Trend of bacterial meningitis in Bahrain from 1990 to 2013 and effect of introduction of new vaccines.

Meningitis is among the 10 commonest infectious causes of death worldwide. This retrospective analysis of reported cases of meningitis in Bahrain aimed to assess the trend in the incidence of bacterial meningitis from 1990 to 2013, before and after the introduction of new vaccines. Of 1455 reported cases of meningitis during the study period 73.1% were viral and 26.9% were bacterial etiology (tuberculous meningitis 8.3%; Streptococcus pneumoniae 4.9%, Haemophilus influenzae 3.6% and Neisseria meningitidis 1.7%). There was a peak of meningitis cases in 1995-1996. The incidence of meningitis due to H. influenzae and N. meningitidis showed a marked reduction after the introduction of the corresponding vaccines in 1998 and 2001 respectively, and S. pneumoniae became the predominant organism after Mycobacterium tuberculosis. The changing trend in the etiology of bacterial meningitis points to the need to study vaccination programme modifications, such as pneumococcal vaccine for the adult population, especially high-risk groups.

Hemodialysis Patients' Willingness to Undergo Kidney Transplantation: An Observational Study.

BACKGROUND: The number of dialysis patients is increasing, with only 20% undergoing kidney transplantation. In Saudi Arabia, no studies had examined transplantation barriers from the patients' perspectives. We aimed in this study to estimate hemodialysis (HD) patients' willingness to undergo kidney transplantation and to explore its underlying determinants. METHODS: In an observational cross-sectional study involving adult HD patients from King Abdulaziz Medical City and King Abdullah Dialysis Center-Jeddah, patients were interviewed through a pre-tested questionnaire. Calculated sample size was 243. RESULTS: Among the 252 HD patients (mean age, 55 years [standard deviation = 15.21]; 59% men; median duration on HD, 24 months [interquartile range, 11.1, 60]), 61% described their knowledge about kidney transplantation as "poor" or "very poor." Only 69% chose "willingness to undergo kidney transplantation" (proportion, 0.69; 95% confidence interval [CI], 0.64-0.75). The main reported reasons against willingness were being too old for transplantation (61%) and fear of surgical complications (26%). Less willingness was shown with age ≥60 years (adjusted odds ratio [AOR], 0.2; 95% CI, 0.11-0.36; P < .001), duration on HD ≥5 years (AOR, 0.47; 95% CI, 0.25-0.89; P = .021), and being non-married (AOR, 0.47; 95% CI, 0.24-0.93; P = .03). CONCLUSIONS: Approximately one third of the respondents did not choose "willingness to undergo kidney transplantation." Willingness was negatively associated with older age, lack of spouse, and longer duration on HD. The majority of HD patients reported poor knowledge about kidney transplantation. Therefore, structured education may optimize the knowledge, perceptions, and attitudes of HD patients toward kidney transplantation and hence improve their transplantation willingness.

Autoimmunity to the M(r) 32,000 subunit of replication protein A in breast cancer.

PURPOSE: We sought to identify autoantigens recognized by antibodies in breast cancer patient sera with potential diagnostic or prognostic significance. EXPERIMENTAL DESIGN: Serum from a female breast cancer patient exhibiting a high titer antinuclear antibody was used to screen a HeLa cDNA expression library, leading to the cloning of a cDNA for the M(r) 32,000 subunit of replication protein A (RPA32). RPA32 expression and localization were assayed in autologous tumor by monoclonal antibody staining. A specific ELISA using recombinant protein was used to screen sera from 801 breast cancer patients and 65 controls. RESULTS: A relationship between anti-replication protein A (RPA) antibodies and the ductal breast carcinoma of the proband was suggested by overexpression and aberrant localization of RPA32 in tumor cells as compared with surrounding normal ductal tissue and by the presence of anti-RPA32 antibodies before the diagnosis. The prevalence of anti-RPA32 antibodies was significantly higher (P < 0.01) among breast cancer patients (87 of 801 patients) than among noncancer controls (0 of 65 controls). Similarly, anti-RPA32 antibodies were present in 4 of 39 patients with intraductal in situ carcinoma. No associations were found between anti-RPA antibodies and survival, occurrence of a second tumor, metastases, or antibodies to p53. Reactivity to RPA32 also was detected in sera from 3 of 47 patients with other cancers. CONCLUSIONS: In view of the central role of RPA in DNA replication, recombination, and repair, we suggest that autoimmunity to RPA32 may reflect molecular changes involved in the process of tumorigenesis. The finding of antibodies to RPA32 before diagnosis and their prevalence in in situ carcinoma suggest that they are potentially useful markers of early disease.

Single and double polymerase chain reaction for detection of bovine viral diarrhea virus in tissue culture and sera.

Bovine viral diarrhea virus (BVDV) is an ubiquitous pathogen of cattle and has been reported in other ruminants. It is also frequently present in laboratory and biological materials as an adventitious agent. This virus is difficult to detect in some specimens, especially in the presence of specific antibody and when the virus is present in low concentrations. In this paper, we describe a single polymerase chain reaction (PCR) to amplify virus sequences from infected cell culture and a nested double PCR to detect small concentrations of several virus strains in sera. Total cellular RNA was extracted from cell cultures infected with the cytopathic strain 72 and noncytopathic strain 2724 of BVDV. Ten different genomic sequences along the length of the viral RNA ranging in size from 397 to 1,016 base pairs (bp) were successfully amplified by PCR. A 404-bp probe made from amplified product from the 3' end hybridized specifically with the RNA of several BVDV strains blotted on nylon filters. Viral RNA was extracted from serum and amplified using 2 sets of degenerate nested primers designed from the 3' end of the viral genome in a double PCR protocol. Double amplification of the viral sequences greatly enhanced the sensitivity of the detection of many strains present in serum. Advantages of using double PCR over single PCR and virus isolation is discussed.

Analysis of ruminant respiratory syncytial virus isolates by RNAse protection of the G glycoprotein transcripts.

Two different respiratory syncytial virus (RSV) radiolabeled probes were used to characterize the genetic heterogeneity of 25 ruminant RSV isolates by the ribonuclease protection assay. A 32P-radiolabeled antisense RNA probe was transcribed from cloned ovine and bovine RSV G glycoprotein genes and then hybridized with total RNA isolated from infected cells with various ruminant RSV isolates. The results of this study, along with previously published nucleotide sequence data of the ovine RSV G glycoprotein gene, suggest the presence of at least 2 ruminant RSV subgroups. One subgroup is represented by RSV isolated from respiratory disease outbreaks from calves and goats, and the other is represented by RSV isolated from sheep.

Nucleotide sequence analysis of the ovine respiratory syncytial virus G glycoprotein gene.

Respiratory syncytial virus (RSV) infects humans and animals including ruminants. Among the 10 genes coded for in the viral genome, the putative attachment glycoprotein G gene has been the most variable among strains. Human RSV have been divided to two subgroups based on immunological and base sequence data on the attachment glycoprotein G and its gene, respectively. It has been suggested that similar antigenic diversity also exists among bovine RSV (BRSV) isolates. In this study, we report on the cloning and sequencing of the G glycoprotein from an ovine RSV (ORSV) strain originally isolated from a naturally infected sheep with rhinitis. This ORSV G glycoprotein gene had greater identity to the BRSV G gene than to the human RSV G gene. ORSV G gene and its encoded protein shared 70 and 62% nucleotide and amino acid identity to the equivalent gene and encoded protein, respectively, of BRSV but, in contrast, only 50-55% and 21-29% identity, respectively, to equivalent sequences of the HRSV strains. The relationship of the ORSV to other RSV subgroups and the possibility that ORSV could be a subgroup of the ruminant RSV is discussed.

Nucleotide and predicted amino acid sequence analysis of the ovine respiratory syncytial virus non-structural 1C and 1B genes and the small hydrophobic protein gene.

Respiratory syncytial virus (RSV) infects humans and cattle causing serious respiratory tract disease in both. The genome of the human and bovine RSV (HRSV and BRSV) codes for two non-structural and eight structural proteins. RSV has also been isolated from naturally infected sheep, but the genome of the ovine RSV (ORSV) has not been characterized and nor has the virus host range been identified. Here we report on the cloning and sequencing of the two non-structural 1C and 1B genes and of the small hydrophobic (SH) protein gene of the ORSV. The nucleotide identity of the ORSV 1C gene to those of subgroups A and B of HRSV was 70% and 65% respectively whereas the predicted amino acid identity was 68% and 69% respectively. The ORSV 1B gene had a 70% and 72% nucleotide identity with that of subgroups A and B of the HRSV respectively, and 79% predicted amino acid identity with both HRSV subgroups. The identity level of these two ORSV 1C and 1B genes to those of the BRSV could not be determined since these two BRSV genes have not been sequenced. The SH protein of RSV is a structural protein expressed on the surface of infected cells. In common with HRSV and BRSV subgroups, the ORSV SH had the three proposed domains with the C-terminal domain least conserved among the viruses. In the latter domain, the ORSV SH gene had a nucleotide identity of 68 to 69% and 47 to 51% with those of the BRSV and HRSV, respectively, and a predicted amino acid identity of 56% and 33 to 47% with those of BRSV and HRSV, respectively. Defining the genes and their products should help determine which genes and gene products are most suitable for use as diagnostic tools or as vaccine candidates.

Molecular cloning and sequence analysis of the phosphoprotein, nucleocapsid protein, matrix protein and 22K (M2) protein of the ovine respiratory syncytial virus.

Respiratory syncytial viruses (RSVs) cause serious respiratory tract disease in infants and children worldwide and similar disease in calves. Strains have been isolated from other ruminant animals such as sheep and goats, but these viruses have not been characterized at the molecular level. In this study, we report the cloning and sequencing of four structural genes coding for the phosphoprotein, nucleocapsid (N) protein, matrix (M) protein and 22K protein of an ovine RSV strain. Comparisons of these sequences with those of bovine and human RSV show that the M and N proteins are the most conserved between ruminant RSV strains and the N protein is the most conserved protein between human and ruminant RSV strains. The attachment G glycoprotein and the small hydrophobic protein are the most divergent proteins among human and ruminant RSV subgroups.