Laboratory Biosafety: Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of the current landscape of invasive meningococcal disease in children

BackgroundImmunizations have led to a decrease in the incidence of invasive meningococcal disease (IMD) in Canada, but this infection still leads to significant morbidity and mortality.ObjectivesThe purpose of this study was to determine the burden of illness and management of IMD in paediatric hospitals.MethodsData were collected on all cases of IMD in eight paediatric hospitals from 2013 to 2017.ResultsThere were 17 cases of IMD. Three of eight hospitals had no cases. Just over half of the cases were serogroup B (n=9); a quarter (n=4) were serogroup W; less than a quarter (n=3) were serogroup Y; and one was unknown. Two infected children were not started on antibiotics until day one and day five after the initial blood culture was collected, but had uneventful recoveries. Six cases required admission to intensive care units; two died. Six cases had probable or proven meningitis. Thrombocytopenia was documented in seven cases. All cases had elevated C-reactive protein levels. Seven children received more than seven days of antibiotics; of these seven, only two had complications that justified prolonged therapy (subdural empyema and septic knee). Six cases had a central line placed.ConclusionIMD is now rare in Canadian children, but about one-third of the cases in our study required treatment in the intensive care unit and two died. Clinicians appear to not always be aware that a five to seven-day course is adequate for uncomplicated cases of bacteremia or meningitis.     

Inflammatory pseudotumor of the diaphragm

A 5-year-old-boy presented with a right pleural effusion and fever. A tumorous mass was located between the right lung and the liver. The boy underwent a right thoracotomy with excision of the tumor and the adherent parts of the right hemidiaphragm. Histology and immunohistochemistry showed an inflammatory pseudotumor of the diaphragm. This is the first reported case of an inflammatory pseudotumor in this location. A brief review of the heterogeneous theories about the pathogenesis and the different therapeutic regimens for this rare neoplastic entity are discussed. Accepted: 17 June 1998     

Direct control of drug release behavior from layered double hydroxides through particle interactions

We report the control of drug release rate from Mg(2)Al-layered double hydroxides (Mg(2)Al-LDHs) intercalated with ibuprofen as a model drug. Different aggregation states in the dry powders of ibuprofen intercalated Mg(2)Al-LDHs can be obtained due to different particle interactions by changing the materials synthesis parameters including the solvent system and aging conditions. Compared with the samples prepared in water alone or aged at atmospheric conditions (70 degrees C, 3 days), the sample synthesized in the mixture of ethylene glycol and water (volume ratio of 1:1) and aged hydrothermally (150 degrees C, 18 h) exhibits a more stable suspension of regularly shaped and larger LDH platelets (ca. 450 nm). Upon drying, it forms relatively oriented dense powder through preferential face-to-face and edge-to-edge aggregation. The release rate of ibuprofen from such dense powder is considerably lower compared with those from the loose powders. This can be attributed to a less breakdown of aggregates, a longer diffusion path length and a higher diffusion resistance in the oriented solid matrix.     

The association between G-197A gene polymorphism of IL-17A with changes in protein interaction of IL-17A,levels of urinary IL-17, and degree of lupus nephritis abnormality

Elevated levels of IL-17 in systemic lupus erythematosus (SLE) patients have been reported to be correlated to renal disorders, but the involvement of the G-197A gene polymorphism of IL 17 in lupus nephritis (LN) and the degree of renal abnormality have not been reported. Therefore, the aim of this study was to investigate these associations. This study involved 30 LN patients and 20 healthy control. Levels of uIL-17 were measured by ELISA, while the G-197A gene polymorphisms of IL-17A were examined using polymerase chain reaction (PCR) and sequence analysis. Changes in the protein structure due to G-197A gene polymorphism of IL-17A were analyzed by in silico investigation. In addition, renal biopsies were performed to determine the degree of renal abnormality (classes I–VI). A significant difference was found between LN patients and the control group in term of uIL-17 levels (p?=?0.004). However, the G-197A gene polymorphism of IL-17A between LN patients and the control group were not significantly different (p?=?0.154). There were no difference in the levels of uIL-17 between patients and control group on G-197A gene polymorphism of IL-17A (p?=?0.682). Also, there were no significant differences in G-197A gene polymorphism of IL-17A toward the degree of nephritis (p?=?0.300). In silico investigation showed that G197A gene polymorphism of IL-17A resulted in changes of the pattern of IRF-4 binding to the promoter, thereby affecting its activity. In conclusion, the levels of uIL-17 in LN patients were significantly higher than those in the control group, but G-197A gene polymorphism of IL-17A did not cause varying levels of IL-17 and did not influence the degree of renal abnormalities in LN.     

Use of hospital data for Safe Motherhood programmes in South Kalimantan, Indonesia

The evaluation of Safe Motherhood programmes has been hampered by difficulties in measuring the preferred outcomes of maternal mortality and morbidity. The need for adequate indicators has led researchers and programme managers alike to resort to indicators of utilization and quality of health services. In this study we assess the magnitude of four indicators of use of essential obstetric care (EOC) and one indicator of quality of care in health facilities in three districts in South Kalimantan, Indonesia. The general picture which emerges for South Kalimantan is that the use of obstetric services is low. Even in the more urban district of Banjar where facility-based coverage is highest, fewer than 14% of all deliveries take place in an EOC facility, 2% of expected births are admitted to such a facility with a major obstetric intervention (MOI), and 1% of expected births have an MOI for an absolute maternal indication. The use of facility-based EOC is consistently lower in Barito Kuala compared to the other districts, and the differences persist regardless of the indicators used. In this setting with low utilization rates, general rates of utilization of EOC facilities seem to be as satisfactory an indicator of relative access to EOC as more elaborate indicators specifying the reasons for admission. The inequalities in access to care revealed by the various indicators of use of EOC services may prove to be a more powerful stimulus for change than the widely reported and highly inaccurate accounts of the high levels of maternal mortality.     

Clinical efficacy of dialkylcarbamoylchloride‐coated cotton acetate dressing versus combination of normal saline dressing and 2% mupirocin ointment in infected wounds of epidermolysis bullosa

Dialkylcarbamoylchloride (DACC)‐coated cotton acetate dressing works directly through hydrophobic interaction to reduce the number of bacteria without the risk of resistance. It is easy to use and therefore expected to improve patient's compliance. This study aimed to assess the clinical efficacy of DACC‐coated cotton acetate dressing compared to a combination of normal saline dressing and 2% mupirocin ointment. A single‐blind controlled trial was conducted and included 14 infected epidermolysis bullosa (EB) wounds which were divided into two groups. Group I received DACC‐coated cotton acetate dressing, and Group II received the combination of normal saline dressing and 2% mupirocin ointment. Study results showed that the average time required for complete wound closure was 8.6 and 11.1 days in Groups I and II, respectively (p = .014), which was statistically significant. Both groups showed complete bacterial elimination on Day 3 based on negative Gram stain results and on Day 6 based on clearance of clinical manifestations (p = 1.000). This is a novel study in EB‐infected wounds, which shows that DACC‐coated cotton acetate dressing promotes faster wound closure and is as effective as the combination of normal saline dressing and 2% mupirocin ointment in eliminating bacterial infection.     

Impact of repeated nicotine and alcohol coexposure on in vitro and in vivo chlorpyrifos dosimetry and cholinesterase inhibition

Chlorpyrifos (CPF) is an organophosphorus insecticide, and neurotoxicity results from inhibition of acetylcholinesterase (AChE) by its metabolite, chlorpyrifos-oxon. Routine consumption of alcohol and tobacco modifies metabolic and physiological processes impacting the metabolism and pharmacokinetics of other xenobiotics, including pesticides. This study evaluated the influence of repeated ethanol and nicotine coexposure on in vivo CPF dosimetry and cholinesterase (ChE) response (ChE- includes AChE and/or butyrylcholinesterase (BuChE)). Hepatic microsomes were prepared from groups of naive, ethanol-only (1 g/kg/d, 7 d, po), and ethanol + nicotine (1 mg/kg/d 7 d, sc)-treated rats, and the in vitro metabolism of CPF was evaluated. For in vivo studies, rats were treated with saline or ethanol (1 g/kg/d, po) + nicotine (1 mg/kg/d, sc) in addition to CPF (1 or 5 mg/kg/d, po) for 7 d. The major CPF metabolite, 3,5,6-trichloro-2-pyridinol (TCPy), in blood and urine and the plasma ChE and brain acetylcholinesterase (AChE) activities were measured in rats. There were differences in pharmacokinetics, with higher TCPy peak concentrations and increased blood TCPy AUC in ethanol + nicotine groups compared to CPF only (approximately 1.8- and 3.8-fold at 1 and 5 mg CPF doses, respectively). Brain AChE activities after ethanol + nicotine treatments showed significantly less inhibition following repeated 5 mg CPF/kg dosing compared to CPF only (96 ± 13 and 66 ± 7% of naive at 4 h post last CPF dosing, respectively). Although brain AChE activity was minimal inhibited for the 1-mg CPF/kg/d groups, the ethanol + nicotine pretreatment resulted in a similar trend (i.e., slightly less inhibition). No marked differences were observed in plasma ChE activities due to the alcohol + nicotine treatments. In vitro, CPF metabolism was not markedly affected by repeated ethanol or both ethanol + nicotine exposures. Compared with a previous study of nicotine and CPF exposure, there were no apparent additional exacerbating effects due to ethanol coexposure.     

Common molecular cytogenetic pathway in papillary tumors of the pineal region (PTPR)

Primary papillary tumors of the central nervous system and particularly the pineal region are rare. Papillary tumor of the pineal region (PTPR) is a recently described neoplasm that has been formally recognized in the 2007 World Health Organization Classification of Tumors of the Nervous System. Because of their rarity, further pheno- and genotypical observations as well as therapeutic experience are necessary to differentiate PTPR from other primary or secondary papillary tumors of this region. We herein present three cases of PTPR characterized by local recurrence in two of them. Primary and recurrent tumors were analyzed by immunohistochemistry and comparative genomic hybridization (CGH). From our results clonal chromosomal aberrations can be postulated which seem to be a feasible tool to differentiate PTPRs from other primary or secondary papillary tumors of this region.