Anatomical Sites Research Articles

The novel immune landscape of immune‐checkpoint blockade in EBV‐associated malignancies

AbstractThe Epstein–Barr virus (EBV) is a ubiquitous gamma‐herpesvirus and a class 1 carcinogen that is closely associated with a series of malignant lymphomas and epithelial cell carcinomas. Although these EBV‐related cancers may exhibit different features in clinical symptoms and anatomical sites, they all have a characteristic immune‐suppressed tumor immune microenvironment (TIME) that is tightly correlated with an abundance of tumor‐infiltrating lymphocytes (TILs) that primarily result from the EBV infection. Overwhelming evidence indicates that an upregulation of immune‐checkpoint molecules is a powerful strategy employed by the EBV to escape immune surveillance. While previous studies have mainly focused on the therapeutic effects of PD‐1 and CTLA‐4 blockades in treating EBV‐associated tumors, several novel inhibitory receptors (e.g., CD47, LAG‐3, TIM‐3, VISTA, and DDR1) have recently been identified as potential targets for treating EBV‐associated malignancies (EBVaMs). This review retrospectively summarizes the biological mechanisms used for immune checkpoint evasion in EBV‐associated tumors. Its purpose is to update our current knowledge concerning the underlying mechanisms by which an immune checkpoint blockade triggers host antitumor immunity against EBVaMs. Additionally, this review may help investigators to more fully understand the correlation between EBV infection and tumor development and subsequently develop novel therapeutic strategies.

Adherence to Synoptic Cancer Pathology Reporting Among Pathologists in the National Department of Veterans Affairs Health Care System

Context.— Quality communication between clinicians and pathologists is required for optimal cancer care. The College of American Pathologists provides anatomic site–specific cancer protocols that facilitate synoptic reporting for efficient communication, contributing to accuracy and completeness of cancer staging. Objective.— To evaluate synoptic cancer pathology reporting across the Department of Veterans Affairs (VA), the largest integrated health system in the United States, for 4 common cancers: melanoma and colon, bladder, and kidney cancer. Design.— For each cancer type, we investigated at least 200 biopsy and 200 resection reports from 2019 to 2021. In each report, we determined whether a synoptic format was used. The reports were selected using random sampling across all VA health care facilities. We also identified a set of core elements that were underdocumented. Results.— Among 1618 pathology reports, 778 (48%; 95% CI, 46%–50%) were synoptic reports. Synoptic reporting was much more common among resections (621 of 811; 77%; 95% CI, 74%–79%) than among biopsies (157 of 807; 19%; 95% CI, 17%–22%). It was most common in colorectal resections (200 of 206; 97%; 95% CI, 94%–99%) and least common in colon biopsy reports (1 of 200; 0.5%; 95% CI, 0%–3%). Core elements that were underdocumented included procedure and regional lymph nodes for resections of bladder and kidney cancer and of melanoma. Conclusions.— Synoptic reporting was used about three-quarters of the time for resections and about 1 in 5 times for biopsies. Future work should develop implementation strategies to improve synoptic reporting, especially for biopsy specimens and core elements that were relatively underdocumented.

Formulation-dependent differences in paclitaxel distribution to anatomical sites relevant to chemotherapy-induced peripheral neuropathy

IntroductionChemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse event observed in patients receiving paclitaxel, associated with initial pathological changes in the peripheral nervous system, i.e., distal nerves and dorsal root ganglia (DRG). The prevalence of CIPN in patients receiving paclitaxel formulated i) in polyethylated castor oil with ethanol (CreEL-PTX), ii) as albumin-bound (nab-PTX), and iii) in XR17 micelles (micellar-PTX), is unexpectedly varying. We hypothesize that the discrepancy in CIPN prevalence could be governed by differences in the extent of paclitaxel distribution across blood-to-tissue barriers at the CIPN-sites, caused by the specific formulation.MethodsThe recently developed Combinatory Mapping Approach for CIPN was used to determine the unbound tissue-to-plasma concentration ratio Kp,uu,tissue, after a 4-h infusion of 4 mg/kg CreEL-PTX, 4 mg/kg nab-PTX or 1 mg/kg micellar-PTX in male and female Sprague Dawley rats. Kp,uu,tissue was determined in conventional (DRG, sciatic nerve) and non-conventional (brain, spinal cord, skeletal muscle) CIPN-sites.ResultsBased on our data, the Cremophor-free paclitaxel formulations were associated with a higher distribution of paclitaxel to CIPN-sites than CreEL-PTX, e.g., Kp,uu,DRG of 0.70 and 0.60 for nab-PTX and micellar-PTX, respectively, in comparison to 0.27 for CreEL-PTX (p < 0.01). In addition, the fraction of unbound paclitaxel in plasma was on average 1.6-fold higher in nab- and micellar PTX arms and equal to 0.061 and 0.065, respectively, compared to 0.039 for the CreEL-PTX treatment arm (p < 0.0001).DiscussionIn the case of similar unbound paclitaxel concentration in the plasma of patients and assumed species-independent extent of paclitaxel transport across the barriers, nab- and micellar-PTX formulations can lead to higher paclitaxel exposure at CIPN-sites in comparison to CreEL-PTX.

Hand infections : when to consult a hand surgeon ?

The hand is an anatomical site frequently affected by infection due to its central role in all daily activities. It is therefore regularly the site of wounds (contused, penetrating, insect stings, bites, etc.), all of which are potential entry points for infections. Recognition by the general practitioner of the red flags requiring an urgent specialist consultation is therefore essential in order to improve the patient's functional prognosis, determined by the initial management. In this article, we focus on the most frequent situations encountered in primary care.

Biphenotypic Sinonasal Sarcoma: Literature Review of a Peculiar Pathological Entity—The Neurosurgical Point of View

Background: Biphenotypic sinonasal sarcoma (BSNS) is a low-grade tumor of the sinonasal tract with frequent extension to the orbit and skull base. Due to its rare incidence and recent histopathological and molecular characterization, little data are available in regard to its natural history, treatment and surveillance protocol. Methods: A comprehensive literature review in Embase online electronic databases on BSNS was made. The analyzed factors included the patients’ sex and age, presenting symptoms and signs, anatomical origin and pattern of growth of the tumor, immunohistochemical and molecular features, time to treatment, type of treatment, surgical approach, extent of resection, peri- and post-operative complications, adjuvant therapies, clinical outcome, recurrence and overall survival rates. Results: This literature review involved 34 studies for an overall series of 149 cases of BSNS. The female (66.9%) and middle-aged populations (median 54.88 years old) were mainly affected. The most frequent clinical onset was nasal obstruction (81%), followed by facial discomfort (44%), epistaxis (15.5%) and ocular impairment (14.3%). Ethmoid sinus (67.8%) and nasal cavity (45.4%) were the most common anatomical site of tumor origin, while an extension to the orbit and skull base was registered in 28.7% and 24.5% of cases. Surgery was the main treatment, especially in the form of endoscopic endonasal approach (56.9%), and allowed for gross total resection in 79% of cases. The recurrence rate was 26.2%; three cases of tumor-related death were reported. Median follow-up was 4.6 years. Conclusions: Biphenotypic sinonasal sarcoma is a rare and unique tumoral entity in terms of biological and clinical behavior. Based on the current knowledge, surgery plays the leading role in treatment, accounting for gross total tumor resection in most cases, allowing for clinical symptom and sign resolution and presenting a low rate of perioperative complications. The type of approach and the aim of surgery should be assessed case by case according to patient and pathology features and the surgeon’s experience, as well as the aim of the treatment. Further studies including large surgical series and with long follow-up are required to define prognostic factors and guidelines of treatment for this peculiar pathological entity.

Alterations in the transcriptome and microRNAs of adipose-derived mesenchymal stem cells from different sites in rats during aging.

Aging is an intricate and gradual process characterized by tissue and cellular dysfunction. Adipose-derived mesenchymal stem cells (ADMSCs) experience a functional decline as part of systemic aging. However, the alterations in ADMSCs across various anatomical sites throughout an individual's lifespan remain unclear. To shed light on these changes, we collected white adipose tissue and brown adipose tissue samples from the epididymis, perirenal, inguinal, and scapular regions of young, adult, and aged rats and subsequently isolated ADMSCs for RNA sequencing. As aging progressed, we observed a reduction in the number of ADMSCs at all anatomical sites. Marker genes of ADMSCs from different sites were identified. Aging triggered notable activation of inflammatory and immune responses while diminishing the ADMSC differentiation capacity and ability to maintain normal tissue morphology. Furthermore, miR-195-5p and miR-497-3p, which promoted cell senescence and apoptosis while inhibiting proliferation and differentiation, were positively correlated with aging. These findings increase our understanding of ADMSC senescence and underscore the unique physiological changes and functions of ADMSCs across different anatomical sites during aging.

Hypoxia-adenosinergic regulation of B cell responses

Hypoxic microenvironments induce widespread metabolic changes that have been shown to be critical in regulating innate and adaptive immune responses. Hypoxia-induced changes include the generation of extracellular adenosine followed by subsequent signaling through adenosine receptors on immune cells. This evolutionarily conserved “hypoxia-adenosinergic” pathway of hypoxia → extracellular adenosine → adenosine receptor signaling has been shown to be critical in limiting and redirecting T cell responses including in tumor microenvironments and the gut mucosa. However, the question of whether hypoxic microenvironments are involved in the development of B cell responses has remained unexplored until recently. The discovery that germinal centers (GC), the anatomic site in which B cells undergo secondary diversification and affinity maturation, develop a hypoxic microenvironment has sparked new interest in how this evolutionarily conserved pathway affects antibody responses. In this review we will summarize what is known about hypoxia-adenosinergic microenvironments in lymphocyte development and ongoing immune responses. Specific focus will be placed on new developments regarding the role of the hypoxia-adenosinergic pathway in regulating GC development and humoral immunity.

Sexually Transmitted Infections in Pre-Exposure Prophylaxis Patients

Background: Pre-exposure Prophylaxis (PrEP) has revolutionized HIV prevention, but concerns exist about its potential impact on other Sexually Transmitted Infections (STIs). This study aimed to assess the prevalence and patterns of STIs among PrEP users at a single urban clinic. Methods: We conducted a retrospective analysis of 100 patients on PrEP, evaluating STI diagnoses over a 12-month period. Comprehensive STI screening was performed quarterly, including nucleic acid amplification tests for chlamydia and gonorrhea at multiple anatomical sites, and serological testing for syphilis. Results: Of the 100 participants (mean age 32.5 years, 82% men who have sex with men), 42% were diagnosed with at least one STI during the study period. The most common infections were chlamydia (28%), gonorrhea (18%), and syphilis (8%). Among chlamydia and gonorrhea cases, 60.9% were rectal infections. Fifteen percent of patients experienced multiple STI diagnoses. Factors independently associated with STI diagnosis included age <30 years (OR 2.1, 95% CI: 1.3-3.4), ≥5 sexual partners in the past 6 months (OR 2.8, 95% CI: 1.7-4.6), and inconsistent condom use (OR 1.9, 95% CI: 1.2-3.0). Conclusion: This study demonstrates a high prevalence of STIs among PrEP users, emphasizing the need for comprehensive STI prevention, frequent screening, and prompt treatment in this population. While PrEP effectively prevents HIV transmission, it must be implemented as part of a holistic approach to sexual health to address the risk of other STIs.

Trajectories of Obesity Indices and Their Association with Pain in community-dwelling older adults: Findings from the English Longitudinal Study of Ageing

BackgroundThe prevalence of pain has increased with the increase of obesity, and finding indicators to predict pain risk has become an urgent need. BMI, WC, and WHtR have the potential to be excellent predictors. However, the association of these obesity indicators with various pains remains unclear. MethodsThis longitudinal cohort study included 2,155 pain-free participants (mean age = 68.5 years, standard deviation [SD] = 8.6) from the English Longitudinal Study of Ageing (ELSA). BMI, WC, and WHtR were measured during nurse visits at waves 0, 2, and 4. The Group-Based Trajectory Model (GBTM) was used to identify optimal trajectories for BMI, WC, and WHtR. Self-reported pain at four anatomical sites (lower back, hip, knee and total pain) was assessed at Waves 4 to 9. Cox proportional hazards models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obesity indices and pain risk. ResultsOver a median follow-up period of 7.49 years, we observed 1,059 incident cases of all-cause pain. After adjusting for confounders, participants in the High-Stable WC group had a 30% higher risk of experiencing pain (HR: 1.30, 95% CI: 1.05–1.60, P = 0.014), while those in the High-Stable WHtR group had a 29% higher risk (HR: 1.29, 95% CI: 1.06–1.56, P = 0.010) compared to the Low-Stable group. High-stable trajectories for BMI, WC, and WHtR were also associated with an elevated risk of back, hip, and knee pain. ConclusionThis study identifies long-term obesity indices as significant predictors of pain, suggesting the importance of monitoring these measures for effective clinical risk assessments. Further research is needed to explore the underlying mechanisms of these associations.

Echocardiographic estimates of stroke volume in healthy dogs: Comparability, reference intervals, and reproducibility

Introduction/Objectives: To compare estimates of stroke volume (SV) from different anatomic sites and to generate reference intervals for indices such as shunt volume (ShuntVol) or regurgitant volume (RegVol) in a large sample of healthy dogs. Animals, Materials and MethodsNinety healthy dogs underwent an echocardiogram where SV was assessed at the level of the pulmonary valve (SVPV), aortic valve (SVAV), mitral valve (SVMV), and left ventricle using the difference in end-diastolic volume and end-systolic volume from a right parasternal long-axis four-chamber view (SVLV_RPLx) and left apical four-chamber view (SVLV_Ap4Ch). Eight dogs underwent repeated echocardiograms by the same operator on three different days and by three different operators on the same day. Bland-Altman plots and 95% reference intervals were generated. Reproducibility was described using coefficients of variation (CV) and reproducibility coefficients. ResultsMean difference (95% limits of agreement) for ShuntVol (SVPV-SVAV), RegVolLV_RPLx (SVLV_RPLx-SVAV), RegVolLV_Ap4Ch (SVLV_Ap4Ch-SVAV), and RegVolMV (SVMV-SVAV) were: -0.14 (-0.72, 0.44), -0.05 (-0.59, 0.48), -0.16 (-0.71, 0.39), and 0.12 (-0.76, 1.00) mL/kg, respectively. All but RegVolLV_RPLx showed significant (P<0.01) fixed bias. Reference intervals for ShuntVol, RegVolLV_RPLx, RegVolLV_Ap4Ch, and RegVolMV were: -0.85-0.64, -0.65-0.58, -0.77-0.52, and -0.91-1.06 mL/kg, respectively. Intra-operator and inter-operator CVs were lowest for SVAV, and highest for SVMV and SVLV_AP4Ch, respectively. ConclusionsEchocardiographic estimates of SV are not interchangeable and can exhibit wide limits of agreement. Reference intervals help provide a frame of reference to assess disease severity in dogs with a shunting lesion (ShuntVol) and mitral regurgitation (RegVol).

Decreased mortality in patients with fragility fracture of a fracture liaison service coordinated by Chile's first nurse practitioner.

Fragility fractures have significant sequelae, including pain, loss of mobility, and increased risk of mortality. Fracture liaison services (FLS) represent a coordinated, interdisciplinary approach to secondary prevention and reduce mortality. To investigate the effectiveness and patient outcomes regarding readmission and mortality of a newly developed, nurse practitioner (NP) coordinated FLS in Chile. Retrospective longitudinal analysis of 214 patients who agreed to participate in a FLS was conducted. Variables studied include patient age, gender, anatomical fracture site, dual x-ray absorptiometry scans, medication, readmission information, and mortality. Demographics and clinical data were collected and analyzed with bivariate and multivariate statistics. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who did and did not participate in the FLS. The study sample was predominantly female (85%) with a mean age of 76 (SD: 12; range 41-101) years. The most frequently noted fracture sites were hip (n = 167), wrist (n = 132), and spine (n = 72). At one-year follow-up, the FLS group had a significantly lower mortality (5%, 10 patients) than those who did not participate in the program (12% [N = 50], p = .005). The Kaplan-Meier analysis indicated that patients who participated in the FLS had significantly better survival rates than those who did not participate. Significantly improved survival rates were observed in FLS patients. Chile's first FLS demonstrated improved patient outcomes, specifically a reduced mortality in patients who were enrolled in the FLS. The NP role was fundamental in the screening, diagnosis, and treatment of patients with osteoporosis.

A multi-modal single-cell and spatial expression map of metastatic breast cancer biopsies across clinicopathological features.

Although metastatic disease is the leading cause of cancer-related deaths, its tumor microenvironment remains poorly characterized due to technical and biospecimen limitations. In this study, we assembled a multi-modal spatial and cellular map of 67 tumor biopsies from 60 patients with metastatic breast cancer across diverse clinicopathological features and nine anatomic sites with detailed clinical annotations. We combined single-cell or single-nucleus RNA sequencing for all biopsies with a panel of four spatial expression assays (Slide-seq, MERFISH, ExSeq and CODEX) and H&E staining of consecutive serial sections from up to 15 of these biopsies. We leveraged the coupled measurements to provide reference points for the utility and integration of different experimental techniques and used them to assess variability in cell type composition and expression as well as emerging spatial expression characteristics across clinicopathological and methodological diversity. Finally, we assessed spatial expression and co-localization features of macrophage populations, characterized three distinct spatial phenotypes of epithelial-to-mesenchymal transition and identified expression programs associated with local T cell infiltration versus exclusion, showcasing the potential of clinically relevant discovery in such maps.

Histopathological patterns of gastrointestinal lesions: Insights from a Tertiary Care Centre

Gastrointestinal (GI) lesions are a common clinical concern with significant implications for patient health, particularly in cases involving malignancies. Understanding the histopathological spectrum of these lesions is crucial for improving diagnosis and treatment strategies. This study aimed to investigate the histopathological spectrum of gastrointestinal lesions at a tertiary care center, focusing on the prevalence of different types of lesions and their distribution according to clinicopathological parameters. Methods: This cross-sectional study was conducted over a one-year period, from November 2022, to October 2023, at the Department of Pathology, Rohilkhand Medical College and Hospital, Bareilly, UP. A total of 100 patients with clinically suspected GI lesions were included. Biopsy specimens were collected and analyzed using standard histopathological techniques. The data were analyzed to determine the frequency of different types of GI lesions and their correlation with clinical features. Results: The study found that inflammatory lesions were the most prevalent, accounting for 57% of the cases. Malignant lesions were identified in 35% of the patients, with adenocarcinoma being the most common malignancy, especially in the colon, representing 57.14% of malignant cases. The small intestine was the most frequently affected anatomical site, involved in 33% of the cases, followed by the appendix at 22%. The majority of patients were middle-aged males, with a significant correlation between the type of lesion and gender. Conclusion: This study highlights the significant burden of gastrointestinal lesions, particularly inflammatory and malignant lesions, in the studied population. The findings underscore the importance of early detection and intervention to prevent the progression of these lesions, particularly in high-risk groups such as older males. Enhanced clinical management strategies are needed to address the substantial impact of GI pathologies on patient health.

Parameter analysis in stereoelectroencephalography-guided radiofrequency thermocoagulation: A common basis for objective comparison between protocols

ObjectiveStereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) is an invasive procedure based on stereotactic lesioning of cortical targets in the brain using bipolar current through electrode contacts within the SEEG implant. To date, several RF-TC protocols have been described in the literature; however, a consensus has yet to be reached. This work aims to analyze the electrical parameters during RF-TC processes, offering a method to objectively describe and compare different SEEG-guided RF-TC protocols. MethodsThe study included patients who underwent RF-TC procedures at the IRCCS Istituto delle Scienze Neurologiche di Bologna from February 2022 to May 2023. During each procedure, modifications of the following parameters were measured: voltage, current, impedance, and electric power. An ad-hoc algorithm was implemented to detect abrupt impedance raises, which reflects the occurrence of the thermocoagulation. A two-sample t-test was used to compare parameter curves in RF-TC of different brain structures. ResultsA total of ninety-two RF-TC procedures were performed in eight patients according to a standardized protocol. During each procedure, impedance levels started at about 700Ω and rose up to 1300Ω, displaying an erratic pattern characterized by one or multiple raises. All measured parameters exhibited similar trends until the first peak, after which changes were influenced by the frequency of impedance raises. No significant correlations were observed between parameter modifications in distinct anatomical sites of RF-TC. SignificanceThe systematic analysis of electrical parameters may represent a reliable tool to compare different RF-TC protocols, paving the way for identifying optimal configurations for SEEG-guided RF-TC procedures in the future.

A practical approach to the post esophagectomy CT: expected postoperative anatomy and anatomical approach to associated complication.

This pictorial review aims to provide a structured approach to the interpretation of post esophagectomy CT by reviewing the major esophagectomy surgeries and conduit reconstructions, along with their associated complications at key anatomical landmarks. This paper combines an image rich experience and evidence-based approach to common and rare complications. The paper begins with an overview of the conventional Ivor Lewis esophagectomy and the expected postoperative imaging appearance (with separate detailed tables on additional surgical reconstructions), followed by a focused review of various complications at specific anatomical sites in a systematic fashion. By the conclusion of this review, radiologists will be equipped to employ a systematic approach to post-esophagectomy CT interpretation, confidently identifying both common and uncommon complications.

Molecular and cellular dynamics of squamous cell carcinomas across tissues.

Squamous cell carcinomas (SCCs), arising from the skin, head and neck, lungs, esophagus, and cervix, are collectively among the most common cancers and a frequent cause of cancer morbidity and mortality. Despite distinct stratified epithelial tissues of origin, converging evidence points toward shared biologic pathways across SCCs. With recent breakthroughs in molecular technologies have come novel SCC treatment paradigms, including immunotherapies and targeted therapy. This review compares commonalities and differences across SCCs from different anatomical sites, including risk factors and genetics, as well as cellular and molecular programs driving tumorigenesis. We review landmark discoveries of the "cancer stem cells" (CSCs) that initiate and propagate SCCs and their gene and translational regulation programs. This has led to an appreciation that interactions between CSCs and the immune system play key roles in invasion and therapeutic resistance. Here, we review the unifying principles of SCCs that have emerged from these exciting advances in our understanding of these epithelial cancers.

Unusual Presentation of Myeloid Sarcoma as Thigh Mass

IntroductionMyeloid sarcoma (MS) is a tumor containing myeloid blasts, with or without maturation, involving any anatomical site other than the bone marrow. It can occur de novo or following a hematological malignancy. CaseWe report a 6-year-old female who presented with fever and a rapidly enlarging left thigh mass. The initial provisional diagnosis considered was tubercular hip arthritis with an abscess, but imaging investigations suggested neoplastic swelling. A biopsy of the mass showed a malignant small-round cell tumor. Bone marrow aspiration revealed the diagnosis of acute myeloid leukemia without the presence of blasts in the peripheral smear. ConclusionMS is a rare malignancy. The diagnosis is often delayed due to a lack of clinical suspicion and the absence of blasts in peripheral blood. This report aims to enhance the awareness of pediatric nurse practitioners that MS should also be considered as a differential for an extremity mass.

Case Report: Facial fracture sequelae: the importance of using a specific customized implant (PSI) for orbital reconstruction

The reconstruction of orbital fracture sequelae is a major challenge due to concerns regarding surgical approach and implant stability. Few anatomical sites of such minute size have presented with as much variation in treatment as the orbital floor fractures and related sequelae. Our patient developed sequelae of an orbital fracture over the last 3 years, presenting with dystopia, ophthalmoplegia, and diplopia in the supra- and lateroversion and aesthetic impairment. The variety of implant materials for reconstruction after orbital fractures is extensive, and the decision as to which material to use continues to be debated. The continuing development of computer-aided diagnosis and management and the construction of stereolithographic models offer comparable reproduction of anatomical detail. This technology is described in relation to the planning of trauma surgery and sequelae and the planning of ablative surgery for malignant neoplasms of the head and neck. The use of specific 3D printed titanium implants for bone defects was first reported in cranial reconstruction in 2012, and several studies have reported their use in orbital fractures. The advantages of this implant were increased stiffness, preventing shape loss during placement, a precise fit, and decreased surgical time. However, in the existing literature, the one-piece implant done in this way was a precise fit; therefore, it is possible that navigation between intraoperative anatomical landmarks is lost. However, in cases where reconstruction is difficult, such as extensive orbital wall fractures and large orbital sequelae, the 3D printed implant has been helpful in decreasing surgical time and can be accessed by a limited surgical approach with a precise fit. Our clinical case involved a 37-year-old male patient who experienced severe physical aggression in 2020, amid the COVID-19 pandemic. At the time, due to the overwhelming healthcare demands and resource constraints imposed by the pandemic, immediate surgical intervention for the correction of the fracture was not feasible. As a result of this delay, the patient developed sequelae of the orbital fracture over the last 3 years.

Characterisation of Neisseria gonorrhoeae strain differences in patients with multisite infection

BackgroundNeisseria gonorrhoeae, the aetiological agent of gonorrhoea, is an increasing global health priority due to high levels of antimicrobial resistance (AMR). It is estimated that up to 42% of patients...

Gonococcal infections and risk factors for reinfection: a descriptive and case-case analysis of notifications in the Australian Capital Territory, 2017-2022.

In Australia, gonococcal infection notification rates are increasing with reinfections representing a substantial proportion of infections. Understanding the local epidemiology of gonococcal infections and reinfections and the risk factors for reinfection can assist with the design of targeted interventions. This study aimed to describe the epidemiology of gonococcal infections and reinfections between 2017 and 2022 in the Australian Capital Territory (ACT), and to examine the risk factors for reinfection. Data for gonococcal infections notified in the ACT between 2017 and 2022 were described. The epidemiological characteristics of individuals with a single infection and reinfection were compared using a case-case study design. There were 1,886 gonococcal infection notifications during the study period. Of these, 20.4% were reinfections (n = 385). Of 1,501 individuals, 1,254 (83.5%) had a single infection and 247 (16.5%) had a reinfection. Between 2017 and 2022, the annual gonococcal infection notification rate per 100,000 population increased from 59.98 to 80.14 and the proportion of reinfections from 4.0% to 26.8%. Compared with those with a single infection, individuals with a reinfection had significantly greater odds of being male, of having a same-sex sexual exposure, of using HIV pre-exposure prophylaxis at diagnosis, and of having been diagnosed at a sexual health/family planning clinic. Individuals with a reinfection had significantly greater odds of being in the 25-34, 35-44 and 45-54 years age groups than in the 14-24 years age group. The odds of anatomical site of first infection being only the rectum, only the throat, or at more than one site, compared with urogenital only, were significantly greater for those with a reinfection. Gonococcal reinfections contribute substantially to gonococcal infection notifications in the ACT. Targeted interventions are needed to prevent gonococcal reinfections among at-risk groups, particularly among men who have sex with men, people who use HIV pre-exposure prophylaxis, and individuals accessing sexual health/family planning services.