Infected Patients Research Articles

Do Prophylactic Postoperative Antibiotics Prevent Sacral Neuromodulation Infections?

There are no definitive guidelines for use of postoperative antibiotics after sacral neuromodulation (SNM) leading to practice pattern variation among health care professionals. The objectives of this study were to determine if additional antibiotics beyond preoperative intravenous antibiotics and surgical preparation decrease postoperative infections and to determine if additional antibiotics are associated with other postoperative complications. This was a single-center, retrospective cohort study of all SNM procedures from 2014 to 2023 performed by 12 surgeons. Cohorts were stratified between patients who received preoperative antibiotics only (OnlyPreAbx) and patients who received both preoperative antibiotics and postoperative antibiotics (PrePostAbx) after either insertion of tined lead and/or after insertion of a neurostimulator. There were 212 patients included in this study: 70 (33.0%) in the OnlyPreAbx group and 142 (67.0%) in the PrePostAbx group. Of patients receiving postoperative antibiotics, 76 (53.5%) received cephalexin, 49 (34.5%) received sulfamethoxazole-trimethoprim, and 17 (12.0%) received alternative antibiotics. Six patients overall (2.8%) experienced infections after SNM. There was no difference in the rates of infection between groups (4 [1.9%] PrePostAbx vs 2 [0.9%] OnlyPreAbx, P = 0.99). Of the 4 patients with postoperative infections in the PrePostAbx group, 2 had cellulitis requiring antibiotics and 2 required full explantation. Of the 2 patients with postoperative infections in the OnlyPreAbx group, both patients required explantation. In a subanalysis comparing infected and noninfected patients, infected patients (n = 6) had higher rates of hypertension (n = 6, 100%; P = 0.02) and diabetes mellitus (n = 3, 50%; P = 0.05). Additional postoperative antibiotics did not decrease infection rates in patients undergoing SNM. Similar comparative analyses should be performed with larger sample sizes.

Evaluation of the Rock1 and microRNA-148a expression in biopsies collected from patients with Helicobacter pylori induced gastritis

BackgroundHelicobacter pylori infection is one of the most common chronic bacterial infections, especially in developing countries. MicroRNA-148a is involved in the regulation of various genes, including Rock1, which is altered in gastric cancer. Decreased expression of mir-148a leads to tumor metastasis and increased Rock1 gene expression in gastric cancer. This study aimed to investigate the expression of these genes in biopsies collected from patients with H. pylori induced gastritis.MethodsInformed consent forms were gotten from the studied patients with gastritis who needed endoscopy. Gastric biopsies were taken by a gastroenterologist from patients with inflammation. Rapid urease test, stool antigen detection, and histopathological staining were used to determine the H. pylori infected patients. Real time PCR was used to evaluate the miRNA and Rock1 expression levels.ResultsThe Rock1 expression level in biopsies that were positive for H. pylori was significantly increased compared to our control gastritis group that were H. pylori-negative, but the results were not statistically significant. Moreover, the mir-148a expression level in H. pylori-positive patients with gastritis was increased compared to our control group. However, the results were not statistically significant. We did not find a significant relation between the expression levels of Rock1 and mir-148a in samples with gastritis infected or uninfected by H. pylori. This result may be due to the small sample size.ConclusionWe suggest that this test should be carried out with more samples, and the comparison should be done between biopsies with inflammation and no inflammation in a patient.

A systematic review and meta-analysis of cortisol levels in Plasmodium infections

Malaria has complex interactions with host physiology, including alterations in cortisol levels. Cortisol, a key hormone in the stress response, is known to be dysregulated in various infectious diseases. This systematic review and meta-analysis aimed to elucidate the relationship between Plasmodium infection and cortisol levels, shedding light on the intricate interplay between the parasite and the host’s endocrine system. The methodological protocol for assessing cortisol levels in malaria patients was registered in PROSPERO (CRD42024496578), a widely recognized international prospective register of systematic reviews. This registration ensures transparency and minimizes the risk of bias in our research. A comprehensive search strategy was employed across major databases, including Embase, PubMed, Scopus, and Medline, to include studies that reported cortisol levels in infected patients. The qualitative synthesis was undertaken to synthesize the difference in cortisol levels between malaria-infected and uninfected individuals. The meta-analysis employed the random effects model in the quantitative synthesis to calculate the effect estimate. The review included a total of 20 studies, with a substantial number conducted in Africa, followed by Asia and South America. Most included studies (13/20, 65%) reported higher cortisol levels in infected patients than in uninfected patients. The meta-analysis confirmed significantly higher cortisol levels in infected patients compared to uninfected individuals (P < 0.0001, standardized mean difference (SMD): 1.354, 95% confidence interval: 0.913 to 1.795, I2: 88.3%, across 15 studies). Notably, the method for cortisol measurement and the type of blood sample used (serum or plasma) were significant moderators in the analysis, indicating that these factors may influence the observed relationship between Plasmodium infection and cortisol levels. The systematic review and meta-analysis confirmed that Plasmodium infection is associated with increased cortisol levels, highlighting the intricate relationship between the disease and the host stress response. These findings underscore the potential of cortisol as a supplementary biomarker for understanding the pathophysiological impact of malaria. By providing insights into the stress-related mechanisms of malaria, this comprehensive understanding can inform future research and potentially enhance disease management and treatment strategies, particularly in regions heavily burdened by malaria.

Willingness toward voluntary counseling and testing and associated factors among tuberculosis infected patients at public hospitals in Addis Ababa, Ethiopia

BackgroundVoluntary counseling and testing for HIV has proven to be a highly effective and cost-efficient approach in many locations, yielding excellent results. It serves as a gateway to a range of HIV-related services, including the provision of antiretroviral drugs. Therefore, this study was aimed to assess the willingness toward VCT and associated factors among TB infected patients at Public Hospitals in Addis Ababa, Ethiopia; 2023.MethodsA facility-based cross-sectional study was undertaken at public hospitals in Addis Ababa from 1st to 30th of March 2023 with 235 participants using systematic random sampling. Trained data collectors employed a pretested data extraction tool for information gathering. Variables with p-value less than 0.05 in the multivariable logistic regression were considered statistically significant.ResultsThe prevalence of willingness toward VCT among TB infected patients was (78.3, 95%CI: 72.8, 83.4). Individuals with a primary education level (AOR: 6.32; 95%CI: 1.65, 24.25), government employees (AOR: 5.85; 95%CI: 1.78, 19.22) and private employees (AOR: 3.35; 95%CI: 1.12, 10.01), good knowledge of VCT (AOR: 3.12; 95%CI: 1.36, 7.16), perceived a higher risk (AOR: 6.58; 95%CI: 2.44, 17.73) and perceived stigma (AOR: 14.95; 95%CI: 4.98, 44.91) were factors associated with willingness toward VCT.ConclusionThe proportion of Tuberculosis infected patients expressing willingness toward Voluntary Counseling and Testing in this study was higher than in previous studies, it falls below the UNAIDS target of 90% of people knowing their HIV status. Notably, factors such as level of education, occupation, knowledge, perceived risk, and perceived stigma emerged as independent factors significantly associated with the willingness of TB-infected patients to undergo VCT. These findings underscore the importance of considering socio-demographic characteristics, knowledge levels, and psychosocial factors in designing strategies to enhance VCT acceptance among TB-infected individuals.

Lab-in-a-Vial Rapid Test for Internet of Things-Embedded Point-of-Healthcare Protein Biomarker Detection in Bodily Fluids.

Amateurs often struggle with detecting and quantifying protein biomarkers in body fluids due to the high expertise required. This study introduces a Lab-in-a-Vial (LV) rapid diagnostic platform, featuring hydrangea-like platinum nanozymes (PtNH), for rapid, accurate detection and quantification of protein biomarkers on-site within 15min. This method significantly enhances detection sensitivity for various biomarkers in body fluids, surpassing traditional methods such as enzyme-linked immunosorbent assays (ELISA) and lateral flow assays (LFA) by ≈250 to 1300 times. The LV platform uses a glass vial coated with specific bioreceptors such as antigens or antibodies, enabling rapid in vitro evaluation of disease risk from small fluid samples, similar to a personal ELISA-like point-of-care test (POCT). It overcomes challenges in on-site biomarker detection, allowing both detection and quantification through a portable wireless spectrometer for healthcare internet of things (H-IoT). The platform's effectiveness and adaptability are confirmed using IgG/IgM antibodies from SARS-CoV-2 infected patients and nuclear matrix protein (NMP22) from urothelial carcinoma (UC) patients as biomarkers. These tests demonstrated its accuracy and flexibility. This approach offers vast potential for diverse disease applications, provided that the relevant protein biomarkers in bodily fluids are identified.

Evaluation of the Fluorion HCV QNP v3.0 real-time PCR assay for quantifying HCV RNA in Moroccan patients: A comparative study with COBAS AmpliPrep/COBAS TaqMan HCV v2.0

PurposeHepatitis C Virus (HCV) RNA quantification is crucial for diagnosing and monitoring chronic HCV treatment. Cost-effective methods are crucial to ensure accessibility. This study evaluated the Fluorion HCV QNP v3.0 Real-Time PCR assay's effectiveness in EDTA-plasma and serum, comparing it with the COBAS AmpliPrep/COBAS TaqMan HCV v2.0 (CAP/CTM HCV v2.0) test. Methods105 matched pairs of EDTA-plasma and serum specimens (91 positive and 14 negative) from HCV infected Moroccan patients were analyzed using the Fluorion HCV QNP v3.0 assay and compared to the CAP/CTM HCV v2.0 test, being the reference method. ResultsThe values obtained by the Fluorion HCV QNP v3.0 in plasma were slightly higher than those in serum (3.94 ± 2.23 log10 IU/mL versus 3.91 ± 2.22 log10 IU/mL) and were both significantly lower than those quantified by the CAP/CTM HCV v2.0 assay (4.34 ± 2.28 log10 IU/mL; p < 0.001). High correlations were observed between the Fluorion HCV QNP v3.0 serum and CAP/CTM HCV v2.0 (R2 = 0.9433), the Fluorion HCV QNP v3.0 plasma and CAP/CTM HCV v2.0 (R2 = 0.949) and the Fluorion HCV QNP v3.0 serum and plasma (R2 = 0.9954). HCV RNA was detected in all tested genotypes by both assays. ConclusionThe Fluorion HCV QNP v3.0 assay demonstrated excellent performance in comparison with the CAP/CTM HCV v2.0 on both plasma and serum samples which can be used interchangeably for HCV quantification. The test was shown to be suitable for disease monitoring including all HCV genotypes.

Reducing personal protective equipment waste in the emergency department of a large regional hospital: codesign informed by system science

BackgroundThis study aimed to bring together health workers from an emergency department (ED) and broader health system changemakers to cocreate a system-oriented understanding of the drivers of single-use personal protective...

Bacilli load in PTB- intestinal helminths co-infected and PTB non -infected patients at selected public health facilities in Jimma zone, Oromia, Ethiopia: comparative cross-sectional study

BackgroundTuberculosis (TB) and intestinal helminths are diseases that pose a dual burden on public health in low-income countries. Previous studies have shown that helminths can affect the shedding of bacteria or the bacterial load in the sputum of active TB patients. However, there is limited information on bacterial load in TB patients with helminth infections.ObjectiveThis study aimed to compare bacterial load in helminths-infected and non-infected pulmonary tuberculosis patients at selected public health facilities in Jimma zone, Oromia, Ethiopia.MethodsThe study was conducted in Jimma Zone, Oromia, Ethiopia. A facility-based comparative cross-sectional study was employed from August 01, 2020, to January 2021. A total of 124 (55 intestinal helminths-infected and 69 non-infected) newly diagnosed smear-positive pulmonary tuberculosis (PTB) patients were included in the study. A convenience sampling technique was employed to recruit study participants, and a semi-structured questionnaire was used to collect data regarding socio-demographic characteristics and possible risk factors for intestinal helminths co-infection. Stool examination was performed using both wet mount and Kato Katz technique. Additionally, weight and height measurements, sputum, and blood samples were taken to determine body mass index, bacilli load, and diabetic mellitus, respectively. Data were entered into Epi-Data software version 3.1 and analyzed using Statistical Packages for Social Sciences (SPSS) Version 25. A statistically significant difference was defined as a P-value of less than 0.05.ResultsIntestinal helminths reduced bacilli load 3 times more than intestinal helminths non-infected PTB (AOR = 3.44; 95% CI; 1.52, 7.79; P = 0.003) However, diabetes mellitus, HIV, drinking alcohol and cigarette smoking were not associated with bacilli load. The rate of co-infection TB with intestinal helminths was 44%. The three most prevalent parasites detected were Trichuris trichiura 29 (66%), hookworm 19 (43%), and Ascaris lumbricoides 11(25%)). Among co-infected patients about 36 (81.8%) had a single parasite infection, and 19 (43.2%) had multiple infections. A body mass index < 18.5 (AOR = 3.26; 95% CI; 1.25, 8.56;P = 0.016) and untrimmed fingernail status (AOR = 3.63; 95%CI;1.32,9.93;P = 0.012) were significantly associated with PTB- intestinal helminth –co-infection.ConclusionHelminth infection was associated with a lower bacilli load compared to helmenths non-infected PTB. The rate of co-infection TB with intestinal helminths was 44%. Trichuris trichiura was the most prevalent helminth. Untrimmed fingernail and a body mass index were associated with PTB-intestinal helminth co-infection.

The roles played by hsa-miR-223-5p and mutations in the S gene of SARS-CoV-2 in COVID-19.

Increased proinflammatory molecules are a main reason for severe symptoms in patients infected with SARS-CoV-2. This study evaluated mutations in the S gene of SARS-CoV-2 and the expression of hsa-miR-223-5p, interleukin 2 receptor α (IL-2Rα), and CCL16 chemokine in hospitalized SARS-CoV-2 infected patients. This is a cross-sectional study. This study included 75 SARS-CoV-2-infected patients with severe symptoms and 75 age-sex-matched healthy controls. Real-time polymerase chain reaction techniques were used to evaluate the expression levels of hsa-miR-223-5p, IL-2Rα, and CCL16 chemokine. The Sanger technique was used to sequence the S gene of SARS-CoV-2 from positions 23,274 to 23,641. The relative expression of hsa-miR-223-5p was significantly increased whereas that of IL-2Rα was significantly decreased in the SARS-CoV-2 infected patients. Two mutations were found in the S gene of SARS-CoV-2 at positions 23,403 (p.Asp23403Gly) and 23,525 (p.His23525Tyr) of the S gene of SARS-CoV-2. Increased hsa-miR-223-5p may be a main cause for the downregulation of IL-2Rα, which is a main developer of T-regulatory lymphocytes. The mutations in the S gene of SARS-CoV-2-infected patients may affect immune responses to the molecule and alter the avidity of virus-human cell interactions.

Design of hospitals for the post-pandemic era: an international survey of design professionals on infection control design strategies

ABSTRACT The COVID-19 pandemic placed unpreceded stress on healthcare systems, highlighting their deficiencies and vulnerabilities. The risk of cross-infection among patients and healthcare workers increased significantly, hindering the overall healthcare process. Hospital design should meet the challenges that will be posed by future pandemics, especially infection control. This paper reports on the results of an online survey for healthcare design professionals and academics from across the globe. The questionnaire addressed how hospital design can contribute to the infection control during future pandemic situations. Respondents agreed that the benefits of designing hospitals to meet the needs of pandemic/emergency situations outweigh the additional cost, and that infection control should play a more pronounced role when designing hospitals for the coming era. Results indicate that the overall organization of hospitals should allow for the compartmentation of critical/isolation departments/units and the creation of separate circulation routes to suit this compartmentation during pandemic times. The circulation system of the emergency departments and Intensive Care Units (ICU) should allow for the separation of infectious patients from others during pandemic times. 20–30% of the ICU beds of tertiary level care hospitals should be designed as single patient rooms. 53% of these rooms should be easily convertible to Air-Borne-Infection Isolation (AII) rooms, 44% should have an additional space for adding anterooms during pandemics, and 55% of these rooms should have permanent storage spaces for Personal Protective Equipment. The inpatient units should also be designed to support infection control. AII rooms should be grouped in designated inpatient units.

The 90-Day Risk of Hospitalization in Heart Transplant Recipients After COVID-19 Infection

BackgroundHeart transplant recipients are at a high-risk of complications from the coronavirus-2019 (COVID-19) infection. Heart transplant recipients are a special group of persistently immunosuppressed people, and COVID-19 may cause them to experience an unpredictable course of infection, with a risk of hospitalization occurring well beyond their initial infection period. The seriousness of COVID-19 disease in heart transplant recipients emphasizes how vital it is to refer patients promptly and early to specialized heart transplant centers. MethodsWe retrospectively reviewed all heart transplant recipients at a single center between March 2019 and October 2021. All recipients with positive nasopharyngeal reverse transcriptase-polymerase chain reaction tests for COVID-19 were included in this study. After IRB approval, we obtained medical records and patient data from electronic medical records. ResultsThis study followed 126 heart transplant patients from March 2019 to October 2021 of which only 49 had COVID-19 infections. The median age at infection was 58 years (49-65), with 41% female. Race distribution was as follows: 59% Caucasian and 39% African American. The median time from transplant to infection was 384 days (237-677). All infected patients had a 50% dose reduction in mycophenolate mofetil per institutional protocol. The majority of symptoms were cough, fatigue, shortness of breath, and fever. Among all patients with COVID-19, 45 (92%) were vaccinated. Of those vaccinated, 27 (60%) patients received Pfizer initial and booster doses, whereas 18 (40%) received Moderna initial and booster doses. Twelve patients (24%) were hospitalized within 90 days of infection, with only two requiring ICU level of care. The median duration of hospitalization was 5 days (4-9). Of the hospitalized patients, 11 (92%) were discharged, and 1 (8%) died in the hospital. Three of the four unvaccinated patients were hospitalized, and one died while hospitalized. The remaining 37 patients were managed as outpatients. ConclusionHeart transplant recipients have an increased risk of contracting COVID-19 and developing severe symptoms due to multiple healthcare contacts, preexisting health conditions, and weakened immune systems. Our data highlight that most vaccinated patients do not require hospitalization within 90 days of infection, and those hospitalized have a high likelihood of survival without needing ICU care.

The Analysis Study of Detection of Gonorrhea among HIV Infected Patients: A Comprehensive Systematic Review

The Analysis Study of Detection of Gonorrhea among HIV Infected Patients: A Comprehensive Systematic Review

Occurrence of blaOXA-116 Carbapenemase in Escherichia coli ST2519 of Clinical Origin: A Report from Northeast India.

Carbapenem-resistant Escherichia coli pose a significant threat to global public health due to the dearth of available treatment options, resulting in infections with high mortality and morbidity. The study aimed to investigate the mechanism of carbapenem resistance in a carbapenem non-susceptible E. coli isolate recovered from an urinary tract infection patient admitted to a tertiary referral hospital, through whole-genome sequencing using Illumina NovaSeq 6000 platform. Carbapenemase production followed by antibiotic susceptibility testing were performed following Clinical Laboratory Standard Institute guidelines.Polymerase chain reaction targeting carbapenemase genes was performed followed by an investigation of horizontal transferability. The Center for Genomic Epidemiology database was used to analyze the sequenced data. ST2519 E. coli BJD_EC1808 with a genome size of 5.8 Mb harbored Col440I plasmid and a chromosomally located blaOXA-116 gene with an IS18 element upstream, along with multiple antibiotic resistance genes conferring clinical resistance toward beta-lactams, aminoglycosides, amphenicols, sulfonamides, tetracyclines, trimethoprim, rifampin, macrolide, and streptogramin antibiotics and antiseptics. E. coli ST2519 harboring blaOXA-116 associated with a mobile genetic element exhibiting carbapenem resistance is a public health threat due to its limiting effect on the therapeutic usage of carbapenem and their dissemination into carbapenem non-susceptible phenotypes will contribute to carbapenem resistance burden and, therefore, warrants urgent monitoring and clinical intervention.

The appropriateness of empirical antibiotic therapy in the management of symptomatic urinary tract infection patients-a cross-sectional study in Nairobi County, Kenya.

In low- and middle-income countries, symptomatic urinary tract infection (UTI) patients are often prescribed antibiotics without microbiological confirmation. UTIs caused by antibiotic-resistant bacteria are increasingly common, and this heightens the risk of empirical treatment failure. This study evaluates the appropriateness of empirical antibiotic therapy to UTI patients in Nairobi County, Kenya. A hospital-based, cross-sectional study was conducted in Nairobi County, Kenya, amongst symptomatic adult and child patients. UTI was defined as a monoculture growth with colony counts of ≥104 cfu/mL. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Empirical therapy was considered appropriate if the pathogen isolated was susceptible to the prescribed antibiotic and inappropriate if the pathogen was resistant to the prescribed antibiotic. A total of 552 participants were enrolled with a median age of 29 years (interquartile range: 24-36). The majority were female, 398 (72%). Of the 552, 274 (50%) received empirical antibiotic therapy, and 95/274 (35%) were confirmed to have UTI by culture. The antibiotics most frequently prescribed were fluoroquinolones [ciprofloxacin in 80 (30%) and levofloxacin 43 (16%)], amoxicillin-clavulanic acid in 48 (18%) and nitrofurantoin in 32 (12%). Amongst the 95 patients with bacteriological confirmation of UTI, 50 (53%) received appropriate empirical antibiotic therapy, whilst for 38 (40%) participants, the therapy was inappropriate. The complexity of appropriate empirical treatment for UTIs is compounded by high levels of resistance in UTI pathogens. Antimicrobial resistance surveillance strategies that could help in designing appropriate empirical regimens in resource constrained settings should be adopted for optimal empiric therapy.

Pathogen-Agnostic Advanced Molecular Diagnostic Testing for Difficult-to-Diagnose Clinical Syndromes-Results of an Emerging Infections Network Survey of Frontline US Infectious Disease Clinicians, May 2023.

During routine clinical practice, infectious disease physicians encounter patients with difficult-to-diagnose clinical syndromes and may order advanced molecular testing to detect pathogens. These tests may identify potential infectious causes for illness and allow clinicians to adapt treatments or stop unnecessary antimicrobials. Cases of pathogen-agnostic disease testing also provide an important window into known, emerging, and reemerging pathogens and may be leveraged as part of national sentinel surveillance. A survey of Emerging Infections Network members, a group of infectious disease providers in North America, was conducted in May 2023. The objective of the survey was to gain insight into how and when infectious disease physicians use advanced molecular testing for patients with difficult-to-diagnose infectious diseases, as well as to explore the usefulness of advanced molecular testing and barriers to use. Overall, 643 providers answered at least some of the survey questions; 478 (74%) of those who completed the survey had ordered advanced molecular testing in the last two years, and formed the basis for this study. Respondents indicated that they most often ordered broad-range 16S rRNA gene sequencing, followed by metagenomic next-generation sequencing and whole genome sequencing; and commented that in clinical practice, some, but not all tests were useful. Many physicians also noted several barriers to use, including a lack of national guidelines and cost, while others commented that whole genome sequencing had potential for use in outbreak surveillance. Improving frontline physician access, availability, affordability, and developing clear national guidelines for interpretation and use of advanced molecular testing could potentially support clinical practice and public health surveillance.

Unveiling the devastations of streptococcus sanguinis infective endocarditis masquerading as iron deficiency anaemia: a case report

Abstract Background Iron deficiency is the leading cause of anaemia worldwide and frequently observed in adolescent women, particularly those with eating disorders like anorexia nervosa. Consequently, clinicians may overlook iron deficiency anaemia, potentially missing a more serious diagnosis. Case summary A 19-year-old woman was referred to the hospital by her general practitioner due to worsening symptomatic iron deficiency anaemia, despite treatment with oral iron supplementation. Her blood cultures consistently grew Streptococcus sanguinis, and an echocardiogram revealed vegetations on the mitral and tricuspid valves, confirming the diagnosis of infective endocarditis. Several systemic complications of varying acuity were identified, including a ruptured left common iliac artery aneurysm with active haemorrhage into the left psoas muscle, enlarging cerebral, hepatic, and right common femoral artery aneurysms, splenic infarction with abscess formation, and an infected left psoas muscle hematoma. Multimodal imaging and collaboration within the multidisciplinary endocarditis team were crucial for coordinating further evaluation and managing the complex array of peripheral lesions in infective endocarditis. The patient was discharged with a good clinical outcome after 81 days. Discussions This case highlights the risks of overlooking iron deficiency anaemia in adolescent women with anorexia nervosa and the serious consequences of untreated complicated infective endocarditis. It emphasises the need for thorough investigation of anorexia nervosa patients for infections due to their reduced clinical response, to ensure early diagnosis and treatment.

Differentiating lung neuroendocrine neoplasms from tumor-like infection using CT in patients with ectopic ACTH syndrome

ObjectivesPulmonary neuroendocrine neoplasms (NENs) are the most frequent cause of ectopic adrenocorticotropic hormone syndrome (EAS); lung infection is common in EAS. An imaging finding of infection in EAS patients can mimic NENs. This retrospective study investigated EAS-associated pulmonary imaging indicators.MethodsForty-five pulmonary NENs and 27 tumor-like infections from 59 EAS patients (45 NEN and 14 infection patients) were included. Clinical manifestations, CT features, 18F-FDG, or 68Ga-DOTATATE-PET/CT images and pathological results were collected.ResultsHigh-sensitivity C-reactive protein (p < 0.001) and expectoration occurrence (p = 0.04) were higher, and finger oxygen saturation (p = 0.01) was lower in the infection group than the NENs group. Higher-grade NENs were underrepresented in our cohort. Pulmonary NENs were solitary primary tumors, 80% of which were peripheral tumors. Overlying vessel sign and airway involvement were more frequent in the NENs group (p < 0.001). Multifocal (p = 0.001) and peripheral (p = 0.02) lesions, cavity (p < 0.001), spiculation (p = 0.01), pleural retraction (p < 0.001), connection to pulmonary veins (p = 0.02), and distal atelectasis or inflammatory exudation (p = 0.001) were more frequent in the infection group. The median CT value increment between the non-contrast and arterial phases was significantly higher in NENs lesions (p < 0.001). Receiver operating characteristic curve analysis indicated a moderate predictive ability at 48.3 HU of delta CT value (sensitivity, 95.0%; specificity, 54.1%).ConclusionChest CT scans are valuable for localizing and characterizing pulmonary lesions in rare EAS, thereby enabling prompt differential diagnosis and treatment.Critical relevance statementThin-slice CT images are valuable for the localization and identification of pulmonary ectopic adrenocorticotropic hormone syndrome lesions, leading to prompt differential diagnosis and effective treatment.Key PointsLung tumor-like infections can mimic neuroendocrine neoplasms (NENs) in ectopic adrenocorticotropic hormone syndrome (EAS) patients.NENs are solitary lesions, whereas infections are multiple peripheral pseudotumors each with identifying imaging findings.Typical CT signs aid in localization and creating an appropriate differential diagnosis.Graphical

Financial burden and social implications of chronic liver disease in a patient population group in Pakistan.

To assess economic and social issues faced by cirrhotic patients & its financial burden for developing nations like Pakistan. This cross-sectional study was carried out at the Department of Gastroenterology & Hepatology, Shaikh Zayed Hospital, Lahore, Pakistan during the period between July & December 2019. Patients with liver cirrhosis were recruited and information regarding disease, financial status, treatment expenses & dependency was recorded. A total of 450 patients were recruited, 272 (60%) were males & 178 (40%) were females, with mean age 55.4±6.2 years. HCV was cause of cirrhosis in 86% of cases, 65% were diagnosed incidentally and 39.6% were illiterate. About 82.7% were urban while only 28.7% own their own home. Co-morbid conditions including diabetes, hypertension & ischemic heart disease were present in 54% of cases. Monthly income was <PKR 45,000 in 23% of cases while 47% were non-earning. Our study shows the financial difficulties & dependency faced by patients with liver cirrhosis. Aggressive national screening is required to discover infected patients before cirrhosis develops.

Clostridioides difficile and Gut Microbiota: From Colonization to Infection and Treatment

Clostridioides difficile is the main causative agent of antibiotic-associated diarrhea (AAD) in hospitals in the developed world. Both infected patients and asymptomatic colonized individuals represent important transmission sources of C. difficile. C. difficile infection (CDI) shows a large range of symptoms, from mild diarrhea to severe manifestations such as pseudomembranous colitis. Epidemiological changes in CDIs have been observed in the last two decades, with the emergence of highly virulent types and more numerous and severe CDI cases in the community. C. difficile interacts with the gut microbiota throughout its entire life cycle, and the C. difficile’s role as colonizer or invader largely depends on alterations in the gut microbiota, which C. difficile itself can promote and maintain. The restoration of the gut microbiota to a healthy state is considered potentially effective for the prevention and treatment of CDI. Besides a fecal microbiota transplantation (FMT), many other approaches to re-establishing intestinal eubiosis are currently under investigation. This review aims to explore current data on C. difficile and gut microbiota changes in colonized individuals and infected patients with a consideration of the recent emergence of highly virulent C. difficile types, with an overview of the microbial interventions used to restore the human gut microbiota.

Clinical, Microbiological Profile and Antibiotics Use in Admitted Patients of Urinary Tract Infection

Urinary tract infections (UTI) can vary from simple cystitis to pyelonephritis with severe sepsis. The objective of this study is to provide information about the clinical and microbiological profile of admitted patients of urinary tract infection, patterns of organisms isolated, antibiotic sensitivity pattern and antibiotics use. It was a prospective observational study conducted on 40 patients age &gt;14 years admitted with diagnosis of UTI based on clinical and microbiological criteria over 8 months at a tertiary care hospital in North India. Data was collected for the clinical, microbiological profile, empirical and definite antibiotics use with duration of stay and outcome of patients. Among 40 cases of UTI; male to female ratio was 1:1 with mean age of 51.3± 16.32 years. Fever was present in almost all (97.5%) of the patients and three-fourth (75%) of them had dysuria. Type-2 Diabetes Mellitus was most common (55%) underlying condition and mean HbA1c was 9.37±2.27 followed by obstructive uropathy (17.50%). Most of cases (82.5%) were of complicated UTI; where Pyelonephritis was 42%, Emphysematous Pyelonephritis 12.5% and Renal Abscess 7.5%. Most common (37.5%) organism isolated from urine/ pus culture was Escherichia coli. More than half of the patients (55%) were given empirical antibiotics injection piperacillin tazobactam and carbapenems was used in more than one third (35%) of patients. The mean duration of antibiotics use was 14.55±4.94 days. Two (5.0%) patients expired out during the study period. Uncontrolled Diabetes Mellitus remains the major underlying condition in cases of complicated UTI. E coli is the most common organism isolated from urine/ pus culture. Most of the patients had favourable outcome with guided antibiotics and interventions. Bangladesh Med J. 2023 May; 52(2): 15-19