Παρασκευή, 26 Αυγούστου 2016

Selection of some fungal pathogens for biological control of Trianthema portulacastrum L., a common weed of vegetable crops

2016-08-26T16-20-48Z
Source: Journal of Applied Biology & Biotechnology
Gaddeyya Gandi Pilli, P. K. Ratna Kumar, Bharathi Pilaka.
ABSTRACT Trianthema portulacastrum Linn. is a weed plant of aizoaceae (Fig marigold family). It is indigenous to South Africa but widely distributed in India, Sri Lanka and tropical and subtropical areas as a noxious weed. The mycoflora namely Alternaria alternata (Fr.) Keissler., Colletotrichum capsici (Syd.) E.J. Butler & Bisby., Bipolaris maydis (Y.Nisik. & C.Miyake) Shoemaker., Curvularia lunata (Wakker) Boedijin., Curvularia tuberculata Sivan. and Gibbago trianthemae E.G. Simmons was isolated from highly infected portions of the weed. The pathogenicity of various fungal species was confirmed by Kochs postulates. The host specificity of the isolates of horse purslane was tested on green house plants by spore treatment. Among the isolates, Gibbago trianthemae was highly aggressive to weed and it was considered as potential biocontrol agent (Mycoherbicidal agent) against horse purslane weed.


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Production and Characterization of Collagenase by Penicillium sp. UCP 1286 Isolated From Caatinga Soil

2016-08-26T16-20-48Z
Source: Journal of Applied Biology & Biotechnology
Maria Carolina de Albuquerque Wanderley, José Manoel Wanderley Duarte Neto, Carolina de Albuquerque Lima, Sara Isabel da Cruz Silvério, José Luiz de Lima Filho, José António Couto Teixeira, Ana Lúcia Figueiredo Porto.
A new Penicillium sp. strain isolated from the soil of Caatinga, a Brazilian Biome (UCP 1286) was selected for collagenase production. Fermentation system allowing obtention of collagenolytic activity about 2.7 times higher than existing data, with the highest values of collagenolytic and specific activity (379.80 U/mL, 1460.77 U/mg, respectively), after 126 hours. Applying a factorial design, enzyme production was increased by about 65% compared to the preliminary results. The factorial design demonstrated the existence of two factors with statistical significance on the production of the enzyme: pH and temperature, both with negative effects. Enzyme was found to be more active at pH 9.0 and 37 °C, and also to be very stable in comparison with the collagenase produced by other microorganisms. The enzyme seems to belong to collagenolytic serine proteases family. Concerning the substrate specificity, it was observed that the highest enzyme activity corresponds to azocoll, there was no relevant activity on azocasein and the enzyme showed to be more specific to type V collagen and gelatin than the commercial colagenase produced by Clostridium histolyticum. Major band observed at electrophoresis was approximately 37 kDa. Zymogram analysis confirmed the collagenolytic activity. All data indicates this enzyme as promising biotechnology product.


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Influence of growth conditions on production of poly(3-hydroxybutyrate) by Bacillus cereus HAL 03 endophytic to Helianthus annuus L.

2016-08-26T16-20-48Z
Source: Journal of Applied Biology & Biotechnology
Rituparna Das, Agnijita Dey, Arundhati Pal, A. K. Paul.
Systematic screening of culturable endophytic bacteria for production of poly(3-hydroxybutyric acid) [P(3HB)] has resulted in the isolation of a potent strain identified as Bacillus cereus HAL 03 (GenBank Accession No. KR869088) from leaf tissue of Helianthus annuus L. Production of P(3HB) by this strain was influenced significantly by the quality as well as quantity of suitable carbon and nitrogen sources in the growth medium. At 2% (w/v) sucrose, the accumulated P(3HB) reached to a level of 50.46 % of its cell dry weight (CDW), whereas yeast extract (0.2%) as nitrogen source enhanced P(3HB) production and accounted for 53.19% of CDW. Moreover, the non-conventional carbon sources such as molasses further increased the production of the polyester up to 54.05% of its CDW. Finally, the identity of this intracellularly accumulated polyester was confirmed as a homopolymer of 3(hydroxybutyric acid) by the Fourier-transform infrared and proton nuclear magnetic resonance spectroscopic analysis. This study appears to indicate the first ever report of P(3HB) production by any strain of B. cereus endophytic to H. annuus L.


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Inter- and intra-rater reliability of clinical tests associated to functional lumbar segmental instability and motor control impairment in patients with LBP: a systematic review

Publication date: Available online 26 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Lenie Denteneer, Gaetane Stassijns, Willem De Hertogh, Steven Truijen, Ulrike Van Daele
ObjectiveTo provide a comprehensive overview of clinical tests associated with functional lumbar segmental instability and motor control impairment in patients with low back pain (LBP) and to investigate their intra and/or inter-rater reliability.Data sourcesA systematic computerized search was conducted in four different databases on the 1st of December 2015: Pubmed (1972 - ) , Web of Science (1955 - ), Embase (1947 - ), Medline ( 1946 - ).Study selectionPRISMA guidelines were followed during design, search and reporting stages of this review. The included population are patients with primary LBP. Data was extracted as follows: (1) description and scoring of the clinical tests (2) population characteristics (3) in- and exclusion criteria (4) description of the used procedures (5) results for both intra- and inter-rater reliability and eventually (6) notification on used statistical method. The risk of bias (ROB) of the included articles was assessed with the use of the COSMIN checklist.Data synthesisA total of 16 records were eligible and 30 clinical tests were identified. All included studies investigated inter-rater reliability and three studies investigated intra-rater reliability. The identified Inter-rater reliability scores ranged from poor to very good (k-0.09-0.89 and ICC 0.72-0.96) and the Intra-rater reliability scores ranged from fair to very good (k 0.51-0.86).ConclusionsThree clinical tests (aberrant Movement pattern, prone instability test and the beighton scale) could be identified for having an adequate inter-rater reliability. No conclusions could be made for intra-rater reliability. However, further research should focus on better study designs, provide an overall agreement for uniformity and interpretation of clinical tests and should implement research regarding validity.



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Conservative Care in Lumbar Spine Surgery Trials: A Descriptive Literature Review

Publication date: Available online 26 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Aaron J. Yang, Rogelio A. Coronado, Lilian Hoffecker, Chan Gao, Kelly Saurwein, Danielle Shoreman, Adam S. Hoffberg, Venu Akuthota
ObjectiveTo evaluate the degree to which conservative care and failure was specifically defined in studies comparing non-operative treatment versus surgery for low back pain (LBP) conditions in adults.Data SourcesA comprehensive literature search was conducted by an experienced librarian using MEDLINE (PubMed), EMBASE, Google Scholar, and CENTRAL (the Cochrane Central Register of Controlled Trials) from January 2003 to June 2014. Endnote bibliographic management application was utilized to remove duplicates and organize the citations.Study SelectionProspective, randomized or cohort trials comparing surgery versus conservative intervention for patients with LBP conditions. Study selection was conducted by two independent reviewers.Data ExtractionThree independent reviewers extracted data from each article using a structured data extraction form. Data extracted included type of study, participant characteristics, sample size, description, and duration of conservative care, and whether failed conservative care criterion was defined.Data SynthesisA total of 852 unique records were screened for eligibility, and of those, 72 articles were identified for further full text review. Thirty-four full texts were excluded based on the exclusion criteria and 38 articles, representing 20 unique studies, were included for qualitative synthesis. Fifteen of the 20 studies defined the duration of conservative care. Only three studies defined the dosage of physical therapy sessions including total number of visits and visit duration. Two studies described medication usage including the duration and type. No studies specifically defined what constituted failed conservative therapy.ConclusionsThis literature review suggests conservative care is poorly defined in randomized trials which can lead to ambiguity of research procedures and unclear guidelines for clinicians. Future studies should increase transparency and explicitly define conservative care.



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Development and Validation of the State-Trait Inventory of Cognitive Fatigue in Community-Dwelling Older Adults

Publication date: Available online 26 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Melissa Shuman-Paretsky, Vance Zemon, Frederick W. Foley, Roee Holtzer
ObjectiveTo develop and validate a subjective measure of cognitive fatigue—the State-Trait Inventory of Cognitive Fatigue (STI-CF)—in community-dwelling older adults.DesignScale development and test construction.SettingCommunity-dwelling older adults enrolled in a longitudinal cohort aging study.ParticipantsParticipants (N=175) were healthy, English-speaking, community-dwelling adults, age 65 and above.InterventionsNot applicable.Main Outcome MeasuresSTI-CF total, cognitive fatigue, motivation, mental effort, and boredom summation scores for both state and trait forms.ResultsPrincipal component analysis yielded the expected four components for both state and trait forms: cognitive fatigue, mental effort, motivation, and boredom. All components had good reliability. There was good convergent validity as measured by the strong positive relationship between cognitive fatigue and a subjective measure of general fatigue, even after controlling for depressive symptoms. Greater subjective cognitive fatigue was associated with worse performance on measures thought to be more sensitive to aspects of executive functioning.ConclusionsThe current study developed and established the psychometric properties of a new instrument for the subjective measurement of cognitive fatigue for use in community-dwelling older adults. The STI-CF's relatively brief administration time (less than 10 minutes; M = 5.6, SD = 2.9) and strong psychometric properties support its utility in both research and clinical settings. Future studies should establish the psychometric properties of this scale in other populations and examine its predictive utility for relevant clinical outcomes.



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Perspectives on postural control dysfunction to inform future research: A Delphi study for children with cerebral palsy

Publication date: Available online 26 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Rosalee Dewar, Andrew P. Claus, Kylie Tucker, Leanne Marie Johnston
ObjectiveTo identify if consensus can be achieved in how clinicians and researchers define, describe, assess and treat postural control dysfunction in children with cerebral palsy (CP).DesignDelphi study with 3 iterative rounds.SettingElectronic surveyParticipants43 researchers and/or clinicians from 7 countries with a mean(SD) of 20(11) years experience working with children with cerebral palsy (CP) participated. Participants included authors of published works on postural control in CP (identified from a recent systematic review), members of the Australasian CP and Developmental Medicine Academy and two major Australian rehabilitation providers.InterventionNot applicable.Main Outcome measuresThe Delphi study consisted of 3 iterative rounds of surveys. In Round-I, respondents answered open-ended questions regarding their views on: i) definition items for postural control, ii) theoretical frameworks, iii) methods for assessment, and iv) interventions for postural control dysfunction in children with CP. Round II and III were made up of items generated by participants in Round-I and combined with items identified from the literature. Participants indicated their level of agreement for each item on a 7-point Likert scale. Threshold for consensus was ≥85% agreement.ResultsOf 306 items generated, 174 items reached consensus by Round-III. Most postural control Definition items (90%) achieved consensus. Two theoretical Frameworks reached consensus (14%). Less than half (42%) of Assessment items reached consensus. More individual assessment items (89%) reached consensus than multi-item tools (4%). Just over half (61%) of the items generated for interventions reached consensus.ConclusionConsensus was achieved for a postural control definition. However, substantial research is needed to establish a comprehensive, postural control specific framework and suite of assessments. These would provide a foundation to improve intervention selection and dosage.



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What do I know? I’m just a paramedic

By Justin Schorr, EMS1 Contributor 

I get yelled at while at work. It happens more than I'd like, but sometimes I just can't seem to get things right.

I've either shown up late, been rude or didn't complete the tasks I was assigned to do. And sometimes I get yelled at for doing exactly what I'm supposed to do. You may be thinking that I've got an overbearing boss or supervisor who just doesn't get it. But it isn't my boss who yells at me, it's my customers.

Randal, the noted philosopher and video clerk in the movie Clerks, once said, "This job would be great if it wasn't for the (expletive) customers." His associate casually asks, "Which ones?"

"All of them."

If you're fortunate enough to work in a position that doesn't require you to directly interact with the end user of your work, congratulations, you've hit the jackpot. Dealing with customers is a challenge, especially when they expect something other than what you provide or question the manner in which you provide it.

As a paramedic, you'd think it would be all hugs and kisses since we respond to life-or-death emergencies and handle them with our education, training, equipment, and experience, all integrated with the entire healthcare system. Still, we get yelled at.

"What took you so long?!" a mother shouts through clenched lips, barely keeping the lit cigarette in her mouth. "My daughter is having an asthma attack and it takes you 4 minutes to get here? And where's the ambulance, I called for an ambulance, why did you bring the fire truck?"

It is a challenge, nay a skill, to be able to assess an 18-month-old's breathing while the mother is screaming. Our usual instructions for her to quit smoking and the baby will improve over time are met with a tirade of expletives about her rights to live her life the way she wants. I get yelled at for doing my job because she doesn't want to hear what my job actually is.

"This man's bag fell onto my wife's arm and made a red mark, I want a report taken!" is a far more common 911 call at a major airport than you want to believe. The plane is held at the gate until paramedics arrive in less than 6 minutes to address this 'life-or-death emergency.'

As I walk into the jet bridge near the aircraft, I can hear yelling between 3 men. Turns out one of them is a police officer trying to calm the other two. One is complaining that he was bumped and a bag fell and he apologized. The other is irate that his wife has been 'injured' and demands action from the police.

"There you are, thanks for taking your sweet time. My wife's arm is red and I demand you take a report immediately." I glance behind me, wondering if someone who actually does that is nearby. When I ask the man and his wife, who has yet to chime in on the discussion, to exit the plane, he erupts into an expletive-laced outburst that results in his forcible removal from the plane at the request of the flight deck.

He was eventually detained by police for half an hour as a safety precaution, all the while screaming about how we're all going to be fired, that we are incompetent, and that he will see to it that our careers are destroyed.

About 50 feet away, his wife and I can still hear him, but she consents to an assessment of the 'arm injury' that started this all. Nothing is wrong, even remotely. "Why didn't you mention that you were OK? All of this could have been avoided," I ask, rolling her shirt's sleeve back down and placing my hand over hers.

"You're not a doctor, I should have the ambulance take me in to get checked out. It's OK, you'll get paid, that man on the plane will pay."

When I tried to explain that the man on the plane was not detained, questioned or otherwise held, nor will he in any way be responsible for her decisions, her voice rose, and I decided it best to walk her back towards the husband, who had apparently run out of things to say and was simply grinding his teeth and murmuring about his rights.

As we walked, I offered an arm under her elbow in case she needed to steady herself. "Get your damned hands off of me. You can't touch me," she said, clearly disgusted with my presence.

Folks call 911 when they don't know what else to do. Emergency or not, we'll come running as fast as we can.

A young child having an asthma attack needs an Advanced Life Support assessment, possible treatment, and an evaluation of conditions to eliminate future events. That child, in particular, needed a home free of constant cigarette smoke to get healthy, but mom won't listen to me—I'm just a paramedic.

A sore arm that used to be red can be uncomfortable, but likely does not require an ambulance to the hospital just "to get checked out." Paramedics can make a fair assessment and diagnosis to advise you on the most appropriate manner of seeking additional care if needed.

What we don't want to do is get yelled at for doing what we've been trained to do. Customers and their family berate paramedics all day long simply because of their misunderstanding of our capabilities, responsibilities, and mission.

That said, would this job be great without the customers? This job wouldn't exist without the customers. Ultimately, I'd rather they yell at me than the alternative: Not be able to yell, or talk, or breathe.

 



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5 signs the last EMS crew had a bad shift

By Sean Eddy, EMS1 Contributor 

We never wish bad things on the off-going crew, but there is a belief that a busy shift the day before means an easy shift today. We like to see the streets and neighborhoods looking like a ghost town as we drive to work. That usually indicates that everyone was already taken to the hospital and there's nobody left for us to transport. Like I said, we hate to wish bad things on our counterparts, but you know…

There are many indicators that the previous crew had a bad shift. Here are my top 5:

1. The dispatcher has been placed in protective custody.

Never shoot the messenger, unless the messenger is an EMS dispatcher. It doesn't matter who called 911, it's the dispatcher's fault that the EMS crew was busy. It doesn't have to make sense, it's just the rules. When you arrive for work to see police barricades around the comm center and Secret Service agents escorting dispatchers to their cars, you can be assured the previous crew had a busy shift. Be sure to use caution because you are at fault for the last call since you didn't arrive 90 minutes early for work to relieve the off-going crew.

2. The tarp used to move large people was removed from its packaging. 

To put this into perspective, these tarps typically have a weight capacity of 1,000lbs. While these are an extremely valuable asset, they are never used in ideal situations. These patients almost always find themselves in the most difficult-to-access locations known to man. On top of that, they almost always require movement down at least 1 set of stairs. Nobody walks away from these calls saying "man, that wasn't so bad."

3. The ambulance isn't in the bay when you arrive to work. 

This means that the off-going crew got a late call. This is quite possibly the most dreaded call of the shift and no matter what time the call comes in, the crew is going to look around the station, then look at their watch before asking where the hell you are. They already hate you and you haven't even said good morning yet.

4. The off-going crew is sitting at the computer writing charts.

This almost always indicates that the crew ran calls all night. This also means that they're not leaving anytime soon and you're going to have to listen to them complain about their shift for at least another 2 hours. Just keep their coffee cups topped off and don't make eye contact.

5. You notice an incident command post in front of the nursing home.

This means that the doctor showed up to make his once-every-six-month visit and wrote a list of patient transport orders long enough that it had to be rolled out on a scroll. Since everyone's week-long ailment became an emergency on Tuesday morning at 07:00, your service wound up with so many calls for service that a state-of-emergency had to be declared. Chances are, FEMA is en route and strike teams are being deployed.

The good news? You're going to have a good shift.



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5 signs the last EMS crew had a bad shift

By Sean Eddy, EMS1 Contributor

We never wish bad things on the off-going crew, but there is a belief that a busy shift the day before means an easy shift today. We like to see the streets and neighborhoods looking like a ghost town as we drive to work. That usually indicates that everyone was already taken to the hospital and there's nobody left for us to transport. Like I said, we hate to wish bad things on our counterparts, but you know…

There are many indicators that the previous crew had a bad shift. Here are my top 5:

1. The dispatcher has been placed in protective custody.

Never shoot the messenger, unless the messenger is an EMS dispatcher. It doesn't matter who called 911, it's the dispatcher's fault that the EMS crew was busy. It doesn't have to make sense, it's just the rules. When you arrive for work to see police barricades around the comm center and Secret Service agents escorting dispatchers to their cars, you can be assured the previous crew had a busy shift. Be sure to use caution because you are at fault for the last call since you didn't arrive 90 minutes early for work to relieve the off-going crew.

2. The tarp used to move large people was removed from its packaging.

To put this into perspective, these tarps typically have a weight capacity of 1,000lbs. While these are an extremely valuable asset, they are never used in ideal situations. These patients almost always find themselves in the most difficult-to-access locations known to man. On top of that, they almost always require movement down at least 1 set of stairs. Nobody walks away from these calls saying "man, that wasn't so bad."

3. The ambulance isn't in the bay when you arrive to work.

This means that the off-going crew got a late call. This is quite possibly the most dreaded call of the shift and no matter what time the call comes in, the crew is going to look around the station, then look at their watch before asking where the hell you are. They already hate you and you haven't even said good morning yet.

4. The off-going crew is sitting at the computer writing charts.

This almost always indicates that the crew ran calls all night. This also means that they're not leaving anytime soon and you're going to have to listen to them complain about their shift for at least another 2 hours. Just keep their coffee cups topped off and don't make eye contact.

5. You notice an incident command post in front of the nursing home.

This means that the doctor showed up to make his once-every-six-month visit and wrote a list of patient transport orders long enough that it had to be rolled out on a scroll. Since everyone's week-long ailment became an emergency on Tuesday morning at 07:00, your service wound up with so many calls for service that a state-of-emergency had to be declared. Chances are, FEMA is en route and strike teams are being deployed.

The good news" You're going to have a good shift.



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Species-specific control of acoustic gaze by echolocating bats, Rhinolophus ferrumequinum nippon and Pipistrellus abramus , during flight

Abstract

Based on the characteristics of the ultrasounds they produce, echolocating bats can be categorized into two main types: broadband FM (frequency modulated) and narrowband CF (constant frequency) echolocators. In this study, we recorded the echolocation behavior of a broadband FM (Pipistrellus abramus) and a narrowband CF echolocator species (Rhinolophus ferrumequinum nippon) while they explored an unfamiliar space in a laboratory chamber. During flight, P. abramus smoothly shifted its acoustic gaze in relation to its flight direction, whereas R. ferrumequinum nippon frequently shifted its acoustic gaze from side to side. The distribution of the acoustic gazes of R. ferrumequinum nippon was twice as wide as that of P. abramus. Furthermore, R. ferrumequinum nippon produced double pulses twice as often as P. abramus. Because R. ferrumequinum nippon has a horizontal beam width (−6 dB off-axis angle) half as wide (±20.8 ± 6.0°) as that of P. abramus (±38.3 ± 6.0°), it appears to double the width of its acoustical field of view by shifting its acoustic gaze further off-axis and emitting direction-shifted double pulses. These results suggest that broadband FM and narrowband CF bats actively control their acoustic gazes in a species-specific manner based on the acoustic features of their echolocation signals.



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A comparative analysis of the effects of sevoflurane and propofol on cerebral oxygenation during steep Trendelenburg position and pneumoperitoneum for robotic-assisted laparoscopic prostatectomy

Abstract

Purpose

Steep Trendelenburg position and pneumoperitoneum during robotic-assisted laparoscopic prostatectomy (RALP) increase intracranial pressure (ICP) and may alter cerebral blood flow (CBF) and oxygenation. Volatile anesthetics and propofol have different effects on ICP, CBF, and cerebral metabolic rate and may have different impact on cerebral oxygenation during RALP. In this study, we measured jugular venous bulb oxygenation (SjO2) and regional oxygen saturation (SctO2) in patients undergoing RALP to evaluate cerebral oxygenation and compared the effects of sevoflurane and propofol. We also verified whether SctO2 may be an alternative to SjO2.

Methods

Fifty patients scheduled for RALP were randomly assigned to undergo sevoflurane (group S) or propofol (group P) anesthesia. SjO2, SctO2, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), central venous pressure (CVP), partial pressures of arterial oxygen (PaO2) and carbon dioxide (PaCO2), hemoglobin concentration (Hb), Bispectral Index (BIS) and nasopharyngeal temperature (BT) were recorded 5 min before surgery commencement, 5 min after pneumoperitoneum, 5, 30, 60, 90, and 120 min after pneumoperitoneum in a Trendelenburg position, and after desufflation in a supine position.

Results

SjO2 was significantly higher in group S than in group P at all measurement points [group S vs. group P: 77 % (11) vs. 65 % (13), mean of all measurement points (1SD); p < 0.01]. Linear regression analysis (β = 0.106; r 2 = 0.065; p = 0.004) shows a weak relationship between SjO2 and SctO2.

Conclusions

Sevoflurane maintains higher SjO2 levels than propofol during RALP. SctO2 does not accurately reflect SjO2.



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Immunohistochemistry in the diagnosis of dysplasia in chronic inflammatory bowel disease colorectal polyps

Publication date: Available online 25 August 2016
Source:Arab Journal of Gastroenterology
Author(s): Ehsen B. Brahim, Ali Mrabet, Raja Jouini, Wafa Koubaa, Rimel B. Sidhom, Hela Elloumi, Aschraf Chadli
Background and study aimsDevelopment of cancer is the most significant complication in inflammatory bowel disease (IBD). Distinguishing true dysplasia from reactive atypia in polyps is difficult, leading sometimes to the unsatisfactory diagnosis of "indefinite for dysplasia". Therefore, there is a need for the development of markers that can help improve diagnosis.We evaluated the diagnostic value of the expression of AMACR, Ki67 and p53 by immunohistochemistry in the diagnosis of dysplasia in polyps developed on IBD.Patients and methodsForty colorectal polyps in IBD were studied. These had been diagnosed over a period of 11years. Dysplasia was classified according to the Vienna Classification (version 2000). Immunohistochemistry was performed using anti-AMACR, anti-Ki67 and anti-p53 antibodies.ResultsPolyps were classified as follows: 21 negative for dysplasia (ND), 10 indefinite for dysplasia (IFD), 6 low-grade dysplasia (LGD), 1 high-grade dysplasia (HGD) and 2 adenocarcinomas (ACA).AMACR positivity was observed in all polyps with HGD and ACA, 5 of the 6 LGD polyps and 3 of the 10 IFD (p=0.007).p53 immunostaining showed nuclear staining in the basal part of the crypts in 8 of the 10 IFD lesions. In ACA and HGD polyps, p53 positivity was typically observed in all epithelial cell layers (p=0.004).ACA and HGD showed diffuse and scattered staining of Ki67 along the full length of the crypts. Five lesions with LGD had extension of Ki-67 positive cells up to and into the surface epithelium. Ki67 staining in all IFD lesions was restricted to the basal third of the crypt (p<0.001).By combining the three markers, a relationship with dysplasia was statistically significant (p<0.001). Sensitivity ranged from 66.7% to 88.9% and specificity from 71.4% to 100%.The positive predictive value (PPV) for detecting dysplasia using these different antibodies ranged from 66.7% to 100% and the negative predictive value (NPV) for excluding dysplasia ranged from 85.7% to 93.3%.ConclusionsThe high degree of sensitivity and specificity of AMACR, p53 and Ki67 for dysplasia in IBD suggests that these antibodies, when combined, may be useful to detect neoplastic epithelium in this condition.



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An alternate red and white colour-changing rectal carcinoid tumour

A 56-year-old female presented with a 3-month history of diarrhoea and abdominal pain. Colonoscopy examination found a mass (approximately 0.5×0.6×0.3cm) in the rectum 5cm from the anus. The overlying mucosa regularly alternated colour from white (Fig. 1) to red (Fig. 2) approximately every 10s. Endoscopic ultrasonography revealed its origin in the submucosa, and rectal carcinoid tumour was suspected. However, an ulcerative lesion was found in the transverse colon, and was pathologically diagnosed as adenocarcinoma.

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99mTc-3PRGD2 SPECT/CT Imaging for Monitoring Early Response of EGFR-TKIs Therapy in Patients with Advanced-Stage Lung Adenocarcinoma

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.


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Typical findings of epidemiological and clinical characteristics of patients with coronary artery diseases in South India: a retrospective analysis

2016-08-26T09-19-56Z
Source: International Journal of Medical Science and Public Health
Javeed Ahmad Tantray, Pratap K Reddy, Kaiser Jamil, Shiva Kumar Yerra.
Background: Cardiovascular disease (CVD) remains a major cause of morbidity and death not only in developed countries but also in developing countries. The associated risk factors which have been linked to CVD include diabetes, hypertension, and the like and non-modifiable risk factors such as age, sex, and family history. However, one cannot fully explain why some individuals are prone to CAD and others are not. Indians, like the Americans, Europeans, and Japanese also have the highest rate of heart disease, but are associated with high mortality. Objective: The aim of this study was to analyze various demographic and clinical characteristics retrospectively to investigate any unreported parameters. Materials and Methods: It has been examined and statistically analyzed the records of 530 patients with coronary heart disease on angiography and who underwent cardiac evaluation at Mahavir Hospital and Research Centre, Hyderabad, Telangana, India between July 2012 and March 2014. Also, a few routine parameters like TC, HDL, LDL, triglycerides and conventional risk factors, serum electrolytes, blood grouping, pattern, and severity of the disease were included. Result: Among 530 patients 70% were males, 30% were females. Smokers were 320 patients, and very few (10%) were alcoholics. 30.18% patients suffered from hypertension, 40.56% had diabetes mellitus, 47.16% had dyslipidemia, and about 1520% had family history. The levels of TC, LDL-C and triglycerides were higher in males than females as compared to HDL-C. Angiographic analysis showed 20% patients had single vessel disease (SVD), 24.5% patients had double vessel disease (DVD), and 40.56% had triple vessel disease (TVD). Further 4.33% had left main disease and 10% had normal coronary angiogram. The mean values for serum creatinine, serum potassium, and serum sodium were highly associated (p=0.001). Conclusion: The present study recorded major abnormalities in mean lipid levels as elevated TC and LDL-C levels and low HDL-C in CAD patients. The male preponderance indicted smoking as the major risk factor, while associated complications like diabetes and hypertension were significantly more common. Double and triple vessels disease was most common in this study. One interesting observation was that CVD patients with B blood group were more in numbers in this study followed by O group, then A and very few with AB group. Further most of them were non-alcoholic. These results reinforces in the control of biochemical parameters, improvement of quality of life, in the prevention and management of CAD.


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Evaluation of respiratory function in physically active elderly males in comparison to males having sedentary lifestyle

2016-08-26T09-08-28Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Jitendra B Bamrotia, Dharmesh Patel, A. N. Joshi.
Background: Various studies showed that physically active geriatric population remain more physically fit than their sedentary peers. Various respiratory functional changes occur as the age progresses. Benefits of regular exercise in lowering risk of early death, stroke, coronary artery disease, and incidences of hypertension have been proven. Aims and Objective: To study the effect of ageing on respiratory system in elderly persons. Material and Methods: Subjects were divided into two groups according their physical activity level into test group and control group. The test group consist of subjects having higher physical activity, whereas sedentary subjects were included in the control group. Various respiratory parameters were measured by spirometry. Result: The study found that physically active elderly had significantly higher pulmonary function compared to their sedentary peers: Forced vital capacity (FVC) in liters (2.58 ± 1.03 vs. 1.99 ± 0.81; P

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The Availability and Use of Postpartum LARC in Mexico and Among Hispanics in the United States

Abstract

Objectives In the 1980s, policy makers in Mexico led a national family planning initiative focused, in part, on postpartum IUD use. The transformative impact of this initiative is not well known, and is relevant to current efforts in the United States (US) to increase women's use of long-acting reversible contraception (LARC). Methods Using six nationally representative surveys, we illustrate the dramatic expansion of postpartum LARC in Mexico and compare recent estimates of LARC use immediately following delivery through 18 months postpartum to estimates from the US. We also examine unmet demand for postpartum LARC among 321 Mexican-origin women interviewed in a prospective study on postpartum contraception in Texas in 2012, and describe differences in the Mexican and US service environments using a case study with one of these women. Results Between 1987 and 2014, postpartum LARC use in Mexico doubled, increasing from 9 to 19 % immediately postpartum and from 13 to 26 % by 18 months following delivery. In the US, <0.1 % of women used an IUD or implant immediately following delivery and only 9 % used one of these methods at 18 months. Among postpartum Mexican-origin women in Texas, 52 % of women wanted to use a LARC method at 6 months following delivery, but only 8 % used one. The case study revealed provider and financial barriers to postpartum LARC use. Conclusions Some of the strategies used by Mexico's health authorities in the 1980s, including widespread training of physicians in immediate postpartum insertion of IUDs, could facilitate women's voluntary initiation of postpartum LARC in the US.



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Capnography: A vital sign for every EMS patient

Monitoring ETCO2 with waveform capnography gives EMS providers real-time feedback to make treatment decisions and improve care for a multitude of medical problems and traumatic injuries

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Zebrafish Cdh5 negatively regulates mobilization of aorta-gonad-mesonephros-derived hematopoietic stem cells

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Publication date: Available online 25 August 2016
Source:Journal of Genetics and Genomics
Author(s): Ping Meng, Yongxiang Liu, Xiaohui Chen, Wenqing Zhang, Yiyue Zhang




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Study of biochemical parameters in metabolic bone disease with chronic renal failure

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Chitra A. Sathe, Vinaya P. Khamkar.
Background: Renal osteodystrophy and metabolic bone disease are terms that encompass a number of skeletal abnormalities, including osteomalasia, osteitis fibrosa cystica and impaired bone growth in children. The proposed work aimed to evaluate the status of bone health by estimating levels of elements like calcium, phosphorus, magnesium, alkaline phosphatase and alkaline phosphatase isoenzymes in serum of patients suffering from metabolic bone disease with chronic renal failure. Methods: The routine biochemical investigations were estimated by known standard methods and alkaline phosphatase isoenzymes were done by polyacrylamide slab gel electrophoresis. The assay values were statistically validated. Results: Serum calcium levels were significantly decreased (p


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Hyperleptinemia - an independent predictor of metabolic syndrome in the adult population in Kerala, India

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Manju K. Sudharmadevi, Vijayalekshmi Lekshminarayan, Leena K. Balakumaran, Shenoy K. Trivikrama.
Background: Hyperleptinemia, associated with obesity which is a major risk factor for metabolic syndrome. Kerala has the highest prevalence of most of the cardio metabolic disorders and risk factors. So we analysed the ability of serum leptin level to predict the risk of developing metabolic syndrome among the adult population in Kerala, India. Methods: The study included 149 men and 155 women in the age group of 20-60years. Anthropometric measurements and Blood pressure were recorded. BMI and WHR were calculated. Fasting blood sample was used to measure serum leptin, insulin, lipid profile and glucose. HOMA-IR and HOMA-β were calculated. Baseline characterestics (means ± SEM) of men and women were examined by quartiles of serum leptin levels using ANOVA. The strength of association between leptin and components of metabolic syndrome was expressed as Odds Ratio (OR) using logistic regression analysis. p values


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Evaluation of various culture and staining techniques for the detection of extra pulmonary tuberculosis

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Seema Gupta, Rahul K. Goyal, Rajesh Bareja, Rabindra N. Behara.
Background: Though pulmonary tuberculosis form is the commonest presentation, the extra pulmonary tuberculosis (EPTB) is also an important emerging clinical problem. The objective of the current study was to compare two staining techniques, Ziehl-Neelsen (ZN) stain, fluorescent stain and two-culture medium, solid Löwenstein-Jensen (LJ) medium and liquid 7H9 Middle brook medium in MGIT (Mycobacterium Growth Indicator Tube) 320 system, for detection of Mycobacterium in clinically suspected patients of EPTB. Methods: A total of 100 clinically suspected cases of EPTB samples from various extrapulmonary sites had been collected. All the specimens were stained with ZN stain and fluorescent stain. The culture were processed after decontamination of specimens with NaOH-NALC method and thereafter inoculated on solid and liquid culture medium. Results: Out of the 100 EPTB specimens, 30 were found positive by any of the above techniques used. Out of 30 positive cases 18 showed positivity by ZN staining while 20 showed positivity by fluorescent staining technique. In two culture methods, 27 isolates were grown by any of the culture system. Out of 27, 22 and 26 specimens showed growth of MTB complex on LJ media and MGIT culture system respectively. In AFB smear positive specimens, the average turnaround time was found to be 8.45 days and 22.5 days in MGIT and LJ medium culture assay respectively. While the turnaround times in AFB smear negative cases, it was 16.5 days and 32.3 days in MGIT and LJ medium culture assay respectively. Conclusions: MGIT was a dependable, highly efficient system for recovery of MTB complex for EPTB specimens in combination with LJ media.


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Observational study of tympanic membrane changes in allergic rhinitis

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
V. M. Hemlata Katiyar, D. Elango, Vincent Prasanna.
Background: Allergic rhinitis (AR) is a common condition affecting 20-30% of the population. This condition affects not only the nose but also the sinuses and ears in many ways. Many studies are there worldwide implicating AR as a cause of serous otitis media. But only few studies have actually studied the tympanic membrane (TM) changes observed in patients with allergic rhinitis. The aim of this study is to document the TM changes observed in patients with AR and to correlate them with the duration of symptoms and also influence of prior treatment of AR on the TM changes observed. Methods: A total of 111 patients and so 222 ears were studied. A detailed history of the duration of symptoms and any prior treatment for AR was recorded. The TM changes seen were classified and recorded. The duration of disease and treatment were taken as grouping variables and the tympanic membrane changes were ranked and used as testing variable. The results were statistically analyzed using non- parametric test, Kruskal Wallis test. Results: There was no statistically significant correlation between duration of AR and the TM changes observed. However there was a significantly less no of patients with TM retraction observed in the patients who had taken prior treatment compared to those patients who had taken no prior treatment. Conclusions: It is concluded that institution of early treatment may prevent development of Eustachian tube dysfunction and TM changes in patients with AR.


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Study of compliance of crash carts to standards in the emergency of a tertiary care teaching hospital

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Namrata Makkar, Nirupam Madaan.
Background: The successful management of cardiopulmonary emergencies revolves around the optimum utilization of the golden hour, so that the patient gets the best possible advantage at survival. Aim of the study was to perform gap analysis of crash carts in the emergency of a tertiary care teaching hospital by comparing the salient parameters with standards listed by Resuscitation Council UK (for equipment) and National Accreditation Board of Hospitals and health care providers (for management of medication). Further, to assess the improvement in compliance with the simple intervention of educating staff regarding protocols. Methods: A descriptive, quantitative, observational study, supplemented in the second phase by an intervention to increase awareness of staff in achieving standardization, followed further by assessing the level of improvement in compliance to standards in terms of content, labeling, documentation and functionality of the contents of the carts. Results: The root causes of non-adherence to standardization were design of the area and of the cart, amount of workload which led to neglect of labelling, documentation protocols resulting in decreased accountability and inefficient monitoring. This impacted the adequate provision of content and functionality of the items in the crash carts. Human factor engineering in the form of customization of crash carts for cognitive ergonomic design, clarity and awareness of guidelines among the nursing staff i.e. first responder went a long way in improving compliance to standards. Conclusions: Human factor engineering supplemented by usage of sub-trolleys, along with increasing sensitivity and awareness to standard protocols, can help achieve maximum compliance in terms of the effective functioning of crash carts in the emergency.


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Prevalence of raised IgE levels and absolute eosinophil count in bronchiolitis in children aged 2 months-2 years in tertiary care hospital

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Elango Krishnan, Raja Periyasamy, Sindhu Bharathi.
Background: Bronchiolitis is defined by IAP as 'A constellation of clinical symptoms and signs including viral upper respiratory prodrome followed by increased respiratory effort and wheeze in less than 2 year old children'. Aim of the study was to study the prevalence of raised IgE levels and raised Absolute eosinophil count & RSV (respiratory syncytial virus) antigen by PCR in bronchiolitis between age group of 2 months - 2 years with the occurrence of wheeze after first episode in 1 year follow up. Methods: 96 Children between 2 months - 2 years with first episode of bronchiolitis are included with the exclusion criteria of previous heart disease, lung disease, immune deficiency, second episode of bronchiolitis. In all the children CRP (C reactive protein), IgE (Immunoglobulin E), AEC (Absolute eosinophil count), RSV, PCR was done. Results: Out of 96 children, 60 children (62%) are males with maximum incidence on subjects of 53 (55.2%) in age group 2-6months. Fever, cough and rhinorrhoea are the major presenting complaints apart from breathlessness. Among 96 children 37 children (38.5%) had high serum IgE out of which 17 developed wheeze in 1 year of follow up. 27 (28.2%) had raised AEC, out of which 10 had wheeze in follow up. Out of 10 children who had raised IgE and AEC, 3 had wheeze on follow up. 34 (35.4%) children had positive RSV PCR, 14 children had wheeze in follow up. Conclusions: The prevalence of raised IgE, AEC and RSV PCR are 38.5%, 28.1% and 41.1% and the occurrence of wheeze on follow up was 45.9%, 37% and 41.1% respectively.


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Assessment of endothelial dysfunction in diabetes mellitus in Indian population by color Doppler

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Abhilash Haridas, Payal Mukker, Sanjay Pandey, Manoj Kumar Parashar, Virender Kumar Mehta.
Background: Endothelial dysfunction is regarded as a systemic marker of cardiovascular disease. Brachial artery flow-mediated dilation (FMD) is a mode of evaluating endothelial function and for early diagnosis of atherosclerotic diseases. We studied whether there is a difference in vascular endothelial function between type 1 and 2 diabetes mellitus and normal population. Methods: We assessed %FMD of 50 patients with diabetes mellitus and 50 control populations without diabetes mellitus or other risk factors. SPSSS version 13 was used for statistical analysis. Students T test was used for comparison of means of the two groups. Results: The %FMD was significantly lower in patients with type1 and 2 diabetes mellitus compared to normal population. Conclusions: Diabetes mellitus is associated with endothelial dysfunction irrespective of Type 1 or Type 2 diabetes mellitus, as suggested by impairment in vascular reactivity to hyperemia in both. Monitoring FMD may help in assessment of progression of atherosclerosis.


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Adenosine deaminase and interferon-gamma in diagnosis of tubercular pleural effusion

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Varuna Jethani, Girish Sindhwani, Vinit Mehrotra, Aarti Kotwal, Rakhee Khanduri.
Background: Pleural effusion is a common extrapulmonary manifestation of tuberculosis (TB). The conventional culture suffers from lack of sensitivity. Many pleural fluid markers have been evaluated to diagnose tubercular pleural fluid but none has proved to be an ideal. We have studied Adenosine deaminase (ADA), Interferon gamma (IFN) and their combination for diagnosis of tubercular pleural effusion. Methods: All consecutive patients with pleural effusion were subjected to thoracentesis and segregated into transudative and exudative using Light`s criteria. Patients with exudative pleural effusion were enrolled and divided into two groups. Group-I comprised of patients with tubercular etiology, Group-II- non-tubercular etiology. 45 patients were selected for each group. ADA and IFN in pleural fluid of these patients were measured. The sensitivity, specificity and predictive values were calculated. Results: The sensitivity, specificity, positive predictive value, negative predictive value of ADA and IFN were 88.89%, 99.85%, 86.96%, 99.87%; 97.78%, 97.78%, 97.78%, 97.78% respectively. Combination of ADA and IFN didnt improve the sensitivity or specificity compared to IFN alone. Conclusions: Pleural fluid ADA, IFN were found to be useful in differentiating tubercular from non-tubercular patients. Combination of ADA and IFN doesnt give additional benefit over IFN alone.


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Role of fine needle aspiration cytology in male breast lesion: 4 year observational study

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Pratik Mohanrao Chide, Suprita Nayak, Dinkar Kumbhalkar.
Background: Fine needle aspiration (FNA) is a well-established and widely accepted procedure in the evaluation of breast masses. However breast masses in males is rarely aspirated and hence there is limited cytopathologic experience. The aim of our study was to determine the efficacy of FNAC in the diagnosis of male breast lesions and also we attempted to describe the cytomorphological features of some of these lesions. Its advantages over other more invasive diagnostic methods, in terms of speed, cost effectiveness and low complication rate have made it a first line investigation for both diagnosis and management of breast lesions. Methods: Data on male breast FNAC done between June 2009 to June 2013 were retrieved from the records of the department of pathology. FNAC diagnoses were categorized as: C1 (Inadequate/ Insufficient) C2 (benign), C3 (Atypical /Indeterminate), C4 (Suspicious /probably malignant), C5 (malignant). Histopathological correlation done with subsequent surgical specimens wherever possible. Sensitivity, specificity and diagnostic accuracy were calculated using standard statistical methods. Results: 53 out of 2144 patients undergoing breast FNAC were males. Histopathology was available in 7 (13.20%) out of 53 cases. FNAC had a sensitivity of 80%, specificity of 100% and diagnostic accuracy of 85.71 % for male breast lesions. Conclusions: FNAC is a very accurate tool for the diagnosis of male breast lesions. It is less sensitive due to inadequate cellularity but when cellularity is adequate then it is 100% specific. To reduce the high rate of surgical biopsies of benign male breast masses, we conclude that FNAC should be performed as a standard procedure in the clinical evaluation of male breast lesions.


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Evaluation of brainstem auditory evoked potential in type 2 diabetes mellitus individuals

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Rathnavel Kumaran Murugesan, Gayathiri Munusamy, Ramesh Kannan.
Background: Diabetes mellitus (DM) is a group of common metabolic disorders that share the phenotype of hyperglycemia. The long term complication of DM includes diabetic neuropathy, which involves both central and peripheral nervous system. Objective of the study was to assess diabetic neuropathy in type 2 diabetes mellitus individuals using brainstem auditory evoked potential. Methods: This, study was carried out in the Neurophysiology Lab of Department of Physiology, Government Villupuram Medical College and Hospital (GVMCH), Villupuram, Tamil Nadu, India. The BAEP was performed in 50 patients with type-2 DM selected from the Diabetic OPD without overt hearing loss along with 50 age and gender matched controls with the exclusion of other possible causes which can cause peripheral and central neuropathies. BAEP was statistically analysed using Student independent unpaired t test by IBM SPSS software 19.0 version. Results: On analysis, the latencies I, III, V and Inter Peak Latencies (IPLs) III-V, I-V of BAEP revealed a significant difference between those of diabetes and those of controls (p


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A prospective study on prevalence and characteristics of hematologic effects associated with subclinical hypothyroidism

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
M. Kaleemullah Khan, Mohd Nasir Mohiuddin.
Background: Distinctive types of iron deficiency have been accounted for patients with obvious hypothyroidism with a predominance of up to 47%. Regardless of the fact that vitamin B12, folic corrosive and iron fixations are ordinary, weakness that standardizes in light of thyroxine substitution is found in up to 25% of hypothyroid patients. Methods: Briefly, 50 women with SCH were enrolled in the study. Patients between 18 and 65 years old, with TSH levels more than 5.0 mIU/L, the patients selected has a history of hypothyroidism for more than a year and were on oral levothyroxine. A total of 50 participants were enrolled in the study. Blood samples were collected from 50 selected hypothyroid patients on the basis of a history of a hypothyroidism, persistent Anemia, of these patients all were females. Results: In present study 25 cases of age group 41-65 years there were almost 10 patients having high thyroid stimulating factor (Tsh) that is more than (0.3-5.0U/Ml), Constitute to be 40% cases in this age category. Hence patients with high age may slower the response towards a levothyroxine hormone and hence have the high risk of developing anemia. Conclusions: Thyroid dysfunctions have an immediate impact on hemoglobin levels and these progressions should be considered in therapeutic consideration by medical practitioner.


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Detection of virulence determinants and its association with drug resistance in clinical isolates of Pseudomonas aeruginosa

2016-08-26T08-01-06Z
Source: International Journal of Research in Medical Sciences
Pramodhini S., Umadevi S., Seetha K. S..
Background: Pseudomonas aeruginosa is most commonly noted significant nosocomial pathogen, because of its distribution, of multi drug resistance and expression of various virulence factors. This study was aimed to detect various resistance mechanism and virulence factors of Pseudomonas aeruginosa and to determine the significant association between them. Methods: A total of 203 clinical isolates of Pseudomonas aeruginosa were included in this study. All isolates were detected for various virulence factors like Phospholipase, Hemolysin, Gelatinase and DNAse. Screening of β-lactamase like extended spectrum beta-lactamase (ESBL), AmpC beta-lactamase and Metallo β-lactamase (MBL) of Pseudomonas aeruginosa were also done. Results: Of total 203 isolates of Pseudomonas aeruginosa studied, 103 were from pus, 50 each from urine and respiratory samples. Virulence factors distribution of Pseudomonas aeruginosa showed 80.3% ,70% , 71.4% , 44.8% and 34% were positive for hemolysin, phospholipase, gelatinase, DNAse and biofilm production respectively. Study on prevalence of various β-lactamase in Pseudomonas aeruginosa isolated showed 25.6%, 24.1% and 10.3% were ESBL, MBL and AmpC producers respectively. Conclusions: This study suggests that production of virulence factors may not be significantly associated with antibiotic resistance. However, expression of certain virulence factors, most notably hemolysin and DNAse activity were significantly associated with β-lactamase production. Hence forth, future trends in clinical microbiology laboratories should focus on development of tests for the rapid detection of the most important virulence markers in addition to identification of pathogens and susceptibility pattern.


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A study on assessment of knowledge on biomedical waste management among health care workers of Malabar Medical College Teaching Hospital, Calicut, Kerala, India

2016-08-26T07-56-53Z
Source: International Journal of Community Medicine and Public Health
Ananthachari K. R., Divya C. V..
Background: Health care institutions and hospitals generate biomedical waste which can introduce various infections and injuries to the healthcare workers, patients and harm the surrounding environment. For proper management of biomedical waste Government of India has introduced the biomedical waste management and Handling rules in 1998, unfortunately health care workers awareness regarding biomedical waste segregation, handling and management is minimal hence, the study addresses the issues related to it. Methods: This cross sectional study was conducted in the month of July 2016 among health care workers at Malabar Medical College Hospital and Research Centre, Calicut, India. A pre-tested, semi-structured questionnaire was used to elicit the various information like collection, segregation and disposal of biomedical waste. Results: 567 health care workers were interviewed.44.3% (251) opined correctly that biomedical waste should not be kept more than 48 hours at hospital settings. 61.6% (349) opined waste sharps should be disposed in white/blue puncture proof containers.89.6% (508) knew about HIV, hepatitis B and hepatitis C are common infections transmitted due to improper biomedical waste management. 60.5% (345) and 61% (346) opined that human anatomical waste and pads, cottons, dressings should be disposed in yellow bags, respectively. 70.7% (401) were fully immunised against hepatitis B. 29.8% (169) had received training on biomedical waste management. Conclusions: Knowledge regarding biomedical waste disposal among nursing staff is satisfactory compared to other health care workers, adequate training among health care workers can improve the biomedical waste management and handling practices at hospital settings.


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A study of fungi isolated from cases of otitis media diagnosed at tertiary care hospital of Gujarat, India

2016-08-26T07-42-33Z
Source: International Journal of Advances in Medicine
Kirankumar Navnitlal Patel, Gaurishanker P. Shrimali, Nilesh Thakor.
Background: Otitis media is commonest disease seen in children. Apart from bacteria fungus are responsible for majority of the cases of otitis media. The objective was to speculate the aetiological fungal flora which was responsible for the cases of otitis media. Methods: The present study was conducted by Department of Microbiology, B. J. Medical College, Ahmedabad during 1st May 2000 to 30th April 2002. Before conducting the study approval was obtained from institutional ethical committee for human research. Total 140 patients of otitis media were included after written informed consent. The ear discharge from each diseased middle) ear was collected and cultured on Sabourauds dextrose agar slant and was examined for gross and the microscopic morphology of the fungi. The organisms were identified by using a standard procedure. Data was analyzed using Microsoft exel software (Trial Version). Results: Out of 140 samples 114 (81.43%) had positive culture. out of 114 cases, 64 (56.14%) were male. Majority of the cases (32.45%) were in the age group of 0-14 years. Out of 114 positive cases, single organism was isolated in 99 (86.8%) cases. Out of total 129 strains 44 (37.9%) were gram positive, 72 (62.1%) were gram negative organisms and 13 (10.07%). Out of total 13 strains of fungus isolated 6 (46.15%) were Candida albicans and 7 (53.84%) were Aspergillus niger. Aspergillus niger is predominant isolated fungus as compared to Candida albicans. Isolation of Aspergillus niger was only seen in adults. Conclusions: Aspergillus niger and Candida albicans were found to be the common fungal causes of otitis media in our study.


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What can EMS learn from 100 years of the National Park Service?

What can EMS learn from 100 years of the National Park Service?

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What can EMS learn from 100 years of the National Park Service?

Yellowstone, Yosemite, Glacier and the Grand Canyon are among the crown jewels of America that are under the stewardship of the National Park Service. Since August 25, 1916 the staff and volunteers of the federal agency have protected 412 national parks, monuments, battlefields, military parks, historical parks, historic sites, lakeshores, seashores, recreation areas, scenic rivers and trails and the White House.

Last week I visited several parks and monuments in South Dakota and Wyoming. During my hikes and explorations I contemplated the NPS 100-year anniversary and the lessons EMS leaders and providers can draw from the agency as it looks forward to its second century.

1. Uniformity from park to park
Park rangers have a distinct uniform, regardless of their work location or position in the NPS. Park visitors can quickly identify a ranger by the gray shirt, green pants and tan hat with a band. All park staff wear an NPS patch on their left shoulder.

EMS provider uniforms vary widely in color, styling and formality. Our uniforms are sometimes indistinguishable from law enforcement, often carry more fire department branding or try to carry over the trim of hospital scrubs or lab coats.

NPS vehicles are white with a single green stripe. NPS fire vehicles have a red stripe. Vehicle branding and specifications, likely easing purchasing across the NPS, is consistent.

2. A variety of services is available for visitors with different needs and wants
The NPS offers a multitude of services to meet the needs and interests of visitors. Front-country driving routes, scenic overlooks and interpretive programs cater to the majority of visitors looking to have a short-duration, low intensity experience. A smaller group of visitors can journey deep into the backcountry and wilderness of the larger parks. Devils Tower in Wyoming, the first national monument, offers visitors scenic views, ranger-led programs, overnight camping, hiking trails and rock climbing.

EMS, through programs like community paramedicine, is just beginning to explore how it might cater its expertise and service offerings to the people they served. For most agencies it is no longer enough to simply be a 911 response agency. EMS, in the second half of its first century, will interact with its customers through a combination of short patient contacts, ongoing community outreach programs and long-term connections with high-frequency utilizers.

3. Predictable, transparent fees are charged for access and experiences
The NPS charges an entrance fee for some of its properties and then visitors pay additional fees for experiences like overnight camping at the Badlands National Park or an interpretive tour of the Jewel Cave. In addition visitors can make donations to parks and a percentage of gift shop receipts are returned to the park. The fee system, though it varies from park to park, is expected, predictable and transparent to park visitors.

When a patient asks, "What will this ambulance ride cost?" the best answer is usually, "It depends." EMS fees depend on insurance coverage, level of service provided and local practices for billing. The specific cost, before providing care is rarely predictable or transparent.

4. Paid staff, volunteers and contractors work together as a team
The NPS provides services to visitors with 22,000 professional staff and 221,000 volunteers. The paid staff likely have specialized training and are considering the NPS as a career. Volunteers, often with unique expertise, are able to supplement the paid staff, support the different needs of the park and contribute in areas aligned with their interests. There are likely some parks with high numbers of professional staff and only a handful of volunteers. As well as some parks that are highly reliant on volunteers.

Is the 10 volunteers to one paid staff a comparable ratio for combination EMS departments to consider? The high participation of volunteers in the NPS might point to opportunities for public EMS agencies with all paid staff to integrate community-minded volunteers into non-clinical areas of operations.

The NPS also shifts some of the visitor experience and care to concessions operators. Hotels, restaurants, retail stores and recreational tours are often the domain of contactors working inside the park and within the regulations set by the NPS. The use of contractors is familiar to EMS agencies that contract certain types of calls, such as non-emergent transfers to private providers. Patient billing, staff hiring, education and fleet maintenance are other areas to consider contracting to a concession operator.

5. Career advancement and mobility
NPS professionals are able to, and often expected, to move between parks to advance their careers. Their knowledge, skills and abilities are transferable throughout the system. We met an interpretive ranger and educator at Devils Tower who was at his fourth park, including previous stints at Everglades National Park and Shenandoah National Park. He expects to be at Devils Tower for several years before moving to his next assignment.

Local protocol approval processes and licenses, based on state-specific scope of practice documents, make it difficult for paramedics to move between systems within a state and nearly impossible to move to services in different states. The Recognition of EMS Personnel Licensure Interstate Project is model legislation for States to make it easier for EMS providers licensed in one state to practice in other states. Making it easier for EMS professionals to move between organizations, including transition from the military to civilian EMS, is essential to the future of EMS.

Have you worked in a National Park as a paramedic or EMT? Tell us about your experience in the comments. What are other lessons for EMS from the NPS? Find Your Park to join in the NPS celebration.



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This is your profession. Make of it what you will

Three truths about relationships for new paramedic graduates to succeed as professionals in a radically changing world of health care.

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An out-patient survey of wheezing pediatric patients

2016-08-26T06-47-31Z
Source: International Journal of Contemporary Pediatrics
S.K. Nazeer Ahmed.
Background: Literature reports that approximately one in three children have at least one episode of wheezing prior to third birthday, and the cumulative prevalence of wheeze is almost 50% at the age of 6 years. Hence, an out-patient survey was planned and commenced to evaluate the common causes of wheezing in paediatric patients. Methods: An out-patient survey of wheezing was conducted among 140 patients who reported with conditions giving rise to wheezing. These cases were investigated relevantly and followed upto 3 months. Obtained data was arranged according to characteristics and was expressed as a number and percentage of respondents and were analyzed using the SPSS Version 17 software. Results: Bronchial asthma was diagnosed in 80 patients, worm infestation in 20, acute bronchiolitis in 12, tropical eosinophilia in 10, post measles bronchopneumonia in 8, acute bronchitis in 7 and primary complex in 3 patients. Maximum patients of bronchial asthma (69%), worm infestation (75%) and tropical eosinophilia (70%) were in 5-9 years age group. Maximum patients in case of bronchiolitis were in 7-12 months age group. Conclusions: An out-patient survey revealed wheezing or noisy breath as one of the common symptoms with which children are brought to out-patient. The present study found apart from bronchial asthma, acute respiratory infections, worm infestations, and tropical eosinophilia constituted large percentage of cases.


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Lower urinary tract symptoms suggestive of benign prostatic hyperplasia among Ghanaian men: a hospital-based cross-sectional prospective study

2016-08-26T05-58-18Z
Source: International Journal of Research in Medical Sciences
Aboah Kenneth, Agyemang-Yeboah Francis, Gyase-Sarpong Kofi Christian, Laing Edwin Ferguson, Acheampong Emmanuel, Twumasi Frimpong Benjamin, Amoah George, Batu Nsenbah Emmanuella, Adutwumwaah Asamoah Portia.
Background: Lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) are common in the elderly. This study sought to determine the prevalence of LUTS among patients visiting the urology clinic at Komfo Anokye Teaching Hospital, Kumasi, Ghana and to explore its presentation patterns. Methods: Simple randomized sampling technique was used to recruit 225 subjects with a mean age of 67.96±14.57 (range=40-100years) in a prospective cross-sectional study. LUTS related characteristics and international prostate symptom score (IPSS) questionnaire were employed to obtain relevant data. Results: The average IPSS of the studied participants was 17.52±7.83. Based on the IPSS, the prevalence of LUTS suggestive of BPH was 88.89%. Bladder storage symptoms were also recorded at 88.59% whilst prostate enlargement based on digital rectal examination (DRE) was 60.4% among the studied subjects. PSA levels ≥4.0ng/ml gave a prevalence of 81.5%. The prevalence of prostate enlargement defined as PSA ≥1.5ng/ml was 85.23% among the studied subjects whilst 63.11% of the subjects examined had troublesome LUTS. Urgency was the most predominantly reported LUTS (93.3%) among the subjects studied. Conclusions: This study has clearly shown that, the most prevalent urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia were bladder storage symptoms and urgency. These symptoms when present clinically therefore, suggest benign prostatic hyperplasia and that the prevalence estimates of LUTS in older men are relatively higher at diagnosis.


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Prevalence of human metapnemovirus in children with acute respiratory tract infection Shiraz, Iran during 2014-2015

2016-08-26T05-58-18Z
Source: International Journal of Research in Medical Sciences
Abouzar Babaei, Saber Mojarad, Neda Pirbonyeh, Mohammad Rahim Kadivar, Jamal Sarvari, Afagh Moattari.
Background: Human metapneumovirus (HMPV) is a newly discovered viral agent of respiratory infections. In present study we determined prevalence of HMPV in children less than10 years with acute respiratory infections (ARTI) that referred to the health centers of Shiraz University of Medical Sciences, Iran. Methods: Nasal swabs were obtained from 180 children less than 10 years old with respiratory tract symptoms during fall, winter and spring seasons of 2014 and 2015. The specimens were tested for HMPV F gene using one step RT-PCR. Results: HMPV was detected in 30 (16.66%) of 180 children with (ARTI) less than 10 years old. Approximately 63.33% of HMPV positive patients aged less than 3 years and 86.33% were younger than 5 years old. The clinical symptoms were bronchiolitis, wheezing and cough. Conclusions: The frequency distribution of HMPV revealed that most patients aged between 1 to 5 years and this virus is one of the respiratory viral agents to causes ATRI, especially children less than 5 years old.


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Nature and extent of perceived stigma among epileptics in Pakistan

2016-08-26T05-58-18Z
Source: International Journal of Research in Medical Sciences
Rehana Khalil, Saadia Gul, Zahid Naeem.
Background: Epilepsy is one of the oldest disorders known to mankind. Often the social stigma (whether a felt stigma or an enacted stigma) attached to epilepsy is a greater handicap to the person with epilepsy compared to the disability associated with seizures or the side-effects from medications. The aim of this study was to explore the perceived sigma and discrimination among epileptics of Karachi, Pakistan. Methods: A descriptive cross sectional study was conducted in Karachi, Pakistan in the year 2016. A standardized pretested semi-structured questionnaire was completed by 120 epilepsy patients selected through purposive sampling from Department of Neurology, Jinnah Postgraduate Medical Centre. Informed verbal consent was obtained prior to the interview. The data were analysed using IBM SPSS Statistics version 22 and Microsoft excel. Results: The average age of the sample participants was 18-50 years. Almost two third (68%) of the respondents were male. More than half (55%) of the sample was educated up to matriculation. Among them 28.5% were married. Three fifth (60%) of participants were unemployed. More than half (60%) of the respondents reported discrimination in educational opportunities and three fourth (78.5%) in job opportunities. Results indicated that (75%) participants encountered social problem like being discriminated (30%), or segregated (11%) in performance of daily tasks and were avoided (58.8%) to get marry more often with the belief that people with epilepsy are infectious. Conclusions: The study concludes that there is significant perceived stigma among epileptics living in a big metropolitan city of a developing country. The nature of stigma includes discrimination in education, marriage and job opportunities. There is a need for public awareness programmes to address this ignored facet of epilepsy, since it has both medical as well as social implications.


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Compare the effect of high and low doses of atorvastatin on the levels of high-sensitivity C-reactive protein in patients with acute coronary syndrome

2016-08-26T05-58-18Z
Source: International Journal of Research in Medical Sciences
Bijan Zamani, Behzad Babapour, Hosein Doustkami, Mirhashem Mousavi.
Background: Findings of other researches indicate that inflammation process is one of the most important molecular interactions mediated in atherosclerosis and the inflammation indexes of plasma level such as high-sensitivity C-reactive protein (hs-CRP) is regarded to predict the risk of cardio-vascular diseases. According to various studies, statins are certainly effective in the prevention of atherosclerosis and anti-inflammatory role of atorvastatin by lowering effect on hs-CRP can be considered. The aim of this study was to compare the effect of high and low doses of atorvastatin on levels of hs-CRP in patients with acute coronary syndrome. Methods: This is a clinical trial study that has been done on 180 patients with acute coronary syndrome who referred to Imam Khomeini hospital in Ardabil. Patients were divided in 2 groups randomly. Atorvastatin with low dose (20mg) and high dose (40mg) with routine treatments were given to first and second groups, respectively. The hs-CRP level was evaluated for all patients in hospitalized time and third month late. Data were collected and analyzed by statistical methods in SPSS.19. Results: Of all patients, 40 patients (22.2%) was assayed with STEMI, 8 patients (4.4%) with N/Q WMI and132 patients (73.3%) with U/A. 125 patients (69.4%) were male and rest of them were female. The age average of patients was 59.1±8.1 years. 74 (41.1%) of patients had blood pressure and 35 (19.4%) use smoke. After three months, in group with low dose, 81 patients (90%) and in group with high dose 85 patients (94.4%) improved. The atorvastatin with high dose could significantly decrease the hs-CRP ratio with 40% more than other group with 13.3%. Conclusions: In this study high dosage of atorvastatin could lessen significantly the hs-CRP and LDL ratio compared to atorvastatin with low dosage.


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Bacteriological profile isolated from cases of otitis media diagnosed at tertiary care hospital of Gujarat, India

2016-08-26T05-58-18Z
Source: International Journal of Research in Medical Sciences
Kirankumar Navnitlal Patel, Gaurishanker P. Shrimali, Nilesh Thakor.
Background: Otitis media is commonest disease seen in children. Bacteria are responsible for majority of the cases of otitis media. The aim of the study was to speculate the aetiological bacterial flora which was responsible for the cases of otitis media. Methods: The present study was conducted by Department of Microbiology, B. J. Medical College, Ahmedabad, India during 1st May 2000 to 30th April 2002. Before conducting the study approval was obtained from Institutional Ethical Committee for human research. Total 140 patients of otitis media were included after written informed consent. The ear discharge from each diseased middle ear was collected and inoculated on blood agar, MacConkeys agar and chocolate agar media and were incubated at 37°C for 24 hours. The organisms were identified by using a standard procedure. Data was analyzed using Microsoft exel software (Trial Version). Results: Out of 140 samples 114 (81.43%) had positive culture. out of 114 cases, 64 (56.14%) were male. Majority of the cases (32.45%) were in the age group of 0-14 years. Out of 114 positive cases, single organism was isolated in 99 (86.8%) cases. Out of total 116 strains 44 (37.9%) were gram positive and 72 (62.1%) were gram negative organisms. Among gram positive organisms, Staphylococcus aureus (63.63%) was predominant organisms isolated followed by coagulase negative Staphylococci (20.45%) and among gram negative organism Pseudomonas (69.44%) was predominant organisms isolated followed by proteus species. Conclusions: Staphylococcus aureus and Pseudomonas sp. were found to be the common cause of otitis media in our study.


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Morphologic study of diaphyseal nutrient foramina in dried fibulae and its clinical implications

2016-08-26T05-58-18Z
Source: International Journal of Research in Medical Sciences
Jayaprakash T..
Background: Fibula is an important site for muscle attachment. It is used as a vascularised graft for conditions such as stabilization of lost mandible, spine and even the tibia. The knowledge of morphological and topographic distribution of nutrient foramina of fibula is important to avoid damage to the nutrient arteries during surgical procedures. Methods: The study was conducted on 50 adult dried fibulae. Diaphyseal nutrient foramina were identified by their elevated margins and by the presence of a distinct groove proximal to them. Foramen index was calculated. Results: 90% fibulae showed single nutrient foramen, in 8% of fibulae nutrient foramen was absent and 2% fibulae presented with double nutrient foramina. 95.74% nutrient foramina were directed away from growing end, while 4.54% nutrient foramina were directed towards the growing end. 82.7% nutrient foramina were observed in the middle zone. All the foramina were present on the posterior surface. 48.93% of the foramina were present on the medial crest, 38.29% were present between the medial crest and posterior border. The mean foramen index of all the fibulae studied was 43.73. Conclusions: The knowledge of nutrient foramina is essential to preserve the vascularity of bone. This study aids the clinician in fracture reductions and bone grafting.


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Prevalence of shigella, salmonella and vibrio isolated from stool samples in district hospital

2016-08-26T05-58-18Z
Source: International Journal of Research in Medical Sciences
Minal Trivedi, Pankti Panchal.
Background: Diarrhoea is one of the main causes of morbidity and mortality of in developing countries. Bacterial diarrhoea is commonly caused by salmonella, shigella, campylobacter species, and diarrheogenic Escherichia coli. Of the pathogens causing diarrhoea, shigella continues to play a major role in etiology of inflammatory diarrhoea and dysentery. Thus, it presents a serious challenge to public health authorities worldwide. The objective was to know the prevalence of shigella, salmonella and vibrio in patients suffering from diarrhoea Methods: This study was conducted in microbiology department of district hospital over period of July 2015 to July 2016. We had collected total 424 stool samples. From this first we had done routine microscopy of all samples and then inoculated it on various culture media and enteric pathogen were identify by biochemical reaction and by agglutination with anti-sera. Results: From 424 stool samples, we isolated, shigella species 10 (2.3%), Vibrio cholerae 6 (1.4%) and Salmonella species 3 (0.7%). Conclusions: Results of study reveal that shigella species is predominant bacterial entero-pathogen causing diarrhoea and shigella is among highly resistant isolates while salmonella isolates had least resistance to majority of antibiotics. Vibrio cholerae is a major contributor to the diarrhoea causing severe dehydration.


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Effect of lung-protective ventilation-induced respiratory acidosis on the duration of neuromuscular blockade by rocuronium

Abstract

Purpose

The purpose of this study was to elucidate whether lung-protective ventilation-induced respiratory acidosis increased the duration of neuromuscular blockade by rocuronium.

Methods

A total of 72 patients were enrolled. After the induction of general anesthesia, rocuronium 0.6 mg/kg real body weight was administered. Tidal volume and positive end-expiratory pressure were randomly assigned as either 10 ml/kg predicted body weight and 0 cmH2O (group S) or 6 ml/kg and 5 cmH2O (group L), respectively. Respiratory rate was started at 10/min. Neuromuscular blockade was monitored by acceleromyography at the adductor pollicis with train-of-four stimulation. The time from the initial bolus injection of rocuronium to first recovery of the first twitch was defined as DUR1. Immediately, rocuronium 0.15 mg/kg was administered. The time from first recovery of the first twitch to second recovery of the first twitch was defined as DUR2. We also measured arterial pH (pH1 and pH2, respectively).

Results

Data from 66 patients (33 each in groups L and S) were eventually available. pH1 and pH2 were significantly lower in group L compared with group S [pH1: 7.308 (7.288–7.334) vs. 7.439 (7.423–7.466); p < 0.01, pH2: 7.306 (7.285–7.330) vs. 7.453 (7.436–7.476); p < 0.01]. DUR1 and DUR2 were significantly prolonged in group L compared with group S [DUR1: 31 (24–36) vs. 24 (20–30) min; p = 0.029, DUR2: 19 (15–22) vs. 15 (12–17) min; p = 0.020].

Conclusions

Lung-protective ventilation-induced respiratory acidosis increased the duration of neuromuscular blockade by rocuronium.



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Team working in airway crisis: role of operating department practitioner in management of failed intubations



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Endothelium-dependent vasodilatory signalling modulates α1-adrenergic vasoconstriction in contracting skeletal muscle of humans

Abstract

Stimulation of α-adrenoceptors elicits vasoconstriction in resting skeletal muscle that is blunted during exercise in an intensity-dependent manner. In humans, the underlying mechanisms remain unclear. We tested the hypothesis that stimulating endothelium-dependent vasodilatory signalling will enhance the ability of contracting skeletal muscle to blunt α1-adrenergic vasoconstriction. Changes in forearm vascular conductance (FVC; Doppler Ultrasound, brachial intra-arterial pressure via catheter) to local intra-arterial infusion of phenylephrine (PE; α1-adrenoceptor agonist) were calculated during (1) infusion of the endothelium-dependent vasodilators acetylcholine (ACh) and adenosine triphosphate (ATP), the endothelium-independent vasodilator (sodium nitroprusside, SNP), or potassium chloride (KCl) at rest; (2) mild or moderate intensity handgrip exercise; and (3) combined mild exercise + ACh, ATP, SNP, or KCl infusions in healthy adults. Robust vasoconstriction to PE was observed during vasodilator infusion alone and mild exercise, and this was blunted during moderate intensity exercise (ΔFVC:−34 ± 4 and −34 ± 3 vs. −13 ± 2% respectively, P < 0.05). Infusion of ACh or ATP during mild exercise significantly attenuated PE vasoconstriction similar to levels observed during moderate exercise (ACh:−3 ± 4; ATP:−18 ± 4%). In contrast, infusion SNP or KCl during mild exercise did not attenuate PE-mediated vasoconstriction (−32 ± 5 and −46 ± 3%). To further study the role of endothelium-dependent hyperpolarization (EDH), ACh trials were repeated with combined nitric oxide synthase and cyclooxygenase inhibition. Here, PE-mediated vasoconstriction was blunted at rest (blockade: −20 ± 5 vs. control: −31 ± 3% vs.; P < 0.05) and remained blunted during exercise (blockade: −15 ± 5 vs. control: −14 ± 5%). We conclude that stimulation of EDH-like vasodilatation can blunt α1-adrenergic vasoconstriction in contracting skeletal muscle of humans.

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Physiological roles of Kv2 channels in entorhinal cortex layer II stellate cells revealed by Guangxitoxin-1E

Abstract

The medial entorhinal cortex (mEC) is strongly involved in spatial navigation, memory, dementia and epilepsy. Although potassium channels shape neuronal activity, their roles in mEC are largely unknown. We used the new Kv2 blocker Guangxitoxin-1E (GTx, 10–100 nm) in rat brain slices to investigate Kv2 channel functions in mEC layer II stellate cells (SCs). These neurons project to the hippocampus and are thought to be grid cells representing space. Voltage clamp recordings from SCs nucleated patches showed that GTx inhibited a delayed rectifier K+ current activating beyond -30 mV, but not transient, A-type current. In current clamp, GTx (1) had virtually no effect on the first action potential, but markedly slowed repolarization of late spikes during repetitive firing; (2) enhanced the after-depolarization (ADP); (3) reduced fast and medium after-hyperpolarizations (fAHPs, mAHPs); (4) strongly enhanced burst firing and increased excitability at moderate spike rates, but reduced spiking at high rates; (5) reduced spike clustering and rebound potentials. The changes in bursting and excitability were related to the altered ADPs and AHPs. Kv2 channels strongly shape the activity of mEC stellate cells, by affecting spike repolarization, after-potentials, excitability and spike patterns. GTx is a useful tool and may serve to further elucidate Kv2 channel functions in neurons. We conclude that Kv2 channels in mEC SCs are important determinants of intrinsic properties that allow these neurons to produce spatial representation. Our results may also be important for accurate modelling of grid cells.

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Increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with increased cardiovascular morbidity/mortality and an incompletely understood pathophysiology. In animal studies, central and blood-borne inflammatory cytokines that can be elevated in RA evoke pathogenic increases in sympathetic activity and reductions in baroreflex sensitivity (BRS). We hypothesised that muscle sympathetic nerve activity (MSNA) was increased and BRS decreased in RA. MSNA, blood pressure and heart rate (HR) were recorded in age- and sex-matched RA-normotensive (n = 13), RA-hypertensive patients (RA-HTN; n = 17), normotensive (NC; n = 17) and hypertensive controls (HTN; n = 16). BRS was determined using the modified Oxford technique. Inflammation and pain were determined using serum high sensitivity C-reactive protein (hs-CRP) and a visual analogue scale (VAS), respectively. MSNA was elevated similarly in RA, RA-HTN and HTN patients (32 ± 9, 35 ± 14, 37 ± 8 bursts/min) compared to NC (22 ± 9 bursts/min; P = 0.004). Sympathetic BRS was similar between groups (P = 0.927), while cardiac BRS (cBRS) was reduced in RA, RA-HTN and HTN patients (5[3-8], 4[2-7], 6[4-9] ms/mmHg) compared to NC (11[8-15] ms/mmHg; P = 0.002). HR was independently associated with hs-CRP. Increased MSNA and reduced cBRS were associated with hs-CRP although confounded in multivariable analysis. VAS was independently associated with MSNA burst frequency, cBRS and HR. We provide the first evidence for heightened sympathetic outflow and reduced cBRS in RA that can be independent of hypertension. In RA patients, reported pain was positively correlated with MSNA and negatively correlated with cBRS. Future studies should assess whether therapies to ameliorate pain and inflammation in RA restores autonomic balance and reduces cardiovascular events.

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