Diversity, multifaceted evolution, and facultative saprotrophism in the European Batrachochytrium salamandrivorans epidemic

While emerging fungi threaten global biodiversity, the paucity of fungal genome assemblies impedes thoroughly characterizing epidemics and developing effective mitigation strategies. Here, we generate de novo genomic assemblies for six outbreaks of the emerging pathogen Batrachochytrium salamandrivorans (Bsal). We reveal the European epidemic currently damaging amphibian populations to comprise multiple, highly divergent lineages demonstrating isolate-specific adaptations and metabolic capacities. In particular, we show extensive gene family expansions and acquisitions, through a variety of evolutionary mechanisms, and an isolate-specific saprotrophic lifecycle. This finding both explains the chytrid's ability to divorce transmission from host density, producing Bsal's enigmatic host population declines, and is a key consideration in developing successful mitigation measures.

Blastomycosis in Africa and the Middle East: A Comprehensive Review of Reported Cases and Reanalysis of Historical Isolates Based on Molecular Data

BACKGROUND

Blastomycosis has been reported from countries in Africa and the Middle East, but a decades-long debate has persisted regarding whether this is the same disease known in North America and caused by Blastomyces dermatitidis and Blastomyces gilchristii.

METHODS

We reviewed published cases of human and veterinary blastomycosis from Africa and the Middle East. We abstracted epidemiological and clinical features of cases, including sites of disease, diagnosis, management, outcomes, and, where available, genetic and antigenic typing of case isolates. In addition, we sequenced nucleic acids from 9 clinical isolates from Africa deposited in global collections as B. dermatitidis; for 5, we sequenced the internal transcribed spacer regions, and for the other 4 we sequenced the whole genomes.

RESULTS

We identified 172 unique human patients with blastomycosis, including 159 patients from 25 African countries and 12 patients from 5 Middle Eastern countries, and also identified 7 reports of veterinary blastomycosis. In humans, cutaneous disease predominated (n = 100/137, 73%), followed by pulmonary (n = 73/129, 57%) and osteoarticular involvement (n = 61/128, 48%). Unusual direct microscopy/histopathological presentations included short hyphal fragments in tissues (n = 23/129, 18%). There were 34 genotyped case isolates that comprised 4 species: Blastomyces percursus (n = 22, 65%), from 8 countries throughout all regions; Blastomyces emzantsi (n = 9, 26%), from South Africa; B. dermatitidis (n = 1, 3%), from the Democratic Republic of Congo; and B. gilchristii (n = 2, 6%), from South Africa and Zimbabwe.

CONCLUSIONS

Blastomycosis occurs throughout Africa and the Middle East and is caused predominantly by B. percursus and, at least in South Africa, B. emzantsi, resulting in distinct clinical and pathological patterns of disease.

In Vitro Antifungal Resistance of Candida auris Isolates from Bloodstream Infections, South Africa

Candida auris is a multidrug-resistant fungal pathogen that is endemic in South African hospitals. We tested bloodstream C. auris isolates that were submitted to a reference laboratory for national laboratory-based surveillance for candidemia in 2016 and 2017. We confirmed the species identification by phenotypic/molecular methods. We tested susceptibility to amphotericin B, anidulafungin, caspofungin, micafungin, itraconazole, posaconazole, voriconazole, fluconazole, and flucytosine using broth microdilution and Etest methods. We interpreted MICs using tentative breakpoints. We sequenced the genomes of a subset of isolates and compared them to the C. auris B8441 reference strain. Of 400 C. auris isolates, 361 (90%) were resistant to at least one antifungal agent, 339 (94%) to fluconazole alone (MICs of ≥32 µg/ml), 19 (6%) to fluconazole and amphotericin B (MICs of ≥2 µg/ml), and 1 (0.3%) to amphotericin B alone. Two (0.5%) isolates from a single patient were pan-resistant (resistant to fluconazole, amphotericin B, and echinocandins). Of 92 isolates selected for whole-genome sequencing, 77 clustered in clade III, including the pan-resistant isolates, 13 in clade I, and 2 in clade IV. Eighty-four of the isolates (91%) were resistant to at least one antifungal agent; both resistant and susceptible isolates had mutations. The common substitutions identified across the different clades were VF125AL, Y132F, K177R, N335S, and E343D in ERG11; N647T in MRR1; A651P, A657V, and S195G in TAC1b; S639P in FKS1HP1; and S58T in ERG3. Most South African C. auris isolates were resistant to azoles, although resistance to polyenes and echinocandins was less common. We observed mutations in resistance genes even in phenotypically susceptible isolates.

Understanding the Emergence of Multidrug-Resistant Candida: Using Whole-Genome Sequencing to Describe the Population Structure of Candida haemulonii Species Complex

The recent emergence of a multidrug-resistant yeast, Candida auris, has drawn attention to the closely related species from the Candida haemulonii complex that include C. haemulonii, Candida duobushaemulonii, Candida pseudohaemulonii, and the recently identified Candida vulturna. Here, we used antifungal susceptibility testing and whole-genome sequencing (WGS) to investigate drug resistance and genetic diversity among isolates of C. haemulonii complex from different geographic areas in order to assess population structure and the extent of clonality among strains. Although most isolates of all four species were genetically distinct, we detected evidence of the in-hospital transmission of C. haemulonii and C. duobushaemulonii in one hospital in Panama, indicating that these species are also capable of causing outbreaks in healthcare settings. We also detected evidence of the rising azole resistance among isolates of C. haemulonii and C. duobushaemulonii in Colombia, Panama, and Venezuela linked to substitutions in ERG11 gene as well as amplification of this gene in C. haemulonii in isolates in Colombia suggesting the presence of evolutionary pressure for developing azole resistance in this region. Our results demonstrate that these species need to be monitored as possible causes of outbreaks of invasive infection.

Pathways of Pathogenicity: Transcriptional Stages of Germination in the Fatal Fungal Pathogen Rhizopus delemar

Rhizopus delemar is an invasive fungal pathogen responsible for the frequently fatal disease mucormycosis. Germination, a crucial mechanism by which infectious spores of Rhizopus delemar cause disease, is a key developmental process that transforms the dormant spore state into a vegetative one. The molecular mechanisms that underpin this transformation may be key to controlling mucormycosis; however, the regulation of germination remains poorly understood. This study describes the phenotypic and transcriptional changes that take place over the course of germination. This process is characterized by four distinct stages: dormancy, isotropic swelling, germ tube emergence, and hyphal growth. Dormant spores are shown to be transcriptionally unique, expressing a subset of transcripts absent in later developmental stages. A large shift in the expression profile is prompted by the initiation of germination, with genes involved in respiration, chitin, cytoskeleton, and actin regulation appearing to be important for this transition. A period of transcriptional consistency can be seen throughout isotropic swelling, before the transcriptional landscape shifts again at the onset of hyphal growth. This study provides a greater understanding of the regulation of germination and highlights processes involved in transforming Rhizopus delemar from a single-cellular to multicellular organism.IMPORTANCE Germination is key to the growth of many organisms, including fungal spores. Mucormycete spores exist abundantly within the environment and germinate to form hyphae. These spores are capable of infecting immunocompromised individuals, causing the disease mucormycosis. Germination from spore to hyphae within patients leads to angioinvasion, tissue necrosis, and often fatal infections. This study advances our understanding of how spore germination occurs in the mucormycetes, identifying processes we may be able to inhibit to help prevent or treat mucormycosis.

GROUT-CONCRETE INTERFACE BOND PERFORMANCE: EFFECT OF INTERFACE MOISTURE ON THE TENSILE BOND STRENGTH AND GROUT MICROSTRUCTURE

Bond between two cementitious materials is crucial in applications such as repairs, overlays, and connections of prefabricated bridge elements (PBEs), to name just a few. It is the latter that has special interest to the authors of this paper. After performing a dimensional stability study on grout-like materials commonly used as connections between PBEs, it was observed that the so-called 'non-shrink' cementitious grouts showed a considerable amount of early-age shrinkage. This might have negative effects on the integrity of the structure, due not only to the grout material's early degradation, but also to a possible loss of bond between the grout and the prefabricated concrete element. Many factors affect the bond strength between two cementitious materials (e.g., grout-concrete), the presence of moisture at the existing concrete substrate surface being one of them. In this regard, pre-moistening the concrete substrate surface prior to the application of the grout material is sometimes recommended for bond enhancement. This topic has been the focus of numerous research studies in the past; however, there is still controversy among practitioners on the real benefits that this practice might provide. This paper evaluates the tensile bond performance of two non-shrink cementitious grouts applied to the exposed aggregate surface of a concrete substrate, and how the supply of moisture at the grout-concrete interface affects the bond strength. "Pull-off" bond results show increased tensile bond strength when the concrete surface is pre-moistened. Reasons to explain the observed increased bond strength are given after a careful microstructural analysis of the grout-concrete interface. Interfaces where sufficient moisture is provided to the concrete substrate such that moisture movement from the grout is prevented show reduced porosity and increased hydration on the grout side of the interface, which is thought to directly contribute to the increased tensile bond strength.

Influence of Substrate Moisture State and Roughness on Interface Microstructure and Bond Strength: Slant Shear vs. Pull-Off Testing

There are conflicting views in the literature concerning the optimum moisture state for an existing substrate prior to the application of a repair material. Both saturated-surface-dry (SSD) and dry substrates have been found to be preferable in a variety of studies. One confounding factor is that some studies evaluate bonding of the repair material to the substrate via pull-off (direct tension) testing, while others have employed some form of shear specimens as their preferred testing configuration. Available evidence suggests that dry substrate specimens usually perform equivalently or better in shear testing, while SSD ones generally exhibit higher bond strengths when a pull-off test is performed, although exceptions to these trends have been observed. This paper applies a variety of microstructural characterization tools to investigate the interfacial microstructure that develops when a fresh repair material is applied to either a dry or SSD substrate. Simultaneous neutron and X-ray radiography are employed to observe the dynamic microstructural rearrangements that occur at this interface during the first 4 h of curing. Based on the differences in water movement and densification (particle compaction) that occur for the dry and SSD specimens, respectively, a hypothesis is formulated as to why different bond tests may favor one moisture state over the other, also dependent on their surface roughness. It is suggested that the compaction of particles at a dry substrate surface may increase the frictional resistance when tested under slant shear loading, but contribute relatively little to the bonding when the interface is submitted to pull-off forces. For maximizing bond performance, the fluidity of the repair material and the roughness and moisture state of the substrate must all be given adequate consideration.

Novel taxa of thermally dimorphic systemic pathogens in the Ajellomycetaceae (Onygenales)

Recent discoveries of novel systemic fungal pathogens with thermally dimorphic yeast-like phases have challenged the current taxonomy of the Ajellomycetaceae, a family currently comprising the genera Blastomyces, Emmonsia, Emmonsiellopsis, Helicocarpus, Histoplasma, Lacazia and Paracoccidioides. Our morphological, phylogenetic and phylogenomic analyses demonstrated species relationships and their specific phenotypes, clarified generic boundaries and provided the first annotated genome assemblies to support the description of two new species. A new genus, Emergomyces, accommodates Emmonsia pasteuriana as type species, and the new species Emergomyces africanus, the aetiological agent of case series of disseminated infections in South Africa. Both species produce small yeast cells that bud at a narrow base at 37°C and lack adiaspores, classically associated with the genus Emmonsia. Another novel dimorphic pathogen, producing broad-based budding cells at 37°C and occurring outside North America, proved to belong to the genus Blastomyces, and is described as Blastomyces percursus.

Involvement of the 90 kDa heat shock protein during adaptation of Paracoccidioides brasiliensis to different environmental conditions

HSP90 is a molecular chaperone that participates in folding, stabilization, activation, and assembly of several proteins, all of which are key regulators in cell signaling. In dimorphic pathogenic fungi such as Paracoccidioides brasiliensis, the adaptation to a higher temperature, acid pH and oxidative stress, is an essential event for fungal survival and also for the establishing of the infectious process. To further understand the role of this protein, we used antisense RNA technology to generate a P. brasiliensis isolate with reduced PbHSP90 gene expression (PbHSP90-aRNA). Reduced expression of HSP90 decreased yeast cell viability during batch culture growth and increased susceptibility to acid pH environments and imposed oxidative stress. Also, PbHSP90-aRNA yeast cells presented reduced viability upon interaction with macrophages. The findings presented here suggest a protective role for HSP90 during adaptation to hostile environments, one that promotes survival of the fungus during host-pathogen interactions.

Differential PbP27 expression in the yeast and mycelial forms of the Paracoccidioides brasiliensis species complex

p27 is an antigenic protein produced by Paracoccidioides brasiliensis, the etiologic agent of paracoccidioidomycosis (PCM). Despite its unknown function, it has been suggested as a putative virulence factor, proposed as a suitable target for the design of diagnostic tools and vaccines, and considered as an enhancer in antifungal treatment of PCM. We evaluated sequence polymorphisms of PbP27 gene sequence among isolates, finding some polymorphisms associated with the isolates' phylogenetic origin. In order to determine if there was a differential expression pattern between morphological states and among isolates, we also evaluated PbP27 expression, at transcriptional and translational levels, in mycelia and yeast cultures in 14 isolates belonging to the P. brasiliensis species complex (S1, PS2, PS3, and "Pb01-like", proposed to be named Paracoccidioides lutzii) by two techniques, real time RT-PCR (RT-qPCR) and protein dot blot. For the latter, four protein extracts from different cell localizations (SDS or β-mercaptoethanol, cytoplasmic and extracellular proteins) were analyzed for each isolate. p27 was present in the four extracts evaluated, mainly in the SDS extract, corresponding to an extract containing proteins loosely attached to the cell wall. This information correlates with immunohistochemical analysis, where positive staining of the yeasts' cell wall was observed. We found that p27 was present in all isolates, mainly in the yeast form. This pattern was corroborated by RT-qPCR results, with higher expression levels found in the yeast form for most of the isolates. The results provide new insights into the expression patterns of this protein, and further characterize it in view of potential uses as a diagnostic and/or therapeutic tool.

Estimators and confidence intervals for the proportion using binary auxiliary information with applications to pharmaceutical studies

Estimation of a proportion is commonly used in areas such as medicine, biopharmaceutical experiments, etc. Estimation of a proportion using auxiliary information has not been investigated in the literature. Ratio estimators of the population proportion and two-sided confidence intervals based upon auxiliary information are derived in this paper. Real data extracted from the Spanish National Health Survey are used to demonstrate the application of the proposed methods in the estimation of prevalences. Results derived from simulation studies show that proposed estimators are more efficient than the traditional estimator. Proposed confidence intervals outperform the alternative methods, especially in terms of interval width. A study on patients with hypertension is also considered to calculate various estimators and confidence intervals.

[Spanish version of the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit). Pilot study of validation]

OBJECTIVE

To validate the Spanish version of the CAM-ICU.

DESIGN

Validation study. The inter-rater reliability and validity were evaluated using a blind comparison with the DSM-IVTR criteria (reference standard) in a group of patients hospitalized in an Intensive Care Unit (ICU).

SETTING

Medical-surgical ICU.

PATIENTS

129 adults with RASS >-4 score, within the 24-48 h of ICU admission. Independent application of the CAM-ICU by two intensive care specialists and evaluation by a psychiatrist using the DSM-IVTR criteria for delirium.

RESULTS

Prevalence of delirium in the sample was 26.4%, this being and 48.3% in the 29 patients who received mechanical ventilation. Inter-rater reliability in the whole sample according to the Kappa index was 0.792 (95% CI 0.662-0.922, p<0.001) and in those who received mechanical ventilation was 0.726 (95% CI 0.487-0.965, p<0.001). The sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were 79.4% (95% CI 63.2-89.7%); 97.9% (95% CI 92.6-99.4%); 93.1% (95% CI 78.0-98.1%); 93.0% (95% CI 86.3-96.6%); 37.72 (95% CI 9.47-150.20) and 0.21(95% CI 0.11-0.41), respectively, in the whole sample. In mechanically-ventilated patients, sensitivity, specificity, PPV, NPV, +LR and -LR were 92.9% (95% CI 68.5-98.7%); 86.7% (95% CI 62.1-96.3%); 86.7% (95% CI 62.1-96.3%); 92.9% (95% CI 68.5-98.7%); 6.96(95% CI 1.90-25.51) and 0.08 (95% CI 0.01-0.55), respectively.

CONCLUSION

The Spanish version of the CAM-ICU is reliable. Its sensitivity, specificity and predictive values should be considered good.

Evaluation of six pesticides leaching indexes using field data of herbicide application in Casablanca Valley, Chile

A field study was performed to evaluate the accuracy of six pesticide screening leaching indexes for herbicide movement. Adsorption, dissipation and soil movement were studied in a vineyard in a sandy loam soil during 2005 season. Simazine, diuron, pendimethalin, oxyfluorfen and flumioxazin were applied to bare soil at rates commonly used, and their soil concentrations throughout soil profile were determined at 0, 10, 20, 40 and 90 days after application (DAA). Herbicides were subjected to two pluviometric regimens, natural field condition and modified conditions (plus natural rainfall 180 mm). Leaching indexes utilized were: Briggs's Rf, Hamaker's Rf, LEACH, LPI, GUS and LIX. Simazine reached 120 cm, diuron 90 cm, flumioxazin 30 cm soil depth respectively. Pendimethalin and oxyfluorfen were retained up to 5 cm. None of the herbicides leaching was affected by rainfall regimen. Only flumioxazin field dissipation was clearly affected by pluviometric condition. The best representation of the herbicide soil depth movement and leaching below 15 cm soil depth were: Hamaker's Rf < Briggs's Rf < GUS < LPI, < LEACH < LIX. Field results showed a good correlation between herbicides K(d) and their soil depth movement and mass leached below 15 cm soil depth.

Effect of human immunodeficiency virus type 1 on intracellular activation and superoxide production by neutrophils

The immunopathogenesis of AIDS is associated with the development of opportunistic infections by intracellular pathogens that can invade and reproduce freely because of impaired cellular functions. Neutrophils from asymptomatic human immunodeficiency virus (HIV) type 1-infected persons and from symptomatic patients with AIDS were found to retain normal phagocytosis activity while producing significantly less superoxide than neutrophils from HIV-1-negative subjects, when stimulated through Fc receptors or protein kinase C. After priming with a synthetic HIV-1 envelope peptide and stimulation via the Fc receptor, the neutrophils from HIV-1-negative controls had suppressed superoxide production, reduced phosphorylation of two unidentified cellular proteins, and increased expression of a third phosphoprotein. These results suggest that HIV-1 can produce direct functional damage of neutrophils through binding of envelope components to the cell membrane.

[Comparative study of three systems for in vitro activity investigation of fluconazole against yeast isolates of clinical interest]

BACKGROUND

Study of antifungal sensitivity can help in treatment screening and evaluation of patients suffering from some fungal infections. The purpose of this study is to compare fluconazole MICs obtained by E-test and agar dilution with the NCCLS method.

MATERIAL AND METHODS

The in vitro activity of fluconazole against 158 yeast strains by three systems: E-test, agar dilution and the microbroth NCCLS M27P method.

RESULTS AND CONCLUSION

A correlation between 84 to 100% was observed the degree varying in the result among different species. The E-test was found to be comparable to the NCCLS M27P microbroth method, was easier to perform and provides MIC result for Candida species within 24 h.

Study of the susceptibility of yeast isolates of clinical interest to five antifungal agents using the E test

The E test is a quantitative technique for determining antimicrobial susceptibility; it is based on the diffusion of a stable predetermined gradient of a specific antifungal agent along an inert plastic strip which is applied to a solid culture medium. The E test is an alternative method for determining inhibitory concentrations of antimicrobial agents. The aim of the present study was to determine the in vitro susceptibility of different yeasts to 5 antifungal agents using the E test. The antifungal susceptibility of 87 strains, 73 of which were yeasts obtained from clinical samples, 11 were Prototheca strains and 3 controls, were examined using a gradient diffusion technique (E test). Of these isolates, 13% of Candida albicans were resistant to flucytosine, and 20%, 17% and 33% showed resistance to ketoconazole, itraconazole and fluconazole, respectively. All Candida krusei isolates showed resistance to flucytosine and fluconazole. The Candida parapsilosis and Candida tropicalis strains all presented in vitro susceptibility to all the agents tested. Prototheca strains were only susceptible in vitro to amphotericin B. It was found that the E test was easy to perform, and provided MIC values similar to those obtained with other well documented techniques. It was therefore concluded that the E test could be implemented as a standard procedure in clinical mycology laboratories.

[Intraoperative anesthetic management of kidney failure in adult liver transplantation. Conventional hemodialysis]

OBJECTIVE

To evaluate our application of indications, use and benefits of conventional hemodialysis during surgery in patients with advanced liver disease and acute or chronic renal failure undergoing liver transplantation (LP), liver retransplantation (LRT) or combined hepatorenal transplantation (CHRT).

PATIENTS AND METHODS

We retrospectively reviewed the cases of 22 patients with advanced liver disease, 11 with acute renal failure and 11 with chronic renal failure. We performed 6 LT, 5 LRT and 11 CHRT. The following data were recorded in the periods before, during and immediately after surgery: metabolic, hemodynamic and coagulation parameters; bicarbonate, calcium and inotropic drug requirements; incidences during reperfusion of the graft; surgical technique used; and survival.

RESULTS

Seven patients (32%) needed hemodialysis, 4 (18%) needed ultrafiltration, 7 (32%) needed both and 4 (18%) required neither. For 6 patients total clamping of the inferior vena cava (ICV) was required with external venovenous bypass. For 8 patients total clamping of the IVC was performed without venovenous bypass. For 8 others IVC clamping was partial with retrohepatic preservation (piggy-back). There were 2 deaths during surgery, 4 more within the first month after surgery and 4 more in the second month. Overall survival was 36.4% among acute patients and 72.7% among CHRT patients.

CONCLUSIONS

1) Conventional hemodialysis during surgery is feasible and gives good results; 2) conventional "high efficiency" hemodialysis is more effective and useful in these patients than is either slow, continuous hemodialysis or filtration; 3) the survival rate of CHRT patients is similar to that of patients undergoing LT with normal kidney function, and 4) partial IVC clamping in the anhepatic phase may decrease the need for ultrafiltration.

Entamoeba histolytica: fecal antigen capture immunoassay for the diagnosis of enteric amebiasis by a monoclonal antibody

Amebiasis continues to be of epidemiological importance in underdeveloped countries. Clinical diagnosis and epidemiological setting in a region are based on the fecal microscopic identification of cysts or trophozoites. This procedure requires well trained personnel, is laborious, of low sensitivity and frequently yields false-positives results. The present study was designed to develop an immunoenzymatic fecal 96 kDa antigen capture test (COPROELISA-Eh) more sensitive and specific than microscopic diagnosis of amebiasis. Triplicates of 177 stool samples processed by the formol-ether concentration method, were defined as positive or negative by three experienced microscopic observers. Another aliquot was submitted to the antigen capture test by a monoclonal antibody against a specific membrane antigen of pathogenic strains of Entamoeba histolytica. Optical densities were interpreted as positive when they exceeded the mean value of negative samples plus two standard deviations. COPROELISA-Eh showed a 94.4% sensitivity, 98.3% specificity, 96.2% positive predictive value and 97.6% negative predictive value for the detection of E. histolytica in feces. COPROELISA-Eh is more sensitive and specific than microscopic examination, does not require specially trained personnel and allows the simultaneous processing of a large number of samples.

Activation of human monocyte-derived macrophages by immune complexes containing low-density lipoprotein

Human monocyte-derived macrophages are transformed into foam cells upon incubation with immune complexes containing low-density lipoprotein (LDL-IC), which are internalized predominantly through Fc gamma receptor-mediated phagocytosis. We investigated whether the FcR gamma-mediated ingestion of LDL-IC is associated with functional and metabolic activation of the ingesting cells. As end points we used the assay of released interleukin-1 beta (IL-1 beta) and tumor necrosis factor alpha (TNF alpha) and the reduction of nitroblue tetrazolium, which measures the respiratory burst. LDL-IC, added to the macrophages in concentrations known to induce intracellular accumulation of cholesterol esters and foam cell transformation, stimulated both the cytokine release and the respiratory burst more efficiently than control immune complexes. Time course studies of cytokine release and mRNA expression suggest that the synthesis and release of these two cytokines is under independent control. TNF alpha was released almost immediately after addition of LDL-IC to the macrophages, coinciding with increased early expression of TNF alpha mRNA, detectable 30 min after stimulation. In contrast, IL-1 beta was only increased in stimulated cell supernatants after 8 hr, and the onset of expression of IL-1 beta mRNA was also delayed in comparison to that of TNF alpha mRNA. We noted wide variations in the amounts of TNF alpha released by monocyte-derived macrophages from different donors. We also found that those macrophages which released higher levels of TNF alpha also took up higher amounts of 125I-labeled LDL, suggesting that the expression of LDL receptors by LDL-IC-stimulated macrophages is somehow linked to the degree of activation of these cells. Experiments using the measurement of the oxidative burst as end point corroborated that LDL-IC cause a general activation of macrophage functions. In conclusion, human macrophages are efficiently activated by LDL-IC, as reflected by the release of IL-1 beta and TNF alpha and by the release of oxygen active radicals. Thus, the presentation of LDL-IC to human macrophages induces a variety of metabolic and functional changes which are likely to contribute, directly or indirectly, to endothelial damage and progression of the atheromatous lesion.

[Abdominal echography in patients with human immunodeficiency virus (HIV) infection. Diagnostic usefulness in the evaluation of associated medico-surgical pathology]

BASIS

The abdominal manifestations in the patient with HIV infection are increasingly frequent. We have conducted the present study in order to determine the diagnostic usefulness of the abdominal echography in the clinical assessment of the patient.

MATERIALS AND METHODS

We review the echographic findings of 112 patients carrying the HIV with or without the Acquired Immunodeficiency Syndrome (AIDS). Seventy eight patients were men and 34, women, with an average age of 30 years. The main risk group was parenterally drug addiction (72%). The stage of the HIV infection was IVC1 in 41% of the cases, II in 23%, III in 13% and IVC2 in 13%. The echographic exploration was performed using a real-time echography, with a probe of 3.5 Mhz, assessing according to conventional criteria the abdominal organs and their pathology, masses and free intraabdominal fluid. The echographic characteristics were first broadly assessed in the patients from the series and later on, according to the patient's pathology. (Infectious, acute abdominal, hepatic biochemical disorders, HIV carrier-associated pathology).

RESULTS

In 33% of the cases, the echography was normal. Hepatomegaly was the most frequent echographic sign: 56 patients (50%), followed by splenomegaly in 43 patients (38.3%), standing out the affection of the biliary and/or vesicular ductus in 7 patients (6.2%). The echographic findings were not related to the HIV infection stage, nor with the presence of hepatic biochemical disorders. However, the presence of organomegaly (hepatosplenomegaly associated or not to retroperitoneal adenopathies) were more frequent in the group with infectious complication, 33.3% vs 19.6% (p < 0.01), that in the patients without associated infectious processes. In patients with medical or surgical acute abdominal pathology, the echography was diagnostic in 9 out of 10 patients.

CONCLUSION

In the HIV patient, the echography allows an specific initial diagnostic assessment, being able in most of the patients with abdominal manifestations to diagnose the causal pathology.

[Risk of occupational exposure to hepatitis B virus in Venezuelan health workers. Multicenter study]

In a multicenter study, 970 serum samples were collected from venezuelan health workers. Presence of HBV serological markers (HBsAg, antiHBs and total anticore) were screened by microELISA. Two-hundred and forty-seven samples (27%) showed at least one positive marker, being the most frequently found the antisurface antibody which was present in different working areas, including those considered at the low exposure level (medicine 24.7%). The proportion of antisurface positive samples also was significantly higher in the group with more than 10 years of service compared to the prevalence showed by the group with less than 5 years (19.1 vs 12.8%). Groups considered to be at low risk, contrary to the expected results, showed a similar or higher prevalence compared to the groups classified as continues or frequent exposure (17.7 vs 8.6%). Our findings suggest a permanent HBV load circulation at the venezuelan hospitals environment.