directed and antibiotic-mediated phagocytosis and killing of mucoid P. aeruginosa was studied both in vitro and in vivo. In vitro, pretreatment of a mucoid P. aeruginosa strain (144MR) resulted in a significant enhancement of PMN phagocytosis and killing of the organism (P less than 0.05), to levels similar to that observed with its nonmucoid mate, strain 144NM. Moreover, alginase treatment of the mucoid strain 144MR caused a substantial removal of bacterial cell surface alginate as assessed by immunofluorescence staining with a murine monoclonal antialginate antibody. The experimental endocarditis model was used to evaluate the in vivo effect of alginase in modifying the course of a deep-seated pseudomonal infection caused by mucoid strain 144MR. In right-sided endocarditis, in which PMNs normally mediate spontaneous clearance of the organism from cardiac vegetations (A. S. Bayer, J. Yih, C. Y. Chiu, and C. C. Nast, Chemotherapy 35:278-288, 1989), the presence of the alginate exopolysaccharide on strain 144MR was associated with an inability to reduce intravegetation pseudomonal counts over a 13-day postinfection period; in contrast, right-sided vegetations infected with the nonmucoid strain 144NM underwent significant reductions in bacterial densities over this same time (P less than 0.05). Administration of alginase intravenously (i.v.) (750 enzyme units per day for 7 days) to animals with right-sided endocarditis caused by the mucoid strain 144MR was associated with a significant reduction in intravegetation pseudomonal counts (P less than 0.05), to levels similar to that seen with endocarditis caused by the nonmucoid strain. In left-sided endocarditis caused by mucoid strain 144MR, animals received either no therapy, amikacin (20 or 40 mg/kg twice a day for 7 or 14 days), or amikacin plus alginase (750 U/day [i.v.]). The coadministration of alginase for 14 days with the higher-dose amikacin regimen rendered more left-sided vegetations culture negative than those in animals receiving the antibiotic alone for 7 or 14 days (P = 0.001 and 0.056, respectively). These salutary effects of alginase in vivo were paralleled by the ability of the enzyme to remove the exopolysaccharide from the surface of mucoid pseudomonal cells within cardiac vegetations, as assessed by transmission electron microscopy.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparison of daptomycin, vancomycin, and ampicillin-gentamicin for treatment of experimental endocarditis caused by penicillin-resistant enterococci

Infections with enterococci that are resistant to multiple antibiotics are an emerging clinical problem. We evaluated the antibiotic treatment of experimental enterococcal endocarditis caused by two strains with different mechanisms of penicillin resistance. Enterococcus faecalis HH-22 is resistant to aminoglycosides and penicillin on the basis of plasmid-mediated modifying enzymes; Enterococcus raffinosus SF-195 is susceptible to aminoglycosides but is resistant to penicillin on the basis of low-affinity penicillin-binding proteins. Animals infected with strain HH-22 received 5 days of treatment with the following: no treatment; daptomycin (20 mg/kg of body weight twice daily [b.i.d.], intramuscularly [i.m.]), vancomycin (20 mg/kg b.i.d., intravenously), or ampicillin (100 mg/kg three times daily, i.m.) plus gentamicin (2.5 mg/kg b.i.d. i.m.). Although vancomycin was superior to ampicillin-gentamicin (P less than 0.01), daptomycin was significantly better than all other treatment regimens (P less than 0.01) in reducing intravegetation enterococcal densities, although no vegetations were rendered culture negative by this agent. Animals infected with strain SF-195 received 5 days of no therapy, ampicillin, ampicillin-gentamicin, vancomycin, or daptomycin (all at the dosage regimens described above). Daptomycin, vancomycin, and ampicillin-gentamicin each lowered intravegetation enterococcal densities significantly better than did ampicillin monotherapy or no treatment (P less than 0.01); moreover, these three treatment regimens rendered significantly more vegetations culture negative than did ampicillin monotherapy or no treatment (P less than 0.05). Serum daptomycin levels remained above the MICs and MBCs for both enterococcal strains throughout the 12-h dosing interval used in the study. Daptomycin and vancomycin were both active in vivo in these models of experimental enterococcal endocarditis caused by penicillin-resistant strains, irrespective of the mechanism of resistance. This activity correlated with the unique cell wall sites of action of these agents (binding to lipoteichoic acid and pentapeptide precursor, respectively) compared with the sites of action of beta-lactams (penicillin-binding proteins). Beta-Lactamase production by strain HH-22 precluded in vivo efficacy with ampicillin-gentamicin combinations. In contrast, this combination was active in vivo against strain SF-195, which exhibited intermediate-level penicillin resistance (MIC, 32 micrograms/ml), likely reflecting the ability of high-dose ampicillin to achieve enough binding to low-affinity penicillin-binding proteins to cause augmented aminoglycoside uptake.

The nurse-patient relationship: theme and variations

The nurse-patient relationship traditionally has been thought central to professional practice. For several decades, nurse theorists have explored the communication processes which mediate clinical practice and the variously described outcomes of these processes. Yet while interpersonal skills and personal attributes have been considered integral to professional bonding, and while outcomes of the process are widely discussed, clinically based validation of theorized process components has not been definitively accomplished. To this end, 67 critical incidents concerning experienced clinicians' perceptions of their closest professional relationships were analysed. The perceived professional bond was demonstrated to be a cumulative process of attachment with three qualitatively different levels of involvement and two impasse states. The most intense levels of attachment were perceived to be the most beneficial by the nurses who described relationships characterized by mutuality and reciprocity. This level was not, however, achieved by all nurses in the sample. Implications of the perceived outcomes of the most intimate professional relationships were discussed.

Premenstrual seizure increase: influence of age, duration of disease, seizure frequency, previous complaint of perimenstrual accentuation, EEG and CT scan findings

We selected prospectively 80 mentally healthy women at menacme age, with chronic epilepsy and at least one seizure in the month preceding this study. They underwent four EEGs weekly. CT scan of the skull was done in 57 patients (71.25%). Seven patients were excluded because they had no seizures or menses. We registered 5630 seizures during 579 regular menstrual cycles over a 30 month period.

RESULTS

there was a higher incidence of seizures in the premenstrual period (p less than 0.001); age did not influence the distribution of seizures during the menstrual cycle in the group studied; patients with 11 or more years of disease showed more accentuation of premenstrual seizures than patients with 10 or less years of disease; there was no relation between the patients frequency of seizures and the occurrence of premenstrual seizures; the patients impression of the incidence of seizures not related to menstruation was not confirmed; patients with abnormal skull CT scans had more accentuation of premenstrual seizures than patients with normal exams; patients with abnormal EEGs had more premenstrual seizures than patients with normal exams. Our findings suggest that the female sexual hormones alter cerebral excitability when there is an underlying structural pathology shown by CT scan or an electrical cerebral dysfunction revealed by EEG.

Some ethical implications of qualitative research

Traditional values in nursing dictate a high level of concern for the welfare of research participants. Initial attempts at setting minimal ethical standards stemmed from the quantitative approaches. As qualitative modalities are more widely used, nurses must become acutely aware of possible problems in study design and planning, the dangers of coercion and deception, threats to confidentiality and trust, implications of the emergent design, and providing for a new concept of informed consent. The new character of the research relationship is examined in light of possible strategies for protection of research participants while preserving the integrity of qualitative investigation.

Adopting an evolutionary lens: an optimistic approach to discovering strength in nursing

Appropriately, the state of the art of nursing is in constant review. Philosophy of science, particularly the work of Thomas Kuhn, has traditionally provided the criteria upon which these introspective evaluative processes are based. More recent developments in philosophy of science have introduced alternative models, such as Toulmin's evolutionary model, which might yield a more cogent, optimistic assessment of theoretical progress within nursing. Specific shortcomings of Kuhn's model and possible advantages of one evolutionary model are explored with comparative outcomes presented. Evidence of emerging evaluative criteria within nursing is also explicated.

Effect of ultraviolet light irradiation on viability and aflatoxin production by Aspergillus parasiticus

The effect of ultraviolet light irradiation (254 nm) on both the viability and the aflatoxin-producing ability of the fungus Aspergillus parasiticus NRRL 2999, a good aflatoxin-producing strain, was studied. This strain showed noticeable resistance and irradiation for more than 10 min was necessary to reduce survival to under 10%, while the white mutants were more susceptible (5 min of irradiation reduced survival to under 1%). Induction of mutants with complete loss of aflatoxigenicity was rare and only 3 of the 1463 survivors tested were aflatoxinless.

Detection of Cysticercus cellulosae antigens in cerebrospinal fluid by dot enzyme-linked immunosorbent assay (Dot-ELISA) and standard ELISA

The dot enzyme-linked immunoassay and standard enzyme-linked immunoassay were used to detect Cysticercus cellulosae antigens in cerebrospinal fluid of patients suffering with neurocysticercosis. Using the dot enzyme-linked immunoassay, 10 of 17 patients (59%) were positive at a reciprocal titer of 128 (range 128-1,024). In the standard assay, 13 of 17 (77%) were positive (range 128-512). Specificity was 100% in both assays using 48 cerebrospinal fluids from patients with various central nervous system infections. The quantification of antigens in cerebrospinal fluid using standard assay and photometric readings showed a range of 17 to 138 ng/ml. The results indicate that both assays are sensitive, specific, and economical for the diagnosis of neurocysticercosis.

[Polyradiculoneuritis and malaria: report of a case]

Case report of a patient who three weeks after a Plasmodium falciparum malaria presented the Guillain-Barré syndrome. There was a severe type of polyradiculoneuritis with tetraplegia and involvement of several cranial nerves (VI, VII, IX, X) evolving to death. The Guillain-Barré syndrome has been considered a immune disorder with several eliciting antigenic stimuli. The case suggests that protozoan may be one these antigenic factors.

Cytogenetic findings in a human malignant melanoma metastatic to the brain

Cytogenetic analysis by G-banding of direct and preparations of a malignant melanoma metastatic to the brain in vitro showed a pseudodiploid modal chromosome number, including five marker chromosomes, one of which was an i(6p). These results agree with those recently reported about the preferential involvement of chromosome #6 in malignant melanoma.

Treatment of neurocysticercosis with flubendazole

Thirteen patients with neurocysticercosis were studied and treated with flubendazole. Diagnostic procedures included computerized tomography (CT) and enzyme-linked immunosorbent assay. In 12 cases treatment with the drug led to clinical improvement. CT showed that some cysts regressed in size, and in two patients they disappeared. The treatment also lowered the antibody levels. The drug was well tolerated and no allergic reaction or other side effects were observed.

Cytogenetic and clinical findings in ten 45,X/46,XY patients

We report ten cases with 45,X/46,XY karyotype. Cytogenetic and clinical findings have been compared. No constant relationship was found either between blood and gonadal karyotype, or between karyotype and gonadal morphology.

Homozygosity for a Robertsonian translocation (13q14q) in three offspring of heterozygous parents

A family containing three homozygous carriers for a Robertsonian (13q14q) translocation, 44,XX or XY,t(13q14q),t(13q14q), is reported. Their parents are first cousins, and both are heterozygous carriers of the same (13q14q) translocation. The fertility of both the heterozygous and homozygous carriers is discussed.