The effect of body weight on interfragmentary fracture strain in plate fixation of distal femur fractures: A finite element analysis.

INTRODUCTION: Distal femur fractures are difficult to successfully treat due to high rates of nonunion. Obesity is an independent prognostic risk factor for nonunion. Advances in finite element analyses (FEAs) have allowed researchers to better understand the performance and behavior of constructs at the bone-implant interface under a variety of conditions. The purpose of this study is to determine the impact of body weight on fracture strain in a lateral locking plate construct for supracondylar femur fractures and whether additional construct rigidity is beneficial to optimize fracture strain in high body mass patients. HYPOTHESIS: We hypothesized that increased loads would produce a higher interfragmentary strain (IFS), which could be decreased by shortening the working length of the construct. MATERIALS AND METHODS: A 3D finite element analysis was performed on two separate femur models with a comminuted supracondylar distal femur fracture fixed with a lateral distal femoral locking plate in bridging mode with Ansys software. Axial forces were varied to recreate the effect of load from normal and high body mass patients. Working length and screw density of the construct were varied for each condition. Measurements of interfragmentary strain and shear motion (SM) were compared. RESULTS: Doubling the axial load from 70kg (control) to 140kg (high body mass) increased the interfragmentary strain by an average of 76% for the three working lengths (3.38%±1.67% to 4.37%±0.88% at the baseline working length (BWL), 1.42%±1.00% to 2.87%±2.02% at the intermediate working length (IWL) and 0.62%±0.22% to 1.22%±0.42% at the short working length (SWL)). On average, decreasing the working length in the 140kg load reduced the mean IFS to within 15% of the mean IFS of the 70kg load at the longer working length (2.87%±2.02% at IWL 140kg versus 3.38%±1.67% at BWL 70kg and 1.22%±0.45% SWL 140kg versus 1.42±1.00% IWL 70kg). DISCUSSION: Increased axial load increases interfragmentary strain in an AO/OTA 33A distal femur fracture fixed with a lateral distal femoral locking plate. Decreasing the working length of the fixation construct in the high body mass model decreased interfragmentary strain. Higher loading conditions reflective of high body mass patients should be considered in studies investigating optimization of fracture strain. LEVEL OF PROOF: V; Finite Element Analysis (FEA).

MORBIDITY PATTERN AND LEVEL OF COMPLIANCE WITH SAFETY MEASURES AMONG QUARRY WORKERS IN GUSAU METROPOLIS, ZAMFARA STATE.

Introduction: Quarrying is a thriving occupation providing widespread employment opportunities to the poor indigenes of Zamfara State. The workers are more susceptible to various morbidities due to numerous hazards in their working environment. This study aims to assess the morbidity pattern, availability, and compliance with safety measures among quarry workers in Gusau metropolis, Zamfara State. Methodology: A cross-sectional study was conducted among 307 quarry workers in Gusau metropolis between July and August 2022. The respondents were selected by multi-stage sampling technique. Data was collected using an interviewer-administered questionnaire (ODK), an observer checklist, and clinical examination. Appropriate descriptive and inferential statistics were done to determine significant association (p<0.05). Results: The common morbidities among the respondents were respiratory (39.4%), ear (6.5%), eye (30.0%), and injuries (39.7%). Working hours per day and duration of work in the quarry were factors associated with respiratory morbidities. Respondents' level of compliance with safety measures were; no compliance (5.2%), low compliance (43.7%), moderate compliance (49.8%), and considerable compliance (1.3%). Conclusions: This study showed high morbidities and low compliance with safety measures among quarry workers in Gusau metropolis, Zamfara State.

Cross-species surveillance and risk factors associated with Avian Coronavirus in North-Central and South West Regions of Nigeria.

Infectious bronchitis viral (IBV) (Avian coronavirus) diseases is among the major reproductive diseases affecting the avian production in Africa. There is scanty information on its current status and vaccination compliance among captive wild birds (CWB) and indigenous chickens (LC) in Nigeria. This study aimed to assess the exposure and the risk factors associated with IBV in CWB and LC from North-central and South west regions of Nigeria. Sera samples from 218 LC and 43 CWB were examined for IBV IgG using enzyme linked immunosorbent assay. Also, owners of LC and managers of CWB were interviewed using a pre-tested structured checklist. An overall IBV prevalence of 42.9% (112/261) was obtained. Captive wild birds and indigenous chickens had 11.6% (5/43) and 49.1% (107/218) prevalence respectively with a significant difference (p< 0.0001, OR= 7.3, 95% CI= 2.8-19.3). Also, geo-location indicated significant difference in IBV exposure among birds (p<=0.034). Furthermore, the study showed that there had never been laboratory screening on all acquired wild birds for exposure to infectious agents in the study location while none of these birds (LB/CWB) had history of vaccination. Since IBV is endemic in Nigeria, the use of vaccine for prophylactic measure should be advocated among LC and CWB owners in order to avoid unnecessary losses. Also, the essence of screening for infectious agents in newly acquired wild birds should be considered crucial for health sustenance and public safety.

Salmonella Serovars, Antibiotic Resistance, and Virulence Factors Isolated from Intestinal Content of Slaughtered Chickens and Ready-to-Eat Chicken Gizzards in the Ilorin Metropolis, Kwara State, Nigeria.

Salmonellosis is one of the most common and widely distributed food-borne diseases, and the presence of antimicrobial-resistant Salmonella in poultry and poultry products is a global public health problem. Therefore, a cross-sectional study was conducted from November 2016 to July 2017 with an aim of determining the isolation rates of Salmonella species from the intestinal contents of slaughtered chickens, the most common serotypes that invade and colonize the tissues of chickens in Ilorin, and the susceptibilities of the isolated species to commonly used antibiotics. Four hundred samples of intestinal contents from apparently healthy slaughtered chickens and one hundred ready-to-eat chicken gizzards in Ilorin, Kwara State, were examined for the presence of Salmonella and their serotypes. Salmonellae were isolated and identified according to the techniques recommended by the World Health Organization: preenrichment, selective plating, biochemical testing, and serotyping. A total number of forty-three (43) Salmonella isolates consisting of 33 from intestinal contents and 10 from ready-to-eat chicken gizzards were isolated and identified. There was an overall Salmonella prevalence rate of 8.6% (43/500), and the isolates were distributed as follows: gizzard, 2% (n = 10) and intestinal contents, 6.6% (n = 33). The predominant serovars were Salmonella enterica subsp. enterica serovar 45: d: 1, 7 (16) and S. Haifa (5). All ready-to-eat chicken gizzards were associated with Salmonella enterica subsp. enterica serovar 45: d: 1, 7 (5). The Salmonella from intestinal contents belong to Salmonella enterica subsp. enterica serovars 45: d: 1, 7 (11) and S. Haifa (5). Salmonella species isolated were 100% resistant to ciprofloxacin, ampicillin, and ceftazidime. This is followed by cloxacillin (81%), tetracycline (75%), and sulfamethoxazole (67%). The Salmonella isolates were, however, 100% sensitive to enrofloxacin, 74% to streptomycin, and 72% to gentamycin antibiotics. The most common serotype was S. enterica subsp. enterica serovar 45: d: 1, 7. All the twenty five Salmonella serovars consisting of twenty-one serotypes (n = 21), two of the Salmonella that could not be cultured after enrichment, and the two that were contaminated with Proteus possessed the virulence genes of invA and stn. The Salmonella enterica subsp. enterica serovar 45: d: 1, 7 and S. Haifa possess virulence genes so they are potentially virulent for humans in this area. The national and local health authorities in Nigeria should improve hygiene measures especially at retail slaughter markets to reduce salmonellosis which is one of the most important food-borne diseases in humans.

Comorbidities and the COVID-19 pandemic dynamics in Africa.

The debate around the COVID-19 response in Africa has mostly focused on effects and implications of public health measures, in light of the socio-economic peculiarities of the continent. However, there has been limited exploration of the impact of differences in epidemiology of key comorbidities, and related healthcare factors, on the course and parameters of the pandemic. We summarise what is known about (a) the pathophysiological processes underlying the interaction of coinfections and comorbidities in shaping prognosis of COVID-19 patients, (b) the epidemiology of key coinfections and comorbidities, and the state of related healthcare infrastructure that might shape the course of the pandemic, and (c) implications of (a) and (b) for pandemic management and post-pandemic priorities. There is a critical need to generate empirical data on clinical profiles and the predictors of morbidity and mortality from COVID-19. Improved protocols for acute febrile illness and access to diagnostic facilities, not just for SARS-CoV-2 but also other viral infections, are of urgent importance. The role of malaria, HIV/TB and chronic malnutrition on pandemic dynamics should be further investigated. Although chronic non-communicable diseases account for a relatively lighter burden, they have a significant effect on COVID-19 prognosis, and the fragility of care delivery systems implies that adjustments to clinical procedures and re-organisation of care delivery that have been useful in other regions are unlikely to be feasible. Africa is a large region with local variations in factors that can shape pandemic dynamics. A one-size-fits-all response is not optimal, but there are broad lessons relating to differences in epidemiology and healthcare delivery factors, that should be considered as part of a regional COVID-19 response framework.

Cross-species surveillance and risk factors associated with Avian Coronavirus in North-Central and South West Regions of Nigeria

@#Infectious bronchitis viral (IBV) (Avian coronavirus) diseases is among the major reproductive diseases affecting the avian production in Africa. There is scanty information on its current status and vaccination compliance among captive wild birds (CWB) and indigenous chickens (LC) in Nigeria. This study aimed to assess the exposure and the risk factors associated with IBV in CWB and LC from North-central and South west regions of Nigeria. Sera samples from 218 LC and 43 CWB were examined for IBV IgG using enzyme linked immunosorbent assay. Also, owners of LC and managers of CWB were interviewed using a pre-tested structured checklist. An overall IBV prevalence of 42.9% (112/261) was obtained. Captive wild birds and indigenous chickens had 11.6% (5/43) and 49.1% (107/218) prevalence respectively with a significant difference (p< 0.0001, OR= 7.3, 95% CI= 2.8-19.3). Also, geo-location indicated significant difference in IBV exposure among birds (p<0.034). Furthermore, the study showed that there had never been laboratory screening on all acquired wild birds for exposure to infectious agents in the study location while none of these birds (LB/CWB) had history of vaccination. Since IBV is endemic in Nigeria, the use of vaccine for prophylactic measure should be advocated among LC and CWB owners in order to avoid unnecessary losses. Also, the essence of screening for infectious agents in newly acquired wild birds should be considered crucial for health sustenance and public safety.

Seroprevalence of brucellosis and Q fever (Coxiellosis) in cattle herds in Maigana and Birnin Gwari agro-ecological zone of Kaduna State, Nigeria.

A cross sectional study was conducted to determine the seroprevalence and risk factors of brucellosis and Q fever in cattle in Maigana and Birnin Gwari agro-ecological zone of Kaduna State, Nigeria. This study aimed at determining the significance of Brucella spp. and Coxiella burnetti infections in cattle. A total of 400 sera samples (139 from males and 261 from females cattle) were collected and screened for brucellosis using Rose Bengal Plate test (RBPT) and competitive enzyme linked immunosorbent assay (cELISA) for brucellosis and indirect enzyme-linked immunosorbent assay (iELISA) for Q fever. A structured questionnaire was used to collect data on the sampled animals from the study population. Data were analyzed to determine association and risk factors. Sera analysis revealed that, 18.5 and 6.8% were seropositive by RBPT and cELISA for brucellosis, while 6.2% was seropositive by iELISA for Q fever. A significant association was detected between cattle sex and sensitivity of RBPT for detecting Brucella. Meanwhile, a non-significant association was found between cattle age and breed with sensitivity of RBPT, cELISA, and iELISA. The study indicates that brucellosis and Q ever exist with high prevalence particularly among female cattle. This presents a serious public health problem, calling for greater awareness among stakeholders and for co-ordinated surveillance for the diseases among cattle populations in Nigeria.

Probing nanoliposomes using single particle analytical techniques: effect of excipients, solvents, phase transition and zeta potential.

There has been a steady increase in the interest towards employing nanoliposomes as colloidal drug delivery systems, particularly in the last few years. Their biocompatibility nature along with the possibility of encapsulation of lipid-soluble, water-soluble and amphipathic molecules and compounds are among the advantages of employing these lipidic nanocarriers. A challenge in the successful formulation of nanoliposomal systems is to control the critical physicochemical properties, which impact their in vivo performance, and validating analytical techniques that can adequately characterize these nanostructures. Of particular interest are the chemical composition of nanoliposomes, their phase transition temperature, state of the encapsulated material, encapsulation efficiency, particle size distribution, morphology, internal structure, lamellarity, surface charge, and drug release pattern. These attributes are highly important in revealing the supramolecular arrangement of nanoliposomes and incorporated drugs and ensuring the stability of the formulation as well as consistent drug delivery to target tissues. In this article, we present characterization of nanoliposomal formulations as an example to illustrate identification of key in vitro characteristics of a typical nanotherapeutic agent. Corresponding analytical techniques are discussed within the context of nanoliposome assessment, single particle analysis and ensuring uniform manufacture of therapeutic formulations with batch-to-batch consistency.

Tocosome: Novel drug delivery system containing phospholipids and tocopheryl phosphates.

The potential of two derivatives of vitamin E, i.e. α-tocopheryl phosphate (TP) and di-α-tocopheryl phosphate (T2P), for the protection and delivery of therapeutics is being investigated in our laboratory and some promising results have been obtained so far. Novel nanocarrier systems containing TP, T2P and different lipids/phospholipids (phosphatidylcholine, stearyl amine, Phospholipon 90H, Phospholipon 100H) with and without cholesterol were prepared using Mozafari method. The preparation method did not require utilization of potentially toxic solvents, detergents or employment of harsh treatments such as sonication or high-shear force homogenization. Tocosomes, containing 5-fluorouracil (as a model drug), were shown to possess narrow size distribution, acceptable encapsulation efficiency and long-term stability (more than two years).

Prevalence and direct economic losses from bovine tuberculosis in makurdi, Nigeria.

A retrospective study was conducted to investigate the prevalence of bovine tuberculosis and direct economic losses (DEL) from tuberculosis in cattle slaughtered in Makurdi abattoirs from 2008 to 2012, using abattoir records obtained from the Ministry of Agriculture and Natural Resources. Out of 61654 cattle slaughtered during the study period 1172 (1.90%) were positive for tuberculosis lesions. The annual prevalence of bovine tuberculosis ranges from 0.90% in 2008 to 4.04% in 2012. There was significant (P < 0.05) difference in annual prevalence of bovine tuberculosis. It was also observed that there was no seasonal difference in the prevalence of bovine tuberculosis. A total of 1935 affected organs by BTB weighing 3046.50 kg, amounting to 2.91 × 10(6) Naira (1.82 × 10(4) USD), were condemned within the study period. Seasonal variation in organ condemnation due to bovine tuberculosis was significantly different (Mann-Whitney U statistics = 774 × 10(3), P = 0.034). It was concluded that bovine tuberculosis is prevalent in Makurdi and accounts for heavy economic losses due to condemnation of edible organs.

Cytotoxicity of synthesized Iron Oxide nanoparticles: toward novel biomarkers of colon cancer.

In this paper we present the preliminary results of a novel biological analysis platform for early colon cancer detection using magnetic separation of magnetized markers. The platform consists of a microfluidic structure integrated with biosensors. Super-Paramagnetic Iron Oxide nanoparticles (SPIO-NPs) were functionalized with purified DNA Aptamer and their synthesis is described. In this paper, we also present the physicochemical results of the synthesized SPIO/Au-NPs characterized by TEM and XRD. Toxicity of our synthesized biomarkers on HCT116 cell line is discussed. Based on our findings, a concentration of 1mg/ml of our biomarkers added to 5 × 105 cells per well has no effect the viability of the human cells even after 24 hours.

Assessment of carcass contamination with E. coli O157 before and after washing with water at abattoirs in Nigeria.

The study was carried out to assess the level of beef carcass contamination with Escherichia coli including O157 strains before and after washing with water. Samples of water used for washing carcasses were collected and thirty beef carcasses were swabbed within a period of one month in each of three abattoirs located in North-Western states of Nigeria. E. coli were enumerated as indicator organisms. Using conventional biochemical tests, the isolation rate of E. coli in the 120 swab samples collected in each abattoir from external and internal surfaces of the carcasses was 58.3% at Kano abattoir, 70.8% at Sokoto abattoir, while 76.7% was recorded at Zango abattoir. E. coli counts from external and internal surfaces of the carcasses were enumerated as mean log and ranged between 4.3 Log(10) and 4.6 Log(10) cfu/cm(2) before washing, while the values were 4.6 Log(10) and 4.9 Log(10) cfu/cm(2) after washing. Data analysis revealed that the increase in E. coli counts after washing carcasses with water was statistically significant (P<0.05) in all the abattoirs. However, there was no statistically significant difference (P>0.05) between the 3 abattoirs in mean log of E. coli counts from external surfaces of carcass after washing. E. coli O157 was identified from both the water and surfaces of carcasses using Latex agglutination kit. A prevalence of 2.8% of E. coli O157 was detected in 360 swab samples from 90 beef carcasses examined. E. coli counts from water used in washing carcasses were between 22 and 120 cfu/100 ml. Of the 72 water samples, 3(4.2%) were positive for E. coli O157. In conclusion, there was increased contamination of carcasses during processing and water used in washing carcasses might have contributed to carcass contamination in all the abattoirs studied due to use of non-potable water.

Using multivariate statistical methods to model the electrospray ionization response of GXG tripeptides based on multiple physicochemical parameters.

Response factors were determined for twelve GXG peptides (where G stands for glycine and X is any of alanine [A], arginine [R], asparagine [N], aspartic acid [D], glycine [G], histidine [H], leucine [L], lysine [K], phenylalanine [F], serine [S], tyrosine [Y], valine [V]) by electrospray ionization mass spectrometry (ESI-MS). The response factors were measured using a novel flow injection method. This new method is based on the Gaussian distribution of analyte concentration resulting from band-broadening dispersion experienced by the analyte upon passage through an extended volume of PEEK tubing. This method removes the need for preparing a discrete series of standard solutions to assess concentration-dependent response. Relative response factors were calculated for each peptide with reference to GGG. The observed trends in the relative response factors were correlated with several analyte physicochemical parameters, chosen based on current understanding of ion release from charged droplets during the ESI process. These include analyte properties: nonpolar surface area; polar surface area; gas-phase basicity; proton affinity; and Log D. Multivariate statistical analysis using multiple linear regression, decision tree, and support vector regression models were investigated to assess their potential for predicting ESI response based on the analyte properties. The support vector regression model was more versatile and produced the least predictive error following 12-fold cross-validation. The effect of variation in solution pH on the relative response factors is highlighted, as evidenced by the different predictive models obtained for peptide response at two pH values (pH = 6.0 and 9.0). The relationship between physicochemical parameters and associated ionization efficiencies for GXG tripeptides is discussed based on the equilibrium partitioning model.

Prevalence and Characterization of Verotocytoxin Producing Escherichia coli O157 from Diarrhoea Patients in Morogoro; Tanzania

Escherichia coli O157:H7 is an important agent of haemorrhagic colitis and haemolytic uraemic syndrome in children less than five years old and elderly people. The objective of this study was to investigate the prevalence of verotocytoxin producing E. coli 0157 (VTEC O157) among human patients with diarrhoea in Morogoro; Tanzania. Faecal samples originating from 275 human patients with diarrhoea were screened for presence of E. coli O157:H7. A total of 96 E.coli isolate were identified. Of these; 10 isolates were grouped into sorbitol non-fermenting and glucuronide negative and 49 isolates were sorbitol positive and glucuronide positive. The remaining 37 were sorbitol negative and glucuronide positive. Using the polymerase chain reaction techniques; a total of ten verotocytocin producing E. coli isolated in this study were used. The overall two (15) and one (7) of the isolated of E. coli possessed both attaching and effacing (eae A) and enterohemolysin (ehly) A genes respectively. Other enterobacterial agents including Pseudomonas spp; Proteus spp and coliforms were also isolated. The VTEC O157 isolates were 100resistant to oxytetracycline; chloramphenicol; streptomycin; and amoxyclav. In conclusion; the isolation of diarrhoeaogenic E. coli O157:H7 in this region suggests that the pathogen is an important aetiology of acute gastroenteritis in Tanzania. There is therefore; need to improve sewage and refuse disposal system; the provision of safe potable water; sanitation; personal hygiene and health education in order to reduce infection with this and other enteric pathogens

N-acetylcysteine prevents reactive oxygen species-mediated myocardial stress in patients undergoing cardiac surgery: results of a randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVE: Reactive oxygen species have been shown to contribute to myocardial stress in patients undergoing cardiac surgery, as demonstrated by myocardial 8-iso-prostaglandin-F(2)alpha and nitrotyrosine formation. We hypothesized that the reactive oxygen species scavenger N-acetylcysteine attenuates reactive oxygen species-mediated myocardial stress in patients undergoing cardiac surgery. METHODS: Forty patients undergoing coronary artery surgery (mean age +/- SD, 66 +/- 9 years; 9 women and 31 men) were randomized to receive either N-acetylcysteine (100 mg/kg into cardiopulmonary bypass prime followed by infusion at 20 mg.kg(-1).h(-1), n = 20) or placebo (n = 20). Patients and clinical staff were blinded to group assignment. Transmural left ventricular biopsy specimens collected before and at the end of cardiopulmonary bypass were subjected to immunocytochemical staining against 8-iso-prostaglandin-F(2)alpha (primary measure) as an indicator for reactive oxygen species-mediated lipid peroxidation and nitrotyrosine (coprimary measure) as a marker for peroxynitrite-mediated tissue injury. Cardiomyocyte staining was quantitatively determined by using densitometry (in gray units). Global left ventricular function was measured on the basis of fractional area of contraction by using transesophageal echocardiography. RESULTS: Patient characteristics in both groups were comparable. The change in left ventricular cardiomyocyte staining (end of cardiopulmonary bypass--before cardiopulmonary bypass) differed significantly between groups for both primary measures: 8-iso-prostaglandin-F(2)alpha, -1.8 +/- 7.5 gray units (mean +/- SD, N-acetylcysteine group) versus 5.0 +/- 4.1 gray units (placebo group; 95% confidence interval, 2.6-11.0, P =.003); nitrotyrosine, -6.4 +/- 10.0 gray units (N-acetylcysteine group) versus 9.2 +/- 8.4 gray units (placebo group; 95% confidence interval, 9.4-21.7, P <.001). Hemodynamics and clinical outcomes were comparable in both groups. CONCLUSIONS: Reactive oxygen species scavenging with N-acetylcysteine attenuates myocardial oxidative stress in the hearts of patients subjected to cardiopulmonary bypass and cardioplegic arrest.

Escherichia coli 0157: H7 reservoir, transmission, diagnosis and the African situation: a review.

OBJECTIVES: To provide an overview of the current understanding of verotoxigenic Escherichia coli 0157:H7 (VTEC) and to describe clinical picture, reservoir, transmission and diagnosis and African situations of VTEC. DATA SOURCE: A literature review was performed of major published series between 1980 and 2001 inclusive, using the PUB MED and MEDLINE search. Some earlier published series were also reviewed in instances where they directly led to the understanding of current review. STUDY SELECTION: Data from laboratory studies on cultural and isolation, serological and molecular techniques are summarised in this review. RESULTS: Verotoxigenic Escherichia coli 0157:H7 (VTEC) is an important cause of uncomplicated diarrhoea, bloody diarrhoea (BD) and haemolytic uremic syndrome (HUS) in developed countries. The incidence and importance of 0157: H7 (VTEC) infections in most developing countries are not known; however, 0157: H7 (VTEC) cases have been isolated from many sporadic cases of diarrhoea, BD and HUS, while several cases have also been associated with diarrhoeal disease outbreaks in Africa. CONCLUSION: The morbidity and mortality associated with several recent outbreaks of VTEC disease have highlighted the threat these organisms pose to public health. For this reason, there is an increasing demand for improved diagnostic procedures for detection of VTEC in clinical specimen and in particular, in foods such as meat and dairy products in developing countries.

Cardiopulmonary bypass copolymer surface modification reduces neither blood loss nor transfusions in coronary artery surgery.

OBJECTIVE: Surface-modifying additives (SMA) have been suggested for improving cardiopulmonary bypass (CPB) circuit biocompatibility, potentially minimizing inflammatory complications and bleeding associated with CPB. The purpose of this prospective, randomized clinical study was to compare a novel copolymer surface-modified CPB circuit (SMARXT; COBE Cardiovascular) against the unmodified circuit. METHODS: We randomized 122 patients with isolated coronary artery disease subjected to first-time surgery on CPB into either the SMA (n = 62) or the control group (n = 60). Exclusion criteria included renal insufficiency, liver disease, coagulopathy, anticoagulation therapy < 6 days preop, carotid artery stenosis > 70 %, and a history of stroke. We collected perioperative clinical data including drainage blood loss, transfusion requirements, duration of mechanical ventilation, and ICU stay. Platelet function was determined pre- and post-CPB. RESULTS: SMA patients received 3.2 +/- 0.9 (SD) grafts during 48 +/- 16 min of aortic cross clamp and 91 +/- 30 min CPB (Control: 3.0 +/- 0.9 grafts; p = 0.33, 46 +/- 14 min AXC; p = 0.36, and 84 +/- 23 min CPB; p = 0.14). In the SMA group, 23 patients (37 %) received red blood-cell transfusions, 9 patients (15 %) fresh frozen plasma, and 3 patients (5 %) received platelets (control: n = 27 [46 %], p = 0.44; n = 10 [17 %], p = 0.91; and n=4 [7 %], p = 0.71, respectively). Platelet count on CPB fell to the same level in both groups. In SMA patients, platelet function decreased from 94.2 +/- 24.9 % pre-CPB to 79.5 +/- 32.8 % post-CPB (p = 0.043) (control: from 87.7 +/- 25.6 % to 69.4 +/- 34.7 %; p = 0.001). Postoperative drainage blood loss, mechanical ventilation duration, and ICU stay were similar in both groups (p > 0.3). One patient of the control group was excluded due to surgical bleeding, and one SMA patient died. CONCLUSIONS: Our results show that the surface-modified CPB circuit decreased neither blood loss nor transfusions despite slightly better platelet function preservation compared to the unmodified circuit. This type of CPB circuit surface modification does not appear to improve clinical outcome in low-risk coronary artery surgery patients.

Mirtazapine for treatment of depression and comorbidities in Alzheimer disease.

BACKGROUND: Depression in patients with Alzheimer disease is a treatable cause of functional decline, caregiver burden, and mortality. It is often associated with severe weight loss, insomnia, and anxiety. These symptoms independently and collaboratively further worsen the prognosis of these vulnerable patients. An antidepressant medication with good adverse effect profile and salutary effects on these comorbid symptoms may be of significant therapeutic value in these patients. OBJECTIVE: To describe the role of mirtazapine in the treatment of depressed Alzheimer patients with comorbid weight loss, insomnia, and anxiety. CASE SUMMARY: Three patients with dementia and depression complicated by weight loss, insomnia, and anxiety were treated with mirtazapine at an outpatient memory loss clinic of a university hospital. DISCUSSION: Despite the persistence of memory loss, the patients experienced a prompt and sustained response to mirtazapine. There was a complete remission of poor appetite, weight loss, sleep disturbances, and anxiety. Other depression symptoms, including sad mood, anhedonia, and energy level, were also substantially improved. CONCLUSIONS: The clinical response of our patients underscores the usefulness of mirtazapine in the treatment of the comorbid symptoms of weight loss, insomnia, and anxiety. The effectiveness of mirtazapine in depressed Alzheimer patents may be a reflection of its enhancement of brain serotonergic and noradrenergic neurotransmission. The usefulness of mirtazapine in depressed Alzheimer patients merits further study in a large randomized, controlled, clinically comparative trial.

Impact of myocardial protection during coronary bypass surgery on patient outcome.

We have recently shown that continuous coronary perfusion with warm blood enriched with the ultra-short acting beta-blocker Esmolol (ES) improves functional and structural myocardial protection during coronary artery surgery as compared with conventional cardioplegia (CP). The purpose of the present study was to compare both myocardial protection techniques in terms of patient outcome. We retrospectively analyzed the charts of 150 consecutive patients subjected to coronary artery surgery using the ES-technique; 150 patients matched for age, gender, preoperative left ventricular function, history of renal failure, and history of neurological symptoms undergoing surgery with conventional CP during the same time period served as control group. There were no significant differences between both groups with respect to perioperative myocardial infarction rate, need for positive inotropic medication, need for mechanical circulatory support, duration of mechanical ventilation, duration of intensive care unit stay, time of mobilization, postoperative renal failure, cardiac arrhythmias, neurological symptoms, infections or in-hospital mortality. ES-patients were less frequently readmitted to the intensive care unit (ES: 3/150; 2.2% [95% confidence interval: 0-4.2%] vs. CP: 13/150; 8.7% [4.2-13.2%]; P=0.010) and total hospital stay was shorter (ES: 12.3+/-4.8 days [95% CI: 11.5-13.0] vs CP: 13.5+/-3.8 [12.9-14.1] days; P=0.0013), thus saving 159 patient days on the normal ward. Procedural costs were less for the ES-technique (US$ 60 per patient) as compared to the cardioplegia technique (US$ 120 per patient). These data suggest that myocardial protection using the ES-technique does not improve clinical outcome in patients subjected to routine coronary artery surgery, but may save costs.

Intracoronary shunt insertion prevents myocardial stunning in a juvenile porcine MIDCAB model absent of coronary artery disease.

OBJECTIVE: The relevance of regional LV myocardial ischemia/reperfusion induced by temporary left anterior descending (LAD) coronary artery occlusion during minimally invasive direct coronary artery bypass (MIDCAB) grafting is controversial. The purpose of our study was (1) to determine the impact of conventional LAD occlusion during left internal thoracic artery (LITA)-LAD anastomosis on regional LV myocardial ischemia and function, and (2) to evaluate if intra-LAD shunt insertion during LITA-LAD anastomosis prevents potential regional LV ischemia and dysfunction in a pig model. METHODS: In 20 anesthetized, mechanically ventilated pigs we performed LITA-LAD anastomosis on the beating heart without cardiopulmonary bypass during either 15 min LAD occlusion (occlusion-group; n = 10) or 15 min intra-LAD shunt insertion to maintain blood supply to the myocardium beyond the anastomosis (shunt-group; n = 10). Besides standard hemodynamics we determined the global and regional LV wall motion score index (WMSI) using epimyocardial echocardiography. To quantitate structural myocardial alteration we determined the inducible heat-shock protein-70 (HSP-70) in LV anterior wall myocardial biopsies. Data were recorded at baseline, at 15 min of LAD occlusion or shunt insertion, respectively, and at 30 min of reperfusion. At the end of the experiments we determined myocardial adenine nucleotide (ATP, ADP, AMP) and glycogen content. RESULTS: In both groups WMSI was not significantly different at 15 min LAD occlusion or shunt insertion, respectively, as compared to baseline. However, at 30 min reperfusion both global and regional WMSI demonstrated significant LV dysfunction in the occlusion-group, whereas LV function in the shunt-group remained normal. This was associated with higher myocardial HSP-70 expression in the occlusion-group (P < 0.05). Myocardial adenine nucleotide and glycogen contents were significantly better preserved in the shunt-group. CONCLUSIONS: Our data show that in a porcine MIDCAB model 15 min LAD occlusion and 30 min reperfusion result in significant myocardial stunning. In contrast, maintenance of LAD perfusion using intracoronary shunt insertion minimizes ischemia/reperfusion injury and prevents regional LV dysfunction. Although our experiments were conducted in healthy pig hearts absent from coronary artery disease, similar results may--at least partially--be expected in humans, and thus, intracoronary shunts could be a useful tool for myocardial protection during 'off-pump revascularization'.