Rationale and design of the multicentric, double-blind, double-placebo, randomized trial APrepitant versus HYdroxyzine in association with cytoreductive treatments for patients with myeloproliferative neoplasia suffering from Persistent Aquagenic Pruritus. Trial acronym: APHYPAP.

BACKGROUND: Aquagenic pruritus (AP), an intense sensation of scratching induced after water contact, is the most troublesome aspect of BCR-ABL1-negative myeloproliferative neoplasms (MPNs). Mostly described in polycythemia vera (PV, ~ 40%), it is also present in essential thrombocythemia (ET) and primary myelofibrosis (PMF) (10%). Even if this symptom can decrease or disappear under cytoreductive treatments, 30% of treated MPN patients still persist with a real impact on the quality of life (QoL). Because its pathophysiology is poorly understood, efficient symptomatic treatments of AP are missing. The neuropeptide substance P (SP) plays a crucial role in the induction of pruritus. Several studies showed the efficacy of aprepitant, an antagonist of SP receptor (NK-1R), in the treatment of chronic pruritus but never evaluated in AP. The objectives of APHYPAP are twofold: a clinical aim with the evaluation of the efficacy of two drugs in the treatment of a persistent AP for MPN patients and a biological aim to find clues to elucidate AP pathophysiology. METHODS/DESIGN: A multicentric, double-blind, double-placebo, randomized study will include 80 patients with MPN (PV or ET or PMF) treated since at least 6 months for their hemopathy but suffering from a persistent AP (VAS intensity ≥6/10). Patients will be randomized between aprepitant (80 mg daily) + placebo to match to hydroxyzine OR hydroxyzine (25 mg daily) + placebo to match to aprepitant for 14 days. At D0, baseline information will be collected and drugs dispense. Outcome measures will be assessed at D15, D30, D45, and D60. The primary study endpoint will be the reduction of pruritus intensity below (or equal) at 3/10 on VAS at D15. Secondary outcome measures will include the number of patients with a reduction or cessation of AP at D15 or D60; evaluation of QoL and AP characteristics at D0, D15, D30, D45, and D60 with MPN-SAF and AP questionnaires, respectively; modification of plasmatic concentrations of cytokines and neuropeptides at D0, D15, D30, and D60; and modification of epidermal innervation density and pruriceptor expression at D0 and D15. DISCUSSION: The APHYPAP trial will examine the efficacy of aprepitant vs hydroxyzine (reference treatment for AP) to treat persistent AP in MPN patients. The primary objective is to demonstrate the superiority of aprepitant vs hydroxyzine to treat persistent AP of MPN patients. The treatment received will be considered efficient if the AP intensity will be reduced at 3/10 or below on VAS after 14 days of treatment. The results of this study may provide a new treatment option for this troublesome symptom and also give us more insights in the pathophysiology understanding of AP. TRIAL REGISTRATION: APHYPAP. NCT03808805 , first posted: January 18, 2019; last update posted: June 10, 2021. EudraCT 2018-090426-66.

Design and testing of communication materials for a breastfeeding social media marketing campaign: Breastfeed4Ghana.

Breastfeed4Ghana was a social media-based campaign implemented to address identified gaps in the protection, promotion, and support of breastfeeding in Ghana. This paper describes the process of campaign materials development and testing to ensure their cultural and content appropriateness. The 60 campaign materials, each consisting of an image and text message, underwent a process of creation, testing, revision, and finalization. Existing research evidence and infant and young child feeding communication tools that were culturally relevant for Ghana were used to develop the materials. All materials were tested and finalized through an iterative process that incorporated input from six focus group discussions (FGDs) with mothers, and content and technical experts. The materials were revised to ensure scientific accuracy, understandability, and cultural appropriateness of the messages, as well as alignment of the messages with the images. Finalized materials were reviewed and approved by the Ghana Food and Drugs Authority. Analysis for this paper involved summarizing and categorizing the types and sources of input as well as the research team's responses to the input received. The 60 campaign materials received a total of 132 inputs. Most inputs came from FGDs (78.4%); and most inputs were on the campaign material images. The evidence-informed process of materials creation, use of multiple input sources, and a broad-based iterative process allowed the creation of 60 evidence-based and culturally appropriate materials for a breastfeeding social media campaign in Ghana. This paper could serve as a guide for other social media campaign efforts looking to develop culturally appropriate materials.

Continuous analogue to iterative optimization for PDE-constrained inverse problems.

The parameters of many physical processes are unknown and have to be inferred from experimental data. The corresponding parameter estimation problem is often solved using iterative methods such as steepest descent methods combined with trust regions. For a few problem classes also continuous analogues of iterative methods are available. In this work, we expand the application of continuous analogues to function spaces and consider PDE (partial differential equation)-constrained optimization problems. We derive a class of continuous analogues, here coupled ODE (ordinary differential equation)-PDE models, and prove their convergence to the optimum under mild assumptions. We establish sufficient bounds for local stability and convergence for the tuning parameter of this class of continuous analogues, the retraction parameter. To evaluate the continuous analogues, we study the parameter estimation for a model of gradient formation in biological tissues. We observe good convergence properties, indicating that the continuous analogues are an interesting alternative to state-of-the-art iterative optimization methods.

Invited review: Genetics and claw health: Opportunities to enhance claw health by genetic selection.

Routine recording of claw health status at claw trimming of dairy cattle has been established in several countries, providing valuable data for genetic evaluation. In this review, we examine issues related to genetic evaluation of claw health; discuss data sources, trait definitions, and data validation procedures; and present a review of genetic parameters, possible indicator traits, and status of genetic and genomic evaluations for claw disorders. Different sources of data and traits can be used to describe claw health. Severe cases of claw disorders can be identified by veterinary diagnoses. Data from lameness and locomotion scoring, activity information from sensors, and feet and leg conformation traits are used as auxiliary traits. The most reliable and comprehensive information is data from regular hoof trimming. In genetic evaluation, claw disorders are usually defined as binary traits, based on whether or not the claw disorder was present (recorded) at least once during a defined time period. The traits can be specific disorders, composite traits, or overall claw health. Data validation and editing criteria are needed to ensure reliable data at the trimmer, herd, animal, and record levels. Different strategies have been chosen, reflecting differences in herd sizes, data structures, management practices, and recording systems among countries. Heritabilities of the most commonly analyzed claw disorders based on data from routine claw trimming were generally low, with ranges of linear model estimates from 0.01 to 0.14, and threshold model estimates from 0.06 to 0.39. Estimated genetic correlations among claw disorders varied from -0.40 to 0.98. The strongest genetic correlations were found among sole hemorrhage (SH), sole ulcer (SU), and white line disease (WL), and between digital/interdigital dermatitis (DD/ID) and heel horn erosion (HHE). Genetic correlations between DD/ID and HHE on the one hand and SH, SU, or WL on the other hand were, in most cases, low. Although some of the studies were based on relatively few records and the estimated genetic parameters had large standard errors, there was, with some exceptions, consistency among studies. Various studies evaluate the potential of various data soureces for use in breeding. The use of hoof trimming data is recommended for maximization of genetic gain, although auxiliary traits, such as locomotion score and some conformation traits, may be valuable for increasing the reliability of genetic evaluations. Routine genetic evaluation of direct claw health has been implemented in the Netherlands (2010); Denmark, Finland, and Sweden (joint Nordic evaluation; 2011); and Norway (2014), and other countries plan to implement evaluations in the near future.

Melt growth and properties of bulk BaSnO3 single crystals.

We present the first-time growth of bulk BaSnO3 single crystals from the melt by direct solidification, their basic electrical and optical properties as well as their structural quality. Our measurement of the melting point (MP) of BaSnO3 amounts to 1855 °C ± 25 K. At this temperature an intensive decomposition and non-stoichiometric evaporation takes place as the partial pressure of SnO(g) is about 90 times higher than that of BaO(g). X ray powder diffraction identified only the BaSnO3 perovskite phase, while narrow rocking curves having a full width at half maximum of 26 arcsec and etch pit densities below 106 cm-2 confirm a high degree of structural perfection of the single crystals. In this respect they surpass the structural properties of those single crystals that were reported in the literature. The electrical conductivity of nominally undoped crystals depends on the growth conditions and ranges from insulating to medium n-type conductivity. After post-growth annealing in an oxidizing atmosphere undoped crystals are generally insulating. Doping the crystals with lanthanum during growth results in a high n-type conductivity. For a La doping concentration of 0.123 wt.% we measured an electron concentration of 3.3 × 1019 cm-3 and an electron mobility of 219 cm2 V-1 s-1. Based on optical absorption measurements we determined an energy of 3.17 ± 0.04 eV at 5 K and of 2.99 ± 0.04 eV at 297 K for the indirect band gap of BaSnO3.

[How to promote the respect of good infusion practices by meeting health care professionals?]. / Comment promouvoir le respect des bonnes pratiques de perfusion en allant à la rencontre des soignants ?

INTRODUCTION: Health care professionals often forget that there are risks associated with infusion therapy even if it is a common care. In order to assess this practice and to draw potential improvement actions, an audit of local gravity-flow intravenous infusion practices was conducted. MATERIAL AND METHOD: The audit, based on a grid including 66 items from the medical prescription to the end of the infusion therapy administration, was conducted in the 6 units which use the most gravity-flow intravenous infusion devices. A multidisciplinary working group was created to decide and organize priority corrective measures in order to improve infusion practices and quality of healthcare. RESULTS: The audit enabled to observe 90hours of nurse's practices (96 infusions) and highlighted heterogeneity in infusion, in some cases inappropriate infusion practices and misuse of infusion devices. We found 4 main issues: labelling infusion therapy, training of health care professionals on good practices, support the purchase of infusion pumps and standardize perfusion line. An interactive educational program for nurses (workshops) was organized to enhance the respect of good practices: infusion identification at any time, respect of hygiene rules, flow rate regulation by counting drops, appropriate use of pumps and flow rate regulators. DISCUSSION: The audit drew up work priorities. The workshops made easier exchanges between professionals and had a warm welcome that's why it is essential to carry on such training. CONCLUSION: This collaborative approach between pharmacists, nurses, hygienists and biomedical technicians contribute to drug management improvement and promote optimal patient care.

Polyurethane dressing, tetracycline and salicylic acid use for treatment of digital dermatitis in cattle. A comparative study.

OBJECTIVE: The use of antibiotics is a proven approach for local and systemic treatment of digital dermatitis (DD). Even if they are administered only locally and at low dosage, their use should be restricted to an absolute minimum. The efficacy of a commercial polyurethane wound dressing in treating acute digital dermatitis was compared with topical treatment using a commercially available tetracycline spray and a salicylic acid paste. MATERIALS AND METHODS: A total of 105 cows in a dairy farm (with about 160 dairy cows) were included in the study, with 101 cows needing topical treatment for digital dermatitis on one or both hind feet. All animals underwent hoof trimming prior to the treatment. Affected feet (n = 152) were randomly assigned to one of three comparable treatment groups. Topical treatment was administered to all visible digital dermatitis lesions. Animals in the positive control groups were given a topical treatment of tetracycline (53 DD lesions in 49 cows) or salicylic acid (53 DD lesions in 50 cows) formulations, whose therapeutic effects were scientifically verified. Spray was applied once, at a usual dosage and without any bandage. Salicylic acid paste was fixed in place with a bandage for 5 days. In the test group (46 DD lesions in 45 cows), a polyurethane bandage was left in place for 10 days. Whereas, 47 feet (from 38 cows) without lesions or with lesions showing no pain were designated as group 0. Each lesion was evaluated at day 0 during trimming, and on day 10 and 36. The lesions were scored based on severity and size. RESULTS: All groups showed a statistically significant improvement in the clinical appearance of the lesions at day 10. There were no significant differences in the findings between the second and the third evaluation (day 10 and day 36) either within a group or between the groups. CONCLUSION: The use of an alternative treatment regimen like a polyurethane wound dressing shows good clinical healing, it is as effective as the conventional methods, and unlike the conventional methods, does not require a latency period.

[Prevention of preterm birth by Shirodkar cerclage--clinical results of a retrospective analysis]. / Klinische Ergebnisse der Cerclage nach Shirodkar bezüglich der Prävention der Frühgeburtlichkeit--eine retrospektive Analyse.

In spite of the continuous progress in prenatal care, 1 out of 10 babies is born too early--tendency rising worldwide. As a consequence of the heterogeneous aetiology of preterm birth, there is still no single and efficient interventional therapy. Cerclage is one option for pregnancies with cervical insufficiency, whereas the clinical benefit is discussed controversially. We analyzed in a retrospective study with 120 patients the effect of a cerclage intervention regarding pregnancy prolongation. Patients with cervical incompetence and Shirodkar cerclage were compared to those undergoing conservative treatment. As expected, gestational age at delivery was significantly lower after emergency cerclage (31 weeks) compared to prophylactic (36 weeks) and therapeutic cerclage (35 weeks). Prolongation differs significantly between the prophylactic (18 weeks), therapeutic (14 weeks) and emergency cerclage (10 weeks) groups. Conservative management achieved 8 weeks prolongation. Of note, particularly emergency cerclage in cases with advanced cervical incompetence resulted in a substantially higher pregnancy prolongation (10 weeks) compared to no intervention (one week). The efficiency of cerclage operations has to be assessed in a differentiated manner based on the clinical situation and indication. The clinical benefit depends strongly on proper patient selection.

[Musculotendinopathy of the gastrocnemius muscle in a Labrador Retriever. A case report]. / Muskulotendinopathie des Musculus gastrocnemius bei einem Labrador Retriever. Ein Fallbericht.

Musculotendinopathy at the origin of the gastrocnemius muscle is a rare disease mostly described in herding dogs. The etiology is based on repeated myotendinous strain of the muscle in athletic dogs. Clinically, the patient displays chronic pelvic limb lameness and pain at the lateral fabella during palpation of this area. There is no instability of the stifle present. Radiographic findings (osteophyte formation at the origin of the muscle and the lateral fabella) support the potential diagnosis. Magnetic resonance tomography shows edematous changes and enhancement after intravenous application of contrast agent in the area of the origin of the lateral gastrocnemius head. With conservative treatment (i. e. leash confinement, NSAID application and physiotherapy) the prognosis is good. This case report describes clinical findings, diagnostic imaging, therapy and long-term outcome of an athletic Labrador Retriever presented with this disease.

[Influence of a new biocidal product on the prevalence of digital dermatitis in dairy cows]. / Einfluss eines neuartigen Biozids auf die Prävalenz von Dermatitis digitalis bei Milchkühen.

OBJECTIVE: It was investigated whether usage of the biocidal product T-Hexx Dragonhyde (Hydromer, Branchburg, NJ, USA) could influence the prevalence of digital dermatitis (DD). MATERIAL AND METHODS: On a dairy farm (110 milking cows) 48 dairy cows without lameness were selected randomly for a test group or a control (negative) group, respectively. A high prevalence of DD (70-80%) was documented over a period of 2 months, during which four examinations were made, with an interval of 16-21 days between each examination. The respective grade of the DD-lesion on the hind hoofs was documented according to a scoring scheme. After precleaning the claws with water, the test group passed through a hoof bath containing T-Hexx Dragonhyde on 2 days per week at two milking times on each day, whereas the claws of control animals were cleaned using only a water bath. Splashes contaminating the animals and the environment were documented photographically and evaluated. Bacteriological examinations of the water bath and the T-Hexx-bath were performed after increasing numbers of animals had passed through the baths. RESULTS: Between and within groups no statistically significant differences in the prevalence of DD were found. DD-lesion scoring did not show any difference between the groups. With increasing numbers of animals having passed through the water bath, there was a significant increase in colony-forming units per millilitre and of enterobacteriaceae. In the T-Hexx Dragonhyde footbath, bacterial contamination remained below the detection limit at all times. The coloured splashes of the footbath were visible up to the level of the udder and teats. CONCLUSION AND CLINICAL RELEVANCE: The prevalence of DD was not influenced by the 2% or 4% concentration of the biocidal product in the footbath. Thus the microbiocidal effect of the solution did not lead to an efficient reduction in bacteria on the hoof. To demonstrate a potential preventive effect on DD, future studies would require herds with lower prevalence and a higher sample size. However, when applying footbaths there is the general risk of milk contamination or causing mastitis.

[Evaluation of a claw hygiene system concerning its cleaning effect, the cow traffic and the quality of the washing water]. / Einsatz einer Klauenwaschanlage unter Beurteilung der Reinigungswirkung, des Tierverhaltens und der Waschwasserqualität.

OBJECTIVE: Only limited scientific information on the efficiency of claw cleaning systems for dairy cows is currently available. For this reason, this investigation aimed to test the devio AG's claw hygiene system regarding its cleaning effect as well as its impact on the cow traffic and the quality of its washing water. MATERIAL AND METHODS: During the first of two investigative phases of this controlled study, main water was used to clean the claws, while in the second phase a biozide was additionally applied. Every 4 weeks the hind claws of approximately 55 dairy cows (German Fleckvieh breed) were evaluated and their degree of soiling classified into four categories. In addition to the system's cleaning effect, its effect on cow traffic was investigated using video recordings and the quality of the recycled washing water was tested using bacteriological sampling. RESULTS: In the second investigation phase, claw cleanliness in the treatment group was significantly higher than in the control group. However, there was no significant difference between the two groups during the first investigation phase. The video analysis showed, that after a short period of adaptation, there was undisturbed cow traffic. Within one week of installing the claw hygiene system, the length of stay in the system increased from a mean of 23 s to 32 s and the time the cows spent waiting in front of the system was reduced from a mean of 3 min 51 s to 2 min 20 s. Water analysis revealed an increasing bacterial count from initially 1.2 × 106 to 7.3 × 107 CFU/ml. CONCLUSIONS: The undisturbed cow traffic allows the easy integration of the claw cleaning system into a free-stall barn. The improvement of claw cleanliness can make a positive contribution to claw hygiene. However, the increasing bacterial contamination of the washing water gives cause for concern in terms of infections being passed between cows when using this system.

XPS investigations of electrolyte/electrode interactions for various Li-ion battery materials.

For future Li-ion battery applications the search for both new design concepts and materials is necessary. The electrodes of the batteries are always in contact with electrolytes, which are responsible for the transport of Li ions during the charging and discharging process. A broad range of materials is considered for both electrolytes and electrodes so that very different chemical interactions between them can occur, while good cycling behavior can only be obtained for stable solid-electrolyte interfaces. X-ray photoelectron spectroscopy (XPS) was used to study the most relevant interactions between various electrode materials in contact with different electrolyte solutions. It is shown how XPS can provide useful information on reactivities and thus preselect suitable electrode/electrolyte combinations, prior to electrochemical performance tests.

Hepatitis B-associated acute liver failure: immediate treatment with entecavir inhibits hepatitis B virus replication and potentially its sequelae.

BACKGROUND: Acute hepatitis B virus (HBV) infection is followed by high viral replication rates leading to hepatocyte death and ultimately, in some cases, to acute liver failure (ALF) necessitating liver transplantation. Thus, the objective of treating HBV-induced ALF is to eliminate or significantly suppress HBV replication. METHODS/RESULTS: This prospective study (02/2008-02/2009) included 6 patients (1 female and 5 males, median age 35.5 years). HBV DNA and hepatitis B surface antigen (HBsAg) levels were detected, and hepatocyte death was quantified in patients' sera by (a) M65 ELISA and (b) M30 ELISA. All patients received entecavir treatment at 1 mg daily within 1-18 days after admission. Upon treatment, pathologic parameters rapidly decreased and returned to normal values or trace amounts (HBV DNA) within 3 months in all of the cases. A seroconversion to anti-HBsAg was achieved in 5 out of 6 patients; one patient with late onset of treatment did not seroconvert. M65 and the difference of M65-M30 as a marker for cell necrosis dropped significantly within 1 week of treatment. CONCLUSION: This preliminary series of 6 patients reveals that immediate treatment of HBV-induced ALF with entecavir is well tolerated and beneficially affects the course of the disease.

Outbreak of Clostridium difficile 027 infection in Vienna, Austria 2008-2009.

From November 2008 to 15 April 2009, 36 isolates of CD027 identified in Austria, all originating from four hospitals in Vienna. All isolates were positive for toxin A, toxin B and the binary toxin, and showed a characteristic 18 bp deletion in the tcdC gene. Clostridium difficile is an anaerobic spore-forming bacterium. Some strains may cause diarrhoea due to formation of toxins. Symptomatic C. difficile infection (CDI) is primarily linked with hospital admission and antibiotic treatment, although antibiotic exposure is neither necessary nor sufficient for CDI [1,2]. In Belgium, for instance, one third of CDI cases reported in the hospital surveillance system are not hospital-associated [3]. Symptoms range from mild diarrhoea to serious manifestations such as pseudomembranous colitis, toxic megacolon or perforation of the colon. C. difficile challenges hygiene standards as it is forms spores. The risk of infection rises with increasing age, underlying disease and immunodeficiency [4]. In recent years, a particularly virulent strain, ribotype 027 (CD027), has emerged in a number of countries, particularly in connection with hospital outbreaks, but also in community-acquired diarrhoea cases [5]. The risk of serious disease and death associated with CD027 exceeds that of other C. difficile strains. The classical CD027 is characterised - among other things - by an increased production of toxins A and B, production of a binary toxin and resistance to newer fluoroquinolones such as moxifloxacin. The first three Austrian cases of CD027 occurred in 2006 and in March 2008 [6,7]. Since August 2006, the Austrian National Reference Centre for C. difficile has ribotyped approximately 2,700 human C. difficile isolates received from all nine Austrian provinces. In recent months, a drastic increase in CD027 cases has been noted, all originating from four hospitals in Vienna. From November 2008 to 15 April 2009, 36 isolates of CD027 were received at the National Reference Centre. The Figure summarises these C. difficile 027 cases by month of reception of the sample at the reference centre.

Fetal heart rate variability reveals differential dynamics in the intrauterine development of the sympathetic and parasympathetic branches of the autonomic nervous system.

The aim of this study was to investigate the hypothesis that fetal beat-to-beat heart rate variability (fHRV) displays the different time scales of sympatho-vagal development prior to and after 32 weeks of gestation (wks GA). Ninety-two magnetocardiograms of singletons with normal courses of pregnancy between 24 + 1 and 41 + 6 wks GA were studied. Heart rate patterns were either quiet/non-accelerative (fHRP I) or active/accelerative (fHRP II) and recording quality sufficient for fHRV. The sample was divided into the GA groups <32 wks GA/>32 wks GA. Linear parameters of fHRV were calculated: mean heart rate (mHR), SDNN and RMSSD of normal-to-normal interbeat intervals, power in the low (0.04-0.15 Hz) and high frequency range (0.15-0.4 Hz) and the ratios SDNN/RMSSD and LF/HF as markers for sympatho-vagal balance. fHRP I is characterized by decreasing SDNN/RMSSD, LF/HF and mHR. The decrease is more pronounced <32 wks GA. Beyond that GA SDNN/RMSSD is predominantly determined by RMSSD during fHRP I and by SDNN during fHRP II. In contrast to fHRP I, during fHRP II, mHR is positively correlated to SDNN/RMSSD instead of SDNN >32 wks GA. LF/HF increases in fHRP II during the first half of the third trimester. Non-accelerative fHRP are indicative of parasympathetic dominance >32 wks GA. In contrast, the sympathetic accentuation during accelerative fHRP is displayed in the interrelations between mHR, SDNN and SDNN/RMSSD. Prior to 32 wks GA, fHRV reveals the increasing activity of the respective branches of the autonomic nervous system differentiating the types of fHRP.

Characterization of Clostridium difficile isolates using capillary gel electrophoresis-based PCR ribotyping.

We have developed a Clostridium difficile PCR ribotyping method based on capillary gel electrophoresis and have compared it with conventional PCR ribotyping. A total of 146 C. difficile isolates were studied: five isolates were reference strains (PCR ribotypes 001, 014, 017, 027 and 053); 141 were clinical isolates comprising 39 Austrian PCR ribotypes collected in the period 2006-2007 at 25 Austrian healthcare facilities. Capillary gel electrophoresis yielded up to 11 fragments per isolate and 47 ribotype patterns. All but one of the five PCR ribotypes of reference strains were clearly reflected in the chromatograms of capillary-based typing. Capillary gel electrophoresis divided 24 isolates belonging to PCR ribotype type 014 into seven subgroups, whereas subtyping the same isolates using multiple-locus variable-number tandem-repeat analysis yielded three unrelated subgroups, without obvious correlation to sr subgroups. Using a web-based software program (http://webribo.ages.at), we were able to correctly identify these 014 isolates by simply allocating the seven subgroup patterns to one ribotype, i.e. to PCR ribotype 014. We consider capillary gel electrophoresis-based PCR ribotyping to be a way of overcoming the problems associated with inter-laboratory comparisons of typing results, while at the same time substantially diminishing the hands-on time for PCR ribotyping.

Characterization of clinical Clostridium difficile isolates by PCR ribotyping and detection of toxin genes in Austria, 2006-2007.

In order to assess the lethality of Clostridium difficile-associated disease (CDAD) and the PCR ribotypes prevalent in Austria, the Austrian Agency for Health and Food Safety requested isolates of C. difficile from patients in a structured but arbitrary sampling scheme. In the allocated period from February 2006 to January 2007, local hospital laboratories within each of the nine provinces were asked to submit C. difficile isolates from at least ten cases of CDAD. Confirmation of species identification, toxin detection, susceptibility testing against four antimicrobial agents and typing using a PCR ribotyping method were performed at the reference laboratory. In total, 149 isolates of putative C. difficile were submitted, from which 142 were included for study. Antimicrobial susceptibility patterns revealed resistance to clindamycin in 57% and high-level resistance to moxifloxacin in 38% of isolates tested. CDAD manifested as diarrhoea (including eight cases of bloody diarrhoea) in 126 cases (88.7%), as pseudomembranous colitis in 15 cases (10.6%) and as toxic megacolon in one case. Twelve of the 142 patients died within 30 days of specimen collection (8.45% lethality). A lethal outcome occurred in 2/15 cases (13.3%) when pseudomembranous colitis was present and in 10/126 cases (7.9%) in the absence of pseudomembranous colitis or toxic megacolon. Among the 142 isolates from 25 health-care facilities, 41 PCR ribotype patterns were found. The most frequent ribotypes were AI-5 (including six lethal cases out of 26 patients), 014 (two out of 24) and 053 (one out of 24). The typing patterns demonstrated the occurrence of clusters in hospitals.

Attractiveness of Michigan native plants to arthropod natural enemies and herbivores.

The use of plants to provide nectar and pollen resources to natural enemies through habitat management is a growing focus of conservation biological control. Current guidelines frequently recommend use of annual plants exotic to the management area, but native perennial plants are likely to provide similar resources and may have several advantages over exotics. We compared a set of 43 native Michigan perennial plants and 5 frequently recommended exotic annual plants for their attractiveness to natural enemies and herbivores for 2 yr. Plant species differed significantly in their attractiveness to natural enemies. In year 1, the exotic annual plants outperformed many of the newly established native perennial plants. In year 2, however, many native perennial plants attracted higher numbers of natural enemies than exotic plants. In year 2, we compared each flowering plant against the background vegetation (grass) for their attractiveness to natural enemies and herbivores. Screening individual plant species allowed rapid assessment of attractiveness to natural enemies. We identified 24 native perennial plants that attracted high numbers of natural enemies with promise for habitat management. Among the most attractive are Eupatorium perfoliatum L., Monarda punctata L., Silphium perfoliatum L., Potentilla fruticosa auct. non L., Coreopsis lanceolata L., Spiraea alba Duroi, Agastache nepetoides (L.) Kuntze, Anemone canadensis L., and Angelica atropurpurea L. Subsets of these plants can now be tested to develop a community of native plant species that attracts diverse natural enemy taxa and provides nectar and pollen throughout the growing season.

Plant characteristics associated with natural enemy abundance at Michigan native plants.

Habitat management is a type of conservation biological control that focuses on increasing natural enemy populations by providing them with plant resources such as pollen and nectar. Insects are known to respond to a variety of plant characteristics in their search for plant-provided resources. A better understanding of the specific characteristics used by natural enemy insects in selecting these resources could greatly improve efficiency in screening plants for habitat management. We examined 5 previously tested and widely recommended resource plants and 43 candidate plants to test whether the number and type of natural enemies and herbivores at each plant were predicted by plant characteristics including: period of peak bloom, floral area, maximum flower height, hue, chroma, and corolla size. Natural enemy abundance increased with week of peak bloom and greater floral area across all plants tested. Ordination of plant characteristics indicated that increasing floral area, period of peak bloom, maximum flower height, and decreasing corolla width grouped together into a single principal component. Both natural enemy and herbivore abundance increased significantly with the principal component for this set of characteristics, but the relationship with herbivore abundance was weaker. These results indicate that, for a given time of the season, selection of plants with the largest floral area has potential to increase natural enemy abundance in habitat management plantings and streamline plant selection for habitat management.

Reacciones adversas medicamentosas mucocutáneas en pacientes hospitalizados en servicio de medicina interna / Mucocutaneous adverse reactions to drugs in hospitalized patients of internal medicine service

Las reacciones adversas medicamentosas mucocutáneas (RAMM) son una de las manifestaciones más frecuentes de reacción adversa a medicamentos. Su incidencia según datos internacionales alcanza un 2 por ciento a 3 por ciento en pacientes hospitalizados. Nosotros investigamos la incidencia de RAMM en el Servicio de Medicina Interna del Hospital Base de la ciudad de Los Ángeles. En el período junio-septiembre de 2006 se hospitalizaron 1.052 pacientes, diagnosticándose 3 casos de RAMM que representan un 0,3 por ciento. Se identificaron los fármacos atribuibles a las RAMM, correspondiendo a cloxacilina, toxoide tetánico y drogas antituberculosas; éstas se compararon posteriormente con un grupo control. Los casos identificados fueron un rash morbiliforme, una reacción inflamatoria local tipo celulitis y un rash urticariforme. La incidencia obtenida fue más baja de lo esperado, atribuyéndose a las características de atención del centro estudiado.

Mucocutaneous adverse reactions to drugs (MCRD) are one of the most frequent manifestations of adverse drug reaction. Its incidence, according to international data, reaches 2 to 3 percent in hospitalized patients. We studied the incidence of MCRD in the Internal Medicine Service of the Base Hospital, located in the city of Los Angeles, Chile. 1,052 patients were hospitalized during the June-September 2006 period, and three cases of MCRD were diagnosed, representing 0.3 percent. The drugs causing to MCRD were cloxacilin, tetanic toxoid and antituberculosis drugs; these were later compared to a control group. The identified cases were morbiliform rash, a cellulitis-type local inflammatory reaction, and urticariform rash. The obtained incidence was lower than expected, attributed to the characteristics of the studied center.