Does Low Body Mass Index Predict the Hospital Mortality of Adult Western or Asian Patients?

BACKGROUND: Some strategies for screening and assessment of malnutrition include a low but variable body mass index (BMI) cutoff, while others do not. The purpose of this systematic review was to investigate published data for Western and Asian hospital samples to determine how the prevalence of low BMI is associated with increased hospital mortality. METHOD: A PubMed search of the past 10 years (2006-2016) was conducted with the terms "BMI," "malnutrition," "adult," "outcome," and "hospital" or "ICU" for articles published in English. Studies that examined BMI levels among Western or Asian populations were included. Forest plots were constructed to determine the odds of hospital mortality in low versus normal BMI groups. RESULTS: Twenty studies met inclusion criteria. The prevalence of BMI <18.5 kg/m2 was greater in Asian (15%-20%) than Western (2%-7%) patient groups. In Western populations, BMI <18.5 kg/m2 was so rare that most studies lacked power to evaluate outcomes. Hospital mortality among ICU patients was greater for patients with BMI <18.5 than those with BMI of 18.5-24.9 kg/m2 (Western: odds ratio, 1.42 [95% CI, 1.33-1.50]; Asian: odds ratio = 1.78 [95% CI, 1.7-1.86]). RECOMMENDATIONS: BMI <18.5 kg/m2 is a possible screening variable for malnutrition. Since low BMI was associated with increased mortality in Western and Asian patient groups, we suggest that all populations at risk based on low BMI undergo a full nutrition assessment with a validated method.

Whole genome structural analysis of Caribbean hair sheep reveals quantitative link to West African ancestry.

Hair sheep of Caribbean origin have become an important part of the U.S. sheep industry. Their lack of wool eliminates a number of health concerns and drastically reduces the cost of production. More importantly, Caribbean hair sheep demonstrate robust production performance even in the presence of drug-resistant gastrointestinal nematodes, a rising concern to the industry. Despite the growing importance of hair sheep in the Americas their genetic origins have remained speculative. Prior to this report no genetic studies were able to identify a unique geographical origin of hair sheep in the New World. Our study clarifies the African and European ancestry of Caribbean hair sheep. Whole-genome structural analysis was conducted on four established breeds of hair sheep from the Caribbean region. Using breeds representing Africa and Europe we establish an objective measure indicating Caribbean hair sheep are derived from Iberian and West African origins. Caribbean hair sheep result from West African introgression into established ecotypes of Iberian descent. Genotypes from 47,750 autosomal single nucleotide polymorphism markers scored in 290 animals were used to characterize the population structure of the St. Croix, Barbados Blackbelly, Morada Nova, and Santa Ines. Principal components, admixture, and phylogenetic analyses results correlate with historical patterns of colonization and trade. These patterns support co-migration of these sheep with humans.

Cyclospora infection linked to travel to Mexico, June to September 2015.

Cyclospora cayetanensis was identified in 176 returned travellers from the Riviera Maya region of Mexico between 1 June and 22 September 2015; 79 in the United Kingdom (UK) and 97 in Canada. UK cases completed a food exposure questionnaire. This increase in reported Cyclospora cases highlights risks of gastrointestinal infections through travelling, limitations in Cyclospora surveillance and the need for improved hygiene in the production of food consumed in holiday resorts.

Serum creatine kinase and lactate dehydrogenase activities in patients with thyroid disorders.

BACKGROUND AND OBJECTIVES: There is the recognition of a pattern of elevations of serum enzymes in hyperthyroid and hypothyroid patients. The aims of this study were to determine the activities of serum creatine kinase (CK) and lactate deydrogenase (LDH) in thyroid disorders, and to evaluate the relationship between CK, LDH and FT4, and TSH levels. MATERIALS AND METHODS: In this retrospective study, thyroid function tests, serum CK and LDH activities were obtained from the medical records of newly diagnosed hyperthyroid and hypothyroid patients attending the Endocrinology Clinic at the University Hospital of the West Indies from 2005- 2009. RESULTS: Elevation of CK activity was found in 5 patients (28%, 5/18) with overt hypothyroidism and in 12 patients (24.0%, 12/50) with subclinical hypothyroidism. The mean CK activity in subclinical hypothyroid patients was 179.80 ± 125.68 U/L compared with 389.901 ± 381.20 U/L in overt hypothyroid patients. The elevation of LDH activity was found in 6 patients (33.3%, 6/18) with overt hypothyroidism and in 37 patients (74.0%, 37/50) with subclinical hypothyroidism. In the hypothyroid patients, a positive correlation was found between CK activity and TSH (r = 0.292, P = 0.015), and a negative correlation between CK activity and FT4 (r = - 0.325, P = 0.007); and between FT4 and TSH (r = - 0.371, P = 0.002). CONCLUSION: The significant elevation in serum CK and LDH activities indicates that these can be used as parameters for screening hypothyroid patients but not hyperthyroid patients.

Knowledge, awareness and compliance with universal precautions among health care workers at the University Hospital of the West Indies, Jamaica.

BACKGROUND: Universal precautions are not well understood or implemented by health care practitioners, though crucial in the prevention and transmission of blood-borne pathogens like HIV. OBJECTIVE: To assess knowledge, awareness and compliance of universal precautions among health care workers at the University Hospital of the West Indies, Jamaica. METHODS: A cross-sectional survey was conducted in September and October 2007. A 28-item self-administered questionnaire was provided to 200 health care workers including medical doctors, medical technologists, nurses and porters to assess their knowledge, awareness and practice towards universal precautions. RESULTS: Almost two-thirds (64.0%) of the respondents were very knowledgeable of universal precautions with significantly more females (75.4%) than males (42.9%) (p<0.0001). More nurses (90.0%), medical doctors (88.0%) and medical technologists (70%) were very knowledgeable of universal precautions (p<0.0001). More respondents (92.9%) who were employed in the health sector for 16 years and over reported high levels of awareness of universal precautions than those who were employed for less than five years (p<0.0001). 28.6% of males and only 6.2% of females reported that they do not use protective gear. More nurses reported frequent use of protective equipment followed by medical technologists and medical doctors (p<0.0001). CONCLUSION: There was adequate knowledge and a fair level of awareness among medical doctors, medical technologists, and nurses towards universal precautions.

Stability of valacyclovir: implications for its oral bioavailability.

The absolute bioavailability of the prodrug valacyclovir, the l-valyl ester of acyclovir, after oral administration is approximately 54.5%. Since premature hydrolysis of this prodrug in the intestinal lumen may be a possible reason for its incomplete bioavailability and the chemical and enzymatic stability of the valacyclovir has been investigated. Release rates were investigated in both phosphate buffers with varying pH as well as in human and dog gastrointestinal fluids. The stability of the prodrug was found to be dependent on pH. This prodrug is chemically stable along the acidic pH side (under 4), while the prodrug degrades in alkaline medium through a base-catalyzed pseudo-first-order kinetics. The degradation of the prodrug valacyclovir progressed faster in intestinal fluid than in phosphate buffer at the same pH. There was no appreciable release of valacyclovir neither in the human and dog stomach contents nor in phosphate buffers at pHs fewer than 4, although its degradation was fastest in the human and dog stomach contents. In light of this result, we can conclude that the degradation of the valacyclovir in the upper intestinal lumen is probably one of the causes of its poor bioavailability.

Lipid transfer protein from Hevea brasiliensis (Hev b 12), a cross-reactive latex protein.

BACKGROUND: Latex-allergic individuals experience clinical cross-reactivity to a large number of fruits and vegetables. Much of the cross-reactivity can be attributed to Hev b 6, but evidence indicates that additional cross-reactive allergens may be present. A common pan-allergen, which has not previously been identified in latex, but may contribute to this cross-reactivity is lipid transfer protein (LTP). We sought to determine whether Hevea brasiliensis produces LTP and whether it would bind immunoglobulin E from latex-allergic patients. METHODS: LTP was identified in H. brasiliensis RNA by polymerase chain reaction using degenerate primers. The entire cDNA was obtained by polymerase chain reaction using rapid amplification of cDNA ends reactions. The complete coding sequence for LTP was determined and produced as a recombinant protein using the glutathione S-transferase and pET32 expression systems. Immunoblot analysis of sera from latex-allergic patients was used to determine whether patients recognize LTP as an allergen. RESULTS: We identified a 662-basepair cDNA with a 351-basepair open reading frame that encodes for a 116-amino acid protein. The protein has significant homology to the family of nonspecific LTPs. We expressed the protein as a mature LTP of 92 amino acids with a predicted isoelectric point of 10.8 and molecular weight of 9.3 kDa. Immunoblots demonstrated specific immunoglobulin E for LTP in the sera of 9 of 37 (24%) latex-allergic individuals. CONCLUSIONS: We describe the initial identification of rLTP in H. brasiliensis that may be important as a cross-reactive pan-allergen (Hev b 12).

The effect of yoga exercise therapy on metabolic activity and oxidative stress indicators in non-insulin dependent diabets mellitus (NIDDM) patients [abstract]

OBJECTIVE: To evaluate the effort of yoga traditional exercises on indicators of oxidative damage and on anti-oxidative enzyme system in patients with NIDDM. METHODS: Ninety-four NIDDM volunteers were divided randomly into two groups: traditional and yoga exercise (female to male 5:1, age 50 to 70 yeras, with 2-5 years of duration of diabetes and without clinical complications). Both groups twice weekly for six months with similar nutritional support. Blood samples were taken at the beginning, and six months following exercise treatments and the following were determined: glycaemia by glucose oxidase (automatic analyser), microalbuminuria by semiquantative methods, creatinine by kinetic method, malondialdehyde (MDA) by products of thiobarbituricacid, superoxide dismutase (SOD) by kinetic method - the inhibition of pyrogallol, phospholipase A2 by colorimetry, protein oxidation (POX) by the method of Reznicky and Pucker. RESULTS: There was a reduction of glycaemia in the yoga group after 6 months (8.84 vs 8.35 mmol/l), while there was an increase in the traditional group 8.74 vs 9.51 mmol/l). The concentration of creatinine and microalbumin decreased in both groups notably in the yoga group. (AU)

Survey of bat populations from Mexico and Paraguay for rabies.

A mammalian survey was conducted in Mexico (October 1994-January 1996) and in Paraguay (August 1996-March 1997); a complete specimen was collected for each bat in the survey, including primary voucher specimen, ectoparasites, karyotype, and various frozen tissues. The surveys combined provided 937 brain samples (65 bat species) for rabies diagnosis. One male Lasiurus ega, collected in Paraguay, tested positive for the rabies virus (overall prevalence rate of 0.1%). Nucleotide sequence from a 300 bp region of the rabies nucleoprotein gene was compared with sequence obtained from representative rabies virus samples in the repository at the Centers for Disease Control and Prevention (Atlanta, Georgia, USA). Rabies virus extracted from the brain material of L. ega differed by only one nucleotide from a 300 bp consensus sequence (>99% homology) derived from samples for the variant of rabies virus transmitted by Lasiurus cinereus. Lasiurus ego differed by approximately 15% for the variant transmitted by Desmodus rotundus. Phylogenetic analysis found no evidence to suggest L. ego is a reservoir for rabies antigenic variant 6. The most likely explanation for rabies in L. ega was infection following contact with a rabid L. cinereus.

Safety and immunogenicity of Haemophilus influenzae type b polysaccharide and polysaccharide diphtheria toxoid conjugate vaccines in children 15 to 24 months of age.

To evaluate the safety and immunogenicity of the Haemophilus influenzae type b polysaccharide vaccine, PRP, and a new polysaccharide-diphtheria toxoid conjugate vaccine, PRP-D, a collaborative study was carried out in six centers in five states. Subjects were 585 infants 15 to 24 months of age. They were randomly assigned to receive a single dose of PRP or PRP-D vaccine. There were no significant differences in the rate of adverse reactions between the two vaccine groups. Minor local reactions occurred in 10.3% of PRP and 12.5% of PRP-D recipients, and fever in 27.4% of PRP and 23.8% of PRP-D recipients. All reactions resolved within 48 hours. Serum samples were obtained just before vaccination and after 1 month. Prevaccination antibody levels were similar for the PRP (0.035 micrograms/mL) and PRP-D (0.027 micrograms/mL) groups, with no differences in levels by age, sex, race, vaccine lot, or study site. Both groups had significant rises in geometric mean levels, but this difference was significantly greater for PRP-D (2.166 micrograms/mL) than for PRP (0.154 micrograms/mL). In addition, the percentage of responders as determined by three definitions (twofold titer rise, greater than 0.15 micrograms/mL, and greater than 1.0 micrograms/mL) was also significantly greater for PRP-D than PRP. In contrast to a marked age-related immunogenicity to PRP (P less than 0.001), there was no significant variation in immune response to PRP-D by age. PRP-D conjugate vaccine appears to be as safe and significantly more immunogenic than PRP vaccine for children vaccinated at 15 to 24 months of age.

Persistence of antibody and response to booster dose of Haemophilus influenzae type b polysaccharide diphtheria toxoid conjugate vaccine in infants immunized at 9 to 15 months of age.

At approximately 2 years of age, 27 infants previously immunized at 9 to 15 months of age with two doses of polyribosylribitol phosphate-diphtheria toxoid conjugate vaccine (PRP-D) and 23 infants immunized with polyribosylribitol phosphate (PRP) vaccine were given a single injection of PRP-D. Pre- and post-immunization sera were obtained. No serious local or systemic reactions were observed. The PRP-D recipients had a geometric mean anti-PRP antibody level of 4.8 micrograms/ml 1 month after the second primary injection, retained 1.2 microgram/ml 1 year later, and had a level of 71 micrograms/ml after the booster immunization. In contrast, PRP recipients had a geometric mean level of 0.083 microgram/ml 1 month after the second primary injection, retained 0.042 microgram/ml 1 year later, and after a single dose of PRP-D at approximately 2 years of age had a geometric mean level of 8.6 micrograms/ml. The significantly higher antibody response in the prior PRP-D recipients suggests the recall of immunologic memory induced by the PRP-D vaccine.

Safety and immunogenicity of Haemophilus influenzae type b-polysaccharide diphtheria toxoid conjugate vaccine in infants 9 to 15 months of age.

Sixty 9- to 15-month-old infants were randomly assigned to receive two doses, 1 month apart, of a Haemophilus influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine (PRP-D) or PRP vaccine, each containing 20 micrograms PRP. There were no significant local or systemic reactions. After one dose of PRP-D, 93% of the subjects attained levels of greater than or equal to 0.15 microgram/ml and 59% achieved greater than or equal to 1 microgram/ml antibody protein. These percentages rose to 100% and 86%, respectively, after the second dose, at which time the geometric mean titer of anti-PRP antibody was 4.8 micrograms/ml. IgG anti-PRP levels were 4.3 times higher than IgM. The proportion of IgG to IgM antibody induced by PRP-D increased with age. After two doses, 33% of the PRP recipients responded with a level of greater than or equal to 0.15 microgram/ml and only 19% responded to a level of greater than or equal to 1.0 microgram/ml. One year later, all of the PRP-D recipients tested still had greater than or equal to 0.15 microgram/ml and more than half had greater than or equal to 1.0 microgram/ml antibody protein.