Moving towards a reliable HIV incidence test - current status, resources available, future directions and challenges ahead.

In 2011 the Incidence Assay Critical Path Working Group reviewed the current state of HIV incidence assays and helped to determine a critical path to the introduction of an HIV incidence assay. At that time the Consortium for Evaluation and Performance of HIV Incidence Assays (CEPHIA) was formed to spur progress and raise standards among assay developers, scientists and laboratories involved in HIV incidence measurement and to structure and conduct a direct independent comparative evaluation of the performance of 10 existing HIV incidence assays, to be considered singly and in combinations as recent infection test algorithms. In this paper we report on a new framework for HIV incidence assay evaluation that has emerged from this effort over the past 5 years, which includes a preliminary target product profile for an incidence assay, a consensus around key performance metrics along with analytical tools and deployment of a standardized approach for incidence assay evaluation. The specimen panels for this evaluation have been collected in large volumes, characterized using a novel approach for infection dating rules and assembled into panels designed to assess the impact of important sources of measurement error with incidence assays such as viral subtype, elite host control of viraemia and antiretroviral treatment. We present the specific rationale for several of these innovations, and discuss important resources for assay developers and researchers that have recently become available. Finally, we summarize the key remaining steps on the path to development and implementation of reliable assays for monitoring HIV incidence at a population level.

Characterization of coagulase-positive staphylococci isolated from tank and silo ewe milk.

The prevalence of coagulase-positive staphylococci (CPS) was studied among 390 samples of ewe milk. Fifty-seven (14.85%) samples of tank milk and all samples (6) of silo milk gave a positive result on Baird-Parker agar base supplemented with rabbit plasma fibrinogen, whereas amplification of the coagulase (coa) gene was successful in 6 (1.56%) samples of tank milk and in all silo samples. Phenotypic and genetic analysis of 153 isolates identified 151 (98.69%) as Staphylococcus aureus. Amplification of the coa gene was positive for 149 isolates (97.39%). The staphylococcal enterotoxin (SE) C gene was detected in 116 strains (75.82%), whereas more than one SE gene was carried in 5 strains (3.26%). None of the isolates harbored the genes for SEE or for methicillin resistance. A high prevalence of CPS carrying enterotoxin genes should be of concern because ewe milk is mainly processed into raw milk cheeses. The detection of the coa gene from milk samples could help to assess the microbiological safety of raw milk intended for direct use in the dairy industry.

Carnosic acid dietary supplementation at 0.12% rates slows down meat discoloration in gluteus medius of fattening lambs.

Thirty-two Merino lambs fed barley straw and a concentrate alone (CONTROL) or enriched with vitamin E (VITE006) or carnosic acid (CARN006; CARN012) were used to assess the effect of these antioxidant compounds on meat quality attributes. The animals were slaughtered after being fed for at least 5weeks with the experimental diets. The longissimus lumborum samples of VITE006, CARN006 and CARN012 groups showed higher values (P<0.001) of L* (lightness) through the complete storage period under modified atmosphere when compared to the CONTROL group. Moreover, the VITE006 and CARN012 samples revealed lower discoloration when compared to the CONTROL group, these differences being more apparent in a less color stable muscle such as gluteus medius (P<0.05 for hue after 14days of refrigerated storage). Meat sensory traits were not significantly affected by carnosic acid and microbiological analyses were not conclusive at the doses administered.

Identification and epidemiological relationships of Aeromonas isolates from patients with diarrhea, drinking water and foods.

A collection of Aeromonas isolates obtained over a three-year period in the same geographic area (León, NW of Spain) was characterized by (GTG)5-PCR fingerprinting, amplified fragment length polymorphism (AFLP) analysis and gyrB gene sequence analysis. The isolates originated from human diarrheal stools (29 isolates), potable water (13 isolates), rabbit meat (13 isolates) and marine fish (5 isolates). The distribution of Aeromonas species varied with the strain source. Aeromonas caviae HG4 and Aeromonas media HG5 were predominant in clinical and water isolates, respectively, whereas motile Aeromonas salmonicida HG3 strains were most frequently found in fish and meat. Molecular typing revealed several genotypic relationships among specific isolate subsets: (i) two clones of A. media HG5 persisted in drinking water over the study period, (ii) different patients harbored identical or closely related clones during several months, and (iii) clonal relatedness was observed in two sets of water and human isolates. The first of these sets comprised nine water isolates and two human A. media HG5 isolates, whereas the other one included a water isolate and a human isolate of A. caviae HG4. The latter finding suggests that Aeromonas transmission in the studied region followed a waterborne route. Interestingly, the three human isolates closely related to water isolates were recovered in a period of four days in June 2006 from non-related patients without underlying medical conditions that tested negative for other enteric pathogens. The data imply the transmission through contaminated water of strains of the A. caviae group that can produce disease in humans.

Emission polarization control in semiconductor quantum dots coupled to a photonic crystal microcavity.

We study the optical emission of single semiconductor quantum dots weakly coupled to a photonic-crystal micro-cavity. The linearly polarized emission of a selected quantum dot changes continuously its polarization angle, from nearly perpendicular to the cavity mode polarization at large detuning, to parallel at zero detuning, and reversing sign for negative detuning. The linear polarization rotation is qualitatively interpreted in terms of the detuning dependent mixing of the quantum dot and cavity states. The present result is relevant to achieve continuous control of the linear polarization in single photon emitters.

Identity, virulence genes, and clonal relatedness of Aeromonas isolates from patients with diarrhea and drinking water.

Among 800 stool specimens from patients with diarrhea submitted by Primary Care Centers for routine analysis to the Hospital of León (NW Spain) Microbiology and Parasitology Service, 32 (4%) were tested positive for Aeromonas spp. Mixed infections with other enteric pathogens occurred in 12 patients. A. caviae was isolated from 23 clinical specimens. There were also patients infected with A. media, A. hydrophila, A. bestiarum, and A. veronii biovar veronii. All but three isolates carried one or more of the virulence genes. The incidence of the alt, hlyA, aerA, ast, and laf genes was 71.9, 28.1, 25.0, 18.8, and 9.4%, respectively. The alt(+)/ast(+) combination was detected in four isolates and the aerA(+)/hlyA(+) combination was detected in the two A. hydrophila isolates. None of the strains harbored the TTSS, stx1, or stx2 genes and nine bore plasmids. Thirty clinical isolates and a collection of 12 A. caviae and A. media strains obtained from León municipal drinking water over the study period were typed by pulsed-field gel electrophoresis (PFGE). PFGE patterns revealed genetic relatedness and persistence over time among water isolates and some clinical isolates. Interestingly, one A. caviae (aerA(-)/hlyA(-)/alt(+)/ast(-)/laf(+)) human isolate and two A. caviae (aerA(-)/hlyA(-)/alt(+)/ast(-)/laf(+)) drinking water isolates had indistinguishable PFGE patterns, suggesting waterborne infection.

Foodborne and indicator bacteria in farmed molluscan shellfish before and after depuration.

Galicia's coast (northwestern Spain) is a major producer of bivalve molluscs. Over an 18-month period, the presence of Salmonella, Aeromonas, Plesiomonas shigelloides, Vibrio parahaemolyticus, and Clostridium botulinum was determined by PCR methods in mussels (22 batches) and infaunal bivalves (31 batches of clams and cockles) before and after depuration. All batches were harvested from Galician class B harvesting areas where bivalve molluscs must not exceed 4,600 Escherichia coli per 100 g of flesh and liquor in 90% of the samples. Virulence-associated genes of Salmonella (invA), Aeromonas (aerA, hlyA, alt, ast, and laf), P. shigelloides (hugA), V. parahaemolyticus (tdh and trh), and C. botulinum (BoNT) were not detected. The pR72H chromosomal DNA fragment, which is conservative in V. parahaemolyticus strains, was detected in five (4.7%) samples. A number of 192 suspect isolates did not fit the description of clinical Aeromonas phenospecies, pathogenic Vibrio spp., or P. shigelloides. The effectiveness of commercial depuration in reducing bacterial indicators was also examined. E. coli was reduced to < or = 230/100 g of flesh and liquor in 90.9% of mussel lots but in only 70.9% of infaunal bivalve lots. For total coliform elimination, mussels were also more effective. Total counts significantly (P < 0.005) correlated with numbers of Pseudomonas, Aeromonas, and Vibrio. Our data indicate that Salmonella and pathogenic bacteria indigenous to estuarine environments do not appear to be significant hazards in Galician molluscan shellfish. A reason for concern, however, is that clearance of E. coli to acceptable levels was not always achieved especially in infaunal bivalves.

Cuidados paliativos y tratamiento del dolor en la solidaridad internacional / Palliative care and pain treatment: international solidarity

Los cuidados paliativos (CP) y el tratamiento del dolor (TD) son elementos esenciales para mejorar o mantener la calidad de vida de muchos enfermos afectados por procesos incurables, crónicos o terminales. Su necesidad se acentúa en países con bajos y medianos recursos donde la incidencia del cáncer y de otras enfermedades como el sida va en aumento, con una alta proporción de pacientes diagnosticados en fase avanzada y con un muy difícil acceso a unos CP o TD adecuados, a pesar de que son la única alternativa realista y humana al abandono que sufren la gran mayoría de estos enfermos. Además el perfil epidemiológico de muchos países del sur está cambiando con un aumento de enfermedades crónicas y el acceso a niveles más altos de cobertura de antirretrovirales. Para modificar esta situación, los gobiernos deben incorporar los CP y el TD en sus sistemas de salud. También es necesario que éstos se consideren una forma más de cooperación internacional. Se revisan diversos aspectos para una mayor colaboración sanitaria española en este campo con Latinoamérica y África, y se sugieren vías para hacerlo a distintos niveles institucionales y asociativos (AU)

Palliative care and pain treatment are essential to improve or maintain quality of life in many patients with incurable, chronic or terminal diseases. The need for palliative careis more pressing in countries with scarce or medium resources and where the incidence of cancer and other diseases such as AIDS is increasing. In these countries, a high proportion of patients are diagnosed in the advanced stage of the disease and access to appropriate palliative care and pain treatment is difficult, even though these options are the only realistic and human alternatives to the abandonment experienced by most of these patients. Moreover, the epidemiological profile of many southern countries is changing, with an increase of chronic diseases and access to higher levels of antiretroviral coverage. To modify this situation, governments should incorporate palliative care and pain treatment in their health systems and these options should also be seen as one more form of international cooperation. The present article reviews several factors required for greater healthcare collaboration between Spain and Latin America and Africa and suggests ways to achieve this collaboration through distinct institutions and associations (AU)

Hematoma of the floor of the mouth and airway obstruction during mandibular dental implant placement: a case report.

BACKGROUND: Hematoma of the floor of the mouth during mandibular dental implant placement is a rare but potentially life-threatening complication. REPORT: A 53-year-old man developed a hematoma of the floor of the mouth following a dental implant procedure, requiring admission to the hospital. SUMMARY: The floor of the mouth is richly vascularized by a number of branches of the submental and sublingual arteries. During a dental implant procedure in the anterior zone of the mandible, perforation of the lingual cortex may invade the floor of the mouth and therefore damage structures within the sublingual space. The anatomy of the lower portion of the anterior mandibular zone, with the mylohyoid ridge, makes it particularly vulnerable to this kind of injury, particularly in patients with atrophic mandibles. Only a few cases have been reported in the literature to date.

The quality of sero-surveillance in low- and middle-income countries: status and trends through 2007.

OBJECTIVE: To examine the quality of HIV sero-surveillance systems in 127 low-income and middle-income countries by 2007, as well as gaps in data needed for reliable estimates of HIV prevalence and size of populations at risk for infection. METHODS: The quality of countries' surveillance systems was scored using information from 2001 through 2007. Sero-surveillance data were compiled from the US Census Bureau's HIV/AIDS Surveillance Database, from countries' national HIV surveillance reports available to UNAIDS, from demographic and health survey (DHS) data, from the scientific literature and from countries' Estimation and Projection Programme (EPP) data files. The quality of systems was scored according to the classification of the epidemic in each country (generalised, concentrated or low-level). RESULT: The number of countries categorised as fully functioning in 2007 was 40. 43 countries were identified as partially functioning while 44 were categorised as poorly functioning. Low scores were most often attributed to a lack of recent data or data from appropriate risk groups. CONCLUSION: Many countries still have poorly functioning surveillance systems. The inclusion of HIV testing in national population-based surveys in recent years has resulted in some countries with generalised epidemics receiving higher coverage scores, but many countries with concentrated or low-level epidemics continue to lack data on high-risk populations.

Utilización de Colloss(R) para el tratamiento de quistes mandibulares. Descripción de una serie clínica / The use of lyophilized bovine collagen (Colloss(R)) for treating mandibular cysts. Description of a clinical series

La enucleación de quistes óseos conlleva la aparición de defectosóseos. Se acepta que los cuando son menores de 3 cm. de diámetro y están alejados del reborde alveolar se rellenan de hueso neoformado en unos meses. Por el contrario, defectos óseos mayores no regeneran completamente."Colloss(R)" parece ser un interesante material osteoinductivo. Se tratade un complejo liofilizado de las proteínas extracelulares extraídas del huesobovino diafisario. Contiene fundamentalmente colágeno tipo I y cantidadesvariables de BMPs. En el período comprendido entre Febrero de 2002 y Enerode 2004 se utilizó colágeno liofilizado bovino para la reconstrucción ósea de7 pacientes con quistes mandibulares tratados en el Hospital Universitario LaPaz (Madrid). Este material se combinó con injertos óseos autólogos o conmallas de titanio en varios de los casos. Se observó en la totalidad de los casosuna adecuada regeneración ósea. En dos de los casos, en los que se mezcló Colloss(R) con hueso autólogo se produjo el rechazo de este último. Tras susretirada el proceso curativo discurrió sin incidencias. También se constatóuna tendencia a la exposición intraoral de las mallas de titanio sin que ellose viese reflejado en el proceso de curación. Podemos señalar como ventajasde la utilización del colágeno liofilizado bovino (Colloss(R)) para el tratamiento de quistes odontogénicos: su capacidad osteoinductiva demostrada;la ausencia de efectos adversos de importancia y su utilidad en la determinaciónprecoz de recidivas. Como posibles desventajas destacaríamos: sudifícil manejo; la conveniencia de encontrar un carrier adecuado que permitieseuna manipulación más sencilla, la necesidad de ajustar la dosis necesariade forma precisa y, por último, las complicaciones potenciales relacionadascon cualquier tipo de xenoinjerto de origen bovino (AU)

The treatment of mandible bone cysts commonly leadsto the development of bone defects. When the defects are less than 3 cm and located away from the alveolar ridge, they usually heal spontaneously within a 6 to 12 month period. However, if the defectis larger, the regenerative ability of the body is overcome. Colloss(R) appears to be an interesting osteoinductive biomaterial. It is alyophilized complex from extracellular matrix proteins of bovine bone. It is composed primarily of type I collagen and variablea mounts of BMPs. Between February 2002 and January 2004, 7 patients with mandible cysts were treated with lyophilized collagen to enhance bone regeneration. In some of the cases this was combined withaut ologous bone or a titanium mesh. We observed incompatibility with autologous bone and a slight tendency for intraoral exposure of the titanium mesh. Apart from this, we noted adequate bonehealing and regeneration in all the cases.For the authors of this paper, the advantages of lyophilized collagenare the following: osteoinductive capacity, absence of any major adverse effects and the role played in the early detection of recurrence. Its possible disadvantages are its difficult handling and the inherent complications related to bovine xenografts (AU)

La enfermedad de Kimura: comunicación de un caso en un varón caucásico y revisión de la literatura / Kimura disease: Report of a case in a Caucasian male and revision of the literature

La enfermedad de Kimura es un trastorno inflamatorio que afecta principalmente a sujetos de origen asiático. Se manifiesta por la existencia de masas de tejido subcutáneo y subplatismal generalmente en la cabeza y el cuello. Suele acompañarse de linadenopatías, y aumento de los niveles de eosinófilos e IgE en sangre periférica. Comunicamos un caso de enfermedad de Kimura, descubierto en un varón caucasiano, tras una biopsiaexcisional de una masa cervical

Kimura disease is a chronic inflammatory disorder mainlyinvolving Asians. It often presents as soft-tissue nodes or lymphadenopathy of the head and neck. Commonly associated with increased levels of eosinophils and IgE in peripheral blood. We report a case of Kimura disease in a Caucasian, diagnosed after lymph node and submaxillary gland removal

The 2005 Workbook: an improved tool for estimating HIV prevalence in countries with low level and concentrated epidemics.

OBJECTIVE: This paper describes improvements and updates to an established approach to making epidemiological estimates of HIV prevalence in countries with low level and concentrated epidemics. METHODS: The structure of the software used to make estimates is briefly described, with particular attention to changes and improvements. DISCUSSION: The approach focuses on identifying populations which, through their behaviour, are at high risk of infection with HIV or who are exposed through the risk behaviour of their sexual partners. Estimates of size and HIV prevalence of these populations allow the total number of HIV infected people in a country or region to be estimated. Major changes in the software focus on the move away from short term projections and towards developing an epidemiological curve that more accurately represents the change in prevalence of HIV over time. The software continues to provide an output file for use in the Spectrum software so as to estimate the demographic impact of HIV infection at country level.

National population based HIV prevalence surveys in sub-Saharan Africa: results and implications for HIV and AIDS estimates.

BACKGROUND: Sentinel surveillance among pregnant women attending antenatal clinics (ANCs) has been the main source of information on HIV trends in sub-Saharan Africa. These data have also been used to generate national HIV and AIDS estimates. New technologies and resources have allowed many countries to conduct national population based surveys that include HIV prevalence measurement, as an additional source of information on the AIDS epidemic. METHODS: The authors reviewed the reports of 20 national population based surveys from 19 countries carried out in sub-Saharan Africa since 2001. They examined the sampling methodology, HIV testing and response rates, and female:male and urban:rural prevalence ratios. They also constructed adjusted prevalence scenarios assuming different relative risks for survey non-responders. RESULTS: The national population based surveys vary considerably in quality, as reflected in the household response rate (ranging from 75.4% to 99.7%), women's testing rate (ranging from 68.2% to 97.3%), and men's testing rate (ranging from 62.2% to 95.4%), while for some surveys detailed response information is lacking. While 95% confidence intervals around the female:male and urban:rural prevalence ratios in individual countries are large, the median female:male ratio of the combined set of surveys results is 1.5 and the median urban:rural ratio 1.7. A scenario assuming that non-responders have twice the HIV prevalence of those who fully participated in the survey suggests that individual non-response could result in an adjusted HIV prevalence 1.03 to 1.34 times higher than the observed prevalence. CONCLUSIONS: Population based surveys can provide useful information on HIV prevalence levels and distribution. This information is being used to improve national HIV and AIDS estimates. Further refinements in data collection, analysis, and reporting, combined with high participation rates, can further improve HIV and AIDS estimates at national and regional level.

Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti.

OBJECTIVE: To determine whether observed changes in HIV prevalence in countries with generalised HIV epidemics are associated with changes in sexual risk behaviour. METHODS: A mathematical model was developed to explore the relation between prevalence recorded at antenatal clinics (ANCs) and the pattern of incidence of infection throughout the population. To create a null model a range of assumptions about sexual behaviour, natural history of infection, and sampling biases in ANC populations were explored to determine which factors maximised declines in prevalence in the absence of behaviour change. Modelled prevalence, where possible based on locally collected behavioural data, was compared with the observed prevalence data in urban Haiti, urban Kenya, urban Cote d'Ivoire, Malawi, Zimbabwe, Rwanda, Uganda, and urban Ethiopia. RESULTS: Recent downturns in prevalence observed in urban Kenya, Zimbabwe, and urban Haiti, like Uganda before them, could only be replicated in the model through reductions in risk associated with changes in behaviour. In contrast, prevalence trends in urban Cote d'Ivoire, Malawi, urban Ethiopia, and Rwanda show no signs of changed sexual behaviour. CONCLUSIONS: Changes in patterns of HIV prevalence in urban Kenya, Zimbabwe, and urban Haiti are quite recent and caution is required because of doubts over the accuracy and representativeness of these estimates. Nonetheless, the observed changes are consistent with behaviour change and not the natural course of the HIV epidemic.

Behavioural data as an adjunct to HIV surveillance data.

BACKGROUND: Second generation surveillance for HIV aims to improve the validity and utility of routine serial HIV prevalence data. It includes the collection of data on sexual behaviour and sexually transmitted disease prevalence. METHODS: This paper reviews the function of sexual behaviour data in HIV surveillance and the methods used to determine which behaviours are monitored and how changes in behaviour can be assessed. RESULTS: Sexual behaviour data provide a poor predictor of the future spread of HIV, but these data can provide corroboration of changes in HIV incidence and assist in attributing changes to particular aspects of risk. Significance tests should be used to assess changes in behaviour, but this requires transparent reporting of methods and sample sizes. CONCLUSIONS: Collection of behavioural data will provide important retrospective information about the HIV epidemic progress and should not be neglected because of the focus on improving HIV sero-surveillance.

Variation in resistance of natural isolates of Staphylococcus aureus to heat, pulsed electric field and ultrasound under pressure.

AIMS: To study and compare the resistance of 15 Staphylococcus aureus isolates to heat, pulsed electric field (PEF) and ultrasound (UW) under pressure (manosonication, MS). METHODS AND RESULTS: Survival curves to heat (58 degrees C), to PEF (22 kV cm(-1), 2 micros square wave pulses) and to UW under pressure (117 microm, 20 kHz, 200 kPa) were obtained and inactivation parameters (decimal reduction times for heat and UW under pressure, and b-values for PEF) were calculated. A wide resistance variation to heat treatment, but not to PEF and MS, was observed amongst the 15 strains. CONCLUSIONS: There was no relationship between the resistances to the three physical agents studied. Staphylococcus aureus was relatively resistant to MS but sensitive to PEF. Heat resistance varied with strain and was positively correlated to carotenoid pigment content. SIGNIFICANCE AND IMPACT OF THE STUDY: Results would help in defining safe food preservation processes. Care should be taken to choose the most adequate strain of S. aureus to model food preservation processing.

The workbook approach to making estimates and projecting future scenarios of HIV/AIDS in countries with low level and concentrated epidemics.

This paper describes an approach to making estimates and short term projections of future scenarios of HIV/AIDS in countries with low level and concentrated epidemics. This approach focuses on identifying populations which through their behaviour are at higher risk of infection with HIV or who are exposed through the risk behaviour of their sexual partners. Estimates of the size and HIV prevalence of these populations allow the total number of HIV infected people in a country or region to be estimated. Subsequently, assumptions about the possible level and timing of saturation of HIV prevalence among each population can be used to explore future scenarios of HIV prevalence. The basic structure of the software used to make estimates and projections is described. This software includes a set of consistency and audit checks to help exclude unrealistic projections. The paper also discusses the strengths and weakness to this approach to making estimates and projections of HIV/AIDS in countries with low level and concentrated epidemics.

A global analysis of trends in the quality of HIV sero-surveillance.

OBJECTIVE: To examine the quality of HIV sero-surveillance systems in countries by 2002, as well as trends between 1995 and 2002. METHODS: The quality of countries' surveillance systems was scored for five years: 1995, 1997, 1999, 2001, and 2002. Sero-surveillance data were compiled from the US Census Bureau's HIV/AIDS Surveillance Database, the EuroHIV database, and from countries' national HIV surveillance reports that were available to WHO/UNAIDS. The quality of systems was scored according to the level of the countries' epidemic. RESULTS: There has been a large variation in the quality of HIV surveillance systems across the 132 countries by type of the epidemic and over time from 1995 to 2002. Over the 1995-2002 period the number of countries with a fully implemented system decreased from 57 (43%) in 1995 to 48 (36%) in 2002. The proportion of countries with a fully implemented system was 58%, 34%, and 10% in countries with a generalised, concentrated, and low level epidemic, respectively. In the 53 countries with generalised epidemics the number of countries with a fully implemented system increased from 24 (45%) in 2001 to 31 (58%) in 2002. CONCLUSION: Many countries still have poor functioning HIV surveillance systems and require urgent strengthening. Countries should monitor and evaluate their own HIV surveillance systems and examine whether the systems are appropriate and adequate.