Disruption of gut barrier integrity and host-microbiome interactions underlie MASLD severity in patients with type-2 diabetes mellitus

Aberration of the "gut-liver axis" contributes to the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). Here, we use multi-omics to analyze the gut microbiota composition and metabolic profile of patients with type-2 diabetes mellitus (T2DM). T2DM patients were screened for liver disease by blood tests, ultrasound, and liver stiffness measurements. Stool microbiota was analyzed by 16S rRNA gene sequencing; metabolomic profiling by Nuclear Magnetic Resonance spectroscopy and Ultra-High Performance-Mass Spectrometry. Microbiome and metabolic signatures were analyzed in the whole cohort and in matched subsets to identify signatures specific for steatosis (MASLD±) or fibrosis (Fibrosis±). Gut permeability was assessed in-vitro using monolayers of MDCK cells and trans-epithelial electric resistance (TEER). Cytokine profile was assessed in serum and stools.Overall, 285 patients were enrolled: 255 serum, 252 urine and 97 stool samples were analyzed. Anaeroplasma and Escherichia/Shigella ASVs were higher, while Butyricicoccus ASVs were lower in those with normal liver. In MASLD±, Butyricicoccus ASV was significantly higher in those with steatosis. In the Fibrosis±, Butyricicoccus ASV was significantly lower in those with fibrosis. Glycochenodeoxycholic acid-3-sulfate (G-UDCA-3S) appeared to be higher in MASLD with fibrosis. Fecal water from patients with MASLD and fibrosis caused the greatest drop in the TEER vs those with normal liver; this was reversed with protease inhibitors. Finally, fecal IL-13 was lower in MASLD with fibrosis. We identified microbiome signatures which were specific for steatosis and fibrosis and independent of other metabolic risk factors. Moreover, we conclude that protease-related gut permeability plays a role in those MASLD patients with fibrosis, and that disease progression is linked to a gut-liver axis which is at least partially independent of T2DM.

Brainstem phaeohyphomycosis due to Curvularia lunata (Cochliobolus lunatus) in a cat

A 13-year-old female neutered domestic short-hair cat was presented with chronic progressive vestibular ataxia, lethargy and anorexia. Clinical examination revealed bilateral mucopurulent nasal discharge. Neurological examination revealed obtundation, a right head tilt, ambulatory tetraparesis, generalised vestibular ataxia, decreased postural reactions in all limbs, right Horner's syndrome, spontaneous conjugate jerk rotatory nystagmus and right positional ventral strabismus. Neuroanatomical localisation was observed in the right central vestibular system. Computed tomography revealed a solitary ill-defined contrast-enhancing mass lesion at the level of the right cerebellopontine angle. Cerebrospinal fluid (CSF) analysis revealed mild mononuclear pleocytosis and fungal elements. CSF culture was positive for Curvularia spp. Further tests for underlying diseases were all negative. The cat was treated with antibiotic and antifungal treatment, but it deteriorated rapidly and was euthanased. Necropsy of the brainstem mass lesion revealed pyogranulomatous inflammation. Panfungal polymerase chain reaction (PCR) targeting the internal transcribed spacer (ITS) region and subsequent sequencing identified Curvularia lunata in the formalin fixed brain tissue. This is the first report of brainstem phaeohyphomycosis by Curvularia lunata (Pleosporales) in a cat. In addition, this is the first report among animal and humans where fungal elements of Curvularia lunata were found in the CSF cytology. Opportunistic fungal pathogens should be always considered within the differential diagnoses list in cats with neurological signs and advanced imaging findings compatible with solitary mass lesions in the brain. In feline patients with pyogranulomatous meningoencephalitis and a suspicion of a fungal aetiology, panfungal PCR for the ITS region and sequencing should be performed regardless of the absence of fungal elements in histopathology.

Training development in the ORAMMA (Operational Refugee and Migrant Maternal Approach) project

Background

ORAMMA is a European capacity-building project (GR, NL, UK) for pregnant migrant, asylum-seeking and refugee (MAR) women to improve maternal and newborn outcomes. ORAMMA is an operational and strategic approach for mother-centred, community-oriented, gender-sensitive, interdisciplinary and compassionate care, to meet the needs of MAR women in Europe.

Objectives

ORAMMA developed training for midwives and other primary health and social care (PC) professionals to meet the needs of MAR women. Methodology comprised three phases: evidence synthesis and needs assessment, training material development, and community enablement through locally recruited women in the innovative role of Maternal Peer Supporters (MPSs).

Results

Needs assessment highlighted the need to train ORAMMA’s teams of midwives and other PC professionals to care for women who suffered undue hardship, oftentimes leading to PTSD, i.e., victims of trafficking, rape, underage women, sufferers of acute or chronic conditions, and sole family carers. The experiences encountered informed curriculum development for midwives and other PC professionals. Interprofessional training for integrated perinatal care delivery was developed for and delivered in three phases, i.e., detection of pregnancy (GP coordination), care during pregnancy (midwive coordination), and support after birth (social worker coordination), with special modules developed in a participatory manner on: migration status and policies, maternity care for MAR women, and communication and culturally sensitive practices.

Conclusions

Training midwives and other PC professionals along with members of MAR communities in the MPS role was identified to be a key element to efficiently support women and their families, to propagate key perinatal and public health messages, and to advocate for the rights of MAR women to ensure access equity to quality care in a highly responsive manner. ORAMMA’s tools are available in easily accessible platform online.

Key messages

ORAMMA developed multilingual material to meet the needs of PC professionals and of MAR women, in an innovative manner and with high relevance for cross-border knowledge transfer. ORAMMA addressed key aspects in delivery and access, focusing on cultural awareness and communication; its relevance extends well beyond perinatal care to improved family outcomes and public health.

Particulate matter pollution from aviation-related activity at a small airport of the Aegean Sea Insular Region

The unprecedented growth in aviation during the last years has resulted in a notable increase of local air pollution related to airports. The impacts of aviation on air quality can be extremely high particularly around airports serving remote insular regions with pristine atmospheric environments. Here we report measurements that show how the atmospheric aerosol is affected by the activity at a small airport in a remote region. More specifically, we provide measurements performed at the airport of Mytilene, Greece, a regional yet international airport that serves the entire island of Lesvos; the third largest island of the country. The measurements show that the activity during landing, taxiing and take-off of the aircrafts accounted for up to a 10-fold increase in particulate matter (PM) mass concentration in the vicinity of the airport. The number concentration of particles having diameters from 10 to 500nm also increased from ca. 4×10² to 8×10⁵particlescm^-3, while the mean particle diameter decreased to 20nm when aircrafts were present at the airport. Elemental analysis on particle samples collected simultaneously at the airport and at a remote site 3km away, showed that the former were significantly influenced by combustion sources, and specifically from the engines of the aircrafts. Our results show that despite their small size, local airports serving remote insular regions should be considered as important air pollution hotspots, raising concerns for the exposure of the people working and leaving in their vicinities to hazardous pollutants.

Low-dose alemtuzumab for GvHD prevention followed by prophylactic donor lymphocyte infusions in high-risk leukemia

We analyzed the use of low-dose alemtuzumab in a cohort of 158 consecutive patients who underwent allogeneic PBSC transplantation. Patients with high-risk acute leukemia were prospectively screened for prophylactic donor lymphocyte infusion (pDLI). Lymphocytes were administered repeatedly at low and non-escalating doses (0.5-1 × 10⁶/kg). Low-dose alemtuzumab was effective in prevention of acute GvHD after sibling or well-matched unrelated transplantation, whereas a more intensified approach was needed after mismatched transplantation. The cumulative incidence of chronic moderate/severe chronic-GvHD (cGvHD) was 15.6%. In total, 63 high-risk leukemia patients were eligible for pDLI. Only 1 out of the 39 pDLI recipients relapsed as compared with 7 out of the 24 recipients, who did not receive pDLI due to logistical hurdles. In multivariate analysis, the use of adjuvant lymphocyte therapy was significantly associated with reduced incidence of relapse and improved disease-free survival. In summary, low-dose alemtuzumab confers to a low cGvHD incidence and the administration of pDLIs in this context is very likely to reduce relapse risk in high risk leukemia patients. This is translated in an estimated 5-year probability of GvHD-free and relapse-free survival of 43.3% for the 136 leukemia patients.

Influenza surveillance during the post-pandemic influenza 2010/11 season in Greece, 04 October 2010 to 22 May 2011

In this manuscript, we summarise the experience of Greece during the post-pandemic influenza season 2010/11 from 04 October 2010 to 22 May 2011. The spread of the disease and its impact were monitored using multiple surveillance systems, such as sentinel surveillance, virological surveillance and all-cause mortality surveillance. We also focus on the characteristics of laboratory-confirmed severe influenza cases who required admission to an intensive care unit (ICU) (n=368), and/or with a fatal outcome (n=180). The influenza-like illness rate reported from sentinel surveillance started rising in early January 2011 and peaked between 31 January and 6 February 2011. The total number of ICU admissions was higher in the post-pandemic influenza season than during the pandemic period causing a lot of pressure on ICUs. The overall population mortality rate due to influenza A(H1N1)2009 was higher than during the pandemic period (15.9 vs 13.2 fatal cases per million, p=0.087). Our data suggest that the severity of clinical illness in the first post-pandemic influenza season was comparable or even higher than during the pandemic.

Influenza surveillance during the post-pandemic influenza 2010/11 season in Greece, 04 October 2010 to 22 May 2011

In this manuscript, we summarise the experience of Greece during the post-pandemic influenza season 2010/11 from 04 October 2010 to 22 May 2011. The spread of the disease and its impact were monitored using multiple surveillance systems, such as sentinel surveillance, virological surveillance and all-cause mortality surveillance. We also focus on the characteristics of laboratory-confirmed severe influenza cases who required admission to an intensive care unit (ICU) (n=368), and/or with a fatal outcome (n=180). The influenza-like illness rate reported from sentinel surveillance started rising in early January 2011 and peaked between 31 January and 6 February 2011. The total number of ICU admissions was higher in the post-pandemic influenza season than during the pandemic period causing a lot of pressure on ICUs. The overall population mortality rate due to influenza A(H1N1)2009 was higher than during the pandemic period (15.9 vs 13.2 fatal cases per million, p=0.087). Our data suggest that the severity of clinical illness in the first post-pandemic influenza season was comparable or even higher than during the pandemic.

Serratia infections in a general hospital: characteristics and outcomes

We aimed to present our experience regarding infections caused by Serratia spp. in a region with relatively high antimicrobial resistance rates. We retrospectively reviewed the databases of the microbiological laboratory of the University Hospital of Heraklion, Crete (2/2004-12/2009). A total of 77 patients [67.5% men, mean age ± standard deviation (SD) = 56.9 ± 24.5 years) were identified; 37.7% were outpatients. Sixty-five (84.4%) of the 77 included patients had a Serratia marcescens isolate; the remaining 12 patients had a non-marcescens Serratia spp. The most frequently observed infections were respiratory tract infection (32.5%) and keratitis/endophthalmitis (20.8%). Seventy-three (94.9%) patients were cured. Four deaths were observed; three of them were considered as attributed to the Serratia infection. No difference was found regarding the characteristics and outcomes between patients with Serratia marcescens and non-marcescens infections. In addition, antipseudomonal penicillins and their combinations with beta-lactamase inhibitors, as well as carbapenemes, and fluoroquinolones exhibited high antimicrobial activity against both the tested Serratia marcescens and non-marcescens isolates. Our study adds useful information regarding the characteristics and outcomes of patients with Serratia infection, as well as the susceptibilities of the respective Serratia marcescens and non-marcescens isolates, in a region with relatively high levels of antimicrobial resistance.

A pseudo-outbreak of human A/H5N1 infections in Greece and its public health implications

The recent wide geographic spread of the highly pathogenic avian influenza A/H5N1 virus has important public health implications. Several wild migratory birds were confirmed to be infected with avian influenza A/H5N1 in Greece in February and March 2006. The aim of this paper is to report data from potential H5N1 human cases that presented to local hospitals during this period with a respiratory infection and expressing concern about exposure to avian influenza. A case-control investigation was conducted that included case identification with the use of a structured definition, review of epidemiological and clinical characteristics and molecular testing for avian influenza A/H5N1. The setting was the entire country of Greece during February and March 2006. The main outcomes were rates of possible cases (meeting both a clinical and an epidemiological criterion) and clinical or epidemiological characteristics differentiating them from potential cases that met either one of the criteria of a possible case, but not both. Twenty six potential patients (81% of whom met a clinical criterion, and 39% of whom met an epidemiological criterion) presented and most (85%) were admitted in local hospitals during the period of interest. The majority of cases (85%) were observed in northern Greece where most of the confirmed A/H5N1 avian cases were documented. Five of the 26 evaluated patients met the definition of a possible case. These clustered within the early period of confirmed A/H5N1 cases in wild migratory birds (P=0.05). Molecular testing was negative for all possible cases. Application of a revised case definition constructed according to newer European Union guidance resulted in the exclusion of two possible cases. Several potential A/H5N1 human cases were recently identified in Greece. Both the timing of identification and the geographical location of potential cases suggest an increased awareness on the part of the general public, as well as poor interpretation of the case definition by the clinicians.