Comparison of interferon-gamma release assay versus tuberculin skin test for tuberculosis screening in inflammatory bowel disease

OBJECTIVES: Reactivation of latent tuberculosis (TB) in inflammatory bowel disease (IBD) patients treated with antitumor necrosis factor-alpha medication is a serious problem. Currently, TB screening includes chest x-rays and a tuberculin skin test (TST). The interferon-gamma release assay (IGRA) QuantiFERON-TB Gold In-Tube (QFT-G-IT) shows better specificity for diagnosing TB than the skin test. This study evaluates the two test methods among IBD patients. METHODS: Both TST and IGRA were performed on 212 subjects (114 Crohn's disease, 44 ulcerative colitis, 10 indeterminate colitis, 44 controls). RESULTS: Eighty-one percent of IBD patients were under immunosuppressive therapy; 71% of all subjects were vaccinated with Bacille Calmette Guérin; 18% of IBD patients and 43% of controls tested positive with the skin test (P < 0.0001). Vaccinated controls tested positive more often with the skin test (52%) than did vaccinated IBD patients (23%) (P = 0.011). Significantly fewer immunosuppressed patients tested positive with the skin test than did patients not receiving therapy (P = 0.007); 8% of patients tested positive with the QFT-G-IT test (14/168) compared to 9% (4/44) of controls. Test agreement was significantly higher in the controls (P = 0.044) compared to the IBD group. CONCLUSIONS: Agreement between the two test methods is poor in IBD patients. In contrast to the QFT-G-IT test, the TST is negatively influenced by immunosuppressive medication and vaccination status, and should thus be replaced by the IGRA for TB screening in immunosuppressed patients having IBD.

Novel screening tools for latent tuberculosis: time to leave an old friend?

PURPOSE OF REVIEW: Therapeutic inhibition of tumour necrosis factor-alpha strongly increases the risk of reactivation in latent tuberculosis infection. Recent blood tests based on antigen-specific T cell response and measuring production of interferon-gamma, so called interferon-gamma release assays (IGRAs), are promising novel tools to identify infected patients. The performance of diagnostic testing for latent tuberculosis infection in patients with rheumatic diseases will be discussed. RECENT FINDINGS: In patients with rheumatoid arthritis, IGRAs are more sensitive and more specific than traditional tuberculin skin testing. They are unaffected by Bacillus-Calmette-Guérin vaccination and most nontuberculous mycobacteria. Most comparative studies show a better performance of the IGRAs than tuberculin skin testing in terms of a higher specificity. The rate of indeterminate results may be affected by glucocorticoids and the underlying disease but appears independent of disease-modifying antirheumatic drugs. Despite using identical Mycobacterium tuberculosis antigens, the two commercially available tests show differences in clinical performance. SUMMARY: The current information about the performance of the tuberculin skin testing and the IGRAs in the detection of latent tuberculosis infection in patients with rheumatic diseases strongly suggest a clinically relevant advantage of the IGRAs. Their use will help to reduce overuse and underuse of preventive treatment in tumour necrosis factor inhibition.

Paternal inheritance of growth in fish pursuing alternative reproductive tactics

In species with indeterminate growth, age-related size variation of reproductive competitors within each sex is often high. This selects for divergence in reproductive tactics of same-sex competitors, particularly in males. Where alternative tactics are fixed for life, the causality of tactic choice is often unclear. In the African cichlid Lamprologus callipterus, large nest males collect and present empty snail shells to females that use these shells for egg deposition and brood care. Small dwarf males attempt to fertilize eggs by entering shells in which females are spawning. The bourgeois nest males exceed parasitic dwarf males in size by nearly two orders of magnitude, which is likely to result from greatly diverging growth patterns. Here, we ask whether growth patterns are heritable in this species, or whether and to which extent they are determined by environmental factors. Standardized breeding experiments using unrelated offspring and maternal half-sibs revealed highly divergent growth patterns of male young sired by nest or dwarf males, whereas the growth of female offspring of both male types did not differ. As expected, food had a significant modifying effect on growth, but neither the quantity of breeding substrate in the environment nor ambient temperature affected growth. None of the environmental factors tested influenced the choice of male life histories. We conclude that in L. callipterus growth rates of bourgeois and parasitic males are paternally inherited, and that male and female growth is phenotypically plastic to only a small degree.

Infection of cattle with Border disease virus by sheep on communal alpine pastures

The purpose of this study was to investigate whether sheep grazing communal alpine pastures with cattle can transmit Border disease virus (BDV) to cattle. A total of 1170 sheep and 923 cattle were tested for BDV using RT-PCR (sheep) and for pestivirus antibodies using an ELISA (cattle), respectively, before being moved to one of 4 pastures (A, B, C and D). Eight sheep from pasture C were viraemic. 396 of 923 cattle examined before the pasture season were seronegative. The latter were re-examined after the pasture season and 99 were seropositive or indeterminate. Antibody specificity was determined in 25 of these using a serum neutralization test (SNT). BDV infection was confirmed in 10 cattle and was considered likely in 8 others. BVDV infection was confirmed in 4 cattle and considered likely in 3 after pasturing. The study has shown that the transmission of BDV from sheep to cattle is possible on communal alpine pastures.

Investigation of border disease and bovine virus diarrhoea in sheep from 76 mixed cattle and sheep farms in eastern Switzerland

The purpose of this study was to examine the occurrence of sheep persistently infected with Border disease virus (BDV) on 76 mixed cattle and sheep farms and whether seroconversion to BDV infection occurred in cattle of these farms. Seroprevalence of BDV and bovine viral disease virus (BVDV) infection in sheep was also investigated. Quantitative RT-PCR for pestivirus detection and an ELISA to detect pestivirus antibodies were used in 2'384 and 2'291 ovine blood samples, respectively. Another 27 seropositive sheep from ten flocks underwent serum neutralization testing to differentiate between BDV and BVDV antibodies. A BDV titre that was at least four times higher than the BVDV titre was interpreted as the result of BDV infection. Titres against BVDV were interpreted in an analogous fashion. All examined sheep were pestivirus-negative, 310 sheep were seropositive, 119 had an indeterminate titre and 1'862 were seronegative. The flock seroprevalence ranged from 0.0 to 73.9 %. Three of the 27 flocks that underwent serum neutralization testing were interpreted as BDV-infected because of 6 sheep with higher BDV titres, and 6 flocks were interpreted as BVDV-infected because of 14 sheep with higher BVDV titres.

Against Universal Mereological Composition

This paper opposes Universal Mereological Composition. Sider defends it: unless UMC were true, he says, it could be indeterminate how many objects there are in the world. I argue that there is no general connection between how widely composition occurs and how many objects there are in the world. Sider fails to support UMC. Moreover, we should disbelieve in UMC objects. Existing objections against them say that they are radically unlike Aristotelian substances. True, but there is a stronger objection. This is that they are characterized by no properties, and so fail to be like anything—not even themselves.

Gender differences in paediatric patients of the swiss inflammatory bowel disease cohort study.

PURPOSE Gender differences in paediatric patients with inflammatory bowel disease (IBD) are frequently reported as a secondary outcome and the results are divergent. To assess gender differences by analysing data collected within the Swiss IBD cohort study database since 2008, related to children with IBD, using the Montreal classification for a systematic approach. METHODS Data on gender, age, anthropometrics, disease location at diagnosis, disease behaviour, and therapy of 196 patients, 105 with Crohn's disease (CD) and 91 with ulcerative or indeterminate colitis (UC/IC) were retrieved and analysed. RESULTS THE CRUDE GENDER RATIO (MALE : female) of patients with CD diagnosed at <10 years of age was 2.57, the adjusted ratio was 2.42, and in patients with UC/IC it was 0.68 and 0.64 respectively. The non-adjusted gender ratio of patients diagnosed at ≥10 years was 1.58 for CD and 0.88 for UC/IC. Boys with UC/IC diagnosed <10 years of age had a longer diagnostic delay, and in girls diagnosed with UC/IC >10 years a more important use of azathioprine was observed. No other gender difference was found after analysis of age, disease location and behaviour at diagnosis, duration of disease, familial occurrence of IBD, prevalence of extra-intestinal manifestations, complications, and requirement for surgery. CONCLUSION CD in children <10 years affects predominantly boys with a sex ratio of 2.57; the impact of sex-hormones on the development of CD in pre-pubertal male patients should be investigated.

The phylogenetic position of the Dura Language of Nepal

The precise phylogenetic propinquity of Dura within the Tibeto-Burman or Trans-Himalayan language family has hitherto been indeterminate. In the absence of compelling comparative evidence, the language has previously been assigned to a subgroup in its own right within the linguistic phylum as a whole. Meanwhile, the Dura language is effectively extinct, although attempts at revival may be undertaken by well-intentioned members of Dura ethnicity. On the basis of a comprehensive study and analysis of all of the extant Dura language material, the phylogenetic position of the language within the family will be clarified. Comparative evidence from the Dura lexicon, its nominal and verbal morphology as well as from syntactic and phonological properties is adduced to determine the phylogenetic position of Dura. Moreover, this result will help explain some of the sociocultural realities associated with the Dura language community in Lamjung, Nepal

Chronological Order of Appearance of Extraintestinal Manifestations Relative to the Time of IBD Diagnosis in the Swiss Inflammatory Bowel Disease Cohort.

BACKGROUND Data evaluating the chronological order of appearance of extraintestinal manifestations (EIMs) relative to the time of inflammatory bowel disease (IBD) diagnosis is currently lacking. We aimed to assess the type, frequency, and chronological order of appearance of EIMs in patients with IBD. METHODS Data from the Swiss Inflammatory Bowel Disease Cohort Study were analyzed. RESULTS The data on 1249 patients were analyzed (49.8% female, median age: 40 [interquartile range, 30-51 yr], 735 [58.8%] with Crohn's disease, 483 [38.7%] with ulcerative colitis, and 31 [2.5%] with indeterminate colitis). A total of 366 patients presented with EIMs (29.3%). Of those, 63.4% presented with 1, 26.5% with 2, 4.9% with 3, 2.5% with 4, and 2.7% with 5 EIMs during their lifetime. Patients presented with the following diseases as first EIMs: peripheral arthritis 70.0%, aphthous stomatitis 21.6%, axial arthropathy/ankylosing spondylitis 16.4%, uveitis 13.7%, erythema nodosum 12.6%, primary sclerosing cholangitis 6.6%, pyoderma gangrenosum 4.9%, and psoriasis 2.7%. In 25.8% of cases, patients presented with their first EIM before IBD was diagnosed (median time 5 mo before IBD diagnosis: range, 0-25 mo), and in 74.2% of cases, the first EIM manifested itself after IBD diagnosis (median: 92 mo; range, 29-183 mo). CONCLUSIONS In one quarter of patients with IBD, EIMs appeared before the time of IBD diagnosis. Occurrence of EIMs should prompt physicians to look for potential underlying IBD.

The illness narratives of Hispanic American women with coronary heart disease (CHD): An ethnographic approach

Purpose. To provide a descriptive representation of the illness narratives described by Hispanic American women with CHD. ^ Design. Focused ethnographic design. ^ Setting. One outpatient general medicine clinic, one nurse-managed health promotion clinic, and informants' homes in a large metropolitan city located in southeast Texas. ^ Sample. Purposeful sampling from two different sites resulted in 17 interviews being conducted with 14 informants. ^ Method. Focused ethnographic techniques were employed in the designation of participants for the study, data collection, analysis and re-presentation. Audiotaped interviews and fieldwork were transcribed verbatim and analyzed through an iterative process of data reduction, data display, drawing conclusions and verification. ^ Findings. The developing conceptual framework that emerged from the data is labeled after the overarching experience described by informants, the experience of Embodied Exhaustion. Embodied Exhaustion, as described in this study, refers to an ongoing, dynamic, indeterminate experience of mind-body exhaustion resulting from a complex constellation of biologic, psychological and social distresses occurring over the life course. The experience consists of three categories: Taking Care of Others, Wearing Down and Hurting Hearts. Two stabilizing forces were identified: Collective Self and Believing in God. ^ Conclusions. The findings of this study emphasize the importance of framing all research, theory and practice targeting Hispanic women with CHD within a sociocentric paradigm. Nursing is challenged to provide care that extends beyond the physical body of the patient to include the social context of illness, especially the family. ^

The epidemiology of dengue among children less than 18 months of age in Puerto Rico, 1999--2011

Between 1999 and 2011, 4,178 suspected dengue cases in children less than 18 months of age were reported to the Centers for Disease Control and Prevention Dengue Branch in Puerto Rico. Of the 4,178, 813 were determined to be laboratory-positive and 737 laboratory-negative. Those remaining were either laboratory-indeterminate, not processed or positive for Leptospira . On average, 63 laboratory-positive cases were reported per year. Laboratory-positive cases had a median age of 8.5 months. Among these cases, the median age for those with dengue fever was 8.7 months and 7.9 months for dengue hemorrhagic fever. Clinical signs and symptoms indicative of dengue were greatest among laboratory-positive cases and included fever, rash, thrombocytopenia, bleeding manifestations, and petechiae. The most common symptoms among patients who were laboratory-negative were fever, nasal congestion, cough, diarrhea, and vomiting. Using the 1997 WHO guidelines, nearly 50% of the laboratory-positive cases met the case definition for dengue fever, and 61 of these were further determined to meet the case definition for dengue hemorrhagic fever. In comparison, 15% of laboratory-negative cases met the case definition for dengue fever and less than 1% for dengue hemorrhagic fever. None of the laboratory-positive or laboratory-negative cases met the criteria for dengue shock syndrome.^

Eocene-Oligocene nannofossils from the Labrador Sea

During Ocean Drilling Program (ODP) Leg 105, a thick sequence of lower Eocene to lower Oligocene sediments was recovered from Hole 647A in the southern Labrador Sea. These sediments contain diverse, well-preserved, high-latitude calcareous nannofossil flora. The nannofossil biostratigraphy of the hole indicates the presence of a minor hiatus between Zones NP 16 and NP 17 in the upper middle Eocene and a barren interval separating Zones NP 13 and NP 15. Species abundance is highest within the lower to middle Eocene and starts to decline near the base of the upper Eocene. No major change in the nannoflora was observed across the Eocene/Oligocene boundary, although a slight decrease in species abundance was recorded. The Paleogene calcareous nannofossils of nearby DSDP Site 112 were reexamined and compared with those of Site 647. Several cores were reassigned to different nannofossil zones. The calcareous nannoflora are dominated by high-latitude indicative species and also exhibit a high diversity, which suggests the influence of more temperate water masses in this region during Eocene and Oligocene time. One new subspecies from the middle Eocene, Sphenolithus furcatolithoides labradorensis, is described.

Organic facies variations in the Mesozoic South Atlantic DSDP Holes

Visual kerogen and total organic carbon determinations indicate that there are two periods of organic enrichment events in the Mesozoic sediments of the South Atlantic. The first period, from the Late Jurassic through the late Aptian, is recorded in sediments from the Falkland Plateau, the Cape Basin, and the Angola Basin. Apparently, salinity stratification in the restricted basin, coupled with rising sea level, led to bottom water anoxia and organic enrichment. The second event, from the late Albian to the Santonian period, is recorded in sediments from the Angola Basin and the Sao Paulo Plateau. It appears to have been caused by development of an anoxic oxygen minimum zone at midwater depths. Organic matter sedimentation in the Mesozoic South Atlantic is controlled by geologic, climatic, eustatic, and Oceanographic factors.

Characteristic magnetizations of paleomagnetic samples from ODP Leg 103

Lower Cretaceous and Tithonian sediments were sampled for magnetostratigraphy at six holes (Holes 638B, 638C, 639A, 639D, 640A, and 641C). Magnetic polarity chrons were assigned to polarity zones using biostratigraphic constraints. In Holes 638B and 638C, polarity Chrons M3 and perhaps Ml are present in the upper part, M4 and M5 are apparently absent, M6 through M9 are poorly represented, M10 and M10N are apparently absent, and Ml 1 and M12 are tentatively assigned to the lower part. Strata in Holes 638B and 638C dip toward the south. In Hole 639A, polarity Chron M13 is well documented and M12A may be present. In Hole 639D, polarity Chrons M19 through M21 may be present, but the data is poor. Hole 640A had inadequate recovery to identify polarity chrons. In Hole 641C, polarity Chron MO is well documented and occurs significantly above the nannofossil marker of the Barremian/Aptian boundary; comparison to Italian magnetostratigraphy implies that this nannofossil datum is timetransgressive.

Paleomagnetic of lower Cretaceous sediments from the Argo and Gascoyne Abyssal Plain

Lower Cretaceous sediments were sampled for magnetostratigraphy at three sites. ODP Site 765 and DSDP Site 261, in the Argo Abyssal Plain, consist primarily of brownish-red to gray claystone having hematite and magnetite carriers of characteristic magnetization. ODP Site 766, in the Gascoyne Abyssal Plain, consists mainly of dark greenish-gray volcaniclastic turbidites with magnetite as the carrier of characteristic magnetization. Progressive thermal demagnetization (Sites 765 and 261) or alternating field demagnetization (Site 766) yielded well-defined polarity zones and a set of reliable paleolatitudes. Magnetic polarity chrons were assigned to polarity zones using biostratigraphic correlations. Late Aptian chron M"-1"r, a brief reversed-polarity chron younger than MOr, is a narrow, 40-cm feature delimited in Hole 765C. Early Aptian reversed-polarity chron MOr is also present in Hole 765C. Polarity chrons Mir through M3r were observed in the Barremian of all three sites. Valanginian and Hauterivian polarity chrons can be tentatively assigned to polarity zones only in Hole 766A. The paleolatitude of this region remained at 35° to 37°S from the Berriasian through the Aptian. During this interval, there was approximately 16° of clockwise rotation, with the oriented sample suites of Site 765 displaying a Berriasian declination of 307° to an Aptian declination of 323°. These results are consistent with the interpolated Early Cretaceous apparent polar wander for Australia, but indicate that this region was approximately 5? farther north than predicted.