Genetic classification of Echinococcus granulosus cysts from humans, cattle and camels in Libya using mutation scanning-based analysis of mitochondrial loci

We genetically classified Echinococcus granulosus from humans, cattle and camels in Libya utilizing DNA regions (designated pcox1 and pnad1) within the cytochrome c oxidase subunit 1 (cox1) and NADH dehydrogenase 1 (nad1) mitochondrial genes, respectively. Polymerase chain reaction (PCR)-based single-strand conformation polymorphism (SSCP) analysis of pcox1 and pnad1 amplicons derived from genomic DNA samples from individual cysts (n = 176) revealed four distinct electrophoretic profiles for each locus. Direct sequencing of selected amplicons representing each of these profiles defined four different sequence types for each locus, which were present in five different combinations (designated haplotypes A–E) amongst all 176 isolates. Phylogenetic analysis of concatenated sequence data for these five haplotypes, together with a range of well-defined reference sequences, inferred that all cyst isolates from humans (n = 55) and a small number from cattle (13% of 38) belonged to the G1–G3 complex of E. granulosus (or E. granulosus sensu stricto), whereas most (87%) cysts from cattle and all 83 of them from camels were linked to the G6–G10 complex (or Echinococcus canadensis). The present study provides a foundation for future large-scale studies of the epidemiology and ecology of E. granulosus in Libya and other African countries.     

Diagnostic efficacy of 0, 30, 45, 60, 90 and 120 min growth hormone samples in insulin tolerance test: utility of growth hormone measurement at different time‐points and a cost‐effective analysis

Objective. To determine the utility of growth hormone (GH) measurement with the insulin tolerance test (ITT), and to carry out a cost‐effective analysis of the diagnosis of GH deficiency. Material and methods. Ninety‐nine patients clinically suspected of GH deficiency were evaluated over a period of 14 months (January 2005 to April 2006). Post‐insulin samples of GH and blood glucose (BG) samples were drawn at six different time‐points. Serum GH levels of <10?µg/L (prepubertal) and <6.1?µg/L (adolescents) were taken as cut‐off for the normal response. Results. Ninety‐nine ITTs were carried out during the study period, and GH levels were found to be deficient in 47 subjects. Specificities at different time‐points were 0?%, 54?%, 77?%, 62?%, 39?% and 23?% for 0, 30, 45, 60, 90 and 120?min, respectively, in the prepubertal group, and 5?%, 41?%, 80?%, 87?%, 77?% and 46?% at the same time‐points for the adolescent group. Accuracy was highest at 45 and 60?min in both the prepubertal and adolescent groups. The receiver operating characteristic curve showed that the highest area under the curve was found in samples drawn at 45, 60 and 90?min in both the prepubertal and adolescent groups. Conclusion. Our data suggest that 0, 45, 60 and 90?min samples are sufficient for diagnosing GH deficiency, which could lead to potential cost reductions of up to 29.8?%.     

Screening for subclinical subclavian artery stenosis before coronary artery bypass grafting: Should we do it?

Atherosclerotic subclavian artery disease is detected in about 5% of patients referred for coronary artery bypass (CABG) surgery. The internal mammary artery, a branch of the subclavian artery, is the most frequently utilized graft to restore coronary circulation because of its longevity. Stenosis or occlusion of the subclavian artery can cause retrograde blood flow in the ipsilateral internal mammary artery, known as “steal,” compromising coronary circulation supplied by the graft. Steal may be asymptomatic or may result in symptoms of myocardial ischemia. Symptomatic subclavian artery stenosis post bypass is referred to as coronary subclavian steal syndrome post‐CABG. The incidence is not well defined, and the benefits of screening patients referred for CABG are not known. Despite the various modalities available to detect subclavian artery stenosis, current guidelines fail to provide guidance about screening high‐risk patients for this entity. Detection of subclavian artery disease prior to CABG can reduce complications posed by post‐mammary artery graft cardiac ischemia. This review discusses the utility of preoperative subclavian artery screening prior to CABG.     

Additional complex fractionated atrial electrogram ablation does not improve the outcomes of non-paroxysmal atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials

BackgroundNon-paroxysmal atrial fibrillation (AF) has a complex pathophysiological process. The standard catheter ablation approach is pulmonary vein isolation (PVI). The additional value of complex fractionated electrogram (CFAE) ablation is still unclear. We aimed to investigate the additional value of CFAE ablation for non-paroxysmal AF.MethodsWe performed a systematic review and meta-analysis of randomized controlled studies up to May 2020. Articles comparing pulmonary vein isolation (PVI) plus CFAE ablation and PVI alone for AF were obtained from the electronic scientific databases. The pooled mean difference (MD) and pooled risk ratio (RR) were assessed.ResultsA total of 8 randomized controlled trials (RCTs) including 1034 patients were involved. Following a single catheter ablation procedure, the presence of any atrial tachyarrhythmia (ATA) with or without the use of antiarrhythmic drugs (AADs) between both groups were not significantly different (RR = 1.1; 95% confidence interval [CI] = 0.97–1.24; p = 0.13). Similar results were also obtained for the presence of any ATA without the use of AADs (RR = 1.08; 95% CI = 0.96–1.22; p = 0.2). The additional CFAE ablation took longer procedure times (MD = 46.95 min; 95% CI = 38.27–55.63; p = < 0.01) and fluoroscopy times (MD = 11.69 min; 95% CI = 8.54–14.83; p = < 0.01).ConclusionAdditional CFAE ablation failed to improve the outcomes of non-paroxysmal AF patients. It also requires a longer duration of procedure times and fluoroscopy times.     

Thyroid Hormones and Cardiovascular Function and Diseases

Thyroid hormone (TH) receptors are present in the myocardium and vascular tissue, and minor alterations in TH concentration can affect cardiovascular (CV) physiology. The potential mechanisms that link CV disease with thyroid dysfunction are endothelial dysfunction, changes in blood pressure, myocardial systolic and diastolic dysfunction, and dyslipidemia. In addition, cardiac disease itself may lead to alterations in TH concentrations (notably, low triiodothyronine syndrome) that are associated with higher morbidity and mortality. Experimental data and small clinical trials have suggested a beneficial role of TH in ameliorating CV disease. The aim of this review is to provide clinicians dealing with CV conditions with an overview of the current knowledge of TH perturbations in CV disease.     

Serological investigation of ovine theileriosis by ELISA in Gannan Tibet Region of Gansu Province in China

The Gannan Tibet Autonomous Region is the biggest and most important stock-raising region of Gansu Province, People's Republic of China. Many sheep and goats from this region suffer from Theileria challenge each year, resulting in inestimable economical losses. A first large-scale serological investigation by enzyme-linked immunosorbent assay of ovine theileriosis in this region was performed by testing a total of 1,165 sera samples collected from seven districts of three counties. The results showed that seroprevalence of reactive antibodies varied from 27.8 to 83.3%, whereby the average was 70.1% in the disease-endemic areas. Another 44 sera samples collected every month from July 2004 to June 2005 from a stable flock of sheep in Biandu Town of Lintan County were analysed to evaluate the seasonal kinetics of anti-Theileria antibodies. The results indicated that anti-Theileria antibody seroprevalence rose from March, reaching a peak value of 68.2% in May, declining in October and reaching the lowest value of 36.4% in January. The data indicate that seroprevalence of anti-Theileria antibodies correlate to the known activities of its transmitting vector and also imply that chemical therapy of animals should be performed during May to June in these Theileriosis-epidemic regions.     

Isolated Aneurysms of the Membranous Ventricular Septum Without Residual Shunts: Systematic Review and Description of 3 Cases in Adults

A ventricular septal defect is the most common congenital cardiac abnormality encountered in infants and children. Many of them survive through adulthood before diagnosis. Two‐thirds of the cases involve the membranous part of the septum. In the absence of an interventricular shunt or concomitant cardiac surgery, guidelines for surgical intervention or resection of isolated aneurysms of the membranous septum are not well established. In this report, we discuss a multi–imaging modality approach for the diagnosis and assessment of membranous ventricular septal aneurysms and review the experts' consensuses for follow‐up and treatment strategies.