Epidemiological and Diagnostic Features of Blastocystis Infection in Symptomatic Patients in Izmir Province,Turkey

Background

The aims of this study were to identify Blastocystis subtypes (STs) in a cohort of Turkish patients with various gastrointestinal symptoms using a novel Real Time PCR method developed recently for Blastocystis detection and assess the relationship between Blastocystis STs and patient symptoms.

Methods

Totally, 617 stool samples of patients with gastrointestinal symptoms were examined with microscopy and inoculated in Jones medium. Blastocystis-positive samples were further assessed to identify coinfections with other possible pathogens, including bacteria and viruses. Diagnostic efficacies of microscopy, culture and Real-Time PCR were compared. PCR products were sequenced to identify the subtypes of Blastocystis isolates.

Results

Totally 94 (15.24%) samples were positive for Blastocystis after all methods. Among these, 83 of 94 (88.3%) samples were identified with all methods, while 11 were positive only with Real Time PCR. Diarrhea and abdominal pain were the leading symptoms in the patients. The only pathogenic agent identified in 76 of 94 (80.9%) patients was Blastocystis. Subtype 3 was the leading Blastocystis subtype (44.6%), while subtypes 6 and 7 were firstly isolated from symptomatic patients in our region.

Conclusion

Comparison of three diagnostic methods indicated Real Time PCR as the most sensitive and specific method. Blastocystis was the only pathogenic agent among symptomatic patients, with subtype 3 being predominant. Patients with subtypes 6 and 7 need further assessments concerning the zoonotic potential of Blastocystis.     

Retrospective analysis of relative parameter sensitivity in multi-generation reproductive toxicity studies

Current suggestions towards amending the OECD two-generation protocol include omission of the second generation and inclusion of additional parameters. This study analysed the relative parameter sensitivity in 18 individually published multi-generation studies with substances toxic to fertility. Among parameters that most often determined the reproductive LOAEL were weight of testis, dam and pup as well as litter size. Several other parameters were found to be unaffected in all studies evaluated. Some substances affected a specific set of parameters, indicating that rarely affected parameters may prove crucial in individual situations. This argues for the inclusion of a wide spectrum of parameters to cover all possible effects. Less sensitive parameters, mechanistically related to more sensitive ones, may be omitted as they will unlikely contribute to the overall LOAEL. This study gives first insights and needs follow-up by more extensive analyses before firm conclusions on the design of the two-generation study protocol can be drawn.     

Paying for the Kasongo hospital in Zaire: a conceptual framework

Experiences and discussions relative to community financingof health services tend to focus on the health facility of firstaccess, that is, the health centre. The referral level, thehospital, a crucial element in the district health system, ishardly mentioned in the debate. In this paper a conceptual reference framework for user feesis presented. It is argued that a financing policy at districtlevel should be comprehensive and, therefore, not a priori excludethe referral level. Criteria for raising fees, as well as therationale for fees-apart from raising funds-are discussed. Specialemphasis is put on fees charged at the district hospital, whichmay be an important source of financing (complementary to external-nationalor international - funding). The case of the Kasongo hospitalis presented in detail.     

Interview expectancies: awareness of potential biases influences behaviour in interviewees

Expectancy effects are known to influence behaviour so that what is expected appears to be true. In this study, expectancy was induced using (fabricated) information about honesty and specific group membership. Targets were tested in a non-accusatory interview environment using neutral and information-gathering questions. It was hypothesized that those exposed to the negative information (the expectancy) would demonstrate behaviour consistent with an increased cognitive load, and evidence was found to support this prediction. Due to the investigative nature of the information-gathering questions, it was also expected that the targets exposed to the expectancy would exhibit more of these behaviours in the investigative portion of the interview. Some behaviour was found to support this prediction (i.e. shorter responses and increased speech disturbances); however, indicators of performance altering load were not observed during this phase of the interview. These findings support the hypothesis that expectancy effects can noticeably alter interviewee behaviour.     

New England souvenirs

A 54-year-old woman presented with 2 weeks of fever after a trip to the Northeastern United States. Except for an erythematous skin lesion on her right shoulder, no physical abnormality was detected. We diagnosed concomitant borreliosis and babesiosis. Both infections were possibly acquired by one bite from Ixodes scapularis.     

Endocrine effects of hexabromocyclododecane (HBCD) in a one-generation reproduction study in Wistar rats

The brominated flame retardant (BFR) hexabromocyclododecane was tested in a one-generation reproduction assay in Wistar rats, enhanced for endocrine parameters. A solution of the compound in corn oil was mixed in the feed, targeting at dietary exposure of 0–0.1–0.3–1–3–10–30–100 mg/kg body weight/day (mkd) in parental rats during 10 (males) or 2 (females) weeks premating, during gestation and lactation, and in their F1 offspring from weaning until final necropsy. Effects were assessed in F1 animals. Livers of these animals showed increased HBCD concentrations, in a dose-dependent way. The trabecular bone mineral density of the tibia was dose-dependently decreased in females (BenchMark Dose Lower confidence bound, BMDL = 0.056 mkd). The IgG response after immunization with sheep red blood cells (SRBC) was increased in males (BMDL = 0.46 mkd). Further sensitive effects were decreased weight of the testis (BMDL = 1.5 mkd), increased fraction of neutrophilic granulocytes (BMDL = 7.7 mkd), decreased concentration of apolar retinoids in female livers (BMDL = 1.3 mkd), and decreased plasma alkaline phosphatase in females (BMDL = 8.6 mkd). CYP19/aromatase activity in the ovary was correlated to the concentration of γ-HBCD in the liver. A developmental origin of these effects is considered, and this is also true for sensitive effects observed in neurobehavioural testing in littermates from the same experiment, i.e. in the brainstem auditory evoked potentials and in a catalepsy test [Lilienthal, H., Van der Ven, L.T.M., Piersma, A.H., Vos, J.G. Neurobehavioral effects of the brominated flame retardant hexabromocyclododecane (HBCD) in rats after pre- and postnatal exposure, in press]. The low BMDLs of these effects may raise concern for human health, particularly when based on body burdens of HBCD, which leads to critical margins of exposure particularly for the occupational setting.