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This study aimed to determine the ability of different wheat genotypes to form a symbiosis with arbuscular mycorrhizal fungi (AMF) present in the field and the effect of such a symbiosis on disease severity and grain yield. A bioassay was performed during an agricultural cycle under field conditions in a randomized block factorial design. The factors used were application of fungicide (two levels: with and without fungicide) and wheat genotypes (six levels). Arbuscular mycorrhizal colonization, green leaf area index, and severity of foliar diseases were evaluated in the tillering and early dough stages. At maturity, the number of spikes per square metre the number of grains per spike, and the thousand-kernel weight were determined to estimate grain yield. In addition, the spores of Glomeromycota present in the soil were identified by morphological techniques. Spores belonging to 12 fungal species were recovered. Genotypic variability was found for arbuscular mycorrhization, with the cultivars Klein Liebre and Opata exhibiting the highest colonization values. The results obtained show a beneficial effect of mycorrhizal symbiosis on foliar disease resistance and grain yield in the controls, but the results varied in the case of fungicide treatment. A greater understanding of the ecological role of these microorganisms in agricultural systems can lead to more sustainable agronomic practices.

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Effective disease surveillance is critical to the functioning of health systems. Traditional approaches are, however, limited in their ability to deliver timely information. Internet-based surveillance systems are a promising approach that may circumvent many of the limitations of traditional health surveillance systems and provide more intelligence on cases of infection, including cases from those that do not use the healthcare system. Infectious disease surveillance systems built on Internet search metrics have been shown to produce accurate estimates of disease weeks before traditional systems and are an economically attractive approach to surveillance; they are, however, also prone to error under certain circumstances. This study sought to explore previously unmodeled diseases by investigating the link between Google Trends search metrics and Australian weekly notification data. We propose using four alternative disease modelling strategies based on linear models that studied the length of the training period used for model construction, determined the most appropriate lag for search metrics, used wavelet transformation for denoising data and enabled the identification of key search queries for each disease. Out of the twenty-four diseases assessed with Australian data, our nowcasting results highlighted promise for two diseases of international concern, Ross River virus and pneumococcal disease.

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BACKGROUND: Internet-based surveillance systems provide a novel approach to monitoring infectious diseases. Surveillance systems built on internet data are economically, logistically and epidemiologically appealing and have shown significant promise. The potential for these systems has increased with increased internet availability and shifts in health-related information seeking behaviour. This approach to monitoring infectious diseases has, however, only been applied to single or small groups of select diseases. This study aims to systematically investigate the potential for developing surveillance and early warning systems using internet search data, for a wide range of infectious diseases. METHODS: Official notifications for 64 infectious diseases in Australia were downloaded and correlated with frequencies for 164 internet search terms for the period 2009-13 using Spearman's rank correlations. Time series cross correlations were performed to assess the potential for search terms to be used in construction of early warning systems. RESULTS: Notifications for 17 infectious diseases (26.6%) were found to be significantly correlated with a selected search term. The use of internet metrics as a means of surveillance has not previously been described for 12 (70.6%) of these diseases. The majority of diseases identified were vaccine-preventable, vector-borne or sexually transmissible; cross correlations, however, indicated that vector-borne and vaccine preventable diseases are best suited for development of early warning systems. CONCLUSIONS: The findings of this study suggest that internet-based surveillance systems have broader applicability to monitoring infectious diseases than has previously been recognised. Furthermore, internet-based surveillance systems have a potential role in forecasting emerging infectious disease events, especially for vaccine-preventable and vector-borne diseases.

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To determine if there was an association between recto-vaginal group B streptococcus (GBS) colonization and pre-eclampsia, two cross-sectional studies were conducted using statewide hospital databases. The first study analysed data from the state of Florida, USA, and included 190 645 women who were discharged in 2001. This dataset was used to generate the hypothesis that GBS colonization is associated with pre-eclampsia. The second study tested the GBS hypothesis using the records of 577 153 women who delivered in 2004 or 2005 in Texas, USA. Adjusted odds ratios (aOR) for the outcome of pre-eclampsia comparing GBS-positive to GBS-negative women were calculated using logistic regression. The aOR for the association between GBS carriage and pre-eclampsia was 0.71 [95% confidence interval (CI) 0.65-0.77] in the Florida dataset. In the Texas dataset, the overall prevalence of GBS carriage was 14.1% while the overall prevalence of pre-eclampsia was 4.0%. GBS carriers were 31% less likely than non-carriers to have pre-eclampsia (aOR 0.69, 95% CI 0.66-0.72) in Texas. In two large statewide analyses, GBS carriage was inversely associated with pre-eclampsia. A sensitivity analysis revealed that misclassification of GBS status is not a likely explanation of our findings.

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BACKGROUND: Previous US population-based epidemiologic studies of anaphylactic deaths have been limited by small populations and/or few deaths. The objective of this study was to determine the 10-year incidence of death from anaphylaxis in Florida and its descriptive epidemiology. METHODS: Patients who died from anaphylaxis from 1996 to 2005 were identified from ICD-9 and ICD-10 codes on death certificates statewide. Age, race and gender-specific anaphylactic death rates were calculated. RESULTS: There were 89 deaths among Florida residents. The individuals with autopsy confirmed diagnoses, and those with clinical diagnoses only, did not differ with regard to race, anaphylactic triggers or the clinical variables of lung and heart disease. Annual death rate for anaphylaxis in Florida was 5.02/10 000 000. The relative risk of death from anaphylaxis was 14.09 for individuals > or =65 years old (P = 0.0000002) and 6.38 for individuals 35-64 years old (P = 0.0019) compared with those who were 5-14 years of age. Deaths among Florida residents that occurred in emergency rooms or outpatient settings were 2.11 times as likely to be anaphylactic deaths than deaths that occurred in inpatient settings (P = 0.0026). The ratios of anaphylactic deaths to total deaths in March and April and in July and August were greater than the ratios for the other bimonthly periods (P = 0.02). CONCLUSION: Death from anaphylaxis in Florida was more likely to occur in older individuals, in an emergency department, and in the months of March and April and July and August.

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BACKGROUND: The incidence of sarcoidosis is different among distincts geographic areas, probably due to climate variations. At present, there is in Spain few studies that correlate the observed cases with a concrete population. The aim of this study is to investigate the epidemiology of sarcoidosis in Leon"s sanitary area, in comparison with others spanish geographic areas. Moreover, we present a description of the clinic and radiologic characteristics of the studied cases. METHOD: We analyzed the cases of sarcoidosis attended in the area from 1993 until 2001. The incidence, age, sex, place of residence and clinic-radiologic characteristics are described. The population data of the sanitary area to calculate the incidence were obtain from the Insalud"s data base. The climatology values were collected from the National Institute of Meteorology. RESULTS: The incidence of sarcoidosis in Leon"s sanitary area was 1,37/100.000 habitants/year, and was similar to that founded in Catalonia, Galizia and others provinces of the Castilla and Leon community. We observed a higher incidence of sarcoidosis in female patients, because of predominance of cases among women aged forty years or more. No differences between rural and urban populations were founded. The clinical characteristics were similar those described in other geographics areas of our country. CONCLUSION: Although there are climate differences between the geographics areas of Spain, these aren"t enough to explain his influence in the incidence of sarcoidosis, which is similar in all of them, at least in the middle north of the country.

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INTRODUCTION: Ten new cases of Listeria monocytogenes meningitis (LMM) in the adult are here reported. Also, a review is made of reported cases by Spanish authors in the last 30 years, with an analysis of the predisposing conditions and mortality rate from this type of bacterial meningitis (BM) throughout the study period. METHODS: The reported cases met two criteria: CSF biochemistry consistent with BM and positive CSF and/or blood culture for Listeria monocytogenes. The bibliographic search of previously reported cases was made through Medline. Cases were divided into two periods: from 1974 to 1988, and from 1989 onwards. Predisposing conditions, therapy, and mortality were analyzed and compared between the two study periods. RESULTS: The features of the cases reported here did not differ from those in the cases reported so far, with the single feature of two HIV-positive patients. Of the analyzed cases, 73% had some predisposing condition. Thirty-eight and 39% of the total of patients and of patients with some predisposing conditions, respectively, died, with a statistically significant difference (p < 0.001) between those with and without predisposing conditions. Among the treated patients, 87% received either ampicillin or penicillin and the mortality rate among these patients was 30%. No differences regarding mortality was rate observed between the two study periods, the total of cases of between those treated with the aforementioned antibiotics. CONCLUSIONS: Patients with LMM commonly have a predisposing condition. The mortality rate in this type of BM is still high among those treated with ampicillin or penicillin, and a decrease in the mortality rate was not observed when the reported cases in Spain in the last 30 years were analyzed. The optimal therapy for this condition is still to be defined.

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BACKGROUND: Vocal cord dysfunction can coexist with or masquerade as asthma. Vocal cord dysfunction, when coexistent with asthma, contributes substantially to the refractory nature of the respiratory problem. OBJECTIVE: To report a case of an asthmatic patient with vocal cord dysfunction and a previously unreported unique expiratory flow volume curve. RESULTS: A 16-year-old female, known to have asthma, developed increased frequency of her asthma exacerbations. Spirometry, during symptoms, showed an extrathoracic airway obstruction with a reproducible unique abrupt drop and rise in the expiratory flow volume loop. Laryngoscopy showed adduction of the vocal cords during inspiration and expiration. CONCLUSIONS: We report a unique expiratory flow volume curve in an asthmatic with vocal cord dysfunction that resolved with panting maneuvers. Speech and psychological counseling helped prevent future attacks.

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Vocal cord dysfunction (VCD) is a respiratory disorder characterized by paradoxical closure of the vocal cords during the respiratory cycle leading to obstructive airway symptoms. The presenting symptoms vary from stridor to wheezing. VCD may coexist with asthma or masquerade as asthma. Misdiagnosis of VCD as asthma leads to inappropriate use of systemic steroids with its adverse effects, frequent emergency department visits, hospitalization, and, rarely, intubation and tracheostomy. Attenuation of the inspiratory flow volume loop on spirometry is suggestive of VCD. Laryngoscopic demonstration of the paradoxical vocal cord movements during an acute attack is the gold standard for the diagnosis of VCD. Patient education, speech therapy, and psychologic counseling are the therapeutic tools for treatment.

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OBJECTIVE: Menopause may be associated with new onset psychiatric symptoms or may exacerbate or heighten preexisting psychiatric problems in women. We present a model center for midlife women, with a multidisciplinary approach to treating this population, and patients' perceptions of satisfaction with treatment received during referral visits to an outpatient psychiatry clinic. DESIGN: In this study, 59 patients were referred from their primary care provider at the midlife center for evaluation by a faculty psychiatrist in an outpatient setting. A brief telephone interview was administered within 1 year of initial evaluation, using items from the Client Satisfaction Questionnaire-8 (CSQ-8) to assess patient satisfaction with psychiatric services received during the referral visits. Findings were based on responses provided by 50 women who were successfully contacted by telephone for the follow-up assessment. RESULTS: For this sample, the mean total client satisfaction score was 27.8 (s = 5.4) of a possible score of 32, which indicated that most women who were referred for psychiatric services reported a positive experience with the services provided by outpatient psychiatrists and reported being very satisfied with their treatment. CONCLUSIONS: We feel that this model center represents a unique way to identify and treat psychiatric disorders in a patient population that may be at high risk for depression and other psychiatric disorders.

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BACKGROUND: Oropharyngeal candidiasis is a well-described side effect of inhaled corticosteroids. Nevertheless, few cases of esophageal candidiasis have been reported. OBJECTIVE: To present a patient with esophageal candidiasis associated with inhaled corticosteroids. METHODS: Case report. RESULTS: Our patient is a 70-year-old white woman with a 20-year history of intrinsic asthma, well controlled on triamcinolone acetonide 400 micrograms, ipratropium bromide 36 micrograms, and pirbuterol acetate 400 micrograms, each inhaled four times daily. She reported no oral steroid use for > 4 years and that she always rinsed her mouth following triamcinolone acetonide inhalation. The patient had gastritis with peptic ulcer disease in the past and developed worsening dyspeptic pain and heartburn. Following discontinuation of cimetidine and initiation of ranitidine without improvement, esophagogastroduodenoscopy was performed. Several small white patches in the mid and distal esophagus could not be removed with pressure. A biopsy confirmed the diagnosis of candidal esophagitis. Following a 4-week course of fluconazole, the patient was clinically improved and follow-up esophagogastroduodenoscopy was normal. There was no evidence of underlying cellular immunosuppression, malignancy, or diabetes mellitus and no history of recent antibiotic usage. Delayed skin tests revealed 5 x 5 mm induration to dermatophytin. Delayed hypersensitivity to Candida and mumps tests was absent. There was strong in vitro lymphocyte transformation and a positive immediate skin test response to Candida. ELISA for human immunodeficiency virus was negative. T and B cell counts were normal with CD4 = 630/mm3, CD8 = 520/mm3, and absolute B cell = 120/mm3. It is possible that this patient's immediate hypersensitivity response to Candida suppressed her delayed response. Candidal esophagitis is a rare, yet important, complication of inhaled corticosteroid use. CONCLUSION: Immunocompetent patients on inhaled corticosteroids with medically unresponsive symptoms of esophagitis should be investigated for esophageal candidiasis.

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BACKGROUND: Treatment with the atypical antipsychotic drug clozapine appears to be associated with an increased incidence of urinary incontinence (UI). We posited that the potent anti-alpha-adrenergic effects of clozapine were involved, and hence that an alpha-adrenergic agonist would reduce UI. We tested this hypothesis by using ephedrine, an approved alpha-adrenergic agonist. METHOD: Fifty-seven inpatients with schizophrenia or schizoaffective disorder (DSM-IV) who met the Kane criteria for being treatment refractory were treated with clozapine (75-900 mg/day). Patients who developed UI were then openly treated with ephedrine in increasing doses until UI was attenuated or a dose of 150 mg/day was attained. RESULTS: Seventeen patients developed UI as evidenced by either urine-stained sheets/clothing or direct patient reports. In 2 cases, the UI was sufficiently severe that adult diapers had to be used. Comparison of patients who developed UI and those who did not showed that UI was associated with female gender and with concomitant treatment with typical antipsychotic drugs. One patient was treated with a behavioral program, but the remaining 16 patients were treated with ephedrine. Ephedrine treatment was very effective, with 15/16 patients showing improvement within 24 hours after reaching maximum ephedrine dosage. Twelve of 16 (including the 2 most severe) eventually had a complete remission of their UI. In the remaining 4 patients, 3 had a reduction in the frequency of UI and 1 showed no response. These benefits have been maintained over the course of 12 months of subsequent treatment for several patients. There were no side effects associated with the use of ephedrine nor were there any changes in neuropsychiatric status. CONCLUSION: Ephedrine appears to be a safe and effective treatment clozapine-associated UI. By inference, it is likely that clozapine may cause UI via its anti-alpha-adrenergic properties.

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Atopic dermatitis is characterized by elevated serum IgE concentrations and dysregulation of T-lymphocyte function. To examine the pattern of cytokine production associated with elevated IgE levels, phorbol ester plus ionomycin-stimulated production of interleukin (IL)-4, IL-5, and interferon-gamma (IFN-gamma) by blood mononuclear cells from 16 patients with atopic dermatitis was compared with that of 18 healthy subjects. Spontaneous in vitro IgE production was also studied longitudinally in patients receiving placebo or daily treatment with 0.05 mg/m2 IFN-gamma. Spontaneous in vitro IgE production and mitogen-driven IL-4 and IFN-gamma synthesis did not differ when patients were receiving interferon treatment compared with no treatment. Furthermore, ionomycin plus phorbol ester-stimulated mononuclear cells from patients with atopic dermatitis produced less IL-4 and more IFN-gamma than did cells from healthy subjects. IL-5 production by cells from patients with atopic dermatitis did not differ from that of cells from healthy subjects. The ratio of IL-4 to IFN-gamma produced in vitro was significantly lower (p = 0.04) in the cells of patients with atopic dermatitis (0.9) as compared with those of healthy subjects (2.7). The findings suggest that when circulating T cells are stimulated under antigen presenting cell-independent conditions, atopic dermatitis is not characterized by the shift in the reciprocal relationship between IL-4 and IFN-gamma production, which has been postulated to explain the pathogenesis of IgE elevation and the therapeutic action of IFN-gamma in patients with atopic dermatitis.

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RATIONALE AND OBJECTIVES: The author evaluated the hypothesis that the incidence of allergic-type adverse events among atopic and asthmatic cardiac angiography patients would be lower in patients randomized to receive nonionic versus ionic lower osmolal contrast medium. METHODS: Enrollment criteria included a history of food allergy, asthma, atopic dermatitis or pollinosis but not prior contrast media-induced adverse events. One hundred forty-two patients enrolled were randomized to receive either the ionic agent ioxaglate or nonionic iopamidol. Patients and investigators were masked. Sixty-eight patients received iopamidol, and 74 received ioxaglate. Group means were compared using the unpaired Student's t test. Contingency tables were analyzed using chi-square or Fisher's exact test. RESULTS: Allergic-type adverse events (excluding flushing, warmth, and cardiac events) were recorded in 8 of 68 patients in the iopamidol group versus 19 of 74 in the ioxaglate group. Ioxaglate was more likely to be associated with a reaction than iopamidol (P < 0.05, chi-square test). Iopamidol was more likely to be associated with flushing when considered independently (38 of 68) than use ioxaglate (24 of 74)(P < 0.005, chi-square test). There was no difference in the incidence of cardiac events, or any combination of allergic-type adverse events, cardiac events, and flushing in patients who received iopamidol or ioxaglate. CONCLUSION: In this double-masked study, iopamidol caused fewer allergic-type adverse events (excluding flushing and cardiac events) but more flushing than ioxaglate in patients with a history of asthma or atopic disease. When cardiac events also were considered, there was no difference in the incidence of reactions after iopamidol and ioxaglate.

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BACKGROUND: Anaphylactic reactions usually occur seconds to minutes after exposure to the relevant antigen. Late onset, biphasic, and protracted anaphylaxis also occur. The incidence of prolonged responses is unknown, but may be common. In all nonfood-related cases, levels of tryptase were not measured during protracted episodes. Tryptase has been shown to be a useful specific indicator of mast cell involvement in anaphylaxis. OBJECTIVE: To determine whether mast cell activation, as demonstrated by elevated serum tryptase concentrations, can occur in protracted anaphylaxis. METHODS: Case report; serum tryptase concentrations were measured by radioimmunoassay. RESULTS: A 33-year-old white man developed hives three days prior to admission. The next day, vomiting, abdominal cramps and bloating, lower lip swelling, wheezing, and a feeling of tightness over his throat and chest were experienced. The gastrointestinal symptoms continued until his hospital admission. One day prior to admission, he developed transient lightheadedness. On admission he had generalized urticaria and abdominal tenderness. Blood pressure of 115/58 mm/Hg rose to 180/60 and heart rate fell from 107/min to 90/min following 2.2 L of intravenous fluids. Serum tryptase levels were elevated at 7.2 ng/mL and 5.1 ng/mL on the first and second hospital days (fourth and fifth days of symptoms). Serum tryptase was < 1.0 ng/mL 5 months later. CONCLUSIONS: The elevated serum tryptase levels at 96 and 120 hours following the onset of symptoms strongly suggest that continued mast cell degranulation can occur during protracted anaphylaxis. This strengthens the argument that mast cell activation is important in the pathophysiology of protracted anaphylaxis.

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The relationship of angiotensin converting enzyme activity and angiotensin II to the inflammatory process in diseases such as sarcoidosis remains unclear. We hypothesize that granuloma macrophages regulate inflammation by release of angiotensin converting enzyme, which produces angiotensin II, and that angiotensin II in turn modulates monocyte/macrophage activity. Since tyrosine kinase catalyzes phosphorylation of tyrosine residues in proteins and is important in signal transduction and cellular activation, we further postulated that monocyte tyrosine kinases may play a role in the regulation of this process. Mononuclear cells from 11 healthy subjects were assayed for tyrosine kinase activity in the presence and absence of angiotensin II. In addition, tyrosine-specific phosphorylation of cellular proteins was also determined. Angiotensin II increased tyrosine kinase activity in a concentration-dependent manner. The maximal stimulation, which varied from 31 to 506%, was achieved following incubation of cells with 10(-4) M angiotensin II. Angiotensin II also increased the tyrosyl-phosphorylation of three proteins with molecular weights of 57, 62, and 63 kDa. We conclude that tyrosine kinase activity of adherent mononuclear cells and tyrosine phosphorylation of certain protein(s) may be involved in angiotensin II regulation of inflammatory processes.

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