Leukocytoclastic Vasculitis as an Onset Symptom of Crohn's Disease

We report the case of an octagenerian who presented with leukocytoclastic vasculitis as the first symptom of Crohn's disease. The patient was admitted with skin rash on the lower extremities and ankles and episodes of bloody diarrhea. Skin and colon biopsies revealed acute leukocytoclastic vasculitis and moderate Crohn's disease, respectively. The patient was treated with intravenous corticosteroids in conjunction with antibiotics and per os mesalazine. Symptoms resolved rapidly within 5 days, and the patient was still asymptomatic on follow-up 3 months later

Specific Immunoassays Confirm Association of Mycobacterium avium Subsp. paratuberculosis with Type-1 but Not Type-2 Diabetes Mellitus

Mycobacterium avium subspecies paratuberculosis (MAP) is a versatile pathogen with a broad host range. Its association with type-1 diabetes mellitus (T1DM) has been recently proposed. Rapid identification of infectious agents such as MAP in diabetic patients at the level of clinics might be helpful in deciphering the role of chronic bacterial infection in the development of autoimmune diseases such as T1DM.We describe use of an ELISA method to identify live circulating MAP through the detection of a cell envelope protein, MptD by a specific M13 phage--fMptD. We also used another ELISA format to detect immune response to MptD peptide. Both the methods were tested with blood plasma obtained from T1DM, type-2 diabetes (T2DM) patients and non-diabetic controls. Our results demonstrate MptD and fMptD ELISA assays to be accurate and sensitive to detect MAP bacilli in a large fraction (47.3%) of T1DM patients as compared to non-diabetic controls (12.6%) and those with confirmed T2DM (7.7%). Comparative analysis of ELISA assays performed here with 3 other MAP antigen preparations, namely HbHA, Gsd and whole cell MAP lysates confirmed comparable sensitivity of the MptD peptide and the fMptD based ELISA assays. Moreover, we were successful in demonstrating positive bacterial culture in two of the clinical specimen derived from T1DM patients.The MptD peptide/fMptD based ELISA or similar tests could be suggested as rapid and specific field level diagnostic tests for the identification of MAP in diabetic patients and for finding the explanations towards the occurrence of type-1 or type-2 diabetes in the light of an active infectious trigger

Linking Chronic Infection and Autoimmune Diseases: Mycobacterium avium Subspecies paratuberculosis, SLC11A1 Polymorphisms and Type-1 Diabetes Mellitus

(MAP) has been reported to be a possible trigger in the development of T1DM. gene (274C/T) associated to type 1 diabetic patients and not to controls. The presence of MAP DNA was also significantly associated with T1DM patients and not with controls. alter the processing or presentation of MAP antigens triggering thereby an autoimmune response in T1DM patients

Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

Abstract Background This study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena. Methods Primary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg. Results A total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p Conclusions In primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH

Where Are All the Mycobacterium avium Subspecies paratuberculosis in Patients with Crohn's Disease?

Mycobacterium avium subspecies paratuberculosis (MAP) causes a chronic granulomatous inflammation of the intestines, Johne's disease, in dairy cows and every other species of mammal in which it has been identified. MAP has been identified in the mucosal layer and deeper bowel wall in patients with Crohn's disease by methods other than light microscopy, and by direct visualization in small numbers by light microscopy. MAP has not been accepted as the cause of Crohn's disease in part because it has not been seen under the microscope in large numbers in the intestines of patients with Crohn's disease. An analysis of the literature on the pathology of Crohn's disease and on possible MAP infection in Crohn's patients suggests that MAP might directly infect endothelial cells and adipocytes and cause them to proliferate, causing focal obstruction within already existing vessels (including granuloma formation), the development of new vessels (neoangiogenesis and lymphangiogenesis), and the “creeping fat” of the mesentery that is unique in human pathology to Crohn's disease but also occurs in bovine Johne's disease. Large numbers of MAP might therefore be found in the mesentery attached to segments of intestine affected by Crohn's disease rather than in the bowel wall, the blood and lymphatic vessels running through the mesentery, or the mesenteric fat itself. The walls of fistulas might result from the neoangiogenesis or lymphangiogenesis that occurs in the bowel wall in Crohn's disease and therefore are also possible sites of large numbers of MAP. The direct visualization of large numbers of MAP organisms in the tissues of patients with Crohn's disease will help establish that MAP causes Crohn's disease

Drivers of labor-related indicators across diverse Mediterranean fisheries

This regional case study is focused on employment, remuneration and labor productivity, with a particular emphasis on the interplay between labor productivity and other labor-related indicators and macroeconomic conditions in Italy, Egypt, Lebanon and Greece. Its value lies in the high degree of consistency and comparability of the data, owing to a shared data collection methodology. This has allowed for the compilation of both national and regional comparisons. The data is treated in two groups-the first group consists of national data that considers all the active vessels in a country; the second group focuses on the trawl segments of Italy and Egypt. These two countries present an interesting case study because they are so different in terms of labor productivity and remuneration performance. For instance, in Italy labor shortages have caused a shift in fishing strategies towards less labor-intensive operations to maintain the socioeconomic sustainability of the fisheries, while in Egypt macroeconomic conditions have resulted in a larger labor pool and strong incentives to work in the fisheries sector. The regional study demonstrates that labor-related indicators are interconnected and there is an inversely proportional relationship between labor productivity and remuneration and employment levels. This relationship necessitates a combined analysis. The results across and between the countries were compared, with particular attention given to labor productivity and remuneration in the respective countries with a discussion centred around the potential drivers of labor productivity. © 2017 by the authors

An unconventional approach to estimating crew remuneration in fisheries

Fishing is a labour-intensive activity and consequently labour is one of its primary costs. Labour costs refer to remuneration, which is almost universally paid by means of some kind of crew-share system. At the same time, remuneration is the most challenging socio-economic information to collect, owing to a combination of complexity, sensitivity and the frequency of informal transactions. Data on remuneration, when paid by means of crew-share systems, does not adequately capture the real value of income derived from fishing because it is collected as a singular monetary value. Furthermore, the remuneration of fishers’ labour, as recorded in vessel or company financial statements were generally found to be underestimated. The main aim of this paper is to provide insight into the remuneration of fisheries labour so as to improve accuracy when estimating remuneration; the focus is on both the formula used for the calculation of remuneration and the data required, and an unconventional method that replicates the fishers’ methods is proposed. This method allows for the sensitivity around discussions about remuneration, and the informal nature of these transactions, to be circumvented. The result is improved data quality. When remuneration is estimated in this way it naturally becomes an indicator for economic performance and livelihoods derived from fishing. © 2017 Elsevier Lt