Development of three quantitative real-time PCR assays for the detection of Rickettsia raoultii,Rickettsia slovaca,and Rickettsia aeschlimannii and their validation with ticks from the country of Georgia and the Republic of Azerbaijan

A previous surveillance study of human pathogens within ticks collected in the country of Georgia showed a relatively high infection rate for Rickettsia raoultii, R. slovaca, and R. aeschlimannii. These 3 spotted fever group rickettsiae are human pathogens: R. raoultii and R. slovaca cause tick-borne lymphadenopathy (TIBOLA), and R. aeschlimannii causes an infection characterized by fever and maculopapular rash. Three quantitative real-time polymerase chain reaction (qPCR) assays, Rraoul, Rslov, and Raesch were developed and optimized to detect R. raoultii, R. slovaca, and R. aeschlimannii, respectively, by targeting fragments of the outer membrane protein B gene (ompB) using species-specific molecular beacon or TaqMan probes. The 3 qPCR assays showed 100% specificity when tested against a rickettsiae DNA panel (n = 20) and a bacteria DNA panel (n = 12). The limit of detection was found to be at least 3 copies per reaction for all assays. Validation of the assays using previously investigated tick nucleic acid preparations, which included Rickettsia-free tick samples, tick samples that contain R. raoultii, R. slovaca, R. aeschlimannii, and other Rickettsia spp., gave 100% sensitivity for all 3 qPCR assays. In addition, a total of 65 tick nucleic acid preparations (representing 259 individual ticks) collected from the country of Georgia and the Republic of Azerbaijan in 2009 was tested using the 3 qPCR assays. R. raoultii, R. slovaca, and R. aeschlimannii were not detected in any ticks (n = 31) from the Republic of Azerbaijan, but in the ticks from the country of Georgia (n = 228) the minimal infection rate for R. raoultii and R. slovaca in Dermacentor marginatus was 10% and 4%, respectively, and for R. aeschlimannii in Haemaphysalis sulcata and Hyalomma spp. it was 1.9% and 20%, respectively.     

Tobacco use prevalence, knowledge and attitudes, and tobacco cessation training among medical students: results of a pilot study of Global Health Professions Students Survey (GHPSS) in Italy

Aim

The aims of this study were to examine tobacco use prevalence, knowledge and attitudes, and tobacco cessation training among students attending Italian medical schools using the Global Health Professions Student Survey approach and to identify possible factors associated with smoking status.

Subjects and Methods

A multicentre cross-sectional pilot study was carried out in five Italian Schools of Medicine from March to April 2009. Questionnaires were administered in anonymous, voluntary and self-administered form to third year students attending medical schools. The outcome measure was ??being a current smoker??. A logistic regression was used to evaluate possible factors associated with smoking status.

Results

The prevalence of current smokers was 31.4%. More than half considered health professionals as models for patients, and around 90% thought health professionals have a role in giving advice or information about smoking cessation. Only 5.8% of responders had received smoking cessation training during medical school. Medical students who considered healthcare professionals as behavioural models had lower likelihood of smoking (OR?=?0.52).

Conclusions

Given the high prevalence of smokers among medical students and the poorness of smoking cessation programmes, it is important to create tobacco control training programmes addressed to healthcare students.     

The Cuban experience in public health: does political will have a role?

The role of political will in public health has been largely ignored. In Cuba, however, for the past 50 years, political will has been the ultimate, encompassing intersectoral action in public health. The excellent achievements in population health in Cuba during these 50 years have been widely recognized. Researchers have sought to explain this "Cuban paradox" by focusing on a large array of public health factors, including health promotion, primary care activities, and intersectoral action on health determinants. These factors constitute necessary but not sufficient conditions to achieve good health outcomes. This article defines political will and uses the experience of Cuba to illustrate the potential role of political will in public health. The authors suggest a framework for the evaluation of political will aimed at achieving good health, examining the "Five R's of political will," five observable features that may provide systematic information on the direction and realization of political will: (1) renewal of commitment, (2) reform of the system, (3) resource development, (4) review of performance, and (5) responsible management. These five features focus the spotlight on the consistency between health goals and public discourse and action.     

A new questionnaire for assessment of adverse events associated with triptans: methods of assessment influence the results. Preliminary results

Triptans are the treatment of choice for migraine sufferers with disabling attacks. However, the proportion of patients reporting side effects after any acute treatment may vary in regard to the method of assessment. This study was conducted in a neurology office focusing on headache in Italy. We prospectively surveyed adult headache sufferers who had been using the same triptan for at least 3 months (from March 2001 to May 2003). Participants were asked about their headache and treatment history. Subjects then completed a standardized questionnaire, assessing adverse events in two different ways. First, subjects were asked if they had any adverse events when using the triptan. If they answered yes, they were asked to list them and grade their severity as mild, moderate, or severe. After returning the first part of the questionnaire, subjects received a second form, where 49 possible adverse events were listed. Most of them were known triptan side effects; some confounders (side effects not expected to be related with triptan use) were added. We contrasted and correlated both sets of answers. We surveyed 108 subjects, (87.1% female, mean age 39.5 years). Most patients (65.5%) reported no side effects in the unprompted questionnaire. However, most of them (54.1%) reported at least one side effect in the prompted questionnaire. The majority of patients that reported side effects in the unprompted questionnaire said they had only one adverse event, while most reported two or more side effects in the prompted questionnaire. Both in the unprompted and in the prompted questionnaires, most side effects were rated as mild or moderate. Two (1.9%) subjects graded their adverse events as severe in the prompted questionnaire, but had not self-reported them. We conclude that when assessing the adverse events of triptans (or any class of medication), the method of data collection may dramatically influence the results.     

Pain prevalence and predictors among inpatients in a major Italian teaching hospital. A baseline survey towards a pain free hospital.

Pain prevalence among inpatients is an important indicator of quality care; it may reach over 80% in various clinical settings. A cross-sectional survey was conducted in a teaching hospital to depict benchmark data regarding pain prevalence and predictors among the entire inpatient population. Overall 892 patients, 6 years old and hospitalized for at least 24 h in 57 hospital wards were interviewed using an internationally applied questionnaire. Patients self-reported their pain intensity at the time of the interview (T(0)) and worst pain perceived during the previous 24 h (T(-1)), using a numerical rating scale (NRS) and indicated current pain duration. Specific pain predictor data (hospital stay, gender, age and marital status) were obtained from patient medical charts. Pain prevalence at T(0) was 38% and 52% at T(-1). Pain was moderate to severe (NRS4) in approximately 25% of the patients at T(0) and in 40% at T(-1). High pain prevalence was found (at T(0) and T(-1), respectively) in Radiotherapy (63%;77%), Obstetrics (68%;54%), and Surgery (59%;45%) wards. Gender was a prominent determinant as pain was significantly associated with females. Pain prevalence was high among young adults or divorced/separated individuals and low among pediatric patients ( approximately 20%). Protracted hospitalization and prolonged pain duration were associated with major pain severity. Results yield Quality Assurance interventions to ameliorate pain undertreatment. Predictor analysis suggests that attention should be paid to pain management in young adults, socially vulnerable patients and those with protracted hospitalization and pain.     

The effect of surgically created gastroesophageal reflux on intrapleural pressures in dogs

The causal relationship between gastroesophageal reflux (GER) and respiratory disorders is not well understood. Previous experimental studies that investigated this relationship were performed in anesthetized animals and used artificial acidification of esophagus for simulation of GER. In this study, we investigated the impact of GER on intrapleural pressures (IPP) in conscious, unanesthetized dogs. After the induction of appropriate anesthesia, 5 purpose-bred mongrel dogs underwent reflux-creating surgery (partial cardiomyectomy). The presence of GER was confirmed by determining the reflux index (RI) and the duration of longest reflux episode (DLRE) after 24-h intraesophageal pH-metry. IP was monitored before and after cardiomyectomy using a subcutaneously placed telemetric implant with its pressure-sensor catheter tip inserted into the pleural space. Partial cardiomyectomy resulted in a significant increase in RI from a preoperative mean value of 0.38 +/- 0.21 to 7.52 +/- 2.56%, and DLRE from 1.22 +/- 1.12 to 36.80 +/- 12.71 min, as recorded by the proximal sensor of the pH probe. A similar trend was observed at the distal sensor. After cardiomyectomy, the negative inspiratory IPP significantly increased from 17.2 +/- 7.9 to 28.4 +/- 9.7 mm Hg. A similar effect was observed in the negative expiratory IPP. The negative inspiratory IPP had a significant correlation with both RI (R = 0.932) and DLRE (R = 0.899). Cardiomyectomy causes GER, the severity of which correlates with negative inspiratory IPP in a dog model. The suggested model allows for the investigation of the pathologic association of GER with respiratory disorders in conscious animals.     

Low‐dose azacitidine maintenance therapy after allogeneic stem cell transplantation for high‐risk pediatric acute myeloid leukemia

The dismal prognosis of pediatric acute myeloid leukemia (AML) relapsing after hematopoietic stem cell transplantation (HSCT) requires exploration of novel strategies to prevent relapse. Azacitidine (AZA) maintenance therapy could potentially reduce the recurrence rate post HSCT. Here, we presents the cases of three children with high‐risk AML post HSCT who were treated with low‐dose AZA maintenance therapy, demonstrating the feasibility of this therapy. Currently, all three are in complete remission for 13–41 months despite their high‐risk characteristics. Our encouraging data warrant larger prospective studies to assess the efficacy and safety of low‐dose AZA maintenance therapy post HSCT for pediatric patients with high‐risk AML.     

The global burden of disease due to outdoor air pollution

As part of the World Health Organization (WHO) Global Burden of Disease Comparative Risk Assessment, the burden of disease attributable to urban ambient air pollution was estimated in terms of deaths and disability-adjusted life years (DALYs). Air pollution is associated with a broad spectrum of acute and chronic health effects, the nature of which may vary with the pollutant constituents. Particulate air pollution is consistently and independently related to the most serious effects, including lung cancer and other cardiopulmonary mortality. The analyses on which this report is based estimate that ambient air pollution, in terms of fine particulate air pollution (PM(2.5)), causes about 3% of mortality from cardiopulmonary disease, about 5% of mortality from cancer of the trachea, bronchus, and lung, and about 1% of mortality from acute respiratory infections in children under 5 yr, worldwide. This amounts to about 0.8 million (1.2%) premature deaths and 6.4 million (0.5%) years of life lost (YLL). This burden occurs predominantly in developing countries; 65% in Asia alone. These estimates consider only the impact of air pollution on mortality (i.e., years of life lost) and not morbidity (i.e., years lived with disability), due to limitations in the epidemiologic database. If air pollution multiplies both incidence and mortality to the same extent (i.e., the same relative risk), then the DALYs for cardiopulmonary disease increase by 20% worldwide.