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Blaauw J, Chikwana J, Chaima D, Khoswe S, Samikwa L, de Vries I, Voskuijl W. The presence of enteropathy in HIV infected children on antiretroviral therapy in Malawi. PLoS One 2024; 19:e0298310. [PMID: 38330085 PMCID: PMC10852317 DOI: 10.1371/journal.pone.0298310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Undernutrition and malnutrition in children in low- and middle-income countries contribute to high mortality rates. Stunting, a prevalent form of malnutrition, is associated with educational and productivity losses. Environmental enteric dysfunction (EED) and human immunodeficiency virus (HIV) infection worsen these conditions. This study seeks to investigate the presence of enteropathy using EED fecal biomarkers in HIV-infected children who are stable on antiretroviral therapy (ART) across various nutritional statuses. By understanding the interplay between EED, HIV, and nutritional status, this study aims to provide insights that can inform targeted interventions to optimize nutritional outcomes in HIV infected children. METHODS/PRINCIPAL FINDINGS This study evaluated the levels of alpha-1-antitrypsin, calprotectin and myeloperoxidase in frozen fecal samples from 61 HIV infected (mean age 9.16 ±3.08 years) and 31 HIV uninfected (6.65 ±3.41 years) children in Malawi. Anthropometric measurements and clinical data were collected. The height-for-age z-score (-1.66 vs -1.27, p = 0.040) and BMI-for-age z-score (-0.36 vs 0.01, p = 0.037) were lower in HIV infected children. Enzyme-linked immunosorbent assays were used to measure biomarker concentrations. Statistical tests were applied to compare biomarker levels based on HIV status and anthropometric parameters. Myeloperoxidase, alpha-1-antitrypsin, and calprotectin concentrations did not differ between HIV infected and HIV uninfected children of different age groups. In HIV infected children from 5-15 years, there is no difference in biomarker concentration between the stunted and non-stunted groups. CONCLUSION/SIGNIFICANCE Our study found a higher prevalence of stunting in HIV infected children compared to uninfected children, but no significant differences in biomarker concentrations. This suggests no causal relationship between enteropathy and stunting in HIV infected children. These results contribute to the understanding of growth impairment in HIV infected children and emphasize the need for further research, particularly a longitudinal, biopsy-controlled study.
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Affiliation(s)
- Julia Blaauw
- Department of Global Child Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jessica Chikwana
- Department of Pediatrics & Child Health, The Kamuzu University of Health Sciences, Blantyre, Malawi
| | - David Chaima
- Department of Pediatrics & Child Health, The Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Stanley Khoswe
- Department of Pediatrics & Child Health, The Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lyson Samikwa
- Department of Pediatrics & Child Health, The Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Isabelle de Vries
- Department of Global Child Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Wieger Voskuijl
- Department of Global Child Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Kopczynska M, Crooks B, Deutsch L, Conley T, Stansfield C, Bond A, Soop M, Carlson G, Lal S. Disease Recurrence and Long-term Outcomes Following the Development of Intestinal Failure in Crohn's Disease: Over 20 Years of Experience from a National Reference Centre. J Crohns Colitis 2023; 17:1910-1919. [PMID: 37343184 DOI: 10.1093/ecco-jcc/jjad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND AIMS Intestinal failure [IF] is a recognised complication of Crohn's disease [CD]. The aim of this study was to identify factors predicting the development and recurrence of CD in patients with IF [CD-IF], and their long-term outcomes. METHODS This was a cohort study of adults with CD-IF admitted to a national UK IF reference centre between 2000 and 2021. Patients were followed from discharge with home parenteral nutrition [HPN] until death or February 28, 2021. RESULTS In all, 124 patients were included; 47 [37.9%] changed disease location and 55 [44.4%] changed disease behaviour between CD and CD-IF diagnosis, with increased upper gastrointestinal involvement [4.0% vs 22.6% patients], p <0.001. Following IF diagnosis, 29/124 [23.4%] patients commenced CD prophylactic medical therapy; 18 [62.1%] had a history of stricturing or penetrating small bowel disease; and nine [31.0%] had ileocolonic phenotype brought back into continuity. The cumulative incidence of disease recurrence was 2.4% at 1 year, 16.3% at 5 years and 27.2% at 10 years; colon-in-continuity and prophylactic treatment were associated with an increased likelihood of disease recurrence. Catheter-related bloodstream infection [CRBSI] rate was 0.32 episodes/1000 catheter days, with no association between medical therapy and CRBSI rate. CONCLUSIONS This is the largest series reporting disease behaviour and long-term outcomes in CD-IF and the first describing prophylactic therapy use. The incidence of disease recurrence was low. Immunosuppressive therapy appears to be safe in HPN-dependent patients with no increased risk of CRBSI. The management of CD-IF needs to be tailored to the patient's surgical disease history alongside disease phenotype.
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Affiliation(s)
- Maja Kopczynska
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Benjamin Crooks
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Liat Deutsch
- Department of Gastroenterology and Liver Disease, Tel Aviv Sourasky Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Conley
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Ashley Bond
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Mattias Soop
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
- Department of Inflammatory Bowel Disease and Intestinal Failure Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Gordon Carlson
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
- School of Health Sciences, University of Manchester, Manchester, UK
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Zhan Y, Gu H, Li X. Study on association factors of intestinal infectious diseases based-Bayesian spatio-temporal model. BMC Infect Dis 2023; 23:720. [PMID: 37875791 PMCID: PMC10598920 DOI: 10.1186/s12879-023-08665-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Intestinal infectious diseases (IIDs) are a significant public health issue in China, and the incidence and distribution of IIDs vary greatly by region and are affected by various factors. This study aims to describe the spatio-temporal trends of IIDs in the Chinese mainland and investigate the association between socioeconomic and meteorological factors with IIDs. METHODS In this study, IIDs in mainland China from 2006 to 2017 was analyzed using data obtained from the China Center for Disease Control and Prevention. Spatio-temporal mapping techniques was employed to visualize the spatial and temporal distribution of IIDs. Additionally, mean center and standard deviational ellipse analyses were utilized to examine the spatial trends of IIDs. To investigate the potential associations between IIDs and meteorological and socioeconomic variables, spatiotemporal zero-inflated Poisson and negative binomial models was employed within a Bayesian framework. RESULTS During the study period, the occurrence of most IIDs has dramatically reduced, with uneven reductions in different diseases. Significant regional differences were found among IIDs and influential factors. Overall, the access rate to harmless sanitary toilets (ARHST) was positively associated with the risk of cholera (RR: 1.73, 95%CI: 1.08-2.83), bacillary dysentery (RR: 1.32, 95%CI: 1.06-1.63), and other intestinal infectious diseases (RR: 1.88, 95%CI: 1.52-2.36), and negatively associated with typhoid fever (RR: 0.66, 95%CI: 0.51-0.92), paratyphoid fever (RR: 0.71, 95%CI: 0.55-0.92). Urbanization is only associated with hepatitis E (RR: 2.48, 95%CI: 1.12-5.72). And GDP was negatively correlated with paratyphoid fever (RR: 0.82, 95%CI: 0.70-0.97), and bacillary dysentery (RR: 0.77, 95%CI: 0.68-0.88), and hepatitis A (RR: 0.84, 95%CI: 0.73-0.97). Humidity showed positive correlation with some IIDs except for amoebic dysentery (RR: 1.64, 95%CI: 1.23-2.17), while wind speed showed a negative correlation with most IIDs. High precipitation was associated with an increased risk of typhoid fever (RR: 1.52, 95%CI: 1.09-2.13), and high temperature was associated with an increased risk of typhoid fever (RR: 2.82, 95%CI: 2.06-3.89), paratyphoid fever (RR: 2.79, 95%CI: 2.02-3.90), and HMFD (RR: 1.34, 95%CI: 1.01-1.77). CONCLUSIONS This research systematically and quantitatively studied the effect of socioeconomic and meteorological factors on IIDs, which provided causal clues for future studies and guided government planning.
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Affiliation(s)
- Yancen Zhan
- Department of Big Data in Health Sciences, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310058, Zhejiang, China
| | - Hua Gu
- The Cancer Hospital, University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, 310022, China
| | - Xiuyang Li
- Department of Big Data in Health Sciences, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
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Regassa R, Tamiru D, Duguma M, Belachew T. Environmental enteropathy and its association with water sanitation and hygiene in slum areas of Jimma Town Ethiopia. PLoS One 2023; 18:e0286866. [PMID: 37352168 PMCID: PMC10289393 DOI: 10.1371/journal.pone.0286866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/25/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Environmental Enteropathy is an inflammatory condition of the gut that leads to intestinal barrier dysfunction. It is a common problem in resource-limited countries and results from exposure to larger quantities of fecal bacteria to poor personal hygiene and environmental sanitation. Due to poor intestinal permeability, there is a problem with absorption of nutrients, which in turn leads to growth faltering, poor cognitive development, and oral-vaccine failure. The aim of this study was to identify the children with an elevated lactulose to mannitol ratio (indicative of possible environmental enteropathy) and its association with water sanitation and hygiene in slum areas of Jimma Town so as to mitigate the problem of malnutrition in under-five children. METHODS A community-based cross-sectional study was carried out from January to April 2021. A Lactulose mannitol test was performed to determine the prevalence of elevated lactulose to mannitol ratio (possibly environmental enteropathy) in children aged 12 to 59 months. A pretested questionnaire was used to collect data on water sanitation and hygiene (WASH) indicators and sociodemographic characteristics. A multivariable logistic regression analysis was used to isolate independent predictors for possible environmental enteropathy. All tests were two-sided and statistical significance was declared at P<0.05. RESULTS The results of this study showed that 19.3% (95%CI: 14.8-23.7) of children had an increased lactulose to mannitol ratio (>0.15). On multivariable logistic regression analysis, the variables drinking water from unimproved water sources (AOR 3.741; 95%CI: 0.914-15.310,p = 0.048), unsafe coverage of water storage (AOR 0.363; 95%CI: 0.169-0.777, P = 0.009), public latrine utilization (AOR 0.139 95%CI: 0.024-0.816, P = 0.029),and hand washing less than 3 critical time of hand washing practices (AOR 4.369;95%CI: 1.411-13.524,P = 0.011) were significantly associated with an increased in lactulose mannitol ratio (possible indicative of intestinal permeability/environmental enteropathy). CONCLUSION This study showed that one fifth of under-five children in Jimma Town had an elevated lactulose to mannitol ratio (possibly environmental enteropathy). The WASH sectors and other governmental organizations should give emphasis to areas with poor water sanitation and hygiene to mitigate the problem of environmental enteropathy and related consequences like growth faltering, poor cognitive development, and oral-vaccine failure in the study area.
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Affiliation(s)
- Rediet Regassa
- Nutrition and Dietetics Department, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dessalegn Tamiru
- Nutrition and Dietetics Department, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Markos Duguma
- Jimma University Laboratory of Drug Quality (JuLaDQ) and School of Pharmacy, Jimma, Ethiopia
| | - Tefera Belachew
- Nutrition and Dietetics Department, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Zhang X, Xiao X, Chen PR, Li YN, Lv XH, Yang JL. Proton Pump Inhibitors Increase the Risk of Nonsteroidal Anti-inflammatory Drug-Related Small-Bowel Injury: A Systematic Review With Meta-analysis. Clin Transl Gastroenterol 2023; 14:e00588. [PMID: 37019683 PMCID: PMC10299777 DOI: 10.14309/ctg.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Conflicting results exist on the association between proton-pump inhibitor (PPI) and nonsteroidal anti-inflammatory drug (NSAID)-related small-bowel damage. The aim of this study was to determine whether PPIs increased the risk of NSAID-related small-bowel damage by meta-analysis. METHODS A systematic electronic search in PubMed, Embase, and Web of Science was conducted from the time the database was created until March 31, 2022, for studies reporting associations between PPI use and outcomes, including the endoscopy-verified prevalence of small-bowel injury, mean number of small-bowel injuries per patient, change in hemoglobin level, and risk of small-bowel bleeding in subjects taking NSAIDs. Meta-analytical calculations for odds ratio (OR) and mean difference (MD) were performed with the random-effects model and interpreted with 95% confidence intervals (CIs). RESULTS Fourteen studies comprising 1996 subjects were included. Pooled analysis demonstrated that concomitant use of PPIs significantly increased the prevalence and number of endoscopy-verified small-bowel injuries (prevalence: OR = 3.00; 95% CI: 1.74-5.16; number: MD = 2.30; 95% CI: 0.61-3.99) and decreased hemoglobin levels (MD = -0.50 g/dL; 95% CI: 0.88 to -0.12) in NSAID users but did not change the risk of small-bowel bleeding (OR = 1.24; 95% CI: 0.80-1.92). Subgroup analysis demonstrated that PPIs significantly increased the prevalence of small-bowel injury in subjects taking nonselective NSAIDs (OR = 7.05; 95% CI: 4.70-10.59, 4 studies, I 2 = 0) and COX-2 inhibitors (OR = 4.00; 95% CI: 1.18-13.60, 1 study, no calculated I 2 ) when compared with COX-2 inhibitors alone. DISCUSSION PPIs increased the risk of NSAID-related small-bowel damage, and the clinical significance of higher prevalence of small-bowel injuries should be studied in the future.
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Affiliation(s)
- Xian Zhang
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu, China
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China;
| | - Xue Xiao
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu, China
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping-Run Chen
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Na Li
- Department of Respiratory Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Xiu-He Lv
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu, China
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin-Lin Yang
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu, China
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, China
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Mundi MS, Mercer DF, Iyer K, Pfeffer D, Zimmermann LB, Berner-Hansen M, Bishop J, Seidner DL. Characteristics of Chronic Intestinal Failure in the USA Based on Analysis of Claims Data. JPEN J Parenter Enteral Nutr 2022; 46:1614-1622. [PMID: 35726729 DOI: 10.1002/jpen.2426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 06/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study investigated the prevalence, characteristics, and management of patients with chronic intestinal failure (CIF) in the USA in 2012-2020, based on parenteral support (PS) prescription claims and healthcare utilization. METHODS Patients with CIF were identified from the Integrated DataVerse® claims database if they had at least two PS prescriptions within six months and a relevant diagnosis. Analysis included prevalence and characteristics of patients with CIF, their travel distance to receive PS prescriptions, and the distribution of PS providers and their prescribing history. RESULTS Up to 24,048 patients with CIF were identified, equivalent to 75 patients per million. CIF affected people of all ages, being more prevalent in women than in men. Many providers signed PS orders for small patient groups over short time periods, whereas few providers signed PS orders for large patient groups long term, indicating a lack of centralization. The distribution of PS providers suggested a disparity in healthcare coverage in rural vs urban areas, leading to patients traveling considerable distances to receive PS prescriptions. This may be exacerbated by a decline of providers with expertise in CIF and nutrition. CONCLUSIONS Healthcare disparities for patients with CIF have likely been obscured by the lack of CIF-specific diagnostic and procedure codes, obliging providers to code for their patients under other codes. Effective policy changes, including centralized care, revision of reimbursement models, and expansion of nutrition-focused education in addition to the newly introduced International Classification of Diseases codes, are needed to provide the best care for patients. CLINICAL RELEVANCY STATEMENT CIF affects people of all ages and is more prevalent in women than in men. Healthcare coverage for patients with CIF is largely decentralized. Disparities are evident in rural compared to urban areas, leading to patients traveling considerable distances to receive PS prescriptions, which may be exacerbated by a decline of providers with expertise in CIF and nutrition. These healthcare inequalities necessitate effective policy changes, including introduction of CIF-specific diagnostic and procedure codes, such as the ongoing introduction of unique ICD codes for CIF and associated diseases, revision of reimbursement models and assurance of the continuity of providers with expertise in CIF and nutrition (eg, by expansion of nutrition-focused education in medical schools). Importantly, improvements in healthcare centralization are required to secure management of patients by highly experienced multidisciplinary teams throughout the USA. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Mercer
- Department of Surgery, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kishore Iyer
- Recanati Miller Transplant Institute, Department of Surgery, Mount Sinai Hospital, New York, New York, USA
| | | | | | - Mark Berner-Hansen
- Zealand Pharma A/S, Søborg, Denmark
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - Joan Bishop
- The Oley Foundation, Albany Medical Center, Delmar, New York, USA
| | - Douglas L Seidner
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
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Abstract
Intestinal failure (IF) is the inability of the gut to absorb necessary water, macronutrients, micronutrients, and electrolytes sufficient to sustain life and requiring intravenous supplementation or replacement. IF Types 1 and 2 are the initial phase of this condition and usually last for weeks to a few months. Type 3 IF (also known as chronic IF [CIF]) is a chronic and stable condition, usually irreversible, whose main treatment is home parenteral nutrition. CIF is a relatively rare condition, and its prevalence and different causes vary throughout the world. Due to its complexity, CIF requires a multidisciplinary team with experience in this field to achieve successful outcomes. This editorial aims to provide an overview of CIF in adults, emphasizing the challenges faced by clinicians when managing this rare entity, as well as outlining the role of the gastroenterologist.
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Affiliation(s)
| | | | - Simon Lal
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust
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Lezo A, Diamanti A, Marinier EM, Tabbers M, Guz-Mark A, Gandullia P, Spagnuolo MI, Protheroe S, Peretti N, Merras-Salmio L, Hulst JM, Kolaček S, Ee LC, Lawrence J, Hind J, D’Antiga L, Verlato G, Pukite I, Di Leo G, Vanuytsel T, Doitchinova-Simeonova MK, Ellegard L, Masconale L, Maíz-Jiménez M, Cooper SC, Brillanti G, Nardi E, Sasdelli AS, Lal S, Pironi L. Chronic Intestinal Failure in Children: An International Multicenter Cross-Sectional Survey. Nutrients 2022; 14:nu14091889. [PMID: 35565856 PMCID: PMC9103944 DOI: 10.3390/nu14091889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 02/02/2023] Open
Abstract
Background: The European Society for Clinical Nutrition and Metabolism database for chronic intestinal failure (CIF) was analyzed to investigate factors associated with nutritional status and the intravenous supplementation (IVS) dependency in children. Methods: Data collected: demographics, CIF mechanism, home parenteral nutrition program, z-scores of weight-for-age (WFA), length or height-for-age (LFA/HFA), and body mass index-for-age (BMI-FA). IVS dependency was calculated as the ratio of daily total IVS energy over estimated resting energy expenditure (%IVSE/REE). Results: Five hundred and fifty-eight patients were included, 57.2% of whom were male. CIF mechanisms at age 1−4 and 14−18 years, respectively: SBS 63.3%, 37.9%; dysmotility or mucosal disease: 36.7%, 62.1%. One-third had WFA and/or LFA/HFA z-scores < −2. One-third had %IVSE/REE > 125%. Multivariate analysis showed that mechanism of CIF was associated with WFA and/or LFA/HFA z-scores (negatively with mucosal disease) and %IVSE/REE (higher for dysmotility and lower in SBS with colon in continuity), while z-scores were negatively associated with %IVSE/REE. Conclusions: The main mechanism of CIF at young age was short bowel syndrome (SBS), whereas most patients facing adulthood had intestinal dysmotility or mucosal disease. One-third were underweight or stunted and had high IVS dependency. Considering that IVS dependency was associated with both CIF mechanisms and nutritional status, IVS dependency is suggested as a potential marker for CIF severity in children.
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Affiliation(s)
- Antonella Lezo
- Department of Clinical Nutrition, OIRM-S, Anna Hospital, Città della Salute e della Scienza, 10126 Turin, Italy;
| | | | - Evelyne M. Marinier
- Service des Maladies Digestives et Respiratoires de l’Enfant, Centre de Référence des Maladies Digestives Rares, Hôpital R Debré, 75019 Paris, France;
| | - Merit Tabbers
- Emma Children’s Hospital/Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands;
| | - Anat Guz-Mark
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel;
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Paolo Gandullia
- Pediatric Gastroenterology and Endoscopy, IRCCS G, Gaslini Institute, 16147 Genoa, Italy;
| | - Maria I. Spagnuolo
- Section of Paediatrics, Department of Translational Medical Science, University of Naples Federico II, 80138 Naples, Italy;
| | - Sue Protheroe
- Department of Gastroenterology and Nutrition, Birmingham Children’s Hospital NHS Trust, Birmingham B4 6NH, UK;
| | - Noel Peretti
- Paediatric Hospital “Femme Mère Enfant de Lyon”, 69677 Lyon, France;
| | - Laura Merras-Salmio
- Pediatric Gastroenterology Unit, Helsinki University Hospital, Children’s Hospital Helsinki, 00290 Helsinki, Finland;
| | - Jessie M. Hulst
- Erasmus Medical Center, Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
| | - Sanja Kolaček
- Children’s Hospital Zagreb, Zagreb Medical University, 10000 Zagreb, Croatia;
| | - Looi C. Ee
- Queensland Children’s Hospital, Brisbane, QLD 4101, Australia;
| | | | - Jonathan Hind
- Paediatric Liver, GI and Nutrition Centre, King’s College Hospital, London SE5 9RS, UK;
| | - Lorenzo D’Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation, “Papa Giovanni XXIII” Hospital, 24127 Bergamo, Italy;
| | - Giovanna Verlato
- Paediatric Nutrition Service-Neonatal Intensive Care Unit, University Hospital of Padova, 35128 Padova, Italy;
| | - Ieva Pukite
- University Children Hospital, LV-1004 Riga, Latvia;
| | - Grazia Di Leo
- Pediatric Department, University of Trieste, IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Tim Vanuytsel
- University Hospital Leuven, Leuven Intestinal Failure and Transplantation (LIFT), 3000 Leuven, Belgium;
| | | | - Lars Ellegard
- Sahlgrenska University Hospital, Institute of Medicine, Departement of Internal Medicine and Clinical Nutrition, University of Gothenburg, 41390 Gothenburg, Sweden;
| | | | - María Maíz-Jiménez
- Department of Endocrinology and Nutrition, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Sheldon C. Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK;
| | - Giorgia Brillanti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy;
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
| | - Anna S. Sasdelli
- Clinical Nutrition and Metabolism Unit, Center for Chronic Intestinal Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bolohna, Italy;
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford M6 8HD, UK;
| | - Loris Pironi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy;
- Clinical Nutrition and Metabolism Unit, Center for Chronic Intestinal Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bolohna, Italy;
- Correspondence:
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Watanabe K, Kawai M, Yokoyama Y. [The review of intestinal Behçet's disease:from epidemiology and diagnosis to future issues]. Nihon Shokakibyo Gakkai Zasshi 2022; 119:217-226. [PMID: 35264485 DOI: 10.11405/nisshoshi.119.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Kenji Watanabe
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine
| | - Mikio Kawai
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine
| | - Yoko Yokoyama
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine
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10
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Abstract
OBJECTIVES Details of intestinal failure in the Finnish adult population are unknown. This study aimed to specify the intestinal failure prevalence and to clinically characterize the patient population in Finland. METHODS All Finnish healthcare units with the potential of providing parenteral support received an electronic survey to report whether they had patient(s) aged ≥18 years on long-term (≥120 days) parenteral support due to intestinal failure. Patient details came from patient records. IBM SPSS v.25 was used to analyze descriptive statistics. RESULTS Of the 74 patients, 52 were included after confirming parenteral support indication from the records. The adult intestinal failure prevalence for 2017 was 11.7 per million, 95% confidence interval: 8.9-15.3. Most patients were women (69%), and the median age was 62 (45-72) years. Short bowel syndrome was the most frequent intestinal failure mechanism (73%), and surgical complication the most frequent underlying diagnosis (29%). Of patients, 66% represented the clinical classification category parenteral nutrition 1 or parenteral nutrition 2. Median Charlson Comorbidity Index was one (0-2.8); hypertension (37%) and diabetes (23%) were the most frequent comorbidities. Patients received seven (3.5-7) parenteral support infusions weekly, and eight patients (15%) were on fluids and electrolytes only. The median duration of parenteral support was 27.5 (11.3-57.3) months. Ten patients ceased parenteral support during 2017 after a median of 20.0 (9.0-40.3) parenteral support months. Eight weaned off parenteral support, one ran out of catheter sites, and one died. CONCLUSION Prevalence and patient characteristics of adult intestinal failure in Finland are similar to those in other Western countries.
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Affiliation(s)
- Anne K Pohju
- Clinical Nutrition Unit, Department of Internal Medicine and Rehabilitation
| | - Mikko P Pakarinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Department of Children's Hospital, Pediatric Research Center
| | - Taina M Sipponen
- Department of Gastroenterology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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11
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Al Kassaa I, El Omari S, Abbas N, Papon N, Drider D, Kassem II, Osman M. High association of COVID-19 severity with poor gut health score in Lebanese patients. PLoS One 2021; 16:e0258913. [PMID: 34673813 PMCID: PMC8530309 DOI: 10.1371/journal.pone.0258913] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has affected millions of lives globally. However, the disease has presented more extreme challenges for developing countries that are experiencing economic crises. Studies on COVID-19 symptoms and gut health are scarce and have not fully analyzed possible associations between gut health and disease pathophysiology. Therefore, this study aimed to demonstrate a potential association between gut health and COVID-19 severity in the Lebanese community, which has been experiencing a severe economic crisis. Methods This cross-sectional study investigated SARS-CoV-2 PCR-positive Lebanese patients. Participants were interviewed and gut health, COVID-19 symptoms, and different metrics were analyzed using simple and multiple logistic regression models. Results Analysis of the data showed that 25% of participants were asymptomatic, while an equal proportion experienced severe symptoms, including dyspnea (22.7%), oxygen need (7.5%), and hospitalization (3.1%). The mean age of the participants was 38.3 ±0.8 years, and the majority were males (63.9%), married (68.2%), and currently employed (66.7%). A negative correlation was found between gut health score and COVID-19 symptoms (Kendall’s tau-b = -0.153, P = 0.004); indicating that low gut health was associated with more severe COVID-19 cases. Additionally, participants who reported unhealthy food intake were more likely to experience severe symptoms (Kendall’s tau-b = 0.118, P = 0.049). When all items were taken into consideration, multiple ordinal logistic regression models showed a significant association between COVID-19 symptoms and each of the following variables: working status, flu-like illness episodes, and gut health score. COVID-19 severe symptoms were more common among patients having poor gut health scores (OR:1.31, 95%CI:1.07–1.61; P = 0.008), experiencing more than one episode of flu-like illness per year (OR:2.85, 95%CI:1.58–5.15; P = 0.001), and owning a job (OR:2.00, 95%CI:1.1–3.65; P = 0.023). Conclusions To our knowledge, this is the first study that showed the impact of gut health and exposure to respiratory viruses on COVID-19 severity in Lebanon. These findings can facilitate combating the pandemic in Lebanon.
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Affiliation(s)
- Imad Al Kassaa
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Doctoral School of Science and Technology, Lebanese University, Beirut, Lebanon
- * E-mail: (IAK); , (MO)
| | - Sarah El Omari
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nada Abbas
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nicolas Papon
- Univ Angers, Univ Brest, GEIHP, SFR ICAT, Angers, France
| | - Djamel Drider
- UMR Transfrontalière BioEcoAgro1158, Univ. Lille, INRAE, Univ. Liège, UPJV, YNCREA, Univ. Artois, Univ. Littoral Côte d’Opale, ICV—Institut Charles Viollette, Lille, France
| | - Issmat I. Kassem
- Center for Food Safety and Department of Food Science and Technology, University of Georgia, Griffin, GA, United States of America
| | - Marwan Osman
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States of America
- * E-mail: (IAK); , (MO)
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12
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Kim YJ, Yu J, Park SP, Lee SH, Kim YS. Prevention of radiotherapy induced enteropathy by probiotics (PREP): protocol for a double-blind randomized placebo-controlled trial. BMC Cancer 2021; 21:1032. [PMID: 34530750 PMCID: PMC8444386 DOI: 10.1186/s12885-021-08757-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 09/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Radiation induced enteropathy is a common complication of radiotherapy for pelvic tumors and adversely affects patient quality of life. Probiotics are thought to restore bowel microflora to optimal levels and reinforce intestinal barrier capacity. Although probiotics are effective in the treatment of radiation induced enteropathy, less is known about their efficacy to prevent radiation induced enteropathy. METHODS This double-blind randomized placebo-controlled study will investigate the efficacy of probiotics to prevent radiation-induced enteropathy in patients with gynecologic or urologic cancer who received pelvic radiotherapy. The study is designed to enroll 248 eligible patients, who will be randomized 1:1 to a probiotic or placebo group. Toxicities will be evaluated using Common Terminology Criteria for Adverse Events (CTCAE) v5.0. DISCUSSION The primary aim of this study is to provide high level evidence for the ability of probiotics to prevent acute radiation induced enteropathy. The secondary aims are to determine the effects of probiotics on the incidence of chronic radiation induced enteropathy and the safety of probiotics in patients with gynecologic or urologic cancer. TRIAL REGISTRATION ClinicalTrials.gov ( NCT03978949 , Registered on 7 June 2019).
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Affiliation(s)
- Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
| | - Jesang Yu
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University, College of Medicine, Gangdong-Gu, Seoul, 05355 Republic of Korea
| | - Seung Hae Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
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Hasan MM, Gazi MA, Das S, Fahim SM, Hossaini F, Alam MA, Mahfuz M, Ahmed T. Association of lipocalin-2 and low-density lipoprotein receptor-related protein-1 (LRP1) with biomarkers of environmental enteric dysfunction (EED) among under 2 children in Bangladesh: results from a community-based intervention study. BMJ Paediatr Open 2021; 5:e001138. [PMID: 34423140 PMCID: PMC8340289 DOI: 10.1136/bmjpo-2021-001138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/17/2021] [Indexed: 11/03/2022] Open
Abstract
Background Environmental enteric dysfunction (EED) is thought to occur from persistent intestinal inflammation. Studies also revealed the association of lipocalin-2 (LCN2) and low-density lipoprotein receptor-related protein-1 (LRP1) with intestinal inflammation. Therefore, we intended to explore the relationship of LCN2 and LRP1 with gut inflammation and biomarkers of EED in Bangladeshi malnourished children. Methods A total of 222 children (length-for-age z-score (LAZ) <-1) aged 12-18 months were enrolled in this study in a cross-sectional manner. Among the participants, 115 were stunted (LAZ <-2) and 107 were at risk of being stunted (LAZ -1 to -2) children. Plasma and faecal biomarkers were measured using ELISA. Spearman's rank correlation was done to see the correlation among LCN2, LRP1 and biological biomarkers. Results LCN2 correlates positively with myeloperoxidase (r=0.19, p=0.005), neopterin (r=0.20, p=0.004), calprotectin (r=0.3, p=0.0001), Reg1B (r=0.20, p=0.003) and EED score (r=0.20, p=0.003). Whereas, LRP1 correlates negatively with myeloperoxidase (r = -0.18, p=0.006), neopterin (r = -0.30, p=0.0001), alpha-1-antitrypsin (r = -0.18, p=0.006), Reg1B (r=-0.2, p=0.003) and EED score (r = -0.29, p=0.0001). Conclusions Our findings imply that LCN2 might be a promising biomarker to predict gut inflammation and EED. Whereas, increased level of LRP1 may contribute to alleviating intestinal inflammation.
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Affiliation(s)
- Md. Mehedi Hasan
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Md. Amran Gazi
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Subhasish Das
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Shah Mohammad Fahim
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Farzana Hossaini
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Md. Ashraful Alam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b), Dhaka, Bangladesh
- Department of Global Health, University of Washington, Seattle, Washington, USA
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14
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Jamil Z, Iqbal NT, Idress R, Ahmed Z, Sadiq K, Mallawaarachchi I, Iqbal J, Syed S, Hotwani A, Kabir F, Ahmed K, Ahmed S, Umrani F, Ma JZ, Aziz F, Kalam A, Moore SR, Ali SA. Gut integrity and duodenal enteropathogen burden in undernourished children with environmental enteric dysfunction. PLoS Negl Trop Dis 2021; 15:e0009584. [PMID: 34264936 PMCID: PMC8352064 DOI: 10.1371/journal.pntd.0009584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 08/09/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Environmental enteric dysfunction (EED) is a subclinical condition of intestinal inflammation, barrier dysfunction and malabsorption associated with growth faltering in children living in poverty. This study explores association of altered duodenal permeability (lactulose, rhamnose and their ratio) with higher burden of enteropathogen in the duodenal aspirate, altered histopathological findings and higher morbidity (diarrhea) that is collectively associated with linear growth faltering in children living in EED endemic setting. In a longitudinal birth cohort, 51 controls (WHZ > 0, HAZ > −1.0) and 63 cases (WHZ< -2.0, refractory to nutritional intervention) were recruited. Anthropometry and morbidity were recorded on monthly bases up to 24 months of age. Dual sugar assay of urine collected after oral administration of lactulose and rhamnose was assessed in 96 children from both the groups. Duodenal histopathology (n = 63) and enteropathogen analysis of aspirate via Taqman array card (n = 60) was assessed in only cases. Giardia was the most frequent pathogen and was associated with raised L:R ratio (p = 0.068). Gastric microscopy was more sensitive than duodenal aspirate in H. pylori detection. Microscopically confirmed H. pylori negatively correlated with HAZ at 24 months (r = −0.313, p = 0.013). Regarding histopathological parameters, goblet cell reduction significantly correlated with decline in dual sugar excretion (p< 0.05). Between cases and controls, there were no significant differences in the median (25th, 75th percentile) of urinary concentrations (μg/ml) of lactulose [27.0 (11.50, 59.50) for cases vs. 38.0 (12.0, 61.0) for controls], rhamnose [66.0 (28.0, 178.0) vs. 86.5 (29.5, 190.5)] and L:R ratio [0.47 (0.24, 0.90) vs. 0.51 (0.31, 0.71)] respectively. In multivariable regression model, 31% of variability in HAZ at 24 months of age among cases and controls was explained by final model including dual sugars. In conclusion, enteropathogen burden is associated with altered histopathological features and intestinal permeability. In cases and controls living in settings of endemic enteropathy, intestinal permeability test may predict linear growth. However, for adoption as a screening tool for EED, further validation is required due to its complex intestinal pathophysiology. EED is a subclinical condition of compromised gut integrity secondary to frequent and repeated exposure to enteropathogens in global settings with a high prevalence of undernutrition. In this study, we reported association of gut mucosal architecture with a dual sugar intestinal permeability assay (lactulose-rhamnose) in Pakistani children. In the presence of duodenal enteropathogens, features such as chronic inflammation, intra-epithelial lymphocytosis, enterocyte injury and Paneth cell reduction were consistently observed. When comparing undernourished cases and controls living in the same setting, we found urinary excretion of the sugars was similar among groups; however, variability in HAZ among children at 24 months was partially explained by a model that includes excretion values.
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Affiliation(s)
- Zehra Jamil
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeha Talat Iqbal
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Romana Idress
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Zubair Ahmed
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Kamran Sadiq
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Junaid Iqbal
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sana Syed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition; Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kumail Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sheraz Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fayaz Umrani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jennie Z. Ma
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Fatima Aziz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Adil Kalam
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sean R. Moore
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition; Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
- * E-mail: (SRM); (SAA)
| | - Syed Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- * E-mail: (SRM); (SAA)
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15
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Aksan A, Farrag K, Blumenstein I, Schröder O, Dignass AU, Stein J. Chronic intestinal failure and short bowel syndrome in Crohn’s disease. World J Gastroenterol 2021; 27:3440-3465. [PMID: 34239262 PMCID: PMC8240052 DOI: 10.3748/wjg.v27.i24.3440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/24/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic intestinal failure (CIF) is a rare but feared complication of Crohn’s disease. Depending on the remaining length of the small intestine, the affected intestinal segment, and the residual bowel function, CIF can result in a wide spectrum of symptoms, from single micronutrient malabsorption to complete intestinal failure. Management of CIF has improved significantly in recent years. Advances in home-based parenteral nutrition, in particular, have translated into increased survival and improved quality of life. Nevertheless, 60% of patients are permanently reliant on parenteral nutrition. Encouraging results with new drugs such as teduglutide have added a new dimension to CIF therapy. The outcomes of patients with CIF could be greatly improved by more effective prevention, understanding, and treatment. In complex cases, the care of patients with CIF requires a multidisciplinary approach involving not only physicians but also dietitians and nurses to provide optimal intestinal rehabilitation, nutritional support, and an improved quality of life. Here, we summarize current literature on CIF and short bowel syndrome, encompassing epidemiology, pathophysiology, and advances in surgical and medical management, and elucidate advances in the understanding and therapy of CIF-related complications such as catheter-related bloodstream infections and intestinal failure-associated liver disease.
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Affiliation(s)
- Aysegül Aksan
- Institute of Nutritional Sciences, Justus-Liebig-Universität, Giessen 35392, Germany
- Department of Clinical Research, Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main 60594, Germany
| | - Karima Farrag
- Department of Clinical Research, Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main 60594, Germany
- Department of Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Teaching Hospital of the JW Goethe University, Frankfurt am Main 60594, Germany
| | - Irina Blumenstein
- Department of Gastroenterology, Hepatology and Clinical Nutrition, First Medical Clinic, JW Goethe University Hospital, Frankfurt am Main 60529, Germany
| | - Oliver Schröder
- Department of Clinical Research, Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main 60594, Germany
- Department of Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Teaching Hospital of the JW Goethe University, Frankfurt am Main 60594, Germany
| | - Axel U Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt am Main 60431, Germany
| | - Jürgen Stein
- Department of Clinical Research, Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main 60594, Germany
- Department of Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Teaching Hospital of the JW Goethe University, Frankfurt am Main 60594, Germany
- Institute of Pharmaceutical Chemistry, JW Goethe University, 60438 Frankfurt am Main, Germany
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16
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Cha YH, Nam DC, Song SY, Yoo JI. A prospective randomized controlled trial to evaluate effect of chewing gum on postoperative ileus in elderly patient after hip fracture. Medicine (Baltimore) 2021; 100:e25321. [PMID: 33787625 PMCID: PMC8021342 DOI: 10.1097/md.0000000000025321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/02/2021] [Indexed: 01/04/2023] Open
Abstract
Factors related to developing postoperative ileus (POI) vary from pharmacologic, inflammatory, hormonal, metabolic, gastrointestinal physiology, neurologic, to psychological factors. Although orthopedic-related incidence of postoperative ileus is about 10%, these studies are limited to spine surgery and pelvic surgery. The purpose of this study was to investigate prevalence of POI and to analyze effect of chewing gum on POI and bowel function in elderly patients after hip fracture surgery.A prospective randomized controlled trial was conducted at the Gyeongsang National University Hospital. Elderly patients with hip fracture who underwent surgery from March 2017 to June 2018 were eligible to participate. Patients were excluded if they had a mastication disability, impaired cognitive function, previous history of gastrointestinal disease, respiratory disease and low oxygen saturation, hip arthroplasty with causes other than hip fractures, acetabular fractures, periprosthetic fractures, or pathological fractures. Patients with consciousness problem by excessive anesthesia were also excluded. Patients were classified into 2 groups by randomization. Group I received sugar-free gum and were encouraged to chew 6 hours following surgery until the first intestinal gas is released. Group II was given the same postoperative procedure and encouraged to consume water after 6 hours.After applying exclusion criteria, 74 patients were finally included. Thirty-one patients were classified to Group I and 43 patients were classified to the Group II. Prevalence of POI in all patients with hip fracture was 63.5% (47/74). Prevalence of POI in Group I was statistically significant lower than that in Group II (Group I: 41%, Group II: 79.1%, P = .01)The prevalence of POI in elderly patients with hip fracture was 63.5%. Chewing gum had a significant effect on reduction of POI in elderly patients with hip fractures.
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Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon
| | - Dae Cheol Nam
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Sang-Youn Song
- Department of Orthopaedic Surgery, School of Medicine, Gyeongsang National University Hospital, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, School of Medicine, Gyeongsang National University Hospital, Korea
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Vignal C, Guilloteau E, Gower-Rousseau C, Body-Malapel M. Review article: Epidemiological and animal evidence for the role of air pollution in intestinal diseases. Sci Total Environ 2021; 757:143718. [PMID: 33223187 DOI: 10.1016/j.scitotenv.2020.143718] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Ambient air pollution is recognized as one of the leading causes of global burden of disease. Involvement of air pollution in respiratory and cardiovascular diseases was first recognized, and then cumulative data has indicated that the intestinal tract could be also damaged. AIM To review and discuss the current epidemiological and animal data on the effects of air pollution on intestinal homeostasis. METHODS An extensive literature search was conducted using Google Scholar and Pubmed to gather relevant human and animal studies that have reported the effects of any air pollutant on the intestine. RESULTS Exposure to several gaseous and particulate matter components of air pollution have been associated either positively or negatively with the onset of various intestinal diseases including appendicitis, gastroenteric disorders, irritable bowel syndrome, inflammatory bowel diseases, and peptic ulcers. Several atmospheric pollutants have been associated with modifications of gut microbiota in humans. Animal studies have showed that inhalation of atmospheric particulate matter can lead to modifications of gut microbiota, impairments of oxidative and inflammatory intestinal balances, and disruption of gut epithelial permeability. CONCLUSIONS Overall, the literature appears to indicate that the gut is an underestimated target of adverse health effects induced by air pollution. It is therefore important to develop additional studies that aim to better understand the link between air pollutants and gastro-intestinal diseases.
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Affiliation(s)
- Cécile Vignal
- Univ. Lille, Inserm, CHU Lille, U1286- INFINITE - Institute for translational research in inflammation, F-59000 Lille, France
| | - Eva Guilloteau
- Univ. Lille, Inserm, CHU Lille, U1286- INFINITE - Institute for translational research in inflammation, F-59000 Lille, France
| | - Corinne Gower-Rousseau
- Univ. Lille, Inserm, CHU Lille, U1286- INFINITE - Institute for translational research in inflammation, F-59000 Lille, France; Epidemiology Unit, Epimad Registry, Lille University Hospital, France
| | - Mathilde Body-Malapel
- Univ. Lille, Inserm, CHU Lille, U1286- INFINITE - Institute for translational research in inflammation, F-59000 Lille, France.
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18
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Rodríguez-Padilla Á, Morales-Martín G, Pérez-Quintero R, Gómez-Salgado J, Balongo-García R, Ruiz-Frutos C. Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure. Nutrients 2021; 13:nu13020626. [PMID: 33671968 PMCID: PMC7919021 DOI: 10.3390/nu13020626] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022] Open
Abstract
Loop ileostomy closure after colorectal surgery is often associated with Postoperative ileus, with an incidence between 13-20%. The aim of this study is to evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to ileostomy closure in patients operated on for colorectal carcinoma. For this, a prospective, randomized, double-blind, controlled study is designed. All patients who underwent surgery for colorectal carcinoma with loop ileostomy were included. Randomized and divided into two groups, 34 cases and 35 controls were included in the study. Postoperative ileus, the need for nasogastric tube insertion, the time required to begin tolerating a diet, restoration of bowel function, and duration of hospital stay were evaluated. The incidence of Postoperative ileus was similar in both groups, 9/34 patients stimulated with probiotics and 10/35 in the control group (CG) with a p = 0.192. The comparative analysis showed a direct relationship between Postoperative ileus after oncological surgery and Postoperative ileus after reconstruction surgery, independently of stimulation. Postoperative ileus after closure ileostomy is independent of stimulation of the ileostomy with probiotics through the efferent loop. There seem to be a relationship between Postoperative ileus after reconstruction and the previous existence of Postoperative ileus after colorectal cancer surgery.
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Affiliation(s)
- Ángela Rodríguez-Padilla
- Department of General Surgery, Infanta Elena University Clinical Hospital, 21080 Huelva, Spain; (Á.R.-P.); (G.M.-M.)
| | - Germán Morales-Martín
- Department of General Surgery, Infanta Elena University Clinical Hospital, 21080 Huelva, Spain; (Á.R.-P.); (G.M.-M.)
| | - Rocío Pérez-Quintero
- Department of General Surgery, Juan Ramón Jiménez University Clinical Hospital, 21005 Huelva, Spain;
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain;
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil 092301, Ecuador
- Correspondence: ; Tel.: +34-959219700
| | - Rafael Balongo-García
- Chief of Gastrointestinal Surgery, Department of General Surgery, Juan Ramón Jiménez University Clinical Hospital, 21005 Huelva, Spain;
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain;
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil 092301, Ecuador
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Atabati H, Kassiri H, Shamloo E, Akbari M, Atamaleki A, Sahlabadi F, Linh NTT, Rostami A, Fakhri Y, Khaneghah AM. The association between the lack of safe drinking water and sanitation facilities with intestinal Entamoeba spp infection risk: A systematic review and meta-analysis. PLoS One 2020; 15:e0237102. [PMID: 33147225 PMCID: PMC7641376 DOI: 10.1371/journal.pone.0237102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Intestinal protozoa infections are responsible for considerable morbidity and mortality, especially where the exposed population suffers from a lack of drinking water and sanitation facilities. In this study, the association between the lack of safe drinking water and sanitation (toilet) facilities with intestinal Entamoeba spp infection in the children (5-11 years), adult (18-55 years), and all age (5-55 years) were assessed. For this purpose, some of the international databases such as Scopus, PubMed, Web of Science, and Embase were screened to up to 7 June 2019 in order to retrieve the related citations. Also, the pooled odds ratios (ORs) following 95% confidence intervals (CIs) were calculated using a random-effects model. Twenty-nine articles with 36 studies were included while the OR extracted or calculated by using 2 × 2 contingency tables. However, the ingestion of contaminated water insignificantly can increase the odds ratio (OR) of Entamoeba spp infection (OR 1.01, (95% confidence interval [CI] 0.58 to 1.43), no access to sanitation (toilet) facilities significantly can increase odds of Entamoeba spp infection (OR 1.18, 95% CI 1.05 to 1.32). The meta-regression analysis showed that over time, odds of intestinal Entamoeba spp infection increased in both lack of safe drinking water (Coefficient: 3.24, P-value < 0.01) and sanitation (toilet) facilities (Coefficient: 2.36, P-value < 0.05) subgroups. Considering the findings, lack of safe drinking water resulted in a further increase in intestinal Entamoeba spp infection among adult (OR: 2.76), children (OR = 0.57) and all age groups (OR: 1.50), and also lack of sanitation (toilet) facilities resulted in further increase intestinal Entamoeba spp infection in children (OR: 1.06), adult (OR: 1.26) and all age (OR: 1.16). In this context, the lack of safe drinking water and sanitation facilities (toilet) was associated with a high risk of intestinal Entamoeba spp infection. Further attempts to providing public health facilities can control the prevalence of intestinal Entamoeba spp.
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Affiliation(s)
- Hamid Atabati
- Department of the environment faculty of fishery and environment, Gorgan University of agriculture and natural resources sciences, Golestan Province, Gorgan, Iran
| | - Hamid Kassiri
- Department of Medical Entomology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ehsan Shamloo
- Noncommunicable Diseases Research Center, Department of Food Science and Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mitra Akbari
- Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Ali Atamaleki
- Department of Environmental Health Engineering, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sahlabadi
- Department of Environmental Health Engineering, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nguyen Thi Thuy Linh
- Institute of Research and Development, Duy Tan University, Danang, Vietnam
- Faculty of Environmental and Chemical Engineering, Duy Tan University, Danang, Vietnam
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Yadolah Fakhri
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Mousavi Khaneghah
- Department of Food Science, Faculty of Food Engineering, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Coskun Y, Yuksel I. Polyethylene glycol versus split high-dose senna for bowel preparation: A comparative prospective randomized study. J Gastroenterol Hepatol 2020; 35:1923-1929. [PMID: 32424868 DOI: 10.1111/jgh.15101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM The aim of this study was to compare the quality and tolerability of bowel preparation using split high-doses of sennosides versus split-dose polyethylene glycol (PEG). METHODS In this prospective, randomized, and endoscopist-blinded study, 474 outpatients were included and randomly assigned to two groups: Group 1 was comprised of 237 patients receiving split high-dose (1000 mg) sennoside solutions, and group 2 included 237 patients receiving 4 L of PEG. The efficacy of the preparations was evaluated on the Boston Bowel Preparation Scale (BBPS), and compliance and adverse effects were recorded. RESULTS The quality of colon cleansing and the ease of bowel preparation were significantly better in the senna group; the mean of total BBPS scores was 7.35 in the senna group and 6.57 in the PEG group, cleansing was adequate (BBPS score ≥ 6) in 89.9% of patients taking senna, and 73.8% in the PEG group (P = 0.001). The rates of vomiting in the senna and PEG groups were 12.7% and 29.5%, nausea rates were 28.7% and 43.9%, and abdominal pain rates were 70.9% and 43%, respectively (P < 0.001). Cecal intubation rates in the senna and PEG groups were 95.4% and 86.1% (P = 0.001), and the cecal intubation times were 6.73 ± 2.84 and 5.34 ± 5.98 min, respectively (P = 0.001). CONCLUSIONS Split high-dose senna is more effective than split-dose PEG in terms of bowel preparation quality and patient compliance. The patients who received senna had significantly less vomiting and nausea but significantly more abdominal pain. Thus, senna may be used as an alternative to PEG for bowel preparation.
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Affiliation(s)
- Yusuf Coskun
- Department of Gastroenterology, University of Health Sciences, Diskapı Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ilhami Yuksel
- Department of Gastroenterology, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
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21
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Lee JH, Song DY, Jun SH, Song SH, Shin CH, Ki CS, Lee K, Song J. High prevalence of increased sitosterol levels in hypercholesterolemic children suggest underestimation of sitosterolemia incidence. PLoS One 2020; 15:e0238079. [PMID: 32845916 PMCID: PMC7449458 DOI: 10.1371/journal.pone.0238079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/10/2020] [Indexed: 01/26/2023] Open
Abstract
Background Sitosterolemia is an inherited lipid disorder which presents with elevated serum sitosterol and can result in an increased risk of premature cardiovascular disease. However, sitosterol cannot be accurately measured by routine diagnostic assays, meaning that sitosterolemia diagnosis can often be difficult, especially with many clinical features overlapping with familial hypercholesterolemia. With such complications resulting in increasing reports of misdiagnosis, the prevalence of sitosterolemia is predicted to be much higher than previously reported. Methods Gas chromatography-mass spectrometry was utilized to measure sitosterol levels of normocholesterolemic and hypercholesterolemic children. Subsequently, an epidemiologically determined cutoff level of sitosterol was calculated and applied to estimate the prevalence of children with increased sitosterol and identify potential sitosterolemia patients. Massively parallel sequencing was used to confirm the diagnosis in suspected patients. Results Samples from 109 normocholesterolemic and 220 hypercholesterolemic were tested for phytosterols. Sitosterol and campesterol levels were significantly increased in hypercholesterolemic children (mean 22.0±45.9 μmol/L for sitosterol and 26.0±32.8 μmol/L for campesterol) compared to normocholesterolemic children (mean 12.1±4.9 μmol/L for sistosterol and 14.8±6.7 μmol/L for campesterol). Via application of a cutoff of 35.9 μmol/L, the prevalence rates for increased and overtly increased sitosterol in hypercholesterolemic children were 6.4% and 1.4% respectively. Furthermore, 3 suspected sitosterolemia patients were identified, with 2 patients receiving molecular confirmation for sitosterolemia diagnosis. Conclusions Our findings reaffirm that the prevalence of sitosterolemia is probably much higher than previously reported, which also indicates the significant risk of misdiagnosis of sitosterolemia with familial hypercholesterolemia. Special lipid testing including sitosterol, especially in children with uncontrolled hypercholesterolemia, is recommended in children in order to identify potential sitosterolemia patients that would otherwise be neglected.
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Affiliation(s)
- Joon Hee Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Da Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun-Hee Jun
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | | | - Kyunghoon Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail: (KL); (JS)
| | - Junghan Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail: (KL); (JS)
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Abstract
Endometriosis is a chronic disease characterized by the growth of endometrial-like glands and stroma outside the uterine cavity. Nowadays, the exact etiology of endometriosis is unclear and the interaction between a variety of environmental physical and chemical compounds may potentially promote the disease in women with an individual susceptibility. The first demonstration of a relation between an environmental factor and endometriosis was obtained with the chronic dietary exposure of a primate colony to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Besides the well-known dioxin's pathway of action, several papers are focusing on the role of epigenetic mechanisms, a way through which the genome responds to the environment and can lead to permanent changes in gene expression until affecting the phenotypes or cause disease. In this review, we focus on the possible role of dioxin epigenetics modification in endometriosis.
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Affiliation(s)
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Virginia Foreste
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Porpora MG, Scaramuzzino S, Sangiuliano C, Piacenti I, Bonanni V, Piccioni MG, Ostuni R, Masciullo L, Benedetti Panici PL. High prevalence of autoimmune diseases in women with endometriosis: a case-control study. Gynecol Endocrinol 2020; 36:356-359. [PMID: 31476950 DOI: 10.1080/09513590.2019.1655727] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The immune system seems to be involved in the pathogenesis of endometriosis. Peritoneal chronic inflammation is present and natural killer cells and macrophages abnormalities have been reported in women with the disease. Moreover, a higher production of serum autoantibodies has been found, which could be related to various factors; some still need to be clarified. The correlation between endometriosis and autoimmune diseases is still unclear with few and conflicting available data. The aim of this study was to evaluate the prevalence of autoimmune diseases, as conditions with a possible common pathogenetic factor, in women affected by endometriosis, in order to address future research on its pathogenesis. This retrospective case-control study includes one hundred and forty-eight women with endometriosis and 150 controls. All women were aged between 18 and 45. Informed consent was obtained from all participants of the study. Considered autoimmune diseases include systemic lupus erythematosus (SLE), celiac disease (CD), inflammatory bowel disease (IBD), and autoimmune thyroiditis. Statistical comparison of patients and control group was performed by means of chi-square test or Fisher's exact test as appropriate. Statistical comparison of parametric variable (age) among the groups was performed by t-test for unpaired data. Age was expressed as mean. A value of .05 or less was considered as significant. In the case group, five patients were affected by IBD, while the disease was not observed in the control group (p = .07). SLE was found in eight patients in the case group, while only one was found in the control group (p = .01). Fifteen women in the case group were affected by CD, while the disease was present only in one woman in the control group (p<.0001). A significant correlation was also found between endometriosis and autoimmune thyroiditis: 80 patients with endometriosis had thyroid diseases versus 14 patients in the control group (p<.0001). Our study reports an association between endometriosis and autoimmune disorders, showing a higher prevalence of autoimmune diseases in women affected by endometriosis. These results support a possible autoimmune pathogenesis of endometriosis.
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Affiliation(s)
- M G Porpora
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - S Scaramuzzino
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - C Sangiuliano
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - I Piacenti
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - V Bonanni
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - M G Piccioni
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - R Ostuni
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - L Masciullo
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - P L Benedetti Panici
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
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Yang J, Sun H, Wan S, Mamtawla G, Gao X, Zhang L, Wang X. Prolonged Parenteral Nutrition Is One of the Most Significant Risk Factors for Nosocomial Infections in Adult Patients With Intestinal Failure. Nutr Clin Pract 2020; 35:903-910. [PMID: 32166772 DOI: 10.1002/ncp.10483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intestinal failure (IF) and its management are associated with an increased likelihood of infectious complications. This study aimed to evaluate the prevalence and potential risk factors for nosocomial infections (NIs) in hospitalized adult patients with IF. METHODS In total, 259 eligible patients with IF admitted to a single clinical nutrition center in a tertiary referral hospital from January 1, 2012, to January 1, 2019, were retrospectively identified. NIs were defined according to the 2008 Centers for Disease Control and Prevention criteria. Univariate and multivariate analyses were performed to identify independent risk factors for NIs. RESULTS The mean age of the study population was 47.0 ± 17.7 years, and 158 (61.0%) were men. The mean body mass index was 16.2 ± 2.9 kg/m2 , and 219 (84.6%) were diagnosed with malnutrition. The prevalence of NIs was 25.5% (113 NIs in 66 patients). The most common NIs were pneumonia (14.3%), bacteremia of unknown origin (13.5%), catheter-related bloodstream infection (5.0%), lower respiratory tract infection (5.0%), surgical site infection (3.9%), and urinary tract infection (1.9%). Multivariate analysis revealed that decreased serum albumin level (odds ratio [OR], 0.884; 95% CI, 0.883-0.978, P < .05), presence of gallbladder stones or cholestasis (OR, 3.144; 95% CI, 1.044-9.464; P < .05), and prolonged parenteral nutrition (PN) use (OR, 1.072; 95% CI, 1.039-1.105; P < .001) were independent predictors for NIs. CONCLUSIONS NIs remain prevalent in hospitalized adult patients with IF. Prolonged PN use was one of the most significant predictors for NIs.
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Affiliation(s)
- Jianbo Yang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P. R. China
| | - Haifeng Sun
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P. R. China
| | - Songlin Wan
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P. R. China
| | - Gulsudum Mamtawla
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P. R. China
| | - Xuejin Gao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P. R. China
| | - Li Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P. R. China
| | - Xinying Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P. R. China
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Abstract
PURPOSE OF REVIEW Small bowel diverticulosis is a well-known clinical entity whose diagnosis and management has evolved in recent years. This review covers pathophysiology, incidence, and prevalence, and it also provides an update on modern diagnosis and management. Meckel's diverticula are covered elsewhere in this volume. RECENT FINDINGS CT scan and MRI have largely supplanted barium follow-through for diagnosis. No intervention is needed in asymptomatic individuals. Endoscopic management is playing an increasing role for both bleeding and resection of intraduodenal diverticula, but surgical intervention remains the only definitive intervention for other complications like diverticulitis and small bowel obstruction. Small bowel diverticulosis is an uncommon condition which is associated with numerous possible complications. While endoscopy is playing an increasingly large role in management, surgical resection remains the treatment of choice for most complications. A high index of suspicion is needed in order to diagnose this entity.
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Affiliation(s)
- Vikram Rangan
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.
| | - J Thomas Lamont
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
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26
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Liu TC, VanBuskirk K, Ali SA, Kelly MP, Holtz LR, Yilmaz OH, Sadiq K, Iqbal N, Amadi B, Syed S, Ahmed T, Moore S, Ndao IM, Isaacs MH, Pfeifer JD, Atlas H, Tarr PI, Denno DM, Moskaluk CA. A novel histological index for evaluation of environmental enteric dysfunction identifies geographic-specific features of enteropathy among children with suboptimal growth. PLoS Negl Trop Dis 2020; 14:e0007975. [PMID: 31929525 PMCID: PMC6980693 DOI: 10.1371/journal.pntd.0007975] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/24/2020] [Accepted: 12/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background A major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity. Methods Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists via a secure web browser-based platform. A semi-quantitative scoring index composed of 11 parameters encompassing tissue injury and response patterns commonly observed in routine clinical practice was constructed by three gastrointestinal pathologists, with input from EED experts. The pathologists then read the WSIs using the EED histology index, and inter-observer reliability was assessed. The histology index was further used to identify within- and between-child variations as well as features common across and unique to each cohort, and those that correlated with host phenotype. Results Eight of the 11 histologic scoring parameters showed useful degrees of variation. The overall concordance across all parameters was 96% weighted agreement, kappa 0.70, and Gwet’s AC 0.93. Zambian and Pakistani tissues shared some histologic features with GSE, but most features were distinct, particularly abundance of intraepithelial lymphocytes in the Pakistani cohort, and marked villous destruction and loss of secretory cell lineages in the Zambian cohort. Conclusions We propose the first EED histology index for interpreting duodenal biopsies. This index should be useful in future clinical and translational studies of this widespread, poorly understood, and highly consequential disorder, which might be caused by multiple contributing processes, in different regions of the world. The study of EED has been limited by the lack of a rigorously tested, reproducible histology index that can provide insight to the pathogenesis of this entity. In this study we report the first duodenal histology index that was developed using an unbiased approach, with excellent inter-observer reproducibility, for the study of EED. The EED histology index readily identified histologic features that are common or unique to cohorts of distinct geographic locations. Incorporating the histology index into future clinical studies will provide useful insight into the pathogenesis and for intervention strategy development.
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Affiliation(s)
- Ta-Chiang Liu
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Kelley VanBuskirk
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Syed A. Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - M. Paul Kelly
- Tropical Gastroenterology and Nutrition group, University of Zambia School of Medicine, Lusaka, Zambia
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Lori R. Holtz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Omer H. Yilmaz
- The David H. Koch Institute for Integrative Cancer Research at MIT, Cambridge, MA, Department of Pathology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Kamran Sadiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeha Iqbal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Sana Syed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Department of Pediatrics, University of Virginia, Charlottesville, VA, United States of America
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sean Moore
- Department of Pediatrics, University of Virginia, Charlottesville, VA, United States of America
| | - I. Malick Ndao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Michael H. Isaacs
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - John D. Pfeifer
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Hannah Atlas
- Departments of Pediatrics and Global Health, University of Washington, Seattle, WA, United States of America
| | - Phillip I. Tarr
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Donna M. Denno
- Departments of Pediatrics and Global Health, University of Washington, Seattle, WA, United States of America
| | - Christopher A. Moskaluk
- Department of Pathology, University of Virginia, Charlottesville, VA, United States of America
- * E-mail:
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Grass JE, Kim S, Huang JY, Morrison SM, McCullough AE, Bennett C, Friedman CR, Bowen A. Quinolone nonsusceptibility among enteric pathogens isolated from international travelers - Foodborne Diseases Active Surveillance Network (FoodNet) and National Antimicrobial Monitoring System (NARMS), 10 United States sites, 2004 - 2014. PLoS One 2019; 14:e0225800. [PMID: 31800600 PMCID: PMC6892504 DOI: 10.1371/journal.pone.0225800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022] Open
Abstract
Gastrointestinal illnesses are the most frequently diagnosed conditions among returning U.S. travelers. Although most episodes of travelers’ diarrhea do not require antibiotic therapy, fluoroquinolones (a type of quinolone antibiotic) are recommended for treatment of moderate and severe travelers’ diarrhea as well as many other types of severe infection. To assess associations between quinolone susceptibility and international travel, we linked data about isolate susceptibility in NARMS to cases of enteric infections reported to FoodNet. We categorized isolates as quinolone-nonsusceptible (QNS) if they were resistant or had intermediate susceptibility to ≥1 quinolone. Among 1,726 travel-associated infections reported to FoodNet with antimicrobial susceptibility data in NARMS during 2004–2014, 56% of isolates were quinolone-nonsusceptible, of which most (904/960) were Campylobacter. International travel was associated with >10-fold increased odds of infection with quinolone-nonsusceptible bacteria. Most QNS infections were associated with travel to Latin America and the Caribbean (390/743; 52%); however, the greatest risk of QNS infection was associated with travel to Africa (120 per 1,000,000 passenger journeys). Preventing acquisition and onward transmission of antimicrobial-resistant enteric infections among travelers is critical.
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Affiliation(s)
- Julian E. Grass
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Sunkyung Kim
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer Y. Huang
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephanie M. Morrison
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andre E. McCullough
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christy Bennett
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cindy R. Friedman
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Bowen
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Pokharel N, Katwal G, Adhikari SK. Incidence of The Bowel, Bladder, and Sexual Dysfunction Following Surgery for Colorectal Malignancy. J Nepal Health Res Counc 2019; 17:262-267. [PMID: 31735933 DOI: 10.33314/jnhrc.v17i3.2060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Colorectal malignancy is a very common disease of the gastrointestinal tract. Surgery following neoadjuvant chemoradiotherapy has been found to improve the survival of the patients with colorectal carcinoma. Research on bowel, bladder and sexual dysfunction following colorectal surgery remains limited in Nepal. The aim of this study is to evaluate the incidence of the bowel, bladder, and sexual dysfunction after colorectal surgery. METHODS It is a cross-sectional study carried out at National Academy of Medical Science, Bir hospital. Patients who underwent low anterior resection and abdominoperineal resection with curative intention post neoadjuvant chemoradiotherapy were included in the study. RESULTS A total of 26 patients [20 (76.9%) males and 6 (23.1%) females] who underwent surgery for the colorectal malignant disease were included. 24 (92.30%) underwent low anterior resection and 2(7.6%) patient underwent abdominoperineal resection respectively after neoadjuvant chemo radiotherapy. 19(79.16%) of the patients developed bowel dysfunction with mean low anterior resections score of 22.88±4.394. And 5(20.83%) had normal bowel function. Bladder dysfunction was seen in 3 (11.5%) patients. And rest of the 23 (88.5%) patient had normal bladder function. In males, Sexual Dysfunction was observed in 11 (42.3%)and no sexual dysfunction was observed in 15(57.69%). While in females, 38.46% had no sexual desire and 50% had dyspareunia due to vaginal dryness. CONCLUSIONS This study clearly demonstrated a higher incidence of bowel and sexual dysfunction compared to bladder dysfunction following low anterior resection and abdominoperineal resection for colorectal malignant diseases.
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Affiliation(s)
- Nabin Pokharel
- National Academy of Medical Science, Surgical Gastroenterology, Bir Hospital, Mahabaudha, Kathmandu, Nepal
| | - Gaurav Katwal
- National Academy of Medical Science, Surgical Gastroenterology, Bir Hospital, Mahabaudha, Kathmandu, Nepal
| | - Subodh Kumar Adhikari
- National Academy of Medical Science, Surgical Gastroenterology, Bir Hospital, Mahabaudha, Kathmandu, Nepal
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Abstract
RATIONALE Postoperative intussusception in adults is a rare but serious complication after gastrointestinal anastomosis surgery. Postoperative intussusception in adults caused by tube feeding was rarely been reported before. The aim of the current study was to summarize the clinical data on a group of patients with tube feeding associated postoperative intussusceptions. The possible etiology and preventive measures will also be discussed. PATIENT CONCERNS During the period from May 2013 to January 2018, patients who received gastrointestinal anastomosis in our center were retrospectively reviewed. Preoperative variables including standard demographic and pathological characteristics as well as the treatment and prognosis were also analyzed. DIAGNOSES Tube feeding associated postoperative intussusceptions. INTERVENTIONS 7 patients were identified with tube feeding associated postoperative intussusceptions with a prevalence of 0.38%. Intussusceptions occurred from 10 to 69 days (median 25.7 days) postoperatively in an acute form. OUTCOMES None of the patients had spontaneous reduction and all patients underwent surgery. Antegrade efferent limb intussusceptions were found in all the cases. Intussusception occurred at efferent loop at 23.6 cm (range 15-60) from the gastrointestinal or Braun anastomosis. None of the patients was found recurrence throughout the follow-up period. LESSONS In contrast with other postoperative intussusceptions, the tube feeding associated postoperative intussusceptions have special clinical manifestations. It is more likely to occur in early period of time after the surgery and in an acute form. Surgical correction is recommended for most of patients. Several measures have been proposed to prevent such complications after gastrointestinal surgery, however more research and information are still needed.
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Hernández-Torres FA, Hernández-Nava N. [Analysis of the epidemiological profile of the indigenous community of Hueyapan, Morelos]. Rev Med Inst Mex Seguro Soc 2019; 57:291-298. [PMID: 32568484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The epidemiological transition is a phenomenon that has had a different impact between urban and rural settings. The WHO points out that the population with the lowest socioeconomic status is the most adversely affected for the unequal distribution of resources, indigenous people are a part of this population. OBJECTIVE To analyze the epidemiological profile of the indigenous people of Hueyapan, Morelos during the months of March to June 2017. METHODS A cross-sectional epidemiological study was carried out in the indigenous community of Hueyapan, belonging to the municipality of Morelos, in 2017. A sample of 338 households was calculated; as inclusion criteria, those dwellings where the age of residence in Hueyapan was equal to or greater than four years were taken; a systematic sampling was carried out every three households, in addition, Mexico's INEGI and Health Department databases were analyzed from 2011 to 2015. RESULTS In relation to morbidity, an upward trend was found in the crude rate, from 119.7 per 1,000 in 2011 to 270.7 per 1000 in 2015, among the most prevalent diseases in those years, infectious diseases were identified as major and the appearance of noncommunicable diseases began to be observed. In relation to mortality, a linear trend was observed in the crude rate of 5.7 per 1000 in 2011 to 6.6 per 1000 in 2015. CONCLUSIONS The epidemiological profile of Hueyapan coincides with a process of epidemiological transition where there is a double burden of disease. This suggests a challenge for the public health area that should be addressed from the creation of health strategies, programs and policies aimed at this population from an intercultural approach.
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Affiliation(s)
- Francisca Angélica Hernández-Torres
- Instituto Nacional de Salud Pública, Escuela de Salud Pública de México Campus Cuernavaca, Maestría en Salud Pública. Cuernavaca, Morelos, México
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Affiliation(s)
- Simon Hales
- Department of Public Health, University of Otago, Wellington, New Zealand
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Bourée P. Fréquence des entéropathogènes chez les enfants. Med Sante Trop 2019; 29:28. [PMID: 31031243 DOI: 10.1684/mst.2018.0849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Harris JP, Iturriza-Gomara M, Allen DJ, Kelly S, O’Brien SJ. Norovirus strain types found within the second infectious intestinal diseases (IID2) study an analysis of norovirus circulating in the community. BMC Infect Dis 2019; 19:87. [PMID: 30683063 PMCID: PMC6346499 DOI: 10.1186/s12879-019-3706-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/10/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Norovirus is the commonest cause of infectious intestinal disease (IID) worldwide. In the UK community incidence of norovirus has been estimated at 59/1000 population, equating to four million cases a year. Whilst norovirus infects people of all ages, a substantial burden occurs in infants and young children. The population of viruses found in sporadic cases among infants has been observed to be more diverse than that associated with outbreaks. In this study, we analysed norovirus-positive specimens collected during the second study of infectious intestinal diseases (IID2 Study) a national community cohort study conducted between April 2008 and August 2009 We examined the data for differences in circulating norovirus strains between two arms of a community cohort, and differences between genotypes and disease outcomes such as illness duration and symptom profiles. METHODS Analysis was conducted to assess genetic diversity of noroviruses in the community. We also assessed differences in the cycle threshold (Ct) value, as a proxy for viral load, between norovirus genogroups and genotypes, and differences in reported symptoms or length of illness in relation to genogroup and genotype. RESULTS There were 477 samples where norovirus was detected. Whilst 85% of people recovered within two days for vomiting; diarrhoea symptoms were reported to day 4 for 83% of the cases, and 10% of people reported symptoms of diarrhoea lasting between five and six days. Both diarrhoea and vomiting symptoms lasted longer in children aged < 5 years compared to adults. There was a significantly higher proportion of GII.4 in samples obtained from the GP arm of the study (chi-square = 17.8, p < 0.001) compared to samples received via post in the self-reporting arm. In the latter group, the prevalence of GII.6 was significantly higher (chi-square = 7.5, p < 0.001). CONCLUSIONS We found that there is a difference in disease severity by age group. Children aged < 5 years had longer duration of illness, with 10% still having diarrhoea at seven days, and vomiting of between four and five days. The duration of illness reported is higher overall than one might expect for cases in the community in otherwise healthy individuals which has implications for infection control. No differences were observed in relation to duration of vomiting and or diarrhoea by genotype.
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Affiliation(s)
- John P. Harris
- University of Liverpool, Instutue of Population Health Sciences, Liverpool, UK
- NIHR HPRU in Gastrointestinal Infections, Liverpool, UK
| | - Miren Iturriza-Gomara
- University of Liverpool Institute of Global Health, Liverpool, UK
- NIHR HPRU in Gastrointestinal Infections, Liverpool, UK
| | - David J. Allen
- London School of Hygiene and Tropical Medicine, Liverpool, UK
- NIHR HPRU in Gastrointestinal Infections, Liverpool, UK
| | - Susan Kelly
- University of Liverpool Institute of Global Health, Liverpool, UK
| | - Sarah J. O’Brien
- University of Liverpool, Instutue of Population Health Sciences, Liverpool, UK
- NIHR HPRU in Gastrointestinal Infections, Liverpool, UK
- Modelling, Evidence and Policy Research Group, School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, UK
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You SC, Park H, Yoon D, Park S, Joung B, Park RW. Olmesartan is not associated with the risk of enteropathy: a Korean nationwide observational cohort study. Korean J Intern Med 2019; 34:90-98. [PMID: 29172402 PMCID: PMC6325440 DOI: 10.3904/kjim.2017.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/12/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS Olmesartan, a widely used angiotensin II receptor blocker (ARB), has been linked to sprue-like enteropathy. No cases of olmesartan-associated enteropathy have been reported in Northeast Asia. We investigated the associations between olmesartan and other ARBs and the incidence of enteropathy in Korea. METHODS Our retrospective cohort study used data from the Korean National Health Insurance Service to identify 108,559 patients (58,186 females) who were initiated on angiotensin converting enzyme inhibitors (ACEis), olmesartan, or other ARBs between January 2005 and December 2012. The incidences of enteropathy were compared among drug groups. Changes in body weight were compared after propensity score matching of patients in the ACEis and olmesartan groups. RESULTS Among 108,559 patients, 31 patients were diagnosed with enteropathy. The incidences were 0.73, 0.24, and 0.37 per 1,000 persons, in the ACEis, olmesartan, and other ARBs groups, respectively. Adjusted rate ratios for enteropathy were: olmesartan, 0.33 (95% confidential interval [CI], 0.10 to 1.09; p = 0.070) and other ARBs, 0.34 (95% CI, 0.14 to 0.83; p = 0.017) compared to the ACEis group after adjustment for age, sex, income level, and various comorbidities. The post hoc analysis with matched cohorts revealed that the proportion of patients with significant weight loss did not differ between the ACEis and olmesartan groups. CONCLUSION Olmesartan was not associated with intestinal malabsorption or significant body weight loss in the general Korean population. Additional large-scale prospective studies of the relationship between olmesartan and the incidence of enteropathy in the Asian population are needed.
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Affiliation(s)
- Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Hojun Park
- Department of Statistics, Ewha Womans University, Seoul, Korea
| | - Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Sooyoung Park
- Department of Statistics, Ewha Womans University, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
- Correspondence to Rae Woong Park, M.D. Department of Biomedical Informatics, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-4471 Fax: +82-31-219-4472 E-mail:
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Yang S, Chua ME, Bauer S, Wright A, Brandström P, Hoebeke P, Rittig S, De Gennaro M, Jackson E, Fonseca E, Nieuwhof-Leppink A, Austin P. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children's Continence Society. Pediatr Nephrol 2018; 33:2207-2219. [PMID: 28975420 DOI: 10.1007/s00467-017-3799-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND We present a consensus view from the International Children's Continence Society (ICCS) on the evaluation and management of bladder bowel dysfunction (BBD) in children with urinary tract infection (UTI). The statement aims to highlight the importance of BBD in the development and recurrence of childhood UTI and its management to reduce its associated morbidity and sequelae. METHODS A systematic literature search was done on PubMed, Embase, and Scopus databases until August 15, 2016. Relevant publications concerning BBD and its relationship with UTI among children were reviewed and aggregated for statements of recommendation. Discussion by the ICCS Board and a multi-disciplinary core group of authors resulted in a document available on its website for all ICCS members to review. Insights and feedback were considered with consensus and agreement reached to finalize this position statement. RESULTS BBD in children with UTI is summarized. Details regarding epidemiology, pathophysiology, and recommendations for general and family practitioners and pediatricians relating to the evaluation and management of this condition are presented. CONCLUSIONS This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI.
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Affiliation(s)
- Stephen Yang
- Department of Urology, Taipei Tzu-Chi Hospital, and Buddhist Tzu Chi University, Taipei, Taiwan.
| | - Michael E Chua
- Department of Urology, Taipei Tzu-Chi Hospital, and Buddhist Tzu Chi University, Taipei, Taiwan
- Department of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Stuart Bauer
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Anne Wright
- Department of Paediatric Nephrourology, Evelina Children's Hospital, London, UK
| | - Per Brandström
- Department of Pediatrics, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Søren Rittig
- Department of Pediatrics, Aarhus University, Aarhus, Denmark
| | - Mario De Gennaro
- Department of Urology, Bambino Gesù Children's Hospital of Rome, Rome, Italy
| | - Elizabeth Jackson
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eliane Fonseca
- Department of Pediatrics, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Paul Austin
- Department of Urology, St Louis Children's Hospital, St. Louis, MO, USA
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Tada H, Nohara A, Inazu A, Sakuma N, Mabuchi H, Kawashiri MA. Sitosterolemia, Hypercholesterolemia, and Coronary Artery Disease. J Atheroscler Thromb 2018; 25:783-789. [PMID: 30033951 PMCID: PMC6143779 DOI: 10.5551/jat.rv17024] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/31/2022] Open
Abstract
Sitosterolemia is a rare inherited disease characterized by increased levels of plant sterols, such as sitosterol. The cause of this disease is ATP-binding cassette (ABC) subfamily G member 5 or member 8 (ABCG5 or ABCG8, respectively) gene mutations. Recent advances in genetics have revealed that the prevalence of subjects with deleterious mutations in ABCG5 and/or ABCG8 genes could be more than 1 in ~200,000 individuals among the general population. Furthermore, accumulated evidence, including infantile cases exhibiting progression/regression of systemic xanthomas associated with LDL cholesterol levels, have shown that the elevation of LDL cholesterol seems to be the major cause of development of atherosclerosis and not the elevation of sitosterol. Regarding therapies, LDL apheresis, as well as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, could be useful for sitosterolemia, in addition to ezetimibe and/or colestimide. In this study, we provide the current understanding and future perspectives of sitosterolemia, which is currently considered an extremely rare disorder but is expected to be much more prevalent in clinical settings.
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Affiliation(s)
- Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Atsushi Nohara
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Akihiro Inazu
- Department of Laboratory Science, Molecular Biochemistry and Molecular Biology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Nagahiko Sakuma
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Mabuchi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masa-aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Norsa L, Nicastro E, Di Giorgio A, Lacaille F, D'Antiga L. Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children. Nutrients 2018; 10:nu10060664. [PMID: 29882922 PMCID: PMC6024802 DOI: 10.3390/nu10060664] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/01/2023] Open
Abstract
Intestinal failure-associated liver disease (IFALD) is a threatening complication for children on long-term parenteral nutrition because of intestinal failure. When progressive and intractable, it may jeopardize intestinal rehabilitation and lead to combined liver and intestinal transplantation. The institution of dedicated intestinal failure centers has dramatically decreased the incidence of such complication. IFALD may rapidly fade away if very early management aimed at preventing progression to end-stage liver disease is provided. In this review, we address the etiology and risk factors of IFALD in order to introduce pillars of prevention (nutritional management and catheter-related infections control). The latest evidence of therapeutic strategies, such as medical and surgical treatments, is also discussed.
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Affiliation(s)
- Lorenzo Norsa
- Pediatric Gastroenterology Hepatology and Nutrition, Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy.
| | - Emanuele Nicastro
- Pediatric Gastroenterology Hepatology and Nutrition, Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy.
| | - Angelo Di Giorgio
- Pediatric Gastroenterology Hepatology and Nutrition, Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy.
| | - Florence Lacaille
- Pediatric Gastroenterology Hepatology and Nutrition, Hôpital Necker Enfants Malades, 75015 Paris, France.
| | - Lorenzo D'Antiga
- Pediatric Gastroenterology Hepatology and Nutrition, Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy.
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Chen HK, Hsieh CJ. Risk of gastrointestinal Hypomotility in schizophrenia and schizoaffective disorder treated with antipsychotics: A retrospective cohort study. Schizophr Res 2018; 195:237-244. [PMID: 29107449 DOI: 10.1016/j.schres.2017.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The risk of gastrointestinal hypomotility (GIHM) with the use of antipsychotic medications in patients with schizophrenia remains inadequately recognized. The aim of this study was to explore the incidence of GIHM and its risks in patients with schizophrenia treated with antipsychotics. METHODS We conducted a retrospective cohort study using the National Health Insurance Research Database. We identified adult (≥ 20years of age) patients with a first-time diagnosis of schizophrenia or schizoaffective disorder in the Registry for Catastrophic Illness Patients during the period from 2001 to 2011. Each subject in the cohort was followed until their corresponding diagnosis of GIHM was made, until the time of death, or to December 31, 2012. The incidence rates of each outcome were calculated. Cox proportional hazards regression with time-dependent covariates for antipsychotics use was employed to evaluate the associations between different types of antipsychotics and the risk of GIHM. RESULTS Our study found that the incidence densities of constipation, ileus, and ischemic bowel disease were 42.5, 4.4, and 0.1 per 1000 person-years. In terms of the risk of hypomotility with the use of antipsychotics, clozapine and quetiapine were significant in developing constipation, with a hazard ratio of 2.15 and 1.34, respectively. High-potency first-generation antipsychotics and clozapine were also significant in the occurrence of ileus, with a hazard ratio of 1.30 and 1.95, respectively. Similar associations were found in an anticholinergic agent subgroup analysis. CONCLUSION Patients receiving antipsychotics such as high-potency first-generation antipsychotics, clozapine, or quetiapine should undergo proper evaluation and intervention to minimize the disease burden and life-threatening outcomes of treatment.
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Affiliation(s)
- Hsing-Kang Chen
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; Department of psychiatry, Yuli hospital, Ministry of Health and Welfare, Hualien, Taiwan; St. Mary's Junior College of Medicine, Nursing and Management, Ilan, Taiwan
| | - Chia-Jung Hsieh
- Department of Public Health, Tzu Chi University, Hualien, Taiwan.
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Ontiveros N, Rodríguez-Bellegarrigue CI, Galicia-Rodríguez G, Vergara-Jiménez MDJ, Zepeda-Gómez EM, Arámburo-Galvez JG, Gracia-Valenzuela MH, Cabrera-Chávez F. Prevalence of Self-Reported Gluten-Related Disorders and Adherence to a Gluten-Free Diet in Salvadoran Adult Population. Int J Environ Res Public Health 2018; 15:ijerph15040786. [PMID: 29670007 PMCID: PMC5923828 DOI: 10.3390/ijerph15040786] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/26/2018] [Accepted: 04/13/2018] [Indexed: 02/06/2023]
Abstract
Gluten-related disorders are not considered of relevance at public health level in Central America. The prevalence of gluten-related disorders, and adherence to a gluten-free diet, remain unknown in the Central American region. We conducted a cross-sectional survey of the Central American population from San Salvador, El Salvador, to estimate the prevalence rates of self-reported gluten-related disorders and adherence to a gluten-free diet. 1326 individuals were surveyed. Self-reported prevalence rates were (95% Confidence Interval): gluten sensitivity 3.1% (2.3–4.2); physician-diagnosed celiac disease 0.15% (0.04–0.5); wheat allergy 0.75% (0.4–1.3); non-celiac gluten sensitivity 0.98% (0.5–1.6). The prevalence rate of adherence to a gluten-free diet was 7.0% (5.7–8.5). Seven self-reported physician diagnosed gluten-sensitive cases informed the co-existence of non-celiac gluten sensitivity with celiac disease and/or wheat allergy. Among the non-self-reported gluten sensitivity individuals following a gluten-free diet, 50% reported that they were seeing a health professional for gluten-free dietary advice. Gluten sensitivity is commonly reported in Salvadoran population, but some health professionals acknowledge the coexistence of wheat allergy, celiac disease, and non-celiac gluten sensitivity. Among studies at population level, the prevalence of adherence to a gluten-free diet in Salvadoran population is the highest reported until now. However, just a few of the gluten-free diet followers were doing it for health-related benefits; the others reported weight control and the perception that the diet is healthier as the main motivation for adopting such a diet.
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Affiliation(s)
- Noé Ontiveros
- División de Ciencias e Ingeniería, Departamento de Ciencias Químico Biológicas y Agropecuarias, Universidad de Sonora, Navojoa, Sonora 85880, Mexico.
| | - Cecilia Ivonne Rodríguez-Bellegarrigue
- Facultad de Ciencias de la Salud Luis Edmundo Vasquez, Departamento de Salud Pública, Universidad Dr. José Matias Delgado, Antiguo Cuscatlán 1502, El Salvador.
| | - Gerardo Galicia-Rodríguez
- Nutrition Sciences Academic Unit, University of Sinaloa, Av. Cedros and Sauces Street, Los Fresnos, Culiacán, Sinaloa 80019, Mexico.
| | - Marcela de Jesús Vergara-Jiménez
- Nutrition Sciences Academic Unit, University of Sinaloa, Av. Cedros and Sauces Street, Los Fresnos, Culiacán, Sinaloa 80019, Mexico.
| | - Elia María Zepeda-Gómez
- Nutrition Sciences Academic Unit, University of Sinaloa, Av. Cedros and Sauces Street, Los Fresnos, Culiacán, Sinaloa 80019, Mexico.
| | - Jesús Gilberto Arámburo-Galvez
- Nutrition Sciences Academic Unit, University of Sinaloa, Av. Cedros and Sauces Street, Los Fresnos, Culiacán, Sinaloa 80019, Mexico.
| | | | - Francisco Cabrera-Chávez
- Nutrition Sciences Academic Unit, University of Sinaloa, Av. Cedros and Sauces Street, Los Fresnos, Culiacán, Sinaloa 80019, Mexico.
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Syed S, Iqbal NT, Sadiq K, Ma JZ, Akhund T, Xin W, Moore SR, Liu E, Qureshi S, Gosselin K, Gewirtz A, Duggan CP, Ali SA. Serum anti-flagellin and anti-lipopolysaccharide immunoglobulins as predictors of linear growth faltering in Pakistani infants at risk for environmental enteric dysfunction. PLoS One 2018; 13:e0193768. [PMID: 29509790 PMCID: PMC5839587 DOI: 10.1371/journal.pone.0193768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/17/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Environmental Enteric Dysfunction (EED) in children from low-income countries has been linked to linear growth declines. There is a critical need to identify sensitive and early EED biomarkers. OBJECTIVE Determine whether levels of antibodies against bacterial components flagellin (flic) and lipopolysaccharide (LPS) predict poor growth. DESIGN/METHODS In a prospective birth cohort of 380 children in rural Pakistan blood and stool samples were obtained at ages 6 and 9 months. Linear mixed effects models were used to examine longitudinal associations between quartiles of anti-flic and anti-LPS antibodies and changes in LAZ, WAZ and WLZ scores. Spearman's correlations were measured between anti-flic and anti-LPS immunoglobulins with measures of systemic/enteric inflammation and intestinal regeneration. RESULTS Anti-LPS IgA correlated significantly with CRP, AGP and Reg1 serum at 6mo and with MPO at 9mo. In multivariate analysis at 6mo of age, higher anti-LPS IgA levels predicted greater declines in LAZ scores over subsequent 18mo (comparing highest to lowest quartile, β (SE) change in LAZ score/year = -0.313 (0.125), p-value = 0.013). Anti-flic Ig A in the two highest quartiles measured at 9mo of age had declines in LAZ of -0.269 (0.126), p = 0.033; and -0.306 (0.129), p = 0.018 respectively, during the subsequent 18mo of life, compared to those in the lowest quartile of anti-flic IgA. CONCLUSIONS AND RELEVANCE Elevated anti-flic IgA and anti-LPS IgA antibodies at 6 and 9mo, predict declines in linear growth. Systemic and enteric inflammation correlated with anti-LPS IgA provides mechanistic considerations for potential future interventions.
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Affiliation(s)
- Sana Syed
- Department of Pediatrics, University of Virginia, Charlottesville, VA, United States of America
- Department of Pediatrics, the Aga Khan University, Karachi, Pakistan
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, United States of America
| | - Najeeha T. Iqbal
- Department of Pediatrics, the Aga Khan University, Karachi, Pakistan
| | - Kamran Sadiq
- Department of Pediatrics, the Aga Khan University, Karachi, Pakistan
| | - Jennie Z. Ma
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States of America
| | - Tauseef Akhund
- Department of Pediatrics, the Aga Khan University, Karachi, Pakistan
| | - Wenjun Xin
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States of America
| | - Sean R. Moore
- Department of Pediatrics, University of Virginia, Charlottesville, VA, United States of America
| | - Enju Liu
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, United States of America
| | - Shahida Qureshi
- Department of Pediatrics, the Aga Khan University, Karachi, Pakistan
| | - Kerri Gosselin
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, United States of America
| | - Andrew Gewirtz
- Center for Inflammation Immunity & Infection, Georgia State University, Atlanta, GA, United States of America
| | - Christopher P. Duggan
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, United States of America
- Departments of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - S. Asad Ali
- Department of Pediatrics, the Aga Khan University, Karachi, Pakistan
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Tsuboi M, Hayakawa K, Yamasaki H, Katanami Y, Yamamoto K, Kutsuna S, Takeshita N, Kanagawa S, Ohmagari N, Kato Y. Clinical characteristics and epidemiology of intestinal tapeworm infections over the last decade in Tokyo, Japan: A retrospective review. PLoS Negl Trop Dis 2018; 12:e0006297. [PMID: 29462133 PMCID: PMC5834203 DOI: 10.1371/journal.pntd.0006297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/02/2018] [Accepted: 02/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tapeworm (cestode) infections occur worldwide even in developed countries and globalization has further complicated the epidemiology of such infections. Nonetheless, recent epidemiological data on cestode infections are limited. Our objectives were to elucidate the clinical characteristics and epidemiology of diphyllobothriosis and taeniosis in Tokyo, Japan. METHODOLOGY/PRINCIPAL FINDINGS We retrospectively reviewed 24 cases of human intestinal cestode infection from January 2006 to December 2015 at a tertiary referral hospital in Tokyo, Japan. The patients included were diagnosed with cestode infection based on morphological and/or molecular identification of expelled proglottids and/or eggs and treated in our hospital. Fifteen and 9 patients were diagnosed with diphyllobothriosis and taeniosis, respectively. The median patient age was 31 years (interquartile range [IQR]: 26-42 years), and 13 (54%) were male. Most of the patients (91.7%) were Japanese. All patients were successfully treated with praziquantel without recurrence. Diphyllobothriosis was caused by Diphyllobothrium nihonkaiense in all patients. Taeniosis was due to infection of Taenia saginata in 8 [88.9%] patients and T. asiatica in 1 [11.1%] patient. All patients with taeniosis were infected outside Japan, as opposed to those with diphyllobothriosis, which were domestic. The source locations of taeniosis were mostly in developing regions. The median duration of the stay of the patients with taeniosis at the respective source location was 1 month (IQR: 1-8). CONCLUSIONS/SIGNIFICANCE The cestode infection, especially with D. nihonkaiense, has frequently occurred, even in Japanese cities, thereby implicating the probable increase in the prevalence of diphyllobothriosis among travelers, as the number of travelers is expected to increase owing to the Tokyo Olympics/Paralympics in 2020. In addition, medical practitioners should be aware of the importance of providing advice to travelers to endemic countries of taeniosis, including the potential risks of infection and preventive methods for these infections.
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Affiliation(s)
- Motoyuki Tsuboi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Yamasaki
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shuzo Kanagawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Bell A, Conway N, Courtney J, Kennedy K, Raubenheimer Z, Rice N, Kevans D, Donohoe CL, Reynolds JV. Point Prevalence of Adult Intestinal Failure in Republic Of Ireland. Ir Med J 2018; 111:688. [PMID: 29952437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parenteral Nutrition (PN) is a life-saving treatment used for patients with Intestinal Failure (IF). PN is complex and demands highly specialised care to avoid serious complications in the home setting. All tertiary centres in the Republic of Ireland (ROI) were contacted to assess the prevalence of IF requiring PN and complications, over a one year period. Sixty-seven patients were treated across 15 centres: a period prevalence of 14.6 and 9.6 patients per million for long-term PN and home PN respectively. Three-quarters of patients experienced at least one major complication with 18% mortality rate over the study period. There were 2.86 admissions per HPN patient, each lasting mean 13.4 days. One-third experienced catheter-related infections. There was a reduced length of stay during emergency re-admissions in high volume centres (mean 31 v 43 days, p=0.17). The establishment of a National Centre for IF/HPN in ROI is integral to reducing PN-associated complications.
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Affiliation(s)
- A Bell
- School of Medicine, Trinity College Dublin
| | - N Conway
- School of Medicine, Trinity College Dublin
| | - J Courtney
- School of Medicine, Trinity College Dublin
| | - K Kennedy
- School of Medicine, Trinity College Dublin
| | | | - N Rice
- Irish Society for Clinical Nutrition and Metabolism (IrSPEN)
| | - D Kevans
- Dept of Gastroenterology, St James' Hospital, Dublin 8
| | - C L Donohoe
- Dept of Surgery, St James' Hospital, Dublin 8
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Adams NL, Rose TC, Hawker J, Violato M, O’Brien SJ, Whitehead M, Barr B, Taylor-Robinson DC. Socioeconomic status and infectious intestinal disease in the community: a longitudinal study (IID2 study). Eur J Public Health 2018; 28:134-138. [PMID: 29016791 PMCID: PMC5965370 DOI: 10.1093/eurpub/ckx091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Infectious intestinal diseases (IID) are common, affecting around 25% of people in UK each year at an estimated annual cost to the economy, individuals and the NHS of £1.5 billion. While there is evidence of higher IID hospital admissions in more disadvantaged groups, the association between socioeconomic status (SES) and risk of IID remains unclear. This study aims to investigate the relationship between SES and IID in a large community cohort. Methods Longitudinal analysis of a prospective community cohort in the UK following 6836 participants of all ages was undertaken. Hazard ratios for IID by SES were estimated using Cox proportional hazard, adjusting for follow-up time and potential confounding factors. Results In the fully adjusted analysis, hazard ratio of IID was significantly lower among routine/manual occupations compared with managerial/professional occupations (HR 0.74, 95% CI 0.61-0.90). Conclusion In this large community cohort, lower SES was associated with lower IID risk. This may be partially explained by the low response rate which varied by SES. However, it may be related to differences in exposure or recognition of IID symptoms by SES. Higher hospital admissions associated with lower SES observed in some studies could relate to more severe consequences, rather than increased infection risk.
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Affiliation(s)
- Natalie L Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
- National Infection Service, Public Health England, London/Birmingham,
UK
| | - Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Jeremy Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- National Infection Service, Public Health England, London/Birmingham,
UK
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah J O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
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Brandt CF, Tribler S, Hvistendahl M, Naimi RM, Brøbech P, Staun M, Jeppesen PB. Home Parenteral Nutrition in Adult Patients With Chronic Intestinal Failure: Catheter-Related Complications Over 4 Decades at the Main Danish Tertiary Referral Center. JPEN J Parenter Enteral Nutr 2018; 42:95-103. [PMID: 29505150 DOI: 10.1177/0148607116678766] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/20/2016] [Indexed: 10/13/2023]
Abstract
BACKGROUND/AIMS Catheter-related complications (CRCs) cause mortality and morbidity in patients dependent on parenteral support at home (HPN) due to intestinal failure (IF). This study describes the incidences of CRCs in an adult IF cohort over 40 years. It illustrates the evolution and consequences of CRCs, their association to demographic characteristics, and potential risk factors in an effort to provide the rationale for preventive precautions to the relevant patients with IF at risk. METHODS All patients with IF discharged with HPN from 1970-2010 were included. Patient and treatment characteristics were extracted from the Copenhagen IF database. The incidences were given per 1000 central venous catheter (CVC) days. RESULTS The 1715 CRCs occurred in 70% of the 508 patients with IF (56% of the 2191 CVCs). The incidence of catheter-related bloodstream infections (CRBSIs) was 1.43. Higher age, HPN administration by community home nurses, and prior CRBSIs significantly raised the hazard for CRBSIs. In the 1970s, catheters were generally replaced following CRBSIs, whereas catheter salvage was the norm in the 2000s. The incidences of mechanical complications, tunnel infections, and catheter-related venous thromboses were 0.80, 0.25, and 0.11, respectively. The overall CRC incidence was 2.58, decreasing the first 3 decades but peaking in the last (2.84). The deaths related to CRCs were low (0.018). CONCLUSION Even in an experienced IF center of excellence, the incidence of CRCs increased over the 4 decades. This increase could be explained by the expansion of the indication of HPN to a more elderly and frail patient population.
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Affiliation(s)
| | - Siri Tribler
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark Hvistendahl
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rahim M Naimi
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Brøbech
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Staun
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Palle Bekker Jeppesen
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
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O'Donnell FL, Stahlman S, Oh GT. Incidence of Campylobacter intestinal infections, active component, U.S. Armed Forces, 2007-2016. MSMR 2017; 24:2-5. [PMID: 28665626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
During 2007-2016, there were 1,753 diagnosed cases of Campylobacter intestinal infection among active component service members. The overall rate for the period was 14.1 cases per 100,000 person-years (p-yrs), but the annual incidence rates steadily increased from 7.6 cases per 100,000 p-yrs in 2007 to 22.1 cases per 100,000 p-yrs in 2016. Overall rates were higher in females, those aged 45 years or older, members of the Air Force and Army, offi cers, and those in military healthcare occupations. Incidence rates were lowest among service members who were recruit trainees, younger than 20 years of age, non-Hispanic blacks, and Marines. For the entire 10-year surveillance period, more cases were diagnosed in the warmer months of the year. Only eight cases were diagnosed in deployment settings during the 10-year period. Discussion of the recognized risk factors for Campylobacter infections reviewed the hazards of undercooked meats (especially poultry), unpasteurized milk, and untreated surface water in the environment. The limitations of the study methodology were described.
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Williams VF, Stahlman S, Oh GT. Incidence of Escherichia coli intestinal infections, active component, U.S. Armed Forces, 2007-2016. MSMR 2017; 24:20-25. [PMID: 28665630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
During 2007-2016, there were 290 incident cases of Escherichia coli infection among active component service members, with an overall crude incidence rate of 2.3 cases per 100,000 person-years (p-yrs). Subgroup-specific rates were higher among service members aged 50 years or older and those aged 25-29 years than those in other age groups. Compared to their respective counterparts, females, non-Hispanic white service members, members of the Air Force, and service members in healthcare occupations had the highest rates of E. coli infection. Crude overall incidence rates were highest among senior enlisted service members and junior officers, compared to those in other ranks/grades. Annual incidence rates of E. coli infection among active component service members peaked in 2011 (3.4 cases per 100,000 p-yrs) and in 2016 (4.7 cases per 100,000 p-yrs) but otherwise were relatively stable. The monthly distribution of the cumulative number of incident cases of infections during the 10-year period showed a modest pattern of seasonality. During 2008-2016, a total of 14 incident cases of E. coli infection were identified among active component service members during deployments. Standard measures for the prevention of intestinal E. coli infection are reviewed.
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Chen T, Sarnat SE, Grundstein AJ, Winquist A, Chang HH. Time-series Analysis of Heat Waves and Emergency Department Visits in Atlanta, 1993 to 2012. Environ Health Perspect 2017; 125:057009. [PMID: 28599264 PMCID: PMC5730512 DOI: 10.1289/ehp44] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 10/13/2016] [Accepted: 10/24/2016] [Indexed: 05/09/2023]
Abstract
BACKGROUND Heat waves are extreme weather events that have been associated with adverse health outcomes. However, there is limited knowledge of heat waves' impact on population morbidity, such as emergency department (ED) visits. OBJECTIVES We investigated associations between heat waves and ED visits for 17 outcomes in Atlanta over a 20-year period, 1993-2012. METHODS Associations were estimated using Poisson log-linear models controlling for continuous air temperature, dew-point temperature, day of week, holidays, and time trends. We defined heat waves as periods of consecutive days with temperatures beyond the 98th percentile of the temperature distribution over the period from 1945-2012. We considered six heat wave definitions using maximum, minimum, and average air temperatures and apparent temperatures. Associations by heat wave characteristics were examined. RESULTS Among all outcome-heat wave combinations, associations were strongest between ED visits for acute renal failure and heat waves defined by maximum apparent temperature at lag 0 [relative risk (RR) = 1.15; 95% confidence interval (CI): 1.03-1.29], ED visits for ischemic stroke and heat waves defined by minimum temperature at lag 0 (RR = 1.09; 95% CI: 1.02-1.17), and ED visits for intestinal infection and heat waves defined by average temperature at lag 1 (RR = 1.10; 95% CI: 1.00-1.21). ED visits for all internal causes were associated with heat waves defined by maximum temperature at lag 1 (RR = 1.02; 95% CI: 1.00, 1.04). CONCLUSIONS Heat waves can confer additional risks of ED visits beyond those of daily air temperature, even in a region with high air-conditioning prevalence. https://doi.org/10.1289/EHP44.
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Affiliation(s)
- Tianqi Chen
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Stefanie E Sarnat
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | | | - Andrea Winquist
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
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Hine JL, de Lusignan S, Burleigh D, Pathirannehelage S, McGovern A, Gatenby P, Jones S, Jiang D, Williams J, Elliot AJ, Smith GE, Brownrigg J, Hinchliffe R, Munro N. Association between glycaemic control and common infections in people with Type 2 diabetes: a cohort study. Diabet Med 2017; 34:551-557. [PMID: 27548909 DOI: 10.1111/dme.13205] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 01/03/2023]
Abstract
AIM To investigate the impact of glycaemic control on infection incidence in people with Type 2 diabetes. METHODS We compared infection rates during 2014 in people with Type 2 diabetes and people without diabetes in a large primary care cohort in the UK (the Royal College of General Practitioners Research and Surveillance Centre database). We performed multilevel logistic regression to investigate the impact of Type 2 diabetes on presentation with infection, and the effect of glycaemic control on presentation with upper respiratory tract infections, bronchitis, influenza-like illness, pneumonia, intestinal infectious diseases, herpes simplex, skin and soft tissue infections, urinary tract infections, and genital and perineal infections. People with Type 2 diabetes were stratified by good [HbA1c < 53 mmol/mol (< 7%)], moderate [HbA1c 53-69 mmol/mol (7-8.5%)] and poor [HbA1c > 69 mmol/mol (> 8.5%)] glycaemic control using their most recent HbA1c concentration. Infection incidence was adjusted for important sociodemographic factors and patient comorbidities. RESULTS We identified 34 278 people with Type 2 diabetes and 613 052 people without diabetes for comparison. The incidence of infections was higher in people with Type 2 diabetes for all infections except herpes simplex. Worsening glycaemic control was associated with increased incidence of bronchitis, pneumonia, skin and soft tissue infections, urinary tract infections, and genital and perineal infections, but not with upper respiratory tract infections, influenza-like illness, intestinal infectious diseases or herpes simplex. CONCLUSIONS Almost all infections analysed were more common in people with Type 2 diabetes. Infections that are most commonly of bacterial, fungal or yeast origin were more frequent in people with worse glycaemic control.
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Affiliation(s)
- J L Hine
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - S de Lusignan
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - D Burleigh
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - S Pathirannehelage
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - A McGovern
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - P Gatenby
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
- Royal Surrey County Hospital, Guildford, Surrey, UK
| | - S Jones
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - D Jiang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - J Williams
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | | | - G E Smith
- Public Health England, Birmingham, UK
| | - J Brownrigg
- St George's Vascular Institute, Division of Cardiovascular Sciences, St George's University of London, London, UK
| | - R Hinchliffe
- St George's Vascular Institute, Division of Cardiovascular Sciences, St George's University of London, London, UK
| | - N Munro
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
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Phung D, Chu C, Rutherford S, Nguyen HLT, Luong MA, Do CM, Huang C. Heavy rainfall and risk of infectious intestinal diseases in the most populous city in Vietnam. Sci Total Environ 2017; 580:805-812. [PMID: 28012659 DOI: 10.1016/j.scitotenv.2016.12.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/13/2016] [Accepted: 12/03/2016] [Indexed: 05/13/2023]
Abstract
The association between heavy rainfall and infectious intestinal diseases (IID) has not been well described and little research has been conducted in developing countries. This study examines the association between heavy rainfall and hospital admissions for IID in Ho Chi Minh City, the most populous city in Vietnam. An interrupted time-series method was used to examine the effect of each individual heavy rainfall event (HRE) on IID. The percentage changes in post-HRE level and trends of IID were estimated for 30days following each HRE. Then a random-effect meta-analysis was used to quantify the pooled estimate of effect sizes of all HREs on IID. The pooled estimates were calculated over a 21day lag period. The effects of a HRE on IID varied across individual HREs. The pooled estimates indicate that the levels of IID following a HRE increased from 7.3% to 13.5% for lags from 0 to 21days, however statistically significant increases were only observed for lags from 4 to 6days (13.5%, 95%CI: 1.4-25.4; 13.3%, 95%CI: 1.5-25.0; and 12.9%, 95%CI: 1.6-24.1 respectively). An average decrease of 0.11% (95%CI: -0.55-0.33) per day was observed for the post-HRE trend. This finding has important implications for the projected impacts on residents living in this city which is highly vulnerable to increased heavy rainfall associated with climate change. Adaptation and intervention programs should be developed to prevent this additional burden of disease and to protect residents from the adverse impacts of extreme weather events.
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Affiliation(s)
- Dung Phung
- Centre for Environment and Population Health, Griffith University, Australia; School of Public Health, Sun Yat-sen University, China.
| | - Cordia Chu
- Centre for Environment and Population Health, Griffith University, Australia
| | - Shannon Rutherford
- Centre for Environment and Population Health, Griffith University, Australia
| | | | - Mai Anh Luong
- Health Environment Management Agency, Vietnam Ministry of Health, Viet Nam
| | - Cuong Manh Do
- Health Environment Management Agency, Vietnam Ministry of Health, Viet Nam
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, China; Centre for Environment and Population Health, Griffith University, Australia.
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Uddin MI, Islam S, Nishat NS, Hossain M, Rafique TA, Rashu R, Hoq MR, Zhang Y, Saha A, Harris JB, Calderwood SB, Bhuiyan TR, Ryan ET, Leung DT, Qadri F. Biomarkers of Environmental Enteropathy are Positively Associated with Immune Responses to an Oral Cholera Vaccine in Bangladeshi Children. PLoS Negl Trop Dis 2016; 10:e0005039. [PMID: 27824883 PMCID: PMC5100882 DOI: 10.1371/journal.pntd.0005039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/13/2016] [Indexed: 12/14/2022] Open
Abstract
Environmental enteropathy (EE) is a poorly understood condition that refers to chronic alterations in intestinal permeability, absorption, and inflammation, which mainly affects young children in resource-limited settings. Recently, EE has been linked to suboptimal oral vaccine responses in children, although immunological mechanisms are poorly defined. The objective of this study was to determine host factors associated with immune responses to an oral cholera vaccine (OCV). We measured antibody and memory T cell immune responses to cholera antigens, micronutrient markers in blood, and EE markers in blood and stool from 40 Bangladeshi children aged 3-14 years who received two doses of OCV given 14 days apart. EE markers included stool myeloperoxidase (MPO) and alpha anti-trypsin (AAT), and plasma endotoxin core antibody (EndoCab), intestinal fatty acid binding protein (i-FABP), and soluble CD14 (sCD14). We used multiple linear regression analysis with LASSO regularization to identify host factors, including EE markers, micronutrient (nutritional) status, age, and HAZ score, predictive for each response of interest. We found stool MPO to be positively associated with IgG antibody responses to the B subunit of cholera toxin (P = 0.03) and IgA responses to LPS (P = 0.02); plasma sCD14 to be positively associated with LPS IgG responses (P = 0.07); plasma i-FABP to be positively associated with LPS IgG responses (P = 0.01) and with memory T cell responses specific to cholera toxin (P = 0.01); stool AAT to be negatively associated with IL-10 (regulatory) T cell responses specific to cholera toxin (P = 0.02), and plasma EndoCab to be negatively associated with cholera toxin-specific memory T cell responses (P = 0.02). In summary, in a cohort of children 3-14 years old, we demonstrated that the majority of biomarkers of environmental enteropathy were positively associated with immune responses after vaccination with an OCV.
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Affiliation(s)
- Muhammad Ikhtear Uddin
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Shahidul Islam
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Naoshin S. Nishat
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Motaher Hossain
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Tanzeem Ahmed Rafique
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Rasheduzzaman Rashu
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Mohammad Rubel Hoq
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Yue Zhang
- Department of Internal Medicine, Division of Epidemiology, University of Utah, School of Medicine, Salt Lake City, Utah, United States of America
| | - Amit Saha
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Jason B. Harris
- Department of Immunology and Infectious Diseases, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen B. Calderwood
- Department of Immunology and Infectious Diseases, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Taufiqur Rahman Bhuiyan
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Edward T. Ryan
- Department of Immunology and Infectious Diseases, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel T. Leung
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- Department of Internal Medicine, Division of Infectious Diseases, University of Utah, School of Medicine, Salt Lake City, Utah, United States of America
- Department of Pathology, Division of Microbiology and Immunology, University of Utah, School of Medicine, Salt Lake City, Utah, United States of America
| | - Firdausi Qadri
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- * E-mail:
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