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1.  Retrospective review of in hospital use of mineralocorticoid receptor antagonists for high risk patients following myocardial infarction 
There is little data regarding use of mineralocorticoid antagonists (MRAs) for patients reduced LV ejection fraction (LVEF) following acute myocardial infarction (MI). We determined the frequency and temporal trends of MRA use in these patients.
We performed a retrospective review of all cases of acute MI between June 1, 2010 and April 1, 2012. Patients were considered eligible for MRA therapy if they were admitted with acute MI with LVEF ≤ 40 % and had heart failure symptoms or a history of diabetes.
Of 3910 cases of acute MI, 332 patients were considered eligible for MRA therapy. MRA therapy was prescribed for 92/332 (28 %) eligible patients, while 66 of 1142 (6 %) of ineligible patients were so treated. Over the study period, usage in eligible and ineligible patients rose significantly (22 to 30 %, p = 0.08 and 4 to 7 %, p = 0.04 respectively).
Prescription of MRAs for eligible patients occurred in a minority of patients, and demonstrated a modest increase over time. In patients without an indication for MRAs, a similar trend was observed. Further study is required to better understand barriers to appropriate use of MRAs in this patient population.
PMCID: PMC4469001  PMID: 26060129
Heart failure; Myocardial infarction; Mineralocorticoid receptor antagonists
2.  Reduced Efficacy of Commercial Acaricides Against Populations of Resistant Cattle Tick Rhipicephalus microplus from Two Municipalities of Antioquia, Colombia 
Environmental Health Insights  2015;8(Suppl 2):71-80.
Two distant Antioquian cattle farms where systemic and topical acaricides had previously failed to control infestations by Rhipicephalus (Boophilus) microplus were studied. An initial in vivo study was conducted using single subcutaneous injections with a long-acting formulation of ivermectin (630 μg/kg). Injections were made at 3-month intervals on animals at each farm to evaluate the therapeutic and persistent efficacy of ivermectin against R. microplus. Body tick counts and reproductive parameters of semi- or fully engorged females (≥5 mm) were assessed at 10-day intervals, and since no negative control group could be included, values were compared against those for day 0. Although there was an overall reduction of 50%–75% in tick numbers that persisted for 30–40 days, it was not significantly different at one of the farms and not enough to afford protection from severe infestations. The engorgement weight and egg mass weight of ticks from treated animals were significantly lower throughout the 50-day posttreatment period. Egg hatch was not significantly reduced posttreatment and remained at levels of 80%–90%. A random selection of 9 out of 28 commercial formulations of ivermectin sold in Colombia were analyzed by High Performance Liquid Chromatography (HPLC). All were within the expected labeled concentration (±15% deviation) of 1% and 3.15% ivermectin except for one. A popular unregistered injectable widely used in both farms and labeled as “natural pyrethrin”, was found to contain 10.5% ivermectin. An adult immersion test was conducted to evaluate the efficacy of topical acaricides to recommended concentrations of five commercial products and/or their combinations. Efficacy was determined by comparing the reproductive index of each treated group to that of the control group. Cypermethrin (150 ppm) was completely ineffective at both farms. Amitraz (208 ppm) exhibited low and intermediate efficacies of 14% and 56%. The combination of amitraz (100 ppm) and cypermethrin (150 ppm) was less efficacious than the amitraz alone. A generic product based on amitraz + citronella (208 ppm + 10 ppm, respectively) was shown to be less efficacious than the name-brand amitraz product. Products containing the organophosphate chlorpyrifos or trichlorfon exhibited intermediate efficacies of approximately 60% at the Tarso farm. We conclude that at these two locations, there is a high degree of resistance to many of the acaricides available in Colombia and confirm suspicions that ivermectin is no longer able to eliminate tick infestations.
PMCID: PMC4421976  PMID: 25987840
southern cattle fever tick; multi-resistance; acaricide
3.  Rhipicephalus (Boophilus) microplus aquaporin as an effective vaccine antigen to protect against cattle tick infestations 
Parasites & Vectors  2014;7:475.
Vaccination as a control method against the cattle tick, Rhipicephalus (Boophilus) microplus has been practiced since the introduction of two products in the mid-1990s. There is a need for a vaccine that could provide effective control of R. microplus in a more consistent fashion than existing products. During our transcriptome studies of R. microplus, several gene coding regions were discovered to encode proteins with significant amino acid similarity to aquaporins.
A cDNA encoding an aquaporin from the cattle tick, Rhipicephalus microplus, was isolated from transcriptomic studies conducted on gut tissues dissected from fully engorged adult female R. microplus.
Bioinformatic analysis indicates this aquaporin, designated RmAQP1, shows greatest amino acid similarity to the human aquaporin 7 family. Members of this family of water-conducting channels can also facilitate the transport of glycerol in addition to water. The efficacy of this aquaporin as an antigen against the cattle tick was explored in cattle vaccine trials conducted in Brazil. A cDNA encoding a significant portion of RmAQP1 was expressed as a recombinant protein in Pichia pastoris, purified under native conditions using a polyhistidine C-terminus tag and nickel affinity chromatography, emulsified with Montanide adjuvant, and cattle vaccinated intramuscularly. The recombinant protein provided 75% and 68% efficacy in two cattle pen trials conducted in Campo Grande, Brazil on groups of 6 one year old Holstein calves.
The effectiveness of this vaccine in reducing the numbers of adult female ticks shows this aquaporin antigen holds promise as an active ingredient in cattle vaccines targeted against infestations of R. microplus.
Electronic supplementary material
The online version of this article (doi:10.1186/s13071-014-0475-9) contains supplementary material, which is available to authorized users.
PMCID: PMC4200143  PMID: 25306139
Cattle tick; Recombinant protein; Vaccine antigen; Aquaporin
4.  Conservative Management of an Iatrogenic Arteriovenous Fistula 
Nephron Extra  2014;4(3):155-158.
Arteriovenous fistula is an uncommon complication of central venous catheterization that often requires invasive repair.
Case Report
We report the case of an arteriovenous fistula that presented as ongoing pain following removal of a tunneled central venous catheter. The fistula resolved spontaneously following a period of compression and observation.
Our study highlights the etiology of this uncommon complication as well as suggesting a role for conservative management.
PMCID: PMC4224231  PMID: 25404936
Arteriovenous fistula; Catheter; Catheterization; Complications; Fistula
5.  Multiple mutations in the para-sodium channel gene are associated with pyrethroid resistance in Rhipicephalus microplus from the United States and Mexico 
Parasites & Vectors  2014;7:456.
Acaricide resistant Rhipicephalus microplus populations have become a major problem for many cattle producing areas of the world. Pyrethroid resistance in arthropods is typically associated with mutations in domains I, II, III, and IV of voltage-gated sodium channel genes. In R. microplus, known resistance mutations include a domain II change (C190A) in populations from Australia, Africa, and South America and a domain III mutation (T2134A) that only occurs in Mexico and the U.S.
We investigated pyrethroid resistance in cattle fever ticks from Texas and Mexico by estimating resistance levels in field-collected ticks using larval packet discriminating dose (DD) assays and identifying single nucleotide polymorphisms (SNPs) in the para-sodium channel gene that associated with resistance. We then developed qPCR assays for three SNPs and screened a larger set of 1,488 R. microplus ticks, representing 77 field collections and four laboratory strains, for SNP frequency.
We detected resistance SNPs in 21 of 68 U.S. field collections and six of nine Mexico field collections. We expected to identify the domain III SNP (T2134A) at a high frequency; however, we only found it in three U.S. collections. A much more common SNP in the U.S. (detected in 19 of 21 field collections) was the C190A domain II mutation, which has never before been reported from North America. We also discovered a novel domain II SNP (T170C) in ten U.S. and two Mexico field collections. The T170C transition mutation has previously been associated with extreme levels of resistance (super-knockdown resistance) in insects. We found a significant correlation (r = 0.81) between the proportion of individuals in field collections that carried any two resistance SNPs and the percent survivorship of F1 larvae from these collections in DD assays. This relationship is accurately predicted by a simple linear regression model (R2 = 0.6635).
These findings demonstrate that multiple mutations in the para-sodium channel gene independently associate with pyrethroid resistance in R. microplus ticks, which is likely a consequence of human-induced selection.
Electronic supplementary material
The online version of this article (doi:10.1186/s13071-014-0456-z) contains supplementary material, which is available to authorized users.
PMCID: PMC4189684  PMID: 25266983
Bovine babesiosis; Para-sodium channel gene; Pyrethroid resistance; Rhipicephalus microplus; Rhipicephalus annulatus; Super-kdr
6.  Widespread movement of invasive cattle fever ticks (Rhipicephalus microplus) in southern Texas leads to shared local infestations on cattle and deer 
Parasites & Vectors  2014;7:188.
Rhipicephalus (Boophilus) microplus is a highly-invasive tick that transmits the cattle parasites (Babesia bovis and B. bigemina) that cause cattle fever. R. microplus and Babesia are endemic in Mexico and ticks persist in the United States inside a narrow tick eradication quarantine area (TEQA) along the Rio Grande. This containment area is threatened by unregulated movements of illegal cattle and wildlife like white-tailed deer (WTD; Odocoileus virginianus).
Using 11 microsatellite loci we genotyped 1,247 R. microplus from 63 Texas collections, including outbreak infestations from outside the TEQA. We used population genetic analyses to test hypotheses about ecological persistence, tick movement, and impacts of the eradication program in southern Texas. We tested acaricide resistance with larval packet tests (LPTs) on 47 collections.
LPTs revealed acaricide resistance in 15/47 collections (32%); 11 were outside the TEQA and three were resistant to multiple acaricides. Some collections highly resistant to permethrin were found on cattle and WTD. Analysis of genetic differentiation over time at seven properties revealed local gene pools with very low levels of differentiation (FST 0.00-0.05), indicating persistence over timespans of up to 29 months. However, in one neighborhood differentiation varied greatly over a 12-month period (FST 0.03-0.13), suggesting recurring immigration from distinct sources as another persistence mechanism. Ticks collected from cattle and WTD at the same location are not differentiated (FST = 0), implicating ticks from WTD as a source of ticks on cattle (and vice versa) and emphasizing the importance of WTD to tick control strategies. We identified four major genetic groups (K = 4) using Bayesian population assignment, suggesting multiple introductions to Texas.
Two dispersal mechanisms give rise to new tick infestations: 1) frequent short-distance dispersal from the TEQA; and 2) rare long-distance, human-mediated dispersal from populations outside our study area, probably Mexico. The threat of cattle fever tick transport into Texas is increased by acaricide resistance and the ability of R. microplus to utilize WTD as an alternate host. Population genetic analyses may provide a powerful tool for tracking invasions in other parts of the world where these ticks are established.
PMCID: PMC4022356  PMID: 24742041
Bovine babesiosis; Cattle fever ticks; Eradication; Population genetics; Rhipicephalus (Boophilus) microplus
7.  Impact of Engineered Zinc Oxide Nanoparticles on the Individual Performance of Mytilus galloprovincialis 
PLoS ONE  2013;8(4):e61800.
The increased use of engineered nanoparticles (ENPs) in consumer products raises the concern of environmental release and subsequent impacts in natural communities. We tested for physiological and demographic impacts of ZnO, a prevalent metal oxide ENP, on the mussel Mytilus galloprovincialis. We exposed mussels of two size classes, <4.5 and ≥4.5 cm shell length, to 0.1–2 mg l−1 ZnO ENPs in seawater for 12 wk, and measured the effect on mussel respiration, accumulation of Zn, growth, and survival. After 12 wk of exposure to ZnO ENPs, respiration rates of mussels increased with ZnO concentration. Mussels had up to three fold more Zn in tissues than control groups after 12 wk of exposure, but patterns of Zn accumulation varied with mussel size and Zn concentrations. Small mussels accumulated Zn 10 times faster than large mussels at 0.5 mg l−1, while large mussels accumulated Zn four times faster than small mussels at 2 mg l−1. Mussels exposed to 2 mg l−1 ZnO grew 40% less than mussels in our control group for both size classes. Survival significantly decreased only in groups exposed to the highest ZnO concentration (2 mg l−1) and was lower for small mussels than large. Our results indicate that ZnO ENPs are toxic to mussels but at levels unlikely to be reached in natural marine waters.
PMCID: PMC3629123  PMID: 23613941
8.  Distribution patterns of three sodium channel mutations associated with pyrethroid resistance in Rhipicephalus (Boophilus) microplus populations from North and South America, South Africa and Australia 
Graphical abstract
► We developed a multiplex PCR for three SP resistance associated Rhipicephalus microplus mutations. ► We screened ticks from South and Central America, South Africa and Australia. ► We report geographic separation between the three mutations. ► The three mutations result in different resistance phenotypes.
Resistance to synthetic pyrethroids (SP) in the cattle tick Rhipicephalus (Boophilus) microplus is widespread throughout its distribution area. Three single nucleotide substitutions identified in Domains II and III of the sodium channel gene of R. (B.) microplus are known to be associated with target site pyrethroid resistance. We developed a multiplex PCR using allele-specific primers to amplify wild type or mutated genotypes of the three mutations simultaneously. This assay was used to screen tick samples originating from Brazil, Argentina, Mexico, South Africa and Australia whose phenotype to flumethrin and cypermethrin had been determined by the use of the Larval Tarsal test (LTT) or the Larval Packet Test (LPT). These mutations were found to have distinct geographical distributions and result in different resistance phenotypes. The L64I Domain II mutation conferring resistance to several SP compounds was found in all the Brazilian, Argentinean and Australian populations and in one South African population, with frequencies between 38% and 100% in flumethrin and cypermethrin resistant populations. In contrast, this mutation was not found in samples from Mexico, while the Domain III mutation was found exclusively in this country. The G72V Domain II flumethrin-specific mutation was found in a single Australian population, with a very low resistant allele frequency (3%). The homozygous resistant RR genotype of the L64I Domain II mutation correlated significantly with the survival rates at the discriminating doses of flumethrin and cypermethrin. This survey shows the widespread distribution of the L64I Domain II mutation and provides evidence of its geographic separation from the Domain III mutation.
PMCID: PMC3862404  PMID: 24533283
Rhipicephalus (Boophilus) microplus; Multiplex PCR; Synthetic pyrethroid resistance; Mutation
9.  Toxicity of Nano-Zero Valent Iron to Freshwater and Marine Organisms 
PLoS ONE  2012;7(8):e43983.
We tested whether three commercial forms (uncoated, organic coating, and iron oxide coating) of nano zero-valent iron (nZVI) are toxic to freshwater and marine organisms, specifically three species of marine phytoplankton, one species of freshwater phytoplankton, and a freshwater zooplankton species (Daphnia magna), because these organisms may be exposed downstream of where nZVI is applied to remediate polluted soil. The aggregation and reactivity of the three types of nZVI varied considerably, which was reflected in their toxicity. Since levels of Fe2+ and Fe3+ increase as the nZVI react, we also evaluated their toxicity independently. All four phytoplankton species displayed decreasing population growth rates, and Daphnia magna showed increasing mortality, in response to increasing levels of nZVI, and to a lesser degree with increasing Fe2+ and Fe3+. All forms of nZVI aggregated in soil and water, especially in the presence of a high concentration of calcium ions in groundwater, thus reducing their transports through the environment. However, uncoated nZVI aggregated extremely rapidly, thus vastly reducing the probability of environmental transport and potential for toxicity. This information can be used to design a risk management strategy to arrest the transport of injected nZVI beyond the intended remediation area, by injecting inert calcium salts as a barrier to transport.
PMCID: PMC3431385  PMID: 22952836
10.  Integrated Strategy for Sustainable Cattle Fever Tick Eradication in USA is Required to Mitigate the Impact of Global Change 
The ticks Rhipicephalus (Boophilus) annulatus and R. (B.) microplus, commonly known as cattle and southern cattle tick, respectively, impede the development and sustainability of livestock industries throughout tropical and other world regions. They affect animal productivity and wellbeing directly through their obligate blood-feeding habit and indirectly by serving as vectors of the infectious agents causing bovine babesiosis and anaplasmosis. The monumental scientific discovery of certain arthropod species as vectors of infectious agents is associated with the history of research on bovine babesiosis and R. annulatus. Together, R. microplus and R. annulatus are referred to as cattle fever ticks (CFT). Bovine babesiosis became a regulated foreign animal disease in the United States of America (U.S.) through efforts of the Cattle Fever Tick Eradication Program (CFTEP) established in 1906. The U.S. was declared free of CFT in 1943, with the exception of a permanent quarantine zone in south Texas along the border with Mexico. This achievement contributed greatly to the development and productivity of animal agriculture in the U.S. The permanent quarantine zone buffers CFT incursions from Mexico where both ticks and babesiosis are endemic. Until recently, the elimination of CFT outbreaks relied solely on the use of coumaphos, an organophosphate acaricide, in dipping vats or as a spray to treat livestock, or the vacation of pastures. However, ecological, societal, and economical changes are shifting the paradigm of systematically treating livestock to eradicate CFT. Keeping the U.S. CFT-free is a critical animal health issue affecting the economic stability of livestock and wildlife enterprises. Here, we describe vulnerabilities associated with global change forces challenging the CFTEP. The concept of integrated CFT eradication is discussed in reference to global change.
PMCID: PMC3374960  PMID: 22712018
cattle; tick; babesiosis; integrated eradication; global change; climate; modeling; sustainability
11.  Structure-Forming Corals and Sponges and Their Use as Fish Habitat in Bering Sea Submarine Canyons 
PLoS ONE  2012;7(3):e33885.
Continental margins are dynamic, heterogeneous settings that can include canyons, seamounts, and banks. Two of the largest canyons in the world, Zhemchug and Pribilof, cut into the edge of the continental shelf in the southeastern Bering Sea. Here currents and upwelling interact to produce a highly productive area, termed the Green Belt, that supports an abundance of fishes and squids as well as birds and marine mammals. We show that in some areas the floor of these canyons harbors high densities of gorgonian and pennatulacean corals and sponges, likely due to enhanced surface productivity, benthic currents and seafloor topography. Rockfishes, including the commercially important Pacific ocean perch, Sebastes alutus, were associated with corals and sponges as well as with isolated boulders. Sculpins, poachers and pleuronectid flounders were also associated with corals in Pribilof Canyon, where corals were most abundant. Fishes likely use corals and sponges as sources of vertical relief, which may harbor prey as well as provide shelter from predators. Boulders may be equivalent habitat in this regard, but are sparse in the canyons, strongly suggesting that biogenic structure is important fish habitat. Evidence of disturbance to the benthos from fishing activities was observed in these remote canyons. Bottom trawling and other benthic fishing gear has been shown to damage corals and sponges that may be very slow to recover from such disturbance. Regulation of these destructive practices is key to conservation of benthic habitats in these canyons and the ecosystem services they provide.
PMCID: PMC3309998  PMID: 22470486
12.  TiO2 Nanoparticles Are Phototoxic to Marine Phytoplankton 
PLoS ONE  2012;7(1):e30321.
Nanoparticulate titanium dioxide (TiO2) is highly photoactive, and its function as a photocatalyst drives much of the application demand for TiO2. Because TiO2 generates reactive oxygen species (ROS) when exposed to ultraviolet radiation (UVR), nanoparticulate TiO2 has been used in antibacterial coatings and wastewater disinfection, and has been investigated as an anti-cancer agent. Oxidative stress mediated by photoactive TiO2 is the likely mechanism of its toxicity, and experiments demonstrating cytotoxicity of TiO2 have used exposure to strong artificial sources of ultraviolet radiation (UVR). In vivo tests of TiO2 toxicity with aquatic organisms have typically shown low toxicity, and results across studies have been variable. No work has demonstrated that photoactivity causes environmental toxicity of TiO2 under natural levels of UVR. Here we show that relatively low levels of ultraviolet light, consistent with those found in nature, can induce toxicity of TiO2 nanoparticles to marine phytoplankton, the most important primary producers on Earth. No effect of TiO2 on phytoplankton was found in treatments where UV light was blocked. Under low intensity UVR, ROS in seawater increased with increasing nano-TiO2 concentration. These increases may lead to increased overall oxidative stress in seawater contaminated by TiO2, and cause decreased resiliency of marine ecosystems. Phototoxicity must be considered when evaluating environmental impacts of nanomaterials, many of which are photoactive.
PMCID: PMC3262817  PMID: 22276179
13.  Sex disparities in effects of cystic fibrosis-related diabetes on clinical outcomes: A matched study 
Cystic fibrosis-related diabetes (CFRD) is an increasingly prevalent comorbidity factor for patients with cystic fibrosis (CF). CFRD has been associated with an accelerated decline in clinical parameters and an increased mortality rate.
To investigate the clinical impact of CFRD on pulmonary function and clinical status using a matched study design to further explore potential causality.
Charts from the adult CF clinic at St Paul’s Hospital (Vancouver, British Columbia) were retrospectively reviewed. Forty CFRD patients with and without fasting hyperglycemia were matched to CF patients with nondiabetic glucose tolerance based on sex, age and forced expiratory volume in 1 s (FEV1).
Sixteen of 40 CFRD patients (40%) died compared with nine of 40 patient controls (23%) (P=0.13). CFRD patients were more likely to experience declines in FEV1 (P<0.01), especially women (P<0.01). Patients with CFRD were not more likely to be hospitalized (P=0.39). Body mass index did not differ between groups.
Patients with CFRD had higher rates of FEV1 deterioration than nondiabetic patients with CF, and showed a trend toward increased mortality. The present study suggests that CFRD has a significant clinical impact and should be carefully considered when evaluating the status of CF patients.
PMCID: PMC2679559  PMID: 18818782
Cystic fibrosis; Cystic fibrosis-related diabetes; Forced expiratory volume
14.  Molecular survey of pyrethroid resistance mechanisms in Mexican field populations of Rhipicephalus (Boophilus) microplus 
Parasitology Research  2009;105(4):1145-1153.
Susceptibility to synthetic pyrethroids (SP´s) and the role of two major resistance mechanisms were evaluated in Mexican Rhipicephalus microplus tick populations. Larval packet test (LPT), knock-down (kdr) PCR allele-specific assay (PASA) and esterase activity assays were conducted in tick populations for cypermethrin, flumethrin and deltamethrin. Esterase activity did not have a significant correlation with SP´s resistance. However a significant correlation (p < 0.01) was found between the presence of the sodium channel mutation, and resistance to SP´s as measured by PASA and LPT respectively. Just over half the populations (16/28) were cross-resistant to flumethrin, deltamethrin and cypermethrine, 21.4% of the samples (6/28) were susceptible to all of the three pyrethroids 10.7 of the samples (3/28) were resistant to flumethrin, 3.4 of the samples (1/28) were resistant to deltamethrin only and 7.1% (2/28) were resistant to flumethrin and deltamethrin. The presence of the kdr mutation correlates with resistance to the SP´s as a class. Target site insensitivity is the major mechanism of resistance to SP´s in Mexican R. microplus field strains, involving the presence of a sodium channel mutation, however, esterase-based, other mutations or combination of mechanisms can also occur.
PMCID: PMC2729983  PMID: 19565267
15.  Uvular Edema Secondary to Snoring Under Deep Sedation 
Anesthesia Progress  2006;53(1):13-16.
A 57-year-old male with a documented history of obstructive sleep apnea with loud snoring received deep intravenous sedation with midazolam, fentanyl, ketamine, and propofol infusion and a left interscalene brachial plexus nerve block for a left biceps tendon repair. Loud snoring during the case was noted. On the second postoperative day, he was observed to have significant uvular edema. After due consideration of the various elements in the differential diagnosis, it was concluded that negative pressure trauma from deep snoring during the sedation was the most likely etiology.
PMCID: PMC1586864  PMID: 16722279
Uvular edema; Obstructive sleep apnea; Deep sedation; Negative pressure edema

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