Efficacy and safety of pegylated-interferon α-2a in hemodialysis patients with chronic hepatitis C

AIM： To evaluate the efficacy and safety of pegylated- interferon alpha-2a in hemodialysis patients with chronic hepatitis C. METHODS： Thirty-six hemodialysis patients with chronic hepatitis C were enrolled in a controlled and prospective study. All patients were treatment naive, positive tested for anti-HCV antibodies, and positive tested for serum HCV-RNA. Twenty-two patients received 135 μg peglyated-interferon α-2a weekly for 48 wk （group A）. The remaining patients were left untreated, eleven refused therapy, and three were not candidates for kidney transplantation and were allocated to the control group （group B）. At the end of the treatment biochemical and virological response was evaluated, and 24 wk after completetion of therapy sustained virological response （SVR） was assessed. Side effects were monitored. RESULTS： Of 22 hemodialysis patients, 12 were male and 10 female, with a mean age of 35.2 ± 12.1 years. Virological end-of-treatment response was observed in 14 patients （82.4%） in group A and in one patient （7.1%） in group B （P = 0.001）. Sustained virological response was observed in 11 patients （64.7%） in group A and in one patient in group B （7.1%）. Biochemical response parameters normalized in 10/14 patients （71.4%） at the end of the treatment. ALT levels in group B were initially high in six patients and normalized in one of them （25%） at the end of the 48 wk. In five patients （22.7%） therapy had to be stopped at mo 4 due to complications of weakness, anemia, and bleeding. CONCLUSION： SVR could be achieved in 64.7% of patients on hemodialysis with chronic hepatitis C by a treatment with peglyated-interferon α-2a. Group A had a significantly better efficacy compared to the control group B, but the side effects need to be concerned.

Bacteremia and “Endotipsitis” following transjugular intrahepatic portosystemic shunting

AIM: To identify all cases of bacteremia and suspected endotipsitis after Transjugular intrahepatic portosystemic shunting (TIPS) at our institution and to determine risk factors for their occurrence. METHODS: We retrospectively reviewed records of all patients who underwent TIPS in our institution between 1996 and 2009. Data included: indications for TIPS, underlying liver disease, demographics, positive blood cultures after TIPS, microbiological characteristics, treat- ment and outcome. RESULTS: 49 men and 47 women were included with a mean age of 55.8 years (range 15-84). Indications for TIPS included variceal bleeding, refractory ascites,hydrothorax and hepatorenal syndrome. Positive blood cultures after TIPS were found in 39/96 (40%) patients at various time intervals following the procedure. Seven patients had persistent bacteremia fitting the definition of endotipsitis. Staphylococcus species grew in 66% of the positive cultures, Candida and enterococci species in 15% each of the isolates, and 3% cultures grew other species. Multi-variate regression analysis identified 4 variables: hypothyroidism, HCV, prophylactic use of an- tibiotics and the procedure duration as independent risk factors for positive blood cultures following TIPS (P < 0.0006, 0.005, 0.001, 0.0003, respectively). Prophylactic use of antibiotics before the procedure was associated with a decreased risk for bacteremia, preventing mainly early infections, occurring within 120 d of the procedure. CONCLUSION: Bacteremia is common following TIPS. Risk factors associated with bacteremia include failure to use prophylactic antibiotics, hypothyroidism, HCV and a long procedure. Our results strongly support the use of prophylaxis as a means to decrease early post TIPS infections.

Evaluation of bacterial contamination rate of the anterior chamber during phacoemulsification surgery using an automated microbial detection system

·AIM: To assess the incidence of anterior chamber bacterial contamination during phacoemulsification surgery using an automated microbial detection system(BacT/Alert).·METHODS: Sixty-nine eyes of 60 patients who had uneventful phacoemulsification surgery, enrolled in this prospective study. No prophylactic topical or systemic antibiotics were used before surgery. After antisepsis with povidone-iodine, two intraoperative anterior chamber aqueous samples were obtained, the first whilst entering anterior chamber, and the second at the end of surgery. BacT/Alert culture system was used to detect bacterial contamination in the aqueous samples.·RESULTS: Neither aqueous samples obtained at the beginning nor conclusion of the surgery was positive for microorganisms on BacT/Alert culture system. The rate of bacterial contamination during surgery was 0%. None of the eyes developed acute-onset endophthalmitis after surgery.· CONCLUSION: In this study, no bacterial contamination of anterior chamber was observed during cataract surgery. This result shows that meticulous surgical preparation and technique can prevent anterior chamber contamination during phacoemulsification cataract surgery.

Ritual Immersion in a Mikveh Is Associated with Increased Risk of Group B Streptococcal Carrier State in Israeli Parturient Women

Purpose: Group B Streptococcus (GBS) infection is a major cause of neonatal sepsis. The objective of this study was to estimate the prevalence and risk factors for GBS carriership among parturient women in Jerusalem. Methods: A cross-sectional study of 436 parturient Jewish women at Hadassah-Hebrew University Medical Center, Mount Scopus. The study included patient interview and vagino-rectal swab for culture. Main outcome measures were the prevalence of GBS carriership among study population. Results: Of the 436 participants, 77 had a positive culture for GBS, giving a carrier rate of 17.7%. No differences were found between carriers and non-carriers in age, BMI or parity. Orthodox Jewish women had a significantly higher carrier rate compared with secular Jewish women (20.6% vs. 12.8% respectively), yielding an age, education and BMI adjusted odds ratio (OR) of 1.9 (95% confidence interval (CI): 1.06 - 3.40). Similarly, ritual immersion was associated with increased risk of carrier state with an adjusted OR of 2.01 (95% CI: 1.03 - 3.92, P = 0.039). Conclusions: Our study suggests an association between ritual immersion in the Mikveh and GBS carriership.

南非严重耐多药结核基因型的多样性

背景:严重耐多药结核(XDR-TB)已成为结核病控制的新威胁,但对其流行病学尚不十分了解。目的:采用分子手段研究南非XDR-TB菌株基因型的人群结构组成,从而确定XDR-TB主要是获得性还是原发感染。方法:收集耐多药结核(MDR-TB)患者的痰菌分离株,送至国家参比实验室进行二线抗结核药物的药敏试验。对XDR-TB的分离株进行Spoligotyping分型,并与该分离株的地理来源相匹配。结果:自2005年6月至2006年12月共获得699例MDR-TB患者的分离株,其中101例(17%)菌株耐氧氟沙星(OFX)或卡那霉素(KAN),41例(6%)对二者均耐药(XDR-TB)。Spoligotyping法将XDR-TB分离株共分为17个基因型。结果表现为高度的基因型多样性和地理分布多样性,所以我们估计63%～75%的XDR-TB患者为获得性耐药。结论:获得性严重耐多药可能是导致南非XDR-TB流行的主要机制。因此结核病控制的迫切问题是必须致力于阻止这种潜在的不治之症的传播。

Evaluation of febrile neutropenic patients hospitalized in a hematology clinic

Objective:To evaluate the febrile neutropenic patients with hematological malignancies hospitalized in hematology clinic with poor hygiene standards.Methods:A total of 124 patients with hematological malignancies(69 male,55 female)hospitalized in hematology clinic with poor hygiene conditions depending on hospital conditions,between January 2007 and December 2010,were evaluated,retrospectively.Results:In this study,250 febrile neutropenia episodes developing in 124 hospitalized patients were evaluated.Of the patients,69 were men(56%)and 55 women(44%).A total of 40 patients(32%)had acute myeloid leukemia,25(20%)acute lymphoblastic leukemia,19(15%)non-Hodgkin's lymphoma,10(8%)multiple myeloma,and 8(8%)chronic myeloid leukemia.In our study,56 patients(22%)were diagnosed as pneumonia,38(15%)invasive aspergillosis,38(15%)sepsis,16(6%)typhlitis,9(4%)mucormycosis,and 4(2%)urinary tract infection.Gram-positive cocci were isolated from 52%(n=20),while Gram-negative bacilli 42%(n=16)and yeasts from 6%(n=2)of the sepsis patients,respectively.The most frequently isolated Gram-positive bacteria were methicillin-resistant coagulase-negative staphylococci(n=18),while the most frequently isolated Gram-negative bacteria was Escherichia coli(n=10).Conclusions:Febrile neutropenia is still a problem in patients with hematological malignancies.The documentation of the flora and detection of causative agents of infections in each unit would help to decide appropriate empirical therapy.Infection control procedures should be applied for preventing infections and transmissions.

评价散寒化湿颗粒与奈玛特韦-利托那韦对照治疗轻型/中型新型冠状病毒感染有效性和安全性的随机、开放、多中心临床研究

Sanhan Huashi granules(SHG)demonstrated therapeutic effects against coronavirus disease 2019(COVID-19)in observational studies.In order to compare the effectiveness and safety of SHG and nirmatrelvir–ritonavir in treating adults with mild-to-moderate COVID-19,we conducted a randomized,activecontrolled,open-label,multi-center trial conducted between February and July in 2023.The patients were randomized in a 1:1 ratio to the SHG group and the nirmatrelvir–ritonavir group.A total of 400participants were randomized,among which 200 participants ultimately received SHG and 198 received nirmatrelvir–ritonavir.The primary outcome was time to sustained clinical recovery through day 28.SHG significantly shortened the median time to sustained clinical recovery compared to nirmatrelvir–ritonavir(6.0(95%CI,5.0 to 6.0)vs.8.0(95%CI,6.0 to 9.0)d;P=0.001),particularly for individual symptoms including fever,sore throat,cough and fatigue.No participants in either group died and incidence of severe COVID-19 showed no difference between two groups.Participants who received nirmatrelvir–ritonavir demonstrated a higher rate of virus clearance on day 5 compared to those received SHG(46.4%(95%CI,39.1 to 53.7)vs.65.6%(95%CI,58.3 to 72.4);P<0.001).Most adverse events were mild in both groups.In summary,SHG was superior to nirmatrelvir–ritonavir in shortening the time to sustained clinical recovery in participants with mild-to-moderate COVID-19,despite a lower virus clearance rate observed after 5 d of treatment(Chinese Clinical Trial Registry Identifier:Chi CTR2300067872).

Biofilm formation and invasive ability contribute to CC17 serotype Ⅲ group B Streptococcus virulence

To the Editor:Group B Streptococcus(GBS)colonizes the vagina and rectum of 7-30%of pregnant women and contributes to materno-neonatal invasive infections.To date,the pathogenesis of clinical GBS strains has remained elusive.Our previous study revealed that the clinical GBS isolates representing hypervirulent clonal complex 17(CC17)with enhanced invasiveness would disproportionately affect neonates and cause severe invasive diseases,including bacteriemia or meningitis,frequently than other strains of clonal complexes(CCs),for example,CC23.

肺炎克雷伯菌中同时具有高毒力和碳青霉烯类耐药性的“超级细菌”:这类新兴医院感染病原菌正在中国迅速发展

高毒力肺炎克雷伯菌(hvKP)和碳青霉烯耐药肺炎克雷伯菌(CRKP)是两种引发严重感染的细菌.hvKP通常在年轻健康的人群中引发社区获得性感染,如肝脓肿、眼内炎和脑膜炎.而CRKP则主要与医院获得性感染有关,包括尿路感染、肺炎、败血症和软组织感染.然而,近年来出现了碳青霉烯耐药高毒力肺炎克雷伯菌(CR-hvKP),使得两种细菌之间的界限逐渐模糊.CR-hvKP具有多重耐药性、高毒力和高传播性等特点,对人类健康造成了严重威胁.目前,大多数CR-hvKP的病例报告来自中国等亚洲国家.CR-hvKP的形成机制通常是hvKP或CRKP分别获得携带碳青霉烯耐药基因或毒力基因的质粒,或者两者的杂交质粒而成.该综述概述了CR-hvKP的关键耐药机制、毒力因子、临床表现和预后,并探讨了其在中国的演化过程和流行情况.

Tracheobronchopathia osteochondroplastica： four cases

Tracheobronchopathia osteochondroplastica （TO） is a rare and benign disorder of unknown cause affecting the large airways. It is characterized by the presence of multiple osseous and cartilaginous nodules in the submucosa of the trachea and main bronchi that is characterized by the progression of submucosal bone and/or cartilage including nodules through the lumen of trachea and bronchus, We present four cases that were diagnosed TO while investigating for the causes of hemoptysis and chronic cough. We plan to emphasize TO in differential diaqnosis in proper patients.

A signature for biological heterogeneity in susceptibility to HIV infection?

Data on female sex workers and sero-discordant couples indicate a pattern of waning of the risk of HIV infection with longer duration of exposure to infected partners.Understanding risk of HIV acquisition and transmission is critical to understanding HIV epidemiology and informing prevention interventions.Informed by empirical data,we aimed to develop a statistical model to explain these observations.In our proposed model,the time to infection for each individual is exponentially distributed,but the marginal(population averaged)distribution of time to infection follows a Weibull distribution with shape parameter of about 0.5,and with the L
evy distribution being the mixing distribution.Simulations based on this model demonstrated how HIV epidemics are destined to emerge rapidly,because of the rapid sero-conversion upon exposure,but also simultaneously destined to saturate and decline rapidly after emergence,just as observed for the HIV epidemics in sub-Saharan Africa.These results imply considerable individual variability in infection risk,probably because of biological heterogeneity in the susceptibility to HIV infection.Factoring this variability in mathematical models,through the methodology provided here,could be critical for valid estimations of impact of HIV interventions and assessments of cost-effectiveness.