Dietary supplementation of micro-encapsulated sodium butyrate in healthy horses: effect on gut histology and immunohistochemistry parameters.

BACKGROUND: As colic and intestinal disorders are a major concern in horses, the aim of the present study was to investigate the effect of dietary supplementation of butyrate, known to have a diverse array of beneficial effects on intestinal health. The effect of micro-encapsulated sodium butyrate supplementation on gut histology and immunohistochemistry parameters was studied in 14 healthy warmblood horses destined for slaughter in two separate periods. Horses were fed a low fiber - high starch diet, designed to induce subsequent starch overflow in the large intestine, aiming to create a mild challenge for large intestinal health. Treatment included supplementation with either micro-encapsulated sodium butyrate (Excential Butycoat®, Orffa, Werkendam, the Netherlands) or placebo (containing only coating material). The horses were fed for 20 consecutive days at a dosage of 0.4 g/kg BW (body weight). At day 21, the horses were slaughtered and intestinal samples were collected for determination of gut pH, villus length, crypt depth and area % of CD3+ and CD20+ cells. RESULTS: Horses on the butyrate supplemented diet had significantly reduced crypt depths in the right dorsal colon compared to placebo-fed horses (P < 0.001). However, a treatment x period interaction (P = 0.002) was discovered regarding this parameter, which could not be explained by the authors. Further investigation into the number of KI67+ cells in the RDC crypts did not reveal any significant differences between treatments (P = 0.650), indicating that the reduction in crypt depth in butyrate-fed horses could not be explained by a significant difference in cellular proliferation. Intestinal pH, villus length and expression of intestinal CD3+ and CD20+ cells were not significantly affected by treatment at any intestinal level. CONCLUSIONS: Our data indicate that supplementation of micro-encapsulated sodium butyrate to the equine diet did not influence gut histology (with the exception of a decrease found in the crypts of the RDC) or immunohistochemistry parameters in healthy horses. Further research is warranted to investigate the impact of butyrate supplementation in horses with intestinal disease.

Does release of encapsulated nutrients have an important role in the efficacy of xylanase in broilers?

The non-starch polysaccharides (NSPs) in cell walls can act as a barrier for digestion of intracellular nutrients. This effect is called "cage effect." Part of the success of fibrolytic enzymes in broiler feed is assumed to be attributed to cage effect reduction. Further, changes in viscosity and potential prebiotic action should also be considered. The aim of this study was to gain insight into the relative importance of the cage effect in xylanase efficacy in broilers. Using a 2×2 factorial design, 24 pens with 30 Ross 308 male chicks were fed corn-soy based diets consisting of normal and freeze-thawed (5 d at -18°C) corn, both with and without xylanase. The freeze-thaw method was used to eliminate the cage effect, whereas a corn-based diet was used to exclude viscosity effects. Body weights (BW), feed intake (FI), and feed conversion ratio (FCR) were determined at d 13, 26, and 39. A balance study was executed at the end of the growing phase. These birds were euthanized at d 34 (non-fasted) to determine the viscosity of digesta, blood metabolites, intestinal morphology, and microbiota composition. During the finisher period, there was a significant interaction between enzyme supplementation and freeze-thawing for FCR, in which FCR was improved by freeze-thawed corn and tended to be improved by normal corn+enzyme compared with the control group. The improvement in performance (finisher period) of freeze-thawed corn and xylanase coincided with increased gut absorption of glucose (based on postprandial plasma concentrations) and increased number of Clostridiumcluster IV in the caecum, and agreed with the higher gut villus height. In addition, xylanase inclusion significantly increased the postprandial plasma glycine and triglycerides concentration, and led to elevated bacterial gene copies of butyryl CoA:acetate CoA-transferase, suggesting a prebiotic effect of xylanase addition through more than just the cage effect reduction. The applied model managed to rule out viscosity by using corn, and it was possible to isolate the cage effect by freeze-thawing the dietary corn.

Improving plant transformation using Agrobacterium tumefaciens.

Here, we report a quick and low-cost method to improve plant transformation using Agrobacterium tumefaciens. This method involves the use of physical wounding, ultrasound, and an increase in exposure time to the bacteria. We show how the transformation rate increased from 0 to 14% when an ultrasound pulse of 10 s was used in conjunction with 96 h of bacterial exposure in Eclipta alba explants.

High temperature luminescence of Dy3+ in crystalline silicon in the optical communication and eye-safe spectral regions.

We report on photoluminescence in the 1.3 and 1.7 µm spectral ranges in silicon doped with dysprosium. This is attributed to the Dy3+ internal transitions between the second Dy3+ excited state and the ground state, and between the third Dy3+ excited state and the ground state. Luminescence is achieved by Dy implantation into Si substrates codoped with boron, to form dislocation loops, and show a strong dependence on fabrication process. The spectra consist of several sharp lines with the strongest emission at 1736 nm, observed up to 200 K. No Dy3+ luminescence is observed in samples without B codoping, showing the paramount importance of dislocation loops to enable the Dy emission.

Study of autonomic modulation by non-linear analysis of heart rate variability in different age groups and analysis of health status, disease and risk of death in dogs.

The symbolic analysis of heart rate variability (biomarker of cardiac autonomic homeostasis) is a nonlinear and effective tool for pattern extraction and classification in a series analysis, which implies the transformation of an original time series into symbols, represented by numbers. Autonomic heart rate control is influenced by different factors, and better indicators of heart rate variability are found in healthy young individuals than in older and sicker individuals. The aim of this study was to compare the indicators of heart rate variability among healthy dogs in different age groups and in health status using the nonlinear method of symbolic analysis to evaluate the diagnostic accuracy of this method for the risk of death in dogs. An increase in cardiac sympathetic modulation was observed in puppies and dogs at risk of death, which was evidenced by a marked increase of 0 V% (without variation - associated with sympathetic modulation) and a decrease in patterns of 2 V% (two variations - associated with parasympathetic modulation), while the opposite was observed in young adult dogs with increased parasympathetic modulation. Elderly dogs showed a gradual decrease in parasympathetic activity, which tended to worsen with loss of health. It is concluded that the variables of symbolic analysis may be useful to evaluate autonomic modulation in dogs and assist in the differentiation between health states, advanced disease and death throughout the life cycle and have been shown to be indices with high specificity, sensitivity and diagnostic accuracy to help identify dogs at risk of death.

Prior MRI-imaging impact of patients submitted to brachytherapy for prostate cancer.

INTRODUCTION: Brachytherapy for the treatment of prostate cancer is a well-established option. Use of Multiparametric Magnetic Resonance Imaging (mpMRI) for staging and diagnosis of prostate cancer has come to change the current paradigm. In this study we aim to assess the impact of performing mpMRI to evaluate the presence of extracapsular lesions before brachytherapy in patients with prostate cancer concerning biochemical recurrence and time to nadir. METHODS: Review data from 73 patients submitted to brachytherapy. The following factors were evaluated: age, initial PSA, MRI local staging results, ISUP, nadir, time to nadir, PSA at one-year, biochemical recurrence, and time to recurrence. RESULTS: Median age was 68 years (51-72) and median follow-up 53 months (30-72). Concerning imaging modality 30,1% (n = 22) patients performed mpMRI. In the mpMRI group, 90.9% (n = 20) had at least one suspect lesion on mpMRI. Time to nadir was 27 months (3-64) in patients where mpMRI was not performed and 23.5 months (2-48) in patients submitted to mpMRI (P = .244). The median value of nadir was 0.42 ng/mL (<0.001-2) in patients submitted to mpMRI and vs 0.28 ng/mL (<0.001-4) in patients without MRI (P = .062) Recurrence utilizing Phoenix criteria was 9% (n = 2) in patients with MRI and 9.2% (n = 5) without mpMRI (P = .456), median follow-up of 43 months (12-72) for the MRI group with 58 months (30-78) for the non-mpMRI group. Both groups were statistically similar. CONCLUSION: Our results allow us to conclude that in our series MRI did not influence biochemical recurrence, time to nadir, or nadir value.

Phosphoric acid containing proanthocyanidin enhances bond stability of resin/dentin interface.

Proanthocyanidin (PA) is a promising dentin biomodifier due to its ability to stabilize collagen fibrils against degradation by matrix metalloproteinases (MMPs); however, the most effective protocol to incorporate PA into bonding procedures is still unclear. This study evaluated the effect of dentin biomodification with a PA acid etchant on MMP activity, adhesive interface morphology and resin-dentin microtensile bond strength. Sound extracted human molars were flattened to expose dentin and acid-etched for 15 s according to the groups: EXP - experimental phosphoric acid; EXP+PA - experimental phosphoric acid 10% PA; TE - total-etching system; SE - self-etching system. Samples were restored with composite resin and stored in distilled water (37ºC). MMP activity and interface morphology were analyzed after 24 h by in situ zymography (n=6) and scanning electron microscopy (n=3), respectively. The resin-dentin microtensile bond strength (µTBS) was evaluated after 24 h and 6 months storage (n=6). Significantly higher MMP activity was detected in etched dentin compared with untreated dentin (p<0.05), but no difference among acid groups was found. Resin tags and microtags, indicative of proper adhesive system penetration in dentinal tubules and microtubules, were observed along the hybrid layer in all groups. There was no difference in µTBS between 24 h and 6 months for EXP+PA; moreover, it showed higher long-term µTBS compared with TE and EXP (p<0.05). The results suggest that 15 s of biomodification was not sufficient to significantly reduce MMP activity; nonetheless, EXP+PA was still able to improve resin-dentin bond stability compared with total- and self-etching commercial systems.

Prevalence of anxiety in patients awaiting diagnostic procedures in an oncology center in Brazil.

OBJECTIVE: Anxiety disorders have been shown to undermine the quality of life of cancer patients. Unfortunately, medical professionals often neglect to screen for anxiety in their patients. The aim of the present study was to describe the prevalence of anxiety in patients awaiting diagnostic procedures in an oncology center waiting room, and to investigate possible relationships between anxiety and demographic and clinical variables. METHODS: A cross-sectional study was performed with 398 patients who completed a self-administered questionnaire containing the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). RESULTS: Results of the HADS indicated that 38% of participants had anxiety, while data from the STAI showed that 46% had either high state or trait anxiety. The most frequently cited source of anxiety was concern over test results. Age, gender, employment status, and education level were correlated with anxiety. CONCLUSIONS: The prevalence of anxiety is high among patients awaiting diagnostic procedures. Patients in the waiting room should be routinely screened for anxiety. Careful assessment and treatment of anxiety are important components in the care of patients with cancer.

Synthesis and evaluation of rifabutin analogs against Mycobacterium avium and H(37)Rv, MDR and NRP Mycobacterium tuberculosis.

Clinical utility of rifabutin 1 (RBT), a potent antibiotic used in multidrug regimens for tuberculosis (TB) as well as for infections caused by Mycobacterium avium complex (MAC), has been hampered due to dose-limiting toxicity. RBT analogs 2-11 were synthesized and evaluated against M. avium 1581 and Mycobacterium tuberculosis susceptible and resistant strains in vitro. A selection of candidates were also assayed against non-replicating persistent (NRP) M. tuberculosis. Subsequent in vivo studies with the best preclinical candidate drugs 5 and 8, in a model of progressive pulmonary tuberculosis of Balb/C mice infected either with H(37)Rv drug-sensible strain or with multidrug resistant (MDR) clinical isolates, resistant to all primary antibiotics including rifampicin, were performed. The results disclosed here suggest that 5 and 8 have potential for clinical application.

Microcrystalline cellulose induces time-dependent lung functional and inflammatory changes.

We determined whether microcrystalline cellulose (MCC), a component of pharmaceutical tablets, induces pulmonary changes. In vivo [resistive and viscoelastic pressures (DeltaP(1) and DeltaP(2)), static elastance (E(L))] and in vitro [tissue resistance (R), elastance (E), and hysteresivity (eta)] lung mechanics, histology, and bronchoalveolar lavage fluid (BALF) were analyzed 3h, 24h, and 3, 15 and 30 days after intratracheal instillation of saline (C) or MCC in BALB/c mice. DeltaP(1) increased at 3h, remaining higher than C until day 3, while E(L) and DeltaP(2) increased only at 24h. At 3 days all mechanical parameters returned to baseline. R and E increased only at 24h. MCC increased alveolar collapse and the number of neutrophils in BALF at 3h, until 3 and 15 days, respectively. At 3 days MCC migrate from the airways into the parenchyma, where they were observed until 30 days. In conclusion, microcrystalline cellulose yielded an acute and self-limited inflammation that impaired lung mechanics.

Effects of previous diet and duration of soybean oil supplementation on light lambs carcass composition, meat quality and fatty acid composition.

Forty Merino Branco ram lambs were used to study the effects of initial diet and duration of supplementation with a conjugated linoleic acid (CLA) promoting diet, on carcass composition, meat quality and fatty acid composition of intramuscular fat. The experimental period was 6 weeks. The experimental design involved 2 initial diets (commercial concentrate (C); dehydrated lucerne (L)), and 2 finishing periods (2 and 4 weeks) on dehydrated lucerne plus 10% soybean oil (O). Data were analysed as a 2×2 factorial arrangement with initial diet and time on finishing (CLA promoting) diet as the main factors. The lambs were randomly assigned to four groups: CCO; COO; LLO; LOO according to the lamb's diet fed in each period. Lambs initially fed with concentrate showed higher hot carcass weights (11.2 vs 9.6kg) than lambs fed initially with lucerne. The increase of the duration of finishing period reduced the carcass muscle percentage (57.4% vs 55.5%) and increased the subcutaneous fat percentage (5.67% vs 7.03%). Meat colour was affected by initial diet. Lambs initially fed with concentrate showed a lower proportion of CLA (18:2cis-9, trans-11 isomer) (0.98% vs 1.38% of total fatty acids) and most of n-3 polyunsaturated fatty acids than lambs initially fed with lucerne. Initial diet did not compromise the response to the CLA-promoting diet and the proportion of 18:2cis-9, trans-11 in intramuscular fat increased with the duration of time on the CLA-promoting diet (1.02% vs 1.34% of total fatty acids).

Microstructure and selected mechanical properties of aged Ti-15Zr-based alloys for biomedical applications.

In this study, Ti-15Zr-xMo (5, 10, 15, and 20 wt%) alloys were submitted to solution and aging treatments and their effects evaluated in terms of phase composition and selected mechanical properties (Vickers microhardness and Young's modulus) for use as biomedical implants. The solution treatment was performed at 1123 K for 2 h, while aging treatments were carried out at 698 K for 4, 8, and 12 h, followed by water quenching. Phase composition and microstructure were dependent of the heat treatments, with Ti-15Zr-5Mo (α +â€¯ß type) and Ti-15Zr-10Mo (metastable ß type) alloys exhibiting intense α phase precipitation. The α-phase precipitates were related to α″ → α and ß → α phase decompositions. The Ti-15Zr-10Mo alloy exhibited an intermediary isothermal ω-phase precipitation after aging for 4 h. Vickers microhardness and Young's modulus values changed gradually with the amount of α phase. Aged Ti-15Zr-15Mo and Ti-15Zr-20Mo alloys presented better combinations of hardness and Young's modulus than CP-Ti and Ti-64 ELI for biomedical applications.

Effect of grazing pastures of different botanical composition on antioxidant enzyme activities and oxidative stability of lamb meat.

The aim of this work was to study the influence of different pastures (Intensive ryegrass, Botanically diverse and Leguminosa rich pastures) on the antioxidant status and oxidative stability of meat from lambs that had been exclusively grazing for three months. Lipid, colour and protein oxidation, α-tocopherol content and activity of antioxidant enzymes (superoxide dismutase (SOD), catalase (Cat) and glutathione peroxidase (GSH-Px)) were measured in Longisimus thoracis et lumborum muscle samples taken 1 day after slaughter. Pasture type significantly affected protein oxidation and the activity of GSH-Px, but no significant differences were found for the α-tocopherol content, colour and lipid oxidation, and the activities of SOD and Cat. Grazing a Botanically diverse pasture induced significantly higher protein oxidation in meat, as measured by the free thiol and carbonyl contents, compared to a Leguminosa rich or Intensive ryegrass pasture (P<0.05). The GSH-Px activity was significantly higher in meat from lambs on the Leguminosa rich pasture compared to the other pasture groups (P<0.01).

Application of morphological and physiological parameters representative of a Brazilian population sample in the respiratory tract model.

The human respiratory tract model (HRTM) adopted by ICRP in its Publication 66 accounts for the morphology and physiology of the respiratory tract. The characteristics of air drawn into the lungs and exhaled are greatly influenced by the morphology of the respiratory tract, which causes numerous changes in pressure, flow rate, direction and humidity as air moves into and out of the lungs. These characteristics are important to determine the fractional deposition. It is known that the morphology and physiology are influenced by environmental, occupational and economic conditions. The ICRP recommends, for a reliable evaluation of the regional deposition, the use of parameters from a local population wherever such information is available. The main purpose of this study is to verify the influence of using the morphology and physiology parameters representative of a sample of the Brazilian population on the deposition model of the ICRP Publication 66 model.

Phosphoric acid containing proanthocyanidin enhances bond stability of resin/dentin interface

Abstract Proanthocyanidin (PA) is a promising dentin biomodifier due to its ability to stabilize collagen fibrils against degradation by matrix metalloproteinases (MMPs); however, the most effective protocol to incorporate PA into bonding procedures is still unclear. This study evaluated the effect of dentin biomodification with a PA acid etchant on MMP activity, adhesive interface morphology and resin-dentin microtensile bond strength. Sound extracted human molars were flattened to expose dentin and acid-etched for 15 s according to the groups: EXP - experimental phosphoric acid; EXP+PA - experimental phosphoric acid 10% PA; TE - total-etching system; SE - self-etching system. Samples were restored with composite resin and stored in distilled water (37ºC). MMP activity and interface morphology were analyzed after 24 h by in situ zymography (n=6) and scanning electron microscopy (n=3), respectively. The resin-dentin microtensile bond strength (μTBS) was evaluated after 24 h and 6 months storage (n=6). Significantly higher MMP activity was detected in etched dentin compared with untreated dentin (p<0.05), but no difference among acid groups was found. Resin tags and microtags, indicative of proper adhesive system penetration in dentinal tubules and microtubules, were observed along the hybrid layer in all groups. There was no difference in μTBS between 24 h and 6 months for EXP+PA; moreover, it showed higher long-term μTBS compared with TE and EXP (p<0.05). The results suggest that 15 s of biomodification was not sufficient to significantly reduce MMP activity; nonetheless, EXP+PA was still able to improve resin-dentin bond stability compared with total- and self-etching commercial systems.

Resumo A proantocianidina (PA) é um biomodificador dentinário promissor devido a sua capacidade de estabilizar as fibrilas colágenas contra a degradação por metaloproteinases da matriz (MMPs); no entanto, o protocolo mais eficaz para a incorporação de PA em procedimentos adesivos ainda não está claro. Este estudo avaliou o efeito da biomodificação da dentina com um condicionador ácido contendo PA na atividade de MMPs, morfologia da interface adesiva e resistência à microtração resina-dentina. Molares humanos extraídos foram lixados para exposição da dentina e condicionados com ácido por 15 s de acordo com os grupos: EXP - ácido fosfórico experimental; EXP+PA - ácido fosfórico experimental com 10% PA; TE - sistema total-etch; SE - sistema self-etch. As amostras foram restauradas com resina composta e armazenadas em água destilada (37ºC). A atividade de MMP e morfologia da interface foram analisadas após 24 h por zimografia in situ (n=6) e microscopia eletrônica de varredura (n=3), respectivamente. A resistência à microtração resina-dentina (μTBS) foi avaliada após 24 horas e 6 meses de armazenamento (n=6). Atividade de MMP detectada na dentina condicionada foi significativamente maior em comparação com a dentina não tratada (p <0,05), mas não houve diferenças entre os diferentes ácidos. Tags e microtags de resina, indicativos de uma penetração adequada do sistema adesivo nos túbulos e microtúbulos dentinários, foram observadas ao longo da camada híbrida em todos os grupos. Não houve diferença entre os valores de μTBS de 24 h e 6 meses para EXP+PA; além disso, EXP+PA apresentou maiores valores de μTBS após 6 meses em comparação com TE e EXP (p <0,05). Os resultados sugerem que a biomodificação por 15 s não foi suficiente para reduzir significativamente a atividade de MMP; apesar disso, EXP + PA foi capaz de melhorar a estabilidade da interface resina-dentina em comparação com sistemas total- e self-etch comerciais.

Fatty acid composition, conjugated linoleic acid isomers and cholesterol in beef from crossbred bullocks intensively produced and from Alentejana purebred bullocks reared according to Carnalentejana-PDO specifications.

The purpose of this study was to characterise and compare the nutritional value of Portuguese Carnalentejana-PDO beef, obtained from Alentejana purebred bullocks reared in a semi-extensive system, with the meat from Alentejana×Charolais crossbred bullocks produced in a conventional intensive concentrate-based system. In addition, seasonal changes in Carnalentejana-PDO beef quality were assessed, by analysing meat samples from animals slaughtered in early autumn and late spring. The results showed that beef-PDO has different intramuscular fat characteristics in comparison with meat from crossbred bullocks fed intensively with concentrate. However, the finishing period of Alentejana purebred bullocks with concentrate seems to attenuate most of the typical grass-fed characteristics of meat fat. Nevertheless, from a human nutrition perspective, Carnalentejana-PDO beef seems to be healthier than that from intensively reared animals since it has a lower n-6/n-3 ratio, although always above the recommended guidelines for human diet, and higher proportions of c9,t11 conjugated linoleic acid (CLA) isomer and total CLA relative to saturated fatty acids plus total cholesterol (CLA/SFA+CHR). Furthermore, no seasonal variation in the nutritional quality of beef-PDO was apparent. Taken together, the data indicate that Carnalentejana-PDO beef is of greater nutritional value than intensively produced beef from crossbred bullocks throughout the year.

Super-enhancement of 1.54 µm emission from erbium codoped with oxygen in silicon-on-insulator.

We report on the super enhancement of the 1.54 µm Er emission in erbium doped silicon-on-insulator when codoped with oxygen at a ratio of 1:1. This is attributed to a more favourable crystal field splitting in the substitutional tetrahedral site favoured for the singly coordinated case. The results on these carefully matched implant profiles show that optical response is highly determined by the amount and ratio of erbium and oxygen present in the sample and ratios of O:Er greater than unity are severely detrimental to the Er emission. The most efficient luminescence is forty times higher than in silicon-on-insulator implanted with Er only. This super enhancement now offers a realistic route not only for optical communication applications but also for the implementation of silicon photonic integrated circuits for sensing, biomedical instrumentation and quantum communication.

New portable instrument for the measurement of thermal conductivity in gas process conditions.

The development of high temperature gas sensors for the monitoring and determination of thermophysical properties of complex process mixtures at high temperatures faces several problems, related with the materials compatibility, active sensing parts sensitivity, and lifetime. Ceramic/thin metal films based sensors, previously developed for the determination of thermal conductivity of molten materials up to 1200 °C, were redesigned, constructed, and applied for thermal conductivity measuring sensors. Platinum resistance thermometers were also developed using the same technology, to be used in the temperature measurement, which were also constructed and tested. A new data acquisition system for the thermal conductivity sensors, based on a linearization of the transient hot-strip model, including a portable electronic bridge for the measurement of the thermal conductivity in gas process conditions was also developed. The equipment is capable of measuring the thermal conductivity of gaseous phases with an accuracy of 2%-5% up to 840 °C (95% confidence level). The development of sensors up to 1200 °C, present at the core of the combustion chambers, will be done in a near future.

Chance of psychiatric morbidity amongst recently diagnosed cancer outpatients attending a chemotherapy unit.

The prevalent rate of psychiatry morbidity amongst patients with cancer reported in various studies ranges from 5 to 50%, a variation that can be attributed to differences in sample size, the disease itself and treatment factors. The objectives of the present study were to determine the frequency of psychiatric morbidity amongst recently diagnosed cancer outpatients and try to identify which factors might be related to further psychological distress. Two hundred and eleven (70.9%) female patients and 87 (29.1%) male patients from the chemotherapy unit of the Cancer Hospital A.C. Camargo (São Paulo) completed a questionnaire that featured data on demographic, medical and treatment details. The Self Reporting Questionnaire (SRQ-20) was administered to the patients to determine their personal psychiatric morbidity. Seventy-two patients (25.8%) scored > or = 8 in the SRQ-20, the cut-off point for a patient to be considered a psychiatric case. When the low and high scoring groups were compared no differences were detected regarding age, marital status, tumor site, sex, or previous treatment. Nonetheless, patients in the lowest social class and those who were bedridden less than 50% of the time had a significantly higher probability of being a psychiatric case. Regarding help-seeking behavior in situations in which they had doubts or were frightened, about 64% of the total sample did not seek any type of support and did not talk to anyone. This frequency of psychiatric morbidity agrees with data from the cancer literature. According to many investigators, the early detection of a comorbid psychiatric disorder is crucial to relieve a patient's suffering.

Mycobacteremia in patients with the acquired immunodeficiency syndrome.

BACKGROUND: Bacillemia is a key event in the pathogenesis of tuberculosis. Although current evidence indicates that Mycobacterium tuberculosis bacteremia is rare in patients seronegative for the human immunodeficiency virus, it has been increasingly reported in patients with the acquired immunodeficiency syndrome (AIDS). OBJECTIVE: To determine clinical and laboratory characteristics of patients with AIDS and tuberculosis with and without bacillemia. METHODS: Fifty patients with AIDS with clinical suspicion of disseminated mycobacterial disease were prospectively selected. Three consecutive blood samples were collected for culture using a standardized protocol. RESULTS: Mycobacterium was isolated from any body site in 42 patients (84%). Bacillemia was detected in 30 (71.4%) of these 42 patients: 11 (28.2%) caused by Mycobacterium avium-intracellulare complex and 19 (71.8%) caused by M tuberculosis. Blood culture was the only method used to confirm the diagnosis in 5 (15%) of the 33 tuberculosis cases. Tuberculosis in patients with AIDS developed with nonspecific insidious symptoms, a remarkable elevated alkaline phosphatase level, and without the classic miliary radiological pattern. We could demonstrate 2 previously unrevealed clinical characteristics of bacteremic tuberculosis in patients with AIDS: a shift to the left in the white blood cell count and abdominal lymph node enlargement. In patients with tuberculosis, the in-hospital mortality rate was higher among patients with bacillemia, although the posttreatment survival rate was comparable. CONCLUSIONS: Blood culture is a valuable tool to confirm the clinical diagnosis of disseminated tuberculosis in patients with AIDS and can distinguish patients with characteristic clinical findings and outcome. Abdominal ultrasonography may be an additional helpful tool to identify these patients.