Head CT is of limited diagnostic value in critically ill patients who remain unresponsive after discontinuation of sedation

<p>Abstract</p> <p>Background</p> <p>Prolonged sedation is common in mechanically ventilated patients and is associated with increased morbidity and mortality. We sought to determine the diagnostic value of head computed tomography (CT) in mechanically ventilated patients who remain unresponsive after discontinuation of sedation.</p> <p>Methods</p> <p>A retrospective review of adult (age >18 years of age) patients consecutively admitted to the medical intensive care unit of a tertiary care medical center. Patients requiring mechanical ventilation for management of respiratory failure for longer than 72 hours were included in the study group. A group that did not have difficulty with awakening was included as a control.</p> <p>Results</p> <p>The median time after sedation was discontinued until a head CT was performed was 2 days (interquartile range 1.375–2 days). Majority (80%) of patients underwent head CT evaluation within the first 48 hours after discontinuation of sedation. Head CT was non-diagnostic in all but one patient who had a small subarachnoid hemorrhage. Twenty-five patients (60%) had a normal head CT. Head CT findings did not alter the management of any of the patients. The control group was similar to the experimental group with respect to demographics, etiology of respiratory failure and type of sedation used. However, while 37% of subjects in the control group had daily interruption of sedation, only 19% in the patient group had daily interruption of sedation (p < 0.05).</p> <p>Conclusion</p> <p>In patients on mechanical ventilation for at least 72 hours and who remain unresponsive after sedative discontinuation and with a non-focal neurologic examination, head CT is performed early and is of very limited diagnostic utility. Routine use of daily interruption of sedation is used in a minority of patients outside of a clinical trial setting though it may decrease the frequency of unresponsiveness from prolonged sedation and the need for head CT in patients mechanically ventilated for a prolonged period.</p

Status of aquatic animal health in the Philippines

The national aquatic animal disease surveillance and reporting system is implemented by the Bureau of Fisheries and Aquatic Resources in coordination with other recognized laboratories. It covers the OIE/NACA listed diseases particularly those that cause major problems in aquaculture. The fisheries laboratories continuously enhance their capabilities to support the surveillance activities, controls on transboundary movement of aquatic animals, and provide services to the fish farmers. Programs are implemented to strengthen the aquatic animal health services in the country. Promotion of Good Aquaculture Practice and implementation of biosecurity measures are being done to prevent disease occurrences. Collaboration with other institutions on aquatic animal health programs are also established. The paper provides the information on the country’s status on aquatic animal health management

Biosynthetic Gene Cluster for the Cladoniamides, Bis-Indoles with a Rearranged Scaffold

The cladoniamides are bis-indole alkaloids isolated from Streptomyces uncialis, a lichen-associated actinomycete strain. The cladoniamides have an unusual, indenotryptoline structure rarely observed among bis-indole alkaloids. I report here the isolation, sequencing, and annotation of the cladoniamide biosynthetic gene cluster and compare it to the recently published gene cluster for BE-54017, a closely related indenotryptoline natural product. The cladoniamide gene cluster differs from the BE-54017 gene cluster in gene organization and in the absence of one N-methyltransferase gene but otherwise contains close homologs to all genes in the BE-54017 cluster. Both gene clusters encode enzymes needed for the construction of an indolocarbazole core, as well as flavin-dependent enzymes putatively involved in generating the indenotryptoline scaffold from an indolocarbazole. These two bis-indolic gene clusters exemplify the diversity of biosynthetic routes that begin from the oxidative dimerization of two molecules of l-tryptophan, highlight enzymes for further study, and provide new opportunities for combinatorial engineering

Genotyping and Molecular Detection of Polymorphism in FUT1 Gene of Swine

Alpha (1, 2)-fucosyltransferase (FUT1), as a candidate gene in controlling the expression of E. coli F18 receptor has been identified to determine whether an animal is resistant or susceptible to infections. This study was conducted to determine the genotypes of 150 blood samples of the three swine breeds and 20 representatives were randomly selected for sequencing. Polymerase Chain Reaction - Restriction Fragment Length Polymorphism results revealed that among the 150 blood samples, seven of the Duroc x Pietrain samples carried AG genotype which was previously reported susceptible to ETEC infection. Two AA genotypes that are presumptively resistant and 50 were presumptively susceptible as these samples carried either AG or GG genotypes from the Landrace variety. Of the Large White samples, two samples carried AA genotype and 89 have either AG or GG genotype. The twenty samples sent for DNA sequencing registered 100% homologies to Sus scrofa FUT1 gene. Twelve of the sequenced samples exhibited a shift from G to A in the 117th nucleotide and one sample had a C to T shift in the 39th nucleotide. The mutation was found in all of the Duroc X Pietrain samples as well as those samples with AA genotype. Heterozygous forms of Landrace and Large White also exhibited this mutation