Rapid appraisal of human intestinal helminth infections among schoolchildren in Osh oblast, Kyrgyzstan

A population-representative lot quality assurance sampling (LQAS) survey was conducted in 2009 to determine the prevalence of intestinal helminth infections among schoolchildren across Osh oblast, Kyrgyzstan. The diagnostic approach consisted of duplicate Kato-Katz thick smears from a single stool sample and an adhesive tape test. A questionnaire was administered to identify risk factors for infections. A total of 1262 schoolchildren aged 6-15 years were recruited; 41% of them harboured at least one of the eight identified helminth species. The two most prevalent helminths were Ascaris lumbricoides (23.1%) and Enterobius vermicularis (19.3%). Lower prevalences were found for Hymenolepis nana (4.4%), Fasciola hepatica (1.9%) and Dicrocoelium dendriticum (1.8%). Washing raw vegetables was a protective factor with regard to A. lumbricoides infection (odds ratio (OR) = 0.69, p = 0.022); tap water was borderline protective (OR = 0.56, p = 0.057). Children of the richest families were at a lower risk of E. vermicularis infection than the poorest ones (OR = 0.41, p = 0.011). Sharing the bed with more than one person was a risk factor for E. vermicularis infection (OR = 2.0, p = 0.002). The results call for targeted interventions against intestinal helminths in Osh oblast. In a first stage, annual deworming of schoolchildren and other high-risk groups with albendazole or mebendazole should be implemented, and reliable diagnosis and additional anthelminthic drugs should be made available. Subsequently, transmission control including locally-adapted health education, improved water supply and adequate sanitation should become the central features.     

Accuracy of the Kato-Katz, adhesive tape and FLOTAC techniques for helminth diagnosis among children in Kyrgyzstan

The purpose of this study was to assess the accuracy of three copro-microscopic techniques for helminth diagnosis: Kato-Katz, adhesive tape and FLOTAC. A total of 163 children from a peri-urban municipality near Bishkek, Kyrgyzstan, participated and submitted multiple stool samples and adhesive tapes. Ninety children supplied at least two stool samples and two adhesive tapes. Three stool samples and three adhesive tapes were available from 71 and 64 children, respectively. From each stool sample, a single Kato-Katz thick smear was prepared and examined quantitatively. Additionally, the first stool sample was subjected to the FLOTAC technique and helminth eggs were counted. Adhesive tapes were checked for the presence of Enterobius vermicularis eggs. Using pooled results as a diagnostic ‘gold’ standard, the prevalence of Ascaris lumbricoides, E. vermicularis, Hymenolepis nana and Dicrocoelium dendriticum were 54.4%, 13.3%, 11.1% and 11.1%, respectively. Infection intensities were low. When compared to triplicate Kato-Katz, a single FLOTAC was more sensitive for the diagnosis of A. lumbricoides (89.5% versus 39.5%) and D. dendriticum (88.9% versus 33.3%), but less sensitive for H. nana (66.7% versus 88.9%). For E. vermicularis, three adhesive tapes showed much higher sensitivity than a single FLOTAC (92.9% versus 14.3%). FLOTAC yielded significantly higher faecal egg counts than Kato-Katz for A. lumbricoides and D. dendriticum. Overall results suggest that, although FLOTAC represents a promising technique for helminth diagnosis in Kyrgyzstan, the repeated adhesive tape test remains so far the method of choice for diagnosing E. vermicularis.     

Rapid Re-Infection with Soil-Transmitted Helminths after Triple-Dose Albendazole Treatment of School-Aged Children in Yunnan,People's Republic of China

Post-treatment soil-transmitted helminth re-infection patterns were studied as part of a randomized controlled trial among school-aged children from an ethnic minority group in Yunnan province, People''s Republic of China. Children with a soil-transmitted helminth infection (N = 194) were randomly assigned to triple-dose albendazole or placebo and their infection status monitored over a 6-month period using the Kato-Katz and Baermann techniques. Baseline prevalence of Trichuris trichiura, Ascaris lumbricoides, hookworm, and Strongyloides stercoralis were 94.5%, 93.3%, 61.3%, and 3.1%, respectively, with more than half of the participants harboring triple-species infections. For the intervention group (N = 99), the 1-month post-treatment cure rates were 96.7%, 91.5%, and 19.6% for hookworm, A. lumbricoides, and T. trichiura, respectively. Egg reduction rates were above 88% for all three species. Rapid re-infection with A. lumbricoides was observed: the prevalence 4 and 6 months post-treatment was 75.8% and 83.8%, respectively. Re-infection with hookworm and T. trichiura was considerably slower.     

Anémie chez les patients avec syndrome coronarien aigu au centre hospitalier de Vichy

IntroductionObjectives were to determine the clinical, epidemiological and biological profile of the patients suffering from acute coronary syndrome and presenting the anaemia, the determinants of variation of the haemoglobin rate, and to estimate the impact of the anaemia on the prognosis of these patients.Patients and methodsRetrospective and observational study conducted in the cardiology department of Vichy Hospital in France. All patients with acute coronary syndrome admitted from 31 of October 2015 to 30 of April 2016 were selected. The patients were followed for 1 month. The anaemia was defined by: less than 13 g/dL in man and less than 12 g/L in woman (WHO definition). Biological markers were taken at the admission. Factors associated to the haemoglobin rate were analysed by multivariate linear regression and those associated to the mortality within 30 days were analysed by logistic regression.ResultsAmong 251 included patients, there were 180 males and 71 females with the average age of 67 years. 94 patients had ST elevation myocardial infarction (STEMI), 116 had Non ST myocardial infarction (NSTEMI) and 41 had unstable angina. Haemoglobin value was known in 238 patient's, among whom 44.1% were anaemic (105/238). The anaemia was more frequent in women. The tobacco was less frequent; High blood pressure, renal failure, malnutrition, subclinical atherosclerosis, lower limb arteritis and the inflammatory syndrome were more frequent in patients with anaemia. They presented more complications. The age (P = 0,003), the pulsed pressure (P = 0,007), LVEF (P = 0,005), the albumin (P = 0,010), Creatine kinase (CK) level (P = 0,048) and of CRP (P = 0,011), were linear factors of variations of the haemoglobin rate (R² = 0,955). Ten patients died during the follow-up. The multivariate analysis revealed the anaemia as independently associated with the mortality in 30 days (Odds Ratio 3,69; P = 0,02).ConclusionAnaemia is frequent in patients with an ACS, and it is associated with a particular clinical and biological profile. The patients with anaemia have a mortality rate in 30 days higher than the patients without anaemia.     

High level of Schistosoma mansoni infection in pre-school children in Sierra Leone highlights the need in targeting this age group for praziquantel treatment

BackgroundSchistosomiasis and soil-transmitted helminth (STH) infections are endemic in Sierra Leone. The consequences of these diseases to pre-school children are well understood. The national control program currently does not target this group of children for schistosomiasis, while mass drug administration (MDA) has been performed six monthly for STHs in children 12–59 months of age since 2006.MethodsTo assist the national decision on MDA strategy to control schistosomiasis and STH, three cross-sectional surveys were conducted in pre-school children in 2009–2011 as part of routine surveillance performed in different areas and in different phases of MDA, including known ‘Hard to Reach’ villages where consistently poor coverage results were seen in recent MDA. Thirty 4–5 year-old children were randomly selected per site and a stool sample from each child was examined by Kato-Katz thick smear. Pooled data were analyzed for schistosomiasis and separate sets of data were presented for STHs. In total 61 sites were surveyed and a total of 1803 children were examined.ResultsThe overall prevalence and intensity of Schistosoma mansoni was 11.2% (95% CI 9.7–12.8) and 33.5 epg (95% CI 19.7–47.3). Relatively high level of infection was found in Kono (35.4% and 102.9 epg), Tonkolili (30.4% and 142.3 epg) and Koinadugu (20.8% and 47.0 epg). There were 8.1% of children 4–5 years old moderately or heavily infected with S. mansoni. Overall level of STH infections were generally low, with hookworm 8.4–22.8%, Ascaris lumbricoides 0.2–17.2%, and Trichuris trichiura 0.9–2.6% in three surveys. However, prevalence of hookworm and A. lumbricoides was relatively high in those hard-to-reach villages even two months after MDA.ConclusionsRelatively high levels of S. mansoni infections were found in children aged 4–5 years old in Sierra Leone, in line with geographical distribution of the disease observed in older children in the country. The results suggest that this group of children should not be neglected further in the schistosomiasis MDA and a global guideline is needed. Overall prevalence of STH infection was relatively low. Although there was no baseline data for direct comparison, it did show a marked reduction in STH infections, compared with historical data. However, relatively higher prevalence in hard-to-reach villages suggests the difficulty and quality of implementing MDA in such difficult locations, and more efforts and perhaps different delivery strategies are needed in these locations to increase the quality of MDA.     

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

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

Increased intestinal permeability,measured by serum zonulin,is associated with metabolic risk markers in overweight pregnant women

BackgroundIncreased intestinal permeability with subsequent metabolic endotoxemia, i.e., elevated circulating levels of bacterial lipopolysaccharide, LPS, has been introduced as a novel initiator of obesity related metabolic disturbances in non-pregnant individuals. The objective was to investigate the extent to which intestinal permeability, measured by serum zonulin concentration, is related to metabolic endotoxemia and metabolic risk markers in overweight pregnant women.MethodsThis was a cross-sectional study including 100 pregnant overweight women in early pregnancy. Serum zonulin was analyzed using ELISA, and markers for metabolic endotoxemia (LPS), inflammation (high-sensitive C-reactive protein and glycoprotein acetylation GlyA), glucose metabolism (fasting glucose and insulin), and lipid metabolism were measured.ResultsHigher serum zonulin concentration associated positively with LPS (P = 0.02), inflammatory markers (P < 0.001), insulin (P < 0.001), insulin resistance (P < 0.001), and triglycerides (P = 0.001), and negatively with insulin sensitivity (P = 0.001) (ANOVA with Tukey's corrections or Kruskal–Wallis nonparametric test with Bonferroni correction for zonulin quartiles). All the observed associations were confirmed (P < 0.015) in a linear regression model adjusted with potential confounding factors. Both LPS and GlycA showed positive relationship with insulin resistance, serum insulin, triglycerides, total and LDL-cholesterol and negative relationship with insulin sensitivity (P ≤ 0.03) in the univariate linear regression. Positive relationship was also found between LPS and HDL-cholesterol (P = 0.03).ConclusionsOur findings suggest that increased serum zonulin concentration, i.e., increased intestinal permeability, contributes to metabolic endotoxemia, systemic inflammation, and insulin resistance in overweight pregnant women. By reinforcing intestinal barrier, it may be possible to manipulate maternal metabolism during pregnancy with subsequent health benefits.     

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

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

Intestinal permeability is increased in children with non-alcoholic fatty liver disease,and correlates with liver disease severity

BackgroundIncreased intestinal permeability seems to play a major role in non-alcoholic liver disease development and progression.AimTo investigate the prevalence of altered intestinal permeability in children with non-alcoholic fatty liver disease, and to study its potential association with the stage of liver disease.MethodsWe performed a case–control study examining intestinal permeability in children using the lactulose–mannitol bowel permeability test.ResultsOverall, 39 consecutive patients (30 males, median age 12 years) and 21 controls (14 males, median age 11.8 years) were included. The lactulose/mannitol ratio resulted impaired in 12/39 patients (31%) and none of the controls. Intestinal permeability was higher in children with non-alcoholic fatty liver disease (lactulose/mannitol ratios: 0.038 ± 0.037 vs. 0.008 ± 0.007, p < 0.05). Within the non-alcoholic fatty liver disease group, intestinal permeability was increased in children with steatohepatitis compared to those with steatosis only (0.05 ± 0.04 vs. 0.03 vs. 0.03, p < 0.05). Pathological lactulose/mannitol ratio correlated with portal inflammation (p = 0.02), fibrosis (p = 0.0002), and ballooning of hepatocytes (p = 0.003). Blood lipopolysaccharides levels were higher in children with steatohepatitis (2.27 ± 0.68 vs. 2.80 ± 0.35, p < 0.05).ConclusionsIntestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with the severity of the disease.     

Increased intestinal permeability as a risk factor for type 2 diabetes

AimRelationships between the intestinal microbiota, intestinal permeability and inflammation in the context of risk for obesity-associated disease continue to be of interest. The aim of the study was to examine the associations between intestinal permeability and type 2 diabetes (T2D).MethodsA total of 130 individuals with T2D (age: 57.5 ± 6.2 years (mean ± SD); BMI: 30.4 ± 3.2; 45% female) and 161 individuals without T2D (age: 37.4 ± 12.5 years; BMI: 25.1 ± 3.9; 65% female) were included in the study. Assessment of intestinal permeability included measurement of circulating lipopolysaccharide (LPS), LPS-binding protein (LBP) and intestinal fatty acid binding protein (iFABP) concentrations, which were used for calculation of a derived permeability risk score (PRS). Associations between permeability measures and T2D status were assessed using logistic regression models.ResultsLBP (∼34%, P < 0.001), iFABP (∼46%, P < 0.001) and the PRS (∼24% P < 0.001) were all significantly higher in the T2D affected individuals. Individuals with a PRS in the upper tertile were 5.07 times more likely (CI: 1.72–14.95; P = 0.003) to have T2D when models were adjusted for age, sex and BMI. There was a trend towards improved prediction when including the PRS in models containing age, sex and BMI (AUC: 0.954 versus 0.962; P = 0.06).ConclusionThese data demonstrate differences in measures of intestinal permeability between individuals with and without T2D. The utility of using intestinal permeability measures as a tool for predicting T2D risk in at risk individuals should be further investigated.     

Advances with the Chinese anthelminthic drug tribendimidine in clinical trials and laboratory investigations

The anthelminthic drug tribendimidine has been approved by Chinese authorities for human use in 2004, and a first comprehensive review was published in Acta Tropica in 2005. Here, we summarise further advances made through additional clinical trials and laboratory investigations. Two phase IV trials have been conducted in the People's Republic of China, the first one enrolling 1292 adolescents and adults aged 15–70 years and the second one conducted with 899 children aged 4–14 years who were infected with one or multiple species of soil-transmitted helminths. Oral tribendimidine (single 400 mg enteric-coated tablet given to adolescents/adults and 200 mg to children) showed high cure rates against Ascaris lumbricoides (90.1–95.0%) and moderate-to-high cure rates against hookworm (82.0–88.4%). Another trial done in school-aged children using a rigorous diagnostic approach found a cure rate against hookworm of 76.5%. A single oral dose of tribendimidine showed only low cure rates against Trichuris trichiura (23.9–36.8%) confirming previous results. Tribendimidine administered to children infected with Enterobius vermicularis (two doses of 200 mg each on consecutive days) resulted in a high cure rate (97.1%). Importantly, a series of randomised, exploratory trials revealed that tribendimidine shows interesting activity against the liver flukes Opisthorchis viverrini and Clonorchis sinensis, the tapeworm Taenia spp. and the threadworm Strongyloides stercoralis with respective cure rates of 70.0%, 40.0%, 53.3% and 36.4%. Pharmacokinetic studies in healthy Chinese volunteers indicated that after oral administration of tribendimidine, no parent drug was detected in plasma, but its primary metabolite, p-(1-dimethylamino ethylimino) aniline (aminoamidine, deacylated amidantel) (dADT), was found in plasma. dADT is then further metabolised to acetylated dADT (AdADT). dADT exhibits activity against several species of hookworm and C. sinensis in experimental studies, similar to that of tribendimidine. First studies elucidating the mechanism of action suggested that tribendimidine is an L-type nicotinic acetylcholine receptor agonist. Additional experimental studies revealed that the anti-parasite spectrum of tribendimidine is very broad. Indeed, to date, activity has been documented against 20 different nematode, trematode and cestode species. Taken together, tribendimidine warrants further scientific inquiry, including more comprehensive toxicity appraisals, mechanism of action studies and clinical investigation as it holds promise as a broad spectrum anthelminthics.     

Studying progression from glucose intolerance to type 2 diabetes in obese children

AimIdentification of metabolic and genetic factors capable to mediate progression from normal glucose tolerance (NGT) through impaired glucose tolerance (IGT) to type 2 diabetes (T2D) in childhood obesity.Patients and methodsThree groups of obese children with NGT (n = 54), IGT (n = 35), and T2D (n = 62) were evaluated. A control group of non-obese normal children (n = 210) was also studied. In obese patients, an oral glucose tolerance test (OGTT) was performed. Insulin resistance (IR) was assessed using HOMA-IR index. Insulin sensitivity (IS) was assessed according to the Matsuda formula. Genomic DNA from obese and control children was genotyped for genetic variants of PPARG, ADIPOQ, ADIPOR1, FTO, TCF7L2, and KCNJ11 using a real-time PCR strategy. The unpaired Student's t-test and Kruskal–Wallis one-way test were used to compare quantitative data in two and more groups. To assess the extent to which the various genetic variants were associated with pathology, ORs (odds ratios) and 95% CI (confidence interval) were estimated.ResultsIn T2D children, HOMA-IR value (7.5 ± 3.1) was significantly (P < 0.001) higher than that in IGT (4.21 ± 2.25) and NGT (4.1 ± 2.4) subjects. The Matsuda IS index was significantly increased in normoglycemic patients compared to IGT individuals (2.8 ± 1.75 vs. 2.33 ± 1.2, P < 0.05). The Pro12Ala polymorphism of PPARG was significantly associated with obesity (OR = 1.74, 95% CI = 1.19–2.55, P = 0.004) and T2D in obesity (OR = 2.01, 95% CI = 1.24–3.26, P = 0.004).ConclusionIR is a major risk factor that mediates progression from NGT to clinical T2D in Russian obese children. This progression may be genetically influenced by the Pro12Ala variant of PPARG.     

Association of atopy, asthma, allergic rhinoconjunctivitis, atopic dermatitis and intestinal helminth infections in Cuban children

Objective To examine the relationship of past and current intestinal helminth infections with asthma, allergic rhinoconjunctivitis, atopic dermatitis and atopy. Methods Cross‐sectional study of 1320 children aged 4–14 years from two Cuban municipalities. Helminth infections were determined by stool examination and parental questionnaire. Asthma, rhinoconjunctivitis and atopic dermatitis were diagnosed by International Study of Asthma and Allergies in Childhood questionnaire, asthma additionally by spirometry, atopy by skin prick testing. Results Questionnaire‐based frequencies were 21% for asthma, 14% for allergic rhinoconjunctivitis and 8% for atopic dermatitis. According to spirometry, 4% had asthma; 20% had a positive skin prick test. A history of infection for Enterobius vermicularis was associated with increased risk of atopic dermatitis (OR 1.88, P = 0.001) and allergic rhinoconjunctivitis (OR 1.34, P = 0.046), and hookworm with increased risk of allergic rhinoconjunctivitis (OR 2.77, P = 0.021). A positive stool examination for Ascaris lumbricoides infection was negatively associated with atopic dermatitis (OR 0.22, P = 0.007). Asthma and atopy were unrelated to helminth infections. Conclusion Current A. lumbricoides infection protects against atopic dermatitis in Cuban children, while past infection with E. vermicularis and hookworm are risk factors for allergic rhinoconjunctivitis and/or atopic dermatitis. Apparently, interactions differ depending on the type of helminth and atopic disease and on the time of helminth infestation.     

Potential association between allergic diseases and pertussis infection in schoolchildren: Results of two cross-sectional studies seven years apart

BackgroundIn this study, we aimed to investigate the relationship between pertussis infections and allergic diseases in two cross-sectional questionnaire-based surveys carried out in 1997 and 2004. We also measured serum level of antibody to B. pertussis.Material and MethodsTwo cross-sectional, questionnaire-based surveys were carried out in 1997 (n = 3164) and 2004 (n = 3728). 361 cases and 465 controls were recruited from both surveys. The skin tests were performed using standardised extracts. The level of pertussis specific IgG was measured in 136 allergic and 168 non-allergic children.ResultsWe found that allergic diseases prevalence was significantly higher in the children suffering from pertussis infections (22.3 % first and 8.8 % second survey) compared to children who did not suffer from pertussis infections (6.6 % first and 4.5 % second survey) (p = 0.001 and p = 0.035, respectively). Asthma prevalence was also significantly higher in children suffering from pertussis infection (37.6 % first and 26.2 % second survey) compared to children who did not suffer from pertussis (7.4 % first and 5.0 % second survey) (p = 0.001 and p = 0.001, respectively). However, the mean serum levels of anti-pertussis IgG were similar in allergic and non-allergic groups (p > 0.05).ConclusionAlthough pertussis antibody levels in atopic and non-atopic children were similar to each other, pertussis infection still seemed to have a significant effect on the development of atopic diseases.     

Thyroid hormones and erythrocyte indices in a cohort of euthyroid older subjects

ObjectivesHypothyroidism is associated with normocytic anaemia. Indeed, a limited number of studies have shown significant associations between free thyroxin (T4) and erythrocyte indices. These studies did not include vitamin B12, folic acid, iron and renal function in the analyses. We therefore studied the association between thyroid hormones and erythrocyte indices in a population-based cohort of older euthyroid subjects, with adjustment for major confounding parameters.DesignData, including thyroid hormones and erythrocyte indices, are from the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study on predictors and consequences of changes in health in the ageing population in the Netherlands. Multivariable linear regression analyses were applied to study the cross-sectional associations between free T4, thyroid stimulating hormone (TSH) and erythrocyte indices (haemoglobin content, haematocrit, mean cell volume (MCV) and erythrocyte count) in a euthyroid sub-sample. The final models were adjusted for vitamin B12, folic acid, iron levels and renal function.ResultsIn 708 euthyroid older subjects, an increase of 5 pmol/L free T4 was associated with a mean increase of 0.12 mmol/L or 0.19 g/dL of haemoglobin, 0.068 10¹²/L erythrocytes and 0.006 L/L haematocrit (P = 0.007, P = 0.005, P = 0.001, respectively). Free T4 was not significantly associated with MCV (P > 0.05). TSH appeared not to be associated with any of the erythrocyte indices (all P > 0.05).ConclusionsIn a cohort of older subjects, free T4, but not TSH, was associated with erythrocyte indices, confirming the role of thyroid hormones in the regulation of erythropoiesis.     

Expression of soluble sCD163 in serum of psoriatic patients is modulated by Goeckerman therapy

BackgroundCD163 is the monocyte/macrophage receptor for haptoglobin–haemoglobin complexes. The aim of this study was to assess the kinetics in the expression of CD163 on monocytes and the concentration of soluble sCD163 in serum of psoriatic patients in order to examine the effect of Goeckerman therapy.MethodssCD163 was measured in 71 patients before and after therapy, and in 57 healthy donors. A subgroup of 40 patients and 25 controls was used to assess the expression of membrane CD163. sCD163 was evaluated by ELISA. Flow cytometry method was used to determine the expression of membrane CD163 on monocytes, expressed as mean fluorescence index (MFI).ResultsBefore therapy, the serum level of sCD163 was significantly higher in our patients than in controls (P = 0.0154). However, we observed a profound decrease in sCD163 in our patients after therapy (P = 0.0037). Similar to sCD163, pre-treatment expression of CD163 on monocytes was significantly more enhanced in patients than that in controls (P = 0.0078). There was a trend towards down-regulation of the expression after therapy, nonetheless, the change was not statistically significant compared to the values before therapy (P = 0.8666). This was also confirmed by comparison with controls which displayed lower expression of CD163 than patients after therapy (P = 0.0019). The disease activity, expressed as PASI score, was significantly decreased in our patients by GT (P = 0.0001).ConclusionsWhile sCD163 level in psoriatic patients was diminished after GT therapy, CD163 expression on monocytes was altered only to a minor extent.     

Significance of platelets to lymphocytes and platelets to haemoglobin ratios in patients with systemic sclerosis

BackgroundSystemic sclerosis (SSc) is a progressive autoimmune connective tissue disease. Platelets to lymphocytes (PLR) and platelets to haemoglobin ratios (PHR) are emerging biomarkers used in the assessment of activity and severity of various autoimmune diseases. This study was designed to clarify the association of PLR and PHR with SSc disease activity and its different manifestations.MethodA cross-sectional study involved sixty SSc patients. Demographic, clinical data and investigations were done.ResultsPLR and PHR were correlated positively with ESR (r = 0.351, p = 0.003*), (r = 0.620, p = 0.000**), CRP (r = 0.417, p = 0.001*), (r = 0.305, p = 0.018**) and SSc activity index (r = 0.292, p = 0.024*), (r = 0.359, p = 0.005*). PLR and PHR were highly significantly related to digital ulcerations, musckeloskeletal, and pulmonary manifestations. Also, they had a significant relation to ground glass abnormalities on HRCT, mild restriction in pulmonary function tests and anti-scleroderma-70 antibodies. The cutoff value for PLR was 107.8 with high sensitivity 97.9% and specifity 92.3%, area under the curve (AUC = 0.723, P 0.015) on receiver operating characteristic curve (ROC). PHR AUC (0.799, P .001), cut value was 23.5 at 95.7% sensitivity and 84.6% specifity.ConclusionPLR and PHR were significantly related to digital ulcerations, musculoskeletal, and pulmonary manifestations and can be considered as predictive biomarkers for the assessment of SSc disease activity and severity.     

Comparison of manual compression and vascular hemostasis devices after coronary angiography or percutaneous coronary intervention through femoral artery access: A meta-analysis of randomized controlled trials

ObjectivesTo compare the efficacy and safety of manual compression (MC) with vascular hemostasis devices (VHD) in patients undergoing coronary angiography (CA) or percutaneous coronary intervention (PCI) through femoral artery access.IntroductionThe use of femoral artery access for coronary procedures may result in access-related complications, prolonged immobility and discomfort for the patients. MC results in longer time-to-hemostasis (TTH) and time-to-ambulation (TTA) compared to VHDs but its role in access-related complications remains unclear in patients undergoing coronary procedures.MethodsWe searched MEDLINE, EMBASE, Cochrane CENTRAL and relevant references for English language randomized controlled trials (RCT) from inception through September 30, 2016. We performed the meta-analysis using random effects model. The outcomes were time-to-hemostasis, time-to-ambulation, major bleeding, large hematoma > 5 cm, pseudoaneurysm and other adverse events.ResultsThe electronic database search resulted in a total of 44 RCTs with a total of 18,802 patients for analysis. MC, compared to VHD resulted in longer TTH [mean difference (MD): 11.21 min; 95% confidence interval (CI) 8.13–14.29; P < 0.00001] and TTA [standardized mean difference: 1.2 (0.79–1.62); P < 0.00001] along with excess risk of hematoma > 5 cm formation [risk ratio (RR): 1.38 (1.15–1.67); P = 0.0008]. MC resulted in similar risk of major bleeding [1.01 (0.64–1.60); P = 0.95] pseudoaneurysm [0.99 (0.75–1.29); P = 0.92], infections [0.52 (0.25–1.10); P = 0.09], need of surgery [0.60 (0.29–1.22); P = 0.16), AV fistula [0.93 (0.68–1.27); P = 0.63] and ipsilateral leg ischemia [0.95 (0.57–1.60); P = 0.86] compared to VHD.ConclusionManual compression increase time-to-hemostasis, time-to-ambulation and risk of hematoma formation compared vascular hemostasis devices.     

A meta-analysis of efficacy of topical steroids in eosinophilic esophagitis: From the perspective of histologic,clinical, and endoscopic outcome

BackgroundSwallowed topical steroids are a mainstay drug therapy for eosinophilic esophagitis (EoE), studies have demonstrated good histologic response, but with enormous discrepancy in clinical and endoscopic improvement. We conducted this meta-analysis to investigate the efficacy of topical steroids in EoE in histological, clinical and endoscopic improvement.MethodsSeveral databases were searched from inception to August 1, 2019 for randomized controlled trials (RCTs) comparing topical steroids with placebo for EoE in the short-term. The outcomes of interest mainly included basic characteristics of the studies, histologic, clinical, endoscopic response rate and adverse events. The results were pooled together using Reviewer Manager 5.3.5 software, and inconsistency was quantified using I² statistics.ResultsNine studies were eventually selected. The results showed that topical steroids were effective in inducing histologic response compared with placebo for both complete (OR 35.82, 95% CI 14.98–85.64, P < 0.0001; I² = 0, P = 0.72) and partial response (OR 28.44, 95% CI 8.56–94.47, P < 0.0001; I² = 70%, P = 0.0009). Moreover, topical steroids were useful in gaining clinical response (OR 2.53, 95% CI 1.14–5.60, P = 0.02; I² = 60%, P = 0.02) and endoscopic response (OR 3.51, 95% CI 1.47–8.36, P = 0.005; I² = 0, P = 0.57). Generally, topical steroids are well tolerated. The most common adverse events are infections and infestations (59 cases).ConclusionTopical steroids were effective in inducing histological, clinical and endoscopic response in the short-term, and the adverse events were almost tolerable; however, we should interpret the result of clinical and endoscopic response with caution.