Reliable exclusion of prognostically significant coronary disease in left ventricular dysfunction by cardiac MRI.

AIM: To assess the ability of cardiac magnetic resonance (CMR) to exclude prognostically significant coronary artery disease (CAD) in patients with left ventricular systolic dysfunction (LVSD). MATERIALS AND METHODS: A cohort of patients who underwent both X-ray angiography and CMR since 2006 was reviewed retrospectively. Records of those with European criteria for LVSD (left ventricular ejection fraction [LVEF] <50% or LV end-diastolic volume index [LVEDVI] ≥97 ml/m2) on CMR or transthoracic echo were analysed. The presence and extent of subendocardial late gadolinium enhancement (LGE) was recorded with the 17-segment model. The degree of coronary stenosis at X-ray angiography was assessed visually and significant disease defined as stenosis of the LMS ≥50%, or proximal left anterior descending ≥75%, or ≥70% in two main coronary vessels. RESULTS: One hundred and sixteen patients were included. The mean age was 64 years and 78% were male. The mean LVEF was 40%. The prevalence of prognostic CAD was 47%. The presence of subendocardial LGE detected prognostically significant CAD with a sensitivity of 100% (95% CI: 94-100%) with no false-negative results. CONCLUSIONS: The absence of subendocardial LGE on CMR reliably excludes prognostic CAD in patients with LVSD.

Incidence and clinical presentation of acute otitis media in children aged <6 years in European medical practices.

We conducted an epidemiological, observational cohort study to determine the incidence and complications of acute otitis media (AOM) in children aged <6 years. Data on physician-diagnosed AOM were collected from retrospective review of medical charts for the year preceding enrolment and then prospectively in the year following enrolment. The study included 5776 children in Germany, Italy, Spain, Sweden, and the UK. AOM incidence was 256/1000 person-years [95% confidence interval (CI) 243-270] in the prospective study period. Incidence was lowest in Italy (195, 95% CI 171-222) and highest in Spain (328, 95% CI 296-363). Complications were documented in <1% of episodes. Spontaneous tympanic membrane perforation was documented in 7% of episodes. Both retrospective and prospective study results were similar and show the high incidence during childhood in these five European countries. Differences by country may reflect true differences and differences in social structure and diagnostic procedures.

Screening method for detection of immediate amino acid decarboxylases--producing bacteria implicated in food poisoning.

Assessment of amino acid decarboxylase activity can be conducted using tubed broth or plated agar. In this study, the test was carried out in microtitre plates containing lysine, ornithine, arginine, tyrosine, tryptophan, phenylalanine or histidine as biogenic amine precursors. Møller decarboxylase base broth (MDB) with or without 1% of a known amino acid were added to wells of a 96 well-microtitre plate. The wells were inoculated with Escherichia coli, Klebsiella pneumoniae, Acinetobacter anitratus or Staphylococcus aureus to the final concentration of 6.0 x 10(7) cfu/ml and incubated at 35ºC. The absorbance of the culture broth was read at 570 nm at 0, 1.0, 2.0, 3.0, 4.0, 5.5, 6.5 and 7.5 hour. Comparison of means of A'(570) between 0 hour and a specified incubation time was determined statistically. Positive decarboxylase activities were detected in the media inoculated with E. coli and K. pneumoniae in less than 6 hours. The current method is suitable for immediate producers of amino acid decarboxylase enzymes. It costs less as it uses less amino acid and it has the potential to be used for screening aliquots of food materials for amino acid decarboxylase activities.

Screening method for detection of immediate amino acid decarboxylases - producing bacteria implicated in food poisoning

Assessment of amino acid decarboxylase activity can be conducted using tubed broth or plated agar. In this study, the test was carried out in microtitre plates containing lysine, ornithine, arginine, tyrosine, tryptophan, phenylalanine or histidine as biogenic amine precursors. Møller decarboxylase base broth (MDB) with or without 1% of a known amino acid were added to wells of a 96 well-microtitre plate. The wells were inoculated with Escherichia coli, Klebsiella pneumoniae, Acinetobacter anitratus or Staphylococcus aureus to the final concentration of 6.0 x 107 cfu/ml and incubated at 35oC. The absorbance of the culture broth was read at 570 nm at 0, 1.0, 2.0, 3.0, 4.0, 5.5, 6.5 and 7.5 hour. Comparison of means of A’570 between 0 hour and a specified incubation time was determined statistically. Positive decarboxylase activities were detected in the media inoculated with E. coli and K. pneumoniae in less than 6 hours. The current method is suitable for immediate producers of amino acid decarboxylase enzymes. It costs less as it uses less amino acid and it has the potential to be used for screening aliquots of food materials for amino acid decarboxylase activities.

Mutagenic and cytotoxic properties of three herbal plants from Southeast Asia.

Three popular medicinal plants regarded as improving human sexual function in some parts of Southeast Asia were analysed for their mutagenic properties using modified Ames test (fluctuation test). Extract of one of the plants, Tacca integrifolia Ker-Gawl., was found to be mutagenic using Salmonella typhimurium strains TA98 and TA100. Extract of T. integrifolia, Eurycoma longifolia Jack and Helmintostachys zeylanica (L.) Hook were cytotoxic to human cell lines, Hep2 and HFL1, with IC50 ranging from 11 mug/ml to 55 mug/ml. Extract of E. longifolia was the most cytotoxic with IC50 of 11 mug/ml and 13 mug/ml on Hep2 and HFL1 cell lines respectively. Combined extract of T. integrifolia and H. zeylanica was more cytotoxic than single extract on both Hep2 and HFL1 cell lines while combined extract of E. longifolia and H. zeylanica was more cytotoxic than single extract on Hep2 cell lines. Under the conditions of this study it can be concluded that T. integrifolia is mutagenic and the combined extracts of the medicinal plants was highly cytotoxic.

Comparison of in vitro cytotoxicity of Fusarium mycotoxins,deoxynivalenol, T-2 toxin and zearalenone on selected human epithelial cell lines.

Three human epithelial cell lines (CaCo-2, HEp-2 and HeLa) implicated as potential targets for three Fusarium toxins were tested for the extent of survival on exposure to increasing toxin concentration and incubation periods. Cytotoxicity assay using 3(4,5-dimethylthiazol-2-yl)2,5-diphenyltetrazolium bromide (MTT) was carried out with deoxynivalenol (DON), T-2 toxins and zearalenone (ZON) on CaCo-2, HEp-2 and HeLa cell lines. Of the three cell lines used, HeLa was the most sensitive, eliciting cell death after 2 days exposure at 100 ng ml(-1)with T-2 toxin. HeLa was the only cell line to exhibit cytotoxicity towards ZON showing cell death at 1000 ng ml(-1)after 2 days which increased to 4 days, showing substantial cell death at 200 ng ml(-1). HEp-2 was sensitive to DON showing cell death after 2 days (100 ng ml(-1)) with complete cell death occurring at 200 ng ml(-1) after 4 days of exposure. Substantial cytoxicity of T-2 towards HEp-2 occurred after 2 days at 1000 ng ml(-1) and complete cell death occurred with 100 ng ml(-1) at day 4. The CaCo-2 cell line was generally resistant to the mycotoxins tested between 100 and 1000 ng ml(-1). This study shows that cytotoxicity of Fusarium toxins to epithelium cell lines is concentration- and time- dependant and results from ZON-HeLa interaction indicate possible cell type-mycotoxin specificity.

Clinical and economic issues associated with switching between triptans in clinical practice.

Seven oral triptans are now generally available for the acute treatment of migraine, and physicians may sometimes feel under pressure to switch patients from one triptan to another for nonclinical reasons. This commentary article provides advice on what information should be taken into account by the physician before they consider switching one triptan for another. We review recommendations on switching triptans from international guidelines for migraine management and relate these to data from a recently published study on the economic implications of switching triptans in the UK. Controlled clinical studies reveal that most of the oral triptans have broadly similar efficacy profiles. Switching triptans can therefore only be recommended if the patient experiences problems such as lack of efficacy or intolerable side effects following repeated use of the initial triptan. The retrospective database study revealed that most patients who had their triptan switched were subsequently switched again during a 15 month review period, most usually back to their original triptan. Overall, switching a patient's triptan led to increased costs (analysed as costs of medication and the GP consultation) to the healthcare provider. These data indicate that patients should only be switched from one triptan for another for clinical reasons and not for perceived economic reasons, i.e. cost of the medication.

Bridging the treatment gap: the primary care perspective.

The Darlington heart failure service model, part of the South Durham Heart Failure Network, was devised to overcome barriers to accurate diagnosis and effective management of heart failure. It involves rapid diagnosis of left ventricular systolic dysfunction (LVSD) and ongoing heart failure management. A weekly one stop diagnostic clinic, run by a general practitioner (GP) specialist and a heart failure nurse, is jointly funded by the primary care trust and the South Durham NHS Trust. If LVSD is confirmed, a management plan is formulated which includes patient education and initiation of evidence based treatment. The heart failure nursing service is invaluable in bridging the gap between primary and secondary care. Local guidelines, together with continuing education of GPs and practice nurses, and the new General Medical Services contract, should further increase the uptake of evidence based treatments at target doses.

Effect of intra-articular administration of hyaluronan and cortisone on secondary osteoarthritis of the infected rabbit's knee.

Hyaluronan is known to play an important role in the healing of degenerative osteoarthritis. But there is no clear consensus how it effects on osteoarthritis compare to cortisone. The purpose of the research was to determine the comparative effects of hyaluronan and cortisone on the healing of degenerative osteoarthritis. A rabbit model used in which a degenerative osteoarthritis were created in the articular cartilage by the inoculation of Staphylococcus Aureus (S. Aureus). The rabbits divided into two groups namely injected with hyaluronan (group A) and cortisone (group B) at days 20, 23 and 26. After hyaluronan and cortisone injections for treatment of osteoarthritis at day of 25 and 35 six rabbits (each of three injected with hyaluronan and cortisone) and at day 50 (six of injected with hyaluronan and five of cortisone) were sacrified. In biopsies obtained from these knees both articular cartilage degeneration and inflammation around the joint were examined by light microscopy. It was seen that the histopathologic findings were consistent with active chronic inflammation at day 10, followed by chronic inflammation. At day 5 of treatment the degeneration decreased (60%) in group A, and clinical findings disappeared after day 9 of treatment. At day 15 of hyaluronan treatment the degeneration degree regressed and at day 30 absolutely healed (all except one). In group B, at day 5 of treatment, the clinical findings disappeared and the healing rate was 72%. At day 15 of cortisone treatment, the degeneration slightly increased and at day 30 the degeneration degree increased more than that day of 15. The results showed that cortisone is effective in the treatment of cartilage degeneration and inflammation early in the course of the septic arthritis whereas the therapeutic effect of hyaluronan is higher late in the course of the disease. Further studies are required in order to understand the effectiveness of the combined or consecutive use of these drugs in degenerative osteoarthritis.