Vitamin K antagonists--current concepts and challenges

Vitamin K antagtonists (VKAs) have, for decades, been the corner-stone of anticoagulation in the outpatient setting. While the long half life makes once daily administration practical, close monitoring of VKA effect is necessary because these medicines have a narrow therapeutic index. Despite inter-individual variations in response to VKA doses, the increasing availability of specialized anticoagulation monitoring systems, along with a better understanding of potential drug and dietary interactions, has made the use of VKAs safer and less burdensome. In the future, newer classes of oral anticoagulants and genomic-based dosing strategies may further expand or improve the management options for many patients at risk for thromboembolism.     

Characterization of rickettsial adhesin Adr2 belonging to a new group of adhesins in α-proteobacteria

Background

Rickettsia prowazekii is the etiological agent of epidemic typhus and is an obligate intracellular bacterium that grows as a parasite freely within the cytoplasm of a eukaryotic host cell. Previous studies have shown that rOmpA and rOmpB which belong to the family of rickettsial cell surface antigens are involved in vitro in the adhesion of Rickettsiae to epithelial cells. Recently, two putative rickettsial adhesins have been identified using high resolution 2D-PAGE coupled with mass spectrometry. In this study, we further characterize and describe the adhesin Adr2 from R. prowazekii.

Methodology/Principal findings

Using an overlay assay coupled with mass spectrometry two adhesins, Adr1 (RP827) and Adr2 (RP828), were identified from the R. prowazekii proteome Recombinant R. prowazekii Adr2 was expressed through fusion with Dsbc in Escherichia coli, purified and concentrated, thus allowing production of specific monoclonal antibodies, as confirmed by western blot assays. Finally, inhibition of rickettsiae-induced cytotoxicity with monoclonal anti-Adr2 antibody has showed a greatest impact on bacterial cell entry at 8 h post-infection (ca50%) and then decreased progressively to attempt 18% of inhibition at day 7. These, correlated to the inhibition of rickettsiae-induced cytotoxicity with monoclonal anti-rOmpB antibody. Thus, Adr2 is sufficient to mediate R. prowazekii entry into the cell at early stage of mammalian cell infection.

Conclusions

Our results suggest that R. prowazekii Adr2 could be the main actor promoting the entry of rickettsiae into the host cells. The present study opens the framework for future investigations for better understanding of the Adr2 -mediated mechanisms involved in adhesion/invasion or intracellular survival of R. prowazekii.     

An image processing application for the localization and segmentation of lymphoblast cell using peripheral blood images

An important preliminary step in the diagnosis of leukemia is the visual examination of the patient’s peripheral blood smear under the microscope. Morphological changes in the white blood cells can be an indicator of the nature and severity of the disease. Manual techniques are labor intensive, slow, error prone and costly. A computerized system can be used as a supportive tool for the specialist in order to enhance and accelerate the morphological analysis process. This research present a new method that integrates color features with the morphological reconstruction to localize and isolate lymphoblast cells from a microscope image that contains many cells. The localization and segmentation are conducted using a proposed method that consists of an integration of several digital image processing techniques. 180 microscopic blood images were tested, and the proposed framework managed to obtain 100% accuracy for the localization of the lymphoblast cells and separate it from the image scene. The results obtained indicate that the proposed method can be safely used for the purpose of lymphoblast cells localization and segmentation and subsequently, aiding the diagnosis of leukemia.     

Dofetilide induced trigeminal neuralgia

Anti-arrhythmic medications are uncommonly used due to their pro-arrhythmic effect. However, just like any other class of medication, they can cause idiosyncratic reactions that may or may not be related to their mechanism of action. Those reactions can be severe enough to warrant discontinuation of a successful therapeutic intervention. In this case, we present a case of trigeminal neuralgia caused by dofetilide.KEY WORDS: Adverse effects, dofetilide, trigeminal neuralgia     

Serum N-terminal pro-B-type natriuretic peptide levels are associated with functional capacity in patients with peripheral arterial disease

We hypothesized that higher serum levels of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) are associated with lower functional capacity in patients with peripheral arterial disease ([PAD] n = 481, mean age 67, 68% men). Functional capacity was quantified as distance walked on a treadmill for 5 minutes. Patients were divided into 3 groups according to the distance walked: >144 yards (group 1, n = 254); 60 to 144 yards (group 2, n = 80); <60 yards or did not walk (group 3, n = 147). The association between NT-pro-BNP levels and the ordinal 3-level walking distance was assessed using multivariable ordinal logistic regression analyses that adjusted for several possible confounding variables. Higher levels of NT-pro-BNP were associated with a lower ordinal walking category independent of possible confounders (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.28-1.77; P < .001). In conclusion, higher levels of NT-pro-BNP are independently associated with lower functional capacity in patients with PAD and may be a marker of hemodynamic stress in these patients.