Predictors of Mortality in Neonatal Pneumonia: An INCLEN Childhood Pneumonia Study.

BACKGROUND: Neonatal pneumonia contributes significantly to mortality due to pneumonia in the under-five age group, but the predictors of mortality are largely unknown. OBJECTIVES: To evaluate the clinical and microbiological characteristics and other risk factors that predict mortality in neonates admitted with pneumonia in tertiary care centres. STUDY DESIGN: Prospective observational cohort study. PARTICIPANTS: Term and preterm (32 weeks to 36 6/7 weeks) neonates (<28 days of life) admitted with clinical and radiological features suggestive of pneumonia. INTERVENTION: Baseline sociodemographic data, clinical details, blood culture and nasopharyngeal swabs for virologic assay (RT PCR for RSV, Influenza) were collected at admission and the neonates were observed throughout their hospital stay. OUTCOME: The primary outcome was predictors of mortality in neonatal pneumonia. RESULTS: Five hundred neonates were enrolled in the study. Out of 476 neonates with known outcomes, 39 (8.2%) died. On multivariate analysis, blood culture positive sepsis was independently associated with mortality (adjusted OR 2.51, 95% CI1.23 to 5.11; P-0.01). CONCLUSIONS: Neonates with blood culture positive pneumonia positive are at a higher risk of death.

Genetic and structural characterization of PvSERA4: potential implication as therapeutic target for Plasmodium vivax malaria.

Plasmodium vivax malaria is geographically the most widely distributed and prevalent form of human malaria. The development of drug resistance by the parasite to existing drugs necessitates higher focus to explore and identify new drug targets. Plasmodial proteases have key roles in parasite biology and are involved in nutritional uptake, egress from infected reticulocytes, and invasion of the new target erythrocytes. Serine repeat antigens (SERA) of Plasmodium are parasite proteases that remain attractive drug targets and are important vaccine candidates due to their high expression profiles in the blood stages. SERA proteins have a unique putative papain-like cysteine protease motif that has either serine or cysteine in its active site. In P. vivax, PvSERA4 is the highest transcribed member of this multigene family. In this study, we have investigated the genetic polymorphism of PvSERA4 central protease domain and deduced its 3D model by homology modeling and also performed MD simulations to acquire refined protein structure. Sequence analysis of protease domain of PvSERA4 from Indian field isolates reveals that the central domain is highly conserved. The high sequence conservation of the PvSERA4 enzyme domain coupled with its high expression raises the possibility of it having a critical role in parasite biology and hence, being a reliable target for new selective inhibitor-based antimalarial chemotherapeutics. The 3D model showed the presence of an unusual antiparallel Beta hairpin motif between catalytic residues similar to hemoglobin binding motif of Plasmodial hemoglobinases. Our PvSERA4 model will aid in designing structure-based inhibitors against this enzyme.

Molecular characterization reveals involvement of altered El Tor biotype Vibrio cholerae O1 strains in cholera outbreak at Hyderabad, India.

Thirty-four Vibrio cholerae isolates collected from a cholera outbreak in Hyderabad, South India were found to belong to serogroup Ol biotype El Tor serotype Ogawa. The genotype of all the isolates was confirmed by PCR assays. All the isolates were found PCR positive for ctxAB, ompW, rflOl, rtxC, and tcpA genes. All the isolates but one harboured rstR ( El Tor ) allele. However, one isolate carried both rstR ( EL Tor ) as well as rstR ( Classical ) alleles. Cholera toxin (ctxB) genotyping of the isolates confirmed the presence of altered cholera toxin B of classical biotype in all the isolates. All the isolates except VCH35 harboured an RS1-CTX prophage array on the large chromosome. The isolate VCH35 contained a tandem repeat of classical CTX prophage on the small chromosome. The clonal relationship among the V. cholerae isolates as carried out by enterobacterial repetitive intergenic consensus sequences PCR, BOX PCR and randomly amplified polymorphic DNA, uniformly showed a genetic relationship among the outbreak isolates. The results of this study suggest that altered El Tor biotype V. cholerae with the classical cholera toxin gene are involved in cholera outbreaks in India.

Rural intentions: factors affecting the career choices of family medicine graduates.

OBJECTIVE: To investigate the reasons for family medicine graduates' career choices. DESIGN: Qualitative study using focus groups and one-on-one interviews. SETTING: University of Calgary in Alberta. PARTICIPANTS: Seventeen male and female second-year family medicine residents, representing a range of ages and areas of origin, enrolled in the 2004 urban and rural south streams of the family medicine residency program at the University of Calgary. METHOD: During the final month of training, 2 focus groups were conducted to determine graduating students' career choices and the reasons for them. After focus-group data were analyzed, a questionnaire was constructed and subsequently administered to participants during face-to-face or telephone interviews. MAIN FINDINGS: Most residents initially planned to do urban locums in order to gain experience. In the long term, they planned to open practices in urban areas for lifestyle and family reasons. Many residents from the rural stream had no long-term plans to establish rural practices. Most residents said they felt prepared for practice, but many indicated that an optional third year of paid training, with an emphasis on emergency medicine, obstetrics, and pediatrics, would be desirable. Reasons cited for not practising in rural areas were related to workload, lifestyle issues, family obligations, and perceived lack of medical support in the community. Only 4 female graduates and 1 male graduate intended to practise obstetrics. The main reason residents gave for this was inadequate training in obstetrics during residency. Finances were cited as a secondary reason for many choices, and might in fact be more important than at first apparent. CONCLUSION: Despite its intention to recruit family medicine graduates to rural areas and to obstetrics, the University of Calgary residency training program was not successful in recruiting physicians to these areas. The program likely needs to re-examine the effectiveness of current approaches. If other programs are having similar difficulties recruiting graduates to obstetrics and rural practice, perhaps changes in policies should be considered.