The prognostic significance of the risk scores at upper gastrointestinal bleeding.

BACKGROUND: Upper gastrointestinal system (GIS) bleeding is one of the most common causes of mortality and morbidity. The predictive values of pre-endoscopic Rockall score (PERS), full Rockall score (FRS), Glasgow-Blatchford score (GBS), pre-endoscopic Baylor score (PEBS), and full Baylor score (FBS) to predict bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death are investigated in our study. METHODS: This study was retrospectively conducted in patients admitted to emergency department with upper GIS bleeding. Demographic and clinical characteristics of the patients were recorded. The relationships of the aforementioned scores with in-hospital termination, bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death were explored. RESULTS: The study included a total of 420 subjects, of which 269 (64%) were men. All scoring systems were able to predict transfusion need and GBS was superior to other scores (P < 0.0001). In terms of endoscopic treatment, it was determined that only PERS, FRS, and FBS were statistically significant in predicting ability and PERS >3, FRS >5 and FBS >10 patients needed endoscopic treatment. All scoring systems were able to predict rebleeding. In comparison of two groups for rebleeding, it was found that PEBS was better able to predict bleeding during follow-up than both FRS and FBS, and PERS was better able to predict bleeding during follow-up than both FRS and FBS. All scoring systems were able to predict mortality. FRS and PERS scores had a greater discriminatory power for predicting death than the rest of the scores (P < 0.001). CONCLUSION: All scoring systems were effective for predicting need for blood transfusion, rebleeding, and death. GBS had more predictive power for transfusion need, PERS and PEBS for rebleeding, and FRS for mortality. PERS, FRS, and FBS were found to be effective in predicting endoscopic treatment.

Allergic reactions to Hymenoptera stings in Turkish school children.

BACKGROUND: Reported prevalence of the insect stings and rates of allergic reactions vary among studies. The aim of the present study was to carry out the first epidemiological study on the prevalence of Hymenoptera allergy among school children in Izmir, Turkey. METHODS: We planned to reach 6100 children, assuming the frequency of allergic reactions to Hymenoptera stings as 20%. Thirty-seven and eight schools were chosen from rural and urban areas, respectively. Parents were asked to complete a questionnaire which included questions about history of insect stings and the presence of atopic disease. All cases with severe systemic reactions and a representative sample from the remaining population were surveyed by telephone afterwards. RESULTS: A total of 8565 questionnaires were distributed and the response rate was 70.8%. Of the 5602 children, 61.6% were stung at least once in their lifetime. Of these, 24.3% had a LLR, 8.1% had a MSR, 0.8% had a SSR. Overall reliability of the questionnaire was calculated as 40.7% for SSR and 91.6% for other reactions after telephone survey. On logistic regression analysis, male sex and rural residence were associated with a higher risk of being stung (OR: 1.39; CI 1.25-1.56; OR: 4.37; CI 3.36-5.69, respectively). Male subjects and asthmatic children were more likely to experience a SSR (OR: 2.44; CI 1.06-5.65; OR: 3.3; CI 1.52-7.19, respectively). CONCLUSION: Hymenoptera stings are common in our population and large local reactions are the most common type of reactions. Prevalence of severe reactions is low in our population compared to previous studies.

Direct genotyping and nucleotide sequence analysis of VS1 and VS2 of the Omp1 gene of Chlamydia trachomatis from Moroccan trachomatous specimens.

To determine the range of ocular strains of Chlamydia trachomatis circulating in southern Morocco, where trachoma is endemic, and to compare the value of the molecular methods for genotyping C. trachomatis, ocular specimens were subjected to a direct Omp1 PCR-restriction fragment length polymorphism (RFLP)-based analysis and direct sequencing. PCR-RFLP analysis shows that the Ba genotype represents the most frequent one (63%), followed by genotype A (45%), whereas no B or C genotypes were identified among the 53 out of 108 specimens that were strongly positive in the Omp1 CT1-CT5 PCR. Our results further show that the notion of interfamily and intrafamily transmission is very likely. To confirm the genotype identity of C. trachomatis as determined by PCR-RFLP, 16 selected specimens were sequenced across variable sequence 1 (VS1) and 2 (VS2). No discrepancies were found between PCR-RFLP typing and the genotype identity confirmed by nucleotide sequencing of the PCR product. Our results clearly indicate that both molecular methods of typing chlamydiae (i.e., PCR-RFLP and sequencing) are important and have specific applications for clinical epidemiological purposes. This is the case for individuals infected with more than one clonal population of C. trachomatis. The unambiguous nucleotide sequencing therefore defines an important epidemiologic descriptor for the infected patient whether the source is from a clonal population of organisms or whether it represents a more dynamic process of strain dominance or genetic change. Furthermore, Omp1 genotyping affords the necessary approach to epidemiologic investigations in areas of the world endemic for trachoma, where only one or two serovars are known to predominate.

[Transmission of tuberculosis in Gironde: epidemiologic investigation by genomic analysis of Mycobacterium tuberculosis]. / Transmission de la tuberculose en Gironde : approche épidémiologique par l'analyse génomique du Mycobacterium tuberculosis.

BACKGROUND: Over the past few years, epidemiologic surveys of tuberculosis have been strengthened by new biologic technology, in particularly using RFLP (Restriction Fragment Length Polymorphism). This technique, which identifies Mycobacterium tuberculosis patterns, has allowed to study thoroughly tuberculosis bacilli transmission and pathogenesis. First applied on tuberculosis epidemics in at risk groups, RFLP has now an interest in the epidemiologic molecular survey of urbans populations. The aim of this study is to identify, in a French department, the proportion of clustering cases of tuberculosis, suspected of recent contamination. METHODS: An active surveillance of tuberculosis allows to record systematically the cases of tuberculosis-disease in Gironde. All M. tuberculosis isolates from the patients reported in this surveillance system were processed through IS6110 based RFLP analysis. Patients were interviewed face to face before this analysis, using a standardised data collection instrument. RESULTS: 102 patients were included in 1997; the RFLP analysis of all available strains identifies a high degree of polymorphism with 71 unique patterns; twelve groups with clustering patterns were found, grouping two (nine clusters), three (two clusters) and seven patients (one cluster) each. Those cases suspected of recent transmission were younger (age<60 years) and lived in poorer conditions. Epidemiologic links were confirmed in only 35% of the 31 patients clustered. CONCLUSION: This community survey analysis has allowed to identify at risk groups for tuberculosis transmission and to strengthen tuberculosis control in Gironde.

Chlamydial infection of polarized HeLa cells induces PMN chemotaxis but the cytokine profile varies between disseminating and non-disseminating strains.

While genital infections caused by Chlamydia trachomatis are generally asymptomatic, the density and pattern of inflammation varies considerably. The purpose of this study was to try to dissect the signalling in chlamydiae-infected epithelial cells that triggers innate responses and regulates polymorphonuclear neutrophil (PMN) chemotaxis. Polarized endocervical epithelial HeLa cells, grown in commercial inserts, were inoculated either with the non-disseminating (luminal) serovar E or the disseminating serovar L2. At 12-48 h after infection, the chambers were used in a quantitative chemotaxis assay, and cytokine production by infected cells was examined using cDNA microarray technology and confirmed by enzyme-linked immunosorbent assay (ELISA). Infection of HeLa cells with C. trachomatis E or L2 induced a strong and similar PMN chemotactic response, but larger amounts of interleukin (IL)-8 and IL-11 were released after infection with serovar L2. IL-6 was also produced in modest amounts after infection with either strain, but no IL-1alpha or tumour necrosis factor (TNF)-alpha was detected in any of the culture supernatants tested. IL-11 did not appear to influence the PMN response to chlamydial infection, but secretion of large amounts of this anti-inflammatory cytokine, mainly active on macrophages, in the very early stages of the infection may allow C. trachomatis to escape some innate defences to establish infection.

Sequencing of gyrase and topoisomerase IV quinolone-resistance-determining regions of Chlamydia trachomatis and characterization of quinolone-resistant mutants obtained In vitro.

The L2 reference strain of Chlamydia trachomatis was exposed to subinhibitory concentrations of ofloxacin (0.5 microg/ml) and sparfloxacin (0.015 microg/ml) to select fluoroquinolone-resistant mutants. In this study, two resistant strains were isolated after four rounds of selection. The C. trachomatis mutants presented with high-level resistance to various fluoroquinolones, particularly to sparfloxacin, for which a 1,000-fold increase in the MICs for the mutant strains compared to the MIC for the susceptible strain was found. The MICs of unrelated antibiotics (doxycycline and erythromycin) for the mutant strains were identical to those for the reference strain. The gyrase (gyrA, gyrB) and topoisomerase IV (parC, parE) genes of the susceptible and resistant strains of C. trachomatis were partially sequenced. A point mutation was found in the gyrA quinolone-resistance-determining region (QRDR) of both resistant strains, leading to a Ser83-->Ile substitution (Escherichia coli numbering) in the corresponding protein. The gyrB, parC, and parE QRDRs of the resistant strains were identical to those of the reference strain. These results suggest that in C. trachomatis, DNA gyrase is the primary target of ofloxacin and sparfloxacin.

Antibiotic susceptibility testing for Chlamydia trachomatis using flow cytometry.

The aim of this study was to compare the effectiveness of two methods of antibiotic susceptibility testing performed on Chlamydia trachomatis-infected cells: a flow cytometric detection method and the standard method, which consists of a microscopic reading of minimal inhibitory concentration (MIC). The L2 reference strain and 13 clinical strains isolated from six patients presenting recurrent infections were tested. McCoy cells infected with an inoculum of 10(5) inclusion forming units (IFU)/ml were incubated with serial dilutions of doxycycline, ofloxacin, and erythromycin. Mean fluorescence intensity (MFI) of cells was determined by flow cytometry after staining of chlamydial inclusions with an anti-Chlamydia fluorescent monoclonal antibody. The end-point values determined by flow cytometry and microscopic reading were equivalent but presented the same imprecision. Calculation of the inhibitory concentration 50 (IC50) by flow cytometry, defined as the antibiotic concentration required to reduce the drug-free control MFI by 50%, allowed a more objective and precise evaluation of antibiotic activity than MIC. Moreover, IC50 values were reproducible, independent of the antibiotic dilution series tested, and could be used to compare the in vitro efficiency of various drugs on C. trachomatis. No resistant strain was found among the 13 clinical isolates of C. trachomatis tested.