The identification of the Tick Borne Relapsing Fever (TBRF) agent in Israel and the Palestinian Authority relies on the morphology and the association of Borrelia persica with its vector Ornithodoros tholozani. Molecular based data on B. persica are very scarce as the organism is still non-cultivable. In this study, we were able to sequence three complete 16S rRNA genes, 12 partial flaB genes, 18 partial glpQ genes, 16 rrs-ileT intergenic spacers (IGS) from nine ticks and ten human blood samples originating from the West Bank and Israel. In one sample we sequenced 7231 contiguous base pairs that covered completely the region from the 5′end of the 16S rRNA gene to the 5′end of the 23S rRNA gene comprising the whole 16S rRNA (rrs), and the following genes: Ala tRNA (alaT), Ile tRNA (ileT), adenylosuccinate lyase (purB), adenylosuccinate synthetase (purA), methylpurine-DNA glycosylase (mag), hypoxanthine-guanine phosphoribosyltransferase (hpt), an hydrolase (HAD superfamily) and a 135 bp 5′ fragment of the 23S rRNA (rrlA) genes. Phylogenic sequence analysis defined all the Borrelia isolates from O. tholozani and from human TBRF cases in Israel and the West Bank as B. persica that clustered between the African and the New World TBRF species. Gene organization of the intergenic spacer between the 16S rRNA and the 23S rRNA was similar to that of other TBRF Borrelia species and different from the Lyme disease Borrelia species. Variants of B. persica were found among the different genes of the different isolates even in the same sampling area.
The use of automatic external defibrillators (AEDs) during pulseless resuscitations is considered safe and reliable, and was established as part of the guidelines in out-of-hospital events. Based on extensive studies, the use of the standard AED is now indicated in every age group with a preference of pediatric pad application for small children and babies. If unavailable, adult pads are recommended. We report a case of 2 inappropriate AED shocks that were delivered to a neonate during a pulseless resuscitation after application of adult pads. The 3.6-kg patient received 2 shocks, over 200 J each, for sinus bradycardia that was not detected by the device. Although treated inappropriately with high voltage, no cardiac or skin sequelae were detected, and the patient had normal cardiac and neurological development later on.
Introduction and objectivesProgressive respiratory disease accounts for most of the mortality and morbidity in CF. Identification of early lung disease is imperative to recognise young patients who are at high risk of developing future lung damage. The London CF collaboration has shown that infant pulmonary function at one and at two years is essentially normal, and one year HRCT has mild abnormalities only, so new markers need to be identified. We have used ventilation scans (VS) at the CF annual assessment in infants too young to perform standard pulmonary function tests; VS are more sensitive than chest radiography, and have been used to guide immediate management. We hypothesised that an abnormal pre-school lung VS predicted worse spirometry by age six years in CF children.MethodsData from children born after 2000 under the care of the RBH were retrieved from hospital databases and Port CF. We recorded demographics (gender, age, CFTR genotype, weight, height, ethnicity) and spirometry nearest to 6 years of age because repeatable measurements in a clinical context are feasible at this age. The primary outcome was FEV1% predicted (%p) (GLI reference equation (); and VS at annual assessment. Between 1–5 scans were performed prior to the age 6 year spirometry, and were independently reported as normal or abnormal (at least one abnormal VS). Statistical analysis was performed using Student t test. P < 0.05 was considered significant.Results143/217 children (72 females, 71 males) had data on VS and spirometry available; mean age at first spirometry was 6.36 (range 5.0–7.6). The remaining 73 were excluded due to late diagnosis, moving away before the first reliable spirometry, or first being seen later than the window for ventilation scans (1–5 years). Children with ≥1 abnormal VS had a statistically significant reduction in lung function (mean FEV1% p 83.4%) when compared with children with normal ventilation scans (mean FEV1% p%89.6), P = 0.03 (Figure 1).Abstract S17 Figure 1Dot plot showing%p comparison between those with normal and abnormal scans. The black horizontal lines are the group meansConclusionAlthough abnormal VS predict abnormal first spirometry, the overlap between the two groups means that VS are not a useful clinical tool to delineate a high risk group.
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