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By: Soheir Saeed Adam, MBBCh
- Assistant Professor of Medicine
Clinical association: the diagnostic relevance of autoantibodies against vimen- tin remains as unclear as that of the much rarer autoantibodies against cytoker- atin generic prinivil 10mg mastercard blood pressure 34 year old male, tropomyosin purchase prinivil 2.5mg with visa arrhythmia greenville sc, etc discount prinivil 2.5mg mastercard wide pulse pressure icd 9 code. They are considered to be associated with different inﬂammatory reactions and infections buy generic prinivil 10mg on line blood pressure chart in canada. The primate liver shows a ﬂuorescence of the basal boundary surface of endo- thelium and stroma in the sinusoids. Clinical association: Autoantibodies agianst vinculin are very rare and are asso- ciated with Myasthenia gravis, ulcerative colitis and Crohns disease. Hepatocytes of the primate liver show a cytoplasmic ﬂuorescence of the entire surface with patchy accentuation. In mitotic cells the ﬂuorescence is peri- chromosomally intensiﬁed, the chromosomes are unaffected. Hepatocytes of the primate liver generally show a ﬁne speckled ﬂuorescence distributed over the whole organ. They are also markers for necrotis- ing myopathy, an autoimmune myopathy that differs from polymyositis, but can manifest with skin changes typical for dermatomyositis. According to recent ﬁndings, Jo-1 target antigens are not solely local- ised in the cytoplasm, but are also found in the cell nucleus in some species. On frozen tissue sections of primate liver the cytoplasm is only slightly stained. Clinical association: Antibodies against Jo-1 can be detected in polymyositis with a prevalence of 25 – 35 %. Clinical association: Autoantibodies against mitochondria can be detected in various diseases. In cells which are in the mitosis, the Golgi apparatus is to a large extent dispersed. Detection of these antibodies has little relevance due to their low disease speciﬁcity. These ﬁlamentous structures, which are expressed in all stages of the cell cycle, present themselves as rings, rods or loops. Clinical association: the depicted pattern was observed mainly in patients with hepatitis C infections, particularly after treatment with interferon-alpha or riba- virin (prevalence 35 %). On primate liver, high-titer samples produce small ﬂuorescing dots in the cyto- plasm of hepatocytes. Clinical association: A high titer (> 1:1,000) indicates progressive systemic scle- rosis or Raynauds syndrome, the prevalence however, only amounts to a few percent. In the presence of these antibodies only the spindle ﬁbres of the mitotic cells, but not the cell nuclei of the interphase cells are stained. On tissue sections of primate liver a speckled ﬂuorescence of the cell nuclei can be observed. In mitotic cells in the metaphase, the spindle ﬁbres manifest as two opposing fans. In contrast to the pattern found with antibodies against centromeres, this ﬂuorescing line remains in the middle until the end of mito- sis. Their length corresponds to the whole cell width in the separation zone, and the line increasingly shortens until only a ﬂuorescing dot is seen in the telophase, binding the daughter cells together (“goodbye kiss). Clinical association: Raynaud syndrome, malignoma and progressive systemic sclerosis. Clinical association: Polymyalgia rheumatica, discoid lupus erythematosus, Sjögrens syndrome and chronic lymphatic leukaemia. In mitotic cells the border area of condensed chromosomes ﬂuoresces, sometimes the entire chromosomal region is positive. On rat kidney tissue sections, the cell nuclei of the tubular epithelium ﬂuoresce. Clinical association: Topoisomerase I antibodies are detected in 25 – 75% of patients with progessive systemic sclerosis (diffuse form), depending on the analysis method and the activity of the disease. Therefore, we recommend using a dilution scheme based on the square root of 10 to yield dilution steps of 1 : 10, 1 : 32, 1 : 100, 1 : 320, 1 : 1. A symbol from + to ++++ is attributed to a dilution step with a speciﬁc ﬂuores- cence.
The strength of this network is its access to information on antibiotic use cheap 2.5mg prinivil with visa arrhythmia games, which is the other arm of surveillance cheap 10 mg prinivil amex blood pressure medication memory loss. It was noted that data on antibiotic use already exists in many settings and as pharmacists they have easy access to this  prinivil 5mg amex arrhythmia cough. It remains to be seen whether such data could be incorporated into national surveillance programmes usefully generic 10 mg prinivil mastercard blood pressure medication hctz, as the data are often from non-representative populations. The bottleneck in understanding the extent of antibiotic resistance in many settings is the difficulty of scaling up microbiology capacity in the field. The LabCap Scheme Fondation Mérieux Royal College of Pathologists (LabSkills Africa) Universities and postgraduate institutions. The programme supports countries in strengthening policies related to drug use, procurement of essential medicines and medicines quality. ReActs strategy has been to raise awareness on antibiotic resistance to a range of constituencies, develop networks with interested parties, and move forward towards developing national policy platforms with social mobilisation in selected countries. The group is currently developing a pilot project that includes three countries in three continents using point prevalence surveys to raise awareness. We summarise standalone databases only and not academic networks already presented in the earlier sections which also have a data repository, i. It can be used as a Laboratory information Management System or receive files transferred from other databases. The plan is to collect data aggregated at national level with individual level data kept locally. Robust, systematic approaches will be needed to attain these standards or specifications, i. Criteria used to assess laboratory quality management programmes the assessment was performed using a standard form. The remainder was a mixture of governmental, non- governmental and academic groups or commercial enterprises. Some programmes offered proficiency testing only (15), while many offered different combinations of proficiency testing, standards or policy setting, accreditation, training, assessment and evaluation, or were a repository for/provider of reference material. A range of diagnostic methods (culture, serology, molecular), and pathogens was covered by the programmes (e. Before data aggregation at national or international level they will need to be harmonised . In the case of bacterial diseases however, molecular tests are of limited use currently since resistance genes, even if present in an isolate, may not be expressed into a corresponding resistance phenotype. The lack of correlation between genotype and phenotype is likely to be a result of a multitude of factors, not the least of which may be differential expression of the resistance genes . Nonetheless, given the rapid advances in omics- related data generation and analysis, it is likely that practical applications will be found. A methodology to validate or reject candidate molecular markers or assays currently in development by comparison with existing validated methods will be required [118-120]. This is in addition to clear guidelines on the contexts, pathogens and antimicrobials for which the use of currently available knowledge, i. Various molecular typing methods based on nucleic acid typing or on mass spectrometry are being applied increasingly in pathogen identification and serotyping,. In malaria, molecular markers of drug resistance can be used for surveillance but the gold standard of evidence to change treatment policies at the public health level remains in vivo studies . This is also because it has been difficult to standardise methods and breakpoints of in vitro assays for antimalarial susceptibility testing thus hindering its widespread deployment. These are all topics which are typically included in a quality assurance manual along with measures for quality monitoring and improvement. The exact measures and how or when they are implemented may differ between various applications of such manuals but the basic premise remains the same – to ensure that the inputs, the outputs and the process producing one from the other is performing within acceptable limits of variation or tolerance and that there are adequate controls to signal deviations from such limits. It would be worthwhile to review available materials for coherence with harmonised testing and reporting guidelines and for completeness before promoting further dissemination as a complete package to end users. Such checks are accomplished through the use of well characterised reference materials to test whether the assay produces expected results. External quality assessments and accreditation External quality assessments can be performed through re-checking of specimens already tested in a laboratory in a reference laboratory or through proficiency testing.
Provincial/district hospitals are under the control of provincial/district health departments and are responsible for the medical care of the people from respective provinces and districts generic 2.5mg prinivil with visa blood pressure chart numbers. Commune health centers are managed by the district health centers and are responsible for the primary healthcare of the local people purchase prinivil 5 mg visa blood pressure normal ki dua. Importantly discount 5 mg prinivil with amex heart attack nausea, increases in antibiotic resistance rates have been reported in various studies buy 2.5mg prinivil free shipping heart attack kidz bop. From 1999 to 2007, penicillin-resistance rates in Streptococcus pneumoniae increased from 8% to 75% in Ba Vi district . An increase in tetracycline and chloramphenicol resistance (from 81 to 99% and from 2. High carbapenem-resistance rates are found in Pseudomonas aeruginosa and Acinetobacter baumannii . A national action plan on prevention and control of drug resistance including antibiotics has been in place. However, of note is the fact that what has been studied and reported is most likely only the tip of the iceberg [personal communications with the head of 9 a microbiology department in a national hospital]. Many Vietnamese hospitals are old and overcrowded, making effective infection control challenging. The MoH estimates the average bed occupancy rate across all levels of public hospitals to be approximately 130% . Patient overload in public hospitals is one of the most considerable challenges across the Vietnamese healthcare system, compounded by the fact that patients tend to seek health care in public hospitals rather than their commune health stations. With high workload, it is difficult to ensure adequate practices including infection control. The first regulation which raised hospital infection control was the MoHs regulation on hospital organisation, conditions and activities, issued in 1997 . During the last decade, efforts have been made to improve the system for infection control, however, much is still unknown regarding the compliance with regulations. To the best of my knowledge, there has been no study published from Vietnam regarding knowledge, perceptions and practices of infection control among hospital staff. Regulations on healthcare waste management exist, specifying that every hospital must have a wastewater treatment plant. Nevertheless, no standards have yet been established on how hospital wastewater should be treated in terms of antibiotic residues and antibiotic-resistant bacteria. Evidence on the hospital dissemination of antibiotic residues and antibiotic-resistant bacteria into the environment in Vietnam is very scarce. To the best of my knowledge, there has been 10 only one study published, which attempted to investigate residual concentrations of fluoroquinolones and the fate of resistant E. This study used grab sampling, indicating the presence of ciprofloxacin and norfloxacin residues, and susceptible E. It has however been suggested that continuous sampling should be used to determine antibiotic concentrations in hospital wastewater as grab sampling only provides the quantities of antibiotics present in wastewater at the time of sampling . In combating with antibiotic resistance, an important development is the endorsement of a global action plan at the 69th World Health Assembly in 2015. Various factors contribute to the spread of antibiotic resistance including inadequate hospital infection control and the discharge of antibiotic residues and antibiotic-resistant bacteria from hospitals into the environment. This study was therefore undertaken to understand the problem, contributing to the global action in combating with antibiotic resistance. The studies were conducted in two general hospitals in Hanoi: one rural and one urban hospital. A mixed method approach was used including both quantitative and qualitative methods (Table 2). Study framework Paper I – a quantitative cross-sectional study using a questionnaire to evaluate and compare knowledge and reported practices of hospital infection control among various occupation groups. Hanoi, located in northern region of Vietnam, is the capital and the countrys second largest city by population. Hanoi is also one of the countrys largest centres in terms of the healthcare system.
The in vivo growth rate of the same strains was determined by injection of bacteria into the flies at time 0 and samples were collected between time 0-3 purchase 5 mg prinivil visa blood pressure tracking chart printable, 4-6 and 12 hours post infection (Fig prinivil 2.5mg generic prehypertension que es. Whereas flies infected with approximately the same number of 8325-4 lived significantly longer (Fig effective 5mg prinivil hypertension online. Survival data are compiled results from all in vivo experiments presented in figures 2 and 5 purchase 5mg prinivil with amex blood pressure 800. In order to establish the appropriate dosages, we made the following reasoning: Because insects are known to have an open circulatory system, we assumed that the administered compound would be rapidly and uniformly distributed in the hemolymph of the fly. Antimicrobial peptide dosages: We calculated the concentration of compound injected in mg/kg Fly, based on the data in table 2. However, the results indicate that administration of this peptide to animals infected with bacteria may reduce the survival because a higher number of the animals treated with the peptide after infection died, although this was not statistically significant. S4 and S5 respectively), but they caused a moderate decrease in survival of infected flies that may indicate detrimental effects of peptides, although the results were somewhat ambiguous. Animals reacted to injection with these compounds by being partially paralyzed for up to 10 hours post injection (not shown). This paralysis was not manifested as complete immobilization but as uncoordinated movements and an inability to walk or fly. We rationalized that infected animals treated with these compounds would mount less of an immune response provided that bacterial proliferation in the host was inhibited. Samples in triplicate were taken at 6 and 12 hours post infection and processed as described in Materials and methods. As a measure of immune response we analyzed expression of Drosomycin (Drs), Cecropin A1 (CecA1) and Attacin-B (AttB) genes, which have all been implicated in the immune response of Drosophila to infection by Gram-positive bacteria (50, 51). In general we observed that animals that received any form of treatment had elevated transcription of immune response genes (Fig. Further, it is highly plausible that injection of any protein like structure will elicit some degree of immune response. Drosomycin expression increased 30-180- fold within 6 hours post infection and remained at that level at 12 hours 3A). Expression of Cecropin A1 followed the same pattern as observed for Drs 100 except that maximal induction was only around 20-fold (Fig. Gene expression was increased considerately in all flies injected with peptides and irrespective of a concurrent S. Some compounds, including nisin, have previously been associated with immunomodulatory actions in mice (52). However, whether this is due to true immunomodulatory action or because of the observed toxicity is unclear. A non-infected control was used as reference of normal expression; these values were set as 1. However, as observed for exponentially growing cells, the nisin treated stationary phase cells re-grew by 24 hours (Fig. Nisin was not tested at higher concentrations due to the aforementioned lethal effects. Although nisin did not rescue flies over the duration of the experiment, it did delay mortality by doubling the mean survival time (p < 0. We examined several cationic antimicrobial peptides previously reported to have either in vitro or in vivo efficacy against S. We found that both lantibiotics, can delay or even rescue lethal injections with wild type S. Amphipathic peptides None of the cationic amphipathic peptides previously tested in vitro and/or in vivo against both gram- negative and gram-positive bacteria (41) had any positive effect on the survival of S. These peptides are believed to work through pore formation, thereby disrupting the integrity of the bacterial membrane(s). Although this does not exclude the possibility that peptides may be effective in mammalian models, our data do not support their use in whole-animal infections.
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