Posterior reversible encephalopathy syndrome after kidney transplantation in pediatric recipients: Two cases

PRES is a neuro‐clinical and radiological syndrome that can result as a consequence of several different conditions including hypertension, fluid overload, and immunosuppressive treatment. Herein, we report two children who received kidney and combined liver–kidney transplantation as treatment for renal hypodysplasia associated with bilateral vesico‐ureteral reflux and methylmalonic acidemia, respectively. Early after surgery (seven and 10 days), both patients presented with hypertension and seizures. The patients' immunosuppressive regimen included steroid and calcineurin inhibitors (tacrolimus and cyclosporine, respectively) and basiliximab and one with anti‐IL2 receptor. In both cases, the imaging strongly supported the diagnosis of PRES. In details, the CT scan showed hypodensities in the posterior areas of the brain, and brain MRI demonstrated parieto‐occipital alterations indicative of vasogenic edema. Treatment with calcineurin inhibitors was temporally discontinued and restarted at lower dosage; arterial hypertension was treated with Ca‐channel blockers. Both children fully recovered without any neurological sequels. In conclusion, in children undergoing solid organ transplantation, who develop neurological symptoms PRES, should be carefully considered in the differential diagnosis and once the diagnosis is ruled in, we recommend strict arterial blood pressure control and adjustment or withholding of calcineurin inhibitor therapy should be considered based upon blood levels.     

Interleukin-1beta and interleukin-1 receptor antagonist gene polymorphisms and gastric cancer: a meta-analysis.

BACKGROUND: Polymorphisms of interleukin-1B (IL1B) and its receptor antagonist (IL1RN) genes have been inconsistently associated with gastric cancer risk. We examined these associations by performing meta-analyses. MATERIALS AND METHODS: Twenty-five studies testing the association between IL1B and/or IL1RN gene polymorphisms and gastric cancer were examined: 14 studies of IL1B-511, 14 studies of IL1B-31, 8 studies of IL1B+3954, and 23 studies of IL1RN. Overall and ethnicity-specific summary odds ratios and corresponding 95% confidence intervals for gastric cancer associated with these polymorphisms were estimated using fixed- and random-effects models. Heterogeneity and publication bias were evaluated. RESULTS: IL1B-511T and IL1RN*2 were associated with gastric cancer risk in Caucasians, but not in Asians. For IL1B-511T, the association in Caucasians was stronger when intestinal-subtype and noncardia gastric cancer cases were examined. A nonsignificant trend was observed between IL1B-31C and gastric cancer in Caucasians. No significant association of IL1B+3954T and gastric cancer risk was detected. Studies with better methodologic characteristics reported stronger effects. There was no evidence of publication bias. CONCLUSION: IL1B-511T is associated with gastric cancer susceptibility in Caucasians. The meta-analyses suggest that the conflicting results among studies may be explained by variation in allele frequencies among the ethnic groups and variation in tumor types, as well as by the methodologic quality of the studies.     

Analyzing data in which the outcome is time to an event part II: The presence of multiple covariates

In this article, the second of a series on the analysis of time to event data, we address the case in which multiple predictors (covariates) that may influence the time to an event are taken into account. The hazard function is introduced, and is given in a form useful for assessing the impact of multiple covariates on time to an event. Methods for the assessment of model fitting are also discussed and an example with cancer survival as outcome with the presence or absence of multiple genes as covariates is presented.     

Direct ultraviolet method for enzymatic determination of uric acid, with equilibrium and kinetic data-processing options

We developed and evaluated a direct ultraviolet method for the enzymatic determination of uric acid in serum, plasma, or urine, without deproteinization of sera and plasma. Equilibrium and nonlinear curve-fitting kinetic options are evaluated and compared, and results of the proposed method are compared with those of a candidate Reference Method. All data-processing options yield a linear relation for absorbance and concentration of uric acid between 0.1 and 2 mmol/L; with the equilibrium option, results are linear to 5 mmol/L. For 100 plasma samples, results correlate well between the proposed method (y) and a reference method (x): y = 0.99x - 0.002 mmol/L. Between-run imprecision is about 2.3%, and interference by hemolyzed, icteric, or lipemic specimens or specimens containing high concentrations of xanthine or paraproteins is minimal. The kinetic option with a data-processing range of 100 s or longer yields results that correlate well with the equilibrium method: y = 1.006x + 0.002 mmol/L (n = 118). For 20 urine samples processed by the proposed (y) and a reference (x) methods, y = 1.04x + 0.038 mmol/L.     

Effect of smoking on failure of H. pylori therapy and gastric histology in a high gastric cancer risk area of Colombia

It has been proposed that eradication of Helicobacter pylori infection is a sound strategy for gastric cancer prevention. Several factors including smoking have been associated to treatment failure rates. This study aimed to evaluate the smoking effect on the efficacy of H. pylori therapy, as well as on the histological parameters in the gastric mucosa from subjects from a high gastric cancer risk area. Two-hundred-sixty-four Colombian subjects with gastric precancerous lesions who participated in a chemoprevention trial, received anti-H. pylori treatment at baseline and had data recorded on cigarette use, were included in this study. A detailed histopathological assessment of the gastric mucosa was performed in biopsies taken before any intervention. H. pylori eradication was assessed in gastric biopsies at 36 months post-treatment. The overall eradication rate was 52.3%; rates of 41.3% and 57.1% were observed for active-smokers and non-smokers, respectively. Multivariate logistic regression analysis showed that smokers had a 2-fold higher probability of failure in Helicobacter pylori eradication than non-smokers (OR: 2.0; 95% CI: 1.01-3.95). At baseline, active-smokers had a higher score of intestinal metaplasia compared to non-smokers. In the corpus mucosa, active-smokers showed lower scores of H. pylori density, total inflammation, neutrophil infiltration, and mucus depletion than non-smokers. In the antrum, no significant differences were observed between active-smokers and non-smokers. In summary, in patients who smoked, H. pylori treatment was less effective. Smoking cessation may benefit H. pylori eradication rates.     

Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States over a 10-year period: Alexander Project

The Alexander Project is a global surveillance study conducted from 1992 to 2001. Minimum inhibitory concentrations and percent resistance to a panel of antimicrobial agents were determined according to National Committee for Clinical Laboratory Standards methodology. Resistance to penicillin (PEN-R) and erythromycin (ERY-R) have increased in the period 1992-2001 by 3.9 and 4.5 times to 20.7% and 27.9%, respectively. Joint PEN-ERY-R has increased 4.9 times, up to 15.3%. In 1992, 57.1% of all PEN-R isolates were also ERY-R, whereas in 2001, 75.8% were ERY-R. Resistance to only 1 antibiotic increased slightly, from 8% in 1992 to 12% in 2001, whereas resistance to more than 1 antibiotic increased 4.3 times, from 6.4% in 1992 to 27.8% of all strains in 2001. Multidrug-resistant pneumococci are an increasingly common finding in the United States. Three of four PEN-R isolates are also multiresistant. The rate of growth of multidrug resistance is higher than that of single antibiotic resistance.