Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals

OBJECTIVES

We evaluated the association of HIV infection and immunodeficiency with acute coronary syndrome (ACS) recurrence, and with all-cause mortality as a secondary outcome, after hospitalization for ACS among HIV-infected and HIV-uninfected individuals.

METHODS

We conducted a retrospective cohort study within Kaiser Permanente Northern California of HIV-infected and HIV-uninfected adults discharged after ACS hospitalization [types: ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina] during 1996-2010. We compared the outcomes of ACS recurrence and all-cause mortality within 3 years, both overall by HIV status and stratified by recent CD4 count, with HIV-uninfected individuals as the reference group. Hazard ratios (HRs) were obtained from Cox regression models with adjustment for age, sex, race/ethnicity, year, ACS type, smoking, and cardiovascular risk factors.

RESULTS

Among 226 HIV-infected and 86 321 HIV-uninfected individuals with ACS, HIV-infected individuals had a similar risk of ACS recurrence compared with HIV-uninfected individuals [HR 1.08; 95% confidence interval (CI) 0.76-1.54]. HIV infection was independently associated with all-cause mortality after ACS hospitalization overall (HR 2.52; 95% CI 1.81-3.52). In CD4-stratified models, post-ACS mortality was higher for HIV-infected individuals with CD4 counts of 201-499 cells/μL (HR 2.64; 95% CI 1.66-4.20) and < 200 cells/μL (HR 5.41; 95% CI 3.14-9.34), but not those with CD4 counts ≥ 500 cells/μL (HR 0.67; 95% CI 0.22-2.08), compared with HIV-uninfected individuals (P trend < 0.001).

CONCLUSIONS

HIV infection and immunodeficiency were not associated with recurrence of ACS after hospitalization. All-cause mortality was higher among HIV-infected compared with HIV-uninfected individuals, but there was no excess mortality risk among HIV-infected individuals with high CD4 counts.

Irradiation-Induced Compositional Effects on Human Bone After Extracorporeal Therapy for Bone Sarcoma

The present study investigates Raman scattering of human bone irradiated with 50 Gy single dose during therapeutic treatment of Ewing and Osteosarcoma. Bone quality was evaluated via mineral-to-matrix ratio, degree of crystallinity, change in amount of calcium, and carbonate substitution. Alteration in collagen and its cross-links was quantified through second-derivative deconvolution of Amide I peak. A dose of 50 Gy radiation leads to almost 50% loss of mineral content, while maintaining mineral crystallinity, and small changes in carbonate substitution. Deconvolution of Amide I suggested modifications in collagen structure via increase in amount of enzymatic trivalent cross-linking (p < 0.05). Overall irradiation led to detrimental effect on bone quality via changes in its composition, consequently reducing its elastic modulus with increased plasticity. The study thus quantifies effect of single-dose 50 Gy radiation on human bone, which in turn is necessary for designing improved radiation dosage during ECRT and for better understanding post-operative care.

Abstract TP294: Improving the Prospect of Diagnosing Paroxysmal Atrial Fibrillation After Cryptogenic Stroke to Prevent Recurrent Strokes by Appropriate Counseling, Cardiology Referral and Telephone Follow-Up: a Quality Improvement Initiative From Neurology Residents

Introduction: 25% of all strokes are Cryptogenic; paroxysmal atrial fibrillation is frequently the underlying cause. Patients with cryptogenic stroke require cardiac event monitoring (CEM) after hospital discharge in order to diagnose paroxysmal atrial fibrillation and switch to anticoagulant therapy from antiplatelet therapy. Very important question remains regarding who is responsible for CEM among healthcare providers. The objectives of our quality improvement project were to understand the barriers and ensure all patients receive CEM after cryptogenic stroke.

Methods: All patients with MRI evidence of ischemic stroke and documented transient ischemic attack during a two-month period at an academic comprehensive stroke center were included. Data were recorded and compared for one month prior to (Group A) and one month after (Group B) implementation of the QI project. The QI project included patient counseling about importance of CEM and dual-verification of orders for CEM and cardiology referral. Two members of the stroke team independently verified placement of the CEM order and the referral to cardiology. One month after discharge, patients in the QI project were contacted by telephone to ensure CEM placement.

Results: 48 patients suffered ischemic stroke or TIA before and 54 patients after implementation of the QI project. The incidence of cryptogenic stroke was 20.83% (10/48) in group A and 16.66% (9/54) in group B. In Group A, only 2 of 10 patients with cryptogenic stroke received CEM. Major barriers were (1) patient ignorance and concern (2)unapproachable patient (3) lack of follow-up with primary care provider/neurologist. In Group B, after implementation of the QI project, 8 of 9 patients received CEM. One patient in Group B refused cardiac event monitoring. CEM diagnosed paroxysmal atrial fibrillation in one patient in group B and anticoagulation was initiated. Our quality improvement initiative increased the incidence of cardiac event monitoring from 20% in group A to 88.88% in group B.

Conclusion: This project highlights that patient’s with cryptogenic stroke face barriers towards receiving cardiac event monitoring which can be improved by proper counseling, ensuring cardiology referral and a telephone follow-up by neurologist.

Outcome Analysis of Neonates following Laparotomy for Acute Abdomen: A Prospective Study

Background Low and middle-income countries (LMIC) bear the majority of the global pediatric surgical burden. Despite increasing volume of pediatric surgeries being performed in LMIC, outcomes of these surgeries in low and middle-income countries remain unknown due to lack of robust data. Objective The objective of our study was to collect data on and evaluate neonatal surgical outcomes at a tertiary level center in India. Method The surgical outcomes data of all neonates undergoing laparotomy between February 15, 2015 and October 14, 2015, at Sir Ganga Ram Hospital, New Delhi, India was collected prospectively. Descriptive statistics were used to determine the rates of various postoperative outcomes. Result A total of 37 neonatal surgeries were performed during the study period. The mean age of the neonates on the day of surgery was 7 days (range: 1-30 days). Most of the neonates (72.9%, n=27) were males. About 40% (n=15) of the neonates were preterm and 15 (40.5%) of them were small for gestational age. In our study, 10 neonates (28.6%) needed ventilation for 48 hours or less after surgery and 5 neonates (13.5%) were kept Nil per Oral (NPO) postoperatively for more than 10 days. Out of 37 neonates, 4 (10.80%) developed a surgical site infection and 8 neonates (21.6%) had postoperative sepsis. The in-hospital mortality rate among neonates undergoing laparotomy during the study period was 8.1 deaths per 100 neonates. Conclusion Co-ordination of care among pediatric surgeons, neonatologists, nursing and anesthesia team is required for optimal surgical outcome.

Recent advancements and new perspectives in animal models for Neurocysticercosis immunopathogenesis

Neurocysticercosis (NCC), one of the most common parasitic diseases of the central nervous system, is caused by Taenia solium. This parasite involves two hosts, intermediate hosts (pig and human) and a definitive host (human) and has various stages in its complex life cycle (eggs, oncosphere, cysticerci and adult tapeworm). Hence, developing an animal model for T. solium that mimics its natural course of infection is quite challenging. We have reviewed here the animal models frequently used to study immunopathogenesis of cysticercosis and also discussed their usefulness for NCC studies. We found that researchers have used mice, rats, guinea pigs, dogs, cats and pigs as models for this disease with varying degrees of success. Mice and rats models have been utilized extensively for immunopathogenesis studies due to their relative ease of handling and abundance of commercially available reagents to study these small animal models. These models have provided some very exciting results for in-depth understanding of the disease. Of late, the experimentally/naturally infected swine model is turning out to be the best animal model as the disease progression closely resembles human infection in pigs. However, handling large experimental animals has its own challenges and limitations.

Polymerase chain reaction (PCR) based amplification of hmcp3 and hmcp6 cysteine protease genes of Haemonchus contortus from small ruminants

Haemonchus contortus is a haematophagous nematode in small ruminants population and causes anaemia, weakness and mortality especially in young animals. In the present study, hmcp3 partial gene of 836 bp and hmcp6 full length gene of 1041 bp were amplified from the cDNA of Bareilly isolate of adult male H. contortus by polymerase chain reaction. Further gene characterization and expression studies are warranted to know the immunoprophylactic potential of hmcp3 and hmcp6 proteins of H. contortus.

Competition in Indian Banking

It is widely perceived that competition in the Indian banking sector has increased since the inception of the financial sector reforms in 1992. Using annual data on scheduled commercial banks for the period 1996–2004, the article evaluates the validity of this proposition in the Indian context. The empirical evidence reveals that Indian banks earn revenues as if under monopolistic competition.

Primary lymphoma of CNS, mycophenolate mofetil and lupus

Lymphoproliferative disorders are known to complicate immunosuppressive therapy and two cases of primary lymphoma of CNS (PCNSL) have previously been described in association with mycophenolate mofetil (MMF) treatment. We report the third case of PCNSL in a patient with lupus nephropathy while on MMF treatment. PCNSL may be seen more frequently considering the increased use of MMF in immunosuppressant responsive conditions.

Leg Ulcers and Oedema: A Study Exploring the Prevalence, Aetiology, and Possible Significance of Oedema in Venous Ulcers

Oedema is commonly associated with venous leg ulcers, and is thought to discourage wound healing. However, little attention has been paid to the mechanism or significance of oedema in this condition. This study assessed the prevalence of oedema and lymphatic insufficiency and their influence on wound healing amongst 56 patients. Two populations were studied – community and hospital-managed, with an almost equal number of cases in each. The presence of oedema and lymphatic insufficiency was assessed clinically and, the duration of the current ulcer was used as an indicator of healing rate.

Oedema was present in 55% of patients, but its prevalence in the community-treated group was much greater than in the hospital-treated group. Lymphatic insufficiency was present in 22% of patients with an equal prevalence in the two groups. The presence of oedema was associated with a longer duration of ulcer whereas the use of diuretics was associated with a shorter duration. This suggests that oedema may be an important factor in discouraging the healing of ulcers.

Greater attention should be paid clinically to the prevention of oedema, as its presence suggests inadequate treatment and a failure to heal.

Immediate tangential excision accelerates wound closure but does not reduce scarring of mid-dermal porcine burns

Current evidence supports the use of excision to remove eschar from deep dermal and full-thickness burns. However, the role of excision of mid-dermal burns remains unclear. This study aimed to develop a porcine model that could produce reproducible middermal thermal burns that undergo tangential excision; and investigate the effects of immediate tangential excision (30 minutes postburn) on healing and scarring. An aluminum bar preheated in hot water (70°C) was applied for 20 or 30 s to produce a total of sixteen mid-dermal burns per pig on each of six pigs. Thirty minutes after burn creation, half of the burns were tangentially excised. Four partial- thickness wounds per pig were created as controls. Depth of burn injury (1 and 24 h), reepithelialization (7 and 10 d) and scar depth (28 d) were assessed microscopically. Total scar surface area was grossly evaluated on day 28. Exposure of porcine skin to a preheated aluminum bar at 70 °C for 20 or 30 sec resulted in reproducible mid-dermal burns, where immediate excision enhanced complete wound closure as judged by complete re-epithelialization, but did not reduce initial depth of injury, scar contraction and scar depth. Immediate surgical intervention is sufficient to enhance wound closure, but not to mitigate mid-dermal burn scar formation. This work provides a suitable animal model to evaluate novel therapies that may be used to inhibit burn progression, accelerate wound closure and decrease scarring, especially those therapies unable to penetrate burn eschar.

Effect of non-genetic factors on the prevalence of Stilesia globipunctata in the goat

Despite its high prevalence and pathogenicity, Stilesia globipunctata is a neglected cestode infection of ruminants in the tropics and sub-tropics. The present study reports the effect of sex, age, year and month on the prevalence of S. globipunctata in the goat. A total of 5208 eviscerated intestines of the goat carcasses were screened for a period of seven years, from January 2001 to December 2007. The overall prevalence of 36.6 % was significantly affected by the factors studied (P<0.05). Male goats were more susceptible to the S. globipunctata infection than that of female (P<0.05). Goat aged between 6 months and 1 year were found to be significantly more susceptible (P<0.05) which was followed by animals between 1 and 4 years of age and then more than 4 years of age. Morbidity was high (59 to 86 %) in animals of less than one year of age. The striking observation was that the prevalence peaked during monsoon and at nadir in May.

Evaluation of immunogenicity and protective efficacy of a liposome containing Brucella abortus S19 outer membrane protein in BALB/c mice

The use of liposome as an adjuvant and a vaccine carrier has been cited previously in the literature. It has also been shown to be effective in enhancing the immunogenicity of vaccine candidates. BALB/c mice immunized subcutaneously with outer membrane protein (OMP) of Brucella abortus S19 vaccine strain entrapped in a commercial cationic liposome (S19-OMP-liposome) for vaccine delivery, showed enhanced protection (P<0.05) compared to groups of mice inoculated with S19 OMP alone, S19 live B. abortus vaccine and liposome alone, when challenged intra-peritoneally with virulent B. abortus strain 544 at 30 days post-immunization (DPI). The S19-OMP-liposome preparation was found to be safer compared to the live B. abortus S19 vaccine at 15 days post challenge (DPC), as evidenced by the significant difference in spleen weight between S19-OMP-liposome, S19 OMP and S19 live as well as the liposome control groups (P<0.01). Antibody isotype response profiles of the experimental groups indicated that the immune response was Th1 cell mediated. The protective advantage conferred to mice immunized with S19-OMP entrapped in liposome over those immunized with the live B. abortus S19 version, could probably be related to the significantly different response of IgG2b at 30 DPI (P<0.01), IgG2a (P<0.01), IgG2b (P<0.01) and IgG3 (P<0.05) at the DPC stages, respectively.

An electron microscopy based method for the detection and quantification of nanomaterial number concentration in environmentally relevant media

Improved detection and characterization of nanomaterials (NMs) in complex environmental media requires the development of novel sampling approaches to improve the detection limit to be close to environmentally realistic concentrations. Transmission electron microscopy (TEM) is an indispensable metrological tool in nanotechnology and environmental nanoscience due to its high spatial resolution and analytical capabilities when coupled to spectroscopic techniques. However, these capabilities are hampered by the conventional sample preparation methods, which suffer from low NM recovery. The current work presents a validated, fully quantitative sampling technique for TEM that overcomes conventional sample preparation shortcomings, and thus enables the use of TEM for measurement of particle number concentration and their detection in complex media at environmentally realistic concentrations. This sampling method is based on ultracentrifugation of NMs from suspension onto a poly-l-lysine (PLL) functionalized TEM grid, using active deposition (by ultracentrifugation) and retention (by PLL interactions with NM surface) of NMs on the substrate, enabling fully quantitative analysis. Similar analysis with AFM was satisfactory in simple media but the lack of chemical-selectivity of AFM limits its applicability for the detection of NMs in complex environmental samples. The sampling approach was validated using both citrate- and PVP-coated AuNMs in pure water, which demonstrated an even distribution of NM on the TEM grid and high NM recovery (80-100%) at environmentally relevant NM concentrations (ca. 0.20-100 μg L(-1)). The applicability of the sampling method to complex environmental samples was demonstrated by the quantification of particle number concentration of AuNMs in EPA soft water (with and without Suwannee River fulvic acid) and lake water. This sample preparation approach is also applicable to other types of NMs with some modifications (e.g. centrifugation force and time) to insure full sample recovery. This TEM sampling method is key to the accurate quantification of NM number concentration, and therefore to improving our understanding of environmental fate, behavior, effects and dose of NMs.