Application of the ISTH bleeding score in hemophilia

Background

Hemophilia is an inherited bleeding disorder. With proper treatment and self-care, persons with hemophilia can maintain an active, productive lifestyle. Hemophilia can be mild, moderate, or severe, depending on the degree of plasma clotting factor deficiency. The aim of the study was to assess the utility of ISTH-BAT in diagnosis, determining severity of the bleeding condition in newly diagnosed and known hemophilia patients, compare the bleeding score (BS) in adult and pediatric groups and investigate its association with plasma factor levels.

Non-pharmacological management of phantom limb pain in lower limb amputation: a systematic review

Background: The incidence and severity of phantom limb pain (PLP) does not differ much between the extremities of amputation. However, its impact on functional ability and quality of life in lower limb amputation may be different, as prosthetic weight bearing is a key component in the movement and functional rehabilitation of individuals with a lower limb amputation.

Objective: To evaluate the evidence for effectiveness or efficacy of non-pharmacological interventions in the management of PLP in adults with lower limb amputation.

Methods: A comprehensive literature search conducted on 11 electronic databases, from their inception to 25 March 2016 identified 626 potentially relevant articles. Full-text randomised controlled trials in English which examined any form of non-pharmacologic intervention for managing PLP in lower limb amputees were included. The data with regard to characteristics of the studies, participants, intervention and outcome measures and overall statistical result were extracted. The Cochrane ‘Risk of bias assessment tool’ was used to assess the bias of all included articles.

Results: Four studies met the final criteria to be included in the review. Four treatment techniques had been used in the treatment of 204 patients with lower limb amputation. Two trials showed a positive impact of intervention on PLP compared to control group. Risk of bias varied across studies, and only one included study was assessed as having a low risk of bias.

Conclusion: The review identified lack of evidence to support non-pharmacological interventions in the management of PLP. Adequately powered high-quality trials are needed in this area to inform rehabilitation.     

Prevalence of Antibodies to Hepatitis C Virus among Hemodialysis Patients in Damascus, Syria

Background: Evaluation of the epidemiology of hepatitis C virus (HCV) infection was made possible by the development of a serological assay to detect antibodies to epitopes of HCV. Hemodialysis (HD) is considered to be one of the main risk factors of HCV transmission. Therefore, the prevalence of antibodies to HCV (anti-HCV) was studied in patients undergoing maintenance dialysis therapy. Patients and Methods: Anti-HCV were detected using a third-generation assay. The study group consisted of HD patients, transplant recipients and staff members from two dialysis units in Damascus, Syria. Results: The overall prevalence of anti-HCV among HD patients was 48.9%; 24,4% in one center (Al-Mouassat Hospital) and 88,6% in the other (Kidney Hospital). There was a significant correlation between prevalence of anti-HCV and duration of HD. The prevalence was 36.7% for patients on HD for < 3 years and 65% in patients on HD for > 3 years (p < 0.05). There was a significant correlation beteen anti-HCV positivity and elevated liver enzymes: alanine aminotransferase (ALT) and asparate aminotransferase (AST). However, there was no significant correlation between anti-HVC positivity and history of blood transfusion, exposure to hepatitis B virus, age and sex. The prevalence of anti-HCV among kidney transplant recipients was 48%, among staff members of the dialysis units it was 5.8%. Conclusion: Factors related to infrastructure and operational system might be responsible for the very high prevalence of anti-HVC found in one of the two units. There was no data available on anti-HCV status of transplant recipients prior to transplantation. However, the prevalence among those patients, which is very similar to that of HD patients, suggests that HD may be responsible for such high prevalence among this group. An intensive educational program for staff members and proper evaluation of the HD situation in the two units are needed. Received: November 27, 1999 · Revision accepted: March 2, 2001     

Predominance and Emergence of Clones of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus in Malaysia

We define the epidemiology of predominant and sporadic methicillin-resistant Staphylococcus aureus (MRSA) strains in a central teaching and referral hospital in Kuala Lumpur, Malaysia. This is done on the basis of spa sequencing, multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec) typing, and virulence gene profiling. During the period of study, the MRSA prevalence was 44.1%, and 389 MRSA strains were included. The prevalence of MRSA was found to be significantly higher in the patients of Indian ethnicity (P < 0.001). The majority (92.5%) of the isolates belonged to ST-239, spa type t037, and possessed the type III or IIIA SCCmec. The arginine catabolic mobile element (ACME) arcA gene was detected in three (1.05%) ST-239 isolates. We report the first identification of ACME arcA gene-positive ST-239. Apart from this predominant clone, six (1.5%) isolates of ST-22, with two related spa types (t032 and t4184) and a singleton (t3213), carrying type IVh SCCmec, were detected for the first time in Asia. A limited number of community-acquired (CA) MRSA strains were also detected. These included ST-188/t189 (2.1%), ST-1/t127 (2.3%), and ST-7/t091 (1%). Panton-Valentin leukocidin (PVL) was detected in all ST-1 and ST-188 strains and in 0.7% of the ST-239 isolates. The majority of the isolates carried agr I, except that ST-1 strains were agr III positive. Virulence genes seg and sei were seen only among ST-22 isolates. In conclusion, current results revealed the predominance of ST-239-SCCmec III/IIIA and the penetration of ST-22 with different virulence gene profiles. The emergence in Malaysia of novel clones of known epidemic and pathogenic potential should be taken seriously.Methicillin-resistant Staphylococcus aureus (MRSA) is an established human pathogen that causes both health care-associated (HA) and community-acquired (CA) infections. Modern MRSA has evolved from several successful clonal lineages of methicillin-susceptible S. aureus strains via acquisition of a mobile genetic element called staphylococcal cassette chromosome mec (SCCmec). This element contains the mecA gene, which encodes penicillin-binding protein 2′ (PBP2′) with significantly reduced affinity for β-lactams (36).Increased emergence of multidrug resistance among MRSA strains has become a major concern in the hospital environment, as it invokes a tremendous financial burden and enhanced morbidity and mortality due to hard-to-treat systemic infections (7). Genotyping data from large international studies have shown that a limited number of major clones of MRSA display an enhanced propensity to spread and cause opportunistic human infections in various parts of the world (5, 13, 33). MRSA was introduced into Malaysia in the early 1970s (26), and a review of the records of the microbiology laboratories of all state hospitals in Malaysia showed that the proportion of MRSA isolates from S. aureus-infected individuals had been approximately 21% throughout the last few years.Phenotypic MRSA typing methods are not suited to detailed epidemiological surveillance (20, 40). Several superior molecular typing methods can be used for supporting infection control and for tracing the nosocomial sources and transmission routes of bacterial pathogens. Among these methods, multilocus sequence typing (MLST) has recently been proven to be the best for long-term global epidemiological and bacterial population genetics studies. It is a discriminatory genotypic method where isolates are typed by sequencing variable regions of housekeeping genes. A combination of alleles from the seven loci forms a sequence type (ST). Similar STs are grouped into clonal complexes (13). spa typing has been shown to be as discriminatory as the current gold standard method, pulsed-field gel electrophoresis (PFGE) (10). spa types can be determined via amplification and sequencing of the X region of the protein A gene (spa), which contains polymorphic direct repeats. StaphType (version 1.4; Ridom GmbH, Würzburg, Germany) provides a software tool enabling straightforward sequence analysis and designation of spa types by synchronization via a central server (42). spa typing is useful in analyzing hospital outbreaks and in identifying genetic changes that occur over a relatively short time span (14, 43). Molecular typing data on HA MRSA isolates in Malaysia are sparse in comparison with those on strains deriving from Europe, the United States, or Japan. This is notwithstanding the steadily increasing but already high rates of MRSA infections in Malaysia (38). Pilot data hinted at the predominance of a single MRSA genotype in Malaysia. This is similar to the situation in many other Asian countries (1, 23, 31).For the present study, clinical MRSA isolates associated with various infections were collected from the largest public tertiary referral hospital in Kuala Lumpur, the capital of Malaysia. The epidemiology of MRSA in this hospital (HKL) will most likely reflect the nation''s epidemiology as it is the major government referral hospital for patients from all states in Malaysia. Each year at least 1 million people (∼3.8% of the total Malaysian population) are treated here. HKL records an annual MRSA prevalence over 40%. Many of these MRSA strains are multidrug resistant. Additional epidemiological studies are clearly warranted in order to increase the insight into the dynamics of MRSA epidemiology in Malaysia.The aims of the present study were to characterize the current Malaysian MRSA isolates and determine their molecular epidemiology by MLST, spa typing, SCCmec typing, and virulence gene profiling.     

CSF beta-amyloid 1-42 and tau in Tunisian patients with Alzheimer's disease: the effect of APOE epsilon4 allele

Alzheimer's disease (AD) is the leading cause of dementia. Currently, no definitive diagnostic test for AD exists. An accurate, convenient and objective test to detect AD is urgently needed for efficient drug development and effective clinical use of emerging therapies. The aim of the present work is to investigate the usefulness of cerebrospinal fluid (CSF) beta-amyloid protein (Abeta1-42) and total tau protein (t-tau) analyses in the diagnosis of AD and whether apolipoprotein E (ApoE) epsilon4 allele is a factor for AD affecting Tunisian people. Abeta1-42 and t-tau levels were measured in CSF from AD patients (n=73), non-Alzheimer dementia (nAD, n=35) and healthy controls (HC, n=38) by sandwich enzyme-linked immunosorbent assay. Abeta1-42 levels were decreased and t-tau increased in AD patients. The combination of Abeta1-42 and t-tau at baseline yielded a sensitivity of 87.4% for detection of AD. The specificities were 97.3% for controls and 82.7% for other dementia. The ApoE epsilon4 allele frequency (29.5%) was significantly higher in the AD patients than in the nAD patients (17.1%) or in the control groups (9.5%). AD patients carrying ApoE epsilon4 allele had lower Abeta1-42 (p<0.001) levels than those without a epsilon4 allele. The combination of t-tau and Abeta1-42 is a robust and reliable assay that may be useful in discriminating cases at risk for AD such as ApoE epsilon4 allele carriers from nAD patients or from age-matched control subjects.     

Successful kidney transplant in a patient with IgG anti HLA Class-I auto-antibodies: A case report

Donor specific antibodies (DSA) play a significant role in graft rejection. Many laboratory methods, varied in sensitivity and specificity, are used to detect them. We report a case of a 38-year-old man presented with end stage renal disease considered for kidney transplantation. He had no history of blood transfusions nor transplantation procedures. Dilemma rose when he got multiple positive crossmatches with matching donors and a positive autologous crossmatch due to IgG anti HLA auto-antibodies, which are at the same time against matched donors. Since positive crossmatch is a contraindication for transplant, we couldn’t perform transplant from any matched donor. Therefore, we considered a total mismatched donor then transplantation was performed. Observation after surgery showed normalization of creatinine, blood pressure and a good function of the planted allograft for two years of follow up.     

Tualang honey supplement improves memory performance and hippocampal morphology in stressed ovariectomized rats

Recently, our research team has reported that Tualang honey was able to improve immediate memory in postmenopausal women comparable with that of estrogen progestin therapy. Therefore the aim of the present study was to examine the effects of Tualang honey supplement on hippocampal morphology and memory performance in ovariectomized (OVX) rats exposed to social instability stress. Female Sprague-Dawley rats were divided into six groups: (i) sham-operated controls, (ii) stressed sham-operated controls, (iii) OVX rats, (iv) stressed OVX rats, (v) stressed OVX rats treated with 17β-estradiol (E2), and (vi) stressed OVX rats treated with Tualang honey. These rats were subjected to social instability stress procedure followed by novel object recognition (NOR) test. Right brain hemispheres were subjected to Nissl staining. The number and arrangement of pyramidal neurons in regions of CA1, CA2, CA3 and the dentate gyrus (DG) were recorded. Two-way ANOVA analyses showed significant interactions between stress and OVX in both STM and LTM test as well as number of Nissl-positive cells in all hippocampal regions. Both E2 and Tualang honey treatments improved both short-term and long-term memory and enhanced the neuronal proliferation of hippocampal CA2, CA3 and DG regions compared to that of untreated stressed OVX rats.