Incidence Rate Of Infection Research Articles

Incidence and predictors of respiratory tract infections among birth cohorts in Ethiopia, 2023

BackgroundRespiratory tract infection (RTI) has been a predominant health problem worldwide, including Ethiopia. It is one of the major causes of under-five mortality in Ethiopia, accountable for 18% of total deaths. Nationwide studies on the incidence of respiratory infections and maternal risk factors are limited. Hence, this study was aimed to determine the incidence and predictors of respiratory infections among infants aged less than six months in Ethiopia, 2023.MethodsThis was a retrospective follow up study using data from Performance Monitoring for Action Ethiopia (PMA Ethiopia). A two-stage cluster sampling technique was used to select a total 2,246 eligible study participants from 206 enumeration areas. A Cox proportional hazards regression model was used to identify independent predictors of respiratory tract infection incidence. Hazard ratios with 95% confidence intervals and p value < 0.05 were used to declare statically significant associations between variables.ResultsThe incidence rate of respiratory tract infections among birth cohorts was 22.99 per 1000 infant weeks of observation. Infants born from mothers who sustained convulsion during labor had nearly doubled [AHR = 1.65, 95%CI (1.20, 2.28)] hazard or risk of developing respiratory tract infections than their counterparts. Similarly, infants born from mothers having prolonged labor (more than 12 h) had one and half times [AHR = 1.48, 95%CI (1.13, 1.93)] increased risk of developing respiratory tract infections as compared to their counterparts.ConclusionThe incidence of respiratory tract infections is a significant public health concern in Ethiopia. Infants born to mothers with prolonged labor and convulsions need closer monitoring for early signs of respiratory tract infections.

Epidemiology and spatiotemporal analysis of acute hemorrhagic conjunctivitis in Zhejiang province, China (2004–2023)

BackgroundAcute hemorrhagic conjunctivitis (AHC) has become a significant public health issue in Zhejiang province. However, the analysis of epidemiological characteristics and spatio-temporal patterns of AHC in Zhejiang province has not been studied yet.MethodsMonthly cases of AHC from 2004 to 2023 reported at the county level in Zhejiang province were obtained from the China Information System for Disease Control and Prevention. Demographic features, yearly county incidence, global spatial autocorrelation, local spatial autocorrelation analyses, and temporal and space–time cluster analysis were performed to identify and visualize the spatiotemporal patterns of AHC cases in Zhejiang province. The epidemiological characteristics of AHC outbreaks in the same period in Zhejiang province were also compared.ResultsA total of 52,119 AHC cases were reported in Zhejiang province, yielding an average incidence rate of 5.37 per 100,000. No fatalities were reported. The average age of those affected was 25.44 ± 4.37 years, with the highest incidence (16.70%) among individuals aged between 10 and 19 years. Seasonal peaks occur from August to October each year. Students and farmers experienced the highest incidence rates of infection. Significant positive spatial correlations for AHC were observed in Zhejiang province in the years 2007 (Moran’s I = 0.095, p = 0.039), 2009 (Moran’s I = 0.075, p = 0.031), and 2011 (Moran’s I = 0.173, p = 0.034), indicating spatial clustering. Spatiotemporal scanning identified two distinct clusters: Cluster 1 and Cluster 2. Cluster 1, characterized by a relative risk of 21.44 (p &amp;lt; 0.001), was located in northeastern Zhejiang province, comprising 30 counties, with an active period from 1st September 2010 to 30th September 2010. Compared to low-risk regions, high-risk counties exhibited a different demographic profile with a higher proportion of men, older people, and farmers. Among the affected students during outbreaks, the predominant symptoms were conjunctival congestion, increased eye secretions, eye swelling, eye pain, photophobia and tearing, while the incidence of fever was relatively low.ConclusionThe results of this study demonstrate the spatiotemporal heterogeneity of AHC cases in Zhejiang province and underscore the necessity for targeted prevention and control measures in high-risk areas to mitigate transmission and occurrence.

P-637. Infection Incidence and Trajectory of Immune Recovery in Children, Adolescents, and Young Adults After Chemotherapy for Acute Lymphoblastic Leukemia

Abstract Background Advances in chemotherapy for acute lymphoblastic leukemia (ALL) have improved survival rates, but survivors remain vulnerable to infection after completing chemotherapy. Data have shown increased infection risk for pediatric ALL survivors compared to healthy children, yet few studies have prospectively tracked infection rates alongside immune recovery. This study aims to quantify infection incidence and describe the trajectory of immune reconstitution in the year after ALL therapy completion. Methods Patients aged 3-30 completing ALL therapy at a pediatric center are being followed for the first year off-therapy. Total immunoglobulin-G (IgG) and antibody (Ab)-specific IgG levels for varicella, measles, and 23 pneumococcal serotypes are measured at 3, 6, and 12 months. Infection events are recorded monthly to calculate infection incidence per 1000 patient-days. Results To date, 21 patients have been followed for ≥ 6 months. Median age at ALL diagnosis was 7.3 years (IQR: 3.4-10.1). 67% of patients had ≥ 1 infections; 93% of those with infections had ≥ 2. The overall infection incidence rate was 6.1 per 1000 patient-days. Of 46 infections, upper respiratory illness (20, 43.5%) and gastroenteritis (6, 13%) were most common (Table 1). 17 of 21 patients had not received intravenous immunoglobulin replacement (IVIG) within 6 months of therapy completion; their mean total IgG was 859.6 mg/dL at 3 months and 918.2 mg/dL at 6 months (Table 2). All 17 received ≥ 1 pneumococcus, varicella, and/or measles vaccine before ALL diagnosis. None had evidence of pneumococcus or varicella Ab recovery at 6 months, regardless of pre-ALL partial or full vaccination status (Tables 2-3). 7/11 patients fully vaccinated and 3/6 partially vaccinated for measles before diagnosis had normal Ab indices at 6 months off-therapy (Table 4). Conclusion Infections were common during the first year off-therapy, with many experiencing multiple illnesses. Total IgG levels were reasonable at 3 and 6 months, but there was no recovery of varicella or pneumococcus Ab, and only a subset of patients retained measles Ab. Continued assessment until 12-month follow-up for all 85 enrolled patients is necessary but preliminary data suggest potential need for Ab-informed revaccination. Disclosures Brian T. Fisher, DO, MPH/MSCE, Allovir: Grant/Research Support|Astellas: Data Safety Monitoring Board|Merck: Grant/Research Support|Pfizer: Grant/Research Support

P-914. Clinical Outcomes and Predictors of Mortality among Hospitalized HIV/ AIDS Adult Patients Diagnosed with Central Nervous System Infections in a National Tertiary Referral Hospital in the Philippines: A 5-year Retrospective Study

Abstract Background HIV infection remains a significant global health concern despite the major advances in its understanding and treatment. Central nervous system (CNS) infections are common complications among HIV-infected patients. In the Philippines, limited local data on the clinical profile and outcome among HIV-infected patients with CNS infections is available. Case Distribution of CNS Infections among HIV-infected patients in the Philippines Methods This is a 5-year retrospective study of confirmed HIV-infected patients hospitalized and managed as CNS Infections at San Lazaro Hospital, Manila Philippines between 2018 and 2022. Demographics and clinical data were extracted from medical records and the association with clinical outcome and length of hospital stay were analyzed. Incidence and Case Fatality Rate of CNS Infections among HIV-infected patients in the Philippines Results One hundred twenty-eight (128) HIV-infected patients, mostly male (95%), were included, with a mean age of 31 years, and a mean CD4 lymphocyte count of 56.8 (0-282) cells/mm3. Forty-one patients (32%) were newly diagnosed with HIV, and 51% (n=65) were not on antiretroviral therapy (ART). The mean duration of HIV diagnosis among those known to have HIV before admission was 1.4 years. The most common CNS infection was Tuberculous Meningitis (TBM) (35%), followed by Cryptococcal Meningitis (CM) (29%), and Toxoplasma Encephalitis (TE) (17%). The presence of dual CNS Infection was diagnosed among 20 patients (15.6%), of which a total of 16 (12.5%) had co-infection of TBM and TE, while 4 (3.1%) had co-infection of TBM and CM. The most common clinical manifestations were headache (87.5%), fever (61%), and sensorial changes (60%). The overall in-hospital mortality rate was 30.4% (n=39), with the highest case-fatality rate among those infected with Cryptococcal Meningitis at 53% (n=19). Among those diagnosed with CM, 23 patients (62%) had concomitant Cryptococcal Fungaemia. Those with CM and dual CNS infection had a longer hospital stay of &amp;gt;31 days ( &amp;gt;1 month). Conclusion In the Philippines, the most common CNS infection among HIV-infected patients was Tuberculous Meningitis, followed by Cryptococcal Meningitis, and Toxoplasma Encephalitis. Early diagnosis of HIV infection with timely initiation of ART, together with an effective diagnostic and management approach to these conditions is needed to decrease the risk of further complications and death. Disclosures All Authors: No reported disclosures

P-1000. The Impact of Re-Initiation of Universal Antenatal Screening on the Incidence of Group B Streptococcus (GBS) Infection

Abstract Background Group B streptococcus (GBS) is a leading cause of neonatal bacterial sepsis and meningitis globally. Despite the similar incidence rate of neonatal GBS infection in Saudi Arabia as compared to other countries, there has been a notable increase in Early Onset Disease (EOD) following the discontinuation of universal antenatal screening. Addressing this issue, we evaluated the incidence of EOD after the re-initiation of universal antenatal screening. Association of gestational age, diagnosis, and mortality with the onset of GBS EOD: Early-onset disease LOD: Late-onset disease Methods This study was conducted in a tertiary children's hospital in Riyadh, Saudi Arabia, using a retrospective cohort chart review, which included all cases of neonatal GBS disease identified through microbiology records within the first 90 days of life from January 2017 to December 2023. A standardized form was used to collect maternal and neonatal characteristics by reviewing the charts Results Over seven years, of 61,049 live births, 47 cases of GBS disease were identified (overall incidence, 0.77/1000 live births), and 70% (n = 34) of those had early onset disease (EOD). The annual incidence from 2017 to 2020 showed no significant difference compared to the years when the universal screen was discontinued (2015 and 2016). However, a significant drop was noted in the years after (2021 to 2023), in which the incidence rate was 0.23/1000 live births. We found that 64% (n=30) of mothers who had neonates with GBS disease were either not screened antenatally or were un-booked. Additionally, 49% (n=23) of mothers had a positive GBS screen; however, none of them received appropriate antibiotic prophylaxis. Sepsis was the most common manifestation (76.6%, n = 36), followed by meningitis and Urinary tract infection , 15% and 10.6% respectively. Mortality rate was 8.5% (n = 4) Conclusion After three years of re-initiation of universal screening, the incidence of neonatal GBS infection has declined and returned to its previous baseline rate, and similar to worldwide incidence Disclosures All Authors: No reported disclosures

P-833. The trends of hospital-onset bacteremia at a tertiary care center and the impact of the establishment of infectious diseases department on its incidence: a 10-year longitudinal study

Abstract Background Hospital-onset bacteremia (HOB) is defined as the onset of bacteremia occurring three or more days after hospitalization. The incidence density of HOB has recently been used to assess the quality of overall hospital infection control practice in lieu of the central line-associated bloodstream infection incidence rate since the HOB incidence might better predict the length of stay, hospital costs, and mortality rates. At the study institution, Infectious Diseases (ID) department was established in April 2018. The present study aims to investigate the incidence density of HOB prior to and after the establishment of ID department. Change and trend of the incidence density of HOB before and after the establishment of ID department as determined by ITSA. Methods We investigated the monthly incidence density of HOB per 1,000 patient-days from 2013 through 2023 at Fujita Health University Hospital. The trends of overall incidence of HOB and HOB by causative pathogens group, including Streptococcus species (spp), Staphylococcus aureus, Coagulase-negative staphylococci (CNS), Enterococcus spp., Enterobacterales, and Candida spp. were tracked. Changes in the trend of HOB before (from July 2013 through March 2018) and after (from April 2018 through June 2023) the establishment of ID department were evaluated. Interrupted time series analysis was used for statistical analyses. Change and trend of the incidence density of HOB before and after the establishment of ID department as determined by ITSA. Results In total, 4,422 HOB events were identified during the study period. The overall incidence density of HOB was 0.94 per 1,000 patient-days. Comparison of the incidence of HOB between the period before and after the establishment of ID department revealed an immediate increase in the incidence of overall HOB (+0.3246; P&amp;lt; .001 for change in level) and HOB caused by S. aureus (+0.10; P&amp;lt; 0.001 for change in level), CNS (+0.12; P&amp;lt; 0.001 for change in level), and Candida spp. (+0.05; P=0.03 for change in level). A significant trend increase in the incidence of HOB was also observed in HOB due to S. aureus (+0.002; P&amp;lt; .001 for change in trend) Candida spp. (+0.002; P=0.002 for change in trend), and Enterobacterales (+0.002; P=0.002 for change in trend). Conclusion The overall incidence density of HOB has increased significantly in the last decade, and the trend was steeper after the establishment of ID department. Improvement in ID clinical practice may contribute to increasing the detection of HOB. Disclosures Yohei Doi, MD, PHD, AbbVie: Honoraria|Entasis: Grant/Research Support|Gilead: Advisor/Consultant|GSK: Advisor/Consultant|Meiji Seika: Advisor/Consultant|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria Hitoshi Honda, MD, Moderna Inc: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria

P1163 Treatment-based risk stratification of serious and opportunistic infections in IBD patients from an tertiary center in brazil: a comparison between advanced therapies and non-biologic exposure in real world setting

Abstract Background The risks of serious and opportunistic (OIs) infections associated with advanced therapies for IBD is one of the main concerns of both physicians and advanced practice clinicians in IBD care. We assessed the incidence and stratify the risk of serious infections or OIs in patients with IBD treated with advanced therapy. Methods We performed an ambispective observational study of adults patients with a diagnosis of IBD in a tertiary IBD center located in Brazil. We retrospectively analyzed the IBD patients from 2014 to 2017 and prospectively those from 2018 to 2022. Serious infections were defined as those requiring intravenous antibiotic therapy or hospitalization. The incidence (per 100 patient-years) and risks of serious and OIs associated with exposure to combination therapy (anti-TNF and thiopurines), monotherapies with anti-TNF, vedolizumab, ustekinumab or tofacitinib were compared with exposure to aminosalicylates using marginal structural Cox proportional hazard models adjusted for baseline characteristics and medications. Results Among the 504 patients, 75 serious infections and 35 OIs were observed, resulting in overall incidence rates of serious infections and OIs of 3.1 and 1.1 per 100 PY, respectively. Overall incidence rates of serious infections ranged from 0.1, 0.15, 0.13, 0.16, 1.2., and 3.1 per 100 PY in those exposed to aminosalicylates, ustekinumab, vedolizumab, tofacitinib, anti-TNF monotherapy, and combination therapy, respectively. Conversely, the overall incidence rates of OIs ranged from 0, 0.1, 0.1, 0.3, 0.9, and 2.1 per 100 PY in those exposed to aminosalicylates, ustekinumab, vedolizumab, tofacitinib, anti-TNF monotherapy, and combination therapy, respectively. OIs were mostly due to Mycobacterium tuberculosis (n=21) and herpes zoster (n=11). Compared with aminosalicylates, vedolizumab and ustekinumab therapy did not increase the risk of serious infections and OIs (HR, 0.93; 95% CI, 0.42-1.81). Conversely, tofacitinib, anti-TNF monotherapy and combination therapy were associated with increased risks of OIs (HR, 1.13; 95% CI, 1.05-2.01), HR, 2.13; 95% CI, 1.92-5.81 and HR, 32.3; 95% CI, 19.21-40.53, respectively). Conclusion Anti-TNF therapy and combotherapy were associated with an increased risk of serious infections and OIs, while vedolizumab and ustekinumab presented a insignificant risk of these infections. Tofacitinib was associated with a small increased risk of OIs. Tuberculosis was the main OI, and was associated exclusively with the use of anti-TNF monotherapy or combotherapy. In choosing advanced therapy for IBD, clinicians should consider, among other factors, the risk of serious infections and OIs and weighed against potential benefits of the various targeted therapies for IBD.

Comparison of Clinical Outcomes Between Two Types of Dipeptidyl Peptidase-4 Inhibitors in Posttransplant Diabetes Mellitus in Kidney Transplantation Recipients: A Nationwide Population-Based Cohort Study in Korea.

Dipeptidyl peptidase-4 inhibitors (DPP-4i) are antidiabetic drugs known for their minimal side effects and limited drug interaction witih immunosuppressants, making them suitable for patients with diabetes and kidney transplant recipients. However, there is limited real-world information regarding the use of DPP-4 inhibitors in patients with post transplant diabetes mellitus (PTDM). We performed a retrospective observational cohort study of 13,828 kidney transplant recipients form Janary 1, 2002, through December 21, 2018, using the Korean National Health Information Database. We extracted PTDM patients, and divided the patients into 2 groups baased on whether they received DPP4-inhibitor which needs dose adjustement (group A) or not (Group B) according to estimaged glomerular filtration rate. Out of 3154 patients who developed PTDM after transplantation, 738 patients prescribed DPP-4 inhibitors. Among these, 490 patients prescribed Group B DPP-4 inhibitors and 238 patients prescribed Group A DPP-4 inhibitors. Multivariate-adjusted Cox regression analysis showed that compared Group B, Group A DPP-4 inhibitors was associated with higher incidence rate of genital tract infection (hazard ratio (HR) 1.87, 95% Confidence Interval (CI) 1.18-2.99), and emergency department visit (HR 3.12, 95% CI 1.89-5.16). However, there was no significantly difference in death (any cause), admission, graft failure, infection, or hypoglycemia between the 2 groups. In patients with PTDM, some kinds of DPP-4 inhibitors, which need dose adjustment according to renal function, were associated with an increased rate of emergency department visit and genital tract infection.

Impact of Fc-gamma receptor IIIA polymorphism on late-onset neutropenia and clinical outcomes in kidney transplant recipients following rituximab induction therapy.

This study aimed to investigate the association between the Fc-gamma receptor IIIA (FCGR3A) 158 polymorphism and clinical outcomes in kidney transplantation (KTx) patients. Specifically, we focused on late-onset neutropenia (LON) in ABO-incompatible (ABOi) or HLA-incompatible (HLAi) KTx recipients who underwent rituximab (RTx) desensitization therapy. FCGR3A 158F/V polymorphisms were identified in 85 ABOi or HLAi KTx recipients who underwent RTx desensitization at our institution between April 2008 and October 2021. We analyzed these polymorphism groups in relation to their preoperative background and incidence of LON, infection, and rejection. In addition, we examined the risk factors for LON development. The following FCGR3A 158F/V polymorphisms were identified: FF genotype (n = 45); FV genotype (n = 36), and VV genotype (n = 4). LON occurred in 25 out of 85 recipients within 1year after KTx, significantly more frequently in patients with the FCGR3A FV + VV genotype (17/40) than in those with the FF genotype (8/45) (p = 0.01). A multivariate analysis identified the V-allele as an independent risk factor for LON (OR, 4.03; 95% CI, 1.38-11.73, p = 0.01). However, there were no significant differences in the incidence rates of post-transplant infection and rejection between the FF and FV + VV genotypes. Recipients with the FCGR3A 158V-allele were identified as having a higher risk of developing LON following KTx with RTx desensitization therapy. However, the presence of this V-allele did not affect the safety or efficacy of RTx desensitization before KTx.

Evaluation of the frequency and risk of corona virus in different occupations of a teaching hospital in Yazd City

Introduction: Healthcare professionals are the frontline soldiers against Corona. Materials and Methods: This cross-sectional study was conducted on all personnel at a teaching hospital located in Yazd City. Each participant completed a questionnaire that included demographic information as well as their history regarding the frequency and length of daily contact with a patient infected with COVID-19. It also covered the duration of personal protective equipment (PPE) usage and alcohol-based hand rub application during direct exposure (with 1 meter) and throughout aerosolizing procedures performed on the patient. Incidence rate, Frequency rate, probability, severity rate, and risk of corona infection were evaluated among various occupational groups within the hospital. Results: 40.66% of the staff employed in the hospital were infected with corona virus. The highest frequency of corona infection was observed among nurses (51.60%). Over 90% of healthcare personnel who did not utilize PPE for 95% of their work time faced a high-risk level for the coronavirus. Physicians reported the highest number of daily exposures (averaging 27.94 exposures) and the longest exposure time (averaging 243.89 minutes). The highest risk of infection among doctors (60.93) and nurses (39.49) was observed. The nurses exhibited the highest incidence rate (51.22) and frequency rate (26.27). Conclusion: Due to a significant percentage of hospital staff with coronavirus, and with the highest infection rates occurring among nurses, adequate training for the use of PPE is necessary.

Helicobacter pylori infection and peptic ulcer disease in patients with advanced chronic liver disease

IntroductionPeptic ulcer disease (PUD) is more prevalent in patients with advanced chronic liver disease (ACLD) than in the general population. Helicobacter pylori (Hp) infection is the main aetiological factor in...

Parasitology Study: Trypanosoma sp. In Cattle Blood Tests At The Gorontalo Animal, Fish And Plant Quarantine Center

This study aims to detect the presence of Trypanosoma sp. blood parasites in Balinese cattle in the area of Gorontalo Animal, Fish and Plant Quarantine Center. Samples were taken from 27 Balinese cattle, which were selected based on a prevalence of 10% of the total population of 270 cattle. Blood was drawn from the auricular vein using sterile procedures to prevent infection, and the drawn blood was used for thin blood review. Blood reviews were fixed using absolute methanol and stained with 10% giemsa solution for 45 minutes. Microscopic examination was performed at 400 to 1000 times magnification to detect the presence of Trypanosoma sp. parasites. The results showed that there was no indication of Trypanosoma sp. blood parasite infection in all blood samples examined, with a recorded infection incidence rate of 0%. This finding indicates the absence of Trypanosoma sp. infection in the tested Bali cattle in Gorontalo region.

The Incidence Rate of Central Line-associated Blood Stream Infections Related to Peripherally Inserted Central Catheters and Its Related Factors in the Neonatal Intensive Care Units

The Incidence Rate of Central Line-associated Blood Stream Infections Related to Peripherally Inserted Central Catheters and Its Related Factors in the Neonatal Intensive Care Units

Trends in the incidence of the Epstein-Barr virus-associated malignancies extranodal NK/T-cell lymphoma and nasopharyngeal carcinoma in Taiwan.

Nasopharyngeal carcinoma (NPC) and extranodal NK/T-cell lymphoma (ENKTL) are associated with the Epstein-Barr virus (EBV). The current study aimed to evaluate the trends in the incidence of ENKTL and NPC in Taiwan within the last 15-30 years. To assess the incidence of ENKTL from 2008 to 2021 and NPC from 1995 to 2021, an epidemiological study was performed using population-based registry data from the Taiwan Cancer Registry. The secular trends in the annual incidence rates were expressed as average annual percent change (AAPC). During the study period, 872 new ENKTL diagnoses and 39412 new NPC diagnoses were reported. The annual age-adjusted incidence rates of ENKTL and NPC decreased significantly, with an AAPC of -2.47 (p = 0.014) and -1.16 (p < 0.001), respectively. The incidence rates of NPC from 1995 to 2021 in the 20-44-, 45-64-, and ≥65-year-old age groups decreased from 5.23 to 4.42 per 100,000 person-years (AAPC = -0.45, p = 0.011), from 15.28 to 11.36 per 100,000 person-years (AAPC = -1.21, p < 0.001), and from 10.48 to 7.24 per 100,000 person-years (AAPC = -1.91, p < 0.001), respectively. The age-specific incidence rates of ENKTL in the 45-64-year-old age group significantly decreased from 0.46 to 0.32 per 100,000 person-years during 2008-2021 (AAPC = -3.37, p = 0.008). The incidence of ENKTL between 2008 and 2021 in the 20-44- and ≥65-year-old age groups also decreased from 0.16 to 0.11 per 100,000 person-years and from 0.87 to 0.79 per 100,000 person-years, respectively. Interestingly, the EBV seroprevalence in Taiwan remained stable from 1984 to 2007. Nonetheless, there was a downward trend in the EBV seroprevalence in early childhood, with a decrease of approximately 20% in children aged 4 years and nearly 50% in children aged <2 years. Based on these findings, the downward trend in the incidence of NPC/ENKTL could be affected by the decline in early EBV infection rates. Considering that the EBV seroprevalence remained stable but the incidence rate of early EBV infection decreased during the same period, delayed EBV infection or factors other than EBV might play an important role in the downward trend in the incidence of NPC/ENKTL in Taiwan. Nevertheless, further investigations should be performed to assess these results.

Comparison of trans-umbilical single-port laparoscopic complete extraperitoneal closure and laparoscopic intracorporeal closure for pediatric inguinal hernia: a randomized controlled study

BackgroundThe purpose of this study was to compare the outcomes of Trans-umbilical single-port laparoscopic complete extraperitoneal closure (LCEC) and laparoscopic intracorporeal closure (LIC) for inguinal hernia by analysis of follow-up data over 5 years.MethodsIn this prospective randomized controlled trial, 524 children with inguinal hernia were randomly assigned to undergo LCEC or LIC between August 2016 and December 2017. The primary outcome measures were the success and recurrence rates. The secondary outcome measures were operative time; length of hospital stay; postoperative pain score; and incidence of postoperative complications, including rates of wound infection, stitch abscess, and testicular atrophy.ResultsPrimary analysis of the 227 patients in the LIC group and 215 patients in the LCEC group revealed that in the LCEC group, the success rate of was significantly higher in LCEC group (96.7% vs. 90.3%, P &amp;lt; .05) and the length of hospital stay was significantly shorter (P &amp;lt; .05) than those of the LIC group. Neither the recurrence rate (P &amp;gt; .05) nor the operative time (P &amp;gt; .05) of the groups significantly differed. The pain scores at postoperative 12 and 24 h were significantly lower in the LCEC group than in the LIC group (P &amp;lt; .05). The incidence rates of wound infection (0.93% vs. 5.7%, P &amp;lt; .05) and stitch abscess (1.4% vs. 7.0%, P &amp;lt; .05) were significantly lower in the LCEC group than in the LIC group. No testicular atrophy occurred in either group.ConclusionLCEC is associated with better clinical success and fewer postoperative complications for repair of pediatric inguinal hernia compared with LIC.

Preserving one artery shortens the surgical time and does not affect the efficacy of microsurgical subinguinal varicocelectomy: preliminary findings from a retrospective study

BackgroundTo analyze the safety and efficacy of microsurgical subinguinal varicocelectomy(MSV) performed with and without preservation of all testicular arteries and lymphatic system.MethodsAll of the 98 patients with varicocele who underwent MSV were included in the analysis. Fifty-eight male patients surgically underwent MSV with preservation of all testicular arteries and lymphatic system(Group 1). The other 40 male patients surgically underwent MSV with preservation of a single testicular artery, while the remaining vascular bundle sparing the vas deferens with its vessels was then isolated"en bloc,” ligated and cut(Group 2). Operative time, semen parameters and complications were then compared.ResultsMean operative time for Group 1 was significantly longer than that of Group 2(90.26 ± 21.69 min vs. 79.30 ± 19.58 min, P = 0.01). Visual analogue pain scale (VAS) decreased significantly in both groups. Group 1 experienced a decrease from a median of 5 (interquartile range, IQR: 4 ~ 6) to 1 (IQR: 0 ~ 2), P < 0.001; similarly, Group 2 saw a reduction from a median of 4 (IQR: 3 ~ 5.75) to 1 (IQR: 1 ~ 2), P < 0.001. Additionally, notable improvements were recorded in sperm count and motility in both groups at the 12-month follow-up compared to their pre-operative measurements. For Group 1, sperm count increased from a median of 35.5 × 106/mL(IQR: 29 ~ 60) to 60 × 106/mL(IQR: 50 ~ 74.25), and motility from 46.5% (IQR: 32 ~ 56%) to 69%(IQR: 54.5 ~ 79%), both with P < 0.001. Group 2 showed similar enhancements, with sperm count rising from a median of 31 × 106/mL (IQR: 20 ~ 56.25) to 57.5 × 106/mL(IQR: 51.25 ~ 73.75) and motility from 44% (IQR: 23 ~ 54.75%) to 75% (IQR: 51.25 ~ 80%), P < 0.001. The duration of postoperative hospital stay was comparable between the two groups, with both reporting a median stay of 3 days (IQR: 2–3 days, P = 0.83). No testicular atrophy and varicocele recurrence was observed in all patients. The incidence rates of hydrocele, wound infection, and orchitis and epididymitis showed no significant disparity between the two groups. Specifically, both groups each had a single incidence of hydrocele. Group 1 had one incidence of wound infection, while Group 2 had none. Orchitis and epididymitis occurred once in Group 1, but not in Group 2.ConclusionOur study provides preliminary evidence supporting the implementation of the"en bloc” procedure in MSV as a potentially safe and effective option, especially for managing cases with severe adhesion.

Failure mode and effects analysis-based strategies for controlling multidrug-resistant organism infections in cancer patients.

In the context of advancing medical procedures, postoperative infections in cancer patients, particularly those involving multidrug-resistant organisms, have become a significant clinical concern. This study aims to comprehensively and systematically evaluate the effectiveness of infection prevention and control for multidrug-resistant organisms (MDROs) in postoperative cancer patients using Failure Mode and Effects Analysis (FMEA). This study was conducted in a tertiary A-level cancer specialty hospital in China, employing Failure Mode and Effects Analysis (FMEA) to assess the risks of hospital infections. Intervention measures were implemented for high-risk and medium-high-risk factors. Through the hospital's infection information system, data on patients who underwent surgical treatment from 2017 to 2022 were extracted. Data from 2017 to 2019 served as the control group, and data from 2020 to 2022 as the intervention group, to compare the changes in hospital infection incidence and MDRO infection incidence before and after the intervention. Categorical data were described in terms of frequency and percentage. The chi-square test was utilized for statistical inference to assess the differences in infection rates before and after the intervention. Prior to the intervention (2017-2019), the incidence rate of hospital infections was 1.66%, which decreased to 1.22% after the intervention (2020-2022), showing a statistically significant difference (χ2 = 48.83, P < 0.001). The incidence rate of MDRO infections also decreased from 1.808‰ before the intervention to 1.136‰ after the intervention, with a statistically significant difference (χ2 = 11.417, P = 0.001). This study confirms the effectiveness of the FMEA method in preventing and controlling MDRO infections in postoperative cancer patients. It highlights the practicality and value of widespread adoption of this method, particularly in the context of the COVID-19 pandemic.

Implementation of a paraprofessional role across the public health sector in Manitoba: Impacts on system capacity.

Manitoba experiences sexually transmitted and blood-borne infection (STBBI) incidence rates above the national average and fundamental public health sector responses face human resource constraints. Manitoba implemented a paraprofessional role, the Communicable Disease Technician (CD Tech), to complete low-complexity STBBI investigations and support STBBI testing, care engagement initiatives, provider reporting, harm reduction supply distribution, and community engagement. Secondary roles included tuberculosis directly observed treatment (DOT) and virtual DOT, and flu and COVID immunization support. Twenty CD Tech positions were allocated to regional public health teams along with additional Public Health Nurse (PHN) positions to support the role. Mixed methods were used to evaluate the impact on public health system capacity. Follow-up of chlamydia and gonorrhea case investigations increased from 35% to 98%. Volume of contacts followed by public health increased for chlamydia (114%), gonorrhea (33%), and HIV (68%). Health care provider reporting for cases of STBBI and treatment more than doubled (116%). No significant differences in case investigation data quality were found between CD Techs and PHNs. Qualitative interviews by public health staff (n = 24) found CD Techs highly flexible and competent team members who can fill gaps and expand capacity in direct client service, outreach, administration, data entry, or community/partner engagement. Mentorship, ongoing supervision, role clarity, training, and clear practice standards are required to optimize the role. There is potential to expand this innovation and build surge capacity in other areas of public health practice, and other public health jurisdictions.

Application of Submandibular Intubation as Alternative to Elective Short-Term Tracheotomy for Particular Cases of Oral and Maxillofacial Tumors Resection and Defects Reconstruction.

To describe the cases of oral and maxillofacial tumors (OMFT) resection and defects reconstruction under submandibular intubation (SMI) performed in our institution; secondly, to systematically review and analyze the characteristics of studies about SMI in oral and maxillofacial surgery to estimate the incidence rate of complication. Data related to all 6 patients included in this study were prospectively collected from November 2016 to November 2023. The tract for endotracheal tube was created by bluntly dissection from the submandibular area to the floor of mouth. We performed an exhaustive search for studies about SMI using Pubmed, Embase, Proquest, and Chinese Biomedical Literature Database. Meta-analysis of the incidence rate of complication and infection was performed using STATA 14.1. There was a male predominance (87.3%); the mean age was 47.8±16.8 years; squamous cell carcinoma (SCC) was the most frequent diagnosis (33.3%); the mean time of the operation was 237.0±65.2 minutes; the SMI procedure mean time was 5.5±0.9 minutes; and the mean time to extubation 133.3±12.5 minutes. No accident or complication was observed intraoperatively and postoperatively. The systematic review included 22 out of 234 studies screened. The meta-analysis showed an overall complication rate and superficial infection rate of 5.7% and 3.7% in the last 15 years versus 20.2% and 10.6% in over 15 years ago. Submandibular intubation was found technically easy, safe, and effective alternative of elective short-term tracheotomy, orotracheal and nasotracheal intubations in our series of OMFT resection and defects reconstruction.

Clinical and microbiological characterization of invasive group a Streptococcus infection in children in Japan: A single-center experience

Invasive group A Streptococcus (iGAS) infections are rare but potentially fatal. Although the number of invasive group A Streptococcus (iGAS) infections decreased during the coronavirus disease (COVID-19) pandemic, it sharply increased worldwide following the pandemic due to the emergence of M1UK strains. In Japan, non-fluminant iGAS infections have not been included in the national survey notification system. Therefore, the clinical and microbiological characteristics of iGAS infection are unknown. In this study, we aimed to clarify the clinical and microbiological characteristics of pediatric iGAS infections. We conducted a case-series analysis of children aged 0-15 years with positive Streptococcus pyogenes cultures from otherwise sterile sites, diagnosed between July 2018 and June 2024. Clinical data were extracted from the electronic medical records. Samples of clinical isolates were sent to the Public Health Research Institute for further analysis. We identified 11 patients (median age, 5 years [interquartile range 1-8.5 years]; 6 girls). The incidence rate of the iGAS infections was highest in 2024, with 3 cases in 6 months. Primary bacteremia without focal infection was the predominant diagnosis, followed by skin and soft tissue infections with bacteremia. Among the 11 iGAS infections, 9 isolates were available for additional microbiological tests. M12 and M1 strains were predominant (four cases each). Three of the four M1 isolates were M1UK strains. In the present study, the increasing incidence of iGAS infection and clinical diagnoses are similar to those reported in other countries; however, M12 strains as well as M1 strains are predominant.