Baseline serum interleukin-6 to interleukin-2 ratio is associated with the response to seasonal trivalent influenza vaccine in solid organ transplant recipients

BackgroundThe analysis of pre- and post-vaccination B-cell-associated cytokines might be useful in predicting the immunogenicity of seasonal trivalent influenza vaccine (TIV) in solid organ transplant (SOT) recipients.MethodsWe performed a subanalysis of a clinical trial that compared the safety and efficacy of high-dose intradermal (ID) versus intramuscular (IM) TIV in SOT recipients. Serum levels of selected cytokines (interferon [IFN]-γ, interleukin [IL]-2, IL-4, IL-5, IL-6, IL-12 and IL-21, and tumor necrosis factor [TNF]-α) were measured pre- and one month post-vaccination in 155 patients (with 84 and 71 receiving the ID and IM vaccines, respectively). Cytokine profiles were compared according to vaccine response (seroconversion [≥4-fold increase in hemagglutination inhibition antibody titers] to ≥1 influenza vaccine antigen).ResultsMean baseline IL-6 levels were higher (1.20 versus 0.65 pg/mL; P-value = 0.021) and IL-2 levels were lower (0.01 versus 0.50 pg/mL; P-value = 0.051) in patients achieving vaccine response. After adjusting for clinical variables, baseline IL-6/IL-2 ratio remained predictive of vaccine response (odds ratio per 10-unit increment: 1.06; 95% confidence interval: 1.02–1.10; P-value = 0.002). Vaccination induced an increase in TNF-α (P-value <0.0001) and a decrease in IL-5 levels (P-value = 0.0007). There were no significant differences in cytokine kinetics between vaccine responders and non-responders. Mean baseline TNF-α levels were higher in patients experiencing moderate-to-severe adverse events after vaccination (1.93 versus 1.72 pg/mL; P-value = 0.009).ConclusionsBaseline serum IL-6 and IL-2 levels, two cytokines that modulate the role of CD4⁺ T follicular helper cells and the terminal differentiation of B-cells, predict vaccine response in SOT recipients.     

Risk of solid organ transplant rejection following vaccination with seasonal trivalent inactivated influenza vaccines in England: A self-controlled case-series

BackgroundAnnual seasonal influenza vaccination is recommended for transplant recipients. No formal pharmacoepidemiology study has been published on the association between solid organ transplant (SOT) rejection and vaccination with seasonal trivalent inactivated influenza vaccines (TIIVs).MethodsThe risk of SOT (liver, kidney, lung, heart or pancreas) rejection after TIIV vaccination was assessed using a self-controlled case-series method (NCT01715792). SOT recipients in England with transplant rejection were selected from the Clinical Practice Research Datalink and linked Hospital Episode Statistics inpatient data. The study period (September 2006 to August 2009) encompassed three consecutive influenza seasons. We calculated the relative incidence (RI) of SOT rejection between the 30- and 60-day post-vaccination risk periods and the control periods (any follow-up period excluding risk periods), using a Poisson regression model.ResultsIn seasons 2006/07, 2007/08, 2008/09 and pooled seasons, 132, 136, 168 and 375 subjects, respectively, experienced at least one transplant rejection; approximately half (45%–51%) of these subjects had received a TIIV. For season 2006/07, the RI of rejection of any organ, adjusted for time since transplantation, was 0.74 (95% CI: 0.24–2.28) and 0.58 (95% CI: 0.24–1.38) during the 30-day and 60-day risk periods, respectively. Corresponding RIs for season 2007/08 were 1.21 (95% CI: 0.55–2.64) and 1.31 (95% CI: 0.69–2.48); for season 2008/09, 0.99 (95% CI: 0.43–2.28) and 0.64 (95% CI: 0.31–1.33); and for pooled seasons 1.01 (95% CI: 0.58–1.76) and 0.88 (95% CI: 0.56–1.38). The results of a separate analysis of kidney rejections and analyses that took into account additional potential confounders were consistent with those of the main analyses, with 95% CIs including 1 and upper limits below 3.ConclusionThis study provides reassuring evidence of the safety profile of TIIVs in SOT recipients, thus supporting current recommendations to vaccinate this risk group annually.     

Humoral,T-cell and B-cell immune responses to seasonal influenza vaccine in solid organ transplant recipients receiving anti-T cell therapies

BackgroundWe analyzed the impact of the anti-T-cell agents basiliximab and antithymocyte globulins (ATG) on antibody and cell-mediated immune responses after influenza vaccination in solid-organ transplant recipients.Methods71 kidney and heart transplant recipients (basiliximab [n = 43] and ATG [n = 28]) received the trivalent influenza vaccine. Antibody responses were measured at baseline and 6 weeks post-vaccination by hemagglutination inhibition assay; T-cell responses were measured by IFN-γ ELISpot assays and intracellular cytokine staining (ICS); and influenza-specific memory B-cell (MBC) responses were evaluated using ELISpot.ResultsMedian time of vaccination from transplantation was 29 months (IQR 8–73). Post-vaccination seroconversion rates were 26.8% for H1N1, 34.1% for H3N2 and 4.9% for influenza B in the basiliximab group and 35.7% for H1N1, 42.9% for H3N2 and 14.3% for influenza B in the ATG group (p = 0.44, p = 0.61, and p = 0.21, respectively). The number of influenza-specific IFN-γ-producing cells increased significantly after vaccination (from 35 to 67.5 SFC/10⁶ PBMC, p = 0.0007), but no differences between treatment groups were observed (p = 0.88). Median number of IgG-MBC did not increase after vaccination (H1N1, p = 0.94; H3N2 p = 0.34; B, p = 0.79), irrespective of the type of anti-T-cell therapy.ConclusionsAfter influenza vaccination, a significant increase in antibody and T-cell immune responses but not in MBC responses was observed in transplant recipients. Immune responses were not significantly different between groups that received basiliximab or ATG.     

SARS-CoV-2 anti-spike antibodies after a fourth dose of COVID-19 vaccine in adult solid-organ transplant recipients

BackgroundA fourth dose of SARS-CoV-2 vaccine is recommended in solid-organ transplant (SOT) recipients, but the immunogenicity is poorly known.MethodsWe conducted a retrospective, observational, monocentric study between the 1st January 2021 and 31st March 2022 of the anti-Spike antibody titers after one to four doses of vaccine in SOT.Results825 SOT were included. Median age at first vaccine injection was 61.2 (IQR 50.9–69.3) years; 66.7 % were male; 63.4 % had received four vaccine doses. The proportion of participants with a strong humoral response (>260 BAU/mL) increased with the number of vaccine doses: 10.6 % after the 1st dose (D1), 35.1 % after the 2nd (D2), 48.5 % after the 3rd (D3), and 65.1 % after the 4th (D4) (p < 0.001). Among the tested patients, the proportion with a detectable humoral response was significantly higher after D4 than after D3 (47 % vs 22 %, p = 0.01). Liver transplant recipients had more frequently a strong humoral response after D2, D3 and D4 (OR = 5.3, 3.7 and 6.6 respectively when compared with other organ transplant recipients, p < 0.001). In kidney transplant recipients, belatacept-containing regimen was associated with a lower rate of detectable humoral (9 % vs 40 %, p = 0.025) after D3, but there was no statistical difference after D4.ConclusionA fourth dose should be proposed to SOT recipients who did not developed an immune response after 3 doses. Kidney transplant recipients receiving belatacept have a poorer, although frequently detectable response.     

Prevalence of Cryptosporidium species and subtypes in paediatric oncology and non-oncology patients with diarrhoea in Jordan

Cryptosporidiosis is a protozoan parasitic disease which affects human and animals worldwide. In adult immunocompetent individuals, cryptosporidiosis usually results in acute and self-limited diarrhoea; however, it can cause life threatening diarrhoea in children and immunocompromised individuals. In the present study, we compared the prevalence of Cryptosporidium species and gp60 subtypes amongst paediatric oncology patients with diarrhoea (n = 160) from King Hussein Medical Centre for Cancer in Jordan, and non-oncology paediatric patients with diarrhoea (n = 137) from Al-Mafraq paediatric hospital. Microscopy results using modified acid fast staining identified a significantly (p ≤ 0.05) higher prevalence of Cryptosporidium in paediatric oncology patients with diarrhoea (14.4% - 23/160), compared to non-oncology paediatric patients with diarrhoea only (5.1% - 7/137). With the exception of one sample, all microscopy-positive samples (n = 29) and an additional 3/30 microscopy-negative controls were typed to species and subtype level at the 18S and gp60 loci, respectively. All Cryptosporidium positives were typed as C. parvum. Of the 22 typed Cryptosporidium positives from the paediatric oncology patients, 21 were subtyped as IIaA17G2R1 and one as IIaA16G2R1 C. parvum subtypes. The 7 typed positives from the paediatric patients from Al-Mafraq hospital were subtyped as IIaA17G2R1 (n = 5) and IIaA16G2R1 (n = 2). The 3 additional positives from the 30 microscopy negative control samples were subtyped as IIaA17G2R1. The high prevalence of the IIaA17G2R1 subtype, particularly amongst oncology patients, suggests that an outbreak of cryptosporidiosis may have been occurring in oncology patients during the collection period (April to December, 2016). New therapies for cryptosporidiosis in immunocompromised patients are urgently required.     

Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea

ObjectiveAlthough malnutrition is common in cancer patients in Korea, little attention is paid to its risks and consequences. This study was carried out to investigate the prevalence and risk factors of malnutrition in hospitalized cancer patients according to tumor location and stage.MethodsOf 14 972 cancer patients admitted to the National Cancer Center, screening examinations were carried out for 12 112 patients and nutritional status was assessed in 8895 patients. Information on age, sex, length of hospital stay, and tumor location and stage were collected from the electronic medical records system. The nutritional status of each subject was assessed using body mass index, serum albumin, total lymphocyte count, and diet and classified into three groups: high risk, moderate risk, and low risk of malnutrition.ResultsAbout 61% of hospitalized patients were malnourished and the prevalence of malnutrition was higher in male patients with longer hospital stays (60.2%, P = 0.0101) and readmitted patients (66.6%, P < 0.0001). Patients with liver and lung cancer (86.6% and 60.5%, respectively) and patients with advanced cancer stage (60.5%, III or IV) had a higher prevalence of malnutrition than other patients (P < 0.0001). Logistic regression analysis showed that patients with advanced cancer stage and longer hospital stay and readmitted patients were at a higher risk for malnutrition.ConclusionThe prevalence of malnutrition in hospitalized cancer patients was high and varied across tumor location and stage. Early identification of malnutrition status is required for proper nutritional intervention during hospitalization.     

Cost-Effectiveness Analysis of Screening for Persistent Hepatitis E Virus Infection in Solid Organ Transplant Patients in the United Kingdom: A Model-Based Economic Evaluation

BackgroundDespite potentially severe and fatal outcomes, recent studies of solid organ transplant (SOT) recipients in Europe suggest that hepatitis E virus (HEV) infection is underdiagnosed, with a prevalence of active infection of up to 4.4%.ObjectivesTo determine the cost-effectiveness of introducing routine screening for HEV infection in SOT recipients in the UK.MethodsA Markov cohort model was developed to evaluate the cost-utility of 4 HEV screening options over the lifetime of 1000 SOT recipients. The current baseline of nonsystematic testing was compared with annual screening of all patients by polymerase chain reaction (PCR; strategy A) or HEV-antigen (HEV-Ag) detection (strategy B) and selective screening of patients who have a raised alanine aminotransferase (ALT) value by PCR (strategy C) or HEV-Ag (strategy D). The primary outcome was the incremental cost per quality-adjusted life-year (QALY). We adopted the National Health Service (NHS) perspective and discounted future costs and benefits at 3.5%.ResultsAt a willingness-to-pay of £20 000/QALY gained, systematic screening of SOT patients by any method (strategy A-D) had a high probability (77.9%) of being cost-effective. Among screening strategies, strategy D is optimal and expected to be cost-saving to the NHS; if only PCR testing strategies are considered, then strategy C becomes cost-effective (£660/QALY). These findings were robust against a wide range of sensitivity and scenario analyses.ConclusionsOur model showed that routine screening for HEV in SOT patients is very likely to be cost-effective in the UK, particularly in patients presenting with an abnormal alanine aminotransferase.     

Chronic high-level multidrug-resistant Campylobacter coli enterocolitis in an agammaglobulinemia patient: Oral gentamicin efficacy

BackgroundCampylobacter is the most common cause of infectious diarrhea in agammaglobulinemia patients. These infections can be severe, prolonged, and recurrent in such patients.Patient and methodsWe report a 29-year-old male patient with X-linked agammaglobulinemia with Campylobacter coli enterocolitis that persisted for nine months despite multiple 10- to 14-day courses of oral ciprofloxacin and azithromycin.ResultsThe isolate was highly resistant to ciprofloxacin, erythromycin, tetracycline, and fosfomycin. The patient failed to respond to intravenous ertapenem, 1.0 g/day for two weeks, to which the pathogen was susceptible. He was finally cured with oral gentamicin, 80 mg four times daily, and stool cultures remained negative during the seven-month follow-up.ConclusionOral aminoglycoside might be the most appropriate choice for eradication of persistent Campylobacter in the intestinal tract for macrolide- and fluoroquinolone-resistant isolate in agammaglobulinemia patients with chronic diarrhea or relapsing systemic infections.     

Factors associated with treatment failure after advice from infectious disease specialists

ObjectiveRisk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.MethodsWe included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.ResultsA total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR = 0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR = 1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR = 8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR = 12.50, 95%CI [3.16–49.46]).ConclusionReassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.     

Risk factors associated with hospitalisation for influenza-associated severe acute respiratory illness in South Africa: A case-population study

BackgroundInfluenza is a common cause of severe respiratory illness, but risk factors for hospitalisation in low income settings with a high HIV prevalence are not well described. We aimed to assess risk factors associated with influenza-associated severe acute respiratory illness (SARI) hospitalisation in South Africa.MethodsWe conducted a case-population study using data on risk conditions in patients hospitalised with SARI and the national prevalence of these conditions. Data on hospitalised cases were from the national SARI surveillance program while data on the referent population were from the latest national census or health and demographic surveillance surveys.FindingsFrom 2009 to 2012, we identified 3646 (7.9%) of 46,031 enrolled cases of SARI that were associated with influenza infection. Risk factors associated with hospitalisation included previous history of smoking [case-population ratio (CPR) 3.82, 95% confidence interval (CI) 3.5–4.16], HIV infection (CPR 3.61, 95% CI 3.5–3.71), asthma (CPR 2.45, 95% CI 2.19–2.73), previous history of hospital admission in the past 12 months (CPR 2.07, 95% CI 1.92–2.23), and tuberculosis (CPR 1.85, 95% CI 1.68–2.02). When stratified by age, there is increased risk of hospitalisation in those ⩽5 years of age (CPR 3.07, 95% CI 2.93–3.21) and among those 35 years of age and above (CPR 1.23, 95% CI 1.28–1.18). Male sex (CPR 0.85, 95% CI 0.82–0.88) and completion of pneumococcal conjugate vaccination schedule in children <5 years of age (CPR 0.74, 95% CI 0.71–0.77) were associated with decreased risk of hospitalisation.ConclusionThese results identify groups at high-risk for severe influenza who should be considered potential targets for influenza vaccination in South Africa and similar settings.     

Safety and immunogenicity of inactivated varicella-zoster virus vaccine in adults with hematologic malignancies receiving treatment with anti-CD20 monoclonal antibodies

BackgroundImmunocompromised patients can experience significant morbidity and occasional mortality from complications associated with herpes zoster (HZ), but live attenuated HZ vaccine is contraindicated for these patients. Inactivated zoster vaccine (ZV_IN) is in development for prevention of HZ in immunocompromised patients. However, there are limited data in the literature regarding the effect of anti-CD20 monoclonal antibodies on vaccine-related cell-mediated immune response. This study evaluated safety and immunogenicity of ZV_IN in patients with hematologic malignancies (HM) receiving anti-CD20 monoclonal antibodies (alone or in combination chemotherapy regimens) and not likely to undergo hematopoietic cell transplant (HCT) (n = 80).MethodsThis was an open-label, single-arm, multicenter Phase I study (NCT01460719) of a 4-dose ZV_IN regimen (∼30 days between doses) in patients ⩾18 years old. Blood samples were collected prior to dose 1 and 28 days Postdose 4 to measure varicella zoster virus (VZV)-specific T-cell responses using interferon-γ enzyme-linked immunospot (IFN-γ ELISPOT). The primary hypothesis was that ZV_IN would elicit significant VZV-specific immune responses at ∼28 days Postdose 4, with a geometric fold rise (GMFR) >1.0. All vaccinated patients were evaluated for adverse events (AE) through 28 days Postdose 4.ResultsZV_IN elicited a statistically significant VZV-specific immune response measured by IFN-γ ELISPOT at 28 days Postdose 4 (GMFR = 4.34 [90% CI:3.01, 6.24], p-value < 0.001), meeting the pre-specified success criterion.Overall, 85% (68/80) of patients reported ⩾1 AE, 44% (35/80) reported ⩾1 injection-site AE, and 74% (59/80) reported ⩾1 systemic AE. The majority of systemic AEs were non-serious and considered unrelated to vaccination by the investigator. Frequencies of AEs did not increase with subsequent doses of vaccine. No recipient of ZV_IN had rash polymerase chain reaction (PCR) positive for VZV vaccine strain.ConclusionsIn adults with HM receiving anti-CD20 monoclonal antibodies, ZV_IN was well-tolerated and elicited statistically significant VZV-specific T-cell responses ∼28 days Postdose 4.CLINICALTRIALS.GOV identifier: NCT01460719.     

Smoking dependence in 18 European countries: Hard to maintain the hardening hypothesis

ObjectiveWhen the prevalence of smoking decreases in a population, there is a hypothesis—the so-called “hardening hypothesis”—that the remaining smokers form a subgroup of “hardcore smokers.” Our aims were to test the hardening hypothesis and to analyze the determinants of high dependence taking into account both individual and country-level characteristics.MethodWithin the Pricing Policies and Control of Tobacco in Europe (PPACTE) project, we conducted a face-to-face survey on smoking between January and July 2010 in 18 European countries, including 2882 male and 2254 female smokers with complete information on smoking dependence. The Heaviness of Smoking Index (HSI) was used as a measure of tobacco dependence. We correlated smoking prevalence and dependence using the country as unit of analysis. Moreover, we fitted multilevel logistic regression models.ResultsCountry-specific prevalence of smoking was positively, although not significantly, correlated with the proportion of highly tobacco-dependent smokers (overall r_sp = 0.203, p = 0.419), both in men (r_sp = 0.235, p = 0.347) and women (r_sp = 0.455, p = 0.058). Using individual-level analysis, high dependence was positively related to age, and, although not significantly, to smoking prevalence, and inversely related to level of education. The lack of a smoking ban at home was positively related to smoking dependence.ConclusionsUsing both ecological and individual-level analyses, the relations between smoking prevalence and HSI were not significant, but in the opposite direction as compared to that assumed by the “hardening hypothesis.” Therefore, our data provide empirical evidence against this theory, thus supporting the feasibility of an endgame strategy.     

Immunosuppressive drugs impairs antibody response of the polysaccharide and conjugated pneumococcal vaccines in patients with Crohn's disease

BackgroundPatients with Crohn's disease (CD) have a higher risk of infectious diseases including pneumococcal infections, and the risk increases with immunotherapy. The primary endpoint of this study was to investigate the specific antibody response to two pneumococcal vaccines in CD patients with and without immunosuppressive treatment four weeks post vaccination.MethodsIn a randomized trial of the 23-valent pneumococcal polysaccharide vaccine (PPV23) and the 13-valent pneumococcal conjugated vaccine (PCV13), a group of CD patients treated with immunosuppressive drugs (IS) alone or in combination with TNF-α antagonists were compared to a group of CD patients not treated with any of these drugs (untreated). Specific pneumococcal antibody concentrations were measured against 12 serotypes common to the two vaccines before and 4 week after vaccination.ResultsPCV13 induced a significantly higher antibody response for one serotype (23F) in IS treated patients and for two serotypes (9V and 23F) in untreated patients compared to CD patients vaccinated with PPV23. Untreated PPV23 recipients had higher responses for serotypes 9V and 18C compared to IS + TNF-α treated PPV23 recipients. Comparison between treatment groups showed that immunosuppressive treatment impaired the antibody response to both vaccines and that TNF-a treatment further conveyed additional impairment of the response.ConclusionPCV13 induces higher antibody response for some serotypes compared to PPV23. In addition, CD patients treated with immunosuppressive drugs alone or in combination with TNF-α antagonists had an impaired antibody response to both PPV23 and PCV13 compared to patients not receiving any of these treatments.The study has been registered in the European Clinical Trials Database (EudraCT, record no 2012-002867-86) and ClinicalTrials.gov (record no. NCT01947010).     

Zinc and copper supplementation are not cost-effective interventions in the treatment of acute diarrhea

BackgroundDiarrhea is one of the principal causes of morbidity and mortality among children in the developing world. Cumulative costs of treating diarrhea would be high and would further increase if zinc was used as an adjunct to treatment of acute diarrhea.ObjectiveTo determine the impact of zinc supplementation on the mean predicted costs of treating acute diarrhea and the incremental cost-effectiveness (CE) as compared with placebo, from the provider's (government) and patient's perspective.Study Design and SettingIn a randomized, double-blind, placebo-controlled clinical trial, 808 children aged 6–59 months with acute diarrhea were individually randomized to placebo (Pl), zinc (Zn) only, and zinc and copper (Zn + Cu) together with standard treatment of acute diarrhea. The actual resource utilization and cost data were collected for all participants. The incremental CE ratio and its 95% confidence interval (95% CI) were assessed.ResultsThe relative CE for treating acute diarrhea was 1.5 (95% CI: 1.50, 1.52) times more when supplemented with zinc and 1.7 (95% CI: 1.69, 1.71) times more when supplemented with Zn + Cu with no additional beneficial effect.ConclusionThis study showed that zinc or zinc with copper supplementation were not cost-effective in the treatment of acute diarrhea in this study population.     

Prévalence de l’hypertension artérielle en population générale à la Martinique

BackgroundSince 1996, arterial hypertension has been recognized as one of the main health priorities in Martinique. However, its prevalence in the general population has never been measured. Furthermore, obesity is increasing in many countries and studies have shown that hypertension is more frequent in obese people than in people with normal body mass index. The objective of this survey is to measure hypertension prevalence in the general population and to study the link between hypertension, weight status and socioeconomic level.MethodsCross-sectional study of randomly selected homes in randomly selected geographical islets. All household members in these homes constituted the eligible population. Arterial hypertension was defined as systolic pressure greater than 140 mmHg and/or diastolic pressure greater than 90 mmHg and/or antihypertensive treatment. Weight status was estimated using the body mass index.ResultsStudy concerned 1504 persons aged 16 years or older with a sex-ratio of 0.7 and an average age of 48.3 years for men and 48.5 years for women, p = 0.88. The prevalence rate of hypertension is 29% [IC_95%: 25.9–31.8] in the sample and declines to 22.5% [IC_95%: 20.1–25.1] using weighted data. The prevalence rate is 33.1% [IC_95%: 30.2–36.6] for overweight and 20.1% [IC_95%: 17.8–22.6] for obesity. Being overweight is more frequent among persons with hypertension than among ones with normal blood pressure, 73.0 versus 47.4%; p < 0.001. In those with hypertension, overweight does not differ significantly between men and women, but the prevalence of obesity is greater among women than among men (35.7 versus 20.6 %, p < 0.05).ConclusionThe high prevalence of both hypertension and obesity in the general Martinican population has been confirmed by this study. Prevention actions are required to decrease the cardiovascular risk in this population.     

Role of cryptosporidia and microsporidia in diarrhea in immunocompromised patients

Cryptosporidium and Microsporidian play an important part in the diarrhoeic pathology of the immunocompromised patients. The study of 35 cases of cryptosporidiosis and 4 cases of intestinal microsporidiosis diagnosed in the parasitology laboratory of Rabta hospital of Tunis shows that cryptosporidiosis prevalence is 17.24% for AIDS patients, 3.45% for immunocompromised patients VIH (-), and microsporidiosis prevalence is 5.7% for patients with acquired immunodeficiency syndrome. Common points for these two parasitosis are: Clinical syndromes dominated by an acute diarrhea A diagnosis based on specific techniques showing the significance of the clinical orientation. Lack of an effective specific therapy.     

Obesity and its associations with hypertension and type 2 diabetes among Chinese adults age 40 years and over

AimTo investigate the prevalence of obesity in a Chinese community according to the World Health Organization recommended criteria for Asians in 2000 based on body mass index (BMI) and waist circumference (WC), and to examine the associations between obesity and the risk of hypertension and type 2 diabetes among adults age 40 years and over in Shanghai, China.MethodsA population-based survey was conducted in Youyi Community in Shanghai. Five thousand seventy-one subjects (1917 men and 3154 women) were included in this study. Standard questionnaires were used to collect baseline data of participants. Body weight, height, WC, blood pressure, and glucose in the blood were measured.ResultsThe prevalence of general obesity was 44.6% (46.4% for men and 43.6% for women) according to BMI and 36.1% (25.5% for men and 42.6% for women) for central obesity according to WC. The prevalence of obesity I was higher in men (41.6%) than in women (36.2%; χ² = 14.8, P < 0.05), although the rate was higher in women than in men for obesity II (7.4% versus 4.8%, χ² = 13.6, P < 0.01) or central obesity (42.6% versus 25.5%, χ² = 152.1, P < 0.01). Odds ratios of hypertension and type 2 diabetes were significantly higher in the obesity group compared with either the group with BMI 18.5–<23.0 kg/m² or the group with WC < 90 cm for men or <80 cm for women.ConclusionsAccording to the criteria of obesity for Asians, the prevalence of obesity among Chinese adults age 40 years and over in Shanghai is high. Subjects with obesity have a significantly higher risk of hypertension and type 2 diabetes.