Gastrointestinal manifestations in severe scorpion envenomation

OBJECTIVES: To evaluate the type and incidence of gastrointestinal manifestations secondary to scorpion envenomation and their prognostic significance. PATIENTS AND METHODS: All patients admitted to our ICU for scorpion envenomation were included in this retrospective chart review of a 13-year period (1990 - 2002). RESULTS: During the study period, 951 patients were admitted for scorpion envenomation and 72 (7.6%) died. Ages ranged from 0.5 to 90 years with a mean of 14.7 +/- 17.4 years. Gastrointestinal symptoms were present in 700 patients (73.6%): nausea in 24 (2.5%), vomiting in 687 (72.2%) and diarrhea in 41 patients (4.3%). At univariate analysis, the presence of diarrhea was associated with a fatal outcome (P < 0.05). Diarrhea was also correlated with other indicators of severe envenomation and poor prognosis: respiratory failure (P = 0.01), neurological failure (P < 0.0001), liver failure (P < 0.0001) and low blood pressure requiring catecholamine support (P = 0.02). The multivariate analysis showed that young age (age less than 5 years), fever > 38.5 degrees C, neurological failure and pulmonary edema were independent factors of severity. Digestive disorders were more frequent in children and in this subgroup diarrhea appeared to be associated with poor outcome. In a subset of patients for whom data were available, fatal cases demonstrated significantly higher liver enzymes levels on admission. CONCLUSION: In Tunisia, gastrointestinal symptoms are often observed in severe scorpion envenomations, especially in young patients. In children, diarrhea and elevated liver enzymes are associated with poor prognosis.     

HLA-DRB1/DQB1 susceptibility for autoimmune polyglandular syndrome type II and III in south of Tunisia

Objectives

The aim of our study was to investigate the association of HLA-DRB1 and HLA-DQB1 alleles with autoimmune polyglandular syndromes (APS) type II and III in a southern Tunisian population.

Patients and methods

Sixty-two unrelated patients with APSII (n = 20) and APSIII (n = 42) and 146 healthy controls were genotyped for HLA class II alleles (DRB1*, DQB1*) by PCR-SSP technique.

Results

An increased frequencies of HLA-DQB1*03:02 (P = 0,02; OR = 2.98) in APSII patients, HLA-DRB1*03 (P = 3 10⁻⁶; OR = 4.28) and HLA-DQB1*02:01 (P = 0.04; OR = 1.95) in APSIII patients were found compared to healthy controls. Study of the HLA-DRB1*;DQB1* haplotype frequencies showed a higher occurrence of DRB1*04;DQB1*03:02 and DRB1*03;DQB1*02:01 in APSII patients (P = 4 10⁻³; OR = 3.31 and P = 0.03; OR = 2.74 respectively) whereas APSIII was only associated with DRB1*03;DQB1*02:01 (P = 7.2 10⁻⁸, OR = 4.71).

Conclusion

Our data suggest that the variation in class II HLA alleles and haplotypes could be a genetic factor involved in the susceptibility of APS syndrome.     

Hyperparathyroidism-jaw tumor syndrome: A case report

We report the clinical and genetic findings in a 23-year-old woman with hyperparathyroidism-jaw tumor syndrome (HPT-JT). The patient had a family history of primary hyperparathyroidism (PHPT) and uterine fibroma in her mother. The patient presented muscle weakness. The diagnosis of PHPT was confirmed by an elevated parathyroid hormone level above 1450 pg/ml with hypercalcemia and hypercalciuria. X-ray radiographies showed a radiolucent lesion in the right body of the mandible. Bilateral neck exploration was performed. An inferior right parathyroidectomy, a left thyroid lobectomy with isthmectomy and thymectomy were carried out. Histopathological examination of the specimen showed a diffuse hyperplasia of the parathyroid principal cells. The association of PHPT with a right jaw tumor and uterine fibroma suggested the diagnosis of HPT-JT syndrome. Mutation screening of HRPT2 gene was carried out and identified a germline mutation, consisting in a base deletion in exon 1, 85delG, inducing a frameshift. The diagnosis of HPT-JT syndrome is clinically important because of its hereditary component and its high risk of parathyroid malignancy, making a genetic inquiry necessary.     

Detailed Inspection of γ-ray,Fast and Thermal Neutrons Shielding Competence of Calcium Oxide or Strontium Oxide Comprising Bismuth Borate Glasses

For both the B₂O₃-Bi₂O₃-CaO and B₂O₃-Bi₂O₃-SrO glass systems, γ-ray and neutron attenuation qualities were evaluated. Utilizing the Phy-X/PSD program, within the 0.015–15 MeV energy range, linear attenuation coefficients (µ) and mass attenuation coefficients (μ/ρ) were calculated, and the attained μ/ρ quantities match well with respective simulation results computed by MCNPX, Geant4, and Penelope codes. Instead of B₂O₃/CaO or B₂O₃/SrO, the Bi₂O₃ addition causes improved γ-ray shielding competence, i.e., rise in effective atomic number (Z_eff) and a fall in half-value layer (HVL), tenth-value layer (TVL), and mean free path (MFP). Exposure buildup factors (EBFs) and energy absorption buildup factors (EABFs) were derived using a geometric progression (G–P) fitting approach at 1–40 mfp penetration depths (PDs), within the 0.015–15 MeV range. Computed radiation protection efficiency (RPE) values confirm their excellent capacity for lower energy photons shielding. Comparably greater density (7.59 g/cm³), larger μ, μ/ρ, Z_eff, equivalent atomic number (Z_eq), and RPE, with the lowest HVL, TVL, MFP, EBFs, and EABFs derived for 30B₂O₃-60Bi₂O₃-10SrO (mol%) glass suggest it as an excellent γ-ray attenuator. Additionally, 30B₂O₃-60Bi₂O₃-10SrO (mol%) glass holds a commensurably bigger macroscopic removal cross-section for fast neutrons (Σ_R) (=0.1199 cm⁻¹), obtained by applying Phy-X/PSD for fast neutrons shielding, owing to the presence of larger wt% of ‘Bi’ (80.6813 wt%) and moderate ‘B’ (2.0869 wt%) elements in it. 70B₂O₃-5Bi₂O₃-25CaO (mol%) sample (B: 17.5887 wt%, Bi: 24.2855 wt%, Ca: 11.6436 wt%, and O: 46.4821 wt%) shows high potentiality for thermal or slow neutrons and intermediate energy neutrons capture or absorption due to comprised high wt% of ‘B’ element in it.     

Structure of CARB-4 and AER-1 CarbenicillinHydrolyzing β-Lactamases

We determined the nucleotide sequences of bla_CARB-4 encoding CARB-4 and deduced a polypeptide of 288 amino acids. The gene was characterized as a variant of group 2c carbenicillin-hydrolyzing β-lactamases such as PSE-4, PSE-1, and CARB-3. The level of DNA homology between the bla genes for these β-lactamases varied from 98.7 to 99.9%, while that between these genes and bla_CARB-4 encoding CARB-4 was 86.3%. The bla_CARB-4 gene was acquired from some other source because it has a G+C content of 39.1%, compared to a G+C content of 67% for typical Pseudomonas aeruginosa genes. DNA sequencing revealed that bla_AER-1 shared 60.8% DNA identity with bla_PSE-3 encoding PSE-3. The deduced AER-1 β-lactamase peptide was compared to class A, B, C, and D enzymes and had 57.6% identity with PSE-3, including an STHK tetrad at the active site. For CARB-4 and AER-1, conserved canonical amino acid boxes typical of class A β-lactamases were identified in a multiple alignment. Analysis of the DNA sequences flanking bla_CARB-4 and bla_AER-1 confirmed the importance of gene cassettes acquired via integrons in bla gene distribution.Penicilloyl serine transferases, routinely called β-lactamases, cleave the cyclic amide bond of β-lactam antibiotics via the formation of a serine ester-linked penicilloyl enzyme giving a product devoid of antibacterial activity (46). A close inspection of databases indicated that in the last 3 years, a collection of at least 150 DNA sequences from plasmid-mediated and chromosomal bla genes has been acquired. Analysis of deduced peptides confirmed that most have conserved motifs typical of serine active-site enzymes that are divided into three major classes (classes A, C, and D) on the basis of a level of amino acid sequence identity of more than 20% between members in each class (10).In 1969, a β-lactamase was found in Pseudomonas aeruginosa Dalgleish, it was noticed to be “markedly active against carbenicillin,” and the enzyme was named PSE-4 (13, 32). As other β-lactamase enzymes were found, it was noticed that some β-lactamases have better activities than others against carbenicillin. All β-lactamases except class C enzymes hydrolyze carbenicillin at very different levels; class C enzymes hydrolyse it poorly. Genes encoding enzymes similar to PSE-4 were subsequently discovered in other bacterial species and are now known to be part of multidrug resistance transposons (24). In addition to the four original β-lactamases called PSE-1, PSE-2, PSE-3, and PSE-4, a plethora of plasmid-mediated enzymes capable of hydrolyzing carbenicillin at a high rate, such as LCR-1 (10), AER-1 (16), CARB-3 (22), NPS-1 (26), CARB-5 (35), and CARB-4 (36), were identified; but these enzymes have subtle differences in their biochemical properties and in their substrate profiles (7). The amino acid sequences of PSE-1 (17), PSE-2 (18), PSE-3 (8), PSE-4 (4), and CARB-3 (23) have been compared to those of other class A and class D enzymes, and it has been confirmed that PSE-2 (OXA-10) is a class D enzyme (10).The relationship of CARB-4 to other plasmid-mediated β-lactamases has been tested by determining the neutralization of benzylpenicillin-hydrolyzing activity with antisera prepared against purified the TEM-1, OXA-4, and CARB-3 β-lactamases (36). Antisera prepared with CARB-3 antigen inactivated the CARB-4 β-lactamase as well as the PSE-1, PSE-4, and CARB-3 enzymes (22, 36). The bla_CARB-3 and bla_CARB-4 genes are localized within transposons Tn1413 (7 kb) and Tn1408 (25 kb), respectively; these mobile elements were from plasmids isolated from bacterial strains of distinct origins (24, 27, 47).Unusual β-lactamases such as a metalloenzyme have been reported in Aeromonas hydrophila, a water-borne, gram-negative rod known to be highly resistant to β-lactam antibiotics, including carbenicillin (42). A carbenicillin-hydrolyzing β-lactamase has been discovered in an isolate of A. hydrophila from blood (16). The substrate profile of the AER-1 enzyme resembled those of plasmid-mediated carbenicillin-hydrolyzing enzymes, but it had a different isoelectric point (pI 5.9) and molecular mass (29 kDa); these values are reminiscent of those for BRO-1 (pI 5.45), PSE-1 (pI 5.7), CARB-3 (pI 5.75), and CARB-5 (pI 5.35). The gene coding for AER-1 is part of the Ω7711 unit which is IncP mobilizable but RecA dependent and which inserts only between purC and guaB at a specific site in the Escherichia coli chromosome (16). The Ω7711 unit cotransfers resistance to the antibiotics chloramphenicol, streptomycin, and sulfonamide; the transfer of multidrug resistance and insertion at a unique site are properties analogous to those of Tn7.In the study described in this report, we have focused on a carbenicillin-hydrolyzing enzyme identified from a clinical isolate, P. aeruginosa p83372, containing the pUD12 plasmid and producing CARB-4. This enzyme has an acidic isoelectric point (pI 4.3) and hydrolyzes carbenicillin very efficiently (36). We also present the nucleotide sequences of bla_AER-1 and bla_CARB-4, including flanking sequences containing integrons that explain their distribution and presence in different mobile genetic elements (15). We compared the deduced AER-1 and CARB-4 polypeptides with those of other group 2c enzymes (7) via a multiple alignment.     

The new information technologies in medicine: what about the patient?]

The automation of the medical records involves many ethical and complex questions totally out of suspicion two decades ago. Effectively, the patient being in the core of the medical information system belonging to any medical structure, it should be evident that this system generates much more information than any classical medical record. This new approach in dealing with medical information has certainly multiple advantages because it helps, according to the case, gather all the information about the patient. It also helps distant diagnosis or treatment. The back of the coin is however the complexity of same situation dictated by the system which requires very clear and precise answers in order to preserve mainly the patient interests and then to optimise the use of all information collected.     

Serological and pathogenic characterization of avian reoviruses isolated in Quebec

Reoviruses were isolated from intestinal contents of broiler chickens from nine flocks in Quebec with malabsorption syndrome. Serum neutralization test demonstrated the existence of antigenic differences between the isolates and the reference vaccine strain. The isolated reoviruses were inoculated orally and into the foot pad in one-day-old chicks, resulting in a transient, but significant depression in body weight gains. Chickens infected with isolate 615, showed in addition to growth problems, clinical signs and tissue lesions similar to those observed in field cases. When isolate 615 was inoculated into SPF chicks at one day of age, intestinal absorption of D-xylose in infected chicks at 7 days post-infection was significantly lower (P <0.05) than for corresponding controls. This study suggests the implication of some reovirus isolates, such as 615 which was serologically distinct from the vaccine strain S1133, as infectious agents associated with pathological conditions other than viral arthritis.