Surgery, 2002 Aug, 132(2), 200 - 4 Tissue-engineered colon exhibits function in vivo; Grikscheit TC et al.; BACKGROUND: Postcolectomy morbidities include important changes in enterohepatic circulation, stool microbiology, and absorption . The surgical substitution of an ileal pouch for the absent colon also has a number of serious complications . We report in vivo colon replacement by tissue-engineered colon (TEC) in lieu of an ileal pouch . METHODS: End-ileostomies were created in 22 male Lewis rats . In 11 animals, side-to-side ileum-TEC anastomosis was performed 1 cm from the stoma . This group was compared with end-ileostomy alone . Serial weights were measured, and animals were harvested sequentially for assessment of histologic signs of pouchitis . Transit times, stool dry and wet weights, and serum and stool colon function markers were collected . RESULTS: Animals survived 41 days . Weight loss was more than 1.5 times greater in the end-ileostomy alone group compared with the ileum-TEC group . Transit times were significantly longer in the ileum-TEC group than the end-ileostomy alone group, with lower stool moisture content and higher total serum bile acids . Animals without TEC had statistically significant hyponatremia, elevated serum urea nitrogen, and lower stool short chain fatty acids (13.5 micromol/kg vs 84.2) with an abnormal distribution . CONCLUSIONS: TEC successfully recapitulates some major physiologic functions of native large intestine in vivo. Curr Opin Ophthalmol, 2002 Oct, 13(5), 303 - 9 Obstruction of the lacrimal drainage system; Mandeville JT et al.; This review covers evolving concepts in lacrimal outflow obstruction . Recent studies have increased our understanding of the surgical anatomy and pathophysiology of the lacrimal drainage system through radiologic, clinical, and microbiologic techniques . While external dacryocystorhinostomy remains an important treatment for nasolacrimal duct obstruction, there have been a number of therapeutic developments worthy of review, including advances in endoscopic and transcanalicular dacryocystorhinostomy, conjunctivodacryocystorhinostomy, and the use of mitomycin C in these procedures . In addition, we summarize recent advances in minimally invasive techniques for lacrimal outflow obstruction, including balloon dacryocystoplasty, lacrimal stents, and conjunctivoplasty . Finally, the roles of probing versus irrigation, nasal endoscopy, and endoscopic dacryocystorhinostomy in children are discussed. J Telemed Telecare, 2002, 8 Suppl 2, 14 - 7 Development of a website for clinical microbiology in Brazil; Rossi F et al.; The quality of Brazilian health services, including clinical microbiology laboratories, varies enormously . We established a Website to provide different professionals with up-to-date information and to create a virtual Brazilian microbiology community . The Website became operational in February 2000 and had 198,976 hits in the subsequent 20 months . There were 1031 user registrations in its virtual community . Different microbiology topics were discussed and three virtual training courses (representing about 300 printed pages of information) were given . The e-learning centre and the Brazilian virtual community created by this Website have facilitated distance learning, and have encouraged professional integration within Brazilian clinical microbiology. Nurs Stand, 2001 Apr 11-17, 15(30), 50 - 4, 56, 58 A proactive approach to wound infection; Kingsley A; The management and treatment of infection is a complex and important area in tissue viability nursing . Andrew Kingsley discusses the value of microbiology to clinical practice and the importance of adopting a proactive approach to the management of infected wounds using an infection continuum and algorithm to help promote effective care. Eur J Gynaecol Oncol, 2002, 23(4), 269 - 77 The role of colposcopy in modern gynecology; Dexeus S et al.; The purpose of this review is to demonstrate that colposcopy, introduced in 1925--which is, notably before the development of great technological advances in modern gynecology--continues to be a valid technique without essential innovations to the original method described at the beginning of the last century . Colposcopy was developed in Germany during the rise of Nazism with the Second World War being an important barrier for the spread and diffusion of the technique . Colposcopy, however, continued to progress in a few countries such as Spain, Italy, Brazil, France and Switzerland . When colposcopy was introduced in the United States during the 70s, its use was mostly restricted to specialists who were almost exclusively dedicated to cervical pathology and knowledgeable about cytopathology, anatomic pathology, and colposcopy and who were competent both in the diagnosis and treatment of cervical lesions . These circumstances were completely different from what happened in the majority of European countries where colposcopists were trained as gynecologists and their histocytological knowledge, which was focused on the lower genital tract, was somewhat more extensive than that acquired by specialists in gynecology . There are two clearly different trends in relation to the use of colposcopy with characteristic geographic distribution: countries with an Anglo-Saxon influence in which colposcopy is performed selectively, and countries with a German medical inheritance in which colposcopy is carried out routinely during a standard general gynecological consultation . However, this difference is not restrictive and by no means can it be stated that colposcopy is systematically being used by all European or Latin American gynecologists for reasons related to training in the colposcopic technique . In 1977, we introduced the concept of dynamic colposcopy with the aim of differentiating it from the descriptive immobility of the original classification of Hinselmann (1954) that had remained almost unchanged by his immediate followers . Briefly, the objective was to turn colposcopy into a diagnostic tool able to identify the pathological substrate corresponding to traditional colposcopic images . We established ten differential signs that allow us to classify an ATZ area as subsidiary or not to be biopsied . The classification system proposed in Rome (International Federation of Cervical Pathology and Colposcopy {IFCPC}, 1990) supports our original concept because by identifying major or minor changes in the original images, a diagnosis of the severity of the lesion can be established . With regard to specificity, the figures range between 48% and 10% with 96% for sensitivity . Obviously, a wide range of colposcopic specificity must be related to the expected efficacy of the method . When after biopsy of an atypical colposcopic image, only a low-grade lesion is detected, should this be considered a false positive colposcopic result? Although histopathologic findings are accepted as the "gold standard"...it is well known that a certain degree of subjectivity can be present . Inter- and intra-observer differences (when the same pathologist is reviewing the diagnosis after a certain time lapse) may be present . It has been argued that microbiopsy under colposcopic control gives rise to a wide error range and that it cannot be considered representative of the lesion . It is likely that this situation may occur when colposcopy-guided biopsy is performed by inexperienced hands or when biopsy is limited to small and insufficient sampling . A very important colposcopic sign, such as complete visual inspection of the squamocolumnar junction is frequently missed . Any lesion with boundaries in the endocervix, cannot be simply assessed by means of microbiopsies from the ectocervix unless there is no doubt regarding the severity of the lesions . Microcolpohysteroscopy (MCH) may be of great value in these cases by showing the limits of endocervical involvement . CONCLUSIONS: According to the evidence presented here, it can be concluded that "colposcopy is in good health" and that probably the popularity of this technique in the field of gynecology would increase if cytopathologists and gynecologists' tasks were limited to their own fields rather than turning them into improvised specialists for their counterpart disciplines . The coordinating role of the gynecologist as a specialist for integral women's health should continue to be defended and in this respect, colposcopy should be considered a routine technique in daily practice. Eur Respir J, 2002 Aug, 20(2), 440 - 3 Side-effects of antituberculosis drug treatment in patients with chronic renal failure; Quantrill SJ et al.; Patients with chronic renal failure (CRF) have a high incidence of tuberculosis (TB) . Those from the Indian subcontinent are at particular risk . The frequency of side-effects associated with antituberculous treatment in a group of patients with CRF was studied . All cases of TB in patients with CRF occurring over a 13-yr period at the Manchester Royal Infirmary, from 1986-1999, were identified by diagnostic coding, microbiology records and a TB database . The case notes were then reviewed . Twenty-four cases were identified, eight predialysis and 16 requiring regular dialysis . TB occurring in the dialysis group was extrapulmonary in every case . Nineteen of 24 (79%) patients were of Indian subcontinent origin and 14 of 16 (87%) dialysis patients were non-Caucasian . Adverse effects of treatment occurred in two of eight (25%) in the predialysis group and nine of 16 (56%) of the dialysis group . These were most commonly neuropsychiatric (6), hepatic (4) and gastrointestinal (4) . Neuropsychiatric symptoms occurred exclusively in dialysis patients . In conclusion, a high incidence of side-effects from antituberculous medication, especially neuropsychiatric, hepatic and gastrointestinal, was identified in patients with chronic renal failure . Careful monitoring for side-effects is essential in this group, and consideration should be given to administering antituberculous chemoprophylaxis to all high-risk groups. Int J Periodontics Restorative Dent, 2002 Aug, 22(4), 323 - 33 GTR treatment of intrabony defects in patients with early-onset and chronic adult periodontitis; Zucchelli G et al.; Young, systemically healthy subjects may suffer from early-onset forms of periodontitis characterized by the presence of localized deep vertical bony defects . The aim of this study was to compare the healing response after guided tissue regeneration (GTR) treatment of similar intrabony defects in patients affected by early-onset and chronic adult periodontitis . Twenty systemically healthy, nonsmoking subjects were enrolled in the study; 10 were affected by early-onset periodontitis (EOP) and 10 by chronic adult periodontitis (CAP) . In each subject, only one deep vertical bony defect (intrabony component > 4 mm, probing attachment level > or = 8 mm) was treated according to the principles of GTR therapy with titanium-reinforced e-PTFE membranes . At the time of the surgery and at the 1-year follow-up, a microbiologic test for the identification of the main periodontopathogens was performed in each of the treated sites . There was no statistically significant difference at 1 year in the amount of clinical attachment gain (P = .4), reduction of probing pocket depth (P = .3), or increase in gingival recession (P = 1.0) between EOP and CAP patients . The 1-year microbiologic results demonstrated the complete disappearance of the putative periodontopathogens from all surgically treated sites in both patient groups . The results of the study demonstrated that deep intrabony defects in patients with EOP can be successfully treated by means of GTR procedures and that the suppression of periodontopathogens under threshold values can be maintained for at least 1 year, provided that the patient is enrolled in a maintenance program consisting of recalls for professional tooth cleaning and reinforcement of self-performed oral hygiene measures at 1-month intervals. Ned Tijdschr Tandheelkd, 2002 Aug, 109(8), 303 - 6 {Risk factors in adult periodontitis: polymorphism in the interleukin-1 gene family}; Laine ML et al.; Interleukin (IL)-1 alpha, IL-1 beta and IL-1 receptor antagonist (ra) play a major role in regulation of the inflammatory response in periodontal tissues . The aim of this study was to investigate the distribution of genetic variation in the IL-1 gene family among periodontitis patients and controls, taking into account smoking and microbiology as additional variables . There were 53 non-smoking and 52 smoking patients with severe adult periodontitis and 53 periodontal healthy controls genotyped for genetic variation in the IL-1 gene family . The presence of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans was established by culture techniques . A higher frequency of genotype+ (IL-1A*2 + IL-1B*2 + IL-1RN*2) was found in non-smoking periodontitis patients in whom P . gingivalis and A . actinomycetemcomitans could not be detected (42.1% vs . 11.3% in controls; p = 0.0068; or 5.7, 95% ci: 1.6-19.8) . This data provide evidence that polymorphisms in genes of the IL-1 family are associated with severe adult periodontitis and may be a risk factor for severe periodontitis. Nat Rev Mol Cell Biol, 2002 Sep, 3(9), 685 - 95 Listening in on bacteria: acyl-homoserine lactone signalling; Fuqua C et al.; Bacterial cell-to-cell signalling has emerged as a new area in microbiology . Individual bacterial cells communicate with each other and co-ordinate group activities . Although a lot of detail is known about the mechanisms of a few well-characterized bacterial communication systems, other systems have been discovered only recently . Bacterial intercellular communication has become a target for the development of new anti-virulence drugs. Pediatr Pulmonol, 2002 Oct, 34(4), 297 - 303 Invasive mechanical ventilation for acute respiratory failure in children with cystic fibrosis: outcome analysis and case-control study; Berlinski A et al.; The outcome for cystic fibrosis (CF) patients requiring intubation and invasive mechanical ventilation (IMV) due to acute respiratory failure (ARF) has been poor . Mortality rates have been reported as high as 60-90% . However, a review of mortality in children has not been published in 20 years . Our objectives were to study outcomes in CF patients requiring IMV due to ARF between 1988-1998, compare recent outcomes with those previously reported, and identify risk factors associated with poor outcome . We additionally attempted to identify factors suggesting an increased risk of developing ARF requiring IMV . A retrospective cohort study design was used, comparing IMV survivors and nonsurvivors with a nested case-control study to identify risk factors for ARF leading to IMV . All patients cared for at our Center who required IMV for ARF between 1988-1998 were identified . Outcome, age, steroid use, forced vital capacity (FVC), forced expired volume in 1 sec (FEV(1)), microbiology, nutritional status, CF-related diabetes (CFRD), liver dysfunction, and history of major hemoptysis (HEM) or pneumothorax (PTX) were recorded . Cases were matched for gender and age with CF controls identified through a clinical database.Thirty-eight episodes of IMV due to ARF were reported in 33 patients . Three subjects underwent IMV on two or more occasions, but only the first episode was included in analysis . Older age was the only factor that was significantly associated with mortality: 9 subjects were <5 years of age (mortality, 22%), while 24 were 5-34 years old (mortality, 75%) (P = 0.013) . There was an increased risk of having an episode of ARF requiring IMV in malnourished subjects (OR = 4.2; 95% CI = 1.66-10.51) and in those with a history of HEM (OR = 6.3; 95% CI = 1.75-22.65).Infants and young children with CF requiring IMV due to ARF have a favorable prognosis, whereas those >or=5 years of age suffer significantly higher mortality . Malnutrition and a history of HEM are important risk factors for having an episode of ARF requiring IMV . Pediatrics . 2002 Sep;110(3):e37. Outcomes of primary image-guided drainage of parapneumonic effusions in children; Mitri RK et al.; OBJECTIVE: To assess the outcome of image-guided needle aspiration when compared with image-guided percutaneous catheter drainage in the management of parapneumonic effusions in children . METHODS: A retrospective chart review was conducted of the medical records, microbiology, and radiology reports of 67 children who presented with parapneumonic effusions and underwent primary image-guided drainage between April 1, 1995, and April 1, 2000 . RESULTS: Thirty-four patients had aspiration only, and 33 patients had pigtail catheters placed . The 2 drainage methods had similar median length of stay and complication rates . The reintervention rate in this study was 27% (18 patients) . Children who underwent primary aspiration without catheter placement had significantly higher rates of reintervention . Method of drainage, pH lower than 7.2, and loculation of the fluid collection were independent predictors of reintervention . A low glucose level was an additive predictor of reintervention when the pH was low . CONCLUSIONS: Aspiration and catheter drainage of parapneumonic effusions had similar complication rates and lengths of stay, but children who underwent primary aspiration had significantly higher reintervention rates, particularly when pH and glucose levels were low . Therefore, primary catheter placement for parapneumonic effusions should be considered in children who undergo diagnostic thoracentesis . The decision regarding tube placement could be facilitated by the on-site availability of a pH meter and a glucometer. J Clin Microbiol, 2002 Sep, 40(9), 3350 - 7 Fast, noninvasive method for molecular detection and differentiation of Malassezia yeast species on human skin and application of the method to dandruff microbiology; Gemmer CM et al.; Malassezia fungi have been the suspected cause of dandruff for more than a century . Previously referred to as Pityrosporum ovale, Pityrosporum orbiculare, or Malassezia, these fungi are now known to consist of at least seven Malassezia species . Each species has a specific ecological niche, as well as specific biochemical and genetic characteristics . Malassezia yeasts have fastidious culture conditions and exceedingly different growth rates . Therefore, the results of surveys of Malassezia based on culture methods can be difficult to interpret . We developed a molecular technique, terminal fragment length polymorphism analysis, to more accurately survey the ecology of Malassezia yeasts without bias from culture . This technique involves fluorescent nested PCR of the intergenic transcribed spacer (ITS) ITS I and ITS II region ribosomal gene clusters . All known Malassezia species can be differentiated by unique ITS fragment lengths . We have used this technique to directly analyze scalp samples from subjects enrolled in a demographic scalp health study . Results for subjects assigned composite adherent scalp flaking scores (ASFS) <10 were compared to those for subjects assigned composite ASFS >24 . Malassezia restricta and M . globosa were found to be the predominant Malassezia species present in both groups . Importantly, we found no evidence of M . furfur in either group, indicating that M . furfur can be eliminated as the causal organism for dandruff . Both groups also showed the presence of non-Malassezia fungi . This method, particularly when it is used in combination with existing fungal ITS databases, is expected to be useful in the diagnosis of multiple other fungal infections. Appl Environ Microbiol, 2002 Sep, 68(9), 4495 - 501 Evidence for natural horizontal transfer of the pcpB gene in the evolution of polychlorophenol-degrading sphingomonads; Tiirola MA et al.; The chlorophenol degradation pathway in Sphingobium chlorophenolicum is initiated by the pcpB gene product, pentachlorophenol-4-monooxygenase . The distribution of the gene was studied in a phylogenetically diverse group of polychlorophenol-degrading bacteria isolated from contaminated groundwater in Karkola, Finland . All the sphingomonads isolated were shown to share pcpB gene homologs with 98.9 to 100% sequence identity . The gene product was expressed when the strains were induced by 2,3,4,6-tetrachlorophenol . A comparative analysis of the 16S rDNA and pcpB gene trees suggested that a recent horizontal transfer of the pcpB gene was involved in the evolution of the catabolic pathway in the Karkola sphingomonads . The full-length Karkola pcpB gene allele had approximately 70% identity with the three pcpB genes previously sequenced from sphingomonads . It was very closely related to the environmental clones obtained from chlorophenol-enriched soil samples (M . Beaulieu, V . Becaert, L . Deschenes, and R . Villemur, Microbiol . Ecol . 40:345-355, 2000) . The gene was not present in polychlorophenol-degrading nonsphingomonads isolated from the Karkola source. Appl Environ Microbiol, 2002 Sep, 68(9), 4307 - 14 Seasonal variation in lysogeny as depicted by prophage induction in Tampa Bay, Florida; Williamson SJ et al.; A seasonal study of the distribution of lysogenic bacteria in Tampa Bay, Florida, was conducted over a 13-month period . Biweekly water samples were collected and either were left unaltered or had the viral population reduced by filtration (pore size, 0.2 micro m) and resuspension in filtered (pore size, 0.2 micro m) water . Virus-reduced and unaltered samples were then treated by adding mitomycin C (0.5 micro g ml(-1)) to induce prophage or were left untreated . In order to test the hypothesis that prophage induction was phosphate limited, additional induction experiments were performed in the presence and absence of phosphate . Induction was assessed as an increase in viral direct counts, relative to those obtained in controls, as detected by epifluorescence microscopy . Induction of prophage was observed in 5 of 25 (20%) unaltered samples which were obtained during or after the month of February, paralleling the results from a previous seasonal study . Induction of prophage was observed in 9 of 25 (36%) of the virus-reduced samples, primarily those obtained in the winter months, which was not observed in a prior seasonal study (P . K . Cochran and J . H . Paul, Appl . Environ . Microbiol . 64:2308-2312, 1998) . Induction was noted in the months of lowest bacterial and primary production, suggesting that lysogeny was favored under conditions of poor host growth . Phosphate addition enabled prophage induction in two of nine (22%) experiments . These results indicate that prophage induction may occasionally be phosphate limited or respond to increases in phosphate concentration, suggesting that phosphate concentration may modulate the lysogenic response of natural populations. An Esp Pediatr, 2002 Sep, 57(3), 244 - 8 {Perinatal cytomegalovirus infection in preterm infants}; Perez Paya A et al.; OBJECTIVE: To study the incidence of perinatal cytomegalovirus infection in neonates admitted to our hospital in the last three years, as well as the mode of transmission, serologic and microbiologic data, and the clinical outcome of these infants . METHODS: We performed a retrospective study by reviewing the medical records of neonates with a diagnosis of cytomegalovirus infection . RESULTS: Twenty-four neonates received this diagnosis . Of these, 21 (85 %) were premature infants with a birthweight of less than 1500 gr, representing 6 % of all neonates with this birthweight hospitalized during the study period . The percentage of transfusion and breastfeeding was high (87 % and 91 %, respectively) and consequently the route of transmission could not be identified . Nine neonates (34 %) presented associated hepatic dysfunction and three (12 %) developed severe disease requiring antiviral treatment . CONCLUSIONS: Perinatal cytomegalovirus infection is frequent in preterm infants and may be serious . It is important to detect cytomegalovirus infections and to develop preventive methods. Nucl Med Commun, 2002 Sep, 23(9), 851 - 5 The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses; Chacko TK et al.; Ten per cent of patients with hip replacement will eventually complain of significant pain after surgery, often requiring a revision arthroplasty . The majority of these patients experience aseptic loosening rather than infection . Despite significant advances made in diagnostic imaging, distinguishing infection from aseptic loosening remains a significant challenge . Imaging using fluorodeoxyglucose (FDG) positron emission tomography (PET) has been reported to have excellent sensitivity in detecting infections associated with hip prostheses . However, in some studies, a high rate of false positive results has been reported, especially when increased tracer uptake adjacent to the prosthesis (which is not surrounded by bone) is used as the sole criterion for diagnosing infection . The objective of this investigation was to determine the optimal criteria for diagnosing periprosthetic infection, thereby avoiding false positive results in this setting . A total of 41 total hip arthroplasties from 32 patients and for whom complete clinical follow-up was available were included in this analysis . The location and intensity of FDG uptake were determined for each scan . Final diagnosis was made by microbiology, histopathology, surgical findings and clinical follow-up . Patients who did not undergo surgery were followed up to at least 9 months . Twelve patients were proven eventually to have periprosthetic infection . Images from 11 of these patients displayed increased tracer uptake along the interface between bone and prosthesis . The intensity of the increased tracer uptake varied from mild to moderate, with standardized uptake values less than 2 . In contrast, images from uninfected, loose hip prostheses revealed very intense uptake around the head or neck of the prosthesis with standardized uptake values as high as 7 . It is concluded that the intensity of increased FDG uptake is less important than the location of increased FDG uptake when FDG PET is used to diagnose periprosthetic infection in patients with hip arthroplasty . Using increased uptake as the sole criterion for diagnosing infection will result in false positive results in this setting. Am J Obstet Gynecol, 2002 Aug, 187(2), 305 - 10; idscussion 310-1 Necrotizing fasciitis in gynecologic and obstetric patients: a surgical emergency; Gallup DG et al.; OBJECTIVE: We reviewed the cases of 23 patients who were admitted to the hospital with a primary diagnosis of histopathologically confirmed necrotizing fasciitis in the lower abdomen or pelvis . Rapid demise of a healthy postpartum women piqued our interest in trying to identify the early signs and symptoms that may lead to earlier diagnosis and treatment of this often fatal disease . STUDY DESIGN: A retrospective analysis of charts of all patients who were admitted to the gynecology and obstetrics services of our hospital systems with a diagnosis of necrotizing fasciitis for the past 14 years was performed . Age, comorbid factors, precipitating events, weight, symptoms and signs, microbiologic factors, radiographs, surgical therapy, and morbidity were correlated . RESULTS: Definitive operation was accomplished within 48 hours of the diagnosis of necrotizing fasciitis in all but 3 patients . Of the 17 patients who were not puerperal, 88% of the women were obese; 65% of the women were hypertensive, and 47% of the women were diabetic . Of the total 23 patients, 70% of the women complained of severe pain, and 35% of the women had radiographic diagnostics for necrotizing fasciitis ("gas") . Four patients had diverting colostomies, and 39% of the patients had flaps or synthetic grafts . Three patients died (mortality rate, 13%) . One patient who was puerperal died of a severe rapid septicemia; the 2 late deaths were the result of systemic candidiasis . CONCLUSION: Necrotizing fasciitis is a rapidly progressive, often lethal, infectious disease process that requires early aggressive debridement . Any patient with inordinate pain and unilateral edema in the pelvis, especially in the puerperium, should be suspected of having this disease . Radiographic studies are often diagnostic of this condition . The triad of pelvic pain, edema, and any sign of septicemia carries an extremely grave prognosis and mandates immediate surgical intervention. Croat Med J, 2002 Aug, 43(4), 503 - 7 Public health training in Albania: long way toward a school of public health; Roshi E et al.; AIM: To assess the needs for a school of public health in Albania, where health system has been going through difficult periods of transition after the collapse of the communist regime and its "Soviet" health system in 1991 . METHOD: Review of the past and current state of public health training, as well as the evolution of the main institutions involved in public health training in Albania, in view of the recent attempts undertaken to establish a school of public health . RESULTS: Up to early 1990s, public health training in Albania involved mostly physicians and was based to a great extent on sanitary engineering approach . In the mid 1990s, the activities of the Department of Public Health of the Faculty of Medicine in Tirana focused on development of comprehensive public health training program . The aim of the current 2-year training program is to train public health specialists in a new fashion, in line with current international trends in the "new" public health . However, the size and the background of the faculty of the Department of Public Health (8 members, 7 physicians) is too limited and medically oriented . Since 1969, the Institute of Hygiene and Epidemiology (later National Institute of Public Health) has been providing short-term (1-3 months) courses for hygienists, chemists, and microbiologists working at the district level . CONCLUSION: Only the establishment of a school of public health capable to train specialists according to international standards can meet the health needs of Albania. Infect Immun, 2002 Sep, 70(9), 4798 - 804 Decreased electroporation efficiency in Borrelia burgdorferi containing linear plasmids lp25 and lp56: impact on transformation of infectious B . burgdorferi; Lawrenz MB et al.; The presence of the linear plasmids lp25 and lp56 of Borrelia burgdorferi B31 was found to dramatically decrease the rate of transformation by electroporation with the shuttle vector pBSV2, an autonomously replicating plasmid that confers kanamycin resistance (P . E . Stewart, R . Thalken, J . L . Bono, and P . Rosa, Mol . Microbiol . 39:714-721, 2001) . B . burgdorferi B31 clones had transformation efficiencies that were either low, intermediate, or high, and this phenotype correlated with the presence or absence of lp25 and lp56 . Under the conditions utilized in this study, no transformants were detected in clones that contained both lp25 and lp56; the few kanamycin-resistant colonies isolated did not contain pBSV2, indicating that the resistance was due to mutation . Intermediate electroporation rates (10 to 200 colonies per micro g of DNA) were obtained with B31 clones that were either lp25(-) and lp56(+) or lp25(+) and lp56(-) . Clones in this group that initially contained lp25 lacked this plasmid in pBSV2 transformants, a finding consistent with selective transformation of lp25(-) variants . High transformation rates (>1,000 colonies per micro g of DNA) occurred in clones that lacked both lp25 and lp56 . Sequence analysis indicated that lp25 and lp56 contain genes that may encode restriction and/or modification systems that could result in the low transformation rates obtained with strains containing these plasmids . The previously reported correlation between lp25 and infectivity in mice, coupled with the barrier lp25 presents to transformation, may explain the difficulty in obtaining virulent transformants of B . burgdorferi. Antimicrob Agents Chemother, 2002 Sep, 46(9), 3035 - 8 Predicting evolution by in vitro evolution requires determining evolutionary pathways; Hall BG; In an early example of DNA shuffling, Stemmer (W . P . C . Stemmer, Nature 370:389-390, 1994) demonstrated a dramatic improvement in the activity of the TEM-1 beta-lactamase toward cefotaxime as the consequence of six amino acid substitutions . It has been pointed out (B . G . Hall, FEMS Microbiol . Lett . 178:1-6, 1999; M . C . Orencia, J . S . Yoon, J . E . Ness, W . P . Stemmer, and R . C . Stevens, Nat . Struct . Biol . 8:238-242, 2001) that the power of DNA shuffling might be applied to the problem of predicting evolution in nature from in vitro evolution in the laboratory . As a predictor of natural evolutionary processes, that power may be misleading because in nature mutations almost always arise one at a time, and each advantageous mutation must be fixed into the population by an evolutionary pathway that leads from the wild type to the fully evolved sequence . Site-directed mutagenesis was used to introduce each of Stemmer's six substitutions into TEM-1, the best single mutant was chosen, and each of the remaining five substitutions was introduced . Repeated rounds of site-directed mutagenesis and selection of the best mutant were used in an attempt to construct a pathway between the wild-type TEM-1 and Stemmer's mutant with six mutations . In the present study it is shown (i) that no such pathway exists between the wild-type TEM-1 and the supereffective cefotaxime-hydrolyzing mutant that was generated by six amino acid substitutions via DNA shuffling (Stemmer, Nature 370:389-390, 1994) but that a pathway to a fourfold more efficient enzyme resulting from four of the same substitutions does exist, and (ii) that the more efficient enzyme is likely to arise in nature as the result of a single mutation in the naturally occurring TEM-52 allele. Sex Transm Infect, 2002 Aug, 78(4), 235 - 40 Sexually acquired hepatitis; Brook MG; OBJECTIVES: To assess current knowledge of sexually transmitted viral hepatitis in relation to epidemiology, clinical presentation, management, and diagnosis with particular reference to resource-poor settings . METHOD: A search of published literature identified through Medline from 1966 to October 2001, the Cochrane Library, and reference lists taken from each article obtained . Textword and MeSH searches for hepatitis A, B, C, D, E, G, delta, GB virus, GBV-C, and TT virus were linked to searches under the textword terms sex$, prevent$, and MeSH subheadings, microbiology, complications, drug therapy, therapy, diagnosis, epidemiology, transmission, and prevention and control . CONCLUSIONS: In heterosexual relationships, hepatitis B is readily transmitted sexually and hepatitis C and D less so, with no evidence for sexual transmission of hepatitis A . Hepatitis types A-D are all transmissible sexually in male homosexual relationships under certain conditions . In resource-poor countries sexual transmission is generally only a significant route of transmission for hepatitis B. Transpl Immunol, 2002 May, 9(2-4), 251 - 6 Xenotransplantation--how far have we come? Cooper DK, Gollackner B, Knosalla C, Teranishi K. The immunologic barriers to xenotransplantation are summarized and approaches to overcome them briefly reviewed . Intensive investigation is being directed to the problem of acute humoral xenograft rejection, which is the major current barrier . Although the induced antibody response appears to be prevented by combination therapy with an anti-CD154 monoclonal antibody and mycophenolate mofetil, deposition of natural anti-Gal antibody on the graft endothelial cells appears to be sufficient to lead to rejection or a state of consumptive coagulopathy . Approaches towards the induction of tolerance are described . The potential microbiologic risks and physiologic incompatibilities of pig-to-human organ transplantation are also briefly discussed. J Gastroenterol Hepatol, 2002 Sep, 17(9), 1001 - 7 Pyogenic liver abscess: retrospective analysis of 80 cases over a 10-year period; Wong WM et al.; BACKGROUND: A total of 80 patients with pyogenic liver abscess managed at a single institution over a 10-year period were studied . METHODS: The clinical features, laboratory, imaging, and microbiologic findings, management strategy, and final outcome were studied . RESULTS: Fever and chills, leucocytosis and elevated alkaline phosphatase were the most common clinical and laboratory findings . Forty-one percent of patients were diabetic and 61% had biliary pathology . Systemic antibiotics and image-guided aspiration had a success rate of 94% . By multiple logistic regression analysis, malignancy on presentation (P = 0.011) was an independent risk factor associated with mortality . A past history of endoscopic sphincterotomy was an independent factor associated with resolution of liver abscess within 6 weeks (P = 0.03) . CONCLUSION: Pyrexia, leucocytosis, elevated alkaline phosphatase, presence of diabetes, and underlying biliary pathology are common clinical and laboratory findings in patients with pyogenic liver abscess . Malignancy was associated with a poor outcome . Previous endoscopic sphincterotomy was a good prognostic factor for early resolution . Parasitology, 2002 Jul, 125(Pt 1), 11 - 9 Giardia lamblia disrupts tight junctional ZO-1 and increases permeability in non-transformed human small intestinal epithelial monolayers: effects of epidermal growth factor; Buret AG et al.; In order to improve our understanding of the host cell-parasite interactions in giardiasis, this study assessed the effects of Giardia lamblia on epithelial permeability and tight junctional ZO-1, determined whether epidermal growth factor (EGF) may affect Giardia-induced epithelial injury, and evaluated if EGF modulates epithelial colonization by live G . lamblia trophozoites . Permeability was assessed in assays of trans-epithelial fluxes of FITC-dextran, and ZO-1 integrity was characterized by confocal laser immunofluorescence microscopy in confluent epithelial cell monolayers . G . lamblia significantly increased paracellular permeability and disrupted tight-junctional ZO-1 of a novel non-transformed human small intestinal epithelial cell line (SCBN) . Pre-treatment with EGF prevented the development of these abnormalities and significantly inhibited attachment of live trophozoites to the enterocytes, independently of a direct microbiocidal action . These findings demonstrate that G . lamblia may cause intestinal pathophysiology by disrupting tight junctional ZO-1 and increasing epithelial permeability . Apical administration of EGF prevents these abnormalities, and reduces epithelial colonization by the live parasites. Pediatrics . 2002 Aug;110(2 Pt 1):e21. Acute disseminated encephalomyelitis in children; Murthy SN et al.; OBJECTIVE: To describe the epidemiologic, clinical, neuroimaging, and laboratory features; treatment; and outcome in a cohort of children with acute disseminated encephalomyelitis (ADEM) . METHODS: A 6-year retrospective chart review of children with the diagnosis of ADEM was conducted . RESULTS: Eighteen cases were identified . Sixteen patients (88%) presented in either winter or spring . Thirteen children (72%) had a recent upper respiratory tract illness . Patients presented most often with motor deficits (77%) and secondly with altered consciousness (45%) . Spinal fluid abnormalities occurred in 70% . Despite rigorous microbiologic testing, a definite microbiologic diagnosis was established only in 1 child with Epstein-Barr virus disease and probable or possible diagnoses in 3 children with Bartonella henselae, Mycoplasma pneumoniae, or rotavirus disease . Brain magnetic resonance imaging identified lesions in the cerebral cortex in 80%, in subcortical white matter in 93%, in periventricular white matter in 60%, in deep gray matter in 47%, and in brainstem in 47% of patients . Eleven patients (61%) were treated with corticosteroids, and 2 were treated with intravenous immunoglobulins . All patients survived . Three patients (17%) had long-term neurologic sequelae . CONCLUSIONS: Epidemiologic evidence from this study suggests an infectious cause for ADEM . The agent is most likely a difficult-to-diagnose winter/spring respiratory virus . Magnetic resonance imaging was the neuroimaging study of choice for establishing the diagnosis and for following the course of the disease . Prognosis for survival and outcome was excellent . Recurrent episodes of ADEM must be differentiated from multiple sclerosis. J Trop Pediatr, 2002 Jun, 48(3), 149 - 55 Utility of clinically-directed selective screening to diagnose HIV infection in hospitalized children in Bombay, India; Karande S et al.; The increasing prevalence of HIV infection in urban India together with limited financial resources necessitates judicious HIV testing . This prospective study was undertaken to determine the utility of selective screening for HIV infection based on five clinical risk factors reported in African children . The study was conducted at the Departments of Paediatrics and Microbiology, LTMG Hospital, Bombay, India between September 1998 and 2000 . The children were enrolled after taking informed consent from their parents . The HIV seroprevalence rate was determined in children (aged 1 month to 12 years) consecutively admitted with severe malnutrition, serious pyogenic infections (pneumonia, pyogenic meningitis, septicaemia), disseminated tuberculosis, chronic diarrhoea and oral candidiasis, present either singly or in combination . Children above 18 months of age were diagnosed as being infected with HIV if they tested positive by two different HIV enzyme-linked immunosorbent assay (ELISA) tests . In children less than 18 months of age the diagnosis of HIV infection was made if they were ELISA positive and also fulfilled the WHO criteria for symptomatic HIV infection . Of a total 204 children (110 male, 94 female) screened, 24 (11.8 per cent) were diagnosed as HIV-infected . The HIV seropositive rate was highest in children having oral candidiasis (40.6 per cent), followed by chronic diarrhoea (18.2 per cent), disseminated tuberculosis (16.2 per cent), severe malnutrition (14.4 per cent), and serious pyogenic infections (11.2 per cent) . Only the presence of oral candidiasis was a significant independent risk factor for predicting HIV infection (p < 0.0001) . However, as the number of risk factors concomitantly present increased, the chances of the child being infected with HIV also increased significantly (p < 0.001) . Our study shows that clinically-directed selective screening does have a practical role in diagnosing HIV infection in a resource-poor setting. J Nutr, 2002 Aug, 132(8 Suppl), 2345S - 2349S Nutritional and genetic inefficiencies in one-carbon metabolism and cervical cancer risk; Ziegler RG et al.; Folate deficiency has long been postulated to play a role in the etiology of cervical cancer, the third most frequent cancer among women worldwide . In a large, multiethnic community-based case-control study of invasive cervical cancer in five U.S . areas, we assessed accepted and postulated risk factors with an in-home interview and successfully obtained blood samples, at least 6 mo after completion of cancer treatment, from 51 and 68%, respectively, of interviewed cases and controls . Cases with advanced disease (6%) and/or receiving chemotherapy (4%) were excluded, leaving 183 cases and 540 controls . Serum and red blood cell folate were measured with both microbiologic and radiobinding assays . For all four folate measures, risk was moderately, but nonsignificantly, elevated for women in the lowest quartile, compared to the highest {fully adjusted relative risks (RR), including serologic human papillomavirus (HPV)-16 status = 1.2-1.6} . However, for women in the upper three homocysteine quartiles (>6.31 micro mol/L), risk of invasive cervical cancer was substantially and significantly elevated (fully adjusted RR, including serologic HPV-16 status = 2.4-3.2; P for trend = 0.01) . This strong relationship suggests that circulating homocysteine may be 1) an especially accurate indicator of inadequate folate, 2) an integratory measure of insufficient folate in tissues or 3) a biomarker of disruption of one-carbon metabolism . The contribution of common polymorphisms in one-carbon pathway genes, as well as inadequate vitamin B-6, vitamin B-12 and/or riboflavin, to elevated homocysteine, inefficient one-carbon metabolism and increased cervical cancer risk merits further exploration. J Cataract Refract Surg, 2002 Aug, 28(8), 1446 - 51 Corneal haze after photorefractive keratectomy for myopia: role of collagen IV mRNA typing as a predictor of haze; Winkler von Mohrenfels C et al.; PURPOSE: To develop a test based on the individual expression of collagen type IV synthesis in corneal epithelial cells to identify patients who have the potential for significant corneal haze after myopic photorefractive keratectomy (PRK) . SETTING: Department of Ophthalmology and the Institute of Microbiology, University of Regensburg, Germany . METHODS: The individual synthesis of collagen type IV alpha3 mRNA was quantitatively measured in corneal epithelial cells of 34 eye (34 patients) with myopia ranging from -1.5 to -10.0 diopters (D) by a polymerase chain reaction (PCR) test . The corneal epithelial cells were collected before the PRK procedure . Collagen type IV alpha3 mRNA levels were correlated to postoperative haze and regression at 12 months . RESULTS: In all samples, collagen type IV alpha3 mRNA was detected; the mean was 1.47 (range 0.11 to 6.42) . There was a correlation between haze and the amount of collagen type IV alpha3 mRNA; that is, eyes with haze had more collagen IV expression . In contrast, no correlation was observed between regression and the amount of collagen type IV alpha3 mRNA . CONCLUSIONS: The results show that collagen type IV alpha3 is an important factor in the development of corneal haze after PRK . Based on a quantitative PCR test, the individual collagen IV mRNA concentration in corneal epithelial cells could be measured . Further development could establish a screening test by which eyes with pronounced synthesis of collagen IV could be identified as being at high risk for haze after PRK. Scand J Infect Dis, 2002, 34(6), 449 - 55 Antibiotic use and Escherichia coli resistance trends for quinolones and cotrimoxazole in Sweden; Farra A et al.; Resistance rates among Escherichia coli isolates for quinolones and cotrimoxazole were analysed at 12 Swedish hospitals, and compared with antibiotic use . Resistance figures for E . coli were retrieved from the diagnostic microbiology service databases for the period 1989-99, and antibiotic sales figures were obtained from the National Corporation of Swedish Pharmacies . At the 2 university teaching hospitals included, norfloxacin resistance of E . coli increased significantly (p < 0.001) from 0% to 2.7% and 2.5%, respectively . Ciprofloxacin resistance increased (p < 0.001) in parallel . Quinolone use increased until 1992; subsequently, sales have remained at a stable level . The increase in norfloxacin and ciprofloxacin resistance started relatively simultaneously in all hospitals, around 1991 . Cotrimoxazole resistance has also been increasing significantly in most hospitals, in spite of decreasing sales of cotrimoxazole and trimethoprim . Similar trends could be seen in blood isolates from the same hospitals for the period 1991-98 . Clinical laboratory data are subject to bias but surveillance over longer periods of time provides a useful method for detecting trends in increasing resistance and therefore functions as a resistance warning system. Lijec Vjesn, 2002 May, 124(5), 140 - 5 {Gas gangrene and hyperbaric oxygenation--a lesson forgotten or never learned?}; Petri NM et al.; Gas gangrene develops in devitalized hypoxic tissue . It spreads rapidly under strong influence of enzymes produced by the causing bacteria and often results in fatal outcome . It is of utmost importance to stop toxin production as soon as possible, which is most effectively achieved by early application of hyperbaric oxygenation (HBO2), as the first measure in a "trident" (HBO2, antibiotics, surgical measures) . The paper reviews the most important data from microbiology, pathophysiology and epidemiology of gas gangrene, current clinical practice, scientific basis for application of HBO2 in the treatment of this disease, and data from the archives of the Naval Medical Institute of the Croatian Navy in Split (NMI) . At the NMI, in the period from 1982 to 2000, HBO2 was administered in the treatment of 21 patients with gas gangrene, of average age 41.6 +/- 16.3 years . The average treatment consisted of 6.8 +/- 3.8 sessions . 13 (76%) patients were cured. Orthopade, 2002 Jun, 31(6), 551 - 5 {Diagnosis and therapy of necrotizing fasciitis}; Baer W et al.; Necrotizing fasciitis is a soft tissue infection with a lethality ranging up to 80% . Infection causes the activation of interleukin, tumor necrosis factor alpha, and gamma-interferon through a triggering mechanism . This results in a capillary thrombosis with necrosis of the fascia, cutis, and subcutis . The patient's history often reveals a triggering event in the form of a recent minimal trauma or operative procedure . In a fulminant necrotizing fasciitis, the development of sepsis with consecutive multiple-organ failure mainly determines the outcome of the disease . Diagnosis is made initially upon clinical findings with a rapid progression of the disease and confirmed later by histologic and microbiologic findings . Radical surgical debridement within the first 24 h with postoperative treatment in an intensive care unit represents the cornerstone of therapy . Between January 1992 and March 2001, we treated 15 patients with necrotizing fasciitis . Lethality was 33% . There was a significant correlation between risk factors (present in 86% of the patients) and morbidity . Diagnosis and therapy should be performed by an experienced surgeon . In this contribution, we discuss the most important criteria that lead to the diagnosis and the therapeutic consequences. Presse Med, 2002 May 25, 31(18), 841 - 8 {Mycologic surveillance of the environment for preventive invasive aspergillosis . Proposals for standardization of the methodologies and implementation}; Gangneux JP et al.; A MAJOR RISK: The infection of immunodepressed patients by Aspergillus-type fungi increases morbidity and mortality, particularly in hematology units or during solid organ transplantation . Although present diagnostic means benefit from the progress over the last years, they remain limited and chemoprophylaxis protocols have still not demonstrated significant efficacy . THE NEED FOR RECOMMENDATIONS: Today, the handling of environmental risks is the only strategy that has proved its efficacy and usefulness . On the basis of administrative recommendations and data from the literature, a multicentric and pluri-disciplinary task force, grouping clinicians, microbiologists and hygienists, has assessed different methods and has proposed recommendations for the standardization and optimization of fungal surveillance of the environment. Biol Cell, 2002 May, 94(2), 55 - 63 In situ ageing of fine beech roots (Fagus sylvatica) assessed by transmission electron microscopy and electron energy loss spectroscopy: description of microsites and evolution of polyphenolic substances; Watteau F et al.; Root biomass is quantitatively and qualitatively important in most ecosystems, but its contribution to the pool of organic matter in the soil is not clear . This work was designed to specify root ageing on an ultrastructural scale by transmission electron microscopy combined with microanalysis by electron energy loss spectroscopy . This approach is very suitable for studying the soil/plant interface, and for semi-quantitative analysis of the evolution of polyphenolic substances during root evolution . Three root segments were studied according to a gradient of root senescence: the apical and basal segments of the mycorrhiza and the mycorrhiza-carrier root . Each segment contained a certain proportion of senescent cells, some of which were of fungal origin, and this proportion increased as the root aged . In the three segments, the soil/plant interfaces were differentiated, and the micro-organisms observed in situ were described . Senescent root cells contained many polyphenolic substances and our results showed that these substances were, according to the root segment, differently associated with Ca, N and Si . When all these ultrastructural data are correlated with more global data, they can be usefully applied to root cell physiology, microbiology and pedology . This approach makes it possible to specify the evolution of organic matter in situ in soils whatever its origin. Ann Biol Clin (Paris), 2002 Jul-Aug, 60(4), 468 - 70 {A case report of Cardiobacterium hominis endocarditis}; Lesimple B et al.; We here report a case of endocarditis due to Cardiobacterium hominis in a 53-year-old patient, who presented with large vegetations on the mitral valve . Good cooperation between clinicians and microbiologists and an efficient automated blood culture system were the decisive factors in establishing the diagnosis . Early and appropriate treatment prevented the septic embolisms often observed in this pathology. Clin Infect Dis, 2002 Aug 15, 35(4), 409 - 13 Epub 2002 Jul 17. Tuberculous peritonitis-associated mortality is high among patients waiting for the results of mycobacterial cultures of ascitic fluid samples; Chow KM et al.; We identified 60 cases of tuberculous peritonitis during the past 12 years at our health care center . Most of the patients had severe underlying medical conditions, such as cirrhosis, renal failure, diabetes mellitus, and malignancy . Abnormal chest radiograph findings, ascitic fluid lymphocytosis, and biochemical findings for exudates could only identify 33%, 37%, and 53% of the cases, respectively . On the other hand, peritoneal biopsy allowed early definitive diagnosis for 9 patients . Thirty-one patients died, 26 of whom died < or =6 weeks after their initial presentation, often before the result of mycobacterial culture was available . Only 8 patients died of advanced disease after antituberculous therapy was started . Univariate analysis showed that advanced age, underlying diagnosis, and delayed initiation of therapy were associated with higher mortality rates . Standard antituberculous chemotherapy is highly effective . However, conventional microbiologic diagnostic methods are slow and not sensitive enough for establishing a diagnosis of tuberculous peritonitis. J Pediatr Hematol Oncol, 2002 Jun-Jul, 24(5), 360 - 3 Factitious fungus in two children with cancer receiving liposomal amphotericin; Fisher MJ et al.; Amphotericin B deoxycholate and liposomal formulations of amphotericin are often started and continued empirically, in immunocompromised hosts, based on the computed tomography findings and the patient's clinical picture . The authors describe two patients with presumed fungal pulmonary nodules, which were progressive despite prolonged treatment with liposomal amphotericin B . At subsequent biopsy, neither had evidence of active fungal disease; rather, the nodules revealed reactive changes and lipid-laden macrophages . These cases underscore the importance of establishing a microbiologic diagnosis in cases of presumed fungal infection. Annu Rev Microbiol, 2002, 56, 703 - 41 Epub 2002 Jan 30. Prions as protein-based genetic elements; Uptain SM et al.; Fungal prions are fascinating protein-based genetic elements . They alter cellular phenotypes through self-perpetuating changes in protein conformation and are cytoplasmically partitioned from mother cell to daughter . The four prions of Saccharomyces cerevisiae and Podospora anserina affect diverse biological processes: translational termination, nitrogen regulation, inducibility of other prions, and heterokaryon incompatibility . They share many attributes, including unusual genetic behaviors, that establish criteria to identify new prions . Indeed, other fungal traits that baffled microbiologists meet some of these criteria and might be caused by prions . Recent research has provided notable insight about how prions are induced and propagated and their many biological roles . The ability to become a prion appears to be evolutionarily conserved in two cases . {PSI(+)} provides a mechanism for genetic variation and phenotypic diversity in response to changing environments . All available evidence suggests that prions epigenetically modulate a wide variety of fundamental biological processes, and many await discovery. Int J Med Microbiol, 2002 Jun, 292(1), 51 - 7 A pulsed-field gel electrophoresis study of Mycobacterium fortuitum in a Caribbean setting underlines high genetic diversity of the strains and excludes nosocomial outbreaks; Legrand E et al.; Among rapidly-growing opportunistic mycobacteria, organisms of the Mycobacterium fortuitum-Mycobacterium chelonae complex (M . fortuitum, M . chelonae, M . abscessus and M . peregrinum) were isolated in significantly higher numbers during the period 1993-99 from clinical samples in Guadeloupe, Martinique and French Guiana . Based on biochemical and cultural tests and PCR-restriction fragment length polymorphism (RFLP) of the hsp65 gene, 51 isolates from 47 patients were unambiguously identified as M . fortuitum . A molecular epidemiological study by pulsed-field gel electrophoresis (PFGE) using DraI and Xbal digestions of bacterial DNA revealed two clusters designated A and B; cluster A was composed of strains showing 10 bands that were isolated from 3 patients in Martinique within a 2-months period in 1999, and the cluster B was composed of 2 strains showing 9 bands from 2 patients in Martinique, also isolated within a 2-months period in 1999 . The available epidemiological and clinical information neither incriminated M . fortuitum as a cause of disease in these patients, nor showed any potential epidemiolgical links between them, except for the fact that the samples were processed in the same microbiology laboratory within a short span of time . In conclusion, isolation of M . fortuitum from non-sterile sites in patients without predisposing conditions, and in absence of repeated isolation, may be caused by contaminants or colonizers that are picked up more easily due to improvement of techniques used for mycobacterial isolation and identification. Expert Rev Mol Diagn, 2002 Jul, 2(4), 329 - 36 Diagnostic tests for CAP: current approaches and future perspectives; Saranglao A et al.; Diagnostic testing in community-acquired pneumonia (CAP) serves three functions: firstly, to confirm the presence of CAP; secondly, to assess severity; and thirdly, to identify the causative pathogen . Available techniques are satisfactory to fulfill the first two roles but are seriously inadequate as regards the third . Accordingly, antibiotic therapy for CAP must be empirical, at least initially . This article reviews current diagnostic methods and provides suggestions for appropriate use of diagnostic tests in CAP . The shortcomings of the available methods for microbiologic diagnosis are discussed . The potential for PCR to become the much sought after 'ideal' test for microbiologic diagnosis in CAP is explored. J Biol Chem, 2002 Oct 11, 277(41), 38001 - 12 Epub 2002 Jul 22. Succinate secreted by Trypanosoma brucei is produced by a novel and unique glycosomal enzyme, NADH-dependent fumarate reductase; Besteiro S et al.; In all trypanosomatids, including Trypanosoma brucei, glycolysis takes place in peroxisome-like organelles called glycosomes . These are closed compartments wherein the energy and redox (NAD(+)/NADH) balances need to be maintained . We have characterized a T . brucei gene called FRDg encoding a protein 35% identical to Saccharomyces cerevisiae fumarate reductases . Microsequencing of FRDg purified from glycosome preparations, immunofluorescence, and Western blot analyses clearly identified this enzyme as a glycosomal protein that is only expressed in the procyclic form of T . brucei but is present in all the other trypanosomatids studied, i.e . Trypanosoma congolense, Crithidia fasciculata and Leishmania amazonensis . The specific inactivation of FRDg gene expression by RNA interference showed that FRDg is responsible for the NADH-dependent fumarate reductase activity detected in glycosomal fractions and that at least 60% of the succinate secreted by the T . brucei procyclic form (in the presence of d-glucose as the sole carbon source) is produced in the glycosome by FRDg . We conclude that FRDg plays a key role in the energy metabolism by participating in the maintenance of the glycosomal NAD(+)/NADH balance . We have also detected a significant pyruvate kinase activity in the cytosol of the T . brucei procyclic cells that was not observed previously . Consequently, we propose a revised model of glucose metabolism in procyclic trypanosomes that may also be valid for all other trypanosomatids except the T . brucei bloodstream form . Interestingly, H . Gest has hypothesized previously (Gest, H . (1980) FEMS Microbiol . Lett . 7, 73-77) that a soluble NADH-dependent fumarate reductase has been present in primitive organisms and evolved into the present day fumarate reductases, which are quinol-dependent . FRDg may have the characteristics of such an ancestral enzyme and is the only NADH-dependent fumarate reductase characterized to date. Clin Lab Med, 2002 Jun, 22(2), 491 - 503 Appropriate use of clinical microbiology tests; Wilson ML; Laboratory medicine lacks the tools necessary to define appropriate test use; nonetheless, existing laboratory test characteristics, although inadequate, provide a common starting point for developing definitions of appropriate test use . As Lundberg {1}, Szczepura {15}, and van Walraven and Naylor {2} have emphasized, developing a process for defining appropriate laboratory use should receive a high priority . There is a particular need to develop methods for standardizing studies {59} . Laboratory medicine does not, however, lack the tools necessary to change test use . Although past interventions were largely ineffective, there is growing evidence that test use can be changed by use of a variety of approaches . By using the existing tools there is much that can be done to change inappropriate test use, such as minimizing redundant testing or the use of tests that have no clinical relevance . The real opportunities will come when there are scientifically and medically sound definitions of appropriate test use that can be used to change test use and improve patient care in a cost-effective way. Cornea, 2002 Aug, 21(6), 555 - 9 The epidemiological features and laboratory results of fungal keratitis: a 10-year review at a referral eye care center in South India; Gopinathan U et al.; PURPOSE: To report the epidemiological features and laboratory results of 1,352 cases of fungal keratitis diagnosed at the L.V . Prasad Eye Institute (LVPEI) in south India . METHODS: The medical and microbiology records of 1,352 culture proven cases (1,354 eyes) of fungal keratitis diagnosed at the LVPEI between January 1991 to December 2000 was retrospectively reviewed for demographic features, risk factors, seasonal variation, and laboratory findings . RESULTS: Males (962) were affected significantly more (p< 0.0001) than females (390) . Of 1,352 patients, 853 (64.4%) were in the younger age group (16-49 years) . Ocular trauma predisposed to infection in 736 (54.4%) of 1,354 eyes . There was a higher incidence of fungal keratitis during the monsoon and winter than summer . A fungal cause was established by smears of corneal scrapings in 1,277 (95.4%) eyes . The potassium hydroxide preparation (KOH), Calcofluor white (CFW), Gram-, and Giemsa-stained smears revealed fungus in 1,219 (91.0%), 1,224 (91.4%), 1,181 (88.2%), and 1,139 (85.1%) eyes, respectively . Fusarium(506, 37.2%) and Aspergillus species (417, 30.7%) predominated the hyaline fungal spectrum (1,133) and Curvularia species (39, 2.8%) were the highest among the dematiaceous isolates (218) . CONCLUSIONS: To the best of our knowledge, this review presents the epidemiological features and laboratory results of the largest series of fungal keratitis ever reported in the literature . Keratomycosis is predominant in young adults with trauma as the major predisposing factor . With fungal keratitis being a major ophthalmologic problem in the tropical regions of the world, data available on the epidemiological features of a large series would greatly help medical practitioners at primary and secondary health care centers in the management of the disease . A simple KOH preparation of corneal scraping alone is highly beneficial in confirming the diagnosis. Crit Care Med, 2002 Jul, 30(7), 1459 - 66 Internal and external validation of the NOSEP prediction score for nosocomial sepsis in neonates; Mahieu LM et al.; OBJECTIVE: To evaluate the performance of a scoring system (NOSEP) to predict nosocomial sepsis in neonates at the hospital where the score was developed (internal validation) and in an independent data set from other centers (external validation) . DESIGN: Multiple center prospective cohort study . SETTING: Six neonatal intensive care units from the Flanders in Belgium . PATIENTS: We analyzed two groups of patients: 62 episodes of presumed nosocomial sepsis in the internal validation cohort and 93 episodes of presumed nosocomial sepsis in a multiple center external validation cohort . INTERVENTIONS: Assessment of the predictive power of the NOSEP score 24 hrs preceding sepsis workup and the patients' basic demographic characteristics and co-morbidity was performed . Diagnosis of nosocomial sepsis and the microbiology results were registered . MAIN RESULTS: The NOSEP score's discriminative capability was very good in the internal validation (area under receiver operating characteristic curve = 0.73 +/- 0.08 {sem}) . The NOSEP score performed satisfactory in the external validation (area under receiver operating characteristic curve = 0.66 +/- 0.06) . The calibration capability in both validation sets as measured by goodness-of-fit tests (internal validation, p =.56; external validation, p =.48) was good . An improvement of the NOSEP score was obtained for the external centers by redefining the cut-off of the items of the NOSEP score (area under receiver operating characteristic curve for NOSEP-NEW-I = 0.71 +/- 0.05) or adding co-morbidity factors (area under receiver operating characteristic curve for NOSEP-NEW-II = 0.82 +/- 0.04), with good calibration performance (goodness-of-fit test, p >.50) . Finally, the fit of the NOSEP score demonstrated no significant variation across subgroups of patients . CONCLUSIONS: The predictive power of the original NOSEP score is very good in neonates at the original neonatal intensive care unit . In other neonatal intensive care units, its discriminatory performance is satisfactory but could be improved after modification of the variables in the model or adding additional variables . To use such a NOSEP score in other neonatal intensive care units, its accuracy has to be validated and adjusted if necessary. Dis Colon Rectum, 2002 Jul, 45(7), 967 - 72 Hyperbaric oxygen ameliorates bacterial translocation in rats with mechanical intestinal obstruction; Akin ML et al.; PURPOSE: The aim of this study was to demonstrate bacterial translocation after experimentally induced intestinal obstruction as well as investigate the preventive effects of hyperbaric oxygen on obstruction-induced bacterial translocation in rats . METHODS: Forty Wistar-albino male and female rats were used . Although no procedure was done in the control group (n = 8), hyperbaric oxygen treatment under 2.5 atm absolute for 90 minutes daily was applied for two days in the hyperbaric oxygen group (n = 8) . In the sham group (n = 8), after laparotomy the small bowel was only handled gently, and tissue sampling was done 48 hours later . In the obstruction group (n = 8) the ileum was ligated by 5-0 polypropylene just 5 cm proximal to the ileocecal valve . In the obstruction and hyperbaric oxygen group (n = 8), after obstruction hyperbaric oxygen treatment was applied . Forty-eight hours after the procedures, tissue samples from small bowel, mesenteric lymph nodes, spleen, and liver were taken and 1 ml of blood from the portal vein was withdrawn . All samples were cultured for microbiologic examination . RESULTS: Hyperbaric oxygen treatment significantly reduced the endogenous bacterial overgrowth in the small intestine of normal rats . Endogenous bacteria in the small intestine were significantly increased in the obstruction group, and the presence of bacterial overgrowth was proven by bacterial presence on mesenteric lymph nodes, spleen, liver, and blood . Hyperbaric oxygen treatment significantly reduced the endogenous bacterial overgrowth in the small intestine and prevented the bacterial translocation almost completely in obstruction-induced rats . CONCLUSIONS: Intestinal obstruction causes bacterial overgrowth and translocation . Hyperbaric oxygen treatment prevents the bacterial translocation effectively. Clin Liver Dis, 2002 May, 6(2), 421 - 54 Common diagnostic problems in pediatric liver pathology; Finegold MJ; The role of the pathologist in dealing with common problems of liver disease in children is likely to change dramatically as the molecular genetic revolution progresses . For example, microchip arrays for genes involved in bile salt synthesis and transport will pinpoint the specific mutations responsible for infantile cholestasis and similar methods will sort out infectious agents of acute and chronic hepatitis . But even as biochemistry, microbiology, and immunology laboratories already provide essential diagnostic information in such settings, informed histopathologic interpretation will continue to guide investigations of etiology and therapeutics and will remain an important medical necessity {95,96,100,102,104}. Infect Immun, 2002 Aug, 70(8), 4523 - 33 A hag mutant of Moraxella catarrhalis strain O35E is deficient in hemagglutination, autoagglutination, and immunoglobulin D-binding activities; Pearson MM et al.; Previous studies correlated the presence of a 200-kDa protein on the surface of Moraxella catarrhalis with the ability of this organism to agglutinate human erythrocytes (M . Fitzgerald, R . Mulcahy, S . Murphy, C . Keane, D . Coakley, and T . Scott, FEMS Immunol . Med . Microbiol . 18:209-216, 1997) . In the present study, the gene encoding the 200-kDa protein (designated Hag) of M . catarrhalis strain O35E was subjected to nucleotide sequence analysis and then was inactivated by insertional mutagenesis . The isogenic hag mutant was unable to agglutinate human erythrocytes and lost its ability to autoagglutinate but was still attached at wild-type levels to several human epithelial cell lines . The hag mutation also eliminated the ability of this mutant strain to bind human immunoglobulin D . The presence of the Hag protein on the M . catarrhalis cell surface, as well as that of the UspA1 and UspA2 proteins (C . Aebi, I . Maciver, J . L . Latimer, L . D . Cope, M . K . Stevens, S . E . Thomas, G . H . McCracken, Jr., and E . J . Hansen, Infect . Immun . 65:4367-4377, 1997), was investigated by transmission electron and cryoimmunoelectron microscopy . Wild-type M . catarrhalis strain O35E possessed a dense layer of surface projections, whereas an isogenic uspA1 uspA2 hag triple mutant version of this strain did not possess any detectable surface projections . Examination of a uspA1 uspA2 double mutant that expressed the Hag protein revealed the presence of a relatively sparse layer of surface projections, similar to those seen on a uspA2 hag mutant that expressed UspA1 . In contrast, a uspA1 hag mutant that expressed UspA2 formed a very dense layer of relatively short surface projections . These results indicate that the surface-exposed Hag protein and UspA1 and UspA2 have the potential to interact both with each other and directly with host defense systems. Eur J Med Res, 2002 Jun 28, 7(6), 292 - 4 Clinical management and evidence based treatment of chronic hepatitis C--12th European Congress of Clinical Microbiology and Infectious Diseases, Milan, Italy, 21-24 April 2002; Tossing G; As in totally 1% of the worldwide population is afflicted by hepatitis C virus with most of the 200 Mio carriers not diagnosed or treated, the clinical management of chronic hepatitis C remains an urgent demand for global health . The 12th European Congress of Clinical Microbiology and Infectious Diseases (12th ECCMID) held in Milan, Italy, from 21 to 24 April 2002, focussed on viral hepatitis in a keynote lecture as well as a session on evidence based treatment of chronic infection and various poster presentations. Br J Biomed Sci, 2002, 59(2), 69 - 75 Effect of staff attitudes on quality in clinical microbiology services; Pitt SJ et al.; Technical quality of the work of clinical pathology laboratories is monitored regularly by both internal and external sources . Among the factors that might affect quality, laboratory staff attitudes are rarely considered . In this study, the psychological concepts of 'job satisfaction' and 'climate' are measured among microbiology biomedical scientists in the United Kingdom . A self-report questionnaire was developed and distributed (between November 1998 and February 1999) to biomedical scientists in 161 microbiology laboratories throughout the UK From 2415 questionnaires distributed, 931 replies were received--a response rate of 39% . A separate set of questions covering customer service and participation in internal and external quality assurance schemes was sent to laboratory managers . Biomedical scientists reported lower job satisfaction than did medical technologists in a previous study in the USA . Perception of climate was influenced by several demographic factors, the most important of which being the size of the laboratory . Optimal number of staff in a department was found to be less than 30 . Aggregation of climate scores from members of the same department showed that a positive laboratory climate was important for good performance in internal and external measures of technical quality . For the best service, laboratory climate must be supported by a staff perception that the department is committed to enhancing quality--a climate for laboratory quality. Eur J Clin Microbiol Infect Dis, 2002 Jun, 21(6), 468 - 70 Epub 2002 Jun 11. Mycobacterium tuberculosis and Mycobacterium fortuitum osteomyelitis of the foot and septic arthritis of the ankle in an immunocompetent patient; Lazzarini L et al.; Mycobacteria, both tuberculous and nontuberculous, are recognized as a cause of chronic bone and joint infection . However, the diagnosis of mycobacterial infection is easily missed because of the absence of systemic involvement . Moreover, specific microbiologic techniques are required to detect mycobacteria in clinical specimens . Infections due to uncommon pathogens such as mycobacteria are more likely to occur in the immunocompromised host . A case of septic arthritis of the ankle and osteomyelitis of the foot due to both tuberculous and nontuberculous mycobacteria in an immunocompetent host is reported here. Ann Bot (Lond), 2002 Jun, 89(6), 783 - 9 Ectomycorrhizal symbiosis can enhance plant nutrition through improved access to discrete organic nutrient patches of high resource quality; Tibbett M et al.; It is known that roots can respond to patches of fertility; however, root proliferation is often too slow to exploit resources fully, and organic nutrient patches may be broken down and leached, immobilized or chemically fixed before they are invaded by the root system . The ability of fungal hyphae to exploit resource patches is far greater than that of roots due to their innate physiological and morphological plasticity, which allows comprehensive exploration and rapid colonization of resource patches in soils . The fungal symbionts of ectomycorrhizal plants excrete significant quantities of enzymes such as chitinases, phosphatases and proteases . These might allow the organic residue to be tapped directly for nutrients such as N and P . Pot experiments conducted with nutrient-stressed ectomycorrhizal and control willow plants showed that when high quality organic nutrient patches were added, they were colonized rapidly by the ectomycorrhizal mycelium . These established willows (0.5 m tall) were colonized by Hebeloma syrjense P . Karst . for 1 year prior to nutrient patch addition . Within days after patch addition, colour changes in the leaves of the mycorrhizal plants (reflecting improved nutrition) were apparent, and after I month the concentration of N and P in the foliage of mycorrhizal plants was significantly greater than that in non-mycorrhizal plants subject to the same nutrient addition . It seems likely that the mycorrhizal plants were able to compete effectively with the wider soil microbiota and tap directly into the high quality organic resource patch via their extra-radical mycelium . We hypothesize that ectomycorrhizal plants may reclaim some of the N and P invested in seed production by direct recycling from failed seeds in the soil . The rapid exploitation of similar discrete, transient, high-quality nutrient patches may have led to underestimations when determining the nutritional benefits of ectomycorrhizal colonization. Mol Cell Biol, 2002 Aug, 22(15), 5593 - 605 Guanidine hydrochloride inhibits the generation of prion "seeds" but not prion protein aggregation in yeast; Ness F et al.; {PSI(+)} strains of the yeast Saccharomyces cerevisiae replicate and transmit the prion form of the Sup35p protein but can be permanently cured of this property when grown in millimolar concentrations of guanidine hydrochloride (GdnHCl) . GdnHCl treatment leads to the inhibition of the replication of the {PSI(+)} seeds necessary for continued {PSI(+)} propagation . Here we demonstrate that the rate of incorporation of newly synthesized Sup35p into the high-molecular-weight aggregates, diagnostic of {PSI(+)} strains, is proportional to the number of seeds in the cell, with seed number declining (and the levels of soluble Sup35p increasing) in the presence of GdnHCl . GdnHCl does not cause breakdown of preexisting Sup35p aggregates in {PSI(+)} cells . Transfer of GdnHCl-treated cells to GdnHCl-free medium reverses GdnHCl inhibition of {PSI(+)} seed replication and allows new prion seeds to be generated exponentially in the absence of ongoing protein synthesis . Following such release the {PSI(+)} seed numbers double every 20 to 22 min . Recent evidence (P . C . Ferreira, F . Ness, S . R . Edwards, B . S . Cox, and M . F . Tuite, Mol . Microbiol . 40:1357-1369, 2001; G . Jung and D . C . Masison, Curr . Microbiol . 43:7-10, 2001), together with data presented here, suggests that curing yeast prions by GdnHCl is a consequence of GdnHCl inhibition of the activity of molecular chaperone Hsp104, which in turn is essential for {PSI(+)} propagation . The kinetics of elimination of {PSI(+)} by coexpression of a dominant, ATPase-negative allele of HSP104 were similar to those observed for GdnHCl-induced elimination . Based on these and other data, we propose a two-cycle model for "prionization" of Sup35p in {PSI(+)} cells: cycle A is the GdnHCl-sensitive (Hsp104-dependent) replication of the prion seeds, while cycle B is a GdnHCl-insensitive (Hsp104-independent) process that converts these seeds to pelletable aggregates. Clin Microbiol Rev, 2002 Jul, 15(3), 465 - 84 Current status of nonculture methods for diagnosis of invasive fungal infections; Yeo SF et al.; The incidence of invasive fungal infections has increased dramatically in recent decades, especially among immunocompromised patients . However, the diagnosis of these infections in a timely fashion is often very difficult . Conventional microbiologic and histopathologic approaches generally are neither sensitive nor specific, and they often do not detect invasive fungal infection until late in the course of disease . Since early diagnosis may guide appropriate treatment and prevent mortality, there has been considerable interest in developing nonculture approaches to diagnosing fungal infections . These approaches include detection of specific host immune responses to fungal antigens, detection of specific macromolecular antigens using immunologic reagents, amplification and detection of specific fungal nucleic acid sequences, and detection and quantitation of specific fungal metabolite products . This work reviews the current status and recent developments as well as problems in the design of nonculture diagnostic methods for invasive fungal infections. Infect Dis Clin North Am, 2002 Jun, 16(2), 477 - 505, xii Infections of intracardiac devices; Karchmer AW et al.; Intracardiac devices are increasingly used to correct hemodynamically dysfunctional valves and electrophysiologic abnormalities . These devices become infected at relatively low rates . Nevertheless, when these low rates are applied to widely used devices, significant numbers of infections result . Additionally, these infections have been associated with high degrees of morbidity and high mortality rates . This article reviews the epidemiology, microbiology, clinical presentation, and medical as well as surgical therapy of intracardiac device infections. Sb Lek, 2001, 102(3), 433 - 41 {Conflicts regarding the Hospital for Epidemics in Olomouc 1925-1938} }; Masova H; The argument between the municipality of Olomouc and the provincial government in Brno was caused by diverse opinions, if an epidemic hospital for the large region of the North-Eastern Moravia should have been built in Olomouc . The Czechoslovak health care laws needed rehabilitation and unification of norms and conditions for building, financing and managing hospitals, as well as modernization of institutions concerning infectious diseases . The Moravian authorities quarrelling on the financial issues of the projected hospital, and later on the technical aspects of it, had to ask the Ministry of Public Health and Physical Training in Prague to unravel the problem, but without an effect . The solution was not easily achievable until the era of antibiotics and buckshee and compulsory inoculation after the World War II came . Microbiologist Professor Jan Kabelik took part in both the battles--for the new hospital in Olomouc in the pre-war period as well as for the immunization of the whole populace after the war. Prehospital Disaster Med, 2001 Oct-Dec, 16(4), 244 - 51 Rehabilitating public health infrastructure in the post-conflict setting: epidemic prevention and preparedness in Kosovo; Brennan RJ et al.; The war in Kosovo in 1999 resulted in the displacement of up to 1.5 million persons from their homes . On the subsequent return of the refugees and internally displaced persons, one of the major challenges facing the local population and the international community, was the rehabilitation of Kosovo's public health infrastructure, which had sustained enormous damage as a result of the fighting . Of particular importance was the need to develop a system of epidemic prevention and preparedness . But no single agency had the resources or capacity to implement such a program . Therefore, a unique six-point model was developed as a collaboration between the Kosovo Institute of Public Health, the World Health Organization, and an international, non-governmental organization . Important components of the program included a major Kosovo-wide baseline health survey, the development of a province-wide public health surveillance system, rehabilitation of microbiology laboratories, and the development of a local capacity for epidemic response . While all program objectives were met, important lessons were learned concerning the planning, design, and implementation of such a project . This program represents a model that potentially could be replicated in other post-conflict or development settings. West Indian Med J, 2002 Mar, 51(1), 25 - 7 Intestinal parasites among young children in the interior of Guyana; Lindo JF et al.; Intestinal parasites contribute greatly to morbidity in developing countries . While there have been several studies of the problem in the Caribbean, including the implementation of control programmes, this has not been done for Guyana . The aim of this study was to determine the prevalence of intestinal parasites among young children in a town located in the interior of Guyana . Eighty-five children under the age of 12 years were studied prospectively for intestinal parasites in Mahdia, Guyana . Stool samples were transported in formalin to the Department of Microbiology, The University of the West Indies, Jamaica, for analysis using the formalin-ether concentration and Ziehl-Neelsen techniques . Data on age and gender of the children were recorded on field data sheets . At least one intestinal parasite was detected in 43.5% (37/85) of the children studied and multiple parasitic infections were recorded in 21.2% (18/85) . The most common intestinal helminth parasite was hookworm (28.2%; 24/85), followed by Ascaris lumbricoides (18.8%; 16/85) and then Trichuris trichuria (14.1%; 12/85) . Among the protozoan infections Giardia lamblia was detected in 10.5% (9/85) of the study population while Entamoeba histolytica appeared rarely . All stool samples were negative for Cryptosporidium and other intestinal Coccidia . There was no predilection for gender with any of the parasites . The pattern of distribution of worms in this area of Guyana was unlike that seen in other studies . Hookworm infection was the most common among the children and a large proportion had multiple infections . The study established the occurrence and prevalence of a number of intestinal parasites in the population of Guyana . This sets the stage for the design and implementation of more detailed epidemiological studies. J Clin Microbiol, 2002 Jul, 40(7), 2370 - 80 Characterization of an unusual Mycobacterium: a possible missing link between Mycobacterium marinum and Mycobacterium ulcerans; Chemlal K et al.; In an attempt to characterize an unusual mycobacterial isolate from a 44-year-old patient living in France, we applied phenotypic characterizations and various previously described molecular methods for the taxonomic classification of mycobacteria . The results of the investigations were compared to those obtained in a previous study with a set of temporally and geographically diverse Mycobacterium ulcerans (n = 29) and Mycobacterium marinum (n = 29) isolates (K . Chemlal, G . Huys, P.-A . Fonteyne, V . Vincent, A . G . Lopez, L . Rigouts, J . Swings, W . M . Meyers, and F . Portaels, J . Clin . Microbiol . 39:3272-3278, 2001) . The isolate, designated ITM 00-1026 (IPP 2000-372), is closely related to M . marinum according to its phenotypic properties, lipid pattern, and partial 16S rRNA sequence . Moreover, fingerprinting by amplified fragment length polymorphism (AFLP) analysis unequivocally classified this strain as a member of the species M . marinum, although it lacked two species-specific AFLP marker bands . However, PCR and restriction fragment length polymorphism analysis based on M . ulcerans-specific insertion sequence IS2404 showed the presence of this element in a low copy number in isolate ITM 00-1026 . In conclusion, the designation of this isolate as a transitional species further supports the recent claim by Stinear et al . (T . Stinear, G . Jenkin, P . D . Johnson, and J . K . Davies, J . Bacteriol . 182:6322-6330, 2000) that M . ulcerans represents a relatively recent phylogenetic derivative of M . marinum resulting from the systematic acquisition of foreign DNA fragments. Eur J Pharm Biopharm, 2002 Jul, 54(1), 83 - 7 Long term stability of rh-Cu/Zn-superoxide dismutase (SOD)-liposomes prepared by the cross-flow injection technique following International Conference on Harmonisation (ICH)-guidelines; Vorauer-Uhl K et al.; The current market position of liposomes as drug carriers is still being discussed with regard to large scale production, product characterisation and the stability of the dispersions . In this study, long term stability of liposomal suspensions with encapsulated rh-Cu/Zn-superoxide dismutase was tested according to the International Conference on Harmonisation (ICH) recommendations . The guidelines of the ICH provide general requirements for stability testing for registration and export in particular . The Institute of Applied Microbiology has examined a process to produce large amounts of pharmaceutical-grade liposomes for the treatment of inflammatory diseases by topical application . For the evaluation of its long-term storage stability, liposomal stability and protein stability were tested under appropriate conditions . Therefore, size alterations of the vesicles, protein release and protein activity were evaluated . During the observation period, neither significant alterations of the liposomes nor any protein degradation could be detected . In the light of these findings our liposomal formulations seem to provide chemical, physical and biological stability according to the definitions of the ICH . Appropriate lipid compounds and environmental factors, in combination with an optimised process and adequate storage conditions, facilitate the production of liposome dispersions suitable as drug carriers on the market. J Bacteriol, 2002 Jul, 184(14), 3879 - 85 Network of hydrogenase maturation in Escherichia coli: role of accessory proteins HypA and HybF; Hube M et al.; We have studied the roles of the auxiliary protein HypA and of its homolog HybF in hydrogenase maturation . A mutation in hypA leads to the nearly complete blockade of maturation solely of hydrogenase 3 whereas a lesion in hybF drastically but not totally reduces maturation and activity of isoenzymes 1 and 2 . The residual level of matured enzymes in the hybF mutant was shown to be due to the function of HypA; HybF, conversely, was responsible for a minimal residual activity of hydrogenase 3 in the mutant hypA strain . Accordingly, a hypA DeltahybF double mutant was completely blocked in the maturation process . However, the inclusion of high nickel concentrations in the medium could restore limited activity of all three hydrogenases . The results of this study and of previous work (M . Blokesch, A . Magalon, and A . Bock, J . Bacteriol . 189:2817-2822, 2001) show that the maturation of the three functional hydrogenases from Escherichia coli is intimately connected via the activity of proteins HypA and HypC and of their homologs HybF and HybG, respectively . The results also support the suggestion of Olson et al . (J . W . Olson, N . S . Mehta, and R . J . Maier, Mol . Microbiol . 39:176-182, 2001) that HypA cooperates with HypB in the insertion of nickel into the precursor of the large hydrogenase subunit . Whereas HypA is predominantly involved in the maturation of hydrogenase 3, HybF takes over its function in the maturation of isoenzymes 1 and 2. Rinsho Byori, 2002 May, 50(5), 455 - 62 {Advances of laboratory testing for the rapid diagnosis of tuberculosis}; Ichiyama S; Rapid diagnosis and treatment are extensively important for preventing transmission of Mycobacterium tuberculosis: In 1994, The Centers for Disease Control and Prevention, CDC, has published recommendations for the rapid diagnosis in the laboratories, in which smear result should be reported within 24 h, detection and identification within 10 to 14 days, and susceptibility within 15 to 30 days . New technologies, therefore, should be implemented in the laboratory . There have been significant advances in the practice of microbiology . Nucleic acid amplification, rapid culture system, antigen detection, and ATP assay system have provided new approaches to the rapid diagnosis of tuberculosis . In the present paper, we review studies which evaluated the reliability, rapidity, and requisite diagnostic capability for each method . Furthermore, we propose an appropriate test algorithm in the clinical laboratories. Cochrane Database Syst Rev . 2002;(2):CD000026. Routine versus selective antifungal administration for control of fungal infections in patients with cancer; Gotzsche PC et al.; BACKGROUND: Systemic fungal infection is considered to be an important cause of morbidity and mortality in cancer patients, particularly those with neutropenia . Antifungal drugs are often given prophylactically, or to patients with persistent fever . OBJECTIVES: The objective of this review was to assess the effect of antifungal drugs in cancer patients with neutropenia . SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register and MEDLINE (November 2001) and the reference lists of articles . We searched the proceedings of the ICAAC (from 1990 to 2001, General Meeting of the ASM (from 1990 to 2001), and the European Congress of Clinical Microbiology and Infectious Diseases (1995 to 2001) and contacted researchers in the field . SELECTION CRITERIA: Randomised trials of amphotericin B, fluconazole, ketoconazole, miconazole, or itraconazole compared with placebo or no treatment in cancer patients with neutropenia . DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial eligibility, methodological quality and abstracted data . MAIN RESULTS: Thirty trials involving 4094 patients were included . Prophylactic or empirical treatment with antifungals as a group had no statistically significant effect on mortality (relative risk 0.95, 95% confidence interval 0.82 to 1.11) . The relative risk was smallest for amphotericin B, 0.73 (0.52 to 1.03) (P=0.08) . In another review, three trials compared intravenous lipid soluble amphotericin B (AmBisome) with smaller doses of standard intravenous amphotericin B; the relative risk was 0.74 (0.52 to 1.07) . Taken together, these results indicate that intravenous amphotericin B might decrease mortality . In contrast, trials with fluconazole, ketoconazole, miconazole and itraconazole failed to find an effect on mortality . The incidence of invasive fungal infection decreased significantly with administration of amphotericin B (relative risk 0.39, 95% CI 0.20 to 0.76), fluconazole (0.39, 0.27 to 0.57) and itraconazole (0.51, 0.27 to 0.96), but not with miconazole or ketoconazole . REVIEWER'S CONCLUSIONS: Intravenous amphotericin B is the only antifungal agent for which there is evidence suggesting that it might reduce mortality . It should therefore be preferred when prophylactic or empirical antifungal therapy in cancer patients with neutropenia is considered indicated. J Theor Biol, 2002 May 7, 216(1), 1 - 4 Bacteriophage T4 development in Escherichia coli is growth rate dependent; Rabinovitch A et al.; Three independent parameters (eclipse and latent periods, and rate of ripening during the rise period) are essential and sufficient to describe bacteriophage development in its bacterial host . A general model to describe the classical "one-step growth" experiment {Rabinovitch et al . (1999a) J . Bacteriol.181, 1687-1683} allowed their calculations from experimental results obtained with T4 in Escherichia coli B/r under different growth conditions {Hadas et al . (1997) Microbiology143, 179-185} . It is found that all three parameters could be described by their dependence solely on the culture doubling time tau before infection . Their functional dependence on tau, derived by a best-fit analysis, was used to calculate burst size values . The latter agree well with the experimental results . The dependence of the derived parameters on growth conditions can be used to predict phage development under other experimental manipulations . Anaesth Intensive Care, 2002 Jun, 30(3), 364 - 6 Vancomycin reaction during spinal anaesthesia; Duffy BL; A 77-year-old female received uneventful spinal anaesthesia for a total knee replacement . Upon the advice of the microbiologists and at the request of the orthopaedic surgeon, a vancomycin infusion was commenced prior to the application of the leg tourniquet . Five minutes later, having received only 40 mg of the antibiotic dose, she became unconscious and suffered severe cardiovascular collapse, from which she was resuscitated with intravenous ephedrine and adrenaline. J Radiol, 2002 Apr, 83(4 Pt 2), 535 - 50 {Screening and imaging guided biopsies of the breast}; Grumbach Y et al.; In cases of subclinical mammographic abnormalities, being able to determine after screening, the indications regarding the type of imaging guidance and the type of biopsy equipment . In presence of microcalcifications, stereotactic mammography, either screen-film or digital, is the modality of choice . As fine needle aspiration cytology is insufficient, it is necessary to obtain tissue specimens with at least 14 Gauge Tru-cut needle, triggered by automatic guns, or coaxial needles of 11 G or 8 G, adaptable on a vacuum aspiration system . In case of mammographic opacities or masses, the same type of sampling can be used under US guidance as long as there is a good sonographic contrast of the lesion . Fine needle puncture, well accepted, keeps all its interest for cystic lesions and for solid ones, because of the value of its multidirectionnal sampling that well trained cytopathologists can make very informative . However, in case of insufficient or discordant results, US guided microbiopsies or macrobiopsies, using newer guns, allow to obtain a histologic diagnosis equivalent to surgical biopsy . If fine needle US guided puncture can be performed in first intention, straight after ultrasonographic examination, percutaneous micro- or macrobiopsies (using US or stereotactic guidance) must be undertaken in second intention after having explained to the patient this ambulatory procedure, the eventual risks, and by insisting on the results that can be expected for a precise diagnosis. Cornea, 2002 Jul, 21(5), 516 - 8 Severe keratomycosis secondary to Scedosporium apiospermum; Diaz-Valle D et al.; PURPOSE: To report an unusual case of severe keratomycosis caused by Scedosporium apiospermum without any known previous ocular injury, that resulted in a corneal perforation, which was treated with an emergency penetrating tectonic keratoplasty and later with phacoemulsification and astigmatic keratotomy to restore good visual function . METHODS: A 45-year-old woman with a history of multiple sclerosis presented with a severe and refractory corneal abscess in her right eye without any known prior injury . Corneal scrapings were obtained and stained for microscopic evaluation . The samples were sent for aerobic and anaerobic bacterial and fungal cultures . RESULTS: Microbiologic examination of the corneal scraping showed Scedosporium apiospermum micelle . The fungal culture was sensitive to miconazole, itraconazole and voriconazole . Partial clinical improvement was achieved with hourly topical natamycin, amphotericin B, and systemic itraconazole application, although in vitro sensitivity tests showed resistance to the topical antifungal agents used . A corneal paracentral perforation occurred despite aggressive treatment . An emergency eccentric penetrating keratoplasty was performed with satisfactory results . Subsequent phacoemulsification and astigmatic keratotomy restored a good visual function . CONCLUSION: A fungal etiology should be suspected in a progressive and refractory corneal abscess . This report highlights the utility of microbiologic investigation to perform an early and accurate diagnosis . Aggressive medical treatment and even therapeutic penetrating keratoplasty to remove infected tissue could result in the maintenance of useful visual function . In view of the poor prognosis of this specific fungus, a closer observation and early keratoplasty might be required to preserve the ocular globe. Ann Ig, 2002 Mar-Apr, 14(2), 163 - 9 {Sexually transmitted diseases: epidemiological and social aspects}; Marin V et al.; STDs represent a major public health problem for two reasons: their serious sequelae and the facts that they facilitate transmission of HIV . This article presents WHO estimates new cases of some of curable STDs, and italian data from national reporting system (published from ISTAT and ISS) . The number of new reported cases decreases in Italy, but reported cases are not all cases . People with STDs tend not to seek treatment or to self-medicate, this behaviour is common in youths . In many cases STDs are asymptomatic in both sexes, particularly in women . Women are also much more vulnerable biologically, culturally, socioeconomically . There is also a lack of notification by physicians . Important social determinants of STDs diffusion are migration and travels . Prevention and control of STDs need collaboration between medical disciplines: gynaecology, urology, dermo-venerology, microbiology, epidemiology, public health . Contributions of nurses, laboratory technician and social workers are also required . The role of public health specialists in the prevention is strictly related to health education . Health education will promote responsible sexual behaviour and early recourse to health services by people with STDs and their sexual partners. Am J Respir Crit Care Med, 2002 Jun 15, 165(12), 1618 - 23 Reproducibility of blind protected bronchoalveolar lavage in mechanically ventilated children; Gauvin F et al.; Blind protected bronchoalveolar lavage (BAL) could be an interesting tool in the diagnosis of ventilator-associated pneumonia in intubated children, but its reproducibility has never been evaluated . This study evaluates the reproducibility, feasibility, and safety of blind protected BAL in mechanically ventilated children . Two blind protected BAL were done, at a 2-hour interval, in 30 patients . The reproducibility of microbiologic and cytologic results was studied . A total of 60 BALs was analyzed . Bacterial growth was present in 26 of 60 BAL (43%) . Reproducibility for the presence of bacteria on quantitative cultures was excellent (concordance, 93%; kappa {kappa}, 0.86) . Concordance for the type of bacteria isolated was 86% and for the number of bacteria was 79% . Reproducibility for the presence of neutrophils containing bacteria was perfect (concordance, 100%; kappa, 1) although only a few BALs had a positive result (8/60) . Blind protected BAL was feasible in all patients and all samples were considered adequate for analysis . Complications were mostly benign and transitory except in two cases: one pneumothorax and one significant increase in intracranial pressure . Overall, blind protected BAL is a reproducible test in mechanically ventilated children, is easily feasible, and is usually well tolerated. Trends Mol Med, 2002 Jun, 8(6), 280 - 7 Molecular diagnostics in infectious diseases and public health microbiology: cottage industry to postgenomics; Gilbert GL; Molecular methods have been used increasingly over the past ten years to improve the sensitivity and speed of diagnosis in infectious diseases . Although their routine use is still limited to the detection of pathogens that are difficult to culture in vitro,'real-time' methods, commercial kits, quantification and automation will increase potential applications . Molecular methods are now widely used for epidemiological fingerprinting of isolates of public health importance . Sequence-based identification and strain typing, together with the development of tools that can probe for thousands of markers, will allow detailed strain fingerprinting to assist in disease management and control. Compend Contin Educ Dent, 2002 May, 23(5), 416 - 8, 421-2 Nutrition and oral infectious diseases: connections and future research; Mangan DF; A workshop on nutrition and oral infectious diseases was held November 5-7, 2000 at the Forsyth Institute, Boston, Massachusetts . The goal of the symposium was to review the current state-of-the-science with regard to nutrition and oral infectious diseases (particularly periodontitis) and then connect the disciplines of nutrition, microbiology, immunology, and clinical periodontology through a comprehensive list of recommendations for future research . The workshop featured five scientific sessions (oral infections and general health, research models, nutrition and infection, nutrition and oral infection, and nutrition, oral health, and life cycle) . An agenda with the complete list of speakers together with the recommendations can be found at A brief summary of the workshop is presented in this article. J Clin Periodontol, 2002 May, 29(5), 400 - 10 Periodontal diseases in the child and adolescent; Oh TJ et al.; BACKGROUND: Periodontal diseases are among the most frequent diseases affecting children and adolescents . These include gingivitis, localized or generalized aggressive periodontitis (a.k.a., early onset periodontitis which includes generalized or localized prepubertal periodontitis and juvenile periodontitis) and periodontal diseases associated with systemic disorders . The best approach to managing periodontal diseases is prevention, followed by early detection and treatment . METHODS: This paper reviews the current literature concerning the most common periodontal diseases affecting children: chronic gingivitis (or dental plaque-induced gingival diseases) and early onset periodontitis (or aggressive periodontitis), including prepubertal and juvenile periodontitis . In addition, systemic diseases that affect the periodontium and oral lesions commonly found in young children are addressed . The prevalence, diagnostic characteristics, microbiology, host-related factors, and therapeutic management of each of these disease entities are thoroughly discussed. Med Mycol, 2002 Apr, 40(2), 115 - 21 Occurrence of Malassezia spp . in the external ear canals of dogs and cats with and without otitis externa; Crespo MJ et al.; We studied the lipophilic microbiota of the external ear canals of 332 animals (264 dogs and 68 cats), with and without otitis externa, over an 11-year period from 1988 to 1999 . Malassezia pachydermatis was isolated from 62.2% and 50% of dogs with and without otitis externa, respectively, and from 41.2% and 17.6% of cats with and without otitis externa, respectively . In the group of animals studied for lipid-dependent species, these yeasts were isolated from 4.5% of dogs with otitis externa and from 23.1% and 8.9% of cats with and without otitis externa, respectively . M . sympodialis and M . furfur were isolated from cats and M . furfur and M . obtusa from dogs . Our findings show that lipid-dependent Malassezia species may contribute to the etiology of otitis externa in dogs and cats. Transfus Clin Biol, 2002 Apr, 9(2), 144 - 51 {Biovigilance, a vigilance exercised on the utilization of products obtained from the human body}; Quaranta JF et al.; Organ transplantations and tissue/cells grafts are efficacious in many diseases . Nevertheless, beside the risk due to the technology which permits to carry out transplantations and grafts (surgery, tissue and cells collection, preservation, storage, cell expansion technics, immunosuppressive regimen,...), the microbiology risk must be controlled throughout the process leading to the transplantation or the graft . The structures, the organizations, the procedures, the information network and the controls assure the control of the risk . It is the main objective of human product vigilance . Future regulations will define the objectives of this sanitary vigilance more precisely. An R Acad Nac Med (Madr), 2001, 118(4), 891 - 912; discussion 912-9 {Quality control in parasitology}; Vasallo Matilla F; Between 1990 and 1996 we coordinated a Quality Control (QC) Program in Parasitology directed to Public Health Institutions in Spain . Periodically, parasited specimens, mainly feces or blood, were sent to Microbiology Laboratories for identification . Each QC was accompanied by a short clinic and epidemiological information in order to help in the diagnostic approach . After the answers to the QC were received a bulletin that included the solution to the QC, comments on the several answers received and a chapter with parasitological themes related with the QC, was sent to each participating Laboratory . The bulletin was accompanied by a card that included a photograph and a short description of the organism object of the QC. Ophthalmology, 2002 Jun, 109(6), 1123 - 9 Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy; Mruthyunjaya P et al.; PURPOSE: To determine the yield of diagnostic pars plana vitrectomy in eyes with suspected posterior segment inflammation or malignancy when clinical examination and systemic laboratory testing did not yield a specific diagnosis . DESIGN: Non-comparative interventional case series PARTICIPANTS: Eighty-seven consecutive patients (90 eyes) who underwent diagnostic pars plana vitrectomy from 1989 through 1999 . INTERVENTIONS: Vitreous samples were analyzed in a directed manner based on the preoperative clinical examination and systemic laboratory testing . MAIN OUTCOME MEASURES: Diagnosis from each test performed on the vitreous samples . RESULTS: Diagnostic vitrectomy was performed alone in 6 eyes (7%) and as part of a therapeutic procedure in the remaining 84 eyes . The diagnostic tests performed most frequently included cytopathology (83%), microbiologic culture and sensitivity (43%), polymerase chain reaction (PCR) (36%), and intraocular antibody levels for T . canis (14%) . Of these, intraocular antibody testing and PCR had the highest positive yield, 46% and 39%, respectively . Overall, directed vitreous analysis identified a specific cause in 35 eyes (39%) . Of the 65 cases in which an underlying infection was suspected preoperatively, the procedure yielded a specific diagnosis in 27 (42%) . When intraocular malignancy was considered preoperatively (71 eyes), a diagnosis of intraocular lymphoma was obtained in seven (10%) . This difference between these diagnostic yields was significant (P = 0.02, Fisher's exact test) . CONCLUSIONS: Diagnostic vitrectomy with directed vitreous fluid analysis yields a specific cause and guides subsequent therapy in a high percentage of cases . This procedure is a valuable adjunct in cases that cannot be diagnosed by less invasive methods. J Asthma, 2002 May, 39(3), 191 - 201 Studies of sick building syndrome . IV . Mycotoxicosis; Assoulin-Daya Y et al.; There has been increasing public attention to the potential health risks of mold exposure, particularly in wet buildings . A variety of molds has been isolated from both damaged homes and businesses, including agents that secrete toxigenic materials . One area that is attracting particular notice is the relative toxigenic potential of mycotoxins . Although exposure to molds can produce significant mucosal irritation, there are very few data to suggest long-term ill effects . More importantly, there is no evidence in humans that mold exposure leads to nonmucosal pathology . In fact, many of the data on toxigenic molds are derived from animal toxicity studies, and these are based primarily, on ingestion . Although every attempt should be made to improve the quality of indoor air, including avoidance of molds, the human illnesses attributed to fungal exposure are, with the exception of invasive infections and mold allergy, relatively rare . In this review we discuss selected aspects of the microbiology of mycotoxin-producing molds and their potential role in human immunopathology with respect to wet building environments. J Chemother, 1991 Jan, 3 Suppl 1, 245 - 6 The therapy of blastocystosis; Garavelli PL; During the period 1985-1989 I observed 35 patients of both sexes and of all ages, who were suffering from signs and symptoms of clear blastocystosis, such as prevailingly watery diarrhea, abdominal pain, nausea, tenesmus, eosinophilia and fever . 5 of them showed concomitant diseases, like Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC), diabetes mellitus and nephrocarcinoma . By means of the administration of metronidazole 2 g/die for 5 days on average, I obtained the disappearance of Blastocystis hominis from the stools and the absence of the clinical symptomatology in 11 patients, while in another 7 the treatment did not prevent, in the following months, the arising of one or more clinical and microbiologic relapses. Adv Space Res, 2000, 26(12), 1901 - 9 Integrating public perspectives in sample return planning; Race MS et al.; Planning for extraterrestrial sample returns--whether from Mars or other solar system bodies--must be done in a way that integrates planetary protection concerns with the usual mission technical and scientific considerations . Understanding and addressing legitimate societal concerns about the possible risks of sample return will be a critical part of the public decision making process ahead . This paper presents the results of two studies, one with lay audiences, the other with expert microbiologists designed to gather information on attitudes and concerns about sample return risks and planetary protection . Focus group interviews with lay subjects, using generic information about Mars sample return and a preliminary environmental impact assessment, were designed to obtain an indication of how the factual content is perceived and understood by the public . A research survey of microbiologists gathered information on experts' views and attitudes about sample return, risk management approaches and space exploration risks . These findings, combined with earlier research results on risk perception, will be useful in identifying levels of concern and potential conflicts in understanding between experts and the public about sample return risks . The information will be helpful in guiding development of the environmental impact statement and also has applicability to proposals for sample return from other solar system bodies where scientific uncertainty about extraterrestrial life may persist at the time of mission planning . c2001 COSPAR Published by Elsevier Science Ltd . All rights reserved. J Clin Microbiol, 2002 Jun, 40(6), 2278 - 81 Exposure of laboratory workers to Francisella tularensis despite a bioterrorism procedure; Shapiro DS et al.; A rapidly fatal case of pulmonary tularemia in a 43-year-old man who was transferred to a tertiary care facility is presented . The microbiology laboratory and autopsy services were not notified of the clinical suspicion of tularemia by the service caring for the patient . Despite having a laboratory bioterrorism procedure in place and adhering to established laboratory protocol, 12 microbiology laboratory employees were exposed to Francisella tularensis and the identification of the organism was delayed due to lack of notification of the laboratory of the clinical suspicion of tularemia . A total of 11 microbiology empl