Prospective multicentre cohort trial on acute appendicitis and microbiota, aetiology and effects of antimicrobial treatment: study protocol for the MAPPAC (Microbiology APPendicitis ACuta) trial

Introduction Based on the epidemiological and clinical data, acute appendicitis can present either as uncomplicated or complicated. The aetiology of these different appendicitis forms remains unknown. Antibiotic therapy has been shown to be safe, efficient and cost-effective for CT-confirmed uncomplicated acute appendicitis. Despite appendicitis being one of the most common surgical emergencies, there are very few reports on appendicitis aetiology and pathophysiology focusing on the differences between uncomplicated and complicated appendicitis. Microbiology APPendicitis ACuta (MAPPAC) trial aims to evaluate these microbiological and immunological aspects including immune response in the aetiology of these different forms also assessing both antibiotics non-responders and appendicitis recurrence. In addition, MAPPAC aims to determine antibiotic and placebo effects on gut microbiota composition and antimicrobial resistance.Methods and analysis MAPPAC is a prospective clinical trial with both single-centre and multicentre arm conducted in close synergy with concurrent trials APPendicitis ACuta II (APPAC II) (per oral (p.o.) vs intravenous+p.o. antibiotics, NCT03236961) and APPAC III (double-blind trial placebo vs antibiotics, NCT03234296) randomised clinical trials. Based on the enrolment for these trials, patients with CT-confirmed uncomplicated acute appendicitis are recruited also to the MAPPAC study. In addition to these conservatively treated randomised patients with uncomplicated acute appendicitis, MAPPAC will recruit patients with uncomplicated and complicated appendicitis undergoing appendectomy. Rectal and appendiceal swabs, appendicolith, faecal and serum samples, appendiceal biopsies and clinical data are collected during the hospital stay for microbiological and immunological analyses in both study arms with the longitudinal study arm collecting faecal samples also during follow-up up to 12 months after appendicitis treatment.</p

Pediatric campylobacteriosis in northern Taiwan from 2003 to 2005

<p>Abstract</p> <p>Background</p> <p>There has been a marked increase in the incidence of, and concern regarding, human <it>Campylobacter jejuni </it>and <it>C. coli </it>infections worldwide during the last decade. As the highest infectious disease control apparatus in Taiwan, we aimed to describe the character of <it>Campylobacter </it>isolates from infected children, as well as basic information about the patients, from December 2003 to February 2005.</p> <p>Methods</p> <p>A total of 894 fecal specimens were collected by several clinics and hospitals from children who had diarrhea, followed by plating onto selective media. Drug susceptibility test of the isolates from these specimens were conducted by disc diffusion method and their serotypes were also studied using commercial antisera made in Japan.</p> <p>Results</p> <p>The isolation rate of <it>Campylobacter </it>during these 15 months was 6.8% and was higher in winter (11.1%) than in other seasons. <it>C. jejuni </it>was the most prevalent (95.1%) species in northern Taiwan, comparable to other developed countries. Among the 61 <it>Campylobacter </it>isolates, most were resistant to tetracycline (93.4%), nalidixic acid (91.8%), ciprofloxacin (90.2%), and ampicillin (85.5%). Erythromycin-resistant isolates represented 3.3% of all isolates, suggesting that this drug may be the first choice for treatment. The serotypes of the 61 isolates were demonstrated and only 41.4% were typable.</p> <p>Conclusion</p> <p>In this study, the Taiwan CDC provided an epidemiological analysis of <it>Campylobacter </it>infection, including the isolation rate, age, seasonal distribution, antimicrobial drug susceptibility patterns, and serotypes of the isolates from pediatric patients in northern Taiwan from 2003 to 2005.</p

From monogenic to polygenic obesity: recent advances

The heritability of obesity and body weight in general is high. A small number of confirmed monogenic forms of obesity—the respective mutations are sufficient by themselves to cause the condition in food abundant societies—have been identified by molecular genetic studies. The elucidation of these genes, mostly based on animal and family studies, has led to the identification of important pathways to the disorder and thus to a deeper understanding of the regulation of body weight. The identification of inborn deficiency of the mostly adipocyte-derived satiety hormone leptin in extremely obese children from consanguineous families paved the way to the first pharmacological therapy for obesity based on a molecular genetic finding. The genetic predisposition to obesity for most individuals, however, has a polygenic basis. A polygenic variant by itself has a small effect on the phenotype; only in combination with other predisposing variants does a sizeable phenotypic effect arise. Common variants in the first intron of the ‘fat mass and obesity associated’ gene (FTO) result in an elevated body mass index (BMI) equivalent to approximately +0.4 kg/m² per risk allele. The FTO variants were originally detected in a genome wide association study (GWAS) pertaining to type 2 diabetes mellitus. Large meta-analyses of GWAS have subsequently identified additional polygenic variants. Up to December 2009, polygenic variants have been confirmed in a total of 17 independent genomic regions. Further study of genetic effects on human body weight regulation should detect variants that will explain a larger proportion of the heritability. The development of new strategies for diagnosis, treatment and prevention of obesity can be anticipated

Teacher Wellbeing: The Importance of Teacher–Student Relationships

Many studies have examined the importance of teacher-student relationships for the development of children. Much less is known, however, about how these relationships impact the professional and personal lives of teachers. This review considers the importance of teacher-student relationships for the wellbeing of teachers guided by the Transactional Model of Stress and Coping of Lazarus (1991). Based on theories on interpersonal relationships, it is postulated that teachers have a basic need for relatedness with the students in their class that originates from the close proximity between teacher and student. It is discussed that teachers internalize experiences with students in representational models of relationships that guide emotional responses in daily interactions with students, and changes teacher wellbeing in the long run. In addition, the notion of mental representations of relationships at different levels of generalization could offer a window to understand how individual teacher-student relationships may affect the professional and personal self-esteem of teachers. Lastly, it is argued that the influence of student misbehavior on teacher stress may be more fully understood from a relationship perspective. The review shows that few studies have directly tested these propositions and offers suggestions for future research

Estimating the burden of healthcare-associated infections caused by selected multidrug-resistant bacteria Finland, 2010

<p>Abstract</p> <p>Background</p> <p>Knowledge of the burden of healthcare-associated infections (HAI) and antibiotic resistance is important for resource allocation in infection control. Although national surveillance networks do not routinely cover all HAIs due to multidrug-resistant bacteria, estimates are nevertheless possible: in the EU, 25,000 patients die from such infections annually. We assessed the burden of HAIs due to multidrug-resistant bacteria in Finland in 2010.</p> <p>Methods</p> <p>By combining data from the National Infectious Disease Registry on the numbers of bacteremias caused by <it>Staphylococcus aureus</it>, <it>Enterococcus faecium</it>, <it>Escherichia coli</it>, <it>Klebsiella pneumoniae, Enterobacter</it> spp., <it>Pseudomonas aeruginosa</it> and <it>Acinetobacter</it> spp.<it>,</it> and susceptibility data from the National Antimicrobial Resistance Network and the Finnish Hospital Infection Program, we assessed the numbers of healthcare-associated bacteremias due to selected multidrug-resistant bacteria. We estimated the number of pneumonias, surgical site and urinary tract infections by applying the ratio of these infections in the first national prevalence survey for HAI in 2005. Attributable HAI mortality (3.2%) was also derived from the prevalence survey.</p> <p>Results</p> <p>The estimated annual number of the most common HAIs due to the selected multidrug-resistant bacteria was 2804 (530 HAIs per million), 6% of all HAIs in Finnish acute care hospitals. The number of attributable deaths was 89 (18 per million).</p> <p>Conclusions</p> <p>Resources for infection control should be allocated not only in screening and isolation of carriers of multidrug-resistant bacteria, even when they are causing a small proportion of all HAIs, but also in preventing all clinical infections.</p