Notes

Diagnosis of dog misuse: The B razil study.
Shigellosis is a diarrheal disease that causes high mortality every year, especially in children, elderly and immunocompromised patients. Recently, resistance strains to antibiotic therapy are in the rise and the World Health Organization prioritizes the development of a safe vaccine against the most common causal agent of shigellosis, Shigella flexneri. This pathogen uses autotransporter proteins such as SigA, Pic and Sap to increase virulence and some of them have been described as highly immunogenic proteins. In this study, we used immune-informatics analysis to identify the most antigenic epitope as a vaccine candidate on three passenger domains of auto-transporter proteins encoded on the pathogenic island SHI-1, to induce immunity against S. flexneri. Epitope identification was done using various servers such as Bepipred, Bcepred, nHLAPRED, NetMHCII, Rankpep and IEDB and the final selection was done based on its antigenicity using the VaxiJen server. Moreover, to enhance immunity, the GroEL adjuvant was added to the final construct as a Toll-like receptor 2 (TLR2) agonist. On the other hand, to predict the tertiary structure, the I-TASSER server was used, and the best model was structurally validated using the ProSA-web software and the Ramachandran plot. Subsequently, the model was refined and used for docking and molecular dynamics analyses with TLR2, which demonstrated an appropriate and stable interaction. In summary, a potential subunit vaccine candidate, that contains B and T cell epitopes with proper physicochemical properties was designed. This multiepitope vaccine is expected to elicit robust humoral and cellular immune responses and vest protective immunity against S. flexneri. Application of 1064 nm activatable NIR-IIa fluorescence imaging (FI) and NIR-II photothermal therapy (PTT) results in high-resolution imaging and good deep-tissue therapy, respectively. Combining NIR-IIa FI with NIR-II PTT may allow precise diagnosis guided efficient treatment of deep-tissue tumors. However, designing a 1064 activatable theranostic nanoplatform using a single dye for both NIR-IIa FI and NIR-II PTT is a challenge. Herein, we synthesized squaraine-based semiconducting polymer nanoparticles (PSQPNs-DBCO) that were excited by a 1064 nm laser for precise NIR-IIa fluorescence imaging guided NIR-II PTT treatment. Combined with bioorthogonal labeling technology, the PSQPNs-DBCO largely accumulated in the tumor section, extremely enhancing signal-to-background ratio (SBR) of imaging and NIR-II PTT efficiency of tumor in live colorectal-bearing animals. BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibodies (Abs) have been associated with a heterogeneous range of acquired CNS demyelinating disorders. More recently, increasing evidence correlates the presence of such Abs with seizures, occurring in concomitance with CNS demyelinating events, or even as isolated phenomena. In this scenario, the full clinical spectrum of MOG Ab-associated seizures and the contribution of such Abs to epileptogenesis are unclear. METHODS We report on two paradigmatic cases of MOG Ab-associated seizures, one showing isolated seizures, without evidence of encephalopathy or MRI changes, followed by a demyelinating event one month later, and the other presenting with seizures as the main manifestation of an acute disseminated encephalomyelitis (ADEM) event. To better frame this topic, we performed a literature review, identifying 49 patients with MOG Ab-associated disorders presenting seizures at any stage of their disease, and analysed the clinico-therapeutic, brain MRI, cerebrospinal fluid, and EEG features. RESULTS MOG Ab-associated seizures occurred mostly during encephalitis, including a) "cortical encephalitis", a clinically poorly defined syndrome characterised by gray matter lesions on brain MRI, with or without subcortical white matter involvement; b) ADEM; c) NMDAR encephalitis with demyelinating features. Seizures can also occur in isolation, often in clusters of focal motor seizures, in patients with normal brain MRI, heralding the more typical MOG Ab-associated demyelinating syndrome by days to months. CONCLUSION Testing for MOG Abs should be considered in children with isolated and unexplained seizures, and in adults with suspected encephalitis and/or seizures. In these cases, MOG Abs detection is highly relevant for patients' clinical management. BACKGROUND There is scarce information in Latin America regarding the prevalence of anxiety in patients with multiple sclerosis (MS) and its association with different clinical-demographic factors. OBJECTIVE We aimed to determine the prevalence of anxiety in Argentinian MS patients and to analyze associated factors. MATERIALS AND METHODS A cross-sectional analysis was performed with consecutive MS outpatients from two centers in Buenos Aires, Argentina. Anxiety was evaluated according to the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A). RESULTS Eighty-three patients were included. Fifty-three (63%) were females, mean age 46 (SD=13.9) years. Forty-five percent (n = 38) had anxiety according to the HADS-A. Patients with anxiety were significantly younger (42.2 vs 49.1 years, p = 0.02), had a shorter time since diagnosis (8.3 vs 12.3 years, p = 0.02), had a history of psychiatric disorders (36.8% vs 8.8%, p = 0.002), were depressed (57.8% vs 2.2%, p less then 0.001) and had worse health-related quality of life according to the COOP/Wonca questionnaire (mean score 21.5 vs 15.2, p less then 0.001). Depression (OR 15.2, 95% CI 1.4-157.3, p = 0.02) and worse health-related quality of life (OR 1.2,95% CI 1-1.4, p = 0.008) remained significantly associated with anxiety after adjusting for all other significant variables. No differences were observed regarding sex, marital and occupational status, education, family history of psychiatric disorders, disease course and disability according to the EDSS. CONCLUSIONS The prevalence of anxiety in Argentinian MS outpatients was higher than previously reported in other populations. Anxiety was strongly associated with negative outcomes such as depression and reduced health-related quality of life. These results emphasize the burden of psychiatric morbidity in Argentinian MS patients. In the period between 2000 and 2014, 584,704 admissions with non-ST-segment elevation myocardial infarction that received early coronary angiography (day zero) were identified from the National Inpatient Sample. In-hospital cardiac arrest was noted in 4349 (0.8%), of which ~47% were from ventricular arrhythmias and ~90% of occurred within ≤4 days. Non-ST-segment elevation myocardial infarction admissions with in-hospital cardiac arrest had higher in-hospital mortality compared to those without (61% vs. 1.6%) with an unchanged temporal trend of in-hospital cardiac arrest rates (adjusted odds ratio 1.29 [95% confidence interval 0.73-2.28]) in 2014 compared to 2000). BACKGROUND Although cardiac resynchronization therapy (CRT) is effective for some patients with heart failure and a reduced left ventricular ejection fraction (HFrEF), evidence gaps remain for key clinical and policy areas. check details The objective of the study was to review the data on the effects of CRT for patients with HFrEF receiving pharmacological therapy alone or pharmacological therapy and an implantable cardioverter-defibrillator (ICD) and then, informed by a diverse group of stakeholders, to identify evidence gaps, prioritize them, and develop a research plan. METHODS Relevant studies were identified using PubMed and EMBASE and ongoing trials using clinicaltrials.gov. Forced-ranking prioritization method was applied by stakeholders to reach a consensus on the most important questions. Twenty-six stakeholders contributed to the expanded list of evidence gaps, including key investigators from existing randomized controlled trials and others representing different perspectives, including patients, the public, device manufacturers, and policymakers. RESULTS Of the 18 top-tier evidence gaps, 8 were related to specific populations or subgroups of interest. Seven were related to the comparative effectiveness and safety of CRT interventions or comparators, and 3 were related to the association of CRT treatment with specific outcomes. The association of comorbidities with CRT effectiveness ranked highest, followed by questions about the effectiveness of CRT among patients with atrial fibrillation and the relationship between gender, QRS morphology and duration, and outcomes for patients either with CRT plus ICD or with ICD. CONCLUSIONS Evidence gaps presented in this article highlight numerous, important clinical and policy questions for which there is inconclusive evidence on the role of CRT and provide a framework for future collaborative research. PURPOSE To identify barriers and facilitators for the use of augmentative and alternative communication (AAC) and voice restorative strategies for adult patients with an advanced airway in the intensive care unit (ICU). MATERIALS AND METHODS Scoping review searching five databases between 1990 and 2019. We screened 13, 167 citations and included all study types reporting barriers and/or facilitators to using communication strategies in an ICU setting. Two authors independently extracted and coded reported barriers and facilitators to the Theoretical Domains Framework (TDF) domains. RESULTS Of the 44 studies meeting inclusion criteria 18 (44%) used qualitative, 18 (44%) used quantitative, and 8 (18%) used mixed methods. In total, 39 unique barriers and 46 unique facilitators were identified and coded to the domains of the TDF. Barriers were most frequently coded to the Skills, Environmental Context and Resources, and Emotion domains. Facilitators were most frequently coded to Reinforcement, Environmental Context and Resources, and Social and Professional Roles/Identity domains. Thematic synthesis produced four potentially modifiable factors context, emotional support, training, and decisional algorithms. CONCLUSIONS Identified barriers (skills, environment, resources, emotions) and facilitators (reinforcement, resources, roles) to ICU communication strategy use in the literature may be modified through formal training and role support. PURPOSE We report the use and effect of prophylactic platelet transfusions in critically ill thrombocytopaenic patients, comparing patients with or without bone marrow failure as a cause of thrombocytopaenia. METHODS A retrospective observational study of admissions to three intensive care units (ICU) in the UK. We identified thrombocytopaenic patients who received a platelet transfusion and extracted the platelet count prior and subsequent to platelet transfusion. We grouped patients with or without suspected bone marrow failure, defined by a total white cell count ≤1.0 × 109/L. RESULTS Of 11,757 admissions, 399 (3.4%) patients received a platelet transfusion for thrombocytopaenia. The median [IQR] platelet count prior to transfusion in patients without bone marrow failure was 42 [28-64] × 109/L versus 14 [7-24] × 109/L (p less then .0001) in those with. The median [IQR] increment in platelets following transfusion was lower in patients with marrow failure (12 [-1-23] × 109/L) compared to those without (18 [5-36] × 109/L) (p = .
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