We report the design and synthesis of a novel class of asymmetrically functionalized, ditopic bis-dipicolylamine (BDPA) ligands. A key feature of this research involved the controlled, sequential functional group decoration of a potent molecular recognition scaffold. Calorimetric screening identified a BDPA analogue as a highly potent (K(a) approximately 10(6) M(-1)) and selective sensor for inorganic phosphate.

The noninvasive measurement of peripheral vascular reactivity, as an indicator of vascular function, provides a valuable tool for cardiovascular screening of at-risk populations. Practical and economical considerations demand that such a test be low-cost and simple to use. To this end, it is advantageous to substitute digital thermal monitoring (DTM) for the more costly and complex Doppler system commonly used for this measurement. A signal processing model was developed to establish the basis for the relationship between finger temperature reactivity and blood flow reactivity following a transient brachial artery occlusion and reperfusion protocol (reactive hyperemia). Flow velocity signals were acquired from the radial artery of human subjects via an 8 MHz Doppler probe while simultaneous DTM signals were acquired from a distal fingertip via DTM sensors. The model transforms the DTM temperature signals into normalized flow signals via a deconvolution method which employs an exponential impulse function. The DTM normalized flow signals were compared to simultaneous, low-frequency, normalized flow signals computed from Doppler sensors. The normalized flow signals, derived from DTM and Doppler sensors, were found to yield similar reactivity responses during reperfusion. The reactivity areas derived from DTM and Doppler sensors, indicative of hyperemic volumes, were found to be within +/- 15%. In conclusion, this signal processing model provides a means to measure vascular reactivity using DTM sensors, that is equivalent to that obtained by more complex Doppler systems.

Varicella-zoster virus (VZV) infections are a particular problem in healthcare settings. A survey of chickenpox was carried out amongst healthcare workers (HCWs) following potential ward exposures. A prior history of chickenpox was given by 61/98 (62.2%). Of 64 HCWs tested for VZV IgG, 10 (15.6%) were seronegative, indicating susceptibility. The sensitivity, specificity, positive predictive value, and negative predictive value of a history of prior chickenpox were 57.4%, 90%, 96.4%, and 31.0%, respectively. VZV screening of HCWs without a history of chickenpox, and vaccination of susceptible HCWs should be undertaken in this hospital.

Background: Psoriasis is a chronic inflammatory skin disease with an immunogenetic background. This study was planned to check for the association of polymorphisms related to cytokine genes TNF-alpha-308(G/A), IL-10-1082(G/A), IL-6-174(G/C), and IL-1Ra (VNTR) with psoriasis in cases from Egypt. Methods: This study included 46 cases with psoriasis recruited from the Department of Dermatology, University Hospitals, Nile Delta region of Egypt. They included 14 males and 32 females with a mean age +/- SD of 46.68 +/- 12.16 years and a range of 15 to 70 years. Their genotypes were compared to 98 healthy controls of matched age and sex from the same locality. Genotyping was done through DNA amplification using PCR with sequence-specific primers for polymorphic alleles. Results: Compared to controls, cases showed a significantly higher frequency of certain genotypes including IL-6-174 CC (p < 0.001, OR = 6.7), IL-10-1082 GG (p < 0.05, OR = 5.1), and TNF-alpha-308 GG (p < 0.05, OR = 3.7). Combined heterozygosity for IL-10 GA, IL-6 GC, and TNF GA showed a significant low frequency among the cases studied. Conclusion: Genetic polymorphisms related to the IL6, IL10, and TNF-alpha genes showed a particular pattern of association with psoriasis that may have a potential impact on disease counseling and management.

Aims and Objectives: To investigate the potential role of a simple insulin resistance index i.e. Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) in identifying insulin resistance in patients admitted with an acute coronary syndrome without diabetes mellitus and its effect on short term outcome on cardiovascular morbidity and mortality. Methods: Seventy non-diabetic patients with impaired fasting glucose admitted with a diagnosis of acute myocardial infarction and followed prospectively for a median of six months for outcomes. Admission fasting glucose and insulin concentrations were measured and from these values an Insulin Resistance index was calculated. Results: During hospital course a high incidence of heart failure (11/;29 vs5/;41; p<0.05) and mortality (4/29 vs 1/41; p=0.152) was seen in patients with Index > 2 as compared to patients with Index <2, but mortality data failed to show any statistical significance because of small sample size. At six months patients with Index >2 had high incidence of heart failure (9/25 vs 4/40; p<0.020), reinfarct (2/25 vs. 0; p=0.141), repeated admissions (7/25 vs 3/40; p=0.092) and mortality (1/25 vs 1/40; p=0.181). Six out of twenty-five (p<0.001) patients with Index > 2 required antidiabetic treatment to achieve glycemic control. Conclusions: A simple index of insulin resistance (Homeostatic Model Assessment-Insulin Resistance) measured on patients admitted with myocardial infarction provides an important predictive measure of poor outcome and is superior to admission glucose measurement. It may be useful in identifying patients admitted with myocardial infarction who could benefit from alternative early invasive strategies.

The present study evaluated serum neopterin, high-sensitivity C-reactive protein (hs-CRP) and thiobarbituric acid reactive substances (TBARS) in Egyptian patients with acute coronary artery disease. Thirty-six patients with unstable angina aged (mean +/- SD) 61.3+/-9.4 years, 29 patients with myocardial infarction aged 58.2+/-8.7 years and 24 sex- and age-matched control subjects were included in the study. Neopterin levels were significantly higher in patients with myocardial infarction and those with unstable angina than in the healthy control group (P<0.001). The serum level of neopterin in the control group (median [range]) was 3.25 nmol/L (1.25 nmol/L to 5.4 nmol/L), whereas in patients with unstable angina and those with myocardial infarction, neopterin levels were 10.4 nmol/L (3.5 nmol/L to 15.2 nmol/L) and 12.6 nmol/L (3.25 nmol/L to 17.8 nmol/L), respectively. Levels of hs-CRP and TBARS were also significantly higher in patients with unstable angina and those with myocardial infarction than in the healthy control group (P<0.01). The medians (ranges) of hs-CRP were 4.8 mg/L (2.5 mg/L to 9.9 mg/L), 12.0 mg/L (4.6 mg/L to 31.0 mg/L) and 12.3 mg/L (7.5 mg/L to 32.1 mg/L) in the control group, patients with unstable angina and those with myocardial infarction, respectively. The means +/- SD of TBARS in the control group, patients with unstable angina and those with myocardial infarction were 0.64+/-0.17 mumol/L, 1.17+/-0.31 mumol/L and 1.17+/-0.49 mumol/L, respectively. TBARS positively correlated with hs-CRP and neopterin levels. Furthermore, when both patients and controls were classified according to their smoking status, significantly higher levels of neopterin and TBARS were found in the smokers of each subgroup than in the nonsmokers.In conclusion, the present study found a higher level of neopterin, hs-CRP and TBARS in patients with coronary artery disease. Serum neopterin and hs-CRP positively correlated with the level of TBARS. The authors suggest that triggering factors (eg, smoking, high cholesterol, elevated body mass index or raised blood pressure) may lead to increased oxidative stress, which induces an inflammatory insult leading to higher levels of inflammatory markers such as neopterin and hs-CRP.

Abstract We tested for negative effects of West Nile virus (WNV) on a breeding population of eastern bluebirds in Alabama by comparing fecundity and reproductive success in years before and after the arrival of WNV and by comparing fecundity, reproductive success, and overwinter survival of seropositive and seronegative individuals within the same population in the same years. We found that female bluebirds were more likely to be seropositive than male bluebirds. Age and individual condition did not affect likelihood of being seropositive. Being seropositive for WNV was not associated with any negative effects on reproduction or survival. However, female fecundity was higher in years after WNV compared to years before the arrival of WNV. The reproductive success of males who tested positive for WNV exposure was higher than that of males that were seronegative. Overall, we found no negative effects on reproduction or survival after exposure to WNV.

ABSTRACT: BACKGROUND: Staphylococcus aureus is a major human pathogen, especially methicillin-resistant S. aureus (MRSA), which causes a wide range of hospital and community-acquired infections worldwide. Conventional testing for detection of MRSA takes 2-5 days to yield complete information of the organism and its antibiotic sensitivity pattern. RESULTS: The present study focused on the development of a pentaplex PCR assay for the rapid detection of MRSA. The assay simultaneously detected five genes, namely 16S rRNA of the Staphylococcus genus, femA of S. aureus, mecA that encodes methicillin resistance, lukS that encodes production of Panton-Valentine leukocidin (PVL) a necrotizing cytotoxin, and one internal control. Specific primer pairs were successfully designed and simultaneously amplified the targeted genes. The analytical sensitivity and specificity of the pentaplex PCR assay was evaluated by comparing it with the conventional method. The analytical sensitivity of the pentaplex PCR at the DNA level was found to be 10 ng DNA. The analytical specificity was evaluated with 34 reference staphylococci and non-staphylococcal strains and was found to be 100%. The diagnostic evaluation of MRSA carried out using 230 clinical isolates, showed 97.6% sensitivity, 99.3% specificity, 98.8% positive predictive value and 98.6% negative predictive value compared to the conventional method. The presence of an internal control in the pentaplex PCR assay is important to exclude false-negative cases. CONCLUSION: The pentaplex PCR assay developed was rapid and gave results within 4 h, which is essential for the identification of Staphylococcus spp., virulence and their resistance to methicillin. Our PCR assay may be used as an effective surveillance tool to survey the prevalence of MRSA and PVL-producing strains in hospitals and the community.

OBJECTIVE: The aim of this study was to assess and compare the Confusion Assessment Method (CAM) and the Delirium Rating Scale (DRS) in the detection of delirium in the acute stroke setting, when used by a non-psychiatrist doctor. METHODS: Consecutive participants within 4 days of an acute stroke were screened for delirium using the CAM and the DRS. Patients also had a Mini-Mental State Examination at each assessment. Patients were screened weekly for a maximum of 4 weeks. The CAM and DRS were compared against each other with respect to agreement and applicability. RESULTS: Of 110 eligible patients, 82 were recruited over a 7 month period. Delirium developed in 23 patients (28%), 21 of whom developed delirium during week 1. We found high agreement between the CAM and the DRS in the detection of stroke in the acute stroke setting (kappa values 0.97, 0.86, 0.79 and 1 at weeks 1, 2, 3 and 4, respectively). In addition, there was strong correlation between low MMSE scores (MMSE less that 10) and delirium (kappa scores 1.0, 0.82, 0.83 and 1.0 at weeks 1, 2, 3 and 4, respectively). CONCLUSIONS: Delirium is a common complication post-stroke. The CAM is equivalent to the DRS in the acute stroke setting when used by a trained non-psychiatrist. A low MMSE score may have a small benefit in identifying patients that are at risk of having delirium. Copyright (c) 2009 John Wiley & Sons, Ltd.

Background and purpose: several studies have assessed delirium post-stroke but conflicting results have been obtained. Also, the natural history and outcome of delirium post-stroke need to be fully elucidated. Methodology: eligible stroke patients were assessed for delirium on admission and for four consecutive weeks using the Confusion Assessment Method (CAM). Risk factors for delirium were recorded. Our outcome measures were length of stay, inpatient mortality and discharge destination. RESULTS: of 110 eligible patients, 82 were recruited over 7 months. Delirium was detected in 23 patients (28%); 21 of these were delirious on their first assessment. Sixty-nine per cent of patients who had four weekly assessments were delirious at 4 weeks. Multivariate logistic regression analysis was performed, and two models were identified. With unsafe swallow in the analysis, delirium was associated with an unsafe swallow on admission (OR 28.4, P<0.001), Barthel score < 10 (OR 32.1, P = 0.004) and poor vision pre-stroke (OR 110.8, P = 0.01). With unsafe swallow removed from the analysis, delirium was associated with an admission C-reactive protein (CRP)> 5 mg/l (OR 10.2, P = 0.009), Barthel score < 10 (OR 46.5, P = 0.001) and poor vision pre-stroke (OR 85.2, P = 0.01). Delirious patients had a higher mortality (30.4% vs. 1.7%, P<0.001), longer length of stay (62.2 vs. 28.9 days, P<0.001) and increased risk of institutionalisation (43.7 vs. 5.2%, OR 14, P<0.001). CONCLUSIONS: delirium is common post-stroke. Most cases develop at stroke onset and remain delirious for an appreciable period. Delirium onset is associated with stroke severity (low admission Barthel), unsafe swallow on admission, poor vision pre-stroke and a raised admission CRP. Delirium is a marker of poor prognosis.