Apparent Infection Research Articles

Bacterial Bioagents and Compost as Two Tools for Management of Eggplant Fusarium Wilt

Isolation trials from the roots of wilted eggplant plants grown at five governorates yielded many fungal isolates. The isolates of the fungus F. oxysporum were selected to test their pathogenicity and Kalubia isolate was the most virulent one. The fungus was virulent to eggplant and no apparent infection was found in case of the other seven tested plants. Therefore, the fungus F. oxysporum named Fusarium oxysporum Schlecht. f.sp. melongenae Fomg. All the tested bioagents and compost tea caused significant reduction to the linear growth of F.o. f.sp. melongenae and the germinated conidiospores compared with control treatment. Adding the two tested bioagents, i.e. B. subtilis and P. fluorescens each alone or in combination to the infested soil with the causal pathogen resulted in significant reduction to eggplant wilt with significant increase to plant height as well as the number of fruits and their weight / plant compared with control treatment. Moreover, amending the soil with compost increased the efficiency of the two bioagents in reducing the disease and increasing the produced fruit yield compared with the clay soil only. In addition, the fungicide Topsin M-70 was the superior treatment in reducing the severity of the disease and increasing plant height and the produced fruit yield followed by the combination of B. subtilis and P. fluorescens. The total phenol compounds were greatly increased in the bacterial treated plants and compost as compared to the control (untreated plants with the bioagents) and those infested with the pathogen only.

Management of pepper verticillium wilt by combinations of inducer chemicals for plant resistance, bacterial bioagents and compost

Inducer resistance chemicals (IRCs) Bion (BTH), chitosan and salicylic acid, bacterial bioagents, i.e. Bacillus chitinosporus, B. megaterium, B. pumilus, B. subtilis, B. thuringiensis, Pseudomonas fluorescens and P. putida and compost tea caused a reduction to the linear growth of the fungus Verticillium dahliae, in culture plates. In general, P. fluorescens followed by B. subtilis were the most efficient in reducing the linear growth of V. dahliae. The viability of microsclerotia of V. dahliae was greatly reduced by the tested bacterial bioagents. In addition, B. megaterium, B. subtilis, P. fluorescens and P. putida were the most efficient bioagents, where no microsclerotia germinated three weeks after treatment with these bioagents. In addition, few of microsclerotia germinated when treated with B. chitinosporus, B. pumilus and B. thuringiensis. However, all the microsclerotia of the control treatment were viable even three weeks after treatment with bioagents. The combination and use singly of BTH, B. subtilis, P. fluorescens and compost resulted in a reduction of verticillium wilt in pepper and increase of fruit, photosynthetic pigments, and vitamin-C compared with the control treatment (infested with the causal fungus). Compost was the most efficient of single tactics in disease management. Moreover, no apparent infection was detected when BTH, the two bioagents B. subtilis and P. fluorescens and compost were used together and the fruit yield, photosynthesis pigments and vitamin-C were, similar to the control treatment (un-infested soil). Photosynthesis pigments including chlorophyll a, chlorophyll b and carotenoids as well as free and total ascorbic acid (vitamin-C) were greatly increased due to the tested treatments, i.e. BTH, both bioagents and compost in pepper plants grown in infested soil compared with those of untreated plants (grown in infested soil only). Compost was the best single treatment for minimizing the reduction in photosynthesis pigments in plants grown in infested soil with V. dahliae, as well as free and total ascorbic acid compared with plants grown in soil infested with the causal fungus without any another treatment.

Chapter 7 - HIV-associated neurocognitive disorder

Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) affects roughly half the HIV-positive population. The symptoms of cognitive slowing, poor concentration, and memory problems can impact on everyday life. Its diagnosis is validated where possible by identifying deficits in two cognitive domains on neuropsychologic testing in patients either with or without symptoms. Corroborating evidence may be found on imaging, blood tests, and cerebrospinal fluid analysis, though sensitive and specific biomarkers are currently lacking. The introduction of combined antiretroviral therapy in the 1990s has generated a therapeutic paradox whereby the number of severe cases of HAND has fallen, yet milder forms continue to rise in prevalence. New emphasis has been placed on identifying the cause of apparent ongoing HIV infection and inflammation of the central nervous system (CNS) in the face of durable systemic viral suppression, and how this equates to the neuronal dysfunction underlying HAND. The interaction with aging and comorbidities is becoming increasingly common as the HIV-positive population enters older adulthood, with neurodegenerative, metabolic, and vascular causes of cognitive impairment combining and probably accelerating in the context of chronic HIV infection. Therapies targeted to the CNS, but without neurotoxic side-effects, are being investigated to attempt to reduce the likelihood of developing, and improving, HAND.

Status and management of banded leaf and sheath blight of Little Millet caused by Rhizoctonia solani Kühn with chemicals

Mean disease incidence and frequency of occurrence ranging from 6.9 to 18.8% and 26.1 to 75.4%, respectively were recorded during survey. Highest average BLSB incidence (13.7%) and disease frequency (61.1%) were recorded in the farmers field of Satna district, whereas lowest values were recorded at Anuppur district of Madhya Pradesh. Foliar spray of two non-conventional chemicals salicylic acid (SA) and sodium fluoride (SF) in 100, 150 and 200 ppm along with one fungicide Validamycin (0.2%) were evaluated against BLSB during 2012–13 and 2013–14. Lowest relative lesion height (19.0%) and highest grain yield (967.5 kg ha−1) were recorded in the treatment of Validamycin. Average apparent infection rate varied 0.081 to 0.201%/day in all the treatments. Both the non-conventional chemicals were found to reduce the severity of the disease, infection rate and enhancing the grain yield possibly due to induction of resistance in host plant against the pathogen. Maximum reduction in relative lesion height (50.5%) and highest grain yield (937.5 kg ha−1) was recorded in foliar spray of salicylic acid (200 ppm) followed by sodium fluoride (200 ppm).

Wilt Disease of Tara (<i>Caesalpinia spinose</i> Molina Kuntz) in Nursery in the Inter Andean Valley of Cochabamba, Bolivia

Tara (Caesalpinia spinose Molina Kuntz) is a native plant of the Bolivian Andes. A number of projects have promoted the cultivation of this species over the last 20 years, in efforts to make use of its medicinal, food and industrial properties. However, as tara plantations have grown, so too has the incidence of disease affecting the species, leading to economic losses. The aim of the present work was to identify the causal agent of wilting in tara, and to determine the incidence of the disease in nursery-grown plants. Three experimental plots (R1-R3) were established in plantlet production bedsat the ESFOR nursery in order to assess the incidence of wilting. Plant spacing was 1 × 1 m. At the two leaf stage, samples of diseased and apparently healthy plants were taken to the laboratory for the isolation of pathogens. Both the apparently healthy and diseased plants gave rise to the same kinds of fungal colony on PDA. Microscopic examination revealed microconidia, macroconidia, phialides and chlamydospores suggesting the causal agent to be Fusarium oxysporum. Over the (up to) 84-day period following thinning, the incidence of wilting for 2010 was R1 = 2.56%, R2 = 3.15% and R3 = 2.22% per 14 days, and for 2013 it was R1 = 1.24%, R2 = 2.45% and R3 = 2.13% per 14 days; the apparent infection rates for 2010 were rR1 = 0.0003/day, rR2 = 0.0003/day and rR3 = 0.0003/day, and for 2013 they were rR1 = 0.0003/day, rR2 = 0.0004/day and rR3 = 0.0003/day. These values are characteristic of monocyclic epiphytic fungi such as F. oxysporum.

Identification of opossums Didelphis aurita (Wied-Neuweid, 1826) as a definitive host of Sarcocystis falcatula-like sporocysts.

This study was conducted to identify the Sarcocystis species that infect the opossum Didelphis aurita in order to determine which sporocysts they are excreating in to the environment and help determine the role of D. aurita in the epidemiology of Sarcocystis. Sporocysts were obtained from intestinal tracts of 8 of 13 D. aurita trapped in Rio de Janeiro state, Brazil, and were orally inoculated into Melopsittacus undulatus and Balb/c nude Mus musculus. Portions of organs and muscles were processed for histology, immunohistochemistry, transmission electron microscopy (TEM), and PCR using primers JNB 33/54, and ITS. Amplification products were subjected to RFLP using DraI and HinfI. Some birds were euthanized 6, 7, 13, 16, and 24days after inoculation (DAI). All other birds and all mice were euthanized 60 DAI. Schizonts were observed in the lungs using histology and immunostaining in birds examined prior to 60 DAI. Sarcocysts with a ~ 1.5-μm-thick wall were found in the breast, thigh, and tongue of some birds. Sarcocystis asexual stages were isolated in cell cultures inoculated with sporozoites. Parasite DNA isolated from bird tissues and cell cultures demonstrated that S. falcatula-like parasites were present in all samples derived from positive opossums. Asexual stages molecularly characterized as S. lindsayi-like were isolated in cell culture from one opossum with an apparent multiple infection. This study demonstrated that D. aurita is a definitive host for S. falcatula-like parasites and indicates that S. lindsayi-like parasites can be found in coinfections of this opossum species.

Trichinella spp. biomass has increased in raccoon dogs (Nyctereutes procyonoides) and red foxes (Vulpes vulpes) in Estonia

BackgroundRaccoon dogs and red foxes are well-adapted hosts for Trichinella spp. The aims of this study were to estimate Trichinella infection prevalence and biomass and to investigate which Trichinella species circulated in these indicator hosts in Estonia.MethodsFrom material collected for evaluating the effectiveness of oral vaccination program for rabies eradication in wildlife, samples from 113 raccoon dogs and 87 red foxes were included in this study. From each animal, 20 g of masseter muscle tissue was tested for the presence of Trichinella larvae using an artificial digestion method. The Trichinella larvae were identified to species level by multiplex polymerase chain reaction method.ResultsThe majority of tested animals were infected with Trichinella spp. The parasite species identified were T. nativa and T. britovi. The apparent infection prevalence was 57.5% in raccoon dogs and 69.0% in red foxes, which were higher than previous estimates. In addition, the larval burden had also increased in both hosts. We estimated that in 2011–2012, the Trichinella spp. biomass was more than 15 times higher in raccoon dogs and almost two times higher in red foxes than in 1992–2000 (based on mean larval burden), and almost 20 times higher in raccoon dogs and almost five times higher in red foxes than in 2000–2002 (based on median larval burden).ConclusionsRaccoon dogs and red foxes are relevant reservoirs for Trichinella spp. in Estonia. The biomass of Trichinella circulating in sylvatic cycles was substantial and had increased: there is substantial infection pressure in the sylvatic cycle.

Effect of cultivar susceptibility and planting date on narrow brown leaf spot progression in rice

Narrow brown leaf spot (NBLS) of rice (Oryza sativa L.) is caused by Cercospora janseana (Racib). O. Const. (Synonyms: Cercospora oryzae Miyake, Passalora janseana Racib. U.). Experimental studies were conducted in Louisiana to study NBLS progression in resistant to very susceptible cultivars at different planting dates. The very susceptible cultivars CL131 and Cheniere, susceptible CL111, moderately susceptible CL151, and resistant cultivars, Della and Presidio were planted in mid-April and mid-May plantings. Weekly disease assessments began at 45 days after sowing (DAS) and the final disease assessments were done at 109 DAS. Results revealed that AUDPC and final NBLS severity were greater in very susceptible and susceptible cultivars as compared to resistant cultivars. The AUDPC for mid-May plantings were greater for all cultivars. AUDPC increased with increasing susceptibility rating in the mid-April planting. Early onset of NBLS was observed in very susceptible and susceptible cultivars regardless of planting date. Significant interactions were detected between cultivar and planting date for AUDPC and final disease but were non-significant for apparent infection rate. Apparent NBLS infection rate was greatest in the highly susceptible Cheniere and CL131 in the mid-May planting. Apparent infection rates were less in the susceptible and moderately susceptible cultivars and least for the resistant cultivars in both plantings.

Resistance status of cultivated potatoes to early blight (Alternaria solani) in Denmark

Field experiments were conducted in 2015 and 2016 to classify the resistance level to early blight of the main potato cultivars in Denmark. A total of 38 cultivars were used. The experiment was designed as a randomized complete block design (RCBD) with four replicates. The potatoes were inoculated by spreading barley (Hordeum vulgare) kernels infested with Alternaria solani and A. alternata. Disease assessment was done at weekly intervals starting from the onset of the first symptoms. The disease progress curves (DPC) of early blight on the cultivars were compared to that of Bintje. A multivariate analysis was performed with the apparent infection rate, the relative area under the disease progress curve, the time to reach 50% severity, the daily defoliation, the disease severity in the middle of the epidemic and the duration of the epidemic to classify the resistance level of the cultivars. The analysis of the DPC of the cultivars showed that none of the cultivars was completely resistant to early blight. However, the epidemic development differed between the different cultivars. The resistance levels of the cultivars were thus classified into classes I, II, III and IV interpreted as ‘very susceptible’, ‘susceptible’, ‘moderately slow blighting’ and ‘slow blighting’, respectively. All the late maturity cultivars were classified as class IV, and the earlier maturing cultivars were either class I or class II.

Screening St. Augustinegrass Genotypes for Brown Patch and Large Patch Disease Resistance

Two diseases of St. Augustinegrass (SAG) [Stenotaphrum secundatum (Walt.). Ktze.] are caused by different anastomosis groups (AGs) of Rhizoctonia solani. Brown patch (BP) is a foliar disease of little economic importance, and large patch (LP) causes leaf sheath rot and death of affected turfgrass shoots and stolons. St. Augustinegrass genotypes were inoculated with an isolate that causes BP and an isolate that causes LP in repeated experiments. Three disease severity parameters were calculated from data recorded from each genotype, including final disease severity (Y), area under the disease progress curve (AUDPC), and the apparent infection rate (r L ). The inoculation protocol reliably produced symptoms, and both r L and AUDPC provided statistically significant separations between genotypes for their susceptibility to BP and LP. A significant interaction between isolate and genotype was observed, and some genotypes that were very susceptible to LP were among the least susceptible to BP. These data suggest that differences in resistance to LP can be quantified in SAG genotypes, but genotype response may be isolate dependent.

Tomato root microbiota and Phytophthora parasitica-associated disease

BackgroundInteractions between pathogenic oomycetes and microbiota residing on the surface of the host plant root are unknown, despite being critical to inoculum constitution. The nature of these interactions was explored for the polyphagous and telluric species Phytophthora parasitica.ResultsComposition of the rhizospheric microbiota of Solanum lycopersicum was characterized using deep re-sequencing of 16S rRNA gene to analyze tomato roots either free of or partly covered with P. parasitica biofilm. Colonization of the host root surface by the oomycete was associated with a shift in microbial community involving a Bacteroidetes/Proteobacteria transition and Flavobacteriaceae as the most abundant family. Identification of members of the P. parasitica-associated microbiota interfering with biology and oomycete infection was carried out by screening for bacteria able to (i) grow on a P. parasitica extract-based medium (ii), exhibit in vitro probiotic or antibiotic activity towards the oomycete (iii), have an impact on the oomycete infection cycle in a tripartite interaction S. lycopersicum-P. parasitica-bacteria. One Pseudomonas phylotype was found to exacerbate disease symptoms in tomato plants. The lack of significant gene expression response of P. parasitica effectors to Pseudomonas suggested that the increase in plant susceptibility was not associated with an increase in virulence. Our results reveal that Pseudomonas spp. establishes commensal interactions with the oomycete. Bacteria preferentially colonize the surface of the biofilm rather than the roots, so that they can infect plant cells without any apparent infection of P. parasitica.ConclusionsThe presence of the pathogenic oomycete P. parasitica in the tomato rhizosphere leads to a shift in the rhizospheric microbiota composition. It contributes to the habitat extension of Pseudomonas species mediated through a physical association between the oomycete and the bacteria.

When the Snake Oil Salesman Knocks on Your Door

When the Snake Oil Salesman Knocks on Your Door

Ultrasound Detection of a Foreign Body Reaction in a Cesarean Patient with Anti-Adhesive Barrier Placement

To demonstrate exploration of a case with local peritonitis post cesarean section and to showcase the intra-abdominal ultrasound finding. a 25 year-old, Gravida 1, Parity 1, female patient was referred to our hospital ; she received cesarean section at a local women’s hospital two weeks ago due to labor arrest; then she began to experience severe low abdominal pain and ran a fever in the past two days. Physical examination disclosed no apparent wound infection, but peritoneal sign could be easily elicited. There was a mild leukocytosis accompanied with a 38.5 degree Celsius temperature. Transvaginal ultrasound revealed some echogenic round material about one cm in diameter bathed in a pocket of fluid on the anterior surface of uterus. After confirmation with the prior hospital of placement of barrier during cesarean, we did explorative laparotomy to remove the infected, broken, barrier and debride the granulomatous tissue on the uterine wall. The patient recovered well and was discharged on Day 5. Anti-adhesive barrier placement is beneficial and usually risk free. However, rare instances of foreign body inflammatory reaction, abnormal fluid collection with fever can sometimes happen. Ultrasound assisted investigation can be very helpful in delineating the yet to absorb material submerged in a collection of ascites, thereby prompting appropriate treatment.

Study of Retinal Nerve Fibre Layer Thickness and Visual Contrast Sensitivity in HIV Positive Individuals.

Measurement of Retinal Nerve Fibre Layer Thickness (RNFLT) by Optical Coherence Tomography (OCT) is a sensitive, non invasive and cheap method of detecting early retinal changes in a variety of diseases. In HIV infection, RNFLT is altered and this may have effect on other visual functions like Contrast Sensitivity (CS) and visual acuity. Such ocular pathology can affect the daily life and profession (especially driving) of HIV infected individuals. However, studies on this topic in HIV infected population are rare from India. To study RNFLT, CS and their correlation in a sample of HIV positive Indian population. The present cross-sectional study was done in a tertiary care medical college hospital of Eastern India between May 2016 and September 2016. We did this study on HIV positive subjects with no clinically apparent ocular infection or other pathology. In this study, we have measured the RNFLT using the HRA-OCT Spectralis machine. The CS was tested using a smartphone version of the Pellie-Robson chart. CD4 count, visual acuity and colour vision were also tested. The data was analysed using SPSS version 20.0 for any correlation between these parameters. Pearson coefficient was used for continuous data and Spearman rank correlation was used for categorical data. A p-value <0.05 was considered significant. We had 17 patients, that is 34 eyes. RNFLT loss was found in 21% of the eyes and borderline thinning was found in a further 26%. Predominantly, the temporal quadrant was involved. The mean of log CS was 1.33±0.38. Taking 1.5 as the cut-off value for normalcy, 47% of the eyes tested showed decreased CS. Log CS showed significant correlation with RNFLT of the temporal quadrant only (r=0.37; 95% C.I. 0.041 to 0.631; p=0.02). Temporal RNFLT also showed statistical correlation with the CD4 count. The low CS was also significantly correlated with low visual acuity (r=0.5). In HIV infected persons, subtle ocular changes may occur and this may affect visual functions quite early. Hence, a comprehensive eye check-up should include parameters like CS and OCT.

Pregnancy-associated morphea: a case report and literature review

Morphea, also known as localized scleroderma, is arare fibrosing disorder of the skin, the pathogenesisof which is incompletely understood. It is thought,however, to involve interplay of genetic dispositionand triggering environmental factors, such asinfections and autoimmunity. Pregnancy as a potentialtrigger has only been reported in four cases. Herein,we present a patient who developed morphea of thebreasts during pregnancy, which rapidly resolvedwith a normal delivery. Our patient was distinct fromsome of the reported patients because her conditionwas tightly correlated with her pregnancy, as judgingby rapid resolution after delivery. In addition, therewas no apparent infection, history of autoimmunity,or development of autoimmunity during or afterpregnancy. Although the pathogenesis of pregnancyassociatedmorphea is largely unknown, we exploredpotential mechanisms of this condition, which mayinvolve mechanical injury, "microchimerism," andshifts in intrapartum hormones, such as TGF-β.

High rates of infection by blood parasites during the nestling phase in UK Columbids with notes on ecological associations.

Studies of blood parasite infection in nestling birds rarely find a high prevalence of infection. This is likely due to a combination of short nestling periods (limiting the age at which nestlings can be sampled) and long parasite prepatent periods before gametocytes can be detected in peripheral blood. Here we examine rates of blood parasite infection in nestlings from three Columbid species in the UK. We use this system to address two key hypotheses in the epidemiology of avian haemoparasites: first, that nestlings in open nests have a higher prevalence of infection; and second, that nestlings sampled at 14 days old have a higher apparent infection rate than those sampled at 7 days old. Open-nesting individuals had a 54% infection rate compared with 25% for box-nesters, probably due to an increased exposure of open-nesting species to dipteran vectors. Nestlings sampled at 14 days had a 68% infection rate compared with 32% in nestlings sampled at 7 days, suggesting that rates of infection in the nest are high. Further work should examine nestlings post-fledging to identify rates of successful parasite infection (as opposed to abortive development within a dead-end host) as well as impacts on host post-fledging survival and behaviour.

Erratum to: Reconstruction After Hemipelvectomy With the Ice-Cream Cone Prosthesis: What Are the Short-term Clinical Results?

Erratum to: Clin Orthop Relat Res DOI 10.1007/s11999-016-4747-x In the Results section of the Abstract, the sentences: Local wound complication occurred in five of the 10 of the patients and two developed deep infection. None of them had to be removed. should read: Surgical site complications occurred in five patients. Of those, two developed superficial infections with necrosis, two developed deep infections, and one patient developed wound necrosis without apparent infection. No prostheses were removed as a result of these complications. In the Results section, the sentences: Local wound complication with necrosis was observed in four of 10 patients. Four patients had wound infections; two of them were superficial infections and were managed with irrigation and débridement, a vascularized flap (one VRAM flap and one gluteus flap), and antibiotics with good results. The other two patients had deep infections, One of them, with an Enterococcus cloacae infection, was operated on with irrigation and débridement, polyethylene exchange, and a VRAM flap; this patient also developed recurrent dislocation, which was treated in the same surgery with cemented cup repositioning. The other patient with a deep infection was an elderly woman who developed a chronic Candida albicans infection, and she is being managed on suppressive antifungal treatment. No patient has undergone Ice-Cream Cone implant removal or amputation. should read: Surgical site complications occurred in five patients. Of those, two developed superficial infections with necrosis, two developed deep infections, and one patient developed wound necrosis without apparent infection. The patients with superficial infections were managed with irrigation and débridement, a vascularized flap (one VRAM flap and one gluteus flap), and antibiotics with good results. As noted, two patients had deep infections. One of them, with an Enterococcus cloacae infection, was treated with surgical irrigation and débridement, polyethylene exchange and a VRAM flap; this patient also developed recurrent dislocation, which was treated during that same procedure with cemented acetabular revision. The other patient with a deep infection was an elderly woman who developed a chronic Candida albicans infection, and she is being managed on suppressive antifungal treatment. The one patient who had a wound necrosis without apparent infection was managed with a local gluteus maximus flap. No patient has undergone Ice-Cream Cone implant removal or amputation. Additionally, in the Results section, a heading in Table 2 is incorrect. The heading, “Zones resected” should be “Stage”. The authors apologize for the errors.

Reconstruction After Hemipelvectomy With the Ice-Cream Cone Prosthesis: What Are the Short-term Clinical Results?

Reconstruction after internal hemipelvectomy resection likely provides better function than hindquarter amputation. However, many reconstruction methods have been used, complications with these approaches are common, and function often is poor; because of these issues, it seems important to investigate alternative implants and surgical techniques. The purposes of this study were (1) to identify the frequency of surgical site complications and infection associated with the use of the Ice-Cream Cone prosthesis for reconstruction after hemipelvectomy for oncological indications; (2) to evaluate the Musculoskeletal Tumor Society (MSTS) outcomes scores in a small group of patients treated with this implant in the short term; and (3) to quantify the surgical margins and frequency of local recurrence in the short term in this group of patients. Between 2008 and 2013, one center performed a total of 27 internal hemipelvectomies for oncological indications. Of those, 23 (85%) were treated with reconstruction. Our general indications for reconstruction were patients whose pelvic stability was affected by the resection and whose general condition was sufficiently strong to tolerate the reconstructive procedure. Of those patients undergoing reconstruction, 14 (61%) were treated with an Ice-Cream Cone-style implant (Coned®; Stanmore Worldwide Ltd, Elstree, UK; and Socincer® custom-made implant for the pelvis, Gijón, Spain), whereas nine others were treated with other implants or allografts. The indications during this time for using the Ice-Cream Cone implant were pelvic tumors affecting the periacetabular area without iliac wing involvement. Of those 14, 10 were available for followup at a minimum of 2 years (median, 3 years; range, 2-5 years) unless a study endpoint (wound complication, infection, or local recurrence) was observed earlier. Study endpoints were ascertained by chart review performed by one of the authors. Surgical site complications occurred in five patients. Of those, two developed superficial infections with necrosis, two developed deep infections, and one patient developed wound necrosis without apparent infection. No prostheses were removed as a result of these complications [corrected]. Median MSTS score was 19 out of 30 when 0 is the worst possible result and 30 a perfect function and emotional status. Five of seven primary tumors had wide margin surgery and three of seven developed local recurrences by the end of the followup. Pelvic reconstruction with the Ice-Cream Cone prosthesis yielded fair functional results at short-term followup. Longer term surveillance is called for to see whether this implant will represent an improvement over available reconstructive alternatives such as allograft, custom-made implants, and saddle prostheses. We are cautiously optimistic and continue to use this implant when we need to reconstruct the periacetabular area in patients without Enneking Zone 1 involvement. Level IV, therapeutic study.

Elevation in liver enzymes is associated with increased IL-2 and predicts severe outcomes in clinically apparent dengue virus infection

The objective of the present study was to assess the circulating TNF-α and IL-2 levels in dengue virus (DENV) infected patients and to correlate these with clinical severity of DENV infections. A single analyte quantitative immunoassay was used to detect TNF-α and IL-2 in 24 dengue fever (DF) and 43 dengue haemorrhagic fever (DHF) patients, 15 healthy adults and 6 typhoid patients. The mean TNF-α and IL-2 levels of DENV- infected patients were higher than that of healthy adults and typhoid patients. No significant difference in TNF-α levels was noted between DF and DHF patients (p=0.5) but a significant increase in IL-2 levels was observed in DHF compared with DF patients (mean of DF=59.7pg/mL, mean of DHF=166.9pg/mL; p=0.02). No significant association of TNF-α or IL-2 levels was noted with packed cell volume (>45), thrombocytopenia, leucopenia or the presence of viraemia. The liver function tests measuring AST (aspartate aminotransferase) (p=0.01) and ALT (alanine aminotransferase) (p=0.02) levels were significantly elevated in DENV-infected patients. AST:ALT was significantly elevated in DHF/DSS (dengue shock syndrome) compared with DF patients. A significant positive linear correlation was noted between AST and IL-2 (r=0.31; p=0.01) and ALT and IL-2 elevations (r=0.2; p=0.02). Thus, AST and ALT levels correlate with both disease severity and circulating IL-2 levels. We suggest a role for circulating IL-2 in liver dysfunction and propose that a combined assessment of AST/ALT in conjunction with IL-2 at the early stages of symptomatic DENV infection may be useful to predict the severe forms of dengue.

Defining the Lower Limit of a "Critical Bone Defect" in Open Diaphyseal Tibial Fractures.

To determine healing outcomes of open diaphyseal tibial shaft fractures treated with reamed intramedullary nailing (IMN) with a bone gap of 10-50 mm on ≥50% of the cortical circumference and to better define a "critical bone defect" based on healing outcome. Retrospective cohort study. Forty patients, age 18-65, with open diaphyseal tibial fractures with a bone gap of 10-50 mm on ≥50% of the circumference as measured on standard anteroposterior and lateral postoperative radiographs treated with IMN. IMN of an open diaphyseal tibial fracture with a bone gap. Level-1 trauma center. Healing outcomes, union or nonunion. Forty patients were analyzed. Twenty-one (52.5%) went on to nonunion and nineteen (47.5%) achieved union. Radiographic apparent bone gap (RABG) and infection were the only 2 covariates predicting nonunion outcome (P = 0.046 for infection). The RABG was determined by measuring the bone gap on each cortex and averaging over 4 cortices. Fractures achieving union had a RABG of 12 ± 1 mm versus 20 ± 2 mm in those going on to nonunion (P < 0.01). This remained significant when patients with infection were removed. Receiver operator characteristic analysis demonstrated that RABG was predictive of outcome (area under the curve of 0.79). A RABG of 25 mm was the statistically optimal threshold for prediction of healing outcome. Patients with open diaphyseal tibial fractures treated with IMN and a <25 mm RABG have a reasonable probability of achieving union without additional intervention, whereas those with larger gaps have a higher probability of nonunion. Research investigating interventions for RABGs should use a predictive threshold for defining a critical bone defect that is associated with greater than 50% risk of nonunion without supplementary treatment. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.