Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis

OBJECTIVES

To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children.

DESIGN

Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts.

SETTING

Community congregate settings and households.

INCLUSION CRITERIA

Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays.

DATA EXTRACTION

Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis.

RESULTS

The primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77).

CONCLUSIONS

BCG protects against M tuberculosis infection as well as progression from infection to disease.Trial registration PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/).

Enhanced field emission properties from CNT arrays synthesized on Inconel superalloy

One of the most promising materials for fabricating cold cathodes for next generation high-performance flat panel devices is carbon nanotubes (CNTs). For this purpose, CNTs grown on metallic substrates are used to minimize contact resistance. In this report, we compare properties and field emission performance of CNTs grown via water assisted chemical vapor deposition using Inconel vs silicon (Si) substrates. Carbon nanotube forests grown on Inconel substrates are superior to the ones grown on silicon; low turn-on fields (∼1.5 V/μm), high current operation (∼100 mA/cm(2)) and very high local field amplification factors (up to ∼7300) were demonstrated, and these parameters are most beneficial for use in vacuum microelectronic applications.

Harnessing local and systemic immunity for vaccines against tuberculosis

The lung is the portal of entry for Mycobacterium tuberculosis (Mtb) and animal experimental evidence indicates that local immune defense mechanisms are crucial for protective immunity. Immunization via the lower respiratory tract efficiently induces a dividing, activated, antigen-dependent, lung-resident, memory T-cell population, which is partly recoverable by bronchoalveolar lavage. These cells can inhibit the growth of Mtb in the lungs immediately after infection. Delivery of appropriate signals to the lung innate immune system is critical for induction of effective local immunity. In contrast after parenteral immunization, antigen-specific cells may be found in lung tissue but few are recoverable by lavage and inhibition of mycobacterial growth is delayed. Harnessing both local and systemic immunity can provide highly effective protection in animal models and the evidence suggests that taken in aggregate, multiple animal models may predict the success of novel vaccine strategies in humans.

An unusual case of paraganglioma

Pheochromocytomas or Paragangliomas are neroendocrine tumors elaborating catecholamines. They may not present always in a classic manner and a high degree of suspicion is important in diagnosing them early. They can grow large enough to impinge on the great vessels and yet symptoms may not indicate the severity until late. A young African 32 year old Male presented with occasional headaches, moderate weight loss, abdominal pain and hypertension for three years. On investigation for hypertension a large paraganglioma was discovered wrapped around the Aorta and vena cava. He was operated successfully after preoperative preparation and was discharged normotensive.

CONCLUSION

Young hypertensive should always be worked up fully including checking for abdominal masses. The classic paroxysm was absent in this case. After surgical removal the catecholamines elaborated by the tumor also take time to be washed out of the circulation thus the blood pressure will need careful monitoring. Conventional alpha blockage first and beta blockage later was the algorithm followed but choice of agent was also discussed with nesthethesiologist. Though classically taught phenoxy benzamine is used, in this case it was not used and a combination of Prazosin and Propranolol.

Removal of hazardous chlorinated VOCs from aqueous solutions using novel ZSM-5 loaded PDMS/PVDF composite membrane consisting of three hydrophobic layers

Hydrophobic polymer possesses significant potential for selective separation of volatile organic compounds (VOCs) from their aqueous solutions by pervaporation (PV). In the present study mixed matrix hydrophobic membranes of polydimethylsiloxane (PDMS) supported on polyvinylidenefluoride (PVDF) substrate were synthesized by incorporating hydrophobic inorganic ZSM-5 filler. The indigenous membranes were crosslinked with tetraethylorthosilicate (TEOS) for the extraction of volatile chlorinated hydrocarbons such as dichloromethane (DCM), trichloromethane (TCM), 1,2-dichloroethane (DCE), and 1,1,2,2-tetrachloroethane (TeCE), which pose serious environment threat and health hazard. Thermal stability, crosslinking, crystallinity, surface morphology and swelling characteristics of the indigenously developed membranes were determined by TGA, FTIR, XRD, SEM and sorption studies, respectively. Effect of operating parameters such as feed composition and filler concentration on separation performance in terms of flux and selectivity were determined. Flux of DCM, TCM, DCE and TeCE was found to be 0.166, 0.146, 0.141 and 0.06 kg m(-2)h(-1) with selectivity of 541, 1068, 917 and 15,000, respectively, for 20% ZSM-5 filled PDMS membrane for aqueous feeds containing 1.33% (w/v) DCM, 0.8% (w/v) TCM, 0.84% (w/v) DCE and 0.28% (w/v) TeCE in water. The membrane exhibited considerable feasibility for scale-up with significant potential for removal of hazardous chlorinated VOCs from aqueous solutions.

Fibronectin and vitronectin promote human fetal osteoblast cell attachment and proliferation on nanoporous titanium surfaces

Improvements in osteoconduction of implant biomaterials require focusing on the bone-implant interface, which is a complex multifactorial system. Surface topography of implants plays a crucial role at this interface. Nanostructured surfaces have been shown to promote serum protein adsorption and osteoblast adhesion when compared to micro-structured surfaces for bone-implant materials. We studied the influence of the serum proteins fibronectin and vitronectin on the attachment and proliferation of osteoblasts onto nanostructured titania surfaces. Human fetal osteoblastic cells hFOB 1.19 were used as model osteoblasts and were grown on nanoporous TiO2 templates, using Ti6AI4V and commercially pure Ti substrates as controls. Results show a significant increase in cell proliferation'on nanoporous TiO2 over flat substrates. Initial cell attachment data exhibited a significant effect by either fibronectin or vitronectin on cell adhesion at the surface of any of the tested materials. In addition, the extent of cell adhesion was significantly different between the nanoporous TiO2 and both Ti6AI4V and commercially pure Ti substrates, with the first showing the highest surface coverage. There was no significant difference on osteoblast attachment or proliferation between the presence of fibronectin or vitronectin using any of the material substrates. Taken together, these results suggest that the increase in osteoblast attachment and proliferation shown on the nanoporous TiO2 is due to an increase in the adsorption of fibronectin and vitronectin because of the higher surface area and to an enhanced protein unfolding, which allows access to osteoblast binding motifs within these proteins.

Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool

BACKGROUND

Assessment of the potentially difficult airway (DA) is a critical aspect of resident education. We investigated the impact of a new assessment form on airway prediction and management by anaesthesia residents. We hypothesized that residents would demonstrate improvement in evaluation of DAs over the study duration.

METHODS

After IRB approval, anaesthesia residents were randomized into two groups: control (existing form) and experimental (new form). Data were collected prospectively from August 2008 to May 2010 on all non-obstetric adult patients undergoing non-emergent surgery.

RESULTS

Eight thousand three hundred and sixty-four independent preoperative assessments were collected and 8075 were analysed. The experimental group had the higher completion rate than the control group (94.3% vs 84.3%, P=0.001). DA prediction was higher for the control group (71.2%) compared with the experimental group (69.1%; P=0.032). A significant improvement in prediction rates was found over time for the experimental group (likelihood estimate=0.00068, P=0.031).

CONCLUSIONS

The use of a comprehensive airway assessment did not improve resident ability to predict a DA in an academic, tertiary-based hospital, anaesthesiology residency training programme.

Suppression of cardiac alternans by alternating-period-feedback stimulations

Alternans response, comprising a sequence of alternating long and short action potential durations in heart tissue, seen during rapid periodic pacing can lead to conduction block resulting in potentially fatal cardiac failure. A method of pacing with feedback control is proposed to reduce the alternans and therefore the probability of subsequent cardiac failure. The reduction is achieved by feedback control using small perturbations of constant magnitude to the original, alternans-generating pacing period T, viz., using sequences of two alternating periods of T+ΔT and T-ΔT, with ΔT<<T. Such a control scheme for alternans suppression is demonstrated experimentally in isolated whole heart experiments. This alternans suppression scheme is further confirmed and investigated in detail by simulations of ion-channel-based cardiac models both for a single cell and in one-dimensional spatially extended systems. The mechanism of the success of our method can be understood in terms of dynamics in phase space, viz., as the state of activity of the cell being confined within a narrow volume of phase space for the duration of control, resulting in extremely diminished variation in successive action potential durations. Our method is much more robust to noise than previous alternans reduction techniques based on fixed point stabilization and should thus be more efficient in terms of experimental implementation, which has implications for clinical treatment for arrhythmia.