Increased identification of the primary care provider as the main source of asthma care among urban minority children

Objective: Urban, minority, and disadvantaged youth with asthma frequently use emergency departments (EDs) for episodic asthma care instead of their primary care providers (PCPs). We sought to increase the rate of guardians' identification of the PCP as the source of asthma care for their children through integrated electronic health records and care coordination. Methods: In this prospective cohort study, we implemented an electronic communication process between an asthma specialty clinic and PCPs coupled with short-term care coordination in sample of youth aged 2–12 years with asthma and surveyed their guardians at baseline and 3 and 6 months after the intervention. Results: Guardians of 50 children (median age 5.8 years, 64% male, 98% African American, 94% public insurance) were enrolled. Compared to baseline, at 3 and 6 months after the intervention, significantly more guardians reported that the PCP was their child's primary asthma health care provider [70% at baseline, 85% at 3 months, 83% at 6 months (time averaged adjusted OR 77.4, 95% CI 3.0, 2027.1]. Further, significantly more guardians reported that they took their child to the PCP when the child experienced problems with his/her asthma [16% at baseline, 35% at 3 months, 41% at 6 months (time averaged adjusted odds ratio (OR) 10.6, 95% CI 2.7, 41.7]. Conclusion: Care in a subspecialty asthma clinic augmented by electronic communication with PCPs and short term care coordination was associated with significantly improved identification of PCPs as the primary source of asthma care in a cohort of urban minority youth.     

Diagnosis of tuberculous meningitis: clinical and laboratory parameters.

BACKGROUND: Confirming the clinical suspicion of tuberculous meningitis (TBM) has always been problematic. Whilst smear and culture positivity are diagnostic, these tests have low sensitivity. The polymerase chain reaction (PCR) assay has given variable results. AIM: This study attempted to improve the diagnostic yield by: (a) increasing the cerebrospinal fluid (CSF) volumes; (b) testing the yield from three specimens of CSF assumed to represent lumbar, cervico-thoracic cord, and base of brain CSF samples; (c) undertaking PCR assays using multiple primer sets; and (d) using real-time PCR. METHOD: Patients suspected of having cranial or spinal meningeal tuberculosis were entered into the study. Three aliquots of CSF were subjected to smear, culture, and conventional and real-time PCR. Three sets of primers - IS6110, MPB64, and PT8/9 - were used. Patients were retrospectively classified into four categories: 'definite TB' (culture positive), 'probable TB' (clinical and other tests suggestive of TB), 'not TB', and 'uncertain diagnosis'. RESULTS: A total of 68 patients were studied. There were 20 patients classified as definite TB, 24 probable TB, 17 not TB, and seven uncertain diagnosis. Forty-eight of 57 (84.2%) patients tested were HIV seropositive. The IS6110 PCR was positive in 27 patients which included 18/20 culture positive cases, six in the probable TB group, and three in the not TB group. The MPB64 and PT8/9 primers did not increase the yield. Real-time PCR was positive in seven additional patients. Combining the definite and probable TB, the sensitivity of all PCR assays was 70.5% (31/44) and specificity 87.5% (21/24). CONCLUSION: Targeting multiple sites of the TB genome using conventional PCR did not increase the number of positive cases. Real-time PCR was more sensitive. However, all the current techniques are still too insensitive to confidently exclude the diagnosis on laboratory grounds.     

Embolic protection device use and its association with procedural safety and long‐term outcomes following saphenous vein graft intervention: An analysis from the British Columbia Cardiac registry

• Coronary stents are commonly deployed using high pressure. However, the duration time of balloon inflation during deployment is still to be determined.
• Vallurupalli and coworkers, in this issue of CCI, show that the stent system takes an average of 33 sec to “accommodate” its pressure during in vitro deployment. In patients, the mean stent inflation time to achieve pressure stability was 104 seconds, ranging from 30 to 380 sec.
• These results challenge a rapid inflation/deflation approach for stent deployment. It is suggested that the duration of the inflation might be individualized, in a case‐by‐case approach.
• However, the findings must be interpreted with caution, as they cannot be directly extrapolated to more diverse clinical, angiographic, and interventional scenarios.

     

Work-related musculoskeletal disorders among dental professionals in Saudi Arabia

[Purpose] Musculoskeletal disorders are common causes of work-related disability in different professions involving the frequent practice of lifting, stooping, twisting, prolonged sitting, or standing. The dental profession is one such profession. Our aim was to determine the prevalence of work-related musculoskeletal disorders among dental professionals in Saudi Arabia, the factors associated with them, and their consequences and to propose preventive measures for them. [Subjects and Methods] A self-administered online questionnaire was sent to 225 members of the Saudi Dental Association. It included questions on demographic and professional characteristics, general medical history, and history of work-related musculoskeletal disorders before and after joining the dental profession. [Results] The questionnaire was completed by 65% of the respondents. Among them 85% reported that they had developed some pain due to work after joining the dental profession, and 42% reported that they were suffering pain at the time of the survey. Besides lower back, shoulder, and neck regions, the hands, upper back, and other regions like the elbows, buttocks, thighs, leg, and feet were areas in which they pain. [Conclusion] The prevalence of work-related musculoskeletal disorders among dental professionals in Saudi Arabia is high, affecting their daily activities, sometimes even forcing them to change their work setting. Age, gender, specialty of work, work setting, number of contact hours with patients, etc., were all found to be related to their work-related pain. We need to emphasize the role of ergonomics, counseling, proper techniques of patient handling, etc., during the training of dental professionals so that they can work efficiently.Key words: Work-related musculoskeletal disorders, Dentists, Saudi Arabia     

Screening and identification of bioactive compounds from citrus against non-structural protein 3 protease of hepatitis C virus genotype 3a by fluorescence resonance energy transfer assay and mass spectrometry

BACKGROUNDHepatitis C virus genotype 3a (HCV G3a) is highly prevalent in Pakistan. Due to the elevated cost of available Food and Drug Administration-approved drugs against HCV, medicinal natural products of potent antiviral activity should be screened for the cost-effective treatment of the disease. Furthermore, from natural products, active compounds against vital HCV proteins like non-structural protein 3 (NS3) protease could be identified to prevent viral proliferation in the host.AIMTo develop cost-effective HCV genotype 3a NS3 protease inhibitors from citrus fruit extracts.METHODSFull-length NS3 without co-factor non-structural protein 4A (NS4A) and codon optimized NS3 protease in fusion with NS4A were expressed in Escherichia coli. The expressed protein was purified by metal ion affinity chromatography and gel filtration. Citrus fruit extracts were screened using fluorescence resonance energy transfer (FRET) assay against the protease and polyphenols were identified as potential inhibitors using electrospray ionization-mass spectrometry (MS)/MS technique. Among different polyphenols, highly potent compounds were screened using molecular modeling approaches and consequently the most active compound was further evaluated against HCV NS4A-NS3 protease domain using FRET assay.RESULTSNS4A fused with NS3 protease domain gene was overexpressed and the purified protein yield was high in comparison to the lower yield of the full-length NS3 protein. Furthermore, in enzyme kinetic studies, NS4A fused with NS3 protease proved to be functionally active compared to full-length NS3. So it was concluded that co-factor NS4A fusion is essential for the purification of functionally active protease. FRET assay was developed and validated by the half maximal inhibitory concentration (IC₅₀) values of commercially available inhibitors. Screening of citrus fruit extracts against the native purified fused NS4A-NS3 protease domain showed that the grapefruit mesocarp extract exhibits the highest percentage inhibition 91% of protease activity. Among the compounds identified by LCMS analysis, hesperidin showed strong binding affinity with the protease catalytic triad having S-score value of -10.98.CONCLUSIONFused NS4A-NS3 protease is functionally more active, which is effectively inhibited by hesperidin from the grapefruit mesocarp extract with an IC₅₀ value of 23.32 µmol/L.     

Effects of Hybridized Synthetic Fibers on the Shear Properties of Cement Composites

The use of fibers in cementitious composites yields numerous benefits due to their fiber-bridging capabilities in resisting cracks. Therefore, this study aimed to improve the shear-resisting capabilities of conventional concrete through the hybridization of multiple synthetic fibers, specifically on reinforced concrete structures in seismic-prone regions. For this study, 16 hybrid fiber-reinforced concretes (HyFRC) were developed from the different combinations of Ferro macro-synthetic fibers with the Ultra-Net, Super-Net, Econo-Net, and Nylo-Mono microfibers. These hybrids were tested under direct shear, resulting in improved shear strength of controlled specimens by Ferro-Ultra (32%), Ferro-Super (24%), Ferro-Econo (44%), and Ferro-Nylo (24%). Shear energy was further assessed to comprehend the effectiveness of the fiber interactions according to the mechanical properties, dosage, bonding power, manufactured material, and form of fibers. Conclusively, all fiber combinations used in this study produced positive synergistic effects under direct shear at large crack deformations.     

Behavioral and electrophysiological responses of Aedes albopictus to certain acids and alcohols present in human skin emanations

Human skin emanations attract hungry female mosquitoes toward their host for blood feeding. In this study, we report the flight orientation and electroantennogram response of Aedes albopictus females to certain unsaturated acids and alcohols found in human skin. In the Y-tube olfactometer, odors of lactic acid and 2-methyl-3-pentanol attracted 54–65 % of Ae. albopictus females at all doses in a dose-dependent manner. However, at the highest dose (10^?2 g), the acids repelled 40–45 % females. Attractancy (ca. 62–68 %) at lower doses and repellency (ca. 30–45 %) at higher doses were recorded for 3-methyl-3-pentanol and 1-octen-3-ol, while 5-hexen-1-ol, cis-2-hexen-1-ol, and trans 2-hexen-1-ol odor repelled ca. 55–65 % of Ae. albopictus females at all doses. Antenna of female Ae. albopictus exhibited a dose-dependent EAG response up to 10^?3 g of l-lactic acid, trans-2-methyl-2-pentenoic acid, 2-octenoic acid, trans-2-hexen-1-ol and 1-octen-3-ol stimulations; however, the highest dose (10^?2 g) caused a little decline in the EAG response. EAG response of 9–10-fold was elicited by lactic acid, 2-octenoic acid, trans-2-hexenoic acid, and 3-methyl-3-pentanol, while cis-2-hexen-1-ol and trans-2-methyl pentenoic acid elicited 1–5-fold responses compared to solvent control. A blend of attractive compounds could be utilized in odor-baited trap for surveillance and repellent molecules with suitable formulation could be used to reduce the biting menace of mosquitoes.     

Natural compounds with xanthine oxidase inhibitory activity: A review

Hyperuricemia (HUA), a disease due to an elevation of body uric acid level and responsible for various diseases such as gout, cardiovascular disorders, and renal failure, is a major ground debate for the medical science these days. Considering the risk factors linked with allopathic drugs for the treatment of this disease, the debate has now become a special issue. Previously, we critically discussed the role of dietary polyphenols in the treatment of HUA. Besides dietary food plants, many researchers figure out the tremendous effects of medicinal plants‐derived phytochemicals against HUA. Keeping in mind all these aspects, we reviewed all possible managerial studies related to HUA through medicinal plants (isolated compounds). In the current review article, we comprehensively discussed various bioactive compounds, chemical structures, and structure–activity relationship with responsible key enzyme xanthine oxidase.