Epidemiology, risk factors and outcomes of multi-drug-resistant bloodstream infections in haematopoietic stem cell transplant recipients: importance of previous gut colonization

BACKGROUND

Bloodstream infections (BSI) are a major complication in the early phase of a haematopoietic stem cell transplant (HSCT).

AIM

To describe the incidence and risk factors for BSI occurring in the pre-engraftment phase of HSCT, and its impact on mortality.

METHODS

Clinical variables of 232 HSCT patients were analysed retrospectively between 2014 and 2015. Univariate Cox regression analyses were performed to test the association between each covariate and the outcome. Covariates with P < 0.10 on univariate analysis were included in a multiple Cox regression analysis using a backward elimination method.

FINDINGS

The cumulative incidence of BSI was 25.4%, mainly caused by Gram-negative bacteria (GNB) (55.2%). Approximately 40.5% of the patients had gut colonization by multi-drug-resistant (MDR) bacteria (vancomycin-resistant enterococcus and carbapenem-resistant GNB). Among patients colonized by MDR GNB, 20% developed an overt BSI due to MDR bacteria with the same pattern of sensitivity. Of the 13 deaths related to infection, 10 were patients with BSI caused by MDR GNB. The independent risk factors for BSI were gut colonization by MDR bacteria including GNB (P < 0.001) and duration of neutropenia >10 days (P = 0.005), and those associated with BSI caused by MDR bacteria were age >62 years (P = 0.03), use of total parenteral nutrition (TPN) (P < 0.001) and previous gut colonization by MDR GNB (P = 0.002).

CONCLUSIONS

Previous gut colonization by MDR was an independent risk factor for BSI, together with TPN and age, and had an impact on outcome. These findings suggest that gut decolonization may be a potential strategy to prevent BSI.

Parasite molecules and host responses in cystic echinococcosis

Cystic echinococcosis is the infection by the larvae of cestode parasites belonging to the Echinococcus granulosus sensu lato species complex. Local host responses are strikingly subdued in relation to the size and persistence of these larvae, which develop within mammalian organs as 'hydatid cysts' measuring up to tens of cm in diameter. In a context in which helminth-derived immune-suppressive, as well as Th2-inducing, molecules garner much interest, knowledge on the interactions between E. granulosus molecules and the immune system lags behind. Here, we discuss what is known and what are the open questions on E. granulosus molecules and structures interacting with the innate and adaptive immune systems, potentially or in demonstrated form. We attempt a global biological approach on molecules that have been given consideration primarily as protective (Eg95) or diagnostic antigens (antigen B, antigen 5). We integrate glycobiological information, which traverses the discussions on antigen 5, the mucin-based protective laminated layer and immunologically active preparations from protoscoleces. We also highlight some less well-known molecules that appear as promising candidates to possess immune-regulatory activities. Finally, we point out gaps in the molecular-level knowledge of this infectious agent that hinder our understanding of its immunology.

Floristic and phytosociology in dense "terra firme" rainforest in the Belo Monte Hydroelectric Plant influence area, Pará, Brazil

The objective of the present study was to characterise the floristic and phytosociological composition on a stretch of dense "Terra Firme" rainforest located in the Belo Monte hydroelectric plant area of influence, located in the state of Pará, Brazil. All trees with DAP >10 cm situated in 75 permanent plots of 1 ha were inventoried. 27,126 individuals trees (361 ind.ha-1), distributed in 59 botanical families, comprising 481 species were observed. The families with the largest number of species were Fabaceae (94), Araceae (65) and Arecaceae (43), comprising 43.7% of total species. The species Alexa grandiflora (4.41), Cenostigma tocantinum (2.50) and Bertholletia excelsa (2.28) showed the highest importance values (IV). The ten species with greater IV are concentrated (22%). The forest community has high species richness and can be classified as diverse age trees, heterogeneous and of medium conservation condition.

Responses of CYP450 dependent system to aliphatic and aromatic hydrocarbons body burden in transplanted mussels from South coast of Portugal

Mussels Mytilus galloprovincialis were cross-transplanted at South Portugal from a reference site (site 1) to a site more contaminated with hydrocarbon compounds (site 2), and vice versa, in an active biomonitoring (ABM) concept, to assess the biotransformation capacity catalyzed by the mixed function oxygenase (MFO) system. Total alkanes (TAlk), the unresolved complex mixture (UCM), and total polycyclic aromatic hydrocarbons (TPAHs) concentration increased respectively 6, 4.4 and 4.2 fold relatively to control, in mussels transplanted from site 1 to 2. In the cross-transplant, a 48, 57 and 62% depuration of TAlk, UCM and TPAHs concentrations occurred by the end of the 3-4th week. Petrogenic and biogenic (marine and terrigenous) sources of AHs, and petrogenic and pyrolitic (biomass and oil/fuel incomplete combustion) sources of PAHs were detected at both sites. CYP450, CYT b (5) and NADPH-RED in mussels transplanted from site 1 to 2 were induced from day 0 to 28, with a total increase of 35, 32 and 35%, respectively, while biochemical equilibrium to lesser environmental contamination occurs in mussels transplanted from site 2 to 1. A significant relationship between CYP450 and NADPH-RED was found with TPAH, with distinctive behavior at the two sites. MFO system components increase with exposure time at one site and decreases in the other, reflecting an adaptation to distinct environmental hydrocarbon loads. The ABM strategy proved to be useful to understand the environment real impact on the biochemical responses in mussels' local populations. In this study, CYP450 and NADPH-RED are a useful biomarker for hydrocarbon exposure.

Prevalence of diabetes mellitus in a rural population of Goa, India

BACKGROUND

We aimed to estimate the prevalence of diabetes mellitus and study the associated factors in a rural population in Goa, India.

METHODS

A cross-sectional study was done in the rural area of Mandur, Goa. Participants>20 years of age were selected by systematic random sampling. They were interviewed with the help of a structured, pretested questionnaire. This was followed by clinical examination, anthropometry and relevant laboratory investigations. Diabetes mellitus was defined as per the American Diabetes Association (ADA) criteria. Statistical analysis was done using the SPSS software package (version 14.0).

RESULTS

The prevalence of diabetes mellitus in the study population was 10.3% (130/1266) with a prevalence of 8.4% among men and 12% among women. On bivariate analysis, the prevalence of diabetes mellitus was found to be significantly associated with age, occupation, family income, family history of diabetes, smoking, obesity, hypertension, and high serum cholesterol and triglycerides levels. Multiple logistic regression analysis identified age, family history, hypertension, smoking, total cholesterol and triglyceride as the Independently associated variables for diabetes mellitus.

CONCLUSION

Innovative community outreach programmes are required to create awareness, and for screening and treatment of diabetes mellitus to curb the growing epidemic of diabetes in the population.

Organic pollutants in microplastics from two beaches of the Portuguese coast

Microplastics pose a threat to coastal environments due to their capacity to adsorb persistent organic pollutants (POPs). These particles (less than 5 mm in size) are potentially dangerous to marine species due to magnification risk over the food chain. Samples were collected from two Portuguese beaches and sorted in four classes to relate the adsorption capacity of pollutants with color and age. Polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and DDTs were analysed on pellets through gas chromatography mass spectrometry (GC-MS), and types of plastic were identified using Fourier transformed infra-red spectroscopy (micro-FTIR). Microplastics were mostly polyethylene and polypropylene. Regarding sizes, some fibres ranged from 1 to 5 μm in diameter and were 500 μm in length. The majority of samples collected had sizes above 200 μm. Black pellets, unlike aged pellets, had the highest concentrations of POPs except for PAHs in Fonte da Telha beach. PAHs with higher concentrations were pyrene, phenantrene, chrysene and fluoranthene. Higher concentrations of PCBs were found for congeners 18, 31, 138 and 187. Further investigation is necessary to understand the relationship between plastic degradation and adsorption for different pollutants.

Validating a multi-biomarker approach with the shanny Lipophrys pholis to monitor oil spills in European marine ecosystems

Oil spills are an importance source of polycyclic aromatic hydrocarbons (PAHs) in the aquatic environment. Intertidal communities are particularly sensitive since most organisms from these ecosystems are sessile or present reduced mobility. Hence, it is important to validate the use of resident species as sentinels to characterize the impact of oil spills on the rocky shores and the improvement during the restoration process. Recently the advantages of using the shanny Lipophrys pholis in pollution monitoring within the northwestern Atlantic coast has been pointed out. Therefore, with the aim of further validating the use of L. pholis in pollution monitoring associated with petrogenic hydrocarbon contamination, a multi-biomarker approach study was carried out 1 week after a moderate oil spill from the waste treatment plant (WTP) of the major Portuguese refinery in the north of Portugal (Petrogal). Fish collected at 2 km from the accident displayed a significant induction of ethoxyresorufin-O-deethylase activity (EROD) and fluorescent aromatic compounds (FACs) in bile (up to a 5-fold induction) in comparison with the pre-spill scenario, and a 15% induction in erythrocytic nuclear abnormalities (ENA), a biomarker of genotoxicity. In contrast, no significant differences were recorded in the reference site. In order to better characterize the time-course accumulation of FACs in bile after a PAH insult, laboratory exposure of L. pholis to benzo[a]pyrene (B[a]P) was performed. A clear dose-response accumulation of B[a]P metabolites was observed that closely reflected nominal exposure concentrations already after 3d. Overall, the findings of the present study highlight the potential of L. pholis in pollution monitoring dealing not only with chronic contamination, but also with oil spill accidents of a moderate scale. Taking into consideration that EROD and FACs determinations in L. pholis are cost effective, rapid and easy to use, they offer a great potential to be incorporated into risk assessment of PAHs in the scope of national monitoring programs and the European Water Policy legislation.

Prevalence of human cysticercosis and taeniasis in rural Goa, India

A cross sectional study among 450 individuals selected by strafified random sampling was carried out in rural Goa to find out the prevalence of cysticercosis and taeniasis, as well as to study the role of various factors associated with this diseases. The study participants were administered a pre-tested structured questionnaire and subsequently blood and stool samples were examined. SPSS software was used to analyze the data statistically. The sero-prevalence of cysterosis was 22.4%, which increased with age. Prevalence of taeniasis was 9.7% by stool examination. Individuals with taeniasis were thrice more likely to have cysticercosis; however no association between sero-positivity for cysterosis and pork consumption as well as religion could be established. The study confirmed a high sero-prevalence of cysticercosis in Goa underscoring the need to general awareness about good cooking habits and sanitation.

Resistance of the Echinococcus granulosus cyst wall to complement activation: analysis of the role of InsP6 deposits

The larva of the cestode Echinococcus granulosus (hydatid cyst) is protected by the acellular laminated layer (LL). The mechanisms that make this thick coat a poor activator of host complement are incompletely understood. The structure binds, through unknown motifs, the host regulator of the alternative complement pathway (ACP), factor H. A second potential mechanism of ACP regulation, the inhibition of factor B activation, was detected in assays employing purified components (Immunopharmacology 42 : 91). The inhibitor was subsequently identified as myo-inositol hexakisphosphate (InsP(6)), which in the form of nano-deposits is a major component of the LL (Biochem J 362 : 297; J Cell Biochem 93 : 1272; FEBS J 273 : 3192). In this report we show that colloidal InsP(6 )solids inhibit factor B activation, through adsorption and associated impairment of C3b binding. However, this interaction is not relevant in the presence of serum proteins. In serum, InsP(6) deposits instead bind C1q, and initiate complement activation. This activation is curtailed through efficient C3b inactivation, previously shown to be entirely factor H-dependent, and now observed to be independent of the InsP(6) deposits. Therefore the complement resistance of the LL must be based on functional factor H binding sites present on the mucin-based meshwork that is its other major constituent.

Sediment contamination, bioavailability and toxicity of sediments affected by an acute oil spill: Four years after the sinking of the tanker Prestige (2002)

Sediment contamination and three bioassays were used to determine the sediment quality four years after an oil spill (Prestige, 2002): the Microtox test, a 10-day bioassay using the amphipod Ampelisca brevicornis, and a polychaete 10-day toxicity test with the lugworm Arenicola marina. In addition, bioaccumulation of PAHs was examined in the polychaete after 10 days of exposure. The results obtained from the toxicity tests and bioaccumulation analyses were statistically compared to the sediment chemical data, in order to assess the bioavailability of the contaminants, their effects, and their relationship with the oil spill. The sediments studied were from two areas of the Galician Coast (NW Spain): the Bay of Corme-Laxe and the Cíes Island, located in the Atlantic Island National Park. The results point to a decrease in contamination with respect to previous studies and to the disappearance of the acute toxicity four years after the oil spill. However an important bioaccumulation of PAHs was detected in the organisms exposed to sediments from Corme-Laxe, suggesting that despite the recovery of the environmental quality of the area, effects in the biota might be occurring.

Comparative petroleum hydrocarbons levels and biochemical responses in mussels from hydrothermal vents (Bathymodiolus azoricus) and coastal environments (Mytilus galloprovincialis)

Aliphatic hydrocarbons and PAHs in the whole soft tissues of Bathymodiolus azoricus from three Mid-Atlantic Ridge hydrothermal vents (Menez-Gwen, Lucky Strike and Rainbow), and Mytilus galloprovincialis from three contaminated coastal sites in South Portugal were analysed, and its effects on the digestive gland microsomes mixed-function oxygenase system (MFO) were assessed. Aliphatic hydrocarbons levels were present in the same magnitude in both coastal and hydrothermal environments, while the UCM (unresolved complex mixture) for coastal mussels were higher than in vent mussels. In general, significantly higher PAHs concentrations were found in coastal mussels, compared to B. azoricus where low molecular weight PAHs (2-3 rings) represented the majority of PAHs contrarily to what was observed in M. galloprovincialis. The MFO components were present in both mussel species, and were detected in vent mussels for the first time. However this system seems to have different roles in species from these contrasting environments. In coastal mussels MFO responded to hydrocarbon contamination while response in hydrothermal organisms appeared to be related mainly to endogenous factors.

Is Arenicola marina a suitable test organism to evaluate the bioaccumulation potential of Hg, PAHs and PCBs from dredged sediments?

This paper presents the results of investigations on the suitability of lugworms (Arenicola marina) to study the bioaccumulation potential of Hg, PCB and PAH compounds from dredged sediments upon laboratory exposure. The results of tissue concentrations for several sediments from Spanish ports showed that it is possible to identify increased levels of contaminants in lugworms just after 10 days of exposure although different bioaccumulation trends were shown amongst compounds and sediments. Total and organic Hg compounds were accumulated following a non-linear trend, with a sharp increase of tissue concentrations in lugworms exposed to levels of contamination associated to a significant increase in mortality. Interestingly organic Hg compounds accounted for an average of 40% of the total Hg in lugworms exposed to sediments presenting sublethal concentrations while, when exposed to sediments presenting lethal concentrations, organic Hg compounds only accounted for 4% of the total Hg accumulated in lugworms. While lugworms seem to readily accumulate Hg and PCB compounds, with some variability explained by the organic matter content in sediments or other factor for which it accounts for, the results for PAHs suggest a more complex process of bioaccumulation as no relationship was observed between the measured concentrations in sediments and in lugworms, not even after correcting the results for this factor. Besides, the differences in the calculated BSAFs for each compound and for each sediment supported the use of bioassays for evaluating the bioaccumulation potential of sediment-bound contaminants as part of the assessment framework required in pre-dredging investigations, as they still offer unique information about the bioavailability of sediment-bound contaminants.

The use of the shanny Lipophrys pholis for pollution monitoring: a new sentinel species for the northwestern European marine ecosystems

The contamination of aquatic ecosystems by organic contaminants such as polycyclic aromatic hydrocarbons (PAHs) is a matter of great concern. Mussels have been extensively used as sentinel species in a large number of monitoring programs. However, the use of bivalves as the sole species has some limitations, because they are not as responsive as fish to Aryl Hydrocarbon Receptor agonists. Hence, for many marine areas, there is the need to validate new sentinel fish species that can be used in the assessment of pollution by organic contaminants. The shanny Lipophrys pholis is an intertidal fish that combines many characteristics required in a sentinel species: is abundant and easy to catch, has a wide geographical distribution and restrict home range. After larvae recruitment to the intertidal rocky shores, they remain in the same area for the rest of the life-cycle, thus reflecting local pollutants exposure. In order to evaluate the species sensitivity to organic contaminants under field conditions, L. pholis were collected at six sites reflecting different degrees of anthropogenic contamination. The induction of two biomarkers extensively validated in the assessment of PAHs contamination ethoxyresorufin-O-deethylase activity (EROD) and Fluorescent Aromatic Compounds (FACs) was evaluated. In parallel, mussels were collected at the same locations and levels of 16 PAHs and selected heavy metals determined. Overall, the specimens collected in the urban areas showed a significant induction of EROD and FACs (up to a six-fold induction) if compared with the reference sites. Additionally, a positive correlation was observed between the biomarkers and PAHs levels in mussel tissues. Even though further validation is currently in progress, the available data indicate that L. pholis is responsive to organic contaminants such as PAHs, suggesting its future integration in monitoring programmes designed to evaluate the presence of these contaminants in European marine ecosystems.

Bed utilization indices at a tertiary care hospital in Goa: an eight year trend analysis

A retrospective data analysis of records from medical records department of Goa Medical College Hospital was done to analyse the trends of various bed utilisation indices from 1999 - 2006. Average length of stay, bed occupancy rate, turnover interval and bed turnover ratio were the indices calculated. During the eight year period from 1999 to 2006, the average length of stay for the entire hospital registered a small decline from 6.23 to 5.51 days, the overall bed occupancy rate increased from 72.13% to 83.12% and the bed turnover interval declined from 2.41 days to 1.12 days. The Orthopaedics ward had the highest increase in bed occupancy and also fastest decline in turnover interval in 2006. Bed utilization indices are an objective measure of the efficiency of the hospital management system.

Developmental competence and expression of the Hsp 70.1 gene in oocytes obtained from Bos indicus and Bos taurus dairy cows in a tropical environment

Bos indicus cows usually have better reproductive performance in tropical and subtropical regions than Bos taurus cows, presumably due to their better adaptation to tropical environments. The aim of this study was to evaluate the developmental competence and expression of the Hsp 70.1 gene in immature oocytes from B. taurus (Holstein) and B. indicus (Gyr) dairy cows raised in a tropical region. Cumulus-oocyte complexes were obtained by transvaginal ultrasound-guided follicle aspiration between spring and early autumn, and subjected to in vitro maturation and fertilization. Presumptive zygotes were co-cultured with their own cumulus cells in CR2aa media with 10% fetal calf serum; Grade 1 blastocysts were transferred to synchronized crossbred recipients. The total RNA was extracted from immature Holstein and Gyr oocytes (three pools for each breed) and relative quantification of the Hsp 70.1 transcripts was performed by real time PCR after reverse transcription. Cleavage and blastocyst rates were greater (P<0.05) for Gyr (n=390 oocytes) than Holstein (n=505) breed (66.7% versus 53.1% of cleavage and 19.6% versus 10.8% of blastocysts, respectively), but pregnancy rates were not significantly different following transfer to recipients (44.5% for 36 Gyr embryos; 60% for 10 Holstein embryos). Holstein immature oocytes had a higher level (P<0.05) of Hsp 70.1 relative expression (1.82+/-0.22; mean+/-S.E.M.) than Gyr oocytes (1.12+/-0.11). In conclusion, Gyr oocytes obtained in a tropical region were less subject to stress and more likely to develop (after IVF) than Holstein oocytes.

Doppler assessment of uterine blood flow in recurrent pregnancy loss

OBJECTIVE

To compare uterine artery pulsatility index (PI) and flow velocity wave (FVW) patterns between women with no history of abortion and women with recurrent pregnancy loss of unexplained cause.

METHOD

A cross-sectional study was conducted with 43 women with recurrent pregnancy loss and 43 women with no history of abortion and at least 1 child born at term (control group). Transvaginal ultrasonography with uterine artery Doppler evaluation was performed in the second phase of the menstrual cycle to calculate the PI and analyze the FVW pattern.

RESULTS

The women with recurrent pregnancy loss had a significantly higher uterine artery PI than those in the control group (2.71+/-0.54 and 2.30+/-0.44, respectively), as well as a higher incidence of FVWs of the A and B types.

CONCLUSION

Compared with the control group, a higher PI and a higher incidence of FVW of the A and B types--and thus a higher uterine artery impedance--were found among women with recurrent pregnancy loss.

Eosinophil cationic protein damages protoscoleces in vitro and is present in the hydatid cyst

Eosinophils are locally recruited during the establishment and chronic phases of cystic hydatidosis. This study provides evidence that eosinophil cationic protein (ECP), one of the major components of eosinophil granules, can damage Echinococcus granulosus protoscoleces (PSC). The toxicity of ECP was investigated in vitro by following parasite viability in the presence of this protein. ECP was found to damage PSC at micromolar concentrations; the effect was blocked by specific antibodies and heparin, and was more severe than the one caused by similar concentrations of RNase A, suggesting that the cationic nature of ECP, and not its ribonuclease activity, is involved in toxicity. This observation may highlight the capacity of eosinophils to control secondary hydatidosis, derived from PSC leakage from a primary cyst. To further assess the relevance of the previous result during infection, the presence of eosinophil proteins was investigated in human hydatid cysts. ECP was found to be strongly associated with the laminated layer of the cyst wall, and present at micromolar concentrations in the hydatid fluid. Overall, these results demonstrate that eosinophils degranulate in vivo at the host-parasite interface, and that the released ECP reaches concentrations that could be harmful for the parasite.