bluuebunny/crossref_metadata_2025 huggingface dataset:
Visceral leishmaniasis in southeastern Nepal: A cross‐sectional survey on Leishmania donovani infection and its risk factors
Authors: Schenkel Karl , Rijal Suman , Koirala Siddhartha , Koirala Shekhar , Vanlerberghe Veerle , Van der Stuyft Patrick , Gramiccia Marina , Boelaert Marleen
Published: October 2006

Objective  To document the frequency of Leishmania donovani infection at community level in a highly endemic region in southeastern Nepal, and to assess socioeconomic and environmental risk factors.

Methods  A random cross‐sectional population survey was held in two visceral leishmaniasis (VL) foci in Morang District in April to May 2003, enrolling individuals 2 years or older and residing in the endemic area for at least 12 months. Leishmania infection was defined as a direct agglutination test (DAT) titre equal to or higher than 1:3200. Risk factors were identified by logistic regression.

Results  The direct agglutination test was positive in 7.5% (95% CI: 5.1–10.8) and the leishmanin skin test (LST) in 13.2% (95% CI: 9.9–17.2) of the 373 study participants. No case of current kala‐azar was found, but 5.1 % (95% CI: 3.1–7.8) reported having suffered from VL. Independent risk factors for Leishmania infection were proximity of the house to ponds [odds ratio (OR) 3.7, 95% CI: 1.6–8.5], family size (OR 4.4, 95% CI: 1.6–12.6), age 15 years (OR 5.5, 95% CI: 1.2–25.0) and house constructed in mud (OR 3.0, 95% CI: 1.1–7.6). Bednets, not impregnated and in poor condition, were used by 95.2% (95% CI: 92.3–97.0) of the population, but did not show any protective effect.

Conclusion  This study shows that there is a serious problem of transmission of VL in this area of Nepal. The risk factors identified are linked with the socioeconomic level and the environment. The population would benefit from a community intervention to improve the environmental and housing conditions in the villages.
The synergistic effect of FC gamma receptor IIa and interleukin‐10 genes on the risk to develop systemic lupus erythematosus in Thai population
Authors: Hirankarn N. , Wongpiyabovorn J. , Hanvivatvong O. , Netsawang J. , Akkasilpa S. , Wongchinsri J. , Hanvivadhanakul P. , Korkit W. , Avihingsanon Y.
Published: October 2006

Several linkage analyses have consistently shown that systemic lupus erythematosus (SLE) susceptible genes are located on chromosome 1q21‐44. In this study, two major candidate genes, interleukin‐10 (IL‐10) and Fc gamma receptor IIa (FcγRIIa), within these regions were investigated in Thai SLE patients. The genotyping of three single‐nucleotide polymorphisms (promoter area: −1082, −819 and −592) within IL‐10 gene and one polymorphism (change amino acid at position 131) within FcγRIIa gene was determined in 195 SLE patients and 159 ethnically matched controls. The RR/RH genotypes of FcγRIIa were found to be significantly increased in SLE patients compared with healthy controls [OR = 2.01, 95% confidence interval (CI) = 1.28–3.14, P= 0.001]. Interestingly, the synergistic effect between RR/RH genotypes of FcγRIIa and ACC/ACC haplotype of IL‐10 in susceptibility to SLE was observed (OR = 7.84, 95% CI = 1.60–52.04, P= 0.002). In addition, the FcγRIIa, RR homozygotes was also strongly associated with anticardiolipin antibody production (OR = 6.09, 95% CI = 1.38–30.54, P= 0.006). The result demonstrated that ACC haplotype of IL‐10 gene and FcγRIIa R131 polymorphism can be used as marker for genetic susceptibility and severity to SLE in Thai population, particularly individuals carrying both specific genotypes.
HLA‐A*02010102L: a laborious assignment†
Authors: Perrier P. , Dormoy A. , Andre‐Botte C. , Froelich N.
Published: October 2006

In the present report we describe the laborious identification of the A*02010102L allele found in three healthy individuals of a French family who have shown a reduced A2 antigen expression using serological tests since the 1980s. PCR‐SSP typing showed a classical A*0201 allele. Sequencing of exons 2, 3 and 4 confirmed this assignment. Sequencing of the whole gene (promoter, introns and exons 1–8) revealed one single point mutation (T to C) at position ‐101 in the enhancer B element region compared to the A*02010101 allele. This single mutation appears to be related to the reduced expression of the A2 antigen. This allele segregates with the haplotype Cw*12, B44, DR7, DQ2, which is different to the one described earlier.
Study of KIR genes in tuberculosis patients
Authors: Méndez A. , Granda H. , Meenagh A. , Contreras S. , Zavaleta R. , Mendoza M. F. , Izquierdo L. , Sarmiento M. E. , Acosta A. , Middleton D.
Published: October 2006

A total of 97 patients with tuberculosis (TB) and 51 controls from Xalapa, Veracruz, Mexico, were studied for the presence and absence of killer cell immunoglobulin‐like receptor (KIR) genes. The number of patients with either KIR2DL1 or KIR2DL3 differed significantly compared with the controls. However, only the difference in KIR2DL3 remained significant after correction for the number of factors analysed. We also found KIR2DS2 with its presumed C1 group ligand less prevalent in TB patients than in the control group, but this result lost significance after correction.
Estimation of the species‐specific mutation rates at the DRB1 locus in humans and chimpanzee
Authors: Ohashi J. , Naka I. , Toyoda A. , Takasu M. , Tokunaga K. , Ishida T. , Sakaki Y. , Hohjoh H.
Published: October 2006

To estimate the species‐specific mutation rates at the DRB1 locus in humans and chimpanzee, we analyzed the nucleotide sequence of a 37.6‐kb chimpanzee chromosomal segment containing the entire Patr‐DRB1*0701 allele and the flanking nongenic region and we compared it with two corresponding human sequences containing the HLA‐DRB1*070101 allele using the sequence of HLA‐DRB1*04011 as an outgroup. Because the allelic pair of HLA‐DRB1*070101 and Patr‐DRB1*0701 shows the lowest number of substitutions between the two species, it appears that these sequences diverged close to the time of the humans–chimpanzee divergence (6 million years ago). Alignment of the nucleotide sequences for HLA‐DRB1*070101 and Patr‐DRB1*0701 alleles showed that they share a high degree of similarity, suggesting that the studied chromosomal segments with these sequences have not been subjected to recombination since the humans–chimpanzee divergence. Comparison of the flanking 10.6 kb of nongenic sequences revealed an average of 41.5 and 83 single nucleotide substitutions in humans and chimpanzee, respectively. Thus, the species‐specific nucleotide substitution rates in the flanking nongenic region were estimated to be 6.53 × 10−10 and 1.31 × 10−9 per site per year in humans and chimpanzee, respectively. Unexpectedly, the estimated rate in humans was twofold lower than in chimpanzee (P < 10−3, Tajima’s relative rate test) and lower than the average substitution rate in the human genome. Because the nucleotide substitution rate in nongenic regions free from selection is expected to be equal to the mutation rate, the estimated substitution rate should correspond to the species‐specific mutation rate at the DRB1 locus. Our results strongly suggest that the mutation rate at DRB1 locus differs among species.
Severe parvovirus B19 encephalitis after renal transplantation
Authors: Laurenz M. , Winkelmann B. , Roigas J. , Zimmering M. , Querfeld U. , Müller D.
Published: October 2006

Abstract:  Human parvovirus B19 is a common cause of benign erythema infectiosum (fifth disease) in otherwise healthy children. Immunocompromized patients are at risk of developing chronic infections leading to chronic hyporegenerative anemia. We report the case of a nine‐year‐old boy who presented five days after renal transplantation with seizures and signs of encephalitis on MRI. The clinical course was characterized by anemia and seroconversion for parvovirus B19 accompanied by a high viral load (>109 copies per milliliter). A transfusion of red blood cells that the patient required after transplantation was found to be negative for parvovirus B19, leaving the donated organ as the most likely source of infection. Reduction of the immunosuppressive regimen led to complete recovery of the patient with a stable RBC count upon discharge. Parvovirus B19 infections should be considered in the differential diagnosis of seizures after solid organ transplantation.
Vascular complications in living‐related and deceased donation pediatric liver transplantation: Single center's experience from Turkey
Authors: Yilmaz Aygen , Arikan Cigdem , Tumgor Gokhan , Kilic Murat , Aydogdu Sema
Published: October 2006

Abstract:  The aim of the study was to assess early and long‐term incidence of venous complications, in both deceased donation (DD) and living‐related (LR) liver transplantation (LT) in a pediatric population. Seventy‐five liver transplants performed in 69 (39 boys, 30 girls) children at Ege University Hospital between 1997 and 2004 were prospectively monitored and reviewed. Age, sex, primary diagnosis, graft type, vascular complications and their management were evaluated. All patients received Doppler ultrasonographic examination both during operation and daily for the first three postoperative days and when necessary thereafter. The complications were classified as early and late presented. Thirty‐three grafts (47.8%) were from DD and 36 (52.2%) were from LR donors. Recipients of DD were older than LR donors (mean age 10.5 ± 5.1 and 5.0 ± 0.7, respectively) (p < 0.05). Vascular complication occurrence was not statistically different between DDLT and LRLT recipients (p = 0.2), and between infants and children (p = 0.9). Overall, stenosis was more common than thrombosis. We observed hepatic artery (HA) thrombosis, in five of 75 (6.7%) transplants within 30 days post‐transplant. Portal vein (PV) thrombosis and hepatic vein (HV) thrombosis were detected in six and one patients (8.7% and 1.3%), respectively. Six PV stenosis were identified (8.7%), while HA and HV‐VC (vena cava) stenosis occurred in one and six patients (1.4% and 8.7%), respectively. All PV stenosis (6/33, 18.2%) and one PV aneurysm occurred in DDLT recipients while HV‐VC stenosis were detected almost equally in LRLT and DDLT recipients (4/36 vs. 2/33). Except one, all PV stenosis were detected as a late complication and no intervention were needed. Stenosis of HV‐VC was more common in girls (5/30 vs. 1/39) (p < 0.05) and the incidence was not different in DDLT and LRLT recipients (p = 0.8). In conclusion, overall incidences of thrombosis and stenosis formation after orthotopic liver transplantation (OLT) were 17.4% and 18.8%, respectively in our center. We suggest that in the cases with HA thrombosis manifested intra‐operatively or within the early postoperative period, graft salvage was successful. Thrombosis of HA causes significant mortality. Thrombosis of PV was among the causes of mortality and morbidity. Stenosis of HV‐VC could be managed by angioplasty and endovascular stenting with no significant effect to mortality.
Long‐term therapy with aerosolized ribavirin for parainfluenza 3 virus respiratory tract infection in an infant with severe combined immunodeficiency
Authors: Stankova Jitka , Carret Anne‐Sophie , Moore Dorothy , McCusker Christine , Mitchell David , Davis Michael , Mazer Bruce , Jabado Nada
Published: October 2006

Abstract:  We report the case of an infant with severe combined immunodeficiency who was presented with PIV3 infection. Aerosolized ribavirin was administered for 10 months until the child gained a functional immune system through an allogeneic hematopoietic stem cell transplant and cleared PIV3 infection. No adverse effect was observed in the child and in healthcare personnel, with a follow‐up of three years. Despite the burden of aerosolized administration, early and prolonged administration of aerosolized ribavirin was feasible, well tolerated, and safe for the patient and the caregivers. This is a case report and no definite conclusions can be drawn. However, our experience suggests that prolonged aerosolized ribavirin administration should be considered for the treatment of PIV3 infection in the context of primary immunodeficiency, where there is no currently available alternative treatment, until a functional immune system is gained.
Light and Electron Microscopic Studies of the Trachea in the One‐Humped Camel (Camelus dromedarius)
Authors: Raji A. R. , Naserpour M.
Published: October 2006

Histology of trachea of camel (Camelus dromedarius) was studied using light, scanning (SEM) and transmission electron microscopy (TEM). Tissue samples taken from the trachea (proximal, middle and distal part) were routinely prepared for histology (LM, EM) and stained with haematoxylin and eosin, Van Giesson (VG), Alcian blue, Periodic acid schiff (PAS), Masson's trichrome (MT), Verhof, PAS–VG and PAS–MT. The trachea of camel consists of 66–75 incomplete cartilaginous rings of hyaline. The lamina epithelium is composed of pseudostratified‐ciliated columnar epithelium with many goblet cells. Submucosal layers were loose connective tissue with many elastic fibres. The mucosal and submucosal layers were 517.2 ± 61.6 μm (n = 20) thick. Submucosal glands were tubuloalveolar with mucous (acidic and neutral) secretions. Trachealis muscle was attached to the inside sheet of tracheal cartilage. Ultrastructural studies showed that surface epithelium is pseudostratified with mucus‐producing goblet cells, ciliated and basal cells, similar to other mammals. The ciliated cells contained many mitochondria, oval nucleus and many big granules. In scanning electron microscopy (SEM) studies, viscoelastic layers were observed on the epithelial surface of trachea, and there were highly condensed cilia under this layer.
Perniosis‐like tinea corporis caused by Trichophyton verrucosum in cold‐exposed individuals
Authors: Placzek M. , Van Den Heuvel M. E. , Flaig M. J. , Korting H. C.
Published: October 2006

Trichophyton verrucosum is a zoophilic infectious agent causing 98% of the dermatophytic infections of cattle. Transmission to humans has, until recently, been rare. One reason for an increase of infection in humans and animals seems to be the decrease in immunisation of cattle. We report on three cases of pertinent human infections with disseminated, sharply defined, bluish red, partly oedematous nodules and plaques in particular not only on the thighs, but also on the trunk and arms. Two of our patients work with farm animals. The third one works as an assistant in a butcher shop, but lives on a cow farm. All three patients are often exposed to the cold. In all three cases T. verrucosum was detected by culture. Tinea corporis was histologically confirmed in two patients. Based on the microbiological results, we began a combined systemic and local antimycotic therapy with fluconazole 50 mg day−1 in two patients, itraconazole 100 mg day−1 in one patient p.o. combined with topical ciclopiroxolamine. All patients were cured. Dermatophytosis caused by T. verrucosum can, under certain circumstances, such as frequent exposure to cold or a long‐term corticosteroid therapy, mimic the characteristic clinical picture of perniosis, as we demonstrate here.
Fluconazole and itraconazole susceptibilities of Candida spp. isolated from oropharyngeal specimens and blood cultures of paediatric haematology/oncology patients
Authors: Kennedy H. F. , Shankland G. S. , Bagg J. , Chalmers E. A. , Gibson B. E. S. , Williams C. L.
Published: October 2006

This study examined the in vitro susceptibilities to fluconazole and itraconazole of isolates of Candida spp. from surveillance oropharyngeal specimens and blood cultures from paediatric patients with malignancy. The species distribution of 100 isolates from oropharyngeal specimens was C. albicans 86%, C. glabrata 7%, C. lusitaniae 4%, C. parapsilosis 2% and C. tropicalis 1%. From a total of nine isolates from blood cultures the species distribution was C. albicans 33.3%, C. parapsilosis 33.3 % and C. guilliermondii 33.3%. Only three of the oropharyngeal isolates were resistant to fluconazole (MIC ≥ 64 mg l−1) and only two were resistant to itraconazole (MIC ≥ 1 mg l−1). None of the blood culture isolates was resistant to either agent. At this centre, C. albicans is the predominant species from oropharyngeal specimens, but non‐albicans Candida species predominate in blood cultures. Although resistance to fluconazole and itraconazole is rare at present, continued surveillance is warranted to monitor trends in species distribution and antifungal susceptibility.
Respiratory allergies in Venezuela: are fungi responsible?
Authors: Galante David , Hartung de Capriles Claudia , Mata‐Essayag Sofía , Conesa Angela , Córdova Yuraima , Trejo Ernesto , Tassinari Paolo
Published: October 2006

Exposure to fungi in the indoor environment may trigger hypersensitivity to a variety of fungi and is known to be an influencing factor in allergic rhinitis and asthma. A wide list of airborne fungal spores and dust containing fungi have been described for different environments; however, their clinical relevance is seldom clear. In this survey we measure levels of fungi indoor and outdoor of domestic dwellings of 10 patients with known chronic allergic respiratory disease to fungi. To measure hypersensitivity to fungi, Prick (sensitivity to fungi), RAST (specific serum IgE levels) and PAR (persistent allergic rhinitis) severity are assessed in relation to fungal load in the environment. Only association of PAR and indoor fungal load were found to be significant (P = 0.1648). No direct causality with sensitivity to the amount of exposure, or a hypersensitivity to a specific fungal genus could be established. There is still no consensus on the most relevant methods for measuring personal exposure and ‘no safe levels’ have been established yet.
Prevalence of dermatophytosis in junior secondary schoolchildren in Ogun State, Nigeria
Authors: Popoola T. O. S. , Ojo D. A. , Alabi R. O.
Published: October 2006

A total of 2772 randomly selected junior secondary school pupils (aged 8–14) from 60 schools were examined for dermatophytic infections by direct microscopy and culture‐based laboratory diagnostic methods. Of these, 641 (23.21%) had dermatophytosis. Out of these, 376 (13.56%) were male while 265 (9.56%) were female. Aetiological agents identified with infection were Microsporum canis (30.19%), Microsporum audouinii (32.92%), Trichophyton interdigitale (14.37%), Trichophyton soudanense (9.73%) and Trichophyton tonsurans (12.05%). Most of the dermatophytes encountered were anthropophilic species. Microsporum canis was the only zoophilic dermatophyte. Differences were not observed in infection pattern for all the different geo‐political zones that make up the state. The head and the skin of the students were more frequently infected than the nails and toes. Infection frequency increased steadily up to age 11 after which it drastically decreased.
Isolation of Exophiala dermatitidis from endotracheal aspirate of a cancer patient
Authors: Taj‐Aldeen S. J. , El Shafie S. , Alsoub H. , Eldeeb Y. , De Hoog G. S.
Published: October 2006

Exophiala (Wangiella) dermatitidis is a melanised (darkly pigmented) yeast‐like organism that has been reported from the environment and wild animals. The organism is a frequent coloniser of lungs of patients with cystic fibrosis and causes occasional disseminated phaeohyphomycosis and fungaemia. Exophiala dermatitidis is distributed worldwide, but cerebral cases are restricted to East Asia. We report a case of 54‐year‐old Qatari female patient with a known history of cancer, suffering from pulmonary disorder. Culture of endotracheal aspirate revealed the growth of E. dermatitidis concomitant with Candida krusei. The final diagnosis of E. dermatitidis and attribution to genotype B was achieved by sequencing the rDNA internal transcribed spacer (ITS) region. The present case concerns a pulmonary colonisation by E. dermatitidis, similar to that commonly seen in cystic fibrosis patients. For the detection of E. dermatitidis in clinical specimens culturing techniques are required. The patient finally expired with persistent cancer and C. krusei fungaemia. Review of literature and listing of E. dermatitidis cases published after 1992 show a sharp increase in clinical cases during the 1990s.
Study of the ITS region in an atypical isolate and comparison with six species of Microsporum
Authors: Leon‐Mateos A. , Paredes‐Suárez C. , Pereiro M. , Toribio J.
Published: October 2006

Microsporum species are a frequent cause of cutaneous mycoses in humans. Atypical strains of Microsporum can sometimes be difficult to identify with conventional methods. Recently, we have obtained a Microsporum isolate with atypical morphology and special nutritional requirements (Microsporum CHUS‐126‐02). As several molecular techniques have been developed for the identification of fungi, we analysed six Microsporum species (M. canis, M. gypseum, M. gallinae, M. nanum, M. ferrugineum and M. persicolor) in order to compare them with our isolate, by using polymerase chain reaction‐restriction enzyme analysis (PCR‐REA). We studied the nucleotide sequence of the internal transcribed spacer regions from the nuclear DNA encoding for the ribosomal domain. Digestion with MvaI and EcoRI endonucleases obtained specific patterns for M. gypseum, M. gallinae, M. nanum and M. persicolor. Microsporum canis, M. ferrugineum and Microsporum CHUS‐126‐02 yielded the same patterns. Based on these results and phenotypic criteria, we classified our atypical isolate as M. canis.
A 5‐year (2000–2004) epidemiological survey of Candida and non‐Candida yeast species causing vulvovaginal candidiasis in Graz, Austria
Authors: Paulitsch A. , Weger W. , Ginter‐Hanselmayer G. , Marth E. , Buzina W.
Published: October 2006

Vulvovaginal candidasis (VVC) is a common disease. The majority of cases is caused by Candida albicans, but in recent years an increase has been observed in the frequency of non‐albicans Candida infections, especially due to C. glabrata and C. tropicalis. The aim of the study was to assess the prevalence of non‐albicans Candida infections in patients suffering from VVC. Therefore, the statistical data of culture‐confirmed VVC ascertained at the Institute of Hygiene (Medical University Graz) have been studied. Altogether, 10 463 samples from patients with vulvovaginal complaints were analysed in the years 2000–2004, a number of 3184 proved to be culture‐positive for yeast. Candida albicans was the most prevalent cause in 87.9% of all cases. Non‐albicans Candida yeast were detected in 12.1%, mainly C. glabrata and Saccharomyces cerevisiae. During a 1‐year period 185 patients showed more than one episode of VVC. Patients aged 21–40 years were significantly more prone to suffer from VVC compared with other age‐related groups.
Report on the Second Asia Autoimmunity Forum, Hong Kong, 3–5 March 2006
Authors: KAVIKONDALA S. , YINGJIE N. , LAU C. S.
Published: October 2006

The Second Asia Autoimmunity Forum was jointly organized by the Hong Kong Society of Rheumatology, the University of Hong Kong, and the Singapore National Arthritis Foundation, and was attended by over 200 delegates from around Asia. More than 20 invited international and regional experts in the field of autoimmune rheumatic diseases from China, Greece, Hong Kong, Israel, Italy, the Netherlands, Singapore, and South Korea attended the meeting. A total of eight plenary lectures and four clinical symposia covered topics ranging from the role of dendritic cells and various genes in the pathogenesis of systemic lupus erythematosus, the changes in disease manifestations during pregnancy in lupus, advances on genetic studies in ankylosing spondylitis (AS), the role of dendritic cells and cytokines in the pathogenesis of rheumatoid arthritis (RA) to the novel emerging targets for treatment of RA, systemic sclerosis (SSc) and primary Sjogren's syndrome (pSS). It was an excellent avenue promoting the co‐ordination and exchange of knowledge in the area of autoimmune rheumatic diseases in Asia.
Cerebrospinal fluid and serum prolactin in systemic lupus erythematosus with and without central nervous system involvement
Authors: DAI Lie , WU Yimei , ZHENG Donghui , HAN Zhijuan , CHEN Lan X. , SCHUMACHER H. Ralph
Published: October 2006

Aim: Recent research has shown that prolactin (PRL) may participate in the pathogenesis of systemic lupus erythematosus (SLE), and hyperprolactinemia may be related to disease activity. The current study investigated both serum and cerebrospinal fluid (CSF) PRL in SLE patients and their possible relationship to central nervous system (CNS) involvement.

Methods: Prolactin levels were determined by immunoradiometric assay. Serum PRL levels were detected in 80 patients with SLE and 25 matched healthy controls. Disease activity was scored by SLEDAI. CSF PRL levels were detected in 7 cases of CNS‐involved SLE, eight cases of non‐CNS‐involved inactive SLE and eight cases of non‐SLE CNS disorders.

Results: Hyperprolactinemia was present in 40% of SLE patients. Serum PRL levels were significantly correlated with SLEDAI scores. There was no significant difference of serum PRL levels between SLE patients with or without CNS involvement, but the mean CSF PRL levels were higher in CNS‐involved SLE patients than in non‐CNS‐involved SLE and non‐SLE patients. There was no significant correlation between serum and CSF PRL levels.

Conclusions: Our results suggest that high serum PRL levels correlate with active disease in SLE, but not with CNS involvement. CSF PRL levels in SLE patients correlate with CNS involvement, which indicates that CSF PRL may be involved in the pathogenesis of CNS‐SLE.
Performance of existing diagnosis/classification criteria for Behcet's disease in Iranian patients: analysis of 5666 patients and 2406 controls
Authors: DAVATCHI Fereydoun , SHAHRAM Farhad , NADJI Abdolhadi , CHAMS‐DAVATCHI Cheyda , SHAMS Hormoz , AKHLAGHI Ma'ssoomeh , ABDOLLAHI Bahar Sadeghi , ZIAIE Naghmeh
Published: October 2006

Aim:  To analyse the performance of existing diagnosis/classification criteria for Behcet's disease (BD) in Iranian patients. There are 13 sets: Curth (1946), Hewitt (1969), Mason and Barnes (1969), Hewitt revised (1971), Japan (1972), Hubault and Hamza (1974), O'Duffy (1974), Cheng and Zhang (1980), Dilsen (1986), Japan revised (1988), International (1990), Iran (1993), Classification Tree (1993), and Dilsen revised criteria (2000).

Methods:  All patients from the Behcet's Disease Registry (5666) and control patients (2406) entered the study. Sensitivity, specificity and accuracy were calculated.

Results:  The most sensitive was Curth criteria with (99.7%), followed by Classification Tree (97.3%), Zhang (93.5%), Iran (91.4%), Japan revised (86.4%), Japan (85.3%), Dilsen (83.7%), Hubault and Hamza (81.6%), Dilsen revised (81.2%), International criteria (79.8%), Hewitt (73.8%), O'Duffy (70.7%), and Masson and Barnes (65.7%). The most specific was Masson and Barnes (99.6%), followed by the International criteria (98.3%), Dilsen revised (98.2%), O'Duffy (97.6%), Japan (97.1%), Japan revised (97%), Classification Tree (96.7%), Hewitt (95.8%), Iran (95.8%), Zhang (92.4%), Dilsen (91.4%), Hubault (90.8%), and Curth (78.6%). The most accurate criteria was Classification Tree (97.1%), followed by Curth (93.4%), Zhang (93.1%), Iran (92.7%), Japan revised (89.6%), Japan (88.8%), Dilsen revised (86.2%), Dilsen (86%), International criteria (85.3%), Hubault (84.3%), Hewitt (80.4%), O'Duffy (78.8%), and Mason and Barnes (75.8%).

Discussion:  Among the existing criteria, the best to classify Iranian patients is the Classification Tree. The second most accurate is Curth criteria. The difference is statistically significant. Further, Curth criteria is not optimized, having very high sensitivity and low specificity.
Spectrum of rheumatological disorders: an experience of 337 cases in a tertiary care hospital in Pokhara valley, Nepal
Authors: DAS Rabindra N. , PAUDEL Raju
Published: October 2006

Aim:  To reveal the commonly occurring important types of rheumatological disorders, as well as various clinico‐epidemiological aspects, concurrent medical illnesses, and the ancillary medications used, along with their side‐effects.

Method:  A total of 365 patients with various rheumatological disorders were studied at the Rheumatology Department of Manipal Teaching Hospital, Pokhara, Nepal from September 2001 to September 2004. The diagnosis was based on the criteria of the American College of Rheumatology (1988). A pro forma was prepared for 30 common rheumatological disorders, listing patient identification, clinical characteristics, disease duration, objective and subjective assessment of the progress of the diseases, monitoring the response of treatment and side‐effects of medications. Patients aged 15–75 years, men and women suffering from various musculoskeletal disorders, fulfilling the ACR criteria, were studied. Each patient was followed up at 1–3 monthly interval and data recorded systematically to monitor the progress of joint function and evaluating the effects of medications.

Results:  Out of the 365 patients recorded, only 337 fulfilled the criteria laid down by ACR. Most common rheumatological disorders in order of frequency were soft tissue rheumatism (40.0%), inflammatory arthritis (21.36%) and bone and cartilage diseases (21.06%). Connective tissue disorders were only 4.74%. Seronegative spondyloarthritis group was only 2.67% and least common disease was gout at 3.85%. Rheumatoid arthritis was the most common inflammatory arthritis observed in 20.17% of total cases. Fibromyalgia was the most common soft tissue rheumatism seen in 19.88%. Osteoarthritis of knee, hand and hip were the most common degenerative disorder of the bone and cartilage, constituting 10.38%. Lumbago, lumbar spondylolisthesis and spinal canal stenosis together comprised 14.24% of patients with low back pain. Cervical spondylosis and all types of shoulder joint pain syndromes comprised 5.93% and 5.34%, respectively. Patients were mostly in the age group 20–60 years. The most common type of drug used in all rheumatic conditions was non‐steroidal anti‐inflammatory drugs in 81.6% of cases followed by steroids in 26.7%, disease‐modifying and cytotoxic drugs in 18.6% and 17.2% of cases, respectively. Chronic obstructive airway disease and hypertension constituted the major concurrent illness in 23.63% and 18.78%, respectively.

Conclusion:  This unique type of clinico‐epidemiological study on rheumatological disorders, the first in Nepal, will provide a rich database for future investigations into rheumatology and would plan for all levels of prevention and therapy in the future.
The development of systemic lupus erythematosus following interferon‐α therapy for hepatitis C infection
Authors: Wahid FADILAH S‐Abdul , NORELLA Kong‐Chiew‐Tong , SHAHRIL Mohd‐Said , AZMA Raja‐Sabudin , LEONG Chooi‐Fun , CHEONG Soon‐Keng
Published: October 2006

Interferon‐alpha (IFN‐α) therapy has been associated with de novo development of systemic lupus erythematosus (SLE), and discontinuation of IFN‐α resulted in disease resolution in most patients. Recurrence of SLE in the absence of concomitant IFN‐α therapy has not been reported. We present here a woman who developed overt clinical manifestations of SLE one year after withdrawal of IFN‐α therapy for hepatitis C virus (HCV) infection. This report highlights the importance of long‐term follow‐up for the belated development of SLE in patients who have experienced IFN‐α induced autoimmune phenomena.
The Efficiency of Payments for Environmental Services in Tropical Conservation
Authors: WUNDER SVEN
Published: October 2006

Abstract:  Payments for environmental services (PES) represent a new, more direct way to promote conservation. They explicitly recognize the need to address difficult trade‐offs by bridging the interests of landowners and external actors through compensations. Theoretical assessments praise the advantages of PES over indirect approaches, but in the tropics PES application has remained incipient. Here I aim to demystify PES and clarify its scope for application as a tool for tropical conservation. I focus on the supply side of PES (i.e., how to convert PES funding into effective conservation on the ground), which until now has been widely neglected. I reviewed the PES literature for developing countries and combined these findings with observations from my own field studies in Latin America and Asia. A PES scheme, simply stated, is a voluntary, conditional agreement between at least one “seller” and one “buyer” over a well‐defined environmental service—or a land use presumed to produce that service. Major obstacles to effective PES include demand‐side limitations and a lack of supply‐side know‐how regarding implementation. The design of PES programs can be improved by explicitly outlining baselines, calculating conservation opportunity costs, customizing payment modalities, and targeting agents with credible land claims and threats to conservation. Expansion of PES can occur if schemes can demonstrate clear additionality (i.e., incremental conservation effects vis‐à‐vis predefined baselines), if PES recipients' livelihood dynamics are better understood, and if efficiency goals are balanced with considerations of fairness. PES are arguably best suited to scenarios of moderate conservation opportunity costs on marginal lands and in settings with emerging, not‐yet realized threats. Actors who represent credible threats to the environment will more likely receive PES than those already living in harmony with nature. A PES scheme can thus benefit both buyers and sellers while improving the resource base, but it is unlikely to fully replace other conservation instruments.
Fecundity as a Basis for Risk Assessment of Nonindigenous Freshwater Molluscs
Authors: KELLER REUBEN P. , DRAKE JOHN M. , LODGE DAVID M.
Published: October 2006

Abstract: The most efficient way to reduce future damages from nonindigenous species is to prevent the introduction of harmful species. Although ecologists have long sought to predict the identity of such species, recent methodological advances promise success where previous attempts failed. We applied recently developed risk assessment approaches to nonindigenous freshwater molluscs at two geographic scales: the Laurentian Great Lakes basin and the 48 contiguous states of the United States. We used data on natural history and biogeography to discriminate between established freshwater molluscs that are benign and those that constitute nuisances (i.e., cause environmental and/or economic damage). Two statistical techniques, logistic regression and categorical tree analysis, showed that nuisance status was positively associated with fecundity. Other aspects of natural history and biogeography did not significantly affect likelihood of becoming a nuisance. We then used the derived statistical models to predict the chance that 15 mollusc species not yet in natural ecosystems would cause damage if they become established. We also tested whether time since establishment is related to the likelihood that nonindigenous mollusc species in the Great Lakes and United States would cause negative impacts. No significant relationship was evident at the U.S. scale, but recently established molluscs within the Great Lakes were more likely to cause negative impacts. This may reflect changing environmental conditions, changing patterns of trade, or may be an indication of “invasional meltdown.” Our quantitative analyses could be extended to other taxa and ecosystems and offer a number of improvements over the qualitative risk assessments currently used by U.S. (and other) government agencies.
Alcohol Intake and Its Relationship with Bone Mineral Density, Falls, and Fracture Risk in Older Men
Authors: Cawthon Peggy M. , Harrison Stephanie L. , Barrett‐Connor Elizabeth , Fink Howard A. , Cauley Jane A. , Lewis Cora E. , Orwoll Eric S. , Cummings Steven R.
Published: October 2006

OBJECTIVES: To examine the association between alcohol intake and problem drinking history and bone mineral density (BMD), falls and fracture risk.

DESIGN: Cross‐sectional and prospective cohort study.

SETTING: Six U.S. clinical centers.

PARTICIPANTS: Five thousand nine hundred seventy‐four men aged 65 and older.

MEASUREMENTS: Alcohol intake and problem drinking histories were ascertained at baseline. Follow‐up time was 1 year for falls and a mean of 3.65 years for fractures.

RESULTS: Two thousand one hundred twenty‐one participants (35.5%) reported limited alcohol intake (<12 drinks/y); 3,156 (52.8%) reported light intake (<14 drinks/wk), and 697 (11.7%) reported moderate to heavy intake (≥14 drinks/wk) in the year before baseline. One thousand one men (16.8%) had ever had problem drinking. In multivariate models, as alcohol intake increased, so did hip and spine BMD (P for trend <.001). Greater alcohol intake was not associated with greater risk for nonspine or hip fractures. Men with light intake, but not moderate to heavy intake, had a lower risk of two or more incident falls (light intake: relative risk (RR)=0.77, 95% confidence interval (CI)=0.65–0.92; moderate to heavy intake: RR=0.83, 95% CI=0.63–1.10) than abstainers. Men with problem drinking had higher femoral neck (+1.3%) and spine BMD (+1.4%), and a higher risk of two or more falls (RR=1.59; 95% CI=1.30–1.94) than those without a history of problem drinking and similar total hip BMD and risk of fracture.

CONCLUSION: In older men, recent alcohol intake is associated with higher BMD. Alcohol intake and fracture risk is unclear. Light alcohol intake may decrease the risk of falling, but a history of problem drinking increased fall risk.
The Effects of In‐Home Rehabilitation on Task Self‐Efficacy in Mobility‐Impaired Adults: A Randomized Clinical Trial
Authors: Sanford Jon A. , Griffiths Patricia C. , Richardson Peg , Hargraves Katina , Butterfield Tina , Hoenig Helen
Published: October 2006

OBJECTIVES: To examine the effect on mobility self‐efficacy of a multifactorial, individualized, occupational/physical therapy (OT/PT) intervention delivered via teletechnology or in‐home visits.

DESIGN: Randomized, clinical trial.

SETTING: One Department of Veterans Affairs and one private rehabilitation hospital.

PARTICIPANTS: Sixty‐five community‐dwelling adults with new mobility devices. Thirty‐three were randomized to the control or usual care group (UCG), 32 to the intervention group (IG).

INTERVENTION: Four, once‐weekly, 1‐hour OT/PT sessions targeting three mobility and three transfer tasks. A therapist delivered the intervention in the traditional home setting (trad group n=16) or remotely via teletechnology (tele group n=16).

MEASUREMENTS: Ten‐item Likert‐scale measure of mobility self‐efficacy.

RESULTS: The IG had a statistically significantly greater increase in overall self‐efficacy over the study period than the UCG (mean change: IG 8.8, 95% confidence interval (CI)=3.8–13.7; UCG 1.2, 95% CI=−5.8–8.2). Descriptively, the IG exhibited positive changes in self‐efficacy for all tasks and greater positive change than the UCG on all items with the exception of getting in and out of a chair. Comparisons of the two treatment delivery methods showed a medium standardized effect size (SES) in both the tele and trad groups, although it did not reach statistical significance for the tele group (SES: tele=0.35, 95% CI=−2.5–0.95; trad=0.54, 95% CI=0.06–1.14).

CONCLUSION: A multifactorial, individualized, home‐based OT/PT intervention can improve self‐efficacy in mobility‐impaired adults. The trend toward increased self‐efficacy irrespective of the mode of rehabilitation delivery suggests that telerehabilitation can be a viable alternative to or can augment traditional in‐home therapy.
Identifying Frailty in Hospitalized Older Adults with Significant Coronary Artery Disease
Authors: Purser Jama L. , Kuchibhatla Maragatha N. , Fillenbaum Gerda G. , Harding Tina , Peterson Eric D. , Alexander Karen P.
Published: October 2006

OBJECTIVES: To characterize physiological variation in hospitalized older adults with severe coronary artery disease (CAD) and evaluate the prevalence of frailty in this sample, to determine whether single‐item performance measures are good indicators of multidimensional frailty, and to estimate the association between frailty and 6‐month mortality.

DESIGN: Observational cohort study.

SETTING: Inpatient hospital cardiology ward.

PARTICIPANTS: Three hundred nine consecutive inpatients aged 70 and older admitted to a cardiology service (n=309; 70% male, 84% white) with minimum two‐vessel CAD determined using cardiac catheterization.

MEASUREMENTS: Two standard frailty phenotypes (Composite A and Composite B), usual gait speed, grip strength, chair stands, cardiology clinical variables, and 6‐month mortality.

RESULTS: Prevalence of frailty was 27% for Composite A versus 63% for Composite B. Utility of single‐item measures for identifying frailty was greatest for gait speed (receiver operating characteristic curve c statistic=0.89 for Composite A, 0.70 for Composite B) followed by chair‐stands (c=0.83, 0.66) and grip strength (c=0.78, 0.57). After adjustment, composite scores and single‐item measures were individually associated with higher mortality at 6 months. Slow gait speed (≤0.65 m/s) and poor grip strength (≤25 kg) were stronger predictors of 6‐month mortality than either composite score (gait speed odds ratio (OR)=3.8, 95% confidence interval (CI)=1.1–13.1; grip strength OR=2.7, 95% CI=0.7–10.0; Composite A OR=1.9, 95% CI=0.60–6.1; chair‐stand OR=1.5, 95% CI=0.5–5.1; Composite B OR=1.3, 95% CI=0.3–5.2).

CONCLUSION: Gait speed frailty was the strongest predictor of mortality in a population with CAD and may add to traditional risk assessments when predicting outcomes in this population.
Effect of supportive extracorporeal treatment in liver transplantation recipients and advanced liver failure patients
Authors: OZDEMIR Fatma N. , TUTAL Emre , SEZER Siren , GÜR Gürden , BILGIC Ayse , HABERAL Mehmet
Published: October 2006

Recently, continuous venovenous hemodiafiltration (CVVHDF) and plasmapheresis (PF) were suggested as supportive therapy options in combination with standard treatment in advanced liver failure. The aim of this study was to analyze the effects of supportive extracorporeal treatment (SET) in a group of patients with advanced hepatic failure. A total of 25 patients (7 women, 18 men; mean age, 39.3±15.4 years; 13 were transplant recipients [6 women, 7 men; mean age, 37.7±16.9 years]) were included. All patients were in hepatic coma and receiving standard coma and liver failure management when they received SET. Number of SET sessions; levels of serum blood urea nitrogen, creatinine, albumin, calcium, phosphorus, ammonia, alanine and aspartate aminotransferase, and total/conjugated bilirubin; and prothrombin times (PTT) before and after SET were recorded retrospectively. 7.7±7.9 SET sessions were performed. Thirteen liver transplant recipients required SET for an average of 9.7±8.3 days after transplantation. Serum ammonia and bilirubin levels were lower after termination of supportive therapy when compared with initial levels (p<0.0001 and p<0.005 respectively). During follow‐up, hepatic encephalopathy and liver failure resolved in 11 patients, while 14 patients (7 transplant recipients) died. There was no significant difference between patients in either group except that PTT was shorter in patients who survived (p<0.01). Further analyses revealed that in surviving patients, ammonia clearance was higher (p<0.01). In patients with advanced liver failure, or liver transplants, CVVHDF and/or PF could be supportive options combined with standard treatment.
Cystatin C in critically ill patients treated with continuous venovenous hemofiltration
Authors: BAAS Marije C. , BOUMAN Catherine S. C. , HOEK Frans J. , KREDIET Raymond T. , SCHULTZ Marcus J.
Published: October 2006

Assessment of residual renal function in critically ill patients with acute renal failure (ARF) treated with continuous venovenous hemofiltration (CVVH) is difficult. Cystatin C (CysC) is a low‐molecular‐weight protein (13.3 kDa) removed from the body by glomerular filtration. Its serum concentration has been advocated for assessment of renal function in patients with kidney disease. To investigate whether the removal of CysC by CVVH is likely to influence its serum concentration, concentrations of CysC were measured in 3 consecutive samples in 18 patients with oliguric ARF treated with CVVH (2 L/hr). Samples were taken from the afferent and efferent blood lines and from the ultrafiltrate line. Concentrations of CysC did not change during the time interval studied. The mean serum concentrations of CysC were 2.25±0.45 mg/L in the afferent and 2.19±0.56 mg/L in the efferent samples (NS); ultrafiltrate concentrations of CysC were 1.01±0.45 mg/L. The sieving coefficient of CysC was 0.52±0.20; the clearance of CysC was 17.3±6.6 mL/min; and the quantity of CysC removed averaged 2.13 mg/hr. During CVVH (2 L/hr), the quantity of CysC removed is less than 30% of its production and no rapid changes in its serum concentration are observed. Therefore, CVVH (2 L/hr) is unlikely to influence serum concentrations of CysC significantly, which suggests that it can be used to monitor residual renal function during CVVH.
In search of an advance directive that works for end‐stage renal disease patients
Authors: BARTLOW Bruce
Published: October 2006

Although loss, disability, and death are constant possibilities for any end‐stage renal disease patient, very few have planned for the last of life. Currently available Advance Directives (ADs) are refusal of specific therapies in only specific but nebulous circumstances. They fail to provide positive guidance for a patient's remaining time. Without addressing goals, quality of life, reversibility of medical problems, and desired end‐of‐life (EOL) care, such ADs are useless. End‐stage renal disease providers are generally untrained and unsupported in offering guidance. Financial, emotional, and structural factors collude to justify ignoring EOL planning. Several alternative ADs are offered, along with a goal‐directed approach to EOL counseling for patients and staff.
Coagulation cascade
Authors: GREEN David
Published: October 2006

The coagulation cascade is now recognized to be a series of proteolytic events mainly localized to the surface of activated platelets. Once platelets become activated by exposure to activated endothelium, they release mediators such as P‐selectin and von Willebrand factor that promote microvesicle formation and platelet adherence. The microvesicles fuse with the activated platelet membrane, providing tissue factor and its ligand, factor VIIa. Clotting factors bind to adjacent receptors on the membrane, enabling the cascading proteolytic cleavages of zymogens to active enzymes, culminating in thrombin generation. Fibrin formation thus occurs in the sheltered environment of the platelet membrane, where it is localized to the site of injury and protected from circulating inhibitors.
Management of hyperphosphatemia
Authors: KUHLMANN Martin K.
Published: October 2006

Hyperphosphatemia is a well recognized risk factor for cardiovascular mortality in dialysis patients. Despite advanced technology and regular and efficient dialysis treatment the prevalence of hyperphosphatemia is still high. The goal of normalization of serum phosphorus (iP) levels can only be reached by optimization of dialysis prescription in combination with individualized dietary and medical strategies. Due to the unique characteristics of intradialytic iP kinetics, dialysis treatment time and frequency are the most effective factors governing intradialytic iP removal. Although the combination of diffusive and convective removal by hemodiafiltration allows a further increase in iP mass removal, a neutral phosphorus balance without dietary restrictions and the use of phosphate binders has only be achieved by daily nocturnal hemodialysis. Strict dietary phosphate restriction bears the risk of inadequate protein intake and the development of protein/calorie malnutrition. Although phosphate binders (PB) can effectively lower serum iP levels into the normal range, this is rarely achieved in clinical practice probably due to inadequate relation of PB dose to dietary phosphorus intake. Developing methods to enable patients to self‐adjust phosphate binder dose to individual meal phosphate content, similar to adjusting insulin dose to carbohydrate intake, may lead to further improvements in phosphate management.