Reperfusion therapy in renal dysfunction patients presenting with STEMI: Which is better in the Tunisian context?

BackgroundPatients with renal insufficiency experience worse prognosis after STEMI. Current guidelines do not clearly draw specific strategies for renal dysfunction (RD) patients, and most clinical trials exclude them from the study population.Aim of the studyTo compare primary PCI (PPCI) and thrombolysis (using Strepokinase) results as well as in-hospital mortality after successful reperfusion between patients with or without RD.MethodsFrom January 1995 to October 2011, 1388 patients admitted for STEMI were enrolled in the MIRAMI (MonastIR’s Acute Myocardial Infarction) registry. Two reperfusion groups were identified: PPCI (315 patients) and thrombolysis (379 patients). Patients who underwent rescue PCI were excluded. Due to lacking clearance data, we used a serum creatinine level >130μmol/l to define RD patients. We compared in each reperfusion group: (1) The success of revascularization (TIMI III flow restoring with <20% residual stenosis after PPCI, pain relief with ST regression >50% 60min after thrombolysis) and (2) the in-hospital mortality rate after reperfusion success between the RD patients (RD+) and normal renal function patients (RD−).ResultsNinety patients (13%) had RD, 50% of which underwent PPCI, and 50% received thrombolytics. Among RD+ and RD- groups, baseline characteristics were similar between the two reperfusion groups.In the PPCI group, although TIMI flow was similar before angioplasty (p=0.82), TIMI III restoring was significantly lower in the RD+ group (78.6% vs 91.8%, p=0.013). Suboptimal result was also higher in the RD+ group (13.6% vs 2.7%, p<0.001), but ST regression after TIMI III achievement was similar in the 2 groups (p=0.43) reflecting probably no microvascular damage.In the thrombolysis group, successful reperfusion was also significantly lower when RD exists (58% vs 74%, p=0.03).After successful reperfusion, in-hospital mortality is higher among RD+ patients in the PPCI group (33.3% vs 4.3%, p<0.001), whereas it is similar after successful thrombolysis (2.6% vs 0%, p=0.42).ConclusionRD reduces either PPCI or thrombolysis success, with no proven microvascular damage after PPCI. In-hospital prognosis is however worse in RD group only after successful PPCI, but not after successful Streptokinase thrombolysis

Simulation of heat transfer in 2D porous tank in appearance of magnetic nanofluid

In current two dimensional nanomaterial convective flow, Lorentz force has been utilized to manage the flow pattern. Nano sized powders with homogeneous behavior were dispersed into H2O within a permeable media. Not only the buoyancy force but also the radiation affects the temperature distribution. In addition, nanoparticles’ shape was involved in correlation of estimating nanomaterial behavior. Result demonstrated that convective flow augments with both Rayleigh and Darcy number and lessen with respect to Hartman number. Augmenting Darcy number wills leads to reduce the effect of Lorentz forces. Nuave augment with thermal radiation Rd and decrease with Hartmann number Ha. Thinner boundary layer is an output of augmenting permeability

Morphology- and size-controlled synthesis of a metal-organic framework under ultrasound irradiation : an efficient carrier for pH responsive release of anti-cancer drugs and their applicability for adsorption of amoxicillin from aqueous solution

Support of this investigation by Tarbiat Modares University is gratefully acknowledged.In this study, we have reported a biocompatible metal-organic framework (MOF) with ultra-high surface area, which we have shown to have uses as both a cancer treatment delivery system and for environmental applications. Using a sonochemical approach, highly flexible organic H3BTCTB and ditopic 4,4́′-BPDC ligands, along with modulators of acetic acid and pyridine were combined to prepare a Zn(II)-based metal-organic framework, DUT-32, [Zn4O(BPDC)(BTCTB)4/3(DEF)39.7(H2O)11.3]. Powder X-ray diffraction (PXRD), field-emission scanning electron microscopy (FE-SEM), and Fourier transform infrared spectroscopy (FTIR) were used to characterize, the particle size, shape, and structure of the DUT-32. To show the effects of shape and size of DUT-32 micro/nano-structures on doxorubicin (DOX) drug release and amoxicillin (AMX) adsorption, time of sonication, initial reagent concentrations, irradiation frequency, and acetic acid to pyridine molar ratios were optimized. The drug-loaded DUT-32 was soaked in simulated body fluid (SBF) and the drug release ratio was monitored through release time to perform in vitro drug release test. A slow and sustained release was observed for DUT-32 micro/nano-structures, having a considerable drug loading capacity. At the pH values 7.4-4.5, various profiles of pH-responsive release were achieved. Also, the prepared DUT-32 micro/nano-structures are found to be biocompatible with PC3 (prostate cancer) and HeLa (cervical cancer) cell lines, when tested by MTT assay. Moreover, DUT-32 micro/nano-structures were studied to show AMX adsorption from aqueous solution. Finally, kinetic studies indicated that AMX adsorption and drug release of DOX via this MOF are of first-order kinetics.PostprintPeer reviewe

Acute ST segment elevation during exercise stress echocardiography due to severe pulmonary hypertension

A 51-year-old female undergoing an outpatient stress echocardiogram to evaluate atypical chest pain developed acute ST elevation in the anterior precordial leads on electrocardiogram following exercise. Echocardiography revealed a severe rise in pulmonary artery systolic pressure (PASP) with marked right ventricular (RV) enlargement and interventricular septum flattening. Subsequently, cardiac catherization confirmed an exercise-induced elevation in PASP and diagnosed pulmonary arterial hypertension without evidence of coronary artery disease. This case suggests that an acute elevation in pulmonary artery pressure with RV dilation may be a potential cause of acute ST elevation during stress testing

Dynamique de la conductance hydraulique chez l'olivier de table (Olea europaea L., cv Meski)

Hydraulic Conductance Dynamic in Olive Table Tree (Olea europaea L. cv Meski). Cette étude expose les effets de l'aménagement des pâturages par la digue filtrante sur la dynamique de la végétation. Dans les régions sahéliennes, de nombreuses techniques sont appliquées sur les sols pour la restauration des parcours dégradés. La digue filtrante s'intéresse particulièrement aux axes de drainage ou bas-fonds en dégradation. La méthode d'étude a consisté à évaluer l'impact des digues filtrantes par l'inventaire de la végétation, la mesure de la biomasse produite, et l'analyse chimique d'échantillons de fourrage et de sol. Ces observations ont été faites à la fois sur l'espace aménagé et sur un espace témoin représentatif en deux fois durant cinq ans. Les observations sur l'espace aménagé (stations d'observation d'un ha) ont été faites en fonction du gradient par rapport à la digue filtrante tandis que sur le témoin (station d'observation d'un ha), les mesures ont été homogénéisées sur l'ensemble de la parcelle. Les résultats obtenus des inventaires de végétation montrent un effet positif de l'aménagement sur la dynamique de la végétation qui se maintient après cinq années. Les effets concernent la composition floristique pour laquelle certaines espèces connaissent une amélioration. Il s'agit de Panicum laetum (+ 5,9% en 1999 et + 1,9% en 2003), Setaria pallide fusca (+ 2,4 à + 8,6%), Cassia obtusifolia (+ 13,6% à + 9,3%) et Zornia glochidiata (- 2,9% à + 1,7 %). Les espèces en régression sont surtout composées de Schoenefeldia gracilis (+ 1,7% à - 12%) et Microchloa indica (- 28,9% à - 12,1% entre 1999 et 2003). L'écart de recouvrement du sol entre la parcelle aménagée et le témoin a été de -0,4% en 1999 contre + 14,6% en 2003. La biomasse produite et la capacité de charge ont connu une expansion allant de 3,14 à 4,5 fois par rapport à l'espace non aménagé. Cependant, des suivis doivent encore être maintenus en associant surtout les effets de l'exploitation (fauche et pâture) pour mieux préciser l'efficacité et la durabilité de ces aménagements sur les zones pastorales en même temps que des stratégies sont définies au niveau village sur la gestion de ces espaces restaurés

Bacteriological and physico-chemical assessment of wastewater in different region of Tunisia: impact on human health

<p>Abstract</p> <p>Background</p> <p>In many parts of the world, health problems and diseases have often been caused by discharging untreated or inadequately treated wastewater. In this study, we aimed to control physico-chemical parameters in wastewater samples. Also, microbiological analyses were done to reveal <it>Salmonella </it>strains and each <it>Escherichia coli </it>(<it>E.coli</it>) pathotype.</p> <p>Findings</p> <p>Sixty wastewater samples were collected from fifteen different regions of Tunisia. All physico-chemical parameters (pH, residual free chlorine, total suspended solids, biological oxygen demand, and chemical oxygen demand) were evaluated.</p> <p>For microbiological analyses, samples were filtered to concentrate bacteria. DNA was extracted by boiling and subjected to polymerase chain reaction (PCR) using different pairs of primers.</p> <p>The mean pH values recorded for the sampling point were above the WHO pH tolerance limit. The total suspended solids (TSS) concentrations varied between 240 mg/L and 733 mg/L in entrance points and between 13 mg/L and 76 mg/L in exit points. In entrance points, the studied wastewater has an average COD concentration that varied between 795 mg/mL to 1420 mg/mL. Whereas, BOD concentration of the wastewater ranged between 270 mg/L to 610 mg/L. In exit points, COD concentration varied between 59 mg/L and 141 mg/L, whereas BOD concentration ranged from 15 mg/L to 87 mg/L.</p> <p>The bacteriological control of wastewaters showed that, in entrance points, <it>Escherichia coli </it>(<it>E.coli</it>) was detected at the rate of 76.6%. Three <it>E.coli </it>pathotypes were found: ETEC (53.3%), EAEC (16.6%) and EIEC (6.6%).</p> <p>Concerning the ETEC isolated strains, 8 of 16 (50%) have only the heat-labile toxin gene, 5 of 16 (31.2%) present only the heat-stable toxin gene and 3 of 16 (18.7%) of strains possess both heat-labile toxin gene and heat-stable toxin gene. In exist point, the same pathotypes were found but all detected ETEC strains present only the "est" gene.</p> <p>Concerning <it>Salmonella </it>isolated strains; percentages of 66.6% and 20% were found in entrance and exit points respectively.</p> <p>Conclusions</p> <p>Wastewaters contain a large amount of pathogenic bacteria that present a real impact on human health. Assessment wastewater treatment stations have to consider in account enterobacterial pathogens as potential pathogens that should be correctly controlled.</p

The minimal kinome of Giardia lamblia illuminates early kinase evolution and unique parasite biology

Background: The major human intestinal pathogen Giardia lamblia is a very early branching eukaryote with a minimal genome of broad evolutionary and biological interest. Results: To explore early kinase evolution and regulation of Giardia biology, we cataloged the kinomes of three sequenced strains. Comparison with published kinomes and those of the excavates Trichomonas vaginalis and Leishmania major shows that Giardia's 80 core kinases constitute the smallest known core kinome of any eukaryote that can be grown in pure culture, reflecting both its early origin and secondary gene loss. Kinase losses in DNA repair, mitochondrial function, transcription, splicing, and stress response reflect this reduced genome, while the presence of other kinases helps define the kinome of the last common eukaryotic ancestor. Immunofluorescence analysis shows abundant phospho-staining in trophozoites, with phosphotyrosine abundant in the nuclei and phosphothreonine and phosphoserine in distinct cytoskeletal organelles. The Nek kinase family has been massively expanded, accounting for 198 of the 278 protein kinases in Giardia. Most Neks are catalytically inactive, have very divergent sequences and undergo extensive duplication and loss between strains. Many Neks are highly induced during development. We localized four catalytically active Neks to distinct parts of the cytoskeleton and one inactive Nek to the cytoplasm. Conclusions: The reduced kinome of Giardia sheds new light on early kinase evolution, and its highly divergent sequences add to the definition of individual kinase families as well as offering specific drug targets. Giardia's massive Nek expansion may reflect its distinctive lifestyle, biphasic life cycle and complex cytoskeleton

IFT Proteins Accumulate during Cell Division and Localize to the Cleavage Furrow in Chlamydomonas

Intraflagellar transport (IFT) proteins are well established as conserved mediators of flagellum/cilium assembly and disassembly. However, data has begun to accumulate in support of IFT protein involvement in other processes elsewhere in the cell. Here, we used synchronous cultures of Chlamydomonas to investigate the temporal patterns of accumulation and localization of IFT proteins during the cell cycle. Their mRNAs showed periodic expression that peaked during S and M phase (S/M). Unlike most proteins that are synthesized continuously during G1 phase, IFT27 and IFT46 levels were found to increase only during S/M phase. During cell division, IFT27, IFT46, IFT72, and IFT139 re-localized from the flagella and basal bodies to the cleavage furrow. IFT27 was further shown to be associated with membrane vesicles in this region. This localization pattern suggests a role for IFT in cell division

Response of a CMS HGCAL silicon-pad electromagnetic calorimeter prototype to 20-300 GeV positrons

The Compact Muon Solenoid Collaboration is designing a new high-granularity endcap calorimeter, HGCAL, to be installed later this decade. As part of this development work, a prototype system was built, with an electromagnetic section consisting of 14 double-sided structures, providing 28 sampling layers. Each sampling layer has an hexagonal module, where a multipad large-area silicon sensor is glued between an electronics circuit board and a metal baseplate. The sensor pads of approximately 1 cm$^2$ are wire-bonded to the circuit board and are readout by custom integrated circuits. The prototype was extensively tested with beams at CERN's Super Proton Synchrotron in 2018. Based on the data collected with beams of positrons, with energies ranging from 20 to 300 GeV, measurements of the energy resolution and linearity, the position and angular resolutions, and the shower shapes are presented and compared to a detailed Geant4 simulation

Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort

Objectives:We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged-infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies.Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries.Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT(&gt; MIC) (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving beta-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of &gt;= 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025].Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infections