Characterization of the Level and Type of Resistance of Potato Varieties to Late Blight (Phytophthora infestans).

Understanding the level and type of resistance in potato varieties is relevant for integrating varietal resistance into the management of potato late blight. Accordingly, 54 potato varieties were tested for their level and type of resistance to late blight in 2019 and 2020 in Denmark. Spreader rows were artificially inoculated to ensure an even inoculum distribution in the trial. Disease severity was assessed once or twice per week. Cluster analysis (CA) was done based on the weighted mean absolute rate (WMAR), the relative area under the disease progress curve, the onset of disease (Xo), the severity of disease in the middle of the season, the time to reach 1% disease severity, the time to reach final disease severity, and the maximum disease severity. The resistance types were determined by comparing the tested varieties to Bintje (susceptible reference) for Xo and WMAR. The CA ranked the varieties as susceptible, moderately resistant, resistant, and very resistant based on their level of resistance. Except for a few varieties, the expressed resistance levels varied between the years. Several varieties that were susceptible in 2019 were moderately resistant in 2020. Also, the types of resistance that the varieties exhibited varied from year to year. In 2020, most varieties exhibited race-specific resistance, while in 2019 they mostly showed susceptible characteristics. The variation between years for the level and types of resistance of the varieties highlights the importance of regularly monitoring varietal resistance across time and space.

A new Tardigrade species, Stygarctus keralensis sp. nov. (Arthrotardigrada: Stygarctidae) from the intertidal zone of Southwest coast of India.

Stygarctus keralensis sp. nov. (Arthrotardigrada: Stygarctidae), is described from the intertidal sandy sediments of Vadakara beach, Kerala, Southwest coast of India. To a certain extent, this new species shows morphological similarity with Stygarctus gourbaultae Renaud-Mornant, 1981, however it can be differentiated by some significant distinguishable characters like double looped seminal receptacle ducts and the presence of a bow shaped internal thickening in between the opening of seminal receptacles situated below the level of gonopore and above the anus; unsculptured body plates I-III; paired sub-cephalic pore/muscle attachment; shape and structure of caudal processes. Presence of minute spikes on third lateral processes in the new species is another unique character by which it can be easily differentiated from S. gourbaultae.

Nutrition management guideline for very-long chain acyl-CoA dehydrogenase deficiency (VLCAD): An evidence- and consensus-based approach.

The nutrition management guideline for very-long chain acyl-CoA dehydrogenase deficiency (VLCAD) is the fourth in a series of web-based guidelines focusing on the diet treatment for inherited metabolic disorders and follows previous publication of guidelines for maple syrup urine disease (2014), phenylketonuria (2016) and propionic acidemia (2019). The purpose of this guideline is to establish harmonization in the treatment and monitoring of individuals with VLCAD of all ages in order to improve clinical outcomes. Six research questions were identified to support guideline development on: nutrition recommendations for the healthy individual, illness management, supplementation, monitoring, physical activity and management during pregnancy. This report describes the methodology used in its development including review, critical appraisal and abstraction of peer-reviewed studies and unpublished practice literature; expert input through two Delphi surveys and a nominal group process; and external review from metabolic physicians and dietitians. It includes the summary statements of the nutrition management recommendations for each research question, followed by a standardized rating based on the strength of the evidence. Online, open access of the full published guideline allows utilization by health care providers, researchers and collaborators who advise, advocate and care for individuals with VLCAD and their families and can be accessed from the Genetic Metabolic Dietitians International (https://GMDI.org) and Southeast Regional Genetics Network (https://southeastgenetics.org/ngp) websites.

Association of 25-Hydroxyvitamin D status and genetic variation in the vitamin D metabolic pathway with FEV1 in the Framingham Heart Study.

BACKGROUND: Vitamin D is associated with lung function in cross-sectional studies, and vitamin D inadequacy is hypothesized to play a role in the pathogenesis of chronic obstructive pulmonary disease. Further data are needed to clarify the relation between vitamin D status, genetic variation in vitamin D metabolic genes, and cross-sectional and longitudinal changes in lung function in healthy adults. METHODS: We estimated the association between serum 25-hydroxyvitamin D [25(OH)D] and cross-sectional forced expiratory volume in the first second (FEV1) in Framingham Heart Study (FHS) Offspring and Third Generation participants and the association between serum 25(OH)D and longitudinal change in FEV1 in Third Generation participants using linear mixed-effects models. Using a gene-based approach, we investigated the association between 241 SNPs in 6 select vitamin D metabolic genes in relation to longitudinal change in FEV1 in Offspring participants and pursued replication of these findings in a meta-analyzed set of 4 independent cohorts. RESULTS: We found a positive cross-sectional association between 25(OH)D and FEV1 in FHS Offspring and Third Generation participants (P=0.004). There was little or no association between 25(OH)D and longitudinal change in FEV1 in Third Generation participants (P=0.97). In Offspring participants, the CYP2R1 gene, hypothesized to influence usual serum 25(OH)D status, was associated with longitudinal change in FEV1 (gene-based P<0.05). The most significantly associated SNP from CYP2R1 had a consistent direction of association with FEV1 in the meta-analyzed set of replication cohorts, but the association did not reach statistical significance thresholds (P=0.09). CONCLUSIONS: Serum 25(OH)D status was associated with cross-sectional FEV1, but not longitudinal change in FEV1. The inconsistent associations may be driven by differences in the groups studied. CYP2R1 demonstrated a gene-based association with longitudinal change in FEV1 and is a promising candidate gene for further studies.

An enantioselective synthesis of optically pure azaferrocenyl anions--first general and practical approach to chiral azaferrocenes.

[reaction: see text] Herein we report a very simple route that allows the construction of a variety of optically pure azaferrocenyl compounds. The key feature is the preparation of optically pure 2-azaferrocenyl anions, which can serve as precursors for the construction of novel chiral azaferrocenyl complexes.

Validity of wet-mount bacterial morphotype identification of vaginal fluid by phase-contrast microscopy for diagnosis of bacterial vaginosis in family practice.

The aim of this study was to determine the accuracy of a wet-mount bacterial morphology scoring (BMS) system and Nugent's Gram stain analysis for the diagnosis of bacterial vaginosis, using Amsel's criteria as the gold standard. The three diagnostic criteria were assessed independently The BMS diagnosis was based on a scoring system which weighed the number of small bacterial morphotypes regarded as typical of bacterial vaginosis against lactobacillary morphotypes in phase-contrast microscopy of wet-mount preparations. Three groups of non-pregnant women attending either because of vaginal discharge, other genitourinary symptoms, or for a routine check-up, and a group of pregnant women attending for antenatal care were studied. The diagnostic accuracy was measured by sensitivity, specificity, positive and negative predictive values, and likelihood ratio. The accuracy of the BMS diagnosis was substantially high in all of the examined groups (LR 15.4-20.3). The accuracy of the Gram stain diagnosis was lower (LR 7.6-10.9). In the total material, the accuracy of the BMS diagnosis was higher than that of the Nugent's Gram staining. Intra- and inter-observer reproducibility of all three criteria applied was high. We propose greater routine use of the new BMS diagnosis for point-of-care testing in family practice as well as in research and in microbiology laboratories.

Bacterial vaginosis in a family practice population.

BACKGROUND: To determine and evaluate the prevalence of bacterial vaginosis diagnosed according to three sets of diagnostic criteria in three well-defined groups of non-pregnant women attending a family practice, and to determine the proportion of women diagnosed with bacterial vaginosis during a year involving the entire population registered at the practice. METHODS: During a year, bacterial vaginosis was diagnosed both according to the composite clinical diagnosis, a new wet mount diagnosis, and Nugent's gram stain diagnosis for bacterial vaginosis in women of reproductive age attending with new episodes either of abnormal vaginal discharge, other genito-urinary symptoms, or for a routine check-up. RESULTS: In non-pregnant women, bacterial vaginosis was diagnosed in a third of those with abnormal vaginal discharge (n=189), and in a tenth of those without, regardless of whether they had other genito-urinary symptoms (n=186) or not (n=273). Including all examined women, at least 11%, 13%, and 16% of the 880 women registered at the practice, were diagnosed with bacterial vaginosis according to the composite clinical, the wet mount, and the gram stain diagnoses, respectively. The results were based on the 57% of the women who attended during the year. The prevalence data differed significantly according to which diagnostic method we used, the composite clinical lowest, the wet mount intermediate, and the gram stain highest. CONCLUSION: Both well-defined criteria of inclusion and unison diagnostic procedures are necessary for reliable comparison and generalization of prevalence data of bacterial vaginosis.

[Penicillin treatment of acute maxillary sinusitis in adults. A randomized, double-blind, placebo-controlled trial from general practice]. / Penicillinbehandling af akut kaebehulebetaendelse hos voksne. En randomiseret, dobbeltblind, placebokontrolleret undersøgelse fra almen praksis.

INTRODUCTION: The aim of the study was to compare the effectiveness of penicillin V with placebo in the treatment of adult patients with acute maxillary sinusitis (in general practice). MATERIAL AND METHODS: The study was designed as a randomised, double-blind, placebo-controlled trial in 26 Danish general practices. The participants were 133 adult patients with acute maxillary sinusitis clinically diagnosed on maxillary pain and raised values of either C-reactive protein (CRP) or the erythrocyte sedimentation (ESR) rate. Main outcome measures were pain score and illness score, and CRP and ESR values after initiation of treatment. RESULTS: Penicillin V led to a better recovery than placebo. The difference in pain reduction was statistically significant three days after initiation of treatment, whereas no significant difference was found in the reduction in the sense of illness. At the end of the study, significantly more patients in the penicillin group were completely free of pain than in the placebo group. This difference was found only in patients with an initial pain score of more than three. The cure rate was 71% in the penicillin group and 37% in the placebo group. Significantly more patients treated with penicillin achieved normal CRP values than those receiving placebo, respectively 88% and 75%. CONCLUSION: Penicillin V is more effective than placebo in the treatment of acute maxillary sinusitis in adults in general practice, but only in patients with pronounced pain.

[Treatment of upper respiratory tract infections]. / Behandling af øvre luftvejsinfektioner.

Today most upper respiratory tract infections are mild and of short duration with minor risk of complications. Hence, the effects of antibiotic treatment are marginal. The only and most important reason for treatment is to stop dissemination. Penicillin V should be the first drug of choice. A review of the literature about antibiotic treatment of upper respiratory tract infections shows that most published studies exclude two categories of patients: children below the age of 6 months and patients who are severely ill. Therefore, there is an additional need for further studies focused on select groups of patients to investigate the benefit, if any, of antibiotic treatment as well as to study the effect of introducing near-patient-tests and the use of extended microbiological service in daily clinical practice.

[C-reactive protein and infections in general practice]. / C-reaktivt protein og infektioner i almen praksis.

C-reactive protein (CRP) is a sensitive and non-specific inflammatory marker. The serum level of CRP starts to rise 6-12 hours after the start of an inflammatory stimulus. Sequential CRP measurements will have greater diagnostic value than a single measurement, and changes of the CRP values often reflect the clinical course. In use in general practice the diagnostic value of CRP is found to be high in adults with pneumonia, sinusitis and tonsillitis, however it is found to be low regarding otitis and pneumonia in children. As to urinary tract infections and salpingitis the value is still undefined. Measurement of CRP is an important diagnostic test but the analysis should not stand by itself but be evaluated together with the patient's history and clinical examination.

Randomised, double blind, placebo controlled trial of penicillin V in the treatment of acute maxillary sinusitis in adults in general practice.

OBJECTIVE: To compare the effectiveness of penicillin V with placebo in the treatment of adult patients with acute maxillary sinusitis in general practice. DESIGN: Randomised, double blind, placebo controlled trial. SETTING: 26 Danish general practices. PATIENTS: 133 adult patients with a clinical diagnosis of acute maxillary sinusitis based on maxillary pain and raised values of either C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). MAIN OUTCOME MEASURES: Pain score and illness score as well as measurement of CRP and ESR values after initiation of treatment. RESULTS: Penicillin V led to a better recovery than did placebo. The difference was statistically significant 3 days after the initiation of treatment with regard to pain reduction, whereas no significant difference was found with regard to the reduction in the sense of illness. At the end of the study, significantly more patients in the penicillin group were completely free of pain compared to the placebo group. This difference was only found in patients with an initial pain score of more than three. The cure rate was 71% in the penicillin group and 37% in the placebo group. Significantly more patients achieved normal CRP values when treated with penicillin (88%) as opposed to placebo (75%). CONCLUSION: Penicillin V is more effective than placebo in the treatment of acute maxillary sinusitis in adults in general practice, but only in patients with pronounced pain.

[Tympanometry]. / Tympanometri.

A flat tympanogram predicts a middle ear effusion in about 90% of cases. This paper describes how to perform tympanometry, some common problems when doing it and how to classify the curves in normal (type A), middle ear effusion (type B) or negative pressure (type C). The theoretical background of impedance audiometry is outlined. The stapedius reflex, pneumatic otoscopy, reflexometry and otomicroscopy are described as supplements or alternatives in diagnosing fluid in the middle ear. Tympanometry is recommended as a diagnostic modality for general practitioners.

Diagnosis of bacterial vaginosis by wet mount identification of bacterial morphotypes in vaginal fluid.

In order to develop a more practical way of diagnosing bacterial vaginosis (BV), we evaluated a scoring system, weighting small bacterial morphotypes versus lactobacillary morphotypes in wet mounts, assessed criteria for BV and normalcy from this scoring, and then evaluated their reproducibility and accuracy. We examined 754 women for pH, homogeneous vaginal discharge, amine odour, clue cells and the composite clinical diagnosis. We also examined wet mounts for small bacterial morphotypes and lactobacillary morphotypes, and weighted their quantitative presence as a bacterial morphotype score. The term 'small bacterial morphotypes' denotes a group of small bacillary forms comprising coccobacilli, tiny rods, and mobile curved rods. The different characteristics of BV were all gradually associated with increased bacterial morphotype scoring. We deemed a score of 0-1 as normal, 2-4 as intermediate phase, grade I, 5-6 as intermediate phase, grade II, and 7-8 indicative of BV. Reproducibility of the interpretation was high, both for the new grading system (weighted Kappa 0.90 in women perceiving and 0.81 in women not perceiving abnormal vaginal discharge) and for the new criterion for BV (non-weighted Kappa 0.91 and 0.84 in the 2 groups of women). The new criterion also proved highly concurrent with the composite clinical diagnosis (Kappa 0.91 and 0.81 in the 2 groups). In conclusion, the wet mount bacterial morphotype scoring is valid for grading of the disorder of the vaginal microbial ecosystem, and the new criterion for BV a more practical option than existing diagnostic methods.

Prostatic asymmetry as a risk factor for prostatic carcinoma: serial prostate-specific antigen monitoring and cancer detection.

OBJECTIVE: To compare the rates of cancer detection in men with a normal, asymmetric, or suspicious prostate on digital rectal examination (DRE) initially and after 3 years of serial monitoring of prostate specific antigen (PSA) level. PATIENTS AND METHODS: Prostatic 'asymmetry' was defined as asymmetric growth of the lateral lobes of the prostate without induration or nodules, as assessed by a DRE. The study included 963 men with no clinical evidence of prostate cancer and whose serum PSA levels were monitored at 4 month intervals. Prostatic biopsy was recommended if the PSA level became persistently abnormal (> 4ng/mL) or increased by > 20% after having been initially abnormal. Cancer detection rates were compared among groups categorized by the initial DRE findings and serum PSA level. RESULTS: On comparing groups with suspicious and normal DREs, and abnormal with normal PSA levels both, as expected, were associated with a statistically significant increase in cancer detection. However, an asymmetric prostate did not carry an increased risk of detecting prostate cancer when compared with a normal prostate, regardless of PSA level. CONCLUSIONS: An asymmetric prostate does not appear to be an independent risk factor for detecting prostate cancer. Therefore, an asymmetric prostate with no abnormality in PSA level should not mandate prostatic biopsy, or even an increase in monitoring frequency above the presently recommended annual interval.

[Clinical criteria for acute maxillary sinusitis in general practice]. / Klinisk kriterium for sinuitis maxillaris acuta i almen praksis.

The purpose of the investigation was to examine the diagnostic value of various symptoms, clinical findings, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) in acute maxillary sinusitis using the aspiration of purulent or mucopurulent from the sinus of a patient with a pathological CT-scanning as the golden standard. Of 174 patients with suspected acute maxillary sinusitis seen in general practice we found 70% to have a pathological CT-scanning and 53% to have pus or mucous pus in the sinus aspirate. Only the ESR and CRP level were found to be significantly and independently associated with a positive diagnosis as defined by the golden standard. A clinical criterion based on either an elevated ESR and/or CRP level in a patient with pain related to the maxillary sinus region had sensitivity of 0.82, a specificity of 0.57, a positive predictive value of 0.68 and a negative predictive value of 0.75, and was diagnostically superior to the clinical examination. The investigation also confirms that this disease is most likely overdiagnosed in general practice.

[Diagnosis and treatment of bacterial vaginosis by general practitioners]. / Alment praktiserende laegers diagnostik og behandling af bakteriel vaginose.

In order to evaluate which diagnostic procedures and treatments general practitioners (GP) used for bacterial vaginosis, and to describe their knowledge of the disease, all the GPs in two counties were asked to fill in a questionnaire. Two hundred and sixty-six (59%) answered. The GP used the criteria of Amsel in 9%, the wet smear criteria in 12%, clue cells in 6%, the amine test in 30%, culture of Gardnerella vaginalis in 29%, 8% only used clinical examination and 6% did not use any criteria. Many examinations were carried out unnecessarily. Sixty-six percent stated that they had a sufficient knowledge of bacterial vaginosis, 36% had knowledge of the criteria of Amsel, 78% of the definition of clue cells and 58% considered culture of Gardnerella vaginalis as being diagnostically useful. Seventy-one percent used metronidazole for treatment. Treatment of the sexual partner was carried out in 33%. In conclusion, we recommend introduction of a more simple criterion than the criteria of Amsel.

Predicting acute maxillary sinusitis in a general practice population.

OBJECTIVE: To evaluate the diagnostic value of symptoms, signs, erythrocyte sedimentation rate, and C reactive protein for acute maxillary sinusitis. DESIGN: Prospective cohort study. SETTING: Danish general practice in cooperation with the otorhinolaryngology and neuroradiology department at Aalborg County Hospital. SUBJECTS: 174 patients aged 18-65 years who were suspected by the general practitioner of having acute maxillary sinusitis. MAIN OUTCOME MEASURE: The independent association of symptoms, signs, erythrocyte sedimentation rate, and concentration of C reactive protein in patients with acute maxillary sinusitis defined as purulent or mucopurulent antral aspirate. RESULTS: Only raised erythrocyte sedimentation rate (P = 0.01) and raised C reactive protein (P = 0.007) were found to be independently associated with a diagnosis of acute maxillary sinusitis. The combination of the two variables had a sensitivity of 0.82 and a specificity of 0.57. CONCLUSION: Erythrocyte sedimentation rate and C reactive protein are useful diagnostic criteria for acute maxillary sinusitis.

A wet smear criterion for bacterial vaginosis.

OBJECTIVE: To evaluate a simpler criterion for bacterial vaginosis than the recommended criterion of Amsel. DESIGN: Cross-sectional study comparing diagnostic data with a recommended standard. SETTING: Danish general practice. PARTICIPANTS: 595 non-pregnant women aged 15-49 years who were gynaecologically examined, were divided into two groups in accordance with a complaint of vaginal discharge. MAIN OUTCOME MEASURE: The associations of pH > 4.5, homogeneity, amine odour, clue cells, and wet smear assessment of predominance of lactobacilli, Gardnerella vaginalis, motile rods with the criterion of Amsel. RESULTS: The four components of Amsel showed a considerable variation of association. Predominance of GV was more highly associated than several of the components. The association of a wet smear criterion composed of the presence of clue cells in combination with predominance of Gardnerella vaginalis and absence of lactobacilli was superior to other combinations. In the group without a complaint of vaginal discharge, preceding screening with use of a pH-measurement seemed advantageous. CONCLUSION: The wet smear criterion seems suitable for use in general practice. But before a definitive establishment, calculation of the reproducibility of interpretation of this criterion, preferably with a more explicit setting of the components, has to be carried out.

[Diagnosis and treatment of acute sinusitis by Danish general practitioners]. / Danske praktiserende laegers diagnosticering og behandling af sinuitis acuta.

We studied Danish general practitioners' (GP) weighting of symptoms, clinical findings and use of paraclinical investigations when diagnosing acute sinusitis in adults. Questionnaires were sent to 300 representative GPs. Sixty-seven percent answered the questionnaire. The GPs weighted pain and tenderness on application of pressure over the sinuses as the most important symptom and finding. Only a few used paraclinical investigations. The GPs estimated their own diagnostic certainty as being 70%. Detumescent nose-drops were prescribed in 95% of the cases, and antibiotic treatment was given in 50%, most frequently as V-penicillin.