Etiological Characteristics Research Articles

Etiology and clinical features of children with bronchiectasis-Insight from Chinese experience.

Bronchiectasis is a clinical syndrome characterized by cough, sputum production, and the presence of abnormal thickening and dilation of the bronchial wall on imaging. There has been a remarkable resurgence in incidence and prevalence during the past 20 years. There was few data from children. In China, it has been estimated that 1.5% of women and 1.1% of men in the general population have physician-diagnosed bronchiectasis.

Clinical, aetiological, and epidemiological studies of outpatient cases of hand, foot, and mouth disease in Chengdu, China, from 2019 to 2022: a retrospective study

BackgroundThe introduction of the Enterovirus A71 (EV-A71) vaccine in China in 2016 has led to a considerable decline in severe hand, foot, and mouth disease (HFMD) cases, with mild outpatient instances now representing the majority of HFMD cases in the country. Nevertheless, epidemiological investigations concerning mild outpatient cases remain scarce, resulting in inadequate descriptions of their clinical, etiological, and epidemiological characteristics. Our study aimed to analyze the clinical, etiological, and epidemiological characteristics of HFMD outpatients in Chengdu from 2019 to 2022 while identifying potential risk factors associated with the progression of outpatients requiring hospitalization.MethodsA retrospective study was conducted to summarize the clinical, etiological, and epidemiological characteristics of outpatient HFMD cases in Chengdu from 2019 to 2022. Risk factors associated with progression to hospitalization of HFMD outpatients were evaluated using binomial logistic regression analysis.ResultsThe study included 1,073 coxsackievirus A6 (CVA6), coxsackievirus A10 (CVA10), and coxsackievirus A16 (CVA16) HFMD nucleic acid test-positive outpatients. Among these, only 45 outpatients (4.19%) progressed to hospitalization. The median ages for CVA6, CVA10, and CVA16 infections were 25.23, 28.13, and 38.45 months, respectively (P < 0.001). CVA6 (76.51%, 821/1,073) has become the main serotype among outpatients in Chengdu, with the proportions from the second half of 2019 to 2022 being 45.59%, 95.17%, 77.67% and 80.71% respectively. EV-A71 cases even disappeared. Patients infected with CVA10 had a significantly higher likelihood of hospitalization (P < 0.05), while the presence of oral rash served as a protective factor (P < 0.05).ConclusionsOur study highlights the critical need for enhanced surveillance of multiple HFMD pathogens, predominantly caused by the prevalent serotype CVA6. Clinically, enhanced surveillance of CVA10 is imperative to mitigate the hospitalization rate associated with HFMD.

Accurate Differential Diagnosis of Cardiomyopathy Phenotype Based on Multimodal AI Technology

Cardiomyopathy is a group of diseases involving the heart muscle, mainly manifested by the abnormality of the structure and function of the heart muscle. According to etiology and pathological characteristics, cardiomyopathy can be divided into various types, including hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), non-dilated left ventricular cardiomyopathy (NDLVC) and restrictive cardiomyopathy (RCM). These different types of cardiomyopathy differ significantly in clinical presentation, pathophysiological mechanisms, and treatment strategies, so accurately differentiating the different phenotypes of cardiomyopathy is critical to developing a personalized treatment plan. However, traditional diagnostic methods such as electrocardiogram (ECG), echocardiography, magnetic resonance imaging (MRI) and genetic testing, while able to provide useful information to a certain extent, still have limitations in complex cases and can lead to misdiagnosis or missed diagnosis. In order to overcome the limitations of traditional diagnostic methods and improve the ability of accurate diagnosis of different phenotypes of cardiomyopathy, this study developed a cardiomyopathy phenotypic differential diagnosis system based on multimodal artificial intelligence (AI) technology. We integrate patient data from multiple centers, including clinical data, electrocardiograms (ECG), echocardiograms, magnetic resonance imaging (MRI), and genomic data, standardized and pre-processed. Through machine learning and deep learning algorithms, multimodal AI models are constructed and trained using large-scale training data sets. The accuracy and stability of the model in the differentiation of different cardiomyopathy phenotypes were verified on an independent data set, and the model parameters were optimized according to the verification results to improve the generalization ability and clinical applicability of the model.

Etiological, Clinical, and Epidemiological Characteristics of Acute Viral Gastroenteritis in an Adult Population in a Tertiary Level Hospital in Spain.

Acute gastroenteritis (AGE) represents a significant global health burden, with enteric viruses being a leading cause of gastroenteritis worldwide. Despite advances in diagnosis and treatment, there are limited data on adults seeking care due to AGE of viral etiology. This study aimed to describe the etiological, clinical, and epidemiological characteristics of viral AGE in adult patients presenting for medical consultation in a tertiary hospital over a 2-year period. A retrospective cross-sectional study was conducted, with 8886 stool samples from 8356 adult patients presenting acute diarrhea between January 2021 and December 2022. A molecular real-time RT-PCR panel was used to screen for common bacterial, parasitic, and viral pathogens. Clinical and demographic data were collected, and statistical analysis was performed to evaluate possible associations. Enteric viruses constituted 10.3% (307 cases) of all AGE of known etiology, with norovirus being the predominant pathogen (196, 63.8%), followed by rotavirus (82, 26.7%) and adenovirus (29, 9.4%). The different viruses showed a distinct seasonal predominance. Coinfection with other microorganisms was common. Most cases exhibited a self-limiting course. Mortality and hospitalization rates were high in patients with higher comorbidity indices, mainly in individuals with immunosuppression. Viruses are an important cause of acute gastroenteritis in adults presenting for medical consultation. The new multiplex molecular tests with high sensitivity and specificity allow early differential diagnosis in AGE. It is therefore necessary to identify which special populations particularly with higher comorbidity indices, would benefit from the implementation of these techniques, to guide decision-making related to appropriate treatments and avoid unnecessary interventions.

Clinical and etiological characteristics and cytokine profile in school-age children with community-acquired pneumonia

The urgent task of modern pediatrics is the study of the etiology and pathophysiology of community-acquired pneumonia in school-aged children due to difficulties in diagnosis and treatment, as well as the high risk of life-threatening complications and death.Purpose. To investigate the activity of pro-inflammatory and anti-inflammatory responses as measured by cytokine levels in the peripheral blood of children with community-acquired pneumococcal and non-pneumococcal pneumonia.Material and methods. The etiology of community-acquired pneumonia was confirmed by comparing the results of rapid testing of pneumococcus in urine and data from traditional bacteriological methods. The study included 118 children (57 boys and 61 girls) aged 7 to 16 years with various morphological variants of community-acquired pneumonia, which were divided into 2 groups. The first group included 28 children with pneumococcal etiology of community-acquired pneumonia, and the second group included 90 patients with non-pneumococcal community-acquired pneumonia. Levels of interleukins IL-1, IL-4, IL-8 and TNF-α were determined in all children by enzyme immunoassays.Results. In the etiology of community-acquired pneumonia in school-age children, atypical pathogens are responsible for more than 50% of cases. The clinical effectiveness of rapid testing of pneumococcal antigens in urine has been shown, and their use in routine pediatric practice has made it possible to timely identify a group of severe community-acquired pneumonia and reasonably prescribe antibacterial medications. It has been demonstrated that pneumococcal-induced pneumonia is characterized by higher levels of proinflammatory cytokines. These levels, along with the clinical course of the disease, confirm the high level of systemic inflammation. Relatively lower levels of proinflammatory cytokines corresponded to a more mild clinical picture of community-acquired pneumonia of non-pneumococcal etiology, which on the one hand may reflect a relatively «balanced» inflammatory response, and on the other hand determine the protracted and polyclinic course of the infectious process.Conclusion. The etiology of community-acquired pneumonia in school-age children is dominated by atypical pathogens. Community-acquired pneumonia of pneumococcal etiology has more severe clinical courses, and their early identification will allow for the appropriate prescription of initial antibacterial treatment.

Etiological characteristics and whole genome sequence analysis of Clostridium perfringens causing a food poisoning outbreak

This study investigated the etiological characteristics and whole genome sequencing of clostridium perfringens (CP) from a food poisoning outbreak. Multiplex real-time PCR was employed to screen pathogens in collected samples. Based on the preliminary screening results, the isolation, cultivation, and identification of suspected pathogenic CP bacteria were performed. The nucleic acid tests were conducted for CP-related virulence genes on CP isolates, anal swab specimens and food samples. The molecular typing of CP isolates was analyzed by using pulsed-field gel electrophoresis (PFGE). A phylogenetic tree was established to analyze nucleotide and amino acid homology after sequencing the PLC gene. The whole genome sequencing and gene annotation on the representative strain QD2022FB4-CP4 were performed to explore its drug resistance, toxin genes and biological characteristics. The analysis revealed that the food poisoning was triggered by F-type Clostridium perfringens, which infected the consumers by contaminating'roujiamo' sandwiches. The whole genome sequencing of the strain QD2022FB4-CP found that it had active metabolic processes, multiple virulence genes and multidrug resistance characteristics.

Effects of separate and combined estradiol and progesterone administration on fear extinction in healthy pre-menopausal women

Altered fear conditioning and extinction learning are discussed as key etiological features in anxiety disorders. Women have an increased risk for anxiety disorders and fear conditioning has been shown to be influenced by the menstrual cycle phase and circulating gonadal hormones. The objective of our study was to investigate the effects of separate and combined estradiol and progesterone administration on fear extinction in healthy women. We conducted a placebo-controlled, randomized study in healthy women, who completed a fear conditioning paradigm on three consecutive days: fear acquisition training on day 1, fear extinction training on day 2, and return of fear test on day 3. Skin conductance responses (SCRs) served as main outcome variable. Two hours before testing on day 2, participants received pills containing either placebo, estradiol (2 mg), progesterone (400 mg) or the combination of both. We examined 116 women (mean age 25.7 ± 6.0 years), who showed significantly stronger conditioned SCRs to the CS+ than CS- during fear acquisition training indicating successful fear learning. At the beginning of the fear extinction training, estradiol administration reduced the differentiation between the conditioned stimuli. In the return of fear test, the estradiol groups showed heightened SCR responses to the previously extinguished stimulus, i.e., impaired extinction recall. Administration of progesterone did not have any significant influence on SCRs. There were also no effects on fear potentiated startle response. In our interpretation, exogenous estradiol administration affected the extinction of the conditioned fear response which led subsequently to a stronger return of fear. From a clinical perspective our findings suggest that estradiol levels may have an influence on the success of exposure therapy and could be taken into consideration when planning exposure sessions.

Emergence and etiological characteristics of novel genotype Ⅱ pseudorabies virus variant with high pathogenicity in Tianjin, China

Pseudorabies (PR) is a highly infectious disease caused by pseudorabies virus (PRV). This study aimed to detect and identify recent outbreaks of genotype Ⅱ PRV, and further analysis it's etiological characteristics and pathogenicity. The brain tissues with suspected PRV infection were isolated and the main virulence-related genes of the isolated PRV strain were amplified and sequenced for phylogenetic analysis. In addition, the pathogenicity of the isolated PRV strain to 6-week-old mice and 9-days-old suckling piglets were evaluated. The results showed that a PRV strain was successfully isolated and named PRV TJbd2023 strain, which could proliferate in PK-15 cells and TCID50 of the 6th generation virus reached 107.57/0.1 ml. Phylogenetic trees and amino acids analysis were constructed based on full-length gE sequences, which showed that PRV TJbd2023 strain was clustered into genetype Ⅱ PRV variant with a characteristic 21-nucleotide insertion (encoding 63AASTPAA69) in gC gene, and some amino acid point mutations were also found in other virulence-related genes, including gB protein R223H and E836K, gD protein R320S, and gE protein T242A. Animal experiments showed that TJbd2023 could cause acute neurological symptoms with 103.41/mL LD50 on KM mice, and intranasal inoculation of suckling piglets with 2 ml of TJbd2023 strain(106.57/0.1 ml) led to a mortality rate of 66.70 %. Emerging genotype Ⅱ PRV variant such as isolated in our research named TJbd2023 with high pathogenicity might be responsible for recent outbreaks of PRV and immunization failure of Bartha-K61 vaccine in Tianjin, China.

The Role of Neuromuscular Ultrasound in the Diagnosis of Peripheral Neuropathy.

The classification of peripheral neuropathies has traditionally been based on etiology, electrodiagnostic findings, or histopathologic features. With the advent of modern imaging, they now can also be characterized based on their varied distribution of imaging findings. We describe the major morphologic patterns of these changes, which include homogeneous enlargement; homogeneous thinning; focal, multifocal, and segmental enlargement; and focal thinning and beading (multifocal thinning). Representative disorders in each of these categories are discussed, along with examples of the more complex imaging manifestations of neuralgic amyotrophy, nerve transection, and hereditary amyloidosis. An appreciation of the diverse morphologic manifestations of neuropathy can help neuromuscular clinicians conduct appropriate imaging studies with ultrasound and, when needed, order suitable investigations with magnetic resonance neurography.

Characteristics of overnight video-EEG monitoring in infantile epileptic spasms syndrome at 2-week follow-up.

To determine the optimal duration of electroencephalography (EEG) recording to detect epileptic spasms (ES) based on inpatient overnight video-EEG monitoring in patients with infantile epileptic spasms syndrome (IESS) at the 2-week follow-up. Patients with IESS and overnight EEG monitoring between January 2020 and June 2022 were retrospectively reviewed. Time-to-ES, time-to-sleep and time-to-epileptic encephalopathy (EE) per the Burden of Amplitudes and Epileptiform Discharges (BASED 2021) score. BASED 2021 score were reported. ES and sleep detection sensitivity were calculated with respect to monitoring time. Etiology, treatment, and EEG features were assessed for strength of association with continued ES. Time-to-event analysis was performed with the first ES as the event of interest. Of 90 patients, 39 (43%) continued to have ES; 78.6% with EE continued to have ES, whereas only 27.4% without EE had ES (odds ratio [OR] 12.05). Structural etiologies were also associated with continued ES (OR 5.24). ES detection was 35.9%, 76.9%, and 84.6% at 1, 4, and 6 h, respectively, with corresponding negative likelihood ratios (NLRs) of .64, .23, and .15. ES detection reached >90% and >95% at 14 and 19 h, respectively. Sleep detection was 52.2%, 84.4%, and 95.6% at 1, 4, and 6 h, respectively, and captured in all patients by 11 h. EE was observed by 6 h for all associated patients. Typical routine EEG durations (<1 h) were not sufficient to detect ES, EE, or sleep in patients with IESS at the 2-week follow-up. Four hour outpatient EEG will capture ES in 77% and sleep in 84% of the patients. EE, if present, was shortly after sleep onset. Additional monitoring of up to 19 h was needed to capture >95% of patients with ES. Although EE was strongly associated with continued ES, 27.4% of patients without EE demonstrated ES. This study will help guide adequate duration of EEG monitoring at the 2-week follow-up for patients with IESS.

Construction and interpretation of machine learning-based prognostic models for survival prediction among intestinal-type and diffuse-type gastric cancer patients

BackgroundGastric cancer is one of the most common malignant tumors worldwide, with high incidence and mortality rates, and it has a complex etiology and complex pathological features. Depending on the tumor type, gastric cancer can be classified as intestinal-type and diffuse-type gastric cancer, each with distinct pathogenic mechanisms and clinical presentations. In recent years, machine learning techniques have been widely applied in the medical field, offering new perspectives for the diagnosis, treatment, and prognosis of gastric cancer patients.MethodsThis study recruited 2158 gastric cancer patients and constructed prognostic prediction models for both intestinal-type and diffuse-type gastric cancer. Clinical pathological data were collected from patients, and machine learning algorithms were used for feature selection and model construction. The performance of the models was validated with training and testing datasets. The Shapley additive explanations (SHAP) values were used to interpret the model predictions and identify the main factors that influence patient survival.ResultsIn the prognostic model for intestinal-type gastric cancer, the gradient boosting decision tree (GBDT) model demonstrated the best performance, with key features including pTNM, CA125, tumor size, CA199, and PALB. Similarly, in the prognostic model for diffuse-type gastric cancer, the GBDT model was utilized, with key features comprising pTNM, Borrmann type IV disease, lymphocyte (LYM), lactate dehydrogenase (LDH), potassium (K), perineural invasion (PNI), tumor size, and whole stomach location. Risk stratification analysis revealed that the prognosis of high-risk patients was significantly worse than that of low-risk patients.ConclusionMachine learning shows great potential in predicting survival outcomes of gastric cancer patients, providing strong support for the development of personalized treatment plans.

Update understanding on diagnosis and histopathological examination of atrophic gastritis: A review.

Chronic atrophic gastritis (CAG) is a complex syndrome in which long-term chronic inflammatory stimulation causes gland atrophy in the gastric mucosa, reducing the stomach's ability to secrete gastric juice and pepsin, and interfering with its normal physiological function. Multiple pathogenic factors contribute to CAG incidence, the most common being Helicobacter pylori infection and the immune reactions resulting from gastric autoimmunity. Furthermore, CAG has a broad spectrum of clinical manifestations, including gastroenterology and extra-intestinal symptoms and signs, such as hematology, neurology, and oncology. Therefore, the initial CAG evaluation should involve the examination of clinical and serological indicators, as well as diagnosis confirmation via gastroscopy and histopathology if necessary. Depending on the severity and scope of atrophy affecting the gastric mucosa, a histologic staging system (Operative Link for Gastritis Assessment or Operative Link on Gastritis intestinal metaplasia) could also be employed. Moreover, chronic gastritis has a higher risk of progressing to gastric cancer (GC). In this regard, early diagnosis, treatment, and regular testing could reduce the risk of GC in CAG patients. However, the optimal interval for endoscopic monitoring in CAG patients remains uncertain, and it should ideally be tailored based on individual risk evaluations and shared decision-making processes. Although there have been many reports on CAG, the precise etiology and histopathological features of the disease, as well as the diagnosis of CAG patients, are yet to be fully elucidated. Consequently, this review offers a detailed account of CAG, including its key clinical aspects, aiming to enhance the overall understanding of the disease.

Preoperative Evaluation, Informed Consent and Postoperative Care in Pediatric Vitreoretinal Surgery

In childhood, vitreoretinal surgery may be required due to trauma and some congenital or developmental disorders. Pediatric vitreoretinal surgery differs from that of adults in terms of etiology, anatomical and surgical characteristics, response to treatment and follow-up. This process has many challenges that require patient follow-up over many years as the child develops. Pre-operative preparation according to the age of the patient and the nature of the pathology will make it easier for the surgeon to manage all the processes. The consent of the child must be obtained in accordance with the child's cognitive abilities, in addition to the informed consent of the family. Despite surgical and technological advances in pediatric vitrectomy, anatomical and functional outcomes are worse than in adults. This article discusses pediatric vitreoretinal surgery in terms of preoperative preparation, informed consent and follow-up.

Etiologic and demographic characteristics of syncope in children and adolescents: a nationwide population-based study in Korea.

Syncope is common among children and adolescents. Although it is most commonly caused by vasovagal syncope, it can also be due to undiagnosed, potentially serious, or even life-threatening conditions. We aimed to investigate the distribution of subsequent sinister diagnoses, such as heart disease (HD) and epilepsy, and analyze their demographic characteristics in children presenting with syncope. This nationwide, population-based study was conducted using the Korean Health Insurance Review and Assessment Service database. Patients aged <19 years at the time of their first visit between January 2010 and December 2014, who had primary, secondary, or additional diagnostic codes for syncope, were selected and followed up for a minimum of 5 years from the index date to investigate subsequent diagnoses of HD or epilepsy. Patient demographics, diagnostic codes, and prescriptions were retrieved from the database. A total of 75,839 patients with new-onset syncope were identified, of which 239 (0.3%) and 2,516 (3.3%) were subsequently diagnosed with HD and epilepsy, respectively. In the infant, toddler, and preschool age groups, the proportions of patients with subsequent diagnoses of HD and epilepsy were relatively lower (5/5,353, 0.1%) and higher (206/5,353, 3.8%), respectively, than the proportions in the other age groups. A male preponderance was noted for patients with syncope who were later diagnosed with HD or epilepsy (P<0.001). The proportion of patients experiencing syncope with a subsequent diagnosis of HD was relatively high in the summer. The subsequent diagnosis of potentially life-threatening diseases in pediatric syncope, including HD and epilepsy, is relatively low in all age groups. In addition to comprehensive history taking and physical examination, demographic data such as age and sex, and season of occurrence, can aid in diagnosing the underlying cause of pediatric syncope by helping to identify patients who may require further investigations.

Geospatial Analysis of Pediatric Burns Reveals Opportunities for Injury Prevention

BackgroundGeospatial analysis is useful for identifying hot spots for preventable injuries and for informing prevention efforts. We hypothesize that specific populations of children in South Florida are at increased risk of burn injury. MethodsWe used a regional burn center registry to geocode burn cases treated from July 2013 to December 2022 for patients <18 years. Spatial analysis was utilized to identify high-density areas and potential spatial clusters of patients living in Palm Beach, Broward, and Miami-Dade Counties. Sociodemographic factors, burn etiology, and physiologic characteristics were analyzed using geospatial and statistical analyses. Results689 patients (58% male, median age 2 [1–8] years) were identified. The annual incidence of burns was 5.5 per 100,000 children. There was no seasonal variation in injury patterns. Most patients were Black (51%) and non-Hispanic (73%). Scald burns (72%) represented the most common etiology, followed by flame (10%) and contact with hot objects (9%). Most patients (58%) required inpatient admission. Scald and contact burns occurred in younger patients compared to other mechanisms (median [IQR] age: 2 [1–6] vs. 8 [4–12] years, p < 0.001). Race, ethnicity, and insurance status were not associated with inpatient admission (all p > 0.05). Overall, there was a higher rate of pediatric burn injuries affecting Black residents, with a paucity of injuries in predominately high-income areas. ConclusionsA disproportionate amount of pediatric burn injuries occur in low-income and predominantly Black neighborhoods. Additionally, scald and contact burns are a target for injury prevention in South Florida. These data may inform public health implementation to reduce morbidity in vulnerable populations. Level of EvidenceLevel III. Type of StudyRetrospective comparative study.

Revisiting the etiology and clinical characteristics of hemorrhagic polyps of the vocal fold.

Benign phonotraumatic lesions of the vocal folds (BVFLs) are typically seen in younger female patients with high vocal loads. Hemorrhagic polyps (HPs) do not fit the classic paradigm of most BVFLs, as they tend to occur in an older population, have a male predominance, and report to result from a vocal accident. We present one of the largest cohorts of HPs, to reexamine their etiology and clinical features. Retrospective cohort study, inclusive of all patients with HP managed by the senior authors between the years 2016 through 2023. Demographic data, management, phonotraumatic risk factors, pre- and post-treatment VHI-10 were reviewed. We examined patient videostroboscopy, categorized the size of the lesion, and identified any concurrent mucosal abnormality. One hundred and eleven patients had confirmed HP, 84 males (75.7%). Thirty-five patients were size category 1; pinpoint (28.9%), 57 were category 2; less than 1/3rd the vocal fold (45.5%), and 26 were category 3; greater than 1/3rd the vocal fold (21.5%). Ten patients (9%) had bilateral HPs. Thirty-five patients had an additional 40 mucosal lesions in addition to the HP(s). The onset of symptoms was gradual in 60% of patients. The mean pretreatment VHI-10 was 18.0 (SD 10.7), compared to 6.0 (SD 10.5) post-treatment, (p < .001). 57/111 patients reported high voice demand professions or recreational activities. The average self-reported talkative scale score was 7.6/10. Patients were managed with operative microdirect laryngoscopy and microflap excision (53.1%), in-office clinic potassium titanyl phosphate (KTP) laser (24.3%), voice therapy alone (7.2%), and KTP in the operating room (6.3%). In our cohort, most patients were male, had high vocal demands, reported gradual symptom onset, and almost a third of patients had additional BVFLs. Level 3: Retrospective cohort study.

Research participant perceptions of personal utility in disclosure of individual research results from genomic analysis.

This article elaborates research participant perspectives on the communication of individual research results from genomic analyses. While most analyses focus on how to communicate results from the perspectives of clinicians or researchers, there is insufficient data on user perspectives and how this information may be used, valued, and interpreted by patients and their families. The concept of personal utility, which considers factors related to quality of life, including on how information may impact the person's future decisions, has been shown to be particularly relevant to understand research participant perspectives and to move beyond clinical and analytic utility factors such as mortality and morbidity. This article draws from qualitative research of research participants awaiting genomic results in the case of sudden cardiac death. Our results show perspectives of personal utility in communication of genomic results, including cognitive, behavioral, and affective outcomes. Cognitive outcomes include gain of information, improved knowledge of etiology and inheritance characteristics, and curiosity for what might be found. Behavioral outcomes include being able to plan life decisions, while affective outcomes include various coping strategies used. We will also discuss the value of knowing negative results and incidental findings from the research participant's perspective. This contribution gives suggestions on best practices to guide genome analysis returns, including incorporating participant wishes on individualized communication at the consent stage; developing relational autonomy approaches; and engaging them throughout the research trajectory.

Microbiology, Treatment, and Postoperative Outcomes of Gram-Negative Prosthetic Joint Infections-A Systematic Review of the Literature.

Gram-negative prosthetic joint infections (PJIs) represent 10% to 25% of all PJIs and are associated with worse outcomes than gram-positive infections. We sought to assess the microbiology, surgical treatment, and outcomes of patients with gram-negative PJIs. A systematic review using the PubMed and Embase databases was conducted. Our study was conducted following the PRISMA guidelines. Included studies were assessed for quality using the STROBE checklist. The primary outcome of analysis was treatment failure. A total of 593 patients with gram-negative PJIs were included. Two-year survival free of treatment failure for hip and knee PJIs was 66% and 68% for acute infections, 39% and 78% for acute hematogenous infections, and 75% and 63% for chronic infections, respectively. Two-year survival free of treatment failure for acute infections treated with débridement, antibiotics, and implant retention was 65% and 67% for hip and knee PJIs, respectively. Exchange of the polyethylene during débridement, antibiotics, and implant retention was associated with higher treatment success (P = 0.045). Chronic PJIs treated with two-stage revision had a two-year treatment success rate of 87% and 65% for the hip and knee, respectively. Risk factors of treatment failure were chronic obstructive pulmonary disease and C-reactive protein ≥30 mg/L in acute PJIs and female sex, knee infection, and previously revised implant in chronic PJIs. Acute PJIs caused by Pseudomonas spp. were associated with lower treatment failure rates. Gram-negative PJIs are associated with a high treatment failure rate. Patient comorbidities, preoperative biochemical tests, microorganism etiology, and PJI characteristics affected the treatment success rate.

Clinical, etiological, and electrophysiological characteristics of patients with peripheral nerve damage caused by the February 6 earthquake in Türkiye

Objectives: This study aimed to analyze the clinical, etiological, and electrophysiological characteristics of the February 6 earthquake victims referred to our center due to nerve damage. Patients and methods: In this retrospective study, the demographic characteristics and findings of clinical examinations of 36 earthquake victims (25 females, 11 males; mean age: 31.6±15.5 years; range, 5 to 61 years) referred to our electrophysiology laboratory during the four-month period following the February 6 earthquake were investigated. The patients’ time spent under rubble, affected extremities, and electrophysiological findings were evaluated, and the locations of their lesions were determined using electromyography. Results: The mean time spent under rubble was 14.94±18.62 h, and 31 (86.1%) patients experienced partial nerve damage. Nerves were affected peripherally in 23 (74.2%) patients, at the lumbosacral plexus level in four (12.9%) patients, and at the brachial plexus level in another four (12.9%). Patients who were under rubble for more than 6.5 h had an increased risk of developing crush syndrome (p=0.014), and those under rubble for more than 8.5 h had an increased risk of developing compartment syndrome (p=0.008). Conclusion: The duration of exposure to rubble has been identified as a significant factor in the severity of nerve injury, as well as the development of compartment syndrome and crush syndrome. Therefore, the potential for peripheral nerve injury, which is a significant cause of morbidity, should be considered in the follow-up of patients who have survived earthquakes.

A cross-sectional study of the spectrum, aetiology and clinical characteristics of adult mitral valve disease at Chris Hani Baragwanath Academic Hospital.

Valvular heart disease constitutes a considerable amount of cardiovascular morbidity and mortality worldwide. There is a scarcity of data from Africa. In this descriptive, cross-sectional study, we documented the demographic, clinical and echocardiographic features of current patients with adult mitral valve disease (MVD) at Chris Hani Baragwanath Academic Hospital from December 2018 to March 2019. The study included 134 patients (mean age 50 ± 13.3 years) and 77% were female. The majority were of African ethnicity (96%). Mitral regurgitation (39%), followed by mixed MVD (38%) were the dominant lesions. Mitral stenosis was found in 23% of the patients. The main aetiologies were rheumatic heart disease (80%), mitral valve prolapse (11%), myxomatous degeneration (6%) and infective endocarditis (3%). Hypertension (30%) and HIV (12%) were the main co-morbidities. Heart failure was present in 78% of the patients at index hospitalisation. The main complications were pulmonary hypertension (28%) and atrial fibrillation (14%). The patients with MVD tended to be older African females with co-morbidities who had predominant rheumatic mitral regurgitation.