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We examined the prevalence and correlates of Helicobacter pylori (H. pylori) infection according to cytotoxin-associated gene A (CagA) phenotype, a main virulence antigen, among the ethnically diverse population groups of Jerusalem. A cross-sectional study was undertaken in Arab (N = 959) and Jewish (N = 692) adults, randomly selected from Israel's national population registry in age-sex and population strata. Sera were tested for H. pylori immunoglobulin G (IgG) antibodies. Positive samples were tested for virulence IgG antibodies to recombinant CagA protein, by enzyme-linked immunosorbent assay. Multinomial regression models were fitted to examine associations of sociodemographic factors with H. pylori phenotypes. H. pylori IgG antibody sero-prevalence was 83.3% (95% confidence interval (CI) 80.0%–85.5%) and 61.4% (95% CI 57.7%–65.0%) among Arabs and Jews, respectively. Among H. pylori positives, the respective CagA IgG antibody sero-positivity was 42.3% (95% CI 38.9%–45.8%) and 32.5% (95% CI 28.2%–37.1%). Among Jews, being born in the Former Soviet Union, the Middle East and North Africa, vs. Israel and the Americas, was positively associated with CagA sero-positivity. In both populations, sibship size was positively associated with both CagA positive and negative phenotypes; and education was inversely associated. In conclusion, CagA positive and negative infection had similar correlates, suggesting shared sources of these two H. pylori phenotypes.
Tools applied at the point of care can provide valuable prognostic information for practitioners. In this one-year, prospective observational study, we examined the association of the short performance physical battery (SPPB) and one-year emergency department (ED) visits and hospitalizations. Overall, 191 new referrals attending an outpatient geriatric clinic in Hamilton, Ontario, were approached, and 120 were enrolled. SPPB and other assessments were completed during the routine clinical visit. ED visits and hospitalizations within one year of the baseline assessment were abstracted from electronic medical records. Logistic regression analyses were used to determine ED visits and hospitalization predictors. The mean SPPB score in the study cohort (mean age 80.6, SD 6.3 years; 53% female) was 6.3 (SD 3.2). SPPB score was associated with a one-year ED visit (OR = 0.90 [0.78–1.03]) and hospitalization (OR = 0.84 [0.72–0.97]) after adjusting for age, sex, and co-morbidities.
Objective: To summarize the findings of randomized controlled trials (RCTs) on the efficacy and safety of vitamins and minerals for migraine prophylaxis. Methods: We systematically searched bibliographic databases and relevant websites for parallel and crossover RCTs reporting efficacy and/or safety of vitamins and/or minerals for migraine prophylaxis. Our primary outcomes were migraine frequency (number of attacks) and duration (hours). Secondary outcomes were severity (intensity), days with migraine, and adverse events. Meta-analysis was conducted when analyzable data were available from at least two trials. Results: Eighteen placebo-controlled trials met our eligibility criteria. Only coenzyme Q10 and magnesium contributed to meta-analyses. In adults, compared with placebo, coenzyme Q10 did not significantly decrease migraine frequency (mean difference (MD) −0.44 (−2.14 to 1.26); I2 53%; 2 trials; 97 participants; moderate strength of the evidence), duration (MD −1.97 (−4.82 to 0.87); I2 0%; 2 trials; 97 participants; moderate strength of the evidence), or severity (ratio of means (RoM) −0.05 (−0.20 to 0.11); I2 0%; 2 trials; 97 participants). In adults, compared with placebo, magnesium did not significantly decrease migraine severity (RoM −0.17 (−0.36 to 0.02); I2 48%; 3 trials; 226 participants; low strength of the evidence). Meta-analysis of other vitamins and minerals, and other outcomes were not feasible due to a lack of sufficiently reported data. Conclusions: Based on insufficient evidence, it is unknown if coenzyme Q10 and magnesium are effective for migraine prophylaxis in adults. High-quality, adequately powered RCTs are needed to fully evaluate the efficacy and safety of vitamins and minerals for migraine prophylaxis.
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
Mainstream media faces challenges in developed democracies like never before. On one hand, seemingly “free” digital (including social media) options are eroding the market for print drastically. Ads are not so much shifting from print to digital, but apparently simply disappearing. In the face of the pressures stemming from changing economics of the news business—which still has to be gathered at great expense, even if it can be distributed or shared by third parties practically for free (denying the gatherers their share of revenue)—one now encounters a new form of threat that is more political and cultural, namely, “fake news” and state and nonstate actors who wield it to undermine the public's trust in traditional media or news sources.
A novel low profile dual band patch antenna is presented. It consists of a composite right/left-handed transmission line (CRLH TL) unit cell gap coupled with the radiating edge of a rectangular patch antenna. The dual band behavior is achieved by coupling the zeroth order resonance mode of CRLH TL and TM10 mode of the patch antenna. It is shown that frequency ratio can be changed by varying the gap between the patch and CRLH TL unit cell. The proposed configuration enables frequency reconfigurability by changing the CRLH TL unit cell using a switch. A prototype of the antenna having frequency ratio f2/f1 = 1.08 is designed and fabricated. The proposed antenna shows measured S11 ≤ −10 dB bandwidth of 100 and 50 MHz at resonance frequencies of f1 = 4.84 and f2 = 5.22 GHz, respectively. A 2 × 2 dual band CRLH TL coupled patch array is also presented, showing more than 12.7 dBi gain at both resonance frequencies.
Oxidative stress is a major cause of defective embryo development during in vitro culture. Retinoids are recognized as non-enzymatic antioxidants and may have an important role in the regulation of cell differentiation and vertebrate development. However, there are not enough reports discussing the antioxidant and developmental capacity of retinoids, including retinol (RT), on the in vitro development of embryos recovered from livestock animals, particularly in rabbit species. Therefore, morula embryos obtained from nulliparous Red Baladi rabbit does were cultured for 48 h in TCM199 medium in the absence of RT (control group) or in the presence of RT at concentrations of 10, 100 and 1000 nM. The developmental capacity to the hatched blastocyst stage, the antioxidant biomarker assay and the expression of several selected genes were analyzed in each RT group. The data show that RT significantly (P<0.001) promoted the embryo hatchability rate at the concentration of 1000 nM to 69.44% versus 29.71% for the control. The activity of malondialdehyde (MDA) level was significantly (P<0.05) lower in the RT groups than in the control group, while the total antioxidant capacity (TAC), superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities were significantly (P<0.05) higher following treatment with RT. Furthermore, RT treatment considerably upregulated the relative expression of gap junction protein alpha 1 (GJA1), POU class 5 homeobox 1 (POU5F1) and superoxide dismutase 1 (SOD1) genes compared with the control group. The current study highlights the potential effects of RT as antioxidant in the culture medium on the in vitro development of rabbit embryos.
Patulous Eustachian tube is a distressing condition characterised by chronic patency of the Eustachian tube and its failure to close. Patients typically present with symptoms of autophony and aural fullness. In patients requiring surgical intervention, a variety of different procedures have been demonstrated (both transtympanic and endonasal), with limited success. Evidence of the effectiveness of a number of surgical interventions is limited to small case series only.
This paper describes a novel treatment for patulous Eustachian tube using a 3 mm VortX Diamond endovascular coil.
A transnasal endoscopic approach was adopted, with cannulation of the Eustachian tube orifice using a Relieva sinus guide suction tube from a balloon sinuplasty set. The coil was deployed 1.5 cm deep into the Eustachian tube. Post-operative imaging was used to confirm correct positioning. Regular follow up was arranged. The patient reported complete resolution of her symptoms.
The technique has so far proved highly effective and minimally invasive. It will be employed in more patients to fully establish its effectiveness in treating patulous Eustachian tube.
Background: The natural history of small unruptured intracranial aneurysms (UIAs) <7mm is 0 to 1.3% per year. Our centre provides cerebrovascular care for the entire province allowing for long-term follow-up. We studied the safety of observation for aneurysms <7mm. Methods: We performed a retrospective chart review of patients with intracranial aneurysm referred to our centre between July 2008 and April 2015. Aneurysm characteristics and current status (followed, treated, not followed), were collected along with patient factors. Follow-up duration for each aneurysm was used to calculate total follow-up in aneurysm-years. Statistical evaluation consisted of multivariate analysis and logistic regression analysis. Results: 428 patients harbouring 497 aneurysms <7mm were identified. 67 presented with rupture. Of the remaining 430 aneurysms, there was a 9.3% treatment rate. 2 cases of rupture occurred in those patients who were followed, creating a 0.5% rupture rate. 325 aneurysms were followed for 631.3 total cumulative aneurysm-years, an average of 1.9 aneurysm-years. Smoking status and hypertension associated with presence of aneurysm (p≈0.009,0.026, respectively). Conclusions: In our selected patient group there is a low yearly rate of aneurysm rupture, and observation of aneurysms <7mm is safe. Hypertension and smoking were associated with the development of aneurysm. 9.3% of patients were treated, likely leading to a reduced natural history risk.
Background: Neurosurgical residents face a unique combination of challenges, including long duty hours, technically challenging cases, and uncertain employment prospects. We sought to assess the demographics, interests, career goals, self-rated happiness, and overall well-being of Canadian neurosurgery residents. Methods: A cross-sectional survey was developed and sent through the Canadian Neurosurgery Research Collaborative to every resident enrolled in a Canadian neurosurgery program as of April 1, 2016. Results: We analyzed 76 completed surveys of 146 eligible residents (52% response rate). The median age was 29 years, with 76% of respondents being males. The most popular subspecialties of interest for fellowship were spine, oncology, and open vascular neurosurgery. The most frequent self-reported number of worked hours per week was the 80- to 89-hour range. The majority of respondents reported a high level of happiness as well as stress. Sense of accomplishment and fatigue were reported as average to high and overall quality of life was low for 19%, average for 49%, and high for 32%. Satisfaction with work-life balance was average for 44% of respondents and was the only tested domain in which significant dissatisfaction was identified (18%). Overall, respondents were highly satisfied with their choice of specialty, choice of program, surgical exposure, and work environment; however, intimidation was reported in 36% of respondents and depression by 17%. Conclusions: Despite a challenging residency and high workload, the majority of Canadian neurosurgery residents are happy and satisfied with their choice of specialty and program. However, work-life balance, employability, resident intimidation, and depression were identified as areas of active concern.
Immunoactivation depends upon the antigen potential to modulate T-cell repertoires. The present study has enumerated the effect of 61 kDa recombinant Leishmania donovani co-factor-independent phosphoglycerate mutase (rLd-iPGAM) on mononuclear cells of healthy and treated visceral leishmaniasis subjects as well as on THP-1 cell line. rLd-iPGAM stimulation induced higher expression of interleukin-1β (IL-1β) in the phagocytic cell, its receptor and CD69 on T-cell subsets. These cellular activations resulted in upregulation of host-protective cytokines IL-2, IL-12, IL-17, tumour necrosis factor-α and interferon-γ, and downregulation of IL-4, IL-10 and tumour growth factor-β. This immune polarization was also evidenced by upregulation of nuclear factor-κ light-chain enhancer of activated B cells p50 and regulated expression of suppressor of mother against decapentaplegic protein-4. rLd-iPGAM stimulation also promoted lymphocyte proliferation and boosted the leishmaniacidal activity of macrophages by upregulating reactive oxygen species. It also induced 1·8-fold higher release of nitric oxide (NO) by promoting the transcription of inducible nitric oxide synthase gene. Besides, in silico analysis suggested the presence of major histocompatibility complex class I and II restricted epitopes, which can proficiently trigger CD8+ and CD4+ cells, respectively. This study reports rLd-iPGAM as an effective immunoprophylactic agent, which can be used in future vaccine design.
Unavailability of irrigation water for early sowing has remained a constant problem in cold arid deserts of Ladakh. In order to get a solution to this problem, a 2-yr farmers’ participatory research trial with best bet agronomic management on artificial glacier water harvesting technology was conducted. The technology involves collecting water from natural glaciers that melt during late December. The water is diverted toward a shed constructed with stone embankments set up at regular intervals. The area is chosen where there is minimum interference of solar radiation, generally between two mountain slopes or ridge that is on the leeward side. The melted water is that melts from the natural glacier impeded by the embankments and get frozen here. This frozen water starts melting in late March and is used for both pre sowing and initial crop water requirement. It also ensures early sowing of wheat by creating additional 45-day window which leads to introduction of long- and medium-duration wheat varieties to replace decades old locally grown short-duration varieties. The work was initiated with a benchmark survey of 100 farmers to get an understanding of present irrigation scenario, crop management practices and date of sowing. Data from 99 farmer participating trial of wheat conducted after or from bench mark survey clearly indicated that the effect of water shortage can be seen on yield and yield attributing characters due to unavailability of pre sowing irrigation and water requirement at imperative growth stages and may also lead to terminal heat stress in wheat crop. Out of total number of irrigations applied, initial two irrigations can be compensated by artificial glacier water harvesting technique, leading to a revolution in the agriculture scenario of the tribal population by introduction of long- and medium-duration wheat varieties in cold arid desert of Ladakh for the very first time. It was observed that wheat seeding done in first fortnight of April gave better yields in comparison to late seeded wheat. Moreover, the long-duration varieties (LDVs) or medium-duration varieties (MDVs) sown under late condition gave better yield in comparison to locally grown short-duration varieties sown at same time. Yield potential of LDVs and MDVs of wheat under late sowing was found quite low in comparison to early-sown wheat, still when compared with the performance of locally grown wheat the yields were more even if the local varieties were sown early. The outcome of this study will help the farmers of tribal, cold arid community in harvesting better wheat yields by timely sowing of the wheat crop accompanied with better bet agronomic management practices. Government initiative is further required to ensure better outreach of complete crop management strategies to the tribal farming community of the region in order to ensure food security and improve their socioeconomic status.
Livestock health is economically important for agropastoral households whose wealth is held partly as livestock. Households can invest in disease prevention and treatment, but livestock disease risk is also affected by grazing practices that result in inter-herd contact and disease transmission in regions with endemic communicable diseases. This paper examines the relationships between communal grazing and antimicrobial use in Maasai, Chagga and Arusha households in northern Tanzania. We develop a theoretical model of the economic connection between communal grazing, disease transmission risk, risk perceptions, and antimicrobial use, and derive testable hypotheses about these connections. Regression results suggest that history of disease and communal grazing are associated with higher subjective disease risk and greater antimicrobial use. We discuss the implications of these results in light of the potential for relatively high inter-herd disease transmission rates among communal grazers and potential contributions to antimicrobial resistance due to antimicrobial use.
The effect of nature and pressure of ambient environment on laser-induced breakdown spectroscopy (LIBS) and ablation mechanisms of silicon (Si) have been investigated. A Q-switched Nd-YAG laser with the wavelength of 1064 nm, pulse duration of 10 ns, and pulsed energy of 50 mJ was employed. Si targets were exposed under ambient environments of inert gases of argon, neon, and helium for different pressures ranging from 5 to 760 torr. The influence of nature and pressure of ambient gases on the emission intensity of Si plasma have been explored by using the LIBS spectrometer system. The plasma parameters such as electron temperature and number density were determined by applying Boltzmann plot and Stark broadening method, respectively. Our experimental results suggest that the nature and pressure of ambient environment play a significant role for generation, recombination, and expansion of plasma and consequently affect the excitation temperature as well as electron density of plasma. The surface morphological analysis of laser-irradiated Si was performed by using scanning electron microscope (SEM). Various kinds of structures, for example laser-induced periodic surface structures or ripples, cones, droplets, and craters have been generated and their density and size are found to be strongly dependent upon the ambient environment. A quantitative analysis of particulate size and crater depth measured from SEM images showed a strong correlation between plasma parameters and the growth of micro/nanostructures on the modified Si surface.
Background: Studies have placed the rate of infection associated with neuromodulation units to be up to 20%. We present our experience with the TYRX absorbable antibiotic envelope. Our length of follow-up adds to the body of evidence around the use of antibiotic envelops. Methods: We conducted a retrospective chart review of patients referred to our center for either new implantation or revision of neuromodulation units between July 2014 and September 2016. Consecutive cases were included for analysis. We included a control group of consecutive patients with neuromodulation units placed immediately prior to our experience with the TYRX envelopes for comparison Results: Between July 2014 and September 2016, 76 patients had 81 instances of neuromodulation unit insertion. All patients received the TYRX antibiotic envelope. There were no incidences of infection involving antibiotic envelope-containing implants over an average follow-up period of 11 months. In 77 consecutive cases of neuromodulation unit implantation prior to usage of the antibiotic pouch, there were 4 instances of infection (5.2%). Conclusions: Our single center experience demonstrates a significant drop in the rate of infections with the use of an antibiotic envelope for neuromodulation unit implantation. We consider the routine use of the envelope to be a cost-effective method of infection avoidance.