A197 ACUTE ILEITIS IN ADULT PATIENT: A RETROSPECTIVE STUDY OF PATIENT OUTCOMES

Background

Rising availability of medical imaging exams in the emergency room potentially leads to an increase of ileitis findings by imaging in a context of gastrointestinal symptoms. However, it can be difficult to determine the clinical significance of this radiological finding in an acute consultation setting and to establish the relevant investigations.

Aims

The aim of this study is to describe the current management and the long-term outcome of patients with diagnostic of acute ileitis on imaging during an emergency consultation in our center, Centre Hospitalier Universitaire de Sherbrooke(CHUS).

Methods

We performed a retrospective study of all patients diagnosed with ileitis by abdominal ultrasound or computed tomography (CT scan) during a visit in our emergency department over the years 2010 and 2017. Patients with previous diagnosis of Crohn disease were excluded. Data collected were clinical, radiological and endoscopic at diagnostic and over at least 3 years following the initial visit.

Results

A total of 118 files were reviewed. The initial imaging modality was 43% ultrasound and 57% CT scan. 36% of patients had an ileocolonoscopy within one month of the initial visit. Of these, 60% demonstrated macroscopic endoscopic abnormalities. 51% of patients had follow-up imaging within 3 months of the initial consultation. 64% of these images demonstrated persistence of pathological changes in the ileal region. Only 48% had a stool culture at diagnosis. 72% of patients met a gastroenterologist and 45% saw a general surgeon. The most common cause of ileitis was an infectious origin at 44% predominantly with Yersinia enterocolitica and Campylobacter jejuni. 13% received a diagnostic of Crohn disease. 20% of ileitis remained undetermined. Among these, there was a case of Crohn’s disease which was eventually diagnosed 2 years later. The initial factors associated with a diagnosis of Crohn’s disease were family history of inflammatory bowel disease (OR 6.17 95% CI 1.67 to 22.781 p = 0.006), extra-digestive manifestations (OR 23.31 95% CI 2.255 to 240.92 p = 0.008), discontinuous impairment at initial imaging (OR 19.8 95% CI 4.284 to 91.52 p = 0.000), presence of stenosis at initial imaging (OR 14.429 95% CI 1.227 to 169.68 p = 0.034), the presence of abscess or collection on imaging (OR 11.54 95% CI 1.76 to 75.63 p = 0.011) and wall thickness in mm (1.22 95% CI 1.06 to 1.40 p = 0.005).

Conclusions

Our study shows that the majority of acute ileitis found on imaging are of infectious origin. A portion of acute ileitis corresponded to the initial presentation of Crohn’s disease. Thus, we believe that it is preferable to offer at least clinical follow-up to patients with acute ileitis on imaging and to consider additional investigation by imaging and / or colonoscopy when symptoms persist and this particularly in presence of factors associated with Crohn’s disease.

Funding Agencies

None

Interactions regulating the head-to-tail directed assembly of biological Janus rods

We show that the directed assembly of microtubule filaments is governed by a careful balance of long- and short-range interactions.

Directed self-assembly of 1D microtubule nano-arrays

The intrinsic properties of microtubule filaments (e.g., biological nano-rods) direct their self-assembly into one-dimensional nano-arrays over extended timescales.

Fate of native and introduced seeds consumed by captive white-lipped and collared peccaries (Tayassu pecari, Link 1795 and Pecari tajacu, Linnaeus 1758) in the Atlantic rainforest, Brazil

We studied the role of white-lipped and collared peccaries (Tayassu pecari and Pecari tajacu) as seed predators and dispersers in the Atlantic rainforest of Brazil. The Atlantic rainforest ecosystem is highly threatened and has experienced dramatic declines in its populations of large mammals. Local extinctions can disrupt essential plant-animal interactions such as seed dispersion and seed predation. We tracked seeds from time of consumption to germination to assess the direct impact peccaries have on seed survival. We offered fruits of 20 species found in the Atlantic rainforest to the peccaries. Seeds were categorised as intact, scarified, ingested or defecated, and germination tests were performed. The overall impact by both peccary species was similar. Seeds were sometime scarified by mastication, always with fatal consequences. Most seeds that were consumed were destroyed during ingestion and digestion. Only small seeds (<10 mm) were found in the feces and germination tests suggest a positive effect from the passage through the guts. Peccaries clearly have a double role as both seed predators and as small seeds dispersers, which is a specialised role within the granivore/frugivore community of the Atlantic rainforest.

Genetic variability in resistance to gastro-intestinal strongyles during early lactation in Creole goats

The study was undertaken in a Creole goat flock at INRA-Gardel in Guadeloupe, to evaluate the opportunity to use artificial selection as a means of controlling gastro-intestinal infection during early lactation. The flock grazed all year on Digitaria decumbens pastures. Faecal and blood samples were taken from kids at 11 months of age and from does at kidding before drenching (week 0) and at weeks 4 and 6 after kidding. Faecal egg counts (FEC) were estimated using a modified McMaster method. Blood samples were used to determine packed cell volume (PCV) and eosinophil concentrations (EOS) values. Haemonchus contortus, Trichostrongylus colubriformis and Oesophagostomum columbianum were the main strongyle species identified in faecal cultures. The data came from 1092 litters obtained from 688 does sired by 142 bucks and 413 dams. Variance and covariance components for genetic and residual effects were estimated with multivariate animal models using the restricted maximum likelihood VCE package. Repeatability and overall heritability for FEC during the post-partum period were 0·17 and 0·10±0·02. The genetic correlations between FEC and PCV were −0·56±0·11 at 4 weeks after kidding and −0·79±0·13 at 6 weeks after kidding. The genetic correlations between FEC and EOS were 0·37±0·15 at 4 weeks after kidding and 0·68±0·17 at 6 weeks after kidding. Hence, does that contributed least to pasture contamination during the postpartum period also had low EOS and high PCV breeding values. The genetic correlations between FEC measured at 11 months of age and FEC during periparturient period ranged from 0·57±0·12 to 0·76±0·16. Therefore, breeding goats for increased resistance during the post-weaning period will lead to a less marked and less persistent rise in doe FEC during early lactation. The epidemiological implications of this selection have to be quantified in terms of lower pasture contamination, lower kid parasitism, and higher milk production of does.

Impact on productivity of peri-parturient rise in fecal egg counts in Creole goats in the humid tropics

The control of gastrointestinal nematodes requires an understanding of their epidemiology so that particular parasite stages can be targeted. Dam infection during early lactation is one example of this in ruminant nematode infections. The existence of the peri-parturient relaxation in immunity and its impact on productivity were examined in a Creole goat flock from Guadeloupe, exposed to mixed natural infection (predominantly Haemonchus contortus and Trichostrongylus colubriformis). A total of 1,511 l were obtained from 909 does resulting from 463 dams and 150 sires. Fecal and blood samples were collected at kidding before anthelmintic drenching, 4 and 6 weeks after kidding. The traits analyzed were logarithm transformed fecal egg counts (FEC), packed cell volume (PCV), and logarithm transformed blood eosinophilia counts (EOS) for does at each sampling point and changes in these during the postpartum period. With the exception of the PCV values measured at kidding, lactating does had significantly higher FEC and lower PCV than control dry does at every sampling point. Geometric means of FEC in lactating does were 819 +/- 174, 677 +/- 146 and, 699 +/- 160 eggs per gram (EPG) at kidding, 4 and 6 weeks after kidding respectively. Geometric means of FEC in dry does were 187 +/- 57, 89 +/- 28, 133 +/- 43 at these time points, respectively. EOS differences were not consistent between groups and probably not specific enough for variations in Creole goats' peri-parturient rise to be discussed. As does aged, their egg output decreased and primiparous does always had greater egg output than multiparous ones. Overall, does' FEC at 4 weeks after kidding decreased by 1.3% each year. The higher the litter size, the higher the FEC at kidding and inverse applied for PCV measurements. Does that stopped lactating had significantly lower FEC and higher PCV values than lactating does with low milk yields. Higher infection rates during early lactation in Creole goats were recorded in does with lower maternal ability assessed by the average daily weight gain of kids between 10 and 30 days of age. Kids from dams with higher FEC (i.e. >600 EPG higher than corresponding does) had 17% lower average daily weight gain between 30 and 70 days postpartum and were approximately 1 kg lighter at weaning than kids from dams with lower FEC. Thus, it is clear that a peri-parturient rise in FEC exists in Creole goats. By controlling the intensity of this peri-parturient rise in FEC, herd health and productivity could be substantially improved.

Detection and Partial Characterization of Tenuiviruses from Black Spruce

Filamentous viral ribonucleoproteins (RNPs) 12 to 16 nm in diameter and 100 to 1,260 nm in length, and characteristic of the genus Tenuivirus, were detected by transmission electron microscopy in purified extracts of needles collected from two mature, asymptomatic black spruce (Picea mariana) trees in New York, but not in extracts of needles from nursery seedlings. Purified RNPs from one tree had a buoyant density in CsCl = 1.39 g/cm³ and an A _260/280 = 1.436. Four ssRNA segments of 1.3, 2.1, 2.3, and 3.5 kb, but not the 8- to 9-kb fragment characteristic of most tenuiviruses, were detected in purified RNA extracts. Amplification products of the expected size were observed when RNA extracts from the two spruce trees and Maize stripe tenuivirus (MStpV), but not from tobacco, Chenopodium quinoa, or spruce seedlings were subjected to reverse transcription-polymerase chain reaction (RT-PCR) using primers to the p3 open reading frame (ORF) of MStpV vRNA 3. However, only MStpV amplified when primers to the nucleocapsid ORF (pc3 ORF on vcRNA 3) were used. Similarly, only MStpV amplified by immunocapture polymerase chain reaction (PCR) using antiserum to MStpV and primers to the p3 ORF. Sequence comparisons suggest that two distinct tenuiviruses occur in black spruce, one more closely related to MStpV than the other. One of these tenuiviruses was detected in one of 10 additional black spruce trees tested, but not in trees of six other coniferous species sampled in the Adirondack Mountains of New York.

Clinical reassessment of malignant hyperthermia in Abitibi-Témiscamingue

PURPOSE

In 1992, 1812 individuals (1.2% of the population) were labelled at risk for malignant hyperthermia (MH) in seven families from Abitibi-Témiscamingue. To evaluate the effective risk in this population, a multidisciplinary study was undertaken which included clinical, genealogical and molecular aspects. This paper presents the clinical aspects of the study.

METHOD

For each of the 1546 individuals reached, all anesthetic exposures were screened for elements relevant to MH. Malignant hyperthermia events were analyzed with "the clinical grading scale." All 44 reports of caffeine halothane contracture tests were reappraised. Finally, genealogical study was done to complete each family tree up to the initial French settlers in order to identify links between these seven families through common ancestors.

RESULTS

Following this reassessment, the families were compared and classified into four groups. Two families (1097 individuals) are not considered to be at a higher risk for MH than the population in general. Two families are still considered possibly at risk. Finally, one family (402 individuals) is highly at risk and two other families are probably at risk. Family trees did not show any link up to the colonization of Abitibi-Témiscamingue in the beginning of this Century but common ancestors were found around the 9th generation.

CONCLUSION

This clinical reassessment will help to focus education and prevention on a much smaller group of individuals still considered potentially at risk for MH. By adequate evaluation of phenotypes, combined with the use of a genealogical approach, it will be possible to target families for molecular research.

Nuclear medicine patients do not have higher mutant frequencies after exposure to thallium-201

The HPRT-lymphocyte clonal assay has been used to detect mutants induced in vivo in humans. This method has previously detected a rise in mutant frequency among nuclear medicine patients following exposure to technetium-99m, at a dose corresponding in theory to 5.1 mGy. In the present study, nuclear medicine patients were sampled before and after exposure to thallium-201, corresponding to a whole-body dose of 4.2 mGy. No rise in mutant frequency was found. We suggest that a difference in the effective dose received by the patients' lymphocytes accounts for the apparent contradiction with earlier results.