Fungal dysbiosis predicts the diagnosis of pediatric Crohn's disease

AIM To investigate the accuracy of fungal dysbiosis inmucosa and stool for predicting the diagnosis of Crohn's disease(CD). METHODS Children were prospectively enrolled in two medical centers: one university hospital and one private gastroenterology clinic in the city of Riyadh, Kingdom of Saudi Arabia. The children with confirmed diagnosis of CD by standard guidelines were considered cases, and the others were considered non-inflammatory bowel disease controls. Mucosal and stool samples were sequenced utilizing Illumina MiSeq chemistry following the manufacturer's protocols, and abundance and diversity of fungal taxa in mucosa and stool were analyzed. Sparse logistic regression was used to predict the diagnosis of CD. The accuracy of the classifier was tested by computing the receiver operating characteristic curves with 5-fold stratified cross-validation under 100 permutations of the training data partition and the mean area under the curve(AUC) was calculated. RESULTS All the children were Saudi nationals. There were 15 children with CD and 20 controls. The mean age was 13.9(range: 6.7-17.8) years for CD children and 13.9(3.25-18.6) years for controls, and 10/15(67%) of the CD and 13/20(65%) of the control subjects were boys. CD locations at diagnosis were ileal(L1) in 4 and colonic(L3) in 11 children, while CD behavior was non-stricturing and non-penetrating(B1) in 12 and stricturing(B2) in 3 children. The mean AUC for the fungal dysbiosis classifier was significantly higher in stools(AUC = 0.85 ± 0.057) than in mucosa(AUC = 0.71 ± 0.067)(P 0.001). Most fungal species were significantly more depleted in stools than mucosal samples, except for Saccharomyces cerevisiae and S. bayanus, which were significantly more abundant. Diversity was significantly more reduced in stools than in mucosa. CONCLUSION We found high AUC of fungal dysbiosis in fecal samples of children with CD, suggesting high accuracy in predicting diagnosis of CD.     

Clinical and genetic characteristics for the Urofacial Syndrome (UFS)

The Urofacial (Ochoa) Syndrome (UFS) is a rare autosomal recessive disorder and over 100 patients have been reported thus far. UFS is characterized by the abnormal facial expression and dysfunctional voiding. The patients show a peculiar distortion of the facial expression (grimacing as if in pain or sadness when they tried to smile or laugh) along with urinary tract infection, enuresis, vesicoureteral reflux and hydronephrosis without any underlying neurological lesion and previous urinary obstruction. Some patients are also noted with nocturnal lagophthalmos. Until 2010, HPSE2, the gene encodes Heparanse 2 on chromosome 10, was thought to be the only culprit gene for this syndrome. However, another criminal gene, LRIG2, which encodes leucine-rich repeats and immunoglobulin-like domains 2, was also come into the light in 2012. Studies for dissecting the biological functions of HPSE2 and LRIG2 in urinary abnormalities are ongoing. In this minireview, we will update the discovery of novel clinical manifestations relevant to this syndrome and discuss with focus for the impact of HPSE2 on voiding dysfunction.     

Infectious Middle East Respiratory Syndrome Coronavirus Excretion and Serotype Variability Based on Live Virus Isolates from Patients in Saudi Arabia

The newly emerged Middle East respiratory syndrome coronavirus (MERS-CoV) has infected at least 1,082 people, including 439 fatalities. So far, no empirical virus isolation study has been done to elucidate infectious virus secretion or serotype variability. Here, we used 51 respiratory samples from 32 patients with confirmed MERS-CoV infection for virus isolation in Vero B4 and Caco-2 cells. We found Caco-2 cells to significantly enhance isolation success over routinely used Vero cells. Isolation success correlated with viral RNA concentration and time after diagnosis as well as with the amount of IgA antibodies secreted in respiratory samples used for isolation. Results from plaque reduction neutralization assays using a representative range of serum samples and virus isolates suggested that all circulating human MERS-CoV strains represent one single serotype. The choice of prototype strain is not likely to influence the success of candidate MERS-CoV vaccines. However, vaccine formulations should be evaluated for their potential to induce IgA.     

Human Infection with MERS Coronavirus after Exposure to Infected Camels,Saudi Arabia, 2013

We investigated a case of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV) after exposure to infected camels. Analysis of the whole human-derived virus and 15% of the camel-derived virus sequence yielded nucleotide polymorphism signatures suggestive of cross-species transmission. Camels may act as a direct source of human MERS-CoV infection.     

Inhibition of oxalate nephrolithiasis with Ammi visnaga (AI-Khillah)

We investigated the effect of Ammi visnaga seeds on experimentally – induced kidney stones – in male Wistar albino rats. Oxalate nephrolithiasis was experimentally induced by 3% glycolic acid (added in their diet) given for the period of four weeks. A highly significant amount of deposits were found in the kidneys, which were analyzed quantitatively. These deposits were mainly of calcium oxalate in composition.Daily oral (gavage) treatment with Ammi visnaga (500 mg/kg) highly reduced the incidence of nephrolithiasis (calcium oxalate deposition in the kidneys). Ammi visnaga seeds extract showed highly potent diuretic activity. The reduction in body weight, increase in kidneys weight, increase in water intake, decrease in urine output found in glycolic acid control group were prevented to various extent on Ammi visnaga treatment; and the values became to insignificant difference with control group. The changes in weights of liver, heart and lungs of the three groups were insignificant. Uraemia and hyperbilirubinaemia observed in glycolic acid control group were found to be ameliorated by Ammi visnaga seed extract treatment.     

Effects of an Inhibitor of Nitric Oxide Synthesis on Skin Wound Repair

Introduction:  The aim of this study was to compare the effects of Urgotul^® and other greasy dressings and interfaces on normal human dermal fibroblasts (NHDF) monolayers in vitro . The selected end points were the cell proliferation, the morphology of the extracellular matrix (ECM) upon dressing removal, and the structure of the underlying fibroblasts.
Materials and methods:  Equivalent pieces of each dressing were applied on NHDF monolayers for different times. Cell proliferation was measured via [3H] thymidine incorporation. Identical cultures were used to assess the dressing impact on the morphology of cells in culture after MTT staining and micro‐photographing. ECM morphology was shown by immunoflorescence, using an anticollagen I antibody. Effects on cell ultrastructure were documented by confocal laser microscopy after tubulin/actin double labelling.
Results:  Among the five tested greasy dressings and interfaces, only Urgotul^® showed a stimulating effect on the proliferation of NHDF. Two dressings did not modify proliferation and two other had cytostatic effects.
In addition, the lesions of the ECM upon dressing removal were clearly the lowest with Urgotul^®(low adherence to cellular surface and/or to extracellular matrix). The ultrastructure of the NHDF in direct contact with Urgotul^® was not significantly modified.
Conclusion:  Fibroblasts are the key cells of wound healing. The use of nonaggressive greasy gauzes and/or interfaces promoting cell proliferation should be of interest. Clinical evaluations are required to confirm these in vitro results.     

Synoptic characteristics of dusty spring days over central and eastern Saudi Arabia

The synoptic characteristics of dusty spring days in central and eastern Saudi Arabia were analyzed using the aerosol index (AI) from the TOMS satellite and meteorological parameters from the NCEP/NCAR reanalysis dataset. The AI distributions were used to detect and classify dusty spring days into three classes (narrow, moderate, and wide spread). The synoptic features of the cases and classes demonstrated the common synoptic characteristics that represented the dusty spring cases. The strength of these common synoptic characteristics was found to increase with increasing dust severity. Specifically, as the following factors occurred, the cyclone located over the southern Arabian Peninsula deepened, the maximum wind at 250 hPa weakened and shifted northward, the instability over the northern Arabian Peninsula increased, the northerly wind generated, and the gradient of the 850-hPa potential temperature west of the cyclone increased; the severity of the dust class increased. The results were confirmed by examining three specific cases representing weak, moderate, and severe dust events.     

Secondary prostatic adenocarcinoma: a cytopathological study of 50 cases

Positive diagnosis of metastatic prostate adenocarcinoma (PAC) can be made by microscopic examination of the cytologic specimens and immunostaining for prostate-specific antigen (PSA) and prostate acid phosphatase (PAP). Immunohistochemical markers have been known to display negative, weak, or focal staining in poorly differentiated PAC and in patients with prior hormonal and/or radiation therapy. The purpose of this study is to characterize the cytopathology of metastatic PAC as it has not been documented in large series. Fifty cases of metastatic PAC with cytological specimens consisting of 41 fine-needle aspiration biopsies (FNAB), 6 pleural fluid aspirates, and 3 catheterized urine samples were reviewed and correlated with the surgical specimens and the clinical charts. Immunostaining for PSA, PAP, cytokeratin AE1/3, cytokeratin 7 (CK7), cytokeratin 20 (CK20), vimentin, and carcinoembryonic antigen (CEA) was done. Mean patient age was 77 +/- 8 yr; serum PSA, 4.1 +/- 2.3; and primary PAC Gleason score, 8.1 +/- 1.5. Cytologically, the specimens consisted of cell clusters or cell sheets with overlapping uniform hyperchromatic nuclei with or without nucleoli. Twelve cases were not reactive to PSA and PAP and 44 cases displayed negative immunoreactivity to both CK7 and CK20. Carcinoid-like lesions and small cell carcinomas were seen in 4 cases and were misdiagnosed as nonprostatic origin based on the following features: negative immunoreactivity to PSA and PAP with or without positive reactivity to CEA, and different histopathological features when compared with the primary PAC. In addition to the frequency of high-grade PAC, awareness of the negative immunoreactivity to PSA and PAP, the discrepancy in the histopathological patterns between the primary and secondary tumors, especially the frequent neuroendocrine differentiation, are helpful features for the diagnosis of metastases of prostatic origin.     

Drainage vs. non-drainage after cholecystectomy for acute cholecystitis: a retrospective study

Many surgeons practice prophylactic drainage after cholecystectomy without reliable evidence. This study was conducted to answer the question whether to drain or not to drain after cholecystectomy for acute calculous cholecystitis. A retrospective review of all patients who had cholecystectomy for acute cholecystitis in Aseer Central Hospital, Abha, Saudi Arabia, was conducted from April 2010 to April 2012. Data were extracted from hospital case files. Preoperative data included clinical presentation, routine investigations and liver function tests. Operative data included excessive adhesions, bleeding, bile leak, and drain insertion. Complicated cases such as pericholecystic collections, mucocele and empyema were also reported. Patients who needed therapeutic drainage were excluded. Postoperative data included hospital stay, volume of drained fluid, time of drain removal, and drain site problems. The study included 103 patients allocated into two groups; group A (n  =  38) for patients with operative drain insertion and group B (n  =  65) for patients without drain insertion. The number of patients with preoperative diagnosis of acute non-complicated cholecystitis was significantly greater in group B (80%) than group A (36.8%) (P < 0.001). Operative time was significantly longer in group A. All patients who were converted from laparoscopic to open cholecystectomy were in group A. Multivariate analysis revealed that hospital stay was significantly (P < 0.001) longer in patients with preoperative complications. There was no added benefit for prophylactic drain insertion after cholecystectomy for acute calculous cholecystitis in non-complicated or in complicated cases.