Population structure of Erysiphe necator on domesticated and wild vines in the Middle East raises questions on the origin of the grapevine powdery mildew pathogen.

Plant pathogens usually originate and diversify in geographical regions where hosts and pathogens co-evolve. Erysiphe necator, the causal agent of grape powdery mildew, is a destructive pathogen of grapevines worldwide. Although Eastern US is considered the centre of origin and diversity of E. necator, previous reports on resistant native wild and domesticated Asian grapevines suggest Asia as another possible origin of the pathogen. By using multi-locus sequencing, microsatellites and a novel application of amplicon sequencing (AmpSeq), we show that the population of E. necator in Israel is composed of three genetic groups: Groups A and B that are common worldwide, and a new group IL, which is genetically differentiated from any known group in Europe and Eastern US. Group IL showed distinguished ecological characteristics: it was dominant on wild and traditional vines (95%); its abundance increased along the season; and was more aggressive than A and B isolates on both wild and domesticated vines. The low genetic diversity within group IL suggests that it has invaded Israel from another origin. Therefore, we suggest that the Israeli E. necator population was founded by at least two invasions, of which one could be from a non-East American source, possibly from Asian origin.

[A multi-disciplinary approach to diabetic foot patients--an organizational model for the treatment of leg complications in diabetic patients].

Diabetes mellitus is the major cause of non-traumatic limb amputations in the Western world. In the diabetic foot patient, 85% have developed a leg ulcer prior to limb amputation. Due to the complicated nature of therapy in such patients, a multi-disciplinary approach is warranted. In this review, we describe an organizational model which provides an immediate solution to the factors involved in the evolution of a diabetic foot. At the end of 2002, The Wolfson Medical Center administration decided to centralize the diabetic foot patients into one unit situated in the Department of Medicine C. Ten beds were allocated for this purpose and situated at the far end of the department reducing the potential spread of infections to the rest of the ward. With the opening of the unit, a multi-disciplinary team was established that included internists, orthopedists, vascular surgeons, diabeticians, infectious disease specialists, and a specialized nursing staff that acquired their expertise while working with the medical staff and consultants including plastic surgeons and orthotists as required. With the initiation of the Diabetic Foot Unit, there was a reduction of 50% in major amputations in the unit when compared to the preceding years. During the years 2003-2004, the major amputation rate dropped to Less than 8%. Treatment of the diabetic foot patient is complex. In order to reduce the morbidity of limb amputation, a Diabetic Foot Unit is justified. In addition, specialized staff working in concert enable a synergistic effort that cannot be acquired individually. Most importantly, the amputation rate can be significantly reduced by utilizing the Diabetic Foot Unit model.

[Infections in diabetic patients--a two-year experience from the Diabetic Foot Unit at Wolfson Medical Center].

Diabetes mellitus is the main cause for limb amputations in the western world. Leg ulcers among patients with diabetes mellitus is the leading cause in up to 85% of cases of nontraumatic amputations of the lower limbs in this patient population. Bacterial infections penetrate the leg ulcers causing further complications in the diabetic patient. The rationale of establishing the Diabetic Foot Unit in these patients is to strive to maintain an intact limb. Some studies indicate that there can be a substantial reduction in leg amputations in diabetics who are treated by a multidisciplinary medical team. In late 2002, the Diabetic Foot Unit was established at the Wolfson Medical Center teamed by a medical and nursing staff specializing in the treatment of the diabetic foot. The aim of this study was to identify the microbial agents leading to leg ulcers, and to follow the definitive therapy and outcome for these diabetic patients. The data was retrieved from medical files over a 2 year period (2003-2004). The patients received conservative as well as surgical treatment. The major microbial agents were Gram-negative species, and some patients harbored resistant bacteria such as ESBL and MRSA. Less than 11% of patients required major limb amputation. The percent of major amputations in our specialized unit was comparable to other such units around the world.