Neonatal Sepsis: past, present and future; a review article

Sepsis is the most common cause of neonatal mortality. As per NationalNeonatal Perinatal Database (NNPD) 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live birth. It is 3% among intramural babies and 39.7% among extramural admissions. The early manifestations of neonatal sepsis are vague and ill-defined. Novel approaches in the diagnosis of neonatal sepsis include heart rate analysis on ECG or colorimetric analysis of skin color. Although blood culture is the gold standard for the diagnosis of sepsis, culture reports would be available only after 48-72 hours. In this era of multidrug resistance, it is mandatory to avoid unnecessary use of antibiotics to treat noninfected infants. Thus, rapid diagnostic test(s) that differentiate infected from non-infected infants, particularly in the early newborn period, that include Interleukien-6 (IL-6), neutrophil CD64 index, procalcitonin and nucleated RBC count, have the potential to make a significant impact on neonatal care. The aim of this review is to specify the diagnostic criteria, treatment guidelines and a summary of the newer diagnostic tests of sepsis.KEY WORDS: Sepsis; Intramural; Extramural; Multidrug resistanc

Study of Ventilator Associated Pneumonia in Neonatal Intensive Care Unit: characteristics, risk factors and outcome

Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection.Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates. Neonates admitted to neonatal intensive care unit (NICU), over a period of 1 year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Diagnosis of VAP was made by the guidelines given by National Nosocomial infection Surveillance System (NNIS, 1996). Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The risk factors such as birth weight, prematurity (gestational age < 37 weeks), duration of mechanical ventilation, number of reintubations, length of hospital stay, primary diagnosis of neonate, postnatal age and small for gestational age (SGA) were studied for the development of VAP. Risk factors found significant on bivariate analysis were subjected to multiple regression analysis to determine the most important predictors of VAP. The study group comprised of 98 neonates out of which, 30 neonates developed VAP (30.6%). VAP rates were 37.2 per 1000 days of mechanical ventilation. Most common bacterial isolated from endotracheal aspirate of VAP patients was Klebsiella spp (32.8%), E.coli (23.2%) and Acinetobacter (17.8%) being the other two common organisms. Very low birth weight

Supervisory Control Theory in System Safety Analysis

Development of safety critical systems requires a risk management strategy to identify and analyse hazards, and apply necessary actions to eliminate or control them as malfunctions could be catastrophic. Fault Tree Analysis (FTA) is one of the most widely used methods for safety analysis in industrial use. However, the standard FTA is manual, informal, and limited to static analysis of systems. In this paper, we present preliminary results from a model-based approach to address these limitations using Supervisory Control Theory. Taking an example from the Fault Tree Handbook, we present a systematic approach to incrementally obtain formal models from a fault tree and verify them in the tool Supremica. We present a method to calculate minimal cut sets using our approach. These compositional techniques could potentially be very beneficial in the safety analysis of highly complex safety critical systems, where several components interact to solve different tasks

Applying refinement to the use of mice and rats in rheumatoid arthritis research

Rheumatoid arthritis (RA) is a painful, chronic disorder and there is currently an unmet need for effective therapies that will benefit a wide range of patients. The research and development process for therapies and treatments currently involves in vivo studies, which have the potential to cause discomfort, pain or distress. This Working Group report focuses on identifying causes of suffering within commonly used mouse and rat ‘models’ of RA, describing practical refinements to help reduce suffering and improve welfare without compromising the scientific objectives. The report also discusses other, relevant topics including identifying and minimising sources of variation within in vivo RA studies, the potential to provide pain relief including analgesia, welfare assessment, humane endpoints, reporting standards and the potential to replace animals in RA research

The use of complementary and alternative medicines among patients with locally advanced breast cancer – a descriptive study

BACKGROUND: Complementary and alternative medicine (CAM) use is common among cancer patients. This paper reviews the use of CAM in a series of patients with locally advanced breast cancer (LABC). METHODS: Women with LABC attending a specialist clinic at a single Canadian cancer centre were identified and approached. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM usage, views of their risks of developing recurrent cancer and of dying of breast cancer. Responses were scored and compared between CAM users and non-users. RESULTS: Thirty-six patients were approached, 32 completed the questionnaire (response rate 89%). Forty-seven percent of LABC patients were identified as CAM users. CAM users were more likely to be younger, married, in a higher socioeconomic class and of Asian ethnicity than non-users. CAM users were likely to use multiple modalities simultaneously (median 4) with vitamins being the most popular (60%). Motivation for CAM therapy was described as, "assisting their body to heal" (75%), to 'boost the immune system' (56%) and to "give a feeling of control with respect to their treatment" (56%). CAM therapy was used concurrently with conventional treatment in 88% of cases, however, 12% of patients felt that CAM could replace their conventional therapy. Psychological evaluation suggests CAM users perceived their risk of dying of breast cancer was similar to that of the non-Cam group (33% vs. 35%), however the CAM group had less severe anxiety and depression. CONCLUSION: The motivation, objectives and benefits of CAM therapy in a selected population of women with LABC are similar to those reported for women diagnosed with early stage breast cancer. CAM users display less anxiety and depression and are less likely to believe they will die of their breast cancer. However the actual benefit to overall and disease free survival has yet to be demonstrated, as well as the possible interactions with conventional therapy. Consequently more research is needed in this ever-growing field

Particle tracking for polydisperse sedimenting droplets in phase separation

When a binary fluid demixes under a slow temperature ramp, nucleation, coarsening and sedimentation of droplets lead to an oscillatory evolution of the phase separating system. The advection of the sedimenting droplets is found to be chaotic. The flow is driven by density differences between the two phases. Here, we show how image processing can be combined with particle tracking to resolve droplet size and velocity simultaneously. Droplets are used as tracer particles, and the sedimentation velocity is determined. Taking these effects into account, droplets with radii in the range of 4 -- 40 micrometers are detected and tracked. Based on this data we resolve the oscillations in the droplet size distribution which are coupled to the convective flow.Comment: 13 pages; 16 figures including 3 photographs and 3 false-color plot

Transcriptomic, proteomic and metabolomic analysis of UV-B signaling in maize

<p>Abstract</p> <p>Background</p> <p>Under normal solar fluence, UV-B damages macromolecules, but it also elicits physiological acclimation and developmental changes in plants. Excess UV-B decreases crop yield. Using a treatment twice solar fluence, we focus on discovering signals produced in UV-B-irradiated maize leaves that translate to systemic changes in shielded leaves and immature ears.</p> <p>Results</p> <p>Using transcriptome and proteomic profiling, we tracked the kinetics of transcript and protein alterations in exposed and shielded organs over 6 h. In parallel, metabolic profiling identified candidate signaling molecules based on rapid increase in irradiated leaves and increased levels in shielded organs; pathways associated with the synthesis, sequestration, or degradation of some of these potential signal molecules were UV-B-responsive. Exposure of just the top leaf substantially alters the transcriptomes of both irradiated and shielded organs, with greater changes as additional leaves are irradiated. Some phenylpropanoid pathway genes are expressed only in irradiated leaves, reflected in accumulation of pathway sunscreen molecules. Most protein changes detected occur quickly: approximately 92% of the proteins in leaves and 73% in immature ears changed after 4 h UV-B were altered by a 1 h UV-B treatment.</p> <p>Conclusions</p> <p>There were significant transcriptome, proteomic, and metabolomic changes under all conditions studied in both shielded and irradiated organs. A dramatic decrease in transcript diversity in irradiated and shielded leaves occurs between 0 h and 1 h, demonstrating the susceptibility of plants to short term UV-B spikes as during ozone depletion. Immature maize ears are highly responsive to canopy leaf exposure to UV-B.</p

Measurement of the Bottom-Strange Meson Mixing Phase in the Full CDF Data Set

We report a measurement of the bottom-strange meson mixing phase \beta_s using the time evolution of B0_s -> J/\psi (->\mu+\mu-) \phi (-> K+ K-) decays in which the quark-flavor content of the bottom-strange meson is identified at production. This measurement uses the full data set of proton-antiproton collisions at sqrt(s)= 1.96 TeV collected by the Collider Detector experiment at the Fermilab Tevatron, corresponding to 9.6 fb-1 of integrated luminosity. We report confidence regions in the two-dimensional space of \beta_s and the B0_s decay-width difference \Delta\Gamma_s, and measure \beta_s in [-\pi/2, -1.51] U [-0.06, 0.30] U [1.26, \pi/2] at the 68% confidence level, in agreement with the standard model expectation. Assuming the standard model value of \beta_s, we also determine \Delta\Gamma_s = 0.068 +- 0.026 (stat) +- 0.009 (syst) ps-1 and the mean B0_s lifetime, \tau_s = 1.528 +- 0.019 (stat) +- 0.009 (syst) ps, which are consistent and competitive with determinations by other experiments.Comment: 8 pages, 2 figures, Phys. Rev. Lett 109, 171802 (2012

Quantifying coronary sinus flow and global LV perfusion at 3T

<p>Abstract</p> <p>Background</p> <p>Despite the large availability of 3T MR scanners and the potential of high field imaging, this technical platform has yet to prove its usefulness in the cardiac MR setting, where 1.5T remains the established standard. Global perfusion of the left ventricle, as well as the coronary flow reserve (CFR), can provide relevant diagnostic information, and MR measurements of these parameters may benefit from increased field strength. Quantitative flow measurements in the coronary sinus (CS) provide one method to investigate these parameters. However, the ability of newly developed faster MR sequences to measure coronary flow during a breath-hold at 3T has not been evaluated.</p> <p>Methods</p> <p>The aim of this work was to measure CS flow using segmented phase contrast MR (PC MR) on a clinical 3T MR scanner. Parallel imaging was employed to reduce the total acquisition time. Global LV perfusion was calculated by dividing CS flow with left ventricular (LV) mass. The repeatability of the method was investigated by measuring the flow three times in each of the twelve volunteers. Phantom experiments were performed to investigate potential error sources.</p> <p>Results</p> <p>The average CS flow was determined to 88 ± 33 ml/min and the deduced LV perfusion was 0.60 ± 0.22 ml/min·g, in agreement with published values. The repeatability (1-error) of the three repeated measurements in each subject was on average 84%.</p> <p>Conclusion</p> <p>This work demonstrates that the combination of high field strength (3T), parallel imaging and segmented gradient echo sequences allow for quantification of the CS flow and global perfusion within a breath-hold.</p

Epidemiological Characteristics of 2009 (H1N1) Pandemic Influenza Based on Paired Sera from a Longitudinal Community Cohort Study

Steven Riley and colleagues analyze a community cohort study from the 2009 (H1N1) influenza pandemic in Hong Kong, and found that more children than adults were infected with H1N1, but children were less likely to progress to severe disease than adults