Phenotypic virulence characterization of avian pathogenic Escherichia coli (APEC) isolates from broiler breeders with colibacillosis in Mississippi

AIMS

In this study, we evaluated the phenotypic virulence characteristics of avian pathogenic Escherichia coli (APEC) isolates from broiler breeders with colibacillosis in Mississippi. Also, the relationship between phenotypic and genotypic virulence patterns was determined.

METHODS AND RESULTS

Twenty-eight APEC isolated from lesions of broiler breeders diagnosed with colibacillosis were used for embryo lethality assay and chick challenge study. The percentage of embryo mortality following embryo lethality assay and pathogenicity score following the chick challenge study were used to categorize the isolates based on virulence. Pearson correlation analysis was performed to determine the relationship between embryo mortality, chick pathogenicity, and the presence of virulence-associated genes in the isolates. Overall, 39.3% of the isolates were highly virulent and 3.5% were avirulent, following both assays. There existed a positive correlation between embryo mortality and chick pathogenicity (r = 0.73, P < .01), as well as percentage embryo mortality and pathogenicity score with the presence of some virulence genes.

CONCLUSIONS

Even though all the APEC were isolated from lesions of diseased breeders, the virulence potential varied from being avirulent to highly virulent. Further, we identified a positive relationship between phenotypic virulence and the frequency of virulence-associated genes.

Complete genome sequences of two avian pathogenic Escherichia coli strains isolated from broilers exhibiting colibacillosis in Mississippi

We report the whole-genome sequences of Escherichia coli strains APEC-O2-MS1266 and APEC-O2-MS1657 isolated from the liver and heart of infected broilers in Mississippi State, US. The genomic information of these two causative strains may provide a valuable reference for comparative studies of avian pathogenic E. coli.

Avian Pathogenic Escherichia coli (APEC) in Broiler Breeders: An Overview

Poultry meat is one of the major animal protein sources necessary to meet the global protein demand. Sustainability in broiler production is the key to achieving its continuous supply, and broiler breeders play a critical role in maintaining this sustainability by providing good quality chicks. Colibacillosis, the disease caused by avian pathogenic Escherichia coli (APEC), causes severe economic losses to the poultry industry globally. Moreover, APEC causes an additional burden among broiler breeders, such as a decrease in egg production and mortality among these birds. There is vertical transmission of APEC to the broiler chicks through eggs, resulting in increased first-week mortality and subsequent horizontal transmission at the hatchery. In this regard, the vertical transmission of antibiotic resistance genes is another concern that needs attention. Controlling several diseases in broiler breeders would possibly reduce the first-week mortality in chicks, thereby maintaining the production level. For that, constant monitoring of the bacterial populations is critical. Moreover, amidst the increased antibiotic resistance pattern, more focus on alternative treatment strategies like vaccines, probiotics, and bacteriophages is necessary. Future research focusing on strategies to mitigate APEC in broiler breeders would be one of the finest solutions for sustainable broiler production.

COVID 19 Vaccine Breakthrough Infection among Health Care Workers

Background Mass vaccination is considered the primary strategy for reducing the impact of COVID-19, and it has been implemented globally. Objective To study the extent of SARS-CoV-2 infection and breakthrough infection among the HCWs who were fully vaccinated for at least 14 days and investigated the relation between neutralizing antibody response and breakthrough infection. Method This study was a retrospective cohort study among health care workers at Dhulikhel Hospital Kathmandu University Hospital from December 2021 to October 2022. The interviews with semi structured questionnaire were conducted in person or over phone. Out of 1450 participants 137 fully vaccinated HCWs without breakthrough infection were randomly selected for the prospective serological cohort. Result Out of 1079 participants' majority (51.8%) were of age 25-34 years. Two thirds (66.7%) were females. More than half of participant (54.7%) had infection with SARS-CoV-2 at least once whereas more than one third people (35%) had reported SARS-CoV-2 infection 14 days after receiving full vaccination. Infection after vaccination had less moderate and sever/critical illness and less need for hospitalization as compared to infection before vaccination. Staffs who were directly involved in patient care had higher chance of breakthrough infection compared to those not involved directly in patient care. Those who had prior infection or booster dose had relatively higher antibody level and participants with low level of antibody had higher chance for breakthrough infection (35.3%) than participants with moderate to high level of antibody (11.9%). Conclusion Vaccinations significantly decreased severe diseases and the need for hospitalizations. Breakthrough infection was higher among the health care workers involved in direct patient care and with low level of antibody.

A compilation of virulence-associated genes that are frequently reported in avian pathogenic Escherichia coli (APEC) compared to other E. coli

Escherichia coli survive in various hosts and environments due to their highly diversified genome. These bacteria have coevolved with humans, colonized a broad range of hosts, and survive as a commensal organism or pathogen. Escherichia coli that adopted a pathogenic lifecycle in avian hosts typically belong to phylogroups B2 and D. Phylogenic investigations discovered these E. coli are noticeably overlapped with the phylogroup of E. coli infecting humans. This overlapping is possibly due to a parallel evolution in both hosts from a common ancestor, which indicates a high zoonotic potential of avian pathogenic E. coli (APEC). However, some contrasting evidence of other phylogroups infecting the avian host has also been reported in recent studies indicating phylogroups of E. coli are not definitive, only suggestive to their virulence in chickens. Furthermore, virulence-associated genes that contribute to bacterial features necessary to establish APEC infection, are predominantly located in plasmids. Therefore, phylogenetic classification based on chromosomal markers is often inadequate to identify APEC. Moreover, E. coli can obtain virulent plasmids from other bacteria, which further complicates the link between phylogenetic classification and pathotype. Previous research has reported an array of virulence-associated genes highly prevalent only in APEC isolates. Function of these genes are possibly a prerequisite to establishing APEC infections in chickens. Consequently, these genes can be used to distinguish APEC from environmental, commensal, intestinal, and other extraintestinal E. coli. Therefore, we have extensively reviewed previous literature to compile the virulence-associated genes that are highly prevalent in APEC compared to other E. coli. From this review, we have identified 10 key virulence-associated genes (iss,tsh,iroN, episomal/chromosomal ompT,iutA,cvaC,hlyF,iucD,papG allel(II/III), and papC) that are frequently reported in APEC isolates than nonpathogenic E. coli. A compilation of these research findings can be crucial to the molecular identification of APEC. Furthermore, it can serve as a guideline for future investigation and aid in formulation of intervention strategies.

In silico prediction and expression analysis of vaccine candidate genes of Campylobacter jejuni

Campylobacter jejuni (C. jejuni) is the most common food-borne pathogen that causes human gastroenteritis in the United States. Consumption of contaminated poultry products is considered as the major source of human Campylobacter infection. An effective vaccine would be a promising alternative to antibiotic supplements to curb C. jejuni colonization in poultry gastrointestinal (GI) tract. However, the genetic diversity among the C. jejuni isolates makes vaccine production more challenging. Despite many attempts, an effective Campylobacter vaccine is not yet available. This study aimed to identify suitable candidates to develop a subunit vaccine against C. jejuni, which could reduce colonization in the GI tract of the poultry. In the current study, 4 C. jejuni strains were isolated from retail chicken meat and poultry litter samples and their genomes were sequenced utilizing next-generation sequencing technology. The genomic sequences of C. jejuni strains were screened to identify potential antigens utilizing the reverse vaccinology approach. In silico genome analysis predicted 3 conserved potential vaccine candidates (phospholipase A [PldA], TonB dependent vitamin B12 transporter [BtuB], and cytolethal distending toxin subunit B [CdtB]) suitable for the development of a vaccine. Furthermore, the expression of predicted genes during host-pathogen interaction was analyzed by an infection study using an avian macrophage-like immortalized cell line (HD11). The HD11 was infected with C. jejuni strains, and the RT-qPCR assay was performed to determine the expression of the predicted genes. The expression difference was analyzed using ΔΔCt methods. The results indicate that all 3 predicted genes, PldA, BtuB, and CdtB, were upregulated in 4 tested C. jejuni strains irrespective of their sources of isolation. In conclusion, in silico prediction and gene expression analysis during host-pathogen interactions identified 3 potential vaccine candidates for C. jejuni.

Effect of housing environment and hen strain on egg production and egg quality as well as cloacal and eggshell microbiology in laying hens

This study was conducted to determine the effect of housing environment and laying hen strain on performance, egg quality, and microbiology of the cloaca and eggshell. A total of 1,152 Hy-Line Brown (HB) and Hy-Line W-36 White Leghorn (W-36) hens were used. All hens were kept in conventional cages (CC) from 18 to 32 wk of age and then moved to either enriched colony cages (EC) or free-range (FR) pens or continued in CC. Hens were randomly allocated into a 2 × 3 factorial arrangement of 2 laying hen strains (brown and white) and 3 housing environments (CC, EC, and FR) in a split plot in time (hen age) design. The experiment was conducted from 32 to 85 wk of age. The experiment was divided into 2 phases: early phase (32-51 wk of age) and late phase (52-85 wk of age). A 3-way interaction was observed for hen day egg production (HDEP) among housing environments, hen strain, and bird age in the early phase (P = 0.004) as well as in the late phase (P < 0.0001). In both of the phases, HDEP was higher in CC and FR than in EC. Hy-Line W-36 hens raised in EC had the lowest HDEP compared to other treatments. A 3-way interaction was observed for feed intake (FI; P = 0.017) and feed conversion ratio (FCR) in the late phase (P < 0.0001). The lowest FI and highest FCR were observed in EC for W-36 hens. Free-range hens performed in-between for eggshell quality when compared to CC and EC while HB had better egg quality than W-36. Free-range hens had higher cloacal bacterial counts for aerobes, anaerobes, and coliforms than CC and EC. Higher eggshell bacterial contamination was observed in eggs from FR versus eggs from CC and EC. These results indicate that both housing environment and laying hen strain affect performance and egg quality as well as cloacal and eggshell microbiology. Further studies should be conducted to determine food safety and economic impacts when using different hen strains and housing environments.

First Direct Detection Constraints on Planck-Scale Mass Dark Matter with Multiple-Scatter Signatures Using the DEAP-3600 Detector

Dark matter with Planck-scale mass (≃10^{19}  GeV/c^{2}) arises in well-motivated theories and could be produced by several cosmological mechanisms. A search for multiscatter signals from supermassive dark matter was performed with a blind analysis of data collected over a 813 d live time with DEAP-3600, a 3.3 t single-phase liquid argon-based detector at SNOLAB. No candidate signals were observed, leading to the first direct detection constraints on Planck-scale mass dark matter. Leading limits constrain dark matter masses between 8.3×10^{6} and 1.2×10^{19}  GeV/c^{2}, and ^{40}Ar-scattering cross sections between 1.0×10^{-23} and 2.4×10^{-18}  cm^{2}. These results are interpreted as constraints on composite dark matter models with two different nucleon-to-nuclear cross section scalings.

Pulse-shape discrimination against low-energy Ar-39 beta decays in liquid argon with 4.5 tonne-years of DEAP-3600 data

The DEAP-3600 detector searches for the scintillation signal from dark matter particles scattering on a 3.3 tonne liquid argon target. The largest background comes from 39 Ar beta decays and is suppressed using pulse-shape discrimination (PSD). We use two types of PSD estimator: the prompt-fraction, which considers the fraction of the scintillation signal in a narrow and a wide time window around the event peak, and the log-likelihood-ratio, which compares the observed photon arrival times to a signal and a background model. We furthermore use two algorithms to determine the number of photons detected at a given time: (1) simply dividing the charge of each PMT pulse by the mean single-photoelectron charge, and (2) a likelihood analysis that considers the probability to detect a certain number of photons at a given time, based on a model for the scintillation pulse shape and for afterpulsing in the light detectors. The prompt-fraction performs approximately as well as the log-likelihood-ratio PSD algorithm if the photon detection times are not biased by detector effects. We explain this result using a model for the information carried by scintillation photons as a function of the time when they are detected.

Effects of the housing environment and laying hen strain on tibia and femur bone properties of different laying phases of Hy-Line hens

This study aimed to determine the effect of the housing environment and laying hen strain on tibia and femur properties. A 3 × 2 factorial arrangement of 3 housing environments (conventional cages [CC], enriched colony cages [EC], and free range [FR]) and 2 laying hen strains (Hy-Line W-36 [W-36] and Hy-Line Brown [HB]) in a completely randomized design was conducted from 32 to 85 wk of age. Six left tibias were collected at 8 different time points (38, 45, 52, 59, 65, 72, 79, and 85 wk of age), whereas 6 left femurs were collected at 3 time points (38, 65, and 85 wk of age). Tibias were evaluated for tibia breaking strength (TBS) and ash percentage, whereas femurs were evaluated for bone mineral density (BMD), bone mineral content, bone volume as a fraction tissue volume, and porosity percentage from total, cortical, medullary, and trabecular bones. The higher TBS (P = 0.0005) and ash percentage (P = 0.045) was observed in hens raised in FR systems compared with those raised in the CC. Overall, TBS of W-36 hens was significantly greater than that of HB hens (P < 0.0001); however, there was no difference in the ash percentage between the strains (P > 0.05). An interaction between the housing environment and hen strain was observed for BMD (P = 0.04), wherein W-36 hens raised in the FR system had higher BMD than HB hens. Similarly, hens raised in FR systems had higher trabecular bone volume than those raised in CC (P = 0.022). Hen strain influenced total and cortical bone properties: BMD, bone volume as a fraction tissue volume, and porosity percentage, wherein W-36 hens had better properties than HB hens (P < 0.05). Trabecular BMD was higher in W-36 hens than in HB hens (P = 0.04), whereas bone volume was higher in HB hens (P < 0.0001). The results suggest that raising laying hens in alternative housing systems that have provision for exercise such as FR reduces structural bone loss, stimulate structural bone formation, and improve breaking strength of bones; however, it varies with the strain.

First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt

The first case of coronavirus disease 2019 was reported on December 31, 2019 in Wuhan, China where the average case fatality rate was 6.1 ± 2.9%. There are 453 deaths as of September 24, 2020 in Nepal. We report the first death of a 29-years-old postpartum woman due to COVID-19 in Nepal who was referred from a rural health center to Dhulikhel Hospital. On arrival, she was taken to the acute respiratory zone of the emergency department to provide immediate lifesaving procedures. Despite the repeated resuscitative measures, return of spontaneous circulation could not be achieved. The real time polymerase chain reaction test was positive. Our case report highlights the importance of early clinical suspicion, importance of "safety first" in healthcare settings, and the chain of management in such patients. We consider the fact that a postpartum woman registered as the first case of COVID-19 related death in Nepal to be an area of further study.

Knowledge, Attitude and Practice towards COVID-19 among Private School Teachers of Chitwan, Nepal

Background The coronavirus disease (COVID-19) pandemic has brought life to a standstill across the world, with nearly 178 countries reporting school closures. As the schools have started reopening slowly, precautions are utmost necessary to prevent the potential spread of COVID-19 in school and community settings. Objective To assess knowledge, attitude and practice towards COVID-19 among private school teachers. Method A web based cross-sectional analytical study design was undertaken. Currently working private school teachers of Chitwan District were included as a unit of analysis. The snowball sampling technique was employed to identify the eligible participant. Collected data was entered in SPSS version 20 and analyzed using the Chi-square test, Pearson correlation, and binary logistic regression. Result Of 344 participants, the majority were male (52.9%), most of the participants were from age group 26-30 years (38.4%). Regarding knowledge, attitude and practice, 57% had good knowledge, 53.2% had favorable attitude and 51.7% had good practice towards COVID-19. Logistic regression analysis demonstrated gender (OR 0.475, 95% CI: 0.256-0.818) and COVID-19 training (OR 25.687, 95% CI 5.354-123.226) were significant with good knowledge. Conclusion Knowledge about COVID-19 among private schools teacher was good, attitudes have been mostly favorable, and the practices were mostly adequate. However, good knowledge is not the only factor for better attitude and good practices. It is necessary to implement massive education campaigns, trainings and information via school authorities and health authorities by developing and adopting appropriate guidelines on COVID-19.

Effects of Housing Types on Cecal Microbiota of Two Different Strains of Laying Hens During the Late Production Phase

Due to animal welfare issues, European Union has banned the use of conventional cages (CC) and non-EU countries including the US are also under constant public pressure to restrict their use in egg production. Very limited information is available on the composition of the microbial community of hens raised in different housing environments. This study was conducted to determine the effects of CC and enriched colony cages (EC) on cecal microbiota of two commercial laying hen strains, Hy-Line W36 (W36) and Hy-Line Brown (HB) during the late production stage (53, 58, 67, and 72 weeks of age). Cecal microbiota was studied by analyzing 16S rRNA gene sequences with Quantitative Insights Into Microbial Ecology (QIIME) 2 ver. 2018.8. Differentially abundant taxa were identified by Linear discriminant analysis Effect Size (LEfSe) analysis (P < 0.05, LDA score > 2.0). At phylum level, Actinobacteria was significantly enriched in W36 at all time points while Synergistetes (53 weeks), Spirochaetes (58 weeks), and Synergistetes and Spirochaetes (67 weeks) were significantly higher in HB. At genus level, Bifidobacterium (at all time points) and butyric acid producing genera such as Butyricicoccus and Subdoligranulum (58 and 72 weeks) were significantly higher in W36 as compared to HB. Moreover, Proteobacteria (72 weeks) and its associated genus Campylobacter (67 and 72 weeks) were significantly enriched in EC as compared to CC. Alpha diversity was significantly higher in HB (at all time points) and in EC (67 weeks) as compared to W36 and CC, respectively. Similarly, there was a significant difference in community structure (beta diversity) between W36 and HB (all time points) as well as between EC and CC (67 weeks). The effect of housing and strains was not only seen at the bacterial composition and structure but also reflected at their functional level. Notably, KEGG metabolic pathways predicted to be involved in carbohydrates degradation and amino acids biosynthesis by PICRUSt analysis were significantly different between W36 and HB housed at CC and EC. In sum, cecal microbiota composition, diversities, and their functional pathways were affected by housing type which further varied between two commercial laying hen strains, HB and W36. This suggests that both housing and genetic strains of laying hens should be considered for selection of the alternative housing systems such as enriched colony cage.

Research Note: Effect of organic acid mixture on growth performance and Salmonella Typhimurium colonization in broiler chickens

Feed additives can be alternatives to antibiotics for routinely encountered pathogens in the poultry production. The objective of this study was to understand effects of organic acid mixture on growth parameters and Salmonella Typhimurium (ST) colonization in broilers. Organic acid mixture is a feed-grade buffered formic acid and sodium formate mixture (Amasil NA). A total of 800 1-day-old Cobb500 males were fed one of the five dietary treatments: a negative control diet without ST challenge (NC), positive control diet with ST challenge (PC), 0.3% organic acid mixture with ST, 0.6% organic acid mixture with ST, and 0.9% organic acid mixture with ST. Treatments were assigned to 20 pens with 40 chicks/pen and 4 replicates of each treatment. Chickens were challenged with 107 CFU/mL of nalidixic acid-resistant ST (STNAR) 4-D posthatch. In the grower phase, feed conversion rate was significantly reduced in the 9% organic acid mixture compared with the PC. The body weight and body weight gain (BWG) were not affected either in the starter or grower phases. However, in the finisher phase, the nonchallenged NC had higher BWG than the PC (P < 0.05), whereas there were no differences in BWG among the NC and organic acid mixture fed groups. In addition, there was a significant effect of organic acid mixture on the colonization of cecal STNAR. At 9 dpi, cecal STNAR was 3.28 log10 in the PC that was reduced to 2.65 log10 at 0.3%, 1.40 log10 at 0.6%, and 0.84 log10 in 0.9% organic acid mixture. At 24 dpi, cecal STNAR recovery was 0.81, 0.99, 0.53, and 0.33 log10 in the PC and 0.3, 0.6, and 0.9% organic acid mixture, respectively. Similarly, at 38 dpi, cecal STNAR was 0.26, 0.11, 0.33, and 0 log10 in the PC, 0.3, 0.6, and 0.9%, respectively. These results show that organic acid mixture can be one dietary strategy to control ST infection and maintain efficient growth performance.

Changes in cecum microbial community in response to total sulfur amino acid (TSAA: DL-methionine) in antibiotic-free and supplemented poultry birds

The effect of essential total sulfur amino acids (TSAA) like methionine and cysteine on the cecal microbiome of broilers was investigated at 2 different time points (days 21 and 42) of broiler rearing. A total of 360-day-old Cobb male broiler chicks were randomly distributed to 6 dietary treatments in a 2 × 3 factorial arrangement, with 2 levels of antibiotic growth promoters (AGP: 0 and 0.05%) and 3 levels of TSAA (DL-methionine) either for starter (0.7, 0.8, and 0.9%) or finisher chicks (0.52, 0.62, and 0.72%), labeled as diets 1 to 6. Cecal digesta from each replicate (n = 10) were sampled on days 21 and 42. DNA was extracted for the amplification of the V4 region of bacterial 16S rRNA genes and subjected to Illumina sequencing. Bioinformatic analyses were performed using QIIME, Mothur, and ad hoc tools and functional profiles of the inferred metagenome were analyzed using PICRUST. Statistical difference was determined by 2-way ANOVA and PERMANOVA. Clustering of cecal communities using PCoA showed clear separation of microbial communities based on age (P < 0.05) of birds and between low and medium/ high levels of TSAA (DL-methionine). At day 21, bacterial richness and diversity were higher than at day 42 where Clostridium cluster XI and Lactobacillus were found most abundant. No variability in taxonomic richness at the genus level was observed with AGP and DL-methionine supplementation. Interbird variation for richness was greater at day 42 compared to day 21. The mean fold difference of richness was greater (1.5 mean fold) with diets 1 and 6, suggesting interactive effects of AGP and TSAA (DL-methionine) in the diet. KEGG function profiles calculated by PICRUST suggest that the cecal microbiome increased glycolysis and energy generation correlated with increased dietary TSAA (DL-methionine) supplementation levels during the late broiler growth period (day 42). This study increases our knowledge of microbial dynamics and functions that are relevant to host nutrition and performance that may help us tailoring alternative strategies for raising poultry birds under antibiotic-free conditions.

Search for a Dark Matter-Induced Annual Modulation Signal in NaI(Tl) with the COSINE-100 Experiment

We present new constraints on the dark matter-induced annual modulation signal using 1.7 years of COSINE-100 data with a total exposure of 97.7 kg yr. The COSINE-100 experiment, consisting of 106 kg of NaI(Tl) target material, is designed to carry out a model-independent test of DAMA/LIBRA's claim of WIMP discovery by searching for the same annual modulation signal using the same NaI(Tl) target. The crystal data show a 2.7  cpd/kg/keV background rate on average in the 2-6 keV energy region of interest. Using a χ-squared minimization method we observe best fit values for modulation amplitude and phase of 0.0092±0.0067  cpd/kg/keV and 127.2±45.9  d, respectively.

First Direct Search for Inelastic Boosted Dark Matter with COSINE-100

A search for inelastic boosted dark matter (IBDM) using the COSINE-100 detector with 59.5 days of data is presented. This relativistic dark matter is theorized to interact with the target material through inelastic scattering with electrons, creating a heavier state that subsequently produces standard model particles, such as an electron-positron pair. In this study, we search for this electron-positron pair in coincidence with the initially scattered electron as a signature for an IBDM interaction. No excess over the predicted background event rate is observed. Therefore, we present limits on IBDM interactions under various hypotheses, one of which allows us to explore an area of the dark photon parameter space that has not yet been covered by other experiments. This is the first experimental search for IBDM using a terrestrial detector.

Effect of probiotics on fecal excretion, colonization in internal organs and immune gene expression in the ileum of laying hens challenged with Salmonella Enteritidis

A study was conducted to evaluate the supplementation of probiotics on Salmonella colonization in the ceca and various internal organs as well as immune response in laying hens challenged with Salmonella enterica serovar Enteritidis (SE). Thirty-two 46-wk-old White Leghorns (W-36) were housed individually in wired laying cages under 16L:8D lighting schedule. Hens were challenged individually with nalidixic acid resistant Salmonella Enteritidis (SENAR) after which time they were grouped into four treatments: T1 = SENAR unchallenged control, T2 = SENAR challenged control, T3 = SENAR challenged + 0.05% probiotics (Lactobacillus plantarum), and T4 = SENAR challenged + 0.1% probiotics. All hens, including T1, were euthanized and sampled for the liver with gall bladder (L/GB), ileum, ovary, spleen, and ceca on 7-days post-infection (dpi). Fecal screening was performed on individual hens at both 3 and 6 dpi. No difference was detected between the treatments in cecal SENAR enumeration, and the mean log 10 cfu/gm of SENAR in the ceca was 3.7 for all three treatments. The prevalence of SENAR was lowest for ovary in all treatments and was highest in the spleen. However, there were no significant differences among the treatments in the internal organs. There was no significant difference in the fecal shedding among the treatments on either 3 or 6 dpi, with incidence of positive feces higher at 3 dpi compared to 6 dpi (100 vs. 70% to 80%). SENAR challenge resulted in significant upregulation (P < 0.05) of interleukin (IL)-1β, 6, 10, interferon gamma (IFN-γ), and toll-like receptor (TLR)-4 mRNA expression. Highest level of probiotics resulted in a significant decrease in IFN-γ and elevation of IL-6 and IL-10 gene expression in the ileum. However, IL-1B and TLR-4 gene expression were not different from the SENAR challenge control. This study reveals that there was important regulation of immune genes by probiotics supplementation.

Secreted frizzled-related protein 2 (SFRP2) expression promotes lesion proliferation via canonical WNT signaling and indicates lesion borders in extraovarian endometriosis

STUDY QUESTION

What is the role of SFRP2 in endometriosis?

SUMMARY ANSWER

SFRP2 acts as a canonical WNT/CTNNB1 signaling agonist in endometriosis, regulating endometriosis lesion growth and indicating endometriosis lesion borders together with CTNNB1 (also known as beta catenin).

WHAT IS KNOWN ALREADY

Endometriosis is a common, chronic disease that affects women of reproductive age, causing pain and infertility, and has significant economic impact on national health systems. Despite extensive research, the pathogenesis of endometriosis is poorly understood, and targeted medical treatments are lacking. WNT signaling is dysregulated in various human diseases, but its role in extraovarian endometriosis has not been fully elucidated.

STUDY DESIGN, SIZE, DURATION

We evaluated the significance of WNT signaling, and especially secreted frizzled-related protein 2 (SFRP2), in extraovarian endometriosis, including peritoneal and deep lesions. The study design was based on a cohort of clinical samples collected by laparoscopy or curettage and questionnaire data from healthy controls and endometriosis patients.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Global gene expression analysis in human endometrium (n = 104) and endometriosis (n = 177) specimens from 47 healthy controls and 103 endometriosis patients was followed by bioinformatics and supportive qPCR analyses. Immunohistochemistry, Western blotting, primary cell culture and siRNA knockdown approaches were used to validate the findings.

MAIN RESULTS AND THE ROLE OF CHANCE

Among the 220 WNT signaling and CTNNB1 target genes analysed, 184 genes showed differential expression in extraovarian endometriosis (P < 0.05) compared with endometrium tissue, including SFRP2 and CTNNB1. Menstrual cycle-dependent regulation of WNT genes observed in the endometrium was lost in endometriosis lesions, as shown by hierarchical clustering. Immunohistochemical analysis indicated that SFRP2 and CTNNB1 are novel endometriosis lesion border markers, complementing immunostaining for the known marker CD10 (also known as MME). SFRP2 and CTNNB1 localized similarly in both the epithelium and stroma of extraovarian endometriosis tissue, and interestingly, both also indicated an additional distant lesion border, suggesting that WNT signaling is altered in the endometriosis stroma beyond the primary border indicated by the known marker CD10. SFRP2 expression was positively associated with pain symptoms experienced by patients (P < 0.05), and functional loss of SFRP2 in extraovarian endometriosis primary cell cultures resulted in decreased cell proliferation (P < 0.05) associated with reduced CTNNB1 protein expression (P = 0.05).

LIMITATIONS REASONS FOR CAUTION

SFRP2 and CTNNB1 improved extraovarian endometriosis lesion border detection in a relatively small cohort (n = 20), although larger studies with different endometriosis subtypes in variable cycle phases and under hormonal medication are required.

WIDER IMPLICATIONS OF THE FINDINGS

The highly expressed SFRP2 and CTNNB1 improve endometriosis lesion border detection, which can have clinical implications for better visualization of endometriosis lesions over CD10. Furthermore, SFRP2 acts as a canonical WNT/CTNNB1 signaling agonist in endometriosis and positively regulates endometriosis lesion growth, suggesting that the WNT pathway may be an important therapeutic target for endometriosis.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Academy of Finland and by Tekes: Finnish Funding Agency for Innovation. The authors have no conflict of interest to declare.

Effect of dietary fructooligosaccharide supplementation on internal organs Salmonella colonization, immune response, ileal morphology, and ileal immunohistochemistry in laying hens challenged with Salmonella enteritidis

A study was conducted to evaluate the efficacy of fructooligosaccharides (FOS) in controlling the infection of Salmonella Enteritidis (SE) in White Leghorns. A total of 30 laying hens (white leghorns W-36) were challenged both orally and cloacally with approximately 108 colony-forming units of nalidxic acid resistant SE (SENAR) and divided into 3 treatments: 1) SENAR challenged + 0.0% FOS, 2) SENAR challenged + 0.5% FOS (Nutraflora), and 3) SENAR challenged + 1.0% FOS. SENAR recovery via fecal shedding was measured at 3- and 6-d post-infection (dpi), whereas in the ceca and internal organs, SENAR recovery was measured at 7-d post-infection. In the first experiment, there was a 1.0 log10 and a 1.3 log10 reduction in cecal SENAR by supplementation of FOS at 0.5 and 1.0%, respectively. In the second experiment, there was a 0.6 log10 and a 0.8 log10 reduction in cecal SENAR by supplementation of FOS at 0.5 and 1.0%, respectively. Fecal shedding was significantly lower in 1.0% FOS supplemented groups compared to SENAR challenge 0.0% FOS. There was no significant difference among the 3 treatments on SENAR recovery in liver with gall bladder and ovaries. However, the frequency of positive SENAR in the ovaries (10 to 40%) in SENAR challenge 0.0% FOS was significantly lower than liver with gall bladder (60 to 80%) in both experiments. There was a significant upregulation of toll-like receptor-4 in 1.0% FOS and interferon gamma in both 0.5 and 1.0% FOS. Histologic measurements of ileal villi height and crypt depth were similar across all treatments. Immunohistochemistry analyses of ileal samples showed that immunoglobulin A positive cells increased as FOS concentration increased reaching significance at 1.0% as well as altered cytokine gene expression in the ileum. Further, FOS supplementation also reduced cecal SENAR and feces SENAR levels. Collectively, the results suggest that dietary supplementation with FOS may impair SE pathogenesis while modulating humoral immunity within the gut-associated lymphoid tissue.

Background model for the NaI(Tl) crystals in COSINE-100

The COSINE-100 dark matter search experiment is an array of NaI(Tl) crystal detectors located in the Yangyang Underground Laboratory (Y2L). To understand measured backgrounds in the NaI(Tl) crystals we have performed Monte Carlo simulations using the Geant4 toolkit and developed background models for each crystal that consider contributions from both internal and external sources, including cosmogenic nuclides. The background models are based on comparisons of measurement data with Monte Carlo simulations that are guided by a campaign of material assays and are used to evaluate backgrounds and identify their sources. The average background level for the six crystals (70 kg total mass) that are studied is 3.5 counts/day/keV/kg in the (2-6) keV energy interval. The dominant contributors in this energy region are found to be 210 Pb and 3 H.

Mef2 induction of the immediate early gene Hr38/Nr4a is terminated by Sirt1 to promote ethanol tolerance

Drug naïve animals given a single dose of ethanol show changed responses to subsequent doses, including the development of ethanol tolerance and ethanol preference. These simple forms of behavioral plasticity are due in part to changes in gene expression and neuronal properties. Surprisingly little is known about how ethanol initiates changes in gene expression or what the changes do. Here we demonstrate a role in ethanol plasticity for Hr38, the sole Drosophila homolog of the mammalian Nr4a1/2/3 class of immediate early response transcription factors. Acute ethanol exposure induces transient expression of Hr38 and other immediate early neuronal activity genes. Ethanol activates the Mef2 transcriptional activator to induce Hr38, and the Sirt1 histone/protein deacetylase is required to terminate Hr38 induction. Loss of Hr38 decreases ethanol tolerance and causes precocious but short‐lasting ethanol preference. Similarly, reduced Mef2 activity in all neurons or specifically in the mushroom body α/β neurons decreases ethanol tolerance; Sirt1 promotes ethanol tolerance in these same neurons. Genetically decreasing Hr38 expression levels in Sirt1 null mutants restores ethanol tolerance, demonstrating that both induction and termination of Hr38 expression are important for behavioral plasticity to proceed. These data demonstrate that Hr38 functions as an immediate early transcription factor that promotes ethanol behavioral plasticity.

Unilateral retinitis pigmentosa

OBJECTIVE

To report a rare case of unilateral retinitis pigmentosa and to present the clinical features, and findings of multifocal ERG and visual field of this case.

CASE

A 70-year-old-female diagnosed as Retinitis Pigmentosa in right eye 7 years back, presented with further gradual painless diminution of vision in the very eye and without any similar symptoms in left eye. On examination, the findings (including multifocal ERG and visual field) suggested the features of retinitis pigmentosa in her right eye, while the other eye being unaffected.

CONCLUSION

In this rare case, the distinct features of retinitis pigmentosa are seen only in one eye, and this can be further confirmed from multifocal ERG and visual field.

Gynaecological and other health problems of postmenopausal women and their health seeking behaviour in rural Terai, Nepal

Background: There is very few data available in menopausal study done in Nepal.   The data is even less on the various gynecological and medical problems postmenopausal women are suffering from. This study was done in Duhabi area, a community in Eastern Nepal, around the Comprehensive Health Service area of a   community hospital under B.P Koirala Institute of Health Sciences.Objective: This study was done to document the various gynecological problems among the postmenopausal   women and their relation with the socio-demographic characteristics.Methods: By using specific questionnaire, 234 post-menopausal women were   interviewed regarding menopausal symptoms, other gynaecological problems and   medical problems and their health seeking behaviour. Results: Our study showed   that the most common symptoms among the post-menopausal women were loss of libido (53%) and hot flushes (41.5%). Other noted symptoms found were vaginal   dryness (29.1%) and excessive vaginal bleeding (14.5%). The most common urinary symptoms were urgency (34.2%), dysuria (17.1%) and incontinence (17.1%). Uterine prolapse was reported by 6.4% of respondents. The most common medical condition seen in our study was low back ache (70.1%). Despite majority (62%) seeking medical treatment for their symptoms only 1.7% of the respondents were using hormone replacement therapy.Conclusion: The prevalence of gynaecological problems among the post-menopausal women was high in our study with the main symptoms of loss of libido and hot flushes. Majority of women with postmenopausal   symptoms sought medical care for their problems.   Health Renaissance 2014;12(2): pp: 87-91

Characterization of Escherichia coli Phylogenetic Groups Associated with Extraintestinal Infections in South Indian Population

Background:

Escherichia coli strains mainly fall into four phylogenetic groups (A, B1, B2, and D) and that virulent extra-intestinal strains mainly belong to groups B2 and D.

Aim:

The aim was to determine the association between phylogenetic groups of E. coli causing extraintestinal infections (ExPEC) regarding the site of infection, expression of virulence factors, antimicrobial resistance patterns, and clinical outcome. This descriptive study was carried out in a multi-specialty Tertiary Care Hospital.

Materials and Methods:

A total of 300 E. coli causing ExPEC were studied. Triplex polymerase chain reaction was used to classify the phylogenetic groups; hemolysin production was assessed on sheep blood agar and biofilm production in a microtiter plate assay. Production of extended spectrum of beta-lactamase (ESBLs) was detected by combination disk method; AmpC was detected by AmpC disk test, Carbapenemase production was detected by modified Hodge test and metallo-β-lactamase by metallo-beta-lactamases (MBL) E-test.

Results:

Of 300 isolates, 61/300 (20%) belonged to phylogroup A, 27/300 (9%) to phylogroup B1, 104/300 (35%) were B2 and 108/300 (36%) belonged to group D, respectively. Phylogroups B2 and D were the most predominant groups in urinary tract infection and sepsis. Prognoses were better in infections with group A and B1 isolates, and relapses and death were common in infections with B2 and D. Expression of biofilm was greatest in B1 and hemolysin in group B2. Group A and B1 showed higher resistance to ciprofloxacin and were most frequent β-lactamase (ESBL, AmpC, Carbapenemase and MBL) producers.

Conclusions:

Phylogenetic group B2 and D were predominant in ExPEC and exhibited least antimicrobial resistance among the groups. Resistance to multiple antibiotics was most prevalent in group A and B1. Regular monitoring of antimicrobial susceptibility in commensal strains is essential as they might transfer the property of antimicrobial resistance to pathogenic strains.

Do geriatrics require dose titration for antidiabetic agents?

OBJECTIVE

To evaluate the antidiabetic drug dosage differences between geriatric and nongeriatric diabetics with reference to duration of disease and creatinine clearance (Crcl).

MATERIALS AND METHODS

Prospective study conducted for 6 months in a tertiary care hospital. Patients with type 2 diabetes mellitus were grouped into geriatric (age ≥60 years) and nongeriatric (age <60 years). Patients' demographic data, duration of diabetes, medication, and serum creatinine were recorded. Crcl was calculated using Cockcroft-Gault formula. Doses of sulfonylureas (SU) were converted into equivalent doses, taking glibenclamide as standard. Univariate analysis was done for comparison of drug doses between groups.

RESULT

A total of 320 geriatric and 157 nongeriatric diabetics completed the study. The duration of diabetes and Crcl adjusted dose reduction of glibenclamide (mean dose: Geriatrics 7.2±0.4 mg, nongeriatrics 9.6±0.7 mg; P=0.01) and gliclazide (mean dose: Geriatrics 85.5±11.5 mg, nongeriatrics 115.3±32.7 mg; P=0.42) was 25%, glimepiride (mean dose: Geriatrics 1.62±0.13 mg, nongeriatrics 2.1±0.18 mg; P=0.06) was 22%. Glipizide did not require dose reduction. Mean converted equivalent dose of sulfonylurea monotherapy was significantly lower in geriatrics than nongeriatrics (3.2±0.5 vs 6.4±1.02 mg; P=0.01) and showed 50% dose reduction. Mean dose of metformin was lower in geriatrics (901±32.2 mg vs 946.7±45.8 mg; P=0.45) and showed 5% reduction in dosage. There was no difference in the mean drug doses of thiazolidinediones and insulin between the groups.

CONCLUSION

A substantial dose reduction of glibenclamide (25%), gliclazide (25%), glimepiride (22%), and metformin (5%) in geriatrics compared to nongeriatrics was observed. Smaller dosage formulations like 0.75 mg glibenclamide, 0.5 mg glimepiride, 20 mg gliclazide, and 250 mg metformin may be of value in geriatric diabetic practice.

Carotid Doppler and lipid profile findings in ischemic stroke patients--a hospital based study

A prospective study was carried out during 2010 - 2011 in the Department of Radiology & Imaging of Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu and Om Hospital and Research Centre, Chabahil, Kathmandu in which a total of 45 patients with clinically and CT scan diagnosed ischaemic cerebrovascular accident (CVA) underwent carotid Doppler study. During the hospital stay these patients also underwent lipid profile estimation to see for presence or absence of hyperlipidemia. Of these 45 patients, CT scan showed left middle cerebral artery (MCA) infarctions in 12, right MCA infarction in 12, lacunar infarctions in 10, watershed territory infarction in 4, posterior circulation infarction in 1 and venous infarction in 1 patient. Carotid Doppler study showed more than 50% stenosis in 31 patients. Among these 31 patients, 28 had hyperlipidemia where as blood cholesterol and triglyceride values in 3 patients were normal. The present study like several other studies done in the past showed association between carotid stenosis and hyperlipidemia, leading to CVA.

Common reasons for hospitalization among adult patients with diabetes in a private medical college in Kathmandu

Diabetes Mellitus is one of the important non communicable disease affecting the adult populations around the world. Incidence of diabetes increasing in South Asia. Nepal is also experiencing increasing in diabetes disease burden. Diabetes mellitus is one of the important causes of hospital admission in the western world. In this study we evaluated the causes of hospital admission amongst diabetic population. Most common cause is of diagnosis is some forms of infections commonest (20%) being urinary tract infections. Ten out of total 69 patients had septicemia. Six patients out of 69 had sputum positive pulmonary tuberculosis only one patient presented with metabolic complications of diabetes i.e. diabetic ketoacidosis. Coronary artery disease with heart failure was present in 14 patients. Five patients had diabetic nephropathy and 3 had retinopathy. This shows that infections is the major cause of hospital admission for diabetics followed by heart failure. Tuberculosis is important diagnosis in person with diabetes. This study shows more female patients get admitted and amongst admitted patents glycemic control is poor. This signify that women had more complications than male counter parts.

Pseudomembranous colitis in a pregnant woman

Pseudomembranous colitis in association with pregnancy has not been well described in English literature. Recent studies show a drastic increase in the incidence and severity of Pseudomembranous colitis in pregnant women, who were once thought to be at low risk. We report here a case of Pseudomembranous colitis in a young healthy immunocompetent pregnant lady. An early suspicion of this entity with the characteristic appearance of pseudomembranes on colonoscopy and histology confirmed the diagnosis enabling prompt treatment and complete recovery without any serious consequences.

Clinical and molecular characterization of neonatal diabetes and monogenic syndromic diabetes in Asian Indian children

Mutations in the pancreatic ATP sensitive K(+) channel proteins [sulfonyluea receptor 1 (SUR1) and inward rectifier K(+) channel Kir6.2 (Kir6.2), encoded by ATP-binding cassette transporter subfamily C member 8 (ABCC8) and potassium channel J11 (KCNJ11), respectively], are the most common cause of neonatal diabetes. We describe the clinical presentation and molecular characterization of Asian Indian children with neonatal diabetes mellitus and monogenic syndromes of diabetes. We sequenced KCNJ11, ABCC8 and insulin (INS) genes in 33 unrelated Indian probands with onset of diabetes below one year of age. A total of 12 mutations were identified which included ABCC8 mutations in seven, KCNJ11 mutations in three and INS mutations in two children. The Asp212Tyr mutation in ABCC8 was novel. We also detected two novel mutations (Val67Met and Leu19Arg) in children with syndromic forms of diabetes like Berardinelli Seip syndrome [1-acyl-sn-glycerol-3-phosphate acyltransferase beta (AGPAT2)] and Fanconi Bickel syndrome [solute carrier family 2A2 (SLC2A2)]. Children carrying the KCNJ11 (Cys42Arg, Arg201Cys) and ABCC8 (Val86Ala, Asp212Tyr) mutations have been successfully switched over from insulin therapy to oral sulfonylurea. Our study is the first large genetic screening study of neonatal diabetes in India.

Profile of ascites patient admitted in Nepal Medical College Teaching Hospital

Ascites is one of the frequently encountered problems in internal medicine. Common causes of ascites are portal hypertension including cirrhosis of liver and congestive heart failure, hypoalbuminemia associated with nephrotic syndrome, intra-abdominal malignancy and abdominal tuberculosis. We evaluated 43 patients presented with ascites in Nepal Medical College Teaching Hospital (NMCTH). After history taking, clinical examination, imaging studies and laboratory evaluation alcoholic liver disease and abdominal tuberculosis were diagnosed in 19 and 5 patients restively. Constrictive pericarditis was diagnosed in 2 patients and 2 patients were suffering from HCV related liver disease. Present study revealed alcoholic liver disease as the commonest cause of ascites.

Intraoperative Blood Loss & operating time in Tonsillectomy: Is Electrodissection Better?

DOI: 10.3126/njenthns.v1i1.4728 Nepalese J ENT Head Neck Surg Vol.1 No.1 (2010) p.6-7

Ocular morbidity in hearing impaired schoolchildren

AIMS

To determine the pattern and prevalence of ocular morbidity in hearing impaired schoolchildren.

METHODS

A cross-sectional descriptive study was conducted in the three different deaf schools of Kathmandu, Bhaktapur and Kavre districts. All children in the deaf school underwent complete ocular examination. Examination included visual acuity assessment, refraction, binocular vision assessment, and anterior and posterior segment evaluation.

RESULTS

Ocular examination was carried out in 279 children with age range within 5 to 20 years (mean age 14.1 ± 3.14 years). Ocular morbidity was detected in 78 (28%) children with 46 (16.48%) having refractive errors. Seventy eight percent children did not have corrective lenses despite having refractive errors. Two children were found to have pigmentary retinopathy where electro-retinogram findings suggested Usher's Syndrome in one child. Another child was found to have Waardenburg Syndrome.

CONCLUSIONS

Hearing impaired children are at an increased risk of having ocular morbidity. Hence, periodic eye examinations are important in deaf children.

Comparison of fine needle aspiration cytology and histopathology in diagnosing cervical lymphadenopathies

BACKGROUND

Lymphadenopathies are the most common form of extrapulmonary tuberculosis and tuberculous lymphadenitis is the most common cause of peripheral lymphadenopathy in a developing country like Nepal. The objective of this study is to compare the findings of fine needle aspiration cytology to histopathology in diagnosing cervical lymphadenopathies.

METHOD

This is a prospective, longitudinal, comparative study was performed in the Department of ENT and Head and Neck Surgery, TU Teaching Hospital, Kathmandu between August 2007 and January 2009. Patients 13 years of age or older were included. There were 55 patients with cervical lymphadenopathies subjected to both fine needle aspiration cytology (FNAC) and histopathology (HPE). The sensitivity, specificity, false positive, false negative, positive predictive value and negative predictive value were calculated.

RESULTS

Of 55 patients, 48 patients had lymphadenopathies of infective origin while 7 patients had metastatic disease. Majority of patients (n=20) were in age group 23-32 years and males outnumbered females. The sensitivity, specificity, false positive, false negative, positive predictive value and negative predictive value of FNAC of lymphadenopathies to diagnose tubercular lymphadenopathies were 80.0%, 100.0%, 0.0%, 20.0%, 100.0% and 82.14% respectively. Similarly, sensitivity, specificity of FNAC of lymphadenopathies to differentiate benign and malignant lesion were 100% each. False positive, false negative, positive predictive value and negative predictive value were 0.0%, 0.0%, 100.0% and 100.0% respectively. Overall correlation of FNAC and HPE was 90.9%.

CONCLUSION

FNAC can distinguish tubercular lymphadenitis from reactive and granulomatous lymphadenitis in majority of cases. Similarly, it can distinguish well between benign and malignant lymphadenopathies. It can be used as an initial investigation for routine screening of cervical lymphadenopathies where facilities of histopathology are not available.