Wheat (Triticum aestivum L.) lipid species distribution in the different stages of straight dough bread making.

Although wheat endogenous lipids strongly impact bread quality, knowledge on their detailed distribution throughout the different stages of straight dough bread making is lacking. We here compared the lipid populations in hexane [containing free lipids (FLs)] and water-saturated butanol extracts [containing bound lipids (BLs)] of wheat flour, freshly mixed and fermented doughs, and bread crumb using high-performance liquid-chromatography [for nonpolar lipids, i.e. mainly free fatty acids (FFA) and triacylglycerols] and electrospray ionization tandem mass spectrometry (for polar lipids). Freshly mixed doughs had lower FL and higher BL levels than flour, a phenomenon referred to as lipid-binding. Furthermore, probably due to the disintegration of flour particles, the overall extractability of nonpolar lipids was higher in freshly mixed dough than in flour. Dough fermentation decreased the extractability of glycolipids, but increased that of nonpolar lipids and phospholipids. We hypothesize that these phenomena result from stretching of the gluten network due to gas cell expansion, which leads to the replacement of some lipids associated with gluten proteins by others. Baking increased the extractability of bound lysophospatidylcholine (LPC) levels, but decreased that of free FFA. This is probably due to in situ dissociation of amylose-LPC inclusion complexes and formation of amylose-FFA inclusion complexes during bread baking and cooling, respectively. The approach and ESI-MS/MS methodology we developed provided valuable insights regarding the distribution of lipids at the different stages of bread making. Hence, it opens perspectives for future efforts to relate differences in lipid composition between wheat cultivars to their bread making quality.

Lipases as Processing Aids in the Separation of Wheat Flour into Gluten and Starch: Impact on the Lipid Population, Gluten Agglomeration, and Yield.

Three lipases with different hydrolysis specificities were tested in a laboratory-scale dough-batter wheat flour separation process in two concentrations. Lipolase specifically hydrolyzed nonpolar flour lipids. At the highest concentration tested, it significantly improved gluten agglomeration and yield, also when combined with a xylanase with hydrolysis specificity toward water-extractable arabinoxylan. We hypothesize that its action is due to the release of adequate levels of free fatty acids, which, because at least a part of them is dissociated, act as anionic surfactants. Lipolase at the lowest concentration, Lecitase Ultra, hydrolyzing both nonpolar and polar lipids, and YieldMAX, which specifically hydrolyzed phospholipids, had no or a negative impact on gluten agglomeration and yield. In conclusion, this study demonstrated that lipases with hydrolysis specificity toward nonpolar lipids can be used as processing aids in wheat flour separation in the absence or presence of added xylanases to maximize gluten agglomeration and yield.

Outbreak of Elizabethkingia meningoseptica sepsis with meningitis in a well-baby nursery.

Between March and May 2012, three neonates born at a regional maternity hospital developed Elizabethkingia meningoseptica (previously Chryseobacterium meningosepticum) sepsis with meningitis aged <10 days, and were treated successfully with intravenous ciprofloxacin plus vancomycin or piperacillin-tazobactam for three to six weeks. Four (16.6%) of 24 environmental specimens obtained from the nursery and delivery room were positive for this organism. All of the clinical isolates and two isolates from storage boxes for pacifiers and pacifier covers were genetically identical. After changing the storage boxes to stainless steel boxes that underwent regular autoclave sterilization, there were no further cases of infection with E. meningoseptica.

Hemodynamic reference for neonates of different age and weight: a pilot study with electrical cardiometry.

OBJECTIVE: Electrical cardiometry (EC) is an impedance-based monitor that provides noninvasive, real-time hemodynamic assessment. However, the reference values for neonates have not been established. STUDY DESIGN: EC (Aesculon) was applied to hemodynamically stable preterm and term infants. Hemodynamic variables included cardiac output (CO), cardiac index (CI), stroke volume (SV) and heart rate (HR). Their gestational age (GA), weight and body surface area (BSA) were recorded. RESULTS: A total of 280 neonates were studied. Their GA ranged from 26(5/7) to 41(4/7) weeks, weight 800 to 4420 g and BSA 0.07 to 0.26 m(2). CO was positively correlated to GA, weight and BSA (r=0.681, 0.822, 0.830, respectively; all P<0.001). Using regression analysis, CO was most significantly correlated to BSA. Mean CI was 2.55±0.37 l min(-1) per m(2). CONCLUSION: Hemodynamic reference by EC is notably distinct among neonates of diverse maturity. CO is most closely correlated to BSA.

Predictors of clinical and microbiological treatment failure in neonatal bloodstream infections.

This study aimed to identify independent predictors of clinical and microbiological treatment failure and develop a predictive model for neonates with bloodstream infection (BSI). This study included 1087 episodes of BSIs in 793 neonates in a tertiary-level neonatal intensive care unit of northern Taiwan between 2004 and 2012. Patient demographics, underlying chronic comorbidities, clinical features, antimicrobial treatment and microbiological characteristics were evaluated. The presence of underlying congenital anomalies (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.09 to 4.10) and pulmonary hypertension (OR 3.63, 95% CI 1.70 to 7.74), infections caused by multidrug-resistant gram-negative bacteria (OR 2.89, 95% CI 1.23 to 6.79), group B Streptococcus (OR 3.15, 95% CI 1.33 to 7.46), and fungi (OR 4.13, 95% CI 2.02 to 8.46), a Neonatal Therapeutic Intervention Scoring System score of ≥ 23 (OR 6.96, 95% CI 2.55 to 28.58), inappropriate antibiotics (OR 2.13, 95% CI 1.41 to 3.23), and concomitant meningitis (OR 4.25, 95% CI 2.08 to 8.69) and ventilator-associated pneumonia (OR 2.73, 95% CI 1.22 to 6.13) were identified as independent risk factors for 28-day treatment failure in neonatal BSI. A risk score model was created by adding the points for each independent risk factor, and had a c-statistic of 0.83. Patients with risk scores of 0, 4, 8, 12 and 15 had estimated 28-day treatment failure rates of approximately 3.5%, 17.0%, 53.5%, 86.6% and 95.9%, respectively. This predictive model, calculated after documentation of a BSI, reflects a spectrum of BSI severity and was associated with subsequent treatment failure through illness severity score and case mix variables. This simple score could prove useful in clinical and research settings, and practical in estimating the prognosis.

Native and enzymatically modified wheat (Triticum aestivum L.) endogenous lipids in bread making: a focus on gas cell stabilization mechanisms.

Lipopan F and Lecitase Ultra lipases were used in straight dough bread making to study how wheat lipids affect bread loaf volume (LV) and crumb structure setting. Lipase effects on LV were dose and dough piece weight dependent. The bread quality improving mechanisms exerted by endogenous lipids were studied in terms of gluten network strengthening, which indirectly stabilizes gas cells, and in terms of direct interfacial gas cell stabilization. Unlike diacetyl tartaric esters of mono- and diacylglycerols (DATEM, used as control), lipase use did not impact dough extensibility. The effect on dough extensibility was therefore related to its lipid composition at the start of mixing. Both lipases and DATEM strongly increase the levels of polar lipids in dough liquor and their availability for and potential accumulation at gas cell interfaces. Lipases form lysolipids that emulsify other lipids. We speculate that DATEM competes with (endogenous) polar lipids for interacting with gluten proteins.

Refractive errors after the use of bevacizumab for the treatment of retinopathy of prematurity: 2-year outcomes.

PURPOSE: To evaluate the refractive outcomes in children treated after intravitreal injection of bevacizumab (IVB) for retinopathy of prematurity (ROP). METHODS: A retrospective, bi-centre study of 34 patients (64 eyes) was conducted. The patients were divided into three groups, patients received intravitreal IVB (IVB group), patients received combined IVB and laser treatment (IVB + Laser group), or patients received lens-sparing vitrectomy (IVB + LSV group). Cycloplegic refraction and axial length (AXL) were evaluated at 2 years old. RESULTS: The prevalences of myopia and high myopia were 47.5 and 10.0% in the IVB group, respectively, which were lower than those in the IVB + Laser (82.4 and 29.4%) and IVB + LSV (all 100%) groups (P = 0.001 and P < 0.001). The prevalences of emmetropia in the IVB group, IVB + Laser group, and IVB + LSV group were 50, 5.9, and 0% (P = 0.001). The AXL were similar among all groups. CONCLUSIONS: At the 2-year follow-up, severe ROP patients treated with IVB alone were more likely to remain emmetropic and had lower prevalences of myopia and high myopia. The development of high myopia in severe ROP patients could not be explained by AXL changes but may be associated with abnormalities in the anterior segment.

Recurrent late-onset sepsis in the neonatal intensive care unit: incidence, clinical characteristics and risk factors.

We aimed to characterize the incidence, clinical features, risk factors and outcomes of recurrent late-onset sepsis (LOS) in the neonatal intensive care unit (NICU). All neonates with LOS from the NICU of a tertiary-level teaching hospital in northern Taiwan between 2004 and 2011 were enrolled for analyses. A case-control study was performed to determine risk factors for recurrence. Of 713 neonates with LOS, 150 (21.0%) experienced recurrence and 48 (6.7%) had >1 recurrences; c. two-thirds of recurrent LOS occurred in infants with birth weight (BW)≦1500 g or gestational age (GA)≦30 weeks. The recurrent LOS episodes were significantly more severe and had a higher sepsis-attributable mortality rate than the first episodes. The overall in-hospital mortality rate was 30.7% for neonates with recurrent LOS and 7.8% for those with single LOS (odds ratio (OR), 5.22; 95% CI, 3.28-8.30). When both BW and GA were controlled, neonates with recurrent LOS had a significantly prolonged hospitalization compared with the controls (median 109 vs. 84 days, p<0.001). After multivariate logistic regression, longer duration of total parenteral nutrition (TPN; OR, 1.30; 95% CI, 1.10-1.52 for every 10-day increment), presence of congenital anomalies (OR, 2.64; 95% CI, 1.10-6.35) and neurological co-morbidities (OR, 4.14; 95% CI, 1.14-15.10) were identified as the independent risk factors for LOS recurrence. We concluded that c. one-fifth of neonates with LOS had recurrence, which significantly resulted in prolonged hospitalization and increased mortality. Longer TPN administration, presence of congenital anomalies and neurological co-morbidities are independently associated with recurrent LOS.

A lipase based approach for studying the role of wheat lipids in bread making.

While endogenous wheat lipids exert a major effect on bread quality, little is known on the way they impact on bread loaf volume (LV). Here we altered wheat flour lipid composition during bread making using lipases in situ. Lipopan F, Lecitase Ultra, and surfactants increased LV to similar extents. The increases in bread LV as a result of these enzymes were related to decreased levels of galactolipids and phospholipids and concomitant increased 'lyso'-lipid as well as free fatty acid (FFA) levels. The FFA formed were transferred to the free lipid fraction, while the 'lyso'-lipids remained in the bound lipid fraction. For optimal gas cell stabilisation, an equilibrium between the lipid classes present and hence, the type of mesophase formed, is essential. Sufficient levels of lipids forming lamellar mesophases and lipids forming hexagonal I mesophases, which respectively form condensed monolayers or emulsify (deleterious) non-polar lipids in dough liquor, are needed.

Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants.

OBJECTIVE: To identify the risk factors contributing to intraventricular hemorrhage (IVH) in extremely low birth weight infants during early postnatal life, after appropriate matching for gestational age (GA) and birth body weight (BBW). STUDY DESIGN: A case-control retrospective study was designed to evaluate preterm infants with a GA ≤ 26 weeks and a BBW ≤ 1000 g admitted to our hospital during a 7.5-year period. From a cohort of 347 preterm infants, 36 infants (10.7%) had severe IVH (grades III and/or IV). We selected a control group of 36 preterm infants without IVH who were closely matched for GA (± 1 week) and body weight (± 100 g). Univariate and multivariate logistic regression analyses were performed to identify risk factors for severe IVH. RESULT: The GA and BBW of the IVH and control groups were 24.6 ± 1 weeks and 764.4 ± 118.5 g, and 24.8 ± 0.9 weeks and 771.5 ± 125.9 g, respectively. Vaginal delivery, male sex, resuscitation in the delivery room, high sodium serum levels (meq l(-1)) (162.6 vs 148.8), fluctuation of serum sodium (meq l(-1)) (17.3 vs 6.2), pH, PaCO(2), hemoglobin and platelet counts were associated with an increased risk of severe IVH. Multivariate logistic regression indicated that sodium fluctuations >13 meq l(-1), vaginal delivery, male sex and hemoglobin fluctuations are strongly associated with the development of severe IVH. CONCLUSION: Hypernatremia and fluctuations of sodium seem to be related to early severe IVH among preterm infants; however, further studies are required to clarify the causal relationship.

Influence of long-bright and increasing-dim photoperiods on live and processing performance of two broiler strains.

The influence of long-bright and increasing-dim photoperiods on live and processing performance was investigated in 2 broiler strains. Fifty males of moderate (M) and high (H) yield strains were placed by strain in 2 pens in each of 12 rooms. Six rooms were provided a long-bright photoperiod (LB treatment) of 23L:1D with 2 footcandles of intensity. The other 6 rooms were provided an increasing-dim photoperiod (ID treatment) of 20L:4D from 1 to 10 d, 12L:12D from 10 to 21 d, 15L:9D from 21 to 28 d, 18L:6D from 28 to 35 d, and 20L:4D from 35 to 54 d, with 0.1 foot-candle throughout. Relative to LB, the ID treatment had lower BW from 7 to 28 d, feed consumption from 7 to 35 d, and feed conversion from 7 to 42 d; however, these variables did not differ between treatments at 54 d. The M strain had consistently greater BW and feed consumption than the H strain. However, M strain feed conversion was only greater from 7 to 35 d. Mortality was unaffected by treatment or strain. Total breast weights and yields were 42 g or 5.1% greater, respectively, in the LB than the ID treatment. Fillet weights and yields, and tender yields, were greater in the LB than ID treatment. Leg weights and yields, and wing yields, were greater in the ID than LB treatment. Total breast weights of M and H strains were similar; however, yield was 3.3% greater in the H than M strain. Fillet yields were greater in the H than M strain. Wing and leg weights and yields were greater in the M than H strain. There was an interaction effect on fat pad weights and yields, which were greater in H strain subjected to ID treatment than other strain and treatment combinations. These results indicate that increasing photoperiods and dim intensities, which often improve broiler live performance, may have a greater negative effect on breast meat production than differences in strains.

Effect of light intensity on live performance and processing characteristics of broilers.

This study investigated the effects of different light intensities provided via an increasing photoperiod program on broiler live performance and processing characteristics. A total of 1,080 male broilers were evenly distributed in 12 rooms. Six rooms were subjected to intensities of either 15 footcandles (FC) from 1 to 51 d (Bright), or 0.5 FC from 1 to 9 d and 0.1 FC from 9 to 51 d (Dim). Both intensity treatments were provided in an increasing photoperiod program (23L:1D, 1 to 9 d; 12L:12D, 9 to 16 d; 14L:10D, 16 to 23 d; 17L:7D, 23 to 30 d; 20L:4D, 30 to 37 d; and 23L:1D, 37 to 51 d). Feed consumption and BW were determined, and feed conversions were calculated approximately weekly. Mortalities were necropsied and recorded daily. At 51 d, 30 birds from each room were processed and cut up to determine weights and yields. Beginning at 23 and 30 d, respectively, BW and feed consumption were greater in the Dim treatment. At 51 d, Dim treatment BW was 4.7% greater and feed consumption was 3.9% greater. Feed conversion, metabolic and total mortality, and BW uniformity were not influenced by light intensity. Weights of lean carcass, total breast, fillets, tenders, and legs were from 4.9 to 6.2% greater in the Dim treatment, which was proportional to the BW difference and resulted in similar yields of these parts. However, wings were 9.9% heavier in the Dim treatment, which resulted in greater wing yield. Equal fat pad weights resulted in reduced fat pad yield in the Dim treatment. These results indicate that BW, feed consumption, and most parts weights were increased proportionally by providing 0.1 vs. 15 FC of light intensity via an increasing photoperiod program, and that only the yields of minor parts were affected by intensity.

Outcome of antenatally diagnosed cardiac rhabdomyoma: case series and a meta-analysis.

OBJECTIVES: Rhabdomyoma, the most common primary fetal cardiac tumor, is often associated with tuberous sclerosis (TS). We aimed to evaluate outcome in cases diagnosed with fetal cardiac rhabdomyoma. METHODS: This study presents 11 cases with fetal cardiac rhabdomyoma. In addition, all relevant published cases of antenatally diagnosed cardiac rhabdomyoma since 1982 were identified from MEDLINE. We evaluated the following risk factors associated with clinical impact and perinatal outcome: family history of TS, gestational age at diagnosis, tumor size, site and number of tumors, tumor progression, and associated intracardiac and extracardiac anomalies. RESULTS: In this meta-analysis, 138 cases, including nine newly added by us, were categorized into Group A (107 live babies) and Group B (16 neonatal deaths and 15 intrauterine fetal deaths). Univariate analysis showed that large cardiac tumors (P < 0.0001), fetal dysrhythmia (P < 0.0001) and hydrops (P < 0.0001) were strong predictors of neonatal outcome. Tumor size >or= 20 mm (relative risk (RR), 20.6; 95% CI, 2.2-195.9; P = 0.009) and fetal dysrhythmia (RR, 13.6; 95% CI, 2.9-62.3; P = 0.001) were significantly associated with neonatal morbidity. TS, present in 85/133 (63.9%) cases, was significantly associated with multiple cardiac tumors (P < 0.0001) and family history of TS (P = 0.02). CONCLUSIONS: Large tumor size and hydrops are significantly associated with poor neonatal outcome, whereas family history of TS and multiple fetal cardiac tumors are associated with TS. Any sonographic detection of a fetal cardiac tumor should warrant further investigation for the possible presence of associated disorders.

Effect of light intensity and photoperiod on live performance, heterophil-to-lymphocyte ratio, and processing yields of broilers.

This study investigated effects of light intensity and photoperiod on live and processing performance and physiological stress of broilers. One hundred broilers were housed in each of 12 rooms, provided 23L:1D with 3 footcandles (FC) of intensity to 8 d, and then subjected to the following treatments in a 2 x 2 factorial arrangement: either 1 FC (1FC) or 0.1 FC (0.1FC) from 8 to 49 d and either 23L:1D from 8 to 49 d (23L) or 18L:6D from 8 to 43 d followed by 23L:1D from 43 to 49 d (18L). At 40 d, blood samples were drawn and heterophil:lymphocyte ratios determined. At 49 d, 16 birds from each room were processed to determine weights and yields. There were interaction effects on BW from 29 to 49 d. At 29 d, BW was reduced by either 18L or 0.1FC treatments. At 43 d, BW was greatest in 1FC-23L, reduced in 1FC-18L and 0.1FC-23L, and intermediate in the 0.1FC-18L treatment. At 49 d, BW of 1FC-23L and 0.1FC-18L were similar and greater than those of 1FC-18L and 0.1FC-23L treatments. Feed consumption was reduced by 18L treatment from 15 to 29 d and the 0.1FC treatment at 15 d. Feed conversion and mortality were not affected by treatments. The 0.1FC treatment decreased uniformity at 15 d. Heterophil:lymphocyte ratios averaged about 0.45 and were not affected by treatments. Carcass yield and tender weight were reduced by the 0.1FC treatment, whereas whole breast yield was reduced by the 18L treatment. There were interaction effects on whole breast weight and fillet weight and yield, which were reduced by either the 18L or 0.1FC treatments. These results indicate that although the combination of 18L:6D and 0.1FC may result in broiler live performance comparable to that achieved with 23L:1D and 1FC, and no combination of the photoperiods and intensities tested caused physiological stress, breast meat is generally reduced by either 18L:6D or 0.1FC.

Methicillin-resistant Staphylococcus aureus bacteraemia in neonatal intensive care units: an analysis of 90 episodes.

AIM: To delineate the clinical features of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in infants hospitalized at the neonatal intensive care unit. METHODS: Episodes of MRSA bacteraemia in Chang Gung Children's Hospital neonatal intensive care unit from 1997 to 1999 were reviewed for incidence, predisposing factors, clinical presentations, treatment and outcome. RESULTS: Ninety episodes of MRSA bacteraemia were identified. The overall rate of MRSA bacteraemia was 1.05 per 1000 patient days during the 3-y period. Most of the patients were premature infants (76%), with prior operation or invasive procedures (39%), had an indwelling intravascular catheter (79%) and exposure to antibiotic therapy (96%). A localized cutaneous infection was found in 53.3% of the episodes. The most common clinical diagnoses were catheter-related infections (54.4%), skin and soft tissue infections (21.1%), bacteraemia without a focus (20%) and pneumonia (16.7%). Metastatic infection occurred in 18% of these infants. Among the patients treated with vancomycin for < or = 14 d, 88.7% did not develop any complications, and 11.3% developed a recurrence. CONCLUSIONS: MRSA is an established pathogen in our NICU. MRSA bacteraemia in the neonates predominantly presented as catheter-related infections, and metastatic infections were not infrequently seen. In uncomplicated MRSA bacteraemia, treatment with vancomycin for < or = 14 d seems to be adequate.

Study of plasma endothelin-1 concentrations in Taiwanese neonates with respiratory distress.

BACKGROUND: Endothelin-1 (ET-1) is a novel and potent endothelium-derived vasoconstriction peptide present in human plasma. In this study, plasma ET-1 concentrations were determined and their physiological significance was evaluated in Taiwanese neonates with respiratory distress. METHODS: Sixty newborn infants consisting of 22 with respiratory distress syndrome (RDS), 13 with transient tachypnea of newborn (TTNB), 4 with meconium aspiration syndrome, 10 healthy preterm and 11 healthy full-term infants were included for plasma ET-1 determination. Plasma ET-1 levels were measured by enzyme immunoassay at the of age of 1 day. For those who were diagnosed with RDS, plasma ET-1 concentrations were scheduled for evaluation at the ages of 1, 2, 3, 7, 14, 28, and 35 days as long as oxygen was being used. RESULTS: On the first day of life, there was no significant difference in plasma ET-1 concentrations between healthy preterm and term infants (3.92 +/- 0.88 vs. 3.56 +/- 1.98 pg/mL, p = 0.606). However, plasma ET-1 concentrations of infants with RDS were significantly higher than those with TTNB (6.46 +/- 0.58 vs. 3.77 +/- 1.29 pg/mL, p < 0.001). In RDS infants, plasma ET-1 concentrations showed no significant difference between those who developed bronchopulmonary dysplasia (BPD, N = 4) and those who recovered (non-BPD, n = 18) (7.84 +/- 1.85 vs. 5.81 +/- 2.76 pg/mL, p = 0.242). CONCLUSION: Plasma ET-1 concentrations were similar in preterm and term infants. ET-1 concentrations were higher in infants with RDS than in infants with TTNB, which suggests that plasma ET-1 levels can be useful in the differential diagnosis. However, the plasma ET-1 concentrations can not be a predictor for BPD.

Prophylaxis of intravenous immunoglobulin and acyclovir in perinatal varicella.

UNLABELLED: Maternal chickenpox around the time of delivery can cause severe and even fatal illness in the newborn but an effectively preventive method has not yet been established. We proposed that a combination of intravenous immunoglobulin (IVIG) and acyclovir (ACV) intravenously could effectively prevent perinatal varicella. A group of 24 newborn infants whose mother had developed a varicella rash within 14 days before and after delivery were studied. Some 15 infants whose mothers' rash appeared within 7 days before and 5 days after delivery were categorised as an at-risk group and received IVIG prophylaxis (500 mg/kg) administered soon after birth or post-natal contact either alone or with intravenous acyclovir (5 mg/kg every 8 h) for a total of 5 days starting from 7 days after the onset of maternal rash. Of four infants receiving IVIG alone, two developed clinical varicella. None of ten infants receiving both IVIG and ACV contracted varicella. One infant receiving ACV alone had no varicella vesicles either. Of nine infants in the not at-risk group four had undetectable varicella-zoster virus antibody on admission and developed clinical varicella subsequently. CONCLUSION: The combination of intravenous immunoglobulin given soon after birth and prophylactic acyclovir intravenously administered 7 days after the onset of maternal rash can effectively prevent perinatal varicella.

[Prevalence of sexually transmitted diseases (STD) and HIV-infection among attendees of STD Outpatient Clinic, Dijkzigt University Hospital in Rotterdam; comparative analysis of years 1993 and 1998]. / Prevalentie van seksueel overdraagbare aandoeningen (SOA) en HIV-infectie bij bezoekers van de SOA-polikliniek van het Academisch Ziekenhuis Rotterdam-Dijkzigt; een vergelijking van de jaren 1993 en 1998.

OBJECTIVE: To gain an impression as to the possible trends in the prevalence of VD and HIV between 1993 and 1998. DESIGN: Retrospective. METHOD: Data of age, gender, ethnic background, sexual preference, intravenous drug use and a diagnosis of VD or HIV infection for persons attending the VD Outpatient Clinic of the Department of Dermato-Venereology of the Dijkzigt University Hospital in Rotterdam, the Netherlands, for the first time were compared for the years 1993 and 1998. RESULTS: The number of patients examined was 3099 (1894 men and 1205 women) in 1993 and 3696 (1878 men and 1818 women) in 1998. No diagnosis of venereal disease was made in 58.9% and 56.2% of them, respectively. The prevalence of HIV infection decreased from 1.3% in 1993 to 0.6% in 1998. This was caused mainly by a decline in the prevalence of HIV-antibodies among men with homosexual contacts. In the total population, the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis decreased significantly (from 5.4% to 2.5% and from 9.3% to 7.5%, respectively), but there was no similar decrease among the men with homosexual contacts.

Candidaemia in special care nurseries: comparison of albicans and parapsilosis infection.

OBJECTIVES: Candidaemia caused by Candida parapsilosis (CP) is being increasingly reported among infants in neonatal intensive care units (NICU). To assess relative severity, clinical manifestations of candidaemia caused by C. albicans (CA) and CP in a NICU were compared. METHODS: Between January 1994 and July 1997, episodes of candidaemia occurring among infants hospitalized in the NICU were identified in a children's hospital. The demographic characteristics, associated risk factors, clinical manifestations and outcome of the infants with CP fungaemia were collected and compared with those of the infants with CA fungaemia. RESULTS: Twenty-four episodes caused by CA and 22 episodes caused by CP were included in this study. No significant differences were found between the two groups for gestational age, birth weight, male gender, post-natal age at onset of candidaemia, frequency of antecedent neonatal events, prior duration of antibiotic therapy and hyperalimentation, as well as presence of central venous catheter (CVC). Infants with CA fungaemia were significantly more likely than those with CP fungaemia to present with hypoxaemia, bradycardia and respiratory distress requiring intubation, and have a longer prior duration of indwelling CVC and a higher dissemination rate. The eradication rate of candidaemia and overall case fatality rate were comparable in both groups. but CP fungaemia did not appear to cause acute lethal events. CONCLUSION: The presenting signs of CP fungaemia are relatively not so severe, but CP fungaemia, which is relatively difficult to eradicate, increases the morbidity and mortality of the infants.

Fluconazole therapy in neonatal candidemia.

We reviewed 62 episodes (from 59 infants) of neonatal candidemia that occurred between January 1994 and June 1999. Except 5 term babies, all infants were premature (median gestational age [GA], 30 weeks) and birth weight was less than 2,500 g (median, 1,300 g). Most infants had reported risk factors and other neonatal problems. The age at onset of candidemia ranged from 15 to 173 days with a median of 34 days. In addition to catheter removal, all but one infants received antifungal agents and candidemia was eradicated subsequently in 46 episodes (75%). Eighteen infants with 19 episodes ever received fluconazole therapy. Fluconazole was administered as the first line agent in 6 episodes and successfully cleared candidemia in 5 episodes. Fluconazole was used as an alternative agent in an additional 13 episodes after amphotericin B (am B) +/- flucytosine were given for a period without a satisfactory result and eradication of candidemia was achieved in 8 episodes subsequently. All 18 infants tolerated fluconazole well and no withdrawal was required on account of its adverse effect. In contrast, am B alone was administered as the first line agent in 55 episodes and successfully cleared candidemia in 32 episodes (58%). This retrospective analysis suggests that fluconazole appears to be safe in neonates and can be used as an alternative agent in treating neonatal candidemia. A large-scaled prospective study may be needed.