First molecular detection of Ehrlichia canis and Anaplasma platys in ticks from dogs in Cebu,Philippines

Ehrlichia canis infection of dogs in the Philippines has been detected by serological and peripheral blood smear examination methods, but not by molecular means. Anaplasma platys infection in dogs has not yet been officially reported, although it is suspected to occur in the country. Thus, sensitive and specific molecular techniques were used in this study to demonstrate the presence of both E. canis and A. platys in the Philippines. A total of 164 Rhipicephalus sanguineus ticks was collected from 36 dogs. Seven tick samples were found positive with E. canis and one sample with A. platys. To further characterize these pathogens, molecular analyses based on citrate synthase and heat-shock operon genes were also performed. Philippine strains were found to be not divergent from strains from other countries. The present results are the first molecular detection and analyses of E. canis and A. platys in ticks from dogs in the Philippines.     

FEASIBILITY AND RELIABILITY OF DYNAMIC POSTURAL CONTROL MEASURES IN CHILDREN IN FIRST THROUGH FIFTH GRADES

Purpose/Background:

Although dynamic postural control is a prerequisite to the development of fundamental movement skills in children, few studies have examined the feasibility and reliability of assessment techniques that measure dynamic postural control in youth under 13 years of age. Therefore, the purpose of this study was to determine the feasibility and reliability of the Lower Quarter Y Balance Test (YBT‐LQ) in children and to examine the reproducibility of these measures across developmental periods of childhood.

Methods:

188 subjects in first through fifth grades (age = 6.9 to 12.1 yr) performed the YBT‐LQ on two occasions in a field‐based setting. Reach distances and cumulative score (sum of 3 directions) were measured and analyzed using intraclass correlation coefficients (ICC). Sub‐cohorts of 14 and 8 subjects were used to assess inter‐rater reliability within‐session and between‐session, respectively.

Results:

The overall ICC was moderate‐to‐good for the anterior (right=0.82; left=0.82), posteromedial (right=0.77; left=0.75), and posterolateral (right 0.80; left=0.77) reach directions. The combined ICC was also moderate‐to‐good for children in grades 1 (0.71), 2 (0.74), 3 (0.84), 4 (0.82), and 5 (0.79). Typical error values for right and left limbs were less than 10% of the mean for all reach measures across all grades. Interrater reliability within session (ICC > 0.995) and between sessions (0.907 ≤ ICC ≤ 0.974) were both excellent. No unexpected responses or injury occurred during testing.

Conclusions:

These findings indicate that the YBT‐LQ is a feasible and reproducible measure of dynamic postural control in children in first through fifth grades.

Level of Evidence:

2b     

High dose artesunate in combination with mefloquine: pharmacovigilance in the Venezuelan Amazon

Forty-six patients in a remote health post of Amazonas, Venezuela, accidentally received artesunate in a dose of 10 mg/kg/day combined with mefloquine. This corresponds to the upper limit of the therapeutic range recommended by the WHO (2-10 mg/kg/day). Side effects were retrospectively investigated and a pharmacovigilance report was written. The main side effects were vomiting and diarrhea. Four patients developed complications with signs of dehydration. It is suggested to re-assess the therapeutic range of artesunate when given in combination with mefloquine and to establish a worldwide centralized antimalarial toxicity reporting system.     

Does aerobic exercise intensity affect health‐related parameters in overweight women?

The aim of this study was to compare the effect of a cycling training programme performed at intensity corresponding to the lowest value of the respiratory quotient (RQ) versus at intensity corresponding to the ventilatory threshold (VT), on body composition and health‐related parameters in overweight women. Thirty‐two sedentary obese women (27–42 years old) were studied in a randomized trial of either RQ (n = 17) or VT (n = 15). RQ and VT training sessions were equalized by time (60 min) and performed in a cycloergometer. Anthropometry, body composition, lipid profile, glucose, basal metabolic rate (BMR) and fitness (maximal oxygen uptake) were evaluated before and after 12 weeks of intervention. Body weight, body mass index, fatness and fitness were improved in both groups (P<0·001). Triglycerides (TG) levels decreased only in response to RQ (P<0·001) and fat‐free mass (FFM) to VT (P = 0·002). No differences were observed between groups. Both exercise intensities seem to be effective for improving health in overweight women. However, low‐intensity compared with the high‐intensity exercise training appears to have additional benefits on TG levels and to maintenance of FFM.     

Thromboelastometry and organ failure in trauma patients: a prospective cohort study

Introduction

Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality.

Methods

This was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of ≥11.7 dynes/cm² and hypocoagulability as a G value of <5.0 dynes/cm². ROTEM was performed on admission and 24 hours later.

Results

A total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients (P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality.

Conclusions

The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-014-0687-6) contains supplementary material, which is available to authorized users.     

Bronchial interleukin-5 and eotaxin expression in nasal polyposis. Relationship with (a)symptomatic bronchial hyperresponsiveness

An eosinophilic bronchial inflammation was previously demonstrated in patients with nasal polyposis (NP) and asymptomatic bronchial hyperresponsiveness (BHR) similar to that observed in asthmatic patients with NP, whereas patients with NP without BHR did not. The aim of the study was to investigate the contribution of interleukin 5 (IL-5) and eotaxin to the pathogenesis of BHR associated with NP. Eleven patients with NP without BHR (Group A), 8 patients with NP and asymptomatic BHR (Group B), and 9 patients with NP and asthma (Group C) were included. Bronchial biopsies were studied for IL-5 and eotaxin immunoreactivity and IL-5 mRNA expression. IL-5 levels were determined in bronchial lavage (BL). Compared with Groups A and B, Group C patients exhibited higher numbers of IL-5 protein(+) cells, IL-5 mRNA(+) cells, and eotaxin(+) cells in bronchial submucosa. Compared with Group A, Group B patients showed an increased number of IL-5 protein(+) cells, whereas the number of IL-5 mRNA(+) cells and eotaxin(+) cells was similar. IL-5 levels in BL were increased only in Group C. Our study provides evidence of IL-5 involvement in bronchial eosinophilia and in the pathogenesis of asymptomatic BHR associated with NP, whereas both IL-5 and eotaxin are involved in asthma associated with NP.     

Effects of the gp130 cytokines ciliary neurotropic factor (CNTF) and interleukin-11 on pituitary cells: CNTF receptors on human pituitary adenomas and stimulation of prolactin and GH secretion in normal rat anterior pituitary aggregate cultures

Two of the most potent cytokines regulating anterior pituitary cell function are leukemia inhibitory factor (LIF) and interleukin (IL)-6, which belong to the cytokine family using the common gp130 signal transducer. Recently, the expression and action of two other members of this family, IL-11 and ciliary neurotrophic factor (CNTF), on different cell lines has also been demonstrated. We studied the expression of the specific receptor subunits for CNTF in mammotropic, non-functioning and somatotropic tumors and the action of CNTF and IL-11 in the regulation of hormone secretion in these and normal pituitary cells. The mRNA for the alpha chain specific for the CNTF receptor was detected by Northern blot in tumors secreting prolactin (PRL) and GH and in non-functioning tumors. We found that both IL-11 and CNTF exerted a similar stimulatory effect on GH mRNA expression in somatotropic monolayer cell cultures from acromegalic tumors, but these cytokines had no significant influence on GH secretion. CNTF stimulates prolactin secretion in lactotropic monolayer cell cultures from patients with prolactinoma. In monolayer cell cultures from normal rat anterior pituitary, IL-11 and CNTF had no significant effect on the release of either GH or PRL, or on GH mRNA. However, when the cells were cultured in aggregate cultures, in which the three-dimensional structure of the cells is reconstituted, both cytokines, in doses at which they had no effect on monolayer cultures, significantly stimulated both PRL and GH secretion. These data show that IL-11 and CNTF may act as regulatory factors in anterior pituitary cells, in which the three-dimensional structure of the gland is of critical importance.     

Variation in patient management and outcomes for acute coronary syndromes in Latin America and North America: results from the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial

BACKGROUND: Although more than 9500 patients have been enrolled in major clinical trials in Latin America, practice patterns in this region have rarely been examined. We sought to compare characteristics, resource utilization, and outcomes of patients treated for acute coronary syndromes in Latin America with those in North America. METHODS: The Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Theraphy Trial (PURSUIT) enrolled 10,948 patients with non-ST-segment elevation acute coronary syndromes, including 585 in Latin America and 4358 in North America. We analyzed regional differences in patient groups, treatment patterns, and outcomes and used logistic regression analysis to identify association of enrollment region and survival. RESULTS: For patients in Latin America, the length of hospital stay was significantly longer (10 [7, 15] days vs 6 [4, 9], P <.001). Angiograms, angioplasty, and bypass surgery were significantly less common in Latin America (46.2%, 17.6%, and 11.3% vs 79.4%, 33.6%, and 19.4%, P <.001). Thirty-day death/myocardial infarction was not significantly higher, although mortality alone was significantly higher (6.8% vs 3.1%, P <.001). After adjustment for baseline characteristics, enrollment in Latin America remained an independent predictor for death at 30 days (odds ratio [OR] [95% confidence interval (CI)] 2.42 [1.60-3.67]) and persisted at 6 months (OR [95% CI] 2.5 [1.8-3.4]). CONCLUSIONS: Latin American patients treated for acute coronary syndromes were managed less invasively and were twice as likely as their North American counterparts to die within 6 months. This mortality difference was not explained by imbalances in baseline risk.