Molecular and phenotypic characterization of multidrug-resistant Mycobacterium tuberculosis isolates resistant to kanamycin,amikacin, and capreomycin in China

Although second-line anti-tuberculosis (TB) injectable drugs have been widely used to improve treatment outcomes of multidrug-resistant TB (MDR-TB), little is known about the prevalence and mechanism of second-line injectable drug resistance among MDR Mycobacterium tuberculosis isolates in China. Here, we found that 12.7 % (20/158) of isolates showed resistance to at least one second-line injectable drug among 158 MDR isolates. At the same time, there were 16 (10.1 %) strains resistant to kanamycin (KAN), 9 (5.7 %) to amikacin (AMK), and 12 (7.6 %) to capreomycin (CAP). In addition, our data revealed no significant difference in the drug resistance patterns for Beijing versus non-Beijing genotype strains (p?>?0.05). The most frequently observed mutation was A-to-G substitution at position 1401 of the rrs gene, conferring high-level resistance to KAN and AMK, but had varying minimum inhibitory concentrations (MICs) for CAP. The mutations in the eis promoter and tlyA gene were responsible for low-level resistance to CAP. 83.3 % of A1401G substitutions in the rrs gene was observed in Beijing genotype strains, while the difference was not significant (p?=?0.157). Our data demonstrated that the hot-spot regions localized in the rrs gene serve as excellent markers for AMK, but is not a sensitive marker for KAN and CAP. In addition, the cross-resistance patterns and MICs differed among different genetic mutation types, which challenge the practice in China of generalizing resistance to AMK and CAP based on the resistance to KAN alone. Our findings suggested that the individualized drug susceptibility to three major second-line injectable drugs is essential in order to generate more effective treatment regimens for MDR patients.     

Autoantibody induction and adipokine levels in patients with psoriasis treated with infliximab

This study was aimed to analyse the prevalence of antinuclear antibodies in patients with psoriasis after treatment with infliximab and correlates the development of antibodies with both response to treatment and adipokines levels. Serum levels of ANA, anti-dsDNA, anti-histone, anti-nucleosome and anti-ENA antibodies at baseline after 2 and 12 months of treatment with infliximab were measured in 27 patients with psoriasis, as well as in 27 matched controls. Serum C-reactive protein (CRP), chemerin, visfatin and resistin were also assessed. The prevalence of ANA increased from 22 to 37 % and 63 % (p < 0.01) during treatment with infliximab, with a gradual progressive increase both in ANA titre and in percentage of ANA pattern. The prevalence of other antibodies also increased from 7 to 30 % and 48 % (p < 0.01) for anti-ds-DNA and from 7 to 26 % and 37 % for anti-nucleosome antibodies (p < 0.05), whereas the prevalence of anti-histone and anti-ENA antibodies was unchanged throughout the study period. Basal chemerin, resistin and CRP levels were higher in patients than in controls, and their levels progressively normalized during treatment (p < 0.01). Conversely, visfatin levels gradually increased (p < 0.01). ANA+ patients tended to show a faster decrease in PASI score, CRP and chemerin levels after 2 months, but the PASI score did not differ between ANA+ and ANA? patients at 12 months. A higher increase of visfatin was also found in ANA+ patients at 2 and 12 months. The antinuclear antibody response induced by infliximab was restricted to ANA, anti-dsDNA and anti-nucleosome antibodies. Patients who developed ANA positivity showed a faster clinical, inflammatory and immunological response to infliximab therapy.     

Trends in Underweight and Overweight/Obesity Prevalence in Chinese Youth, 2004–2009

Background

There is a paucity of recent data on Chinese childhood overweight and underweight prevalence especially since 2004.

Purpose

The purpose of this study was to examine trends in underweight and overweight/obesity (“overweight” hereafter) prevalence and energy balance-related behaviors of Chinese youth from 2004 to 2009.

Methods

Data from the China Health and Nutrition Survey, 2004–2009 (N?=?4,061 students aged 6–18 years), were analyzed. Trained health workers took anthropometric measures at the participant’s house or at a local clinic following a reference protocol recommended by the World Health Organization. The international age- and sex-specific body mass index reference standard proposed by the International Obesity Task Force was used to define underweight and overweight children in this study.

Results

Among 6- to 11-year-old boys, underweight prevalence increased from 14.5 % (2004) to 20.1 % (2009, p?=?0.068). Among 12- to 18-year-old boys, however, overweight prevalence increased from 7.5 to 12.6 % (p?=?0.034). From 2004 to 2009, after-school sedentary behavior increased from 2.3 to 3.4 h/day for 6- to 11-year-olds (p?<?0.001) and from 2.2 to 3.1 h/day for 12- to 18-year-olds (p?<?0.01). Meanwhile, the total energy intake decreased 7 % for 6- to 11-year-olds (p?<?0.05) and 10 % for 12- to 18-year-olds (p?<?0.01).

Conclusions

Both underweight and overweight Chinese students are increasing, with underweight increases more pronounced in 6- to 11-year-olds and overweight increases more pronounced in 12- to 18-year-olds. Nationwide efficacious interventions are needed that improve the diet, decrease sedentary behavior, and encourage a healthy and realistic body image in Chinese youth.     

Prevalence, intensity and seasonality of gastrointestinal parasites in abattoir horses in Germany

Prevalence and intensity of gastrointestinal parasites were studied through a longitudinal survey in 400 horses over a 17-month period in an abattoir in Germany. Three hundred and ten horses (77.5 %) were demonstrated harbouring endoparasites either by direct recovery of parasites from the digestive tract and/or in terms of faecal egg counts (strongyles). The following parasites were found (percentage prevalence, range of counts): Gasterophilus intestinalis larvae (2.25 %, 1–154), Gasterophilus nasalis larvae (0.25 %, 44), Trichostrongylus axei (11.0 %, 1–3,620), Habronema majus (8.0 %; 1–422), Habronema muscae (26.5 %, 1–3,563), Habronema spp. fourth-stage larvae (5.5 %; 1–1,365), Parascaris equorum (total prevalence 11.3 %; adults 8.8 %, 1–178; fourth-stage larvae 2.5 %, 5–2,320), Anoplocephala perfoliata (28.5 %, 1–2,013) and Paranoplocephala mamillana (1.0 %, 1–11). Strongyle eggs (≥10 eggs per gram of faeces) were recorded in 60.8 % of the horses (10–6,450 eggs per gram of faeces). Prevalences of infection with T. axei, P. equorum and strongyles did not show a correlation to specific seasons. In contrast, a significant variation among seasons of collection was shown for the infection rates of Habronema spp. (p?<?0.05) and A. perfoliata (p?<?0.001). Seasonal prevalence of Habronema spp. infection was significantly (p?<?0.01) higher in summer (39.0 %), autumn (34.8 %) and winter (36.5 %) than in spring (18.7 %), and A. perfoliata were significantly (p?<?0.001) more often recorded during autumn (36.1 %) and winter (36.5 %) than in spring (17.3 %) and summer (15.9 %). Prevalences of T. axei, Habronema spp., strongyles and A. perfoliata in male and female horses were almost alike, but ascarids were significantly (p?=?0.025) more often recorded in male than in female horses.     

Mother-child bonding at 1 year; associations with symptoms of postnatal depression and bonding in the first few weeks

Some mothers experience neutral or negative feelings toward their new infant. This study examined the association between symptoms of postnatal depression and mother–infant bonding and the persistence of these feelings over the first year. Bonding was assessed using the Mother–Infant Bonding Scale (MIBQ), at four times postnatal, “early weeks” (1–4 weeks), 9 weeks, 16 weeks and 1 year, in 50 depressed, Edinburgh Postnatal Depression scale (EPDS) ≥13 at 4 weeks post natal, and 29 non-depressed mothers. A significant association between the EPDS score at 4 weeks and bonding score at 1–4 weeks, 9 weeks, and at 1 year postnatal, χ ²(1)?=?9.85, p?<?0.01, 5.44, p?<?0.05 and 5.21, p?<?0.05, respectively, was found, with a trend at 16 weeks. There was a strong association between bonding in the early weeks and all later time points χ ²(1)?=?17.26, p?<?0.001, 7.89, p?<?0.01 and 13.69, p?<?0.001, respectively. Regression showed early bonding rather than early depression was the major predictor of bonding at 1 year. Women who are depressed postnatally can fail to bond well with their baby and this can persist for a year. Early identification and intervention for poor bonding is indicated.     

Molecular characterisation of Escherichia coli isolated from hospitalised children and adults with urinary tract infection

Urinary tract infection (UTI) is common amongst children and recurs in 10–30 % of cases. The differences between Escherichia coli strains causing UTI among hospitalised children and adults remains to be fully elucidated. Here, we examined the genetic relatedness and virulence gene (VG) profiles of a collection of E. coli causing UTI among hospitalised children and adults. Genetic relatedness among the strains was investigated using random amplified polymorphic DNA (RAPD) analysis and the strains were characterised using a combination of phylogenetic grouping, the ability to form biofilm and the presence of antigen 43 (Ag43) and its five known alleles, as well 20 VGs associated with uropathogenic E. coli (UPEC). RAPD analysis resolved six major clusters, with two clusters (A and B) consisting almost exclusively of E. coli isolated from children. Isolates from children had a higher prevalence of alpha-haemolysin (hlyA, p?<?0.05) and group II capsular polysaccharide synthesis genes (kpsMT II, p?<?0.01) than adults. In contrast, E. coli strains from adults had a higher prevalence of invasive ibeA (p?<?0.05) and Ag43 (agn43) (p?<?0.05) genes, and produced significantly (p?<?0.001) more biofilm than E. coli from children. Adult isolates also carried significantly (p?<?0.05) more agn43 allele RS218 compared to isolates from children, which carried significantly (p?<?0.05) more of the agn43 allele bCFT073. Our results suggest that bacterial virulence factors play an important role in UTI among hospitalised children; however, further research will determine whether these findings apply to a larger cohort and other clinical settings for UTI in children and adults.     

Clinical Symptoms in Adults with Selective IgA Deficiency: A Case-Control Study

Selective IgA deficiency (SIgAD) is the most common primary immunodeficiency in Caucasians with a prevalence of 1/600 and is generally considered a mild disorder. In this study, the clinical status of 32 adults with SIgAD was investigated and compared to 63 age- and gender matched controls, randomly selected from a population database. The SIgAD individuals reported significantly more often contracting various upper and lower respiratory infections, with 8 (25.0 %) having been diagnosed with ≥1 pneumonia in the preceding two years, compared to one (1.6 %) control (p?<?0.001). Furthermore, the SIgAD individuals were found to have increased proneness to infections and increased prevalence of allergic diseases and autoimmunity, with a total of 84.4 % being affected by any of these diseases, compared to 47.6 % of the controls (p?<?0.01). This study challenges the common statement of SIgAD being a mild form of immunodeficiency. It also highlights the importance of using matched controls in PID clinical research to better detect clinically important manifestations.     

Haematological and acute-phase response of dogs with experimental skin <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> infection to treatment with antibiotic and parthenolide

Changes in white blood cells, leukogram patterns, the positive acute-phase protein (APP) fibrinogen and negative APPs (albumin and arylesterase) were monitored to evaluate their potential as sensitive indicators throughout the course of therapy in canine skin Pseudomonas aeruginosa infection. The study was performed on 15 male mixed-breed dogs, divided in three groups of 5 dogs each. Dogs from group A were injected subcutaneously with P. aeruginosa bacterial culture (1?×?10⁸ CFU/mL) at a dose of 0.3 mL/kg and treated with enrofloxacin (5 mg/kg, s.c.) on post infection hour 48 for 10 consecutive days. Dogs from group B were infected and treated with a combination of enrofloxacin (at above-mentioned dose and intervals) and parthenolide (feverfew extract 90 mg, 0.7 % parthenolide). The schedule consisted of daily oral intake of two capsules of feverfew beginning on post infection hour 4 and continued for 6 days. The control group C included healthy dogs, injected s.c. with 0.3 mL/kg physiological saline. The haematological indices and APPs were assayed before infection and on 4th, 24th, 48th and 72nd hours and on 7th, 10th and 14th days after infection. Infected and antibiotic-treated dogs responded with significant leukocytosis, left shift, eosinopaenia and lymphopaenia between hours 24 and 72. In this group, fibrinogen increased substantially by post infection hours 24 (p?<?0.01 vs 0 h; p?<?0.05 vs group C), 48 (p?<?0.001 vs 0 h; p?<?0.05 vs group C) and 72 (p?<?0.001 vs 0 h; p?<?0.01 vs group C) while albumin reduction was marked by hours 48 (p?<?0.05 vs 0 h) and 72 (p?<?0.05 vs 0 h; p?<?0.001 vs group C) and day 7 (p?<?0.01 vs 0 h; p?<?0.001 vs group C). The combination of enrofloxacin and parthenolide modified, at a significant extent, the deviations in studied parameters except for eosinophil percentage, which persisted low.     

Expression of miRNAs and ZEB1 and ZEB2 correlates with histopathological grade in papillary urothelial tumors of the urinary bladder

Histopathological grading of papillary urothelial tumors (PUTs) of the urinary bladder is subjective and poorly reproducible. We investigated the relationship between the expression of frequently deregulated microRNAs (miRNAs) as well as their target genes (ZEB1/ZEB2) and bladder cancer histopathological grade in an attempt to find a miRNA that might allow more reliable grading of PUTs. We measured the expression levels of four miRNAs (miR-145, miR-205, miR-125b, and miR-200c) in 120 formalin-fixed, paraffin-embedded bladder tumor tissue samples using real-time PCR assays. ZEB1 and ZEB2 expression was assessed in the same bladder tissues by immunohistochemistry. MiR-205 distinguished low-grade papillary urothelial carcinoma (LG) from high-grade papillary urothelial carcinoma (HG), and miR-145 distinguished HG from infiltrating carcinoma (CA) with an area under the receiver operator characteristic curve (AUC) of 0.992 and 0.997, respectively (sensitivity/specificity of 95.8/96.7 % and 100/91.7 %, respectively; p?<?0.05). The expression level of miR-125b was significantly lower in LG than in PUNLMP, with an AUC value of 0.870 (93.3 % sensitivity and 84.2 % specificity; p?<?0.05). ZEB1 immunoreactivity was more frequently detected in HG than in LG (57 % vs 13 %, p?<?0.01) and in HG than in CA (57 % vs 17 %, p?<?0.01). ZEB2 immunoreactivity was more frequent in CA than in HG (83 % vs 54 %, p?<?0.05). ZEB1/ZEB2 and miRNAs expression seems to reliably distinguish between different grades of PUTs of the urinary bladder. They might well serve as useful complementary diagnostic biomarkers for grading of papillary urothelial tumors.     

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.     

Fibroblast growth factor 23 enhances renal klotho abundance

Klotho constitutes the receptor for fibroblast growth factor 23 (FGF23). However, the effects of FGF23 on renal and circulating klotho are not well-known. In vivo experiments were performed to assess the effects of FGF23 (10 μg/kg), parathyroid hormone (PTH, 10 μg/kg), and 1,25-dihydroxy-vitamin D3 (1,25VD, 1 μg/kg) on renal expression and serum concentration of klotho in Wistar rats. Phosphate excretion was increased at 3 h after FGF23 administration (p?<?0.05). Renal klotho expressions and serum klotho levels were elevated at 3 h (p?<?0.01) by FGF23. At 24 h, phosphate excretion was still elevated (p?<?0.05), and serum phosphate, 1,25VD, and PTH were reduced (p?<?0.05). However, serum and renal klotho returned to the control level at 24 h. PTH markedly increased phosphate excretion after 24 h (p?<?0.01). There were increases in FGF23 at 3 and 24 h, and 1,25VD at 24 h after PTH administration (p?<?0.05). Serum klotho concentration and renal klotho expression were elevated by PTH at 3 or 24 h. After 24 h of exposure to 1,25VD, considerable increases in serum FGF23, calcium, and phosphate were seen (p?<?0.05), but PTH was decreased (p?<?0.01). 1,25 VD elevated renal klotho expression and serum klotho (p?<?0.05) at 3 h, but returned to control levels at 24 h. Our data indicate that FGF23 rapidly increases renal klotho expression and serum klotho. The present findings are consistent with the notion that PTH increases phosphate excretion at least in part through elevations of FGF23 and klotho. Moreover, our results suggest that 1,25VD increases klotho expression independently of FGF23.     

Descriptive epidemiology and seasonality of intestinal parasites of cats in Southeast Nigeria

An epidemiological survey was conducted on the prevalence, intensity, seasonality and risk factors associated with intestinal parasites of cats in Southeast Nigeria between February 2011 and January 2012, spanning all the seasons of the year. A total of 119 cats (68 stray and 51 domesticated) were surveyed. Out of these, 88 (73.9 %) were infected with at least one intestinal parasite. In terms of individual infections, Dipylidium caninum had the highest prevalence (59.7 %) and intensity (42.5?±?4.3), while the lowest prevalence was for Blastocystis spp. (1.7 % prevalence and 0.8?±?0.6 intensity). While the prevalence of individual parasites was comparable between the stray and domesticated cats except for Blastocystis spp., the intensity of infection was significantly higher (p?<?0.05) in stray than domesticated cats. The prevalences of infection of the individual parasites were comparable by gender (p?>?0.05) except for Blastocystis spp. but age dependent. On the basis of individual organisms, prevalence of nematode parasites was significantly higher (p?<?0.05) in kittens than adult cats, cestodes were significantly higher in adults than kittens, trematode showed insignificant difference by age (p?>?0.05) while protozoa followed no definite pattern. The overall prevalence of the parasitic agents varied significantly (p?<?0.05) with seasonal changes, being highest during summer (June–August) and least during winter (December–February). Age, residency status and seasonal variations were found to be important risk factors associated with infection. The above findings are critical, given recent concerns about the growing public health importance of zoonosis worldwide.     

Declining drug resistance of Mycobacterium tuberculosis isolates from elderly patients in Taiwan, 2000–2008

We retrospectively investigated the prevalence of drug resistance in Mycobacterium tuberculosis (MTB) isolates recovered from elderly patients and compared the drug resistance patterns between the elderly (≥65 years old) and adult (15–64 years old) patients. Data on the prevalence of drug resistance in clinical and non-duplicate isolates of MTB recovered from 2000 to 2008 were evaluated. Among the 3,186 non-duplicate MTB isolates found during the study period, 1,497 isolates were recovered from elderly patients. Thirty-eight (2.54%) isolates were multidrug-resistant tuberculosis (MDRTB). The rates of resistance to isoniazid (INH), rifampicin (RIF), ethambutol (EMB), streptomycin (SM), ofloxacin, rifabutin, any one drug-resistant (ADR), and multidrug-resistant (MDR) were significantly lower in isolates from the elderly than from adults (p < 0.05). Significant decreasing trends in resistance rates to EMB, SM, at least any one of the four first-line agents (ADR), and MDRTB were observed (p < 0.05) . In conclusion, elderly patients had a lower rate of anti-TB drug resistance than adults and a decreasing overall trend of anti-TB drug resistance was found in the elderly in recent years, but the higher rate of MDRTB in Taiwan continues to present a challenge for the control of TB in the elderly.     

Impact of pneumococcal conjugate vaccine in children on the serotypic epidemiology of adult invasive pneumococcal diseases in Taiwan

Background

Invasive pneumococcal disease (IPD) causes significant morbidity and mortality, especially in children and older adults. Pneumococcal 7-valent and 13-valent conjugate vaccines (PCV7 and PCV13) were introduced in Taiwan in 2005 and 2011, respectively, for children. This study was conducted to evaluate the impact of PCV administered in children on adult IPD.

Liver involvement in patients with brucellosis: results of the Marmara study

Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with ≥5 times of the upper limit of normal for aminotransferases, total bilirubin level ≥2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n?=?73), doxycycline plus rifampicin (n?=?71), doxycycline plus rifampicin and an aminoglycoside (n?=?27). The duration of ALT normalization differed significantly in three treatment groups (p?<?0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p?<?0.05). However, the length of hospital stay did not differ significantly between these three combinations (p?>?0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.     

Characteristics of Mycobacterium Tuberculosis Positive Patients Screened for Drug-Resistant Tuberculosis at a Tertiary Health Facility in Lagos,Nigeria

Background

Nigeria is one of the ten countries with the highest tuberculosis (TB) burden globally and is experiencing an increasing incidence of drug resistance. This study aimed to determine the prevalence of mycobacterium tuberculosis and rifampicin resistance (DR-TB) among patients screened at the TB clinic of a tertiary institution in Lagos, South-West, Nigeria.

Relationship among nausea,anxiety, and orthostatic symptoms in pediatric patients with chronic unexplained nausea

This study evaluated the relationship among nausea, anxiety, and orthostatic symptoms in pediatric patients with chronic unexplained nausea. We enrolled 48 patients (36 females) aged 15 ± 2 years. Patients completed the Nausea Profile, State-Trait Anxiety Inventory for Children and underwent 70° head upright tilt testing (HUT) to assess for orthostatic intolerance (OI) and measure heart rate variability (HRV). We found nausea to be significantly associated with trait anxiety, including total nausea score (r = 0.71, p < 0.01) and 3 subscales: somatic (r = 0.64, p < 0.01), gastrointestinal (r = 0.48, p = 0.01), and emotional (r = 0.74, p < 0.01). Nausea was positively associated with state anxiety, total nausea (r = 0.55, p < 0.01), somatic (r = 0.48, p < .01), gastrointestinal (r = .30, p < .05), and emotional (r = .64, p < .01) subscales. Within 10 min of HUT, 27 patients tested normal and 21 demonstrated OI. After 45 min of HUT, only 13 patients (27 %) remained normal. Nausea reported on the Nausea Profile before HUT was associated with OI measured at 10 min of tilt (nausea total r = 0.35, p < 0.05; nausea emotional subscale r = 0.40, p < 0.01) and lower HRV at 10 min of HUT (F = 6.39, p = 0.01). We conclude that nausea is associated with both anxiety symptoms and OI. The finding of decreased HRV suggests an underlying problem in autonomic nervous system function in children and adolescents with chronic unexplained nausea.     

Characteristics of Haemophilus influenzae invasive isolates from Portugal following routine childhood vaccination against H. influenzae serotype b (2002–2010)

We aimed to characterize Haemophilus influenzae invasive isolates recovered in Portugal over a 9-year period (2002–2010) following the inclusion of H. influenzae serotype b (Hib) conjugate vaccination in the National Immunization Program (NIP) in the year 2000 and compare the results with those obtained in a similar study from the pre-vaccination era (1989–2001) previously described by us. As part of a laboratory-based passive surveillance system, 144 invasive isolates obtained in 28 Portuguese hospitals were received at the National Reference Laboratory for Bacterial Respiratory Infections and were characterized. Capsular types and antibiotic susceptibility patterns were determined. The ftsI gene encoding PBP3 was sequenced for β-lactamase-negative ampicillin-resistant (BLNAR) isolates. Genetic relatedness among isolates was examined by multilocus sequencing typing (MLST). Most isolates (77.1 %) were non-capsulated, a significant increase compared to the pre-vaccination era (19.0 %, p?<?0.001). Serotype b strains decreased significantly (from 81.0 to 13.2 %, p?<?0.001) and serotype f increased significantly (from 0.8 to 6.9 %, p?=?0.03). Ten percent of the isolates were β-lactamase producers, a value lower than that previously observed (26.9 %, p?=?0.005). Eight percent of all isolates were BLNAR. A high genetic diversity among non-capsulated isolates was found. By contrast, capsulated isolates were clonal. The implementation of Hib vaccination has resulted in a significant decline in the proportion of serotype b H. influenzae invasive disease isolates. Most episodes of invasive disease occurring in Portugal are now due to fully susceptible, highly diverse, non-capsulated strains. Given the evolving dynamics of this pathogen and the increase in non-type b capsulated isolates, continuous surveillance is needed.     

Clinical outcomes and treatment approach for community-associated methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> (CA-MRSA) infections in Israel

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasingly documented worldwide. We recently identified two major CA-MRSA clones in Israel: USA300 and t991. Here, we assessed clinical outcomes by CA-MRSA clones and the physicians’ treatment approach to CA-MRSA infections. All community-onset, clinical MRSA isolates detected during 2011–2013 by Maccabi Healthcare Services were collected and characterized phenotypically and genotypically; data were collected retrospectively from electronic medical records. Of 309 patients with MRSA infections, 64 were identified as CA-MRSA (21 %). Of the CA-MRSA infections, 72 % had skin and soft tissue infections (SSTIs), 38 % were Panton–Valentine leukocidin (PVL)+, the major clone being USA300 (n?=?13, 54 %). Of PVL? isolates (n?=?40, 62 %), t991 was the major clone. Age was the only predictor for PVL+ CA-MRSA infection (p?<?0.001). Patients with PVL+ CA-MRSA had higher incidence of SSTI recurrences (1.061 vs. 0.647 events per patient/per year, p?<?0.0001) and were more likely to have the SSTI drained (64 % vs. 21 %, p?=?0.003) when compared to PVL? CA-MRSA. USA300 was more common among adults, while t991 was more common among children (p?=?0.002). The physician’s referral to culture results and susceptibility were the only predictors of appropriate antibiotic therapy (p?<?0.001). However, only a minority of physicians referred to culture results, regardless of subspecialties. PVL+ CA-MRSA isolates caused significantly more recurrences of SSTIs and increased the need for drainage compared with PVL? isolates. Physicians’ awareness of CA-MRSA as a cause of SSTIs in the community was suboptimal. Culturing of pus-producing SSTIs is crucial for providing adequate antimicrobials and elucidating MRSA epidemiology.