Chlamydia trachomatis: time for screening?

Genital Chlamydia trachomatis infection is the leading cause of bacterial sexually transmitted disease in industrialised countries, particularly among young people. The consequences of chlamydial infection may involve urethritis, cervicitis, pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, epididymitis and prostatitis. In addition, chlamydial infection increases the risk of acquisition of human immunodeficiency virus and has been associated with cervical cancer. Although screening programmes exist in a number of countries, the continuously increasing prevalence of chlamydial infections demonstrates the necessity for health authorities to establish effective screening policies, and the importance of defining a comprehensive European screening policy is emerging.     

Remodeling of myocyte gap junctions in arrhythmogenic right ventricular cardiomyopathy due to a deletion in plakoglobin (Naxos disease).

OBJECTIVES: We tested the hypothesis that defective interactions between adhesion junctions and the cytoskeleton caused by the plakoglobin mutation in Naxos disease lead to remodeling of gap junctions and altered expression of the major gap junction protein, connexin43. BACKGROUND: Naxos disease, a recessive form of arrhythmogenic right ventricular cardiomyopathy, is associated with a high incidence of arrhythmias and sudden cardiac death. Naxos disease is caused by a mutation in plakoglobin, a protein that links cell-cell adhesion molecules to the cytoskeleton. METHODS: Myocardial expression of connexin43 and other intercellular junction proteins was characterized in 4 patients with Naxos disease. Immunohistochemistry was performed in all 4 patients, and immunoblotting and electron microscopy were performed in 1 patient who died in childhood before overt arrhythmogenic right ventricular cardiomyopathy had developed. RESULTS: Connexin43 expression at intercellular junctions was reduced significantly in both right and left ventricles in all patients with Naxos disease. Electron microscopy revealed smaller and fewer gap junctions interconnecting ventricular myocytes. Mutant plakoglobin was expressed but failed to localize normally at intercellular junctions. Localization of N-cadherin, alpha- and beta-catenins, plakophilin-2, desmoplakin-1, and desmocollin-2 at intercalated disks appeared normal. CONCLUSIONS: Remodeling of gap junctions occurs early in Naxos disease, presumably because of abnormal linkage between mechanical junctions and the cytoskeleton. Gap junction remodeling may produce a coupling defect which, combined with the subsequent development of pathologic changes in myocardium, could contribute to a highly arrhythmogenic substrate and enhance the risk of sudden death in Naxos disease.     

Nontraumatic rhabdomyolysis with short‐term alcohol intoxication – a case report

Alcohol‐induced rhabdomyolysis is a potentially life‐threatening condition due to the probability of progression to acute renal injury. Patients admitted to emergency department with acute alcohol intoxication should always undergo blood and urine tests for early recognition and treatment of rhabdomyolysis.     

Old opioids,new concerns: the case of acetylfentanyl

Acetylfentanyl is a potent synthetic opioid analgesic that has been increasingly available in America, Europe, Japan, China, and Australia during the last years. It has no approved medical or veterinary use, but it is used illicitly around the world as a substitute of its controlled precursor, fentanyl, as well as of heroin or other related substances in opioid dependent individuals. It is available in retail or “head shops” or over the Internet by companies based mainly in China. Acetylfentanyl is available in the form of powder, tablets, and blotters, while liquid and injectable formulations have been also reported. Acetylfentanyl seizures have dramatically increased during the last 4 years, and its abuse has already caused a number of deaths in the United States, the United Kingdom, Sweden, and Japan, thus leading to its scheduling under the 1961 Single Convention on Narcotic Drugs in the United States, and some European Countries, China, and Japan since 2015. The aim of this review is to summarize the current knowledge about this drug concerning its chemistry, synthesis, prevalence, metabolism, pharmacology, and toxicology, as well as its legal status. Analytical methodologies developed for the determination of acetylfentanyl in biological specimens, as well as published or reported acetylfentanyl related cases, fatal or not, and self reports from drug users are presented.     

erm(C) is the predominant genetic determinant for the expression of resistance to macrolides among methicillin-resistant Staphylococcus aureus clinical isolates in Greece

OBJECTIVES: Macrolide, lincosamide and streptogramin type B (MLS(B)) resistance was determined in Staphylococcus aureus clinical isolates from two University Hospitals. METHODS: Antibiotic resistance was investigated by double disc diffusion and MIC determination. Resistance determinants were detected by PCR and DNA hybridization, while clonal types were identified by pulsed-field gel electrophoresis (PFGE) analysis of SmaI DNA fragments. RESULTS: Among methicillin-susceptible S. aureus (MSSA) isolates, inducible and MS phenotypes were detected, with the predominance of the erm(A) gene, followed by the msr(A) and erm(C) genes. The majority of methicillin-resistant S. aureus (MRSA) isolates expressed the constitutive phenotype and carried the erm(C) gene. PFGE revealed the dissemination of two major clones among the MRSA in both hospitals. CONCLUSIONS: erm(C) is the predominant genetic determinant for the expression of MLS(B) resistance among S. aureus isolates, especially MRSA, in Greece. This is due to the spread of two major clones in the country.     

Niemann-Pick type C disease associated with peripheral neuropathy

Niemann-Pick type C disease is an autosomal-recessive, inherited neurovisceral lipid storage disorder. This disease results from either protein NPC1 or HE1 deficiency, which leads to cholesterol metabolism disturbance and is characterized by early hepatosplenomegaly and progressive ataxia, dystonia, cataplexy, dysarthria, and dementia. We describe a 3 1/2-year-old patient with Niemann-Pick type C disease, who presented with regression in both cognitive and motor domains. Almost 10 months before admission to the hospital, the child developed progressive speech and behavioral changes, as well as gait disturbances with frequent falls. The examination demonstrated hepatosplenomegaly, ataxia, and vertical gaze palsy. Nerve conduction velocities demonstrated mild demyelinating peripheral neuropathy. Bone marrow examination revealed foam cells, and cholesterol esterification studies found massive accumulation of unesterified cholesterol and very low intracellular esterification of exogenous lipoprotein-derived cholesterol. These results indicate Niemann-Pick type C disease. Peripheral neuropathy is a rare complication in patients with Niemann-Pick type C disease, which certainly contributes to their neurologic deterioration.     

The possible role of locally produced cytokines in the pathogenesis of peritrochanteric fractures in the elderly

Sixteen patients with intertrochanteric femoral fractures were studied for possible involvement of the cytokines interleukin-6 (IL-6), interleukin-1 beta (IL-1beta), tumor necrosis factor-alpha, and the disease activity factors C-reactive protein and alpha1-antitrypsin as local bone-resorbing agents. Cytokine and disease activity factor levels were measured in gluteus medius muscle and serum samples and were compared to sera obtained from age- and sex-matched healthy controls. Interleukin-6 and IL-1beta levels were significantly higher (P=.0024 and P=.036, respectively) in the muscle samples from the fractured side than in the samples from the contralateral unaffected side. Levels of IL-6 and IL-1beta also were significantly higher in patients' sera than in the sera of healthy controls. These results support a new hypothesis that may contribute to the pathogenesis of fractures in the elderly: unilaterally locally over-produced IL-6 and IL-1beta may lead to local bone resorption in the intertrochanteric region, which subsequently weakens the femoral bone and increases the risk of unilateral peritrochanteric fractures.     

Liver metallothionein expression in thioacetamide-intoxicated rats

Metallothioneins (MT), a group of ubiquitous low molecular weight proteins, implicated primarily in metal ion detoxification, are known to be expressed during hepatocellular proliferation after partial hepatectomy in rats. In the present study, we investigated the expression of MT in a rat model of liver injury and regeneration, induced by intraperitoneal administration of thioacetamide (TAA). The animals were killed at 0, 12, 24, 36, 48, 60, 72, 84, 96, 108 and 120 hours after TAA administration. The rate of tritiated thymidine incorporation into hepatic DNA, the enzymatic activity of thymidine kinase, and the assessment of the mitotic index in hepatocytes were used as indices of liver regeneration. Liver MTs were detected immunohistochemically. TAA administration caused severe hepatic injury, followed by regeneration. MT expression became prominent in hepatocytes as early as 12 hours post-TAA administration. At 24 and 36 hours post-TAA administration intense nuclear and cytoplasmic staining of hepatocytes was found in the vicinity of necrotic areas. The maximal nuclear and cytoplasmic MT expression coincides with the peak of hepatocyte proliferative capacity, occurring at 48 and 60 hours post-TAA administration. MT expression correlated positively with the Zn content of liver tissue, but negatively with serum one, at the time of maximum hepatocyte proliferative capacity. This study suggests that MT participates in hepatocyte replication after toxin-induced liver injury.     

Tendon vibration during submaximal isometric strength and postural tasks

To establish the effect of tendon vibration (TV) on steady submaximal strength and static balance control, 29 women performed isometric plantarflexions at 10, 20, 30 and 50% of MVC and postural tasks of increasing difficulty (Normal Quiet Stance, NQS, Sharpened Tandem Stance and One Leg Stance) with vibrators (80?Hz) applied to the Achilles tendon. Both tasks were performed under four conditions (10?s each): eyes open, eyes closed, eyes closed with TV, eyes open with TV. During the isometric tasks, the application of TV increased the plantarflexion torque at 20 and 30% of MVC, accompanied by a greater (p?<?0.001) activation of agonists (Medial Gastrocnemius, MGAS and Soleus, SOL), as well as a greater (p?<?0.05) coactivation of the antagonist (tibialis anterior, TA). Non-significant differences were observed at 10 and 50% of MVC. During posture, TV resulted in a backward displacement of the Centre of Pressure only for NQS and an increase (p?<?0.01) in EMG activity of the ankle muscles in all balance tasks. The MGAS contraction during TV application was confirmed (by ultrasonography) at ten participants by an increase of the pennation angle and decrease of its fascicle length (p?<?0.05). The vibration-induced muscle excitation and accompanying increase in motor output, probably due to excitatory Ia afferent input, was confirmed during strength and postural tasks. However, motor output attenuates when the magnitude of central drive to the ankle muscles increases.