Infectious Origin Research Articles

The induced membrane technique: A therapeutic option for managing bone defects in the upper extremity: Case series for 7 patients

IntroductionThe reconstruction of bone defects of tumoral, infectious or traumatic origin of the limbs remains a major therapeutic challenge for the orthopedic surgeon and the patient, in terms of anatomical and functional results. Cases presentationWe report the case of 7 patients who underwent induced membrane bone reconstruction of the upper extremity, 5 patients with initial injury to the forearm, and 2 of our patients, to the humerus. In terms of function, the range of prono-supination was 125°, the range of wrist flexion-extension was 165°, and the range of elbow mobility was 170°. All patients achieved union at the time of the last follow-up. Two patients achieved union at 6 months, one patient at 5 months, one patient at 4 months, and three patients at 3 months. DiscussionThe induced membrane (IM) technique has been used for more than 30 years, and it's more and more widely accepted all over the world, as a simple and effective technique for reconstruction of segmental bone defects. The technique comprises 2 surgical stages, The first step involves the total excision of infected and non-viable lesions both bone and soft tissue until tissue with optimal vascularization "Paprika sign", then the strict instrumental stabilization of the skeleton and the realization of a covering flap if necessary, depending on the site of the initial injury initial lesion and the extent of the resection. ConclusionThe technique of induced membrane has proven its effectiveness in the management of bone loss.

Neonatal Conjunctivitis.

Neonatal conjunctivitis is an important cause of ocular morbidity with infectious and noninfectious origins. Common practice in the United States is to administer prophylactic antibiotic ointment at birth; however, prophylaxis is ineffective for some causes. Moreover, recognition of the etiologies that threaten systemic complications to the neonate is critical in providing timely and appropriate treatment. This review summarizes the clinical features, etiology, and treatment recommendations of various forms of neonatal conjunctivitis.

An Unusual Case Of A Calcaneal Stress Fracture

HISTORY: A 56-year-old healthy female presented to clinic with several weeks of left heel pain. No inciting injury, patient is generally active but had not done any recent strenuous activity, however after the onset of the pain any slight bump of the heel produced severe pain. She also had mild swelling around the distal ankle, without any warmth or erythema. The pain gradually worsened to the point the patient started using crutches due to the pain she experienced with weight-bearing. She denied any radiation of the pain as well as any numbness, tingling, or weakness of the foot. PHYSICAL EXAMINATION: Examination revealed mild swelling over the lateral calcaneus, without erythema or induration. Patient had severe tenderness to palpation of the lateral aspect of the calcaneal tuberosity. No tenderness was noted over either malleolus or the Achilles tendon. Range of motion revealed normal inversion, eversion, and plantar flexion but dorsiflexion limited to 10 degrees due to pain. Sensation was intact and strength testing was normal. Talar tilt testing and squeeze test of the calcaneus were negative. DIFFERENTIAL DIAGNOSIS:1. Septic arthritis2. Calcaneal fracture3. GoutTEST AND RESULTS:Labs:-Normal WBC, ESR, CRP, RF, ANA, uric acid, and Lyme and anaplasma titersImaging:-Left ankle radiographs: no acute osseous abnormality-Left ankle MRI without contrast:1.Nondisplaced fracture along the posterior dorsal surface of the calcaneus2.Trace ankle joint effusion3. Mild tibialis posterior tenosynovitis FINAL DIAGNOSIS:Nondisplaced stress fracture of posterior calcaneus TREATMENT AND OUTCOMES:1. Patient was referred to Infectious Disease (ruled out infectious origin including tick-borne infection) and Orthopedics.2. Initial treatment consisted of limited weight-bearing with walking boot, however pain worsened in the boot and she developed numbness of her foot with symptoms suggestive of tarsal tunnel syndrome.3. Patient transitioned to non-weight bearing status without boot, and after approximately two months of slow improvement progressed to limited weight-bearing and physical therapy.5. Due to prolonged recovery, patient still undergoing work-up for less common risk factors for stress fractures and bone infections, including Celiac disease, Bartonella, and Rickettsia testing.

Searching Potential Molecules Against SARS-CoV-2 from Costus arabicus L. Root Smoke: A Docking Study

Background: The root smoke of Costus arabicus L. (Qust-e Shirin) has been used in Iranian traditional medicine (ITM) for rhinorrhea and catarrh, especially with infectious origin. Objectives: This study aimed to inspect potential anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) activities of chemical compositions of this smoke through a docking study. Materials and Methods: Based on our previous study on the chemical compositions of C. arabicus root smoke, the chemical structure of components was revealed by GC-MS. In this study, these structures were generated in HyperChem software, and an energy-minimization procedure was performed for the molecules. For the docking study, the Hex software was used. Docking was performed using the Protein Data Bank (PDB) structure of the COVID-19 RNA-dependent RNA polymerase (RdRp) (PDB ID: 6M71) enzyme which was obtained from PDB bank, water molecules were removed, Coleman charge was added, and non-polar hydrogens were merged. Then, docking was performed. Results: The result indicated the energy of each interaction between molecules and enzymes. The lower the energy, the higher the probability of interaction will be. The best molecule was 6H-quindoline which has the best total energy among the molecules. The next molecule was 5-methoxy-alpha methyl tryptamine with -210.82 kcal energy. Their similar structure in indole moiety suggests that this fragment can play a crucial role in attachment to the enzyme and can be kept intact in future designs against COVID-19 inhibitors. Conclusion: In conclusion, this study showed that C. arabicus root smoke may be effective in SARS-CoV-2 infection. Further in vitro and in vivo studies on the activity of the smoke and its constituents against COVID-19 would be fruitful.

Microbial Analysis of Umbilical Cord Blood Reveals Novel Pathogens Associated with Stillbirth and Early Preterm Birth.

ABSTRACTStillbirths account for half of all perinatal mortality, but the underlying cause of a significant portion of the cases remains unknown. We set out to test the potential role and extent of microbial infection in stillbirth through a case-control analysis of fetal cord blood collected from the multisite Stillbirth Collaborative Research Network. Cases (n = 60) were defined as stillbirths at >20 weeks of gestation, and controls (n = 176) were live births. The bacterial presence, abundance, and composition were analyzed by endpoint PCR of full-length 16S rRNA and the V4 amplicon sequence variants (ASVs). The results demonstrate that bacterial prevalence and abundance were both significantly increased in stillbirth, even after adjusting for maternal age, race, body mass index, number of pregnancies, gestational age, and multiple gestations. Composition of bacterial communities in the cord blood also differed significantly. Using a group of 25 ASVs differentially abundant between the two groups, a Random Forest classification model achieved an accuracy score of 0.76 differentiating stillbirth and live birth, with Group B Streptococcus as the most enriched species in stillbirth. Positive PCR was also significantly associated with early preterm birth. A group of oral anaerobes, including Actinomyces, Campylobacter, Fusobacterium, Peptostreptococcus, Porphyromonas, and Prevotella, were enriched in live early preterm birth, suggesting possible oral origin of infection. Our ASV-based microbiome analysis revealed specific candidate pathogens associated with infections in stillbirth and early preterm birth. The cord blood microbial signatures may be markers of adverse pregnancy outcomes. Our study will help identify possible mechanism of infection and improve our ability to prevent stillbirth and early preterm birth.

Analysis of shell anomalies in the Spanish upper cretaceous basal pan-pleurodire Dortoka vasconica (Dortokidae).

The study of pathological bone modifications of extinct organisms of lineages, which are still living today, in combination with extant representatives, allows to infer data about population dynamics, lifestyle, and diseases they were subject to. Pathological studies in turtles are extensive; however, these contributions are mainly focused on extant representative records of survival rates or on non-skeletonized material, and do not generally include morphological descriptions, illustrations, or data concerning their etiology and pathogenesis. As a consequence, paleopathology in turtles remains relatively poorly understood, especially considering extinct forms. In this context, we herein analyze marks of possible pathological origin recognized in two disarticulated plastral plates of the Spanish freshwater basal pan-pleurodiran turtle Dortoka vasconica (Dortokidae), from its type locality, the Upper Cretaceous (late Campanian-early Maastrichtian) fossil site of Laño 1 (Treviño County, Burgos, Spain). As a result, information regarding the possible etiology, pathogenesis, and stages of healing of the marks studied here are provided. A probable infectious origin is recognized as the etiology in both plates, these marks being considered as pathologies. This study contributes to our understanding of pathologies in extinct turtle taxa, specifically a stem-pleurodiran turtle.

A continental-scale survey of Wolbachia infections in blue butterflies reveals evidence of interspecific transfer and invasion dynamics.

Infections by maternally inherited bacterial endosymbionts, especially Wolbachia, are common in insects and other invertebrates but infection dynamics across species ranges are largely under studied. Specifically, we lack a broad understanding of the origin of Wolbachia infections in novel hosts, and the historical and geographical dynamics of infections that are critical for identifying the factors governing their spread. We used Genotype-by-Sequencing data from previous population genomics studies for range-wide surveys of Wolbachia presence and genetic diversity in North American butterflies of the genus Lycaeides. As few as one sequence read identified by assembly to a Wolbachia reference genome provided high accuracy in detecting infections in host butterflies as determined by confirmatory PCR tests, and maximum accuracy was achieved with a threshold of only 5 sequence reads per host individual. Using this threshold, we detected Wolbachia in all but 2 of the 107 sampling localities spanning the continent, with infection frequencies within populations ranging from 0% to 100% of individuals, but with most localities having high infection frequencies (mean = 91% infection rate). Three major lineages of Wolbachia were identified as separate strains that appear to represent 3 separate invasions of Lycaeides butterflies by Wolbachia. Overall, we found extensive evidence for acquisition of Wolbachia through interspecific transfer between host lineages. Strain wLycC was confined to a single butterfly taxon, hybrid lineages derived from it, and closely adjacent populations in other taxa. While the other 2 strains were detected throughout the rest of the continent, strain wLycB almost always co-occurred with wLycA. Our demographic modeling suggests wLycB is a recent invasion. Within strain wLycA, the 2 most frequent haplotypes are confined almost exclusively to separate butterfly taxa with haplotype A1 observed largely in Lycaeides melissa and haplotype A2 observed most often in Lycaeides idas localities, consistent with either cladogenic mode of infection acquisition from a common ancestor or by hybridization and accompanying mutation. More than 1 major Wolbachia strain was observed in 15 localities. These results demonstrate the utility of using resequencing data from hosts to quantify Wolbachia genetic variation and infection frequency and provide evidence of multiple colonizations of novel hosts through hybridization between butterfly lineages and complex dynamics between Wolbachia strains.

Viruses in neurodegenerative diseases: More than just suspects in crimes.

Neurodegenerative diseases (NDs) such as Alzheimer’s and Parkinson’s disease are fatal neurological diseases that can be of idiopathic, genetic, or even infectious origin, as in the case of transmissible spongiform encephalopathies. The etiological factors that lead to neurodegeneration remain unknown but likely involve a combination of aging, genetic risk factors, and environmental stressors. Accumulating evidence hints at an association of viruses with neurodegenerative disorders and suggests that virus-induced neuroinflammation and perturbation of neuronal protein quality control can be involved in the early steps of disease development. In this review, we focus on emerging evidence for a correlation between NDs and viral infection and discuss how viral manipulations of cellular processes can affect the formation and dissemination of disease-associated protein aggregates.

MPoxVR: A comprehensive genomic resource for monkeypox virus variant surveillance

Monkeypox is a viral zoonotic disease endemic in Central and West Africa. Since January 1, 2022, 3413 laboratory-confirmed monkeypox cases and one death have been reported from 50 countries/territories in five WHO regions (as of June 22, 2022; https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396), and 1310 new cases and eight new countries have been reported in the past week. Genomic epidemiology is vital to determine the similarity between viruses and suggest possible links between cases, origins of infection, and transmission dynamics when combined with epidemiological information.

Antibacterial and anti-trichomunas characteristics of local landraces of Lawsonia inermis L.

BackgroundHenna (Lawsonia inermis) with anti-bacterial properties has been widely used in traditional medicine especially Persian medicine. Henna oil is suggested for diseases of infectious origin, such as cervical ulcers. Group B Streptococcus agalactiae, Pseudomonas aeruginosa and, Trichomonas vaginalis are involved in the infection of women especially cervicitis. Henna grows in dry and tropical regions. The main important landraces of henna landraces are cultivated in Kerman, Sistan and Baluchestan, Hormozgan, and Bushehr provinces in Iran.Proper use of antimicrobial agents, use of new antimicrobial strategies, and alternative methods, such as herbal methods may help reduce drug resistance in the future. This study’s objective was to investigate the anti-Trichomonas vaginalis activity of three different henna landraces and antimicrobial effects against group B Streptococcus agalactiae and, Pseudomonas aeruginosa.MethodsTotal phenol content was measured by Folin ciocaltu method. Antibacterial effect of landraces of Henna against P. aeruginosa and S. agalactiae were assayed by well diffusion method and minimal inhibitory concentration assessments were done using the broth micro-dilution technique. Anti-Trichomonas effect of Henna landraces were assayed by Hemocytometery method.ResultsTotal phenol content of Shahdad, Rudbar-e-Jonub, and Qaleh Ganj was 206.51, 201.96, and 254.85 μg/ml, respectively. Shahdad, Rudbar-e-Jonub, and Qaleh Ganj had MIC against GBS at 15, 15 and, 4 μg/ml. The growth inhibition diameter of the most effective henna (Shahdad landrace) at a concentration of 20 μg/ml on P. aeruginosa was 2.46 ± 0.15 cm and in the MIC method at a concentration of 5 μg/ml of Shahdad landrace, P. aeruginosa did not grow. IC50 of shahdad Henna after 24 h, 48 h, and 72 h was 7.54, 4.83 and 20.54 μg/ml, respectively. IC50 of Rudbar-e-Jonub extract was 5.76, 3.79 and 5.77 μg/ml in different days. IC50 of Qaleh Ganj extract was 6.09, 4.08 and 5.74 μg/ml in different days.ConclusionsThe amount of total phenol in Qaleh Ganj was higher than the other varieties. In the well diffusion method, Qaleh Ganj was more effective against group B Streptococcus (Gram-positive bacterium) than the other two landraces, and Shahdad landrace was more effective against P. aeruginosa (Gram-negative bacterium) than other. In the MIC method, the same result was obtained as in the well diffusion method, but at a lower concentration.

Association of carbohydrate 125 antigen with sepsis mortality in critical patients

IntroductionThe increased synthesis of CA125 in mesothelial cells is connected with pathophysiological processes, also present in sepsis, that link inflammation with systemic congestion. We propose to evaluate serum levels of this biomarker in patients with sepsis and to study its association with the severity and evolution of the disease. MethodsLongitudinal retrospective observational study, which included 126 patients admitted to an Intensive Care Unit with sepsis criteria. The main variables analyzed were: CA125 values for 7 days, the variation of its levels according to the source of infection (abdominal, pulmonary, nephrourinary and others), sepsis, septic shock, APACHE-II score and mortality. ResultsCA125 levels remained elevated throughout the study period. The abdominal focus presented higher mean levels of CA125 (62 ± 55.5 U/mL; P = 0.001) and were higher in non-survivors (77.2 U/mL; interquartile range 35.9−118.5; P = 0.0273). CA125 levels > 35 U/mL throughout the weal had an independently effect on the evolution (relative risk [RR] 3.1; 95% confidence interval [CI] 1.6–6.2; P = 0.001) and the elevated mean value of CA125 was also associated with mortality (RR 1.004; 95% CI 1.001–1.005; P = 0.0001). ConclusionsSeptic patients presented high levels of CA125 on the study days, being higher in abdominal infections. In our study, serial determination of CA125 is a prognostic marker of mortality independent of age, origin of infection or severity.

Knowledge and Attitude of the Community People on Indoor Residual Spraying (IRS) Program at Kala-azar Endemic Area in Bangladesh

Visceral leishmaniasis also known as kala-azar is a chronic and potentially fatal parasitic disease in the world, affecting mainly the underprivileged people in the world. The success of the Kala-azar elimination program is mostly dependent on community participation which is an important aspect implemented by the world health organization in five south Asian countries. The participation of the community people mostly depends on the level of knowledge, attitude, and practice around risk factors associated with disease transmission among the population. This study was undertaken to assess the level of knowledge and attitude of the community people towards the indoor residual spraying (IRS) program in the Kala-azar endemic area. The study was carried out in 240 households by systemic random sampling on both hyper and moderate endemic areas in Bangladesh, and information was collected through a semi-structured questionnaire. Data from the study indicated that 44.6% of participants were illiterate, 99% had heard of kala-azar and 100% had heard about IRS. Team of IRS, family members, and neighbors play an important role as a source of information while the role of mass media was found to be limited. Almost all respondents who participate here seem to be that kala-azar is a serious health condition that drains family resources, but their attitude to doing beneficial activities of the IRS is not satisfactory because of their thought that it could be controlled by community effort. From the data, it is seen that people are knowledgeable about kala-azar, but disease transmission, infection origin, and control of the diseases are still not adequate. Their attitude toward indoor residual spraying program practice was not satisfactory. These findings suggest that it is necessary to continue and strengthen behavioral change through the implementation of the IRS program to progress the disease’s condition in the pandemic areas of Bangladesh.

Inferring spatial source of disease outbreaks using maximum entropy.

Mathematical modeling of disease outbreaks can infer the future trajectory of an epidemic, allowing for making more informed policy decisions. Another task is inferring the origin of a disease, which is relatively difficult with current mathematical models. Such frameworks, across varying levels of complexity, are typically sensitive to input data on epidemic parameters, case counts, and mortality rates, which are generally noisy and incomplete. To alleviate these limitations, we propose a maximum entropy framework that fits epidemiological models, provides calibrated infection origin probabilities, and is robust to noise due to a prior belief model. Maximum entropy is agnostic to the parameters or model structure used and allows for flexible use when faced with sparse data conditions and incomplete knowledge in the dynamical phase of disease-spread, providing for more reliable modeling at early stages of outbreaks. We evaluate the performance of our model by predicting future disease trajectories based on simulated epidemiological data in synthetic graph networks and the real mobility network of New York State. In addition, unlike existing approaches, we demonstrate that the method can be used to infer the origin of the outbreak with accurate confidence. Indeed, despite the prevalent belief on the feasibility of contact-tracing being limited to the initial stages of an outbreak, we report the possibility of reconstructing early disease dynamics, including the epidemic seed, at advanced stages.

Comparison of approaches for source attribution of ESBL-producing Escherichia coli in Germany.

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia (E.) coli have been widely described as the cause of treatment failures in humans around the world. The origin of human infections with these microorganisms is discussed controversially and in most cases hard to identify. Since they pose a relevant risk to human health, it becomes crucial to understand their sources and the transmission pathways. In this study, we analyzed data from different studies in Germany and grouped ESBL-producing E. coli from different sources and human cases into subtypes based on their phenotypic and genotypic characteristics (ESBL-genotype, E. coli phylogenetic group and phenotypic antimicrobial resistance pattern). Then, a source attribution model was developed in order to attribute the human cases to the considered sources. The sources were from different animal species (cattle, pig, chicken, dog and horse) and also from patients with nosocomial infections. The human isolates were gathered from community cases which showed to be colonized with ESBL-producing E. coli. We used the attribution model first with only the animal sources (Approach A) and then additionally with the nosocomial infections (Approach B). We observed that all sources contributed to the human cases, nevertheless, isolates from nosocomial infections were more related to those from human cases than any of the other sources. We identified subtypes that were only detected in the considered animal species and others that were observed only in the human population. Some subtypes from the human cases could not be allocated to any of the sources from this study and were attributed to an unknown source. Our study emphasizes the importance of human-to-human transmission of ESBL-producing E. coli and the different role that pets, livestock and healthcare facilities may play in the transmission of these resistant bacteria. The developed source attribution model can be further used to monitor future trends. A One Health approach is necessary to develop source attribution models further to integrate also wildlife, environmental as well as food sources in addition to human and animal data.

In-Hospital Mortality of Sepsis Differs Depending on the Origin of Infection: An Investigation of Predisposing Factors.

Sepsis is a heterogeneous syndrome characterized by a variety of clinical features. Analysis of large clinical datasets may serve to define groups of sepsis with different risks of adverse outcomes. Clinical experience supports the concept that prognosis, treatment, severity, and time course of sepsis vary depending on the source of infection. We analyzed a large publicly available database to test this hypothesis. In addition, we developed prognostic models for the three main types of sepsis: pulmonary, urinary, and abdominal sepsis. We used logistic regression using routinely available clinical data for mortality prediction in each of these groups. The data was extracted from the eICU collaborative research database, a multi-center intensive care unit with over 200,000 admissions. Sepsis cohorts were defined using admission diagnosis codes. We used univariate and multivariate analyses to establish factors relevant for outcome prediction in all three cohorts of sepsis (pulmonary, urinary and abdominal). For logistic regression, input variables were automatically selected using a sequential forward search algorithm over 10 dataset instances. Receiver operator characteristics were generated for each model and compared with established prognostication tools (APACHE IV and SOFA). A total of 3,958 sepsis admissions were included in the analysis. Sepsis in-hospital mortality differed depending on the cause of infection: abdominal 18.93%, pulmonary 19.27%, and renal 12.81%. Higher average heart rate was associated with increased mortality risk. Increased average Mean Arterial Pressure (MAP) showed a reduced mortality risk across all sepsis groups. Results from the LR models found significant factors that were relevant for specific sepsis groups. Our models outperformed APACHE IV and SOFA scores with AUC between 0.63 and 0.74. Predictive power decreased over time, with the best results achieved for data extracted for the first 24 h of admission. Mortality varied significantly between the three sepsis groups. We also demonstrate that factors of importance show considerable heterogeneity depending on the source of infection. The factors influencing in-hospital mortality vary depending on the source of sepsis which may explain why most sepsis trials have failed to identify an effective treatment. The source of infection should be considered when considering mortality risk. Planning of sepsis treatment trials may benefit from risk stratification based on the source of infection.

Etiología viral en el síndrome de Guillain-Barré: buscando una respuesta a lo idiopático

Guillain-Barré Syndrome (GBS) is a rare disorder of the nervous system, where the patient's immune system attacks the peripheral nerve cells in the arms and legs, causing muscle weakness, loss of sensation and sometimes total paralysis. The origin of this disorder has been associated with immune responses triggered by post-infection with Campylobacter spp. However, when there is no obvious cause of the disease, it is usually not investigated due to the greater interest in the treatment. Therefore, most cases are reported as idiopathic origin. Between January and March 2016 worldwide, GBS outbreaks were reported in 8 countries, linked to the emergence of the Zika virus. In Peru, since the end of 2018, outbreaks of GBS have been reported more frequently and although no association with Zika has been confirmed, the increase in cases, the geographical extension where they occurred and the clinical characteristics of affected patients, have common patterns that lead to suspect an infectious origin mainly of viral type. Therefore, it is important to know the current scientific evidence about the role that some viruses play in this syndrome, allowing us to expand our epidemiological picture with new tools to address this disease

Management of Lifestyle Disorders with Tenets of Ayurveda

Ayurveda is one of the world’s ancient health care systems. Ayurveda has always emphasized maintaining the health and prevention of diseases by following a proper diet and lifestyle regimen rather than treatment and cure of the diseases. Ayurveda describes Traya-upastambhah, three pillars for a healthy life are Aahar (proper diet), Nidra (proper sleep), and Brahmacharya (celibacy). Aahar has been given prime importance since the Vedic Period. It is considered Brahma in Upanishad. Acharaya Kashyapa gives it the name “Mahabhaisajya”. Lifestyle disorders originate due to Poor lifestyle which includes poor diet, poor eating habits, Viruddhahara (dietetic incompatibility), lack of exercise, Smoking, excess alcohol, poor sleep, stress due to heavy workload, and increased consumption of unhealthy food. So, nowadays the number of individuals having lifestyle diseases like Heart disease, Obesity, Diabetes, Hypertension, and Cancer are continuously increasing and these are the primary cause of death. According to WHO, four main types of lifestyle disorders are Cardiovascular disease, Cancer, Chronic respiratory diseases, and Diabetes. Diseases of infective origin can be easily treated as compared to lifestyle disorders because lifestyle disorders are generally non-reversible. It is the need of time to review the Ayurveda in order to apply measures in preventing the upcoming epidemic of lifestyle disorders which are preventable with changes in diet (ahara), lifestyle, and environment.

Advancing Key Gaps in the Knowledge of Plasmodium vivax Cryptic Infections Using Humanized Mouse Models and Organs-on-Chips.

Plasmodium vivax is the most widely distributed human malaria parasite representing 36.3% of disease burden in the South-East Asia region and the most predominant species in the region of the Americas. Recent estimates indicate that 3.3 billion of people are under risk of infection with circa 7 million clinical cases reported each year. This burden is certainly underestimated as the vast majority of chronic infections are asymptomatic. For centuries, it has been widely accepted that the only source of cryptic parasites is the liver dormant stages known as hypnozoites. However, recent evidence indicates that niches outside the liver, in particular in the spleen and the bone marrow, can represent a major source of cryptic chronic erythrocytic infections. The origin of such chronic infections is highly controversial as many key knowledge gaps remain unanswered. Yet, as parasites in these niches seem to be sheltered from immune response and antimalarial drugs, research on this area should be reinforced if elimination of malaria is to be achieved. Due to ethical and technical considerations, working with the liver, bone marrow and spleen from natural infections is very difficult. Recent advances in the development of humanized mouse models and organs-on-a-chip models, offer novel technological frontiers to study human diseases, vaccine validation and drug discovery. Here, we review current data of these frontier technologies in malaria, highlighting major challenges ahead to study P. vivax cryptic niches, which perpetuate transmission and burden.

Impact of the COVID-19 pandemic on the training of otorhinolaryngology residents

Background and objectivesTraining in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain. MethodsA cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearson’s Chi-square test (χ2) with Yates’s correction and Pearson's correlation coefficient (r) were used. Results143 completed surveys were received from 264 Residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalisation (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6 months of their training period, and in 18.8% of cases, it was as high as 10 and 12 months. There has been a reduction of more than 75% of what was planned in surgical training (p<0.05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty. ConclusionsThe decline in ENT activity and residents having to assist in other COVID-19 units during the most critical moments of the pandemic, has caused the main reduction in their training capacity. Contagion mainly occurred through contact with asymptomatic carriers during patient care and through supposedly close contact with asymptomatic carriers. Virtual activities have been widely accepted, but they have not completely replaced all residents’ training needs. Measures should be implemented to recover lost training, especially surgical practical learning in otology and rhinology.

PENYULUHAN PENCEGAHAN PENYAKIT INFEKSI MIKROORGANISME PADA SANTRIWAN DAN SANTRIWATI PONDOK PESANTREN KYAI MAROGAN PALEMBANG

Introduction: Infection prevention and control is the application of microbiology in clinical practice and its success depends on the theoretical knowledge of microbiology that underlies safe clinical practice. Infectious diseases are still one of the health problems in the world, including Indonesia. Judging from the origin or acquisition of infection can come from the community (Community Acquired Infection) or come from the environment. Objective: to increase knowledge about infection prevention and control application of microbiology in clinical practice and its success. Solution: Conduct infection prevention and control counseling to students who are queuing and at the Kyai Marogan Islamic boarding school in Palembang. Time : Held on Thursday, August 26, 2021, attended by 96 students and students, with 3 lecturers and 3 students as implementers. Results: There was an increase in the understanding of students and female students (100%) after counseling on infection prevention and control to students and female students queuing at the Kyai Marogan Islamic Boarding School in Palembang. Suggestion: To always instill the belief that cleanliness is part of our faith, be open and respectful to each other to improve personal and environmental hygiene.