Evaluation of the Du Pont HERPCHEK herpes simplex virus antigen test with clinical specimens.

The HERPCHEK herpes simplex virus (HSV) antigen test (Du Pont, Billerica, Mass.) is a biotinstreptavidin-amplified enzyme-linked immunoassay for the detection of HSV antigen directly in clinical specimens. In a total of 200 mucocutaneous specimens, predominantly lesions from nongenital sites, HERPCHEK had a sensitivity of 90% and a specificity of 99% compared with the shell vial tissue culture method which uses primary rabbit kidney cells. Five false-negative results by HERPCHEK were found with specimens that contained a low percentage of positive cells by the direct immunoperoxidase stain used in a tissue culture method (1 to 9%). The absorbance values of the clinical specimens by the HERPCHEK test do not correlate well with the percentage of positive cells. Our results indicate that the HERPCHEK HSV antigen test, when performed with specimens from lesions, is a sensitive and specific test as compared with shell vial culture.     

Creatine kinase activity associated with the contractile proteins of the guinea-pig carotid artery

Summary Activity and role of creatine kinase associated with contractile proteins of vascular smooth muscle have been investigated using skinned guinea-pig carotid artery rings. Membrane solubilization was performed with the detergent Triton X-100. Creatine kinase activity, isoenzyme profile as well as mechanics were performed on the Triton skinned carotid artery rings. Total creatine kinase activity was 47.3±9.3 IU g¹ ww and electrophoresis showed BB, MB, and MM isoforms (BB-CK being the predominant isoenzyme). One hour incubation with Triton X-100, produced predominantly BB-CK remaining with the myofibrils with some MB, representing 23% of the preskinned creatine activity. When relaxed carotid artery rings were exposed to pCa 9 in the presence of 250 M ADP, 0 ATP, and 12 mM phosphocreatine, tension was not significantly different from resting tension, but changing to pCa 4.5 caused the carotid artery rings to generate 49.5±4.5% of maximal tension. When a high-tension rigor state was achieved (250 M ADP, 0 ATP, 0 phosphocreatine, and pCa 9), the addition of 12 mM phosphocreatine effected significant relaxation. These observations implicate an endogenous form of creatine kinase, associated with the myofilaments, which is capable of producing enough ATP for submaximal tension generation and significant relaxation from rigor conditions. These results suggest co-localization of ATPase, MLCK, and creatine kinase on the contractile proteins of the carotid artery. Such an enzymic association may play a role in the energetic supply to the contractile apparatus of vascular smooth muscle.Recipient of INSERM/NIH Fogarty International Fellowship, TW01585-01.     

Intracellular calcium does not directly modulate cardiac pacemaker (if) channels

A study on the cardiac pacemaker current if in inside-out macro-patches of sino-atrial (SA) node cells has recently demonstrated that i_f channels are directly activated by intracellular cAMP [4]. Using the same preparation, here we investigate the possibility that internal Ca²⁺ ions play a role in the modulation of i_f channels. Our results indicate that Ca²⁺ ions do not have a direct activating effect on i_f.     

Law as a Tool for Preventing Chronic Diseases: Expanding the Spectrum of Effective Public Health Strategies

Law, which is a fundamental element of effective public health policy and practice, played a crucial role in many of public health's greatest achievements of the 20th century. Still, conceptual legal frameworks for the systematic application of law to chronic disease prevention and control have not been fully recognized and used to address public health needs. Development and implementation of legal frameworks could broaden the range of effective public health strategies and provide valuable tools for the public health workforce, especially for state and local health department program managers and state and national policy makers. In an effort to expand the range of effective public health interventions, the Centers for Disease Control and Prevention will work with its partners to explore the development of systematic legal frameworks as a tool for preventing chronic diseases and addressing the growing epidemic of obesity, heart disease, stroke, and other chronic diseases and their risk factors.     

Effect of early application of social distancing interventions on COVID-19 mortality over the first pandemic wave: An analysis of longitudinal data from 37 countries

ObjectivesTo estimate the effect of early application of social distancing interventions on Covid-19 cumulative mortality during the first pandemic wave.MethodsEcological longitudinal study using multivariable negative binomial regression for panel data. Daily numbers of Covid-19 cases and deaths, and data on social distancing interventions, for the 37 member countries of the Organization for Economic Cooperation and Development (OECD) were analysed.ResultsCovid-19 cumulative mortality over the first pandemic wave varied widely across countries (range, 4.16 to 855 deaths per million population). On average, one-day delay in application of mass gatherings ban was associated with an adjusted increase in Covid-19 cumulative mortality by 6.97% (95% CI, 3.45 to 10.5), whilst a one-day delay in school closures was associated with an increase of 4.37% (95% CI, 1.58 to 7.17) over the study period. We estimated that if each country had enacted both interventions one week earlier, Covid-19 cumulative mortality could have been reduced by an average of 44.1% (95% CI, 20.2 to 67.9).ConclusionsEarly application of mass gatherings ban and school closures in outbreak epicentres was associated with an important reduction in Covid-19 cumulative mortality during the first pandemic wave. These findings may support policy decision making.     

Does current treatment of cardiogenic shock complicating the acute coronary syndromes comply with guidelines?

Background

The purpose of our study was to evaluate the implementation of guidelines for the treatment of cardiogenic shock (CS) complicating the acute coronary syndromes (ACS).

Methods and Results

Of the 10 136 patients in the Euro-Heart-Survey-ACS with complete data, CS occurred in 549 (5.4%), of whom 28.6% had CS upon presentation. We examined the use of coronary angiography (CA), percutaneous (PCI) and surgical (CABG) revascularization, and intra-aortic balloon counterpulsation (IABP) among ACS patients with and without CS. During the hospital course, there were no significant differences between patients with and without CS in referral to CA (52.4% vs 53.3%, respectively) or CABG (4.4% vs 4.5%), but CS patients were more likely to undergo IABP (17.7% vs 0.8%, P < .001) and PCI (40.8% vs 31.8%, P < .001), especially younger (<75 years) patients (52.2% vs 31.8%, P < .001). A similar trend was observed when comparing ST-elevation-ACS patients with (368 [8.5%]) and without CS (3945): CA (58.1% vs 56.2%), CABG (3.6% vs 3.3%), IABP (20.0% vs 0.9%, P < .01), and PCI (47.3% vs 40.6%, P < .01; 54.4% vs. 44.6% for patients <75 years, P < .003). Of the 94 ST-elevation-ACS patients presenting with CS, only 39 (41.4%) received any reperfusion treatment, more often fibrinolysis (64.1%). The in-hospital mortality was 52.1% for all CS pts vs 2.0% for all others (P < .001).

Conclusions

Our contemporary survey demonstrates prohibitively-high mortality rates among ACS patients complicated by CS and poor implementation of recent guidelines advocating an aggressive invasive approach, including low rates of revascularization and IABP. Improved adherence to the guidelines pertaining to ACS patients developing CS may hopefully improve outcomes.     

Management of Appendiceal Mass and Abscess. An 11-Year Experience

The aim of our study is to compare the results of emergency surgery versus conservative treatment with interval surgery in patients diagnosed with appendiceal mass and abscess. A retrospective review of 48 patients with appendiceal mass and abscess treated from January 2002 to January 2013 at General Surgery Department of Kipshidze Central University Hospital was performed. Patients with emergency surgery were compared to patients treated by nonoperative management with interval surgery. Demographics, clinical profile, and operative outcomes were studied. The emergency surgery group included 25 patients, and the interval surgery group included 23 patients. The clinical characteristics of the emergency surgery and interval surgery groups were not statistically different. In the emergency surgery group, an open appendectomy was performed on 17 patients, and colonic resections (ileocecectomy or right hemicolectomy) were performed on 8 patients. In the interval surgery group, an open appendectomy was performed on 21 patients, and colonic resections were performed on 2 patients. There were no statistical differences in types of surgery, postoperative complications, operation time without colonic resections, and postoperative hospitalization period among these 2 groups. Operation time with colonic resections was of greater duration in the emergency surgery group than in the interval surgery group (P = 0.04). Both treatment methods for appendiceal mass and abscess have the same results. The surgeon must consider clinical symptoms and results of investigations in each particular case when choosing an appropriate treatment method. Prospective randomized controlled trials are required for comparing the results of all 3 treatment methods of appendiceal mass.Key words: Appendicitis, Mass, Abscess, Appendectomy, Ileocecectomy, Right hemicolectomyAcute appendicitis is one of the most frequent acute surgical pathologies. The inflammation in acute appendicitis may sometimes be fixed by the patient''s own defense mechanisms, by the formation of an inflammatory mass (an appendiceal phlegmon) or a circumscribed abscess (an appendiceal abscess), often presenting as a palpable mass days following the onset of symptoms. This complication occurs in 2 to 7% of all cases of appendicitis.^1,2Management of appendiceal mass and abscess is either operative or conservative. More evidence is needed to identify which method is superior.¹ Immediate appendectomy may be technically demanding because of the distorted anatomy and difficulties in closing the appendiceal stump due to the inflamed tissues. According to the aforementioned, the operation could be finished with colonic resections (ileocecectomy or right hemicolectomy).^2–4Conservative management with interval appendectomy has traditionally remained the gold standard management. The need for interval appendectomy after a successful nonsurgical treatment has recently been questioned as the risk of recurrence is relatively small.^5–7 After successful nonsurgical treatment of an appendiceal mass, the true diagnosis is uncertain in some cases and underlying diagnosis of cancer or Crohn''s disease (CD) may be delayed.^1,8,9The aim of our study is to compare the results of emergency surgery versus conservative treatment followed by elective surgery in patients diagnosed with appendiceal mass and abscess.     

Characteristics of non-clustered tuberculosis in a low burden country

Molecular genotyping studies often focus on clustered tuberculosis and recent transmission. Less attention has been paid to non-clustered tuberculosis. However, non-clustered cases also contribute significantly to the tuberculosis burden, especially in low-incidence countries. The objective of this study is to characterize non-clustered tuberculosis cases in Denmark and point out potential implications for tuberculosis control. The study is based on nationwide IS6110-RFLP genotyping of tuberculosis cases from 1992 through 2004, corresponding to 98% of culture verified cases. Of 3988 cases, 45% were non-clustered. Both Danes and immigrants had a peak incidence of non-clustered tuberculosis at older ages, 80-89 years (4.3 cases/10(5) population/year) and 60-69 years (28.8 cases/10(5) population/year), respectively. In addition, immigrants had a peak at 20-29 years (43.2?cases/10(5) inhabitants/year). In Danes, the incidence of non-clustered tuberculosis decreased during the study period and was predominantly found in elderly persons, presumably reactivating infection acquired during 1910-40, when tuberculosis incidence was high. In immigrants, the incidence was high at all ages, presumably reflecting reactivation of imported infections. In the future, the number of non-clustered tuberculosis cases will decrease, as older Danes die, and as time since primary infection increases for immigrants residing in Denmark. TB control should include focus on non-clustered cases.     

Sclerostin and Dickkopf-1 in Post-menopausal Renal Allograft Recipients

Background

Age, pre-existing renal osteodistrophy, impaired renal function, and chronic use of immunosuppressive drugs are the main factors involved in the onset and development of bone metabolism disturbances and skeletal alterations occurring after renal transplantation. However, at the state of the art, no reports have analyzed the additional post-menopausal physiological mechanisms associated with the onset and development of bone complications in renal transplant recipients.

Methods

We measured by means of molecular strategies (enzyme-linked immunoassay, chemiluminescence) the serum levels of Sclerostin and Dickkopf-1 (DKK1), two major antagonists of the Wnt/β-catenin pathway, and several bone resorption/formation biomarkers (N-terminal procollagen type 1, bone-specific alkaline phosphatase, and serum C-terminal telopeptides of type I collagen) in 19 post-menopausal kidney transplant patients and 12 post-menopausal chronic kidney disease patients (CKD group) matched for age and renal function.

Results

Our results showed that the levels of both Wnt antagonists were similar in the two study groups (P = .15 and .96, respectively). Additionally, no correlation was found between Sclerostin and DKK1 serum levels in all patients included in the study (R² = 0.03, P = .2). After statistical analysis, we found no differences in the bone resorption/formation biomarkers between renal transplant and CKD patients. Multivariate analysis showed that Sclerostin levels were significantly positively correlated with serum phosphorus levels (P = .008) and inversely correlated with renal function (P = .026). Surprisingly, no significant correlation was found between all the analyzed demographic and clinical parameters and DKK1.

Conclusions

Our study demonstrated for the first time that renal transplantation per se and immunosuppressive treatments do not represent additional factors contributing to bone metabolic/biochemical alterations in post-menopausal women. However, our results emphasized that a better preservation of the graft function could significantly slow down the progression of bone metabolic deregulations and prevent clinical bone complications.