The role of F18-fluorodeoxyglucose positron emission tomography in identifying patients at high risk for lethal arrhythmias from cardiac sarcoidosis and the use of serial scanning to guide therapy

Substantial literature exists linking inflammation with arrhythmia, in particular with regards to serological markers of systemic inflammation. Regional inflammation can be identified using positron emission tomography (PET) with the radiotracer F18-fluorodeoxyglucose (F18-FDG). In the current series, we demonstrate novel applications of cardiac PET using F18-FDG and N13-ammonia radiotracers in the evaluation and treatment of arrhythmia associated with cardiac sarcoidosis. These applications include defining the cause of arrhythmia, identifying arrhythmias that will be amenable to medical management, and guiding therapy using serial scanning. Though these applications are promising, prospective multicenter studies are needed to provide better understanding of the utility of PET imaging in the diagnosis and treatment of arrhythmias.     

Genomic Epidemiology of Vibrio cholerae O1 Associated with Floods,Pakistan, 2010

In August 2010, Pakistan experienced major floods and a subsequent cholera epidemic. To clarify the population dynamics and transmission of Vibrio cholerae in Pakistan, we sequenced the genomes of all V. cholerae O1 El Tor isolates and compared the sequences to a global collection of 146 V. cholerae strains. Within the global phylogeny, all isolates from Pakistan formed 2 new subclades (PSC-1 and PSC-2), lying in the third transmission wave of the seventh-pandemic lineage that could be distinguished by signature deletions and their antimicrobial susceptibilities. Geographically, PSC-1 isolates originated from the coast, whereas PSC-2 isolates originated from inland areas flooded by the Indus River. Single-nucleotide polymorphism accumulation analysis correlated river flow direction with the spread of PSC-2. We found at least 2 sources of cholera in Pakistan during the 2010 epidemic and illustrate the value of a global genomic data bank in contextualizing cholera outbreaks.     

Exploration of Nutraceutical Potential of Herbal Oil Formulated from Parasitic Plant

Background

Cuscuta reflexa (C. reflexa) is a parasitic climber of medicinal importance. The present study was aimed to evaluate the nutraceutical potential of C. reflexa stems collected from different hosts and to evaluate the role of the herbal formulation in dandruff, hair fall control as well as hair growth promoter.

Materials and Methods

Hair formulations of C. reflexa collected from different host plants were prepared in the form of herbal oils (10% w/v). C. reflexa stems were extracted using mustard oil as base oil by using direct boiling technique. Prepared oil was studied as hair tonic. The experimental protocols used were anti-dandruff hair growth activity, as well as hair fall reduction. Herbal hair oils versus mustard oil were evaluated by applying oils on human volunteers with hair fall and dandruff problem whereas promotion of hair growth activity was conducted on rats. The formulated oils were also characterised for proximate analysis, physiochemical composition, as well as antimicrobial activity.

Result

The test oils of C. reflexa collected from Azadiracta indica and Zizyphus jujuba were effective in the promotion of hair growth, dandruff control, as well as reduction in hair fall activity.

Conclusion

All the formulated oils showed potent antimicrobial activity against all selected strains of bacteria and fungi.     

Coactivating signals for the hepatic lymphocyte gamma interferon response to Francisella tularensis

The facultative intracellular bacterium Francisella tularensis is capable of causing systemic infections in various hosts, including mice and humans. The liver is a major secondary site of F. tularensis infection, but hepatic immune responses to the pathogen remain poorly defined. Immune protection against the pathogen is thought to depend on the cytokine gamma interferon (IFN-gamma), but the cellular basis for this response has not been characterized. Here we report that natural killer cells from the livers of na?ve uninfected mice produced IFN-gamma when challenged with live bacteria in vitro and that the responses were greatly increased by coactivation of the cells with either recombinant interleukin-12 (IL-12) or IL-18. Moreover, the two cytokines had strong synergistic effects on IFN-gamma induction. Neutralizing antibodies to either IL-12 or IL-18 inhibited IFN-gamma production in vitro, and mice deficient in the p35 subunit of IL-12 failed to show IFN-gamma responses to bacterial challenge either in vitro or in vivo. Clinical isolates of highly virulent type A Francisella tularensis subsp. tularensis organisms were comparable to the live attenuated vaccine strain of Francisella tularensis subsp. holarctica in their ability to induce IL-12 and IFN-gamma expression. These findings demonstrate that cells capable of mounting IFN-gamma responses to F. tularensis are resident within the livers of uninfected mice and depend on coactivation by IL-12 and IL-18 for optimum responses.     

Impact of critical care reconfiguration and track-and-trigger outreach team intervention on outcomes of haematology patients requiring intensive care admission

Patients with haematological disorders have previously been considered to have poor outcomes following admission to intensive care units. Although a number of haematology centres from outside the UK have now demonstrated improved outcomes, the continuing perception of poor outcomes in this patient group continues to adversely affect their chances of being admitted to some intensive care units (ICUs). Over the past 10 years, there have been many advances within the disciplines of both haematology and intensive care medicine. This study was done to assess outcomes and the impact of an early warning scoring system (EWS) and early involvement of ICU outreach teams. One hundred five haematology patients (haematopoietic stem cell transplant (HSCT) or non-HSCT) had 114 admissions to ICU between April 2006 and August 2008 which coincided with hospital-wide implementation of EWS. The survival to ICU discharge was 56 (53%). Thirty-three (33%) patients were alive at 6 months giving a 1-year survival of 31%. Of the 39 HSCT patients, nine were post-autologous and 30 post-allogeneic transplant. The survival to ICU discharge was 22 (56%) with 14 (36%) patients alive at 6 months. One year survival was 36%. Prior to the introduction of EWS and critical care outreach team (2004), survival to ICU discharge was 44% which has increased to 53% (2006–2008). This is despite an increase in mechanical ventilation in 2006–2008 (50%) as compared to 2004 (32%).The improvement in ICU survivorship was even more prominent in HSCT patients (37% in 2004 versus 56% in 2006–2008). There was a trend towards decreasing Acute Physiology and Chronic Health Evaluation scores with time, suggesting appropriate patients being identified earlier and having timely escalation of their treatment.     

Pericardial fluid proteomic label-free quantification of differentially expressed proteins in ischemic heart disease patients with systolic dysfunction by nano-LC-ESI-MS/MS analysis

Left ventricular systolic dysfunction (LVSD) is common in patients with pre-existing ischemic heart disease (IHD) and myocardial infarction. An untargeted proteomic approach is used to improve the understanding of the molecular mechanisms associated with LVSD and to find out potential proteomic signatures in pericardial fluid. The pericardial fluid of IHD (n = 45) patients was grouped into two categories according to the left ventricular ejection fraction, LVEF ≥45 (n = 33) and LVEF <45 (n = 12), and analyzed by using nano-liquid chromatography–mass spectrometry (nano-LC-MS/MS) technique. The nano-LC-MS/MS analysis resulted in the identification of 709 pericardial fluid (PF) proteins in both normal and impaired systolic functional groups (LVEF ≥45 vs. LVEF <45). Sixteen proteins were found to be differentially expressed (p < 0.05, fold change >2) including 12 down-regulated and 4 up-regulated in the impaired systolic functional group (LVEF <45) compared to the normal group (LVEF ≥45). Among the differentially expressed proteins the inflammatory marker albumin, atherosclerosis marker apolipoprotein A-IV and hedgehog-interacting protein marker of angiogenesis were predominantly associated with the impaired LVEF <45 group. KEGG pathway analysis revealed that the hedgehog (Hh) signalling pathway is up-regulated in LVSD reflecting the underlying molecular and pathophysiological processes.

Proteomics of pericardial fluid from patients with ischemic heart disease having impaired systolic function.