Reduced Cholesterol Levels during Acute Human Babesiosis

BACKGROUND

Babesiosis, an intra-erythrocytic protozoan disease, is an emerging zoonotic parasitic disease worldwide. Cholesterol levels are correlated with severe infections, such as sepsis and COVID-19, and anecdotal reports suggest that high-density lipoprotein (HDL) cholesterol declines during acute babesiosis. Our aim was to describe the cholesterol levels in patients with acute babesiosis diagnosed in an endemic area in New York, hypothesizing that HDL levels correlate with the severity of infection.

METHODS

We reviewed the medical records of adult patients with babesiosis diagnosed by identification of Babesia parasites on a thin blood smear and confirmed by polymerase chain reaction from 2013 to 2018, who also had available a lipid profile drawn at the time of clinical presentation. Additional lipid profile levels were considered as "baseline" if they were drawn within 2 months before or after the infection as part of routine care.

RESULTS

A total of 39 patients with babesiosis had a lipid profile drawn on presentation. The patients were divided into two groups for comparison based on the treating physician's clinical decision: 33 patients who were admitted to the hospital and 8 patients who were evaluated as outpatients. A history of hypertension was more common in admitted patients (37% vs. 17%, p = 0.02). The median levels of low-density lipoprotein (LDL) and HDL were significantly reduced in admitted patients compared to non-admitted patients (46 vs. 76 mg/dL, p = 0.04; and 9 vs. 28.5 mg/dL, p = 0.03, respectively). In addition, LDL and HDL levels returned to baseline values following resolution of acute babesiosis.

CONCLUSION

LDL and HDL levels are significantly reduced during acute babesiosis, suggesting that cholesterol depletion may predict disease severity. Pathogen and host factors may contribute to a reduction in serum cholesterol levels during acute babesiosis.

A Short Series of Case Reports of COVID-19 in Immunocompromised Patients

Immunocompromised individuals are at risk of prolonged SARS-CoV-2 infection due to weaker immunity, co-morbidities, and lowered vaccine effectiveness, which may evolve highly mutated variants of SARS-CoV-2. Nonetheless, limited data are available on the immune responses elicited by SARS-CoV-2 infection, reinfections, and vaccinations with emerging variants in immunocompromised patients. We analyzed clinical samples that were opportunistically collected from eight immunocompromised individuals for mutations in SARS-CoV-2 genomes, neutralizing antibody (NAb) titers against different SARS-CoV-2 variants, and the identification of immunoreactive epitopes using a high-throughput coronavirus peptide array. The viral genome analysis revealed two SARS-CoV-2 variants (20A from a deceased patient and an Alpha variant from a recovered patient) with an eight amino-acid (aa) deletion within the N-terminal domain (NTD) of the surface glycoprotein. A higher NAb titer was present against the prototypic USA/WA1/2020 strain in vaccinated immunocompromised patients. NAb titer was absent against the Omicron variant and the cultured virus of the 20A variant with eight aa deletions in non-vaccinated patients. Our data suggest that fatal SARS-CoV-2 infections may occur in immunocompromised individuals even with high titers of NAb post-vaccination. Moreover, persistent SARS-CoV-2 infection may lead to the emergence of newer variants with additional mutations favoring the survival and fitness of the pathogen that include deletions in NAb binding sites in the SARS-CoV-2 surface glycoprotein.

Hemagophagocytic lymphohistiocytosis associated with recurrent Babesiosis with Lyme disease co-infection in an immunocompromised host on anti-CD20 monoclonal antibody therapy: A case report

In the Northeastern United States, a nationally notifiable emerging infectious disease caused by a protozoan infecting erythrocytes is endemic. Transmitted by a deer tick, Ixodes scapularis, this protozoan, Babesia microti, has a complex life cycle including multiple mammalian hosts with humans affected as a dead end reservoir. Although humans are not necessary for the survival of this protozoan, if human erythrocytes are infected by it, especially in a host that is immunocompromised, devastating clinical illness with a significant risk of mortality occurs. Erythrocytic infection of the human host causes many pathogenic changes within the human body, leading to red blood cell destruction and release of pro inflammatory cytokines (3). This pro-inflammatory cascade can very rarely lead to a cycle of further erythrocytic destruction through development of a rare syndrome with high mortality, hemagophagocytic lymphohistocytosis (HLH), which requires early recognition and diagnosis for treatment. This case discusses infection in an immunocompromised host with Babesiosis with complications of HLH and co-infection with Lyme disease requiring multiple diagnostic and therapeutic decisions.

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Human Babesiosis is an emerging infectious disease in the Northeastern United States, particularly in Long Island, NY.

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Babesiosis can lead to a rare syndrome (pro-inflammatory cascade) with high mortality, Hemagophagocytic lymphohistiocytosis.

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HLH may present as a management challenge in Babesiosis, as it requires addition of steroids to anti parasitic therapy.

348. Characteristics and Outcomes in Hospitalized Patients with Covid-19 Complicated by Fungemia: A Single Center Retrospective Study

Background

Covid19 caused by SARS-CoV2 can lead to significant morbidity and mortality. Fungemia is a rare hospital-associated infection and there are limited data regarding its association with Covid19. We reviewed all cases of fungemia in our Covid19 cohort at Stony Brook University Hospital (SBUH).

Methods

We conducted a retrospective medical record review of patients admitted with Covid19 in a 3-month interval. We reviewed positive blood cultures for fungi and recorded co-morbidities, co-infections, length of stay, treatments, and outcomes (survival vs death). There were 60 positive blood cultures for fungi in 25 unique patients (Table 1); in prior years < 30 per year reported at SBUH.

Table 1. Fungal Blood Cultures

Results

During a 3 month interval at the local peak of the pandemic 1398 patients hospitalized with Covid19 at SBUH, 25 cases of fungemia were detected; C. albicans (CA) n=8,32%, non C albicans species (nCA) n=16,64%, and C. neoformans n=1,4%, 17/25 (68%) also with bacteremia during same hospitalization. In same 3 months there were 264 cases of bacteremia and Covid19 co-infection. Demographics and medical co-morbidities of fungemic patients are in Table 2. Majority were men (76%). No difference between fungaemic (FC) and total cohort (TC) in median age (62 vs 62), DM p=0.31, HTN p=1.0, COPD p=0.12. Within FC, DM was higher in nCA group (58.8%) vs CA group (37%). Mortality was 40% in FC vs 15% in TC, p< 0.001. Within FC mortality was 56% in nCA and 25% in CA group. C. parapsilosis was the most common nCA species isolated with 43% mortality. FC more likely to require ICU and mechanical ventilation (88% vs 15%, p< 0.0001) and had longer median length of stay 42 days vs 22 days. The median time from admission to fungaemia was 21d, from central line placement 19d, Table 3. Of FC 21 (84%) were treated with steroids/Tocilizumab concurrently. Of note, no mortality was recorded in the 4 patients that did not receive steroids/Tocilizumab.

PCT and WBC were significantly higher at time of fungemia as compared to admission, Table 3.

Table 2, Patient co-morbidities and hospitalization stay characteristics

Conclusion

Fungemia in hospitalized patients with COVID-19 is associated with higher mortality. We observed higher fatality in non C. albicans infections. Prolonged use of central line catheters and concurrent treatment with steroids/tociluzimab are likely high-risk factors for development of fungemia.

Disclosures

All Authors: No reported disclosures

734. Abnormal Lipid Profiles in Human Babesiosis

Background

Babesiosis has gained attention as an emerging protozoal zoonotic disease with an expanding known incidence and geographical range in the US. The infection is caused by Babesia microti in the US and is transmitted by the bite of Ixodes ticks, and occasionally by blood transfusion. The diagnosis is usually established by microscopic examination of a stained blood smear to see intraerythrocytic organisms. The level of parasitemia is only loosely correlated with clinical severity. Anecdotal reports suggest that HDL cholesterol levels decline during acute babesiosis. In this study, we report cholesterol levels in a series of patients with acute babesiosis with the hypothesis that HDL levels may be a potential biomarker for more severe infections.

Methods

A retrospective chart review was performed at Stony Brook University Hospital and Stony Brook Southampton Hospital between 2013 and 2018. Inclusion criteria was defined as a case of acute Babesia infection proven by peripheral blood smear microscopy and who had a lipid profile drawn during presentation to the emergency department. Cholesterol levels that were measured either before or after the infection (at least 1 month apart) were also recorded to compare to the levels reported during acute infection.

Results

A total of 40 patients (27.5% female) met criteria for acute Babesia infection. Fifteen (37.5%) had a history of splenectomy. The patients were divided into two groups for comparisons based on the treating physician’s clinical decision: 32 patients who were admitted to the hospital and 8 patients who were not-admitted. History of hypertension was more common in admitted than non-admitted patients (37% vs. 17%, Chi-square test p=0.02); the median levels of LDL and HDL were more reduced in admitted than non-admitted patients (46 vs 76 mg/dL, p=0.04 and 9 vs 28.5 mg/dL, p=0.03, based on t-test respectively)

Conclusion

LDL and HDL levels are significantly reduced in acute babesiosis, and LDL levels are inversely proportional to the parasitemia, suggesting that low levels of LDL may predict worsening disease in babesiosis. The mechanism of this phenomenon is unknown. Further prospective studies are needed.

Disclosures

All Authors: No reported disclosures

328. Bacteremia in Patients Hospitalized with Covid-19 Disease, Risk Factors, Impact of immunomodulator Therapy, Role of Inflammatory Markers, Antibiotic Use, and Outcomes: A Single Center Retrospective Study

Background

Novel coronavirus 2019 (Covid19) caused by SARS-CoV2 can lead to significant morbidity and mortality. There is unclear association between Covid19 and bacteremia. Patient characteristics and outcomes are not well defined. This retrospective cohort study assessed this in patients with Covid19 and bacteremia.

Methods

Patients with Covid-19 admitted to a tertiary care suburban academic medical center (UH) were assessed retrospectively by EMR chart review for co-morbidities, pre and in hospital factors, and outcomes as defined below. Bacteremias grouped into gram-negative or gram-positive with collation of each unique bacterial species (Table 1).

Results

Total 1398 patients with Covid19 hospitalized at UH during local peak of pandemic of whom 238 (17.02%) developed 264 bacteremias with gram-positive (244, 92.4%) and gram-negative organisms (20, 7.57%). Relevant characteristics (Table 2) 53% with immunomodulator therapy (steroids/Tocilizumab), mean length of stay 21.04days (SEM ± 1.67) with day SARS-CoV2 PCR positivity -1.15days from hospitalization (SEM ± 0.49) and day initial bacteremia 6.38 (SEM ± 0.77), 55.4% required ICU admission, with 89% ICU admissions requiring mechanical ventilation. Most common co-morbidity (Figure 1 full list) Hypertension 56.3% followed by Obesity (BMI >30) 45.8% and CAD/CHF 40.3%. Laboratory parameters (Table 3)significant for average difference (date bacteremia- date admission) for Procalcitonin 4.15ng/mL (SEM ± 0.97, p-value 0.02), CRP -0.934mg/dL (SEM ± 0.95, p-value 0.32), WBC 7.027 K/uL (SEM ± 0.65, p-value < 0.005). These analyses excluded difference of 0 from hospital day 1 bacteremia. Average antibiotic number (1+ dose per antibiotic) 3.24 (SEM ± 0.16) and total C difficile cases 3 (1.26%). Mortality rate34.45%.

Relevant hospitalization characteristics, Covid19 and bacteremia co-infections

Relevant laboratory parameters for patients with Covid19 and bacteremia co-infection

Conclusion

Patients with Covid19 and bacteremia had high mortality (Figure 2), 53% received immunomodulator therapy, possibly contributing to bacteremia development. With bacteremia increase in WBC and Procalcitonin, not CRP, noted. Most organisms CoNS, likely contaminants, gram positive bacteremias likely from indwelling lines. Only 3 C difficile infections identified. Trends noted in Procalcitonin rise, immunomodulator therapy, and low C difficile infection rates warrant further studies.

Post-hospitalization Outcomes

Disclosures

All Authors: No reported disclosures

Bacterial infections and death among patients with Covid-19 versus non Covid-19 patients with pneumonia

Background

Many patients with Coronavirus disease-2019 (Covid-19) present with radiological evidence of pneumonia. Because it is difficult to determine co-existence of bacterial pneumonia, many of these patients are initially treated with antibiotics. We compared the rates of bacterial infections and mortality in Covid-19 patients with pulmonary infiltrates versus patients diagnosed with ‘pneumonia’ the year previously.

Methods

We conducted a medical record review of patients admitted with Covid-19 and a pulmonary infiltrate and compared them with patients diagnosed with pneumonia admitted in the prior year before the pandemic. Data abstracted included baseline demographics, comorbidities, signs and symptoms, laboratory and microbiological results, and imaging findings. Outcomes were bacterial infections and mortality. Patients presenting with and without Covid-19 were compared using univariable and multivariable analyses.

Results

There were 1398 and 1001 patients admitted through the emergency department (ED) with and without Covid-19 respectively. Compared with non-Covid-19 patients, those with Covid-19 were younger (61±18 vs. 65±25 years, P < 0.001) and had a lower Charlson Comorbidity Index (0.7 vs. 1.2, P < 0.001). Bacterial infections were present in fewer Covid-19 than non-Covid-19 patients (8% vs. 13%, P < 0.001), and most infections in Covid-19 were nosocomial as opposed to community acquired in non-Covid-19 patients. CXR was more often read as abnormal and with bilateral infiltrates in patients with Covid-19 (82% vs. 70%, P < 0.001 and 81% vs. 48%, P < 0.001, respectively). Mortality was higher in patients with Covid-19 vs. those without (15% vs. 9%, P < 0.001). Multivariable predictors (OR [95%CI]) of mortality were age (1.04 [1.03–1.05]/year), tachypnea (1.55 [1.12–2.14]), hypoxemia (2.98 [2.04–4.34]), and bacterial infection (2.80 [1.95–4.02]). Compared with non-Covid-19 patients with pneumonia, patients with Covid-19 were more likely to die (2.68 [1.97–3.63]).

Conclusions

The rate of bacterial infections is lower in Covid-19 patients with pulmonary infiltrates compared with patients diagnosed with pneumonia prior to the pandemic and most are nosocomial. Mortality was higher in Covid-19 than non-Covid-19 patients even after adjusting for age, tachypnea, hypoxemia, and bacterial infection.

Synthesis of CuO-NPS by simple wet chemical method using various dicarboxylic acid salts as precursors: Spectral characterization and in-vitro biological evaluation

In this study, a simple chemical reduction method was employed to synthesize CuO-NPs.  Various dicarboxylic acids were converted into Cu(II) salt of dicarboxylic acid which were used as precursors. NPs were produced by reducing precursors with NaBH4. Characteristics of synthesized NPs were investigated by using important analytical techniques including Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), thermo gravimetric analysis (TGA) and scanning electron microscopy (SEM). Developed NPs were investigated for their antibacterial activity against a range of bacterial strains by employing agar well diffusion method. CuO-NPs exhibited good to moderate activity against E-Coli, B. Subtilis and poor activity against K. pneumonia and Methicillin-resistant Staphylococcus aureus (MRSA). It was found that amongst all experienced compounds sample 2 showed good activity with minimum inhibition concentration (MIC) 10 µg/mL (zone of inhibition: 22± 0.12 mm) while sample 3 showed poor activity with MIC 40 µg/mL (zone of inhibition: 8.0 ± 0.18 mm).                     KEY WORDS: CuO-NPs, Dicarboxylic acids, Sodium borohydride, Antibacterial study   Bull. Chem. Soc. Ethiop. 2020, 34(2), 323-334 DOI: https://dx.doi.org/10.4314/bcse.v34i2.10

Cranial cruciate ligament rupture in large and giant dogs

Forty-two dogs weighing between 30 and 87 kg (mean body weight of 49 kg) with cranial cruciate ligament ruptures (CCLR) were treated with a modified lateral extra-capsular stabilization using braided polyester prosthetic ligament-suture anchor technique. Clinical and radiographic outcomes of 48 stifles were retrospectively evaluated with a mean follow-up of 18 months. Ten dogs had pulled out their bone anchors with no clinical relevance. Draining tracts did not appear. Despite mild radiographic progression of osteoarthritis, all of the dogs regained acceptable function of the operated limb.

Ca2+ Signaling but Not Store-Operated Ca2+ Entry Is Required for the Function of Macrophages and Dendritic Cells

Store-operated Ca(2+) entry (SOCE) through Ca(2+) release-activated Ca(2+) (CRAC) channels is essential for immunity to infection. CRAC channels are formed by ORAI1 proteins in the plasma membrane and activated by stromal interaction molecule (STIM)1 and STIM2 in the endoplasmic reticulum. Mutations in ORAI1 and STIM1 genes that abolish SOCE cause severe immunodeficiency with recurrent infections due to impaired T cell function. SOCE has also been observed in cells of the innate immune system such as macrophages and dendritic cells (DCs) and may provide Ca(2+) signals required for their function. The specific role of SOCE in macrophage and DC function, as well as its contribution to innate immunity, however, is not well defined. We found that nonselective inhibition of Ca(2+) signaling strongly impairs many effector functions of bone marrow-derived macrophages and bone marrow-derived DCs, including phagocytosis, inflammasome activation, and priming of T cells. Surprisingly, however, macrophages and DCs from mice with conditional deletion of Stim1 and Stim2 genes, and therefore complete inhibition of SOCE, showed no major functional defects. Their differentiation, FcR-dependent and -independent phagocytosis, phagolysosome fusion, cytokine production, NLRP3 inflammasome activation, and their ability to present Ags to activate T cells were preserved. Our findings demonstrate that STIM1, STIM2, and SOCE are dispensable for many critical effector functions of macrophages and DCs, which has important implications for CRAC channel inhibition as a therapeutic strategy to suppress pathogenic T cells while not interfering with myeloid cell functions required for innate immunity.

Cardiovascular disease and diabetes mortality, and their relation to socio-economical, environmental, and health behavioural factors in worldwide view

BACKGROUND

Today, non-communicable diseases, mainly cardiovascular diseases and diabetes, represent a leading threat to human health and development. This study observed mortality trends in all income group countries in relation to a wide variety of related factors like economical and environmental factors, health behaviour and health risk factors.

STUDY DESIGN

Ecological study.

METHOD

Data were analysed for 72 countries using the ecological study method. Data were collected from various sources including WHO, World Bank and previous studies. Cardiovascular disease and diabetes mortality rates for males and females were used as the dependent variables. GDP, GINI, literacy rate, urbanization, health expenditure, the number of physicians and the number of beds, BMI, western diet, blood glucose, blood pressure, serum cholesterol, physical inactivity, alcohol, and smoking were used as the independent variables initially. The final model was decided on the basis of availability of complete data and result of co-linearity test. Correlation test and linear regression were employed to identify the affecting factors for the dependent variables.

RESULT

Analysis showed that cardiovascular disease and diabetes mortality was more concentrated in middle- and low-income countries and was negatively associated with GDP, GINI, and western diet. Countries with high average blood pressure had higher mortality rates showing a positive relationship.

CONCLUSION

Non-communicable disease mortality rate is strongly associated with many economical, social, environmental, and behavioural factors. More comprehensive preventive and diagnostic strategies are needed to decrease mortality especially in low- and middle-income countries.

Mycobacterium tuberculosis type VII secreted effector EsxH targets host ESCRT to impair trafficking

Mycobacterium tuberculosis (Mtb) disrupts anti-microbial pathways of macrophages, cells that normally kill bacteria. Over 40 years ago, D'Arcy Hart showed that Mtb avoids delivery to lysosomes, but the molecular mechanisms that allow Mtb to elude lysosomal degradation are poorly understood. Specialized secretion systems are often used by bacterial pathogens to translocate effectors that target the host, and Mtb encodes type VII secretion systems (TSSSs) that enable mycobacteria to secrete proteins across their complex cell envelope; however, their cellular targets are unknown. Here, we describe a systematic strategy to identify bacterial virulence factors by looking for interactions between the Mtb secretome and host proteins using a high throughput, high stringency, yeast two-hybrid (Y2H) platform. Using this approach we identified an interaction between EsxH, which is secreted by the Esx-3 TSSS, and human hepatocyte growth factor-regulated tyrosine kinase substrate (Hgs/Hrs), a component of the endosomal sorting complex required for transport (ESCRT). ESCRT has a well-described role in directing proteins destined for lysosomal degradation into intraluminal vesicles (ILVs) of multivesicular bodies (MVBs), ensuring degradation of the sorted cargo upon MVB-lysosome fusion. Here, we show that ESCRT is required to deliver Mtb to the lysosome and to restrict intracellular bacterial growth. Further, EsxH, in complex with EsxG, disrupts ESCRT function and impairs phagosome maturation. Thus, we demonstrate a role for a TSSS and the host ESCRT machinery in one of the central features of tuberculosis pathogenesis.

Mycobacterium tuberculosis (Mtb) causes the disease tuberculosis, one of the world's most deadly infections. The host immune system can't eradicate Mtb because it grows within macrophages, cells that normally kill bacteria. One of the intracellular survival strategies of Mtb is to avoid delivery to lysosomes, a phenomenon described over 40 years ago, but for which the mechanism and molecular details remain incomplete. Mtb possess specialized secretion systems (Type VII secretion systems; TSSS) that transfer particular proteins out of the bacteria, but how these proteins promote infection is not well understood. In this study, we used a high stringency yeast two-hybrid system to identify interactions between secreted effectors from Mtb and human host factors. We identified ninety-nine such interactions and focused our attention on the interaction between EsxH, secreted by Esx-3, a TSSS of Mtb, and Hrs, a component of the host ESCRT machinery. We provide evidence that Mtb EsxH directly targets host Hrs to disrupt delivery of bacteria to lysosomes. Thus, this study demonstrates the role of a TSSS effector and the ESCRT machinery in what is one of the central features of tuberculosis pathogenesis, thereby providing molecular insight into why humans can't clear Mtb infection.

Induction of pancreatic phenotypes in central nervous system derived pluripotential progenitor cells

Fetal rat brain stem cells (RSCs) have been induced to express pituitary properties when exposed to pituitary cells (U et al., 2002). In this study, we explored whether these RSCs could also be influenced to acquire properties characteristic of the pancreas. To this end, RSCs in culture were exposed to media conditioned by rat islet tumor cells and media containing Exendin-4 and nicotinamide since both have been shown to induce pancreatic phenotypes in embryonic stem cells. Lastly, an expression construct for pdx-1 was introduced into RSCs. The expression of pancreatic markers was analyzed using RT-PRC and immunocytochemistry. When RSCs were exposed to rat islet tumor cell conditioned media and media containing Exendin-4 and nicotinamide, the expression of pdx-1, insulin and somatostatin were observed. They also acquired a spherical shape typical of pancreatic cells in culture. Under these varied conditions, transcriptional factors essential to pancreatic development such as pdx-1 and Isl-1 were induced. The critical role of pdx-1 in stimulating certain endocrine pancreatic properties in RSCs was further confirmed upon the introduction of an expression construct for pdx-1 which markedly induced insulin and somatostatin. Taken together, these findings suggests that fetal brain stem cells are pluripotent and can be reprogrammed to acquire pancreatic properties through pathways which involved the transcription factor Pdx1.

Polyarthrite associée à une leishmaniose chez un jeune chien

Un chien de race Cane corso, mâle, âgé de deux ans, est examiné en consultation pour abattement et dysorexie. Il présente également une boiterie d’appui persistante du membre postérieur gauche depuis plusieurs semaines. À l’examen clinique, le chien est en hyperthermie (39,3 °C) ; il a des saignements spontanés des babines, une polyadénomégalie périphérique, notamment des nœuds lymphatiques poplités, ainsi qu’une splénomégalie. Par ailleurs, l’examen orthopédique montre que les tarses sont gonflés et chauds. Cela laisse suspecter une synovite bilatérale. L’examen cytologique des nœuds lymphatiques et du liquide synovial permet de diagnostiquer avec certitude une leishmaniose. En effet, de très nombreuses formes amastigotes sont visualisées dans les macrophages. Une analyse par PCR sur sang, liquide synovial, suc ganglionnaire et ponction de moelle osseuse écarte l’ehrlichiose et la borréliose. Une PCR leishmaniose sur sang est également effectuée pour suivre la réponse au traitement. Malgré une forte infestation, une anémie non régénérative, une leucopénie, des signes de néphropathie et l’apparition d’une épistaxis, le chien est traité avec succès principalement à l’aide d’antimoniate de méglumine, d’allopurinol, de corticostéroïdes, associés à des antibiotiques.

Cranial cruciate ligament rupture in large and giant dogs. A retrospective evaluation of a modified lateral extracapsular stabilization

Forty-two dogs weighing between 30 and 87 kg (mean body weight of 49 kg) with cranial cruciate ligament ruptures (CCLR) were treated with a modified lateral extra-capsular stabilization using braided polyester prosthetic ligament-suture anchor technique. Clinical and radiographic outcomes of 48 stifles were retrospectively evaluated with a mean follow-up of 18 months. Ten dogs had pulled out their bone anchors with no clinical relevance. Draining tracts did not appear. Despite mild radiographic progression of osteoarthritis, all of the dogs regained acceptable function of the operated limb.

[Some analytical aspects of mescaline]

Mescaline was extracted from a vegetal powder, seazed on the "Côte d'Azur", then analyzed by several techniques (thin layer chromatography, infra-red spectrometry, gas chromatography/mass spectrometry) and determined by high performance liquid chromatography with methyl-amphetamine as internal standard. The powder contained 0.76% of mescaline. The presence of a possible isomer was noted in the powder as well as in a "old" sample of mescaline.

Acanthosis palmaris in a patient with bullous pemphigoid

Acanthosis palmaris, a recently described dermatologic entity, is often associated with internal malignancy. We report the development, disappearance, and reappearance of this condition in a patient with bullous pemphigoid. Relevant screening tests did not reveal any internal malignant neoplasm. The significance of the appearance and disappearance of the condition is discussed.

Dermatoglyphics in vitiligo

One hundred probands of vitiligo were studied for palmar dermatoglyphics, both qualitatively and quantitatively, and were compared with those of 100 phenotypically normal control subjects. Ulnar loop pattern was the most common digital pattern observed in both probands and controls. An increased incidence of whorls and arches in men and women probands, respectively, was found to be statistically significant when compared with those of controls. Simian crease and Sydney line also have been observed in the present study, which has not been previously reported. A statistically highly significant reduction has been observed in total finger ridge count (TFRC) and a-b ridge count in both sexes of vitiligo cases when compared with those of controls. No significant changes was observed in the values of atd angle and position of axial triradius.

Yaws in Southeast Asia: an overview

A summary is presented of yaws control programs, from their initiation up to the present, in India, Indonesia, and Thailand. In all three countries, the prevalence was spectacularly reduced. From 1950 to 1961, in Java and Bali the rates fell from 11.34% to 0.72%, and comparable results were achieved in India and Thailand. In all programs, resurveys were carried out after the original mass treatment campaigns, and quite successful efforts were made to integrate the yaws control activities into more general health services. Although a small number of active cases of yaws in localized foci are still found, with the rapid expansion of primary health services and continuing surveillance for yaws and the appropriate use of selective or juvenile mass treatment approaches, it should be possible to achieve eradication in the foreseeable future.

Multi-drug treatment for reactions in leprosy

Thirty three leprosy patients in reaction were treated with a combination of Metronidazole--Diethyl carbamazine citrate--Chloroquin which was reinforced either with prednisolone and/or Clofazimine in some, depending on the clinical state. The results were quite encouraging as to recommend the combination alone to be the first choice while encountering leprosy patients in reaction early during the maiden spell--at no time in any case was Dapsone withdrawn.

The role of the World Health Organization in health related aspects of family planning

As part of its mandate and in answer to requests from governments, the World Health Organization works in three main areas relating to human reproduction, family planning, and population dynamics: the introduction of family planning into health services, provision of appropriate education and training for health personnel at all levels, and research in human reproduction, both biomedical and operational. The underlying strategy of the organization is to assist the strengthening of national health services, family planning being included as an integral part of health care. To help administrations to meet the demands posed by the increased scope and multidisciplinary nature of family planning, WHO pays particular attention to the planning, administration, and evaluation of projects, emphasizing the use of modern managerial techniques and the importance of operational research. WHO sponsors scientific and technical meetings in human reproduction, family planning, and population dynamics, to provide an international forum for collaborative efforts and to emphasize the importance of national and international coordination of efforts and resources.