Evaluation of the First Commercial Hepcidin ELISA for the Differential Diagnosis of Anemia of Chronic Disease and Iron Deficiency Anemia in Hospitalized Geriatric Patients

Introduction. Anemia is a frequent problem in hospitalized geriatric patients, and the anemia of chronic disease (ACD) and iron deficiency anemia (IDA) are the 2 most prevalent causes. The aim of the study was to assess the possible role of serum hepcidin in the differential diagnosis between ACD and IDA. Methods. We investigated serum hepcidin, iron status, anemia, and C-reactive protein in 39 consecutive geriatric patients with ACD and IDA. Serum hepcidin levels were determined using a commercial ELISA kit (DRG Instruments, Marburg, Germany). We also measured hepcidin in 26 healthy controls. Results. The serum hepcidin levels were not significantly higher in the 28 patients with ACD as compared to the 11 patients with IDA. Conclusions. The serum hepcidin levels measured using the commercial ELISA kit (DRG) do not appear to increase in older patients with ACD. It should be noted that an assay-specific problem could explain our results

Clinical burden of hepatitis E virus infection in a tertiary care center in Flanders, Belgium

Background: Hepatitis E virus (HEV) infection is increasingly recognized as a cause of hepatitis in developed countries. A high HEV IgG seroprevalence in humans and pigs is reported as well as sporadic clinical cases of autochtonous HEV but there are currently no data available on the clinical burden of HEV in Belgium. Objectives: The objective of the current study was to evaluate the actual clinical burden of HEV infections in our tertiary care center in Flanders, Belgium. Study design: In the setting of Ghent University Hospital, patients were assessed for the presence of HEV IgG and IgM as well as HEV RNA if no other cause was found for one of the following clinical presentations: a) elevation of liver enzymes in post-liver transplant; b) suspicion of acute or toxic hepatitis; c) unexplainable elevation of liver enzymes; d) cirrhosis with acute-on-chronic exacerbation. Results: In a period of 39 months (January 2011-April 2014) 71 patients were enrolled. HEV IgG was found positive in 13 (18,3%) patients; HEV IgM in 6 patients (8,5%) and HEV RNA in 4 (5,6%) patients. All HEV IgM/ RNA positive patients were male, aged 41-63, and classified in the clinical groups a), b) or d). HEV IgG seroprevalence was slightly higher but not significantly different from the seroprevalence in the general population in this region in Belgium previously reported to be 14% (p-value 0.41) by our group. Conclusions: HEV should be considered as a cause of liver pathology especially in middle-aged men with elevation of liver enzymes

A novel UBE3A sequence variant identified in eight related individuals with neurodevelopmental delay, results in a phenotype which does not match the clinical criteria of Angelman syndrome

Background: Loss of functional UBE3A, an E3 protein ubiquitin ligase, causes Angelman syndrome (AS), a neurodevelopmental disorder characterized by severe developmental delay, speech impairment, epilepsy, movement or balance disorder, and a characteristic behavioral pattern. We identified a novel UBE3A sequence variant in a large family with eight affected individuals, who did not meet the clinical AS criteria. Methods: Detailed clinical examination and genetic analysis was performed to establish the phenotypic diversity and the genetic cause. The function of the mutant UBE3A protein was assessed with respect to its subcellular localization, stability, and E3 ubiquitin ligase activity. Results: All eight affected individuals showed the presence of a novel maternally inherited UBE3A sequence variant (NM_130838.4(UBE3A):c.1018-1020del, p.(Asn340del), which is in line with a genetic AS diagnosis. Although they presented with moderate to severe intellectual disability, the phenotype did not match the clinical criteria for AS. In line with this, functional analysis of the UBE3A p.Asn340del mutant protein revealed no major deficits in UBE3A protein localization, stability, or E3 ubiquitin ligase activity. Conclusion: The p.(Asn340del) mutant protein behaves distinctly different from previously described AS-linked missense mutations in UBE3A, and causes a phenotype that is markedly different from AS. This study further extends the range of phenotypes that are associated with UBE3A loss, duplication, or mutation

Clinical aspects of a large group of adults with Angelman syndrome

Descriptions of the clinical features of Angelman syndrome (AS) have mainly been focused on children. Here, we describe

Necrotiserende primaire cryptokokken cellulitis bij een 71-jarige patiënt

Necrotising primary Cryptococcus cellulitis in a 71 years old patient. We report a case of a 71-year-old male, with a previous medical history of diabetes and chronic asthma, treated with systemic corticosteroids for years, who developed a severe necrotising cellulitis of his left hand and forearm after an accidental scratch injury from a pigeon. Culture of wound aspirates revealed growth of Cryptococcus neoformans. After combined treatment with antibiotics, antifungals (amfotericine B + fluconazole) and surgical debridement followed by mesh grafts, the patient achieved complete healing of the wound. The clinical and microbiological characteristics of this patient as well as epidemiological and therapeutical aspects of primary cutaneous cryptococcosis are discussed, in the setting of a review of the literature

Collar-induced elevation of mRNA and functional activity of 5-HT(1B) receptor in the rabbit carotid artery

1. Hypersensitivity to serotonin (5-HT) develops in rabbit collared carotid arteries. Previous data demonstrated the involvement of 5-HT(1)-like receptors which are not active in normal carotid arteries. This study investigated the interaction in the rabbit carotid artery between 5-HT and a moderate tone as this can uncover functional 5-HT(1)-like receptors. Furthermore, the expression of messenger RNA (mRNA) and protein of 5-HT(1B), 5-HT(1D) and 5-HT(2A) receptors was addressed. 2. Silicone collars were placed around the carotid arteries of male New Zealand White rabbits for 1 week. Rings from inside (=collar) and outside (=sham) the collar were either mounted in isolated organ baths for isometric force measurements or frozen in liquid nitrogen to isolate total RNA or proteins which were subsequently analysed by respectively reverse transcriptase-polymerase chain reaction and Western blot analysis. 3. In sham and collared rings concentration-response curves (CRC's) to 5-HT were monophasic. Only in collared segments the presence of a 5-HT(2A) antagonist (spiperone or ketanserin, 0.1 μM) revealed a biphasic CRC which was even more pronounced when a moderate tone was induced by KCl pointing to functional 5-HT(1)-like receptors. 4. The rabbit carotid artery constitutively expressed 5-HT(1B) and 5-HT(2A) mRNA, not 5-HT(1D) mRNA. Manipulation of the carotid artery increased the 5-HT(1B) mRNA level. Collar placement raised it even further. The 5-HT(2A) mRNA level remained unchanged. All the anti-5-HT receptor antibodies tested resulted in variable, non specific patterns with multiple bands. 5. In conclusion, collar placement elevates mRNA expression and activity of the 5-HT(1B) receptor in the rabbit carotid artery

Involving people with dementia in the development process of assistive technology:Multi-stakeholder experiences of a user-driven living lab

Despite the potential value of assistive technology to support people with dementia and their informal caregivers (=PlwD) to age in place, use of these innovations is still limited. To ensure that innovations better address specific needs of PlwD, it is important to actively involve them into the innovation process. A Living Lab (LL) is a user-centred research design in which multiple stakeholders, develop, test and validate innovative solutions in real-life environment together with end-users (i.e. PlwD). Although user involvement activities in LLs are seen as their main goal, little literature is available on how different stakeholders, including users, experience their collaboration in LLs. This case study (Playtime) investigates the experiences of various stakeholders, including PlwD, when developing a serious game in a LL. 18 semi-structured interviews were conducted with PlwD, healthcare professionals, developers and researchers about their experiences following the key-principles of a successful User Centred Design project. Results shows that the stakeholders of the Playtime LL are most positive with regard to the key-principles active user participation, continuous iteration of design solutions and multidisciplinary networks. Some lessons learned are selected to inspire other LLs when collaborating with PlwD in the development of assistive technology for dementia