Pharmacological targeting of secondary brain damage following ischemic or hemorrhagic stroke, traumatic brain injury, and bacterial meningitis - a systematic review and meta-analysis

Background: The effectiveness of pharmacological strategies exclusively targeting secondary brain damage (SBD) following ischemic stroke, aneurysmal subarachnoid hemorrhage, aSAH, intracerebral hemorrhage (ICH), traumatic brain injury (TBI) and bacterial meningitis is unclear. This meta-analysis studied the effect of SBD targeted treatment on clinical outcome across the pathological entities. Methods: Randomized, controlled, double-blinded trials on aforementioned entities with ‘death’ as endpoint were identified. Effect sizes were analyzed and expressed as pooled risk ratio (RR) estimates with 95% confidence intervals (CI). 123 studies fulfilled the criteria, with data on 66,561 patients. Results: In the pooled analysis, there was a minor reduction of mortality for aSAH [RR 0.93 (95% CI:0.85–1.02)], ICH [RR 0.92 (95% CI:0.82–1.03)] and bacterial meningitis [RR 0.86 (95% CI:0.68–1.09)]. No reduction of mortality was found for ischemic stroke [RR 1.05 (95% CI:1.00–1.11)] and TBI [RR 1.03 (95% CI:0.93–1.15)]. Additional analysis of “poor outcome” as endpoint gave similar results. Subgroup analysis with respect to effector mechanisms showed a tendency towards a reduced mortality for the effector mechanism category “oxidative metabolism/stress” for aSAH with a risk ratio of 0.86 [95% CI: 0.73–1.00]. Regarding specific medications, a statistically significant reduction of mortality and poor outcome was confirmed only for nimodipine for aSAH and dexamethasone for bacterial meningitis. Conclusions: Our results show that only a few selected SBD directed medications are likely to reduce the rate of death and poor outcome following aSAH, and bacterial meningitis, while no convincing evidence could be found for the usefulness of SBD directed medications in ischemic stroke, ICH and TBI. However, a subtle effect on good or excellent outcome might remain undetected. These results should lead to a new perspective of secondary reactions following cerebral injury. These processes should not be seen as suicide mechanisms that need to be fought. They should be rather seen as well orchestrated clean-up mechanisms, which may today be somewhat too active in a few very specific constellations, such as meningitis under antibiotic treatment and aSAH after surgical or endovascular exclusion of the aneurysm

Neue Kleeblattkriterien fürs Fleckvieh

Im Stierenkatalog von Swissgenetics werden speziell für Biobetriebe geeignete Stiere mit dem Biokleeblatt ausgezeichnet. Eine Gruppe Bioviehzüchter der Rassen Simmentaler, Swiss Fleckvieh und Red Holstein hat mit Swissgenetics die Kriterien für das Biokleeblatt überarbeitet

Rapid Dynamics of Polyomavirus Type BK in Renal Transplant Recipients

BackgroundPolyomavirus type BK-associated nephropathy (PVAN) is an emerging cause of early renal transplant failure. No specific antiviral treatment has been established. Current interventions rely on improving immune functions by reducing immunosuppression. In patients with PVAN, a high BK virus (BKV) load is detectable in plasma. However, the relationship between BKV replication and disease is not well understood MethodsIn a retrospective analysis of BKV plasma load in renal transplant recipients undergoing allograft nephrectomy (n=3) or changes in immunosuppressive regimen (n=12), we calculated viral clearance rates and generation times and estimated the loss of BKV-infected renal cells ResultsAfter nephrectomy, BKV clearance was fast (viral half-life [t 1/2], 1-2 h) or moderately fast (t 1/2, 20-38 h), depending on the sampling density, but it was independent of continued immunosuppressive regimens. After changing immunosuppressive regimens, BKV was cleared with a t 1/2 of 6 h-17 days. Using the basic reproductive ratio, the efficacies of intervention ranged from 7% to 83% (mean, 28%; median, 22%) ConclusionThe results emphasize that high-level BKV replication is a major pathogenetic factor that may have implications for genome rearrangements, immune evasion, and antiviral resistanc

PCR amplification of DNA from malaria parasites on fixed and stained thick and thin blood films

Under some circumstances, polymerase chain reaction (PCR) amplification of deoxyribonucleic acid (DNA) from Plasmodium may become necessary from infections for which only blood slides are available. Established methods used for DNA preparation do not work in that case. We have developed a reliable and controlled method for DNA preparation from malaria parasites on fixed and stained blood films. 162 slides from 2 different locations, some stored for at least one year, have been analysed by PCR amplification of the polymorphic loci for MSA1 and MSA2. In 92% of microscopically positive slides, a PCR product could be detected using material derived from thick blood films. When thin blood films with scanty parasitaemia were used, a PCR product could be obtained with only 71% of samples. In all unsuccessful cases, DNA preparation was the limiting factor, which was controlled for by amplification of a control human templat