[Improvement of antibiotic therapy adequacy with local guidelines and their reassessment through a multidisciplinary action: Prospective study in an Internal Medicine department]. / Amélioration de l'adéquation des antibiothérapies aux recommandations et de leur réévaluation par une action pluridisciplinaire : étude prospective dans un service de médecine interne.

INTRODUCTION: The implementation of antimicrobial stewardship actions is important in the fight against antimicrobial resistance. The objective of our study was to evaluate the impact of a multidisciplinary program on the adequacy of antibiotic prescriptions with local guidelines in terms of indication, molecule, dosage and treatment duration during the 48-72h reassessment in an internal medicine department. METHOD: This was a before/after monocentric, prospective study. All patients hospitalized in the internal medicine department who were treated with antibiotics for at least 48h were included. The intervention had two components: training of residents about antibiotic treatment and development of a multidisciplinary 48-72h reassessment team. Our primary endpoint was the adequacy of prescriptions with local guidelines, assessed by an independent blinded committee. We also measured antibiotic consumptions. RESULTS: One hundred and twelve patients were included. Adequacy with local recommendations increased from 57.1% to 97.8% (P<0.01), including for the duration of treatment. Traceability of reassessment in medical records increased from 65.3 % to 97.8 % (P<0.01). Finally, the part of consumption of antibiotics with high risk of resistance selection decreased during the period "after" (-10.2 %, P<0.01). CONCLUSION: The set-up of a multimodal (association of pedagogic and incentive actions) and multidisciplinary (internist, clinical pharmacist and antimicrobial stewards) action improved the adequacy of antibiotic prescriptions with local guidelines.

Citrus Viroids: Symptom Expression and Performance of Washington Navel Sweet Orange Trees Grafted on Carrizo Citrange.

Citrus are natural hosts of several viroid species. Citrus exocortis viroid (CEVd) and Hop stunt viroid (HSVd) are the causal agents of two well-known diseases of citrus, exocortis and cachexia. Other viroids have been found to induce specific symptoms and different degrees of stunting in trees grafted on trifoliate orange and trifoliate orange hybrids. A field assay was initiated in 1989 to establish the effect of CEVd, HSVd, Citrus bent leaf viroid (CBLVd), Citrus dwarfing viroid (CDVd), and Citrus bark cracking viroid (CBCVd) on Washington navel sweet orange trees grafted on Carrizo citrange rootstock. Here we report the effect of viroid infection on symptom expression, tree size, fruit production and quality evaluated from 2004 to 2007. Vegetative growth was affected by viroid infection with height and canopy volume being reduced. No bark scaling symptoms were observed in CEVd-infected trees albeit they presented lesions and blisters in the roots. Bark cracking symptoms were consistently observed in CBCVd-infected trees that were smaller with enhanced productivity and fruit size. No major effects were found as a result of infection with CBLVd, HSVd, or CDVd. The quality of the fruits was not affected by viroid infection, except for the low diameter of the fruits harvested from HSVd-infected trees. An interesting effect was identified in terms of tree productivity increase (yield/canopy volume) as a result of infection with CEVd, CDVd, and especially CBCVd.

First Report of Citrus viroid V in Moro Blood Sweet Orange in Iran.

Viroids are nonencapsidated, small, circular, single-stranded RNAs that replicate autonomously when inoculated in their host plants in which they may elicit diseases (sensitive hosts) or replicate as latent infections (tolerant hosts). Citrus viroid V (CVd-V) was initially identified in Spain (1) and later found to be present in the United States, Nepal, and the Sultanate of Oman (2). CVd-V is a member of the Apscaviroid genus within the Pospiviroidae family. Like other members of this genus, CVd-V has a restricted host range but it is able to infect a wide range of citrus and citrus related species (1,2). Within the framework of a comprehensive survey of the sanitary status of the citrus industry in Iran, a sample from a private orchard of symptomless Moro blood sweet orange (Citrus sinensis) trees grafted on Mexican lime (C. aurantifolia) located at Javanan in the southern inland region was found to be infected with CVd-V. Briefly, RNAs of nucleic acid preparations from bark tissues were separated by 5% polyacrylamide gel electrophoresis (PAGE), electrotransferred to positively charged nylon membranes, immobilized by UV cross-linking, and hybridized with a full length CVd-V specific digoxigenin (DIG)-labeled DNA probe (2). A positive identification of CVd-V was made in these extracts. This positive detection of CVd-V was confirmed by reverse transcription-PCR using CVd-V specific primers of opposite polarity (5'-GACGAAGGCCGGTGAGCAGTAAGCC-3') and (5'-GACGACGACAGGTGAGTACTTTC-3') corresponding to CVd-V positions 90 to 114 and 69 to 89, respectively. Analysis of the sequence of the 293-bp amplicon (Genbank Accession No. GQ466068) revealed 99% identity with the reference sequence (Genbank Accession No. NC010165) of CVd-V. The rod-like predicted minimum free energy secondary structure of this new variant has 68.3% paired nucleotides. The changes with respect to the reference CVd-V variant are: (i) a deletion (48→-U) located in a loop of the V domain; (ii) a substitution (155A→C) located in a loop of the TR domain of the viroid secondary structure; and (iii) two compensatory substitutions located in the upper (46A→G) and lower (244U→C) strands of the viroid secondary structure. As shown earlier, the genome of CVd-V allows little variation with a large loop located in the segment I of the secondary structure (2) being the most amenable for mutations/changes. Among the viroids that have been found naturally infecting citrus, the members of the genus Apscaviroid are not associated with specific diseases but they cause a reduction of tree size and fruit harvest (3), an effect that is enhanced when several viroids coinfect the same plant (4). Therefore, the presence of CVd-V should be considered in further indexing tests aimed at the production and distribution of pathogen-free plants in Iran. References: (1) P. Serra et al. Virology 370:102, 2008. (2) P. Serra et al. Phytopathology 98:1199, 2008. (3) C. Vernière et al. Plant Dis. 88:1189, 2004. (4) C. Vernière et al. Phytopathology 96:356, 2006.

Molecular and biological characterization of natural variants of Citrus dwarfing viroid.

Citrus dwarfing viroid has been proposed as an agent to control tree size in high-density plantations. Thirty-three field isolates have been characterized, and the most frequent sequence/s have been identified. Five distinct variants were selected for biological characterization. Symptom expression analysis demonstrated a good correlation between leaf/stem symptoms and plant growth. The discriminating nucleotide sequence differences included two deletions and an insertion resulting in a reorganization of the base pairing of the terminal left loop, two (G42 --> A and C52 --> U) changes found in one of the variants, and as many as thirteen changes located in the right and left regions flanking the CCR.

TiO2 nanofibre assisted photocatalytic degradation of reactive blue 19 dye from aqueous solution.

The photocatalytic degradation of Reactive Blue 19 (RB19) dye has been studied using TiO2 nanofibre as the photocatalyst in aqueous solution under UV irradiation. Titanium dioxide nanofibre was prepared using a templating method with tetraisopropylorthotitanate as a precursor. The experiments were carried out in the presence of the TiO2 nanofibre, and the effects of pH and electron acceptors on the degradation process were investigated. In order to observe the quality of the aqueous solution, chemical oxygen demand (COD) measurements were also carried out before and after the treatments. The photocatalytic decomposition of RB19 was most efficient in acidic solution. With the addition of hydrogen peroxide and potassium persulphate, as electron acceptors, into illuminated TiO2 nanofibre suspensions, a synergistic effect was observed leading to an enhancement of the decolorization. From experimental results, under the condition of 1 g TiO2 nanofibre l(-1), pH 3, and UVC light irradiation, decolorization would be complete in two hours. A significant decrease in the COD values was observed, which clearly indicates that the photocatalytic method offers good potential for the removal of RB19 from aqueous solution. The kinetic of photocatalytic removal of RB19 followed the Langmuir-Hinshelwood model. These results suggest that TiO2 nanofibres with UV photocatalysis can be envisaged as a method for the treatment of coloured wastewaters, in particular in textile industries.

Effect of a Field-Source Mixture of Citrus Viroids on the Performance of 'Nules' Clementine and 'Navelina' Sweet Orange Trees Grafted on Carrizo Citrange.

A field-source mixture of citrus viroids was characterized and shown to contain Citrus exocortis viroid (CEVd), Hop stunt viroid (HSVd), Citrus bent leaf viroid (CBLVd), and Citrus dwarfing viroid (CDVd). Sequencing results showed that: (i) CEVd contained the PL and PR characteristic of class A variants; (ii) HSVd was a noncachexia variant; (iii) CBLVd was related to CVd-Ia variants; (iv) CDVd was a mixture of two types (CVd-IIIa and CVd-IIIb) of variants. The presence of the same type of variants in inoculated clementine (Citrus clementina 'Nules') and sweet orange (C. sinensis 'Navelina') trees on Carrizo citrange (Poncirus trifoliata × C. sinensis) rootstocks was confirmed. The effect of infection was determined by assessing the performance of infected and noninfected trees growing in the field. Infection resulted in small trees with reduced canopy, yielding a reduced crop. Fruit characteristics were also affected: (i) clementine and sweet orange fruits from infected trees were larger than those from noninfected trees; (ii) clementine fruits from infected trees differed in shape from those of noninfected trees; (iii) sweet orange fruits from infected trees had maturity indexes and juice contents higher than those from noninfected trees; (iv) in both species, the density of the juice, the amount of soluble solids, and the acidity of the fruits from infected trees were lower than those of fruits from noninfected trees. Infected trees had a poorly developed root system with fibrous roots containing fewer amyloplasts than noninfected trees. The results of an in vitro assay on the induction and development of roots in cultured explants are discussed.

Citrus viroid V: occurrence, host range, diagnosis, and identification of new variants.

The recently described Citrus viroid V (CVd-V) has been proposed as a new species of the genus Apscaviroid within the family Pospiviroidae. Analysis of 64 samples from different citrus-growing areas has shown that CVd-V is present in the United States, Spain, Nepal, and the Sultanate of Oman. CVd-V found in six sweet orange sources from the Sultanate of Oman was identical to the reference CVd-V variant, whereas three new variants with sequence identities of 98.6% (CVd-VCA), 97.3% (CVd-VST), and 94.9% (CVd-VNE) were identified in sources from California, Spain, and Nepal, respectively. These results suggest that this viroid has not emerged recently and that it is relatively widespread. Transmission assays to sweet orange, mandarin, and mandarin hybrids, clementine, satsuma, lemon, sour orange, Tahiti lime, Palestine sweet lime, calamondin, bergamot, and kumquat have shown that all these citrus species and citrus relatives are hosts for CVd-V. Several indexing approaches, including slot blot, northern blot hybridization, and reverse transcription-polymerase chain reaction, have been evaluated for detecting CVd-V, either using Etrog citron as an amplification host or directly from commercial species and cultivars.

Posttreatment of upflow anaerobic sludge blanket-treated industrial wastewater by a rotating biological contactor.

The performance of a rotating biological contactor (RBC) for posttreatment of the slaughterhouse effluent from an upflow anaerobic sludge blanket (UASB) reactor was investigated in this study. The 280-L, six-stage RBC pilot plant was operated at different organic loading rates (OLRs) and biodisk speeds. The overall removal efficiencies for soluble biochemical oxygen demand (SBOD), total biochemical oxygen demand (TBOD), and total chemical oxygen demand (TCOD) decreased with increasing OLRs. Disk rotational speed did not have a significant effect on performance in the range studied. The results showed that satisfactory posttreatment to meet regulatory requirements for agricultural purposes (effluent biochemical oxygen demand of 100 mg/L) can be achieved at an OLR of 5.3 +/- 2.9 g SBOD x m(-2) x d(-1), with an SBOD removal efficiency of 85 +/- 3%. Most of the organics were removed in the first three stages, with minimal contribution from the remaining stages of the RBC reactor. There was a decrease in SBOD removal efficiency to 74 +/- 3% at an OLR value of 17.8 +/- 2.1 g SBOD x m(-2) x d(-1). The results for elimination capacity indicated a linear relationship with first-stage OLRs without any signs of limitation at the range of loading rates investigated in this study. However, average first-stage elimination capacity rates of 4.8 and 3.8 g x m(-2) x d(-1) at OLR values of 17.8 and 11 g SBOD x m(-2) x d(-1) were relatively lower than previous studies of RBC performance using domestic or industrial wastewater without anaerobic pretreatment. It was suggested that the lower elimination capacity rates were due to the fact that a smaller fraction of UASB effluent was biodegradable as reflected in TBOD/TCOD ratios of 0.47 +/- 0.04.

Video-assisted thoracoscopic surgical (VATS) closure of Patent Ductus Arteriosus: report of three-hundred cases.

BACKGROUND: Video-Assisted Thoracoscopic Surgery (VATS) has recently been used for Patent Ductus Arteriosus (PDA) closure on a routine basis. Our experience with this technique is supporting its efficacy. The results and advantages of VATS are the same as when thoracotomy is being performed. METHODS: From June 1997 to October 2000, there were 300 consecutive patients (mean age: 6 years old) with PDA recognized by echocardiography and/or cardiac catheterization, on whom VATS were studied. With the patients under general anesthesia, three 5 mm holes were made through the left thoracic wall. A video camera and specialized surgical devices were introduced. The ductus was dissected, and two titanium clips were applied for complete closure of the ductus. Exclusion criteria were: 1) Diameter of the ductus > 9 mm, 2) Complicated PDA such as aneurysm formation, endocarditis, and calcification, 3) Pleural adhesion and/or left sided thoracic operation in the past. RESULTS: All cases were re-assessed immediately after the procedure, and followed up by control echocardiography. No significant complication and residual shunt was recorded during the observation period. The procedure was changed to thoracotomy in three adult patients due to an inappropriately dilated canal (>9mm). Moreover, two other patients developed transient recurrent laryngeal nerve dysfunction. Mean procedure time was about 20 +/- 2 minutes. All patients were discharged shortly after the procedure (approximately 20 hours). CONCLUSION: Our results suggest that VATS compared to other techniques for PDA closure is rapid, cost-effective, painless and more cosmetic.