Whole antigenic lysates of Ixodes ricinus, but not Der-p2 allergen-like protein, are potent inducers of basophil activation in previously tick-exposed human hosts

The clinical suspicion of tick anaphylaxis is based on a history of the bite and occurs often during the warm season. Further arguments are the presence of natural hosts in the immediate environment and, eventually, the identification of the tick. The diagnosis is confirmed when immediate-type sensitization is shown by positive skin prick tests performed with specific tick extracts or the demonstration of specific IgE in vitro. In the current study, we hypothesize that hard tick-derived material contains potent inducers being able to promote basophil stimulation, which correlates with a sensitization immunological response following tick bites. To this end, biological material from two hard tick cell lines (IRE11 and IDE8 - derived from Ixodes ricinus and I. scapularis, respectively) as well as I. ricinus salivary gland and body lysates were used in a human basophil activation test (BAT) to analyse binding and cross-linking capacity of membrane-bound IgE, because basophils are one of the main effector cells of allergic reactions. Additionally, Der-p2 allergen-like gene from I. ricinus was recombinantly expressed as a 15-kDa histidine-tagged fusion protein, purified and included as a stimulus within the setup. Blood was drawn and submitted to BAT screening from a pool of 36 individuals, both bitten and who served solely as negative controls. We have found that seven subjects (19%), all of whom were at least two times tick-bitten, positively reacted to the aforementioned stimuli, whereas the reactivity level of the ones bearing single bites proved to be within the normal range. Moreover, no significant upregulation of the assessed basophil activation marker was detected in the case of Der-p2, except a faint reaction at high dosages. We conclude that at least two tick bites of the human host must occur in order to induce significant basophil activation.

Coinfection of sheep with Anaplasma, Theileria and Babesia species in the Kurdistan Region, Iraq

Infections of small ruminants with Anaplasma, Theileria and Babesia species are widely distributed in the old world and are of great economic impact. In Iraq, data on disease occurrence in sheep caused by above-mentioned infectious agents are scarce. This study provides information on various haemoparasitic agents infecting sheep in the Kurdistan Region, Iraq, using molecular diagnostic tools. Altogether, 195 samples originating from three governorates in the Kurdistan Region, namely Duhok, Erbil and Sulaimaniya, were analysed. The following pathogens were identified: Anaplasma ovis (62.6%), Theileria ovis (14.35%), T. lestoquardi (7.7%), T. uilenbergi (5.6%) and Babesia ovis (1.5%). T. uilenbergi is detected for the first time in Iraq. Coinfection of sheep with different pathogens could be observed in this study, and it was found that 45 of 195 (23%) of the samples contained more than one pathogen. Even triple-positive samples were identified in 3% of the investigated animals. In conclusion, we confirm the coinfection of sheep with various haemoparasitic pathogen species in the Kurdistan Region of Iraq. Further investigations are needed to reveal the epidemiology of the diseases, the respective tick vectors, and, in the case of coinfection, pathogens' interaction and possible cross-protection.

Can Anaplasma ovis in small ruminants be neglected any longer?

Anaplasma species are obligate intracellular rickettsial pathogens transmitted by ticks with an impact on human and animal health. Anaplasma ovis infects sheep and goats in many regions of the world, and it can be diagnosed by different methods like Giemsa staining, PCR or competitive ELISA. In this study, a PCR based on the gene coding for major surface protein 4 (MSP-4) was used to examine field samples collected from sheep in different countries. Altogether, 1161 blood samples from Turkey (n = 830), Iraq (n = 195), Sudan (n = 96) and Portugal (n = 40) were examined, of which 31.4%, 66.6% 41.6% and 82.5%, respectively, were positive. This indicates high prevalence of A. ovis in the countries under investigation, and it can be assumed that the situation in other areas of the world might be similar. Thus, A. ovis should be considered as an important constraint of livestock production, and further efforts are needed to better understand the epidemiology and to implement suitable control measures.

Pathophysiology, clinical presentation and management of diversion colitis: a review of current literature

INTRODUCTION

Diversion colitis is a non-specific inflammation of a de-functioned segment of intestine after diversion of the faecal stream.

AIM

The aim of this study was to review the current level of knowledge about diversion colitis.

METHODS

A literature search of relevant literature in the English language was carried out on PUBMED, MEDLINE and EMBASE. The following keywords were used: diversion colitis; disuse colitis; proctitis; colonic bacterial flora; stoma; de-functioned colon; faecal diversion; short chain fatty acids and lymphoid follicular hyperplasia.

RESULTS

In total 35 articles met the inclusion criteria. 22 were case series, 9 were case reports, 2 were retrospective analysis and 2 were prospective randomized controlled studies. Diversion colitis is invariably present in all diverted segments of the colon. It is usually asymptomatic but can present with tenesmus, rectal discharge, bleeding per rectum and abdominal pain. Major macroscopic changes include mucosal nodularity, erythema and friability. Microscopic features are predominantly those of lymphoid follicular hyperplasia, apthous ulceration and chronic inflammatory changes, mostly limited to sub mucosa. Treatment modalities include surveillance for asymptomatic patients, restoration of bowel continuity for severely symptomatic cases and the use of short chain fatty acid (SCFA) enemas in selected cases.

CONCLUSION

The clinical presentation of diversion colitis varies significantly. In symptomatic patients short chain fatty acid enema may help. Further prospective studies are required for evaluation.

Direct access colonoscopy in primary care: is it a safe and practical approach?

BACKGROUND

Implementation of colorectal cancer screening programme and provision of cancer service within certain timeframe has significantly increased the workload on endoscopy services. Direct access colonoscopy in primary care centers helps offload burden on conventional colonoscopy in secondary care, thereby reducing waiting times. The aim of this study was to assess the safety and efficacy of direct access colonoscopy service.

MATERIALS AND METHODS

Provision of colonoscopy service in our healthcare trust was analysed retrospectively during a two-year period. Safety and feasibility of direct access colonoscopy was analysed against conventional colonoscopy. The groups were compared for findings at colonoscopy, procedural outcomes, and complications.

RESULTS

A total of 3468 colonoscopies were analysed. Of those, 1189(34.3%) were performed as direct access colonoscopy and 2279(65.7%) as conventional colonoscopy. No abnormality was detected in 408/1189(34.3%) and 825/2279(36.2%) patients in the direct access colonoscopy and conventional colonoscopy groups, respectively (p = 0.52). Colorectal cancer detection rate was similar between the groups; conventional colonoscopy vs direct access colonoscopy, 3.1% (68/2279) vs 3.2% (39/1189) (p = 0.85). However, there was significantly higher detection rate of polyps greater than 1 cm in conventional colonoscopy group compared to direct access colonoscopy group, 22.6%(518/2289) vs 12.6% (150/1189) (p = 0.02). Complication rates were comparable between the groups.

CONCLUSION

Direct access colonoscopy in primary care centers is safe and feasible. Colorectal cancer detection remains comparable to that of conventional colonoscopy in secondary care despite relatively lower polyp detection rate.

Identification and partial characterization of a Salp15 homolog from Ixodes ricinus

The immunomodulatory molecule Salp15 is originally described in Ixodes scapularis and has been shown to inhibit CD4 T cell activation. Many Salp15 homologs have been described from Ixodes species, and all were well conserved at C-terminal residues that seem to be essential for the function of the protein. In this study, a gene sequence was amplified from cDNA isolated from engorged female I. ricinus ticks, which was predicted to generate a protein of 12.3 kDa. The protein displayed distinct amino acid differences from previously described I. ricinus Salp15 homologs, with amino acid identity ranging between 46.6% and 93.9%. It was referred to as I. ricinus Salp15-like protein. The protein showed 48.1% sequence identity to I. scapularis Salp15. We analyzed the effect of the recombinant I. ricinus Salp15-like protein on the production of cytokines from human peripheral blood mononuclear cells stimulated with LPS. The recombinant protein exerted no effect on the production of TNF-α and IL-6, but the production of IL-10 was dose-dependently reduced. It can be concluded that I. ricinus Salp15-like protein exerts an immunomodulatory effect on the host. The inhibition of IL-10 production may possibly lead to a retardation of B cell activity.

Influence of enhanced recovery after surgery pathways and laparoscopic surgery on health-related quality of life

AIM

This study set out to compare the postoperative health related quality of life (HQoL) of patients undergoing elective open colorectal surgery using a well-established enhanced recovery after surgery (ERAS) pathway with those undergoing laparoscopic surgery without an established an ERAS pathway.

METHOD

Using a power calculation, it was estimated that 40 patients would be required in each group. HQoL of the two groups was prospectively assessed using SF-12 (Short Form 12) and EORTC QLQ 30 (European Organisation of Research and Treatment of Cancer, Quality of Life Questionnaire) preoperatively, and at 2 and 6 weeks after discharge.

RESULTS

Data were collected from 83 patients, 41 in the laparoscopic group and 42 in the open-ERAS group. There was a significant difference between the median length of stay of the open-ERAS (5 days) and laparoscopic (7 days, P = 0.028) groups. There were no significant differences between the HQoL score of the two groups at any stage. In both groups, the majority of HQoL scores had improved considerably by 6 weeks.

CONCLUSION

Laparoscopic and open-ERAS surgery have a similar impact on postoperative HQoL. HQoL tends to improve by the 6-week stage.

Prevalence of and factors associated with obesity among Pakistani schoolchildren: a school-based, cross-sectional study

Childhood obesity is nowadays a concern in the developing world. This cros-sectional study was conducted on 501 randomly selected students from 10 high schools in an urban setting in Hyderabad, Pakistan. Children who were underweight were excluded. Interviews were conducted to determine demographic data, dietary intake, physical activity and other variables that may be associated with obesity. Overall 58 students (12%) had body mass index (BMI)>or=95th percentile, 40 (8%) BMI>or=85th percentile and 403 (80%) had BMI<85th percentile (WHO age- and sex-specific cut-offs). The prevalence of obesity was higher in boys than girls (15% than 8% respectively). In multivariate regression analysis significant risk factors for obesity/overweight were male sex, middle socioeconomic status, poor self-rated athletic ability, trying to lose weight and eating fruit<4 times per week. Childhood obesity is determined by factors in the home, school and society and a multidisciplinary approach is needed to prevention.

Insights into the tobacco cessation scenario among dental graduates: an Indian perspective

INTRODUCTION

To curb the ever growing menace of tobacco and its ill effects, it is essential to prevent its usage. Dental professionals' contributions can be invaluable in this venture.

OBJECTIVES

To assess Indian dental graduates' knowledge, attitude and practices towards tobacco cessation; perceived effectiveness in pursuing tobacco cessation activities; perception of factors that interfere in tobacco cessation as barriers; and willingness to participate in tobacco cessation. Further, to determine associations among the aforementioned variables.

METHODOLOGY

All house surgeons in Manipal College of Dental Sciences, Manipal University, Mangalore were included in the study. A structured, pre-tested and self-administered questionnaire was employed to assess participants' knowledge, attitude, behavior, perceived effectiveness, perceived barriers and willingness to participate in tobacco cessation. Information regarding respondents' age, gender and residence was collected.

RESULTS

A total of 100 out of 103 respondents participated in the study. Mean knowledge, attitude, behavior, perceived effectiveness, perceived barrier scores were 17.6 ± 2.53 (73.2%), 72.1 ± 6.59 (90.2%), 28.3 ± 5.12 (67.4%), 13.3 ± 5.36 (53.16%) and 35.0 ± 3.79 (89.8%) respectively. Overall, 97% respondents were willing to participate in tobacco cessation activities. Correlation analysis revealed that knowledge was associated with attitude (r=0.36, p=0.00) and perceived barriers (r=0.34, p=0.00) and behavior was associated with perceived barriers (r=0.22, p=0.03).

CONCLUSIONS

Respondents reported high knowledge and attitude scores, along with high perceived barriers scores and willingness to participate in tobacco cessation activities. Present study highlights the need for a more meaningful involvement of dental professionals in tobacco cessation and has policy implications for curriculum changes regarding the same.

Sexually transmitted infections and sexual behaviour among youth clients of hotel-based female sex workers in Dhaka, Bangladesh

A cross-sectional study was conducted among youth clients of hotel-based female sex workers (YCHBFSWs) in nine randomly selected hotels in Bangladesh to examine sexual-risk behaviour, condom use and determinants of condom use in last sex, knowledge of HIV, sexually transmitted infection (STI) prevalence and STI care-seeking behaviour. A prestructured questionnaire was used to collect sociodemographic, behavioural, clinical information; urine specimens (before sex) and blood were collected for diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, syphilis and herpes simplex virus 2 (HSV2) infection. One thousand and thirteen participants were enroled in the study. Approximately half of them reported visiting female sex workers (FSWs) at least once a month and 25% visited FSWs at least once a week. Only 12% of participants reported regular condom use. The prevalence of N. gonorrhoeae, C. trachomatis, T. vaginalis, syphilis and HSV2 was 2.2%, 3.9%, 7.2%, 2.6% and 12.9%, respectively. Only 15.3% of the YCHBFSW sought STI care in the past year. Negotiation of condom use with FSWs was the main determinant (odds ratio = 17.95) for condom use at last sex. Male clients of FSWs, including YCHBFSW, are an important bridge population for HIV transmission in Bangladesh and HIV interventions should be designed and implemented for them.

Enhanced recovery after surgery protocols - compliance and variations in practice during routine colorectal surgery

AIM

Although there are numerous studies on the efficacy of enhanced recovery after surgery (ERAS) protocols in reducing length of stay, the long-term compliance to such protocols in routine clinical practice has not been well documented. The aim of this study was to review the published literature on compliance to ERAS in patients undergoing colorectal surgery in routine clinical practice.

METHOD

Medline, Embase and PubMed databases were searched to identify studies that focused on compliance to ERAS protocols during routine clinical practice. Fourteen studies fulfilled the inclusion criteria and a total of 19 perioperative ERAS modalities were identified across these studies.

RESULTS

None of the studies used all 19 ERAS modalities within their ERAS protocols. Compliance to the various modalities varied considerably between studies and, in general, was poorest during the postoperative period. The use of epidural had the highest compliance (between 67 and 100%), whereas the use of transverse incisions (25%) had the lowest compliance. Length of stay in hospital ranged from 2 to 13 days. Higher compliance was associated with a reduced length of hospital stay. However, reduced length of hospital stay was associated with a high rate of readmission.

CONCLUSION

There is significant variation in the components of, as well as in compliance to, ERAS protocols in daily practice. This may contribute to the observed variation between the studies in length of hospital stay. A standardized and practically feasible ERAS protocol should be established in order to improve the implementation and optimal outcome.

MRI brain abnormalities in cochlear implant candidates: how common and how important are they?

OBJECTIVE

To investigate the incidence of abnormal findings on brain MRI in paediatric cochlear implantation candidates.

METHODS

Retrospective review of brain MRI scans of cochlear implant patients between 2000 and 2009 who underwent MRI brain as part of their pre-operative work-up.

RESULTS

MRI scans of 162 patients were reviewed (76 female patients and 86 male patients). The mean age at time of MRI scan was 3 years 8 months. Abnormalities were detected/ reported in 49 patients (30%). The total number of abnormalities detected was 51 (two patients had two separate abnormalities each). Of the abnormalities 82% could be related to known pre-existing conditions. 18% of the abnormalities were incidental/unexpected. Incidental/unexpected abnormalities were found in 9 patients (6%). Four of the patients with incidental abnormalities required referral and further investigations (2.5%). The most common abnormality detected was white matter changes (70%). All the white matter changes were related to pre-existing known medical conditions.

CONCLUSION

At our institution abnormalities detected by pre-operative brain MRI scans on cochlear implant candidates are common (30%). The majority of abnormalities are related to known pre-existing medical conditions. Incidental findings are rare (4%) and approximately half of them required further investigation or referral.