Correlation of The Total Population of Black Soldier Fly (Hermetia illucens) Larva with The Population of The House Fly (Musca domestica) in Chicken Feces

The increase in the house fly population (Musca domestica) indicates pollution from chicken farms due to the chicken feces produced. The house fly population from farms can be reduced by using Black Soldier Fly (BSF) larvae, but the exact number of BSF larvae has yet to be discovered to reduce the house fly population. This study aims to determine the presence of BSF larvae in chicken feces waste media in inhibiting the population of house flies. The research sample used 7-day-old BSF larvae from fishing for BSF flies from nature using organic waste to lay eggs and produce larvae. The research method used a completely randomized design (CRD) consisting of 4 treatments and 3 replications. Treatment without the addition of larvae (P0), 100 grams (P1), 200 grams (P2) and 300 grams (P3) into 1 kg of chicken feces stocked in a 50 cm x 50 cm container. The variable observed was the number of house flies perched on each treatment's feces. The results showed that the number of flies that landed on chicken feces with the addition of 0 g, 100 g, 200 g, and 300 g BSF larvae was 34.33±12.09, 22.33±10.21, 16.33 ±2.08 tails, 11.00±2.64 individuals. Based on the results of statistical analysis, it was found that the population of the house fly was significantly reduced (P0.05) between the addition of 0 grams of BSF larvae, 100 grams, 200 grams and 300 grams. The results of the study concluded that the more BSF larvae added, the less population of house flies perched around chicken feces. The presence of BSF larvae weighing 200 g per kg of chicken feces can reduce the population of flies that perch on chicken feces by 52%.

STUDI ANATOMIS DAN HISTOLOGIS PANKREAS BIAWAK AIR (Varanus salvator) (Anatomical and Histological Study of the Pancreas of Water Monitor Lizard (Varanus salvator))

The aim of this research was to determine the anatomy and histology of pancreas of water monitor lizard (Varanus salvator). Two pancreas were used in this research (a male and a female). Water monitor lizard was euthanized using chloroform and subsequently necropsied to collect the pancreas. The pancreas was washed in 0.9 % NaCl solution. Anatomical observations were carried out including location, shape, and color of pancreas, also the length and weight measurements. Then, pancreas was fixed with 4% paraformaldehyde for 7 days to proceed to histological preparation and hematoxylin eosin (HE) staining. The results of the anatomical observations showed that pancreas of water monitor lizard have two lobes, dorsal lobe (splenic lobe) and ventral lobe (duodenal lobe). Dorsal lobe which was in oval form adhered with the spleen, and ventral lobe was located in the cranial of intestines with the form of long spherical. Both of pancreas lobes were white-yellow color with the length of 1.45±0.64 cm (dorsal lobe) and 7.00±0.42 cm (ventral lobe). Weight of dorsal lobe was 0.15±0.01 g and ventral lobe was 6.35±2.30 g. The histological observations found the acinar cells, ducts, and blood vessels in both of pancreas lobes. Additionally, the similar structure of Langerhans islet only found at the ventral lobe of pancreas. In conclusion, pancreas of water monitor lizard consists of two lobes which located differently. Ventral lobe is larger than the dorsal lobe. Both lobes have similar histological structure except the Langerhans islets are only appeared in the ventral lobe.

Venous Aneurysm Occurring after Revisional Hip Surgery: A Case Report

Objective:

To report a rare case of venous aneurysm.

Design:

Case report.

Setting:

Departments of General Surgery and Orthopaedic Surgery, The Princess Royal Hospital, Haywards Heath, a district general hospital.

Patient, intervention and results:

A 63-year-old woman underwent revision of a right total hip replacement in 1994, using a cemented prosthesis. She continued to have pain in the region of the hip and a pulsatile swelling was noted in the right iliac fossa. A pseudoaneurysm of the external iliac artery was suspected but investigations showed a venous aneurysm of the external iliac vein. Thus far, this aneurysm has been observed without complication. In 1996 the prosthesis was revised because of loosening of the femoral component and the pain resolved.

Conclusion:

Vascular injury is a rare complication of total hip replacement and thermal arterial injury can occur. Iliac venous aneurysms are recognized but are extremely rare so we conclude that this lesion was caused by thermal injury.

Panobinostat plus lenalidomide and dexamethasone phase I trial in multiple myeloma (MM)

8542

Background: Panobinostat (LBH589) is a highly potent pan-deacetylase inhibitor (pan-DACi), affecting with epigenetic and non-epigenetic pathways of cancer. In vivo experiments demonstrated potent MM cytotoxicity of the triplet panobinostat + lenalidomide + dexamethasone. Methods: Trial started with 5 mg panobinostat (po, TIW) combined with fixed doses of lenalidomide (25 mg po, QD, Days 1–21) and dexamethasone (40 mg po, Days 1–4, 9–12, 17–20, Cycles 1–4), in a 28-day cycle. MTD of panobinostat in this combination for second-line MM will be established based on data from cohorts of ≥6 evaluable patients (pts). Safety, tolerability, PK/PD, and preliminary efficacy will be assessed. Results: Twenty-two pts with relapsed or relapsed refractory MM were treated in three dose levels to date. Dose escalation started at 5 mg panobinostat (po, thrice weekly) combined with fixed doses of 25 mg lenalidomide (po, qd, Days 1–21) and 40 mg of dexamethasone (po, Days 1–4, 9–12, 17–20, Cycles 1–4), in a 28-day cycle. Data from all eight patients in Cohort 1 were evaluated. The median number of prior lines of therapy was two (range 1–3). Six out of eight patients in Cohort 1 remain on therapy. Median follow-up is six cycles (range 4–8+). No DLT was observed. In Cohort 2, eight patients were treated at the dose level of 10 mg of panobinostat, with one single DLT: a Gr 1 increase of QT interval duration was detected on Day 3, persisting on Day 8 with therapy withheld, meeting DLT definition although not deemed clinically relevant. Cohort 3 is enrolling with six patients at 20 mg of panobinostat, thus far. SAEs included fever (two pts), anxious depressive syndrome, respiratory infection, atrial fibrillation, exertional dyspnea, cellulitis, superficial blood clot of thigh, phlebitis, hypokalemia. All, but fever in one patient, were assessed by the investigator as not study drug related. Conclusions: The potential for anti-myeloma activity of this triple combination is strongly supported by in vivo preclinical data. In this first clinical trial assessing this triple oral combination, the 5 and 10 mg dose level of panobinostat appear safe. Updated safety, early efficacy, and subsequent dose-level patient data will be presented.

[Table: see text]

New walking dependence associated with hospitalization for acute medical illness: incidence and significance

BACKGROUND

The ability to walk independently may become jeopardized during hospitalization. It is unknown which patients are at risk for decline in walking, or to what extent patients will recover. The purpose of this study was to determine the incidence of, risk factors for, and outcomes associated with new walking dependence after hospitalization.

METHODS

Baseline characteristics and functional outcomes at hospital discharge and 3 months after discharge were measured for 1,181 community-dwelling adults aged 70 and over who were hospitalized for medical illness and who walked independently prior to hospitalization.

RESULTS

At discharge, 16.8% of patients were newly dependent in walking. Risk factors included age > 85 (odds ratio [OR] 2.7 vs age <75, 95% confidence interval [CI] 1.5-4.9), functional impairment before hospitalization (OR 1.4 for each impairment, CI 1.1-1.7), Caucasian race (OR 1.9, CI 1.1-3.3), and use of a walker (OR 1.8, CI 1.04-3.2) or wheelchair (OR 3.2, CI 1.3-7.6) before admission. A cancer diagnosis (OR 2.3, CI 1.2-4.6) and more than four comorbid conditions (OR 1.9, CI 1.2-3.0) were also predictive. New walking dependence was associated with discharge to a nursing home (p = .0001) and higher postdischarge mortality (p < .001). Twenty-seven percent of patients who developed new walking dependence and survived 3 months continued to be dependent in walking.

CONCLUSIONS

New walking dependence occurs frequently with hospitalization, may be predicted by specific risk factors, and portends a poor prognosis. Strategies are needed to help at-risk patients maintain walking independence during and after hospitalization.

Comparative study of coronary collaterals in diabetic and nondiabetic patients by angiography

Myocardial ischaemia is known to be significantly related to the development of coronary collaterals, but there are considerable variations in their formation. The nature of this variability is not well understood. Likewise it remains unclear whether diabetes mellitus. DM has any effect on coronary collaterals. The aim of this study was to evaluate the effect of diabetes mellitus on coronary collaterals. This prospective case- control study was done from January to December 2000 in patients undergoing coronary angiography in National Institute of Cardiovascular Diseases (NICVD), Dhaka, who fulfilled the inclusion criteria of having < or = 75% stenosis in at least one coronary artery. The patients with diabetes having CAD without other modifiable major risk factors (hypertension, smoking, dyslipidaemia) were constituted case study group (n=36) and nondiabetic patients having CAD with those risk factors were constituted control group (n=50). Coronary collaterals were graded according to Rentrope scoring system and the collateral score was calculated by summing the Rentrope number of every patient. There was no statistical difference between patients with and without diabetes in clinical characteristics. The mean number of diseased vessel in DM group 2.6+/-0.6 was higher than that in nondiabetic patients (2.1+/-0.8, P>.05). The mean collateral score was 0.5+/-0.6 in DM group and 1.2+/-1.0 in nondiabetic group. These findings suggest that coronary collateral development is significantly poorer in diabetic than on diabetic patients.

High-performance liquid chromatography determination of phenolic constituents in 17 varieties of cowpeas

Seventeen varieties of cowpeas grown in Arkansas were analyzed for their phenolic constituents using high-performance liquid chromatography (HPLC). Protocatechuic acid was identified as the major phenolic acid present in esterified forms. The amount of protocatechuic acid increased from trace-3.6 to 9.3-92.7 mg/100 g of flour in the 17 varieties of cowpeas after hydrolysis. Six other phenolic acids, including, p-hydroxybenzoic acid, caffeic acid, p-coumaric acid, ferulic acid, 2,4-dimethoxybenzoic acid, and cinnamic acid, were also identified. These phenolic acids were evenly distributed mainly in free acid forms at <7 mg/100 g of flour. Total phenolic contents determined using Folin-Ciocalteu's reagent were largely different among the 17 varieties, ranging from 34.6 to 376.6 mg/100 g of flour. A comparison of the HPLC chromatograms of the 17 cowpea phenolics before and after alkali hydrolysis indicated the conversion of a pattern with evenly distributed peaks to one with a single major peak for protocatechuic acid, suggesting that the chromatograms before hydrolysis better represent the identities of the cowpea varieties.

Temporal association between hospitalization and rate of falls after discharge

BACKGROUND

Evidence suggests that acute illness and hospitalization may increase the risk for falls.

OBJECTIVE

To evaluate the rate of falls, and associated risk factors, for 90 days following hospital discharge.

METHODS

We consecutively enrolled 311 patients, aged 65 years and older, discharged from the hospital after an acute medical illness and receiving home-nursing services. Patients were assessed within 5 days of discharge for prehospital and current functioning by self-report, and balance, vision, cognition, and delirium by objective measures. Patients were followed up weekly for 13 weeks for falls, injuries, and health care use.

RESULTS

The rate of falls was significantly higher in the first 2 weeks after hospitalization (8.0 per 1000 person-days) compared with 3 months later (1.7 per 1000 person-days) (P =.002). Fall-related injuries accounted for 15% of all hospitalizations in the first month after discharge. Independent prehospital risk factors significantly associated with falls included dependency in activities of daily living, use of a standard walker, 2 or more falls, and more hospitalizations in the year prior. Posthospital risk factors included use of a tertiary amine tricyclic antidepressant, probable delirium, and poorer balance, while use of a cane was protective.

CONCLUSIONS

The rate of falls is substantially increased in the first month after medical hospitalization, and is an important cause of injury and morbidity. Posthospital risk factors may be potentially modifiable. Efforts to assess and modify risk factors should be integral to the hospital and posthospital care of older adults (those aged >/=65 years).

Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. PROMISE (Prospective Randomized Milrinone Survival Evaluation) Investigators

BACKGROUND

Ventricular arrhythmias are a frequent finding in congestive heart failure (CHF) patients and a cause of concern for physicians caring for them. Previous studies have reached conflicting conclusions regarding the importance of ventricular arrhythmias as predictors of sudden death in patients with CHF. This study examined the independent predictive value of ventricular arrhythmias for sudden death and all-cause mortality in PROMISE (Prospective Randomized Milrinone Survival Evaluation).

METHODS AND RESULTS

Ventricular arrhythmias were analyzed and quantified by use of prespecified criteria on baseline ambulatory ECGs from 1080 patients with New York Heart Association (NYHA) class III/IV symptoms and a left ventricular ejection fraction </=35% enrolled in PROMISE. The relationship of ventricular arrhythmias and other clinical parameters to overall mortality and sudden death classified by an independent, blinded mortality committee was determined. There were 290 deaths, of which 139 were classified as sudden. Of the several measures of ventricular ectopy that were univariate predictors, the frequency of nonsustained ventricular tachycardia (NSVT) was the most powerful predictor and remained a significant independent predictor when included with other clinical variables in multivariate models of both sudden death mortality and non-sudden death mortality. However, multiple logistic analysis with models including the clinical variables with and without the NSVT variable demonstrated that the frequency of NSVT did not add significant information beyond the clinical variables.

CONCLUSIONS

This study demonstrates that ventricular arrhythmias do not specifically predict sudden death in patients with moderate-to-severe heart failure. Thus, the finding of asymptomatic NSVT on ambulatory ECG does not identify specific candidates for antiarrhythmic or device therapy.

Use of an ambulation assistive device predicts functional decline associated with hospitalization

BACKGROUND

Loss of functional independence occurs frequently with hospitalization. In community-dwelling elders, lower extremity disability is an important predictor of functional loss. Ambulation assistive devices (canes, walkers), as markers of lower extremity disability, may predict functional decline associated with hospitalization, but this has not been evaluated previously. We sought to determine the association of mobility impairment, as indicated by cane or walker use prehospitalization, with adverse outcomes at hospital discharge and 3 months post discharge.

METHODS

Subjects were community-dwelling adults (N = 1212) aged 70 and older, hospitalized for acute medical illness. The study was a secondary analysis of the Hospital Outcomes Project for the Elderly, a prospective randomized trial at three university and two private acute-care hospitals, which randomized patients to usual care or an intervention group designed to maintain functional abilities.

RESULTS

After controlling for demographic and illness-related characteristics and prehospital function, mobility impairment was significantly associated with functional decline. Use of a walker was associated with 2.8 times increased risk for decline in ADL function by hospital discharge (p = .0002). Three months after discharge, patients who used assistive devices prior to hospitalization were more likely to have declined in both ADLs (p = .02) and IADLs (p = .003).

CONCLUSIONS

Hospitalized patients with mobility impairment, as indicated by use of a cane or a walker, are at high risk for functional decline. Such patients may benefit from more intensive in-hospital and post-hospital rehabilitative therapy to maintain function.

Comprehensive analysis of risk factors for acquisition of Pseudomonas aeruginosa in young children with cystic fibrosis

The objective of this study was to identify risk factors of significance for acquisition of Pseudomonas aeruginosa by children with cystic fibrosis (CF). Our working hypothesis is that exposure of infants and young children with CF to older, infected patients increases their risk for acquiring this organism. A special opportunity arose to study this question in detail, as we have been performing a randomized clinical trial of neonatal screening for CF throughout the state of Wisconsin during the period of 1985-1994. Patients were selected for this study based on either early identification through screening or diagnosis by standard methods. A longitudinal protocol employed at Wisconsin's two CF Centers includes routine cultures of respiratory secretions and collection of clinical, demographic, and activity information on patients and their families. Previous observations in our trial revealed that one center at an old hospital in an urban location showed a significantly shorter time to acquisition of P. aeruginosa for CF patients followed there. To study the center effect further, we performed statistical analyses using survival curves and stepwise regression analysis of all life history covariates available. The results of these analyses showed that the statistically significant correlations involve the following risk factors: 1) center and old hospital (r=0.42); 2) center and original physician (r=0.61); 3) center and exposure to pseudomonas-positive patients (r=0.29); and 4) population density and urban location (r=0.49). The final statistical model demonstrated that increased risk due to aerosol use (odds ratio=3.45, P=0.014) and a protective effect associated with education of the mother (odds ratio=0.81, P=0.024) were the most significant factors for acquisition of P. aeruginosa. The previously observed center effect was confined to the 1985-1990 interval at the old hospital (odds ratio=4.43, P < 0.001). We conclude that multiple factors are involved in increasing the risk of young children with CF to acquire P. aeruginosa, and that the observed center effect can best be explained by a combination of factors. These results suggest that facilities and methods used to care for young children with CF can significantly influence their likelihood of acquiring pseudomonas in the respiratory tract.

Brain abscess and hereditary haemorrhagic telangiectasia: a report of three cases

Hereditary haemorrhagic telangiectasis (HHT) has long been viewed as a rare disease which is not usually associated with high morbidity and mortality. We report three patients with HHT who developed cerebral abscesses secondary to pulmonary arteriovenous malformations (PAVM).

Adverse drug events in hospitalized elderly

BACKGROUND

The study objectives were (a) to describe the occurrence, types, and preventability of adverse drug events (ADEs) in hospitalized patients 70 years of age and older; (b) to examine the association between potential risk factors and ADEs; and (c) to examine the relationship of an ADE occurrence and hospital length of stay (LOS) and functional decline.

METHOD

Consecutive general medical admissions (n = 157) of community-dwelling persons were prospectively monitored daily for ADE occurrence. Admission assessment included demographic factors, cognition, preadmission medication use, and functional status. Discharge assessment included functional status. LOS, discharge diagnoses, and medication use during the hospitalization.

RESULTS

Twenty-three patients (14.6%) experienced 28 probable ADEs, of which 54.2% (13/24) were judged to be potentially preventable. Patients experiencing an ADE had a significantly lower mean Mini-Mental State Examination score (23.6 +/- 4.3 vs 25.5 +/- 3.6, p = .039) and were prescribed significantly more new inpatient medications (4.0 +/- 2.3 vs 2.6 +/- 1.7, p = .01) compared to non-ADE patients. Age, gender, functional status prior to admission, percent with more than four active diagnoses, or number of preadmission medications were not associated with ADE status. Upon discharge, 50.0% of ADE patients experienced a decline in one or more activities of daily living (ADLs), compared with 24.1% of non-ADE patients (p = .017). ADE patients had a longer LOS (8.7 +/- 4.9 vs 6.6 +/- 3.0 days, p = .022) compared to non-ADE patients.

CONCLUSIONS

ADEs were associated with number of new inpatient medications and admission cognitive status, but not demographic, disease, or physical function variables. Patients experiencing an ADE were more likely to experience a longer LOS and to decline in ADL function. ADEs may be one factor contributing to functional decline during hospitalization. Future research in this area should include larger samples and multivariable analyses controlling for potential confounders.

Depression, cognitive impairment, and understanding of medication directions in hospitalized elderly patients

PURPOSE

The objectives of this study were 1) to assess understanding of medication directions of drug therapy in a group of hospitalized elderly who were not receiving assistance with medication administration; and 2) to determine whether depression, cognitive impairment, age, and other characteristics are associated with patient understanding of medication directions.

METHODS

The sample consisted of 117 hospitalized elderly patients aged 70 years and older who were taking two or more medications prior to hospitalization and reported medication self-administration. Data collection included demographic characteristics, mood, cognition, and pre-admission medication use and knowledge.

RESULTS

Thirteen (11%) patients did not understand directions for two or more pre-admission medications. Being 80 years or older was associated with not understanding medication directions (OR = 6.2, p = .017). There was a trend for depressive symptoms to be associated with not understanding medication directions, however, this was not significant (OR = 3.9, p = .058).

CONCLUSIONS

Although all individuals should be assessed for comprehension of their medication regimens, those over 80 years of age with depressive symptoms deserve increased attention. Alternative strategies may need to be developed to improve medication knowledge in the older, depressed hospitalized patient.

Hospital admission risk profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization

OBJECTIVES

To develop and validate an instrument for stratifying older patients at the time of hospital admission according to their risk of developing new disabilities in activities of daily living (ADL) following acute medical illness and hospitalization.

DESIGN

Multi-center prospective cohort study.

SETTING

Four university and two private non-federal acute care hospitals.

PATIENTS

The development cohort consists of 448 patients and the validation cohort consists of 379 patients who were aged 70 and older and who were hospitalized for acute medical illness between 1989 and 1992.

MEASUREMENTS

All patients were evaluated on hospital admission to identify baseline demographic and functional characteristics and were then assessed at discharge and 3 months after discharge to determine decline in ADL functioning.

RESULTS

Logistic regression analysis identified three patient characteristics that were independent predictors of functional decline in the development cohort: increasing age, lower admission Mini-Mental Status Exam scores, and lower preadmission IADL function. A scoring system was developed for each predictor variable and patients were assigned to low, intermediate, and high risk categories. The rates of ADL decline at discharge for the low, intermediate, and high risk categories were 17%, 28%, and 56% in the development cohort and 19%, 31%, and 55% in the validation cohort, respectively. Patients in the low risk category were significantly more likely to recover ADL function and to avoid nursing home placement during the 3 months after discharge.

CONCLUSION

Hospital Admission Risk Profile (HARP) is a simple instrument that can be used to identify patients at risk of functional decline following hospitalization. HARP can be used to identify patients who might benefit from comprehensive discharge planning, specialized geriatric care, and experimental interventions designed to prevent/reduce the development of disability in hospitalized older populations.