Search

Abstract Background BK virus infections can have clinically significant consequences in immunocompromised individuals. Detection and monitoring of active BK virus infections in certain situations is recommended and therefore PCR assays for detection of BK virus have been developed. The performance of current BK PCR detection assays is limited by the existence of viral polymorphisms, unknown at the time of assay development, resulting in inconsistent detection of BK virus. The objective of this study was to identify a stable region of the BK viral genome for detection by PCR that would be minimally affected by polymorphisms as more sequence data for BK virus becomes available. Results Employing a combination of techniques, including amino acid and DNA sequence alignment and interspecies analysis, a conserved, stable PCR target region of the BK viral genomic region was identified within the VP2 gene. A real-time quantitative PCR assay was then developed that is specific for BK virus, has an analytical sensitivity of 15 copies/reaction (450 copies/ml) and is highly reproducible (CV ≤ 5.0%). Conclusion Identifying stable PCR target regions when limited DNA sequence data is available may be possible by combining multiple analysis techniques to elucidate potential functional constraints on genomic regions. Applying this approach to the development of a real-time quantitative PCR assay for BK virus resulted in an accurate method with potential clinical applications and advantages over existing BK assays.

Laparoscopy is increasingly being adopted for the treatment of ovarian pathologies in adults. However, its implementation for the management of pediatric ovarian masses varies and the evidence, to date, has not been comprehensively analyzed. This review aims to compare laparoscopic and open surgical management of pediatric ovarian masses. We searched PubMed, Cochrane Library and Google Scholar from the year 2000 till April 2017. Studies selected for this included those on epidemiological trends of pediatric ovarian lesions, assessing outcomes of laparoscopic management and comparison of laparoscopic and open surgical techniques for pediatric ovarian masses. A meta-analysis comparing outcomes of both modalities was performed using standard methodology. A total of 44 studies met the inclusion criteria of which 15 were on histological types of ovarian lesions, 24 assessed laparoscopic management only and five compared laparoscopy with open surgery for pediatric ovarian masses. Nonneoplastic lesions were the most common ranging from 36.5% to 73.7%, with cystic lesions being the most prevalent. Neoplastic lesions ranged between 26.3% and 63.5%, with germ cell tumors being the most common, while malignancy ranged between 3.5% and 10.8%. Laparoscopic management was generally advocated for managing benign lesions with a cautious approach for suspicion of malignant lesions. In comparison to open surgery, laparoscopic surgery had shorter operating time (MD = − 33.24 min, 95% CI = − 34.29 to − 32.19, p < 0.0001), less intraop bleeding (MD = − 61.46 ml, 95% CI = − 62.69 to − 60.24, p < 0.0001), and reduced length of hospital stay (MD = − 2.78 days, 95% CI = − 2.82 to − 2.74, p < 0.0001). Complication rates were equivocal between the two approaches. Spillage rates could not be assessed. Limited evidence suggests that laparoscopic approach to presumptively benign ovarian masses have better outcomes when compared to open surgery with regards to operating time, blood loss and hospital stay. However, complication rates were similar between the two approaches. Studies with rigorous scientific methods are needed for a definitive recommendation, especially in resource limiting settings. However malignant lesions should still be managed with an open surgical approach to avoid upstaging of disease status. II. [ABSTRACT FROM AUTHOR]

Hepatitis C infection imposes a high economic burden globally. It has been estimated that in 2012, the healthcare cost of Hepatitis C virus (HCV) was $6.5 billion. Furthermore, it has been projected that the cost will reach at $9.1 billion by the year 2024.Frequency of hepatitis C in Pakistan is significantly higher (4.5%) when compared to the populations like India (0.7%), Nepal (1.0), Myanmar (2.5%), Iran (0.8%), China (1%) and Afghanistan (1.1%). The current standard of care for chronic infection with hepatitis C virus is 24 or 48 weeks of therapy with Pegylated interferon-alfa-2a (Peg INF) +Ribavirin (RV) or Interferon alfa-2a (INF) + RV. The objective of this study was to determine that which combination is more effective and the gain in sustained virologic response (SVR) is worth the incremental cost. In total 84 patients were enrolled who received current standard treatment of care for chronic infection with HCV either 24 or 48 weeks of therapy with Peg INF + RV or INF + RV. A pharmacoeconomic analysis was done including fixed and variable cost (comprising concomitant therapies, emergency visits and hospital admissions) of both treatment regimens were calculated and compared with the SVR accomplished by the patients. It was concluded that the Peg INF + RV is cost effective as compared with conventional INF + RV for the treatment of adult patients infected with HCV genotype 3a under a varied array of possibilities regarding treatment costs and effectiveness. [ABSTRACT FROM AUTHOR]

Coronary artery calcium (CAC), identified via low-radiation, non-contrast computed tomography of the heart, quantifies the burden of calcified coronary atherosclerosis. This modality is highly useful for cardiovascular (CV) risk stratification among individuals without known coronary heart disease (CHD), especially for those at intermediate risk. The presence of CAC is associated with up to a 10-fold higher risk of adverse CV events, even after fully adjusting for the standard CV risk factors. In fact, the CAC score is among the strongest clinically available predictors of future risk of adverse CV events among primary prevention patients. Additionally, the absence of CAC in asymptomatic individuals confers a very low risk of CV events. Even in the presence of a benign CV risk factor profile and normal cardiac stress test, a very high CAC score portends a high risk of adverse CV events. On the other hand, a CAC score of zero is associated with a low CHD risk despite significant CV risk factor profiles. CAC scoring is a quick, low-cost screening tool to help risk-stratify patients and identify those likely to benefit from aggressive preventive treatments (such as high-intensity statin therapy, ezetimibe, PCSK9 inhibitors, and aspirin) and to identify those likely who warrant close monitoring. Moreover, individuals with a zero CAC score may be at low enough risk to avoid or defer daily aspirin therapy and pharmacological therapy for cholesterol management, and instead work on therapeutic lifestyle changes. An abnormal CAC score may also lead to better adherence to pharmacological regimens and suggested lifestyle changes. [ABSTRACT FROM AUTHOR]

Abstract: Cardiovascular diseases, especially myocardial infarction, are the leading cause of morbidity and mortality in the world, also resulting in huge economic burdens on national economies. A cardiac patch strategy aims at regenerating an infarcted heart by providing healthy functional cells to the injured region via a carrier substrate, and providing mechanical support, thereby preventing deleterious ventricular remodeling. In the present work, polyaniline (PANI) was doped with camphorsulfonic acid and blended with poly(glycerol-sebacate) at ratios of 10, 20 and 30vol.% PANI content to produce electrically conductive composite cardiac patches via the solvent casting method. The composites were characterized in terms of their electrical, mechanical and physicochemical properties. The in vitro biodegradability of the composites was also evaluated. Electrical conductivity increased from 0Scm−1 for pure PGS to 0.018Scm−1 for 30vol.% PANI–PGS samples. Moreover, the conductivities were preserved for at least 100h post fabrication. Tensile tests revealed an improvement in the elastic modulus, tensile strength and elasticity with increasing PANI content. The degradation products caused a local drop in pH, which was higher in all composite samples compared with pure PGS, hinting at a buffering effect due to the presence of PANI. Finally, the cytocompatibility of the composites was confirmed when C2C12 cells attached and proliferated on samples with varying PANI content. Furthermore, leaching of acid dopants from the developed composites did not have any deleterious effect on the viability of C2C12 cells. Taken together, these results confirm the potential of PANI–PGS composites for use as substrates to modulate cellular behavior via electrical stimulation, and as biocompatible scaffolds for cardiac tissue engineering applications. [Copyright &y& Elsevier]

Background: Despite its high prevalence and clinical impact, research on peripheral artery disease (PAD) remains limited due to poor accuracy of billing codes. Ankle-brachial index (ABI) and toe-brachial index can be used to identify PAD patients with high accuracy within electronic health records. Methods: We developed a novel natural language processing (NLP) algorithm for extracting ABI and toe-brachial index values and laterality (right or left) from ABI reports. A random sample of 800 reports from 94 Veterans Affairs facilities during 2015 to 2017 was selected and annotated by clinical experts. We trained the NLP system using random forest models and optimized it through sequential iterations of 10-fold cross-validation and error analysis on 600 test reports and evaluated its final performance on a separate set of 200 reports. We also assessed the accuracy of NLP-extracted ABI and toe-brachial index values for identifying patients with PAD in a separate cohort undergoing ABI testing. Results: The NLP system had an overall precision (positive predictive value) of 0.85, recall (sensitivity) of 0.93, and F1 measure (accuracy) of 0.89 to correctly identify ABI/toe-brachial index values and laterality. Among 261 patients with ABI testing (49% PAD), the NLP system achieved a positive predictive value of 92.3%, sensitivity of 83.1%, and specificity of 93.1% to identify PAD when compared with a structured chart review. The above findings were consistent in a range of sensitivity analysis. Conclusions: We successfully developed and validated an NLP system for identifying patients with PAD within the Veterans Affairs electronic health record. Our findings have broad implications for PAD research and quality improvement. [ABSTRACT FROM AUTHOR]

The article presents comparisons of dermal pattern frequencies of white, black and Japanese patients and matched controls, to investigate whether their phenotypic resemblance of Down's syndrome extended to include their dermatoglyphic characteristics. Results showed similarities in frequencies of digital whorls and ulnar loops in all patients, of patterns in hallucal thenar, second and third interdigital areas in white and black patients and hypothenar patterns in Japanese and black patients.

Background: A hospital's risk-standardized survival rate (RSSR) for in-hospital cardiac arrest has emerged as an important metric to benchmark and incentivize hospital resuscitation quality. We examined whether hospital performance on the RSSR metric was stable or dynamic year-over-year and whether low-performing hospitals were able to improve survival outcomes over time.Methods and Results: We used data from 84 089 adult patients with an in-hospital cardiac arrest from 166 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A 2-level hierarchical regression model was used to compute RSSRs during a baseline (2012-2013) and two follow-up periods (2014-2015 and 2016-2017). At baseline, hospitals were classified as top-, middle-, and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25%, respectively, on their RSSR metric during 2012 to 2013. We compared hospital performance on RSSR during follow-up between top, middle, and bottom-performing hospitals' at baseline. During 2012 to 2013, 42 hospitals were identified as top-performing (median RSSR, 31.7%), 82 as middle-performing (median RSSR, 24.6%), and 42 as bottom-performing (median RSSR, 18.7%). During both follow-up periods, >70% of top-performing hospitals ranked in the top 50%, a substantial proportion remained in the top 25% of RSSR during 2014 to 2015 (54.6%) and 2016 to 2017 (40.4%) follow-up periods. Likewise, nearly 75% of bottom-performing hospitals remained in the bottom 50% during both follow-up periods, with 50.0% in the bottom 25% of RSSR during 2014 to 2015 and 40.5% in the bottom 25% during 2016 to 2017. While percentile rankings were generally consistent over time at ≈45% of study hospitals, ≈1 in 5 (21.4%) bottom-performing hospitals showed large improvement in percentile rankings over time and a similar proportion (23.7%) of top-performing hospitals showed large decline in percentile rankings compared with baseline.Conclusions: Hospital performance on RSSR during baseline period was generally consistent over 4 years of follow-up. However, 1 in 5 bottom-performing hospitals had large improvement in survival over time. Identifying care and quality improvement innovations at these sites may provide opportunities to improve in-hospital cardiac arrest care at other hospitals. [ABSTRACT FROM AUTHOR]

Presents a case of a sex-reversed female infant with camptomelic syndrome who was exposed to oral contraceptives during the major portion of gestation. Abnormal cartilage and bone formation; Pathogenesis of sex reversal in camptomelic syndrome; Implications of an autosomal recessive gene.

Background: Podophyllum hexandrum is a highly endangered valuable medicinal plant of the Himalayas belonging to family Berberidaceae. This plant needs conservation efforts due to the over-exploitation and unscrupulous harvesting from the wild because of its ever-increasing demand., Objective: To establish a long-term cryopreservation method for Podophyllum hexandrum using two techniques: Vitrification and V Cryo-plate., Materials and Methods: Zygotic embryos were cryopreserved using vitrification and V cryo-plate by optimization of parameters including preculture time, loading time and PVS2 dehydration time. Recovery of zygotic embryos was performed on different regrowth media for plantlet formation., Results: With V cryo-plate, 90% regrowth was obtained as compared to 73.3% with vitrification. V Cryo-plate conditions were pre-culture of zygotic embryos in 0.3 M sucrose for 4 days, treatment in loading solution with 0.8 M sucrose for 20 min, dehydration in PVS2 for 50 min, LN exposure, unloading in 1.2 M sucrose for 20 min and transfer of zygotic embryos to regrowth medium for recovery. During recovery, the maximum number of shoots (4.2) and highest shoot length (5.1 cm) were observed on regrowth medium with 1.5 mg per liter BAP and 0.1 mg per liter IAA (R7)., Conclusion: Zygotic embryos of Podophyllum hexandrum were cryopreserved with 90% regrowth using a V cryoplate technique and plantlets were produced directly after cryopreservation. Doi: 10.54680/fr23410110712.