Improved outcome prediction using CT angiography in addition to standard ischemic stroke assessment: results from the STOPStroke study

Purpose

To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA).

Methods

In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as “major” by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores>10.

Results

Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p<0.0001). Combining NIHSS with BASIS was highly predictive: 77.6% (114/147) classified as NIHSS>10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS− (p<0.0001), regardless of treatment. The odds ratios for poor outcome is 12.6 (95% CI: 7.9 to 20.0) in patients who are NIHSS>10/BASIS+ compared to patients who are NIHSS≤10/BASIS−; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+.

Conclusions

BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment.     

Evaluation of Paracoccidioides brasiliensis Infection by gp 43 Intradermal Test in Rural Settlements in Central-West Brazil

Epidemiological studies of paracoccidioidomycosis have been based on surveys achieved with intradermal tests, and paracoccidioidin is the most common antigen used in most cases. The glycoprotein of 43-kDa (gp43) has been used in intradermal tests. It is the most antigenic component of Paracoccidioides brasiliensis, and it provides greater specificity to evaluate infection for this fungus. In this study, the prevalence of P. brasiliensis infection was estimated with intradermal tests involving gp43 for 695 people in rural Central-West Brazil. The infection rate was 45.8 % (95 % CI = 42.1–49.5), and the average age of those infected was 45.8 ± 18.2 years. The prevalence did not show gender-based differences but increased with age. The results demonstrate the importance of P. brasiliensis infection in rural settlements and the early exposure of children in the region to the fungus. Despite the high antigenicity and specificity of gp43, its usage must be standardized, so that epidemiological surveys will be comparable and more accurately reflect P. brasiliensis infection in endemic areas.     

Effects of nanostructured essential oils against subterranean termites (Coptotermes gestroi)

Currently, the control of termites is mainly carried out with the use of chemical pesticides, which although effective, pose risks to the environment and to human beings. An alternative to using such chemical pesticides is natural products such as essential oils in insecticidal action. Despite the fact of being effective, essential oils are unstable, poorly soluble in water, and degrade from the action of light, oxygen even at moderate temperatures. Thus, the nanostructuring of essential oils could circumvent such problems and ensure its effectiveness. The following study aimed to assess for the first time the effects of nanostructured systems of essential oils of Cymbopogon flexuosus, Eucalyptus globulus and Melaleuca alternifolia in subterranean termites (Coptotermes gestroi). The results showed that the solid lipid nanoparticles of M. alternifolia have both repellent and insecticide action. The following study showed that nanostructuring of essential oils with insecticidal action is a promising tool in the fight against termites.     

Quantitative Shedding of Two Genotypes of Cryptosporidium parvum in California Ground Squirrels (Spermophilus beecheyi)

Sixteen percent of California ground squirrels (Spermophilus beecheyi) were found to be shedding an average of 53,875 Cryptosporidium parvum oocysts/g of feces. Male squirrels had a higher prevalence and higher intensity of shedding than did female squirrels. The majority of C. parvum isolates matched a bovine-murine genotype, with a few isolates resembling a porcine genotype. Higher intensities of shedding by males may enhance dissemination and genotypic mixing of this protozoa given males' proclivity to disperse to nonnatal colonies.     

Prototheca stagnora, an encapsulated organism

The type species of Prototheca stagnora, SEC-L-1690 (ATCC 16528) (2) was found to have a large capsule surrounding the cells, in India ink preparations. Cryptococcus neoformans and P. stagnora are very similar organisms in their morphology and they should be differentiated by their reproduction process or by their biochemical and physiological characteristics.     

Physical resistance as a criterion in the selection of foraging material by Acromyrmex subterraneus brunneus Forel, 1911 (Hym., Formicidae)

Abstract:  Leaf-cutting ants forage on a wide variety of plant species using the physical and chemical characteristics of the plants as a selection criterion. In order to determine the influence of the physical factor on the selection of foraging material, inert materials such as floral sponge, polystyrene, plastic and clay, which possess different degrees of physical resistance to cutting, were offered simultaneously to five Acromyrmex subterraneus brunneus colonies, and assessed 12 and 24 h after foraging. No substrate selectivity was observed during foraging. Physical resistance was used as a decision criterion for the incorporation or return of the foraged material. This fact suggests the existence of a second time of selection of the foraged material inside the colony during cultivation of the symbiontic fungus.