Anti-JC virus antibody sera positivity and index value among patients with multiple sclerosis may be correlated with age,sex, and area of residence

Anti-JC virus (JCV) antibody index is the predictive factor of progressive multifocal leukoencephalopathy (PML) for multiple sclerosis (MS) patients treating with natalizumab. The aim of this study is to evaluate the prevalence of anti-JCV antibody positivity and index among Iranian patients who are the candidate for natalizumab and its correlation with their demographic data and previous therapies. A cross-sectional design was assessed for receiving anti-JCV antibody test results between January 2014 and December 2016. Demographic data and disease characteristics were also obtained. Statistical analysis and logistic regression were done using SPSS. Among 803 MS patients that were observed, the prevalence of anti-JCV antibody positivity was 67.9% (mean of index?=?2.23?±?1.16) and 67.6% of positive patients had an index ≥?1.5. Males were more antibody positive than females (81.7 and 64% respectively; significance (sig.) <?0.001, OR?=?2.51, CI 1.65–3.81). The rate of positivity was lower in patients under the age of 18. Patients who lived in cold regions had significantly more prevalence of positivity (Num.?=?403; sig.?=?0.043 and OR?=?1.86; CI 1.02–3.39) and with higher rate of index ≥?1.5 (sig.?=?0.017; OR?=?3.99, CI 1.79–8.88). Disease onset age between 28 and 37 years were more positive compared to 18–27 years (N?=?480; sig.?=?0.02; OR?=?1.85, CI 1.09–3.14). Age, male gender, onset age, and cold area of residency significantly influenced anti-JCV antibody sera positivity. Only age of onset and cold area of residency were related to the index. No significant difference was observed between type, dosage, and duration of previous immunosuppressant drugs and anti-JCV antibody positivity and index value.     

The Prevalence of Biopsy-Proven Eosinophilic Esophagitis in Hispanics Undergoing Endoscopy Is Infrequent Compared to Caucasians: A Cross-Sectional Study

Digestive Diseases and Sciences - The prevalence of eosinophilic esophagitis (EoE), a chronic, immune-mediated, clinicopathologic, inflammatory disorder, has been well described in the pediatric...     

Whole genome survey of coding SNPs reveals a reproducible pathway determinant of Parkinson disease

It is quickly becoming apparent that situating human variation in a pathway context is crucial to understanding its phenotypic significance. Toward this end, we have developed a general method for finding pathways associated with traits that control for pathway size. We have applied this method to a new whole genome survey of coding SNP variation in 187 patients afflicted with Parkinson disease (PD) and 187 controls. We show that our dataset provides an independent replication of the axon guidance association recently reported by Lesnick et al. [PLoS Genet 2007;3:e98], and also indicates that variation in the ubiquitin-mediated proteolysis and T-cell receptor signaling pathways may predict PD susceptibility. Given this result, it is reasonable to hypothesize that pathway associations are more replicable than individual SNP associations in whole genome association studies. However, this hypothesis is complicated by a detailed comparison of our dataset to the second recent PD association study by Fung et al. [Lancet Neurol 2006;5:911-916]. Surprisingly, we find that the axon guidance pathway does not rank at the very top of the Fung dataset after controlling for pathway size. More generally, in comparing the studies, we find that SNP frequencies replicate well despite technologically different assays, but that both SNP and pathway associations are globally uncorrelated across studies. We thus have a situation in which an association between axon guidance pathway variation and PD has been found in 2 out of 3 studies. We conclude by relating this seeming inconsistency to the molecular heterogeneity of PD, and suggest future analyses that may resolve such discrepancies.     

Strengthening evidence-based decision-making: is it possible without improving health system stewardship?

BACKGROUND Health systems worldwide have always suffered resource constraints. Therefore, making decisions informed by scientific evidence to optimize costs and prevent wastage of resources is both important and necessary. The current study was designed to identify barriers to evidence-based decision-making (EBDM) in Iran's health system. METHODS Participants were purposively selected. In-depth interviews with policy-makers and focus group discussions (FGDs) with researchers were used to collect data. Thirteen in-depth interviews and six FGDs were held. Data were analysed using thematic analysis. RESULTS The barriers mentioned were categorized into decision-makers' characteristics, the decision-making environment and the research system, with each category consisting of further relevant themes and subthemes. Organizational values, criteria for selecting decision-makers, and the attitude toward EBDM were found to be important barriers to EBDM, and were related to stewardship. CONCLUSION There are various barriers to EBDM at different levels, and multi-dimensional solutions are required to strengthen the impact of scientific evidence on decision-making. Several recognized barriers to EBDM are rooted in health system stewardship, such as the weakness of inter-sectoral collaborations and ill-defined priorities. It appears that improvement of EBDM is secondary to the strengthening of health system stewardship.     

加强循证决策:不改善卫生系统管理,可能吗?

背景:世界范围内的卫生系统都面临资源限制。因此,通过科学循证决策来削减成本并防止资源浪费非常重要和必要,本研究旨在分析伊朗卫生系统循证决策的障碍。方法:通过对决策者的深度访谈和焦点小组讨论收集数据,共进行了13次访谈和6组焦点小组讨论,并对数据进行了主题分析。结果:障碍涉及决策者特点、决策环境和研究系统三个方面,每个方面由相关主题和分主题构成;机构价值观、选择决策者的标准、对循证决策的态度是循证决策的重要障碍,并且与管理有关。结论:循证决策有不同层级的障碍,需要从多个角度寻找强化科学循证决策影响的解决方案;几个已经确定循证决策的障碍植根于卫生体系治理,如跨部门合作的薄弱、没有制定卫生研究重点。因此,为做好循证决策,加强卫生系统管理势在必行。     

Is it necessary to operate quickly in patients with significant left main coronary stenosis?

Although coronary bypass surgery is performed rapidly in the majority of cases of left main coronary stenosis to prevent cardiovascular complications, there is no reported consensus in the literature about the ideal interval between diagnostic coronary angiography and surgery. The aim of this multicenter study was to make an inventory of the serious vascular cardiovascular events which occurred between coronary angiography and surgery to determine possible predictive factors for complications and thereby identify a high risk subgroup requiring immediate revascularisation. The population comprised 283 patients with significant left main coronary disease, out of a total of 8,205 patients who underwent coronary angiography in the university hospitals of Angers, Brest, Nantes, Poitiers and Rennes. A surgical indication was retained in 216 patients. The choice of the operation date depended on clinical data in the presence of an acute coronary syndrome, patients remaining in the intensive care unit and undergoing revascularisation rapidly. Serious cardiac events (death, myocardial infarction, refractory unstable angina and left ventricular failure) occurring while waiting for surgery were rare, observed in only 6.5% of patients. Recent myocardial infarction and, to a lesser degree, unstable angina and/or left ventricular systolic dysfunction, were predictive of serious cardiac complications before surgery. The severity of the left main coronary disease and the association of right coronary disease did not increase the risk of serious cardiac events in the preoperative period. The low incidence of complications demonstrates that this strategy enables patients to wait for surgery with an acceptable risk without having to operate all patients with left main coronary disease as an emergency.     

Predicting post-electrical injury autonomic dysfunction symptom occurrence by a simple test

Background

Sensory, motor, and autonomic neuropathy has been reported after electrical injury. Besides subclinical involvement of the sympathetic nervous system during the 1st year post injury, late clinical manifestations of this involvement have been reported sporadically. This study was designed to investigate how the clinical and electrodiagnostic manifestations of sympathetic involvement would change with time in electricity victims.

Methods and materials

Sixty electrically burnt patients were followed for 22 months with sympathetic skin response (SSR) and autonomic system derangement symptom surveillance.

Results

Thirty-one patients reported autonomic derangement symptoms during the 2nd year post injury. SSR latency prolongation showed direct negative correlation with time; but SSR amplitude was decreased in all cases irrespective of the time laps. Symptomatic patients showed significantly lower SSR amplitudes compared to asymptomatic ones. This was true for the pre-symptom SSR test results too.

Conclusion

SSR amplitude can be used as a predictive test for the symptoms of autonomic derangement to occur post electrical injury.     

Gastroesophageal Reflux Disease and Tooth Erosion: A Cross-Sectional Observational Study

Background/Aims

Gastroesophageal reflux disease (GERD) is common in children. Recurrent exposure to gastric acid in GERD may contribute to tooth erosion.

Methods

In this prospective study, 54 GERD patients qualified according to endoscopy, pH-metry, and the GERD questionnaire and 58 healthy controls qualified by the GERD questionnaire were assessed. Two groups underwent dental evaluations for the presence, severity, and patterns of erosion and for the stage of dentition using a Tooth Wear Index. The health care providers who performed the dental exams did not know which children had been diagnosed with GERD.

Results

A total of 112 children, 3 to 12 years old were enrolled in the study, and 53 of 54 (98.1%) GERD patients and 11 of 58 (19.0%) controls had dental erosions (p<0.0001). In GERD patients, the posterior occlusal surfaces of milk teeth were more affected (p<0.0001). There was no correlation between GERD and the affected surfaces in permanent teeth, nor in the patterns or erosion grades (localized or general). In both groups, milk teeth had more erosions than permanent teeth, but the difference was not statistically significant.

Conclusions

According to this study, there is a positive correlation between GERD and dental erosion. Posterior occlusal surface erosions in milk teeth could indicate GERD.