A Point Prevalence Survey of Antimicrobial Use at Geita Regional Referral Hospital in North-Western Tanzania.

We conducted a point prevalence survey (PPS) to determine the prevalence of antibiotic use at Geita Regional Referral Hospital (GRRH) located along the shores of Lake Victoria in north-western Tanzania. This has led to the identification of gaps for improvement. This PPS study was conducted on 9-10 March 2023. Patient-related information, including sociodemographic and clinical data, was collected from medical records. STATA software version 15.0 was used to perform descriptive data analysis. About 94.8% (55/58) patients were on antibiotics with a mean (±SD) prescription of 2 (±0.5) antibiotic agents ranging from 1 to 4 different agents. The commonest indications of the antibiotic prescription were medical prophylaxis 47.3% (26/55) followed by empiric treatment 41.8% (23/55). In total, 110 prescriptions were made, of which metronidazole (25.5%; n = 28), ceftriaxone (23.6%; n = 26), and ampicillin-cloxacillin (23.6%; n = 26) were frequently observed. Only 67.3% (n = 74) of prescriptions complied with Tanzania Standard Treatment Guidelines. Moreover, according to the WHO-AWaRe classification, 50.9%, 23.6%, and 25.5% were under the Access category, Watch category, and Not Recommended category, respectively. The prevalence of antibiotic use among patients admitted to GRRH was high, whereby medical prophylaxis and empiric treatment were the commonest indications for antibiotic prescription. To support rational therapy and antimicrobial stewardship initiatives, we recommend that laboratories in regional hospitals be equipped to conduct sustained routine culture and antimicrobial susceptibility testing.

Análisis de la situación de la fisioterapia en los centros educativos en España / Analysis of the situation of School-based Physiotherapy Services in Spain

Antecedentes y objetivo: El alumnado con necesidades educativas especiales puede necesitar el apoyo específico y especializado de fisioterapia, con el fin de facilitar el desarrollo de su máximo potencial y ayudar en su inclusión educativa. La información acerca de la implementación de la fisioterapia en los centros educativos en el territorio español es muy escasa. El objetivo de este estudio es describir la situación de la fisioterapia en los centros educativos y compararla entre las diferentes comunidades autónomas. Materiales y métodos: Se realizó un estudio descriptivo y transversal a través de la elaboración de una encuesta online, diseñada junto a un panel de expertos a través del método Delphi. Se incluyeron seis bloques temáticos relacionados con la atención de fisioterapia, las condiciones laborales de los fisioterapeutas en los centros educativos y con la cobertura de las necesidades del alumnado. Resultados: Se obtuvieron 178 respuestas. Su distribución geográfica fue homogénea, aunque se detectaron grandes diferencias entre las comunidades autónomas. La mayoría de las personas encuestadas trabajan en centros de educación especial y existen comunidades autónomas en las que no se trabaja en centros ordinarios. Solo el 28,4% contestaron que la figura del fisioterapeuta está integrada en los equipos de orientación educativa de su comunidad autónoma y tienen la función de determinar la necesidad del recurso. Conclusiones: El desarrollo del trabajo de fisioterapia en los centros educativos como apoyo al alumnado con necesidades educativas especiales es desigual entre las comunidades autónomas, y en algunas, se considera insuficiente.

Background and objective: Students with special educational needs may need the specific and specialized support of Physiotherapy in order to facilitate the development of their maximum potential and help in their educational inclusion. The information about school-based Physical Therapy development in Spain is very scarce. The objective of this study is to describe the situation of physiotherapy in educational centers and compare it among the different autonomous communities. Materials and methods: A descriptive and cross-sectional study was carried out through the elaboration of an online survey, designed together with a panel of experts using the Delphi method. Six thematic blocks were included related to the provision of the physiotherapy service, working conditions and the coverage of the students’ needs. Results: 178 responses were obtained. Their geographical distribution was homogeneous, although large differences were detected among the autonomous communities. Most of the participants work in special education centers and there are autonomous communities in which physical therapists do not work in ordinary centers. Only 28.4% answered that the physiotherapist is integrated into the educational orientation teams of their autonomous community and has the function of determining the need for the resource. Conclusions: School-based Physiotherapy services to support students with special educational needs is unequal among the autonomous communities, and in some of them it is considered insufficient.

Eastern Spanish experience with nivolumab in metastatic renal cell carcinoma.

BACKGROUND (OR PURPOSE): Nivolumab has been shown to be effective for the treatment of second-line mRCC. The present study has investigated the effectiveness and safety of nivolumab in real-world Eastern Spanish patients with advanced mRCC at TKI progression. PATIENTS AND METHODS: A retrospective review of mRCC patients treated with nivolumab as a second-line treatment was performed. Analyzed variables included age, sex, ECOG (quality of life scale designed by the Eastern Cooperative Oncology Group), histology, nephrectomy, location of metastases, number of metastasis locations, previous treatments, analytical data from the standard blood count and biochemistry, and response to treatment. RESULTS: 98 patients from 18 sites in Spain were retrospectively reviewed. The majority of patients were male (75%), had ECOG 0-1 (90.6%), had no brain metastasis (91.4%), had undergone one prior systemic regimen (94.3%), and were current/former smokers (97.1%). Fourteen patients (13.1%) had non-clear cell histology, seven (7.1%) had poor-IMDC prognostic group characteristics, 13 patients (13.1%) had liver metastasis and 35 (35.7%) had bone lesions. All patients received prior systemic therapy (63.3% sunitinib, 34.7% pazopanib). During the study, a median of eight doses of nivolumab was given (range 2-62) and 11 patients received more than 12 doses. Eleven patients (11.2%) received nivolumab as a third or fourth line of treatment. Median duration of therapy was 3.6 months (range 0.5-29.3). Confirmed response rate was 25%. Median progression free survival was 7.8 months (range 1.2-12.1). Median overall survival was 16.3 months (range 1.7-29.3). After discontinuation of treatment, 27.58% of the patients received subsequent systemic cancer therapy. Side effects were mostly grade 1-2 (7.2% had hypothyroidism and 6.2% liver toxicity, 4% had nephritis and 2% hypophysitis). Two cases of grade 3-4 adverse events (2%) were reported. CONCLUSION: Benefit/risk profile of nivolumab in Eastern-Spanish real-world population with mRCC after tyrosine-kinase inhibitors was consistent with prior real-life studies reported as well as pivotal study.

Trastorno Dismórfico Corporal: revisión sistemática de un trastorno propio de la adolescencia / Body Dysmorphic Disorder: a systematic review of a disorder typical in adolescence

Introducción: El Trastorno Dismórfico Corporal es un trastorno propio de la adolescencia, poco conocido y poco tenido en cuenta en la clínica diaria con niños y adolescentes, lo que demora el diagnóstico y empeora el pronóstico. Métodos: Se realizó una revisión sistemática práctica para el clínico infanto-juvenil, con una búsqueda electrónica en las principales bases de datos junto a una búsqueda manual en revistas y tratados especializados. Resultados: El trastorno es muy común, con prevalencias del 1,7 al 2,5%. Dos terceras partes de los casos se inician en la adolescencia y una edad de inicio más temprana se asocia a mayor probabilidad de comorbilidad a lo largo de la evolución y a un mayor riesgo suicida. Se trata de un trastorno del espectro obsesivo-compulsivo que implica preocupaciones persistentes por uno o más defectos físicos percibidos y que no son observables por otras personas, así como comportamientos compulsivos en respuesta a dichas preocupaciones. La vergüenza y el miedo al rechazo promueven que el adolescente no explique sus síntomas y es muy habitual la demora de años en el diagnóstico, que si llega a establecerse, lo hace por lo general en la edad adulta. El curso es crónico y en caso de no diagnosticarse, el pronóstico será pobre con frecuente aislamiento social y deterioro funcional. Un diagnóstico correcto y a tiempo mejorará mucho la evolución, tratándose de un trastorno que responde bien a los tratamientos tanto farmacológicos como psicológicos. Conclusión: Conocer el trastorno dismórfico corporal es muy importante para diagnosticarlo a tiempo en el adolescente, lo cual mejorará el pronóstico de forma clara

Introduction: Body Dysmorphic Disorder is a disorder of adolescence, not enough known and not always taken into account by child and adolescent clinicians, which delays diagnosis and worsens its prognosis. Methods: We aimed to carry out a practical systematic review for clinicians working with adolescents, by means of an electronic search using the main databases, along with a manual search in journals and specialized textbooks. Results: The disorder is very common, with prevalences of 1.7 to 2.5%. Two thirds of cases begin in adolescence and an earlier age of onset is more likely to be associated with comorbidity throughout the course of the disease and with an increased suicide risk. It is a disorder of the obsessive-compulsive spectrum that involves persistent concerns about one or more perceived physical defects that are not observable by others, as well as compulsive behaviors in response to those concerns. The shame and the fear of rejection prevent adolescents from explaining their symptoms and a delay of several years to diagnosis is very usual, with most of the diagnoses established in adult age, if they are ever reached. The course is chronic and if not diagnosed, the prognosis will be very poor, with frequent social isolation and functional deterioration. A correct diagnosis at an appropriate time will greatly improve clinical course as it is a disorder that responds well to both pharmacological and psychological treatments. Conclusion: Adequate knowledge of Body Dysmorphic Disorder in the adolescent is very important to diagnose it in time, which will improve prognosis very considerably

First Report of Leaf Spot of Spinach Caused by Pleospora betae in Spain.

The production of spinach (Spinacia oleracea L.) in Spain has increased 50% since 2009, mainly due to the commercialization of fresh-cut spinach leaves packaged in modified atmosphere containers. In October 2012, light brown leaf spots 1 to 2 cm in diameter with dark concentric rings were observed in a commercial spinach production area in Valencia Province, Spain. The initial outbreak comprised an area of about 3 ha with a 20% disease incidence. Symptomatic leaves from spinach cv. Apollo were collected in the affected area and were surface disinfected with 0.5% NaOCl for 2 min. Small fragments from lesions were placed onto potato dextrose agar (PDA) amended with 0.5 g streptomycin sulfate/liter. Fungal colonies developed after 3 days of incubation at 23°C from about 90% of the infected tissues plated. Isolates were transferred to oatmeal agar (OA) (1) and water agar (WA) amended with autoclaved pea seeds (2). Plates were incubated for 30 days at 24°C with 13 h of fluorescent light and 11 h of dark for morphological examination. Colonies were olivaceous grey in OA and pycnidia developed in WA were globose to subglobose, olivaceous black, and 100 to 200 µm in diameter. Conidia were globose to ellipsoidal, hyaline, aseptate, and 3.8 to 7.7 × 2.4 to 3.9 µm. Swollen cells were observed. Isolates showed a positive reaction to NaOH (1). Partial 18S, ITS1, 5.8S, ITS2, and partial 28S ribosomal RNA (rRNA) regions were amplified using the primers ITS1 and ITS4 (4) and sequenced from DNA extracted from the isolate designated as IVIA-V004 (GenBank Accession No. KF321782). The sequence had 100% identity (e-value 0.0) with that of Pleospora betae (Berl.) Nevod. (syn. Phoma betae A.B. Frank) representative strain CBS 523.66 (1). Pathogenicity tests were performed twice by inoculating 4-month-old plants of spinach cv. Apollo, table beet (Beta vulgaris L.) cv. Detroit, and Swiss chard (B. vulgaris subsp. cicla) cv. Verde de Penca Blanca. Plants were inoculated by spraying a conidial suspension of isolate IVIA-V004 (10 ml/plant, 105 conidia/ml water) using a manual pressure sprayer. Plants were immediately covered with black plastic bags and incubated in a growth chamber at 23°C. In each experiment, four plants of each host were inoculated with the fungus and four additional plants sprayed with sterile distilled water were used as controls. Plastic bags were removed after 48 h and leaf spots similar to those observed in affected spinach plants in the field were visible on all spinach, table beets, and Swiss chard plants 3 to 5 days after inoculation. No symptoms were observed on control plants. Fungal colonies morphologically identified as P. betae were re-isolated from leaf lesions on inoculated plants, but not from asymptomatic leaves of control plants. To our knowledge, this is the first report of leaf spot caused by P. betae on spinach in Spain, where it was previously described affecting sugar beet (3). The disease reduces the quality of spinach leaves and proper control measures should be implemented. References: (1) G. H. Boerema et al. Phoma Identification Manual, Differentiation of Specific and Infra-Specific Taxa in Culture. CABI Publishing, Wallingford, UK, 2004. (2) O. D. Dhingra and J. B. Sinclair. Basic Plant Pathology Methods, 2nd ed. CRC Press, Boca Raton, FL, 1995. (3) P. Melgarejo et al. Patógenos de Plantas Descritos en España. MARM-SEF, Madrid, 2010. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

Inoculum Sources, Infection Periods, and Effects of Environmental Factors on Alternaria Brown Spot of Mandarin in Mediterranean Climate Conditions.

Alternaria brown spot (ABS), caused by Alternaria alternata, is a serious disease affecting mandarin in humid and in semi-arid regions. The information available from Florida cannot be easily extrapolated to Mediterranean regions; thus, epidemiological studies were conducted during two consecutive years in Spain. Pathogenic isolates were found in the canopy and leaf litter and on weeds of the genus Sonchus. The pathogen survived in fallen immature leaves for up to 76 days, until complete leaf decay. Conidia of Alternaria spp. were captured continuously and pathogenic isolates were detected in all sampling dates. However, the number of pathogenic isolates was not correlated with the total captured, indicating that morphological identification is not sufficient for airborne inoculum monitoring. In contrast to humid areas, infections occurred mainly in spring and autumn. Classification tree analysis indicated that virtually all infections occurred on weeks with rainfall ≥2.5 mm and average temperature ≥12.5°C. Based on regression quantiles, the amount of rainfall, number of rain days, and total wetness duration were considered important factors increasing ABS incidence during infection periods. The development of decision support systems for ABS control in Mediterranean conditions may benefit from the restricted periods of infection and the strong influence of weather factors in disease onset.

First Report of Alternaria japonica Causing Black Spot of Turnip in Spain.

Turnip (Brassica rapa subsp. rapa L.) is an annual vegetable crop cultivated for consumption of its succulent root. In July 2011, symptoms consisting of leaf spots 1 to 8 mm in diameter with a dark brown color surrounded by a yellow halo and black sunken lesions in the swollen storage root were observed in production areas in Alicante Province in east-central Spain. Disease incidence was approximately 20% in fields of about 3 ha where infection was highest. Symptomatic leaves and roots collected from turnip cv. Virtudes-Martillo in three affected fields were surface disinfected with 0.5% NaOCl for 2 min, and small fragments from necrotic lesions were plated on potato dextrose agar (PDA) amended with 0.5 g streptomycin sulfate per liter. Alternaria colonies were consistently isolated from affected leaves and roots after 7 days of incubation at 24°C, and were transferred to V-8 with autoclaved turnip cv. Virtudes-Martillo leaves. Two isolates from leaves and two isolates from roots were included in the study. Plates were incubated for 15 days at 24°C with an 8-h fluorescent light period and a 12-h dark period for morphological examination. Conidia produced in culture were mostly solitary or in short chains of 2 to 3 spores, beakless, ovoid to ellipsoid, and light brown. Conidia were 32 to 78 × 13 to 24 µm, with 3 to 7 transverse septa and 1 to 2 longisepta. Aggregated hyphal chains of dark, thick-walled ornamented cells distinctive of Alternaria japonica Yoshii (3) were observed. The 5.8S, ITS2, and 28S ribosomal RNA (rRNA) regions were amplified using the primers ITS3 and ITS4 (4) and sequenced from DNA extracted from the isolate designated as IVIA-A070, obtained from turnip leaves cv. Virtudes-Martillo in Alicante Province (GenBank Accession No. JX983044). The sequence had 100% identity (total score 302, 73% coverage) with that of A. japonica strain ATCC 13618 (2) (AY376639). Pathogenicity tests were performed twice on two 3-month-old plants of turnip cv. Virtudes-Martillo and cv. Blanco-Globo, and cabbage (B. oleracea var. capitata L.) cv. Brunswick. Plants were inoculated by spraying a conidial suspension of the isolate IVIA-A070 (10 ml/plant, 104 conidia/ml water) using manual pressure sprayer. Two plants of each host sprayed with sterile distilled water were used as controls in each experiment. Plants were covered with black plastic bags and incubated in a growth chamber for 48 h at 25°C. Leaf spots similar to those observed in affected plants in the field were visible on all turnip and cabbage plants 4 days after inoculation with the fungus. No symptoms were observed on control plants. Fungal colonies morphologically identified as A. japonica were reisolated from leaf lesions on inoculated turnip and cabbage plants, but not from asymptomatic leaves of control plants. Based on these results, the disease was identified as black spot of turnip caused by A. japonica. In Spain, black spot of brassicas was previously associated only with A. brassicae (Berkeley) Saccardo and A. brassicicola (Schw.) Wiltshire (1). References: (1) P. Melgarejo et al. Patógenos de Plantas Descritos en España. MARM-SEF, Madrid, 2010. (2) B. M. Pryor and R. L. Gilbertson. Mycol. Res. 104:1312, 2000. (3) E. G. Simmons. Alternaria: An Identification Manual. CBS Fungal Biodiversity Centre, Utrecht, 2007. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

First Report of Pseudocercospora angolensis Causing Fruit and Leaf Spot of Citrus in Ghana.

Citrus is one of the most important crops in Ghana, representing a large proportion of the fresh fruit consumed in the country. In 2004, symptoms consisting of necrotic leaf spots of about 1 cm in diameter with light brown centers and dark brown margins surrounded by a yellow halo were first observed in sweet orange (Citrus sinensis) and mandarin (C. reticulata) orchards in the Eastern Region of Ghana. Fruits with raised corky lesions of up to 3 to 4 cm in diameter with yellow halos were also observed. Affected fruit had longitudinal and transversal cracks in the rind with the internal locules exposed. Juice content in diseased fruit was strongly reduced, making them unsuitable for fresh consumption or processing. The disease expanded to the Central and Ashanti Regions, with incidences over 95% and estimated yield losses of about 50 to 90%. Symptomatic leaves and fruit collected in Kade in the Eastern Region were surface disinfested with 0.5% NaOCl for 5 min and small fragments from lesions were plated onto malt extract agar (MEA). Slow-growing fungal colonies were isolated from about 5% of the affected tissues plated after 5 days of incubation at 24 to 26°C, and were transferred to V-8 juice agar and MEA. Plates were incubated for 30 days at 24 to 26°C with 12 h of fluorescent light and 12 h of dark for morphological examination. Colonies were gray in the upper side and dark green on the underside. Conidia produced in culture were mostly solitary or in short chains of 2 to 6 spores, hyaline to pale brown, cylindrical, with rounded apex and base truncated. Conidia were 24 to 82 × 4 to 6 µm, with up to 3 to 5 transverse septa and no longisepta. The 5.8S, ITS2, and 28S ribosomal RNA (rRNA) regions were amplified using the primers ITS1 and ITS4 (3) and sequenced from DNA extracted from the isolate MC-39, obtained from sweet orange leaves in Kade (GenBank Accession No. KF111755). The sequence had 99% identity (total score 819, 85% coverage) with that of Pseudocercospora angolensis (T. Carvalho & O. Mendes) Crous & U. Braun epitype strain CBS 112933 (GU269836) (1). Pathogenicity tests were performed twice on 12-week-old detached fruit of sweet orange cv. Valencia Late of about 4 to 5 cm in diameter. Inoculations were performed using a conidial suspension (3.0 × 105 conidia/ml water) by spraying fruit to run off, brushing the rind, dipping for 6 min, or injecting 2 ml in the albedo. Twenty-two isolates were evaluated and 18 fruit were used for each inoculation technique, isolate and experiment. Fruit treated with sterile distilled water were used as controls. Inoculated fruit were maintained in humid chambers at 24 to 26°C. Disease incidence on inoculated fruit varied from 40.7% to 92.6% and severity from 2 to 3 to 3 to 11 lesions per fruit, depending on the isolate and inoculation technique. No symptoms were observed on control fruit. Fungal colonies morphologically identified as P. angolensis were reisolated from lesions on inoculated fruit, but not from asymptomatic control fruit. Based on these results, the disease was identified as Pseudocercospora fruit and leaf spot of citrus caused by P. angolensis. Until this present report, Ghana was considered one of the few countries in Central Africa that was still free of this citrus disease (2). References: (1) P. W. Crous et al. Stud. Mycol. 75:37, 2013. (2) A. A. Seif and R. J. Hillocks. Int. J. Pest Manag. 39:44, 1993. (3) T. J. White et al. Pages 315-322 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

First Report of Alternaria petroselini Causing Leaf Blight of Fennel in Spain.

Fennel (Foeniculum vulgare Mill.) is an aromatic herb widely cultivated in Mediterranean areas for culinary and medicinal uses. In 2010, symptoms consisting of leaf blight and necrosis were observed in commercial organic fennel production areas in Valencia Province in east-central Spain. Disease incidence in affected fields was approximately 20%. Symptomatic leaves from four fields were surface disinfected with 0.5% NaOCl for 2 min, and small fragments from necrotic lesions were then plated on potato dextrose agar (PDA) amended with 0.5 g of streptomycin sulfate/liter. After 7 days at 25°C, isolates of the genus Alternaria were consistently isolated. Single conidium cultures were grown on PDA and V8 agar for morphological examination. On both agar media, colonies were dark olive brown without production of pigments. On V8 agar, conidia were solitary, darkly pigmented, and predominantly ovoid-subsphaeroid. Mature conidia were 25 to 59 × 12 to 23 µm with up to six to seven transepta and one to three longisepta. The 5.8S, ITS2, and 28S ribosomal RNA (rRNA) regions were amplified with the primers ITS3 and ITS4 (3) from DNA extracted from the isolate IVIA-A029, and sequenced (GenBank Accession No. JQ240204). The sequence had 100% identity (total score 399, 97% coverage) with that of Alternaria petroselini (Neergard) Simmons strain EGS 09-159 (GenBank Accession No. AF229454.1) (1). Pathogenicity tests were conducted on four 3-month-old fennel plants (cv. Giotto) by spraying a conidial suspension of the fungus (10 ml/plant, 103 conidia/ml of water). Four control plants were sprayed with sterile, distilled water. Plants were covered with plastic bags and incubated in a growth chamber for 72 h at 25°C. Leaf necrosis was visible on inoculated plants after 4 days, but symptoms were not observed on control plants. The fungus was reisolated from leaf lesions on inoculated plants, but not from leaves of control plants, confirming Koch's postulates. On the basis of the morphological (2), molecular, and pathogenicity data, the disease was identified as Alternaria leaf blight of fennel caused by A. petroselini. To our knowledge, this is the first report of A. petroselini in Spain. References: (1) B. M. Pryor and R. L. Gilbertson. Mycol. Res. 104:1312, 2000. (2) E. G. Simmons. Alternaria: An Identification Manual. CBS Fungal Biodiversity Centre, Utrecht, The Netherlands, 2007. (3) T. J. White et al. Pages 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

Estimation of leaf wetness duration requirements of foliar fungal pathogens with uncertain data-an application to Mycosphaerella nawae.

Wetness of the host surface is a critical environmental factor for the development of foliar fungal diseases, but it is difficult to estimate the wetness durations required by pathogens for infection when only few experimental data are available. In this paper, we propose a method to estimate wetness duration requirements of foliar fungal pathogens when precise experimental data are not available. The proposed method is based on approximate Bayesian computation. It only requires lower and upper bounds of wetness duration requirements for one or fewer temperatures. We describe the method, show how to apply it to an infection model, and then present a case study on Mycosphaerella nawae, the causal agent of circular leaf spot of persimmon. In this example, the parameters of a simple infection model were estimated using experimental data found in the literature for the pathogen, and the model was applied to assess the risk in a Spanish area recently affected by the disease. The results showed that the probability of successful infection was higher than 0.5 for 32% of the on-site wetness durations recorded in the affected area. Results obtained with simulated data showed that our method was able to improve the estimation of wetness duration requirement. Given the flexibility of the proposed method, we expect it to become adopted for assessing the risk of introduction of exotic fungal plant pathogens.

Experience with a scalloped thoracic stent graft: a good alternative to preserve flow to the celiac and superior mesenteric arteries and to improve distal fixation and sealing.

Thoracic endografting has been proposed as an effective alternative to open repair to treat several aortic pathologies. Cranial migration is one of the critical issues concerning long-term durability. The scalloped thoracic endograft was proposed to improve distal sealing and fixation crossing the diaphragm. The objective of this study was to evaluate technical feasibility and experience with a custom-made scalloped thoracic endograft using the Relay platform (Bolton Medical, Sunrise, FL) in selected cases. From January 2006 to June 2009, 57 patients (40 men) were treated in Europe with a customized distal scalloped thoracic endograft. Forty-five patients presented with thoracic aortic aneurysm, nine presented with type B dissection, and three had a pseudoaneurysm. Successful and accurate deployment was achieved in all cases except one partial rotation in an extremely tortuous anatomy. Technical success was achieved in 96.4%. Good sealing and no mortality, paraplegia, or visceral embolization were observed. At a mean follow-up of 6 months, no complications were registered. The Relay endograft with the distal scallop represents a feasible alternative for distal short necks. This approach may increase the applicability and durability of the endograft in short distal necks.

Synthesis and performance of bismuth trioxide nanoparticles for high energy gas generator use.

Our experiments showed that the combustion of an Al-Bi2O3 nanoparticle mixture generated the highest pressure pulse among common nanothermite reactions and can potentially be used as a nanoenergetic gas generator. The combustion front propagation velocity and rate of energy release increased by up to three orders of magnitude when the particle size was reduced to a nanosize range for both the aluminum and the oxidizer. We developed a novel one-step (metal nitrate-glycine) combustion synthesis of nanostructured amorphous-like and highly crystalline bismuth trioxide nanoparticles. The combustion synthesis was conducted using a solution of molten bismuth nitrate as an oxidizer and glycine as a fuel. The glycine was completely combusted during the thermal decomposition of the bismuth nitrate pentahydrate and generated a temperature front that propagated through the sample. Increasing the fuel concentration increased the maximum combustion temperature from 280 to 1200 degrees C and the Bi2O3 particle size from 20 to 100 nm. The oxidizer/fuel ratio had a strong impact on the bismuth trioxide particle crystallinity. At low temperature (280 degrees C), amorphous-like bismuth trioxide nanoparticles formed, while at T > or =370 degrees C the structures were crystalline. A peak pressure of approximately 12 MPa and a thermal front propagating velocity of approximately 2500 m s(-1) were achieved during the combustion of an Al-Bi2O3 mixture containing 80 wt% of the synthesized Bi2O3 crystalline nanoparticles (size: 40-50 nm).

Avisos médicos domiciliarios en un centro de salud urbano. Estudio de la demanda y estrategias para su optimización / Medical domiciliary care requests in an urban health center. A study of the demand and strategies for its improvement

OBJETIVO. Conocer el perfil del solicitante de atención domiciliaria en nuestra área de salud, como primer paso para intentar aplicar soluciones que mejoren la calidad de la asistencia sanitaria en nuestro centro y, posiblemente, en otros centros de similares características. MATERIAL Y MÉTODOS. Se realiza un estudio transversal analítico. Se incluyeron todas las llamadas recibidas para atención médica domiciliaria en nuestro centro de salud durante los 3 primeros meses del año 2007. Los avisos domiciliarios son divididos en urgentes y demorables. Se incluyeron distintas variables de filiación, datación, diagnóstico y tratamiento. La fuente de información fue la historia clínica informatizada y el libro de registro de urgencias de nuestro centro. Los datos se trataron estadísticamente. RESULTADOS. Durante el período de estudio se realizaron 1.665 avisos a domicilio, de los cuales el 48% se atendieron como urgentes. La edad media fue de 68 años, con un rango de edad de 1 a 101 años. La mayoría de los avisos fue demandada por mujeres (64%). En el 80% de los casos no era la primera vez que el paciente solicitaba la atención domiciliaria. Los diagnósticos varían en función de si el paciente es visto de urgencias o en forma de domicilio a demanda. Se consideró que el aviso no estaba justificado en el 40% de las ocasiones. CONCLUSIONES. Creemos que existe una sobreutilización de la atención domiciliaria, tanto urgente como de demanda, malgastando recursos en actos médicos innecesarios, existiendo múltiples factores involucrados. La educación sanitaria, la recepción telefónica del aviso por el médico, la modulación de la dependencia por su médico y un buen programa de atención al paciente inmovilizado y crónico-dependiente son medidas propuestas para optimizar la atención domiciliaria (AU)

OBJECTIVE. To know the profile of the person requesting domiciliary care in our health care area as a first step to try to apply solutions that improve the quality of the health care in our center and possibly, in other centers of similar characteristics. MATERIAL AND METHODS. A cross-sectional, analytical study was conducted. All the calls received for medical domiciliary care in our Health Care Center during the first 3 months of the year 2007 were included. The domiciliary care requests were divided into urgent and with possibility of delay. Different personal data, dates, diagnosis and treatment variables were included. The information was obtained from the computerized clinical records and registry book of emergencies of our center. The data were processed statistically. RESULTS. During the study period, 1665 patients were attended at home, 48% of whom were seen as emergencies. Mean age was 68 years, with an age range going 1 to 101 years. Most of the domiciliary care was demanded by women (64%). In 80% of the cases, it was not the first time that the patient had requested domiciliary care. The diagnoses varied based on whether the patient was seen as an emergency visit or home care on demand. The demand was considered unjustified in 40% of the cases. CONCLUSIONS. We believe that there is overuse of urgent and on demand domiciliary care, wasting resources for unnecessary medical acts, and that there are many factors involved. Health care education, telephonic reception of the notice by the doctor, modulation of the dependence by the doctor and a good program of care of the immobilized and chronic-dependent patient are measures proposed to improve domiciliary care (AU)

Comparison of Application Methods of Systemic Fungicides to Suppress Branch Cankers in Clementine Trees Caused by Phytophthora citrophthora.

Since 2002, considerable losses of Clementine trees (Citrus clementina) have been observed in Spain due to Phytophthora branch canker of citrus caused by Phytophthora citrophthora. Due to the low efficiency of the available cultural and genetic control measures, application of fungicides is required for economic management of the disease. Fosetyl-Al, metalaxyl, and its enantiomer mefenoxam are the only systemic fungicides registered for control of Phytophthora diseases in Spain. However, their efficacy has not been tested against Phytophthora branch canker. Greenhouse and field experiments were conducted for 3 years in Spain to evaluate the ability of these fungicides and application methods to reduce lesion expansion. Nevertheless, with the inoculation technique used, it was not possible to evaluate the protective activity of fungicides, which can play an important role in their performance under field conditions. None of the fungicide treatments inhibited lesion expansion when applications were made on a curative basis. The residual effect was better on young than on mature trees. Paint treatments were generally more effective in reducing lesion expansion that drip chemigation or foliar sprays. However, this application method is laborious and becomes uneconomical in Spain. Trunk and branch sprays as well as long-term programs of foliar sprays or drip chemigation for control of spring and autumn infections are proposed as targets for future research.

Comparative Epidemiology of Monosporascus Root Rot and Vine Decline in Muskmelon, Watermelon, and Grafted Watermelon Crops.

Disease progression and soil population dynamics of Monosporascus cannonballus ascospores were studied and compared through the entire growing season in muskmelon, watermelon, and watermelon grafted onto Cucurbita rootstock crops. In muskmelon and watermelon, there was a decrease of ascospore counts in soil from transplanting until first symptoms of vine decline were observed. This decrease probably was related to ascospore germination and subsequent root infection. Later, there was a remarkable increase of ascospore counts in a parallel way to the quick development of vine decline symptoms, which lead to plant death. In these crops, root colonization adjusted to first-order linear equations and vine decline progression best correlated with exponential and logistic models. In contrast, there were no symptoms of vine decline on grafted watermelon. Furthermore, the isolation of M. cannonballus from Cucurbita roots was considerably lower, perithecia were never observed, and ascospore soil populations remained stable. These results suggest that disease control by grafting onto genus Cucurbita seems to be related primarily by the increased resistance of its root system to infection by M. canonballus, and provide further evidence of the use of grafting as a disease management measure for this disease.

Efficacy of Pre- and Postinoculation Application of Fungicides to Expanding Young Citrus Leaves for Control of Melanose, Scab, and Alternaria Brown Spot.

In greenhouse trials, copper hydroxide, pyraclostrobin, and famoxadone were applied to actively growing young citrus seedlings to determine the duration of protection of young leaves provided by these fungicides against melanose, caused by Diaporthe citri, citrus scab, caused by Elsinoe fawcettii, and Alternaria brown spot, caused by Alternaria alternata. Fungicides were applied to different sets of potted plants of grapefruit for control of melanose, of rough lemon for control of scab, and of Dancy tangerine for control of Alternaria brown spot 1 to 6 days prior to inoculation, as well as on the day of inoculation. Leaf area of treated shoots was estimated on the day of fungicide application and the day of inoculation and disease severity evaluated subsequently. In most cases, copper hydroxide and famoxadone provided at least 50% control of all three diseases for only about 2 days after application. Generally, there was little or no disease control when the products were applied 4 or more days before inoculation. In contrast, pyraclostrobin usually provided a high level of control of all three diseases when applied up to 5 days prior to inoculation. The level of disease control decreased as the interval between a fungicide application and inoculation increased and the relationship between disease control and leaf expansion best fit a quadratic equation. Effective disease control was observed with copper hydroxide and famoxadone until leaf area had increased by 100 to 200%, whereas control with pyraclostrobin was observed up to 400 to 500% increase in leaf area. In postinoculation tests with scab and melanose, pyraclostrobin provided high levels of disease control (>75%) when applied up to 2 days after inoculation, whereas copper hydroxide and famoxadone had minimal postinoculation activity. Applications of pyraclostrobin to the spring flush growth of citrus trees are much more likely to provide control of melanose, scab, and Alternaria brown spot than those of famoxadone or copper hydroxide.

Characterization of Cylindrocarpon Species Associated with Black Foot Disease of Grapevine in Spain.

In this work, 82 Cylindrocarpon isolates associated with black foot disease of grapevines in Spain were studied by means of phenotypical characterization, DNA analyses, and pathogenicity tests. Partial sequences of the beta-tubulin (BT) gene, BT1, were amplified using primers BT1a and BT1b. A unique and conserved 52-bp insertion in the BT1 sequence, which is a specific marker for C. macrodidymum, was found in 56 of the isolates. The rest of the isolates (26) were identified as C. liriodendri. The BT phylogeny grouped all the isolates of each species into two well-supported clades. Phenotypical data were subjected to multivariate factorial analysis. According to this study, the isolates were clearly separated into two groups which were in agreement with BT species identification. C. macrodidymum isolates were differentiated from C. liriodendri by producing fewer conidia, presenting longer and wider macroconidia, and lower growth rate at 5 and 10°C. Selected isolates of each species inoculated onto rooted cuttings of grapevine rootstock cv. 110 R caused typical black foot disease symptoms. This is the first report of C. liriodendri and C. macrodidymum causing black foot disease of grapevines in Spain.

Saprophytic Colonization of Citrus Twigs by Diaporthe citri and Factors Affecting Pycnidial Production and Conidial Survival.

Melanose, caused by Diaporthe citri, produces reddish brown lesions on the fruit, leaves, and twigs of citrus trees, and greatly reduces the marketability of fresh fruit. Most of the inoculum is produced in pycnidia on dead twigs in the tree canopy, which exude large numbers of conidia in slimy masses. In this study, detached twigs inoculated with conidia were readily colonized and produced large numbers of pycnidia within 30 to 40 days when they were soaked 3 to 4 h on alternate days. Conidial production was measured by wetting twigs in a rain tower periodically and collecting the conidia in the runoff water. Production began after 80 days and continued for nearly 300 days. In other experiments, production of mature pycnidia on detached twigs was greatest at 94 to 100% relative humidity (RH) and at 28°C. Low RH and temperature, however, favored survival of conidia in exuded masses on twigs. In the field, colonization of detached twigs by D. citri was high in rainy season, moderate in spring and early fall, and minimal in late fall and winter. Twig colonization was positively related to the number of rain days and average temperature, but not to total rainfall. In another experiment, inoculated twigs placed in the tree canopy developed pycnidia and then produced conidial masses for about 200 days. D. citri is a serious pathogen, but a weak parasite, that survives primarily by colonization and reproduction on dead twigs.

Rain Fastness and Persistence of Fungicides for Control of Alternaria Brown Spot of Citrus.

Field persistence and simulated rain experiments were conducted to determine the residual activity and rain fastness of several fungicides used for the control of Alternaria brown spot of citrus. Fungicidal activity persisted well in simulated rain experiments, despite the high rainfall amounts tested (40 mm in 2004 and 90 mm in 2005). However, most of the fungicides showed a significant reduction of disease control on fruit of 'Fortune' mandarin in the orchard after natural rain in 2004. Fruit growth rate was low and did not appear to play an important role in decline of fungicide residues. Copper products showed longer residual activity on fruit and higher rain fastness than did mancozeb, difenoconazole, iprodione, famoxadone, and pyraclostrobin. Cuprous oxide and copper oxychloride SC provided satisfactory disease control on fruit through 28 days and withstood 71 mm of rainfall in the orchard. A 4-week schedule with copper compounds is proposed for disease control on Fortune fruit during periods of weather favorable for disease development. Respray to replace fungicide deposit seems to be necessary only after heavy or wind-driven rains. With this program, about half of the sprays applied per season for fruit protection could be saved compared with the current schedule in Spain.

First Report of Phoma exigua var. heteromorpha Causing Oleander Dieback in Spain.

During the autumn of 2003, a new disease was detected in oleander (Nerium oleander L.) nurseries in Valencia and Murcia in eastern Spain. Affected leaves showed ovoid or ellipsoid necrotic spots. Necrotic lesions were also observed on stems and lateral shoots that resulted in severe blight and defoliation. In some cases, severe infections caused the death of plants. Isolations from symptomatic leaves and stems onto potato dextrose agar (PDA) supplemented with 0.5 g liter-1 of streptomycin sulfate (PDAS) consistently yielded dark olivaceous fungal colonies. For sporulation, these isolates were transferred to potato carrot agar (PCA) and incubated at 25°C for 15 days with a 12-h photoperiod. Abundant pycnidia (200 µm in diameter) developed superficially or immersed in the culture medium. Conidia were hyaline, ellipsoid or cylindrical, guttulate, and occasionally, one septate. Conidial dimensions were 6.1 to 9.6 × 2.2 to 3.2 µm (average 6.2 × 2.8 µm). The addition of a drop of concentrated NaOH to the cultures gave a blue-green pigmentation to the agar changing to brown-red. On the basis of cultural characteristics and fungal morphology, the isolates were identified as Phoma exigua Desmaz. This identification was confirmed by sequencing the complete internal transcribed spacer regions 1 and 2, including the 5.8S ribosomal DNA of isolate Pho 6 (GenBank Accession No. AY899262). This sequence was identical to sequences in GenBank from well-characterized strains of P. exigua (1). Pathogenicity tests were conducted on 9-month-old oleander plants (cv. Splendens Gigantium) using three isolates of P. exigua from different locations. Two methods of inoculation were used. Leaves were spray inoculated with an aqueous suspension (1.5 × 105 conidia per ml) of conidia harvested from 15-day-old cultures grown on PCA, or a 5-mm-diameter agar disc, cut from the margin of an 8-day-old culture growing on PCA, was inserted mycelium side down in a stem wound made with a sterile scalpel and sealed with Parafilm. Controls were inoculated with sterile distilled water or sterile PCA discs. There were five replicates for each isolate and inoculation method with an equal number of uninoculated plants. After inoculation, all plants were covered separately with plastic bags for 48 h to maintain high humidity. Plants were maintained in a greenhouse at 20 to 30°C. Within 5 to 15 days after inoculation, symptoms developed that were similar to those observed in the nurseries. The fungus was reisolated from the stems and leaves of all inoculated plants, completing Koch's postulates. On the basis of ITS sequence data and the host from which they were isolated, our isolates were identified as P. exigua var. heteromorpha (Sch. et Sacc.) Noordeloos et Boerema (2,3). This disease has been previously reported to cause severe damage to oleander in France, California, Italy, and the Netherlands. To our knowledge, this is the first report of P. exigua var. heteromorpha on oleander in Spain. References: (1) E. C. A. Abeln et al. Mycol. Res. 106:419, 2002. (2) M. E. Noordeloos and G. H. Boerema. Versl. Meded. Plziektenk. Dienst. Wageningen 166:108, 1988. (3) H. A. van der AA et al. Persoonia 17:435, 2000.