LPS-induced impairment of Na+/K+-ATPase activity: ameliorative effect of tannic acid in mice

Metabolic Brain Disease - Acetylcholine is an excitatory neurotransmitter that modulates synaptic plasticity and communication, and it is essential for learning and memory processes. This...     

Non-tuberculous Mycobacterial Infections in Thoracic Transplant Candidates and Recipients

Purpose of Review

To review and discuss the epidemiology, risk factors, clinical presentation, diagnosis, and treatment of non-tuberculous mycobacteria (NTM) in thoracic transplantation.

Recent Findings

Non-tuberculous mycobacteria are ubiquitous but are an uncommon cause of disease after solid organ transplantation. The incidence of infection is higher in thoracic transplant recipients than in abdominal transplant recipients, with most cases seen after lung transplantation. It is associated with increased morbidity and, occasionally, mortality. Infection in the pre-transplant setting can occur in lung transplant candidates, often posing a dilemma regarding transplant listing. Disease manifestations are diverse, and pulmonary disease is the most common. Diagnosis requires a high index of suspicion. Treatment requires a multiple-drug combination and is limited by drug-drug interactions and tolerability. Mycobacterium abscessus is a challenge in lung transplant recipients, due to its intrinsic resistance and propensity to relapse even after prolonged therapy. Mycobacterium chimaera is an emerging pathogen associated with contamination of heater-cooler units and is described to cause disease months after cardiothoracic surgery.

Summary

NTM infections in thoracic organ transplant recipients are uncommon but are associated with substantial morbidity and mortality. Data from larger multicenter studies is needed to better define the epidemiology of NTM in thoracic transplantation, best treatment options, and the management of infected transplant candidates.

     

Respiratory muscle weakness and normal ventilatory drive in dilative cardiomyopathy

BACKGROUND: In dilative cardiomyopathy several factors influence dyspnoea.Patients with chronic heart failure may demonstrate impairmentof breathing pattern, ventilatory drive and respiratory musclestrength, as well as reduction of ventilatory efficiency. Thepurpose of this study was to evaluate whether dilative cardiomyopathyis accompanied by changes in breathing pattern, respiratorymuscle weakness and ventilatory neural drive. METHODS: We investigated 47 patients (36 men, mean age=47·8±11·2years) with chronic heart failure due to dilative cardiomyopathy,and 30 healthy subjects (10 men, mean age=35·4±11·7years) served as controls. Patients and controls underwent evaluationof left ventricular ejection fraction by 2D echocardiography,spirometry, body plethysmography, mouth occlusion pressure andrespiratory muscle strength, as well as by submaximal treadmillexercise testing with gas exchange measurements. The patients'results were compared to controls and predicted standard normalvalues, and evaluated for differences according to the degreeof severity of functional impairment. RESULTS: Patients with dilative cardiomyopathy demonstrated a slightreduction in lung volumes (15% of the patients with obstructiveand 15% with restrictive lung function pattern) and diffusioncapacity (20·4±6·8 vs 15·4±6·7ml. min^–1 . kPa^–1; P<0·01). In neuraldrive, as assessed by mouth occlusion pressure, there was nosignificant difference between patients and controls. Therewas a slight but significant reduction in respiratory musclestrength, as assessed by measuring maximal inspiratory pressurein patients with dilative cardiomyopathy (6·7±2·4kPavs 8·6±3·5kPa; P<0·01). The observedchanges were more pronounced in the severe chronic heart failurepatients (with a reduction in ventilatory efficiency) whereasno relationship among indices of cardiac or respiratory functionwas found. CONCLUSION: Patients with chronic heart failure due to dilative cardiomyopathydevelop respiratory muscle weakness without changes in neuralventilatory drive, and slight changes in breathing pattern relatedto the severity of the disease.     

Targeting the Use of Pooled HIV RNA Screening to Reduce Cost in Health Department STD Clinics: New York City, 2009–2011

Objective

Staff at public New York City sexually transmitted disease (STD) clinics screen patients for acute HIV infection (AHI) using pooled nucleic acid amplification tests. AHI screening is expensive but important for populations at high risk of acquiring HIV. We analyzed if targeting AHI screening in STD clinics could reduce program costs while maintaining AHI case detection.

Methods

From January 2009 through May 2010, we screened all patients with negative rapid HIV tests for AHI. Using risk information on cases detected during this universal screening period, we developed criteria for targeted AHI screening and compared case yields and testing costs during 12 months of universal screening (June 2009 through May 2010) vs. 12 months of targeted screening (June 2010 through May 2011).

Results

During the defined period of universal screening, we identified 40 AHI cases, and during targeted screening, we identified 35 AHI cases. Because of targeting efforts, the number needed to test to find one AHI case dropped from 1,631 to 254. With targeted screening, it cost an average of $4,535 per case detected and 39.3 cases were detected per 10,000 specimens; using universal screening, $29,088 was spent per case detected and 6.1 cases were detected per 10,000 specimens processed.

Conclusion

Targeted screening identified similar numbers of AHI cases as when screening all clinic patients seeking HIV testing, but at one-seventh the cost.During the acute phase of human immunodeficiency virus (HIV) infection (AHI), infected people are often unaware of their condition, as AHI symptoms—which include fever, sore throat, fatigue, myalgia, lymphadenopathy, rash, joint pain, night sweats, and diarrhea—are nonspecific.¹ During AHI, patients are highly viremic (and, thus, highly infectious), and antibodies to HIV have not yet developed.² This stage of infection, therefore, is not detected by traditional antibody tests. Detecting AHI requires nucleic acid amplification or antigen tests and enables infected people to adopt safer behaviors and be linked to earlier treatment and care, all of which may reduce HIV transmission.^3,4 A multisite study conducted in 14 clinics in New York City (NYC); Los Angeles, California; and four counties in Florida from 2006 to 2008 found that AHI screening, when added to point-of-care rapid testing, increased HIV detection by 8.2% across all sites; in three NYC clinics, 24% more HIV infections were detected using AHI screening than with HIV detection using rapid antibody tests alone (seven cases detected by nucleic acid amplification testing [NAAT]; 22 cases detected by rapid test).⁵ NAAT is an important tool for identifying AHI, and NAAT pooling methods (pNAATs) help to contain the costs of screening.⁶ By 2009, the NYC Department of Health and Mental Hygiene (NYC DOHMH) had implemented routine AHI screening via pNAAT for all patients with negative rapid HIV tests in all of its sexually transmitted disease (STD) clinics. At that time, the NYC DOHMH joined just a handful of state and local health departments in the United States that were routinely using pNAAT.⁷While AHI screening increased HIV detection in NYC STD clinics, it came at a considerable cost. Annualized other-than-personnel costs of this screening were more than $1 million, or approximately $30,000 per new diagnosis, which was as much as 16 times greater than the average cost of routine opt-out HIV screening in health-care facilities in the U.S.⁸ We present our evaluation of a strategy to reduce program costs while maintaining a high level of AHI case detection among clinic patients.     

Validation to Portuguese of the Scale of Student Satisfaction and Self-Confidence in Learning

Objective:

translate and validate to Portuguese the Scale of Student Satisfaction and Self-Confidence in Learning.

Material and Methods:

methodological translation and validation study of a research tool. After following all steps of the translation process, for the validation process, the event III Workshop Brazil - Portugal: Care Delivery to Critical Patients was created, promoted by one Brazilian and another Portuguese teaching institution.

Results:

103 nurses participated. As to the validity and reliability of the scale, the correlation pattern between the variables, the sampling adequacy test (Kaiser-Meyer-Olkin) and the sphericity test (Bartlett) showed good results. In the exploratory factorial analysis (Varimax), item 9 behaved better in factor 1 (Satisfaction) than in factor 2 (Self-confidence in learning). The internal consistency (Cronbach''s alpha) showed coefficients of 0.86 in factor 1 with six items and 0.77 for factor 2 with 07 items.

Conclusion:

in Portuguese this tool was called: Escala de Satisfação de Estudantes e Autoconfiança na Aprendizagem. The results found good psychometric properties and a good potential use. The sampling size and specificity are limitations of this study, but future studies will contribute to consolidate the validity of the scale and strengthen its potential use.