Group A Rotaviruses (RVA) have been established as significant contributory agents of acute gastroenteritis in young children and many animal species. In 2008, we described the first RVA strain ...detected in a giraffe calf (RVA/Giraffe-wt/IRL/GirRV/2008/G10P11), presenting with acute diarrhoea. Molecular characterisation of the VP7 and VP4 genes revealed the bovine-like genotypes G10 and P11, respectively. To further investigate the origin of this giraffe RVA strain, the 9 remaining gene segments were sequenced and analysed, revealing the following genotype constellation: G10-P11-I2-R2-C2-M2-A3-N2-T6-E2-H3. This genotype constellation is very similar to RVA strains isolated from cattle or other members of the artiodactyls. Phylogenetic analyses confirmed the close relationship between GirRV and RVA strains with a bovine-like genotype constellation detected from several host species, including humans. These results suggest that RVA strain GirRV was the result of an interspecies transmission from a bovine host to the giraffe calf. However, we cannot rule out completely that this bovine-like RVA genotype constellation may be enzootic in giraffes. Future RVA surveillance in giraffes may answer this intriguing question.
Pesticides with chlorpyrifos and endosulfan as active element are used for pest control on agricultural lands and are high-risk inputs in aquatic systems. The acute toxicity of these insecticides in ...the freshwater prawn Palaemonetes argentinus was evaluated. The results were used to determine the lowest observed-effect and no observed-effect concentrations. Individual growth of prawns in relation to chlorpyrifos and endosulfan exposure was analyzed. LC(50) values to chlorpyrifos and endosulfan exposure were 2.98 microg L(-1) and 14.10 at 24 hours and 0.49 microg L(-1) and 6.28 microg L(-1) at 96 hours of exposure, respectively. The size increment of prawns was the same in all treatments; cephalothorax length increased linearly per molt. The intermolt period was influenced by the toxic effect of pesticides during rearing time, and this decreased with the molt cycles compared with the normal growth pattern. The results suggest that juveniles of P. argentinus are sensitive to chlorpyrifos and endosulfan pollution.
This study was designed to examine the relationship between the Voice Handicap Index (VHI) and acoustic measures of voice samples common in clinical practice. Fifty participants, 38 women and 12 men, ...ranging in age from 19 to 80 years, with a mean age of 49 years, served as participants. Of these 50 participants, 17 participants could be included in the acoustic analysis of voice based on measures of error calculated with the
TF32 software. All participants completed the VHI and provided voice samples including three trials of the sustained vowel /A/ at a comfortable loudness level as well as a connected speech sample consisting of the
Zoo Passage. Acoustic measures were made with
TF32 and
Cool Edit software and included fundamental frequency, jitter %, shimmer %, signal-to-noise ratio, mean root-mean-square intensity, fundamental frequency standard deviation, aphonic periods, and breath groups. Results indicate that these measures were not predictive of overall VHI score, and no cohesive or predictable pattern was identified when comparing individual measures with overall VHI or with each subscale item. Likely contributions to this lack of correlation and subsequent clinical implications are discussed, as well as the direction for further research.
Summary
Background There is considerable variability in the number of exposures of narrowband ultraviolet B (NB‐UVB) needed to clear psoriasis and in the duration of remission.
Objectives We ...assessed clinical parameters as predictors of the number of exposures needed to clear psoriasis and of the duration of remission. The influence of genetic polymorphisms of the vitamin D receptor (VDR) on treatment response was also evaluated.
Methods This was a prospective study of 119 patients with chronic plaque psoriasis treated with NB‐UVB until clearance was achieved. They were then followed for up to 1 year or until relapse occurred. The frequency of the Fok1, Apa1, Bsm1, Taq1 and rs4516035 polymorphisms of the VDR gene was assessed in 93 of the 119 patients.
Results Of the 119 patients, 105 completed the course of phototherapy. Using an intention to treat analysis, 83% of the initial cohort (99 of 119 patients) achieved clearance, in a median of 26 exposures (interquartile range 19–35) with a median remission duration of 16 weeks (interquartile range 9–22). Factors significantly associated with a lower number of exposures to clearance included a lower baseline Psoriasis Area and Severity Index (P = 0·004), lower baseline Dermatology Life Quality Index (P = 0·047), female sex (P =0·043), lower body weight (P = 0·008), and a higher number of previous courses of TL‐01 (P = 0·005). The only clinical factor influencing remission duration was number of exposures (P = 0·0009), with a decreased remission duration in those who required a greater number of exposures to clear. The Taq1 VDR polymorphism (rs731236) also significantly predicted remission duration (P = 0·038). Patients homozygous for the C allele, which is associated with decreased activity of the VDR, had a shorter remission duration than those heterozygous for the allele (P = 0·026) and those homozygous for the T allele (P = 0·013).
Conclusions This study highlights the fact that both genetic and clinical parameters are important in determining treatment outcomes in psoriasis.
Abstract Background Dyspnea is the most common presenting symptom in patients with acute heart failure (AHF), but is difficult to quantify as a research measure. The URGENT Dyspnea study compared 3 ...scales: (1) 10 cm VAS, (2) 5-point Likert, and (3) a 7-point Likert (both VAS and 5-point Likert were recorded in the upright and supine positions). However, the minimal clinically important difference (MCID) to patients has not been well established. Methods We performed a secondary analysis from URGENT Dyspnea, an observational, multi-center study of AHF patients enrolled within 1 h of first physician assessment in the ED. Using the anchor-based method to determine the MCID, a one-category change in the 7-point Likert was used as the criterion standard (‘minimally improved or worse’). The main outcome measures were the change in visual analog scale (VAS) and 5-point Likert scale from baseline to 6-h assessment relative to a 1-category change response in the 7-point Likert scale (‘minimally worse’, ‘no change’, or ‘minimally better’). Results Of the 776 patients enrolled, 491 had a final diagnosis of AHF with responses at both time points. A 10.5 mm (SD 1.6 mm) change in VAS was the MCID for improvement in the upright position, and 14.5 mm (SD 2.0 mm) in the supine position. However, there was no MCID for worsening, as few patients reported worse dyspnea. There was also no significant MCID for the 5-point Likert scale. Conclusion A 10.5 mm change is the MCID for improvement in dyspnea over 6 h in ED patients with AHF.
Introduction
Chronic infection with human T‐cell lymphotropic virus type‐1 (HTLV‐1) may result in aggressive adult T‐cell leukaemia/lymphoma (ATL) in 4‐6% carriers. The majority of this risk arises ...in carriers infected during infancy, and so each infant has ∼25% lifetime risk. Other risk factors include a family history of ATL. Antenatal HTLV‐1 screening is not undertaken in the UK.
Methods
Here we describe four cases of ATL diagnosed during pregnancy and describe strategies to minimise HTLV‐1 transmission to neonates.
Results/conclusion
These cases highlight undiagnosed HTLV‐1 in pregnancy which allows ongoing mother to child vertical transmission and risk of future ATL. We recommend the UK National Screening Committee incorporate HTLV‐1 serology into antenatal screening.
Vasculitis restricted to the peripheral nervous system (PNS), referred to as nonsystemic vasculitic neuropathy (NSVN), has been described in many reports since 1985 but remains a poorly understood ...and perhaps under-recognized condition. There are no uniform diagnostic criteria. Classification is complicated by the occurrence of vasculitic neuropathies in many systemic vasculitides affecting small-to-medium-sized vessels and such clinical variants as nonsystemic skin/nerve vasculitis and diabetic/non-diabetic lumbosacral radiculoplexus neuropathy. Most patients present with painful, stepwise progressive, distal-predominant, asymmetric or multifocal, sensory-motor deficits evolving over months-to-years. NSVN is identical to but less severe than systemic vasculitis-associated neuropathies (SVNs). All vasculitic neuropathies are axonal by electrodiagnostic/pathologic criteria. Laboratory testing is unremarkable except for mildly elevated erythrocyte sedimentation rate (ESR) in 50%. Highly elevated ESRs, leukocytosis, rheumatoid factors, and anti-neutrophil cytoplasmic antibodies (ANCAs) raise concern for underlying systemic vasculitis. Without a specific clinical/laboratory marker, the condition depends on nerve biopsy for diagnosis. Biopsies showing necrotizing vasculitis are about 50% sensitive, mandating reliance on "suspicious" changes in many patients. Vasculitic lesions predominate in smaller epineurial vessels and are milder than those in SVNs. The disorder is often accompanied by subclinical involvement of adjacent muscles and skin. NSVN has the potential to spontaneously relapse and remit but neurologic deficits accumulate. No randomized controlled trials have been performed, but one retrospective cohort survey showed combination therapy to be more effective than prednisone alone. Although most patients have a good outcome, more than 30% relapse and 60% have residual pain. Many nosologic, pathogenic, diagnostic, and therapeutic questions remain unanswered.
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