Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis

BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) is an orphan hepatobiliary disorder associated with inflammatory bowel disease (IBD). We aimed to estimate the risk of disease progression based on distinct clinical phenotypes in a large international cohort of patients with PSC. METHODS: We performed a retrospective outcome analysis of patients diagnosed with PSC from 1980 through 2010 at 37 centers in Europe, North America, and Australia. For each patient, we collected data on sex, clinician-reported age at and date of PSC and IBD diagnoses, phenotypes of IBD and PSC, and date and indication of IBD-related surgeries. The primary and secondary endpoints were liver transplantation or death (LTD) and hepatopancreatobiliary malignancy, respectively. Cox proportional hazards models were applied to determine the effects of individual covariates on rates of clinical events, with time-to-event analysis ascertained through Kaplan-Meier estimates. RESULTS: Of the 7121 patients in the cohort, 2616 met the primary endpoint (median time to event of 14.5 years) and 721 developed hepatopancreatobiliary malignancy. The most common malignancy was cholangiocarcinoma (n = 594); patients of advanced age at diagnosis had an increased incidence compared with younger patients (incidence rate: 1.2 per 100 patient-years for patients younger than 20 years old, 6.0 per 100 patient-years for patients 21-30 years old, 9.0 per 100 patient-years for patients 31-40 years old, 14.0 per 100 patient-years for patients 4150 years old, 15.2 per 100 patient-years for patients 51-60 years old, and 21.0 per 100 patient-years for patients older than 60 years). Of all patients with PSC studied, 65.5% were men, 89.8% had classical or large-duct disease, and 70.0% developed IBD at some point. Assessing the development of IBD as a time-dependent covariate, Crohn's disease and no IBD (both vs ulcerative colitis) were associated with a lower risk of LTD (unadjusted hazard ratio [HR], 0.62; PPeer reviewe

Investigation of the Efficiencies of Bioaerosol Samplers for Collecting Aerosolized Bacteria Using a Fluorescent Tracer.I: Effects of Non-sampling Processes on Bacterial Culturability

By sampling aerosolized microorganisms, the efficiency of a bioaerosol sampler can be calculated depending on its ability both to collect microorganisms and to preserve their culturability during a sampling process. However, those culturability losses in the non-sampling processes should not be counted toward the sampling efficiency. Prior to the efficiency assessment, this study was designed to investigate the culturability losses in three non-sampling processes: (1) the tracer uranine induced loss; (2) the loss during aerosolization (pre-sampling process); and (3) the bacteria and uranine recovery in air sample handling procedures for the samples of the Andersen 6-stage impactor and the Airport MD8 (post-sampling process). The results indicated that uranine had no significant effect on the culturability of Enterococcus faecalis, Escherichia coli, and Mycoplasma synoviae in suspensions (P > 0.05), but negatively affected the culturability of Campylobacter jejuni (P = 0.01). The culturability of E. faecalis, E. coli, and M. synoviae was not affected by stresses caused by aerosolization (P > 0.05). Only 29% of C. jejuni were still culturable during aerosolization (P = 0.02). In the air sample handling procedures, the four species of bacteria were recovered without significant losses from the samples of the Andersen impactor, but only 33-60% uranine was recovered. E. faecalis, E. coli, and M. synoviae were recovered without significant losses from the samples of the Airport MD8. More C. jejuni was recovered (172%), probably due to multiplication or counting variation. It is suggested that tracer and bacteria should be aerosolized separately when the tracer negatively affects the bacterial culturability. In both pre- and post-sampling processes, losses of bacterial culturability (or multiplication) may occur, which should be taken into account when assessing the efficiencies of bioaerosol samplers

Evaluation of an algorithm for integrated management of childhood illness in an area of Vietnam with dengue transmission

OBJECTIVES: To determine whether nurses, using the WHO/UNICEF algorithm for integrated management of childhood illness (IMCI), modified to include dengue infection, satisfactorily classified children in an area endemic for dengue haemorrhagic fever (DHF). METHODS: Nurses assessed and classified, using the modified IMCI algorithm, a systematic sample of 1250 children aged 2 months to 10 years (n = 1250) presenting to a paediatric hospital in Dong Nai Province, Vietnam. Their classification was compared with that of a paediatrician, blind to the result of the nurses' assessment, which could be modified in the light of simple investigations, e.g. dengue serology. RESULTS: In children aged 2-59 months (n = 859), the nurses were able to classify, using the modified chart, the presenting illness in >99% of children and found more than one classification in 70%. For the children with pneumonia, diarrhoea, dengue shock syndrome, severe DHF and severe disease requiring urgent admission, the nurse's classification was >60% sensitive and >85% specific compared with that of the paediatrician. For the nurse's classification of DHF the specificity was 50-55% for the children <5 years and in children with definitive dengue serology. Alterations in the DHF algorithm improved specificity at the expense of sensitivity. CONCLUSION: Using the IMCI chart, nurses classified appropriately many of the major clinical problems in sick children <5 years in southern Vietnam. However, further modifications will be required in the fever section, particularly for dengue. The impact of using the IMCI chart in peripheral health stations remains to be evaluated