Local Spread Research Articles

Effect of Abdominal Girth and Vertebral Column Length in Spread of Spinal Anesthesia for Lower Limb Surgery: A Prospective Study

Background: Subarachnoid spread of local anesthetics is quite erratic and is determined by several factors. There is a high predictive for the spread of spinal anaesthesia in terms of abdominal girth and vertebral column length. Our study is designed to determine the effect of abdominal girth and vertebral column length with cephalad spread of spinal anaesthesia for a given dose of 0.5% hyperbaric bupivacaine in Nepalese patients. Materials and Methods: In this prospective observational study, a total 100 patients of ASA PS I-II, aged16-65 years and undergoing lower extremity surgery under spinal anesthesia were enrolled. 2.8 mL of 0.5% hyperbaric bupivacaine was injected intrathecally at L3-4 interspace in sitting position. Extent of sensory blockade was assessed for 60 min. Simple linear regression, multiple linear regression and Pearson’s correlation coefficient analysis were performed to determine the correlation between patient variables viz abdominal girth, vertebral column length, height, weight, body mass index and age and maximum sensory block height. Results: Abdominal girth and vertebral column length correlated significantly with the maximal sensory block height after intrathecal administration of a fixed dose of 0.5% hyperbaric bupivacaine by all the three statistical tools used. Conclusion: Abdominal girth and vertebral column lengthcorrelate significantly with the maximal sensory block height in Nepalese patients receiving a fixed dose subarachnoid block with 0.5% hyperbaric bupivacaine

The timeline of overseas imported cases acts as a strong indicator of dengue outbreak in mainland China.

The emergence of dengue viruses in new, susceptible human populations worldwide is increasingly influenced by a combination of local and global human movements and favorable environmental conditions. While various mathematical models have explored the impact of environmental factors on dengue outbreaks, the significant role of human mobility both internationally and domestically in transmitting the disease has been less frequently addressed. In this context, we introduce a modeling framework that integrates the effects of international travel-induced imported cases, climatic conditions, and local human movements to assess the spatiotemporal dynamics of dengue transmission. Utilizing the generation matrix method, we calculate the basic reproduction number and its sensitivity to various model parameters. Through numerical simulations using data on climate, human mobility, and reported dengue cases in mainland China, our model demonstrates a good agreement with observed data upon validation. Our findings reveal that while climatic conditions are a key driver for the rapid dengue transmission, human mobility plays a crucial role in its local spread. Importantly, the model highlights the significant impact of imported cases from overseas on the initiation of dengue outbreaks and their contribution to increasing the disease incidence rate by 34.6%. Furthermore, the analysis identifies that dengue cases originating from regions, such as Cambodia and Myanmar internationally, and Guangzhou and Xishuangbanna domestically, have the potential to significantly increase the disease burden in mainland China. These insights emphasize the critical need to include data on imported cases and domestic travel patterns in disease outbreak models to improve the precision of predictions, thereby enhancing dengue prevention, surveillance, and response strategies.

An all-out assault on a dominant resistance gene: Local emergence, establishment, and spread of strains of tomato spotted wilt orthotospovirus (TSWV) that overcome Sw-5b-mediated resistance in fresh market and processing tomatoes in California.

Tomato spotted wilt orthotospovirus (TSWV) causes substantial economic loss to tomato production, and the Sw-5b resistance gene is widely deployed for management. Here, we show (i) the emergence of resistance-breaking (RB) TSWV strains in processing and fresh market tomato production in California over the past ten years, and (ii) evolutionary relationships with RB strains from other areas. A specific RT-PCR test was used to show the C118Y RB strain that emerged in Fresno County in 2016 quickly became predominant in the central production area and remained so through this study. In 2021, the C118Y strain was detected in the Northern production area, and was predominant in 2022. However, in 2023, the C118Y strain was unexpectedly detected in fewer spotted wilt samples from resistant varieties. This was due to emergence of the T120N RB strain, previously known to occur in Spain. A specific RT-PCR test was developed and used to show that the T120N RB strain was predominant in Colusa and Sutter counties (detected in 75-80% of samples), and detected in ~50% of samples from Yolo County. Pathogenicity tests confirmed California isolates of the T120N strain infected Sw-5b tomato varieties and induced severe symptoms. Another RB strain, C118F, was associated with spotted wilt samples of Sw-5 varieties from fresh market tomato production in southern California. Phylogenetic analyses with complete NSm sequences revealed that the C118Y and T120N RB strains infecting resistant processing tomato in California emerged locally, whereas those from fresh market production were more closely related to isolates from Mexico. Thus, widespread deployment of this single dominant resistance gene in California has driven the local emergence of multiple RB strains in different tomato production areas and types. These results further emphasize the need for ongoing monitoring for RB strains, and identification of sources of resistance to these strains.

Subtotal glossectomy with conservation of the hyo-styloglossus unit (HSU): a new pivotal concept for preserving tongue function in extended glossectomy.

The local spread of oral tongue squamous cell carcinoma (OTSCC) follows pathways of dissemination along areas of lesser resistance. In more advanced scenarios, the tumor can extend beyond the hemi-tongue of origin, by passing through the lingual septum and following the fibers of the transverse muscle. This can lead to the invasion of the contralateral extrinsic muscles, the first being the genioglossus and more laterally the hyoglossus. An anatomically guided surgical resection of the tumor can be planned to ensure both oncological safety and an acceptable functional outcome. This approach aims to preserve the hyo-styloglossus unit (HSU) whenever feasible. Between January 2019 and November 2022, six patients received extended glossectomy Type B (EG Type B), with preservation of the HSU. Preliminary oncological results and functional results in terms of swallowing (FOIS score) and quality of life (MDADI) are presented. Five out of the six patients are alive and disease-free, while one patient died due to other causes. All patients who were candidates for an EG Type B underwent a swallowing assessment prior to surgery and followed daily postoperative swallowing training. At discharge, the patients continued swallowing training in an outpatient clinic. Five out of the six patients reached a full oral diet within 1 year of follow-up. The oncological results confirm the safety of this technique. The importance of preserving the HSU, the minimal functional unit, shows very encouraging results in terms of swallowing rehabilitation.

Prevalence of Candida auris Among High-Risk Patients at a Comprehensive Cancer Center

Background: Candida auris (C. auris) is a multidrug-resistant fungus that is increasingly implicated in outbreaks in healthcare facilities worldwide. The Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services recommend healthcare facilities screen patients who are considered high-risk for C. auris, including patients with an overnight stay in a healthcare facility outside the United States (U.S.) in the previous year, or recently stayed in a rehabilitation (rehab) facility, long-term acute care (LTAC), or skilled nursing facility (SNF). Screening patients for C. auris colonization allows for early implementation of infection control measures, preventing transmission to healthcare workers and other patients. According to the CDC, most cases of C. auris result from local spread within and among healthcare facilities in the same city or state. In Texas, 160 clinical cases have been reported during the past 12 months. At present, the necessity of screening high-risk patients at our center for C. auris is not known. We aimed to determine the prevalence of C. auris colonization among our patient population. Method: During a 4-week period, we performed targeted screening of patients meeting the CDC’s high-risk definition for C. auris. Admitted patients were screened by an Infection Preventionist (IP) using the electronic health record to identify patients who were either international or admitted from a rehab or care facility. A composite swab of bilateral axilla and groin creases was collected using an eSwab™ (Becton Dickinson) and sent to a reference lab (Mayo Clinic Laboratories) for polymerase chain reaction (PCR)-based detection of C. auris. Additionally, we reviewed historic cases of C. auris diagnosed at our institution to better define our at-risk patients. Results: Between July 14 – August 8, 2023, we consecutively screened 25 high-risk patients, including 18 (72%) international and 7 (28%) patients from rehabs, LTAC, or SNF. None were positive for C. auris. Since 2019, we identified six patients with C. auris positive cultures, including five clinical cases and one colonization case. Five patients were international and one was local with no history of international travel or stay in a care facility. Interestingly, all six were known to be colonized with extended-spectrum beta-lactamase (ESBL) E. coli. Conclusion: We have a very low prevalence of C. auris among CDC-defined high-risk patients. A review of historic C. auris cases indicated an association with colonization by other multidrug-resistant organisms, specifically ESBL E. coli, which will inform future screening protocols at our institution.Disclosure: Roy Chemaly: Contracted Research paid for my institution: Merck, Karius, AiCuris, Ansun Pharmaceuticals, Takeda, Genentech, Oxford Immunotec, and Eurofins-Viracor; Honorarium/Ad Board/Consultant: ADMA Biologics, Janssen, Merck/MSD, Partner Therapeutics, Takeda, Shinogi, AiCuris, Roche/Genentech, Astellas, Tether, Oxford Immunotec, Karius, Moderna, and Ansun Pharmaceuticals; Stock Options: Xenex

Precision in practice: Exploring the impact of AI and machine learning on ultrasound guided regional anaesthesia.

Ultrasound Guided Regional Anaesthesia (UGRA) is a commonly utilized practice in both elective and emergency situations during surgical procedures and for pain management. Its benefits include, being non-invasive, cost-effective, readily accessible, and providing the anaesthetist with clear visualization of essential anatomical landmarks, needle progression, and the spread of local anaesthetic. Ultrasonography has been shown to increase success rates for regional anaesthesia and decrease complications. One of the critical steps during UGRA is identifying relevant anatomical structures like nerves or vertebras. However, this aspect can be hindered by external influences such as variations in nerve structure and position, interference from noise, and positional instability. Machine learning is a promising branch of artificial intelligence. It is used to conduct predictive tasks without programming instructions by creating algorithms. Extensive research has been conducted to evaluate the influence of machine learning on innovative anaesthesia methods. In 2023, Lopez et al. published a systematic review on how Artificial Intelligence could positively impact traditional anaesthesia practices.1 Various studies included in the review employed different models to achieve variable targets during the induction of anaesthesia. In one experiment, Alkhatib et al. used Convolutional neural network (CNN) based deep trackers to track the median and sciatic nerve with a surprising accuracy of 0.87.2 Another study employed the same CNN model to locate and discriminate accurate images of sacrum, vertebral levels and intervertebral gaps during percutaneous spinal needle insertion.3 Another study used a different AI model called SVM (support vector machine) classification, image processing, and template matching to locate lumbar level L3-L4 and the ideal puncture site for epidural anaesthesia in real-time. In this experiment, anaesthetists with minimal experience in ultrasonography were able to successfully determine needle puncture sites accurately.4 All these studies utilizing AI models not only yielded beneficial results but also led to significant time savings. Considering this, anaesthesiologists nationwide must integrate effective AI models to improve their clinical practice. This would minimize adverse outcomes in regional anaesthesia and ultimately enhance patient care and satisfaction.

Mice fatal pneumonia model induced by less-virulent Streptococcus pneumoniae via intratracheal aerosolization.

Aim: Animal models of fatal pneumonia caused by Streptococcus pneumoniae (Spn) have not been reliably generated using many strains of less virulent serotypes.Materials & methods: Pulmonary infection of a less virulent Spn serotype1 strain in the immunocompetent mice was established via the intratracheal aerosolization (ITA) route. The survival, local and systemic bacterial spread, pathological changesand inflammatory responses of this model were compared with those of mice challenged via the intratracheal instillation, intranasal instillationand intraperitoneal injection routes.Results: ITA and intratracheal instillation both induced fatal pneumonia; however, ITA resulted in better lung bacterial deposition and distribution, pathological homogeneityand delivery efficiency.Conclusion: ITA is an optimal route for developing animal models of severe pulmonary infections.

Optimizing peripheral regional anaesthesia: strategies for single shot and continuous blocks.

Regional anaesthesia is increasingly prominent within anaesthesia, offering alternative analgesic options amidst concerns over opioid-based analgesia. Since Halsted's initial description, the field has burgeoned, with ultrasound visualization revolutionizing local anaesthetic spread assessment, leading to the development of numerous novel techniques. The benefits of regional anaesthesia have gained increasing evidence to support their application, leading to changes within training curricula. Consequently, regional anaesthesia is at a defining moment, embracing the development of core skills for the general anaesthesiologist, whilst also continuing the advancement of the specialty. Recent priority setting projects have focussed attention on key aspects of regional anaesthesia delivery, including pain management, conduct and efficacy, education, and technological innovation. Developments in our current understanding of anatomy and pharmacology, combined with strategies for optimizing the conduct and maximizing efficacy of techniques, minimizing complications, and enhancing outcomes are explored. In addition, advancements in education and training methodologies and the integration of progress in novel technologies will be reviewed. This review highlights recent scientific advances in optimizing both single-shot and continuous peripheral regional anaesthesia techniques. By synthesizing these developments, this review offers valuable insights into the evolving landscape of regional anaesthesia, aiming to improve clinical practice and patient care.

Prevalence of gallbladder cancer in cholecystectomized patients in Sulaymaniyah city.

Gallbladder cancers (GBC) are rare, and they are one of lethal neoplasms of biliary system. The diagnosis is either incidentally during histopathological examinations after cholecystectomy or due to complications of local or systemic spread of the malignancy. The incidence differs ethnically and geographically. The aim was to identify increase risk of cancer in the Kurdistan region by searching for the number of GBC cases among cholecystectomy patients in Sulaymaniyah governorate. This study is laboratory-based retrospective study, including data obtained from 8315 cholecystectomized patients in Sulaymaniyah governorate from 2017- 2021. The information within the questionnaire included: age, sex, clinical notes and histopathological findings; including GBC. The total of 8315 cases; were 2149 males (25.8%) and 6166 females (74.2%). The mean age was (44.67+/-15.18) years. Forty-five cases have been reported as adenocarcinoma of GB and one case of Carcinosarcoma. Among the patients, 875 cases (10.50%) had acute cholecystitis. A significant relationship was found between the findings and the age and gender of the patients. GBC is not common and is mainly diagnosed incidentally after routine post-operative histopathological examination, and mainly affects old ages.

A prospective observational study on magnetic resonance imaging (MRI) based evaluation of pelvic masses in females in tertiary care hospital in central India

Background Pelvic masses in females often present a diagnostic challenge, necessitating accurate detection and characterization for appropriate clinical management. Magnetic Resonance Imaging (MRI) has emerged as a valuable tool in pelvic mass evaluation, offering superior soft tissue contrast and multiplanar imaging capabilities. This prospective observational study aims to assess the diagnostic accuracy of pelvic MRI, determine anatomic origin, classify masses, estimate local spread, and evaluate the impact of gadolinium contrast in a tertiary care hospital in Central India. Methods The study will be conducted over a two-year period, enrolling female patients with lower back pain and clinical suspicion or inconclusive ultrasonographic findings of pelvic masses. A systematic approach to participant identification, recruitment, and engagement will be employed, with both verbal and written informed consent obtained. The imaging protocol will involve T1 and T2 weighted images, and gadolinium contrast administration when necessary. Data collection will encompass demographic information, medical history, clinical details, and MRI findings. Statistical analyses, including sensitivity, specificity, prevalence estimates, and regression analyses, will be performed to evaluate the diagnostic accuracy of pelvic MRI. Expected outcome We anticipate that pelvic MRI will exhibit high diagnostic accuracy in detecting and characterizing pelvic masses, providing valuable information on anatomic origin and pelvic compartment localization. The study aims to contribute evidence on the impact of gadolinium contrast in enhancing diagnostic capabilities. The findings are expected to optimize clinical decision-making for effective management of females with pelvic masses, leading to timely interventions and improved patient outcomes.

Pest categorisation of Popillia quadriguttata.

The EFSA Panel on Plant Health performed a pest categorisation of Popillia quadriguttata (Coleoptera: Scarabaeidae), following a commodity risk assessment of bonsai Pinus parviflora grafted onto P. thunbergii from China, in which P. quadriguttata was identified as a pest of possible concern for the territory of the European Union. This is a univoltine polyphagous pest that occurs in eastern Asia from Vietnam northwards through eastern China and Taiwan, South Korea and into Far East Russia. Hosts include species of fruit trees within the genera Malus and Prunus, trees of forestry and environmental importance such as Quercus and Ulmus, shrubs such as Wisteria, soft fruit such as Rubus, grasses, including amenity turf and field crops such as potatoes, maize and soybean. Adults feed on host leaves, tender stems, flower buds, flowers and fruits; larvae feed on host roots. In northern China P. quadriguttata is a major pest of soybean; in South Korea, P. quadriguttata is one of the most serious insect pests of golf course turf. P. quadriguttata could enter the EU on various pathways including infested soil and growing media accompanying host plants for planning. Biotic factors (host availability) and abiotic factors (climate suitability) suggest that large parts of the EU would be suitable for establishment. Local spread would be mainly via natural dispersal of adults. Long distance spread would be facilitated by the movement of eggs, larvae and pupae infesting soil especially with plants for planting; adults could spread on plants for planting without soil. Economic and or environmental impacts would be expected on a range of plants if P. quadriguttata were to establish in the EU. Phytosanitary measures are available to reduce the likelihood of its introduction. P. quadriguttata satisfies all of the criteria that are within the remit of EFSA to assess for it to be regarded as a potential Union quarantine pest.

68Ga]Ga-ABY-025 PET in HER2-positive breast cancer: Benefits and pitfalls in staging of axillary disease.

1035 Background: [68Ga]Ga-ABY-025 PET showed promising results in quantifying human epidermal growth factor receptor Type 2 (HER2) expression in breast cancer patients [1]. In this study we extend the findings from [68Ga]Ga-ABY-025 PET with data from both treatment-naïve patients and previously treated patients with recurrences, mimicking the clinical situation other sites might encounter when HER2-targeting imaging is made more widely available. The focus of this additional data analysis is on staging, potential pitfalls and changes in uptake patterns associated with previous treatments. Methods: [68Ga]Ga-ABY-025 PET and [18F]-FDG PET images from 50 women with biopsy confirmed HER2 positive breast cancer were examined. Each patient underwent both scans within 1 week. A follow-up [18F]-FDG PET was performed after 2 courses of HER2-targeted treatment to assess metabolic response. Results: Twelve out of 50 patients showed heterogeneous [68Ga]Ga-ABY-025 uptake. Three out of these 12 patients presented with a wider local spread that was only detectable using [68Ga]Ga-ABY-025 PET as distinct uptake in lymph nodes of 2-5 mm size. Based on the additional information from [68Ga]Ga-ABY-025 PET, restaging was evaluated in two of the three cases, both of which had lobular carcinoma, and resulted in modifications in treatment plans. Two patients who received COVID-19 vaccine closely before undergoing PET scans showed high uptake on [18F]-FDG PET in lymph nodes ipsilateral to the vaccine injection site, but not on [68Ga]Ga-ABY-025 PET. Additionally, the physiological [68Ga]Ga-ABY-025 uptake in thyroid gland and axillary sweat glands was inversely correlated with the number of previous treatments and was significantly more pronounced in treatment-naïve patients. Conclusions: [68Ga]Ga-ABY-025 PET provided additional information that, in conjunction with [18F]-FDG PET findings, might help in accurate staging, particularly in cases with very small lymph node metastases. It also helped reduce false positive results as [68Ga]Ga-ABY-025 uptake was so far not seen in any benign inflammatory lesions. Physiological uptake can be seen in thyroid and apocrine glandular tissues but gradually disappear with subsequent HER2-targeted therapies. 1,Alhuseinalkhudhur, A. et al. J Nucl Med, 2023 64(9): p. 1364-1370. Clinical trial information: NCT03655353 .

Photoimmunotherapy of Prostate Cancer With Antibody and Fab Fragments Targeting the Prostate Specific Membrane Antigen.

The standard treatment for localized prostate cancer involves surgical removal of the prostate with curative intent. However, when tumor cells persist in the operation site, there is high risk of local recurrence and tumor spread, leading to stressful follow-up treatments, impaired quality of life, and reduced overall survival. This study examined photoimmunotherapy (PIT) as a new treatment option for prostate cancer cells. We generated conjugates consisting of either a humanized antibody or Fab fragments thereof targeting the prostate specific membrane antigen (PSMA), along with our silicon phthalocyanine photosensitizer dye WB692-CB1. PSMA-expressing prostate cancer cells were incubated with the antibody dye or Fab dye conjugates and cell binding was measured using flow cytometry. Cells were irradiated with varying doses of red light for dye activation, and cytotoxicity was determined by erythrosin B staining and subsequent analysis using a Neubauer counting chamber. Specific cytotoxicity was induced with the antibody dye conjugate in the prostate cancer cells in a light dose-dependent manner. Treatment of the cells with the Fab dye conjugate resulted in lower cytotoxicity, which could be attributed to a reduced binding affinity and a reduced dye uptake of the Fab fragment. Our new antibody dye and Fab dye conjugates offer potential for future intraoperative PIT in patients with localized prostate cancer, with the aim to ensure complete removal of tumor cells from the surgical area, to avoid local recurrence, and to improve clinical outcome.

Floods and fire ants, Solenopsis invicta (Hymenoptera: Formicidae): the Australian experience

AbstractThe rafting behaviour of the red imported fire ant, Solenopsis invicta, in response to flooding events is well documented, although studies generally have focussed on the mechanisms of raft assembly and the behaviour of the raft's occupants. Flooding as a means of dispersal of S. invicta is frequently mentioned in the literature, although there are few data on the distances travelled or how effective it is compared to natural flight. In Australia, S. invicta is a priority invasive species with a national eradication program operating for 23 years, focussed on the population in southeast Queensland, which currently encompasses more than 700 000 ha. Flooding presents a risk to the success of the program through extending the infestation area or recolonising successfully treated areas. We used the program's extensive spatiotemporal dataset of known fire ant colony locations to assess the effects of two significant flood events on the dispersal or displacement of S. invicta in Queensland. Results indicated that flooding did not spread S. invicta beyond the known boundaries of infestation but contributed to localised spread, particularly for sites with known polygyne infestations. This situation could change if the ant spreads to new river catchments. A novel method developed to assess the risk of S. invicta dispersal through flooding is presented, alongside program actions that can be applied to mitigate this risk.

Foliar Inoculation of Phyllachora maydis into Corn Induces Infection and Local Spread in Field Environments.

Tar spot of corn (Zea mays L.) is a significant disease in the United States and Canada caused by Phyllachora maydis, an obligate biotroph fungus. However, field research critical for understanding and managing the disease has been hindered by a need for methods to inoculate corn with P. maydis in field environments. In this study, we developed and demonstrated the efficacy of a method to initiate tar spot in field settings using inoculations of corn leaves with P. maydis inoculum that had been stored at -20°C for 10 months. Stromata of P. maydis were observed 19 days after inoculations in two field experiments, and stromata resulting from secondary spread were initially observed 39 to 41 days after the initial inoculations. Tar spot was not present in the fields beyond the inoculated areas or localized spread area, signifying that the establishment of initial disease resulted solely from inoculations. This study enhances our understanding of inoculation and infection of corn with P. maydis and tar spot development in field environments. The results will aid new research into understanding the corn tar spot pathosystem and improving management strategies.

Identification of a novel matrix metalloproteinases-related prognostic signature in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer worldwide. Cancer cells' local infiltration, proliferation, and spread are mainly influenced by the protein hydrolyzing function of different matrix metalloproteinases (MMPs). However, no study has determined the relationship between MMPs and prognostic prediction in HCC. Expression profiles of mRNA and MMPs-related genes were obtained from publicly available databases. Cox regression and LASSO Cox regression analysis were used to identify and predict MMPs-related prognostic signature and construct predictive models for overall survival (OS). A nomogram was used to validate the accuracy of the prediction model. Drug prediction was performed using the Genomics of Drug Sensitivity in Cancer (GDSC) dataset, and single-cell clustering analysis was performed to further understand the significance of the MMPs-related signature. A MMPs-related prognostic signature (including RNPEPL1, ADAM15, ADAM18, ADAMTS5, CAD, YME1L1, AMZ2, PSMD14, and COPS6) was identified. Using the median value, HCC patients in the high-risk group showed worse OS than those in the low-risk group. Immune microenvironment analysis showed that patients in the high-risk group had higher levels of M0 and M2 macrophages. Drug sensitivity analysis revealed that the IC50 values of sorafenib, cisplatin, and cytarabine were higher in the high-risk group. Finally, the single-cell cluster analysis results showed that YME1L1 and COPS6 were the major genes expressed in the monocyte cluster. A novel MMPs-related signature can be used to predict the prognosis of HCC. The findings of this research could potentially impact the predictability of the prognosis and treatment of HCC.

Population structure and spatial distribution of Mycobacterium tuberculosis in Ethiopia

Ethiopia is one of the countries with a high tuberculosis (TB) burden, yet little is known about the spatial distribution of Mycobacterium tuberculosis (Mtb) lineages. This study identifies the spoligotyping of 1735 archived Mtb isolates from the National Drug Resistance Survey, collected between November 2011 and June 2013, to investigate Mtb population structure and spatial distribution. Spoligotype International Types (SITs) and lineages were retrieved from online databases. The distribution of lineages was evaluated using Fisher’s exact test and logistic regression models. The Global Moran’s Index and Getis-Ord Gi statistic were utilized to identify hotspot areas. Our results showed that spoligotypes could be interpreted and led to 4 lineages and 283 spoligotype patterns in 91% of the isolates, including 4% of those with multidrug/rifampicin resistance (MDR/RR) TB. The identified Mtb lineages were lineage 1 (1.8%), lineage 3 (25.9%), lineage 4 (70.6%) and lineage 7 (1.6%). The proportion of lineages 3 and 4 varied by regions, with lineage 3 being significantly greater than lineage 4 in reports from Gambella (AOR = 4.37, P < 0.001) and Tigray (AOR = 3.44, P = 0.001) and lineage 4 being significantly higher in Southern Nations Nationalities and Peoples Region (AOR = 1.97, P = 0.026) than lineage 3. Hotspots for lineage 1 were located in eastern Ethiopia, while a lineage 7 hotspot was identified in northern and western Ethiopia. The five prevalent spoligotypes, which were SIT149, SIT53, SIT25, SIT37 and SIT26 account for 42.8% of all isolates under investigation, while SIT149, SIT53 and SIT21 account for 52–57.8% of drug-resistant TB cases. TB and drug resistant TB are mainly caused by lineages 3 and 4, and significant proportions of the prevalent spoligotypes also influence drug-resistant TB and the total TB burden. Regional variations in lineages may result from both local and cross-border spread.

The Impact of Type 2 Diabetes Mellitus on Treatment Outcomes in Patients Operated for Stage III Rectal Adenocarcinoma

Introduction: Colorectal cancer (CRC) ranks as the world&amp;#39;s fourth most prevalent cancer and is the third leading cause of death globally. Stage III CRC indicates localized spread to nearby lymph nodes without metastasis to other body parts. While numerous studies have explored outcomes in CRC patients based on various predictive factors, a comprehensive literature review has identified a gap in research specifically investigating surgical outcomes for stage III rectal adenocarcinoma in individuals with type 2 diabetes mellitus (DM2).Aim: To explore the impact of DM2 on treatment outcomes in patients undergoing surgery for stage III rectal adenocarcinoma.Patients and methods: Our retrospective cohort study involved 95 patients who underwent elective radical anterior rectal resection with established mechanical colorectal anastomosis. Patients were categorized into two groups based on DM2 status.Results: Univariate regression analysis demonstrated that DM2 patients face a significantly higher risk of preoperatively elevated carcinoembryonic antigen levels and postoperative complications such as surgical site infection, urinary issues, and anastomotic leakage. Kaplan-Meier analysis indicated a shorter time to complication onset, particularly anastomotic leakage, and a diminished overall survival in DM2 patients.Conclusion: DM2 emerged as a significant prognostic factor influencing the treatment outcomes of patients undergoing surgery for stage III rectal adenocarcinoma.

Genomic characterization of carbapenemase-producing Klebsiella pneumoniae ST307 revealed multiple introductions in Buenos Aires, Argentina

Objective: to describe at genomic level nine carbapenemase-producing Klebsiella pneumoniae ST307 (Kp-ST307) clinical isolates recovered in Buenos Aires during 2017-2021, investigating their resistome, virulome and phylogeny.Methods: Antimicrobial susceptibility was determined according to CLSI. Genomic DNA was sequenced by Illumina MiSeq and analyzed using SPAdes, PROKKA and Kleborate. Phylogeny of 355 randomly selected Kp-ST307 genomes and those from nine local isolates was inferred by a maximum-likelihood approach. The tree was visualized using Microreact.Results: Besides resistance to ß-lactams and fluoroquinolones, six out of nine Kp-ST307 were also resistant to ceftazidime/avibactam (CZA). This difficult-to-treat resistance phenotype was mediated by blaSHV-28 and gyrA-83I/parC-80I mutations in addition to carbapenemase coding genes. Among CZA susceptible isolates, two of them harbored blaKPC-3 while the other harbored blaKPC-2+blaCTX-M-15. Respect to CZA resistant isolates, three harbored blaKPC-3+blaNDM-1+blaCMY-6, two carried blaKPC-2+blaNDM-5+blaCTX-M-15, and blaNDM-5+blaCTX-M-15 were detected in the remaining isolate. Besides, five colistin resistant isolates presented a nonsense mutation in mgrB.Global Kp-ST307 isolates were distributed in two deep-branching lineages while local isolates set in the main clade of the phylogenetic tree. The five isolates from a same hospital, harboring blaKPC-3 or blaKPC-3+blaNDM-1+blaCMY-6, clustered in a monophyletic subclade with Italian isolates. Also, an isolate harboring blaKPC-2+blaNDM-5+blaCTX-M-15 recovered in another hospital was closed to this group. The remaining local Kp-ST307 grouped in other subclades containing isolates of diverse geographically origin.Conclusion: The inferred resistome was consistent with the resistant phenotype. Phylogeny suggested multiple introduction events in our region and a single major introduction in one hospital followed by local spread.

Introduced species infiltrate recent stages of succession after glacial retreat on sub-Antarctic South Georgia

Biological invasions are one of the main drivers of global biodiversity decline. At the same time, glacial retreat induced by climate warming is occurring at an alarming rate across the globe, threatening unique taxa and ecosystems. However, we know little about how introduced species contribute to the dynamics of colonisation in newly-deglaciated forelands. To answer this question, detailed inventories of plant and invertebrate communities were undertaken during two summer field seasons in the forelands of three tidewater and three inland glaciers that are retreating on the sub-Antarctic Island of South Georgia. The vascular plant communities present included a large proportion of South Georgia’s native flora. As expected, plant richness and cover increased with time since deglaciation along a deglaciation chronosequence. Introduced plants were well represented in the study sites and two species (Poa annua and Cerastium fontanum) were amongst the earliest and most frequent colonisers of recently-deglaciated areas (occurring on more than 75% of transects surveyed). Introduced arthropods were also present around tidewater glaciers, including an important predatory species (Merizodus soledadinus) with known detrimental impacts on native invertebrate communities. Our study provides a rare and detailed picture of developing novel communities along a deglaciation chronosequence in the sub-Antarctic. Introduced species are able to track glacial retreat on South Georgia, indicating that further local colonisation and spread are inevitable as the region’s climate continues to warm.