Diagnostic Clinical and Laboratory Findings in Response to Predetermining Bacterial Pathogen: Data from the Meningitis Registry

BACKGROUND: Childhood meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis. METHODOLOGY AND PRINCIPAL FINDINGS: During the 32 year period, 2477 cases of probable bacterial meningitis (BM) were collected from the Meningitis Registry (MR). Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta) and SPSS (version 15.0-Chicago) software. Statistically significant (p<0.05) variables were included in a conditional backward logistic regression model. A total of 838 (63.0%) attributed to Neisseria meningitidis, 252 (18.9%) to Haemophilus influenzae, 186 (14.0%) to Streptococcus pneumoniae and 55 (4.1%) due to other bacteria. For the diagnosis of Meningococcal Meningitis, the most significant group of diagnostic criteria identified included haemorrhagic rash (OR 22.36), absence of seizures (OR 2.51), headache (OR 1.83) and negative gram stain result (OR 1.55) with a Positive Predictive Value (PPV) of 96.4% (95%CI 87.7-99.6). For the diagnosis of Streptococcus pneumoniae, the most significant group of diagnostic criteria identified included absence of haemorrhagic rash (OR 13.62), positive gram stain (OR 2.10), coma (OR 3.11), seizures (OR 3.81) and peripheral WBC > or = 15000/microL (OR 2.19) with a PPV of 77.8% (95%CI 40.0-97.2). For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61), age > or = 1 year (OR 2.04), absence of headache (OR 3.01), CSF Glu < 40 mg/dL (OR 3.62) and peripheral WBC < 15,000/microL (OR 1.74) with a PPV of 58.5% (95%CI 42.1-73.7). CONCLUSIONS: The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied

Greece in crisis: austerity, populism and the politics of blame

Within the broader debate on the Greek crisis, the theory of ‘populist democracy’ postulates that populism is fundamental to the sustenance of the Greek political system and is at the heart of Greece's endemic domestic weaknesses. This article tests this assumption empirically through the use of a sophisticated framing analysis of speeches delivered by the leaders of the five parties in the Greek parliament in the period 2009–11. The findings confirm that populism: (a) is expressed through the narratives of political actors; (b) is observed across the party system; (c) is expressed in the forms of blame-shifting and exclusivity; and (d) differs depending on position in the party system. The article contributes to the debate by testing and building on the theory of democratic populism, providing a novel way of measuring and operationalizing populism and identifying a new typology that distinguishes between mainstream and fringe populism

Preanalysis of Neutron Activation Measurements in Shielding Penetrations at JET

In the present work, the preanalysis of activation foil experiments to determine neutron fluence rates along JET hall ducts and labyrinths is discussed. Simulations were performed using computational codes MCNPX and FISPACT-II and a detailed model of the JET hall, including the tokamak, biological shield and penetrations. The induced activity and detector count rate were predicted for activation foils placed at selected positions within the JET hall for Deuterium-Deuterium and Deuterium-Tritium JET plasma sources. The results of the calculations showed that satisfactory counting statistics can be obtained with the use of activation detectors and therefore activation analysis offers an unbiased and robust cross-benchmarking tool for comparison against other experimental and computation techniques applied in neutron streaming studies at JET

calibration of activation foils at the 14 mev frascati neutron generator

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preparation of activation experiments for iter material characterization and data validation in the deuterium tritium jet campaign

The levels of induced activity in samples of ITER materials and dosimetry foils to be irradiated during the planned JET campaign with deuterium-tritium (D-T) plasma were predicted. Calculations were performed for the neutron energy spectrum of the JET internal Long Term Irradiation Station (LTIS). The European Activation System (EASY-II) and the EAF-2010 nuclear data library were used in order to estimate specific activity and dose rates as a function of time after the end of irradiation. The results of the study provide important data for comparison against activation measurements and support the planning of the irradiation, measurement and radiation protection procedures to be implemented in the planned JET activation experiment

Opportunity or threat? Public attitudes towards EU Freedom of Movement

This article examines the effect of individual and contextual variables on preference formation towards European Union (EU) freedom of movement. Our multilevel analyses of Eurobarometer data show that citizens with low levels of human capital and strong feelings of national identity are more likely to oppose intra-EU migration. However, we argue that in order to fully grasp variation in public preferences, we need to consider the domestic context. Utilitarian and affective theories have more explanatory power in richer countries, but in less affluent member states support for free movement is evenly high irrespective of individual dispositions. Our findings have implications for the progress of European integration, especially at a time when the EU is in the process of deciding on a course of action about its future direction

Thymosin-B4: a key modifier of renal disease

Introduction: There is an urgent need for new treatments for chronic kidney disease (CKD). Thymosin-B4 is a peptide that reduces inflammation and fibrosis and has the potential to restore endothelial and epithelial cell injury, biological processes involved in the pathophysiology of CKD. Therefore, thymosin-B4 could be a novel therapeutic direction for CKD. Areas covered: Here, we review the current evidence on the actions of thymosin-B4 in the kidney in health and disease. Using transgenic mice, two recent studies have demonstrated that endogenous thymosin-B4 is dispensable for healthy kidneys. In contrast, lack of endogenous thymosin-B4 exacerbates mouse models of glomerular disease and angiotensin-II-induced renal injury. Administration of exogenous thymosin-B4, or its metabolite, Ac-SDKP, has shown therapeutic benefits in a range of experimental models of kidney disease. Expert opinion: The studies conducted so far reveal a protective role for thymosin-B4 in the kidney and have shown promising results for the therapeutic potential of exogenous thymosin-B4 in CKD. Further studies should explore the mechanisms by which thymosin-B4 modulates kidney function in different types of CKD. Ac-SDKP treatment has beneficial effects in many experimental models of kidney disease, thus supporting its potential use as a new treatment strategy

Prognostic factors related to sequelae in childhood bacterial meningitis: Data from a Greek meningitis registry

<p>Abstract</p> <p>Background</p> <p>Bacterial meningitis (BM) is a life-threatening disease, often related with serious complications and sequelae. Infants and children who survive bacterial meningitis often suffer neurological and other sequelae.</p> <p>Methods</p> <p>A total of 2,477 patients aged 1 month to 14 years old hospitalized in a Children's Hospital in Greece diagnosed with acute bacterial meningitis were collected through a Meningitis Registry, from 1974 to 2005. Clinical, laboratory and other parameters (sex, age, pathogen, duration of symptoms before and after admission) were evaluated through univariate and multivariate analysis with regard to sequelae. Analysis of acute complications were also studied but not included in the final model.</p> <p>Results</p> <p>The rate of acute complications (arthritis and/or subdural effusion) was estimated at 6.8% (152 out of 2,251 patients, 95%CI 5.8-7.9) while the rate of sequelae (severe hearing loss, ventriculitis, hydrocephalus or seizure disorder) among survivors was estimated at 3.3% (73 out of 2,207 patients, 95%CI 2.6-4.2). Risk factors on admission associated with sequelae included seizures, absence of hemorrhagic rash, low CSF glucose, high CSF protein and the etiology of meningitis. A combination of significant prognostic factors including presence of seizures, low CSF glucose, high CSF protein, positive blood culture and absence of petechiae on admission presented an absolute risk of sequelae of 41.7% (95%CI 15.2-72.3).</p> <p>Conclusions</p> <p>A combination of prognostic factors of sequelae in childhood BM may be of value in selecting patients for more intensive therapy and in identifying possible candidates for new treatment strategies.</p

Serum endotoxins and flagellin and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) Cohort

Background: Chronic inflammation and oxidative stress are thought to be involved in colorectal cancer development. These processes may contribute to leakage of bacterial products, such as lipopolysaccharide (LPS) and flagellin, across the gut barrier. The objective of this study, nested within a prospective cohort, was to examine associations between circulating LPS and flagellin serum antibody levels and colorectal cancer risk. Methods: A total of 1,065 incident colorectal cancer cases (colon, n = 667; rectal, n = 398) were matched (1:1) to control subjects. Serum flagellin- and LPS-specific IgA and IgG levels were quantitated by ELISA. Multivariable conditional logistic regression models were used to calculate ORs and 95% confidence intervals (CI), adjusting for multiple relevant confouding factors. Results: Overall, elevated anti-LPS and anti-flagellin biomarker levels were not associated with colorectal cancer risk. After testing potential interactions by various factors relevant for colorectal cancer risk and anti-LPS and anti-flagellin, sex was identified as a statistically significant interaction factor (Pinteraction < 0.05 for all the biomarkers). Analyses stratified by sex showed a statistically significant positive colorectal cancer risk association for men (fully-adjusted OR for highest vs. lowest quartile for total anti-LPS + flagellin, 1.66; 95% CI, 1.10–2.51; Ptrend, 0.049), whereas a borderline statistically significant inverse association was observed for women (fully-adjusted OR, 0.70; 95% CI, 0.47–1.02; Ptrend, 0.18). Conclusion: In this prospective study on European populations, we found bacterial exposure levels to be positively associated to colorectal cancer risk among men, whereas in women, a possible inverse association may exist. Impact: Further studies are warranted to better clarify these preliminary observations