First molecular characterization of Giardia duodenalis from goats in Malaysia

In the present study, 310 faecal samples from goats from eight different farms in Malaysia were tested for the presence of Giardia using a PCR-coupled approach. The nested PCR for SSU amplified products of the expected size (～200 bp) from 21 of 310 (6.8%) samples. Sixteen of these 21 products could be sequenced successfully and represented six distinct sequence types. Phylogenetic analysis of the SSU sequence data using Bayesian Inference (BI) identified Giardia assemblages A, B and E. The identification of the ‘zoonotic’ assemblages A and B suggests that Giardia-infected goats represent a possible reservoir for human giardiasis in Malaysia.     

Prediction of iron deficiency in chronic inflammatory rheumatic disease anaemia

Summary. We prospectively studied 45 anaemic patients (3 7 women, 8 men) with chronic inflammatory rheumatic diseases. The combination of serum ferritin and CRP (as well as ESR) in its predictive capacity for bone marrow iron stores was examined. The relationship between other iron-related measurements (transferrin, transferrin saturation, soluble transferrin receptor, erythrocyte porphyrins and percentage of hypochromic/microcytic erythrocytes) and bone marrow iron stores was also investigated. Stainable bone marrow iron was taken as the most suitable standard to separate iron-deficient from iron-replete patients. 14 patients (31%) were lacking bone marrow iron. Regression analysis showed a good correlation between ferritin and bone marrow iron (adjusted R ²=0.721, P<00001). The combination of ferritin and CRP (ESR) did not improve the predictive power for bone marrow iron (adjusted R ²=0.715) in this cohort of patients with low systemic inflammatory activity. With respect to the bone marrow iron content the best predictive cut-off value of ferritin was 30μg/l (86% sensitivity, 90% specificity). The other iron-related parameters both individually and when combined were less powerful in predicting bone marrow iron than ferritin alone. Only zinc bound erythrocyte protoporphyrin in combination with ferritin slightly improved prediction (adjusted R ²=0.731). A cut-off point of 11% hypochromic erythrocytes reached a high specificity (90%), but was less sensitive (77%).     

Barriers to interferon-alpha therapy are higher in intravenous drug users than in other patients with acute hepatitis C

BACKGROUND/AIMS: Treatment with interferon-alpha (IFN-alpha) may eradicate HCV in most acute hepatitis C patients, thus preventing chronic hepatitis and avoiding less efficacious combination therapy. METHODS: In a prospective study, we evaluated the impact of barriers to successful start and completion of treatment of acute and subacute (<12 months from infection) hepatitis C with pegylated IFN-alpha2b, 1.5 microg/kg, QW, for 24 weeks. RESULTS: Out of 27 patients (22 were active intravenous drug users [IVDU]), 5 cleared HCV spontaneously. Antiviral treatment was indicated in 22 patients: six refused therapy for fear of side effects, whereas two others were lost to observation. Eight patients completed the treatment or received >80% of the scheduled drug: seven (88%) were sustained virological responders 24 weeks after the end of treatment. Six patients (all IVDU) stopped prematurely due to side effects: only one had a sustained virological response. Based on an intent-to-treat analysis, and considering all 14 patients in whom at least one dose of drug was administered, only 8 (57%) became sustained virological responders. CONCLUSIONS: Treatment of acute hepatitis C with pegylated IFN-alpha is highly beneficial, but its effectiveness is affected by a poor rate of acceptance and/or adherence to currently available regimens, especially in IVDU and women.     

Ultra-sensitive TSH levels: an aid in the screening for amiodarone-induced thyroid dysfunction

Amiodarone modifies thyroid hormone secretion and hypothyroidism occurs in some cases. The latter diagnosis is often difficult and is of particular importance in these patients as it may have serious consequences for the heart. Early diagnosis is therefore essential but difficult because of the induced hyperthyroxinemia with maintenance of euthyroidism and a hypotriiodothyronemia. The diagnostic performance of an ultrasensitive method of measuring TSH (TSH-U), capable of distinguishing hyper and euthyroidism were compared with standard thyroid function tests and TSH stimulation with TRH in 50 patients treated with amiodarone. Only 6 of the 14 patients with hyperthyroxinaemia had TSH-U values in the hyperthyroid range: only one of these patients had an increased triiodothyronine. In 2 cases the THS-U was low but the T4L was normal. In 4 patients, increased TSH-U allowed diagnosis of latent or patent hypothyroidism. There was a close correlation between results of the TRH stimulation test and those of the TSH-U in all cases. This test may therefore be used as an initial screening test for thyroid dysfunction in patients on amiodarone and is simple, reliable and relatively cheap to perform. It makes it unnecessary to measure all thyroid hormonal parameters and the TRH test simultaneously.     

Growth processes leading to a large or small adult size

Background: The way in which a large size in anthropometric variables is achieved is a longstanding problem, since the pubertal spurt shows statistically and clinically little association with adult size (mostly studied for height). By analysing longitudinal growth of groups of subjects with a large or a small adult size separately for height, leg and sitting height, and bihumeral and biiliac width, we studied this problem in some detail. Of interest are growth patterns specific for these variables and for boys or girls.

Methods: The data consist of 120 boys and 112 girls followed longitudinally from 4 weeks until adulthood. Statistically, structural average velocity curves were computed for each variable and each subgroup separately for comparison. This velocity curve represents the average intensity and the average tempo of growth. Since the area under the velocity curve is adult size, differences in the growth process can be visualized.

Results: Both sexes show similar patterns in reaching a small or large adult size. The different variables, however, show marked differences. Only for legs is the pubertal spurt delayed for the large groups (with additional gains in prepubertal years). For sitting height and biiliac width, a slightly elevated velocity all along development (after 2 years) leads to a larger size and for bihumeral width the size of the pubertal peak is decisive.

Conclusions: The steering of growth to a certain target size is qualitatively similar for boys and girls, but quite different for different anthropometric variables. This leads to questions about endocrinological control for various parts of the body and differential bone growth in development.

Hintergrund: Die Art, in der anthropometrische Variable die Erwachsenengröße erreichen, ist ein seit langer Zeit bestehendes Problem, da der puberale Spurt statistisch und klinisch nur geringe Assoziationen zur Erwachsenengröße zeigt (am häufigsten untersucht für die Körperhöhe). Wir untersuchten dieses Problem detailliert durch die Analyse des longitudinalen Wachstums von Probandengruppen mit großer oder geringer Erwachsenengröße jeweils für Körperhöhe, Beinlänge, Sitzhöhe sowie Ellbogenbreite und Beckenbreite. Dabei waren die Wachstumsmuster speziell für diese Variablen für Jungen und Mädchen von Interesse. Methodik: Die Daten stammen von 120 Jungen und 112 Mädchen, die von der vierten Lebenswoche bis zum Erwachsenenalter longitudinal untersucht wurden. Statistisch wurden die strukturellen mittleren Kurven der Wachstumsgeschwindigkeit für jede Variable und zum Vergleich getrennt für jede Untergruppe berechnet. Diese Geschwindigkeitskurven stellen die mittlere Intensität und das mittlere Tempo des Wachstums dar. Da die Fläche unter der Geschwindigkeitskurve die adulte Größe darstellt, können auf diese Weise Unterschiede im Wachstumsprozess verdeutlicht werden. Ergebnisse: Beide Geschlechter zeigen ähnliche Muster hinsichtlich des Erreichens einer geringen oder großen Erwachsenengröße. Die einzelnen Variablen weisen jedoch erhebliche Unterschiede auf. Nur bei der Beinlänge ist der puberale Wachstumsspurt in der Gruppe mit großer Endgröße verzögert (mit einem zusätzlichen Zuwachs in den präpuberalen Jahren). Bei der Sitzhöhe und der Beckenbreite führt eine geringfügig gesteigerte Geschwindigkeit während der gesamten Entwicklung (nach dem zweiten Lebensjahr) zu einer größeren Erwachsenengröße und bei der Ellbogenbreite ist die Höhe des puberalen Wachstumsgipfels ausschlaggebend. Schlussfolgerungen: Die Steuerung des Wachstums hin zu einer bestimmten Zielgröße ist für Jungen und Mädchen qualitativ ähnlich, dagegen ziemlich unterschiedlich für verschiedene anthropometrische Variable. Daraus ergeben sich Fragen bezüglich der endokrinologischen Steuerung des Wachstums verschiedener Körperteile und eines unterschiedlichen Knochenwachstums während der Entwicklung.

Arrière plan: Considérant qu'il y a peu d'association statistique et clinique entre la poussée pubertaire et le format adulte (surtout étudié pour la stature), la façon dont de grandes valeurs des dimensions anthropométriques sont atteintes, demeure un problème irrésolu. C'est à cela que s'attache ce travail, en procédant par l'analyse de la croissance longitudinale d'un groupe de sujets de format corporel adulte soit petit soit grand, pour lesquels sont considérées séparément, les dimensions de la stature, de la jambe, de la taille-assis, de la largeur bihumérale et de la largeur biiliaque. En particulier, s'est-on intéressé aux modalités spécifiques de croissance de ces variables chez les garçons et chez les filles. Méthodes: Les données portent sur 120 garçons et 112 filles suivis longitudinalement de l'âge de quatre semaines jusqu'à l'état adulte. Des courbes statistiques de vélocitéstructurale moyenne ont été établies pour comparaison dans chaque sous-groupe séparément et pour chaque variable. Cette courbe de vélocité représente l'intensité moyenne et le tempo moyen de la croissance. L'aire située au-dessous de la courbe étant la taille adulte, des différences dans le processus de croissance peuvent ainsi être observées. Résultats: Les deux sexes montrent des modalités similaires dans l'atteinte de la taille adulte, qu'elle soit petite ou grande. Les diverses variables montrent cependant des différences marquées. La poussée pubertaire n'est retardée que pour les jambes, dans le groupe de grand format (avec des gains additionnels pendant la période prépubertaire). Pour la taille-assis et la largeur biiliaque, une vélocité modérément élevée pendant l'ensemble du développement (après deux ans) conduit à une taille plus grande; pour la largeur bihumérale, on observe que l'importance du pic pubertaire est décisive. Conclusions: le déroulement de la croissance jusqu'à atteindre une dimension projetée est qualitativement semblable pour les garçons et pour les filles, mais très différent suivant les variables anthropométriques concernées. Ceci conduit à s'interroger sur le contrôle endocrinologique de diverses parties du corps, ainsi que sur la croissance osseuse différentielle pendant le développement.