Tuberculosis vaccine candidates based on mycobacterial cell envelope components

Even after decades searching for a new and more effective vaccine against tuberculosis, the scientific community is still pursuing this goal due to the complexity of its causative agent, Mycobacterium tuberculosis (Mtb). Mtb is a microorganism with a robust variety of survival mechanisms that allow it to remain in the host for years. The structure and nature of the Mtb envelope play a leading role in its resistance and survival. Mtb has a perfect machinery that allows it to modulate the immune response in its favor and to adapt to the host's environmental conditions in order to remain alive until the moment to reactivate its normal growing state. Mtb cell envelope protein, carbohydrate and lipid components have been the subject of interest for developing new vaccines because most of them are responsible for the pathogenicity and virulence of the bacteria. Many indirect evidences, mainly derived from the use of monoclonal antibodies, support the potential protective role of Mtb envelope components. Subunit and DNA vaccines, lipid extracts, liposomes and membrane vesicle formulations are some examples of technologies used, with encouraging results, to evaluate the potential of these antigens in the protective response against Mtb.

Early estimates of influenza vaccine effectiveness in Navarre, Spain: 2012/13 mid-season analysis

We present estimates of influenza vaccine effectiveness (VE) in Navarre, Spain, in the early 2012/13 season, which was dominated by influenza B. In a population-based cohort using electronic records from physicians, the adjusted VE in preventing influenzalike illness was 32% (95% confidence interval (CI): 15 to 46). In a nested test-negative case-control analysis the adjusted VE in preventing laboratory-confirmed influenza was 86% (95% CI: 45 to 96). These results suggest a high protective effect of the vaccine.

Early estimates of influenza vaccine effectiveness in Navarre, Spain: 2012/13 mid-season analysis

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Evolutionary history of almond tree domestication in the Mediterranean basin

Genetic diversity of contemporary domesticated species is shaped by both natural and human-driven processes. However, until now, little is known about how domestication has imprinted the variation of fruit tree species. In this study, we reconstruct the recent evolutionary history of the domesticated almond tree, Prunus dulcis, around the Mediterranean basin, using a combination of nuclear and chloroplast microsatellites [i.e. simple sequence repeat (SSRs)] to investigate patterns of genetic diversity. Whereas conservative chloroplast SSRs show a widespread haplotype and rare locally distributed variants, nuclear SSRs show a pattern of isolation by distance with clines of diversity from the East to the West of the Mediterranean basin, while Bayesian genetic clustering reveals a substantial longitudinal genetic structure. Both kinds of markers thus support a single domestication event, in the eastern side of the Mediterranean basin. In addition, model-based estimation of the timing of genetic divergence among those clusters is estimated sometime during the Holocene, a result that is compatible with human-mediated dispersal of almond tree out of its centre of origin. Still, the detection of region-specific alleles suggests that gene flow from relictual wild preglacial populations (in North Africa) or from wild counterparts (in the Near East) could account for a fraction of the diversity observed.

Effectiveness of trivalent seasonal and monovalent influenza A(H1N1)2009 vaccines in population with major chronic conditions of Navarre, Spain: 2010/11 mid-season analysis

We defined a cohort of people with major chronic conditions (152,585 subjects) in Navarre, Spain, using electronic records from physicians, to obtain 2010/11 mid-season estimates of influenza vaccine effectiveness. The adjusted estimates of the effectiveness of the 2010/11 trivalent influenza vaccine were 31% (95% confidence interval (CI): 20–40%) in preventing medically attended influenza-like illness, and 58% (95% CI: 11–80%) in preventing laboratory-confirmed influenza. Having received the monovalent influenza A(H1N1)2009 vaccine in the 2009/10 season had an independent preventive effect against medically attended influenza-like illness (17%, 95% CI: 1–30%), and having received both vaccines had 68% (95% CI: 23–87%) effectiveness in preventing laboratory-confirmed influenza.

Effectiveness of trivalent seasonal and monovalent influenza A(H1N1)2009 vaccines in population with major chronic conditions of Navarre, Spain: 2010/11 mid-season analysis

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Genetic structure and evolution of Alpine polyploid complexes: Ranunculus kuepferi (Ranunculaceae) as a case study

The alpine white-flowered buttercup, Ranunculus kuepferi Greuter & Burdet, is a polyploid complex with diploids endemic to the southwestern Alps and polyploids - which have been previously described as apomictic - widespread throughout European mountains. Due to the polymorphic status of both its ploidy level and its reproductive mode, R. kuepferi represents a key species for understanding the evolution of polyploid lineages in alpine habitats. To disentangle the phylogeography of this polyploid taxon, we used cpDNA sequences and AFLP (amplified fragment length polymorphism) markers in 33 populations of R. kuepferi representative of its ploidy level and distribution area. Polyploid individuals were shown to be the result of at least two polyploidization events that may have taken place in the southwestern Alps. From this region, one single main migration of tetraploids colonized the entire Alpine range, the Apennines and Corsica. Genetic recombination among tetraploids was also observed, revealing the facultative nature of the apomictic reproductive mode in R. kuepferi polyploids. Our study shows the contrasting role played by diploid lineages mostly restricted to persistent refugia and by tetraploids, whose dispersal abilities have permitted their range extension all over the previously glaciated Alpine area and throughout neighbouring mountain massifs.

[Relapsing acute pancreatitis associated with gluten enteropathy. Clinical, laboratory, and evolutive characteristics in thirty-four patients]

OBJECTIVES

To describe the frequency and the clinical and laboratory characteristics of relapsing acute pancreatitis (AP) associated with gluten enteropathy (GE).

PATIENTS AND METHODS

We prospectively examined all acute pancreatitis cases admitted to our Department in 2006. We recorded a total of 185 patients. With recurring forms, 40 (22%) in all, we used a clinical-lab protocol including serologic and genetic markers, and duodenal biopsy to rule out GE.

RESULTS

A total of 34 patients (18%) met clinical-biological criteria for GE (group1), and were compared to the remaining non-GE AP cases (n=161) (group2). Mean age in the GE group was 54 +/- 25 years, slightly younger than group 2 (61 +/- 14) (NS). There was a mild predominance of women (50%) in group 1 versus group 2 (38.5%) (NS). Seven patients in group 1 (20%) had severe AP, as compared to 27 (17%) in group 2 (NS). The presence of cholelithiasis in group 1 involved 6 cases (18%), which was significantly lower than in group 2--72 cases (45%) (p < 0.05). Four patients with GE developed pseudocysts (12%) versus 13 (8%) in group 2 (NS). Tissue transglutaminase (tTG) was elevated only in 3 patients (9%). Nine patients (34%) were DQ2 (+) and 4 (12%) DQ8 (+); the rest (54%) were all negative for both markers. From an endoscopic perspective there was diffuse duodenitis in 32 patients (95%). Duodenal biopsies revealed villous atrophy (Marsh 3) in 2 patients (6%); submucosal inflammatory infiltration (Marsh 2) in 10 (29.4%); increased intraepithelial lymphocytes (Marsh 1) in 8 cases (23.5%), and normal mucosa (Marsh 0) in 14 patients (41.2%). Response to GFD after 1 year was excellent in 30 patients (88%).

CONCLUSIONS

Relapsing AP with GE represents a relatively common association that is indistinguishable from other APs from a clinical-evolutive standpoint, except for a lower presence of cholelithiasis (p < 0.05). A specific diagnostic protocol is much needed in the identification of these patients since GFD is the only effective therapy to prevent new AP events from developing.

Rosmarinic acid, a photo-protective agent against UV and other ionizing radiations

Solar UV and other ionizing radiations cause a generation of reactive oxygen species, induce cellular DNA damage and alter skin homeostasis. The use of exogenous antioxidants is increasingly frequents, we attempt to demonstrate that a rosmarinic acid extract acts as photo-protector; both free radical scavenger as an inducer of the body's own endogenous defence mechanisms by regulating tyrosinase activity and stimulating melanin production. Malonyldialdehyde formation (TBARS) was delayed when RA was used. The protection factor was 3.24 times vs AA. TEAC value for RA was 1.6 times vs AA. The radioprotective-antimutagenic effects of RA were measure using the micronucleus test. The level of micronucleous for treatments before irradiation was: RA [14] Collapse

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MESH Headings

• Animals
• Antioxidants/chemistry
• Antioxidants/pharmacology
• Cinnamates/chemistry
• Cinnamates/pharmacology
• DNA Damage/drug effects
• Depsides/chemistry
• Depsides/pharmacology
• Female
• Humans
• In Vitro Techniques
• Linoleic Acid/chemistry
• Lymphocytes/drug effects
• Lymphocytes/radiation effects
• Malondialdehyde/metabolism
• Mice
• Micronuclei, Chromosome-Defective/drug effects
• Micronuclei, Chromosome-Defective/radiation effects
• Micronucleus Tests
• Neoplasms, Radiation-Induced/prevention & control
• Oxidation-Reduction
• Plant Extracts/chemistry
• Plant Extracts/pharmacology
• Radiodermatitis/etiology
• Radiodermatitis/pathology
• Radiodermatitis/prevention & control
• Skin/drug effects
• Skin/pathology
• Skin/radiation effects
• Skin Neoplasms/etiology
• Skin Neoplasms/prevention & control
• Sunscreening Agents/chemistry
• Sunscreening Agents/pharmacology
• Ultraviolet Rays/adverse effects
• Rosmarinic Acid

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Grants Collapse

Affiliation(s)

M Sánchez-Campillo Food Safety Department, Centro Tecnológico Nacional de Conserva y Alimentación, Concordia s/n, 20500 Molina de Segura, Murcia, Spain
J A Gabaldon
J Castillo
O Benavente-García
M J Del Baño
M Alcaraz
V Vicente
N Alvarez
J A Lozano

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Disposition of loratadine in healthy volunteers

The absorption, metabolism and excretion of carbon-14-labeled loratadine (LOR, SCH 29851, Claritin) administered orally to healthy male volunteers were evaluated. Following a single oral 10-mg dose of [(14)C]LOR ( approximately 102 microCi), concentrations of LOR and desloratadine (DL; a pharmacologically active descarboethoxy metabolite of LOR) were determined in plasma. Metabolites in plasma, urine and feces were characterized using a liquid chromatography-mass spectrometry system (LC-MS) connected in line with a flow scintillation analyzer (FSA). Maximum plasma LOR and DL concentrations were achieved at 1.5 h and 1.6 h, respectively; thus, LOR was rapidly absorbed but also rapidly metabolized as indicated by these similar t(max) values. Metabolite profiles of plasma showed that LOR was extensively metabolized via descarboethoxylation, oxidation and glucuronidation. Major circulating metabolites included 3-hydroxy-desloratadine glucuonide (3-OH-DL-Glu), dihydroxy-DL-glucuronides, and several metabolites resulting from descarboethoxylation and oxidation of the piperidine ring. LOR was completely metabolized by 6 h post-dose. LOR-derived radiocarbon was excreted almost equally in the urine (41%) and feces (43%). About 13% of the dose was eliminated in the urine as 3-OH-DL-Glu. DL accounted for less than 2% of the dose recovered in the urine and only trace amounts of LOR were detected. 3-OH-DL was the major fecal metabolite ( approximately 17% of the dose). The combined amount of 5- and 6-hydroxy-DL contributed to an additional 10.7% of the dose in feces. Approximately 5.4% and 2.7% of the dose were excreted in the feces as unchanged drug and DL, respectively.

Metabolism and excretion of loratadine in male and female mice, rats and monkeys

The metabolism and excretion of loratadine (LOR), a long-acting non-sedating antihistamine, have been evaluated in male and female mice, rats and monkeys. Following a single (8 mg kg-1) oral administration of [14C]LOR, radioactivity was predominantly eliminated in the faeces. Profiling and characterization of metabolites in plasma, bile, urine and faeces from male and female mice, rats and monkeys showed LOR to be extensively metabolized with quantitative species and gender differences in the observed metabolites. In all species investigated, the primary biotransformation of LOR involved decarboethoxylation to form desloratadine (DL), subsequent oxidation (hydroxylation and N-oxidation) and glucuronidation. More than 50 metabolites were profiled using liquid chromatography-mass spectrometry (LC-MS) with in-line flow scintillation analysis (FSA) and characterized using LC-MSn techniques. The major circulating metabolite in male rats is a DL derivative in which the piperidine ring was aromatized and oxidized to pyridine-N-oxide. Much lower levels of the pyridine-N-oxide metabolite were observed in female rat plasma. In contrast, the relative amount of DL was notably higher in female than in male rats. The major circulating metabolite in either gender of mouse and male monkey is a glucuronide conjugate of an aliphatic hydroxylated LOR; in the female monkey, the major circulating metabolite is formed through oxidation of the pyridine moiety and subsequent glucuronidation. Qualitatively similar metabolic profiles were observed in the mouse, rat and monkey urine and bile, and the metabolites characterized resulted from biotransformation of LOR to DL, hydroxylation of DL and subsequent glucuronide conjugation. 5-Hydroxy-desloratadine was the major faecal metabolite across all three species irrespective of gender.

Disposition of desloratadine in healthy volunteers

The absorption, metabolism and excretion of desloratadine (DL, Clarinex) were characterized in six healthy male volunteers. Subjects received a single oral 10-mg dose of [(14)C]DL ( approximately 104 microCi). Blood, urine and feces were collected over 240 h. DL was well absorbed; drug-derived radioactivity was excreted in both urine (41%) and feces (47%). With the exception of a single subject, DL was extensively metabolized; the major biotransformation pathway consisted of hydroxylation at the 3 position of the pyridine ring and subsequent glucuronidation (3-OH-DL-glucuronide or M13). In five of the six subjects, DL was slowly eliminated (mean t((1/2)) = 19.5 h) and persisted in the plasma for 48-120 h post-dose. This is in contrast to a t((1/2)) of approximately 110 h and quantifiable plasma DL concentrations for the entire 240-h sampling period in one subject, who was identified phenotypically as a poor metabolizer of DL. This subject also exhibited correspondingly lower amounts of M13 in urine and 3-OH-DL (M40) in feces. Disposition of DL in this subject was characterized by slow absorption, slow metabolism and prolonged elimination. Further clinical studies confirmed the lack of safety issues associated with polymorphism of DL metabolism (Prenner et al. 2006, Expert Opinion on Drug Safety, 5: 211-223).

Effects of exogenous melatonin and circadian synchronization on tumor progression in melanoma-bearing C57BL6 mice

Circadian rhythmicity impairment reportedly becomes significant as a tumor progresses, while the incidence of cancer can be affected by disruption of the circadian system. Melatonin has oncostatic effects on several types of cancer (breast, prostate, and colorectal cancers), while it can be self-defeating in others, such as lymphoma. Melanoma is one of the most aggressive cancers in humans; however, it seems to respond positively to melatonin in vitro. The present work tested whether body temperature (BT) rhythms are impaired by tumor progression, and whether exogenous melatonin restricts tumor growth and restores circadian rhythmicity; therefore, enhancing survival. To this end, C57 mice were intraperitoneal implanted with a temperature data logger and subcutaneously inoculated with melanoma cells. Animals were then submitted to light-dark (LD) 12:12 cycles or continuous light (LL), with or without melatonin administration. Under LD light conditions, the BT rhythm exhibited a marked reduction in the first circadian harmonic amplitude, and increased phase instability (Rayleigh vector) as the tumor progressed. Melatonin administration (2 mg/kg BW/day), on the other hand, increased the BT rhythm amplitude and phase stability, reduced tumor weight and prevented intraperitoneal dissemination. Exposure to LL induced a free-running rhythm (1500 min), significantly increasing tumor malignity, and therefore reducing survival. Surprisingly, the highest tumor weights and morbidity by metastasis were seen in the LL group treated with melatonin probably because this indoleamine was being administered at different subjective hours to free-running animals. Circadian rhythmicity can thus be used as a marker rhythm for tumor progression, as rhythm impairment increases along with tumor malignancy. While melatonin administration improves rhythmicity and enhances survival under LD conditions, the results are self-defeating when they coexist with circadian disruption as it occurs under LL. This emphasizes the importance of taking into account endogenous rhythmicity and limiting melatonin administration to the subjective night in order to restrict melanoma progression.

Study of the reproductive capacity of Trichinella spiralis recovered from experimentally infected mice under-dosed with albendazole or mebendazole

The reproductive capacity of Trichinella spiralis recovered from experimentally infected mice under-dosed with albendazole (ALB) or mebendazole (MEB) was studied. Different groups of male C57/BL mice were infected with 10 +/- 0.5 muscular larvae (ML) per gram of body weight and treated with a single dose by oral (20 mg/kg) of ALB, MEB or praziquantel (PZQ) given at 5th day post infection (DPI), during the intestinal phase of infection. In other group of mice, treatment with the same drugs and dosage was for seven days, starting at day 45 PI through the stage of encapsulating larvae (parenteral phase of infection). A reduction of 72.9 to 89.9% in the parasitic load was observed in ALB or MEB treated groups but not in mice untreated or administered with PZQ. The recovered larvae were used to infect naïve mice and, after 45 DPI, a similar Reproductive Capacity Index (RCI) was observed between the different groups (P=0.323, one-way ANOVA), either from mice infected with larvae recovered from the intestinal treatments (RCI-ALB = 51.6 +/- 12.1 and RCI-MEB = 49.2 +/- 14.) or from the parenteral ones (RCI-ALB = 52.2 +/- 14.0 and RCI-MEB = 51.9 +/- 11.8). The RCI of non-treated ML was 59.5 +/- 7.7 and 57.9 +/- 15.9 for PZQ. This information is significant for practical strategies when under-dosage is dispensed.

Genetic and Environmental Sources of Variation in the Autogenous Chemical Defense of a Leaf Beetle

Chemical defense plays a central role for many herbivorous insects in their interactions with predators and host plants. The leaf beetle genus Oreina (Coleoptera, Chrysomelidae) includes species able to both sequester pyrrolizidine alkaloids and autogenously produce cardenolides. Sequestered compounds are clearly related to patterns of host-plant use, but variation in de novo synthesized cardenolides is less obviously linked to the environment. In this study, intraspecific variation in cardenolide composition was examined by HPLC-MS analysis in 18 populations of Oreina speciosa spanning Europe from the Massif Central to the Balkans. This revealed the defense secretion to be a complex blend of up to 42 compounds per population. There was considerable geographical variation in the total sample of 50 compounds detected, with only 14 found in all sites. The environmental and genetic influences on defense chemistry were investigated by correlation with distance matrices based on habitat factors, host-plant use, and genetics (sequence data from COI, COII, and 16s rRNA). This demonstrated an influence of both genetics and host-plant use on the overall blend of cardenolides and on the presence of some of the individual compounds. The implications of this result are discussed for the evolution of defense chemistry and for the use of cardenolide compounds as markers of the evolutionary history of the species.

[Increased prevalence of celiac disease in first and second-grade relatives. A report of a family with 19 studied members]

INTRODUCTION

celiac disease (CD) is an autoimmune condition that is triggered by the ingestion of gluten, a substance present in most cereals, and that affects genetically predisposed individuals. As a result, this condition is clearly familial, and mainly associated with HLA class II markers.

OBJECTIVES

in this work we set out to analyze the prevalence of CD in an extensive family based on an index subject who had already died from this disease a few years ago, where CD had been complicated by the development of a small-bowel malignancy, namely an adenocarcinoma.

METHODS

nineteen members were studied. They all were subjected to a diagnostic protocol including a detailed medical history, hemogram, coagulation tests, and blood biochemistry (including liver function tests, serum iron metabolism, circulating folic acid and vitamin B12 levels, thyroid function tests, tissue transglutaminase measurement, and genetic markers (DQ2 and DQ8). Suspect cases underwent gastroscopy plus multiple duodenal biopsy for confirmation.

RESULTS

overall we encountered CD in 9/19 studied members, which represents 47.4% with the following distribution according to degree of kinship -four of seven siblings (57%); one of three children (33.3%); three of eight nephews and nieces (37.5%), and the only grandnephew, who was 9 years old.

CONCLUSIONS

from all this it may be seen that family studies are needed every time a patient is diagnosed with celiac disease; these studies should include both first- and second-degree relatives, given the high prevalence encountered and the fact that these tests are relatively straighforward to perform.

Parallels in the evolution of the two largest New and Old World seed-beetle genera (Coleoptera, Bruchidae)

This study provides the first phylogenetic analysis of a large sample of the two largest genera of seed-beetles, Acanthoscelides Schilsky and Bruchidius Schilsky, which mostly feed on legumes (Fabaceae). The goal of this study was to investigate evolutionary patterns in relation to biogeography and host-plant associations. We used three mitochondrial molecular markers and parsimony and Bayesian inference methods to reconstruct the phylogeny of 76 species. In addition, we critically reviewed host-plant records in the literature for these two bruchid genera. Our results demonstrated the existence of two major clades, one New World and one largely Old World, which generally correspond to the two genera. Yet, current classification of several species is erroneous, so that both genera as currently defined are paraphyletic. We highlighted a strong trend toward specialization (with high taxonomic conservatism in host-plant use) exhibited by the two studied genera. However, we showed the existence of several host shifts during the evolution of this group of bruchids. Our phylogenetic hypotheses and our evaluation of host-plant associations both suggest that the two genera have undergone parallel evolution, as they have independently colonized similar host plants in their respective areas of distribution. Our estimation of divergence times indicated a more ancient origin for bruchids than that suggested by the fossil records. Interestingly, the suggested timing of diversification is consistent with the hypothesis of a radiation that could have occurred contemporaneously with the diversification of their legume hosts.

Zn adsorption by different fractions of Galician soils

To evaluate the contribution of organic matter, oxides, and clay fraction to Zn adsorption in six soils from Galicia (Spain), after soil characterization, adsorption isotherms were obtained by adding nine solutions containing between 20 and 500 mg L(-1) concentrations of Zn(NO(3))(2). Distribution coefficients were obtained from the data of adsorption isotherms. Zn adsorption isotherms corresponding to untreated soil and to the organic matter removed samples and organic matter and oxides removed samples were compared with curves pattern and adjusted to Langmuir and Freundlich empirical models. Untreated soils described L-curves whereas when soils were deprived of any component, the curves described were S-type. Distribution coefficients allowed knowing the Zn adsorption capacity of the untreated soil, and of the organic matter, oxides, and clay fraction. Soil organic matter is the main component that affects Zn adsorption as long as soil pH is near neutrality. At acid pH, the oxides are the main component that affects Zn adsorption, although to a much smaller extent than the organic matter near neutral conditions. So soil pH is the main soil factor that determines Zn adsorption, before any other soil property.

In vitro and in vivo antileishmanial activity of 2-amino-4,6-dimethylpyridine derivatives against Leishmania mexicana

Leishmania mexicana promastigote and intracellular amastigote growths were inhibited by the water-soluble furan-2-carboxamide issued from the pharmacophore 2-amino-4,6-dimethylpyridine with IC50 values of 69 +/- 2 and 89 +/- 9 microM, respectively. This compound was also tested against established L. mexicana infection in susceptible BALB/c mice; an intraperitoneal administration of 10 mg/Kg/day during five consecutive days induced a high reduction in the amastigote burden of the poplitea lymph node (81 +/- 6.4%), the spleen (80 +/- 1.6%) and the liver (73 +/- 9%). Approach of the mechanism of antileishmanial activity of this compound, assessed by the flow cytometry, showed a reduction in the protein and DNA synthesis. Finally, an actual increase of the in vitro antileishmanial activity was obtained by replacement of the amidic function by an imidazolidin-2-one moiety. In this new series, two of the N-substituted derivatives showed IC50 values of 13 +/- 0.5 and 7 +/- 3 microM in intracellular amastigotes constituting new promising compounds for further studies.

Olanzapine as alternative therapy for patients with haloperidol-induced extrapyramidal symptoms: results of a multicenter, collaborative trial in Latin America

Conventional antipsychotic agents can induce extrapyramidal symptoms (EPS) that may be alleviated by switching patients to novel agents such as olanzapine. Patients with schizophrenia and related disorders (ICD-10) who were taking haloperidol (N = 94; mean dose = 12.7 mg/day) and had EPS (Simpson-Angus Scale [SAS] > 3) were directly switched to 6 weeks of open-label olanzapine treatment (mean dose = 11.4 mg/day). There were significant mean improvements (p <0.001 for all measurements) from baseline to endpoint on the SAS (-9.69+/-5.33; percentage change, 87.2%), the Barnes Akathisia Scale (-1.00+/-1.19; percentage change, 82.5%), and the Abnormal Involuntary Movement Scale (-1.48+/-2.89; percentage change, 81.1%), and anticholinergic use decreased from 47.9% to 12.8% (mean baseline to endpoint change: -1.52+/-1.91-mg equivalents of benztropine; p < 0.001). Significant mean baseline to endpoint improvements (p < 0.001 for all measurements) were observed on the Positive and Negative Syndrome Scale (PANSS; -25.28+/-18.67; percentage change, 30.3%), the PANSS-extracted Brief Psychiatric Rating Scale (0-6 scale, -13.41+/-10.16; percentage change, 54.4%), and the Clinical Global Impressions Severity scale (-1.16+/-1.19; percentage change, 26.4%). Spontaneously reported treatment- emergent adverse events with a greater than 5% incidence were somnolence (16.0%), increased appetite (14.9%), weight gain (11.7%), headache (8.5%), anxiety (7.4%), dizziness (6.4%), and insomnia (5.3%). Criteria for a successful switch were met by 90.5% of patients. Psychotic symptom exacerbation was experienced by 30.9% of patients at any time during the study and by 11.7% of patients at endpoint. Results suggest that a direct switch to olanzapine is a therapeutic option when patients with haloperidol-induced EPS are unable to tolerate a more gradual switch.

Role of 17beta-estradiol and/or progesterone on insulin sensitivity in the rat: implications during pregnancy

The mechanism for the development of insulin resistance in normal pregnancy is complex and is associated with serum levels of both progesterone and 17beta-estradiol. However, it remains unclear whether estrogens alone or progestins alone can cause insulin resistance, or whether it is a combination of both which produces this effect. We attempted to determine the role played by progesterone and/or 17beta-estradiol on the phenomena of sensitivity to insulin action that take place during pregnancy in the rat. Ovariectomized rats were treated with different doses of progesterone and/or 17beta-estradiol in order to simulate the plasma levels in normal pregnant rats. A euglycemic/hyperinsulinemic clamp was used to measure insulin sensitivity. At days 6 and 11, vehicle (V)- and progesterone (P)-treated groups were more insulin resistant than 17beta-estradiol (E)- and 17beta-estradiol+progesterone (EP)-treated groups. Nevertheless, at day 16, the V, EP and E groups were more resistant to insulin action than the P group. On the other hand, the V, EP and E groups were more insulin resistant at day 16 than at day 6, whereas the P group was more insulin resistant at day 6 than at day 16. Our results seem to suggest that the absence of female steroid hormones gives rise to a decreased insulin sensitivity. The rise in insulin sensitivity during early pregnancy, when the plasma concentrations of 17beta-estradiol and progesterone are low, could be due to 17beta-estradiol. However, during late pregnancy when the plasma concentrations of 17beta-estradiol and progesterone are high, the role of 17beta-estradiol could be to antagonize the effect of progesterone, diminishing insulin sensitivity.

Comparison of treadmill exercise echocardiography before and after exercise in the evaluation of patients with known or suspected coronary artery disease

OBJECTIVES

We sought to compare the feasibility and accuracy of peak treadmill exercise echocardiography versus postexercise echocardiography imaging.

BACKGROUND

Although peak exercise echocardiography has been reported for both supine and orthostatic bicycle exercise and has shown higher sensitivity than postexercise imaging, acquiring images at peak exercise with treadmill has not been explored.

METHODS

Peak and post-treadmill exercise echocardiography and coronary angiography were performed on 89 patients with known or suspected coronary artery disease. Positive exercise echocardiography was defined as necrosis or ischemic response. Positive coronary angiography was defined as >/=1 diseased vessels (>/=50% luminal narrowing). Images were analyzed in a blind manner by an expert observer.

RESULTS

Postexercise images were acquired within 80 seconds after exercise (40 +/- 14). Mean heart rate (bpm) was 139 +/- 22 at peak versus 118 +/- 25 at postexercise imaging (P <.001). Interpretable peak and postexercise images were obtained for all 89 patients. Of the 72 classified as having positive exercise echocardiography, 23 had new regional wall motion abnormality at peak (21 with positive angiography), which resolved at postexercise imaging. Sensitivity was higher with peak than with postexercise imaging (94% vs 73%, P <.001). Specificity was similar (68% vs 79%), as was predictive positive value (92% vs 93%). Negative predictive value was again higher with peak imaging (76% vs 44%, P <.05). Total accuracy was higher with peak imaging (89% vs 74%, P <.05).

CONCLUSIONS

Peak treadmill exercise echocardiography is technically feasible and has higher sensitivity and accuracy than post-treadmill exercise echocardiography. Therefore in the clinical setting peak exercise echocardiography should be performed to diagnose ischemia.

[A strategic family medicine model for controlling borderline and mild arterial hypertension]

OBJECTIVE

To research on the relationship of the patient and his/her family as a non-pharmacological factor for blood hypertension. To determine whether a hyposodic, hypocaloric, hypofat, and hypocholesterolemic diet decreases the blood tension. To determine whether physical exercises in the patient and his/her family help to reduce the hypertension. To observe whether the psychological therapy of muscles relaxation helps to reduce the hypertension. To evaluate in the sample of families, the experience of each member, as well as their suggestions and complaints about the programme. To design the strategic model to control the blood tension by ambulatory means.

DESIGN

Controlled intervention study, descriptive, non-randomized, prospective. PLACEMENT: Primary care.

PATIENTS AND OTHER PARTICIPANTS

Study group of 10 patients, 10 wives, and 12 children, and control group of 10 patients excluding family members.

INTERVENTIONS

With both groups (study and control) there were meetings every 15 days for 6 months according to an established schedule. In the meetings there were given talks, pamphlets, physical exercises, muscles relaxation therapy, all about blood hypertension. There were questionnaires before and after each activity. MEASURING AND MAIN RESULTS: In both groups (study and control) there was a statistically significant (t < 0.01) reduction in the weight. The blood systolic tension decreased in both positions, seated and standing, in the study group (difference statistically significant) but not so in the control group, although there was a non-significant difference (decrease of 1.5 mmHg) in the seated position. The diastolic tension decreased significantly in the study group both in seated and standing positions, not so in the control group.

CONCLUSIONS

The study sample showed that systolic tension seated and standing had a statistically significant reduction in the study group but not so in the control group. The weight had statistically significant reduction in both study and control groups. Total cholesterol had statistically significant decrease in the study group but not in the control group. HDL-C had statistically significant reduction in the study group; in the control group there was a decrease but not statistically significant. The triglycerides did not decrease statistically significant in any of the groups (study and control).

Streptococcus pluranimalium sp. nov., from cattle and other animals

Strains from subclinical mastitis, from the genital tract and tonsils of cattle, from tonsils of a goat and a cat and from the crop and the respiratory tract of canaries were found to constitute a new streptococcal species, for which the name Streptococcus pluranimalium sp. nov. is proposed. Sequencing of 16S rRNA showed that Streptococcus thoraltensis and Streptococcus hyovaginalis were its closest known phylogenetic relatives. The new species showed some phenotypic resemblance to the poorly described species Streptococcus acidominimus, but whole-cell protein analysis and 16S rRNA sequencing revealed that the new species was only distantly related to the type strain of S. acidominimus. Identification of these bacteria, which showed heterogeneous biochemical reaction patterns, was most reliably made by whole-cell protein analysis. Nevertheless, a number of biochemical reactions can be used to differentiate S. pluranimalium from other animal streptococci. Strain LMG 14177T, isolated from mastitic milk of a dairy cow, was designated as the type strain of S. pluranimalium sp. nov.

An indigo-reducing moderate thermophile from a woad vat, Clostridium isatidis sp. nov

A Gram-positive, anaerobic, moderate thermophile, strain Wv6T, capable of reducing indigo dye, was isolated from a fermenting woad vat prepared essentially as in medieval Europe. Strain Wv6T formed rod-shaped cells, which occurred singly, in pairs or in chains and produced terminal oval endospores. Strain Wv6T was saccharolytic. Growth occurred at pH 5.9-9.9 (initial pH) with an optimum at 50 degrees C of pH 7.2 +/- 0.2 (constant pH). At pH 7.8, the temperature range for growth was 30-55 degrees C with the optimum at 49-52 degrees C. Comparative 16S rRNA gene sequence analysis demonstrated that the bacterium represents a hitherto unknown subline within rRNA cluster I Clostridium. Based on the results of the phylogenetic analysis and phenotypic criteria, it is proposed that the unknown moderate thermophile should be classified as Clostridium isatidis sp. nov., a new species of the genus Clostridium. The type strain of Clostridium isatidis is strain Wv6T (= NCFB 3071T).

Use of antiepileptic drugs in the treatment of epilepsy in people with intellectual disability

The main principles of antiepileptic drug treatment of epilepsy in patients with intellectual disability are basically the same as for other patients with epilepsy. However, some specific issues need to be taken into account These are primarily associated with the diagnostic difficulties of epilepsy in this population. In addition, a number of other relevant issues, including the degree and location of brain lesion, the nature of the underlying disease, the higher frequency of difficult-to-treat epilepsies, the additional intellectual impairment caused by inappropriate antiepileptic medication, or by frequent and prolonged seizures, the appropriate use of monotherapy versus rational polytherapy, and the use of broad-spectrum antiepileptic drugs will be discussed in the present paper. Although the goals of treatment are to keep the patient seizure-free and alert while preventing possible mental deterioration, we have to accept compromises between these primary goals in many cases. Some people with epilepsy and intellectual disability are very vulnerable to insidious neurotoxic effects; for example, sedative effects caused by phenobarbital, or cognitive and/or cerebellar dysfunction caused by long-term phenytoin, especially together with other drugs. Because of the adverse effects of phenobarbital and phenytoin, these drugs are no longer recommended as a first-choice drugs when long-term antiepileptic medication is required. In primary generalized tonic-clonic seizures, valproate, oxcarbazepine/carbamazepine and lamotrigine are recommended in this order of preference. The corresponding recommendations are: in typical absences, valproate, ethosuximide and lamotrigine; in atypical absences, valproate and lamotrigine; in juvenile myoclonic epilepsy, valproate, lamotrigine and clobazam; in infantile spasms vigabatrin, ACTH and valproate; in Lennox-Gastaut syndrome, valproate, lamotrigine and vigabatrin; in atonic seizures, valproate and lamotrigine; in simple and complex partial seizures with or without secondary generalization, oxcarbazepine/carbamazepine, valproate/ vigabatrin and lamotrigine; and in status epilepticus lorazepam, diazepam and clonazepam together with phenytoin or fosphenytoin. In cases of poor response to the monotherapy recommended above, the following combinations may be indicated: in primary generalized tonic-clonic epilepsy, valproate and oxcarbazepine/ carbamazepine, or valproate and lamotrigine; in typical absences, valproate and lamotrigine, or valproate and ethosuximide; in juvenile myolonic epilepsy, valproate and lamotrigine, or valproate and clonazepam; and in partial epilepsies, add to the monotherapy one of the following drugs, vigabatrin, lamotrigine, gabapentin, tiagabine, topiramate, zonisamide or clobazam. So far, the order of preference of these new drugs remains undetermined. More data are needed on the efficacy and adverse effects of the new drugs based on controlled studies on patients with intellectual disability and epilepsy.

Carbamazepine in the treatment of epilepsy in people with intellectual disability

Carbamazepine is a major antiepileptic drug which is primarily used to treat epileptic patients suffering from partial seizures with or without secondary generalization, but which also has applications in those suffering from primary generalized tonic-clonic seizures. Besides its antiepileptic effect, carbamazepine is also indicated in the treatment of trigeminal and occipital neuralgia, and in manic depressive disorders. Because of its minimal unwanted effects on cognition and behaviour, carbamazepine is an excellent drug for the treatment of people with intellectual disability and epilepsy. Carbamazepine is still one of the most commonly prescribed medications in the treatment of epileptic disorders.

Barbiturates in the treatment of epilepsy in people with intellectual disability

Barbiturates are effective drugs in the treatment of epileptic disorder. The systemic side-effects are minimal. The main limiting factor is the presence of cognitive and behavioural problems. Relevant research is presented in this paper; however, it is somewhat difficult to extrapolate some of these experiences to a population of children and adults with intellectual disability and epilepsy. Recent reviews of this subject have suggested that, although the cognitive deficiencies seem to be a serious problem when phenobarbital is given in high doses, the problem is much less severe when the doses are on the low side. The most consistent findings with regard to behaviour are the exacerbation of behaviour disorders (mostly hyperactivity), as well as sleep disorders and depression in individuals who already have a predisposition to these disorders. However, the clinical experience of many professionals involved with the care of people with intellectual disability strongly suggests that barbiturates, and especially phenobarbital, produces intolerable side-effects at the point that the use of phenobarbital has been reduced to a minimum, and it is no longer considered a drug of choice. It is probably that the simultaneous presence of brain damage, epilepsy, intellectual disability and psychiatric disorders in people with intellectual disability is responsible for the high incidence of behaviour problems observed by clinicians.

Corynebacterium phocae sp. nov., isolated from the common seal (Phoca vitulina)

Phenotypic and phylogenetic studies were performed on four strains of a Gram-positive non-acid-fast coryneform-like organism isolated from the nasal cavities of common seals (Phoca vitulina). Chemotaxonomic investigations revealed the presence of corynomycolic acids in the unidentified isolates, which is consistent with corynebacteria. 16S rRNA gene sequence analysis demonstrated that the strains from seals represent a hitherto unknown subline within the genus Corynebacterium sensu stricto. Based on the results of the phylogenetic analysis and phenotypical criteria, it is proposed that the bacterium should be classified as a new species, Corynebacterium phocae. The type strain of Corynebacterium phocae is CCUG 38205T.