Bacteremia following complex percutaneous coronary intervention

BACKGROUND AND OBJECTIVE: Complex percutaneous coronary intervention (PCI) often requires introduction of numerous devices into and out of the arterial circulation and this may result in an increased risk of bacteraemia or even septicaemia. This study was undertaken to detect the frequency of bacteraemia that may be associated with such procedures. METHODS: 147 patients undergoing complex PCI had blood culture tests immediately after and 12 hours after the procedure. RESULTS: Of 147 patients, 26 (17.7%) had detectable bacteraemia immediately after PCI. Coagulase-negative staphylococcus was isolated most commonly. An additional 12% of patients yielded positive blood cultures in the next 12 hours with femoral sheaths still in-situ. There were no associated clinical sequelae. CONCLUSIONS: Uncomplicated bacteraemia is not uncommon as a result of complex PCI procedures. Although there are usually no clinical sequelae, these findings are important for those patients who are considered to be at moderate or high risk of infective endocarditis who require an invasive procedure such as PCI. This paper emphasizes the need for maximum sterility during PCI procedures if infective complications and stent infection are to be avoided.     

Genetic diversity of Plasmodium vivax and Plasmodium falciparum in Kohat District, Pakistan

Malaria is one of the serious diseases threatening human health in Pakistan and contributes to a large proportion of the total malaria deaths in South Asia. However, little is known about the nature and extent of genetic diversity of the malarial parasites circulating in Pakistan. This study was designed to assess the infection status of Plasmodium and the genetic diversity of Plasmodium vivax and Plasmodium falciparum by analyzing msp-3α, msp-3β and msp-1, msp-2 genes respectively using allele specific nested PCR and RFLP assays. For this purpose, 130 field isolates were collected from the individuals who exhibited clinical symptoms associated with malaria in the Kohat region of Khyber Pakhtoonkhwa (KPK), Pakistan. Among 130 blood samples collected, P. vivax was detected in 105/130 (80.8%) and P. falciparum in 21/130 (16.2%). Mixed infections with both parasites were detected in 4/130 (3%) of the isolates. A large number of distinguishable alleles were found for msp genetic markers: 10 alleles for msp-3α and seven for msp-3β with one mixed infection in case of msp-3β. The genotyping of P. falciparum showed that K1+MAD20 mixed genotype was dominant in msp-1 and FC27 in msp-2. The results collectively suggest that P. vivax and P. falciparum populations in this region are highly polymorphic and mixed infections are prevalent.     

Discordance between pain and radiographic severity in knee osteoarthritis: Findings from quantitative sensory testing of central sensitization

Objective

Radiographic measures of the pathologic changes of knee osteoarthritis (OA) have shown modest associations with clinical pain. We sought to evaluate possible differences in quantitative sensory testing (QST) results and psychosocial distress profiles between knee OA patients with discordant versus congruent clinical pain reports relative to radiographic severity measures.

Methods

A total of 113 participants (66.7% women; mean ± SD age 61.05 ± 8.93 years) with knee OA participated in the study. Radiographic evidence of joint pathology was graded according to the Kellgren/Lawrence scale. Central sensitization was indexed through quantitative sensory testing, including heat and pressure–pain thresholds, tonic suprathreshold pain (cold pressor test), and repeated phasic suprathreshold mechanical and thermal pain. Subgroups were constructed by dichotomizing clinical knee pain scores (median split) and knee OA grade scores (grades 1–2 versus 3–4), resulting in 4 groups: low pain/low knee OA grade (n = 24), high pain/high knee OA grade (n = 32), low pain/high knee OA grade (n = 27), and high pain/low knee OA grade (n = 30).

Results

Multivariate analyses revealed significantly heightened pain sensitivity in the high pain/low knee OA grade group, while the low pain/high knee OA grade group was less pain‐sensitive. Group differences remained significant after adjusting for differences on psychosocial measures, as well as age, sex, and race.

Conclusion

The results suggest that central sensitization in knee OA is especially apparent among patients with reports of high levels of clinical pain in the absence of moderate‐to‐severe radiographic evidence of pathologic changes of knee OA.

     

Complete nucleotide sequence of watermelon chlorotic stunt virus originating from oman

Watermelon chlorotic stunt virus (WmCSV) is a bipartite begomovirus (genus Begomovirus, family Geminiviridae) that causes economic losses to cucurbits, particularly watermelon, across the Middle East and North Africa. Recently squash (Cucurbita moschata) grown in an experimental field in Oman was found to display symptoms such as leaf curling, yellowing and stunting, typical of a begomovirus infection. Sequence analysis of the virus isolated from squash showed 97.6-99.9% nucleotide sequence identity to previously described WmCSV isolates for the DNA A component and 93-98% identity for the DNA B component. Agrobacterium-mediated inoculation to Nicotiana benthamiana resulted in the development of symptoms fifteen days post inoculation. This is the first bipartite begomovirus identified in Oman. Overall the Oman isolate showed the highest levels of sequence identity to a WmCSV isolate originating from Iran, which was confirmed by phylogenetic analysis. This suggests that WmCSV present in Oman has been introduced from Iran. The significance of this finding is discussed.     

Gaps in health insurance coverage and emergency department use among children with asthma

Background: Gaps in health insurance coverage may complicate asthma management and increase emergency department (ED) use. Using two nationally-representative surveys, we characterize the prevalence of coverage gaps among children with asthma, and describe their association with ED visits in this population. Methods: De-identified data were obtained from the 2016 National Survey of Children’s Health (NSCH) and National Health Interview Survey (NHIS). Among children with asthma, we classified coverage over the past year as: (1) continuous private, (2) continuous public, (3) gap in coverage, and (4) continuously uninsured. The primary outcome was all-cause ED visits in the past year (both surveys). Secondary outcomes included unmet health care needs (NSCH), asthma-related ED visits or hospitalizations (NHIS) and asthma exacerbations (NHIS). Results: The analysis included 3739 (NSCH) and 854 (NHIS) children with asthma, representing a population of 5.5 million children in the US. Estimated prevalence of coverage gaps was 5% in the NSCH and 3% in the NHIS. On multivariable ordinal logistic regression using NSCH data, coverage gaps were associated with increased all-cause ED use (OR?=?2.5; 95% CI: 1.3, 4.7, p?=?0.005), compared to continuous private coverage. Further analysis confirmed higher odds of unmet health care needs, asthma exacerbations, and asthma-related ED visits among children with coverage gaps. Conclusions: Children with asthma who experience insurance coverage gaps have increased ED use, possibly related to poorer access to appropriate health care. Protecting insurance coverage continuity may reduce ED use and improve clinical outcomes in this population.     

Do patients at risk of sleep apnea have an increased risk of cardio-respiratory complications during endoscopy procedures?

Background

Patients with sleep apnea (OSA) have an increased risk of perioperative complications.

Aim

The purpose of this study is to assess whether OSA increases the risk of cardio-respiratory complications in patients undergoing endoscopic procedures with conscious sedation.

Methods

A prospective study over a 7-month period was performed. All patients undergoing upper, lower, or combined endoscopy were asked to fill in the Berlin questionnaire. The questionnaire was scored, and patients were classified as high or low risk for sleep apnea based on the suggested scoring criteria. Patients who had previously undergone a sleep study were excluded. Demographics and co-morbidities were identified from the electronic medical record. Procedure type, amount of sedation, and minor and major complications were identified from the endoscopy flow sheet. The minor complications were defined as hypertension, hypotension, bradycardia, tachycardia, hypoxemia, and bradypnea (respiratory rate <8?breaths/min). Major complications included chest pain, arrhythmia, altered mental status, respiratory distress, and a minor complication that required a significant intervention, such as use of a reversal agent, atropine, up-titration of oxygen for hypoxemia, or prolonged observation.

Results

Procedures were performed in 904 patients: colonoscopies, 68.0%; upper endoscopies, 22.8%; and combined procedures, 9.2%. Five hundred fifty-three patients were identified as low risk (61.2%), and 351 were identified as high risk (38.8%). The mean age was 59.5?±?10.5?years, mean body mass index was 28.9?±?6.6, mean neck circumference was 16.2?±?6.3?in., and 91.4% were males. The median Charlson co-morbidity index was 1 (25?C75% percentage range 0?C2). All patients received midazolam and fentanyl during endoscopy. The median and 25?C75% range for midazolam and fentanyl dosages were 5?mg, 4?C6?mg and 100???g, 75?C125???g, respectively. Minor complications were observed in 10.56% of low-risk patients and 10.63% of high-risk patients (p = not significant (NS); odds ratio, 1.01; 95% confidence interval 0.65?C1.56). Major complications were observed in 3.25% of low-risk patients and 1.9% of high-risk patients (p = ns; odds ratio, 0.6; 95% confidence interval 0.26?C1.46).

Conclusion

For patients undergoing endoscopy procedures under conscious sedation, the presence of OSA does not clearly increase the risk of cardiopulmonary complications.     

Dose-dependent effect of histamine on antibody generation in vivo

ObjectiveTo delineate immunomodulatory role of histamine on antibody generation profile in rabbit in the present dose-dependent histamine study.MethodsThe cohort comprised of three groups (III, IV and V), containing six rabbits each, and received subcutaneous histamine 50 μ g/kg × bis in die (b.i.d.), 100 μg/kg × b.i.d. and 200 μg/kg × b.i.d., respectively for 10 days (starting from the 1st day). They were subsequently immunized on the 3rd day with intravenous injection of sheep blood cell (SRBC) (1×10⁹ cells/mL). Group II (positive control) (n=6) received vehicle (sterile distilled water) and immunized at day 3 similarly while group I (negative control) (n=6) remained non-immunized and received only vehicle. All experimentations were performed in triplicate. Blood samples were collected on pre-immunization (pre-I) (day 0), as well as on days 7-, 14-, 21-, 28- and 58- post-immunization (post-I). Immunological parameters [total immunoglobulins (Igs), IgM and IgG] were analyzed by enzyme linked immunosorbent assay (ELISA) technique.ResultsHistamine could influence a detectable antibody response to SRBC as early as day 7-post-I, which lasted until day 58- post-I. The results were found statistically significant (P < 0.05).ConclusionsOur results provide evidence that histamine has a short-term effect on antibody generation (until its presence in the body), and the antibody generation titer in vivo were affected by the concentration of histamine.     

A novel haplotype in ABCA1 gene effects plasma HDL-C concentration

On the basis of pathological, angiographical, intravascular ultrasound and computed tomography data coronary atherosclerosis appears to be more prevalent in the left coronary arterial system compared to the right. However, the pathophysiological mechanisms implicated in this discrepancy largely remain uncertain. The hemodynamic or anatomical differences between the right and left coronary artery might play a key role. Physiologically, the right coronary flow is more uniform during the cardiac cycle compared to the left, which experiences a remarkable systolic decline accompanied by a significant diastolic increment. Thus, the oscillatory shear stress, that constitutes a proved atherogenic factor, is more intense in regions with disturbed flow in the left coronary system. Likewise, the wall stress is more oscillatory during the cardiac cycle in the left coronary artery. On top of that, several differences regarding the anatomical configuration (3D geometry, branching) and the phasic motion between the right and the left arterial system appear to play a critical role in the modulation of the local atherogenic environment. Therefore, it could be assumed that the flow characteristics along with the geometrical and phasic motion patterns generate an intense oscillation of the imposed to the arterial wall stresses, especially in the left coronary artery. Over the long-term, these augmented oscillatory stresses, in combination with the effect of systemic risk factors, might modulate a more atherogenic environment in the atherosclerosis-prone regions of the left coronary system.