Coexistence of urinary tuberculosis and urothelial carcinoma:A case report

BACKGROUND Taiwan has a high prevalence of tuberculosis and urothelial carcinoma.However,the simultaneous occurrence of both disorders in one patient is uncommon.Tuberculosis and urothelial carcinoma share some common risk factors and could demonstrate overlapping clinical manifestations.CASE SUMMARY Herein,we report the case of a patient who presented with fever,persistent hematuria,and pyuria.Chest computed tomography scans revealed a bilateral upper lobes cavitary lesion with fibrosis.Severe hydronephrosis of the right kidney and renal stones and cysts in the left kidney were observed.Initial microbiological testing was negative;however,a polymerase chain reaction assay of the urine confirmed a urinary tuberculosis infection.The patient was started on an anti-tuberculosis regimen.Ureteroscopy performed to resolve obstructive nephropathy revealed the incidental finding of a left middle-third ureteral tumor.Examination after biopsy and transurethral resection of the bladder tumor indicated urothelial carcinoma.The patient underwent laparoscopic nephroureterectomy,with bladder cuff excision for the right kidney and ureter,and holmium laser ablation of the ureteral lesion to preserve the left kidney and ureter.He has remained stable after the procedures.CONCLUSION Although establishing a causal relationship between tuberculosis and cancer is difficult,medical personnel should consider their correlation.

Non-traumatic coma in young children in Benin:are viral and bacterial infections gaining ground on cerebral malaria?

Background:While malaria morbidity and mortality have declined since 2000,viral central nervous system infections appear to be an important,underestimated cause of coma in malaria-endemic Eastern Africa.We aimed to describe the etiology of non-traumatic comas in young children in Benin,as well as their management and early outcomes,and to identify factors associated with death.Methods:From March to November 2018,we enrolled all HIV-negative children aged between 2 and 6 years,with a Blantyre Coma Score≤2,in this prospective observational study.Children were screened for malaria severity signs and assessed using a systematic diagnostic protocol,including blood cultures,malaria diagnostics,and cerebrospinal fluid analysis using multiplex PCR.To determine factors associated with death,univariate and multivariate analyses were performed.Results:From 3244 admissions,84 children were included:malaria was diagnosed in 78,eight of whom had a viral or bacterial co-infection.Six children had a non-malarial infection or no identified cause.The mortality rate was 29.8%(25/84),with 20 children dying in the first 24 h.Co-infected children appeared to have a poorer prognosis.Of the 76 children who consulted a healthcare professional before admission,only 5 were prescribed adequate antimalarial oral therapy.Predictors of early death were jaundice or increased bilirubin[odd ratio(OR)=8.6;95% confidential interval(CI):2.03-36.1]and lactate>5 mmol/L(OR=5.1;95%CI:1.49-17.30).Antibiotic use before admission(OR=0.1;95%CI:0.02-0.85)and vaccination against yellow fever(OR=0.2,95%CI:0.05-0.79)protected against mortality.Conclusions:Infections were found in all children who died,and cerebral malaria was by far the most common cause of non-traumatic coma.Missed opportunities to receive early effective antimalarial treatment were common.Other central nervous system infections must be considered in their management.Some factors that proved to be protective against early death were unexpected.

Field investigation of antibiotic removal efficacies in different hospital wastewater treatment processes in Thailand

The removal efficacies of 19 antibiotics in different hospital wastewater treatment processes(WWTP)were investigated at various sizes of 60 hospitals across Thailand.The results showed slight differences in the total antibiotic removals(79e84%)among WWTP sizes.High antibiotics loading to all WWTP were amoxicillin,ciprofloxacin,tetracycline ampicillin,and norfloxacin,respectively.Amoxicillin and ampicillin were eliminated highly(90e99%)in every size of WWTP,while various efficacies showed for other antibiotics(0e93%).According to process comparison,activated sludge(CAS),oxidation ditch(OD),and sequencing batch reactor(SBR)systems showed similar removals of overall antibiotics(P>0.05).The attached growth systems such as submerged aerated fixed-film(SAFF)demonstrated relatively lower antibiotic removals.The natural processes such as aerated lagoon(AL),facultative pond(FP),and constructed wetland(CW)presented substantial biodegradation of some recalcitrant antibiotics such as fluoroquinolones,sulfamethoxazole,and trimethoprim.Post-chlorination provided additional elimination of some antibiotics such as amoxicillin and ampicillin.Finally,the top-five of antibiotics released into the water environment via discharged effluent are amoxicillin,tetracycline,ampicillin,ciprofloxacin,and imipenem,respectively,which mainly from the suspended growth systems.

Elevated plasma interleukin-8 as a risk factor for mortality in children presenting with cerebral malaria

Background Cerebral malaria(CM)is a neuropathology which remains one of the deadliest forms of malaria among African children.The kinetics of the pathophysiological mechanisms leading to neuroinflammation and the death or survival of patients during CM are still poorly understood.The increasing production of cytokines,chemokines and other actors of the inflammatory and oxidative response by various local actors in response to neuroinflammation plays a major role during CM,participating in both the amplification of the neuroinflammation phenomenon and its resolution.In this study,we aimed to identify risk factors for CM death among specific variables of inflammatory and oxidative responses to improve our understanding of CM pathogenesis.Methods Children presenting with CM(n=70)due to P.falciparum infection were included in southern Benin and divided according to the clinical outcome into 50 children who survived and 20 who died.Clinical examination was complemented by fundoscopic examination and extensive blood biochemical analysis associated with molecular diagnosis by multiplex PCR targeting 14 pathogens in the patients'cerebrospinal fluid to rule out coinfections.Luminex technology and enzyme immunoassay kits were used to measure 17 plasma and 7 urinary biomarker levels,respectively.Data were analysed by univariate analysis using the nonparametric Mann-Whitney U test and Pearson’s Chi2 test.Adjusted and multivariate analyses were conducted separately for plasma and urinary biomarkers to identify CM mortality risk factors.Results Univariate analysis revealed higher plasma levels of tumour necrosis factor(TNF),interleukin-1beta(IL-1β),IL-10,IL-8,C-X-C motif chemokine ligand 9(CXCL9),granzyme B,and angiopoietin-2 and lower urinary levels of prostanglandine E2 metabolite(PGEM)in children who died compared to those who survived CM(Mann-Whitney U-test,P-values between 0.03 and<0.0001).The multivariate logistic analysis highlighted elevated plasma levels of IL-8 as the main risk factor for death during CM(adjusted odd ratio=14.2,P-value=0.002).Values obtained during follow-up at D3 and D30 revealed immune factors associated with disease resolution,including plasma CXCL5,C-C motif chemokine ligand 17(CCL17),CCL22,and urinary 15-F2t-isoprostane.Conclusions The main risk factor of death during CM was thus elevated plasma levels of IL-8 at inclusion.Follow-up of patients until D30 revealed marker profiles of disease aggravation and resolution for markers implicated in neutrophil activation,endothelium activation and damage,inflammatory and oxidative response.These results provide important insight into our understanding of CM pathogenesis and clinical outcome and may have important therapeutic implications.