Molecular characterisation of multidrug-resistant Mycobacterium tuberculosis isolates from a high-burden tuberculosis state in Brazil.

Tuberculosis (TB) is the leading cause of death among infectious diseases worldwide. Among the estimated cases of drug-resistant TB, approximately 60% occur in the BRICS countries (Brazil, Russia, India, China and South Africa). Among Brazilian states, primary and acquired multidrug-resistant TB (MDR-TB) rates were the highest in Rio Grande do Sul (RS). This study aimed to perform molecular characterisation of MDR-TB in the State of RS, a high-burden Brazilian state. We performed molecular characterisation of MDR-TB cases in RS, defined by drug susceptibility testing, using 131 Mycobacterium tuberculosis (M.tb) DNA samples from the Central Laboratory. We carried out MIRU-VNTR 24loci, spoligotyping, sequencing of the katG, inhA and rpoB genes and RDRio sublineage identification. The most frequent families found were LAM (65.6%) and Haarlem (22.1%). RDRio deletion was observed in 42 (32%) of the M.tb isolates. Among MDR-TB cases, eight (6.1%) did not present mutations in the studied genes. In 116 (88.5%) M.tb isolates, we found mutations associated with rifampicin (RIF) resistance in rpoB gene, and in 112 isolates (85.5%), we observed mutations related to isoniazid resistance in katG and inhA genes. An insertion of 12 nucleotides (CCAGAACAACCC) at the 516 codon in the rpoB gene, possibly responsible for a decreased interaction of RIF and RNA polymerase, was found in 19/131 of the isolates, belonging mostly to LAM and Haarlem families. These results enable a better understanding of the dynamics of transmission and evolution of MDR-TB in the region.

Dental fear/anxiety among children and adolescents. A systematic review.

AIM: The aim of this paper was to review the published scientific literature to quantify the prevalence and mean score of dental fear/anxiety (DFA) in children/adolescents and its variation according to several variables. MATERIALS AND METHODS: Cross- sectional and cohort studies published from 2000 to 2014, that measured DFA in children /adolescents (aged 0-19 years), in the general population, or visiting private or public dental services (general or pediatric) or attending school and kindergarten, were searched, with specific terms, in 3 electronic databases (Medline, Embase, Web Of Science). Primary data, collected with specific questionnaires of demonstrated reliability and/or validity, were extracted. RESULTS: After screening 743 abstracts and evaluating 164 full-text publications, 36 articles were selected. Dental fear/anxiety prevalence rates were 12.2%, 10.0%, 12.2%,11.0% and 20.0% for the CFSS-DS, DAS, MDAS, DFS, and DFSS-SF scores, respectively. In the studies that used MCDAS Dental fear/prevalence rates varied from 13.3% to 29.3%. In the studies that used CFSS-DS ratings, the prevalence and the mean score of dental fear/anxiety was lower in Northern Europe than the remaining countries, the prevalence decreased with increasing age and the frequency was higher in females than males. CONCLUSIONS: Dental fear/anxiety is a common problem in children/adolescents worldwide, therefore, new strategies to overcome this relevant children/adolescent condition should be encouraged.

The rs39335 polymorphism of the RELN gene is not associated with otosclerosis in a southern Italian population.

Otosclerosis, the single most common cause of hearing impairment in white adults, is characterised by bone dystrophy localized to the otic capsule and isolated endochondral bone sclerosis with alternating phases of bone resorption and formation. Conductive hearing loss develops when otosclerotic foci invade the stapedio-vestibular joint (oval window) and interfere with free motion of the stapes, but affected subjects frequently develop profound sensorineural hearing loss. The aetiology of otosclerosis is unknown. In the last years, several association studies have been performed and have suggested that single nucleotide polymorphisms in some genes may be implicated in development of otosclerosis. The strongest association has been demonstrated for the reelin gene, located on chromosome 7q22.1, which encodes an extracellular matrix protein. The involvement of reelin in the pathogenesis of otosclerosis is controversial; it was identified in European and North African populations, but was excluded in an Indian population. To analyze the role of reelin in otosclerosis, it has been studied in a case-control analysis for the polymorphism rs39335 in a southern Italy population. In this population, the pathogenic link between the rs39335 variant and otosclerosis was excluded.

The morphine-prostigmin provocative test--is it useful for making clinical decisions?

The morphine-Prostigmin test has been used to diagnose disease of the sphincter of Oddi in patients with chronic abdominal pain. A twofold rise in amylase or lipase levels, reproduction of abdominal pain or both have been considered positive responses. A positive morphine-Prostigmin test has been used as a justification for a sphincteroplasty, a surgical procedure with significant morbidity. Little data are available on the response of control populations to morphine-Prostigmin, or the reproducibility of this test on different days. Ten healthy volunteers, 5 patients with symptoms of irritable bowel syndrome and 4 patients with chronic abdominal pain were given the morphine-Prostigmin test. Sixty percent of our healthy control subjects and patients with the irritable bowel syndrome had a marked elevation in amylase and lipase. Forty percent of those with the irritable bowel syndrome had reproduction of their typical abdominal pain after morphine-Prostigmin. Two of four patients with chronic abdominal pain had a different response to morphine-Prostigmin on second as compared to initial testing. We conclude that: (a) neither enzyme rise nor reproduction of abdominal pain produced by morphine-Prostigmin are specific for disease of the sphincter of Oddi, and (b) the morphine-Prostigmin test may give different results on different days in the same patient. Major clinical decisions should not be made on the basis of this test.