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1.
Parasitol Res ; 120(6): 2199-2218, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33963899

ABSTRACT

Leishmaniasis is considered a neglected disease, which makes it an unattractive market for the pharmaceutical industry; hence, efforts in the search for biologically active substances are hampered by this lack of financial motivation. Thus, in the present study, we report the leishmanicidal activity and the possible mechanisms of action of compounds with promising activity against the species Leishmania (V.) braziliensis, the causative agent of the skin disease leishmaniasis. The natural compound 1a (piplartine) and the analog 2a were the most potent against promastigote forms with growth inhibition values for 50% of the parasite population (IC50) = 8.58 and 11.25 µM, respectively. For amastigote forms, the ICa50 values were 1.46 and 16.7 µM, respectively. In the molecular docking study, piplartine showed favorable binding energy (-7.13 kcal/mol) and with 50% inhibition of trypanothione reductase (IC50) = 91.1 µM. Preliminary investigations of the mechanism of action indicate that piplartine increased ROS levels, induced loss of cell membrane integrity, and caused accumulation of lipid bodies after 24 h of incubation at its lowest effective concentration (IC50), which was not observed for the synthetic analog 2a. The mode of action for the leishmanicidal activity of piplartine (1a) was assigned to involve affinity for the trypanothione reductase of Leishmania (V.) braziliensis TR.


Subject(s)
Amides/pharmacology , Leishmania braziliensis/drug effects , Piperidones/pharmacology , Trypanocidal Agents/pharmacology , Amides/chemistry , Animals , Cell Line, Tumor , Chlorocebus aethiops , Computer Simulation , Humans , Molecular Docking Simulation , NADH, NADPH Oxidoreductases/antagonists & inhibitors , Piperidones/chemistry , Vero Cells
2.
Article in English | MEDLINE | ID: mdl-32653660

ABSTRACT

OBJECTIVES: Melioidosis, caused by Burkholderia pseudomallei, requires intensive antimicrobial treatment. However, standardized antimicrobial susceptibility testing (AST) methodology based on modern principles for determining breakpoints and ascertaining performance of methods are lacking for B. pseudomallei. This study aimed to establish MIC and zone diameter distributions on which to set epidemiological cut-off (ECOFF) values for B. pseudomallei using standard EUCAST methodology for non-fastidious organisms. METHODS: Non-consecutive, non-duplicate clinical B. pseudomallei isolates (9-70 per centre) were tested at eight study centres against eight antimicrobials by broth microdilution (BMD) and the EUCAST disc diffusion method. Isolates without and with suspected resistance mechanisms were deliberately selected. The EUCAST Development Laboratory ensured the quality of study materials, and provided guidance on performance of the tests and interpretation of results. Aggregated results were analysed according to EUCAST recommendations to determine ECOFFs. RESULTS: MIC and zone diameter distributions were generated using BMD and disc diffusion results obtained for 361 B. pseudomallei isolates. MIC and zone diameter ECOFFs (mg/L; mm) were determined for amoxicillin-clavulanic acid (8; 22), ceftazidime (8; 22), imipenem (2; 29), meropenem (2; 26), doxycycline (2; none), tetracycline (8; 23), chloramphenicol (8; 22) and trimethoprim-sulfamethoxazole (4; 28). CONCLUSIONS: We have validated the use of standard BMD and disc diffusion methodology for AST of B. pseudomallei. The MIC and zone diameter distributions generated in this study allowed us to establish MIC and zone diameter ECOFFs for the antimicrobials studied. These ECOFFs served as background data for EUCAST to set clinical MIC and zone diameter breakpoints for B. pseudomallei.

3.
Clin Microbiol Rev ; 33(2)2020 03 18.
Article in English | MEDLINE | ID: mdl-32161067

ABSTRACT

The causative agent of melioidosis, Burkholderia pseudomallei, a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of rainfall. Increasing reports of this condition have occurred worldwide, with estimates of up to 165,000 cases and 89,000 deaths per year. The ecological niche of the organism has yet to be clearly defined, although the organism is associated with soil and water. The culture of appropriate clinical material remains the mainstay of laboratory diagnosis. Identification is best done by phenotypic methods, although mass spectrometric methods have been described. Serology has a limited diagnostic role. Direct molecular and antigen detection methods have limited availability and sensitivity. Clinical presentations of melioidosis range from acute bacteremic pneumonia to disseminated visceral abscesses and localized infections. Transmission is by direct inoculation, inhalation, or ingestion. Risk factors for melioidosis include male sex, diabetes mellitus, alcohol abuse, and immunosuppression. The organism is well adapted to intracellular survival, with numerous virulence mechanisms. Immunity likely requires innate and adaptive responses. The principles of management of this condition are drainage and debridement of infected material and appropriate antimicrobial therapy. Global mortality rates vary between 9% and 70%. Research into vaccine development is ongoing.


Subject(s)
Burkholderia pseudomallei/drug effects , Melioidosis/drug therapy , Melioidosis/epidemiology , Africa/epidemiology , Americas/epidemiology , Animals , Anti-Bacterial Agents/therapeutic use , Asia, Southeastern/epidemiology , Bacteremia , Burkholderia pseudomallei/genetics , Humans , Microbiological Techniques , Molecular Diagnostic Techniques , Oceania/epidemiology , Risk Factors , Virulence
4.
BJOG ; 126 Suppl 4: 34-42, 2019 Aug.
Article in English | MEDLINE | ID: mdl-31257668

ABSTRACT

OBJECTIVES: A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long-term risks. DESIGN: Qualitative study using modified grounded theory. SETTING: Two states in rural India: Haryana and Andhra Pradesh. POPULATION: Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. METHODS: In-depth interviews and focus group discussions explored: (1) priorities for high-risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long-term sequelae of high-risk conditions. A thematic analysis was undertaken. RESULTS: Seven focus group discussions and 11 in-depth interviews (n = 71 participants) were performed. The key priority area for high-risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long-term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long-term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal. CONCLUSIONS: There is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings. FUNDING: SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India. TWEETABLE ABSTRACT: Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long-term risks.


Subject(s)
Attitude of Health Personnel , Diabetes, Gestational/psychology , Health Knowledge, Attitudes, Practice , Pre-Eclampsia/psychology , Adult , Aged , Anemia/psychology , Female , Focus Groups , Grounded Theory , Humans , India , Male , Middle Aged , Postnatal Care , Pregnancy , Qualitative Research , Rural Population/statistics & numerical data , Women's Health
5.
J Clin Microbiol ; 57(5)2019 05.
Article in English | MEDLINE | ID: mdl-30842230

ABSTRACT

Burkholderia pseudomallei is the causative agent of melioidosis. This condition most often presents as pneumonia and bacteremia, with mortality rates of 9% to 70%. Therefore, early identification of this organism may aid in directing appropriate management. This study aimed to use the Vitek matrix-assisted laser desorption ionization-time of flight mass spectrometer to create a spectrum for the rapid identification of B. pseudomallei Spectra from 85 isolate cultures were acquired using the Vitek mass spectrometer research mode. A SuperSpectrum was created using peak matching and subsequently activated for analysis of organism identification. All 85 isolates were correctly identified as B. pseudomallei A total of 899 spectra were analyzed and demonstrated a specificity of 99.8%. Eighty-one clinical isolates were used, of which 10 were neuromelioidosis, and no discernible spectrum difference was appreciated. Spectrum acquisition from a single spot was only successful in 374/899 (41%) of isolates. This increased to 100% when 3 spots of the same extract were analyzed. The Vitek mass spectrometer can be used for the rapid identification of B. pseudomallei with a high level of specificity.


Subject(s)
Burkholderia pseudomallei/isolation & purification , Melioidosis/diagnosis , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/instrumentation , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods , Burkholderia pseudomallei/classification , Humans , Melioidosis/microbiology , Phenotype , Reproducibility of Results , Sensitivity and Specificity
6.
Lab Chip ; 18(18): 2816-2825, 2018 09 11.
Article in English | MEDLINE | ID: mdl-30027962

ABSTRACT

Moving to ultra-low (<100 nL) sample volumes presents numerous challenges, many of which can be resolved by implementation of open nanofluidic films. These nanofluidic films are fabricated using a hexagonal network of gold-coated open microchannels which capture all of the following innovative advantages: (1) sample volumes of <100 nL cm-2; (2) zero analyte exchange and loss with the film materials; (3) rapid and omni-directional wicking transport of >500 nL min-1 per square of film; (4) ultra-simple roll-to-roll fabrication; (5) stable and bio-compatible super-hydrophilicity for weeks in air by peptide surface modification. Validation includes both detailed in vitro characterization and in vivo validation with sweat transport from the human skin. Sampling times (skin-to-sensor) of <3 min were achieved, setting new benchmarks for the field of wearable sweat sensing. This work addresses significant challenges for sweat biosensing, or for any other nano-liter regime (<100 nL) fluid sampling and sensing application.


Subject(s)
Lab-On-A-Chip Devices , Nanotechnology/instrumentation , Biological Transport , Biomimetic Materials/metabolism , Electrodes , Gold/chemistry , Hydrophobic and Hydrophilic Interactions , Kinetics , Skin/metabolism , Sweat/metabolism
7.
Int Immunopharmacol ; 47: 227-230, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28433944

ABSTRACT

American tegumentary leishmaniasis (ATL) is considered a neglected disease, for which an effective vaccine or an efficient diagnosis is not yet available and whose chemotherapeutic arsenal is threatened by the emergence of resistance by etiological agents such as Leishmania amazonensis. ATL is endemic in poor countries and has a high incidence in Brazil. Vaccines developed from native parasite fractions have led to the identification of defined antigenic subunits and the development of vaccine adjuvant technology. The purpose of the present study was to develop and compare preparations based on membrane antigens from L. amazonensis, as a biotechnological prototype for the immunoprophylaxis of the disease in a murine experimental model. For this purpose, batches of biodegradable polymeric micro/nanoparticles were produced, characterized and compared with other parasite's antigens in solution. All preparations containing membrane antigens presented low toxicity on murine macrophages. The in vivo evaluation of immunization efficacy was performed against a challenge with L. amazonensis, along with an evaluation of the immune response profile generated in BALB/C mice. The animals were followed for sample processing and quantification of serum-specific cytokines, nitrites and antibodies. The sera of animals immunized with the non-encapsulated antigen formulations showed higher intensities of nitrites and total IgGs. This approach evidenced the importance of the biological studies involving the immune response of the host against the parasite being interconnected and related to the subfractionation of its proteins in the search for more effective vaccine candidates.


Subject(s)
Antigens, Protozoan/immunology , Leishmania/immunology , Leishmaniasis Vaccines/immunology , Leishmaniasis, Cutaneous/immunology , Leishmaniasis/immunology , Macrophages/immunology , Membrane Proteins/immunology , Animals , Antibodies, Protozoan/blood , Cells, Cultured , Cytokines/blood , Humans , Male , Mice , Mice, Inbred BALB C , Models, Animal , Nanoparticles , Nitric Oxide/metabolism
8.
Open Heart ; 3(2): e000463, 2016.
Article in English | MEDLINE | ID: mdl-27738516

ABSTRACT

OBJECTIVE: To update the Cochrane review comparing the effects of home-based and supervised centre-based cardiac rehabilitation (CR) on mortality and morbidity, quality of life, and modifiable cardiac risk factors in patients with heart disease. METHODS: Systematic review and meta-analysis. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL were searched up to October 2014, without language restriction. Randomised trials comparing home-based and centre-based CR programmes in adults with myocardial infarction, angina, heart failure or who had undergone coronary revascularisation were included. RESULTS: 17 studies with 2172 patients were included. No difference was seen between home-based and centre-based CR in terms of: mortality (relative risk (RR) 0.79, 95% CI 0.43 to 1.47); cardiac events; exercise capacity (mean difference (MD) -0.10, -0.29 to 0.08); total cholesterol (MD 0.07 mmol/L, -0.24 to 0.11); low-density lipoprotein cholesterol (MD -0.06 mmol/L, -0.27 to 0.15); triglycerides (MD -0.16 mmol/L, -0.38 to 0.07); systolic blood pressure (MD 0.2 mm Hg, -3.4 to 3.8); smoking (RR 0.98, 0.79 to 1.21); health-related quality of life and healthcare costs. Lower high-density lipoprotein cholesterol (MD -0.07 mmol/L, -0.11 to -0.03, p=0.001) and lower diastolic blood pressure (MD -1.9 mm Hg, -0.8 to -3.0, p=0.009) were observed in centre-based participants. Home-based CR was associated with slightly higher adherence (RR 1.04, 95% CI 1.01 to 1.07). CONCLUSIONS: Home-based and centre-based CR provide similar benefits in terms of clinical and health-related quality of life outcomes at equivalent cost for those with heart failure and following myocardial infarction and revascularisation.

9.
Clin Microbiol Infect ; 22(7): 632-5, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27172806

ABSTRACT

Cryptococcosis is a mycotic disease caused by the yeast Cryptococcus sp. It is associated with significant mortality and morbidity, including long-term neurological sequelae. It is not known whether the high morbidity observed is related to a delay in diagnosis. A retrospective chart review of all cryptococcal infections that had been diagnosed in the region between 1997 and 2015 was performed. Twenty-nine cases were identified. Overall mortality rate was 10.3%, with an attributable mortality rate of 6.9%. Forty-five per cent of patients with central nervous system involvement developed long-term neurological deficits. Significant associations were noted between those with and without long-term neurological deficits and in both time from onset of symptoms to diagnosis (median of 45.5 days versus 18.5 days, respectively) and time from presentation to diagnosis (median 14.5 days versus 7 days, respectively). In addition, raised intracranial pressure (p 0.03) and female gender (p 0.02) were significantly associated with poor neurological outcomes. This highlights the importance of early diagnosis and the need to limit raised intracranial pressure to minimize long-term neurological deficits.


Subject(s)
Delayed Diagnosis , Meningitis, Cryptococcal/complications , Meningitis, Cryptococcal/diagnosis , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Meningitis, Cryptococcal/drug therapy , Middle Aged , Retrospective Studies , Survival Analysis , Treatment Outcome , Young Adult
10.
Osteoporos Int ; 27(2): 677-81, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26267012

ABSTRACT

UNLABELLED: Despite the high burden of hip fracture in China, there is limited information on its management. This study investigated the management of hip fractures in a Beijing tertiary hospital and compared practice with that in 180 hospitals in the UK. The findings show a significant gap exists between the countries. INTRODUCTION: The purpose of this study was to determine if the management of older people with hip fractures in a Beijing tertiary hospital is comparable with the UK best practice guidelines for hip fracture management and the UK National Hip Fracture Database 2012, obtained from 180 hospitals. METHODS: A retrospective audit was undertaken in a large tertiary care hospital in Beijing. Data were compared with the National Hip Fracture Database 2012 collected in 180 hospitals in the UK on the proportion of patients managed according to the UK Blue Book standards. RESULTS: Sixty-six percent of patients were admitted to an orthopaedic ward within 24 h of fracture, while 100 % of patients in the UK were admitted to an orthopaedic ward within 24 h of arrival to an accident and emergency department. Only 8 % of patients received surgery within 48 h of admission compared with 83 % in the UK; 10 % received no surgery compared with 2.5 % in the UK; and 27 % received orthogeriatrician assessment compared with 70 % in the UK. New pressure ulcers developed in 2 % of patients compared with 3.7 % of those in the UK; whereas, 0.3 % of patients were assessed for osteoporosis treatment and 3.8 % received falls assessment, and comparable figures for the UK were 94 and 92 %, respectively. CONCLUSIONS: Significant gaps exist in hip fracture management in the Beijing hospital compared with the best practice achieved in 180 UK hospitals, highlighting the need to implement and evaluate proactive strategies to increase the uptake of best practice hip fracture care in China.


Subject(s)
Health Services for the Aged/organization & administration , Hip Fractures/therapy , Osteoporotic Fractures/therapy , Aged , Aged, 80 and over , China , Disease Management , Evidence-Based Medicine , Female , Health Services for the Aged/standards , Hospitalization , Humans , Male , Medical Audit , Middle Aged , Practice Guidelines as Topic , Professional Practice/standards , Professional Practice/statistics & numerical data , Retrospective Studies , Time Factors , United Kingdom
11.
Epidemiol Infect ; 141(5): 1034-8, 2013 May.
Article in English | MEDLINE | ID: mdl-22882795

ABSTRACT

The aims of this study were to define the basic epidemiology of serologically confirmed acute Q fever in patients tested via the Townsville Hospital laboratory from 2000 to 2010 and to determine the impact of geographical location and seasonality on the incidence of acute cases in the Townsville region. Seven Statistical Local Areas (SLA) were identified as having an incidence higher than the average Queensland incidence over the study period. The SLA with the highest incidence was Woodstock-Ross with 24.9 cases/100,000. A clear seasonal peak was found, with the greatest number of cases observed in May, 3 months following the peak in rainfall in February. We hypothesize that an increase in wildlife numbers and drier conditions seen immediately following the wet season is the reason for the seasonal peak of human acute Q fever cases in Townsville.


Subject(s)
Q Fever/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Demography , Female , Humans , Incidence , Male , Middle Aged , Queensland/epidemiology , Rain , Retrospective Studies , Risk Factors , Young Adult
12.
Intern Med J ; 42(6): 634-41, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22372985

ABSTRACT

AIM: To determine the relationship of sleep disorders with blood pressure and obesity in a large, relatively healthy, community-based cohort. METHODS: A cross-sectional study was undertaken using data from 22,389 volunteer blood donors in New Zealand aged 16-84 years. Height, weight, neck circumference and blood pressure were measured directly, and data on sleep and other factors were ascertained using a validated self-administered questionnaire. RESULTS: Even in a relatively young, non-clinical cohort, lack of sleep (34%), snoring (33%), high blood pressure (20%) and obesity (19%) are common. After adjusting for relevant confounders, participants at high risk of sleep apnoea had double the odds of having high blood pressure but only in participants over 40 years. Very low and high quantities of sleep are also associated with high blood pressure. Even after controlling for neck circumference, self-reported sleep apnoea, sleep dissatisfaction and low amounts of sleep are associated with a higher body mass index. CONCLUSIONS: Obesity and hypertension have significant associations with a variety of sleep disorders, even in those less than 40 years of age and after adjusting for a wide range of potential confounders.


Subject(s)
Hypertension/epidemiology , Obesity/epidemiology , Sleep Wake Disorders/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Neck/anatomy & histology , New Zealand , Young Adult
13.
Injury ; 43(9): 1593-9, 2012 Sep.
Article in English | MEDLINE | ID: mdl-21719008

ABSTRACT

BACKGROUND: This study aims to examine factors associated with variation in crash-related hospitalization costs for young adults in New South Wales (NSW), Australia with a particular focus on types of vehicle occupant, rurality of residence and socioeconomic status (SES). METHODS: Data on patients aged 17-25 years, admitted to public hospitals due to a crash during July 2000-June 2007 were extracted from the NSW Health Admission Collection database. The hospitalization cost of each admission was calculated based on published charges for specific Australian Refined-Diagnosis Related Groups (AR-DRG). Multivariable analyses using generalized estimating equations were used to estimate costs by vehicle occupant type (driver, passenger and other occupants), rurality of residence (urban, regional and rural areas) and SES (low, moderate and high SES areas). RESULTS: During 2000-2007, there were 11,892 crash-related hospitalizations involving young adults, aged 17-25 years, in NSW. These cost the health sector about A$87.6 million or on average, A$7363 per hospitalization (mean length of stay (LOS) 5.3 days). Compared to drivers, passengers had significantly longer LOS (<0.01) as well as higher hospitalization costs (p = 0.04). Regional and rural young adults had significantly longer LOS and higher hospitalization costs compared to urban young adults (p<0.05). Compared with young adults from high SES areas, young adults from moderate SES areas had significantly higher costs (p = 0.02), whilst the higher costs for young adults of low SES areas was borderline significant (p = 0.06), although differences in LOS by SES were not significant. CONCLUSION: Annually, young adults' crashes in NSW were estimated to cost the health sector at least A$14.6 million between 2001 and 2007. The higher hospitalization costs and LOS for young adults living in regional and rural vs. urban areas, and those living in moderate and low SES vs. high SES areas partly reflects the severity of these crashes and challenges for treatment. Based on these findings, a strong economic argument can be made for targeting prevention strategies to young people living in rural and low SES areas. The area variations in costs also suggest some scope for policy makers to consider potentially more efficient ways of targeting both treatment and preventative programmes.


Subject(s)
Accidents, Traffic , Automobile Driving , Hospital Charges/statistics & numerical data , Hospitalization/economics , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Wounds and Injuries/economics , Accidents, Traffic/economics , Accidents, Traffic/mortality , Adolescent , Adult , Female , Healthcare Disparities , Hospitalization/statistics & numerical data , Humans , Length of Stay/economics , Male , New South Wales/epidemiology , Policy Making , Risk Factors , Socioeconomic Factors , Wounds and Injuries/mortality , Young Adult
14.
Infection ; 39(6): 579-82, 2011 Dec.
Article in English | MEDLINE | ID: mdl-21713429

ABSTRACT

We describe an unusual presentation of Q fever with associated haemophagocytic syndrome, confirmed by bone marrow aspirate, Q fever polymerase chain reaction (PCR) and serological testing. Clinical recovery was observed after the commencement of doxycycline with normalisation of the patient's full blood count and serum biochemistry. Serial monitoring of the Q fever serology revealed the subsequent development of sustained high phase 1 IgG antibodies, suggestive of chronic Q fever. Although many infectious aetiologies have been associated with haemophagocytosis, Q fever has only rarely been described in this context. The diagnosis of Q fever is often overlooked, especially when the presentation is atypical. We describe how the use of PCR testing significantly shortened the interval to definitive diagnosis and helped elucidate the underlying cause of the patient's haematological disorder.


Subject(s)
Coxiella burnetii/isolation & purification , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/microbiology , Q Fever/complications , Q Fever/diagnosis , Antibodies, Bacterial/blood , Bone Marrow/pathology , Coxiella burnetii/genetics , Coxiella burnetii/immunology , Histocytochemistry , Humans , Immunoglobulin G/blood , Male , Middle Aged , Polymerase Chain Reaction , Serologic Tests
15.
Intern Med J ; 41(1a): 60-3, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21265962

ABSTRACT

We describe a case of severe falciparum malaria with hyperparasitaemia. Treatment with automated erythrocytapheresis, in conjunction with parenteral artesunate, produced a rapid and sustained fall in parasite burden. Several poor prognostic features were present at admission. Despite the development of a severe headache with abnormal cerebrospinal fluid parameters and transient pulmonary oedema, a complete recovery was observed. Erythrocytapheresis can be considered in selected cases where facilities exist and has theoretical and practical advantages over traditional methods of red cell exchange transfusion. The paucity of systematic or trial evidence convincingly demonstrating a benefit in terms of morbidity or mortality has limited its application. However, the lack of robust trial data should not in itself invalidate considering this therapeutic option in the appropriate context.


Subject(s)
Blood Component Removal/methods , Malaria, Falciparum/therapy , Parasitemia/therapy , Adult , Antimalarials/therapeutic use , Artemether , Artemisinins/therapeutic use , Artesunate , Australia , Automation , Cambodia , Combined Modality Therapy , Drug Therapy, Combination , Erythrocyte Transfusion , Erythrocytes/parasitology , Ethanolamines/therapeutic use , Fluorenes/therapeutic use , Humans , Lumefantrine , Malaria, Falciparum/drug therapy , Malaria, Falciparum/parasitology , Male , Parasitemia/drug therapy , Parasitemia/parasitology , Travel
16.
Clin Microbiol Infect ; 17(8): 1216-22, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21073630

ABSTRACT

Group A streptococci (GAS) are usually the predominant species in cases of bacteraemia caused by ß haemolytic streptococci (BHS). An increasing worldwide incidence of invasive disease from non-group A BHS has been reported. Little is known about the changing trends in invasive disease caused by BHS in Australia. North Queensland has a relatively large indigenous population, who experience significantly higher rates of group A-related disease than the non-indigenous population. This prospective study examined changing trends of disease from large colony BHS that group with A, B, C and G antisera over a 14-year period at the single large tertiary referral hospital in the area. We identified 392 bacteraemic episodes caused by BHS. GAS were most commonly isolated (49%), with adjusted rates remaining stable over the period. There was a significant increase in the incidence of non-neonatal bacteraemia caused by group B streptococci (GBS) over the study period (r = 0.58; p 0.030), largely driven by infection in older, non-indigenous women. Rates of bacteraemia caused by group C streptococci also experienced a modest, but significant, increase over time (r = 0.67; p 0.009). GAS, which had no predominant emm type, were seen most commonly in indigenous subjects (52%). Mortality rates ranged from 3.2% (group G) to 10.3% (group C), with a rate of 7.9% associated with group A disease. The marked rise in GBS disease has been noted worldwide, but the relatively low incidence in indigenous Australian patients has not been described before, despite the burden of well-recognized risk factors for GBS disease within this group.


Subject(s)
Bacteremia/epidemiology , Streptococcal Infections/epidemiology , Streptococcus agalactiae/isolation & purification , Streptococcus pyogenes/isolation & purification , Streptococcus/isolation & purification , Bacteremia/ethnology , Bacteremia/microbiology , Bacteremia/mortality , Female , Humans , Incidence , Male , Prospective Studies , Queensland/epidemiology , Streptococcal Infections/ethnology , Streptococcal Infections/microbiology , Streptococcal Infections/mortality , Streptococcus/classification
17.
J Safety Res ; 41(2): 123-8, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20497797

ABSTRACT

BACKGROUND: Little has been published on changes in young driver fatality rates over time. This paper examines differences in Australian young driver fatality rates over the last decade, examining important risk factors including place of residence and socioeconomic status (SES). METHODS: Young driver (17-25years) police-recorded passenger vehicle crashes were extracted from New South Wales State records from 1997-2007. Rurality of residence and SES were classified into three levels based on drivers' residential postcode: urban, regional, or rural; and high, moderate, or low SES areas. Geographic and SES disparities in trends of fatality rates were examined by the generalized linear model. Chi-square trend test was used to examine the distributions of posted speed limits, drinking driving, fatigue, seatbelt use, vehicle age, night-time driving, and the time from crash to death across rurality and socioeconomic status. RESULTS: Young driver fatality rate significantly decreased 5% per year (p<0.05); however, stratified analyses (by rurality and by SES) showed that only the reduction among urban drivers was significant (average 5% decrease per year, p<0.01). The higher relative risk of fatality for rural versus urban drivers, and for drivers of low versus high SES remained unchanged over the last decade. High posted speed limits, fatigue, drink driving and seatbelt non-use were significantly associated with rural fatalities, whereas high posted speed limit, fatigue, and driving an older vehicle were significantly related to low SES fatality. CONCLUSION: The constant geographic and SES disparities in young driver fatality rates highlight safety inequities for those living in rural areas and those of low SES. Better targeted interventions are needed, including attention to behavioral risk factors and vehicle age.


Subject(s)
Accidents, Traffic/mortality , Adolescent , Adult , Geography , Humans , Motor Vehicles/statistics & numerical data , New South Wales/epidemiology , Risk Factors , Rural Population/statistics & numerical data , Socioeconomic Factors , Urban Population/statistics & numerical data , Young Adult
18.
Neotrop Entomol ; 39(2): 253-9, 2010.
Article in Portuguese | MEDLINE | ID: mdl-20498964

ABSTRACT

This work was conducted to evaluate biological parameters of Plutella xylostella L. reared on leaves of several cauliflower genotypes under laboratory conditions. The experiment was set in a randomized block design and arranged in a 6 x 2 factorial (genotypes x generations). Leaf disks of the cultivars Barcelona, Verona, Piracicaba Precoce, Sharon, Silver Streak, and Teresópolis Gigante were placed in Petri dishes with 12 newly-hatched larvae. Leaf disks were initially changed after the fourth day, but daily afterwards until the larvae reached the pupal stage. The same procedure was adopted for the second generation. Twenty adults of each sex were separated from each genotype to evaluate their longevity, and 10 couples from each treatment were used to assess female fecundity. The lowest larval survival was obtained on the 'Silver Streak' (78.9%) and highest on 'Verona' (97.1%). The 'Silver Streak' and 'Teresópolis Gigante' showed the lowest pupal weights (4.83 mg and 5.11 mg, respectively), as well as the lowest fecundity, 119.4 and 123.0 eggs/female, respectively, while 'Piracicaba Precoce' the highest (167.7 eggs/female). Males obtained from larvae reared on 'Teresópolis Gigante' and 'Silver Streak' lived shorter (5.1 days), while the short-lived females were obtained from larvae reared on 'Barcelona' and 'Verona' (4.9 and 5.0 days). Insect development was prolonged in the second generation in all tested genotypes.


Subject(s)
Brassica/genetics , Brassica/parasitology , Lepidoptera/growth & development , Animals , Genotype , Larva , Pupa
19.
Anaesth Intensive Care ; 38(2): 266-73, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20369758

ABSTRACT

Over the last ten years more reliable information regarding the risks and benefits of the use of albumin for fluid resuscitation has emerged. To determine what influence this has had on clinical practice, we sought to document albumin use (from mass of albumin supplied to hospitals) in 16 industrialised countries between 1995 and 2006. Data on national albumin and synthetic colloid use was sought from independent intensive care researchers and albumin issuers. The mass of albumin supplied per 10,000 persons on an annual basis by country and aggregated across the study countries was calculated. Volumes of synthetic colloid supplied per 10,000 persons were calculated. Data were obtained for 15 countries. Albumin use varied significantly between countries and throughout the observation period. Overall, aggregate albumin use decreased from a peak of 2.54 kg per 10,000 persons in 1995 to 1.40 kg per 10,000 persons in 1999; use has remained relatively constant since. Data on supply of synthetic colloids was available in only three countries and varied from 11.7 litres per 10,000 persons in Canada in 1995, to 231.8 litres per 10,000 persons in Denmark in 2004. Between 1995 and 1999 albumin use decreased and has been materially constant since; where data were available, use of synthetic colloids increased. Whether these practice changes have resulted in a net health gain or in harm requires further research.


Subject(s)
Albumins/administration & dosage , Fluid Therapy , Colloids/administration & dosage , Humans , Time Factors
20.
Neotrop. entomol ; 39(2): 253-259, mar.-abr. 2010. tab
Article in Portuguese | LILACS | ID: lil-547689

ABSTRACT

This work was conducted to evaluate biological parameters of Plutella xylostella L. reared on leaves of several cauliflower genotypes under laboratory conditions. The experiment was set in a randomized block design and arranged in a 6 x 2 factorial (genotypes x generations). Leaf disks of the cultivars Barcelona, Verona, Piracicaba Precoce, Sharon, Silver Streak, and Teresópolis Gigante were placed in Petri dishes with 12 newly-hatched larvae. Leaf disks were initially changed after the fourth day, but daily afterwards until the larvae reached the pupal stage. The same procedure was adopted for the second generation. Twenty adults of each sex were separated from each genotype to evaluate their longevity, and 10 couples from each treatment were used to assess female fecundity. The lowest larval survival was obtained on the 'Silver Streak' (78.9 percent) and highest on 'Verona' (97.1 percent). The 'Silver Streak' and 'Teresópolis Gigante' showed the lowest pupal weights (4.83 mg and 5.11 mg, respectively), as well as the lowest fecundity, 119.4 and 123.0 eggs/female, respectively, while 'Piracicaba Precoce' the highest (167.7 eggs/female). Males obtained from larvae reared on 'Teresópolis Gigante' and 'Silver Streak' lived shorter (5.1 days), while the short-lived females were obtained from larvae reared on 'Barcelona' and 'Verona' (4.9 and 5.0 days). Insect development was prolonged in the second generation in all tested genotypes.


Subject(s)
Animals , Brassica/genetics , Brassica/parasitology , Lepidoptera/growth & development , Genotype , Larva , Pupa
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