bluuebunny/crossref_metadata_2025_split huggingface dataset:
A167 ASSESSMENT OF QUALITY OF LIFE AMONG CHILDREN WITH CELIAC DISEASE IN JORDAN
Authors: Altamimi E , Haj-Ahmad L , Alqaisi A 
Published: February 2024

Abstract

Background
Celiac disease has a profound impact on the daily lives of patients who are diagnosed with this chronic disease and affected by its myriad of clinical implications. Thus, health-related quality of life (HrQol) surveys proved invaluable in assessing children with this condition.

Aims
We aimed to assess HrQol of children with celiac disease in Jordan. In addition to the effect of gender, diet-restriction compliance compliance and the concomitant occurance of other chronic illnesses on the HrQol in our cohort.

Methods
A cross-sectional study of all children registered with the Celiac Disease Care Providers Society (CDPS) were asked to fill an online quality of life questionnaire. The Arabic version of the Kidscreen-52 questionnaire, with 10 domains was adopted. Data was analyzed using descriptive statistics and average T-scores across 10 health domains. Data was compared to previously published international norms.The sample was divided into four cohorts based on concomitant disorders, disease duration, adherence to gluten free diet (GFD), and growth issues. Independent sample t-tests, p-values, and Cohen's ds were determined for each cohort. Subcohorts were compared to each other.

Results
Out of 400 children registered with the society. 126(31.5%) patients responded. Male celiac patients performed worse in six health domains compared to the general population: moods and emotions, self-perception, bullying, psychological well-being, social support, and financial resources. The last three of which showed poorer performance in female celiacs too. Moods and emotions and self-perception were significantly worse in males with chronic disease and without GFD adherence. Females with growth issues performed worse in school environment and financial resources.

Conclusions
The study reveals a significant reduction in Hrqol in celiac patients compared to healthy individuals, a first in Jordan. This highlights the need for education initiatives for patients and physicians, as well as campaigns for national support for GFD. Further research is needed to identify other contributing factors and what interventions at community level should be taken.

Funding Agencies
None
A170 A RARE CASE OF CELIAC DISEASE WITH PULMONARY HEMOSIDEROSIS AND DILATED CARDIOMYOPATHY
Authors: Dessie E K 
Published: February 2024

Abstract

Background
Celiac disease (CD) is a primary disease of the intestine but patients also present with extra intestinal manifestations like iron deficiency anemia, dermatitis herpetiformis, selective IgA deficiency, thyroid disorders, diabetes mellitus and various connective tissue disorders but rarely with pulmonary hemosiderosis and dilated cardiomyopathy.

Aims
We present a rare case of CD associated with pulmonary hemosiderosis and dilated cardiomyopathy in a 10 year old child.

Methods
Patient interview and chart review was conducted. Literature reveiw was performed using pub med data base.

Results
A 10 year old presented with a 1 day of cough and hemoptysis. His past medical history includes Constipation and low percentile for weight and height. His first cousin is recently diagnosed with celiac disease, otherwise his family history is unremarkable. He is pale on exam and has a BMI of 13.64 which is ampersand:003C1% for age. He had fine crackles on bilateral lung fields but no signs of respiratory distress. His pericardium was active but no murmur or gallop. CXR showed cardiomegaly and Echo was suggestive of dilated cardiomyopathy. ECG was significant for LBBB. Chest CT showed bilateral confluent symmetric ground glass densities with possibility of pulmonary hemosiderosis. His blood work was significant for iron deficiency anemia, low selenium of 0.94umol/L and zinc 8.4umol/L. His antibody screen was positive for ANA, a tTGA of ampersand:003E4,965.5 and positive EMA. The cardiomyopathy and pulmonary hemosiderosis in this case are considered to be secondary findings as both have been reported in the context of celiac disease and patient was initiated on gluten free diet (GFD). Patient was blood transfused and kept on oral iron and multivitamins. He was also started on aldactazide 1 tab daily, 20mg twice daily enteresto and carvedilol 3.125mg twice daily as part of his heart failure management. At one month follow up, patient was having abdominal discomfort due to his constipation and follow up labs showed improvement of his anemia.

Conclusions
Patients with pulmonary hemosiderosis occuring with CD demonstrate improvement of their symptoms with GFD highlighting the importance of screening all pulmonary hemosiderosis patients for CD. Cardiomyopathy associated with celiac disease is also another very rare occurrence and only few studies have been reported so far.
In conclusion, although a rare occurrence, the association of CD with pulmonary hemosiderosis and cardiomyopathy has huge therapeutic implications emphasizing the need to have high index of suspicion and routine screening for CD among patients with pulmonary hemosiderosis and dilated cardiomyopathy.

Funding Agencies
The hospital for sick children/sick kids hospital
A172 A CLASSIC CASE OF WHIPPLE'S DISEASE
Authors: Hearn J , Webster D , Carpentier S 
Published: February 2024

Abstract

Background
Whipple’s disease is a systemic disorder caused by the Gram-positive bacillus Tropheryma whippelii. It is classically defined by the four cardinal clinical manifestations of arthralgias, weight loss, diarrhea and abdominal pain. Classic Whipple’s disease is considered extremely rare, with an estimated global incidence of 30 cases per year, though this may be an underestimate.

Aims
To present a case of classic Whipple’s disease, so as to raise awareness and clinical suspicion for this rare condition.

Methods
We performed a retrospective chart review of a case of classic Whipple’s disease diagnosed in Saint John, NB, in 2020.

Results
A 55-year-old female presented to hospital with intractable weakness and diarrhea. Her history was notable for several years of right leg weakness, myalgias and low-grade fevers. More acutely, she presented to hospital due to worsening secretory diarrhea resulting in 15kg weight loss. Initial investigations were remarkable for an elevated C-reactive protein. The patient was admitted for coordinated evaluation for possible rheumatologic and infectious causes. As part of that workup, colonoscopy was performed.
Colonoscopy revealed an abnormal ileum, with villi described as edematous with a mosaic pattern alternating between erythematous and “white tipped”. On histologic assessment, ileal biopsies showed macrophages with PAS-positive diastase resistant granules suspicious for Whipple’s disease. A follow-up esophagogastroduodenoscopy with duodenal biopsies was thus performed to gain further tissue for confirmatory testing. The duodenal mucosa was also noted to have a mosaic pattern with hypertrophic villi alternating between pale and erythematous in appearance. Duodenal biopsies were taken and sent for PCR testing. This testing was positive for T. whippelii, confirming the diagnosis of Whipple’s disease.
The patient was initiated on long-term antibiotic therapy with ceftriaxone transitioning to trimethoprim-sulfamethoxazole prior to discharge. She unfortunately re-presented one month post-discharge with recurrent fevers, malaise and arthralgias. Given suspicion that her disease may be resistant to trimethoprim-sulfamethoxazole, she was transitioned to doxycycline and hydroxychloroquine as second-line therapy. She clinically improved on this regimen, and was able to be de-escalated to long-term doxycycline monotherapy after one year. At a recent follow-up, nearly three years from her initial diagnosis, she was doing well with essentially no ongoing symptoms of her Whipple’s disease.

Conclusions
Whipple’s disease is a rare infection presenting with intractable diarrhea and abdominal discomfort. Our case highlights the excellent clinical response that can be achieved with successful diagnosis and management of this otherwise debilitating disease.

Funding Agencies
None
A174 TESTING FOR AND INCIDENCE OF CELIAC DISEASE AUTOIMMUNITY SAW SIGNIFICANT BUT TEMPORARY DECLINES DURING COVID-19 PANDEMIC
Authors: King J A , Coward S , Kaplan G G , Williamson T 
Published: February 2024

Abstract

Background
Celiac disease (CD) is an autoimmune disorder with various complications and long-term health risks. The COVID-19 pandemic affected the entire healthcare system—including screening for and diagnosing non-infectious conditions.

Aims
Determine how the COVID-19 pandemic affected the testing for, and incidence of, CD autoimmunity.

Methods
Using the population-based Alberta Medical Laboratory database, all tissue transglutaminase antibody tests (tTG-IgA) were identified in Alberta (April 2012 to March 2023). Incident cases of CD autoimmunity comprised of individuals newly positive for tTG-IgA between April 2015 and March 2023. Prevalent cases of CD were excluded based on previous tTG-IgA positivity and/or CD diagnosis codes in outpatient or inpatient settings. Average monthly percent changes and inflection points for testing and incidence rates were estimated using Joinpoint regression. Autoregressive integrated moving average models were performed to forecast rates if the pandemic had not occurred. Incidence rate ratios (IRRs) were estimated to compare a pre-pandemic era (April 2017 to March 2020) and a pandemic era (April 2020 to March 2023) overall and across subgroups.

Results
In the pandemic era, 311,971 tTG-IgA tests were performed on 284,882 unique individuals (21.1 per 1000 person-years (Table 1)). Testing decreased by 23.4% per month from February 2020 until May 2020 (Figure 1A). From June 2020 to August 2020, testing rates increased by 22.3% per month and then remained stable until the end of the study period. There were 4907 new cases of CD autoimmunity in the pandemic era, with an incidence of 36.3 per 100,000 person-years (Table 1). Incidence rates decreased by 14.1% per month from January 2020 until April 2020 (Figure 1B). Subsequently, incidence continued to rise by 2.0% per month from May 2020 until the end of the study period.

Conclusions
The COVID-19 pandemic appears to have had a minor impact on identifying potential CD. Future surveillance is needed to determine if the pandemic affected the diagnostic pathway to biopsy-confirmed CD through upper endoscopy procedures and any adverse outcomes individuals may have had from delayed diagnosis.
Table 1: Testing and incidence rates for CD autoimmunity in Alberta in pre-pandemic era (April 2017 to March 2020) and pandemic era (April 2020 to March 2023)
IRR=incidence rate ratio; CI=confidence interval

Figure 1: Testing (A) and incidence (B) rates for CD autoimmunity before and after the start of the COVID-19 pandemic

Funding Agencies
CAG, CIHRhttps://triangleprogram.org
A175 IMPACT OF THE COVID-19 PANDEMIC ON CANADIANS WITH CELIAC DISEASE
Authors: King J A , McAulay C , Secord M , Pinto-Sanchez M , Turner J , Gidrewicz D , Case S , Duerksen D 
Published: February 2024

Abstract

Background
The COVID-19 pandemic affected various healthcare services, including primary care and management of certain health conditions. There is limited data on how the pandemic impacted those with celiac disease (CD).

Aims
Explore the implications of the COVID-19 pandemic on CD diagnosis and management.

Methods
The State of Celiac Disease in Canada Survey was made available online by Celiac Canada in December 2022. Over 75 questions were included, covering diagnostic pathways, COVID-19 factors such as infection and vaccination, perceptions around COVID-19, and gluten-free food access during the pandemic. Analysis was restricted to those who responded to having CD, dermatitis herpetiformis, or gluten ataxia.

Results
A total of 6052 participants were included. A total of 2320 (38.3%) reported having tested positive for COVID-19 at some time during the pandemic. Among those with an infection at some point, 93.8% tested positive after already being diagnosed with CD. Just under 2% of those testing positive for COVID-19 required hospitalization, of which 10% were admitted to the intensive care unit. Vaccination against COVID-19 was reported by 4695 (77.6%) individuals, although 1157 (19.1%) did not provide a response to this specific question. This did not differ significantly by gender (p = 0.901), although it did across age groups (p ampersand:003C 0.001), with a mean age of 54.2 years who were vaccinated compared to a mean age of 45.7 years who were not vaccinated. 718 (11.9%) of individuals felt they were at higher risk of COVID-19 complications due to having CD; however, 1290 did not respond. Reported delays from symptoms to diagnosis did not increase among those diagnosed during the pandemic compared to those diagnosed before. Most respondents did not feel the pandemic made it more challenging to follow the gluten-free diet, and just over half (52.8%) did not feel it was harder to obtain or access gluten-free food during this time. However, almost three-quarters (73.4%) noted an increase in the cost of gluten-free food during the pandemic – this meant adjusting finances in other areas to afford gluten-free food (28.5%), changing the type of food purchased (19.3%), or accessing a food bank (0.7%).

Conclusions
A significant number of patients with CD reported COVID-19 infections, but less than 2% had serious outcomes. This survey identified gaps in our understanding of COVID-19 vaccination in patients with CD and highlighted some adverse impacts of the pandemic on the costs of gluten-free foods.

Funding Agencies
Celiac Canada (FKA Canadian Celiac Association)
A180 SYSTEMATIC REVIEW OF MACHINE LEARNING-BASED PREDICTIVE MODELS FOR CLOSTRIDIOIDES DIFFICILE INFECTION
Authors: Tariq R , Malik S , Khanna S 
Published: February 2024

Abstract

Background
Clostridioides difficile infection (CDI) is a significant healthcare-associated infection that poses a substantial burden on patients and healthcare systems. Despite extensive research, accurately predicting CDI incidence and its associated complications remains a challenge. Electronic health records (EHRs) contain a wealth of clinical data that could potentially aid in predicting CDI and its outcomes. Machine-learning (ML) models have emerged as promising tools in healthcare, offering the potential to harness this data and enhance our ability to predict CDI incidence and complications.

Aims
This systematic review aimed to evaluate the performance of machine-learning (ML) models in predicting CDI incidence and complications using clinical data from electronic health records.

Methods
We conducted a comprehensive search of databases up to September 2023, adhering to the PRISMA guidelines. Studies employing ML techniques for predicting CDI or its complications were included. The primary outcome was the type of and performance of ML models, assessed using the area under the receiver operating characteristic curve (AUROC).

Results
Twelve retrospective studies that evaluated CDI incidence or outcomes were included. The most commonly used ML models were random forest and Gradient Boosting. The AUROC ranged from 0.60 to 0.81 for CDI incidence, 0.59 to 0.80 for recurrence, and 0.64 to 0.88 for complication prediction. Advanced ML models demonstrated similar performance over traditional logistic regression in predicting CDI complication. However, there was notable heterogeneity in defining CDI and the different outcomes, such as incidence, recurrence, and complications, and a lack of external validation in many studies.

Conclusions
ML models show promise in predicting CDI incidence and outcomes. However, the observed heterogeneity in CDI definitions and the lack of real-world validation highlight challenges in clinical implementation. Future research should focus on external validation and use of standardized definitions across studies.

Funding Agencies
None
Microbiome & Microbial Therapy
A184 HCPE CONTRIBUTES TO THE HOST INFLAMMATORY RESPONSE TO HELICOBACTER PYLORI
Authors: Creuzenet C , Salloum N , Lester J , Takougoum J M , Carroll D , Patel K , Atanassov C , Bodet C , Burucoa C 
Published: February 2024

Abstract

Background
Helicobacter pylori (HP) colonizes chronically 50% of the world population, leading to gastric ulcers or cancers in 2-10 % of infections. Due to rising antibiotic resistance, curtailing HP-induced diseases requires the identification of new anti-HP molecules that can reduce HP viability or its ability to elicit inflammation. Amongst HP’s virulence factors are the Helicobacter Cysteine-rich Proteins (Hcp) that are secreted outside the bacteria and contain Sel-Like Repeats (SLR) which support protein / protein interactions involved in signal transduction across kingdoms. Several SLR-containing bacterial proteins including HcpA are involved in bacteria / host interactions. Thus, Hcps may affect HP’s virulence via interaction of their SLRs with host proteins.

Aims
We aim to elucidate the role of Hcps in HP’s virulence. Hcps were considered as immune decoys since anti-Hcp antibodies made in infected patients are unable to clear the infection. However, recent data suggest that Hcps interact with host components and may modulate the function of immune cells. However, their effects on gastric cells remain unknown and functional differences between Hcps remain to be explored.

Methods
This work uses knockout mutagenesis, interactions with gastric cells, transcriptomics, and microscopy.

Results
We focus on HcpE, the largest Hcp that may interact with many host proteins via its 9 SLRs motifs. We showed that HcpE is secreted outside HP in 2 lab strains and that ~ 30% of secreted HcpE was comprised in outer membrane vesicles that may deliver HcpE into eukaryotic cells by membrane fusion. We also showed that the DiSulfide Bond forming protein DsbK is essential for HcpE production and secretion. Here, we demonstrate the production and secretion of HcpE by clinical isolates in vitro, and its production in situ in infected patients. Using our HcpE and DsbK knockout mutants, we investigate the role of HcpE and other Hcps in interactions with human gastric cells in vitro and in ex vivo gastric explants, showing a role in inflammation activation. Finally, we demonstrate their role in murine gastric colonization and in murine splenocytes activation. Overall, our data show a role of Hcps in host / pathogen interactions largely due to immuno-modulatory functions and a role in gastric colonization, with a predominant role of HcpE over other Hcps.

Conclusions
The findings open up possibilities to use Hcps or the gate keeper DsbK that controls their production as novel therapeutic targets to alleviate the burden of HP-associated disease.This could benefit the ~6 million patients who develop gastric ulcers or cancers each year worldwide due to HP infection, also saving billions of annual health care costs.

Funding Agencies
Western University
A186 INFLAMMATION MODIFIES DOSE-DEPENDENT RESPONSES OF INTESTINAL ANTI-TUMOUR MICRORNAS TO CRANBERRY PROANTHOCYANIDIN AND ITS MICROBIAL METABOLITE 3-(4-HYDROXYPHENYL)-PROPIONIC ACID
Authors: Dimoff Z , Lofft Z , Liang F , Chen S , Paetau-Robinson I , Khoo C , Taibi A , Comelli E 
Published: February 2024

Abstract

Background
Cranberries are a rich source of proanthocyanidins (PAC), a type of polyphenol with anti-cancer properties. We previously found that PAC, along with its microbially-derived metabolite 3-(4-hydroxyphenyl)-propionic acid (HPPA), trigger unique regulatory responses of microRNAs (miRNAs) in intestinal epithelial cells including the upregulation of miR-146a-5p. Both miR-146a-5p and miR363-3p are anti-inflammatory and downregulate anti-tumorigenic signalling pathways such as the interleukin (IL)-17 and wingless-related integration site (Wnt) respectively. miR-146a-5p also attenuates IL-17-promoting cytokines levels (e.g., IL-6).

Aims
To determine if miR-146a-5p and miR-363-3p respond to different physiologically relevant concentrations of PAC and HPPA in inflammatory and non-inflammatory conditions.

Methods
Fully differentiated Caco-2BBe1 colonic epithelial cells were treated with two doses of PAC-enriched cranberry extract (50μg/ml, 100μg/ml), HPPA (5μg/ml, 10μg/ml), or with Dulbecco’s Modified Eagle Medium (DMEM; control) for 24 hours, followed by IL-1β (1ng/ml) or mock stimulation for three hours. Human IL-6 homogeneous time-resolved fluorescence (HTRF) kits were used to quantify IL-6 in cell supernatant. RNA was extracted and used for miRNA profiling using Nanostring technology. Statistical analysis was performed in R version 4.2.1 with the R-packages NanostringDiff, NanostringNorm, and Pheatmap.

Results
At homeostasis, 42 and 2 (miR-146a and miR363-3p) miRNAs, respectively, uniquely responded to increasing PAC or HPPA concentrations. In the inflammatory state, no miRNAs responded to increasing concentrations of PAC and HPPA. However, the expression of miR-363-3p increased (qampersand:003C0.001) in response to 50μg/ml of PAC + IL-1β but decreased in response to 5μg/ml of HPPA + IL-1β , and the expression of miR-146a-5p increased (qampersand:003C0.001) in response to 5μg/ml of HPPA + IL-1β, and 50μg/ml PAC + IL-1β. Predicted miRNA gene-pathway analysis revealed that miR-146a-5p, miR-363-3p, and the other 42 miRNAs commonly target pathways involved in the tumorigenesis of colorectal cancer such as mitogen-activated protein kinases (MAPK), hedgehog, and Wnt pathways. Though, in inflamed cells, only HPPA (5 or 10 μg/ml) attenuated IL-6 secretion (pampersand:003C0.05), which may be driven by increased expression of miR-146a-5p.

Conclusions
These findings suggest that cranberries proanthocyanidins and their metabolites affect miRNAs involved in cancer related pathways in different manners and concentrations, which may depend on the inflammatory status. The gut microbiota may be partially responsible for unlocking these effects.

Funding Agencies
Ocean Spray Cranberries, Inc. and the Natural Sciences of Engineering Research Council of Canada (NSERC)