Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.

Small extrachromosomal circular DNA in amyotrophic lateral sclerosis matter

Comprehensive studies identify motor neuron spectrum disorders including amyotrophic lateral sclerosis(ALS)as globally rising fatal disorders with the highest prevalence in aging populations,influenced by ethnicity and ancestry(GBD 2016 Motor Neuron Disease Colla borators,2018).While~10% of diagnoses involve a family history(fALS),most cases are considered sporadic(sALS).However,population-based studies suggest that even cases without a common index mutation impart heritability(Ryan et al.,2019),indicating a crucial role of rare and as yet unknown genetic denominators.

Emerging and re-emerging human infectious diseases:A systematic review of the role of wild animals with a focus on public health impact

Infectious diseases continue to impose unpredictable burdens on global health and economies, a subject that requires constant research and updates. In this sense, the objective of the present article was to review studies on the role of wild animals as reservoirs and/or dispersers of etiological agents of human infectious diseases in order to compile data on the main wild animals and etiological agents involved in zoonotic outbreaks. A systematic review was carried out using PRISMA guidelines, using the PubMed, Scopus and SciELO platforms as data banks. The descriptors used were "zoonosis", "human infectious diseases" and "wild animals". The results show that wild animals(mainly bats, birds and primates) play an important role in the dissemination of etiological agents(mainly viruses, as a new coronavirus called 2019 Novel Coronavirus) in extensive geographic regions. Moreover, these wild animal organisms can act as the site for essential biotic synergy among several pathogenic microorganisms, promoting a higher rate of adaptation, mutation and even genetic recombination, with consequent stimulation of new strains and subtypes, inducing new infectious agents with unknown virulent potential. In conclusion, the monitoring of these diseases and adequate preparation for possible epidemics and pandemics are fundamental conditions for the mitigation of their future impact. The zoonotic threat of these etiological agents and the impact on public health can be enormous as shown by the ongoing epidemic of 2019 novel coronavirus(2019-nCoV) infections.

Prevalence and risk factors of prolonged grief disorder among bereaved survivors seven years after the Wenchuan earthquake in China: A cross-sectional study

Background:This study aimed to determine the prevalence and predictive factors of prolonged grief disorder(PGD)among those bereaved by the Wenchuan earthquake in Southwestern China seven years after the event.Methods:A cross-sectional survey based on census tracts was conducted on the bereaved earthquake survivors.Responses to the questionnaire regarding PGD and its potential associated factors were obtained either through face-to-face or telephone interview.PGD was screened by a validated Chinese version of the PGD questionnaire-13(PG-13).Bivariate and multivariate regression analyses were used to determine the prevalence and associated risk factors of PGD.Results:A total of 1464 bereaved earthquake survivors,with a response rate of 97.6%,were included in the study.Of the 1464 respondents studied,124(8.47%)were diagnosed with PGD.Multivariate regression analysis demonstrated that PGD in the bereaved earthquake individuals was significantly associated with several factors,including age,economic burden,close kinship with the deceased,and living with the deceased before the loss.Wenchuan earthquake bereaved aged 41e60 years were more likely to develop PGD compared to those aged younger than 40 or older than 60(OR=2.075,95%CI=1.297e3.319).Those who had a close kinship with the deceased had a higher tendency to develop PGD(OR=5.144,95%CI=2.716e9.740).The odds of PGD among the earthquake bereaved with economic burdens were higher relative to those who did not experience an economic burden(OR=8.123,95%CI=2.657e24.831).Those who living with the deceased before loss also had a higher tendency to develop PGD(OR=0.179,95%CI=0.053e0.602).Conclusions:This study revealed that a significantly high proportion(8.47%)of the Wenchuan earthquake-bereaved remain grieving seven years after the event.Those diagnosed with PGD should receive appropriate interventions from clinical psychologists.The risk factors identified in this study are crucial for the early screening and prevention of PGD in future nursing and psycho-clinical practices.

Seroprevalence of Helicobacter pylori in dyspeptic patients and its relationship with HIV infection,ABO blood groups and life style in a university hospital,Northwest Ethiopia

AIM： To determine the prevalence of Helicobacter pylori （H pylori） among dyspeptic patients and to assess the relationship between Hpylori infection, blood group, HIV infection and life style of the patients. METHODS： In a hospital-based cross-sectional study, patients attending Outpatient Department of University of Gondar Hospital were enrolled. Socio-demographic information was collected using questionnaires. Serum was analyzed for anti-H pylori IgG antibodies using a commercial kit. HIV serostatus was determined by enzyme-linked immunosorbent assay （ELISA）. Blood grouping was performed by slide agglutination tests. RESULTS： A total of 215 dyspeptic patients were included in the study. One hundred and sixteen patients （54%） were females and 99 （46%） were males. Anti-H pylori IgG antibodies were detected in sera of 184 （85.6%） patients. The prevalence was significantly higher in patients aged 50 years and above. Twenty point five percent of the patients were found to be seropositive for HIV. No significant association was found between sex, ABO blood groups, consumption of spicy diets, socioeconomic status and seropositivity for Hpylori. However,alcohol consumption was significantly associated with H pylori serology. CONCLUSION： The prevalence of H pylori infection is associated with a history of alcohol intake and older age. The effect of different diet, alcohol and socioeconomic status as risk factors for H pylori infection needs further study.

Neuropilin-1: A feasible link between liver pathologies and COVID-19

The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)pandemic has a tremendous impact on the health of millions of people worldwide.Unfortunately,those suffering from previous pathological conditions are more vulnerable and tend to develop more severe disease upon infection with the new SARS-CoV-2.This coronavirus interacts with the angiotensin-converting enzyme 2 receptor to invade the cells.Recently,another receptor,neuropilin-1(NRP-1),has been reported to amplify the viral infection.Interestingly,NRP-1 is expressed in nonparenchymal liver cells and is related to and upregulated in a wide variety of liver-related pathologies.It has been observed that SARS-CoV-2 infection promotes liver injury through several pathways that may be influenced by the previous pathological status of the patient and liver expression of NRP-1.Moreover,coronavirus disease 2019 causes an inflammatory cascade called cytokine storm in patients with severe disease.This cytokine storm may influence liver sinusoidal-cell phenotype,facilitating viral invasion.In this review,the shreds of evidence linking NRP-1 with liver pathologies such as hepatocellular carcinoma,liver fibrosis,nonalcoholic fatty liver disease and inflammatory disorders are discussed in the context of SARS-CoV-2 infection.In addition,the involvement of the infection-related cytokine storm in NRP-1 overexpression and the subsequent increased risk of SARS-CoV-2 infection are also analyzed.This review aims to shed some light on the involvement of liver NRP-1 during SARSCoV-2 infection and emphasizes the possible involvement this receptor with the observed liver damage.

New variola(mpox)in Brazil:Epidemiological update and perspectives

New variola(NV)-mpox(monkeypox)-is a zoonosis caused by the mpox virus,which belongs to the genus Orthopoxvirus in the family Poxviridae.This disease,in the present year(2022),has caused several cases and deaths around the world,including Brazil[1].The group of poxviruses,in which the species that causes NV is included,consists of agents widely distributed in nature.Due to their considerably large size,they were among the first viruses to be microscopically visualized.The Poxviridae family is capable of infecting epithelial and connective tissue cells.Currently,such a viral family is classified as a genome lineage composed of doublestranded DNA,completely independent of the host nucleus[1].

COVID-19 in Brazil:Epidemiological update and perspectives

Coronaviruses are RNA viruses (Family: Coronaviridae) constituents of a significant number of viruses that provoke diseases in animals and human beings. There are four genera of these microorganisms: Alphacoronavirus, Betacoronavirus, Deltacoronavirus and Gammacoronavirus. From this group, the alpha- and beta-coronaviruses are designated as human coronavirus (HCoV) for their propensity to infect human beings[1].

Epidemiological, prevention and control updates of yellow fever outbreak in Brazil

Yellow fever is an acute viral disease endemic to tropical countries, like Brazil, where, since the 1940 s, has no significant documented outbreaks similar to that observed between 2016/2018(2 045 confirmed cases and 677 deaths; caused by the sylvatic form).The principal manipulating factors inciting this change were absence of appropriate vaccination campaigns and increased urbanization & population growth in forest areas, with prevalence of the virus in the species inhabiting of these areas.The 2016/2018 outbreaks exhibited incidence in areas with historically low or no yellow fever virus activity, triggering a surge in recorded deaths-mainly in the Southeastern states of Brazil.The Brazilian government aggressively responded, reforming the countries' prophylactic measures, including vaccine implementation-as of March, 2018, switching from the former double dose regimen of the vaccine, to a single dose protocol, deemed as adequate.Moreover, some states appropriated the fractionated dosage(1/5 of the standard dose), in foresight of potential vaccine shortages.To prevent the uprising of new sylvatic yellow fever cases in Brazil, it's obligatory the development of effective combative plans, including adaptation of prophylactic measures individually(use of repellents, protective clothing etc.), applicable vaccination campaigns in every endemic region, to raise awareness to locals and visitors alike.Notwithstanding these preventative strategies, the persistence of cases and the recent outbreaks in Brazil, highlight the possible ineffectiveness of combative measures.Based on these considerations, the objective of this review was to raise more awareness of the epidemiological impact of the disease in Brazil.

Liver Histology after Chronic Use of Alcohol and Exercise Training in Rats

Objectives： To investigate the effects of physical training on the liver morphology and morphometry after chronic use of alcohol in rats. Methods： Twenty-four Wistar rats were housed in cages with controlled environment and randomly divided into four groups according to treatment received. In the initial treatment, alcohol was administered to SA （sedentary alcohol） and EA （exercise alcohol） groups. After four weeks, physical training program was held on a treadmill with EA and EC （exercise control） groups. Area, perimeter, maximum and minimum diameter and form factor of nucleus and cytoplasm of hepatocytes were analyzed. Key findings： Micro-vesicular fatty degeneration, predominantly pericentrolobular, of mild to moderate intensity, was found especially in animals treated with alcohol. EC group showed nucleus area greater than the nucleus area of EA and SA groups. The form factor was lower in the EC group than in the EA group. EA group showed maximum cytoplasm diameter is smaller than in SC （sedentary control） group. Conclusions： Physical training for two weeks was not enough to suppress histopathologic changes in the liver caused by chronic use of alcohol in rats. Chronic use of alcohol seems to have minimized the beneficial effect of physical training in the nucleus area of hepatocytes.

组合锻炼对养老院老年人生活质量和抑郁症状的效果研究

目的本研究旨在调查组合锻炼项目对居住在长期养老院的老年人的健康相关生活质量和抑郁症状的影响。方法采用类实验研究设计。在西班牙北部巴斯克地区最大的长期养老院中便利选取41名老年人,并分为干预组(21名)和对照组(20名)。干预组接受50 min中等强度的组合锻炼干预课程(力量和平衡,每周3次,为期3个月)。对照组继续进行他们在长期疗养院中的常规活动。在干预前(基线时)、干预后(12周后)采用健康调查简表(the Short Form Health Survey,SF-36)和简版老年抑郁量表(Geriatric Depression Scale,GDS)对老年人的健康相关生活质量和抑郁症状进行调查,并比较两组的干预效果。结果共38名老年人完成研究(每组19例)。干预组中,干预后老年人身体功能得分比干预前增加11.06分(增加17.2%);角色情感方面得分比干预前提高5.27分(增加29.1%)(P<0.05)。对照组中,干预后老年人社会功能得分比干预前提高13.16分(增加15.4%)。其余参数没有明显的变化,组间差异无统计学意义(P>0.05)。结论尽管本研究结果中组合锻炼对养老院院老年人健康相关的生活质量和抑郁症状的改善没有显示统计学意义,但增加样本量可能证实其有效性。这些结果有助于为未来的研究设计提供信息。

Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.

Troubleshooting a Difficult Trans-Tibial/Fibula Amputation: A Case Report

Necrotic feet secondary to vascular compromise in the diabetic patient may require an emergent guillotine amputation. Unrecognized, retained hardware in a distal ankle years after fracture repair may complicate the intraoperative guillotine amputation at the transtibial/fibula level. Troubleshooting such an unexpected surgical problem is not necessarily straightforward depending on the clinical situation. Presented is a case report where a patient with a necrotic burned foot failed to inform the burn team that he had implanted ankle hardware, prior to his surgical intervention. A successful amputation was completed after proceeding down a specific algorithm devised for such a scenario.

Air embolism complicating gastrointestinal endoscopy: A systematic review

Gastrointestinal endoscopy has become an important modality for the diagnosis and treatment of various gastrointestinal disorders. One of its major advantages is that it is minimally invasive and has an excellent safety record. Nevertheless, some complications do occur, and endoscopists are well aware and prepared to deal with the commonly recognized ones including bleeding, perforation, infection, and adverse effects from the sedative medications. Air embolism is a very rare endoscopic complication but possesses the poten-tial to be severe and fatal. It can present with cardio-pulmonary instability and neurologic symptoms. The diagnosis may be difficult because of its clinical presen-tation, which can overlap with sedation-related cardio-pulmonary problems or neurologic symptoms possibly attributed to an ischemic or hemorrhagic central nervous system event. Increased awareness is essential for prompt recognition of the air embolism, which can allow potentially life-saving therapy to be provided.Therefore, we wanted to review the risk factors, the clinical presentation, and the therapy of an air embolism from the perspective of the practicing endoscopist.

Denervated muscle extract promotes recovery of muscle atrophy through activation of satellite cells. An experimental study

Purpose: The objective of the present study was to determine whether a denervated muscle extract(DmEx) could stimulate satellite cell response in denervated muscle.Methods: Wistar rats were divided into 4 groups: normal rats, normal rats treated with DmEx, denervated rats, and denervated rats treated with DmEx. The soleus muscles were examined using immunohistochemical techniques for proliferating cell nuclear antigen, desmin, and myogenic differentiation antigen(MyoD), and electron microscopy was used for analysis of the satellite cells.Results: The results indicate that while denervation causes activation of satellite cells, DmEx also induces myogenic differentiation of cells localized in the interstitial space and the formation of new muscle fibers. Although DmEx had a similar effect in nature on innervated and denervated muscles, this response was of greater magnitude in denervated vs. intact muscles.Conclusion: Our study shows that treatment of denervated rats with DmEx potentiates the myogenic response in atrophic denervated muscles.

Manipulation of bicarbonate concentration in sperm capacitation media improves in vitro fertilisation output in porcine species

Background: The in vivo concentration of bicarbonate(HCO3-), one of the essential sperm capacitating effectors,varies greatly in the different environments sperm go through from cauda epididymis to the fertilisation site. On the contrary, porcine in vitro sperm capacitation and fertilisation media usually contains a standard concentration of25 mmol/L, and one of the main problems presented is the unacceptable high incidence of polyspermy. This work hypothesised that by modifying the HCO3-concentration of the medium, the output of in vitro sperm capacitation and fertilisation could be increased.Results: Once exposed to the capacitation medium, the intracellular pH(pHi) of spermatozoa increased immediately even at low concentrations of HCO3-, but only extracellular concentrations of and above 15 mmol/L increased the substrates protein kinase A phosphorylation(pPKAs). Although with a significant delay, 15 mmol/L of HCO3-stimulated sperm linear motility and increased other late events in capacitation such as tyrosine phosphorylation(Tyr-P) to levels similar to those obtained with 25 mmol/L. This information allowed the establishment of a new in vitro fertilisation(IVF)system based on the optimization of HCO3-concentration to 15 mmol/L, which led to a 25.3% increment of the viable zygotes(8.6% in the standard system vs. 33.9%).Conclusions: Optimising HCO3-concentrations allows for establishing an IVF method that significantly reduced porcine polyspermy and increased the production of viable zygotes. A concentration of 15 mmol/L of HCO3-in the medium is sufficient to trigger the in vitro sperm capacitation and increase the fertilisation efficiency in porcine.

Spontaneous liver rupture as first sign of polyarteritis nodosa

Polyarteritis nodosa(PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical profile. Liver involvement is very diverse, ranging from the development of cirrhotic liver disease to acute abdomen presentation that requires surgery because of liver rupture. The management of these patients requires an expert multidisciplinary team. There are several cases in the literature that describe a sudden liver rupture as the first manifestation of a PAN. In this paper we present the case of a 75 years old patient without any previous disease, who is subjected to major hepatic resection for spontaneous liver rupture.

Assessment of Water Microbiologic Pollution in Durres＇s Marine Harbour Basin, Albania

The aim of this study is to assess the water microbiologic pollution in Durres＇s Harbour basin and to compare it with European standards. The comparison of heterotrophs and total coliforms level in sampling are the essence of this research. The object of this study is done in four sampling areas of Durres＇s Harbour basin. In order to compare the level of water microbiologic pollution in four areas of Durres＇s Harbour basin, control area is also studied which is a beach area near the Harbour named Apollonia Beach. The sampling areas were： Ferry Terminal （FT）, Fishery Harbor （FH）, East Zone （EZ）, Fuel Quay （FQ） and Apollonia Beach （AB）, respectively. The period of sample-taking was July-October 2008. The strategy used for this purpose consisted in water insemination with coverage method by means of Petri＇s plates according to respective dilutions in culture media Plate Count Agar （PCA） for heterotrophs and MacConkey for total coliforms. The number of colonies that are formed determines the number of cells at the moment of water insemination, the number of heterotrophs in culture media PCA, respectively. The number of pink and red colonies that were formed determines the number of cells at the moment of water insemination, the number of total coliforms in culture media MacConkey, respectively. The measure ofheterotrophic bacteria and total coliforms used is Colony-Forming Units （CFU）/100 mL seawater. （AB） is within European standards. The richest area with heterotrophs is （FH）, which confirms the fact that it is the most polluted microbiologic area in the Harbour basin of Durres. The richest area with total coliforms is （FT）. The poorest area with heterotrophs and total coliforms is （FQ）.

Research Progress on the Relationship among Circadian Rhythm, Melatonin and Aging

It is generally believed that aging is a gradual decline in the efficiency of our biological metabolism, which eventually leads to the deterioration of individual physiological function and the development of a series of age-related degenerative diseases.The circadian clock machinery orchestrates the normal metabolism of the organism in order to assure that individual growth,development and reproduction are adapted to the changes of diurnal environmental variations. The circadian rhythm in the elderly is attenuated with age and is accompanied by the onset of metabolic syndrome, the accumulation of genomic or epigenomic instability, the decline of metabolic tissue homeostasis and the change of natural feeding behavior. Existing results corroborate that light at night(LAN) and melatonin inhibition affect genomic integrity and normal metabolic function. In several animal models,LAN accelerated aging by inhibiting melatonin production in the pineal gland and promoting age-related carcinogenesis. This paper reviews the effects of the circadian rhythm on aging and discusses the complex relationship among circadian rhythms, melatonin and aging in different models of organisms, which may provide clues for prolonging human life and maintaining health.

Local renin angiotensin system and sperm DNA fragmentation

The renin angiotensin system(RAS)appears to influence male fertility at multiple levels.In this work,we analyzed the relationship between the RAS and DNA integrity.Fifty male volunteers were divided into two groups(25 each):control(DNA fragmentation≤20%)and pathological(DNA fragmentation>20%)cases.Activities of five peptidases controlling RAS were measured fluorometrically:prolyl endopeptidase(which converts angiotensin[A]I and A II to A 1–7),neutral endopeptidase(NEP/CD10:A I to A 1–7),aminopeptidase N(APN/CD13:A III to A IV),aminopeptidase A(A II to A III)and aminopeptidase B(A III to A IV).Angiotensin-converting enzyme(A I to A II),APN/CD13 and NEP/CD10 were also assessed by semiquantitative cytometry and quantitative flow cytometry assays,as were the receptors of all RAS components:A II receptor type 1(AT1R),A II receptor type 2(AT2R),A IV receptor(AT4R or insulin-regulated aminopeptidase[IRAP]),(pro)renin receptor(PRR)and A 1–7 receptor or Mas receptor(MasR)None of the enzymes that regulate levels of RAS components,except for APN/CD13(decrease in fragmented cells),showed significant differences between both groups.Micrographs of RAS receptors revealed no significant differences in immunolabeling patterns between normozoospermic and fragmented cells.Labeling of AT1R(94.3%normozoospermic vs 84.1%fragmented),AT4R(96.2%vs 95.3%)and MasR(97.4%vs 87.2%)was similar between the groups.AT2R(87.4%normozoospermic vs 63.1%fragmented)and PRR(96.4%vs 48.2%)were higher in non-fragmented spermatozoa.These findings suggest that fragmented DNA spermatozoa have a lower capacity to respond to bioactive RAS peptides.