Predicting mortality in cardiogenic shock secondary to ACS requiring short-term mechanical circulatory support: The ACS-MCS score.

OBJECTIVE: To identify predictors of 30-day all-cause mortality for patients with cardiogenic shock secondary to acute coronary syndrome (ACS-CS) who require short-term mechanical circulatory support (ST-MCS). BACKGROUND: ACS-CS mortality is high. ST-MCS is an attractive treatment option for hemodynamic support and stabilization of deteriorating patients. Mortality prediction modeling for ACS-CS patients requiring ST-MCS has not been well-defined. METHODS: The Utah Cardiac Recovery (UCAR) Shock database was used to identify patients admitted with ACS-CS requiring ST-MCS devices between May 2008 and August 2018. Pre-ST-MCS clinical, laboratory, echocardiographic, and angiographic data were collected. The primary endpoint was 30-day all-cause mortality. A weighted score comprising of pre-ST-MCS variables independently associated with 30-day all-cause mortality was derived and internally validated. RESULTS: A total of 159 patients (mean age, 61 years; 78% male) were included. Thirty-day all-cause mortality was 49%. Multivariable analysis resulted in four independent predictors of 30-day all-cause mortality: age, lactate, SCAI CS classification, and acute kidney injury. The model had good calibration and discrimination (area under the receiver operating characteristics curve 0.80). A predictive score (ranging 0-4) comprised of age ≥ 60 years, pre-ST-MCS lactate ≥2.5 mmol/L, AKI at time of ST-MCS implementation, and SCAI CS stage E effectively risk stratified our patient population. CONCLUSION: The ACS-MCS score is a simple and practical predictive score to risk-stratify CS secondary to ACS patients based on their mortality risk. Effective mortality risk assessment for ACS-CS patients could have implications on patient selection for available therapeutic strategy options.

The most common spoligotype of Mycobacterium bovis isolated in the world and the recommended loci for VNTR typing; A systematic review.

Mycobacterium bovis is a neglected zoonotic organism that epidemiological studies are of crucial importance in identifying its source, control it and prevent it from spreading. The aim of this study was to investigate the most common spoligotypes of Mycobacterium bovis circulating around the world and introduce the most and least strong determine powers of loci for VNTR. We have used different databases such as ISC, science direct, Embase (Elsevier), Web of Science, Scopus and Medline via PubMed. Searches were performed by key words including: Mycobacterium bovis, MIRU -VNTR, spoligotyping and discrimination power. Finally, thirty-one articles were selected after filtering out some titles, abstracts and full texts. Spoligotype SB0120 was the most common circulating type on several continents while SB0121 existed in Europe, Africa and America. SB0140 was also detected in Asia, Europe and America. QUB3232 and QUB11b were more appropriate loci among the loci with high discriminatory power. MIRU 10 and MIRU4 were among the loci with poor discriminatory power. Taking the published data into consideration, SB0120 and SB0121 are predominant spoligotypes of M. bovis circulating among animals around the world. Determining the most common spoligotype of M. bovis is the key to find source of infection, control and prevent the disease.

Characterization of New Leprosy Cases in Northeast of Iran within the Last 15 Years.

Leprosy is a neglected disease. The insidious onset of leprosy results in its late diagnosis and therefore the spread of the disease. Characterization of leprosy in areas with higher risk and collection of enough information about these spots to adopt more effective controlling measures are of great importance. In the present study, data for every patient who either referred to the health care center for leprosy or had had similar leprous symptoms between 2002 and 2016 were collected. Forty-two new cases of leprosy were identified with 28 of them being Iranian and 14 from Afghanistan. All patients were older than 15. 26.2% of the patients were women and 73.8% were men. According to World Health Organization (WHO) protocol, 36 patients (85.7%) were diagnosed to have been affected by the Multi Bacillary form; and among those patients, 61.9%, 19.05%, and 19.05% suffered from grade 1, 0, and 2 of the disease, respectively. There was a significant relationship between disability grading and sex (P=0.032), with grade 1 disability happening more often in men. Another significant relationship was also observed between Multi Bacillary form and nationality (P=0.011) indicating that Multi Bacillary form is more common among Iranians. With 0.02 leprosy cases in 10000 people, Iran is at elimination phase of the disease; however, identification of new cases in our region demands constant controlling programs and establishment of strict policies. Fortunately, the few numbers of patients diagnosed with leprosy in Northeast of Iran shows successful implementation of such policies under the scrutiny of the public health authorities.

Genotyping of Mycobacterium tuberculosis complex isolated from humans and animals in northeastern Iran.

The objective of this study was to genotype Mycobacterium tuberculosis complex isolated from humans and cattle in northern Iran. Over the course of one year, a total of 120 human and 21 cattle isolates were tested using region of difference (RD)-based polymerase chain reaction (PCR) and mycobacterial interspersed repetitive unites-variable number tandem repeats (MIRU-VNTR). In M. tuberculosis, out of 120 isolates investigated, the most common genotype detected was NEW-1 (53.3%), followed by CAS/ Delhi (24.1%), Haarlem (5%), Beijing (4.16%), Uganda I (4.16%), S (3.3%), Ural (0.83%), TUR (0.83%), Uganda II (0.83%), Lam (0.83%) and Cameroon (0.83%). The HGDI rate was 0.9981 and the clustering rate was 10.83. Of the isolates, QUB26 had the highest allele diversity (h: 0.76), while the loci Mtub29 and MIRU24 had the lowest (h: 0). In M. Bovis, out of 123 collected tissue samples, 21 (17%) grew on culture media. The HGDI rate was 0.71 and clustering rate was 85.7%. The locus ETRC had the highest allele diversity (h: 0.45). The findings of this study suggest that there is high genetic diversity among M. tuberculosis isolates in Khorasan Razavi Province, which is consistent with similar results from other studies in other provinces in Iran and neighboring countries. This indicates that the prevalent genotypes in this study are spreading in the Middle East region. Furthermore, considering that M. Bovis isolates were identified in two clusters, it seems that all of them have a common origin and are circulating among the livestock farms in the province.

Virulence factors analysis and antibiotic resistance of uropathogenic Escherichia coli isolated from patients in northeast of Iran.

BACKGROUND AND OBJECTIVES: Escherichia coli is known to be the pathogen commonly isolated from those infected with urinary tract infections (UTIs). The aim of this study was to investigate the presence of E. coli virulence genes and antibiotics' resistance pattern among clinical isolates in the Northeast of Iran. Relationships between virulence genes and antimicrobial resistances were studied as well. MATERIALS AND METHODS: Three hundred isolates of E. coli were isolated from patients with UTIs that referred to Ghaem and Imam Reza hospitals (Mashhad, Iran) during August 2016 to February 2017. A multiplex PCR was employed to amplify the genes encoding pyelonephritis associated pili (pap), S-family adhesions (sfa), type1fimbriae (fimH) and aerobactin (aer). Disk diffusion test was performed to test the susceptibility of isolates to ß-lactams, aminoglycosides, cephalosporins, quinolone, fluoroquinolones, carbapenems and trimethoprim-sulfamethoxazole. RESULTS: The PCR results identified the fimH in 78.4%, aer in 70.5%, sfa in 13.6% and the pap in 8.2% of isolates. The rates of antibiotic resistance of the isolates were as follows: 64.7% resistant to cephalosporins, 34% to trimethoprim-sulfamethoxazole, 31% to fluoroquinolones, 15.3% to aminoglycosides, 13.3% to ß-lactams, 7.8% to quinolones and 4.4% to carbapenems. Significant relationships existed between pap and aer, pap and sfa, aer and fluoroquinolones also pap and cephalosporins. CONCLUSION: fimH and aer were found in > 50% of isolates suggesting the importance of both genes in UPEC. The majority of isolates had fimH as adhesion factor for colonization. Determining antibiotic resistance patterns in specific geographical areas is necessary for appropriate treatment of urinary tract infection. The high rate of resistance to cephalosporins is most likely due to incorrect drug administration.

Childhood Abuse and Intimate Partner Violence Victimization Among Filipina and South Asian Women in the United States.

Background: Intimate partner violence (IPV) is a common form of interpersonal violence and impacts the health and well-being of victims over their lifetime. Many victims of IPV experience multiple types of victimization throughout their lives, often starting in childhood. The prevalence of IPV victimization of women varies among different race/ethnic groups. The purpose of this project is to examine childhood abuse among Filipina and South Asian women living in the United States who had experienced IPV. Methods: Data were extracted from Lifecourse Experiences of Intimate Partner Violence and Help-Seeking among Filipina, Indian, and Pakistani Women: Implications for Justice System Responses 2007-2009 (San Francisco, CA) (ICPSR 29682). Data were collected from 143 women (87 Filipina and 56 South Asian (i.e., Indian or Pakistani) aged between 18 and 60 years who had been a victim of IPV and lived in the United States. Results: Although both Filipina and South Asian women who had experienced IPV reported a high prevalence of childhood abuse, Filipina women reported a higher prevalence than South Asian women. South Asian women were more likely to have first experienced IPV at a younger age and sought some form of IPV services as compared with Filipina women. The factors associated with experiencing all the types of IPV victimization included younger age at the first physical IPV victimization experience and higher educational attainment. Conclusions: Future research should examine the cumulative victimization of childhood abuse and IPV among Asian populations and its impact on health.

Introducing the Best Six Loci in Mycobacterial Interspersed Repetitive Unit-Variable-Number Tandem Repeat (MIRU-VNTR) Typing for Mycobacterium Tuberculosis Genotyping.

BACKGROUND: Tuberculosis (TB) still remains endemic worldwide making epidemiological studies essential to mitigating efforts implicated in identifying its source, controlling, and preventing the spread of dangerous strains amongst humans such as Mycobacterium tuberculosis (Mtb). METHODS: In this study, we sought to determine the 6 Mycobacterial Interspersed Repetitive Unit-Variable-Number Tandem Repeat (MIRU-VNTR) loci with high discriminatory powers for Mtb genotyping as well as the loci with the highest and the lowest discriminatory powers for MIRU-VNTR. To conduct our search, we used several databases such as science direct, Embase (Elsevier), Web of Science, Scopus and Medline via PubMed. Searches were performed using key words including: Mycobacterium tuberculosis, MIRU-VNTR, Allele diversity, Genetic diversity and human patient. Finally, 56 articles were selected after filtering out titles, abstracts and full texts. RESULTS: Loci with high discriminatory powers included MIRU10 and MIRU26, while MIRU2, MIRU20, MIRU24 and ETRD had poor discriminatory powers. According to previous data in the literature, the loci MIRU10, MIRU26, MIRU40, QUB 26, QUB 11b and Mtub21 have high discriminatory powers. CONCLUSION: Therefore, these loci recommended for genotyping Mtb to save time and cost and to ensure the production of reliable results.

Perceived Environmental Pollution and Its Impact on Health in China, Japan, and South Korea.

OBJECTIVES: Environmental pollution is a significant global issue. Both objective (scientifically measured) environmental pollution and perceived levels of pollution are important predictors of self-reported health. The purpose of this study was to compare the associations between perceived environmental pollution and health in China, Japan, and South Korea. METHODS: Data were obtained from the East Asian Social Survey and the Cross-National Survey Data Sets: Health and Society in East Asia, 2010 (n=7938; China, n=3866; Japan, n=2496; South Korea, n=1576). RESULTS: South Koreans perceived environmental pollution to be the most severe, while Japanese participants perceived environmental pollution to be the least severe. Although the Japanese did not perceive environmental pollution to be very severe, their self-rated physical health was significantly related to perceived environmental pollution, while the analogous relationships were not significant for the Chinese or Korean participants. Better mental health was related to lower levels of perceived air pollution in China, as well as lower levels of perceived all types of pollution in Japan and lower levels of perceived noise pollution in South Korea. CONCLUSIONS: Physical and mental health and individual socio-demographic characteristics were associated with levels of perceived environmental pollution, but with different patterns among these three countries.

Factors associated with oral health-related quality of life among safety-net clinic patients.

OBJECTIVES: Oral health-related quality of life (OHRQoL) is an important health indicator not only for individuals but also for oral health care providers to treat a person holistically. Previous studies focused on OHRQoL do not provide comprehensive knowledge regarding low-income patients in the United States, many of whom have chronic health conditions that can affect their oral health. The purpose of this study is to examine factors associated with OHRQoL among low-income, uninsured patients of safety-net providers, which provide free or reduced fee medical and/or dental care to underserved populations. METHODS: Uninsured patients (N = 584) participated in a self-administered survey in May and June 2016 at a safety-net clinic in the United States serving a low-income uninsured population, which provides limited oral health care services. This study used cross-sectional design and a nonprobability sample. The dependent variable was OHRQoL measured using the Oral Health Impact Profile-14. Chi square tests, Analysis of Variance tests, and multiple regression were used for statistical analysis. RESULTS: Higher levels of dental care neglect and lower frequency of oral hygiene practice were associated with lower levels of OHRQoL (P < 0.01). Participants utilizing a diabetes clinic reported better OHRQoL than those who were not patients of a diabetes clinic (P < 0.05). US born English speakers had worse general health and OHRQoL compared to non-US born English speakers and Spanish speakers (P < 0.01). CONCLUSIONS: An intervention to remedy dental neglect is recommended to improve OHRQoL among uninsured safety-net patients.