Etiology and Epidemiology of Diarrhea in Hospitalized Children from Low Income Country: A Matched Case-Control Study in Central African Republic

Background

In Sub-Saharan Africa, infectious diarrhea is a major cause of morbidity and mortality. A case-control study was conducted to identify the etiology of diarrhea and to describe its main epidemiologic risk factors among hospitalized children under five years old in Bangui, Central African Republic.

Methods

All consecutive children under five years old hospitalized for diarrhea in the Pediatric Complex of Bangui for whom a parent’s written consent was provided were included. Controls matched by age, sex and neighborhood of residence of each case were included. For both cases and controls, demographic, socio-economic and anthropometric data were recorded. Stool samples were collected to identify enteropathogens at enrollment. Clinical examination data and blood samples were collected only for cases.

Results

A total of 333 cases and 333 controls was recruited between December 2011 and November 2013. The mean age of cases was 12.9 months, and 56% were male. The mean delay between the onset of first symptoms and hospital admission was 3.7 days. Blood was detected in 5% of stool samples from cases. Cases were significantly more severely or moderately malnourished than controls. One of the sought-for pathogens was identified in 78% and 40% of cases and controls, respectively. Most attributable cases of hospitalized diarrhea were due to rotavirus, with an attributable fraction of 39%. Four other pathogens were associated with hospitalized diarrhea: Shigella/EIEC, Cryptosporidium parvum/hominis, astrovirus and norovirus with attributable fraction of 9%, 10%, 7% and 7% respectively. Giardia intestinalis was found in more controls than cases, with a protective fraction of 6%.

Conclusions

Rotavirus, norovirus, astrovirus, Shigella/EIEC, Cryptosporidium parvum/hominis were found to be positively associated with severe diarrhea: while Giardia intestinalis was found negatively associated. Most attributable episodes of severe diarrhea were associated with rotavirus, highlighting the urgent need to introduce the rotavirus vaccine within the CAR’s Expanded Program on Immunization. The development of new medicines, vaccines and rapid diagnostic tests that can be conducted at the bedside should be high priority for low-resource countries.     

Communal roosting,thermoregulatory benefits and breeding group size predictability in cooperatively breeding sociable weavers

Extreme temperatures impose energy costs on endotherms through thermoregulation and different adaptations help individuals to cope with these conditions. In social species, communal roosting and huddling are thought to decrease the energetic requirement of thermoregulation under low temperatures. This is likely to represent an important mechanism by which individuals save energy during the coldest parts of the year and hence to represent a non‐breeding benefit of sociality. Here, we investigate the potential thermoregulatory benefits of group living in roosting groups of sociable weavers Philetairus socius, a colonial cooperatively breeding passerine that builds communally a massive nest structure with several independent chambers wherein individuals breed and roost throughout the year. To investigate the benefits of sociality during the non‐breeding season, we studied the thermal environment during roosting in relation to group size. In addition, to understand the link between non‐breeding and breeding sociality in this species we studied group size stability between the pre‐breeding and breeding periods. As expected, we found that the nest chamber's night‐time temperature is strongly related to the number of birds roosting together, especially during cold nights. Specifically, birds in larger groups spent less time below the critical thermal minimum temperature (i.e. the temperature below which energy expenditure increases substantially). They were less exposed to external temperature variations. We also found a positive relationship between the number of birds roosting during winter and the breeding group size, indicating breeding group size predictability. In cooperative breeders such as the sociable weaver, the costs and benefits of sociality are usually studied during the breeding period. This study shows that a better understanding of non‐breeding benefits of group membership and group dynamics between the non‐breeding and breeding periods are necessary for a comprehensive understanding of the benefits of sociality.     

Relative importance of landscape and species characteristics on extinction debt,immigration credit and relaxation time after habitat turnover

Habitat turnover concomitantly causes destruction and creation of habitat patches. Following such a perturbation, metapopulations harbor either an extinction debt or an immigration credit, that is the future decrease or increase in population numbers due to this disturbance. Extinction debt and immigration credit are rarely considered simultaneously and disentangled from the relaxation time (time to new equilibrium). In this contribution, we test the relative importance of two potential drivers of time-delayed metapopulation dynamics: the spatial configuration of the habitat turnover and species dispersal ability. We provide a simulation-based investigation projecting metapopulation dynamics following habitat turnover in virtual landscapes. We consider two virtual species (a short-distance and a long-distance disperser) and five scenarios of habitat turnover depending on net habitat loss or gain and habitat aggregation. Our analyses reveal that (a) the main determinant of the magnitude of the extinction debt or immigration credit is the net change in total habitat area, followed by species dispersal distance and finally by the post-turnover habitat aggregation; (b) relaxation time weakly depends on the magnitude of the immigration credit or of the extinction debt; (c) the main determinant of relaxation time is dispersal distance followed by the net change in total habitat area and finally by the post-turnover habitat aggregation. These results shed light on the relative importance of dispersal ability and habitat turnover spatial structure on the components of time-delayed metapopulation dynamics.     

Membrane cholesterol content modulates ClC-2 gating and sensitivity to oxidative stress

ClC-2 is a broadly expressed member of the voltage-gated ClC chloride channel family. In this study, we aimed to evaluate the role of the membrane lipid environment in ClC-2 function, and in particular the effect of cholesterol and ClC-2 distribution in membrane microdomains. Detergent-resistant and detergent-soluble microdomains (DSM) were isolated from stably transfected HEK293 cells by a discontinuous OptiPrep gradient. ClC-2 was found concentrated in detergent-insoluble membranes in basal conditions and relocalized to DSM upon cholesterol depletion by methyl-beta-cyclodextrin. As assessed by patch clamp recordings, relocalization was accompanied by acceleration of the activation kinetics of the channel. A similar distribution and activation pattern were obtained when cells were treated with the oxidant tert-butyl hydroperoxide and after ATP depletion. In both cases activation was prevented by cholesterol enrichment of cells. We conclude that the cholesterol environment regulates ClC-2 activity, and we provide evidence that the increase in ClC-2 activity in response to acute oxidative or metabolic stress involves relocalization of this channel to DSM.     

Granzyme B-induced cell death involves induction of p53 tumor suppressor gene and its activation in tumor target cells

In this study we investigated the involvement of p53 in cytotoxic T-lymphocyte (CTL)-induced tumor target cell killing mediated by the perforin/granzymes pathway. For this purpose we used a human CTL clone (LT12) that kills its autologous melanoma target cells (T1), harboring a wild type p53. We demonstrated initially that LT12 kills its T1 target in a perforin/granzymes-dependent manner. Confocal microscopy and Western blot analysis indicated that conjugate formed between LT12 and T1 resulted in rapid cytoplasmic accumulation of p53 and its activation in T1 target cells. Cytotoxic assay using recombinant granzyme B (GrB) showed that this serine protease is the predominant factor inducing such accumulation. Furthermore, RNA interference-mediated lowering of the p53 protein in T1 cells or pifithrin-alpha-induced p53-specific inhibition activity significantly decreased CTL-induced target killing mediated by CTL or recombinant GrB. This emphasizes that p53 is an important determinant in granzyme B-induced apoptosis. Our data show furthermore that when T1 cells were treated with streptolysin-O/granzyme B, specific phosphorylation of p53 at Ser-15 and Ser-37 residues was observed subsequent to the activation of the stress kinases ataxia telangiectasia mutated (ATM) and p38K. Treatment of T1 cells with pifithrin-alpha resulted in inhibition of p53 phosphorylation at these residues and in a significant decrease in GrB-induced apoptotic T1 cell death. Furthermore, small interference RNAs targeting p53 was also accompanied by an inhibition of streptolysin-O/granzyme B-induced apoptotic T1 cell death. The present study supports p53 induction after CTL-induced stress in target cells. These findings provide new insight into a potential role of p53 as a component involved in the dynamic regulation of the major pathway of CTL-mediated cell death and may have therapeutic implications.     

Tumor ablation with irreversible electroporation

We report the first successful use of irreversible electroporation for the minimally invasive treatment of aggressive cutaneous tumors implanted in mice. Irreversible electroporation is a newly developed non-thermal tissue ablation technique in which certain short duration electrical fields are used to permanently permeabilize the cell membrane, presumably through the formation of nanoscale defects in the cell membrane. Mathematical models of the electrical and thermal fields that develop during the application of the pulses were used to design an efficient treatment protocol with minimal heating of the tissue. Tumor regression was confirmed by histological studies which also revealed that it occurred as a direct result of irreversible cell membrane permeabilization. Parametric studies show that the successful outcome of the procedure is related to the applied electric field strength, the total pulse duration as well as the temporal mode of delivery of the pulses. Our best results were obtained using plate electrodes to deliver across the tumor 80 pulses of 100 micros at 0.3 Hz with an electrical field magnitude of 2500 V/cm. These conditions induced complete regression in 12 out of 13 treated tumors, (92%), in the absence of tissue heating. Irreversible electroporation is thus a new effective modality for non-thermal tumor ablation.     

Altered processing of sensorimotor feedback in schizophrenia

Schizophrenia is characterized by an altered sense of the reality, associated with hallucinations and delusions. Some theories suggest that schizophrenia is related to a deficiency of the system that generates information about the sensory consequences of the actions realized by the subject. This system monitors the reafferent information resulting from an action and allows its anticipation. In the present study, we examined visual-event-related potentials (ERPs) generated by a sensorimotor task in 15 patients with schizophrenia and 15 normal controls. The visual feedback from hand movements performed by the subjects was experimentally distorted. Behavioral results showed that patients were impaired in recognizing their own movements. The ERP signal in patients also differed from those of control subjects. In patients, the ERP waveform was affected during the early part of the response (200 ms). This early effect in schizophrenic patients reveals a modified processing of the visual consequence of their actions.