The mechanisms that control the preantral to early antral follicle transition and the strategies to have efficient culture systems to promote their growth in vitro

Preantral to early antral follicles transition is a complex process regulated by endocrine and paracrine factors, as well as by a precise interaction among oocyte, granulosa cells and theca cells. Understanding the mechanisms that regulate this step of folliculogenesis is important to improve in vitro culture systems, and opens new perspectives to use oocytes from preantral follicles for assisted reproductive technologies. Therefore, this review aims to discuss the endocrine and paracrine mechanisms that control granulosa cell proliferation and differentiation, formation of the antral cavity, estradiol production, atresia, and follicular fluid production during the transition from preantral to early antral follicles. The strategies that promote in vitro growth of preantral follicles are also discussed.

POS0564 SHOULD WE USE PHYSICIAN’S GLOBAL TO DEFINE REMISSION IN RHEUMATOID ARTHRITIS AND CONSIDER A SEPARATE PATIENT-CENTRED TARGET?

Background

The definitions of remission play a crucial role in the treat-to-target strategy in rheumatoid arthritis.The patient’s and physician’s global assessment (PGA|PhGA) of disease activity are considered in current definitions, but PGA has been criticized for its poor relationship with actual disease activity. This leads to a considerable risk of overtreatment in patients who are otherwise in remission but fail this target solely because of PGA: PGA-near-remission. A dual-target strategy, excluding PGA from the definition of biological remission and the creation of a second target focused on disease impact has been proposed.1 Another proposal is to substitute PGA by PhGA with the purpose of strengthening the definition with a fourth variable capable of conveying relevant unaccounted factors, such as comorbidity.2

Objectives

To assess the relationship of PGA and PhGA with objective measures of disease activity (DAS3v) and their impact upon near-remission and risk of overtreatment.

Methods

This is a cross-sectional analysis of data from RAID.PT, an observational, prospective and multicenter study, including adult patients fulfilling RA classification criteria. Tender (TJC28) and swollen (SJC28) 28 joint counts, C-Reactive Protein (CRP), Pain score, Health Assessment Questionnaire (HAQ), the Rheumatoid Arthritis Impact of Disease (RAID) total score, Hospital Anxiety and Depression Scale (HADS) scores, PGA and PhGA were collected. Disease Activity Score (DAS28-3v-CRP) was calculated and taken as the reference measure of current disease activity. Correlation between PGA and PhGA with other continuous variables was evaluated through Pearson´s Correlation Coefficient and variables with p<0.10 in univariate analysis were included in multivariable linear regression models.

Results

We included 299 patients, 81.3% women, mean age of 57.4±12.0 years and disease duration 9.4±9.5 years. Average DAS28-3v-PCR 2.4 (±1.9).

DAS3v-CRP is the strongest factor associated with PhGA, explaining 45% of its variance. Inversely, it only explains 2% of the variance of PGA, which is more affected by disease impact.

In this clinical cohort, 13% of patients were in full Boolean remission and 41% in PGA-near-remission. Only 49 of 123 patients in the latter group had a PhGA >1.

Considering PhGA instead of PGA in the Boolean definition of remission would increase the proportion of remission from 13 to 37.5% of the whole cohort.

Table 1.

Factors Associated with PGA and PhGA in multivariate regression analysis

PGAPhGA(β, 95% CI)(β, 95% CI)(β, 95% CI)ΔR2ΔR2DAS28-3v-CRP3.7 (1.9-5.5)10.9 (9.4 to12.5)0.020.45RAID7.7 (6.7-8.8)3.4 (2.5 to 4.3)0.610.09HAQ5.6 (1.0-8.1)-3.4 (-6.4 to -0.4)0.010.01R20.64*0.55*

DAS28-3v-CRP: Disease Activity Score-3 variables C-Reactive Protein. PGA: Patient global assessment; PhGA: Physician Global Assessment; HAQ (health assessment questionnaire); RAID: Rheumatoid Arthritis Impact Disease score. ΔR2 change of R2associated with the inclusion of the variable in the model. *p<0,01

Conclusion

PhGA is a closer representation of actual disease activity than PGA, thus providing a more valid basis for treatment decisions aimed at disease activity. These observations support the substitution of PGA by PhGA in the Boolean definition of remission as it would strengthen the representation of disease activity and significantly reduce the risk of overtreatment in comparison to current definitions. The consequences of this change upon the prediction of long-term function and structural stability warrant evaluation. The patient’s perspective will remain central to disease management in the form of a distinct target.

References

[1]Ferreira et al. Ann Rheum Dis 2019 Oct;78(10):e109.doi: 10.1136/annrheumdis-2018-214199

[2]Pazmino et al. J Rheumatol. 2021 Feb;48(2):174-178.doi: 10.3899/jrheum.200758

Disclosure of Interests

None declared.

POS0496 YOUNG VERSUS LATE-ONSET RHEUMATOID ARTHRITIS: A PROSPECTIVE 12 MONTH-FOLLOW-UP COHORT STUDY IN AN EARLY ARTHRITIS COHORT

Background:

Rheumatoid Arthritis (RA) is a chronic inflammatory arthropathy that can present at any age. Data regarding differences in the clinical course and outcome in Late-Onset Rheumatoid Arthritis (LORA) comparing to Young-Onset RA (YORA) are conflicting. Some studies suggested that LORA may represent a more benign form of RA (1), while others have shown a poorer prognosis in these patients (2,3). Only a few publications have included patients with early disease (3).

Objectives:

To compare demographic and clinical features between LORA and YORA patients, and clinical activity at baseline and after 12 months of initial therapy, in patients with early disease.

Methods:

We conducted a prospective cohort study of 12 months of follow-up based on an early arthritis clinic. Consecutive patients with early RA – less than 12 months duration – fulfilling ACR/EULAR 2010 and/or ACR 1987 RA classification criteria, were included and classified in LORA (disease onset ≥60 years) and YORA groups. Variables were collected from patients’ registries at first appointment after symptoms onset and after 12 months of treatment, according to a treat-to-target strategy. Independent t-test and chi-square test were performed to compare variables between groups.

Results:

We included 72 patients (40 (55.6%) YORA; 32 (44.4%) LORA), mean age at diagnosis 44.9±1.78 and 72.5± 1.34 years, respectively. In LORA group, the symptoms duration at first observation was shorter (17.0±2.26 vs. 23.8±2.45 weeks; p=0.046) and rheumatoid factor (RF)/ anti-citrullinated protein antibodies (ACPA) positivity was lower (28.1% vs 65.0%; p= 0.002; 31.3% vs 72.5%; p<0.001). At baseline, LORA had higher mean number of tender joints (9.76±1.29 vs 6.50±0.67; p=0.021), erythrocyte sedimentation rate (ESR) (45.7±4.98 vs. 29.3±3.74; p=0.011), C-reactive protein (CRP) (4.63±0.91 vs 2.22±0.46; p=0.022) and disease activity using DAS28-3V (5.11±0.28 vs 4.42±0.19; p=0.046), CDAI (33.7±3.39 vs 23.6±2.18; p=0.015) and SDAI (37.4±3.43 vs 26.3±2.57; p=0.015). At the end of follow-up, there were no statistically significant differences between LORA and YORA groups regarding treatment, disease activity and patient-reported outcomes at 12 months (Table 1).

Table 1.

Clinical variables assessment at 12 months of follow-up.

EORAYORAp-valueTreatment, % users Corticosteroids93.397.4p= 0.576 Methotrexate76.774.4p=0.825 Hydroxychloroquine43.346.2p= 0.815 Sulfasalazine10.015.4p=0.722 Leflunomide3.305.10p=1.000 TNF blockers3.305.10p=0.717DAS28-3V, mean (SD)1.99±0.152.22±0.15p=0.286SDAI, mean (SD)4.64±1.357.68±1.39p=0.128CDAI, mean (SD)4.15±1.176.56±1.32p=0.180Swollen joints, mean (SD)1.29±0.491.03±0.25p=0.613Tender joints, mean (SD)0.32±0.131.28±0.53p=0.084ESR, mean (SD)10.6±1.799.43±1.14p=0.585CRP, mean (SD)0.44±0.090.50±0.15p=0.730PtGA, mean (SD)21.8±5.9029.2±6.11p=0.387PhGA, mean (SD)10.6±3.2613.1±3.11p= 0.593Pain intensity (VAS), mean (SD)20.7±5.8232.7±6.30p=0.169HAQ, mean (SD)0.23±0.0890.54±0.13p=0.060

Legend: DMARD- disease-modifying anti-rheumatic drug; TNF- tumoral necrosis factor; SDAI-simplified disease activity score; CDAI- clinical disease activity score; PtGA/ PhGA – patient’s/ physician’s global assessment of general health; VAS- visual analogic scale; HAQ- health assessment questionnaire.

Conclusion:

LORA patients presented with higher disease activity manifested by higher joint counts and laboratory inflammatory markers but lower RF and ACPA positivity proportion. Despite the more aggressive clinical presentation, the clinical and functional outcomes at 12 months were similar between LORA and YORA patients.

References:

[1]Deal et al. Arthritis Rheum 1985;28(9):987-94.

[2]Arnold et al. Rheumatology (Oxford) 2014; 53:10751086.

[3]Romão et al. Semin Arthritis Rheum 2020;0(4):735-743.

Disclosure of Interests:

None declared

AB0147 OLDER AGE AT ONSET AND NOT DISEASE ACTIVITY IS ASSOCIATED WITH FUNCTIONAL DISABILITY AT RA DIAGNOSIS: RESULTS FROM AN EARLY ARTHRITIS COHORT

Background:

Rheumatoid Arthritis (RA) is a chronic inflammatory arthropathy that potentially leads to loss of function and disability early in the disease course. (1) Optimizing physical function is one of the primary goals of RA treatment (2). Several demographic, psychosocial and clinical factors may influence the impact of RA upon physical capacity, and understanding their relative contribution to disability at disease diagnosis is key to an effective treatment approach.

Objectives:

To evaluate functional disability at the time of disease diagnosis and identify its demographic and clinical correlates in an early RA cohort.

Methods:

We conducted a cross-sectional study based on a Rheumatology centre early arthritis cohort. Consecutive patients with early RA – less than 12 months duration– fulfilling ACR/EULAR 2010 and/or ACR 1987 RA classification criteria, were included. Variables were collected from patients’ registries at the first rheumatology appointment after symptom’s onset. Functional disability was assessed using the Health Assessment Questionnaire- Disability Index (HAQ-DI) (range 0 to 3, higher values indicating greater disability). Independent t-test, one way-ANOVA and Pearson’s correlation coefficient were performed to evaluate differences between groups. Variables with p<0.1 were included in a stepwise multiple linear regression analysis to assess the independent association of variables with the HAQ-DI at baseline.

Results:

We included 71 patients (63.4% female, mean age 57.2 ±2.01 years). Mean HAQ-DI score was 1.42±0.08. Sociodemographic and clinical variables are described in Table 1. There was a significant difference in HAQ-DI scores between rheumatoid factor (RF) positive (mean 1.24±0.11) and RF negative (1.61±0.113) patients. HAQ-DI was positively weakly correlated with age (r=0.48; p<0.001), CDAI (r=0.43; p=0.038), SDAI (r=0.49; p=0.015), and moderately with DAS28-3V (r=0.60; p<0.001) and DAS28-3V-CRP (r=0.60; p<0.001). The number of tender (r=0.35; p=0.024) and swollen joints (r=0.42; p= 0.005), ESR (r=0.46; p=0.001), CRP (r=0.35; p=0.018), HADS-depression (r=0.46; p=0.023) and educational level (r= -0.48; p=0.002) were also associated with HAQ-DI in univariate analyses. After multivariate regression analysis, age at disease diagnosis (β= 0.022 [95 CI 0.010 to 0.034]; p= 0.001) was the only independent predictor of HAQ-DI (R2= 0.46, p=0.001).

Table 1.

Patients’ baseline sociodemographic and clinical characteristics.

Age at diagnosis (years), mean (SD)57.2±2.01Educational level (years), mean (SD)7.37±0.59Employment: full-time, %42.4Employment: partial-time, %3.00Employment: retired, %48.4Employment: absenteeism in the last month, %1.50Unemployed, %4.50Disease duration at presentation (weeks), mean (SD)20.4±1.70Morning stiffness >30 minutes, %83.0RF positivity, %47.9ACPA positivity, %53.5Fibromyalgia, %6.60DAS28-3V, mean (SD)4.72±0.17CDAI, mean (SD)29.2±2.28SDAI, mean (SD)32.4±2.42PtGA, mean (SD)66.8±3.73PhGA, mean (SD)54.7±3.08Pain intensity (VAS), mean (SD)67.7±3.75EQ-5D score, mean (SD)0.26±0.039HADS-depression, mean (SD)7.17±0.87

Legend: ACPA- anti-citrullinated protein antibodies; ESR- erythrocyte sedimentation rate; CRP- c-reactive protein; DAS- disease activity score; CDAI- clinical disease activity score; SDAI-simplified disease activity score; PtGA/ PhGA – patient’s/physician’s global assessment of general health; VAS- visual analogic scale; EQ-5D- EuroQoL 5-Dimensional Descriptive System; HADS-Hospital Anxiety and Depression Scale.

Conclusion:

Older age at disease onset is associated with greater functional impairment at diagnosis, assessed by HAQ-DI, in this cohort of early RA patients, irrespective of disease activity and other clinical variables. This result suggests that older newly diagnosed RA patients may deserve special attention regarding physical function.

References:

[1]Wolfe F et al. Arthritis Res Ther. 2010; 12(2): R35.

[2]Smolen JS et al. Ann Rheum Dis. 2010; 69:631-637.

Disclosure of Interests:

None declared

AB0416 THE IMPACT OF FATIGUE ON SYSTEMIC SCLEROSIS PATIENTS

Background:

Fatigue is a frequent and commonly undervalued symptom among rheumatic disease, including Systemic Sclerosis (SSc).1,2

Objectives:

To determine the prevalence of severe fatigue in a SSc cohort and to evaluate how it correlates with disability, quality of life and mental illness.

Methods:

A cross-sectional study was conducted evaluating a cohort of SSc patients. Fatigue was evaluated using Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F) questionnaire. A value < 30 was defined as severe fatigue. Health Assessment Questionnaire (HAQ), Scleroderma HAQ (SHAQ), 36-Item Short Form Health Survey (SF-36), EuroQol-5D (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) questionnaires were also filled. Clinical data was obtained and analysed.

Results:

We included 20 patients, 17 females [n = 17 (85%)], median (min, max) age was 52.5 (28, 75) years-old. Regarding disease classification, 13 (65%) had limited SSc, 4 (20%) had diffuse SSc and 3 (15%) had early SSc. The median FACIT-F score was 34 (3, 48). The prevalence of severe fatigue was 40% (n = 8). Fatigue had a moderate negative correlation with HAQ (τ = -0.641; p < 0.001) and a weak negative correlation with lung (τ = -0.345; p = 0.039) and gastrointestinal (τ = -0.419; p = 0.011) involvements and with patient global assessment (τ = -0.325; p = 0.047) subtopics of SHAQ. A moderate positive correlation was found between FACIT-F and EQ-5D (τ =0.625; p < 0.001) and physical functioning (τ = 0.560; p = 0.001) and vitality (τ = 0.777; p < 0.001) domains of SF-36. The remaining SF-36 domains had a weak positive correlation with FACIT-F (Table 1). Regarding mental illness, there was a moderate negative correlation between FACIT-F and HADS-D (τ = -0.638; p < 0.001) and HADS-A (τ =-0.535; p = 0.001).

Conclusion:

Severe fatigue is frequent among SSc patients. The greater the fatigue, the greater the disability, the lower the quality of life and the worse the score on the scale of depression and anxiety.

References:

[1]F. Basta, A. Afeltra, D.P.E. Margiotta. Fatigue in systemic sclerosis: a systematic review. Clin Exp Rheumatol 2018; 36 (Suppl. 113): S150-S160

[2]Sarah Hewlett, Emma Dures, And Celia Almeida. Measures of Fatigue. Arthritis Care & Research Vol. 63, No. S11, November 2011, pp S263–S286

Table 1.

Correlation of FACIT-F with measures of disability, quality of life and mental illness

VariablesKendall’s τ coefficientp-valueHAQ-0.6410.000SHAQ - GI involvement-0.3450.039 - Lung involvement-0.4190.011 - Vascular involvement-0.2150.192 - Digital ulcers0.1020.549 - Patient global assessment-0.3250.047EQ-5D0.6250.000SF-36 - Physical functioning0.5600.001 - Role physical0.4910.003 - Bodily pain0.4630.006 - General health0.3410.045 - Vitality0.7770.000 - Social functioning0.4430.009 - Role emotional0.3500.041 - Mental health0.3760.024HADS-D-0.6380.000HADS-A-0.5350.001

Disclosure of Interests:

None declared

AB0415 ANXIETY AND DEPRESSION IN SSc – ASSESSING FUNCTION, QUALITY OF LIFE AND GASTROINTESTINAL INVOLVEMENT

Background:

Systemic Sclerosis (SSc) is a chronic disease with multi-organ manifestations that may contribute to disability and low quality of life.1 Therefore, anxiety and depression are more frequent in SSc patients than in general population.2

Objectives:

To assess the prevalence of anxiety and depression in a SSc cohort and to evaluate its correlation with function, quality of life and assessment of gastrointestinal (GI) involvement scores.

Methods:

A cross-sectional study was conducted evaluating a cohort of SSc patients. All patients answered to the Hospital Anxiety and Depression Scale (HADS) questionnaire. A cut-off score < 8 was considered normal. Health Assessment Questionnaire (HAQ), Scleroderma HAQ (SHAQ), 36-Item Short Form Health Survey (SF-36), EuroQol-5D (EQ-5D) and University Of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT) 2.0 questionnaires were also obtained. Clinical data was obtained and analyzed.

Results:

We included 20 patients, 17 females [n = 17 (85%)], median (min, max) age was 52.5 (28, 75) years-old. Regarding disease classification, 13 (65%) had limited SSc, 4 (20%) had diffuse SSc and 3 (15%) had early SSc. A score ≥ 8 was found in 14 (70%) patients on HADS-A [median (min, max) = 9 (2, 19)] and in 12 (60%) patients on HADS-D [median (min, max) = 8 (1, 15)]. Depressive patients had significantly worst scores on the measures of function, such as HAQ and lung and gastrointestinal involvements and patient global assessment of SHAQ, of quality of life, such as EQ-5D and physical functioning, role physical, bodily pain, vitality, social functioning and mental health domains of SF-36, and on the UCLA SCTC GIT 2.0 scale. Anxious patients had significantly worst scores on social functioning and mental health domains of SF-36 and on the UCLA SCTC GIT 2.0 scale (Table 1).

Conclusion:

The prevalence of depression and anxiety on SSc patients is high and should not be neglected. Overall disability and multiorgan manifestations, particularly GI involvement, may contribute to a low quality of life and consequently to depression and anxiety.

References:

[1]Firestein & Kelley’s Textbook of Rheumatology 2-Volume Set, 11th Edition

[2]Brett D. Thombs et al. Depression in Patients With Systemic Sclerosis: A Systematic Review of the Evidence. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 57, 2007, pp 1089–1097

Table 1.

Function, quality of life and gastrointestinal (GI) involvement assessment according to HADS score.

Results, median [min, max]HADS-D ≥ 8 (n = 12)HADS-D < 8 (n = 8)P-valueHADS-A ≥ 8 (n = 14)HADS-A < 8 (n = 6)P-valueSHAQ- GI involvement26.5 [0, 90]2 [0, 40]0.00918.5 [0, 90]2.5 [0, 40]0.091- Lung involvement48.5 [5, 90]2.5 [0, 30]0.00118 [0, 90]3 [0, 65]0.126- Patient global assessment67.5 [30, 100]4 [0, 85]0.01153.5 [2, 100]41.5 [0, 85]0.509HAQ1.375 [0.5, 2]0.1875 [0, 1]0.0011.25 [0, 2]0.875 [0, 1.125]0.147EQ5D0.3667 [-0.0573, 0.6937]0.6752 [0.2870, 1]0.0060.4640 [-0.0573, 0.7667]0.6752 [0.287, 1]0.075SF36- Physical functioning25 [15, 75]75 [50, 100]0.00140 [15, 100]72.5 [25, 85]0.106- Role physical31.25 [0, 75]72.875 [31.25, 100]0.02537.5 [0, 100]65.625 [31.25, 100]0.214- Bodily pain41 [0, 74]68 [20, 88]0.01141 [0, 88]61.5 [20, 74]0.428- Vitality25 [0, 43.75]65.625 [25, 75]0.00137.5 [0, 75]65.625 [12.5, 75]0.135- Social functioning37.5 [12.5, 87.5]87.5 [50, 100]0.00250 [12.5, 100]87.5 [87.5, 100]0.003- Mental health45 [25, 80]65.7 [51.4, 85]0.01245 [25, 75]77.5 [51.4, 85]0.005UCLA SCTC GIT 2.0- Reflux0.38 [0, 1.25]0 [0, 1.25]0.0240.25 [0, 1.25]0 [0, 1]0.139- Distension1 [0.5, 2]0.25 [0, 1.5]0.0171 [0.25, 2]0.125 [0, 1]0.024- Total0.44[0.1, 0.99]0.04 [0, 0.97]0.0100.34 [0.04, 0.99]0.02 [0, 0.44]0.018

Disclosure of Interests:

None declared

Real-world impact of glucocorticoid replacement therapy on bone mineral density: retrospective experience of a large single-center CAH cohort spanning 24 years

The congenital adrenal hyperplasia population seems to have an intrinsic tendency to a high frequency of low bone mass. However in this single-center and long-term evaluated cohort, the simplified corticoid regimen, with exclusive dexamethasone single dose reposition during adulthood, did not represent a risk factor for decrease in bone health.

INTRODUCTION

The impact of long-term and supposedly physiological doses of gluco and mineralocorticoid (GC/MC) on bone mineral density (BMD) in congenital adrenal hyperplasia (CAH) remains discordant among studies, which contain different clinical forms and corticoid regimens. Our aim was to evaluate the BMD in CAH adults receiving similar GC regimen since childhood and to correlate it with GC/MC cumulative doses.

METHODS

Only patients with good compliance, who used cortisone acetate (CA) during childhood and dexamethasone after the final height achievement. Cumulative GC/MC doses were calculated from diagnosis until last evaluation. BMD was analyzed by the first and last energy X-ray absorptiometry (DXA) scans performed.

RESULTS

Twenty simple virilizing (SV) and 14 salt wasting (WS) whose mean age was 26 ± 6 years, mean CA, dexamethasone, and fludrocortisone cumulative doses were 63,813 ± 32,767, 812 ± 558, and 319 ± 325 mg/m², respectively. Based on the last DXA, low BMD was observed in 11% of patients, total hip Z-score was lower in the SW than SV form (p = 0.04). Cumulative CA dose had an inverse correlation with femoral neck Z-score (p < 0.01). Total cumulative GC and MC doses had an inverse correlation with total hip Z-score (p < 0.01). In the analysis of sequential BMD during dexamethasone therapy, no association was observed among cumulative GC/MC doses, clinical forms, sex, and lumbar Z-score delta.

CONCLUSIONS

Even though a low CA regimen during growth periods in addition to MC replacement appears to have an influence on BMD at femoral sites, interestingly a low dexamethasone one does not seem to be deleterious for bone health in adulthood.

Selenocysteine biosynthesis and insertion machinery in Naegleria gruberi

Selenium (Se) is an essential trace element primarily found in selenoproteins as the 21st amino acid (selenocysteine, Sec, or U). Selenoproteins play an important role in growth and proliferation and are typically involved in cellular redox balance. Selenocysteine is encoded by an in-frame UGA codon specified by a stem-loop structure, the Sec insertion sequence element (SECIS), which, in eukaryotes, is located in the 3'-untranslated region (UTR). The availability of the Naegleria gruberi (ATCC 30224) genome sequence and the use of this organism as a model system for the pathogenic amoeba N. fowleri allowed us to investigate the Sec incorporation pathway in this primitive eukaryote. Using bioinformatics tools, we identified gene sequences encoding PSTK (O-phosphoseryl-tRNA(Sec) kinase), SepSecS (O-phosphoseryl-tRNA:selenocysteinyl-tRNA synthase), SelD/SPS2 (selenophosphate synthetase), EFSec (selenocysteine-specific elongation factor) and SBP (SECIS binding protein). These findings were confirmed by RT-PCR and by sequencing. A potential tRNA(Ser)Sec (SelC) gene and a putative selenoprotein with sequence similarity to a mitochondrial thioredoxin reductase (TR3) were also identified. Our results show that the selenocysteine incorporation machinery is indeed present in N. gruberi. Interestingly, the SelD/SPS2 gene is 2214 bp in length and contains two distinct domains. The N-terminal region shows sequence similarity to predicted methyltransferase proteins, and the C-terminal region is homologous to prokaryotic SelD/SPS2. Our results suggest the possibility of novel selenoproteins.

Chagas Disease Control Programme in Brazil: a study of the effectiveness of 13 years of intervention

Reported is an evaluation of 13 years of intervention by the Chagas Disease Control Programme in an endemic area (Montalvania) in the State of Minas Gerais, Brazil. The design used was an epidemiological panel study. The reduction of Trypanosoma cruzi infection rates was estimated from data collected on three separate occasions: a serological survey in 1975-80, a quasi-experimental study in 1987, and the present investigation. A random sample of 156 households was selected and blood samples were collected from 653 inhabitants. The data routinely collected by the control programme were analysed to correlate the results with the incidence of T. cruzi. The overall prevalence of infection was 2.3%; however, no participant under 14 years of age was found to have a positive serological test. The total reduction in T. cruzi infection rates in this area from the start of the programme's activities was estimated to be 83.5%. Cross-sectional comparisons for the age groups 2-6 years and 7-14 years indicated a 100% reduction in T. cruzi incidence rates; but cohort comparisons showed that 100% reduction was achieved only for the 2-6-years age group.