Zoonotic and emerging orbivirus infections.

Many novel emerging orbiviruses have been isolated in the past 15 years. Important viruses include Peruvian horse sickness virus (PHSV) and Yunnan orbivirus (YUOV), pathogens of equids which were originally isolated almost simultaneously from 1997 to 1999 in the People's Republic of China, Australia and Peru. YUOV has also been isolated from cattle, sheep and a dog. The isolation of YUOVfrom a dog is not the first case of an orbivirus being isolated from a carnivore. Bluetongue virus and African horse sickness virus were earlier detected in carnivores which fed on contaminated meat. PHSV and YUOV both offer an opportunity to study the emergence of a single pathogen in geographically distant locations, although the original point of emergence is still unidentified. PHSV has been isolated from horses with neurological disease both in Australia and in Peru (where it is now endemic). Serological and molecular diagnostic assays have been developed for these viruses to assist in their identification and diagnosis. Other orbiviruses, such as Palyam virus and Equine encephalosis virus, have more recently been identified outside their geographical boundaries and may represent a threat to domesticated livestock and horses, respectively. The article also reviews four zoonotic orbivirus species (Corriparta virus, Changuinola virus, Kemerovo virus and Orungo virus) which have been identified in livestock and/or wildlife.

Association of Biofilm Inducer with bla VIM, bla IMP, and bla NDM in Pseudomonas aeruginosa Isolates.

Pseudomonas aeruginosa (P. aeruginosa) is a ubiquitous opportunistic organism that is hard to treat. This study aimed to investigate the association of bla VIM, bla IMP, and bla NDM prevalence with Cyclic di-GMP (c-di-GMP) in P. aeruginosa. To this end, 27 clinical isolates of P. aeruginosa were obtained from different hospitals in Baghdad, Iraq. The phenotypic detection of carbapenem and biofilm assays was performed by the M63 minimal medium, supplemented with glucose, magnesium sulfate. The polymerase chain reaction was utilized to detect carbapenem genes. The results showed that the isolates were highly resistant to Imipenem (37%) and Meropenem (63%). Imipenem (37%) and Meropenem (63%) demonstrated a moderate sensitivity against P. aeruginosa. The P. aeruginosa No.5 showed high resistance to carbapenem by bla VIM +, bla IMP +, and bla NDM +, followed by a robust biofilm confirmed with c-di-GMP levels and the twitching motility ability. Upon these findings, the use of antibiotics should be restricted to severe bacterial infections to avoid the rapid emergence of new resistant isolates, which leads to the hard treatment of infection with P. aeruginosa. It is highly recommended that these findings be notified for infectious control. Future studies can investigate the link between transferable resistant genes and c-di-GMP values.

Tsukamurella tyrosinosolvens intravascular catheter-related bacteremia in a haematology patient: a case report.

Tsukamurella spp. are a rare but important cause of intravascular catheter-related bacteremia in immunocompromised patients. The organism is an aerobic, Gram-positive, weakly acid-fast bacillus that is difficult to differentiate using standard laboratory methods from other aerobic actinomycetales such as Nocardia spp., Rhododoccus spp., Gordonia spp., and the rapid growing Mycobacterium spp. We report a case of Tsukamurella tyrosinosolvens catheter-related bacteremia in a 51-year-old haematology patient who responded to treatment with imipenem and subsequent line removal. 16srRNA sequencing allowed for the prompt identification of this organism.

Incidence and implications of acute kidney injury in patients hospitalized with acute decompensated heart failure.

Acute kidney injury (AKI) is a common complication in patients hospitalized with heart failure (HF). There is a paucity of research on the incidence and consequences of AKI among patients hospitalized with HF who do not have evidence of chronic kidney disease (CKD). The National Inpatient Sample database was used to identify index hospitalizations for acute HF from January 2012 through September 2015. The incidence of new-onset AKI was determined, and the study population was divided into two groups: HF with AKI (HFwAKI) and HF without AKI (HFwoAKI). These groups were further divided into the subgroups HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). A total of 2,010,095 index hospitalizations for HF were identified. The incidence of new-onset AKI was found to be ~ 20% for this population. In a fully adjusted model, in-hospital mortality was higher in the HFwAKI group (adjusted OR 3.63, P ≤ 0.001) and higher among patients with HFrEF (adjusted OR 3.85), as opposed to patients with HFpEF (adjusted OR 3.21). Similarly, length of stay and cost of care for the HFwAKI group were significantly higher as well. New-onset AKI among hospitalizations for HF poses a significant health problem, especially considering the increasing prevalence of HF. Further research into the causes of AKI among HF hospitalizations is, therefore, important as it will enable the development of treatment strategies to prevent AKI in HF hospitalizations and, consequently, benefit both the patients and health care system of the United States.

Adverse reactions to fluorescein angiography: A comprehensive review of the literature.

We reviewed literature on adverse reactions to intravenous fluorescein angiography using PubMed and found 78 articles in English from 1961 to 2017. The reported rates of adverse reactions were overall 0.083-21.69%, separated into mild (1.24-17.65%), moderate (0.2-6%), and severe (0.04-0.59%). There were 1:100,000 to 1:220,000 deaths. Fluorescein concentration, volume injected, speed of injection, temperature, and contaminants were not correlated with the incidence of reactions. Patient characteristics including other comorbid diseases, allergy history, age, race, and gender showed only an increased rate of reaction in patients with a history of reaction to fluorescein. Although a number of studies examine techniques to reduce adverse reactions to intravenous fluorescein angiography, to date, the only proven method is reviewing allergy history, specifically a history of previous reaction to fluorescein.

Comparison of Baseline Characteristics and In-hospital Outcomes in Medicaid Versus Private Insurance Hospitalizations for Atrial Fibrillation.

The prevalence of atrial fibrillation (Afib) has been increasing over the past few decades. There are very few comparisons of health insurance plans available that incorporate measurement of co-morbidities and in-hospital outcomes. We sought to compare an impact of Medicaid versus private insurance (PI) on outcomes in hospitalizations with Afib. The US National Inpatient Sample database from years January 2010 to September 2015 was used to identify adult (≥18 years) Afib hospitalizations, whose payment source was either Medicaid or PI. We included propensity score-matched analysis for comparison of outcomes between the groups. In a total of 3,264,258 Afib hospitalizations, 22.9% hospitalizations were insured with Medicaid, while 77.1% had PI. Compared with PI, Medicaid beneficiaries (MB) were younger (59 vs 64 years), fewer were men (55.15% vs 63.16%), and fewer were Caucasians (52.66% vs 81.67%; all p<0.0001). As suggested by Charlson co-morbidity index ≥3, more MB (40.86%) had the significantly higher burden of co-morbidities compared with PI (29.87%; p<0.0001). About 83% of Afib hospitalizations had a CHA2DVASC2 score ≥2 in both the groups. After adjusting for confounders, in-hospital mortality was significantly higher (4.8% vs 4.3%, p = 0.02) in MB compared with PI. In MB, 55.3% hospitalizations were discharged to home and their median length of hospital stay was 5 days, whereas 61.3% hospitalizations with PI were discharged to home and their median length of stay was 4 days (p<0.0001). In conclusion, this extensive study of Afib hospitalizations, Medicaid group had greater co-morbidities, marginally higher in-hospital mortality, longer length of stay, and lesser disposition to home as compared with PI group.

'Acute leukemia in congenital methehemoglobinemia - an enigma to explore'.

Congenital methemoglobinemia is a rare disease, resulting in increased oxygen affinity and impaired oxygen delivery to the tissues. While there have been studies that have linked acquired methemoglobinemia in almost 79% of leukemia patients, to the best of our knowledge, this is the first case of leukemia development in a patient with congenital methemoglobinemia. Chronic deprivation of oxygen to metabolically active bone marrow can theoretically lead to hematopoietic disorders. It would be interesting to further investigate if presence of congenital methemoglobinemia is a risk factor for developing acute leukemia.

Recurrent Unilateral Transudative Pleural Effusion Due to Low Flow, Low Gradient Severe Aortic Stenosis.

BACKGROUND In symptomatic severe aortic stenosis (AS), the majority of patients have high gradient AS. However, some patients have an AS gradient less than 40 with a valve area under 1.0 cm². For patients with a low gradient, severe AS is difficult to detect and requires a high index of suspicion. Transcatheter aortic valve replacement (TAVR) is currently recommended for patients with moderate to high risk AS according to the Society of Thoracic Surgery (STS) risk score. CASE REPORT Here we present the case of an 86-year-old female with recurrent pleural effusion over the course of 2-year; she had multiple thoracentesis procedures and was being considered for a pleurodesis. Later the patient was found to have severe AS; an echocardiogram showed an aortic valve (AV) area of 0.67 cm², AV mean gradient of 34 mmHg, and ejection fraction of 75%. The patient underwent a diagnostic cardiac catheterization and was treated with TAVR. CONCLUSIONS The diagnosis was made after exclusion of all other causes of unilateral pleural effusion and was confirmed by improvement of effusion following the TAVR procedure.

Targeting genes in insulin-associated signalling pathway, DNA damage, cell proliferation and cell differentiation pathways by tocotrienol-rich fraction in preventing cellular senescence of human diploid fibroblasts.

BACKGROUND AND OBJECTIVES: Tocotrienols have been known for their antioxidant properties besides their roles in cellular signalling, gene expression, immune response and apoptosis. This study aimed to determine the molecular mechanism of tocotrienol-rich fraction (TRF) in preventing cellular senescence of human diploid fibroblasts (HDFs) by targeting the genes in senescence-associated signalling pathways. MATERIALS AND METHODS: Real time quantitative PCR (qRT-PCR) was utilized to evaluate the expression of genes involved in these pathways. RESULTS: Our findings showed that SOD1 and CCS-1 were significantly down-regulated in pre-senescent cells while CCS-1 and PRDX6 were up-regulated in senescent cells (p<0.05). Treatment with TRF significantly down-regulated SOD1 in pre-senescent and senescent HDFs, up-regulated SOD2 in senescent cells, CAT in young HDFs, GPX1 in young and pre-senescent HDFs, and CCS-1 in young, pre-senescent and senescent HDFs (p<0.05). TRF treatment also caused up-regulation of FOXO3A in all age groups of cells (p<0.05). The expression of TP53, PAK2 and CDKN2A was significantly increased in senescent HDFs and treatment with TRF significantly down-regulated TP53 in senescent cells (p<0.05). MAPK14 was significantly up-regulated (p<0.05) in senescent HDFs while no changes was observed on the expression of JUN. TRF treatment, however, down-regulated MAPK14 in young and senescent cells and up-regulated JUN in young and pre-senescent HDFs (p<0.05). CONCLUSIONS: TRF modulated the expression of genes involved in senescence-associated signalling pathways during replicative senescence of HDFs.

Increasing social and psychological information conveyed to General Practitioners after bad news consultations by use of separate letters from the Lung Cancer Nurse Specialist.

Multidisciplinary teams (MDT) now review all cases of lung cancer. These teams include a Lung Cancer Nurse Specialist (LCNS). These Nurses help support the patient and should facilitate communication and liaise with other services. The LCNS is present when the diagnosis is given to the patient but also usually spends time afterwards with the patient and their family. We postulated that a separate letter from the LCNS to the General Practitioner (GP) after the consultations would convey extra information to the GP. In 58 new lung cancer patients reviewed in the clinic, the LCNS and Physician independently wrote separate letters after the consultation in which the diagnosis of lung cancer was given. The GPs were asked by questionnaire about the usefulness of the letter from the LCNS. This letter was considered by the GP to provide extra information in: (i) 69% concerning the patients reaction to the diagnosis; (ii) 85% concerning who attended the clinic with the patient; (iii) 85% about what referrals were made to community services; (iv) 86% about who the patient was living with; (v) 81% about who the patients carers were; (vi) 81% information on the patients condition; (vii) 70% concerning the information given to patients about benefits. Ninety-seven percent of the GPs found the LCNS letter useful or very useful and 92% of the GPs thought that the information in the letter would be useful or very useful when they next saw the patient. Separate and independent letters from the LCNS after "bad news" consultation in lung cancer provides added useful information for GPs. Ninety-one percent of the GPs wanted the letters from the LCNS to continue.

Malaysianol A, a new trimer resveratrol oligomer from the stem bark of Dryobalanops aromatica.

A new resveratrol trimer, malaysianol A (1), five known resveratrol oligomers: laevifonol (2), ampelopsin E (3), α-viniferin (4), ε-viniferin (5), diptoindonesin A (6), and bergenin (7) have been isolated from the acetone extract of the stem bark of Dryobalanops aromatica by combination of vacuum and radial chromatography techniques. Their structures were established on the basis of their spectroscopic evidence and comparison with the published data. The cytotoxic activity of the compounds was tested against several cell lines in which compound 4 was found to inhibit strongly the growth of HL-60 cell line.

Genus Coltivirus (family Reoviridae): genomic and morphologic characterization of Old World and New World viruses.

We report a genomic and morphologic study of the European Eyach (EYA) virus (genus Coltivirus, family Reoviridae) and a comparative analysis with the American Colorado tick fever (CTF) virus (the type species of the genus). The previously established, but distant, antigenic relationship between these viruses was strengthened by genetic findings (presence of cognate genes, amino acid identity between 55 and 88%, similar conserved terminal motifs, suspected read-through phenomenon in segment 9 of both viruses) and by indistinguishable ultramicroscopic morphologies. Moreover, putative constitutive modifying enzyme activities were suspected to be carried out by homologous viral proteins (RNA-dependent RNA polymerase, methyl/guanylyl transferase, NTPase). These findings, together with the comparative analysis to genomes of southeast Asian isolates, support the recent classification of arboviruses with 12 segments of dsRNA within two distinct genera (genus Coltivirus and genus Seadornavirus) and raise interesting questions about the evolutionary origins of coltiviruses. The previously proposed hypothesis that EYA virus was derived from an ancestral virus introduced in Europe with the migration of lagomorphs from North-America, would imply a divergence date between American and European isolates of over 50 million years ago (MYA). This analysis allows for the first time to propose an evolutionary rate for virus dsRNA genomes which was found to be in the order of 10(-8) to 10(-9) mutations/nt/year, a rate similar to that of dsDNA genomes.