Prophylaxis Measures Research Articles

Generalized tetanus complicated with Takotsubo-cardiomyopathy in a septuagenarian following a laceration injury with soil contamination – a case report

BackgroundTetanus is a clinical rarity due to the successful globally adopted childhood vaccination programme. The rising elderly population in the United Kingdom creates a subset of individuals whom are prone to develop Tetanus as they preceded this vaccination drive.Case summaryA 76 year old Caucasian lady presented with a soil contaminated laceration injury on her knee following a fall. Though she received urgent assessment and wound care, the relevance of the injury in the backdrop of her age was not appreciated and her tetanus post exposure prophylaxis was overlooked. She readmitted seeking further management 1 week later with an infected wound with Trismus and clinical features favoring Generalized tetanus. During her stay she developed Takotsubo-cardiomyopathy with congestive cardiac failure and required prolonged care in the intensive unit with mechanical ventilation and rehabilitation before being discharged home.ConclusionFirst contact physicians should have a greater appreciation of the types of injuries and at-risk individuals who are more prone to develop tetanus upon exposure to ensure early and appropriate identification. There should be greater situational awareness with regard to the elderly in view of their heightened risk of development of tetanus specially those born before the vaccination drive. Knowledge regarding post exposure prophylaxis measures for tetanus should be regularly updated using local guidance to ensure awareness, so as to despite its rarity Tetanus remains an adequately appreciated disease.

BK virus associated hemorrhagic cystitis in pediatric patients undergoing hematopoietic stem cell transplantation

Abstract Background BK virus (BKV) is one of the most common causes of hemorrhagic cystitis (HC) in children undergoing hematopoietic stem cell transplantation (HSCT). Methods Descriptive and retrospective study that included patients from 0-18 years old undergoing HSCT with a diagnosis of HC, admitted from 1/1/2018 to 11/30/2023 in a tertiary care pediatric hospital. Patients with HC were tested for BKV by quantitative polymerase chain reaction (PCR) in urine samples, if positive, plasma viral load was also requested. BKV-HC grading was defined by the European Conference on Infections in Leukemia (ECIL) consensus document. Asymptomatic patients did not undergo standardized screening for BKV. Results During this period 86 HSCT were performed for either malignant (75,6%) or non-malignant disorders (24,4%). Overall, 16 (18,6%) were autologous and 70 (81.4%) were allogeneic: 40 human leukocyte antigen (HLA) matched unrelated donor, 26 HLA-matched related donor and 4 haploidentical. Six patients (7%) suffered HC, all associated with BKV as the cause. These six patients underwent allogeneic HSCT, and 4 of them had HLA-matched unrelated donors. All patients were over 5 years old. Male sex predominated (n:5). All of the patients had hematologic malignancies as the underlying diagnosis (5 with acute lymphoblastic leukemia - ALL). The stem cell source was bone marrow in 3 patients and peripheral blood in the other 3. All patients received myeloablative conditioning regimen and 4 underwent total body irradiation. Only one patient received post-transplant cyclophosphamide. Symptoms (dysuria, abdominal pain, macroscopic hematuria, clots) began more than 14 days after HSCT in 100% of the cases. Hematuria was categorized as grade III in 5 patients and grade IV (severe) only in one. All patients tested positive for BKV PCR in urine samples. High-level BK viruria (>107 copies/mL) was found in 66,6%. BK viremia was detected in 4 patients. All of the patients had another concomitant viral infection, with cytomegalovirus reactivation being the most frequent (n:4). Two patients also had detectable adenovirus (ADV) PCR in urine samples. Acute graft versus host disease (GVHD) was diagnosed in 5 patients, all with skin involvement. All patients were hospitalized and prolonged the length of stay. Regarding treatment, they all received hyperhydration and Cidofovir (more than 3 doses). Dose of immunosuppressive treatment was reduced in 5 cases. Acute kidney failure (AKF) was found in 3 patients. One patient developed chronic kidney failure. The patient with no GVHD was the one who improved the fastest. The patient with severe hematuria required bladder irrigation, had dialysis indication and presented a related death. Conclusion The development of BKV-HC in HSCT patients results in suffering and pain, prolonged hospitalizations and significant morbidity (AKF). Literature shows that male sex, older age and acute GVHD are important risk factors, and this is what we also found in our case series. BKV-HC is considered a difficult and severe condition to manage, remaining troublesome so we should overcome this deficiency with new approaches, particularly emphasizing in preemptive or prophylaxis measures for the benefit of our patients.

Obesity is an independent risk factor for postoperative pulmonary embolism after anterior cervical discectomy and fusion

BACKGROUNDOver the past decade, the prevalence of obesity has risen in the United States, in parallel with the demand for anterior cervical discectomy with fusion (ACDF). Prior studies have evaluated the role of obesity classes in cervical spine surgery in smaller patient populations. We aimed to evaluate any potential correlation to a national population sample by utilizing a large multicenter database. PURPOSEThe purpose of this study was to analyze obesity level's influence on perioperative complication rates in patients undergoing ACDF. STUDY DESIGN/SETTINGA retrospective cohort, large multicenter database study. PATIENT SAMPLEThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients who had undergone an elective ACDF procedure between 2011 and 2020 using Current Procedural Terminology (CPT) code 22551. OUTCOME MEASURESMedical and surgical complications within thirty days of operation. METHODSPatients were categorized into four BMI groups: nonobese (BMI 18.5−29.9 kg/m2), obese class I (BMI 30−34.9 kg/m2), obese class II (BMI 35−39.9 kg/m2), and obese class III (BMI ≥40 kg/m2). A univariate analysis conducted for demographic variables and preoperative comorbidities identified age, sex, race, smoking status, hypertension requiring medication, diabetes, history of congestive heart failure, history of bleeding disorder, and chronic obstructive pulmonary disease as risk factors. Chi-square test was used to compare incidence of complications among groups. A multivariable logistic regression analysis was subsequently performed to adjust for these preoperative risk factors and compare obesity classes I-III to nonobese patients. RESULTSAbout 64,718 patients were identified of whom 33,365 were nonobese, 17,190 were obese class I, 8,608 were obese class II, and 5,555 were obese class III. Obese classes I-III patients had a higher incidence of surgical site infections (0. 33%, 0.36%, 0.41%, vs. 0.24%, p=.039) and pulmonary embolism (PE) (0.25%, 0.31, 0.29 vs. 0.15%, p=.003). Obese classes I-III had a lower incidence of blood transfusion (0.23%, 0.17%, 0.27% vs. 0.4%, p<.001) obese class I, obese class II, and obese class III independently increased the risk for PE (OR: 1.716, 95% CI (1.129−2.599); OR: 2.213, 95% CI (1.349−3.559); OR: 2.207, 95% CI (1.190--3.892), respectively). CONCLUSIONSRisk for postoperative PEs after an ACDF was significantly higher for obese classes I-III compared to nonobese patients. These findings may further support the use of additional prophylaxis measures and precaution in the perioperative setting.

The Impact of Infection Prevention Bundles on Neurosurgical Outcomes and Healthcare Costs: A Systematic Review

Background: Post-operative infections represent a significant challenge in neurosurgery, leading to increased morbidity, mortality, and healthcare costs. The implementation of infection prevention bundles, which encompass a set of evidence-based practices, has emerged as a potential solution to mitigate these adverse outcomes. This systematic review aims to evaluate the effectiveness of infection prevention bundles in improving neurosurgical outcomes and reducing healthcare costs. Methods: A comprehensive search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify studies published between 2010 and 2023 that evaluated the impact of infection prevention bundles on neurosurgical outcomes and healthcare costs. The search strategy included keywords such as "neurosurgery," "infection prevention," "surgical site infection," "bundle," "outcomes," and "healthcare costs." Studies were included if they reported on at least one clinical outcome (e.g., surgical site infection rates, mortality, length of stay) and/or healthcare costs. Data extraction and quality assessment were performed independently by two reviewers. Results: The search yielded 45 studies that met the inclusion criteria. The studies encompassed a variety of neurosurgical procedures, including craniotomies, spinal surgeries, and deep brain stimulation. The infection prevention bundles implemented varied across studies but commonly included preoperative antibiotic prophylaxis, skin antisepsis, and intraoperative measures. The pooled analysis demonstrated a significant reduction in surgical site infection rates and length of stay associated with the use of infection prevention bundles. Moreover, several studies reported cost savings, primarily attributed to reduced complications and shorter hospital stays. Conclusion: The evidence suggests that infection prevention bundles are effective in improving neurosurgical outcomes and reducing healthcare costs. The implementation of these bundles should be considered a standard of care in neurosurgery to enhance patient safety and optimize resource utilization. Keywords: Neurosurgery, infection prevention, surgical site infection, healthcare costs, systematic review.

Postoperative management following endoscopic skull base surgery.

The purpose of this opinion is to review current evidence regarding postoperative management following endoscopic skull base surgery. Postoperative management encompasses consideration of level of care, laboratory tests, analgetic and antiemetic therapy, antibiotic, antithrombotic and antiepileptic prophylaxis, pharmacological and nonpharmacological cerebrospinal fluid (CSF) pressure reduction measures, including CSF diversion, activity restrictions, nasal packing removal, nasal debridement and toilet, nasal glucocorticoid administration, positive pressure ventilation, imaging, CSF leak diagnosis, and future perspectives. Although significant effort has been put into research of postoperative measures after endoscopic skull-base surgery, there is a heterogeneity of practices and deficit of high-level studies, which would enable highly powered systematic reviews and meta-analyses.

Exploring Canine Picornavirus Diversity in the USA Using Wastewater Surveillance: From High-Throughput Genomic Sequencing to Immuno-Informatics and Capsid Structure Modeling.

The SARS-CoV-2 pandemic resulted in a scale-up of viral genomic surveillance globally. However, the wet lab constraints (economic, infrastructural, and personnel) of translating novel virus variant sequence information to meaningful immunological and structural insights that are valuable for the development of broadly acting countermeasures (especially for emerging and re-emerging viruses) remain a challenge in many resource-limited settings. Here, we describe a workflow that couples wastewater surveillance, high-throughput sequencing, phylogenetics, immuno-informatics, and virus capsid structure modeling for the genotype-to-serotype characterization of uncultivated picornavirus sequences identified in wastewater. Specifically, we analyzed canine picornaviruses (CanPVs), which are uncultivated and yet-to-be-assigned members of the family Picornaviridae that cause systemic infections in canines. We analyzed 118 archived (stored at -20 °C) wastewater (WW) samples representing a population of ~700,000 persons in southwest USA between October 2019 to March 2020 and October 2020 to March 2021. Samples were pooled into 12 two-liter volumes by month, partitioned (into filter-trapped solids [FTSs] and filtrates) using 450 nm membrane filters, and subsequently concentrated to 2 mL (1000×) using 10,000 Da MW cutoff centrifugal filters. The 24 concentrates were subjected to RNA extraction, CanPV complete capsid single-contig RT-PCR, Illumina sequencing, phylogenetics, immuno-informatics, and structure prediction. We detected CanPVs in 58.3% (14/24) of the samples generated 13,824,046 trimmed Illumina reads and 27 CanPV contigs. Phylogenetic and pairwise identity analyses showed eight CanPV genotypes (intragenotype divergence <14%) belonging to four clusters, with intracluster divergence of <20%. Similarity analysis, immuno-informatics, and virus protomer and capsid structure prediction suggested that the four clusters were likely distinct serological types, with predicted cluster-distinguishing B-cell epitopes clustered in the northern and southern rims of the canyon surrounding the 5-fold axis of symmetry. Our approach allows forgenotype-to-serotype characterization of uncultivated picornavirus sequences by coupling phylogenetics, immuno-informatics, and virus capsid structure prediction. This consequently bypasses a major wet lab-associated bottleneck, thereby allowing resource-limited settings to leapfrog from wastewater-sourced genomic data to valuable immunological insights necessary for the development of prophylaxis and other mitigation measures.

Periodontal plastic surgery and regenerative periodontal surgery in a forty-seven-year-old patient with cleft lip and palate

Cleft lip and palate represent one of the most prevalent congenital malformations in humans, with an estimated prevalence of 0.45 per 1,000 individuals. During childhood and adolescence, affected patients undergo lengthy and complicated interdisciplinary treatment including treatment from specialists in pediatric medicine, oral and maxillofacial surgery, orthodontics, and otorhinolaryngology. The patient exhibited scarred adhesions with localized mucogingival deformities of the premaxilla (region 12 − 11), bilateral cleft lip and palate, and a complex underlying one-wall intrabony osseous defect on tooth 11, in addition to hard- and soft-tissue deficiencies at the dental implant in region 12. Following the administration of localized anti-infective periodontal therapy, regenerative periodontal surgery, regenerative surgical therapy of periimplantitis, and periodontal plastic surgery were performed. This resulted in a long-term, stable improvement in the clinical situation. Regenerative periodontal therapy and periodontal plastic surgery in patients with palato-alveolar cleft present a significant challenge due to the poor condition of the mucosa and gingiva adjacent to the defect and the insufficient bone dimensions. For this reason, it seems beneficial to include the periodontist in the interdisciplinary treatment team of a patient with cleft lip and palate from the outset. It is recommended that the patient be provided with dental prophylaxis measures and receive individualized oral hygiene instructions in addition to the main maxillofacial and orthodontic treatment. This approach would facilitate the identification of mucogingival issues at an early stage and the implementation of appropriate treatment.

Malaria prevention practices among patients attending the NTOUM departmental hospital, Northwest Gabon

Introduction: In Gabon, a territory located in Central Africa, prevention is an essential measure in the fight against malaria. The aim of this study was to evaluate, in the Komo-Mondah department, the prophylaxis practices employed by the inhabitants of the commune of Ntoum and the prevalence of anti-malarial drugs prescribed by local doctors. Methods: We carried out a prospective, cross-sectional study over a 3-month period, on patients of both sexes and of all ages who came for consultation to the departmental hospital of Ntoum. Patients who had a prescription for malaria drugs at the end of their medical visit were included in the study. Results: Of the 248 subjects enrolled, children under 5 years of age were the main victims (84%).Indeed, children under 5 were two (2) and three (3) times more likely to test positive to malaria than the age group 16-24 (OR = 2.44 [1.05 - 5.63]; P ˂ 0.05) , 25 and over (OR= 3.10 [1.46 - 6.59]; P ˂ 0.05), respectively. Anti-malaria prophylaxis was practiced by 80% of the study population. Patients who declared sleeping under a bed net appear to be protected compare to those who did not (OR= 0.53 [0.28 - 0.97] ; P ˂ 0.05). Self-medication was recorded in 29% of patients, and the drugs most commonly prescribed by doctors were artemisinin-based combinations, including Artefan (51%), Coartem (30%) and Eurartesim (2%). Conclusion: Although conventional prophylaxis measures (vector control and chemoprevention) are adopted by many Gabonese, careful pharmacological management and the implementation of targeted, long-term prevention-surveillance and health education strategies will enable effective malaria control in this part of Gabon.

Strategies For The Treatment Of Chronic Bronchitis In Children, Taking Into Account Sexual Development

A study was carried out to study the characteristics of sexual development and measures of secondary prophylaxis in patients with chronic bronchitis. The study included 84 children with chronic bronchitis aged 10 to 16 years. Of them, 37 (44%) are girls and 47 (56%) are boys. Moderate - severe course of the disease was revealed in 43 (51,2%) children, severe - in 41 (48,8%). It was revealed that chronic bronchitis adversely affects the sexual development of children of both sexes. The pace of development of secondary sexual characteristics occurs gradually and does not complete until the end of puberty. The comprehensive stage-by-stage secondary prophylaxis we proposed for children with chronic bronchitis disease contributed to the improvement of both the underlying disease and sexual development.

Comparative study of venous thromboembolic prophylaxis strategies in hemorrhagic stroke: A systematic review and network meta-analysis.

Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are frequent complications in patients with intracerebral hemorrhage (ICH). Various prophylactic strategies have been employed to mitigate this risk, such as heparin, intermittent pneumatic compression (IPC), and graduated compression stockings (GCS). The optimal thromboembolic prophylaxis approach remains uncertain due to the lack of randomized controlled trials (RCTs) comparing all interventions. We conducted a network meta-analysis and meta-analysis to systematically review and synthesize evidence from RCTs and non-randomized studies on the efficacy and safety of thromboembolic prophylaxis strategies in hospitalized ICH patients. Our study followed a registered protocol (PROSPERO CRD42023489217) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines incorporating the extension for network meta-analyses. Search for eligible studies was performed up to December 2023. We considered the occurrence of DVT, PE, hematoma expansion (HE), and all-cause mortality as outcome measures. A total of 16 studies, including 7 RCTs and 9 non-randomized studies, were included in the analysis. Network meta-analysis revealed that IPC demonstrated the highest efficacy in reducing DVT incidence (odds ratios (OR) 0.30, 95% confidence interval (CI) 0.08-1.16), particularly considering only RCTs (OR 0.33, 95% CI 0.16-0.67). GCS showed the highest safety profile for HE (OR 0.67, 95% CI 0.14-3.13), but without efficacy. Chemoprophylaxis did not reduce the risk of PE events (OR 1.10, 95% CI 0.17-7.19) with a higher occurrence of HE (OR 1.33, 95% CI 0.60-2.96), but the differences were not significant. Our study supports the use of IPC as the primary thromboembolic prophylaxis measure in ICH patients. Further research, including head-to-head RCTs, is needed to strengthen the evidence base and optimize clinical decision-making for thromboembolic prophylaxis in this vulnerable patient population.

Update on endocarditis 2024

Infective endocarditis (IE) is alife-threatening disease with an increasing incidence despite improved preventive measures. The revision of the European Society of Cardiology (ESC) guidelines on infective endocarditis in 2023 brings significant innovations in prevention, diagnostics, and treatment. Many measures for prophylaxis and prevention have been more clearly defined and given higher recommendation levels. In the diagnostics of IE the use of other imaging modalities besides echocardiography, such as cardiac computed tomography (CT), positron emission tomography (PET)/CT or single photon emission computed tomography (SPECT)/CT with radioactively labeled leukocytes was more strongly emphasized. The diagnostics and treatment of IE associated with a cardiac implantable electronic device (CIED) were also revised. An essential innovation is also the possibility of an outpatient antibiotic treatment for certain patients after initial treatment in hospital. The indications for surgery have also been revised and, in particular, the timing of surgery has been more clearly defined. This article provides an overview of the most important changes.

Acute Graft versus Host Disease in Beta Thalassemia Patients Following Allogeneic Haematopoietic Stem Cell Transplantation.

To analyse the frequency, risk factors, and clinical symptoms of acute graft-versus-host disease (aGvHD) in patients with beta-thalassemia major after allogeneic haematopoietic stem cell transplantation (HSCT). Descriptive study. Place and Duration of the Study: Department of Clinical Haematology, Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan, from January 2017 to December 2021. Data were obtained from patients diagnosed with bone and tissue malignancies (BTM) who had undergone haematopoietic stem cell transplantation (HSCT) and experienced aGVHD. Patients who experienced initial graft failure and individuals who underwent subsequent bone marrow transplantation were excluded. Total of 117 patients diagnosed with BTM underwent fully matched HSCT, including 76 (65%) males, and 41 (35%) females. The median age of the patients undergoing transplantation was 7.34±7.32 years and the donors' median age was 7.6±9.85 years. Among the donors, 53 (45.3%) were males and 64 (54.7%) were females. Gender disparity was observed in 46 (39.3%) instances as a female donor matched with a male recipient. A total of 106 individuals underwent bone marrow harvest (BMH); with 5 (4.3%) patients receiving peripheral blood stem cells (PBSC) and 6 (5.2%) patients receiving both BMH and PBSC. Acute GvHD was observed in 50 (42.7%) patients, including 30 (60%) males and 20 (40%) females. Grade I GvHD occurred in 32 (27.3%) individuals, Grade II GvHD in 16 (13.7%) patients, and Grade III GvHD in one (0.8%) patient. It had no statistically significant association with recipient/donor age, gender disparity, the source of the graft source, the dose of stem cells, or the presence of thymoglobulin (TG). Acute GvHD was observed in high frequency in Beta-thalassemia patients receiving morrow harvesting proportional to their gender distribution. Associated factors were GvHD prophylaxis measure, mucositis and, CMV reactivation. Beta thalassemia major patients, Acute graft versus host disease, Allogeneic haematopoietic stem cell.

Burden of HIV on Society Current Management Options and Future Prospective

Nevertheless, there is still a disparity in the availability of antiretroviral therapy (ART), especially in low- and middle-income nations, due to obstacles such as financial constraints, inadequate infrastructure,and on going social stigma. The future outlook for HIV management is optimistic, as current research is dedicated to exploring innovative treatment methods such as long-acting injectable, gene editing medicines, and therapeutic vaccinations. Furthermore, progress in pre-exposure prophylaxis (PrEP) and other preventive measures provide optimism for decreasing the number of new infections. Furthermore, it is crucial to make endeavors towards tackling societal factors that influence health outcomes, such as poverty, education, and gender inequality, as they play a vital role in attaining long-lasting advancements in HIV prevention and care. Notwithstanding these progressions, there are still obstacles to overcome, such as the rise of drug-resistant variations, deficiencies in testing and diagnosis, and enduring social obstacles. To tackle these difficulties, a comprehensive strategy is needed that combines biological, behavioral, and structural interventions, with a focus on fairness and human rights. To reduce the impact of HIV/AIDS on society and achieve the objective of ending the epidemic, it is important to continue investing in research, improving health systems, and promoting collaboration across all sectors.

Transient bacteremia following the removal of four different types of rapid palatal expanders.

General health related recommendations for prophylactic measures in connection with orthodontic treatments are limited due to the lack of evidence-based data. This study aimed to investigate the development of transient bacteremia following the removal of four types of rapid palatal expanders (RPE). Seventy-five individuals aged 10-18years undergoing rapid palatal expansion with four types of RPE were categorized according to the type of RPE used in their treatment: banded tooth-borne (groupA (1), n = 17), banded tooth- and tissue-borne (groupA (2), n = 17), bonded tooth-borne (groupB (1), n = 18), and bonded tooth- and tissue-borne (groupB (2), n = 23). Gingival inflammation was assessed using the gingival index one day before RPE removal. Furthermore, samples of blood (5 ml each) were collected before and 3 min after RPE removal. The groups were statistically evaluated for comparability with respect to sex, age, or wear time of the RPE and to the gingival index. In addition, the prevalence of bacteremia in the different groups was evaluated and statistically compared. No significant difference was found among the groups (p > 0.05) for sex, age, and RPE wear time. Mean gingival index was higher in groupB (2) than in groupA (1) (p < 0.05). The prevalence of bacteremia did not differ significantly between groups. Streptococcus species were identified in all bacteremia cases. The bacteremia prevalence of the groups was as follows: groupA (1), 11.8%; groupA (2), 23.5%; groupB (1), 16.7%; and groupB (2), 30.4%. This investigation demonstrated that removal of aRPE could cause bacteremia, but the RPE design did not affect the prevalence of bacteremia. The results of this study support the necessity of prophylaxis measures before RPE removal in indicated patients.

STATE OF PERIODONTAL TISSUES IN CHILDREN LIVING IN EDUCATIONAL AND REHABILITATION CENTERS

Assessment of periodontal tissues state in children from educational and rehabilitation centers aimed at further monitoring and development of therapeutic and preventive measures is an urgent task of modern dentistry.&#x0D; The purpose of the study was to determine the periodontal tissues state in children from educational and rehabilitation centers (ERC).&#x0D; Research material and methods: 182 children aged 7 to 15 from communal institutions of the Lviv Re-&#x0D; gional Council (CI LRC) and 165 children of the same age from the secondary schools (comparison group) have been examined. The periodontal tissues state was assessed on the basis of clinical examination, the Schiller-Pysarev’s test and the Papillary-Marginal-Alveolar index (PMA) (Parma, 1960).&#x0D; Research results and their discussion: It was established that chronic catarrhal gingivitis was found in the average of 71,68±4,25% of children aged 7-15 years from the ERC, which is significantly higher than the children of the comparison group – 46,75±3,51% (р&lt;0,001). With age, the prevalence of CCG increases and in the age group of 10-12 years, accounting on average for 81,53±7,28%, which is by 1,7 times higher than in children of the comparison group (р&lt;0,001). In children aged 13-15 years, the frequency of CCG is by 1,4 times higher than that in children of the comparison group and by 1,2 times higher than that of children aged 7-9 years.&#x0D; The analysis of the results shows that in all age groups, the children from the ERC have a mild degree of CCG and, on average, accounted for 57,83±7,28%, which is by 1,4 times lower that in the comparison group (79,76±3,79%), and the average degree of CCG is much higher – 37,89±3,68%, respectively, in children of the comparison group (18,79±3,45% (р1&lt;0,001, р2&lt;0,001)). The significant prevalence of a severe degree of chronic catarrhal gingivitis in children of 7-9 years old from ERC (8,33±3,25%) is revealed.&#x0D; Therefore, the findings of the study indicate a significant prevalence of inflammatory processes in the periodontal tissues of children from ERC, which must be taken into account in providing of dental care for children who are in such institutions, and should be actively implemented in treatment and prophylaxis measures to prevent the further development of pathological processes in periodontal tissues.

National Quality Indicators in Pediatric Sickle Cell Anemia.

To assess nationally endorsed claims-based quality measures in pediatric sickle cell anemia (SCA). Using data from the Sickle Cell Data Collection programs in California and Georgia from 2010 to 2019, we evaluated 2 quality measures in individuals with hemoglobin S/S or S/β-zero thalassemia: (1) the proportion of patients aged 3 months to 5 years who were dispensed antibiotic prophylaxis for at least 300 days within each measurement year and (2) the proportion of patients aged 2 to 15 years who received at least 1 transcranial Doppler ultrasound (TCD) within each measurement year. We then evaluated differences by year and tested whether performance on quality measures differed according to demographic and clinical factors. Only 22.2% of those in California and 15.5% in Georgia met or exceeded the quality measure for antibiotic prophylaxis, with increased odds associated with rural residence in Georgia (odds ratio 1.61; 95% confidence interval 1.21-2.14) compared with urban residence and a trend toward increased odds associated with a pediatric hematologist prescriber (odds ratio 1.28; 95% confidence interval 0.97, 1.69) compared with a general pediatrician. Approximately one-half of the sample received an annual assessment of stroke risk using TCD (47.4% in California and 52.7% in Georgia), with increased odds each additional year in both states and among younger children. The rates of receipt of recommended antibiotic prophylaxis and annual TCD were low in this sample of children with SCA. These evidence-based quality measures can be tracked over time to help identify policies and practices that maximize survival in SCA.

Practical Management of Adverse Events Associated With FGFR Inhibitors for Cholangiocarcinoma for the Advanced Practice Provider

Cholangiocarcinoma is a cancer of the bile duct frequently diagnosed at a late stage with a poor prognosis. Selective fibroblast growth factor receptor (FGFR) inhibitors have demonstrated efficacy in the treatment of cholangiocarcinoma with FGFR2 fusions or rearrangements, but are associated with hyperphosphatemia, fatigue, and ocular, dermatologic, and gastrointestinal adverse events (AEs). Treatment adherence and patient outcomes can be improved by anticipating and effectively managing the AEs associated with FGFR inhibitors and providing appropriate intervention and patient education. The multidisciplinary care team for patients with cholangiocarcinoma can involve optometrists and advanced practice providers, including nurse practitioners, physician assistants, pharmacists. This review provides practical insights for advanced practice providers on the management of these common AEs associated with selective FGFR inhibitors in the real-world setting, focusing on pemigatinib and futibatinib. Impacts of renal or hepatic impairment, drug–drug interactions, and drug–food interactions are discussed. Also presented are practical recommendations for prophylaxis and supportive care measures, and resources for health-care professionals and patients.

Current understanding of Bordetella-induced cough.

Typical pathogenic bacteria of the genus Bordetella cause respiratory diseases, many of which are characterized by severe coughing in host animals. In human infections with these bacteria, such as whooping cough, coughing imposes a heavy burden on patients. The pathophysiology of this severe coughing had long been uncharacterized because convenient animal models that reproduce Bordetella-induced cough have not been available. However, rat and mouse models were recently shown as useful for understanding, at least partially, the causative factors and the mechanism of Bordetella-induced cough. Many types of coughs are induced under various physiological conditions, and the neurophysiological pathways of coughing are considered to vary among animal species, including humans. However, the neurophysiological mechanisms of the coughs in different animal species have not been entirely understood, and, accordingly, the current understanding of Bordetella-induced cough is still incomplete. Nevertheless, recent research findings may open the way for the development of prophylaxis and therapeutic measures against Bordetella-induced cough.

Assessing the impact of COVID-19 on epidemiological changes of severe pediatric respiratory syncytial virus infections in Malaysia.

Respiratory syncytial virus (RSV) is one of the leading causes of hospitalization and mortality among children with respiratory tract infections. The non-pharmaceutical preventive measures against severe acute respiratory syndrome coronavirus (COVID-19) may have reduced the transmission of RSV, altering its tropical epidemiological seasonality. Thus, this study represents the first attempt to evaluate changes in RSV epidemiology in the context of COVID-19 pandemic in Malaysia. Conducted at a tertiary hospital in Kuala Lumpur, Malaysia, this retrospective study analyzed collated data of children aged <12 years who were admitted for severe respiratory infections from 2017 to 2022. Time series models were used to predict the differences between actual and forecasted RSV cases, while logistic regression assessed the statistical association between RSV and COVID-19. Among the 4,084 children analyzed, we reported a significant inverse relationship between RSV and COVID-19 infections during the pandemic (2020-2021) (p < 0.05). In 2020, the RSV positivity rate sharply declined to 8.3 and 5.9%, respectively, in the two prominent seasons. Time series analysis showed a tremendous decrease in cases compared to the expected values, with reductions of 98.3% in the first season and 95.7% in the second season. However, following the lifting of the restriction order in 2022, RSV infections rose sharply with a positivity rate of 36.3%, higher than pre-COVID-19 pandemic levels. This study provides evidence of increasing RSV cases post-COVID-19 pandemic, due to immunity debt. Hence, the healthcare system must be prepared to address future RSV outbreaks with the appropriate implementation of prophylaxis and public health measures.

Influence of alpha-glutamil-tryptophan on the background and induced activity of factors of adaptive immunity for prevention

Background. During the ongoing COVID-19 pandemic and in the season of rising incidence of other respiratory infections, it is relevant to use preventive measures of non-specific prophylaxis. Synthetic peptides are widely considered as a tool. The representative of this group is the synthetic analogue of thymus regulatory peptides Thymogen, which has been used in Russia for more than 20 years in the treatment of acute and chronic infection diseases.The aim of the study. To evaluate the effect of Thymogen, a dosed nasal spray, on induced parameters of the immune system during prophylactic use in healthy volunteers.Materials and methods. Twenty healthy volunteers received Thymogen nasal dosed spray (JSC “Cytomed”, Russia) at a dose of 25 μg twice a day for 10 days. A comparative assessment of immunological parameters was carried out in dynamics: before the start of therapy, on days 6 and 11 of taking the drug and 14 days after the end of the course. Clinical observation was carried out from day 1 to day 11, registration of adverse events – the entire period of the study for 24 days. The first day was considered the day the drug was started.Results. In the course of the work, according to the data of immunological examination, a statistically significant increase in the virus-induced production of interferon alpha (INF-α) by a culture of peripheral blood cells was revealed. The growth rate was recorded on day 11 of taking Thymogen and persisted for 14 days after the end of the course. Significant differences in the dynamics of bactericidal and phagocytic activity of neutrophils, serum α- and γ-interferon were not obtained.Conclusion. The use of Thymogen spray at a dose of 25 μg for 10 days was safe and contributed to a significant induction of interferon-alpha in response to exposure to a viral pathogen, which allows us to recommend the drug for prophylactic use during the period of rising incidence of acute respiratory diseases.