Cutaneous features of Zika virus infection: a clinicopathological overview.

Zika virus (ZIKV) is an emerging mosquito-borne flavivirus transmitted mainly by Aedes species of mosquitos. Although the infection is usually mild and self-limiting, it is emerging as a public health challenge in tropical and subtropical countries owing to its unprecedented pathogenicity and increased risk for fetal malformations and neurological symptoms. Cutaneous manifestations as for other mosquito-borne viruses remain a hallmark of the disease. This article provides a detailed overview on ZIKV infection, including its varied cutaneous clinical manifestations and diagnostic aspects, and also provides detailed insights into its pathogenesis in human skin.

Repeated Dietary Exposure to Low Levels of Domoic Acid and Problems with Everyday Memory: Research to Public Health Outreach.

Domoic Acid (DA) is a marine-based neurotoxin. Dietary exposure to high levels of DA via shellfish consumption has been associated with Amnesic Shellfish Poisoning, with milder memory decrements found in Native Americans (NAs) with repetitive, lower level exposures. Despite its importance for protective action, the clinical relevance of these milder memory problems remains unknown. The purpose of this study was to determine whether repeated, lower-level exposures to DA impact everyday memory (EM), i.e., the frequency of memory failures in everyday life. A cross-sectional sample of 60 NA men and women from the Pacific NW was studied with measures of dietary exposure to DA via razor clam (RC) consumption and EM. Findings indicated an association between problems with EM and elevated consumption of RCs with low levels of DA throughout the previous week and past year after controlling for age, sex, and education. NAs who eat a lot of RCs with presumably safe levels of DA are at risk for clinically significant memory problems. Public health outreach to minimize repetitive exposures are now in place and were facilitated by the use of community-based participatory research methods, with active involvement of state regulatory agencies, tribe leaders, and local physicians.

Environmental and health effects of the herbicide glyphosate.

The herbicide glyphosate, N-(phosphonomethyl) glycine, has been used extensively in the past 40years, under the assumption that side effects were minimal. However, in recent years, concerns have increased worldwide about the potential wide ranging direct and indirect health effects of the large scale use of glyphosate. In 2015, the World Health Organization reclassified glyphosate as probably carcinogenic to humans. A detailed overview is given of the scientific literature on the movement and residues of glyphosate and its breakdown product aminomethyl phosphonic acid (AMPA) in soil and water, their toxicity to macro- and microorganisms, their effects on microbial compositions and potential indirect effects on plant, animal and human health. Although the acute toxic effects of glyphosate and AMPA on mammals are low, there are animal data raising the possibility of health effects associated with chronic, ultra-low doses related to accumulation of these compounds in the environment. Intensive glyphosate use has led to the selection of glyphosate-resistant weeds and microorganisms. Shifts in microbial compositions due to selective pressure by glyphosate may have contributed to the proliferation of plant and animal pathogens. Research on a link between glyphosate and antibiotic resistance is still scarce but we hypothesize that the selection pressure for glyphosate-resistance in bacteria could lead to shifts in microbiome composition and increases in antibiotic resistance to clinically important antimicrobial agents. We recommend interdisciplinary research on the associations between low level chronic glyphosate exposure, distortions in microbial communities, expansion of antibiotic resistance and the emergence of animal, human and plant diseases. Independent research is needed to revisit the tolerance thresholds for glyphosate residues in water, food and animal feed taking all possible health risks into account.

Neonatal sepsis in rural India: timing, microbiology and antibiotic resistance in a population-based prospective study in the community setting.

OBJECTIVE: To examine the timing and microbiology of neonatal sepsis in a population-based surveillance in the Indian community setting. STUDY DESIGN: All live born infants in 223 villages of Odisha state were followed at home for 60 days. Suspect sepsis cases were referred to study hospitals for further evaluation including blood culture. RESULTS: Of 12 622 births, 842 were admitted with suspected sepsis of whom 95% were 4 to 60 days old. Culture-confirmed incidence of sepsis was 6.7/1000 births with 51% Gram negatives (Klebsiella predominating) and 26% Gram positives (mostly Staphylococcus aureus). A very high level of resistance to penicillin and ampicillin, moderate resistance to cephalosporins and extremely low resistance to Gentamicin and Amikacin was observed. CONCLUSION: The bacterial burden of sepsis in the Indian community is not high. Judicious choice of empiric antibiotics, antibiotic stewardship and alternate modalities should be considered for the management or prevention of neonatal sepsis in India.

Longitudinal development of match-running performance in elite male youth soccer players.

This study longitudinally examined age-related changes in the match-running performance of retained and released elite youth soccer players aged 8-18 years. The effect of playing position on age-related changes was also considered. Across three seasons, 263 elite youth soccer players were assessed in 1-29 competitive matches (988 player-matches). For each player-match, total distance and distances covered at age group-specific speed zones (low-speed, high-speed, sprinting) were calculated using 1 Hz or 5 Hz GPS. Mixed modeling predicted that match-running performance developed nonlinearly, with age-related changes best described with quadratic age terms. Modeling predicted that playing position significantly modified age-related changes (P < 0.05) and retained players covered significantly more low-speed distance compared with released players (P < 0.05), by 75 ± 71 m/h (mean ± 95% CI; effect size ± 95% CI: 0.35 ± 0.34). Model intercepts randomly varied, indicating differences between players in match-running performance unexplained by age, playing position or status. These findings may assist experts in developing training programs specific to the match play demands of players of different ages and playing positions. Although retained players covered more low-speed distance than released players, further study of the actions comprising low-speed distance during match play is warranted to better understand factors differentiating retained and released players.

The accumulation of exercise and postprandial endothelial function in boys.

The purpose of this study was to investigate the effect of accumulating 60 min of exercise on endothelial function and triacylglycerol concentrations following the ingestion of a high-fat breakfast and lunch in 14 adolescent boys (aged 12 to 14 years). Two, 2-day main trials (control and exercise) were completed in a counter-balanced, cross-over design. Participants were inactive on day 1 of the control trial but on day 1 of the exercise trial completed 6 × 10 min runs at 70% of peak oxygen uptake, spread over the day. On day 2, triacylglycerol concentrations and flow-mediated dilation (FMD) were measured prior to, and following, ingestion of the high-fat meals. In the control trial, FMD was reduced by 30% and 33% (P < 0.001) following the high-fat breakfast and lunch; following exercise these reductions were negated (main effect trial, P = 0.002, interaction effect trial × time, P < 0.001). The total and incremental areas under the triacylglycerol concentration vs time curve were reduced by 11% and 16% in the exercise trial; however, these differences were not significant (P > 0.05). These results support the concept of accumulating physical activity for health in adolescents as the accumulated exercise attenuated the decline in FMD seen following the consumption of high-fat meals.

Half-time and high-speed running in the second half of soccer.

This study investigated if the quantity of high-speed running (movements >15 km.h(-1) completed in the first 15 min of competitive football matches differed from that completed in the corresponding 15 min of the second half. 20 semi-professional soccer players (age 21.2±3.6 years, body mass 76.4±3.8 kg, height 1.89±0.05 m) participated in the study. 50 competitive soccer matches and 192 data files were analysed (4±2 files per match) using Global Positioning Satellite technology. Data were analysed using 2-way repeated measures ANOVA and Pearson correlations. No differences were found between the first 15 min of each half for the distance completed at high-speed (>15 km.h(-1) or sprinting (>21 km.h(-1), or in the number of sprints undertaken (p>0.05). However, total distance covered was shorter (1st half vs. 2nd half: 1746±220 vs. 1644±224 m; p<0.001) and mean speed lower (1st half vs. 2nd half: 7.0±0.9 vs. 6.6±0.9 km.h(-1); p<0.001) in the first 15 min of the second half compared to the first. The correlations between the duration of the half-time interval and the difference in the high-speed running or sprinting between first and second halves (0-15 min) were very small (r=0.08 [p=0.25] and r=0.04 [p=0.61] respectively). Therefore, this study did not find any difference between the amount of high-speed running and sprinting completed by semi-professional soccer players when the first 15 min of the first and second half of competitive matches were compared The maintenance of high-speed running and sprinting, as total distance and mean speed declined, may be a function of the pacing strategies adopted by players in competitive matches.

A field-test battery for elite, young soccer players.

The validity and reliability of a battery of field-based performance tests was examined. The opinions of coaches, fitness professionals and players (n=170, 172 and 101 respectively) on the importance of performance testing were established using a questionnaire. On 2 occasions, separated by 7 days, 80 elite, young soccer players (mean±SD [and range]: age 13.2±2.6 [8.9-19.1] years; stature 1.59±0.18 m [1.32-1.91]; body mass 50.6±17.1 [26.5-88.7] kg) completed a battery of field-based tests comprised of heart rate response to a submaximal Multi-stage fitness test, 3 types of vertical jump, sprints over 10 and 20 m, and an agility test. Physical performance testing was considered important by coaches (97%), fitness professionals (94%) and players (83%). The systematic bias ratio and the random error components of the 95% ratio limits of agreement for the first and second tests, for the U9-U11 vs. U12-U14 vs. U15-U18 age groups, were [Systematic bias (*/÷ ratio limits)]: Heart rate (Level 5): 0.983 (*/÷ 1.044) vs. 0.969 (*/÷ 1.056) vs. 0.983 (*/÷ 1.055); Rocket jump: 0998 (*/÷ 1.112) vs. 0.999 (*/÷ 1.106) vs. 0.996 (*/÷ 1.093); 10 m sprint: 0.997 (*/÷ 1.038) vs. 0.994 (*/÷ 1.033) vs. 0.994 (*/÷ 1.038); Agility test: 1.010 (*/÷1.050) vs. 1.014 (*/÷1.050) vs. 1.002 (*/÷1.053). All tests, except heart rate recovery from the Multi-stage fitness test, were able to distinguish between different ability and age groups of players (p<0.05). Thus, the field-test battery demonstrated logical and construct validity, and was shown to be a reliable and objective tool for assessing elite, young soccer players.

Dementia in Parkinson's disease: a 20-year neuropsychological study (Sydney Multicentre Study).

OBJECTIVE: To determine whether neuropsychological measures differ between patients with idiopathic Parkinson's disease (PD) who acquire dementia within 10 years of disease onset versus those who acquire dementia later in the disease course, using data from the longitudinal Sydney Multicentre Study of PD. METHODS: The Sydney Multicentre Study of PD is a cohort of 149 community-living de novo patients with idiopathic PD studied over a 20-year period. Detailed clinical and neuropsychological tests were administered at baseline and at 3, 5, 10, 15 and 20 years, and the dementia status was assessed at each time point. For the present study, the pattern of longitudinal neuropsychological measures was compared between PD patients with the onset of dementia in the middle (5-10 years, mid-stage PD dementia, N = 20) or late (>10 years, late-stage PD dementia, N = 10) disease stages using analysis of variance and multiple linear regression modelling, and the relationship between age and dementia onset assessed using survival statistics. RESULTS: Mid-stage PD dementia patients were differentiated from late-stage PD dementia patients by having greater deficits in vocabulary skills prior to and at dementia onset. The pattern of cognitive deficits following dementia onset are similar, and there is no difference in the age of dementia onset between the different PD groups. CONCLUSIONS: These data suggest that the evolution of dementia within PD occurs at around 70 years of age, regardless of the time of PD onset, and affects cognitive domains in a similar way, although patients with earlier-onset PD have a preserved linguistic ability prior to dementia onset.

Effect of glycemic index meals on recovery and subsequent endurance capacity.

This study examined the effect of ingesting a high or low glycemic index (GI) meal during a short-term recovery period on endurance running capacity. On two occasions, seven men (age 30.0+/-2.6 yr, body mass 60.7+/-1.4 kg, VO (2max) 62.1+/-2.2 ml.kg (-1).min (-1)) ran at 70% VO (2max) on a level treadmill for 90 min (R1), followed by a 4 h recovery (REC) and a further exhaustive run at the same speed (R2). Twenty minutes after R1, each subject consumed an isoenergetic meal containing either high GI (HGI, GI=77) or low GI (LGI, GI=37) carbohydrate providing 1.5 g CHO.kg (-1) BM. During REC, subjects also ingested a prescribed volume of water equal to 150% of their BM loss during R1. The duration of R2 in the HGI trial was 15% longer than in the LGI trial (HGI: 86.6+/-10.7 min vs. LGI: 75.2+/-8.1 min, p<0.05). The subjects also achieved complete rehydration after REC on both occasions. In conclusion, the consumption of a HGI meal during a 4 h recovery improved endurance capacity in a subsequent run; however, the precise mechanism(s) by which this takes place is yet to be clarified.

A heat acclimation protocol for team sports.

BACKGROUND: It is well documented that heat acclimation of six or more sessions of at least 60 min duration prolongs the time to exhaustion during endurance walking, cycling and running in the heat. However, this type of acclimation is not specific to team sport activity and the effect of acclimation on prolonged high-intensity intermittent running has not yet been investigated. OBJECTIVE: To assess the impact of an intermittent acclimation protocol on distance run during team sport activity. METHODS: The impact of four short heat acclimation sessions (30-45 min of the Loughborough Intermittent Shuttle Test; LIST) on high-intensity intermittent running capacity (LIST) in the heat (30 degrees C, 27% relative humidity (RH)), was examined. Seventeen female well-trained games players were split into three groups: an acclimation group (30 degrees C, 24% RH), a moderate training group (18 degrees C, 41% RH) and a control group who did not complete any training between the main trials (pre-acclimation and post-acclimation). The pre-acclimation (A) and post-acclimation (B) trials were separated by 28 days to control for menstrual phase and verified using hormonal analysis. The four acclimation or moderate training sessions utilising the LIST were completed with one or two rest days interspersed between each session in a 10-day period prior to the post-acclimation trial (B). RESULTS: In the post-acclimation trial distance run was increased by 33% in the acclimation group (A: 7703 (SEM 1401) m vs B: 10215 (SEM 1746) m; interaction group x trial p<0.05), but was unchanged in the moderate and control groups. The acclimation group had a lower rectal temperature (interaction group x trial x time p<0.01) due to a lower rate of rise, and an increase in thermal comfort1 after acclimation (End A: 7 (SEM 2) vs 6 (SEM 2); interaction group x trial p<0.01). There was no difference in serum progesterone, aldosterone or cortisol concentrations following acclimation or between groups. CONCLUSION: Four 30-45 min sessions of intermittent exercise induced acclimation, and resulted in an improvement in intermittent running exercise capacity in female games players. A lower rectal temperature and a concomitant rise in thermal comfort may be partly responsible for the improvement in exercise capacity.

Dietary crude protein has minimal effect on the activity of selected enzymes of methionine catabolism in kittens fed diets near-limiting in methionine.

Previous experiments have shown that increasing the dietary crude protein (CP) of cats does not increase urea cycle enzymes or alanine amino transferase as occurs in rats. Also when an essential amino acid (EAA) is limiting in a diet for growing kittens, the kittens do not exhibit an amino acid imbalance when other EAAs are added to the diet. To study the metabolic basis for these observations which are different from that found in omnivores and herbivores, the hypothesis that increased dietary CP decreases methionine catabolism, so more is spared for growth, was tested. Fifteen male kittens were randomly assigned to one of three dietary treatments. Each diet contained 2.5 g l-methionine/kg diet and 200, 300 or 500 g CP/kg diet. The livers and kidneys were removed and assayed for methionine transaminase (MTA), cystathionase (CASE) and cystathionine synthase (CS). Free amino acid concentrations were determined in liver, kidney and plasma. The 300 and 500 g CP/kg groups had significantly greater kidney weights and body weight gains than the 200 g CP/kg group. Hepatic MTA activity was lower in the 300 than the 200 or 500 g CP/kg groups (p < 0.05). Renal MTA and CASE activities were 35% and 50% greater, respectively, for the 500 g CP/kg group than for the 200 g CP/kg diet group (p < 0.05). Renal CS activities for the 300 and 500 g CP/kg groups were 29% (p > 0.05) and 38% (p < 0.05) greater, respectively, than the 200 g CP/kg group. Cyst(e)ine concentrations were lower in the livers of the 500 g CP/kg group than the 200 g CP/kg group (p < 0.05). Cystathionine was lower in plasma and kidney from the 500 g CP/kg diet group than from the 200 g CP/kg diet group (p < 0.05). It was concluded that the metabolic basis for the increased growth of kittens fed diets marginally limiting in methionine, with increasing concentrations of dietary CP, was not mediated through decreased enzyme activity associated with the catabolism of methionine, but was the result of an increase in food (methionine) intake.

Characterisation of Yersinia pestis isolates from natural foci of plague in the Republic of Georgia, and their relationship to Y. pestis isolates from other countries.

Forty Yersinia pestis isolates from endemic foci of plague in the Republic of Georgia, and six Y. pestis isolates from neighbouring former Soviet Union countries, were analysed for their biochemical and phenotypic properties, and their genetic relatedness was compared with Y. pestis strains KIM and CO92 by pulsed-field gel electrophoresis (PFGE). In addition, 11 Y. pestis isolates from the USA, together with published nucleotide sequences from Y. pestis strains KIM, CO92 and 91001, were compared with the 46 isolates in the present collection using multilocus sequence typing (MLST), based on sequence data for the 16S rRNA, hsp60, glnA, gyrB, recA, manB, thrA and tmk loci. Four virulence gene loci (caf1, lcrV, psaA and pla) were also sequenced and analysed. Two sequence types (ST1 and ST2), which differed by a single nucleotide, were identified by MLST. With the exception of a single isolate (771G), all of the Georgian Y. pestis isolates belonged to ST2. PFGE also grouped the Georgian Y. pestis isolates separately from the non-Georgian isolates. Overall, PFGE discriminated the Y. pestis isolates more effectively than MLST. The sequences of three of the four virulence genes (lcrV, psaA and pla) were identical in all Georgian and non-Georgian isolates, but the caf1 locus was represented by two allele types, with caf1 NT1 being associated with the non-Georgian isolates and caf1 NT2 being associated with the Georgian isolates. These results suggest that Georgian Y. pestis isolates are of clonal origin.

Increasing dietary crude protein does not increase the methionine requirement in kittens.

The objective of this study was to determine if the methionine (met) requirement of kittens is correlated with the concentration of dietary crude protein (CP). The study used 48 male kittens in two replications of six 4 x 4 Latin squares, each representing one concentration of met (1.5, 2.5, 3.5, 4.5, 6.0 or 9.0 g/kg diet) with four CP concentrations (150, 200, 300 and 500 g/kg diet) in 2-week periods. Cystine was present in the lowest CP diet at 5.3 g/kg diet and increased as dietary CP increased. Body weight gain, food intake, nitrogen balance and plasma amino acids, glucose, insulin, cortisol, somatomedin C, T(3) and T(4) concentrations on day 12 were measured. From breakpoint analysis of the nitrogen retention curves, the met requirement of kittens was found to be 3.1, 3.8, 3.1 and 2.4 g met/kg for the 150, 200, 300 and 500 g CP/kg diets, respectively. When met was limiting (1.5 or 2.5 g/kg diet), increasing dietary CP did not decrease, but rather increased food intake, body weight gain and nitrogen retention. Plasma met concentrations increased as dietary met increased and at 2.5-3.5 g met/kg diet were not different among kittens fed the various CP diets. Total plasma T(3) and T(4) increased significantly as dietary CP increased in kittens given the 2.5 and 4.5 g met/kg diets. Results indicate that food intake and possibly altered hormonal secretion play a role in this growth response. In conclusion, the met requirement of growing kittens, unlike omnivores and herbivores studied, was not positively correlated with the concentration of dietary CP.

Patient-to-patient transmission is important in extended-spectrum beta-lactamase-producing Klebsiella pneumoniae acquisition.

We performed a prospective cohort study to quantify the number of cases of patient-to-patient transmission of extended-spectrum beta-lactamase-producing Klebsiella species on perianal surveillance culture. Among 27 patients who acquired Klebsiella pneumoniae infection, 14 had infections (52%) that were due to patient-to-patient transmission, and 6 (22%) had a subsequent positive extended-spectrum beta-lactamase clinical culture results.

The capsule polysaccharide structure and biogenesis for non-O1 Vibrio cholerae NRT36S: genes are embedded in the LPS region.

BACKGROUND: In V. cholerae, the biogenesis of capsule polysaccharide is poorly understood. The elucidation of capsule structure and biogenesis is critical to understanding the evolution of surface polysaccharide and the internal relationship between the capsule and LPS in this species. V. cholerae serogroup O31 NRT36S, a human pathogen that produces a heat-stable enterotoxin (NAG-ST), is encapsulated. Here, we report the covalent structure and studies of the biogenesis of the capsule in V. cholerae NRT36S. RESULTS: The structure of the capsular (CPS) polysaccharide was determined by high resolution NMR spectroscopy and shown to be a complex structure with four residues in the repeating subunit. The gene cluster of capsule biogenesis was identified by transposon mutagenesis combined with whole genome sequencing data (GenBank accession DQ915177). The capsule gene cluster shared the same genetic locus as that of the O-antigen of lipopolysaccharide (LPS) biogenesis gene cluster. Other than V. cholerae O139, this is the first V. cholerae CPS for which a structure has been fully elucidated and the genetic locus responsible for biosynthesis identified. CONCLUSION: The co-location of CPS and LPS biosynthesis genes was unexpected, and would provide a mechanism for simultaneous emergence of new O and K antigens in a single strain. This, in turn, may be a key element for V. cholerae to evolve new strains that can escape immunologic detection by host populations.

Excess dietary cystine intensifies the adverse effect of a methionine deficiency in the cat.

Foot pad dermatitis has been observed in turkeys, puppies and kittens fed diets deficient in methionine. Excess cystine aggravated the lesions and decreased body weight gain in puppies and turkeys. The objective of this study was to determine whether methionine deficiency induced perioral and foot pad lesions in kittens and whether excess cystine exacerbated the lesions. Eighteen kittens were divided into three groups and offered one of three diets: diet 1, low-methionine, low-cystine (LMLC; 1.6 g methionine and 1.6 g cystine/kg diet); diet 2, low-methionine, high-cystine (HMHC; 1.6 methionine and 15 g cystine/kg diet); diet 3, high-methionine, high-cystine (HMHC; 15 g methionine and 15 g cystine/kg diet). Kittens in the LMLC group lost body weight, whereas those in the LMHC group maintained their body weight and those in the HMHC group gained weight. Plasma methionine concentrations were significantly higher (p < 0.001) for the HMHC group than for the LMLC and LMHC groups. Plasma cyst(e)ine (sum of cysteine and cystine) concentrations were different (p < 0.001) among all the three groups. Two kittens given the LMLC diet developed mild perioral lesions. All kittens receiving the LMHC diet developed foot pad lesions and severe perioral lesions. Histopathological changes observed in perioral biopsy specimens were similar to those described in protein deficiency. In conclusion, the results showed that a diet severely deficient in methionine causes perioral lesions in kittens, and that addition of excess cystine to the diet aggravates the perioral lesions and also causes foot pad lesions.

Increasing dietary crude protein does not increase the essential amino acid requirements of kittens.

Essential amino acid (EAA) requirements of omnivores and herbivores (e.g. chicks, lambs, pigs and rats) are directly related to the concentration of dietary crude protein (CP). When an EAA is limiting in the diet, addition of a mixture of EAA lacking the limiting one (which increases dietary CP) results in a decrease in food intake and weight gain. This interaction has been referred to as an AA imbalance and has not been studied in depth in strict carnivores. The objectives of these experiments were to examine the effects on growing kittens (2-week periods) of the addition to diets of a mixture of AA lacking the limiting one. The control diets were at the requirement of the respective limiting EAA (or about 85% of the 1986 National Research Council requirement). In experiment 1, with the dietary EAAs at the minimally determined requirements, the concentration of the essential or dispensable amino acids was increased to determine if CP or an EAA was limiting. Results of growth rates (n = 12) and plasma AA concentrations indicated that tryptophan was limiting, but increased body weight gain also occurred when the concentration of CP was increased as dispensable amino acids without additional tryptophan. Experiment 1 was repeated in experiment 2 using a crossover design. Again, when tryptophan was limiting additional concentrations of dispensable AAs increased body weight gain. This response is the opposite of that in herbivores and omnivores. Experiment 3 consisted of 10 separate crossover trials, one for each of the 10 EAA and examined the effect of two concentrations of dietary CP (200 and 300 g CP/kg diet) on body weight gain of kittens (n = 8) offered diets limiting in each respective EAA. Body weight gain was numerically greater when diets contained 300 g CP/kg than 200 g CP/kg for eight of 10 EAAs (p < 0.05 for only isoleucine and threonine) when each amino acid was limiting. This response is the reverse of that which occurs in chicks, lambs, pigs and rats when an EAA is limiting and dietary CP lacking the limiting EAA is increased. These results indicate that the EAA requirements of kittens are not positively correlated with dietary CP concentrations.