Influence of socioeconomic factors on delays, management and boutcome amongst patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Background¦The outcome after primary percutaneous coronary intervention (pPCI) for STElevation¦Myocardial Infarction (STEMI) is strongly affected by time delays. In thepresent study, we sought to identify the impact of specific socioeconomic factors on time delays, subsequent STEMI management and outcomes in STEMI patients from a well-defined region of the French part of Switzerland.¦Method¦A total of 402 consecutive patients undergoing pPCI for STEMI in a large tertiary hospital were retrospectively studied. Symptom-to-first-medical-contact time was analyzed for the following socioeconomic factors: level of education, gender, origin and marital status. Main exclusion criteria were: time delay beyond 12 hours, previous treatment by fibrinolysis or patients immediately referred for CABG.¦Therefore, 352 patients were finally included.¦Results¦At one year, there was no difference in mortality amongst the different socioeconomic groups. Furthermore, there was no difference in management characteristics between them. Symptom-to-first-medical-contact time was significantly higher for patients with a low level of education, Swiss citizens and non-married patients with median differences of 40 minutes, 48 minutes, and 60 minutes, respectively (p<0.05).¦Nevertheless, no difference was found regarding in-hospital management and clinical outcome.¦Conclusion¦This study demonstrates that symptom-to-first-medical-contact time is higher amongst people with a lower educational level, Swiss-citizens, and non-married people. Because of the low mortality rate in general, these differences in time delays did not affect clinical outcomes. Still, primary prevention measures should particularly focus on these vulnerable populations.

Failure of vancomycin continuous infusion against experimental endocarditis due to vancomycin-intermediate Staphylococcus aureus.

Continuous infusion of vancomycin was evaluated against experimental endocarditis due to heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) and VISA. Animals were infected with hVISA PC1 (vancomycin MIC, 2 mg/liter) or VISA PC3 (vancomycin MIC, 8 mg/liter) and treated for 5 days with constant serum levels of 20 or 40 mg/liter. Vancomycin continuous infusion was unsuccessful, as 20 mg/liter was barely active against PC1 (6 of 13 sterile vegetations) and 40 mg/liter failed against PC3 (2 of 9 sterile vegetations).

Differences in self-reported prevalence and management of cardiovascular risk factors in Switzerland, 2007

Purpose: To assess the prevalence of four self-reported cardiovascular risk factors (CV RFs: smoking, hypertension, dyslipidaemia and diabetes) and their reported management in seven Swiss regions (Léman, MiUelland, Zurich, North-West Switzerland, Oriental Switzerland, Central Switzerland and Tessin). Methods: National health interview survey conducted in 2007 in a representative sample of the Swiss population (17,879 subjects). Age-adjusted data on prevalence of self-reported CV RFs, treatment among participants reporting a RF, control of RFs among treated participants and CV RF screening in the last 12 months levels were computed after weighting. Results: The prevalence of hypertension was highest in North-West Switzerland (27.3%) and lowest in Central Switzerland (21.0%, p<0.001). Antihypertensive treatment was highest in Léman region (62.7%) and lowest in Oriental Switzerland (55.2%, p<0.001). Screening was higher in Tessin (89.3%) and lowest in Léman region (81.8%, p<0.001). Prevalence of dyslipidaemia was highest in Tessin and Léman region (20.7% and 20.1 %, respectively) and lowest in Oriental Switzerland (14.5%, p<0.001). Lipid-Iowering treatment was highest in Tessin and Léman region (44.3% each) and lowest in Central Switzerland (30.7%, p<0.001). Dyslipidaemia screening was highest in Tessin (76.6%) and lowest in Central Switzerland (58.6%, p<0.001). Prevalence of diabetes was highest in North-West Switzerland (5.4%) and lowest in Central Switzerland (3.3%, p<0.05). Diabetes screening was highest in Tessin (78.1%) and lowest in Oriental Switzerland (64.0%, p<0.001). Conversely, no between-region differences were found for hypertension or dyslipidaemia control (see table). Conclusion: there are significant differences between the Swiss regions in self-reported prevalence and management of CV RFs. Screening is beUer in Tessin than in the other regions.

Eurytrema coelomaticum (Digenea, Dicrocoeliidae): the effect of infection on carbohydrate contents of its intermediate snail host, Bradybaena similaris (Gastropoda, Xanthonychidae)

The interface Eurytrema coelomaticum/Bradybaena similaris was studied by quantifying the amount of glucose on the hemolymph and the content of glycogen in the cells of the digestive gland and the cephalopedal mass of infected and uninfected snails. Samples were analyzed on days 0, 30, 90 and 150 post-infection. The infected snails had less glucose in the hemolymph, with a reduction of 67.05 por cento at 30 days, and 62.09 por cento at 90 days post-infection. The reduction in glycogen content was 86.41 por cento in the digestive gland and 79.1 por cento in the cephalopedal mass at 30 days, and 92.71 por cento and 90.89 por cento in these organs respectively at 90 days post-infection. It is proposed that the sporocysts absorb glucose directly from the hemolymph.

Degree of host-parasite compatibility between Schistosoma mansoni and their intermediate molluscan hosts in Brazil

The compatibility of Biomphalaria tenagophila, B. straminea and B. glabrata from Minas Gerais with different strains of Schistosoma mansoni was evaluated using the method of Frandsen (1979b) in standardized experiments. One hundred and fifty of each species of snail were individually exposed in the laboratory to 50 miracidia of S. mansoni lines LE, SJ and AL. The cercariae from the infected snails were counted and used to calculate TCP/100 indices, which were compared with those of Frandsen (1979b). For B. tenagophila the TCP/100 indices varied from 37,996 to 74,266 (class II and III). The snail was poorly compatible with LE (class II) and compatible with SJ and AL (class III). For B. straminea the indices varied from 9,484 to 20,508. The snail was not very compatible with SJ (class I) and poorly compatible with LE and AL (class II). For B. glabrata the indices varied from 588,828 to 1,039,065. The snails was extremely compatible (class VI) with the three lines of S. mansoni. These results confirm the epidemiological importance of B. glabrata in Brazil followed by B. tenagophila and B. straminea.

Quantitative ultrasound for the detection and management of osteoporosis.

Quantitative ultrasound (QUS) appears to be developing into an acceptable, low-cost and readily-accessible alternative to dual X-ray absorptiometry (DXA) measurements of bone mineral density (BMD) in the detection and management of osteoporosis. Perhaps the major difficulty with their widespread use is that many different QUS devices exist that differ substantially from each other, in terms of the parameters they measure and the strength of empirical evidence supporting their use. But another problem is that virtually no data exist outside of Caucasian or Asian populations. In general, heel QUS appears to be most tested and most effective. Some, but not all heel QUS devices are effective assessing fracture risk in some, but not all populations, the evidence being strongest for Caucasian females > 55 years old, though some evidence exists for Asian females > 55 and for Caucasian and Asian males > 70. Certain devices may allow to estimate the likelihood of osteoporosis, but very limited evidence exists supporting QUS use during the initiation or monitoring of osteoporosis treatment. Likely, QUS is most effective when combined with an assessment of clinical risk factors (CRF); with DXA reserved for individuals who are not identified as either high or low risk using QUS and CRF. However, monitoring and maintenance of test and instrument accuracy, precision and reproducibility are essential if QUS devices are to be used in clinical practice; and further scientific research in non-Caucasian, non-Asian populations clearly is compulsory to validate this tool for more widespread use.

In vivo detection of brain Krebs cycle intermediate by hyperpolarized magnetic resonance.

The Krebs (or tricarboxylic acid (TCA)) cycle has a central role in the regulation of brain energy regulation and metabolism, yet brain TCA cycle intermediates have never been directly detected in vivo. This study reports the first direct in vivo observation of a TCA cycle intermediate in intact brain, namely, 2-oxoglutarate, a key biomolecule connecting metabolism to neuronal activity. Our observation reveals important information about in vivo biochemical processes hitherto considered undetectable. In particular, it provides direct evidence that transport across the inner mitochondria membrane is rate limiting in the brain. The hyperpolarized magnetic resonance protocol designed for this study opens the way to direct and real-time studies of TCA cycle kinetics.

Multi-level SLA-driven resource management on Cloud Providers

Nowadays, service providers in the Cloud offer complex services ready to be used as it was a commodity like water or electricity to their customers with any other extra effort for them. However, providing these services implies a high management effort which requires a lot of human interaction. Furthermore, an efficient resource management mechanism considering only provider's resources is, though necessary, not enough, because the provider's profit is limited by the amount of resources it owns. Dynamically outsourcing resources to other providers in response to demand variation avoids this problem and makes the provider to get more profit. A key technology for achieving these goals is virtualization which facilitates provider's management and provides on-demand virtual environments, which are isolated and consolidated in order to achieve a better utilization of the provider's resources. Nevertheless, dealing with some virtualization capabilities implies an effort for the user in order to take benefit from them. In order to avoid this problem, we are contributing the research community with a virtualized environment manager which aims to provide virtual machines that fulfils with the user requirements. Another challenge is sharing resources among different federated Cloud providers while exploiting the features of virtualization in a new approach for facilitating providers' management. This project aims for reducing provider's costs and at the same time fulfilling the quality of service agreed with the customers while maximizing the provider's revenue. It considers resource management at several layers, namely locally to each node in the provider, among different nodes in the provider, and among different federated providers. This latter layer supports the novel capabilities of outsourcing when the local resources are not enough to fulfil the users demand, and offering resources to other providers when the local resources are underused.

Best practice in the management of mild-to-moderately active ulcerative colitis and achieving maintenance of remission using mesalazine.

Optimizing treatment goals in ulcerative colitis requires recognizing the needs of patients. It is increasingly recognized that adapting treatment strategies aligned with patient needs can improve patient compliance and consequently minimize relapse rates. Tailoring of treatment strategies can improve not only patient quality of life, and decrease the number harmed by adverse events from more potent drugs, but can also save valuable healthcare costs by avoiding high-cost treatment interventions associated with acute ulcerative colitis. This review will consider several elements of mesalazine management from the patient perspective based on a range of clinical and patient-focused evidence. By highlighting patient preferences in disease management it is envisaged that this review will aid physicians to optimize treatment decisions with the different mesalazine preparations available.