SummaryBackgroundNational levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.MethodsWe mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.FindingsBetween 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among...

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Helicobacter pylori is a Gram-negative bacterium that causes chronic atrophic gastritis and peptic ulcers and it has been associated with the development of gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT). One of the more remarkable characteristics of H. pylori is its ability to survive in the hostile environment of the stomach. H. pylori regulates the expression of specific sets of genes allowing it to survive high acidity levels and nutrient scarcity. In the present study, we determined the expression of virulence associated protein D (VapD) of H. pylori inside adenocarcinoma gastric (AGS) cells and in gastric biopsies. Using qRT-PCR, VapD expression was quantified in intracellular H. pylori-AGS cell cultures at different time points and in gastric mucosa biopsies from patients suffering from chronic atrophic gastritis, follicular gastritis, peptic ulcers, gastritis precancerous intestinal metaplasia and adenocarcinoma. Our results show that vapD of H. pylori presented high transcription levels inside AGS cells, which increased up to two-fold above basal values across all assays over time. Inside AGS cells, H. pylori acquired a coccoid form that is metabolically active in expressing VapD as a protection mechanism, thereby maintaining its permanence in a viable non-cultivable state. VapD of H. pylori was expressed in all gastric biopsies, however, higher expression levels (p = 0.029) were observed in gastric antrum biopsies from patients with follicular gastritis. The highest VapD expression levels were found in both antrum and corpus gastric biopsies from older patients (>57 years old). We observed that VapD in H. pylori is a protein that is only produced in response to interactions with eukaryotic cells. Our results suggest that VapD contributes to the persistence of H. pylori inside the gastric epithelial cells, protecting the microorganism from the intracellular environment, reducing its growth rate, enabling long-term infection and treatment resistance. PLOS ONEPLOS ONE | https://doi.org/10.1371/journal.pone.et al. (2020) High expression of Helicobacter pylori VapD in both the intracellular environment and biopsies from gastric patients with severity. PLoS ONE 15(3): e0230220. https://doi.org/10.

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to 4.6% of the placebo group (P .001). 56% of the ISO group had continued nausea relief at 10 minutes compared to 2.3% of the placebo group (P .002). Pain relief was not different between the groups (P > .05). 64.8% of the ISO group was satisfied with the effect of the intervention compared to 2.3% of the placebo group (P .001).Conclusion: Nasally inhaled ISO is a safe, effective and non-invasive treatment option for NV in the ED with relief onset by 4 minutes and persisting through the 10 minute study duration.Study Objective: To describe the clinical presentations of pediatric patients exposed to carbon monoxide (CO) and treated with hyperbaric oxygen therapy (HBOT).Methods: Design: Retrospective review of data from patients discharged with CO poisoning after consultation with HBOT physicians at the R Adams Cowley Shock Trauma Center (STC) and University of Maryland Medical Center (UMMC) between 2008 and 2012. Setting: Data were collected from the out-of-hospital, transferring hospital, and STC/UMMC settings and analyzed descriptively. Participants: Patients <19 years of age.Results: Over the 5-year study period, 47 pediatric patients were treated for CO poisoning. Their mean age was 8.9 (SD 5.0) years; 55% were male; and 45 had been exposed to CO accidentally, one was an intentional suicide attempt and one was unknown. Forty-one (97.6%) were transported directly from the scene by ambulance and 1 (2.4%) by helicopter and five patients had missing data. Nineteen (40.4%) were transferred after initial evaluation; their median length of stay in the transferring hospital was 178 minutes (IQR 134-262). The average first measured serum carboxyhemoglobin (COHb) level was 14.3% (SD 8.3). The most common presenting symptoms were headache and nausea/vomiting. Chief complaints of burns, being unresponsive, and smoke inhalation had the highest serum COHb levels. The table shows the relationship between initial symptoms and COHb level. Several patients had more than one presenting complaint. Two patients were asymptomatic but had serum COHb levels similar to symptomatic patients. The Rad57 SpCO level averaged 26.1 (SD 11.7) and the average ambient CO level was 724 ppm. Most incidents occurred between October and March, correlating with the use of furnaces, radiators, and indoor heating units. Five patients were admitted to the ICU. Thirty-nine patients (83.0%) received one or two hyperbaric treatments. Two patients were unable to complete the first HBO treatment due to barotrauma.Conclusions: The severity of presenting complaints varied in this population and did not correlate with serum COHb levels. Although neurologic symptoms that caused concern were common, the serum COHb level was >25% only for patients who were unresponsive or had smoke inhalation/burns. Symptoms vary among pediatric patients suffering similar exposures, complicating the decision to treat mild to moderate CO toxicity with HBOT. There is little published literature describing CO poisoning in pediatric patients. Our observations can be used as the basis...