Microbial

J Trop Pediatr, 2004 Jun, 50(3), 153 - 7
Childhood brucellosis--a microbiological, epidemiological and clinical study; Mantur BG et al.; A total of 5726 blood specimens (from children aged 14 years and younger) were studied for the serological evidence of brucellosis . Ninety-three (1.6 per cent) showed diagnostic agglutinin titres with a geometric mean titre of 403 (SD +/- 547) . Forty-three (59.7 per cent) blood specimens yielded the growth of Brucella melitensis . Thirty-nine patients (41.93 per cent) were shepherds, who constituted the major occupational group affected in the present series . More than 60 per cent of the patients had a history of both consumption of fresh goat's milk and close animal contact . The habit of consuming fresh goat's milk to obtain relief from chronic ailments was noted in nine patients . Seventy-three (78.49 per cent) were males and 20 (21.51 per cent) were females, with a male to female ratio of 3:1 . The disease occurred mainly in the school age group (mean age 10.3 years) . All the patients had an acute history of less than 2 months . Forty-nine (52.68 per cent) patients presented with persistent fever, 19 (20.43 per cent) with joint pain, and the rest with a combination of fever and joint pain with and without low backache, fever being the commonest complaint . One case presented with involuntary movements of limbs alone and the other with burning feet only . Pityriasis alba was the consistent physical finding, with fever in the majority of the patients . The major joint found to be involved was the knee (52.77 per cent) . The synovial fluid obtained from the knee joint of five patients demonstrated Brucella agglutinins and also three grew B . melitensis . Eight patients presented with complications that included skin lesions (3), carditis (2), neurobrucellosis such as chorea (1), peripheral neuritis (1), and meningitis (1) . Brucella melitensis biotype 1 was successfully isolated from the papular eruption of one out of three cases who presented with skin lesions . To our knowledge this is the fourth confirmed isolation of B . melitensis from skin lesions with brucellosis, reported in the literature . The cerebrospinal fluid obtained from the meningitis patient was positive for B . agglutinins . To our knowledge chorea of brucellar origin appears to be the first case reported in the literature . In 15 cases (16.13 per cent) brucellosis was suspected clinically whereas 78 (83.87 per cent) cases, only serological evidence of brucellosis confirmed the diagnosis . None of the cases relapsed . In our experience an initial combination therapy with a three-drug regimen followed by a two-drug regimen for a minimum of 6 weeks has been found to be effective in the prevention of a relapse.

Rev Panam Salud Publica, 2004 May, 15(5), 307 - 12
Infectious disease risks from dead bodies following natural disasters; Morgan O; OBJECTIVE: To review existing literature to assess the risks of infection from dead bodies after a natural disaster occurs, including who is most at risk, what precautions should be taken, and how to safely dispose of the bodies . METHODS: Disease transmission requires the presence of an infectious agent, exposure to that agent, and a susceptible host . These elements were considered to characterize the infectious disease risk from dead bodies . Using the PubMed on-line databases of the National Library of Medicine of the United States of America, searching was done for relevant literature on the infection risks for public safety workers and funeral workers as well as for guidelines for the management of the dead and prevention of infection . A small but significant literature was also reviewed regarding the disposal of the dead and the contamination of groundwater by cemeteries . RESULTS: Victims of natural disasters usually die from trauma and are unlikely to have acute or "epidemic-causing" infections . This indicates that the risk that dead bodies pose for the public is extremely small . However, persons who are involved in close contact with the dead-such as military personnel, rescue workers, volunteers, and others-may be exposed to chronic infectious hazards, including hepatitis B virus, hepatitis C virus, HIV, enteric pathogens, and Mycobacterium tuberculosis . Suitable precautions for these persons include training, use of body bags and disposable gloves, good hygiene practice, and vaccination for hepatitis B and tuberculosis . Disposal of bodies should respect local custom and practice where possible . When there are large numbers of victims, burial is likely to be the most appropriate method of disposal . There is little evidence of microbiological contamination of groundwater from burial . CONCLUSIONS: Concern that dead bodies are infectious can be considered a "natural" reaction by persons wanting to protect themselves from disease . However, clear information about the risks is needed so that responsible local authorities ensure that the bodies of disaster victims are handled appropriately and with due respect . This paper provides a source of information for those who are in the unfortunate position of managing those bodies.

Pol J Vet Sci, 2004, 7(2), 149 - 51
Effect of the dry feed contaminated with moulds on the prevalence of alimentary tract disorders in cats; Popiel J et al.; The experiment was performed on the group of 8 kittens aged from 7 to 9 weeks . The aim of the studies was to establish the reasons for alimentary tract disorders and lower gains of body weight occurring in these animals . The cats were fed with commercial dry diet . Morphological and biochemical blood tests were carried out in the animals at the onset of the experiment . The tests were re-performed at the end of the studies, together with bacteriological and mycological cultures of faeces, hygienic litter and internal organs of dead cats . The feed samples underwent microbiological and toxicological analyses . An increase in leukocyte count was recorded on morphological blood inspection while the biochemical tests revealed the rise of AIAT and amylase activities and urea concentration . The moulds of Aspergillus flavus and A . fumigatus were isolated on quality feed assessment . Toxicological analyses of feed performed by means of thin layer chromatography revealed zearalenone within the samples . Technology of dry diet production may not be efficient enough to protect the feed against contamination and subsequent growth of moulds . Consumption of Aspergillus-contaminated feed may result in growth inhibition and alimentary tract disorders, including the fatal ones.

Probl Tuberk Bolezn Legk, 2004, (5), 3 - 6
{Microbiological aspects of identification of patients with drug-resistant tuberculosis}; Kheifets LB; This review discusses controversial issues, such as definitions of drug resistance, the conditions laboratory drug-susceptibility testing in all new patients is justified, and the requirements for the optimum turnaround time of laboratory reports . It also analyses the advantages and disadvantages of different methods for drug susceptibility testing, including those based on cultivation in the solid and liquid media, as well as molecular phenotypic and genotypic methods . While molecular genotypic methods represent the most promising direction for future development, their application in the clinical laboratory setting today is limited to the initial preliminary screening for rifampicin resistance as a marker for possible MDR and as an indicator for the need for subsequent testing with other drugs . The direct susceptibility test in the solid media (at least that with rifampicin and isoniazid) represents the most affordable method that allows timely adjustment in the treatment regimen if drug resistance is detected . The total turnaround time can be as short as three weeks for 85-90% of smear-positive specimens when the agar plate technique is used for a direct test . Introduction of a liquid media system is the next step to achieving the expected results in all patients.

Am J Respir Crit Care Med, 2004 Sep 15, 170(6), 621 - 5 Epub 2004 Jun 30.
Invasive aspergillosis in critically ill patients without malignancy; Meersseman W et al.; Using criteria designed for invasive aspergillosis (IA) in patients with cancer, we aimed to determine the impact of IA in patients without malignancy in a medical intensive care unit (ICU) . In this retrospective study, 127 patients out of 1,850 admissions (6.9%) hospitalized between 2000 and 2003 had microbiological or histopathologic evidence of Aspergillus during their ICU stay . There were 89 cases (70%) without hematologic malignancy . These patients were classified as proven IA (n = 30), probable IA (n = 37), possible IA (n = 2), or colonization (n = 20) . In these patients, mean SAPS II score was 52 with a predicted mortality of 48% . The observed mortality was 80% (n = 71) . Mortality of the proven and the probable IA was 97 and 87%, respectively . Postmortem examination was done in 46 out of 71 patients, and 27 autopsies (59%) showed hyphael invasion with Aspergillus . Aspergillus infections occurred in five critically ill patients with proven IA who did not have any predisposing factors according to the currently available definitions . Three of these patients had Child C liver cirrhosis . IA is an emerging and devastating infectious disease in patients in the ICU without malignancy . In those patients, host criteria for probable fungal infections should probably be adapted.

Srp Arh Celok Lek, 2004 Jan-Feb, 132(1-2), 44 - 9
{Importance of microbiologic examination of vaginal secretions in the reproductive period}; Arsic-Arsenijevic V et al.; Vaginal infections, during reproductive period are frequent and although not life treating, they can affect their normal functions . They can also affect women's fertility as well as the course of pregnancy . The outcome of pregnancy can be endangered due to the possibility of infection of newborn while passing trough birth canal of the infected mother . As statistically shown, bacterial vaginosis is considerably more often found with the patients having precancerous changes on cervix, or diagnosed cancer of cervix, comparing with women with healthy cervix . It can also cause the appearance of postoperative pelvic cellulitis after hysterectomy . On the other side, the presence of S . agalactiae in vaginal secretion may cause very serious and lethal infections of the newborn such as meningitis, pneumonia and sepsis . As for protozoa T . vaginalis it has been shown that it could cause reduced fertility ability and that during pregnancy it could damage fetal membranes and bring to its premature rupture and premature birth . There is also increased risk of cervix cancer . During reproductive period of women especially if risk factors are existing such as hormone therapy, diabetes mellitus type 1 and applications of wide range antibiotics, vaginal fungal infections caused by Candida can frequently appear . These infection apart from the discomfort like itch and affluent secretion they can also mean diagnostic and therapeutical problem . Regular microbiological test of women are highly recommended during reproductive period as standard for bacterial vaginosis, fungal and trichomonas infections . If those results appear negative, further microbiological tests are necessary . Such tests which are more elaborate, more timely and more expensive are referring to tests on chlamydia, microplasma and some viruses that can also be the cause of vaginal secretion disbalance in women during reproductive period.

Srp Arh Celok Lek, 2004 Jan-Feb, 132(1-2), 14 - 7
{Pathologic conditions associated with drug-induced rhinitis}; Milosevic D et al.; Rhinitis medicamentosa ("nose-drop-nose") is a term used for pathological condition of the nasal mucous membrane that results from long-term abuse with intranasal vasoconstrictors . The aim of this work was to examine what lead the patients with nosedropnose rhinitis to the initial usage of intranasal vasoactive drugs . In this prospective study, 92 patients with rhinitis medicamentosa were included . The evaluation of all study subjects comprised the history, ORL, microbiological and radiological examination, skin prick tests with a battery of routine respiratory and nutritive allergens and nasal cytology . The results of this study showed that the pathological conditions for initial use of intranasal vasoactive drugs were: acute upper respiratory infections in 29.3%, vasomotor rhinitis in 21.7%, allergic rhinitis in 16.3%, deviated nasal septum in 13.0%, nasal polyposis in 12%, rhinitis induced by mechanical trauma in 4.4%, and hormonal rhinitis in 3.3% of patients with rhinitis medicamentosa . In conclusion, the most common pathological conditions for developing rhinitis medicamentosa were chronic inflammatory and structural diseases manifested by permanent nasal obstruction as well as acute upper respiratory infections are.

Folia Microbiol (Praha), 2004, 49(2), 117 - 22
Microbiological aspects of determination of trichloroacetic acid in soil; Matucha M et al.; Soils have been shown to possess a strong microbial trichloroacetic acid (TCA)-degrading activity . High TCA-degradation rate was also observed during soil extraction with water . For correct measurements of TCA levels in soil all TCA-degrading activities have to be inhibited immediately after sampling before analysis . We used rapid freezing of soil samples (optimally in liquid nitrogen) with subsequent storage and slow thawing before analysis as an efficient technique for suppressing the degradation . Frozen soil samples stored overnight at -20 degrees C and then thawed slowly exhibited very low residual TCA-degrading activity for several hours . Omitting the above procedure could lead to the confusing differences between the TCA levels previously reported in the literature.

Yonsei Med J, 2004 Jun 30, 45(3), 453 - 61
Clinical manifestations and diagnosis of extrapulmonary tuberculosis; Yoon HJ et al.; Since the diagnosis of extrapulmonary tuberculosis (EPT) is largely depended on the physician's suspicion in respect of the disease, we believed that it would be worthwhile to scrutinize the clinical characteristics of EPT . Thus, here we present retrospectively evaluated clinical manifestations of patients who were diagnosed as EPT cases in a tertiary referral care hospital . Medical records of 312 patients, diagnosed as having EPT at Yongdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively . In total 312 patients, 149 (47.8%) males and 163 (52.2%) females aged from 13 years to 87 years, were included into this study . The most common site of the involvement was pleura (35.6%) . The patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%) . The most common symptom was pain at the infected site (48.1%) . Leukocytosis, anemia, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found in 12.8%, 50.3%, 79.3% and 63.1% of the patients, respectively . Twenty-four percent of the patients had underlying medical illnesses such as, diabetes mellitus or liver cirrhosis, or were over 60 years old . In 67.3% of patients, tuberculosis was suspected at the initial visit . However, tuberculosis was microbiologically proven in only 23.7% of the patients . The time interval from the symptom onset to the diagnosis varied, with the mean duration of the period 96 days . Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs . EPT has a wide spectrum of clinical manifestations, so it is difficult to diagnose it . Based on our studies, only 11.2% of the patients were confirmed as EPT . So it is important that the physician who first examines the patient should have a high degree of suspicion based on the chest radiography, localized or systemic symptoms and several laboratory parameters reviewed in this study.

Klin Mikrobiol Infekc Lek, 2004 Jun, 10(3), 109 - 113
{Saprophytic microorganisms in food - impact on human health}; Hruby S; The paper discusses issues that research, in both the world and the Czech Republic, has for the most part been resolved . Yet in practice very little attention has been paid to them in this country . And yet non-specific microbial toxicoses produced by the enzymatic activity of various microorganisms in certain substrates, more specifically in food, may cause not only fairly insignificant, but also highly significant threats to human health, in both individuals and large groups of the population . They are thus important not only from a microbiological, but also epidemiological point of view . In this respect the greatest danger represent microbes with a lipolytic or proteolytic activity . Aldehydes, ketones, peroxides, epoxides and various other polymeres may be generated in fats, more particularly in butter, and in foodstuffs containing small or large proportion of fats, while various forms of biogenic amines may be found in foodstuffs containing proteins . The result are non-specific toxicoses - epidemiological examinations clearly point to an alimentary toxicosis, yet bacterial toxins cannot be demonstrated and possible products of enzymatic microbial activity are disregarded . In all such instances we should not only explore the suspicious foodstuffs for the presence of pathogenic or conditionally pathogenic microbes and bacterial toxins, but we should also carry out qualitative and quantitative investigations to detect lipolytic or proteolytic microorganisms (depending on the content of the foodstuff) and their metabolic activity.

Int J Antimicrob Agents, 2004 Jul, 24(1), 67 - 71
Mode of action of novel polyamines increasing the permeability of bacterial outer membrane; Yasuda K et al.; We have clarified how the polyamines naphthylacetylspermine and methoctramine (N,N'-bis{6-{{(2-methoxyphenyl)methyl}amino}hexyl}-1,8-octanediamine), originally developed as a synthetic analogue of joro spider toxin and a muscarinic receptor antagonist, respectively, can increase the permeability of the outer membrane of Escherichia coli . These polyamines were recently found to be outer membrane permeabilisers, based on investigations of the structure-activity relationship using ion-selective electrodes . In a standard microbiological assay examining membrane-permeabilising ability, these polyamines enhanced the action of hydrophobic antibiotics such as novobiocin and erythromycin, which ineffectively traverse the outer membrane of E . coli, to inhibit the growth of E . coli . This result substantiated the outer membrane-permeabilising ability of these polyamines demonstrated by using ion-selective electrodes . We observed the release of lipopolysaccharide from the outer membrane in the concentration range causing permeabilisation, showing that the action of the polyamines is attributable to disruption of the outer membrane structure.

J Food Prot, 2004 Jun, 67(6), 1303 - 8
Sampling methods for microbiological analysis of red meat and poultry carcasses; Capita R et al.; Microbiological analysis of carcasses at slaughterhouses is required in the European Union for evaluating the hygienic performance of carcass production processes as required for effective hazard analysis critical control point implementation . The European Union microbial performance standards refer exclusively to the excision method, even though swabbing using the wet/dry technique is also permitted when correlation between both destructive and nondestructive methods can be established . For practical and economic reasons, the swab technique is the most extensively used carcass surface-sampling method . The main characteristics, advantages, and limitations of the common excision and swabbing methods are described here.

J Food Prot, 2004 Jun, 67(6), 1299 - 302
An outbreak of ammonia poisoning from chicken tenders served in a school lunch; Dworkin MS et al.; Although foodborne outbreaks of illness are relatively common, they are rarely caused by chemical agents . An outbreak of gastrointestinal illness occurred among students at two schools shortly after lunch was served . A cohort study, an environmental investigation, and microbiological and toxicological laboratory testing of food samples were performed . A case was defined as a student or teacher who ate food prepared in the kitchen at school A on 25 November 2002 (and served at schools A and B) and who later developed headache or symptoms of gastrointestinal tract irritation, with onset within 180 min of eating lunch . Among 312 persons interviewed, 157 persons became ill (attack rate = 49%; attack rate 41% for school A, 11% for school B) . Onset of illness occurred within 60 min for 81% of cases; 91% of students reported that their chicken tenders smelled unusual . Eating chicken tenders that smelled unusual was associated with being a case (relative risk 9.2, 95% confidence interval 1.4 to 62.6, P < 0.05) . Ammonia was detected in uncooked chicken tenders at levels as high as 2,468 ppm . The chicken had been contaminated during a warehouse leak of ammonia refrigerant . This outbreak of ammonia poisoning is only the second reported in food, and the first in a solid food . Heated chicken tenders contaminated with ammonia can cause acute illness within a short period of time.

Vet Clin Pathol, 1987, 16(4), 102 - 6
A comparison of commercial kit methods for assay of vitamin b(12) in ruminant blood; Schultz WJ; Five commercially available radioisotope dilution (RID) kits for assay of Vitamin B(12) were obtained for evaluation with ovine and bovine serum; also, for comparison with our laboratory's (Lab 1) RID method and the methods of two independent laboratories, one using RID and the other a microbiological method . One commercial kit was found to be suitable for both species because negligible non-specific binding occurred when extraction was performed at 100 degrees C (212 degrees F) . Of the other four kits, two were found to be suitable for ovine and bovine serum provided non-specific binding of the latter was measured . This was also the case with the Lab 1 method . Two of the commercial kits were found to be unsuitable for assay of Vitamin B(12)in ruminant blood.

Bioelectrochemistry, 2004 Aug, 64(1), 79 - 84
Oxidative dissolution of chalcopyrite by Acidithiobacillus ferrooxidans analyzed by electrochemical impedance spectroscopy and atomic force microscopy; Bevilaqua D et al.; The microbiological leaching of chalcopyrite (CuFeS(2)) is of great interest because of its potential application to many CuFeS(2)-rich ore materials . However, the efficiency of the microbiological process is very limited because this mineral is one of the most refractory to bacterial attack . Knowledge of bacterial role during chalcopyrite oxidation is very important in order to improve the efficiency of bioleaching operation . The oxidative dissolution of a massive chalcopyrite electrode by Acidithiobacillus ferrooxidans was evaluated by electrochemical impedance spectroscopy (EIS) and atomic force microscopy (AFM) . A massive chalcopyrite electrode was utilized in a Tait-type electrochemical cell in acid medium for different immersion times in the presence or absence of bacterium . The differences observed in the impedance diagrams were correlated with the adhesion process of bacteria on the mineral surface.

Int Dent J, 2004 Jun, 54(3), 149 - 53
Relationship between volatile sulphide compounds concentration and oral bacteria species detection in the elderly; Senpuku H et al.; AIM: To evaluate the relationship between oral bacteria species detection and volatile sulphide compounds (VSC) concentration in the elderly . DESIGN: Cross-sectional microbiological and clinical VSC examination of elderly . PARTICIPANTS: Sixty-seven elderly people aged 75, who were functionally independent and dentate . METHODS: VSC (H2S and CH3SH) concentrations in the mouth air of subjects were measured using portable gas chromatography . Oral bacteria samples were taken from dental plaque and identification of bacteria species was accomplished using standard methods . RESULTS: Fewer than 20% of subjects showed more than 10 ng/10 ml of H2S (severe odour level) . The detection rate of P . melaninogenica was significantly higher in elderly people with more than 10 ng/10 ml (p=0.043) levels . Fusobacterium had a tendency to be found in those with more than 10 ng/10 ml, but a significant relation was not found . CONCLUSIONS: The results suggest that Fusobacterium and P . melaninogenica may be involved in the production of H2S in the oral cavity of elderly people.

Indoor Air, 2004 Aug, 14(4), 243 - 57
Dampness in buildings as a risk factor for health effects, EUROEXPO: a multidisciplinary review of the literature (1998-2000) on dampness and mite exposure in buildings and health effects; Bornehag CG et al.; The scientific literature on health effects from dampness in buildings, including mite exposure over the period 1998-2000 has been reviewed by an European group (EUROEXPO) of eight scientists in experience from medicine, epidemiology, toxicology and engineering . Forty studies deemed relevant have been the foundation for the conclusions . Dampness in buildings is a risk factor for health effects among atopics and non-atopics both in domestic and in public environments . However, the literature is not conclusive in respect of causative agents, e.g . mites, microbiological agents and organic chemicals from degraded building materials . There is a strong need for more multidisciplinary studies including expertise from all relevant areas . A general conclusion from the work was that there is a strong need for multidisciplinary reviews in scientific journals of articles dealing with associations between indoor environmental factors and health effects . PRACTICAL IMPLICATIONS: There is good evidence for a true association between dampness in buildings and health . As the causative factors behind this association are not known, the main focus in practical investigations should be on finding out and remediate the reasons for the humidity problem.

J Chemother, 2004 Apr, 16(2), 156 - 9
Ciprofloxacin as treatment for conjunctivitis; Chisari G et al.; The authors studied the bactericidal action and therapeutic effectiveness of ciprofloxacin in treating external ocular infections (bacterial conjunctivitis and bacterial blepharoconjunctivitis) . 108 ambulatory patients with clinical signs of conjunctivitis and blepharoconjunctivitis were enrolled in the study . All subjects underwent a conjunctival swab before starting therapy and at 10 days, to identify the causative bacteria and their susceptibility to ciprofloxacin, following routine microbiological methods . The reported therapeutic success rate (95%) and bacteriological analysis confirmed the effectiveness of ciprofloxacin in subjects with bacterial conjunctivitis and bacterial blepharoconjunctivitis . In vitro tests conducted 10 days after treatment confirmed the in vivo therapeutic effectiveness, even for those infections characterized by a difficult etiological identification which interferes with specific antibiotic therapy.

Surg Endosc, 2004 May, 18(5), 736 - 40 Epub 2004 Apr 06.
Endoscopic ultrasound-guided transrectal aspiration of pelvic fluid collections; Sailer M et al.; BACKGROUND: The aim of this study was to evaluate the feasibility, safety, and diagnostic accuracy of endorectal ultrasound-guided aspiration and drainage of pelvic fluid collections . METHODS: All patients who underwent endorectal ultrasound-guided aspiration and/or drainage of pelvic fluid collections were included in this prospective study . Patients were prepared using bowel lavage and a single-dose antibiotic combination . The procedure was carried out in the lithotomy position usually without sedation . All aspirates were examined microbiologically and/or cytologically . RESULTS: Twenty-nine patients {18 females and 11 males; median age, 67 years (range, 18-79)} underwent 33 endosonographic controlled aspirations . No procedure-related complications were encountered . In 22 cases (76%) the lesions were encountered following a surgical procedure . Fluid amounts varied between 5 and 750 ml . Fluids were sterile in 14 cases (42%) . These fluid collections were hematomas, seromas, peritoneal cysts, and a mucocele . Microorganisms were found in the remaining 19 aspirations (58%), i.e., abscesses (n = 16) and infected hematomas (n = 3) . A transrectal (n = 14) or transvaginal (n = 2) drainage catheter was placed in 16 patients under endosonographic guidance . Only two patients required a subsequent laparotomy for definitive treatment of their septic focus, whereas all other patients could be treated successfully by this conservative approach . CONCLUSION: Endoscopic ultrasound-guided transrectal aspiration and drainage of pelvic fluid collections is a safe method with a favorable outcome because it avoids unnecessary operations in selected patients.

Ig Sanita Pubbl, 2004 Jan-Apr, 60(1-2), 39 - 50
{A ten-year risk evaluation study in Catania hospital operating rooms}; Ferrante M et al.; Previous studies conducted in Catania hospitals have revealed a high burden of contamination in the air of operating rooms and have recommended measures to improve air quality . In this study we verified the effectiveness of the undertaken measures . Furthermore we evaluated the possibility of using microclimatic parameters as "markers" of operating room contamination . Changes made to ventilation systems and to waste gas scavenging systems in the monitored operating rooms were remarkably effective . Microclimatic conditions and degree of chemical contamination improved over time; nevertheless airflow velocity values were found to be insufficient and nitrous oxide values, in some cases, remained slightly elevated . A significant correlation was observed only between some nitrous oxide values and relative humidity . Monitoring important marker levels is useful for correctly evaluating operating room thermal, chemical and microbiological air quality.

Chemosphere, 2004 Aug, 56(5), 449 - 56
Improvement of soil characteristics and growth of Dorycnium pentaphyllum by amendment with agrowastes and inoculation with AM fungi and/or the yeast Yarowia lipolytica; Medina A et al.; The effectiveness of two microbiologically treated agrowastes {dry olive cake (DOC) and/or sugar beet (SB)} on plant growth, soil enzymatic activities and other soil characteristics was determined in a natural soil from a desertified area . Dorycnium pentaphyllum, a legume plant adapted to stress situations, was the test plant to evaluate the effect of inoculation of native arbuscular mycorrhizal (AM) fungi and/or Yarowia lipolytica (a dry soil adapted yeast) on amended and non-amended soils . Plant growth and nutrition, symbiotic developments and soil enzymatic activities were limited in non-amended soil where microbial inoculations did not improve plant development . The lack of nodules formation and AM colonization can explain the limited plant growth in this natural soil . The effectiveness and performance of inocula applied was only evident in amended soils . AM colonization and spores number in natural soil were increased by amendments and the inoculation with Y . lipolytica promoted this value . The effect of the inoculations on plant N-acquisition was only important in AM-inoculated plants growing in SB medium . Enzymatic activities as urease and protease activities were particularly increased in DOC amended soil meanwhile dehydrogenase activity was greatest in treatments inoculated with Y . lipolytica in SB added soil . The biological activities in rhizosphere of agrowaste amended soil, used as indices of changes in soil properties and fertility, were affected not only by the nature of amendments but also by the inoculant applied . All these results show that the lignocellulosic agrowastes treated with a selected microorganism and its further interaction with beneficial microbial groups (native AM fungi and/or Y . lipolytica) is a useful tool to modify soil physico-chemical, biological and fertility properties that enhance the plant performance probably by making nutrients more available to plants.

Risk Anal, 2004 Jun, 24(3), 521 - 36
The potential of next-generation microbiological diagnostics to improve bioterrorism detection speed; Casman EA; Emerging, rapid, multivalent, microbial diagnostic technologies can produce results in hours, as contrasted to the standard methods that require at least the better part of a week . Used in bioterrorism surveillance in medical settings, the new biodetectors could significantly reduce the time between a covert attack and its detection . By how much is determined by the intensity of sampling . If used to screen all patients reporting flu-like symptoms to their doctors, this basic level of "front-line" sampling would reduce life-threatening medical floundering and missteps and give responders 3-5 days of warning that they otherwise would not have had . Being miniaturized and amenable to mass production, these devices could reduce the cost of screening to a fraction of current costs and so it is tempting to imagine their use in more intensive bioterrorism screening programs aimed at the apparently healthy population, programs that could detect a covert attack even before the victims felt ill . This article examines the tradeoffs between surveillance effort and probability of detection for such programs . Dual-use deployment, where the biodetector provides some medically useful information in addition to bioterrorism surveillance, is discussed.

Bioresour Technol, 2004 Oct, 95(1), 107 - 12
Characteristics of rice straw and sewage sludge as composting materials in Valencia (Spain); Iranzo M et al.; This work supports the idea that composting can be useful for minimizing the rice straw and sewage sludge environmental impact . Several physical, chemical and microbiological properties of these raw materials were analyzed . The characteristics of the rice straw were complementary to those of the sewage sludge for the application of composting . The C/N ratios suitable for a rapid increased in microbial activity were the lowest (17-24) . A temperature of 62 degrees C during 48 h removed pathogenic microorganisms from rice straw and sewage sludge mixture . The results obtained in the present work suggested that these materials could be use in the composting process.

Med Clin (Barc), 2004 May 29, 122(20), 786 - 8
{Rickettsia africae infection . Three cases confirmed by PCR}; Oteo JA et al.; BACKGROUND AND OBJECTIVE: African tick bite fever or Rickettsia africae infection has been recognized as an emerging health problem in the last few years . The aim of this study was to describe 3 cases of Spanish tourists who suffered from R . africae infection after visiting South Africa . PATIENTS AND METHOD: Three patients with a suspected rickettsial disease according to epidemiological and clinical manifestations (fever, eschar and exanthema) were studied . Antibodies against Rickettsia conorii were determined by IFI assays . Semi-nested PCR reactions (rOmpA) and subsequent sequence analysis of the amplified products were also carried out . RESULTS: Epidemiological and clinical aspects of this rickettsiosis are described . For diagnosis of this rickettsial disease, conventional serological assays (IFI) were less useful than semi-nested rOmpA PCR reactions, which showed a sensitivity of 100% in our samples . CONCLUSIONS: Three cases of R . africae infection are reported . PCR and subsequent sequencing of the amplicons are useful for the microbiological confirmation of this type of infection . We must think about African tick-bite fever as a possible diagnosis in patients with a febrile rash after returning from endemic areas.

Orv Hetil, 2004 May 23, 145(21), 1123 - 6
{Bronchoscopic specimen collection, role of the protected specimen brush in lower respiratory tract infections}; Dulka E et al.; INTRODUCTION: The ineffectiveness of microbiological methods in the lower respiratory tract infections are caused by anachronistic sampling methods . Authors checked the protected specimen brush effectiveness and those of the influencing factors . MATERIALS AND METHODS: 103 patients were involved in the study . The causative agents were identified in 44 cases . These results were compared to last year's classic sampling techniques and they experienced 20.4% improvement of the sensitivity . Further increasing in effectiveness can be reached if we perform bacteriological sampling after the first unsuccessful antibiotic treatment was performed . Out of 103 examined patients only 69 underwent antibiotic treatment . In the case of 13 patients after the course of one type antibiotic treatment 10 positive bacteriological cultures were positive . In the case of 31 patients 2 types of antibiotics were administered sequentially and examined afterwards and the authors found 15 positive bacteriological cultures . In the case of 25 patients the administered sequentially 3 times of antibiotics and examined afterwards, 6 cultures were positive . CONCLUSION: The examinations prove that the protected specimen brush, used in time, raises the sensitivity of microbiological processes.

J Invest Surg, 2004 May-Jun, 17(3), 127 - 34
Effects of prostaglandin E1 and E2 analogues on mucosal injury-induced, and on bacterial translocation promoted by, experimental intestinal obstruction; Gurleyik G et al.; The aim of this experimental study was to investigate effects of prostaglandin E1 and E2 analogues on mucosal structure and bacterial translocation during small bowel obstruction . The study was carried out on 40 Wistar rats equally divided into four groups; group 1 = control, group 2 = intestinal obstruction by ligation of distal ileum, and groups 3 and 4 = obstruction and administration of PGE2 and PGE1, respectively . Intestinal bacterial content and translocation to mesenteric lymph nodes and to the blood were determined by microbiological analysis . Mucosal structural changes were assessed by histopathological examination and expressed as a structural damage score and as the thickness of the mucosal layer . Bacterial overgrowth was determined in all obstruction groups . Mucosal thickness was 39.7 microm in group 1 and 26.8 microm in group 2 (p <.001) . The thickness was significantly preserved by administration of PGE1 and PGE2 (p <.001) . Mean structural damage score was 0.4 in group 1 and 6.7 in group 2 (p <.001) . The damage scores were significantly lower in groups treated with PGE1 and PGE2 than obstruction alone group (p <.001) . Better scores were obtained in rats treated with PGE1 than rats treated with PGE2 (p =.0026) . Translocation to the lymph nodes did not occur in group 1, but was 70% in group 2 (p =.0015); significantly lower rates of translocation to lymph nodes were observed in rats treated with PGE1 (p =.035), but not with PGE2 . We conclude that mucosal structure is partly maintained by administration of PGE1 and PGE2 during intestinal obstruction; PGE1 is more effective than PGE2 for ameliorating mucosal injury . PGE1 prevents bacterial translocation by preserving structural integrity of the mucosa . PGE2 partially prevents mucosal damage but not bacterial translocation.

Clin Chem Lab Med, 2004 May, 42(5), 533 - 9
An International Standard for whole blood folate: evaluation of a lyophilised haemolysate in an international collaborative study; Thorpe SJ et al.; Folate measurements, particularly for whole blood, show wide inter-laboratory and inter-methodology variability . This variability appears to be due in part to the lack of internationally accepted reference materials . A whole blood haemolysate, lyophilised in ampoules and designated 95/528, was therefore evaluated by 15 laboratories in five countries for its suitability as an International Standard (IS) for whole blood folate . The preparation was assayed using a variety of microbiological and protein-binding methodologies against local standards and calibrators . A consensus folate content was assigned to 95/528 . The inclusion of three whole blood samples in the study with widely differing folate levels demonstrated a considerable reduction in inter-laboratory variability when the folate content of the samples was determined relative to the proposed IS 95/528 rather than to laboratories' local standards and calibrators . Accelerated degradation studies indicated that the folate content of 95/528 is stable when stored at -20 degrees C . On the basis of the results presented here, the World Health Organization Expert Committee on Biological Standardization established 95/528 as an IS for whole blood folate.

Can J Neurol Sci, 2004 May, 31(2), 282 - 5
Intramedullary blastomycosis in a child: case report; Parr AM et al.; OBJECTIVE: To report a case of spinal intramedullary blastomycosis causing myelopathy . CLINICAL PRESENTATION: An otherwise healthy 13-year-old patient was diagnosed with respiratory North American blastomycosis . She subsequently received a five-month course of itraconazole with presumed resolution of the infection . The patient presented again at 14 years of age with a lumbar myelopathy . Magnetic resonance imaging revealed an intramedullary lesion of 1 cm diameter at the level of T12-L1 . INTERVENTION: A T12-L1 laminectomy was performed with a gross total resection of the lesion . Pathological examination and microbiological culture of the specimen was consistent with blastomycosis . Postoperatively, the patient was placed on a five week course of amphotericin B . The patient showed substantial improvement in neurological function . CONCLUSION: Blastomycosis can present as an isolated intramedullary lesion causing compromised function . It should be considered in the differential diagnosis of a patient with a myelopathy and previously recognized blastomycosis . The prognosis is good with surgical resection.

J Eur Acad Dermatol Venereol, 2004 Jul, 18(4), 467 - 70
HIV seronegative eosinophilic pustular folliculitis successfully treated with doxicycline; Brazzelli V et al.; Eosinophilic pustular folliculitis (EPF) is an unusual disease, first described in adult East Asians in 1970 by Ofuji . It is characterized by follicular papules and pustules tending to coalesce and form plaques involving the trunk, face and extremities . In recent years, it has been often associated with human immunodeficiency virus (HIV) infection or with immunosuppressed and/or oncohaematological patients . EPF has been described in immunocompetent adult caucasian patients only occasionally . The diagnosis requires clinical and microbiological features such as sterile folliculitis and histopathological findings characterized by folliculitis and perifolliculitis with eosinophilic infiltrate . We describe an HIV seronegative caucasian male with EPF, allergic to non-steroidal anti-inflammatory drugs and indomethacin, treated with oral doxicycline . The treatment led to the complete remission of the lesions within 2 months.

Otolaryngol Head Neck Surg, 2004 Jun, 130(6), 759 - 66
Tuberculous otitis media: a significant diagnostic challenge; Vaamonde P et al.; OBJECTIVE: This study was undertaken to revise the diagnostic characteristics of tuberculous otitis media (TOM), a disorder that is often diagnosed late, leading to delay in specific treatment . STUDY DESIGN AND SETTING: Retrospective study of a longitudinal series of 10 TOM patients over a 7-year period at an institutional referral center . RESULTS: Most patients showed intractable otorrhea, moderately severe hearing loss, and necrotic eardrums with granulation tissue and single perforations . Multiple perforations, facial palsy, and cervical adenopathies were rare (<10% of patients) . CT generally showed soft tissue involvement of the middle ear without bone erosion . The most effective laboratory test microbiological culture of exudate (diagnostic efficacy 71%) . Specific antibiotic treatment was effective in all cases . CONCLUSION: The diagnosis of TOM remains a significant challenge for otorhinolaryngologists . SIGNIFICANCE: If there are strong clinical grounds for suspicion, standard laboratory tests for tuberculosis should be repeated even if initially negative.

Rev Panam Salud Publica, 2004 Apr, 15(4), 249 - 55
{Efficacy and safety of a vaccine against human leptospirosis in Cuba}; Martinez R et al.; OBJECTIVES: To evaluate the efficacy of vax-SPIRAL, a Cuban vaccine against leptospirosis, and to provide additional information concerning the safety of this vaccine (which was developed by Cuba's Finlay Institute) . METHODS: This phase III efficacy trial of vax-SPIRAL was controlled, randomized, and double blind . The control vaccine used for the trial was Heberbiovac-HB (Heber Biotec, Cuba), a recombinant hepatitis B vaccine . The randomization unit for allocating persons to the study group or the control group were 523 family physician offices in the selected municipalities . The study covered the entire population of males and females from 20 to 64 years old who voluntarily agreed to participate, from the municipalities of Ranchuelo, Quemado, Santo Domingo, Encrucijada, Corralillo, Cifuentes, and Camajuani, which are in the province of Villa Clara, in the central region of Cuba . The vaccinations were given in the physicians' offices between February and July 1998, with an interval of 6 weeks between the two doses . The follow-up period was 12 months . A case was considered positive if a person who had received the two doses of the vaccine became ill with leptospirosis more than 21 days after receiving the second dose, with the diagnosis confirmed through serological and microbiological methods . We calculated the efficacy of the vaccine and the relative risk of becoming ill with leptospirosis after the vaccination . For the safety study, two persons were chosen at random from among the individuals vaccinated at the office of each physician participating in the study . Follow-up of local and systemic adverse reactions was carried out by the family physicians during the seven days after the application of each dose . The level of statistical significance was set at 0.05 . RESULTS: A total of 101 832 persons were vaccinated, with 50 354 of them (49.4%) receiving the leptospirosis vaccine and 51 478 of them (50.6%) receiving the control vaccine . The efficacy of the vax-SPIRAL vaccine was 78.1% (95% confidence interval (CI): 59.2% to 88.3%), and the relative risk of becoming ill with leptospirosis after receiving the leptospirosis vaccine was 0.22 (95% CI: 0.12 to 0.41) . General discomfort was the most frequent systemic adverse reaction, and mild spontaneous pain at the injection site was the most frequent local effect . The local and systemic adverse reactions were both more frequent in the study group than in the control group (P = 0.003) . There were no serious adverse events . CONCLUSION: The vax-SPIRAL vaccine proved to be safe and efficacious for leptospirosis control . The vaccine is recommended for use in preventing this disease among groups at risk of contracting it.

Crit Care Med, 2004 May, 32(5), 1166 - 9
Diagnostic and prognostic value of procalcitonin in patients with septic shock; Clec'h C et al.; OBJECTIVE: To determine whether procalcitonin is a reliable diagnostic and prognostic marker in septic shock compared with nonseptic shock . DESIGN: Prospective controlled trial . SETTING: Intensive care unit of the Avicenne Teaching Hospital, Bobigny, France . PATIENTS: All patients admitted to our intensive care unit over a 12-month period with clinical evidence of shock . INTERVENTIONS: None . MEASUREMENTS AND MAIN RESULTS: Echocardiography or pulmonary artery flotation catheter measurements were used to assess hemodynamics, and multiple specimens were obtained for microbiological studies . Standard criteria were used to diagnose septic shock . Serum concentrations of procalcitonin, C-reactive protein, and lactate were determined on the day of shock onset (day 1) and on days 3, 7, and 10 . Seventy-five patients were included, 62 in the septic shock group and 13 in the cardiogenic shock group . Serum procalcitonin on day 1 was significantly higher in patients with than without septic shock (median, 14 {0.3-767} ng/mL vs . 1 {0.5-36} ng/mL, p < .01) . A cutoff value of 1 ng/mL had 95% sensitivity and 54% specificity for separating patients with and without sepsis . C-reactive protein failed to discriminate between these two groups . Among patients with sepsis, procalcitonin concentrations were significantly higher in those who died than in the survivors, at all four measurement time points (median, 16 {0.15-767} ng/mL vs . 6 {0.2-123} ng/mL, p = .045 on day 1; 6.5 {0.3-135} ng/mL vs . 1.05 {0.11-53} ng/mL, p = .02 on day 10) . A cutoff value of 6 ng/mL on day 1 separated patients who died from those who survived with 87.5% sensitivity and 45% specificity . C-reactive protein was not helpful for predicting mortality . Serum lactate was a nonspecific prognostic marker . CONCLUSIONS: These data indicate that procalcitonin may be a valuable early diagnostic and prognostic marker in patients with septic shock.

Zhonghua Nan Ke Xue, 2004 May, 10(5), 376 - 7, 381
{Diagnosis and treatment of tuberculosis in the male genital system}; Shen Z et al.; OBJECTIVE: To probe into and improve the diagnosis and treatment of tuberculosis (TB) in the male genital system . METHODS: Fifteen patients with the male genital system TB established by microbiological and pathological examinations were retrospectively reviewed . RESULTS: The male genital system TB was diagnosed by history, physical examination, semen analysis, TB culture and biopsy . Treatment consisted of antituberculous chemotherapy for all the patients before and/or after operation, including 5 cases of epididymectomy and 6 cases of orchi-epididymectomy . CONCLUSION: The male genital system TB tends to be atypical and semen polymerase chain reaction of TB (TB-PCR) may provide a new specific means for diagnosis in case of clinical suspicion . Surgical approaches should be cautiously adopted, especially for young patients.

Trop Med Int Health, 2004 Jun, 9(6), 718 - 23
Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases; Lodhi S et al.; Distinguishing amoebic from pyogenic liver abscesses is crucial because their treatments and prognoses differ . We retrospectively reviewed the medical records of 577 adults with liver abscess in order to identify clinical, laboratory, and radiographic factors useful in differentiating these microbial aetiologies . Presumptive diagnoses of amoebic (n = 471; 82%) vs . pyogenic (n = 106; 18%) abscess were based upon amoebic serology, microbiological culture results, and response to therapy . Patients with amoebic abscess were more likely to be young males with a tender, solitary, right lobe abscess (P = 0.012) . Univariate analysis found patients with pyogenic abscess more likely to be over 50 years old, with a history of diabetes and jaundice, with pulmonary findings, multiple abscesses, amoebic serology titres <1:256 IU, and lower levels of serum albumin (P < 0.04) . Multivariate logistic regression analysis confirmed that age >50 years, pulmonary findings on examination, multiple abscesses, and amebic serology titres <1:256 IU were predictive of pyogenic infection . Several clinical and laboratory parameters can aid in the differentiation of amebic and pyogenic liver abscess . In our setting, amebic abscess is more prevalent and, in most circumstances, can be identified and managed without percutaneous aspiration.

Berl Munch Tierarztl Wochenschr, 2004 May-Jun, 117(5-6), 193 - 200
{Sampling plans and microbiological criteria as risk management options in recently developed food safety concerns}; Dahms S; In connection with the World Trade Organization SPS-Agreement new concepts for ensuring food safety have been discussed for some years now . Main topics have been quantitative risk analyses investigating relationships between microbial concentrations in foods and disease probabilities as well as the concept of food safety objectives developed by ICMSF . So far food safety demands have been defined as microbiological criteria . However, usually it is not transparent, whether sampling plans incorporated in such criteria are based on specific prescriptions with regard to decision reliability and tolerable food qualities . In addition, it is still to be discussed, which parts microbiological criteria can play in connection with new concepts of food risk management, for instance as an option to test whether food safety objectives are met or not . The performance of microbiological sampling plans, as visualized by operation characteristic curves, assumptions made in this context, and relationships between food safety objectives and microbiological criteria as well as implications for food safety issues are investigated in this paper.

J Appl Microbiol, 2004, 97(1), 191 - 204
Identification of waterborne bacteria by the analysis of 16S-23S rRNA intergenic spacer region; Perez-Luz S et al.; AIM: In this study, we evaluated, the use of universal primers, specific for the 16S-23S rRNA intergenic region, to detect and identify nine species that are of high interest for the microbiological control of water . METHODS AND RESULTS: The analysis of the fragments was carried out using a High Resolution acrylamide/bisacrylamide gels in a fluorescent automated DNA sequencer . The results showed specific profiles for each of the nine species but this technique failed to detect simultaneously micro-organisms in samples containing a mixed population . CONCLUSION: Nevertheless, the electrophoretic profiles obtained provided a very useful tool for the rapid and specific identification of water isolates . SIGNIFICANCE AND IMPACT OF THE STUDY: A possible new methodology for a rapid identification of pathogens in water.

J Appl Microbiol, 2004, 97(1), 78 - 86
Genotypic analysis of Escherichia coli recovered from product and equipment at a beef-packing plant; Aslam M et al.; AIMS: To identify sources of Escherichia coli on beef by characterizing strains of the organism on animals, equipment and product at beef-packing plant . METHODS AND RESULTS: Generic E . coli were recovered from hides, carcasses, beef trimmings, conveyers and ground beef during the summer of 2001 (750 isolates) and winter of 2002 (500 isolates) . The isolates were characterized by Random Amplification of Polymorphic DNA (RAPD) . The numbers of E . coli recovered from dressed carcasses were less than the numbers recovered from hides . The numbers recovered from chilled carcasses were too few for meaningful analysis of the strains present on them but the numbers recovered from trimmings and ground beef were larger . The RAPD patterns showed that the majority of isolates from hides, carcasses, beef trimmings, conveyers and ground beef were of similar RAPD types, but a few unique RAPD types were recovered from only one of those sources . The E . coli populations present on the hides of incoming animals and in the beef-processing environment were highly diverse . Randomly selected E . coli isolates from each of the five sources were further characterized by pulsed-field gel electrophoresis (PFGE) . Most genotypes of E . coli defined by PFGE corresponded to the E . coli types defined by RAPD . CONCLUSIONS: The hides of the incoming animals appeared to be only one of the sources of the E . coli on trimmings and in ground beef, as additional sources were apparently present in equipment used for carcass breaking . SIGNIFICANCE AND IMPACT OF THE STUDY: This study indicates that hazardous microbiological contamination of meat may occur after the dressing of carcasses at commercial beef-packing plants, which suggests that attention should be given to the control of the contamination of meat during carcass breaking as well as during the dressing of carcasses.

Rev Prat, 2003 Sep 30, 53(14), 1545 - 53
{What must one know about microbiology for prescribing antibiotics?}; Andreu M et al.; Antibiotics are usually prescribed for serious bacterial infections . The knowledge of ecological niche of each bacterium, mechanisms of action and resistance to antibiotics and the correct interpretation of a direct exam of microbiological samples are essential to improve the use of antibiotics . Finally, the update of the epidemiology of resistance is necessary to interpret the susceptibility tests and for the optimal use of empirical antibiotherapy.

Eye, 2004 Jun, 18(6), 580 - 7
Surveillance of endophthalmitis following cataract surgery in the UK; Kamalarajah S et al.; AIMS: To estimate the incidence of acute-onset presumed infectious endophthalmitis (PIE) following cataract surgery in the UK and provide epidemiological data on the presentation, management, microbiology, and outcome of cases of endophthalmitis . METHODS: Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period October 1999 to September 2000 inclusive . Questionnaire data were obtained from ophthalmologists throughout the UK at baseline and 6 months after diagnosis . Under-reporting was estimated by independently contacting units with infection databases . RESULTS: Data were available on 213 patients at baseline and 201 patients at follow-up . The minimum estimated incidence of PIE was 0.086 per 100 cataract extractions and the corrected incidence was 0.14 per 100 cataract extractions . For the management of PIE, 96% of patients received intravitreal, 30% subconjunctival, 65% oral, and 17% intravenous antibiotics . In all, 17% of patients received intravitreal steroid . From the intraocular samples taken for microbiological analysis, 56% were culture positive . At follow-up, 48% of patients achieved visual acuity of 6/12 or better and 66% achieved better than 6/60 . 13% of patients were unable to perceive light or had evisceration of the globe . CONCLUSIONS: The incidence of PIE after cataract surgery in the UK is comparable to that of other studies . Approximately 50% of patients achieved a visual acuity close to the driving standard.

Ann Readapt Med Phys, 2004 Jun, 47(5), 233 - 8
{Management of infectious risk associated with therapeutic pools}; Chapuis C et al.; There is no specific legislation concerning pools and others medical hydrotherapy equipments relating hygiene and security rules . For this reason, the hydrotherapy pools use the public swimming pools legislation . METHOD: This article is based on literature review (database Medline and Embase--manual research) . RESULTS: This article offers a review of pool associated infections along with the description of the measures designed to minimise the possible transmission of infection during hydrotherapy activities such as: Technical measures: pool and premises conception, water treatments, feed tanks, air quality . Hygiene rules for patients and hospital staff and pathologies which are contra-indications to hydrotherapy activities . Microbiological and physico-chemical monitoring . DISCUSSION: The infectious risk remains low with therapeutic pools . However, the development of specific legislation and surveillance should be enhanced . CONCLUSION: All these measures are part of the quality assurance program that must be implemented to control the safety of these installations.

Eur J Haematol, 2004 Jul, 73(1), 67 - 70
Fulminant bronchiolitis obliterans organizing pneumonia following 2 d of treatment with hydroxyurea, interferon-alpha and oral cytarabine ocfosfate for chronic myelogenous leukemia; Kalambokis G et al.; A 65-yr-old man developed increasing dyspnea and fulminant respiratory failure 48 h after introduction of hydroxyurea, oral cytarabine ocfosfate (YNK01) and interferon-alpha for treatment of Philadelphia chromosome-positive chronic myelogenous leukemia . The chest radiograph showed bilateral patchy infiltrates while computed tomography revealed multiple bullas, ground glass opacities, and patchy consolidations with possible cavitation . Bronchoscopic examination was normal and microbiological tests performed on all biologic fluids were negative . The patient did not respond to multiple antibiotic treatment and corticosteroid administration and died of progressive respiratory failure 5 d after chemotherapy introduction . The postmortem lung examination was consistent with the diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP).

S Afr J Surg, 2004 Feb, 42(1), 17 - 9
Disseminated nocardiosis masquerading as abdominal tuberculosis; John MA et al.; A 32-year-old patient was admitted with a community-acquired pneumonia . She had clinical evidence of AIDS and chest X-ray features consistent with pulmonary tuberculosis . While in the ward she developed an acute abdomen necessitating laparotomy, at which a diagnosis of abdominal tuberculosis was made . Sputum and intraoperative pus specimens grew a multiresistant Nocardia brasiliensis . Microbiological investigations for tuberculosis were negative . The patient died after a short ICU admission from multiple organ dysfunction syndrome.

An Med Interna, 2004 May, 21(5), 215 - 22
{Tuberculosis in Santiago de Compostela from 1999 to 2002 . An epidemiological study}; Salgueiro Rodriguez M et al.; OBJECTIVE: The purpose of this study was to determine the epidemiological characteristics of tuberculosis (TB) in the Public Health System District of Santiago de Compostela (population : 386125) from 1999 to 2002 . METHODS: Inclusion criteria were: 1) . microbiological and/or pathological diagnosis of TB in any specimen, and 2) . patient younger 35 years old with recent medical history of TB . Mantoux test positive, and pleural effusion with linfocitosis and adenosine deaminase >47 IU/ml . RESULTS: 946 patients were included (568 men and 378 women), with ages ranging from 2 months to 96 years . The incidence of TB was 60.9/100000 in 1999, 67.6/100000 in 2000, 61.9/100000 in 2001 and 54.6/100000 in 2002 . The incidence rate of tuberculous meningitis was 1.03/100000 in 1999 and 2000, 0.77/100000 in 2001 and 0.51/100000 in 2002 . The percentage of cases associated with HIV was 3.4% in 1999, 1.9% in 2000, 2.4% in 2001 and 2002 . We found an increase in the rate of males over 55 years of age; with incidence per 100000 inhabitants of 122.4 in 1999, 142.8 in 2000, 115 in 2001 and 119 in 2002, whereas in females the incidence was 40.6 in 1999, 60.9 in 2000, 54.1 in 2001 and 39.1 in 2002 . CONCLUSIONS: In last four years the incidence of tuberculosis has decreased but remains high in males over 55 years old.

Org Lett, 2004 Jun 10, 6(12), 1955 - 8
Microbiological transformations 57 . Facile and efficient resin-based in situ SFPR preparative-scale synthesis of an enantiopure "unexpected" lactone regioisomer via a Baeyer-Villiger oxidation process; Hilker I et al.; {reaction: see text} The microbiological Baeyer-Villiger oxidation of (-)-bicyclo{3.2.0}hept-2-en-6-one allowed exclusive formation of the "unexpected" lactone regioisomer in 84% yield, high chemical purity, and enantiopure form . Substrate (25 g) was transformed in a 1 L bubble column reactor, following a in situ substrate feeding/product removal methodology, which afforded high volumetric productivity (1.2 g L(-)(1) h(-)(1)) . This illustrates the high "sustainable chemistry" advantages of such a process, simply conducted in aqueous medium, at room temperature and using atmospheric oxygen.

Ann Acad Med Singapore, 2004 May, 33(3), 285 - 8
Routine microbiological screening in septic patients in a cardiac surgical intensive care unit; Meininger D et al.; INTRODUCTION: Patients in a surgical intensive care unit (ICU) have a high incidence of nosocomial infections which often lead to septic shock and death . Since specific antibiotic treatment is often difficult, it is recommended that routine nose/throat swabs be obtained in order to have a better idea of the causative agent when a systemic inflammatory response occurs in a given patient . MATERIALS AND METHODS: In 1435 patients in a cardiac surgical ICU, routine nose/throat swabs were taken thrice a week and tested for microorganisms and systemic inflammation . Blood cultures were also obtained . Antibiotic treatment was given to cover the microbes from the nose/throat swabs . Alternatively, an empirical antibiotic therapy was given to patients whose swabs had tested negative . RESULTS: Of the 86 patients with systemic inflammation, 29 had blood cultures positive for microbes . Of these, 18 received a specific antibiotic therapy based on their positive nose/throat cultures prior to the return of the blood cultures from the laboratory . However, only 11 patients tested positive for the same microbes on routine swabs and blood cultures . While positive routine swabs are quite specific to sepsis when there is a systemic inflammatory response, routine swabs are not a suitable screening tool due to their low sensitivity . CONCLUSION: Routine nose/throat swabs led to earlier specific antibiotic treatment in only 22 % of patients with clinical signs of systemic inflammation . In 36 % of cases, the organisms detected in the routine swabs and blood cultures were not identical . Hence, we believe that routine swabs are of limited value in instituting earlier, specific antibiotic therapy in septic patients.

Ann Otol Rhinol Laryngol Suppl, 2004 May, 193, 24 - 6
Biopsy and specimen collection in chronic rhinosinusitis; Orlandi RR; Biopsy, aspiration, swab, and irrigation of the nose and sinuses are methods used in specimen collection and culture when chronic rhinosinusitis is suspected . Biopsy may be indicated to identify the presence of fungal elements in the mucus or tissues, suspected neoplasm, or inflamed bone . Aspiration directly from the maxillary sinus is considered to be the gold standard for culture, but it is painful . Direct endoscopic-guided culture of the middle meatus appears to be a viable substitute, with swab and suction methods having similar rates of microbiological contamination . Topical delivery methods for irrigating sinus cavities may utilize spray bottles, nebulizers, or a bulb syringe; these have various degrees of efficacy in dispersing materials to the sinuses . Use of the bulb syringe appears to offer broad distribution with limited risk of sample contamination . Specimens must be handled carefully to avoid loss of fungal elements . Advantages and indications of various methods are reviewed.

Med Clin (Barc), 2004 May 22, 122(19), 741 - 3
{Tuberculosis in health care personnel in a general hospital}; Casas X et al.; BACKGROUND AND OBJECTIVE: Tuberculosis is an occupational disease in health care workers . The objective of our study was to review tuberculosis cases in health care professionals from a general hospital and to determine their incidence in relation to the general population . PATIENTS AND METHOD: This was a retrospective study of tuberculosis cases among health care workers in a university hospital from 1988 to 2002, evaluating the annual cumulative incidence . RESULTS: 21 tuberculosis cases were found in health care workers . Pulmonary disease was the most frequent type (62%) followed by pleural effusion (28%) . The most affected professional category were medical residents (38%) with the emergency service (48%) being the work place with the highest risk . The cumulative incidence in our hospital was higher in relation to the general population although there was a variability between both populations . CONCLUSIONS: There is risk of tuberculosis transmission among health care workers, principally in the emergency service and the pathology and microbiological departments . A concerted effort is needed to maintain prevention measures in the work place where there is a high risk of infection.

Pediatr Pulmonol, 2004 Jul, 38(1), 82 - 7
Clinical value of obtaining sputum and cough swab samples following inhaled hypertonic saline in children with cystic fibrosis; Ho SA et al.; Prompt detection and treatment of lower respiratory tract infection are essential in the management of patients with cystic fibrosis (CF), who often have signs or symptoms of respiratory infection without any pathogens being isolated from sputum or cough swab specimens . The aims of this study were to assess the efficacy and clinical value of obtaining sputum and oropharyngeal cough swab samples following induction with hypertonic saline (HS) in this group of patients . Forty-three outpatients with CF, mean age 7.2 years (range, 1.8-12.9 years), were recruited over a 2-year period . Nebulized salbutamol was administered, followed by 6% HS . Sputum was preferentially obtained before and after HS induction if possible . If the patient was not able to expectorate, oropharyngeal cough swabs were taken instead . Four patients were able to expectorate sputum before and 19 after HS induction . The procedure was tolerated in 41 of 43 patients . Pathogens were isolated from 13 patients' HS-induced samples, but not from their corresponding preinduced specimens, and 4 patients' preinduced specimens cultured organisms which were not identified from their HS-induced samples . Significant changes were made in the management of 13 (30.2%) patients directly resulting from the positive culture of pathogens only from HS-induced samples . Cultures from oropharyngeal cough swab or expectorated sputum specimens following inhalation of HS provide additional microbiological information which is of clinical value and may lead to changes in patient management .

Dtsch Med Wochenschr, 2004 May 28, 129(22), 1243 - 5
{Unexpected cause of a tarsal destruction in a diabetic patient}; Guttler A et al.; HISTORY: A 56-year-old male patient has suffered from increasing pain in the left foot which limited the ability of walking since 18 months . There was a soft and painful swelling below the left inner ankle . In addition the patient reported back pain, but no neurological symptoms . Insulin dependent diabetes type II was known for 20 years, and a diabetic foot syndrome was suspected . 6 months prior the patient consulted his physician because of repeated acute bronchitis with expectoration and no improvement following antibiotic therapy . INVESTIGATIONS: Osteolytic destruction of the left middle foot and the tarsal with soft tissue infiltration according to MR, a spondylodiscitis of the lumbar vertebra I and II (MR) and mixed interstitial/alveolar infiltrates throughout the lung with a predominance in both upper lobes were found . The microbiological examination of sputum and biopsy of inflamed soft tissue of the left ankle revealed infection with mycobacterium tuberculosis . DIAGNOSIS: Open lung tuberculosis with concomitant bone tuberculosis and tuberculous arthritis of the left middle foot and spondylodiscitis . THERAPY AND CLINICAL COURSE: The antibiotic therapy consisted of a combination of five antibiotic drugs for 2 weeks and of a four drug combination for further 3.5 months . After that there will be a consolidation therapy with a two drug regime for 6 months . An orthopaedist is also involved . Surgical procedures with respect to the left foot will not be considered as long as the antibiotic therapy has not been finished . CONCLUSION: A combination of symptoms resulting from inflammatory bone processes and pulmonary symptoms is always suspicious for a hematogenic dissemination of a pulmonary tuberculosis.

Sex Transm Infect, 2004 Jun, 80(3), 219 - 22
Zafirlukast for severe recurrent vulvovaginal candidiasis: an open label pilot study; White DJ et al.; BACKGROUND: Recurrent vulvovaginal candidiasis (VVC) has been linked to allergic disease, particularly allergic rhinitis . OBJECTIVE: A pilot study to assess the possible use of the leukotriene receptor antagonist zafirlukast as a treatment for recurrent VVC . METHODS: 20 women with six or more symptomatic attacks of VVC in the past year (at least four proved microbiologically) . Clinical atopy determined by the International Study for Asthma and Allergies in Childhood (ISAAC) questionnaire assessed blindly . Monitoring by daily symptom diary and self taken vaginal swabs . Treatment with zafirlukast 20 mg twice daily for 24 weeks or until three microbiologically confirmed episodes of VVC . Response assessed by daily symptom diary and self taken vaginal swabs . Subjective response scales for improvement, side effects, and change in other allergic disease completed when stopping treatment . Semistructured telephone interview 1 year after stopping medication . RESULTS: 14 patients (70%) reported a subjective response on the improvement response scale . Six (30%) showed a complete response with no further symptomatic attacks of VVC or negative swabs when symptomatic . Seven (37%) remained symptom free 18 months after entering the study-that is, 12 months after stopping therapy . 11 (58%) remained symptom free for at least 3 months after stopping therapy . This does not include one patient who remained symptom free but continued on zafirlukast because of an improvement in her asthma . There was no clear relation between response and atopic status . Six of nine atopic subjective responders reported improvements in other allergic symptoms . Side effects were minimal; one seemed clearly attributable to the drug . CONCLUSION: Zafirlukast offers a potential new treatment for recurrent VVC that requires confirmation in controlled studies.

Inflamm Bowel Dis, 2004 Mar, 10(2), 129 - 34
Pulmonary involvement in Crohn's disease report of a case and review of the literature; Omori H et al.; Crohn's disease (CD) is a granulomatous systemic disorder of unknown etiology . Obvious pulmonary involvement is exceptional in patients with CD . We report a case of a 38-year-old man who suffered from CD for more than 14 years and was treated with oral steroids for more than 10 years . Surgical excision of parts of the ileum was performed for life-threatening ileal bleeding caused by CD . After acute tapering of oral steroids, pulmonary symptoms and radiologic abnormalities were noted . Lung biopsy through thoracoscopy was performed and revealed signs of chronic inflammation with multiple subepithelial noncaseating and epithelioid granulomas on pathologic examination . Intravenous steroids were required in the initial management of life-threatening pulmonary dysfunction after diagnostic thoracoscopy and led to marked improvement . Tuberculocidal therapy was performed until all microbiological cultures were negative . Oral steroid dosage had slowly been tapered over 1 month . He was discharged with clinical and radiologic improvements . After 36 months, the patient's condition is stable on continued treatment with prednisolone and mesalazine.

Cancer, 2004 Jun 1, 100(11), 2462 - 9
Assessment of procalcitonin as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia; Jimeno A et al.; BACKGROUND: Cancer patients with fever and neutropenia currently are assessed on clinical grounds only . The current study prospectively evaluated the efficacy of baseline procalcitonin (PCT) in the detection of bacteremia and in the prediction of outcome in patients with solid tumors and febrile neutropenia . METHODS: PCT levels were determined at baseline and every 48 hours in 104 patients undergoing chemotherapy who developed fever (axillary temperature > 38 degrees C on 2 occasions or > 38.3 degrees C in a single record) and neutropenia (absolute neutrophil count < 500 cells/microL) . RESULTS: The median baseline PCT values were significantly higher in patients who had microbiologically documented infections (1.24 ng/mL) compared with patients who had clinically documented infections (0.27 ng/mL) or fever of unknown origin (0.21 ng/mL; P < 0.01) . Accordingly, a PCT cut-off value of 0.5 ng/mL was reached more frequently in patients who had microbiologically documented infections compared with patients who had clinically documented infections or fever of unknown origin (66.7% vs . 13.4%, respectively; P < 0.001) . Furthermore, this threshold also was associated with an increased likelihood of treatment failure (70.0% vs . 14.9%; P < 0.001) . All 4 septic patients and all 5 patients who ultimately died presented PCT values 5-fold to 10-fold greater than the median values . Clinical evaluation in combination with baseline PCT assessment appeared to improve clinical risk evaluation alone . CONCLUSIONS: Baseline PCT levels were higher in patients who had febrile neutropenia with bacteremia compared with patients who had clinical infections or fever of unknown origin . PCT helped to identify patients who had microbiologic infections and patients who were at high risk of treatment failure, and PCT may constitute a complementary tool in the initial assessment of such patients .

Am J Clin Nutr, 2004 Jun, 79(6), 1006 - 12
Nutrient partitioning during treatment of tuberculosis: gain in body fat mass but not in protein mass; Schwenk A et al.; BACKGROUND: Tuberculosis is an important cause of wasting . The functional consequences of wasting and recovery may depend on the distribution of lost and gained nutrient stores between protein and fat masses . OBJECTIVE: The goal was to study nutrient partitioning, ie, the proportion of weight change attributable to changes in fat mass (FM) versus protein mass (PM), during antimycobacterial treatment . DESIGN: Body-composition measures were made of 21 men and 9 women with pulmonary tuberculosis at baseline and after 1 and 6 mo of treatment . All subjects underwent dual-energy X-ray absorptiometry and deuterium bromide dilution tests, and a four-compartment model of FM, total body water (TBW), bone minerals (BM), and PM was derived . The ratio of PM to FM at any time was expressed as the energy content (p-ratio) . Changes in the p-ratio were related to disease severity as measured by radiologic criteria . RESULTS: Patients gained 10% in body weight (P < 0.001) from baseline to month 6 . This was mainly due to a 44% gain in FM (P < 0.001); PM, BM, and TBW did not change significantly . Results were similar in men and women . The p-ratio decreased from baseline to month 1 and then fell further by month 6 . Radiologic disease severity was not correlated with changes in the p-ratio . CONCLUSIONS: Microbiological cure of tuberculosis does not restore PM within 6 mo, despite a strong anabolic response . Change in the p-ratio is a suitable parameter for use in studying the effect of disease on body composition because it allows transformation of such effects into a normal distribution across a wide range of baseline proportion between fat and protein mass.

Environ Manage, 2004 Jul, 34(1), 26 - 37 Epub 2004 May 13.
Public water sources in rural watersheds of Nepal's Middle Mountains: issues and constraints; Merz J et al.; Inadequacy and poor quality of water supply for domestic purposes is increasingly becoming a concern in rural catchments of the Middle Mountains of Nepal . Water quantity is an issue in pocket areas of these catchments, while water quality is subject to concern in most of the water sources . Microbiological contamination in particular poses a risk to human health . In addition, sediment pollution during the monsoon season is perceived as an issue by the local residents . Elevated phosphate and nitrate levels in many water sources indicate intensive interaction with surface water hailing from agricultural areas and human settlements . These water quantity and quality concerns in two watersheds of Nepal, the Jhikhu Khola and the Yarsha Khola watersheds, are not isolated cases . Similar problems are reported from other watersheds monitored under the People and Resource Dynamics in Mountain Watersheds of the Hindu Kush-Himalayas (PARDYP) project in China, India, and Pakistan and the literature of this region.

Methods Mol Biol, 2004, 268, 303 - 10
Microbiological test for sanitation of equipment in the food factory; Herrera AG; Microbiological sampling of utensils, tableware, and kitchen ware, in addition to equipment, permits objective evaluation of sanitation practices and procedures used for these items from food service operations.

Methods Mol Biol, 2004, 268, 235 - 80
The hazard analysis and critical control point system in food safety; Herrera AG; The Hazard Analysis and Critical Control Point (HACCP) system is a preventive method of ensuring food safety . Its objectives are the identification of consumer safety hazards that can occur in the production line and the establishment of a control process to guarantee a safer product for the consumer; it is based on the identification of potential hazards to food safety and on measures aimed at preventing these hazards . HACCP is the system of choice in the management of food safety . The principles of HACCP are applicable to all phases of food production, including basic husbandry practices, food preparation and handling, food processing, food service, distribution systems, and consumer handling and use . The HACCP system is involved in every aspect of food safety production (according to the UN Food and Agriculture Organization {FAO} and the International Commission on Microbiological Specifications for Foods {ICMSF}).The most basic concept underlying the HACCP system is that of prevention rather than inspection . The control of processes and conditions comprises the critical control point (CCP) element . HACCP is simply a methodical, flexible, and systematic application of the appropriate science and technology for planning, controlling, and documenting the safe production of foods.The successful application of HACCP requires the full commitment and involvement of management and the workforce, using a multidisciplinary approach that should include, as appropriate, expertise in agronomy, veterinary health, microbiology, public health, food technology, environmental health, chemistry, engineering, and so on according to the particular situation . Application of the HACCP system is compatible with the implementation of total quality management (TQM) systems such as the ISO 9000 series.

Arch Dis Child, 2004 Jun, 89(6), 577 - 9
Cough plate versus cough swab in patients with cystic fibrosis; a pilot study; Maiya S et al.; BACKGROUND: Accurate identification of lower respiratory tract pathogens is important in the management of cystic fibrosis patients . AIM: To evaluate the cough plate as an alternative method of obtaining respiratory samples for microbiological culture . METHODS AND RESULTS: Using sputum culture as the "gold standard", the cough plate method identified significantly more positive cases than either dry or moistened cough swabs . Of 20 patients who had a positive sputum culture, 16 had a positive culture on cough plate compared to seven positive cultures each on moistened swab and on dry swab respectively . CONCLUSIONS: In this study cough plates were more sensitive than cough swabs in isolating respiratory pathogens in sputum producers . As patients prefer it, the cough plate merits further evaluation, particularly in non-sputum producers.

Antimicrob Agents Chemother, 2004 Jun, 48(6), 2021 - 4
Phase 2, randomized, dose-ranging study evaluating the safety and efficacy of anidulafungin in invasive candidiasis and candidemia; Krause DS et al.; This study evaluated the safety and efficacy of anidulafungin, a novel echinocandin, in patients with invasive candidiasis, including candidemia . A total of 123 eligible patients were randomized to one of three intravenous regimens, 50, 75, or 100 mg once daily . Treatment continued for 2 weeks beyond resolution or improvement of signs and symptoms . The primary efficacy criterion was a successful global response rate (i.e., clinical and microbiological success) in the evaluable population at the follow-up (FU) visit, 2 weeks after end of therapy (EOT) . One hundred twenty (120) patients received at least one dose of anidulafungin; 68 were evaluable . Review of adverse events and laboratory data indicated no dose response for safety parameters . Non-albicans Candida species accounted for approximately one-half of all isolates . Success rates at EOT were 84, 90, and 89% in the 50-, 75-, and 100-mg groups, respectively . At FU, the success rates were 72, 85, and 83% . Phase 3 studies of anidulafungin for the treatment of invasive candidiasis and candidemia are warranted.

J Antimicrob Chemother, 2004 Jun, 53 Suppl 2, ii51 - 7
Treatment of polymicrobial infections: post hoc analysis of three trials comparing ertapenem and piperacillin-tazobactam; Solomkin J et al.; The efficacy of ertapenem 1 g once a day for the treatment of polymicrobial complicated intra-abdominal, complicated skin/skin-structure and acute pelvic infections was compared with piperacillin-tazobactam 3.375 g every 6 h in a post hoc analysis of data from three large randomized double-blind trials . Of the 1,558 treated patients in the three trials, no pathogen was identified in 345 (22.1%), 423 (27.2%) had a monomicrobial infection and 790 (50.7%) had a polymicrobial infection . At the test-of-cure assessment, there were no significant differences in outcome between the two treatment groups for any of the three infections . Cure rates (clinical and microbiological for intra-abdominal infection, clinical for skin/skin-structure and pelvic infections) in microbiologically evaluable patients for ertapenem and piperacillin-tazobactam, respectively, were 85.6% (154/180 evaluable patients) and 82.5% (127/154) for polymicrobial intra-abdominal infection, 80.3% (53/66) and 78.7% (48/61) for polymicrobial skin/skin-structure infection, and 95.7% (88/92) and 92.6% (88/95) for polymicrobial pelvic infection . Respective cure rates for all evaluable patients in the original trials were: 83.6% and 80.4% for intra-abdominal, 83.9% and 85.3% for skin/skin-structure, and 93.9% and 91.5% for pelvic infections . These data show that in the three trials, ertapenem 1 g once a day was highly effective for the treatment of polymicrobial infections and as effective as piperacillin-tazobactam 3.375 g every 6 h.

Vaccine, 2004 Jun 2, 22(17-18), 2221 - 5
Burden of hospitalizations attributable to rotavirus infection in children in Spain, period 1999-2000; Gil A et al.; The aim of this study is to provide estimates on the incidence of rotavirus infection requiring hospitalization in children <or=5 years of age during the 1999-2000 period in Spain and the associated direct cost of these hospitalizations . Hospital admissions attributable to rotavirus were estimated by using data on confirmed laboratory reports of rotavirus and hospital admissions due to acute gastroenteritis . During the study period a total of 32541 cases of pathogens responsible for acute gastroenteritis were reported to the microbiological information national system (SIM) and 14.0% were rotavirus . The proportion of laboratory-confirmed rotavirus cases was extrapolated to the total number of hospitalizations for acute gastroenteritis in children <or=5 years of age . An annual incidence of 1.0 hospital admissions attributable to rotavirus per 1000 persons <or=5 years of age was found, although during the winter season it reached 2.5 hospitalizations per 1000 . Overall, the estimated annual number of days of hospitalization attributable to rotavirus was 8742 days that results in a cost of 3.6 million per year.

Methods Mol Biol, 2004, 266, 115 - 35
Exploring and exploiting bacterial proteomes; Cordwell SJ; The plethora of data now available from bacterial genome sequencing has opened a wealth of new research opportunities . Many of these have been reviewed in preceding chapters . Genomics alone, however, cannot capture a biological snapshot from an organism at a given point in time . The genome itself is static, and it is the changes in expression of genes, leading to the production of functional proteins, which allows an organism to survive and adapt to a constantly changing environment . Proteomics is the term used to describe the global analysis of proteins involved in a particular biological process . Such processes may be analyzed via comparative studies that examine bacterial strain differences, both phenotypic and genetic, bacteria grown under nutrient limiting conditions, growth phase, temperature, or in the presence of chemical compounds, such as antibiotics . Proteomics also provides the researcher with a tool to begin characterizing the functions of the vast proportion of "hypothetical" or "unknown" proteins elucidated from genome sequencing and database comparisons . For example, study of protein-protein, protein-ligand, protein-substrate, and protein-nucleic acid interactions for a given target protein may all help to define the functions of previously unknown proteins . Furthermore, genetic manipulation combined with proteomics technologies can provide an understanding of how gene expression is regulated . This chapter examines the technologies used in proteome analysis and the applications of proteomics to microbiological research, with an emphasis on clinically-relevant bacteria.

Int J Gynaecol Obstet, 2004 Jun, 85 Suppl 1, S52 - 61
Puerperal sepsis and maternal mortality: what role can new technologies play?
Hussein J, Fortney JA.
OBJECTIVE: To identify new and underutilized technologies to reduce maternal mortality related to puerperal sepsis in developing countries . METHOD: Review of current medical literature . RESULT: The literature indicates that infection-control protocols and evidence-based procedures--including prophylactic antibiotics for cesarean section or preterm rupture of membranes, and updated antibiotic regimens--should be widely adopted . Devices such as hand rubs, needle-disposal systems, and rapid microbiological diagnostic tests can improve compliance and efficiency . Operational research on promising developments like vaginal cleansing with antiseptics, vitamin A supplementation, and prophylactic antibiotics in high-risk women is needed . CONCLUSION: Sepsis management continues to depend on good implementation of established technologies . Program-based approaches are required to improve uptake.

Int J Med Microbiol, 2004 Apr, 293 Suppl 37, 93 - 103
Zoonotic Babesia: possibly emerging pathogens to be considered for tick-infested humans in Central Europe; Hunfeld KP et al.; The three host-tick Ixodes (I.) ricinus is regarded as an important vector of tick-borne microorganisms pathogenic for humans in central Europe and is primarily known as the main vector of Borrelia (B.) burgdorferi and the virus causing tick-borne encephalitis (TBE), the most clinically relevant tick transmitted pathogens for humans in European countries . Furthermore, it is now well established that I . ricinus also transmits Ehrlichia (E.) phagocytophila, Babesia (Ba.) divergens, and Ba . microti, all agents of zoonotic infections in dear, sheep, cattle, dogs, and horses . In addition to their known zoonotic potential, recent molecular-epidemiological and seroepidemiological surveys as well as increasingly reported clinical cases of infections caused by these tick-borne organisms other than B . burgdorferi (TOBB) also strongly suggest a possible relevance of Babesia, Ehrlichia and Rickettsia for humans at risk in Europe . However, there are few medical microbiological investigations and epidemiological data on the distribution and relevance of Babesia for humans in our part of the northern hemisphere . There is also very little diagnostic and clinical knowledge on human babesiosis in many regions of Europe . Furthermore, sophisticated diagnostic tools designed for the reliable detection of the underlying pathogens, are not yet generally available to the microbiological laboratory . This review aims to provide basic information on human babesiosis and the most relevant causative pathogens of the disease in Europe and to draw attention to this parasitic infection as a possibly emerging and probably under-diagnosed disease in this part of the northern hemisphere.

Int J Food Microbiol, 2004 May 1, 92(3), 297 - 306
Heterotrophic plate count monitoring of treated drinking water in the UK: a useful operational tool; Sartory DP; The count of general or heterotrophic bacterial populations in treated drinking water in the UK has been undertaken since the 1880s . Counts of heterotrophic bacteria at 22 and 37 degrees C are used widely as part of an overall assessment of treated drinking water quality . There were no legislated standards for water quality in the UK until adoption of the first EU Directive in 1989 . The UK has, however, never stipulated numerical standards or guidelines for heterotrophic bacteria, although their enumeration has long been part of the assessment of 'wholesome' water, on which advice regarding microbiological quality was given in a series of documents known as 'Report 71' . The current regulations stipulate only that there should be 'no abnormal change' in numbers normally associated with a given supply . This paper reviews the historical context regarding the enumeration, and interpretation of results, of heterotrophic bacteria from treated drinking water, and information regarding current practices by UK water suppliers . The appropriateness of using heterotrophic bacteria counts as an operational tool or as a health parameter is briefly discussed in the light of the UK experience .

Photodermatol Photoimmunol Photomed, 2004 Jun, 20(3), 144 - 7
Photodynamic therapy of interdigital mycoses of the feet with topical application of 5-aminolevulinic acid; Calzavara-Pinton PG et al.; BACKGROUND: Findings of in vitro studies have demonstrated that dermatophytes and yeasts can be effectively photosensitized after topical delivery of 5-aminolevulinic acid (ALA) . This procedure, called photodynamic therapy (PDT), seems to lack mutagenic activity and hazard of selection of drug-resistant strains . METHODS: Twenty percent ALA preparation in Eucerin cream was applied under an occlusive dressing to skin lesions of nine patients with clinical and microbiological evidence of interdigital mycosis of the feet . After 4 h, lesions were irradiated with 75 J/cm(2) of broad-band red light . Interdigital lesions of the other foot served as control (treated with only light or only ALA) . After 7 days from the first treatment, no further treatment was delivered if lesions were not clinically evident and direct microscopic examination was negative . Otherwise, three additional weekly treatments were delivered . Four weeks after the last treatment, patients had a final follow-up clinical and laboratory examination . RESULTS: Clinical and microbiological recovery was seen in six out of nine patients after one (four cases) or four (two cases) treatments . However, after 4 weeks, recurrences were seen in four patients . Overall tolerability was always good . CONCLUSION: Under the conditions employed in the present study, ALA-PDT had good therapeutic effects on interdigital mycosis of the feet . However, recurrences were quick . In vivo environmental conditions, i.e . temperature, humidity and pH of the interdigital skin, could induce a poor cell uptake of ALA and a deficient biosynthesis of photosensitizing protoporphyrin IX . In addition, the irregular tridimensional shape of this peculiar anatomical area could lead to a non-uniform delivery of light and/or ALA cream . However, the present results can stimulate further studies on the PDT of superficial skin mycoses.

Tuberk Toraks, 2003, 51(3), 282 - 8
{The evaluation of close contact case of pulmonary tuberculosis patients enrolled to Eskisehir Deliklitas Tuberculosis Control Dispensary}; Kolsuz M et al.; Persons infected with Mycobacterium tuberculosis are at greatest risk for developing active tuberculosis especially in children, adolescents, young adults and persons who have selected risk factors . Persons who were contact with tuberculosis patients and who have positive tuberculin skin test reactions and had high risk for developing active tuberculosis should be use preventive chemotherapy . In this study, we aimed to evaluate retrospectively 1663 close contacts of 486 active tuberculosis patients who registered in Eskisehir Deliklitas Tuberculosis Control Dispensary . The mean age was 25.4 +/- 18.1 years, 961 (57.7%) cases were female and 702 (42.3%) cases were male . Diagnosis was performed 1114 (67%) of close contacts people's patients with microbiological study . The scatrix of BCG has been recorded 901 (54.2%) cases, tuberculin skin test results has been recorded 952 (57.2%) cases . Tuberculin skin test of 612 (64.5%) cases were above 15 mm . 37.8% of cases were used preventive chemotherapy and 2.6% of cases had active tuberculosis disease . The age group was 7-14 years and persons who had close contacts of bacile positive patients, 80.5% of them had used preventive chemotherapy . Persons who's tuberculin skin test positive and younger than 6 years, 98.5% of them had preventive chemotherapy . Only 372 (59.2%) of patients completed preventive chemotherapy . At the results; we established that the preventive chemotherapy programme which recommended to our country is using regularly, but most of the close contact patients didn't completed their therapy.

Eur J Clin Microbiol Infect Dis, 2004 Jun, 23(6), 491 - 4 Epub 2004 May 13.
Clinical significance of lower respiratory tract Aspergillus culture in elderly hospitalized patients; Soubani AO et al.; In order to evaluate the clinical significance of Aspergillus-positive culture results from the lower respiratory tract specimens of elderly hospitalized patients, and to identify the clinical variables that differentiate between colonization and infection with Aspergillus spp . in this patient population, a retrospective study was conducted . The records of 66 elderly patients whose lower respiratory tract specimens yielded Aspergillus spp . between January 1995 and July 2000 were examined . The majority of the patients ( n=61) were determined to be colonized with Aspergillus spp., and serious lung infection due to Aspergillus spp . was rare . Clinical, radiological, and microbiological data did not help differentiate between infection and colonization.

Reg Anesth Pain Med, 2004 May-Jun, 29(3), 237 - 42
Spinal cord compression from intrathecal catheter-tip inflammatory mass: case report and a review of etiology; Peng P et al.; OBJECTIVES: The majority of intrathecal pumps are implanted by anesthesiologists . Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature . The present case report describes a patient with spinal cord compression as a result of an inflammatory mass and reviews the current literature as to the etiology of inflammatory mass formation . CASE REPORT: A 47-year-old man with intractable neck and arm pain received an intrathecal pump implantation in 2001, at a stable dose of morphine 8 mg and clonidine 40 microg/d . After an injury in late 2001, his dose requirement for intrathecal morphine steadily increased . In May 2002, hydromorphone was substituted for morphine . The concentrations of hydromorphone and clonidine were 12.5 mg/mL and 150 microg/mL, respectively, infusing at 0.3 mL/d . In October 2003, he developed progressive T9 paraparesis . A computed tomography scan with myelogram showed complete blockage of contrast flow at T8-9 . Surgical exploration found an intradural-extramedullary mass compressing the spinal cord anteriorly and to the left . Four weeks after surgical removal of the mass, the patient's neurologic function had improved minimally . All the microbiological analyses were negative . Review of the current literature suggests that the development of an inflammatory mass is related to the delivery of the high dose opioids in the intrathecal space . CONCLUSION: Delivery of high-dose intrathecal opioids can result in the formation of an inflammatory mass, leading to poor pain control and neurologic complications . Anesthesiologists should be vigilant as to these complications when managing patients receiving intrathecal pump therapy.

Support Care Cancer, 2004 Oct, 12(10), 720 - 4
Piperacillin-tazobactam and netilmicin as a safe and efficacious empirical treatment of febrile neutropenic children; Le Guyader N et al.; GOALS OF WORK: We evaluated piperacillin-tazobactam in association with netilmicin (TN) in the early empirical treatment of neutropenic children, as data are limited in number . PATIENTS AND METHOD: In 1996, an observational study was initiated to assess the efficacy and safety of this association, with a glycopeptide (TNG) if needed . The impact on the bacterial ecology of our unit was also observed . Children were treated for hematological malignancy or solid tumor between September 1996 and December 1998 and presented a febrile neutropenia . RESULTS: There were 148 evaluable febrile neutropenic episodes in 104 patients . Median age was 7 years, 55% of the episodes were fever of unknown origin, 22% were clinically documented and 23% microbiologically documented (27 bacteriemia) . A glycopeptide was added in 67 episodes . The initial unmodified treatment was successful in 114 episodes (77%): 75/81 episodes in the TN group and 39/67 in the TNG group . For successful episodes, median treatment duration was 6 days . There were 22 febrile recurrences . These patients, as well as initial failures, always responded to a second-line treatment . One child was considered a failure because he developed a skin rash probably due to piperacillin-tazobactam and required another beta-lactamase . CONCLUSION: This study suggests that piperacillin-tazobactam in association with netilmicin presents a satisfactory efficacy and a good tolerance as empirical therapy for febrile neutropenic children . It allowed us to maintain the bacterial ecology of our unit.

Probl Tuberk Bolezn Legk, 2004, (1), 36 - 9
{Chronic bronchitis in children}; Rachinskii SV et al.; Current approaches to diagnosing in children a group of chronic lung diseases running with the symptoms of chronic bronchitis . Chronic bronchitis is demonstrated to be a major syndrome underlying the clinical manifestations of a number of chronic lung diseases, such as congenital malformations of the lung, chronic pneumonia, ciliary dyskinesia, immunodeficiencies running with the involvement of the lung, cystic fibrosis, etc . The paper shows it necessary to diagnose these conditions, by using various diagnostic studies (bronchological, immunological, biochemical, microbiological, etc.) . Primary chronic bronchitis in childhood occurs rarely and it is diagnosed after excluding the above diseases.

Biol Sci Space, 2003 Dec, 17(4), 310 - 7
{Search for life in deep biospheres}; Naganuma T; The life in deep biospheres bridges conventional biology and future exobiology . This review focuses the microbiological studies from the selected deep biospheres, i.e., deep-sea hydrothermal vents, sub-hydrothermal vents, terrestrial subsurface and a sub-glacier lake . The dark biospheres facilitate the emergence of organisms and communities dependent on chemolitoautotrophy, which are overwhelmed by photoautotrophy (photosynthesis) in the surface biospheres . The life at deep-sea hydrothermal vents owes much to chemolithoautotrophy based on the oxidation of sulfide emitted from the vents . It is likely that similarly active bodies such as the Jovian satellite Europa may have hydrothermal vents and associated biological communities . Anoxic or anaerobic condition is characteristic of deep subsurface biospheres . Subsurface microorganisms exploit available oxidants, or terminal electron acceptors (TEA), for anaerobic respiration . Sulfate, nitrate, iron (III) and CO2 are the representative TEAs in the deep subsurface . Below the 3000-4000 m-thick glacier on Antarctica, there have been >70 lakes with liquid water located . One of such sub-glacial lakes, Lake Vostok, is about to be drill-penetrated for microbiological studies . These deep biosphere 'platforms' provide new knowledge about the diversity and potential of the Earth's life . The expertise obtained from the deep biosphere expeditions will facilitate the capability of exobiologial exploration.

Int J Food Microbiol, 2004 May 15, 93(1), 11 - 29
Fine-tuning Food Safety Objectives and risk assessment; Havelaar AH et al.; Food Safety Objectives (FSOs) have been proposed as a practical tool to translate public health targets for food safety into tolerable levels of pathogens in a food product . The FSO concept is subject to intensive debate, and has not been developed in detail . We evaluate the proposed definition of FSOs and their implementation from the perspective of Quantitative Microbiological Risk Assessment (QMRA) . The relationship between QMRA and FSOs is illustrated by a model for the public health risk of Shiga-producing Escherichia coli in steak tartare . We conclude that the proposed definition of FSOs needs to be modified to properly account for variability in and uncertainty about the contamination of food with pathogenic microorganisms and emphasize that both prevalence and concentration of pathogens must be considered . For this purpose, we propose the P-D equivalence curve, a simple graphical tool to separate "tolerable" from "non-tolerable" combinations of prevalence and concentration (dose) .

J Clin Microbiol, 2004 May, 42(5), 2255 - 7
Quantitative microbiological study of subgingival plaque by real-time PCR shows correlation between levels of Tannerella forsythensis and Fusobacterium spp; Suzuki N et al.; A TaqMan-based real-time PCR assay was established to quantify the periodontopathic bacteria Tannerella forsythensis and Fusobacterium spp . With this assay, the prevalence and proportion of these bacteria in clinical specimens were evaluated . Our preliminary results suggest a positive colocalization of T . forsythensis and Fusobacterium spp . in periodontal pockets.

Eur J Nucl Med Mol Imaging, 2004 Feb, 31(2), 233 - 9
99mTc-ciprofloxacin planar and tomographic imaging for the diagnosis of infection in the postoperative spine: experience in 48 patients; De Winter F et al.; The non-invasive assessment of postoperative spinal infections can pose a substantial diagnostic challenge, especially in the presence of orthopaedic devices . Whereas white blood cell scanning is of limited use in the spine, the low normal bone marrow uptake of technetium-99m ciprofloxacin combined with its claimed bacterial specificity makes it theoretically an ideal candidate for the evaluation of postoperative spinal infections . This study aimed to evaluate 99mTc-ciprofloxacin planar and single-photon emission tomography (SPET) imaging in relation to microbiological and clinical diagnosis in the postoperative spine . Planar imaging was performed at 1, 3 and 24 h and SPET was performed at 3 h post injection of 370 MBq 99mTc-ciprofloxacin . Images were scored by two independent certified nuclear medicine physicians, blinded to the final diagnosis . Within the 48 patients, there were 13 deep infections . Sensitivity, specificity and accuracy at visual scoring were respectively 54%, 71% and 67% (1 h), 62%, 77% and 73% (3 h), 42%, 91% and 77% (24 h) for planar imaging and 100%, 74% and 81% for SPET . When recently operated patients (< 6 months) were excluded, the specificity of the SPET imaging rose to 81% . In conclusion, unlike white blood cell scanning, 99mTc-ciprofloxacin SPET is sensitive in evaluating infections in the postoperative spine . Sensitivity is much higher for SPET than for planar imaging . However, the results presented prove that its specificity is limited, especially in recently operated patients . Taking this limitation into account, we advise planar and SPET imaging at 3 h post injection and an interval of at least 6 months after surgery to minimise the likelihood of false positives.

Appl Environ Microbiol, 2004 May, 70(5), 2577 - 87
Impact of soil drying-rewetting stress on microbial communities and activities and on degradation of two crop protection products; Pesaro M et al.; Prior to registration of crop protection products (CPPs) their persistence in soil has to be determined under defined conditions . For this purpose, soils are collected in the field and stored for up to 3 months prior to the tests . During storage, stresses like drying may induce changes in microbiological soil characteristics (MSCs) and thus may influence CPP degradation rates . We investigated the influence of soil storage-related stress on the resistance and resilience of different MSCs by assessing the impact of a single severe drying-rewetting cycle and by monitoring recovery from this event for 34 days . The degradation and mineralization of the fungicide metalaxyl-M and the insecticide lufenuron were delayed by factors of 1.5 to 5.4 in the dried and rewetted soil compared to the degradation and mineralization in an undisturbed reference . The microbial biomass, as estimated by direct cell counting and from the soil DNA content, decreased on average by 51 and 24%, respectively . The bulk microbial activities, as determined by measuring substrate-induced respiration and fluorescein diacetate hydrolysis, increased after rewetting and recovered completely within 6 days after reequilibration . The effects on Bacteria, Archaea, and Pseudomonas were investigated by performing PCR amplification of 16S rRNA genes and reverse-transcribed 16S rRNA, followed by restriction fragment length polymorphism (RFLP) and terminal RFLP (T-RFLP) fingerprinting . Statistical analyses of RFLP and T-RFLP profiles indicated that specific groups in the microbial community were sensitive to the stress . In addition, evaluation of rRNA genes and rRNA as markers for monitoring the stress responses of microbial communities revealed overall similar sensitivities . We concluded that various structural and functional MSCs were not resistant to drying-rewetting stress and that resilience depended strongly on the parameter investigated.

Photochem Photobiol Sci, 2004 May, 3(5), 403 - 5 Epub 2004 Apr 29.
Photosensitized inactivation of microorganisms; Jori G et al.; Despite major advances in medicine in the last 100 years, microbiologically-based diseases continue to present enormous global health problems . New approaches that are effective, affordable and widely applicable and that are not susceptible to resistance are urgently needed . The photodynamic approach is known to meet at least some of these criteria and, with the creation and testing of new photosensitisers, may develop to meet all of them . The approach, involving the combination of light and a photosensitising drug, is currently being applied to the treatment of diseases caused by bacteria, yeasts, viruses and parasites, as well as to sterilisation of blood and other products.

Environ Int, 2004 Aug, 30(6), 841 - 54
Development of coastal recreational water quality standards in the Mediterranean; Kamizoulis G et al.; Concern about adverse health effects arising out of human exposure to polluted seawater through bathing and other forms of aquatic recreation has led to the development of various quality criteria and standards worldwide . Attempts at quantifying health hazards from polluted recreational waters have been made in several Mediterranean countries through the conduction of epidemiological studies aimed at establishing direct correlation between the microbiological quality of the water and health effects on exposed population groups . This article provides an overview on the development of the criteria and standards for coastal recreational waters in the Mediterranean by examining the evolution of the WHO guidelines, the WHO/UNEP interim criteria for bathing waters and the EU Directives . It also provides a brief account of the various quality criteria and standards for coastal recreational waters in current use in all the Mediterranean countries.

Ig Sanita Pubbl, 2003 Nov-Dec, 59(6), 365 - 72
{Effectiveness of the maintenance operations on the air conditioning systems of a university building in relation to the microbiological quality of the air indoor}; De Filippis P et al.; The microbiological quality of the air indoor is influenced from various factors and one of the most important is represented from the maintenance of the conditioning systems . In this study it has been estimated the effectiveness of an intervention of cleaning and maintenance on the systems of conditioning of an university building executing sampling before and after such intervention . The two results were confronted and it is observed as the maintenance of the air conditioners has influenced on the quality of the air indoor.

Ig Sanita Pubbl, 2003 Nov-Dec, 59(6), 359 - 64
{Microbiological monitoring activities: a report in a food-crockery-cleaning factory}; Capannolo D; The purpose of this report is to describe the checks, the methods and the results obtained in a crockery-cleaning and polishing factory . Investigating the most important biological index for food contamination (e.g . T.B.C., Yeast, Mould), in order to determine the presence/absence of biological agent and to obtain good results in terms of hygiene and health.

Ann Transplant, 2003, 8(3), 39 - 48
Porcine endogenous retroviruses (PERVs) and xenotransplantation: screening for transmission in several clinical trials and in experimental models using non-human primates; Denner J; Xenotransplantation may develop into a medical technology able to save or improve the quality of life . Porcine endogenous retroviruses (PERVs), because they are integrated in the genome of all pig strains, because they are produced by normal pig cells, and because they can infect human cell in vitro, are considered to be the main microbiological risk if pig cells, tissues or organs are to be transplanted . Indeed, serial passaging of PERV on human cells, simulating the situation during xenotransplantation, was found to increase the titer of the virus and was associated with corresponding genetic changes in the viral LTR . In vitro infection studies showed a productive infection of primary cells of different species including non-human primates and man . However, using newly developed sensitive detection methods, evidence for PERV transmission was seen neither in over 200 patients who had received porcine xenotransplants nor in butchers frequently exposed to pig tissues . Similarly, rats, guinea pigs, minks, rhesus macaques, pig tailed macaques and baboons inoculated with high doses of PERV and given strong daily immunosuppressive treatment failed to exhibit evidence of infection . These data are crucial for the evaluation of xenotransplantation safety because they demonstrate that PERVs cannot easily be transmitted to other species including man.

Transfus Med, 2004 Apr, 14(2), 105 - 12
Comparative analysis of national regulations concerning blood safety across Europe; Mascaretti L et al.; In October 2001, representatives of 17 European countries (Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Federal Republic of Yugoslavia, Finland, France, Germany, Greece, Italy, Macedonia, Romania, Slovenia, Spain, Turkey and UK) met in Sarajevo at a course organized by the European School of Transfusion Medicine to discuss their countries' regulations concerning different aspects of the safety of blood transfusion . Results are summarized in tables to facilitate comparisons . Most countries (13/17) have specific transfusion laws and 9/17 have hospital-based systems as opposed to national organizations . Quality assurance is common among investigated countries (14/17) . Voluntary associations are responsible for donor promotion in the majority of countries (13/17) . Exclusively, voluntary non-remunerated donors are found in 5/17 countries, whereas in the remaining ones, incentives, family replacement and remuneration are mechanisms stimulating blood donation . Medical doctors using official selection criteria are checking donor suitability in virtually all countries, which also perform main microbiological testing . Regulations on good clinical use of blood and derivatives are present in most countries but applied only in some . Although the data presented need to be interpreted with some caution, this preliminary analysis shows that, although some significant differences still exist, the majority of countries studied are moving in the same direction to ensure safety of their blood supply.

J Hosp Infect, 2004 Apr, 56 Suppl 2, S23 - 6
Reprocessing endoscopes: national recommendations with a special emphasis on cleaning--the German perspective; Heeg P; Transmission of pathogens through endoscopes or endoscopic procedures has been documented frequently, although reliable data on the incidence of endoscope-associated infections do not exist . In order to control such infections as well as to ensure adequate quality management in endoscopy, the German Robert Koch Institute has produced recommendations for hygienic processing of flexible endoscopes and accessory devices . Reprocessing using a washer disinfector is explicitly preferred to manual procedures . Control measures are focused on microbiological sampling and limiting values have been defined for rinsing fluids taken from the channels of the scopes . Although the guideline leaves a number of questions open, e.g . test methods to control the efficacy of the cleaning process . It helps to establish quality management in the field of endoscopy and to improve the level of safety both for patients and staff.

J Hosp Infect, 2004 Apr, 56 Suppl 2, S16 - 22
The importance of cleaning for the overall results of processing endoscopes; Martiny H et al.; Reprocessing comprises three steps: cleaning, disinfection and-if required-sterilisation . While the extents of disinfection and of sterilisation are quantitatively defined, there are only imprecise (qualitative) definitions of cleaning . There are two main reasons for accurate cleaning . First organic and inorganic materials that remain on inner and outer surfaces will interfere with the efficacy of the disinfectants . In case of endoscopes this will lead to channel blockages; they remain undisinfected . Second the bioburden found on endoscopes after use can be very high . Data available demonstrate that a bacterial burden of up to 10(9)cfu/endoscope channel can be expected . Therefore it is necessary to perform a thorough cleaning . Studies using endoscopes showed a reduction in microbial counts by a factor of approximately 10(4) by cleaning (manual and mechanical) . Therefore in 2001 the German Society of Hospital Hygiene (DGKH) specified its requirements and recommendations for determining cleaning efficacy separately from those for disinfection . Cleaning and disinfecting can be done manually or mechanically, but it seems impossible to validate manual processes . However our studies in two different washer-disinfectors (WD) showed differences in cleaning efficacy . The tested cleaning processes showed different efficacies . Not all cleaning processes showed better results than water alone with regard to visible cleanliness and to a microbiological reduction E . faecium . Our results show that the evaluation of cleanliness exclusively by visible inspection is not sufficient, particular for the lumens of endoscopes . The results also show that a cleaning process may be very effective also in reducing micro-organisms present.

Int J Infect Dis, 2004 May, 8(3), 139 - 46
Tick-borne rickettsioses in international travellers; Jensenius M et al.; BACKGROUND: Tick-borne rickettsioses are of emerging importance in today's travel medicine but have until recently received little attention . We describe the current knowledge of tick-borne rickettsioses as they relate to international travel, their microbiological diagnosis, treatment, possible prevention, and future prospects . METHODS: Literature-based review and personal observations . RESULTS: During the last decade, some 400 cases of tick-borne rickettsioses have been reported in international travellers, the vast majority being African tick bite fever caused by Rickettsia africae and Mediterranean spotted fever caused by Rickettsia conorii . Only a minority of infected travellers can recall a preceding tick bite . Most patients present with a mild-to-moderately severe flu-like illness typically accompanied by a cutaneous rash and an inoculation eschar at the site of the tick bite, but potentially life-threatening disease with disseminated vaculitis is occasionally seen . Definite microbiological confirmation of tick-borne rickettsioses by isolation or antigen detection is only available at reference laboratories and diagnosis must in most cases rely on clinical and epidemiological data supported by serology . Doxycycline is the recommended treatment for tick-borne rickettsioses and prevention is based on personal protective measures against tick bites when travelling in endemic areas . CONCLUSION: Tick-borne rickettsiosis should be suspected in febrile returnees from endemic areas, especially in cases with skin eruptions . Travellers to endemic areas should be encouraged to use personal protective measures against tick bites.

An Med Interna, 2004 Apr, 21(4), 166 - 70
{Clinical patterns of community acquired pneumonia microbiologically documented compared to the not documented.}Prospective and comparative study between 1991 and 1997}; Sanchez Gonzalez ME et al.; INTRODUCTION: The diagnostic of the pneumonia is the problems more important for its adequate treatment and best evolution . OBJECTIVES: To study in a prospective way the patron clinic de la NAC compared the documented with the not documented in a microbiological way . PATIENTS Y METHODS: We have studied patients with NAC hospitalized in the HUVA between January of 1991 and May of 1997 . The diagnostical criterion of pneumonia and of the hospitable ingress were the classics accepted for this infections, was doing in all cases diagnostical studies not invasive . It was analyzed the clinical patron of the NAC microbiologically documented compare to with the not documented . In the same way, the documented was divided in typical and not typical according to the microorganisms aisled . Besides was realized an statistic study using tables of contingency and test Fisher . RESULTS: It was studied 409 patients with NAC, from which 161 (39.6%) had microbiological documentation, it was found 119 micro organism typical and 42 atypical . On the one hand, the female sex, EPOC, fever, tos and purulence esputum and hyperglucaemia, were associated significantly with the documented NAC . The presence of cardiopaty, seriously initial clinical situation, gastrointestinal disorders and previous infections and use of antibiotics, were associated with not documented . The age more than 65 years, presence of comorbility, purulence sputum, pleural pain, toghether with VSG>50 and lobar infiltrate, were associated significantly to typical pneumonia, while tabaquical habit and extrapulmonary sintoms (artromialgias) were with the atypical . CONCLUSIONS: The knowledge of the clinical patrons of the NAC are great impact in the diagnostic and treatment antibiotic adecuate.

Infect Control Hosp Epidemiol, 2004 Apr, 25(4), 352 - 4
Prevalence and fluconazole susceptibility of Candida species recovered from the oropharynx of healthcare workers (HCWs) and non-HCWs; Klein JD et al.; We compared oropharyngeal cultures and fluconazole susceptibility for Candida in 100 healthcare workers (HCWs) and 100 non-HCWs . Isolates were identified using standard microbiological methods . Susceptibility was determined by Etest and microtiter method . There was no significant difference in prevalence or species of oropharyngeal Candida between HCWs and non-HCWs . Fluconazole resistance was infrequent.

Infect Control Hosp Epidemiol, 2004 Apr, 25(4), 284 - 90
Assessment of a novel approach to evaluate the outcome of endoscope reprocessing; Sciortino CV Jr et al.; OBJECTIVE: To investigate and evaluate the use of a portable luminometer system for detecting contamination following the reprocessing and high-level disinfection of flexible endoscopes . DESIGN: Random sampling of endoscopes spaced at 1- to 2-week intervals following normal use in patients . METHODS: Portable luminometer system testing of 31 endoscopes undergoing reprocessing, 63 stored endoscopes, and 15 reprocessed endoscopes that underwent in-depth microbiological analysis . For testing with the portable luminometer system, samples were collected by swabbing a 100-cm2 shank surface area and the internal tip end orifice . Standardization of portable luminometer system results was performed in vitro by comparison of serial dilutions of known quantities of microorganisms and blood, tested before and after sterilization by autoclave . Microbiological analysis included Gram stain, culture for aerobic bacteria, and gene probes for Mycobacterium tuberculosis, herpes simplex viruses 1 and 2, and Cytomegalovirus . Trichrome and calcofluor white stains were used to detect parasites and fungi . Legionella was detected by stain with fluorescent-labeled monoclonal antibody . SETTING: The gastroendoscopy unit of a Veterans Affairs hospital . RESULTS: The portable luminometer system was capable of detecting microbial and cellular contamination of flexible endoscopes following high-level disinfection and reprocessing . The sensitivity of the assay was sufficient for detecting low-level contamination . CONCLUSIONS: The system provided a rapid microbiological outcome monitor for the cleaning and disinfection process . The system was easy to use and relatively accurate.

Bull Soc Pathol Exot, 2004 Feb, 97(1), 53 - 8
{Implementation of the HACCP system in the production line of the traditional sandwich in Phnom Penh City, Cambodia}; Lay KS et al.; From July 2000 to July 2001, the hazard analysis and critical control points (HACCP) system was implemented to the benefit of the traditional sandwich production in Phnom Penh City Sandwiches were initially analyzed for bacterial indicators among 6 large-scale producers during a 2 months period . In the second stage of the study, two selected producers were involved in the HACCP process . Microbiological analyses revealed a poor sanitary quality of samples from all the production lines tested . Implementation of HACCP method resulted in a reduction of microbial contamination, but this decrease was not significant compared with others steps of HACCP process (chi2 test for trend, p > 0.05) . HACCP system was well accepted by producers but routine practices and wrong perception by production-line workers did limit the success of the process . A regulation on the mass catering sector should be part of a large strategy of food safety and environmental health in the city.

Wei Sheng Yan Jiu, 2004 Jan, 33(1), 115 - 8
{Study advance and control measure on disinfection by-products in drinking water}; Wei J et al.; The related studies on the chemistry, toxicology, epidemiology, distribution level, hygienic standard or maximum contaminant level and control measure were summarized . The results showed that a lot of disinfection by-products (DBPs) formed during chlorination and trihaloromethanes (THMs) and haloacetic acids (HAAs) were the two major groups of found in drinking water . From the present knowledge and health effects, the DBPs of most interest are THMs, HAAs, bromate and chlorite . The hygienic standard or maximum contaminant level of drinking water have been revised or supplemented . In order to decrease the chemical risk due to DBPs without compromising microbiological quality, the monitor parameters have been increased and maximum contaminant levels of the parameters have been controlled strictly.

Z Gastroenterol, 2004 Apr, 42(4), 303 - 10
Contrast-enhanced ultrasound allows for interventions of hepatic lesions which are invisible on convential B-mode; Schlottmann K et al.; BACKGROUND AND AIMS: Contrast harmonic imaging significantly increases the detectability of liver lesions which are invisible on conventional B-mode sonography . With the introduction of contrast agents, which can be visualized at low mechanical index (low-MI), continuous real time observation of liver lesions under contrast conditions is possible . We addressed the question whether contrast-enhanced sonography allows for intervention of hepatic lesions impossible to detect on conventional B-mode imaging . PATIENTS AND METHODS: We evaluated twelve patients with hepatic tumors or abscesses, which could not be analyzed and punctured under fundamental B-mode guidance . The ultrasound contrast agent BRI was used for detection of the hepatic lesions under contrast harmonic imaging (CHI) conditions with phase inversion at low-MI . RESULTS: In eleven out of twelve patients interventions under CHI conditions were successful, as proven by histological, microbiological or tumor marker analysis . The puncture needles were visible in all cases . With an algorithm for optimizing the puncture conditions at low-MI CHI the biopsies can be performed in two steps . CONCLUSIONS: Our results show that biopsies of liver lesions under real-time continuous CHI at low-MI are feasible.

Nucl Med Commun, 2004 Mar, 25(3), 277 - 83
99mTc ciprofloxacin imaging for the diagnosis of infection in the postoperative spine; Gemmel F et al.; BACKGROUND: The non-invasive assessment of postoperative spinal infections can pose a substantial diagnostic challenge, especially in the presence of orthopaedic devices . In contrast to white blood cell scanning, which is of limited use in the spine, the low uptake of 99mTc ciprofloxacin into normal bone marrow, combined with its claimed bacterial specificity, makes it, theoretically, an ideal candidate for evaluating postoperative spinal infections . AIM: This study aimed to evaluate 99mTc ciprofloxacin planar and single photon emission tomography (SPET) imaging in relation to microbiological diagnosis in the postoperative spine . METHODS: Only patients with a microbiologically confirmed diagnosis were included in this analysis . Planar imaging was performed at 1, 3 and 24 h, and SPET was performed at 3 h post-injection of 370 MBq 99mTc ciprofloxacin . Images were scored by two independent, certified, nuclear medicine physicians, blinded for the final diagnosis . RESULTS: Within the first 22 consecutive patients with microbiological diagnosis, there were nine deep infections . Sensitivity, specificity and accuracy at visual scoring were, respectively, 67%, 77%, 73% (1 h), 78%, 69%, 73% (3 h), and 56%, 92%, 77% (24 h) for planar imaging, and 100%, 54%, and 73% for SPET . CONCLUSION: In contrast to white blood cell scanning, SPET with Tc ciprofloxacin is sensitive in evaluating infections in the postoperative spine . Sensitivity is higher for SPET than for planar imaging . However, the results presented prove that its specificity is limited, especially in patients who have recently (< 6 months) undergone surgery . Taken this limitation into account, we advise planar and SPET imaging at 3 h post-injection and at an interval of at least 6 months after surgery to minimize the chance for false positives.

Environ Pollut, 1997, 95(3), 379 - 87
Trout farm effluents: Characterization and impact on the receiving streams; Boaventura R et al.; Effluents from three rainbow trout (Oncorhyncus mykiss) farms located in Northern Portugal were characterized and their impact on the receiving streams was evaluated . Mean fish productions in the studied fish farms were 15, 55 and 500 t of trout per year, respectively . The feeding water was abstracted from Fornelo, Inha and Coura Rivers, at flow rates ranging from 1.2 (15 t year(-1) fish farm) to 4.8 litre s(-1) per ton annual fish production (500 t year(-1) fish farm) . As the water flows through the farms, net variations in the chemical characteristics were observed: a mean reduction in the dissolved oxygen (DO) concentration between 0.7 and 2.4 mg litre(-1); mean increases between 1.9 and 3.2 mg CaCO(3) litre(-1) for total alkalinity, between 0.9 and 14 mg litre(-1) for BOD(5), between 0.27 and 1.46 mg litre(-1) for ammonia nitrogen (NH(4)?N), between 0.060 and 0.579 mg litre(-1) for soluble phosphorus (PO(4)?P) and less than 16 mg litre(-1) for suspended solids; variations in the pH value and nitrate nitrogen concentration were not statistically significant ( {Formula: see text} ) . At the 500 t year(-1) fish farm it was also possible to detect net increases of total hardness (3.2 mg CaCO(3) litre(-1)), electric conductivity (19 mS cm(-1)) and permanganate value (3.6 mgO(2) litre(-1)) . At the other farms net variations in these parameters were not significant . Net mass flow variations reported to the annual fish production are presented . The DO mass flow decreased, on average, between 255 and 549 g t(-1) of fish per day . The mean daily BOD(5) increase ranged from 353 to 1510 g t(-1) of fish . The corresponding ranges for the other parameters were 105-157 g t(-1) for NH(4)?N, 24-62 g t(-1) for PO(4)?P, 348-1035 g CaCO(3) t(-1) for total alkalinity and 224 x 10(6)-506 x 10(6) t(-1) for mesophilic bacteria . Daily net variations of suspended solids, total hardness, electric conductivity and permanganate value were below 1753 g t(-1), 342 g CaCO(3) t(-1), 2081 mS cm t(-1) and 392 gO(2) t(-1), respectively . Longitudinal concentration profiles for the most relevant parameters show the impact of the effluent discharges on the physico-chemical and bacteriological river water quality downstream from the trout farms . Analyzing the situations from a purely chemical point of view, the polluted stretches were 3, 5 and 12 km long downstream from the effluent discharges, respectively . The microbiological contamination extended over longer distances.

Toxicol Lett, 2004 Apr 1, 149(1-3), 177 - 86
Human health risk assessment of processing-related compounds in food; Tritscher AM; Many types of food processing techniques have been employed throughout human history, mainly to ensure microbiological and chemical safety of foods and to improve palatability . Growing consumer demand for healthy, nutritious and convenient food is a key driver for improvements and new developments in food processing . New processes or newly recognized compounds, often identified due to improved analytical capabilities, require careful evaluation of potential human health impact . As examples for processing-related contaminants, the risk assessments for 3-monochloropropanediol (3-MCPD) and acrylamide are discussed, exemplifying two traditional approaches in food safety assessment . 3-MCPD is formed in a variety of industrially and domestically produced foods in the presence of fat and chloride . 3-MCPD is considered a non-genotoxic carcinogen, hence a threshold of effect is assumed and sufficient data are available to establish a safe level of intake . The recent discovery of the formation of acrylamide in certain high heat-treated foods, domestically or industrially, has raised considerable concern, since acrylamide, besides neurotoxicity and reproductive toxicity, is considered as genotoxic carcinogen . Unavoidable substances considered to be genotoxic carcinogens are unwanted in foods and are usually dealt with via the ALARA principle . However, for such unavoidable substances, a quantitative risk assessment may give more useful advice to risk managers for appropriate actions . Currently, adequate dose-response relationships and mechanistic information regarding carcinogenicity of acrylamide are lacking . Once this information becomes available, the health risk from acrylamide exposure through food can be assessed.

Environ Pollut, 1989, 58(2-3), 221 - 35
A multiple testing approach for hazard evaluation of complex mixtures in the aquatic environment: the use of diesel oil as a model; Johnson BT et al.; Traditional single species toxicity tests and multiple component laboratory-scaled microcosm assays were combined to assess the toxicological hazard of diesel oil, a model complex mixture, to a model aquatic environment . The immediate impact of diesel oil dosed on a freshwater community was studied in a model pond microcosm over 14 days: a 7-day dosage and a 7-day recovery period . A multicomponent laboratory microcosm was designed to monitor the biological effects of diesel oil (1.0 mg litre(-1)) on four components: water, sediment (soil + microbiota), plants (aquatic macrophytes and algae), and animals (zooplanktonic and zoobenthic invertebrates) . To determine the sensitivity of each part of the community to diesel oil contamination and how this model community recovered when the oil dissipated, limnological, toxicological, and microbiological variables were considered . Our model revealed these significant occurrences during the spill period: first, a community production and respiration perturbation, characterized in the water column by a decrease in dissolved oxygen and redox potential and a concomitant increase in alkalinity and conductivity; second, marked changes in microbiota of sediments that included bacterial heterotrophic dominance and a high heterotrophic index (0.6), increased bacterial productivity, and the marked increases in numbers of saprophytic bacteria (10 x) and bacterial oil degraders (1000 x); and third, column water acutely toxic (100% mortality) to two model taxa: Selenastrum capricornutum and Daphnia magna . Following the simulated clean-up procedure to remove the oil slick, the recovery period of this freshwater microcosm was characterized by a return to control values . This experimental design emphasized monitoring toxicological responses in aquatic microcosm; hence, we proposed the term 'toxicosm' to describe this approach to aquatic toxicological hazard evaluation . The toxicosm as a valuable toxicological tool for screening aquatic contaminants was demonstrated using diesel oil as a model complex mixture.

Environ Pollut, 1991, 71(2-4), 131 - 69
Mercury methylation in aquatic systems affected by acid deposition; Gilmour CC et al.; Recently, it has been noted that fish in acidified lakes may contain elevated levels of mercury . While there is correlation among lakes between depressed pH and high mercury concentrations in fish, the cause of this problem is unknown . A number of hypotheses have been advanced in explanation, including increased mercury deposition, changes in mercury mobility due to acidification, pH dependent changes in mercury uptake by biota, and alterations in population size and/or structure which result in increased bioaccumulation in fish . Because fish accumulate mercury mainly in an organic form, methylmercury, changes in the biogeochemical cycling of this compound might account for elevated bioaccumulation . Mercury methylation is predominantly a microbial process which occurs in situ in lakes . This review focuses on microbiological and biogeochemical changes that may lead to increased levels of methylmercury in fresh waters impacted by acid-deposition . In particular, we focus on the hypothesis that sulfate-reducing bacteria are important mediators of metal methylation in aquatic systems and, moreover, that sulfate-deposition may stimulate methylmercury production by enhancing the activity of sulfate-reducing bacteria in sediments.

Environ Pollut, 1992, 76(2), 169 - 75
Microbiological and chemical characteristics of an acidic stream draining a disused copper mine; Walton KC et al.; Water samples draining a disused copper mine (Parys Mountain) in Anglesey, North Wales, were analysed for distribution of acidophilic bacteria (iron oxidising and heterotrophic) and for changes in physicochemical composition along the length of the drainage stream . Ten samples were taken at regular distance intervals along a 1 km stretch from the source of the acid mine drainage . The stream remained highly acidic ( {Formula: see text} ) although a slight decrease (0.6 pH unit) in acidity with distance from source was observed . Concentrations of most metals measured decreased with distance along the length of the stream, although some showed a gradual increase and others peaked at c . 200 m from source . Most dissolved iron was in the ferrous form in the upper reaches of the stream, but ferric iron became increasingly dominant downstream as a result of microbial oxidation . Although concentrations of nutrients such as nitrogen and phosphorus were low in the acid mine drainage, they were not limiting rates of bacterial iron oxidation, which appeared to be limited more by temperature . The iron oxidising bacteria Thiobacillus ferrooxidans and Leptospirillum ferrooxidans were both isolated from all sampling sites, although their relative abundances varied; L . ferrooxidans accounted for 57% of all iron oxidising isolates . Numbers of iron oxidising bacteria decreased with distance from drainage source, in contrast to those of acidophilic heterotrophic bacteria which increased . The diversity of heterotrophic isolates also increased with distance . The relationship between the chemistry and microbiology of the stream is discussed.

Environ Pollut, 1992, 77(1), 87 - 92
Comparative studies of water quality in two brackish ponds for shrimp cultivation in a salt marsh; Wong PK et al.; Physical, chemical and microbiological characteristics of two 'keiwais' (brackish ponds built along the coastal area for shrimp cultivation) in the Mai Po Marshes, Hong Kong, were measured and compared . One keiwai, located closer to the domestic and agricultural areas, had lower shrimp production than the other . Physical, microbiological and most of the chemical parameters of two keiwais showed no significant difference, while the keiwai closer to the domestic and agricultural areas had higher biochemical oxygen demand (BOD(5)), and higher levels of phosphate (PO(4)(3-)?P) and cadmium (Cd(2+)) . Results of the present study indicate that these keiwais were polluted by sewage discharged from nearby domestic, agricultural and industrial areas . The possibility that water received by the less polluted keiwai was purified by surrounding mangroves and sediments in the Mai Po Marshes is discussed.

J Oral Rehabil, 2004 Apr, 31(4), 385 - 92
Future directions in bonding resins to the dentine-pulp complex; Bouillaguet S et al.; Resin-based materials are rapidly becoming the primary restorative material to replace tooth structure and the low percentage of biological problems reported for resin-based restorations is testimony to their relative biocompatibility . Despite considerable advances in the understanding of the mechanisms, which govern the integration of resin composite materials with the dentine-pulp complex, considerable potential for improvement remains . Most of these improvements centre around a better understanding of the biological and microbiological risks of resin materials and will only be possible with improved in vitro and in vivo models . There are also a number of possible future developments in materials, clinical techniques and diagnostic methods that may improve the long-term success and reliability of resin-based restorations . The remainder of this paper describes the most likely avenues for future improvements.

Aust Vet J, 2004 Jan-Feb, 82(1-2), 69 - 74
Detection of White Spot Syndrome virus and Yellowhead virus in prawns imported into Australia; McColl KA et al.; OBJECTIVE: To determine whether viable White Spot Syndrome virus (WSSV) or Yellowhead virus (YHV) were present in prawn products imported into Australia . PROCEDURE: A sample of fourteen uncooked prawns was obtained from a consignment imported from southeast Asia . Each of the prawns was examined for WSSV by polymerase chain reaction (PCR), and then a bioassay was conducted in which a 10% homogenate of cuticular epithelium from each of the prawns was inoculated intramuscularly into healthy challenge prawns (Penaeus monodon) from Australia . The latter were then monitored for clinical signs of disease, and tissue samples were processed for electron microscopy, histological examination and for detection of WSSV by in situ hybridization (ISH) using a commercial kit . Limited numbers of haemolymph samples from inoculated challenge prawns were also examined by PCR for the presence of WSSV and YHV . All work was carried out under microbiologically secure conditions . RESULTS: Results of the initial PCR examination for WSSV on the imported prawns were not definitive . However, in the bioassay, several of the challenge prawns inoculated with homogenates from the imported prawns showed clinical signs of disease (inappetence and lethargy) within 24 h post inoculation (pi) and died at 1 to 4 days pi . Tissue samples from a number of moribund prawns demonstrated lesions typical of White Spot Disease (WSD), and the presence of the virus was confirmed by electron microscopy, ISH and PCR . YHV was also demonstrated by PCR in two challenge prawns inoculated with homogenates . CONCLUSION: Viable WSSV and YHV were present in frozen prawn products imported into Australia for human consumption from southeast Asia . Importation of frozen infected products may present a risk of transferring virus to wild and farmed populations of crustaceans in this country . To date, WSD and Yellowhead Disease remain exotic to Australia.

J Fam Plann Reprod Health Care, 2004 Apr, 30(2), 126 - 7
The laboratory diagnosis of gonorrhoea and syphilis infection; Chan EL et al.; Following a decline in prevalence during the 1980s and early 1990s, gonorrhoea and syphilis infections are once again posing a threat to public health . In addition, the antibiotic sensitivity pattern for gonorrhoea appears to have changed with an increased prevalence of resistance . Both syphilis and gonorrhoea appear to disproportionately affect MSM and black ethnic minorities, and are concentrated in urban areas . Their diagnosis requires microbiological tests to be performed appropriately, and a rapid diagnosis can often be provided in GUM clinics using near-patient microscopy . Early diagnosis and effective, rapid treatment is crucial in limiting the morbidity for the affected individual and the public health risks resulting from the spread of infection.

J Heart Valve Dis, 2004 Mar, 13(2), 200 - 8; discussion 208-9
Native versus primary prosthetic valve endocarditis: comparison of clinical features and long-term outcome in 353 patients; Romano G et al.; BACKGROUND AND AIM OF THE STUDY: The study aim was to compare preoperative and intraoperative features, and long-term outcome of patients operated on for native (NVE) and primary prosthetic valve endocarditis (PVE) . METHODS: Between January 1978 and December 2002, 258 patients (mean age 47.5 +/- 16 years) were referred for NVE, and 95 for PVE . Demographics, clinical preoperative conditions, indications to surgery, microbiological data, surgical pathology, early postoperative course and long-term outcome were compared via hospital chart review and outpatient clinic follow up . RESULTS: Female sex prevailed in the PVE group (49.5%) versus NVE (27.1%; p < 0.0001) . Mitral valve involvement was more common in PVE (46.3% versus 24.8%, p = 0.0001), and multivalvular in 16.3% of NVE patients versus 4.2% of PVE (p = 0.001) . Active endocarditis (80.6% versus 58.9%, p = 0.00004) and preoperative embolism (29.5% versus 11.6%, p = 0.0002) were significantly prevalent in the NVE group . Emergency operation (21.1% versus 10.5%, p = 0.009) and preoperative NYHA class IV or V (40% versus 19.8%, p < 0.0001) were significantly more frequent in PVE . Overall hospital mortality was 11.3% (n = 40), with 6.6% among NVE patients and 24.2% among PVE (p < 0.0001) . Mean follow up (94% complete) was 5.8 +/- 5.3 years (6.0 +/- 5.5 years for NVE versus 5.1 +/- 4.6 years for PVE, p = 0.191), and total follow up was 1,707.85 patient-years . Actuarial survival at 1, 5, 10 and 15 years was respectively 91, 82, 67.5 and 48.8% in NVE, and 79.7, 64.2, 33.5 and 33.5% in PVE (p = 0.0016) . A significantly lower survival in PVE versus NVE was found for the mitral site subgroup (p = 0.018), but not for the aortic site (p = 0.14) . Actuarial freedom from reoperation for recurrent endocarditis at 1, 5, 10 and 15 years was 97.5, 91.4, 80.5 and 49.4% in NVE versus 90.8, 84.9, 59.4 and 43.9% in PVE (p = 0.015) . CONCLUSION: PVE patients were older, presented with more compromised clinical conditions, and had worse early and long-term outcomes than NVE patients . PVE had a higher incidence of recurrence and worse prognosis, especially if the mitral valve was involved.

Isotopes Environ Health Stud, 2004 Mar, 40(1), 75 - 80
Helicobacter pylori determination in non-municipal drinking water and epidemiological findings; Krumbiegel P et al.; BACKGROUND: Studies conducted in Europe as well as in North and South America have tried to link Helicobacter pylori colonization with the drinking water supply, especially since H . pylori is known to survive quite well in water . METHODS: In 2000, a cohort of 1884 grade-two children from two rural counties surrounding the city of Leipzig, Germany (77.4% of the 1991/1992 birth cohort) were tested for H . pylori colonization using the {13C}urea breath test . A parent-completed questionnaire elicited details on living conditions and lifestyle habits including questions on the children's drinking water from sources other than public water supplies, swimming in natural waters, etc . In a second independent study, samples of well water, taken from 157 private wells still used in the two counties, were being tested for the presence of H . pylori, using polymerase chain reaction (PCR) method to determine relevant target DNA fragments of H . pylori . RESULTS: In county I, 5.7% of the children and in county II 6.6% tested H . pylori-positive . Cluster analyses of the questionnaire data in both counties pointed to 'drinking water from other than municipal sources', as the closest H . pylori-associated cluster variable . The cluster estimations were supported by odds ratio (OR) calculations with an OR=16.4 (95% confidence interval (CI) 3.1,...,88.5) for county I and OR=4.0 (95% CI 1.3,...,12.4) for county II . The PCR analyses showed H . pylori DNA fragments in 10.8% of the wells in county I and 9.2% in county II . The detection limit was set at 10 DNA copies corresponding to 125 bacteria/L, the average infestation of these wells was 931 bacteria/L . CONCLUSION: Despite the fact that the microbiological and epidemiological data do not correspond except that both studies were conducted in the same geographical areas, the independent findings of H . pylori in well water in the same general areas where children do seem to drink water other than from the public water supply suggests that water may be an important source of H . pylori infection.

Isotopes Environ Health Stud, 2004 Mar, 40(1), 3 - 19
Transport and geochemical controls on the distribution of solutes and stable isotopes in a thick clay-rich till aquitard, Canada; Hendry MJ et al.; A comprehensive understanding of the transport and geochemical processes controlling solutes in clay-rich aquitard confining units is needed to accurately predict the long-term migration of contaminants into the subsurface . To this end, the geochemical and stable isotopic composition of porewaters in the upper 22 m of a thick, unoxidized and nonfractured clay-rich, till aquitard (Sutherland Group) was examined in detail . The aquitard is overlain by about 8 m of oxidized and fractured till (Floral Fm) . Concentrations of TDS, SO4(2-), HCO3-, Cl-, Na+, Mg2+, Ca2+ and porewater deuterium were greater in the Floral Fm and decreased with depth through the aquitard . The elevated and seasonably variable solute concentrations in the oxidized Floral Fm were attributed to geochemical weathering and dynamic water movement through fractures . Good fits between measured delta2H, TDS, SO4(2-), Cl- and HCO3- profiles through the aquitard and simulated solute transport profiles were obtained by diffusion (without advection) with transport times of 4-6 ka . The deficiency of geochemical reactions affecting HCO3- and SO4(2-) in the aquitard was supported by delta13C(DIC) and delta34S(SO4) analyses . Geochemical and isotope mass balance modelling (NETPATH) indicated that diffusive mixing with minor calcite dissolution and ion exchange could account for the distribution of Na+, Ca2+ and Mg2+ in the aquitard . Results of this study further suggested that microbiological activity in the aquitard was limited . With minor exceptions, the solute and isotopic profiles, their transport and the controlling geochemical reactions in the Sutherland are similar to those determined at another clay-rich till aquitard, 160 km south of this site, suggesting that geochemical and biological processes in some clay-rich aquitards may have a minimal effect on the migration of dissolved constituents.

Arch Anim Nutr, 2004 Feb, 58(1), 89 - 98
Physiological effects of lactulose and inulin in the caecum of rats; Zdunczyk Z et al.; A model experiment was performed on rats to evaluate the effect of partial or total substitution of saccharose (S) and cellulose (C) by preparations of lactulose and inulin on the development and metabolism of the caecum . In the experimental diets given to rats for 4 weeks, the examined preparations were administered either with an equivalent amount of cellulose (each at 4% of the diet) or as sole source of dietary fibre at 8% of the diet . Compared to the saccharose group cellulose had no effect, and low doses of lactulose and inulin in the diet increased to a medium extent the weight of the caecum wall and caecal digesta . The addition of lactulose and inulin at 8% increased significantly the content of caecal digesta (4.62 and 4.11 g/100g BW, respectively) and the weight of the caecal wall (1.10 and 0.86 g/100g BW, respectively), compared to the groups with saccharose and cellulose (0.73, 0.90 and 0.24, 0.28 g/100g BW, respectively) . Cellulose and cellulose partially-substituted with lactulose and inulin caused an increase in the dry matter content of caecal digesta (26.5-27.5%), compared to other groups (21.8-22.8%) . The administration of lactulose and inulin preparations was accompanied by a significant drop in pH (5.47-5.81), compared to the groups with cellulose or saccharose (6.83-6.91), and a decrease in the ammonia concentration in the caecal digesta, compared to the cellulose control (0.27-0.40 and 0.62 mg/g, respectively) . The group with 8% lactulose was characterized by the highest activities of microbiological alpha- and beta-galactosidase and beta-glucosidase in the caecal digesta . Cellulose and both preparations significantly decreased the activity of beta-glucuronidase, compared to the saccharose group (0.39-0.89 and 1.52 U/g, respectively) . The highest concentration of VFA in the caecal digesta was observed in the saccharose group (89.2 micromol/g), and the lowest concentration in the group where cellulose was totally substituted by lactulose and inulin (55.1 and 57.5 micromol/g, respectively) . The total production of VFA in the caecum was fourfold higher with 8 % lactulose and inulin (254.7 and 236.4 micromol/100g BW, respectively) than in both controls groups (65.1 and 67.8 micromol/100g BW, respectively) . The high dose of inulin and lactulose increased the share of propionic acid in the VFA profile (C2:C3:C4) compared to both control groups . When 4% inulin was added to the diet a significant increase of butyrate concentration in the caecum was observed.

Clin Oral Implants Res, 2004 Apr, 15(2), 174 - 9
Microbiological and clinical effects of chlorhexidine enclosed in fixtures of 3I-Titamed implants; Groenendijk E et al.; This double-blind study used a split-mouth design to investigate the microbiological and clinical effects of 0.2% chlorhexidine enclosed in fixtures . Twelve patients had 46 fixtures implanted . At second-stage surgery, a microbiological sample (baseline sample) of the inner parts of the fixtures was taken . Then, a 0.2% chlorhexidine solution was applied into the inner space of 23 fixtures (test group), and in 23 fixtures saline was applied (control group) . Abutments were installed and gingival index, plaque index and crevicular fluid flow were monitored weekly . After 6 weeks, a second microbiological sample of the inner part of the fixtures was taken . At baseline, viable bacteria were detected within 46% of the fixtures . After weeks, bacteria were found in 87% of the fixtures . The numbers of bacteria in the control group were significantly higher than those in the test group . The results indicate that, after first-stage surgery, contamination of the inner spaces of the fixtures is commonplace . Application of a 0.2% chlorhexidine solution at second-stage surgery inhibits growth or acquisition of bacteria in the fixtures . In both test and control groups, the crevicular fluid flow as well as the gingival index decreased during the experimental period . At 4, 5, and 6 weeks after chlorhexidine application, these values in the test group appeared lower, but did not attain statistical significance.

Chemotherapy, 2004 Apr, 50(1), 17 - 21
Pharmacokinetics of cationic liposome-encapsulated doxycycline in mice challenged with genital infection by Chlamydia trachomatis; Selliah S et al.; Our previous studies demonstrated the efficacy of cationic liposome-encapsulated doxycycline (CaL-DOX) on the course of infection with Chlamydia trachomatis in vitro and in vivo . In this investigation, the pharmacokinetics of CaL-DOX are reported . Female mice inoculated intravaginally with 4.84 x 10(5) inclusion-forming units were treated intramuscularly, 3 days postinfection, as determined by a preliminary study, with 0.1 ml of unencapsulated doxycycline (DOX) or CaL-DOX, at 10 microg/ml body weight for 3 consecutive days . Sampling was performed at 12, 24, 48, 72 and 96 h after treatment . The microbiological test was used to measure the DOX concentration in sera, liver, kidneys and genital organs . The maximum concentration in kidneys, liver and genital organs was higher in mice treated with DOX than in those treated with CaL-DOX . However, in sera, the amount was similar to that in mice treated with DOX . The DOX concentration found in mice treated with CaL-DOX was much less than in those treated with unencapsulated DOX . This may have a direct impact on the secondary effects caused by the medication . Decreased secondary effects should have a positive outcome on patient physical and mental health . Even if this study is the only one of its kind so far, CaL-DOX could be an alternative solution for the treatment of chlamydial infections .

Nefrologia, 2004, 24 Suppl 2, 1 - 42
{Guideline for dialysate (LD) quality of Spanish Society of Nephrology}; Perez Garcia R et al.; A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology . The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems . The Guideline was based on the European pharmacopoeia, the Real Farmacopea Espanola, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group . Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate . Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis . Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: {table: see text} Monitoring frequency, maintenance and corrective actions were specified . Methods of sampling and analysis were described in appendix (Anexos) . For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C . The dialysate quality assurance process involves all dialysis staff members and requires strict protocols . The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality . All suggestions and questions about this Guideline are wellcome to www.senefro.org

Nat Rev Microbiol, 2004 Mar, 2(3), 259 - 62
Opinion: Politics, media and microbiologists; Pennington H; Severe acute respiratory syndrome (SARS) took everybody by surprise . Its emergence was one of the most significant microbiological events of 2003 . It challenged microbiologists to identify the aetiological agent and satisfy Koch's postulates - in so far as they ever can be met for a virus - in real time . Not only were the patients' respiratory secretions and the agents grown in cultured cells put under the microscope, but so were the actions of politicians . What lessons can we learn from SARS?

Sci Total Environ, 2004 May 5, 323(1-3), 21 - 32
Environmental hypothesis: is poor dietary selenium intake an underlying factor for arsenicosis and cancer in Bangladesh and West Bengal, India?
Spallholz JE, Mallory Boylan L, Rhaman MM.
To reduce the incidence of dysentery, cholera and other water-borne diseases and mortality of people drinking from surface contaminated sources of water, the World Bank and United Nations Children's Fund began to sink tube wells into the underlying aquifers of Bangladesh and West Bengal, India, in the 1970s . Many of the tube wells were drilled into underground aquifers that provided microbiologically clean water that was later determined to contain arsenic (As) . As contamination of drinking water is a problem of natural occurrence throughout the world and domestic water often exceeds the World Health Organization limit of 50 microg As/l in the countries of Bangladesh, West Bengal, India and Nepal as well as other areas occupying much of the Ganges-Brahmaputra delta . It is estimated that as many as one-half of these tube wells discharge water with sufficient amounts of As to produce arsenicosis, i.e . As toxicity in the human population . Access to clean As free water is the priority of most organized relief efforts . Where As free domestic water cannot be provided, an improved diet and/or dietary supplements may ameliorate As toxicity or prevent its toxicity all together . The dietary status of the essential human trace element, selenium (Se) may be adversely affected by a chronic excessive ingestion of As . As added to animal diets has been known to counteract Se toxicity in animals since the 1930s . It is reasoned therefore, that high levels of chronic As ingestion from well water by people within the delta will accelerate the excretion of Se lowering the body's content of this essential trace element . Excessive Se excretion owing to Se/As complexation may add to the likelihood of As being more toxic and carcinogenic over time, due to the oxidative stress imposed by the excessive As and low Se ingestion . Because of the unique environment of the Ganges-Brahmaputra delta in which millions of people are presently exposed to As, we ask the question: are low dietary Se ingestion and accelerated Se depletion by As possible contributing factors to arsenicosis?

Bioresour Technol, 2004 Aug, 94(1), 57 - 63
Technologically indicative properties of straw fractions of flax, linseed (Linum usitatissimum L.) and fibre hemp (Cannabis sativa L.); Kymalainen HR et al.; In this study of the behaviour of the fractions of unretted and frost-retted fibre straws in damp air, a production scale method to separate fibre and shive from fibre plants was introduced and tested on bast fibre plants (Linum usitatissimum L . and Cannabis sativa L.) . The method consists of optional drying of stalks, unloading bales, milling the straws with a hammer mill, separating the fractions from air stream with a cyclone and finally separating fibres from shives with a screening drum . Fractions were characterized focusing on technologically indicative properties such as equilibrium moisture content, ash and microbiological quality . Unretted fractions of the bast fibre plant stem reached higher equilibrium moisture contents than the retted fractions, and hemp fibres absorbed more moisture from air than did the Linum fibres . In very humid air, all fractions began to lose weight due to moulding . The weight decrease during the first week was lower in frost-retted than in unretted fractions . The frost-retted fractions appeared to be more resistant to humidity in the short term . The total number of microbes and especially the numbers of yeasts and moulds can be used as a criterion of hygienic level . For green fractions, the mould level was similar in fibres and in shives, but frost-retted shives contained more moulds than the unretted shives . The mould content of a fraction had no direct correlation with the moulding tendency of the fraction . The ash contents of fibres were somewhat higher than those of shives, due to a probable soil contamination . Ash content did not have significant correlation with microbiological quality, although ash is a possible risk factor for hygienic quality . According to the results of this study it is highly important to study the quality of the production chain of bast fibre plants to ensure the quality of industrial products . From the producer's point of view, raw material with defined quality can be directed to the most suitable application . The behaviour of fractions in various ambient atmospheres, and other quality aspects such as hygienic level can be used as criteria for defining the most appropriate product applications.

Int J Pharm, 2004 May 4, 275(1-2), 211 - 5
Endotoxin testing in inhalation grade lactose-a useful quality parameter?
Steckel H, Furkert FH.
Alpha-lactose monohydrate is the standard carrier used for dry powder inhalation drug products . The physico-chemical characteristics of this carrier material need to be monitored and specified carefully in order to guarantee functionality of the powder formulation . But also microbiological acceptance criteria need to be considered during development and routine testing . In this study, the endotoxin content of 19 batches of alpha-lactose monohydrate provided by two different manufacturers was determined with a semi-quantitative LAL assay . The endotoxin content was found to be less than 18 endotoxin units (EU)/g lactose in all cases and less than 3 EU/g in most cases . Assuming that the typical lactose has an endotoxin content of 10 EU/g and that a patient inhales six times daily 25 mg of lactose and that the total amount of lactose reaches the lung, this translates to an endotoxin exposure of 1.5 EU per day . On the other hand, the proposal for endotoxins in air limits the endotoxin concentration to 50 EU/m3 which corresponds to approximately 3333 EU inhaled endotoxins a day during normal breathing (breathing at rest conditions) . The maximum endotoxin exposure by dry powder inhalations is thus two log steps lower than the recommended acceptable daily intake.

Int J Antimicrob Agents, 2004 Apr, 23(4), 371 - 6
The influence of indomethacin co-administration on ofloxacin levels in plasma and cerebrospinal fluid in rats; Dontas I et al.; The possible increase of ofloxacin levels in serum and cerebrospinal fluid (CSF) by concomitant indomethacin administration was investigated in 120 healthy adult rats . The animals were administered intramuscular doses of ofloxacin 30 mg/kg alone (Group A, n = 60) or with indomethacin 2 mg/kg (Group B, n = 60) . Blood and CSF samples were obtained from both groups at 30, 45, 60 and 90 min post-administration . Concentrations of ofloxacin were estimated using a microbiological assay . Co-administration of indomethacin did not affect plasma levels of ofloxacin significantly; however, higher levels were found in all CSF samples after co-administration with indomethacin, particularly after 90 min with 0.59 microg/ml versus zero median values when only ofloxacin was administered (P = 0.05) . No central nervous system adverse effects were observed clinically . No correlation between levels of ofloxacin in plasma and CSF could be established either in rats administered only ofloxacin or in rats administered both drugs . The presented pharmacokinetic findings revealed that co-administration of ofloxacin and indomethacin may result in protracted quinolone levels in the CSF . However, the absence of significant correlation between concentrations of ofloxacin in plasma and CSF upon co-administration of indomethacin, as well as of central nervous system adverse effects, make the probability of an epileptogenic interaction between them unlikely . These results merit further clinical evaluation.

Emerg Infect Dis, 2004 Jan, 10(1), 76 - 81
Nosocomial bloodstream infection and clinical sepsis; Hugonnet S et al.; Primary bloodstream infection (BSI) is a leading, preventable infectious complication in critically ill patients and has a negative impact on patients' outcome . Surveillance definitions for primary BSI distinguish those that are microbiologically documented from those that are not . The latter is known as clinical sepsis, but information on its epidemiologic importance is limited . We analyzed prospective on-site surveillance data of nosocomial infections in a medical intensive care unit . Of the 113 episodes of primary BSI, 33 (29%) were microbiologically documented . The overall BSI infection rate was 19.8 episodes per 1,000 central-line days (confidence interval {CI} 95%, 16.1 to 23.6); the rate fell to 5.8 (CI 3.8 to 7.8) when only microbiologically documented episodes were considered . Exposure to vascular devices was similar in patients with clinical sepsis and patients with microbiologically documented BSI . We conclude that laboratory-based surveillance alone will underestimate the incidence of primary BSI and thus jeopardize benchmarking.

Mycoses, 2004 Apr, 47(3-4), 163 - 7
Aspergillus niger infection in patients with haematological diseases: a report of eight cases; Fianchi L et al.; In this paper we analysed clinical, laboratory characteristics and outcome of patients with haematological diseases who developed an Aspergillus niger infection, in a multicentre study involving 14 Italian Haematological Divisions during a 10-year period . The study recorded 194 consecutive microbiologically documented aspergilloses, eight of which (4%) were due to A . niger, and were observed only in five of the participating centres . The primary localization of infection was lung in seven cases and paranasal sinus in one case . Seven patients died at the end of follow-up . The death was mainly attributable to A . niger progression in six of them . Our study that collected the largest number of cases of A . niger infection in haematological malignancies confirms that this infrequent complication is characterized by a high mortality rate.

J Chemother, 2004 Feb, 16(1), 62 - 9
Management of complicated appendicitis and comparison of outcome with other primary sites of intra-abdominal infection: results of a trial comparing ertapenem and piperacillin-tazobactam; Teppler H et al.; A post-hoc analysis of data from a trial of complicated intra-abdominal infection was performed to compare the demographic and disease characteristics of patients with complicated appendicitis to those whose primary infection involved other intra-abdominal sites, assess the impact of site of primary infection on outcome, and compare the efficacy and safety of ertapenem 1 g daily with piperacillin-tazobactam 3.375 g every 6 h for treatment of complicated appendicitis . Compared with patients who had primary infection of the colon or another site in the abdomen, patients with complicated appendicitis were younger, had less severe disease (based on lower APACHE II score and lower proportion with generalized peritonitis), and were less likely to be managed by percutaneous drainage of an abscess or to have a postoperative infection . Patients with complicated appendicitis were more likely to have a favorable outcome than were patients with infection of the colon (OR, 3.02; 95% CI, {1.54-5.901; P = .001) . At the test-of-cure assessment, 109/123 (88.6%) microbiologically evaluable patients with complicated appendicitis who received ertapenem and 102/113 (90.3%) who received piperacillin-tazobactam had a favorable combined clinical and microbiologic outcome . The frequency and severity of drug-related adverse events were similar in the two treatment groups.

Water Sci Technol, 2004, 49(4), 201 - 6
Electrochemical oxidation of drug residues in water by the example of tetracycline, gentamicine and aspirin; Weichgrebe D et al.; Electro-chemical oxidation as a method to destroy drug residues like aspirin, tetracycline or gentamicine in water was investigated with C-anodes (modified by manganese oxides) and Pt anodes . The mechanism of aspirin and tetracycline oxidation and the influence of the biocide effect was observed using GC-MS and three different microbiological tests . In general, the biological availability increases with progressive oxidation of the antibiotics.

Ann Surg, 2004 Mar, 239(3), 409 - 16
Clinical and therapeutic features of nonpostoperative nosocomial intra-abdominal infections; Montravers P et al.; OBJECTIVE: To compare the clinical, microbiological, and therapeutic features of nonpostoperative nosocomial intra-abdominal infections (non-PostopNAI) with community-acquired intra-abdominal infections (CAI) . SUMMARY BACKGROUND DATA: Prospective (June 2000 through January 2001) consecutive case series analysis of patients operated for secondary nonpostoperative intra-abdominal infections collected in 176 study centers (surgical wards and intensive care units) . PATIENTS AND METHODS: Clinical, microbiological, and therapeutic characteristics of CAI and non-PostopNAI infections were collected . Management of antibiotic therapy was decided by the attending physician . The efficacy of treatment was evaluated over a 30-day period after the index episode . RESULTS: Evaluatable observations (n = 1008) were collected (761 CAI and 247 non-PostopNAI), including 285 intensive care unit patients . When compared with CAI patients, non-PostopNAI patients presented an increased interval between admission to the surgical ward and operation (1.3 +/- 1.5 vs . 0.5 +/- 0.7 days in CAI patients; P < 0.001), increased proportions of underlying diseases, a more severe clinical condition as assessed by increased proportions of hospitalization in the intensive care unit (48% vs . 22% in CAI patients, P < 0.001) and a higher SAPS II score (34 +/- 15 vs . 24 +/- 14, P < 0.001) . In non-PostopNAI patients, increased proportions of therapeutic failure (15% vs . 7% in CAI patients, P < 0.01) and of fatalities (12% vs . 4% in CAI patients, P < 0.001) were observed . CONCLUSIONS: Delayed diagnosis and increased severity are the main characteristics of non-PostopNAI infections . Microbiological features are quite similar in CAI and non-PostopNAI infections, suggesting that antibiotic therapy recommended for CAI infections could be applied to non-PostopNAI patients . Characteristics of non-PostopNAI patients should lead to identify them as a specific entity in clinical trials.

Int J STD AIDS, 2004 Apr, 15(4), 238 - 9
How useful are high vaginal swabs in general practice? Results of a multicentre study; Jungmann E et al.; Vulvovaginal symptoms are a common reason for consultation with a general practitioner (GP) . High vaginal swabs (HVS) are used to investigate symptoms, but their usefulness is poorly evaluated and microbiological tests performed vary between laboratories . In this multicentre study of 797 women with genital symptoms attending GPs, diagnostic yield of HVS was poor except for Candida spp . (22%) . There is an urgent need to establish the most cost-effective approach for the management of these women.

Mod Pathol, 2004 Jul, 17(7), 857 - 60
Bacterial vaginosis: comparison of Pap smear and microbiological test results; Tokyol C et al.; Our purpose was to determine the reliability of the Pap smear in making the diagnosis of bacterial vaginosis and to examine the characteristics of Pap smear vs vaginal culture in diagnosis of bacterial vaginosis, with the vaginal Gram stain used as the diagnostic standard . We performed a prospective, blinded study involving 245 women who referred to the Department of Gynecology and Obstetrics in our hospital for routine genital examination between September 2001 and September 2002 . Exclusion criteria included vaginal bleeding and pregnancy . Each patient had standard Pap smear, Gram-stained vaginal smear and culture of vaginal swab . The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic value of Pap smear and vaginal culture results were determined with Gram stain used as the standard for diagnosis of bacterial vaginosis . Using Gram stain diagnosis of bacterial vaginosis as the standard, Pap smear and vaginal culture test results had sensitivity of 43.1 and 77.8%, specificity of 93.6 and 97.7%, positive predictive value of 73.8 and 93.3%, negative predictive value of 79.8 and 91.4%, diagnostic value of 78.8 and 91.8%, respectively, for the diagnosis of bacterial vaginosis . Compared to the microbiological test results, Pap smear is not sensitive enough for screening of bacterial vaginosis . However, because of its high specificity, it may be an adequate diagnostic criteria when it is positive .

J Clin Microbiol, 2004 Apr, 42(4), 1547 - 51
Practical strategies for performance optimization of the enhanced gen-probe amplified mycobacterium tuberculosis direct test; Sloutsky A et al.; The enhanced Gen-Probe Amplified Mycobacterium Tuberculosis Direct (MTD) test was evaluated using a combined set of 338 acid-fast smear-positive and smear-negative, respiratory and nonrespiratory clinical specimens received by the Massachusetts State Tuberculosis Laboratory from September 1999 through March 2002 . Microbiological culture was used as the reference method; therefore, the sensitivity and specificity of the MTD test were calculated for culture-positive specimens only . The initial assessment indicated that the overall sensitivity, specificity, and positive and negative predictive values of the MTD test for all specimens grouped together were 62, 98, 99, and 68%, respectively . A detailed discrepancy analysis revealed that two major factors causing negative MTD results in specimens that were culture positive for M . tuberculosis complex were patient treatment with antituberculosis drugs prior to testing and the presence of inhibitory substances in the specimen . Based on these findings, a protocol for optimizing MTD test performance in this setting is proposed in which (i) specimens from patients taking antituberculosis medications are excluded from testing and (ii) all initially MTD-negative or MTD-equivocal specimens are subjected to testing for inhibitors . If this strategy was followed, the MTD test sensitivity would be at least 91%, a significant improvement over the initial sensitivity of 62% . Accordingly, the negative predictive value would increase from 68 to 91%.

Arch Orthop Trauma Surg, 2004 Jun, 124(5), 346 - 8 Epub 2004 Apr 07.
Tuberculous osteomyelitis of the lumbosacral region: a spinal epidural abscess with presacral extension; Buyukbebeci O et al.; INTRODUCTION: Tuberculous osteomyelitis in the lumbosacral region is an uncommon occurrence, and its treatment is not well-defined in the literature, particularly when it is associated with abscess formation . We present the outcome of a patient who had an epidural abscess with presacral extension . MATERIALS AND METHODS: A 30-year-old man had microbiologically confirmed tuberculous infection of the lumbosacral vertebrae complicated by extensive abscess formation . After a trial of chemotherapy, the infection proved refractory, and the treatment proceeded with abscess drainage through the anterior route . RESULTS: Approximately 1 year after surgery, the patient was symptom-free and did not show any significant radiologic changes . CONCLUSION: Antituberculous chemotherapy combined with anterior surgery seems to be beneficial in the setting of lumbosacral osteomyelitis complicated by epidural abscess formation with presacral extension.

Toxicol Lett, 2004 Apr 15, 150(1), 25 - 7
Nutraceutical/drug/anti-terrorism safety assurance through traceability; Lachance PA; Nutraceuticals are naturally occurring/derived bioactive compounds that are reported to have health benefits . The delivery systems for nutraceuticals are foods (functional foods), supplements, or both . Drugs are designed to have medicinal properties for the prevention and treatment of identified diseases or signs and symptoms of disease . Counterfeit drugs contain either placebo, materials not identified in the labeling or substandard or impure materials, which may produce untoward pharmacological or toxicological effects . In addition, the consumer has the right to microbiological safety and prevention from adverse exposure to hazardous chemical(s), and other adverse compounds . Nutraceutical/drug delivery systems are viewed as approaches to (1) enhanced consumer health, (2) decreased healthcare costs, and (3) enhanced economic development . Therefore, the nutra/pharma/ceutical industry is reliant upon a strong underpinning of diversified research that addresses safety and assures chemical and biological efficacy . Significant safety through traceability can be assured by the coupling of the technologies of (a) global positioning (GPS); (b) bar/chip coding; and (c) hazard analysis critical control point (HACCP) management, coupled to rapid nanotechnology marker assays now under development.

Australas J Dermatol, 2004 May, 45(2), 114 - 8
Unusual case of subcutaneous panniculitis-like T-cell lymphoma; Wells J et al.; An unusual case of subcutaneous panniculitis-like T-cell lymphoma is presented involving multiple organ systems, which eventually culminated in rapid demise from the haemophagocytic syndrome, after an initial protracted course . A 44-year-old man presented in April 2001 with bronchiolitis obliterans organising pneumonia that initially responded well to corticosteroids . However, the condition relapsed on attempted prednisone withdrawal in January 2002 and the patient was noted to have developed truncal subcutaneous nodules . Initial skin biopsy revealed lobular panniculitis, with negative microbiological culture . In July 2002, mononeuritis multiplex was diagnosed after the patient presented with paresthesiae and was treated with pulse cyclophosphamide therapy . By November 2002 there was ulceration of the subcutaneous nodules . Repeat skin biopsy revealed subcutaneous panniculitis-like T-cell lymphoma . The clinical manifestations were supportive of an unifying diagnosis of malignancy involving pulmonary, cutaneous and nervous systems . Combination chemotherapy with fludarabine, mitoxantrone and dexamethasone was commenced . However, the patient deteriorated, with fevers, weight loss, pancytopenia and laboratory features consistent with the haemophagocytic syndrome . Despite maximal supportive therapy the patient succumbed to his disease.

Cent Eur J Public Health, 2004 Mar, 12(1), 3 - 5
Rapid detection of bacterial atypical pneumonia agents by multiplex PCR; Pinar A et al.; Approximately one third of community acquired pneumonia cases are caused by atypical pneumonia agents, Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydophila pneumoniae (formerly Chlamydia pneumoniae) . The laboratory diagnosis of these organisms is difficult and time-consuming by conventional microbiological techniques . Polymerase chain reaction (PCR) is one of the important tools which can circumvent this problem . A multiplex PCR assay was developed to achieve the diagnosis of these three organisms in a single tube . Primers used in PCR were selected in a way that they amplified different length DNA fragments from different agents but they all worked at the same amplification conditions . Therefore the organisms could be diagnosed according to the length of amplified products by agarose gel electrophoresis without using any hybridization probes . After development of the multiplex PCR method, totally 309 clinical samples which were sent to our laboratory for single-agent PCR, were also evaluated by this technique . The results showed that the multiplex PCR assay is a sensitive, useful, cheap, and rapid diagnostic tool for the management of pneumonia patients.

J Hosp Infect, 2004 Apr, 56(4), 318 - 20
Pressure sore prevention pads as an infective source in orthopaedic theatres; Ranawat VS et al.; Current theatre practice and protocol involves the use of pressure sore prevention pads in the positioning and support of all patients undergoing orthopaedic surgery . Microbiological swabs were taken from those pads placed adjacent to the operative field immediately before implant surgery . Eleven out of the 13 pads sampled yielded bacterial growth capable of causing deep-seated infection . The transfer of these pads between the designated orthopaedic theatres and the rest of the theatre complex was also noted . We recommend that the use of these pads should be closely reviewed . They should either be used with stricter guidelines for decontamination between use or disposable 'clean' alternatives sought.

J Infect, 2004 May, 48(4), 303 - 6
Procalcitonin in severe acute respiratory syndrome (SARS); Chua AP et al.; OBJECTIVE AND METHODS: The role of procalcitonin (PCT) in severe acute respiratory syndrome (SARS) has not been highlighted so far . We described retrospectively eight cases of sepsis from pneumonia of various microbiological aetiologies including two due to SARS, compared their PCT concentrations and provided further descriptors of SARS as a viral pneumonia . RESULTS: Like any viral pneumonia, patients with SARS had low PCT levels in contrast to bacterial or fungal pneumonia . CONCLUSIONS: In the setting of pneumonia with a finding of low PCT, testing for SARS should be considered, especially if there is a positive travel or contact history . During a SARS epidemic, we also strongly advocate isolating all suspected community acquired pneumonia with a low PCT level.

Acta Clin Belg, 2004 Jan-Feb, 59(1), 24 - 9
Clinical impact of the fungicidal activity of caspofungin administered alone or in combination in critically ill patients with severe abdominal candidiasis refractory to conventional antifungal drugs: case studies and critical review of the problem; Canivet JL; We discuss two cases of abdominal candidiasis in critically ill patients with multiple organ failure and sepsis . Microbiological and clinical courses remained unresponsive to apparently appropriate antifungal therapy with azole or polyene derivatives . Both microbiological and clinical outcomes dramatically improved after starting caspofungin therapy . Lack of cross-resistance, lack of toxicity and potent fungicidal activity make caspofungin a very attractive drug in life threatening abdominal candidiasis . The optimal treatment of life threatening candidiasis remains a controversial issue . Because of recent advances in the field, we propose a critical review of the problem of refractory candidiasis.

Pathol Biol (Paris), 2004 Apr, 52(3), 131 - 7
{Prospective follow-up of hospital-acquired diarrhoea in 28 paediatric wards of the south-east part of France during a winter season}; Thuret A et al.; The aim of this study was to evaluate the risk of hospital-acquired diarrhoea during an epidemic period through a prospective multicentre observational study . A systemic investigation of the hospital-acquired diarrhoea (occurring at least 48 h after hospital admission) was conducted through a standardised questionnaire from January to March 1999 in patients of 5 years old or less hospitalised in 28 wards (620 beds) belonging to 20 hospitals located in the south-east part of France . Overall, 241 cases of hospital-acquired diarrhoea were collected, corresponding to a prevalence of 3.3% (3.6% after exclusion of patients admitted for diarrhoea) and a density of incidence of 0.81 per 100 days of hospitalisation . The mean stay duration of hospital-infected patients was greater than 10 days, versus 3.9 days for the other children (P < 0.001) . A readmission was required in 27% of the infected children . Rotavirus was involved in 97.8% of microbiologically documented cases (88%) . In 50% of the cases, the hospital-acquired diarrhoea was seen in patients with bronchiolitis . Contact isolation measures were prescribed in 88.4% of the cases . These results stress that hospital-acquired diarrhoea represent an important medical and economic load for paediatric units and could be used as reference data to evaluate the impact of preventive measures, especially to reduce readmission and mean stay duration.

Perspect Biol Med, 2004 Winter, 47(1), 47 - 66
From "butyribacterium" to "E . coli": an essay on unity in biochemistry; Friedmann HC; New ideas in science frequently arise from neglected or distorted antecedents . This essay deals with the idea of biochemical unity, encapsulated in Jacques Monod's well-known phrase, dating from 1954: "Anything found to be true of E . coli must also be true of elephants." An earlier version of this phrase,--"From the elephant to butyric acid bacterium--it is all the same!"--was coined in 1926 by the Dutch microbiologist Albert Jan Kluyver . In that year Kluyver and his associate Hendrick Jean Louis Donker published a celebrated paper, "Unity in Biochemistry." The concept of biochemical unity had many antecedents, but these had never caught on . The Kluyver-Donker paper has often been regarded to provide a boost to biochemical and especially to microbiological thinking . Its interpretations and misinterpretations represent an encapsulated history of biochemistry . The present paper examines the history of the concept of biochemical unity from before to beyond Kluyver, investigates the two "elephant" phrases and their possible relationships, and ends with a discussion of the attractiveness of unifying ideas in science.

Clin Microbiol Infect, 2004 Apr, 10(4), 322 - 6
Testing for viral penetration of non-latex surgical and examination gloves: a comparison of three methods; O'Connell KP et al.; Currently, there are no international standards based on microbiological methodology for testing the ability of medical examination or surgical gloves to prevent the passage of viruses . Three protocols for the direct examination of the viral barrier properties of non-latex gloves were compared with 1080 gloves (270 gloves from each of two surgical brands and two medical examination brands) . In two of the methods, gloves were filled with and suspended in a nutrient broth solution, and bacteriophage phiX174 was placed either inside or outside the glove, while the entire test vessel was agitated . Gloves tested using the third method were filled with a suspension of bacteriophage and allowed to rest in a vessel containing nutrient broth . Gloves were tested directly from the manufacturer's packaging, or after being punctured intentionally or subjected to a stress protocol . The passage of bacteriophage was detected with plaque assays . Significant differences in failure rates between glove brands were apparent only among gloves that had been subjected to the stress protocol . Overall, the two methods in which bacteriophage were placed inside the gloves provided more sensitivity than the method in which bacteriophage was spiked into broth outside the gloves . Thus the placement of bacteriophage inside test gloves (or the use of pressure across the glove barrier during testing), and the use of a standardised stress protocol, will improve significantly the ability of a glove test protocol to determine the relative quality of the barrier offered by medical examination and surgical gloves . Further research is needed to provide test methods that can incorporate reproducibly both the use of bacteriophage and simulated glove use in an industrial quality control setting.

Epidemiol Prev, 2003 Nov-Dec, 27(6), 333 - 9
{Impact of guidelines in investigating foodborne disease outbreaks services in Lazio region, Italy}; Faustini A et al.; Epidemiological investigation of foodborne disease outbreaks helps us to better define the risks, hazards and vehicles involved . In 1997 guidelines on epidemiological methods for investigating these outbreaks were implemented in the Lazio Region . Methods used in investigating the 410 foodborne disease outbreaks reported in the 1996-2000 period were analysed to evaluate the impact of the guide lines on health services . Specific food attack-rates (epidemiological methods) were calculated more frequently in outbreaks with setting of mass catering with many exposed people (46% of these outbreaks) than in outbreaks in home setting with few exposed people (13% of these cases) . Inversely, in smaller outbreaks the proportion of cases with detected aetiology (microbiological method) was higher (66%) than in larger ones (43%) . For foodborne disease outbreaks with at least 30 people exposed epidemiological methods of investigating showed temporal trend in the period 1996-2000: the epidemics in which attack rates were calculated increased from 50% to 83%, those in which epidemic curve was drawn increased from 17% to 79%, and those in which food specific attack rates were calculated increased from 33% to 58% . The hazard analysis of critical control points (HACCP) was performed only in 18.3% of the cases . In conclusion, the guide lines resulted in a wider application of epidemiological methods in large outbreaks with a well defined exposure resulting in an improved detection of vehicles of foodborne diseases . Epidemiological methods possibly are not adequate to investigate smaller foodborne outbreaks.

Pol Merkuriusz Lek, 2003 Dec, 15(90), 563 - 9
{Health Polish foods as the chance for Polish agriculture in the united Europe}; Szponar L et al.; This paper discuss the matter of food quality and safety which is available for whole population in Poland in 2001 . The results of the nation wide control survey of food safety in 2001 conducted by the State Sanitary Inspection, where used as the source of data . Those results concerned 233.249 samples of foodstuffs taken from the market to assess . Based on the results of laboratory analysis of microbiological, chemical and physical contaminations in food and regarding organoleptic quality and labelling, the samples of foodstuffs were assessed . There were 24 of foodstuffs assortment in the survey distinguished . The result of this survey were discussed in the background of the changes in food industry in Poland during the last decade of XX century . The results show that over 88% of whole examined samples of food available for consumers in 2001 came from the health safety food . Generally the reason of the call in question of food safety were microbiological contaminations . It concerned 11% of examined samples . Chemical contaminants were detected in 3.48% of food samples and biological contaminants--in 1.77% . More over 1.13% samples because of inappropriate organoleptic food features where the reason of withdrawal them from the trade . Incorrect labelling was the reason of disqualification in 1.5% samples . Appearance of extraneous elements detected in 0.5% of samples . As result from gathering dates many of contaminated food samples were disqualified from a few reasons . From among 24 of foodstuffs assortment the samples of meat processing products were most often disqualified . The smallest percentage of disqualified food samples was observed in the group of foodstuffs for particular nutritional uses for infants . Strengthening of internal control system in production and processing establishment, rapid implement of Hazard Analysis and Critical Control Point (HACCP) in establishment and improve official control of foodstuffs system are the most important directions of activities in order to improve food safety in our country.

Folia Microbiol (Praha), 2003, 48(6), 839 - 47
Inflammatory and autoimmune diseases of the nervous system; possibilities of laboratory diagnostic methods in cerebrospinal fluid; Lodin Z; Contemporary aspects of cerebrospinal fluid analysis are discussed, including the relationship to neuro-infective, autoimmune and other neurological diseases . The actual state of cerebrospinal fluid microbiological and cytological investigation and analysis of cerebrospinal fluid protein fractions are described in detail.

Folia Microbiol (Praha), 2003, 48(6), 829 - 38
ARC-microscopy--a novel microscopic technique used in microbiological studies; Zizka Z et al.; ARC-microscopy (azimuth relief contrast; a new method of optical microscopy in transmitted light developed in cooperation with Lambda Ltd . Prague) was used to study fungi and algae at both low and higher (480-2880x) magnification . The novel ARC condenser features a higher resolving power, higher contrast and stronger three-dimensional effect than the standard condenser particularly when studying elongated structures that are present in a random orientation in the specimen . The results of these microscopic observations can be used for both morphological (taxonomical) and ecological studies of microorganisms.

Enferm Infecc Microbiol Clin, 2004 Apr, 22(4), 212 - 6
{Bordetella spp . infection: A 19-year experience in diagnosis by culture}; Villuendas MC et al.; Introduction . This retrospective study reviews the findings from cultures positive for Bordetella spp . obtained over a 19-year period, from January 1984 to December 2002 . Methods . Nasopharyngeal swabs were directly plated onto charcoal agar supplemented with 10% sheep blood and cephalexin (40 mg/L) . Identification of suspected colonies was done by biochemical testing and slide agglutination with specific antisera for B . pertussis and B . parapertussis . The study includes microbiological findings and epidemiological data (age, sex, yearly distribution, seasonal period and number of inpatients and outpatients) . Results . The 2064 nasopharyngeal specimens yielded 269 positive cultures: B . pertussis was isolated from 244 patients, B . parapertussis from 23 and B . bronchiseptica from two . Among the positive patients, 36.9% were younger than 7 months, 38.8% were 7 months to 6 years old and 24.3% were older than 6 years of age . Conclusions . The constant number of cases along the 19 years of the study shows that Bordetella spp . continues to circulate in our area . A high percentage of positive cultures were obtained from the group of children theoretically immunized by vaccination . Despite the low number of cases in young people and adults, adult pertussis seems to be a greater public health threat than was previously suspected and probably deserves to be further investigated.The gold standard for the diagnosis of Bordetella spp . infection is still recovery of the organism by culture, and it is especially useful for confirming outbreaks.

Orthopade, 2004 Apr, 33(4), 416 - 23
{Diagnosis and follow-up management of postoperative bacterial osteitis}; Fluckiger U et al.; Osteomyelitis is a term used to describe bone infection . As a complication, it can occur after open bone fracture and is associated with the implantation of foreign material . Acute disease after surgery starts after about 7 days to 4 weeks, and is characterized by a suppurative infection . Chronic infection sometimes manifests even years after surgery with a purulent sinus tract . Diagnosis is based on clinical signs, microbiological culture, histological evidence of the presence of granulocytes, and on radiological signs of osteomyelitis . However, it is sometimes difficult to distinguish between merely soft tissue involvement and osteomyelitis, especially in the presence of implanted material . Management includes a thoroughly surgical debridement and antibiotic treatment . Though frequently used, bacterial cultures of swabs of superficial wounds or fistulas are often misleading, whereas needle biopsy or surgical sampling with at least three tissue samples provides more reliable information . Because of the prolonged antibiotic treatment, it is mandatory for a successful outcome to culture the microorganism in order to determine antibiotic susceptibility . In addition to conventional radiological approaches, magnetic resonance imaging has become useful for the diagnosis of osteomyelitis . Despite significant progress in antibiotic therapy and orthopedic surgery, osteomyelitis remains difficult to treat and often relapses, even after years.

Sex Transm Infect, 2004 Apr, 80(2), 108 - 12
Markers of local immunity in cervico-vaginal secretions of HIV infected women: implications for HIV shedding; Zara F et al.; OBJECTIVES: To link local proinflammatory cytokines with HIV related nucleic acids in cervico-vaginal secretions and the factors associated with them . METHODS: An observational study on 60 HIV positive women attending the department of obstetrics and gynaecology, University of Pavia, Italy . HIV-1 RNA in plasma, proviral HIV-1-DNA, cell associated and cell free HIV-1 RNA in cervico-vaginal secretions were evaluated by competitive polymerase chain reaction (c-PCR) and reverse transcriptase PCR (cRT-PCR) . IL-1beta, IL-6, and TNF-alpha were measured by ELISA in cervico-vaginal lavages . Multiple regression analysis on ordinal categorical variables was used to test for the simultaneous associations of clinical and microbiological variables on quartiles of cytokine concentrations in lavage samples . RESULTS: Proviral HIV-1 DNA, cell associated and cell free HIV-1 RNA were detected in 76.7% (46/60), 70% (42/60), and 71.7% (43/60) of the patients, respectively . IL-1beta concentration was directly correlated with proviral HIV-DNA (Spearman rho = 0.35, p = 0.01) and cell associated HIV-RNA levels (Spearman rho = 0.263, p = 0.05) . IL-1beta concentration (153.9 pg/ml) was higher (p<0.05) among women with cytological squamous intraepithelial lesion (SIL) than negative controls (73.4 pg/ml) . In women with vaginal infection both IL-1beta (41.7 pg/ml) and IL-6 (10.2 pg/ml) were lower (p<0.05) in comparison to negative controls (144.9 pg/ml and 23.7 pg/ml, respectively) . Women receiving stable antiretroviral therapy had significantly lower TNF-alpha (34.4 pg/ml versus 44.4 pg/ml, p = 0.04) and higher IL-6 (24.0 pg/ml versus 1.4 pg/ml, p = 0.004) levels in lavage samples compared to untreated women . The associations between the presence of SIL, antiretroviral treatment, vaginal infection and cytokine concentrations in cervico-vaginal secretions were confirmed in multiple regression analysis . CONCLUSIONS: Local immune activation may modulate HIV-1 shedding in cervico-vaginal secretion with possible influence on vaginal physiology and host defence . Pharmacological agents lowering HIV-1 replication cause a shift to a pattern of cytokine production which seems less favourable to the transmission of the disease.

Rocz Panstw Zakl Hig, 2003, 54(4), 393 - 8
{Total concentration of fungi in atmospheric and indoor air}; Krogulski A et al.; Methods of evaluation of microbiological air pollution are not standardized in Poland . As a result of this status miscellaneous media and various methods of sedimentation of microorganisms on/or these media are applied in the studies . Additionally plates of various diameters are used . In practice it makes difficult (or even impossible) comparison of results published studies and expert's reports . To illustrate the range of the problem in the presented paper are shown results of measurements of total number of fungi performed parallel with: sedimentation and respiratory methods plates 55 mm and 90 mm diameter three various media . Practical instructions concerned selection of measurements methods and interpretation of results are presented.

Intensive Care Med, 2004 May, 30(5), 853 - 8 Epub 2004 Mar 30.
Diagnosis of ventilator-associated pneumonia: agreement between quantitative cultures of endotracheal aspiration and plugged telescoping catheter; Elatrous S et al.; OBJECTIVE: To evaluate the diagnostic agreement between quantitative cultures of samples obtained with endotracheal aspiration (ETA) and plugged telescoping catheter (PTC) . DESIGN: Prospective study . SETTING: Medical ICU . PATIENTS: Hundred thirty-eight episodes of suspected ventilator-associated pneumonia studied in 100 consecutive patients . INTERVENTIONS: For each suspected episode of ventilator-associated pneumonia, ETA and PTC were performed consecutively . The agreement between microbiological results obtained from the two techniques was evaluated (kappa statistic test) . Pneumonia was diagnosed on a positive culture result of telescoping catheter with the threshold set at 10(3) cfu/ml or more . The cut-off points evaluated for ETA ranged from 10(2 )to 10(6) cfu/ml . RESULTS: Micro-organisms retrieved by aspiration and telescoping catheter were similar and bacterial counts obtained by the two procedures were well correlated ( r = 0.71 p < 0.001) . There was good agreement between positive and negative ETA and PTC specimens (kappa: 0.78) with a diagnostic threshold for ETA of 10(4) cfu/ml . The sensitivity and specificity of ETA for the diagnosis of PTC-confirmed pneumonia were 92% and 85%, respectively . Kappa decreased to 0.48 when the diagnostic threshold was increased to 10(6) cfu/ml . CONCLUSIONS: Quantitative cultures of ETA and PTC tallied for both micro-organisms and counts . The simpler ETA appears adequate for determining the presence of pathogenic organisms in significant concentration in the lower respiratory tract.

Indian J Med Sci, 2004 Mar, 58(3), 115 - 21
Epidemiology based etiological study of pediatric cataract in western India; Johar SR et al.; BACKGROUND: Cataract is responsible for about 10% blindness among children in India . Etiology of cataract is not well defined especially for childhood cataracts and epidemiological data for Indian population is not available in details . AIM: This study was performed to survey the causes of childhood cataracts and to identify the preventable factors in four western states of India . SETTINGS AND DESIGN: The present study is a hospital-based, prospective study on 172 consecutive pediatric cataract patients . MATERIAL AND METHODS: Type of cataract was determined using slit-lamp bio-microscopy or operation microscope after mild general anesthesia especially on very young babies . Other anomalies of eye were determined using appropriate ophthalmic instruments . Parents of the patients were interviewed in their native language using a standardized questionnaire . Biochemical and microbiological tests such as for rubella, reducing sugar and blood glucose were also performed . RESULTS: Out of 172 children, 88.4% had non-traumatic cataract and 11.6% had traumatic cataracts . Among non-traumatic cataracts, 7.2% were hereditary, 4.6% were due to congenital rubella syndrome, 15.1% were secondary and 73.0% were undetermined . In the group of undetermined cases, during pregnancy 67% of the mother had history of illness, and 22% had taken medications during pregnancy . CONCLUSIONS: Our study shows that nearly 12% of non-traumatic cataract is due to potentially preventable causes . Health education of women to childbearing age and school children can decrease incidence of pediatric cataracts.

Ann Ig, 2003 Nov-Dec, 15(6), 911 - 21
{Risk assessment of cemetery workers of Naples . Ergonomic evaluation of manual load transfer and evaluation of total bacterial concentration during some steps of work: body transfer, inhumation, exhumation}; Triassi M et al.; The purpose of this study was to describe the type of activity of cemetery workers of Naples and to evaluate the associated risks, through microbiological and ergonomic risk assessment.

An Acad Bras Cienc, 2004 Mar, 76(1), 29 - 47 Epub 2004 Mar 04.
Organic matter composition in the sediment of three Brazilian coastal lagoons: district of Macaé, Rio de Janeiro (Brazil); Zink KG et al.; Freshwater lagoons comprise important coastal ecosystems and natural buffers between urbanized land areas and open ocean in the Rio de Janeiro State, Brazil . Studies of sediment and water chemistry, zooplankton and bacterial communities to assess the extent of anthropogenic disturbance are available . Here we contribute with an organic-geochemical approach supplemented by some microbiological aspects to complete the characterization of these lagoonal ecosystems . Bulk organic matter and extractable lipids (aliphatic hydrocarbons, alcohols and fatty acids, sterols) were investigated from two locations per lagoon: at the seaward site and landward ends - and at two depth intervals (0-3 and 3-6 cm) per site . Urbanized Imboacica Lagoon received increased anthropogenic input over the most recent years represented by the topmost 3 cm of sediment, whereas deeper sediment layers are less affected by human influence . Eutrophication or nutrient availability favored enhanced algal/cyanobacterial growth . In remote Cabiunas and Comprida Lagoons pristine conditions are preserved . Organic matter from vascular plants dominates (chain length of free lipids up to C36), which is exceptionally well preserved by acidic lagoonal waters . Differentiation between landward and seaward sites in these two lagoons is less well established due to much smaller surface/volume to catchment ratios . No anthropogenic influences are yet detectable in sediments of Cabiunas and Comprida Lagoons.

Res Vet Sci, 2004 Jun, 76(3), 199 - 202
Microbiological and serological study of leptospirosis in horses at slaughter: first isolations; Rocha T et al.; A bacteriological survey of kidneys from 145 abattoir horses was performed, which resulted in the isolation of two Leptospira strains . The isolates were serologically typed as belonging to serogroups Australis and Pomona, and REA identified them as L . interrogans serovar Bratislava and L . kirschneri serovar Tsaratsovo, respectively . These are the first Leptospira isolates obtained from horses in Portugal and the Bratislava strain is the first serogroup Australis strain to be isolated in this country . The 145 horses were also serologically tested for leptospiral antibodies, and 37% had MAT titres #10878;1:10.

Berl Munch Tierarztl Wochenschr, 2004 Mar-Apr, 117(3-4), 136 - 9
{Detection of Mycobacterium avium subsp . paratuberculosis from the testicles of a clinically infected breeding animal}; Glawischnig W et al.; During a post mortem of a six year old simmental bull with severe paratuberculosis infection the testicles were further examined by pathological, histological and microbiological methods . No gross or histological lesions could be observed . Single acid fast organisms were detected in smears taken from sterile testicle tissue . Tissue material was additionally cultured in mycostatin culture media and after 8 weeks of incubation acid fast colonies were demonstrated . Polymerase chain reaction with DNA extracted from cultured bacteria and testicle tissue material resulted in M . avium subsp . paratuberculosis-specific amplicons . The detection of M . avium subsp . paratuberculosis in the testicle of the bull demonstrates the possibility of bacteriemia in the final stage of clinical paratuberculosis infection . The evidence of transmitting paratuberculosis through contaminated semen and its relevance for artificial insemination is being discussed in the presented paper.

J Bone Joint Surg Br, 2004 Mar, 86(2), 279 - 81
AIDS-related ankle arthropathy: Mycobacterium avium-intracellulare infection; Redfern DJ et al.; We present a case of Mycobacterium avium-intracellulare (MAI) infection of the ankle joint in a patient with HIV infection . The patient presented with a painful, destructive arthropathy of the ankle . Initial microbiological studies were negative but infection with MAI was later identified from biopsies taken during hindfoot fusion . Antibiotic triple therapy was given and the patient remains pain-free without evidence of active infection . To our knowledge, this is the first case of MAI infection of the ankle reported in the literature . A high index of suspicion of (atypical) Mycobacterial infection should be maintained in patients with HIV infection presenting with an indolent but destructive arthropathy of the ankle joint.

J Antimicrob Chemother, 2004 May, 53(5), 878 - 81 Epub 2004 Mar 24.
Second-line therapy with caspofungin for mucosal or invasive candidiasis: results from the caspofungin compassionate-use study; Kartsonis NA et al.; OBJECTIVES: To prospectively assess the efficacy and safety of caspofungin as second-line therapy for mucosal or invasive candidiasis in patients enrolled in the caspofungin compassionate-use study . MATERIALS AND METHODS: Thirty-seven patients with mucosal or invasive candida infections (17 oesophageal, four oropharyngeal and 16 invasive candidiasis) were enrolled in the caspofungin compassionate-use study . All patients were refractory to or intolerant of intravenous amphotericin B or lipid amphotericin formulation(s) . Efficacy was assessed at the end of intravenous caspofungin therapy based on clinical (and, where appropriate, microbiological) response . RESULTS: HIV was the most common (91%) risk factor in patients with mucosal candidiasis; patients with invasive candidiasis commonly had acute leukaemia/lymphoma (50%) or diabetes mellitus (31%) . Most patients with mucosal candidiasis (91%) and invasive candidiasis (94%) were refractory to >/=1 antifungal agent(s) . A favourable response was noted in 82% (14/17) with oesophageal candidiasis, 100% (4/4) with oropharyngeal candidiasis and 87% (13/15) with invasive candidiasis . Caspofungin was generally well tolerated; one serious drug-related adverse event was reported . CONCLUSION: In this study, caspofungin was an effective alternative for patients with refractory candida infections.

Am J Respir Crit Care Med, 2004 Jul 1, 170(1), 49 - 53 Epub 2004 Mar 24.
Intrapleural streptokinase for empyema and complicated parapneumonic effusions; Diacon AH et al.; We conducted a single-center, randomized, placebo-controlled trial to determine whether streptokinase instillations adjunctive to chest tube drainage reduce the need for surgery and improve outcome in patients with pleural empyema . Fifty-three patients (frank pus aspirated, 81%; microbiological agent cultured, 62%; mean effusion pH, 6.6 +/- 0.4) received antibiotic treatment, chest tube drainage, and once-daily pleural rinses with either normal saline or normal saline with streptokinase (250,000 IU) . Nine patients were excluded for various reasons before pleural rinses were started . Streptokinase (n = 22) was instilled over 4.5 +/- 2 days and saline (n = 22) was instilled over 3 +/- 1.3 days . One patient in each group died during treatment . Clinical treatment success and need for referral to surgery were the main outcome measures . No difference was observed after 3 days . After 7 days, streptokinase-treated patients had a higher clinical success rate (82 vs . 48%, p = 0.01) and fewer referrals for surgery (45 vs . 9%, p = 0.02) . No significant radiologic or functional differences were observed between groups during follow-up over 6 months . We conclude that intrapleural streptokinase adjunctive to chest tube drainage reduces the need for surgery and improves the clinical treatment success in patients with pleural empyema.

Presse Med, 2004 Mar 13, 33(5), 330 - 7
{Outpatient antibiotherapy in children with neutropenia and fever . A review of the literature.}; Leverger G; NEW STRATEGIES: Fever in a neutropenic patient requires the rapid initiation of a broad spectrum antibiotic and continued until correction of the neutropenia . Several studies have been conducted recently in order to define the populations of children in whom the antibiotherapy could be suspended early without risk of relapse of fever and/or severe infection . Moreover, the high costs of hospitalisation and the limited number of beds in the departments of Paediatric Oncology Haematology have led to studies on the feasibility of an antibiotherapy at home . THE EARLY SUSPENSION OF THE ANTIBIOTHERAPY: The criteria retained in several studies for the early suspension of the antibiotherapy have been: apyrexia for at least 24 hours, a satisfactory clinical status, the absence of positive haemocultures and haematological signs showing the end of aplasia in patients in remission of their disease . Studies have confirmed the possibility of early suspension of intravenous antibiotics in low-risk patients, without fever and without microbiological signs . THE PLACE OF ORAL ANTIBIOTICS: In several comparative studies, the success rate with intravenous antibiotics and oral antibiotics was comparable . The rate of failures was greater in patients with severe initial neutropenia . OUTPATIENT ANTIBIOTICS: In children, 2 types of studies have been conducted . The first studied the feasibility of an antibiotherapy at home following antibiotherapy in the hospital in order to reduce the costs and duration of hospitalisation . The others proposed an antibiotherapy at home from the start, either with the intravenous or the oral route . Following all these studies, it appeared that, in certain low-risk neutropenic children with fever, not only the antibiotics could be suspended before the complete correction of the neutropenia, but also a large spectrum oral antibiotherapy could replace the intravenous antibiotherapy and outpatient treatment would therefore be feasible.

Nat Rev Microbiol, 2003 Oct, 1(1), 70 - 4
Bioterrorism and biodefence research: changing the focus of microbiology; Atlas RM; Fear that terrorists can use biological agents as weapons of mass destruction is significantly impacting the conduct of microbiological research . Abundant new funds are available for biodefence research, and many researchers are racing to enter the field . There are some concerns, however, that a large emphasis on this issue could skew the microbiology research agenda . Furthermore, new responsibilities for safely conducting research with biothreat agents and concern that information might be misused could drive some researchers away from the field.

Clin Ther, 2004 Feb, 26(2), 294 - 303
Evaluation of an algorithm for switching from IV to PO therapy in clinical practice in patients with community-acquired pneumonia; van der Eerden MM et al.; BACKGROUND: In patients with community-acquired pneumonia (CAP), switching from IV to PO antibiotics offers advantages over IV therapy alone, including improved cost-effectiveness through reductions in the length of hospital stay and treatment costs . OBJECTIVE: The aim of this study was to determine whether a method for switching therapy in clinical practice could be used in patients with CAP and whether differences were found in the duration of IV treatment and length of hospital stay between the 5 risk classes of the Pneumonia Severity Index (PSI) after the therapy switch . METHODS: This was a prospective, observational study of patients aged >/=18 years presenting with CAP at our teaching hospital between December 1998 and November 2000 . Microbiological and serological tests were performed, and signs and symptoms of CAP, C-reactive protein levels, and white blood cell counts were assessed throughout treatment and at the 1-month follow-up . Patients were stratified by PSI risk class . When the patient's temperature had been normalized for 72 hours and respiratory symptoms (dyspnea, coughing, and thoracal pain) had improved, patients were switched from IV to PO therapy (same drug) . RESULTS: The study included 180 patients with CAP Clinical cure was seen in 174 (97%) patients . No significant difference between the 5 risk classes was found in duration of therapy . Patients in risk class V remained hospitalized for a significantly longer period than patients in risk classes I through IV (P < 0.001) . Furthermore, after patients were switched to PO antibiotics, the level of C-reactive protein decreased in patients in all risk classes and was normalized by follow-up . CONCLUSIONS: In the population studied, use of specific criteria (ie, absence of fever for 72 hours and reduction in respiratory symptoms) allowed successful switch from IV to PO antibiotic therapy for the treatment of CAP Duration of therapy was not affected by PSI risk class, but those in risk class V were hospitalized longer than other risk classes.

J Food Prot, 2004 Mar, 67(3), 536 - 43
Multiplex real-time PCR detection of fumonisin-producing and trichothecene-producing groups of Fusarium species; Bluhm BH et al.; Some species of Fusarium can produce mycotoxins during food processing procedures that facilitate fungal growth, such as the malting of barley . The objectives of this study were to develop a 5' fluorogenic (Taqman) real-time PCR assay for group-specific detection of trichothecene- and fumonisin-producing Fusarium spp . and to identify Fusarium graminearum and Fusarium verticillioides in field-collected barley and corn samples . Primers and probes were designed from genes involved in mycotoxin biosynthesis (TRI6 and FUM1), and for a genus-specific internal positive control, primers and a probe were designed from Fusarium rDNA sequences . Real-time PCR conditions were optimized for amplification of the three products in a single reaction format . The specificity of the assay was confirmed by testing 9 Fusarium spp . and 33 non-Fusarium fungal species . With serial dilutions of purified genomic DNA from F . verticillioides, F . graminearum, or both as the template, the detection limit of the assay was 5 pg of genomic DNA per reaction . The three products were detectable over four orders of magnitude of template concentration (5 pg to 5 ng of genomic DNA per reaction); at 50 ng template per reaction, only the TRI6 and FUM1 PCR products were detected . Barley and corn samples were evaluated for the presence of Fusarium spp . with traditional microbiological methods and with the real-time PCR assay . The 20 barley samples and 1 corn sample that contained F . graminearum by traditional methods of analysis tested positive for the TRI6 and internal transcribed spacer (ITS) PCR products . The five corn samples that tested positive for F . verticillioides by traditional methods also were positive for the FUMI and ITS PCR products . These results indicate that the described multiplex real-time PCR assay provides sensitive and accurate differential detection of fumonisin- and trichothecene-producing groups of Fusarium spp . in complex matrices.

Enferm Infecc Microbiol Clin, 2003 May, 21 Suppl 2, 90 - 4
{The role of the clinical microbiologist in bioterrorism}; Alonso R et al.; There are lots of early examples of biological warfare along the history . Nevertheless, recent events have made microbiological threat jump from the very restricted and specialized circles to the public arena . Although bioterrorism concerns all segments of the population, the impact on clinical microbiologists is more direct . At this review we have made special mention to laboratory detection systems, as well as to the facilities and laboratory designs requested for this purpose including protection measurements . Preparedness plans and therapeutical considerations have also been mentioned . We think the clinical microbiologist has an undeniable role in the scenario of a potential biological attack, being extremely valuable in diagnosis duties as well as in epidemiological issues, organization and therapeutic advice.

Enferm Infecc Microbiol Clin, 2003 May, 21 Suppl 2, 28 - 31
{Clinical microbiology and the outpatient}; Gomez-Garces JL; The boundaries between "hospital" and "extrahospital" microbiology do not exist as such and it would be more appropriate to speak of the microbiological care of inpatients or outpatients . Therefore, today, the development of clinical microbiology obligatorily the outpatient . The strengthening of this interventional setting should entail both individual diagnosis of outpatients as well as epidemiological surveillance of infectious diseases in the non-hospital setting, detection of levels of resistance among the most common pathogens and, moreover, the control of this resistance in the healthy population.

Environ Int, 2004 Jun, 30(4), 547 - 56
Modeling soil organic matter dynamics as affected by soil water erosion; Polyakov V et al.; Soil organic carbon (SOC) stock is an important component of the global carbon (C) cycle, which has the potential to influence global climate . In this paper we presented an overview of soil organic matter (SOM) models in the context of soil erosion and discussed basic processes driving erosion-induced SOC loss . Although the mechanism of this loss is poorly understood, erosion influences SOC in two ways: redistribution of C within the watershed or ecosystem, and loss of C to the atmosphere . Erosion disperses soil, altering its microbiological activity as well as water, air and nutrient regimes . This, along with sediment enrichment, has an impact on greenhouse gas emission from soil . For most of agricultural settings, field studies suggest that cultivation along with soil erosion are the primary reasons for SOC loss . Tracing the fate of eroded C is a challenging task . Modeling is the approach taken most often . In this paper we discuss approaches used in various SOC models to assess erosion-induced C loss from soil in agricultural ecosystems . An example with Century model applied to meadow and corn-soybean rotation under chisel-till demonstrated the model's ability to respond well to different erosion scenarios . It was estimated that at soil loss rate of 10 t ha(-1) year(-1) (value often considered a threshold for maintaining productivity) 19% of the total SOC loss would be attributed to erosion after 90 years of cultivation.

Clin Nutr, 2004 Apr, 23(2), 171 - 5
The routine microbiological screening of central venous catheters in home parenteral nutrition patients; Catton JA et al.; BACKGROUND & AIMS: Catheter-related bloodstream infection (CRBSI) is a major complication for patients receiving home parenteral nutrition (HTPN) . Endoluminal sampling techniques allow the diagnosis of CRBSI without catheter removal and may allow the screening of asymptomatic patients . METHODS: Over a 5-year period, patients receiving HTPN were offered screening on a 3 monthly basis . All patients had tunnelled cuffed Hickman lines . All were asymptomatic at the time of screening, which took the form of either endoluminal brushing or quantitative cultures on through-line blood . RESULTS: Thirty-two patients were suitable for inclusion within the study period (10 male, median age 51 (iqr 46-61)) years with 30 of these having a least one screening performed . Four had positive screening results and underwent appropriate treatment . Of the remainder, 12 presented with at least one clinical episode of CRBSI and 14 had neither clinical CRBSI nor a positive screening result . The combined clinical and screening CRBSI rate was 0.39 episodes per catheter year . CONCLUSION: Although routine microbiological catheter screening can detect subclinical infections in HTPN patients the positive rate is low with the majority of patients still presenting clinical . Identification of higher risk patients and appropriate alterations to screening frequency may improve its value further.

Afr J Med Med Sci, 2003 Mar, 32(1), 99 - 102
Exudative retinal detachment occurring in a patient with pyogenic liver abscess; Ndububa DA et al.; This is a report of a rare case of bilateral exudative retinal detachment occurring in a young Nigerian male with pyogenic liver abscess . Detailed ocular and clinical examination with biochemical, haematological and microbiological studies of the blood and liver aspirate were done . Ocular and abdominal scan plus surgical drainage of abscess were also done . The main features were febrile illness with hepatomegaly and sudden loss of eyesight . Visual acuity was light perception in both eyes . The cardiovascular and renal systems were normal . Ocular scan showed bilateral bullous retinal detachment while abdominal ultrasound revealed multiple liver abscess cavities . HIV and HBsAg tests were negative . Pyogenic liver abscess should be regarded as possible cause of exudative retinal detachment and has a potential blinding complication.

Rev Neurol, 2004 Mar 1-15, 38(5), 446 - 8
{Migraine with pleocytosis: a case of atypical progression}; Santos S et al.; AIMS: Migraine with cerebrospinal fluid pleocytosis is a clinical pattern consisting in intermittent headaches accompanied by episodes of transient neurological deficit and lymphocytic pleocytosis, which last for varying lengths of time and have a spontaneous resolution . We describe the case of migraine with pleocytosis (MP) with atypical progression that responded well to corticoids . CASE REPORT: A 27 year old male with no familial or personal history of migraine who began with bouts of intense headaches that were preceded by neurological deficit (dysphasia and hemiparesis of the right hand side) lasting varying amounts of time (including hours) . The serial study of cerebrospinal fluid (CSF) revealed a notable degree of lymphocytosis (400/mm3) with increased intracranial pressure (ICP) (> 30 mmHg) . The other explorations that were performed (microbiological study of CSF and blood, humoral and cellular immunity, MR angiography and thyroid hormones, among others) were all normal . The neurological exploration carried out in the following days revealed a mild paresis of the right lateral rectus muscle, which was attributed to the intracranial hypertension and which clearly disabled the patient . As a consequence of the recurrence of the seizures and the long lasting increase in ICP, therapy was begun with 1 mg/kg/day of prednisone, at a descending rate; clinical remission and normalisation of the CSF was achieved within a period of two months . DISCUSSION: We describe this case of MP because of how atypical the progression was (paresis of the right abducent nerve secondary to the increase in ICP) and the possibility of associating corticoids in cases in which the benignity of the entity is in doubt.

Presse Med, 2004 Feb 28, 33(4), 265 - 8; discussion 269
{Treatment of severe sepsis and septic shock}; Grimaldi D et al.; The 3 poles of treatment . These are the hemodynamic management, early antibiotherapy and more specific treatments, based on improved physiopathological knowledge . From a hemodynamic point of view The first stage must always be to detect and correct the hypovolemia . The administration of vasopressive amines (or vasoconstricting amines) is mandatory in the case of septic shock . The choice of the antibiotics In the absence of microbiological proof, it is based on the germs most often encountered in infections of the suspected site and community or nosocomial nature of the infection . The antibiotherapy must be set-up as early as possible once the bacteriological samples have been . Treatments based on the physiopathology The activated protein C possesses pro-fibrinolytic, anticoagulant and anti-inflammatory properties; it obtained marketing Authorization in Europe for patients with severe sepsis and at least 2 organ failures or hypotension . Low-dose corticosteroids should be prescribed in the case of septic shock with prolonged use of catecholamines, and if possible following a test with Synacthene(R) (relative adrenal insufficiency) . Intensive insulin therapy is aimed at maintaining normal glycemia in the patients for as long as possible.

Presse Med, 2004 Feb 28, 33(4), 262 - 4; discussion 269
{Diagnosis of sepsis, severe sepsis and septic shock}; Bossi P et al.; Consensual and precise definitions . Sepsis is composed of a suspected or documented infection associated with at least 2 SIRS criteria (systemic inflammatory response syndrome) . Severe sepsis is sepsis with arterial hypotension and failure of one or several organs following the reduction in tIssue perfusion . Septic shock is a severe sepsis, the hypotension of which is refractory to volemic expansion . From an epidemiological point of view . Over the past two decades, its incidence is on the increase . Mortality varies from 25 to 80% of cases and sepsis remains the first cause of death in intensive care . The elements of diagnosis . The initial clinical signs are those of an infection and the port of entry and microbiological proof must be systematically researched before the appearance of a drop in blood pressure with hemodynamic impact on the various organs and hence their possible failure . The biological abnormalities observed depend on the deficient organ(s); hyperlactatemia is a good marker of visceral hypoperfusion . The sepsis risk factors . Any situation enhancing immunodepression is a risk factor for sepsis . Factors of virulence of the micro-organisms also intervene and, in cases of fungal infection, inherent risk factors . Genetic susceptibility probably intervenes, genetic variability playing either a protective or a deleterious role (the interest of Toll-like receptors).

Br J Community Nurs, 2004 Mar, 9(3), S6 - 15
Defined and refined: criteria for identifying wound infection revisited; Cutting KF et al.; Clinical criteria for the identification of wound infection are regularly based on a list created by Cutting and Harding (1994) . This list was established from empirical data generated in a large, multidisciplinary clinical practice, and is now widely accepted as a seminal article in wound care . Both Cutting (1998) and Gardner et al (2001) have conducted validation exercises on these wound infection criteria, based on the assumption that the criteria broadly apply to most wound types . Although many of the original criteria do apply across the spectrum of wound types, the major categories of wounds should be considered separately to avoid the possibility of overlooking the presence of infection . The focus of this article is a review of the published literature on wound infection criteria for acute and surgical wounds, diabetic foot ulcers, venous and arterial leg ulcers, pressure ulcers and burns . All known criteria for each wound type are presented, as well as an outline of the ongoing research project to refine the criteria by wound type using a Delphi panel technique . No attempt has been made to correlate visual signs and symptoms with microbiological sampling techniques . It is clear that there are subtle variations between infection criteria for wound types and that these should be recognized if treatment is to be given appropriately and promptly, and morbidity avoided.

Water Res, 2004 Apr, 38(7), 1884 - 92
Effect of synthetic iron colloids on the microbiological NH(4)(+) removal process during groundwater purification; Wolthoorn A et al.; Subsurface aeration is used to oxidise Fe in situ in groundwater that is used to make drinking water potable . In a groundwater system with pH>7 subsurface aeration results in non-mobile Fe precipitate and mobile Fe colloids . Since originally the goal of subsurface aeration is to remove iron in situ, the formation of non-mobile iron precipitate, which facilitates the metal's removal, is the desired result . In addition to this intended effect, subsurface aeration may also strongly enhance the microbiological removal of ammonium (NH(4)(+)) in the purification station . Mobile iron colloids could be the link between subsurface aeration and the positive effect on the NH(4)(+) removal process . Therefore, the objective of this study was to assess whether synthetic iron colloids could improve the NH(4)(+) removal process . The effect of synthetic iron colloids on the NH(4)(+) removal process was studied using an artificial purification set-up on a laboratory scale . Columns that purified groundwater with or without added synthetic iron colloids were set up in duplicate . The results showed that the NH(4)(+) removal was significantly ( alpha = 0.05 ) increased in columns treated with the synthetic iron colloids . Cumulative after 4 months about 10% more NH(4)(+) was nitrified in the columns that was treated with the groundwater containing synthetic iron colloids . The results support the hypothesis that mobile iron colloids could be the link between subsurface aeration and the positive effect on the NH(4)(+) removal process.

Biosystems, 2004 Mar, 73(3), 163 - 71
Global change in Escherichia coli gene expression in initial stage of symbiosis with Dictyostelium cells; Matsuyama S et al.; Genome-wide gene expression profiling was performed to investigate the early formation of symbiosis using an artificial symbiosis of Escherichia coli and Dictyostelium discoideum . We have previously reported that when these two species were allowed to grow on minimal agar plates, they achieved a stable state of coexistence, in which the emerging E . coli colonies housing Dictyostelium cells were of a mucoidal nature that was not observed originally . We used this microbiological system as a model to study the initial stages of the development of the symbiotic relationship . The E . coli gene expression profiles of symbiotic cells and non-symbiotic cells captured using GeneChip technology were compared . It was clearly shown that the gene expression profile was substantially altered in E . coli cells undergoing symbiotic transition . The genes responsible for central energy metabolism as well as those responsible for translation apparatus were down-regulated in symbiotic E . coli . The transcriptional patterns of genes coding for the E . coli cell surface structure were drastically altered, and this alteration may determine the mucoidal nature and unique structure of coexisting colonies . General stress inducible genes were expressed at low levels in symbiotic E . coli . These observed changes in the transcription profile indicate that the central metabolism of symbiotic E . coli is attenuated as a whole, and the cells are probably under less stress because of the benefits brought by coexistence with the symbiotic counterpart Dictyostelium.

Arch Pediatr, 2003 Dec, 10 Suppl 5, 582s - 587s
{Invasive pulmonary aspergillosis in immunocompromized children: diagnosis and classification}; Tabone MD; Invasive aspergillosis is an opportunistic infection, with frequent lung involvement . High-risk children are allogenic bone marrow recipients, and those with hematological malignancies, aplastic anemia or chronic granulomatous disease . Profound and prolonged neutropenia, and corticosteroid therapy are the most important predisposing factors . Building and demolition works represent the major environmental risk factor . The diagnosis of invasive aspergillosis remains difficult to establish . Clinical manifestations are non-specific . Early thoracic computed tomographic scan shows halo sign in most cases . Subsequently appears the air crescent sign . Galactomannan research by sandwich ELISA can be useful in serum and in bronchoalveolar lavage fluid . Aspergillus DNA detection by PCR is still not standardized . Culture of the organism allows species identification . Aspergillus hyphae can be found at cytological examination, but a biopsy specimen is usually required to affirm tissue damage . A new classification of invasive fungal infections in immunocompromised patients was recently proposed by experts from the European Organization for Research and Treatment of Cancer and from the Mycoses Study Group of the National Institute of Allergy and Infectious Diseases . On the basis of host linked criteria, microbiological, clinical and radiological features, invasive aspergillosis is classified as proven, probable or possible . These definitions should not be used to guide clinical practice in therapy, but they will improve the quality of epidemiological data, and help the comparison of clinical trial results.

Eur J Pharm Biopharm, 2004 Mar, 57(2), 353 - 8
Extension of in-use stability of preservative-free nasalia; Bagel S et al.; Nasal drops and nasal sprays are commonly supplied in multi-dose containers that usually include suitable levels of an appropriate preservative in order to kill or prevent growth of any microorganisms which might enter the dispensing system . Preservatives should both protect the patient from infection and prevent spoilage of the product . Unfortunately, preservatives often cause unwanted side effects; in particular, the nasal mucosa is irritated frequently . Consequently, the use of preservatives in nasal preparations should be avoided . The technical design of the 3K system, a new multi-dose container, combines several microbiological safety features and therefore allows use without preservatives . Earlier tests have shown its safety for 6 weeks after the first opening . In order to test the microbiological safety of this multi-dose system over longer time periods, an in-use stability test was designed . The results revealed that the first dose as well as the contents complied with the requirements of the European Pharmacopoeia . Therefore, from a microbiological point of view for the tested nasalia in the 3K system, the stability after opening could be extended from 6 weeks up to several months without loss of microbiological quality.

Bioorg Med Chem, 2004 Mar 15, 12(6), 1453 - 8
Antimycobacterial compounds . New pyrrole derivatives of BM212; Biava M et al.; We have identified BM212 as a lead compound among a series of pyrrole derivatives with good in vitro activity against mycobacteria and candidae . First studies led us to synthesize some pyrrole compounds in which the thiomorpholine fragment was present . Some compounds revealed very active and these findings prompted us to prepare new pyrrole derivatives 2-15 in the hope of increasing the activity . The microbiological data showed interesting in vitro activity against Mycobacterium tuberculosis and atypical mycobacteria.

East Afr Med J, 2003 Dec, 80(12), 652 - 5
Prevalence of rotavirus, adenovirus and astrovirus infection in young children with gastroenteritis in Gaborone, Botswana; Basu G et al.; OBJECTIVE: To determine the prevalence of three enteric viruses, namely rotavirus, adenovirus and astrovirus, as agents of diarrhoea in and around Gaborone, Botswana . DESIGN: The sample were categorised into four groups according to the age of the patient: 0-3 months, 4-6 months, 7-12 months and 25-60 months . Total monthly samples across age groups formed basis for calcultating seasonal prevalence of rotavirus infection . SETTING: Stool samples were collected from three medical laboratories in Gaborone and one in the town of Mochudi . These were collected from children under the age of five years with gastroenteritis . SUBJECTS: Stool samples were collected between March 2001 and February 2002 from 346 children less than five years of age suffering from gastroenteritis . These samples had been sent to medical laboratories for microbiological examination . METHODS: The samples were screened for rotavirus (RV), adenovirus (Ad) and astrovirus (AsV) antigens using commercially available ELISA kits . The Ad positive samples were further analysed by commercially available group specific Ad type 40/41 Enzyme Immuno Assays (EIA) . RESULTS: Shedding of RV was detected in 9.2%, Ad in 7.8% and AsV in 2.7% of the samples analysed . The enteric Ad (types 40 and 41) were detected in 2% of the samples and the remaining 5.8% of Ad positive samples were non-enteric Ad . An increase of RV was noted in the autumn-winter season but no seasonal pattern was observed in Ad shedding . Seasonal prevalence of AsV could not be determined . The average age of children infected with these agents was less than one year . CONCLUSION: The incidence of rotavirus infection amongst children in Botswana appears to be relatively low . The prevalence rate of adenovirus and astrovirus is similar to other studies in parts of Southern Africa . However, continued enteric virus surveillance and epidemiology amongst this group is required.

J Clin Periodontol, 2004 Apr, 31(4), 273 - 81
Clinical and microbiological effects of subgingival administration of two active gels on persistent pockets of chronic periodontitis patients; Perinetti G et al.; OBJECTIVES: The present controlled, single-blind study was performed to assess and compare the clinical healing and the microbiological findings following repeated intrasulcular applications of 1% metronidazole or 1% chlorhexidine gels in persistent periodontal pockets previously treated by scaling and root planing (SRP) . MATERIAL AND METHODS: Sixty-three systemically healthy subjects, 25 males and 38 females (mean age 48.4+/-7.2 years), diagnosed for chronic periodontitis were enrolled in this study . They underwent SRP and received oral hygiene instructions (OHI) . Three months later, at baseline, a single persistent pocket with a probing depth (PD) of 5-9 mm was chosen as the experimental site in each patient; the subjects were stratified into three matched experimental groups on the basis of the treatment to be performed, which consisted of the subgingival administration of 1% metronidazole gel (MG, n=19), 1% chlorhexidine gel (CG, n=20) or placebo gel (PG, n=24) . The treatments consisted of four repeated administrations of subgingival gels, each separated by 7 days, starting at the baseline . Clinical assessment was performed at the baseline and at the 180-day follow-up, after the end of treatment . For microbiological evaluations, subgingival plaque was sampled from the experimental sites at baseline, prior to the first subgingival gel administration, and at 7, 15, 30 and 90 days after the end of the treatment (days 28, 36, 51 and 111 from baseline) . RESULTS: Plaque accumulation did not change significantly in all three groups . Bleeding on probing and clinical attachment levels reduced in the MGs and CGs only . PD was significantly reduced by the same amount in all experimental groups . In the MGs and CGs a remarkable reduction in the frequencies of detection of several periodontopathic micoorganisms was recorded after the treatment . The same was not seen for the PGs . CONCLUSIONS: Subgingival administration of MG or CG, both at 1%, may have a role in the management of persistent pockets during chronic periodontitis.

Clin Microbiol Infect, 2004 Mar, 10(3), 257 - 60
Investigation of Helicobacter pylori in bronchoscopic lung specimens of young male patients with bronchiectasis but without gastrointestinal symptoms; Ilvan A et al.; Anti-Helicobacter pylori IgG serum levels were measured in 31 young male bronchiectasis patients without gastrointestinal symptoms, and 56 healthy males . The possible presence of H . pylori was also investigated by rapid urease tests, culture and histopathological examination of protected catheter brush and biopsy specimens from the bronchiectatic site . No serological, microbiological or histological evidence of H . pylori infection was found in the bronchiectasis patient group . H . pylori did not appear to be an agent of infection or chronic colonisation in bronchiectasis, and may not have a significant role in the progression of this disease.

ESA Bull . 1996 Aug;87:6 p.
The challenge of the EuroMir95 technology experiments; Viberti C; Microbiological sampling techniques, earth-radiation- environment monitoring, gas-contaminant bio-filtering tools, multimedia communications technology, passive magnetic-levitation techniques for fluid-dynamics study, robotics-technology development, gas-sensor systems and analysis tools for human kinematics in microgravity - all were a part of the truly multidisciplinary Technology Experiments package flown aboard the record-breaking EuroMir 95 mission . Final processing and evaluation of the vast amount of data gathered from the experiments will not be completed until the end of the year - work is currently in progress at nine different centres throughout Europe - and this article therefore provides but a first glimpse of the mission's many findings and their implications for long-term manned spaceflight in the context of the International Space Station.

Biomed Instrum Technol, 2004 Jan-Feb, 38(1), 73 - 8
Bacterial endotoxin testing: a report on the methods, background, data, and regulatory history of extraction recovery efficiency; Bryans TD et al.; Since the mid-1970s the Limulus Amebocyte Lysate (LAL) assay has been used to test medical devices for bacterial endotoxins . The Association for the Advancement of Medical Instrumentation (AAMI) recently published a standard designated ANSI/AAMI ST 72: 2002, Bacterial Endotoxins--Test methodologies, routine monitoring, and alternatives to batch testing, which addresses LAL testing and associated issues . In order to perform the bacterial endotoxins test (BET), the test article must be extracted in an aqueous medium, with the extract being used as the test solution . In the early years of testing, and periodically throughout LAL test history, questions have arisen about validation of the extraction efficiency of endotoxins from medical devices . The AAMI Microbiological Methods Committee appointed a Task Group to thoroughly research the issue of extraction efficiency and to recommend whether validation of extraction efficiency is necessary for LAL testing of medical devices.

Medicina (Kaunas), 2004, 40(2), 135 - 40
C-reactive protein in early prediction of pancreatic necrosis; Barauskas G et al.; AIM OF THE STUDY: to determine relation between the C-reactive protein and pancreatic necrosis, and to estimate the prognostic value of C-reactive protein in early diagnosis of pancreatic necrosis . MATERIAL AND METHODS: During 2001, 78 patients with acute pancreatitis were included in the study . The clinical data, diagnostic procedures, and laboratory values were analyzed . According to severity of the disease patients were divided into two groups . Group I consisted of 17 patients with necrotic pancreatitis, group II--of 61 patients with pancreatic edema . Contrast-enhanced computed tomography scan was used to diagnose pancreatic necrosis with subsequent fine-needle aspiration for microbiological evaluation . C-reactive protein concentration in serum was measured on day 1, 2, 3, 5, 7 and 9 after admission . The sensitivity, specificity, positive and negative predictive values for different C-reactive protein concentration cut-off (100-150 mg/l) were calculated . Average C-reactive protein values were compared between groups by t test for unpaired data . The difference was assumed statistically significant when p<0.05 . RESULTS: There was no significant difference in demographic data between the groups . Necrosis of the pancreas was demonstrated on computed tomography scan in 17 cases . The highest C-reactive protein values were detected on day 3 in group I patients . The difference of average C-reactive protein concentration was significant between groups on all days except day 7 . The highest sensitivity and negative predictive value (94.1% and 95.7% respectively) was obtained for C-reactive protein cut-off at 110 mg/l . CONCLUSIONS: The results of our study show the C-reactive protein values increase significantly in early stages of necrotic pancreatitis . C-reactive protein is an important prognostic marker of pancreatic necrosis with the highest sensitivity and negative prognostic value given the cut-off is 110 mg/l . The patients with C-reactive protein below 110 mg/l are low risk to develop pancreatic necrosis.

Int J Paediatr Dent, 2004 Mar, 14(2), 127 - 35
Periodontal management of an adolescent with Down's syndrome--a case report; Sasaki Y et al.; A case of periodontitis in a young adolescent Japanese girl with Down's syndrome is presented in this report . The patient received a monthly preventive course of dental care consisting of mechanical plaque control and oral hygiene instruction . After 2.5 years she recovered from progression of periodontal disease both clinically and microbiologically . The importance of clinical care for periodontitis in Down's syndrome patients is discussed.

J Chemother, 2003 Dec, 15(6), 558 - 62
Diffusion of oral and intravenous 400 mg once-daily moxifloxacin into lung tissue at pharmacokinetic steady-state; Breilh D et al.; The degree of penetration of an antibiotic into the infection site is an important factor for its therapeutic efficacy, particularly in respiratory tract infections . In the present study, we examined the lung tissue diffusion of moxifloxacin at a dose of 400 mg administered intravenously or orally once-daily, and the results were correlated to microbiological data to estimate the clinical efficacy of moxifloxacin in lower community-acquired respiratory infections . This was a prospective, randomized, parallel-group trial, open-label, single-center study . Patients undergoing lung surgery for bronchial cancer which necessitates the removal of an anatomical piece of lung tissue were randomized into twelve treatment groups, dependent upon the time of surgery and the moxifloxacin formulation, i.v . or oral, administered . During surgery, one blood sample was taken at the time of tissue collection to determine moxifloxacin plasma concentration . At the same time, tissue samples were taken by pulmonary exeresis . A validated new high performance liquid chromatography assay was used to determine moxifloxacin concentrations in plasma and lung tissue . A total of 49 patients (25 for i.v . administration, 24 for oral administration, 44 men and 5 women, mean age, 61 years, mean body weight, 72 kg, mean creatinine clearance was 84 ml/min/1.73 m2) were enrolled . The mean +/- SD steady-state moxifloxacin ratios between lung and plasma concentrations were respectively: 3.53 +/- 1.89 and 4.36 +/- 1.48 for i.v . and oral administration . The mean steady-state moxifloxacin maximal lung concentrations (Cmax) were respectively 12.37 microg/g and 16.21 microg/g for i.v . and oral administration . Moxifloxacin both intravenously and orally exhibits high penetration in lung tissue, with tissue concentrations far above the MIC90s for most of the susceptible pathogens commonly involved, thus underlining its suitability for the treatment of community-acquired, lower respiratory tract infections.

Ying Yong Sheng Tai Xue Bao, 2003 Nov, 14(11), 2067 - 71
{Chemical behavior and ecological effects of pollutants acting on root-soil interface}; Wang M et al.; Root-soil interface is the main entrance of pollutants intruding into plant tissues and the special micro-ecosphere that can result in a series of ecological safety problems . In this review, the concept of root-soil interface is presented and it is suggested that root-soil interface behavior and effects of chemical pollutants should be grouped into two aspects as rhizosphere chemical behavior and ecological effects and root chemical behavior and ecological effects . These two aspects are theoretically discussed according to the latest research advances . Rhizosphere chemical behavior and ecological effects included rhizosphere pH environment and adsorptive behavior, rhizosphere oxidation-reduction behavior, rhizosphere chemical toxicology effects, rhizosphere microbiological effects, and rhizosphere bioenzymatic reaction etc., and root chemical behavior and ecological effects included root exudation, influence of enzymatic systems in roots, disturbance of normal physiological processes, change of cellular structure and function, and interference of structure and function of biological macromolecules . Particular attention should be paid to the significance as well as some problems of research on chemical behavior and ecological effects of pollutants acting root-soil interface in pollution ecology.

Intensive Care Med, 2004 Apr, 30(4), 580 - 8 Epub 2004 Mar 02.
EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units; Brun-Buisson C et al.; OBJECTIVE: Ten years ago 8.4% of patients in French intensive care units (ICUs) were found to have severe sepsis or shock and 56% died in the hospital . As novel therapies for severe sepsis are emerging, updated epidemiological information is required . DESIGN AND SETTING: An inception cohort study conducted in 206 ICUs of randomly selected hospitals over a 2-week period in 2001, including all patients meeting criteria for clinically or microbiologically documented severe sepsis (with > or =1 organ dysfunction) . MEASUREMENTS AND RESULTS: Among 3738 admissions, 546 (14.6%) patients experienced severe sepsis or shock, of which 30% were ICU-acquired . The median age of patients was 65 years, and 54.1% had at least one chronic organ system dysfunction . The median (range) Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA) at onset of severe sepsis were 48 (2-129) and 9 (1-24), respectively . Mortality was 35% at 30 days; at 2 months the mortality rate was 41.9%, and 11.4% of patients remained hospitalized . The median (range) hospital stay was 25 (0-112) days in survivors and 7 (0-90) days in non-survivors . Chronic liver and heart failure, acute renal failure and shock, SAPS II at onset of severe sepsis and 24-h total SOFA scores were the independent risk factors most strongly associated with death . CONCLUSIONS: Although the attack rate of severe sepsis in French ICUs appears to have increased over the past decade, its associated mortality has decreased, suggesting improved management of patients . Severe sepsis incurs considerable resources use, and implementation of effective management strategies and continued research efforts are needed.

Clin Imaging, 2004 Jan-Feb, 28(1), 44 - 8
Computed tomography-guided percutaneous drainage of splenic abscesses; Tasar M et al.; OBJECTIVE: The aim of the study is to evaluate the role of computed tomography (CT)-guided percutaneous drainage in the management of solitary splenic abscesses . MATERIALS AND METHODS: Sonography and CT were used in the initial diagnosis of splenic abscess in patients with vague left upper quadrant pain and/or fever . Solitary splenic abscesses of nine male patients whose ages varied between 21 and 27 years (mean age: 24.7 years) were percutaneously drained under CT guidance . Puncture with 18-gauge Chiba needles and coaxial guidewire technique was used for insertion of six or eight French pigtail catheters . Antibiotics in accordance with the microbiological results were also given adjuvant to drainage . Follow-up examinations were performed by sonography, daily for the first week and weekly for the next 7 weeks, and by CT at the end of first, fourth and eighth weeks . RESULTS: All patients tolerated the intervention well, except for one complicating with splenic rupture and hemorrhage, who underwent emergency splenectomy . The remaining eight patients recovered within 4 weeks without any splenic sequela . A mean of 3.9 days was needed before removing the drainage catheter based on regression criteria . DISCUSSION AND CONCLUSION: CT-guided percutaneous drainage of splenic abscesses may be proven effective and is superior to splenectomy in selected cases, as it preserves host immunity.

Astrobiology, 2003 Winter, 3(4), 649 - 55
Lossless compression of stromatolite images: a biogenicity index?
Corsetti FA, Storrie-Lombardi MC.
It has been underappreciated that inorganic processes can produce stromatolites (laminated macroscopic constructions commonly attreibuted to microbiological activity), thus calling into question the long-standing use of stromatolites as de facto evidence for ancient life . Using lossless compression on unmagnified reflectance red-green-blue (RGB) images of matched stromatolite-sediment matrix pairs as a complexity metric, the compressibility index (delta(c), the log ratio of the ratio of the compressibility of the matrix versus the target) of a putative abiotic test stromatolite is significantly less than the delta(c) of a putative biotic test stromatolite . There is a clear separation in delta(c) between the different stromatolites discernible at the outcrop scale . In terms of absolute compressibility, the sediment matrix between the stromatolite columns was low in both cases, the putative abiotic stromatolite was similar to the intracolumnar sediment, and the putative biotic stromatolite was much greater (again discernible at the outcrop scale) . We propose tht this metric would be useful for evaluating the biogenicity of images obtained by the camera systems available on every Mars surface probe launched to date including Viking, Pathfinder, Beagle, and the two Mars Exploration Rovers.

J Infect Chemother, 2004 Feb, 10(1), 25 - 30
Comparison of clinical features in patients with pulmonary Mycobacterium-avium complex (MAC) disease treated before and after proposal for guidelines; Kobashi Y et al.; We aimed to investigate the transitional pattern of the clinical features of pulmonary Mycobacterium-avium complex (MAC) disease, especially with regard to the clinical effect of treatment, in patients treated before and after the implementation of the 1998 guidelines of the Japanese Society for Tuberculosis for combined chemotherapy for pulmonary MAC disease . The clinical findings and treatments of 220 patients with pulmonary MAC disease during the past 10 years were compared by dividing the patients into two groups, each encompassing a 5-year period . During the past 5 years, we have carried out combined chemotherapy with rifampicin, ethambutol, an aminoglycoside (streptomycin or kanamycin), and clarithromycin (CAM) following the guidelines for the treatment of pulmonary MAC disease proposed in 1998, and we have achieved positive results; both the sputum conversion rate and clinical improvement of the outcome in patients with primary infectious type rose significantly . Although there were no significant differences in the background or in microbiological and radiological findings in the two groups, significant improvement was seen in the sputum conversion rate and in improvement of the clinical effect of treatment . The results of this combined chemotherapy were unsatisfactory, however, when compared with its clinical effect on pulmonary tuberculosis . Therefore, we anticipate the development of new companion drugs for pulmonary MAC disease that are as active as CAM.

Intensive Care Med, 2004 Apr, 30(4), 724 - 8 Epub 2004 Feb 26.
Outbreak of gastric mucormycosis associated with the use of wooden tongue depressors in critically ill patients; Maravi-Poma E et al.; OBJECTIVE: To describe a nosocomial outbreak of gastric mucormycosis caused by Rhizopus microsporus var . rhizopodiformis in five adult patients admitted to an intensive care unit (ICU) . DESIGN: Epidemiological surveillance study . SETTING: A 12-bed polyvalent ICU of an acute care teaching hospital in Pamplona, Spain . PATIENTS: Five patients admitted to the ICU requiring artificial ventilation, diagnosis on admission severe pneumonia in four patients and one polytrauma patient, within a 14-week period, were diagnosed with gastric mucormycosis based on microbiological and/or histopathological characteristics . Upper gastrointestinal bleeding was the presenting manifestation in 80% of patients . INTERVENTIONS: Filamentous fungi isolated at the microbiology laboratory of the hospital were examined at the national Mycology Reference Laboratory in Madrid . MEASUREMENTS AND RESULTS: Rhizopus microsporus var . rhizopodiformis growth was detected in gastric aspiration samples, environmental samples, wooden tongue depressors used to prepare oral medications (and given to patients through a nasogastric catheter), and in some tongue depressors stored in unopened boxes unexposed to the ICU environment . All depressors were purchased from the same supplier . R . microsporus was not isolated from batches purchased at different times from the same supplier and from another supplier . The outbreak terminated when contaminated tongue depressors were withdrawn from use . CONCLUSIONS: Wooden tongue depressors contaminated by R . microsporus var . rhizopodiformis used to prepare oral medications caused an outbreak of fungal gastritis with an attributable mortality of 40% . Wooden material should not be used in the hospital setting.

Chemosphere, 2004 Apr, 55(3), 455 - 66
Soil quality and vulnerability in a Mediterranean natural ecosystem of Central Italy; Francaviglia R et al.; Wet and dry atmospheric depositions and soil chemical and microbiological properties were determined in a Mediterranean natural ecosystem of Central Italy near Rome (Castelporziano Estate) . The monitoring of depositions permitted us to quantify the exceedances of S and N compounds (expressed as eqH(+)ha(-1)year(-1)) over the critical loads of acidity . Critical loads, i.e . the quantity of a substance which a part of the environment can tolerate without adverse effects occurring, were determined adopting the level 0 methodology following the UN/ECE Convention on Long-range Transboundary Air Pollution . Deposition data were available for the period 1992-1997, and acidity exceedances were referred to the main vegetation types present in the area . Results showed that most part of the Estate has a medium degree of vulnerability to acidification, and the corresponding risk of acidification deriving from the exceedances of atmospheric deposition was rather low . The study of soil chemical and microbiological properties included mainly total soil organic carbon (SOC), microbial biomass-C, biomass-C/SOC, soil respiration, and metabolic quotient (qCO2) . Soil organic C metabolism has been discussed on the basis of the results from eight sampling sites.

Transpl Infect Dis, 2003 Dec, 5(4), 158 - 66
Rapid diagnosis of invasive aspergillosis by antigen detection; Wheat LJ; Aspergillosis is a serious and often fatal infection in the bone marrow or organ transplant patient, for which improved methods of diagnosis are desperately needed . Currently, the diagnosis is most often made based on clinical findings and radiographic findings, which are nonspecific, and toxic therapies are initiated empirically, often without ever establishing the diagnosis . Without a definitive diagnosis, physicians often withhold or reduce the doses of the antifungal agent when toxicity develops or the patient improves, permitting progression of disease in those with invasive aspergillosis . The Platelia Aspergillus galactomannan antigenemia assay may assist physicians in making these decisions . With a sensitivity of 81% and a specificity of 89% in the studies leading to its FDA clearance, physicians still must be aware of the potential for false-positive and false-negative results; the test does not replace careful microbiological and clinical evaluation . This report will review the relevant literature and provide guidelines for use of the test in patient management.

Clin Infect Dis, 2004 Mar 1, 38(5), 754 - 6 Epub 2004 Feb 17.
Use of a T cell-based assay for monitoring efficacy of antituberculosis therapy; Carrara S et al.; Monitoring the efficacy of antituberculosis therapy is crucial both for the individual patient and for better control of the spread of tuberculosis . We studied 18 patients with microbiologically confirmed tuberculosis, both at the time of diagnosis and 3 months after they started therapy, using an in vitro assay that detects T cell-mediated interferon- gamma response to selected peptides of Mycobacterium tuberculosis-specific early secretory antigenic target 6 (ESAT-6) protein . All patients had positive results at diagnosis; however, 3 months later, the response to ESAT-6 peptides was still detectable only in the 5 patients with microbiological isolation and/or absence of clinical improvement after treatment . On the basis of these data, we conclude that our assay is a useful tool in monitoring the efficacy of antituberculosis therapy.

Clin Oral Investig, 2004 Jun, 8(2), 63 - 9 Epub 2004 Feb 25.
Clinical effects of scaling and root planing in adults infected with Actinobacillus actinomycetemcomitans; Muller HP et al.; The periodontal pathogen Actinobacillus actinomycetemcomitans can frequently be isolated from subgingival plaque of adults with chronic inflammatory periodontal disease and individuals with plaque-induced gingivitis . Problems with the persistence of the organism after thorough debridement of root surfaces have been reported . In the present study clinical effects of the hygienic phase of periodontal therapy in ten adult patients with moderate or advanced periodontitis harbouring A . actinomycetemcomitans were analysed . Since proper analysis of highly correlated data within a given patient is crucial for appropriate interpretation, a major objective of this study was to compare the results of different models derived from logistic regression of clinical and microbiological factors on gain or loss of clinical attachment under different assumptions . Subgingival samples from every tooth present were obtained before and 6 weeks after thorough subgingival scaling, and selectively cultivated for the organism . A relevant gain of clinical attachment of 2 mm or more was observed at a total of 36% of periodontitis sites after scaling . Overall, loss of attachment of 2 mm or more was observed at 8% sites . Most loss occurred at sites with gingival enlargement (15%), whereas 3% periodontitis sites lost 2 mm or more . In multivariate analyses erroneously assuming either independence of data or correctly considering the correlated structure of observations attachment gain was mainly associated with deep probing depths at the outset . Presence or absence of A . actinomycetemcomitans before or after therapy was not included into the periodontitis models . Also, loss of attachment of 2 mm or more after subgingival scaling was not influenced by the organism . A direct comparison of the results obtained with both approaches of logistic regression may be helpful in the assessment of the influence of the magnitude of correlation of the data on the regression coefficients.

Int J Food Microbiol, 2004 Mar 15, 91(3), 279 - 88
Detection of Cryptosporidium and Giardia in molluscan shellfish by multiplexed nested-PCR; Gomez-Couso H et al.; A multiplexed nested-PCR procedure (ABC-PCR) previously developed to detect Cryptosporidium spp . and Giardia duodenalis assemblages A and B in whole human faeces was applied to DNA extracted from filter-feeding molluscs . Species of Cryptosporidium and G . duodenalis were identified by restriction fragment analysis of the PCR products and by DNA sequencing . The extraction and ABC-PCR procedures were shown to be suitable for application to shellfish by amplification of specific target sequences using DNA from Cryptosporidium parvum genotype 2 and G . duodenalis assemblages A and B which were spiked into DNA extracted from mussels . Using 49 molluscan shellfish specimens (18 clam, 22 mussel and 9 oyster samples) from Spain, cryptosporidial oocysts were detected in 56% by immunofluorescence microscopy, and in 44% by ABC-PCR . For detection of Cryptosporidium, there was a significant association, but not total agreement, between the results of microscopy and PCR . G . duodenalis assemblage B was detected from one oyster sample by PCR . Amongst 38 specimens (20 mussel and 18 cockle samples) collected in the UK and tested by the ABC-PCR, G . duodenalis was not detected, and Cryptosporidium was detected in 11% of the samples . Overall, the 26 samples where Cryptosporidium was detected, C . hominis/C . parvum genotype 1 was detected in 1, C . parvum genotype 2 in 22, and the remaining three samples contained either sequences similar to C . parvum genotype 2 or heterogeneous mixtures of Cryptosporidium species . There was no significant association between the level of Escherichia coli detected by conventional microbiological methods and the presence of Cryptosporidium detected by ABC-PCR.

Respirology, 2004 Mar, 9(1), 81 - 6
Vasoactive mediators (VEGF and TNF-alpha) in patients with malignant and tuberculous pleural effusions; Hamed EA et al.; OBJECTIVE: Vascular endothelial growth factor (VEGF) is a potent endothelial cell-specific mitogen that promotes angiogenesis, vascular hyperpermeability, and vasodilatation by autocrine mechanisms involving nitric oxide (NO) . This study was undertaken to determine the potential role of VEGF in the pathogenesis of pleural effusions, and its relationship with tumour necrosis factor (TNF)-alpha and NO in the pleural fluid and serum of patients with tuberculous and malignant pleural effusions . METHODOLOGY: Pleural fluid and serum (SE) VEGF, TNF-alpha and NO levels were measured in 30 patients with exudative pleural effusion (15 with malignancies and 15 with tuberculosis) . Control pleural fluid was obtained from 10 patients with transudative pleural effusion due to congestive heart failure and control serum samples were obtained from 10 healthy individuals . VEGF and TNF-alpha were measured by enzyme-linked immunosorbent assay and NO by a colorimetric method . Pleural biopsy, cytology or microbiological methods were used to make the final diagnosis . RESULTS: In patients with exudative pleural effusions, the mean pleural fluid and serum VEGF levels and their ratios (P < 0.0001 for all) and TNF-alpha levels (P < 0.01, P < 0.0001 and P < 0.05) were significantly elevated compared to those with transudative pleural effusion . In malignant effusions, pleural fluid and serum VEGF levels were significantly elevated (P < 0.001 and P < 0.0001) while pleural fluid, and serum levels and their ratios of TNF-alpha (P < 0.001, P < 0.01 and P < 0.05) were significantly lower than those in tuberculosis . NO levels did not distinguish between tuberculous and malignant effusions . CONCLUSIONS: In patients with malignant pleural effusions, levels of VEGF were significantly higher, while levels of TNF-alpha were significantly lower, than in patients with tuberculous effusions . In malignant pleural effusions, the elevated pleural fluid levels of VEGF and TNF-alpha are noteworthy . Our data support the hypothesis that blockade of VEGF, might benefit cancer patients with recurrent ascites or pleural fluid accumulation.

J AOAC Int, 2003 Nov-Dec, 86(6), 1208 - 17
Indicator organisms for safety and quality--uses and methods for detection: minireview; Tortorello ML; Indicator organisms have been used for nearly a century to assess the microbiological status of water and foods . Beginning with their use in water sanitation programs, their applications have been extended over the years to other products, and they have become important components of the microbiological testing programs of both industry and regulatory agencies . Functionally, they may be viewed as safety or quality indicators . Safety indicators suggest the presence of conditions associated with increased risk of exposure to a pathogen . Quality indicators assess conditions of importance to product manufacture or consumer acceptability . This minireview summarizes the history, use, and analytical methods for the most commonly used indicator organisms, including the aerobic plate count, yeasts and molds, the coliform groups,

Int J Hematol, 2004 Jan, 79(1), 74 - 8
Once-daily oral levofloxacin monotherapy versus piperacillin/tazobactam three times a day: a randomized controlled multicenter trial in patients with febrile neutropenia; Cornely OA et al.; A prospective, randomized, controlled multicenter trial was performed to evaluate the efficacy and safety of once-daily oral monotherapy with 500 mg levofloxacin in comparison with 4.5 g piperacillin/tazobactam 3 times a day in patients with low-risk febrile neutropenia . Low risk was defined by oral temperature > or = 38.5 degrees C on one occasion or > or = 38.0 degrees C twice within 24 hours and granulocytopenia < or = 500/microL for less than 10 days . The primary end point was defined as defervescence after 72 hours followed by at least 7 afebrile days . Secondary end points were overall response, time to defervescence, survival on day 30, and toxicity . Thirty-four episodes were included . Fever of unknown origin accounted for 26 (76.5%) of the episodes, microbiologically defined infection for 5 (14.7%) of the episodes, and clinically defined infection for 3 (8.8%) of the episodes . On an intent-to-treat basis, all episodes were evaluable for the primary end point . Levofloxacin and piperacillin/tazobactam were successful after 72 hours of treatment in 76.5% and 88.3% of the episodes . Overall response was achieved in 94.1% and 100% of the episodes, respectively . One inpatient in the oral treatment group died of septic shock without identification of a causative pathogen . A larger phase III trial is warranted to further evaluate the lack of inferiority of the oral monotherapy regimen versus standard intravenous therapy.

Med Pr, 2003, 54(5), 437 - 44
{Subjective evaluation of the work environment quality in offices}; Jankowska E et al.; BACKGROUND: Exposure to harmful and strenuous factors in offices lead to the sick building syndrome (SBS) with its various symptoms: fatigue, dyspnoea, decreased ability to concentrate, irritation of mucous membranes of eyes as well as of the upper airways . Those symptoms are induced by: unsuitable microclimate, chemical, aerosol and microbiological pollution, noise, vibration, electromagnetic fields, optical radiation, and static electricity . MATERIALS AND METHODS: A questionnaire survey was aimed at collecting information, opinions and personal perception of the work environment quality reported by office workers . The survey covered 229 workers employed in 100 offices . Offices with different density of workers and varied staff movement were equipped with typical office outfit: computers, laser printers, xerographic printers, faxes, scanners, and others . In the majority of offices, various kinds of plastics were used as finishing materials . Offices were located in newly constructed buildings supplied with air conditioning (3 buildings) as well as in old buildings equipped with mechanical or natural ventilation, used for years and frequently modernized (2 buildings) . RESULTS AND CONCLUSIONS: The respondents (239) reported frequently experienced fatigue (64%), redness, dry eyes, lacrimation, dyspnoea (62%), decreased ability to concentrate (47%), and irritation of the upper airways (44%) . These symptoms were most frequently manifested at the end of the working day (42%) . They were predominantly perceived as a result of unsuitable climate parameters (77%), defective ventilation or air conditioning (63%), unfit lighting (62%) and stress (49%).

Infez Med, 1995, 3(2), 102 - 5
{Treatment with thalidomide of oro-pharyngo-oesophageal ulcus in AIDS: a case report}; Cosentino S et al.; We report a case of oro-pharyngeal and oesophageal ulcerative disease in a AIDS patient . The patient complained of severe oral pain and dysphagia . Systemic manifestations as fever and fatigue were also present . Repeated microbiological exams were negative and therapy with either antibiotics or antiviral agents or corticosteroids or colchicine was unsuccessful . Thus, we started thalidomide: 200 mg/day X 21 days, followed by 100 mg/day X 25 days . A dramatic reduction of symptoms was observed within 15 days from the onset of treatment . The healing of ulcers was evident already one month after the start of therapy . No relevant side effects were reported . Among those patients with AIDS at low risk of side effects, thalidomide may represent a successful therapeutic presidium for severe ulcerative disease of the gastrointestinal tract.

Infez Med, 1995, 3(2), 95 - 101
{Efficacy and safety of cefixime for treatment of exacerbation of chronic bronchitis}; Clini V et al.; An open, multicenter non-comparative study was carried out in 8 centres in Italy to evaluate the efficacy, safety and tolerability of cefixime (Suprax - Lederle), a third generation oral cephalosporin administered once daily to patients affected by exacerbation of chronic bronchitis . All patients, 124 males and 21 females, aged between 50 and 85, were treated with Suprax at the dose of 400 mg/day for a mean period of 7.4 days . Clinical and laboratory examinations were performed at: T0 (beginning of treatment), T1 (3-4 days after the beginning of treatment), T2 (end of treatment) . The following signs/symptoms were recorded in order to evaluate the therapeutic efficacy: sputum quality and quantity, cough, dyspnoea, fever, bronchospasm, chest clinical findings . All these signs and symptoms significantly improved (p between < 0.001 and < 0.05; mean improvement for sign, weighted for time of improvement) . Bio-humoral parameters were also recorded in order to evaluate potential therapeutic influences . A significant decrease was observed (p < 0.01 Student t test for paired data) in the white blood cell count and the leukocyte formula . The datum regarding the white blood cell count and leukocyte formula is to be considered a primary effect of the treatment, proving its success . A microbiological search for the pathogen responsible for the infectious process was also performed: in 70/145 subjects the responsible pathogen was identified . The micro-organism was eradicate in 66/70 at T2 (94.3%), the difference T0 = T2 is significant . The X-Ray evidence suggesting a chronic bronchitis, was also evaluated in 81 patients . At T2, in 75/81 subjects the X-Ray evidence turned out to be negative, while in 6/81 it remained positive . This difference was statistically significant (p < 0.01 sign test) . An overall clinical evaluation showed a therapeutic success in 133/145 treated patients (91.7%) . No side effects were observed.

J Formos Med Assoc, 2003 Dec, 102(12), 845 - 50
Favorable outcome of parapneumonic empyema in children managed by primary video-assisted thoracoscopic debridement; Chen CY et al.; BACKGROUND AND PURPOSE: The appropriate type of intervention for the treatment of empyema in children remains controversial . This study analyzed whether video-assisted thoracoscopic debridement (VATD) as first-line treatment is effective in the management of pediatric parapneumonic empyema . METHODS: We retrospectively reviewed the medical and microbiological records of pediatric patients with parapneumonic empyema diagnosed at a medical center from January 1995 to December 2002 . The 55 patients included in this study were initially treated with either tube thoracostomy drainage (TTD group {n = 37}) or video-assisted thoracoscopic debridement (VATD group {n = 18}) . RESULTS: A comparative analysis found no significant difference in patient characteristics between these 2 groups . Patients in the VATD group had a significantly shorter duration of fever (18.9 +/- 1.7 vs 26.9 +/- 1.3 days), chest tube placement (5.3 +/- 0.7 vs 15.2 +/- 2.0 days), antibiotic therapy after the procedure (12.2 +/- 1.0 vs 26.3 +/- 2.8 days), and hospital stay (21.5 +/- 2.1 vs 33.2 +/- 2.8 days) . No additional procedures were required in the VATD group, whereas 65% (24/37) of patients in the TTD group underwent salvage VATD . CONCLUSION: Primary management using video-assisted thoracoscopic decortication was more effective and reduced the duration of illness in pediatric patients with parapneumonic empyema.

Infez Med, 1996, 4(3), 127 - 36
{Moraxella catarrhalis: an emerging respiratory pathogen}; Blandino G et al.; In the past years Moraxella (Branhamella) catarrhalis has finally gained respect as a pathogen thanks to the many reports of its causal role . The intent of this review is to provide a critical evaluation of the intent of this review is to provide a critical evaluation of the microbiological features (taxonomy, diagnosis, virulence, epidemiology and drug resistance), clinical diseases and therapy of this microorganism

Immunity, 2004 Feb, 20(2), 181 - 91
C-terminal SRC kinase controls acute inflammation and granulocyte adhesion; Thomas RM et al.; To establish whether the widely expressed regulator of Src family kinases Csk contributes to the control of acute inflammation in vivo, we inactivated csk in granulocytes by conditional mutagenesis (Cre/loxP) . Mutant mice (Csk-GEcre) developed acute multifocal inflammation in skin and lung . Animals were protected from the disease in a microbiologically controlled environment, but remained hypersensitive to LPS-induced shock . Csk-deficient granulocytes showed enhanced spontaneous and ligand-induced degranulation with hyperinduction of integrins . This hyperresponsiveness was associated with hyperadhesion and impaired migratory responses in vitro . Hyperphosphorylation of key signaling proteins such as Syk and Paxillin in mutant granulocytes further supported breakdown of the activation threshold set by Csk . By enforcing the need for ligand engagement Csk thus prevents premature granulocyte recruitment while supporting the motility of stimulated cells through negative regulation of cell adhesion.

Biodegradation, 2004 Feb, 15(1), 41 - 8
Detection and decontamination of residual energetics from ordnance and explosives scrap; Jung CM et al.; Extensive manufacturing of explosives in the last century has resulted in widespread contamination of soils and waters . Decommissioning and cleanup of these materials has also led to concerns about the explosive hazards associated with residual energetics still present on the surfaces of ordnance and explosives scrap . Typically, open burning or detonation is used to decontaminate ordinance and explosive scrap . Here the use of an anaerobic microbiological system applied as a bioslurry to decontaminate energetics from the surfaces of metal scrap is described . Decontamination of model metal scrap artificially contaminated with 2,4,6-trinitrotoluene and of decommissioned mortar rounds still containing explosives residue was examined . A portable ion mobility spectrometer was employed for the detection of residual explosives residues on the surfaces of the scrap . The mixed microbial populations of the bioslurries effectively decontaminated both the scrap and the mortar rounds . Use of the ion mobility spectrometer was an extremely sensitive field screening method for assessing decontamination and is a method by which minimally trained personnel can declare scrap clean with a high level of certainty.

Acta Paediatr, 2003 Dec, 92(12), 1445 - 52
Anogenital human papillomavirus in non-abused preschool children; Myhre AK et al.; AIM: To estimate the prevalence of human papillomavirus (HPV) in anogenital samples from children selected for non-abuse . METHODS: A letter of invitation was sent to 2731 girls and 1042 boys, all of them aged 5 or 6 y . Inclusion was based on self-selection, whereby parents who did not suspect any occurrence of sexual abuse of their child gave informed consent to participate . Several mechanisms were undertaken to exclude abused children . A complete examination was done of each child, including anogenital examination with a colposcope and microbiological sampling from the genitals and anus . Polymerase chain reaction (PCR) using primers MY09 and MY11 was used to identify HPV, and sequencing was done on each positive amplicon . RESULTS: PCR was performed on 325 adequate specimens from 211 children enrolled . Seven samples from 5 girls were HPV-positive, making 2/161 (1.2%) of the anal and 5/164 (3.0%) of the genital specimens positive . HPV was not detected in any of the boys . In four girls strong associations with HPV 6 genotypes were found, while one girl probably had a mixed infection with HPV 6 and 16 . Three girls (1.8%) had clinically detectable anogenital warts . CONCLUSION: Since our results are comparable with a prevalence reported from allegedly abused children, and higher rates have been reported from the oral cavity in healthy children, we find detection of HPV unreliable as an indicator of sexual abuse in 5-6-y-old children . The rate of anogenital warts found in our study is comparable with a rate reported in abused children.

Ann Periodontol, 2003 Dec, 8(1), 266 - 302
Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects . A systematic review; Murphy KG et al.; BACKGROUND: Many clinical studies have demonstrated that guided tissue regeneration (GTR) is a successful treatment modality of periodontal reconstructive surgery and it has become an accepted procedure in most periodontal practices . RATIONALE: The purpose of this structured review was to assess the efficacy of guided tissue regeneration (GTR) procedures in patients with periodontal osseous defects compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes . It extends the scope of previous GTR systematic reviews, which were limited to randomized controlled studies, by the scope of outcome measures examined, and the duration of the study . FOCUSED QUESTION: In patients with periodontal osseous defects, what is the effect of physical barriers compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes? SEARCH PROTOCOL: An electronic search of the Cochrane Oral Health Group Trials Register and MEDLINE databases was performed . Manual searching of journals included Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research up to January 2002 . This manual search also included review of relevant bibliographies . Two manufacturers of GTR devices were contacted regarding unpublished data . SELECTION CRITERIA: INCLUSION CRITERIA: Studies were selected for review if the evidence level was 3B (cohort) or above, at least 6 months duration, and compared a test GTR intervention with a surgical control . EXCLUSION CRITERIA: Studies with experimental design problems; histologic or microbiological investigations; or those with outcome measurements, study populations, or study duration not consistent with the inclusion criteria were excluded . Primary outcome measures for intrabony defects were: clinical attachment level (CAL) gain, probing depth reduction (PD), gingival recession (REC) reduction; for furcation defects: vertical probing attachment level (VPAL) gain, vertical probing depth reduction (VPD), horizontal probing depth reduction (HPD), horizontal open probing attachment level gain (HOPA), and vertical open probing attachment level gain (VOPA) . Meta-analysis was performed to compare GTR procedures to other surgical treatments and to examine the resulting clinical outcomes . MAIN RESULTS: 1 . For the primary outcome variables, in both intrabony-defect and furcation-defect studies, GTR was favored over open flap debridement (OFD) therapies (P < 0.0001) . 2 . No differences were detected among barrier types, but barrier types could explain some heterogeneity in the results . 3 . Augmentation of the GTR barrier with a particulate graft enhanced VPD (P < 0.05), VPAL, and HOPA, but none of the intrabony outcomes . REVIEWER'S CONCLUSIONS: Overall, GTR is consistently more effective than OFD in the gain of clinical attachment and probing depth reduction in the treatment of intrabony and furcation defects.

Ann Ig, 2003 Sep-Oct, 15(5), 693 - 700
{Guidelines for a prevalence survey of nosocomial infections in the University Hospital "Madre Teresa" in Tirana, Albania}; Sodano L et al.; The authors present guidelines for the first prevalence survey of nosocomial infections in the University Hospital "Madre Teresa" in Tirana (almost 1,600 beds), the only tertiary health-care centre in Albania . The survey is a joint project involving Italy and Albania, to be coordinated by the Italian National Health Institute . The paper describes goals, methodology and organization of the prevalence survey . The improvement of local expertise in epidemiology and microbiology is one of the most important goals . Therefore, Albanian personnel training and improvement of the infection microbiological diagnosis are fundamental aspects of the project.

J Food Prot, 2004 Feb, 67(2), 413 - 9
Visible contamination on animals and carcasses and the microbiological condition of meat; Gill CO; It is generally assumed that preventing visible contamination of or removing visible contamination from carcasses will enhance the microbiological safety of meat . Visible contamination of carcasses can be reduced by washing or otherwise cleaning animals before slaughter, by dehairing hides before carcasses are skinned or dressed with the skin on, or by performing skinning and eviscerating operations in manners that avoid the transfer of filth from the hide to the meat or the spillage of gut contents . Visible contamination can be removed by washing, trimming, or vacuuming carcasses . The available data appear to indicate that, of the various actions that can be taken to obtain carcasses that are free of visible contamination, only minimizing the visible contamination of meat during skinning and eviscerating operations may also ensure a degree of control over the microbiological contamination of meat . It might be preferable for visible contamination to be controlled largely by superior skinning and eviscerating practices rather than by animal or carcass cleaning treatments, which may not prevent the depositing of bacteria on or the removal of substantial numbers of bacteria from carcasses.

J Food Prot, 2004 Feb, 67(2), 252 - 5
Survival of Escherichia coli O157:H7 in set yogurt as influenced by the production of an exopolysaccharide, colanic acid; Lee SM et al.; Previous studies conducted in our laboratory revealed that Escherichia coli O157:H7 cells capable of producing colanic acid (CA), the acidic polysaccharide of mucoid slime, had increased tolerance to sublethal heat and the extreme pH of microbiological culture media . This study was undertaken to determine the effect of CA on the fate of E . coli O157:H7 during the processing and storage of an acid food: yogurt . Pasteurized and homogenized whole milk was inoculated with a wild-type E . coli O157:H7, its CA-deficient mutant, or a mixture (1:1) of the two strains . Set yogurt was processed from the contaminated milk and stored at 4 degrees and 15 degrees C for 3 weeks . Samples of milk and yogurt were withdrawn during processing and storage and analyzed for total plate counts and populations of E . coli O157:H7 and starter cultures . The results showed that E . coli O157:H7 survived longer in yogurt stored at 15 degrees C than at 4 degrees C . Cells of E . coli O157:H7 deficient in CA production died off more rapidly than those of the parent strain . This suggests that CA plays a role in protecting cells of E . coli O157:H7 from stress during the processing and storage of set yogurt.

Int J Food Microbiol, 2004 Feb 15, 91(1), 99 - 103
Ice as a vehicle for diarrheagenic Escherichia coli; Falcao JP et al.; In a recent study of the microbiological quality of commercial ice, 50 Escherichia coli isolates belonging to different serotypes were found . The potential hazard from these isolates was examined by testing their adherence patterns in HeLa cells and searching for the presence of DNA sequences related to E . coli virulence properties . Twelve potentially diarrheagenic isolates were found and classified as enteroaggregative E . coli (EAEC) based on their ability to produce aggregative adherence to HeLa cells . The remaining isolates were devoid of the virulence properties searched for . The EAEC isolates belonged to 10 different serotypes, among which O128ab:H35 is often found in diarrheic feces . None of these isolates reacted with a specific EAEC DNA probe or carried any of the known EAEC virulence genes . These data indicate that ice may be an important vehicle for transmission of enteropathogens, especially of the EAEC group.

Infez Med, 1997, 5(2), 114 - 7
{Otomastoiditis caused by Mycobacterium avium: a case report}; Ticca F et al.; Non tuberculous Mycobacterial (NTM) Infections mainly affect immunocompromised patients, appearing as disseminated or pulmonary disease . In immunocompetent children the most common form of infection with NTM is cervical adenitis . Ear infection seems to be a rare disease . We present a case of otomastoiditis caused by Mycobacterium avium in a 15 months old child, immunologically normal . Patient was referred for persistent right otitis unresponsive to routine medical therapy . TC scan of the ear and temporal bones revealed: soft tissue in external auditory canal, Eustachian canal, and middle ear overlying ossicles with erosion of tegmen tympani . Tuberculin skin test was positive with 5 units PPD and culture yielded M . avium . The patient undergo timpanomastoidectomy and medical therapy with antituberculous drugs and Steroids, subsequently he was given Clarithromycin and Rifabutin . M . avium is an ubiquitous low grade pathogen found in soil, water, dust and food . There is no evidence of direct transmission . Only a few cases of otomastoiditis due to M . avium have previously been reported . The case presented underlines the importance of microbiological investigations . When a NTM infection is suspected surgeons and infectious diseases specialists should cooperate to find an optimal treatment regimen of this unusual disease.

New Microbiol, 2004 Jan, 27(1), 55 - 63
Microbiological study and scanning electron microscopic analysis of root canal wall dentin following pumped Diodium Nd:YAG laser irradiation; D'Ercole S et al.; The capability of Nd:YAG laser in sterilizing root canals and the alterations of dentinal walls induced by laser treatment were investigated . Thirty root canals were infected by P . aeruginosa ATCC 27853 and thirty canals by A . naeslundii CH-12 . Within each infection, 4 groups were selected on the basis of the treatment . Among them, 2 test groups (TGs) were treated by Nd:YAG laser at 15 Hz for 15 s, using 2 different settings: 1 Watt/70 Joule and 1.5 Watt/100 Joule, respectively (n = 10 each) . The other 2 groups, used as controls (CGs), were: untreated (positive control, n = 5) and sterilized by 5.25% NaClO group (negative control, n = 5) . Observations under scanning electron microscope (SEM) and quantitative bacterial counts were performed . These analyses were performed once per group after infections and treatments . Laser treatments significantly reduced the number of both bacteria . SEM investigation showed melting and crystallization of canal dentin over 1.5 W/100 J . Laser irradiation has a bactericidal effect but it does not completely sterilize the root canal as NaClO 5.25% solution does if the goal of treatment is also to avoid alterations of dentinal walls.

J Immune Based Ther Vaccines . 2004 Feb 13;2(1):4.
Current problems of perinatal Chlamydia trachomatis infections; Numazaki K; Chlamydia trachomatis has been recognized as a pathogen of trachoma, nongonococcal urethritis, salpingitis, endocervicitis, pelvic inflammatory disease, inclusion conjunctivitis of neonates, follicular conjunctivitis of adults, infantile pneumonia and associated conditions . Chlamydial infections during pregnancy may also cause a variety of perinatal complications . Different antigenic strains of C . trachomatis from endocervical, nasopharyngeal and conjunctival origins have been associated with different clinical conditions . Control programs emphasizing early diagnosis, targeted screening, and effective treatment will lead to an eventual decline in the incidence of perinatal chlamydial infection . This review focuses on current problems of perinatal C . trachomatis infections in the aspects of microbiological and immunological pathogenesis.

Xenotransplantation, 2004 Jan, 11(1), 91 - 6
Control of microbial contamination during surgical harvest of pig renal xenografts; Tucker AW et al.; The pig has been identified as the most likely source of xenograft material for clinical use and studies are ongoing to overcome the immunological hurdles of pig-to-human transplantation . Attention is now being focussed on identifying and reducing the potential microbiological hazards associated with this technique . Studies have primarily addressed issues surrounding the production and health monitoring of xenograft source pigs and none have so far specifically evaluated the possible risks of microbial contamination during xenograft harvest . In this report, we evaluate the possible routes for contamination of a pig kidney xenograft during organ harvest and describe approaches to the control of these hazards, including the novel use of a custom designed airtight surgical canopy . A standard procedure for microbiological monitoring during xenograft harvest was devised and evaluated . This allowed the rapid identification and anti-microbial sensitivity testing of any isolated organisms . This would enable an early and appropriate pre-emptive treatment of infection because of transmission of pig micro-organisms.

Pharmeuropa Bio, 2004 Jan, 2003(2), 1 - 8
Collaborative studies for the establishment of reference substances for the microbiological assay of antibiotics; Charton E et al.; Collaborative studies were initiated by the European Directorate for the Quality of Medicines (EDQM) to assign potency values for candidate European Pharmacopoeia Chemical Reference Substances (Ph . Eur . CRSs) used for the microbiological assay of antibiotics . The candidates were assayed against their respective International Standard (IS), using the methods by diffusion or turbidimetry . Potencies were assigned to all the antibiotics concerned, which were adopted by the European Pharmacopoeia Commission.

J Biomater Appl, 2004 Jan, 18(3), 193 - 207
Influence of different sterilization procedures and partial demineralization of screws made of bone on their mechanical properties; Actis AB et al.; Since 1992, screws made of allogenic, autoclaved human cortical bone have been employed as osteosynthesis materials . Autoclaving at 134 degrees C for 5 min makes them microbiologically safe, but on the other hand it reduces both their mechanical properties and osteoconductive capacity . The aim of this in vitro study was to determine if the mechanical properties of these screws could be improved after receiving different autoclaving procedures and partial inner demineralization, the latter additionally tending to increase their osteoconductive potential . 132 screws made of bovine cortical bone were employed . Some of them were partially demineralized with 0.6 N HCl from an inner canal performed following their longitudinal axis . All the specimens were autoclaved at 134 degrees C but under different vacuum conditions and sterilization time (A1-A2) . They were then subjected to tension, shear and torque tests . A difference between both sterilization procedures was observed . Samples sterilized at 134 degrees C, 2-2.4 mbars for 5 min (A1) showed better mechanical properties than those autoclaved for longer time and higher vacuum conditions (A2) . Demineralization also influenced their mechanical properties, being less resistant with increasing time . Based on these results, a standard screw made of bone and autoclaved at 134 degrees C, 2-2.4 mbars, 5 min seems to be the most appropriate, from a biomechanical point of view, to be used as osteosynthesis material.

Methods Mol Biol, 2004, 262, 111 - 24
Detecting carcinogens with the yeast DEL assay; Brennan RJ et al.; The yeast DEL assay is a simple, rapid method for measuring the frequency of reversion of a disrupted his3 gene by homologous intrachromosomal recombination . Reversion to histidine prototrophy results in deletion (DEL) of the disrupting sequence . The DEL assay has been used to study the effects of various DNA-damaging treatments on the frequency of deletion-recombination and has been shown to have a high level of sensitivity and specificity toward carcinogens, many of which are poorly detected by bacterial mutagenicity and other short-term genotoxicity assays . The DEL assay therefore is a useful addition to the arsenal of predictive tests for genotoxicity and carcinogenicity . This chapter provides an in-depth description of materials and methods for the yeast DEL assay from a user's prospective and should allow the assay to be successfully deployed in any laboratory with basic microbiological capability and minimal user training.

Zhonghua Yan Ke Za Zhi, 2003 Dec, 39(12), 743 - 5
{The clinical analysis of endophthalmitis caused by minor ocular perforation}; Fu ZH et al.; OBJECTIVE: To discuss the incidence rate and causes of endophthalmitis caused by minor ocular perforation . To document its damage to the visual function, so as to improve the rate of prevention of this disease . METHODS: The following clinical information of 153 cases with minor ocular perforations from a retrospective study was collected: general conditions, injury objects, wound shape and size, presence or absence of ocular foreign body, associated organic injuries, visual functions in the early stage after injury, speed of occurrence of infection, and positive rate of microbiological tests . The results with the drug treatments and surgical therapy were analyzed . RESULTS: All of 153 cases were followed up from 3 months to 7 years . The visual acuity in 13 cases (8.5%) was over 0.3 . 140 cases (91.5%) were less than 0.3 . Enucleating was performed in 37 cases (24.2%) . CONCLUSION: The patients with minor ocular perforations tend to have good visual acuity in the early stage after injury . But their visual acuity was lost in 4 to 12 hours if rapid and severe infections occurred . The risk of endophthalmitis should be recognized and evaluated on time in the early stage after injury.

Int J STD AIDS, 2004 Jan, 15(1), 21 - 5
Mycoplasma genitalium in chronic non-gonococcal urethritis; Taylor-Robinson D et al.; Seventy-eight men with a history of chronic urethritis were referred for investigation . Of 52 men diagnosed as having persistent or recurrent non-gonococcal urethritis (NGU) at the time of referral, 11 (21%) were infected with Mycoplasma genitalium and three with Chlamydia trachomatis . Men who were M . genitalium-positive had not previously received less antibiotic, in terms of treatment duration, than those who were M . genitalium-negative, suggesting a possible resistance to the antibiotics given . In the current investigation, of 11 M . genitalium-positive men with persistent or recurrent NGU who were treated for four to six weeks with erythromycin, 500 mg four times daily, nine (82%) responded clinically and microbiologically, but later six relapsed without M . genitalium being detected . The results of observing and investigating a patient for about one year, the only one to have concurrent chlamydial and mycoplasmal infections, is presented, a feature being the intermittent persistence of the mycoplasma.

Biotechnol Appl Biochem . 2004 Feb 9; {Epub ahead of print}
Regulatory and microbiological safety issues surrounding cell and tissue engineering products; Galbraith DN; Cell therapies and tissue engineered products that contain living cells are potentially some of the most interesting of the novel therapeutic products currently under development . These products present a number of safety issues particularly with respect to the transmission of human viruses . In addition the short shelf life of these products does preclude the normally extensive characterisation performed on other biotherapeutic products . Careful examination of the risks and extensive testing of the raw materials have been used in place of products testing to ensure safety.

J Ind Microbiol Biotechnol, 2004 Feb, 31(2), 70 - 82 Epub 2004 Feb 06.
Organization of genes required for gellan polysaccharide biosynthesis in Sphingomonas elodea ATCC 31461; Harding NE et al.; Sphingomonas elodea ATCC 31461 produces gellan, a capsular polysaccharide that is useful as a gelling agent for food and microbiological media . Complementation of nonmucoid S . elodea mutants with a gene library resulted in identification of genes essential for gellan biosynthesis . A cluster of 18 genes spanning 21 kb was isolated . These 18 genes are homologous to genes for synthesis of sphingan polysaccharide S-88 from Sphingomonas sp . ATCC 31554, with predicted amino acid identities varying from 61% to 98% . Both polysaccharides have the same tetrasaccharide repeat unit, comprised of {-->4)-alpha- l-rhamnose-(1-->3)-beta- d-glucose-(1-->4)-beta- d-glucuronic acid-(1-->4)-beta- d-glucose-(1-->} . Polysaccharide S-88, however, has mannose or rhamnose in the fourth position and has a rhamnosyl side chain, while gellan has no sugar side chain but is modified by glyceryl and acetyl substituents . Genes for synthesis of the precursor dTDP- l-rhamnose were highly conserved . The least conserved genes in this cluster encode putative glycosyl transferases III and IV and a gene of unknown function, gelF . Three genes ( gelI, gelM, and gelN) affected the amount and rheology of gellan produced . Four additional genes present in the S-88 sphingan biosynthetic gene cluster did not have homologs in the gene cluster for gellan biosynthesis . Three of these gene homologs, gelR, gelS, and gelG, were found in an operon unlinked to the main gellan biosynthetic gene cluster . In a third region, a gene possibly involved in positive regulation of gellan biosynthesis was identified.

Caries Res, 2004 Mar-Apr, 38(2), 124 - 9
The effect of chewing urea-containing gum on plaque acidogenic and alkaligenic parameters; Smith CA et al.; The aim of this double-blind crossover study was to determine the effect of chewing urea-containing gum on selected microbiological plaque properties . Eleven subjects chewed either urea-containing or urea-free placebo gum 3 times daily, each for 4 weeks, with at least a 4-week separation between regimes . After each chewing regime, plaque was sampled from all available surfaces, and inoculated into media indicative of acid or base production . In addition, interdental pH measurements were taken using touch Beetrode electrodes following sucrose and sorbitol mouthrinses, and sucrose mouthrinses followed by urea rinse, urea gum, or placebo gum . No significant differences in plaque acidogenic and alkaligenic properties were found between the urea and placebo gum regimes . Urea rinsing, urea gum and placebo gum all reduced the depth and duration of the pH fall following a sucrose mouthrinse . They also enhanced a rise in pH above the resting pH, but although urea gum produced a larger increase than placebo gum, the difference was not significant .

J Clin Microbiol, 2004 Feb, 42(2), 746 - 52
Determination of infectious load of Mycoplasma genitalium in clinical samples of human vaginal cells; Blaylock MW et al.; Mycoplasma genitalium is a leading cause of chlamydia-negative, nongonoccocal urethritis and has been directly implicated in numerous other genitourinary as well as extragenitourinary tract pathologies . Detection of M . genitalium has relied almost entirely on PCR amplification of clinical specimens and evidence of seroconversion since these mycoplasmas are highly fastidious and culture isolation by microbiological techniques is very rare . We have established a combinatorial strategy using confocal immunoanalysis (CIA) and real-time PCR to qualitatively and quantitatively assess patterns of M . genitalium infection in women attending a sexually transmitted disease-related health clinic in San Antonio, Tex . CIA allows spatial examination of mycoplasmas on surfaces and inside human target cells, plus the ability to evaluate cell-to-cell patterns and variances within samples . Real-time PCR permits determination of genome copy numbers of mycoplasmas and human cells by multiplex amplification using mycoplasma gyrA and human RNase P gene sequences, which indicates overall levels of mycoplasma infection and degree of parasitism . These assays are strongly correlated and, in combination, permit detection and elucidation of heretofore-unrecognized patterns of M . genitalium infections in clinical and experimental samples.

PDA J Pharm Sci Technol, 2003 Nov-Dec, 57(6), 425 - 8
A method for demonstrating appropriate environmental protection for capping aseptically filled and plugged vials; Arnold JF et al.; Conventional aseptic filling of drug product into vials ultimately includes a step that requires time and travel from the stoppering stage to the capping/crimping stage . Lyophilized product necessarily includes a partial stoppering step and, therefore, Grade A conditions . The level of environmental control that is required to protect the contents of fully stoppered, but uncapped, vials of sterile product from microbial contamination hasn't been formally defined . There is considerable range of opinion regarding this topic . This is the result of the lack of data that indicates the level of protection afforded by vials that are closed with a stopper, but that have not yet been capped . In order to provide some insight into the level of environmental control that is appropriate for vials at this stage of production, studies were conducted that consisted of exposing stoppered, uncapped vials containing sterile microbiological media to an aerosolized microbial challenge . The test samples were selected and assembled in such a way that a range of container/closure presentations was simulated . Furthermore, a microbial challenge was selected that was in excess of the environmental conditions to which product vials would be exposed . The results of this testing indicated a high level of confidence that stoppered, uncapped vials exposed to microbiologically challenging conditions would be expected to maintain the sterility of their contents.

Clin Infect Dis, 2004 Feb 15, 38(4), 515 - 20 Epub 2004 Jan 30.
Unusual presentation of life-threatening Toscana virus meningoencephalitis; Baldelli F et al.; This case report describes a brother and a sister with severe meningoencephalitis caused by Toscana virus (TOSv) . The clinical presentation was characterized by stiff neck, deep coma, maculopapular rash, diffuse lymphadenopathy, hepatosplenomegaly, renal involvement, tendency to bleeding, and diffuse intravascular coagulation . The boy had epididymo-orchitis . Recovery with neurologic sequelae as hydrocephalus was observed . Microbiological diagnosis was obtained by serological tests and reverse transcriptase-polymerase chain reaction . Sequencing of polymerase chain reaction products from the S and M segments was carried out . TOSv may be a causative agent in severe meningoencephalitis.

Clin Infect Dis, 2004 Feb 15, 38(4), 467 - 75 Epub 2004 Jan 29.
Viral replication in the nasopharynx is associated with diarrhea in patients with severe acute respiratory syndrome; Cheng VC et al.; The role of severe acute respiratory syndrome (SARS) coronavirus as an enteric pathogen was investigated in a cohort of 142 patients with SARS who were treated with a standard treatment protocol . Data from daily hematological, biochemical, radiological, and microbiological investigations were prospectively collected, and the correlation of these findings with diarrhea was retrospectively analyzed . Sixty-nine patients (48.6%) developed diarrhea at a mean (+/- standard deviation {SD}) of 7.6+/-2.6 days after the onset of symptoms . The diarrhea was most severe at a mean (+/-SD) of 8.8+/-2.4 days after onset, with a maximum frequency of 24 episodes per day (median, 5 episodes; range, 3-24 episodes) . A higher mean virus load in nasopharyngeal specimens obtained on day 10 after the onset of symptoms was significantly associated with the occurrence of diarrhea (3.1 log10 vs . 1.8 log10 copies/mL; P=.01) and mortality (6.2 vs . 1.7 log10 copies/mL; P<.01) . However, diarrhea was not associated with mortality . The lung and the gastrointestinal tract may react differently to SARS coronavirus infection . Additional investigation of the role of SARS coronavirus in the pathogenesis of diarrhea in patients with SARS should be conducted.

Biotechnol Prog, 2004 Jan-Feb, 20(1), 397 - 401
Allyl-thiosulfinates, the bacteriostatic compounds of garlic against Helicobacter pylori; Canizares P et al.; Allicin and allyl-methyl plus methyl-allyl thiosulfinate from acetonic garlic extracts (AGE) have been isolated by high-performance liquid chromatography . These compounds have shown inhibition of the in vitro growth of Helicobacter pylori (Hp), the bacterium responsible for serious gastric diseases such as ulcers and even gastric cancer . A chromatographic method was optimized and used to isolate these thiosulfinates . The method developed has allowed the isolation of natural thiosulfinates extracted from garlic by organic solvents and is an easy and cheap methodology that avoids complex synthesis and purification procedures . The capacity and effectiveness of isolated natural thiosulfinates have been tested, and this has enabled the identification of the main compounds responsible for the bacteriostatic activity shown by AGE origin of these kinds of organosulfur compounds along with ethanolic garlic extracts (EGE) . Additionally, microbiological analyses have suggested that these compounds show a synergic effect on the inhibition of the in vitro growth of Hp . The results described here facilitate the process of obtaining garlic extracts with optimal bacteriostatic properties . The product is obtained in a way that avoids expensive purification methods and will allow the design of live tests with the aim of investigating the potential for the use of these garlic derivatives in the treatment of patients with Hp infections.

Biotechnol Prog, 2004 Jan-Feb, 20(1), 32 - 7
Thermal degradation of allicin in garlic extracts and its implication on the inhibition of the in-vitro growth of Helicobacter pylori; Canizares P et al.; Allicin, the main active principle related to Allium sativum chemistry, is considered to be responsible for the bacteriostatic properties of garlic . The work described here has demonstrated the direct implication of the allicin present in solvent-free garlic extracts obtained with ethanol (ethanolic garlic extract, EGE) and acetone (acetonic garlic extract, AGE) in the inhibition of the in-vitro growth of Helicobacter pylori (Hp), the bacterium responsible for serious gastric diseases such as ulcers and even gastric cancer . The evolution of allicin concentration as a function of time and temperature has been the subject of a kinetic study . The reaction order, activation energy, and preexponential factor (in accordance with Arrhenius theory) have been determined for the decomposition process of allicin in these organic media . First-order decomposition, an activation energy of 97.4 kJ/mol, and an Arrhenius preexponential factor of 8.9 x 10(10) s(-1) have been determined for allicin in EGE . For allicin in AGE the kinetic order determined was 1.5, the activation energy 184.5 kJ/mol, and the preexponential factor 3.1 x 10(24) s(-1) (mg/L)(-0.5) . The presence or absence of allicin in these garlic products was found to be crucial for the inhibition of the in-vitro growth of Hp, as demonstrated by microbiological analysis for AGE . A relationship has been identified between the effectiveness and durability of the anti-Hp properties shown by AGE and the allicin content of these products . The bacteriostatic properties were active for up to 10 months if the samples were maintained at 6 degrees C.

Biotechnol Prog, 2004 Jan-Feb, 20(1), 1 - 12
From time temperature integrator kinetics to time temperature integrator tolerance levels: heat-treated milk; Claeys WL et al.; Six milk compounds were studied as potential intrinsic time temperature integrators (TTIs) for the assessment of heat-treated milk . These include the enzymes alkaline phosphatase and lactoperoxidase, the whey protein beta-lactoglobulin and the chemical compounds hydroxymethylfurfural, lactulose and furosine . In previous research the inactivation/denaturation/formation kinetics of these compounds were analyzed under isothermal and nonisothermal conditions and evaluated for variability of the milk composition . The present paper focuses on the implementation of the TTIs . TTIs are validated with respect to microbiological indices and quality attributes, and a quantitative relationship between the denaturation, inactivation or formation of the TTIs and technological processes is established by construction of general time temperature tolerance (TTT) diagrams . In these diagrams temperature time combinations are presented, which lead to the same formation, inactivation or denaturation of TTIs, or result in the same level of microbiological destruction or quality degradation of the product . TTT-diagrams are very informative since they allow visualization of the impact of a thermal process on milk and evaluation of criteria for evaluating milk authenticity (conformity of the product with the terminology applied) . Moreover, the optimum combination of temperature and time of heating may be readily deduced from these diagrams.

Pesqui Odontol Bras, 2003 Jul-Sep, 17(3), 234 - 40 Epub 2003 Dec 16.
Viability of autogenous bone grafts obtained by using bone collectors: histological and microbiological study; Blay A et al.; The use of autogenous bone grafts is considered to be the best choice for reconstructive surgery . In the periodontal literature, the utilization of osseous coagulum was suggested by the end of the sixties . The purpose of this study is to consider the use of bone collectors (bone traps) as an alternative method for obtaining material to fill small bone imperfections, such as fenestrations and dehiscences . Thirty samples were obtained from bone drilling during fixture installation in patients (13 men and 17 women, with an average age of 54 years) requiring treatment at the Department of Periodontology and Implant Dentistry, University of Santo Amaro . These samples were fixed in 10% neutral formaldehyde for 24 hours and subjected to histological preparation, in order to evaluate the presence of viable osteoblasts . In addition, the material was placed in a fluid thioglycolate medium and incubated for 24 hours at 36 1 C in aerobiosis and anaerobiosis . Bacterial growth evaluation was made by using six different culture media (MacConkey agar, blood agar base, mannitol salt agar, Anaerokit LTD medium, Anaerokit LTD - bile medium, Anaerinsol) . The results show that, if proper care is taken to prevent saliva contamination during the surgical procedure, this method of collecting autogenous bone may be useful in situations where small amounts of bone are required.

Crit Rev Oral Biol Med, 2004, 15(1), 47 - 60
BIOLOGICAL RISKS OF RESIN-BASED MATERIALS TO THE DENTIN-PULP COMPLEX; Bouillaguet S; Over the past 30 years, restorative dentistry has seen a revolution in materials, restorative techniques, and patient priorities . This revolution has been made possible with the development of new resin-based materials which can be bonded to the tooth structure . Not all of these changes have been without controversy or concern, and some have raised questions about the biological safety of these new materials and techniques . It is the purpose of this review to present recent and relevant information about the biological risks and consequences of resin-tooth bonding and how these risks are affected by the material, its clinical properties, and its manipulation by the practitioner . These biological risks are complex and interactive, and are still incompletely defined . In broad terms, these risks can be divided into those stemming from the toxicological properties of the materials themselves (direct biological risks) and those stemming from microbiological leakage (indirect biological risks).

Eur J Pediatr, 2004 Mar, 163(3), 140 - 4 Epub 2004 Jan 31.
Clinical response to antibiotic therapy for community-acquired pneumonia; Juven T et al.; Childhood community-acquired pneumonia is a common and potentially serious problem worldwide . Unless the patient has bacteraemia or pleural empyema, aetiological diagnostics are limited and antibiotic treatment is empirical . Published data on expected response to therapy are scarce . To determine the clinical response to antibiotic treatment in a developed country in otherwise healthy children with community-acquired pneumonia, we conducted a prospective study of 153 hospitalised children with pneumonia . The role of 17 microbes as potential causative agents was evaluated . The duration of fever (>37.5 degrees C) and hospitalisation were studied as objective measures of recovery . A potential aetiology was found in 83% of 153 patients: 29% of the patients had sole viral and 26% sole bacterial and 29% mixed viral-bacterial infections . The median duration of fever after the onset of antibiotic treatment (mainly penicillin G) was 14 h and the median duration of hospitalisation was 48 h . Patients with mixed viral-bacterial infection became afebrile more slowly than those with either sole viral or sole bacterial infections . Conclusion: the findings indicate that in a developed country, children with pneumonia make a rapid, uneventful recovery needing only a short hospital stay . Expensive and time-consuming microbiological investigations are not required once bacterial sepsis has been excluded.

Dermatol Ther, 2004, 17(1), 55 - 67
Vulvar ulcers and erosions--a dermatologist's viewpoint; Bohl TG; Vulvar ulceration can occur as the primary or secondary event in a large variety of conditions . These include infections, autoimmune and/or inflammatory diseases and dermatoses, neoplasias, and conditions with an unknown etiology . A thorough medical history and careful patient examination remain the linchpin of management . Specific microbiological, histological, immunological, and other investigations are often necessary to establish or confirm a diagnosis, but the relevant importance of these will vary in the individual patient . The specific management of each patient will also vary accordingly . Other important factors which will influence the frequency with which any physician will make one of the specific diagnoses include practice location, referral mechanisms, and population demographics . This chapter is written with the generalist dermatologist in mind . Whilst dermatoses are given prime attention, important infections and other conditions are also dealt with . The ultimate aim of the present paper is to provide the generalist dermatologist with a useful tool for the diagnosis and management of a patient that present's with a vulvar ulcer(s).

Rev Med Chir Soc Med Nat Iasi, 2003 Jan-Mar, 107(1), 163 - 72
{Risk of increase in nosocomial infections incidence in a surgical clinic . A case-control study}; Azoicai D et al.; The complex activities of epidemiological surveillance of nosocomial infections (NI) have, among the main objectives, the identification of the causes and the assessment of risk factors . In 2002, the Clinic Hospital of Pneumology Iasi had 220 beds and was divided into the following units: Pneumophtisiology Unit (PPU), Thoracic Surgery Unit (TSU) and Intensive Care Unit (ICU) . The global incidence of NI was of 0.85% . The incidence of cases with NI in the TSU and ICU increased to 5.39% in the interval April-June 2002 so that urgent epidemiological measures were applied to limit the phenomenon . After that, a case-control study was proposed in order to identify and assess the risk levels . The retrospective study met the methodological conditions such as case definitions for NI and post-surgical NI, for extrinsic and intrinsic risk factors, the selection of cases according to inclusion and exclusion criteria, the formation of the representative sample . The study included 16 patients with pleural NI and 55 controls with the pleurotomy performed between April-June in the TCU, as a common feature . The factors that increased the probability of a post-surgical NI development were: the external pleural drainage maintained more than 30 days (OR = 185.5; p < 0.0001 for CI = 95%), tuberculosis as the most important associated disease among the patients' pathological history records (OR = 28.0; p < 0.0001; CI = 95%); the antibiotherapy with multiple associations (OR = 3.30; p < 0.04; CI = 95%) . The conclusions underlined that the patients suffered from tuberculosis since the very admission, which need pleurotomy have an increased risk to develop a NI . This fact should require an appropriate epidemiological, clinical and microbiological surveillance and the empirical antibiotic strategy or that conducted by the antibiogram results has to be performed adequately, according to the operative recommendations.

J Agric Food Chem, 2004 Feb 11, 52(3), 385 - 406
Applications of the ninhydrin reaction for analysis of amino acids, peptides, and proteins to agricultural and biomedical sciences; Friedman M; The reaction of ninhydrin with primary amino groups to form the purple dye now called Ruhemann's purple (RP) was discovered by Siegfried Ruhemann in 1910 . In addition, imines such as pipecolic acid and proline, the guanidino group of arginine, the amide groups of asparagine, the indole ring of tryptophan, the sulfhydryl group of cysteine, amino groups of cytosine and guanine, and cyanide ions also react with ninhydrin to form various chromophores of analytical interest . Since its discovery, extensive efforts have been made to apply manual and automated ninhydrin reactions as well as ninhydrin spray reagents to the detection, isolation, and analysis of numerous compounds of interest across a broad spectrum of disciplines . These include agricultural, biochemical, clinical, environmental, food, forensic, histochemical, microbiological, medical, nutritional, plant, and protein sciences . This reaction is unique among chromogenic reactions in that at pH 5.5 it results in the formation of the same soluble chromophore by all primary amines which react, be they amines, amino acids, peptides, proteins, and even ammonia . Because the chromophore is not chemically bound to the protein or other insoluble material, it is not lost when the insoluble substrate is removed by centrifugation or filtration after the reaction is completed . The visible color of the chromophore is distinctive and is generally not affected by the yellow colors present in many food, plant, and tissue extracts . Adaptations of the classical ninhydrin reaction to specialized needs in analytical chemistry and biochemistry include the use of acid, alkaline, and fluorogenic ninhydrin reagents . To cross-fertilize information among several disciplines wherein an interest in the ninhydrin reaction has developed, and to enhance its utility, this review attempts to integrate and correlate the widely scattered literature on ninhydrin reactions of a variety of structurally different compounds . Specifically covered are the following aspects: historical perspective, chemistry and mechanisms, applications, and research needs . A better understanding of these multifaceted ninhydrin reactions provide a scientific basis for further improvements of this important analytical technique.

J Dent, 2004 Feb, 32(2), 153 - 9
Effect of different crown contours on periodontal health in dogs . Microbiological results; Kohal RJ et al.; OBJECTIVES: In some clinical circumstances, i.e . in cases when the upper anterior region has to be restored by prosthetic means, it is necessary to place the margins of crowns and fixed partial dentures subgingivally . In addition, in periodontally compromised patients the restoration sometimes has to be overcontoured in order to replace the lost interdental papilla . The overcontoured crown margin may influence the subgingival bacterial composition . Therefore, the aim of the present investigation was to evaluate the effect of three different subgingival crown contours in dogs on the composition of the subgingival microbiota . METHODS: In four adult beagle dogs the second and third premolars were prepared in three quadrants and restored with single gold crowns . The unprepared second and third premolars in the last quadrant served as controls . The crowns had three different emergence profiles including a normal contour, a 30 degrees and a 50 degrees over-contour . During the entire study period, professional oral hygiene was performed seven times a week . Microbiological samples were harvested from four sites of test and control teeth (mesial, distal, buccal and lingual) at baseline, after 3 months, and after 5 months . RESULTS: The microbiological analysis (DNA-DNA hybridization technique) of the subgingival microbial flora revealed a dominance of P . intermedia, T . denticola and C . showae in all test and control groups at baseline . At three months, the total amount of bacteria increased and a broader variety of bacterial species could be detected . The detection frequency of most bacterial species increased from baseline to the 5-month evaluation . The frequency of detection of some species was higher in the 30 degrees and 50 degrees overcontoured test groups compared to the normal contour group and to the natural teeth . CONCLUSIONS: It can be concluded within the limits of this investigation that overcontoured gold crowns placed subgingivally have only slight effects on the microbiological composition in dogs when an intensive oral hygiene regimen was executed.

Cytopathology, 2004 Feb, 15(1), 44 - 8
Diagnosis of tuberculous lymphadenitis by FNAC, microbiological methods and PCR: a comparative study; Aljafari AS et al.; Despite its usefulness in the diagnosis of tuberculous lymphadenitis, fine needle aspiration cytology (FNAC) faces several limitations, and its sensitivity and specificity are not well established . The diagnostic accuracy and limitations of FNAC were studied in comparison with conventional microbiological methods and polymerase chain reaction (PCR) . Sixty patients with lymphadenopathy and a clinical diagnosis of tuberculous lymphadenitis were subjected to FNA . The aspirate was used for cytological examination, Ziehl-Neelsen staining, mycobacterial culture and PCR . PCR was performed using two sets of oligonucleotide primers for Mycobacterium tuberculosis and a single primer for M . bovis species . The results of FNAC, microbiological methods and PCR correlated with the clinical outcome after follow-up for an average period of 24 months . Twenty-five cases (41.6%) were treated and responded well to anti-tuberculosis therapy, among them 17 were correctly diagnosed by FNAC (68%), eight by microbiological methods (32%) and 24 by PCR (96%) . When PCR is considered the gold standard, FNAC predicted the correct diagnosis in 62% of cases with a high false negative rate (38%) due to the absence of granuloma/necrosis in smears from cases of early tuberculosis . In the latter group PCR proved to be the most valuable and a diagnostic success of 100% was achieved when FNAC and PCR were combined . In addition, PCR allowed immediate characterization of M . tuberculosis in the vast majority (96.2%) of cases in the study population.

J Public Health Med, 2003 Dec, 25(4), 362 - 8
Early warning and NHS Direct: a role in community surveillance?
Baker M, Smith GE, Cooper D, Verlander NQ, Chinemana F, Cotterill S, Hollyoak V, Griffiths R.
BACKGROUND: NHS Direct is a nurse-led telephone help line that covers the whole of England and Wales . NHS Direct derived data are being used for community surveillance, the purpose of which is to detect a local or national increase in symptoms reported by callers . The system has the potential to identify an increase in symptoms reported by callers about people in the prodromal stages of illness caused by the deliberate release of a biological or chemical agent . There are no other community surveillance projects existing on a national scale that utilize electronic daily data . METHODS: We describe the surveillance system and calls to NHS Direct between December 2001 and July 2002 . Confidence limits have been constructed for 10 key algorithms at each site and control charts devised for five of these algorithms at sites covering the key urban areas . RESULTS: Daily reporting has been achieved from NHS Direct sites in England and Wales . High levels of activity in specific algorithms at both national and regional levels have been detected . A sustained national increase in calls about fever occurred in January 2002 . CONCLUSION: Although the project is still at an early stage, daily analysis of NHS Direct data has the potential to detect symptoms in the community that could be related to deliberate releases of chemical or biological agents or to outbreaks of disease . For this surveillance to act as an 'early warning' of illness resulting from a microbiological or chemical cause, the NHS Direct surveillance needs to be fully integrated into an appropriate public health response (which may require diagnostic samples to be taken from callers).

Rev Clin Esp, 2004 Jan, 204(1), 3 - 8
{Factors related to the tuberculous patient and the study of contacts.}; Alseda Graells Pere M et al.; CONTEXT: While the maximum priority of the programs for tuberculosis prevention and control is the identification and treatment of all the people with active tuberculosis, the second priority is the evaluation of their contacts . The goal of this study has been to evaluate the factors of the tuberculous patients associated with the study of their contacts . PATIENTS AND METHODS: The incident cases of tuberculosis occurred during the period 1992-1997 in the province of Lleida were studied . The variables of the study were: age, sex, place of residence, infection by HIV, parenteral drug use (PDU), excessive alcohol consumption, anatomical location of tuberculosis, existence of cavernous lesions in the chest X-ray, and microbiological result of the samples of respiratory secretions . The association of the dependent variable (study of the contacts in the incident cases of tuberculosis) with the rest of independent variables it was determined by the raw and adjusted odds ratio . RESULTS: The prevalence of tuberculosis patients whose contacts were studied was 60.4% (63.1% in the bacilliferous cases and 51.9% in the non-bacilliferous cases, p=0.003) . A higher number of patients whose contacts were studied was detected between those that were not HIV-infected (ORa: 4.53; 95% CI: 2.91-7.05), between those with lung as the anatomical localization of the tuberculous disease (ORa: 2.62; 95% CI: 1.70-4.05) and between those that did not showed excessive alcohol consumption (ORa: 1.69; 95 CI: 1.17-2.46) . CONCLUSIONS: The global prevalence of tuberculous whose contacts are studied should be increased, especially among the patients with sociosanitary risk (HIV, PDU and alcoholism), and among the patients with higher probability of transmission.

Salud Publica Mex, 2003, 45 Suppl 4, S508 - 19
Vitamins A, and C and folate status in Mexican children under 12 years and women 12-49 years: a probabilistic national survey; Villalpando S et al.; OBJECTIVE: To describe the epidemiology of Vitamin A and C and folic acid deficiencies and their association with sociodemographic and dietary factors in a national probabilistic sample of Mexican women and children . MATERIAL AND METHODS: This is a probabilistic sample from the National Nutrition Survey 1999 (ENN-99) including 1,966 children and 920 women . Vitamins A and C were measured in serum by high-performance liquid chromatography, and folic acid in total blood by a microbiological method . Determinants for such deficiencies were explored by multiple regression models . RESULTS: Vitamin A deficiency (retinol < 10 micrograms/dl) was rare in both children and women . But subclinical deficiency (retinol > 10 and < 20 micrograms/dl) was present in 25% of children . The likelihood of subclinical deficiency of vitamin A was less in older children (OR = 0.98, p = 0.01) and in women with higher body mass index (OR = 0.93, p = 0.01) . About 30% of children < 2 years of age and 40% of women were vitamin C deficient . The likelihood of vitamin C deficiency was less in children and women as socioeconomic level increased (OR = 0.69, p = 0.03, and OR = 0.80, p = 0.04), and higher in older women (OR = 1.02, p = 0.05) . The prevalence of folate deficiency varied in children (2.3 to 11.2), in women it was 5% . Folate deficiency was less in children of higher socioeconomic level (OR = 0.62, p = 0.01), and in those eating more vegetables (OR = 0.22, p = 0.01) . CONCLUSIONS: The high prevalence of subclinical deficiency of vitamin A in children is indicative of risk of further deterioration under adverse circumstances . Vitamin C deficiency in both children and women implies in addition diminished ability for iron absorption . The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Drugs Today (Barc), 1998 Nov, 34(11), 935 - 42
Inflammatory bowel disease (ulcerative colitis and Crohn's disease): diagnostic criteria and differential diagnosis; Winther KV et al.; Chronic inflammatory bowel diseases (i.e., ulcerative colitis and Crohn's disease) are syndromes in which standardized criteria are necessary in the diagnostic process . The present review is based on the diagnostic criteria used at our institution . We base the diagnosis of ulcerative colitis and Crohn's disease on combined information from the patient history, and radiological, endoscopic and histological findings after exclusion of neoplastic and infectious disease . The patient history must include precise information on the nature and duration of symptoms as well as the presence of relevant influential factors such as travel activity, drug intake and sexual habits . In immunocompromised patients extensive microbiological investigations are required to exclude infection . Typical radiological and colonoscopic findings in ulcerative colitis are mucosal inflammatory changes extending circumferentially and continuously from the rectum and proximally in the colon . In contrast, Crohn's disease is most frequently located in the small bowel and in case of colonic involvement, the rectum is often spared . The best predictors of Crohn's disease are discontinuous lesions, cobblestones and apthous ulceration . Histological changes such as abnormal mucosal architecture and lamina propria cellularity, neutrophil polymorph infiltration and epithelial cell abnormality are useful and reproducible features in the evaluation of colorectal biopsy specimens . The inflammatory bowel diseases, ulcerative colitis and Crohn's disease, continue to be etiological and diagnostic challenges . Increased use of standardized criteria and diagnostic algorithms are essential instruments to improve the overall quality of the management of patients with these diseases.

J Laryngol Otol, 2003 Dec, 117(12), 940 - 5
Allergen immunotherapy in ENT: historical perspective; Kim DS et al.; The origins of immunology and allergy are founded upon the early 19th century microbiological studies of Jenner and Pasteur . It was discovered that the immune system could cause harm . The subspecialty of allergy began with the coining of the term by Von Pirquet in 1906 to describe disorders resulting from hyper-reaction to normally innocuous environmental agents . Understanding the scientific basis of the immune system and allergy allowed Noon and Freeman, and later Cooke, to develop allergen immunotherapy . Initially the technique was crude, but with the subsequent key discovery of IgE, more accurate methods of diagnosis (such as the radioallergosorbent test (RAST)) and treatment ensued . The efficacy of specific immunotherapy has been demonstrated by many double-blind trials culminating in the WHO position paper . DNA recombinant technology has provided detailed molecular understanding of allergic disorders, which has resulted in several novel methods of immunotherapy that are potentially safer and more effective . Use of recombinant allergens, T-cell peptides, DNA vaccination with CpG motifs or plasmid vectors and anti-IgE strategies with monoclonal antibodies are showing promise.

J Nat Prod, 2004 Jan, 67(1), 64 - 9
The microbiological transformation of two 15beta-hydroxy-ent-kaurene diterpenes by Gibberella fujikuroi; Fraga BM et al.; The incubation of 15beta-hydroxy-3-oxo-ent-kaur-16-ene (1) with the fungus Gibberella fujikuroi afforded 11beta-hydroxy-3,15-dioxo-ent-kaurane (6), 11beta,15beta-dihydroxy-3-oxo-ent-kaur-16-ene (8), 7beta,11beta,15beta-trihydroxy-3-oxo-ent-kaur-16-ene (9), 7alpha,11beta-dihydroxy-3,15-dioxo-ent-kaurane (7), and 7alpha,11beta,15beta-trihydroxy-3-oxo-ent-kaur-16-ene (10) . The incubation of 15beta-hydroxy-ent-kaur-2,16-diene (3) with the same fungus yielded 7alpha,11beta-dihydroxy-15-oxo-ent-kaur-2-ene (12), 7alpha,11beta,15beta-trihydroxy-ent-kaur-2,16-diene (13), 7beta,15beta-dihydroxy-ent-kaur-2,16-dien-19,6-olide (14), 1beta,7beta,15beta-trihydroxy-ent-kaur-2,16-dien-19-oic acid (15), 7alpha,11beta,16alpha-trihydroxy-15-oxo-ent-kaur-2-ene (17), and 7alpha,15beta,17-trihydroxy-11beta,16beta-epoxy-ent-kaur-2-ene (19) . These results indicated that a 3-oxo group in ent-kaur-16-ene derivatives inhibits the oxidation at C-19, typical of the biosynthetic pathway of gibberellins and kaurenolides, while a 2,3-double bond or a 15beta-OH does not . In both substrates a 15beta-alcohol directs hydroxylations at C-11(beta) and C-7(alpha), while in those with a 2,3-double bond the functionalization of C-1(beta) is favored.

Nephrol Dial Transplant, 2004 Feb, 19(2), 463 - 8
Automated flow cytometry analysis of peritoneal dialysis fluid; Penders J et al.; BACKGROUND: Recently, the Sysmex UF-100 flow cytometer has been developed to automate urinalysis . We have evaluated this instrument to explore the possibilities of flow cytometry in the analysis of peritoneal dialysis fluid (PD) and have compared the obtained data with those of counting chamber techniques, biochemical analysis and bacterial culture . METHODS: UF-100 data were correlated with microscopy and biochemical data in 135 PD samples . Microbiological analysis was performed in 63 suspected cases of peritonitis . RESULTS: Good agreement (P < 0.001) was obtained between UF-100 and microscopy data for leukocytes (r = 0.825) . UF-100 bacterial count correlated (P < 0.001) with UF-100 leukocyte count (r = 0.549) . UF-100 bacterial counts were unreliable in samples where interference by blood platelets was observed . Another major problem was the UF-100 'bacterial' background signal in sterile PD samples . Yeast cells were detected by the flow cytometer in spiked samples . CONCLUSIONS: Flow cytometry of PD with the UF-100 offers a rapid and reliable leukocyte count . Sensitivity of the 'bacterial' channel count in predicting positive culture exceeds the sensitivity of conventional Gram stain . Furthermore, additional semi-quantitative information is provided regarding the presence of yeasts.

Am J Crit Care, 2004 Jan, 13(1), 25 - 33; discussion 34
Oral health and care in the intensive care unit: state of the science; Munro CL et al.; Oral health is influenced by oral microbial flora, which are concentrated in dental plaque . Dental plaque provides a microhabitat for organisms and an opportunity for adherence of the organisms to either the tooth surface or other microorganisms . In critically ill patients, potential pathogens can be cultured from the oral cavity . These microorganisms in the mouth can translocate and colonize the lung, resulting in ventilator-associated pneumonia . The importance of oral care in the intensive care unit has been noted in the literature, but little research is available on mechanical or pharmacological approaches to reducing oral microbial flora via oral care in critically ill adults . Most research in oral care has been directed toward patients' comfort; the microbiological and physiological effects of tooth brushing in the intensive care unit have not been reported . Although 2 studies indicated reductions in rates of ventilator-associated pneumonia in cardiac surgery patients who received chlorhexidine before intubation and postoperatively, the effects of chlorhexidine in reducing ventilator-associated pneumonia in other populations of critically ill patients or its effect when treatment with the agent initiated after intubation have not been reported . In addition, no evaluation of the effectiveness of pharmacological and mechanical interventions relative to each other or in combination has been published . Additional studies are needed to develop and test best practices for oral care in critically ill patients.

Blood Purif, 2004, 22(1), 164 - 74
Extracorporeal therapies in non-renal disease: treatment of sepsis and the peak concentration hypothesis; Ronco C et al.; In the setting of intensive care, patients with acute renal failure often present a clinical picture of the systemic inflammatory response syndrome (SIRS) . SIRS can be caused by bacterial stimuli or by non-microbiological stimuli that induce a significant inflammatory response . When this response is exaggerated, the patient experiences multiple organ system failure and a condition of sepsis also defined as a systemic malignant inflammation . This is mostly characterized by an invasion of cytokines and other pro-inflammatory mediators into the systemic circulation where major biological effects take place, including vasopermeabilization, hypotension and shock . At the same time, the monocyte of the septic patient seems to be hyporesponsive to inflammatory stimuli to a certain extent . In this condition, the patient faces a situation of hyperinflammation but at the same time of immunodepression expressing a clinical entity defined as counter anti-inflammatory response syndrome . The general picture of the clinical disorder is therefore better characterized by an immunodysregulation than by a simple pro- or anti-inflammatory disorder . Due to the short half-life of cytokines and other mediators spilled over into the circulation, it is extremely difficult to approach the problem at the right moment with the right pharmacological agent . For these reasons, the peak concentration hypothesis suggests that continuous renal replacement therapies, due to their continuity and unspecific capacity of removal, might be beneficial in cutting the peaks of the concentrations of both pro- and anti-inflammatory mediators, restoring a situation of immunohomeostasis . Thus the patient may benefit from a lesser degree of immunodysregulation and he/she may restore a close-to-normal capacity of response to exogenous stimuli .

Aviakosm Ekolog Med, 2003, 37(5), 56 - 9
{The concept of microbiological safety of a piloted Martian expedition}; Novikova ND; It is the peculiar evolution of the microbial association aboard long-operating space vehicles that lends additional medical, technical and technological risks that may impact crew safety and orbital systems performance . Based on the experience of the Russian space stations, a concept of microbiological safety of a piloted expedition to Mars has been proposed comprising preventive measures, methods, means and technologies to control the microbiological environment in transport vehicles, lander and Martian habitation module.

Bone Marrow Transplant, 2004 Apr, 33(7), 741 - 4
Measurement of C-reactive protein in adults with febrile neutropenia after hematopoietic cell transplantation; Ortega M et al.; The aim of this study was to evaluate the usefulness of C-reactive protein (CRP) monitoring in the differential diagnosis and prognosis of febrile neutropenic episodes in hematopoietic cell transplantation (HCT) . In all, 100 patients were enrolled in the study . The CRP was determined in serum every 48 h from admission until resolution of the febrile episode . All patients presented with fever during the post-HCT neutropenic period . The febrile episodes were classified as microbiologically documented infection in 32 cases, clinically documented infection in 27 patients and fever of unknown origin in 41 patients . The mean CRP values on the first day of fever in these three groups were similar (NS) . On the fifth day of antibiotic treatment, 50 patients remained pyrexial . Of these, 41 improved with modifications of antibiotherapy (mean CRP: 9.5 mg/dl; standard deviation (s.d.): 6.2) and nine died, five due to an infectious etiology (CRP: 21 mg/dl; s.d.: 4.4; P<0.003) and four from other causes (CRP: 11 mg/dl; s.d.: 3.4) . On multivariate analysis, the CRP on the fifth day of treatment was an independent prognostic factor for fatal outcome . We conclude that persistent elevation of the CRP is an independent factor predicting a fatal outcome in patients who remain febrile on the fifth day of antibiotherapy during neutropenic febrile episodes post-HCT.

Can Bull Med Hist, 2003, 20(2), 419 - 35
Models and microbiology: Pasteur and the body; Hanley JG; Louis Pasteur developed a model of the body as a culture vessel in the late 1870s as an explanation of both natural and acquired immunity, and other investigators quickly applied the model in the explanation of other microbiological phenomena, principally the tissue tropism seen in the normal and the pathological flora . This paper will argue that although Pasteur quickly abandoned the model, it persisted as an explanation of tissue tropism for nearly 70 years, structuring the interpretation of data by and guiding the research of a diverse group of microbiological researchers.

J Microbiol Immunol Infect, 2003 Dec, 36(4), 254 - 9
Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empirical therapy for neutropenic fever in children with malignancy; Hung KC et al.; Fifty-four pediatric cancer patients with a total of 100 febrile neutropenic episodes treated at China Medical College Hospital were randomized to receive meropenem or ceftazidime plus amikacin from January 2001 to April 2002 . The characteristics of 76 assessable febrile episodes (39 with meropenem and 37 with ceftazidime plus amikacin) were compared between the 2 groups . The success rate with unmodified therapy was not significantly different between the meropenem group (72%) and the ceftazidime-plus-amikacin group (57%) . The incidence of side effects was similar between the 2 groups and these side effects were reversible . Microbiologically documented infection, clinically documented infection, and unexplained fever accounted for 35%, 37%, and 28% of episodes, respectively . The clinical response rates in subgroups of documented infection and unexplained fever did not significantly differ between the 2 treatment groups . Meropenem was significantly more effective than ceftazidime plus amikacin in children at high risks of developing severe infection who had profound neutropenia (absolute neutrophil count {ANC} < 100/mm3), prolonged neutropenia (ANC < 500/mm3 lasting for > 10 days), or clinically deteriorating shock (p=0.045) . As an empirical treatment, meropenem seems to be as effective and safe as ceftazidime plus amikacin for febrile episodes in children with cancer and neutropenia . Meropenem is more effective for pediatric cancer patients at the high risk of severe infection.

Am J Respir Med, 2002, 1(2), 107 - 17
Nontuberculous mycobacterial pulmonary infection in patients with cystic fibrosis: diagnosis and treatment; Maiz-Carro L et al.; The prevalence of nontuberculous mycobacteria (NTM) recovered from patients with cystic fibrosis (CF) appears to be increasing, probably related to improved surveillance and microbiological procedures and an increase in the life expectancy of patients with CF . The distinction between active lung infection and colonization is often difficult to assess in patients with CF because of the marked overlap in the clinical and radiological presentation of CF lung disease and lung disease caused by NTM infection . The possibility of active NTM lung infection should be considered in those patients with compatible radiographic changes and/or progressive deterioration in lung function who do not improve with specific antibiotic therapy and who have repeatedly positive sputum cultures and smears for NTM . Patients with repeatedly positive results of acid-fast smears are more likely to be infected than colonized . Pseudomonas overgrowth may confuse the results of sputum and bronchoalveolar lavage fluid cultures . Decontamination of respiratory samples from patients with CF with 5% oxalic acid results in improved bacteriological recovery of NTM . Skin tests are of limited value as a screening tool for NTM . Since the course of NTM lung infection is often slow, careful follow-up with repeated sputum cultures, chest radiographs and computed tomography (CT) scans may be needed . Treatment of NTM lung disease in patients with CF presents great difficulties because of abnormal gastrointestinal drug absorption and pharmacokinetics in this patient population . Treatment varies according to the mycobacterial species isolated . Long-term multidrug regimens including rifampin (rifampicin) and ethambutol are usually required . Monitoring serum drug levels is a useful indicator of correct dosage in order to prevent adverse effects due to potential drug interactions and altered pharmacokinetics in patients with CF.

Ig Sanita Pubbl, 2003 Jul-Aug, 59(4), 215 - 38
{Hygienic monitoring in a municipal solid waste incineration plant}; Boccia A et al.; Under President's Executive Order 915/1982, the Malagrotta waste disposal plant has been surrounded by a water-proof ring . This study reflects a eight-year research activity about "the Plant's steadiness and its impact on the land; hygienic monitoring of aquifers, air quality control and sound pollution; health and safety of workers; disinfection and land reclamation" . For surface subsidence to be measured, 21 spots were monitored and 30 piezometers were set up in adjacent critical areas, both inside and outside the plant . Some of them were also used to pick up water and test it for chemical and microbiological purposes . Samples of leachates were analysed, air quality assessed and sound tests carried out . Overall outcomes show good performance in terms of interaction between plant, hydro-geological regimen and possible impact on the surrounding land.

Anal Biochem, 2004 Feb 1, 325(1), 41 - 51
Solid-phase extraction-electrospray ionization mass spectrometry for the quantification of folate in human plasma or serum; Nelson BC et al.; The measurement of 5-methyltetrahydrofolic acid (5 MT) blood levels is one of several factors used to diagnose folate deficiency in humans . 5 can be selectively purified from either human plasma or human serum via solid-phase extraction procedures and specifically detected and quantified in the extracts with liquid chromatography/isotope-dilution electrospray-ionization mass spectrometry . Two different, yet complementary, solid-phase extraction-liquid chromatography/mass spectrometry methods have been developed and applied to the quantification of 5 MT from such extracts . One method utilizes the high-affinity folate-binding protein from cow's milk coupled with multiple-reaction-monitoring-mode tandem mass spectrometry while the other method utilizes reversed-phase C(18) extraction followed by selected-ion-monitoring-mode mass spectrometry . The accuracy of each method is assessed through a comparative determination of 5 MT levels in homogenous plasma and serum pools . Additionally, each method is compared and evaluated against the "total folate" results provided by routine radioassay and microbiological assay determinations . On the basis of the experimental data presented in this report, it is suggested that both methods have the capacity to serve as potential reference methods for the quantification of circulating 5MT in plasma or serum.

Saudi Med J, 2003 Dec, 24(12), 1377 - 80
Idiopathic granulomatus lobular mastitis . A forgotten clinical diagnosis; Al Nazer MA; OBJECTIVE: To review clinicopathological features of all cases diagnosed as idiopathic granulomatous lobular mastitis (IGLM) in our hospital and compare them with other data from the Kingdom of Saudi Arabia . METHODS: Reports of all breast specimens received in histopathology laboratory in Qatif Central Hospital, Kingdom of Saudi Arabia over a 14 year period (1988 through to 2002) were collected and those diagnosed as IGLM were selected for analysis of both pathological material and clinical data . RESULTS: Eleven patients representing 1.6% of all breast specimens were diagnosed as IGLM . The mean age was 35 years (range 25-50) . Both breasts were equally affected . The most frequent presenting symptom was a breast mass of 2-22 weeks duration . The most common clinical diagnosis was chronic abscess (5 patients) . Relation to pregnancy, lactation or oral contraceptives pills was elicited in 4 patients . Recurrence at different time intervals occurred in 3 patients . Microscopically there was an evident granulomatous inflammation mostly in lobular distribution . Ductal inflammation with epithelial changes was noted in most cases . Staining and cultures were negative for both mycobacterium and fungal organisms . CONCLUSION: Granulomatous mastitis is not unheard of and clinicians should keep it in their list of differential diagnosis of breast lumps so appropriate handling of breast specimens including microbiological studies can be pursued . Utility of fine needle aspiration biopsy as a diagnostic tool is to be considered.

Commun Dis Public Health, 2003 Sep, 6(3), 250 - 8
Microbiological quality of food in relation to hazard analysis systems and food hygiene training in UK catering and retail premises; Little CL et al.; A meta-analysis of eight UK food studies was carried out to determine the microbiological quality of food and its relationship with the presence in food businesses of hazard analysis systems and food hygiene training . Of the 19,022 premises visited to collect food samples in these studies between 1997 and 2002, two thirds (66%) were catering premises and one third (34%) were retail premises . Comparison with PHLS Microbiological Guidelines revealed that significantly more ready-to-eat food samples from catering premises (20%; 2,511/12,703) were of unsatisfactory or unacceptable microbiological quality compared to samples from retail premises (12%; 1,039/8,462) (p < 0.00001) . Three quarters (76%) of retail premises had hazard analysis systems in place compared with 59% of catering premises (p < 0.00001) . In 87% of retail premises the manager had received some form of food hygiene training compared with 80% of catering premises (p < 0.00001) . From premises where the manager had received no food hygiene training a greater proportion of samples were of unsatisfactory and unacceptable microbiological quality (20% retail, 27% catering) compared with premises where the manager had received food hygiene training (11% retail, 19% catering) (p < 0.00001) . Where the manager of the premises had received food hygiene training, documented hazard analysis systems were more likely to be in place (p < 0.00001) . Higher proportions of samples of unsatisfactory and unacceptable microbiological quality (17% retail, 22% catering) were from premises where there was no hazard analysis system in place compared to premises that had a documented hazard analysis system in place (10% retail, 18% catering) (p < 0.00001) . Our meta-analysis suggests that the lower microbiological quality of ready-to-eat foods from catering premises compared with those collected from retail premises may reflect differences in management food hygiene training and the presence of a hazard analysis system . The importance of adequate training for food handlers and their managers as a pre-requisite for effective hazard analysis and critical control point (HACCP) based controls is therefore emphasised.

Crit Care Med, 2004 Jan, 32(1), 21 - 30
Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock; Lopez A et al.; OBJECTIVE: To assess the safety and efficacy of the nitric oxide synthase inhibitor 546C88 in patients with septic shock . The predefined primary efficacy objective was survival at day 28 . DESIGN: Multiple-center, randomized, two-stage, double-blind, placebo-controlled, safety and efficacy study . SETTING: A total of 124 intensive care units in Europe, North America, South America, South Africa, and Australasia . PATIENTS: A total of 797 patients with septic shock diagnosed for <24 hrs . INTERVENTIONS: Patients with septic shock were allocated to receive 546C88 or placebo (5% dextrose) for up to 7 days (stage 1) or 14 days (stage 2) in addition to conventional therapy . Study drug was initiated at 0.05 mL.kg(-1).hr(-1) (2.5 mg.kg(-1).hr(-1) 546C88) and titrated up to a maximum rate of 0.4 mL.kg(-1).hr(-1) to maintain mean arterial pressure between 70 and 90 mm Hg while attempting to withdraw concurrent vasopressors . MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables, organ function data, microbiological data, concomitant therapy, and adverse event data were recorded at baseline, throughout treatment, and at follow-up . The primary end point was day-28 survival . The trial was stopped early after review by the independent data safety monitoring board . Day-28 mortality was 59% (259/439) in the 546C88 group and 49% (174/358) in the placebo group (p <.001) . The overall incidence of adverse events was similar in both groups, although a higher proportion of the events was considered possibly attributable to study drug in the 546C88 group . Most of the events accounting for the disparity between the groups were associated with the cardiovascular system (e.g., decreased cardiac output, pulmonary hypertension, systemic arterial hypertension, heart failure) . The causes of death in the study were consistent with those expected in patients with septic shock, although there was a higher proportion of cardiovascular deaths and a lower incidence of deaths caused by multiple organ failure in the 546C88 group . CONCLUSIONS: In this study, the nonselective nitric oxide synthase inhibitor 546C88 increased mortality in patients with septic shock.

J Hosp Infect, 2004 Jan, 56(1), 42 - 8
Comparison of the collecting efficiency of microbiological air samplers; Shintani H et al.; It is important to evaluate the prevention of nosocomial infections caused by airborne micro-organisms in healthcare facilities . For that purpose, the use of an air sampler is required . A comparison of the collecting efficiency of air samplers has not been studied so far using a single culture medium . Use of the same culture medium is necessary because of the variation of the cultivation efficiency with different culture media . In this study a statistically significant difference in collecting efficiency among air samplers was observed in case of SCDA (soybean casein digest agar) culture medium, but not SCDALP (soybean casein digest agar lecithin polysorbate) culture medium . In addition, a statistically significant difference of the cultivation efficiency was observed between SCDA and SCDALP culture media (P<0.05) . These results suggest that any air sampler can be used with SCDALP culture medium.

Int J Paediatr Dent, 2004 Jan, 14(1), 41 - 8
Detection of a highly toxic clone of Actinobacillus actinomycetemcomitans (JP2) in a Moroccan immigrant family with multiple cases of localized aggressive periodontitis; Haubek D et al.; The JP2 clone of Actinobacillus actinomycetemcomitans, a high-leukotoxin-producing strain, characterized by a 530-basepair (bp) deletion in the promoter region of the leukotoxin gene operon and mainly found among individuals with African origin, is associated with localized aggressive periodontitis . The objective of the study was to examine the occurrence of periodontal disease in a Moroccan immigrant family living in Denmark in which the oldest son (14 year) was referred and treated for localized aggressive periodontitis . Further, the potential occurrence of the JP2 clone of A . actinomycetemcomitans in the family was examined . Here we present the clinical, radiographic, and microbiological findings from the family . Clinical and radiographic examination of the other family members revealed that 3 of 5 younger siblings had localized aggressive periodontitis, one had gingivitis and the mother had chronic periodontitis . Despite scaling followed by intensive maintenance therapy several family members, including the sibling with gingivitis, had further attachment loss at the 1-year examination . The JP2 clone of A . actinomycetemcomitans was isolated from subgingival plaque samples from 4 children with periodontitis . In contrast, it was not detected in plaque from the oldest boy, who had been treated for localized aggressive periodontitis by surgery combined with antibiotic therapy . The 4 children with periodontitis and colonized with the JP2 clone were treated by scaling and antibiotic administration . One month later the JP2 clone could still be detected in plaque samples . In conclusion, it is confirmed that members of immigrant families with African origin are potential carriers of the JP2 clone and that those families often have multiple family members with localized aggressive periodontitis . It is proposed that those families are given periodontal examination frequently to benefit from early diagnosis and treatment of the diseasePublication Types:

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