Pilot study to evaluate the safety and effectiveness of etidronate treatment for arterial calcification due to deficiency of CD73 (ACDC).

BACKGROUND: Arterial calcification due to deficiency of CD73 (ACDC; OMIM 211800) is a rare genetic disease resulting in calcium deposits in arteries and small joints causing claudication, resting pain, severe joint pain, and deformities. Currently, there are no standard treatments for ACDC. Our previous work identified etidronate as a potential targeted ACDC treatment, using in vitro and in vivo disease models with patient-derived cells. In this study, we test the safety and effectiveness of etidronate in attenuating the progression of lower-extremity arterial calcification and vascular blood flow based on the computed tomography (CT) calcium score and ankle-brachial index (ABI). METHODS: Seven adult patients with a confirmed genetic diagnosis of ACDC were enrolled in an open-label, nonrandomized, single-arm pilot study for etidronate treatment. They took etidronate daily for 14 days every 3 months and were examined at the NIH Clinical Center bi-annually for 3 years. They received a baseline evaluation as well as yearly follow up after treatment. Study visits included imaging studies, exercise tolerance tests with ABIs, clinical blood and urine testing, and full dental exams. RESULTS: Etidronate treatment appeared to have slowed the progression of further vascular calcification in lower extremities as measured by CT but did not have an effect in reversing vascular and/or periarticular joint calcifications in our small ACDC cohort. CONCLUSIONS: Etidronate was found to be safe and well tolerated by our patients and, despite the small sample size, appeared to show an effect in slowing the progression of calcification in our ACDC patient cohort.(ClinicalTrials.gov Identifier NCT01585402).

Is Escherichia coli O157:H7 a common pathogen in children with bloody diarrhea in Shiraz, Iran?

Escherichia coli (E. coli) O157:H7 is a common cause of bloody diarrhea in developed countries. The aim of this study was to determine whether E. coli O157:H7 is a possible pathogen of bloody diarrhea in southern Iran. Out of 719 children with diarrhea, 243 (34%) patients with positive occult blood took part in our study. The polyclonal antibody test and polymerase chain reaction (PCR) were used to identify E. coli O157:H7. Stool cultures showed enteropathogens in 107 patients (44%). Shigella (34.3%) was followed by E. coli (8.6%), campylobacter (2%) and salmonella (0.4%). None of the E. coli species was of O157:H7 serotype. Antibiotic sensitivity of shigella species was 100% to ceftriaxone, ciprofloxacin and ceftazidime, 94% to nalidixic acid and 13% to co-trimoxazole. The results of the study showed that E. coli O157:H7 is not a cause of bloody diarrhea in our area.

Prevalence of Helicobacter pylori infection in children (south of Iran).

The prevalence of Helicobacter pylori in children ranges from 10% to more than 80%. High prevalence occurs in developing countries, and after colonization it takes an extended period to be eradicated by the immune system. To evaluate the prevalence and age distribution of H. pylori infection in children in Shiraz (a city in the south of Iran), we collected 593 stool samples from children selected randomly from 5 age groups. Infection was determined based on antigen immunoassay in stool using the enzyme-linked immunosorbent assay method. The prevalence rates were 82%, 98%, 88%, 89%, and 57% in age groups of 9 months, and 2, 6, 10, and 15 years, respectively. There were no significant differences between the prevalence of H. pylori infection in the first 4 age groups (P > 0.05), but there was a significant decrease in the 15-year-old group (P < 0.05). The prevalence of H. pylori infection in the south of Iran is very high. The infection begins at infancy and remains high until late childhood.