Oxygen exchange and C-reactive protein predict safe discharge in patients with H1N1 influenza

Background: Pandemic influenza has potential to overwhelm healthcare resources. There is uncertainty over performance of existing triage tools for hospital admission and discharge decisions. Aim: Our aim was to identify clinical criteria that predict safe discharge from hospital and develop a pragmatic triage tool to guide physician decision-making. Design: We retrospectively examined an existing database of patients who presented to the Royal Liverpool University Hospital during the 2010-2011 influenza pandemic. Methods: Inclusion criteria: patients ≥18 years, with PCR confirmed H1N1 influenza. Exclusion criteria: died in the emergency department or case notes unavailable. Successful discharge was defined as discharge within 24 hours of presentation and no readmission within seven days. Results: Eighty-six patients were included and 16 were successfully discharged. Estimated P/F ratio and C-reactive protein predicted safe discharge in a multivariable logistic regression model (AUC 0.883). A composite univariate predictor (estimated P/F minus C-reactive protein, AUC 0.877) was created to calculate specific cut off points for sensitivity and specificity. A pragmatic decision tool was created to incorporate these thresholds and relevant guidelines. Discharge: SpO2 (in air) ≥ 94% and CRP 50 or SpO2 ≤ 93% and CRP 50. Conclusions: We identified that oxygen exchange and CRP, a marker of acute inflammation, were the most important predictors of safe discharge. Our proposed simple triage model requires validation but has the potential to aid clinical decisions in the event of a future pandemic, and potentially for seasonal influenza

Justification for the use of Ocimum gratissimum L in herbal medicine and its interaction with disc antibiotics

<p>Abstract</p> <p>Background</p> <p>The ethanolic extract of the leaves of <it>Ocimium gratisimum </it>L. (Lamiaceae), used in traditional medicine for the treatment of several ailments such as urinary tract, wound, skin and gastrointestinal infections, was evaluated for its antibacterial properties against four clinical bacteria isolates namely: <it>Escherichia coli, Proteus mirabilis, Staphylococcus aureus and Pseudomonas aeruginosa </it>and the antifungal properties using a clinical isolate of <it>Candida albicans</it>. A typed bacterium of <it>Escherichia coli </it>ATCC 11775 and another typed fungal strain of <it>Candida albicans </it>(ATCC 90028) were also included. The study also intended to verify if the concomitant administration of conventional antibiotics with <it>Ocimium gratisimum </it>which is normally taken as food (spice) will negatively affect its activity.</p> <p>Methods</p> <p>The agar diffusion method was used to test the in vitro activity of the plant extract. The interaction of the plant extract with some disc antibiotics namely: ciprofloxacin, septrin, streptomycin, ampicillin, nystatin and ketoconazole was tested using the agar overlay inoculum susceptibility disc method. Phytochemical analysis of the extract was performed following established methods.</p> <p>Results</p> <p>The extract showed good but varying <it>in vitro </it>activities against all the isolates tested. While ampicillin showed synergistic interaction with the plant extract against clinical isolates of <it>E. coli </it>and <it>P. mirabilis</it>, septrin was synergistic against the clinical isolate of <it>E. coli </it>only. Similarly, the activity of the extract against <it>C. albicans </it>isolate was synergistic with ketoconazole and nystatin.</p> <p>Conclusion</p> <p>The study has validated the folkloric use of <it>O. gratissimum </it>in traditional medicinal practice and goes further to show that the use of this plant material as food spice may not really threaten the efficacy of some conventional antibiotics that may have been taken concomitantly with it as is the popular belief in the practice of herbal medicine in local/rural communities of many countries in the world.</p

Human papillomavirus oncogenic E6 protein regulates human β-defensin 3 (hBD3) expression via the tumor suppressor protein p53.

Human β-defensin-3 (hBD3) is an epithelial cell-derived innate immune regulatory molecule overexpressed in oral dysplastic lesions and fosters a tumor-promoting microenvironment. Expression of hBD3 is induced by the epidermal growth factor receptor signaling pathway. Here we describe a novel pathway through which the high-risk human papillomavirus type-16 (HPV-16) oncoprotein E6 induces hBD3 expression in mucosal keratinocytes. Ablation of E6 by siRNA induces the tumor suppressor p53 and diminishes hBD3 in HPV-16 positive CaSki cervical cancer cells and UM-SCC-104 head and neck cancer cells. Malignant cells in HPV-16-associated oropharyngeal cancer overexpress hBD3. HPV-16 E6 induces hBD3 mRNA expression, peptide production and gene promoter activity in mucosal keratinocytes. Reduction of cellular levels of p53 stimulates hBD3 expression, while activation of p53 by doxorubicin inhibits its expression in primary oral keratinocytes and CaSki cells, suggesting that p53 represses hBD3 expression. A p53 binding site in the hBD3 gene promoter has been identified by using electrophoretic mobility shift assays and chromatin immunoprecipitation (ChIP). In addition, the p63 protein isoform ΔNp63α, but not TAp63, stimulated transactivation of the hBD3 gene and was co-expressed with hBD3 in head and neck cancer specimens. Therefore, high-risk HPV E6 oncoproteins may stimulate hBD3 expression in tumor cells to facilitate tumorigenesis of HPV-associated head and neck cancer

The Effects of Oral Intraperitoneal and Inhaled Methamphetamine on some Biochemical Parameters using Wistar Albino Rats

Abuse of hard drugs has become a norm for an increasing number of young people globally with methamphetamine currently the second most abused in Nigeria. The need for people to know as much as it is consumed was what inspired this research. With the oral, inhaled and intraperitoneal as the three routes of administration to be investigated, the animals were sequestered into seven groups of five each. Besides the control group, the other six were used to investigate effects of administering low and high doses of methamphetamine. Doses 0.57mg/kg and 14.28mg/kg were administered to the test animals via inhalation, oral and intraperitoneal means for 21 days while their weights were taken four times in a five day interval before sacrifice and biochemical analysis. The highest reductions in weight were recorded in groups orally administered 14.28mg/kg with a reduction percentage of 24.4% while those intraperitoneally administered 14.28mg/kg showed a 15.9% increase in weight. Groups orally and intraperitoneally administered 14.28mg/kg showed significant (p<0.05) elevations in AST levels when compared to the control group. The ALT levels increased significantly (p<0.05) in all test groups when compared to the control. Significant increase (p<0.05) in serum urea levels was recorded in groups intraperitoneally administered as well as those administered 0.57mg/kg via inhalation while all test groups administered 14.28mg/kg showed significant (p<0.05) rise in serum urea levels. Also, the creatinine levels showed significant increase (p<0.05) in groups intraperitoneally administered 14.28mg/kg. The results summarily suggest that the substance; both in low and high doses, can cause serious perturbations to vital organs and expose patrons to a host of health complications notwithstanding route of administration.

European propolis is highly active against trypanosomatids including Crithidia fasciculata.

Extracts of 35 samples of European propolis were tested against wild type and resistant strains of the protozoal pathogens Trypanosoma brucei, Trypanosoma congolense and Leishmania mexicana. The extracts were also tested against Crithidia fasciculata a close relative of Crithidia mellificae, a parasite of bees. Crithidia, Trypanosoma and Leishmania are all members of the order Kinetoplastida. High levels of activity were obtained for all the samples with the levels of activity varying across the sample set. The highest levels of activity were found against L. mexicana. The propolis samples were profiled by using liquid chromatography with high resolution mass spectrometry (LC-MS) and principal components analysis (PCA) of the data obtained indicated there was a wide variation in the composition of the propolis samples. Orthogonal partial least squares (OPLS) associated a butyrate ester of pinobanksin with high activity against T. brucei whereas in the case of T. congolense high activity was associated with methyl ethers of chrysin and pinobanksin. In the case of C. fasciculata highest activity was associated with methyl ethers of galangin and pinobanksin. OPLS modelling of the activities against L. mexicana using the mass spectrometry produced a less successful model suggesting a wider range of active components

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children &lt;18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p&lt;0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p&lt;0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p&lt;0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Causal mechanisms proposed for the Alcohol Harm Paradox - a systematic review

Background and Aims The Alcohol Harm Paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. Methods Systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974 – January 2021) and PsycINFO (1967 – January 2021), supplemented via manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm, and socioeconomic position. Papers were set in Organisation for Economic Co-operation and Development high income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. Results Seventy-nine papers met the inclusion criteria and initial coding revealed these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: Individual, Lifestyle, Contextual, Disadvantage, Upstream and Artefactual. Explanations related to risk behaviours, which fit within the Lifestyle domain, were the most frequently proposed (n=51) and analysed (n=21). Conclusions While there are many potential explanations for the Alcohol Harm Paradox, most research focuses on risk behaviours while other explanations lack empirical testing

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Agar-Based Disk Diffusion Assay for Susceptibility Testing of Dermatophytes ▿

Currently, no agar-based susceptibility testing method has been standardized for testing dermatophytes. We describe a newly developed agar-based method employing disk diffusion assay to test the susceptibility of 47 isolates of dermatophytes against 8 antifungals. Our results show that the method is reproducible, is simple, and could be used to determine the antifungal susceptibility of dermatophytes

TECHNICAL EFFICIENCY OF SNAIL FARMING IN NGOR OKPALA LGA OF IMO STATE, NIGERIA.

Low productivity in agriculture is mainly due to the inability of the farmers to exploit the available technologies fully, resulting in lower efficiencies of production. This study employed a Cobb-Douglas stochastic frontier production function to measure the level of technical efficiency and its determinants in snail production in Ngor Okpala LGA of Imo state, Nigeria. Primary data was generated through the use of closed and open ended structured questionnaire in line with the objectives of the study. Respondents were selected through a systematic random sampling procedure. 40 snail farmers were selected, from whom socioeconomic and input-output data were obtained using the cost-route approach. The parameters of the stochastic frontier production function were estimated using the maximum likelihood method. The study found farm size, labour and feed to be positively and significantly related to output at 5% level of significance. Socioeconomic factors influencing technical efficiency directly were farming experience and credit access at 5% level of significance. Age and stock size were negatively and significantly related to technical efficiency at 5% level of significance. Result of returns to scale analysis showed that snail production is at the stage of increasing returns to scale. We recommend that Snail farmers should have greater access to formal credit facilities from lending institutions in order to expand and improve their production. They should be encouraged to form stronger co-operative societies so as to expand their scope of production and marketing. Farmers are advised to grow most of the green feed stuffs the snails eat to save costs