Ribotype 027 Clostridium difficile infections with measurable stool toxin have increased lactoferrin and are associated with a higher mortality

We evaluated clinical and diagnostic indicators of severe C. difficile infection (CDI) and their association with poor clinical outcome. A total of 210 patients positive according to PCR (toxin B: tcdB) were included, with patients having a median age of 62 years and a Charlson co-morbidity index (CI) score of 5. Ninety-one percent (n?=?191) were positive by toxigenic culture and 61 % (n?=?129) had stool toxin. Toxin-positive patients had significantly higher fecal lactoferrin (mean 316 μg/g versus 106 μg/g stool; p?<?0.0001). Forty percent of patients (n?=?85) were infected with ribotype 027 and significantly more of these patients had measurable stool toxin (79 % vs. 50 %; p?<?0.0001). The mean fecal lactoferrin was significantly higher for toxin-positive 027 CDI compared with the 027 toxin-negative group (317 vs 60 μg/g; p?=?0.0014). Ribotype 027 CDI with stool toxin showed a higher all-cause, 100-day mortality compared with non-027 with stool toxin (36 % vs 18 %; p?=?0.017). Logistic regression univariate analysis for odds ratio (OR) and p values revealed that age (OR?=?1.1), intensive care unit treatment (OR?=?2.7), CI (OR?=?1.2), 027 CDI (OR?=?2.1), white blood cell count (OR?=?1.0), albumin level (OR?=?0.1), and stool toxin-positive 027 CDI (OR?=?2.5) were significantly associated with 100-day mortality (p?<?0.05). In conclusion, CDI PCR-positive patients with 027 infection and stool toxin have increased lactoferrin and are at an increased risk of death.     

The relevance of Tim-3 polymorphisms and F protein to the outcomes of HCV infection

Hepatitis C virus (HCV) is one of the major causes of liver inflammation. The aim of this study was to investigate the associations of T-cell immunoglobulin and mucin domain-3 (Tim-3) polymorphisms and the alternate reading frame protein (F protein) with the outcomes of HCV infection. Three single-nucleotide polymorphisms (SNPs; rs10053538, rs12186731, and rs13170556) of Tim-3 were genotyped in this study, which included 203 healthy controls, 558 hepatitis C anti-F-positive patients, and 163 hepatitis C anti-F-negative patients. The results revealed that the rs12186731 CT and rs13170556 TC and CC genotypes were significantly less frequent in the anti-F-positive patients [odds ratio (OR)?=?0.54, 95 % confidence interval (CI)?=?0.35–0.83, p?=?0.005; OR?=?0.26, 95 % CI?=?0.18–0.39, p?<?0.001; and OR?=?0.19, 95 % CI?=?0.10–0.35, p?<?0.001, respectively), and the rs13170556 TC genotype was more frequent in the chronic HCV (CHC) patients (OR?=?1.70, 95 % CI?=?1.20–2.40, p?=?0.002). The combined analysis of the rs12186731 CT and rs13170556 TC/CC genotypes revealed a locus-dosage protective effect in the anti-F-positive patients (OR?=?0.22, 95 % CI?=?0.14–0.33, p _trend?<?0.001). Stratified analyses revealed that the frequencies of the rs12186731 (CT?+?TT) genotypes were significantly lower in the older (OR?=?0.31, 95 % CI?=?0.15–0.65, p?=?0.002) and female (OR?=?0.30, 95 % CI?=?0.17–0.52, p?<?0.001) subgroups, and rs13170556 (TC?+?CC) genotypes exhibited the same effect in all subgroups (all p?<?0.001) in the anti-F antibody generations. Moreover, the rs13170556 (TC?+?CC) genotypes were significantly more frequent in the younger (OR?=?1.86, 95 % CI?=?1.18–2.94, p?=?0.007) and female (OR?=?2.38, 95 % CI?=?1.48–3.83, p?<?0.001) subgroups of CHC patients. These findings suggest that the rs12186731 CT and rs13170556 TC/CC genotypes of Tim-3 provide potential protective effects with the F protein in the outcomes of HCV infection and that these effects are related to sex and age.     

Association of Psychiatric History and Type D Personality with Symptoms of Anxiety, Depression, and Health Status Prior to ICD Implantation

Background

Personality factors and psychiatric history may help explain individual differences in risk of psychological morbidity and poor health outcomes in patients with an implantable cardioverter defibrillator (ICD).

Purpose

We examined associations between previous anxiety and depressive disorder, type D personality, anxiety or depressive symptoms, and health status in ICD patients prior to ICD implantation.

Method

Patients (N?=?278; 83 % men; mean age?=?62.2 years ±11) receiving a first ICD from September 2007 through April 2010 at the Medisch Spectrum Twente, The Netherlands completed validated questionnaires before implantation assessing type D personality (14-item Type D Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), and health status (36-item Short Form Health Survey). History of anxiety or depressive disorder was assessed with the Mini International Neuropsychiatric Interview structural interview.

Results

Previous anxiety or depressive disorder was prevalent in 8 and 19 % of patients, respectively. Type D personality was present in 21 %, depressive symptoms in 15 %, and anxiety in 24 %. In adjusted analyses, type D personality was a dominant correlate of previous depressive disorder (odds ratio (OR) 6.2, p?<?0.001) and previous anxiety disorder (OR 3.9, p?=?0.004). Type D personality (OR 4.0, p?<?0.001), age (OR 1.03, p?=?0.043), and gender (OR 2.5, p?=?0.013) were associated with anxiety symptoms at baseline. Type D personality (OR 5.9. p?<?0.001) was also associated with increased depressive symptoms at baseline. Heart failure and type D personality were related to poorer health status.

Conclusion

In ICD patients, prior to ICD implantation, a previous anxiety or depressive disorder, type D personality, and anxiety and depressive symptoms were associated with poorer health status. Type D personality was also independently associated with increased anxiety and depression symptoms.     

Antioxidant concentrations in serum, follicular fluid, and corpus luteum of cyclic buffalo cows

The present study was undertaken to evaluate antioxidant’s vitamins concentrations in serum, follicular fluid and corpus luteum of cyclic buffalo cows. A total of 34 clinically healthy buffalo cows (Bubalus bubalis), aged 8–10 years, were subjected to study. All animals were examined before slaughtering and the findings on the ovaries and the uterus were recorded. Blood samples and the whole genital tract of each animal were collected just after slaughtering. Antioxidants were measured in serum, CL and follicular fluid at different stage of the estrus cycle (proestrus n?=?8, estrus n?=?7, metestrus n?=?7, and diestrus n?=?12). The results revealed significant increases in serum α-tocopherol concentration during metestrus and diestrus stages (p?<?0.05). On the other hand, there was a significant decrease (p?<?0.05) in follicular ascorbic acid concentration at diestrus phase. Follicular β-carotene (p?<?0.01) showed a significant increase at the metestrus than at estrus and diestrus phases of the cycle. Follicular Vitamin A significantly increased (p?<?0.01) at proestrus phase. Although during metestrus there was significant decrease in the corpus hemorrhagicum weight (p?<?0.01), ascorbic acid concentration was significantly increased (p?<?0.05). In conclusion, the results of the present study suggested that serum α-tocopherol concentration increased during metestrus and diestrus stages, follicular vitamin A increased in proestrus phases when regeneration and steroideogenesis are required. Ascorbic acid increased in diestrus phase to help corpus luteum to function properly.     

The signification of antiphospholipid antibodies in pregnancy-associated pathologies and venous thromboembolism

Women with antiphospholipid antibodies are at high risk of pregnancy complications. Three hundred and two women with pregnancy complications matched with 100 women having a past history of uncomplicated pregnancy outcome were screened for the presence of antiphospholipid antibodies such as lupus anticoagulant and immunoglobulin G (IgG)/M antibodies for cardiolipin. Among the overall positivity for any one of the antiphospholipid antibodies studied, significant associations were found with recurrent pregnancy loss (OR 16.87; 95% CI, 5.5–51.63, p?<?10^?3), intrauterine growth retardation (OR 3.9; 95% CI, 1.08–14.05, p?=?0.04) and preeclampsia (OR 4.54; 95% CI, 1.25–16.42, p?=?0.035). IgG was considered a risk factor for recurrent pregnancy loss (OR 15.31; 95% CI, 3.37–69.7, p?<?10^?3) and intrauterine growth retardation (OR 6.7; 95% CI, 1.3–34.4, p?=?0.017). The lupus anticoagulant was associated only with recurrent pregnancy loss (OR 12.4; 95% CI, 1.48–103.1, p?=?0.006).     

The predictor of mortality outcome in adult patients with Ebola virus disease during the 2014–2015 outbreak in Guinea

The purpose of this study was to examine the association of any demographic and clinical factors with mortality outcome among adult patients with Ebola virus disease (EVD) in Guinea. This retrospective observational study analyzed medical records of laboratory confirmed EVD adult patients during the 2014–2015 EVD outbreak in Guinea. The associations between any demographic or clinical variables and mortality outcome of EVD were assessed using univariate and multivariate logistic regression analyses. Of 2,310 EVD adult patients included for analysis, the overall case fatality rate was 68.1%. Univariate analyses identified factors possibly associated with mortality outcome, including patient age (p?<?0.001), history of visiting or close contact with a suspected or confirmed EVD patient (p?=?0.035), and seven clinical symptoms on admission, i.e., fever (p?=?0.003), hiccups (p?<?0.001), vomiting (p?=?0.003), diarrhea (p?<?0.001), cough (p?=?0.001), sore throat (p?=?0.016), and unexplained bleeding (p?=?0.021). The multivariate analysis showed that patient age was independently associated with mortality outcome of EVD (OR?=?1.06; 95%CI?=?1.03–1.09; p?<?0.001), while none the of clinical symptoms on admission were significantly associated with the mortality outcome. Our analysis indicates that older age was the only independent factor associated with death among EVD adult patients in Guinea. This suggests that older EVD patients should receive intensive medical care and be carefully monitored.     

Early menarche and premature natural menopause in Indonesia

Background: An association has been suggested between early menarche and premature natural menopause. However, existing studies in developed countries show mixed findings.

Aim: This study examined whether early menarche (first menstrual period ≤11 years old) is a factor for premature natural menopause (final menstrual period <40 years old) in the context of a developing country.

Subjects and methods: Data came from the Indonesia Family Life Survey (IFLS) 2014, which consists of 1608 post-menopausal women.

Results: Results of hierarchical logistic regression show that women who experienced early menarche (first menstrual period ≤11 years old) were found to be at higher risk of premature natural menopause (β?=?0.94, p?<?0.01, CI?=?0.24–1.63). The results are robust against potential confounding factors including individual reproductive history, lifestyle and sociodemographic characteristics, as well as unobserved factors at the household and community levels.

Conclusion: The findings support early monitoring of women with early menarche, especially those who have no children, for preventive health interventions aimed at mitigating the risk of adverse health outcomes associated with premature natural menopause.     

Associations between interleukin-23R and interleukin-12B polymorphisms and psoriasis susceptibility: a meta-analysis

Objective: The aim of this study was to determine whether interleukin (IL)-23?R and IL-12B polymorphisms confer susceptibility to psoriasis.

Methods: The authors conducted a meta-analysis on associations between the IL-23?R and IL-12B polymorphisms and psoriasis susceptibility.

Results: A total of 14 comparison studies were included in this meta-analysis. The meta-analysis identified a significant association between psoriasis and 2 alleles of the rs11209026 and rs7530511 polymorphisms in Europeans (odds ratio [OR]?=?0.624, 95% confidence interval [CI]?=?0.565–0.697, p?<?1.0?×?10^?8; OR?=?0.804, 95% CI?=?0.743–0.869, p?=?3.0?×?10^?7, respectively). Meta-analysis of IL-12B showed a significant association between the 2 alleles of the rs6887695 and rs3212227 polymorphisms and the risk of developing psoriasis (OR?=?0.710, 95% CI?=?0.673–0.749, p?<?1.0?×?10^?8; OR?=?0.684, 95% CI?=?0.639–0.731, p?<?1.0?×?10^?8, respectively). Stratification by ethnicity identified an association between the rs6887695 and rs3212227 polymorphisms and psoriasis in Europeans.

Conclusions: This meta-analysis showed that the IL-23?R (rs11209026 and rs7530511) polymorphisms are associated with psoriasis risk in Europeans and that the IL-12B (rs6887695 and rs3212227) polymorphisms are associated with susceptibility to psoriasis in Europeans.     

Risk factor analysis for bone marrow histiocytic hyperplasia with hemophagocytosis: an autopsy study

The excessive release of inflammatory cytokines occasionally induces life-threatening hemophagocytosis referred to as hemophagocytic syndrome (HPS). A similar condition, histiocytic hyperplasia with hemophagocytosis (HHH), is often seen in bone marrow collected during autopsy. Unlike HPS, the pathogenesis of HHH remains unclear. Therefore, we performed a clinicopathological analysis of HHH from 70 autopsy cases at the University of Fukui Hospital. HHH was detected in 29 of 70 autopsies (41.4 %) and was significantly complicated with hematological diseases (p?<?0.05) and sepsis (p?<?0.05). The percentage of macrophages in bone marrow (BM) nucleated cells was significantly increased in HHH (p?<?0.001). Data from medical records indicated no significant changes, except for the minimum values of white blood cell counts (p?<?0.05) and platelet counts (p?<?0.05) in HHH patients as compared with non-HHH patients. Concentrations of inflammatory mediators including IL-1β, IL-6, and IL-8 were significantly increased in HHH patients. Multivariate risk factor analysis identified hematological diseases (odds ratio (OR), 11.71), ≥15 % BM macrophages (OR, 9.42), sepsis (OR, 7.77), and high serum IL-6 levels (OR, 1.00) as independent risk factors for HHH. HHH with hypocellular BM, the most aggressive form of HHH, was recognized in 8 of 29 HHH patients and was associated with ≥25 % BM macrophages (p?<?0.001), leukocytopenia (p?<?0.05), and high IL-8 levels (p?<?0.05). None of the HHH patients fulfilled the diagnostic criteria of HPS. These findings suggest that HHH is a different entity from HPS and that it preferentially develops under conditions of excessive inflammation and its associated risks, such as hematological diseases and sepsis.     

Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case–control study

Differences between the features of invasive community-onset methicillin-resistant Staphylococcus aureus (cMRSA) and methicillin-susceptible S. aureus (cMSSA) infections are incompletely understood. Fifty-seven patients with invasive cMRSA infection were prospectively identified at two teaching hospitals; for each cMRSA case, two cases of invasive cMSSA infection acted as controls. The primary outcome was 30-day all-cause mortality. Patients with invasive cMRSA infection were more likely to be Aboriginal (25% vs. 14%, age-adjusted odds ratio [OR] 2.5, p?=?0.037), reside in a long-term care facility and/or have been hospitalised in the previous year (51% vs. 34%, p?=?0.04) and less likely to have endocarditis (2% vs. 12%, p?=?0.02) or require admission to an intensive care unit or high-dependency area (7% vs. 21%, p?=?0.02). All-cause mortality at 30 days was similar in the cMRSA and cMSSA groups (9% vs. 7%, p?=?0.68). Panton–Valentine leukocidin (PVL) genes were detected in a similar proportion of cMRSA and cMSSA isolates (32% vs. 27%, p?=?0.49) and the presence of PVL genes was associated with younger age (35 years vs. 55 years, p?<?0.001), Aboriginal ethnicity (38% vs. 10%, p?<?0.001), skin and soft-tissue infection (54% vs. 19%, p?<?0.001), lower illness severity at presentation (SAPS II score 9 vs. 21, p?=?0.001) and shorter hospitalisation (9 days vs. 24 days, p?<?0.001). Patients with “PVL-positive” and “PVL-negative” S. aureus infection had similar 30-day all-cause mortality (4% vs. 9%, p?=?0.28). Few clinical features differentiated patients with invasive cMRSA infection from those with infection caused by cMSSA. Invasive “PVL-positive” S. aureus infection was associated with less morbidity but similar mortality to “PVL-negative” infection.     

Gasterophilosis in horses in Sardinia (Italy): effect of meteorological variables on adult egg-laying activity and presence of larvae in the digestive tract,and update of species

Gasterophilus larvae are common obligate parasites of the digestive tract of the equids. Horses become infected with this parasite by ingesting the larvae hatched from eggs laid by the female flies. In this study carried out monthly, we (i) counted the Gasterophilus eggs deposited by female flies on the coat of 30 grazing horses, (ii) counted and identified the Gasterophilus larvae retrieved from the digestive tract of 128 slaughtered horses, and (iii) compared these results to meteorological data. Eggs were deposited on all monitored horses, and were present from October to January and from May to September, whereas they were absent from February to April. The number of laid eggs was significantly different between the months, body regions, genders, and age classes (p?<?0.05). Larvae were recovered in 112 (87.5 %) horses, and 6 species of Gasterophilus were identified. The prevailing species were Gasterophilus intestinalis (recovered in 110 horses; 85.9 %) and Gasterophilus nasalis (69 horses; 53.9 %), recovered in all months. Gasterophilus inermis (5 horses; 3.9 %), Gasterophilus pecorum (3 horses; 2.3 %), Gasterophilus haemorrhoidalis (3 horses; 2.3 %)¸ and Gasterophilus meridionalis (2 horses; 1.6 %) larvae were also found. Significant differences were found among monthly larval burdens for both Gasterophilus spp. and G. intestinalis (p?<?0.05), but not for G. nasalis (p?>?0.05). Larval burdens and prevalences did not differed significantly between both genders and age classes (p?>?0.05). Monthly eggs and larvae trends were not significantly correlated (p?>?0.05). With regard to the meteorological variables, minimum air temperature was significantly correlated with the eggs trend (rho?=?1.000; p?<?0.001) and maximum air temperature with the Gasterophilus spp. (rho?=?0.972; p?<?0.001) and G. intestinalis (rho?=?0.972; p?<?0.001) larvae trends. In addition, the number of hours with a temperature below +10 °C was significantly correlated with G. intestinalis larvae trend (rho?=?0.602; p?<?0.05). Our findings confirmed that in Sardinia, Gasterophilosis is an important parasitosis in the horses, and it needs more attention and extensive and/or correct treatment to reduce its prevalence.     

Two-tier regenerative response in liver failure in humans

Acute and chronic liver failure is associated with high mortality. The enormous regenerative potential of the liver has generated a lot of attention. We undertook this work to assess the two-tier regenerative response in liver failure by immunohistochemistry and to correlate such response with liver histology in acute liver failure (ALF), acute-on-chronic liver failure (ACLF), and decompensated cirrhosis (CHD). Histological examination and immunohistochemical analysis of proliferating hepatocytes and activated hepatic progenitor cells (HPCs) were performed on the liver tissue of patients with ALF (25), ACLF (70), and CHD (70). Comparative analysis of regenerative markers and correlation with histological parameters were done in ALF, ACLF, and CHD. Hepatocytes proliferated significantly more in ALF in comparison to ACLF (p?<?0.001) and CHD (p?<?0.001). HPC proliferation was significantly higher in ACLF (p?<?0.001) and CHD (p?<?0.001) than in ALF. ACLF patients showed the highest HPC proliferation and differentiation. Significantly more intermediate hepatocytes were found in ACLF than in ALF and CHD (p?<?0.001). Marked parenchymal replacement by fibrosis and/or necrosis correlated significantly with activation of HPC in ACLF (p?=?0.01, odds ratio (OR) 4.95) and in CHD (p?=?0.05, OR 4.19). The study of liver regeneration in human acute and chronic liver failure suggests that hepatocyte proliferation, providing the first line of regeneration response, is most active in ALF whereas HPC activation, the second line of defense, is more prominent in ACLF. More HPC differentiate to hepatocytes in ACLF than in CHD, reflecting better regenerative potential in ACLF.     

CD38 Gene polymorphisms and susceptibility to B cell chronic lymphocytic leukemia

CD38 was suggested to be not only a prognostic marker but also a key element in the pathogenetic network underlying chronic lymphocytic leukemia (CLL). We aimed at determining whether polymorphisms of CD38 gene influence the risk of B-CLL and thus analyzed two potentially functional CD38 single nucleotide polymorphisms (SNPs), rs6449182 (184 C>G), and rs1800561 (418 C>T) using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)-based assays in a study including 70 B-CLL patients and 70 age- and gender-matched controls. Our results demonstrated that the homozygous mutant genotypes of the two studied SNPs (GG and TT) showed a significantly higher risk of B-CLL compared with the homozygous wild types (p value?<?0.001, OR?=?2.813, 95% CI?=?1.898–4.168 and p value?=?0.011, OR?=?2.250, 95%CI?=?1.707–2.96, respectively). In addition, G and T carriers had more advanced clinical stage (p value?<?0.001). Also, a significant association was demonstrated between higher proportions of CD38-positive cells and carriers of G and T alleles (p value?<?0.001). Our data suggest that the risk of B-CLL carcinogenesis may be influenced by CD38 SNPs [rs6449182 (184 C>G) and rs1800561 (418 C>T)].     

Molecular epidemiology of Theileria equi in horses and their association with possible tick vectors in the state of Rio de Janeiro, Brazil

The aim of this study was to detect Theileria equi (Laveran 1901) DNA in horses and ticks using real-time PCR and to list the factors associated with infection in animals located in the Seropedica and Petropolis municipalities of the state of Rio de Janeiro. We tested blood samples from 314 horses and samples from 300 ticks, including 191 Amblyomma cajennense, 104 Dermacentor nitens, and 5 Ixodida larvae. Factors inherent to the horse, the ownership, and animal management were obtained from an epidemiological questionnaire and were evaluated in association with the presence of T. equi DNA in the animals. Among the horses in the study, 81 % (n?=?253/314) presented T. equi DNA, and the animals of the Seropedica municipality had the highest infection frequency (91 %, n?=?128/141, p?<?0.001). The factors that had significantly different infection frequencies by chi-squared or Fisher’s exact tests (p?<?0.2) were included in a logistic regression model using the R programming package. Work and walking activity (odds ratio [OR]?=?5.7, CI?=?2.3–14.4), reproductive activity (OR?=?3.8, CI?=?1.3–11.5), and tick infestation (OR?=?2.6, CI?=?1.1–6.2) were factors that favored the presence of T. equi DNA in the animals (p?<?0.05). Among the tick samples, A. cajennense and D. nitens were the identified species. The presence of T. equi DNA was observed in 9.9 % (n?=?19/191) of the A. cajennense samples and 3.8 % (n?=?4/104) of the D. nitens samples. A multivariate analysis revealed that the presence of A. cajennense on the animals (OR?=?4.1, CI?=?1.8–9.1) was associated with the presence of T. equi DNA in the horses. In the studied municipalities, activities related to work, walking, and reproduction and the presence of ticks on the horses, particularly an intense infestation of A. cajennense, are factors that lead to infection with T. equi in the horses.     

Meta-Analysis of Associations Between Interleukin-10 Polymorphisms and Susceptibility to Vasculitis

Objective: This study determined whether interleukin-10 (IL-10) polymorphisms are associated with susceptibility to vasculitis.

Methods: A meta-analysis was conducted of the associations between the IL-10 -1082 G/A, -819 C/T, and -592 C/A polymorphisms and the haplotype of the IL-10-1082 G/A, -819 C/T, -592 C/A polymorphisms and vasculitis.

Results: A total of 21 comparative studies involving 4121 patients and 5504 controls were considered in the meta-analysis. Meta-analysis revealed no association between the IL-10-1082 G allele and vasculitis in all study subjects (OR?=?0.927, 95% CI?=?0.780–1.102, p?=?0.389). However, disease-specific meta-analysis showed an association between Wegener’s granulomatosis (WG) and the IL-10-1082 G allele (OR?=?0.729, 95% CI?=?0.547–0.971, p?=?0.031). Meta-analysis revealed an association between vasculitis and the IL-10-819 C allele (OR?=?0.804, 95% CI?=?0.706–0.916, p?=?0.001) in all study subjects and Behcet’s disease (BD) (OR?=?0.724, 95% CI?=?0.679–0.781, p?<?1.0?×?10^?9). Meta-analysis of the IL-10-592 C allele showed an association with vasculitis in all study subjects (OR?=?0.805, 95% CI?=?0.619–0.938, p?=?0.005) and BD (OR?=?0.718, 95% CI?=?0.661–0.781, p?<?1.0?×?10^?9). Meta-analysis of the IL-10 haplotype revealed an association between the GCC haplotype and vasculitis in Europeans (OR?=?1.239, 95% CI?=?1.105–1.513, p?=?0.035).

Conclusions: This meta-analysis showed that IL-10 polymorphisms are associated with vasculitis susceptibility, especially in WG and BD.     

Association Study of Common Genetic Variants in Pre-microRNAs in Patients with Ulcerative Colitis

Background

Common single-nucleotide polymorphisms (SNPs) in microRNAs (miRNA) have been shown to be associated with susceptibility to several human diseases. We evaluated the associations of three SNPs (rs11614913, rs2910164, and rs3746444) in pre-miRNAs (miR-196a2, miR-146a, and miR-499) with the risk of ulcerative colitis (UC) in a Japanese population.

Methods

The rs11614913 (T?>?C), rs2910164 (C?>?G), and rs3746444 (A?>?G) SNPs were genotyped in 170 UC and 403 control subjects.

Results

The rs3746444 AG genotype was significantly higher among the UC group (odds ratio (OR)?=?1.51, 95% CI?=?1.03?C2.21, p?=?0.037). The rs3746444 AG genotype was associated with onset at an older age (OR?=?1.70, 95% CI?=?1.04?C2.78, p?=?0.035), left-sided colitis and pancolitis (left-sided colitis, OR?=?2.10, 95% CI?=?1.12?C3.94, p?=?0.024; pancolitis, OR?=?1.81, 95% CI?=?1.09?C3.01, p?=?0.028, left-sided colitis?+?pancolitis, OR?=?1.91, 95% CI?=?1.26?C2.92, p?=?0.003), higher number of times hospitalized (OR?=?2.63, 95% CI?=?1.22?C5.69, p?=?0.017), steroid dependence (OR?=?2.63, 95% CI?=?1.27?C5.44, p?=?0.014), and refractory phenotypes (OR?=?2.76, 95% CI?=?1.46?C5.21, p?=?0.002) while the rs3746444 AA genotype was inversely associated with the number of times hospitalized (2??, OR?=?0.36, 95% CI?=?0.17?C0.79, p?=?0.012), steroid dependence (OR?=?0.42, 95% CI?=?0.21?C0.88, p?=?0.021), and refractory phenotypes (OR?=?0.38, 95% CI?=?0.20?C0.72, p?=?0.003). The rs1161913 TT genotype also held a significantly higher risk of refractory phenotype (T/T vs. T/C?+?C/C, OR?=?2.21, 95% CI?=?1.17?C4.18, p?=?0.016).

Conclusions

Our results provided the first evidence that rs3746444 SNP may influence the susceptibility to UC, and both rs3746444 and rs11614913 SNPs may influence the pathophysiological features of UC.     

Community-acquired <Emphasis Type="Italic">Clostridium difficile</Emphasis> infection in Serbian pediatric population

Carriage of Clostridium (C.) difficile in the intestinum of children, as well as its role in the disease (diarrhea) onset, is still controversial. The aim of this study is to investigate the community-acquired Clostridium difficile infection (CA-CDI) in Serbian pediatric population and to describe the basic clinical characteristics and risk factors for CA-CDI occurrence in Serbian pediatric population. The data obtained from 63 Serbian pediatric patients with CA-CDI and from control group of 126 children with community-acquired diarrhea, whose stool specimens were negative for C. difficile and toxins A/B, were mutually compared. In the current work, we found that children with CA-CDI display a significantly less severe disease clinical presentation than children with diarrheas of other origin. Lethal outcome was noted in two cases, but in children with severe underlying diseases (Crohn’s disease and leukemia). By using the multivariate statistical regression model, the following statistically significant risk factors for community-acquired C. difficile-associated diarrhea development were determined: previous application of laxatives (OR?=?0.199, CI 0.55–0.79, p?=?0.015), general antibiotic use during the previous 2 months (OR?=?0.05, CI 0.02–0.17, p?<?0.001), and specifically the use of penicillins (OR?=?0.112, CI 0.04–0.31, p?<?0.0001) and cephalosporins (OR?=?0.16, CI 40.06–0.44, p?<?0.0001). Antibiotics from the groups of cephalosporins and penicillins were found to be the most important independent risk factors. Laxative application plays a significant role in the community-acquired Clostridium difficile infections in children, with mechanisms that are not completely understood.     

Enteroaggregative Escherichia coli and acute diarrhea in children: a meta-analysis of South Asian populations

The purpose of this investigation was to evaluate the association of enteroaggregative Escherichia coli (EAEC) with acute diarrhea in children of South Asian populations. Our meta-analysis included 18 studies published between 1989 and 2011. The odds ratio (OR) was used to evaluate all available observational epidemiology studies. Modifying effects on the overall OR were approached with outlier, subgroup, cumulative, and cumulative recursive analyses. Synthesis of the 18 observational studies revealed an association between EAEC carriage and acute diarrhea, with an overall OR of 1.51, which was significant (p?=?0.008), heterogeneous (P_{heterogeneity}?<?0.0001), and unaffected by outlier analysis. This analysis, however, affected the subgroups by eliminating the following: (i) heterogeneity (from P_{heterogeneity}?<?0.0001 to 0.30–0.72) of pooled ORs in the underpowered (OR 1.37, p?=?0.15), Indian (OR 1.92, p?=?0.09), and hospital-based (OR 1.66, p?=?0.06) studies; (ii) non-significance of these three subgroups (OR 1.56–2.01, p?<?0.0001–0.003); (iii) significance of the high-powered studies (from OR 1.70, p?=?0.02 to OR 1.15, p?=?0.28); (iv) heterogeneity (from P_{heterogeneity}?<?0.0001–0.0002 to 0.11–0.15) of pooled ORs in period three (OR 1.85, p?=?0.14), population-based (OR 1.36, p?=?0.09), and pCVD432 (OR 1.53, p?=?0.07) studies. In general, outlier treatment increased precision with the narrowing of confidence intervals, overall, and in the subgroups. Cumulative meta-analysis generally resulted in increases in the frequencies of significant effects and of heterogeneity. This meta-analysis on observational studies suggests that the association between EAEC and acute diarrhea in children is that of increased risk. This effect generally comes from heterogeneous studies of South Asian populations, but is modified with outlier and subgroup treatments.     

Comparison of colistin–carbapenem,colistin–sulbactam,and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections

The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7 %): colistin–carbapenem (CC), 69 (32.2 %): colistin–sulbactam (CS), and 43 (20.1 %: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p?=?0.97) and microbiological (p?=?0.92) outcomes and 14-day survival rates (p?=?0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p?>?0.05) and also for 14-day survival (p?>?0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p?=?0.02, p?=?0.0001, p?=?0.0001, p?=?0.02, and p?=?0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p?<?0.0001, p?<?0.0001, and p?=?0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.     

Prevalence of and clinicopathologic findings associated with ascites in dogs in Enugu State, Nigeria

This study investigated the prevalence of and clinicopathologic findings associated with grade 3 ascites in dogs presented at three major veterinary clinics in Enugu State, Nigeria between January and December 2010. Blood samples were collected from reported cases for haematology and serum chemistry tests, while the ascites fluid was collected for cytological and relevant clinical chemistry determinations. Blood samples were also collected from 12 apparently healthy non-ascitic dogs from the study population to serve as control. All haematology, cytology and clinical chemistry tests were carried out following standard procedures. Results showed that out of a total of 1,788 dogs presented in the three clinics during the study period, 14 had grade 3 ascites (0.78%), and there were no significant differences (p?>?0.05) between the prevalence obtained from the different clinics. There were also no significant association (p?>?0.05) between sex and prevalence. However, the prevalence was significantly higher (p?<?0.05) in dogs 3 years and above (71.4%) than in those 1 to 2.9 years of age (21.4%) and those less than 1 year of age (7.1%). Alsatian–Rottweiler crosses had a significantly (p?<?0.05) higher prevalence (50%) than all other breeds. The 14 ascites cases were classified into four causative types: cirrhotic liver disease (CLD)—14.3%; chronic active hepatitis (CAH)—21.4%; congestive heart failure (CHF)—50%; and kidney damage (KD)—14.3%. Each of these types presented certain characteristic serum chemistry and haematological findings. Dogs with CLD had a significantly (p?<?0.05) very low serum activity of alanine amino transferase (ALT) and aspartate amino transferase (AST) and very low serum urea levels, and also significantly (p?<?0.05) very high serum activity of alkaline phosphatase (ALP), while dogs with CAH had a contrasting significantly (p?<?0.05) very high serum activity of ALT, AST and ALP when compared to the controls. Dogs with CHF were characterised by significantly (p?<?0.05) very high serum AST activity, while dogs with KD were characterised by significantly (p?<?0.05) very high serum levels of creatinine and urea, significantly (p?<?0.05) very low packed cell volume, red blood cell counts and haemoglobin concentration. The ascites fluid was a transudate in all cases. It was concluded that the prevalence of grade 3 ascites in dogs in the study area was low, and that most of the cases were due to CHF, followed by CLD, CAH and KD, each of which was characterised by some specific serum chemistry and haematological abnormalities that could be of diagnostic importance.