Interactions Between Genotype and Depressive Symptoms on Obesity

Depression and Genetic variation in serotonin and monoamine transmission have both been associated with body mass index (BMI), but their interaction effects are not well understood. We examined the interaction between depressive symptoms and functional polymorphisms of serotonin transporter (SLC6A4) and monoamine oxidase A (MAOA) on categories of BMI. Participants were from the National Longitudinal Study of Adolescent Health. Multiple logistic regression was used to investigate interactions between candidate genes and depression on risk of obesity (BMI ≥ 30) or overweight + obese combined (BMI ≥ 25). Males with an MAOA active allele with high depressive symptoms were at decreased risk of obesity (OR 0.22; 95% CI 0.06–0.78) and overweight + obesity (OR 0.48; 95% CI 0.26–0.89). No similar effect was observed among females. These findings highlight that the obesity–depression relationship may vary as a function of gender and genetic polymorphism, and suggest the need for further study. Handling editor: Tatiana Foroud.     

Longevity-associated NADH dehydrogenase subunit-2 237 Leu/Met polymorphism influences the effects of alcohol consumption on serum uric acid levels in nonobese Japanese men

NADH dehydrogenase subunit-2 237 leucine/methionine (ND2-237 Leu/Met) polymorphism is reportedly associated with longevity in the Japanese population. The ND2-237Met genotype may confer resistance to cardiovascular and cerebrovascular atherogenic diseases. Hyperuricemia is one of the risk factors for cardiovascular disease. To investigate whether ND2-237 Leu/Met polymorphism is associated with serum uric acid (SUA) levels, we conducted a cross-sectional study in 321 healthy Japanese male subjects. In nonobese (body mass index, BMI<25) male subjects, interaction between ND2-237 Leu/Met genotypes and drinking frequency on SUA levels was observed (P=0.031). The SUA levels were significantly higher in daily drinkers with ND2-237Leu than in non-daily drinkers with ND2-237Leu (P=0.018). In nonobese men, after adjustment for covariates, daily drinkers with ND2-237Leu had a significantly higher odds ratio (OR) for hyperuricemia (SUA≥6.5 mg/dl: vs. daily drinkers with ND2-237Met, OR=3.26, 95% confidence interval (CI) 1.14–9.29; vs. non-daily drinkers with ND2-237Leu, OR=3.22, 95% CI 1.39–7.45; SUA≥7.0 mg/dl: vs. non-daily drinkers with ND2-237Met, OR=3.53, 95% CI 1.00–12.4). However, in obese (BMI≥25) men, no significant interaction between ND2-237 Leu/Met polymorphism and habitual drinking on SUA levels or on the risk for hyperuricemia was observed. These results suggest that ND2-237 Leu/Met polymorphism modulates the effects of daily alcohol consumption on SUA levels in nonobese Japanese men.     

Carbohydrate-deficient transferrin as a marker of heavy drinking in Korean males

This study was performed to evaluate the usefulness of carbohydrate-deficient transferrin (CDT) as a marker of heavy drinking in Korean males. The subjects (143 Korean males) were classified into 2 groups according to the amount of drinking, moderate drinkers (72 individuals) who drank 14 drinks or less per week and heavy drinkers (71 individuals) who drank more than 14 drinks per week. Using %CDT, gamma glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) as clinical markers for heavy drinking, sensitivity, specificity, positive and negative predictive values were investigated. Sensitivities of %CDT, GGT, AST, and ALT were 83.1%, 67.6%, 52.1% and 46.5%, respectively. Specificities were 63.9%, 45.8%, 72.2%, and 54.2%, respectively. Positive predictive values were 69.4%, 55.2%, 64.9%, and 50.0% respectively. Negative predictive values were 79.3%, 58.9%, 60.5%, and 50.6% respectively. The areas under the receiver operating characteristic curve (95% confidence interval) for %CDT, GGT, AST, and ALT were 0.823 (0.755-0.891), 0.578 (0.484-0.673), 0.622 (0.528-0.717), and 0.516 (0.420-0.613), respectively. CDT is considered as the most reliable marker for detecting heavy drinking in Korean males.     

Association between elevated serum hepatic enzyme activity and total body fat in obese humans

To investigate the associations between obesity and serum hepatic enzyme activities, we measured total body fat (TBF), body mass index (BMI), and hepatic biochemical parameters in 732 apparently healthy adults. TBF was assessed using a body fat analyzer. Serum activities of alanine and aspartate aminotransferase (ALT and AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and lactate dehydrogenase (LD) were determined by standard spectrophotometric methods. Mean activities (+/- SD) of serum ALT and AST in men with high fatness were 51.2 +/- 12.6 U/L and 32.9 +/- 9.2 U/L, which were significantly higher than those in men with low fatness (23.5 +/- 7.4 U/L and 22.5 +/- 7.8 U/L, p < 0.01). Of 147 men with high fatness, 56 (38.1%) had serum ALT levels above the upper limit of normal, whereas only 9.5% (31/328) of men with low or desirable fatness showed elevated serum ALT activities (p < 0.01). Serum ALT, AST, and GGT activities correlated significantly with TBF in both overweight men and women. Among subjects having high TBF, those with fatty liver showed significantly higher incidence of elevated hepatic enzymes, compared to those without fatty liver. In short, elevated serum hepatic enzyme activities are associated with TBF and a high prevalence of fatty liver is observed in subjects with elevated TBF.     

The association between major depressive disorder and obesity in US adolescents: results from the 2001–2004 National Health and Nutrition Examination Survey

The association between major depressive disorder (MDD) and obesity was assessed in 4,150 US adolescents aged 12–19 years from the 2001–2004 National Health and Nutrition Examination Survey. Weight and height were measured by health professionals and MDD was based on a structured diagnostic interview. The prevalence of MDD in the past year among US adolescents was 3.2% and 16.8% of US adolescents were obese. After adjustment for sex, age, race/ethnicity and poverty, MDD was not significantly associated with obesity among adolescents overall (adjusted odds ratio (adjOR) = 1.6, 95% confidence interval (CI) = 0.9–2.9), but an increased odds of obesity was observed among males (adjOR = 2.7, 95% CI = 1.1–7.1) and non-Hispanic blacks (adjOR = 3.1, 95% CI = 1.1–8.3) with MDD. Future research on strategies that might reduce the risk of obesity in males and non-Hispanic black adolescents with MDD may be warranted.     

The epidemiology of extraintestinal non-typhoid Salmonella in Israel: the effects of patients’ age and sex

Extraintestinal disease occurs in 5–8% of non-typhoid Salmonella enterica (NTS) infections and is more likely to be associated with hospitalization and death. The study examined the epidemiology of extraintestinal NTS infections in Israel and the possible effects of patients’ age and sex. NTS isolates passively submitted to the National Salmonella Reference Center during 1996–2006 were the source for the study cohort. Poisson regression models were used to assess incidence trends over the study years and to evaluate the effects of patients’ age and sex on the incidence of extraintestinal NTS manifestations. A total of 36,822 stool and 1,415 (3.7%) patient-unique NTS isolates from blood (74.1%), urine (18.3%), and other sources (3.7%) were studied. Serotypes Enteritidis, Virchow, and Typhimurium accounted for 66.3% of the isolates. Analysis showed a highly significant quadratic (U-shaped) relationship between patients’ age and the incidence of extraintestinal isolation (p < 0.001), with increasing risk in the two extremes of age. Differences between the incidence of blood and urine sources were significant in patients <10 and ≥60 years old (relative risk [RR] = 5.88, 95% confidence interval [CI] 3.36–10.30, p < 0.001 and RR = 1.66, 95% CI 1.09–2.53, p = 0.017, respectively). Males ≥60 years of age were more likely than females of the same age to have bacteremia (RR = 1.90, 95% CI 1.39–2.61, p > 0.001) and less likely to have urinary NTS isolation (RR = 0.50, 95% CI 0.28–0.89, p = 0.018). Serotype Virchow had the highest incidence in patients <10 years of age, while serotype Enteritidis had the highest incidence in patients ≥60 years old. The study revealed a complex effect of patients’ age and sex on the epidemiology of extraintestinal NTS manifestations.     

Effect of manganese on thyroid function in sheep

Ten healthy adult male sheep aged about 1 year old were randomly allocated into two equal groups of control (no treatment group, n = 5) and experiment (n = 5). The two groups were kept under the same conditions of food and environment. Sheep of experimental group received MnSO₄, H₂O (5 mg/kg/day, SC) from day 0 for 8 weeks. Blood sampling of the two groups were done on days 0, 14, 28, 42, 56, and 70 at 11 a.m. Serum T4, T3, FT3, FT4, TSH, manganese, creatinine, and blood urea nitrogen concentrations were measured. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and serum alkaline phosphatase (ALP) activities were estimated by conventional methods. Serum and urine GGT activities were also measured. Urine samples were tested by urine dipstick analysis. Results indicated that serum manganese concentration was increased significantly on days 14, 28, 42, 56, and 70 of manganese administration (p < 0.05). The changes in serum enzyme activities ALP, GGT, AST, ALT, and urea and creatinine concentrations during these days were not significant. Changes of urine GGT activity were not significant. Serum TSH, FT3, FT4, T3, and T4 concentrations decreased differently on days 14, 28, 42, and 56 (p < 0.05). Urinalysis by urine dipstick analysis was normal.     

The association between serum liver enzymes and cancer mortality

Interpreting levels of liver enzymes is often challenging because they may be influenced by metabolic processes beyond the liver. Given their pathophysiologic roles in inflammation and oxidative stress, higher levels of these enzymes may be associated with increased risk of mortality. However, studies have found inconsistent results. Thus, we examined the association of liver enzymes levels with cancer mortality in the general US adult population. We used the US National Health and Nutrition Examination Survey from 1999 to 2016. Kaplan–Meier survival curve comparisons were examined across quartiles of liver enzymes. Cox proportional hazards models were built to examine the relationship between cancer mortality and liver enzymes quartiles without and with adjustment for potential confounding factors. During the 338,882 person-years follow-up, 1059 participants had cancer-related deaths. There was a nonlinear U-shaped relationship between serum alanine and aspartate aminotransferase (ALT and AST) levels and cancer mortality. There was no relationship between cancer mortality and gamma-glutamyltransferase (GGT); however, each 10 IU/L increase in GGT after median was associated with 1% higher mortality risk (HR?=?1.01; 95% CI?=?1.00, 1.02; P?=?0.001). Only subjects with high levels of alkaline phosphatase (ALP) had higher cancer mortality (HR?=?1.63; 95CI?=?1.30, 2.05; P?<?0.001 and HR?=?1.52; 95%CI?=?1.20, 1.94; P?=?0.001, respectively). Only the lowest and highest serum ALT and AST levels are associated with increased cancer mortality. For ALP, the relationship is present at higher levels. The association with GGT was not robust to different analyses. The mechanisms underlying the observed relationships need further exploration.

     

Determinants for the Development of Oropharyngeal Colonization or Infection by Fluconazole-Resistant Candida Strains in HIV-Infected Patients

 A point prevalence study to document oral yeast carriage was undertaken. Risk factors for the development of oropharyngeal colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients were investigated with a case-control design. Cases included all patients with fluconazole-resistant strains (MIC≥64 μg/ml), and controls were those with susceptible (MIC≤8 μg/ml) or susceptible-dependent-upon-dose (MIC 16–32 μg/ml) strains. One hundred sixty-eight Candida strains were isolated from 153 (88%) patients, 28 (16%) of whom had oropharyngeal candidiasis. Overall, 19 (12%) of the patients harbored at least one resistant organism (MIC≥64 μg/ml). Among patients with resistant strains, tuberculosis (P<0.001), esophageal candidiasis (P=0.001), clinical thrush (P<0.001), and a CD4+ cell count <200/mm³ (P=0.03) were more frequent. These patients had also been treated more commonly with antituberculous drugs (adjusted odds ratio [OR] 6.13; 95% confidence interval [CI] 2.11–17.80), ciprofloxacin (OR 6.0; 95% CI 1.23–29.26), fluconazole (OR 4.59; 95% CI 1.55–13.52), and steroids (OR 4.13; 95% CI 1.11–15.39). Multivariate analysis showed that the determinants for fluconazole resistance were therapy with antituberculous drugs (OR 3.61; 95% CI 1.08–12.07;P=0.03) and one of the following: previous tuberculosis (OR 3.53; 95% CI 1.08–14.57;P=0.03) or fluconazole exposure (OR 3.41; 95% CI 1.10–10.54). Findings from this study indicate that treatment with antituberculous drugs, previous tuberculosis, and fluconazole exposure are the strongest determinants for development of oropharyngeal colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients.     

Effect of cadmium on thyroid function in sheep

The objective of this experiment was to determine the effect of long-term low-dose administration of cadmium on thyroid function in sheep. In this experiment, ten healthy Iranian male sheep, aged about 1 year old, were randomly allocated into two equal groups of control (n = 5) and experiment (n = 5). Both groups were kept under the same conditions of food and environment. Treatment group received cadmium chloride (1 mg/kg/day) orally for 8 weeks. Blood sampling of two groups was done on days 0, 14, 28, 42, 56, and 70 every morning (8 to 9 a.m.). The function of the thyroid was evaluated by measuring the levels of serum thyroid hormones T3, T4, FT3, FT4, and TSH. The hepatic function in both groups was evaluated by measuring hepatic enzyme activities including alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ glutamyl transferase (GGT), and total bilirubin (TBIL). Serum levels of T3, T4, FT3, FT4, and TSH significantly decreased in cadmium-treated sheep when compared to control group (p < 0.05). Serum enzyme activities of ALT, AST, GGT, and TBIL in Cd-treated sheep were significantly increased in comparison with control group (p < 0.05). Our findings suggest that Cd-exposed sheep can be at a risk of low thyroid function.     

Parental characteristics as predictors of birthweight

BACKGROUND: Previous studies provided conflicting results on the relevanceof parental characteristics for offspring's size at birth. Theobjective of this study was to investigate parental predictorsof birthweight. METHODS: In this cross-sectional study, 34 063 women in the Nurses' Mother'sCohort were queried about parental characteristics during thepregnancy with and birthweight of their nurse daughter. RESULTS: The predictive linear regression model of birthweight included13 factors and the majority of the predictive power came fromparental anthropometric factors. In the adjusted analysis, dailyconsumption of each additional glass of milk was associatedwith an increase of 6 g in birthweight (P for trend = 0.01)and daily consumption of each additional cup of coffee was associatedwith a decrease of 10 g in birthweight (P for trend < 0.0001).Drinking 1–2, 3–4 and 5+ cups of coffee daily wasassociated with a 28% [95% confidence interval (CI) 0.12, 0.47],30% (95% CI 0.10, 0.55) and 63% (95% CI 0.25, 1.12) increase,respectively, in the odds of intrauterine growth restrictionwhen compared with non-drinkers. CONCLUSIONS: The present study confirmed several previously reported determinantsof birthweight. Maternal dietary intake of milk and coffee duringpregnancy may influence fetal growth.     

Diphtheria Antibody Levels in the Italian Population

 Immunity to diphtheria was assessed in serum samples obtained from 3111 healthy Italian males and females aged 0–84 years. Diphtheria antitoxin was tested using a double-antigen, time-resolved fluorescence immunoassay (DA-DELFIA). According to internationally accepted criteria, antitoxin concentrations <0.01 IU/ml indicate susceptibility to diphtheria, those ≥0.01–0.09 IU/ml provide basic or inadequate protection, and concentrations ≥0.1 IU/ml are protective. By these criteria, 9.9% (95% CI, 8.9 to 11.18) of the participants were susceptible to diphtheria, 30.2% (95% CI, 28.6 to 31.9) had basic protection, and 59.9% (95% CI, 58.1 to 61.6) were protected. The prevalence of unprotected individuals showed an age-related increase, up to the 45–49-year-old age group for females and the 50–54-year-old age group for males (34.9% and 31.3% of individuals, respectively). The prevalence of immunity did not significantly differ in relation to sex in any of the age groups. These results indicate that booster shots should be routinely provided to the adult population in order to maintain a protective level of diphtheria antibodies.     

Feasibility of diagnosing influenza within 24?hours of symptom onset in children 1–3?years of age

Diagnosing influenza at an early stage of illness is important for the initiation of effective antiviral treatment. However, especially in young children, influenza often commences with an abrupt onset of fever, with full-blown respiratory symptoms developing only later. We determined the feasibility of diagnosing influenza in young children already during the first signs of the illness. During confirmed influenza activity, we obtained nasal swabs from children aged 1–3 years who presented as outpatients within 24 hours of the onset of fever (≥38.0°C). The specimens were tested for influenza viruses with viral culture, antigen detection, PCR, and a rapid point-of-care test (Actim Influenza A&B, Medix Biochemica, Finland). In addition, follow-up specimens were obtained from a proportion of children 3–7 days later. Influenza virus was detected already within 24 hours of symptom onset in 56 of 61 (92%; 95% CI 82–97%) children in whom influenza was eventually confirmed in the laboratory. A total of 158 rapid tests performed within 24 hours of symptom onset yielded a sensitivity of 90% (95% CI 74–98%) for influenza A viruses but only 25% (95% CI 3–61%) for influenza B viruses (P < 0.001), resulting in an overall sensitivity of 77% (95% CI 61–89%) and specificity of 99% (95% CI 95–100%) for all influenza viruses. In most young children, influenza can already be accurately diagnosed within 24 hours of symptom onset. The rapid point-of-care test used was sensitive and specific for diagnosing influenza A, but its sensitivity for influenza B was limited.     

Serum enzyme levels and influencing factors in three indigenous Ethiopian sheep breeds

Serum enzymes were studied in 377 apparently healthy sheep from three indigenous sheep breeds of Ethiopia. The effect of breed, age, sex and season on alanine aminotransferase (ALT)/glutamic pyruvic transaminase (GPT), aspartate aminotransferase (AST)/glutamic oxalacetic transaminase (GOT), alkaline phosphatase (ALP) and acid phosphatase (AcP) levels was assessed. The mean serum enzymes levels of the indigenous Menz, Tukur and Wello sheep breeds ranged from 17.2–17.7 IU l⁻¹, AST/GOT from 50.4–56.6 IU l⁻¹, ALP from 93.2–103.9 IU l−¹, and AcP from 2.47–2.56 IU l⁻¹, were within the normal range for sheep elsewhere. Season had significant influence on all serum enzymes except for the AcP in Menz breed. Sex had significant effect on AST/GOT for Menz and on ALP for all sheep breeds, with consistently higher values in males than in females. Age was significant only on ALP in the Menz and Tukur breeds. The serum enzyme levels of these indigenous sheep breeds can be used as normal reference values for Ethiopian sheep breeds adapted to similar agro-ecology and production system.     

Pregnancy: Alcohol and risk of spontaneous abortion

The objective of this study was to assess the association betweenalcohol drinking before and during pregnancy and the risk ofspontaneous abortion using data from a case-control study conductedin Milan, Italy. A total of 462 women (median age 30 years)were admitted for spontaneous abortion (within the 12th weekof gestation) to a network of obstetrics departments in thegreater Milan area. Of these, 148 (32%) were between the fourthand the eighth week of gestation and 314 (68%) between the ninthand the 12th week. A control group was made up of 814 women(median age 29 years) who gave birth at term (>37 weeks gestation)to healthy infants (Apgar 5th minute 8, weight 3000 g) on randomlyselected days at the same hospitals where cases had been identified.A total of 212 cases (46%) and 355 controls (47%) reported alcoholdrinking before conception. Considering non-drinkers as thereference category, the relative risks (RR) of spontaneous abortionwere 1.2 (95% confidence interval (CI), 0.9–1.6] and 0.8(95% CI, 0.6–1.1), respectively, in drinkers of one toseven and more than seven drinks per week before conception.No association emerged between the duration of alcohol drinkingand the risk of spontaneous abortion. A total of 166 cases (35.9%)and 263 (32.3%) controls reported any alcohol drinking duringthe first trimester of pregnancy. The corresponding relativerisk was 1.1 (95% CI, 0.9–1.4) and no relationship emergedbetween the number of drinks per week and the risk of abortion.Likewise, maternal wine and beer drinking in the first trimesterof pregnancy was not associated with the risk of spontaneousabortion. Evidence available from this and previous studies,although partially controversial, indicates that moderate (oneor two drinks per day) alcohol consumption does not increasemarkedly the risk of miscarriage.     

Comparative serum biochemical profiles of three types of donkeys in Ethiopia

A cross-sectional study was conducted on the three types of working donkeys in Ethiopia (Abyssinian, Ogaden, and Sennar) while they are in their ecological adaptation sites to evaluate and compare the reference values of serum biochemical profiles. Blood samples were collected from a total of 229 apparently healthy adult working donkeys (134 Abyssinian, 55 Ogaden, 40 Sennar types), and ten serum biochemical analytes (total serum protein, glucose, creatinine, gamma glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), sodium, chloride, and potassium) were analyzed using a commercial kit (Centronic GmbH, Wartenberg, Germany) for the target groups. A comparison based on the serum biochemical profile of the three donkey types irrespective of sex has shown significantly lower serum activities of ALT (19.20?±?3.55 IU/l; CI, 18.06–20.34) and AST (178.13?±?55.70; confidence interval (CI), 160.31–195.94) for Sennar donkeys compared to the activities of ALT (23.65?±?7.73; CI, 21.56–25.75) and AST (240.60?±?110.20; CI, 210.81–270.39) (P?<?0.05) for Ogaden-type adult donkeys. A significantly lower serum activity of GGT (36.36?±?14.70 IU/l; CI, 33.85–38.87) was observed for Abyssinian donkeys than for Ogaden donkeys (48.24?±?16.59 IU/l; CI, 43.75–52.72) (P?<?0.001). The serum sodium (147.55?±?21.81 mmol/l; CI, 141.65–153.44) and chloride (116.67?±?16.23 mmol/l; CI, 112.28–121.06) concentrations of Ogaden donkeys were found to be significantly higher than the sodium (132.68?±?14.16 mmol/l; CI, 128.15–137.20) and chloride (104.50?±?6.45 mmol/l; CI, 102.44–106.56) (P?<?0.001) concentrations of Sennar donkeys. A significantly higher serum potassium concentration (4.84?±?0.63 mmol/l; CI, 4.73–4.94) of Abyssinian donkeys was found compared to those of Sennar (4.38?±?0.49 mmol/l; CI, 4.22–4.54) and Ogaden donkeys (4.31?±?0.78 mmol/l; CI, 4.10–4.52) (P?<?0.05). There was no significant variation in the serum concentration of total protein, glucose, creatinine, and ALP activity among the three types of donkeys. A comparison of the serum biochemical profile of adult jacks has shown a significantly different result for the serum activities of GGT, ALT, and AST and the concentrations of serum chloride and sodium among the three donkey types. Abyssinian jennies in Afar had significantly higher serum activities of AST (248.92?±?120.05 IU/l; CI, 202.78–295.07) (P?<?0.05) and ALT (29.04?±?8.34 IU/l; CI, 25.83–32.24) (P?<?0.001) than the AST (192.57?±?66.60 IU/l; CI, 176.97–208.17) and ALT (20.76?±?6.61 IU/l; CI, 19.21–22.31) activities for jennies in Sebeta but had lower serum glucose and chloride concentrations. In conclusion, the findings of the present study could be used as reference values for the serum biochemical parameters of the three types of donkeys in Ethiopia, and clinical interpretation of the biochemical parameter based on the standard reference values should consider the types of donkeys.     

Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study

The purpose of this paper is to determine the incidence of fungal colonization and infection in non-neutropenic critically ill patients and to identify factors favoring infection by Candida spp. A total of 1,655 consecutive patients (>18 years of age) admitted for ≥7 days to 73 medical-surgical Spanish intensive care units (ICUs) participated in an observational prospective cohort study. Surveillance samples were obtained once a week. One or more fungi were isolated in different samples in 59.2% of patients, 94.2% of which were Candida spp. There were 864 (52.2%) patients with Candida spp. colonization and 92 (5.5%) with proven Candida infection. In the logistic regression analysis risk factors independently associated with Candida spp. infection were sepsis (odds ratio [OR] = 8.29, 95% confidence interval [CI] 5.07–13.6), multifocal colonization (OR = 3.49, 95% CI 1.74–7.00), surgery (OR = 2.04, 95% CI 1.27–3.30), and the use of total parenteral nutrition (OR = 4.37, 95% CI 2.16–8.33). Patients with Candida spp. infection showed significantly higher in-hospital and intra-ICU mortality rates than those colonized or non-colonized non-infected (P < 0.001). Fungal colonization, mainly due to Candida spp., was documented in nearly 60% of non-neutropenic critically ill patients admitted to the ICU for more than 7 days. Proven candidal infection was diagnosed in 5.5% of cases. Risk factors independently associated with Candida spp. infection were sepsis, multifocal colonization, surgery, and the use of total parenteral nutrition.     

Appropriateness of blood culture testing parameters in routine practice. Results from a cross-sectional study

We aimed to assess the appropriateness of routine blood culture testing parameters and antimicrobial therapy for patients with suspected bloodstream infection. We conducted a cross-sectional study of blood cultures registered in the microbiological laboratory at a university-affiliated hospital from 4 to 15 June 2007. Using a structured implicit chart review, two infectious disease specialists assessed the appropriateness of the testing parameters and antimicrobial therapy. Overall, 2,696 blood culture bottles were collected from 260 patients during their stay, including 955 bottles that were evaluated during the study period. The indication of fungal and bacterial blood cultures was rated as appropriate for 75% (95% confidence interval [CI], 65–83) and 91% (95% CI, 87–95) of patients. Only 45% (95% CI, 39–52) of patients had an adequate number of blood cultures (i.e., two to four). An optimal volume of blood (i.e., ≥10 mL) was inoculated in 13% (95% CI, 11–15) of adult bottles. Empirical antimicrobial therapy was appropriate for 60% (95% CI, 43–76) of patients with positive blood cultures. There is room for improvement regarding routine blood culture testing parameters and antimicrobial therapy. The effectiveness of multifaceted interventions in altering the appropriateness of blood culture parameters deserves further research.     

Clinical and microbiological characteristics of urine culture-confirmed genitourinary tuberculosis at medical centers in Taiwan from 1995 to 2007

All patients with urine culture-confirmed genitourinary tuberculosis (GUTB) diagnosed between 1995 and 2007 at two medical centers in northern Taiwan were included in this retrospective study. Genotypes of 48 preserved Mycobacterium tuberculosis (MTB) isolates from these patients were determined by spoligotyping and double repetitive element PCR (DRE-PCR) analysis. Among the 64 patients, 38 (59.4%) were male with a mean ±SD age of 60.3 ± 16.1 years old. The overall mortality rate was 26.2%. Poor prognostic factors included age over 65 years (HR = 4.03; 95%; CI: 1.27–12.76), cardiovascular disease (HR = 5.96; 95% CI: 1.98–17.92), receiving steroids (HR = 10.16; 95% CI: 2.27–45.47), not being treated (HR 4.81; 95% CI 1.12–20.67). Spoligotyping and DRE-PCR of the 48 MTB isolates revealed that 20 (41.7%) belonged to the Beijing family and 40 (83.3%) had a clustering pattern. Identification of a Beijing family isolate was not correlated with drug resistance or mortality. Clustering strains were likely to be resistant to isoniazid (OR = 4.71; 95% CI: 1.10 to 23.53). In this study of patients with urine culture-confirmed GUTB, age and coexisting diseases were independently associated with an unfavorable outcome. The Beijing family was the dominant genotype of GUTB isolates, but did not correlate with drug resistance or outcome.     

血清谷氨酰转肽酶含量测定在慢性乙型肝炎中的临床意义

目的探讨血清谷氨酰转肽酶（GGT）含量变化在慢性乙型肝炎（CHB）不同程度肝脏病理损害中的变化规律及临床意义。方法测定70例CHB患者血清ALT、AST、GGT水平，同时行肝活体组织检查，对肝脏进行炎症分级和纤维分期。分析ALT、AST、GGT与CHB之间的关系。结果（1）ALT、AST、GGT随炎症程度和纤维化程度的上升而上升，但到G4和s4后则下降。GGT随ALT、AST的升高而升高，ALT、AST和GGT的相关系数分别为：0．322、0．328（P〈0．05）。在保肝治疗后，ALT较快降至正常且GGT保持在一个较低水平的为轻度CHB，而随着ALT下降，GGT仍持续在一个较高水平的为中度及重度CHB，其中重度CHB的GGT水平有所波动。结论血清GGT比ALT、AST更准确的反映肝脏的炎症程度，GGT的活动度给临床判断慢乙肝的炎症提供了重要的判断依据。