Brote por Salmonella serovar Poona en una guardería / Salmonella Serovar Poona outbreak in a nursery

Introducción: se describe un brote de gastroenteritis causada por Salmonella poona en una guardería infantil en la ciudad de Valladolid (España) en los primeros tres meses del año 2011. Objetivos: describir las características epidemiológicas del brote, su relación con un brote supracomunitario declarado en España en 2010 y analizar el mecanismo de transmisión. Métodos: se realizó un estudio descriptivo bidireccional. Partiendo del caso índice, se elaboró una base de datos con la totalidad de niños asistentes a la guardería y se completó con la información recibida de los pediatras y con la información microbiológica. Se calcularon tasas de ataque por aulas y curva epidémica. Resultados: se encontraron 13 casos, de edades comprendidas entre los cinco meses y los cinco años, tres de los cuales fueron asintomáticos. La tasa de ataque global en la guardería fue del 28,2%, no encontrándose diferencias significativas entre las diferentes aulas. Todas las salmonelas aisladas excepto dos fueron enviadas al Centro Nacional de Microbiología (CNM) para su caracterización, identificándose todas ellas como Salmonella poona 13,22:z:1,6, idéntica a la aislada en el brote nacional. Conclusiones: parece evidente que el brote ocurrido en la guardería fue producido por el mismo microorganismo que el que causó el brote supracomunitario y que la fórmula láctea implicada en dicho brote fue el vehículo de transmisión que permitió la introducción del microorganismo en la guardería, propagándose por otras vías entre los alumnos de la misma (AU)

Introduction: during the first three months of 2011, a gastroenteritis outbreak caused by Salmonella poona was described in one of the Valladolid´s nurseries. Objectives: to describe the epidemiologic characteristics of the outbreak, its relation between a supracommunity outbreak and its transmission mechanism. Methods: a descriptive bidireccional study. Starting from an index case a database from the nursery of the children records, the pediatrics and the microbiology records was done. The overall attack rate and the epidemic curve from each classroom was calculated. Results: thirteen cases between five months and five years old were found; all of them were asymptomatic. The overall attack rate was 28,2% without significant difference between the classrooms. Salmonella poona 13,22:z:1,6 was found, and it was identical to that isolated in the national outbreak. Conclusions: It seems that the nursery´s outbreak was caused by the same organism related to the supracommunity outbreak and the powdered infant formula was the vehicle involved in the transmission and it allowed the introduction of the organism in the nursery spreading through other pathways between students (AU)

Prevalence of cardiac dyssynchrony and correlation with atrio-ventricular block and QRS width in dilated cardiomyopathy: an echocardiographic study.

INTRODUCTION: Cardiac dyssynchrony causes disorganised cardiac contraction, delayed wall contraction and reduced pumping efficiency. We aimed to assess the prevalence of different types of dyssynchrony in patients with dilated cardiomyopathy (DCM), and to establish the correlation between atrio-ventricular block and atrio-ventricular dyssynchrony (AVD), and between impaired intra-ventricular conduction and the existence of inter-ventricular dyssynchrony (inter-VD) and intra-left ventricular dyssynchrony (intra-LVD). METHODS: We included 40 patients in New York Heart Association stage III or IV, admitted consecutively with DCM with severe left ventricular dysfunction (left ventricular end-diastolic diameter ≥ 60 mm and/or ≥ 30 mm/m(2)) and left ventricular ejection fraction < 35%. Electrocardiographic and echocardiographic data were evaluated in all patients. Patients were divided into two groups: group 1: eight patients, with a QRS duration ≥ 120 ms, and all presented with left bundle branch block; group 2: 32 patients with a narrow QRS < 120 ms. RESULTS: Overall, the mean age was 54.7 ± 16.8 years and patients in group 1 were older (67.2 ± 13.6 vs 51.5 ± 15.8 years, p = 0.01). The prevalence of atrio-ventricular dyssynchrony (AVD), inter-VD and intra-LVD was respectively 40, 47.5 and 70%. Two patients (5%) did not exhibit dyssynchrony. AVD was present with a similar frequency in the two groups (37.5% in group 1 vs 40.6% in group 2, p = 0.8). There was no correlation of the magnitude of AVD with the duration of the PR interval (from the beginning of the P wave to the beginning of the QRS complex) (r(2) = 0.02, p = 0.37) or the QRS width (r(2) = 0.01, p = 0.38). A greater proportion of patients with inter-VD was observed in group 1 (87.5 vs 60%, p = 0.03). There was a trend towards a more important inter-ventricular mechanical delay according to QRS width (r(2) = 0.009, p = 0.06). The proportion of intra-LVD was similar in all groups, with a high prevalence (87.5% in group 1 and 65.6% in group 2, p = 0.39). CONCLUSION: The assessment of cardiac dyssynchrony is possible in our country. Intra-ventricular mechanical dyssynchrony had a high prevalence in patients with DCM, irrespective of the QRS width. These data emphasise the usefulness of echocardiography in the screening of patients.

Molecular and ultrastructural profiles of the symbionts in Cephalotes ants.

The molecular and ultrastructural profiles of the symbionts found in the midgut and ileum of Cephalotes atratus, Cephalotes clypeatus, and Cephalotes pusillus were determined using the V3 region of the bacterial 16S rDNA gene and transmission electron microscopy (T.E.M.). Two samples of C. atratus, three of C. clypeatus, and six of C. pusillus were analyzed. The coefficients of similarity ranged from 80% to 94% for the samples of symbionts from C. clypeatus and C. atratus, despite being collected in geographically distant sites. The variability within symbionts found in the samples of C. pusillus varied from 29% to 55%, in samples geographically close as well as distant. PCR-DGGE was effective for the purpose of this study and can be considered a versatile tool to analyze gut microbiota. Details of the ultrastructural aspect of these bacteria are presented.

Intrinsic and extrinsic factors in the conservation of ants and their use as bioindicators / Fatores intrínsecos e extrínsecos na conservação de formigas e seu uso como bioindicadores

Ant communities are sensitive to fragmentation responding through: extinction of specialist species compared with large habitats, invasion of generalist species, changes in community composition and richness of species. Because of these characteristics, this review aims at examining the main risks that ants have been facing to maintain their communities, as well as to report current conservation practices in Brazil and in the world.

Comunidades de formigas são sensíveis à fragmentação e respondem por meio: da extinção de espécies especialistas comparadas com grandes habitats, invasão de espécies generalistas, mudanças na composição da comunidade e na riqueza de espécies. Por causa dessas características, esta revisão pretende descrever os principais riscos que as formigas têm enfrentado para manter suas comunidades, como também descrever práticas atuais no Brasil e no mundo.

The evaluation of human papillomavirus DNA testing in primary screening for cervical lesions in a large Japanese population.

To examine the utility of human papillomavirus (HPV) DNA testing for the screening of cervical cancer and its precursors, a prospective cohort study was performed in which a total of 8156 women with a median age of 36 years were enrolled. Two smear samples scraped from the uterine cervix were served for Papanicolaou test and HPV DNA testing (Hybrid Capture-II system). HPV-positive samples were further examined for HPV subtype using a DNA microarray chip. Women with cytologic abnormality or those with high-risk HPV DNA were further examined by colposcopy to determine histologic diagnosis. High-risk HPV DNA was detected in 11% of the general population, with higher prevalence of specific types, including 52, 16, 58, 51, 56, and 18. As expected, younger women were likely to have increased frequency of HPV infection. Notably, HPV DNA testing detected all 45 cases of cervical intraepithelial neoplasia (CIN) 3, while cytologic findings were negative in 6 of these cases. It is of particular interest that CIN was commonly associated with multiple HPV types, while invasive cancers had a single type of HPV. In terms of both sensitivity and positive predictive value in detecting the CIN, HPV DNA testing is superior to cytology. However, most importantly, HPV DNA testing in combination with cytology significantly improved the efficacy to CIN screening.

A phase II study of cisplatin and docetaxel administered as three consecutive weekly infusions for advanced non-small-cell lung cancer in elderly patients.

BACKGROUND: To evaluate the efficacy and safety of treatments for advanced non-small-cell lung cancer in elderly patients aged 75 years or older, we conducted a phase II study of cisplatin and docetaxel administered in three consecutive weekly infusions. PATIENTS AND METHODS: The eligibility criteria for the study included the presence of chemotherapy-naive advanced non-small-cell lung cancer, age > or =75 years, Eastern Cooperative Oncology Group performance status of 0 or 1, a measurable lesion, adequate organ functions and signed informed consent. The chemotherapy regimen consisted of cisplatin (25 mg/m(2)) and docetaxel (20 mg/m(2)) on days 1, 8 and 15 every 4 weeks. RESULTS: Between February 2000 and March 2002, 34 elderly patients with non-small-cell lung cancer were enrolled in the study and 33 patients were treated. Two complete responses and 15 partial responses were obtained for an objective response rate of 52% in 33 treated patients. The median survival period was 15.8 months, and the 1-year survival rate was 64%. Toxicities were mild with no grade 4 toxicities. Only grade 3 leukopenia (6%), neutropenia (12%), anemia (3%), hyponatremia (3%) and nausea/vomiting (3%) were observed. CONCLUSION: Cisplatin and docetaxel administered in three consecutive weekly infusions was safe and effective for the treatment of elderly patients with chemotherapy-naive non-small-cell lung cancer.

A continuous lactic acid production system using an immobilized packed bed of Lactobacillus helveticus.

A 5 l packed bed bioreactor was used to study the effect of initial lactose concentration and hydraulic retention time (HRT) on cell growth, lactose utilization and lactic acid production. Up to 95% of the initial lactose concentration was utilized at longer HRTs (30-36 h). The study showed that lactic acid production increased with increases in HRT (12-36 h) and initial lactose concentrations. The highest lactic acid production rate (3.90 g l(-1) h(-1)) was obtained with an initial lactose concentration of 100 g/l and an HRT of 18 h, whereas the lowest lactic acid production rate (1.35 g l(-1) h(-1)) was obtained with an initial lactose concentration of 50 g/l and an HRT of 36 h. This suggested that optimal lactic acid production can be achieved at an HRT of 18 h and initial lactose concentration of 100 g/l.

Room temperature phosphorescence of 6-bromo-2-naphthol in micelles of poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) block copolymers and in their mixed aggregates with sodium dodecyl sulfate.

Room temperature phosphorescence (RTP) of 6-bromo-2-naphthol has been investigated in aqueous micellar solutions of poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) block copolymers as well as in their mixed aggregates with sodium dodecyl sulfate. RTP of the phosphorophor was enhanced to some extent in the micelles of the block copolymers. However, marked enhancement of RTP was observed in the mixed aggregates. The enhancement of RTP is attributed to effective incorporation of the phosphorophor into the micelles and the aggregates, resulting in suppression of nonradiative deactivation of the phosphorescent state.

The presence of specialized epithelial cells on the bronchus-associated lymphoid tissue (BALT) in the mouse.

The aggregation of lymphoid cells in the bronchial mucosa has been named the bronchus-associated lymphoid tissue (BALT) and investigated in comparison with the gut-associated lymphoid tissue (GALT). To elucidate precisely the structure and function of the BALT, the present study examined the age-related change in the mouse BALT by light microscopy. We also observed the characteristics of the overlying epithelium, especially the lectin-binding properties of the epithelial cells, by the combined use of light microscopy (LM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). By LM, lymphoid aggregates were not recognizable in the bronchial mucosa of young (8-10 week-old) mice, while they were commonly found at the second to fourth branching portions of the bronchial tree in older (32-40 week-old) mice. The epithelium overlying the lymphoid aggregates of the mature mice often contained a large number of mononuclear cells. Lectin cytochemistry revealed that UEA1 (Ulex europaeus agglutinin 1) positive cells were not only restricted to the overlying epithelium of the BALT in the older mice but also found in a cell group in the mucous epithelium at the branching portions in the young mice. Comparison between the LM and SEM images of the UEA1-stained whole mount specimens clarified the surface morphology of the lectin-stained epithelial cells, showing them to be non-ciliated cells with a large number of short microvillous projections on the apical surface. TEM studies further demonstrated that the UEA1 reaction products appeared on the plasma membrane of the non-ciliated cells which often enfolded lymphocytes in the old mice. Latex microbeads, which were administrated intratracheally, were selectively taken up by the UEA1-positive cells of the BALT. These results indicate that the mouse BALT has specialized epithelial cells similar to the UEA1 positive M cells in the GALT and probably functions as a part of the mucosal immune system. This study also showed the possibility that the UEA1 positive cells appear in the mucous epithelium before the formation of the BALT.

[Outbreak of cryptosporidiosis in Guadarrama (Autonomous Community of Madrid)]. / Brote de criptosporidiosis en Guadarrama (Comunidad Autónoma de Madrid).

BACKGROUND: In spring of 1998, an acute gastroenteritis outbreak, which mainly affected preschool children, took place in Guadarrama (Community of Madrid, Spain). METHODS: A descriptive and analytical (cases and controls) study of the outbreak was done. Stool samples of the cases were taken to microbiological investigation. The tap water getting system of the municipality was inspected and samples were collected to microbiological analysis. RESULTS: Twenty one children from 0 to 5 years-old had liquid diarrhea which lasted more than five days. A significant statistical association was found within tap water consumption and gastroenteritis [OR = 5.73 (1.18-43.30); p < 0.05]. It did not have association with other variables investigated. Cryptosporidium parvum (Cp) oocysts were detected in stool samples of eight cases. Deficiencies were observed in the tap water getting and treatment system of the municipality but no oocysts were found in the analysis of the water. CONCLUSIONS: The results of the epidemiological investigation support that the source of the gastroenteritis outbreak was tap water, likely contaminated with Cp. While this parasite was not detected in the analysis of the water, it is explainable for the difficulties which this technique involves. In our review similar descriptions of outbreaks have not been found in Spain, but it seems that this reports are not infrequent in neighbour countries. Therefore, Cp should be borne in mind in diagnostic and management of these situations.

Three-dimensional cytoarchitecture of rat pulmonary venous walls: a light and scanning electron microscopic study.

The three-dimensional architecture of the rat pulmonary veins was studied by light microscopy (LM) and scanning electron microscopy (SEM). For LM, the left lungs were fixed with formalin, sectioned and immunostained with an anti-alpha-smooth muscle actin (alpha-SMA) antibody in addition to conventional staining. For SEM, the specimens were fixed with glutaraldehyde and immersed in 30% KOH solution for 8 min followed by treatment of collagenase solution for more than 5 h. By LM, the smooth muscle cells stained with anti-alpha-SMA showed discontinuous, periodical thickenings of circular bundles in the wall of the venules, but they became thin and continuous in the larger vessels (or veins) that had a cardiac muscle layer on the outside. Under SEM, the smooth muscle cells formed circular-oriented bundles at constant intervals along the venules less than 100 microm in diameter. These bundles had circumferential constrictions in the lumen. The cardiac muscle cells, which appeared in large pulmonary veins of more than 100 microm, ran in a circular or oblique direction and completely surrounded the vessel wall outside of the thin continuous layer of smooth muscle cells. The muscle arrangements were considered to play a significant role in the return blood flow in rat pulmonary veins.

Xamoterol in severe congestive heart failure: long-term oral treatment, a double-blind randomised study.

Twelve patients in severe congestive heart failure were given placebo, 100 mg xamoterol (Corwin) twice daily and 200 mg xamoterol twice daily, respectively, in 3 two-week periods in a double-blind randomised study. At the end of each treatment period the patients were evaluated. No differences were found between placebo and xamoterol in the following parameters: New York Heart Association function group index, heart volume, body weight, exercise duration on bicycle and treadmill, heart rate and systolic and diastolic blood pressure at rest. However, during exercise we found significantly lower heart rate and rate-pressure product during xamoterol treatment. This reduction is probably indicating occupation of beta-adrenoreceptors with concomitant reduced oxygen consumption during exercise.

Reliability of impedance cardiography in measuring central haemodynamics.

The purpose of the study described here was to investigate the reliability of impedance cardiography (IC) in measuring cardiac output (CO) and central blood volume. Absolute values and changes in these variables obtained by impedance cardiography and by isotope- or thermodilution techniques were compared. The reproducibility of IC within the same day was compared with that of isotope dilution and the reproducibility in IC from day to day was derived. Finally, the effects of the readings of impedance tracings by different observers were quantified. The results are based on 270 measurements in 37 healthy subjects and in 25 unmedicated patients with ischaemic heart disease. We obtained significant correlations between absolute values (y = 0.68x + 1.48) and changes (y = 1.00x + 0.0003) in CO measured by IC and isotope- or thermodilution. IC significantly overestimated absolute values of CO (P less than 0.001). We found a qualitative but no quantitative correlation between thoracic fluid volume measured by IC and central blood volume measured by isotope dilution. IC was highly reproducible both when studies were repeated within the same day (SD on differences in CO = 0.36 1 min-1 for IC; SD on differences in CO = 0.30 1 min-1 for isotope dilution) and on different days (SD on differences in CO = 0.45 1 min-1). A low intra-observer variability was found (SD on differences in CO = 0.12 1 min-1). We conclude that impedance cardiography is reliable in measuring changes in cardiac output and thus suitable for repeated measurements in studies on the haemodynamic effects of physiological or pharmacological intervention. Impedance cardiography is sufficiently reliable for comparison of absolute values of CO between different groups of patients. We cannot recommend impedance cardiography for quantitative studies of central blood volume.

[Recurrent ventricular tachyarrhythmias primarily diagnosed as epilepsy]. / Recidiverende ventrikulaere takyarytmier primaert diagnosticeret som epilepsi.

In Denmark, 6,000-10,000 persons die annually from sudden cardiac death. The majority of these die on account of ventricular fibrillation. A patient is presented here who suffered from recurrent lipothymic seizures which were primarily diagnosed as epilepsy. On account of absence of paraclinical documentation and because of suspected depression, treatment with a cyclic antidepressive agent was commenced, which further increases the tendency to sudden cardiac death. The patient was then brought to hospital with Lidocaine-resistant ventricular fibrillation which responded partly to Ajmalin and partly to Disopyramide. The lipothymic seizures were then interpreted as being precipitated by intermittent malignant episodes of cardiac arrhythmia. During the subsequent six months, the patient has felt well and has been free from lipothymic seizures while receiving 200 mg Mexiletin thrice daily. Attention is drawn to the value of Holter monitoring in the investigation of lipothymic seizures. Lidocaine (despite the existence of resistant cases) must still be considered to be the preparation of first choice on account of extensive knowledge about and confidence in the preparation.

A comparison of systolic time intervals measured by impedance cardiography and carotid pulse tracing.

The purpose of this study was to compare the systolic time intervals (STI) obtained by impedance cardiography and by the conventional carotid technique. This comparison was done with respect to: 1) correlations between variables obtained by the two methods, 2) ability to reflect drug-induced changes, 3) reliability in terms of reproducibility and 4) heart rate dependency of the variables measured. The study included 25 unmedicated patients with ischaemic heart disease and 36 healthy subjects. We obtained significant correlations between STI-variables measured by the two methods (p less than 0.001) and found that left ventricular ejection times were longer when determined by the carotid technique (p less than 0.01). We found a significant correlation between drug-induced changes in STI-variables measured by the two methods (p less than 0.001). Both methods had a high degree of reproducibility and this parameter was significantly better within the same day, when impedance cardiography was used (p less than 0.01). The error due to the reading of STI-tracings obtained by impedance cardiography was very small when performed by the same observer. We found the pre-ejection period to be independent upon heart rate, while the left ventricular ejection time depended upon this parameter. We conclude that impedance cardiography and carotid technique differ with respect to the measurement of left ventricular ejection times, but not with respect to the measurement of other STI-variables. We furthermore conclude that both methods are reliable, but we recommend the use of impedance cardiography because it is easier to apply, it may be more precise and it can be used for simultaneous measurements of other haemodynamic variables.

Prenalterol in severe congestive heart failure. II. Long-term oral treatment. Results with comments on the methods for evaluation of drugs in congestive heart failure.

Nine patients with severe congestive heart failure were treated with a partial beta-1-agonist prenalterol for 9.6 months on average. Five of the nine patients improved with an increase in NYHA-functional capacity of one class. In four of these patients, the improvement was maintained for 12 months. Upon discontinuation, deterioration occurred only in one case; in the latter, improvement reoccurred on reinstitution of prenalterol treatment. Significant improvement on exercise testing, however, occurred only in two patients. Prediction as to which patients would benefit from oral prenalterol was not possible from the pretreatment haemodynamic variables; similarly, the effect of oral prenalterol treatment could not be predicted from the response to prenalterol given intravenously. A critical review of the methods for evaluation of therapeutic intervention in congestive heart failure concludes the article.

Prenalterol in severe congestive heart failure. I. The immediate haemodynamic effects as compared to nitroglycerine.

The immediate haemodynamic effects of prenalterol and nitroglycerine were examined in 15 patients, with severe chronic heart failure. Prenalterol was given intravenously in increasing doses of 2, 4, and 8 mg. Cardiac index increased significantly by 16%, 24%, and 32%, respectively. Heart rate increased by 16%, 19%, and 24%. Stroke volume index, systemic artery pressure, pulmonary artery pressure, and right atrial pressure did not change. Prenalterol reduced systemic vascular resistance by 15%, 17%, and 24%, respectively. Forearm blood flow and forearm vascular resistance was unchanged. Cardiac index and heart rate were not changed by 0.5 mg nitroglycerine, administered sublingually. Systolic and diastolic blood pressure were on average reduced by 14% and 12%, respectively. Systolic and diastolic pulmonary artery pressure and right atrial pressure were similarly reduced by 17%, 31%, and 39%, respectively. Nitroglycerine lowered calculated systemic vascular resistance by 11%, whereas forearm blood flow and forearm vascular resistance was unchanged. The conclusion is that prenalterol acutely increased cardiac index and improved haemodynamics in 14 out of 15 patients, mainly due to an increased heart rate. Nitroglycerine did not change cardiac index in the same group of patients.

Effects of dopaminergic agonists on plasma luteinizing hormone-releasing hormone (LRH) and gonadotropins in man.

To try to determine the site and mode of action of dopamine (DA) on the secretion of gonadotropins in humans, 4 series of studies were performed in 19 healthy volunteers (7 healthy males, 5 females in follicular phase and 7 postmenopausal females). The intravenous infusion of DA at the rate of 4 micrograms/kg/min decreased plasma LH levels to 75.9 +/- 3.7 (mean +/- SE)% of the initial levels. The oral administration of 500 mg of levodopa (Dopa) also suppressed the concentration of plasma LH to 73.0 +/- 3.5%, but the pretreatment with two doses of 100 mg each of carbidopa (CD), a peripheral dopa decarboxylase inhibitor, attenuated this suppressing effect of Dopa on LH levels (nadir 82.4 +/- 4.1). Plasma FSH were not significantly altered by these drugs. On the other hand, the concentration of endogenous LRH in peripheral blood remained unchanged throughout the studies. The administration of CD alone had no effect on any of these 3 parameters. These results would suggest the direct suppressing effect of DA on pituitary gonadotrophs, although the modulation at the level of the hypothalamus also cannot be ruled out.

Haemodynamic effects of atenolol, pindolol and propranolol during adrenaline infusion in man.

In a double blind, cross over study the haemodynamic effects of an i.v. infusion of adrenaline during concomitant administration of atenolol, pindolol, propranolol or placebo were examined in 7 healthy volunteers. During coadministration with placebo, adrenaline caused an increase in systolic blood pressure (SBP) of 26 mm Hg and a decrease in diastolic blood pressure (DBP) of 20 mm Hg. Heart rate (HR) and stroke volume (SV) were increased by about 20-30%. Total peripheral resistance (TPR) fell significantly. When the subjects were pretreated with atenolol, the adrenaline increased SBP by 16 mm Hg, the DBP did not change, HR and SV increased by 19 and 30%, and TPR fell. During concomitant administration of the non-selective betablocker pindolol, which has strong intrinsic sympathomimetic activity (ISA), adrenaline increased SBP by 11 mm Hg and DBP by 17 mm Hg. This pure pressor response led to a significant reduction in HR and SV and an increase in TPR, probably mediated through the baroreceptors. The haemodynamic response to adrenaline during coadministration of propranolol was very similar to that seen after pindolol. It is concluded that a beta1-selective blocker interferes very little with the haemodynamic response to adrenaline, whereas it is changed to a pure pressor response during coadministration of a non-selective betablockers. ISA did not significantly modify the pressor response.