The European response to control and manage multi- and extensively drug-resistant Neisseria gonorrhoeae

Because cefixime and ceftriaxone resistance in Neisseria gonorrhoeae and gonorrhoea treatment failures were increasing, a response plan to control and manage multidrug-resistant N. gonorrhoeae (MDR-NG) in Europe was published in 2012. The three main areas of the plan were to: (i) strengthen surveillance of antimicrobial resistance (AMR), (ii) implement monitoring of treatment failures and (iii) establish a communication strategy to increase awareness and disseminate AMR results. Since 2012, several additional extensively drug-resistant N. gonorrhoeae (XDR-NG) strains have emerged, and strains with high-level ceftriaxone resistance spread internationally. This prompted an evaluation and review of the 2012 European Centre for Disease Prevention and Control (ECDC) response plan, revealing an overall improvement in many aspects of monitoring AMR in N. gonorrhoeae; however, treatment failure monitoring was a weakness. Accordingly, the plan was updated in 2019 to further support European Union/European Economic Area (EU/EEA) countries in controlling and managing the threat of MDR/XDR-NG in Europe through further strengthening of AMR surveillance and clinical management including treatment failure monitoring. The plan will be assessed biennially to ensure its effectiveness and its value. Along with prevention, diagnostic, treatment and epidemiological surveillance strategies, AMR surveillance is essential for effective control of gonorrhoea.     

Two common polymorphisms in the peroxisome proliferator-activated receptor γ gene may improve fertilization in IVF

Genetic factors play an important role in women’s fertility and embryonic development and may also contribute to the efficacy of assisted reproduction techniques. The aim of this study was to investigate the effect of His447His and Pro12Ala peroxisome proliferator-activated receptor γ (PPARγ) gene polymorphisms on oocytes and fertilization in women undergoing IVF. Follicular fluid and blood samples were obtained from 98 IVF patients referred to Tabriz Alzahra Hospital. Samples were analysed for fatty acid content by gas–liquid chromatography and for polymorphisms of the PPARγ gene using polymerase chain reaction-restriction fragment length polymorphism-based methods. Multiple regression analyses were used to test the independence of associations between the number of mature and fertilized oocytes as outcome variables and the polymorphisms of PPARγ gene. For both polymorphisms, fertilization ratio was significantly (P < 0.05) higher in carriers of the rare alleles than homozygous wild-type genotypes. The associations of His447His (P = 0.003) and Pro12Ala (P = 0.015) polymorphisms remained statistically significant in the multiple regression analyses. This study suggests that the two common gene polymorphisms of PPARγ may improve fertilization in vitro and, thus possibly, female fertility.     

Photobiomodulation isolated or associated with adipose-derived stem cells allograft improves inflammatory and oxidative parameters in the delayed-healing wound in streptozotocin-induced diabetic rats

Lasers in Medical Science - The single and associated impressions of photobiomodulation (PBM) and adipose-derived stem cells (ADS) on stereological parameters (SP), and gene expression (GE) of some...     

Clinical characteristics and mortality risk prediction in children with acute kidney injury

Background:

Acute kidney injury (AKI) is characterized by a reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately.

Objective:

AKI is a serious condition in critically ill patients. The aim of the study was to determine incidence rate, identify risk factors, and describe the clinical outcome of AKI in the Pediatric Intensive Care Unit (PICU).

Materials and Methods:

This prospective observational study was conducted in the PICU of a hospital in the South-east Area of Iran (Zahedan City), to study the clinico-etiological profile of AKI (defined according to the AKI network criteria). Over a period of 20 months from April 2012 to December 2014, 303 children were included in the study. Both the groups of patients, those who developed AKI and those who did not develop AKI, were then followed during the course of their hospital stay.

Results:

There were 303 cases included in the study, with the incidence rate of AKI of 14.9% in PICU. The most common PICU admission diagnoses in AKI were neurologic 85 (%28.05), followed by heart diseases 52 (17.18%) and 31 (10.23%) for respiratory diseases. AKI was 43.5 and 5.4 times more prevalent in renal and endocrine patients compared to those with heart disease respectively. The mortality rate was estimated to be higher in patients with AKI compared to their counterparts (40% vs. 17.8%). Chance of death increased in patients with AKI (odds ratio = 3.04).

Conclusion:

AKI is a serious problem, but its true incidence is unknown. Understanding the epidemiology of AKI by using of standard definition help us to find high-risk children that are the first step to improve outcomes. The future multiple-center study may benefit by better identifying risk factors and early detection of AKI by using biomarkers novel to prevent the developing of AKI.     

Activation of Melatonin Receptors Reduces Relapse-Like Alcohol Consumption

Melatonin is an endogenous synchronizer of biological rhythms and a modulator of physiological functions and behaviors of all mammals. Reduced levels of melatonin and a delay of its nocturnal peak concentration have been found in alcohol-dependent patients and rats. Here we investigated whether the melatonergic system is a novel target to treat alcohol addiction. Male Wistar rats were subjected to long-term voluntary alcohol consumption with repeated abstinence phases. Circadian drinking rhythmicity and patterns were registered with high temporal resolution by a drinkometer system and analyzed by Fourier analysis. We examined potential antirelapse effect of the novel antidepressant drug agomelatine. Given that agomelatine is a potent MT1 and MT2 receptor agonist and a 5-HT_2C antagonist we also tested the effects of melatonin itself and the 5-HT_2C antagonist SB242084. All drugs reduced relapse-like drinking. Agomelatine and melatonin administered at the end of the light phase led to very similar changes on all measures of the post-abstinence drinking behavior, suggesting that effects of agomelatine on relapse-like behavior are mostly driven by its melatonergic activity. Both drugs caused a clear phase advance in the diurnal drinking pattern when compared with the control vehicle-treated group and a reduced frequency of approaches to alcohol bottles. Melatonin given at the onset of the light phase had no effect on the circadian phase and very small effects on alcohol consumption. We conclude that targeting the melatonergic system in alcohol-dependent individuals can induce a circadian phase advance, which may restore normal sleep architecture and reduce relapse behavior.     

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Background and objectives: Epidemiologic studies show an association between higher predialysis serum phosphorus and increased death risk in maintenance hemodialysis (MHD) patients. The hypothesis that higher dietary phosphorus intake and higher phosphorus content per gram of dietary protein intake are each associated with increased mortality in MHD patients was examined.Design, setting, participants, & measurements: Food frequency questionnaires were used to conduct a cohort study to examine the survival predictability of dietary phosphorus and the ratio of phosphorus to protein intake. At the start of the cohort, Cox proportional hazard regression was used in 224 MHD patients, who were followed for up to 5 years (2001 to 2006).Results: Both higher dietary phosphorus intake and a higher dietary phosphorus to protein ratio were associated with significantly increased death hazard ratios (HR) in the unadjusted models and after incremental adjustments for case-mix, diet, serum phosphorus, malnutrition-inflammation complex syndrome, and inflammatory markers. The HR of the highest (compared with lowest) dietary phosphorus intake tertile in the fully adjusted model was 2.37. Across categories of dietary phosphorus to protein ratios of <12, 12 to <14, 14 to <16, and ≥16 mg/g, death HRs were 1.13, 1.00 (reference value), 1.80, and 1.99, respectively. Cubic spline models of the survival analyses showed similar incremental associations.Conclusions: Higher dietary phosphorus intake and higher dietary phosphorus to protein ratios are each associated with increased death risk in MHD patients, even after adjustments for serum phosphorus, phosphate binders and their types, and dietary protein, energy, and potassium intakes.The causes for the excessive mortality in people with chronic kidney disease (CKD) who undergo maintenance dialysis treatment are not clearly defined (1,2). Whereas the traditional cardiovascular risk factors do not account for the increased mortality in CKD patients (3,4), measures of mineral and bone disorders (MBD), including hyperphosphatemia, are associated with increased death risk (5–9). Hyperphosphatemia may be involved in the pathogenesis of vascular calcification ((10–12)). Hence, prevention and correction of hyperphosphatemia and dietary phosphorus burden are major components of the management of CKD. This goal is usually approached by restricting dietary phosphorus intake and administering phosphate binders (13–15).There are few data concerning the association of dietary phosphorus intake with outcome. Restriction of dietary intake of phosphorus generally requires some reduction in the allowable protein intake (8) and restricted consumption of highly processed fast and convenience foods (16). However, imposing dietary phosphorus restriction can lead to obligatory reduction in dietary protein intake, which per se is associated with protein-energy wasting (PEW) (17) and increased mortality (8). Hence, it is difficult to determine the effect of dietary phosphorus on survival, because dietary protein intake tends to covary with phosphorus intake (18). However, dietary phosphorus to protein ratio may be a more appropriate metric to this end, as recommended by the Kidney Disease Outcomes Quality Initiative MBD guidelines for mineral and bone disorder of CKD (18,19). In this study, we examined the mortality-predictability of dietary phosphorus intake and the dietary phosphorus to protein ratio in a well-studied cohort of MHD patients who were followed for up to 5 years and in whom nutritional and inflammatory measures, including cytokines, and body composition were assessed. We hypothesized that higher dietary phosphorus intake and intake of foods with higher phosphorus to protein ratios are independently associated with increased death risk in MHD patients.     

Fc gamma RIIa (CD32) polymorphism and onchocercal skin disease: implications for the development of severe reactive onchodermatitis (ROD)

The pathologic manifestations of Onchocerca volvulus infection depend on the interplay between the host and the parasite. A genetic single nucleotide polymorphism in the Fc gamma RIIa gene, resulting in arginine (R) or histidine (H) at position 131, affects the binding to the different IgG subclasses and may influence the clinical variations seen in onchocerciasis. This study investigated the relationship between this polymorphism and disease outcome. Fc gamma RIIa genotyping was performed on clinically characterized onchocerciasis patients (N = 100) and healthy controls (N = 74). Fc gamma RIIa genotype R/R131 frequencies were significantly higher among patients with severe dermatopathology (P < 0.001). Increased risk of developing this form was mostly associated with one tribe (Masalit) (OR = 3.2, 95% CI 1-9.9, P = 0.042). The H131 allele was found to be significantly associated with a reduced risk of having the severe form of the disease (adjusted OR = 0.26, 95% CI = 0.13-0.46, P < 0.001). Our findings suggest that the polymorphism influences the clinical outcome of onchocerciasis.