Laparoscopy could be the best approach to treat colorectal cancer in selected patients aged over 80 years: Outcomes from a multicenter study

BackgroundThe efficacy and safety of treating elderly patients with colorectal cancer (CRC) is of concern. This study aimed to compare the short- and long-term outcomes of elective laparoscopic vs. open surgery to treat CRC in very elderly patients.MethodsAll patients aged >80 years and who had undergone a colectomy for CRC without metastasis between July 2005 and April 2012 were considered for inclusion. Demographic, clinical, operative, and postoperative data, plus overall and disease-free survival rates, were retrospectively collected and compared between two groups of patients that underwent an open procedure (OP group) or laparoscopy (LG).Results123 patients were enrolled (55 OPG, 68 LG). Median age was similar between the groups (84 vs. 83 years, respectively; NS). Duration of surgery was significantly lower in OPG (170 vs. 200 min; p = 0.030). Overall mortality at 3 months was 8.3%: it tended to be greater in the OPG (16.5% vs. 1.5%, NS). Morbidity was significantly greater in the OPG compared to the LG (52.7% vs. 27.5%; p = 0.021), resulting in significantly longer hospital stay (12 vs. 8 days, respectively; p < 0.001). Pathological findings were similar between the two groups. Cumulative overall survival rates at 3 and 5 years were significantly greater after laparoscopy (85% and 72%) compared to open surgery (58.2% and 48%, respectively; p < 0.001).ConclusionsOur study suggests that laparoscopy is safe and could increase overall survival compared to open surgery in elderly patients suffering from CRC.SummaryThis retrospective study compared the short- and longer-term outcomes of patients aged >80 years and undergoing elective laparoscopic or open surgery for CRC between 2005 and 2012.     

The effect of percutaneous coronary revascularization on plasma N-terminal pro-B-type natriuretic peptide levels in stable coronary artery disease

BackgroundThis study was conducted to assess the effect of percutaneous coronary revascularization (PCR) on plasma NT-proBNP concentration in patients with chronic stable angina (CSA).MethodsThis prospective open label interventional study included 22 patients with moderate to severe CSA, normal left ventricular (LV) systolic functions and critical (>90%) proximal stenosis in one of the three major epicardial coronary arteries. After stabilization of medications for 8 weeks, resting supine plasma NT-proBNP levels were measured and patients underwent PCR of the involved vessels. Eight weeks later, with medications unaltered; plasma NT-proBNP levels were repeated and compared with the baseline levels. LV systolic and diastolic functions were assessed before and after PCR.ResultsThe mean age of the patients was 61.27 ± 8.87 years. Out of 22 patients, 20 were male and 2 were female. PCR was performed on left anterior descending coronary artery (LAD) in 12 patients and in a non-LAD vessel in 10 patients. After 8 weeks of successful PCR, there was a significant overall reduction in mean plasma NT-proBNP levels (from 244.36 ± 218.99 to 168.68 ± 161.61 pg/mL, p = 0.016). The patients who underwent PCR of LAD demonstrated significantly reduced NT-pro-BNP levels after PCR (p = 0.009). In the non-LAD group, NT-proBNP levels also decreased, albeit insignificantly (p = 0.432). Reduction in NT-proBNP was independent of change in LV systolic functions.ConclusionSuccessful PCR, by relieving myocardial ischemia, significantly reduced plasma NT-proBNP levels in majority of the patients with chronic stable angina secondary to critical epicardial coronary artery stenosis.     

Tratamiento antibiótico dirigido en infecciones por Mycoplasma genitalium: análisis de mutaciones asociadas con resistencia a macrólidos y fluoroquinolonas

IntroductionThe objective of this study was to analyse the susceptibility of Mycoplasma genitalium to macrolides and fluoroquinolones using molecular techniques.MethodsSusceptibility to macrolides was tested (Gipuzkoa, 2014-2017) by a rapid probe-based real-time polymerase chain reaction assay (23S rRNA gene) and to fluoroquinolones by sequencing the parC and gyrA genes.ResultsMutations associated with macrolide resistance were detected in 43/263 (16.3%) cases and potential fluoroquinolone resistance in 21/267 (7.9%). Macrolide resistance was more frequent in patients previously treated with azithromycin (76.5% vs 7.4%, P < .001) as well as in those treated with a single 1 g dose (31.3%) vs the extended regimen (7%, P < .001). There were 5/245 (2%) cases with mutations probably associated with resistance to both antibiotics.ConclusionsThe technique used for testing Mycoplasma genitalium susceptibility to azithromycin allowed the rapid implementation of resistance-guided antibiotic therapy. Moxifloxacin could be a good option in cases of macrolide resistance.     

Infection with Helicobacter pylori strains carrying babA2 and cagA is associated with an increased risk of peptic ulcer disease development in Iraq

Background and study aimSeveral genes of Helicobacter pylori, such as vacA, cagA, iceA and babA, have been reported to significantly increase the risk of gastrointestinal diseases. The aim of this study was to study the relationship between H. pylori virulence factors and clinical outcomes and identify the independent markers of peptic ulcer disease in Iraq.Patients and methodsDNA was extracted from specimens taken from 154 unselected H. Pylori positive Iraqi patients. Genotyping was performed by the polymerase chain reaction (PCR), using specific primers for cagA, vacA (s, m), iceA and babA2 genes.ResultsA total of 56 (82%) peptic ulcer disease (PUD) patients carried cagA+ strains, significantly more than the 56 (65%) non-ulcer disease (NUD) patients (p = 0.017). The difference in the prevalence of babA2 positivity was significant between patients with NUD (33.7%) and PUD (58.8%) (p = 0.002). In addition, babA2 was associated as an independent factor, with PUD (p = 0.005; odds ratio (OR) = 0.4; confidence interval (CI) = 0.18–0.68) followed by cagA (p = 0.05; OR = 0.4; CI = 0.18–0.85). Forty-five isolates (29%) were typed as ‘triple positive’ strains, and their presence was significantly associated with PUD (p = 0.001).ConclusionThe cagA and babA2 genotypes might be considered as useful markers for PUD patients. However, iceA1 and iceA2 seem not to be good markers for the disease. The presence of H. pylori strains with triple-positive status is of high clinical relevance to H. pylori-associated diseases.     

Clinical significance of different bacterial load of Mycoplasma pneumoniae in patients with Mycoplasma pneumoniae pneumonia

ObjectiveThis retrospective study was conducted to investigate the clinical significance of different Mycoplasma pneumoniae bacterial load in patients with M. pneumoniae pneumonia (MP) in children.MethodsPatients with MP (n = 511) were identified at the Children's Hospital Affiliated to Soochow University database during an outbreak of MP between January 2012 and February 2013.ResultsComparing patients with high and low bacterial load those with higher loads were significantly older (p < 0.01) and had fever significantly more frequently (p = 0.01). Presence of wheezing at presentation was associated with low bacterial load (p = 0.03). Baseline positive IgM was present in 93 (56.4%) patients with high bacterial load compared to 46 (27.8%) patients with low bacterial load (p < 0.001). Co-infection with viruses was found significantly more frequent among patients with low bacterial load (24.2%) than those with high bacterial load (8.5%) [p < 0.001]. Bacterial co-infection was also more frequently detected among patients with low bacterial load (22.4%) than in those with high bacterial load (12.1%) [p = 0.01].ConclusionM. pneumoniae at a high bacterial load could be an etiologic agent of respiratory tract disease, whereas the etiologic role of MP at a low bacterial load remains to be determined.     

Importance of high IgG anti-Toxoplasma gondii titers and PCR detection of T. gondii DNA in peripheral blood samples for the diagnosis of AIDS-related cerebral toxoplasmosis: a case-control study

BackgroundCerebral toxoplasmosis (CT) continues to cause significant morbidity and mortality in human immunodeficiency virus (HIV)-infected patients in Brazil. In clinical practice, the initial diagnosis is usually presumptive and alternative diagnosis tools are necessary. Our objective was to evaluate whether the detection of high titers of IgG anti-Toxoplasma gondii and T. gondii DNA in blood samples are associated with the diagnosis of CT.MethodsIn this case-control study we included 192 patients with HIV-1 infection: 64 patients with presumptive CT (cases) and 128 patients with other diseases (controls). Blood samples to perform indirect immunofluorescense reaction (IFI) to detect anti-T. gondii IgG antibodies and polymerase chain reaction (PCR) were collected before or within the first three days of anti-Toxoplasma therapy. Two multivariate logistic regression models were performed: one including the variable qualitative serology and another including quantitative serology.ResultsIn the first model, positive IgG anti-T. gondii (OR 4.7, 95% CI 1.2-18.3; p = 0.027) and a positive T. gondii PCR result (OR 132, 95% CI 35-505; p < 0.001) were associated with the diagnosis. In the second model, IgG anti-T. gondii titres ≥ 1:1024 (OR 7.6, 95% CI 2.3-25.1; p = 0.001) and a positive T. gondii PCR result (OR 147, 95% CI 35-613; p < 0.001) were associated with the diagnosis.ConclusionsQuantitative serology and molecular diagnosis in peripheral blood samples were independently associated with the diagnosis of CT in HIV-infected patients. These diagnostic tools can contribute to a timely diagnosis of CT in settings where Toxoplasma infection is common in the general population.     

Feasibility of laparoscopic restorative proctocolectomy without diverting stoma

AimRestorative proctocolectomy performed before the advent of laparoscopy had evolved to frequently omit a diverting stoma. Our aim was to assess the impact of a diverting stoma on postoperative outcomes following laparoscopic restorative proctocolectomy.MethodData on all patients undergoing a laparoscopic restorative proctocolectomy at our institution were prospectively collated in a database.ResultsBetween November 2004 and February 2010, 71 patients (38 females) underwent laparoscopic restorative proctocolectomy. Indications included familial adenomatous polyposis (n = 34), ulcerative colitis (n = 35), indeterminate colitis (n = 1) and Lynch syndrome (n = 1). Laparoscopic restorative proctocolectomy was performed as a one-stage procedure in 49 patients, and after a sub-total colectomy in 22. Seven patients in each group underwent the formation of a diverting stoma. Nine patients required conversion to open surgery. Sixteen patients experienced at least one postoperative complication. The postoperative morbidity was 29% (n = 4/14) and 21% (n = 12/21) in patients with and without a stoma (p = 0.8), and the rate of fistula was 21% and 5%, respectively (p = 0.08). Seven percent of patients with a stoma and 16% without stoma had an intra-abdominal collection (p = 0.7). Nine patients required reoperation. The reoperation rate was not influenced by the presence or absence of a diverting stoma.ConclusionLaparoscopic restorative proctocolectomy can be performed safely without a diverting stoma in selected patients.     

Altered molecular signature of intestinal microbiota in irritable bowel syndrome patients compared with healthy controls: A systematic review and meta-analysis

BackgroundMany studies have reported significant changes in intestinal microbiota in irritable bowel syndrome (IBS) patients based on quantitative real-time PCR analysis.AimsWe aimed to review the alterations in intestinal microbiota.MethodsAn online search up to June 9, 2016, was conducted. This systematic review and meta-analysis included differential expression of intestinal microbiota in patients with IBS versus healthy controls (HCs) and subgroup analysis. We assessed the quality of the included studies using an original assessment tool.ResultsA total of 13 articles involving 360 IBS patients and 268 healthy controls were included. The quality assessment scores for these articles ranged from 5 to 8. Significant differences in expression in IBS patients were observed for Lactobacillus (SMD = −0.85, P < 0.001, I² = 28%), Bifidobacterium (SMD = −1.17, P < 0.001, I² = 79.3%), and Faecalibacterium prausnitzii (SMD = −1.05, P < 0.001, I² = 0.0%) but not Bacteroides-Prevotella group, Escherichia coli or other genera or species. Subgroup analysis showed that diarrhea-predominant IBS patients had significantly different expression of Lactobacillus (SMD = −1.81, P < 0.001) and Bifidobacterium (SMD = −1.45, P < 0.001).ConclusionDown-regulation of bacterial colonization including Lactobacillus, Bifidobacterium and F. prausnitzii was observed in IBS patients, particularly in diarrhea-predominant IBS (IBS-D). Microbiota changes participate in the pathogenesis of IBS and may underlie the efficacy of probiotic supplements.     

Copy number variations of the F8 gene are associated with venous thromboembolism

BackgroundVenous thromboembolism (VTE) is a complex disease and several inherited and acquired factors are relevant to its occurrence. Among these, an elevated level of plasma coagulation factor VIII (FVIII) is an established risk factor for VTE; copy number variations (CNVs) have also been discovered to be associated with many diseases.ObjectiveTo explore the proposed association between CNV of the F8 gene and the risk of VTE.MethodsA case–control study including 179 VTE patients and 176 healthy individuals were enrolled in this study. Activity of plasma factor VIII was measured. Genomic DNA was extracted for subsequent quantitative real-time PCR analysis of CNVs of the F8 gene.ResultsPlasma factor VIII levels were significantly higher in VTE patients than in healthy controls (251% vs. 99%, p < 0.01). Copy number of the F8 gene in VTE patients was significantly higher than in healthy controls. (male: p = 6.1 × 10^? 14, OR = 12, 95%CI: 6.0–25; female: p = 4.3 × 10^? 10, OR = 9.5, 95%CI: 4.5–20). Plasma factor VIII levels in the samples with high copies of the F8 gene were higher than in those individuals with normal copy number (male: p = 0.023; female: p = 0.036).ConclusionsAmplification of the F8 gene copy number seems to enhance factor VIII activity and was associated with VTE.     

Relación entre la expresión de IL-2 e IL-4 y sus polimorfismos y los riesgos de padecer infección por Mycoplasma pneumoniae y asma en niños

IntroductionAsthma is an inflammatory disorder of the airways and the symptoms of asthma could be exacerbated by Mycoplasma pneumoniae infection. Interleukin-2 and interleukin-4 have been implicated in immune and inflammatory reactions. We examined the associations of IL2 and IL4 polymorphisms and expression with the risks of asthma and M. pneumoniae infection in children.Methods392 asthmatic children and 849 controls were recruited into the study. Eight polymorphisms in IL2 and IL4 were genotyped with Sequenom MassARRAY platform. M. pneumoniae infection and copy number was determined with fluorescence PCR. IL-2 and IL-4 serum expression levels were determined by using ELISA.ResultsWe found a significant association of IL2 rs6534349 polymorphism with increased asthma risk (heterozygotes, P = .029; homozygous variants; P = .013) and of IL4 rs2227284 polymorphism with reduced asthma risk (heterozygotes, P = .026; homozygous variants; P = .001). Besides, the association of other polymorphisms, except rs2070874 polymorphism, became apparent when the asthmatic children were grouped according to GINA classification of asthma control and severity. In addition, IL-2 and IL-4 serum expression levels were significantly higher in M. pneumoniae negative (P = .038) and positive (P = .011) subjects respectively. This observation holds true among asthmatic patients (P = .016 for IL-2 and P = .042 for IL-4), but only the IL-4 observation remained correct among non-asthmatic controls (P = .032). We also observed that the rs6534349 GG genotype was significantly associated with increased odds of getting high load M. pneumoniae infection (P = .0376).ConclusionsIL2 and IL4 could be important biomarkers for estimating the risks of asthma and M. pneumoniae infection in children.     

Temporal profile and prognostic value of Lp-PLA2 mass and activity in the acute stroke setting

BackgroundLp-PLA2 is a novel biomarker in cardiovascular diseases due to its ability to predict first-ever and recurrent stroke. Little information is known regarding its influence on early outcome after stroke.ObjectivesWe aimed to investigate Lp-PLA2 in t-PA-treated stroke patients and to study its relationship with early outcome.MethodsLp-PLA2 mass and activity were measured in 135 healthy controls and also in stroke patients treated with t-PA at baseline (n = 99) and serially thereafter (n = 34) by means of the PLAC test at an automated Olympus analyzer and by a colorimetric activity method (diaDexus). NIHSS scores and TCD recordings were also obtained serially. Outcome was defined according to early neurological status, the presence of arterial recanalization and functional outcome at third month.ResultsLp-PLA2 mass was increased as compared to controls, whereas Lp-PLA2 activity was significantly decreased at baseline as compared with controls and with 1 and 24 h determinations. Lp-PLA2 mass and activity were not related with early (48 h) neurological status. Regarding recanalization, higher mass and activity were found among patients who did not achieve complete recanalization by the end of t-PA treatment (p = 0.029 for mass, p = 0.044 for activity). Lp-PLA2 mass and the existence of a proximal occlusion at baseline were the most powerful predictors for persistent occlusions (OR for proximal occlusion 6.8. p = 0.036, OR for Lp-PLA2 mass 7.2 per standard deviation increase, p = 0.008).ConclusionsSignificant changes in Lp-PLA2 concentrations occur early after stroke onset. Lp-PLA2 mass may add relevant information regarding early arterial recanalization in intravenous t-PA-treated stroke patients.     

CRP and CD14 polymorphisms correlate with coronary plaque volume in patients with coronary artery disease--IVUS substudy of the ENCORE trials

BackgroundSeveral proinflammatory single-nucleotide polymorphisms (SNPs) have been linked to the progression of atherosclerosis and coronary artery disease (CAD). Plaque size and its destabilization by inflammatory processes are major determinants of ischemia and acute coronary syndromes. Intravascular ultrasound (IVUS) allows for quantification of plaque size in vivo. We therefore investigated the relation of plaque size with mutations of proinflammatory genes in patients with CAD.MethodsIn 196 patients with stable CAD enrolled in the ENCORE trials coronary plaque and vessel volume was assessed by IVUS. 173 patients were successfully genotyped for polymorphisms of proinflammatory genes CD14 C(?260)T and CRP C(+1444)T using the single-nucleotide polymorphism polymerase chain reaction (SNP PCR) approach.ResultsBaseline characteristics were comparable for all genotype groups. Higher ratios of plaque volume/vessel volume were observed in patients with the CRP 1444TT (n = 11) and CD14 260TT (n = 33) genotypes (p = 0.016 and p = 0.026, respectively).ConclusionIn patients with stable coronary artery disease the CRP 1444TT and CD14 260TT variants are associated with larger coronary plaque volume independently of concomitant cardiovascular risk factors.     

Study of CD4+, CD8+, and natural killer cells (CD16+, CD56+) in children with immune thrombocytopenic purpura

Objective/backgroundTo assess the percentage of CD4⁺, CD8⁺, and natural killer cells (CD16⁺, CD56⁺) in children with immune thrombocytopenic purpura (ITP) at presentation and study their impact on disease chronicity.MethodsThis case–control study was conducted at the Pediatric Hematology and Oncology Unit, Menoufia University Hospital (tertiary care center in Egypt). The study was held on 30 children presenting with ITP; they were followed-up and classified into two groups: 15 children with acute ITP; and 15 children with chronic ITP. Patients were compared to a group of 15 healthy children of matched age and sex. Measurements of CD4⁺, CD8⁺, and natural killer cells (CD16⁺, CD56⁺) by flow cytometry were assessed and compared in these groups.ResultsCD4⁺ and CD4⁺/CD8⁺ were significantly lower in acute and chronic patients than the control group (p < 0.05 and p < 0.001, respectively), with no significant difference between acute and chronic patients (p > 0.05). However, CD8⁺ was significantly higher in acute and chronic patients than the control group (p < 0.05), with no significant difference between acute and chronic patients (p > 0.05). Natural killer cell percent was significantly lower in acute patients than the control group (p < 0.001), with no significant difference between chronic and control groups (p > 0.05).ConclusionITP is associated with immunity dysfunction denoted by the increase in cytotoxic T lymphocytes and the decrease in natural killer cells.     

Correlation between skin tests to Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis in Cuban asthmatics

BackgroundDermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis are the most important allergenic mites in Cuba. The aim of this study was to determine the degree of polysensitization and correlation of the skin prick test (SPT) reaction size to these mites in asthmatic patients.MethodsA total of 232 adult patients with asthmatic symptoms caused by house dust and positive SPT to at least one mite were included. Standardized allergenic extracts were used in SPT.ResultsA total of 88.4 % of patients were positive to D. siboney, 87.1 % to D. pteronyssinus, and 68.1 % to B. tropicalis. Sensitization to Dermatophagoides species was predominant, demonstrated by the fact that 31.9 % of patients showed positive SPT to either D. siboney or D. pteronyssinus only, whereas only 5.6 % was sensitized solely to B. tropicalis. Nevertheless, most patients (58.6 %) were polysensitized to the 3 species. The mean wheal size produced by the different allergens in positive patients was similar (n.s. p > 0.05). Reaction size was strongly correlated (r = 0.71, p = 5.3 × 10⁻⁰⁹) between D. siboney and D. pteronyssinus, whereas no significant correlation was found between D. pteronyssinus or D. siboney and B. tropicalis.ConclusionsThe results of this study support the need to include the 3 allergens in diagnostic panels and for combined allergen-specific immunotherapy.     

One- or two-operator techniques for oesophago-gastro-duodenoscopy in unsedated patients: A comparative prospective randomized study

BackgroundThe standard oesophago-gastro-duodenoscopy procedure is performed with a single endoscopist (SE). Nurse-assisted (NA) oesophago-gastro-duodenoscopies have not yet been studied. We aimed to evaluate the efficacy of an NA endoscopy compared to an SE endoscopy.MethodsA prospective, single-center, randomized trial, in which 500 adult patients were divided into two groups. In the first group, patients underwent an endoscopy with an SE. In the second group, the endoscopy was performed with an NA. The ease of the procedure (scores 1–4; 1 difficult, 2 satisfactory, 3 easy, 4 very easy), evaluation of patient satisfaction (scores 1–4; 1 uncomfortable, 2 satisfactory, 3 comfortable, 4 very comfortable), total time of the procedure and vocal cord observation were determined as quality indicators.ResultsMean patient satisfaction scores in groups 1 and 2 were 2.98 ± 0.79 and 3.11 ± 0.78, respectively (p = 0.043), with uncomfortable ratings in 5.2% vs 4%, satisfactory in 16.8% vs 13.2%, comfortable in 53.2% vs 50.4%, and very comfortable in 24.8% vs 32.4% of patients in groups 1 and 2, respectively. Retching rates during the procedure were 54.4% and 45.2% (p = 0.040) in groups 1 and 2, respectively. No differences were seen in vocal cord observation (54.4% vs 56.0%), total procedure time (2.35 ± 1.56 vs 2.41 ± 1.48 min) and easy score (3.26 ± 0.603 vs 3.25 ± 0.64) in groups 1 and 2 for the procedures. Very easy, easy, satisfactory, and difficult ratings were given by 33.6% vs 34.8%, 60.4% vs 56.4%, 4.8% vs 7.6% and 1.2% vs 1.2% of groups 1 and 2, respectively.ConclusionsCompared with the conventional method, the assisted endoscopic technique provides more comfort and less gag reflex without increasing the processing time or difficulty of performing the procedure.     

Proinflammatory HLA-DRB1*01-haplotype predisposes to ST-elevation myocardial infarction

BackgroundMajor histocompatibility complex (MHC) gene region harbours haplotypes that associate with coronary artery disease (CAD). Their role in ST-elevation infarction (STEMI) or on the inflammatory level is not known.MethodsFour candidate MHC markers were analyzed by real-time quantitative PCR and constructed into haplotypes from patients with STEMI (n = 162), matched controls with no CAD (n = 319) and general population sample (n = 149). High sensitivity C-reactive protein (hsCRP) was assessed in a follow-up visit from patients (n = 86) and at inclusion from other study subjects.ResultsThe haplotype with one copy of HLA-DRB1*01, C4A, C4B but no HLA-B*35 doubled the risk of STEMI (OR = 2.15, 95%CI = 1.11–4.15, p = 0.020 for patients vs. controls, and OR = 2.26, 95%CI = 0.97–5.24, p = 0.052 for patients vs. population sample). The association between patients and controls persisted in multivariate analyses. The frequency of the haplotype was 5.86% (n = 19/324) in patients, 2.82% (n = 18/638) in controls and 2.68% (n = 8/298) in population sample. None of the individual MHC markers alone showed significant association with STEMI.In multivariate analyses, the haplotype carriers had higher hsCRP levels in patients (median 3.37 mg/L in carriers vs. 1.14 mg/L in non-carriers, p = 0.019) and in controls (median 2.90 mg/L vs. 1.21 mg/L, p = 0.009, respectively).ConclusionThe MHC haplotype associates with STEMI and elevated baseline hsCRP levels. The results are in concordance with previous data on non-STEMI patients, implying that a HLA-DRB1*01 – related haplotype increases the risk of CAD, possibly though increased inflammation.     

Clinical utility of cytomegalovirus antigenemia assay and blood cytomegalovirus DNA PCR for cytomegaloviral colitis patients with moderate to severe ulcerative colitis

Background and aimsClinical usefulness of cytomegalovirus (CMV) antigenemia assay and blood CMV polymerase chain reaction (PCR) in patients with ulcerative colitis (UC) needs to be evaluated.MethodsMedical records of moderate to severe UC patients between January 2001 and December 2012 were reviewed retrospectively. Diagnostic performances of CMV antigenemia assay and blood PCR to predict CMV colitis, and clinical outcome according to the results were analyzed. CMV colitis was diagnosed by H&E staining and/or CMV immunohistochemistry.ResultsOf the 229 study subjects, 83 patients (36.2%) had CMV colitis. The sensitivity and specificity of CMV antigenemia assay were 47.0% and 81.7%, and those of blood CMV DNA PCR were 44.3% and 87.9%, respectively. If either CMV antigenemia or PCR was positive in the presence of significant ulcers, the sensitivity and specificity of having CMV colitis were 67.3% and 75.7%, respectively, with the area under the receiver operating characteristic curve value of 0.717. Among patients with significant ulcers, positive CMV antigenemia (33/50 [66.0%] vs. 31/102 [30.4%]; p < 0.001) and positive blood CMV PCR (25/37 [67.6%] vs. 24/86 [27.9%]; p < 0.001) showed significantly higher probability of CMV colitis than blood test-negative patients. UC-CMV colitis patients with positive CMV antigenemia showed significantly higher rate of colectomy than those with negative antigenemia (13/39 [33.3%] vs. 5/44 [11.4%]; p = 0.015).ConclusionsAlthough CMV antigenemia and blood CMV PCR showed low sensitivity for diagnosing CMV colitis, the specificity values were high. Among UC-CMV colitis patients, CMV antigenemia showed significant association with subsequent colectomy.     

CTX-M-producing Escherichia coli and Klebsiella pneumoniae isolated from community-acquired urinary tract infections in Valledupar,Colombia

ObjectiveDescribe the presence of CTX-M-1 phylogenetic subgroup extended-spectrum β-lactamases (ESBL), associated with TEM and SHV genes, and the gene encoding cephalosporinase, CMY-2 in Escherichia coli and Klebsiella pneumoniae isolates from community-acquired urinary tract infections.Methods102 E. coli and 21 K. pneumoniae were collected from patients with culture-proven urinary tract infection (UTI), during February and March, 2011. Antimicrobial susceptibility test was performed by disk diffusion according to the standards of the Clinical Laboratory Standard Institute. Screening for cephalosporins-resistant E. coli and K. pneumoniae was performed by PCR assay for bla_TEM, bla_SHV, bla_CTX-M-1,_-2,_-8,_-9, bla_PER-2 and bla_CMY-2 genes. Statistical analysis was performed by chi-squared test and multivariate logistic regression analysis.ResultsESBL production was detected in 12 (11.7%) E. coli and four (19%) K. pneumoniae isolates. TEM ESBLs were detected in seven E. coli and three K. pneumoniae isolates. SHV ESBLs were found in four K. pneumoniae isolates. CTX-M-1 phylogenetic subgroup was positive in seven E. coli and three K. pneumoniae isolates. CMY-2 β-lactamase gene was detected in nine E. coli and one K. pneumoniae isolates. A signi?cant association of ESBL expression in E. coli was observed with resistance to tobramycin (p ≤ 0.001), tetracycline (p = 0.043), and ciprofloxacin (p ≤ 0.001). In K. pneumoniae isolates, significant association was found with resistance to tobramycin and ciprofloxacin (p = 0.006), and trimethoprim-sulfamethoxazole (p = 0.043). Multivariate analyses did not show association between ESBL production in E. coli and K. pneumoniae, and resistance to non-β-lactams drugs.ConclusionsCTX-M ESBL in uropathogens isolated from the community is cause for concern due to the enormous potential for multidrug resistance from strains that produce these enzymes, which could lead to failure of empirically-administered therapies and development of complicated UTIs.     

Measuring change in clinical profiles between hospital admission and discharge and predicting living arrangements at discharge for aged patients presenting behavioral and psychological symptoms of dementia

BackgroundThe clinical courses of psychogeriatric inpatients presenting behavioral and psychological symptoms of dementia, between their admission and discharge, have been poorly documented. Based upon our previously elaborated profiles of psychogeriatric patients, this study aimed to describe these courses and to explore whether changing clinical profiles could predict living arrangements at discharge.MethodsRetrospective data were collected on 397 patients with dementia and hospitalized from 2011 to 2014 in French-speaking Switzerland. Patients were classified on admission and at discharge using four clinical profiles (BPSD-affective, BPSD-functional, BPSD-somatic, and BPSD-psychotic). Multinomial logistic regression analyses were used to identify predictors of living arrangements at discharge. Age, gender, marital status, living arrangements on admission, and clinical profile on admission and discharge, were used as potential predictors.ResultsOf the patients classified as BPSD-functional or BPSD-affective on admission, 70.18% and 73.48%, respectively, had the same classification at discharge. However, 45.74% of patients classified as BPSD-somatic on admission were discharged with a BPSD-functional profile, and 46.15% of inpatients classified as BPSD-psychotic on admission were discharged as BPSD-affective (χ²(9) = 128.8299; p < 0.000). At discharge, 64.99% of all patients were admitted to a nursing home. The significant predictors of return to home were: being male (OR = 0.96; 95% CI: 0.93–0.99) and BPSD-affective profile (OR = 1.95; 95% CI: 1.08–3.54. Significant predictors of transfer to acute care or death were: BPSD-somatic (OR = 12.98; 95% CI: 1.96–85.91) or BPSD-psychotic profile (OR = 13.53; 95% CI: 1.65–111.05).DiscussionThis study provides new information concerning the clinical course of older psychogeriatric inpatients using profiles derived from clinically sensitive profiles.