Implementation of less-invasive surfactant administration in a Canadian neonatal intensive care unit.

BACKGROUND: Less-invasive surfactant administration (LISA) is a recent technique used extensively in Europe but rarely used in North America. The aim of this study was to describe our experience following LISA implementation using poractant in a Canadian neonatal intensive care (NICU). METHODS: A retrospective analysis was conducted from June 2017 to April 2021 of LISA procedures in preterm infants. Data were collected on patient characteristics, outcomes following LISA, laryngoscopy, and adverse events. The primary outcome was the rate of successful LISA procedures. SETTING: Level IIIa academic NICU. RESULTS: LISA was successful in 93 of 101 infants (92%). Median gestational age was 30.9 weeks (interquartile range [IQR]: 29.4-33.0). All infants received atropine and fentanyl premedication. Eight LISA procedures were unsuccessful: five because of thoracic rigidity and three because of inability to expose the vocal cords. In the 93 successful procedures, a second dose of surfactant was needed for 15 of 93 infants (16.1%), either by repeated LISA (7/15; 7.5%) or by endotracheal intubation (8/15; 8.6%). In 63.4% of successful procedures, one laryngoscopy attempt was made. The median duration of laryngoscopy attempts was 60 s (IQR: 52-110). Two types of catheters were used: the multi-access catheter (MAC) or the Angiocath in 67% and 33% of procedures, respectively. One infant had bradycardia and 30.6% had profound desaturation of <75%. CONCLUSION: LISA with poractant alfa was implemented in a Canadian NICU with a high degree of procedural success. Fentanyl may lead to more adverse events with a risk of interrupting LISA and may not be the ideal agent for this procedure. These results may encourage wider dissemination of LISA in North America.

Viral metagenomics reveals the presence of novel Zika virus variants in Aedes mosquitoes from Barbados.

BACKGROUND: The Zika virus (ZIKV) epidemic of 2015/2016 spread throughout numerous countries. It emerged in mainland Latin America and spread to neighboring islands, including the Caribbean island of Barbados. Recent studies have indicated that the virus must have already been circulating in local mosquito populations in Brazil for almost 2 years before it was identified by the World Health Organization in 2015. Metagenomic detection assays have the potential to detect emerging pathogens without prior knowledge of their genomic nucleic acid sequence. Yet their applicability as vector surveillance tools has been widely limited by the complexity of DNA populations from field-collected mosquito preparations. The aim of this study was to investigate local vector biology and characterize metagenomic arbovirus diversity in Aedes mosquitoes during the ongoing 2015/2016 ZIKV epidemic. METHODS: We performed a short-term vector screening study on the island of Barbados during the ongoing 2015/2016 ZIKV epidemic, where we sampled local Aedes mosquitoes. We reanalyzed mosquito viral microbiome data derived from standard Illumina MiSeq sequencing to detect arbovirus sequences. Additionally, we employed deep sequencing techniques (Illumina HiSeq) and designed a novel bait capture enrichment assay to increase sequencing efficiency for arbovirus sequences from complex DNA samples. RESULTS: We found that Aedes aegypti seemed to be the most likely vector of ZIKV, although it prevailed at a low density during the observed time period. The number of detected viruses increased with sequencing depth. Arbovirus sequence enrichment of metagenomic DNA preparations allowed the detection of arbovirus sequences of two different ZIKV genotypes, including a novel one. To our knowledge, this is the first report of the S3116W mutation in the NS5 gene region of ZIKV polyprotein. CONCLUSIONS: The metagenomic arbovirus detection approach presented here may serve as a useful tool for the identification of epidemic-causing arboviruses with the additional benefit of enabling the collection of phylogenetic information on the source. Apart from detecting more than 88 viruses using this approach, we also found evidence of novel ZIKV variants circulating in the local mosquito population during the observed time period.

Prevalence, molecular characteristics and antimicrobial susceptibility patterns of MRSA in hospitalized and nonhospitalized patients in Barbados.

The epidemiology and clonality of methicillin-resistant Staphylococcus aureus (MRSA) has not been investigated, as not much research or surveillance has been undertaken to identify and characterize the circulating MRSA strains in Barbados. Prevalence rates, molecular characteristics and antimicrobial susceptibility pattern of MRSA infections in hospitalized and nonhospitalized patients were investigated. A total of 293 isolates were included in the study, with 100 from the hospital and 193 from the public health laboratory. Isolates were collected over a period of 1 (2015-2016) and 3 years (2013-2016) respectively. MRSA was identified using standard microbiologic techniques and was further analysed by multiplex PCR for the presence of the spa, mec gene complex typing and PVL genes (lukS-PV and lukF-PV). A prevalence rate of 19.7% was calculated for those hospitalized. All hospital isolates were sensitive to vancomycin, rifampin, linezolid and cotrimoxazole (trimethoprim/sulfamethoxazole), whilst 82% were sensitive to clindamycin. The PVL gene was detected in 76% of hospital isolates. In the community isolates, resistance was observed in erythromycin (100%), ciprofloxacin (97.4%), clindamycin (13%) and cotrimoxazole (5.7%). There was no resistance to vancomycin. The PVL gene was detected in 97.9% of the isolates, the mecA gene in only 2.1% and the mecC gene in 0%. Most MRSA isolates were community acquired in both settings, and the antimicrobial susceptibility profile was similar, suggesting transmission of community-associated MRSA into the hospital environment. Further harmonization of antimicrobial policy for the treatment of MRSA (and by extension other pathogens) should be implemented to quell ongoing transmission. We found that 93.4% of MRSA in Barbados treated in the primary healthcare system were sensitive to cotrimoxazole. By typing MRSA isolates and drawing interferences on transmission on the basis of genetic relatedness, transmission pathways may be tracked. Further studies must be performed for this high level of comprehensiveness so that with the surveillance of MRSA, effective strategies may be developed to prevent or limit transmission.

Long-term epidemiological dynamics of dengue in Barbados - one of the English-speaking Caribbean countries.

Using the dengue surveillance program, we prospectively collected data on all the suspected and confirmed cases of dengue in Barbados from 2006 to 2015. Data were analysed for demographic, seasonal and temporal dynamics of this disease in this country. The overall mean annual incidence rate of suspected and confirmed dengue over the study period was 0.49% (range 0.15%-0.99%) and 0.16% (range 0.05%-0.48%), respectively. There was a significant correlation between the mean monthly number of confirmed cases, the mean monthly rainfall and the mean monthly relative humidity percentage. Dengue in this population is predominantly an infection affecting children and young adults. The median age of the patients with both, suspected and confirmed dengue was 25 years and the highest proportion of cases was seen in the age group 0-15 years. The annual incidence rates of both the suspected and the confirmed cases showed an upward trend during the study period and this upward trend was more pronounced among children.

Epidemiological Trend and Clinical Observations among Children and Adults with Dengue in Barbados.

OBJECTIVE: To describe the epidemiological characteristics and the clinical manifestations of the confirmed dengue cases over a ten-year period in Barbados, one of the English-speaking Caribbean countries. METHODS: All the cases of confirmed dengue from 2000 to 2009 were retrospectively studied. Long-term trends in incidence rate, demographic characteristics such as age, gender and seasonal distribution; clinical manifestations, immunological characteristics, need for hospitalization and mortality were studied. RESULTS: There were 3413 confirmed cases of dengue including 778 (22.8%) children and 2635 (77.2%) adults. The mean annual incidence rate of dengue was 1.36/1000 population. The median age of the persons with confirmed dengue was 27 years. The largest number of cases was seen in the 11 to 16-year age group. Hospitalization was required in 13.1% of dengue cases; 72.5% and 84% of all dengue were secondary infections among the children and adults, respectively. Dengue haemorrhagic fever accounted for 2.2% and 6% of all confirmed dengue among children and adults, respectively. The overall case fatality rate in this study was 0.35%. CONCLUSIONS: Dengue is a significant health problem primarily in adolescents and young adults. It is characterized by less severe cases and lower mortality rate.

Trends in the patterns of IgM and IgG antibodies in febrile persons with suspected dengue in Barbados 2006-2013

OBJECTIVES: To describe the seroprevalence of dengue antibodies in febrile suspected persons and investigated for dengue in this country. DESIGN AND METHODS: This was a retrospective population based study of all febrile children and adults with probable dengue from 2006 to 2013. Persons with probable dengue were investigated for dengue IgM and IgG antibodies in the blood sample drawn between days 3 to 5 of their illness. RESULTS: Among the 8296 cases that were tested for IgM antibodies, 2605 (36.6%) cases tested positive. Of the 7227 suspected cases who were tested for IgG, 5473 (75.7%) were positive. During the study years, between 80% and 90% of persons older than 20 years had a positive IgG antibody. Among the persons younger than five years (excluding the first year), between 10% and 20% had a positive IgM titre and a negative IgG titre, between 5 and10% had a positive IgM and IgG titre, 5% had a positive IgG titre and a negative IgM titre and between 45% and 65% had a negative IgM and a negative IgG titre. Between 37% and 59% had a serological evidence of past dengue in absence of any current dengue. CONCLUSIONS: The pattern of IgG antibodies seen in this study was comparable to those seen in the countries known to be hyperendemic for dengue. Based on the pattern of antibodies, the age of infection was likely to shift down to younger age groups with the likelihood of more severe forms of dengue in the future.

Influence of diabetes on endothelial cell response during sepsis.

AIMS/HYPOTHESIS: Several endothelial pathways of cell adhesion, coagulation and vascular endothelial growth factor (VEGF) signalling are activated during sepsis. The objective of this analysis was to investigate the influence of diabetes on biomarkers of endothelial cell activation in sepsis. METHODS: This was a prospective observational cohort study of a convenience sample of adult patients (age ≥ 18 years) for whom infection was clinically suspected and who presented to an urban tertiary care emergency department between February 2005 and November 2008. We investigated the association of diabetes and sepsis with various endothelial activation biomarkers of cell adhesion (E-selectin, vascular cell adhesion molecule 1 [VCAM-1] and intercellular adhesion molecule 1 [ICAM-1]), coagulation (plasminogen activator inhibitor 1 [PAI-1]) and VEGF signalling (soluble fms-like tyrosine kinase-1 [sFLT-1]). RESULTS: A total of 207 patients (34% with sepsis, 32% with severe sepsis and 34% with septic shock) were studied, including 63 (30%) with diabetes. Compared with patients without diabetes, patients with diabetes had significantly increased E-selectin and sFLT-1 levels overall; this was most pronounced during septic shock in the stratified analysis. Multivariate models including age, sex, sepsis severity and other variables as potential covariates confirmed the association of diabetes with elevated circulating plasma levels of E-selectin (standardised ß 0.24, p < 0.001) and sFLT-1 (standardised ß 0.19, p < 0.01), but there was no significant association with VCAM-1, ICAM-1 or PAI-1. CONCLUSIONS/INTERPRETATION: During septic shock, patients with diabetes had higher levels of circulating biomarkers of endothelial cell adhesion (E-selectin) and VEGF signalling (sFLT-1). Future studies should address whether enhanced activation of the endothelium places patients with diabetes at increased risk for the development of sepsis and worsening morbidity and mortality.

Seroprevalence of toxoplasmosis, leptospirosis and brucellosis in sugarcane fieldworkers in Trinidad and Tobago / Seroprevalencia de la toxoplasmosis, la leptospirosis y la brucelosis en los trabajadores de las plantaciones de caña de azúcar en Trinidad y Tobago

Sugarcane field-workers, like rice field-workers, livestock farmers and abattoir workers are known to be occupationally exposed to zoonotic agents. The study determined the seroprevalence of immunoglobulins to Toxoplasma gondii (IgM), Leptospira spp (IgM) and Brucella abortus (IgG) in sugarcane field-workers across weighing stations in the island of Trinidad. In addition, the association of risk factors to infections by the three zoonoses was investigated. Blood samples were collected from consenting apparently healthy sugarcane field-workers across the island of Trinidad. Current/acute infection in individuals was determined in the sera of individuals using the enzyme immunoassay (EIA) for T gondii IgM antibodies, enzyme-linked immunosorbent assay (ELISA) for Leptospira spp IgM immunoglobulins and both buffered plate agglutination test (BPAT) and competitive ELISA for B abortus IgG antibodies. The seroprevalence of IgM immunoglobulins to T gondii was 15.7% (64 of 407) and to Leptospira spp was 0.7% (5 of 704) and the difference was statistically significant (p 0 < 0.05; χ2). All 704 samples tested for B abortus IgG immunoglobulins were negative. All risk factors (age, gender, race and type of work done) were not statistically significantly (p > 0.05; χ2) associated with infections by T gondii and Leptospira spp. It was concluded that sugarcane field-workers in Trinidad were at high risk of acute toxoplasmosis and, to a lesser extent, to leptospirosis. The fact that the four risk factors studied were not significantly associated with T gondiiand Leptospira spp infections suggests that they may not be important in the epidemiology of both diseases in the population studied.

Se sabe que los trabajadores de las plantaciones de caña de azúcar - al igual que los trabajadores de los campos de arroz, la ganadería y los mataderos - se hallan expuestos a agentes zoonóticos debido a su ocupación. El estudio determinó la seroprevalencia de las inmunoglobulinas en relación con Toxoplasma gondii (IgM), Leptospira spp (IgM) y Brucella abortus (IgG) en los trabajadores cañeros a lo largo de las estaciones de pesaje en la isla de Trinidad. Además, se investigó la asociación de factores de riesgo de infecciones por las tres formas de zoonosis. Se obtuvieron muestras de sangre a lo largo de la isla de Trinidad, tomadas de trabajadores cañeros de apariencia saludable, que dieron su consentimiento. La infección aguda presente en los individuos, fue determinada en sus sueros mediante el inmunoensayo enzimático (IEE) para anticuerpos de T gondii IgM, el ensayo inmunosorbente vinculado a enzimas (ELISA) para inmunoglobulinas frente a Leptospira spp IgM, y la prueba de aglutinación tamponada en placa (BPAT) así como el ELISA competitivo para anticuerpos de B abortus IgG. Palabras claves: toxoplasmosis, leptospirosis, brucelosis, trabajadores cañeros, Trinidad. La seroprevalencia de inmunoglobulinas IgM para T gondii fue de 15,7% (64 de 407) en tanto que para la Leptospira spp fue 0,7% (5 de 704). La diferencia fue estadísticamente significativa (p 0 < 0.05; c²). Las 704 muestras sometidas a la prueba de inmunoglobulinas para B abortus IgG, fueron negativas. Los factores de riesgo (edad, género, raza y tipo de trabajo realizado) no estuvieron significativamente asociados (p > 0.05; c²) de manera estadística con las infecciones por T gondii y Leptospira spp Se llegó a la conclusión de que los trabajadores cañeros de Trinidad presentaban un alto riesgo de toxoplasmosis aguda y, en menor medida, de leptospirosis. El hecho de que los cuatro factores de riesgo estudiados no estaban significativamente asociadas con T gondiiy a infecciones de Leptospira spp, sugiere que puede que no sean importantes en la epidemiología de ambas enfermedades en la población estudiada.

An analysis of the subtypes of dengue fever infections in Barbados 2003-2007 by reverse transcriptase polymerase chain reaction.

BACKGROUND: To perform a retrospective analysis of patients with IgM antibodies to dengue fever infection to determine the serotypes present by molecular techniques. A representative sample (approximately 20%/per year) of patients diagnosed with dengue fever infection were selected based on the detection of IgM antibodies in the acute phase serum sample. RNA was extracted from each sample and reverse transcribed. Following this, the amplicons were electrophoresed and serotyped based on band sizes. RESULTS: This study consisted of 71 males and 101 females ranging in age from 0 - 50+ yrs giving a total of 172 persons with an average of 34.4 patients per year. Onset averaged 6.9 days ranging from 0-90 days. Common symptoms were as follows: fever (69%), headache (52%), arthralgia (36%), ocular pain (32%), emesis (15%) and lumbar pain (15%). All patients investigated with the exception of one, were infected with DENV-3. CONCLUSION: DENV-3 is currently circulating on the island and not DENV-1 or DENV-2 as in previous years. This has implications for the enhancement of clinical, laboratory and environmental surveillance systems.

Effects of cocaine on c-fos and NGFI-B mRNA expression in transgenic mice underexpressing glucocorticoid receptors.

Numerous evidences suggest that stress and stress-related hormones can modulate the activity of the brain reward pathway and thus may account for individual vulnerability towards the reinforcing effects of drugs of abuse. Transgenic (TG) mice expressing an antisense mRNA against the glucocorticoid receptor (GR), which partially blocks GR expression, were used to assess the role of GR dysfunction on cocaine (COC)-induced c-fos and Nerve-Growth Factor Inducible-B (NGFI-B, or Nur77) gene expression. These two genes belong to different families of transcription factors and have been shown to be modulated by various dopaminergic drugs. TG and wild-type (WT) mice were both acutely and repeatedly treated with COC (20 mg/kg, i.p.). In the chronic experiment, mice received a 5-day treatment of COC and were challenged 5 days later with COC or vehicle. Locomotor activity was assessed during the entire chronic experiment in the mouse home cages. Animals were sacrificed 1 h after the last injection and NGFI-B and c-fos mRNA levels in the prefrontal cortex, the nucleus accumbens and the striatum were measured by in situ hybridization. Acute COC administration led to significantly smaller c-fos increases in TG mice compared to WT, whereas repeated COC treatment potentiated c-fos induction both in TG and WT mice to equivalent levels. TG mice displayed higher basal NGFI-B expression in the nucleus accumbens and the level of NGFI-B mRNA was differently modulated by COC in TG mice compared to WT mice. In accordance with data on c-fos expression, behavioral data indicate a blunted locomotor effect on the first COC injection in TG mice, a phenomenon corrected by the repeated COC treatment. These results suggest that an alteration of the hypothalamus-pituitary-adrenal axis can modify COC-induced regulation of the transcription factors c-fos and NGFI-B, and that these changes parallel those seen at the behavioral level. It also demonstrates that the differences at the behavioral and molecular levels noted between TG and WT mice after acute COC injection disappear following repeated COC administration, suggesting that repeated COC has a greater impact in TG mice underexpressing GRs.

Age-appropriate HIV prevention messages for older adults: findings from focus groups in New York State.

The Emerging Issues Committee of the New York State HIV Prevention Planning Group identified that prevention messages were not including persons 50 and older and that 15 percent of the newly reported AIDS cases in 1997 in New York were in this age group. Recognizing that there may be unique needs in targeting prevention messages for this age group, a consultant conducted five focus groups throughout the state to speak with people to determine what they identified as unique themes related to HIV prevention for this age group.

Suprathreshold stochastic firing dynamics with memory in P-type electroreceptors.

Weakly electric fish generate a periodic electric field as a carrier signal for active location and communication tasks. Highly sensitive P-type receptors on their surface fire in response to carrier amplitude modulations (AM's) in a noisy phase locked fashion. A simple generic model of receptor activity and signal encoding is presented. Its suprathreshold dynamics, memory and receptor noise reproduce observed firing interval distributions and correlations. The model ultimately explains how smooth responses to AM's are compatible with its nonlinear phase locking properties, and reveals how receptor noise can sometimes enhance the encoding of small yet suprathreshold AM's.

[The formation of Quebec's urban populations: the Saguenay region in the nineteenth and twentieth centuries]. / La formation des populations urbaines au Quebec: les cas du Saguenay aux XIXe et XXe siecles.

The author explores trends in urbanization during the nineteenth and twentieth centuries for the Saguenay region of Quebec province, Canada. He finds that "the Saguenay region experienced rapid urbanization at the end of the 19th century....Towns...attracted large numbers of immigrants from various geographic origins, with a marked male dominance. Flows from the East of Quebec...increased significantly (rural exodus) while new recruitment areas appeared in the more distant and more urbanized regions of western Quebec (selective outmigration)." (SUMMARY IN ENG AND SPA)

Cerebrospinal fluid proteins in multiple sclerosis.

Various CSF proteins were studied in 255 definite multiple sclerosis patients at various disease stages and compared with corresponding values obtained from 174 controls. The CSF changes in acute multiple sclerosis patients included a significant increase of total proteins and of gamma globulin, IgG, IgA, IgM, alpha-2 ceruloplasmin, 7S-gamma-1, and cytotoxic index for nerve cells in tissue culture, and significant decreases of pre-albumin, alpha-1, and alpha-2 and of the beta/gamma globulin ratio. The CSF levels of IgG, IgA, and IgM remained significantly higher in steroid-treated multiple sclerosis patients than in controls, but the levels often were significantly reduced while patients were on treatment or in remission. During remission or treatment with ACTH and/or steroids, the alpha-2 ceruloplasmin, 7S-gamma-1, and cytotoxic index were significantly reduced and the pre-albumin, alpha-1, and alpha-2 globulin classes and the beta/gamma ratio showed a tendency to return to normal.