Of cattle, sand flies and men : a systematic review of risk factor analyses for South Asian visceral leishmaniasis and implications for elimination

Background: Studies performed over the past decade have identified fairly consistent epidemiological patterns of risk factors for visceral leishmaniasis (VL) in the Indian subcontinent. Methods and Principal Findings: To inform the current regional VL elimination effort and identify key gaps in knowledge, we performed a systematic review of the literature, with a special emphasis on data regarding the role of cattle because primary risk factor studies have yielded apparently contradictory results. Because humans form the sole infection reservoir, clustering of kala-azar cases is a prominent epidemiological feature, both at the household level and on a larger scale. Subclinical infection also tends to show clustering around kala-azar cases. Within villages, areas become saturated over a period of several years; kala-azar incidence then decreases while neighboring areas see increases. More recently, post kalaazar dermal leishmaniasis (PKDL) cases have followed kala-azar peaks. Mud walls, palpable dampness in houses, and peridomestic vegetation may increase infection risk through enhanced density and prolonged survival of the sand fly vector. Bed net use, sleeping on a cot and indoor residual spraying are generally associated with decreased risk. Poor micronutrient status increases the risk of progression to kala-azar. The presence of cattle is associated with increased risk in some studies and decreased risk in others, reflecting the complexity of the effect of bovines on sand fly abundance, aggregation, feeding behavior and leishmanial infection rates. Poverty is an overarching theme, interacting with individual risk factors on multiple levels. Conclusions: Carefully designed demonstration projects, taking into account the complex web of interconnected risk factors, are needed to provide direct proof of principle for elimination and to identify the most effective maintenance activities to prevent a rapid resurgence when interventions are scaled back. More effective, short-course treatment regimens for PKDL are urgently needed to enable the elimination initiative to succeed

LipocalinPred: a SVM-based method for prediction of lipocalins

<p>Abstract</p> <p>Background</p> <p>Functional annotation of rapidly amassing nucleotide and protein sequences presents a challenging task for modern bioinformatics. This is particularly true for protein families sharing extremely low sequence identity, as for lipocalins, a family of proteins with varied functions and great diversity at the sequence level, yet conserved structures.</p> <p>Results</p> <p>In the present study we propose a SVM based method for identification of lipocalin protein sequences. The SVM models were trained with the input features generated using amino acid, dipeptide and secondary structure compositions as well as PSSM profiles. The model derived using both PSSM and secondary structure emerged as the best model in the study. Apart from achieving a high prediction accuracy (>90% in leave-one-out), lipocalinpred correctly differentiates closely related fatty acid-binding proteins and triabins as non-lipocalins.</p> <p>Conclusion</p> <p>The method offers a promising approach as a lipocalin prediction tool, complementing PROSITE, Pfam and homology modelling methods.</p

CyclinPred: A SVM-Based Method for Predicting Cyclin Protein Sequences

Functional annotation of protein sequences with low similarity to well characterized protein sequences is a major challenge of computational biology in the post genomic era. The cyclin protein family is once such important family of proteins which consists of sequences with low sequence similarity making discovery of novel cyclins and establishing orthologous relationships amongst the cyclins, a difficult task. The currently identified cyclin motifs and cyclin associated domains do not represent all of the identified and characterized cyclin sequences. We describe a Support Vector Machine (SVM) based classifier, CyclinPred, which can predict cyclin sequences with high efficiency. The SVM classifier was trained with features of selected cyclin and non cyclin protein sequences. The training features of the protein sequences include amino acid composition, dipeptide composition, secondary structure composition and PSI-BLAST generated Position Specific Scoring Matrix (PSSM) profiles. Results obtained from Leave-One-Out cross validation or jackknife test, self consistency and holdout tests prove that the SVM classifier trained with features of PSSM profile was more accurate than the classifiers based on either of the other features alone or hybrids of these features. A cyclin prediction server- CyclinPred has been setup based on SVM model trained with PSSM profiles. CyclinPred prediction results prove that the method may be used as a cyclin prediction tool, complementing conventional cyclin prediction methods

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

So, you want to design an acute mental health inpatient unit: physical issues for consideration

Objective: The aim of this paper is to explore important considerations when planning an acute mental health inpatient unit. Conclusions: Planning a mental health acute inpatient facility should be about more than just building a beautiful, fabulous facility. A novel architectural design, fancy gadgets, safe tapware, new lounge suites, good light and air circulation are all incredibly important and good architects and designers can inform us about new developments in architecture and design that we must incorporate in our design plans. However, to design a facility that is right for tomorrow, it is also important to spend time trying to understand what happens in the facility and how the new facility is going to make things different and better. Planning of a health facility should be about creating an environment that is not only pleasant, comfortable and safe but also one that would enable and facilitate better care. It is important to map processes before rather than after building a facility, so that this process mapping can inform design and we do not keep falling into the trap of building a beautiful new facility but losing the opportunity to make care better

Paranasal sinus inflammation and non-specific orbital inflammatory syndrome: an uncommon association

ObjectivesThe aim of this study is to present a series of patients with orbital inflammatory symptoms associated with significant paranasal sinus inflammation, and to discuss the diagnostic and management modalities.MethodsA retrospective, non-comparative, interventional case series of all patients diagnosed with orbital inflammatory syndrome and significant sinus inflammation, seen at two Orbital Units between January 1999 and October 2005. The clinical records of all patients were reviewed.ResultsOf 91 cases diagnosed with non-specific orbital inflammatory syndrome, six (6.6%, four males, two females mean age 51+/-17 years) had significant sinus inflammation. Symptoms and signs were periorbital swelling and erythema, proptosis, globe displacement and ocular motility restrictions with diplopia. On imaging, there was extraocular muscle enlargement and/or orbital fat haziness, as well as almost complete ipsilateral maxillary sinus opacification with varying degrees of opacification of adjacent sinuses. Sinus biopsy in four cases showed a non-specific inflammatory reaction. Treatment with steroids alone (four cases) or a combination of oral antibiotics and systemic steroids (two cases) resulted in resolution of signs and symptoms within 24-72 h. One case of recurrence was noted during a mean follow-up period of 9 months (range, 3-24 months), and this responded well to oral steroids.ConclusionAlthough uncommon, paranasal sinusitis can be associated with a non-specific orbital inflammatory syndrome. When an infectious etiology is excluded, systemic steroids may play a major role in the management of these patients and result in prompt resolution of orbital signs and symptoms