High Risk Of Infection Research Articles

What determinants of COVID-19 vaccine hesitancy among Chinese nursing students? A cross-sectional study.

The coronavirus disease 2019 (COVID-19) continues to threaten human health, and health professionals, including nursing students, usually work in healthcare frontiers with a high risk of infection. Vaccination is currently one of the most effective preventive measures. This study aimed to explore the determinants of COVID-19 vaccine hesitancy in nursing students. In November 2022, a sample of undergraduate nursing students was recruited from several medical schools in Anhui Province, China, and an online cross-sectional survey was conducted using the questionnaire star platform (Wenjuanxin). A Chi-square test was used to explore vaccine hesitancy among nursing students with different social demographic characteristics and vaccine attitudes. Binary logistic regression analysis was then used to determine the influence factors of vaccine hesitancy among nursing students. A total of 1,090 valid samples were collected in this study. Of these, 27.06% (295) of nursing students reported COVID-19 vaccine hesitancy. The results showed "the need to go out of town recently" (OR = 0.670), "very confident that the outbreak could be controlled sustainably" (OR = 0.393), "feeling at risk of infection" (OR = 0.658), "not being worried/being generally worried about the vaccine's safety" (OR = 0.226 and OR = 0.686, respectively), and "not being worried about the vaccine's effectiveness" (OR = 0.411). These five factors are protective factors associated with COVID-19 vaccine hesitancy in nursing students. The factors "considering the country completely safe from an outbreak" (OR = 3.436), "considering themselves safe because others are vaccinated" (OR = 2.239), and "Agreeing that other protective measures can be relaxed after vaccination with the COVID-19 vaccine" (OR = 2.007) are risk factors associated with COVID-19 vaccine hesitancy among nursing students (P < 0.05). Overall, relatively few nursing students had COVID-19 vaccine hesitancy. Schools and relevant institutions still need to actively guide them to improve their confidence in the COVID-19 vaccine, strengthen the prevention and control measures of the epidemic, and improve their awareness of the crisis to improve the vaccination rate to reduce the COVID-19 vaccine hesitancy in nursing students.

Self-reported Infection Status, Knowledge and Associated Factors of Monkeypox Among Men Who Have Sex with Men in Jiaxing, China

BackgroundAs of September 2023, more than 1,000 cases of monkeypox (mpox) have been reported in China. Based on the available evidence, men who have sex with men (MSM) are at high risk for mpox infection. This study aimed to analyses the self-reported infection status, knowledge, attitude and influencing factors of monkeypox among MSM in Jiaxing City, China.MethodsA web-based cross-sectional survey was conducted in September 2023 to gather data on participants’ socio-demographic profiles, mpox-related knowledge, sexual behavior characteristics, and other potentially related information to mpox knowledge. Multivariate regression modeling was employed to analyze the factors influencing the level of mpox-related knowledge.ResultsA total of 562 MSM were recruited; 4.3% self-reported being HIV-positive, 83.3% of respondents had heard of mpox, and 2.3% of them reported having suspected symptoms. 89.7% of respondents were willing to be vaccinated against mpox, but only 24.8% had a high level of knowledge about mpox. The main factors influencing knowledge of mpox were education level, household registration, homosexual anal intercourse in the past 6 months, and taking the HIV pre-exposure prophylaxis (PrEP).ConclusionsKnowledge of mpox among MSM living in the Jiaxing area needs to be enhanced, but willingness to get vaccinated is high. Educational level, household location, sexual behavior and PrEP use have important effects on knowledge of mpox. Individuals exhibiting symptoms indicative of suspected mpox had a diminutive consultation frequency, and it is imperative to augment screening efforts for mpox symptoms within specific demographic groups to prevent the underreporting of mpox cases.

The effect of nurses' attitudes towards evidence-based nursing on the level of compliance with isolation measures in nurses caring for liver transplant patients.

Liver transplant recipients are at a high risk of infection during the first month. Therefore, it is crucial to implement isolation measures correctly to prevent the spread of nosocomial infections. Evidence-based practices and proper implementation of isolation measures can significantly reduce morbidity and mortality. The study aimed to investigate the impact of nurses' attitudes towards evidence-based nursing on their compliance with isolation measures. This is a descriptive study conducted between October 2023 and January 2024, with the participation of 137 nurses working in the organ transplant clinics of a university hospital in Turkey. Data was collected using a participant introduction form, the attitudes towards evidence-based nursing scale, and the compliance with isolation measures scale. The mean total score for the scale of attitudes towards evidence-based nursing among nurses was 55.95 ± 10.43 (15-75). Similarly, the mean total score for the scale of compliance with isolation measures was 71.44 ± 13.53 (18-90). Both scores were above the middle level. The study found a moderately significant positive correlation between attitudes towards evidence-based nursing and compliance with isolation measures (r: 0.670, p: 0.000). The regression model showed that the attitude towards evidence-based nursing explained 44.9% of the positivity towards isolation measures (R2 = 0.449). The study found a positive correlation between nurses' positive attitudes towards evidence-based nursing and their compliance with isolation precautions when caring for liver transplant patients. This highlights the significance of evidence-based nursing in patient care and the importance of adhering to isolation measures to prevent nosocomial infections.

Burn Wound Healing Activity of Hydroxyethylcellulose Gels with Different Water Extracts Obtained from Various Medicinal Plants in Pseudomonas aeruginosa-Infected Rabbits.

Burn injuries represent a significant problem in clinical practice due to the high risk of infection and the prolonged healing process. Recently, more attention has been given to natural remedies such as water extracts of various medicinal plants, which possess anti-inflammatory and wound healing properties. The aim of this study is to evaluate the efficacy and safety of Satureja montana L. and other water extracts in a burn wound model. The study involved male Californian rabbits (n = 52) divided into eight groups. Burn wounds were modeled on the animals and subsequently treated with gels based on Satureja montana L. and other water extracts. The reparative potential of the epidermis (assessed by Ki-67 expression), the state of local immunity (measured by the number of CD-45 cells), and the anti-inflammatory role of mast cells (measured by tryptase levels) were evaluated. Bacteriological and morphological studies were conducted. The most pronounced bactericidal, reparative, and immunostimulatory effects were observed after the treatment using a gel mixture of water extracts from Satureja montana L., Salvia sclarea, Coriandrum sativum L., and Lavandula angustifolia in equal proportions (1:1:1:1). The other gels also demonstrated high efficacy in treating burn wounds, especially when using a strain of Pseudomonas aeruginosa resistant to several antibiotics. Immunohistochemical studies showed a significant increase in the number of Ki-67-positive cells in the basal layer of the epidermis and a decrease in the number of CD-45-positive cells, indicating improved proliferative activity and reduced inflammation. This study confirms the hypothesis that the use of water extract mixtures significantly enhances the reparative potential, improves the immune response in the treatment of burns, and promotes wound healing. These findings pave the way for further research and the application of complex phytotherapeutic agents, specifically water extracts of medicinal plants containing phenols and antioxidants in burn wound therapy.

Subcutaneous versus Transvenous Implantable Cardioverter Defibrillator in Patients with End-Stage Renal Disease Requiring Dialysis: Extended Long-Term Retrospective Multicenter Follow-Up.

Implantable cardioverter defibrillators (ICD) prevent sudden cardiac death (SCD). Patients with end-stage renal disease (ESRD) requiring dialysis are at a very high risk of infection from cardiac implantable electronic device (CIED) implantation as well as mortality. In the present study, we compared the long-term complications and outcomes between subcutaneous ICD (S-ICD) and transvenous ICD (TV-ICD) recipients. In this retrospective analysis, we analyzed a total of 43 patients with ESRD requiring dialysis who received either a prophylactic S-ICD (26 patients) or a single right ventricular lead TV-ICD (17 patients) at seven experienced centers in Germany. Follow-up was performed bi-annually, at the end of which the data concerning comorbidities and, if applicable, reason for death were checked and confirmed with patients' general practitioner, nephrologist and cardiologist. The median follow up duration was 95.6 months (range 42.8-126.3 months). Baseline characteristics were without noteworthy significant differences between groups. During follow-up (FU), there were significantly more device-associated infections (HR 8.72, 95% confidence interval (CI), 1.18 to 12.85, p < 0.05) and device-associated hospitalizations (HR 10.20, 95% CI 1.22 to 84.61, p < 0.001), as well as a higher cardiovascular mortality (HR 9.17, 95% CI 1.12 to 8.33, p < 0.05), in the TV-ICD group. The number of patients requiring hospitalization for any reason was significantly higher in the TV-ICD group (HR 2.59, 95% CI 1.12 to 6.41, p < 0.05). There was no significant difference in overall mortality (HR 1.92, 95% CI 0.96 to 6.15, p = 0.274). Our data suggest that, in this extended follow-up in seriously compromised renal patients on dialysis, the S-ICD patients have statistically fewer device infections and hospitalizations as well as lower cardiac mortality compared with the TV-ICD cohort.

Commentary on: Factors influencing foot care behaviour among patients with diabetes: An integrative literature review by Woo MWJ, CUI J (2023).

The review by Woo etal. reports on factors influencing behaviour in the care of the diabetic foot, wich are common in diabetic patients and have a high risk of infection and amputation. To improve patient's knowledge and education on foot care, this commentary proposes the Barrows cards as an innovative user-friendly educational method. Conclusion and implications for profession and patient care: adapting these cards to adult diabetic patients could prevent future complications, improving quality of life and reduce the risks associated with diabetes. No patient or public contribution.

Aspirin and Ticagrelor Versus Aspirin and Clopidogrel or Prasugrel and the Effect on Staphylococcal-associated Infections: A Real-world Study

Antiplatelet therapy is used for the primary and secondary prevention of thrombotic diseases such as acute coronary syndrome (ACS). These patients are more vulnerable to infections, as such, strategies are required to mitigate these risks. We conducted a retrospective cohort study using TriNetX, a global federated health research network that includes both inpatient and outpatient electronic medical records from health care organizations worldwide. Patients ≥18 years old, after ACS, who were placed on aspirin and ticagrelor were compared with patients placed on aspirin and clopidogrel or prasugrel. Patients were identified using International Statistical Classification of Diseases and Related Health Problems terminology codes. After propensity score matching (1:1), a total of 239,358 patients were identified in each cohort. The primary outcomes of interest investigated were rates of (1) acute and subacute infective endocarditis, (2) sepsis of unknown origin, (3) staphylococcus arthritis, (4) cellulitis and acute lymphangitis, (5) Staphylococcus aureus bacteremia, and (6) staphylococcal pneumonia after initiation of treatment. Outcomes were analyzed at 1, 3, and 5 years. At 5 years, a combination of aspirin and ticagrelor, compared with a combination of aspirin and clopidogrel or prasugrel, was associated with significantly reduced rates of (1) acute and subacute endocarditis (hazard ratio [HR] plus 95% CI) (HR = 0.85; 0.77-0.945; P = 0.030), (2) sepsis of unknown origin (HR = 0.89; 95% CI, 0.86-0.91; P < 0.0001), (3) cellulitis and acute lymphangitis (HR = 0.89; 95% CI, 0.87-0.92; P < 0.0001, and (4) Staphylococcus aureus bacteremia (HR = 0.72; 95% CI, 0.61-0.85; P = 0.0007). However, a combination of aspirin and clopidogrel was associated with a marinally lower risk of staphylococcal pneumonia (HR = 1.04; 95% CI, 1.01-1.062; P < 0.0001). A combination of aspirin and ticagrelor is associated with a lower rate of a variety of bacterial infections. This combination warrants further investigation in in-vitro studies to tease out mechanisms and through clinical randomized trials in groups who have ACS and are at high infection risk.

Exploring the Antimicrobial Resistance Profile of Salmonella typhi and Its Clinical Burden.

Background: Typhoid fever caused by Salmonella enterica serovar Typhi (S. typhi) continues to pose a significant risk to public health in developing countries, including Pakistan. This study investigated the epidemiological factors linked to suspected and confirmed S. typhi infections in Peshawar's hospital population. Methodology: A total of 5735 blood samples of patients with suspected enteric fever were collected from September 2022 to November 2023. S. typhi infection was confirmed using microbiological culture of blood samples, biochemical-based tests, and DNA-sequencing methods. Drug sensitivity testing on cultures was conducted as per the CLSI guidelines. Chi-square tests were used to analyze the clinical and epidemiologic characteristics of 5735 samples stratified by S. typhi infection status, and risk factors were assessed by applying logistic regression models to estimate odds ratios (ORs). Results: The number of confirmed typhoid fever cases in this hospital-based study population was 691 (/5735, 12.0%), more prevalent in males (447/3235 13.8%) and children (0-11 years) (429/2747, 15.6%). Compared to children, the risk of S. typhi infection was lower in adolescence (adjusted OR = 0.52; 95% CI: 0.42-0.66), adulthood (19-59 years; aOR = 0.30; 95% CI: 0.25-0.38), and older adulthood (aOR = 0.08; 95% CI: 0.04-0.18) (p < 0.001). Compared to males, the risk of S. typhi infection was lower in females (aOR = 0.67; 95% CI = 0.56-0.80; p = 0.002). Living in a rural residence (compared to urban) was associated with a higher risk of infection (aOR = 1.38; 95% CI: 1.16-1.63; p = 0.001), while access to a groundwater source (compared to municipal water supply) led to a lower risk (aOR = 0.56; 95% CI: 0.43-0.73; p = 0.002). Vaccination demonstrated a robust protective effect (aOR = 0.069; 95% CI = 0.04-0.11, p = 0.002). For those with typhoid infections, clinical biomarker analysis revealed the presence of leucopenia (65/691, 9.4%), thrombocytopenia (130/691, 18.8%), and elevated alanine aminotransferase (ALT) (402/691, 58.2%) and C-reactive protein (CRP) (690/691, 99.9%) levels. Worryingly, among the positive S. typhi isolates, there was a high prevalence of drug resistance (653/691), including multidrug-resistant (MDR 82/691, 11.9%) and extensively drug-resistant types (XDR, 571/691, 82.6%). Conclusions: This study highlights the importance of age, sex, locality, water source, and vaccination status in shaping the epidemiological landscape of S. typhi in the Peshawar district. It implies that expanding vaccination coverage to the broader population of Khyber Pakhtunkhwa province, particularly in the district of Peshawar, would be beneficial.

2352 Disease burden of respiratory syncytial virus (RSV) in adults 60+ in the United Kingdom: targeted literature review (TLR)

Abstract Introduction It is increasingly clear that RSV infections in older adults significantly impact the UKs already strained public health system. However, the true burden remains underestimated (Korsten K, Eur Respir J, 2021, 57, 2,002,688; Sharp A, Influenza Other Respir Viruses, 2022, 16, 125–131). We conducted a TLR to scrutinise the available data and reveal evidence gaps. Methods A TLR search was conducted in OVID Medline, Embase, and ECON Lit to identify existing literature from Jan 2011-Aug 2023 and grey literature. Eligibility criteria were defined based on population (intervention/comparator (no limit), outcomes (clinical, epidemiological, economic and QoL) and limited to UK-only results. Results Despite the broad criteria, only 14 out of 1013 studies were included. Nine studies reported on epidemiological outcomes, one on epidemiology and costs, and four on model outcomes. Due to the small number of studies and the heterogeneity in study design and outcomes, it was not possible to draw reliable conclusions on incidence, prevalence, and mortality. One model paper showed that a hypothetical RSV vaccine could be cost effective in the UK, depending on incidence, vaccine effectiveness and cost. All identified studies emphasise the challenges in estimating the true burden due to limitations in testing and a lack of standardised disease definition in older adults. There is a lack of evidence for risk groups, particularly clinical and economic consequences for RSV patients at a higher risk of infection and severe sequelae. Conclusion Only a limited number of studies meeting the criteria focused on RSV infection in older adults were found, with nearly no data on risk groups and related cost. It is imperative that surveillance and testing are improved to understand the true burden. This will serve as a basis for evaluating cost-effectiveness and decisions on the most effective measures to lower the burden, including vaccination programmes.

Adherence and Compliance with Oral Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

Introduction: Men who have sex with men (MSM), transgender people, sex workers, people who inject drugs, individuals in prisons and other closed settings have been considered key populations because they are at high risk of contracting HIV. The World Health Organization (WHO) has recommended Oral Pre-Exposure Prophylaxis (PrEP) because of its protective effect against HIV in this population. This study aims to analyze the factors that influence adherence and compliance with oral PrEP for HIV prevention. Methods: This systematic review was conducted the databases used were the PubMed, CINAHL Complete, and EMBASE. For search keywords, MeSH, CINAHL Subjects, and Emtree terms were combined with AND and OR Boolean operators. Studies selected encompassed quantitative, qualitative, mixed, and multimethod designs, between from 2015 to 2022, in English, Spanish, and Portuguese language. All references were imported and exported through EndNote for data collection. Methodological quality was evaluated using the MMAT checklist. We used deductive thematic analysis based on Taylor there are six categories that influence adherence and compliance to oral PrEP. Results: Out of 526 articles retrieved, 314 duplicates were eliminated and 26 were incorporated. Various factors affect adherence and compliance with oral PrEP. Conclusions: Based on the findings, PrEP's effectiveness and the perceived high risk of HIV infection served as motivators for PrEP utilization, while negative sentiments regarding PrEP, side effects, and stigma acted as hurdles to its use. Readiness facilitated PrEP adoption. Healthcare team support was viewed as an effective attribute for those administering oral PrEP.

A randomised, two-arm (1:1 ratio), double blind, placebo controlled phase III trial to assess the efficacy, safety, cost and cost-effectiveness of Rituximab in treating de novo or relapsing NS in patients with MCD/FSGS (TURING)

BackgroundMinimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) are a spectrum of disease causing the nephrotic syndrome (NS), characterised by proteinuria with debilitating oedema, as well as a high risk of venous thromboembolic disease and infection. Untreated, 50–60% patients with FSGS progress to end stage kidney disease after 5 years. These diseases respond to immunosuppression with high dose glucocorticoids, but 75% will relapse as the glucocorticoids are withdrawn, leading to significant morbidity associated with prolonged use. In children, the B cell depleting monoclonal antibody rituximab reduces relapse risk, but this drug has not been tested in randomised controlled trial in adults.Methods130–150 adults with new or relapsing MCD/FSGS, from UK Renal Units, are being randomised to receive either rituximab (two 1 g infusions two weeks apart) or placebo. Partipicipants are recruited when they present with nephrosis, and all are treated with glucocorticoids as per KDIGO guidelines. Once in remission, prednisolone is withdrawn according to a pre-specified regimen. If in remission at 6 months, participants receive a further dose of trial drug. If they relapse, they are unblinded, and if they have received placebo, they are offered open label rituximab with protocolised prednisolone as in the main phase of the trial. The primary end point is time from remission to relapse. A number of secondary endpoints will be assessed including the effect of rituximab on: (1) NHS and societal resource use and hence cost: (2) safety: (3) other measures of efficacy, such as achievement of partial and complete remission of NS and the preservation of renal function: (4) health status of participant.Trial RegistrationTURING received ethical approval on 14 Jun 2019 - REC reference: 19/LO/0738. It is registered on EudraCT, with ID number: 2018-004611-50, with a start date of 2019-06-14.

Investigation of the Relationship between Surface Features, Protein Adsorption, and Osteoimmunomodulation: The Case of a Chemically Treated Titanium Alloy.

This paper deals with the combined effects of immune response and osseointegration because of the lack of comprehensive studies on this topic. An antibacterial Ti surface was considered because of the high risk of infection for titanium bone implants. A chemically treated Ti6Al4 V alloy [Ti64(Sr-Ag)] with a microporous and Sr-Ag doped surface was compared to a polished version (Ti64) regarding protein adsorption (albumin and fibronectin) and osteoimmunomodulation. Characterization via fluorescence microscopy and zeta potential showed a continuous fibronectin layer on Ti64(Sr-Ag), even with preadsorbed albumin, while it remained filamentous on Ti64. Macrophages (differentiated from THP-1 monocytes) were cultured on both surfaces, with viability and cytokine release analyzed. Differently from Ti64, Ti64(Sr-Ag) promoted early anti-inflammatory responses and significant downregulation of VEGF. Ti64(Sr-Ag) also enhanced human bone marrow mesenchymal cell differentiation toward osteoblasts, when a macrophage-conditioned medium was used, influencing ALP production. Surface properties in relation to protein adsorption and osteoimmunomodulation were discussed.

Assessing molecular genetic and immunological predictors of COVID-19 course in healthcare worker risk group

Relevance. Studying features of innate and adaptive mechanisms of immune response in medical workers (MW), the most vulnerable social group with a high risk of infection, is an urgent research task. The aim of the study: Comprehensive study of innate and adaptive immune mechanisms and analyzing relationships between clinically significant polymorphisms (SNPs) in TLR2, TLR4 genes, TLR2 expression level on peripheral blood monocytes, peripheral blood cytokine profile (IL-1β, IL-10, IL-6, IFNγ, platelet activation marker) and SARS-CoV-2-specific humoral immune response in medical workers (MW) at a temporary infectious disease hospital in early and late COVID-19 convalescence. Materials and methods. immunologic, cytofluorimetric and molecular-genetic research methods were applied. Adaptive immune response in medical workers — COVID-19 convalescent subjects. Results. Early post-COVID-19 convalescence period in MW was linked to higher TLR2 monocyte expression; the mean fluorescence intensity was significantly elevated by 1.5-fold compared to control group. Late convalescence period (7 months post-COVID-19) was characterized by lowered serum IFNγ level. A decline in IFNγ production was significant: decreased by 82-fold in MR that was markedly stronger compared to control group (59 times). The imbalance of cytokines controlling antiviral innate and adaptive immune response was revealed in MW with identified combination of polymorphisms rs5743708 and rs4986790 in TLR2, TLR4 genes with the rate not exceeding 6.7%. It was found that 7 months after COVID-19 there was a markedly decreased IFNγ, IL-1β and IL-10 levels. The studies indicate both altered innate and adaptive immune mechanisms and a need to optimize therapeutic and prophylactic measures aimed at increasing patient-intrinsic resistance, protection of respiratory tract mucosal barriers and identification of genetic predictors of defects in innate and adaptive immune response in medical workers — COVID-19 convalescent subjects.

Antibiotics Within One Hour for Pediatric Open Lower Extremity Fractures May Not be Warranted as a Quality Metric.

Open fractures have been associated with a higher risk of infection if antibiotics are not administered within 1h of presentation in adult trauma patients. Time to antibiotic administration for open fractures is frequently used as a quality metric for trauma centers, but there have been no large studies evaluating this topic for pediatric patients. The 2019 Trauma Quality Improvement Program dataset was queried for patients ≤ 16 years old with isolated open femur or tibia fractures undergoing operative intervention after blunt trauma. Patients transferred from another hospital were excluded. Pediatric patients receiving early antibiotics (EA) within 1h were compared to patients receiving delayed antibiotics (DA) greater than or equal to 1h from arrival. Multivariate logistic regression was used to evaluate risk of surgical site infection (SSI). There were 150 patients with open lower extremity fractures: 98 (64.9%) EA vs 52 (34.4%) DA. There was no difference in the rate of SSI between the 2 groups (EA: 1.0% vs DA: 1.9%, P = 0.65). There remained similar associated risk of infection after adjusting for lower extremity abbreviated injury scale >3, blood transfusion requirement, and vital signs on arrival (OR 0.62, 95% CI 0.04-10.24, P = 0.74). Most pediatric trauma patients with open lower extremity fracture received antibiotics within 1h of presentation. However, SSI was rare and the risk of SSI was not associated with antibiotic administration within 1h. Therefore, timing of antibiotic administration for pediatric open lower extremity fractures should be re-evaluated as a quality metric.Level of Evidence: Level III.

Spatio-temporal occurrence and habitat characteristics of Aedes aegypti (Diptera: Culicidae) larvae in Southern Afar region, Ethiopia

BackgroundDescribing spatio-temporal occurrence and habitat characteristics of Aedes mosquito larvae is crucial for the control of Aedes borne viral diseases. This study assessed spatio-temporal abundance and habitat characteristics of Aedes larvae in the Southern Afar Region, Ethiopia.MethodsImmature mosquitoes were surveyed in Awash Sebat, Awash Arba, and Werer towns of the Southern Afar Region once per month from May 2022 to April 2023. Larvae and pupae surveys were carried out along the available water-holding containers. The collected larvae/pupae were reared to adults and identified by species/genus morphologically. The physical and chemical properties of the habitats were also characterized.ResultsA total of 9099 Aedes larvae/pupae were collected, of which 53.6% (4875) were from Awash Sebat, 29.5% (2687) from Awash Arba and 16.9% (1537) from Werer. Water-holding tyres harboured the highest number of Aedes larvae/pupae followed by water-storage drums. All the Aedes larvae/pupae reared to adults were morphologically identified as Aedes aegypti. The overall Container Index was 47.28%, House Index 18.19%, Breteau Index 59.94% and Pupal Index 171.94. Significant positive relations were observed in the occurrences of Ae. aegypti larvae/pupae with water-holding tyre (AOR = 15.89, CI = 3.55–71.09, p < 0.001), water storage drums (AOR = 19.84, CI = 4.64–84.89, p < 0.001), domestic habitat (AOR = 3.76, CI = 1.27–11.12, p = 0.017), and significant negative relations were observed with Ae. aegypti larvae/pupae occurrence and tap water source (AOR = 0.08, CI = 0.02–0.31, p = 0.001). Ae. aegypti larvae/pupae densities showed positive relations with dissolved oxygen (β = 0.523, p < 0.001) and total hardness (β = 0.475, p = 0.034) of water.ConclusionsDiverse types of artificial water-holding containers were positive for Ae. aegypti larvae/pupae. Ae. aegypti larvae/pupae were abundant in used water-holding tyres, water storage drums, and cement tanks in Awash Sebat, Awash Arba, and Werer towns. This could put the residents of the towns at high risk of infections with Ae. aegypti transmitted viral diseases such as chikungunya and dengue outbreaks. Thus, we recommend artificial water-holding container management as a strategy to control Ae. aegypti and hence the arboviral diseases transmission.

Bullous Cellulitis Due to Coagulase Negative Staphylococcus in Immunocompromised Patient

Introduction: Bullous Cellulitis is initially characterized by erythema and rapid development of bullae. This disease is most often caused by Beta-hemolytic streptococci and rarely by other bacteria such as Coagulase-Negative Staphylococcus (CoNS) type Staphylococcus haemolyticus. Immunocompromised state and history of malignancy are at high risk of infection with this bacterium. Local complications such as bullae can occur in obesity. Case Presentation: A 48-year-old woman with complaints of tensed and loose-walled blisters with a reddish base on the right thigh. The patient had a medical history of Thyroid Cancer, Acute Renal Failure, and Bulging Mass pelvic femur. On physical examination, the patient was unconscious with a ventilator. Dermatological examination of the dextra inferior extremity showed loose bullae with a positive Nikolsky sign and tensed bullae over the erythematous patches, ill-defined, irregular edges, and warm palpable. Laboratory results of leukocytosis, hypoalbumin, and CoNS bacteria from blood culture. An ALT-70 score obtained a total score of 5. Conclusion: Cases of bullous cellulitis are quite rare; cases like this usually occur in patients with an immunocompromised predisposition and obesity. CoNS is a commensal bacteria but, in some cases, could be a pathogen causing cellulitis. Poor prognosis that ends in death could occur in patients who have various complications.

Comparison of Surgical Site Infection After Instrumented Spine Surgery in Patients With High Risk of Infection According to Different Antibiotic Prophylaxis Protocols: A Cohort Study of 132 Patients With a Minimum Follow-Up of 1 year.

Observational Study. Surgical site infections (SSIs) are one of the major complications in spine surgery. Numerous factors that increase the risk of SSI have been widely described. However, clinical guidelines on antibiotic prophylaxis are usually common for all patients. There are no specific guidelines for patients with a high risk of infection. The aim of this paper is to create a specific protocol for patients at high risk of SSI. This is a three-cohort study using a prospective database. Risk patients are those who meet at least two of the following criteria: obesity, diabetes, reoperation and immunosuppression. Between October 2021 and April 2023, 132 patients were recruited.They were divided into three cohorts: cohort A, 46 patients, standard prophylaxis with cefazolin 2g/8h for 24h; cohort B, 46 patients, cefazolin 2g/8h and amikacin 500mg/12h for 24h; cohort C, 40 patients, cefazolin 2g/8h and amikacin 500mg/12h for 72h. There was a significant decrease in the infection rate depending on the prophylaxis (23.9% in cohort A, 8.7% in cohort B, and 2.5% in cohort C). When logistic regression models were applied and cohorts B and C were compared with A, the following results were obtained: OR of 0.30 (CI: 0.08 - 0.97; P = 0.057) and 0.08 (IC: 0.00 - 0.45; P = 0.019), respectively. Prophylaxis with prolonged double antibiotic therapy with cefazolin and amikacin is associated with a statistically significant decrease in the rate of SSI in patients with a high risk of infection.

Fasting and calorie restriction modulate age‐associated immunosenescence and inflammaging

AbstractAging is a multifaceted process impacting cells, tissues, organs, and organ systems of the body. Like other systems, aging affects both the adaptive and the innate components of the immune system, a phenomenon known as immunosenescence. The deregulation of the immune system puts elderly individuals at higher risk of infection, lower response to vaccines, and increased incidence of cancer. In the Western world, overnutrition has increased the incidence of obesity (linked with chronic inflammation) which increases the risk of metabolic syndrome, cardiovascular disease, and cancer. Aging is also associated with inflammaging a sterile chronic inflammation that predisposes individuals to age‐associated disease. Genetic manipulation of the nutrient‐sensing pathway, fasting, and calorie restriction (CR) has been shown to increase the lifespan of model organisms. As well in humans, fasting and CR have also been shown to improve different health parameters. Yet the direct effect of fasting and CR on the aging immune system needs to be further explored. Identifying the effect of fasting and CR on the immune system and how it modulates different parameters of immunosenescence could be important in designing pharmacological or nutritional interventions that slow or revert immunosenescence and strengthen the immune system of elderly individuals. Furthermore, clinical intervention can also be planned, by incorporating fasting or CR with medication, chemotherapy, and vaccination regimes. This review discusses age‐associated changes in the immune system and how these changes are modified by fasting and CR which add information on interventions that promote healthy aging and longevity in the growing aging population.

Incidence of laboratory-confirmed influenza and RSV and associated presenteeism and absenteeism among healthcare personnel, Israel, influenza seasons 2016 to 2019.

BackgroundHealthcare personnel (HCP) are at high risk for respiratory infections through occupational exposure to respiratory viruses.AimWe used data from a prospective influenza vaccine effectiveness study in HCP to quantify the incidence of acute respiratory infections (ARI) and their associated presenteeism and absenteeism.MethodsAt the start and end of each season, HCP at two Israeli hospitals provided serum to screen for antibodies to influenza virus using the haemagglutination inhibition assay. During the season, active monitoring for the development of ARI symptoms was conducted twice a week by RT-PCR testing of nasal swabs for influenza and respiratory syncytial virus (RSV). Workplace presenteeism and absenteeism were documented. We calculated incidences of influenza- and RSV-associated ARI and applied sampling weights to make estimates representative of the source population.ResultsThe median age of 2,505 participating HCP was 41 years, and 70% were female. Incidence was 9.1 per 100 person-seasons (95% CI: 5.8-14.2) for RT-PCR-confirmed influenza and 2.5 per 100 person-seasons (95% CI: 0.9-7.1) for RSV illness. Each season, 18-23% of unvaccinated and influenza-negative HCP seroconverted. The incidence of seroconversion or RT-PCR-confirmed influenza was 27.5 per 100 person-seasons (95% CI: 17.8-42.5). Work during illness occurred in 92% (95% CI: 91-93) of ARI episodes, absence from work in 38% (95% CI: 36-40).ConclusionInfluenza virus and RSV infections and associated presenteeism and absenteeism were common among HCP. Improving vaccination uptake among HCP, infection control, and encouraging sick HCP to stay home are important strategies to reduce ARI incidence and decrease the risk of in-hospital transmission.

Epidemiology and risk stratification of young infants presenting to the emergency department with hypothermia.

Hypothermic infants are presumed to be at high risk for a serious bacterial infection (SBI) or herpes simplex virus (HSV) infection. In contrast to febrile infants, the emergency department (ED) management of hypothermic infants is variable in the absence of consensus guidelines, potentially resulting in low-value care and missed diagnoses. We investigated the diagnostic workup conducted for hypothermic infants in our academic pediatric ED, the incidence of SBI and HSV infection, and risk factors associated with infection. We conducted a single-center retrospective study of infants ≤90 days of age with a rectal temperature ≤36.5°C in the ED between 2013 and 2022. From their medical records, we abstracted the type(s) of testing each infant received in the ED and the diagnosis of SBI and HSV, analyzing characteristics associated with each. Of 1095 hypothermic infants identified, 402 (37%) underwent testing for SBI or HSV. Among these, 34/402 (8.5%) had an SBI or HSV. A minimum temperature below 36°C and hospital admission were characteristics associated with higher rates of infectious testing. Infants aged 29‒90 days, compared to 0‒28 days, were more likely to have a urinary tract infection (odds ratio 3.28, 95% confidence interval 1.47‒7.32). Hypothermic infants have slightly lower rates of SBI or HSV than febrile infants, for whom infectious studies are widely recommended, but still high enough to warrant an infectious workup in most cases. Further research is required to risk stratify hypothermic infants in the ED to standardize care and improve outcomes while optimizing resource utilization.