Genetic polymorphism and population structure of Echinococcus ortleppi.

The zoonotic cestode Echinococcus ortleppi (Lopez-Neyra and Soler Planas, 1943) is mainly transmitted between dogs and cattle. It occurs worldwide but is only found sporadically in most regions, with the notable exception of parts of southern Africa and South America. Its epidemiology is little understood and the extent of intraspecific variability is unknown. We have analysed in the present study the genetic diversity among 178 E. ortleppi isolates from sub-Saharan Africa, Europe and South America using the complete mitochondrial cox1 (1608 bp) and nad1 (894 bp) DNA sequences. Genetic polymorphism within the loci revealed 15 cox1 and six nad1 haplotypes, respectively, and 20 haplotypes of the concatenated genes. Presence of most haplotypes was correlated to geographical regions, and only one haplotype had a wider spread in both eastern and southern Africa. Intraspecific microvariance was low in comparison with Echinococcus granulosus sensu stricto, despite the wide geographic range of examined isolates. In addition, the various sub-populations showed only subtle deviation from neutrality and were mostly genetically differentiated. This is the first insight into the population genetics of the enigmatic cattle adapted Echinococcus ortleppi. It, therefore, provides baseline data for biogeographical comparison among E. ortleppi endemic regions and for tracing its translocation paths.

Risk factors for gastric aspirate culture contamination in children evaluated for tuberculosis in Botswana.

SETTING: Gastric aspirate (GA) sample culture is commonly performed in children evaluated for tuberculosis (TB) who cannot expectorate sputum. Contamination limits culture yield and negatively impacts care. OBJECTIVE: To evaluate the proportion of and factors associated with GA contamination at a central TB reference laboratory in Botswana. DESIGN: This was a 5-year cross-sectional study of untreated children aged 12 years evaluated for TB with the first GA sample registered at the National Tuberculosis Reference Laboratory. We performed descriptive statistics to assess the risk of contamination with patient age, sex, transport time and distance, culture medium, and facility type. We generated multivariable logistic regression models using generalized estimating equation extension. RESULTS: We analyzed 3642 samples. The median age was 2 years (interquartile range [IQR] 1-4), median transport time was 4 days (IQR 2-7), and 64.1% of samples were from clinics or health posts. TB culture positivity was 1.6% (60/3642), and contamination was observed in 35.6% (1298/3642). Hospital collection was associated with lower contamination risk (adjusted OR [aOR] 0.53, 95%CI 0.40-0.69) and Mycobacteria Growth Indicator Tube vs. Löwenstein-Jensen medium with higher risk (aOR 1.88, 95%CI 1.51-2.34). CONCLUSION: In routine care settings, high sample contamination and low TB culture yield were observed. This raises questions about the collection technique and storage in lower-level facilities and affirms higher risk with a liquid culture medium.

Combined therapy for stage III-IV head and neck cancer: preliminary results.

As part of a combined modality treatment program using chemotherapy, surgery, and/or radiotherapy, 25 patients with previously untreated stage III or IV head and neck cancer received initial combination chemotherapy. Pathologically confirmed complete remission was noted in nine patients (36%). The overall objective major response rate (with all patients included in analysis) was 68%. The chemotherapy regimen included bleomycin, cisplatin, vinblastine, methotrexate, and 5-fluorouracil. A novel concept of drug scheduling was used, based on chemotherapy-induced improvement in RBC deformability. The underlying concept is that improved RBC deformability results in improved capillary blood flow and thereby, increased drug delivery to tumor cells. Treatment resulted in moderate hematologic and renal toxicity with no treatment-related deaths. This exceptionally high, pathologically confirmed complete response rate will hopefully provide a mechanism by which combined modality therapy can adequately be tested for its ability to prolong survival of patients with advanced head and neck cancer.

Serological Survey of Foot-and-Mouth Disease Virus in Buffaloes (Syncerus caffer) in Zambia.

A study was conducted to determine the serotypes of foot-and-mouth disease viruses (FMDV) circulating in African buffaloes (Syncerus caffer) from selected areas in Zambia. Sera and probang samples were collected between 2011 and 2012 and analysed for presence of antibodies against FMDV while probang samples were used to isolate the FMDV by observing cytopathic effect (CPE). Samples with CPE were further analysed using antigen ELISA. High FMD seroprevalence was observed and antibodies to all the three Southern African Territories (SAT) serotypes were detected in four study areas represented as follows: SAT2 was 72.7 percent; SAT1 was 62.6 percent; and SAT3 was 26.2 percent. Mixed infections accounted for 68.6 percent of those that were tested positive. For probang samples, CPE were observed in three of the samples, while the antigen ELISA results showed positivity and for SAT1 (n = 1) and SAT2 (n = 2). It is concluded that FMDV is highly prevalent in Zambian buffaloes which could play an important role in the epidemiology of the disease. Therefore livestock reared at interface with the game parks should be included in all routine FMDV vaccination programmes.

Salmonella infections of the abdominal aorta cured with prolonged antibiotic treatment.

Three cases of endovascular infection of atherosclerotic aneurysm of the abdominal aorta due to Salmonella spp. are described. 'Breakthrough' or relapsing bacteraemia were major clues for diagnosis in each case. They were treated with a prolonged course of bactericidal antibiotics before surgery. Resection with an interposed graft was performed in all cases and antibiotic treatment continued. Two of our patients have survived for more than two years and the other for 18 months without evidence of relapse. Thus, it would appear possible at times to treat successfully mycotic aneurysm of the abdominal aorta with antimicrobial agents plus resection of the aneurysm followed by in situ bypass grafting. Extra-anatomical grafts should be kept for infections due to antimicrobial-resistant organisms or when periaortic infection is widespread.

[Prevalence of risk factors for obstetric complications in adolescents Comparison with the adult population]. / Prevalencia y factores de riesgo para complicaciones obstétricas en la adolescente. Comparación con la población adulta.

Ten percent of the pregnancies at Tijuana General Hospital occur in adolescents. We had the hypothesis, based on literature, that teen pregnancy is associated to a higher rate of obstetrical complications; so this study was designed to determine the risk factors and rate of complications in this group, and to compare the results with those in our adult population. A cross-sectional study was conducted with two groups: one included pregnant subjects under 18 years of age; the other included pregnant women ages 18 through 32. Three hundred and one subjects were included in each group. A significantly higher proportion of the adolescent subjects were single or had a couple but were not married. The adolescents reported sexual activity at an earlier age (almost three years earlier), and use contraception methods significantly less than the adult subjects. Both groups received insufficient prenatal care, but this figure was very low in the adolescent group (only 33% received prenatal care). Contrary to the reports in the literature from developed countries, the adolescent group presented with a significantly lower rate of obstetric complications when compared with the adult population, except to abortions, of which adolescents had a higher rate.

Saline irrigation and Zn amendment effect on Cd phytoavailability to Swiss chard (Beta vulgaris L.) grown on a long-term amended agricultural soil: a human risk assessment.

Crops, particularly in the Northeast region of Mexico, have to cope with increasing soil salinization due to irrigation. Chloride (Cl(-)) concentration has been strongly related to enhance cadmium (Cd) uptake by plants due to increased solubility in the soil solution. The effect of irrigation with slightly saline water from a local well was evaluated in this work on the accumulation and translocation of Cd in Swiss chard (Beta vulgaris L.) grown in soil historically amended with stabilized sewage sludge under a regime of phosphorus and zinc fertilization. A factorial pot experiment was conducted with two phosphate fertilizer levels (PF, 0 and 80 kg ha(-1) dry soil, respectively), two Zn levels (0 and 7 kg ha(-1) dry soil), and two sources of water for irrigation deionized water (DW) and slightly saline well water (WW) from an agricultural site. Additionally, a human risk assessment for Cd ingestion from plants was assessed. Results showed that Cl(-) salinity in the WW effectively mobilized soil Cd and increased its phytoavailability. A higher level of Cd was found in roots (46.41 mg kg(-1)) compared to shoots (10.75 mg kg(-1)). Although the total content of Cd in the edible parts of the Swiss chard irrigated with WW exceeded permissible recommended consumption limit, bioavailable cadmium in the aboveground parts of the plant in relation to the total cadmium content was in the range from 8 to 32 %. Therefore, human health risks might be overestimated when the total concentration is taken into account.

IgG and IgM autoantiidiotype antibodies against antibody to HBsAg in chronic hepatitis B.

Antibody directed against HBsAg carries idiotypic determinants that may induce an autoantiidiotype antibody response. We describe a solid-phase radioimmunoassay which allows specific detection of either IgG or IgM antibody to antibody directed against HBsAg. Among 138 chronic hepatitis B virus carriers, IgG autoantiidiotype was detected in 98 (71%) and IgM autoantiidiotype in 10 (80%). The autoantiidiotype reaction was blocked with antibody directed against HBsAg after removal of immune complexes by polyethylene glycol precipitation. The prevalence and levels of both classes of autoantiidiotype antibodies were highest in patients with hepatitis B virus DNA or HBeAg in serum. During follow-up, patients who lost hepatitis B virus DNA and HBeAg from serum had lower titers of autoantiidiotype and were less likely to have autoantiidiotype than patients who persisted in having hepatitis B virus DNA and HBeAg in serum. Thus, the presence and titer of autoantiidiotype correlated with serologic evidence of active viral replication in chronic hepatitis B. These findings suggest that the antibody directed against HBsAg response may play a role in modulating viral replication in chronic hepatitis B.

Assessment of hepatitis B virus DNA levels in chronic HBsAg carriers with or without hepatitis delta virus superinfection.

In order to document the incidence of hepatitis delta virus (HDV) replication markers and their relationship to HBV replication, 91 HBsAg chronic carriers were studied. Of these, 51 were anti-HD-positive (19 HBeAg-positive and 32 anti-HBe-positive). Liver HDAg was found in 75% of anti-HD-positive patients. Of the 19 patients who had anti-HD and HBeAg, 13 were HBV-DNA-positive. None of the anti-HBe patients were HBV-DNA-positive. No differences with respect to HBV-DNA concentration were observed between anti-HD-positive and -negative patients. Liver HDAg was detected with similar frequency in patients who were HBeAg- and HBV-DNA-positive (63.6%) and in those who were anti-HBe-positive (78.5%), with no statistically significant difference. HBcAg and HDAg were simultaneously detected in 36% of the anti-HD cases. Patients with anti-HD and HBV-DNA had the highest levels of transaminases (SGPT). Our results suggest that in certain patients HDV and HBV replication coexists without mutual inhibition.

Improvement of human tumor cloning assay by suspension of fibroblasts into the bottom layer of agarose.

Twenty-nine human tumors were cultured on a soft agarose cloning assay under three conditions: (1) standard (control); (2) standard with varying numbers of mitomycin C-treated 3T3 Swiss mouse embryonic fibroblasts suspended into the bottom layer of agarose; and (3) standard with varying concentrations of conditioned medium derived from those same fibroblasts. Suspension of 1 X 10(5) fibroblasts into the bottom layer of agarose was found to significantly increase the number of colonies formed over control specimens, as did cultures with 30% conditioned medium. In addition, compared with control, both of these techniques increased the number of specimens which would allow optimal vitro chemotherapy sensitivity testing. Specifically, growth of at least 30 colonies per plate increased from 7% of specimens treated under control conditions to 36% and 52% of specimens treated with 30% conditioned medium and 1 X 10(5) fibroblast-supplemented agar, respectively. This data indicate that 3T3 Swiss mouse fibroblasts improve cloning efficiency when suspended in the bottom layer of agarose or when used to produce conditioned medium. As a consequence, these techniques may permit a better opportunity to define the role of the cloning assay for cancer chemotherapy.

Treatment of chronic ventilatory failure using a diaphragmatic pacemaker.

We present our series of patients with chronic ventilatory failure treated with electrophrenic respiration: 13 males and nine females with a mean age of 12 +/- 11.5 years. The etiology was, 13 tetraplegia, five sequelae of surgical treatment of intracranial lesions, and four central alveolar hypoventilation. The mean duration of the conditioning period were 3-4 months. Eighteen patients (81.8%) achieved permanent, diaphragmatically-paced breathing with bilateral stimulation and in four (18.2%) patients, pacing was only during sleep. Five patients died (22.7%): two during the hospital stay and three at home; two deaths had unknown cause and three were due respectively to, lack of at-home care, recurrence of an epidermoid tumor, and sequelae of accidental disconnection of the mechanical ventilation before beginning the conditioning period. Two cases were considered failures: One patient had transitory neurapraxia lasting 80 days, and the other had an ischemic spinal cord syndrome with progressive deterioration of the left-side response to stimulation. One patient had right phrenic nerve entrapment by scar tissue and four suffered infections. The follow-up periods since pacemaker implantation are currently: 1, 11 years; 4, 10 years, and 17, less than 5 years. The results of our experience demonstrate that complete stable ventilation can be achieved using diaphragmatic pacing and that it improves the prognosis and life quality of patients with severe chronic respiratory failure.