Comparison of DNA sequencing of the protein A gene polymorphic region with other molecular typing techniques for typing two epidemiologically diverse collections of methicillin-resistant Staphylococcus aureus

The aim of this study was to compare the recently developed typing approach for methicillin-resistant Staphylococcus aureus (MRSA) based on the DNA sequencing of the protein A gene polymorphic region (spaA typing) with a combination of three well-established molecular typing techniques: ClaI-mecA vicinity polymorphisms, ClaI-Tn554 insertion patterns, and SmaI pulsed-field gel electrophoresis (PFGE) profiles. In order to evaluate the applicability of this typing technique in different types of studies, two groups of MRSA clinical isolates were analyzed: a collection of 185 MRSA isolates circulating in Hungary recovered from 17 hospitals in seven cities during a 3-year period (1994 through 1996), and a selection of 53 MRSA strains isolated in a single hospital in Hungary between 1997 and 1998. The 238 MRSA clinical strains from Hungary were first classified in clonal types (defined as ClaI-mecA::ClaI-Tn554::SmaI-PFGE patterns), and 65 of the 238 strains, representing major MRSA clones and some sporadic clones, were further analyzed by spaA typing. Our results showed that the lineages most recently introduced in the hospital setting showed little variability in spaA types, whereas the MRSA clones circulating for a longer period of time and spread among several hospitals showed a higher degree of variability. The implementation of the spaA typing method was straightforward, and the results obtained were reproducible, unambiguous, and easily interpreted. This method seems to be adequate for outbreak investigations but should be complemented with other techniques in long-term surveillance or in studies comparing distant clonal lineages.     

Impact of hormone replacement therapy on exercise training-induced improvements in insulin action in sedentary overweight adults

Exercise training (ET) and hormone replacement therapy (HRT) are both recognized influences on insulin action, but the influence of HRT on responses to ET has not been examined. To determine if HRT use provided additive benefits for the response of insulin action to ET, we evaluated the impact of HRT use on changes in insulin during the course of a randomized, controlled, aerobic ET intervention. Subjects at baseline were sedentary, dyslipidemic, and overweight. These individuals were randomized to 6 months of one of 3 aerobic ET interventions or continued physical inactivity. In 206 subjects, an insulin sensitivity index (S(I)) was obtained with a frequently sampled intravenous glucose tolerance test pre- and post-ET. Baseline and postintervention fitness, regional adiposity, general adiposity, skeletal muscle biochemistry and histology, and serum lipoproteins were measured as other putative mediators influencing insulin action. Two-way analyses of variance were used to determine if sex or HRT use influenced responses to exercise training. Linear modeling was used to determine if predictors for response in S(I) differed by sex or HRT use(.) Women who used HRT (HRT+) demonstrated significantly greater improvements in S(I) with ET than women not using HRT (HRT-). In those HRT+ women, plasma triglyceride change best correlated with change in S(I). For HRT- women, capillary density change and, for men, subcutaneous adiposity change best correlated with change in S(I). In summary, in an ET intervention, HRT use appears to be associated with more robust responses in insulin action. Furthermore, relationships between ET-induced changes in insulin action and potential mediators of change in insulin action are different for men, and for women on or off HRT. These findings have implications for the relative utility of ET for improving insulin action in middle-aged men and women, particularly in the setting of differences in HRT use.     

Potential Mosquito Vectors for Shuni Virus,South Africa, 2014–2018

Shuni virus is associated with neurologic and febrile illness in animals and humans. To determine potential vectors, we collected mosquitoes in South Africa and detected the virus in species of the genera Mansonia, Culex, Aedes, and Anopheles. These mosquitoes may be associated with Shuni virus outbreaks in Africa and emergence in other regions.     

Seven‐Tesla Magnetization Transfer Imaging to Detect Multiple Sclerosis White Matter Lesions

BACKGROUND AND PURPOSE

Fluid‐attenuated inversion recovery (FLAIR) imaging at 3 Tesla (T) field strength is the most sensitive modality for detecting white matter lesions in multiple sclerosis. While 7T FLAIR is effective in detecting cortical lesions, it has not been fully optimized for visualization of white matter lesions and thus has not been used for delineating lesions in quantitative magnetic resonance imaging (MRI) studies of the normal appearing white matter in multiple sclerosis. Therefore, we aimed to evaluate the sensitivity of 7T magnetization‐transfer‐weighted (MT_w) images in the detection of white matter lesions compared with 3T‐FLAIR.

METHODS

Fifteen patients with clinically isolated syndrome, 6 with multiple sclerosis, and 10 healthy participants were scanned with 7T 3‐dimensional (D) MT_w and 3T‐2D‐FLAIR sequences on the same day. White matter lesions visible on either sequence were delineated.

RESULTS

Of 662 lesions identified on 3T‐2D‐FLAIR images, 652 were detected on 7T‐3D‐MT_w images (sensitivity, 98%; 95% confidence interval, 97% to 99%). The Spearman correlation coefficient between lesion loads estimated by the two sequences was .910. The intrarater and interrater reliability for 7T‐3D‐MT_w images was good with an intraclass correlation coefficient (ICC) of 98.4% and 81.8%, which is similar to that for 3T‐2D‐FLAIR images (ICC 96.1% and 96.7%).

CONCLUSION

Seven‐Tesla MT_w sequences detected most of the white matter lesions identified by FLAIR at 3T. This suggests that 7T‐MT_w imaging is a robust alternative for detecting demyelinating lesions in addition to 3T‐FLAIR. Future studies need to compare the roles of optimized 7T‐FLAIR and of 7T‐MT_w imaging.     

Prevalence of a history of prior varicella/herpes zoster infection in multiple sclerosis

Varicella zoster virus (VZV) infection has been implicated in multiple sclerosis (MS), but direct causal involvement has been disputed. Nevertheless, knowledge of VZV exposure is important, given the risk of serious complications of first exposure while undergoing immunosuppressive treatment, in particular with fingolimod. We distributed questionnaires to MS clinic patients, requesting information about history of chickenpox, sibling/household/occupational exposure, history of zoster (shingles), and disease-modifying treatment. A random, proportionally representative sample of 51 patients that included patients with positive, negative, and unknown chickenpox history were selected for determination of VZV IgG by ELISA. Of 1206 distributed questionnaires, 605 were returned (50% response rate). Of these, 86% reported history of chickenpox, 5.6% gave negative history, and 8.5% did not know. Of 594 who answered the zoster question, 78% gave a negative response, 4% did not know, and 104 (17%) answered yes. Of these, 83 reported 1 episode; 12 had 2; 5 had 3; and 1 each reported 5, 6, and 15 episodes. Of 51 patients tested for VZV IgG (44 “yes,” 4 “no,” and 3 “I don’t know” answers to the question of whether they had chickenpox), 48 were seropositive; the 3 seronegative all had reported having had chickenpox. The high rate of MS patients reporting prior chickenpox infection is comparable with previous reports. A substantial proportion of MS patients, estimated to be higher than an age-matched general population, report single or multiple episodes of zoster. These data are useful for consideration of immunosuppressive treatments and/or VZV and zoster vaccination.     

Forensic nurses' experiences of receiving child abuse disclosures

Purpose. A child's self‐disclosure of abuse is a critical component in initiating intervention to stop abuse and decrease the likelihood of long‐term negative outcomes. This study described the context in which child abuse victims disclosed to forensic nurses. Design and Methods. Thirty interviews were conducted at the International Forensic Nurses Scientific Assembly 2007 and then analyzed using narrative inquiry methodology. Results. Five themes emerged: child‐friendly environment, building rapport, engaged listening, believing unconditionally, and the potential for false disclosures. Practice Implications. Nurses can provide an environment that allows a child the perception of limitless time to share their unique stories.     

Relationships Between Physical and Non-Physical Forms of Intimate Partner Violence and Depression among Urban Minority Adolescent Females

BACKGROUND: Little is known about intimate partner violence (IPV) and depression among low income, urban African American and Hispanic adolescent females. METHOD: Interviews with 102 urban African American and Hispanic adolescent females examined physical abuse, emotional/verbal abuse, and threats, and their unique and combined associations with depression. RESULTS: One-quarter of the sample experienced all three types of abuse. Non-physical forms of IPV were significantly associated with depression. CONCLUSIONS: Some urban adolescent females from lower income households experience high rates of IPV. Physical and non-physical forms of IPV are important in understanding and responding to depression in this population.     

A Meta-analysis to Investigate the Relation Between Fitzpatrick Skin Types and Tolerability of Adapalene-Benzoyl Peroxide Topical Gel in Subjects with Mild or Moderate Acne

The overall goal of acne management for all patients is to select treatments that effectively address as many pathogenic factors as possible while minimizing side effects. Acne therapy in darker skin patients presents unique challenges due to differences in the risk of postinflammatory hyperpigmentation, which may develop in response to acne itself or to irritation secondary to treatment. One combination treatment currently available is a gel formulation containing a retinoid (adapalene 0.1%) in fixed combination with an antimicrobial (benzoyl peroxide 2.5%). Results from three randomized, double-blind, vehicle-controlled, clinical trials of adapalene-benzoyl peroxide were combined in a retrospective meta-analysis that included 909 patients treated for 12 weeks and assessed at each visit for erythema, scaling, dryness, and stinging/burning. Only Week 1 results were included in the meta-analysis because the worst severity of cutaneous irritation was found to occur at this timepoint in all three trials. For each study, and for the meta-analysis, comparisons were made using the Cochran-Mantel-Haenszel test. There were no statistically significant differences in dryness, scaling, and stinging/burning with adapalene-benzoyl peroxide treatment when subjects with Fitzpatrick skin types I to III were compared to subjects with Fitzpatrick skin types IV to VI (P=NS). Erythema assessments were statistically different based on skin types, as subjects with Fitzpatrick skin types IV to VI were rated as having “none” more often than those with Fitzpatrick skin types I to III (P<0.001). This could be due to the difficulty in visualizing erythema in patients with darker skin types, mainly Fitzpatrick skin types VI. Acne patients with Fitzpatrick skin types IV to VI were not found to be more susceptible to cutaneous irritation from treatment with the adapalene-benzoyl peroxide gel than patients with Fitzpatrick skin types I to III.Acne affects individuals of all races and ethnicities. The pathogenesis of acne is multifactorial, and the same factors are probably involved across the spectrum of skin types: sebaceous follicle obstruction, excessive sebum production due to hormonal stimulation of sebaceous glands, and proliferation of Propionibacterium acnes, which produces chemotactic factors and proinflammatory mediators that, in turn, generate an inflammatory response, followed by follicular rupture and extension of inflammation into the dermis, resulting in the formation of inflammatory lesions.^1,2The overall goal of acne management in all patients is to select treatment that effectively addresses as many of the pathogenic factors as possible while minimizing side effects.^3,4 Using multiple agents at the same time during treatment (concomitant therapy) has been recommended as a rational means to achieve this goal.^5,6 Acne therapy in skin of color (high melanin content) presents unique challenges due to differences relating to acne sequelae in these skin types, especially the presence or risk of postinflammatory hyperpigmentation (PIH) and keloidal scarring,^7–10 which are more prevalent in darker skin.^11–13Current acne treatment recommendations include combining gentle cleansing, effective moisturization, and sun protection, along with lower concentrations of benzoyl peroxide (BPO, 2.5%, 5%) and topical retinoids (adaplene 0.1%, tretinoin microsphere 0.04%, tazarotene 0.05%).^6,7,14 These agents can then be titrated up to higher concentrations if tolerated by the patient. Recently, a fixed-dose combination product containing a retinoid (adapalene) in combination with an antimicrobial (BPO) became available. Retinoids, such as adapalene, tretinoin, and tazarotene, are ideally suited for acne therapy because they target key factors in hyperkeratinization and comedogenesis, and are anti-inflammatory.¹⁵ Adapalene itself possesses anticomedogenic, comedolytic, and anti-inflammatory properties.^16–19 Some studies have documented that retinoids in skin of color, in addition to effectively treating noninflammatory and inflammatory acne, may also improve PIH.^20–23 Antimicrobials, such as BPO, provide additional benefits. BPO is an oxidizing agent with antibacterial and keratolytic effects and is used in acne treatment for its activities in decreasing the bacterial population of P. acnes.^24–27 In addition, the nonclinical and clinical safety profile of BPO is well established.²⁸Despite the benefits of combination therapy, the potential for increased cutaneous irritation is a concern. Although it has not been established that skin of color is more or less sensitive to irritants,²⁹ PIH may be triggered in darker skinned patients by skin irritation independent of cause (i.e., a disease or iatrogenic cause).^11,21,30 This issue has led some physicians to believe that skin of color is more sensitive to irritation from therapy. Because acne-related PIH is caused by a response to skin inflammation,^7,8 minimizing inflammation and reducing potential irritation and dryness is also a key goal in treating acne in skin of color. This is why dermatologists who treat acne patients with darker skin strive for a balance between effectively treating acne lesions and recognizing the importance of tolerability.This meta-analysis of the cutaneous irritation of adapalene-BPO gel was conducted to investigate possible differences in the incidence and severity of irritation among patients with different skin types. Three randomized, double-blind, vehicle- and placebo-controlled, clinical trials involving 3,855 patients have established the safety and efficacy of adapalene-BPO gel in the treatment of acne for all skin types.^31–33 The present retrospective meta-analysis is based on the tolerability data from those patients who were assigned to the adapalene 0.1%–BPO 2.5% treatment arm in each of the three randomized trials.