Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease)

Background: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called Buruli ulcer'' (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of >= 10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC).Methods: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment.Findings: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%).Interpretation: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed.

Photosynthetic performance of freshwater Rhodophyta in response to temperature, irradiance, pH and diurnal rhythm

Responses of net photosynthetic rates to temperature, irradiance, pH/inorganic carbon and diurnal rhythm were analyzed in 15 populations of eight freshwater red algal species in culture and natural conditions. Photosynthetic rates were determined by oxygen concentration using the light and dark bottles technique. Parameters derived from the photosynthesis-irradiance curves indicated adaptation to low irradiance for all freshwater red algae tested, confirming that they tend to occur under low light regimes. Some degree of photoinhibition (β = -0.33-0.01 mg O2 g-1 DW h-1 (μmol photons m-2 s-1)-1) was found for all species/populations analyzed, whereas light compensation points (lc) were very low (≤ 2 μmol photons m- photons s-1) for most algae tested. Saturation points were low for all algae tested (lk = 6-54 μmol photons m-2 S-1; lS = 20-170 μmol photons m-2 s-1). Rates of net photosynthesis and dark respiration responded to the variation in temperature. Optimum temperature values for net photosynthesis were variable among species and populations so that best performances were observed under distinct temperature conditions (10, 15, 20 or 25°C). Rates of dark respiration exhibited an increasing trend with temperature, with highest values under 20-25°C. Results from pH experiments showed best photosynthetic performances under pH 8.5 or 6.5 for all but one species, indicating higher affinity for inorganic carbon as bicarbonate or indistinct use of bicarbonate and free carbon dioxide. Diurnal changes in photosynthetic rates revealed a general pattern for all algae tested, which was characterized by two relatively clear peaks, with some variations around it: a first (higher) during the morning (07.00-11.00 hours.) and a second (lower) in the afternoon (14.00-18.00 hours). Comparative data between the 'Chantransia' stage and the respective gametophyte for one Batrachospermum population revealed higher values (ca 2-times) in the latter, much lower than previously reported. The physiological role of the 'Chantransia' stage needs to be better analyzed.

Therapeutic response of benzodiazepine, orphenadrine citrate and occlusal splint association in TMD pain

Loss of function, muscle inflammation, and pain are some of the signs and symptoms of temporomandibular dysfunction (TMD). Pharmacological strategies to minimize the clinical manifestation of these disorders often focus on blocking or inhibiting the pain-causing symptom. Resources such as muscle-relaxants, anxiety-relief drugs, and splint therapy are often used to reduce muscular hyperactivity related to TMD muscle pain. This study compares the effect of a randomly ordered association of occlusal splint therapy (S), nonsteroid anti-inflammatory with a muscle-relaxant drug (orphenadrine citrate) (O), and an anxiety-relief drug (benzodiazepine) (B), to ease painful TMD muscle symptoms. Clinical and anamnestic analyses were recorded in accordance with the Helkimo TMD index and applied before and after treatments. Twenty-one group two Helkimo TMD adult female patients were treated, all of whom were subjected to the three random therapeutic associations proposed: SBO, BOS, and OSB. The same operator applied the three specific associations over a period of 21 days in the proposed sequence, seven days for each therapy. The results show that all the groups presented the best results in terms of relief from pain after the therapeutic association (28.5% showed a decrease and 47.6% showed an absence of symptoms). No significant difference was observed among association therapeutic protocols. Copyright © 2003 by CHROMA, Inc.

Path analysis and expected response in indirect selection for grain yield in soybean

This study aimed to determine the best auxiliary trait for indirect selection of soybean grain yield, through path analysis and in avoidance of the adverse effects of multicollinearity and expected response. Seventy-nine F5 soybean genotypes from the cross FT-Cometa x Bossier were used. The populations were distributed on the field was the families inserted with replicated controls. Primary and secondary traits of grain yield were evaluated in four phenotypically superior plants per family. The traits number of pods, height and number of nodes were considered as the most important, showing the best combination of direct effect and genotypic correlation. The number of pods achieved the highest expected gain through the estimation method based on the selection differential. On the other hand, plant height, by the method based on selection intensity, was not a good indicator of the most productive plants.

Optimization of a synbiotic formulation of soy yoghurt containing yacon extract by response surface methodology

A synbiotic yoghurt based on a combination of soymilk and yacon water extract (from yacon root tubers) was developed as a novel food product fermented with a probiotic culture of Enterococcus faecium CRL 183 and Lactobacillus helveticus ssp jugurti 4l6. Response surface methodology (RSM) was used to optimize the independent variables soymilk protein concentration and percentage of yacon extract in the formulation through a Central Composite Rotatable Design (CCRD), consisting of a 22 factorial design with two levels (-1, +1), two central points (0) and four axial points (± a, 0) (0, ± α). The responses were assessed by consumer acceptance tests. The optimization indicated that a formulation with a soymilk protein concentration of 1.74g/L and 25.86% of yacon extract gave the best average values, 5.91 for the taste and 6.00 for the overall impression responses. The formulation with 40% of yacon extract and the same concentration of soymilk protein achieved similar acceptance values: taste (5.94) and overall impression (5.87), however, with the extra yacon, it probably had a greater content of prebiotic fructooligosaccharides. Consequently, both formulations may give useful functional foods, with sensory properties comparable with those of soy yoghurt (control formulation). Copyright © 2010 by New Century Health Publishers.

Policy response to poverty and inequality in the developing world

Includes bibliography

Optimization of the surimi production from Mechanically Recovered Fish Meat (MRFM) using response surface methodology

The by-products generated from industrial filleting of tilapia surimi can be used for the manufacture of surimi. The surimi production uses large amounts of water, which generates a wastewater rich in organic compounds (lipids, soluble proteins and blood). Optimizing the number of washing cycles will contribute to a more sustainable production. A mathematical model of mechanically recovered tilapia meat (Oreochromis niloticus) for the processing of surimi (minced fish washing cycles and tapioca starch addition) based on two quality parameters (texture and moisture) was constructed by applying the response surface methodology (RSM). Each factor had an important effect on the moisture and texture of surimi. This study found that the optimal formulation for producing the best surimi using the by-products of tilapia filleting in manufacturing fish burger were the addition of 10% tapioca starch and three minced fish washing cycles. A microstructural evaluation supported the findings of the mathematical model. Practical Applications: The use of mechanically recovered fish meat (MRFM) for the production of surimi enables the utilization of the by-products of filleting fish. However, the inferior quality of the surimi produced from MRFM in relation to that produced with fillets necessitates the addition of starch; secondly, surimi production consumes a large volume of water. RSM provides a valuable means for optimizing the number of washing cycles and starch amounts utilized in fish burger production. Tapioca starch, widely produced in Brazil, has desirable characteristics (surface sheen, smooth texture, neutral taste and clarity in solution) for use in MRFM-produced surimi. © 2013 Wiley Periodicals, Inc.

Response surface methodology applied to the evaluation of the SO 2 sorption process in two Brazilian limestones

This paper proposes a response surface methodology to evaluate the influence of the particle size and temperature as variables and their interaction on the sulfation process using two Brazilian limestones, a calcite (ICB) and a dolomite (DP). Experiments were performed according to an experimental design [central composite rotatable design (CCRD)] carried out on a thermogravimetric balance and a nitrogen adsorption porosimeter. In the SO 2 sorption process, DP was shown to be more efficient than ICB. The best results for both limestones in relation to conversion and Brunauer-Emmett-Teller (BET) surface area were obtained under central point conditions (545 μm and 850 C for DP and 274 μm and 815 C for ICB). The optimal values for conversion were 52% for DP and 37% for ICB. For BET surface area, the optimal values were 35 m2 g-1 for DP and 45 m2 g-1 for ICB. A relationship between conversion and pore size distribution has been established. The experiments that showed higher conversions also exhibited more pores in the region between 20 and 150 Å and larger BET surface area, indicating that the amount of smaller pores may be an important factor in the reactivity of limestones. © 2013 American Chemical Society.

Auditory steady state response in hearing assessment in infants with cytomegalovirus

OBJETIVO:Relatar o caso de um lactente com citomegalovírus congênito e disacusia neurossensorial progressiva, analisado por três métodos de avaliação auditiva.DESCRIÇÃO DO CASO:Na primeira avaliação auditiva, aos quatro meses de idade, o lactente apresentou ausência de Emissões Otoacústicas (EOA) e Potencial Evocado Auditivo de Tronco Encefálico (PEATE) dentro dos padrões de normalidade para a faixa etária, com limiar eletrofisiológico em 30dBnHL, bilateralmente. Com seis meses, apresentou ausência de PEATE bilateral em 100dBnHL. A avaliação comportamental da audição mostrou-se prejudicada devido ao atraso no desenvolvimento neuropsicomotor. Aos oito meses, foi submetido ao exame de Resposta Auditiva de Estado Estável (RAEE) e os limiares encontrados foram 50, 70, ausente em 110 e em 100dB, respectivamente para 500, 1.000, 2.000 e 4.000Hz, à direita, e 70, 90, 90 e ausente em 100dB, respectivamente para 500, 1.000, 2.000 e 4.000Hz, à esquerda.COMENTÁRIOS:Na primeira avaliação, o lactente apresentou alteração auditiva no exame de EOA e PEATE normal, que passou a ser alterado aos seis meses de idade. A intensidade da perda auditiva só pôde ser identificada pelo exame de RAEE, permitindo estabelecer a melhor conduta na adaptação de aparelho de amplificação sonora individual. Ressalta-se a importância do acompanhamento audiológico para crianças com CMV congênito.

Non-specific immune parameters and physiological response of Nile tilapia fed beta-glucan and vitamin C for different periods and submitted to stress and bacterial challenge

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

Peritoneal response to abdominal surgery: the role of equine abdominal adhesions and current prophylactic strategies

Intra-abdominal adhesions constitute a significant clinical and surgical problem that can lead to complications such as pain and bowel occlusion or subocclusion. These adhesions are frustrating and potentially fatal, representing a major postoperative complication in abdominal surgery. It is estimated that 32% of horses undergoing laparotomy will present clinical symptoms due to adhesions, but the true prevalence is not known because a large proportion of animals with postoperative recurrent colics are medically treated or submitted to euthanasia without necropsy. Adhesions are highly cellular, vascularized, dynamic structures that are influenced by complex signaling mechanisms. Understanding their pathogenesis could assist in applying better therapeutic strategies and in developing more effective antiadhesion products. Currently, there are no definitive strategies that prevent adhesion formation, and it is difficult to interpret the results of existing studies due to nonstandardization of an induction model and evaluation of their severity. The best clinical results have been obtained from using minimally traumatic surgical techniques, anti-inflammatory agents, antimicrobials, anticoagulants, and mechanical separation of serosal surfaces by viscous intraperitoneal solutions or physical barriers. This paper aims to review adhesion formation pathogenesis, guide the understanding of major products and drugs used to inhibit adhesion formation, and address their effectiveness in the equine species.

Toward a Clinical Protocol for Assessing Rod, Cone, and Melanopsin Contributions to the Human Pupil Response

PURPOSE. To better understand the relative contributions of rod, cone, and melanopsin to the human pupillary light reflex (PLR) and to determine the optimal conditions for assessing the health of the rod, cone, and melanopsin pathways with a relatively brief clinical protocol. METHODS. PLR was measured with an eye tracker, and stimuli were controlled with a Ganzfeld system. In experiment 1, 2.5 log cd/m(2) red (640 +/- 10 nm) and blue (467 +/- 17 nm) stimuli of various durations were presented after dark adaptation. In experiments 2 and 3, 1-second red and blue stimuli were presented at different intensity levels in the dark (experiment 2) or on a 0.78 log cd/m(2) blue background (experiment 3). Based on the results of experiments 1 to 3, a clinical protocol was designed and tested on healthy control subjects and patients with retinitis pigmentosa and Leber`s congenital amaurosis. RESULTS. The duration for producing the optimal melanopsin-driven sustained pupil response after termination of an intense blue stimulus was 1 second. PLR rod-and melanopsin-driven components are best studied with low-and high-intensity flashes, respectively, presented in the dark (experiment 2). A blue background suppressed rod and melanopsin responses, making it easy to assess the cone contribution with a red flash (experiment 3). With the clinical protocol, robust melanopsin responses could be seen in patients with few or no contributions from the rods and cones. CONCLUSIONS. It is possible to assess the rod, cone, and melanopsin contributions to the PLR with blue flashes at two or three intensity levels in the dark and one red flash on a blue background. (Invest Ophthalmol Vis Sci. 2011; 52: 6624-6635) DOI: 10.1167/iovs.11-7586

Fetal Pulmonary Response After Fetoscopic Tracheal Occlusion for Severe Isolated Congenital Diaphragmatic Hernia

OBJECTIVE: To estimate the response in lung growth and vascularity after fetal endoscopic tracheal occlusion for severe congenital diaphragmatic hernia in the prediction of neonatal survival. METHODS: Between January 2006 and December 2010, fetal lung parameters (observed-to-expected lung-to-head ratio; observed-to-expected lung volume; and contralateral lung vascularization index) were evaluated before fetal tracheal occlusion and were evaluated longitudinally every 2 weeks in 72 fetuses with severe isolated congenital diaphragmatic hernia. Thirty-five fetuses underwent fetal endoscopic tracheal occlusion and 37 cases did not. RESULTS: Survival rate was significantly higher in the fetal endoscopic tracheal occlusion group (54.3%) than in the no fetal endoscopic tracheal occlusion group (5.4%, P<.01). Fetal endoscopic tracheal occlusion resulted in a significant improvement in fetal lung size and pulmonary vascularity when compared with fetuses that did not go to the fetal intervention (increase of the observed-to-expected lung-to-head ratio, observed-to-expected total lung volume, and contralateral pulmonary vascularization index 56.2% compared with 0.3%, 37.9% compared with 0.1%, and 98.6% compared with 0.0%, respectively; P<.01). Receiver operating characteristic curves indicated that the observed-to-expected total fetal lung volume was the single best predictor of neonatal survival before fetal endoscopic tracheal occlusion (cutoff 0.23, area under the curve [AUC] 0.88, relative risk 5.3, 95% confidence interval [CI] 1.4-19.7). However, the contralateral lung vascularization index at 4 weeks after fetal endoscopic tracheal occlusion was more accurate in the prediction of neonatal outcome (cutoff 24.0%, AUC 0.98, relative risk 9.9, 95% CI 1.5-66.9) with the combination of observed-to-expected lung volumes and contralateral lung vascularization index at 4 weeks being the best predictor of outcome (AUC 0.98, relative risk 16.6, 95% CI 2.5-112.3). CONCLUSION: Fetal endoscopic tracheal occlusion improves survival rate by increasing the lung size and pulmonary vascularity in fetuses with severe congenital diaphragmatic hernia. The pulmonary response after fetal endoscopic tracheal occlusion can be used to predict neonatal survival. (Obstet Gynecol 2012; 119: 93-101) DOI: 10.1097/AOG.0b013e31823d3aea

Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome

Objective To evaluate the changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization in the ICU and their relation to outcome. Design Prospective observational study. Setting ICU of a veterinary university medical center. Animals Thirty dogs with severe sepsis or septic shock caused by pyometra who underwent surgery and were admitted to the ICU. Measurements and Main Results Severe sepsis was defined as the presence of sepsis and sepsis-induced dysfunction of one or more organs. Septic shock was defined as the presence of severe sepsis plus hypotension not reversed with fluid resuscitation. After the presumptive diagnosis of sepsis secondary to pyometra, blood samples were collected and clinical findings were recorded. Volume resuscitation with 0.9% saline solution and antimicrobial therapy were initiated. Following abdominal ultrasonography and confirmation of increased uterine volume, dogs underwent corrective surgery. After surgery, the animals were admitted to the ICU, where resuscitation was guided by the clinical parameters, central venous oxygen saturation (ScvO2), lactate, and base deficit. Between survivors and nonsurvivors it was observed that the ScvO2, lactate, and base deficit on ICU admission were each related independently to death (P = 0.001, P = 0.030, and P < 0.001, respectively). ScvO2 and base deficit were found to be the best discriminators between survivors and nonsurvivors as assessed via receiver operator characteristic curve analysis. Conclusion Our study suggests that ScvO2 and base deficit are useful in predicting the prognosis of dogs with severe sepsis and septic shock; animals with a higher ScvO2 and lower base deficit at admission to the ICU have a lower probability of death.

Mapping the hydrodynamic response to the initial geometry in heavy-ion collisions

We investigate how the initial geometry of a heavy-ion collision is transformed into final flow observables by solving event-by-event ideal hydrodynamics with realistic fluctuating initial conditions. We study quantitatively to what extent anisotropic flow (nu(n)) is determined by the initial eccentricity epsilon(n) for a set of realistic simulations, and we discuss which definition of epsilon(n) gives the best estimator of nu(n). We find that the common practice of using an r(2) weight in the definition of epsilon(n) in general results in a poorer predictor of nu(n) than when using r(n) weight, for n > 2. We similarly study the importance of additional properties of the initial state. For example, we show that in order to correctly predict nu(4) and nu(5) for noncentral collisions, one must take into account nonlinear terms proportional to epsilon(2)(2) and epsilon(2)epsilon(3), respectively. We find that it makes no difference whether one calculates the eccentricities over a range of rapidity or in a single slice at z = 0, nor is it important whether one uses an energy or entropy density weight. This knowledge will be important for making a more direct link between experimental observables and hydrodynamic initial conditions, the latter being poorly constrained at present.