Long diagnostic delay in Crohn's disease is associated with complicated disease course and increased operation rate

Background and Aims: The impact of d iagnostic delay ( a period from appearance of f irst s ymptoms t o diagnosis) o n the clinical c ourse o f Crohn's disease (CD) i s unknown. W e examined whether length of d iagnostic delay a ffects d isease outcome. Methods: Data from the Swiss IBD cohort study were analyzed. T he frequencies of o ccurrence of b owel s tenoses, internal fistulas, perianal f istulas, and CD-related surgery at distinct i ntervals a fter C D diagnosis (0 - < 2 , 2 - < 6,  6 years) were c ompared f or g roups o f patients w ith different length of d iagnostic delay. Results: T he data from a g roup o f 200 CD patients with long diagnostic delay (> 24 months, 76th - 100th p ercentile) were c ompared to t hose from a group of 4 61 patients with a short diagnostic delay ( within 9 months, 1st - 50th p ercentile). T reatment r egimens d id n ot d iffer between t he two groups. Two years following diagnosis, p atients with long diagnostic delay presented more frequently with bowel stenoses (25% vs. 13.1%, p = 0.044), internal fistulas (10% vs. 2%, p = 0.018), perianal f istulas ( 20% vs. 8 .1%, p = 0.023) a nd more frequently underwent intestinal surgery (15% vs. 5 .1%, p = 0.024) t han patients with short diagnostic delay. Intestinal surgery was a lso m ore frequently p erformed  6 y ears after diagnosis in t he group with long d iagnostic delay ( 56.2% vs. 42.3%, p = 0.005) w hen compared to t he g roup with short diagnostic delay. Conclusions: L ong diagnostic delay i s associated with worse o utcome c haracterized by t he development o f increased bowel damage, n ecessitating more frequently operations in t he years following CD d iagnosis. Efforts should be undertaken to shorten the diagnostic delay.

Iowa Department of Transportation Major Items - Preliminary Quantity Report, February 17, 2015; With Addendums

Weekly letting report.

Evaluation of the compliance with recommended procedures in newborns exposed to HBsAg-positive mothers: a multicenter collaborative study.

BACKGROUND: Maternal-infant transmission of hepatitis B virus (HBV) during birth carries a high risk for chronic HBV infection in infants with frequent subsequent development of chronic disease. This can be efficiently prevented by early immunization of exposed newborns. The purpose of this study was to determine the compliance with official recommendations for prevention of perinatal HBV transmission in hepatitis B surface antigen (HBsAg) exposed infants. METHODS: Records of pregnant women at 4 sites in Switzerland, admitted for delivery in 2005 and 2006, were screened for maternal HBsAg testing. In HBsAg-exposed infants, recommended procedures (postnatal active and passive immunization, completion of immunization series, and serological success control) were checked. RESULTS: Of 27,131 women tested for HBsAg, 194 (0.73%) were positive with 196 exposed neonates. Of these neonates, 143 (73%) were enrolled and 141 (99%) received simultaneous active and passive HBV immunization within 24 hours of birth. After discharge, the HBV immunization series was completed in 83%. Only 38% of children were tested for anti-HBs afterwards and protective antibody values (>100 U/L) were documented in 27% of the study cohort. No chronically infected child was identified. Analysis of hospital discharge letters revealed significant quality problems. CONCLUSIONS: Intensified efforts are needed to improve the currently suboptimal medical care in HBsAg-exposed infants. We propose standardized discharge letters, as well as reminders to primary care physicians with precise instructions on the need to complete the immunization series in HBsAg-exposed infants and to evaluate success by determination of anti-HBs antibodies after the last dose.

Overlapping pathways to transplant glomerulopathy: chronic humoral rejection, hepatitis C infection, and thrombotic microangiopathy.

Transplant glomerulopathy (TG) has received much attention in recent years as a symptom of chronic humoral rejection; however, many cases lack C4d deposition and/or circulating donor-specific antibodies (DSAs). To determine the contribution of other causes, we studied 209 consecutive renal allograft indication biopsies for chronic allograft dysfunction, of which 25 met the pathological criteria of TG. Three partially overlapping etiologies accounted for 21 (84%) cases: C4d-positive (48%), hepatitis C-positive (36%), and thrombotic microangiopathy (TMA)-positive (32%) TG. The majority of patients with confirmed TMA were also hepatitis C positive, and the majority of hepatitis C-positive patients had TMA. DSAs were significantly associated with C4d-positive but not with hepatitis C-positive TG. The prevalence of hepatitis C was significantly higher in the TG group than in 29 control patients. Within the TG cohort, those who were hepatitis C-positive developed allograft failure significantly earlier than hepatitis C-negative patients. Thus, TG is not a specific diagnosis but a pattern of pathological injury involving three major overlapping pathways. It is important to distinguish these mechanisms, as they may have different prognostic and therapeutic implications.

Identificació d'estratègies d'atenció a la diversitat als centres educatius de Pistoia

El treball Identificació d’estratègies d’atenció a la diversitat als centres educatius de Pistoia, pretén mostrar i donar a conèixer diverses estratègies que fomenten i enriqueixen la diversitat que trobem dins les aules. S’explica a través de l’anàlisi de diferents situacions educatives, com es tracta la diversitat, entesa com una escola per a tots, i com a través de les metodologies que utilitzen inclouen a tots els infants.

Desenvolvimento ponderal de bezerras desmamadas em pastejo de Brachiaria decumbens com suplementação protéica e energética

Foi avaliado o efeito da suplementação a pasto, com concentrados fornecidos durante o ano (períodos de seca e águas), sobre o desenvolvimento ponderal de bezerras desmamadas. Foram utilizadas 36 bezerras da raça Santa Gertrudis, com média inicial de idade de 290 dias, média de peso vivo de 194 kg, mantidas em pasto de Brachiaria decumbens, distribuídas em um delineamento inteiramente casualizado, com dois tratamentos e 18 repetições. Foi oferecida mistura mineral o ano todo, ou suplemento com maior nível de proteína degradável na seca, e não-degradável nas águas. Os resultados obtidos para a média diária de ganho de peso vivo indicaram uma diferença significativa entre os tratamentos. O ganho de peso vivo, durante o ano, para o lote testemunha, foi de 0,504 kg animal-1 dia-1 e, para o lote suplementado foi de 0,561 kg. No período de seca, o ganho de peso vivo foi significativamente maior para os animais suplementados e, no período das águas não ocorreu diferença. A suplementação a pasto não apresentou vantagens bioeconômicas para se recomendar o seu uso. Nos dois tratamentos as bezerras alcançaram média de peso limite, para primeira cobertura, com idade próxima a 14 meses.

Atividade isoenzimática em plantas de trigo infectadas com o vírus SBWMV

O objetivo deste trabalho foi elucidar a atividade e a expressão isoenzimática das esterases, das peroxidases e das aspartato aminotransferases em função da infecção de plantas de trigo pelo Soil-borne wheat mosaic virus (SBWMV). Foram analisadas, aos 45 dias após a emergência, quatro cultivares e uma linhagem de trigo, com diferentes níveis de resistência ao SBWMV: BRS Guabiju, BRS 194, BRS 179, BR 23 e PF 980524. De modo geral, ocorreram diferenças qualitativas e quantitativas intra e interpopulacional, quando comparadas plantas assintomáticas e sintomáticas ao SBWMV. Para o sistema esterase, nove padrões de bandas foram determinados e para peroxidase e aspartato aminotransferase foram detectados três padrões de bandas, para ambas as condições. Padrões eletroforéticos foram observados para plantas infectadas, quando comparadas com as não infectadas, destacando-se a atividade da esterase, o que permitiu identificar com maior precisão o estado metabólico e diferenciado das células.

Official Positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

Risk factors for fracture can be purely skeletal, e.g., bone mass, microarchitecture or geometry, or a combination of bone and falls risk related factors such as age and functional status. The remit of this Task Force was to review the evidence and consider if falls should be incorporated into the FRAX® model or, alternatively, to provide guidance to assist clinicians in clinical decision-making for patients with a falls history. It is clear that falls are a risk factor for fracture. Fracture probability may be underestimated by FRAX® in individuals with a history of frequent falls. The substantial evidence that various interventions are effective in reducing falls risk was reviewed. Targeting falls risk reduction strategies towards frail older people at high risk for indoor falls is appropriate. This Task Force believes that further fracture reduction requires measures to reduce falls risk in addition to bone directed therapy. Clinicians should recognize that patients with frequent falls are at higher fracture risk than currently estimated by FRAX® and include this in decision-making. However, quantitative adjustment of the FRAX® estimated risk based on falls history is not currently possible. In the long term, incorporation of falls as a risk factor in the FRAX® model would be ideal.