Clostridioides difficile Infection in Children With Inflammatory Bowel Disease

BACKGROUND

The study's objective was to investigate the incidence and risk factors associated with Clostridioides difficile (previously known as Clostridium) infection (CDI) in children with inflammatory bowel disease (IBD) in the province of Manitoba.

METHODS

Our longitudinal population-based cohort was comprised of all children and young adults aged <17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. The Fisher exact test was used to examine the relationship between categorical variables. A Cox regression model was used to estimate the risk of CDI development in IBD patients.

RESULTS

Among 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years, and the median age at diagnosis (interquartile range) was 12.96 (9.33-15.81) years. The incidence rates of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (P = 0.46). Compared with children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (adjusted hazard ratio [aHR], 4.38; 95% confidence interval [CI], 1.46-13.10) and anti-tumor necrosis factor (anti-TNF) biologics (aHR, 3.31; 95% CI, 1.11-9.90). The recurrence rate of CDI in our pediatric IBD population was 25%.

CONCLUSIONS

Our findings confirm that children with IBD are at high risk of developing CDI, which may predict future escalation of IBD therapy.

A68 CLOSTRIDIOIDES DIFFICILE INFECTION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE

Background

Toxigenic Clostridioides difficile (C. difficile), previously known as Clostridium difficile, is an anaerobic gram-positive spore-forming opportunistic pathogen associated with profuse diarrhea and gastroenteritis associated mortality and morbidity especially in patients with inflammatory bowel disease (IBD).

Aims

To investigate the incidence and risk factors associated with clostridioides difficile infection (CDI) in children with IBD in the province of Manitoba.

Methods

Our longitudinal population-based cohort comprised of all children and young adults &lt; 17y diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. Fisher’s exact test was used to examine the relationship between categorical variables. Cox-regression model was used to estimate the risk of CDI development in IBD patients.

Results

Among the 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years and the median age at diagnosis of 12.96 years (IQR: 9.33–15.81). The incidence rate of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (p=0.46). Compared to children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (hazard ratio (HR)=4.30; 95% CI: 1.44–12.87) and anti-tumor necrosis factor (TNF) biologics (HR=3.37; 95% CI: 1.13–10.09). Recurrence rate of CDI in our pediatric IBD population was 25%.

Conclusions

Our findings confirm that children with IBD are at a high risk of developing CDI, which may predict future escalation of IBD therapy.

Funding Agencies

The Children’s Hospital Research Institute of Manitoba

Review of thiamine deficiency disorders: Wernicke encephalopathy and Korsakoff psychosis

Wernicke encephalopathy (WE) and Korsakoff psychosis (KP), together termed Wernicke-Korsakoff syndrome (WKS), are distinct yet overlapping neuropsychiatric disorders associated with thiamine deficiency. Thiamine pyrophosphate, the biologically active form of thiamine, is essential for multiple biochemical pathways involved in carbohydrate utilization. Both genetic susceptibilities and acquired deficiencies as a result of alcoholic and non-alcoholic factors are associated with thiamine deficiency or its impaired utilization. WKS is underdiagnosed because of the inconsistent clinical presentation and overlapping of symptoms with other neurological conditions. The identification and individualized treatment of WE based on the etiology is vital to prevent the development of the amnestic state associated with KP in genetically predisposed individuals. Through this review, we bring together the existing data from animal and human models to expound the etiopathogenesis, diagnosis, and therapeutic interventions for WE and KP.

Phosphokinome Analysis of Barth Syndrome Lymphoblasts Identify Novel Targets in the Pathophysiology of the Disease

Barth Syndrome (BTHS) is a rare X-linked genetic disease in which the specific biochemical deficit is a reduction in the mitochondrial phospholipid cardiolipin (CL) as a result of a mutation in the CL transacylase tafazzin. We compared the phosphokinome profile in Epstein-Barr-virus-transformed lymphoblasts prepared from a BTHS patient with that of an age-matched control individual. As expected, mass spectrometry analysis revealed a significant (>90%) reduction in CL in BTHS lymphoblasts compared to controls. In addition, increased oxidized phosphatidylcholine (oxPC) and phosphatidylethanolamine (PE) levels were observed in BTHS lymphoblasts compared to control. Given the broad shifts in metabolism associated with BTHS, we hypothesized that marked differences in posttranslational modifications such as phosphorylation would be present in the lymphoblast cells of a BTHS patient. Phosphokinome analysis revealed striking differences in the phosphorylation levels of phosphoproteins in BTHS lymphoblasts compared to control cells. Some phosphorylated proteins, for example, adenosine monophosphate kinase, have been previously validated as bonafide modified phosphorylation targets observed in tafazzin deficiency or under conditions of reduced cellular CL. Thus, we report multiple novel phosphokinome targets in BTHS lymphoblasts and hypothesize that alteration in the phosphokinome profile may provide insight into the pathophysiology of BTHS and potential therapeutic targets.

Prevalence of venous thromboembolism risk factors and prophylactic adequacy among general surgical patients in a tertiary care hospital

Introduction

Venous thromboembolism (VTE) is a disease manifested as deep vein thrombosis and pulmonary embolism. General surgical procedures are associated with significant risk of precipitating VTE, and despite the surging evidences, it is often overlooked. The study attempted at estimating the prevalence of VTE and bleeding risk factors coupled with the adequacy of thromboprophylaxis administered.

Methodology

The study spanning 1-year duration was executed through collection of data from patients older than 18 years, admitted to the general surgery department of a tertiary care hospital. The data were collected using internally validated data collection form and the appraisal of data was done using SPSS 18.

Results

Among the 400 subjects enrolled, number of patients in low, moderate, and high risk, as per the Caprini score, was 24%, 35%, and 41%, respectively, with the difference being significant with p < 0.001. Bleeding risk was positive in 28% subjects and 36% received any form of prophylaxis other than early ambulation. 28% subjects were identified to have received adequate thromboprophylaxis.

Conclusion

Although the prevalence of 41% individuals at high risk for VTE is comparable to the global prevalence of 41.5%, prophylactic adequacy of 28% was lower than the 33% observed globally. Meticulous planning coupled with operational interventions, such as institutional multidisciplinary thromboprophylactic team, can be an effective strategy at enhancing the prophylactic standards and thereby attaining optimal patient outcomes.

Evaluation of prevalence and risk factors of gestational diabetes in a tertiary care hospital in Kerala

AIMS

The prospective study was conducted with the aim to evaluate the prevalence and risk factors of gestational diabetes mellitus in a tertiary care referral hospital in Kerala.

MATERIALS AND METHODS

A prospective observational study was conducted with the aim to study the prevalence, risk factors, complications, treatment pattern and cost analysis of GDM. The study was carried out in the Obstetrics & Gynecology dDepartment of Al Shifa hHospital located in northern Kerala.

RESULTS

Over an eight-month period, 201 patients who met the inclusion criteria were enrolled for study from which prevalence of GDM was estimated at 15.9%. The study revealed higher prevalence of risk factors and complications such as age >25 years, BMI >26kg/m(2), family history of DM, past history GDM, history of big baby, gestational hypertension, vaginal candidiasis, premature rupture of membranes and hyperbilirubinemia in GDM group as compared to non-GDM group. The study also demonstrated that modern life-style was a major influencing factor for development of diabetes in the study population.

CONCLUSION

The study reveals the necessity of proper screening diagnosis and management of GDM in pregnant women by the clinicians so as to prevent the future burden of type 2 diabetes.

Incidence and risk factors of hypoglycemia among Type 2 diabetic patients in a South Indian hospital

AIM

The study was aimed at assessing the cumulative incidence of hypoglycemia and precipitating risk factors among type 2 diabetes mellitus in-patients of a tertiary care hospital in South India.

METHODS

The prospective cross sectional study spanning 14 months was conducted in a tertiary care hospital in Kerala. All T2DM patients who were administered any form of insulin during the length of hospital stay was monitored for assessing the hypoglycemic episodes. Any patient with a GRBS value less than 70mg/dL was defined to be hypoglycemic as per the ADA guidelines. The statistical analysis of collected data was performed using SPSS 18 for windows version.

RESULTS

Of the 1650 subjects enrolled in the study, 204 subjects developed hypoglycemia. The sample composed of 60.8% females and 39.2% males and the difference was significant with p=0.02. A significant positive correlation was observed between HbA1c values and GRBS value, with a 2 tailed Pearson correlation coefficient of 0.027. On stratifying as per the modality of insulin dose prescribed, 72.5% of the hypoglycemic patients were found to have been administered fixed dose insulin.

CONCLUSION

The cumulative incidence of institutional hypoglycemia among type 2 diabetic inpatients was gauged as 12.36%; among which, 26.96% had asymptomatic episodes.

Implications of traditional medicine in the treatment of Hepatitis A in Kerala

Introduction

The recent outbreaks of Hepatitis A in Kerala are suggestive of decrease in endemicity as most adults were not exposed during the childhood. In allopathic system of medicine, there is no established treatment for Hepatitis A and hence most people tend to rely on the alternate systems of medicine. The study was aimed at identifying the burden of Hepatitis A in the locality and to uncover the degree of dependence of the people on traditional systems of medicine.

Methods

The study spanned over 7 months and was conducted in Malappuram district of Kerala. A simple questionnaire having closed-ended questions was prepared and circulated among the physicians in the area. Demographic and other relevant details were obtained from the patients and the medicine system relied on was scrutinized.

Results

Of the 348 patients enrolled, majority of the patients were between the age of 10–30 years. The study revealed that females were more affected than males. Similarly people in rural areas were greater than those from urban areas. Most patients (73.28%) relied on Ayurvedic treatment after one week of onset of symptoms.

Discussion and conclusion

The preparations such as triphala which has great efficacy in treatment has to be further studied to establish the pathways and mechanism through which it acts. A collaborative effort between government, modern medicine and alternate medicine system can be highly effective in reducing the outbreaks of such epidemics through proper preventive and therapeutic strategies.

Prevalence, risk factors and antimicrobial susceptibility pattern of extended spectrum β-lactamase-producing bacteria in a tertiary care hospital

BACKGROUND

The widespread misuse of antibiotics over the past several decades has been regarded as the contributing factor in the development of resistance toward them. Extended spectrum β-lactamases (ESBLs) are enzymes produced by certain bacteria that can make them resistant to certain antibiotics. Early detection of ESBL strains and judicious use of antibiotics and proper implementation of infection control strategies are essential to prevent the spread of this threat in the community. The study aimed at appraising the prevalence, risk factors and antimicrobial susceptibility pattern of ESBL-producing microorganisms.

METHODS

A prospective observational study was carried out in a tertiary care referral hospital located in Malappuram district of Kerala among inpatients with infection by ESBL-producing bacteria in order to estimate the prevalence, risk factors and their antibiotic susceptibility pattern.

RESULTS

Out of the total 1156 patients studied, 118 had confirmed diagnosis on the presence of ESBL-producing microorganisms. Overall, 9.79% of all samples growing Enterobacteriaceae yielded an ESBL producer. Out of the total isolates identified, 66.1% were urinary tract infections, 15.1% were respiratory tract infections, 14.4% were surgical site infections and the remaining constituted blood stream infections. The highest antimicrobial activity against ESBL-producing isolates was observed for meropenem.

CONCLUSIONS

High prevalence of ESBL-producing organisms is evident in the study setting implicating the necessity to report the ESBL production along with the routine sensitivity reports supplemented with control measures which can assist a clinician in prescribing appropriate antibiotics.

Prevalence of hypoglycemia among diabetic old age home residents in South India

AIM

To assess the prevalence of diabetes among inmates at old age care homes in south India and scrutinize their therapy, glycemic levels and burden of hypoglycemic episodes.

MATERIALS AND METHODS

The medication record based observational study was conducted in 9 old-age care facilities across south India from February to September 2015. The cognitive and functional status were analysed and the prevalence of hypoglycemia estimated. Descriptive analysis was performed using SPSS 18.0 for windows.

RESULTS

The prevalence, predisposing variables and therapeutic modalities used in 189 inmates of 9 old-age homes in Kerala. The mean age of the sample was estimated to be 71.3±3.4 years. 67.2% of the total inmates were found to be diabetic and met the inclusion criteria. Of the total patients, 72.44% had co-existence of both cognitive and functional impairment.86% patients developed hypoglycemia at least at some point during the therapy and insulin was found to be the drug used in majority of patients with the condition indicating that aggressive therapies can increase fatality due to hypoglycemia.

CONCLUSIONS

Most guidelines call for an individualized therapeutic approach suing less aggressive strategies for patients vulnerable to hypoglycemia and geriatric population form such a substantial group. The current study highlights the necessity for special attention when considering therapeutic regimen among such patients.