A star in the eye: cat scratch neuroretinitis

Neuroretinitis is one of the atypical presentations of Cat scratch disease (CSD). Fundoscopy showed star pattern macular exudates. CSD should be considered in patients who present with blurry vision and typical fundoscopic findings.     

Clinical Quality Performance in U.S. Health Centers

Objective

To describe current clinical quality among the nation''s community health centers and to examine health center characteristics associated with performance excellence.

Data Sources

National data from the 2009 Uniform Data System.

Data Collection/Extraction Methods

Health centers reviewed patient records and reported aggregate data to the Uniform Data System.

Study Design

Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance.

Principal Findings

Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well.

Conclusions

Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients.     

Identification and development of 2,5-disubstituted oxadiazole as potential candidate for treatment of XDR and MDR tuberculosis

Tuberculosis, the infection on the verge of eradication once, is now a great threat to mankind. Emergence of MDR and XDR-TB synergised with HIV and other immune-compressive diseases have increased the life threatening capacities of the disease. A small molecule has been identified here, which showed potent anti-tubercular activity. The identified hit compound has also been proved active against nearly 25 clinical isolates comparable with isoniazid.     

p-nitrophenol toxicity to and its removal by three select soil isolates of microalgae: The role of antioxidants

The nontarget effects, in terms of biochemical changes induced by p-nitrophenol (PNP) in three soil microalgae, Chlorella sp., Chlorococcum sp., and Heterochlamydomonas sp., and the PNP removal efficiency of these isolates, were determined. On exposure to 20?mg?L(-1) PNP, Chlorella sp. showed greater activity of peroxidase, superoxide dismutase, and glutathione reductase as well as high contents of proline and carotenoids. While Heterochlamydomonas sp. exhibited higher levels of catalase and protein, Chlorococcum sp. produced greater amounts of malondialdehyde, a measure of lipid peroxidation, in the presence of PNP. Chlorella sp. tolerated PNP by producing large quantities of antioxidants coupled with less lipid peroxidation, while Chlorococcum sp. was susceptible, as evidenced by low antioxidant production and high lipid peroxidation. During 7-d exposure, Chlorella sp., Heterochlamydomonas sp., and Chlorococcum sp. were able to remove 39, 18, and 4% of 20?mg?L(-1) PNP, respectively. The present results indicate that proline, carotenoids and malondialdehyde are the potential biomarkers for assessing PNP toxicity toward microalgae, and their response could be considered for differentiating tolerant and susceptible strains. Moreover, there is a clear correlation between PNP removal and antioxidant synthesis in microalgae on exposure to the pollutant. Environ. Toxicol. Chem. 2012; 31: 1980-1988. ? 2012 SETAC.     

Circulating selenium and carboxymethyl-lysine, an advanced glycation endproduct, are independent predictors of anemia in older community-dwelling adults

ObjectiveTo assess whether selenium and carboxymethyl-lysine (CML), two biomarkers of oxidative stress, are independent predictors of anemia in older community-dwelling adults.MethodsPlasma levels of selenium, CML, folate, vitamin B12, and testosterone and markers of iron status and inflammation were measured at baseline in 1036 adults at least 65 y old in the Invecchiare in Chianti Study, a population-based cohort study of aging in Tuscany, Italy, and examined in relation to prevalent anemia and incident anemia over 6 y of follow-up.ResultsAt enrollment, 11.6% of participants were anemic. Of 472 participants who were non-anemic at enrollment, 72 (15.3%) developed anemia within 6 y of follow-up. At enrollment, plasma CML in the highest quartile (>425 ng/mL) and plasma selenium in the lowest quartile (<66.6 μg/L) predicted incident anemia (hazard ratio 1.67, 95% confidence interval 1.07–2.59, P = 0.02; hazard ratio 1.55, 95% confidence interval 1.01–2.38, P = 0.05, respectively) in a multivariate Cox proportional hazards model that adjusted for age, education, body mass index, cognition, inflammation, red blood cell distribution width, ferritin, vitamin B12, testosterone, and chronic diseases.ConclusionElevated plasma CML and low plasma selenium are long-term independent predictors of anemia in older community-dwelling adults. These findings support the idea that oxidative stress contributes to the development of anemia.     

Should we educate about the risks of medication overuse headache?

Background

Medication-overuse headache (MOH) is caused by the regular use of medications to treat headache. There has been a lack of research into awareness of MOH. We distributed an electronic survey to undergraduate students and their contacts via social networking sites. Analgesic use, awareness of MOH, perceived change in behaviour following educational intervention about the risks of MOH and preferred terminology for MOH was evaluated.

Findings

485 respondents completed the questionnaire (41% having received healthcare training). 77% were unaware of the possibility of MOH resulting from regular analgesic use for headache. Following education about MOH, 80% stated they would reduce analgesic consumption or seek medical advice. 83% indicated that over the counter analgesia should carry a warning of MOH. The preferred terminology for MOH was painkiller-induced headache.

Conclusions

This study highlights the lack of awareness of MOH. Improved education about MOH and informative packaging of analgesics, highlighting the risks in preferred lay terminology (i.e. painkiller-induced headache), may reduce this iatrogenic morbidity and warrants further evaluation.     

First heart sound: A phono-echocardiographic correlation with mitral,tricuspid, and aortic valvular events

We evaluated the relationship of S₁ recorded by phonocardiography at the mitral area with motion of the mitral, tricuspid, and aortic valves, recorded by simultaneous echocardiography in 20 cardiac patients with a normal PR interval. The first major component of S₁ coincided with mitral valve closure in 20 of 20 patients (100%) and also with tricuspid valve closure in 14 of 20 patients (70%). The second major component of S₁ coincided with aortic valve opening in 20 of 20 patients and also with tricuspid valve closure in six of 20 patients (30%). We conclude that the first major component of S₁ coincides with mitral valve closure in all patients but may also coincide with tricuspid valve closure in many patients, and the second major component of S₁ coincides with aortic valve opening in all patients but may also coincide with tricuspid valve closure in some patients.