938 resultados para Epidemiology
Resumo:
<b>Verenpaineen kotimittaus epidemiologia ja kliininen kytt</b> Kohonnutta verenpainetta, maailmanlaajuisesti merkittvint ennenaikaiselle kuolemalle altistavaa riskitekij, ei voida tunnistaa tai hoitaa ilman tarkkoja ja kytnnllisi verenpaineen mittausmenetelmi. Verenpaineen kotimittaus on saavuttanut suuren suosion potilaiden keskuudessa. Lkrit eivt ole kuitenkaan viel tysin hyvksyneet verenpaineen kotimittausta, sill riittv todistusaineisto sen toimivuudesta ja eduista on puuttunut. Tmn tutkimuksen tarkoituksena oli osoittaa, ett kotona mitattu verenpaine (kotipaine) on perinteist vastaanotolla mitattua verenpainetta (vastaanottopaine) tarkempi, ja ett se on tehokas mys kliinisess kytss. Tutkimme kotipaineen kytt verenpainetaudin diagnosoinnissa ja hoidossa. Lisksi tarkastelimme kotipaineen yhteytt verenpainetaudin aiheuttamiin kohde-elinvaurioihin. Ensimminen aineisto, joka oli edustava otos Suomen aikuisvestst, koostui 2 120 4574-vuotiaasta tutkimushenkilst. Tutkittavat mittasivat kotipainettaan viikon ajan ja osallistuivat terveystarkastukseen, johon sisltyi kliinisen tutkimuksen ja haastattelun lisksi sydnfilmin otto ja vastaanottopaineen mittaus. 758 tutkittavalle suoritettiin lisksi kaulavaltimon seinmn intima-mediakerroksen paksuuden (valtimonkovettumataudin mittari) mittaus ja 237:lle valtimon pulssiaallon nopeuden (valtimojykkyyden mittari) mittaus. Toisessa aineistossa, joka koostui 98 verenpainetautia sairastavasta potilaasta, hoitoa ohjattiin satunnaistamisesta riippuen joko ambulatorisen eli vuorokausirekisterinnill mitatun verenpaineen tai kotipaineen perusteella. Vastaanottopaine oli kotipainetta merkittvsti korkeampi (systolisen/diastolisen paineen keskiarvoero oli 8/3 mmHg) ja yksimielisyys verenpainetaudin diagnoosissa kahden menetelmn vlill oli korkeintaan kohtalainen (75 %). 593 tutkittavasta, joilla oli kohonnut verenpaine vastaanotolla, 38 %:lla oli normaali verenpaine kotona eli ns. valkotakkiverenpaine. Verenpainetauti voidaan siis ylidiagnosoida joka kolmannella potilaalla seulontatilanteessa. Valkotakkiverenpaine oli yhteydess lievsti kohonneeseen verenpaineeseen, matalaan painoindeksiin ja tupakoimattomuuteen, muttei psykiatriseen sairastavuuteen. Valkotakkiverenpaine ei kuitenkaan vaikuttaisi olevan tysin vaaraton ilmi ja voi ennustaa tulevaa verenpainetautia, sill siit krsivien sydn- ja verisuonitautien riskitekijprofiili oli normaalipaineisten ja todellisten verenpainetautisten riskitekijprofiilien vliss. Kotipaineella oli vastaanottopainetta vahvempi yhteys verenpainetaudin aiheuttamiin kohde-elinvaurioihin (intima-mediakerroksen paksuus, pulssiaallon nopeus ja sydnfilmist todettu vasemman kammion suureneminen). Kotipaine oli tehokas verenpainetaudin hoidon ohjaaja, sill kotipaineeseen ja ambulatoriseen paineeseen, jota on pidetty verenpainemittauksen kultaisena standardina, perustuva lkehoidon ohjaus johti yht hyvn verenpaineen hallintaan. Tmn ja aikaisempien tutkimusten tulosten pohjalta voidaan todeta, ett verenpaineen kotimittaus on selke parannus perinteiseen vastaanotolla tapahtuvaan verenpainemittaukseen verrattuna. Verenpaineen kotimittaus on kytnnllinen, tarkka ja laajasti saatavilla oleva menetelm, josta voi tulla jopa ensisijainen vaihtoehto verenpainetautia diagnosoitaessa ja hoitaessa. Verenpaineen mittauskytntn tarvitaan muutos, sill nyttn perustuvan lketieteen perusteella vaikuttaa, ett vastaanotolla tapahtuvaa verenpainemittausta tulisi kytt vain seulontatarkoitukseen.
Resumo:
L'infection par le virus de l'hpatite C (HCV) reprsente une des causes les plus frquentes d'hpatite chronique, de cirrhose et de carcinome hpatocellulaire au niveau mondial. D'normes progrs ont t raliss durant ces 25 dernires annes depuis la dcouverte du HCV, notamment dans la comprhension de la virologie molculaire, de la pathogense et de l'histoire naturelle ainsi que dans la prvention, le diagnostic et le traitement de l'hpatite C. Ces avances seront rsumes dans cet article et discutes la lumire de nouveaux dfis. Hepatitis C virus (HCV) infection represents a major cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. Great progress in the understanding of the molecular virology, pathogenesis and natural course as well as the prevention, diagnosis and treatment of hepatitis C have been made in over the last 25 years since the discovery of HCV. Here, we review recent advances and discuss them in the light of new challenges.
Resumo:
BACKGROUND: Hypospadias is a common congenital malformation. The prevalence of hypospadias has a large geographical variation, and recent studies have reported both increasing and decreasing temporal trends. It is unclear whether hypospadias prevalence is associated with maternal age. AIM: To analyze the prevalence and trends of total hypospadias, isolated hypospadias, hypospadias with multiple congenital anomalies, hypospadias with a known cause, and hypospadias severity subtypes in Europe over a 10-year period and to investigate whether maternal age is associated with hypospadias. METHODS: We included all children with hypospadias born from 2001 to 2010 who were registered in 23 EUROCAT registries. Information on the total number of births and maternal age distribution for the registry population was also provided. We analyzed the total prevalence of hypospadias and relative risks by maternal age. RESULTS: From 2001 to 2010, 10,929 hypospadias cases were registered in 5,871,855 births, yielding a total prevalence of 18.61 per 10,000 births. Prevalence varied considerably between different registries, probably due to differences in ascertainment of hypospadias cases. No significant temporal trends were observed with the exceptions of an increasing trend for anterior and posterior hypospadias and a decreasing trend for unspecified hypospadias. After adjusting for registry effects, maternal age was not significantly associated with hypospadias. CONCLUSIONS: Total hypospadias prevalence was stable in 23 EUROCAT registries from 2001 to 2010 and was not significantly influenced by maternal age.
Resumo:
Introduction: The Violence Medical Unit (VMU), a specialised forensic medical consultation, was created at the Lausanne university Hospital in 2006. All patients consulting at the ED for interpersonal violencerelated injury are referred to the VMU, which provides forensic documentation of the injury and referral to the relevant community based victim-support organisations within 48 hours of the ED visit. This frees the ED medical staff from forensic injury documentation and legal/social referral, tasks for which they lack both time and training. Among community violence, assaults by nightclub security agents against patrons have increased from 6% to 10% between 2007 and 2009. We set out to characterise the demographics, assault mechanisms, subsequent injuries, prior alcohol intake and ED & VMU costs incurred by this group of patients. Methods: We retrospectively included all patients consulting at the VMU due to assault by nightclub security agents from January 2007 to December 2009. Data was obtained from ED & VMU medical, nursing and administrative records. Results: Our sample included 70 patients, of which 64 were referred by the CHUV ED. The victims were typically young (median age 29) males (93%). 77% of assaults occurred on the weekend between 12 PM and 4 AM, and 73% of the victims were under the influence of alcohol. 83% of the patients were punched, kicked and/or head-butted; 9% had been struck with a blunt instrument. 80% of the injuries were in the head and neck area and 19% of the victims sustained fractures. 21% of the victims were prescribed medical leave. Total ED & VMU costs averaged 1048 SFr. Conclusion: Medical staff treating this population of assault victims must be aware of the assault mechanisms and injury patterns, in particular the high probability of fractures, in order to provide adequate diagnosis and care. Associated inebriation mandates liberal use of radiology, as delayed or missed diagnosis may have medical, medicolegal and legal implications. Emergency medical services play an important role in detecting and reporting of such incidents. Centralised management of the forensic documentation facilitates referral to victim support organisations and epidemiological data collection. Magnitudes and trends of the different types of violence can be determined, and this information can be then impact public safety management policies.
Resumo:
Wastewater-based epidemiology consists in acquiring relevant information about the lifestyle and health status of the population through the analysis of wastewater samples collected at the influent of a wastewater treatment plant. Whilst being a very young discipline, it has experienced an astonishing development since its firs application in 2005. The possibility to gather community-wide information about drug use has been among the major field of application. The wide resonance of the first results sparked the interest of scientists from various disciplines. Since then, research has broadened in innumerable directions. Although being praised as a revolutionary approach, there was a need to critically assess its added value, with regard to the existing indicators used to monitor illicit drug use. The main, and explicit, objective of this research was to evaluate the added value of wastewater-based epidemiology with regards to two particular, although interconnected, dimensions of illicit drug use. The first is related to trying to understand the added value of the discipline from an epidemiological, or societal, perspective. In other terms, to evaluate if and how it completes our current vision about the extent of illicit drug use at the population level, and if it can guide the planning of future prevention measures and drug policies. The second dimension is the criminal one, with a particular focus on the networks which develop around the large demand in illicit drugs. The goal here was to assess if wastewater-based epidemiology, combined to indicators stemming from the epidemiological dimension, could provide additional clues about the structure of drug distribution networks and the size of their market. This research had also an implicit objective, which focused on initiating the path of wastewater- based epidemiology at the Ecole des Sciences Criminelles of the University of Lausanne. This consisted in gathering the necessary knowledge about the collection, preparation, and analysis of wastewater samples and, most importantly, to understand how to interpret the acquired data and produce useful information. In the first phase of this research, it was possible to determine that ammonium loads, measured directly in the wastewater stream, could be used to monitor the dynamics of the population served by the wastewater treatment plant. Furthermore, it was shown that on the long term, the population did not have a substantial impact on consumption patterns measured through wastewater analysis. Focussing on methadone, for which precise prescription data was available, it was possible to show that reliable consumption estimates could be obtained via wastewater analysis. This allowed to validate the selected sampling strategy, which was then used to monitor the consumption of heroin, through the measurement of morphine. The latter, in combination to prescription and sales data, provided estimates of heroin consumption in line with other indicators. These results, combined to epidemiological data, highlighted the good correspondence between measurements and expectations and, furthermore, suggested that the dark figure of heroin users evading harm-reduction programs, which would thus not be measured by conventional indicators, is likely limited. In the third part, which consisted in a collaborative study aiming at extensively investigating geographical differences in drug use, wastewater analysis was shown to be a useful complement to existing indicators. In particular for stigmatised drugs, such as cocaine and heroin, it allowed to decipher the complex picture derived from surveys and crime statistics. Globally, it provided relevant information to better understand the drug market, both from an epidemiological and repressive perspective. The fourth part focused on cannabis and on the potential of combining wastewater and survey data to overcome some of their respective limitations. Using a hierarchical inference model, it was possible to refine current estimates of cannabis prevalence in the metropolitan area of Lausanne. Wastewater results suggested that the actual prevalence is substantially higher compared to existing figures, thus supporting the common belief that surveys tend to underestimate cannabis use. Whilst being affected by several biases, the information collected through surveys allowed to overcome some of the limitations linked to the analysis of cannabis markers in wastewater (i.e., stability and limited excretion data). These findings highlighted the importance and utility of combining wastewater-based epidemiology to existing indicators about drug use. Similarly, the fifth part of the research was centred on assessing the potential uses of wastewater-based epidemiology from a law enforcement perspective. Through three concrete examples, it was shown that results from wastewater analysis can be used to produce highly relevant intelligence, allowing drug enforcement to assess the structure and operations of drug distribution networks and, ultimately, guide their decisions at the tactical and/or operational level. Finally, the potential to implement wastewater-based epidemiology to monitor the use of harmful, prohibited and counterfeit pharmaceuticals was illustrated through the analysis of sibutramine, and its urinary metabolite, in wastewater samples. The results of this research have highlighted that wastewater-based epidemiology is a useful and powerful approach with numerous scopes. Faced with the complexity of measuring a hidden phenomenon like illicit drug use, it is a major addition to the panoply of existing indicators. -- L'pidmiologie base sur l'analyse des eaux uses (ou, selon sa dfinition anglaise, wastewater-based epidemiology ) consiste en l'acquisition d'informations portant sur le mode de vie et l'tat de sant d'une population via l'analyse d'chantillons d'eaux uses rcolts l'entre des stations d'puration. Bien qu'il s'agisse d'une discipline rcente, elle a vcu des dveloppements importants depuis sa premire mise en oeuvre en 2005, notamment dans le domaine de l'analyse des rsidus de stupfiants. Suite aux retombes mdiatiques des premiers rsultats de ces analyses de mtabolites dans les eaux uses, de nombreux scientifiques provenant de diffrentes disciplines ont rejoint les rangs de cette nouvelle discipline en dveloppant plusieurs axes de recherche distincts. Bien que reconnu pour son cot objectif et rvolutionnaire, il tait ncessaire d'valuer sa valeur ajoute en regard des indicateurs couramment utiliss pour mesurer la consommation de stupfiants. En se focalisant sur deux dimensions spcifiques de la consommation de stupfiants, l'objectif principal de cette recherche tait focalis sur l'valuation de la valeur ajoute de l'pidmiologie base sur l'analyse des eaux uses. La premire dimension aborde tait celle pidmiologique ou socitale. En d'autres termes, il s'agissait de comprendre si et comment l'analyse des eaux uses permettait de complter la vision actuelle sur la problmatique, ainsi que dterminer son utilit dans la planification des mesures prventives et des politiques en matire de stupfiants actuelles et futures. La seconde dimension aborde tait celle criminelle, en particulier, l'tude des rseaux qui se dveloppent autour du trafic de produits stupfiants. L'objectif tait de dterminer si cette nouvelle approche combine aux indicateurs conventionnels, fournissait de nouveaux indices quant la structure et l'organisation des rseaux de distribution ainsi que sur les dimensions du march. Cette recherche avait aussi un objectif implicite, dvelopper et d'valuer la mise en place de l'pidmiologie base sur l'analyse des eaux uses. En particulier, il s'agissait d'acqurir les connaissances ncessaires quant la manire de collecter, traiter et analyser des chantillons d'eaux uses, mais surtout, de comprendre comment interprter les donnes afin d'en extraire les informations les plus pertinentes. Dans la premire phase de cette recherche, il y pu tre mis en vidence que les charges en ammonium, mesures directement dans les eaux uses permettait de suivre la dynamique des mouvements de la population contributrice aux eaux uses de la station d'puration de la zone tudie. De plus, il a pu tre dmontr que, sur le long terme, les mouvements de la population n'avaient pas d'influence substantielle sur le pattern de consommation mesur dans les eaux uses. En se focalisant sur la mthadone, une substance pour laquelle des donnes prcises sur le nombre de prescriptions taient disponibles, il a pu tre dmontr que des estimations exactes sur la consommation pouvaient tre tires de l'analyse des eaux uses. Ceci a permis de valider la stratgie d'chantillonnage adopte, qui, par le bais de la morphine, a ensuite t utilise pour suivre la consommation d'hrone. Combine aux donnes de vente et de prescription, l'analyse de la morphine a permis d'obtenir des estimations sur la consommation d'hrone en accord avec des indicateurs conventionnels. Ces rsultats, combins aux donnes pidmiologiques ont permis de montrer une bonne adquation entre les projections des deux approches et ainsi dmontrer que le chiffre noir des consommateurs qui chappent aux mesures de rduction de risque, et qui ne seraient donc pas mesurs par ces indicateurs, est vraisemblablement limit. La troisime partie du travail a t ralise dans le cadre d'une tude collaborative qui avait pour but d'investiguer la valeur ajoute de l'analyse des eaux uses mettre en vidence des diffrences gographiques dans la consommation de stupfiants. En particulier pour des substances stigmatises, telles la cocane et l'hrone, l'approche a permis d'objectiver et de prciser la vision obtenue avec les indicateurs traditionnels du type sondages ou les statistiques policires. Globalement, l'analyse des eaux uses s'est montre tre un outil trs utile pour mieux comprendre le march des stupfiants, la fois sous l'angle pidmiologique et rpressif. La quatrime partie du travail tait focalise sur la problmatique du cannabis ainsi que sur le potentiel de combiner l'analyse des eaux uses aux donnes de sondage afin de surmonter, en partie, leurs limitations. En utilisant un modle d'infrence hirarchique, il a t possible d'affiner les actuelles estimations sur la prvalence de l'utilisation de cannabis dans la zone mtropolitaine de la ville de Lausanne. Les rsultats ont dmontr que celle-ci est plus haute que ce que l'on s'attendait, confirmant ainsi l'hypothse que les sondages ont tendance sous-estimer la consommation de cannabis. Bien que biaiss, les donnes rcoltes par les sondages ont permis de surmonter certaines des limitations lies l'analyse des marqueurs du cannabis dans les eaux uses (i.e., stabilit et manque de donnes sur l'excrtion). Ces rsultats mettent en vidence l'importance et l'utilit de combiner les rsultats de l'analyse des eaux uses aux indicateurs existants. De la mme faon, la cinquime partie du travail tait centre sur l'apport de l'analyse des eaux uses du point de vue de la police. Au travers de trois exemples, l'utilisation de l'indicateur pour produire du renseignement concernant la structure et les activits des rseaux de distribution de stupfiants, ainsi que pour guider les choix stratgiques et oprationnels de la police, a t mise en vidence. Dans la dernire partie, la possibilit d'utiliser cette approche pour suivre la consommation de produits pharmaceutiques dangereux, interdits ou contrefaits, a t dmontre par l'analyse dans les eaux uses de la sibutramine et ses mtabolites. Les rsultats de cette recherche ont mis en vidence que l'pidmiologie par l'analyse des eaux uses est une approche pertinente et puissante, ayant de nombreux domaines d'application. Face la complexit de mesurer un phnomne cach comme la consommation de stupfiants, la valeur ajoute de cette approche a ainsi pu tre dmontre.
Resumo:
Un enregistrement de la tension artrielle ambulatoire (couvrant 24 heures) ainsi que plusieurs mesures en cabinet ont permis de classer chaque participant dans 4 catgories : normotension (tension artrielle normale au cabinet et en ambulatoire), hypertension artrielle soutenue (tension artrielle leve au cabinet et en ambulatoire), hypertension de la blouse blanche (tension artrielle leve au cabinet mais normale en ambulatoire) et hypertension artrielle masque (tension artrielle leve en ambulatoire mais normale au cabinet). Dans la littrature, la prvalence de l'hypertension artrielle masque varie entre 8% et 48% selon la mthodologie utilise et la population tudie. Les personnes prsentant une hypertension artrielle masque ou une hypertension de la blouse blanche pourraient avoir un risque cardiovasculaire plus lev que des personnes normotendues. Il est utile de dterminer les facteurs cliniques associs l'hypertension artrielle masque et l'hypertension de la blouse blanche afin d'identifier les personnes risque de dvelopper ces conditions. Peu d'tudes ont examin la proportion et les facteurs associs l'hypertension artrielle masque et l'hypertension de la blouse blanche en Suisse, et aucune tude n'a t faite au niveau populationnel. Dans cette tude, nous investiguons les facteurs associs l'hypertension masque et l'hypertension de la blouse blanche dans une tude populationnelle Suisse. Le Swiss Kidney Project on Genes in Hypertension (SKIPOGH) est une tude familiale transversale. La tension artrielle au cabinet et la tension artrielle ambulatoire sont mesures par des appareils valids. Dans cette tude, nous avons dfini l'hypertension artrielle masque comme une tension artrielle au cabinet < 140/90 mmHg et une tension ambulatoire (jour) s 135/85 mmHg ; l'hypertension de la blouse blanche comme une tension artrielle au cabinet s 140/90 mmHg et une tension ambulatoire < 135/85 mmHg ; et enfin la tension artrielle la limite suprieure de la norme au cabinet comme une tension systolique entre 130 et 139 mmHg et/ou une tension artrielle diastolique entre 85 et 89 mmHg lors de la mesure au cabinet. Nous avons utilis une rgression logistique multiple pour examiner la relation entre l'hypertension masque et l'hypertension de la blouse blanche, d'une part, et les facteurs associs, d'autre part, en prenant en compte les corrlations familiales. Parmi les 652 participants inclus dans cette analyse, 51% sont des femmes. L'ge moyen ( cart type) est de 48 ans ( 18 ans). Les proportions de participants avec une hypertension masque et une hypertension de la blouse blanche sont de 15.8% et de 2.6% respectivement. L'hypertension masque est associe l'ge (odds ratio (OR) = 1.02, p = 0.012), une tension artrielle au cabinet la limite suprieure de la norme (OR = 6.68, p, 0.001) et l'obsit (OR = 3.63, p = 0.001). L'hypertension de la blouse blanche est associe l'ge (OR = 1.07, p, 0.001) mais pas au niveau d'ducation, l'anamnse familiale d'hypertension ou l'activit physique. Nos donnes suggrent que les mdecins doivent envisager d'effectuer un enregistrement de la tension artrielle ambulatoire chez les personnes ges avec une tension au cabinet la limite suprieure de la norme et/ou chez les patients obses afin de dterminer si ces individus prsentent une hypertension artrielle en ambulatoire.
Resumo:
Abstract Solitary pulmonary nodule corresponds to a common radiographic finding, which is frequently detected incidentally. The investigation of this entity remains complex, since characteristics of benign and malignant processes overlap in the differential diagnosis. Currently, many strategies are available to evaluate solitary pulmonary nodules with the main objective of characterizing benign lesions as best as possible, while avoiding to expose patients to the risks inherent to invasive methods, besides correctly detecting cases of lung cancer so as the potential curative treatment is not delayed. This first part of the study focuses on the epidemiology, the morfological evaluation and the methods to determine the likelihood of cancer in cases of indeterminate solitary pulmonary nodule.
Resumo:
Eradicating measles represents a major public health achievement, yet outbreaks still occur in territories where endemic measles virus (MV) had been eliminated. In Catalonia from the year 2000 cases have occurred as isolated cases or small outbreaks, both linked to imported cases up to the end of 2006 when a large outbreak started out affecting mainly children 15m. In consequence, immunization schedule was amended lowering first dose to 12m. Again new MV importations from neighboring countries triggered another outbreak on November 2010 with a different age distribution sparing small children from infection. Differences in incidence (IR), rate ratio (RR) and 95% CI and hospitalization rate (HR) by age group were determined. Statistic z was used for comparing proportions. Total number of confirmed cases was 305 vs 381 in 2006; mean age 20 yrs (SD 14.8yrs; 3m -51yrs) vs 15m (SD13.1yrs; 1m-50yrs). Highest proportion of cases was set in 25yrs (47%) vs 24.2% in 2006 (p<0.001). Difference in IR for 15m was statistically significant (49/100,000 vs 278.2/100,000; RR:3.9; 95%CI 2.9-5.4) and in HR 30.2% vs 15.7% (p<0.001). The change of the month of administration of the first dose proved successful. Given the current epidemiological situation, continued awareness and efforts to reach young adult population are needed to stop the spread of the virus.
Resumo:
Eradicating measles represents a major public health achievement, yet outbreaks still occur in territories where endemic measles virus (MV) had been eliminated. In Catalonia from the year 2000 cases have occurred as isolated cases or small outbreaks, both linked to imported cases up to the end of 2006 when a large outbreak started out affecting mainly children 15m. In consequence, immunization schedule was amended lowering first dose to 12m. Again new MV importations from neighboring countries triggered another outbreak on November 2010 with a different age distribution sparing small children from infection. Differences in incidence (IR), rate ratio (RR) and 95% CI and hospitalization rate (HR) by age group were determined. Statistic z was used for comparing proportions. Total number of confirmed cases was 305 vs 381 in 2006; mean age 20 yrs (SD 14.8yrs; 3m -51yrs) vs 15m (SD13.1yrs; 1m-50yrs). Highest proportion of cases was set in 25yrs (47%) vs 24.2% in 2006 (p<0.001). Difference in IR for 15m was statistically significant (49/100,000 vs 278.2/100,000; RR:3.9; 95%CI 2.9-5.4) and in HR 30.2% vs 15.7% (p<0.001). The change of the month of administration of the first dose proved successful. Given the current epidemiological situation, continued awareness and efforts to reach young adult population are needed to stop the spread of the virus.
Resumo:
Apple leaf spot (ALS) caused by Colletotrichum spp. is a major disease of apple (Malus domestica) in Southern Brazil. The epidemiology of this disease was studied in experiments carried out in the counties of Passo Fundo and Vacaria, State of Rio Grande do Sul, from February 1998 to October 2000. The disease was found in all the six apple orchards sampled in the growing seasons of 1997/98 and 1998/99. The fungus isolates associated with ALS fit the characteristics of C. gloeosporioides (75%), C. acutatum (8%), and Colletotrichum sp. (17%). The pathogen overwintered in dormant buds and twigs but not in dropped leaves or fruit mummies. Two sprays of copper oxychloride (at 0.3%) reduced the fungus initial inoculum by 65-84.6% in buds and 85.6-93.7% in twigs, but had no effect on the early season progress of the disease. Disease severity increased proportionally to elevation of temperature from 14 to 26-28 C. At 34 C, however, infection was completely inhibited. The duration of leaf wetness required for infection ranged from two hours at 30 C to 32 h at 16 C. The relationship of temperature (T) and leaf wetness (W) to disease severity (Y) was represented by the model equation Y = 0.00145[((T-13)1.78)((34.01-T )1.09)] * 25/[1+14 exp(-0.137W)], R = 0.73 and P < 0.0001. Currently, this information is being used to manage the disease and to validate a forecast system for ALS.
Resumo:
Drug-drug interactions (DDIs) comprise an important cause of adverse drug reactions leading to excess hospitalizations. Drug metabolism is catalyzed by 75% by cytochrome P450 (CYP) enzymes and thus they are often involved in pharmacokinetic DDIs. In general, DDIs are studied in randomized controlled clinical trials in selected study populations. The overall aim of the present studies was to perform observational pharmacoepidemiological surveys on CYP-mediated DDIs in diseases important at the population level. The prevalence of co-administrations of four prodrugs (losartan, codeine, tramadol, and clopidogrel), three sulphonylureas (glibenclamide, glimepiride, and glipizide), or two statins (lovastatin and simvastatin) with well established agents altering CYP activity, as well as of statins with fibrates, was studied in Finland utilizing data from a university hospital medication database (inpatients) and the National Prescription Register of the Social Insurance Institution of Finland, Kela (outpatients). Clinical consequences of potential DDIs were estimated by reviewing laboratory data, and information from hospital care and cause-of-death registers. Concomitant use of study substrates with interacting medication was detected in up to one fifth of patients in both hospital and community settings. Potential CYP3A4 interactions in statin users did not manifest in clear adverse laboratory values but pharmacodynamic DDIs between statins and fibrates predisposed patients to muscular toxicity. Sulphonylurea DDIs with CYP2C9 inhibitors increased the risk of hypoglycaemia. CYP3A4 inhibitor use with clopidogrel was not associated with significant changes in mortality but non-fatal thrombosis and haemorrhage complications were seen less often in this group. Concomitant administration of atorvastatin with clopidogrel moderately attenuated the antithrombotic effect by clopidogrel. The overall mortality was increased in CYP3A4 inducer and clopidogrel co-users. Atorvastatin used concomitantly with prodrug clopidogrel seems to be beneficial in terms of total and LDL cholesterol concentrations, and overall mortality compared with clopidogrel use without interacting medication. In conclusion, CYP-mediated DDIs are a common and often unrecognized consequence of irrational drug prescribing.
Resumo:
The etiology and epidemiology of Pythium root rot in hydroponically-grown crops are reviewed with emphasis on knowledge and concepts considered important for managing the disease in commercial greenhouses. Pythium root rot continually threatens the productivity of numerous kinds of crops in hydroponic systems around the world including cucumber, tomato, sweet pepper, spinach, lettuce, nasturtium, arugula, rose, and chrysanthemum. Principal causal agents include Pythium aphanidermatum, Pythium dissotocum, members of Pythium group F, and Pythium ultimum var. ultimum. Perspectives are given of sources of initial inoculum of Pythium spp. in hydroponic systems, of infection and colonization of roots by the pathogens, symptom development and inoculum production in host roots, and inoculum dispersal in nutrient solutions. Recent findings that a specific elicitor produced by P. aphanidermatum may trigger necrosis (browning) of the roots and the transition from biotrophic to necrotrophic infection are considered. Effects on root rot epidemics of host factors (disease susceptibility, phenological growth stage, root exudates and phenolic substances), the root environment (rooting media, concentrations of dissolved oxygen and phenolic substances in the nutrient solution, microbial communities and temperature) and human interferences (cropping practices and control measures) are reviewed. Recent findings on predisposition of roots to Pythium attack by environmental stress factors are highlighted. The commonly minor impact on epidemics of measures to disinfest nutrient solution as it recirculates outside the crop is contrasted with the impact of treatments that suppress Pythium in the roots and root zone of the crop. New discoveries that infection of roots by P. aphanidermatum markedly slows the increase in leaf area and whole-plant carbon gain without significant effect on the efficiency of photosynthesis per unit area of leaf are noted. The platform of knowledge and understanding of the etiology and epidemiology of root rot, and its effects on the physiology of the whole plant, are discussed in relation to new research directions and development of better practices to manage the disease in hydroponic crops. Focus is on methods and technologies for tracking Pythium and root rot, and on developing, integrating, and optimizing treatments to suppress the pathogen in the root zone and progress of root rot.
