Tele-entomology and tele-parasitology: A citizen science-based approach for surveillance and control of Chagas disease in Venezuela

Chagas Disease (CD), a chronic infection caused by the Trypanosoma cruzi parasite, is a Neglected Tropical Disease endemic to Latin America. With a re-emergence in Venezuela during the past two decades, the spread of CD has proved susceptible to, and inhibitable by a digital, real-time surveillance system effectuated by Citizen Scientists in communities throughout the country. The #TraeTuChipo (#BringYourKissingBug) campaign implemented in January 2020, has served as such a strategy counting on community engagement to define the current ecological distribution of CD vectors despite the absence of a functional national surveillance program. This pilot campaign collected data through online surveys, social media platforms, and/or telephone text messages. A total of 79 triatomine bugs were reported from eighteen Venezuelan states; 67 bugs were identified as Panstrongylus geniculatus, 1 as Rhodnius pictipes, 1 as Triatoma dimidiata, and 10 as Triatoma maculata. We analyzed 8 triatomine feces samples spotted from 4 Panstrongylus geniculatus which were confirmed positive by qPCR for T. cruzi . Further molecular characterization of discrete typing units (DTUs), revealed that all samples contained TcI, the most highly diverse and broadly distributed strain of T. cruzi. Moreover, analysis of the mitochondrial 12S gene revealed Myotis keaysi, Homo sapiens, and Gallus gallus as the main triatomine feeding sources. This study highlights a novel Citizen Science approach which may help improve the surveillance systems for CD in endemic countries.

POS1496-HPR IS NUTRITIONAL FOLLOW-UP IN PATIENTS LIVING WITH RHEUMATOID ARTHRITIS BETTER WITH TELECONSULTATION? - EXPERIENCE BEFORE AND AFTER PANDEMIC

Background:

Nutritional follow-up as part of the integral attention for patients living with rheumatoid arthritis (RA) has been limited due to the COVID-19 pandemic. It made necessary to implement a remote monitoring for the care of the patients and to evaluate the outcomes of the changes in the care model.

Objectives:

To identify the effects of the telemonitoring intervention within the pandemic scenario and the outcomes of the traditional face-to-face nutrition consultation.

Methods:

A retrospective analysis of health records and the administrative data base of the patient’s follow-up, between 2019 and 2020, was developed at the arthritis specialized center of the Santa Fe de Bogotá Foundation in Bogotá, Colombia. The outcomes measured include the number of visits per year and the proportion of patients who attend their nutritional follow-up by telemonitoring in 2020 vs patients attending to face-to-face nutrition consultation. Differences in the Body Max Index (BMI) and the changes based on eating habits, defined by the quality of food consumption per day, were also measured.

Results:

A total of 212 patients from 2020 and 179 from 2019 were analyzed; An increase of 61.5% in the number of consultations, using nutritional telemonitoring per year, was identified in 2020 (n=412) compared to 2019 (n=255). In patients followed from 2019 to 2020, 13% (10/77) experienced an increase of more than 2 units of their BMI, while 22% (17/77) showed a decrease; in 2% of patients was not possible to evaluate their current weight; in the same way, 49% (103/212) in 2020 showed a positive change in their feeding habits compared with a 12% (21/179) in 2019. 135 new patients were recruited for nutritional telemonitoring 2020.

Conclusion:

Nutritional telemonitoring to follow-up patients with RA has increased considerably in terms of consultations per year and changes in the feeding habits. However, more evaluation is required for this model.

References:

[1]Melanie J Martin, Nora Ng, Laura Blackler, Toby Garrood, P227 Remote monitoring of patients with RA: a user-centred design approach, Rheumatology, Volume 59, Issue Supplement_2, April 2020, keaa111.221, https://doi.org/10.1093/rheumatology/keaa111.221

[2]Principio del formulario

Disclosure of Interests:

None declared

Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region

In the past 5-10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela's health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64). Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100 000 people. The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.

Cutaneous features of Zika virus infection: a clinicopathological overview

Zika virus (ZIKV) is an emerging mosquito-borne flavivirus transmitted mainly by Aedes species of mosquitos. Although the infection is usually mild and self-limiting, it is emerging as a public health challenge in tropical and subtropical countries owing to its unprecedented pathogenicity and increased risk for fetal malformations and neurological symptoms. Cutaneous manifestations as for other mosquito-borne viruses remain a hallmark of the disease. This article provides a detailed overview on ZIKV infection, including its varied cutaneous clinical manifestations and diagnostic aspects, and also provides detailed insights into its pathogenesis in human skin.

Generalized pustular psoriasis triggered by Zika virus infection

Zika virus is an emerging arbovirus, which is expanding in epidemic proportions through tropical and subtropical areas of the world. Although Zika is linked to a number of congenital and neurological complications, there is scarce knowledge on the impact of ZIKV infection in human skin. We report the case of a 68-year old woman who presented with generalized pustular psoriasis after a preceding and otherwise uneventful episode of ZIKV infection. Based on recent experimental data on the biology of ZIKV infection in the cutaneous environment, we speculate that ZIKV may have directly triggered the development of generalized pustular psoriasis by stimulation of keratinocyte-derived mediators of inflammation and a polyfunctional T-cell driven immune reaction in the cutaneous milieu.

American cutaneous leishmaniasis in infancy and childhood

Infant and young child skin diseases are among the most common features of morbidity throughout the tropics. Because the skin is directly exposed to the environment, it is considerably affected by climatic and local conditions such as vectors and microorganisms, as in the case of leishmaniasis. In America the observed magnitude of cutaneous leishmaniasis in children has led to the study of increased risk of exposure of this group due to the possibility of peri- and intradomiciliary transmission. The present review pretends to make a concrete approach all through the broad and main figures of this parasitic disease, including the clinical, physiopathological, epidemiological, diagnostic, and therapeutic aspects, in order to be used as a practical source of reference for pediatricians leading with tropical cutaneous pathology in the region.

Impact of universal access to hepatitis C therapy on HIV-infected patients: implementation of the Spanish national hepatitis C strategy

In April 2015, the Spanish National Health System (SNHS) developed a national strategic plan for the diagnosis, treatment, and management of hepatitis C virus (HCV). Our aim was to analyze the impact of this on human immunodeficiency virus (HIV)-infected patients included in the HERACLES cohort during the first 6 months of its implementation. The HERACLES cohort (NCT02511496) was set up in March 2015 to evaluate the status and follow-up of chronic HCV infection in patients co-infected with HIV in the south of Spain. In September 2015, the data were analyzed to identify clinical events (death, liver decompensation, and liver fibrosis progression) and rate of treatment implementation in this population. The study population comprised a total of 3474 HIV/HCV co-infected patients. The distribution according to liver fibrosis stage was: 1152 F0-F1 (33.2 %); 513 F2 (14.4 %); 641 F3 (18.2 %); 761 F4 (21.9 %); and 407 whose liver fibrosis was not measured (12.3 %). During follow-up, 248 patients progressed by at least one fibrosis stage [7.1 %; 95 % confidence interval (CI): 6.3-8 %]. Among cirrhotic patients, 52 (6.8 %; 95 % CI: 5.2-8.9 %) developed hepatic decompensation. In the overall population, 50 patients died (1.4 %; 95 % CI: 1.1-1.9 %). Eight hundred and nineteen patients (23.56 %) initiated interferon (IFN)-free treatment during follow-up, of which 47.8 % were cirrhotic. In our study, during 6 months of follow-up, 23.56 % of HIV/HCV co-infected patients included in our cohort received HCV treatment. However, we observed a high incidence of negative short-term outcomes in our population.

Evaluation of Bone Mineral Density in Patients with Type 1 Gaucher Disease in Argentina

The purpose of this study was to evaluate the frequency of osteoporosis (OP) in patients with Gaucher disease (GD) in Argentina. GD patients from 28 centers were consecutively included from April 2012 to 2014. Bone mineral density (BMD) was determined by dual X-ray absorptiometry in the lumbar spine and the femoral neck or the total proximal femur for patients ≥20 yr of age, and by whole-body scan in the lumbar spine in patients <20 yr of age. In children, mineral density was calculated using the chronological age and Z height. OP diagnosis was determined following adult and pediatric official position of the International Society for Clinical Densitometry. A total of 116 patients were included, of which 62 (53.5%) were women. The median age was 25.8 yr. All patients received enzyme replacement therapy, with a median time of 9.4 yr. Normal BMD was found in 89 patients (76.7%), whereas low bone mass (LBM) or osteopenia was found in 15 patients (13%) and OP in 12 patients (10.3%). The analysis of the pediatric population revealed that 4 patients (9.3%) had LBM and 3 (7%) had OP (Z-score ≤ -2 + fractures height-adjusted by Z), whereas in the adult population (n = 73), 11 patients (15%) had LBM or osteopenia and 9 (12.3%) had OP. Bone marrow infiltration and the presence of fractures were significantly correlated with the presence of OP (p = 0.04 and <0.001, respectively). This is the first study in Argentina and in the region describing the frequency of OP or LBM in GD patients treated with imiglucerase using the official position of the International Society for Clinical Densitometry.

Dimension of chronic hepatitis C virus in HIV-infected patients in the interferon-free era: an overview from south Spain

The implementation of hepatitis C (HCV) direct-acting antiviral drugs is prioritized in several populations in which its application provides the most immediate and impactful benefit. In this scenario, a precise knowledge of the situation of human immunodeficiency virus (HIV)/HCV chronic co-infection is required to adequately address this disease. This cross-sectional study was performed in 21 hospitals in Andalusia (Spain). The study population consisted of HIV-infected patients with an active HCV chronic infection who were not receiving HCV treatment at the time of inclusion. A total of 13,506 HIV-infected patients were included in the study. Of them, 2561 (18.9 %) presented chronic HCV infection. The majority of the patients included were on highly active antiretroviral therapy (HAART; 96.2 %), showed plasma levels with an undetectable HIV viral load (92.5 %), and had a good immunological status (median CD4+ cell count of 486 cells/mL). The HCV genotype distribution was as follows: 58.1 % were genotype 1, 1.1 % were genotype 2, 16.1 % were genotype 3, and 22.1 % were genotype 4 (2.6 % were missing data). In total, 24.8 % of the patients showed liver fibrosis stage F0-F1, 27.9 % showed stage F2, 16.7 % showed stage F3, and 21 % showed stage F4 (9.6 % were missing data). With regards to previous HCV treatment experiences, 68.05 % of the patients were naïve and 31.95 % had failed to respond to a previous treatment. The burden of HCV/HIV co-infected patients in our population was reported as one in five HIV-infected patients requiring HCV treatment. The implementation of extra resources to face this important health challenge is mandatory.

PanGen-Fam: Spanish registry of hereditary pancreatic cancer

PURPOSE

To describe the organisation of the registry and the preliminary results in terms of characteristics of high-risk pancreatic ductal adenocarcinoma (PDAC) families recruited to date and findings of the screening programme. To compare early onset sporadic cases (⩽50 years), sporadic cases (>50 years) and cases with family history of cancer, for PDAC possible risk factors.

METHODS/PATIENTS

Families with hereditary cancer syndromes predisposing to PDAC were recruited from two main sources: Spanish hospitals participating in PanGenEU, a pan-European multicentre case-control study, and their genetic counseling unit. Individuals at high-risk of PDAC were enrolled into a screening programme, consisting of Endoscopic ultrasound, computerised tomography, magnetic resonance imaging. Genetic testing of candidate genes was offered according to each patient's risk.

RESULTS

Among 577 consecutive PDAC cases, recruited via PanGenEU, 36 (6%) had ⩾2 first-degree relative with PDAC: Familial pancreatic cancer (FPC). So far PanGen-Fam has recruited 42 high-risk PDAC families; 25 (60%) had FPC. Five index cases with cancer were positive for BRCA2 and one for BRCA1 germline mutations. In the second year of prospective PDAC screening, one neuroendocrine tumour and a high-grade dysplasia lesion suspicious of carcinoma were diagnosed among 41 high-risk individuals. Furthermore EUS detected chronic-pancreatitis-like parenchymal changes in 15 patients.

CONCLUDING STATEMENT

The identification and recruitment of PDAC high-risk families into the PanGen-Fam registry provides an opportunity to detect early onset cancer and precursor pancreatic cancer lesions at a potentially curative stage and to increase the knowledge of the natural history of the disease.

Live donor liver transplantation: a valid alternative for critically ill patients suffering from acute liver failure

We report the outcome of live donor liver transplantation (LDLT) for patients suffering from acute liver failure (ALF). From 2006 to 2013, all patients with ALF who received a LDLT (n = 7) at our institution were compared to all ALF patients receiving a deceased donor liver transplantation (DDLT = 26). Groups were comparable regarding pretransplant ICU stay (DDLT: 1 [0-7] vs. LDLT: 1 days [0-10]; p = 0.38), mechanical ventilation support (DDLT: 69% vs. LDLT: 57%; p = 0.66), inotropic drug requirement (DDLT: 27% vs. LDLT: 43%; p = 0.64) and dialysis (DDLT: 2 vs. LDLT: 0 patients; p = 1). Median evaluation time for live donors was 24 h (18-72 h). LDLT versus DDLT had similar incidence of overall postoperative complications (31% vs. 43%; p = 0.66). No difference was detected between LDLT and DDLT patients regarding 1- (DDLT: 92% vs. LDLT: 86%), 3- (DDLT: 92% vs. LDLT: 86%), and 5- (DDLT: 92% vs. LDLT: 86%) year graft and patient survival (p = 0.63). No severe donor complication (Dindo-Clavien ≥3 b) occurred after live liver donation. ALF is a severe disease with high mortality on liver transplant waiting lists worldwide. Therefore, LDLT is an attractive option since live donor work-up can be expedited and liver transplantation can be performed within 24 h with excellent short- and long-term outcomes.

Living vs. deceased donor liver transplantation provides comparable recovery of renal function in patients with hepatorenal syndrome: a matched case-control study

Outcomes of living versus deceased donor liver transplantation in patients with chronic liver disease and hepatorenal syndrome (HRS) was compared using a matched pair study design. Thirty patients with HRS receiving a live donor liver transplantation (LDLT) and 90 HRS patients receiving a full graft deceased donor liver transplantation (DDLT) were compared. LDLT versus DDLT of patients with HRS was associated with decreased peak aspartate aminotransferase levels (339 ± 214 vs. 935 ± 1253 U/L; p = 0.0001), and similar 7-day bilirubin (8.42 ± 7.89 vs. 6.95 ± 7.13 mg/dL; p = 0.35), and international normalized ratio levels (1.93 ± 0.62 vs. 1.78 ± 0.78; p = 0.314). LDLT vs. DDLT had a decreased intensive care unit (2 [1-39] vs. 4 [0-93] days; p = 0.004), and hospital stay (17 [4-313] vs. 26 [0-126] days; p = 0.016) and a similar incidence of overall postoperative complications (20% vs. 27%; p = 0.62). No difference was detected between LDLT and DDLT patients regarding graft survival at 1 (80% vs. 82%), at 3 (69% vs. 76%) and 5 years (65% vs. 76%) (p = 0.63), as well as patient survival at 1 (83% vs. 82%), 3 (72% vs. 77%) and 5 years (72% vs. 77%) (p = 0.93). The incidence of chronic kidney disease post-LT (10% vs. 6%; p = 0.4) was similar between both groups. LDLT results in identical long-term outcome when compared with DDLT in patients with HRS.

A comparative study of the use of selective digestive decontamination prophylaxis in living-donor liver transplant recipients

INTRODUCTION

Bacterial infections are major causes of early morbidity and mortality after liver transplantation. Selective digestive decontamination (SDD) can be used pre-operatively for living-donor liver transplant (LD-LT), but its role in this setting remains controversial.

METHODS

To evaluate this strategy, we retrospectively analyzed a cohort of consecutive LD-LTs performed in our center from March 2007 to February 2011 and compared the incidence and nature of early infectious complications, length of intensive care unit stay and hospitalization, antibiotic use, and emergence of resistant bacteria in patients with or without SDD prophylaxis.

RESULTS

Of 148 LD-LTs in the study period, 111 received SDD prophylaxis while 37 did not. In a multivariate model, the independent factors associated with an increased risk of early post-transplant infections were length of postoperative mechanical ventilation (for every additional day odds ratio [OR] = 2.37, 95% confidence interval [CI] 1.4-4.0; P = 0.002), and choledochojejunostomy (OR = 4.5, 95% CI 1.95-10.5; P < 0.001). Use of SDD did not affect the rate or distribution of infectious complications, duration of hospitalization, antibiotic use, or acquisition of resistant bacteria (OR = 3.52, 95% CI 0.43-15.17; P = 0.376).

CONCLUSION

In conclusion, the use of SDD prophylaxis in LD-LT was not beneficial and should be avoided, as it offers no advantage and could potentiate the emergence of multidrug-resistant organisms.

Coaxial Electrospinning for Nanostructured Advanced Materials

Electro-hydro-dynamic (EHD) compound jets, with diameters in the micro and nanometric size range, from conical menisci of two co-flowing liquids, is a consolidated platform for the production of nanofibers with inner structure, in a process so-called coaxial electrospinning or co-electrospinning. In contrast to other multi-step template based procedures, the EHD methodology is much more simple and general since, firstly, a solid template is needless and, secondly, the process is seldom affected by the chemistry of the liquids. This gentle process allows selecting the liquid precursors depending on the application sought for the nanofibers. Here, we review different products obtained by this EHD technique: (1) solid and hollow carbon nanofibers from different precursors (polyacrylonitrile, polyvinylpyrrolidone and lignin), (2) nanofibers of biocompatible polymers encapsulating liquids in the form of beads, (3) spinning nanofibers of alginate and (4) in-fiber encapsulation of active microgels.

Primary breast lymphomas: An Argentinian cooperative study

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Background: Primary Breast Lymphomas are rare tumors (less than 1% of all primary breast tumors). Because of that, the records of two institutions dedicated exclusively to the treatment of cancer (Hospital Municipal de Oncologia “Maria Curie” and Instituto Oncologico Henry Moore) have been working together in a single series. Objective: To make a retrospective study of the clinical onset, treatment and evolution of the patients with Primary Breast Lymphoma (PBL). Methods: Patients from hemato-oncological databases of both institutions, that presented PBL, were studied. A database containing characteristics of the population, clinical onset, treatments, evolution and survival Results: Gender F/M=2/15 pt. Mean age (range)=54.1 years (24–87). Pathology: Hodgkin's Lymphoma = 1 pt, NHL follicular = 8 pt, Large-Cell Diffuse NHL = 6 pt, lymphoplasmocytic NHL = 1 pt, Marginal Zone NHL = 1 pt. Stages: IA = 2 pt, IIA = 8 pt, IIIA = 1 pt, IVA = 6 pt. Radiotherapy: 11 pt. Polychemotherapy: CVP = 7 pt, COPP = 1 pt, CHOP = 2 pt, CNOP = 4 pt, CVP/CHOP = 1 pt, RCHOP = 1 pt, RESHAP = 1 pt. Response: CR16/16 evaluable pt. Evolution: Recurrence = 3 pt, Second tumors = 3 pt (breast cancer = 3 pt), Third tumors = 1 pt (melanoma = 1 pt). Survival. Dead = 4 pt. Alive with no illness = 12 pt, Alive under treatment = 1 pt. Conclusions: 1) Seventeen pt with PBL were identified. 2) Sixteen out of 17 were non-Hodgkin lymphomas. 3) Fifteen of 17 pt were women 4) Fourteen of the 17 cases affected only one breast. 5) Seven out of 17 cases were tumors of less than 5 cm. 6) Response reached 100% of the evaluable pt. 7) There was an important rate of second and third tumors (20%). 8) With a mean follow up time of 82 months, 75% of the population is alive and free of the illness.

No significant financial relationships to disclose.

Applicability of a rapid chromatographic immunoassay for analysis of the distribution of PrPBSE in confirmed BSE cases

The Prionics-Check PrioSTRIP is a rapid chromatographic immunoassay for bovine spongiform encephalopathy (BSE) approved by the European Union in 2004. In this study, the PrioSTRIP was used to analyse PrP(BSE) in 16 different brain areas of nine confirmed BSE cases. The levels of PrP(BSE) in the different brain areas were plotted to give the brain PrP(BSE) distribution curve (BPDC) and compared with the BPDC obtained previously by Western blotting and enzyme-linked immunosorbent assay (ELISA) methods on the same samples. The distribution of PrP(BSE) in different areas of the brain was similar, irrespective of the test applied, indicating that each test could be used for the characterisation of BSE cases.

Clinical findings in a large cohort of adult patients (pts) with Hodgkin’s disease (Hd) in Argentina: A report from two institutions

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Background: More than 20,000 new cases of HD are diagnosed each year all over Europe, Canada and the United States. Nevertheless, there are few reports in current literature showing data from large series in developing countries. Methods: The medical records of adult pts with an oncohaematologic diagnosis in two large oncological centers (HMC and IOHM) were reviewed. A period spanning the past 10 years was considered with the objective of measuring the incidence of HD. Oncologists in charge were asked to fill a form with the relevant clinical data. Results: Three hundred and fifty eight out of 1,884 medical records of pts with HD (19%) were retrieved (M: 55.2%/F: 44.8%). Seven pts were HIV positive. Bulky disease was present in 7,4%. The following table shows the main topics (See table ): Conclusions: Incidence of HD in our serie was similar to the published report. However, two important differences arose: it was not possible to notice neither the double curve described nor the usual histological subtype distribution (more MC than the expected frequency). According to previous reports, prevalence of NS was associated with mediastinal locations and younger pts. Actuarial survival must be presented.

[Table: see text]

No significant financial relationships to disclose.

Neuronal intranuclear inclusion disease in a horse

Neuronal intranuclear inclusion disease (NIID) is reported in a 16-year-old Pure Spanish breed female horse suffering from progressive ataxia and motor deficiencies. The neuropathological study revealed NIIs throughout the central nervous system, although mainly in the brain stem and spinal cord. This distribution did not correlate with neuron loss, which was marked in the hippocampus and moderate in the neocortex, particularly in the occipital cortex. As in humans, NIIs in the horse were hyaline autofluorescent inclusions composed of non-membrane-bound aggregates of filaments and fine granules. NIIs were stained with anti-ubiquitin and anti-clusterin antibodies. In addition, NIIs were stained with antibodies raised against subunits of the 19S and PA28, but not of the 20S, components of the proteasome. These observations indicate similarities between NIID in humans and horses, and suggest that clusterin and abnormal ubiquitin-proteasomal expression participate in NII formation.

A randomized study investigating the efficacy and safety of amprenavir in combination with low-dose ritonavir in protease inhibitor-experienced HIV-infected adults

OBJECTIVES

To compare the safety and efficacy of amprenavir [APV/j Agenerase trade mark; GlaxoSmithKline, [Ware, UK; 600 mg twice a day (bid)] boosted with low-dose ritonavir (RTV, 100 mg bid) with those of other protease inhibitors (PIs) in PI-experienced HIV-infected patients.

STUDY DESIGN

Parallel-group, randomized, open-label, multicentre study.

METHODS

One hundred and sixty-three patients with HIV predicted to be sensitive to APV, another PI and a nucleoside reverse transcriptase inhibitor (NRTI) were randomly assigned to receive either APV boosted with low-dose RTV (APV/r) or a standard of care (SOC) PI with or without low-dose RTV. The non-inferiority of APV/r to the SOC PIs was assessed by time-weighted average change from baseline (AAUCMB) in plasma viral load (vRNA) at week 16.

RESULTS

The antiviral response for APV/r bid was non-inferior to that for the SOC PI group: the vRNA AAUCMB mean treatment difference was 0.043 log(10) HIV-1 RNA copies/mL [95% confidence interval (CI)-0.250, 0.335]. APV/r bid was generally well tolerated.

CONCLUSIONS

Results confirm the antiviral activity, short-term safety and tolerability of APV/r bid in PI-experienced patients.

Micro/nano encapsulation via electrified coaxial liquid jets

We report a method to generate steady coaxial jets of immiscible liquids with diameters in the range of micrometer/nanometer size. This compound jet is generated by the action of electro-hydrodynamic (EHD) forces with a diameter that ranges from tens of nanometers to tens of micrometers. The eventual jet breakup results in an aerosol of monodisperse compound droplets with the outer liquid surrounding or encapsulating the inner one. Following this approach, we have produced monodisperse capsules with diameters varying between 10 and 0.15 micrometers, depending on the running parameters.

Technetium-99m labelling of glycosylated somatostatin-14

This study presents a technetium-99m labelling method based on organometallic chemistry. It describes the simple mixing of a 99mTc(I)-carbonyl compound [99mTc(OH2)3(CO)3]+ with a histidine-tagged somatostatin-dextran (SMS-Dx-His) conjugate. Somatostatin and histidine was coupled to periodate activated dextran. The linkage was stabilised by reductive amination. The conjugate was then radiolabelled with 99mTc by using the 99mTc(CO)3 core. The labelling efficiency was 65-80% and the radiochemical purity > 95%. In the in vitro cysteine challenge, the result showed that 25% of the radiolabel was released after 1 h incubation at 37 degrees C (cysteine-conjugate at 1000:1 molar ratio). The radiolabelled SMS-Dx-His showed similar HPLC profile as the unlabelled conjugate. This labelling method, employing non reducing conditions, is useful for the labelling of peptides containing disulphide bonds. It should be possible to be used also for labelling with rhenium-188 for therapeutic applications.

The effect of handgrip position on upper extremity neuromuscular responses to arm cranking exercise

The purpose of this study was to determine if handgrip position during arm cranking exercise influences the neuromuscular activity of muscles biceps brachii (BB), lateral head of triceps brachii (TB), middle deltoid (DT), infraspinatus (IS) and brachioradialis (BR). Fifteen participants cranked an arm ergometer using three different handgrip positions (supinated, pronated, and neutral). Electromyographic (EMG) data were recorded from the aforementioned muscles, and relative duration of EMG activation and amplitude were quantified for the first and second 180 degrees of crank angle. EMG measures were analyzed with MANOVA and follow-up univariate procedures; alpha was set at 0.01. The relative durations of EMG activation did not differ between handgrip positions. Muscle IS exhibited 36% less amplitude in the supinated versus neutral handgrip position (second half-cycle), and muscle BR displayed 63% greater amplitude across cycles in the neutral versus supinated and pronated handgrip positions. The greater BR activity displayed in the neutral handgrip position may reflect its anatomical advantage as an elbow flexor when the forearm is in neutral position. Muscle IS exhibited less activity in the supinated position and may be clinically relevant if it allows arm cranking to occur without subsequent shoulder pain, which is often the aim of shoulder rehabilitation.

Assessing coronary blood flow dynamics with the TIMI frame count method: comparison with simultaneous intracoronary Doppler and ultrasound

This study compared the TIMI frame count (TFC), which has been proposed as a method for quantifying coronary blood flow, with coronary flow and microvascular function measured with intracoronary Doppler and intracoronary ultrasound. Coronary blood flow volume was calculated from coronary blood velocity (by intracoronary Doppler) and lumen area (by intracoronary ultrasound) in the LAD in 46 post-heart transplant patients at baseline and after intracoronary adenosine. TFC correlated significantly with average peak coronary blood velocity (r = -0.42; P = 0.004) and coronary lumen area (r = 0.39; P = 0.008), but not with coronary blood flow volume (r = -0.01; P = 0.96) or the coronary flow reserve response to adenosine (r = 0.09; P = 0.58). In conclusion, TFC is a simple method of assessing coronary blood velocity but not volumetric flow. While TFC does not predict coronary flow reserve, as a measure of velocity it does provide an assessment of basal microvascular tone, information that is complementary to that afforded by flow reserve measurements.

Radiolabeling of dextran with rhenium-188

This study describes a method for the radiolabeling of dextran with rhenium-188 (188Re). In nuclear oncology 188Re is very useful for therapeutic applications. Its nuclear characteristics allow radiotherapy and in situ monitoring of tumor uptake as well as dosimetry calculations. Consequently new compounds with this radiolabel are of general interest. Dextran was oxidized with sodium periodate yielding reactive aldehyde groups and subsequently reacted with cysteine. The linkage was stabilized by reducing the Schiff bases with sodium cyanoborohydride. The conjugate was then radiolabeled with 188Re by using 188Re-gluconate as the transchelator, labeling the free thiols. Synthesis and radiolabeling were done in the absence of oxygen. The labeling efficiency was 60-70% and the radiochemical purity > 95%. The in vitro stability study, using "cysteine challenge" demonstrated that 50% of the radiolabel was transcomplexed to the 100 mM cysteine solution (after 1 h incubation at 37 degrees C). However, at physiologic conditions and presence of an antioxidant good stability was achieved. The 188Re labeled dextran presented in this study provides a template with therapeutic and diagnostic potential in nuclear oncology, either alone for local treatment or as a backbone in a tumor specific conjugate for systemic treatment.

[Single extramedullary plasmacytoma of the nose]

A new solitary extramedullary plasmacytoma of nasal localization meeting the conditions for definition is reported. The patient was treated with surgery and irradiation, which controlled the disease and produced excellent cosmetic results. The bibliography is reviewed and the pathologic, clinical, and evolutive characteristics are discussed.

Prevention of corticosteroid-induced osteoporosis: results of a patient survey

OBJECTIVE

To evaluate the current use of bone densitometry and agents to prevent bone loss among long-term corticosteroid users.

METHODS

A telephone survey of patients receiving long-term oral corticosteroid treatment.

RESULTS

One hundred forty-seven patients receiving a mean prednisone dose of 10 mg per day for an average of 1-2 years were surveyed. Twenty-nine percent reported having a bone density test, 29% were taking calcium supplements, and 45% were receiving vitamin D. Forty percent of postmenopausal (PMP) women were receiving hormone replacement therapy and 14%, bisphosphonate treatment. Forty-two percent of PMP women were receiving no preventive treatment. Patients who were evaluated by primary care physicians and rheumatologists were more likely to have undergone bone density testing and to have received preventive treatments than were patients of other specialists.

CONCLUSION

Many patients receive inadequate treatment to prevent corticosteroid-induced osteoporosis, and physician specialty is an important predictor of bone density testing and treatment. A broad educational effort directed to physicians of varied specialties is needed to ensure that osteoporosis prevention becomes the standard of care for patients receiving long-term corticosteroid treatment.

Variations in physicians' judgments about corticosteroid induced osteoporosis by physician specialty

OBJECTIVE

Longterm corticosteroid use is associated with an increased risk of osteoporosis and fractures. Calcium and vitamin D supplementation and estrogen replacement therapy can decrease this risk, but the majority of patients receiving longterm corticosteroid treatment do not receive treatments to prevent bone loss. We assess whether this is due to variations in physicians' judgments about risks and efficacy of treatments to prevent corticosteroid-induced osteoporosis.

METHODS

Questionnaires were mailed to 425 physicians, who were sampled so that half were generalists and half were specialists. Physicians were given hypothetical clinical scenarios involving patients taking corticosteroids and asked to judge the importance of osteoporosis as a risk of corticosteroid treatment, the importance of discussing this side effect with patients, and to indicate how often they would use calcium with vitamin D and estrogen for a hypothetical postmenopausal patient receiving longterm corticosteroid treatment.

RESULTS

In total 198 physicians (50%) responded to this survey. Most physicians rated osteoporosis as one of the 3 most significant side effects of corticosteroid treatment for postmenopausal women, but there was significant variation in physician judgments about the importance of corticosteroid induced osteoporosis for premenopausal women (p=0.03) and men (p=0.001). There was also significant variation in physician judgments about the importance of discussing osteoporosis as a side effect with patients (p=0.001), and their use of both calcium and vitamin D (p=0.002) and estrogen replacement therapy (p=0.001) for a hypothetical postmenopausal patient. The physician characteristics most associated with these differences were physician specialty and experience with corticosteroid use. Primary care physicians and physicians who more commonly prescribe corticosteroids were more likely to report that they would use estrogen and calcium to prevent corticosteroid induced bone loss. Physician age, sex, and university affiliation had no association with physician assessments.

CONCLUSION

Physicians' judgments varied significantly by physician specialty and experience with corticosteroid use. These data suggest that patients cared for by physicians in different specialties will get varying advice about osteoporosis risk and preventive treatments when receiving longterm corticosteroid treatment.

Inter-clinician agreement on clinical data abstracted from patients' medical charts

PURPOSE

The purpose of this study was to determine the inter-observer repeatability of retrospective chart reviews.

METHODS

Retrospective abstraction of corneal transplant patients' medical records by two independent observers was performed at the University of California, Davis, Department of Ophthalmology, Sacramento, CA. The sample consisted of 100 consecutive patients who underwent penetrating keratoplasty, and the primary outcome measure was the degree of agreement between the 2 independent observers on clinical ocular data abstracted from patients' medical charts.

RESULTS

Even when given specific criteria for abstraction of data from patients' medical charts, inexperienced but trained observers exhibited a small degree of disagreement (range 0 to 12%) on patient demographic variables (e.g., gender, age, and date of birth) to be used for data analysis. Larger amounts of disagreement (range 3 to 26%) were found on frequently occurring variables (e.g., predisposing ocular conditions, surgical complications, and classification of corneal staining).

CONCLUSIONS

Based on these data, inter-observer repeatability for retrospective chart review studies is good, but investigators using this study methodology must be quite specific about the data to be collected and should be aware of standardization techniques to enhance observer repeatability.

Will patient satisfaction set the preventive services implementation agenda?

BACKGROUND

Patient satisfaction has become a measure of the quality of health care, and in highly competitive markets like the Twin Cities metropolitan area of Minnesota, it has become a health plan marketing tool. The purpose of this analysis is to examine whether the known association between preventive services and patient satisfaction might spontaneously lead clinicians to recommend preventive services at greater rates.

DESIGN

We conducted a mail survey of a stratified random sample (n = 6,830) of adult patients who had recently visited a physician in one of 44 clinics in and around Minneapolis-St. Paul, Minnesota. The main outcome measures are patient-reported rates of being advised to have eight preventive services, patient satisfaction with preventive services, patient satisfaction with overall health care, and correlations among these variables.

RESULTS

Self-reports of being advised to have a preventive service when due were correlated with higher levels of satisfaction with that specific service only at levels of r = 0.16 to r = 0.35. They were correlated at levels of r = 0.01 to r = 0.27 with the Group Health Association of America satisfaction index.

CONCLUSIONS

Although there is a positive association between being advised to have a preventive service on the one hand and reporting satisfaction with care on the other, this association appears too weak to spontaneously stimulate physicians to recommend preventive services to their patients. This suggests that, if preventive services are to be delivered at higher rates, they must become an explicit component of quality evaluations.

Multiple congenital anomalies associated with weekly low-dose methotrexate treatment of the mother

This report describes an infant with multiple congenital anomalies born to a 20-year-old mother with juvenile rheumatoid arthritis who had been taking weekly low-dose methotrexate (MTX) during the first trimester of pregnancy. The abnormalities found were consistent with those associated with maternal ingestion of MTX at dosage levels used to induce abortions, i.e., the group of abnormalities referred to as the "aminopterin syndrome." Although weekly low-dose MTX has been associated with spontaneous abortions, this is, to our knowledge, the first case report describing multiple congenital abnormalities consistent with MTX embryopathy secondary to weekly low-dose MTX treatment.

Modulation of organ uptake of 11C-labelled L-DOPA

The present study was undertaken to investigate if pretreatment with pharmacological agents could change the organ uptake of 11C-labelled L-DOPA, and especially if the urinary excretion could be decreased. L-[beta-11C]DOPA was injected IV into unanesthetized Sprague-Dawley rats. After 20 min the rats were decapitated and organs taken out for radioactivity measurements. The uptake in the organs was investigated in animals only given the tracer, and in animals pretreated with drugs such as decarboxylase inhibitors carbidopa and benserazide as well as the monoamine oxidase inhibitors deprenyl, clorgyline, and the COMT inhibitor OR-486. A marked decrease in the urinary radioactivity was observed after carbidopa and benserazide administration. HPLC analysis revealed that under native conditions the major part of urinary radioactivity existed as dopamine, which was eliminated by the decarboxylase inhibitors. After pretreatment with the COMT inhibitor OR-486, the radioactivity uptake in the pancreas increased fourfold as compared to non-treated animals. HPLC analysis showed that this correlated with a marked increase in radiolabelled DOPAC. In the other organs and with the other drugs, only small effects were observed. With L-[beta-11C]fluoroDOPA as a tracer, similar results were observed although the increase in the pancreas by OR-486 had a lower magnitude. These studies suggest that it might be possible to improve the diagnostic ratio of L-[beta-11C]DOPA or L-[18F]fluoroDOPA in whole-body PET studies by pretreating the patient with decarboxylase inhibitor for reducing the urinary excretion and potentially increase the target organ uptake by COMT inhibition.

Preoperative risk factors for surface disease after penetrating keratoplasty

We sought to identify the types of, prevalence of, and predisposing factors for the development of surface keratopathy after penetrating keratoplasty. We reviewed the records of 120 corneal grafts performed over a 15-month period. Twenty patients were excluded from the study. Fifty-three men and 47 women composed the group studied. All transplants were performed by the same surgeon. Retrospective data from patients' records were gathered preoperatively and from postoperative visits at 1 week and at 1, 2, 3, and 4 months. Data included preoperative medical and demographic data, operative time, postoperative medication regimens, assessment of the presence and degree, if present, of punctate epithelial keratopathy (PEK), hurricane keratopathy, macroepithelial defects, microcystic edema, bullous edema, and filamentary keratitis. In addition, information on the donor material was recorded. Surface disease and normal groups were compared to identify risk factors for the occurrence of surface abnormalities. Thirty-three of the patients demonstrated persistent surface abnormalities. Coarse PEK was the most common surface abnormality in the sample studied and was most prominent in the first week after surgery. Postoperative surface keratopathy was not statistically associated with preoperative diagnosis, donor age, death-to-preservation time, preservation-to-surgery time, or donor epithelial status. However, corneal recipients in the group with surface keratopathy were significantly older (mean, 68.7 years) than patients in the group with no surface abnormalities (mean, 52.6 years; Mann-Whitney U test, p < 0.001). Although many factors may contribute to the normal integrity of the corneal surface after keratoplasty, recipient age is of key importance in the development of surface disease.