Co-infection with Neisseria mucosa in a patient with tuberculous otitis media

Tuberculous otitis media(TOM) is a rare manifestation caused by Mycobacterium tuberculosis with low incidence rates among extrapulmonary tuberculosis cases. Diagnosis is often delayed because of the presence of several clinical manifestations and the high prevalence of secondary bacterial infections. Few reports have attributed secondary bacterial infections in patients with TOM to commensal Neisseria. Thus, understanding the pathogenic mechanisms and clinical features of commensal Neisseria is important, considering its recent presentation as an infection-causing pathogen. Neisseria mucosa is a commensal inhabitant in humans and is generally considered non-pathogenic but can cause infection in rare cases. Here, we report an atypical secondary infection caused by Neisseria mucosa in an 81-year-old woman with TOM being treated for pulmonary tuberculosis. Direct purulent otorrhea smear microscopy revealed no acid-fast bacilli using Ziehl-Neelsen staining, whereas the phagocytosis of gram-negative cocci by white blood cells was confirmed using Gram staining. Otorrhea culture revealed the growth of N. mucosa. Subsequently, M. tuberculosis infection in the otorrhea was identified using a culture-based method. Vigilance is critical for the early detection of TOM to prevent further complications. This report raises awareness regarding TOM and provides insight into the pathogenicity of N. mucosa in otitis media.

Incidence and Outcomes of Surgical Site Infections after Adult Cardiac Surgery: A Single-Center Experience

Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surgeries in Saudi Arabia. Aims: This study aimed to determine the incidence of SSIs after adult cardiac surgeries that were done in Madinah Cardiac Center, Saudi Arabia. Further, to identify the outcomes and risk factors contributing to death among surgical site infection patients. Methods: This was a 6-year, single-center, retrospective cohort study that included 93 consecutive patients who underwent adult cardiac surgery between August 2016 and August 2022. All adult patients aged 18 years or older who had clinical evidence of postoperative surgical wound infection were included. Preoperative, operative, and postoperative data (early and late) were collected from medical records. Microbiological culture reports and clinical outcomes were also recorded. Results: The study revealed a 9.1% (93/1021) incidence rate of SSIs. Of the 93 patients with SSIs, 60 had superficial incisional infections and 33 had deep infections with incidence rates of 5.9% and 3.2%, respectively. In-hospital mortality due to SSI was recorded in 4 out of 93 patients with an incidence rate of 4.3%. There was a significant association between the in-hospital mortality and the type of SSIs (p = 0.014). All non-survivors had deep SSIs. The type of cardiac surgery also showed a significant association with the in-hospital mortality (p = 0.017). Furthermore, the median duration of antibiotic administration was significantly longer in the non-survivors than in the survivors (72.5 vs 17, respectively, p Conclusions: In conclusion, the incidence of surgical wound infections following cardiac surgery is not low (9.1%);of which 3.2% were deep infections. The in-hospital mortality rate after treatment of SSIs was fortunately low (4.3%), and all non-survivors had deep SSIs. The non- survivors showed a significantly longer duration of antibiotics administration than survivors. Combined CABG and valve procedures showed a higher mortality rate (75%) than the isolated procedures.

Serum procalcitonin levels are associated with rhabdomyolysis following exertional heatstroke: an over 10-year intensive care survey

BACKGROUND:Heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heatstroke(EHS)remains unclear.METHODS:A retrospective cohort study enrolled patients with EHS from the intensive care unit(ICU).We collected RM biomarkers,inflammation markers,critical disease scores at admission,24 h,48 h,and discharge,and 90-day mortality.Correlation analysis,linear regression and curve fi tting were used to identify the relationship between PCT and RM.RESULTS:A total of 162 patients were recruited and divided into RM(n=56)and non-RM(n=106)groups.PCT was positively correlated with myoglobin(Mb),acute hepatic injury,disseminated intravascular coagulation(DIC),Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health Evaluation II(APACHE II)score,with correlation coefficients of 0.214,0.237,0.285,0.454,and 0.368,respectively(all P<0.05).Interestingly,the results of curve fi tting revealed a nonlinear relationship between PCT and RM,and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of<4.6 ng/mL.Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases(P=0.0093).CONCLUSION:High serum PCT concentrations are associated with RM after EHS in critically ill patients.Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.

Achieving Zero Coronary Artery Bypass Graft Surgical Site Infections for over Four Years: Our Experience Utilizing Bundle Elements, Education, and Audits

Background: Surgical site infections (SSI) are expensive and potentially deadly infections;however, with evidence-based infection prevention techniques many can be prevented. The purpose of this quality improvement project is to describe our hospital’s experience achieving zero coronary artery bypass graft (CABG) deep incisional and organ/space SSI incidences from October 2016-July 2021. Methods: To prevent CABG deep incisional and organ/space SSI incidences our Infection Prevention and Epidemiology Department along with the Cardiothoracic and Vascular Surgery Department established SSI prevention bundle elements, continuous education, and monthly audits. Results: From quarter one of 2015 through quarter three of 2016 there were three deep incisional or organ/space SSI cases out of 317 CABG procedures. From quarter four of 2016 through quarter two of 2021 there have been 625 CABG procedures, zero of which developed into deep incisional or organ/space SSI incidences. CABG SSI prevention bundle element compliance ranged from 88.2% to 99.6% and operating room environment of care compliance was 94%. Conclusion: Our results show overall improvements in our quarterly CABG SSI SIR from quarter one of 2015 to quarter two of 2021. This experience demonstrates the importance of complying with SSI prevention bundle elements, education, and auditing in reducing and maintaining zero CABG deep incisional and organ/space incidences for over four years.

Wound Infection Caused by Chromobacterium violaceum: A Case Report from a Tertiary Care Hospital in Bangladesh

Chromobacterium violaceum is a Gram negative, facultative anaerobe, generally present in water, soil in tropical and subtropical regions. This bacterium is an emerging environmental pathogen that causes life threatening infection in humans and animals. It can cause wound infection, visceral abscess, septicaemia, meningitis, diarrhoea, UTI. It is associated with significant mortality due to severe systemic infection. As the bacteria have high spreading tendency leading to sepsis, early identification and prompt treatment is necessary. Here we report a case of Chromobacterium violaceum wound infection in a 9 years old male from Dhaka, who was successfully treated with combination of cefixime and flucloxacillin antibiotics as per culture sensitivity report.

蒙药阿拉坦五味丸对LPS诱导RAW264.7细胞的抗炎作用

目的:探究蒙药阿拉坦五味丸体外抗炎作用机制。方法:以脂多糖诱导RAW264.7细胞建立炎症细胞模型,考察蒙药阿拉坦五味丸对RAW264.7细胞活性以及释放一氧化氮水平的影响。结果:蒙药阿拉坦五味丸显著抑制脂多糖诱导的RAW264.7细胞释放一氧化氮水平(P<0.01)。结论:蒙药阿拉坦五味丸可以通过抑制细胞模型中NO释放水平改善炎症反应。

医务人员呼吸防护用品适合性检验和密合性检查有效性的系统综述

目的呼吸防护在医疗卫生工作中至关重要,应使用适当的颗粒过滤呼吸器和等效的呼吸防护用品,以确保良好的佩戴气密性,最大限度地降低医务人员的空气传播感染风险。该文旨在对呼吸防护用品适合性检验和密合性检查有效性研究进行综述和分析。方法系统检索了2003年1月至2022年4月发表的文献,检索范围包括CINAHL、Cochrane图书馆、EMBASE、PubMed、Ovid数据库Medline子库和灰色文献。研究方案已在PROSPERO注册(CRD42020213968)。结果共检索出561篇文献,25篇被纳入该综述,包括22项量性研究和3篇指南文献。在评估呼吸防护用品的有效性方面,适合性检验是更有效且被广泛采用的可靠方法,但呼吸防护程序应该同时包括适合性检验和密合性检查,以最大限度地提高呼吸防护用品的有效性。新型冠状病毒疫情凸显了医务人员相关知识的缺乏,相关教育培训可有效提高呼吸防护用品使用的有效性。结论为确保医务工作者的安全,适合性测试和密合性检查均应采用。建议由专业人员实施全面的呼吸防护项目,包括教育培训、适合性测试和密合性检查,还需要探索适用于实际使用环境的适合性检验方法。

Breast Self-Examination (BSE): Association between “Belief in BSE” and “Awareness of BSE” among University Female Students in Uganda

Background: Regular breast self-examination (BSE) has been known to effectively detect breast cancer occurrence early. Are Women who consider BSE effective in detecting breast cancer more likely to be aware of BSE, or vice versa? The present study was an attempt to answer this question. Methods: A cross-sectional study was performed for 259 female University students in Kampala, Uganda. Data were analyzed using SPSS. Univariate and bivariate analyses were carried out. Results: The majority (64.1%) were aware of the BSE technique. Women considering BSE to be effective for early cancer detection were significantly more likely to be aware of the BSE technique. Conclusions: University students who believed in the benefits of BSE were more likely to be aware of BSE than those who did not. More emphasis should be placed on health education for women of younger ages to increase the knowledge of the practice of BSE.

Novel Species Including Mycobacterium fukienense sp. Is Found from Tuberculosis Patients in Fujian Province, China, Using Phylogenetic Analysis of Mycobacterium chelonae/abscessus Complex

Objective To identify the novel species ‘Mycobacterium fukienense＇ sp. nov of Mycobacterium chelonoe/abscessus complex from tuberculosis patients in Fujian Province, China. Methods Five of 27 clinical Mycobucterium isolates （CIs） were previously identified as M. chelonoe/obscessus complex by sequencing the hsp65, rpoB, 165-235 rRNA internal transcribed spacer region （its）, recA and sodA house-keeping genes commonly used to describe the molecular characteristics of Mycobocterium. Clinical Mycobecterium isolates were classified according to the gene sequence using a clustering analysis program. Sequence similarity within clusters and diversity between clusters were analyzed. Results The 5 isolates were identified with distinct sequences exhibiting 99.8% homology in the hsp65 gene. However, a complete lack of homology was observed among the sequences of the rpoB, 165-235 rRNA internal tronscribed spacer region （its）, sodA, and recA genes as compared with the M. obscessus. Furthermore, no match for rpoB, sodA, and recA genes was identified among the published sequences. Conclusion The novel species, Mycobacterium fukienense, is identified from tuberculosis patients in Fujian Province, China, which does not belong to any existing subspecies of M. cheloneo/abscessus complex.

Hepatitis B in healthcare workers: Transmission events and guidance for management

Hepatitis B virus(HBV) is the most efficiently transmissible of the bloodborne viruses that are important in healthcare settings. Healthcare workers(HCWs)are at risk for exposure to HBV from infected patients and, if infected, are similarly at risk of transmitting HBV to patients. Published cases of HBV transmission from HCW to patient are relatively rare, having decreased in frequency following the introduction of standard(universal) precautions, adoption of enhanced percutaneous injury precautions such as double-gloving in surgery, and routine HBV vaccination of HCWs. Here we review published cases of HCW-to-patient transmission of HBV, details of which have helped to guide the creation of formal guidelines for the management of HBV-infected HCWs. We also compare the published guidelines for the management of HBV-infected HCWs from various governing bodies, focusing on their differences with regard to vaccination requirements, viral load limits, frequency of monitoring, and restrictions on practice. Importantly, while there are differences among the recommendations from governing bodies, no guidelines uniformly restrict HBV-infected HCWs from performing invasive or exposure-prone procedures.

Sclerosing angiomatoid nodular transformation of the spleen, a rare cause for splenectomy: Two case reports

BACKGROUND Sclerosing angiomatoid nodular transformation(SANT)is a rare benign disease of the spleen with unknown origin.Clinical symptoms are inhomogeneous,and suspicious splenic lesion often found incidentally,leading to splenectomy,as malignancy cannot securely be ruled out.Diagnosis is made histologically after resection.CASE SUMMARY Two cases of German,white,non-smoking,and non-drinking patients of normal weight are presented.The first one is a 26-year-old man without medical history who was exhibiting an undesired weight loss of 10 kg and recurring vomiting for about 18 mo.The second one is a 65-year-old woman with hypertension who had previously undergone gynecological surgery,suffering from a lasting feeling of abdominal fullness.Both showed radiologically an inhomogeneous splenic lesion leading to splenectomy approximately 6 and 9 wk after surgical presentation.Both diagnoses of SANT were made histologically.Follow-up went well,and both were treated according to the recommendation for asplenic patients.CONCLUSION SANT is a rare cause of splenectomy and an incidental histological finding.Further research should focus on clinical and radiological diagnosis of SANT as well as on treatment of patients with asymptomatic and small findings.

COVID-19 compared to other epidemic coronavirus diseases and theflu

Coronaviruses are among the largest group of known positive-sense RNA viruses with a wide range of animal hosts as reservoir. In the last two decades,newly evolved coronaviruses such as the severe acute respiratory syndrome coronavirus(SARS-CoV) which caused the infamous 2002 outbreak, the Middle East respiratory syndrome coronavirus(MERS-CoV) which caused an outbreak in 2012, and now the SARS-CoV-2 [responsible for the current coronavirus disease 2019(COVID-19)] have all posed notable threats to global public health.But, how does the current COVID-19 outbreak compare with previous coronaviruses diseases? In this review, we look at the key differences between SARS-CoV, MERS-CoV, and SARS-CoV-2, and examine challenges in determining accurate estimates of the severity of COVID-19. We discuss coronavirus outbreaks in light of key outbreak severity indicators including,disease fatality, pathogen novelty, ease of transmission, geographical range, and outbreak preparedness. Finally, we review clinical trials of emerging treatment modalities and provide recommendations on the control of COVID-19 based on the mode of transmission of the coronaviruses. We also recommend the development and use of a standardized predictive epidemic severity models to inform future epidemic response.

Induction of cytotoxic T lymphocyte respones in vivo after immunotherapy with dendritic cells in patients with nasopharyngeal carcinoma

The aim of the present study was to determine the efficacy of immunotherapy with dendritic cells to elicit EBV-specific CTL-immunity in advanced cases of EBV-positive patients with nasopharyngeal carcinoma (NPC) and to determine the safety and toxicity of this preparation. Nine cases of histologically confirmed patients with NPC undergoing treatment with radiological therapy were enrolled in this study. Dendritic cells, generated in vitro from blood monocytes of patients were cultured and matured with cytokines and then infected with recombinant adenovirus vaccine containing EBV-latent membrane protein-2 (Ad-LMP2). On 9 days' cultivation of cells, the matured DCs were harvested, irradiated with Co and then injected intradermally to patients with NPC. The injections were performed 3 times totally. After immunization, the CTL responses were assayed by means of cytotoxicity and epitope-specific IFN-γproduction. The results of this trial showed that all patients could tolerate this kind of treatment without any side effect, during which marked increase of LMP2-specific CTL-responses could be demonstrated in 5 patients of this group. And the level of IgA/VCA antibody decreased in 8 of 9 patients, thus accounting for a better prognosis for these patients. All patients will be followed up for another one year. At least, the present work shows that intradermal vaccination with autologous DCs infected with recombinant Ad-LMP2 adenovirus is a safe procedure in NPC patients, in which this procedure can enhance the LMP2-specific CTL responses in patients. These data are encouraging to develop more effective vaccine strategies for the treatment of nasopharyngeal carcinoma.

Clinical manifestations of respiratory syncytial virus infection and the risk of wheezing and recurrent wheezing illness:a systematic review and meta‑analysis

Background Respiratory syncytial virus(RSV)infection in infants is a global health priority.We aimed to investigate the common manifestations of RSV infection by age group and human development index(HDI)level and to assess its association with the development of wheezing and recurrent wheezing illness.Methods We searched the literature published between January 1,2010 and June 2,2022 in seven databases.Outcomes included common manifestations and long-term respiratory outcomes of RSV infection in children.Random-and fixed-effect models were used to estimate the effect size and their 95%confidence intervals.Subgroup analysis was conducted by age and HDI levels.This review was registered in PROSPERO(CRD42022379401).Results The meta-analysis included 47 studies.The top five manifestations were cough(92%),nasal congestion(58%),rhinorrhea(53%),shortness of breath(50%),and dyspnea(47%).The clinical symptoms were most severe in infants.In our analysis,compared to very high and high HDI countries,fewer studies in medium HDI countries reported related manifestations,and no study in low HDI countries reported that.The RSV-infected infants were more likely to develop wheezing than the non-infected infants[odds ratio(OR),3.12;95%CI,2.59–3.76]and had a higher risk of developing wheezing illnesses after recovery(OR,2.60;95%CI,2.51–2.70).Conclusions Cough and shortness of breath are common manifestations of RSV infection.More attention should be given to infants and areas with low HDI levels.The current findings confirm an association between RSV infection and wheezing or recurrent wheezing illness.

Eczema herpeticum vs dermatitis herpetiformis as a clue of dedicator of cytokinesis 8 deficiency diagnosis:A case report

BACKGROUND Dedicator of cytokinesis 8(DOCK 8) deficiency,also known as autosomal recessive hyper immunoglobulin E(IgE) syndrome,is a combined immunodeficiency disease that was first recognized in 2009.It is caused by genetic alterations(mutations or deletions) in the DOCK 8 gene and is characterized by multiple allergies,elevated IgE levels,and susceptibility to viral and bacterial infections.Early diagnosis is critical to optimize the success of stem cell transplantation.CASE SUMMARY This study reports the case of a pediatric patient with DOCK 8 deficiency who had negative genetic testing using multiplex primary immunodeficiency(PID) panel and whole-exome sequencing(WES) with a next-generation sequencing method.He presented with chronic diarrhea and was managed as celiac disease based on previous negative workup for immunodeficiency and duodenal biopsy.He developed a generalized vesicular rash which was thought to be dermatitis herpetiformis associated with celiac disease.However,it turned out to be Eczema herpeticum based on positive herpes simplex virus from blood and lesions.The diagnosis was re-evaluated after the child was found to have multiple viral,bacterial,and parasitic co-infections(herpes simplex virus,cytomegalovirus,Epstein-Barr virus,Salmonella,and cryptosporidiosis).Re-evaluation with target gene testing with copy number variation(CNV) analysis and Multiplex Ligation Probe Amplification(MLPA) showed a large homozygous deletion in the DOCK 8 gene,confirming the diagnosis of DOCK 8 deficiency.CONCLUSION Targeted gene testing with CNV analysis might detect deletions that can be missed by WES for diagnosing patients with PID.

Adaptation and Validation of a Proteolytic Activity Methodology Using Dye-Crosslinked Substrate Tablets

Enzymatic activities are important to be quantified in products as enzymatic cleaners, which are used in medical and surgical devices reprocessing. Enzymatic activities are critical for the proper chemical cleaning that intends to remove solid organic dirt from inaccessible sites. The most important enzyme for this purpose is the protease, which is able to dissolve the main dirt attached to medical and surgical instruments. In this context, this study contributes to the development of a new proteolytic activity quantification method and its validation. The methodology is based on colorimetry and uses a UV-Vis spectrophotometer to measure the substrate hydrolysis by the blue color intensity, employing Protazyme AK tablets as substrate.

Nef Mutations in Long-term Non-progressors from Former Plasma Donors Infected with HIV-1 Subtype B in China

Objective To study the specific amino acid variation in Nef that may be related to disease progression after infection with HIV-1 subtype B, a predominant strain circulating in China, and to determine whether changes in Nef secondary structure may influence different stages of AIDS development based on the concept that the Nef gene of HIV infection dramatically alter the severity of viral infection and virus replication and disease progression, and that long-term non-progressors （LTNP） of HIV infection are commonly associated with either a deletion of the Nef gene or the defective Nef alleles. Methods The study subjects were divided into LTNPI（n=14）, LTNP2 （n=16） and slow progressor （SP, n=19） groups for mutational analysis of the Nef sequence. The data were obtained by using Bioedit, MEGA, Anthewin and SAS software. Results Residues in Nef TA48/49 and K151 occurred more frequently in the LTNP group while AA48/49 was more frequently observed in the SP group. Of the differences observed in the secondary structure comparison using Nef consensus sequences of these three groups, one was roughly corresponding to the Nef48/49 mutation site. Conclusion TA48/49, Kiss, and AA48/49 in the Nef gene might be associated with the different stages of HIV infection, and there may be a link between the Nef secondary structure and the progression of HIV- 1 infection.

Therapeutic Potential of Anti-HIV RNA-loaded Exosomes

Highly active antiretroviral therapy（HAART）is used globally and has significantly reduced the morbidity,mortality,and transmission of human immunodeficiency virus（HIV）-related illness.However,the attendant shortcomings such as toxic side effects,necessity of life-long therapy that is expensive, and inefficiency in eradicating latent viral infections have greatly limited the application of HAART.

Factors Associated with Diagnostic Delay of Pulmonary Tuberculosis in China

Tuberculosis(TB)remains a major public health threat;approximately 10 million new TB cases are recorded worldwide,and more than 1.2 million deaths were caused by TB in 2019[1].The diagnostic delay presents a major obstacle to the control of the TB epidemic.