Frequency of post-stroke pneumonia: Systematic review and meta-analysis of observational studies

Background: Post-stroke pneumonia and other infectious complications are serious conditions whose frequency varies widely across studies. Aims: We conducted a systematic review to estimate the frequency of post-stroke pneumonia and other types of major infection. Summary of review: MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched for prospective studies with consecutive recruitment of stroke patients. The primary outcome was post-stroke pneumonia. Secondary outcomes were any infection and urinary tract infection. Quality assessment was done using Newcastle Ottawa scale. Heterogeneity of estimates across study populations was calculated using Cochran's Q (heterogeneity χ2) and I2 statistics. A total of 47 studies (139,432 patients) with 48 sample populations were eligible for inclusion. Mean age of patients was 68.3 years and their mean National Institute of Health Stroke Scale score was 8.2. The pooled frequency of post-stroke pneumonia was 12.3% (95% confidence interval [CI] 11%–13.6%; I2 = 98%). The pooled frequency from 2011 to 2017 was 13.5% (95% CI 11.8%–15.3%; I2 = 98%) and comparable with earlier periods (P interaction = 0.31). The pooled frequency in studies in stroke units was 8% (95% CI 7.1%–9%; I2 = 78%) and significantly lower than other locations (P interaction = 0.001). The pooled frequency of post-stroke infection was 21% (95% CI 13%–29.3%; I2 = 99%) and of post-stroke urinary tract infection was 7.9% (95% CI 6.7%–9.3%; I2 = 96%). Conclusion: Approximately 1 in 10 stroke patients experience pneumonia during the acute period of hospital care. The frequency of post-stroke pneumonia has remained stable in recent decades but is lower in patients receiving stroke unit care compared to management in other ward settings

Functional polymorphisms of macrophage migration inhibitory factor as predictors of morbidity and mortality of pneumococcal meningitis.

Pneumococcal meningitis is the most frequent and critical type of bacterial meningitis. Because cytokines play an important role in the pathogenesis of bacterial meningitis, we examined whether functional polymorphisms of the proinflammatory cytokine macrophage migration inhibitory factor (MIF) were associated with morbidity and mortality of pneumococcal meningitis. Two functional MIF promoter polymorphisms, a microsatellite (-794 CATT5-8; rs5844572) and a single-nucleotide polymorphism (-173 G/C; rs755622) were genotyped in a prospective, nationwide cohort of 405 patients with pneumococcal meningitis and in 329 controls matched for age, gender, and ethnicity. Carriages of the CATT7 and -173 C high-expression MIF alleles were associated with unfavorable outcome (P= 0.005 and 0.003) and death (P= 0.03 and 0.01). In a multivariate logistic regression model, shock [odds ratio (OR) 26.0, P= 0.02] and carriage of the CATT7 allele (OR 5.12,P= 0.04) were the main predictors of mortality. MIF levels in the cerebrospinal fluid were associated with systemic complications and death (P= 0.0002). Streptococcus pneumoniae strongly up-regulated MIF production in whole blood and transcription activity of high-expression MIF promoter Luciferase reporter constructs in THP-1 monocytes. Consistent with these findings, treatment with anti-MIF immunoglogulin G (IgG) antibodies reduced bacterial loads and improved survival in a mouse model of pneumococcal pneumonia and sepsis. The present study provides strong evidence that carriage of high-expression MIF alleles is a genetic marker of morbidity and mortality of pneumococcal meningitis and also suggests a potential role for MIF as a target of immune-modulating adjunctive therapy

Specifying and Analysing SOC Applications with COWS

COWS is a recently defined process calculus for specifying and combining service-oriented applications, while modelling their dynamic behaviour. Since its introduction, a number of methods and tools have been devised to analyse COWS specifications, like e.g. a type system to check confidentiality properties, a logic and a model checker to express and check functional properties of services. In this paper, by means of a case study in the area of automotive systems, we demonstrate that COWS, with some mild linguistic additions, can model all the phases of the life cycle of service-oriented applications, such as publication, discovery, negotiation, orchestration, deployment, reconfiguration and execution. We also provide a flavour of the properties that can be analysed by using the tools mentioned above

High rates of suicide and attempted suicide using pesticides in Nickerie, Suriname, South America

Suicide and attempted suicide are identified as a serious mental health problem in Suriname, especially in the district of Nickerie. An epidemiological study in the Nickerie catchment area revealed high rates of suicide (48 per 100,000) and attempted suicide (207 per 100,000) on average in the years 2000–2004. Particularly remarkable is the high number of attempted suicides among males (49%), and the use of pesticides in both fatal (55%) and nonfatal suicidal behavior (44%). Probably this high incidence of suicidal behavior reflects the very poor economic situation of the district, poverty of most of the population, high levels of alcohol misuse, domestic violence, the rigidity of Hindustani culture regarding family traditions, the accessibility of pesticides, and the lack of future perspectives. Health care alone will not be sufficient to tackle this problem. One of the most urgent measures to prevent suicides is to stow away pesticides in locked cabinets with the key held by the proprietor

Exome Array Analysis of Susceptibility to Pneumococcal Meningitis

Host genetic variability may contribute to susceptibility of bacterial meningitis, but which genes contribute to the susceptibility to this complex disease remains undefined. We performed a genetic association study in 469 community-acquired pneumococcal meningitis cases and 2072 population-based controls from the Utrecht Health Project in order to find genetic variants associated with pneumococcal meningitis susceptibility. A HumanExome BeadChip was used to genotype 102,097 SNPs in the collected DNA samples. Associations were tested with the Fisher exact test. None of the genetic variants tested reached Bonferroni corrected significance (p-value <5 × 10−7). Our strongest signals associated with susceptibility to pneumococcal meningitis were rs139064549 on chromosome 1 in the COL11A1 gene (p = 1.51 × 10−6; G allele OR 3.21 [95% CI 2.05–5.02]) and rs9309464 in the EXOC6B gene on chromosome 2 (p = 6.01 × 10−5; G allele OR 0.66 [95% CI 0.54–0.81]). The sequence kernel association test (SKAT) tests for associations between multiple variants in a gene region and pneumococcal meningitis susceptibility yielded one significant associated gene namely COL11A1 (p = 1.03 × 10−7). Replication studies are needed to validate these results. If replicated, the functionality of these genetic variations should be further studied to identify by which means they influence the pathophysiology of pneumococcal meningitis

Nonlinear DC-response in Composites: a Percolative Study

The DC-response, namely the $I$-$V$ and $G$-$V$ charateristics, of a variety of composite materials are in general found to be nonlinear. We attempt to understand the generic nature of the response charactersistics and study the peculiarities associated with them. Our approach is based on a simple and minimal model bond percolative network. We do simulate the resistor network with appropritate linear and nonlinear bonds and obtain macroscopic nonlinear response characteristics. We discuss the associated physics. An effective medium approximation (EMA) of the corresponding resistor network is also given.Comment: Text written in RevTEX, 15 pages (20 postscript figures included), submitted to Phys. Rev. E. Some minor corrections made in the text, corrected one reference, the format changed (from 32 pages preprint to 15 pages

Desperately constructing ethnic audiences: Anti-immigration discourses and minority audience research in the Netherlands

This article examines how minority ethnic audiences are measured, and thus constructed, in the Netherlands today. The analysis shows that this process is tightly woven into the dominant assimilationist and neoliberal discourse. This discourse portrays specific minority groups as deviant in relation to an essentialized notion of Dutchness. Furthermore, it presents social inclusion as an opportunity that is limited to well-adjusted, profitable consumers. Different attempts to represent minority audiences – including efforts to promote a more just minority representation in Dutch media – are compelled to accommodate to this dominant discourse. The article underscores the limited scope for contesting current hegemonic representations of minority groups and national belonging in the Netherlands

Attenuated cerebrospinal fluid leukocyte count and sepsis in adults with pneumococcal meningitis: a prospective cohort study

BACKGROUND: A low cerebrospinal fluid (CSF) white-blood cell count (WBC) has been identified as an independent risk factor for adverse outcome in adults with bacterial meningitis. Whereas a low CSF WBC indicates the presence of sepsis with early meningitis in patients with meningococcal infections, the relation between CSF WBC and outcome in patients with pneumococcal meningitis is not understood. METHODS: We examined the relation between CSF WBC, bacteraemia and sepsis in a prospective cohort study that included 352 episodes of pneumococcal meningitis, confirmed by CSF culture, occurring in patients aged >16 years. RESULTS: CSF WBC was recorded in 320 of 352 episodes (91%). Median CSF WBC was 2530 per mm(3 )(interquartile range 531–6983 per mm(3)) and 104 patients (33%) had a CSF WBC <1000/mm(3). Patients with a CSF WBC <1000/mm(3 )were more likely to have an unfavourable outcome (defined as a Glasgow Outcome Scale score of 1–4) than those with a higher WBC (74 of 104 [71%] vs. 87 of 216 [43%]; P < 0.001). CSF WBC was significantly associated with blood WBC (Spearman's test 0.29), CSF protein level (0.20), thrombocyte count (0.21), erythrocyte sedimentation rate (-0.15), and C-reactive protein levels (-0.18). Patients with a CSF WBC <1000/mm(3 )more often had a positive blood culture (72 of 84 [86%] vs. 138 of 196 [70%]; P = 0.01) and more often developed systemic complications (cardiorespiratory failure, sepsis) than those with a higher WBC (53 of 104 [51%] vs. 69 of 216 [32%]; P = 0.001). In a multivariate analysis, advanced age (Odds ratio per 10-year increments 1.22, 95%CI 1.02–1.45), a positive blood culture (Odds ratio 2.46, 95%CI 1.17–5.14), and a low thrombocyte count on admission (Odds ratio per 100,000/mm(3 )increments 0.67, 95% CI 0.47–0.97) were associated with a CSF WBC <1000/mm(3). CONCLUSION: A low CSF WBC in adults with pneumococcal meningitis is related to the presence of signs of sepsis and systemic complications. Invasive pneumococcal infections should possibly be regarded as a continuum from meningitis to sepsis

Unified order-disorder vortex phase transition in high-Tc superconductors

The diversity of vortex melting and solid-solid transition lines measured in different high-T$_{c}$ superconductors is explained, postulating a unified order-disorder phase transition driven by both thermally- and disorder-induced fluctuations. The temperature dependence of the transition line and the nature of the disordered phase (solid, liquid, or pinned liquid) are determined by the relative contributions of these fluctuations and by the pinning mechanism. By varying the pinning mechanism and the pinning strength one obtains a spectrum of monotonic and non-monotonic transition lines similar to those measured in Bi$_{2}$Sr$_{2}$CaCu$_{2}$O$$, YBa$_{2}$Cu$_{3}$O$_{7-\delta}$, Nd$_{1.85}$Ce$_{0.15}$CuO$$, Bi$_{1.6}$Pb$_{0.4}$Sr$_{2}$CaCu$_{2}$O$_{8+\delta}$ and (La$_{0.937}$Sr$_{0.063}$)$_{2}$CuO$_{4}$Comment: To be published in Phys. Rev. B Rapid Com