Bilateral thalamic encephalitis due to Epstein-Barr virus (EBV) is a rare and severe manifestation of EBV infection, often leading to rapid neurological deterioration and poor outcomes. We report the case of an 82-year-old man with a history of arterial hypertension and a previous herpes zoster infection who presented to the emergency department with high fever and acute neurological impairment evolving into coma (Glasgow Coma Scale, GCS 3). Cerebrospinal fluid (CSF) analysis revealed mild lymphocytic pleocytosis, elevated protein and normal glucose. EBV-DNA was detected by polymerase chain reaction (PCR) and serology confirmed positive anti-EBV IgM antibodies. Autoimmune and paraneoplastic panels, including anti-NMDA receptor, anti-GQ1b, anti-MOG, anti-AQP4 and anti-LGI1 antibodies, were negative. Magnetic resonance imaging (MRI) demonstrated bilateral thalamic hyperintensities on T2-weighted and FLAIR sequences, with restricted diffusion on DWI and corresponding hypointensity on ADC maps, without contrast enhancement. Angiography showed normal patency of the main intracranial vessels. Differential diagnoses such as autoimmune encephalitis, acute disseminated encephalomyelitis, Bickerstaff's brainstem encephalitis, vascular, metabolic and other viral causes were excluded. Despite prompt antiviral and corticosteroid therapy and intensive supportive management, the clinical outcome was poor. A comprehensive literature review was performed, highlighting key clinical and radiological findings from previously published cases of EBV-related bilateral thalamic encephalitis, to improve recognition and understanding of this rare and devastating condition.

To measure markers of inflammation and angiogenesis in circulating blood in patients who have had an ischemic stroke (IS) during a previous new coronavirus infection (COVID-19). The study included 80 patients diagnosed with IS. Of these, 58 subjects had documented COVID-19 at least 4 months before enrollment (main group). The comparison group consisted of 22 patients with IS who did not have infectious diseases during the specified 4-month period. In addition to the routine laboratory tests, the following serum enzyme-linked immunosorbent assay (ELISA) parameters were measured in all participants: chemokines, monocyte chemoattractant protein 1 (MCP-1), vascular endothelial growth factor type A (VEGF-A), interferon-gamma (IFN-g), and interleukin (IL)-6. Serum levels of IL-6 (p<0.05), MCP-1 (p<0.05), C-reactive protein (p<0.05), and ferritin (p<0.05) were significantly increased in patients with IS with a history of COVID-19, in addition to a decrease in IFN-γ (p<0.05) and an increase in VEGF-A (p<0.05). A history of COVID-19 may contribute to persistent vascular inflammation and exacerbate cerebrovascular disease. Such patients require closer monitoring and, possibly, reconsideration of approaches to prevention and therapy at various stages of follow-up.

Today, COVID-19 reinfection has raised further public health concerns than its primary infection; which make major global health concern that going to the possibility of COVID-19 re-infection, and how strong the body's immunity against this disease in individuals with the previous infection. The present study aimed to investigate the probability of COVID-19 re-infection leading to hospitalization in the population referred to hospitals affiliated with Mashhad University of Medical Sciences, Mashhad, Iran. The present cross-sectional epidemiological study was conducted on patients referred to hospitals affiliated to the Mashhad University of Medical Sciences, Mashhad, Iran supervision with re-infection of COVID-19 from January 21, 2020, to August 23, 2022. The patients had a definite diagnosis through RT-PCR testing in their first and re-infections, with a time interval of at least one month between the two episodes of infection. Out of 125,857 patients evaluated, 9,710 (7.7%) were readmitted with COVID-19 infection more than once, with a time interval of more than one month from their previous hospitalization. The average age of hospitalized patients was 54.8 ± 22.97 years, and more than half were men (51.4%). The most common underlying diseases were hypertension (19.4%) and diabetes (14.8%). cardiovascular diseases, asthma, and cancer were the strongest independent risk factors of COVID-19 re-infection (OR = 2.53, 2.47, and 2.36, respectively, p < 0.001 for all cases). In conclusion, our study demonstrates the importance of understanding the risk factors associated with COVID-19 re-infection and re-hospitalization, particularly in vulnerable populations with comorbidities and substance use disorders.

In order to examine the dynamics of seasonal influenza transmission, this study suggests a fractional-order epidemiological model that was created using the Caputo fractional derivative. The model effectively replicates the observed pandemic progression over a order parameter, with an ideal value of [Formula: see text], offers better accuracy than traditional show that a non-integer order parameter, with an ideal value of [Formula: see text], offers better accuracy than traditional integer-order models. The idea of memory trace, which depicts the impact of previous infection levels on current disease dynamics, is a significant contribution of this work. This characteristic makes it possible to comprehend the impact of past immunity on present epidemiological results in greater detail. Furthermore, the model provides a more accurate depiction of disease spread by taking into consideration variation in infection severity among various population groups. The findings show that incorporating population heterogeneity and memory effects improves predictive performance and offers insightful information for designing public health interventions and policies. Overall, this study highlights fractional calculus’s potential as a potent instrument for enhancing the precision and usefulness of epidemiological models in the control of infectious diseases.

Objective: This study aimed to evaluate the long-term results of radial head arthroplasty (RHA) in treating comminuted radial head fractures (RHF). Methods: Patients who underwent surgery for RHF using the RHA method between 2011 and 2018 were retrospectively analyzed. We included patients who received reconstruction with a radial head prosthesis in the acute or chronic phase due to a comminuted radial head fracture. Patients were excluded if they had a systemic concomitant disease, a previous infection, a fracture or surgery on the same elbow, osteoarthritis, or a follow-up period of less than 5 years. Fractures were classified according to the Mason classification system. For functional assessment, postoperative evaluations included range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Quick Disabilities of the Arm, Shoulder, and Hand score (qDASH). Results: Thirty-five patients (23 male, 12 female) were included in the study. Twenty-five had Mason Type III fractures, and 10 had Mason Type IV RHF. The mean age was 47.8 ± 15.6 years, and the mean follow-up period was 117.3 ± 9.3 months. The mean MEPS was 87.5 ± 10.3, and the mean qDASH score was 16.7 ± 10.8. Patients with Mason Type III RHF demonstrated greater flexion (140° vs. 112.5°) and a larger rotational arc of motion (155.5° vs. 144.9°) compared to those with Mason Type IV fractures. However, extension loss, MEPS, and qDASH scores were comparable between the two groups. Radiological outcomes and complication rates also showed no significant differences between fracture types. Conclusion: The findings of this study indicate that RHA is an effective treatment option for nonreconstructable RHF, offering reliable pain relief, restoration of elbow mobility, and improved quality of life. These outcomes highlight its value in managing patients with poor prognostic factors, where conventional reconstruction is not feasible, and in preventing long-term functional impairment.

Left ventricular non-compaction cardiomyopathy (LVNC) is an infrequent cardiac disorder characterized by prominent trabeculations, deep intertrabecular recesses, and thinning of the compacted myocardial layer, predisposing to heart failure, arrhythmias, and thromboembolic complications. The relationship between myocardial inflammation and chordae tendineae rupture is clinically relevant, as prior inflammatory processes may compromise valvular structures, leading to acute mitral regurgitation and ventricular overload. We present the case of a 45-year-old male with a history of severe mitral regurgitation and heart failure with preserved ejection fraction, who presented with progressive dyspnea, oppressive chest pain, diaphoresis, and lower extremity edema. Clinical assessment revealed arterial hypertension, tachycardia, hypoxemia, a loud systolic mitral murmur, jugular venous distension, and peripheral edema. Complementary studies demonstrated LVNC, severe prolapse of the posterior mitral leaflet with chordae tendineae rupture, acute mitral regurgitation, and pulmonary hypertension. Thoracic computed tomography revealed chronic lesions compatible with a previous viral infection, although specific SARS-CoV-2 testing results were unavailable. The patient underwent mitral valve replacement with a mechanical prosthesis, with postoperative complications including acute pulmonary edema, pleural effusion, renal insufficiency, and left ventricular dysfunction, which resolved favorably during hospitalization. This case highlights the importance of early recognition of LVNC and its valvular complications, as well as a comprehensive approach and timely surgical intervention to optimize clinical outcomes in complex cardiovascular scenarios.

Introduction: The coronavirus infection, COVID-19, still poses the most complex problem in medical science. One of the main links in the etiopathogenesis of this infection is the disturbance in the hemostasis system and capillary blood flow. The tendency to form blood clots in COVID-19 may be associated with a certain hereditary predisposition. Thus, the aim of this work is to study the correlation of several genetic variants with the hereditary predisposition to developing thrombosis following a new coronavirus infection of mild to moderate severity. Methods: This study was carried out on 182 patients aged 21 to 52 years who had episodes of venous thrombosis of various localizations within a year after clinically expressed COVID-19 of mild to moderate severity, confirmed by molecular genetic diagnostics of SARS-CoV-2. There were 154 patients in the control group aged 20 to 55 years (98 men and 58 women) who did not have such episodes after a mild or moderate infection (according to duplex analysis of vessels to exclude subclinical thrombosis and normal level D-dimer). The analysis of genetic variants of the hemostasis system genes (F2 c.20210G&gt;A, F5 c.1691G&gt;A, F7 c.10976G&gt;A, F13 c.G&gt;T, FGB c.-455 G&gt;A, ITGA2 c.807C&gt;T, ITGB3 c.1565 T&gt;C, PAI c.-675 5G&gt;4G) was performed using real-time PCR with automatic melting curve analysis. Statistical analysis of the results was performed using the chisquare analysis method on four-field genotype distribution tables, with a significance criterion of p =0.05 and the calculation of OR and CI. In some cases, Fisher's exact test was used. Results: The study showed a strong association between the development of thrombosis after a previous coronavirus infection and four polymorphic variants: F2 c.20210G&gt;A (genotype GA + AA, OR = 4.75 (CI: 1.72 - 14.23, p &lt;0.001)), F5 c.1691G&gt;A (genotype GA + AA, OR = 5.92 (CI: 2.48 - 15.36, p &lt;0.001)), ITGA2 c.807C&gt;T (TT OR = 5.32 (CI: 2.86-6.09, p &lt;0.0087)), and ITGB3 c.1565 T&gt;C (genotype CC OR = 5.91 (CI: 2.6 - 13.31, p &lt;0.001)). Conclusion: As a result, we identified a relationship between 4 polymorphic variants with a high risk of developing thrombophilia in patients who had a new coronavirus infection of mild to moderate severity.

There is growing incidence of postpartum stroke globally. We aim to assess the incidence rate, predicting factors and outcome of postpartum stroke in a middle income country. In one year long bidirectional study, patients with acute postpartum stroke developed within six weeks after delivery were cases compared to matched control group without stroke in 1:2 ratio. Gestational age, number of pregnancies, BMI, comorbid conditions, evidence of infection, history of stroke, headache, proteinuria, and anemia at time of presentation were exposure variables. The outcome measures were incidence of postpartum stroke and functional outcome of postpartum stroke within four weeks of its development. The incidence rate was 112 new strokes per 100,000 deliveries. The mean ages of cases (290) and controls (400) were 29.5±7.4 and 26.6±5.2 respectively. Among postpartum strokes, 54.8% were ischemic, 22.4% hemorrhagic, 20% venous infarcts, and 2.8% RCVS. Compared with control group patient with postpartum stroke were more likely to be overweight (OR 2.6; 95%CI, 1.71-4.14), anemic (OR, 4.4; CI, 2.50, 8.06), grandmultiparous (OR 2.5 ; CI, 1.27, 5.15), smoker (3.4; CI, 1.76, 6.7), had history of previous stroke (3.77; CI, 1.84, 7.72), migraine (OR 15 ; CI, 8.58, 26.26), infection (OR 2.9; CI, 1.81, 4.94) and heavy proteinuria (OR 4.4; CI, 2.5, 8.06),. Among cases 32 (11%) were died while 70.9% of the survivors had no residual weakness. According to the modified Rankin Score, 79% of post-partum stroke patients had good outcomes, while 61 (21%) had poor outcomes, 32 of whom died within 28 days. The incidence of postpartum stroke is increasing, particularly in low-income countries. Patients with established risk factors for postpartum stroke should get particular attention and all possible measures should be taken to mitigate those risk factors.

Empirical and targeted antimicrobial therapy in patients with febrile neutropenia and haematological malignancy or after haematopoietic cell transplantation: recommendations from the 10th European Conference on Infections in Leukaemia.

Since its discovery in 2019, SARS-CoV-2 has continued to be detected in both humans and animals worldwide. Currently there is limited research focusing on serological surveillance of wildlife under human care. Here we tested 230 serum samples of 134 animals from two zoological institutions collected between 2015 and 2024. To assess prior exposure and antibody responses from natural infection or vaccination, we used three serological assays: a nucleocapsid protein-based ELISA (N-ELISA), a surrogate virus neutralization test (sVNT) for spike (S) protein and a neutralization assay with S-pseudotyped viral particles. Among the 114 samples collected from 58 animals at Fort Wayne Zoo in Indiana, 37 samples from 20 vaccinated animals were sVNT-positive, and 2 of the positive animals had 2 samples prior to vaccination that tested positive by N-ELISA. Of the 116 samples from 76 animals at Brookfield Zoo in Illinois, 20 samples of 20 animals were sVNT-positive, and 19 of the positive animals had been vaccinated. Among these 20 sVNT-positive samples, only one sample from a South American Tapir was positive from prior to vaccination and 1 sample from a sloth bear was also positive by N-ELISA, marking the first documented cases of SARS-CoV-2 exposure in both species. Neutralization assays with S-pseudotyped virus revealed that some of the sVNT-positive samples have strong activity against the WH1-S pseudovirus but showed significantly reduced neutralization against the Omicron LP.8.1-S pseudovirus. These results underscore the need for updated vaccines tailored to emerging variants. Overall, our findings highlight the importance of continued serological surveillance across multiple species to detect new SARS-CoV-2 exposures and monitor vaccine-induced immunity in captive animal populations.

Carbapenem-resistant Enterobacterales (CRE) intestinal colonization is a key risk factor for subsequent infection. The composition of the intestinal microbiota is likely to play a role in the colonization. The aim of the study was to compare the gut microbiota composition between colonised (Col) patients and decolonised (DeCol) patients. Patients were identified from a database of CRE colonised patients. They were categorized as either currently Col or having spontaneously DeCol. Baseline characteristics and survival in the following year after the gut microbiota characterization were also collected. Gut microbiota composition was analysed. A total of 37 patients were included: 14 in the Col group and 23 in the DeCol group. No significant differences in terms of age, BMI, sex, KATZ index, toxics, diet and comorbidity were observed. Previous hospital admission and infections caused by CRE and/or other microorganisms were more frequent in the Col group. During the 12-month follow-up, mortality was higher in the Col group (Col 43% vs. DeCol 9%, p = 0.035). Differences in beta diversity were observed according to Col status (Bray Curtis distance, PERMANOVA, p = 0.013) but not according to recent antibiotic treatment or hospital admission. Suterella, Roseburia faecis and Eubacterium ventriosumwere enriched in DeCol patients. CRE colonisation was associated with a higher abundance of Ruthenibacterium lactatiformans. The composition of faecal microbiota was different between patients with ongoing CRE colonisation and those who achieved decolonisation. Further studies are needed to assess if specific bacterial taxa could be a marker of a longer colonisation risk.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worldwide. While most infected individuals who survive do so with no long-term consequences, approximately 10 to 70% develop long-term sequelae. Of particular concern has been the development of autoimmune diseases. Viral triggers for autoimmune disease have been thoroughly studied for previous viral infections and several recent studies have sought to investigate the link between SARS-CoV-2 and new onset autoimmune disease. Several reviews have also been conducted on the topic, however, many of these reviews are limited in focus, emphasizing biological mechanisms and case reports, as opposed to estimates of risk. Further, these reviews do not capture more recent cohort studies that have been published investigating the association between SARS-CoV-2 and new onset autoimmune disease. Therefore, there is a need for a more comprehensive and temporally updated systematically conducted review of the literature to address the question What is the risk of incident (i.e., new onset) autoimmune disease following a SARS-CoV-2 infection among adults (≥18 years)?. A systematic search of MEDLINE, EMBASE, CINAHL, and grey literature will be conducted, with results screened in duplicate in two stages: 1) Title and abstract screening and 2) Full text screening. A standardized data extraction sheet will be used on any studies passing through both stages of screening to extract details on publication, study population, exposure, and outcomes. Narrative and tabular synthesis of overall findings will be conducted, with diversity and heterogeneity of included studies discussed. If possible, a meta-analysis will also be conducted to combine findings of risk across the included studies. This protocol has been registered to PROSPERO (registration number: CRD42024594446).

ObjectivesSystemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with highly heterogenous clinical manifestations and severity. Herpes zoster (HZ) is a viral disease caused by reactivation of varicella-zoster virus which remains dormant in the dorsal root sensory ganglia after a previous varicella infection. There is limited information on the association between HZ and childhood-onset SLE (cSLE). This study aimed to determine the risk factors for HZ in patients diagnosed with cSLE.Patients and methodsSingle-center retrospective cohort study which included all patients less than 19 years old with SLE at a tertiary hospital in the Philippines.ResultsA total of 388 patients were included in the study. The prevalence of HZ was 15.72%, with an incidence rate of 38.40 per 100 person-years. The most common location of the HZ was the upper extremities (18.03%). The median SLEDAI at HZ diagnosis was 4, 16.39% had recurrent HZ, 11.48% had superimposed bacterial infection, and more than two-thirds were treated with acyclovir or valacyclovir (88.52%). The proportion of participants with renal manifestations was significantly higher among those with HZ (54.10% vs. 40.37%). Glucocorticoid dosage ≥ 5 mg, azathioprine, and intravenous cyclophosphamide significantly predict the likelihood of developing HZ. In particular, IV cyclophosphamide, azathioprine, and glucocorticoid doses of ≥ 5 mg increased the risk for the development of HZ by 1.61 (p = 0.048), 2.07 (p = 0.009), and 10.20 (p = 0.001) times, respectively.ConclusionThe prevalence and incidence of HZ in cSLE patients are 15.72% and 38.40 per 100 person-years, respectively. The risk factors identified for HZ among cSLE patients were lymphopenia, lupus nephritis, and immunosuppressive agents. Glucocorticoid dosage ≥ 5 mg, azathioprine, and intravenous cyclophosphamide significantly predict the likelihood of developing HZ.

This study aimed to analyze the incidence and risk factors of acute anastomotic leak (AL) in patients with colorectal cancer (CRC) during and after the COVID-19 pandemic. Active COVID-19 was evaluated as a risk factor of acute AL. A retrospective multicenter analysis was performed on 390 patients with CRC between April 2020 and October 2024. Patients were divided into acute AL (n = 27) and no acute AL (no AL) (n = 363) groups. In the acute AL group, there were 24 (88.8%) men and three (11.2%) women, with a median age of 63 (65-67) years. Twenty-seven patients in both groups had a previous COVID-19 infection and 15 patients (55.5%) who complained of COVID-19 had AL. The incidence of clinical AL was 6.9% (27/390), of which 11.1% (3/27) and 88.9% (24/27) were grade B and C, respectively. 24/27 (88.9%) had free AL with peritonitis requiring surgical re-intervention. Multivariate analysis showed that active COVID-19 infection (OR = 176, 95% CI 14.27-2172.57, p < 0.001) and serum albumin level < 3g/dl (OR = 16.249, 95% CI 1.033-255.544, p = 0.04) were associated risk predictors of AL, while the laparoscopic approach (OR = 0.032, 95% CI 0.002-0.434, p = 0.01) and splenic flexure mobilization (OR = 0.022, 95% CI 0.003-4.844, p = 0.02) were protective. The incidence of AL after CRC surgery did not increase during or after the COVID-19 pandemic. Active COVID-19 and serum albumin levels < 3g/dl were associated risk factors for AL, while the laparoscopic approach and splenic flexure mobilization were protective.

The role of Epstein-Barr virus (EBV) in multiple sclerosis (MS) pathogenesis is supported by the increased MS risk after infectious mononucleosis. This study aimed to evaluate EBV infection in our pediatric-onset MS (POMS) cohort. MS patients with disease onset < 18years of age seen at Bambino Gesù Children's Hospital were included. We searched for anti-EBV nuclear antigen (EBNA) Immunoglobulin G (IgG) and anti-viral capsid antigen (VCA) IgG and IgM. For comparison, we analyzed the EBV infection seroprevalence in an age- and sex-matched control cohorts of immunologically-healthy children and subjects with non-neurological autoimmune diseases. Fifty-seven POMS were included; all had a previous EBV infection. The controls' cohort included one-hundred and sixty-two patients with a median age of 12years (range 6-17), encompassing two subgroups: non-autoimmune (i.e. primary headaches) and autoimmune controls, namely inflammatory bowel disease and juvenile idiopathic arthritis. In the control group, ninety-six (59%) were EBV seropositive. EBV seropositivity was significantly higher in POMS than in the controls' cohort (OR = 79.2, 95% C.I. 4.8-1305), and compared to autoimmune and non-autoimmune controls separately (p < 0.0001). In our POMS cohort, EBV seropositivity was 100%, higher than previously reported. Our results support a disease-specific role of EBV in the MS development compared to other pediatric autoimmune disorders, consistent with evidence reported in adult-onset MS.

ABSTRACTBackgroundMultidrug‐resistant tuberculosis (MDR‐TB) presents a significant public health challenge, particularly in resource‐limited settings like Ethiopia. Identifying factors associated with MDR‐TB is essential for designing effective control strategies. The objective of this study was to identify the determinants of multidrug‐resistant tuberculosis (MDR‐TB) in southwest Ethiopia, to inform targeted public health interventions, improve prevention and control strategies, and support evidence‐based planning in regions with limited resources and a high burden of drug‐resistant TB.MethodsAn unmatched case‐control study was conducted from October 2022 to February 2023 in Jimma and Illubabor zones, located in Southwest Ethiopia. A total of 201 participants were initially selected, of whom 200 (66 MDR‐TB cases and 134 drug‐susceptible TB controls) completed the study and were included in the final analysis. Data were collected through interviewer‐administered questionnaires and review of medical records. Variables with a p‐value < 0.25 in bivariable analysis were entered into multivariable logistic regression to identify independent predictors of MDR‐TB. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used, and statistical significance was declared at p < 0.05.ResultsAmong the 200 participants included, several factors were significantly associated with MDR‐TB. Compared to those aged 15–24 years, participants aged 25–34 years (AOR = 3.8, 95% CI: 1.34–8.36) and 35–44 years (AOR = 3.3, 95% CI: 1.42–7.65) had higher odds of MDR‐TB. Other significant predictors included urban residence (AOR = 2.1), contact with TB or known MDR‐TB patients (AOR = 2.21), HIV infection (AOR = 1.9), substance use (alcohol, khat, illicit drugs), psychological illness (AOR = 9.4), previous TB treatment (AOR = 5.3), retreatment history (AOR = 13.9), low BMI (< 18.5 kg/m²; AOR = 3.9), living more than 25 km from treatment centers (AOR = 6.2), and perceived social stigma (AOR = 5.2).ConclusionThis study identified multiple independent predictors of MDR‐TB, including previous TB treatment, retreatment history, substance use, HIV infection, psychological illness, malnutrition, and limited access to healthcare. Sociodemographic factors such as age, urban residence, and perceived stigma were also significant. These findings highlight the need for integrated TB control strategies addressing clinical management, behavioral and psychosocial support, and improved healthcare access to effectively reduce MDR‐TB in Southwest Ethiopia.

Total knee arthroplasty (TKA) is the most effective method of pain relief and increased functional status for end stage knee arthritis. Shared by both surgeons and patients, infection is one of the most feared complications. Due to this fear, patients constantly present to physicians complaining of increased temperature on the operated knee. This common clinical observation can be mistaken as a sign for infection leading to unnecessary investigations or the inappropriate use of antibiotics. We aimed to assess in patients undergoing unilateral, primary total knee arthroplasty, whether the temperature of the operated limb, compared to the non-operative limb, remains elevated up to one year post-operatively using a large prospective, longitudinal observational study design. A prospective longitudinal observational study performed in a single center clinical setting (Alberta Hip and Knee Clinic) with patients undergoing operations at three academic hospitals within Calgary, Alberta. These included the Peter Lougheed Center, Rockyview General Hospital and Foothills Medical Center. Fifteen arthroplasty-trained surgeons participated. Patients were Included if they were having an elective primary total knee arthroplasty. Exclusion criteria included patients who have undergone revision TKA, previous major infection, post-traumatic arthritis with previous hardware, previous major operation on the knee including high tibial osteotomy, open reduction internal fixation or major open ligamentous repair excluding arthroscopic ACL reconstruction. Skin temperatures were taken in 4 quadrants using infrared thermometer on the operated and non-operated knees pre-op, 2 weeks, 6 weeks, 3 months and at one year post-operatively. Subgroup analysis was performed in the patients deemed to have a superficial or deep infection. A total of 1094 patients were enrolled in the research study. 889 patients completed a minimum of 4 out of 5 follow-up appointments. Follow-up was impacted due to the COVID-19 pandemic. 864 patients had a normal post-operative course while 25 were deemed to have either superficial or deep infection. Within primary total knee patients, there was a statistically significant increase in skin temperature in the operated versus non-operated knee at every follow-up including the one year follow-up with p&lt;0.001. However, the effect size was small at one-year follow-up with a mean difference in skin temperature of only 0.3oC. In the infected subgroup, there was also a statistically significant difference in skin temperature at 2, 6 and 12 weeks, with a greater difference in skin temperature between operated and non-operated knees (4.05 degrees versus 3.78 degrees in non-infected). However, there was little clinical difference (0.27 degrees) at two weeks between patients who were infected versus not infected. This study has a direct impact to improve the post-operative interaction between patients and surgeons. It is normal for skin temperature post TKA to increase initially and improve over time but can take up to a year before there is little clinical difference. Because of the small difference in the rise of skin temperature between those infected and not infected, there is little indication that skin temperature is a reliable indicator for infection.

The rapid spread of the Omicron BA.1 (B.1.1.529.1) SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) variant in 2021 resulted in international efforts to quickly assess its escape from immunity generated by vaccines and previous infections. Numerous laboratories published BA.1 neutralization data as preprints and reports. We collated this data in real time and regularly presented updates of the aggregated results in US, European and WHO research and advisory settings. Here, we retrospectively analyzed the accuracy of these aggregations from 85 different sources published during a time period from 2021/12/08 up to 2022/08/14. We found that the mean titer fold change from wild type-like variants to BA.1, a standard measure of a variant’s immune escape, remained stable after the first 15 days of data reporting in people who were twice vaccinated, and incoming data increased the confidence in this quantity. Further, it is possible to build reliable, stable antigenic maps from this collated data already after one month of incoming data. We here demonstrate that combining early reports from variable, independent sources can rapidly indicate a new virus variant’s immune escape and can therefore be of immense benefit for public health.

Irritable bowel syndrome (IBS) has a considerable impact on patients and healthcare systems. IBS is a disorder of brain-gut interaction with numerous biopsychosocial factors involved, including early life experiences, previous gastrointestinal infections, and coexisting mood disorders. An understanding of the role of the gut-brain axis in symptom generation is vital to enable delivery of holistic care. We explore psychological mechanisms, such as coexisting anxiety and depression, adverse life experiences, and somatisation and how these impact symptom severity. There is evidence for psychological therapies, such as cognitive behavioural therapy or gut-directed hypnotherapy, in IBS. We go on to summarise gut-based mechanisms, such as abnormal motility, visceral hypersensitivity, inflammation, and dysbiosis. Efficacious treatments targeting these include antidiarrhoeals, laxatives, antispasmodics, drugs acting on ion channels or serotonin, gut-brain neuromodulators, and treatments targeting the microbiota or inflammation. Finally, we consider emerging evidence from models describing distinct IBS phenotypes and their potential to facilitate a more integrated approach to identify best treatment options. For many patients with IBS, both brain and gut mechanisms must be considered within the context of the biopsychosocial model to enable effective delivery of holistic and personalised care.

To identify clinical variables associated with ventricular shunt infection and shunt failure in pediatric hydrocephalus. Patients ≤ 18years treated with ventricular shunts between 2013 and 2024 were identified from one institution's electronic medical record. Children with a confirmed diagnosis of hydrocephalus and ≥ 6months of postoperative follow-up were included. Primary and revision shunt surgeries were included. Records were manually reviewed for clinical variables. Statistical analyses were performed using R (version 4.2.3). The dataset included 474 surgeries, 146 primary and 328 revisions, undergone by 226 patients. Infection necessitating removal of a previously placed shunt occurred following 3.59% (17/474) of cases. Discharge in ≤ 4days had a 75% lower relative risk for infection compared to stays > 4days (1.5% vs. 6% 100-day infection risk; p = 0.011). Patients who underwent revision surgeries for shunt infections were more likely to experience subsequent infections in the first 100days postoperatively than those revised for other causes (2.42% vs. 21.05%; p < 0.0001). Patient characteristics associated with shunt failure during the 10-year study included younger age (median age: 2.23years in those with failure vs. 6.62years in those without; p < 0.0002) and lower weight (median weight: 11.8kg vs. 20.3kg; p < 0.0002) at the time of admission. Congenital hydrocephalus (OR = 1.86; p = 0.0045) and aqueductal stenosis (OR = 1.75; p = 0.025) were also associated with shunt failure. Length of stay > 4days and previous shunt infection are associated with an increased risk of infection after shunt surgery. These findings are important to consider when counseling pediatric patients and during postoperative monitoring.