Aplicação da genética molecular no manejo e conservação de tubarões

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação da eficácia da prednisona na reurite hansênica aguda

Um dos maiores problemas da hanseníase é o desenvolvimento de neurite aguda, que pode resultar em dor, comprometimento da função neural e incapacidade física. Apesar de a prednisona ser o principal medicamento usado no tratamento deste processo, pouco se conhece sobre a sua real eficácia no controle da neurite. O objetivo principal deste trabalho é avaliar a evolução das neurites hansênicas durante o tratamento com prednisona, através do exame clínico-neurológico. O estudo foi realizado na Unidade de Referência Especializada em Dermatologia Sanitária do estado do Pará "Dr. Marcello Candia", com inclusão de 23 sujeitos com idade média de 40,5 anos, 65% do sexo masculino. Todos multibacilares, sendo 20 borderline e 3 lepromatosos. Sessenta e um por cento já haviam recebido alta da poliquimioterapia. Foram incluídos, no estudo, sujeitos com neurite, associada ou não a acompanhamento da função motora e/ou sensitiva, utilizando esquema padrão do Ministério da Saúde, com dose inicial de 60 mg de prednisona/dia e regressão a cada 15 dias. O exame clínico foi realizado nos principais nervos periféricos afetados pela hanseníase. Após 18 semanas de acompanhamento, 60,87% dos pacientes necessitaram de prednisona por um tempo superior ao inicialmente proposto. A dor teve uma evolução clínica melhor que a força muscular e a sensibilidade cutânea. Houve melhora da dor em 71,23% dos nervos (p<0,005); entretanto, 42,47% permaneceram com neurite; a função sensitiva melhorou em 63,16% dos nervos (p > 0,05); e a função motora melhorou em 50% (p < 0,05). Os resultados indicaram que as 18 semanas de uso de prednisona não foram suficientes para a resolução da neurite hansênica e do comprometimento da função neural, na maioria dos pacientes do estudo.

Long-term clinical and ultrasonographic evaluation of thrombophilic patients with deep venous thrombosis

OBJECTIVE:The purpose of this study was to evaluate the long term clinical and ultrasonographic outcomes of thrombophilic patients with deep venous thrombosis (DVT).METHOD:Cohort study, retrospective case-control with cross-sectional analysis. Thirty-nine thrombophilic patients and 25 non-thrombophilic patients were assessed 76.3 ± 45.8 months after diagnosis. Demographic and family data were collected, as well as data from clinical and therapeutic progress, and physical and ultrasound examinations of the limbs were performed. Groups were matched for age and gender and the variables studied were compared across groups.RESULTS:Deep venous thrombosis was more frequent in women. The most common thrombophilias were antiphospholipid syndrome and factor V Leiden mutation. There was no difference between groups in terms of the number of pregnancies or miscarriages and the majority of women did not become pregnant after DVT. Non-spontaneous DVT prevailed. Proximal DVT and DVT of the left lower limb were more frequent, and the main risk factor was use of oral contraceptives. All patients were treated with anticoagulation. There was a higher frequency of pulmonary embolism in non-thrombophilic patients. Most patients considered themselves to have a normal life after DVT and reported wearing elastic stockings over at least 2 years. Seventy-one percent of patients had CEAP > 3, with no difference between groups. Deep venous reflux was more frequent in thrombophilic patients.CONCLUSION:There were no significant differences between groups with respect to most of the variables studied, except for a higher frequency of pulmonary embolism in non-thrombophilic patients and greater frequency of deep venous reflux in thrombophilic patients.

Comparative Analysis of Approaches for Assessing Energy Intake Underreporting by Female Bariatric Surgery Candidates

Objective: To test six variations in the Goldberg equation for evaluating the underreporting of energy intake (EI) among obese women on the waiting list for bariatric surgery, considering variations in resting metabolic rate (RMR), physical activity, and food intake levels in group and individual approaches.Methods: One hundred obese women aged 20 to 45years (33.3 6.08) recruited from a bariatric surgery waiting list participated in the study. Underreporting assessment was based on the difference between reported energy intake, indirect calorimetry measurements and RMR (rEI:RMR), which is compatible with the predicted physical activity level (PAL). Six approaches were used for defining the cutoff points. The approaches took into account variances in the components of the rEI:RMR = PAL equation as a function of the assumed PAL, sample size (n), and measured or estimated RMR.Results: The underreporting percentage varied from 55% to 97%, depending on the approach used for generating the cutoff points. The ratio rEI:RMR and estimated PAL of the sample were significantly different (p = 0.001). Sixty-one percent of the women reported an EI lower than their RMR. The PAL variable significantly affected the cutoff point, leading to different proportions of underreporting. The RMR measured or estimated in the equation did not result in differences in the proportion of underreporting. The individual approach was less sensitive than the group approach.Conclusion: RMR did not interfere in underreporting estimates. However, PAL variations were responsible for significant differences in cutoff point. Thus, PAL should be considered when estimating underreporting, and even though the individual approach is less sensitive than the group approach, it may be a useful tool for clinical practice.

Rural Nebraska: Looking Back at a Decade of Change and Progress: 2005 Nebraska Rural Poll Results

To commemorate the 10th anniversary of the Nebraska Rural Poll, rural Nebraskans were asked about changes they may have experienced during the past ten years. Where have they lived during the past decade? In what types of business activities have they been involved? Have they received any education or training during that time period? What has been their experience with the Internet? This report details 2,851 responses to the 2005 Nebraska Rural Poll, the tenth annual effort to understand rural Nebraskans’ perceptions. Respondents were asked a series of questions about changes they have experienced during the past ten years. For all questions, comparisons are made among different respondent subgroups, that is, comparisons by age, occupation, region, etc. Based on these analyses, some key findings emerged: One quarter of rural Nebraskans have lived somewhere other than their current community during the past ten years. Of those who have lived elsewhere, they have moved their primary residence an average of 2.2 times. Younger rural Nebraskans are more likely than older residents to have lived elsewhere during the past decade. Sixty-six percent of persons between the ages of 19 and 29 have lived in a different location, compared to only 12 percent of persons age 65 and older. Many rural Nebraskans who have lived in a different community during the past ten years have lived in another state. Forty-one percent of persons who have lived elsewhere during the past decade have lived in a different state. Forty-five percent have lived in a larger community (18% have lived in either Omaha or Lincoln and 27% have lived in or near a Nebraska community larger than their current one - other than Lincoln or Omaha). Thirty-six percent have lived in or near a Nebraska community smaller than their current one. Twenty percent of rural Nebraskans currently own a business. Thirteen percent started operating a business during the past ten years, 10 percent closed or stopped operating a business during this time period and four percent tried unsuccessfully to start a business. Persons living in or near the smallest communities are more likely than persons living in or near larger communities to currently own a business. Twenty-nine percent of persons living in or near communities with less than 500 people currently own a business, compared to 15 percent of persons living in or near communities with at least 10,000 persons. In general, rural Nebraskans have favorable opinions about self-employment but they also recognize the hardships and risks involved with this type of employment. Sixtyone percent agree that self-employment is desirable because they can be their own boss. Forty-four percent agree that self-employment provides a better quality of life than being an employee. However, 74 percent agree that self-employed individuals work longer hours than traditional employees and 70 percent agree that the cost of health insurance makes self-employment unappealing. Younger persons are more likely than older persons to agree that the cost of health insurance makes self-employment unappealing. Eighty percent of persons age 19 to 29 agree with that statement, compared to 55 percent of persons age 65 and older. One-half of rural Nebraskans have participated in formal education courses, workshops or other training activities during the past ten years. Sixty-nine percent of rural Nebraskans have Internet access either at home or at work. Sixty-six percent have acquired Internet access either at home or at work during the past ten years. An additional three percent had acquired access more than ten years ago. Persons with higher levels of income are more likely than persons with lower incomes to have acquired Internet access. Sixty-six percent of persons with household incomes of $60,000 or more have acquired Internet access at both home and work during the past ten years, compared to only 11 percent of persons with household incomes less than $20,000. Information searches and email are the most important reasons for having an Internet connection. Eighty-nine percent of rural Nebraskans with access to the Internet at either home or work say that information searches are an important or very important reason for having an Internet connection. Eighty-three percent say email is an important reason. In general, rural Nebraskans say their satisfaction with various features of their Internet connection has increased during the past ten years. Fifty-five percent of rural Nebraskans with an Internet connection at home say their satisfaction with the availability of service has increased during the past ten years and 50 percent report an increase in their satisfaction with the speed of their connection. Persons living in or near the larger communities are more likely than persons living in or near the smaller communities to say their satisfaction with the speed of their Internet connection has increased during the past ten years. Fifty-four percent of persons living in or near communities with populations of 5,000 or more say their satisfaction with the speed of their connection has increased over the past decade, compared to 43 percent of persons living in or near communities with less than 1,000 people.

Importance of early diagnosis of Stickler syndrome in newborns

Objective: The study aims to investigate a possible correlation between the main clinical and ophthalmological characteristics, age and Robin sequence in patients with the Stickler syndrome. Introduction: The Stickler syndrome is an autosomal dominant genetic disorder, characterised by ocular, orofacial and skeletal anomalies and/or auditory loss. Patients with Robin sequence features and respiratory complications are frequently diagnosed with the Stickler syndrome. The heterogeneous phenotypic manifestations may present a challenge for early clinical diagnosis. Methods: We performed a retrospective study of the 98 patients with the Stickler syndrome, between November 1995 and June 2009. The data were compared to investigate their ocular alterations and association with the Robin sequence. To be included, patients had to present with the following triad: cleft palate, facial features (hypoplastic midface, micrognathia and prominent eyes) and ocular anomalies (myopia and/or abnormalities of the retina). Results: Fifty-one percent of the patients presenting with Robin sequence features had been diagnosed with the Stickler syndrome. Ocular alterations were found in 50% of the patients. Discussion: The Robin sequence may appear as an isolated condition or associated with other features, or else as part of other known syndromes. Currently, the diagnosis of the Stickler syndrome is based on clinical signs. Affected individuals eventually develop hearing loss, retinal detachment and blindness. The ophthalmological complications associated are usually progressive and can lead to blindness.

Current practices in the management of patients with ureteral calculi in the emergency room of a university hospital

OBJECTIVE: Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital. MATERIALS AND METHODS: Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients. RESULTS: Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%). The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i. e., 59% of surgeons and 25.6% of clinicians used this combination of drugs) (p = 0.014). Only 21.3% prescribe alpha blockers. CONCLUSION: Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.

Proctocolectomy and ileal J-pouch anal anastomosis on the surgical treatment of familial adenomatous polyposis and ulcerative colitis: analysis of 49 cases

OBJECTIVE: To evaluate the results of ileal J-pouch anal anastomosis in ulcerative colitis and familial adenomatous polyposis. METHOD: Retrospective analysis of medical records of 49 patients submitted to ileal J-pouch anal anastomosis. RESULTS: Ulcerative colitis was diagnosed in 65% and familial adenomatous polyposis in 34%. Mean age was 39.5 years. 43% were male. Among familial adenomatous polyposis, 61% were diagnosed with colorectal cancer. Thirty-one percent of patients with ulcerative colitis was submitted to a previous surgical approach and 21% of these had toxic megacolon. Average hospital stay was 10 days. Post-operative complications occurred in 50% of patients with ulcerative colitis and 29.4% with familial adenomatous polyposis. Intestinal diversion was performed in 100% of ulcerative colitis and 88% of familial adenomatous polyposis. Pouchitis occurred in eight cases (seven ulcerative colitis and one FAP), requiring excision of the pouch in three ulcerative colitis. Mortality rate was 7.6%: two cases of carcinoma on the pouch and two post-operative complications. Late post-operative complications occurred in 22.4%: six familial adenomatous polyposis and five ulcerative colitis). Two patients had erectile dysfunction, and one retrograde ejaculation. One patient with severe perineal dermatitis was submitted to excision of the pouch. Incontinence occurred in four patients and two reported soil. Mean bowel movement was five times a day. CONCLUSION: Ileal J-pouch anal anastomosis is a safe surgery with acceptable morbidity and good functional results, if well indicated and performed in referral centers.

Deposit-feeding in benthic macrofauna : Tracer studies from the Baltic Sea

A low content of organic matter, which is largely refractory in nature, is characteristic of most sediments, meaning that aquatic deposit-feeders live on a very poor food source. The food is derived mainly from sedimenting phytodetritus, and in temperate waters like the Baltic Sea, from seasonal phytoplankton blooms. Deposit-feeders are either bulk-feeders, or selective feeders, which preferentially ingest the more organic-rich particles in the sediment, including phytodetritus, microbes and meiofauna. The soft-bottom benthos of the Baltic Sea has low species biodiversity and is dominated by a few macrobenthic species, among which the most numerous are the two deposit-feeding amphipods Monoporeia affinis and Pontoporeia femorata, and the bivalve Macoma balthica. This thesis is based on laboratory experiments on the feeding of these three species, and on the priapulid Halicryptus spinulosus. Feeding by benthic animals is often difficult to observe, but can be effectively studied by the use of tracers. Here we used the radioactive isotope 14C to label food items and to trace the organic matter uptake in the animals, while the stable isotopes 13C and 15N were used to follow feeding on aged organic matter in the sediment. The abundance of M. balthica and the amphipods tends to be negatively correlated, i.e., fewer bivalves are found at sites with dense populations of amphipods, with the known explanation that newly settled M. balthica spat are killed by the amphipods. Whether the postlarvae are just accidentally killed, or also ingested after being killed was tested by labelling the postlarvae with 14C and Rhodamine B. Both tracer techniques gave similar evidence for predation on and ingestion of postlarval bivalves. We calculated that this predation was likely to supply less than one percent of the daily carbon requirement for M. affinis, but might nevertheless be an important factor limiting recruitment of M. balthica. The two amphipods M. affinis and P. femorata are partly vertically segregated in the sediment, but whether they also feed at different depths was unknown. By adding fresh 14C-labelled algae either on the sediment surface or mixed into the sediment, we were able to distinguish surface from subsurface feeding. We found M. affinis and P. femorata to be surface and subsurface deposit-feeders, respectively. Whether the amphipods also feed on old organic matter, was studied by adding fresh 14C-labelled algae on the sediment surface, and using aged, one-year-old 13C- and 15N-labelled sediment as deep sediment. Ingestion of old organic matter, traced by the stable isotopes, differed between the two species, with a higher uptake for P. femorata, suggesting that P. femorata utilises the older, deeper-buried organic matter to a greater extent. Feeding studies with juveniles of both M. affinis and P. femorata had not been done previously. In an experiment with the same procedure and treatments as for the adults, juveniles of both amphipod species were found to have similar feeding strategies. They fed on both fresh and old sediment, with no partitioning of food resources, making them likely to be competitors for the same food resource. Oxygen deficiency has become more wide-spread in the Baltic Sea proper in the last half-century, and upwards of 70 000km2 are now devoid of macrofauna, even though part of that area does not have oxygen concentrations low enough to directly kill the macrofauna. We made week-long experiments on the rate of feeding on 14C-labelled diatoms spread on the sediment surface in different oxygen concentrations for both the amphipod species, M. balthica and H. spinulosus. The amphipods were the most sensitive to oxygen deficiency and showed reduced feeding and lower survival at low oxygen concentrations. M. balthica showed reduced feeding at the lowest oxygen concentration, but no mortality increase. The survival of H. spinulosus was unaffected, but it did not feed, showing that it is not a surface deposit-feeder. We conclude that low oxygen concentrations that are not directly lethal, but reduce food intake, may lead to starvation and death in the longer term.

Determinants of maximal oxygen uptake in severe acute hypoxia

[EN] To unravel the mechanisms by which maximal oxygen uptake (VO2 max) is reduced with severe acute hypoxia in humans, nine Danish lowlanders performed incremental cycle ergometer exercise to exhaustion, while breathing room air (normoxia) or 10.5% O2 in N2 (hypoxia, approximately 5,300 m above sea level). With hypoxia, exercise PaO2 dropped to 31-34 mmHg and arterial O2 content (CaO2) was reduced by 35% (P < 0.001). Forty-one percent of the reduction in CaO2 was explained by the lower inspired O2 pressure (PiO2) in hypoxia, whereas the rest was due to the impairment of the pulmonary gas exchange, as reflected by the higher alveolar-arterial O2 difference in hypoxia (P < 0.05). Hypoxia caused a 47% decrease in VO2 max (a greater fall than accountable by reduced CaO2). Peak cardiac output decreased by 17% (P < 0.01), due to equal reductions in both peak heart rate and stroke VOlume (P < 0.05). Peak leg blood flow was also lower (by 22%, P < 0.01). Consequently, systemic and leg O2 delivery were reduced by 43 and 47%, respectively, with hypoxia (P < 0.001) correlating closely with VO2 max (r = 0.98, P < 0.001). Therefore, three main mechanisms account for the reduction of VO2 max in severe acute hypoxia: 1) reduction of PiO2, 2) impairment of pulmonary gas exchange, and 3) reduction of maximal cardiac output and peak leg blood flow, each explaining about one-third of the loss in VO2 max.

Petrographie und Geochemie des Eckfelder Maares und von Hillscheid und die Einbindung in den Hocheifelvulkanismus

Tertiäre Vulkanite aus dem Eckfelder Maar, dem Hillscheider Diatrem und dem Hillscheid Basalt (Schlot) wurden petrologisch und geochemisch untersucht. Bis auf tonige Klasten aus dem Bohrkern des Eckfelder Maares handelt es sich bei allen weiteren Proben um undifferenzierte basische Vulkanite. Die tonigen Klasten aus dem Bohrkern müssen der ehemaligen Landoberfläche vor der Eruption des Eckfelder Maares zugerechnet werden, in dessen Krater sie während der Eruption hineingefallen sind. Bis auf die Proben des Hillscheid Basaltes sind die Proben alteriert. Die Alteration zeigt sich an der Bildung von Zeolithen und Calcitmineralisationen, die primär und sekundär gebildete Hohlräume aufgefüllt haben oder an einer vertonten Grundmasse der Proben, die daneben Mineraleinschlüsse (Spinell) und kantige Fremdgesteinsbruchstücke enthalten können. Bei den Proben mit vertonter Grundmasse handelt es sich um Palagonite, Umwandlungsprodukte aus Sideromelan (basaltischem Glas). Geochemische Analysen an Grundmassepräparaten der alterierten bis vertonten Proben zeigen, dass außer den immobilen Elementen Ti, Nb, Zr, Y alle weiteren Elemente teilweise bis vollständig abgereichert worden sind. Eine Ausnahme bildet Barium (Ba), welches z.T. in beträchtlichen Mengen in Zeolithen (Harmotom) angereichert wurde. Bei den Proben aus dem Eckfelder Maar kann die Alteration bis Vertonung der Proben alleine mit der Palagonitisierung und Verwitterung erklärt werden. Es gibt keine Hinweise auf Materialzufuhr und damit für sich anschließende hydrothermale Prozesse. Die Proben des Hillscheider Diatrem sind wesentlich geringer alteriert (glasige Grundmasse). Neuste Erkenntnisse aus einer Bohrung im Sommer 1999 im vermuteten Zentrum des Hillscheider Diatrems beschränken das Diatrem maximal auf einen kleineren Bereich im Nordosten der bisherigen Lokation. Bei der Bohrung stieß man nach 20 Meter auf Anstehendes. Im Hangschutt darüber fand man Blöcke des Hillscheid Basaltes. Eine geringere Größe der Lokation zusammen mit der geringen Alteration könnten auf deren Entstehung mit einer initialen Maarphase gefolgt von Schlackentätigkeit hinweisen. Die Schlacken könnten die ersten Ablagerungen vor Verwitterung geschützt haben. Allerdings gibt es keine Funde die eine Schlackentätigkeit belegen. Beim sogenannten 'Hillscheider Diatrem' könnte es sich aber auch um Hangschutt aus der Randbreccie des Hillscheider Basaltes handeln. Zusammen mit Bruchstücken aus dem Schlot des Hillscheid Basaltes wären die Palagonite des sogenannten 'Hillscheider Diatrem' erst in jüngster Zeit im Bereich einer Uferböschung zur Ablagerung gekommen. Dies würde allerdings das sogenannte 'Hillscheider Diatrem' in seiner Existenz in Frage stellen. Vergleiche der Proben des Hillscheid Basaltes mit basischen Hocheifelvulkaniten deuten auf kogenetische Beziehung aller Proben untereinander und ordnen die Proben des Hillscheid Basaltes geochemisch dem Hocheifelvulkanismus zu. REE- und weitere Spurenelementgehalte und auch deren Elementverhältnisse weisen für alle tertiären Eifelvulkanite gemeinsam auf Mantelschmelzen aus dem Bereich eines Granatperidotits mit niedrigen Aufschmelzgraden um ein Prozent hin. Vergleich der Elementverhältnisse hochinkompatibler Elemente im Bezug auf die Bildung mafischer Schmelzen mit primitivem Mantel deuten darauf hin, dass der Mantel im Bereich der Hocheifel verarmt ist an K, Rb, Sr und angereichert an Ba und eventuell an Nb. Ursachen für diese von typisch primären Mantelzusammensetzung abweichenden Verhältnisse könnten durch Mischungen von Mantelschmelzen mit lithosphärischem Mantel (K-Anomalie) und durch Anreicherungen mit fluiden Phasen (Ba-Anomalie) oder auch Schmelzen aus einem tieferliegenden Plume (Kelberger Hoch) verursacht worden sein. Englischer Zusammenfassung:

Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study

Background: Annual syphilis testing was reintroduced in the Swiss HIV Cohort Study (SHCS) in 2004. We prospectively studied occurrence, risk factors, clinical manifestations, diagnostic approaches and treatment of syphilis. Methods: Over a period of 33 months, participants with positive test results for Treponema pallidum hemagglutination assay were studied using the SHCS database and an additional structured case report form. Results: Of 7244 cohort participants, 909 (12.5%) had positive syphilis serology. Among these, 633 had previously been treated and had no current signs or symptoms of syphilis at time of testing. Of 218 patients with newly detected untreated syphilis, 20% reported genitooral contacts as only risk behavior and 60% were asymptomatic. Newly detected syphilis was more frequent among men who have sex with men (MSM) [adjusted odds ratio (OR) 2.8, P < 0.001], in persons reporting casual sexual partners (adjusted OR 2.8, P < 0.001) and in MSM of younger age (P = 0.05). Only 35% of recommended cerebrospinal fluid (CFS) examinations were performed. Neurosyphilis was diagnosed in four neurologically asymptomatic patients; all of them had a Venereal Disease Research Laboratory (VDRL) titer of 1:≥32. Ninety-one percent of the patients responded to treatment with at least a four-fold decline in VDRL titer. Conclusion: Syphilis remains an important coinfection in the SHCS justifying reintroduction of routine screening. Genitooral contact is a significant way of transmission and young MSM are at high risk for syphilis. Current guidelines to rule out neurosyphilis by CSF analysis are inconsistently followed in clinical practice. Serologic treatment response is above 90% in the era of combination antiretroviral therapy.

Clinical Characteristics of Children with Viral Single- and Co-Infections and a Petechial Rash

BACKGROUND:: Children with petechial rash are more likely to undergo invasive diagnostics, to be treated with antibiotics for potential bacterial infection and to be hospitalized. However, viruses have also been associated with petechial rash. Nonetheless, a systematic analysis of viral infections with modern available techniques as quantitative real time polymerase chain reaction (q-PCR) in the context of petechial rash is lacking. The purpose of this pediatric study was to prospectively uncover viral pathogens that may promote the emergence of petechiae and to analyze the correlation with the clinical characteristics and course. METHODS:: We conducted a prospective study in children (0 to 18 years) presenting with petechiae and signs or symptoms of infection at the emergency department between November 2009 and March 2012. In nasopharyngeal aspirates the following viruses were analyzed by q-PCR: Cytomegalovirus, Epstein-Barr virus, parvovirus B19, Influenza A and B, parainfluenza viruses, human respiratory syncytial virus A and B, human metapneumovirus, rhinovirus, enterovirus, adenovirus, human coronavirus OC43, 229E, NL63 and human bocavirus. RESULTS:: A viral pathogen was identified in 67% of the analyzed 58 cases with petechial rash. Virus positive patients showed a significantly higher incidence of lower respiratory tract infections. Forty-one percent were viral co-infections, which were significantly younger than virus negative patients, had a higher leukocyte count and were hospitalized for a longer time. CONCLUSIONS:: A petechial rash is frequently associated viral single- and co-infections and can rapidly be identified via q-PCR.

Impact of Lifetime Alcohol Use on Liver Fibrosis in a Population of HIV-Infected Patients With and Without Hepatitis C Coinfection

BACKGROUND: The effect of alcohol on liver disease in HIV infection has not been well characterized. METHODS: We performed a cross-sectional multivariable analysis of the association between lifetime alcohol use and liver fibrosis in a longitudinal cohort of HIV-infected patients with alcohol problems. Liver fibrosis was estimated with 2 noninvasive indices, "FIB-4," which includes platelets, liver enzymes, and age; and aspartate aminotransferase/platelet ratio index ("APRI"), which includes platelets and liver enzymes. FIB-4 <1.45 and APRI <0.5 defined the absence of liver fibrosis. FIB-4 >3.25 and APRI >1.5 defined advanced liver fibrosis. The main independent variable was lifetime alcohol consumption (<150 kg, 150 to 600 kg, >600 kg). RESULTS: Subjects (n = 308) were 73% men, mean age 43 years, 49% with hepatitis C virus (HCV) infection, 60% on antiretroviral therapy, 49% with an HIV RNA load <1,000 copies/ml, and 18.7% with a CD4 count <200 cells/mm(3) . Forty-five percent had lifetime alcohol consumption >600 kg, 32.7% 150 to 600 kg, and 22.3% <150 kg; 33% had current heavy alcohol use, and 69% had >9 years of heavy episodic drinking. Sixty-one percent had absence of liver fibrosis and 10% had advanced liver fibrosis based on FIB-4. In logistic regression analyses, controlling for age, gender, HCV infection, and CD4 count, no association was detected between lifetime alcohol consumption and the absence of liver fibrosis (FIB-4 <1.45) (adjusted odds ratio [AOR] = 1.12 [95% CI: 0.25 to 2.52] for 150 to 600 kg vs. <150 kg; AOR = 1.11 [95% CI: 0.52 to 2.36] for >600 kg vs. <150 kg; global p = 0.95). Additionally, no association was detected between lifetime alcohol use and advanced liver fibrosis (FIB-4 >3.25). Results were similar using APRI, and among those with and without HCV infection. CONCLUSIONS: In this cohort of HIV-infected patients with alcohol problems, we found no significant association between lifetime alcohol consumption and the absence of liver fibrosis or the presence of advanced liver fibrosis, suggesting that alcohol may be less important than other known factors that promote liver fibrosis in this population.

Cyclin D1 (CCND1) A870G gene polymorphism modulates smoking-induced lung cancer risk and response to platinum-based chemotherapy in non-small cell lung cancer (NSCLC) patients

PURPOSE: The cyclin D1 (CCND1) A870G gene polymorphism is linked to the outcome in patients with resectable non-small cell lung cancer (NSCLC). Here, we investigated the impact of this polymorphism on smoking-induced cancer risk and clinical outcome in patients with NSCLC stages I-IV. METHODS: CCND1 A870G genotype was determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis (RFLP) of DNA extracted from blood. The study included 244 NSCLC patients and 187 healthy control subjects. RESULTS: Patient characteristics were: 70% male, 77% smokers, 43% adenocarcinoma, and 27% squamous cell carcinoma. Eighty-one percent of the patients had stages III-IV disease. Median age at diagnosis was 60 years and median survival was 13 months. Genotype frequencies of patients and controls both conformed to the Hardy Weinberg equilibrium. The GG genotype significantly correlated with a history of heavy smoking (>or=40 py, P=0.02), and patients with this genotype had a significantly higher cigarette consumption than patients with AA/AG genotypes (P=0.007). The GG genotype also significantly correlated with tumor response or stabilization after a platinum-based first-line chemotherapy (P=0.04). Survival analysis revealed no significant differences among the genotypes. CONCLUSION: Evidence was obtained that the CCND1 A870G gene polymorphism modulates smoking-induced lung cancer risk. Further studies are required to explore the underlying molecular mechanisms and to test the value of this gene polymorphism as a predictor for platinum-sensitivity in NSCLC patients.