Cetacean diversity on the Parnaiba Delta, Maranhão state, northeastern Brazil.

The increase in the research of cetacean surveys on the Brazilian coast has brought new data on the distribution of species never reported before. The present work reviews the current knowledge on cetaceans species and extends this knowledge with an analysis of cetaceans stranded in the Parnaiba Delta, on the coast of Maranhão State, Brazil. The studies on cetacean diversity on the coast of the Parnaíba Delta were made from August 2004 to August 2006. Fourteen strandings were reported, representing six distinct species, such as the estuarine dolphin (Sotalia guianensis), humpback whale (Megaptera novaeangliae), Bryde's whales (Balaenoptera edeni), dwarf minke whale (Balaenoptera acutorostrata), pigmy killer whale (Feresa attenuata), sperm whale (Physeter macrocephalus) and two specimens which have not yet been identified. The significant degree of cetacean diversity in the region shows that the Parnaíba Delta is, possibly, of an important area for cetacean studies in Brasil.

Cetacean diversity on the Parnaiba Delta, Maranhão state, northeastern Brazil / Diversidade de cetáceos no Delta do Parnaíba, estado do Maranhão, nordeste do Brasil

The increase in the research of cetacean surveys on the Brazilian coast has brought new data on the distribution of species never reported before. The present work reviews the current knowledge on cetaceans species and extends this knowledge with an analysis of cetaceans stranded in the Parnaiba Delta, on the coast of Maranhão State, Brazil. The studies on cetacean diversity on the coast of the Parnaíba Delta were made from August 2004 to August 2006. Fourteen strandings were reported, representing six distinct species, such as the estuarine dolphin (Sotalia guianensis), humpback whale (Megaptera novaeangliae), Bryde's whales (Balaenoptera edeni), dwarf minke whale (Balaenoptera acutorostrata), pigmy killer whale (Feresa attenuata), sperm whale (Physeter macrocephalus) and two specimens which have not yet been identified. The significant degree of cetacean diversity in the region shows that the Parnaíba Delta is, possibly, of an important area for cetacean studies in Brasil.

Com o aumento das pesquisas voltadas para o monitoramento de cetáceos no litoral brasileiro, registros inéditos sobre a distribuição de espécies têm sido realizados, ampliando o conhecimento sobre áreas de ocorrência dos cetáceos no Brasil. O presente estudo teve por objetivo realizar um levantamento das espécies de cetáceos encalhadas no Delta do Parnaíba, MA. Os estudos foram realizados através de entrevistas com comunidades locais e por meio de coleta direta, entre agosto de 2004 e agosto de 2006. Foram registrados 14 encalhes de cetáceos, com representantes de 6 espécies distintas, até então desconhecidas para a região do Delta do Parnaíba com um exemplar não identificado. Dentre as espécies registradas foram encontrados cinco exemplares do boto-cinza (Sotalia guianensis), um exemplar de baleia-jubarte (Megaptera novaeangliae), três exemplares de baleia-de-bryde (Balaenoptera edeni), um exemplar de baleia-minke-anã (Balaenoptera acutorostrata), um exemplar de orca-pigméia (Feresa attenuata), dois exemplares de cachalote (Physeter macrocephalus) e dois exemplares não identificados que correspondem a um crânio de misticeto e uma escápula de um possível filhote de odontoceto. A significativa diversidade na região do Delta do Parnaíba indica sua relevância para os estudos de cetáceos no Brasil. As análises de idade, baseadas em análises de suturas ósseas dos exemplares encalhados mostram que a região deltaica pode ser utilizada como área de reprodução por algumas espécies como Sotalia guianensis e Balaenoptera edeni.

Redimune NF Liquid, a ready-to-use, high-concentration intravenous immunoglobulin therapy preparation, is safe and typically well tolerated in the routine clinical management of a broad range of conditions.

In clinical practice, intravenous immunoglobulin therapy (IVIG) is used in the management of a wide variety of medical conditions. Observational studies examining IVIG use in routine clinical practice are therefore an important means of validating findings from more strictly randomized controlled trials of patients with specific conditions. In this observational study, we examined the tolerability of a high-concentration (12%) ready-to-use liquid IVIG (Redimune NF Liquid) when used in the standard management of a diverse range of conditions (including primary immunodeficiency diseases, neurology conditions, oncology conditions and immune thrombocytopaenic purpura). IVIG regimen and dose were selected by the physician based on the summary of product characteristics. During the study, 193 infusions were administered to 51 patients in 153 infusion cycles (per infusion cycle: one to five infusions; mean dose, 347.6 mg/kg; mean duration, 202.4 min). The mean maximum infusion rate per cycle was 2.9 mg/kg/min, demonstrating that the infusion rate was often higher than that recommended in the summary of product characteristics. Redimune NF Liquid was well tolerated: there were 36 adverse reactions (at least probably associated with IVIG) in 10 patients (19.6% of sample, 0.24 per infusion cycle, 0.19 per infusion). The most common adverse reaction was headache (50% of reactions), followed by chills (13.8%). Most reactions (69%) were mild and there were no serious or unexpected reactions. In conclusion, in routine clinical practice involving patients with many different conditions, Redimune NF Liquid was well tolerated by the majority of patients.

Post-ictal fever: a rare symptom of partial seizures.

Although fever may induce seizures, especially in children, its occurrence following epileptic spells has been rarely described, except from generalized convulsive status epilepticus. We present two patients suffering from focal seizures accompanied by episodes of post-ictal fever, and review similar reports in the literature of the last 40 years. Temperature changes following non-convulsive seizures might be induced by gene upregulation occurring in the hypothalamus, the nucleus tractus solitarius, or in other brain regions, producing a local inflammatory response. Direct propagation of electrical discharges seems less consistent with the timing of development of this symptom. Heterogeneity of reported clinical features argues against the assumption of a definite localizing or lateralizing value for post-ictal fever.

[Study of HIV seroprevalence in patients with pulmonary tuberculosis in 1999 in Chad]. / Etude de la séroprévalence du VIH chez les patients atteints d'une tuberculose pulmonaire en 1999 au Tchad.

Tuberculosis is the most common opportunistic disease occurring in the course of human immunodeficiency virus (HIV) infection. With the development of HIV infection in Chad, tuberculosis has quickly become a major public health concern. The purpose of this cross-sectional study in two tuberculosis centres (Moundou and Ndjamena) was to evaluate HIV seroprevalence, epidemiological characteristics and risk factors in patients with tuberculosis. All patients with positive sputum-smears who had never been treated for tuberculosis previously were eligible. A total of 466 patients (sex ratio M/F: 1.96) were included during the six-month period between January and June 99. Each subject was asked to fill out an anonymous standardized questionnaire with detailed information on demographic characteristics, sexual behavior and other risk factors for HIV infection. Data were compared using the Chi-square test, Student's T test and multivariate analysis (logistic regression). One third (33.2%) of patients was seropositive for HIV-1. Mean age was 31.1 years in HIV-positive group and 33.6 years in the HIV-negative group (p = 0.02). The age groups with the highest risk for HIV were 20-29 years and 30-39 years (p < 0.01). Women were more often seropositive that men (39.5% versus 30.1%; p = 0.04). Seropositive patients were more likely to have multiple sexual partners (mean: 1.76; p < 0.01) and a history of sexually transmitted disease (19.9% versus 8.1%; p = 0.01). The mean age at the time of first sexual relations was 16.3 years in the HIV group and 17.1 years in the control (p < 0.01). The percentage of seropositive patients was 39.6% at Moundou and 29.8% at N'djamena (p > 0.01). Multivariate analysis showed that early age of first sex relation (OR = 0.85; 95% IC: 0.74-0.97), higher number of sexual partners (OR = 1.8; 95% CI: 1.4-2.4) and level of education were strongly correlated with HIV infection. The prevalence of HIV in tuberculosis patients is a good indicator of HIV-infection in developing countries. Prevalence of HIV infection is high in tuberculosis patients in Chad. Surveillance for tuberculosis and AIDS must be strengthened in Chad. Mores cooperation is needed between tuberculosis and AIDS control programs. Emphasis should be placed on screening for tuberculosis, early tuberculosis treatment and diagnosis of HIV in tuberculosis patients.

Performance assessment of new multiplex probe assay for identification of mycobacteria.

A new DNA probe assay (INNO LiPA Mycobacteria; Innogenetics, Ghent, Belgium) for the simultaneous identification, by means of reverse hybridization and line-probe technology, of Mycobacterium tuberculosis complex, Mycobacterium kansasii, Mycobacterium xenopi, Mycobacterium gordonae, the species of the Mycobacterium avium complex (MAC), Mycobacterium scrofulaceum, and Mycobacterium chelonae was evaluated on a panel of 238 strains including, besides representatives of all the taxa identifiable by the system, a number of other mycobacteria, some of which are known to be problematic with the only other commercial DNA probe system (AccuProbe; Gen-Probe, San Diego, Calif.), and two nocardiae. The new kit, which includes a control probe reacting with the whole genus Mycobacterium, correctly identified 99.6% of the strains tested; the one discrepancy, which remained unresolved, concerned an isolate identified as MAC intermediate by INNO LiPA Mycobacteria and as Mycobacterium intracellulare by AccuProbe. In five cases, because of an imperfect checking of hybridization temperature, a very slight, nonspecific, line was visible which was no longer evident when the test was repeated. Two strains whose DNA failed amplification at the first attempt were regularly identified when the test was repeated. Interestingly, the novel kit dodged all the pitfalls presented by the strains giving anomalous reactions with AccuProbe. A unique feature of INNO LiPA Mycobacteria is its ability to recognize different subgroups within the species M. kansasii and M. chelonae, while the declared overlapping reactivity of probe 4 with some M. kansasii and Mycobacterium gastri organisms and of probe 9 with MAC, Mycobacterium haemophilum, and Mycobacterium malmoense, may furnish a useful aid for their identification. The turnaround time of the method is approximately 6 h, including a preliminary PCR amplification.

Comparison of MB/Bact alert 3D system with radiometric BACTEC system and Löwenstein-Jensen medium for recovery and identification of mycobacteria from clinical specimens: a multicenter study.

The MB/BacT ALERT 3D System (MB/BacT) (Organon Teknika, Boxtel, The Netherlands) is a fully automated, nonradiometric system with a revised antibiotic supplement kit designed for the recovery of mycobacteria from clinical specimens. In a multicenter study, the recovery rate of acid-fast bacilli (AFB) and the mean time to their detection from clinical specimens was determined by using the MB/BacT system. Data were compared to those assessed by the radiometric BACTEC 460 system (B460) and by culture on Löwenstein-Jensen (L-J) solid medium. A total of 2,859 respiratory and extrapulmonary specimens were processed by the N-acetyl-L-cysteine (NALC)-NaOH method using two different concentrations of sodium hydroxide; 1.5% was adopted in study design A (1,766 specimens), and 1.0% was used in study design B (1,093 specimens). The contamination rates for MB/BacT were 4.6% (study design A) and 7.1% (study design B). One hundred seventy-nine mycobacterial isolates were detected by study design A, with 148 Mycobacterium tuberculosis complex (MTB) isolates and 31 nontuberculous mycobacteria (NTM) isolates. Overall recovery rates were 78.8% for MB/BacT (P = 0.0049), 64.2% for L-J (P < 0.0001), and 87.1% for B460, whereas they were 84.5, 70.9, and 91.2%, respectively, for MTB alone. A total of 125 mycobacteria were detected by study design B, with 46 MTB and 79 NTM. Overall recovery rates by the individual systems were 57.6% (P = 0.0002), 56.8% (P = 0.0001), and 80% for MB/BacT, L-J, and B460, respectively, whereas the rates were 91.3, 78.3, and 97.8% for MTB alone. By study design A, the mean times to detection of smear-positive MTB, smear-negative MTB, and NTM were 11.5, 19.9, and 19.6 days, respectively, with the MB/BacT; 8.3, 16.8, and 16.6 days, respectively, with the B460; and 20.6, 32.1, and 27.8 days, respectively, with L-J medium. By study design B, the mean times were 15.1, 26.7, and 26 days with the MB/BacT; 11.7, 21.3, and 24.8 days with the B460; and 20.4, 28.7, and 28.4 days with L-J medium. Identification was attempted by probing (Accuprobe) MB/BacT-positive bottles within the first working day following instrument positive flag. Results were compared to those obtained in the B460 positive vials by the p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) test (study design A) or by the Accuprobe assay (study design B). About 90% of MTB and 100% of NTM could be identified, showing turnaround times closely related to those obtained by combining B460 and the NAP test or the Accuprobe assay. In conclusion, even though recovery rates were shown to be lower than B460, especially for NTM, and contaminants were somewhat higher, MB/BacT represents a valuable alternative to the radiometric system, especially in those laboratories where disposal of radioactive waste is restricted. Finally, when AFB are cultured in nonradiometric liquid media, our data (detection times and bacterial overgrowth rates) suggest that decontamination with 1.5% NaOH may be more suitable than the standard NALC-NaOH.

[Endemic cholera in Chad: a real public health problem]. / L'endémisation du choléra au Tchad: un réel problème de santé publique.

At the present time, cholera epidemics have become annual, even seasonal, events in Chad. This review of data obtained from a Division of the Sanitation Information System in Chad was carried out to determine the epidemiological profile and natural course of cholera in Chad and to propose preventive measures within the country's means. The main findings were that cholera epidemics start at the junction between the dry and rainy season (March to June), that they last for six months, and that peak incidence occurs 4 to 6 weeks after the first reported cases. The mortality rate is approximately 5 p. 100 depending on time and place. Two foci were located: one at Logone-Gana (Chari-Baguiri) and the other at Fianga (Mayo-Kebbi). These findings show that cholera is now endemic in Chad. A major implication of this study is that decentralized epidemiological surveillance should be set up with monitoring units located around endemic sites. Mortality could probably be lowered by better patient care at the beginning of the epidemic. Improvements in public hygiene, waste disposal, and water purification are needed.

Multicenter evaluation of two commercial amplification kits (Amplicor, Roche and LCx, Abbott) for direct detection of Mycobacterium tuberculosis in pulmonary and extrapulmonary specimens.

Direct detection of Mycobacterium tuberculosis was performed in parallel with the Amplicor M. tuberculosis test (Roche Diagnostic System, USA) and the LCx M. tuberculosis (Abbott Diagnostic Division, USA) on 697 samples, collected from 481 patients, in three different Italian laboratories. Though both systems are licensed only for pulmonary specimens, 113 extrapulmonary specimens (represented mainly by pleural fluids, cerebrospinal fluids and urines) were included in the study. Amplification results were compared with acid-fast microscopy, culture, and identification of isolates. Final clinical diagnosis was used to resolve discrepant results. M. tuberculosis was detected in 105 specimens by both assays, whereas 561 were agreeing negatives; 21 and 6 of the remaining true-positive samples scored positive with LCx only and with Amplicor only, respectively. There were three false-positives with LCx and one false-positive with Amplicor. The diagnostic sensitivity of both methods was significantly better when only respiratory specimens were considered (78% versus 59% in nonrespiratory samples with Amplicor, and 88% versus 65% with LCx). Our data reveal a significantly better sensitivity of the LCx (p = 0.026) and a slight better specificity of the Amplicor assay. It is noteworthy that 16 of the 21 Amplicor-negative specimens in which LCx detected M. tuberculosis were culture negative, thus suggesting that the higher diagnostic sensitivity of the latter assay is attributable to its better analytical sensitivity. However, the majority of such samples originated from patients under antimicrobial treatment, which makes uncertain the clinical significance of such increased sensitivity. Considering true-positive for LCx and true-negative for Amplicor, the 16 culture-negative/LCx-positive/Amplicor-negative specimens resulted true-positives after the resolution of discrepancies, the final overall sensitivity and specificity values of the LCx assay were not significantly different from the ones of the Amplicor assay.

Accessing young adolescents and their families for research.

PURPOSE: To describe the strategies used to obtain and retain a sample of young adolescents and their families. METHODS: The sample was 847 families with young adolescents aged 11 to 14 years who resided in a large urban Midwestern community of the U.S. The first design strategy was becoming credible within the community. For 5 years before conducting the intervention research in the community, surveys were conducted of the needs of middle-school students as they entered adolescence, and programs were delivered to meet the assessed needs. The second design strategy was instituting developmentally appropriate recruitment and retention strategies based upon direct consultation with groups of young adolescents. The consultants recommended referring to young adolescents as young adults and holding the training sessions in sites not associated with schools. The third design strategy was setting up participation methods that were nonburdensome to schools and families. CONCLUSIONS: The successful recruitment of over 800 families and the retention of 80% of them for survey participation and 77% of them for the intervention protocol can be attributed to three major strategies: (a) community involvement; (b) adherence to principles of adolescent development; and (c) ease of participation for school personnel and families.

[The assessment of skin tumors with magnetic resonance with high resolution and a paramagnetic contrast medium]. / Valutazione dei tumori cutanei con Risonanza Magnetica con elevata risoluzione e mezzo di contrasto paramagnetico.

INTRODUCTION: The technologic improvement of surface coils in MRI has allowed better visualization of the skin and thus permitted the clinical use of this technique in dermatology. MRI allows to assess the depth and extent of skin tumors and to detect any malignant transformation. The MR differentiation between benign and malignant skin lesions relies on morphological criteria which however do not have an absolute diagnostic value. We investigated the role of paramagnetic contrast agents in the differentiation between benign and malignant skin lesions. MATERIAL AND METHODS: Forty-one patients, 33 with benign and 8 with malignant skin tumors, were submitted to MRI. All the examinations were performed with a 1.5 T superconductive unit, with a 2.5 cm surface coil. Axial T1- and T2-weighted SE images were acquired with 2 mm slice thickness. Paramagnetic contrast material was administered to all patients. The signal intensity of the skin lesions was calculated before and after paramagnetic contrast agent administration positioning a region of interest. A percentage ratio of contrast enhancement was calculated to quantify contrast agent uptake and the relative values were compared between benign and malignant lesions. A qualitative analysis was also performed rating the contrast enhancement of each lesion as high, intermediate, or absent. RESULTS: The quantitative analysis showed a statistically significant difference (p < .5) between the contrast enhancement values of benign and malignant lesions. In particular, malignancies had values ranging 117.3 (+/- 28.7) to 125 (+/- 32.4), while benign lesions had -20.6 to 99.8 (+/- 21.1). Conversely, no difference in contrast enhancement was found at qualitative analysis. CONCLUSIONS: MRI is a promising tool for characterizing skin tumors. Our preliminary results should be confirmed on larger series of patients with the use of high temporal resolution imaging sequences.

Mycobacterium genavense in AIDS patients, report of 24 cases in Italy and review of the literature.

Mycobacterium genavense is a frequently missed agent of disseminated disease in AIDS patients. The increasing frequency with which such organism is being isolated in Italy suggested a comparison of local survey with data reported in literature. Isolates presumed to belong to the species M. genavense were centralized and identified by means of genomic sequencing and/or HPLC analysis of cell wall mycolic acids; clinical data were obtained from relevant patients' record and collected using a proper questionnaire. In 24 cases in which this organism has been isolated in Italy M. genavense was grown, prevalently from blood, in liquid medium after an average of six weeks of incubation. In overwhelming majority, patients were males, presented other opportunistic diseases and were characterized by very low CD4+ counts (average 23/microl); most frequent symptoms were fever, anemia and weight loss. All but two patients, who died before the mycobacterial infection was diagnosed, were treated with at least three drugs; the mean survival was close to one year. A review of literature reports revealed a wide overlapping of clinical and microbiological features.

Confocal microscopic localization of anti-myelin-associated glycoprotein autoantibodies in a patient with peripheral neuropathy initially lacking a detectable IgM gammopathy.

We report here on a patient with anti-myelin-associated glycoprotein (MAG) neuropathy in whom examination of a sural nerve biopsy by multichannel confocal microscopy showed a partly overlapping distribution of MAG and IgM deposits in myelinated fibers. Our data demonstrate that MAG in Schmidt-Lanterman incisures and paranodal loops, as well as some additional HNK-1-positive components of the basal lamina, are the major targets of the anti-MAG monoclonal IgM autoantibodies in this neuropathy in vivo. Perforation of the basal lamina can allow the penetration and binding of anti-MAG IgM inside myelinated fibers. Our results support and extend the notion that the production of monoclonal anti-MAG IgM may be antigenically driven by MAG molecules and that this process may occur in the immunologically privileged environment of the nerve prior to the appearance of a genuine gammopathy in serum.

Engineering of peptide synthetases. Key role of the thioesterase-like domain for efficient production of recombinant peptides.

Peptide synthetases are large enzymatic complexes that catalyze the synthesis of biologically active peptides in microorganisms and fungi and typically have an unusual structure and sequence. Peptide synthetases have recently been engineered to modify the substrate specificity to produce peptides of a new sequence. In this study we show that surfactin synthetase can also be modified by moving the carboxyl-terminal intrinsic thioesterase region to the end of the internal amino acid binding domains, thus generating strains that produce new truncated peptides of the predicted sequence. Omission of the thioesterase domain results in nonproducing strains, thus showing the essential role of this region and the possibility of obtaining peptides of different lengths by genetic engineering. Secretion of the peptides depends on the presence of a functional sfp gene.

Mycobacterium malmoense in Italy: the modern Norman invasion?

The isolation of Mycobacterium malmoense has for a long time been restricted to few countries of Northern Europe; reports from countries other than Sweden, Great Britain and Finland are rare and the first Italian case report has been published in 1995. Since 1988, however, fifteen strains of M. malmoense have been isolated in Italy, eleven of which in the last two years; of these, ten appeared clinically significant on the basis of medical records. The susceptibility of the strains and the role of high performance liquid chromatography of cell wall mycolic acids for a reliable identification are discussed.