Dietary Polyunsaturated Fatty Acids Increase Survival and Decrease Bacterial Load during Septic Staphylococcus aureus Infection and Improve Neutrophil Function in Mice

Severe infection, including sepsis, is an increasing clinical problem that causes prolonged morbidity and substantial mortality. At present, antibiotics are essentially the only pharmacological treatment for sepsis. The incidence of resistance to antibiotics is increasing; therefore, it is critical to find new therapies for sepsis. Staphylococcus aureus is a major cause of septic mortality. Neutrophils play an important role in the defense against bacterial infections. We have shown that a diet with high levels of dietary saturated fatty acids decreases survival in septic mice, but the mechanisms behind this remain elusive. The aim of the present study was to investigate how the differences in dietary fat composition affect survival and bacterial load after experimental septic infection and neutrophil function in uninfected mice. We found that, after S. aureus infection, mice fed a polyunsaturated high-fat diet (HFD-P) for 8 weeks had increased survival and decreased bacterial load during sepsis compared with mice fed a saturated high-fat diet (HFD-S), similar to mice fed a low-fat diet (LFD). Uninfected mice fed HFD-P had a higher frequency of neutrophils in bone marrow than mice fed HFD-S. In addition, mice fed HFD-P had a higher frequency of neutrophils recruited to the site of inflammation in response to peritoneal injection of thioglycolate than mice fed HFD-S. Differences between the proportion of dietary protein and carbohydrate did not affect septic survival at all. In conclusion, polyunsaturated dietary fat increased both survival and efficiency of bacterial clearance during septic S. aureus infection. Moreover, this diet increased the frequency and chemotaxis of neutrophils, key components of the immune response to S. aureus infections.     

Immunological profile of Fanconi anemia: A multicentric retrospective analysis of 61 patients

In this study, the immunological status of 61 patients with Fanconi anemia (FA) with advanced marrow failure before hematopoietic stem cell transplantation was analyzed by assessing the phenotype of peripheral blood lymphocytes, serum immunoglobulin (Ig) levels, and inflammatory cytokines. In patients with FA, total absolute lymphocytes (P < 0.0001), B cells (P < 0.0001), and NK cells (P = 0.003) were reduced when compared with normal controls. T cells (CD3), that is, cytotoxic T cells, naïve T cells, and regulatory T cells, showed a relative increase when compared with controls. Serum levels of IgG (P < 0.0001) and IgM (P = 0.004) were significantly lower, whereas IgA level was higher (P < 0.0001) than in normal controls. TGF‐β (P = 0.007) and interleukin (IL)‐6 (P = 0.0007) levels were increased in the serum of patients when compared with controls, whereas sCD40L level decreases (P < 0.0001). No differences were noted in the serum levels of IL‐1β, IL‐2, IL‐4, IL‐10, IL‐13, IL‐17, and IL‐23 between FA subjects and controls. This comprehensive immunological study shows that patients with FA with advanced marrow failure have an altered immune status. This is in accordance with some characteristics of FA such as the proinflammatory and proapoptotic status. In addition, B lymphocyte failure may make tight and early immunological monitoring advisable. Am. J. Hematol. 88:472–476, 2013. © 2013 Wiley Periodicals, Inc.     

Case-control comparison of at-home and hospital care for allogeneic hematopoietic stem-cell transplantation: the role of oral nutrition

BACKGROUND: Acute graft-versus-host disease (GVHD) was reduced using home care compared with hospital care after allogeneic hematopoietic stem-cell transplantation (ASCT). METHODS: Between March 1998 and December 2006, 601 patients underwent ASCT at our unit. Requirements for at-home ASCT were fulfilled by 76 patients. A control group of 76 patients treated in the hospital were matched for age, sex, diagnosis, stage of disease, conditioning, stem-cell source, type of donor, and immunosuppression. Oral nutrition was determined as median kcal/kg/day for the first 21 days after ASCT. RESULTS: The home-care patients received more oral nutrition per day than hospital controls (P<0.05). Number of days at home correlated with oral nutrition (P=0.004). In multivariate analysis, acute GVHD of grades II to IV was associated with poor oral nutrition (P=0.003) and hospital care (P=0.06). Transplant-related mortality was associated with acute GVHD grades II to IV (P<0.0001) and bacteremia (P=0.004). In addition to acute GVHD and bacteremia, death was associated with absence of chronic GVHD (P=0.012). Five-year survival was 65% in patients treated at home, when compared with 47% in the controls (P=0.04). CONCLUSION: Better oral nutrition may be one reason for the reduced probability of acute GVHD and better survival with at-home care than with hospital care.     

Tools to assess the nutritional status of acutely ill older adults

Nurses are responsible for identifying patients who are malnourished or at risk of malnutrition. They are also expected to follow-up patients' nutritional status and to initiate preventive and caring interventions. The aim of this Swedish study was to explore whether simple assessment tools used during hospital admission could identify older adults at risk of malnutrition.     

Comparison of terbutaline Turbuhaler and albuterol chlorofluorocarbon (CFC) inhaler in middle-aged and elderly patients with obstructive lung disease.

The aim of the present study was to compare the effect of terbutaline Turbuhaler (0.5 mg qid) with that of albuterol chlorofluorocarbon (CFC) inhaler (0.2 mg qid) in middle-aged and elderly patients with obstructive lung disease. The study was performed as an open cross-over (2 x 2 weeks) and randomized study in 85 patients. A significant increase in PEF was seen after inhalation from both devices (P less than .001). Baseline PEF values before inhalation were higher with Turbuhaler than with the CFC inhaler both in the mornings and in the evenings. Fifty-six percent of the patients preferred terbutaline Turbuhaler and 26% albuterol CFC inhaler (P = .004).     

Predictors of outcome following brief psychodynamic-interpersonal therapy for deliberate self-poisoning

BACKGROUND: We found that brief psychodynamic-interpersonal therapy was more helpful than usual care in deliberate self-poisoning patients, and resulted in reduced suicidal ideation and repetition of self-harm in the 6 months post-treatment. Here, we explore which baseline factors predicted outcome following treatment. METHOD: Patients presenting to an emergency department with deliberate self-poisoning were randomly assigned to brief psychodynamic-interpersonal therapy (PIT) or usual care. Severity of suicidal ideation 6 months post-treatment was used as the main outcome measure. Sociodemographic features and baseline psychological measures were used as predictor variables. Univariate and regression analyses were used to identify predictors of outcome for the whole group and for those who received psychotherapy. RESULTS: Principal predictors for the psychotherapy group were baseline severity of depression and a prior history of self-harm. For the group as a whole predictors were severity of suicidal ideation, anxiety and prior history of self-harm. CONCLUSIONS: Four session PIT for deliberate self-poisoning is effective in reducing suicidal ideation in patients with less severe depression, no prior history of self-harm, and who have not consumed alcohol with the overdose. Extended therapy may be indicated for those with more severe depression.     

Treatment costs and survival in patients with grades III-IV acute graft-versus-host disease after allogenic hematopoietic stem cell transplantation during three decades

To determine development of treatment, costs, and survival for patients with grades III/IV acute graft-versus-host disease (GVHD), data from 88 patients with grades III/IV acute GVHD were collected. The patients were divided into three groups: patients who received transplants from 1977 through 1989 (group A), 1990 through 1999 (group B), and 2000 through 2004 (group C). The costs for treatment, enumerated to year 2003 costs, were calculated. An increased 1-year survival rate was found in group C, at 21% versus 9% and 8% for groups A and B, respectively (P=0.02). Death by acute GVHD was increased by repeat transplantation (P<0.001), grade IV acute GVHD (P<0.001), human leukocyte antigen mismatch (P=0.009), and transplantation before 2000 (P=0.015). Transplantation after 1990 (P=0.003) and grade IV acute GVHD (P=0.03) were associated with higher treatment costs. It was found that the time the patients had GVHD did not differ among the three groups. In conclusion, the costs and survival rates associated with severe acute GVHD has increased in recent years.     

Costs of allogeneic hematopoietic stem cell transplantation

BACKGROUND: This study aims to determine the total costs after allogeneic hematopoietic stem cell transplantation (ASCT) and factors associated with increases or decreases in costs. METHODS: We collected all in- and outpatient costs during 5 years in 93 patients who had undergone ASCT in 1998 and 1999 at our unit. The inpatient costs included all those related to a patient from the first day of admission until discharge and then all costs of readmission in the Stockholm area. RESULTS: The total median cost of five posttransplant years was 139,414 (52,095-345,640) euros (euros) or 167,296 US dollars (the rate of 1 euro is approximately 1.2 US dollars). The costs were highest during the first year-median inpatient and outpatient costs 100,650 euros and 13,066 euros, respectively. The total costs during the first year were higher in patients with acute graft-versus-host disease grades III-IV (relative hazards [RH] 1.35, P = 0.003), bacteremia (RH 1.33, P = 0.005), veno-occlusive disease of the liver (RH 1.32, P = 0.005), prophylaxis with granulocyte colony-stimulating factor (G-CSF; RH 1.31, P = 0.01), acute leukemia (RH 1.32, P = 0.008), and treatment in hospital instead of at home (RH 1.20, P < 0.07). During the early transplant period, a second transplantation (RH 1.28, P = 0.014) and hemorrhagic cystitis (HC; RH 1.24, P = 0.03) were also associated with higher costs. The total 5-year cost declined with longer survival rates (r = 0.4028, P < 0.001) and reduced intensity conditioning (RH 0.79, P=0.024). CONCLUSION: Higher costs of ASCT were associated with retransplantation, acute leukemia, G-CSF prophylaxis, hospital care, myeloablative conditioning, and major transplant-related complications.