Genetic variations among the isolates of Bipolaris Maydis based on phenotypic and molecular markers

Abstract Maydis leaf blight, caused by Bipolaris maydis, is an important disease of maize crop in Khyber Pakhtunkhwa (KP) Pakistan. Fifteen isolates of the pathogen, collected across KP, were studied for variability based on phenotypic and molecular markers. Significant variability among the isolates was observed when assessed using phenotypic traits such as radial growth, spore concentration, fungicide sensitivity and virulence. The isolates were classified into six culture groups based on colour, texture and margins of the colony. Conidial morphology was also variable. These were either straight or slightly curved and light to dark brown in colour. Fungicide test showed significant variation in the degree of sensitivity against Carbendazim. Isolate Bm8 exhibited maximum radial growth on carbendazim spiked plates. Conversely, isolate Bm15 showed the lowest radial growth. Variations in virulence pattern of the isolates were evident when a susceptible maize variety Azam was inoculated with spores of B. maydis. Genetic variability amongst the isolates was also estimated by RAPD as well as sequencing of ITS region. The RAPD dendrogram grouped all the isolates into two major clusters. Average genetic distance ranged from 0.6% to 100%, indicating a diverse genetic gap among the isolates. Maximum genetic distance was found between isolates Bm9 and Bm10 as well as Bm2 and Bm8. Conversely, isolates Bm13 and Bm15 were at minimum genetic distance. Phylogenetic dendrogram based on sequencing of ITS region grouped all the isolates into a single major cluster. The clusters in both the dendrogram neither correlate to the geographical distribution nor to the morphological characteristics.

OP0011 HIGHLY DIFFERENTIATED CD4 AND CD8 T EFFECTOR MEMORY CELLS RE-EXPRESSING CD45RA (TEMRA) ARE ASSOCIATED WITH ACTIVE DISEASE REFRACTORY TO ANTI-TNF THERAPY IN RHEUMATOID ARTHRITIS

Background

Highly differentiated T cells have been reported to be enriched in rheumatoid arthritis (RA) compared to healthy individuals1. The role of terminally differentiated T effector memory re-expressing CD45RA (Temra) in RA pathogenesis and disease activity is still unclear, including whether they can be used as a marker of sustained disease activity in RA patients receiving anti-TNF therapy.

Objectives

To investigate whether the frequency of peripheral blood Temra can be used as a biomarker to identify disease refractory to anti-TNF therapy in RA, if they correlate with inflammation in anti-TNF treated patients, and whether they associate with a flare following tapering anti-TNF.

Methods

RA patients on anti-TNF therapy were recruited from rheumatology clinic (cross-sectional cohort). Clinical data and whole blood were collected. Patients were stratified based on disease activity. Remission was defined as no recorded DAS28-CRP≥2.4, no swollen joints, no C-reactive protein (CRP) of >5mg/L, and on a stable DMARD dose and no reported disease flare/loss of remission in the 6 months prior. Non-remission was defined as any other disease activity which does not fulfil the remission definition. Patients on abatacept, or methotrexate monotherapy and healthy volunteers were recruited as comparison groups. A separate cohort of anti-TNF patients (longitudinal cohort) who have been in remission on a stable dose of anti-TNF for ≥6 months and no use of corticosteroids in the last 6 months, was also recruited. Whole blood was obtained prior to dose tapering (dose halving) and at the point of a flare. Whole blood was processed by gradient centrifugation to obtain peripheral blood mononuclear cells (PBMC). PBMC were stained with fluorochrome-conjugated antibodies for multi-parameter flow cytometry. Analysis was performed on live lymphocytes using FlowJo software version 10.8. Two-tailed Mann-Whitney U test or unpaired t-test were used to obtain unadjusted values, analysis of variance (ANOVA) of log-transformed data was used to obtain age-adjusted values, Spearman’s rank correlation was used to compare correlation between Temra and CRP.

Results

RA patients (36 anti-TNF, 12 abatacept, 16 methotrexate monotherapy) and 14 healthy individuals were recruited. There was a higher proportion of CD4 (age-adjusted p = 0.004) and CD8 Temra (age-adjusted p = 0.0007) in RA patients on anti-TNF with persistent disease activity compared to those who had achieved remission. These differences were confirmed when analysing absolute numbers of CD4 and CD8 Temra. Unexpectedly, the difference in Temra frequency between remission and non-remission RA was not observed in patients treated with methotrexate or abatacept. The median CD4 and CD8 Temra frequencies in RA patients in remission with all treatments studied were similar to healthy individuals.

Temra were not observed to increase with age in the anti-TNF, abatacept, or methotrexate cohorts in contrast to previous reports in healthy individuals2. The frequency of CD4 and CD8 Temra correlated with CRP only in patients on anti-TNF (CD4 Temra Spearman r = 0.5185, p = 0.001, and CD8 Temra Spearman r = 0.5040, p = 0.005).

There was an increase in CD4 (p = 0.003) but not CD8 Temra at 3 months in patients who flared on tapering anti-TNF compared to those who remained in remission (Figure 1).

Conclusion

Increased CD4 and CD8 Temra frequency were associated with persistent disease activity in anti-TNF treated patients but not with other DMARD therapies (abatacept and methotrexate). CD4 Temra increased in those who flared on tapering anti-TNF. These results suggest that Temra may play a role in driving persistent disease activity refractory to anti-TNF therapy rather than merely a marker of inflammation.

References

[1]Weyand CM, Yang Z, Goronzy JJ. T-cell aging in rheumatoid arthritis. Curr Opin Rheumatol. 2014;26(1):93-100.

[2]Callender LA, Carroll EC, Bober EA, et al. Mitochondrial mass governs the extent of human T cell senescence. Aging Cell. 2020;19(2):e13067.

Acknowledgements

SAY is funded by research grants by Versus Arthritis, Royal College of Physicians/Rosetrees Trust, NIHR University College London Hospitals Biomedical Research Centre and UCLH Charities.

Disclosure of Interests

Su-Ann Yeoh: None declared, James Kimpton: None declared, Muhammad Shipa: None declared, Eleanor Hawkins: None declared, Arne Akbar Grant/research support from: AA has received funding from the Leo Skin Foundation (Denmark), Michael Ehrenstein Consultant of: MRE has received consultancy fees from Galapagos and Sanofi., Grant/research support from: MRE has received financial grants from GlaxoSmithKline.

Enterotoxigenic methicillin resistant Staphylococcus aureus contamination in salted fish from Gwadar Balochistan

Staphylococcus aureus is an important foodborne pathogen associated to food intoxication and other multiple infections in human being. Its presence in salted food is a serious issue due to its salt tolerance potential. A study was conducted to analyze the presence of enterotoxins producing drug resistance S. aureus in salted sea fish from Gwadar. Freshly persevered samples (n=50) of salted fish were subjected to analyze the presence of S. aureus using 16S rRNA and Nuc genes primers. The isolates were then evaluated for drug resistance and enterotoxins producing potential using specific primers for MecA (methicillin resistance gene), (SEA) staphylococcal enterotoxin A and (SEB) staphylococcal enterotoxin B genes. Total 13/50 (26%) of the samples were found positive for the presence of S. aureus, preliminary confirmed with biochemical profiling and finally with the help of target genes presence. The isolates were found showing 100% resistant to methicillin, which were molecularly confirmed by the presence of MecA gene present in genome. The isolates 5/13 (38%) were positive for SEA and 3/13 (23%) for SEB genes, whereas 2/13 (15%) were confirmed having both SEA and SEB genes in its genome. It was also confirmed that all the isolates were capable to form biofilm over the glass surfaces. It was concluded that the study confirmed the presence of enterotoxigenic methicillin resistance Staphylococcus aurous (MRSA) in salted fish product, that poses gross food safety concern. Preventive and control measures are necessary to handle this serious food safety concern.

Elucidating antiviral activity of Curcuma longa against H9 N2 influenza virus using embryonated chicken egg model

Curcumin is a potent antimicrobial herb used traditionally as a spice in culinary. This study was designed to evaluate the antiviral effects of curcuma longa extract against H₉ influenza virus. A total of 60 embryonated eggs were equally divided into 5 groups with 12 eggs in each group. Group 1 (G1) served as uninfected negative control. Whereas Group 2 (G2) was kept as positive control infected with known virus @ 0.2 ml with 10^-9.3 EID₅₀. Group 3 (G3) was offered Curcuma longa @ 0.2 mg/0.2 ml and H₉N₂ virus (@ 0.2 ml with 10^-9.3 EID₅₀. Similarly, Group 4 (G4) was inoculated with extract of Curcuma longa @ 0.2 mg/0.2 ml per egg, whereas Group 5 (G5) was given Ribazole @ 0.2 ml/ egg. The crude extract and virus were administered on the 15^th day of incubation and were checked after every 24 hours up to 96th hour post inoculation by random selection of 3 eggs. Death and survival rate were noted in all groups. Gross and histopathological lesions were also observed. Results revealed that Curcuma longa extract had significantly (p<0.05) reduced the mortality rate of embryos infected with H₉N₂ virus. In G3, increased lymphocytes and mild fatty changes were seen in liver. Whereas, mature RBCs, plasma cells and some lymphoblast's were observed in Spleen. Similarly, the bursa follicles were with lymphocytic aggregation. The G4 (Curcuma longa) and G5 (Ribazole) were with maximum embryo survival after 48 and 72 h post inoculation. This study revealed potential antiviral activity of Curcuma longa against H9N2 influenza viruses and can be opted as alternative to antibiotics and antiviral drugs to minimize the antimicrobial resistance in human and animal population.

Molecular detection of Mycoplasma gallisepticum in different poultry breeds of Abbottabad and Rawalpindi, Pakistan

The poultry sector in Pakistan is contributing mainly in bridging gap between demand and supply for protein. Mycoplasma gallisepticum is an emerging bacterium causing serious problems in poultry industry of Pakistan. A cross-sectional study was conducted to evaluate the M. gallisepticum load in poultry populated regions of Pakistan. Total 600 serum and 600 swab samples were collected, 200 from each broiler, layers and breeders poultry in Rawalpindi and Abbottabad districts. Serum samples were analyzed through ELISA for seroprevalence. Swabs were cultured on Frey's medium followed by PCR and partial mgc2 gene sequencing. Results of seroprevalence of M. gallisepticum showed that layers (75%, n=150) are more positive as compared to breeders (70%, n=140) and broilers (50%, n=100). Typical colonies of the M. gallisepticum were observed in breeder (26.5%), followed by layer (21%) and broilers (9%). A total of 37.1% (n=42) samples were identified positive through PCR out of total 113 cultured based positive samples. A total of six M. gallisepticum isolates of current study showed 98-99 percent similarity with previously reported isolates on the basis of mgc2 gene partial sequencing. The M. gallisepticum was found highly prevalent in different poultry breads. Results of this study would add into basic data and provide a direction for livestock sector to strengthen a control strategy for mycoplasmosis in poultry farms.

Poverty-associated emerging infection of Cystic Echinococcosis in population of Northern Pakistan: A hospital based study

Cystic Echinococcosis (CE) is one of the most important zoonotic parasitic diseases in human, livestock, and wildlife globally. The prevalence of CE depends upon human behavioral risk factors, the diversity and ecology of animal host interactions and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. It is a neglected, economic and socio-cultural problem in Pakistan. The available data about the incidence of CE is very limited and no extensive study has been reported in Pakistan. The current study was aimed to analyze the hospital reported cases of CE and the associated risk factors related to the incidence of CE. The hospital-based data of CE for the time period of January 2012-December 2017 was collected from Islamabad, Rawalpindi and Peshawar. The data covered demographic characteristics including age, gender, and cyst localization of infected individuals and socioeconomic determinants. The data was analyzed based upon different risk factors along with the different socioeconomic parameters that has an important impact on the distribution of disease. A total of 228 cases were presented in the selected hospitals of different cities during the study period. Out of total 228 patients, 59.21% were males and 40.78% were females (P<0.001). Most infections have been recorded in young adults (>20-30) showing 22.8% of total infected individuals followed by children (0-10) showing 10.5% (n=24), respectively (P<0.001). Liver was the most vulnerable organ (58.77%, n=134) followed by lungs (14.47%, n=33) (P<0.001). The infection was higher among rural communities (84.2%) than urban (12.8%) (P<0.001). Socioeconomic and demographic factors had an important impact on the intensity of disease (P<0.001). The occurrence of cases in children and young adults was an important finding as it indicated an active transmission of the parasite in Pakistan along with the poverty index. Emergence of echinococcosis in Pakistan showed that emerging health issues in Pakistan could bring the disease to limelight for future research. This finding, together with the fact that 1 hospital reported 214 cases over 6 years 325 underlines the need for a program for prevention/control of this disease in Pakistan. The timely measure needs to be taken to hamper the disease development and establishment. In order to control the disease, complete surveillance should be done which in turn weighs down the disease progress.

Distribution and antimicrobial activity of lactic acid bacteria from raw camel milk

Consumer demand for natural pathogen-control agents for substitution of synthetic food preservatives and traditional antibiotics is increasing. This study aimed to reveal the distribution of lactic acid bacteria (LAB) in raw camel milk and to characterize their antimicrobial traits. The genetic identification by 16S rRNA sequencing of 58 LAB isolates showed the predominance of Enterococcus (24.2%), Lactococcus (22.4%) and Pediococcus (20.7%) genera in raw camel milk. These genera exhibited inhibitory activity against a broad spectrum of Gram-positive and Gram-negative bacteria including multidrug-resistant Salmonella. Among these LAB, two isolates-identified as Pediococcus pentosaceus CM16 and Lactobacillus brevis CM22-were selected for their strong bacteriocinogenic anti-listerial activity estimated at 1600 and 800 AU/mL, respectively. The bacteriocins produced were partially purified by ammonium sulphate precipitation and gel filtration and then biochemically characterized. The proteinaceous nature of bacteriocins was confirmed by the susceptibility to enzymes. These bacteriocins showed significant technological characteristics such as heat-resistance, and stability over a wide range of pH (2.0-10.0). In conclusion, these results indicated that Pediococcus pentosaceus CM16 and Lactobacillus brevis CM22 could be useful as potential probiotics. Moreover, their partially purified bacteriocins may play an important role as food preservatives and feed additives. To our knowledge, this is the first report describing the distribution of LAB population in raw camel milk and the characterization of their bacteriocins from the Arabian Peninsula of western Asia.

New three-dimensional/four-dimensional volume rendering imaging software for detecting the abnormally invasive placenta

OBJECTIVE

This study aimed to determine the role of three-dimensional (3D)/four-dimensional (4D) volume rendering ultrasound (VRU) in the diagnosis of abnormally invasive placenta (AIP).

MATERIALS AND METHODS

Twelve consecutive patients strongly suspected of having AIP on the basis of conventional ultrasound (US) and clinical history performed between September 2016 and December 2016 in the main tertiary referral hospital in Surabaya, East Java were included in this prospective observational study. A Samsung WS 80A Elite US scanner with a 3D/4D "crystal vue" and "realistic vue" volume rendering mode was used to establish the diagnosis of AIP and evaluate the site, and depth of placental invasion. The VRU images were compared with the intraoperative findings.

RESULTS

Using this novel US technique, all cases of suspected AIP were subsequently confirmed during surgery. Importantly, the new US technique provided a correct diagnosis of the degree of invasion in 11 out of these 12 suspected AIP cases: 5/5 for placenta percreta, 3/3 for placenta increta, and 2/3 for placenta accreta; one patient was misdiagnosed in terms of the degree of placenta accreta, and one patient had normal implantation).

CONCLUSION

This new software of 3D/4D VRU represents a promising technique for the preoperative diagnosis and staging of AIP.

Restorative surgery after colectomy for ulcerative colitis in England and Sweden: observations from a comparison of nationwide cohorts

AIM

A longstanding disparity exists between the approaches to restorative surgery after colectomy for patients with ulcerative colitis (UC) in England and Sweden. This study aims to compare rates of colectomy and restorative surgery in comparable national cohorts.

METHOD

The English Hospital Episode Statistics (HES) and Swedish National Patient Register (NPR) were interrogated between 2002 and April 2012. Patients with two diagnostic episodes for UC (age ≥ 15 years) were included. Patients were excluded if they had an episode of inflammatory bowel disease or colectomy before 2002. The cumulative incidences of colectomy and restorative surgery were calculated using the Kaplan-Meier method.

RESULTS

A total of 98 691 patients were included in the study, 76 129 in England and 22 562 in Sweden. The 5-year cumulative incidence of all restorative surgery after colectomy in England was 33% vs 46% in Sweden (P-value < 0.001). Of the patients undergoing restorative surgery, 92.3% of English patients had a pouch vs 38.8% in Sweden and 7.7% vs 59.1% respectively had an ileorectal anastomosis (IRA). The 5-year cumulative incidence of colectomy in this study cohort was 13% in England and 6% in Sweden (P-value < 0.001).

CONCLUSION

Following colectomy for UC only one-third of English patients and half of Swedish patients underwent restorative surgery. In England nearly all these patients underwent pouches, in Sweden a less significant majority underwent IRAs. It is surprising to demonstrate this discrepancy in a comparable cohort of patients from similar healthcare systems. The causes and consequences of this international variation in management are not fully understood and require further investigation.

Microbiome, antibiotics and irritable bowel syndrome

INTRODUCTION

Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal (GI) disorder. Increasing evidence implicates the GI microbiota in IBS pathogenesis and its modulation represents an emerging therapeutic strategy.

SOURCES OF DATA

Original and review articles were identified through selective searches performed on PubMed and Google Scholar.

AREAS OF AGREEMENT

The role of gut microbiota in IBS is supported by evidence from animal and human studies. Randomized controlled trials demonstrate efficacy of the non-systemic antibiotic rifaximin in reducing IBS symptoms.

AREAS OF CONTROVERSY

Existing studies on microbiota alterations are often inconsistent and limited by the heterogeneity of IBS. The exact mechanism of rifaximin remains to be elucidated. Identifying predictors of response to rifaximin and treatment strategies for symptom recurrence are important clinical questions.

GROWING POINTS

High-throughput molecular methods are leading to rapid advances in our understanding of GI microbiota in IBS AREAS TIMELY FOR DEVELOPING RESEARCH: Future well designed longitudinal studies are required to identify characteristic microbial signatures and potential biomarkers to identify therapeutic targets and predict clinical response.

Impact of interacting climate change factors on growth and ochratoxin A production by Aspergillus section Circumdati and Nigri species on coffee

The objectives of this study were to evaluate the effect of interacting climate change (CC) factors (water stress [water activity, aw; 0.99-0.90]); temperature [30, 35 °C]; and elevated CO2 [400 and 1000 ppm] on (1) lag phases prior to growth, (2) growth and (3) ochratoxin A (OTA) production by species of Aspergillus sections Circumdati and Nigri on coffee-based media and stored coffee beans. The lag phases, prior to growth, of all strains/species were slightly increased as aw, temperature and CO2 were modified. The interacting CC factors showed that most strains/species examined grew well at 30 °C and slightly less so at 35 °C except for Aspergillus niger (A 1911) which could tolerate the higher temperature. In addition, the interaction of elevated CO2 (1000 ppm) + temperature (35 °C) increased OTA production when compared with 30 °C but only for strains of Aspergillus westerdijkiae (B2), Aspergillus ochraceus (ITAL 14) and Aspergillus steynii (CBS 112814). Most of the strains had optimum growth at 0.95 aw at 35 °C, while at 30 °C the optimum was at 0.98 aw. On stored coffee beans there was only a significant stimulation of OTA production by A. westerdijkiae strains in elevated CO2 (1000) at 0.90 aw. These results suggest differential effects of CC factors on OTA production by species in the Sections Circumdati and Nigri in stored coffee and that for most species there is a reduction in toxin production.

Efficacy of different caffeine concentrations on growth and ochratoxin A production by Aspergillus species

The objective of this study was to evaluate the effect of different caffeine concentrations (0-4%) on (i) lag phase prior to growth, (ii) growth rates and (iii) ochratoxin A (OTA) production by strains from the Aspergillus section Circumdati and Aspergillus section Nigri groups, isolated from coffee, when grown on a conducive medium at 0·98 water activity and 30°C. The lag phases prior to growth increased with caffeine concentration. A strain of Aspergillus niger and Aspergillus carbonarius were the most sensitive to caffeine with growth being inhibited by <1% caffeine. For strains of Aspergillus westerdijkiae, Aspergillus ochraceus and Aspergillus steynii, although growth was inhibited significantly, some growth (10-15% of controls) occurred in 4% caffeine. OTA production was significantly inhibited by only 0·5% caffeine for strains of A. westerdijkiae, A. niger and A. carbonarius. For A. steynii at least 1·5% caffeine was required to inhibit OTA production. In contrast, for the strain of A. ochraceus there was a stimulation of OTA at 3% with a reduction at 4% caffeine. These results are discussed in the context of the different concentrations of caffeine found in Arabica and Robusta coffee and the development of minimization strategies.

SIGNIFICANCE AND IMPACT OF THE STUDY

Arabic (0·6%) and Robusta coffee (4%) have significantly different amounts of endogenous caffeine. The growth of six ochratoxigenic fungi which contaminate coffee with ochratoxin A (OTA) had differential tolerance/sensitivity to concentrations of caffeine in vitro in this range. However, low concentrations of caffeine (<0·5%) was inhibitory to OTA production. These results are discussed in the context of the potential for using such information for the design of minimization strategies to control mycotoxin production in such products.

Linking pollination effectiveness and interspecific displacement success in bees

Pollen deposition, a surrogate for bee efficiency, becomes increasingly important during their interspecific interactions. We conducted field experiments on highly cross-pollinated melon (Cucumis melo) and watermelon (Citrullus lanatus) in order to understand how bee species with different pollination efficiencies displace each other from floral resources. We observed significant displacement of less abundant but more efficient bees by the more abundant but less efficient bees in both crops, which may lead to deficient pollination. We did not find significant relationship of the bee displacement success and body size or abundance. Apis florea (Fabricius) and Nomia sp.2 (Latreille) had significantly more winner events in melon, while the former also had significantly more winner events in watermelon. A. florea was the only bee species that foraged mostly within the 1-m(2) virtual area after their displacement, which may indicate its behavior of geitinogamous pollination. The two bee species, Ceratina sexmaculata (Smith) and Lasioglossum sp. (Curtis), were more sensitive to displacement as their proportion of leaving the 1-m(2) virtual area was higher.

Dietary treatment of irritable bowel syndrome

INTRODUCTION

Food is a recognized trigger for most patients with irritable bowel syndrome (IBS). In recent years, an emerging evidence base has identified dietary manipulation as an important therapeutic approach in IBS.

SOURCES OF DATA

Original and review articles were identified through selective searches performed on PubMed and Google Scholar.

AREAS OF AGREEMENT

Randomized controlled trials have supported the use of a diet that restricts a group of short-chain carbohydrates known collectively as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). There is evidence that specific probiotics may improve symptoms in IBS.

AREAS OF CONTROVERSY

The role of a high-fibre diet remains subject to ongoing debate with a lack of high-quality evidence. The long-term durability and safety of a low FODMAP diet are unclear.

GROWING POINTS

A paradigm shift has led to a focus on the relationship between diet and pathophysiological mechanisms in IBS such as effects on intestinal microbiota, inflammation, motility, permeability and visceral hypersensitivity.

AREAS TIMELY FOR DEVELOPING RESEARCH

Future large, randomized controlled trials with rigorous end points are required. In addition, predictors of response need to be identified to offer personalized therapy.

TLR8 gene polymorphism and association in bacterial load in southern Punjab of Pakistan: an association study with pulmonary tuberculosis

Only 5-10% of people infected with Mycobacterium tuberculosis develop active tuberculosis which suggests a role of genetic variation in host immunity. Genetic variants in TLRs are potential indicator for host susceptibility and outcome of several diseases. We explored the association of nonsynonymous genetic variants (Met1Val) with Toll-like receptor 8 in Pakistani population. Genotypic and allelic distribution of TLR8 polymorphism (rs3764880) in patients with TB and healthy donors from different areas of southern Punjab, Pakistan, was determined. Results provide that our population is highly influenced by TLR8 Met1Val SNP for TB, and G allele appeared to increase TB susceptibility. Mutant genotype GG or G/- and G allele was significantly higher among all the categories of cases than in controls. Among different levels of bacillary load and genotypes, GG or G/- and G allele significantly supports the incidence of 2 + class for bacterial load.

Covered self-expanding metal stent use in the pancreatic duct: a case series

Plastic stents have been used in the pancreatic duct for a variety of indications. However, unlike in the bile duct, the use of covered self-expanding metal stents (CSEMSs) has been discouraged because multiple side branches drain into main pancreatic duct (MPD) and the ductal diameter is relatively small. This report aims to describe our experience using CSEMSs in the pancreatic duct in a series of nine patients, with special focus on adverse events. Indications were strictures (n = 5), intraductal mucinous neoplasm (IMPN; n = 1), pancreatic duct leak (n = 1), disconnected duct syndrome (n = 1), and severe acute pancreatitis/necrosis with disrupted duct (n = 1). Eight patients had symptomatic improvement, or radiological resolution of or improvement in their strictures, leaks, perforation, and necrosis. Two of these have indwelling CSEMSs for ongoing treatment. One patient (disconnected duct syndrome) was considered a treatment failure as the stent migrated and the patient underwent distal pancreatectomy for refractory pain. Two patients underwent pancreaticoduodenectomy for their malignancies after their CSEMSs had been in place for 43 and 49 days, respectively. Importantly no patients, including those with indwelling CSEMSs, developed stent-related acute pancreatitis with a median follow-up of 4 months. One patient developed post-procedure pain requiring hospitalization for 1 day. Median stent duration was 77 days. These observations suggest there is a potential role for the use of CSEMSs in the MPD in selected patients with pancreatic pathology.

OS002. Comparison TNF-α level and pathogen periodontal microorganismbetween normal pregnant women, periodontitis pregnant women, and lateonset severe preeclampsia women

INTRODUCTION

Preeclampsia Morbidity and Mortality is still high because of unknown etiology and pathogenesis. One of the theory about pathogenesis of preeclampsia in developing country is infections. Periodontitis is found in 10-60% preeclampsia cases in our center. So we held this research to evaluate the association between preeclampsia, periodontal pathogen, and TNF-α level.

OBJECTIVES

To compare and analyse the TNF-α level and pathogen periodontal microorganism between normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia women. Furthermore the research want to find any relationship between periodontitis and late onset severe preeclampsia.

METHODS

Analytic observational research with cross sectional study design at Soetomo Hospital from November 2010 until February 2011. Thirty patients divided into 3 groups, normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia women group. All patients were evaluated whether any periodontitis. Periodontal swab were performed and blood samples were taken from all of the patients. TNF-α level and pathogen periodontal microorganism were evaluated and analysed.

RESULTS

There is a significant difference TNF-α level between normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia p=0.000 (p<0.05). The highest TNF-α level is late onset preeclampsia, and the lowest is normal pregnant women. There is a significant difference pathogen periodontal microorganism between normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia p=0.001 (p<0.05). Porpyromonas ginggivalis is the most pathogen periodontal microorganism found at the samples. There is a significant difference TNF-α level between the samples with positive and negative pathogen periodontal microorganism p=0.04 (p<0.05).

CONCLUSION

There is a significant difference about the TNF-α level and pathogen periodontal microorganism between normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia. Furthermore the TNF-α level between the samples with positive and negative pathogen periodontal microorganism is significantly difference. Maybe periodontitis has association with late onset severe preeclampsia.

Review article: visceral hypersensitivity in irritable bowel syndrome: molecular mechanisms and therapeutic agents

BACKGROUND

Although development of visceral pain is an important defensive mechanism, hypersensitivity results in a significant clinical problem and is likely to be one of the major factors involved in the pathogenesis of abdominal and chest pain in functional bowel disorders (FBDs). Understanding of the molecular mechanisms involved in peripheral sensitization of visceral nociceptors has advanced as a result of the experimental studies, especially in animal models, which have led to knowledge and identification of key mediators and receptors.

AIM

To provide a comprehensive review focused on the peripheral mechanisms believed to be responsible for sensitization and potential molecular targets for a disorder which is common, distressing and has sub-optimal treatment options.

METHODS

Literature review using Ovid and Pubmed from 1966.

RESULTS

There is substantial interest in the development of new drugs for treatment of FBDs in the background of advances in understanding the molecular and physiological mechanisms of visceral hypersensitivity. The potential drug targets include TPRV1, ASICs, voltage-gated sodium channels, ATP, PAR-2, cannabinoid, prostaglandin, tachykinin and 5HT(3) receptors.

CONCLUSION

It is anticipated that with advancing molecular understanding of the basis of visceral hypersensitivity, the next decade will see accelerated development of new molecules for treatment of functional bowel diseases.

Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain

OBJECTIVE

The capsaicin receptor TRPV1 (transient receptor potential vanilloid type-1) may play an important role in visceral pain and hypersensitivity states. In irritable bowel syndrome (IBS), abdominal pain is a common and distressing symptom where the pathophysiology is still not clearly defined. TRPV1-immunoreactive nerve fibres were investigated in colonic biopsies from patients with IBS, and this was related to abdominal pain.

METHODS

Rectosigmoid biopsies were collected from 23 IBS patients fulfilling Rome II criteria, and from 22 controls. Abdominal pain scores were recorded using a validated questionnaire. TRPV1-, substance P- and neuronal marker protein gene product (PGP) 9.5-expressing nerve fibres, mast cells (c-kit) and lymphocytes (CD3 and CD4) were quantified, following immunohistochemistry with specific antibodies. The biopsy findings were related to the abdominal pain scores.

RESULTS

A significant 3.5-fold increase in median numbers of TRPV1-immunoreactive fibres was found in biopsies from IBS patients compared with controls (p<0.0001). Substance P-immunoreactive fibres (p = 0.01), total nerve fibres (PGP9.5) (p = 0.002), mast cells (c-kit) (p = 0.02) and lymphocytes (CD3) (p = 0.03) were also significantly increased in the IBS group. In multivariate regression analysis, only TRPV1-immuno-reactive fibres (p = 0.005) and mast cells (p = 0.008) were significantly related to the abdominal pain score.

CONCLUSIONS

Increased TRPV1 nerve fibres are observed in IBS, together with a low-grade inflammatory response. The increased TRPV1 nerve fibres may contribute to visceral hypersensitivity and pain in IBS, and provide a novel therapeutic target.

Massive Arthrofibrose des Kniegelenks nach Karbonfaserstift-Implantation. Zwei Fallbeschreibungen

Summary. In the treatment of cartilage damage the use of carbon rods is getting more and more popular. The papers are promising. There are no reports about significant complications. The following cases show a post operative enormous increasing discomfort.

Lumbar disc prolapse: management and outcome analysis of 96 surgically treated patients

OBJECTIVE

To evaluate the presentation, diagnosis and management outcome of surgically treated patients of lumbar disc prolapse.

DESIGN

This is a prospective study. SETTING AND DURATION OF STUDY: The study was conducted at Department of Neurosurgery, Chandka Medical College Hospital, Larkana over a period of three years.

SUBJECT AND METHODS

Patients were selected using following neuroimagings like plain radiographs, myelograms, CT myelograms and MRI Scan of lumbosacral spine. The operative procedure applied was hemilaminectomy and removal of herniated disc material. Postoperatively patients were analyzed for outcome by standard subjective analysis (Mac nab criteria), objective examinations and radiographic studies.

RESULTS

There were 96 patients, 70 males and 26 females. Predominant mode of presentation was low back pain with radiation to leg (46.9%), neurogenic claudication in 18 patients (18.7%). Eighty Six percent of the disc prolapses were found at L4 L5 and L5 SI levels. Complication rate was 14.6% with infections being commonest. Excellent to good outcome was found in 85.4% of the cases. Mean follow up period was 18 months.

CONCLUSION

Surgery for cauda equina syndrome and motor deficits has a good outcome with hemilaminectomy and is the best surgical option for large disc prolapses.

Spontaneous rupture of the diaphragm

A 2.5 year old girl with metachromatic leukodystrophy presented with acute respiratory distress and was initially wrongly diagnosed with pneumothorax. Barium meal showed bowel loops in the left hemithorax, which prompted surgical intervention; spontaneous rupture of the diaphragm was diagnosed at surgery.

Aminoglycoside-associated hypomagnesaemia in children with cystic fibrosis

Hypomagnesaemia in children with cystic fibrosis (CF) is under-recognized. We report a child with CF who developed significant hypomagnesaemia following intravenous (i.v.) treatment with aminoglycosides for exacerbations of Pseudomonas aeruginosa infection. Three additional cases have also been observed. Investigations in two patients have revealed excessive renal loss of magnesium. It is postulated that renal tubular damage secondary to the cumulative effects of repeated courses of aminoglycosides resulted in hypomagnesaemia, and we suggest screening for this problem by monitoring serum magnesium regularly in all patients with CF receiving multiple courses of aminoglycosides.