Delayed surgical debridement in pediatric open fractures: a systematic review and meta-analysis.

Purpose: Open fractures are considered orthopedic emergencies that are traditionally treated with surgical debridement within 6 h of injury to prevent infection. However, this proclaimed “6-h rule” is arbitrary and not based on rigorous scientific evidence. The aim of our study was to systematically review the literature that compares late (>6 h from the time of injury) to early (<6 h from the time of injury) surgical debridement of pediatric open fractures. Methods: We searched several databases from 1946 to 2013 for any observational or experimental studies that evaluated late and early surgical debridement of pediatric open fractures. We performed a meta-analysis using a random effects model to pool odds ratios for a comparison of infection rates between children undergoing late versus early surgical debridement. We also investigated the infection rates in upper- and lower-limb pediatric open fractures. Descriptive, quantitative, and qualitative data were extracted. Results: Of the 12 articles identified, three studies (retrospective cohort studies) were eligible for the meta-analysis, encompassing a total of 714 open fractures. The pooled odds ratio (OR = 0.79) for infection between late and early surgical debridement was in favor of late surgical debridement but was not statistically significant (95 % CI 0.32, 1.99; p = 0.38, I 2 = 0 %). No significant difference in infection rate was detected between pediatric open fractures in the upper and lower limbs according to the time threshold in the included studies (OR = 0.72, 95 % CI 0.29, 1.82; p = 0.40, I 2 = 0 %). Conclusions: The cumulative evidence does not, at present, indicate an association between late surgical debridement and higher infection rates in pediatric open fractures. However, initial expedient surgical debridement of open fractures in children should always remain the rule. Thus, multi-center randomized controlled trials or prospective cohort studies will be able to answer this question with more certainty and a higher level of evidence

Probing the nucleotide-binding activity of a redox sensor: two-component regulatory control in chloroplasts

Two-component signal transduction systems mediate adaptation to environmental changes in bacteria, plants, fungi, and protists. Each two-component system consists of a sensor histidine kinase and a response regu- lator. Chloroplast sensor kinase (CSK) is a modified sensor histidine kinase found in chloroplasts—photosynthetic organelles of plants and algae. CSK regulates the tran- scription of chloroplast genes in response to changes in photosynthetic electron transport. In this study, the full- length and truncated forms of Arabidopsis CSK proteins were overexpressed and purified in order to characterise their kinase and redox sensing activities. Our results show that CSK contains a modified kinase catalytic domain that binds ATP with high affinity and forms a quinone adduct that may confer redox sensing activity

Oligomeric states in sodium ion-dependent regulation of cyanobacterial histidine kinase-2

Two-component signal transduction systems (TCSs) consist of sensor histidine kinases and response regulators. TCSs mediate adaptation to environmental changes in bacteria, plants, fungi and protists. Histidine kinase 2 (Hik2) is a sensor histidine kinase found in all known cyanobacteria and as chloroplast sensor kinase in eukaryotic algae and plants. Sodium ions have been shown to inhibit the autophosphorylation activity of Hik2 with precedes phosphoryl transfer to response regulators, but the mechanism of inhibition has not been determined. We report on the mechanism of Hik2 activation and inactivation probed by chemical cross-linking and size exclusion chromatography together with direct visualisation of the kinase using negative-stain transmission electron microscopy of single particles. We show that the functional form of Hik2 is a higher-order oligomer such as a hexamer or octamer. Increased NaCl concentration converts the active hexamer into an inactive tetramer. The action of NaCl appears to be confined to the Hik2 kinase domain

Limited effect of patient and disease characteristics on compliance with hospital antimicrobial guidelines

Objective: Physicians frequently deviate from guidelines that promote prudent use of antimicrobials. We explored to what extent patient and disease characteristics were associated with compliance with guideline recommendations for three common infections. Methods: In a 1-year prospective observational study, 1,125 antimicrobial prescriptions were analysed for compliance with university hospital guidelines. Results: Compliance varied significantly between and within the groups of infections studied. Compliance was much higher for lower respiratory tract infections (LRTIs; 79%) than for sepsis (53%) and urinary tract infections (UTIs; 40%). Only predisposing illnesses and active malignancies were associated with more compliant prescribing, whereas alcohol/ intravenous drug abuse and serum creatinine levels > 130 mu mol/l were associated with less compliant prescribing. Availability of culture results had no impact on compliance with guidelines for sepsis but was associated with more compliance in UTIs and less in LRTIs. Narrowing initial broad-spectrum antimicrobial therapy to cultured pathogens was seldom practised. Most noncompliant prescribing concerned a too broad spectrum of activity when compared with guideline-recommended therapy. Conclusion: Patient characteristics had only a limited impact on compliant prescribing for a variety of reasons. Physicians seemed to practise defensive prescribing behaviour, favouring treatment success in current patients over loss of effectiveness due to resistance in future patients

Bacteriological and chemical properties of soil amended with fermented poultry bird feather

Huge amount of poultry wastes are generated annually in developing nations, of which end up in our environment. Feather as a poultry waste have caused environmental concerns in many of these countries. In this research work, poultry feather was used to study its effects on bacteriological and chemical properties in agricultural soil. The feathers collected were grinded, sterilized and fermented before mixing it with soil. Total heterotrophic counts of colonies were enumerated from the soil samples. Isolates were characterized based on morphological and series of biochemical tests. Soil chemical analysis for pH, carbon, nitrogen, phosphorus, calcium, potassium was also carried out. The heterotrophic bacteria count of the treated soil had the highest count in the range of 1.54 x106 to 2.02 x106 (CFU/g) as against the control soil with 1.24 x106 (CFU/g). The bacteria identified from these samples were Bacillus sp., Proteus sp., Staphylococcus sp. and Actinomyces sp. Actinomyces sp. was isolated only after three weeks of treatment with the feather while all other bacteria were also present in the control soil but at elevated levels based on heterotrophic bacteria count in the treated soil. The soil chemical analysis of the treated soil had high amount of mineral (Organic carbon 1.10 %, nitrogen 0.09%, phosphorus 0.53±0.02 mg/kg, magnesium 0.45±0.01 mg/kg as against the control (Organic carbon 0.26%, nitrogen 0.05%, phosphorus 0.30±0.10 mg/kg, magnesium 0.45±0.01 mg/kg) and their pH is almost near neutrality, 7.12 and 7.08 respectively. The result suggested that soil treated with poultry feather increased the plate count of Bacillus sp, Proteus sp, Staphylococcus sp and Actinomyces sp. Poultry feather which is a waste by-product can provide essential nutrients for the survival of soil microorganisms, plant growth and therefore can be exploited as biofertilizer.Keywords: Bacillus sp., biofertilizer, fermentation, keratin, poultry wast

Trust Perceptions of Online Travel Information by Different Content Creators: Some Social and Legal Implications

Consumers are increasingly turning to the online environment to provide information to assist them in making purchase decisions related to travel products. They often rely on travel recommendations from different sources, such as sellers, independent experts and, increasingly, other consumers. A new type of online content, usergenerated content (UGC), provides a number of legal and social challenges to providers and users of that content, especially in relation to areas such as defamation, misrepresentation and social embarrassment. This paper reports research that examined the level of trustworthiness of online travel information from these different sources. The study used a survey of Australian travel consumers (n= 12,000) and results support the notion that there are differences in the level of trust for online travel information from different sources. Respondents ‘tended to agree’ that they trusted information provided by travel agents, information from commercial operators and comments made by travellers on third party websites. However, the highest level of trust was afforded to information provided on State government tourism websites. These results suggest that greater trust is placed in online travel comments when they are on a specific travel website than when they are on a more generic social networking website. However, respondents were ‘not sure’ that they trusted comments made by travellers on weblogs and on social networking sites. Some 88% of respondents that had not visited UGC websites (or were unsure if they had) indicated that they thought that UGC would be useful in the future – suggesting that they feel that any concerns they may have in relation to legal and social problems resulting from its use will be resolved

Molecular Characterization of the Gastrula in the Turtle Emys orbicularis: An Evolutionary Perspective on Gastrulation

Due to the presence of a blastopore as in amphibians, the turtle has been suggested to exemplify a transition form from an amphibian- to an avian-type gastrulation pattern. In order to test this hypothesis and gain insight into the emergence of the unique characteristics of amniotes during gastrulation, we have performed the first molecular characterization of the gastrula in a reptile, the turtle Emys orbicularis. The study of Brachyury, Lim1, Otx2 and Otx5 expression patterns points to a highly conserved dynamic of expression with amniote model organisms and makes it possible to identify the site of mesoderm internalization, which is a long-standing issue in reptiles. Analysis of Brachyury expression also highlights the presence of two distinct phases, less easily recognizable in model organisms and respectively characterized by an early ring-shaped and a later bilateral symmetrical territory. Systematic comparisons with tetrapod model organisms lead to new insights into the relationships of the blastopore/blastoporal plate system shared by all reptiles, with the blastopore of amphibians and the primitive streak of birds and mammals. The biphasic Brachyury expression pattern is also consistent with recent models of emergence of bilateral symmetry, which raises the question of its evolutionary significance

Neutral Higgs bosons in the MNMSSM with explicit CP violation

Within the framework of the minimal non-minimal supersymmetric standard model (MNMSSM) with tadpole terms, CP violation effects in the Higgs sector are investigated at the one-loop level, where the radiative corrections from the loops of the quark and squarks of the third generation are taken into account. Assuming that the squark masses are not degenerate, the radiative corrections due to the stop and sbottom quarks give rise to CP phases, which trigger the CP violation explicitly in the Higgs sector of the MNMSSM. The masses, the branching ratios for dominant decay channels, and the total decay widths of the five neutral Higgs bosons in the MNMSSM are calculated in the presence of the explicit CP violation. The dependence of these quantities on the CP phases is quite recognizable, for given parameter values.Comment: 25 pages, 8 figure

Potential health impacts of heavy metals on HIV-infected population in USA.

Noninfectious comorbidities such as cardiovascular diseases have become increasingly prevalent and occur earlier in life in persons with HIV infection. Despite the emerging body of literature linking environmental exposures to chronic disease outcomes in the general population, the impacts of environmental exposures have received little attention in HIV-infected population. The aim of this study is to investigate whether individuals living with HIV have elevated prevalence of heavy metals compared to non-HIV infected individuals in United States. We used the National Health and Nutrition Examination Survey (NHANES) 2003-2010 to compare exposures to heavy metals including cadmium, lead, and total mercury in HIV infected and non-HIV infected subjects. In this cross-sectional study, we found that HIV-infected individuals had higher concentrations of all heavy metals than the non-HIV infected group. In a multivariate linear regression model, HIV status was significantly associated with increased blood cadmium (p=0.03) after adjusting for age, sex, race, education, poverty income ratio, and smoking. However, HIV status was not statistically associated with lead or mercury levels after adjusting for the same covariates. Our findings suggest that HIV-infected patients might be significantly more exposed to cadmium compared to non-HIV infected individuals which could contribute to higher prevalence of chronic diseases among HIV-infected subjects. Further research is warranted to identify sources of exposure and to understand more about specific health outcomes

Occupational Hazards and HBV infection among health care workers in Public Teaching Hospitals in Khartoum State, Sudan: A multiple Discriminant Analysis

Background: Infection with HBV leads to a wide spectrum of liver injury. It ranges from acute self-limited infection and fulminant hepatitis to chronic hepatitis.Objectives: To examine the prevalence of sero-epidemiologic markers of hepatitis B virus and to identify the risk factors of exposure to HBV among health care workers in Public Teaching Hospitals in Khartoum State, Sudan; in 2004.Methods: The study was a cross sectional, facility-based study. It was conducted on stratified two stage cluster sampling of 843 subjects. The study adopted multivariate statistical approach, using Multiple Discriminant Analysis (MDA) and some non-parametric tests.Results: Infection rate measured by Anti-HB core, carrier rate measured by HBs Ag, and a profile of high infectivity rate measured by HBe Ag was found to be high; while immunity rate measured by Anti-HBs was found to be low. Needle stick injury, contaminated sharp instruments injury andexposure to blood are the most significant occupational variables related to infection rate of HBV. Contaminated sharp instruments injury and exposure to blood, are the most significant occupational variables related to carrier rate. Date of needle stick injury, incidence and date of contaminated sharp instruments injury, incidence and date of exposure to blood have significant relation to immunity rate against HBV infection.Conclusion: The prevalence rate of HBV markers among HCWs in Public Teaching Hospitals in Khartoum State, Sudan, differs according to occupational hazard factors. With the exception of the HBeAg, seroprevalence of all HBV markers was found to be significantly correlated with occupational hazards (P&lt;0.05).Key words: HBV markers, HCWs