Multiplex PCR for detection of plasmid-mediated colistin resistance determinants, mcr-1, mcr-2, mcr-3, mcr-4 and mcr-5 for surveillance purposes

Background and aim: Plasmid-mediated colistin resistance mechanisms have been identified worldwide in the past years. A multiplex polymerase chain reaction (PCR) protocol for detection of all currently known transferable colistin resistance genes (mcr-1 to mcr-5, and variants) in Enterobacteriaceae was developed for surveillance or research purposes. Methods: We designed four new primer pairs to amplify mcr-1, mcr-2, mcr-3 and mcr-4 gene products and used the originally described primers for mcr-5 to obtain a stepwise separation of ca 200 bp between ampli-cons. The primer pairs and amplification conditions allow for single or multiple detection of all currently described mcr genes and their variants present in Enterobacteriaceae. The protocol was validated testing 49 European Escherichia coli and Salmonella isolates of animal origin. Results: Multiplex PCR results in bovine and porcine isolates from Spain, Germany, France and Italy showed full concordance with whole genome sequence data. The method was able to detect mcr-1, mcr-3 and mcr-4 as singletons or in different combinations as they were present in the test isolates. One new mcr-4 variant, mcr-4.3, was also identified. Conclusions: This method allows rapid identification of mcr-positive bacteria and overcomes the challenges of phenotypic detection of colistin resistance. The multiplex PCR should be particularly interesting in settings or laboratories with limited resources for performing genetic analysis as it provides information on the mechanism of colistin resistance without requiring genome sequencing. © 2018, European Centre for Disease Prevention and Control (ECDC). All rights reserved

What are we measuring? A critique of range of motion methods currently in use for Dupuytren's disease and recommendations for practice

Background: Range of motion is the most frequently reported measure used in practice to evaluate outcomes. A goniometer is the most reliable tool to assess range of motion yet, the lack of consistency in reporting prevents comparison between studies. The aim of this study is to identify how range of motion is currently assessed and reported in Dupuytren’s disease literature. Following analysis recommendations for practice will be made to enable consistency in future studies for comparability. This paper highlights the variation in range of motion reporting in Dupuytren’s disease. Methods: A Participants, Intervention, Comparison, Outcomes and Study design format was used for the search strategy and search terms. Surgery, needle fasciotomy or collagenase injection for primary or recurrent Dupuytren’s disease in adults were included if outcomes were monitored using range of motion to record change. A literature search was performed in May 2013 using subject heading and free-text terms to also capture electronic publications ahead of print. In total 638 publications were identified and following screening 90 articles met the inclusion criteria. Data was extracted and entered onto a spreadsheet for analysis. A thematic analysis was carried out to establish any duplication, resulting in the final range of motion measures identified. Results: Range of motion measurement lacked clarity, with goniometry reportedly used in only 43 of the 90 studies, 16 stated the use of a range of motion protocol. A total of 24 different descriptors were identified describing range of motion in the 90 studies. While some studies reported active range of motion, others reported passive or were unclear. Eight of the 24 categories were identified through thematic analysis as possibly describing the same measure, ‘lack of joint extension’ and accounted for the most frequently used. Conclusions: Published studies lacked clarity in reporting range of motion, preventing data comparison and meta-analysis. Percentage change lacks context and without access to raw data, does not allow direct comparison of baseline characteristics. A clear description of what is being measured within each study was required. It is recommended that range of motion measuring and reporting for Dupuytren’s disease requires consistency to address issues that fall into 3 main categories:- Definition of terms Protocol statement Outcome reportin

Optimal functional outcome measures for assessing treatment for Dupuytren's disease: A systematic review and recommendations for future practice

This article is available through the Brunel Open Access Publishing Fund. Copyright © 2013 Ball et al.; licensee BioMed Central Ltd.Background: Dupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment. Methods: A literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures. Results: Ninety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years. Conclusions: There is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes

Are oral health conditions associated with schoolchildren's performance and school attendance in the Kingdom of Bahrain? A life-course perspective

Background The link between oral diseases and school performance and school attendance remains unclear among Middle Eastern children. Aim To investigate the relationship of oral conditions with schoolchildren’s school performance and attendance using the life course approach. Design A cross-sectional study was conducted with 466 schoolchildren aged 7-8 years from Kingdom of Bahrain (KoB) and their parents. Questionnaire data on children’s current and at birth environmental characteristics were completed by their parents. Children’s oral health measures, including ICDAS (International Caries Detection and Assessment System), PUFA (Pulp, Ulcer, Fistula, Abscess), and DDE (Developmental Defects of Enamel) indices, were the exposure variables. School performance and school attendance data obtained from the school register were the outcome variables. The data were analysed using multivariate ordinal logistic regression. Results The odds of Excellent school performance were significantly lower for children with untreated dentine caries (OR = 0.98 CI 95%: 0.96-0.99). Children with caries-treated teeth showed greater odds of Excellent school performance (OR=1.41 CI 95%: 1.15-1.74). A permissive parental style was associated with poor school attendance (OR= 2.63 CI 95%: 1.08-6.42). Conclusion Dental caries was associated with poor school performance but not with school attendance. Treated caries was associated with good school performance

C-reactive protein and later preeclampsia: systematic review and meta-analysis taking into account the weight status.

OBJECTIVES: This study aims to determine whether high C-reactive protein (CRP) concentration during pregnancy is associated with later preeclampsia and whether weight status (BMI) is a potential modifier of the relation between CRP and preeclampsia. METHODS: Twenty-three studies were included in a systematic literature review and a subset of 18 in a meta-analysis. Weighted mean difference (WMD) [with their 95% confidence intervals (CI)] of CRP in preeclampsia and control groups was the estimator. A quality assessment was carried out using a scale specifically developed for this study. Meta-regression with estimates for study characteristics and inter-arm differences and sensitivity and subgroup analysis was employed. Statistical heterogeneity was investigated using I(2) statistic. RESULTS: The pooled estimated CRP between 727 women, who developed preeclampsia and 3538 controls was 2.30 mg/l (95% CI: 1.27-3.34). The heterogeneity among studies was high (I(2) = 92.8). The WMD was found to be lower in studies comprising preeclampsia and control groups with similar BMI [WMD = 0.85 (95% CI: 0.10-1.61); I(2) = 25.3%] compared with studies among which BMI was significantly elevated in the preeclampsia group [2.01 (95% CI: 1.23-2.78); I(2) = 0.0%], which may explain the high heterogeneity of pooled data. Meta-regression results confirmed that difference in BMI between groups modifies the association of CRP and preeclampsia. High quality studies represented 30%. CONCLUSION: The pooled WMD suggest that women with higher levels of CRP may have an increased risk of developing preeclampsia. This association seems to be modified by confounders, such as BMI. Further studies of high methodological quality are needed

Potential impacts of future land use and climate change on the Red List status of the Proteaceae in the Cape Floristic Region, South Africa

Using spatial predictions of future threats to biodiversity, we assessed for the first time the relative potential impacts of future land use and climate change on the threat status of plant species. We thus estimated how many taxa could be affected by future threats that are usually not included in current IUCN Red List assessments. Here, we computed the Red List status including future threats of 227 Proteaceae taxa endemic to the Cape Floristic Region, South Africa, and compared this with their Red List status excluding future threats. We developed eight different land use and climate change scenarios for the year 2020, providing a range of best- to worst-case scenarios. Four scenarios include only the effects of future land use change, while the other four also include the impacts of projected anthropogenic climate change (HadCM2 IS92a GGa), using niche-based models. Up to a third of the 227 Proteaceae taxa are uplisted (become more threatened) by up to three threat categories if future threats as predicted for 2020 are included, and the proportion of threatened Proteaceae taxa rises on average by 9% (range 2-16%), depending on the scenario. With increasing severity of the scenarios, the proportion of Critically Endangered taxa increases from about 1% to 7% and almost 2% of the 227 Proteaceae taxa become Extinct because of climate change. Overall, climate change has the most severe effects on the Proteaceae, but land use change also severely affects some taxa. Most of the threatened taxa occur in low-lying coastal areas, but the proportion of threatened taxa changes considerably in inland mountain areas if future threats are included. Our approach gives important insights into how, where and when future threats could affect species persistence and can in a sense be seen as a test of the value of planned interventions for conservation.Ctr Invas Bio

Potential impacts of future land use and climate change on the red List status of hthe Proteaceae in the Cape floristic region, south africa

International audienceUsing spatial predictions of future threats to biodiversity, we assessed for the first time the relative potential impacts of future land use and climate change on the threat status of plant species. We thus estimated how many taxa could be affected by future threats that are usually not included in current IUCN Red List assessments. Here, we computed the Red List status including future threats of 227 Proteaceae taxa endemic to the Cape Floristic Region, South Africa, and compared this with their Red List status excluding future threats. We developed eight different land use and climate change scenarios for the year 2020, providing a range of best- to worst-case scenarios. Four scenarios include only the effects of future land use change, while the other four also include the impacts of projected anthropogenic climate change (HadCM2 IS92a GGa), using niche-based models. Up to a third of the 227 Proteaceae taxa are uplisted (become more threatened) by up to three threat categories if future threats as predicted for 2020 are included, and the proportion of threatened Proteaceae taxa rises on average by 9% (range 2–16%), depending on the scenario. With increasing severity of the scenarios, the proportion of Critically Endangered taxa increases from about 1% to 7% and almost 2% of the 227 Proteaceae taxa become Extinct because of climate change. Overall, climate change has the most severe effects on the Proteaceae, but land use change also severely affects some taxa. Most of the threatened taxa occur in low-lying coastal areas, but the proportion of threatened taxa changes considerably in inland mountain areas if future threats are included. Our approach gives important insights into how, where and when future threats could affect species persistence and can in a sense be seen as a test of the value of planned interventions for conservation