Predictors of severe postoperative hyperglycemia after cardiac surgery in infants: a single-center, retrospective, observational study

Abstract

Purpose

Hyperglycemia is a common issue in infants after cardiac surgery for congenital heart disease. Poor glycemic control is suspected to be associated with adverse postoperative outcomes. This study was performed to investigate clinical factors contributing to hyperglycemia in the perioperative period in infats.

Methods

A total of 69 infants (aged 1–12 months) who were admitted to Yokohama City University Hospital Intensive Care Unit (ICU) after surgical repair of congenital heart diseases with cardiopulmonary bypass (CPB) were retrospectively analysed. Hyperglycemia was defined as blood glucose ≥ 250 mg/dL on ICU admission. Clinical background, operative factors, and postoperative factors were compared between the hyperglycemic and non-hyperglycemic groups. Additionally, multivariate analysis was performed to identify factors contributing to hyperglycemia.

Results

Nineteen (27.5%) and 50 (72.5%) infants were classified into the hyperglycemic and non-hyperglycemic groups, respectively. Hyperglycemic infants were significantly younger, shorter, and weighed less, with a higher rate of chromosomal abnormalities. Intraoperatively, they also experienced longer CPB and surgery times and had higher peak lactate levels and higher inotropic requirements. Hyperglycemia was related to longer mechanical ventilation and longer ICU stays. Multivariate analysis detected intraoperative hyperglycemia, longer CPB time, younger age and chromosomal abnormality as significant factors.

Conclusion

Adding to hyperglycemia during the operation, longer CPB time younger age and chromosomal abnormality were identified as predictors of high blood glucose levels at ICU admission.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2musO5I
via IFTTT

Cytologic Diagnosis of Biliary Strictures: FISH or Cut the Sensitivity Rate?

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2D5OcbS
via IFTTT

Ultra-Deep Genomic Sequencing of HCV NS5A Resistance-Associated Substitutions in HCV/HIV Coinfected Patients

Abstract

Background and Aims

The prevalence of naturally occurring HCV-NS5A resistance-associated substitutions (RAS) to DAA drugs might affect the response to treatment in HCV/HIV coinfected subjects. There are limited data on the frequency of HCV-NS5A naturally occurring drug-RAS at baseline in HCV/HIV coinfected patients when ultra-deep sequencing methodologies are applied.

Methods

HCV-NS5A-RAS were evaluated among 25 subjects in each group. Patients were matched by age, gender, and hepatic fibrosis stage category to control for selection bias.

Results

Within subtype 1a, RAS were observed in 28% of HCV monoinfected and 48% of HCV/HIV coinfected subjects. More patients in the HCV/HIV coinfected group had clinically relevant mutations to DAA directed at NS5A.

Conclusion

While the clinical significance of this observation may be limited in highly drug adherent populations, some HCV/HIV coinfected persons may be at greater risk of viral resistance if suboptimal dosing occurs.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2AT4Ghs
via IFTTT

Base-Resolution Analysis of DNA Methylation Patterns Downstream of Dnmt3a in Mouse Naive B Cells

The DNA methyltransferase, Dnmt3a, is dynamically regulated throughout mammalian B cell development and upon activation by antigenic stimulation. Dnmt3a inactivation in hematopoietic stem cells has been shown to drive B cell-related malignancies, including chronic lymphocytic leukemia (CLL), and associates with specific DNA methylation patterns in transformed cells. However, while it is clear that inactivation of Dnmt3a in hematopoietic stem cells has profound functional impacts, the consequences of Dnmt3a inactivation in cells of the B lineage are unclear. To assess whether loss of Dnmt3a at the earliest stages of B cell development lead to DNA methylation defects that might impair function, we selectively inactivated Dnmt3a early in mouse B cell development and then utilized Whole Genome Bisulfite Sequencing to generate base-resolution profiles of Dnmt3a^+/+ and Dnmt3a^-/- naïve splenic B cells. Overall, we find that global methylation patterns are largely consistent between Dnmt3a^+/+ and Dnmt3a^-/-naïve B cells, indicating a minimal functional impact of DNMT3A in mature B cells. However, loss of Dnmt3a induced 449 focal DNA methylation changes, dominated by loss-of-methylation events. Regions found to be hypomethylated in Dnmt3a^-/- naïve splenic B cells were enriched in gene bodies of transcripts expressed in B cells, a fraction of which are implicated in B cell-related disease. Overall, the results from this study suggest that factors other than Dnmt3a are the major drivers for methylome maintenance in B cell development.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2qWYbKV
via IFTTT

Genomic Understanding of an Infectious Brain Disease from the Desert

Rhinocladiella mackenziei accounts for the majority of fungal brain infections in the Middle East and is restricted to the arid climate zone between Saudi Arabia and Pakistan. Neurotropic dissemination caused by this fungus has been reported in immunocompromised, but also immunocompetent individuals. If untreated, the infection is fatal. Outside of humans, the environmental niche of R. mackenziei is unknown, and the fungus has been only cultured from brain biopsies. In this paper we describe the whole genome re-sequencing of two Rhinocladiella mackenziei strains from patients in Saudi Arabia and Qatar. We assessed intra-species variation and genetic signatures to uncover the genomic basis of the pathogenesis and potential niche adaptations. We found that the duplicated genes (paralogs) are more susceptible to accumulate significant mutations. Comparative genomics with other filamentous ascomycetes revealed a diverse arsenal of genes likely engaged in pathogenicity, such as the degradation of aromatic compounds and iron acquisition. In addition, intracellular accumulation of trehalose and choline suggest possible adaptations to the conditions of arid climate region. Specifically protein family contractions were found, including short-chain dehydrogenase/reductase SDR, the cytochrome P450 (E-class) and the G-protein beta WD-40 repeat. Gene composition and metabolic potential indicate extremotolerance and hydrocarbon assimilation, suggesting a possible environmental habitat of oil-polluted desert soil.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2mtlU0I
via IFTTT

The effect of acceptance and commitment therapy on the mental health of women patients with type II diabetes

Marziyeh Kaboudi, Fateme Dehghan, Arash Ziapour

Annals of Tropical Medicine and Public Health 2017 10(6):1709-1713

Background: Diagnosis of diabetes will have a significant impact on patients' psychosocial functioning and patients should devote sufficient time and energy to self-manage the disease. This study aimed to evaluate the effectiveness of treatment based on acceptance and commitment model on the mental health of women with diabetes type II. Methods: The present study is an experimental study with pretest-posttest control group design. The sample consisted of 26 women with diabetes from Kermanshah who were recruited using convenience (availability) sampling and were randomly divided into experimental and control groups. All patients completed the 28-item general health questionnaire before and after the intervention. Data were analyzed using univariate analysis of covariance and applying SPSS version 23. Results: The results clearly showed that the posttest scores of mental health in the experimental group were significant compared to the control group (P

from Health via xlomafota13 on Inoreader http://ift.tt/2AR4qzB
via IFTTT

Advocating for the implementation of recommended measures to improve infant and young child feeding

Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(6):1835-1836



from Health via xlomafota13 on Inoreader http://ift.tt/2D3Yklv
via IFTTT