Assessment of heavy metal stress in the adaptation strategies of Tulipa luanica growing on serpentine soil through some biomarkers in comparison to Tulipa kosovarica.

The aim of this study was to gain a better understanding of how Tulipa luanica adapts to growth in soil with higher concentrations of heavy metals and to assess potential toxic effects using various biomarkers, in comparison to Tulipa kosovarica, a typical serpentine species. For this purpose, we analyzed the concentrations of Al, Ca, Cd, Co, Cr, Cu, Fe, Mg, Mn, Ni, Pb, and Zn in the soil, as well as their accumulation in plants and their associated stress effects. The results indicate that, despite the presence of some metals in very high concentrations in the soil (Al, Fe, Mn, and Ni), they are translocated in minimal amounts within plant organs, particularly in T. luanica. Nearly all metals exhibited significantly higher concentrations in T. kosovarica when compared to T. luanica. Based on the analysis of biomarkers, it is apparent that T. luanica shows greater sensitivity to these conditions. This is evident through the decreased activity of δ-aminolevulinic acid dehydratase and levels of δ-aminolevulinic acid, malondialdehyde, and glutathione observed in T. luanica. It appears that T. luanica effectively restricts the absorption of metals in serpentine soils; however, it experiences oxidative stress induced by these metals, setting it apart from the more resilient T. kosovarica.

Individual differences in the effects of midazolam on anxiety-like behavior, learning, reward, and choice behavior in male mice.

Introduction: The aim of the present study was to investigate the behavioral effects of the benzodiazepine midazolam in male mice, in models of anxiolysis, learning, and abuse-related effects. Methods: In a first set of experiments, male Swiss mice were submitted to the training session of a discriminative avoidance (DA) task on the elevated plus maze to evaluate anxiety-like behavior and learning after vehicle or midazolam (1, 2 or 5 mg/kg, i.g.) administration. The same animals were submitted to a conditioned place preference (CPP) protocol with midazolam (1, 2 or 5 mg/kg, i.g.). In a second experiment, outbred (Swiss) and inbred (C57BL/6) male mice were submitted to a two-bottle choice (TBC) oral midazolam drinking procedure. Animals were exposed to one sucrose bottle and one midazolam (0.008, 0.016 or 0.032 mg/ml) plus sucrose bottle. Results: Midazolam (1 and 2 mg/kg) induced anxiolytic-like effects, and all doses of midazolam prevented animals from learning to avoid the aversive closed arm during the DA training session. Assessment of midazolam reward via the CPP procedure and choice via the TBC procedure showed notable variability. A 2-step cluster analysis for the CPP data showed that midazolam data were well-fitted to 2 separate clusters (preference vs. aversion), albeit with the majority of mice showing preference (75%). Correlational and regression analyses showed no relationship between midazolam reward and anxiolytic-like effects (time spent in the open arms in the DA test) or learning/memory. Two-step cluster analysis of the TBC data also demonstrated that, regardless of strain, mice overall fell into two clusters identified as midazolam-preferring or midazolam-avoiding groups. Both midazolam preference and avoidance were concentration-dependent in a subset of mice. Discussion: Our findings show that midazolam preference is a multifactorial behavior, and is not dependent solely on the emergence of therapeutic (anxiolytic-like) effects, learning impairments, or on genetic factors (inbred vs. outbred animals).

Ibogaine Blocks Cue- and Drug-Induced Reinstatement of Conditioned Place Preference to Ethanol in Male Mice.

Ibogaine is a psychedelic extracted from the plant Tabernanthe iboga Baill. (Apocynaceae), natural from Africa, and has been proposed as a potential treatment for substance use disorders. In animal models, ibogaine reduces ethanol self-administration. However, no study to date has investigated the effects of ibogaine on ethanol-induced conditioned place preference (CPP). The present study aimed to investigate the effects of repeated treatment with ibogaine on the reinstatement of CPP to ethanol in male mice. The rewarding effects of ethanol (1.8 g/kg, i. p.) or ibogaine (10 or 30 mg/kg, p. o.) were investigated using the CPP model. Furthermore, we evaluated the effects of repeated treatment with ibogaine (10 or 30 mg/kg, p. o.) on the reinstatement of ethanol-induced CPP. Reinstatement was evaluated under two conditions: 1) during a priming injection re-exposure test in which animals received a priming injection of ethanol and had free access to the CPP apparatus; 2) during a drug-free test conducted 24 h after a context-paired re-exposure, in which subjects received an injection of ethanol and were confined to the compartment previously conditioned to ethanol. Our results show that ethanol, but not ibogaine, induced CPP in mice. Treatment with ibogaine after conditioning with ethanol blocked the reinstatement of ethanol-induced CPP, both during a drug priming reinstatement test and during a drug-free test conducted after re-exposure to ethanol in the ethanol-paired compartment. Our findings add to the literature suggesting that psychedelics, in particular ibogaine, may have therapeutic properties for the treatment of alcohol use disorder at doses that do not have rewarding effects per se.

Genomic insights of international clones of Haemophilus influenzae causing invasive infections in vaccinated and unvaccinated infants.

The emergence of invasive Haemophilus influenzae infections in vaccinated patient is a public health concern. We have investigated the genomic basis of invasiveness and possible vaccine failure in H. influenzae causing invasive disease in vaccinated and unvaccinated children in Brazil. Three H. influenzae strains isolated from blood cultures of pediatric patients were sequenced. Serotype, MLST, resistome and virulome were predicted using bioinformatic tools, whereas single nucleotide polymorphisms (SNPs) analysis of cap loci and the presence of the putative virulence-enhancing IS1016-bexA partial deletion were predicted in silico. Infections were caused by H. influenzae type a (Hia), type b (Hib) and nontypeable (NTHi), belonging to international high-risk clones of sequence types ST23, ST6 and ST368, respectively, which have been identified in North American, European and Asian countries. Convergence of ampicillin resistance and virulence in Hib-ST6 was supported by blaTEM-1B and deletion in the bexA gene, whereas presence of SNPs in the cap-b locus was associated with antigenic modifications of the capsule structure. Hia-ST23 and NTHi-ST368 strains carried galU, lpsA, opsX, rfaF, iga1, lgtC and lic1/lic2 virulence genes, associated with colonization, adaptation and damage to the lung, or invasiveness. In summary, deletion in the bexA gene and presence of SNPs in the cap locus of Hib could be contributing to invasive disease and possible vaccine failure in pediatric patients, whereas serotype replacement of Hib with type "a" and NTHi strains denotes the ability of non-vaccine serotypes to re-colonize vaccinated patients. Finally, the dissemination of international high-risk clones of H. influenzae emphasizes the importance of monitoring changes in the molecular epidemiology of invasive H. influenzae disease.

Improving cardiopulmonary resuscitation (CPR) performance using an audio-visual feedback device for healthcare providers in an emergency department setting in Malaysia: a quasi-experimental study.

INTRODUCTION: Cardiopulmonary Resuscitation (CPR) remains the primary mechanism of resuscitation for cardiac arrest victims. However, the quality of delivery of CPR varies widely in different settings, possibly affecting patient outcomes. This study is aimed to determine the efficacy of an audio-visual (AV) CPR feedback device in improving the quality of CPR delivered by healthcare providers. METHODS: This pre-post, single-arm, quasi-experimental study randomly sampled 140 healthcare providers working in the Emergency Department of Hospital Ampang, Malaysia. Parameters of CPR quality, namely chest compression rate and depth were compared among participants when they performed CPR with and without an AV CPR feedback device. The efficacy of the AV CPR feedback device was assessed using the Chi-square test and Generalised Estimating Equations (GEE) models. RESULTS: The use of an AV CPR feedback device increased the proportion of healthcare providers achieving recommended depth of chest compressions from 38.6% (95% Confidence Interval, 95%CI: 30.5, 47.2) to 85.0% (95%CI: 78.0, 90.5). A similar significant improvement from 39.3% (95%CI: 31.1, 47.9) to 86.4% (95%CI: 79.6, 91.6) in the recommended rate of chest compressions was also observed. Use of the AV CPR device significantly increased the likelihood of a CPR provider achieving recommended depth of chest compressions (Odds Ratio, OR=13.01; 95%CI: 7.12, 24.01) and rate of chest compressions (OR=13.00; 95%CI: 7.21, 23.44). CONCLUSION: The use of an AV CPR feedback device significantly improved the delivered rate and depth of chest compressions closer to American Heart Association (AHA) recommendations. Usage of such devices within real-life settings may help in improving the quality of CPR for patients receiving CPR.

Genomic instability in peripheral blood lymphocytes of patients diagnosed with high-grade squamous intraepithelial lesions: CIN 2 versus CIN 3.

Cancer is a genomic disease associated with accumulation of genetic damage. Cancer-initiating events, such as chromosome breakage, loss and rearrangement, can be used as biomarkers to evaluate individual cancer risk. Cytokinesis-block micronucleus cytome (CBMN - Cyt) assay parameters in peripheral blood lymphocytes (PBL) of thirty four patients diagnosed with high-grade squamous intraepithelial lesions (HSIL) and fifteen healthy women were measured. The genomic instability of patients diagnosed with HSIL were investigated in order to compare differences between the two subgroups of HSIL (CIN 2 and CIN 3). The micronucleus (MN) frequencies in PBL, as well as the frequencies of nucleoplasmic bridges (NPB) and nuclear buds (NBUD) were higher in patients than in controls (Mann- Whitney test, p < 0.05). These results provide evidence that CBMN cytome assay in peripheral blood lymphocytes may be used to identify individuals who are at high risk of developing cervical cancer. Since the extent of DNA damage varies between CIN 2 and CIN 3, these findings support the CIN grading system.

Ayahuasca blocks the reinstatement of methylphenidate-induced conditioned place preference in mice: behavioral and brain Fos expression evaluations.

RATIONALE: Accumulating evidence suggests that ayahuasca, a hallucinogenic beverage used in traditional Amazonian communities for ritualistic and curative purposes, has been associated with reduced rates of substance use disorders. However, the brain mechanisms underlying the therapeutic effects of ayahuasca have not yet been fully elucidated. OBJECTIVES: The aim of the present study was to investigate the effects of treatment with ayahuasca on the rewarding properties of the psychostimulant methylphenidate. METHODS: The rewarding properties of ayahuasca (100 mg/kg, orally) and methylphenidate (10 mg/kg, i.p.) were investigated using the conditioned place preference (CPP) model. Furthermore, we evaluated the effects of repeated treatment with ayahuasca on the reinstatement of methylphenidate-induced CPP. Fos expression was evaluated in different limbic structures (cingulate cortex-area 1, prelimbic cortex, infralimbic cortex, orbitofrontal cortex-lateral orbital area, nucleus accumbens core and shell, ventral tegmental area, dorsal striatum, and basolateral amygdala) upon each experimental phase. RESULTS: Both ayahuasca and methylphenidate induced CPP in mice. However, ayahuasca had limited effects on Fos expression, while methylphenidate altered Fos expression in several brain regions associated with the behavioral effects of drugs of abuse. Treatment with ayahuasca after conditioning with methylphenidate blocked the reinstatement of methylphenidate-induced CPP. Those behavioral effects were accompanied by changes in Fos expression patterns, with ayahuasca generally blocking the changes in Fos expression induced by conditioning with methylphenidate and/or reexposure to methylphenidate. CONCLUSIONS: Our findings suggest that ayahuasca restored normal brain function in areas associated with the long-term expression of drug wanting/seeking in animals conditioned to methylphenidate.

Blood lead level (BLL), δ-aminolevulinic acid dehydratase activity (ALAD), hemoglobin (Hb) and hematocrit (hct) in primary school-children and adult residents living in smelter rural areas in Kosovo.

The objective of this study was to investigate the effects of chronic environmental lead (Pb) exposure in blood lead level (BLL), δ-aminolevulinic acid dehydratase (ALAD) activity, hemoglobin (Hb) amount and hematocrit (Hct) value in primary schoolchildren and adults. Blood was obtained for BLL, ALAD, Hb and Hct measurements in 23 primary schoolchildren (girls and boys) and 117 adult residents (women and men) living in three villages (Kelmend, Boletin and Zhazhë) defined by concentric circles 2, 3 and 5 km in radius drawn around from the smelter-refinery complex "Trepça"in Zveçan and in Koliq village 40 km away. As expected, BLLs were substantially higher in the schoolchildren from smelter area compared with control (11 ± 4.2 µg/L and 6.9 ± 1.6 µg/L respectively) and in adult residents from Kelmend, Boletin and Zhazhë (24 ± 11.8, 12 ± 4.5, 11 ± 5.4 and 8.0 ± 2.8 µg/L respectively). Blood ALAD activity of children in Zhazhë is 16% inhibited compared to control and blood ALAD activity in adults in villages from smelter area is 32, 3%, 48, 4% and 17, 8% inhibited compared to control. There is no difference of Hb and Hct values in schoolchildren from Zhazhë and in adult residents from Kelmend and Zhazhë compared with control. Results of this study provide evidence of moderate inverse correlation between BLL and ALAD activity in both examined cohorts from smelter area. The inhibition of ALAD activity in primary schoolchildren and adults occurred at blood lead levels < 24 µg/L; consequently it can cause an increase of δ- Aminolevulinic acid.

The frequencies of micronuclei, nucleoplasmic bridges and nuclear buds as biomarkers of genomic instability in patients with urothelial cell carcinoma.

Bladder urothelial cell carcinoma (UCC) is an increasingly prevalent cancer worldwide, and thus, gaining a better understanding of its identifiable risk factors is a global priority. This study addressed this public health need with the understanding that cancer-initiating events, such as chromosome breakage, loss and rearrangement, can be reasonably used as biomarkers to evaluate an individual's cancer risk. Overall, forty bladder cancer patients and twenty controls were evaluated for genomic instability. To the best of the investigators' knowledge, this is the first study to perform micronucleus (MN) assays simultaneously in urothelial exfoliated cells (UEC), buccal exfoliated cells (BEC), and peripheral blood lymphocytes (PBL) in first-diagnosed, non-smoker bladder UCC patients. Additionally, the frequency of nucleoplasmic bridges (NPBs) and nuclear buds (NBUDs) in PBL was evaluated. The MN frequencies in UEC, BEC, and PBL, as well as the frequencies of NPBs and NBUDs, were significantly higher in patients than in controls. In conclusion, MN assays, particularly in UEC, may be used to identify individuals who are at high risk of developing UCC, as single or as additional triage test to UroVysion FISH test. Our results further validate the efficacy of biomarkers, such as MN, NPBs, and NBUDs, as predictors of genomic instability.

Concentration of some metals in soil and plant organs and their biochemical profiles in Tulipa luanica, T. kosovarica and T. albanica native plant species.

The purpose of this study was to determine the concentration of some metals (Al, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Zn, Ca and Mg) in soil of serpentine and limestone sites, their bioaccumulation and impact on some biochemical parameters in T. luanica, T. kosovarica and T. albanica plants. T. kosovarica and T. albanica grows in serpentine soil, while T. luanica grow in limestone soil. The research showed that concentrations of Cd, Co, Cr, Fe, Mn and Ni were significantly higher at serpentine soil sites in comparison with limestone sites, while concentrations of Pb, Cd, Co and Cr in bulbs, leaves and seeds were under the limit of detection. The concentration of Ni in plant samples of T. kosovarica was significantly higher in comparison with its concentration in T. albanica, but it was under the limit of detection in T. luanica. Moreover, concentrations of Al and Fe in leaves of T. kosovarica and T. albanica were higher in comparison with T. luanica. The concentration of Mg was significantly higher in T. kosovarica and T. albanica than in T. luanica. The δ-aminolevulinic acid dehydratase activity, malondialdehyde and glutathione contents in leaves of T. luanica were higher in comparison with T. kosovarica and T. albanica. In addition, the amounts of total chlorophyll and δ-aminolevulinic acid (ALA) in leaves of T. albanica were higher in comparison with T. kosovarica and T. luanica. Our findings show that target organs of metal accumulation in three Tulip species appears to be leaves > seeds > bulbs, while the biochemical parameters show that limestone sites represent a less stressful habitat for growing these plant species in comparison with serpentine sites.

The association between micronucleus, nucleoplasmic bridges, and nuclear buds frequency and the degree of uterine cervical lesions.

BACKGROUND AND AIM: The loss of genomic stability plays an important role in carcinogenesis. Therefore, it is imperative to use certain biomarkers of DNA damage due to genomic instability in order to predict cancer risk. The aim of this study was the evaluation of genomic instability in patients with cervical lesions. MATERIALS AND METHODS: We investigated the genetic damages in 80 subjects: 40 patients with high-grade squamous intraepithelial lesions (HSIL), 20 patients with invasive squamous cervical cancer (SCC) and 20 healthy women with a biomarker in two different tissues; the micronucleus (MN) test in peripheral blood lymphocytes (PBL), and in buccal exfoliated cells (BEC). This study also examined the frequency of other nuclear anomalies such as nucleoplasmic bridges (NPBs) and nuclear bunds (NBUDs) in PBL. RESULTS: The frequency of MN in BEC, MN in PBL, NPB in PBL and NBUD in PBL were significantly higher (p < 0.001), in patients compared to controls. The DNA damages in BEC and PBL were correlated positively with histological grade of cervical lesions. CONCLUSION: Although larger studies are needed, our data support the predictive value of MN, NPB and NBUD as biomarkers of genomic instability for evaluation of risk level of cancer diseases.

Children With Type 1 Diabetes Mellitus: Self-Management Experiences in School.

BACKGROUND: Children with type 1 diabetes mellitus (T1DM) need to perform self-management activities at school and in other environments. Learning about their experiences at school is crucial to assist them in this challenging task. METHODS: Qualitative interviews were conducted with children with T1DM, aged between 7 and 12. A scenario was created and puppets were used during the interviews to help the participating children to communicate about school, daily routines, and experiences in diabetes management. Data were collected over a period of 1 year and analyzed according to content analysis procedures. RESULTS: Nineteen children, 13 boys and 6 girls, at the mean age of 9.8 ± 1.8 years and mean time since diagnosis of 3.3 years, participated in the study. Three themes were identified: lack of information on T1DM, diabetes self-care at school, and support received by the children. CONCLUSIONS: The study provides useful information to understand the children's experiences in managing the disease at school. The partnership between school staff, health teams, children with T1DM, and their families need to be enhanced to promote appropriate strategies that improve the management of diabetes in this setting.

Unravelling the Evolution of the Allatostatin-Type A, KISS and Galanin Peptide-Receptor Gene Families in Bilaterians: Insights from Anopheles Mosquitoes.

UNLABELLED: Allatostatin type A receptors (AST-ARs) are a group of G-protein coupled receptors activated by members of the FGL-amide (AST-A) peptide family that inhibit food intake and development in arthropods. Despite their physiological importance the evolution of the AST-A system is poorly described and relatively few receptors have been isolated and functionally characterised in insects. The present study provides a comprehensive analysis of the origin and comparative evolution of the AST-A system. To determine how evolution and feeding modified the function of AST-AR the duplicate receptors in Anopheles mosquitoes, were characterised. Phylogeny and gene synteny suggested that invertebrate AST-A receptors and peptide genes shared a common evolutionary origin with KISS/GAL receptors and ligands. AST-ARs and KISSR emerged from a common gene ancestor after the divergence of GALRs in the bilaterian genome. In arthropods, the AST-A system evolved through lineage-specific events and the maintenance of two receptors in the flies and mosquitoes (Diptera) was the result of a gene duplication event. Speciation of Anopheles mosquitoes affected receptor gene organisation and characterisation of AST-AR duplicates (GPRALS1 and 2) revealed that in common with other insects, the mosquito receptors were activated by insect AST-A peptides and the iCa2+-signalling pathway was stimulated. GPRALS1 and 2 were expressed mainly in mosquito midgut and ovaries and transcript abundance of both receptors was modified by feeding. A blood meal strongly up-regulated expression of both GPRALS in the midgut (p < 0.05) compared to glucose fed females. Based on the results we hypothesise that the AST-A system in insects shared a common origin with the vertebrate KISS system and may also share a common function as an integrator of metabolism and reproduction. HIGHLIGHTS: AST-A and KISS/GAL receptors and ligands shared common ancestry prior to the protostome-deuterostome divergence. Phylogeny and gene synteny revealed that AST-AR and KISSR emerged after GALR gene divergence. AST-AR genes were present in the hemichordates but were lost from the chordates. In protostomes, AST-ARs persisted and evolved through lineage-specific events and duplicated in the arthropod radiation. Diptera acquired and maintained functionally divergent duplicate AST-AR genes.

[Emergence of Microsporum audouinii and Trichophyton tonsurans as causative organisms of tinea capitis in the Dominican Republic]. / Tinea capitis. Emergencia de Microsporum audouinii y Trichophyton tonsurans en la República Dominicana.

BACKGROUND: Tinea capitis affects mainly children. The frequency and causative organism vary from region to region. OBJECTIVES: To provide epidemiological and mycological data on tinea capitis collected in urban and rural areas of the Dominican Republic. METHODS: Samples were obtained from 118 patients with tinea capitis. Sixty-three of these were from 2 schools in urban areas of the Dominican capital Santo Domingo (53%) and 55 were from rural schools on the border with Haiti (47%). RESULTS: The study included 84 boys (71. 18%) and 34 girls (28. 81%). The urban sample comprised mainly boys (84. 12%). The most represented age ranges were 6 to 8 years (47. 45%), 3 to 5 years (24. 59%), and 9 to 11 years (16. 94%). Microsporum audouinii (39. 68%), Trichophyton tonsurans (23. 80%), Microsporum canis (19. 04%), and Trichophyton violaceum (1. 58%) were isolated from children in urban areas, whereas T. tonsurans (87%) and Trichophyton mentagrophytes (2%) were isolated from those in rural areas. Overall, T. tonsurans (61. 16%), M. audouinii (24. 27%), and M canis (11. 65%) were the most frequently isolated causative organisms, whereas T. violaceum and T. mentagrophytes were rarely reported. CONCLUSIONS: In urban areas of the Dominican Republic, tinea capitis was found mainly in boys, but in rural areas it was evenly distributed among boys and girls. The emergence of M. audouinii and an increase in T. tonsurans were found while M. canis continued to be present at lower frequencies. On the rural border with Haiti, there was a significant predominance of T. tonsurans.

Tinea capitis. Emergencia de Microsporum audouinii y Trichophyton tonsurans en la República Dominicana / Emergence of Microsporum audouinii and Trichophyton tonsurans as Causative Organisms of Tinea Capitis in the Dominican Republic

Antecedentes: Las tiñas de la cabeza predominan en los niños, con una frecuencia y etiología variables en diferentes partes del mundo. Objetivos: Comunicar los datos epidemiológicos y micológicos de tiña del cuero cabelludo observados en la zona urbana y rural de la República Dominicana. Metodología: Se estudiaron 118 muestras de pacientes con diagnóstico de tiña de la cabeza en la República Dominicana, 63 de dos escuelas urbanas en la capital Santo Domingo (53%) y 55 de escuelas rurales en la frontera dominico-haitiana (47%). Resultados: Se estudiaron 84 varones (71,18%) y 34 mujeres (28,81%). En la zona urbana predominó en los varones (84,12%). La edad con mayores porcentajes fue entre 6 y 8años (47,45%), de 3 y 5 años (24,59%) y 9 y 11 años (16,94%). En la zona urbana se aislaron M. audouinii (39,68%), T. tonsurans (23,80%), M. canis (19,04%) y T. violaceum (1,58%) y en la zona rural T. tonsurans (87%) y T. mentagrophytes (2%) y globalmente T. tonsurans (61,16%), M. audouinii (24,27%) y M. canis (11,65%) y rara vez T. violaceum y T. mentagrophytes. Conclusiones: En la República Dominicana, en la zona urbana, la tiña de la cabeza predomina en los varones y en la zona rural tiene una frecuencia similar en ambos sexos. Se detectó una emergencia por M. audouinii, un incremento de Trichophyton tonsurans, y una estabilidad con frecuencia más baja de M. canis. En la zona rural y la frontera con Haití hay un predominio significativo de T. tonsurans (AU)

Background: Tinea capitis affects mainly children. The frequency and causative organism vary from region to region. Objectives: To provide epidemiological and mycological data on tinea capitis collected in urban and rural areas of the Dominican Republic. Methods: Samples were obtained from 118 patients with tinea capitis. Sixty-three of these were from 2 schools in urban areas of the Dominican capital Santo Domingo (53%) and 55 were from rural schools on the border with Haiti (47%). Results: The study included 84 boys (71.18%) and 34 girls (28.81%). The urban sample comprised mainly boys (84.12%). The most represented age ranges were 6 to 8 years (47.45%), 3 to 5 years (24.59%), and 9 to 11 years (16.94%). Microsporum audouinii (39.68%), Trichophyton tonsurans (23.80%), Microsporum canis (19.04%), and Trichophyton violaceum (1.58%) were isolated from children in urban areas, whereas T. tonsurans (87%) and Trichophyton mentagrophytes (2%) were isolated from those in rural areas. Overall, T. tonsurans (61.16%), M. audouinii (24.27%), and M canis (11.65%) were the most frequently isolated causative organisms, whereas T. violaceum and T. mentagrophytes were rarely reported. Conclusions: In urban areas of the Dominican Republic, tinea capitis was found mainly in boys, but in rural areas it was evenly distributed among boys and girls. The emergence of M. audouinii and an increase in T. tonsurans were found while M. canis continued to be present at lower frequencies. On the rural border with Haiti, there was a significant predominance of T. tonsurans (AU)

Cooled ablation reduces pulmonary vein isolation time: results of a prospective randomised trial.

BACKGROUND: Currently, selection of the ablation catheter for pulmonary vein (PV) isolation is a matter of choice. OBJECTIVE: To evaluate the efficiency of cooled ablation for PV isolation. METHODS: A prospective randomised trial was carried out comparing the time required to disconnect each targeted PV using cooled ablation (open irrigation at 15 ml/min, group A) or standard temperature-controlled 4 mm tip catheter ablation (group B). The ablation parameter limit settings were 45 degrees C, 35 (5) W in group A, and 55 degrees C, 35 (5) W in group B. RESULTS: Thirty-six patients referred for a first atrial fibrillation (AF) ablation procedure were randomised to group A or group B (18 patients in each group). There were no significant differences in baseline characteristics between the groups. Bidirectional block was achieved in 61/61 PVs from group A (100%) and 59/61 PVs from group B (97%); p = NS. Time to PV disconnection was significantly shorter in group A than in group B (median (25th-75th centiles) 14 (5-28) min vs 19 (14-32) min, respectively; p = 0.003). Five asymptomatic PV stenoses were identified by MRI, all in group B (p = 0.05). After 1-year minimum follow-up, AF recurrences were less frequently documented in patients treated with cooled ablation (6% vs 33%; p = 0.05). CONCLUSION: Cooled ablation is more efficient than standard ablation in achieving PV isolation. Results obtained from this study also suggest a potential benefit of clinical efficacy and safety from cooled ablation, which should be further evaluated in larger clinical trials.

Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit linked to onychomycosis in a healthcare worker.

OBJECTIVE: To describe an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. METHODS: After the identification of the first cases, the situation was regarded as an outbreak, and basic preventive measures against nosocomial infections were strictly enforced, and possible sources of dissemination were investigated. RESULTS: The outbreak lasted for 6 months and affected 36 newborn infants, causing seven infections and 29 colonizations. In the first stage of the outbreak, patients developed infection, but in the second stage, they were asymptomatic and were only identified by surveillance cultures. The outbreak was controlled after the identification and treatment of the healthcare worker who had been diagnosed with onychomycosis and whose hands were contaminated with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. CONCLUSIONS: The detection and control of occult dissemination of this multiresistant bacterium among low-risk newborn infants prevented its endemic dissemination in the neonatal unit, as well as the exposure of critically ill and susceptible patients to the infection.

Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit linked to onychomycosis in a healthcare worker

OBJETIVO: Descrever surto por Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido em berçário de risco intermediário. MÉTODOS: Após identificação dos primeiros casos, a situação foi conduzida como surto, sendo intensificadas as medidas básicas de prevenção de infecções hospitalares e investigadas possíveis fontes de disseminação da bactéria. RESULTADOS: O surto durou 6 meses e atingiu 36 recém-nascidos, causando sete infecções e 29 colonizações. Na primeira fase do surto, os portadores evoluíram com infecção, porém, na segunda fase, os portadores eram assintomáticos e só foram identificados por culturas de vigilância. O surto foi resolvido após identificação e tratamento de profissional de saúde que apresentava onicomicose e era portadora de Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido nas mãos. CONCLUSÃO: Detecção e controle da disseminação oculta da bactéria multirresistente entre os recém-nascidos de menor risco evitou sua instalação endêmica no berçário, bem como a conseqüente exposição dos pacientes mais graves e suscetíveis à infecção.

OBJECTIVE: To describe an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. METHODS: After the identification of the first cases, the situation was regarded as an outbreak, and basic preventive measures against nosocomial infections were strictly enforced, and possible sources of dissemination were investigated. RESULTS: The outbreak lasted for 6 months and affected 36 newborn infants, causing seven infections and 29 colonizations. In the first stage of the outbreak, patients developed infection, but in the second stage, they were asymptomatic and were only identified by surveillance cultures. The outbreak was controlled after the identification and treatment of the healthcare worker who had been diagnosed with onychomycosis and whose hands were contaminated with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. CONCLUSION: The detection and control of occult dissemination of this multiresistant bacterium among low-risk newborn infants prevented its endemic dissemination in the neonatal unit, as well as the exposure of critically ill and susceptible patients to the infection.

Valor pronóstico de la hiperuricemia en la insuficiencia cardiaca crónica / Prognostic value of hyperuricemia in chronic heart failure

BACKGROUND: Hyperuricemia has been proposed as a risk marker in chronic heart failure, but its value as an independent prognostic is not well established. AIM: To determine the prognostic value of hyperuricemia, in patients with chronic stable heart failure. PATIENTS AND METHODS: Forty six male patients with chronic heart failure, aged 62 +/- 13 years, were studied. Their election fraction was less than 40% and their serum creatinine was less than 2 mg/dl. Serum uric acid and catecholamines, maximal oxygen consumption (VO2 max) and left ventricular ejection fraction were measured. Mortality and the need for cardiac transplant were recorded as endpoints during a mean follow up of 39 +/- 18 months. The relationship between basal measures and the occurrence of events was analyzed using univariate and multivariate methods. RESULTS: Basal VO2 max and left ventricular ejection fraction were 16 +/- 4.6 ml/kg/min and 22 +/- 7% respectively. Eighteen patients died and three required transplantation during the follow up. Patients reaching these endpoints had a lower VO2 max and left ventricular ejection fraction and higher uric acid levels. Multivariate analysis accepted left ventricular ejection fraction (relative risk 0.89, 95% CI 0.82-0.97) and serum uric acid (relative risk 1.335 95% CI 1.02-1.74) as significant predictors of events. The relative risk for cardiac transplantation was 7.07 times higher among those with a serum uric acid over 7 mg/dl. CONCLUSIONS: A high serum uric acid is an independent predictor of bad prognosis in patients with stable chronic heart failure.