Risk assessment of recent Egyptian H5N1 influenza viruses.

Highly pathogenic avian influenza (HPAI) viruses of the H5N1 subtype are enzootic in poultry populations in different parts of the world, and have caused numerous human infections in recent years, particularly in Egypt. However, no sustained human-to-human transmission of these viruses has yet been reported. We tested nine naturally occurring Egyptian H5N1 viruses (isolated in 2014-2015) in ferrets and found that three of them transmitted via respiratory droplets, causing a fatal infection in one of the exposed animals. All isolates were sensitive to neuraminidase inhibitors. However, these viruses were not transmitted via respiratory droplets in three additional transmission experiments in ferrets. Currently, we do not know if the efficiency of transmission is very low or if subtle differences in experimental parameters contributed to these inconsistent results. Nonetheless, our findings heighten concern regarding the pandemic potential of recent Egyptian H5N1 influenza viruses.

Accuracy of economic studies on surgical site infection.

Estimating the cost of hospital infection has become a matter of increasing interest in terms of health economics. This study aimed to assess the accuracy of economic studies on hospital infections, using surgical site infection (SSI) as an example. A search was performed for original articles reporting the cost of SSI, published in the English language between 1996 and 2005. For the critical review, the period of cost tracking, classification of costs and cost counting methods were noted. Fifteen articles met the inclusion criteria. The costs of SSI vary according to surgical procedures, country, publication year, study design and accounting method. Only two studies estimated the additional cost of SSI after discharge. All 15 studies included healthcare costs and none measured patient/family resources. In 10 studies, the costs were calculated based on accounting. Three studies used estimated costs from the ratio of costs to charges and two studies used charge data in place of cost data. It will become increasingly important for future studies to perform multi-centre prospective surveys, establish a standard method for cost accounting, include the cost of healthcare services following hospitalization and consider the morbidity cost to patients themselves from a societal perspective.

[Findings of bedside swallowing assessment and brain computerized tomography in patients with chronic cerebral infarction, and their outcome].

To estimate the usefulness of the bedside swallowing assessment proposed by Smithard et al and neuroimaging findings characteristic for dysphagia, we studied the outcome of 102 patients with chronic cerebral infarction after assessment of swallowing by this test with brain computerized tomography (CT). All patients had a variety of motor disturbance and were admitted on a long-term medicare basis. They were divided into two groups according to the findings: the positive group (n = 33), who showed any of the listed types of difficulty in swallowing water, and the negative group (n = 69). Followed up to 2.2 years, their outcomes were studied. CT findings were studied on type of infarction, number and laterality of infarction, grade of periventricular lucency (PVL), presence of ventricular dilatation (VD), and severity of cortical atrophy (CA). The mean age was 76.4 years at registration and 61 were men. The frequency of severe dementia and disturbed ADL were significantly higher in the positive group. Eighteen patients died during the observation period and 15 of those were in the positive group, indicating higher annual death rate (29.9% vs 2.2% in the negative group). All of the 15 patients in the positive group died of pneumonia. CT findings showed high incidence of multiple infarction, bilateral hemispheric lesion, severe PVL, VD, and severe CA in the positive group. These findings indicated that this evaluation method was useful in screening swallow function for patients with cerebral infarction in the chronic phase. Furthermore, CT findings suggested that severe white matter lesion, VD, and severe CA as well as multiple infarction seen in bilateral hemisphere was related to dysphagia, probably due to multiple factors involving pyramidal- and extrapyramidal-tracts with higher brain function.

Assessment of pulmonary artery pressure by pulsed Doppler echocardiography in patients with chronic pulmonary diseases.

Doppler echocardiography was recently developed for obtaining a flow velocity profile at any point in the cardiac chamber. A pulsed Doppler technique combined with cross sectional echocardiography was used to examine the flow velocity pattern in the right ventricular outflow tract in 32 patients with chronic pulmonary disease (CPD) and in 15 healthy subjects as controls. All patients underwent cardiac catheterization. Pulmonary flow velocity profiles in the right ventricular outflow tract were recorded simultaneously with electrocardiograms and pre-ejection periods (PEP), right ventricular ejection time (RVET), acceleration time (AT), and calculated PEP/RVET, AT/RVET were determined. All normal subjects had "dome-like" flow velocity patterns with a peak flow at the midsystole. In patients with CPD, there was a significant correlation between log10MPAP (mean pulmonary arterial pressure) and AT/RVET, the coefficient being r = -0.623, between PVR (pulmonary vascular resistance) and AT/RVET (r = -0.52), and between SVI (stroke volume index) and PEP (r = -0.645). Complications of pulmonary hypertension in CPD were relatively mild, but the pulsed Doppler technique was found useful for evaluating pulmonary arterial pressure and other right heart hemodynamics of CPD patients.

H-2, Ah, and aging: the immune response and the inducibility of P-450 mediated monooxygenase activities, xanthine oxidase, and lipid peroxidation in H-2 congenic mice on C57BL/10, C3H, and A strain backgrounds.

The effects of beta-naphthoflavone (beta-NF, 80 mg/kg i.p. for 2 consecutive days) on P-450-dependent and -independent enzymes, lipid peroxidation and xanthine oxidase were investigated in 9 strains of young (3-month-old) male mice. Three H-2 congenic strains on each of three different genetic backgrounds were studied. The backgrounds were C57BL/10 (abbreviated as B10), C3H, and A strain mice. The reported longevities (weeks) as expressed in 10th decile of survivorship are significantly different among the H-2 congenic strains on each of these backgrounds: it ranges from 155 to 170 weeks in B10, from 138 to 150 in C3H and from 114 to 134 in A background mice. The inducibility of aryl hydrocarbon hydroxylase (AHH) with beta-NF was highest in B10, intermediate in C3H/He and non-inducible in other C3H mice and in all mice on the A strain background. Within the B10 background, inducibility of AHH varied widely among mice of different H-2 haplotypes: 549 +/- 34 (H-2k), 360 +/- 72 (H-2b) and 349 +/- 47 (H-2r) percent of the mean control values (n = 5; mean +/- S.D.), without change in activities of P-450-independent enzymes. In C3H mice the H-2k haplotype showed inducibility (213 +/- 34%), while other haplotypes, specifically H-2b and H-2j, did not. beta-NF increased the activities of xanthine oxidase in B10 and A background strains, without interbackground differences. Lipid peroxidation was significantly increased in A background strains and in an H-2 dependent manner. The relationship between Ah responsiveness and reported longevities of these nine strains is discussed.

Significance of collateral circulation on peri-infarct zone: assessment with stress thallium-201 scintigraphy.

To evaluate the significance of collateral circulation on peri-infarct zone, stress myocardial scintigraphy and contrast left ventriculography (LVG) were performed in 38 patients with recent myocardial infarction (MI). All patients had at least one completely occluded coronary artery corresponding to the infarct area. In patients with good collaterals, stress induced transient enlargement of the perfusion defect, however, in those with poor or no collaterals the enlargement did not occur (p less than 0.05). Wall motion abnormality on LVG was significantly milder in the former patients than in the latter (p less than 0.001). Transient enlargement of the perfusion defect after stress and milder left ventricular asynergy were more frequently observed in patients with anterior MI and good collaterals. These observations indicate that good collaterals may keep some myocardium in the peri-infarct zone viable.