Severe gram positive bacterial infection in an ulcerative colitis patient treated with Infliximab

Tumour necrosis factor-alpha (TNF-α) inhibitors represent an important treatment advance for a number of inflammatory conditions, including inflammatory bowel disease. Since their introduction in 1999, it has become clear that some biological therapies may be associated with an increased risk for bacterial infections. Herein we present the first case of septic arthritis and spine empyema, caused by S. aureus, in a 63 year-old patient with ulcerative colitis, who was under treatment with Infliximab and with 40mg per day of prednisolone.

[Sedation used during colonoscopies at the Peruvian-Japanese policlinic. Their relationship with quality indicators]

INTRODUCTION

The practice of sedation used during colonoscopy vary widely between countries, even gastroenterologists and endoscopy centers. Knowing the type of sedation used at present and its relationship to quality indicators of colonoscopy, will help improve the quality of it.

OBJECTIVES

To determine the type of sedation used for colonoscopies in the Japanese Peruvian Polyclinic, and its relation to quality indicators in colonoscopy: cecal intubation rate and detection rate of adenomas

MATERIAL AND METHODS

A retrospective cross-sectional correlational. Data were recorded colonoscopies performed in the Japanese Peruvian Polyclinic during 2007, which were conducted by 10 endoscopists

RESULTS

We included 843 colonoscopies, of which 63.1% received moderate sedation, deep sedation, 36.7% and only 0.2% received no sedation. Moderate sedation was performed most commonly with the combination midazolam + meperidine, whereas deep sedation propofol used almost exclusively in combination with other agents. An anesthesiologist was present in 38.4% of the colonoscopies. Statistical analysis showed significant differences in cecal intubation rate when deep sedation was used: 96.1% compared to the moderate: 94.5% (p = 0.009). Equally significant difference in adenoma detection rate with deep sedation, 26.9%, compared with the moderate: 15.8% (p = 0.000). Immediate complications were reported in 9% of procedures was more common when deep sedation was used: 13.3% compared to the moderate: 6.4% (p = 0.003).

CONCLUSIONS

The moderate sedation was the most common method of sedation used for colonoscopies in the Japanese Peruvian Polyclinic. Deep sedation was associated with higher rates of cecal intubation and adenoma detection, but also in more immediate complications.

KEYWORDS

sedation, colonoscopy, colonoscopy quality.

Evidence for a discrete evolutionary lineage within Equatorial Guinea suggests that the tsetse fly Glossina palpalis palpalis exists as a species complex

Tsetse flies of the palpalis group are major vectors of Human African Trypanosomiasis in Africa. Accurate knowledge of species identity is essential for vector control. Here, we combine ribosomal internal transcribed spacer 1 (ITS1), mitochondrial Cytochrome Oxidase 1 (COI) and microsatellites to determine the population structure and phylogenetic relations of Glossina p. palpalis in Equatorial Guinea. CO1 sequence data suggest that G. p. palpalis in Equatorial Guinea is a distinct subspecies from previously described G. p. palpalis in West Africa and Democratic Republic of Congo. Glossina p. palpalis in Equatorial Guinea and DRC share a common ancestor which diverged from West African G. p. palpalis around 1.9 Ma. Previous ITS1 length polymorphism data suggested the possible presence of hybrids in Equatorial Guinea. However, ITS1 showed incomplete lineage sorting compared with clearly defined COI groups, and data from 12 unlinked microsatellites provided no evidence of hybridization. Microsatellite data indicated moderate but significant differentiation between the populations analysed (Rio Campo, Mbini and Kogo). Moreover, unlike previous studies of G. p. palpalis, there was no evidence for heterozygote deficiency, presence of migrants or cryptic population structure. Variance effective population size at Rio Campo was estimated at 501-731 assuming eight generations per year. This study of the population genetics of G. p. palpalis in central Africa provides the first estimate of genetic differentiation between geographically separated G. p. palpalis populations.

High levels of hybridization between molecular forms of Anopheles gambiae from Guinea Bissau

In the malaria vector Anopheles gambiae Giles sensu stricto, two molecular forms denoted M and S are considered units of incipient speciation within this species. Very low hybrid frequencies and significant genetic differentiation have been found in sympatric M- and S-form populations. We studied the molecular form composition and the degree of genetic differentiation at 15 microsatellites in two samples of An. gambiae collected in two consecutive years from Bissau, Guinea Bissau. High frequencies of M/S hybrids (19-24%) were found in this area. Coincidently, very low levels of genetic differentiation were detected between forms when analysis involved microsatellites mapped at chromosome-3 (mean Fst, 0.000-0.002). The single exception was the X-linked AGXH678, for which high differentiation was measured (Fst, 0.158-0.301). This locus maps near the centromere of chromosome X, a low recombination region in which selection is likely to promote divergence between M and S forms. These results strongly suggest that the degree of isolation between M and S forms, considered the units of incipient speciation within An. gambiae, is not homogenous throughout the species distribution range.

Climate change and animal diseases in South America

Climate strongly affects agriculture and livestock production and influences animal diseases, vectors and pathogens, and their habitat. Global warming trends predicted in the 2007 Intergovernmental Panel on Climatic Change (IPCC) report for South America are likely to change the temporal and geographical distribution of infectious diseases, including those that are vector-borne such as bluetongue, West Nile fever, vesicular stomatitis and New World screwworm. Changes in distribution will be partially modulated by El Niño Southern Oscillation events, which will become more frequent and lead to a greater frequency of droughts and floods. Active disease surveillance for animal diseases in South America, particularly for vector-borne diseases, is very poor. Disease reporting is often lacking, which affects knowledge of disease distribution and impact, and preparedness for early response. Improved reporting for animal diseases that may be affected by climate change is needed for better prevention and intervention measures in susceptible livestock, wildlife and vectors in South America. This requires contributions from multidisciplinary experts, including meteorologists, epidemiologists, biologists and ecologists, and from local communities.

Tubes for pretransfusion testing should be collected by blood bank staff and hand labelled until the implementation of new technology for improved sample labelling. Results of a prospective study

BACKGROUND AND OBJECTIVES

The greatest risk in transfusion medicine is actually human error, resulting in the use of the incorrect blood component. The aim of our study was to identify and evaluate the risk factors involved in the collection and labelling of pretransfusion blood samples.

MATERIAL AND METHODS

We prospectively evaluated 6446 samples submitted to the blood bank for pretransfusion testing. Inappropriate samples were classified as 'mislabelled' or 'miscollected'. After 4 months of study, an educational approach was taken.

RESULTS

The frequency of inappropriately labelled samples was 6.45%. Such samples were associated with the use of addressograph labels (vs. hand-written labels) [23.4% vs. 1.4%, P < 0.0001], collection by clinical staff (vs. blood bank staff) [8.8% vs. 2.1%, P = 0.001] and emergency situations (vs. routine sampling) [10.1% vs. 6.1%, P = 0.005]. Following educational intervention, the percentage of inappropriately labelled samples decreased from 7.3% (pre-educational) to 5.8% (post-educational), P = 0.005.

CONCLUSION

Ongoing monitoring and analysis of labelling and collection should be mandatory in order to improve the safety of transfusion.

Ellis-van Creveld Syndrome (chondro-ectodermal dysplasia) in two siblings

Two male siblings aged 12 and 15 years (Figure 1) presented with growth retardation, limb abnormalities and, defective teeth and nail since childhood. There was no history of similar defects in other family members. On examination their height was 114 cm and 130 cm (expected height; 169 cm and 150 cm) respectively. There were hypoplastic and dystrophic nails, and microdontia and hypodontia on dental examination. There were post-axial polydactyly in both the hands and left foot. Skeletal survey revealed short forearms, legs & distal phalanges (Acromesomelia). Cardiac or other organ system defects were not noticed on clinical examination or echocardiogram. Clinical picture was suggestive of a diagnosis of Chondroectodermal dysplasia (Ellis van Creveld syndrome). These cases have been reported for their rarity and for the presence of some rare features of this syndrome.

A primer-introduced restriction analysis-polymerase chain reaction method to detect knockdown resistance mutations in Anopheles gambiae

In the major malaria vector Anopheles gambiae Giles, two point mutations at the voltage-gated sodium channel have been associated with knockdown resistance (kdr) to DDT and pyrethroid insecticides. Simple allele-specific polymerase chain reaction (PCR) assays to detect these single-nucleotide polymorphisms are prone to lack of specificity and therefore alternative techniques have been proposed. However, these may not be easily implemented in many laboratories from malaria endemic regions. Here, we describe a primer-introduced restriction analysis (PIRA)-PCR method to detect kdr mutations in An. gambiae. This method unambiguously identified all six genotypes for the kdr locus in a sample of 113 field-collected mosquitoes for which kdr genotypes had been confirmed by DNA sequencing. Co-occurrence of both kdr alleles was found in sites from Equatorial Guinea and Gabon and the L1014F mutation was detected in M-form individuals from Angola. The PIRA-PCR proved to be a reliable, robust, and simpler alternative for the detection of kdr mutations in this malaria vector.

Correction of failed fertilization despite intracytoplasmic sperm injection with oligoasthenoteratozoospermia but with acrosomes present by oocyte activation with calcium ionophore--case report

PURPOSE

To determine if fertilization and embryo cleavage can be achieved by artificial oocyte activation in circumstances of repeated failed fertilization with sperm that have an acrosome.

METHODS

A woman with three IVF cycles with intracytoplasmic sperm injection (ICSI) failed to fertilize any eggs. The sperm had severe oligoasthenoteratozoospermia with no sperm with normal morphology. In the fourth IVF cycle fertilization was evaluated by performing ICSI with the husband's sperm and egg activation with calcium ionophore, ICSI with the husband's sperm without artificial oocyte activation, and ICSI with donor sperm.

RESULTS

Five mature oocytes were retrieved. Of the four eggs having ICSI with the husband's sperm only one of the two activated by calcium ionophore fertilized and resulted in a cleaved day 3 embryo. Interestingly, the one egg fertilized by donor sperm did not fertilize.

CONCLUSIONS

The data could be consistent with conclusions that in some cases the failure to fertilize may be related to an oocyte activation factor/receptor problem in the oocyte that can be overcome by the use of calcium ionophore.

Improved pregnancy outcome for women with decreased ovarian oocyte reserve and advanced reproductive age by performing in vitro fertilization-embryo transfer

OBJECTIVE

To compare the pregnancy rates with IVF-ET vs non-assisted reproductive technology in women of more advanced reproductive age with decreased egg reserve as manifested by elevated day 3 serum FSH.

METHODS

A retrospective evaluation was made in women aged > or = 38 with a day 3 serum FSH of degrees 15 mIU/ml with > or = 1 year of infertility. Another inclusion criterion was three cycles (unless a pregnancy occurred before that time) of either IVF-ET or non-assisted reproductive therapy which as a minimum included luteal phase support with progesterone.

RESULTS

The clinical pregnancy rates in three cycles for non-IVF were 11.7% vs 27.2% for IVF. Delivery rates were 2.9% vs 15.1%. For ages 40-42 the clinical pregnancy rates were 37.5% vs 0.0% (p = .02).

CONCLUSIONS

Live deliveries are possible in women > or = age 38 with marked decreased egg reserve. In vitro fertilization is more effective than non-IVF when follicle stimulation with gonadotropins is mild.

A putative gene located at the MHC class I region around the D6S105 marker contributes to the setting of CD8+ T-lymphocyte numbers in humans

Significant associations between human leucocyte antigen (HLA)-A and -B alleles and CD8+ T-lymphocyte numbers have been reported in the literature in both healthy populations and in HFE-haemochromatosis patients. In order to address whether HLA alleles themselves or alleles at linked genes are responsible for these associations, several genetic markers at the MHC class I region were typed on a population of 147 apparently healthy unrelated subjects phenotypically characterized for their CD8+ and CD4+ T-lymphocyte numbers. By using a machine learning approach, a set of rules was generated that predict the number of CD8+ T-lymphocyte numbers on the basis of the information of the D6S105 microsatellite alleles only. We demonstrate that the previously reported associations with HLA-A and -B alleles are due to the presence of common long (up to 4 megabases long) haplotypes that increased in frequency recently due to positive selection and that encompass a region where a putative gene contributing to the setting of CD8+ T lymphocytes is located, in the neighbourhood of microsatellite locus D6S105, in the 6p21.3 region.

Advances in scrapie research

The bovine spongiform encephalopathy (BSE) crisis clearly demonstrated the need to keep animal transmissible spongiform encephalopathies (TSE) under control in order to protect animal and human health. Scrapie is the most widespread TSE of livestock in the world. For this reason, health authorities in different countries have elaborated plans that aim towards scrapie eradication. The unusual nature of the scrapie agent and the fragmented status of scientific knowledge about it, along with the limitations of currently available diagnostic tools, make it unlikely that the objective of eradication will be achieved in the near future. Scientific research is focused on acquiring the knowledge that will improve the efficiency of these efforts.

International organisations and their role in helping to protect the worldwide community against natural and intentional biological disasters

Preventing the spread of disease through international movements is one of the key objectives of the World Organisation for Animal Health (OIE). One of the ways it seeks to achieve this is by publishing international standards and guidelines aimed at, inter alia, preventing the importation of pathogens that are dangerous for animals and humans and strengthening Veterinary Services so that they can improve their surveillance and response systems. The OIE works in close partnership with the Food and Agriculture Organization of the United Nations (FAO), and together the two organisations have developed a joint initiative - the Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs). Member Countries of these organisations could increase their capacity to manage the risks of disease occurrences, whether natural or deliberately introduced, if they would all strictly implement existing OIE international standards. Compliance with these standards greatly depends on the political willingness of national policy-makers and on a successful transfer of resources to developing countries in support of good governance and appropriate policy implementation. A United Nations Resolution obliging its Member Countries to implement OIE standards could prove invaluable in this respect.

Human herpes virus 8 (HHV8): Detection in peripheral blood mononuclear cells (PBMC) from Venezuelan patients with human immunodeficienccy virus-1 (HIV-1) infection with/without Kaposi‘s sarcoma (KS)

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Background: The nucleic acid of HHV8 is present in the PBMCs of between 50% and 90% of KS patients,7% and 10% of HIV-1 infected patients without KS.We studied the prevalence of HHV8 in PBMCs from venezuelan patients with HIV-1 infection with/without KS. Methods: Seventy-six patients with HIV-1 infection without KS and 15 patients with KS associated with HIV-1 infection were included. Socioepidemiologic characteristics of HIV-1 infected patients were as follows: mean age (36 years, range 19–69 years); 79% of patients were male, 93% were heterosexuals, 9% were treated with antiherpetic drugs and 74% were on HAART; mean T-CD4 count was 362 cel/mm3. Socioepidemiologic characteristics of patients with KS associated with HIV-1 infection were as follows: mean age 39 years (range, 20- 69 years); 93% of patients were male, 87% were homosexuals, 93% belonged to a ‘high risk group‘, 7% were treated with antiherpetic drug and 80% were on HAART; mean T-CD4 count was 86 cel/mm3. PBMCs were isolated on a Fycoll Hypaque gradient and then stored at -70°C until processed. DNA was extracted from the samples by a standard phenol/chloroform extraction procedure.All DNA samples were confirmed to be amplifiable by PCR primers specific for a conserved region of the human beta-globin gen. Positive (DNA from KS biopsy) and negative controls were included. DNA was PCR amplified using the KS1 and KS2 primers specific for the HHV8 ORF 26. PCR reactions were considered positive only if the PCR products hybridized in the expected 233 bp region. Results: None of HIV-1 infected patients showed the presence of HHV8 in the PBMCs, and after a follow-up of two years, none has developed KS. HHV8 was detected in the PBMCs from 20 % of patients with KS. All patients belonged to a ‘high risk group‘, were male and homosexuals. None received blood transfusion. Conclusions: These preliminary data suggest that the prevalence of HHV8 in PBMCs from venezuelan HIV-1 infected patients with/without KS is probably low in comparison with patiens from USA and Europe.

No significant financial relationships to disclose.

[Retinal cholesterol embolization after coronary angiography]

CASE REPORT

We report a patient with multiple cholesterol retinal embolism in both eyes following coronary angiography. She also had associated renal, skin and cardiac manifestations of the Cholesterol Embolization Syndrome (CES) and died 10 weeks later. Autopsy revealed cholesterol crystal emboli in several organs.

DISCUSSION

Atheromatous plaques can be ruptured and displaced during a diagnostic catheterisation, and thus can be a potential source of these massive emboli. Retinal cholesterol crystals help to establish the diagnosis of the syndrome, particularly when other systemic manifestations exist. When this complication occurs, the prognosis can be devastating because of associated multiorgan failure.