Malaria elimination in Haiti by the year 2020: an achievable goal?

Haiti and the Dominican Republic, which share the island of Hispaniola, are the last locations in the Caribbean where malaria still persists. Malaria is an important public health concern in Haiti with 17,094 reported cases in 2014. Further, on January 12, 2010, a record earthquake devastated densely populated areas in Haiti including many healthcare and laboratory facilities. Weakened infrastructure provided fertile reservoirs for uncontrolled transmission of infectious pathogens. This situation results in unique challenges for malaria epidemiology and elimination efforts. To help Haiti achieve its malaria elimination goals by year 2020, the Laboratoire National de Santé Publique and Henry Ford Health System, in close collaboration with the Direction d'Épidémiologie, de Laboratoire et de Recherches and the Programme National de Contrôle de la Malaria, hosted a scientific meeting on "Elimination Strategies for Malaria in Haiti" on January 29-30, 2015 at the National Laboratory in Port-au-Prince, Haiti. The meeting brought together laboratory personnel, researchers, clinicians, academics, public health professionals, and other stakeholders to discuss main stakes and perspectives on malaria elimination. Several themes and recommendations emerged during discussions at this meeting. First, more information and research on malaria transmission in Haiti are needed including information from active surveillance of cases and vectors. Second, many healthcare personnel need additional training and critical resources on how to properly identify malaria cases so as to improve accurate and timely case reporting. Third, it is necessary to continue studies genotyping strains of Plasmodium falciparum in different sites with active transmission to evaluate for drug resistance and impacts on health. Fourth, elimination strategies outlined in this report will continue to incorporate use of primaquine in addition to chloroquine and active surveillance of cases. Elimination of malaria in Haiti will require collaborative multidisciplinary approaches, sound strategic planning, and strong ownership of strategies by the Haiti Ministère de la Santé Publique et de la Population.

The fallacy of the BUN:creatinine ratio in critically ill patients.

BACKGROUND AND OBJECTIVES: Acute kidney injury (AKI) is common in critically ill patients and is associated with a high mortality rate. Pre-renal azotemia, suggested by a high blood urea nitrogen to serum creatinine (BUN:Cr) ratio (BCR), has traditionally been associated with a better prognosis than other forms of AKI. Whether this pertains to critically ill patients is unknown. METHODS: We conducted a retrospective observational study of two cohorts of critically ill patients admitted to a single center: a derivation cohort, in which AKI was diagnosed, and a larger validation cohort. We analyzed associations between BCR and clinical outcomes: mortality and renal replacement therapy (RRT). RESULTS: Patients in the derivation cohort (N = 1010) with BCR >20 were older, predominantly female and white, and more severely ill. A BCR >20 was significantly associated with increased mortality and a lower likelihood of RRT in all patients, patients with AKI and patients at risk for AKI. Patients in the validation cohort (N = 10 228) with a BCR >20 were older, predominantly female and white, and more severely ill. A BCR >20 was associated with increased mortality and a lower likelihood of RRT in all patients and in those at risk for AKI, BUN correlated with age and severity of illness. CONCLUSIONS: A BCR >20 is associated with increased mortality in critically ill patients. It is also associated with a lower likelihood of RRT, perhaps because of misinterpretation of the BCR. Clinicians should not use a BCR >20 to classify AKI in critically ill patients.

Enhanced Antimould Action of Surface Modified Copper Oxide Nanoparticles with Phenylboronic Acid Surface Functionality.

Antimould agents are widely used in different applications, such as specialty paints, building materials, wood preservation and crop protection. However, many antimould agents can be toxic to the environment. This work aims to evaluate the application of copper oxide nanoparticles (CuONPs) surface modified with boronic acid (BA) terminal groups as antimould agents. We developed CuONPs grafted with (3-glycidyloxypropyl) trimethoxysilane (GLYMO), coupled with 4-hydroxyphenylboronic acid (4-HPBA), which provided a strong boost of their action as antimould agents. We studied the antimould action of the 4-HPBA-functionalized CuONPs against two mould species: Aspergillus niger (A. niger) and Penicillium chrysogenum (P. chrysogenum). The cis-diol groups of polysaccharides expressed on the mould cell walls can form reversible covalent bonds with the BA groups attached on the CuONPs surface. This allowed them to bind strongly to the mould surface, resulting in a very substantial boost of their antimould activity, which is not based on electrostatic adhesion, as in the case of bare CuONPs. The impact of these BA-surface functionalized nanoparticles was studied by measuring the growth of the mould colonies versus time. The BA-functionalized CuONPs showed significant antimould action, compared to the untreated mould sample at the same conditions and period of time. These results can be applied for the development of more efficient antimould treatments at a lower concentration of active agent with potentially substantial economic and environmental benefits.

The economics of standardized patient education materials with veteran patients.

With an increasing number of veterans seeking care, it becomes imperative that the resources within the system are used efficiently and effectively and in a manner that maintains access, safety, and quality of care. Veterans who are able to manage their own care may utilize provider services less frequently, thereby increasing access for others who require more care. The objective of this quality improvement study was to determine the effectiveness of providing a standardized self-management textbook of health information with the intent that it would decrease demand on primary care providers' time for minor health care issues. This initial quality improvement study clearly demonstrated the potential of the return on investment and the subsequent potential for increased access for veteran patients, appropriate use of limited resources, and improved patient outcomes. It also clearly demonstrated the value of interaction with the veterans to educate them about their care and the increased satisfaction individualized attention to their needs creates. That finding alone has a greater value than just economics.

Histone deacetylase inhibition is associated with transcriptional repression of the Hmga2 gene.

The high-mobility-group A2 protein (HMGA2) plays important functional roles in transcriptional regulation, DNA replication and chromatin structure. In this study, the effect of histone deacetylase inhibition on the transcriptional activity of the Hmga2 gene was investigated in vivo both at the endogenous gene level and in a variety of cell lines using transiently transfected promoter constructs. Trichostatin A (TSA) repressed both transfected murine and human Hmga2 promoter constructs 3-8-fold in NIH3T3, F9 and HeLa cells. Steady-state Hmga2 mRNA levels in NIH3T3 cells decreased 4-5-fold following TSA treatment, while pre- treatment of NIH3T3 cells with the transcriptional inhibitor, actinomycin D, completely blocked TSA mediated repression of the Hmga2 gene. Cross-linked chromatin immunoprecipitation (X-ChIP) analysis revealed a 5-6-fold decrease in endogenous Hmga2 promoter bound Sp1 and Sp3 proteins following TSA treatment in parallel with observed loss of acetylated histone H3 and H4. In addition, the poly-pyrimidine-tract-binding protein (PTB) was observed to bind to the Hmga2 promoter in both TSA treated and untreated NIH3T3 cells. Together, these results suggest TSA treatment leads to a decrease in Hmga2 gene transcription, and a significant decrease in promoter bound Sp1, Sp3 and acetylated histones H3 and H4.

Making groups work in the classroom.

Although often part of course requirements, group work can present problems for students and faculty and is not always a positive learning experience. Lack of member motivation to work in a group situation, generational differences between members, and scheduling problems can impact the learning that takes place during a group project. The author discusses several interventions to ameliorate these problems.

Does the urgency of endoscopic retrograde cholangiopancreatography (ercp)/percutaneous biliary drainage (pbd) impact mortality and disease related complications in ascending cholangitis? (deim-i study).

BACKGROUND: The Tokyo Guidelines have greatly impacted the management of ascending cholangitis. Though ERCP is the favored modality for biliary decompression, no evidence exists for the timing of ERCP. The DEIM-I study set out to determine if the time from patient presentation to biliary decompression impacted in hospital all cause mortality in ascending cholangitis. METHOD: DEIM-I cohort study was a single-blinded and consisted of 250 subjects with moderate to severe ascending cholangitis who underwent ERCP/PBD. Subjects were randomized into quartiles based upon time from presentation until ERCP/PBD. The primary outcome utilized logistic regression to estimate relative risk (RR) of all cause, in hospital mortality with time to procedure as the predictive covariate. Secondary outcomes were analyzed using multivariate logistic regression and included; multiple organ failure (MOF), sepsis, systemic inflammatory response syndrome (SIRS), surgical incidence, hospital readmission and length of stay (LOS). RESULTS: The risk for hospital mortality was significantly less when biliary drainage was performed within 11 h, compared to >42 h (RR 0.34, 95%CI 0.12 to 0.99, p=0.049). Hospital readmission was lower in subjects who underwent biliary decompression less than 11 h, when compared to those greater than 22 h. Subjects who underwent biliary decompression within 21 h had significant higher risk for surgery compared to those 22-42 h. CONCLUSION: The relative risk of all cause in hospital mortality was lower in subjects who underwent biliary decompression in under 11 h compared to greater than 42 h.

Microbiological Studies of Chesapeake Bay Soft-shell Clams ( Mya arenaria ).

A total of 472 samples of soft-shell clams ( Mya arenaria ), collected from three major clam harvest areas in the Chesapeake Bay and dockside check stations, was analyzed for standard plate count (SPC), total coliforms, fecal coliforms, Escherichia coli , and coliphages. SPC increased during the summer season. SPC geometric means of 2.6 × 104, 6.9 × 104, and 7.2 × 104/g, respectively, were found in three major harvest areas. Fecal coliforms remained relatively stable with geometric means of 30, 54, and 62/100 g. As seasonal temperatures increased, the total coliform geometric means declined slightly ranging from 1,500 to 6,300/100 g. E. coli means were low (< 27/100 g). The occurrence and levels of male-specific coliphages were also low and did not correlate with bacteriological quality. No significant microbiological quality difference was found between soft-shell clams sampled from harvest waters and check stations. Results indicate that the microbiological quality of soft-shell clams either at harvest or check stations was satisfactory.