Shilpa C. Reddy

Hepatitis C infection and the risk of bacteremia in hemodialysis patients with tunneled vascular access catheters.

Background: The major complication of tunneled vascular catheters in dialysis patients is infection. In preliminary work, an association was noted between hepatitis C virus (HCV) infection and bacteremia in these patients. On this basis, we theorized that HCV infection may be associated with bacteremia in dialysis patients with tunneled catheters. Methods: We conducted a two-phase clinical study to define the association between HCV infection and bacteremia in hemodialysis patients with catheters. Phase 1 was a cross-sectional study designed to assess the association between HCV serologic status and bacteremia. Phase 2 was a prospective study that examined the relationship between HCV viral load and bacteremia. Results: In Phase 1, HCV (+) patients had a significantly greater prevalence of bacteremia than HCV (−) patients (61 vs 7.7% respectively, P < 0.05). In Phase 2, the presence of detectable virus was associated with a numerical trend toward an increase in the incidence of bacteremia (40 vs 0% for patients with and without detectable virus, respectively, P = 0.09). Conclusion: These studies suggest that HCV infection may be associated with the development of bacteremia in hemodialysis patients with tunneled catheters.

An Unusual Presentation of Burkitt Lymphoma

We describe a 37-year-old non-smoker who presented with dyspnea and a unilateral effusion secondary to Burkitt lymphoma (BL). The diagnosis was made by pleural tissue biopsy using video-assisted thoracoscopic surgery (VATS). Burkitt lymphoma is discussed.

Effects on Segmental GI Transit and Physiologic Parameters by Lubiprostone in Patients With Chronic Idiopathic Constipation

baseline characteristics were similar between TGD 300 mg/d (n = 23), TGD 900 mg/d (n = 22), and placebo (n = 19) groups, including hemoglobin A1c (HbA1c), blood insulin, body mass index (BMI), triglyceride, low-density lipoprotein cholesterol (LDL-C), high-molecularweight (HMW) adiponectin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and diastolic blood pressure. At 12 weeks, TGD 300 mg/d and TGD 900 mg/d significantly (p < 0.05 and p < 0.01) reduced HbA1c (0.1% and 0.21%) and insulin concentration (2.8 and 3.6 μU/mL), respectively, versus placebo. TGD 300 mg/d and TGD 900 mg/d also significantly (p < 0.01 and p < 0.05, respectively) reduced LDL-C (9 and 7 mg/dL, respectively). TGD 900 mg/d significantly reduced triglyceride by 21 mg/dL (p < 0.05) and diastolic blood pressure by 8 mmHg (p < 0.01). Placebo was associated with a significant (p < 0.05) increase from baseline in BMI, ALT, and AST (0.17 kg/m2, 3, and 2 U/L, respectively), whereas TGD was not. TGD 300 mg/d significantly (p < 0.05) increased HMW adiponectin by 0.6 mg/mL. Adverse events did not differ significantly between the groups. From T-RFLP analysis, the clusters to which saccharometabolism improvement effect by TGD was invalid existed. Conclusions: Intake of transglucosidase for 12 weeks in subjects with T2DM resulted in lowering of HbA1c and blood insulin level, and improvements in metabolic and cardiovascular risk factors.

Delayed Colonic Transit is Associated With a Decrease of the Normal Predominant Bacteria in the Colon Microbiota

Introduction/Aims: Post-infectious irritable bowel syndrome (PI-IBS) may develop in 4% to 30% of affected patients following bacterial gastroenteritis (GE), but limited information is available on outcome of viral GE. During summer 2009 a massive outbreak of viral GE associated with contamination of municipal drinking water (Norovirus and Enterovirus) occurred in San Felice del Benaco (Lake Garda, Italy) [1]. In order to investigate the natural history of a community outbreak of viral GE and to assess the incidence of functional gastrointestinal disorders and PI-IBS, we carried out a prospective population-based cohort study with control group. Methods: Baseline questionnaires were administered to the resident community within one month of the outbreak. Follow-up questionnaires of the Italian version of Gastrointestinal Symptom Rating Scale (GSRS, a 15 item survey scored according to a 7-point Likert scale) were mailed to all patients responding to baseline questionnaire at 3 and 6 months and to a cohort of unaffected controls, living in the same geographical area, at 6 months after the outbreak. GSRS itemwere grouped into five dimensions: abdominal pain, reflux, indigestion, diarrhea and constipation. At month 12 all patients and controls were interviewed by an health assistant in order to verify Rome III criteria of IBS. T-test and χ2 or fishers exact test were used as appropriate. Results: Baseline questionnaires were returned by 348 patients: mean age ± SD 45 ± 22 years, 53% female. At outbreak nausea (scored ≥4), vomiting and diarrhea lasting 2-3 days or more were reported by 66%, 60% and 77% of patients, respectively. Fifty percent reported fever and 19% referred weight loss (mean 3 Kg). Follow-up surveys were returned at month 6 by 185 patients and 168 controls: mean of GSRS score for each dimension is reported in the figure. At month 12 we identified 40 patients with a new diagnosis of IBS (Rome III criteria), in comparison with 3 subjects in the control cohort (p<0.0001; OR 11.40, 3.44-37.82, 95%CI). The 40 cases of PI-IBS, according to the subclassification of IBS by predominant stool pattern [2], were subtyped as follow: 4 IBS with constipation, 7 IBS with diarrhea, 16 with mixed IBS and 13 with unsubtyped IBS. Conclusion: Our study provides evidence that mixed Norovirus and Enterovirus GE may lead to post-infectious gastrointestinal disordes which persist for at least 12 month after infection. PI-IBS following viral infections develops in a substantial proportion of patients (22%) similar to that reported after bacterial GE. References: 1) Scarcella et al. Eurosurveillance 2009 2) Longstreth et al, Gastroenterology 2006.

W2065 Do HbA1C Levels Correlate with Delayed Gastric Emptying in Diabetic Patients

Background/Aims Gastroparesis is characterized by delayed gastric emptying without obstruction. Diabetes is frequently associated with poor glycemic control and delayed gastric emptying. Gastric emptying scintigraphy (GES) is the standard for measuring gastric emptying. Serum hemoglobin A1C (HbA1C) measures prolonged glycemic control with normal as < 7% glycated. To date, no correlation of serum HbA1C level with gastric emptying, demonstrated by GES, in diabetics has been performed. The aim of the present investigation is to determine if a relationship exists between serum HbA1C levels and gastric emptying, assessed by GES, in diabetics.

HEPATITIS C VIRAL LOAD AND THE RISK OF BACTEREMIA IN HEMODIALYSIS PATIENTS WITH VASCULAR CATHETERS.: 360

Hemodialysis (HD) patients with double-lumen vascular access catheters (D-VAC) are at increased risk of bacteremia. Coinfection with hepatitis C virus (HCV) may be an additional risk factor for bacteremia in these patients. In this regard, we have shown that HCV-seropositive HD patients with D-VAC have an increased incidence of bacteremia when compared with patients seronegative for the virus (Sullivan et al. J Invest Med 2006;54:S289; Zaiden et al. JASN in press). On this basis, we theorized that the circulating HCV viral load may correlate with bacteremic events in these patients. To address this question, we reviewed the most recent records of the cohort from our previous work (in press). In this study, we surveyed for the presence of bacteremia during a 5-month period (5/06-10/06). In addition, we prospectively assessed the HCV viral load by measuring HCV RNA (RT-PCR) in all HCV-positive patients. Results Ninety-nine patients were studied; mean age of 59 years, 38% male, and 64% African American. Twenty-one (21%) patients were HCV positive. For the 5-month study period, bacteremia data were available in 72 of 78 seronegative and 19 of 21 seropositive patients. The HCV-positive subjects demonstrated a numeric trend toward more frequent bacteremic events (5/19 [26%] vs 14/72 [19%] for HCV seropositive vs seronegative, respectively, p = .51). There was no difference in age of D-VAC between HCV-negative and -positive patients (mean ± SEM, 321 ± 20 vs 418 ± 41, respectively). Circulating viral titers were obtained in 18 of 21 HCV-positive patients. Eight of 18 (44%) had undetectable HCV levels, and 10 patients had measurable viral loads ((thousands) 778 ± 328 IU/mL). Sixteen patients with viral titers had bacteremia data available. In this group, there were no differences in viral titers between bacteremic and nonbacteremic patients (323 ± 458 vs 425 ± 264 IU/mL, respectively). In contrast, when patients with measurable titers (n = 8) were compared with patients with no detectable viral RNA (n = 8), there was a significant increase in bacteremic events (4/8 [50%] vs 0/8 respectively, p = .009, Chi-squared). These data support the contention that HCV infection may be a negative immunomodulator in HD patients with D-VAC and thus constitute a risk factor for infection from bacteremia. Conclusion HD patients with D-VAC and HCV infection may be at increased risk of bacteremic events. These data suggest that the presence of detectable HCV RNA may be more important than the absolute circulating level of virus. Following HCV RNA expression in HD patients with D-VAC may allow for risk stratification for bacteremia and modulate the approach to management in these patients.