Extremely premature infants: How does death in the delivery room influence mortality rates in two level 3 centers in France?

OBJECTIVES

Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates' place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU).

METHODS

Retrospective observational study including all pregnancy terminations, stillbirths and live-born infants within a 22- to 26-week ^0/6 gestational age range was registered by two French level 3 university centers between 2009 and 2013. The mortality rates were compared between the two centers according to two places of inclusion: either the delivery room or the NICU.

RESULTS

A total of 344 infants were born at center A and 160 infants were born at center B. Among the live-born neonates, the rates of neonatal death were similar in center A (54/125, 43.2%) and center B (33/69, 47.8%; P=0.54). However, neonatal death occurred significantly more often in the delivery room at center A (31/54, 57.4%) than at center B (6/33, 18.2%; P<0.001). Finally, the neonatal death rate of live-born very preterm neonates admitted to the NICU was significantly lower in center A (25/94, 26.6%) than in center B (27/63, 42.9%; P=0.03).

CONCLUSIONS

This study points out how the inclusion of deaths in the delivery room when comparing neonatal death rates can lead to a substantial bias in benchmarking studies. Center A and center B each endorsed one of the two models of preferential place of neonatal death (delivery room or NICU) detailed in European studies. The reasons behind the two different models and their impact on how parents perceive supporting their neonate need further investigation.

HIV-discordant and concordant HIV-positive male couples' recommendations for how an eHealth HIV prevention toolkit for concordant HIV-negative male couples could be improved to meet their specific needs

A number of HIV prevention interventions for male couples are in the pipeline for development as few evidence-based ones exist. Among these projects, none include all three groups of male couples (concordant HIV-negative, HIV-discordant, and concordant HIV-positive) as their target population, and only two are eHealth-based. The present qualitative study sought to assess whether one of the eHealth HIV prevention interventions for concordant HIV-negative male couples - called MCAP - could be adapted to meet the relationship and HIV prevention needs of HIV-discordant and HIV-positive male couples. Data for this study are drawn from in-person, individual-level interviews conducted with a convenience sample of 10 HIV-discordant male couples (n = 20) and 8 HIV-positive male couples (n = 16) from the Miami-Fort Lauderdale metro area in 2016. Thematic analysis was conducted to identify patterns (themes) of partners' thoughts about the toolkit, including how they perceived it could be improved for their own relationship and other couple's relationships. Two themes emerged from analysis of the qualitative data suggesting how the participants wanted the toolkit to be improved to meet their needs. Specifically, participants recommended for the toolkit to include guidance about integrating the use of biomedical HIV prevention strategies into couple's relationships, as well as for how partners can best take care of each other and further protect themselves from HIV and/or other STIs (Prevention Guidance). In addition, participants requested for the concept of sexual agreements to be broadened to include other aspects they deemed to be important in their life (e.g., mental health, exercise and nutrition) (Holistic agreements). Findings from the present study illuminate the ways in which MCAP would need to be adapted for these two groups of male couples in order to meet the needs for all three groups of male couples in the U.S. in a future iteration of this intervention.

Prevalence of metabolic syndrome and its association with lower urinary tract symptoms and sexual function

OBJECTIVES

To estimate the frequency of metabolic syndrome (MetS) in a daily urology practice and to determine its association with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).

MATERIAL AND METHODS

A retrospective study was conducted. Data from all male patients aged ≥40 years who attended our outpatient urology clinic from 2010 to 2011 was collected. Prevalence of MetS was determined, and LUTS and ED were assessed. A logistic model was used to determine possible associations, controlling for confounders and interaction factors.

RESULTS

A total of 616 patients were included. MetS was observed in 43.8% (95% CI 39.6-48.3). The bivariate model showed an association between MetS and LUTS (p<0.01), but not between MetS and ED. The logistic model showed an association between MetS and the International Prostate Symptom Score (IPSS), while controlling for other variables. Patients exhibiting moderate LUTS had a greater risk for MetS than patients with mild LUTS (OR 1.83, 95% CI 1.14-2.94). After analyzing for individual components of MetS, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24-7.1), and between diabetes and ED (OR 2.57, 95% CI 1.12-5.8).

CONCLUSION

This study was able to confirm an association between MetS and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that MetS is frequent among urological patients, it is advisable that urologists actively screen for it.

A review of perchlorate (ClO4-) occurrence in fruits and vegetables

Since the 1990s, a large number of studies around the world have reported the presence of perchlorate in different types of environmental matrices. In view of their inherent characteristics, such as high solubility, mobility, persistence, and low affinity for the surface of soil, perchlorates are mobilized through the water-soil system and accumulate in edible plant species of high human consumption. However, the ingestion of food products containing perchlorate represents a potential health risk to people due to their adverse effects on thyroid, hormone, and neuronal development, mainly in infants and fetuses. At present, research has been centered on determining sources, fates, and remediation methods and not on its real extension in vegetables under farming conditions. This review presents a comprehensive overview and update of the frequent detection of perchlorate in fruits and vegetables produced and marketed around the world. Additionally, the impact of fertilizer on the potential addition of perchlorate to soil and its mobility in the water-soil-plant system is discussed. This review is organized into the following sections: sources of perchlorate, mobility in the water-soil system, presence in fruits and vegetables in different countries, international regulations, and toxicological studies. Finally, recommendations for future studies concerning perchlorate in fruits and vegetables are presented.

Sphingopyxis chilensis sp. nov., a chlorophenol-degrading bacterium that accumulates polyhydroxyalkanoate, and transfer of Sphingomonas alaskensis to Sphingopyxis alaskensis comb. nov

The taxonomic position of a chlorophenol-degrading bacterium, strain S37T, was investigated. The 16S rDNA sequence indicated that this strain belongs to the genus Sphingopyxis, exhibiting high sequence similarity to the 16S rDNA sequences of Sphingomonas alaskensis LMG 18877T (98.8%), Sphingopyxis macrogoltabida LMG 17324T (98.2%), Sphingopyxis terrae IFO 15098T (95%) and Sphingomonas adhaesiva GIFU 11458T (92%). These strains (except Sphingopyxis terrae IFO 15098T, which was not investigated) and the novel isolate accumulated polyhydroxyalkanoates consisting of 3-hydroxybutyric acid and 3-hydroxyvaleric acid from glucose as carbon source. The G + C content of the DNA of strain S37T was 65.5 mol%. The major cellular fatty acids of this strain were octadecenoic acid (18 : 1omega7c), heptadecenoic acid (17 : 1omega6c) and hexadecanoic acid (16 : 0). The results of DNA-DNA hybridization experiments and its physiological characteristics clearly distinguished the novel isolate from all known Sphingopyxis species and indicated that the strain represents a novel Sphingopyxis species. Therefore, the species Sphingopyxis chilensis sp. nov. is proposed, with strain S37T (=LMG 20986T =DSM 14889T) as the type strain. The transfer of Sphingomonas alaskensis to the genus Sphingopyxis as Sphingopyxis alaskensis comb. nov. is also proposed.

First Report of Fusarium denticulatum from Sweet Potato in Venezuela

During 2001and 2002, 53 accessions of sweet potato (Ipomoea batatas L.) from a germ plasm collection maintained in the field at Centro Nacional de Investigaciones Agropecuarias, Maracay, Venezuela, were evaluated for diseases. Sweet potato accessions Catemaco and 2878 were symptomatic for chlorotic leaf distortion with deformation of young leaves and stunted vines. Symptomatic nodes and shoot tips were excised, surface disinfested in 0.5% sodium hypochlorite, cultured on potato dextrose agar (PDA), and incubated at 28°C. Pale pink colonies with white aerial mycelium developed from symptomatic tissues. At 20°C, pure cultures on PDA developed slow-growing, aerial, white-to-pink mycelium. Pigmentation in reverse was light orange. Conidia aggregated in false heads, and orange sporodochia were abundant. Conidiophores in aerial mycelium were prostrate, short, and sometimes branched. Sporodochial conidiophores were branched. Phialides were mostly monophialidic but occasionally polyphialidic and averaged 25.0 × 3.0 µm. Microconidia were abundant, long, oval to allantoid, and 0 to 1 septate. Macroconidia were fusiform to falcate with a beaked apical cell and a footlike basal cell, 3 to 5 sepate, and 38 to 45 × 3.6 to 4.0 µm. Chlamydospores were absent. The fungus was identified as Fusarium denticulatum Nirenberg and O'Donnell (1). Ten 25-cm-long vine-tip cuttings of accessions Catemaco and 2878 were immersed in a conidial suspension (1 × 10⁶ conidia per ml) of F. denticulatum. As a control, vines were immersed in sterile, distilled water. After inoculation, each cutting was planted in a 13-cm plastic pot containing a soil/sand (1:1) mixture. Inoculated plants were covered with plastic bags for 48 h and grown in a greenhouse at temperatures ranging from 30 to 38°C. After 3 months, three inoculated plants of accession Catemaco and two plants of accession 2878 developed purple terminals and moderate interveinal chlorosis. Leaf distortion was not observed. F. denticulatum was recovered from both symptomatic and asymptomatic inoculated plants. To our knowledge, this is the first report of F. denticulatum from sweet potato germ plasm in Venezuela. Dried, pure cultures and slides of the fungus are being deposited in the Albert S. Muller Herbario Micologico (VIA). Reference: (1) H. I. Nirenberg and K. O'Donnell. Mycologia 90:434, 1998.

Undiagnosed spondyloarthropathy in patients presenting with anterior uveitis

OBJECTIVE

To investigate patients with formerly undiagnosed underlying spondyloarthropathy (SpA) in a series of anterior uveitis (AU) cases and to describe the rheumatologic and ophthalmologic characteristics of these patients.

METHODS

Patients with anterior uveitis referred to the Uveitis Clinic between January 1992 and December 1998 who had a final diagnosis of SpA were included in the study group. The diagnosis of SpA was based on current diagnostic criteria. Patients were classified into 2 groups: formerly diagnosed, or undiagnosed SpA before attendance at the uveitis clinic. Demographic features, clinical symptoms, ophthalmologic characteristics, and laboratory tests were collected prospectively in each patient. A regression logistic model was applied.

RESULTS

We evaluated 514 patients with anterior uveitis; 117 (22.7%) had some type of SpA. Ankylosing spondylitis was the most frequent diagnosis (64.1%). More than half the patients (53%) were diagnosed with SpA after an episode of uveitis; the percentage was up to 90.9% in undifferentiated SpA. Clinically, the formerly diagnosed and undiagnosed groups were quite similar, inflammatory low back pain being the most frequent symptom in both groups. Radiological sacroiliitis was less common and with a lower grade in the formerly undiagnosed group. Acute recurrent unilateral anterior uveitis was the most frequent clinical pattern in the group as a whole (68.3%), observed in all subgroups, except for inflammatory bowel disease related SpA, which presented panuveitis as the most frequent pattern.

CONCLUSION

SpA was the most frequent systemic disease related to anterior uveitis, seen in more than 50% of our SpA cases diagnosed after an episode of uveitis. The undiagnosed SpA patient is generally an atypical case, with a shorter clinical evolution and less radiological damage.

Effects of glucose and phenylalanine upon 2,4,6-trichlorophenol degradation by Pseudomonas paucimobilis S37 cells in a no-growth state

Pseudomonas paucimobilis S37, a strain able to degrade 2,4,6-trichlorophenol (246-TCP), was isolated from an aquatic environment polluted with this compound. The effect of two natural organic compounds on the degradation of 246-TCP by this strain, in a no-growth state, was studied. Bacterial cultures were exposed to 0.1 mM and 0.5 mM of 246-TCP, alone, or in the presence of similar concentrations of glucose, a growth supporting substrate, or phenylalanine, a no-growth supporting compound. The effects on viable counts and 246-TCP degradation were measured. The bacterial culture died with 0.5 mM 246-TCP. This effect was overcome by the presence of glucose or phenylalanine, although no degradation of 246-TCP was detected. At 0.1 mM 246-TCP, the viability was not altered, and cells were able to degrade this compound. Glucose at 0.1 mM increased the degradative activity, but higher levels were inhibitory. Phenylalanine at 0.67 mM or higher concentration was also inhibitory of the 246-TCP degradation.

Tolerance to trichlorophenols in microorganisms from a polluted and a pristine site of a river

The effect of 2,4,5- and 2,4,6-trichlorophenol on the microbiota from a polluted and a pristine site of a river was studied. Bacterial metabolic activity measurements by epifluorescence microscopy showed that the polluted site contained more metabolically active cells than the pristine site. Total culturable bacterial counts and tolerant bacterial counts from both sites were not affected by incubation (for up to 5 days) with 200 ppm of chlorophenols. However, the incubation with 500 ppm of 2,4,5-trichlorophenol prevented detection of total and tolerant bacterial counts in the pristine site, and inhibited tolerants in the polluted site. None of 250 bacterial colonies directly isolated from these samples was able to grow on chlorophenols. However, bacteria able to grow on 2,4,6-trichlorophenol, were obtained by enrichment of water and sediments samples.

Construction of a Pseudomonas hybrid strain that mineralizes 2,4,6-trinitrotoluene

A bacterium, Pseudomonas sp. strain C1S1, able to grow on 2,4,6-trinitrotoluene (TNT), 2,4- and 2,6-dinitrotoluene, and 2-nitrotoluene as N sources, was isolated. The bacterium grew at 30 degrees C with fructose as a C source and accumulated nitrite. Through batch culture enrichment, we isolated a derivative strain, called Pseudomonas sp. clone A, which grew faster on TNT and did not accumulate nitrite in the culture medium. Use of TNT by these two strains as an N source involved the successive removal of nitro groups to yield 2,4- and 2,6-dinitrotoluene, 2-nitrotoluene, and toluene. Transfer of the Pseudomonas putida TOL plasmid pWW0-Km to Pseudomonas sp. clone A allowed the transconjugant bacteria to grow on TNT as the sole C and N source. All bacteria in this study, in addition to removing nitro groups from TNT, reduced nitro groups on the aromatic ring via hydroxylamine to amino derivatives. Azoxy dimers probably resulting from the condensation of partially reduced TNT derivatives were also found.

[Cardiac involvement in Kawasaki disease]

Cardiovascular complications (CVC) of Kawasaki disease (KD) are described in 15 affected children (10 boys, mean age 18.5 months). Clinical records, electrocardiographic tracings (ECG) and bidimensional echocardiograms (BDE) were analysed. In each case the first BDE was done at clinical diagnosis (mean time 10 days from initial symptoms of disease), then at weekly intervals for the first month and each two weeks along the second month. In children showing persistent coronary artery lesions (CAL) BDE was repeated monthly and in patients without CVC at three month intervals. During follow up, no definite clinical evidence of miocardial ischemia was found, but abnormal BDE recordings were obtained from 12/15 patient: CAL in 9/15; right ventricular, left ventricular and aortic enlargement in 3/15. CAL were located at the left coronary artery (LCA) in 3/9 (one LCA aneurysm) and at both coronary arteries in 6/9 (including 3 cases with bilateral aneurysms). All patients were given aspirin and seven were also treated with intravenous gammaglobulin, this last at day 9 (mean) of disease, but 5 of them developed CVC, including 3 cases of CAL.