Intestinal barrier integrity and function in infants with cholestasis

BACKGROUND/AIMS: The safety of the human body is maintained by effective monitoring of the mucosal surface integrity and protection against potentially harmful compounds. This function of the gut called intestinal barrier function can be affected by cholestasis and the absence of bile in the intestinal lumen. We aimed to determine whether the gut barrier integrity is impaired in infants with cholestasis by evaluation of the intestinal fatty acid binding proteins (I-FABP) and ileal bile acid binding protein (I-BABP) as markers of intestinal epithelial cell damage and plasma D-lactate level as a marker of gut wall permeability. METHODS: This case-control study included 53 infants with cholestasis and 29 controls. Serum levels of I-FABP, I-BABP, and D-lactate were measured in all subjects. RESULTS: Both groups of patients with neonatal hepatitis and biliary atresia showed significantly higher levels of I-FABP and I-BABP than the controls. There were no differences in the serum D-lactate level between the cases and controls. There was no difference between the two groups of patients (I and II) regarding any of the parameters studied. No significant correlations between serum levels of I-FABP, I-BABP, or D-lactate and total or direct bilirubin levels were found in the cholestatic infants. CONCLUSIONS: The intestinal epithelial barrier integrity is breached nearly in all parts of the intestine in infants with cholestasis. Further research is recommended to determine the impact of this finding on the management of these infants. The relationship between physical intestinal barrier damage and its functional failure remains subject for further research.

Real-time PCR versus phenotypic diagnostic methods in detection of methicillin and vancomycin resistant staphylococci

Staphylococci are the most frequently isolated bacteria from blood. The prevalence of antibiotic resistance has dramatically increased. Real-time PCR offers rapid, accurate, and sensitive method to detect the presence of antimicrobial resistance. This study is mainly aimed to detect uethicillin [oxacillin] and vancomycin resistant staphylococci isolated from blood of patients with significant bacteremia in Assiut University Hospital using both real-time PCR and phenotypic agnostic methods. Sixty Staphylococcal isolates were included. These isolates were collected from positive blood culture bottles [BACTEC 9050 System] of patients with significant bacteremia in Assiut University Hospital. Identification of staphylococcal species was performed by subculture on Mannitol Salt Agar [MSA] and by Microscan system, while antibiotic sensitivity testing was performed by Microscan system, Epsilometer test [E- test], Disc diffusion [DD] method, Oxacillin Resistance Screening Agar Base [ORSAB] and by real-time PCR for mec A and van A genes. Seven S. aureus isolates and fifty three Coagulase-negative staphylococci [CoNS] were detected by both MSA and Microscan system. The most effective antibiotics for staphylococcal isolates were in order. Vancomycin, Linezolid, Synercid, Rifampicin, Chloramphenicol, Gentamycin, Tetracycline, Trimethoprim/Sulphamethoxazole, Clindamycin, Ofloxacin, Ciprofloxacin, Azithromycin and Erythromycin. Concerning methicillin resistance, Real-time PCR which is the gold standard method detected mecA gene in 57 isolates. Accordingly, sensitivity and specificity of E-test were 964% and 100% respectively, DD method showed 87.7% sensitivity and 100% specificity, ORSAB media showed 92.9% sensitivity and 100% specificity while Microscan showed 100.0% sensitivity and 100.0% specificity. Concerning vancomycin resistance, E-test which is the gold standard method detected vancomycin resistance in 6 staphylococcal isolates. Therefore, the DD method showed 66.7% sensitivity and 100.0% specificity while Microscan showed 83.3% sensitivity and 100.0% specificity. Real-time PCR detected van A gene in only one staphylococcal isolate. CoNS organisms are more implicating than S. aureus in bloodstream infections [BSIs]. About 95% of staphylococcal isolates were resistant to methicillin and 10% were resistant to vancomycin. Real-time PCR was more accurate and rapid method for detection of methicillin resistance than phenotypic methods and it could be considered a confirmatory method for detection of vancomycin resistance in staphylococcal isolates suspected to have the van A gene

Value of serum and synovial fluid activin A and inhibin A in some rheumatic diseases

Activin is a growth and differentiation factor of many cell types and has recently been implanted in inflammatory processes. Clinical data demonstrating roles of activin and its antagonist inhibin in inflammatory arthropathies, are lacking. The Study is to measure serum and synovial fluid levels of activin A and inhibin A in patients with rheumatoid arthritis [RA] systemic lupus erythematosus [SLE] and osteoarthritis [OA] and correlate them with disease activity parameters. This study included 60 patients with three rheumatic diseases [20 with RA, 20 with SLE and 20 with OA], as well as ten healthy subjects as a control group. All of them were subjected to complete history, physical and musculoskeletal examination and estimation of disease activity index [DAS- 28] for RA and [SLEDAI] for SLE. The following investigations were done for all subjects; serum and synovial activin A and inhibin A; in addition to complete blood picture, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP],rheumatoid factor [RF], antinuclear antibodies [ANA],anti-dsDNA, serum complement [C 3, 4] and Xrays on affected joints. The mean values of serum activin A were significantly higher in RA, SLE and OA than controls [P<0.001] also in RA and SLE versus OA [P<0.05 for both]. The mean values of serum inhibin A were significantly higher in all studied groups than controls [P<0.05 for RA and OA and P<0.001 for SLE]. Also serum inhibin levels were significantly higher in SLE versus OA P<0.001, but there was no significant differences between RA and SLE. Synovial fluid activin and inhibin A were significantly higher in RA than OA [P<0.05 for both]. Positive correlations were found between serum activin A and disease activity parameters of RA morning stiffness [MS], Ritchie index [RI], ESR, CRP and DAS 28] P<0.05, for all. Also positive correlation was found between serum inhibin A and RI in RA patient [P<0.05]. In SLE, positive correlations were found between serum activin A and inhibin A with ESR [P<0.001 for activin and P<0.05 for inhibin A and SLEDAI [P<0.001 for both activin and inhibin]. No correlation were found between synovial activin and disease activity and negative correlation between synovial inhibin and ESR. The significant increase of serum and synovial activin A and inhibin A in RA and SLE and their positive correlations with disease activity parameters of RA and SLE suggest pro-inflammatory action. However the lack of correlations or negative correlation of their synovial levels with disease activity may indicate their anti inflammatory action, We recommended further studies to detect the exact role of activin A and inhibin A