Accordance and concordance of PCR and NASBA followed by oligochromatography for the molecular diagnosis of Trypanosoma brucei and Leishmania

Objective To evaluate the repeatability and reproducibility of four simplified molecular assays for the diagnosis of Trypanosoma brucei spp. or Leishmania ssp. in a multicentre ring trial with seven participating laboratories. Methods The tests are based on PCR or NASBA amplification of the parasites nucleic acids followed by rapid read‐out by oligochromatographic dipstick (PCR‐OC and NASBA‐OC). Results On purified nucleic acid specimens, the repeatability and reproducibility of the tests were Tryp‐PRC‐OC, 91.7% and 95.5%; Tryp‐NASBA‐OC, 95.8% and 100%; Leish‐PCR‐OC, 95.9% and 98.1%; Leish‐NASBA‐OC, 92.3% and 98.2%. On blood specimens spiked with parasites, the repeatability and reproducibility of the tests were Tryp‐PRC‐OC, 78.4% and 86.6%; Tryp‐NASBA‐OC, 81.5% and 89.0%; Leish‐PCR‐OC, 87.1% and 91.7%; Leish‐NASBA‐OC, 74.8% and 86.2%. Conclusion As repeatability and reproducibility of the tests were satisfactory, further phase II and III evaluations in clinical and population specimens from disease endemic countries are justified.     

The incidence of group B streptococcus in the vaginal tracts of pregnant women in central Alabama.

Group B streptococcus (Streptococcus agalactiae) or GBS is the most common cause of neonatal sepsis and meningitis in the United States. One important risk factor for infants who acquire GBS is maternal colonization. Colonization rates have been estimated in various studies to be between 15% and 35% of pregnant women. Colonization rates for black women have also been shown to be higher than for non-blacks. Local data were collected and compared to those of other studies. Of the pregnant women in this study overall, 22.76% tested positive for GBS. Black women were colonized by GBS (35.71%) significantly more often than non-black women (19.84%; G = 8.9729, p < 0.00274). Generalized linear models were used to examine age and race. Both maternal age and the interaction of maternal race and age as predictors of infection were ruled out, leaving only race as a significant predictor of colonization.     

Long-term follow-up of Epstein-Barr virus viremia in pediatric recipients of renal transplants

The common observation of Epstein-Barr virus (EBV) viremia in pediatric recipients of renal transplants and the occurrence of an EBV-related pulmonary leiomyoma prompted us to intensify the follow-up of EBV infections from 1995 to October 2000. Follow-up included serology and detection of viral DNA in blood using a semi-quantitative nested polymerase chain reaction (PCR) and later a real-time PCR with higher sensitivity. The aim of this study was the early detection of primary infections or reactivations. We obtained 250 samples from 32 patients. EBV DNA detection was consistently negative in 14 patients. There were 5 patients that were considered at risk for post-transplant lymphoproliferative disease, as they were EBV seronegative and were given a kidney from a positive donor. Of these, 4 had at least one episode of high-level EBV viremia. During these episodes, an absence of noticeable symptoms that could be related to EBV was noted for all but 1 patient. This child presented with severe neutropenia 1 month after grafting and, 28 months later, several nodules of pulmonary leiomyoma, which were found to be EBV related. Four episodes of high-level viremia were observed before the discovery of the leiomyoma. Viral DNA detection is important for the follow-up of such patients that are especially at risk of serious complications of EBV infections.     

Evolution of resistance under insecticide selection pressure in Culex pipiens quinquefasciatus (Diptera, Culicidae) from Martinique

Population surveys of Culex pipiens quinquefasciatus carried out in 1991 and 1999 were compared with data collected in 1990 before the beginning of the control program against this mosquito. Larval samples collected in 1999 displayed resistance to the four tested insecticides: permethrin, propoxur, temephos, and chlorpyrifos. Temephos resistance ratio at LC50 (RR50) ranged between 8.1- and 42-fold compared with 2.9- and 4.6-fold in 1990, and chlorpyrifos RR50 ranged between 8.6- and 123-fold compared with 6.4- and 19-fold in 1990. This increased resistance to organophosphorus insecticides was associated with a sharp decrease of susceptible genotypes at two loci (Ester and ace-1), as well as to an allele replacement at the Ester locus.     

Surgical treatment of recurrent locoregional rectal cancer

Local recurrence (LR) after curative surgery for rectal cancer occurs in 4 to 33% of cases especially if surgery is sub-optimal (without total excision of the mesorectum). In many cases, diagnosis of LR is made at a late stage because of the high rate of asymptomatic patients, 56% in the experience of the Mayo Clinic. MRI and PETscan are most effective for assessing local and general extension, with a high diagnostic accuracy. Surgical treatment alone or with radiation (preoperative and/or intraoperative) is the only curative treatment of LR with R0 resectability rates of 30% to 45%. Morbidity and mortality rates are high, especially for total exenteration and abdomino-sacral resection. After curative surgery, 5-year global survival is between 30% and 40%. Palliative resection of macroscopic residues is not recommended. Careful patient selection for curative surgery is the best way to optimize treatment in these cases.     

Responsabilité pénale et comportement violent lors du sommeil

In France, the 122-1 article of the penal code don’t allow to engage the responsibility in the criminals suffering from a mental disorder. The most frequents pathology are psychosis. Parasomnia may be implicated in cases of not guilty by reason of insanity. As a matter of fact, cases of sleep walking and REM-sleep disorder implicated in homicide or sexual assaults are reported. Their clinical and legal evaluations are described.