Molecular phylogenetic diversity of bacteria associated with soil of the savanna-like Cerrado vegetation.

The Brazilian savanna-like vegetation of Cerrado is rapidly being converted to pasture and agricultural fields. A 16S rDNA-based approach was taken to study the bacterial community associated with the soil of a native cerrado area (sensu stricto) and an area that has been converted to pasture. The bacterial group most abundantly identified in cerrado sensu stricto soil was the alpha-Proteobacteria while in cerrado converted to pasture the Actinobacteria were the most abundant.

Free internal medicine case-based education through the World Wide Web: how, where, and with what?

Objective: To identify and evaluate electronic internal medicine educational sources and develop a list of major Web sites for interested practitioners.

Material And Methods: From July 1 to August 20, 2006, we searched Web sites derived from academic and nonacademic institutions, medical journal Web sites, and medical Web sites based on selection criteria, including extent of information, update periods, and validity of the source.

Results: We present a list of related Web sites that have been selected as practical, valid, and freely accessed.

Antinuclear antibodies giving the 'multiple nuclear dots' or the 'rim-like/membranous' patterns: diagnostic accuracy for primary biliary cirrhosis.

Background: Serum antinuclear antibodies giving the 'multiple nuclear dots' or the 'rim-like/membranous' patterns are frequently detected by indirect immunofluorescence on HEp-2 cells in patients with primary biliary cirrhosis.

Aim: To assess the accuracy of multiple nuclear dot and rim-like/membranous antinuclear antibodies for the diagnosis of primary biliary cirrhosis.

Methods: Sera from 4371 consecutive patients referred to our laboratory were analysed under code for antinuclear antibodies testing by indirect immunofluorescence on HEp-2 cells.

Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review.

Patients suffering from connective tissue diseases (CTDs) constitute an important subgroup of immunosuppressed patients at risk for developing serious infections. Prophylactic antibiotic administration may decrease infection-related morbidity and mortality burden in patients with CTD, though one needs first to evaluate the overall effect of infection on morbidity and mortality in such patients and the presence of adequate prognostic/risk factors for infection development. Studies focusing on infection-related morbidity and mortality in patients with CTD were reviewed.

World Wide Web hepatitis B virus resources.

Background: Hepatitis B virus infection is a global public health issue, often under-discussed due to social prejudices related to its mode of transmission. The World Wide Web, an increasingly popular means of dissemination of health-related information, can serve continuing medical practitioner awareness and enhance public health literacy.

Objective: The authors sought to investigate the existence of, and evaluate the content of websites offering information on hepatitis B.

Evidence of a genetic basis for the different geographic occurrences of liver/kidney microsomal antibody type 1 in hepatitis C.

Antibodies to liver/kidney microsome type 1 occur in Italian patients with hepatitis C, but rarely develop in North American patients. Our goals were to compare the frequencies of the HLA markers associated with autoimmune expression in Italian and North American patients with chronic hepatitis C and to determine genetic bases for regional differences in antibody production. HLA B8, DR3, DR4, DR7, DR11, DR13, DQ2, and the B8-DR3-DQ2 haplotype were determined by microlymphocytotoxicity and polymerase chain reaction in 105 Italian patients (50 with microsomal antibodies), 100 North American patients (none with microsomal antibodies), and Italian and North American healthy control subjects.

Migration, medical education, and health care: a view from Pakistan.

Purpose: To review physician flows in Pakistan in the contexts of capacity to educate and provide for anticipated health needs.

Method: Literature review was used to refine estimates and assumptions about physician supply and demand. Net physician supply was calculated from data on physician inflows and estimates of migration and other causes of physician loss.

Optimal treatment of leptospirosis: queries and projections.

Although the global burden of leptospirosis remains enormous and new aspects of the disease are constantly recognised, little progress has been achieved in the field of leptospirosis therapeutics and queries regarding the utility of antibiotics in the late severe form of the disease remain. From the currently existing data, conclusions on the efficacy of antibiotic administration in severe or late disease cannot easily be drawn, since clinical trials have different selection criteria and may focus on Leptospira serovars with different virulence. However, as a rule the benefit of the doubt should apply.

Doxycycline-rifampicin: physicians' inferior choice in brucellosis or how convenience reigns over science.

Objectives: Brucellosis treatment is based on sub-optimal, not universally implemented regimens (doxycycline-rifampicin and doxycycline-streptomycin). The authors sought to evaluate specialists' and physicians' attitude towards regimens used, non-medical aspects, and future trends in human brucellosis treatment.

Methods: A questionnaire-based survey of multi-national specialists, physicians, and trainees, was conducted, questionnaire answered following lectures outlining major scientific facts about existing regimens.

Long-term follow-up of patients with adult-onset Still's disease.

Objective: To evaluate the long-term outcome of patients with adult-onset Still's disease (AOSD).

Methods: Eleven patients with AOSD who were regularly followed-up during the past 13 years, even after discontinuation of treatment, were evaluated for the long-term prognosis of the disease and its possible complications.

Results: No exacerbation of the symptoms was noted during therapy.

Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population.

Background: The associations of body mass index (BMI) and chronic disease may differ between Indo-Asian and Western populations. We used Indo-Asian-specific definitions of overweight and obesity to determine the prevalence of these problems in Pakistan and studied the sensitivity and specificity of BMI cutoff values for an association with hypertension and diabetes mellitus.

Methods: We analyzed data for 8972 people aged 15 years or more from the National Health Survey of Pakistan (1990-1994).

Future trends in human brucellosis treatment.

The global burden of human brucellosis remains enormous. Existing treatment options, largely based on experience gained > 30 years ago, are adequate but not optimal. The evolving understanding of the pathophysiology of the disease may augment in designing and evaluating alternative approaches that may prove to be superior.

Geographic data on health inequities: understanding policy implications.

Pappas discusses a new study that examines US health disparities using county-level data.

Brucella as a biological weapon.

Brucella has traditionally been considered a biological weapon. It was the subject of extensive offensive research in the past, and still belongs to category B pathogens on most lists. Its propensity for airborne transmission and induction of chronic debilitating disease requiring combined antibiotic regimens for treatment, its abundance around the world and its vague clinical characteristics defying rapid clinical diagnosis are some of the characteristics that apply to the pathogen's weapons potential.

A 26-year-old man with sternoclavicular arthritis.

A 26-year-old man presented to a hospital in Lima, Peru, with a two-week history of fever, myalgias, and arthralgia of the left hip and right sternoclavicular joint. The authors discuss the work up, diagnosis, and management.

Use of ceftriaxone in patients with severe leptospirosis.

The optimal treatment of severe and late leptospirosis, and even the need for antibiotic treatment in such clinical settings, remains a subject of debate. Twenty-two patients with severe late leptospirosis were treated with intravenous ceftriaxone 2g daily. Twenty-one patients recovered and one patient passed away due to respiratory complications of the disease.

Quinolones for brucellosis: treating old diseases with new drugs.

Although quinolones are theoretically interesting candidates for the treatment of brucellosis, the existing data concerning their efficacy are limited and conflicting. A number of small clinical studies with combination regimens that include quinolones have shown adequacy, but not superiority, although cost-effectiveness, excluding certain disease complications, is an important issue. The emergence of quinolone resistance and its implications is another drawback.

Genetically engineered human mesenchymal stem cells produce met-enkephalin at augmented higher levels in vitro.

We have reported that transplantation of adrenal medullary chromaffin cells that release endogenous opioid peptides into pain modulatory regions in the CNS produce significant antinociceptive effects in patients with terminal cancer pain. However, the usefulness of this procedure is minimal because the availability of human adrenal tissue is very limited. Alternative xenogeneic materials, such as porcine and bovine adrenal chromaffin cells present problems of immune rejection and possible pathogenic contamination.

Immunoglobulin GM and KM allotypes and prevalence of anti-LKM1 autoantibodies in patients with hepatitis C virus infection.

GM and KM allotypes-genetic markers of immunoglobulin (Ig) gamma and kappa chains, respectively-are associated with humoral immunity to several infection- and autoimmunity-related epitopes. We hypothesized that GM and KM allotypes contribute to the generation of autoantibodies to liver/kidney microsomal antigen 1 (LKM1) in hepatitis C virus (HCV)-infected persons. To test this hypothesis, we characterized 129 persons with persistent HCV infection for several GM and KM markers and for anti-LKM1 antibodies.

Jaundice of unknown origin: Remember zoonoses!

Zoonotic diseases are randomly remembered in the differential diagnosis of jaundice of unknown origin. We present four characteristic cases of jaundice attributed to brucellosis and Coxiella burnetii infection and discuss the various pathogenetic pathways implicated in each case. We present a brief review of the relevant literature and, in an era of increasing subspecialization, underline the importance of viewing the "whole picture".

Validity of measures of pain and symptoms in HIV/AIDS infected households in resources poor settings: results from the Dominican Republic and Cambodia.

Background: HIV/AIDS treatment programs are currently being mounted in many developing nations that include palliative care services. While measures of palliative care have been developed and validated for resource rich settings, very little work exists to support an understanding of measurement for Africa, Latin America or Asia.

Methods: This study investigates the construct validity of measures of reported pain, pain control, symptoms and symptom control in areas with high HIV-infected prevalence in Dominican Republic and Cambodia Measures were adapted from the POS (Palliative Outcome Scale).

Health literacy in the field of infectious diseases: the paradigm of brucellosis.

Objectives: Treatment outcome for infectious diseases, including brucellosis, may be influenced by patient awareness of the disease itself, as well as by compounding socioeconomic factors. We attempted to evaluate parameters of patient awareness and disease perception in brucellosis and the ways they influence outcome.

Methods: We used a specifically developed questionnaire assessing various parameters of patient literacy on brucellosis in 70 patients with a new diagnosis of brucellosis.