Standardization of chronic uterine infection of hamsters by Leptospira santarosai serovar Guaricura, from serogroup Sejroe

Leptospirosis is an important zoonosis that in cattle is characterized as a reproductive disease. It is well reported that the main agent of bovine leptospirosis worldwide is Sejroe serogroup serovar Hardjo. Reproductive disease in cattle has several gaps in its knowledge and studies with Golden Syrian hamsters, experimentally infected, are limited. Therefore, a protocol that could reproduce the chronic genital disease in hamsters would be extremely valuable for the advance of the knowledge of that syndrome. The aim of this study was to establish an experimental protocol for chronic non-lethal genital infection of female hamsters by L. santarosai serovar Guaricura (Sejroe serogroup), strain 2013_VF52. For this, two concentrations (1.0 × 108 leptospires/mL and 1.0 × 104 leptospires/mL) were used intraperitoneally in female hamsters of 06-08 weeks of age. Hamsters that survived for up to forty days after inoculation were euthanized. Uterine and renal tissues were collected to evaluate leptospires' presence by PCR and culture. The protocol demonstrated that 1.0 × 104 leptospires/mL of the strain determined chronic genital leptospirosis in the hamster model. The standardization of a protocol for chronic genital leptospirosis in hamsters can be extremely useful for the understanding of the physiopathology of the infection, as the distribution of leptospires in the uterus and the agent-host interactions.

P-505 Mapping acceptance and commitment therapy (ACT) outcomes in the context of infertility: A systematic review

Study question

How ACT variables are associated or may impact mental health outcomes (i.e., anxiety, stress, and depression symptoms) in patients with an infertility diagnosis?

Summary answer

ACT variables seem to be associated with better mental health outcomes in patients with an infertility diagnosis.

What is known already

Evidence indicates that people with infertility face psychosocial challenges, with a significant number of studies finding that mental health seems to be negatively affected. ACT is part of the family of behavioral and cognitive therapies and was already established as having a beneficial effect on psychological issues in other health conditions. Since infertility is a relevant stressor, we expected that ACT had also a protective role on mental health. To date, no study tried to summarize this evidence, which might help to develop the intervention with ACT components for this population.

Study design, size, duration

A systematic review of the literature was conducted to identify studies assessing Infertility and ACT. A literature search was conducted from inception to October 2021 in the following electronic databases: Web of Science, Pubmed, and B-On. The PRISMA guidelines were followed.

Participants/materials, setting, methods

A search was conducted using combinations of keywords and MeSH (“infertility” AND “Acceptance and Commitment Therapy” AND “depression”; “anxiety”; “stress”). No limitation regarding the type of publication, date, or language was created during the searches. Empirical and quantitative studies were considered if they assessed mental health variables and ACT hexagon model components in patients with infertility.

Main results and the role of chance

Out of 137 studies initially identified, six of them met eligibility criteria and were included in the review. The studies were carried out between 2012 and 2020 and originated from two countries: four from Portugal and two from Iran. The samples were composed by women (three) and couples (three). The results revealed that couples dealing with infertility present higher psychological inflexibility and experiential avoidance scores, and lower scores of acceptance when compared with fertile couples and couples who pursued adoption. Psychological inflexibility seems to be positively correlated with depressive, anxiety, and stress symptoms. Gender differences were also found, i.e., women tend to show higher scores of depression symptoms, psychological inflexibility, and experiential avoidance than men. Women dealing with infertility have the tendency to avoid thoughts, emotions, and situations somehow associated with pregnancy and parenthood as a way of trying to escape from infertility’s painful experience. In general, studies suggest that ACT may be an adequate approach for patients dealing with infertility.

Limitations, reasons for caution

The number of studies was small and they were predominantly from Portugal, increasing the likelihood of a risk of bias of the findings. Cultural variables must be considered and conclusions need to be interpreted with caution.

Wider implications of the findings

Since ACT variables seem to be associated with better mental health outcomes, these results indicated that couples with infertility would benefit from intervention addressing ACT components. Future studies should explore the effectiveness of these interventions in this population.

Trial registration number

not applicable

Short communication: Uterine leptospiral infection is strongly associated to strains of serogroup Sejroe on experimentally infected hamsters

Leptospira infection is influenced by the host species and the bacterial strain involved. Important differences on their tissue distribution are referred, also depending on the host and the studied strain. Considering tissue distribution of leptospires the majority of the studies focus on a single strain, or strains from the same serogroup with different inoculation doses. Nevertheless, none had associated different serogroups with their tissue distribution. Thus, the present study aims to investigate the hypothesis that tissue distribution of Leptospira spp. on experimentally infected hamsters may vary according to the strain serogroup. Females of Golden Syrian hamsters were used for the experimental infection with Leptospira isolates (n = 13) belonging to serogroups Icterohaemorrhagiae (n = 8) and Sejroe (n = 5). PCRs were conducted in renal, hepatic and uterine tissue. Seven out of the thirteen studied hamsters presented acute clinical signs and were euthanized before the 21° day p.i. (strains VF237, VF52, U81, UFF-SG001, UFF-G19, UFF-B15, L1-130), while the others presented a subclinical infection. Regarding to the PCR results it was possible to observe that, all but one strain (UFF-SG001), which was detected on all the studied tissues, presented some differences on their tissue distribution. All strains could be detected on at least one tissue and a significant association was observed for the occurrence of the strains of serogroup Sejroe in uterus (p = 0.044). The results of the present study indicate that strains of serogroup Sejroe are strongly associated to uterine infection on experimentally infected hamsters.

Infectivity and virulence of leptospiral strains of serogroup Sejroe other than Hardjo on experimentally infected hamsters

To assess the virulence of leptospires from the serogroup Sejroe (from ruminants), hamsters were tested against 12 strains. Three Guaricura strains induced severe lethal disease, in contrast to the Hardjo strains. Although with the preliminary outcomes, this finding may be useful for the control of bovine leptospirosis in the Americas, where Guaricura is prevalent.

The 'Outcome Reporting in Brief Intervention Trials: Alcohol' (ORBITAL) framework: protocol to determine a core outcome set for efficacy and effectiveness trials of alcohol screening and brief intervention

Background

The evidence base to assess the efficacy and effectiveness of alcohol brief interventions (ABI) is weakened by variation in the outcomes measured and by inconsistent reporting. The ‘Outcome Reporting in Brief Intervention Trials: Alcohol’ (ORBITAL) project aims to develop a core outcome set (COS) and reporting guidance for its use in future trials of ABI in a range of settings.

Methods/design

An international Special Interest Group was convened through INEBRIA (International Network on Brief Interventions for Alcohol and Other Drugs) to inform the development of a COS for trials of ABI. ORBITAL will incorporate a systematic review to map outcomes used in efficacy and effectiveness trials of ABI and their measurement properties, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. This will support a multi-round Delphi study to prioritise outcomes. Delphi panellists will be drawn from a range of settings and stakeholder groups, and the Delphi study will also be used to determine if a single COS is relevant for all settings. A consensus meeting with key stakeholder representation will determine the final COS and associated guidance for its use in trials of ABI.

Discussion

ORBITAL will develop a COS for alcohol screening and brief intervention trials, with outcomes stratified into domains and guidance on outcome measurement instruments. The standardisation of ABI outcomes and their measurement will support the ongoing development of ABI studies and a systematic synthesis of emerging research findings. We will track the extent to which the COS delivers on this promise through an exploration of the use of the guidance in the decade following COS publication.

Water residence time affecting phytoplankton blooms: study case in Ibitinga Reservoir (São Paulo, Brazil) using Landsat/TM images

Abstract Satellite images are an effective tool for the detection of phytoplankton blooms, since they cause striking changes in water color. Bloom intensity can be expressed in terms of chlorophyll-a concentration. Previous studies suggest the use of Landsat TM4/TM3 reflectance ratio to retrieve surface chlorophyll-a concentration from aquatic systems. In this study we assumed that a remote sensing trophic state index can be applied to investigate how changes in HRT along the hydrologic year affect the spatial distribution of the phytoplankton blooms at Ibitinga’s reservoir surface. For that, we formulated two objectives: (1) apply a semi-empirical model which uses this reflectance ratio to map chlorophyll-a concentration at Ibitinga reservoir along the 2005 hydrologic year and (2) assess how changes in hydraulic residence time (HRT) affect the spatial distribution of phytoplankton blooms at Ibitinga Reservoir. The study site was chosen because previous studies reported seasonal changes in the reservoir limnology which might be related to the reservoir seasonality and hydrodynamics. Six Landsat/TM images were acquired over Ibitinga reservoir during 2005 and water flow measurements provided by the Brazilian Electric System National Operator - ONS were used to compute the reservoir´s residence time, which varied from 5.37 to 52.39 days during 2005. The HRT in the date of image acquisition was then compared to the distribution of chlorophyll-a in the reservoir. The results showed that the HRT increasing implies the increasing of the reservoir surface occupied by phytoplankton blooms.

Unusual Voltage-Gated Sodium Currents as Targets for Pain

Pain is a serious health problem that impacts the lives of many individuals. Hyperexcitability of peripheral sensory neurons contributes to both acute and chronic pain syndromes. Because voltage-gated sodium currents are crucial to the transmission of electrical signals in peripheral sensory neurons, the channels that underlie these currents are attractive targets for pain therapeutics. Sodium currents and channels in peripheral sensory neurons are complex. Multiple-channel isoforms contribute to the macroscopic currents in nociceptive sensory neurons. These different isoforms exhibit substantial variations in their kinetics and pharmacology. Furthermore, sodium current complexity is enhanced by an array of interacting proteins that can substantially modify the properties of voltage-gated sodium channels. Resurgent sodium currents, atypical currents that can enhance recovery from inactivation and neuronal firing, are increasingly being recognized as playing potentially important roles in sensory neuron hyperexcitability and pain sensations. Here we discuss unusual sodium channels and currents that have been identified in nociceptive sensory neurons, describe what is known about the molecular determinants of the complex sodium currents in these neurons. Finally, we provide an overview of therapeutic strategies to target voltage-gated sodium currents in nociceptive neurons.

Resistance of mRNAs with AUG-proximal nonsense mutations to nonsense-mediated decay reflects variables of mRNA structure and translational activity

Nonsense-mediated mRNA decay (NMD) is a surveillance pathway that recognizes and selectively degrades mRNAs carrying premature termination codons (PTCs). The level of sensitivity of a PTC-containing mRNA to NMD is multifactorial. We have previously shown that human β-globin mRNAs carrying PTCs in close proximity to the translation initiation AUG codon escape NMD. This was called the ‘AUG-proximity effect’. The present analysis of nonsense codons in the human α-globin mRNA illustrates that the determinants of the AUG-proximity effect are in fact quite complex, reflecting the ability of the ribosome to re-initiate translation 3′ to the PTC and the specific sequence and secondary structure of the translated ORF. These data support a model in which the time taken to translate the short ORF, impacted by distance, sequence, and structure, not only modulates translation re-initiation, but also impacts on the exact boundary of AUG-proximity protection from NMD.

Translation of the human erythropoietin transcript is regulated by an upstream open reading frame in response to hypoxia

Erythropoietin (EPO) is a key mediator hormone for hypoxic induction of erythropoiesis that also plays important nonhematopoietic functions. It has been shown that EPO gene expression regulation occurs at different levels, including transcription and mRNA stabilization. In this report, we show that expression of EPO is also regulated at the translational level by an upstream open reading frame (uORF) of 14 codons. As judged by comparisons of protein and mRNA levels, the uORF acts as a cis-acting element that represses translation of the main EPO ORF in unstressed HEK293, HepG2, and HeLa cells. However, in response to hypoxia, this repression is significantly released, specifically in HeLa cells, through a mechanism that involves processive scanning of ribosomes from the 5' end of the EPO transcript and enhanced ribosome bypass of the uORF. In addition, we demonstrate that in HeLa cells, hypoxia induces the phosphorylation of eukaryotic translation initiation factor 2α (eIF2α) concomitantly with a significant increase of EPO protein synthesis. These findings provide a framework for understanding that production of high levels of EPO induced by hypoxia also involves regulation at the translational level.

Probable initial pulmonary lymphangioleiomyomatosis and mediastinal lymphangioleiomyoma

A 68 year old woman was submitted to a mediastinal lymphangioleiomyoma resection found in a follow-up study of lower left lung resection due to bronchiectasis complicated by chylothorax. This led to a revaluation of the pulmonary specimen that revealed, in addition to inflammatory bronchiectasis, small spindle cell nodules in the lung parenchyma, similar to minute pulmonary meningothelial-like nodules, but with smooth muscle actin immunohistochemical positivity. The possibility of initial pulmonary development of lymphangioleiomyomatosis is discussed.

Gene expression regulation by upstream open reading frames and human disease

Upstream open reading frames (uORFs) are major gene expression regulatory elements. In many eukaryotic mRNAs, one or more uORFs precede the initiation codon of the main coding region. Indeed, several studies have revealed that almost half of human transcripts present uORFs. Very interesting examples have shown that these uORFs can impact gene expression of the downstream main ORF by triggering mRNA decay or by regulating translation. Also, evidence from recent genetic and bioinformatic studies implicates disturbed uORF-mediated translational control in the etiology of many human diseases, including malignancies, metabolic or neurologic disorders, and inherited syndromes. In this review, we will briefly present the mechanisms through which uORFs regulate gene expression and how they can impact on the organism's response to different cell stress conditions. Then, we will emphasize the importance of these structures by illustrating, with specific examples, how disturbed uORF-mediated translational control can be involved in the etiology of human diseases, giving special importance to genotype-phenotype correlations. Identifying and studying more cases of uORF-altering mutations will help us to understand and establish genotype-phenotype associations, leading to advancements in diagnosis, prognosis, and treatment of many human disorders.

Comparative analysis between radiographic views for knee osteoarthrosis (bipedal AP versus monopedal AP)

Objective

A comparative analysis by applying the criteria of the original classification Ahlbäck in the anteroposterior (AP) bipedal knee in extension and anteroposterior (AP) monopodal knee in symptomatic knee arthrosis. With this analysis we intend to observe the agreement, any advantage or difference between the incidence and degree of joint involvement between the orthopedic surgeons and radiologists with the referring physician.

Methods

From January 2012 to March 2012, was a prospective study of 60 symptomatic arthrosis knees (60 patients), clinically selected group of outpatient knee and radiographic proposals submitted to the search. Of the 60 patients, 39 were female and 21 male, mean age 64 years (ranging from 50 to 84 years). Of the 60 knees studied, 37 corresponded to the right side and 23 on the left side. Statistical analysis was performed by Kappa statistics, which evaluates the interobserver agreement for qualitative data.

Results

According to the scale of Ahlbäck, there was a significant agreement (p < 0.0001) intra-observer in the classification of knee osteoarthritis among the five evaluators. There was a significant agreement (p < 0.0001) with inter-observer referring physician in the incidence of AP monopodal and AP bipedal for the four raters.

Conclusion

The study found no difference between the incidence in the AP monopodal versus AP bipedal in osteoarthritis of the knee.

Alternative polyadenylation and nonsense-mediated decay coordinately regulate the human HFE mRNA levels

Nonsense-mediated decay (NMD) is an mRNA surveillance pathway that selectively recognizes and degrades defective mRNAs carrying premature translation-termination codons. However, several studies have shown that NMD also targets physiological transcripts that encode full-length proteins, modulating their expression. Indeed, some features of physiological mRNAs can render them NMD-sensitive. Human HFE is a MHC class I protein mainly expressed in the liver that, when mutated, can cause hereditary hemochromatosis, a common genetic disorder of iron metabolism. The HFE gene structure comprises seven exons; although the sixth exon is 1056 base pairs (bp) long, only the first 41 bp encode for amino acids. Thus, the remaining downstream 1015 bp sequence corresponds to the HFE 3′ untranslated region (UTR), along with exon seven. Therefore, this 3′ UTR encompasses an exon/exon junction, a feature that can make the corresponding physiological transcript NMD-sensitive. Here, we demonstrate that in UPF1-depleted or in cycloheximide-treated HeLa and HepG2 cells the HFE transcripts are clearly upregulated, meaning that the physiological HFE mRNA is in fact an NMD-target. This role of NMD in controlling the HFE expression levels was further confirmed in HeLa cells transiently expressing the HFE human gene. Besides, we show, by 3′-RACE analysis in several human tissues that HFE mRNA expression results from alternative cleavage and polyadenylation at four different sites – two were previously described and two are novel polyadenylation sites: one located at exon six, which confers NMD-resistance to the corresponding transcripts, and another located at exon seven. In addition, we show that the amount of HFE mRNA isoforms resulting from cleavage and polyadenylation at exon seven, although present in both cell lines, is higher in HepG2 cells. These results reveal that NMD and alternative polyadenylation may act coordinately to control HFE mRNA levels, possibly varying its protein expression according to the physiological cellular requirements.

Interaction of PABPC1 with the translation initiation complex is critical to the NMD resistance of AUG-proximal nonsense mutations

Nonsense-mediated mRNA decay (NMD) is a surveillance pathway that recognizes and rapidly degrades mRNAs containing premature termination codons (PTC). The strength of the NMD response appears to reflect multiple determinants on a target mRNA. We have previously reported that mRNAs containing PTCs in close proximity to the translation initiation codon (AUG-proximal PTCs) can substantially evade NMD. Here, we explore the mechanistic basis for this NMD resistance. We demonstrate that translation termination at an AUG-proximal PTC lacks the ribosome stalling that is evident in an NMD-sensitive PTC. This difference is associated with demonstrated interactions of the cytoplasmic poly(A)-binding protein 1, PABPC1, with the cap-binding complex subunit, eIF4G and the 40S recruitment factor eIF3 as well as the ribosome release factor, eRF3. These interactions, in combination, underlie critical 3′–5′ linkage of translation initiation with efficient termination at the AUG-proximal PTC and contribute to an NMD-resistant PTC definition at an early phase of translation elongation.

Water quality changes in floodplain lakes due to the Amazon River flood pulse: Lago Grande de Curuaí (Pará)

Assurance of water quality for human consumption is essential for public health policies. In the Amazon floodplain, the seasonal water level variation causes periodic flooding of marginal areas that are usually used for settlements, agriculture and livestock. Therefore, the exchange of materials between the terrestrial and aquatic ecosystem affects the proportion of suspended and dissolved components in water and its physical-chemical characteristics, and consequently the quality of the water used by local people. Following this approach, the aim of this study is to evaluate changes in water quality in Lago Grande de Curuaí floodplain, Óbidos, Pará in response to the flood pulse, during one hydrological year from 2003 to 2004, based on water use classes (according to National Water Agency 357/2005 resolution) using chlorophyll-a and dissolved oxygen concentration as parameters and the eutrophication index. Ordinary kriging was applied to interpolate chlorophyll-a and dissolved oxygen and to predict values at non sampled locations. Each location was then classified according to water use acceptable parameters and to Carlson Trophic State Index modified by Toledo to map lake water classes and trophic status. The result showed that Lago Grande de Curuaí floodplain is a supereutrophic system, with levels of dissolved oxygen and chlorophyll-a not suitable for human supply during the receding water phase. These areas are located near the riverine communities, which can cause health problems due to the presence of potentially toxic algae. Therefore, monitoring water quality in Amazon lakes is essential to ensure the availability has appropriate quality for human and animal supplies.

The timing of diammonium phosphate supplementation of wine must affects subsequent H2S release during fermentation

AIMS

The aim of this study was to evaluate the impact of supplementation by diammonium phosphate (DAP) on hydrogen sulfide (H(2)S) production, when DAP given either prior to fermentation or during the early stationary growth phase of yeast.

METHODS AND RESULTS

Three contrasting Saccharomyces cerevisiae wine strains were used to ferment synthetic grape juice (GJ) containing 67 mg l(-1) of initial yeast assimilable nitrogen (YAN), supplied either as DAP or as mixture of amino acids. Sufficient DAP was added either prior to or 72 h after the initiation of fermentation to achieve a final YAN concentration of 267 mg l(-1). Supplementation prior to fermentation stimulated H(2)S production. The results obtained in model solutions were validated using natural GJ.

CONCLUSION

The timing of DAP supplementation is critical for ensuring that fermentation proceeds without excessive release of H(2)S.

SIGNIFICANCE AND IMPACT OF THE STUDY

This result has important implications for the wine-making industry, because it highlights the value of determining the initial nitrogen level of a GJ. It raises awareness of the dependence of wine quality on the correct timing of DAP supplementation.

Stereotypies in Rett syndrome: Analysis of 83 patients with and without detected MECP2 mutations

BACKGROUND

Hand stereotypies are considered a hallmark of Rett syndrome (RTT) and are usually described as symmetric movements at the midline. However, related pathologies may show the same type of involuntary movement. Furthermore, patients with RTT also have stereotypies with other localizations that are less well characterized.

METHODS

We analyzed stereotypies in 83 patients with RTT, 53 with and 30 without a mutation detected in the MECP2 gene. Patients were observed and videotaped always by the same pediatric neurologist. Stereotypies were classified, and data were submitted to statistical analysis for comparison of mutation-positive and -negative patients and analysis of their evolution with the disease.

RESULTS

All the patients showed hand stereotypies that coincided with or preceded the loss of purposeful hand movements in 62% of the patients with MECP2 mutations. The hair pulling stereotypy was more frequent in the group with detected mutations, whereas hand washing was not. Hand gaze was absent in all RTT patients with MECP2 mutations. Patients with MECP2 mutations also had more varied stereotypies, and the number of stereotypies displayed by each patient decreased significantly with age in this group. In all patients, stereotypies other than manual tended to disappear with the evolution of the disease.

CONCLUSIONS

Although symmetric midline hand stereotypies were not specific to patients with an MECP2 mutation, some of the other stereotypies seemed to be more characteristic of this group. In patients younger than 10 years and meeting the necessary diagnostic criteria of Rett syndrome, the association of hand stereotypies without hand gaze, bruxism, and two or more of the other stereotypies seemed to be highly indicative of the presence of an MECP2 mutation.

Reducing subjectivity in the evaluation of pre-clinical dental preparations for fixed prosthodontics using the Kavo PrepAssistant

The evaluation of pre-clinical technical achievement in fixed prosthodontics cannot be objective when using visual examination of dental preparations. This is, however, still the main method used in dental schools. The present study introduces a new method, based on a mathematical formula, to reduce the problem. The idea emerged when using the Kavo PrepAssistant system (software version 1.05). This system is a 3D-scanner with software that can quantify geometrical differences between an instructor and student dental preparation in model teeth. Therefore, a mathematical formula was created, integrating selected clinically relevant geometric characteristics of dental preparations measured by the system. In this new formula, 70% of the evaluation parameters were computer analysed, whilst 30% were visually evaluated. This new method was compared with the traditional visual evaluation system during a pre-clinical practical examination, with the participation of 25 students. Using both methods to evaluate the 25 preparations, results showed similar grading for both methods (K-S test = 0.16; P < 0.05). Although this method does not provide overall clinical evaluation of student performance these results suggest that it can be helpful accessing technical achievement. In this method, the student has the guarantee that 70% of his/her grade results from an objective computer evaluation, with the possibility to visualise the mistakes with the software. It also reduces problems related to the calibration between different examiners. The Kavo PrepAssistant is a powerful tool in pre-clinical teaching, but has some drawbacks. It has to be developed towards the actual needs of pre-clinical departments, in order to achieve its full potential, as described in this study.

[Early infantile ceroid lipofuscinosis -- role of nuclear magnetic resonance in the diagnosis]

The authors report a case of Infantile Neuronal Ceroid Lipofuscinosis and emphasize the role of MRI in the diagnosis and follow-up of the disease describing a severe progressive cerebral atrophy. Clinical findings and laboratory data were reviewed and the importance of palmitoyl-protein thiosterase activity is described.

[Cervical spondylodiscitis in an infant]

Spondylitis in childhood is rare, presenting a great variety of symptoms that are related to the child s age and to the site of the inflammatory process. We present the case of a nine-month-old infant, who presented to the emergency department with a torticollis of six weeks evolution. The diagnosis of spondylitis (C6-C7) was confirmed by MRI. Intravenous antibiotic therapy was administered. The patient showed complete regression of symptoms and imaging tests were normal. The rarity of this disease in patients in this age group, as well as the site and form of presentation are emphasised as is the importance of diagnosing this disease to prevent permanent neurological injuries or bone deformities.

Recovery of cytomegalovirus and herpes simplex virus from upper and lower genital tract specimens obtained from women with pelvic inflammatory disease

Lower genital tract specimens and endometrial biopsies from 147 women with pelvic inflammatory disease (PID) and surgical specimens (fallopian tubes, ovaries, or both) from 22 women with PID and 37 women without PID were cultured for cytomegalovirus (CMV) and herpes simplex virus (HSV), as well as for organisms commonly associated with PID. CMV was isolated from 39 cervical or endometrial samples from 30 (20.4%) of 147 women with PID and from ovaries or fallopian tubes from 5 (22.7%) of 22 women with PID, but CMV was not recovered from surgical specimens obtained from 37 women undergoing surgery for tubal ligation, ectopic pregnancy, or other gynecologic conditions (P = .005). HSV was isolated from cervical samples obtained from 5 (3.4%) of 147 women with PID but not from any endometrial or surgical specimens. These data suggest that CMV, but not HSV, may contribute to the pathogenesis of PID in some patients.

Pelvic inflammatory disease and human immunodeficiency virus infection

OBJECTIVE

To identify the effect of human immunodeficiency virus (HIV) infection on the clinical course of pelvic inflammatory disease (PID).

METHODS

Women hospitalized with PID at an urban hospital serving a population at high risk for HIV were studied cross-sectionally. Data abstracted from medical records of 349 women, admitted between July 1992 and April 1994 were linked anonymously to HIV serology. Main outcome measures were length of hospital stay, prolonged fever, tubo-ovarian abscess, surgery, and change in antibiotics.

RESULTS

Among the 349 women with PID, 27 were HIV-positive. These HIV-positive women had lower mean white blood cell counts at admission (7411 versus 11,266, P < .01), lower mean lymphocyte counts (1411 versus 1928, P < .01), greater febrile morbidity (54 versus 28.3%, P < .01), and longer hospital stays (10.5 versus 6.4 days, P < .01) than HIV-negative women. Women who were HIV-positive required more time for defervescence and needed to change their antibiotic regimen more frequently (41 versus 12.7%, P < .01); differences in tubo-ovarian abscesses (19 versus 14%, P = .52) or surgery (15 versus 6.2%, P = .10) were not significant. The differences in hospital course between HIV-positive and HIV-negative women were modest, and they were resolved largely by the fourth or fifth hospital day. All HIV-positive women were treated successfully with first- or second-line antibiotic regimens.

CONCLUSION

Despite more severe initial presentation and a prolonged hospital course, HIV-positive women with PID, but without other acute illnesses, were treated successfully with standard therapeutic regimens. These observations support current recommendations for hospitalization of HIV-positive women with PID and treatment according to current standards.

Mimicry of the calcium-induced conformational state of troponin C by low temperature under pressure

Calcium binding to the N-domain of troponin C initiates a series of conformational changes that lead to muscle contraction. Calcium binding provides the free energy for a hydrophobic region in the core of N-domain to assume a more open configuration. Fluorescence measurements on a tryptophan mutant (F29W) show that a similar conformational change occurs in the absence of Ca2+ when the temperature is lowered under pressure. The conformation induced by subzero temperatures binds the hydrophobic probe bis-aminonaphthalene sulfonate, and the tryptophan has the same fluorescence lifetime (7 ns) as in the Ca2+-bound form. The decrease in volume (delta V = -25.4 ml/mol) corresponds to an increase in surface area. Thermodynamic measurements suggest an enthalpy-driven conformational change that leads to an intermediate with an exposed N-domain core and a high affinity for Ca2+.

Ataxia-ocular motor apraxia: a syndrome mimicking ataxia-telangiectasia

We report 14 patients with a slowly progressive syndrome featuring ataxia, choreoathetosis, and ocular motor apraxia in both the horizontal and vertical planes. Although the neurological signs were indistinguishable from those of ataxia-telangiectasia, the onset tended to be later and none of the patients had evidence of multisystemic involvement. Specifically, there was no tendency to frequent infections, and immunoglobulins, alpha-fetoprotein, T- and B-lymphocyte markers, and chromosomes 7 and 14 were normal in all tested patients. The simultaneous absence of telangiectasias and of other nonneurological manifestations made ataxia-telangiectasia an unlikely diagnosis. We suggest that these patients suffer from an unusual type of spinocerebellar degeneration. This syndrome has been observed in different populations from three continents, with a genetic pattern suggesting recessive autosomal inheritance.