H. pylori-infection and antibody immune response in a rural Tanzanian population

BACKGROUND: Helicobacter pylori (H. pylori) infection is ubiquitous in sub-Saharan Africa, but paradoxically gastric cancer is rare. METHODS: Sera collected during a household-based survey in rural Tanzania in 1985 were tested for anti-H. pylori IgG and IgG subclass antibodies by enzyme immunoassay. Odds ratios (OR) and confidence intervals (CI) of association of seropositivity with demographic variables were computed by logistic regression models. RESULTS: Of 788 participants, 513 were aged ≤17 years. H. pylori seropositivity increased from 76% at 0–4 years to 99% by ≥18 years of age. Seropositivity was associated with age (OR 11.5, 95% CI 4.2–31.4 for 10–17 vs. 0–4 years), higher birth-order (11.1; 3.6–34.1 for ≥3(rd )vs. 1(st )born), and having a seropositive next-older sibling (2.7; 0.9–8.3). Median values of IgG subclass were 7.2 for IgG1 and 2.0 for IgG2. The median IgG1/IgG2 ratio was 3.1 (IQR: 1.7–5.6), consistent with a Th2-dominant immune profile. Th2-dominant response was more frequent in children than adults (OR 2.4, 95% CI 1.3–4.4). CONCLUSION: H. pylori seropositivity was highly prevalent in Tanzania and the immunological response was Th2-dominant. Th2-dominant immune response, possibly caused by concurrent bacterial or parasitic infections, could explain, in part, the lower risk of H. pylori-associated gastric cancer in Africa

Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics

For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier

The Synergistic Effect of Concomitant Schistosomiasis, Hookworm, and Trichuris Infections on Children's Anemia Burden

Polyparasitic infections have been recognized as the norm in many tropical developing countries, but the significance of this phenomenon for helminth-associated morbidities is largely unexplored. Earlier studies have suggested that multi-species, low-intensity parasitic infections were associated with higher odds of anemia among school-age children relative to their uninfected counterparts or those with one low-intensity infection. However, specific studies of the nature of interactions between helminth species in the mediation of helminth-associated morbidities are lacking. This study quantifies the extent to which polyparasitic infections have more than the sum of adverse effects associated with individual infections in the context of childhood anemia. This study found that the risk of anemia is amplified beyond the sum of risks for individual infections in children simultaneously exposed to 1) hookworm and schistosomiasis, and 2) hookworm and trichuris, and suggests that combined treatment for some geohelminth species and schistosomiasis could yield greater than additive benefits for the reduction of childhood anemia in helminth-endemic areas. However, more studies to understand the full range of interactions between parasitic species in their joint effects on helminth-associated morbidities will be necessary to better predict the impact of any future public health intervention

Revised diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients : a new classification from the European Society for Blood and Marrow Transplantation

Sinusoidal obstruction syndrome, also known as veno-occlusive disease (SOS/VOD), is a potentially life threatening complication that can develop after hematopoietic cell transplantation. Although SOS/VOD progressively resolves within a few weeks in most patients, the most severe forms result in multi-organ dysfunction and are associated with a high mortality rate (480%). Therefore, careful attention must be paid to allow an early detection of SOS/VOD, particularly as drugs have now proven to be effective and licensed for its treatment. Unfortunately, current criteria lack sensitivity and specificity, making early identification and severity assessment of SOS/VOD difficult. The aim of this work is to propose a new definition for diagnosis, and a severity-grading system for SOS/VOD in adult patients, on behalf of the European Society for Blood and Marrow Transplantation.Peer reviewe

Factors Affecting Hospitalization Length and in-Hospital Death Due to COVID-19 Infection in Saudi Arabia: A Single-Center Retrospective Analysis

Omar A Al Omair,1 Abdallah Essa,2,3 Khaled Elzorkany,4,5 Somaia Shehab-Eldeen,2,3 Hamzah M Alarfaj,6 Sumaia M Alarfaj,7 Fatimah Alabdulqader,7 Alghaydaa Aldoughan,7 Mohammed Agha,8 Sayed I Ali,9 Ehab Darwish3,10 1Internal Medicine Department, College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia; 2Tropical Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt; 3Gastroenterology and Infectious Diseases Unit, College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia; 4Internal Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt; 5Nephrology Unit, College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia; 6King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia; 7Medical Student at the College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia; 8Chest Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt; 9Family Medicine Department, College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia; 10Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptCorrespondence: Somaia Shehab-Eldeen, Tropical Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkom, 32511, Egypt, Tel +201117251523, Email [email protected]: The emerging COVID-19 coronavirus disease has widely spread, causing a serious worldwide pandemic. Disease severity and mortality risk can be predicted using an analysis of COVID-19 clinical characteristics. Finding out what influences patients’ hospitalization length and in-hospital mortality is crucial for decision-making and planning for emergencies. The goal of this study is to identify the factors that influence hospital stay length and in-hospital death due to COVID-19 infection.Methods: This cross-sectional study was conducted from August to October 2020 and included 630 patients with a confirmed diagnosis of COVID-19 infection. Using odds ratios (OR) and 95% confidence intervals (CI), a multivariable logistic regression model was used to assess the variables that are linked to longer hospital stays and in-hospital deaths.Results: Most patients were male (64.3%), and most were older than 40 years (81.4%). The mean length of hospital stay (LoHS) was 10.4± 11.6 days. The overall death rate among these COVID-19 cases was 14.3%. Non-survivors were older, had more comorbidities, had prolonged LoHS with increased ICU admission rates and mechanical ventilation usage, and had a more severe condition than survivors. ICU admission, low serum albumin, and elevated LDH levels were associated with longer LoHS, while ICU admission, DM, and respiratory diseases as comorbidities, total leukocytic count, and serum albumin were predictors of mortality.Conclusion: Longer LoHS due to COVID-19 infection was linked to ICU admission, low serum albumin, and elevated LDH levels, while the independent predictors of in-hospital death were ICU admission, DM, and respiratory diseases as comorbidities, total leukocytic count, and serum albumin.Keywords: COVID-19, Saudi Arabia, hospital stay, Al-Ahs

Can myocardial remodeling be a useful surrogate predictor of myocardial iron load? A 3D echocardiographic multicentric study

The relationship between myocardial iron load and eccentric myocardial remodeling remains an under-investigated area; it was thought that remodeling is rather linked to fibrosis. This study aims to determine whether or not measures of remodeling can be used as predictors of myocardial iron. For this purpose, 60 patients with thalassemia were studied with 3D echocardiography and myocardial relaxometry (T2*) by Cardiac MRI. 3D derived sphericity index was significantly higher in patients with myocardial iron load. It was correlated with T2* with a 100% sensitivity and specificity (cut-off value of 0.34) to discriminate between patients with and without myocardial iron overload