An Experimental Investigation of Electrical Conductivities in Biopolymers

Tuberculosis is a devastating infectious disease causing many deaths worldwide. Recent investigations have implicated neutrophil extracellular traps (NETs) in the host response to tuberculosis. The aim of the current study was to obtain evidence for NETs release in the circulation during human tuberculosis. For this we measured the plasma concentrations of nucleosomes in conjunction with neutrophil elastase, in 64 patients with active pulmonary tuberculosis and 32 healthy controls. Patients with active tuberculosis had elevated plasma levels of nucleosomes and elastase when compared with local healthy blood donors. Furthermore nucleosome and elastase levels showed a positive correlation. These findings provide the first evidence for the release of NETs in the circulation of patients with active pulmonary tuberculosis

A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh

BACKGROUND: Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common. METHODS: Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA. RESULTS: We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) illness duration before admission of five (2-8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died. CONCLUSION: Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality

Acetaminophen as a renoprotective adjunctive treatment in patients with severe and moderately severe Falciparum malaria: a randomized, controlled, open-label trial

Acute kidney injury independently predicts mortality in falciparum malaria. It is not known whether acetaminophen's capacity to inhibit plasma hemoglobin-mediated oxidation is renoprotective in severe malaria.A phase 2, open-label, randomized controlled trial at two hospitals in Bangladesh was conducted to assess effects on renal function, safety, pharmacokinetic properties and pharmacodynamic effects of acetaminophen. Febrile patients ( >12 years) with severe and moderately severe falciparum malaria were randomly assigned to receive acetaminophen (1g 6-hourly for 72 hours) or no acetaminophen, as an adjunct to intravenous artesunate. Primary outcome was the proportional change in creatinine after 72 hours stratified by median plasma hemoglobin.Between July 2012 and September 2014, 62 patients were randomly assigned to receive acetaminophen (n=31) or no acetaminophen (n=31). Median (interquartile range) reduction in creatinine after 72 hours was 23% (37 to 18%) in patients assigned to acetaminophen, versus 14% (29 to 0%) in patients assigned to no acetaminophen (p=0.043). This difference in reduction was 37% (48 to 22%) versus 14% (30 to -71%) in patients with plasma hemoglobin ≥45,000 ng/mL (p=0.010). The proportion of patients with progressing acute kidney injury was higher among controls (subdistribution hazard ratio, 3.0; 95% CI, 1.1 to 8.5; p=0.034). Pharmacokinetic-pharmacodynamic analyses showed that higher exposure to acetaminophen increased the probability of creatinine improvement. No patient fulfilled Hy's Law for hepatotoxicity.In this proof-of-principle study, acetaminophen showed renoprotection without evidence of safety concerns in patients with severe falciparum malaria, particularly in those with prominent intravascular hemolysis

A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh.

Background Fever is a common cause of admission to hospital in Bangladesh but causative agents, other than malaria are, not routinely investigated; enteric fever is thought to be common. Methods Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0oC were investigated in detail using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and NS1 anatigen dengue ELISA. Results We enrolled 300 patients with fever that were malaria smear negative between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) duration of illness before admission of five (2-8) days. Clinical syndromes included: enteric fever in 52 patients (17.3%), lower respiratory tract infection in 48 patients (16.0%), non-specific febrile illness in 48 patients (16.0%), a CNS infection in 37 patients (12.3%), urinary sepsis in 23 patients (7.7%), an upper respiratory tract infection in 21 patients (7.0%), and diarrhea or dysentery in 21 patients (7.0%). Despite a negative microscopy malaria was still suspected in seven patients. S. Typhi was detected in blood by culture or PCR in 34/56 (65.4%) of patients in which typhoid was suspected. Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively and two patients were dengue NS1 antigen positive. Twenty-nine (9%) patients died during their hospital admission: 15/160 (9.4%) of children and 14/144 (9.7%) adults; 2/56 (3.6%) patients with enteric fever, 5/48 (10.4%) patients with lower respiratory tract infections, and 12/36 (33.3%) patients with encephalitis/meningitis. Conclusion Enteric fever was responsible for nearly one in five admissions to this hospital in Chittagong, Bangladesh with non-malaria fever with the diagnosis confirmed in two thirds. Lower respiratory tract infections and CNS infections were also common. The etiology of CNS infections in this location merits more detailed study due to the high mortality rate.</p

Acetaminophen as a renoprotective adjunctive treatment in patients with severe and moderately severe Falciparum malaria: a randomized, controlled, open-label trial

Acute kidney injury independently predicts mortality in falciparum malaria. It is not known whether acetaminophen's capacity to inhibit plasma hemoglobin-mediated oxidation is renoprotective in severe malaria.A phase 2, open-label, randomized controlled trial at two hospitals in Bangladesh was conducted to assess effects on renal function, safety, pharmacokinetic properties and pharmacodynamic effects of acetaminophen. Febrile patients ( >12 years) with severe and moderately severe falciparum malaria were randomly assigned to receive acetaminophen (1g 6-hourly for 72 hours) or no acetaminophen, as an adjunct to intravenous artesunate. Primary outcome was the proportional change in creatinine after 72 hours stratified by median plasma hemoglobin.Between July 2012 and September 2014, 62 patients were randomly assigned to receive acetaminophen (n=31) or no acetaminophen (n=31). Median (interquartile range) reduction in creatinine after 72 hours was 23% (37 to 18%) in patients assigned to acetaminophen, versus 14% (29 to 0%) in patients assigned to no acetaminophen (p=0.043). This difference in reduction was 37% (48 to 22%) versus 14% (30 to -71%) in patients with plasma hemoglobin ≥45,000 ng/mL (p=0.010). The proportion of patients with progressing acute kidney injury was higher among controls (subdistribution hazard ratio, 3.0; 95% CI, 1.1 to 8.5; p=0.034). Pharmacokinetic-pharmacodynamic analyses showed that higher exposure to acetaminophen increased the probability of creatinine improvement. No patient fulfilled Hy's Law for hepatotoxicity.In this proof-of-principle study, acetaminophen showed renoprotection without evidence of safety concerns in patients with severe falciparum malaria, particularly in those with prominent intravascular hemolysis

A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh.

Background Fever is a common cause of admission to hospital in Bangladesh but causative agents, other than malaria are, not routinely investigated; enteric fever is thought to be common. Methods Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0oC were investigated in detail using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and NS1 anatigen dengue ELISA. Results We enrolled 300 patients with fever that were malaria smear negative between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) duration of illness before admission of five (2-8) days. Clinical syndromes included: enteric fever in 52 patients (17.3%), lower respiratory tract infection in 48 patients (16.0%), non-specific febrile illness in 48 patients (16.0%), a CNS infection in 37 patients (12.3%), urinary sepsis in 23 patients (7.7%), an upper respiratory tract infection in 21 patients (7.0%), and diarrhea or dysentery in 21 patients (7.0%). Despite a negative microscopy malaria was still suspected in seven patients. S. Typhi was detected in blood by culture or PCR in 34/56 (65.4%) of patients in which typhoid was suspected. Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively and two patients were dengue NS1 antigen positive. Twenty-nine (9%) patients died during their hospital admission: 15/160 (9.4%) of children and 14/144 (9.7%) adults; 2/56 (3.6%) patients with enteric fever, 5/48 (10.4%) patients with lower respiratory tract infections, and 12/36 (33.3%) patients with encephalitis/meningitis. Conclusion Enteric fever was responsible for nearly one in five admissions to this hospital in Chittagong, Bangladesh with non-malaria fever with the diagnosis confirmed in two thirds. Lower respiratory tract infections and CNS infections were also common. The etiology of CNS infections in this location merits more detailed study due to the high mortality rate.</p