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The article talks about parasitic infections in the intensive care unit. Topics discussed include the Echinococcosis, a tapeworm infection characterized by the formation of cyst in liver and lung; the Schistosomiasis, infection occurs through contact with contaminated freshwater bodies, found at large scale in sub-Saharan Africa; and the Strongyloidiasis, an infection that affects gastrointestinal tract, found in tropical and subtropical Africa, Southeast Asia and Latin America.

A total of 180 crossbred pigs (average BW = 6.1 kg) were used to determine the effects of addition of Yucca schidigera (Micro-Aid; Porterville, CA) to a soybean meal-based diet on growth performance of nursery pigs in a 43-d experiment. Pigs were weaned at 20 d of age and allotted to 1 of 3 treatments in a completely randomized design (5 barrows, 5 gilts/pen; 6 pens/trt). The 3 dietary treatments consisted of: 1) control diet (CNT) containing animal protein sources (plasma, fish meal), 2) a high soybean meal-based diet without animal protein sources (HSBM), and 3) the HSBM-based diet plus 125 ppm of Micro-Aid (MA). Pigs were fed in 4 dietary phases. During d 0-21, animal plasma and fish meal were replaced in the CNT diet with soybean meal. Soybean meal was included at 30% in phases 1 (d 0-7), 2 (d 7-14), and 3 (d 14-21) for the HSBM and MA diets. Soy protein concentrate, soybean oil, L-lysine HC1, DL-methi-onine, L-threonine, dicalcium phosphate, and limestone were added to the HSBM and MA diets to equalize ME, amino acid, Ca, and P concentrations. During phase 4 (d 21-13), due to decreasing use of animal protein sources, the concentration of soybean meal was similar across the 3 dietary treatments. Feed disappearance and BW were recorded to calculate ADG, ADFI, and G:F ford 0-14,0-21,21-13, and 0-13. Ford 0-14, pigs fed CNT had greater (P < 0.02) ADG (222 vs. 186 g/d), ADFI (281 vs. 254 g/d), and G:F (0.79 vs. 0.73) compared with pigs fed the HSBM diet. There was no difference (P > 0.10) in growth performance between pigs fed CNT and MA diets during d 0-14. Pigs fed MA tended to have greater (P < 0.10) ADG (209 vs. 186 g/d) and greater (P < 0.04) G:F (0.78 vs. 0.73) compared with pigs fed the HSBM diet during d 0-14. However, for d 0-21, 21-13, and 0-13, there were no differences (P > 0.10) among treatments. These results suggest pigs fed the HSBM diet from d 0-14 have decreased performance, but recover in the following phases, such that no differences in performance were noted at the end of the nursery phase. Addition of Mcro-Aid tended to partially alleviate the negative effects of high soybean meal on growth performance during d 0-14 in the nursery. This work was partially supported by NPB SREE. [ABSTRACT FROM AUTHOR]

Background/aims: Efflux transporters in the ATP binding cassette (ABC) superfamily have been implicated in multidrug resistance (MDR). Characterization of ABC transporters at the site of drug action is essential to overcoming MDR. In the current study, we examined the expression of seven ABC transporters in humanPBMCs in response to administration of the HIV protease inhibitors atazanavir (ATZ) and saquinavir (SQV).Methods: Fourteen healthy volunteers received 1500 mg SQV and 200 mg ATZ orally twice daily for 11 days. PBMCs were isolated from each subject at baseline and on the 11th day of treatment. Quantitative RT-PCR was used to measure PBMC expression of ABCB1, ABCC1, ABCC2, ABCC3, ABCC4, ABCC6, and ABCG2.Results: Preliminary results show an overall increase in ABCB1 mRNA expression following SQV-ATZ administration. Interestingly, 86% of subjects demonstrated an increase in ABCB1 mRNA expression, while the remaining subjects exhibited a decrease. The effect of SQV-ATZ treatment on mRNA expression of ABCC1, ABCC2, ABCC3, ABCC4, ABCC6, and ABCG2 was variable, with induction of any gene observed in no more than 63% of individuals. (Table)Conclusions: Coadministration of the HIV protease inhibitors SQV and ATZ induced ABCB1 mRNA expression in the majority of individuals tested. The effect of this induction on P-glycoprotein function is being assessed. The variability in response to treatment may be due to genetic differences in these ABC genes or their regulatory partners.Clinical Pharmacology & Therapeutics (2005) 79, P6–P6; doi: 10.1016/j.clpt.2005.12.017 [ABSTRACT FROM AUTHOR]

The recognition, correct diagnosis and adequate clinical management of infections caused by atypical mycobacteria are challenging tasks in clinical practice. Invasive infections caused by Mycobacterium chimaera , a member of the Mycobacterium avium-intracellulare complex, have been increasingly reported over the past few years. Most infections occurred in patients who had undergone open-chest cardiothoracic surgery. Epidemiological and molecular studies showed that transmission of M. chimaera occurred through intraoperative aerosols derived from contaminated heater-cooler units, i. e. devices that are used to enable the extracardiac circuit in cardiothoracic surgery. Thus far, approximately 120 patient cases have been reported worldwide. The latency between exposure and onset of clinical symptoms may comprise several years. Clinical manifestations of M. chimaera infections include not only endocarditis and implant-associated infections, but also non-cardiac entities such as sarcoidosis-like symptoms, vertebral osteomyelitis and chorioretinitis. The pathogen can be detected in blood culture vials and in surgically obtained specimens from affected tissues, if specific microbiological tests for detection of mycobacteria are employed. There are no simple-to-use screening tests and a high clinical index of suspicion is thus mandatory in patients with previous exposure and compatible signs and symptoms. The successful treatment of M. chimaera infections requires the removal of infected devices and prolonged combination therapy with antimycobacterial drugs. This review summarises the clinical relevance, epidemiology, symptomatology, diagnosis and treatment of infections caused by M. chimaera , with a specific focus on pneumological aspects., Competing Interests: F. Trudzinski hat Vortragshonorare und Reisekostenerstattungen von den Firmen Novartis, Berlin-Chemie erhalten. R. Bals erhielt Forschungszuwendung oder Kostenerstattungen von AstraZeneca, Boeringer Ingelheim, GlaxoSmithKleine, Grifols, Novartis, CSL Behring, German Federal Ministry of Education and Research (BMBF) Competence Network Asthma and COPD (ASCONET), Wilhelm Sander Stiftung, Schwiete Stiftung, Krebshilfe, Mukoviszidose e. V. Alle ohne direkten Bezug zur Arbeit. S. Becker hat Vortragshonorare und Reisekostenerstattungen von den Firmen Actelion Pharmaceuticals und Pfizer erhalten. H.-J. Schäfers und U. Schlottauer geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

We report the case of a 19-year-old patient who presented with recurrent circular and scaly skin changes. The patient reported wrestling as his main leisure activity. After an unsuccessful attempt at local antibiotic treatment, detailed dermatological work-up revealed the skin changes to be tinea corporis gladiatorum. According to dermatological guidelines for dermatophytosis, systemic treatment with fluconazole and local ointments containing ciclopirox olamine and ketoconazole were administered, which rapidly led to significant improvement.

Bacterial bloodstream infections (BSI) account for considerable morbidity worldwide, but epidemiological data from resource-constrained tropical settings are scarce. We analysed 293 blood cultures from patients presenting to a regional referral hospital in Bouaké, central Côte d'Ivoire, to determine the aetiology of community-onset BSI. The prevalence of bacteraemia was 22.5%, with children being most commonly affected. Enterobacteriaceae (predominantly Klebsiella pneumoniae and Salmonella enterica) accounted for 94% of BSI. Staphylococcus aureus was the only relevant Gram-positive pathogen. Clinical signs and symptoms were not significantly associated with blood culture positivity after controlling for malaria.

Infectious diarrhoea ranks among the leading causes of morbidity worldwide. Although most acute diarrhoeal episodes are self-limiting, the diagnosis and treatment of persistent diarrhoea (≥2 weeks) are cumbersome and require laboratory identification of the causative pathogen. Stool-based PCR assays have greatly improved the previously disappointing pathogen detection rates in high-income countries, but there is a paucity of quality data from tropical settings. We performed a case-control study to elucidate the spectrum of intestinal pathogens in patients with persistent diarrhoea and asymptomatic controls in southern Côte d'Ivoire. Stool samples from 68 patients and 68 controls were obtained and subjected to molecular multiplex testing with the Luminex(®) Gastrointestinal Pathogen Panel (GPP), microscopy and rapid antigen detection tests for the diagnosis of diarrhoeagenic pathogens. Overall, 20 different bacteria, parasites and viruses were detected by the suite of diagnostic methods employed. At least one pathogen was observed in 84% of the participants, and co-infections were observed in >50% of the participants. Enterotoxigenic Escherichia coli (32%), Giardia intestinalis (29%) and Shigella species (20%) were the predominant pathogens, and Strongyloides stercoralis (10%) was the most prevalent helminth. Pathogen frequencies and numbers of co-infections were similar in patients and controls. Although the Luminex(®) GPP detects a broad range of pathogens, microscopy for helminths and intestinal protozoa remains necessary to cover the full aetiological spectrum in tropical settings. We conclude that highly sensitive multiplex PCR assays constitute a useful screening tool, but that positive results might need to be confirmed by independent methods to discriminate active infection from asymptomatic faecal shedding of nucleic acids., (Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Schistosomiasis is a water-based parasitic disease that affects over 250 million people. Control efforts have long been in vain, which is one reason why schistosomiasis is considered a neglected tropical disease. However, since the new millennium, interventions against schistosomiasis are escalating. The initial impetus stems from a 2001 World Health Assembly resolution, urging member states to scale-up deworming of school-aged children with the anthelminthic drug praziquantel. Because praziquantel is safe, efficacious and inexpensive when delivered through the school platform, diagnosis before drug intervention was deemed unnecessary and not cost-effective. Hence, there was little interest in research and development of novel diagnostic tools. With the recent publication of the World Health Organization (WHO) Roadmap to overcome the impact of neglected tropical diseases in 2020, we have entered a new era. Elimination of schistosomiasis has become the buzzword and this has important ramifications for diagnostic tools. Indeed, measuring progress towards the WHO Roadmap and whether local elimination has been achieved requires highly accurate diagnostic assays. Here, we introduce target product profiles for diagnostic tools that are required for different stages of a schistosomiasis control programme. We provide an update of the latest developments in schistosomiasis diagnosis, including microscopic techniques, rapid diagnostic tests for antigen detection, polymerase chain reaction (PCR) assays and proxy markers for morbidity assessments. Particular emphasis is placed on challenges and solutions for new technologies to enter clinical practice., (Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Optimal sequencing of zidovudine and stavudine in antiretroviral therapy has not been elucidated., Objective: To examine the impact of the sequence of therapeutic regimens containing zidovudine and stavudine on HIV-1 RNA and CD4 lymphocyte counts over 12 months., Design: Observational, multicenter, longitudinal cohort study., Setting: Four large outpatient, HIV practices participating in the community-based Collaborations in HIV Outcomes Research-U.S. (CHORUS) cohort study., Participants: 940 HIV-infected patients., Methods: Comparison of HIV-1 RNA and CD4 lymphocyte responses in patients sequenced from zidovudine to stavudine or from stavudine to zidovudine using repeated measures regression models fit to outcomes by application of generalized estimating equation (GEE) methodology., Results: Patients treated with zidovudine prior to stavudine (n = 834) achieved a greater mean drop from baseline HIV-1 RNA (p = .01) and higher proportion of undetectable HIV-1 RNA results (p = .05) over 12 months than those sequenced from stavudine to zidovudine (n = 106). CD4+ lymphocyte increases did not differ between the groups (p = .6)., Conclusions: Prior zidovudine therapy was not associated with long-term attenuation of HIV-1 RNA or CD4 response to subsequent stavudine-containing regimens. Zidovudine before stavudine may have benefit in a strategic long-term therapeutic plan.

Little is known about the nature of task and ego orientations that are key motivation constructs. The purpose of this study, therefore, was to examine the extent to which perceived social, contextual, and personal factors predicted the goal orientations of youth sport participants. The sample consisted of 166 male and female adolescent soccer players, who completed self-report measures at the end of a 7-week competitive season. A canonical correlation analysis revealed that the set of predictor variables accounted for 24% of the variance in player goal orientations. Higher scores on perceived soccer competence, perceived parent task orientation, and particularly perceived parent ego orientation were primarily associated with higher scores on player ego orientation. In addition, higher scores on perceived soccer competence, perceived parent task orientation, and perceived mastery climate, as well as lower scores on perceived performance climate, were associated with a higher level of player task orientation. These findings are interpreted and discussed in terms of future research directions.

We surveyed 821 Iowa teenage boys to establish patterns of smokeless tobacco use, occurrence of oral lesions and the effect of lesions on attitudes about quitting, current use and plans for future use. Results suggest that young ST users who currently have a lesion or have experienced lesions may be particularly receptive to discussion of quitting options and other information about ST health effects. Dentists and other oral health professionals should initiate ST intervention when establishing a lesion history or on discovering a lesion at examination.

Smoking among adolescents is a developmental phenomenon with several factors exerting an influence on cigarette use at different times. We examined the longitudinal influences of several behavioral and social variables on the smoking status of 443 students followed from early to late adolescence. Of the factors examined, association with friends who smoke and previous smoking status were consistently associated with an adolescent's future smoking status. Other factors, such as attachment to father or to mother, parental supervision, extracurricular activity, perceived negative and positive effects of smoking, and academic involvement, were all related to late adolescent smoking status. These observations suggest that strategies that influence smoking behavior need to be directed not only to the individual child but also to influences within the child's home and school environment.

Human immunodeficiency virus (HIV) is a retrovirus that can be transmitted through sexual activity, blood products, and perinatal exposure. The virus is composed of core, transmembrane, and envelope proteins. Cells of the immune system are the primary target of HIV, and destruction of the immune response is characteristic of end-stage disease. Although male homosexuals continue to represent the largest population of persons with acquired immunodeficiency syndrome (AIDS), transmission among intravenous drug users accounts for the rapidly growing incidence of pediatric and heterosexual AIDS patients. Control of the epidemic among intravenous drug users is the major challenge in the US today.

This article presents theoretical bases for the development of community-wide anti-tobacco programs to reinforce school-based programs, discusses the problems involved in translating these theoretical bases into practice, and suggests means for minimizing those problems. Spiral of silence theory, diffusion theory, and expectancy value theory are covered. Special attention is given to the importance of a community program based in and "belonging" to the community, the need for high visibility, maximum participation by community individuals and organizations, mechanisms for program self-perpetuation, and explicit and visible ties to school-based anti-tobacco programs.

Leber optic atrophy (LOA) is a familial disorder primarily affecting males. We report the case of a 44-year-old male for whom the prescription of low vision aids was an important rehabilitative factor.