High Risk Of Infection Research Articles

Colchicine to reduce coronavirus disease-19-related inflammation and cardiovascular complications in high-risk patients post-acute infection with SARS-COV-2—a study protocol for a randomized controlled trial

BackgroundThere is no known effective pharmacological therapy for long COVID, which is characterized by wide-ranging, multisystemic, fluctuating, or relapsing symptoms in a large proportion of survivors of acute COVID. This randomized controlled trial aims to assess the safety and efficacy of an anti-inflammatory agent colchicine, to reduce symptoms among those at high risk of developing long COVID.MethodsThis multi-centre, parallel arm, 1:1 individual randomized, placebo-controlled, double-blind superiority trial will enrol 350 individuals with persistent post-COVID symptoms. Participants will be randomized to either colchicine 0.5 mg once daily (< 70 kg) or twice daily (≥ 70 kg) or matched placebo for 26 weeks and will be followed up until 52 weeks after randomization. The primary trial objective is to demonstrate the superiority of colchicine over a placebo in improving distance walked in 6 min at 52 weeks from baseline. The secondary objectives are to assess the efficacy of colchicine compared to placebo with respect to lung function, inflammatory markers, constitutional symptoms, and mental health state. In a sub-sample of 100 participants, cardiac biomarkers of myocardial injury and myocardial oedema using MRI will be compared.DiscussionPersistent inflammatory response following SARS-CoV-19 is one of the postulated pathophysiological mechanisms of long COVID. Colchicine, a low-cost anti-inflammatory agent, acts via multiple inflammatory pathways and has an established safety profile. This trial will generate evidence for an important health priority that can rapidly translate into practice.Trial registrationThis clinical trial has been registered prospectively on www.clinicaltrials.gov with registration CTRI/2021/11/038234 dated November 24, 2021.

Smallpox vaccination campaigns resulted in age-associated population cross-immunity against monkeypox virus.

Increased human-to-human transmission of monkeypox virus (MPXV) is cause for concern, and antibodies directed against vaccinia virus (VACV) are known to confer cross-protection against Mpox. We used 430 serum samples derived from the Scottish patient population to investigate antibody-mediated cross-neutralization against MPXV. By combining electrochemiluminescence immunoassays with live-virus neutralization assays, we show that people born when smallpox vaccination was routinely offered in the United Kingdom have increased levels of antibodies that cross-neutralize MPXV. Our results suggest that age is a risk factor of Mpox infection, and people born after 1971 are at higher risk of infection upon exposure.

Relationship between the ABO/Rh Blood Group Factors with Coronavirus Disease 2019 Severity and Mortality among Hospitalized Patients in Algeria: A Single-center Study

Introduction: The novel coronavirus causes the deadly disease, severe acute respiratory syndrome (SARS). Therefore, it is necessary to identify prognostic factors for patients hospitalized with SARS-coronavirus-2 infection to identify patients with increased mortality risk. Several studies have shown that polymorphisms within the ABO gene are associated with different traits, including risk factors for coronavirus disease 2019 (COVID-19) mortality. Methods: We conducted a prospective, single-center study at the Pulmonologist Department of Rouiba Hospital, Algiers. The medical records of 498 COVID-19 patients enrolled in this cohort study were hospitalized between March 2020 and March 2022. The patient reported the blood group (grouping card) or was carried out on site. The patients were divided into 10 groups: A+, A−, B+, B−, O+, O−, AB+, AB−, (Rhesus+ABO/Rh blood groups), and Rhesus-groups, according to the distribution of ABO blood group. The different ABO blood group of the 498 patients was analyzed and compared according to their prognosis, death, or transfer to an intensive care unit. Results: Four hundred and ninety-eight patients were evaluated, 213 (42.8%) were male, and the mean age was 55.2 years (standard deviation: 15.3). A total of 473 (94.98%) patients were discharged, and 25 (5.02%) died during hospitalization. The number of patients with ARh negative was significantly higher in the dead patients 30% among 10 patients (P = 0.0002) versus 5.6% for A+, compared to improved individuals and more computed tomography scan lesion extension 40% (P = 0.021) between 50% and 75% vs. 13.2% ± 34.0% (P = 0.034) for the A(+) group, and hypernatremia 141.2 ± 2.7 (P = 0.056) versus 137.4 ± 4.36 for A(+) group. The distribution of ABO blood groups was statistically different between the two groups. The dead patients had the blood groups A(−), (30%), A+ (5.6%), B− (0%), B+ (1.5%), AB− (0%), AB+ (0%), O− (20%), and O+ (4.3%), respectively. Conclusion: The protective nature of all blood groups (AB, B, and O+) was observed in patients presenting with COVID-19 symptoms of varying severities. Blood grouping A and especially A− and O− are marked by a high risk of COVID-19 infection, serious form, and mortality and therefore deserve particular attention in their management.

The Efficacy of Vibhithaki Ksharasutra in the Management of Nadivrana w.s.r Pilonidal Sinus

Pilonidal sinus (PNS) is a chronic disorder that occurs in the space between the buttocks (natal cleft). Men are more susceptible (because they have more hair) to pilonidal sinus than women. Excision, primary closure and reconstructive flap surgery are the most commonly used surgical techniques for this disease. However, there is a high risk of recurrence or wound infection after surgery. In addition, the patient needs a longer hospital stay, and the procedure is expensive. Acharya Susrutha (800 BC) considered this disease under Nadivrana (Shalyaja) and advocated a minimally invasive para surgical treatment namely the Kshara Sutra procedure. Susrutha mentioned Kshara dravyas like Apamarga, Palasha, Vasa, Vibhithaki, etc used in the preparation of the Ksharasutra. Here we selected Vibhitaki to prepare Kshara and Ksharasutra. Vibhithiki is cost-effective as it is easily available and the properties of this plant are favourable to Kshara qualities. The present case study deals with the efficacy of Vibhitaki Ksharasutra in the management of Nadivrana (pilonidal sinus).

Expansion of effector memory Vδ2neg γδ T cells associates with cytomegalovirus reactivation in allogeneic stem cell transplant recipients.

Cytomegalovirus (CMV) reactivation is a significant concern following allogeneic stem cell transplantation. While previous research has highlighted the anti-CMV reactivation effect of γδ T cells in immunocompromised transplant patients, their characterization in recipients at high risk of CMV reactivation remains limited. This study focused on D+/R+ recipients (where both donor and recipient are CMV seropositive) at high risk of CMV reactivation. We analyzed 28 patients who experienced CMV recurrence within 100 days post-allogeneic hematopoietic stem cell transplantation, along with 36 matched recipients who did not experience CMV recurrence. Clinical data from both groups were compared, and risk factors for CMV reactivation were identified. Additionally, CMV viral load was measured, and flow cytometric analysis was conducted to assess changes in peripheral blood γδ T cell proportions, subpopulation distribution, and differentiation status. We also analyzed the CDR3 repertoire of the TCR δ chain in different γδ T cell subsets. Functional analysis was performed by measuring the lysis of CMV-infected cells upon stimulation. CMV reactivation post-transplantation was associated with acute graft-versus-host disease (aGvHD) and reactivation of non-CMV herpesviruses. Notably, CMV reactivation led to sustained expansion of γδ T cells, primarily within the Vδ2neg γδ T cell subpopulation, with a trend toward differentiation from Naive to effector memory cells. Analysis of the δ chain CDR3 repertoire revealed a delay in the reconstitution of clonal diversity in Vδ2neg γδ T cells following CMV reactivation, while Vδ2pos T cells remained unaffected. Upon stimulation with CMV-infected MRC5 cells, the Vδ2neg γδ T cell subpopulation emerged as the primary effector cell group producing IFN-γ and capable of lysing CMV-infected cells. Moreover, our findings suggest that NKG2D is not necessary involved in Vδ2neg γδ T cell-mediated anti-CMV cytotoxicity. This study provides novel insights into the role of γδ T cells in the immune response to CMV reactivation in transplantation recipients at high risk of CMV infection. Specifically, the Vδ2neg γδ T cell subpopulation appears to be closely associated with CMV reactivation, underscoring their potential role in controlling infection and reflecting CMV reactivation in HSCT patients.

Comparative Evaluation of the Use of the Double Cementation Method and Modular Metal Augments for the Replacement of Bone Defects in Revision Knee Arthroplasty

&lt;b&gt;Background: &lt;/b&gt;During revision arthroplasty of the knee joint, defects of the femur and tibia may occur. One common method to replace these defects is the use of modular metal augments, but this method has certain disadvantages. Therefore, we suggest using the double cementation method.&lt;br /&gt; &lt;b&gt;Objective: &lt;/b&gt;This study aims to compare the effectiveness of the double cementation method and modular metal augments in replacing bone defects during revision knee replacement.&lt;br /&gt; &lt;b&gt;Material and Methods: &lt;/b&gt;We examined 150 patients diagnosed with periprosthetic infection who were treated at the National Scientific Center of Traumatology and Orthopedics named after Academician N.D.Batpenov from 2021 to 2024. For a randomized study, 36 patients were selected, divided into 2 groups of 18 people. In the main group, the double cementing method was used to replace defects of the femur and tibia during revision knee arthroplasty; in the control group, metal augments were used. A follow-up examination was conducted on all patients one year after the surgery.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;No significant differences were found between the groups in terms of the number of hospital beds spent (p = 0.11), bed days spent in the intensive care unit after surgery (p = 0.44), duration of surgery (p = 0.18), amount of intraoperative blood loss (p = 0.18), knee joint function according to the Knee Society Score (p = 0.23) and Oxford Knee Score (p = 0.09). In the main group, signs of radiographic instability were detected in 1 case (5.6%), in the control group, there were revealed 5 (27.8%) cases. The number of cases of periprosthetic infection in the main group was 1 case (5.6%), in the control group were 3 cases (16.7%).&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;The double cementation method is less likely to cause radiography lines of illumination at the cement/bone boundary and may be recommended for high-risk postoperative infections. Additionally, it may be more cost-effective than using metal augments.

Mycotic flora characteristics of the endontic flora in patients affected by COVID-19

BACKGROUND: Owing to the fact that, presently, at a dental appointment, it is possible to observe a wide range of consequences arising after COVID-19, among which are observed lesions of the pulp and periodontium of the tooth, additional diagnostic methods should be introduced before choosing treatment tactics. In our previous study, we analyzed the contents of root canals of teeth in patients who had COVID-19 using bacterioscopy. Coccus flora was detected in all cases and elements of Candida yeast-like fungi were recorded in 89 cases (76.1%). Based on the obtained data, it was advantageous to perform microbiological examination of the endodontium in this group of patients to further study their physical and chemical properties and correct the treatment regimen in gangrenous form of chronic pulpitis and aggravated forms of periodontitis, which determined the relevance of the present study. AIM: To reveal the characteristics of the mycotic flora of the endodontium in patients who previously had COVID-19. MATERIALS AND METHODS: A bacteriologic study of root canal contents in patients who had previously undergone a new coronavirus infection at different times, diagnosed as “exacerbation of chronic periodontitis”, “chronic gangrenous pulpitis”, and “acute suppurative periodontitis”, was conducted to detect fungi of the genus Candida in the tooth root canal system, which was obtained during mechanical treatment with a sterile endodontic instrument. The patients (n=49) were divided into groups according to their final diagnosis: group 1, chronic gangrenous pulpitis (27 patients); group 2, acute purulent periodontitis (9 patients); and group 3, exacerbation of chronic periodontitis (13 patients). Then, the collected material was placed in a tube with Amies transport medium and sent to the laboratory. Seeding of the material was performed in sterile Petri dishes on Sabouraud agar by rubbing with a plastic spatula. Further, Petri dishes were placed in the thermostat for 24–48 hours of incubation at 37±10 °C. Then, the study was carried out according to the generally accepted scheme: the obtained cultures were identified to species by the character of growth on dense medium. RESULTS: The given bacteriological study of the patients’ endontic contents confirmed the data of bacterioscopy and concretized the previously obtained results. On final examination, black colonies of Candida albicans were observed in 95.92% of cases. No growth of Candida albicans colonies was observed in two cases (4.08%). CONCLUSION: The bacteriologic study performed after bacterioscopy of diagnosis confirmed the presence of fungi of the genus Candida in the root canals of teeth in patients who previously had COVID-19. The study showed that when treating similar patients, the high risk of infection of periodontal complex tissues by Candida fungi should be considered. It is advisable to supplement the standard protocols of endodontic treatment with physical exposure, for example, laser radiation, or additional medication with antifungal drugs, such as fluconazole.

Long-term surveillance study of rituximab originator treated patients with granulomatosis with polyangiitis (GPA)or microscopic polyangiitis (MPA).

Rituximab is used for remission induction and the prevention of relapse in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). This study evaluated the incidence of safety events and compared time to first serious adverse event (SAE) between a rituximab cohort and a cohort treated with non-rituximab therapies in a real-life setting. Rituximab surveillance study in vasculitis was a retrospective observational study of patients with AAV who received rituximab (MabThera) or other treatments between 2003 and 2017 at a specialist vasculitis clinic. The primary endpoint was time to first SAE. 392 patients were enrolled: 247 in the rituximab and 145 in the control cohorts with a total follow up of 2217 person-years (mean study duration 5.7 years). Mean age was 61 years, 77% had granulomatosis with polyangiitis (GPA). There were differences in baseline characteristics (disease duration and prior immunosuppressive use) between groups. 134/247 patients (54%) in the rituximab and 58/145 (40%) of controls experienced at least one SAE. Time to first SAE was shorter in the rituximab group (hazard ratio (HR) 1.55, 95% CI 1.07-2.26, P = 0.022). Predictors of first SAE were higher vasculitis damage index and the presence of chronic pulmonary or kidney disease. The risk of serious infection was higher in the rituximab group (relative risk (RR) 2.12, 95% CI 1.31-3.43). Over 40% of patients with AAV experienced at least one SAE. Although shorter time to first SAE and higher risk of infection were observed in the rituximab group, baseline imbalances necessitate a careful interpretation of these results.

Surgical treatment of cripple hypospadias in the adult

Clinical case: The case of a 21-year-old male with a diagnosis of hypospadias of the distal penile urethra and a history of 7 failed surgical interventions to correct hypospadias during his childhood and adolescence is reported. A urethral plasty was performed with oral mucosa graft and a Dartos flap to resolve the hypospadias. Relevance: Hypospadias is the second most common congenital urologic condition in males and presents as incomplete closure of the urethra, ventral displacement of the meatus, and abnormalities of the prepuce, as well as other penile structures. The etiology points towards genetic causes, deficient hormonal stimulation and the placenta-fetus relationship, but the exact cause is still unknown. The treatment is surgical and consists of the tubulation of grafts for the reconstruction of the urethra, its objective is to correct the functionality and preserve the aesthetics, surgery is recommended from 6 to 18 months. Hypospadias is rare in adults, and management is also surgical; there is no treatment of choice due to the complexity of the cases and the factors specific to each patient. The risk of complications will increase with the age of the patient and the number of previous interventions. Conclusion: Hypospadias is rare during the adult stage because most of it is treated during childhood. It is considered that the use of oral mucosa grafts plus data flap is a good option for the treatment of these patients since most present unfavorable factors such as fibrosis, ischemia and a higher risk of infection.

Clinical profile of dengue fever and dengue haemorrhagic fever in Indonesian children: A six year retrospective study

Background: Dengue infection is still a significant public health problem in Indonesia. An appropriate clinical profile is helpful in early identification of patients with a high risk for severe dengue infection. Objectives: To report the prevalence, characteristics, and clinical outcomes of patients with dengue fever (DF) and dengue haemorrhagic fever (DHF). Method: This was a retrospective study of childhood hospitalisation in Siloam Hospitals Lippo Village, Indonesia from January 2015 to December 2020. Demographic data, clinical signs, and laboratory findings were collected and processed using SPSS version 26. Results: Of 528 patients, 85.6% were DF, 10.4% were DHF grades I and II, and 4% were DHF grades III and IV. Median ages of patients with DF, DHF grades I and II, and DHF grades III and IV were 10.9, 12.4 and 8.5 years respectively. Common clinical symptoms of DF patients were headache (67.5%), loss of appetite (41.8%), and vomiting (40.9%). While 52.7% patients with DHF grades I and II had respiratory symptoms, 42.9% patients with DHF grades III and IV had hepatomegaly. Conclusions: Common clinical symptoms of DF and DHF patients were headache, loss of appetite and vomiting. Whilst 52.7% patients with DHF grades I and II had respiratory symptoms, 42.9% patients with DHF grades III and IV had hepatomegaly.

Isolation And Diagnosis Of Skin Fungi That Causes Tinea Capitis In The Children

One hundred clinical samples of hair and scalp flakes were collected for children with tinea capitis aged from 1 year to 12 years from the dermatology consultant affiliated with Tikrit Teaching Hospital and outpatient clinics, with the aim of isolating the pathogenic fungi that cause tinea capitis and diagnosing them in children. Out of the total, 77 samples were found in the laboratory culture, while the findings of the direct microscopic examination indicated the presence of 55 samples. Several dermatophyte species from the genera Trichophyton and Microsporum were identified. T. mentagrophytes was the most prevalent with 18 isolates (23%), followed by T. violaceum and T. rubrum, each with 12 isolates (15%). Next, there were 10 isolates of the fungus T. schoenleinii (13%), compared to 4 isolates (10%) of each of the two species of fungus, T. tonsurans and T. verrucosum. While fungi belonging to the genus Microsporum were isolated at a rate of 10 isolates (13%) of the type M. canis, while 7 isolates of the M. gypsum type were isolated (9%). The incidence of tinea capitis among was greater in men than in women., as the number of infected males was 62 (62%), and females were 38 (38%) infected out of the total number. Regarding age groupings, 20% of children between the ages of one and four have head ringworm. The infection rate for children aged 5-8 was 32%, and the highest risk of infection was for those aged 9-12, who were at risk for 48%. It was also found that the rate of infection with the fungi that cause tinea capitis in the children from whom the samples were taken was high among patients coming from rural areas, at 80%, compared to patients coming from urban areas, at 20%.

Mortality trends (1999-2022) in patients with multiple myeloma with pneumonia, influenza, and COVID-19.

7553 Background: Patients (pts) with multiple myeloma (MM) are immunosuppressed either due to the hypogammaglobulinemia and impaired plasma cell function or due to pharmacological management and stem cell transplantations. Consequently, they are at a higher risk of infections. This study aims to evaluate the changes in mortality from COVID-19 (CVD), influenza virus (FLU), and pneumonia (PNA) in MM pts in the era of CVD pandemic. Methods: Using the Wide-ranging Online Data for Epidemiologic Research (WONDER) database from the CDC, we collected mortality data for pts with CVD (U07.1 code), FLU and PNA (J09-J18 codes), and MM (C90.0 code). Using sex and ethnicity-specific stratification, the gathered data made it easier to calculate age-adjusted mortality rates (AAMRs) per 100,000 people. Using the collected data we were able to analyze mortality patterns over the years 1999-2022. Results: Overall, 25,271 MM pts died from CVD, FLU and PNA between 1999 to 2022. The mortality rate remained stable from 1999 to 2019 ranging between 0.4 AAMR per 100,000 to 0.3 AAMR, representing an annual percentage change (APC) of -0.5%. However, the mortality rate increased in 2019, rising from 0.3 AAMR per 100,000 to 0.5 in 2022, with APC of 7%. When evaluating the trends by gender, there was an increase in mortality among male pts, rising from 0.4 AAMR per 100,000 to 0.7 between 2019 and 2020, while the increase among females was minimal, from 0.3 AAMR per 100,000 to 0.4. While Hispanic, White, and African American ethnicities mortality increased in 2020-2022, Asian pts maintained a rate of 0.2 AAMR in 2019, 2020, and 2022 (Table). Conclusions: We showed an increase in mortality among pts with MM combined with CVD, FLU, or PNA between 2020 and 2021. It might be attributable to the CVD pandemic, announced by WHO in March 2020. Despite the FDA's approval of the first CVD vaccine in December 2020, the emergence of new CVD variants and limited vaccine availability could have contributed to a continued increase in mortality in 2021.In 2022, we noticed a drop in mortality. It might be explained by the wider accessibility to CVD vaccination or to diminished virulence. Additionally, increased awareness of the importance of CVD vaccinations in immunocompromised pts could also lead to increased FLU vaccination rates. It might explain the downtrending mortality of pts with MM, FLU and PNA only in 2021. This is the first study presenting the mortality trend of MM pts with FLU, PNA and CVD, and comes to highlight the importance of vaccination in immunocompromised MM pts. [Table: see text]

Correlation Analysis between STING Promoter Polymorphism and Susceptibility to Infection after Chemotherapy for Multiple Myeloma

To investigate the correlation between the stimulator of interferon genes (STING ) promoter polymorphism and the susceptibility to infection after chemotherapy for multiple myeloma. A total of 102 patients who had undergone chemotherapy for multiple myeloma in our hospital from January 2016 to July 2022 were selected. Depending on the presence or absence of infection after chemotherapy, the enrolled patients were divided into infection group (53 cases) and non-infection group (49 cases). The infection sites and distribution characteristics of pathogenic bacteria of the infection group were analyzed. The genotype distribution of STING gene promoter rs587777609 was compared between the two groups, and the risk factors of infection after chemotherapy for multiple myeloma were analyzed. For infection site, digestive system, respiratory system, urinary system, skin and mucous membranes accounted for 43.40%, 26.42%, 20.75%, and 9.43%, respectively. For pathogenic bacteria, Gram-negative bacteria, Gram-positive bacteria and fungi accounted for 57.14%, 26.98%, and 15.87%, respectively. The CC genotype frequency of STING gene rs587777609 locus in the infection group was lower than that in the non-infection group, while the TT genotype frequency was higher than that in the non-infection group (P < 0.05). The proportions of patients with diabetes, chronic obstructive pulmonary disease, renal insufficiency, serum albumin level< 35 g/L, ISS stage III, mechanical ventilation, and indwelling catheter in the infection group were higher than those in the non-infection group (P < 0.05). Multivariate logistic regression analysis showed that diabetes (OR =1.992), serum albumin level< 35 g/L (OR =2.782), ISS stage III (OR =2.707), mechanical ventilation (OR =3.031), and TT genotype (OR =2.401) were risk factors of infection after chemotherapy for multiple myeloma (P < 0.05). There is a correlation between STING promoter polymorphism and the susceptibility to infection after chemotherapy for multiple myeloma, and patients with TT genotype have a higher risk of infection.

Safety and Efficacy of Mycophenolate Mofetil Associated With Tacrolimus for Kidney-pancreas and Kidney Transplantation: A Systematic Review and Meta-Analysis of Randomized Studies

IntroductionThis study evaluated the efficacy and safety of mycophenolate mofetil (MMF) associated with tacrolimus (TAC) in patients undergoing kidney-pancreas and kidney transplants, in comparison with cyclosporine (CyA), azathioprine (AZA), everolimus (EVL), sirolimus (SRL), manitimus (MAN), mizoribine (MZR), and enteric-coated mycophenolate sodium (ECMPS) in combination or monotherapy. MethodsA systematic review and meta-analysis of randomized clinical trials was performed. The outcomes comprised acute rejection, graft loss, and adverse events. ResultsThirty studies were included. The main adverse events related to the TAC+MMF scheme were infection (36%; 95%CI: 26%-46%), including cytomegalovirus (CMV) (14%; 95%CI: 8%-20%); anemia (20%; 95%CI: 2%-37%); leukopenia (18%; 95%CI: 3%-33%); nausea (20%; 95%CI: 1%-39%); and diarrhea (26%; 95%CI:13%-40%). TAC+MMF was compared to the schemes AZA+TAC, CyA+AZA, CyA+MMF, CyA+SRL, ECMPS, EVL, MAN+TAC, MMF+SRL, MZR, TAC+AZA, TAC+EVR, TAC+MZR, TAC +SRL and TAC. TAC+MMF was associated with a lower risk of rejection than MMF monotherapy (RD: -0.24; 95%CI -0.46; -0.02). Comparing TAC+MMF with the other regimens, no significant difference was found for graft loss. TAC+MMF was associated with a higher risk of infections than MZR (RD: 0.174; 95%CI: 0.25; 0.323) and TAC monotherapy (RD: 0.07; 95%CI 0.003; 0.138). ConclusionGastrointestinal and hematological adverse events and infections are the most common with TAC+MMF for kidney-pancreas and kidney. TAC+MMF effectively prevents acute cellular rejection, and alternatives with AZA, CyA, SRL, ECMPS, EVL, MAN, and MSR have similar efficacy and safety profiles. TAC monotherapy and MZR may be associated with a lower risk of infections.

ОПЫТ ЛЕЧЕНИЯ ПАЦИЕНТОВ СО СВИЩАМИ ОБОДОЧНОЙ КИШКИ ДИВЕРТИКУЛЯРНОГО ПРОИСХОЖДЕНИЯ

Abstract. Introduction. In the 21st century, a massive increase was noted in the incidence of diverticular disease (DD) by more than 10 times with an increase in the frequency of its complications ranging from 5 to 25%. According to the literature, the colon fistulation frequency is 5-30%, over a half of such formations being colovesical fistulas. The problem of surgical approaches to the purulent-inflammatory complications of DD is far from being resolved. Despite the fact that diverticular disease is a benign pathology, inflammatory process often creates serious technical difficulties in surgery due to the violation of the anatomical relationship of the intestine with the surrounding organs, while surgeries often affect several organs with a high infection risk. Aim. Analysis of the results of the treatment of patients with diverticular colon fistulas in a specialized department of a multidisciplinary hospital. Materials and Methods. Treatment outcomes were analyzed retrospectively in 347 patients with diverticular colon disease complications for the period from 2013 to 2022. The study included 17 patients with diverticular fistulas: 14 (82.4%) patients with internal (intestinal-urinary (13) and intestinal-vaginal (1)) fistulas and 3 (17.6%) with external ones. Results and Discussion. The therapeutic and diagnostic algorithm for diverticular fistulas required a wide range of diagnostic methods and a multidisciplinary approach. Surgery remains the single treatment option for this pathology. The choice of the surgical procedure depended on the inflammatory process severity, its spread to the surrounding abdominal organs, and the largest diverticula accumulation in the gut. In the group of patients with intestinal-urinary fistulas, the resection was not limited to the removal of the colon segment only. In 9 (52.9%) cases, it was expanded to the anterior rectum resection due to the inflammation transition to its upper ampullary region. We are supporters of the one-stage surgical procedures with forming the primary anastomosis in patients with diverticular fistulas. We give preference to the Sigal-Ramazanov invagination anastomosis that allows avoiding the anastomosis due to creating a duplicate of the intestinal wall hiding the anastomosis zone. The paper identifies probable predictors of complicating diverticular disease with fistulation. Conclusions. Choosing the optimal treatment option for patients with diverticular disease complications is a difficult problem. It is better to operate on them in the coloproctology departments of multidisciplinary hospitals with the established good interaction among the members of a multidisciplinary team.

Maternal and Fetal Prognosis in Pregnant Women with Renal Disease Associating Urinary Tract Infection.

Pregnancy related acute renal injury is a challenging diagnosis, mainly due to, among other factors, the physiological decrease in blood nitrogen retention parameters. As a consequence, the criteria required to establish the diagnosis may be first met as a result of the complications that appear, especially hypertension. The maternal and fetal complications which may occur in pregnancies with renal failure can be worsened by the relative immunodeficiency during pregnancy, which represents an elusive mechanism that is associated with a high risk of urinary tract infection (UTI). Therefore, the risk for intensive care unit admission, or developing sepsis, or preterm birth can increase. The present study aims to investigate whether the superimposition of UTI over an altered renal function leads to a worsened maternal and fetal prognosis. We performed an observational retrospective study that included pregnant women with increased serum creatinine levels, both with and without UTI. Thus, we analyzed 47 pregnant women who delivered in our unit between 1 January 2021 and 1 September 2023. Patients were divided into three groups: an acute renal injury (AKI) group (n=16), a chronic kidney disease (CKD) group (n=8) and a control group (n=23) which included patients with serum creatinine levels between 0.80-1 mg/dL. We evaluated the maternal and fetal complications in all three groups, taking into consideration the comparison between maternal and fetal parameters in women with UTI. Our study highlighted an important difference between fetal weight at delivery by patients with AKI associating UTI and the two remaining groups (1395 ± 992.50 grams compared to 2340 grams in the CKD group and 3103.33±83.86 grams in the control group, respectively). There was no statistically significant difference regarding preterm birth, intrauterine grow restriction, stillbirth or neonatal intensive care unit (NICU) admission. Preterm birth had a higher incidence in all patients with AKI (87.5% compared to 50% and 34.78%, respectively). Neonatal complications are important in pregnant women with AKI and CKD, irrespective of the UTI diagnosis. Most fetal complications occurred in patients diagnosed with AKI. The correlations highlighted by us should be studied further.

Using inductive machine learning to identify risk factors for healthcare workers to get infected with highly contagious viruses (based on COVID-19 model)

Epidemic and pandemic spread of highly contagious viruses (SARS-CoV, influenza A virus, Ebola virus, MERS-CoV, and SARS-CoV-2) has been a trend observed in the first two decades of the 21st century. The predominant impact made by the biological occupational factor on healthcare workers determines their high occupational risk of infection, a severe disease course and a fatal outcome. Epidemiological data mining based on machine learning algorithms is successfully used in epidemiological practice to identify factors (predictors) contributing to infection in various risk populations. In this study, the database generated from a survey of 1312 healthcare workers was analyzed intelligently. A total of 6912 machine learning models were implemented. SARS-CoV-2 infection was found to be facilitated by providing medical care to a COVID-19 patient, using a full set of PPE after direct contact with a COVID-19 patient, direct contact with items in the external (hospital) environment, vaccination against COVID-19 after direct contact with a COVID-19 patient, acting as nursing staff (cleaners) and being present during aerosol-generating procedures. The study identified four groups of predictors determining SARS-CoV-2 infection in healthcare workers: contact with a COVID-19 patient and environmental items, PPE quality and complexity, occupational affiliation of healthcare workers and their BMI values. One predictor was found in 56.2 % of healthcare workers; two, in 19.2 %; three, in 16.4 %; four, in 5.5 %; and five predictors, in 2.7 %. Thus, epidemiological data mining is a modern stage in epidemiological analysis. The use of machine learning methods allows for multifactorial assessment of SARS-CoV-2 infection risks in healthcare workers and enables identifying and reliably estimating the most significant predictors. Intelligent data analysis has flexible architecture, which allows adjusting the model under study and supplementing new data to the existing database, detecting changes in an epidemiological situation and accomplishing relevant preventive and anti-epidemic activities.

Использование индуктивного типа машинного обучения для выявления факторов риска инфицирования медицинских работников высоко-контагиозными вирусами (на модели COVID-19)

Epidemic and pandemic spread of highly contagious viruses (SARS-CoV, influenza A virus, Ebola virus, MERS-CoV, and SARS-CoV-2) has been a trend observed in the first two decades of the 21st century. The predominant impact made by the biological occupational factor on healthcare workers determines their high occupational risk of infection, a severe disease course and a fatal outcome. Epidemiological data mining based on machine learning algorithms is successfully used in epidemiological practice to identify factors (predictors) contributing to infection in various risk populations. In this study, the database generated from a survey of 1312 healthcare workers was analyzed intelligently. A total of 6912 machine learning models were implemented. SARS-CoV-2 infection was found to be facilitated by providing medical care to a COVID-19 patient, using a full set of PPE after direct contact with a COVID-19 patient, direct contact with items in the external (hospital) environment, vaccination against COVID-19 after direct contact with a COVID-19 patient, acting as nursing staff (cleaners) and being present during aerosol-generating procedures. The study identified four groups of predictors determining SARS-CoV-2 infection in healthcare workers: contact with a COVID-19 patient and environmental items, PPE quality and complexity, occupational affiliation of healthcare workers and their BMI values. One predictor was found in 56.2 % of healthcare workers; two, in 19.2 %; three, in 16.4 %; four, in 5.5 %; and five predictors, in 2.7 %. Thus, epidemiological data mining is a modern stage in epidemiological analysis. The use of machine learning methods allows for multifactorial assessment of SARS-CoV-2 infection risks in healthcare workers and enables identifying and reliably estimating the most significant predictors. Intelligent data analysis has flexible architecture, which allows adjusting the model under study and supplementing new data to the existing database, detecting changes in an epidemiological situation and accomplishing relevant preventive and anti-epidemic activities.

Identifying patterns of sexual behaviors and PrEP uptake characteristics among MSM who were eligible for PrEP: A national cross-section study

Men who have sex with men (MSM) are at a high risk of HIV infection and should be offered effective preventive measures, such as pre-exposure prophylaxis (PrEP). However, PrEP uptake among eligible MSM was not as high as desired. Diverse research findings on how risky sexual behaviors affect PrEP uptake highlight the necessity for a comprehensive investigation. Understanding the interconnectedness of different sexual behaviors is crucial for evaluating their impact on PrEP uptake among eligible MSM.Using a proportional sampling method, we recruited 5877 MSM aged 16 years and above in mainland China according to PrEP eligibility criteria. Through latent class analysis (LCA), three distinct sexual behavior patterns were identified among eligible MSM. Demographic variances and PrEP uptake among the three distinct sexual behavior patterns were examined using chi-squared tests and multinomial logistic regression.LCA revealed three patterns: low-risk (4,815 MSM), medium-risk (516 MSM), and high-risk (546 MSM). MSM aged 25 years or older with a monthly income of ≥¥8,000 were more likely to be in the medium-risk group. Those from areas with high HIV prevalence and engaging as "top" in anal sex were more likely to be in the medium- and high-risk groups. The medium- and high-risk groups had a higher willingness, uptake, and adherence rates for PrEP than the low-risk group.LCA is effective in identifying diverse sexual behavior patterns among MSM, aiding targeted interventions to enhance PrEP uptake. Addressing demographic variations and tailoring interventions for specific risk groups are crucial for promoting PrEP dissemination and reducing HIV infection risk in eligible MSM.

Unveiling a low-hanging fruit: Single-center study on secondary immunodeficiency in newly diagnosed chronic lymphocytic leukemia and multiple myeloma.

e23215 Background: Infectious complications are the leading cause of morbidity and mortality in patients with chronic lymphocytic leukemia(CLL) and multiple myeloma(MM). Despite recognized risks, evaluation of immune function occurs inconsistently. Our retrospective study evaluated practice patterns for assessing secondary immunodeficiency (SID) in newly diagnosed CLL and MM patients. Our aim is to identify areas for improvement to guide future prospective studies. Methods: We analyzed various immune parameters in newly diagnosed CLL and MM patients at Rochester Regional Health, Rochester, NY, focusing on the first six months of their clinical course, with descriptive data analysis. Results: Conclusions: Current infection prevention guidelines for newly diagnosed CLL and MM patients lack robust evidence. Despite our study’s inherent limitations (small, retrospective, single-center), based on our clinical experience, we propose the following recommendations: Complete SID assessment in all new diagnoses of CLL and MM, and this should include not only Ig levels but also vaccine response. If found to have abnormal SID evaluation, consider prophylactic antibiotics and Ig replacement, and consider reevaluation when appropriate to better define the duration of immunoparesis. Consider short-term Ig replacement (irrespective of IgG levels) and antibacterial prophylaxis for all newly diagnosed MM patients due to high infection risk during the initial six months. A thorough immune evaluation is non-invasive and low-cost, yet it can reveal clinically significant immune dysfunction, potentially influencing management in CLL and MM. Consequently, we hope our study will prompt the development of prospective, randomized studies to systematically evaluate these recommendations. [Table: see text]