Tuberculosis Recurrence after Completion Treatment in a European City: Reinfection or Relapse?

Background

Tuberculosis (TB) recurrence can be due to reinfection or relapse. The contribution of each to TB incidence and the factors associated with recurrence are not well known. Effectiveness of TB control programs is assessed in part by recurrence rates. The aim of this study was to establish the recurrence rate of TB in Barcelona, the associated risk factors and the role of reinfection.

Methods

A population-based retrospective longitudinal study was performed in Barcelona, Spain. TB patients with positive culture results who completed treatment between Jan 1^st, 2003 and Dec 31^st, 2006 were followed-up until December 31st, 2009 by the TB Control Program. The incidence rate of recurrence was calculated per person-year of follow-up (py). Kaplan-Meier and Cox regression methods were used for the survival analysis by calculating the hazard ratio (HR) with 95% confidence intervals (CI).

Results

Of the 1,823 TB cases identified, 971 fulfilled the inclusion criteria and 13 (1.3%) had recurrent TB. The recurrence rate was 341 cases per 100,000 py, 13 times higher than the TB incidence of the general population. Likelihood of TB recurrence at the 1st, 3rd and 5th year of follow-up was 0.1%, 1.4% and 1.6%, respectively. Factors associated with recurrence were HIV infection (HR: 4.7, CI: 1.4–15.7), living in the inner city district (HR: 3.9, CI: 1.3–11.8) and history of TB treatment (HR: 5.2, CI: 1.7–16.2). Genotyping results of recurrent cases were available for 6 patients (3 reinfections and 3 relapses).

Conclusion

The rate of TB recurrence in Barcelona is low and most episodes occur within the first three years. Patients at higher risk of recurrence are co-infected with HIV, living in neighborhoods with high TB incidence or with a history of TB treatment. When available, genotyping results help determine whether the recurrence is due to reinfection or relapse.     

Bedside Evaluation of the Functional Organization of the Auditory Cortex in Patients with Disorders of Consciousness

To measure the level of residual cognitive function in patients with disorders of consciousness, the use of electrophysiological and neuroimaging protocols of increasing complexity is recommended. This work presents an EEG-based method capable of assessing at an individual level the integrity of the auditory cortex at the bedside of patients and can be seen as the first cortical stage of this hierarchical approach. The method is based on two features: first, the possibility of automatically detecting the presence of a N100 wave and second, in showing evidence of frequency processing in the auditory cortex with a machine learning based classification of the EEG signals associated with different frequencies and auditory stimulation modalities. In the control group of twelve healthy volunteers, cortical frequency processing was clearly demonstrated. EEG recordings from two patients with disorders of consciousness showed evidence of partially preserved cortical processing in the first patient and none in the second patient. From these results, it appears that the classification method presented here reliably detects signal differences in the encoding of frequencies and is a useful tool in the evaluation of the integrity of the auditory cortex. Even though the classification method presented in this work was designed for patients with disorders of consciousness, it can also be applied to other pathological populations.     

ABA activates ADPR cyclase and cADPR induces a subset of ABA-responsive genes in Arabidopsis

Cyclic ADP-ribose (cADPR) was previously shown to activate transient expression of two abscisic acid (ABA)-responsive genes in tomato cells. Here, we show that the activity of the enzyme responsible for cADPR synthesis, ADP-ribosyl (ADPR) cyclase, is rapidly induced by ABA in both wild-type (WT) and abi1-1 mutant Arabidopsis plants in the absence of protein synthesis. Furthermore, in transgenic Arabidopsis plants, induced expression of the Aplysia ADPR cyclase gene resulted in an increase in ADPR cyclase activity and cADPR levels, as well as elevated expression of ABA-responsive genes KIN2, RD22, RD29a, and COR47 (although to a lesser extent than after ABA induction). Genome-wide profiling indicated that about 28% of all ABA-responsive genes in Arabidopsis are similarly up- and downregulated by cADPR and contributed to the identification of new ABA-responsive genes. Our results suggest that activation of ADPR cyclase is an early ABA-signaling event partially insensitive to the abi1-1 mutation and that an increase in cADPR plays an important role in downstream molecular and physiological ABA responses.     

Is osmotic adjustment required for water stress resistance in the Mediterranean shrub Atriplex halimus L?

The effect of water stress was investigated in plants from two populations of Atriplex halimus L: Tensift issued from a salt-affected coastal area and Kairouan, originating from an inland dried site. Water deficit was applied by withholding water for 22 days. Shoot dry weight (shoot DW), leaf relative water content (RWC), turgid weight to dry weight ratio (TW/DW), osmotic potential (psis), osmotic adjustment (OA), proline, glycinebetaine, and sugar content were determined 1, 8, 15 and 22 days after withholding watering. Water stress induced a decrease in shoot DW, RWC, psis, and TW/DW, but an increase in glycinebetaine and sugar leaf contents. The decrease of psis and TW/DW was more marked in Kairouan than in Tensift. At the end of the stress period, Kairouan showed a greater OA compared with Tensift. However, the contribution of net solute accumulation (OAacc) was similar in both populations in response to stress. Water stress resistance could thus not be associated with higher OA, although the ability of plants to regulate these metabolic and physiological functions could play an important role under harmful conditions. The possible roles of osmolyte accumulations are discussed in relation to the specific physiological strategy of water-stress-resistance in this species.     

Mercury determination in prehispanic Colombian biological samples: first experiences and investigation perspectives

Mercury is useful as a tracer of environmental pollution levels. We measured mercury levels in hair from two human mummies (XII and XIV centuries, respectively) and from a stag (Odocoileus virginianus). The total and inorganic mercury levels found in the samples were very low. This findings indicated a minimal exposure to mercury in food and its absence in the atmosphere. Mercury levels can be used to explore the relationship between humans and environment, especially after metallurgy appeared, and to assess environmental contamination in different periods.     

NaCl alleviates polyethylene glycol-induced water stress in the halophyte species Atriplex halimus L

Atriplex halimus L. is a C4 xero-halophyte species well adapted to salt and drought conditions. To collect information on the physiological impact of low salt levels on their water-stress resistance, seedlings were exposed for 6 d to nutrient solution containing either 0% or 15% polyethylene glycol 10,000 (PEG), in the presence or in the absence of 50 mM NaCl. Similar experiments were performed with one PEG-resistant and one PEG-sensitive selected cell line exposed for 50 d to 0% or 15% PEG on standard Linsmaier and Skoog (LS) medium, on LS medium supplemented with 50 mM NaCl, or on Na+-free medium. NaCl mitigated the deleterious impact of PEG on growth of both whole plants and PEG-sensitive cell lines and improved the ability of stressed tissues to perform osmotic adjustment (OA). Water stress reduced CO2 net assimilation rates quantified in the presence of high CO2 and low O2 levels (A), stomatal conductance and transpiration, but NaCl improved water use efficiency of PEG-treated plants through its positive effect on A values, especially in young leaves. PEG increased the internal Na+ concentration. The resistant cell line accumulated higher concentration of Na+ than the PEG-sensitive one. The complete absence of Na+ in the medium endangered the survival of both cell lines exposed to PEG. Although Na+ by itself contributed only for a small part to OA, NaCl induced an increase in proline concentration and stimulated the synthesis of glycinebetaine in response to PEG in photosynthetic tissues. Soluble sugars were the main contributors to OA and increased when tissues were simultaneously exposed to PEG and NaCl compared with PEG alone, suggesting that Na+ may influence sugar synthesis and/or translocation.     

Evaluation of time-to-pregnancy as a measure in environmental epidemiology

Since the late 80's, time to pregnancy has been used in environmental epidemiology to explore adverse effects of different exposures. The advantages of this measure and additional elements to be considered in the performance of this type of studies are reviewed. Study design includes the following steps: population selection, sample size, outcome measurement, statistical analyses and sources of bias. Guidelines were suggested for the properly development of this type of study.