Compromised Individuals Research Articles

Possible alteration in serum ferritin level in malaria infected HIV seropositive individuals in Nauth, Nnewi, Nigeria

The role of Ferritin in monitoring disease progression in immune compromised HIV individuals with an underlying active infection like malaria is a subject of growing research. Ferritin being an acute phase protein, plays important role in assessing the range of damage due to inflammation in immunosuppressed patients leaving in highly endemic malaria regions. The levels of serum ferritin in malaria infected HIV positive individuals in Nnamdi Azikiwe University teaching hospital (NAUTH), Nnewi, Anambra State, Nigeria, was assessed. Questionnaire was used to obtain the demographic details of the participants, and to rule out other inflammatory infections. 88 participants of the age group 18 - 65 years, comprising 24 with HIV infection, 22 with HIV and Malaria co-infection, 22 with Malaria infection, and a control group of 22 individuals with neither HIV nor malaria infection were randomly recruited. Ferritin level was determined using enzyme linked immunosorbent assay technique and a cross sectional prospective study design was used. A significantly high mean serum ferritin level was observed in HIV infected individuals with and/ or without malaria co-infection than in malaria positive and control group (p<0.05 respectively). Serum ferritin level was significantly higher in female participants than in male counterparts (p < 0.05). Serum ferritin level was significantly higher in individuals with CD4 count >500 than in CD4 count ≤ 500 (p < 0.05). Blood pressure was significantly higher in HIV infected and malaria positive individuals when compared with controls. The increased serum ferritin level and higher blood pressure in HIV infected participants suggests active inflammatory process, reduced immunity and hypertension which may have worsened by malaria co-infection. This may subsequently lead to vascular and endothelia damage causing disease severity.

The association and interactions of malnutrition, micronutrients, and drug therapy in the management of tuberculosis

Tuberculosis is an infectious lung disease that is the leading cause of death worldwide. Globally, over 3,500 people lose their lives to tuberculosis each day – totalling 1.3 million deaths each year. Mycobacterium tuberculosis is the acid-fast bacteria that causes tuberculosis. Fever, coughing, exhaustion, and weight loss are among the symptoms that patients with tuberculosis display. Tuberculosis is transmitted from person to person by inhaling airborne droplets. Immune compromised individuals are at high risk for developing tuberculosis. Direct microscopy of sputum smears and solid media cultures are used as tuberculosis diagnostic techniques. The global effort to combat tuberculosis has so far saved an estimated 75 million lives since 2000. The present review focuses on the association between malnutrition and tuberculosis, micronutrient status, and drugs used in tuberculosis therapy. The greatest risk factor for TB is malnutrition, which weakens immunity by lowering the cells' ability to fight off infections. Many micronutrients are useful in controlling tuberculosis and boosting the host's immunity. These include copper, zinc, selenium, iron, vitamin A, vitamin C, vitamin D, vitamin B6, and vitamin E. Furthermore, the longevity of patients in intensive care units (ICUs) depends on their micronutrient status. Several medications, such as isoniazid, ethambutol, rifabutin, levofloxacin, amikacin, streptomycin, and capreomycin, are used to treat tuberculosis for a certain period of time. Anti-tuberculosis medications can cause vitamin B6 deficiency, arthralgias, gastrointestinal issues, hepatotoxic effects, and allergic reactions as adverse effects. The United Nations Sustainable Development Goals (SDGs) aimed to end the global tuberculosis epidemic by 2023 but more work remains to be done.

Headache and Vision Loss as Initial Symptoms for an Acute Invasive Rhino-orbital-cerebral Mucormycosis

Background: Acute invasive rhino-orbital-cerebral mucormycosis (ROCM) is a rare fungal infection commonly caused by Rhizopus species. It occurs in immune- compromised individuals who have acquired immune deficiency syndrome (AIDS), leukemia, uncontrolled diabetes mellitus, or organ transplant patients who are on immunosuppressive therapy. Diagnosing invasive ROCM is challenging because its clinical presentation can be nonspecific, and it is not frequently observed in ophthalmic practices. Case Report: A 66-year-old Hispanic male with poorly controlled diabetes mellitus presented with the complaint of severe headache and retrobulbar pain in the right eye. An ophthalmic examination revealed normal ocular health in both eyes. Computerized tomography scan showed mild inflammatory mucosal thickening in the sinuses. Initially, he was diagnosed and treated for giant cell arteritis. The patient’s vision deteriorated to no light perception in the right eye with persistent 10 out of 10 headache and eye pain despite various treatments. Further evaluation revealed ROCM involving the sphenoid sinus. This was confirmed by a positive smear and culture of Rhizopus species from the sinus and from the patient’s symptoms improving with antifungal treatment. Conclusion: Sphenoid sinusitis is an unusual site of involvement with ROCM. The absence of nasal drainage adds to the difficulty of diagnosis without contrast imaging. Although rare, acute invasive ROCM should always be considered in any uncontrolled diabetic or immunosuppressed patient with acute headache and vision loss.

Headache and Vision Loss as Initial Symptoms for an Acute Invasive Rhino-orbital-cerebral Mucormycosis

Background: Acute invasive rhino-orbital-cerebral mucormycosis (ROCM) is a rare fungal infection commonly caused by Rhizopus species. It occurs in immune- compromised individuals who have acquired immune deficiency syndrome (AIDS), leukemia, uncontrolled diabetes mellitus, or organ transplant patients who are on immunosuppressive therapy. Diagnosing invasive ROCM is challenging because its clinical presentation can be nonspecific, and it is not frequently observed in ophthalmic practices. Case Report: A 66-year-old Hispanic male with poorly controlled diabetes mellitus presented with the complaint of severe headache and retrobulbar pain in the right eye. An ophthalmic examination revealed normal ocular health in both eyes. Computerized tomography scan showed mild inflammatory mucosal thickening in the sinuses. Initially, he was diagnosed and treated for giant cell arteritis. The patient’s vision deteriorated to no light perception in the right eye with persistent 10 out of 10 headache and eye pain despite various treatments. Further evaluation revealed ROCM involving the sphenoid sinus. This was confirmed by a positive smear and culture of Rhizopus species from the sinus and from the patient’s symptoms improving with antifungal treatment. Conclusion: Sphenoid sinusitis is an unusual site of involvement with ROCM. The absence of nasal drainage adds to the difficulty of diagnosis without contrast imaging. Although rare, acute invasive ROCM should always be considered in any uncontrolled diabetic or immunosuppressed patient with acute headache and vision loss.

Headache and Vision Loss as Initial Symptoms for an Acute Invasive Rhino-orbital-cerebral Mucormycosis

Background: Acute invasive rhino-orbital-cerebral mucormycosis (ROCM) is a rare fungal infection commonly caused by Rhizopus species. It occurs in immune- compromised individuals who have acquired immune deficiency syndrome (AIDS), leukemia, uncontrolled diabetes mellitus, or organ transplant patients who are on immunosuppressive therapy. Diagnosing invasive ROCM is challenging because its clinical presentation can be nonspecific, and it is not frequently observed in ophthalmic practices. Case Report: A 66-year-old Hispanic male with poorly controlled diabetes mellitus presented with the complaint of severe headache and retrobulbar pain in the right eye. An ophthalmic examination revealed normal ocular health in both eyes. Computerized tomography scan showed mild inflammatory mucosal thickening in the sinuses. Initially, he was diagnosed and treated for giant cell arteritis. The patient’s vision deteriorated to no light perception in the right eye with persistent 10 out of 10 headache and eye pain despite various treatments. Further evaluation revealed ROCM involving the sphenoid sinus. This was confirmed by a positive smear and culture of Rhizopus species from the sinus and from the patient’s symptoms improving with antifungal treatment. Conclusion: Sphenoid sinusitis is an unusual site of involvement with ROCM. The absence of nasal drainage adds to the difficulty of diagnosis without contrast imaging. Although rare, acute invasive ROCM should always be considered in any uncontrolled diabetic or immunosuppressed patient with acute headache and vision loss.

Microbial population of wound isolates and socio demographic characteristics in patients attending clinic in national orthopaedic Hospital, Enugu, Nigeria

Background: The microbial population of wound isolates remains a public health concern because of its role in spread of infections. The microorganisms present in wound swab of patients have been reviewed in order to ascertain the presence of emerging and re -emerging pathogens in hospital environment. These microorganisms are generated from nosocomial and opportunistic origin as well as immune compromised individuals. The purpose of this study is to determine the occurrence of microorganisms in wounds of patient’s attending clinic in National Orthopedic Hospital Enugu, Nigeria. Methodology: A cross sectional study of 230 wound patients was selected using convenient sampling technique. Conventional methods and 16SrRNA sequencing was used for characterization of some organisms that could not be identified in the conventional methods. Questionnaire structured from literature review was also deployed for demographic studies obtained from consented participants. Results The frequency distribution of wound isolates showed an increase in Pseudomonas aeruginosa 7(10%) and Klebsiella pneumonia 6(8.6%) respectively. Mixed growths had a notable increase of 42(18.3%),while culture with no bacteria growth had 37(16.1%). Staphylococcus aureus was prevalent with 32(13.9%), Staphylococcus epidermis 15(6.5%) and the least isolates had 1(1.4%), Male gender had the highest wound isolates of one hundred and fourty one (141) with meanSD 21.11 and median of 19.00 while the female had 88 with meanSD 20.3113.457, median of 16.50. The socio demographic data findings for participant’s age were higher in the range of 21-40yrs (94) and 41-60yr (74) while the least was >80 years (5). The mean age of the 230 participantswas 43.15±17.284yrs.Wound type had a notable increase in accident cases (63)27.4%, surgical cases (44)19.1% and lowest was laceration cases (2) 0.9%, The most prevalent population of wound cases according to occupational status was observed in artisans (148) 64.3%, students (33)14.3%, civil servants (29)12.6%, least population was the retired (20)8.7%. The portion of wound site was highest in the leg region (174), trunk (22) and the hand (12). Conclusion: it is advocated that proper measures such as adequate sanitation, personal hygiene, sterilization of hospital equipment and environment should be beefed up to prevent the spread of these microbes to the public.

Poor performance of paired tests of latent tuberculosis in highly immune-compromised individuals exposed to multidrug-resistant tuberculosis: time for new diagnostic markers.

Guideline-based recommendations for diagnosis of latent TB in highly immune suppressed populations are difficult to interpret and poorly characterised. More accurate biomarkers independent of T-cell functions are urgently required. https://bit.ly/41P8vTa.

Bio-hydrolysis Study of Lactose in Produced Yoghurt by β-Galactosidase from Lactobacillus fermentum

The present study investigated the physicochemical and biohydrolysis of lactose in conventional and locally produced yoghurt drinks, respectively. Physicochemical properties of the conventional yoghurt in the presence of the locally produced one were: pH 3.0; 4.0, titratable acid 1.14; 1.04, conductivity 2751.54, 2204, viscosity 71.11; 112.14, TDS 1788.5; 1433, TSS 781; 654, TS 3532.54; 2087, Mg 11.06; 34.19, Ca 28.76; 45.21, TOC 155.23; 145.23 and TOM 190.93, 178.63 for yoghurt sample I and II respectively. Lactose concentrations of the respective yoghurts were: 2.12 and 1.79 Mg/ml. β-galactosidase was produced from isolated Lactobacillus sp under submerged fermentation system after 12 days of incubation. 60% ammonium sulphate was found suitable for precipitation of proteins with highest enzyme activity, the precipitate was desalted through reverse osmosis using dialysis bag. Optimum biohydrolysis was achieved after 20 hours of incubation with residual sugar concentration of 0.51 mg/ml while the control experiment had 0.93 mg/ml of the residual sugar. Optimum pH and temperature of hydrolysis were: 5.0 and 70°C respectively. Rate of hydrolysis proceed linearly as the enzyme concentration increases from 0-20% v/v. the present study has shown exclusively the nutritional components of yoghurts drinks commercially sold in the market, it went further to show hope for the metabolic compromised individuals with intolerance to lactose as the enzyme lactase produced from non noscomial organism showed great potentials of hydrolysis.

Anti-Quorum Sensing Efficacy of Mangifera indica Kernel Extract against Biofilm Formation in Pseudomonas aeruginosa

P.aeruginosa (PA) is responsible for causing both acute and chronic infections in immune compromised individuals. Multi-drug resistance among them is a very common phenomenon due to their complex biofilm forming nature enabling the bacteria to evade antibiotic treatment as well as human immune defence mechanism. In the present study, biofilm inhibition in P.aeruginosa was analysed using mango peel (MPE) and kernel extract (MKE). MKE has a greater content of phytoconstituents such as tannin and phenol (1.6458± 0.07 mg g-1 TAE; 1.56± 0.007 mg g-1 GAE) than MPE (0.2938± 0.05 mg g-1 TAE; 1.31± 0.003 mg g-1 GAE). MKE at 12.5-200μg ml-1 showed significant reduction of biofilm (70-75%) and quorum sensing (QS) (35-65%) against PA and C. violaceum whereas MPE showed only 20-23% of biofilm and 5-15% of QS inhibition. Epi-fluorescence and CLSM micrographs demonstrated the efficacy of MKE in inhibiting surface adhesion and biofilm thickness. As a result, MKE at 50μg ml-1 (1/4 BIC) suppressed PA biofilm formation without impairing planktonic cell growth, reducing the possibility of the emergence of multi-drug resistance. Additionally, MKE inhibited the production of pyocyanin and had a negative impact on swarming and twitching motility. Eight distinct phytochemicals were found in MKE after it was characterised, but 2(3h)-furanone, 3-(15-hexadecynylidene)dihydro-4-hydroxy-5-methyl, 4r-(3e,4.alpha.,5.beta) represented 33.75% of the peak area and is presumed to be the antibiofilm compound.

Prostate cryoablation: A mini review

Abstract In recent years, cryotherapy has gained increasing acceptance as a treatment for prostate cancer, offering complementary therapeutic benefits when combined with radical surgery and radiotherapy. Despite the potential for surgical complications, it stands as a safe and viable therapeutic modality. Cryotherapy provides an efficient approach for elderly patients, especially those with compromised physical conditions and individuals experiencing recurrence after initial treatment. It has shown promise in extending survival periods and improving the overall quality of life for these patients. This article aims to comprehensively examine the developmental trajectory, surgical techniques, indications, therapeutic outcomes, and potential complications associated within prostate cancer treatment.

Using laboratory data to assess the impact of coronavirus (COVID-19) on reflex cryptococcal antigenaemia (CrAg) testing in South Africa.

Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in Wuhan, China. Due to the rapid spread globally, it was declared a pandemic in March 2020. Social distancing and lockdown measures were introduced to limit transmission. These strategies could potentially impact the diagnosis and treatment of patients with advanced HIV who are susceptible to secondary infections like cryptococcal disease. In South Africa, reflexed cryptococcal antigenaemia (CrAg) testing and pre-emptive antifungal treatment are recommended preceding antiretroviral therapy initiation for patients with a CD4<100 cells/μl. This study aimed to assess the impact of COVID-19 on CrAg testing in South Africa. Specimen-level data was extracted for individuals ≥15 years from the National Health Laboratory Services repository for calendar years 2018 to 2021. Test volumes and CrAg positivity were assessed at national and provincial levels, by age category and gender. The percentage change in annual and monthly CrAg test volumes for 2020 and 2021 (during lockdown levels) are compared to data reported for 2018. The monthly median CD4 and the percentage of samples with a count <25, 25-50, 51-75 and >75-<100 cells/μl were assessed. Specimen data of 11 944 929 CD4 results included 1 306 456 CrAg tests. Annual CD4 and CrAg test volumes declined by 22.4% and 27.8% for 2020 and 2021 respectively (relative to 2018). There were 23 670 CrAg positive outcomes in 2018 compared to 21 399 (-9.6%) and 17 847 (-24.6%) in 2020 and 2021 respectively. A monthly test volume reduction of up to 36.6%, 35.5%, 36.1% and 13.3% was reported for infection waves one to four. CrAg detection increased from 6.3% in 2018 to 7.5% in 2020. More testing was offered to males (>56%) with a higher detection rate of 8.1% in 2020. Between 81.0% and 81.8% of testing was for patients aged 20 to 49 years. The monthly percentage of specimens <25 cells/μl ranged from 30.2% (June 2019) to 35.3% (August 2020). Overall, the monthly median CD4 ranged from 39 (IQR: 15-70)(August 2020) to 45 (IQR: 19-72)(March 2019) cells/μl. In 2020, the provincial percentage change in CrAg test volumes ranged from 2.9% to -33.7%. Our findings confirmed the impact of lockdown measures on both the absolute number of CrAg tests performed and detection (increase in 2020). A smaller impact on the median CD4 was noted. The long-term impact on patient management in immune- compromised individuals needs further investigation.

Nanotechnology-based theranostic and prophylactic approaches against SARS-CoV-2.

SARS-CoV-2 (COVID-19) pandemic has been an unpredicted burden on global healthcare system by infecting over 700 million individuals, with approximately 6 million deaths worldwide. COVID-19 significantly impacted all sectors, but it very adversely affected the healthcare system. These effects were much more evident in the resource limited part of the world. Individuals with acute conditions were also severely impacted. Although classical COVID-19 diagnostics such as RT-PCR and rapid antibody testing have played a crucial role in reducing the spread of infection, these diagnostic techniques are associated with certain limitations. For instance, drawback of RT-PCR diagnostics is that due to degradation of viral RNA during shipping, it can give false negative results. Also, rapid antibody testing majorly depends on the phase of infection and cannot be performed on immune compromised individuals. These limitations in current diagnostic tools require the development of nanodiagnostic tools for early detection of COVID-19 infection. Therefore, the SARS-CoV-2 outbreak has necessitated the development of specific, responsive, accurate, rapid, low-cost, and simple-to-use diagnostic tools at point of care. In recent years, early detection has been a challenge for several health diseases that require prompt attention and treatment. Disease identification at an early stage, increased imaging of inner health issues, and ease of diagnostic processes have all been established using a new discipline of laboratory medicine called nanodiagnostics, even before symptoms have appeared. Nanodiagnostics refers to the application of nanoparticles (material with size equal to or less than 100nm) for medical diagnostic purposes. The special property of nanomaterials compared to their macroscopic counterparts is a lesser signal loss and an enhanced electromagnetic field. Nanosize of the detection material also enhances its sensitivity and increases the signal to noise ratio. Microchips, nanorobots, biosensors, nanoidentification of single-celled structures, and microelectromechanical systems are some of the most modern nanodiagnostics technologies now in development. Here, we have highlighted the important roles of nanotechnology in healthcare sector, with a detailed focus on the management of the COVID-19 pandemic. We outline the different types of nanotechnology-based diagnostic devices for SARS-CoV-2 and the possible applications of nanomaterials in COVID-19 treatment. We also discuss the utility of nanomaterials in formulating preventive strategies against SARS-CoV-2 including their use in manufacture of protective equipment, formulation of vaccines, and strategies for directly hindering viral infection. We further discuss the factors hindering the large-scale accessibility of nanotechnology-based healthcare applications and suggestions for overcoming them.

Perspective on receptor-associated immune response to Candida albicans single and mixed infections: implications for therapeutics in oropharyngeal candidiasis.

Oropharyngeal candidiasis (OPC), commonly known as 'thrush', is an oral infection that usually dismantles oral mucosal integrity and malfunctions local innate and adaptive immunities in compromised individuals. The major pathogen responsible for the occurrence and progression of OPC is the dimorphic opportunistic commensal Candida albicans. However, the incidence induced by non-albicans Candida (NAC) species including C. glabrata, C. tropicalis, C. dubliniensis, C. parapsilosis, C. krusei are increasing in company with several oral bacteria, such as Streptococcus mutans, Streptococcus gordonii, Staphylococcus epidermidis and Staphylococcus aureus. In this review, the microbiological and infection features of C. albicans and its co-contributors in the pathogenesis of OPC are outlined. Since the invasion and concomitant immune response lie firstly on the recognition of oral pathogens through diverse cellular surface receptors, we subsequently emphasize the roles of epidermal growth factor receptor (EGFR), ephrin-type receptor 2 (EphA2), human epidermal growth factor receptor 2 (HER2), aryl hydrocarbon receptor (AhR) located on oral epithelial cells to delineate the underlying mechanism by which host immune recognition to oral pathogens is mediated. Based on these observations, the therapeutic approaches to OPC comprising conventional and non-conventional antifungal agents, fungal vaccines, cytokine and antibody therapies, and antimicrobial peptide therapy are finally overviewed. In face of newly emerging life-threatening microbes (C. auris and SARS-CoV-2), risks (biofilm formation and interconnected translocation among diverse organs), and complicated clinical settings (HIV and oropharyngeal cancer), the research on OPC is still a challenging task.

Percolation framework reveals limits of privacy in conspiracy, dark web, and blockchain networks

We consider the limits of privacy based on the knowledge of interactions in anonymous networks. In many anonymous networks, such as blockchain cryptocurrencies, dark web message boards, and other illicit networks, nodes are anonymous to outsiders, however the existence of a link between individuals is observable. For example, in blockchains, transactions between anonymous accounts are published openly. Here we consider what happens if one or more individuals in such a network are deanonymized by an outside investigator. These compromised individuals could then potentially leak information about others with whom they interacted, leading to a cascade of nodes’ identities being revealed. We map this scenario to percolation and analyze its consequences on three real anonymous networks—(1) a blockchain transaction network, (2) interactions on the dark web, and (3) a political conspiracy network. We quantify, for different likelihoods of individuals possessing information on their neighbors, p, the fraction of accounts that can be identified in each network. We then estimate the minimum and most probable number of steps to a desired anonymous node, a measure of the effort to deanonymize that node. In all three networks, we find that it is possible to deanonymize a significant fraction of the network (>50%) within less than 5 steps for values of p>0.4. We show how existing measures and approaches from percolation theory can help investigators quantify the chances of deanonymizing individuals, as well as how users can maintain privacy.

A Case of Brainstem Cryptococcoma Causing Pontine Stroke in an Immunocompetent Male (P1-10.003)

<h3>Objective:</h3> N/A <h3>Background:</h3> Cryptococcus is an invasive fungal disease seen in immune compromised individuals and usually present as meningitis when involved in the Central Nervous System. Cerebral cryptococcoma is a rare form of cryptococcal infection which is often misdiagnosed. Literature reviews showed most of them are located in frontal lobe, parietal lobe or basal ganglia. The involvement of pons only has been extremely rare. There are cases of cryptococcal meningitis causing ischemic stroke due to vasculitis but this case was complicated by perforator infarct adjacent to the lesion. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> <h3>Case presentation:</h3> We are going to discuss a 58 years old immunocompetent male who initially presented with dizziness and double vision. MRI of brain showed small acute infarct in right paramedian pons with adjacent edema out of proportion to the infarct. The contrast showed ring enhancing lesion. The patient returned after 4 months with severe headache and double vision. Repeat MRI of brain showed slightly enlarged ring enhancing lesion in right ventral pons. CSF study was positive for Cryptococcus neoformans both times. <h3>Conclusions:</h3> Diagnosis of cryptococcoma is often challenging especially in immunocompetent individuals where the clinical suspicion is low. There have been case reports where it has been misdiagnosed as neoplasm, tumefactive demyelinating disease and stroke. Therefore, causing delays in treatment leading to increased mortality and morbidity. This discussion indicates that physicians should have low threshold to suspect cryptococcoma in immunocompetent individual with ring enhancing lesion as timely intervention can save lives from this invasive fungal disease. <b>Disclosure:</b> Dr. Jabeen has nothing to disclose. Dr. Maghsoudlou has nothing to disclose.

The First Known Documented Case of Ewingella Americana Urinary Tract Infection

We present a 73-year-old male with a history of end-stage renal disease (ESRD) on dialysis, type 2 diabetes mellitus, coronary artery disease status post stents, prostate carcinoma status post radiation, and prostatectomy, with recurrent bladder neck contracture requiring suprapubic catheter, left urethral stricture with nephrostomy tube placement, penile implant, and recurrent urinary tract infections, who presented to the emergency room complaining of constant bilateral groin pain for one day. Physical exam was significant for suprapubic tenderness and a chronic suprapubic catheter and left-sided nephrostomy tube. An initial examination of the patient's urine revealed turbid, yellow-colored fluid, positive for white blood cells, leukocyte esterase, and bacteria. A urine culture was obtained, which returned positive for E. americana, with>100,000colony-forming units (CFUs)as well as Enterococcus faecalis (E. faecalis) demonstrating low colony counts.The patient was treated with a seven-day course of meropenem 1 gm twice daily, whichimproved of his symptoms, and then completed a 10-day course of ertapenem 500 mg daily. The patient received a five-day course of vancomycin 1 gm on dialysis days for additional coverage of E. faecalis, despite low colony counts. This is the first documented case of a urinary tract infection caused by E. americana.The organism is primarily found in immunocompromised individuals, and a debate is still ongoing as to whether it is a true pathogen or exists primarily as an opportunistic infection.We suggest further inquiry and study of this resistant organism are paramount in establishing its role in both immunocompromised as well as immunocompetent individuals.E. americana is a multidrug-resistant organism, which to date has sparse documentation regarding its prevalence and potential for morbidity, especially in compromised individuals.In the era of increasing antibiotic resistance, we suggest that more research is needed to understand the pathogenicity of E. americana.

Dental implant and bone augmentation treatment in bone-compromised patients: Oral health-related quality of life outcomes

Statement of problemPatient-reported outcomes represent an additional and often overlooked measure of dental implant and bone augmentation treatment. Few implant studies have evaluated patient-reported outcomes in those with systemic bone compromise. PurposeThe purpose of this cohort study was to assess oral health-related quality of life (OHRQoL) outcomes in postmenopausal women receiving dental implants with normal bone density or mild osteopenia (“healthy” group; all DXA T-scores at femoral neck, total hip, and L1-L4 spine>−2.0) versus moderate osteopenia or osteoporosis (“bone compromised” group; any DXA T-score at femoral neck, total hip, or L1-L4 spine≤−2.0). Material and methodsA total of 115 patients were recruited at the University of Connecticut School of Dental Medicine as part of a standard of care, prospective, nonrandomized cohort study. All participants received 1 of 3 bone augmentation procedures with implant placement. At baseline and at various intervals after implant placement, OHRQoL was measured by using the Oral Health Impact Profile-14 (OHIP-14) and surveys of patient expectations and satisfaction. These measures were compared between healthy and bone compromised groups (α=.05). ResultsFor all OHRQoL measures across linear mixed effects models, no significant differences were found between bone groups at baseline and at each time point after implant placement (P>.05). Using the minimally important difference (MID) for OHIP-14, no definitive clinical differences were found in patient outcomes between bone groups at all postimplant time points (P>.05). From baseline to 24 months after implant placement, both healthy and bone compromised groups exhibited significant improvements in OHIP-14 and patient expectations scores (P<.05). While no within group differences were found in patient satisfaction scores, the mean satisfaction score remained high over time in both groups. ConclusionsPatient-reported outcomes as measured through OHIP-14, patient expectations, and patient satisfaction surveys suggest similar postimplant OHRQoL improvement in healthy and bone compromised individuals. OHRQoL improvements between bone groups were similar both in continuity and in scope, with no evidence of statistically significant score differences between groups at 24 months after implant placement across all measures and with no definitive evidence of clinical differences as measured by OHIP-14 MID comparisons across all timepoints.

Toxoplasma Gondii Induces Blood-Brain Barrier Dysfunction in a Human Stem Cell- Derived Model

&#x0D; &#x0D; &#x0D; Background:&#x0D; Toxoplasma gondii is a single-celled obligate intracellular parasite commonly found in cat feces and animal issues and is known to cause cerebral infections in immune- compromised individuals and neonates. Once ingested, T. gondii reaches the host's blood supply and reaches the brain, where infection ensues. However, it remains unclear how T. gondii crosses the blood-brain barrier to reach the brain. In this study, we utilize a human stem cell-derived BBB model with near in vivo properties to investigate the effects of T. gondii on critical barrier properties that permit entry into the brain parenchyma.&#x0D; Methods:&#x0D; Human-induced pluripotent stem cells (iPSCs) were used to derive brain microvascular endothelial cells (BMECs). BMECs were exposed to tachyzoites, the infectious rapid replicating stage of T. gondii, at a multiplicity of infection (MOI) of 0.1 and 1.0 for 24 hours. Following exposure, several critical barrier properties were monitored, including trans- endothelial electrical resistance (TEER) and tight junction analysis.&#x0D; Results:&#x0D; BMECs treated with both MOI of 0.1 and 1.0 showed a significant reduction in all three tight junction proteins (Claudin-5, Occludin, and ZO-1), as indicated by an increase in discontinuous junctions and a decrease in area fraction index. Barrier integrity is directly associated with tight junctional continuity and localization. Furthermore, tachyzoites at an MOI of 0.1 and 1.0 demonstrated a reduction in barrier tightness, as observed by a decrease in TEER.&#x0D; Conclusion and Potential Impact:&#x0D; These results indicate that T. gondii may, in part, have access to the brain by inducing disruption in tight junction proteins, thus increasing barrier leakiness via a para-cellular route. These data may help guide future investigations on T. gondii's ability to evoke blood-brain barrier dysfunction and reach the vulnerable brain tissue.&#x0D; &#x0D; &#x0D;

Post COVID-19 osteomyelitis in maxillofacial region: A report of 3 treated cases

Oral health care professionals have reported about post COVID-19 patients presenting signs of uncommon bacterial diseases such as Osteomyelitis of the maxillofacial region. The hosts at substantial risk of developing these fungal infections were diabetics, immune compromised individuals, patients on corticosteroids, and those with hematologic insufficiencies. Here we report 3 cases that developed osteomyelitis post COVID-19. They were diagnosed and surgically intervened in our department during the peak of COVID-19 pandemic and were kept on long term follow up. Post pandemic the challenge lies with the oral health professionals to diagnose it at an early so as to minimise the disease progression and improve the surgical outcome.

Structure based functional annotation of a MYND-less lysine methyl transferase inCandida albicans.

Candida albicans is opportunistic pathogenic yeast that is widely distributed throughout the world and is classified as the most critical fungal pathogen group. Candida albicans is a common microbiota of healthy individuals but can cause superficial and invasive infections in immune compromised individuals. Protein Post-translational modifications involving methylation of lysine amino acids stand for a major regulator of eukaryotic transcription, and pathways controlling several cellular processes. SMYD makes up a SET (Su (Var) 3-9, Enhancer-of-zeste and Trithorax) and MYND (Myeloid, Nervy, and DEAF-1) domain containing lysine methyl transferase subfamily that transfers methyl groups from methyl donors onto lysine residues in histones (H3 and H4) and non-histone proteins. The SET domain is the methyltransferase catalytic domain, while MYND participates in both protein and DNA interactions. Well-studied examples of SMYD proteins are five human and two Saccharomyces cerevisiae, constituting examples of histone and non-histone protein lysine methyl transferase members. However, there is limited understanding of SET lysine methyltransferases, including the SMYD subfamily, in the pathogenic fungi Candida albicans. Using bioinformatics tools, we characterized the SMYD domain containing proteins in the important pathogen. We report the presence of an atypical SMYD member (CaO19.3863) as a new lysine methyltransferase that can be a target for antifungal therapy.