Publications by authors named "Bashir Ahmed"

66 Publications

Safety and Feasibility of Same Day Discharge Strategy for Primary Percutaneous Coronary Intervention.

Glob Heart 2021 1;16(1):46. Epub 2021 Jul 1.

National Institute of Cardiovascular Diseases (NICVD), Karachi, PK.

Background: The strategy for early discharge after primary percutaneous coronary intervention (PCI) could have substantial financial benefits, especially in low-middle income countries. However, there is a lack of local evidence on feasibility and safety of the strategy for early discharge. Therefore, the aim of this study was to assess the safety of early discharge after primary PCI in selected low-risk patients in the population of Karachi, Pakistan.

Methods: In this study 600 consecutive low-risk patients who were discharged within 48 hours of primary PCI were put under observation for major adverse cardiac events (MACE) after 7 and 30 days of discharge respectively. Patients were further stratified into discharge groups of very early (≤ 24 hours) and early (24 to 48 hours).

Results: The sample consisted of 81.8% (491) male patients with mean age of 54.89 ± 11.08 years. Killip class was I in 90% (540) of the patients. The majority of patients (84%) were discharged within 24 hours of the procedure. Loss to follow-up after rate at 7 and 30 days was 4% (24) and 4.3% (26) respectively. Cumulative MACE rate after 7 and 30 days was observed in 3.5% and 4.9%, all-cause mortality in 1.4% and 2.3%, cerebrovascular events in 0.9% and 1.4%, unplanned revascularization in 0.9% and 1.2%, re-infarction in 0.3% and 0.5%, unplanned re-hospitalization in 0.5% and 0.5%, and bleeding events in 0.5% and 0.5% of the patients respectively.

Conclusion: It was observed that very early (≤ 24 hours) discharge after primary PCI for low-risk patients is a safe strategy subjected to careful pre-discharge risk assessment with minimal rate of MACE after 7-days as well as 30-days.
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http://dx.doi.org/10.5334/gh.1035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252969PMC
July 2021

Disparities in clinical features and outcomes of peripartum cardiomyopathy in high versus low prevalent regions in Nigeria.

ESC Heart Fail 2021 Aug 17;8(4):3257-3267. Epub 2021 Jun 17.

Hatter Institute for Cardiovascular Research in Africa & CHI, Cape Town, South Africa.

Aims: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North-West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere.

Methods And Results: Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow-up, relative to baseline status, were assessed by echocardiography. During median 17 months follow-up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all-cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 μg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling.

Conclusions: This study has shown important non-racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.
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http://dx.doi.org/10.1002/ehf2.13463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318483PMC
August 2021

Myocardial tuberculosis and beyond: A rare form of extra pulmonary TB in a young boy.

Indian J Tuberc 2021 Jul 4;68(3):416-419. Epub 2020 Nov 4.

Pulmonology, National Institute of Diseases of Chest and Hospital (NIDCH), Dhaka, Bangladesh.

Myocardial tuberculosis is an exceptionally rare form of extra-pulmonary TB. Few cases were reported world-wide. Here a young snake charmer who had skin tuberculosis 5 yrs back admitted into National institute of diseases of Chest and hospital (NIDCH), Dhaka with the complaints of cough, palpitation and breathlessness for 2 months. He had right axillary firm matted lymphadenopathy, left sided large pleural effusion, left ventricular and septal hypertrophy with band and mass inside the ventricle (evident on CT scan of heart and echocardiography). His ESR was 95 mm in1st hr, Mantaux test was 15mm, Pleural fluid was exudative lymphocyte predominant with adenosin deaminase (ADA) 68.6 U/L. Fine needle aspirates from right axillary LNs showed Mycobacterium tuberculosis on GeneXpert for MTB/RIF testing and caseous granuloma on cytopathological study. Whole Body F18 FDG PET-CT revealed numerous low FDG avid size significant lymph nodes in right side of neck, mediastinum and right axilla with cardiomegaly with focal FDG avid within the left ventricular cavity likely to be prominent papillary muscle. MRI of heart or Myocardial biopsy for histology was not done due to their cost and invasiveness and also for that there was sufficient evidence of having tuberculosis in lymph node, pleura nas myocardium. This patient was treated with anti tubercular medications (3HRZE2S/5HRE) with prednisolone for six months. After treatment, myocardial lesions, pleural effusion and lymphadenopathy were found resolved. Thus a case of fatal and serious tuberculosis was explored and managed successfully.
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http://dx.doi.org/10.1016/j.ijtb.2019.12.003DOI Listing
July 2021

Psychiatrists and homicidal threats: a cross-sectional study.

Ir J Psychol Med 2021 Mar 8:1-5. Epub 2021 Mar 8.

Department of Psychiatry, Mid-West Mental Health Service, University Hospital Limerick, Limerick, Ireland.

Objectives: To investigate the frequency, characteristics and impact of death threats by patients towards psychiatrists.

Methods: A cross-sectional survey of psychiatrists (n = 60) was undertaken to investigate the frequency, characteristics and impact of death threats by patients in one Irish healthcare region serving a mixed urban-rural population of 470,000.

Results: Forty-nine responses (82%) were received. Thirty-one per cent of respondents experienced death threats by patients during their careers. Victims were more likely to be male and in a consultant role. Patients making the threats were more likely to be males aged 30-60 with a history of violence and diagnosis of personality disorder and/or substance misuse. A majority of threats occurred in outpatient settings and identified a specific method of killing, usually by stabbing. Prosecution of the perpetrator was uncommon. Of the victimised psychiatrists, 53% reported that such threats affected their personal lives, and 67% believed their professional lives were impacted. In half of the incidents, there were adverse incidents subsequent to the threats, involving either the patient or the clinician.

Conclusions: Death threats by patients have significant psychological and professional impacts on psychiatrists. Early liaison with employers and police and transferring the care of the patient to another clinician may be useful measures.
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http://dx.doi.org/10.1017/ipm.2021.14DOI Listing
March 2021

Predictive Factors Associated With Fear Faced by Healthcare Workers During COVID-19 Pandemic: A Questionnaire-Based Study.

Cureus 2020 Aug 14;12(8):e9741. Epub 2020 Aug 14.

Orthopaedic Surgery, Dow University of Health Sciences, Karachi, PAK.

Background The coronavirus disease 2019 (COVID-19) since the beginning has been a reason of fear among healthcare workers (HCWs) due to the increased mortality, especially in the HCWs themselves. In this survey study, we aimed to explore the predictive factors associated with fear faced by HCWs during the COVID-19 pandemic and to identify the areas which need to be addressed to reduce it. Methods On May 14, 2020, we conducted an observational, cross-sectional survey using a self-administered questionnaire, consisting of the following two parts: (1) focused on factors associated with HCWs' fear of getting an infection and being a source of carrying the infection to whom they care, and (2) focused on factors associated with HCWs' fear of uncertainty and lack of support from concerned health authorities. Results The mean age of the participants was 40.04 ± 12.92 years with 79.3% being males. More than half (51.1%) of the participants were consultants. The most important factors associated with fear included getting infected (84.8%), quarantined (69.6%), not getting medical treatment (62%), losing a life (56.8%), and infecting family members (94.2%). Another major factor associated with HCWs' fear was lack of support from concerned health authorities, 80.2% thought of solatium, and 71.7% believed that the job should be given to eligible family members of the deceased. More than 82.2% were concerned about health expenses and around 97.6% felt an additional health risk allowance should be given. Conclusion Our results indicate that the risk of getting infection to themselves and their families, along with a lack of support from concerned health authorities, was strongly associated with fear among HCWs. We hope through these findings that the concerned health authorities will take notice and do something in this regard by developing appropriate policies and measures to make sure that HCWs and their families are cared for if they get infected.
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http://dx.doi.org/10.7759/cureus.9741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489766PMC
August 2020

Investigating the GWAS-Implicated Loci for Rheumatoid Arthritis in the Pakistani Population.

Dis Markers 2020 31;2020:1910215. Epub 2020 Jul 31.

Department of Human Genetics, Graduate School of Public Health (GSPH), University of Pittsburgh, Pittsburgh, PA, USA.

Rheumatoid arthritis (RA) is a complex and multifactorial autoimmune disorder with the involvement of multiple genetic and environmental factors. Genome-wide association studies (GWAS) have identified more than 50 RA genetic loci in European populations. Given the anticipated overlap of RA-relevant genes and pathways across different ethnic groups, we sought to replicate 58 GWAS-implicated SNPs reported in Europeans in Pakistani subjects. 1,959 unrelated subjects comprising 1,222 RA cases and 737 controls were collected from three rheumatology facilities in Pakistan. Genotyping was performed using iPLEX or TaqMan® methods. A total of 50 SNPs were included in the final association analysis after excluding those that failed assay design/run or postrun QC analysis. Fourteen SNPs (/rs1516971, /rs2240336, /rs4409785, /rs3087243, /rs13426947, /rs2596565, /rs26232, /rs951005, /rs2275806, /rs595158, /rs660895, /rs3806624, /rs934734, and /rs9979383) were replicated in our Pakistani sample at false discovery rate (FDR) of <0.20 with nominal values ranging from 4.73-06 to 3.48-02. Our results indicate that several RA susceptibility loci are shared between Pakistani and European populations, supporting the role of common genes/pathways.
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http://dx.doi.org/10.1155/2020/1910215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422001PMC
June 2021

Serum Elabela Levels Are Elevated in Patients with Hyperthyroidism.

Tohoku J Exp Med 2020 08;251(4):255-261

Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center.

The apelinergic system plays an important role in the modulation of the cardiovascular system via the apelin peptide and the apelin receptor (APJ receptor). Apelin and elabela, also known toddler, are peptide ligands for the apelin receptor. These two peptides show similar biological actions, such as vasodilatation, increased myocardial contractility, angiogenesis, and energy metabolism. However, the serum levels of elabela in patients with hyperthyroidism are not well known. The aim of this study was to investigate the changes in serum elabela levels in patients with hyperthyroidism and its association with hypertension. This cross-sectional study included 74 patients with newly diagnosed hyperthyroidism due to Graves' disease and 20 healthy individuals. Serum elabela levels were measured by enzyme-linked immunosorbent assay. The patients were divided into two groups: hyperthyroid patients without hypertension (n = 51) and those with hypertension (n = 23). Basal heart rate, serum glucose and high-sensitive C reactive protein were significantly higher in hyperthyroid patients with and those without hypertension than in healthy controls (p < 0.05 for each). Serum elabela levels were significantly elevated in hyperthyroid patients compared with healthy controls, with higher serum elabela levels found in hyperthyroid patients with hypertension than those without hypertension. Linear regression analysis showed that serum elabela levels were correlated with systolic blood pressure (p < 0.001). In conclusion, serum elabela levels were significantly increased in patients with hyperthyroidism, especially in hyperthyroid patients with hypertension. Elevation in serum elabela levels may contribute to alleviation of cardiovascular complications of hyperthyroidism and hypertension.
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http://dx.doi.org/10.1620/tjem.251.255DOI Listing
August 2020

Energy insecurity, pollution mitigation, and renewable energy integration: prospective of wind energy in Ghana.

Environ Sci Pollut Res Int 2020 Oct 4;27(30):38259-38275. Epub 2020 Jul 4.

School of Management, China Institute for studies in Energy Policy, Collaborative Innovation Centre for Energy Economics and Energy Policy, Xiamen University, Xiamen, 361005, Fujian, China.

Wind energy is seen as an important energy to sustainably meet the energy needs of Ghana. However, the industry in Ghana is yet to take off due to policy uncertainty and regulatory costs. The paper analyzed the key determinants and how they interact to impact the scaling up of wind energy in Ghana, using time series data, the vector auto regression (VAR) model from 2013 to 2019.There were four endogenous variables, grouped under policy, population growth, wind capacity, and electrification rate. The findings revealed the dynamic behavior of the variables from the VAR to a strongly significant positive correlation to deploying wind energy in Ghana. The impulse response functions (IRFs) equally exhibited a positive impact long-run trajectory growth of the variables after a shock to the system. The response of the first lags had differences of log policy and that of the log of GDP produced a curious result from the shock by taking a steady positive growth path in the short run and nosedived to a negative pathway in the long run. On the other hand, the interaction of the first differences of the lags of log wind capacity and log policy is quite instructive, as the headwind produced a negative relationship in the short run and to a positive growth path in the long run. This was anticipated, as the wind capacity installation of Ghana is expected to increase in the long run, when pipeline projects materialize.
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http://dx.doi.org/10.1007/s11356-020-09709-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371795PMC
October 2020

Scaling up renewable energy in Africa: measuring wind energy through econometric approach.

Environ Sci Pollut Res Int 2020 Oct 18;27(29):36282-36294. Epub 2020 Jun 18.

Faculty of Management Sciences, Ghazi University Dera Ghazi Khan, Dera Ghazi Khan, Pakistan.

Wind energy continues to make inroads in Africa due to falling costs and technological advancements. Most African countries are planning, exsiccating and connecting their renewable energy projects with national grid system with giving high propriety to energy security, sustainable energy consumption and low carbon emission. Many policies have been enacted by countries to promote the scaling up of wind energy and renewable energy in particular, across the globe. However, these policies have mixed effects on the deployment of wind energy. For this purpose, current study used panel data and fixed effects model for 17 African countries with wind installed generation capacity to determine the driver of wind energy development on the African continent between 2008 and 2017. The variables were grouped into three thematic areas: policy, socioeconomic, and country-specific factors. After conducting the analysis, socioeconomic variables (GDP, CO, energy use) and energy security variables (energy import, electricity consumption) have significant effects in determining the scaling up of wind energy in Africa. However, the policy variables of FITs, licensing during, and Tax did not have significant effects on wind energy capacity addition for the case of Africa. This study adds to the drivers of nascent wind energy deployment literature in Africa. This study suggests that set of effecitive policies are deem necessary to scale up wind energy in Africa.
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http://dx.doi.org/10.1007/s11356-020-09596-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302724PMC
October 2020

Behavioral flexibility is associated with changes in structure and function distributed across a frontal cortical network in macaques.

PLoS Biol 2020 05 26;18(5):e3000605. Epub 2020 May 26.

Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.

One of the most influential accounts of central orbitofrontal cortex-that it mediates behavioral flexibility-has been challenged by the finding that discrimination reversal in macaques, the classic test of behavioral flexibility, is unaffected when lesions are made by excitotoxin injection rather than aspiration. This suggests that the critical brain circuit mediating behavioral flexibility in reversal tasks lies beyond the central orbitofrontal cortex. To determine its identity, a group of nine macaques were taught discrimination reversal learning tasks, and its impact on gray matter was measured. Magnetic resonance imaging scans were taken before and after learning and compared with scans from two control groups, each comprising 10 animals. One control group learned discrimination tasks that were similar but lacked any reversal component, and the other control group engaged in no learning. Gray matter changes were prominent in posterior orbitofrontal cortex/anterior insula but were also found in three other frontal cortical regions: lateral orbitofrontal cortex (orbital part of area 12 [12o]), cingulate cortex, and lateral prefrontal cortex. In a second analysis, neural activity in posterior orbitofrontal cortex/anterior insula was measured at rest, and its pattern of coupling with the other frontal cortical regions was assessed. Activity coupling increased significantly in the reversal learning group in comparison with controls. In a final set of experiments, we used similar structural imaging procedures and analyses to demonstrate that aspiration lesion of central orbitofrontal cortex, of the type known to affect discrimination learning, affected structure and activity in the same frontal cortical circuit. The results identify a distributed frontal cortical circuit associated with behavioral flexibility.
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http://dx.doi.org/10.1371/journal.pbio.3000605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274449PMC
May 2020

Tinnitus and Vertigo Symptoms: Precursors of Psychiatric Suffering.

J Coll Physicians Surg Pak 2020 Mar;30(3):346

Department of E.N.T, Hearts International Hospital, Rawalpindi, Pakistan.

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http://dx.doi.org/10.29271/jcpsp.2020.03.346DOI Listing
March 2020

Prevalence of tuberculosis, HIV/AIDS, and hepatitis; in a prison of Balochistan: a cross-sectional survey.

BMC Public Health 2019 Dec 4;19(1):1631. Epub 2019 Dec 4.

Faculty of Bolan Medical University, Quetta, Pakistan.

Background: Human Immunodeficiency Virus (HIV), Hepatitis, and Tuberculosis (TB) are three primary communicable infections have the likely potential to cause severe morbidity in prison settings. The prison has the most favorable environment for the transmission of infections. We conducted this survey to determine the prevalence and feasibility of rapid diagnostic tests in an active screening of these infectious diseases in prison.

Methods: This cross-sectional survey conducted in central Jail Gaddani, one of the largest prisons in the Balochistan province of Pakistan. All prisoners, jail staffs, and staff's family members participated. Informed consent obtained from each participant before the screening. Van equipped with digital X-ray linked with Computer-Aided Detection for TB (CAD4TB) software used for testing. Sputum samples tested on Xpert for MTB/RIF assay and blood specimens collected for HIV and hepatitis serology. Diagnosed TB patients enrolled for treatment at Basic Management Unit (BMU), reactive on hepatitis Rapid Diagnostic Tools (RDTs) were referred for further testing and management, while HIV reactive referred to Anti Retro Viral (ARV) center for Anti Retro Viral Treatment (ART).

Results: A total of 567 participants offered screening, 63% (356) prisoners, 23% (129) staff's family members, and 14% (82) jail staffs. Among tested 10.3% (58/562) were hepatitis seropositive (Hepatitis-C 41 [7.29%] Hepatitis-B, 16 [2.84%] Hepatitis B&C both, 01 [0.17%]). In reactive participants, 49 were prisoners, 08 were jail staffs, and 01 was the staff's family member. HIV seropositive was 4% (24/566), and all were prisoners. Almost 99% (565/567) screened by digital X-ray, 172 (30%) were with abnormal CAD4TB suggestion (score > 50), out of them sputum of 26% (148) tested on Xpert, and 2% (03) found Mycobacterium tuberculosis Positive (MTB+). A total of five TB patients were detected; out of two were diagnosed clinically. Co-morbidities observed in 15 patients, (01 TB/HIV co-infected, 12 HIV/HCV, 01 HIV/HBV, and 01 HBV/HCV).

Conclusion: The high frequency of infectious diseases in prison is alarming. For limiting the transmission of infections among prison and community, immediate steps are needed to be taken for improvement of prisons condition by application of recommended screening protocols at the time of the first entry of prisoners in prisons.
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http://dx.doi.org/10.1186/s12889-019-8011-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894348PMC
December 2019

Gamma-ray shielding characteristics of flexible silicone tungsten composites.

Appl Radiat Isot 2020 Jan 5;155:108901. Epub 2019 Oct 5.

Department of Nuclear Engineering (DNE), Pakistan Institute of Engineering and Applied Sciences (PIEAS), P. O. Nilore, 45650, Islamabad, Pakistan.

Silicone being a hybrid elastomer is well known for its excellent thermal and mechanical properties, chemical resistance, compatibility with organic and inorganic fillers, nontoxicity, and flexibility. As the reported literature on silicone tungsten composite is rare, thus, a complete possible spectrum of silicone tungsten composites series with tungsten loading of 0-88.1 %wt has been fabricated by RTV method and studied as a flexible gamma shielding material. Flexible silicone/tungsten composite formulations containing different weight percentages of tungsten powder (0, 30.1, 47.8, 59.8, 68.1, and 88.1 wt %) were developed by the room-temperature vulcanization route. Two lead collimators with diameters of 0.6 cm were used to make a narrow beam geometry for gamma rays emitted from aCs (gamma-ray energy of 662 keV) point source. Uncollided flux was measured with a NaI(Tl) scintillation detector enclosed in lead shielding to reduce the background radiation level. The measured mass attenuation coefficient for our composites with 88.1 wt % tungsten was 0.1035 cm/g, which is nearly 3.5% higher than that of commercially available silicone/tungsten composites named T-Flex (nearly 0.095 cm/g) containing the same tungsten loading. Similarly, superior half value layers (HVL) of our composites with 88.1 % wt loading of tungsten i.e 1.01 cm versus 1.27 cm for the reported T-Flex counterpart with additional advantage of insitu fabrication on complex geometries. It was also found that the effectiveness of gamma-ray shielding increases with increase in density of the composites, which is due to the increase in the weight percent of tungsten powder. Our material will have applications as shielding material for both mobile and stationary radiation sources and it can also be used as fabrication material for gloves, safety shoes, coats, etc. to protect workers in a radiation environment.
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http://dx.doi.org/10.1016/j.apradiso.2019.108901DOI Listing
January 2020

Update on Surgical Management of Pediatric Urolithiasis.

Front Pediatr 2019 3;7:252. Epub 2019 Jul 3.

Philip G. Ransley Department of Paediatric Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.

Urolithiasis has always been a fascinating disease, even more so in children. There are many intriguing facets to this pathology. This article is a nonsystematic review to provide an update on the surgical management of pediatric urolithiasis. It highlights the pros and cons of various minimally invasive surgical options such as extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), laparoscopy, and robotics. This article also describes the various intracorporeal disintegration technologies available to fragment the stone, including the newer advancements in laser technology. It also emphasizes the cost considerations especially with reference to the emerging economies. Thus, this manuscript guides how to select the least-invasive option for an individual patient, considering age and gender; stone size, location, and composition; and facilities and expertise available.
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http://dx.doi.org/10.3389/fped.2019.00252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616131PMC
July 2019

Preserved extrastriate visual network in a monkey with substantial, naturally occurring damage to primary visual cortex.

Elife 2019 05 23;8. Epub 2019 May 23.

Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, United Kingdom.

Lesions of primary visual cortex (V1) lead to loss of conscious visual perception with significant impact on human patients. Understanding the neural consequences of such damage may aid the development of rehabilitation methods. In this rare case of a Rhesus macaque (monkey S), likely born without V1, the animal's in-group behaviour was unremarkable, but visual task training was impaired. With multi-modal magnetic resonance imaging, visual structures outside of the lesion appeared normal. Visual stimulation under anaesthesia with checkerboards activated lateral geniculate nucleus of monkey S, while full-field moving dots activated pulvinar. Visual cortical activation was sparse but included face patches. Consistently across lesion and control monkeys, functional connectivity analysis revealed an intact network of bilateral dorsal visual areas temporally correlated with V5/MT activation, even without V1. Despite robust subcortical responses to visual stimulation, we found little evidence for strengthened subcortical input to V5/MT supporting residual visual function or blindsight-like phenomena.
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http://dx.doi.org/10.7554/eLife.42325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533062PMC
May 2019

Offline impact of transcranial focused ultrasound on cortical activation in primates.

Elife 2019 02 12;8. Epub 2019 Feb 12.

Wellcome Centre for Integrative Neuroimaging (WIN), Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.

To understand brain circuits it is necessary both to record and manipulate their activity. Transcranial ultrasound stimulation (TUS) is a promising non-invasive brain stimulation technique. To date, investigations report short-lived neuromodulatory effects, but to deliver on its full potential for research and therapy, ultrasound protocols are required that induce longer-lasting 'offline' changes. Here, we present a TUS protocol that modulates brain activation in macaques for more than one hour after 40 s of stimulation, while circumventing auditory confounds. Normally activity in brain areas reflects activity in interconnected regions but TUS caused stimulated areas to interact more selectively with the rest of the brain. In a within-subject design, we observe regionally specific TUS effects for two medial frontal brain regions - supplementary motor area and frontal polar cortex. Independently of these site-specific effects, TUS also induced signal changes in the meningeal compartment. TUS effects were temporary and not associated with microstructural changes.
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http://dx.doi.org/10.7554/eLife.40541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372282PMC
February 2019

Phosphocreatine attenuates endoplasmic reticulum stress-mediated hepatocellular apoptosis ameliorates insulin resistance in diabetes model.

Biochem Biophys Res Commun 2018 11 24;506(3):611-618. Epub 2018 Oct 24.

Department of Pharmacology, Dalian Medical University, Dalian, Liaoning, 116044, China. Electronic address:

Diabetes mellitus (DM) associated liver damage is a major health burden. Hepatocellular-damage in DM characterized with elevated endoplasmic reticulum stress (ER) and may enhanced insulin-resistance. Phosphocreatine (PCr) a rapidly high-energy-reserve molecule of phosphates naturally occurs in liver, brain and skeletal muscle. This study aimed to investigate the protective effect of PCr on the liver-injury-associated with DM and to report the mechanism involved. Wistar rat's diabetes model was induced using streptozotocin (STZ), and the animals were treated with 20 mg/kg, or 50 mg/kg PCr injection. Blood glucose level, and body wt were recorded. Liver tissues homogenate were analyzed for liver damage markers alanine transaminase (ALT), aspartate transaminase (AST). Liver tissues proteins further evaluated for apoptosis, endoplasmic reticulum stress (ER), and insulin resistance biomarkers using western blotting. Our results revealed that PCr reduced blood glucose level, improved body wt, ameliorates liver function enzymes. Furthermore, PCr upregulates anti-apoptotic Bcl2 proteins expression, and down-regulates significantly pro-apoptotic casp3 and Bax proteins expression in vivo and invitro. Moreover, ER stress CHOP, GRP78 and ATF4 biomarkers level were significantly attenuated in PCr treated animals comparing to STZ diabetes associated liver-damage model with significant improving in insulin-resistance Akt and IRS-1. Our results revealed that treating with PCr in diabetes-associated liver injury models decreased blood glucose level and possess protective effect in-vitro and in-vivo, which could be suggested as potential therapeutic strategy for diabetes associated liver injury patients.
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http://dx.doi.org/10.1016/j.bbrc.2018.10.122DOI Listing
November 2018

Mutational analysis of the CYP1B1 gene in Pakistani primary congenital glaucoma patients: Identification of four known and a novel causative variant at the 3' splice acceptor site of intron 2.

Congenit Anom (Kyoto) 2019 Sep 15;59(5):152-161. Epub 2018 Oct 15.

Department of Animal Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan.

Primary congenital glaucoma (PCG) causes blindness in early age. It has an autosomal recessive pattern of inheritance, hence is more prevalent in populations with frequent consanguineous marriages that occur in the Pakistani population. Mutations in the CYP1B1 gene are commonly associated with PCG. The aim of the present study was to identify genetic mutations in the CYP1B1 gene in PCG cases belonging to 38 Pakistani families. DNA was extracted using blood samples collected from all enrolled patients, their available unaffected family members and controls. Direct sequencing of the CYP1B1 gene revealed a novel 3' splice acceptor site causative variant segregating in an autosomal recessive manner in a large consanguineous family with four PCG-affected individuals. The novel variant was not detected in 93 ethnically matched controls. Furthermore, four already reported mutations, including p.G61E, p.R355X, p.R368H, and p.R390H were also detected in patients belonging to nine different families. All identified causative variants were evaluated by computational programs, that is, SIFT, PolyPhen-2, and MutationTaster. Pathogenicity of the novel splice site variant identified in this study was analyzed by Human Splicing Finder and MaxEntScan. Ten out of 38 families with PCG had the disease due to CYP1B1 mutations, suggesting CYP1B1 was contributing to PCG in these Pakistani patients. Identification of this novel 3' splice acceptor site variant in intron 2 is the first report for the CYP1B1 gene contributing to genetic heterogeneity of disease.
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http://dx.doi.org/10.1111/cga.12312DOI Listing
September 2019

Role of turmeric in management of alveolar osteitis (dry socket): A randomised clinical study.

J Oral Biol Craniofac Res 2018 Jan-Apr;8(1):44-47. Epub 2017 Sep 1.

Department of geology, University of jammu, Jammu & Kashmir, India.

Plants & their extracts have immense potential for the management or treatment of the wounds. The pyhto medicines for the wound healing are not only cheap & affordable but are purportedly safe as hypersensitivity reactions are rarely encountered with the use of these agents, these natural agents induce healing & regeneration of the lost tissue by multiple mechanisms Turmeric commonly is called as Haldi in Hindi. C Longa has been reported to possess anti bacterial, anti fungal & anti inflammatory activities. Turmeric is known as traditional herb to Asia & India also called as curcuma longa, with maximum healing properties & other great uses. It is widely used in India & China for traditional Chinese medicine. This act as anti inflammatory agent to treat different kind of diseases & health problems.

Aims & Objectives: The aim of this study was to study the therapeutic, healing benefits of turmeric, an herb commonly used in Asia.

Material & Methods: The study was conducted in department of oral & maxillofacial surgery of Indira Gandhi government dental college jammu.178 patients were selected from the outpatient department of oral & maxillofacial surgery. The diagnosis of dry socket was made clinically. Turmeric dressing with mustard oil was given in group A & in group B ZOE dressing was given.

Results: In this study there was significant reduction in pain, inflammation & discomfort after turmeric and ZOE dressing. Wound healing was seen faster, than dressing with ZOE. There is no side effect of Turmeric. Statistical analysis was done p < 0.05, was found statistically significant.
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http://dx.doi.org/10.1016/j.jobcr.2017.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854555PMC
September 2017

Calretinin interneuron density in the caudate nucleus is lower in autism spectrum disorder.

Brain 2017 Jul;140(7):2028-2040

Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.

Autism spectrum disorder is a debilitating condition with possible neurodevelopmental origins but unknown neuroanatomical correlates. Whereas investigators have paid much attention to the cerebral cortex, few studies have detailed the basal ganglia in autism. The caudate nucleus may be involved in the repetitive movements and limbic changes of autism. We used immunohistochemistry for calretinin and neuropeptide Y in 24 age- and gender-matched patients with autism spectrum disorder and control subjects ranging in age from 13 to 69 years. Patients with autism had a 35% lower density of calretinin+ interneurons in the caudate that was driven by loss of small calretinin+ neurons. This was not caused by altered size of the caudate, as its cross-sectional surface areas were similar between diagnostic groups. Controls exhibited an age-dependent increase in the density of medium and large calretinin+ neurons, whereas subjects with autism did not. Diagnostic groups did not differ regarding ionized calcium-binding adapter molecule 1+ immunoreactivity for microglia, suggesting chronic inflammation did not cause the decreased calretinin+ density. There was no statistically significant difference in the density of neuropeptide Y+ neurons between subjects with autism and controls. The decreased calretinin+ density may disrupt the excitation/inhibition balance in the caudate leading to dysfunctional corticostriatal circuits. The description of such changes in autism spectrum disorder may clarify pathomechanisms and thereby help identify targets for drug intervention and novel therapeutic strategies.
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http://dx.doi.org/10.1093/brain/awx131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624365PMC
July 2017

Does incorporating collagen and chondroitin sulfate matrix in implant surfaces enhance osseointegration? A systematic review and meta-analysis.

Int J Oral Maxillofac Surg 2018 Feb 31;47(2):241-251. Epub 2017 Oct 31.

Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA.

Implant surface modification has been used to improve osseointegration. However, evidence regarding improved new bone formation (NBF) and osseointegration with the use of collagen-chondroitin sulfate (CS) matrix coated implants remains unclear. The aim of this study was to assess the efficacy of collagen-CS matrix coating on the osseointegration of implants. The focused question was "Does the incorporation of collagen-CS matrix in implant surfaces influence osseointegration?" To answer the question, indexed databases were searched up to July 2017 using various combinations of the key words "collagen", "chondroitin sulfate", "osseointegration", and "implants". The initial literature search identified 497 articles, of which 18 reporting experimental studies fulfilled the inclusion criteria. Thirteen of the studies included (72%) reported that implants coated with a collagen-CS matrix presented higher NBF, bone-to-implant contact, and/or bone volume density. The strength of this observation was supported by meta-analysis results. Nevertheless, the results should be interpreted with caution due to the lack of standardization regarding the dosage formulation of collagen-CS, short-term follow-up, and lack of assessment of confounders. On experimental grounds, the incorporation of collagen-CS matrix into implant surfaces appears to promote osseointegration. From a clinical perspective, the results from animal models support phase I studies in healthy humans.
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http://dx.doi.org/10.1016/j.ijom.2017.10.010DOI Listing
February 2018

Paediatric urolithiasis in emerging economies.

Int J Surg 2016 Dec 16;36(Pt D):705-712. Epub 2016 Nov 16.

Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.

Background: Paediatric urolithiasis remains endemic in low resource countries. This review highlights the epidemiology, causation and management of urolithiasis in an Asian country in the context of emerging economies.

Methods: A literature review of recent articles with key words paediatric urolithiasis, developing countries, endemic stone disease, stone composition, metabolic risk factors, management of paediatric urolithiasis was undertaken and 51 relevant articles were selected with the main focus on experience of this center in managing stone disease in the last two decades.

Results: Prevalence of paediatric urolithiasis is high upto 15% affecting children under 15 years with male predominance. Bladder stones still constitutes 10-70% of the burden. Etiology remains unknown where 55% are considered idiopathic, 25% metabolic, 7% infection and 12% due to anatomical abnormalities. Hot climate, poor nutrition, diarrheal diseases are the major causative factors. Chemical composition of stones showed CaOX in 30-63%, AAU in 17-55%, struvite in 8-9%, uric acid in 3-6% and cystine in 1%. Important metabolic risk factors are hypocitraturia in 63-87%, hyperoxaluria in 40-43%, hypocalciuria in 20%, hyperuricosuria in 27%, hyperammonuria in 11-51% and hypovolemia in 31%. Minimally invasive surgery is the mainstay of surgical management. ESWL provides excellent free rates of 84% for smaller stones. PCNL is the option for majority of renal stones with success rates of 89% for simple and 71.5% for complex stones. For bladder stones PUCL and PCCL success rates were 100%. URS for ureteric stones showed clearance rate of 90%. Open surgery is required in 12% of patients with large stone burden.

Conclusion: Paediatric urolithiasis remains a devastating health problem in low resource settings. MIS offers relief to majority of patients with excellent stone free rates and short hospital stay. Preventable strategies have to be put in place by improving nutrition and eliminating risk factors by diet and medical intervention.
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http://dx.doi.org/10.1016/j.ijsu.2016.11.085DOI Listing
December 2016

Mechanisms for Rapid Adaptive Control of Motion Processing in Macaque Visual Cortex.

J Neurosci 2015 Jul;35(28):10268-80

Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3QX, United Kingdom, Department of Biological Structure, University of Washington, Seattle, Washington 98195, and.

Unlabelled: A key feature of neural networks is their ability to rapidly adjust their function, including signal gain and temporal dynamics, in response to changes in sensory inputs. These adjustments are thought to be important for optimizing the sensitivity of the system, yet their mechanisms remain poorly understood. We studied adaptive changes in temporal integration in direction-selective cells in macaque primary visual cortex, where specific hypotheses have been proposed to account for rapid adaptation. By independently stimulating direction-specific channels, we found that the control of temporal integration of motion at one direction was independent of motion signals driven at the orthogonal direction. We also found that individual neurons can simultaneously support two different profiles of temporal integration for motion in orthogonal directions. These findings rule out a broad range of adaptive mechanisms as being key to the control of temporal integration, including untuned normalization and nonlinearities of spike generation and somatic adaptation in the recorded direction-selective cells. Such mechanisms are too broadly tuned, or occur too far downstream, to explain the channel-specific and multiplexed temporal integration that we observe in single neurons. Instead, we are compelled to conclude that parallel processing pathways are involved, and we demonstrate one such circuit using a computer model. This solution allows processing in different direction/orientation channels to be separately optimized and is sensible given that, under typical motion conditions (e.g., translation or looming), speed on the retina is a function of the orientation of image components.

Significance Statement: Many neurons in visual cortex are understood in terms of their spatial and temporal receptive fields. It is now known that the spatiotemporal integration underlying visual responses is not fixed but depends on the visual input. For example, neurons that respond selectively to motion direction integrate signals over a shorter time window when visual motion is fast and a longer window when motion is slow. We investigated the mechanisms underlying this useful adaptation by recording from neurons as they responded to stimuli moving in two different directions at different speeds. Computer simulations of our results enabled us to rule out several candidate theories in favor of a model that integrates across multiple parallel channels that operate at different time scales.
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http://dx.doi.org/10.1523/JNEUROSCI.1418-11.2015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4502265PMC
July 2015

Coronary Artery Calcium Assessment in CKD: Utility in Cardiovascular Disease Risk Assessment and Treatment?

Am J Kidney Dis 2015 Jun 6;65(6):937-48. Epub 2015 Mar 6.

Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. Electronic address:

Coronary artery calcification (CAC) is a strong predictor of cardiovascular event rates in the general population, and scoring with multislice computed tomography commonly is used to improve risk stratification beyond clinical variables. CAC is accelerated in chronic kidney disease, but this occurs as a result of 2 distinct pathologic processes that result in medial (arteriosclerosis) and intimal (atherosclerosis) deposition. Although there are data that indicate that very high CAC scores may be associated with increased risk of death in hemodialysis, average CAC scores in most patients are elevated at a level at which discriminatory power may be reduced. There is a lack of data to guide management strategies in these patients based on CAC scores. There are even fewer data available for nondialysis patients, and it is uncertain whether CAC score confers an elevated risk of premature cardiovascular morbidity and mortality in such patients. In this article, we review the evidence regarding the utility of CAC score for noninvasive cardiovascular risk assessment in individuals with chronic kidney disease, using a clinical vignette that highlights some of the limitations in using CAC score and considerations in risk stratification.
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http://dx.doi.org/10.1053/j.ajkd.2015.01.012DOI Listing
June 2015

Malposition of pacing lead into the left ventricle: a rare complication of pacemaker insertion.

BMJ Case Rep 2014 Jul 22;2014. Epub 2014 Jul 22.

Department of Cardiology, Birmingham Queen Elizabeth Hospital, Birmingham, West Midland, UK.

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http://dx.doi.org/10.1136/bcr-2013-202131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112331PMC
July 2014

Association between environmental tobacco smoke and periodontal disease: a systematic review.

Environ Res 2014 Aug 10;133:117-22. Epub 2014 Jun 10.

Department of Dental Medicine, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.

The aim of the present study was to systematically review the association between environmental tobacco smoke (ETS) and periodontal disease. The addressed focused question was "Is there a relationship between ETS and periodontal disease?" PubMed/MEDLINE and Google-Scholar databases were searched from 1987 up to March 2014 using different combinations of the following keywords: "Environmental tobacco smoke", "passive", "periodontal disease", "secondhand" and "smoking". Letters to the Editor, review articles, commentaries, case-reports and articles published in languages other than English were excluded. Thirteen studies were included. Nine studies were clinical and 4 studies were performed in-vitro. Five studies reported the odds ratios for periodontal disease to be significantly higher among individuals exposed to ETS than controls (non-smoking individuals unexposed to ETS). In 2 studies, ETS exposure showed no association with periodontal disease. In 2 studies, salivary aspartate aminotransferase, lactoferrin and albumin levels were reported to be significantly higher in individuals exposed to ETS than controls. In one study, levels of salivary interleukin-1β were reported to be significantly higher in individuals exposed to ETS than controls. The in-vitro studies reported ETS exposure to enhance the production of proinflammatory proteins and phagocytic activity of salivary polymorphonuclear leukocytes thereby contributing to periodontal disease. The association between ETS and periodontal disease remains debatable and requires further investigations.
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http://dx.doi.org/10.1016/j.envres.2014.05.008DOI Listing
August 2014

Chest pain with raised troponin, ECG changes but normal coronary arteries.

BMJ Case Rep 2014 Mar 31;2014. Epub 2014 Mar 31.

Department of Cardiology, Princess Royal Hospital Telford, Telford, Shropshire, UK.

A 65-year-old woman presented to A&E department, with acute onset central chest pain and dyspnoea. ECG showed dynamic T wave changes while 12 h troponin was elevated. A diagnosis of acute coronary syndrome was made and she underwent an inpatient coronary angiogram. Although her coronary arteries were normal, symptoms persisted and D-dimers were found to be elevated. This led to a CT pulmonary angiogram, which ruled out pulmonary embolism, but uncovered a large ascending aortic aneurysm with a contained leak. She was immediately transferred to regional cardiothoracic unit for urgent surgical intervention. This case report illustrates the importance of a good clinical history, physical examination and timely investigations. It also emphasises that not all chest pain events with elevated troponin level are due to acute coronary syndrome and that alternative diagnoses should still be considered.
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http://dx.doi.org/10.1136/bcr-2013-201975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975511PMC
March 2014

Staphylococcus aureus bacteraemia in a UK tertiary referral centre: a 'transoesophageal echocardiogram for all' policy.

J Antimicrob Chemother 2014 Jul 27;69(7):1960-5. Epub 2014 Mar 27.

Microbiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Objectives: Infective endocarditis (IE) is a feared complication in up to 38% of cases of Staphylococcus aureus bacteraemia (SAB). BSAC guidelines recommend echocardiography in all cases of SAB. The aim of this study was to determine the incidence of IE in SAB using transoesophageal echocardiography (TOE) as the first step in diagnostic imaging. This study also sought to identify clinical predictors that could improve stratification of those with and without IE.

Methods: A guideline was implemented that any SAB resulted in the microbiology department (i) recommending that the patient be referred for TOE and (ii) notifying the echocardiography department, resulting in streamlined listing of the patient for TOE. All cases of SAB were then assessed prospectively at University Hospitals Birmingham NHS Foundation Trust between September 2011 and October 2012. Previously identified risk factors for complicated S. aureus bacteraemia were recorded.

Results: There were 98 SAB episodes in total. TOE was performed in 58 (59%) with a further 22 episodes imaged by transthoracic echocardiography alone. IE was diagnosed overall in 13 (16%) cases investigated with echocardiography. No risk factor for IE other than presence of a cardiac device was detected in this group (P = 0.013).

Conclusions: The rate of IE found in SAB is high when TOE is performed first line. There are no clear risk factors to improve yield or the type of echocardiography to be performed. Echocardiography should be performed in all cases and TOE should be considered where it is expected to influence management, as long as local resources allow.
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http://dx.doi.org/10.1093/jac/dku082DOI Listing
July 2014

Mechanical mitral valve thrombosis in rheumatic valve disease.

BMJ Case Rep 2014 Feb 26;2014. Epub 2014 Feb 26.

Department of Cardiology, University Hospital Birmingham, Birmingham, West Midlands, UK.

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http://dx.doi.org/10.1136/bcr-2013-201918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939409PMC
February 2014

Low antibody levels to pregnancy-specific malaria antigens and heightened cytokine responses associated with severe malaria in pregnancy.

J Infect Dis 2014 May 25;209(9):1408-17. Epub 2013 Nov 25.

Department of Medicine, The University of Melbourne, Melbourne Victoria 3052, Australia.

Background:  Pregnant women living in unstable malaria transmission settings may develop severe malaria (SM). The pathogenesis of SM in pregnancy is poorly understood.

Methods:  To determine whether SM in pregnancy is associated with lower malarial antibody responses and higher cytokine responses, plasma samples were collected from 121 Sudanese pregnant women of whom 39 were diagnosed with SM. Antibodies to pregnancy-specific and non-pregnancy-specific Plasmodium falciparum variant surface antigens (VSA) and concentrations of cytokines TNF, IFNγ, IL-1β, IL-6, IL-8 and IL-10 were measured.

Results:  Pregnant women with SM demonstrated significantly lower antibody levels to pregnancy-specific VSA (P = .020) and higher plasma IFNγ (P = .020), IL-10 (P = .0002) and IL-6 levels (P < .0001) than uninfected pregnant women. Concentrations of inflammatory cytokines IL-1β (P = .001), IL-6 (P = .004) and IL-8 (P = .020) were inversely correlated with antibodies to VAR2CSA-DBL5 in pregnant women with SM. Lower haemoglobin levels and higher parasite densities were associated with lack of pregnancy-specific antibodies (P = .028) and higher levels of inflammatory cytokines, in particular IL-6 and IL-8.

Conclusions:  Pregnant women with SM lack pregnancy-specific malaria immunity, and this correlates with heightened inflammatory cytokine concentrations, low haemoglobin levels and high parasite density, suggesting that failure of antibody to control parasitaemia may contribute to SM pathogenesis.
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http://dx.doi.org/10.1093/infdis/jit646DOI Listing
May 2014
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