Comparative outcomes of epidural steroids versus placebo after lumbar discectomy in lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials

European Journal of Orthopaedic Surgery & Traumatology - Treatment for lumbar disc herniation after failed conservative treatment is discectomy. Discectomy can significantly relieve back pain...     

International spread of multidrug-resistant Salmonella Schwarzengrund in food products

We compared 581 Salmonella enterica serotype Schwarzengrund isolates from persons, food, and food animals in Denmark, Thailand, and the United States by antimicrobial drug susceptibility and pulsed-field gel electrophoresis (PFGE) typing. Resistance, including resistance to nalidixic acid, was frequent among isolates from persons and chickens in Thailand, persons in the United States, and food imported from Thailand to Denmark and the United States. A total of 183 PFGE patterns were observed, and 136 (23.4%) isolates had the 3 most common patterns. Seven of 14 isolates from persons in Denmark had patterns found in persons and chicken meat in Thailand; 22 of 390 human isolates from the United States had patterns found in Denmark and Thailand. This study suggests spread of multidrug-resistant S. Schwarzengrund from chickens to persons in Thailand, and from imported Thai food products to persons in Denmark and the United States.     

Salmonella serovars from humans and other sources in Thailand, 1993-2002

We serotyped 44,087 Salmonella isolates from humans and 26,148 from other sources from 1993 through 2002. The most common serovar causing human salmonellosis in Thailand was Salmonella enterica Weltevreden. Serovars causing human infections in Thailand differ from those in other countries and seem to be related to Salmonella serovars in different food products and reservoirs.     

Growth of human immunodeficiency virus-uninfected children exposed to perinatal zidovudine for the prevention of mother-to-child human immunodeficiency virus transmission

BACKGROUND: Perinatal human immunodeficiency virus (HIV) prevention programs have been implemented in several countries, and many children have been or will be exposed to antiretrovirals in utero and during their first weeks of life. Although reducing substantially the number of infected children, the potential adverse consequences of these treatments on the health of HIV-uninfected children need to be assessed. OBJECTIVE: To investigate the impact of in utero and postnatal zidovudine exposure on the growth of HIV-uninfected children born to HIV-infected women. METHODS: We used data prospectively collected in 1408 live born children participating in a clinical trial comparing zidovudine regimens of different durations to prevent perinatal transmission in Thailand (PHPT-1). We used a linear mixed model to analyze the anthropometric measurements (weight for age, height for age and weight for height Z-scores) until 18 months of age according to zidovudine treatment duration (mothers, <7.5 weeks versus more; infants, 3 days versus >4 weeks). RESULTS: Children exposed in utero for >7.5 weeks had a slightly lower birth weight (Z-score difference, 0.08; P = 0.003). However, zidovudine exposure had no effect on the evolution of Z-scores from 6 weeks to 18 months of age. CONCLUSIONS: Although a longer in utero zidovudine exposure may have had a negative impact on birth weight, the magnitude of this effect was small and faded over time. Neither the total nor the postnatal duration of exposure was associated with changes in infant Z-scores from 6 weeks to 18 months of age.     

Comparison of noninvasive scoring systems for the prediction of nonalcoholic fatty liver disease in metabolic syndrome patients

Over half of metabolic syndrome (MetS) patients have nonalcoholic fatty liver disease (NAFLD). To prevent its complications, standard routine screening is required, but the human-resource and budgetary implications need to be taken into consideration. This study compared the performances of 4 noninvasive scoring systems in predicting NAFLD in MetS patients. They were the fatty liver index, hepatic steatosis index, lipid accumulation product index, and nonalcoholic fatty liver disease in metabolic syndrome patients scoring system (NAFLD-MS).Scores were determined for 499 MetS patients, including 249 patients in a type 2 diabetes mellitus (T2DM) subgroup. Ultrasonography was used to diagnose NAFLD. The accuracies and performance of the scoring systems were analyzed using published cutoff values, and comparisons were made of their areas under receiver operating characteristic curves, sensitivities, specificities, positive and negative predictive values, and likelihood ratios.NAFLD was detected in 68% of the MetS patients and 77% of the MetS patients with T2DM. According to the areas under receiver operating characteristic curves, fatty liver index and hepatic steatosis index provided better performances in predicting NAFLD. NAFLD-MS provided the highest specificity of 99% among the MetS patients as a whole, and it provided even better accuracy with similar performance when applied to the subgroup of MetS patients with T2DM. The maximum cost avoidance from unnecessary ultrasonography was also reported by using NAFLD-MS. In terms of simplicity and ease of calculation, the lipid accumulation product index and NAFLD-MS are preferred.All 4 scoring systems proved to be acceptable for predicting NAFLD among MetS and T2DM patients in settings where the availability of ultrasonography is limited. NAFLD-MS provided the highest specificity and cost avoidance, and it is simple to use. All 4 systems can help clinicians decide further investigations.     

Variation of C1 spinolaminar line and prevalence of C1 stenosis in normal population

Background

The variation of C1 spinolaminar line in normal population is not fully understood. The relative position of C1 lamina to C3–C2 spinolaminar line is reported as good screening tool for determination of C1 canal stenosis.

Objective

To determine the variation of C1 spinolaminar line and find the prevalence of C1 canal stenosis in normal population using C3–C2 spinolaminar test.

Materials and methods

Three hundred and fifteen lateral cervical radiographs from 315 volunteers without neurological symptoms were analyzed. The relative position of C1 spinolaminar line was determined by C3–C2 spinolaminar and considered positive if C1 lamina lay ventral to C3–C2 line. C1 space available for cord (SAC) was measured from posterior border of dens to the C1 lamina to determine the sagittal diameter.

Results

The mean sagittal spinal canal diameter of C1 was 22.2 mm (13–26 mm). Of 315, 14 (4.4%) had positive, 184 (58.4%) had neutral, and 117 (37.1%) had negative C1 spinolaminar line in relation to C3–C2 line. The mean SAC among positive group was 14.9 mm compared to neutral and negative groups which were 22.2 and 23.3 mm, respectively. 21.4% of positive group had SAC of less than 12 mm. The 92.8% of positive C1 spinolaminar line was found in age ≥ 60 years.

Conclusion

In a normal population, 4.4% has positive C1 spinolaminar line. The C1 stenosis is more prevalent in positive C1 spinolaminar line group.

     

Lubiprostone Activates Cl<Superscript>−</Superscript> Secretion via cAMP Signaling and Increases Membrane CFTR in the Human Colon Carcinoma Cell Line,T84

Background  

Lubiprostone, used clinically (b.i.d.) to treat constipation, has been reported to increase transepithelial Cl⁻ transport in T84 cells by activating ClC-2 channels.     

Molecular Characterization of Extended-Spectrum Cephalosporinase-Producing Salmonella enterica Serovar Choleraesuis Isolates from Patients in Thailand and Denmark

The objective of this study was to characterize extended-spectrum cephalosporinase (ESC)-producing isolates of Salmonella enterica serovar Choleraesuis recovered from patients in Thailand and Denmark. Twenty-four blood culture isolates from 22 patients were included in the study, of which 23 isolates were recovered from 21 Thai patients during 2003, 2007, or 2008 and one isolate was recovered from a Danish traveler to Thailand. ESC production was confirmed in 13 out of the 24 isolates by MIC testing. Microarray and plasmid profiling (replicon typing and restriction fragment length polymorphism [RFLP]) were used to characterize the genetic mechanisms of antimicrobial resistance in the 13 ESC-producing isolates. Pulsed-field gel electrophoresis (PFGE) and MIC testing were used to compare the clonality between the 13 ESC-producing isolates and the 11 non-ESC-producing isolates. Based on susceptibility patterns, the ESC-producing isolates were more closely related than non-ESC-producing isolates. Microarray, PCR, plasmid profiling, and replicon typing revealed that the 13 ESC-producing isolates harbored either bla_CMY-2 containing incA/C or bla_CTX-M-14 containing incFIIA, incFrepB, and an unknown replicon located on plasmids ranging in size from 75 to 200 kb. The RFLP and replicon typing clustered the isolates into four distinct groups. PFGE revealed 16 unique patterns and five clusters; each cluster contained two or three of the 24 isolates. The isolate from the Danish patient was indistinguishable from two Thai clinical isolates by PFGE. This study revealed the emergence of the bla_CTX-M-14 gene among several clones of Salmonella serovar Choleraesuis. Numerous plasmids were identified containing up to two different ESC genes and four distinct replicons. A “travel-associated” spread was confirmed. Overall, a high degree of clonal diversity between isolates resistant and susceptible to cephalosporins was observed. The findings represent a serious threat to public health for the Thai people and tourists.Salmonella enterica is a common cause of human gastroenteritis and bacteremia worldwide (18, 31), and a wide variety of animals, particularly food animals, have been identified as reservoirs for non-Typhi Salmonella (11, 22, 23). Although approximately 2,600 serovars of Salmonella enterica have been identified, most human infections are caused by a limited number of serovars, and in general these infections are self-limiting. Some Salmonella serovars, including Salmonella Choleraesuis (swine) and Salmonella Dublin (cattle), which are adapted to a specific animal host, have a propensity to cause extraintestinal infections in humans. Compared to those with other serovars of non-Typhi Salmonella, infections with these serovars are associated with higher rates of bacteremia, meningitis, and mortality (4, 5, 24). For patients with severe salmonellosis, antimicrobial chemotherapy may be life-saving. Due to the increasing prevalence of fluoroquinolone resistance, extended-spectrum cephalosporins are increasingly used for the treatment of Salmonella infections in humans (17, 21, 25) and especially for children, for whom treatment of highly resistant Salmonella infections with fluoroquinolones is not advised, since such treatment has been associated with treatment failures (12, 13, 21). Therefore, these compounds have been designated critically important for human health by the World Health Organization (10).We recently reported that the prevalence of human infections with Salmonella serovar Choleraesuis in Thailand increased from 1.5% (n = 87) in 1994 to 9.2% (n = 190) in 2006 (19). The group of people at highest risk for these infections was those between 6 and 40 years of age in the central region of Thailand (19). A 2007 study of Salmonella serovar Choleraesuis isolates from Thailand observed an increasing resistance to both extended-spectrum cephalosporins (ceftriaxone) and fluoroquinolones. Fifty-four isolates obtained between 2003 and 2005 were tested, of which 30% were found to be resistant to an extended-spectrum cephalosporin (ceftriaxone) (25).To date, only two reports, both from Taiwan, have described mechanisms for extended-spectrum cephalosporin resistance in Salmonella serovar Choleraesuis. The first report was published in 2004 with the discovery of the bla_CMY-2 AmpC β-lactamase gene located on a 140-kb F-like plasmid (6). The following year, the same authors detected bla_CTX-M-3 in a Salmonella serovar Choleraesuis isolate from a patient admitted to a university hospital (30). In 2007, a massive increase of fluoroquinolone- and ceftriaxone-resistant Salmonella serovar Choleraesuis isolates was described in Thailand (25).In Taiwan, the usage of antimicrobials in veterinary medicine and as growth promoters in animal feed may have promoted the emergence of resistance (5). Likewise, in Thailand, the extended-spectrum cephalosporin ceftiofur is used as a growth promoter in swine production (25). However, data on antimicrobial usage in disease prevention and as growth promoters are not accessible in both countries.The objective of the present study was to characterize the mechanisms responsible for the emergence of resistance to extended-spectrum cephalosporins in isolates of Salmonella serovar Choleraesuis recovered from patients in Thailand and Denmark.Additional objectives were to determine the clonality of the isolates resistant and susceptible to cephalosporins (ceftriaxone and cefoxitin) using pulsed-field gel electrophoresis (PFGE) and antimicrobial susceptibility testing and to find biological evidence of transmission through international travel.     

Revisiting the role of neutralizing antibodies in mother-to-child transmission of HIV-1

We analyzed the association between mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) and maternal neutralizing antibodies to heterologous primary isolates of various HIV-1 clades, to test the hypothesis that protective antibodies are those with broad neutralizing activity. Our study sample included 90 Thai women for whom the timing of HIV-1 transmission (in utero or intrapartum) was known. The statistical analysis included a conditional logistic-regression model to control for both plasma viral load and duration of zidovudine prophylaxis. The higher the titer of neutralizing antibodies to a heterologous strain of the same clade, the lower the rate of MTCT of HIV-1. More specifically, high levels of neutralizing antibodies to the MBA (CRF01_AE) strain were associated with low intrapartum transmission of HIV-1. This suggested that such heterologous neutralizing antibodies may be involved in the natural prevention of late perinatal HIV transmission. These data are consistent with the hypothesis that the use of some antibodies might help to prevent perinatal HIV transmission, through passive immunoprophylaxis. Moreover, the study of humoral factors associated with MTCT of HIV-1 may identify correlates of protection that should help in the design of efficient HIV/acquired immunodeficiency syndrome vaccines.