Update on hypertrophic cardiomyopathy and a guide to the guidelines

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, affecting 1 in 500 individuals worldwide. Existing epidemiological studies might have underestimated the prevalence of HCM, however, owing to limited inclusion of individuals with early, incomplete phenotypic expression. Clinical manifestations of HCM include diastolic dysfunction, left ventricular outflow tract obstruction, ischaemia, atrial fibrillation, abnormal vascular responses and, in 5% of patients, progression to a 'burnt-out' phase characterized by systolic impairment. Disease-related mortality is most often attributable to sudden cardiac death, heart failure, and embolic stroke. The majority of individuals with HCM, however, have normal or near-normal life expectancy, owing in part to contemporary management strategies including family screening, risk stratification, thromboembolic prophylaxis, and implantation of cardioverter-defibrillators. The clinical guidelines for HCM issued by the ACC Foundation/AHA and the ESC facilitate evaluation and management of the disease. In this Review, we aim to assist clinicians in navigating the guidelines by highlighting important updates, current gaps in knowledge, differences in the recommendations, and challenges in implementing them, including aids and pitfalls in clinical and pathological evaluation. We also discuss the advances in genetics, imaging, and molecular research that will underpin future developments in diagnosis and therapy for HCM

Detection of Plasmid-Mediated Quinolone Resistance Genes in Clinical Isolates of Enterobacter spp. in Spain ▿

We have studied by PCR and DNA sequencing the presence of the qnrA, qnrB, qnrS, aac(6′)-Ib-cr, qepA, intI1, and ISCR1 genes in 200 clinical isolates of Enterobacter cloacae (n = 153) and E. aerogenes (n = 47) consecutively collected between January 2004 and October 2005 in two hospitals located in Santander (northern Spain) and Seville (southern Spain). Mutations in the quinolone resistance-determining region of gyrA and parC also were investigated in organisms containing plasmid-mediated quinolone resistance genes. The isolates had different resistant phenotypes, including AmpC hyperproduction, extended-spectrum β-lactamase production, resistance or decreased susceptibility to quinolones, and/or resistance to aminoglycosides. Among the 116 E. cloacae isolates from Santander, qnrS1, qnrB5, qnrB2, and aac(6′)-Ib-cr were detected in 22 (19%), 1 (0.9%), 1 (0.9%), and 3 (2.6%) isolates, respectively. Twenty-one, 17, and 2 qnrS1-positive isolates also contained blaLAP-1, intI1, and ISCR1, respectively. A qnrB7-like gene was detected in one E. aerogenes isolate from Santander. No plasmid-mediated quinolone resistance gene was detected in the isolates from Seville. The qnrS1-containing isolates corresponded to four pulsed-field gel electrophoresis patterns and showed various levels of resistance to quinolones. Six isolates were susceptible to nalidixic acid and presented reduced susceptibility to ciprofloxacin. The qnrS1 gene was contained in a conjugative plasmid of ca. 110 kb, and when the plasmid was transferred to recipient strains that did not have a specific mechanism of quinolone resistance, the ciprofloxacin MICs ranged from 0.047 to 0.125 μg/ml

REVIEW: Behavioral, physiological, and reproductive performance of buffalo cows during eutocic and dystocic parturitions

Purpose: The reproductive problems at parturition in buffaloes are highly important. The literature describes a high incidence of dystocia in buffalo herds as a cause of significant mortality in neonates. Therefore, understanding the physiology, behavior, and signals of calving in buffalo dams during eutocic and dystocic births will allow the development of accurate responses for the health of dams and the welfare of newborns. This review thus discusses the 3 phases of calving (onset of labor, calf expulsion, and removal of fetal membranes) and their reproductive complications. Sources: The search engines CAB Abstracts, PubMed, ISI Web of Science, and Scopus were used for the following search terms: buffalo, stillbirth, parity difficulties, parturition, calving, postpartum, reproductive problems, delivery, dystocia, and uterine torsion. Synthesis: Dystocia caused by uterine torsion is common in buffalo dams, as are prepartum vaginal prolapse and placental retention. The study cites the higher incidence of clinical and subclinical uterine infection in buffaloes compared with cattle, associated only with a high number of bacteria, or combined with cases of toxic puerperal metritis that affect fertility and cause economic losses. Several studies coincide in citing high rates of stillbirths in buffaloes associated with reproductive factors that result in significant financial losses. Conclusions and Applications: Accurate predictions of the onset of calving are critical for the welfare of both dams and calves, as well as for farm economics, because it can ensure the timely provision of necessary interventions. The strategies to modify, or improve, handling and reproduction methods in buffaloes are the focus of several studies