Postmortem Characterization of Patients With Clinical Diagnosis of Plasmodium vivax Malaria: To What Extent Does This Parasite Kill?

Background.?Severe disease attributable to Plasmodium vivax infection is already well described worldwide; however, autopsies in these patients are scarce. Methods.?From 1996 to 2010, 19 patient deaths with a clinical diagnosis of P. vivax infection occurred in a tertiary care center in the Brazilian Amazon. Seventeen of these 19 deaths were fully autopsied. Clinical charts, macroscopic autopsy reports, and stored paraffinized tissue blocks were retrieved. Nested polymerase chain reaction was performed in paraffinized samples of spleen and lung to confirm P. vivax monoinfection. Immunohistofluorescence was used to detect P. vivax parasitized red blood cells (RBCs). Results.?Of 17 autopsies, 13 revealed that death could be attributed to P. vivax infection; in the remaining 4, acute diseases other than malaria were found to be the cause of death. The primary complication in patients in which malaria contributed to death was acute respiratory distress syndrome (ARDS) and pulmonary edema associated with the accumulation of neutrophils in the interalveolar space (6 cases). Spleen rupture (3 cases) and multiorgan dysfunction syndrome (3 cases) were the second most common complications. One child evolving with coma was also characterized, but no parasite was detected in the brain tissue. In one patient who developed ARDS and presented negative peripheral parasitemia by the time of death, scattered parasitized red blood cells were seen inside pulmonary capillaries, suggesting some sequestration in the lung. Conclusions.?In 13 of 17 deceased patients, P. vivax infection was the plausible cause of death. However, more studies are needed to understand pathogenesis related to severe disease.     

Prevalence of Coxiella burnetii antibodies among febrile patients in Croatia, 2008-2010

Despite the widespread distribution of Q fever, the prevalence in humans is not accurately known, because many infected people seroconvert without symptoms or with a mild febrile disease. The aim of this study was to determine the seroprevalence of Q fever in different regions of Croatia. During a 2-year period (2008-2010), serum samples from 552 febrile patients with prolonged cough aged 1-88 were tested for the presence of Coxiella burnetii antibodies by using indirect immunofluorescent assay. Sera from 27.5% patients showed IgG antibodies. Serological evidence of C. burnetii infection was found in patients from all parts of Croatia. Seroprevalence rates significantly differed among regions from 21.5% to 41.2% (p=0.001). Men were more often seropositive (31.6%) than women (22.2%; p=0.016). According to age, a progressive increase in the IgG seropositivity rates was observed as ranging from 6.7% in children less than 10 years of age to 39.2% in patients aged 40-49 (p=0.001). Above the age of 50, the IgG seroprevalence remained stable. Patients from rural areas were more often seropositive than patients from urban areas (40.8% vs. 19%), p<0.001). Acute Q fever was confirmed in 5.8% of patients. Cases occurred throughout the year. A majority of cases were reported during summer months.     

ARFI-prepared MRgHIFU in liver: simultaneous mapping of ARFI-displacement and temperature elevation, using a fast GRE-EPI sequence

MR acoustic radiation force imaging (ARFI) is an elegant adjunct to MR-guided high intensity focused ultrasound for treatment planning and optimization, permitting in situ assessment of the focusing and targeting quality. The thermal effect of high intensity focused ultrasound pulses associated with ARFI measurements is recommended to be monitored on line, in particular when the beam crosses highly absorbent structures or interfaces (e.g., bones or air-filled cavities). A dedicated MR sequence is proposed here, derived from a segmented gradient echo-echo planar imaging kernel by adding a bipolar motion encoding gradient with interleaved alternating polarities. Temporal resolution was reduced to 2.1 s, with in-plane spatial resolution of 1 mm. MR-ARFI measurements were executed during controlled animal breathing, with trans-costal successively steered foci, to investigate the spatial modulation of the focus intensity and the targeting offset. ARFI-induced tissue displacement measurements enabled the accurate localization, in vivo, of the high intensity focused ultrasound focal point in sheep liver, with simultaneous monitoring of the temperature elevation. ARFI-based precalibration of the focal point position was immediately followed by trans-costal MR-guided high intensity focused ultrasound ablation, monitored with a conventional proton resonance frequency shift MR thermometry sequence. The latter MR thermometry sequence had spatial resolution and geometrical distortion identical with the ARFI maps, hence no coregistration was required.     

Effects of novel catechol ether imidazolidinones on calcium-independent phosphodiesterase activity, [3H]rolipram binding,and reserpine-induced hypothermia in mice

A series of new catechol ether imidazolidinones incorporating structural features of rolipram and Ro 20-1724 were synthesized as inhibitors of the calcium-independent phosphodiesterase (IPDE) from rat cerebral cortex. Several compounds were found to be more potent than rolipram as IPDE inhibitors; all of the compounds studied were more potent than Ro 20-1724. The new imidazolidinones also showed affinity for the [³H]rolipram binding site in mouse brain membranes and reversed reserpine-induced hypothermia in mice at relatively low doses. In vitro, the potency of these compounds as IPDE inhibitors did not correlate with their affinity for the [³H]rolipram binding site. Reversal of reserpine hypothermia by the imidazolidinones (“antidepressant effect”) could not be linked definitively to either in vitro activity.     

Atopy and systemic reactions to drugs

To elucidate whether systemic reactions (SR) to drugs should be included in the atopic status in epidemiological studies, we compared the distribution of atopy in subjects with or without a history of SR to drugs. The studied population comprised 2067 adults, 20 to 60 years old, visiting a health care center for a check-up examination. The protocol included a questionnaire related to history of SR to drugs and a Phadiatop^® test which evaluates on a blood sample the presence of specific IgE against common aeroallergens. Overall, 14.7% of the study group, including 66% women, reported reliable histories of SR to drugs. The cumulative prevalence of asthma, hay fever and childhood dermatitis was higher in the SR group. By contrast, the percentage of positive Phadiatop tests was similar in subjects with or without a history of SR. Thus atopy, defined by an objective criterion, i.e. the presence of specific IgE against common aero-allergens, is not associated with the occurrence of SR to drugs. Such a history should not be included as part of the atopic status.     

Design and implementation of an epidemiological surveillance system for mental health]

OBJECTIVE: To design and test a surveillance system to detect and rank the most significant mental health problems in a community and to establish their association with the living conditions in that community. METHODS: The system was designed and tested at a primary health care center in the community of La Florida, which is in the metropolitan region of Santiago, the capital of Chile. The health problems that were under surveillance, with monthly monitoring, were: addiction (to alcohol, tobacco, and benzodiazepines or other drugs), violence (domestic violence and sexual abuse, real or suspected), and disorders in children (attention deficit and behavioral disorders). By means of a computerized geographical information system (GIS), those surveillance data were combined with other data. These other data included sociodemographic information on the persons who went to the health center for care as well as data on local risk factors and protective factors for health problems, some of which are indicators of the local residents' living conditions. RESULTS: The proposed epidemiological surveillance system, which takes into account local living conditions and environmental variables, is a good tool for health action. The proposed system also complements the incomplete perspective of monitoring systems, which do not include variables describing the local context and that focus only on health problems. The information synthesized in the GIS maps makes it possible to simultaneously display different layers of information on factors related to the health problems studied, linked to a specific area and all its environmental variables, in an easy-to-read, self-explanatory format. CONCLUSIONS: These results and the concurring opinions of the participating physicians show that the experimental system effectively met the basic requirements of an epidemiological surveillance system of this kind.     

Identification of the I507 deletion by site-directed mutagenesis

We describe a compound heterozygous Δ-F508/Δ-I507 cystic fibrosis patient. Molecular analysis by polymerase chain reaction (PCR)-mediated site-directed mutagenesis showed the 219 b_p fragment observed in Δ-F508 homozygotes. The father showed a Δ-F508 heterozygous pattern while the mother and sister showed a normal pattern. There were four possibilities to explain these results: a) the patient was a Δ-F508/Δ-I507 compound heterozygote, because the Δ-I507 allele fails to amplify when analyzed with Δ-F508 primers due to a double mismatch between the primers and template; b) uniparental isodisomy; c) nonmaternity; and d) sample processing mix-up. We then tested for the Δ-I507 mutation using specific primers with a single base mismatch, and we found that the patient was in fact a compound heterozygote who inherited the Δ-F508 mutation from the father and the Δ-I507 from the mother. We underscore the need to detect this rare deletion in patients showing a Δ-F508 homozygous pattern when one parent, particularly the father, is a noncarrier. © 1994 Wiley-Liss, Inc.