NTM Group Research Articles

The diagnostic impact of fractional exhaled nitric oxide for asthmatic cough in nontuberculous mycobacterial pulmonary disease.

Measurement of exhaled nitric oxide (FeNO) is a potentially useful diagnostic test for asthma. However, no study has explored the relationship between FeNO and respiratory symptoms of nontuberculous mycobacterial pulmonary disease (NTM-PD) complicated with asthma. The objective of this study was to assess the utility of measuring FeNO levels in patients with NTM-PD complicated by asthma. In this single-center retrospective cohort study, 140 NTM-PD patients with FeNO measured were enrolled. We selected NTM-PD patients who complicated with asthma as the NTM+BA group, defined using the following criteria: NTM patients with symptoms consistent with asthma, and NTM patients with symptomatic improvement after diagnostic therapy with ICS ± a long-acting beta 2-agonist (LABA). We then calculated a diagnostic cutoff point to distinguish between the NTM+BA groups and the NTM groups (all others). High-resolution computed tomography (HRCT) images were evaluated using the CT scoring system and their association with FeNO was examined. A total of 89 patients were included in the study. (31 in the NTM+BA group and 58 in the NTM group). Compared with the NTM group, the NTM+BA group had higher rates of allergic disease (51.6% vs. 22.4%; p=0.0085) and higher FeNO values (median, 23 [interquartile range {IQR}, 15.0-43.0] ppb vs. median, 17 [IQR, 11.8-23.0] ppb; p=0.015). With diagnostic asthma care using mainly ICS/LABA with reference to the FeNO, most patients (91.0%, 20/22) in the NTM-preceding subgroup in the NTM+BA group demonstrated a prompt improvement of their symptoms and AFB culture findings did not worsen (Culture positive rate (%): Pre-treatment: 59.1% vs. Post-treatment: 40.9%, p=0.3660) at 6 months after starting diagnostic therapy. The optimal diagnostic cutoff point of FeNO to distinguish between the two groups was calculated as 21.5 ppb by the ROC curve (sensitivity 75%, specificity 71.93%, p<0.0001; area under the curve: 0.7989). No significant correlation was observed between FeNO and the severity of CT images in the patients. A certain number of patients with NTM-PD showed exacerbated respiratory symptoms due to asthmatic complications. Elevated FeNO levels suggest asthma complications, even in patients with NTM.

Epidemiology and management of nontuberculous mycobacterial disease in people with cystic fibrosis, the Netherlands

BackgroundNontuberculous mycobacteria (NTM) are opportunistic, difficult to treat pathogens. With increasing prevalence of NTM infections in people with cystic fibrosis (pwCF) and the improved life expectancy, the burden is expected to grow. MethodsWe assessed the epidemiology and management of NTM isolation and disease in pwCF in the Netherlands using a survey and retrospective, case-controlled data from the Dutch CF Registry. We determined the isolation prevalence, treatment and outcomes from 2013-2019. ResultsNTM isolation prevalence increased from 1.0% to 3.6% (2013-2019). This was a single NTM isolation in 53.7% of the adults and 60.0% of the children. M. abscessus and M. avium complex (MAC) were most frequent (47.1 and 30.9%). Of the treated pwCF, 48.5% attained culture conversion of M. abscessus; 54.5% for MAC. Children with an NTM isolation showed more infections with S. maltophilia and/or A. fumigatus (p < 0.001) compared to controls. In the year prior to NTM isolation, children in the NTM group had a lower mean FEV1% predicted (81.5 ± 16.7 vs. 88.6 ± 15.3, p = 0.024), while adults in the NTM group had more IV antibiotic days compared to controls (60 vs. 17, p = 0.047). In the following years, FEV1% predicted declined faster in pwCF with NTM than the control group (children: -3.8% vs. -1.6%, p = 0.023; adults: -0.7% and 0.4%, ns). ConclusionsThe isolation prevalence of 3.6%, poor treatment outcomes and associated lung function decline emphasize that NTM pulmonary disease (NTM-PD) is a significant health issue among pwCF in the Netherlands. Its prevention and treatment require increased attention.

Comparison of frailty in patients with nontuberculous mycobacterial lung disease and bronchiectasis: a prospective cohort study

BackgroundThe incidence of nontuberculous mycobacterial lung disease (NTM-LD) peaks in middle- and old age groups, coinciding with senescence; thus, chronic infectious diseases can accelerate frailty and worsen mental health in the elderly. In this study, we aimed to compare the prevalence of physical and psychiatric frailty between patients with NTM-LD and bronchiectasis (BE).MethodsThe Kihon Checklist Questionnaire (KCQ) was used to assess physical and psychiatric frailties and identify those at risk of requiring care among patients with newly diagnosed NTM-LD and BE. Additionally, the Hospital Anxiety and Depression Scale (HADS) scores and chronic inflammatory biomarkers of the alveolar region (surfactant protein [SP]-A, SP-D, and human cationic antibacterial protein [hCAP]/LL-37) were assessed and compared between NTM-LD and BE patients.ResultsThere were no significant differences in the background characteristics between the 33 NTM and 36 BE patients recruited. The KCQ revealed that the proportion of frail NTM patients at diagnosis was higher than that of frail BE patients (48.5% vs. 22.2%, p = 0.026). HADS scores were significantly higher in the NTM group than in the BE group (p < 0.01). Bronchoalveolar lavage fluid (BALF) hCAP/LL-37 and SP-D levels were significantly higher (p = 0.001), but serum hCAP/LL-37 levels were significantly lower in the NTM group than in the BE group (p = 0.023). However, there were no significant differences in the BALF and serum SP-D levels between the two groups.ConclusionsThe number of frail NTM patients at diagnosis was significantly higher than that of frail BE patients. Biomarker analysis suggested that the former had more localized lung inflammation than the latter.Trial registrationThis trial was prospectively registered in the Clinical Trials Registry (UMIN 000027652).

Association between Atrial Fibrillation, Myocardial Infarction, Heart Failure and Mortality in Patients with Nontuberculous Mycobacterial Infection: a nationwide population-based study

NTM infection demonstrates an increasing incidence and prevalence. We studied the impact of NTM in cardiovascular events. Using the Korean nationwide database, we included newly diagnosed 1,730 NTM patients between 2005 and 2008 and followed up for new-onset atrial fibrillation (AF), myocardial infarction (MI), heart failure (HF), ischemic stroke (IS), and death. Covariates-matched non-NTM subjects (1:5, n = 8,650) were selected and analyzed. Also, NTM infection was classified into indolent or progressive NTM for risk stratification. During 4.16 ± 1.15 years of the follow-up period, AF, MI, HF, IS, and death were newly diagnosed in 87, 125, 121, 162, and 468 patients. In multivariate analysis, NTM group showed an increased risk of AF (hazard ratio [HR] 2.307, 95% confidence interval [CI] 1.560–3.412) and all-cause death (HR 1.751, 95% CI 1.412–2.172) compared to non-NTM subjects, whereas no significant difference in MI (HR 0.868, 95% CI 0.461–1.634), HF (HR 1.259, 95% CI 0.896–2.016), and IS (HR 1.429, 95% CI 0.981–2.080). After stratification, 1,730 NTM patients were stratified into 1,375 (79.5%) indolent NTM group and 355 (20.5%) progressive NTM group. Progressive NTM showed an increased risk of AF and mortality than indolent NTM group. Screening for AF and IS prevention would be appropriate in these high-risk patients.

A Randomized Controlled Trial Comparing a Mapleson Circuit with Nasal Trumpet to Standard Oxygen Supplementation during EBUS Bronchoscopy under Monitored Anesthesia Care

Background: Endobronchial ultrasound (EBUS) procedures tend to be longer than routine bronchoscopies. Increased duration and sedative dosing put patients at increased risk for ­hypoxic events. Objective: To determine whether oxygen supplementation via a nasal trumpet connected to a Mapleson B circuit (NTM) was effective in decreasing hypoxic events when compared with the standard of care, oxygen supplementation with a nasal cannula (NC). Methods: Patients referred for EBUS-guided transbronchial needle aspiration with monitored anesthesia care (MAC) were randomized 1:1 to NTM or to NC. Hypoxia-related procedural interruptions, the primary endpoint of the study, were documented for all patients. Patients in the NC group who had refractory desaturations were allowed to cross over to the NTM group. Secondary endpoints included: number of crossovers from NC to NTM, sedative dosing, total procedure times, whether procedure goals were achieved, complications apart from hypoxia, patient discharge status. Results: Fifty-two patients were randomized to NC and 48 to NTM. Baseline characteristics were comparable. The NC group had significantly more interruptions than did the NTM group (p < 0.001). Procedure duration was also significantly (p < 0.03) shorter for the NTM group. Fourteen patients were crossed over from NC to NTM because of hypoxia. Thirteen out of the 14 completed the procedure with no interruptions. All procedures were successfully completed, and all goals were achieved. All patients returned to baseline status prior to discharge. Three minor complications of epistaxis occurred. Conclusion: For patients undergoing EBUS with MAC, oxygen supplementation with NTM significantly decreased the incidence of hypoxic events when compared with NC. NTM may also be of value for other subsets of patients who are at increased risk for desaturation when undergoing bronchoscopy.

Medición de la capa híbrida resultante del uso de cementos autograbadores de uno y dos pasos

Antecedentes: La formación de la capa híbrida debe ser proporcional a la capacidad de los cementos para retener con éxito postes de fibra de vidrio en el interior del conducto preparado endodónticamente. Objetivo: Medir el espesor de la capa híbrida en los tercios coronal y apical as usar cementos autograbadores de uno y dos pasos. Métodos: Se realizó un estudio experimental con 30 premolares humanos que se trataron endodónticamente y se asignaron a tres grupos. Se cementaron postes de fibra de vidrio con tres cementos siguiendo las instrucciones de los fabricantes. Se realizaron cortes coronales y apicales y se cuantificó el grosor de la capa híbrida por microscopía electrónica de barrido. Los datos se analizaron con las pruebas estadísticas H de Kruskal-Wallis y U de Mann-Whitney (p&lt;0,05). Resultados: El promedio del grosor de la capa híbrida fue de 0,74 mm con Multilink N® (grupo 1), 0,24 mm con RelyX Ultimate® (grupo 2) y 0,03 mm con RelyX U200® (grupo 3) (p = 0,0092). Los promedios en los tercios coronal y apical fueron: 1,29 mm y 0,19 mm para el grupo 1; 0,33 mm y 0,14 mm para el grupo 2 y 0,26 mm y 0,23 mm para el grupo 3, diferencias que fueron estadísticamente significativas (p = 0,043). Conclusiones: El espesor de la capa híbrida formada con el uso de los cementos de dos pasos fue mayor que con el cemento de un solo paso, especialmente en la porción coronal.

Clinical course and significance of nontuberculous mycobacteria and its subtypes in cystic fibrosis

BackgroundNontuberculous mycobacteria (NTM) infections in patients with cystic fibrosis (CF) is increasing globally. However, the related epidemiology, comorbidities, and clinical impact of NTM infection remains unclear in the progress of CF lung disease and patient survival.MethodsWe performed a retrospective, case-control, cohort study (10 years), comparing NTM culture-positive CF patients (N = 28) to matched controls (N = 26). NTM positive patients were divided in to two groups of slow-growing (N = 17) and rapid- growing NTM (N = 8). Three patients were positive for both slow and rapid NTM. For independent group comparisons, a non-parametric Mann-Whitney test (Kruskal-Wallis test for more than two groups) was used to compare the continuous variables, and a Fisher’s exact test was used for the categorical variables. Paired comparisons were performed using a Wilcoxon signed-rank test.ResultsThe prevalence of NTM isolation was 8%. The age at CF diagnosis was significantly lower in the slow-growing NTM group compared to the rapidly growing NTM group (P = 0.04). The median percent predicted forced expiratory flow of 25% − 75% (FEF25–75) was significantly higher before NTM acquisition in slow-growing (P = 0.013) and rapidly growing NTM group (P = 0.028). The slow-growing NTM group received significantly more penicillin/beta lactamase (P = 0.010) and rifampin (P = 0.042) following isolation. Macrolide use was significantly higher after isolation in both the slow-growing NTM (P = 0.018) and rapidly growing NTM groups (P = 0.042).ConclusionsAn earlier CF diagnosis was associated with a higher isolation of slow-growing NTM and greater antimicrobial use after infection. NTM acquisition is associated with a worsening of FEF25–75. Thus, both the early diagnosis and treatment of an NTM infection in patients with CF may positively impact lung function.

EFFECTS OF TRAINING MASK ON HEART RATE AND ANXIETY DURING THE GRADED EXERCISE TEST AND RECOVERY

The aim of this study is to examine the effect of training mask on heart rate (HR) and related anxiety during Graded Exercise Exercise (GXT). Six volunteer participants (age 20,5 ± 0,5 yrs, height 181,8 ± 5,5 cm, weight 74,5 ± 7 kg, BMI 22,51 ± 0,81) have been included in the study. PARQ and ACSM (American College of Sports Medicine) risk factor analysis have been made to all of the participants before the tests. Only healthy experimental subjects have been included in the study. The participants have been randomly separated into two groups (A, B) including 3 people. On the first day of the test, Group A completed the test with the training mask (TM) while the Group B completed it without training mask (NTM). Two days later, the groups were changed and they repeated the tests (Crossover Design). GXT have been applied to the participants on the treadmill until they got exhausted. During the 5-minute recovery time given after the end of GXT, HR variables have been measured. At the end of recovery, Becks Anxiety Inventory (BAI) has been implemented. In order to determine the differences came out at the measurements made after TM and NTM exercises, non-parametric t-test has been used and the confidence interval has been taken as p˂0,05. At the end of GXT and the following 5-minute recovery time, a significant difference has been found in HR variables between both groups (p˂, 005). The termination process of the test with TM has been 2.45% earlier (from 15.02 sec. to 14.49 sec.) than the NTM group and HR average at the end of recovery period has been found 9.12% lower than NTM group. In addition to this, there is no significant difference between anxiety total scores of the two groups (p˃, 005). As a conclusion, while low HR averages of TM group can be explained as CO 2 diaspora, it can be figured that the similarity in terms of anxiety levels between the groups has resulted from the fact that the running test has been finished up to the participation own decision. Article visualizations:

EFFECTS OF TRAINING MASK ON HEART RATE AND ANXIETY DURING THE GRADED EXERCISE TEST AND RECOVERY

The aim of this study is to examine the effect of training mask on heart rate (HR) and related anxiety during Graded Exercise Exercise (GXT). Six volunteer participants (age 20,5 ± 0,5 yrs, height 181,8 ± 5,5 cm, weight 74,5 ± 7 kg, BMI 22,51 ± 0,81) have been included in the study. PARQ and ACSM (American College of Sports Medicine) risk factor analysis have been made to all of the participants before the tests. Only healthy experimental subjects have been included in the study. The participants have been randomly separated into two groups (A, B) including 3 people. On the first day of the test, Group A completed the test with the training mask (TM) while the Group B completed it without training mask (NTM). Two days later, the groups were changed and they repeated the tests (Crossover Design). GXT have been applied to the participants on the treadmill until they got exhausted. During the 5-minute recovery time given after the end of GXT, HR variables have been measured. At the end of recovery, Becks Anxiety Inventory (BAI) has been implemented. In order to determine the differences came out at the measurements made after TM and NTM exercises, non-parametric t-test has been used and the confidence interval has been taken as p˂0,05. At the end of GXT and the following 5-minute recovery time, a significant difference has been found in HR variables between both groups (p˂, 005). The termination process of the test with TM has been 2.45% earlier (from 15.02 sec. to 14.49 sec.) than the NTM group and HR average at the end of recovery period has been found 9.12% lower than NTM group. In addition to this, there is no significant difference between anxiety total scores of the two groups (p˃, 005). As a conclusion, while low HR averages of TM group can be explained as CO 2 diaspora, it can be figured that the similarity in terms of anxiety levels between the groups has resulted from the fact that the running test has been finished up to the participation own decision. Article visualizations:

Risk factors for the development of chronic pulmonary aspergillosis in patients with nontuberculous mycobacterial lung disease.

Nontuberculous mycobacterial lung disease (NTM-LD) is increasingly recognized as an important predisposing condition for the development of chronic pulmonary aspergillosis (CPA), but there are limited data on the risk factors for CPA development in NTM-LD patients. We reviewed the medical records of 566 patients who, at the time of diagnosis of NTM-LD, did not have CPA and who received ≥12 months of treatment for NTM-LD between January 2010 and June 2015. Of these patients, 41 (7.2%) developed CPA (NTM-CPA group), whereas the remaining 525 patients did not develop CPA (NTM group). The median time to the development of CPA was 18.0 months from treatment initiation for NTM-LD. The NTM-CPA group was older and had significantly higher proportions of males, current smokers, and patients with a low body mass index (<18.5 kg/m2), when compared to the NTM group. Moreover, the NTM-CPA group was more likely to have a history of tuberculosis and chronic obstructive lung disease and to have used inhaled or systemic steroids. In the NTM-CPA group, more than 40% of patients had Mycobacterium abscessus complex (MABC) as the cause of NTM-LD, and the fibrocavitary form of NTM-LD was the most common; both associations were higher than in the NTM group. Overall, 17 (3%) patients died, and the NTM-CPA group had a higher mortality rate than did the NTM group (19.5% vs. 1.7%, respectively; P<0.001). In a multivariable analysis, old age, male gender, low body mass index, chronic obstructive lung disease, systemic steroids, MABC as the etiologic organism, and the fibrocavitary form of NTM-LD remained significant predictors of development of CPA. In conclusion, CPA occurred in 7.2% of patients after initiation of treatment for NTM-LD, and some risk factors were associated with CPA development. Given the worse prognosis, early diagnosis and treatment of CPA are important in patients with NTM-LD.

Abstract TP11: Treatment Times and Outcomes With Utilization of Telemedicine Prior to Transfer for Stroke Endovascular Therapy

Background: Reducing time to treatment is important for acute stroke therapy including intravenous tPA and endovascular therapy. Remote evaluation of acute stroke patients by telemedicine may help triage patients for endovascular therapy and facilitate earlier treatment. Purpose: We aimed to evaluate efficiency and clinical outcome using telemedicine as a screening tool prior to transfer of stroke patients to comprehensive stroke centers for endovascular therapy. Methods: We retrospective reviewed patients receiving endovascular therapy at the University of Pittsburgh Medical Center from January 2014 through May 2015 who were initially evaluated for acute stroke at an outside facility and transferred to our hospital. We statistically analyzed our data using unpaired T test with equal standard deviation. Results: 116 patients treated with endovascular therapy were identified. 35 (30.1%) had telemedicine (TM) evaluations prior to transfer and 81 (69.8%) were transferred without telemedicine screening (NTM). The average age was 68 years in TM group and 67 years in NTM group. 71% of TM patients received IV TPA compared to 30% of NTM patients. The average NIHSS on arrival was 17 among TM and 16 in NTM. The mean time from door to groin puncture was 54 minutes in TM patients compared to 66 minutes in NTM group (p=0.37). Good outcomes (mRS &lt; 2) occurred in 54% of TM cases and 36% of the NTM group (p=0.12). Poor outcomes (mRS 5-6) were 21% in TM patients and 40% in the NTM group (p=0.08). TICI 2b/3 revascularization was achieved in 88.5% and 88.9% in TM and NTM groups respectively (p=0.2). Conclusion: Evaluating acute stroke patients using telemedicine prior to transfer to comprehensive stroke centers may reduce time to intervention and improve selection of patients more likely to benefit from endovascular therapy.

An analysis of etiology, causal pathogens, imaging patterns, and treatment of Japanese patients with bronchiectasis.

Bronchiectasis (BE), a syndrome that presents with persistent or recurrent bronchial sepsis related to irreversibly damaged and dilated bronchi, has not been well-characterized in Asians. This study aims to review the etiology, causal pathogens, imaging patterns, and treatment of BE and to define the prognostic factors for acute exacerbation in a Japanese population. We performed a retrospective cohort study of 147 patients (104 women; median age, 73 years; range, 30-95 years) with BE at our institution using high-resolution computed tomography to identify imaging patterns and the area of pulmonary involvement. Common BE etiologies were idiopathic (N=50 [34%]), sinobronchial syndrome (N=37 [25%]), non-tuberculous mycobacteriosis (NTM; N=26 [18%]), and previous respiratory infection (N=21[14%]). Pseudomonas aeruginosa was the most common causal pathogen (24%). Common imaging patterns were cylindrical (66%) and mixed including cylindrical pattern (47%). The median number of involved lobes was 2; 49% of the patients had ≥ 3 involved lobes, and 49% had middle lobe and left lingula dominant BE. Patients with predominantly lower lobe BE comprised 4% of the NTM group and 48% of the non-NTM group (P<0.001). In multivariate analysis, cystic BE was a predictor for frequent exacerbations in non-NTM patients (OR=7.947; P=0.004) which led to increased hospital admissions (OR=4.691; P=0.004). Idiopathic and sinobronchial syndrome were common causes of BE. Etiology did not contribute to imaging pattern or predictors of exacerbations. Cystic BE was a predictor for frequent exacerbations in the non-NTM BE patients.

Outcome Correlation of Smear-Positivity for Acid-Fast Bacilli at the Fifth Month of Treatment in Non-Multidrug–Resistant TB

Sputum samples from patients with non-multidrug-resistant (non-MDR) pulmonary TB may remain smear-positive for acid-fast bacilli (AFB) at the fifth month of anti-TB treatment. However, its significance remains unknown. From January 2004 to April 2009, there were 5,403 patients with culture-confirmed pulmonary TB from four hospitals in Taiwan. Among them, 116 patients (2.2%) with non-MDR TB whose sputum samples were smear-positive by concentration smear method at the fifth month of treatment were evaluated. Sputum culture yielded Mycobacterium tuberculosis in 10 patients (8.6%, MTB group), nontuberculous mycobacteria in 23 (19.8%, NTM group), and no growth in the remaining 83 (71.6%, no-growth group). The relapse rate (22%) was higher in the MTB group (P = .01). Four predictors, smear grading ≥ 3+ at the fifth month ("S") (OR, 10.73; 95% CI, 2.67-43.17), no sputum culture conversion on the second month ("C") (OR, 7.16; 95% CI, 1.45-35.44), lack of directly observed therapy ("O") (OR, 6.40; 95% CI, 1.54-26.56), and no radiographic improvement at the fifth month ("R") (OR, 4.18; 95% CI, 1.02-17.10), were associated with viable M tuberculosis (MTB group). An integrated "SCOR" index of 1 point for each positive factor had the best discriminatory power for predicting culture results at the fifth month. If the SCOR index was 0, all smear-positive sputum was culture-negative for M tuberculosis. Positive sputum smears by a concentrated smear method at the fifth month of treatment in patients with non-MDR TB, especially those with a low SCOR index, may be due to nonviable bacilli and NTM. Careful review of the quality of patient supervision, bacteriologic data, and chest radiography is crucial.

Lower-Extremity Force Decrements Identify Early Mobility Decline Among Community-Dwelling Older Adults

Many apparently independent older adults modify daily tasks. Task modifications strongly predict future mobility disability. Clinically intuitive, easily measured "biomarkers" associated with task modifications would offer quantifiable treatment targets for prevention of age-related functional limitations. The objective of the study was to examine lower-extremity muscle strength deficits and functionally relevant cutoff points associated with daily task modifications in community dwelling older adults living independently. This was a cross-sectional observational study. Fifty-three participants (mean age=76.4 years, SD=5.2) were tested for task modifications and leg strength. Task modifications were assessed using a previously described tool (summary task modification score). Twenty-six of the participants were classified as task modifiers (TM group), and 27 participants were classified as non-task modifiers (NTM group). A net antigravity leg force in the sagittal plane (NETforce) was calculated by summing the normalized isometric and isokinetic torques from the hip extensors, knee extensors, and ankle plantar flexors. Compared with the NTM group, the TM group exhibited 30.0% and 33.5% reduction in lower-extremity isometric and isokinetic NETforces, respectively. Isometric and isokinetic NETforce cutoff points for task modifications were ≤ 4.24 and 2.77 N · m/kg body weight, respectively. The isometric and isokinetic models both yielded sensitivity and specificity values of 74.1% and 80.8%, respectively (positive likelihood ratio=3.852, 95% confidence interval=1.699-8.735; negative likelihood ratio=0.321, 95% confidence interval=0.167-0.618). Isometric and isokinetic NETforces were significantly associated with task modifications (odds ratio=2.50 and 2.42, respectively). The cross-sectional design of this study does not allow for a test of causal relationships. This study used a modest yet adequate sample size that may limit generalization of the results. Isometric and isokinetic NETforce cutoff points provide quantifiable biomarkers that discriminate community-dwelling older adults who modify daily tasks from those who do not.

Potential Impact of Viral Load and Genetic Makeup of HIV Type 1 on Mother-to-Child Transmission: Characterization ofenv-C2V3C3 andnefSequences

HIV-1 mother-to-child transmission (MTCT) was evaluated in terms of the molecular characterization of the env and nef genomic regions and quantification of maternal RNA viral loads. Assignment of viral subtype was achieved by direct sequencing of PCR 1172 products amplified from proviral DNA in 45 HIV-1-nontransmitting mothers (NTM), along with 13 pairs of HIV-1-transmitting mothers (TM) and their infected children (C). Analysis of the env C2V3C3 and nef sequences revealed that subtypes G and B, and their genetic combinations (AG, BG), accounted for over 84.5% of all viruses identified. The genetic structure form envA-nefG was the most commonly observed, with a lower frequency in the NTM (13.3%) compared to the TM (23.1%) group. A greater number of genetic forms was observed among NTM, namely the presence of sequences assigned to subtypes D and F, as well as the intergenetic A/J, and C/U, recombinant forms, along with a mosaic provirus with a complex putative envA-nefEGE genetic structure. No significant differences were found when RNA viral loads were evaluated as a function of the viral subtypes. Nevertheless, a relatively high quantification of HIV-1 RNA was obtained in the NTM group, emphasizing the importance of the compliance and effectiveness of therapeutic schemes to control viral replication and reduce the risk of HIV vertical transmission. V3 sequences displaying features associated with the R5 phenotype dominated in both groups. Both C2V3C3 and Nef's functional domains were conserved during HIV-1 vertical transmission.

Diversity of Nontuberculoid Mycobacterium Species in Biofilms of Urban and Semiurban Drinking Water Distribution Systems

Nontuberculous mycobacteria (NTM) are ubiquitous and have been isolated from a variety of environmental sources, including water. Various NTM were isolated from biofilms in drinking water distribution systems in two urban and two semiurban areas in South Africa. Most of the isolates belonged to opportunistic pathogenic species of the NTM group, but none belonged to the Mycobacterium avium complex.

Assessing the difference between sociodental and normative approaches to assessing prosthetic dental treatment needs in dentate older people.

To illustrate differences in assessed need using normative and sociodental approaches to assess prosthetic treatment needs of dentate older people. A cross-sectional study using non-random sample. Metropolitan area of Chiang Mai, Thailand. 707 older individuals, 549 of the total sample were dentate, living independently, aged 60 to 74 years. The dentate population examined consisted of 289 classified as 'normal health' and 44 with a nutritional problem. Of the total population, 60% (333) had a normative need for partial dentures. Excluding the 44 with a nutritional problem, 50% (146) of the NTM group had 'impact-related treatment need' and of the latter 146, 69% (102) had a high propensity for health behaviour. 41% of the 102 who had 'impact-related' and 'propensity related treatment need' had 'accessible treatment need'. That is 14.5 per 100 of those with normative need. The gap between normative and 'accessible need' was greater among those with 'general health related treatment need' due to underweight. Of the 44 with a NTM and had a health problem, 45% (20) had a 'propensity related treatment need'. 40% of the group with a 'propensity related treatment need' had 'accessible treatment need'. Overall of the 44 older people with a normative need for a prosthesis and who had a health problem, only 2.4% had 'accessible treatment need' mainly due to lack of finance. If the treatment were subsidised then 45% of those with 'propensity related treatment need' would be eligible for treatment. Large differences of estimated treatment need were found between a sociodental and a normative approach to assess prosthetic dental treatment needs of older Thai people.