scholarly journals A norovirus outbreak triggered by copper intoxication on a coach trip from the Netherlands to Germany, April 2010

2012 ◽  
Vol 17 (9) ◽  
Author(s):  
J Hoefnagel ◽  
D H van de Weerdt ◽  
O Schaefer ◽  
R Koene
Keyword(s):  
Renal Function ◽  
Chemical Analysis ◽  
Liver Function ◽  
Gastrointestinal Symptoms ◽  
Copper Level ◽  
Epidemic Curve ◽  
Potential Source ◽  
Toxic Concentration ◽  
Stool Samples ◽  
Copper Intoxication

We report an unusual outbreak of norovirus infection on a coach trip. Overall, 30 of 40 people (including drivers and crew) developed nausea, vomiting and/or diarrhoea, 11 of them on the first day of the trip. The incidence epidemic curve showed a first peak on Day 1 and a second on Day 4. Nine passengers were hospitalised with gastrointestinal symptoms. Norovirus was found in stool samples from two patients, but the infection could not explain the first peak in the epidemic curve only a few hours after departure. Interviews with the passengers and an inspection of the coach and its water supply implicated the water used for coffee and tea as the potential source. Microbiological investigations of the water were negative, but chemical analysis showed a toxic concentration of copper. Blood copper levels as well as renal and liver function were determined in 28 of the 32 passengers who had been exposed to the water. One passenger who did not have gastrointestinal symptoms had an elevated copper level of 25.9 µmol/L, without loss of liver or renal function. It is likely that the spread of norovirus was enhanced because of vomiting of one of the passengers due to copper intoxication.

Iron Chelation with Deferasirox in Thalassemia Major Patients with Low Iron Burdens and Moderate to High Transfusion Regimens.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4070-4070
Author(s):  
Elizabeth Evans ◽  
Dorothy A. Kleinert ◽  
Kevin Mennitt ◽  
Robert W. Grady ◽  
Patricia J. Giardina
Keyword(s):  
Renal Function ◽  
Liver Function ◽  
Serum Ferritin ◽  
Conflicts Of Interest ◽  
Gastrointestinal Symptoms ◽  
Liver Function Tests ◽  
Thalassemia Major ◽  
Serious Adverse Events ◽  
Liver Iron ◽  
Function Tests

Abstract Abstract 4070 Poster Board III-1005 Introduction A worldwide multicenter clinical trial of deferoxamine (DFO) in comparison to deferasirox (DFX/Exjade) established optimal therapeutic doses of DFX for use in b-thalassemia patients (pts) with moderate to severe iron burdens as determined by serum ferritin levels greater than 1000 ng/mL and liver iron concentrations (LICs) greater than 3 mg/g-dry weight (dw) resulting from regular red blood cell (RBC) transfusion regimens designed to maintain pre-tx hemoglobin (Hgb) levels greater than 9 to 10 gm/dL. To date, the use of DFX in less heavily iron overloaded transfused patients is not well documented. Therefore, we studied the safety and efficacy of DFX at a dose of approximately 20 mg/kg/day in a group of regularly transfused thalassemia major pts who had previously been well chelated with subcutaneous (sc) DFO as evidenced by serum ferritin levels less than 1000 ng/mL and LICs less than 3 mg/gm-dw. Patients The pt group consisted of eight transfusion dependent thalassemia major pts (2M/6F) who ranged in age from 13 to 49 yrs (mean ± SEM 28.3 ± 13.2 yrs). Six of the pts were splenectomized (2M/4F) and maintained on moderate to high transfusion regimens (2 to 4 RBC units per month) so as to maintain a pre-tx Hgb level of 9 to 10 gm/dL. Assessments/Methods Clinical parameters, including pre-tx Hgb levels, RBC units transfused, serum ferritins, liver function tests (ALT/AST), and renal function studies (BUN/creatinine) were determined at baseline and monitored monthly thereafter in all patients for one year. Hearing tests, eye exams and determinations of LIC by T2* magnetic resonance imaging (MRI) were done at baseline and 12 months. Annual tx requirements were calculated and expressed as mL of RBCs/kg/yr. All pts previously infused DFO sc 5 days each week at doses of 40 to 60 mg/kg/day. During the study, they ingested DFX daily 30 minutes prior to breakfast at a dose of 20 to 30 mg/kg as a suspension in water, apple or orange juice. Dose adjustments were made depending upon trends in serum ferritin levels, liver function tests or renal studies. Results Each pt received 2 to 4 leukocyte depleted washed RBC units per month (mean 119 ± 8.2 mL/kg/yr). Their mean pre-tx Hgb levels were 9.7 ± 0.2 gm/dL. Average monthly chemistry parameters were as follows: serum ferritin = 550 ± 9.4 ng/mL; AST = 36 ± 5; ALT = 36 ± 7; BUN = 14.8 ± 1.0; creatinine = 0.7 ± 0.1. There were no significant changes in the parameters related to liver or renal function, or in LICs during the 12-month observation period, the mean LICs were 2.0 ± 0.4 mg/gm-dw at baseline vs. 1.6 ± 0.3 mg/gm-dw at 12 months. Serum ferritin levels also remained stable during the course of therapy (577 ± 71 ng/mL at baseline vs. 480 ± 106 ng/mL at 12 months). The starting dose of DFX ranged from 20 to 30 mg/kg/day. Over the course of the study, the dose was increased to 25 and 30 mg/kg/day in pts 2 and 7, respectively, owing to a progressive increase in serum ferritin levels and decreased to 10 mg/kg in pt 3 and 18 mg/kg in pt 8 due to declining ferritin levels. On average, a dose of 20.5 ± 2 mg/kg/day was needed to maintain iron balance. No serious adverse events occurred during the 12-month course of DFX and no significant side effects (e.g. rash or gastrointestinal symptoms) were reported. Conclusion Moderate doses of DFX, slightly more than 20 mg/kg/day, were safe and effective in maintaining iron balance as measured by LICs (MRI) and serum ferritin levels in thalassemia major patients with low iron burdens (LICs <3 mg/g-dw and serum ferritin levels <1000 ng/mL) receiving regular tx therapy to maintain pre-tx Hgb levels of 9 to 10 gm/dL. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Parasitic infections in Swiss children: Are we overtesting?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Corinne Légeret ◽  
Céline Rüttimann ◽  
Hans Fankhauser ◽  
Henrik Köhler
Keyword(s):  
Retrospective Study ◽  
Positive Result ◽  
Pediatric Patients ◽  
Intestinal Parasites ◽  
Gastrointestinal Symptoms ◽  
International Travel ◽  
Parasitic Infections ◽  
Stool Samples ◽  
Stool Specimens

Abstract Background A wide variation of causes can lead to gastrointestinal symptoms in children- an infection with parasites is one of them. The expansion of international travel might lead to an increase in testing children for a correspondent infection. Currently there are no guidelines available, which patients should be tested for a possible parasitical infection. The aim of the study was to characterize Swiss children suffering from intestinal parasites, in order to provide more knowledge for the clinician who should be tested. Methods This is a retrospective study of Swiss pediatric patients, whose stools have been tested for parasites and helminths. Results A total of 1855 stool samples, belonging to 572 different children with an average age of 7.9 years, were tested within a 10-year period. The prevalence of a positive result was 4.2%, of which all were positive for Blastocystis, and 12.5% had a co-infection with Endolimax nana. Conclusion Immigrants, immune compromised children with diarrhea and pediatric patients with bloody or protracted diarrhea should have 2 different stool specimens examined for a possible parasitical infection.

scholarly journals Seasonal Differences in Cyclospora cayetanensis Prevalence in Colombian Indigenous People

2021 ◽  
Vol 9 (3) ◽  
pp. 627
Author(s):  
Hagen Frickmann ◽  
Juliane Alker ◽  
Jessica Hansen ◽  
Juan Carlos Dib ◽  
Andrés Aristizabal ◽  
...  
Keyword(s):  
Indigenous People ◽  
Rainy Season ◽  
Gastrointestinal Symptoms ◽  
Dry Season ◽  
Seasonal Effects ◽  
Chain Reaction ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Stool Samples ◽  
Polymerase Chain

Fecal-orally transmitted cyclosporiasis is frequent in remote resource-limited settings in Central and South America with poor hygiene conditions. In this study, we aimed at assessing seasonal effects on the epidemiology of colonization or infection with C. cayetanensis in Colombian indigenous people living under very restricted conditions. In the rainy season between July and November and in the dry season between January and April, stool samples from indigenous people with and without gastrointestinal symptoms were collected and screened for C. cayetanensis applying in-house real-time polymerase chain reaction (PCR). In the rainy season and in the dry season, positive PCR results were observed for 11.8% (16/136) and 5.1% (15/292), respectively, with cycle threshold (Ct) values of 30.6 (±3.4) and 34.4 (±1.6), respectively. Despite higher parasite loads in the rainy season, fewer individuals (2/16, 12.5%) reported gastrointestinal symptoms compared to the dry season (6/15, 40%). In conclusion, considerable prevalence of C. cayetanensis in Colombian indigenous people persists in the dry season. Low proportions of gastrointestinal symptoms along with higher parasite loads make colonization likely rather than infection.

Bromate Poisoning From Hair Permanent Preparations

PEDIATRICS ◽  
1985 ◽  
Vol 76 (6) ◽  
pp. 975-978
Author(s):  
BARRY L. WARSHAW ◽  
MELODY C. CARTER ◽  
LEONARD C. HYMES ◽  
BARBARA S. BRUNER ◽  
ALBERT P. RAUBER
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Hearing Impairment ◽  
Peritoneal Lavage ◽  
Gastrointestinal Symptoms ◽  
Potassium Bromate ◽  
Cold Wave ◽  
Toxic Substances

Potassium bromate is a tasteless, odorless, and colorless chemical found in the neutralizing solution of cold wave home hair permanents and profesional solutions. Toxic ingestions of this substance were initially reported during the 1940s and 1950s and are characterized primarily by gastrointestinal symptoms, hearing impairment, and acute renal failure.1 Although many manufacturers have now substituted less toxic substances as neutralizers, use of potassium bromate in some hair permanent solutions continues, and poisonings from this substance still occur.2-4 Because renal failure from potassium bromate intoxication may be severe, dialysis may be necessary for replacement of renal function. Moreover, a major toxicology reference presently suggests that "if readily available, the prompt use of hemodialysis or peritoneal lavage may serve to remove absorbed but unreacted bromate in significant amounts."1

A case of Graves’ disease associated with membranoproliferative glomerulonephritis and leukocytoclastic vasculitis

2018 ◽  
Vol 31 (10) ◽  
pp. 1165-1168 ◽  
Author(s):  
Werner Keenswijk ◽  
Eva Degraeuwe ◽  
Anne Hoorens ◽  
Jo Van Dorpe ◽  
Johan Vande Walle
Keyword(s):  
Renal Function ◽  
Membranoproliferative Glomerulonephritis ◽  
Leukocytoclastic Vasculitis ◽  
White Cell Count ◽  
Gastrointestinal Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Complement Factor ◽  
Gradual Improvement ◽  
Complement Factor C3

Abstract Background The association of hyperthyroidism with renal disease is very rare and the importance of timely clinical recognition cannot be overemphasized. Case presentation An 11-year-old girl presented with gastrointestinal symptoms while hypertension, edema and abdominal pain were noticed on clinical examination. Laboratory investigation revealed: hemoglobin 9.4 (11.5–15.5) g/dL, total white cell count 16 (4.5–12)×109/L, platelets 247 (150–450)×109/L, C-reactive protein (CRP) 31.8 (<5) mg/L, blood urea nitrogen (BUN) 126 (13–43) mg/dL, creatinine 0.98 (0.53–0.79) mg/dL, albumin 25 (35–52) g/dL, complement factor C3 0.7 (0.9–1.8) g/L, complement factor C4 0.1 (0.1–0.4) g/L, tri-iodothyronine 6.5 (2.5–5.2) pg/mL, free thyroxine 2.4 (1–1.7) ng/dL, thyroid stimulating hormone (TSH) <0.02 (0.5–4.3) mU/L. Urinalysis showed nephrotic range proteinuria. Renal function deteriorated necessitating hemodialysis (HD). A renal biopsy revealed an immune complex-mediated membranoproliferative glomerulonephritis (MPGN). Elevated thyroid hormones and suppressed TSH levels with elevated thyroperoxidase antibodies and thyroid stimulating immunoglobulins confirmed the diagnosis of Graves’ disease. Corticosteroids were commenced and eventually thiamazole was added with gradual improvement of renal function, cessation of HD and discharge from the hospital. Conclusions Graves’ disease complicated by MPGN is extremely rare, but can cause life-threatening complications.

Cross-correlation of cyclosporine concentrations and biochemical measures of kidney and liver function in heart and heart-lung transplant recipients

1990 ◽  
Vol 36 (8) ◽  
pp. 1474-1478 ◽  
Author(s):  
A Trull ◽  
K Hue ◽  
K Tan ◽  
S Gore ◽  
S Whitewood ◽  
...  
Keyword(s):  
Renal Function ◽  
Liver Function ◽  
Correlation Coefficient ◽  
Negative Correlation ◽  
Whole Blood ◽  
Lung Transplant ◽  
Cross Correlation ◽  
Transplant Recipients ◽  
The Mean ◽  
Lung Transplant Recipients

Abstract Cross-correlation of cyclosporine concentrations with results of biochemical tests of renal and liver function, measured during the first three months post-operatively, was carried out retrospectively in 24 heart and eight heart-lung transplant recipients to assess the temporal relationship between cyclosporine treatment and the development of possible toxic side-effects. We found a statistically significant negative correlation (95% confidence interval of the mean correlation coefficient did not overlap zero) between the five-day mean concentration of cyclosporine in whole blood (but not plasma) as measured with nonselective (NSRIA) and selective radioimmunoassays (SRIA) and the mean reciprocal creatinine concentration measured in the subsequent five days. In 15 of 32 (47%) patients the negative correlation coefficient exceeded 0.7 (high susceptibility), whereas in 11 of 32 (34%) it was between 0.5 and 0.7 (medium susceptibility), and in only six of 32 (19%) was it less than 0.3 (low susceptibility). We found no consistent correlations between cyclosporine measurements and results of other renal-function tests or liver-function tests. This suggests that therapeutic doses of the drug are not hepatotoxic in most patients. There was, however, a significantly correlated decrease in the NSRIA/SRIA ratio and in serum bilirubin concentration with time post-operatively, reflecting improvement in hepatic function and clearance of the cyclosporine metabolites that are detected by NSRIA. Assays of cyclosporine in whole blood, but not in plasma, are of value in anticipating changes in renal function after heart and heart-lung transplantation.

scholarly journals Increased Fecal Calprotectin Is Associated with Worse Gastrointestinal Symptoms and Quality of Life Scores in Children with Cystic Fibrosis

2020 ◽  
Vol 9 (12) ◽  
pp. 4080
Author(s):  
Fabien Beaufils ◽  
Emmanuel Mas ◽  
Marie Mittaine ◽  
Martin Addra ◽  
Michael Fayon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Intestinal Inflammation ◽  
Pancreatic Insufficiency ◽  
Gastrointestinal Symptoms ◽  
Fecal Calprotectin ◽  
Stool Samples ◽  
Digestive Disorders ◽  
Cystic Fibrosis Transmembrane

In cystic fibrosis (CF), cystic fibrosis transmembrane regulator (CFTR) dysfunction leads to digestive disorders that promote intestinal inflammation and dysbiosis enhancing gastrointestinal symptoms. In pancreatic insufficiency CF patients, both intestinal inflammation and dysbiosis, are associated with an increase in the fecal calprotectin (FC) level. However, associations between the FC level, gastrointestinal symptoms, and quality of life (QoL) remain poorly studied. We aimed to assess such associations in pancreatic insufficiency CF children. The FC level was measured in pancreatic insufficiency CF children’s stool samples. Children and their parents completed two questionnaires: The Gastrointestinal Symptoms Scales 3.0-PedsQLTM and the Quality of Life Pediatric Inventory 4.0-PedsQLTM. Lower scores indicated worse symptomatology or QoL. Thirty-seven CF children were included. A FC level above 250 µg/g was associated with worse gastrointestinal symptoms and QoL scores. The FC level was inversely correlated with several gastrointestinal scores assessed by children (i.e., Total, “Heart Burn Reflux”, “Nausea and Vomiting”, and “Gas and Bloating”). Several QoL scores were correlated with gastrointestinal scores. The FC level was weakly associated with clinical parameters. Some gastrointestinal and QoL scores were related to disease severity associated parameters. In CF, the FC level, biomarker previously related to intestinal inflammation and dysbiosis, was associated with worse digestive symptoms and QoL scores.

scholarly journals Increment of plasma glucose by exogenous glucagon is associated with present and future renal function in type 2 diabetes:a retrospective study from glucagon stimulation test

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yasutaka Takeda ◽  
Yukihiro Fujita ◽  
Ryoichi Bessho ◽  
Mao Sato ◽  
Tomoe Abe ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
Liver Function ◽  
Plasma Glucose ◽  
Pancreatic Beta Cells ◽  
Cell Function ◽  
Stimulation Test ◽  
Clinical Parameters ◽  
Glucagon Stimulation Test

Abstract Background Glucagon stimulation test (GST) is often employed to assess the insulin reserve of the pancreatic beta cells in diabetic subjects. The clinical significance of the increment of plasma glucose (Δglucose) by exogenous glucagon during GST has not been elucidated. We investigated the relationship between Δglucose and clinical parameters including the liver and renal function in type 2 diabetic subjects, since we hypothesized that Δglucose is associated with the liver and renal function reflecting the capacity for gluconeogenesis in the organs. Methods A total of 209 subjects with type 2 diabetes who underwent GST during admission were included in this cross-sectional study. We defined the difference between plasma glucose at fasting and 6 min after intravenous injection of 1 mg glucagon as Δglucose. We assessed correlations between Δglucose and clinical parameters such as diabetic duration, BMI, HbA1c, beta cell function, serum free fatty acids (FFA) which is known to stimulate gluconeogenesis, liver function, the indices of liver function, renal function, and urinary albumin excretion (UAE). Results In correlation analysis, Δglucose positively correlated to FFA and estimated glomerular filtration rate (eGFR), but inversely to serum creatinine and cystatin C, although Δglucose showed no correlation with both liver function and the indices of residual liver function. Multiple regression analysis revealed that Δglucose was an independent determinant for the eGFR after 1 year, equally BMI, HbA1c, serum lipids, and UAE, which are known as the predictors for the development of chronic kidney disease. Conclusion Our results suggest that Δglucose during GST might be related to gluconeogenesis in the kidney and could be the determinant of future renal function in type 2 diabetes.

Waterborne norovirus outbreak in a municipal drinking-water supply in Sweden

2011 ◽  
Vol 139 (12) ◽  
pp. 1928-1935 ◽  
Author(s):  
M. RIERA-MONTES ◽  
K. BRUS SJÖLANDER ◽  
G. ALLESTAM ◽  
E. HALLIN ◽  
K.-O. HEDLUND ◽  
...  
Keyword(s):  
Drinking Water ◽  
Water Supply ◽  
Gastrointestinal Symptoms ◽  
Control Measures ◽  
Drinking Water Supply ◽  
Water Network ◽  
Public Network ◽  
The Public ◽  
Increased Risk ◽  
Stool Samples

SUMMARYDuring Easter 2009, almost 200 people resident in a small Swedish village fell ill with gastrointestinal symptoms. We conducted a retrospective cohort study and a molecular investigation in order to identify the source of the outbreak. Residents living in households connected to the public water network were at an increased risk of developing disease (relative risk 4·80, 95% confidence interval 1·68–13·73) compared to those with no connection to the public network. Norovirus genotype GI.3 was identified in stool samples from six patients and in a sample from the public water network. Contamination of one of the wells supplying the public water network was thought to be the source of the outbreak. This is a description of a norovirus outbreak linked to a municipal drinking-water supply in Sweden. Information from epidemiological and molecular investigations is of utmost importance to guide outbreak control measures and to prevent future outbreaks.

Organ dysfunction (dys) and clinical outcomes in patients (pts) treated with immune checkpoint inhibitors (ICIs).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 2569-2569
Author(s):  
QI LIU ◽  
Elad Sharon ◽  
Issam Zineh ◽  
Diqiong (Joan) Xie ◽  
Shrujal S. Baxi ◽  
...  
Keyword(s):  
Renal Function ◽  
Liver Function ◽  
Clinical Outcomes ◽  
Checkpoint Inhibitors ◽  
Stage Iv ◽  
Organ Function ◽  
Kaplan Meier ◽  
Level Data ◽  
The Impact

2569 Background: ICIs (anti-PD-L1/PD-1/CTLA-4) are approved in multiple cancers. The impact of organ dys on the pharmacokinetics of ICIs is known, but associated clinical outcomes are not well characterized. We compared real-world (rw) clinical outcomes in ICI-treated pts by liver and renal function. Methods: This retrospective study used longitudinal, patient-level data from community practices in the Flatiron Health electronic-health record (EHR)-derived database. We included pts diagnosed with advanced cancers (NSCLC, renal cell, melanoma, gastric/esophageal, or head and neck) on or after 1/1/2011, treated with an ICI with follow-up through 12/31/2018 and with baseline liver or renal function results in the EHR ≤30 days prior to ICI start. Organ function was stratified as normal, mild, moderate, or severe dys based on NCI CTCAE. We computed unadjusted median estimates for rw time to treatment discontinuation (rwTTD) for any reason and overall survival (OS) across baseline groups using the Kaplan-Meier method. Results: Of 15,979 pts, we identified 12,978/12,840 pts with evaluable renal/liver function, respectively; median follow-up was 5.1 mos and median age was 69.0 yrs (IQR: 61.0, 76.0) for both. Most pts had NSCLC (69.4/69.0%), were men (60.1/60.0%), white (73.5/73.6%), and diagnosed at stage IV (58.7%/58.6%). Most ICI was given in 1st-line (42.3/42.1%) (outcomes in Table). Conclusions: Pts with categorically worse baseline liver function had progressively worse on-treatment outcomes, including shorter OS, which differed from trends in renal dys. Whether baseline dys is prognostic or predictive of ICI outcomes should be further investigated in addition to reasons for discontinuation. Clinical outcomes (unadjusted median times, mos [95% CI]) by organ function. [Table: see text]

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