DIGESTIVE ENDOSCOPY, Issue 4 2005
Iruru Maetani
Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 as an effective means of enteral nutrition where oral intake is not possible. PEG placement is safe and has now replaced the nasogastric tube in patients who need long-term feeding. Although it is relatively safe with a very low associated mortality, minor complications, especially local and systemic infection, remain a problem. Of these, peristomal wound infections are the most common complication of PEG. In patients indicated for this procedure who are aged and/or frail, this complication may pose a critical problem. In the commonly used pull or push methods for PEG placement, the PEG tube is readily colonized by oropharyngeal bacteria. Infection of the PEG site is considered to be associated with contamination of the PEG catheter. There are important measures that should be taken to prevent peristomal infection. A number of rigorous studies have shown that prophylactic antibiotics are effective in reducing the risk of peristomal infection. As methicillin-resistant Staphylococcus aureus (MRSA) or other resistant organisms are emerging as a major pathogen in peristomal infection, however, currently recommended antibiotic prophylaxis regimens might be inappropriate. Alternative regimens and other approaches to prevent contamination of the PEG tube during the procedure are required. [source]

CONCURRENT GASTRIC AND COLONIC LOW-GRADE MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMATA IN A PATIENT WITHOUT HELICOBACTER PYLORI INFECTION

DIGESTIVE ENDOSCOPY, Issue 1 2003
HIROYUKI OKADA
Mucosa-associated lymphoid tissue (MALT) lymphomata observed simultaneously in the stomach and colon are rare. We report concurrent gastric and colonic low-grade MALT lymphomata that originated from the same clone in a 58-year-old Japanese man without Helicobacter pylori infection. Endoscopy showed multiple erosive lesions in the gastric body and antrum, and a single flat elevation with an irregular margin in the sigmoid colon. Histopathological findings of both lesions suggested low-grade MALT lymphoma. Lymphoepithelial lesions were evident in the gastric lesions, but not in the colonic lesion. Southern blot analysis of lymphoma cells revealed the same immunoglobulin heavy-chain rearrangement pattern. The chromosomal translocation t(11;18)(q21;q21) was also observed. After six courses of cyclophosphamide, doxorubicin, vincristine and predonisolone, the gastric lesions disappeared endoscopically, while the colonic lesion persisted. A sigmoidectomy was consequently performed. The chromosomal translocation may be related to the pathogenesis of the present MALT lymphoma case without H. pylori infection. It is interesting that the gastric and colonic lesions differed in response to treatment and in their endoscopic and histologic features, despite having the same origin. [source]

RECENT PROGRESS IN ENDOSCOPY-BASED DIAGNOSIS OF HELICOBACTER PYLORI INFECTION

DIGESTIVE ENDOSCOPY, Issue 1 2001
Tadashi Sato
Numerous invasive and non-invasive tests are available in the detection of Helicobacter pylori. Endoscopy-based tests that include rapid urease test, histological examination and culture are important generally in the assessment of H. pylori status before eradication therapy. Recently, several new endoscopy-based diagnostic methods have been developed aiming at rapid and accurate detection of the organisms. It would be possible to diagnose H. pylori infection in treated patients by using these new highly sensitive tests. Although the diagnosis of H. pylori infection itself is possible by using non-invasive diagnostic tests, endoscopy-based tests provide not only the diagnosis of the organisms, but also the exclusive information such as treatment indications and the susceptibility for the antimicrobial drugs. Recently, new triple therapy including clarithromycin has been widely performed in Japan. Along with an increase in the prevalence of the antibiotic-resistant strains, culture may become a more important diagnostic method in the future. The inappropriate application of the tests may increase the potential risk of the misdiagnosis and the treatment failures. The diagnostic method should be selected by taking into account the circumstances in which a diagnosis is to be performed. [source]

MULTIPLE HIV-1 INFECTION OF CELLS AND THE EVOLUTIONARY DYNAMICS OF CYTOTOXIC T LYMPHOCYTE ESCAPE MUTANTS

EVOLUTION, Issue 9 2009
Dominik Wodarz
Cytotoxic T lymphocytes (CTL) are an important branch of the immune system, killing virus-infected cells. Many viruses can mutate so that infected cells are not killed by CTL anymore. This escape can contribute to virus persistence and disease. A prominent example is HIV-1. The evolutionary dynamics of CTL escape mutants in vivo have been studied experimentally and mathematically, assuming that a cell can only be infected with one HIV particle at a time. However, according to data, multiple virus particles frequently infect the same cell, a process called coinfection. Here, we study the evolutionary dynamics of CTL escape mutants in the context of coinfection. A mathematical model suggests that an intermediate strength of the CTL response against the wild-type is most detrimental for an escape mutant, minimizing overall virus load and even leading to its extinction. A weaker or, paradoxically, stronger CTL response against the wild-type both lead to the persistence of the escape mutant and higher virus load. It is hypothesized that an intermediate strength of the CTL response, and thus the suboptimal virus suppression observed in HIV-1 infection, might be adaptive to minimize the impact of existing CTL escape mutants on overall virus load. [source]

CLINICAL FEATURES OF INFLUENZA A VIRUS INFECTION IN OLDER HOSPITALIZED PERSONS

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2003
Paul J. Drinka MD
No abstract is available for this article. [source]

PHYSICAL, PHYSIOLOGICAL AND CHEMICAL CHANGES IN POTATO AS INFLUENCED BY ERWINIA CAROTOVORA INFECTION

JOURNAL OF FOOD PROCESSING AND PRESERVATION, Issue 5 2002
F. NOURIAN
Bacterial soft rot, caused by Erwinia carotovora ssp. carotovora (Ecc), is a major disease in stored potatoes. The pathogen causes different physical, physiological and chemical changes in potatoes, which may affect the acceptability of raw and processed products. This study was carried out to evaluate the effect of disease severity on different physico-chemical and physiological properties of raw and cooked potatoes and to select the parameters most responsive to disease severity. Potatoes were inoculated with bacteria and incubated at 20C for different lengths of time to produce different levels of disease. As incubation time increased the volume of disease (VDS) increased, which in turn influenced the respiration rate (RR). In both raw and cooked potatoes, the physical changes (texture and color) associated with the progress of disease were reduced hardness, firmness and L value, and increased a and b values and total color difference (,E). The chemical changes were reduced ascorbic acid and pH, and increased reducing sugars, total sugars and titrable acidity along with the activities of peroxidase and polyphenol oxidase. The changes in physical and chemical parameters of raw and cooked potatoes during storage were described by fractional conversion equation models. All parameters were quite sensitive to disease except reducing sugars, peroxidase and PPO activity. The correlation matrix indicated that several of the quality parameters were related and thus most of them could be successfully used to predict tuber quality from disease. [source]

INFLUENCE OF ACID ADAPTATION ON THE SURVIVAL OF SALMONELLA ENTERITIDIS AND SALMONELLA TYPHIMURIUM IN SIMULATED GASTRIC FLUID AND IN RATTUS NORVEGICUS INTESTINE INFECTION

JOURNAL OF FOOD SAFETY, Issue 2 2010
KARLA JOSEANE PEREZ
ABSTRACT The aim of this study was to investigate the influence of acid adaptation in the survival of Salmonella Enteritidis (SE86) and Salmonella Typhimurium (ST99) during exposure to simulated gastric fluid (SGF) and in intestinal infection of Rattus norvegicus. Acid-adapted and nonadapted Salmonella strains were exposed to SGF (pH 1.5) and were inoculated by gavage in adult rats. Results indicated that acid-adapted SE86 survived significantly better (P < 0.05) than nonadapted SE86, nonadapted ST99 and acid-adapted ST99 in SGF. Nonadapted microorganisms were observed in higher counts in feces than acid-adapted strains, while acid-adapted microorganisms demonstrated higher counts in intestine samples, suggesting intestinal invasion capacity. Acid-adapted SE86 was recovered in higher counts from ileum-cecum junction than the other microorganisms. PRACTICAL APPLICATIONS Salmonella Enteritidis has been identified as the most frequent serovar involved with the foodborne outbreaks in Brazil. In Southern Brazil, a specific strain of Salmonella Enteritidis (SE86) has been involved with more than 90% of the salmonellosis occurring in the last years, and the main food vehicle is home-made mayonnaise frequently added with different quantities of vinegar, which can cause acid adaptation in Salmonella cells. The results of this work indicate that SE86 presented higher acid adaptation, which contributed to higher survival rates in simulated gastric fluid and better intestinal colonization. These results could be related to human virulence and the frequent involvement of this strain with foodborne outbreaks in southern Brazil. [source]

ATTEMPTS TO UTILIZE BACTERIOPHAGE TO COMBAT SALMONELLA ENTERICA SEROVAR ENTEMTIDIS INFECTION IN CHICKENS

JOURNAL OF FOOD SAFETY, Issue 1 2001
IAN B. SKLAR
ABSTRACT Bacteriophage capable of lysing a nalidixic acid-resistant Salmonella enterica serovar Enteritidis strain (SeE Nalr) were tested for the ability to reduce cecal Salmonella counts in young chickens infected with the bacterium. Qualitative analysis of cloacal swabs suggested that phage treatment can possibly reduce shedding of SeE Nalr, but average SeE Nalr counts of between 105 and 107 cfu of SeE Nalr per g of cecum were obtained even from phage-treated 14-day old birds and even when more than 107 plaque forming units of phage were present per gram of cecal content. The average cecal SeE Nalr counts were generally between 0.3 and 1.3 orders of magnitude lower in phage-treated chickens than in untreated controls birds. The difference in counts was statistically not significant in three animal trials, but significant in two trials using feed particles as delivery vehicles for the phage. Although some of the SeE Nalr in the cecae of phage-treated chickens had developed resistance to some of the phage used, factors other than phage resistance must have contributed to the failure of the phage to substantially reduce SeE Nalr counts. [source]

DOES THE CYTOSKELETON OF INTESTINAL EPITHHELIAL CELLS FUNCTION AS A CELLULAR ALARM TO IDENTIFY THE E. COLI INFECTION

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2001
Zhe Li
Intestinal epithelial cells play an important role in regulating host immunity in response to intestinal infection. Pathogenic bacteria (EPEC and EHEC) cause profound cytoskeletal rearrangement in intestinal epithelial cells during attachment or invasion. Rearrangement of cytoskeletal proteins could be a signal to up-regulate host defence response. Aims, To determine the role of actin cytoskeleton and microtubles in IL-8 mRNA response to E. coli infection. Methods, T84 cell monolayers in 6-well plates were infected with HB101, EPEC and EHEC (105 CFU/well) and compared with uninfected control at 3, 6 and 12 h post infection. Control and infected monolayers were treated with nocodazole (Noc, microtubule disrupter, 30 mm), taxol (Tax, microtubule stabiliser, 10 mm), cytochalasin D (CytoD, actin depolymeriser, 100 nm) and Jasplakinolide (Jasp, actin polymeriser, stabilise actin filaments, 1 mm) and studied 6 h post infection. IL-8 gene expression was measured by semiquantitative RT,PCR in control and uninfected monolayers with and without drug treatment and IL8 protein secretion by ELISA. The morphology of F-actin and ,-tubulin was examined by FITC-phaloidin staining (FAS), immunohistochemistry and confocal microscopy. Results, IL-8 mRNA and IL-8 were increased by infection with all bacterial strains at 3 and 6 h but both IL-8 mRNA and IL-8 in EHEC and EPEC infection were decreased compared with control and HB101 at 12 h. Disruption of microfilaments by Noc increased IL-8 (2.7 fold) while preservation of microfilaments by Tax inhibited IL8 response (0.5 fold) to HB101 infection only. CytoD decreased (0.1,0.5 fold) IL8 expression at all time points in all infections while stabilising actin by Jasp markedly increased the IL8 response (2,6 fold) in control, HB101, EHEC and EPEC at 3 and 6 h. CytoD inhibited Noc-induced IL8 gene expression. Confocal microscopy demonstrated that CytoD and Noc caused major morphological damage to the actin and ,-tubulin by 6 h. Similar changes were also observed in EPEC and EHEC infection at 12 h but not HB101. Jasp preserved actin stress filaments in both EPEC and EHEC. Conclusions, Disruption of microtubules and exogenous rearrangement of actin by pathogenic organism may be primary stimuli to up-regulate proinflammatory cytokine gene expression. Preservation of actin filaments is required for this response and may be necessary for signal transduction to the nucleus. [source]

HELICOBACTER PYLORI INFECTION IN ASYMPTOMATIC POPULATION IN SURABAYA

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000
Pangestu Adi
[source]

CHARACTERISTIC OF GASTRIC CANCER IN INDONESIA: THE ROLE OF HELICOBACTER PYLORI INFECTION

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000
Murdani Abdullah
Background Gastric cancer is the second most common fatal malignancy in the world. In 1996, approximately one million new cases of gastric cancer were found. It is generally agreed that the pathogenesis is multifactorial which may include, dietary factors, environmental factors, bacterial and viral infections. Aim to evaluate the frequent of gastric cancer in Indonesia and itís relating factors. Methods A sample size of 7902 subjects were determined based on hospital data of dyspeptic patients following gastroduodenoscopy procedure from January 1997 to September 1999. Patients were recruited from 9 endoscopic centers located in 5 cities in Indonesia. Endoscopic biopsy specimens were taken 2 specimens from the antrum (2 cm from pylorus) and 2 specimens from the corpus. Helicobacter pylori infections were determined by serology (ELISA), rapid urea test (CLO test), or histopathology examination using Haematoxyline Eosin and Giemsa staining. The criteria used to diagnose Helicobacter pylori infection were a positive result either from one of these tests and/or in combination. Results The frequent of proximal gastric cancer and distal gastric cancer finding were 0.63 % and 0.54 %, consecutively. In the proximal and distal gastric cancer groups the present of Helicobacter pylori were 55.77 % and 85.36 %, consecutively (p>0.05). The finding of gastric cancer among ethnic groups were 0.65 % for Chinese ethnicity and 0.81 % for Non-Chinese ethnicity, statistically has no significant different (p=0,9514). The distal-to-proximal gastric cancer ratio was 0.85. The proximal gastric cancer more frequent to be found in the age group of 41-60 years old (47.83%), while the distal gastric cancer in the age group of 51-70 years old (61.54%). Conclusion The distal-to-proximal gastric cancer ratio was 0.85. The present of Helicobacter pylori were lower in proximal gastric cancer rather than distal gastric cancer, but statistically has of no significant. [source]

CORRELATION OF GASTRIC INTESTINAL METAPLASIA AND HELICOBACTER PYLORI INFECTION AMONG FUNCTIONAL DYSPEPTIC PATIENTS

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000
Murdani Abdullah
Background: It is generally accepted that intestinal metaplasia (IM) is a pre cursor of gastric cancer and is associated with Helicobacter pylori (Hp) infection. But still little data available about association of IM and Hp in different clinical groups of patients, especially in areas with high Hp prevalence. Aim: to evaluate the IM and itís correlation with Hp infection in consecutive patients with functional dyspepsia (FD). Methods: a retrospective review of our endoscopy database and histological data from January 1997 to December 1999 was made. In this period we performed 3083 upper intestinal endoscopy in patients with FD. Endoscopy procedure was done without any specific preparation for Hp evaluation. Biopsy specimen were taken from antrum and corpus and were stained with Giemsa, H&E and Alcian Blue. Histological data was evaluated by pathologist from Department of Pathology, Medical Faculty, University of Indonesia according to the Sydney System. IM was evaluated as present or absent. One hundred and fourteen consecutive data were eligible for statistical analysis. Results: Histological data of 114 patients with FD was analyzed. Average age was 45.47 years (SD 14.32), male 62.3 % (71/114), and female 37.7 % (43/114). Forty-eight (42.11%) patients with FD were Hp positive on histology and were significantly older than Hp negative. (48.74 +12.65/43.25+15.04; p < 0.05). IM was present in 13 ( 11.4%) patients with FD. They were significantly older than the patients without IM (mean age 55.08+11.98/44.23+14.18; p <0.05) Frequency of IM was similar both in Hp positive and Hp negative patients with FD (12.5%/10.6%; p>0.05). Conclusions: IM among patients with FD was 11.4%. IM was significantly more frequent found in older age but our data suggest that IM is not related to Hp status in FD patients. [source]

HELICOBACTER INFECTION IN CHILDREN WITH APPENDICITIS AND LACTOSE INTOLERANCE

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000
Eva J. Soelaeman
Helicobacter pylori eradication has been debated. Most investigators do not recommended treating the infection except in severe case. We report a unique case: H. pylori infection with appendicitis and lactose intolerance. Case report: A 6 year old girl was brought to children and maternity Hospital Harapan Kita due to abdominal pain and vomiting. She had 6- month history of epigastric pain. In the past 2 days, she suffered from abdominal pain arround Mc. Burney area. On physical examination, she was in pain. Her weight was 19 Kg. Vital signs were normal. Findings in heart, lung and extremities were also normal. Abdomen: severe pain in the epigastric and Mc. burney area.Laboratory investigations showed hemoglobin 12 g/dl, leukocyte 12800/ul. Platelets 289000/ul. Bleeding and clotting time were normal. Abdominal ultrasonography revealed inflammation of appendix with 9-mm diameter. Stool examination was normal.Appendectomy was done at the same time with esofagogastroduodenoscopy (EGD). On EGD, we found moderete anthral gastritis. On histopathological examination, we found H. pylori at antral of the stomach. Breath hydrogen test was positive. After H. pylori eradication and milk avoidance, abdominal pain has never occurred. Conclusion: Abdominal: pain is not specific for H. pylori infection. The pain caused by many diseases including H. pylori infection. In our case, we can control abdominal pain by H. pylori eradication. [source]

CLOSTRIDIUM TETANUS INFECTION IN 13 DOGS AND ONE CAT

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004
C Bandt
Clostridium tetani infection is uncommon in dogs and cats. Up to this point in time just single case reports have been published in veterinary medicine. The goal of this retrospective study was to describe the clinical features and outcome of 13 dogs and one cat affected with Clostridium tetani. The medical records of the last ten year were reviewed. Dogs and cats that were identified as being infected with Clostridium tetani on the basis of characteristic clinical signs and/or bacterial culture from infected wounds were eligible for study inclusion. Thirteen dogs and one cat met the criteria for study inclusion. Six different breeds and mix-breed dogs were affected, German Shepherd dogs (n=4, 29%) and Labrador retriever (n=3, 21%) were the most frequently affected breeds. Observed clinical complications were ventricular aspiration pneumonia (n=7), laryngeal spasm (n=6), hypersalivation (n=4), ventricular tachycardia (n=3), and third degree AV block (n=1). Median days from onset of clinical signs until first signs of improvement were 10 days (range: 9,12 days). Median hospitalisation time was 18 days (range: 14,22 days). Six animals showed full recovery and 8 animals died or were euthanized. Death was associated with acute onset of ventricular tachycardia in 2 dogs, 1 dog died with non-responsive third degree AV-block, 3 dogs died after developing aspiration pneumonia, and 1 dog died of unknown causes. [source]

CYTOKINES AND ACUTE PHASE PROTEINS AS MARKERS FOR INFECTION IN HARBOR PORPOISES (PHOCOENA PHOCOENA)

MARINE MAMMAL SCIENCE, Issue 4 2007
S. Fonfara
First page of article [source]

AMERICAN SOCIETY OF ANESTHESIOLOGISTS CLASSIFICATION OF PHYSICAL STATUS AS A PREDICTOR OF WOUND INFECTION

ANZ JOURNAL OF SURGERY, Issue 9 2007
John C. Woodfield
Background: Wound infection occurs when bacterial contamination overcomes the hosts' defences against bacterial growth. Wound categories are a measurement of wound contamination. The American Society of Anesthesiologists (ASA) classification of physical status may be an effective indirect measurement of the hosts' defence against infection. This study examines the association between the ASA score of physical status and wound infection. Methods: A retrospective review of a prospective study of antibiotic prophylaxis was carried out. Patients with a documented ASA score who received optimal prophylactic antibiotics were included. The anaesthetist scored the ASA classification of physical status in theatre. Other risk factors for wound infection were also documented. Patients were assessed up to 30 days postoperatively. Results: Of 1013 patients there were 483 with a documented ASA score. One hundred and one may not have received optimal prophylaxis, leaving a database of 382 patients. There were 36 wound infections (9.4%). Both the ASA classification of physical status (P = 0.002) and the wound categories (P = 0.034) significantly predicted wound infection. The duration of surgery, patient's age, acuteness of surgery and the organ system being operated on did not predict wound infection. On logistic regression analysis the ASA score was the strongest predictor of wound infection. Conclusion: When effective prophylactic antibiotics were used the ASA classification of physical status was the most significant predictor of wound infection. [source]

RISK FACTORS FOR SURGICAL WOUND INFECTION AND BACTERAEMIA FOLLOWING CORONARY ARTERY BYPASS SURGERY

ANZ JOURNAL OF SURGERY, Issue 1 2000
Denis W. Spelman
Background: There has been no consensus from previous studies of risk factors for surgical wound infections (SWI) and postoperative bacteraemia for patients undergoing coronary artery bypass graft (CABG) surgery. Methods: Data on 15 potential risk factors were prospectively collected on all patients undergoing CABG surgery during a 12-month period. Results: Of 693 patients, 62 developed 65 SWI using the Centres for Disease Control definition: 23 were sternal wound infections and 42 were arm or leg wound infections at the site of conduit harvest. There were 19 episodes of postoperative bacteraemia. Multivariate analysis revealed that: (i) diabetes, obesity and previous cardiovascular procedure were independent predictors of SWI; and (ii) obesity was an independent risk factor for postoperative bacteraemia. Conclusions: These findings suggest that improved diabetic control and pre-operative weight reduction may result in a decrease in the incidence of SWI. But further prospective studies need to be undertaken to examine (i) whether the increased SWI risk in diabetes occurs with both insulin- and non-insulin-requiring diabetes, and whether improved peri-operative diabetes control decreases SWI; and (ii) what degree of obesity confers a risk of SWI and postoperative bacteraemia, and whether pre-operative weight reduction, if a realistic strategy in this patient group, results in a decrease in SWI. [source]

THE RISKS OF LONG-TERM NITROFURANTOIN PROPHYLAXIS IN PATIENTS WITH RECURRENT URINARY TRACT INFECTION: A RECENT MEDICO-LEGAL CASE

BJU INTERNATIONAL, Issue 5 2009
Richard J. Cetti
No abstract is available for this article. [source]

CONSISTENT CONDOM USE LOWERS RISK OF HPV INFECTION

CA: A CANCER JOURNAL FOR CLINICIANS, Issue 6 2006
Article first published online: 31 DEC 200
No abstract is available for this article. [source]

PATIENT AGE IS A STRONG INDEPENDENT PREDICTOR OF 13C-AMINOPYRINE BREATH TEST RESULTS: A COMPARATIVE STUDY WITH HISTOLOGY, DUPLEX-DOPPLER AND A LABORATORY INDEX IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION

CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 4 2006
Arne RJ Schneider
SUMMARY 1Noninvasive tests for the staging of chronic hepatitis C virus (HCV) infection would be an attractive alternative to liver biopsy. The 13C-aminopyrine breath test (ABT) has been proposed for the noninvasive assessment of hepatic function and partly correlates with fibrosis. We aimed to investigate causes for the lack of discriminatory power for different degrees of hepatic fibrosis. 2Eighty-three patients (median age 49 years (28,78 years)) with chronic HCV infection underwent the ABT after an oral load of 75 mg N,N-dimethyl- 13C-aminopyrine. Portal vein flow was assessed by duplex-Doppler and a laboratory index (aspartate aminotransferase to platelet ratio index or APRI) was calculated. Parameters were compared with liver histology. 3The cumulative 13C-recovery differed significantly between patients without relevant fibrosis (fibrosis score 0,2) and cirrhosis (5,6), beginning after 30 min of sampling (P < 0.05). The ABT did not discriminate patients with fibrosis scores 3,4 from the remaining two patient groups. Sensitivity and specificity for the prediction of cirrhosis was 73.4,82.8% and 63.2,68.4%, depending on the sampling time. Compared with the fibrosis score (P = 0.04), patient age was a highly significant independent predictor for the 13C-recovery (P < 0.0001). Aspartate aminotransferase to platelet ratio index and duplex-Doppler predicted cirrhosis with 76.6%vs. 87.5% sensitivity and 63.2%vs. 68.4% specificity. 4Our data suggest an age-dependent decrease of cytochrome P450 activity which probably accounts for the large overlap of ABT results that preclude clear differentiation. This is also consistent with former pharmacodynamic trials. Age-adapted reference ranges could improve ABT results. [source]

Respiratory Syncytial Viral Infection in an Infant with Unrepaired Anomalous Left Coronary Artery from the Pulmonary Artery

CONGENITAL HEART DISEASE, Issue 4 2007
Karen McClard MD
ABSTRACT Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary anomaly in children that requires necessary and urgent repair. We report a child who was hospitalized with respiratory failure due respiratory syncytial viral (RSV) infection and was subsequently diagnosed with ALCAPA. Aggressive treatment for RSV included synagis and nebulized ribavirin prior to surgical repair. After waiting 4 weeks for the RSV infection to resolve, she underwent successful left coronary artery reimplantation on hospital day 27 and has regained normal left ventricular size and function. [source]

Trials update in wales

CYTOPATHOLOGY, Issue 2007
A. Fiander
Three ongoing studies will be presented and discussed. Prevalence of Human Papillomavirus Infection in a South Wales Screening population Methods: A total of 10 000 consecutive, anonymous liquid based cytology screening samples were collected over a five month period in 2004. Age, cytology result and social deprivation score was provided for each specimen. The methodology was chosen to ensure inclusion of all women attending routine cervical screening, avoiding potential constraints associated with obtaining individual informed consent. The liquid based cytology samples were processed and reported by the receiving cytology laboratory and the residual specimens sent to the HPV Research Laboratory, Wales College of Medicine, where they were processed and stored at -80°C until analysis. High risk and low risk HPV Typing was undertaken using PCR , EIA (Jacobs et al 1997). Full high risk typing was performed on HPV positive specimens. Results: The study population had a mean age of 38 years with 92% negative, 5% borderline and 3% dyskaryotic cytology. The average social deprivation score was 17.4 (based upon the Welsh Index of multiple deprivation). The following results will be presented: HPV prevalence by age. HPV prevalence by cytology result. Type specific HPV prevalence in single and multiple infection. Conclusion: This study represents the largest type specific HPV Prevalence Study in the UK to date. As such it will form a useful base line against which to access performance of marketed HPV tests and evaluating the impact following implementation of HPV vaccination. [Funded by Welsh Office for Research and Development] CRISP , 1 Study (Cervical Randomized Intervention Study Protocol -1) Background: Indole-3-carbinol (I3C) and Diindolylmethane (DIM) are found in cruciferous vegetables and have been identified as compounds that could potentially prevent or halt carcinogenesis. I3C spontaneously forms DIM in vivo during acid digestion. I3C has been shown to prevent the development of cervical cancer in HPV 16 transgenic mice and both I3C and DIM have been shown to promote cell death in cervical cancer cell models. DIM is the major active bi-product of I3C and preliminary data indicate that DIM is active in cervical dysplasia and may be better tolerated than I3C. Aim: To investigate chemoprevention of high grade cervical neoplasia using Diindolylmethane (DIM) supplementation in women with low grade cytological abnormalities on cervical cytology. Objectives: To observe any reduction in the prevalence of histological proven high-grade cervical intraepithelial neoplasia (CIN) after 6 months of supplementation. ,,To observe any reduction in the prevalence of cytological abnormalities. ,,To observe any changes in the clinical appearance of the cervix. To assess acceptability and monitor any side effects of DIM supplementation. ,,To assess whether any benefit is seen in relation to Human Papillomavirus (HPV) status including HPV Type, Viral load and integration. Methods: This is a double blind randomized placebo-controlled trial involving 600,700 women with low grade cytological abnormalities on a cervical smear. Randomization is in the ratio of 2 : 1 in favour of active medication. Women with first mildly dyskaryotic smear or second borderline smear are eligible. They are asked to take two capsules daily for 6 months. At the end of 6 months they undergo repeat cervical cytology, HPV testing and colposcopy. Results: A progress report will be given for this ongoing study. [Funded: - Cancer Research UK] Type Specific HPV Infection in Welsh Cervical Cancers Background: Whilst there have been numerous studies of HPV infection associated with cervical cancer and on prevalence of Human Papillomavirus in diverse populations there have been no studies of these variables in the same population. Against a background of prophylactic HPV vaccination it is important to assess potential protection against cervical cancer within a given population. The most comprehensive analysis of HPV type specific cervical cancer is a meta-analysis published by the IARC in 2003. This however included only three UK based studies, totalling 118 cases, 75 of which were only investigated by HPV type PCR for four high risk types. None of this data was presented with associated population based prevalence data. Therefore, the research objectives for this study in combination with the first study above, are as follows: To determine the frequency of specific HPV types in cervical cancers in Wales. To compare the distribution of specific HPV types amongst cervical cancers with their prevalence in the general population. This will allow accurate delineation of the relationship between prevalence of specific HPV types in the general population and their association with clinically relevant disease. This information is a pre-requisite to assess the potential impact of prophylactic vaccination against HPV infection in Wales. Methods: Welsh Cervical Cancer specimens from 2000,2005 will be identified from pathology departments within Wales. The pathology of each tumour will be reviewed by a single Gynaecological Pathologist. The age of the patient and pathological features of the tumour will be noted. DNA will be extracted from the paraffin sections and HPV typed by PCR-EIA. Results: A progress report will be given for this ongoing study. [Funded by Welsh Office for Research and Development] [source]

Helicobacter pylori activates protein kinase C delta to control Raf in MAP kinase signalling: Role in AGS epithelial cell scattering and elongation

CYTOSKELETON, Issue 10 2009
Sabine Brandt
Abstract Helicobacter pylori is a major etiological agent in the development of chronic gastritis, duodenal ulcer and gastric carcinoma in humans. Virulent H. pylori strains harbor a type IV secretion system (T4SS) encoded by the cag pathogenicity island. This T4SS injects the CagA protein into gastric epithelial cells leading to actin-cytoskeletal rearrangements followed by cell elongation and scattering. Here we report that PMA (4,-phorbol-12-myristate-13-acetate), a well-known cell-permeable activator of protein kinase C (PKC), induces a remarkably similar cellular phenotype as compared to infection with H. pylori. PKCs comprise a large family of serine/threonine kinases which are important for multiple physiological processes of host cells. We therefore investigated the role of individual PKC members and the signalling pathways involved in phenotypical outcome. Using isoform-specific silencing RNAs and pharmacological inhibitors we found that two isoforms, PKC-, and PKC-,, were essential for both PMA- and H. pylori -induced elongation phenotype. Furthermore, we provide evidence that PKC-, activity is profoundly stimulated during the course of infection using activation-specific antibodies against PKC phosphorylated at threonine residue 505 or serine residue 660. Infection with H. pylori wild-type and mutants showed that at least two bacterial factors activate PKC-, in a time-dependent manner, one of which is CagA. Immunofluorescence microscopy studies further demonstrated that phosphorylated PKC-, is accumulated and recruited to dynamic actin-structures at the cell membrane. Finally, we show that PKC-, specifically targets Raf kinase to stimulate the Erk1/2 kinase pathway, which is also crucial for phenotypical outcome. Thus, PKC-, is another important mediator of H. pylori -induced pathogenesis. Cell Motil. Cytoskeleton 2009. © 2009 Wiley-Liss, Inc. [source]

Pemphigus Foliaceus Masquerading as Postoperative Wound Infection: Report of a Case and Review of the Koebner and Related Phenomenon following Surgical Procedures

DERMATOLOGIC SURGERY, Issue 2 2005
Adam M. Rotunda MD
Background The Koebner phenomenon, also known as the isomorphic response, is the development of preexisting skin disease following trauma to uninvolved skin. Various cutaneous disorders have been described to arise at surgical wounds and scars. Moreover, dermatologic procedures, such as cold-steel and laser surgery, can evoke koebnerization. Objective To describe a case of pemphigus foliaceus arising in postoperative wounds and to present a review of dermatologic disorders triggered by surgical procedures. Methods We report a case of pemphigus foliaceus initially presenting at sites of Mohs' micrographic surgery, shave biopsy, and cryotherapy and, subsequently, at a nonsurgical site. We reviewed the English literature in MEDLINE from November 1955 to April 2004 for reports of Koebner and related phenomenon following surgical procedures. Results To our knowledge, this is the first reported case of pemphigus foliaceus erupting at surgical and cryotherapy wounds. The clinical appearance can mimic wound infection. In addition to inducing preexisting disease, cutaneous procedures can also trigger the onset of new disease, which can either be limited only to the surgical site or subsequently become generalized. Conclusion Postoperative Koebner or related responses should be included in the differential diagnosis of poorly healing surgical wounds. Skin biopsies for histopathology and immunologic studies may be necessary for definitive diagnosis and optimal management. ADAM M. ROTUNDA, MD, ANAND R. BHUPATHY, DO, ROBERT DYE, MD, AND TERESA T. SORIANO, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

A review of antiviral therapies in the treatment of cytomegalovirus

DERMATOLOGIC THERAPY, Issue 3 2000
Adrienne M. Hinkle
ABSTRACT: Cytomegalovirus (CMV) is a member of the herpesvirus family that is very prevalent world wide based on serologic testing. In immunocompromised persons CMV produces high rates of morbidity and mortality. Congenital CMV is the leading infectious cause of fetal abnormalities in the United States. Infection of human immunodeficiency virus (HIV) seropositive persons or transplant patients with CMV can produce retinitis, encephalitis, pneumonitis, hepatitis, gastrointestinal ulcerations, and cutaneous lesions. Three intravenous therapies are available for CMV infections: ganciclovir; foscarnet and cidofovir. Most recently a fourth antiviral agent was approved for intravitreal injection. This drug, fomivirsen, is the first antisense oligonucleotide available for therapeutic use. A number of other antiviral drugs and vaccines are currently under study. [source]

Charlson Index Is Associated with One-year Mortality in Emergency Department Patients with Suspected Infection

ACADEMIC EMERGENCY MEDICINE, Issue 5 2006
Scott B. Murray MD
Abstract Objectives: A patient's baseline health status may affect the ability to survive an acute illness. Emergency medicine research requires tools to adjust for confounders such as comorbid illnesses. The Charlson Comorbidity Index has been validated in many settings but not extensively in the emergency department (ED). The purpose of this study was to examine the utility of the Charlson Index as a predictor of one-year mortality in a population of ED patients with suspected infection. Methods: The comorbid illness components of the Charlson Index were prospectively abstracted from the medical records of adult (age older than 18 years) ED patients at risk for infection (indicated by the clinical decision to obtain a blood culture) and weighted. Charlson scores were grouped into four previously established indices: 0 points (none), 1,2 points (low), 3,4 points (moderate), and ,5 points (high). The primary outcome was one-year mortality assessed using the National Death Index and medical records. Cox proportional-hazards ratios were calculated, adjusting for age, gender, and markers of 28-day in-hospital mortality. Results: Between February 1, 2000, and February 1, 2001, 3,102 unique patients (96% of eligible patients) were enrolled at an urban teaching hospital. Overall one-year mortality was 22% (667/3,102). Mortality rates increased with increasing Charlson scores: none, 7% (95% confidence interval [CI] = 5.4% to 8.5%); low, 22% (95% CI = 19% to 24%); moderate, 31% (95% CI = 27% to 35%); and high, 40% (95% CI = 36% to 44%). Controlling for age, gender, and factors associated with 28-day mortality, and using the "none" group as a reference group, the Charlson Index predicted mortality as follows: low, odds ratio of 2.0; moderate, odds ratio of 2.5; and high, odds ratio of 4.7. Conclusions: This study suggests that the Charlson Index predicts one-year mortality among ED patients with suspected infection. [source]

REDUCING THE RISK OF PERISTOMAL INFECTION AFTER PEG PLACEMENT

Antral Red Streaking is a Negative Endoscopic Sign for Helicobacter Pylori Infection

DIGESTIVE ENDOSCOPY, Issue 3 2002
Takao Kawabe
Background: ,One of the most important endoscopic findings for the diagnosis of chronic gastritis is erythema. Erythema is classified into two groups: spotted or scattered erythema and linear erythema. We feel that red streaking has a tendency to be found on the apparently normal gastric mucosa without inflammation. Methods: ,To evaluate this association prospectively, we conducted the present study in 1513 consecutive patients undergoing endoscopy. Helicobacter pylori infection was assessed by rapid urease test, culture, pathological test, serological test and urea breath test using 13C. Results: ,Of these patients, red streaking was recognized in 94 patients (6.2%). All of the tests showed very low prevalence (0,3.5%) of H. pylori infection in patients with red streaking whereas positive results were obtained recognized in 42,49% of 94 age-sex-matched patients without red streaking. Additionally, no peptic-ulcer diseases, such as gastric ulcer/ulcer scar and duodenal ulcer/ulcer scar, were found in the patients with red streaks. In conclusion, red streaking is a negative sign for H. pylori infection and peptic-ulcer diseases. Conclusions: ,The understanding of these results might also improve the effort and cost-effectiveness of endoscopic examinations by avoiding unnecessary further testing. [source]

Role of the Echocardiography Laboratory in Diagnosis and Management of Pacemaker and Implantable Cardiac Defibrillator Infection

ECHOCARDIOGRAPHY, Issue 9 2007
Edmund Kenneth Kerut M.D.
First page of article [source]

Role of Transesophageal Echocardiography in Detecting Implantable Cardioverter Defibrillator Lead Infection

ECHOCARDIOGRAPHY, Issue 3 2003
Sanjeev Wasson
Implantable cardioverter defibrillator (ICD) lead infection is a rare condition with reported incidence of 0.2% to 16%. It usually presents with persistent bacteremia or fever of unknown origin and requires high clinical suspicion for diagnosis. Whenever ICD lead infection is suspected, transesophageal echocardiography is the diagnostic technique of choice for detection and characterization of the lesions. Lead infections are extremely difficult to manage conservatively and surgical removal of the entire defibrillator system is recommended along with antimicrobial therapy. We describe a case of recurrent staphylococci bacteremia due to an ICD lead infection in a patient with arrhythmogenic right ventricular dysplasia. (ECHOCARDIOGRAPHY, Volume 20, April 2003) [source]