The epidemiology of Candida species in the Middle East and North Africa

In recent decades, the epidemiology of invasive candidiasis (IC) has progressively changed worldwide. This notably includes emergence of several Candida species. Although some surveillance programs provided global trends in IC epidemiology, data from countries from the Middle East and North Africa (MENA) remain scarce. In this manuscript, we reviewed the existing available data on the epidemiology of Candida species associated with IC, particularly candidemia, in MENA region regarding species distribution. As witnessed worldwide, an evident shift of Candidaalbicans towards non-albicansCandida (NAC) has been observed in the MENA region. The worrying emergence of multi-drug resistant Candida species in MENA calls for a better understanding of their epidemiology. This represents an essential prerequisite for the implementation of effective infection control strategies and surveillance systems to prevent IC among high-risk patients.

Prognostic scores for sorafenib-treated hepatocellular carcinoma patients: A new application for the hepatoma arterial embolisation prognostic score

BACKGROUND

No prognostic classification is currently used for patients treated with systemic therapies for Hepatocellular Carcinoma (HCC).

METHODS

We retrospectively analysed data from patients treated with sorafenib for HCC from five centres in France and in the United Kingdom (UK). The training set comprised data from two centres and the validation set from three. Variables independently associated with Overall Survival (OS) in the training set were used to build the SAP (Sorafenib Advanced HCC Prognosis) score. The score was tested in the validation set, then compared with other prognostication systems.

RESULTS

The training set and validation set included 370 and 468 patients respectively. In the training set, variables independently associated with OS in multivariable analysis were: performance status (PS) >0, alpha-fetoprotein (AFP) >400 ng/ml, tumour size >7 cm, bilirubin >17 μmol/l and albumin <36 g/l. The SAP score was built giving one point to each abnormal variable, and three classes were constructed. The SAP score was significantly associated with OS in the training set, with median OS of 14.9 months for SAP A, 7.2 months for SAP B and 2.5 months for SAP C (P < 0.001). In the validation set, the SAP score was significantly associated with OS, and showed greater discriminative abilities than Barcelona Clinic Liver Cancer (BCLC) and albumin-bilirubin (ALBI) scores. However, the hepatoma arterial embolisation prognostic (HAP) score showed greater discriminative abilities than the SAP score.

CONCLUSION

In European patients treated with sorafenib, the HAP was the most discriminant prognostic score and may facilitate stratification in trials and inform clinical decision making.

Effect of Different Doses of Oral Cholecalciferol on Serum 1,25(OH)2D in Vitamin D Deficient Schoolchildren

Data regarding 1,25-dihydroxycholecalciferol in adolescents are limited. We aimed to determine serum levels of this active metabolite of vitamin D and the effects of different doses of vitamin D on its concentration in schoolchildren with high prevalence of vitamin D deficiency. In a previously published randomized double-blind, placebo-controlled trial, 210 subjects, aged 14-20 years, were assigned to 3 regimens of vitamin D treatment: group A (n=70) received 50 000 U oral cholecalciferol monthly, group B (n=70), 50 000 U bimonthly, and group C (n=70), placebo. Serum 25(OH)D, calcium, parathyroid hormone, and bone markers were measured at baseline and after 2 and 5 months of treatment. In the present study, serum levels of 1,25(OH)2D were measured in 97 boys and 95 girls. At baseline, girls had significantly higher concentrations of 1,25(OH)2D than boys (36, IQR: 24, 63 vs. 30, IQR: 15, 57.5 pmol/l; p<0.01). There was no significant correlation between serum levels of 25(OH)D and 1,25(OH)2D in the total population (Spearman rho=- 0.111; p=0.126), boys (Spearman rho=0.008; p=0.941), and girls (Spearman rho=0.036; p=0.729). Also, 1,25(OH)2D values did not change over time in different study groups. Moreover, total and sex-stratified analysis did not show any significant difference between different groups at different times of the study period. In an adolescent population with high prevalence of hypovitaminosis D especially in girls, 1,25(OH)2D values were higher in girls than boys. There was no significant change in 1,25(OH)2D concentrations with different doses of vitamin D.

Effects of Dietary Selenium and Vitamin E on Growth Performance, Meat Yield, and Selenium Content and Lipid Oxidation of Breast Meat of Broilers Reared Under Heat Stress

This study was conducted using 360 broiler chickens to evaluate the effects of dietary vitamin E (0, 125, and 250 mg/kg), selenium (0, 0.5, and 1 mg/kg), or their different combinations on performance, meat yield, and selenium content and lipid oxidation of breast meat of broilers raised under either a thermoneutral (TN, 24 °C constant) or heat stress (HS, 24 to 37 °C cycling) condition. There was a reduction (P < 0.05) in body weight and feed intake and an increase (P < 0.05) in feed conversion ratio when broilers exposed to HS. In the overall period of the study (1 to 49 days), growth performance of TN broilers was not affected (P < 0.05) by vitamin E and selenium supplementation. However, under HS condition, broilers receiving 250 mg/kg vitamin E and 0.5 mg/kg selenium consumed more (P < 0.05) feed than that of broilers receiving 250 mg/kg vitamin E alone, but similar (P > 0.05) to that of broilers receiving 250 mg/kg vitamin E and 1 mg/kg selenium. The malondialdehyde (MDA) content of the breast meat was increased (P < 0.05), but its selenium content was decreased (P < 0.05) by exposure to HS. The breast meat selenium content was increased (P < 0.05) by selenium supplementation. The breast meat selenium content was decreased (P < 0.05) by supplementation of 250 mg/kg vitamin E to diet of TN birds. However, the breast meat selenium content was increased (P < 0.05) by supplementation of vitamin E under HS condition. The breast meat MDA content was not affected (P > 0.05) by dietary treatments under TN condition. However, the breast meat MDA content was decreased (P < 0.05) by both vitamin E and selenium supplementation under HS condition, and the lowest MDA content was observed in the breast meat of broilers receiving combination of 125 mg/kg vitamin E and 1 mg/kg selenium. The results showed that supplementation of selenium and vitamin E was capable of increasing the selenium content of the breast meat and could improve the lipid oxidation of the breast meat when broilers reared under HS condition.

Single and combined effects of vitamin C and oregano essential oil in diet, on growth performance, and blood parameters of broiler chicks reared under heat stress condition

This study was conducted to evaluate the effects of adding vitamin C (VC), oregano essential oil (OR), or their combination in diet, on growth performance, and blood parameters of broiler chicks reared under heat stress (HS) condition (38 °C). One-day-old 240 male broilers were randomly assigned to four treatment groups, six replicates of ten birds each. The birds were fed with either a basal diet or a basal diet supplemented with either 200 mg L-ascorbic acid/kg of diet, 250 mg of oregano essential oil/kg of diet, or 200 mg L-ascorbic acid plus 250 mg of oregano essential oil/kg of diet. Average daily feed intake (ADFI), average daily gain (ADG), and feed conversion ratio (FCR) were obtained for 42 days of age and at the end of the experiment (day 42); birds were bled to determine some blood parameters and weighted for final body weight (BW). Feeding birds with diets supplemented with oregano essential oil and vitamin C in a single or combined form increased ADG (P > 0.05). Also BW increased and feed efficiency decreased (P < 0.05) in the birds fed with diets including VC and OR (in a single or combined form), compared to those fed the basal diet. ADFI was not significantly influenced by dietary oregano essential oil and vitamin C (P > 0.05). Supplemental oregano essential oil and vitamin C in a combined form decreased the serum concentration of corticosterone, triglycerides, glucose, and MDA (P < 0.05) compared with other groups. An increase in the serum concentrations of vitamin C were seen in broiler chicks supplemented with vitamin C. From the results of the present experiment, it can be concluded that diet supplementation by combined oregano essential oil and vitamin C could have beneficial effects on some blood parameters of broiler chicks reared under heat stress condition.

Selenium as a feed supplement for heat-stressed poultry: a review

Heat stress is associated with compromised performance and productivity in poultry due to declines in feed intake, nutrient utilization, growth rate, egg production and quality, and feed efficiency. Emerging evidences have shown that acute heat exposure results in increased production of free radicals and causes oxidative damage to lipids, proteins, and DNA. Additionally, heat stress can influence immune response by changing the expression of cytokines and by making the immune cells more susceptible to oxidative stress. Selenium, as a part of specific selenoproteins, can help to maintain antioxidant defenses, thereby preventing damages to tissues. An optimum response with supplementation of selenium in diet has been found to improve feed intake, body weight gain, feed efficiency, egg production and quality, and antioxidant status in heat-stressed poultry. Selenium compounds are also known to improve immune responses by altering the production of certain cytokines secreted by cells of the immune system and by enhancing the resistance of the immune cells to oxidative stress. It was reported that selenium supplementation had inhibitory effects on tumor necrosis factor alpha levels in heat-stressed broiler chicks, but the details are not completely elucidated. In the present review, the effect of selenium on production performance, nutrient utilization, antioxidative status, and immune responses of heat-stressed poultry is summarized.

Effects of dietary selenium and vitamin E on immune response and biological blood parameters of broilers reared under thermoneutral or heat stress conditions

A study was conducted using 360 broiler chickens to evaluate the effects of dietary vitamin E (0, 125 and 250 mg/kg), selenium (Se, 0, 0.5 and 1 mg/kg), or their different combinations on immune response and blood biological parameters of broilers raised under either thermoneutral (TN, 23.9 °C constant) or heat stress (HS, 23.9 to 37 °C cycling) conditions. Humoral immunity was assessed by intravenous injection of 7% sheep red blood cell (SRBC) followed by evaluation of serum for antibody titers in primary and secondary responses. Heterophil to lymphocyte (H/L) ratio also determined as an indicator of stress. Furthermore, at the end of the experiment, birds were bled for determination of some biological parameters. There was a significant reduction in body weight and feed intake, but the feed conversion ratio increased when the birds were exposed to HS (P<0.05). Body weight and feed intake were not influenced significantly by dietary vitamin E and Se (P>0.05), whereas feed conversion was improved significantly by 125 mg/kg vitamin E (P<0.05). The liver and lymphoid organ weights as well as IgM and IgG, antibody titers for primary and secondary antibody responses to SRBC were reduced significantly under HS (P<0.05). Heat stress also resulted in a significant increase in H/L ratio (P<0.05). Dietary vitamin E resulted in improvement of primary and secondary antibody responses both in TN and HS broilers (P<0.05). The HS birds also showed an improved antibody titer in secondary response with high concentration of Se (P<0.05). Vitamin E and Se had interactive effects on anti-SRBC titers; however, no consistent differences were found between dietary levels during the study. The H/L ratio decreased by feeding vitamin E at both levels either under HS or TN conditions (P < 0.05). The serum concentrations of glucose, triglycerides, total cholesterol, and LDL-cholesterol were increased but serum HDL-cholesterol decreased in HS broilers (P<0.05).

Lack of effect of dietary chromium supplementation on growth performance and serum insulin, glucose, and lipoprotein levels in broilers reared under heat stress condition

This study evaluated the effects of supplemental dietary chromium (Cr) on the performance, carcass traits, and some serum parameters of broilers under a heat stress (23.9 to 37 °C cycling) condition. A total of 150 1-day-old broiler chicks (Cobb 500) according to a completely randomized design were assigned into five treatment groups. Each treatment consisted of three replicates and each replicate contained ten chicks. Treatments were supplemented with 0 (control), 600, and 1,200 μg kg(-1) Cr in the form of Cr chloride (CrCl3) and Cr L-methionine from 1 to 49 days of age. Blood samples were collected from two birds in each replicate to determine serum parameters at 35 and 49 days of age. The body mass, feed intake, and conversion ratio were not influenced by dietary Cr (P > 0.05). Dietary supplementation of Cr from either CrCl3 or Cr L-methionine caused increased serum concentrations of Cr (P < 0.05), but had no effect on serum insulin and glucose concentrations at both sampling times (P > 0.05). Serum triglycerides, very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were also not significantly affected (P > 0.05) by dietary treatments, whereas total cholesterol concentration decreased in chicks fed Cr L-methionine compared to the control (P < 0.05).

The effect of different levels of organic and inorganic chromium supplementation on production performance, carcass traits and some blood parameters of broiler chicken under heat stress condition

A total of 250 broilers in a completely randomized design selected to evaluate the effect of different levels of chromium (Cr) supplementation on performance, carcass traits and some blood parameters of heat-stressed broiler chicks. All birds were kept under heat stress temperature (33 ± 3°C) and divided into five treatments groups. Each treatment consisted of five pens with 10 birds in each pen. The basal diets were supplemented with 0 ppb (control), 800 ppb Cr-L-Met (T(1)), 1,200 ppb Cr-L-Met (T(2)) or 800 ppb CrCl(3) (T(3)), and 1,200 ppb CrCl(3) (T(4)). The feed intake and body mass were measured at 10, 21, and 42 days of age. Blood samples were collected from two birds in each replicates to determine biological and hematological values at 28 and 42 days of age. There were no significant difference in mass gain and feed conversion of broilers that received Cr supplementations compared with controls. The serum glucose concentration decreased in broilers received organic chromium methionine supplements compared with other treatments groups. Slight but not significant increases were observed in serum high-density lipoprotein (HDL) concentration of treated groups than controls while the mean serum HDL concentration was significantly higher in T(2) group compared with control group. Serum low-density lipoprotein level decreased in broiler received organic Cr supplements (p < 0.05).

Interest of external photoprotection by means of clothing and sunscreen products in young children

BACKGROUND

Protecting young children is a major public health issue.

OBJECTIVE

We tested children's clothing and sunscreen products that are specially designed for children.

METHODS

The effectiveness of the different types of clothing and sunscreen products was determined using spectrophotometer equipped with an integrating sphere A measure of transmittance carried out, respectively, between 290 and 400 nm and between 320 and 400 nm, allowed us to assess the photoprotective properties in the UVB and UVA range respectively.

RESULTS

Although the photoprotective effect varies according to the type of clothing (UV-protection factor [UPF] of approximately 10 for a cotton T-shirt and 500 for a pair of jeans), the effect is constant for any one type of clothing. Placing fabrics in layers is essential and this enables the protective effect to be greatly increased. Moreover, the authors wished to answer the question, 'what makes a good sun cream?' by analysing the formula of each product tested. It turns out that only creams containing both organic filters and inorganic filters have an sun protection factor (SPF) that is the same as the one stated on the product.

CONCLUSION

Concerning townwear, the jeans, tracksuits, sweatshirts, pullovers and tights turned out to be very photoprotective. They enable, in effect, to reach a UPF higher than 500. The mere presence of titanium dioxide and/or zinc dioxide does not mean that the product will have a high SPF. Products containing alcohol can be eliminated from the possible choices by carefully reading the label.

Preoperative concomitant chemoradiotherapy with oxaliplatin and 5-fluorouracil in locally advanced rectal carcinoma

e15108

Background: Preoperative concomitant chemoradiotherapy has shown to improve local control and sphincter preservation with decreased acute toxicity compared with postoperative treatment in locally advanced rectal carcinoma. The primary endpoint of this phase II trial was pathologic tumor response. Secondary endpoint was sphincter preservation and toxicity Methods: Inclusion criteria: rectal adenocarcinoma <12 cms from anal verge, clinical stage T3–4, adequate renal, hematological and liver function. Planned sample for this trial was 40 patients. Treatment schedule: Pelvic radiotherapy (25 Gy/ 5 fractions: 5 Gy on day 1 to day 5) and chemotherapy: Oxaliplatin 85 mg/m2 on 2 hours, day 1 and 15, folinic acid 20 mg/m2 and 5 fluoro-uracil bolus 500 mg/m2 on day 1, 8 and 15 (cycle repeated every 4 weeks). Surgery with TME was performed after the end of the second cycle of chemotherapy. Adjuvant chemotherapy with 5FULV2 was administered after surgery Results: 15 patients have been recruited between January and October 2006: 10 males/5 females. Median age: 45 years (range 26–62). Clinical stage (determined by CT or RMI): T3: 66.6% and T4: 33.3%. Tumor location (from anal verge): < 6 cm in 10pts, >6 cm in 5pts. Surgery (performed in 14 patients) consisted of low anterior resection in 5pts and abdominal-perineal resection in 10p. Tumor down-staging was observed in 10pts (66.6%), including 5pts with complete pathological response (33.3%). Main adverse effects (NCI-CTC): diarrhea G3–4: 14.2%, sensitive peripheral neurotoxicity G1: 26.6%, nausea/vomiting G3–4: 11%, Anemia G3–4: 7.1%, neutropenia G3–4: 14.2% Conclusions: Preliminary results show that preoperative concomitant chemoradiotherapy with oxaliplatin and 5FU-folinic acid is an effective regimen with an acceptable safety profile for locally advanced rectal cancer, leading to a high probability of tumor downstaging. This interim analysis has to be confirmed by the final analysis.

No significant financial relationships to disclose.

Improvement of the nutritive value of soybean meal by protease and alpha-galactosidase treatment in broiler cockerels and broiler chicks

1. Tube-fed broiler cockerels were used in three experiments to measure the effect of different enzyme treatments on true metabolisable energy (TME) and true nitrogen digestibility (TND) of commercial solvent-extracted, heat-treated soybean meal (SBM). 2. In experiment 1, proteases P2 and P3 (from Aspergillus niger) and alpha-galactosidase (from A. oryzae) improved TME and TND while protease P1 (from Bacillus subtilis) had little effect. The effects of enzyme treatment were similar whether treatment was applied by pre-incubation of enzymes (proteases P1, P2 and P3, 1.0 g/kg; alpha-galactosidase, 0.1 g/kg) with SBM for 2 h at 50 degrees C or by simple mixing of enzymes (proteases P1, P2 and P3, 0.25 g/kg; alpha-galactosidase, 0.1 g/kg) with SBM prior to feeding. 3. In experiment 2, the effects of mixing SBM with each of protease P1 (0 or 0.25 g/kg), protease P3 (0 or 0.25 g/kg) or alpha-galactosidase (0 or 0.1 g/kg) alone or in all possible combinations were studied. Effects of protease P1 were limited, but protease P3 and alpha-galactosidase improved TME and TND. There were significant interactions between protease P3 and alpha-galactosidase for both TME and TND; the response when enzymes were applied together was less than that expected from application of the enzyme preparations individually. 4. In experiment 3, the effect of varying the concentration of protease P3 (0, 0.1, 0.25 and 1.0 g/kg SBM dry matter) and alpha-galactosidase (0, 0.025, 0.0625 and 0.25 g/kg SBM dry matter) mixed with SBM alone or in all possible combinations of protease P3 and alpha-galactosidase were assessed. Increases in TME and TND for both enzymes were non-linear with the greatest response occurring at the lowest concentration of each enzyme. There were also interactions between the two enzyme preparations. 5. Finally, either protease P3 (0, 0.1 and 1.0 g/kg SBM dry matter) or alpha-galactosidase (0, 0.025 and 0.25 g/kg SBM dry matter) were mixed with SBM alone or in all possible combinations and treated SBMs incorporated into semi-purified diets containing 450 g SBM/kg as the sole source of dietary N and offered to growing broiler chicks for 21 d. Similar patterns of increases in chick growth rate and diet digestibility to those recorded in experiment 3 were obtained when protease P3 and alpha-galactosidase where included in the diets. 6. It is concluded that responses measured by tube-feeding SBM treated with protease P3 and alpha-galactosidase were similar to responses obtained with growing broiler chicks. Further, these responses were obtained by simple addition of enzymes to diets and nutritive value of SBM was improved by both protease and alpha-galactosidase treatment.

The potential for the improvement of the nutritive value of soya-bean meal by different proteases in broiler chicks and broiler cockerels

1. The potential for improving the nutritive value of commercial solvent-extracted, heat-treated soya-bean meal (SBM) by protease treatment was measured using growing broiler chicks and tube-fed broiler cockerels. 2. SBM was pre-treated (50 degrees C for 2 h) with water alone; at alkaline pH (initial pH 8.25) with and without protease P1 (isolated from a Bacillus species) or at acid pH (initial pH 4.5) with and without protease P2 (isolated from an Aspergillus species) and incorporated into diets (290 g SBM/kg diet) for broiler chicks (20 chicks/treatment). Only protease P2 treatment improved chick performance; from 7 to 28 d of age, chicks fed on treated SBM had greater feed intakes and gained more weight than chicks fed on untreated SBM. Both proteases P1 and P2 significantly reduced chick serum anti-soya antibodies while protease P2 treatment increased apparent ileal nitrogen (N) digestibility and apparent N retention across the whole digestive tract. 3. Two tube-feeding experiments established that, of the treated SBMs used in experiment 1, only protease P2 treatment improved apparent N digestibility and true metabolisable energy. Also it was shown that increasing the temperature at which treated SBM was dried to 60 degrees C, compared with freeze-drying or drying at 50 degrees C reduced apparent N digestibility and true metabolisable energy of SBM with no significant interactions between enzyme treatment and drying temperature for both apparent N digestibility and TME. 4. It is concluded that, overall, the nutritional value of SBM assayed in a growth trial and by tube feeding was improved by treatment with protease P2 and not by treatment with protease P1.