Abnormal elevation of liver function tests can occur during the process of refeeding patients with severe AN. The cause of this elevation is either due to excessive glucose deposition in liver cells or represents liver cell death due to the sequelae of prolonged starvation which characterizes AN before refeeding is adequately in process.
Staphylococcus aureus bacteremia (SAB) causes significant morbidity and mortality. We assessed the disease severity and clinical outcomes of SAB in patients with pre-existing immunosuppression, compared with immunocompetent patients. A retrospective cohort investigation studied consecutive patients with SAB hospitalized across six hospitals in Toronto, Canada from 2007 to 2010. Patients were divided into immunosuppressed (IS) and immunocompetent (IC) cohorts; the IS cohort was subdivided into presence of one and two or more immunosuppressive conditions. Clinical parameters were compared between cohorts and between IS subgroups. A competing risk model compared in-hospital mortality and time to discharge. A total of 907 patients were included, 716 (79%) were IC and 191 (21%) were IS. Within the IS cohort, 111 (58%) had one immunosuppressive condition and 80 (42%) had two or more conditions. The overall in-hospital mortality was 29%, with no differences between groups (IS 32%, IC 28%, p = 0.4211). There were no differences in in-hospital mortality (sub-distribution hazard ratio [sHR] 1.17, 95% confidence interval [CI] 0.88-1.56, p = 0.2827) or time to discharge (sHR 0.94, 95% CI 0.78-1.15, p = 0.5570). Independent mortality predictors for both cohorts included hypotension at 72 h (IS: p < 0.0001, IC: p < 0.0001) and early embolic stroke (IS: p < 0.0001, IC: p = 0.0272). Congestive heart failure was a mortality predictor in the IS cohort (p = 0.0089). Fever within 24 h (p = 0.0092) and early skin and soft tissue infections (p < 0.0001) were survival predictors in the IS cohort. SAB causes significant mortality regardless of pre-existing immune status, but immunosuppressed patients do not have an elevated risk of mortality relative to immunocompetent patients.
Gancyclovir-treated patients had a more severe disease and outcome, probably unrelated to antiviral therapy. Immunohistochemistry-CMV-positive patients with mild disease may recover without antiviral therapy.
Background Crohn’s disease (CD) is thought to be due to an interaction between environmental factors and the gut microbiome that activates an immune response in genetically susceptible hosts. Epidemiologic studies suggest diet is an important variable in CD development; however, little is known about the mechanism by which diet contributes to pathogenesis. It has recently been shown that diet plays a substantial role in shaping microbiome composition (MC). We hypothesize that specific diet patterns are associated with differences in MC that may be related to CD risk. Aims To characterize associations between diet patterns with MC and fecal calprotectin (FC) in healthy first-degree relatives (FDR’s) of CD patients in the Genetic, Environmental, Microbial (GEM) Project. Methods A validated food frequency questionnaire (FFQ) was used to assess diet for North American FDR’s at recruitment. Each question was summarized as a score based on weekly consumption frequency. The Dirichlet method of unsupervised clustering was used to generate dominant diet clusters. Diet-microbiome associations were assessed using the two-part microbiome model. Stool microbiota at recruitment was characterized by 16s RNA sequencing of V4 region using MiSeq platform. Baseline FC was measured by BUHLMANN ELISA test. Results 2766 FDR’s had FFQ’s at recruitment; mean age 18.52 years, 53% female. The Dirichlet method identified 4 clusters, some of which resembled known diet patterns: Superbowl (mainly organ meats, non-red meat, beer, spirits), High Carbohydrate (HC), Mediterranean (MD) and Western (WD) diets. HC was associated with increased relative abundance of V. veillonella (P=2.68E-4). Both HC and MD were associated with decreased abundance of E. klebsiella (P=2.64E-5 and P=1.02E-5 respectively). WD was associated with decreased abundance of L. dorea (P=5.74E-5), a genus considered high risk for CD. A per question analysis demonstrated significant associations between several taxa and individual foods. Diet clusters were then correlated with FC, and a decrease in FC was observed with MD (estimate -16.96, P=0.012). There were no associations with FC in a per question analysis. Conclusions Dominant dietary patterns and certain individual foods are associated with specific gut MC. As well, MD is inversely associated with FC and therefore has potential use as an intervention for lowering inflammation. Understanding relationships between diet, MC and FC in individuals at high risk for CD would be beneficial in defining new dietary strategies in predictably modulating future risk of CD. Funding Agencies CCCHelmsley Charitable Trust
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