Historical trends in mortality from "older" vaccine-preventable diseases, Colombia: implications for elimination and control

OBJECTIVE

This study aimed to describe the trends in mortality from eight vaccine-preventable diseases in Colombia in the last 40 years and their relationship with vaccination coverage.

STUDY DESIGN

It is a population-based descriptive study.

METHODS

The frequencies of deaths by decade, disease, sex, and the specific mortality rates by age group were calculated. Using a negative binomial regression model, the 10-year changes in mortality and their relationship with vaccination coverage were determined.

RESULTS

The number of deaths and the adjusted rates decreased since 1989 in all diseases (incidence rate ratio <1 when compared with the 1979-1988 decade). Vaccination coverage below 90% is associated with an increase in mortality from diphtheria, measles, mumps, neonatal tetanus, and pertussis.

CONCLUSION

Historical changes in mortality support the benefits of vaccination, but new efforts are required to sustain the elimination of diseases.

Identification of rare-earth minerals associated to K-feldspar: Capacsaya project in Peru

A recently discovered the rare-earth-rich site in Capacsaya, located at 123 km northwest of Cusco, at the south of Peru, contains significant quantities of light and heavy rare-earth elements such as neodymium, lanthanum, cerium, europium, and yttrium. This work reports the identification of rare-earth elements and their associated minerals using scanning electron microscopy, energy-dispersive X-ray spectroscopy and X-ray diffraction analyses. Five (5) samples extracted from different locations at the Capacsaya site were characterized and identified K-feldspar as the mineral associated with the rare-earth elements in a representative sample with a high concentration of lanthanum and cerium. The results showed rare-earth elements contained within the mineral phase monazite, being cerium the dominant element in the phase (La, Ce, Nd)PO$$_4$$ 4 . Finally, through the electrostatic separation process we demonstrate that it was possible to achieve an efficient separation of the K-feldspar phase in the particle size range 75–150 $$\upmu$$ μ m.

[Improved office blood pressure control by automatic delayed-reading oscillometric device]

INTRODUCTION

Office blood pressure (BP) measurement is a recommended procedure, although the out-of-office BP measurements are increasingly used.

OBJECTIVE

To know the degree of BP control by clinical measurement.

MATERIAL AND METHODS

During November 2019 demographic and clinical data, office attended systolic BP (SBP) and diastolic BP (DBP) measured with an automatic device with delayed reading and, if performed, data from ambulatory BP monitoring (ABPM) were collected.

RESULTS

102 patients (67 men) were included, with a mean age of 64.9 years, 30% diabetic and 34% with cardiovascular complications. 70% had a controlled hypertesion (<140/90 mmHg) by office BP, the mean SBP was 131 ± 16.5 mmHg and the DBP was 73 ± 9.5 mmHg. Old age and diabetes were associated with uncontrolled hypertension. Thirty three patients had ABPM data, which allowed them to be classified according to the 24-hour BP into: 30% true normotension, 9% white-coat hypertension, 15% sustained hypertension, and 45% masked hypertension.

CONCLUSION

The use of automatic devices reduces the white-coat phenomenon, improving the % of patients with office BP controlled. However, this is not confirmed outside the clinic, showing the importance of ABPM in the evaluation of hypertension control. Office BP measurement is useful in patients initial assessment and also provides educational aspects, although the methodology must be optimized to define its clinical role.

Analysis of the measurement uncertainty and its effects on noise mapping validations

This paper addresses the use of noise measurements when noise mapping simulations are intended to be validated. For this, a discussion about the measurement uncertainty and how to include it in the process of validation is carried out. Then, the contribution provided by the geo-referencing error of a GPS and its impact in the uncertainty is assessed. This is achieved by means of environmental noise measurements, which are conducted based on the accuracy radius given by a standard GPS. Furthermore, an assessment of the approach is conducted by means of numerical simulations using the commercial package SoundPLAN. The results indicate that the uncertainty of noise measurements should be included as it restricts the validation threshold (usually assumed as ±3 dB). Furthermore, the error generated by the inaccuracy of the geo-referencing process increases the uncertainty of the measurements and, therefore, of the noise maps. Finally, a method to calculate a total uncertainty, which partially includes the contributions of the geo-referencing error is also proposed.

Integrated fixed-film activated sludge ANITA™Mox process--a new perspective for advanced nitrogen removal

ANITA™Mox is a Veolia process using moving-bed biofilm reactor (MBBR) technology tested and validated in full-scale for energy- and cost-effective autotrophic N-removal from sidestream effluent using anammox (ANaerobic AMMonium OXidation) bacteria. In order to increase the ANITA™Mox process performances under different operating conditions (e.g. mainstream and sidestream application), substrate transport and accessibility inside the biofilm must be enhanced. In this work, (i) two laboratory scale biofilm ANITA™Mox reactors were operated using different configurations (IFAS - integrated fixed-film activated sludge - and MBBR) and (ii) the distribution of the anammox (AnAOB) and ammonia-oxidizing bacteria (AOB) in the suspended sludge and the biofilm was characterized using molecular tools (qPCR). This study showed that in IFAS configuration, the ANITA™Mox process achieved very high N-removal rate (up to 8 gN/m².d), which was three to four times higher than that achieved in the pure MBBR mode. The high concentration of suspended solids (mixed liquor suspended solids (MLSS)) in the bulk obtained within the IFAS mode induces a very efficient bacterial distribution between the AOB and AnAOB population. AnAOB activity mainly occurs in the biofilm (96% of total AnAOB in the reactor), whereas nitritation by AOB mostly takes place in the suspended phase (93% of total AOB). This spatial distribution observed in the IFAS reactor results from a natural selection due to more easily substrate accessibility for AOB in the bulk (NH4(+), O2) creating higher nitrite concentration in the bulk liquid compare to pure MBBR mode. The efficient control of MLSS level in the IFAS reactor is a key parameter to enhance the nitrite production by AOB and increase the substrate availability in the AnAOB-enriched biofilm leading to higher N-removal rate. These promising results obtained at laboratory scale have been further confirmed in on-going full-scale IFAS ANITA™Mox trials opening new roads for the widespread application of a very compact and robust ANITA™Mox process for sidestream but also mainstream cost-effective N-removal.

Comparison of two different anaerobic feeding strategies to establish a stable aerobic granulated sludge bed

Two different anaerobic feeding strategies were compared to optimize the development and performance of aerobic granules. A stable aerobic granulation of activated sludge was achieved with an anaerobic plug flow operation (PI) and a fast influent step followed by an anaerobic mixing phase (PII). Two lab scale sequencing batch reactors (SBRs) were operated to test the different operation modes. PI with plug flow and a reactor H/D (height/diameter) ratio of 9 achieved a biomass concentration of 20 g(TSS)/L and an effluent TSS concentration of 0.10 g(TSS)/L. PII with the mixed anaerobic phase directly after feeding and a reactor H/D ratio of 2 achieved a biomass concentration of 9 g(TSS)/L and an effluent quality of 0.05 g(TSS)/L. Furthermore, it is shown that the plug flow regime during anaerobic feeding together with the lower H/D ratio of 2 led to channeling effects, which resulted in lower storage of organic carbon and a general destabilization of the granulation process. Compared to the plug flow regime (PI), the anaerobic mixing (PII) provided lower substrate gradients within the biofilm. However, these disadvantages could be compensated by higher mass transfer coefficients in PII (k(L) = 0.3 m/d for PI; k(L) = 86 m/d for PII) during the anaerobic phase.

First Report of Camphor Tree (Cinnamomum camphora) as a Host of Phytophthora ramorum

Cinnamomum camphora (Lauraceae) is an evergreen shade tree grown in many parts of the United States, including California. From 2007 to 2011, an arborist working in a residential neighborhood in Mill Valley (Marin Co.) noticed several camphor trees with branch dieback and decline. Affected trees had patchy, irregular cankers on the branches and shoot blight. Cankers were black and most had horizontal fissures. Cankers were most abundant in the inside and lower portions of the canopies. In 2011, samples sent to Bartlett Tree Laboratory tested positive for Phytophthora sp. using the Agdia ELISA Phytophthora kit (Agdia, Elkhart, IN). In February 2009 and April 2011, camphor leaf samples were collected by Sacramento Co. inspectors during an annual nursery inspection for Phytophthora ramorum and submitted to CDFA. The normally bright green leaves were reddish with small necrotic spots surrounded by green halos. Camphor samples from Marin Co. were also collected and sent to CDFA in September 2011. An organism with coralloid coenocytic hyphae, chlamydospores, and ellipsoidal semi-papillate sporangia grew on CMA-PARP (4) from both Marin and Sacramento Co. samples. Morphologically, it matched the description of P. ramorum (3). rDNA sequences of the internal transcribed spacer (ITS) region of the Marin (GenBank KC473521) and Sacramento (KC473522) isolates, amplified using primers ITS1 and ITS4 (4), were 100% identical to P. ramorum by a BLAST query (AY038058). Microsatellite loci placed the Marin isolate in the NA1 clonal lineage, while the Sacramento isolate belonged to the NA2 lineage (2). Pathogenicity of both isolates was tested on 5 trees grown in 18.93-liter pots. Three leaves on each tree were inoculated with 6-mm agar plugs taken from the margin of 7-day-old cultures grown on V8 juice agar (V8). Leaves were wounded with a sterile pushpin and two colonized plugs of each isolate were covered with a freezer tube cap filled with sterile dH₂O and attached to the leaves with a pin-curl clip (4). Three branches of the same plants were wounded and inoculated with a 3-mm colonized agar plug for each isolate and secured with Parafilm. An equal number of leaves and stems were treated with uncolonized V8 plugs as controls. Plants were sprayed with dH₂O, covered in large plastic bags, and placed in a growth chamber at 18°C. After 4 days, the bags, caps, and plugs were removed from the leaves. Black lesions were seen 7 days after inoculation on most leaves and 10 to 14 days on inoculated branches. After 32 days, P. ramorum was isolated from leaf lesions and canker margins onto CMA-PARP. No Phytophthora spp. grew from the controls. The experiment was repeated once with similar results. Overall, leaf and stem lesions were larger with the NA2 lineage isolate than the NA1 lineage isolate, which is consistent with previous research (1). Leaf abscission was seen in 30% of the leaves inoculated with the NA2 lineage isolate but none of the NA1 or control leaves. To our knowledge, this is the first report of P. ramorum on camphor in nursery and landscape settings. Mill Valley is known for its mild temperatures and abundant summer fog. Optimal weather conditions likely led to the spread of P. ramorum from infected neighboring forest hosts to camphor in Mill Valley, rather than from an introduction of infected nursery plants. References: (1) E. Elliott et al. For. Pathol. 41:7, 2011. (2) E. M. Goss et al. Phytopathology 101:166, 2011. (3) S. Werres et al. Mycol. Res. 105:1155, 2001. (4) L. E. Yakabe et al. Plant Dis. 93:883, 2009.

Fear, infection and compassion: social representations of tuberculosis in Medellin, Colombia, 2007

OBJECTIVE

To identify and analyse the social representations (SRs) of tuberculosis (TB) among three groups of people in Medellin, Colombia, with the purpose of contributing to improvements in TB treatment and control programme activities.

METHODS

Cross-sectional study using free word association and evocative analysis techniques in 1049 persons within a structural SR framework.

RESULTS

The terms 'cough', 'contagion', 'illness' and 'fear' were found to be components of the central core in the three groups. In the peripheral system, 'rejection' and 'treatment' were considered modifiable factors. Text analysis showed that 'fear' and 'compassion' are associated with evocations among patients and their relatives, 'contagion' among lay people and 'isolation' among health care personnel.

DISCUSSION

Fear of infection may have a negative effect on relationships with patients, health care activities, treatment surveillance and family support for patients. A better understanding of patient beliefs and their family environment can improve treatment quality and adherence in the city.

Development of a portable actuated orthotic glove to facilitate gross extension of the digits for therapeutic training after stroke

An externally actuated glove, controlled by a microprocessor, is being developed to assist finger extension in stroke survivors. The goal of this device is to allow repeated practice of specific tasks for hand therapy in a home environment. The user can control the device by three different means: voice recognition, electromyography, or manual control. These inputs can be used either independently or in combination according to the needs of the user. Both position and force feedback are available for control and safety. Initial testing of the prototype has shown promising performance.

Mulinum spinosum y la carne de cordero: detección de su presencia en ovinos vivos

En Patagonia, la ganadería ovina es una de las principales actividades económicas, pero la calidad de la carne de cordero se ve afectada por el sabor desagradable que toma a causa de la ingesta de neneo (Mulinum spinosum (Cav.) Persoon, Apiaceae) que es una planta predominante, y muy accesible para el ganado en primavera-verano. Para detectar los animales afectados antes de su sacrificio, se ensayaron técnicas fitoquímicas en diferentes órganos de la planta y del animal buscando correspondencias. Se estudiaron 2 grupos (uno con neneo como componente de la dieta y el otro no) de 6 animales cada uno a los que se extrajeron muestras de carne, grasa, hígado, orina y sangre. Los compuestos responsables del efecto del neneo pertenecen al grupo de los terpenos/esteroles, el único presente tanto en las flores de neneo, como en la orina de los corderos. Los tejidos animales fueron inadecuados para detectar el neneo siendo la orina el medio más apropiado para ello. Se propone un protocolo con la intención de generar una herramienta que permita desarrollar tecnologías de bajo costo para superar la dificultad, que queda a disposición de investigadores y productores para su puesta a prueba, con el fin de detectar un posible sabor desagradable previo al sacrificio, evitando así la consecuente pérdida económica.

5-fluorouracil (5-FU) plus cisplatin (CDDP) induction chemotherapy followed by combined external bean radiation therapy (XRT) and mitomycin-C (MMC) and 5-FU chemotherapy in locally advanced anal canal cancer (ACC)

14016

Background: Definitive chemoradiation therapy is the standard of care for squamous or cloacogenic cell ACC. The chemotherapy regimen comprising 5-FU and MMC is the most commonly used among patients with ACC, nearly 70% of patients can get complete response (CR), with the benefit of sphincter preservation, but patients with a large tumors (T3/T4) or nodal metastases have a response of 50%. Methods: To improve outcome, we conducted a phase II, study of 5-FU and CDDP followed by combined XRT plus 5-FU and MMC. Eligibility included patients withT3/T4 ACC with limited locoregional nodal involvement (N0/N1). Treatment: 5-FU 1000 mg/m2/days 1 to 5 in continuous i.v. infusion plus CDDP 100 mg/m2 i.v. day 1 q21d was administered for 2 cycles (weeks 1 and 4) followed by XRT (4.5 Gy) during 6 weeks (weeks 7 to12) with concurrent 5-FU 1000 mg/m2/days 1 to 4 in continuous i.v. infusion plus MMC 10 mg/m2 i.v. day 1 (weeks 9 and 17). RECIST criteria were used to assess tumor response Results: 59 patients were entered on this study from 8/2000 to 2/2005. Median age: 57 yrs (37–83), 49 F/10 M, median ECOG PS 0 (0–1), T3/T4 44/15, N0/N1 20/39. 54 patients were evaluable for clinical response: Induction chemotherapy led to 13 (24%) CR, 38 (70%) partial responses (PR) and 2 (6%) stable disease. After combined modality treatment, there were a total of 36 (67%) CR, 13 (24%) PR, 5 (9%) SD. Median follow up was 21.6 months (5–52).The median time to progression is 20.5 months (3–52). Toxicity grade 3/4: Neutropenia 20% (10/54), thrombocytopenia 13% (7/54), radiodermatitis 13% (7/54), nausea/vomiting 7% (4/54). Our previous experience with concurrent treatment without induction (n=27) resulted in a CR 59%, PR 37%, and 4% progressive disease Conclusions: We concluded that induction chemotherapy followed by combined XRT and chemotherapy could be an option in treatment of locally advanced ACC.

No significant financial relationships to disclose.

Cerebrospinal fluid S-100 protein levels in neurological pathologies

The aim of this paper was to evaluate S-100 concentration in cerebrospinal fluid (CSF) from patients with different neurological disorders, and in subjects with no proven neurological pathology, in order to study possible differences in their protein concentrations. The total number of patient-samples examined was 119 (58 males and 61 females; mean age 35 yrs, 1-79 yrs). Based on the final diagnoses, nine patient groups were studied: a control group, meningitis, acute lymphatic leukemia (ALL), dementia, hydrocephalia, polyneuropathy-motor neuron disease, acute cerebral infarction (ACI), and patients diagnosed with multiple sclerosis. S-100 protein concentrations were measured by the Sangtec 100 two-site immunoradiometric assay. The highest S-100 levels in CSF were found in the dementia group, ACI group, bacterial-fungal and lymphocytic meningitis groups (Kruskal-Wallis test). The S-100 concentrations in these groups were significantly higher compared with the control group (Mann-Whitney U test, p<0.05, p<0.01) and the multiple sclerosis group (p<0.05, p<0.01). No other significant differences were found between groups. Our results suggest that the high protein levels in CSF found in these pathologies may reflect the presence of brain damage. However, the levels need to be considered individually, as they depend on several factors, such as age, severity of brain damage or interval between the onset of brain damage and the taking of the sample.

[Level of S-100 and neuron-specific enolase in cerebrospinal fluid from subjects with neurological pathologies]

AIM

To evaluate S-100 and neuro specific enolase (NSE) levels in cerebrospinal fluid (CSF) from patients with differents neurological disorders in order to study possible differences in their protein concentrations.

MATERIAL AND METHODS

We analysed samples of CSF taked by spinal puncture in subjects either from of the Casualty Department or from the Department of Neurology. Patients displaying neurological symptoms capable of being diagnostically tested. The total number of patients-samples examined was 43 (23 males and 20 females; mean age 43 y, range 1-78 y). Five patients groups were studied: a control group, meningitis, dementia, polyneuropathy-motorneuron disease, and acute cerebral infarction group (ACV). S-100 and NSE concentrations were measured by immunoradiometric procedures.

RESULTS

Highest S-100 median levels in CSF were found in dementia and ACV group, with elevate concentrations in meningitis groups. The increased S-100 levels in these groups was significant compared with control group (Mann-Withney U test). For NSE concentrations, there is a significant differences between dementia group and control group. No other significant differences were found between groups. There were positive correlation between S-100 levels and total protein.

CONCLUSION

Our results suggest that S-100 and NSE can be a sensitive marker of brain damage in different neurological disorders. However, levels must be considered individually, since these concentrations depend on several factors, such as age, severity of brain damage or interval between the onset of brain damage and the taking of the sample.

Modeling of direct recovery of lactic acid from whole broths by ion exchange adsorption

Lactic acid fermentation process with L. casei CRL 686 was performed. The static adsorption isotherm over a strong anionic exchange resin, Amberlite IRA-400 was measured, and the static binding capacity parameters were quantified. Early recovery of lactic acid from this lactate producer from unclarified culture broth was performed in a liquid solid fluidized bed, with the resin as the solid adsorbent, and the dynamic adsorption capacity was calculated. Good agreement was found between static and dynamic binding capacity values. The fluidized bed height was twice the settled bed height and the overall process was controlled by the liquid solid mass transfer. This operation was also simulated by continuously well stirred tanks arranged in series and superficial solid deactivation as in a gas solid catalytic reactor. The deactivation process takes into account liquid channeling and agglomerations of solid induced by the viscosity of the broth and also by the cells during the adsorption. These patterns were also verified by experimental observations, and are in agreement with the results found in the literature. The breakthrough data together with others from previous works were satisfactorily fitted until the 90% dimensionless concentration was reached for both culture broths. The model could be used in future studies on predictions about the liquid solid fluidized bed behavior and other different operating conditions.

Minimally invasive retrieval of a foreign body after penetrating lung injury

Minimally invasive techniques are increasingly used in the management of trauma victims. We report the case of a young man in a motor vehicle crash who sustained a penetrating wound to the anterior left chest caused by the automobile stick shift. Subsequent imaging demonstrated a large foreign body in the left lung. The foreign body was removed successfully by videothoracoscopy, and the patient made a full recovery. This case demonstrates the inroads that minimally invasive surgery is making in care of the injured and highlights an excellent technique for dealing with pulmonary foreign bodies.

Telemedicine: a solution to the followup of rural trauma patients?

BACKGROUND

Outpatient followup of rural trauma patients is problematic for physicians and patients. Our hypothesis was that telemedicine-based followup of trauma patients discharged to remote areas is feasible and is associated with high patient and physician satisfaction.

STUDY DESIGN

We chose 11 counties in Kentucky surrounding a remote telemedicine site as our region of interest. Any adult trauma patient who was discharged from our Level I trauma center to this geographic region was eligible to have routine followup appointment(s) at the TeleTrauma Clinic. Patients were examined and interviewed with the assistance of a nurse, an electronic stethoscope, and a close-up imaging instrument. Radiographs performed at the telemedicine site were viewed. Patients and physicians completed a survey after the appointment.

RESULTS

To date, we have conducted 22 telemedicine-based followup assessments of trauma patients. The average age and Injury Severity Score were 42 years and 18, respectively. Plain radiographs were reviewed in 13 cases. Our patient surveys indicated a high degree of satisfaction with the teleappointment. In 15 of 22 patients, no further clinical followup was arranged. The differences in travel distances and times for an appointment at the TeleTrauma Clinic versus an appointment at our Level I trauma center were significant. The average and median duration of the appointments was 14 minutes. All telemedicine encounters were done by two physicians, who recorded a high level of satisfaction.

CONCLUSIONS

Our early experience with the outpatient followup of remote trauma victims by telemedicine is encouraging. Patient surveys indicate a high degree of satisfaction. As a result of our favorable experience, telemedicine-based followup may be expanded to other regions of Kentucky.

Analysis of nitric oxide activity in prevention of reperfusion injury

This project was designed to determine the role of nitric oxide (NO) in the prevention of ischemia-reperfusion injury. Inferiorly based rectus abdominis muscle flaps were elevated in pigs and subjected to 6 hours of ischemia followed by 4 hours of reperfusion. Group I animals received a bolus of L-arginine before reperfusion, and a continuous infusion once flow was restored. Group II animals served as controls and received an equal volume of saline as a bolus and subsequent continuous infusion. Microdialysis was used to measure tissue NO levels, and these were correlated with muscle survival determined by vital staining with nitroblue tetrazolium. The results demonstrated a significant increase in tissue NO levels in L-arginine-supplemented animals (p < 0.05), which in turn correlated with a significant increase in muscle survival (p = 0.0051). These results suggest that administration of supplemental L-arginine to ischemic skeletal muscle during reperfusion results in increased NO production and decreased tissue damage.

Utilization of FAST (Focused Assessment with Sonography for Trauma) in 1999: results of a survey of North American trauma centers

Although much has been written about FAST (Focused Assessment with Sonography for Trauma) in the last decade little is known about its present clinical utilization. The purpose of this study was to evaluate and characterize the contemporary utilization of FAST at trauma centers in the United States and Canada. In 1999 trauma directors or their delegates at Level I regional trauma centers in the United States and Canada were surveyed either by fax or phone regarding the present utilization and the future of FAST at their center. The overall survey response rate was 91 per cent with 96 of 105 centers completing the survey. Of the 96 centers surveyed 78 were in the United States and 18 were in Canada. Of the 78 U.S. centers surveyed 62 (79%) routinely use FAST, and it is done by surgeons in 39 per cent, surgeons and emergency departments in 21 per cent, emergency departments in 5 per cent, and radiologists in 35 per cent. Most centers (79%) thought that it sped up their workups, and 89 per cent said it was an advance in patient care. FAST is used in penetrating injury at 58 per cent of centers, and some centers use FAST to assess organ injury. The utilization of diagnostic peritoneal lavage and CT has markedly decreased at many centers. Almost all respondents thought that FAST should be a component of surgery resident training. The utilization of FAST is significantly less in Canada than in the United States (P < 0.05). Our conclusions are the following. FAST has become routinely used at the majority of the U.S. centers surveyed. FAST is performed by clinicians at 65 per cent of the trauma centers surveyed. The utilization of CT and diagnostic peritoneal lavage has changed. Many centers have broadened the scope of FAST to include the assessment of organ, pediatric, and penetrating injury.

A minimally invasive approach to bile peritonitis after blunt liver injury

The advent of nonoperative management of liver injuries has made it imperative that surgeons be familiar with the potential delayed complications of this approach. In this report, we describe a minimally invasive strategy for the management of bile peritonitis following nonoperative management of blunt liver injuries. Two cases are presented in which bile peritonitis with massive bile ascites was managed with laparoscopic localization and drainage of the bile leak, irrigation of the peritoneal cavity, and postoperative endoscopic retrograde cholangiography with bile duct stenting. In both cases the bile leak ceased, and the patients recovered without adverse sequelae. The combination of laparoscopic surgery and endoscopic stenting provides a minimally invasive approach to this entity.

First Report of Fusarium Wilt of Babaco (Carica × heilbornii var. pentagona) in Ecuador

Babaco, Carica × heilbornii V.M. Badillo var. pentagona (Heilborn) V.M. Badillo, is a fruit native to Ecuador that has great potential as a cultivated crop. Local market demand and strong potential as an export crop have greatly increased interest in babaco production in Ecuador. Although the crop can be produced in open fields, the majority of crop production is in plastic greenhouses. In 1996, a serious wilt disease developed on babaco in several greenhouses, resulting in up to 100% loss of plants. Symptoms first appeared as chlorosis of the lower leaves, followed by defoliation progressing up the stem until the entire plant was defoliated. When cut in cross section, vascular discoloration was observed in the stem. Eventually necrosis and soft rot of the stem occurred and entire plants collapsed. Fungal isolations were conducted from fine feeder roots of diseased plants by soaking root pieces (2 cm long) in a 0.5% solution of sodium hypochlorite for 3 min. Root pieces were cut into smaller sections and placed on potato dextrose (PDA) or corn meal (CMA) agar in petri dishes. Isolations from larger roots, crowns, stems and fruits were made by soaking tissue sections of each plant part in a 2.87% solution of sodium hypochlorite for 3 min. Tissue sections were rinsed three times in sterile distilled water. Smaller tissue sections (≈0.125 cm³) were cut from surface-disinfested pieces and placed on PDA and CMA in petri dishes. Cultures were incubated at 20°C. A fungus resembling Fusarium sp. was isolated consistently from infected tissues from all infected plant parts. Based on the morphology of the fungal colony and conidia from monosporic isolations, the fungus was identified as Fusarium oxysporum Schlechtend:Fr. (1). Pathogenicity tests were conducted by growing babaco plants in pots containing an equal mixture of sterilized soil, compost, and sand in the greenhouse. Eight 7-month-old plants were inoculated by placing 40 ml of a suspension (10⁶ conidia per ml) of F. oxysporum in four plastic straws placed in the soil (5 cm depth) at equal distances (5 cm) from the base of each plant. Straws around noninoculated control plants received sterile water. Plants were watered with 400 ml of sterile water daily. Pathogenicity tests were repeated once as described. All inoculated plants developed typical wilt symptoms within 45 days after inoculation. No symptoms developed on uninoculated control plants. F. oxysporum was successfully reisolated from infected stem tissues of inoculated plants. Incidence of Fusarium vascular wilt of babaco has continued to increase since 1996 and is currently the major constraint to production. References: (1) P. E. Nelson et al. 1981. Fusarium: Diseases, Biology, and Taxonomy. The Pennsylvania State University Press, University Park.

Endomyocardial fibrosis (Davies disease) coincidental with systemic lupus erythematosus

This is the case of a 27 years-old woman with signs and symptoms of severe untreatable congestive heart failure, anemia, gingival mucosa ulcers, photosensitivity and alopecia. The electrocardiographic, echocardiographic, angiographic and hemodynamic data oriented the diagnosis of restrictive cardiomyopathy, mitral insufficiency secondary to mitral prolapse and bi-atrial dilation. The histologic study of the endomyocardial biopsy, performed during catheterization, showed signs of endomyocardial fibrosis, and immunological analysis was compatible with systemic lupus erythematosus. As far as we know, this is the first case of endomyocardial fibrosis (Davies disease) associated with systemic lupus erythematosus published in the medical literature. The etiology of Davies disease remains unrevealed and its association with systemic lupus erythematosus suggest a probable autoimmune origin.

Prospective evidence of the superiority of a sonography-based algorithm in the assessment of blunt abdominal injury

BACKGROUND

Although the routine use of FAST (focused assessment with sonography for trauma) in the evaluation of trauma victims is increasing, to our knowledge, a prospective comparison of contemporary adult trauma victims managed with and without FAST has not been reported in North America.

METHODS

Adult victims of blunt trauma for whom there was a suspicion of abdominal injury were managed with one of two diagnostic algorithms, FAST or no-FAST. The two algorithms were compared for diagnostic accuracy, cost, time, and delayed diagnoses.

RESULTS

Among 706 patients (mean Injury Severity Score, 23), 460 were managed with FAST and 246 with no-FAST. The two groups were similar with respect to age, Injury Severity Score, prehospital time, and mortality (p = not significant). There were 3 of 460 (0.7%) delayed diagnoses in the FAST group and 4 of 246 (1.6%) in the no-FAST group (p = not significant). The diagnostic accuracy for the FAST and no-FAST algorithms was 99% and 98%, respectfully. The FAST and no-FAST algorithms led to similar rates of laparotomy, 13% and 14%, respectfully, but nonoperative management was more common in the no-FAST group (p < 0.01). The mean diagnostic cost for the FAST algorithm was $156, compared with $540 with the no-FAST algorithm (p < 0.0001) and the mean time required for diagnostic work-up was 53 minutes with the FAST algorithm, compared with 151 minutes with the no-FAST algorithm (p < 0.0001).

CONCLUSION

This study has provided prospective evidence that a FAST-based algorithm for blunt abdominal injury was more rapid, less expensive, and as accurate as an algorithm that used computed tomography or diagnostic peritoneal lavage only. Trauma centers are encouraged to incorporate a FAST-based algorithm into their initial management of blunt trauma victims.

A new transthyretin variant--ATTR Arg104Cys

We report the genetic characterization of a transthyretin variant previously detected by mutation scanning employing single strand conformation polymorphism analysis in patients with peripheral neuropathies. A substitution of a thymine for cytosine resulting in the replacement of an arginine with cysteine at position 104 of the polypeptide chain was found both by DNA sequencing and restriction fragment length polymorphism analysis. The propositus presented a sensory axonal neuropathy, no neurological abnormalities in the upper limbs nor autonomic involvement. No evidence for amyloid deposition was found in either muscle and nerve biopsies. There was no history of amyloidosis in the family. This mutation might be rare in the population and future cases of the mutation will ascertain a relationship with disease.

Activity-dependent slowing of conduction differentiates functional subtypes of C fibres innervating human skin

1. The effects of impulse activity on conduction in cutaneous C fibres have been examined in 46 microneurographic recordings from 11 normal subjects and 11 diabetic patients with normal nerve conduction. A tungsten microelectrode was inserted into a cutaneous nerve, usually the superficial peroneal close to the ankle, and intraneural microstimulation was used to identify an area of skin innervated. Three minute trains of 0.25 ms stimuli at 1, 2 and 4 Hz were then delivered to the surface of the skin, separated by intervals of 6 min with stimulation at 0.25 Hz. Slowing and block of conduction were measured from the nerve responses for up to seven C units per stimulation sequence. 2. Three types of C unit were distinguished by their responses to repetitive stimulation: type 1 units slowed progressively during the 3 min trains; slowing of type 2 units reached a plateau within 1 min; while type 3 units hardly slowed at all. Data from normal and diabetic subjects did not differ and were pooled. After 3 min at 2 Hz, the percentage increases in latency were for type 1, 28.3 +/- 9.7 (n = 63 units, mean +/- s.d.); for type 2, 5.2 +/- 1.6 (n = 14); and for type 3, 0.8 +/- 0.5 (n = 5), with no overlap. After 3 min at 4 Hz, 58 % of type 1 units (but no type 2 or 3 units) blocked intermittently. Recovery of latency after stimulation was faster for type 2 than for type 1 units, but conduction velocities of the three types were similar. 3. Type 1 units were identified as nociceptors and 7 type 2 units were identified as 'cold' fibres, activated by non-noxious cold, with no overlap in modality. None of the units tested was activated by weak mechanical stimuli or reflex sympathetic activation. 4. Spike waveforms were averaged for 18 type 1, 10 type 2 and 6 type 3 units. All units had predominantly triphasic action potentials with a major negative peak, but those of type 3 units were on average both smaller and briefer than those of type 1 and type 2 units. 5. It is concluded that repetitive electrical stimulation reliably differentiates nociceptive from cold-specific C fibres innervating human hairy skin, as has previously been shown for the rat. Cold fibres can propagate impulses continuously at much higher rates than nociceptive fibres. The nature of the type 3 units is unclear.

Flare and hyperalgesia after intradermal capsaicin injection in human skin

Flare and hyperalgesia after intradermal capsaicin injection in human skin. J. Neurophysiol. 80: 2801-2810, 1998. We investigated the neurovascular mechanisms that determine the flare response to intradermal capsaicin injection in humans and delineated the associated areas of mechanical and heat hyperalgesia. The flare response was monitored both visually and with infrared telethermography. The areas of mechanical and heat hyperalgesia were determined psychophysically. Thermography detected very large areas of flare. As an early event underlying the flare and before onset of the area of rubor of the skin, thermography detected the appearance of multifocal spots of increased temperature caused by dilatation of cutaneous arterioles. Repetition of capsaicin injection days apart into the same forearm induced multifocal spots of temperature elevation identical to the ones obtained in the first session, indicating dilatation of the same arterioles. Reactive hyperemia also consisted in the appearance of multifocal spots of increased temperature, which were identical to the ones reacting during the flare response, suggesting participation of the same arterioles in both events. Strips of local anesthetic placed to block cutaneous nerves prevented the spread of both the thermographic flare and associated hyperalgesia. It is inferred that the cutaneous nerve fibers responsible for the thermographic flare branch, or have coupled axons, over a long distance. The large area of flare coincided with the area of mechanical and heat hyperalgesia. Equivalence of the areas of flare and mechanical and heat hyperalgesia induced by intradermal capsaicin injection suggests that all three phenomena are the consequence of neural factors that operate peripherally.