Diagnostic hepatitis C testing of people in treatment for substance use disorders in Belgium between 2011 and 2014 : a cross-sectional study.

BACKGROUND: Hepatitis C prevalence figures for people who use drugs in Belgium are scarce, and particularly for people who inject drugs. The current study refines the existing HCV estimates by focussing on diagnostic HCV testing practices for this population at risk. METHODS: The analysis is the result of a descriptive crosssectional study, based on data extracted from the linkage between a database of people in treatment for substance use disorders in Belgium and a database of the Belgian health insurance companies. By using national nomenclature codes for HCV tests, the number of people in treatment for substance use disorders who were tested on HCV, were estimated. RESULTS: 18,880 out of 30,905 patients (61.1%) in treatment for substance use disorders between 2011 and 2014 have been screened at least once for HCV between 2008 and 2015. 58.0% of those who had never injected and 59.1% of those with an unknown injecting status were tested for HCV, compared to 86.5% of the patients who had recently injected and 84.5% of those who had ever injected. 36.8% of the people who had recently injected were tested for HCV RNA. CONCLUSIONS: This study supports the need of a continued effort of health care providers to identify people infected with HCV. For a population at risk such as people who use drugs, regular screening is needed to reach the goal set by WHO of near viral elimination of HCV by 2030.

Correction of self-reported BMI based on objective measurements: a Belgian experience.

BACKGROUND: Based on successive Health Interview Surveys (HIS), it has been demonstrated that also in Belgium obesity, measured by means of a self-reported body mass index (BMI in kg/m2), is a growing public health problem that needs to be monitored as accurately as possible. Studies have shown that a self-reported BMI can be biased. Consequently, if the aim is to rely on a self-reported BMI, adjustment is recommended. Data on measured and self-reported BMI, derived from the Belgian Food Consumption Survey (FCS) 2014 offers the opportunity to do so. METHODS: The HIS and FCS are cross-sectional surveys based on representative population samples. This study focused on adults aged 18-64 years (sample HIS = 6545 and FCS = 1213). Measured and self-reported BMI collected in FCS were used to assess possible misreporting. Using FCS data, correction factors (measured BMI/self-reported BMI) were calculated in function of a combination of background variables (region, gender, educational level and age group). Individual self-reported BMI of the HIS 2013 were then multiplied with the corresponding correction factors to produce a corrected BMI-classification. RESULTS: When compared with the measured BMI, the self-reported BMI in the FCS was underestimated (mean 0.97 kg/m2). 28% of the obese people underestimated their BMI. After applying the correction factors, the prevalence of obesity based on HIS data significantly increased (from 13% based on the original HIS data to 17% based on the corrected HIS data) and approximated the measured one derived from the FCS data. CONCLUSIONS: Since self-reported calculations of BMI are underestimated, it is recommended to adjust them to obtain accurate estimates which are important for decision making.

Immune system stimulation reduces the efficiency of tryptophan utilization for body protein deposition in growing pigs.

The effect of immune system stimulation (ISS) on N retention and Trp utilization in pigs fed Trp-limiting diets was evaluated using 36 growing pigs (20.0 ± 1.1 kg BW; 3 blocks of 12 barrows). Pigs were randomly assigned to 1 of 5 diets (Diet 1, 2, 4, and 5, n = 7; Diet 3, n = 8) and fed restrictively at 800 g/d. Diets 1 to 4 were generated by blending Diet 1 with a protein-free supplement and were calculated to contain varying amounts of standardized ileal digestible (SID) Trp (1.31, 1.05, 0.80, and 0.55 g/kg). To confirm that Trp was the first-limiting AA in Diets 1 to 4, an additional diet was used (Diet 5), which was equivalent to Diet 4 and contained 0.34 g/kg of added Trp. After a 5-d adaptation period, pigs were injected every 2 d with increasing amounts of E. coli lipopolysaccharide to induce ISS (initial dose 20 µg/kg BW, increasing 15% each subsequent injection). Whole body N balance was measured in 3 periods: before immune stimulation (pre-ISS) and during ISS in 2 subsequent periods (ISS-1, 3 d; ISS-2, 4 d). Regression analysis was used to estimate the marginal efficiency of Trp utilization for whole body protein deposition (PD; N retention × 6.25). Plasma concentrations of acute-phase proteins and white blood cell counts increased (P < 0.001) and plasma albumin decreased (P < 0.001) during ISS. Nitrogen retention increased (P < 0.001) as Trp intake increased. Nitrogen retention was numerically greater but not statistically different between Diet 5 (added Trp diet) and Diet 4. Whole body N retention was less (P < 0.05) during ISS due primarily to an increase (P < 0.05) in urinary N excretion. There was a linear response (P < 0.05) in N retention, urinary N, and total excreted N to increasing Trp intake. Protein deposition increased by 88.2 ± 5.2, 82.5 ± 5.1, and 92.5 ± 3.4 g/d for each additional g/d of SID Trp intake during pre-ISS, ISS-1, and ISS-2, respectively, but the intercept was not different (-32.3 g/d). The slope of the response of PD to increasing Trp intake (based on the common intercept) was less during ISS-1 compared with pre-ISS (P = 0.01) or ISS-2 (P = 0.002) but not different between pre-ISS and ISS-2. Immune system stimulation reduced N retention in pigs fed limiting dietary Trp. The efficiency of Trp utilization for protein deposition was also reduced during ISS, indicating that the Trp requirement for PD is increased ∼7% during an inflammatory state.

Evaluating a decision aid for patients with localized prostate cancer in clinical practice.

AIM: The aim of the study was to evaluate the usefulness of a decision aid regarding treatment options for patients with early-stage localized prostate cancer. METHODS: 50 patients with newly diagnosed localized prostate cancer received the decision aid and were interviewed twice: before the decision-making consultation with the physicians and before treatment or, in case of watchful waiting, before the follow-up consultation. The physicians (radiation oncologists and urologists) were interviewed after the consultation. RESULTS: The patients became more active partners in the decision-making process: They were better prepared for the consultation, asked more direct information, and were able to make a more deliberative choice. Generally, the use of the decision aid improved the quality of the consultation and resulted in a treatment decision agreed upon by both parties. Sometimes the consultation turned out to be more time-consuming. The decision aid did not only improve the patient-physician interaction but also helped patients to discuss the disease with their partner and family members. CONCLUSION: The use of the decision aid has a positive impact on the consultation and the decision-making process. The policy of involving patients more actively in the decision process should be further implemented in daily practice.

[Prediction of functional decline in elderly patients discharged from the accident and emergency department]. / Predictie van functionele achteruitgang bij ambulante geriatrische patiënten op de spoedgevallendienst.

AIM: The aim of this study is to investigate the predictive validity of 5 screening tools with respect to functional decline in older persons discharged from the Accident & Emergency Department. METHODS: The Identification of Seniors at Risk (ISAR), Triage Risk Screening Tool (TRST), questionnaire of Runciman, questionnaire of Rowland and the Voorlopige Indicator voor Plaatsing (VIP) were collected in 83 older persons discharged from the Emergency Department of the University Hospitals of Leuven. Functional decline was derived from the Katz-scale, reflecting the condition 14 days before admission, at admission, 14, 30 and 90 days after discharge. RESULTS: The screening tools with the highest sensitivity and negative predictive value at 14 days after discharge were the questionnaire of Rowland and the ISAR. Thirty and ninety days after discharge, the ISAR was most sensitive and predictive. CONCLUSION: Sensitivity and negative predictive value are the most important parameters for screening tools. Hence, our study suggests that the ISAR instrument is the most appropriate instrument to predict functional decline in ambulatory older persons admitted to the emergency department. The ISAR can easily be integrated in nursing records and can be systematically employed in older persons at the emergency department.

The Glossina morsitans tsetse fly saliva: general characteristics and identification of novel salivary proteins.

The tsetse fly (Glossina spp.) is an obligate blood-sucking insect that transmits different human-pathogenic and livestock threatening trypanosome species in Africa. To obtain more insight in the tsetse salivary function, some general aspects of the tsetse fly saliva and its composition were studied. Direct pH and protein content measurements revealed a moderately alkaline (pH approximately 8.0) salivary environment with approximately 4.3 microg soluble proteins per gland and a constant representation of the major saliva proteins throughout the blood-feeding cycle. Although major salivary genes are constitutively expressed, upregulation of salivary protein synthesis within 48 h after the blood meal ensures complete protein replenishment from day 3 onwards. Screening of a non-normalised Glossina morsitans morsitans lambdagt11 salivary gland expression library with serum from a saliva-immunized rabbit identified three full-length cDNAs encoding for novel salivary proteins with yet unknown functions: a 8.3 kDa glycine/glutamate-rich protein (G. morsitans morsitans salivary gland protein Gmmsgp1), a 12.0 kDa proline-rich protein (Gmmsgp2), and a 97.4 kDa protein composed of a metallophosphoesterase/5'nucleotidase region with a glutamate/aspartate/asparagines-rich region (Gmmsgp3).

Value of magnetic resonance imaging in early assessment of proximal femoral focal deficiency (PFFD).

Proximal femoral focal deficiency (PFFD) is a developmental defect of the proximal femur and acetabulum. PFFD includes a spectrum of findings ranging from mild femoral shortening with varus deformity to complete absence of both the acetabulum and the proximal femur. Most attempts to classify the severity of the abnormality are based on the radiographic findings. The most commonly used system is that of Aitken. This classification scheme is based upon the presence and location of the femoral head and neck on conventional radiography and provides an assessment of future limb function and plan treatment. Since this scheme however relies on conventional radiography for classification, it is difficult to classify a child until skeletal maturity which is often delayed in children with PFFD. Nevertheless, the earlier patients can be treated, the earlier normal growth can start. This case report illustrates the value of Magnetic Resonance Imaging (MRI) in addition to the standard radiographs, for early and more accurate assessment of the articular cartilaginous anatomy and soft tissue prior to ossification of the femoral capital epiphysis. As a consequence, the patient could be treated earlier to benefit treatment outcome.

An integrated methodology to assess the benefits of urban green space.

The interrelated issues of urban sprawl, traffic congestion, noise, and air pollution are major socioeconomic problems faced by most European cities. A methodology is currently being developed for evaluating the role of green space and urban form in alleviating the adverse effects of urbanisation, mainly focusing on the environment but also accounting for socioeconomic aspects. The objectives and structure of the methodology are briefly outlined and illustrated with preliminary results obtained from case studies performed on several European cities.

Screening of bacterial contamination during gelatine production by means of denaturing gradient gel electrophoresis, focussed on Bacillus and related endospore-forming genera.

AIMS: To screen for bacterial contamination during gelatine production by means of denaturing gradient gel electrophoresis (DGGE). As members of Bacillus and related genera were found to persist in the final product, this study focussed on these taxa. METHODS AND RESULTS: Template DNA was extracted from gelatine samples at five crucial points of a gelatine production process. A primer specific for Bacillus and related genera was designed and used in a selective PCR, followed by a nested DGGE-PCR targeting the V9 region of the 16S rDNA. DGGE analysis of the resulting amplicons, and sequence analysis of selected bands, showed high sequence similarities of these bands with Bacillus fumarioli, B. licheniformis, B. coagulans and Clostridium perfringens. When the selective PCR was omitted, primarily Lactobacillus bands were retrieved. CONCLUSIONS: PCR-DGGE analysis of gelatine extracts can be used for tracing and screening of bacterial contamination during gelatine production. A selective PCR, nested with DGGE-PCR, gave much more accurate information about endospore-forming contaminants than did the direct DGGE procedure alone. SIGNIFICANCE AND IMPACT OF THE STUDY: Use of this nested DGGE-PCR protocol may provide important information about possible hazards to the final microbiological quality and/or safety of gelatine, so allowing production parameters and/or remediation procedures may be adjusted on-line.

The use of IS2404 restriction fragment length polymorphisms suggests the diversity of Mycobacterium ulcerans from different geographical areas.

Buruli ulcer, caused by Mycobacterium ulcerans, has been reported in five continents: Africa, Asia, Australia, and North and South America. In the present study, restriction fragment length polymorphism with the recently described M. ulcerans specific insertion sequence IS2404 as a probe, was applied to Mycobacterium shinshuense, Mycobacterium marinum, and 14 clinical M. ulcerans isolates originating from six geographic areas: Africa (n = 6), Australia (n = 2), Mexico (n = 1), south Asia (n = 2), Asia (n = 1), and South America (n = 2). Using this probe, six subtypes of M. ulcerans, related to the six geographic origins of the isolates were distinguished, confirming that M. ulcerans can be divided into subgroups corresponding to different geographic variants of the same species.

Antisaccadic effects of a dopamine agonist as add-on therapy in advanced Parkinson's patients.

We wanted to compare clinical neurological and antisaccadic behavior before and after addition of a dopamine agonist to the usual antiparkinsonian drugs in advanced Parkinson's disease. Parkinson's patients in stage 3 and 4 of Hoehn and Yahr not yet taking a dopamine agonist were selected. In 20 patients, the treating neurologist decided to add pergolide. The dose of pergolide was adjusted by the treating neurologist according to clinical response. Antisaccades were studied by infrared oculography before and after addition of pergolide. Antisaccades are voluntary saccades in the opposite direction of an unanticipated visual target. The patients made more errors, i.e. they glanced to the target or they made no eye movement at all. In contradistinction to the global neurological improvement and the better motor scores, antisaccadic disturbances did not improve significantly with pergolide, except in younger patients. These findings suggest that antisaccadic alterations in patients with advanced Parkinson's disease could be multifaceted. Not only depletion of dopamine, but also non-dopaminergic dysfunctions could contribute. Cortical frontal lesions must also be taken into account.

Maintaining sevoflurane anesthesia during low-flow anesthesia using a single vaporizer setting change after overpressure induction.

STUDY OBJECTIVE: A sevoflurane vaporizer dial setting of 1.9% was previously found to maintain the end-expired sevoflurane concentration (Et(sevo)) at 1.3% during maintenance of anesthesia for procedures up to one hour with an O(2) FGF of 1 L/min. We examined whether applying these parameters could simplify low-flow sevoflurane anesthesia after overpressure induction using two slightly different techniques. DESIGN: Prospective clinical study. SETTING: Large teaching hospital. PATIENTS: Sixteen patients receiving general anesthesia for a variety of peripheral procedures. INTERVENTIONS: Anesthesia was induced with overpressure with sevoflurane (8%) in an 8 L. min(-1) O(2)/N(2)O mixture (30%/70%). After a laryngeal mask airway (LMA) was placed, fresh gas flow (FGF) was lowered to 1 L. min(-1) using O(2) and N(2)O (FiO(2) 30%) with patients breathing spontaneously. In group I patients (n = 8), the vaporizer dial was set at 1.9% at the same time the FGF was lowered. In group II patients (n = 8), the vaporizer was turned off until Et(sevo) had decreased to 1.3%, after which the dial was set at 1.9%. The course of Et(sevo) in the two groups was examined. MEASUREMENTS AND MAIN RESULTS: In group I, Et(sevo) after 3 min was 4.88 +/- 1. 12%. Et(sevo) decreased slowly after reduction of FGF to 1.83 +/- 0. 19%, 1.59 +/- 0.18%, and 1.52 +/- 0.19% at 10, 20, and 30 min, respectively. In group II, Et(sevo) after 3 min was 4.34 +/- 0.84%, and decreased more rapidly after reduction of FGF to 1 L. min(-1) than in group I. Et(sevo) was 1.40 +/- 0.09%, 1.40 +/- 0.11%, and 1. 38 +/- 0.13% at 10, 20, and 30 min, respectively. CONCLUSIONS: After high-flow overpressure induction with sevoflurane, a single change in vaporizer setting (to 1.9%) and FGF (to 1 L. min(-1)) suffices for the Et(sevo) to approach the predicted Et(sevo) (1.3%) within 10-15 min; thereafter the Et(sevo) remains nearly constant. As expected, the predicted Et(sevo) is attained slightly faster when the vaporizer is temporarily turned off. Clinically applying previously derived pharmacokinetic parameters simplifies low-flow sevoflurane anesthesia after overpressure induction.

Blood and charcoal added to acidified agar media promote the growth of Mycobacterium genavense.

Ten different agar media were tested for the in vitro growth of Mycobacterium genavense in primary cultures and in subcultures from BACTEC vials. These agar media were based on Middlebrook 7H9, 7H10 and 7H11, and supplemented with additives: mycobactin J, yeast extract, charcoal, or defibrinated sheep blood. Some media were acidified with phosphoric acid to a final pH of 6.2 +/- 0.2. Fourteen M. genavense strains from nude mouse organs as well as one decontaminated clinical specimen (from a bird) were tested. The optimal medium for primary cultures of M. genavense was Middlebrook 7H11 acidified to pH 6.2 +/- 0.2 and supplemented with charcoal and sheep blood: on this medium, all strains produced colonies within 6-12 weeks of incubation in numbers approaching the number of bacilli inoculated. It was also the only medium to support the growth of the decontaminated clinical specimen. Added blood and charcoal appeared not as essential for subcultures as for primary cultures. Three media supported the growth of all strains within 1 month incubation: they were acidified, and were supplemented with yeast extract or pancreatic digest of casein, and with either blood or charcoal.

Microaerophilic conditions promote growth of Mycobacterium genavense.

Our studies show that microaerophilic conditions promote the growth of Mycobacterium genavense in semisolid medium. The growth of M. genavense at 2.5 or 5% oxygen was superior to that obtained at 21% oxygen in BACTEC primary cultures (Middlebrook 7H12, pH 6.0, without additives). By using nondecontaminated specimens, it was possible to detect growth with very small inocula (25 bacilli/ml) of 12 different M. genavense strains (from nude mice) within 6 weeks of incubation under low oxygen tension; conversely, with 21% oxygen, no growth of 8 of 12 (66.7%) M. genavense strains was detected (growth index, <10). The same beneficial effect of 2.5 or 5% oxygen was observed in primary cultures of a decontaminated clinical specimen. Low oxygen tension (2.5 or 5%) is recommended for the primary isolation of M. genavense. Microaerophilic cultivation of other atypical mycobacteria, especially slow-growing (e.g., Mycobacterium avium) and difficult-to-grow (e.g., Mycobacterium ulcerans) species, is discussed.

In vitro susceptibility of Mycobacterium ulcerans to clarithromycin.

Buruli ulcer (BU), caused by Mycobacterium ulcerans, was recently recognized by the World Health Organization as an important emerging disease. While antimycobacterial therapy is often effective for the earliest nodular or ulcerative lesions, medical management of BU lesions in patients presenting for treatment is usually disappointing, leaving wide surgical excision the only alternative. Advanced ulcerated lesions of BU rarely respond to antimycobacterial agents; however, perioperative administration of such drugs may prevent relapses or disseminated infections. Clarithromycin possesses strong activity in vitro and in vivo against most nontuberculous mycobacteria. In this study we determined the antimycobacterial activity of this drug in vitro against 46 strains of M. ulcerans isolated from 11 countries. The MIC of clarithromycin was determined at pH 6.6 (on 7H11 agar) and at pH 7.4 (on Mueller-Hinton agar). The MICs ranged from 0.125 to 2 microg/ml at pH 6.6 and from <0.125 to 0.5 microg/ml at pH 7.4. For the majority of the strains, geographic origin did not play a significant role. Thirty-eight strains (83%) were inhibited by 0.5 microg/ml at pH 7.4. These MICs are below peak therapeutic concentrations of clarithromycin obtainable in blood. These results suggest that clarithromycin is a promising drug both for the treatment of early lesions of M. ulcerans and for the prevention of hematogenous dissemination of the etiologic agent during and after surgery. Studies should be initiated to evaluate the effects of clarithromycin in combination with ethambutol and rifampin on M. ulcerans both in vitro and in experimentally infected mice. Multidrug regimens containing clarithromycin may also help control the secondary bacterial infections sometimes seen in BU patients, most importantly osteomyelitis.

Inhibitory effects of polyoxyethylene stearate, PANTA, and neutral pH on growth of Mycobacterium genavense in BACTEC primary cultures.

We report on the influences of polyoxyethylene stearate (POES), PANTA, and pH on primary cultures of Mycobacterium genavense in BACTEC vials. As a model for primary cultures from tissue, seven different strains first isolated from AIDS patients (five from Switzerland and two from the United States) were inoculated into nude mice in order to obtain large amounts of bacilli to test different conditions simultaneously. Our results demonstrate that the size of the inoculum (10[6] acid-fast bacilli/vial), an acid pH (pH 6.0), and the absence of additives (POES and PANTA) significantly (P < 0.001) increased the probability of a successful culture in 1 month, considering growth index (GI) of > or =100 or a GI of > or =999 as criterion of success. In logistic regression analysis, all factors maintained a significant (P < 0.001) independent effect, and no interactions were observed between them. The best conditions for the primary cultures of M. genavense were the use of Middlebrook 7H12 medium at pH 6.0 without any additives.

Disturbed striatoprefrontal mediated visual behaviour in moderate to severe parkinsonian patients.

OBJECTIVES: To study visuospatial and visual memory functions in moderate to severe parkinsonian patients. METHODS: Visual antisaccades (AS) and remembered saccades (RS) were examined in 30 patients with moderate to severe Parkinson's disease and in 44 age matched controls. AS are saccades in the direction opposite to the target. RS are saccades towards the remembered position of a target that is no longer visible. RESULTS: Patients with Parkinson's disease had serious difficulties in suppressing a reflex saccade ("visual grasping") or they made no saccade at all ("visual akinesia"). The remembered saccade was often wrongly directed. CONCLUSIONS: These types of errors point to a dysfunction in the striatoprefrontal loop. The discrepancy of the results with those in the literature, which are mostly normal, could be explained by the more advanced stage of our patients. This might correspond to the development of unresponsiveness to levodopa or of non-dopaminergic lesions.

Evaluation of the Gen-Probe amplified Mycobacterium tuberculosis direct test for the routine diagnosis of pulmonary tuberculosis.

A total of 624 respiratory specimens from 543 patients (418 Belgian, 110 Rwandan, and 15 Colombian patients) were tested for the presence of Mycobacterium tuberculosis by the Mycobacterium Tuberculosis Direct Test (MTDT, Gen-Probe). Compared to culture, the MTDT on 497 samples of sputum or broncho-alveolar lavage from Belgium had a sensitivity, specificity and positive and negative predictive value of 86.4%, 96.0%, 50.0% and 99.3% respectively. The pooled results for Rwanda (112 specimens) and Colombia (15 specimens) were 97.8%, 65.7%, 88.2%, 92% respectively. After resolution of discrepant results by taking into account the clinical data, the results for the Belgian patients were 86.9%, 96.2%, 52.6%, 99.3% respectively, and for the Rwandan-Colombian patients 98.1%, 100%, 100% and 92% respectively. Results could be improved by testing more than one specimen from each patient and the inclusion of an internal control to detect inhibitors of the reaction. Culture remains necessary for drug susceptibility tests and the isolation and identification of non-tuberculous mycobacteria.