Dead on arrival in a low-income country: results from a multicenter study in Pakistan

BACKGROUND: This study assessed the characteristics of dead on arrival (DOA) patients in Pakistan. METHODS: Data about the DOA patients were extracted from Pakistan National Emergency Department Surveillance study (Pak-NEDS). This study recruited all ED patients presenting to seven tertiary care hospitals during a four-month period between November 2010 and March 2011. This study included patients who were declared dead-on-arrival by the ED physician. RESULTS: A total of 1,557 DOA patients (7 per 1,000 visits) were included in the Pak-NEDS. Men accounted for two-thirds (64%) of DOA patients. Those aged 20-49 years accounted for about 46% of DOA patients. Nine percent (n = 72) of patients were brought by ambulance, and most patients presented at a public hospital (80%). About 11% of DOA patients had an injury. Factors significantly associated (p \u3c 0.05) with ambulance use were men (adjusted odds ratio [aOR] = 2.72), brought to a private hospital (OR = 2.74), and being injured (aOR = 1.89). Cardiopulmonary resuscitation (CPR) was performed on 6% (n = 42) of patients who received treatment. Those brought to a private hospital were more likely to receive CPR (aOR = 2.81). CONCLUSION: This study noted a higher burden of DOA patients in Pakistan compared to other resourceful settings (about 1 to 2 per 1,000 visits). A large proportion of patients belonging to productive age groups, and the low prevalence of ambulance and CPR use, indicate a need for improving the prehospital care and basic life support training in pakistan

Cellular Immune Responses to Nine Mycobacterium tuberculosis Vaccine Candidates following Intranasal Vaccination

BACKGROUND: The identification of Mycobacterium tuberculosis vaccines that elicit a protective immune response in the lungs is important for the development of an effective vaccine against tuberculosis. METHODS AND PRINCIPAL FINDINGS: In this study, a comparison of intranasal (i.n.) and subcutaneous (s.c.) vaccination with the BCG vaccine demonstrated that a single moderate dose delivered intranasally induced a stronger and sustained M. tuberculosis-specific T-cell response in lung parenchyma and cervical lymph nodes of BALB/c mice than vaccine delivered subcutaneously. Both BCG and a multicomponent subunit vaccine composed of nine M. tuberculosis recombinant proteins induced strong antigen-specific T-cell responses in various local and peripheral immune compartments. Among the nine recombinant proteins evaluated, the alanine proline rich antigen (Apa, Rv1860) was highly antigenic following i.n. BCG and immunogenic after vaccination with a combination of the nine recombinant antigens. The Apa-induced responses included induction of both type 1 and type 2 cytokines in the lungs as evaluated by ELISPOT and a multiplexed microsphere-based cytokine immunoassay. Of importance, i.n. subunit vaccination with Apa imparted significant protection in the lungs and spleen of mice against M. tuberculosis challenge. Despite observed differences in the frequencies and location of specific cytokine secreting T cells both BCG vaccination routes afforded comparable levels of protection in our study. CONCLUSION AND SIGNIFICANCE: Overall, our findings support consideration and further evaluation of an intranasally targeted Apa-based vaccine to prevent tuberculosis

High proportion of cactus species threatened with extinction

This is the author accepted manuscript. The final version is available from Nature Publishing Group via the DOI in this record.Consejo Nacional de Ciencia y Tecnologí

Bioaccumulation of metals in mussels from four sites of the coastal region of Baja California

This study analyzes the concentrations and variations of Cu, Mn, Zn, Al, Cd, Ag, As and Se among different size classes of Modiolus capax, from Punta Estrella, Bahía de los Ángeles and Santa Rosalía in the Gulf of California, and of Modiolus modiolus and Mytilus californianus, from Bahía Tortugas in the Pacific. During November 1988, mussels of these species were collected and 45 organisms were selected (three replicates of 15 organisms each). Their biometric variables were measured: large size (88–98 mm), medium size (70–87 mm) and small size (56–66 mm). The reference standards and procedural blanks were analyzed for each group of 15 samples. The results indicate that the geographic distribution and accumulation of metals in the different sizes are mainly influenced by the sources of input, bioavailability in each place and the biological condition of the organisms. The mussels presented Cu levels independent of size in the region, except at Santa Rosalía. Zn, Cd and Se showed strong regional variability, but no clear trend with respect to the size of the organisms. Al showed high regional variability and a tendency to accumulate in small organisms. As and Se presented higher concentrations in the large to medium mussels, regardless of the sampling site. Mn tended to accumulate in large and medium mussels and was dependent on the sampling site. In Bahía Tortugas, M. californianus accumulates Cu, Mn and Cd at a rate three times lower than M. modiolus at the same level of exposure. Within the Gulf of California, the geographic distribution of Mn, Al and Zn was similar, with higher concentrations in the northern part. This is probably because the mussels are exposed to these metals through the sedimentary material resuspended in the Colorado River Delta. Cd presented levels of 70 and 27 µg g–1 at Bahía Tortugas and Bahía de los Angeles, respectively; both sites are exposed to coastal upwelling. Cu presented relatively low levels (<35 µg g–1), except at Santa Rosalía (89 µg g–1), where Cu is mined. As, Se and Ag presented low variability in the study area, with low levels that reflect natural levels at the sites studied