Swine influenza virus: zoonotic potential and vaccination strategies for the control of avian and swine influenzas

Influenza viruses are able to infect humans, swine, and avian species, and swine have long been considered a potential source of new influenza viruses that can infect humans. Swine have receptors to which both avian and mammalian influenza viruses bind, which increases the potential for viruses to exchange genetic sequences and produce new reassortant viruses in swine. A number of genetically diverse viruses are circulating in swine herds throughout the world and are a major cause of concern to the swine industry. Control of swine influenza is primarily through the vaccination of sows, to protect young pigs through maternally derived antibodies. However, influenza viruses continue to circulate in pigs after the decay of maternal antibodies, providing a continuing source of virus on a herd basis. Measures to control avian influenza in commercial poultry operations are dictated by the virulence of the virus. Detection of a highly pathogenic avian influenza (HPAI) virus results in immediate elimination of the flock. Low-pathogenic avian influenza viruses are controlled through vaccination, which is done primarily in turkey flocks. Maintenance of the current HPAI virus-free status of poultry in the United States is through constant surveillance of poultry flocks. Although current influenza vaccines for poultry and swine are inactivated and adjuvanted, ongoing research into the development of newer vaccines, such as DNA, live-virus, or vectored vaccines, is being done. Control of influenza virus infection in poultry and swine is critical to the reduction of potential cross-species adaptation and spread of influenza viruses, which will minimize the risk of animals being the source of the next pandemic.     

Risk factors of Egyptian male osteoporosis

Background: Osteoporosis (OP) is a growing health problem not only in women but also in men. Subjects and methods: This study was carried out on 100 healthy men, age range 30–65 years (mean ± SD, 44.65 ± 8.3). All were randomly recruited from Assiut city during the period January 2005 to January 2006. Complete clinical history included occupational history, smoking habit, physical activity and calcium intake. Complete clinical examination and anthropometric measurments were done. Laboratory investigations for serum calcium, phosphorus and osteocalcin were performed. Bone mineral density (BMD) was measured by calcaneal ultrasound. Results: Sixty‐three percent of participants had normal BMD, 37% had low BMD, (26% had quantitative bone ultrasound [QUS] T‐score –1 to –2.5 and 11% had QUS T‐score ≤ –2.5). Smoking and low physical activity were risk factors for low BMD. Significant positive correlations were found between BMD and body mass index, serum calcium, and osteocalcin and negative correlation with phosphorus. We concluded that low BMD occurs with high frequency in Egyptian men. Smoking, physical inactivity and low body index are significant risk factors. Low serum calcium, low serum osteocalcin and high serum phosphorus are biochemical risk factors of low BMD in males.     

Long‐standing ulcerative colitis complicated by right subclavian artery occlusion and upper limbs arteriolitis with digital ischemia

A 48‐year‐old male patient with long‐standing ulcerative colitis since February 2001 which was diagnosed by endoscopy, developed acute digital ischemia affecting both hands with fixed colour changes in the left index finger which was followed shortly by digital ulceration. Magnetic resonance angiography (MRA) of both upper limbs showed evidence of vasculitis affecting digital arterioles on both sided and right subclavian occlusion. The patient received pulse methylprednisolone followed by cyclophosphamide pulse therapy, the latter continuing on a monthly basis for 6 months with appreciable improvement and remission of the vasculitic process; follow‐up MRA showed reperfusion of the previously occluded subcalvian artery. To the authors’ knowledge vasculitis complicating the course of ulcerative colitis is a rare association and is only sporadically reported in the literature. This rare entity should be diagnosed early and aggressively treated; MRA is a very promising diagnostic tool that is suitable for both diagnosis and follow‐up of patients with this rare entity.     

Application of the “Hybrid Approach” to Chronic Total Occlusion Interventions: A Detailed Procedural Analysis

Objective

To assess the outcomes of the “hybrid” approach to chronic total occlusion (CTO) percutaneous coronary interventions (PCIs).

Background

The “hybrid approach” to CTO PCI advocates appropriate and early change of crossing strategy to maximize success, safety, and efficiency.

Methods

We prospectively recorded and analyzed detailed step‐by‐step procedural data in 73 consecutive CTO PCI cases performed by a single operator between July 2011 and August 2012.

Results

Technical success was achieved in 66 of 73 cases (90.4%). Mean patient age was 65 ± 7 years, and 30% had prior coronary artery bypass surgery. Dual injection was used in 78%. The primary approach was retrograde in 9 cases (12.5%) and antegrade in 64 cases (87.5%), of whom 25 cases (39.1%) underwent retrograde attempt after failed antegrade approach. The initial crossing approach was successful in 40 cases (54.8%), but 32 cases (44%) required 3.6 ± 1.4 approach changes (range 2–7). Antegrade wire escalation, antegrade dissection/reentry, and retrograde crossing were utilized in 97.2%, 46.6%, and 46.6% of cases, respectively. Among successful cases, the final CTO crossing technique was antegrade wire escalation in 50.0%, antegrade dissection/reentry in 24.2%, and retrograde in 25.8%. The mean procedure time, fluoroscopy time, and air kerma radiation exposure until CTO crossing or stopping the procedure were 66 ± 55 minutes, 25 ± 23 minutes, and 2.3 ± 1.9 Gray, respectively. Three patients (4.1%) had a major complication.

Conclusion

In the “hybrid approach” to CTO PCI, changes in crossing strategy were needed in approximately half the cases, resulting in high success and low complication rates. (J Interven Cardiol 2014;27:36–43)

     

Resilient liner vs. clip attachment effect on peri‐implant tissues of bar‐implant‐retained mandibular overdenture: a 1‐year clinical and radiographical study

Purpose: The aim of this study was to compare between the effects of resilient liner and clip attachments of bar‐implant‐retained mandibular overdenture on peri‐implant tissues. Materials and methods: In a randomized‐controlled clinical trial, 30 edentulous male patients (mean age 62.5 years) were equally assigned to two groups. In each patient, two implants were inserted in the canine area of the mandible using a two‐stage surgical protocol. After 3 months, the implants were connected with resilient bars. Mandibular overdentures were retained to the bars with either clips (group I) or silicone‐resilient liners (group II). Peri‐implant tissues were evaluated clinically (with regard to plaque scores, gingival scores and probing depths) and radiographically (with regard to peri‐implant vertical and horizontal alveolar bone changes). Evaluations were performed at the time of overdenture insertion (T0), 6 months (T6) and 12 months (T12) after overdenture insertion. Results: After 12 months of using bar‐implant‐retained mandibular overdenture, the resilient liner attachment had significantly decreased peri‐implant plaque score, gingival score, probing depth, vertical and horizontal bone loss when compared with the clip attachment. Conclusion: Within the limitations of this study, and in terms of peri‐implant tissue health of bar‐implant‐retained mandibular overdenture, we recommend resilient liner rather than clip attachment. To cite this article:
Elsyad MA, EL Shoukouki AH. Resilient liner vs. clip attachment effect on peri‐implant tissues of bar‐implant‐retained mandibular overdenture: a 1‐year clinical and radiographical study.
Clin. Oral Impl. Res. 21 , 2010; 473–480
doi: 10.1111/j.1600‐0501.2009.01879.x     

The use of DNA markers for carrier detection and prenatal diagnosis of haemophilia A in Egyptian families

Summary. Haemophilia A is the most common inherited X‐linked recessive bleeding disorder. The aim was to investigate the usefulness of two DNA markers in linkage analysis, one intragenic BCL1 affecting restriction site in intron 18, and is detected as restriction fragment length polymorphism (RFLP), and one extragenic variable number of tandem repeat (VNTR) locus DXS52 (St14) to formulate an informative and accurate carrier detection and prenatal diagnosis. The study included 46 families with at least one child affected with haemophilia A, and 30 unrelated normal females as control group. Polymerase chain reaction (PCR) and restriction enzyme analysis were used to study the polymorphism in BCL1, and long‐distance PCR for detection of VNTR (ST14) alleles. The incidence of BCL1 (+) allele was 74%, 72% and 60% in patients, mothers and control group, respectively. Expected heterozygosity for BCL1 was 40% in mothers of affected cases compared with 48% in the female control group. However, observed heterozygosity was found to be 48% in the mothers of affected cases, compared with 60% in the control group. Thus, 48% of the studied families are informative for this marker alone. Nine different alleles of VNTR (St14) were observed in mothers and six alleles in affected cases and six in the control group. The most prevalent alleles were 1300 bp (45.5% and 34%) and 700 bp (13.6% and 20%) in patients and their mothers, respectively. Observed heterozygosity in mothers was 41% compared with 43.3% in controls. The combined use of both BCL1 and St14 markers raised the informative rate to 63.6%. Carrier detection and prenatal diagnosis is possible in haemophilia A families using both DNA markers. We suggest screening haemophilic families first for BCL1 polymorphism followed by analysis of St14 locus.     

Acute otomastoiditis and its complications: role of CT

Acute bacterial (suppurative) otomastoiditis responds to antibiotic treatment; radiologic study is required only when there is clinical suggestion of coalescent mastoiditis, intracranial complications, or an underlying chronic disease. Computed tomography (CT) is the method of choice for evaluating otogenic intra- or extra-cranial complications. CT scans can show stages of disease progression when infection has spread by way of soft tissue, blood, and bone pathways into the dural venous sinuses, meninges, labyrinth, facial nerves, epidural and other intracranial spaces. When there is clinical suggestion of acute coalescent mastoiditis, a CT scan of the temporal bone can confirm the presence of rarefying osteitis, coalescence of the air cells, and subperiosteal abscess.