Exploring the virulence potential of immune evasion cluster genes in methicillin-resistant Staphylococcus aureus from cancer patients

Methicillin-resistant Staphylococcus aureus (MRSA) is accountable for a plethora of infections, ranging from minor cutaneous manifestations to grave metastatic conditions. The dissemination of MRSA among cancer patients poses a substantial public health hazard on a global scale. This study explores the association between MRSA and bacteriophage-encoded immune evasion cluster (IEC) genes. This investigation employed a total of 168 pathogenic MRSA collected from 38 cancer and 130 non-cancer patients. A cefoxitin disc diffusion method followed by PCR analysis was used to identify the mecA gene. In this study, we employed singleplex and multiplexed PCR techniques to detect specific IEC genes. No association (p = 0.98) was observed between the sex and age of patients and MRSA isolates. However, MRSA isolates demonstrated a notable association (p = 0.01) with pus samples in non-cancer patients and skin swabs in cancer patients. The resistance profiles of MRSA strains from cancer and non-cancer patients did not show significant differences (p > 0.05). Notably, the sea gene was found to be more prevalent in MRSA isolates from cancer patients, displaying a significant association (p = 0.03). Additionally, this study identified two novel and distinct combinations of IEC types, namely V1 (sea, chp, scn) and V2 (sea, scn). Cancer patients had higher multidrug resistance and toxin gene abundance than non-cancer patients. The identification of two novel IEC patterns underscores the urgent need to control MRSA dissemination in hospitals and monitor emerging clones.

Sexually transmitted infections and associated risk factors among the transgender population of Pakistan

BACKGROUND

Transgender (TG) people are key drivers for sexually transmitted infections (STIs) all over the world. There is substantial evidence that STIs are associated with an increased likelihood of risky sexual behavior however little is known about the prevalence of STIs (HIV, HBV, HCV, and Syphilis) among HIV infected transgender population in Pakistan.

METHODS

The current study investigated the seroprevalence of four STIs and associated socio-demographic risk factors among TGs of Punjab, Pakistan from July 2019 to June 2021. The samples were tested serologically and final confirmation was done through PCR for HIV, HBV, and HCV.

RESULTS

A total of 1,562 transgenders cross-sectional descriptive records of the Punjab AIDS Control Program (PACP) were reviewed during the period from July 2019 to June 2021. The serological results evidenced that 533 (34.1%) had one pathogen, 309 (19.8%) had two or more (multiple) infections. The most predominant mono-infection among the transgender population was Syphilis 324 (20.7%) followed by HCV 114 (7.3%), HIV 69 (4.4%), and HBV 26 (1.7%). The highest proportions of Infections were found in TG residing in urban areas (68.6%) as compared to rural areas (31.4%). The seropositivity of all STIs was predominantly increased in Sex worker TGs i-e 55%, 46.5%, 38.5%, and 41.8% in HIV, HBV, HCV, and Syphilis respectively. Among 280 HIV-infected Transgender, 177 (63.2%) had Syphilis co-infections. While 87 (31%) and 47 (16.8%) HIV-infected individuals had HC and HBV co-infection respectively.

CONCLUSION

Transgender is neglected population group in society. All STIs were predominantly common among sex worker transgenders, Illiterate educational groups, and TGs residing in urban areas. There is a need to spread awareness about STIs, preventive strategies, and facilitation to health care programs in this high-risk population group.

Association of exogenous factors with molecular epidemiology of Staphylococcus aureus in human oral cavity

The frequency of Staphylococcus aureus strains associated with oral cavity microbiota has prodigious consideration. Although S. aureus has been reflected as an ephemeral member of the human oral cavity microbiota, the isolation, identification, and characterization of S. aureus is important. The present study aimed to characterize S. aureus strains from the oral cavity microflora, isolation of S. aureus from the human oral cavity microbiota, and demographic information of the participants to evaluate exogenous factors associated with the presence of S. aureus and their genetic analysis linkage with different factors. The method used in this study is the isolation of oral cavity microbiomes using sheep blood agar and Mannitol salt agar. We performed antibiotic profiling with various antibiotics and genetic analysis utilizing gene-specific primers for specific genes, including nuc, mecA, pvl, agr, and coa. A significant number of S. aureus isolates were found in the oral cavity of humans 18/84 (21.42%), and all 18 strains tested positive for the confirmatory nuc gene. Antibiotic resistance-conferring gene mecA was positive in 10 (55.6%) isolates. It was found that the occurrence of pvl, agr, and coagulase (coa) genes was 9 (50%), 6 (33.33%), and 10 (55.6%), respectively. The genetic analysis reported that significant associations were present between male and mecA gene (P = 0.03) and coa (P = 0.03), smokers with the occurrence of mecA (P = 0.02), agr (P = 0.048) and coa (P = 0.02) genes. Likewise, the association of antibiotic usage was significantly found with mecA (P = 0.02), coa (P = 0.02); however, the individuals who have taken orthodontic treatment recently have a significant association with agr (P = 0.017). The use of mouth rinse was significantly associated with the prevalence of the pvl gene (P = 0.01), and tooth brushing frequency and inflammation of the buccal cavity were also statistically significant in relation to pvl gene prevalence (P = 0.02, 0.00, respectively). Moreover, calories and weight-controlled diet were significantly associated with mecA, agr, and highly significant with coa (P = 0.02, 0.048, 0.000), so all P < 0.05, and no significant association was found between the socioeconomic status of individuals with aforementioned analyzed genes.

Molecular analysis of Panton-Valentine Leucocidin (pvl) gene among MRSA and MSSA isolates

The present study was conducted in order to determine the frequency of pvl gene among the pathogenic and healthy population isolates of Methicillin Resistant Staphylococcus aureus (MRSA) and Methicillin Sensitive Staphylococcus aureus (MSSA). For this purpose, nasal swab samples were collected from the healthy individuals (to be used as controls, all the samples were collected irrespective of the sex and age factors), the pathogenic samples were collected from different patients suffering from skin &soft tissue infections caused by S. aureus (to be used as test samples).Both of these population samples were analyzed for the presence of pvl gene. S.aureus were identified through conventional microbiological identification procedures. In the case of normal samples, 70 nasal swabs were collected and only 33 (47%) proved to be S. aureus while 20 pathogenic samples were collected and all (100%) were cleared as S. aureus. For further distribution of samples into MRSA and MSSA, antibiotic susceptibility pattern was checked by using the standard protocols of Kirby-Bauer disc diffusion method. Two antibiotic discs Oxacillin (OX: 1ug) and cefoxitin (FOX: 30ug) were used. Among healthy population, MRSA was found to be 79% (n=26) and MSSA were present as 21% (n= 7). Among pathogenic strains 100% MRSA was detected where n= 20. Detection of pvl gene among the MRSA and MSSA isolates was done by using the uniplex PCR followed by gel electrophoresis. MRSA and MSSA of normal healthy population carried 49% and 7% pvl gene respectively. While, pathogenic MRSA samples carried 46% pvl gene among them. Potentially alarming percentage of pvl gene is present among the normal healthy individuals which indicates a future threat and a major health concern.

Persistent medication adherence and lifestyle changes compliance in patients with type 2 diabetes undergoing minor foot amputation and one-year all-cause mortality

Background

The 3-years mortality rate in patients with Type 2 diabetes (T2D) after minor amputations may reach 53–80%. The aim of the study was to evaluate the impact of persistent medication adherence and compliance with lifestyle recommendations on 1-year all-cause mortality in patients with T2D and peripheral artery disease (PAD) after minor foot amputation.

Methods

This is a prospective, single-center, observational cohort study including 785 consecutive T2D patients with PAD undergoing minor amputations and followed-up over 1 year (mean age 62.3±7.2 years; 62.8% males). Based on adherence and compliance, patients were divided into 4 groups: adherent/compliant (n=432), adherent/non-compliant (n=101), compliant/non-adherent (n=68), non-adherent/non-compliant (n=184). Secondary prevention recommendations included healthy diet, smoking cessation, physical exercise ≥30 min/day and &gt;80% drug intake (wound healing, antidiabetic, cardiovascular treatment, dual antiplatelet and statin treatment). Cox proportional hazard models were used to examine how variables predict one-year all-cause mortality.

Results

One-year all-cause mortality was 16.9% (n=133) at 1-year follow-up (Figure 1). After adjusting for confounders, compared to adherent/compliant patients, all other groups had an increased risk of one-year mortality. In non-adherent/non-compliant patients HR=9.08 [95% CI 5.55, 14.86], p&lt;0.001; in adherent/non-compliant patients HR=3.86 (95% CI [2.08, 7.14], p&lt;0.001), in non-adherent/compliant patients HR=2.98 (95% CI [1.45, 6.08] p=0.003). After adjustment, age, history of myocardial infarction, foot infection also remained significant (Figure 2).

Conclusion

T2D and PAD patients who were persistently medication non-adherent and non-compliant to lifestyle changes recommendations had a nine-fold increased risk for one-year all-cause mortality after PFA, non-compliance only increased mortality 3.8-fold, and non-adherence only – 3.0-fold, which outline the importance of secondary preventive measures.

Funding Acknowledgement

Type of funding sources: None.

AB0661 NEUROPSYCHOLOGICAL OUTCOME OF CHILDREN BORN TO WOMEN WITH SYSTEMIC SCLEROSIS ASSESSED THROUGH A SELF-ADMINISTERED MULTIDISCIPLINARY QUESTIONNAIRE: RESULTS FROM A MONOCENTRIC COHORT

Background

In the last years, the rate of successful pregnancies has significantly increased in Systemic Sclerosis (SSc)1 women. However, the long-term outcome of their children remains an unexplored issue.

Objectives

To evaluate the neuropsychiatric (NP) outcome of children born to SSc mothers.

Methods

An ad-hoc questionnaire, regarding different aspects of child’s neurodevelopment (ND) (3 sections: childhood [0-5 years]; scholar age [6-11 years]; adolescence [12-18 years]), was created and administered to female SSc patients (ACR/EULAR 2013 criteria) attending our outpatient clinic during 2021 and who had at least 1 child. Children’s NP characteristics were compared between 3 subgroups: A) born >10 years before SSc diagnosis; B) born ≤10 years before SSc diagnosis; C) born after SSc diagnosis. Results below are expressed as number/total number of answers collected for each question.

Results

100 SSc women reported 189 pregnancies: 152 resulted in 154 live births (2 twin pregnancies).

At least one NP alteration was reported in 42/119 (35%) subjects, more frequently in group B (57%), as compared to group A (31%, p:0.07) and group C (30%, p:0.09) although not statistically significant (Figure 1). Sleep irregularities were the most frequently reported disorder (15/42, 36%). Comparisons between the 3 subgroups for every NP outcome evaluated are shown in Table 1: overall, a higher rate of NP alterations were reported in children belonging to group B.

Table 1.

Analysis of NP outcomes: comparison of the 3 subgroups.

A n=103B n=19C n=32N° of subjects evaluated forDISORDERS IN CHILDHOOD103/10319/1932/32Sleep irregularities6/79 (8)*4/13 (31)*5/27 (19)Motor difficulties0/77 (3)°2/13 (15)°2/26 (8)Difficulty in relationships0/78 (0)1/11 (9)2/26 (8)Difficulty in non-verbal communication skills0/78 (0)1/11 (9)2/26 (8)Difficulty in verbal communication skills1/77 (1)1/12 (8)2/26 (8)Difficulty in social integration6/77 (8)3/12 (25)1/25 (4)Cognitive difficulties0/77 (0)1/12 (8)0/26 (0)N° of subjects evaluated forDISORDERS IN SCHOLAR AGE103/10317/1917/32Difficulty in school lessons/homework7/77 (9)3/12 (25)0/15 (0)Behavioral problems during school period4/76 (5)1/12 (8)1/15 (7)School year repetition11/76 (15)2/13 (15)0/15 (0)N° of subjects evaluated forDISORDERS IN ADOLESCENCE101/10314/1911/32Difficulty in managing anger and aggression4/75 (5)0/11 (0)0/10 (0)Behavioral alterations0/75 (0)0/11 (0)0/10 (0)Difficulty in conduct2/73 (3)0/11 (0)2/10 (20)Mood alterations1/73 (1)1/11 (9)0/10 (0)Alterations of the feeding behavior1/75 (1)0/11 (0)0/10 (0)Anxiety problems1/75 (1)1/10 (10)0/10 (0)

Results are presented as number/total number (%) of answers collected for each question. Variables were compared with Chi Squared/exact Fisher test. *p=0.03; °p=0.02.

Figure 1.

Children with ≥1 NP alteration: comparison of the 3 subgroups.

In addition, SSc mothers declared that 7/123 (6%) children underwent a NP evaluation leading to a diagnosis in 3 cases: 1 cognitive delay, 1 learning disorder (LD) and 1 autism spectrum disorder (ASD). These children were born 1 and 5 years before and 3 years after SSc diagnosis, respectively. The prevalence of these diagnoses (0.8%) does not differ from general pediatric population.

Conclusion

Children born to SSc mothers, had prevalence of major NP alterations (cognitive deficits, LDs, ASDs) similar to general pediatric population. A higher frequency of minor ND disorders, especially sleep irregularities, was observed in children within 10 years before maternal diagnosis, compared to the other groups, possibly suggesting an impact of maternal chronic disease on the relationship with child in the first years of life. To confirm these self-reported preliminary data, the extension of the study will consist in a systematic NP evaluation proposed to all the offspring of SSc mothers aged ≤18 years.

References

[1]Blagojevic J et al. 2019. J Rheumatol.

Acknowledgements

GILS (Gruppo Italiano Lotta Sclerodermia) is kindly acknowledged for supporting the study with a grant.

Disclosure of Interests

None declared

Comparison of the 2010 and 2020 World Health Organization guidelines on physical activity in patients with percutaneous coronary interventions early after hospital discharge

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Swiss heart foundation

Background

Physical activity (PA) is inversely associated with mortality and adverse outcome in patients with cardiovascular disease, and can be objectively measured by accelerometry. In 2020, the World Health Organization (WHO) has updated their recommendations on PA for adults including those with chronic conditions, omitting the 10 min bout criterion.[1] The aim of this study was to determine the proportions of cardiac patients immediately after hospital discharge from percutaneous coronary interventions (PCI) who fulfil the old [2] and updated WHO PA criteria, and compare the results with established step-based cut-off values.

Methods

Patients after PCI for acute or chronic coronary syndrome with a maximal age of 80 and eligible for ambulatory cardiac rehabilitation were recruited for this observational single centre study. They were provided with a wrist-worn tri-axial accelerometer without display that recorded movement data starting from the day following hospital discharge for the subsequent 18 days. Acceleration data was analysed with the widely used free GGIR package. The proportions of patients fulfilling recommendations for moderate to vigorous PA (MVPA) were determined according to the 2010 and 2020 WHO guidelines as well as 7,500 [3] and 10,000 steps.[4]

Results

159 patients (41%) participated in this study. Data from 135 patients (85%), who had at least 7 days of ≥12 h wear-time were included in the analyses. Their median age was 62 (1st quartile 56, 3rd quartile 68), 22 (16%) were women, and 15 and 120 patients had a CCS and ACS, respectively. Their median wear time was 18 (16, 18) days. 102 (75.6%) had at least 30 min of MVPA on an average day and hence fulfilled the 2020 WHO guidelines. When MVPA was determined using the 2010 WHO guidelines, which only counted MVPA of bouts of at least 10 min, only 23 patients (17.8%) achieved at least 30 min of MVPA on an average day (Figure 1). 67.4% of our patients achieved ≥7,500 steps/d and 71 patients (52.6%) performed ≥10,000 steps/d.

Conclusion

In cardiac patients early after PCI most of the MVPA was accumulated in bouts shorter than 10 min. Applying the 2010 and 2020 WHO PA criteria to objectively measured PA led to a fourfold discrepancy. The 7,500 step cut-off corresponded with the 2020 WHO recommendations. Since achievement of intensity- or step-based cut-offs is greatly dependent on device type, wearing location, data sampling and analysis, it is currently poorly defined and not suited for patient classification and counselling. The clinical implication of this observation will be assessed in a cardiovascular outcome analysis.

Physical activity trajectories are associated with the risk of all-cause and cardiovascular disease mortality in patients with coronary heart disease. A systematic review and meta-analysis

Background

Current guidelines recommend that adults with chronic health conditions should engage in regular physical activity (PA), and avoid inactivity. Yet, the exact role of PA trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear.

Purpose

We aimed to perform a systematic review and meta-analysis on the association of longitudinal trajectories of PA with all-cause and cardiovascular disease (CVD) mortality in patients with CHD.

Methods

We performed a systematic review and meta-analysis based on PRISMA statement. Six electronic databases were searched for cohort studies that analysed the association of PA trajectories (inactive over time, active over time, increased activity over time, and decreased activity over time) with the risk of all-cause and CVD mortality in patients with CHD. Study quality was evaluated by the Newcastle Ottawa scale. We used the inverse variance weighted method to combine summary measures using random-effects models to minimize the effect of between-study heterogeneity. The study is registered in PROSPERO.

Results

We meta-analyzed nine longitudinal cohorts involving 33,576 patients (25010 acute CHD, 8566 chronic CHD, mean age 62.5 years, 34% women, median follow-up duration 7.2 years), according to four PA trajectories. All studies assessed PA through validated questionnaires. The definitions of activity and inactivity at baseline and follow-ups were in agreement with current PA guidelines. Trajectories were calculated based on comparison of activity status at baseline and follow-up. All the studies defined increased activity over time as moving from the inactive to the active category, and decreased activity over time as moving from the active to the inactive category. Compared to patients remaining inactive over time, the lowest risk of all-cause and CVD mortality was observed in patients remaining active over time (HR [95% CI]: 0.50 [0.39–0.63] and 0.48 [0.35–0.68], respectively), followed by patients who increased their PA over time (HR [95% CI]:0.55 [0.44–0.7] and 0.63 [0.51–0.78], respectively), and patients who decreased activity over time (HR [95% CI]: 0.80 [0.64–0.99] and 0.91 [0.67–1.24], respectively). These results were consistent both in the acute and chronic CHD settings. The overall risk of bias was low, and no evidence of publication bias was observed. Multiple sensitivity analyses provided consistent results.

Conclusions

In patients with CHD, the risk of all-cause and CVD mortality is progressively reduced from being inactive over time, to decreased activity over time, to increased activity over time, to being active over time. These findings highlight the benefits of adopting a more physically active lifestyle in patients with chronic and acute CHD, independent of previous PA levels. Future studies should clarify the complex interactions between motivations and disease severity as potential drivers for PA trajectories

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Bern

Diabetes is associated with atrial fibrillation phenotype, cardiac and neurological comorbidities: insights from the Swiss-AF study

Background

Diabetes mellitus is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between AF patients with and without diabetes.

Purpose

To investigate the association of diabetes with AF phenotype, cardiac and neurological comorbidities in patients with documented AF.

Methods

Participants of the multicenter Swiss-AF study with available data on diabetes and AF phenotype were eligible. The primary outcomes were parameters of AF phenotype, including AF type (paroxysmal vs non-paroxysmal), AF symptoms (yes vs no), and quality of life (assessed by EQ-5D score). The secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, heart failure) and neurological comorbidities (ie, history of stroke, cognitive impairment). The cross-sectional association of diabetes with these outcomes was assessed using logistic and linear regression. Results were adjusted for age, sex, and cardiovascular risk factors.

Results

We included 2411 AF patients (27.4% women; median age, 73.6 years). Diabetes was not associated with non-paroxysmal AF (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.81 to 1.27). Patients with diabetes less often perceived AF symptoms (OR=0.73; CI=0.59 to 0.91), but had worse quality of life (predicted mean difference in EQ-5D score: β=−4.54; CI=−6.40 to −2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac comorbidities [history of hypertension (OR=3.04; CI=2.19 to 4.22), myocardial infarction (OR=1.55; CI=1.18 to 2.03), heart failure (OR=1.99; CI=1.57 to 2.51)] and neurological comorbidities [history of stroke (OR=1.39; CI=1.03 to 1.87), cognitive impairment (OR=1.75; CI=1.39 to 2.21)].

Conclusions

In the Swiss-AF cohort population, patients with diabetes less often perceived AF symptoms, but had worse quality of life, more cardiac and neurological comorbidities than those without diabetes. These findings have significant clinical implications. The reduced perception of AF symptoms in patients with diabetes might result in a delayed AF diagnosis and consequently more adverse events, especially cardioembolic stroke. This raises the question whether patients with diabetes should be systematically screened for silent AF. Moreover, patients with concomitant AF and diabetes have increased likelihood of comorbidities and therefore deserve more attentive care.

Funding Acknowledgement

Type of funding sources: None.

An ethno-botanical study of indigenous medicinal plants and their usage in rural valleys of Swabi and Hazara region of Pakistan

An ethnobotanical study was conducted to document indigenous medicinal plants and their usage from knowledgeable and elderly persons in Razzar and Gadoon valley of Swabi and Allai and Tanawal valley of Hazara region of Pakistan during 2016-2019. Several systematic field visits and questionnaire surveys were carried out in selected sites of the study area to gather relevant information from the local community. Rapid assessment method was adopted for data collection by interviewing the local people having enough knowledge of medicinal plants use for treatment of different ailments. UV (UV) formula was applied to calculate the relative importance of medicinal plant species in each site of the study area. In the present study, 221 medicinal plants belonging to 105 families have been reported through 580 respondents (385 males, 138 females and 57 local health healer) from the Swabi and Hazara region. The main sources of herbal medicines were leaves (21%) followed by fruits (21%), seeds (17%), whole plants (14%), roots (9%), bark (9%), flowers (7%) and gum (2%). Mentha spicata L. and Berberis lycium Royle were reported with highest UV (UV) i.e. 0.92 and 0.68 in Razzar tehsil and Gadoon valley of Swabi, whereas Mentha longifolia L and Geranium wallichianum D were reported with highest UV i.e. (0.65) and (0.88) in Allai and Tanawal valley of Hazara region, respectively. It was concluded that Swabi and Hazara region is rich in medicinal plants species and associated traditional knowledge. Moreover, ethno-medicines have played significant role in the indigenous healthcare system of the study area. However, uprooting the entire plant for ethno-medicine is a big threat to conservation of medicinal plants diversity in the study area.

Impact of compliance with lifestyle recommendations and medication adherence on 1-year prevention of major cardiovascular events in diabetic patients undergoing partial foot amputation

Funding Acknowledgements

Type of funding sources: None.

Background

Partial foot amputation (PFA) is generally not considered a high-risk surgery. However, 3 years survival rate is less than 50-60%. The purpose of the study was to evaluate the impact of compliance with lifestyle recommendations and medication adherence on 1-year prevention of major cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) after PFA.

Methods

In this prospective single-center interventional cohort study, 785 consecutive T2DM patients after PFA were included in the 1-year follow-up. Physical examination and laboratory tests were performed at baseline and every month after PFA for 1 year. Patients were considered as compliant with lifestyle recommendations if they followed a healthy diet, smoking cessation, and at least ≥30 min/day physical exercise. Patients were defined as adherent to medication if they followed ≥80% prescribed medication intake. MACE was defined as a composite endpoint including cardiovascular death, myocardial infarction (MI), stent thrombosis, acute stroke, or unstable arrhythmia.

Results

During 1-year follow-up MACE occurred in 63/535 patients who were medication adherent compared to 137/249 non-adherent patients (Chi square = 167,2, p &lt; 0,001). Among lifestyle compliant patients, 55/498 had MACE compare with 145/286 non-compliant patients (Chi square = 150.3, p &lt; 0,001). The COX regression analysis was conducted to present the adjusted effect of compliance and adherence to the incidence of MACE (B = 0.989, p &lt; 0.001, and B= 1.096, p &lt; 0.001, respectively) (Table). The potential confounders such as age and previous MI were statistically significant (Table). Gender, smoking, diabetes severity, HbA1c, hypertension, symptomatic coronary artery disease, history of ischemic events, heart revascularization were not statistically significant.

Conclusion. Failure to follow lifestyle recommendations in T2DM patients after PFA increases the OR of the incidence of MACE 2.7 fold, non-adherence to medication 3 fold. Our results indicate that optimizing preventive interventions is of outmost importance for patients with diabetes undergoing PFA

Cox Regression Results for predictors of Indicator Odds ratio B Standard error P-value Age 1.031 0.031 0.009 0.007 History of myocardial infarction 4.017 1.391 0.184 &lt;0.001 Non-compliance to lifestyle changes 2.688 0.989 0.198 &lt;0.001 Medication non-adherence 2.992 1.096 0.186 &lt;0.001

Muscle mass heavily influences creatinine-based renal function estimation: a 12-year longitudinal general population-based cohort study

 

Muscle mass heavily influences creatinine-based renal function estimation: a 12-year longitudinal general population-based cohort study

Background

Current guidelines suggest the use of estimated glomerular filtration rate (eGFR) based on creatinine as measurement of renal function. However, the influence of muscle mass as key determinant of creatinine after renal function may render those estimates imprecise.

Purpose

To investigate the effects of 24-hour height-indexed creatinine excretion rate (CER index) – deemed an excellent marker of total muscle mass – on creatinine-based eGFR and to compare this with effects of CER index on muscle mass-independent cystatin C-based eGFR.

Methods

We included community-dwelling individuals aged 28–75 years enrolled in the prospective Prevention of REnal and Vascular ENd-stage Disease study. CER was assessed in paired 24-h urine specimens collected during five consecutive screening rounds, each round comprising two outpatient visits separated by three weeks. Cross-sectional and longitudinal associations were respectively quantified using linear regression and linear mixed-effects models, both of which were adjusted for sociodemographic and cardiovascular risk factors.

Results

Of the 7,698 individuals aged 49.8 (12.6) years, of whom 3,839 (49.9%) were male, baseline mean (SD) CER index was 7.0 (1.8) mmol/(24 h·m). Lower CER index was curvilinearly associated with higher creatinine-based eGFR and lower cystatin C-based eGFR (Figure 1). In a hypothetical 70-year-old male, assumed to have a CER index of 4 mmol/(24 h·m) (indicating low muscle mass), predicted creatinine-based eGFR and cystatin C-based eGFR were 79.8 and 64.1 (difference: 15.7) ml/min per 1.73 m2, respectively (Figure 1). If the CER index is held constant at 4 mmol/(24 h·m), the predicted ages at which the threshold of 60 ml/min per 1.73 m2 for the detection of chronic kidney disease would have been exceeded, were 84.7 years for creatinine-based eGFR and 72.7 years for cystatin C-based eGFR (difference: 12.0 years) (Figure 1). During 12.5 years of follow-up, CER index decreased with 0.21 (0.23) mmol/(24 h·m) per 10 years. For every 0.1 mmol/(24 h·m) annual decrease in CER index, creatinine-based eGFR increased with 0.16 (0.07 to 0.25; P=0.0004) ml/min per 1.73 m2 per year, whereas cystatin C-based eGFR decreased with 0.25 (0.15 to 0.34; P&lt;0.0001) ml/min per 1.73 m2 after full adjustment.

Conclusions

Low muscle mass may cause considerable overestimation of single measurements of creatinine-based eGFR compared with cystatin C-based eGFR. Moreover, loss of muscle mass may cause spurious increases in repeatedly measured creatinine-based eGFR. Implementing muscle mass-independent markers for estimating renal function, like cystatin C, could provide a better alternative to accurately assess renal function in all settings wherein low muscle mass or muscle wasting may be encountered.

Figure 1. Sex-specific 3D representation.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Dutch Kidney Foundation

P3414Differences in total life expectancy and life expectancy with and without non-communicable diseases within the reference range of thyroid function

Background

Variations in thyroid function within the reference ranges are associated with an increased risk of diseases and death. However, the impact of thyroid function on life expectancy (LE) and the number of years lived with and without non-communicable diseases (NCD) remains unknown.

Purpose

We aimed to investigate the association of thyroid function with total LE and LE with and without NCD among euthyroid subjects.

Methods

Participants of the Rotterdam Study without known thyroid disease and with thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels within the reference ranges were eligible. NCD were defined as the presence of cardiovascular disease, diabetes mellitus type 2, or cancer. We used multistate life tables to calculate the total LE and LE with and without NCD among TSH and FT4 tertiles, in men and women. LE estimates were obtained using prevalence, incidence rates and hazard ratios for three transitions (healthy to NCD, healthy to death and NCD to death). Analyses were adjusted for sociodemographic and cardiovascular risk factors.

Results

The mean (standard deviation) age of 7644 participants was 64.5 (9.7) years and 52.2% were women. Over a median follow-up of 8 years, we observed 1396 incident NCD events and 1422 deaths. Compared with those in the lowest tertile, men and women in the highest TSH tertile lived 1.5 (95% confidence interval [CI], 0.8; 2.3) and 1.5 (95% CI, 0.8; 2.2) years longer, respectively; of which 1.4 (95% CI, 0.5; 2.3) and 1.3 (95% CI, 0.3; 2.1) years with NCD. Compared with those in the lowest tertile, the difference in LE for men and women in the highest FT4 tertile was −3.7 (95% CI, −5.1 to −2.2) and −3.3 (95% CI, −4.7; −1.9), respectively; of which −1.8 (95% CI, −3.1 to −0.7) and −2.0 (95% CI, −3.4 to −0.7) years without NCD.

Life expectancy in TSH and FT4 tertiles

Conclusions

There are meaningful differences in total LE, LE with and without NCD within the reference ranges of thyroid function. People with low-normal thyroid function live more years with and without NCD than those with high-normal thyroid function. These findings support a reevaluation of the current reference ranges of thyroid function.

Impact of phosphate solubilizing bacteria on wheat (Triticum aestivum ) in the presence of pesticides

Three phosphate solubilizing bacteria were isolated and identified by 16S rRNA sequencing as Pseudomonas putida, Pseudomonas sp and Pseudomonas fulva . The strains were subjected to plant biochemical testing and all the PGPR attributes were checked in the presence of pesticides (chlorpyrifos and pyriproxyfen). The phosphate solubilizing index of strain Ros2 was highest in NBRIP medium i.e 2.23 mm. All the strains showed acidic pH (ranges from 2.5-5) on both medium i.e PVK and NBRIP. Strain Ros2 was highly positive for ammonia production as well as siderophore production while strain Rad2 was positive for HCN production. The results obtained by the strains Rad1, Rad2 and Ros2 for auxin production were 33.1, 30.67 and 15.38 µg ml-1, respectively. Strain Rad1 showed 16% increase in percentage germination in comparison to control in the presence of pesticide stress. Most promising results for chlorophyll content estimation were obtained in the presence of carotenoids upto 6 mgg-1 without stress by both strains Rad1 and Rad2. Study suggests that especially strain Ros2 can enhance plant growth parameters in the pesticide stress.

Assessment of microbial diversity in the rhizosphere of Pinus roxburghii (Sarg.) and bio-inoculant potential of selected pine bacterial isolates for wheat varieties based on cultureindependent and culture-dependent techniques

Evidence is lacking regarding compatibility of pine bacteria as bio-inoculants for crops. The diversity and abundance of rhizosphere bacteria of Pinus roxburghii has never been investigated with simultaneous application of culture-dependent and culture-independent techniques. The present study was aimed to isolate, characterise, check the bio-inoculant potential of pine bacteria and assess rhizosphere bacterial diversity using culture-independent advanced approaches. Forty bacteria isolated from the rhizoplane of P. roxburghii growing in a cold climate at high altitude in Murree, were morphologically characterised; nine were identified by 16S rRNA sequence analyses and used in experiments. Diversity and abundance of the 16S rRNA gene and nifH gene in the rhizosphere was assessed by cloning, RFLP analysis, 454-amplicon pyrosequencing and qPCR. The bacterial isolates significantly improved dry weight of shoot, root, root area, IAA and GA₃ content, number of grains plant^-1 , weight of grains plant^-1 in wheat varieties Chakwal-50 and Fareed-06 under axenic and field conditions. The number of 16S rRNA sequences (2979) identified by pyrosequencing shared similarity with 13 phyla of bacteria and archaea. The results confirm the existence of diverse bacteria of agricultural and industrial importance in the rhizosphere and compatibility of rhizoplane bacteria as bio-inoculants for wheat varieties.

Plant defence induced by PGPR against Spodoptera litura in tomato (Solanum lycopersicum L.)

The research conducted including its rationale: Spodoptera litura is the major pest of tomato causing significant reduction in tomato yield. Application of Plant growth promoting rhizobacteria(PGPR) prevent use of chemical fertilizer and synthetic pesticides through enhancement of plant growth and yield and induction of systemic resistance. Present investigation is an attempt to evaluate the role of PGPR, Pseudomonas putida and Rothia sp. on the physiology and yield of tomato fruit infested with the S. litura. Central methods applied: The surface sterilized seeds of tomato were inoculated with 48 h culture of P. putida and Rothia sp. At 6-7 branching stage of the plant, the larvae of S. litura at 2nd in star was used to infect the tomato plant leaves.

KEY RESULTS

The S. litura infestation decreased dry weight of shoots and roots by 46% and 22%, and significant reduction was recorded in tomato fruit yield. The P. putida and Rothia sp. inoculations alleviated the adverse effects of insect infestation and resulted in 60% increase in plant biomass and 40% increase in yield over infested plants. Main conclusions including key points of discussion: PGPR: Defense appears to be mediated via increase in proline production, enhanced activities of antioxidant enzymes, stimulation in the activities of protease and polyphenol oxidases, increased contents of phenolics, protein and chlorophyll. The formulation of biopesticide involving PGPR comprise an environment friendly and sustainable approach to overcome insect infestation.

Comparative effects of wild type Stenotrophomonas maltophilia and its indole acetic acid-deficient mutants on wheat

The present investigation evaluated the role of Stenotrophomonas maltophilia and its IAA-deficient mutant on soil health and plant growth under salinity stress in the presence of tryptophan. In the first phase, S. maltophilia isolated from roots of the halo- phytic herb, Cenchrus ciliaris was used as bio-inoculant on wheat grown in saline sodic soil. A field experiment was conducted at Soil Salinity Research Institute during 2010-2011. Treatments included seed inoculation with S. maltophilia with or without tryptophan; uninoculated untreated plants were taken as control. An aqueous solution of tryptophan was added to rhizosphere soil at 1 μg l(_1) after seed germination. Inoculation with S. maltophilia significantly increased soil organic matter, enhanced (20-30%) availability of P, K, Ca and NO3 -N and decreased Na content and electrical conductivity of rhizosphere soil. Plant height, fresh weight, proline and phytohormone content of leaves were increased 30-40% over the control. Activities of superoxide dismutase (SOD) and peroxidase (POD) were 40-50% higher than control. Addition of tryptophan further augmented (10-15%) growth parameters, whereas NO3 -N, P, K and Ca content, proline content and SOD and POD increased 20-30%. In a second phase, indoleacetic acid (IAA)-deficient mutants of S. maltophilia were constructed and evaluated for conversion of tryptophan to IAA at the University of Calgary, Canada, during 2013-2014. About 1800 trans-conjugants were constructed that were unable to produce IAA in the presence of tryptophan. The results suggest that tryptophan assisted S. maltophilia in the amelioration of salt stress, and that IAA played positive role in induction of salt tolerance.

Ethnomedicinal knowledge of the most commonly used plants from Deosai Plateau, Western Himalayas, Gilgit Baltistan, Pakistan

ETHNOPHARMACOLOGICAL RELEVANCE

The current survey was aimed to identify the prime important medicinal plants in terms of medicines and further pharmacological screening of such plants. As far as, we know, no reported data from Deosai Plateau have been published and this is the first documented information of the study area.

MATERIAL AND METHODS

Ethnomedicinal information of plants was collected through semi-structured interviews through a participatory rural appraisal (PRA) method.

RESULTS AND DISCUSSION

This study provided information of 50 medicinal plant species used to treat 29 different ailments. A total of 42 species (84%) were herbs while shrubs and subshrubs were represented by 8 species (16%). Leaves (37%) were the predominant plant parts followed by, roots (27%), aerial parts (13%), flowers (12%), fruit (7%), seeds (3%), and tuber (1%). Method of preparation fall into five categories including infusion (31%), paste (23%), decoction (20%), powder (18%), and juice (8%).

CONCLUSION

The study area is rich in medicinal plant diversity growing in wild. Our efforts in this regard are only a little contribution to the ethnobotanical study of this area focusing on medicinal plants while more clinical studies are required in future to prove such claims of local inhabitants.

Quantitative ethnomedicinal study of plants used in the skardu valley at high altitude of Karakoram-Himalayan range, Pakistan

BACKGROUND

The tribal inhabitants of the Skardu valley (Pakistan) live in an area of great endemic botanic diversity. This paper presents the first quantitative ethnomedicinal spectrum of the valley and information on the uses of medicinal plant. This paper aims to analyze and catalogue such knowledge based on Relative Frequency Citation (RFC) and Use Value (UV) of medicinal plants in addition to the configuration of the Pearson correlation coefficient.

METHODS

The field study was carried out over a period of approximately 2 years (2011-2013) using semi-structured interviews with 71 informants (most of the informants belonged to an age between 50 and 70 years) in six remote locations in the valley. Ethnomedicinal data was analyzed using frequency citation (FC), relative frequency of citation (RFC) and use value (UV) along with a Pearson correlation coefficient (PCC). Demographic characteristics of participants, ethnobotanical inventory of plants and data on medicinal application and administration were recorded.

RESULTS

A total of 50 medicinal plants belonging to 25 families were reported to be used against 33 different ailments in the valley. The maximum reported medicinal plant families were Asteraceae (7 report species), Lamiaceae (6) , Polygonaceae (4) and Rosaceae (4), the most dominant life form of the species includes herbs (38) followed by shrubs and subshrubs (12), the most frequent used part was leaves (41%) followed by root (26%), flower (14%), fruit (9%), seeds (8%), bulb (1%) and bark (1%), the most common preparation and administration methods were infusion (32%), decoction (26%), paste (18%), herbal juice (17%) and powder drug (7%). The Pearson correlation coefficient between RFC and UV was 0.732 showing highly positive significant association.

CONCLUSIONS

In this study, we have documented considerable indigenous knowledge about the native medicinal plants in Skardu valley for treating common ailments which are ready to be further investigated phytochemically and pharmacologically which leads to natural drug discovery development. The study has various socioeconomic dimensions which are associated with the local communities.

Isolation and 16S rRNA sequence analysis of the beneficial bacteria from the rhizosphere of rice

The present study deals with the isolation of plant growth promoting rhizobacteria (PGPR) from rice (variety NIAB IRRI-9) and the beneficial effects of these inoculants on two Basmati rice varieties. Nitrogen-fixing activity (acetylene-reduction activity) was detected in the roots and submerged shoots of field-grown rice variety NIAB IRRI-9. Estimation of the population size of diazotrophic bacteria by ARA-based MPN (acetylene reduction assay-based most probable number) in roots and shoots indicated about 10(5)-10(6) counts/g dry weight at panicle initiation and grain filling stages. Four bacterial isolates from rice roots and shoots were obtained in pure culture which produced phytohormone indoleacetic acid (IAA) in the growth medium. Among these, three isolates S1, S4, and R3 reduced acetylene to ethylene in nitrogen-free semi-solid medium. Morphological and physiological characteristics of the isolates indicated that three nitrogen-fixing isolates S1, S4, and R3 belonged to the genus Enterobacter, while the non-fixing isolate R8 belonged to the genus Aeromonas. 16S rRNA sequence of one isolate from root (R8) and one isolate from shoot (S1) was obtained which confirmed identification of the isolates as Aeromonas veronii and Enterobacter cloacae, respectively. The 1517-nucleotide-long sequence of the isolate R8 showed 99% similarity with Aeromonas veronii (accession No. AF099023) while partial 16S rRNA sequence (two stretches of total 1271 nucleotide length) of S1 showed 97% similarity with the sequence of Enterobacter cloacae (accession No. AJ251469). The seedlings of two rice varieties Basmati 385 and Super Basmati were inoculated with the four bacterial isolates from rice and one Azospirillum brasilense strain Wb3, which was isolated from wheat. In the rice variety Basmati 385, maximum increase in root area and plant biomass was obtained in plants inoculated with Enterobacter S1 and Azospirillum Wb3, whereas in the rice variety Super Basmati, inoculation with Enterobacter R3 resulted in maximum increase of root area and plant biomass. Nitrogen fixation was quantified by using 15N isotopic dilution method. Maximum fixation was observed in Basmati 385 with the inoculants Azospirillum Wb3 and Enterobacter S1 where nearly 46% and 41% of the nitrogen was derived from atmosphere (%Ndfa), respectively. In general, higher nitrogen fixation was observed in variety Basmati 385 than in Super Basmati, and different bacterial strains were found more effective as inoculants for the rice varieties Basmati 385 and Super Basmati.

Pulmonary vagal innervation is required to establish adequate alveolar ventilation in the newborn lamb

To investigate the effects of bilateral intrathoracic vagotomy on the establishment of continuous breathing and effective gas exchange at birth, we studied 8 chronically instrumented, unanesthetized, sham-operated and 14 vagotomized newborn lambs after a spontaneous, unassisted vaginal delivery. Fetal lambs were instrumented in utero to record sleep states, diaphragmatic electromyogram, blood pressure, arterial pH, and blood-gas tensions. Six of eight sham-operated lambs established effective gas exchange within 10 min of birth, whereas 12 of 14 vagotomized animals developed respiratory acidosis and hypoxemia (P = 0.008). Breathing frequency in vagotomized newborns was significantly lower during the entire postnatal period compared with sham-operated newborns. Vagotomized subjects also remained hypothermic during the entire postnatal period (P < 0.05). Bronchoalveolar lavage indicated an increased minimum surface tension, whereas lung histology showed perivascular edema and partial atelectasis in the vagotomized group. We conclude that stimulation of breathing and effective gas exchange are critically dependent on intact vagal nerves during the transition from fetal to neonatal life.

Umbilical arterial blood flow and plasma prostaglandin E2 concentrations during arousal and breathing movements in fetal sheep

To investigate the effects of lung distension and oxygenation on umbilical blood flow (UBF) and plasma prostaglandin E2 (PGE2) in relation to arousal and stimulation of breathing movements, we studied eight chronically instrumented, unanesthetized fetal sheep between 137 and 143 d of gestation. Electrocorticogram, electro-oculogram, nuchal and diaphragmatic electromyograms, arterial pH and blood gas tensions, Hb oxygen saturation, body temperature, and UBF were recorded in each fetus. Electrocorticogram, electro-oculogram, and nuchal electromyograms were used to define sleep states. No sooner than 4 d after surgery, fetal lungs were distended with 100% O2 or N2 in a randomized order via an in situ Y-endotracheal tube. PGE2 concentrations were analyzed by RIA. A significant increase in fetal arousal and stimulation of breathing during nonrapid eye movement sleep was observed during lung distension with O2 as compared with control periods and lung distension with nitrogen. In all sleep states, UBF significantly decreased during oxygenation as compared with the control values. However, no significant correlation was observed between the time of the onset of arousal and the decrease in UBF. Lung distension with N2 resulted in increased plasma PGE2 concentrations, whereas, no change was observed during oxygenation. Our data suggest that an increase in fetal partial pressure of arterial O2 leads to a decrease in UBF. However, the onset of arousal and stimulation of breathing during lung distension and oxygenation were not dependent on a decrease in plasma PGE2 concentrations.

[Small size breast cancer conservative surgical therapy and subsequent radiotherapy]

From february 1980 to december 1985, 115 breast carcinomas were treated with QU.A.RT. with limited surgery and following radiotherapy. Median age was 51 years (range 25 to 75). Surgical approach was quadrantectomy with axillary nodes dissection. Irradiation of residual breast was performed by an anterior high energy electron beam. 50 Gy in 25 fractions was the minimal dose to whole breast. In pN+ patients systemic adjuvant therapy was done. Local control was obtained in 111 cases. Local recurrence appeared in 4: 1 menopausal pT1 pNO and 3 premenopausal (1 pT1 pNO and 2 pT1 pN+) at respectively 31, 19, 22 months from diagnosis. Distant metastases appeared in 10 patients. 7 died for cancer and 3 are still alive. Cosmetic results were scored as good in 52, better than mastectomy in 26, unsatisfactory in 3, and not stated in 34. Our results are comparable to those of other Centers. Youth, axillary metastases and delay between surgery and radiotherapy appears to influence the risk of recurrence also in our series.

[Diagnostic aspects of aneurysm of the splenic artery (description of a case)]

A case of splenic artery aneurysm with ultrasonic examination discovered is reported and analyzed. The aneurysm pas asymptomatic and founded as incidental finding during standard x-ray. Arteriography was required to confirm the diagnosis and indicate the correct surgical treatment.

[Primary carcinoma of the gallbladder: ultrasonic features (remarks on 8 cases)]

The authors illustrate the ultrasound features of gallbladder carcinoma after reviewing literature and basing upon their own experience. The diagnosis of this neoplasia is formulated more frequently today by introduction of scanning means, but it remains very difficult on initial phase because of its precocious lymphatic and hilar infiltration.

[Hepatic angioma: a bothersome presence during staging of neoplasms of the digestive system]

On reviewing a consecutive series of 1,200 ultrasonic tomographies of the liver to assess the incidence of liver angiomas, the authors describe their sonographic, tomodensitometric and angiographic characteristics. They emphasise the fact that such lesions, though usually not constituting a serious clinical or diagnostic problem, as a simple sonographic follow-up will suffice to clarify the situation, may nevertheless, in certain particular clinical situations such as in the course of tumour staging of the digestive apparatus, require full diagnostic investigation using all the techniques available (ultrasonic tomography, CAT, liver arteriography, sonographically guided thin-needle biopsy.

[Leiomyosarcoma of the duodenum (description of a case and review of the literature)]

The Authors report on a case of duodenal leiomyosarcoma of small dimensions in a paravaterian site and presenting a low degree of histological malignity. They summarize the main anatomoclinical features of the neoplasm and conclude by indicating less aggressive surgical therapy as adequate in such cases, accompanied, however, by a protracted post-operative follow-up.

[Epidemiology and monitoring of closed abdominal injuries]

The authors review the epidemiological and aetiopathogenetic characteristics of abdominal blunt injuries (118 cases) monitored in a homogeneous manner. The relatively young age of the patients, the diagnostic difficulties encountered and the frequent presence of associated lesions call for the rigorous application of a predetermined clinico-diagnostic protocol.

[Ductal adenoma of the breast: correlations between clinico-radiologic and histo-pathologic aspects (considerations on a case)]

The authors report on a case of ductal adenoma of the breast, pointing out that routine clinico-instrumental diagnostic signs, though suggesting a picture of malignancy, may actually relate to this rare benign form of tumor. In the presence of cases of this type, we therefore advise a cautions approach to surgery, in that oncological radicality is subordinate to confirmation in the form of a traditional histological preparation, as freezer examinations are unable to provide wholly reliable responses.

[Clinico-diagnostic aspects of aggressive angiomyxoma of the pelvis and perineum]

The authors report on a case of aggressive angiomyxoma of the pelvis and perineum in a 46-year-old female patient. After reviewing the cases described in the literature, they examine the clinical characteristics of this rare form of neoplasia, which tends to occur more frequently in patients of female sex and in the young to middle-aged age bracket and is characterized by slow growth, non-infiltration of adjacent organs and a tendency to recur owing to incomplete excision. Metastases have never been reported. Failure to recognize the tumor at first approach may be due to the fact that it is easy to confuse it clinically with other more common diseases of the perineum. The authors conclude by advising systematic anatomicopathological identification of all perineal tumors, even when apparently benign.

["Wandering spleen": preoperative diagnosis by echotomography of the abdomen (review of the literature and report of a case)]

Splenic wandering is a rare condition of upset position of spleen, due to congenital fault or to excessive looseness of the supporting apparatus of this organ. The literature reports about 180 cases thereof, few of which recognized as such before operation. Ultimate investigations, in this limited number of preoperative diagnoses, resulted angiography and hepato-splenic scintigraphy; only three times the diagnosis was correctly placed through ultra-sounds. The authors show a case, confirmed by the operative report, where the ultrasonic test allowed to place the diagnosis with certainty, and, due to a particular lot of circumstances, proved to be better than TAC.

[Diagnostic up-date in thrombosis of the portal vein]

Portal thrombosis is a rare acquired condition with various etiology. Clinical manifestations are portal hypertension or nine. The main technics to diagnostic are: CT, indirect splenoportography and ultrasound examination. The first and the second are reliable but the third only is useful to explore the portal system and to evaluate patients with suspect portal vein thrombosis.