Distribution of inflammation and association between active and chronic alterations within the endometrium of dairy cows.

Objectives of this study were twofold: (i) to assess the association between polymorphonuclear (PMN) counts and chronic alterations within the bovine endometrium and (ii) to determine the distribution of inflammation throughout the endometrium of clinically healthy dairy cows. Holstein-Friesian cows (n = 32) from a single dairy farm were selected for this experiment. Before slaughtering, a complete reproductive examination was performed to discard any type of clinical disease. After slaughtering, reproductive tracts were collected, and the endometrium was sampled at 8 pre-defined locations. At each location, endometrial biopsies (EBs) and cytology (CY) samples were harvested. Histopathology samples were stained with haematoxylin-eosin (EB-HE) and naphthol-AS-D-chloroacetate-esterase (EB-naphthol), while CY samples were stained with Wright-Giemsa. In the EB-HE samples, parameters assessed were epithelium height, mononuclear cells infiltration, lymphocytic aggregates, periglandular fibrosis, angiosclerosis and haemorrhage. In EB-naphthol and CY slides, PMNs counts were evaluated. Binomial logistic regression was used to assess the association between the number of PMNs present in both the EB-naphthol and CY samples and alterations identified in the EB-HE samples and to analyse the distribution of the histopathological alterations (EB-HE). A Poisson mixed-effect model was used to analyse the distribution of PMNs within the endometrium. A significant positive association was found between the PMN counts and the mononuclear cells infiltration. The presence of erythrocytes was associated with higher odds to detect PMNs in the stratum compactum. Significantly, higher infiltration of PMNs and mononuclear cells were detected in the uterine body and the right horn region. Concluding, CY is a technique that allows the evaluation of PMN counts and therefore only evaluates active inflammation. A complete assessment of endometrial health can only be obtained using EB. To optimize the sensitivity to diagnose endometrial inflammation in cows, adjacencies of the corpus uteri should be considered as the preferred region to harvest samples.

Toward a Reliable Evaluation of Forecasting Systems for Plant Diseases: A Case Study Using Fusarium Head Blight of Wheat.

Despite great efforts to forecast plant diseases, many of the existing systems often fall short in providing farmers with accurate predictions. One of the main problems arises from the existence of year and location effects, so that more advanced procedures are required for evaluating existing systems in an unbiased manner. This paper illustrates the case of Fusarium head blight of winter wheat in Belgium. We present a new cross-validation strategy that enables the evaluation of the predictive performance of a forecasting system for years and locations that are different from the years and locations on which the forecast was developed. Four different cross-validation strategies and five regression techniques are used. The results demonstrated that traditional evaluation strategies are too optimistic in their predictions, whereas the cross-year cross-location validation strategy yielded more realistic outcomes. Using this procedure, the mean squared error increased and the coefficient of determination decreased in predicting disease severity and deoxynivalenol content, suggesting that existing evaluation strategies may generate a substantial optimistic bias. The strongest discrepancies between the cross-validation strategies were observed for multiple linear regression models.

Improved endocervical sampling and HPV viral load detection by Cervex-Brush Combi.

OBJECTIVE: Liquid-based cytology (LBC) for cervical screening is becoming increasingly used. Together with SurePath LBC, various collecting devices can be utilized, among which the Cervex-Brush is the most widely used. The new Rovers Cervex-Brush Combi combines the advantages of the Cervex-Brush with the EndoCervex-Brush increasing sampling of the endocervical canal. The objective of this study was to analyse and to compare the Cervex-Brush Combi with the Cervex-Brush for the collection of squamous and endocervical cells, human papillomavirus (HPV) typing/quantification and disease detection in SurePath LBC. METHODS: Using either the Cervex-Brush or the Cervex-Brush Combi 100 consecutive SurePath LBC samples were collected using each brush type. All 200 slides were read by the FocalPoint and screened by guided screening using slide wizards. The viral load of HPV type 16 E7, 18 E7, 31 E6, 33 L1, 33 E6, 35 E4, 39 E7, 45 E7, 51 E6, 52 L1, 52 E7, 53 E6, 56 E7, 58 L1, 58 E6, 59 E7, 66 E6 and 68 E7 was determined using a TaqMan-based real-time quantitative PCR analysis. RESULTS: The mean number of sampled squamous cells did not differ between the two brush types (54 963 versus 54 595 cells). The use of the Cervex-Brush Combi, however, resulted in a two- to threefold increase in the number of sampled endocervical cells (P < 0.00001). Using the Cervex-Brush Combi slightly more lesions were detected (three versus two low-grade squamous intraepithelial lesions), and resulted in the detection of more atypical squamous cells of undetermined significance (six versus three). In the Cervex-Brush group, 60% (3/5) of abnormal smears were positive for oncogenic HPV types, whereas 66.7% (6/9) of abnormal smears in the Cervex-Brush Combi group tested positive. The median HPV viral load for samples taken with the Cervex-Brush Combi was 0.1825 copies/cell and was significantly higher than in samples taken with the Cervex-Brush (0.0042 copies/cell) (P = 0.02). CONCLUSION: Sampling with the Cervex-Brush Combi resulted in the collection of the same amount of squamous cells, but in a two to threefold harvest of endocervical cells. This led to the detection of a higher viral load for oncogenic HPV and an increase in the number of detected abnormal smears.

Estimates of the number of female sex workers in different regions of the world.

OBJECTIVES: To collect estimated numbers of female sex workers (FSW) and present proportions of FSW in the female population (FSW prevalence) in different regions of the world. METHODS: Subnational and national estimated numbers of FSW reported in published and unpublished literature, as well as from field investigators involved in research or interventions targeted at FSW, were collected. The proportion of FSW in the adult female population was calculated. Subnational estimates were extrapolated to national estimates if appropriate. Population surveys were scanned for proportions of adult women having sex in exchange for money or goods. RESULTS: In sub-Saharan Africa, the FSW prevalence in the capitals ranged between 0.7% and 4.3% and in other urban areas between 0.4% and 4.3%. Population surveys from this same region yielded even higher proportions of women involved in transactional sex. The national FSW prevalence in Asia ranged between 0.2% and 2.6%; in the ex-Russian Federation between 0.1% and 1.5%; in East Europe between 0.4% and 1.4%; in West Europe between 0.1% and 1.4%; and in Latin America between 0.2% and 7.4%. Estimates from rural areas were only available from one country. CONCLUSIONS: Although it is well known and accepted that FSW are a highly vulnerable group in the scope of the HIV epidemic, most countries in the world do not know the size of this population group. The estimates of the prevalence of FSW presented in this paper show how important this hard-to-reach population group is in all parts of the world.

Antimicrobial resistance and serotypes of Shigella isolates in Kigali, Rwanda (1983 to 1993): increasing frequency of multiple resistance.

The serotype distribution and susceptibility to nine antibiotics was determined for 2491 Shigella isolates cultured in the medical laboratory of the Centre Hospitalier de Kigali, Rwanda, during 1983 to 1993. Overall, Shigella flexneri was the most frequent species, ranking before Shigella sonnei, Shigella boydii, and Shigella dysenteriae. However, the relative frequency of the different Shigella spp. showed an important variability over time. S flexneri increased from 40% in 1983 to 68% of the isolates in 1993 whereas S. dysenteriae Type 1 decreased gradually from 30 to 0.5% of the isolates in 1992. After the outbreak of severe civil unrest, which caused the displacement of many people to the capital, a new epidemic of dysentery started in the Kigali area and S. dysenteriae Type 1 accounted again for 24% of the isolates in 1993. In 1983, resistance to tetracycline, streptomycin, and sulfonamides was common among the endemic Shigella spp. Resistance to chloramphenicol was observed in 17% (30/182) of the isolates. Only 10% were resistant to ampicillin and an equal proportion to trimethoprim, whereas 5% of the isolates showed resistance to both products. By 1993, 66% (195/295) of the isolates were resistant to chloramphenicol (for comparison with 1983, p < 0.001), 70% (207/295) to ampicillin (p < 0.001), 67% to trimethoprim (p < 0.001), and 58% had combined resistance to the latter two drugs (p < 0.001). Resistance patterns differed strongly by species, S. flexneri being more frequently resistant than S. sonnei. In 1983, all S. dysenteriae Type 1 isolates were resistant to ampicillin, chloramphenicol, tetracycline, and sulfonamides. Trimethoprim resistance increased from 31% (25/80) in 1983 to 96% (26/27) of the isolates in 1986 (p < 0.001). After the introduction of nalidixic acid as an alternative for trimethoprim-sulfamethoxazole, trimethoprim resistance decreased to 87%, during 1987 to 1992, and subsequently to 68% of the isolates in 1993. However, 20% of the isolates became resistant to nalidixic acid in 1993. Ampicillin and trimethoprim-sulfamethoxazole are no longer useful for the empirical treatment of shigellosis in Rwanda.

Lymphangiectomy and treatment modalities in Merkel cell carcinoma: a report of five new cases.

Merkel-cell trabecular carcinoma of the skin has a prognosis poorer than expected for a small skin lesion. Surgery is central to actual treatment. A wide excision is indicated for localized disease. For selected cases we believe that an extensive resection of the draining lymphatics in continuity with the tumor should be performed. We have called this procedure "lymphangiectomy" in comparison to lymphadenectomy when the lymph nodes are removed. An early diagnosis and prompt treatment can contribute to improve the survival for this aggressive skin tumor.

[Epidemiological study on neonatal septicemia and meningitis in Belgium]. / Etude épidémiologique sur les septicémies et méningites néonatales en Belgique.

Epidemiological data were collected for 219 cases of neonatal septicaemia and/or meningitis. In two thirds of the cases the diagnosis was made in newborns aged 4 days or less. Risk factors related to the delivery, to the health status of the infant at birth and to pregnancy were mentioned respectively in 74, 63 and 36% of the cases. Half of the newborns given antibiotics in prophylaxis received an association of aminopenicillin and aminoside. In more than four fifths of the cases the bacterium was only isolated from blood. In newborns aged 4 days or less at the time of diagnosis, S. agalactiae was the most frequently isolated agent (50%). In newborns aged 5 days or more at the time of diagnosis, E. coli was the most frequent isolate (23%), followed by S. agalactiae and coagulase-negative Staphylococcus (20%). The lethality was 18%. About three fourths of the children dying from the infection, died during the first week of life. For the children who did not die during their stay in hospital, the duration of hospitalization was longer than 4 weeks in 41%.

Cyclospora sp.: a coccidian that causes diarrhoea in travellers.

Cyclospora sp. is a coccidian (protozoan) that has been incriminated in cases of diarrhoea in particular among travellers. We report two cases of intestinal Cyclospora infection in immunocompetent Belgians, who travelled to Indonesia. Although the diarrhoea persisted for several days recovery seemed to occur spontaneously.

The novel epidemic strain O139 is closely related to the pandemic strain O1 of Vibrio cholerae.

A new Vibrio cholerae serogroup O139 strain of unknown origin recently emerged in India and Bangladesh, causing a major outbreak of cholera. The genetic relationship between this epidemic strain and the O1 strain responsible for the 7th pandemic of cholera was studied by analyzing the DNA polymorphism of V. cholerae by pulsed-field gel electrophoresis and arbitrarily primed polymerase chain reaction. The restriction patterns of the reference strain O139 Bengal and 10 wild O139 strains isolated early in the Indian outbreak strikingly resemble that of the pandemic O1 strain of V. cholerae El Tor, thus suggesting a close genetic relationship among these strains. This similarity contrasts with the genetic heterogeneity of sporadic non-O1 strains isolated in various parts of the world. Study results strongly suggest that the new epidemic O139 strain is closely related to and might be derived from the pandemic O1 strain of V. cholerae.

Основные методы лабораторных исследований в клинической бактериологии.

В настоящей публикации объединены и модифицированы с учетом современных знаний различные рекомендации, разработанные ВОЗ в ходе многолетней работы по отбору образцов для исследований, идентификации микроорганизмов и определению их чувствительности к антибиотикам. Включенная в настоящую публикацию информация призвана привести к гармонизации микробиологических исследований, повышению чувствительности используемых тестов, а также улучшению качества работы как центральных лабораторий, так и лабораторий среднего звена. В центре внимания данной публикации общие методики исследований, а не конкретные методы микроскопии и окрашивания препаратов, которые нашли детальное отражение в другой публикации ВОЗ.

Antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae from Rwanda, 1984-1990.

A total of 383 clinical isolates of Streptococcus pneumoniae, obtained from an equal number of patients in Kigali, Rwanda, was tested for resistance to penicillin G with a 1 microgram oxacillin disc. Of these isolates, 99 (25.8%) showed reduced zones of inhibition. By means of an agar dilution method, 21% all isolates were confirmed as relatively resistant (MIC > or = 0.12- < or = 1.0 mg/l) strains of Streptococcus pneumoniae (RRSP). A high degree of resistance to penicillin G (MIC > or = 2 mg/l) was not observed. Resistance to chloramphenicol (MIC > or = 8 mg/l) was found in 31% RRSP and in 6% penicillin susceptible strains (PSSP). Doxycycline resistance was common in both RRSP and PSSP strains. All isolates remained fully susceptible to erythromycin. Children more often harboured a strain giving a reduced inhibition zone than did adults (74/230 versus 25/153; P = 0.0005). A total of 32 serotypes or serogroups were identified, seven of them relating to 64.8% all isolates typed. Of all the isolates 84% belonged to a serotype represented in the 23-valent vaccine or to a cross-reacting serotype. Serotype 25, not included in the vaccine, accounted for 10.7% typed isolates from adults but only for 2.0% typed isolates from children. Results of susceptibility testing and clinical experience suggest that penicillin G, ampicillin and chloramphenicol should not be used alone as empirical treatment for pneumococcal meningitis in patients in Rwanda.

Listeria monocytogenes infection of a prosthetic vascular graft.

A 75-year-old man was admitted for acute ischaemia of his right leg for which he had undergone vascular prosthetic surgery at another hospital, ten and three years before. Cultures of the thrombosed graft and the clots removed on re-operation were positive for Listeria monocytogenes. After parenteral treatment with amoxicillin-clavulanic acid and gentamicin, the patient died from cardiorespiratory failure.

Fluconazole-resistant Cryptococcus neoformans var gattii in an AIDS patient.

We describe a case of meningitis due to Cryptococcus neoformans var gattii in an AIDS patient. The reasons for the observed predominance of C. neoformans var neoformans infections in AIDS patients living in areas endemic for the gattii variety are not understood thus far. Treatment with fluconazole resulted in poor clinical and mycological response. In vitro sensitivity testing of the fungus revealed high minimal inhibitory concentrations, suggesting fluconazole resistance. Treatment with amphotericin B was successful.