Genome-wide transcriptional profiling of Clostridium species during sporulation

Dormancy strategies utilized by bacteria contribute to their survival under adverse conditions, as well as persistence and transmission between hosts. The formation of endospores produces some of the most resilient forms of life by members of the Firmicutes phylum. Genome studies of the human gut bacteria have shown that sporulation genes are widespread among commensal Clostridia, which play an essential role in maintaining gut homeostasis, but sporulation of non-pathogenic bacteria has been poorly studied. Defining the sporulation conditions and the genetic makeup behind cell differentiation into endospores may allow for practical applications in the treatment of gut disease and to promote well-being. Select commensal Clostridia strains were cultivated under conditions that promote sporulation in Bacillus and Clostridium species. Spore-like cells were observed by phase-contrast and electron microscopy, but could not be cultured. Gene expression studies and 16s rRNA sequencing revealed that the strains belonged to non-sporulating species of Actinotignum schaalii and Staphylococcus epidermidis, which have close family members capable of exospore formation and entry into a viable but non culturable state. Differentially regulated genes during S. epidermidis entry into a VBNC state were analyzed using RNA sequencing. The upregulated expression of membrane proteins, cell transport, stress response, and a shift in metabolism towards protein and carbohydrate catabolism were similar to gene expression patterns in other bacteria previously reported to enter the VBNC state. The subject of bacterial dormancy has been gaining momentum through techniques such as RNA sequencing, which allows the discovery of genetic factors previously unassociated with cell differentiation.Hvile-stadier hos bakterier bidrar til deres overlevelse ved ugunstige forhold, i tillegg til å fremme standhaftighet og utspredning mellom verter. Formering av endosporer produserer noen av de mest resistente livsformer på jorda hos medlemmer i rekken Firmicutes. Genom studier av menneskets tarmbakterier har vist at sporuleringsgener er utbredte blant kommensale Clostridia, som spiller en viktig rolle i å opprettholde homeostase i tarmen, men sporulering hos ikke-patogene arter har blitt lite studert. Å definere sporuleringsforhold og det genetiske grunnlaget for celle differensiering kan bidra til behandling av tarmsykdommer og gi en økning i generell velferd. Utvalgte Clostridiastammer ble kultiverte ved forhold som hadde vært tidligere vist til å fremme sporulering hos Bacillus og Clostridium-arter. Spore-liknende celler ble observerte med fase-kontrast mikroskopi og elektron mikroskopi, men kunne ikke kultiveres. Genuttrykks studier og 16srRNA sekvensering viste at stammene tilhørte til ikke-sporulerende Actinotignum schaalii og Staphylococcus epidermidis-arter, men som har nære familie slektninger med evne til å danne exosporer og til gå in en VBNC hvile-stadium Differensialt uttrykte gener i løpet S. epidermidis overgang til en VBNC stadiet ble analyserte ved hjelp av RNA sekvensering. De oppregulerte gener som tilhørte membran proteiner, celle transport, stress respons, og en overgang til katabolisme av proteiner og karbohydrater, var i likhet til genuttrykk fra tidligere studier hos andre arter i VBNC stadiet. Hvile-stadier hos bakterier har fått en økning i oppmerksomhet og fremgang ved hjelp av nyere metoder som RNA sekvensering, som tillater oppdagelse av nye genetiske faktorer som tidligere var ikke assosierte med celle differensiering.M-VE

Association between vitamin D and fatigue in patients with rheumatoid arthritis: a cross-sectional study

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Worries and Concerns among Inflammatory Bowel Disease Patients Followed Prospectively over One Year

Disease-related worries are frequently reported in inflammatory bowel disease (IBD), but longitudinal assessments of these worries are scarce. In the present study, patients completed the rating form of IBD patient concerns (RFIPC) at three occasions during one year. One-way analysis of variance (ANO VA), t-tests, bivariate correlation, and linear regression analyses were used to analyse data. The validity and reliability of the Norwegian RFIPC was tested. A total of 140 patients were included (V1), ulcerative colitis (UC) n = 92, Crohn's disease (CD) n = 48, mean age 46.9 and 40.0-year old, respectively. The highest rated worries included having an ostomy bag, loss of bowel control, and reduced energy levels. Symptoms were positively associated with more worries. A pattern of IBD-related worries was consistent over a period of one year. Worries about undergoing surgery or having an ostomy bag seemed to persist even when symptoms improved. The Norwegian RFIPC is valid and reliable

Interventions for fatigue in inflammatory bowel disease (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: The aim of this review is to assess the efficacy and safety of interventions for fatigue in IBD

Hospital physicians' experiences with procalcitonin - implications for antimicrobial stewardship; a qualitative study.

Background. Procalcitonin is an inflammatory biomarker that is sensitive for bacterial infections and a promising clinical decision aid in antimicrobial stewardship programs. However, there are few studies of physicians’ experiences concerning the use of PCT. The objective of this study was to investigate whether hospital physicians’ experience with procalcitonin after 18 months of use can inform the PCT implementation in antimicrobial stewardship programs. Materials/methods. We deployed a qualitative approach using semi-structured interviews with 14 hospital physicians who had experience with procalcitonin in clinical practice. Interviews were audio-taped, transcribed verbatim and analysed using thematic analysis. Results. Physicians reported a knowledge gap, which made them uncertain about the appropriate procalcitonin use, interpretation, and trustworthiness. Simultaneously, the physicians experienced procalcitonin as a useful clinical decision aid but emphasised that their clinical evaluation of the patient was the most important factor when deciding on antibiotic treatment. Conclusions. Procalcitonin was regarded a helpful clinical tool, but the physicians called for more knowledge about its appropriate uses. Active implementation of unambiguous procalcitonin algorithms and physician education may enhance the utility of the test as an antimicrobial stewardship adjunct.publishedVersio

Incidence of cancer in patients with ulcerative colitis 30 years after diagnosis (the IBSEN study)

Objectives Patients with ulcerative colitis (UC) have shown an increased risk for colorectal cancer, hepatobiliary, hematologic, and skin cancers, but updated long-term data is needed. This study aimed to estimate the risk of cancer in patients with UC compared to the general Norwegian population, in a population-based cohort (the IBSEN study), 30 years after diagnosis; and to identify possible risk factors associated with cancer. Methods The IBSEN cohort prospectively included all incident patients between 1990 and 1993. Cancer incidence data were obtained from the Cancer Registry of Norway. The overall and cancer-specific hazard ratios (HR) were modelled using Cox regression. Standardized incidence ratios were estimated compared to the general population. Results In total, the cohort included 519 patients, and 83 cases were diagnosed with cancer. There was no statistically significant difference in the overall cancer risk (HR = 1.01, 95% CI: [0.79–1.29]) and colorectal cancer risk (HR = 1.37, 95% CI: [0.75–2.47]) between patients and controls. The incidence of biliary tract cancer was higher than expected (SIR = 9.84, 95%CI: [3.19–20.15]), especially when UC patients suffered from primary sclerosing cholangitis. Male UC patients were also more at risk of being diagnosed with hematologic malignancies (HR = 3.48, 95% CI: [1.55–7.82]). Being prescribed thiopurines was associated with a higher risk of cancer (HR = 2.03, 95% CI: [1.02–4.01]). Conclusions At 30 years after diagnosis, the risk of all cancer in patients with UC was not significantly increased compared with the general population. However, the risks of biliary tract cancer and hematologic cancers were increased, particularly in male patients.publishedVersio

Risk of Cancer in Patients With Crohn's Disease 30 Years After Diagnosis (the IBSEN Study)

Background: Patients with Crohn's disease (CD) are most often diagnosed as young adults; therefore, long-term studies are needed to assess the risk of cancer over their lifetime. Thus, the aims of the present study were to determine the risk of cancer in a Norwegian population-based cohort (the Inflammatory Bowel South Eastern Norway [IBSEN] study), 30 years after diagnosis, and to assess whether patients with CD were at an increased risk of specific cancer types. Methods: The IBSEN cohort prospectively included all incident patients diagnosed between 1990 and 1993. Data on cancer incidence were obtained from the Cancer Registry of Norway. Overall and cancer-specific hazard ratios (HRs) for CD patients compared with age- and sex-matched controls were modeled using Cox regression. Standardized incidence ratios (SIRs) were estimated compared to the general population. Results: In total, the cohort included 237 patients with CD, and 36 of them were diagnosed with cancer. Compared to the general Norwegian population, patients with CD had an increased overall risk of cancer (HR = 1.56, 95% CI: 1.06-2.28), particularly male patients (HR = 1.85, 95% CI: 1.08-3.16). The incidence of lung cancer and nonmelanoma skin cancer was increased; however, the difference was not statistically significant (SIR = 2.29, 95% CI: 0.92-4.27 and SIR = 2.45, 95% CI: 0.67-5.37, respectively). Conclusions: After 30 years of follow-up, the risk of all cancers in patients with CD was increased compared to the general population. Keywords: Cancer; Crohn’s disease. © The Author(s) 2023. Published by Oxford University Press on behalf of Crohn's & Colitis Foundation.publishedVersio

The Role of Procalcitonin as an Antimicrobial Stewardship Tool in Patients Hospitalized with Seasonal Influenza

Background: Up to 60% of the antibiotics prescribed to patients hospitalized with seasonal influenza are unnecessary. Procalcitonin (PCT) has the potential as an antimicrobial stewardship program (ASP) tool because it can differentiate between viral and bacterial etiology. We aimed to explore the role of PCT as an ASP tool in hospitalized seasonal influenza patients. Methods: We prospectively included 116 adults with seasonal influenza from two influenza seasons, 2018–2020. All data was obtained from a single clinical setting and analyzed by descriptive statistics and regression models. Results: In regression analyses, we found a positive association of PCT with 30 days mortality and the amount of antibiotics used. Influenza diagnosis was associated with less antibiotic use if the PCT value was low. Patients with a low initial PCT (<0.25 µg/L) had fewer hospital and intensive care unit (ICU) days and fewer positive chest X-rays. PCT had a negative predictive value of 94% for ICU care stay, 98% for 30 days mortality, and 88% for bacterial coinfection. Conclusion: PCT can be a safe rule-out test for bacterial coinfection. Routine PCT use in seasonal influenza patients with an uncertain clinical picture, and rapid influenza PCR testing, may be efficient as ASP tools.publishedVersio

Patient experiences and predictors in an acute geriatric ward: a cross-sectional study

Aims and objectives To investigate older peoples’ experiences with acute hospital treatment and care, and variables that may influence these experiences. Background In the Nordic countries, research on older peoples’ experiences with hospital care is sparse. Methods Participants were recruited from an acute geriatric ward in a hospital in Norway during a 1‐year period (n = 189). Patient experience was assessed using the Picker Patient Experience Questionnaire, self‐rated health by Euro‐QoL 5‐dimension, three‐level version and comorbidity by Charlson comorbidity index. Results Responders’ median age was 79 years, 48.7% male. Most of the problems were related to continuity and transition, while fewest problems were related to respect for patient preferences. Charlson comorbidity index score and the variables “still working,” “in a relationship” and “living alone” negatively influenced patient experience. Conclusions A high amount of problems were identified among patients hospitalised in an acute geriatric ward. Findings from this study may provide important information about issues that need focus to increase the care experiences of older people. Relevance to clinical practice Results from this study adds to existing knowledge, and emphasize the need for increased focus on discharge and continuity of care processes.acceptedVersio