Genetic diversity among Mycobacterium avium complex strains recovered from children with and without human immunodeficiency virus infection

The genetic diversity and molecular epidemiology of Mycobacterium avium complex (MAC) infections in children with and without human immunodeficiency virus (HIV) infection were evaluated. Isolates recovered from 136 children were subtyped by sequence analysis of a 360-bp region of the gene (hsp65) encoding a 65-kDa heat-shock protein. Twenty-one distinct hsp65 alleles were identified. On the basis of hsp65 genotype, 6 isolates were not MAC organisms. Of the remaining 130 samples, 61% were M. avium, 37% were Mycobacterium intracellulare, and 2% were species nonspecific MAC. Eighty-eight percent of the isolates obtained from HIV-infected children were M. avium. In contrast, only 38% of the isolates obtained from children without HIV infection were M. avium (chi2 test, P < .001). M. avium isolates were further subtyped by Southern blot analysis with insertion element IS1245. Taken together, no evidence for a single clonal M. avium strain causing infection was detected.     

Increased intraventricular velocities: an unrecognized cause of systolic murmur in adults

OBJECTIVES: The purpose of this study was to determine the frequency, clinical features and echocardiographic characteristics of increased intraventricular velocities (IIVs) in patients referred to the echocardiography laboratory for systolic murmur. BACKGROUND: A subset of patients referred to the echocardiography laboratory for evaluation of a systolic murmur have IIVs in the absence of other recognized causes of systolic murmur. METHODS: We prospectively studied echocardiograms from 108 consecutive patients referred for evaluation of a systolic murmur. Clinical data were obtained from patient examinations and medical records. RESULTS: The sole explanation for systolic murmur was IIVs in 16.7% of referred patients. Compared with those without IIVs, patients with IIVs had a higher ejection fraction (EF) (58.7+/-7.8% vs. 51.1+/-12.5%, p < 0.001), percent fractional shortening (42.3+/-9.7% vs. 31.0+/-11.4%, p < 0.0001), left ventricular (LV) mass index (181+/-70 vs. 152+/-48 g/m2, p=0.046) and prevalence of hypertension (73.3% vs. 51.7%, p=0.043) and a lower prevalence of segmental wall motion abnormalities (2.2% vs. 39.3%, p < 0.001). CONCLUSIONS: Increased intraventricular velocities are a common cause of systolic murmur in this group of patients and should be included in the differential diagnosis of systolic murmurs in adults. The association of IIVs with LV hypertrophy should be a clinical consideration when these murmurs are identified.     

Geographical distribution of radiation risks in The Netherlands

Risk assessment of exposure to sources of radiation is an important tool for national governments in regulating radionuclide emissions and thus reducing radiation doses for the general public. For this reason radiation doses from sources throughout The Netherlands have been analyzed. For sources with well-defined locations and doses that were thought to vary significantly throughout The Netherlands, radiation dose maps were produced. Average dose values were calculated or derived from the literature for doses considered to be evenly distributed throughout the country or for which no information on the geographical distribution of dose was available. Emission, dispersion, and individual dose were modeled for each source using various pathways and exposure routes. Indoor radon and gamma radiation from building materials generate the highest dose values. The highest human induced radiation doses for industries of which the doses showed to be geographically distributed are found in the cement industry, elemental phosphorus production, phosphoric acid production, and iron and steel production. Radiation dose from some of these sources has a very local peak and decreases rapidly with distance. The elemental phosphorus production causes relatively high radiation doses throughout a large part of The Netherlands. Cumulation of doses from various sources occurs, but these are often masked by doses from a few large industries.     

Hypervariability generated by natural selection in an extracellular complement-inhibiting protein of serotype M1 strains of group A Streptococcus

In many countries, M1 strains of the human pathogenic bacterium group A Streptococcus are the most common serotype recovered from patients with invasive disease episodes. Strains of this serotype express an extracellular protein that inhibits complement [streptococcal inhibitor of complement (Sic)] and is therefore believed to be a virulence factor. Comparative sequence analysis of the 915-bp sic gene in 165 M1 organisms recovered from diverse localities and infection types identified 62 alleles. Inasmuch as multilocus enzyme electrophoresis and pulsed-field gel electrophoresis previously showed that most M1 organisms represent a distinct streptococcal clone, the extent of sic gene polymorphism was unexpected. The level of polymorphism greatly exceeds that recorded for all other genes examined in serotype M1 strains. All insertions and deletions are in frame, and virtually all nucleotide substitutions alter the amino acid sequence of the Sic protein. These molecular features indicate that structural change in Sic is mediated by natural selection. Study of 70 strains recovered from two temporally distinct epidemics of streptococcal infections in the former East Germany found little sharing of Sic variants among strains recovered in the different time periods. Taken together, the data indicate that sic is a uniquely variable gene and provide insight into a potential molecular mechanism contributing to fluctuations in streptococcal disease frequency and severity.     

Total phenolic and carotenoid contents in acerola genotypes harvested at three ripening stages

Acerola fruits (Malpighia emarginata D.C.) were harvested from 12 different genotypes cultivated at the Active Germplasm Bank in Federal Rural University of Pernambuco, in the northeast region of Brazil. The effects of maturity stages and weather conditions on total phenolics and carotenoids content were analysed. Mature fruits harvested in the dry season showed the highest and the lowest levels of total phenolics and carotenoids, respectively. During the maturation process, phenolics degradation and carotenoids biosyntheses were observed. Among the acerola genotypes, fruits from genotype number 05 stood out, presenting the highest phenolic and carotenoid contents.     

Isolation and partial characterization of a lectin from Artocarpus incisa L. seeds

A lectin was isolated from the saline extract of Artocarpus incisa seed by affinity chromatography on cross-linked Adenanthera pavonina galactomannan in 0.15 M NaCl. The lectin was also retained in a D-gal-agarose resin and had no requirements for divalent metal cations (Ca2+ and Mn2+) for activity. The lectin contains 2.1% of carbohydrate and is characterized by high contents of acidic and hydroxylated amino acids. The lectin presented two protein bands in SDS-PAGE, with M(r) 15.5 and 12 kDa, respectively, and contains no alpha-helix, 64% antiparallel beta-sheet and 21% parallel beta-sheet/beta-turn. When submitted to gel filtration in Superose 12 R (FPLC) and Superdex 75 HR 5/5 (HPLC) columns, the lectin showed an M(r) of 48-49 kDa, suggesting a tetrameric structure.     

Prophylactic antibiotics in surgery for chronic ear disease

OBJECTIVES/HYPOTHESIS: The role of prophylactic antibiotics in otologic surgery continues to be debated and perhaps misused. Prior studies have provided conflicting evidence with regard to the benefit obtained from the use of prophylactic antibiotics in surgery for chronic otitis media. The current study was designed to evaluate the role of prophylactic antibiotics in the outcomes of surgery for chronic ear disease. It was the authors' impression that there was no indication for prophylactic antibiotics in such surgery. STUDY DESIGN: Randomized prospective study performed in a tertiary care facility. METHODS: Patients who met inclusion criteria (n = 146) were randomly assigned to an antibiotic treatment group or a control group receiving no prophylactic antibiotics. Patients in the antibiotic treatment group were given preoperative intravenous antibiotics followed by oral antibiotics for 5 days after surgery. Patients were followed postoperatively and observed for clinical evidence of infection and graft failure. RESULTS: There was no statistically significant difference between the two groups with regard to the incidence of postoperative infection or graft survival. CONCLUSIONS: The use of prophylactic antibiotics in surgery for chronic ear disease cannot be recommended based on the findings of this study.     

Case report: true massive thymic hyperplasia

Leiomyoma is the most uncommon benign neoplasm of the breast. We report a case of a middle-aged woman with a palpable breast mass who underwent excisional biopsy. Pathologic examination revealed a leiomyoma. The clinical characteristics, pathologic findings, and proper management of this lesion are discussed. The tumor is thought to arise from the smooth muscle of the endothelium and can be managed similarly to leiomyomas occurring elsewhere. The possible effects of tamoxifen on uterine leiomyomas may be of theoretical concern with breast leiomyomas. The recognition of this entity and an understanding of the management of this rare lesion are necessary by all surgeons who perform breast surgery.     

Vancomycin penetration into biofilm covering infected prostheses and effect on bacteria

To evaluate the adequacy of penetration of antibiotics into biofilm, a novel in vitro model for prosthesis-related infection was developed. Sterile stainless steel orthopedic nuts were incubated with slime-producing Staphylococcus epidermidis. Biofilm-covered nuts were exposed to varying concentrations of vancomycin; then biofilms were harvested. Vancomycin levels in biofilm, as measured by fluorescent polarization immunoassay, far exceeded the MIC and MBC of vancomycin for the organism. Bacterial growth in biofilm was inversely related to vancomycin concentration in biofilm, but even extremely high drug concentrations did not eradicate bacteria embedded in biofilm. The MICs and MBCs for bacteria recovered from biofilm did not differ from those for incubating organisms. Thus, failure of glycopeptide antibiotics to cure prosthesis-related infection is not due to poor penetration of drugs into biofilm but likely due to diminished antimicrobial effect on bacteria in the biofilm environment.     

Influence of propellant composition on drug delivery from a pressurized metered-dose inhaler

Hydrofluoroalkanes (HFAs) are used to replace chlorofluorocarbons (CFCs) as non-ozone-depleting propellants for pressurized metered-dose inhalers (pMDIs). HFA 134a and HFA 227 are used in combination to precisely manipulate the density and vapor pressure of pMDI formulations. The influence of propellant composition on the dose delivery characteristics of a suspension-based pMDI formulation was investigated. The results showed that as the density of the propellant blends approached the density of the suspended drug particles, the formulation became more physically stable and exhibited the most consistent dose delivery and greatest respirable fraction. The mass median aerodynamic diameter of the aerosolized particles contained in the emitted dose also was decreased by using propellant blends with higher vapor pressures. The performance of a suspension-based pMDI formulation was optimized by varying the propellant composition using HFA 134a and HFA 227.