Epidemiology of masked and white-coat hypertension : the family-based SKIPOGH study

Un enregistrement de la tension artérielle ambulatoire (couvrant 24 heures) ainsi que plusieurs mesures en cabinet ont permis de classer chaque participant dans 4 catégories : normotension (tension artérielle normale au cabinet et en ambulatoire), hypertension artérielle soutenue (tension artérielle élevée au cabinet et en ambulatoire), hypertension de la blouse blanche (tension artérielle élevée au cabinet mais normale en ambulatoire) et hypertension artérielle masquée (tension artérielle élevée en ambulatoire mais normale au cabinet). Dans la littérature, la prévalence de l'hypertension artérielle masquée varie entre 8% et 48% selon la méthodologie utilisée et la population étudiée. Les personnes présentant une hypertension artérielle masquée ou une hypertension de la blouse blanche pourraient avoir un risque cardiovasculaire plus élevé que des personnes normotendues. Il est utile de déterminer les facteurs cliniques associés à l'hypertension artérielle masquée et à l'hypertension de la blouse blanche afin d'identifier les personnes à risque de développer ces conditions. Peu d'études ont examiné la proportion et les facteurs associés à l'hypertension artérielle masquée et à l'hypertension de la blouse blanche en Suisse, et aucune étude n'a été faite au niveau populationnel. Dans cette étude, nous investiguons les facteurs associés à l'hypertension masquée et à l'hypertension de la blouse blanche dans une étude populationnelle Suisse. Le Swiss Kidney Project on Genes in Hypertension (SKIPOGH) est une étude familiale transversale. La tension artérielle au cabinet et la tension artérielle ambulatoire sont mesurées par des appareils validés. Dans cette étude, nous avons défini l'hypertension artérielle masquée comme une tension artérielle au cabinet < 140/90 mmHg et une tension ambulatoire (jour) s 135/85 mmHg ; l'hypertension de la blouse blanche comme une tension artérielle au cabinet s 140/90 mmHg et une tension ambulatoire < 135/85 mmHg ; et enfin la tension artérielle à la limite supérieure de la norme au cabinet comme une tension systolique entre 130 et 139 mmHg et/ou une tension artérielle diastolique entre 85 et 89 mmHg lors de la mesure au cabinet. Nous avons utilisé une régression logistique multiple pour examiner la relation entre l'hypertension masquée et l'hypertension de la blouse blanche, d'une part, et les facteurs associés, d'autre part, en prenant en compte les corrélations familiales. Parmi les 652 participants inclus dans cette analyse, 51% sont des femmes. L'âge moyen (± écart type) est de 48 ans (± 18 ans). Les proportions de participants avec une hypertension masquée et une hypertension de la blouse blanche sont de 15.8% et de 2.6% respectivement. L'hypertension masquée est associée à l'âge (odds ratio (OR) = 1.02, p = 0.012), à une tension artérielle au cabinet à la limite supérieure de la norme (OR = 6.68, p, 0.001) et à l'obésité (OR = 3.63, p = 0.001). L'hypertension de la blouse blanche est associée à l'âge (OR = 1.07, p, 0.001) mais pas au niveau d'éducation, à l'anamnése familiale d'hypertension ou à l'activité physique. Nos données suggèrent que les médecins doivent envisager d'effectuer un enregistrement de la tension artérielle ambulatoire chez les personnes âgées avec une tension au cabinet à la limite supérieure de la norme et/ou chez les patients obèses afin de déterminer si ces individus présentent une hypertension artérielle en ambulatoire.

Solitary pulmonary nodule and 18F-FDG PET/CT. Part 1: epidemiology, morphological evaluation and cancer probability

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.

Analysis of translational errors in frame-based and frameless cranial radiosurgery using an anthropomorphic phantom

Abstract Objective: To evaluate three-dimensional translational setup errors and residual errors in image-guided radiosurgery, comparing frameless and frame-based techniques, using an anthropomorphic phantom. Materials and Methods: We initially used specific phantoms for the calibration and quality control of the image-guided system. For the hidden target test, we used an Alderson Radiation Therapy (ART)-210 anthropomorphic head phantom, into which we inserted four 5mm metal balls to simulate target treatment volumes. Computed tomography images were the taken with the head phantom properly positioned for frameless and frame-based radiosurgery. Results: For the frameless technique, the mean error magnitude was 0.22 ± 0.04 mm for setup errors and 0.14 ± 0.02 mm for residual errors, the combined uncertainty being 0.28 mm and 0.16 mm, respectively. For the frame-based technique, the mean error magnitude was 0.73 ± 0.14 mm for setup errors and 0.31 ± 0.04 mm for residual errors, the combined uncertainty being 1.15 mm and 0.63 mm, respectively. Conclusion: The mean values, standard deviations, and combined uncertainties showed no evidence of a significant differences between the two techniques when the head phantom ART-210 was used.

Epidemiology of measles virus outbreaks in Catalonia: importance of immunization in the elimination era

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.

Epidemiology of measles virus outbreaks in Catalonia: importance of immunization in the elimination era

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.

Alternative technique for biodiesel quality control using an optical fiber long-period grating sensor

We report the use of an optical fiber sensor to measure the soybean oil concentration in samples obtained from the mixture of pure biodiesel and commercial soybean oil. The operation of the device is based on the long-period grating sensitivity to the surrounding medium refractive index, which leads to measurable modifications in the grating transmission spectrum. The proposed analysis method results in errors in the oil concentration of 0.4% and 2.6% for pure biodiesel and commercial soybean oil, respectively. Techniques of total glycerol, dynamic viscosity, density, and hydrogen nuclear magnetic resonance spectroscopy were also employed to validate the proposed method.

Least squares regression with errors in both variables: case studies

Analytical curves are normally obtained from discrete data by least squares regression. The least squares regression of data involving significant error in both x and y values should not be implemented by ordinary least squares (OLS). In this work, the use of orthogonal distance regression (ODR) is discussed as an alternative approach in order to take into account the error in the x variable. Four examples are presented to illustrate deviation between the results from both regression methods. The examples studied show that, in some situations, ODR coefficients must substitute for those of OLS, and, in other situations, the difference is not significant.

Epidemiology of apple leaf spot

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)], R² = 0.73 and P < 0.0001. Currently, this information is being used to manage the disease and to validate a forecast system for ALS.

Epidemiology of Cytochrome P450-mediated Drug-Drug Interactions

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.

Etiology and epidemiology of Pythium root rot in hydroponic crops: current knowledge and perspectives

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.

Method of numerical correction of errors occasioned by delay of records during the monitoring of environmental variables of interest for animal production

Thermal and air conditions inside animal facilities change during the day due to the influence of the external environment. For statistical and geostatistical analyses to be representative, a large number of points spatially distributed in the facility area must be monitored. This work suggests that the time variation of environmental variables of interest for animal production, monitored within animal facility, can be modeled accurately from discrete-time records. The aim of this study was to develop a numerical method to correct the temporal variations of these environmental variables, transforming the data so that such observations are independent of the time spent during the measurement. The proposed method approached values recorded with time delays to those expected at the exact moment of interest, if the data were measured simultaneously at the moment at all points distributed spatially. The correction model for numerical environmental variables was validated for environmental air temperature parameter, and the values corrected by the method did not differ by Tukey's test at 5% significance of real values recorded by data loggers.

Epidemiology of leptospirosis at Sorocaba Zoo, São Paulo state, Southeastern Brazil

Leptospirosis is considered a worldwide distributed zoonosis, caused by the bacteria Leptospira spp. Since several species of wildlife animals are reportedly reservoirs, the aim of the present study was to know the epidemiology of leptospirosis at the Sorocaba Zoo, Southern Brazil. Serum samples of wild mammals from Artiodactyla, Carnivora, Didelphimorphia, Diprotodontia, Perissodactyla, Pilosa, Primates, Proboscidea and Rodentia orders, kept in captivity as well as from zoological staff were assayed by microscopic agglutination test (MAT). Whole blood, urine and tissue samples from wild mammals and synanthropic animals were assayed by polymerase chain reaction (PCR). An epidemiological survey was applied to evaluate the risk factors for animal infection and staff level of knowledge on leptospirosis. A total of 13/229 (5.68%; CI95% 3.37-9.47%) serum samples from wild mammals were reagent on MAT. Serology from synanthropic animals, zoo staff and molecular analysis of animal samples were all negative. Leptospirosis knowledge of zoo park staff was considered medium. In conclusion, leptospiral infection occurs at the studied zoo but due to the low occurrence found, the lowest reported in literature, wild captive mammals do not act as source of infection of leptospirosis to other animals and human beings.

Molecular epidemiology and extended-spectrum β-lactamases production of Klebsiella pneumoniae isolated from three dairy herds

The objectives of this study were to isolate Klebsiella pneumoniae from different sources in three dairy cattle herds, to use the pulsed-field gel electrophoresis (PFGE) to measure genotypic similarities between isolates within a dairy herd, to verify the production of extended-spectrum β-lactamases (ESBLs) by the double-disk synergy test (DDST), and to use the PCR to detect the main ESBLs subgroups genes. Three dairy farms were selected based on previous mastitis outbreaks caused by K. pneumoniae. Milk samples were collected from lactating cows and from the bulk tank. Swabs were performed in different locations, including milking parlors, waiting room, soil, animal's hind limbs and rectum. K. pneumoniae was isolated from 27 cases of intramammary infections (IMI) and from 41 swabs. For farm A isolates from IMI and bulk tank were considered of the same PGFE subtype. One isolate from a bulk tank, three from IMI cases and four from environmental samples were positive in the DDST test. All eight DDST positive isolates harbored the bla shv gene, one harbored the bla tem gene, and three harbored the bla ctx-m gene, including the bulk tank isolate. Our study confirms that ESBL producing bacteria is present in different locations in dairy farms, and may be responsible for IMI. The detection of ESBLs on dairy herds could be a major concern for both public and animal health.