Ciprofloxacin treatment in preterm neonates in Bangladesh: lack of effects on growth and development

BACKGROUND: Quinolone-induced arthropathic toxicity in weight-bearing joints observed in juvenile animals during preclinical testing has largely restricted the routine use of ciprofloxacin in the pediatric age group. As histopathologic, radiologic and magnetic resonance imaging monitoring evidence has gathered supporting the safety of fluoroquinolones in children, many pediatricians have started to prescribe quinolones to some patients on a compassionate basis. OBJECTIVE: The objective of this study was to ascertain the safety of ciprofloxacin in preterm neonates <33 weeks gestational age treated at Dhaka Shishu (Children) Hospital in Bangladesh. METHODS: Long-term follow up was done to monitor the growth and development of preterm infants who were administered intravenous ciprofloxacin in the neonatal period. Ciprofloxacin was used only as a life-saving therapy in cases of sepsis produced by bacterial agents resistant to other antibiotics. Another group of preterm neonates with septicemia who were not exposed to ciprofloxacin, but effectively treated with other antibiotics and followed up, were matched with cases for gender, gestational age and birth weight and included as a comparison group. Forty-eight patients in the ciprofloxacin group and 66 patients in the comparison group were followed up for a mean of 24.7 +/- 18.5 months and 21.6 +/- 18.8 months, respectively. RESULTS: No osteoarticular problems or joint deformities were observed in the ciprofloxacin group during treatment or follow up. No differences in growth and development between the groups were found. CONCLUSIONS: Ciprofloxacin is a safe therapeutic option for newborns with sepsis produced by multiply resistant organisms.     

Vascular rings and pulmonary artery sling: early and mid-term results of surgical correction

Background The great majority of patients with complete vascular rings and pulmonary artery sling present before their first birthday. This retrospective report summarises the surgical experience of a single institution with the majority of vascular ring group presenting after infancy and having associated congenital cardiac anomalies. Possible reasons of delayed presentation of vascular ring, the asymptomatic left pulmonary artery sling and the individualised surgical management of each subgroup are discussed. Methods Fifteen consecutive patients, aged 2 months to 9 years (mean±SD=41.33±31.55 months) underwent surgical correction of vascular rings and sling during the last 12 years, including one infant. All patients underwent chest roentgenogram, barium esophagogram, two dimensional echocardiogram and cardiac catheterisation. Magnetic resonance imaging was employed in three patients. Four patients with isolated complete vascular ring were symptomatic (group A), one patient with left pulmonary artery sling was asymptomatic (group B) and 10 symptomatic patients with complete vascular rings had associated congenital cardiac anomalies (group C). The operative approach was through a left posterolateral thoracotomy (n=5), a median sternotomy (n=8) and a combination of median sternotomy and left thoracotomy (n=2). Operations of various types were performed. Results The operative mortality was 6.6% and there was no late death. All survivors are doing well and asymptomatic after a mean follow up period of 66.87 months (range=1 month to 143 months). Postoperative barium esophagogram in all survivors revealed no stasis of contrast in the upper esophagus and marked diminution in the degree of esophageal indentations. Conclusions Accuracy in diagnosis is important to determine the optimal surgical approach. Individualization of surgical management provides gratifying results. Asymptomatic left pulmonary artery sling without associated anomalies may be left untreated.     

One and a half ventricle repair with pulsatile bidirectional Glenn: results and guidelines for patient selection

Background. The guidelines for performing a one and a half ventricle repair with pulsatile bidirectional Glenn remains controversial. This retrospective report summarizes the experience of a single institution, with an attempt at providing an answer.

Methods. Fifty consecutive patients, aged 4 months to 42 years, underwent intracardiac repair along with a superior cavopulmonary connection. Twenty-seven of the patients had had previous surgical palliation. Repair consisted of patch closure of the ventricular septal defect (n = 25), tricuspid valve repair (n = 26), reconstruction of the right ventricular outflow tract (n = 34), transpulmonary annular patch (n = 34), right ventricle to pulmonary artery homograft conduit (n = 4), and concomitant repair of atrioventricular canal (n = 9). Ten patients were left with a fenestration in the atrial septum.

Results. There were six hospital deaths (12%) and two late deaths (4.5%). Forty-two survivors were followed from 8 months to 116 months. Eighty-eight percent are in functional class I. Actuarial survival at 97 months was 74%.

Conclusions. Moderate right heart hypoplasia constitutes a safe anatomic category for a pulsatile bidirectional Glenn. It is advisable not to proceed with a one and a half ventricle repair if postoperative residual pulmonary artery hypertension is anticipated. Patients requiring an intricate intracardiac repair and those with concomitant right heart hypoplasia may be better suited for a Fontan type of repair to reduce the complexity of the procedure.     

Registration and surveillance of acute myocardial infarction in Japan: monitoring an entire community by the Takashima AMI Registry: system and design.

BACKGROUND: The purpose of this registration is to follow incidence and case fatality trend of acute myocardial infarction (AMI) in Japan, using a whole community population disease registry that surveys the most up-to-date information. Since the 1970s, mortality from coronary heart disease has followed a declining trend in Japan, which has been attributed to a decrease in the incidence of AMI and some evidence suggests that incidence has leveled off during the past couple of decades. These reported decreasing or stable trends in AMI have been observed despite recent worsening of the cardiovascular risk factor situation in Japan (Japanese paradox). Therefore, monitoring the disease course of AMI is of immense importance. METHODS AND RESULTS: The Takashima AMI Registry established in 1988 covers a stable population of approximately 55,000 in Takashima County in central Japan. Registered patients included all Takashima County residents who have been diagnosed with AMI. The criteria of AMI are in accord with those of the World Health Organization's Monitoring of Trends and Determinants in Cardiovascular Disease (WHO-MONICA) project. CONCLUSION: Comprehensive disease registry data is especially appropriate for determining the incidence as well as the trend of diseases such as AMI. This registration study covering an entire community will enable researchers to follow trends in AMI incidence with a high degree of precision.     

Tunable electrical properties of carbon dot doped photo-responsive azobenzene–clay nanocomposites

The development of photo-responsive nanocomposite materials is important in the fabrication of optoelectronic devices. In this work, we fabricated a carbon dot doped azobenzene–clay nanocomposite which possesses different ac conductivity with and without UV treatment. At first, azobenzene nanoclusters were synthesised and then successfully used to make an azobenzene–clay nanocomposite. It was observed that there is a small change in the ac conductivity of the azobenzene–clay nanocomposite with and without UV treatment. However, this change in ac photoconductivity can be enhanced in the azobenzene–clay nanocomposite by doping with electron-rich cysteine and methionine carbon dots. Hence, ac conductivity properties of the carbon-doped azobenzene–clay nanocomposite can be tuned using UV light. Impedance measurements were determined using Electrochemical Impedance Spectroscopy. Mechanistic insight into the phenomenon is also discussed in the paper. Thus fabrication of tunable carbon dot doped photo-responsive azobenzene–clay nanocomposites will lead to the use of carbon dot doped azobenzene–clay nanocomposites in photo-switchable optoelectronic devices.

We demonstrate successful fabrication of an azobenzene–clay nanocomposite doped with electron-rich cysteine and methionine carbon dots with photo-switchable ac conductivity.     

“Think it. Mix it. Vape it.”: A Content Analysis on E-Cigarette Radio Advertisements

Background: E-cigarette (EC) use is increasing rapidly across the United States, especially among youth. EC advertisements are one likely contributor to this increase, as they currently have few marketing restrictions. Radio advertising reaches most of the U.S. population and may be particularly influential in this regard. Objectives: The purpose of the current study was to examine content themes and spending data from EC radio advertisements. Methods: Competitrack, a marketing tracking firm, gathered 19 advertisements from four different EC brands across the United States from 2015 to 2016, which were coded by two individuals and analyzed for main content themes. Additionally, spending data were analyzed by identified EC brand. Results: Logic was the most common EC brand advertised on the radio and included themes potentially appealing to youth, such as humor and sound effects. Of the 28 analyzed content themes, references to “taste” were the most popular, followed by highlighting benefits of using ECs, presence of music, and comparison to other EC brands. Only Logic advertisements (n?=?7) included health disclaimers and age restriction messages, yet frequently included themes that were attractive to youth. Conclusions/Importance: As these radio advertisements are exposing youth and other vulnerable populations to ECs, regulations, similar to those made for conventional cigarette advertising, are necessary for prevention efforts.     

Lifetime risk of ESRD

Lifetime risk is the cumulative risk of experiencing an outcome between a disease-free index age and death. The lifetime risk of ESRD for a middle-aged individual is a relevant and easy to communicate measure of disease burden. We estimated lifetime risk of ESRD in a cohort of 2,895,521 adults without ESRD from 1997 to 2008. To estimate lifetime risk of ESRD by level of baseline kidney function, we analyzed a cohort of participants who had a serum creatinine measurement. We also estimated the sex- and index age-specific lifetime risk of incident ESRD and accounted for the competing risk of death. Among those individuals without ESRD at age 40 years, the lifetime risk of ESRD was 2.66% for men and 1.76% for women. The risk was higher in persons with reduced kidney function: for eGFR=44-59 ml/min per 1.73 m(2), the lifetime risk of ESRD was 7.51% for men and 3.21% for women, whereas men and women with relatively preserved kidney function (eGFR=60-89 ml/min per 1.73 m(2)) had lifetime risks of ESRD of 1.01% and 0.63%, respectively. The lifetime risk of ESRD was consistently higher for men at all ages and eGFR strata compared with women. In conclusion, approximately 1 in 40 men and 1 in 60 women of middle age will develop ESRD during their lifetimes (living into their 90s). These population-based estimates may assist individuals who make decisions regarding public health policy.     

Angiotensin II-dependent persistent podocyte loss from destabilized glomeruli causes progression of end stage kidney disease

Podocyte depletion is a major mechanism driving glomerulosclerosis. Progression is the process by which progressive glomerulosclerosis leads to end stage kidney disease (ESKD). In order to determine mechanisms contributing to persistent podocyte loss, we used a human diphtheria toxin transgenic rat model. After initial diphtheria toxin-induced podocyte injury (over 30% loss in 4 weeks), glomeruli became destabilized, resulting in continued autonomous podocyte loss causing global podocyte depletion (ESKD) by 13 weeks. This was monitored by urine mRNA analysis and by quantitating podocytes in glomeruli. Similar patterns of podocyte depletion were found in the puromycin aminonucleoside and 5/6 nephrectomy rat models of progressive end-stage disease. Angiotensin II blockade (combined enalapril and losartan) restabilized the glomeruli, and prevented continuous podocyte loss and progression to ESKD. Discontinuing angiotensin II blockade resulted in recurrent glomerular destabilization, podocyte loss, and progression to ESKD. Reduction in blood pressure alone did not reduce proteinuria or prevent podocyte loss from destabilized glomeruli. The protective effect of angiotensin II blockade was entirely accounted for by reduced podocyte loss. Thus, an initiating event resulting in a critical degree of podocyte depletion can destabilize glomeruli and initiate a superimposed angiotensin II-dependent podocyte loss process that accelerates progression resulting in eventual global podocyte depletion and ESKD. These events can be monitored noninvasively in real-time through urine mRNA assays.