Development of a loop-mediated isothermal amplification method for detection of Theileria lestoquardi

A loop-mediated isothermal amplification (LAMP) assay was developed for the diagnosis of Theileria lestoquardi infection. The primers were designed based on the clone-5 sequence of T. lestoquardi. The specificity and sensitivity of the assay were established. Analysis of the specificity showed that the selected LAMP primers amplified the target sequence from T. lestoquardi DNA successfully, while no amplification was seen with DNA from Theileria annulata, Theileria ovis, Babesia ovis, Anaplasma ovis, or ovine genomic DNA. The specificity of the LAMP product was further confirmed by restriction digestion and sequencing. The sensitivity of the LAMP assay was analyzed in comparison to PCR resulting in a detection limit of 10 fg/μl of plasmid DNA containing the clone-5 sequence. The suitability for utilizing the LAMP assay in the field for the diagnosis of T. lestoquardi infection was tested on 100 field samples collected in Sudan and compared with results obtained by PCR. The relative specificity and sensitivity of the established LAMP assay was determined to be 92.1% and 87.5%, respectively, indicating that it may be regarded as an alternative molecular diagnostic tool to PCR which could be used for epidemiological surveys on T. lestoquardi infection.     

Medicaid integrity program: what you need to know

Over the last few years, Congress has established more programs for increased Medicaid enforcement activities. One of the earliest of these is the Medicaid Integrity Program, a federal program that was established in 2005 to cause uniform and consistent Medicaid enforcement activities across all states. Since that time, the Centers for Medicare & Medicaid Services (CMS) has been slowly implementing this program. Although it is based within CMS's framework, the vast majority of the work will be done by subcontractors, similar to the Medicare Recovery Audit Contractor program. The actual roll out of this program has been slow, but it is expected that enforcement activities will increase over the next 6 to 12 months.     

Evaluation of aggressive heart rate reduction in patients with stable angina

Background

There is a strong correlation between heart rate and myocardial ischemia, cardiovascular diseases, and life expectancy in general; however, heart rate has been neglected as an important risk factor as well as a therapeutic opportunity.

Purpose

To investigate the effect of aggressive heart rate reduction (50 ⩽ HR ⩽ 60 bpm) on anti-ischemic and anti-anginal efficacy, left ventricular function, exercise tolerance and quality of life in patients with stable coronary artery disease with or without left ventricular dysfunction during 4 months.

Methods

A total of 159 patients presented with stable CAD without clinical heart failure symptoms were included in a open-label, non-comparative, prospective clinical study between June 2009 to February 2010 in King Abdul Aziz Specialist Hospital, Taif, KSA, Al Hayah National Hospital, Khamis Mushyt, KSA and Critical care department, Cairo University, Egypt. All included patients were, in addition to the ant ischemic treatment, subjected to aggressive heart rate control starting by beta blocker titrated to the maximum dose as tolerated, then Ivabradine added if the target heart rate is not achieved or rate control started by Ivabradine if beta blockers are contraindicated. Exercise treadmill test (ETT) to assess exercise capacity using time to 1 mm ST-segment depression in milliseconds, ejection fraction (EF) assessed by transthoracic echocardiography and frequency of angina attacks and the use of sublingual nitroglycerin per week during the last week were evaluated during a follow-up for 4 months. The patients were divided into two groups, group-I (patients achieved a resting heart rate between 50 and 60 bpm with heart rate reduction treatment) and group-II (patients with resting HR >60 bpm in spite of maximum treatment for heart rate reduction).

Results

The resting heart rate was significantly reduced from 77.98 ± 8.7 at baseline to 60.68 ± 4.34 bpm after 4 months of treatment, P < 0.001. The frequency of angina pectoris attacks had been significantly reduced from 2.14 ± 1.27 to 0.48 ± 0.58 attacks per week, P < 0.001 and the highest significant reduction was observed with group-I. Also, the frequency of use sublingual nitrate therapy was significantly reduced from 1.38 ± 1.1 tablet per week at the last week before the study to 0.12 ± 0.33 tablet per week during the last week after 4 months of treatment, P < 0.001 and the reduction was more significantly with group-I. Exercise treadmill test demonstrated statistically significant increase in the time to 1 mm ST-segment depression from 357.36 ± 66.73 at baseline to 387.96 ± 65.19 ms. after 4 months with P < 0.001. The degree of improvement was significantly higher for group-I (from 358.06 ± 68.81 at baseline to 391.71 ± 69.01 after 4 months with P < 0.001) than that of group-II (from 356.11 ± 64.8 at baseline to 381.27 ± 59.08 after 4 months with P < 0.001). Ejection fraction showed a statistically significant increase from 59.76 ± 6.86 at baseline to 61.04 ± 5.35 after 4 months with P < 0.001.

Conclusion

This study indicates that heart rate reduction has been associated with an improvement in quality of life in patients with stable coronary artery disease, presenting new opportunities for treatment.     

The impact of maintaining normal serum albumin level following living related liver transplantation: does serum albumin level affect the course? A pilot study

Hypoalbuminemia in patients with end-stage liver disease persists for weeks even after liver transplantation. Human albumin is widely used for volume replacement, to increase oncotic pressure, to improve organ function, and to promote wound healing. However, these practices are not evidence-based. We prospectively studied the clinical outcome of 40 patients following living related liver transplantation. Patients were randomized to an albumin group (n=20), where 20% human albumin was administered to maintain serum albumin level>or=3 g/dL, and a control group (n=20), where there was no correction for serum albumin. Hemodynamics and laboratory investigations, fluid administration, blood transfusion, and fluid balance were recorded during the first 5 days in the intensive care unit. Serum albumin level was significantly higher in the albumin group. Heart rate, blood pressure, central venous pressure, and cardiac output did not vary significantly between the groups. There was no significant difference in serum creatinine, creatinine clearance, bilirubin, ALT, AST, prothrombin time, and international normalized ratio between both groups. No significant difference between Tacrolimus level and dose required to maintain therapeutic concentration was noted between both groups. Postoperative course and complications did not vary significantly between both groups. In conclusion, postoperative albumin administration to a target serum albumin>or=3 g/dL does not have additional benefits for the postoperative course in patients scheduled for living related liver transplantation.     

Capacity building of nurses providing neonatal care in Rio de Janeiro, Brazil: methods for the POINTS of care project to enhance nursing education and reduce adverse neonatal outcomes

Background

Increased survival of preterm infants in developing countries has often been accompanied by increased morbidity. A previous study found rates of severe retinopathy of prematurity varied widely between different neonatal units in Rio de Janeiro. Nurses have a key role in the care of high-risk infants but often do not have access to ongoing education programmes. We set out to design a quality improvement project that would provide nurses with the training and tools to decrease neonatal mortality and morbidity. The purpose of this report is to describe the methods and make the teaching package (POINTS of care--six modules addressing Pain control; optimal Oxygenation; Infection control; Nutrition interventions; Temperature control; Supportive care) available to others.

Methods/Design

Six neonatal units, caring for 40% of preterm infants in Rio de Janeiro were invited to participate. In Phase 1 of the study multidisciplinary workshops were held in each neonatal unit to identify the neonatal morbidities of interest and to plan for data collection. In Phase 2 the teaching package was developed and tested. Phase 3 consisted of 12 months data collection utilizing a simple tick-sheet for recording. In Phase 4 (the Intervention) all nurses were asked to complete all six modules of the POINTS of care package, which was supplemented by practical demonstrations. Phase 5 consisted of a further 12 months data collection. In Phase 1 it was agreed to include inborn infants with birthweight ?? 1500 g or gestational age of ?? 34 weeks. The primary outcome was death before discharge and secondary outcomes included retinopathy of prematurity and bronchopulmonary dysplasia. Assuming 400-450 infants in both pre- and post-intervention periods the study had 80% power at p = < 0.05 to detect an increase in survival from 68% to 80%; a reduction in need for supplementary oxygen at 36 weeks post menstrual age from 11% to 5.5% and a reduction in retinopathy of prematurity requiring treatment from 7% to 2.5%.

Discussion

The results of the POINTS of Care intervention will be presented in a separate publication.

Trial registration

Current Controlled Trials: ISRCTN83110114     

Nursing students motivation toward their studies – a survey study

Background

Antenatal education (AE) started more than 30 years ago with the purpose of decreasing pain during childbirth. Epidural anaesthesia has achieved this objective, and the value of AE is therefore currently questioned. This article describes the protocol and process of a study designed to assess AE results today.

Methods/Design

A prospective study was designed in which a cohort of 616 nulliparous pregnant women attending midwife offices of the Basque Health Service were followed for 13 months. Three exposure groups were considered based on the number of AE sessions attended: (a) women attending no session, (b) women attending 1 to 4, and (c) women attending 5 or more sessions. Sociodemographic, personality, and outcome variables related to childbirth and breastfeeding were measured. It was expected 40% of pregnant women not to have participated in any AE session. However, 93% had attended at least one session. This low exposure variability decreased statistical power of the study as compared to the initially planned power. Despite this, there was a greater than 80% power for detecting as significant differences between exposure groups of, for instance, 10% in continuation of breastfeeding at one and a half months and in visits for false labour. Women attending more sessions were seen to have a mean higher age and educational level, and to belong to a higher socioeconomic group (p < 0.01). Follow-up was completed in 99% of participants.

Discussion

Adequate prior estimation of variability in the exposure under study is essential for designing cohort studies. Sociodemographic characteristics may play a confounding role in studies assessing AE and should be controlled in design and analyses. Quality control during the study process and continued collaboration from both public system midwives and eligible pregnant women resulted in a negligible loss rate.     

Unusual finding of bronchopulmonary carcinoma through a pterygoid muscle metastasis. About a case

Bronchopulmonary cancer muscle metastases are uncommon, especially when they are visible. They can impact any muscle in the body, but the psoas, diaphragmatic, and paravertebral muscles have a clear advantage. We present a case of lateral pterygoid muscle metastasis of squamous cell carcinoma of the lung in a 70-year-old habitual smoker (40 packs per year) presents headaches more marked on the right and progressively worsening. A complementary brain MRI revealed a well-limited oval formation with irregular contours in hypo signal T1 hyper signal T2 heterogeneous, with area of central necrosis of the right pterygoid muscle, which was revealed to be a secondary location of bronchopulmonary malignancy after further examination (CT scan of the cervico-thoraco-abdomino-pelvic region, TEP scan, and biopsy). Moreover, muscle metastases are rarely revealing of primary cancer.     

Post-traumatic biloma intrahepatic a rare complication of closed abdominal trauma: A case report

Post-traumatic hepatic biloma is a rare complication of closed trauma of the abdomen. Generally, biloma occurs spontaneously or secondary to traumatic or iatrogenic injury to the biliary system. It can lead to significant morbidity and mortality if not diagnosed promptly and properly managed. A 4-year-old child was admitted to the emergency room with abdominal pain following a traffic accident. Clinical examinations suspected closed abdominal trauma without biological signs of icteric cholestasis. Abdominal CT scan performed within 24 hours showed a focus of hepatic laceration, and follow-up imaging at 5 days showed post-traumatic intrahepatic cystic formations. This case report aims to emphasize the importance of imaging including ultrasound, CT, MRI, MRI cholangiopancreatography (MRCP), or hepatobiliary cholescintigraphy to establish the diagnosis and guide the therapeutic gestures.     

Mediastinal bronchial artery aneurysm presenting as an incidental mediastinal mass: A rare finding

Mediastinal bronchial artery aneurysm is very rare and only few cases have been reported in the literature. The clinical presentations are varied, ranging from an incidental radiological finding to a cataclysmic rupture leading to hemorrhagic shock. Thus, a quick treatment is indicated upon diagnosis. Therapeutic options are various including surgical resection, stent grafting with percutaneous embolization of feeding vessel or transtarterial embolization. Herein we describe a case of an incidental mediastinal bronchial artery aneurysm in a 63-year-old man, managed by transtarterial embolization.