Pathologic Criteria for the Diagnosis of Usual Interstitial Pneumonia vs Fibrotic Hypersensitivity Pneumonitis in Transbronchial Cryobiopsies

Transbronchial cryobiopsy (TBCB) is increasingly used for the diagnosis of fibrosing interstitial pneumonias, but there are few detailed descriptions of the pathologic findings in such cases. It has been proposed that a combination of patchy fibrosis and fibroblast foci with an absence of alternative features is diagnostic of usual interstitial pneumonia (UIP; ie, idiopathic pulmonary fibrosis [IPF]) in TBCB. In this study, we reviewed 121 TBCB in which a diagnosis of fibrotic hypersensitivity pneumonitis (FHP; n = 83) or IPF (n = 38) was made by multidisciplinary discussion and evaluated a range of pathologic features. Patchy fibrosis was found in 65 of 83 (78%) biopsies from FHP and 32of 38 (84%) biopsies from UIP/IPF cases. Fibroblast foci were present in 47 of 83 (57%) FHP and 27 of 38 (71%) UIP/IPF cases. Fibroblast foci/patchy fibrosis combined did not favor either diagnosis. Architectural distortion was seen in 54 of 83 (65%) FHP and 32 of 38 (84%) UIP/IPF cases (odds ratio [OR] for FHP, 0.35; P = .036) and honeycombing in 18 of 83 (22%) and 17 of 38 (45%), respectively (OR, 0.37; P = .014). Airspace giant cells/granulomas were present in 13 of 83 (20%) FHP and 1 of 38 (2.6%) UIP/IPF cases (OR for FHP, 6.87; P = .068), and interstitial giant cells/granulomas in 20 of 83 (24%) FHP and 0 of 38 (0%) UIP/IPF (OR, 6.7 x 106; P = .000). We conclude that patchy fibrosis plus fibroblast foci can be found in TBCB from both FHP and UIP/IPF. The complete absence of architectural distortion/honeycombing favors a diagnosis of FHP, as does the presence of airspace or interstitial giant cells/granulomas, but these measures are insensitive, and many cases of FHP cannot be separated from UIP/IPF on TBCB.

Curvularia and the Brain: Case Demonstration of Optimal Management

Background

Curvularia is a ubiquitous fungus found in tropical climates and has been reported to grow on marijuana leaves. Rarely, it can infect humans and propagate from the nasal sinuses into the brain.

Case

A 28-year-old immunocompetent patient presented with history of nasal polyps, headache, and subtle visual deficits on the right. Imaging revealed what appeared to be an invasive mass growing through the ethmoid and sphenoid sinuses into the anterior cranial fossa.

Results

Otolaryngology performed an endoscopic nasal biopsy with pathology and cultures consistent for Curvularia (figure 6). A combination case with neurosurgery and otolaryngology was planned. Surgeons used a bifrontal craniotomy and endonasal approach for gross total resection. Following resection, the patient was placed on 4 weeks of amphotericin treatment followed by 12 months of voriconazole based on recommendations by infectious disease. The patient has been stable since surgery.

Conclusion

Curvularia is a rare but potentially life threatening central nervous system infection that can be acquired from inhalational marijuana use. This illustrative case shows the importance of aggressive debridement followed by broad spectrum antifungal treatment to optimize outcome. With marijuana's increasing popularity, Curvalaria should be included on the differential diagnosis.

A pig slurry feast/famine feeding regime strategy to improve mesophilic anaerobic digestion efficiency and digestate hygienisation

The increasing concentration of livestock farms results in large amounts of waste production and the need for their management. The study of anaerobic digestion (AD) technology, under mesophilic conditions, applied to pig slurry is of the upmost importance for biogas recovery and sanitised digestate, contributing to a circular economy. The assessment of the effects of a feast/famine regime on biogas and biomethane (bio-CH₄) yield with different feeding frequencies was performed. The evaluation was made in regards to three scenarios: the first is based on daily feeding (FR1); in the second, the feeding occurs once every two days (FR2); and in the third, the feeding happens once every three days (FR3). The results demonstrate that the biogas and methane yield increased by 34% and 37% between FR1 and FR3. The stability inside the reactor was maintained since specific loading energetic rate values did not exceed the recommended limit (0.4 d^-1). It was also possible to conclude that the AD technology was efficient to sanitise the pig slurry, with the count of Escherichia coli going from 1 × 10⁵ colony-forming units (CFU) g^-1 to less than 100 CFU g^-1, meeting the legal requirements for agricultural valorisation. The total anaerobic mesophile plate counts were significantly (p < 0.1) reduced from feeding to digestate, and the plate counts of Clostridia were significantly (p < 0.05) increased, reflecting the changes in the composition of the microbiota. The increasing yield in bio-CH₄ in accordance with Clostridium counts suggests this genus as a positive microbiological key indicator of the AD performance.

The Retornus-2 study: impact of respiratory muscle training in subacute stroke patients with dysphagia, study protocol of a double-blind randomized controlled trial

Background

Stroke can lead to varying degrees of oropharyngeal dysphagia, respiratory muscle dysfunction and even increase medical complications such as aspiration, malnutrition and death. Recent studies suggest that inspiratory and expiratory respiratory muscle training (IEMT) can improve swallowing efficacy and may reduce aspiration events. The main purpose of this study is to examine whether an 8-week IEMT programme can improve respiratory muscle strength and swallow dysfunction severity in subacute stroke patients with dysphagia.

Methods

Retornus-2 is a two-arm, prospectively registered, randomized controlled study with blinded assessors and the participation of fifty individuals who have suffered a stroke. The intervention group undergoes IEMT training consisting of 5 sets of 10 repetitions, three times a day for 8 weeks. Training loads increase weekly. The control group undergoes a sham-IEMT protocol. The primary outcome examines the efficacy of the IEMT protocol to increase respiratory muscle strength and reduce dysphagia severity. The secondary outcome assesses the longitudinal impact of dysphagia on body composition and nutritional assessment over a 6-month follow-up.

Discussion

IEMT induces an improvement in respiratory muscle strength and might be associated with relevant benefits in dysphagia patterns, as well as a reduction in the number of aspiration events confirmed by videofluoroscopy or fiberoptic endoscopic evaluation of swallowing. The description of the impact of swallowing impairment on nutritional status will help develop new strategies to face this known side-effect.

Trial registration

Clinicaltrials.gov NCT03021252. Registered on 10 January 2017. https://clinicaltrials.gov/ct2/results?cond=retornus+2&term=&cntry=ES&state=&city=&dist=

WHO trial Registration data set: Due to heavy traffic generated by the COVID-19 outbreak, the ICTRP Search Portal does not respond. The portal recommends other registries such as clinicaltrials.gov. Protocol version: RETORNUS 2_ PROTOCOL_2.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05353-y.

[Cooperation between the department of ophthalmology at the University of Düsseldorf (Germany) and the Fundación Visión in Asunción (Paraguay) as an example of the German hospital partnerships programm]

BACKGROUND

A hospital partnership between the University Eye Hospital Düsseldorf (UAK Düsseldorf) and Fundación Visión in Asunción has existed since 2014 based on a memorandum of understanding. Fundación Visión plays a leading role in ophthalmological treatment and prevention of blindness in Paraguay. Since 2016 a program for the promotion of international hospital partnerships of the German government has been in place.

MATERIAL AND METHODS

Following a written application in 2016 the hospital partnership Düsseldorf-Asunción is funded by the Federal Ministry for Economic Cooperation in Germany. The aim of the project was to establish modern minimally invasive corneal transplantation techniques with faster postoperative rehabilitation and less follow-up in Paraguay with the help of several activities within a defined schedule. Secondary aims were to obtain first data on the prevalence of eye diseases in a typical patient cohort of the Fundación Visión and to establish an infrastructure for modern eye banking techniques in Paraguay.

RESULTS

First a Paraguayan surgeon was trained to carry out Descemet membrane endothelial keratoplasty (DMEK) transplantations in Germany. At the same time, the surgical instruments required for the DMEK technique were purchased and delivered to the Fundación Visión. In September 2018 the first lamellar corneal transplantations were successfully performed in Paraguay by the team from the Fundación Visión under the supervision of an experienced surgical team from Düsseldorf. Subsequently, the split cornea approach using a donor cornea for a posterior and an anterior lamellar keratoplasty (DMEK and DALK) was also implemented in Asunción. In November 2019 epidemiological data on eye diseases were collected during a field campaign of the Fundación Visión in a rural region of Paraguay. In the course of data collection an employee of the University Eye Hospital Düsseldorf learned small incision cataract surgery. In March 2019, a technician from the Fundación Visión was trained in Düsseldorf in corneal tissue culture techniques and preparation of amniotic membrane transplants in the Lions eye bank North-Rhine/Westfalia.

CONCLUSION

With the aid of a supported hospital partnership modern minimally invasive corneal transplantation techniques can be successfully transferred to the eye hospital of a developing country and in return surgical skills can be taught to surgeons from Germany who are in training. Therefore, an efficient hospital partnership is the basis for a mutual exchange and is not purely one-way traffic.

[Long-term cognitive and functional status in survivors of an aneurysmal subarachnoid hemorrhage: Analysis of a retrospective cohort]

OBJECTIVE

Little data is available on long-term functional and cognitive outcomes in patients with aneurysmal subarachnoid hemorrhage (ASH). The main objective of this study was to assess cognition, functional state, mood disorders, and quality of life in patients with SAH at least six months following the ASH.

PATIENTS AND METHODS

Cross-sectional study of 40 patients (aged 58.2 [SD 9.9] years) with ASH, discharged from a Neurologic Rehabilitation unit between January 2010 and July 2017.

MAIN OUTCOME VARIABLES

functional status (Barthel index), cognition (Pfeiffer questionnaire), depression (Hamilton scale), and health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), as well as type and duration of therapeutic rehabilitation procedures after discharge.

RESULTS

From 35 patients with cognitive disorders, only 12 received cognitive therapy at hospital discharge. In the long-term follow-up, cognitive impairment persisted in 22 patients. When compared with those without cognitive impairment, they presented significantly worse mean differences in the Barthel index (15.5 [95% CI: 1.2-29.7]), Hamilton scale (-0.8 [95% CI: -1.27 to -0.37]), and EQ-5D (27.6 [95% CI: 12.4-19]).

CONCLUSION

The prevalence of long-term cognitive impairments in survivors of a SAH episode is high, and their presence is associated with worse functional status, more depression and worse quality of life. The low percentage of subjects who received cognitive therapies through their recovery process and the clinical implications observed, support the need of including neuropsychological therapies in the rehabilitation programs after an SAH event.

Avaliação do ponto de congelamento do leite cru por espectroscopia de infravermelho com transformada de Fourier como método de triagem

RESUMO O objetivo deste estudo foi investigar a interferência do teor de gordura do leite no ponto de congelamento (PC) obtido pelo infravermelho com transformada de Fourier (FTIR). Uma fração de leite cru foi desnatada, obtendo-se creme e leite desnatado. O leite integral e o desnatado foram adicionados com água (0%, 2%, 5%, 10%, 15% e 20%). O leite desnatado remanescente foi adicionado com creme (5%, 10%, 15%, 20%) e água (0%, 2%, 5%, 10%, 15% e 20%). As amostras foram analisadas para PC (crioscópio eletrônico e FTIR) e composição (FTIR). O PC medido por FTIR foi altamente correlacionado com o método do crioscópio eletrônico (acima de 98,5%) e, como esperado, a adição de água foi significativa (P≤0,001) ao aumentar o PC do leite em ambos os métodos. No entanto, o alto teor de gordura no leite cru resultou na redução do PC ao se utilizar o FTIR, enquanto o baixo teor de gordura resultou em aumento do PC (P≤0,001). Uma vez que a adição de água causou o efeito inverso do alto teor de gordura no PC medido por FTIR, é importante considerar o teor de gordura do leite para evitar interpretações erradas do PC quando se utiliza o método FTIR.

Performance of Iris pseudacorus and Typha domingensis for furosemide removal in a hydroponic system

The potential of Iris pseudacorus and Typha domingensis to remove the pharmaceutical active compound (PhAC) Furosemide from a nutrient solution was assessed. Both plants were exposed to 2 mg L^-1 of furosemide during 21 days and the removal of furosemide was monitored. Vessels without furosemide were also implemented as control systems for plants development. Likewise, unplanted vessels with furosemide were employed to assess abiotic removal mechanisms. All vessels were covered with aluminum foil to avoid photodegradation of the compound. Both plants showed potential to remove Furosemide, attaining, at the end of the experiment, a removal of 42.0-66.9% and 40.5-57.8%, for Typha and Iris, respectively. The plants do not presented a visible negative stress response to the exposure to furosemide, having a positive growth rate at the end of the experiment. Biodegradation seems to play an important role in furosemide removal, being enhanced by the presence of the plants. The two macrophytes presented different removal behaviors, particularly in the first 48 h of contact time. FUR removal by Iris follows a pseudo-first order while by Typha is divide in different phases. These results indicate that different plants species seem to have different mechanisms to remove pollutants from water.HighlightsPhACs removal potential of Iris pseudacorus and Typha domingensis was assessed.Plants were exposed to 2 mg L^-1 of furosemide during 21 days.Both macrophytes showed good removal efficiencies.Biodegradation of furosemide seems to be the main removal mechanism.Plants demonstrated different removal behavior along the experiment.Removal mechanisms of plants seem to differ between species.

Translation and Validation of the Spanish Version of the SARC-F Questionnaire to Assess Sarcopenia in Older People

OBJECTIVES

The revised European consensus on sarcopenia definition and diagnosis (EWGSOP2) includes the SARC-F questionnaire, the most valid and consistent sarcopenia screening tool, as the mandatory first step. Our aim was the translation, cross-cultural adaptation, and validation of the SARC-F questionnaire as a culturally-responsive Spanish-language version for the European population.

STUDY DESIGN

Cross-sectional descriptive study, applying the two-step WHO methodology for translation and cross-cultural adaptation of health questionnaires, and harmonization with the Mexican-Spanish version. European Union Geriatric Medicine Society recommendations for SARC-F validation in European languages were considered.

PARTICIPANTS

Outpatient clinics of a university hospital.

INCLUSION CRITERIA

stable, ambulatory (including aids), community-dwelling population ≥65 years old.

MAIN OUTCOME MEASURES

The self-reported 5-item SARC-F questionnaire was administered; scores ≥4 indicated sarcopenia. Sensitivity, specificity, accuracy-likelihood ratios, predictive values, and kappa statistics were calculated and consecutively compared with European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2 criteria.

RESULTS

This Spanish version, administered in an average 70s, has adequate internal consistency (Cronbach alpha=0.779). For the validation study, 90 (43.3%) of 208 potentially eligible subjects (81.4 ± 5.9 years old, 75.6% women) were included. SARC-F identified 51 (56.7%) subjects with sarcopenia and 39 (43.3%) without the disease. Prevalence was 17.8% per EWGSOP and 25.6% per EWGSOP2 (58% accuracy and fair agreement: sensitivity, 78.3%; specificity, 50.8%).

CONCLUSIONS

SARC-F is a feasible tool, suitable for bedside assessment in community-dwelling older patients. Wide diffusion of this culturally-responsible SARC-F Spanish version is expected as EWGSOP2 is adopted and sarcopenia assessment is broadly implemented in Spain.

Furosemide removal in constructed wetlands: Comparative efficiency of LECA and Cork granulates as support matrix

The removal efficiency of LECA and cork granulates as support matrix for pharmaceuticals active compounds in a constructed wetland system was investigated using the diuretic drug Furosemide. Kinetics studies were performed testing three different concentrations of Furosemide in an ultrapure water matrix, along seven days. LECA achieved higher removal values compared to cork granulates. However, cork granulates presented a higher removal in the first 24 h of contact time compared to the other adsorbent. The kinetic studies showed that LECA and cork granulates have different adsorption behaviours for Furosemide which is controlled by different adsorption mechanisms. Both materials showed good removal efficiencies and a combination of the two should be further explored in order to applied both materials as support matrix to cope with different furosemide concentrations.

Overview of the state of the art of constructed wetlands for decentralized wastewater management in Brazil

Conventional wastewater treatment plants (WWTPs) commonly require large capital investments as well as operation and maintenance costs. Constructed wetlands (CWs) appear as a cost-effective treatment, since they can remove a broad range of contaminants by a combination of physical, chemical and biological processes with a low cost. Therefore, CWs can be successfully applied for decentralized wastewater treatment in regions with low population density and/or with large land availability as Brazil. The present work provides a review of thirty nine studies developed on CWs implemented in Brazil to remove wastewater contaminants. Brazil current sanitation data is also considered to evaluate the potential role of CWs as decentralized wastewater treatment. Performance of CWs was evaluated according to (i) type of wetland system, (ii) different support matrix (iii) vegetation species and (iv) removal efficiency of chemical oxygen demand (COD), biological oxygen demand (BOD₅), nitrogen (N), and phosphorus (P). The reviewed CWs in overall presented good efficiencies, whereas H-CWs achieved the highest removals for P, while the higher results for N were attained on VF-CW and for COD and BOD₅ on HF-CW. Therefore, was concluded that CWs are an interesting solution for decentralized wastewater treatment in Brazil since it has warm temperatures, extensive radiation hours and available land. Additionally, the low percentage of population with access to the sewage network in the North and Northeast regions makes these systems especially suitable. Hence, the further implementation of CW is encouraged by the authors in regions with similar characteristics as Brazil.

[Early pharmacologic treatment with botulinum toxin A in post-stroke spasticity: consensus evidence-based recommendations]

Spasticity is a common complication that occurs in those patients that have suffered a stroke. To identify those patients at high risk of having post-stroke spasticity and to start treatment at early stages would probably benefit the patient. The key aspects in the early management of post-stroke spasticity were review and the clinical implications and strength of evidences were also considered. The document drafted by the study coordinators was subsequently reviewed and then a validated document was developed. The experts recommend defining early treatment of spasticity as one that begins before the first three months after stroke. The panel considers very important to identify the risk factors associated with the onset of spasticity, since this might reduce its impact. Additionally, the most common conditions subsidiaries of early treatment of both upper and lower limb are defined. The panel recommends that the treatment with botulinum toxin A must only be given by specialists with experience in diagnosis and management of spasticity. In conclusion, the treatment of focal spasticity in the first three months after stroke is indicated in certain situations. These recommendations help to standardize the early management of post-stroke spasticity, with the consequent support to clinicians and patients.

Water-energy nexus: Anaerobic co-digestion with elephant grass hydrolyzate

The anaerobic co-digestion process in a continuous stirred-tank reactor (CSTR) was carried out under mesophilic conditions (37 ± 0.2 °C). All the trials were performed at a hydraulic retention time (HRT) of 15 days and the AD reactor was daily fed with a mixture of sewage sludge (SS) and elephant grass hydrolyzate (EGH). In this study, three different trials were assessed, with different mixture proportions of SSSS and EGH: F0 (100:0,v/v), F1 (75:25, v/v) and F2 (50:50, v/v), during 90 days each trial, keeping the organic loading rate (OLR) in a range of 0.94-1.16 g VS L(-1) day(-1). The experimental results obtained showed that the soluble chemical oxygen demand (SCOD) removal efficiency was around 77% and 86% for trials F1 and F2, respectively. SS co-digestion with EGH enhanced methane yield, leading to an increment between 23% and 38%, in comparison with the reference scenario (F0).

Use of simulations to enhance knowledge integration and livestock producers’ adaptation to variability in the climate in northern Uruguay

Basaltic soils have an extremely reduced capacity to accumulate water in Uruguay where they occupy 3.5 m ha (25% of the area of Uruguay) and are mainly exploited by extensive cattle production systems. Drought can have a negative effect on forage growth and cattle production and can have a devastating impact on the economy of livestock producers, and damage the entire beef-supply chain. To improve the livestock producers ability to adapt to climate variability, the past effects of droughts were modelled to understand the dynamics of droughts at the level of the production unit through the development of an interactive agent-based simulation model. The simulator was constructed in four steps by simulating: (i) forage growth using a logistic growth equation calibrated with data originated from the Moderate resolution imaging spectroradiometer (MODIS) satellite, (ii) the life cycle of livestock, (iii) the interaction between forage and livestock, and (iv) different strategies of management. Outputs of simulations were explored in five workshops with 82 livestock farmers and development actors. In these workshops, both biophysical models and those related to farm management were recognised as valid, and the typologies used were identified as realistic. Through the workshops and discussions about the models, the producers’ understanding of droughts was investigated. It was found that two types of information were important in encouraging better adaptation: (i) information that allowed a better understanding of the complex system and (ii) information that supported action. The workshops were found to valuable in generating a motivation to analyse and discuss climate variability.

Clinical effectiveness of grip strength in predicting ambulation of elderly inpatients

Background

Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients.

Methods

A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old). Manual muscle test was used for checking strength of hip flexor muscles, hip abductor muscles and knee extensor muscles. Grip strength was assessed by hydraulic dynamometer. Walking ability was assessed by functional ambulation categories and Functional Classification of Sagunto Hospital Ambulation. Existence of cognitive impairment (Short Portable Mental Status of Pfeiffer) and comorbidity (abbreviated Charlson index) were considered to be confounding variables.

Statistical analysis

Simple comparisons and mixed models of multiple ordinal regression.

Results

The sample presented generalized weakness in scapular (mean 4.22) and pelvic (mean 3.82) muscle. Mean hand grip values were similar: 11.98 kg right hand; 11.70 kg left hand. The patients had lost walking ability. After treatment, there was a statistically significant for scapular waist strength (P=0.001), pelvic waist strength (P=0.005) and walking ability (P=0.001). A statistically significant relationship in the regression analysis was found between the grip (right and left hands) and walking ability post-treatment (P=0.009; odds ratio 1.14 and P=0.0014 odds ratio 1.113 for each walking scale). The confounding variables showed no statistical significance in the results.

Conclusion

Grip strength is associated with walking ability in hospitalized frail elderly. Grip strength assessment by hydraulic dynamometry is useful in patients with poor collaboration. Walking ability training in frail elderly inpatients is useful.

Anaerobic co-digestion of dairy cattle manure and pear waste

Anaerobic co-digestion of pre-treated dairy cattle manure (LCM) with pear waste after a storage period (PLF) was tested at four inclusion levels: 0%, 25%, 75% and 100%. Inclusion levels consisted in the replacement of the volatile solids (VS) from the LCM with the VS from PLF keeping the organic loading rate around 1.1 ± 0.4 g SVL(-1)d(-1). The introduction of the co-substrate clearly enhanced methane production rate (MPR) in comparison to single substrate (phase I) as phases II and III, respectively, achieving values 1.3 and 2.8 times higher than phase I. The overall performance was optimized for the mixture 25:75 (LCM:PLF; v:v). Moreover, storage of pear waste did not compromise its use in AD. This fact is important once it can improve waste management from pear production through its valorisation as co-substrate in AD process.

Sports injuries in Brazilian blind footballers

The purpose of this study was to assess the characteristics and prevalence of sports-related injuries in visually disabled athletes of the Brazilian football 5-a-side team. The participants were 13 male athletes, all classified as B1 visual class, members of the Brazilian team, who played in five consecutive international competitions. Data were collected using the Brazilian Paralympic Committee and the Brazilian Confederation of Sports for the Blind report form. From the total of 13 athletes, 11 succumbed to some form of injury during the 5 competitions, which incorporated 23 matches, representing a prevalence of 84.6%. A total of 35 sports injuries were recorded, giving a clinical incidence of 2.7 injuries per athlete and an injury risk of 0.85 and an incidence rate of 0.12 injuries per match. Traumatic injuries (80%) were more common than overuse injuries (20%) (p<0.05). The highest distribution of injury was in the lower limbs (80%), followed by the head (8.6%), spine (5.7%) and upper limbs (5.7%). The body regions most affected were the knee (28.6%), feet (17.1%), ankle (11.4%) and thigh (11.4%). Contusions (31.4%), sprains (25.7%) and tendinopathy (8.6%) were the most frequent diagnoses. This is the first study to describe the nature and prevalence of sports-related injuries in 5-a-side football in blind athletes. The results are important in guiding strategies to inform the implementation of preventive pathways and provide a strong rationale for the compulsory use of additional protective equipment.

Utilization of wasted sardine oil as co-substrate with pig slurry for biogas production--a pilot experience of decentralized industrial organic waste management in a Portuguese pig farm

This work aimed to demonstrate in a pig farm and in real conditions, the possibilities to co-digest wasted sardine oil (WSO) and pig slurry (PS) at farm scale. A biogas mobile pilot plant, was set up in the farm and operated in real conditions during 4 months. Dynamic mesophilic (35-37 °C) continuous pilot trials were performed during four different periods of time. In each period a different organic loading rate (OLR) based on the chemical oxygen demand (COD) was operated sequentially, with pig slurry (PS) (OLR = 1.6 kg COD/m(3) d(-1)) and with mixtures of WSO:PS with a volumetric composition (% v/v) of 2:98 (OLR = 3.0 kg COD/m(3) d(-1)), 3:97 (OLR = 3.7 kg COD/m(3) d(-1)) and 5:95 (OLR = 5.2 kg COD/m(3) d(-1)). Biomass adapted very fast in metabolise the WSO and biogas productivity was raised substantially for different compositions of WSO:PS. Process stability indicators pH and Total volatile fatty acids/bicarbonate alkalinity (T-VFA/BA) ratio, suggests that the co-digestion process was robust. It was concluded that WSO could be easily co-digested in farm scale biogas plants.

[Trunk control test: early predictor of gait balance and capacity at 6 months of the stroke]

INTRODUCTION

It has been challenging to establish a prognostic tool in the acute period following stroke to predict gait outcomes. The purpose of this study is to determine the relationship between trunk control and other early functional prognostic measures with equilibrium and the capacity to ambulate at six months following acute stroke.

METHODS

Sixty-eight patients with stoke admitted consecutively to the Physical Medicine and Rehabilitation unit were followed prospectively. At one and two weeks following admission, the following data were collected: sex, age, type of stroke, urinary incontinence, National Institutes of Health Stroke Scale (NIHSS) and the Trunk Control Test (TCT). At six months following acute stroke, balance was assessed with the Berg Balance score, baropodometry, and computerized posturography as well as gait capacity (measured as velocity and gait ability and limits)

RESULTS

This study found a significant correlation between age, sex, urinary incontinence, TCT and NIHSS at one and two weeks from onset of stroke and the results of equilibrium and gait capacity at six months (p<0.05). When the TCT is <37 in the second week following acute stroke, the Berg Balance score was found to be lower, and with worse gait characteristics (<0.001). The TCT score in the second week is predictive of the achieving functional gait at the six month endpoint (area beneath the curve 0.920).

CONCLUSIONS

The TCT is a simple and quick test which may be considered as an early prognostic indicator for functional motor endpoints in the patient with stroke.

Organic residues as immobilizing agents in aided phytostabilization: (II) effects on soil biochemical and ecotoxicological characteristics

Sewage sludge (SS), municipal solid waste compost, and garden waste compost (GWC) were used as immobilizing agents in aided phytostabilization of an acid metal-contaminated soil affected by mining activities. The organic residues were applied at 25, 50 and 100 Mg ha(-1) (dry weight basis) and perennial ryegrass (Lolium perenne L.) was used as a "green cover". We studied the effects of the treatments on soil phytotoxicity and enzymatic activities, and on the composition and toxicity of the soil leachate towards Vibrio fischeri and Daphnia magna. Application of SS led to the greatest values of dehydrogenase, acid phosphatase, beta-glucosidase, protease and urease activities, corresponding to the greatest overall microbial and biochemical activity in amended soils. Conversely, GWC did not increase these enzymatic activities, relative to the unamended soil, or enhance ryegrass growth. Cellulase activity increased with increasing application rates of the amendments tested, but decreased at the highest SS application rate. The organic amendments were able to suppress soil toxicity to levels that did not affect D. magna, when applied at 50 and 100 Mg ha(-1), but SS, at the same application rates, increased the soil leachate toxicity towards V. fischeri. Moreover, ryegrass showed some phytotoxic symptoms when 100 Mg ha(-1) of SS were applied. This study showed the importance of an integrated evaluation of soil quality on remediation processes. Although SS immobilized trace metals and corrected soil acidity, improving soil biochemical status, when used at high application rates it led to toxicity of soil leachate towards V. fischeri, decreased soil cellulase activity and impaired ryegrass growth.

Organic residues as immobilizing agents in aided phytostabilization: (I) effects on soil chemical characteristics

A greenhouse experiment was conducted to evaluate the effect of three different organic residues, sewage sludge (SS), municipal solid waste compost (MSWC), and garden waste compost (GWC), as immobilizing agents in aided phytostabilization of a highly acidic metal-contaminated soil, affected by mining activities, using perennial ryegrass (Lolium perenne L.). The organic residues were applied at 25, 50 and 100 Mg ha(-1) (dry weight basis), and their effects on soil chemical characteristics and on relative plant growth and metal concentrations were assessed. All the organic residues tested immobilized Cu, Pb and Zn, decreasing their mobile fractions. This was corroborated by negative correlations obtained between mobile Cu, Pb and Zn and other soil chemical characteristics, which rose as a consequence of the amendments applied (i.e., pH, electrical conductivity, organic matter, nitrogen content, available P and available K), and by the multivariate exploratory techniques performed that showed an inverse correlation between these groups of variables. The greatest increase in ryegrass relative growth (more than three times) was obtained in the presence of 50 MgMS WC ha(-1), followed by SS at the same application dosage. GWC did not contribute to an increase in shoot growth, due to its small capacity to correct soil acidity and to supply essential macronutrients (N, P, K). No extractant was able of demonstrating by a linear correlation the uptake of Cu, Pb and Zn by ryegrass. This plant was therefore not a good "indicator" of Cu, Pb and Zn availability in the soil. The results obtained in this study suggest that ryegrass can be used in aided phytostabilization for this type of mine contaminated soils and that MSWC, and to a minor extent SS, applied at 50Mg ha(-1), were effective in the in situ immobilization of metals, improving soil chemical properties and leading to a large increase in plant biomass.

Aerobic treatment of winery wastewater with the aim of water reuse

An air micro-bubble bioreactor (AMBB) using a free self-adapted microbial population, 15 dm3 working volume, was used for aerobic treatment of winery wastewater. This reactor utilizes a Venturi injector in conjunction with mass transfer multiplier nozzles, which allow an efficient oxygen transfer. The reactor can operate in batch or continuous conditions. The dynamics of chemical oxygen demand (COD), biomass and total contents of polyphenolic compounds was followed throughout each trial. The wastewater COD ranged between 4.0-8.0 kg COD m(-3) and the efficiency of the batch treatment was about 90.0 +/- 4.3%, after 6 days of operation. The maximum efficiency obtained was achieved after 15 days of treatment (99%). In continuous conditions, the loading rate and the treatment efficiency ranged between 0.45-1.00 kg COD m(-3) d(-1) and 93.3 +/- 2.0%, respectively. The AMBB hydraulic retention time was 15 days. To assess the suitability of treated water in relation to vineyard irrigation, the effluent was physico-chemical analysed and direct toxicity bioassays with effluent matrix were carried out using Lepidium sativum L. seeds. The results showed the water quality required to be reutilised minimizing water consumption. This study will contribute for the implementation of an efficient water use plan, aiming the preservation of the water resource and the reduction of the wastewater production.

Evaluation of composts and liming materials in the phytostabilization of a mine soil using perennial ryegrass

A microcosm experiment was carried out to evaluate the effects of municipal solid waste compost (MSWC) or garden waste compost (GWC), and liming materials in the rehabilitation of a soil affected by mining activities, and to study the use of perennial ryegrass (Lolium perenne L.) for phystostabilization. The performance of the amendments was assessed by soil chemical parameters, total and bioavailable metals (Cu, Pb and Zn), soil enzymatic activities, and plant relative growth and mineral composition. In general, both composts corrected soil acidity and increased the total organic matter content of the soil, although with a better performance in the case of MSWC, especially when considering total N and available P and K levels in the amended soil. The application of both composts and liming materials led to a decrease in the mobile fractions of Cu, Pb and Zn, but mobilisable fractions of Cu and Zn increased with MSWC application. Plant biomass increased more than three times in the presence of 50 Mg MSWC ha(-1) and with the combined use of 25 or 50 Mg MSWC ha(-1) and CaO, but no significant differences were observed when GWC was applied. Plant tissue analysis showed that the treatments did not significantly reduce Cu, Pb and Zn uptake by the plant. Dehydrogenase, and the enzymes related to the N-cycle, urease and protease, had increased activities with increasing MSWC application rate. Conversely, the enzymatic activities of both enzymes related to the C-cycle, cellulase and beta-glucosidase, were only positively affected by GWC application, a compost obtained from raw materials rich in C. Principal component analyses evidenced this clear separation between the effect of MSWC on soil enzymes related to the N-cycle and of GWC on soil enzymes related to the C-cycle. This study indicates that MSWC (50 Mg ha(-1), limed or unlimed) can be used successfully in the remediation of a highly acidic metal-contaminated soil, allowing the establishment of perennial ryegrass.

Assessment of chemical, biochemical and ecotoxicological aspects in a mine soil amended with sludge of either urban or industrial origin

A greenhouse pot experiment was conducted to evaluate the effect of sewage sludge (SS), of sugar beet sludge (SBS), or of a combination of both, in the remediation of a highly acidic (pH 3.6) metal-contaminated soil, affected by mining activities. The SS was applied at 100 and 200 Mg ha(-1) (dry weight basis), and the SBS at 7 Mg ha(-1). All pots were sown with Italian ryegrass (Lolium multiflorum Lam.). After 60 d of growth, shoot biomass was quantified and analysed for Cu, Pb and Zn. The pseudo-total and bioavailable contents of Cu, Pb and Zn and the enzymatic activities of beta-glucosidase, acid phosphatase, cellulase, protease and urease were determined in the soil mixtures. Two indirect acute bioassays with leachates from the soil (luminescent inhibition of Vibrio fischeri and Daphnia magna immobilization) were also used. The SS, in particular when in combination with SBS, corrected soil acidity, while increasing the total organic matter content and the cation exchange capacity. The application of SS led to a decrease in the level of effective bioavailable metals (extracted by 0.01 M CaCl(2), pH 5.7, without buffer), but caused an increase in their potential bioavailability (extracted by a solution of 0.5M NH(4)CH(3)COO, 0.5 M CH(3)COOH and 0.01 M EDTA, pH 4.7). Plant biomass increased more than 10 times in the presence of 100 Mg SS ha(-1), and more than five times with the combined use of 100 Mg SS ha(-1) and SBS, but a considerable phytotoxic effect was observed for the application rate of 200 Mg SS ha(-1). Copper, Pb and Zn concentrations in the shoots of L. multiflorum decreased significantly when using 100 Mg SS ha(-1) or SBS. The activities of beta-glucosidase, urease and protease increased with increasing SS applications rates, but cellulase had a reduced activity when using 200 Mg ha(-1)SS. Both amendments were able to suppress soil toxicity to levels that did not affect D. magna, but increased the soil leachate toxicity towards V. fischeri, especially with the application of 200 Mg SS ha(-1). This study showed that for this type of mine soils, and when using SS of similar composition, the maximum SS application rate should be 100 Mg ha(-1), and that liming the SS amended soil with SBS did not contribute to a further improvement in soil quality.

Comparison of three DNA extraction methods for Mycobacterium bovis, Mycobacterium tuberculosis and Mycobacterium avium subsp. avium

AIMS

To compare three methods for DNA extraction from Mycobacterium bovis, Mycobacterium tuberculosis and Mycobacterium avium subsp. avium.

METHODS AND RESULTS

The DNA was extracted from mycobacterial cultures using enzymatic extraction, combined bead beating and enzymatic extraction and cetyltrimethylammonium bromide (CTAB) extraction. The yield and quality of DNA were compared by spectrophotometry, agarose gel electrophoresis, restriction endonuclease analysis and PCR. The combined bead beating and enzymatic extraction method yielded more DNA. However, that method produced some sheared DNA, visible either by agarose gel electrophoresis or by restriction endonuclease analysis. All methods were appropriate for PCR amplification of a 123 bp fragment of IS6110 in M. bovis and M. tuberculosis, and of a 1700 bp fragment of FR300 region in M. avium avium.

CONCLUSIONS

Combined bead beating and enzymatic extraction method was the most efficient and easy method for extracting DNA from bacteria of the M. tuberculosis complex.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results reveal important differences among the DNA extraction methods for mycobacteria, which are relevant for the success of further downstream molecular analysis.

Evaluation of tests to assess the quality of mine-contaminated soils

An acid metal-contaminated soil from the Aljustrel mining area (a pyrite mine located in SW Portugal in the Iberian Pyrite Belt) was subjected to chemical characterisation and total metal quantification (Cd, Cr, Cu, Ni, Pb and Zn). Water-soluble metals were determined and a sequential extraction procedure was used to investigate metal speciation. Two bioavailable metal fractions were determined: a mobile fraction and a mobilisable fraction. Soil ecotoxicity was studied using a battery of bioassays: plant growth test and seed germination with cress (Lepidium sativum L.), earthworm (Eisenia fetida) mortality, E. fetida avoidance behaviour, luminescent inhibition of Vibrio fischeri and Daphnia magna immobilisation. Although the total content of Cu, Zn and Pb in the soil was large (362, 245 and 1,250 mg/kg dry matter, respectively), these metals were mostly structurally bound (87% for Cu, 81% for Zn and 89% for Pb) and, therefore, scarcely bioavailable. Nonetheless, the D. magna immobilization test using soil leachate showed an EC50 (48 h) of 36.3% (v/v), and the luminescent inhibition of V. fischeri presented an EC20 (15 min) of 45.2% and an EC20 (30 min) of 10.7% (v/v), suggesting a considerable toxic effect. In the direct exposure bioassays, E. fetida avoided the mine soil at the highest concentrations (50%, 75% and 100% v/v). At the same soil concentrations, cress showed negligible growth. The results suggest the need to use a battery of toxicity tests, in conjunction with chemical methods, in order to assess the quality of mine-contaminated soils correctly.

Evaluation of chemical and ecotoxicological characteristics of biodegradable organic residues for application to agricultural land

The use of organic waste and compost as a source of organic matter and nutrients is a common practice to improve soil physico-chemical properties, meanwhile reducing the need for inorganic fertilisers. Official guidelines to assess sewage sludge and compost quality are mostly based on total metal content of these residues. Measurement of the total concentration of metals may be useful as a general index of contamination, but provides inadequate or little information about their bioavailability, mobility or toxicity when the organic residue is applied to the soil. However, ecotoxicity tests provide an integrated measure of bioavailability and detrimental effects of contaminants in the ecosystem. In the present study, three different types of biodegradable organic residues (BORs) have been considered: sewage sludge from municipal wastewater treatment (SS), compost from the organic fraction of unsorted municipal solid waste (MSWC), and garden waste compost (GWC). The BORs were subjected to chemical characterisation and total metal quantification (Cd, Cr, Cu, Ni, Pb and Zn), in order to verify their suitability for land application. Water leachability was determined through the DIN 38414-S4 method, while the modified BCR sequential extraction procedure was used for metal speciation. Ecotoxicity of the BORs was studied by direct and indirect bioassays. Direct toxicity bioassays were: plant growth tests with cress (Lepidium sativum L.) and barley (Hordeum vulgare L.), and earthworm (Eisenia fetida) mortality. On the other hand, indirect exposure bioassays, with leachate from the residues, took into account: luminescent bacteria (Vibrio fischeri), seed germination (L. sativum and H. vulgare) and Daphnia magna immobilization. As far as total metal concentration is concerned, with particular reference to Zn, SS resulted neither suitable for the use in agriculture nor compatible to be disposed of as an inert material into landfill, according to the Directive 1999/31/EC. Zinc in SS was mainly present in exchangeable form (28.5%), appearing as highly bioavailable. As a consequence, SS exhibited either high ecotoxicity effects with the indirect exposure bioassays or significant mortality with the earthworm bioassay. Total content of metals in MSWC allowed its classification as "stabilised biowaste", according to 2nd draft [DG Env.A.2. Working document of Biological treatment of biowaste - 2nd draft. Directorate-General Environment, Brussels, 12th February; 2001. accessed in:http://europa.eu.int/comm/environment/waste/facts_en.htm, at 10/09/2002] while leachate, on the basis of the concentration of these contaminants, could be classified as "inert waste". This residue showed significant ecotoxicity effects with direct exposure bioassays as well as with the luminescent bacteria bioassay. However, it resulted less toxic than SS. Finally, GWC could be classified as a Class 2 compost, with no detectable toxic effects on the organisms used in the bioassays, except for the luminescent bacteria. In this case, an EC(50) of 73.0% was observed. Considering the results, the use of a battery of toxicity test in conjunction with chemical analysis should be suggested, in order to correctly assess possible environmental risks deriving from disposal or land application of biodegradable organic residues.

[Short form 36 health questionnaire in hemiplegic patients 2 years after stroke]

INTRODUCTION

Many studies show that subjects with sequelae after stroke have a worse health perception in western societies. Due to the shortage of papers on the Spanish population in this regard, a study was carried out to assess health perception in hemiplegic patients 2 years after stroke in comparison with that of the general population and correlate health perception with demographic, clinical and functional variables.

METHODS

Cross-sectional study of 212 community stroke survivors. The main variables collected were: health perception assessed with the Short Form 36 (SF-36), disability assessed with the motor Functional Independence Measure (FIM) and Geriatric Depression Scale (GDS). Statistical tests used: chi2, Student t test and Spearman correlation coefficient.

RESULTS

In comparison with the Spanish general population, health perception in hemiplegic male stroke patients is diminished in all areas. In hemiplegic female patients, physical function is the only subscale significantly affected in all age groups. Variables related to worse health perception are: presence of depression, dependence and the belief of the need for kind of social support, A significant correlation was observed between SF-36 values and the motor FIM (r = 0.737 with physical function) and the GDS (r = -0.821 with mental health).

CONCLUSIONS

Health perception in hemiplegic patients 2 years after stroke is diminished in comparison with that 348 of the general population. Factors which determine worst health perception are depression, motor dependence, need of caregiver assistance and need of social support.

Trunk control test as a functional predictor in stroke patients

The purpose of this study was to evaluate prospectively the Trunk Control Test (TCT) correlation at admission to rehabilitation with length of stay, functional independence measure (FIM), gait velocity, walking distance and balance measured at discharge in 28 hemiparetic patients. FIM and TCT were registered on admission. Outcome measures at discharge were: FIM, gait velocity, walking distance and balance assessed with the Berg Balance Scale and computerized posturography. TCT was significantly correlated with length of stay (r = -0.722), discharge FIM (r = 0.738), discharge motor FIM (r = 0.723), gait velocity (r = 0.654), walking distance (p = 0.003), centre of gravity symmetry r = 0.601) and Berg Balance Scale (r = 0.755). Initial TCT predicts the 52% of the variation in length of stay and 54% in the discharge FIM. The predictive value of a compound variable (TCT and admission FIM) reaches 60% of the variation in length of stay and 66% in the FIM at discharge.

Diabetes in Bolivia

OBJECTIVE

To measure the prevalence of diabetes mellitus (DM), hypertension, obesity, and related risk factors in major cities in Bolivia.

METHODS

A population-based survey was conducted in four Bolivian cities: La Paz, El Alto, Santa Cruz, and Cochabamba. The total sample size was chosen to be 2,948 persons. The overall response rate was 86%, with the rate varying somewhat among the four cities. DM was diagnosed through an oral glucose tolerance test (OGTT) 2 hours after an overload of 75 grams of glucose, using World Health Organization criteria.

RESULTS

The overall prevalence of DM in the four urban areas combined was 7.2% (95% confidence interval (CI): 6.2%-8.3%) and of impaired glucose tolerance (IGT) was 7.8%. A total of 73.1% (95% CI: 65.0%-81.0%) of those previously diagnosed with DM and 73.7% (95% CI: 61.0%-86.4%) of newly diagnosed cases were overweight, according to measurements of body mass index. Hypertension was found in 36.5% (95% CI: 27.6%-45.5%) of known diabetics and in 36.6% (95% CI: 23.0%-50.1%) of newly diagnosed cases, compared to only 15.9% (95% CI: 14.3%-17.5%) among people without DM. The disease was most common among older persons and those with little education.

CONCLUSIONS

Diabetes is a genuine public health problem in Bolivia. Further, the high prevalence of IGT that was found suggests that diabetes prevalence will increase in the near future in the country unless prevention strategies are implemented.

Inhibition of CCR5-dependent HIV-1 infection by hairpin ribozyme gene therapy against CC-chemokine receptor 5

CCR-5 is a major cellular coreceptor for R5 strains of HIV-1. Individuals carrying a homozygous 32-base-pair deletion in this gene are apparently healthy and are relatively resistant to HIV-1 infection. Since CCR5 appears to be dispensable for the host, but important for initial HIV-1 infection, CCR5 mRNA is an excellent therapeutic target for inhibiting HIV-1 replication via ribozyme knockout. We report here that hairpin ribozymes are able to reduce cellular CCR5 mRNA and cell surface CCR5 when stably introduced into PM1 cells by transduction with recombinant adenoassociated viral vector. The ribozymes effectively protect the cells from infection by R5 HIV-1 strains or non-syncytium-inducing clinical isolates commensurate with a reduction in CCR5 mRNA. These results suggest a novel gene therapy approach to preventing or slowing the disease progression of HIV-1 infection.

[Spontaneous remission of cervical epidural hematoma with pathological confirmation]

Spontaneous cervical epidural hematoma (CEH) is a rare entity but one that can cause permanent neurologic deficit unless, it is widely believed, surgical evacuation is prompt. A diagnosis of CEH is confirmed by computed tomography and/or magnetic resonance imaging. Spontaneous remission is unusual, with only 7 such cases reported in the literature as of 1993. We present a case of CEH with clinical remission and confirmation by neuroimaging in a patient who died of an unrelated cause. We conclude that when neurologic deficit is incomplete and there are no signs of clinical progression after 48 h, surgical treatment should not be applied routinely.

Rapid fitness losses in mammalian RNA virus clones due to Muller's ratchet

Muller's ratchet is an important concept in population genetics. It predicts that when mutation rates are high and a significant proportion of mutations are deleterious, a kind of irreversible ratchet mechanism will gradually decrease the mean fitness of small populations of asexual organisms. In contrast, sexual recombination may stop or reverse this mutational ratchet by recombinational repair of genetic damage. Experimental support for Muller's ratchet has previously been obtained in protozoa and in a tripartite RNA bacteriophage. We now show clear evidence that Muller's ratchet can operate on a nonsegmented nonrecombining pathogenic RNA virus of animals and humans. We did genetic bottleneck passages (plaque-to-plaque transfers) of vesicular somatitis virus (VSV) and then quantitated relative fitness of the bottleneck clones by allowing direct replication competition in mixed infections in cell culture. We document variable fitness drops (some severe) following only 20 plaque-to-plaque transfers of VSV. In some clones no fitness changes (or only insignificant changes) were observed. Surprisingly, the most regular and severe fitness losses occurred during virus passages on a new host cell type. These results again demonstrate the extreme genetic and biological variability of RNA virus populations. Muller's ratchet could have significant implications for variability of disease severity during virus outbreaks, since genetic bottlenecks must often occur during respiratory droplet transmissions and during spread of low-yield RNA viruses from one body site to another (as with human immunodeficiency virus). Likewise, the lower-probability generation of increased-fitness clones during repeated genetic bottleneck transfers of RNA viruses in nature might also affect disease pathogenesis in infected individuals and in host populations. Whenever genetic bottlenecks of RNA viruses occur, enhanced biological differences among viral subpopulations may result.

Quantitation of relative fitness and great adaptability of clonal populations of RNA viruses

We describe a sensitive, internally controlled method for comparing the genetic adaptability and relative fitness of virus populations in constant or changing host environments. Certain monoclonal antibody-resistant mutants of vesicular stomatitis virus can compete equally during serial passages in mixtures with the parental wild-type clone from which they were derived. These genetically marked "surrogate wild-type" neutral mutants, when mixed with wild-type virus, allow reliable measurement of changes in virus fitness and of virus adaptation to different host environments. Quantitative fitness vector plots demonstrate graphically that even clones of an RNA virus are composed of complex variant populations (quasispecies). Variants of greater fitness (competitive replication ability) were selected within very few passages of virus clones in new host cells or animals. Even clones which were well adapted to BHK21 cells gained further fitness during repeated passages in BHK21 cells.

Virus mutation frequencies can be greatly underestimated by monoclonal antibody neutralization of virions

Monoclonal antibody-resistant mutants have been widely used to estimate virus mutation frequencies. We demonstrate that standard virion neutralization inevitably underestimates monoclonal antibody-resistant mutant genome frequencies of vesicular stomatitis virus, due to phenotypic masking-mixing when wild-type (wt) virions are present in thousandsfold greater numbers. We show that incorporation of antibody into the plaque overlay medium (after virus penetration at 37 degrees C) can provide accurate estimates of genome frequencies of neutral monoclonal antibody-resistant mutant viruses in wt clones. By using this method, we have observed two adjacent G----A base transition frequencies in the I3 epitope to be of the order of 10(-4) in a wt glycine codon. This appears to be slightly lower than the frequencies observed at other sites for total (viable and nonviable) virus genomes when using a direct sequence approach.

Field evaluation of a simplified unit-dose syringe for administration of measles vaccine

Ezeject is a plungerless syringe prefilled with lyophilized measles vaccine. Ezeject syringes were compared with standard 3-cc syringes and 10-dose measles vaccine vials in the vaccination of 884 Guatemalan infants 8-23 months of age. Vaccination was performed by experienced vaccinators and by individuals without prior vaccination experience who received 2.5-3 hours of training. The overall seroconversion rate following administration was 96%, regardless of the type of syringe used or of the experience of the vaccinator. No significant adverse events were observed in children vaccinated with the new syringes. Although incomplete emptying was noted in 87% of the Ezeject syringes used, this had no effect on the serologic response to measles vaccine. Aspiration for detection of blood before injection of the vaccine was performed significantly (P less than .001) less frequently with Ezeject than with 3-cc syringes by both experienced and inexperienced personnel. Inexperienced vaccinators administered measles vaccine significantly faster (P less than .001) with Ezeject than with 3-cc syringes, but the times were similar for experienced vaccinators. Ezeject is an acceptable alternative to standard syringes for the administration of measles vaccine. Several design modifications that would improve the handling of the device and eliminate the possibility of its reuse have been suggested.

Marginal malnutrition and reduced physical work capacity of migrant adolescent boys in Southern Brazil

We measured the effect of marginal malnutrition on physical work capacity of adolescent children of agricultural migrant workers in Southern Brazil. Nutritional status was evaluated using 24-h dietary recall. Body size was evaluated anthropometrically. Biochemical assessments were also made. Physical work capacity (PWC170) was assessed by measuring heart rate, blood lactic acid levels, and oxygen consumption during submaximal bicycle ergometer work. The same tests were also carried out on a comparable group of local well-to-do boys of the same age in the same community who served as controls. The dietary results suggest that adolescent boys of migrant families were marginally malnourished. Their physical growth and development were retarded by at least 1 yr. They had significantly lower reserves of body fat and less muscle mass when compared with controls. Their Hb levels were normal. At the submaximal work loads measured (0, 25, 50, 75 W) the migrant children exhibited similar oxygen consumption and gross exercise efficiency as the control children, but achieved this work at a higher percentage of their maximum work capacity as shown by significantly higher heart rates for the same oxygen consumption. Higher blood lactic acid levels in the migrant children suggest that the available muscle mass was under greater stress to accomplish the same task. PWC170 was reduced one-third in the migrant children (migrant 643 +/- 162 kpm/min, control 905 +/- 345 kpm/min; p less than 0.005). These differences were largely associated with weight (migrant 20.6 +/- 5.9 kpm/min; control 18.8 +/- 4.3 kpm/kg/min; p greater than 0.1). These observations suggest that marginal as well as severe malnutrition affect physical work capacity at levels low enough to affect growth and development.