Characterization of monkey enteropathogenic Escherichia coli (EPEC) and human typical and atypical EPEC serotype isolates from neotropical nonhuman primates

Enteropathogenic Escherichia coli (EPEC) has been associated with infantile diarrhea and mortality in humans in developing countries. While diarrhea is also a major problem among primates kept in captivity, the role of E. coli is unclear. This study was designed to characterize diarrheagenic E. coli recovered from the feces of 56 New World nonhuman primates, primarily marmosets (Callithrix spp.). Seventeen of the 56 primates had signs of diarrhea and/or enteritis. E. coli recovered from feces from these animals was tested by PCR for genes encoding virulence factors of diarrheagenic E. coli and for patterns of adherence to HeLa cells. In addition, isolates were characterized by the fluorescence actin staining test and by their ability to induce attaching and effacing lesions. PCR for the eae gene was positive in 10 of the 39 (27%) apparently healthy animals and in 8 of the 17 (47%) animals with diarrhea and/or enteritis. Colonies of eae(+) E. coli were serotyped and examined by PCR for genes encoding EPEC virulence markers. The eae(+) E. coli isolates recovered from both healthy and sick nonhuman primates demonstrated virulence-associated attributes similar to those of EPEC strains implicated in human disease and are designated monkey EPEC. The results presented here indicate that EPEC may be a significant pathogen for nonhuman primates, deserving further investigation. The similarities between the affected animals investigated in this study and human EPEC infections suggest that marmosets may represent an important model for EPEC in humans.     

Acute respiratory insufficiency in burn patients from smoke inhalation

Respiratory injuries by smoke inhalation are one of the most frequent reasons for acute respiratory failure in burn victims. They are most often of chemical origin and are responsible of a 20 to 70% increase of the mortality compared to the mortality of patients with similar burn injuries, but without inhalation lesions. They are often associated to a certain degree to other factors of acute respiratory failure: superior air way obstruction by oedema in face and neck burns, thoracic expansion hindrance due to thoracic burns, lung trauma lesions by blast injury. The generalized inflammatory reaction due to the extent of burns and an initial inadequate resuscitation are worsening factors. The inflammatory process may be responsible of lung injuries similar to those induced by smoke inhalation, even when there is no inhalation. The treatment remains symptomatic and based on the oxygen therapy, mechanical ventilation, prevention of infections and maintain of homeostasis by hydroelectrolytic adequate resuscitation. The nitric oxyde associated to the almitrin allows in a certain number of cases to minimize intra pulmonary shunting and to normalize the VA/O ratio. The development of treatments allowing to modulate inflammatory mediators may lead to news therapies in the future.     

Evaluation of prognostic factors in the burned patient]

Mortality predictive factors of burned patients are analyzed in a population of 1929 patients by the statistical method of logistic regression. Among the variables studied (total burn skin area, deep burn area, superficial burn area, age, sex, burn location, preexisting disorders), two only, deep burn area and age, have been retained as predictive factors which, when associated, allow to classify 94.47% of the patients in either survival or death group. The prognosis weight of the deep burn area (SBP) is superior to that of the total burn skin area, yet retained in most previous studies. The superficial burn area, the inhalation injuries and the preexisting disorders are not factors determining prognosis. The F equation = e(-6.0061 + (0.0829*SBP) + (0.0443*%AGE)) resulting of the logistic regression, allows a direct evaluation of the death probability. A simple linear relation can be proposed as score of severity: IG = (2 x %SBP) + age. Below 80, mortality is close to zero, above mortality increases linearly up to 210, reaching 100%. This relation must be handled cautiously when comparing the severity score of two groups of patients, just as any other severity score that uses a linear relation with the burnt area associated or not to age.     

Accuracy of a computerized tomography-guided template-assisted implant placement system: an in vitro study

Objectives: To evaluate the accuracy of computer-assisted 3D planning and implant insertion using computerized tomography (CT).
Materials and methods: Nine implants were planned on pre-operative CTs of six resin models, which were acquired with radiographic templates, using a planning software (E implants). Each resin model contained three pre-existing control implants (C implants). Radiographic templates were converted into operative guides containing 4.8-mm-diameter titanium sleeves. A single set of insertable sleeves was used for consecutively drilling the six models, followed by implant insertion through the guide sleeves. Models were further divided into group A (the first three models) and group B (the last three models). Post-operative CTs were used to compare implant positions with pre-operative planned positions. Statistical analysis included the Mann–Whitney U test for E and C implants and the Wilcoxon's signed ranks test for groups A and B.
Results: The mean apex depth deviations for E and C implants [0.49 mm±0.36 standard deviation (SD) and 0.32 mm±0.21 SD, respectively], and the mean apex radial deviations (0.63 mm±0.38 SD and 0.49 mm±0.17 SD, respectively) were similar ( P >0.05). The mean angulation deviations for E and C implants were 2.17±1.06°SD and 1.33±0.69°SD, P <0.05. E implant deviations of all the parameters in group A were significantly smaller than E implant deviations in group B.
Conclusions: Computer-assisted implant planning and insertion provides good accuracy. Deviations are mainly related to system and reproducibility errors. Multiple use of drills and titanium sleeves significantly reduces system accuracy.     

Imported severe malaria in adults: a retrospective study of ten cases admitted to intensive care units in Casablanca

INTRODUCTION: We report a retrospective study in the medical intensive care unit of the Casablanca Ibn-Rochd University hospital. MATERIAL AND METHODS: All patients over 14 years of age with falciparum malaria, who were admitted to ICUs between 1996 and 2001, were included. The main epidemiological features, criteria of admission, treatment, and outcome were investigated. RESULTS: Ten patients were included for severe imported malaria. The mean age was 32+/-4 years. All patients had acquired falciparum malaria in sub-Saharan Africa. Chemoprophylaxis was inadequate in all patients. The mean time from symptom onset to treatment initiation was 9+/-2 days. Criteria of admission were impaired consciousness (7), acute renal failure (4), and respiratory distress (3). The most worrying factors were the severity of consciousness disorders, the acute respiratory distress syndrome, the metabolic acidosis, and the refractory shock. All patients presented with nosocomial respiratory infection related to Gram-negative bacilli, in the evolution. All patients received quinine therapy with loading dose and symptomatic treatment. Five patients died. CONCLUSION: The lethality of severe imported malaria is still high despite optimal management in ICUs. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly the mortality rate.     

Increased serum S-100B and neuron specific enolase - Potential markers of early nervous system involvement in essential hypertension

ObjectivesTo investigate the occurrence of subclinical neurologic involvement in patients with essential hypertension employing serum biochemical markers.Design and methodsFifty patients with essential hypertension and 42 controls with no clinical evidence of neurological disease were recruited. Serum S100B protein and neuron specific enolase (NSE) were determined by employing immunoassay kits from CanAg Diagnostics AB (Sweden). Brain MRI and fundoscopic exploration were conducted.ResultsS-100B and NSE levels were significantly higher in hypertensive patients than in controls. In hypertensive patients, multivariate analysis revealed that NSE was independently associated with two variables expressing severity of hypertension: diastolic blood pressure and grade of retinopathy. Brain MRI studies demonstrated higher NSE levels in patients with more severe white matter lesions.ConclusionsRaised NSE levels are associated with a higher severity of hypertension and of white matter lesions, providing preliminary evidence that suggests the presence of silent brain damage in a subset of hypertensive patients.