Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging

BACKGROUND The introduction of modern diagnostic tools has transformed the field of maxillofacial radiology.Odontogenic infection and fascial space involvement have been evaluated with many diagnostic tools,including ultrasonography(USG)and magnetic resonance imaging(MRI).AIM To explore USG as an alternative model to MRI in the detection of fascial space spread of odontogenic infections.METHODS Among 20 patients,50 fascial spaces were clinically diagnosed with odontogenic infection and included in this prospective study.Fascial space infection involvement was examined by USG and MRI.Results were compared for both and confirmed by microbiological testing.RESULTS Ultrasonography identified 42(84%)of 50 involved fascial spaces.Whereas MRI identified all 50(100%).USG could stage the infections from edematous change to cellulitis to complete abscess formation.CONCLUSION MRI was superior in recognizing deep fascial space infections compared to USG.However, USG is a significant addition and has a definite role in prognosticatingthe stage of infection and exact anatomic location in superficial space infections.

Severity Score as a Prognostic Factor for Management of Infections of Odontogenic Origin, a Study of 100 Cases

Purpose: The main objective of the current study is to determine whether it is possible to correlate the longevity of the hospitalization period (LOS) to efficacy of surgical treatment regime and severity scoring. Materials and Methods: A total of 100 patients met our inclusion criteria. All patient records, including results of hematologic and biochemical parameters, were recorded. The patients were later subcategorized further according to a severity score (“Low, Moderate, Severe”) of their main facial space involvement. The main analysis of the study is a regression analysis model;all the variables (sex, age, CRP, white blood cell count, fever, space, and etiology) were stratified according to the overall hospital stay. A crosstab comparison was performed next;the variables were categorized and combined with hospital stay, and then entered in Spearman’s rank correlation coefficient or Spearman’s rho (ρ), 2-tailed (t) Test, and regression equation. The significance level was set at p Results: The most prevalent anatomical space infection was vestibular space abscess or cellulitis 33%, followed by an infraorbital space abscess or cellulitis 17%. Most commonly involved teeth are lower molars with 43% of the total, upper central sixth with 20% and upper molars with 10%;mandibular origin was found to be the cause in 54%. The regression equation showed no linear relation between CRP with the overall hospital stay (p > 0.05). No systemic temperature values were found to be correlated to any space involved or LOS. Log-rank chi-square effect tests indicated only a significant effect of severity, p =0.00016. The “Moderate & Severe” group compared to the “Low” group had a longer median LOS, 4.5 (2 to 8) vs 3 (1 to 8) respectively. Conclusion: The findings of this study have shown severity scoring to be statistically significant parameter in LOS prediction.

Clinical and Pathohistological Profiles of Chronic Odontogenic Infections with Microvascular Proliferation in Children with Permanent Dentition

The apical periodontitis as an infection is the result of endodontic infections and is manifested when the immunological system of the host is activated from microorganisms which penetrate in to the dental pulp through the root canals. The aim of this study is to compare the clinical diagnosis and the pathohistological identification of chronic odontogenic infections with microvascular proliferation. The study was carried out in University Dental Clinical Center of Kosova in cooperation with Histopathology Departement. In this study were included 36 children between 10 - 15 years old, 20 girls and 16 boys, with permanent dentition and chronic apical changes. After the clinical and x-ray examination, the tooth extraction was done, and then the tissue of periapical region was taken, by the exvaction of the periapical granulomas and the other pathological tissues. From a total of 36 children with chronic apical changes and granulomas, 9 (25.0%) of the children had chronic apical periodontitis, from which 6 (16.67%) of the children did not have microvascular proliferation, 1 (2.78%) child had a medium level of microvascular proliferation and 2 (5.56%) children had signification microvascular changes (proliferation). A total of 6 (16.67%) children had chronic apical periodontitis with a fistula from which 5 (13.89%) children did not have microvascular proliferation and 1 (2.78%) child had a medium level of microvascular proliferation. A total of 5 (13.89%) children had chronic apical periodontitis with parulis, from which 3 (8.33%) children did not have microvascular proliferation, 1 (2.78%) child had a low level of microvascular proliferation and 1 (2.78%) child had severe microvascular proliferation.

Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for "Non-infection"

Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively,in order to make a more effective and safer preventive and therapeutic strategy.Methods From January 2010 to January 2015,5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study.These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory results,while they had no infection in their blood and urine preoperatively.Without delay,5 patients were treated by anti-inflammation and anti-shock.Results The vasopressor drug was stopped gradually after 12-36 hours.The body temperature was recovered to normal in 2 or 3 days,and the blood and urine test results were not abnormal in 7 days.At last,5patients were all cured.Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy.Especially for patients who had not presented infection preoperatively,careful preparation preoperatively,corrective manipulation,low pressure irrigation,drainage and controlling time during operation,and early diagnosis,appropriate treatment postoperatively are the key to cure and prevent urosepsis.

Non-albicans Candida prosthetic joint infections: A systematic review of treatment

BACKGROUND Non-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been developed regarding the agent or treatment duration. Hence, a broad range of antifungal and surgical treatments have been reported so far. AIM To clarify treatment of non-albicans Candida PJIs. METHODS A literature review of all existing non-albicans Candida PJIs cases through April 2018 was conducted. Information was extracted about demographics, comorbidities, responsible species, duration and type of antifungal treatment, type of surgical treatment, time between initial arthroplasty and symptom onset, time between symptom onset and definite diagnosis, outcome of the infection and follow-up. RESULTS A total of 83 cases, with a mean age of 66.3 years, were located. The causative yeast isolated in most cases was C. parapsilosis (45 cases;54.2%), followed by C. glabrata (18 cases;21.7%). The mean Charlson comorbidity index was 4.4 ± 1.5. The mean time from arthropalsty to symptom onset was 27.2 ± 43 mo, while the mean time from symptom onset to culture-confirmed diagnosis was 7.5 ± 12.5 mo. A two stage revision arthroplasty (TSRA), when compared to one stage revision arthroplasty, had a higher success rate (96% vs 73%, P = 0.023). Fluconazole was the preferred antifungal agent (59;71%), followed by amphotericin B (41;49.4%). CONCLUSION The combination of TSRA and administration of prolonged antifungal therapy after initial resection arthroplasty is suggested on the basis of limited data.

Occult hepatitis B virus infection and surgical outcomes in non-B, non-C patients with curative resection for hepatocellular carcinoma

AIM To investigate the prevalence, clinicopathological characteristics and surgical outcomes of occult hepatitis B virus(HBV) infection(OBI) in patients with non-B, non-C(NBNC) hepatocellular carcinoma(HCC).METHODS This study retrospectively examined the cases of 78 NBNC patients with curative resection for HCC for whom DNA could be extracted from formalin-fixed paraffin-embedded tissue. OBI was determined by the HBV-DNA amplification of at least two different sets of primers by TaqM an realtime polymerase chain reaction. Possibly carcinogenetic factors such as alcohol abuse, diabetes mellitus, obesity and non-alcoholic steatohepatitis(NASH) were examined. Surgical outcomes were evaluated according to diseasefree survival(DFS), overall survival(OS) and diseasespecific survival(DSS).RESULTS OBI was found in 27/78 patients(34.6%) with NBNC HCC. The OBI patients were significantly younger than the non-OBI cases at the time of surgery(average age 63.0 vs 68.1, P = 0.0334) and the OBI cases overlapped with other etiologies significantly more frequently compared to the non-OBI cases(P = 0.0057). OBI had no impact on the DFS, OS or DSS. Only tumorrelated factors affected these surgical outcomes.CONCLUSION Our findings indicate that OBI had no impact on surgical outcomes. The surgical outcomes of NBNC HCC depend on early tumor detection; this reconfirms the importance of a periodic medical examination for individuals who have NBNC HCC risk factors.

Elizabethkingia miricola :A rare non-fermenter causing urinary tract infection

Elizabethkingia miricola(E.miricola) is a gram-negative non-fermentative bacterium which is rarely encountered.It is usually misidentified or considered as a contaminant in routine microbiology laboratories due to the limitations in conventional biochemical techniques.However,with the advent of the matrix-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOFMS),the identification of non-fermenters has become easy and this has led to enhanced understanding of the clinical significance of these uncommonly isolated microorganisms.The genus Elizabethkingia has only two species E.meningoseptica and E.miricola.Both of these organisms are known to be multi-drug resistant and therefore,their accurate identification and antimicrobial susceptibility testing are necessary prior to the initiation of appropriate therapy.In the world literature till date,only 3 cases of sepsis caused by E.miricola have been reported.We present the first case of E.miricola association with urinary tract infection.

Reducing the Rate of Catheter-Associated Urinary Tract Infection in the Non-ICU Setting

Background: In 2008, the catheter associated urinary tract infection (CAUTI) rate at King Fahad Medical City (KFMC) was 3.8/1000 urinary catheter days with some variability between departments. KFMC is the newest tertiary, referral and teaching hospital with 1100 beds in Riyadh, Saudi Arabia. The Infection Control Department at KFMC decided to implement a quality improvement project by applying the bladder bundle in our general ward (Non-ICU) using the model of National Health Service (NHS) hospitals in England even though there was good evidence supporting this infection control practice only in ICU patients?[1][2]. Our objective was to decrease CAUTI in two non-ICU units by at least 50% in one year. Study design: This was a prospective interventional quality improvement project aiming to decrease CAUTI in two non-ICU inpatient units with a total of?193 beds including children and adult patients. Our intervention includes insertion and maintenance components. Results: CAUTI decreased significantly in both departments from 23 infections in?2008 (Rate: 5.03/1000 CDs) to 12 infections in 2009 (Rate: 1.92/1000 CDs) (P?= 0.0001);in RH (Rehabilitation hospital) from 18 in 2008 (Rate: 4/1000 CDs) to 11 infections in 2009 (Rate: 0.36/1000?CDs) (P?< 0.0001) and in NSI (National Neuroscience Institute) from 5 in 2008 (Rate: 5.42/1000?CDs) to 1 infections in 2009 (Rate: 3.16/1000 CDs) (P?< 0.0001). Conclusion: Implementation of urinarycatheter insertion and daily care bundles, and creation of a competitive spirit among employees were associated with a significant reduction in catheter associated urinary tract infections.

Distribution Characteristics of Drug Susceptibility Test Results of Tuberculosis and Non-Tuberculous Bacilli in Patients with Opportunistic Infections of AIDS

Objective: To understand the distribution of drug susceptibility test results of opportunistic infections of tuberculosis and non-tuberculous bacilli in AIDS patients. Methods: The AIDS patients who were hospitalized in our hospital from January 2016 to June 2019 were collected as the research objects, and patients with opportunistic tuberculosis and non-tuberculous bacilli from AIDS patients were screened for drug susceptibility tests, and the distribution characteristics of drug susceptibility were analyzed. Results: 179 strains of tuberculosis and non-tuberculous mycobacteria were isolated from the specimens of AIDS patients, including 135 cases of tuberculosis mycobacteria and 44 cases of non-tuberculous mycobacteria. In the results of the drug susceptibility test, most strains of Mycobacterium tuberculosis showed sensitivity to commonly used drugs, and a few strains showed resistance;most strains of non-tuberculous mycobacteria showed resistance, and a few strains showed sensitivity. Conclusion: AIDS opportunistic infection of Mycobacterium tuberculosis and non-tuberculous mycobacteria have significant differences in drug sensitivity test results. Timely detection and analysis are of great significance to the diagnosis and treatment of the disease.

Prevalence of Non-<i>Albicans Candida</i>Infections in Women with Recurrent Vulvovaginal Symptomatology

Background: Candida vulvovaginitis is one of the most frequently diagnosed conditions in women’s care practices. Historically, 90% of cultured yeast species were C. albicans. However, due to a variety of interventions, the proportion of non-albicans Candida (NAC) infections appears to be increasing. We sought to estimate the current prevalence of Candida vulvovaginitis and the species-specific distribution of such infections in recurrent cases. Methods: Women with recurrent vulvovaginal symptomatology referred to an Obstetrics and Gynecology practice were tested by genital fungus culture, Candida-specific polymerase chain reaction (PCR), or both between July 2010 and February 2013. Results: A total of 103 women were tested. Mean age was 45.6 years. Including only their most recent positive test result, 29.1% (30/103) of women tested positive for Candida by any of the above testing measures. Of those, 50% (15/30) tested positive for C. albicans and 50% (15/30) tested positive for a NAC species. Across all visits, 60% (18/30) tested positive for C. albicans, 56.7% (17/30) tested positive for NAC, and 16.7% (5/30) tested positive for both a C. albicans and a NAC species. Among all isolated NAC species, 28.6% (6/21) were determined to be C. glabrata, 23.8% (5/21) C. krusei, 23.8% (5/21) C. parapsilosis, and 23.8% (5/21) other Candida species. Conclusion: Approximately 30% of women with recurrent vulvovaginal symptomatology have detectable Candida strains and it appears that NAC species may cause half of all these infections. This is imperative because NAC infections are usually more difficult to diagnose and are resistant to most treatments.

Non-odontogenic toothache revisited

Although pain of dental origin is the most common orofacial pain, other non-odontogenic pains can af-fect the orofacial region and occasionally mimic den-tal pain. These non-odontogenic pains may pose a diagnostic dilemma for the dental practitioner who routinely diagnoses and treats dental pain. Knowledge of the various non-odontogenic pains will ultimately prevent misdiagnosis and the delivery of incorrect and sometimes irreversible and invasive procedures to patients. The purpose of this article is to review the clinical presentations of the various types of non-odontogenic pains which may be mistaken as dental pain: myofascial, cardiac, sinus, neurovascular, neuropathic, neoplastic and psychogenic pain.

Multi-Drug Resistance Pattern of Lactose Non-Fermenting <i>Escherichia coli</i>as Causative Agent of Urine Tract Infections in Luanda, Angola

This prospective study was carried out to assess the sensitivity and resistance pattern of lactose non-fermenting Escherichia coli from July 2018 to December 2018 in the Laboratory of Microbiology at Luanda Medical Center, Angola. Out of 1170 patient, a total of 120 urine specimens infected with Escherichia coli (>105 CFU/ml) were collected according to the routine protocol of urinalysis. Among these 120 isolates, 25 (21%) isolates were determined as “atypical”, lactose non-fermenting E. colis trains. The twenty-five lactose non-fermenting Escherichia coli strains isolated from urine samples in Luanda Medical Center were declared as Multiple Drugs-Resistant strains with high resistance to Cefalexine (100%), Cefuroxime (100%), Ceftriaxone (92%), Gentamycin (92%), Ciprofloxacin (72%) and Amoxiciclin/Clavulanic (80%). The alarming resistance level to the first-choice drugs for the treatment of urinary tract infections caused by non-fermentative lactose E. coli was observed.

The Increased Frequency of Carbapenem Resistant Non Fermenting Gram Negative Pathogens as Causes of Health Care Associated Infections in Adult Cancer Patients

Background and Aim: Multi drug resistant Non fermenting gram negative bacilli (NFGNB) have emerged as a major cause of health-care associated infections especially in immunocompromised hosts. The aim of the study was to investigate the prevalence of NFGNB as a cause of health-care associated infections (HAI) in cancer patients and determine their resistance pattern. Patients and Methods: During the study period, 158 NFGNB isolates were collected. Microscan Walk Away 9 was used for identification and testing for the metallo-β-lactamases (MBLs) was done by Imipenem-EDTA combined disk synergy test (CDST-IPM). Results: NFGNB represented 29.0% of infections caused by gram negative organisms. Carbapenem resistance, the multi-drug resistant (MDR) phenotype, and MBL production were documented in 70%, 63%, and 59% of NFGNB isolates, respectively. MDR-NFGNB rates were significantly higher among hospitalized patients, medical department and those with longer duration of hospital stay (p = 0.034, 0.026, 0.019;respectively) than non MDR-NFGNB. Conclusion: A high level of carbapenem and multi-drug resistance were detected among the non-fermenter pathogens isolated from hospitalized cases and were more frequently encountered in high risk adult cancer patients requiring longer duration of hospitalization. The MDR-NFGNB are constituting important causes of health-care associated infections in cancer patients.

Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report

BACKGROUND Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions.Clinically,if early odontogenic infections such as acute periapical periodontitis,alveolar abscess,and pericoronitis of wisdom teeth are not treated timely,effectively and correctly,the infected tissue may spread up to the skull and brain,down to the thoracic cavity,abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck.Severe multi-space infections are formed and can eventually lead to life-threatening complications(LTCs),such as intracranial infection,pleural effusion,empyema,sepsis and even death.CASE SUMMARY We report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions.One week before admission,due to pain in the right lower posterior teeth,the patient placed a cigarette butt dipped in the pesticide"Miehailin"into the"dental cavity"to relieve the pain.Within a week,the infection gradually spread bilaterally to the floor of the mouth,submandibular space,neck,chest,waist,back,temporal and other areas.The patient had difficulty breathing,swallowing and eating,and was transferred to our hospital as an emergency admission.Following admission,oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology,thoracic surgery,general surgery,hematology,anesthesia and the intensive care unit to assist with treatment.The patient was treated with the highest level of antibiotics(vancomycin)and extensive abscess incision and drainage in the oral,maxillofacial,head and neck,chest and back regions.Unfortunately,the patient died of septic shock and multiple organ failure on the third day after admission.CONCLUSION Odontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions,which can result in multiple LTCs.The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.

Steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Objectives: To report a series of MSI managed with antibiotics, surgical intervention and exogenous steroids as an adjunct, highlighting functional improvement following steroid administration. Methods: A retrospective cohort study was carried out from December 2013 to September 2016, involving 30 patients (n = 30, 22 males, 8 females) diagnosed with MSI. All patients were initially managed with intravenous empirical antibiotics, analgesics and removal of potential source of infection. A course of 3 doses of IV Dexamethasone 8 mg at an interval of 8 hours was started during the first day of hospital admission. Results: This series reports 30 patients presenting with MSI, who received prompt antibiotics and 3 doses of steroids as inpatients. Significant clinical improvement was noted in the form of amelioration of pain, rapid reduction in edema, and improved trismus, shortening hospital stay to an average of 3.5 days, and omission of surgical intervention in 50% of our cases. No adverse effects or drug reaction was noted. Conclusion: In conclusion, the value of synergistic use of corticosteroids with antibiotics in management of MSI is significant. Despite these promising findings, there is scarce evidence in the literature to fully support the use of corticosteroids in abscess management. The role of corticosteroids in treatment of MSI should be explored further.

Association of H.pylori infection with gastric carcinoma:a Meta analysis

AIM: To follow the principles of evidence based medicine to reach the integrated results of these studies.METHODS: Twenty-one papers of case-control studies were selected, including 11 on gastric cancer, 7 on precancerous lesion of stomach and 3 on lymphoma of stomach: Meta analysis was used to sum up the odds ratios (OR) of these studies.RESULTS: H. Pylori vsgastric cancer (intestinal and diffuse type): the odds ratio from the fixed effect model is 3.0016(95% Cl 2.4197-3.7234, P < 0.001 ). H. Pylori vs precancerous lesion of stomach: a random effect model was used to calculate the summary odds ratio and its value is 2.5635 (95% Cl: 1.8477-3.5566, P < 0.01). H. Pylori vs lymphoma of stomach: though the quantity of literature is too small to make Meta analysis, the data of these 3 studies show that lymphoma of stomach is highly associated with H. Pylori infections.CONCLUSION: Since it had been revealed that H. Pylori infection pre-exists in gastric carcinoma and precancerous lesions, the results of Meta analysis present a strong evidence to support the conclusion that H. Pylori infection is a risk factor for gastric carcinoma.

Comments on the article about the treatment of peripancreatic infection

We read with great interest the article by Tang et al published in issue 4 of World Journal of Gastroenterology 2010.The results of their study indicate that percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple,safe and reliable treatment procedure for peripancreatic infections secondary to severe acute pancreatitis.However,there are some points that need to be addressed,including data about the patients in the study and their clinical characteristics,data about infection and superinfection during the treatment and type of treatment of patients with acute necrotizing pancreatitis.

Hepatitis C infection and lymphoproliferative disease:Accidental comorbidities?

Chronic hepatitis C virus(HCV)infection has been associated with liver cancer and cirrhosis,autoimmune disorders such as thyroiditis and mixed cryoglobulinema,and alterations in immune function and chronic inflammation,both implicated in B cell lymphoproliferative diseases that may progress to non-Hodgkin lymphoma(NHL).HCV bound to B cell surface receptors can induce lymphoproliferation,leading to DNA mutations and/or lower antigen response thresholds.These findings and epidemiological reports suggest an association between HCV infection and NHL.We performed a systematic review of the literature to clarify this potential relationship.We searched the English-language literature utilizing Medline,Embase,Paper First,Web ofScience,Google Scholar,and the Cochrane Database of Systematic Reviews,with search terms broadly defined to capture discussions of HCV and its relationship with NHL and/or lymphoproliferative diseases.References were screened to further identify relevant studies and literature in the basic sciences.A total of 62 reports discussing the relationship between HCV,NHL,and lymphoproliferative diseases were identified.Epidemiological studies suggest that at least a portion of NHL may be etiologically attributable to HCV,particularly in areas with high HCV prevalence.Studies that showed a lack of association between HCV infection and lymphoma may have been influenced by small sample size,short follow-up periods,and database limitations.The association appears strongest with the B-cell lymphomas relative to other lymphoproliferative diseases.Mechanisms by which chronic HCV infection promotes lymphoproliferative disease remains unclear.Lymphomagenesis is a multifactorial process involving genetic,environmental,and infectious factors.HCV most probably have a role in the lymphomagenesis but further study to clarify the association and underlying mechanisms is warranted.

Age-related differences in response to peginterferon alfa-2a/ribavirin in patients with chronic hepatitis C infection

AIM: To evaluate the safety and efficacy of pegylated interferon alfa-2a and ribavirin therapy in elderly patients with chronic hepatitis C infection.METHODS: Patients characteristics, treatment results and safety profiles of 4859 patients with hepatitis c virus(HCV) infection receiving treatment with pegylatedinterferon alfa-2a and ribavirin were retrieved from a large ongoing German multicentre non-interventional study. Recommended treatment duration was 24 wk for GT 2 and GT 3 infection and 48 wk for GT 1 and GT 4 infection. Patients were stratified according to age(< 60 years vs ≥ 60 years). Because of limited numbers of liver biopsies for further assessment of liver fibrosis APRI(aspartate aminotransferase- platelet ratio index) was performed using pre-treatment laboratory data.RESULTS: Out of 4859 treated HCV patients 301(6.2%) were ≥ 60 years. There were more women(55.8% vs 34.2%, P < 0.001) and predominantly GT 1(81.4% vs 57.3%, P < 0.001) infected patients in the group of patients aged ≥ 60 years and they presented more frequently with metabolic(17.6% vs 4.5%, P < 0.001) and cardiovascular comorbidities(32.6% vs 6.7%, P < 0.001) and significant fibrosis and cirrhosis(F3/4 31.1% vs 14.0%, P = 0.0003). Frequency of dose reduction and treatment discontinuation were significantly higher in elderly patients(30.9% vs 13.7%, P < 0.001 and 47.8% vs 30.8%, P < 0.001). Main reason for treatment discontinuation was "virological non-response"(26.6% vs 13.6%). Sustained virological response(SVR) rates showed an age related difference in patients with genotype 1(23.7% vs 43.7%, P < 0.001) but not in genotype 2/3 infections(57.7% vs 64.6%, P = 0.341). By multivariate analysis, age and stage of liver disease were independent factors of SVR.CONCLUSION: Elderly HCV patients differ in clinical characteristics and treatment outcome from younger patients and demand special attention from their practitioner.

Mycoplasma infections and different human carcinomas

AIM To explore relationships between human carcinomas and mycoplasma infection.METHODS Monoclonal antibody PD4, which specifically recognizes a distinct protein from mycoplasma hyorhinis, was used to detect mycoplasma infection in different paraffinembedded carcinoma tissues with immunohistochemistry. PCR was applied to amplify the mycoplasma DNA from the positive samples for confirming immunohistochemistry.RESULTS Fifty of 90 cases (56%) of gastric carcinoma were positive for mycoplasma hyorhinis. In other gastric diseases, the mycoplasma infection ratio was 28% (18/49) in chronic superficial gastritis, 30% (14/ 46) in gastric ulcer and 37% (18/ 49) in intestinal metaplasia. The difference is significant with gastric cancer (X2=12.06, P＜0.05). In colon carcinoma, the mycoplasma infection ratio was 55.1% (32/58), but it was 20.9% (10/49) in adenomarous polyp (X2=13.46, P＜0.005).Gastric and colon cancers with high differentiation had a higher mycoplasma infection ratio than those with low differentiation (P＜ 0.05). Mycoplasma infection in esophageal cancer, lung cancer, breast cancer and glioma was 50.9% (27/53), 52.6% (31/ 59), 39.7%(25/63) and 41% (38/91), respectively. The mycoplasma DNA was successfully amplified with the DNA extracted from the cancer tissues that were positive for mycoplasma infection (detected with antibody PD4).CONCLUSION There was high correlation between mycoplasma infection and different cancers, which suggests the possibility of an association between the two. The mechanism involved in oncogenesis by mycoplasma remains unknown.