Risk factors for secondary infection after liver failure and effect of comprehensive nursing intervention

BACKGROUND In patients with liver failure(LF),the high rate of secondary infections,which are associated with poor prognosis,highlights the clinical significance of understanding the underlying risk factors and implementing targeted intervention programs.AIM To investigate risk factors for secondary infections in patients with LF and evaluate the effectiveness of comprehensive nursing interventions.METHODS This retrospective study included 64 patients with LF,including 32 with and 32 without secondary infections.A questionnaire was used to collect data on age;laboratory parameters,including total and direct bilirubin,prothrombin time,blood ammonia,and other biochemical parameters;invasive procedures;and complications.Patients with secondary infections received comprehensive nursing intervention in addition to routine nursing care,whereas those without secondary infections received only routine nursing care to compare the effect of nursing intervention on outcomes.RESULTS The infection rate,which was not associated with age or complications,was significantly associated with biochemical parameters and invasive procedures(P<0.05).The infection rate was 61.6%in patients who had undergone invasive procedures and 32.1%in those who had not undergone invasive procedures during the hospital stay.The infection rate was also significantly associated with the type of LF(P<0.05),with the lowest rate observed in patients with acute LF and the highest rate observed in those with subacute LF.The nursing satisfaction rate was 58.3%in the uninfected group and 91.7%in the infected group,indicating significantly higher satisfaction in the infected group(P<0.05).CONCLUSION In patients with LF,the rate of secondary infections was high and associated with biochemical parameters and type of LF.Comprehensive nursing intervention can improve patient satisfaction.

Secondary Bacterial Organizing Pneumonia in a Patient Recovered from COVID-19 Disease: A Case Report

COVID-19 disease is a global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) that mainly presents with pneumonia, but has variable multi-systemic manifestations. Concomitant bacterial infections associated with the acute stage of COVID-19 disease have been rarely reported in the literature. However, to our knowledge, post viral organizing pneumonia (OP) secondary to bacterial infection after recovery from SARS-CoV2 infection has not been noted before. We report a 27-year-old male patient with Type 1 Diabetes Mellitus who presented with fever post recovery from COVID-19 disease for seven weeks and was found to have OP secondary to Klebsiella pneumoniae. Furthermore, the bronchoalveolar lavage was positive for SARS-CoV2 by RT-PCR despite multiple negative nasopharyngeal RT-PCR. The patient was successfully treated with antibiotics only. Therefore, we conclude that early recognition of OP secondary to bacterial infection in patients with COVID-19 disease and prompt antibiotic treatment could avoid the use of a prolonged course of steroids.

Persistent occult hepatitis B virus infection:Experimental findings and clinical implications

Hepatitis B virus (HBV) is a highly pathogenic virus that causes chronic liver diseases in millions of people globally. In addition to a symptomatic, serologically evident infection, occult persistent HBV carriage has been identified since nucleic acid amplification assays of enhanced sensitivity became introduced for detection of hepadnaviral genomes and their replicative intermediates. Current evidence indicates that occult HBV infection is a common and long-term consequence of resolution of acute hepatitis B. This form of residual infection is termed as secondary occult infection (SOI). The data from the woodchuck model of HBV infection indicate that exposure to small amounts of hepadnavirus can also cause primary occult infection (POI) where virus genome, but no serological makers of exposure to virus, are detectable, and the liver may not be involved. However, virus replicates at low levels in the lymphatic system in both these forms. We briefly summarize the current understanding of the nature and characteristics of occult hepadnaviral persistence as well as of its documented and expected pathological consequences.

Pathogenesis of occult chronic hepatitis B virus infection

Occult hepatitis B infection(OBI) is characterized by hepatitis B virus(HBV) DNA in serum in the absence of hepatitis B surface antigen(HBsAg) presenting HBsAg-negative and anti-HBc positive serological patterns.Occult HBV status is associated in some cases with mutant viruses undetectable by HBsAg assays;but more frequently it is due to a strong suppression of viral replication and gene expression.OBI is an entity with world-wide diffusion.The failure to detect HBsAg,despite the persistence of the viral DNA,is due in most cases to the strong suppression of viral replication and gene expression that characterizes this"occult"HBV infection;although the mechanisms responsible for suppression of HBV are not well understood.The majority of OBI cases are secondary to overt HBV infection and represent a residual low viremia level suppressed by a strong immune response together with histological derangements which occurred during acute or chronic HBV infection.Much evidence suggests that it can favour the progression of liver fibrosis and the development of hepatocellular carcinoma.

Asymptomatic dengue infection in adults of major cities of Pakistan

Objective: To determine the asymptomatic dengue infection in adults of Pakistani population.Methods: This study was conducted in five major cities(Islamabad, Karachi, Lahore,Multan, and Peshawar) of Pakistan.A total of 5 230 adults aged 18 years and above without a history of dengue fever at any point in their life were enrolled from participating laboratories.Those who were confirmed for dengue previously were excluded.Of the total, 62.6%(n = 3 276) were male with an average age of 34.6 years.Participants were briefed about the objectives of the study, and written consent was obtained to perform dengue Ig G test using enzyme linked immunosorbent assay.The brief information related to age, gender and area was also taken on proforma.Results: Overall 32.3%(n = 1 691) was having asymptomatic dengue infection which was 67.5%(n = 756) in Karachi followed by 39.1%(n = 391) in Islamabad, 29.9%(n =316) in Lahore and 21%(n = 228) in Peshawar and none from Multan.More males were affected with asymptomatic dengue infection than females.The asymptomatic dengue infection was significantly higher in different cities; however, there was no significant difference with respect to age groups.Conclusions: The asymptomatic dengue infection is higher in cities i.e.Karachi,Islamabad and Lahore which are at risk of developing secondary dengue infections.There is a need of awareness among the public about secondary dengue infection.

Antibiotic Therapy and Offstage about Covid-19 Vaccination

In this overview, we discuss the impact of antibiotic therapy on the COVID infection, the complications after vaccination, possible causes of adverse events, and ways to protect against pandemic infection, as well as try to dispel myths about COVID. Antibiotics are necessary only in case of secondary infection, but overlapping with bacterial infection mainly occurs after hospitalization, and the vast majority of infections were caused by the Acinetobacter baumannii strain. Commonly used antimicrobial disinfectants are chlorhexidine derivatives;due to their frequent use, microorganisms have become resistant to them, and in addition, chloroquine has no clinical benefit in the treatment of COVID-19. Virus escapes from the immune response due to multiple mutations in the receptor-binding domain, or the N-terminal end, which are the sites responsible for antibody binding and virus neutralization. The COVID infection itself is characterized by a rather powerful suppression of immunity. For this reason, the use of antibiotics in the absence of a secondary infection layer leads to greater suppression of the immune system and an aggravation of the process, which often ends up fatally. Immune dysregulation predisposes to the development of severe COVID-19. A decrease in the number of leukocytes gives an unfavorable prognosis for the severity of the COVID infection course. The main reason for the death cases after vaccination seems to be an increase in blood clotting, which is observed not only among the population over 60 years old, but also amid young people.

Comparative assessment of primary and secondary infection risks in a norovirus outbreak using a household model simulation

Diarrheal diseases can be transmitted via both primary infection due to exposures to contaminated materials from the environment and secondary infection due to person- to-person contacts. Usually, the importance of secondary infection is empirically assessed by fitting mathematical models to the epidemic curves. However, these empirical models may not be applicable to other epidemic cases because they are developed only for the target epidemics and they don＇t consider the detail routes of infection. In our previous study, we developed a theoretical model taking into account the various routes of infection that commonly occur in households （e.g., shaking hands, food handling, and changing diapers）. This model was made flexible and applicable to any epidemics by means of adjusting model parameters. In this study, we proposed a new index ＂Vulnerability indicator to secondary infection （VISI）＂, which expressed a ratio of secondary infection to primary infection risks and calculated this index in a simulated norouirus （NOV） epidemic that involved I0,000 households. The results demonstrated that households composed of more than three members including infant（s） had much higher levels of VlSl （5-45） than two-member-households with VlSI （0.1-4）. These results concluded that the infants were likely to be a hub of secondary infections in highly dense families and therefore careful handling of diapers was deemed indispensible in such families to effectively control the secondary infections.

Asymptomatic Hepadnaviral Persistence and Its Consequences in the Woodchuck Model of Occult Hepatitis B Virus Infection

Woodchuck hepatitis virus (WHV) is molecularly and pathogenically closely related to hepatitis B virus (HBV).Both viruses display tropism towards hepatocytes and cells of the immune system and cause similar liver pathology,where acute hepatitis can progress to chronic hepatitis and to hepatocellular carcinoma (HCC).Two forms of occult hepadnaviral persistence were identified in the woodchuck-WHV model:secondary occult infection (SOI) and primary occult infection (POI).SOI occurs after resolution of a serologically apparent infection with hepatitis or after subclinical serologically evident virus exposure.POI is caused by small amounts of virus and progresses without serological infection markers,but the virus genome and its replication are detectable in the immune system and with time in the liver.SOI can be accompanied by minimal hepatitis,while the hallmark of POI is normal liver morphology.Nonetheless,HCC develops in about 20% of animals with SOI or POI within 3 to 5 years.The virus persists throughout the lifespan in both SOI and POI at serum levels rarely greater than 100 copies/mL,causes hepatitis and HCC when concentrated and administered to virus-na(i)ve woodchucks.SOI is accompanied by virusspecific T and B cell immune responses,while only virusspecific T cells are detected in POI.SOI coincides with protection against reinfection,while POI does not and hepatitis develops after challenge with liver pathogenic doses >1000 virions.Both SOI and POI are associated with virus DNA integration into the liver and the immune system genomes.Overall,SOI and POI are two distinct forms of silent hepadnaviral persistence that share common characteristics.Here,we review findings from the woodchuck model and discuss the relevant observations made in human occult HBV infection (OBI).

Prevalence of copepod parasite(Lernaeenicus polynemi)infestation on Eleutheronema tetradactylum from Pazhayar coastal waters,southeast coast of India

Objective:To study the prevalence and mean intensity of copepod parasite Lernaeenicus polynemi infestation on Eleutheronema tetradactylum from Pazayar,Tamil Nadu,southeast coast of India.Methods:The fish was collected from Pazhayar landing centre from January to December 2012 and their biometric measurements were examined.Toal number of infected fish and total number of parasites were recorded.Results:Higher prevalence and mean intensity of infestation of 35.23%and 3.1 were respectively reported during monsoon season of 2012.The parasitic infestations were scattered over the entire body of the host and targeted the different internal organs such as liver and the dorsal aorta.The highest intensity was reported to be 66 parasites in a single host.Conclusions:Due to the heavy parasitic attack the fish will suffer and its economical value or the marketability may reduce.

Dengue-specific serotype related to clinical severity during the 2012/2013 epidemic in centre of Brazil

Multilingual abstracts:Please see Additional file 1 for translations of the abstract into the five official working languages of the United Nations.Background:Currently,in Brazil,there is a co-circulation of the four dengue(DENV-1 to DENV-4)serotypes.This study aimed to assess whether different serotypes and antibody response patterns were associated with the severity of the disease during a dengue outbreak,which occurred in 2012/2013 in centre of Brazil.Methods:We conducted a prospective study with 452 patients with laboratory confirmed dengue in central Brazil,from January 2012 to July 2013.The clinical outcome was the severity of cases:dengue,dengue with warning signs,and severe dengue.The patients were evaluated at three different moments.Blood sampling for laboratory testing and confirmatory tests for dengue infection were performed.We performed a multinomial analysis considering the three categories of the dependent variable,as outlined above.The odds ratios(ORs)were calculated.A multinomial logistic regression model was applied for variables with a P-value<0.20.Statistical analysis was performed with STATA 12.0 software.Results:Four hundred fifty-two patients(452/632,71.5%)were diagnosed with dengue.The dengue virus(DENV)serotypes were identified in 243 cases.DENV-4 was detected in 135 patients(55.6%),DENV-1 in 91(37.4%),DENV-3 in 13(5.3%),and DENV-2 in 4(1.6%).Patients with the DENV-1 serotype were more prone to present with several clinical and laboratory features as compared with DENV-4 patients,including spontaneous bleeding(P=0.03),intense abdominal pain(P=0.004),neurological symptoms(P=0.09),and thrombocytopenia(P=0.01).Secondary infection was more predominant among DENV-4 cases(80.0%)compared with DENV-1 cases(62.3%)(P=0.03).The univariate analysis showed that females(OR=2.12;95%CI:1.44-3.13;P<0.01)had a higher risk of having dengue with warning signs.The multinomial analysis showed that severe dengue cases with secondary infection had an adjusted OR of 2.80(95%CI:0.78-10.00;P=0.113)as compared with dengue fever with primary infection when adjusted for age and sex.Conclusion:The current data show that 5.8%of patients recruited for treatment in healthcare centres and hospitals during the study period had severe dengue.DENV-4 was the predominant serotype,followed by DENV-1,in a large outbreak of dengue in central Brazil.Our findings contribute to the understanding of clinical differences and immune status related to the serotypes DENV-1 and DENV-4 in central of Brazil.

Modeling the impact of migrated population on human-to-human transmission of Ebola virus disease

A nonlinear SEIR mathematical model is developed to investigate the impact of migrated population,infected with Ebola virus,on human-to-human transmission of Ebola Virus Disease(EVD)in a disease-free area.In view of the dynamics of Ebola virus disease,here,the infected class is supposed to be divided into subclasses,viz.primary and secondary infected.The proposed model is analyzed qualitatively using the stability theory of differential equations and quantitatively using numerical simulation.The obtained results,qualitatively and quantitatively,suggest that migration and contact rates play an important role in controlling the spreading of disease.Critical values for migration and contact rates are evaluated and it is revealed that if these rates go beyond their critical values,it leads to delay in the stabilization of the system.It is also found that primary reproductive number increases with increase in migration rate.Besides this,the approximate time required to attain stability of the disease model system is also determined.The model analysis recommends quarantining the noninfected from the secondary infected in order to control the spreading out of disease.