Multilocus phylogeography reveals nested endemism in a gecko across the monsoonal tropics of Australia.

Multilocus phylogeography can uncover taxonomically unrecognized lineage diversity across complex biomes. The Australian monsoonal tropics include vast, ecologically intact savanna-woodland plains interspersed with ancient sandstone uplands. Although recognized in general for its high species richness and endemism, the biodiversity of the region remains underexplored due to its remoteness. This is despite a high rate of ongoing species discovery, especially in wetter regions and for rock-restricted taxa. To provide a baseline for ongoing comparative analyses, we tested for phylogeographic structure in an ecologically generalized and widespread taxon, the gecko Heteronotia binoei. We apply coalescent analyses to multilocus sequence data (mitochondrial DNA and eight nuclear DNA introns) from individuals sampled extensively and at fine scale across the region. The results demonstrate surprisingly deep and geographically nested lineage diversity. Several intra-specific clades previously shown to be endemic to the region were themselves found to contain multiple, short-range lineages. To infer landscapes with concentrations of unique phylogeographic diversity, we probabilistically estimate the ranges of lineages from point data and then, combining these estimates with the nDNA species tree, estimate phyloendemism across the region. Highest levels of phyloendemism occur in northern Top End, especially on islands, across the topographically complex Arnhem escarpment, and across the sandstone ranges of the western Gulf region. These results drive home that deep phylogeographic structure is prevalent in tropical low-dispersal taxa, even ones that are ubiquitous across geography and habitats.

[Clinical and microbiological aspects of fungal peritonitis in peritoneal dialysis]. / Aspectos clínicos y microbiológicos de la peritonitis fúngica en diálisis peritoneal.

Peritonitis is one of the most serious complications of peritoneal dialysis. Pathogenic bacteria cause the majority of cases of peritonitis. Fungal infection is rare but it is associated with high morbidity, the inability to continue on the dialysis program and important mortality. Its incidence varies from 4% to 10% of all peritonitis episodes in children and from 1% to 23% in adults. Its clinical presentation is similar to bacterial peritonitis. Until now, predisposing factors of fungal peritonitis have not been clearly established; history of bacterial peritonitis episodes and treatment with broad-spectrum antibiotics have been often reported in the literature. Candida species were the most common pathogens and Candida albicans was the most frequent, but high prevalence of Candida parapsilosis has been observed in the last decade. Microbiological findings are essential to to determine the etiology of peritonitis. Successful management of fungal peritonitis requires antifungal therapy, the removal of peritoneal catheter and the subsequent transfer to hemodialysis. Fluconazole and amphotericin B are recommended as antifungal agents. New drugs as voriconazole and caspofungin are very effective. The aim of this systematic review has been to analyse the clinical and microbiological aspects of fungal peritonitis, as they are not well known and have changed in the last few years.

[Fungal peritonitis in ambulatory continuous peritoneal dialysis: description of 10 cases]. / Peritonitis fúngica en diálisis peritoneal continua ambulatoria: descripción de 10 casos.

BACKGROUND: Fungal peritonitis is a rare but serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS: During a ten-year period (1999-2008), from a total of 175 patients with chronic renal failure undergoing CAPD, we retrospectively studied 10 cases of fungal peritonitis analyzing the predisposing factors, clinical aspects, etiological agents and treatment. Diagnosis was based on elevated CAPD effluent count (>100/microl) and isolation of fungi on culture. RESULTS: Fungal peritonitis represented 3.6% of all peritonitis episodes. Nine patients had a history of previous bacterial peritonitis and all of them were under antibiotic therapy. Other common findings were: age higher than 70 years old (50%) and diabetes mellitus (40%). Direct microscopic examination of the peritoneal fluid was useful for the suspicion of fungal infection in six patients (60%). The responsible agents for peritonitis were: Candida parapsilosis (4), Candida albicans (2), Candida tropicales (1), Candida glabrata (1), Candida famata (1) and Fusarium oxysporum (1). Intraperitoneal and oral fluconazole, intravenous and oral voriconazole and intravenous amphotericin B were the antifungal agents used in the treatment. As a result of fungal infection, eight patients were transferred to hemodialysis. One patient died before the diagnosis and three other during the episode of peritonitis. CONCLUSIONS: Patients with previous bacterial peritonitis and antibiotic treatment were at greater risk of developing fungal peritonitis. Candida parapsilosis was the most common pathogen. For the successful management of fungal peritonitis besides the antifungal therapy, peritoneal catheter removal was necessary in 60% of patients.

[Identification of yeasts of clinical interest on CHROMagar Candida culture medium.]. / Identificación de levaduras de interés clínico en el medio de cultivo CHROMagar Candida.

The efficiency of CHROMagar Candida was evaluated as a medium for the presumptive identification of yeasts. We tested 36 different yeast species, pertaining to 9 genera: one Blastoschizomyces, 20 Candida, five Cryptococcus, two Geotrichum, one Kloeckera, two Pichia, three Rhodotorula, one Saccharomyces and one Trichosporon, to determine the colony colors and characteristics on this medium. Afterwards, we identified 2,230 strains isolated directly on CHROMagar Candida from clinical samples by specific colouration and morphology of the colonies after 72 hours. Their results were compared with standard methods for the identification of yeasts. The sensitivity and specificity were both superior to 97% for all strains, 100% and 100% for Candida albicans, 97.3% and 99.9% for Candida glabrata, 92.3% and 99.6% for Candida krusei, 90.3% and 99.6% for Candida parapsilosis, and 100% and 100% for Candida tropicalis. CHROMagar Candida is a very useful medium for the culture of clinical samples; its use for identification of yeasts has an accuracy of 97.5%, close to 100% of conventional methods.

[Study of the susceptibility of black yeasts of the Exophiala genus to antifungals using the Sensititre System]. / Sensibilidad a los antifúngicos en levaduras negras del género Exophiala determinada mediante Sensititre.

Black yeasts belong to a group of dematiaceous fungi which are difficult to classify and identify. One of the genera that cause human infection, mainly phaeohyphomycosis, is Exophiala, which includes the species E. berger, E. castellanii, E. dermatitidis, E. jeanselmei, E. lecanii-corni, E. moniliae, E. pisciphila, E. salmonis and E. spinifera. We carried out a susceptibility study of five of these species (E. castellanii, E.dermatitidis, E, jeanselmei, E. lecanii-corni and E. moniliae), isolated from cutaneous exudates, to the usual antimycotic agents. Strains were cultured on Sabouraud agar and potato-dextrose agar. Species identification was made by conidiogenous microscopic observation and the following characteristics: maximum growth temperature, tolerance to cicloheximide and carbohydrate assimilation. Susceptibility to antimycotic agents (amphotericin B, fluconazole, itraconazole, ketoconazole and 5-fluorocytosine) was determined by the Sensititre YeastOne (Aamar Blue) commercial method. Amphotericin B activity was good for the five tested species, although the MIC for E. jeanselmei was high (1 mg/l. MICs for fluconazole were high for all the species, but only E. moniliae and E. lecanii-corni c be considered resistant. Activity of itraconazole, ketoconazole and 5-fluorocytosine was good.

Efficacy of a hepatitis B vaccination schedule with two cycles of four double doses of conventional vaccine and four doses of adjuvanted vaccine in chronic kidney disease patients evaluated for renal transplantation.

INTRODUCTION: The response to hepatitis B (HB) vaccine remains suboptimal among chronic kidney disease patients. The aim of this study was to analyze the efficacy of a hepatitis B vaccination schedule with two 4-double doses of conventional vaccine and four doses of adjuvant vaccine in chronic kidney disease patients evaluated for renal transplantation. METHODS: In this prospective study, we recruited chronic kidney disease patients evaluated for renal transplantation to receive four 40-µg doses of hepatitis B virus vaccine (0, 1, 2 and 6 months) and another four 40 µg doses of hepatitis B virus vaccine and four 20 µg doses of adjuvant vaccine if they were nonresponders. AntiHBs titers were analyzed before every vaccine dose and 1 month after the fourth dose. RESULTS: One hundred fifty-five patients were enrolled in the study. The response to the vaccination increased until the seventh dose: first dose, 5.4%; second, 29.5%; third, 66.7%; fourth, 75.9%; fifth, 83.3%; sixth, 87.3%; seventh, 92.5%; and eighth, 93.8%. AntiHBs titers after the first and second vaccination with Engerix were 10 to 99 mIU/mL in the 12% and 7.7%, 100 to 999 mIU/mL in the 30.1%, and 46.2%, and 1000 mIU/mL in the 34.9% and 15.4%, respectively. Fendrix was administrated in 6.2% of the patients and 75% of them obtained a response. AntiHBc-positive patients obtained a response with one vaccination cycle in the 71.4%. The response was influenced by age and was greater in women. Adverse events were found in 11.5% of the patients (inflammation and/or local pain), which were less frequent in men (8.9% versus 16.1%) and similar for both vaccines. CONCLUSION: The response to the hepatitis B vaccination with four double doses of conventional vaccine and revaccination with the same schedule and adjuvanted vaccine shows a high response rate in chronic kidney disease evaluated for renal transplantation.

Management of HCV infection in chronic kidney disease.

The prevalence of chronic infection with the hepatitis C virus (HCV) in patients with chronic kidney disease is higher than in the general population. The estimated prevalence is 13% in haemodialysis, with wide variations geographically and between units in the same country. A liver biopsy is a useful tool for deciding whether to start antiviral therapy and to exclude concomitant causes of liver dysfunction. Examples of this include non-alcoholic fatty liver disease, whose incidence is on the rise, and haemosiderosis, which may affect the progression of the disease and determine the response to antiviral therapy. In addition, the transjugular approach can be used to measure the hepatic venous pressure gradient and confirm the existence of portal hypertension. Chronic hepatitis due to HCV has been shown to reduce survival in haemodialysis, renal transplantation and graft survival. It is the fourth leading cause of death and the leading cause of post-renal transplantation liver dysfunction. HCV behaves as an independent risk factor for the occurrence of proteinuria; it increases the risk of developing diabetes mellitus, de novo glomerulonephritis and chronic allograft nephropathy; it leads to a deterioration in liver disease and causes a greater number of infections. An increased frequency of fibrosing cholestatic hepatitis has also been described which, together with the rapid evolution to cirrhosis, can significantly increase morbidity and mortality and lead to the need for liver transplantation. In addition, immunosuppression in renal transplantation predisposes a reactivation of HCV. However, as the pharmacokinetics of interferon and ribavirin is impaired in kidney failure and their use has adverse effects on function and graft survival, a combination therapy must be limited to non-transplanted individuals with an estimated glomerular filtration rate greater than 50ml/min, and with the interferon being used as monotherapy in dialysis. The fact that a quarter of HCV-positive patients evaluated for a renal transplant have bridging fibrosis or cirrhosis in the liver biopsy may renew renal pre-transplant treatment planning.

Parry Romberg syndrome and linear scleroderma in coup de sabre mimicking Rasmussen encephalitis.

We present one patient with Parry Romberg syndrome and another with linear scleroderma in coup de sabre, with focal neurologic deficits and intractable seizures arising from the hemisphere ipsilateral to the cutaneous lesion. Brain MRI showed progressive hemispheric atrophy. Pathology after functional hemispherectomy showed chronic inflammatory features suggestive of Rasmussen encephalitis.

Cortical laminar necrosis related to prolonged focal status epilepticus.

Cortical laminar necrosis (CLN) is radiologically defined as high intensity cortical lesions on T1 weighted MRI images following a gyral distribution. Histopathologically, CLN is characterised by pannecrosis of the cortex involving neurones, glial cells, and blood vessels. It has been reported to be associated with hypoxia, metabolic disturbances, drugs, and infections. We present two patients who developed CLN and permanent neurological deficits after prolonged and repeated focal status epilepticus. The possible mechanisms leading to CLN in these patients are discussed, together with the implications of prompt and aggressive treatment in similar cases.

Complex motor behaviors in temporal lobe epilepsy.

Complex motor behaviors differing from typical automatisms were found in 12 of 502 patients with temporal lobe epilepsy. Movements involved proximal limb segments (6) or body axis (6) and were often preceded by auras and followed by automatisms. Seven of 12 patients are seizure free after surgery. The other 5 patients declined surgery.

[The influence of health education on nutrition]. / Evaluación de la influencia de la educación sanitaria en la alimentación.

To assess the effectiveness of health education in relation to the changes it produces in both information and the general population's outlook on food consumption. DESIGN. A controlled intervention study, with a randomized double-blind sample. PLACE. Village covered by the Fuenlabrada Health Centre. PARTICIPANTS. 88 families agreed to take part, out of the 408 that made up the total sample for the field study on food consumption previously undertaken. 24 families in the intervention group (46% loss) and 35 in the control group (20% loss) completed the study. ACTIVITY. A group of nurses with diplomas in Health Education delivered advice and instruction on diet and health to the families in the study group, during April, May and June, 1990. MEASUREMENTS AND MAIN RESULTS. Two kinds of questionnaires, both previously validated, were used to measure the varying levels of food consumption and of information. These questionnaires were filled by both sample groups (intervention and control), before and after the health education. The level of knowledge, taking into account the number of positive answers in the information questionnaire, was significantly higher in the intervention group than in the control one (p less than 0.005). The level of food consumption was significantly higher in the meat intervention group, attaining an average of 3.08 (2.46-3.67); whereas in the control group an average of 4.39 was obtained. (3.72-5.06) (p less than 0.005). CONCLUSIONS. There was scant participation among the healthy population.(ABSTRACT TRUNCATED AT 250 WORDS)

[Antifungal susceptibility of emerging yeast pathogens]. / Sensibilidad a antifúngicos de levaduras patógenas emergentes.

BACKGROUND: To study the antifungal susceptibility of emerging yeast pathogens to know their possible resistance under the need of applying a treatment. MATERIAL AND METHODS: We investigated the in vitro susceptibility of 69 yeast strains isolates of clinical samples, belonging to 24 different species, to amphotericin B, fluconazole, itraconazole, ketoconazole and 5-fluorocytosine. RESULTS: Only 9 species showed susceptibility to all antifungal agents: Candida famata, C. guillermondii, C. holmii, C. kefyr, C. pelliculosa, C. rugosa, C. utilis, C. zeylanoides y Trichosporon cutaneum; the rest of them presented resistance to some antifungal agent. C. haemulonii, Pichia farinosa and Trichosporon mucoides were resistant to amphotericin B; C. haemulonii, C. inconspicua, C. lusitaniae, C. norvegensis, C. pintolepesii, C. valida, P. ohmeri, Rhodotorula glutinis, R. minuta, R. mucilaginosa and Saccharomyces cerevisiae were resistant to azoles; Blastoschizomyces capitatus and C. lipolytica were resistant to 5-fluorocytosine. CONCLUSIONS: The resistance of emerging yeast pathogens to amphotericin B and 5-fluorocytosine is low, while resistance to azoles is significative, especially to fluconazole (36%). Many of this yeasts present problems of intrinsic resistance. In yeast infections, the correct identification of species and the study of the in vitro susceptibility is important in order to choose the most adequate antifungal treatment.