Infection Rate Research Articles

Risk Factors for Surgical Site Infections and the Effects of Betadine Irrigation and Intrawound Vancomycin Powder on Infection Rates in Spine Tumor Surgery

Risk Factors for Surgical Site Infections and the Effects of Betadine Irrigation and Intrawound Vancomycin Powder on Infection Rates in Spine Tumor Surgery

Central lines, aseptic batching services, and infection rates: A pharmacy-led initiative of intravenous tube priming within a NICU.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Central line-associated bloodstream infections (CLABSIs) are hospital-acquired, serious complications that greatly affect many vulnerable neonates throughout their hospital stay. This article describes the implementation of a unique practice in which pharmacy primes continuous infusions through medication tubing for neonatal central lines in a cleanroom at Children's Hospital Colorado - Colorado Springs (CHCO-CSH). This institution is a freestanding children's hospital with a level III neonatal intensive care unit (NICU) that opened in April 2019. Since then, the pharmacy department has been priming central line tubing for continuous infusions for all patients in the NICU. Neonates are at increased risk for developing CLABSIs due to their immature immune systems and frequent need for central line placement. With that in mind, the pharmacy department decided to focus efforts on this population. Pharmacists and pharmacy technicians received training on how to properly prime tubing, document when a patient received a new central line, document if a central line was removed, and record when new tubing was due based on a department policy. This novel, pharmacy-led priming procedure resulted in a low CLABSI incidence, offering a promising strategy to reduce CLABSIs in a NICU.

Acarological Risk of Infection with Borrelia burgdorferi, the Lyme Disease Agent, in Staten Island, New York City

Lyme disease, the leading vector-borne ailment in the U.S., annually affects an estimated 476,000 individuals, predominantly in the Northeast and Upper Midwest. Despite its increasing incidence, the evaluation of risk within U.S. cities, including natural public lands, remains inadequate. This study focuses on blacklegged tick occurrences and Borrelia burgdorferi infection prevalence in 24 Staten Island parks, aiming to assess Lyme disease exposure risk. Monthly acarological risk index (ARI) calculations from 2019 to 2022 revealed elevated values (0.16–0.53) in specific parks, notably Wolfe’s Pond Park, High Rock Park, Clay Pit Pond Park, Clove Lake Park, and Fair View Park. June (0.36) and November (0.21) consistently exhibited heightened ARIs, aligning with peak tick collection months. Despite stable yearly infection rates at 28.97%, tick densities varied significantly between parks and years. Identifying a high transmission risk in specific parks in Staten Island, a highly urbanized part of New York City, emphasizes the continuous necessity for Lyme disease risk management, even within the greenspaces of large cities.

Incidence density rate of multidrug-resistant organism (MDRO) at a tertiary care teaching hospital: A retrospective cross-sectional study

: Multidrug-resistant organisms (MDROs) has become a major public health concern. Rise of MDROs and their negative consequences on patient’s survival and health care costs need the assessment of their burden and implementation of practices to control their emergence and spread. There is a lack of literature mentioning incidence density rates (IDR) of various MDRO infections in Indian hospitals. Therefore, the study was conducted to determine the infection IDR and trend of various MDROs at a tertiary care teaching hospital. It will serve as a benchmark data for similar facilities using the same surveillance definitions and methodology. : A retrospective cross-sectional study was conducted using culture data of ten years (January 2014 to December 2023) at Shree Krishna Hospital, Karamsad. MDRO studied included Methicillin-resistant (MRSA), V (VRE), (CRE), Multidrug-resistant (MDR) spp. and MDR . A total of 7311 MDRO were detected from 1321793 in-patients, showing the overall IDR of 5.53 per 1000 patients-days. CRE (n = 3056, 42%) was the most common MDRO. The overall IDR per 1000 patient-days of MRSA, VRE, CRE, MDR- ., and MDR- was 0.81, 0.23, 2.31, 1.29 and 0.89 respectively. Overall MDRO IDR has increased from 4.20 to 8.77 from 2014 to 2023. An increasing IDR was observed for MRSA (0.57 to 1.48) and MDR- (0.43 to 1.60). Around 80% of the . were MDR as compared to other MDRO. MDROs have been identified as a significant problem at our institute showing an increasing trend. We recommend following stringent infection control practices including isolation protocols as well as adherence to hospital antibiotic policy to reduce the burden of MDROs.

LIMBERG FLAP VERSUS BASCOM CLEFT LIFT TECHNIQUES FOR SACROCOCCYGEAL PILONIDAL SINUS

Objective: The study aims to evaluate and compare the outcomes of two surgical techniques, the limberg flap and Bascom cleft lift, used in the treatment of sacrococcygeal pilonidal sinus. Key metrics for comparison include postoperative complications, hospital stay duration, and surgery duration. Methods: This was a prospective study conducted at ESIC Hospital, Jaipur, involving 100 patients diagnosed with sacrococcygeal pilonidal sinus requiring surgical intervention. Patients were divided into two groups: Group I underwent the Bascom cleft lift procedure (n=40), and Group II underwent the limberg flap technique (n=60). Both groups were evaluated over a period of one and a half years with preoperative assessments and postoperative follow-ups for complications, duration of surgery, and length of hospital stay. Results: The study included 40 patients in the Bascom group (42.5% male, 57.5% female) and 60 in the limberg group (55% male, 45% female). The average surgery duration was significantly shorter for the Bascom procedure (36.73±6.52 min) compared to the limberg flap (74.58±10.10 min). Postoperative complications were higher in the limberg flap group. The Bascom cleft lift patients experienced shorter hospital stays and fewer postoperative issues, including lower rates of discharge and infection. Conclusion: The Bascom cleft lift procedure appears to be superior to the limberg flap in terms of shorter operative time, fewer complications, and quicker recovery. These findings suggest that the Bascom cleft lift could be a more efficient and safer option for the surgical treatment of pilonidal sinus, promoting faster patient recovery with fewer postoperative complications.

Carbapenem-resistant Enterobacteriaceae in the livestock, humans and environmental samples around the globe: a systematic review and meta-analysis

Carbapenem-resistant Enterobacteriaceae (CRE) have diminished treatment options causing serious morbidities and mortalities. This systematic review and meta-analysis assessed the prevalence and associated factors of Enterobacteriaceae infections in clinical, livestock and environmental settings globally. The population intervention comparison and outcome strategy was used to enroll studies using the preferred reporting system for systematic review and meta-analysis to include only cross-sectional studies. Search engines used to retrieve articles included journal author name estimator, PubMed, Google Scholar and African Journals Online (AJOL). The Newcastle–Ottawa scale was used to assess the quality of studies. Sixteen articles from 2013 to 2023 in Africa, Asia, Europe and South America were studied. The pooled prevalence of CRE was 43.06% (95% CI 21.57–66.03). Klebsiella pneumoniae (49.40%), Escherichia coli (26.42%), and Enterobacter cloacae (14.24%) were predominant. Klebsiella pneumoniae had the highest resistance with the blaKPC-2 in addition to blaNDM, blaOXA-48, blaIMP and blaVIM. The blaKPC-2 genes occurrence was associated with environmental (P-value < 0.0001) and South American studies (P-value < 0.0001), but there was no difference in the trends over time (P-value = 0.745). This study highlights the high rates of CRE infections, particularly within blaKPC production. Monitoring and surveillance programs, research and infection control measures should be strengthened. Additionally, further studies are needed to explore the mechanisms driving the predominance of specific bacterial species and the distribution of resistance genes within this bacterial family.

Multiple human papillomavirus infection and high-grade cervical squamous intraepithelial lesions among women with human immunodeficiency virus: a systematic review and a meta-analysis

BackgroundThis study aimed to evaluate the prevalence of multiple high-risk (HR) human papillomavirus (HPV) infections in women with human immunodeficiency virus (HIV) compared to negative controls. This study also aimed to assess the impact of multiple HR-HPVs on the risk of high-grade squamous cervical lesions (HSILs) among women with HIV.MethodsWe performed a systematic search of PubMed/Medline, Scopus, Cochrane databases, and ClinicalTrials.gov from 1 January 2004 to 30 June 2023, including screenings and clinical studies evaluating the rates and role of multiple HPV infections in squamous intraepithelial lesions (SILs). Three reviewers independently screened the abstracts of the selected studies and extracted data from full-text articles. The data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the OSQE method.ResultsForty-seven studies meet definitive inclusion criteria. The quality of the observations was considered low in 26 of the included studies and moderate in 21 of the included studies. In comparative screening studies, the pooled prevalence of multiple HR-HPV was 39.1% (95% CI = 33.7–44.7) among women with (n = 1734) and 21.6% (95% CI = 17.3–26.1) in those without HIV infection (n = 912) (OR = 2.33, 95% CI = 1.83–2.97, I2 = 2.8%). The pooled ORs of HR-HPV multiple infections were similar in African (OR = 2.72, 95% CI = 1.89–3.9) and non-African countries (OR = 2.1, 95% CI = 1.46–3, p for difference = 0.96). Among women with HIV, the risk of HSIL diagnosed either by cytology or histology was higher among those with overall (OR = 2.62, 95% CI = 1.62–4.23) and HR multiple infections than those with single HPV infection (OR = 1.93, 95% CI = 1.51–2.46). Among women with HIV, the excess rates of multiple HPV infections and the excess risk of associated HSIL were consistent across studies including both HIV-naïve subjects and those on antiretroviral therapy, as well as in studies with different rates of immunocompromised women. When study quality (low vs. moderate) was used as a moderator, the results were unchanged.ConclusionMultiple HR-HPV infections are common among women living with HIV and are associated with an increased prevalence of HSIL. These associations were also confirmed in studies with high rates of antiretroviral therapy and low rates of immunocompromise.Systematic Review Registration: PROSPERO [registration number: CRD42023433022].

Clinical Impact of Plasma Metagenomic Next-Generation Sequencing on Infection Diagnosis and Antimicrobial Therapy in Immunocompromised Patients.

Clinical impact of plasma metagenomic next-generation sequencing (mNGS) on infection diagnosis and antimicrobial therapy in immunocompromised patients with suspected infection remains unclear. Between March and December 2022, 424 cases with fever, infection history, mechanical ventilation, or imaging abnormalities underwent plasma mNGS testing at a single center. Eleven patients have received solid organ transplantation, and the remaining patients were categorised into febrile neutropenia (FN), non-neutropenia (NN), and non-haematologic disease (NTHD) groups based on immunosuppression severity. The diagnostic rate of infection and the utilisation of antimicrobial agents based on mNGS were assessed. The use of mNGS significantly improved the diagnostic rates for fungi in the FN (56.1%, P = 0.003) and NN (58.8%, P = 0.008) groups versus the NHD group (33.3%). Positive impacts associated with therapy were significantly greater than negative impacts across all three groups (all P < 0.001), and the utilisation of escalation therapy was significantly more frequent in the FN group than in the NN groups (P = 0.006). Over 70% of cases with negative mNGS results across the three groups underwent de-escalation therapy, with >1/3 being discontinued, preventing antimicrobial overuse. Plasma mNGS has a clinically confirmed positive impact in immunocompromised patients with neutropenia, improving the diagnosis of fungal infections and antimicrobial therapy.

Epidemiological characteristics of common respiratory pathogens in children

Children's respiratory tract infection is a common disease affecting children's health, our purpose is to describe the epidemiological characteristics of common pathogens of children's respiratory tract infection in central Shandong, China, and compare them with those in other parts of world, so as to summarize the rules of children's respiratory tract infection in central Shandong, and provide scientific basis for health departments to prevent and treat local children's respiratory tract infection. Sputum, tracheal aspirate, alveolar lavage fluid and other samples of 4804 children admitted to wards of Zibo Maternal and Child Health Hospital for treatment of respiratory tract infection from June 2019 to December 2022 were collected, and 12 common respiratory tract pathogens were detected by PCR capillary electrophoresis fragment analysis, two bacteria (Streptococcus pneumoniae, Haemophilus influenzae), two atypical pathogens (Mycoplasma Pneumoniae, Chlamydia Pneumoniae) and eight viruses (Human rhinovirus, Respiratory Syncytial Virus, Influenza A Virus, Parainfluenza Virus, Human metapneumovirus, Human boca virus, Human coronavirus, Influenza B virus) were included, the positive detection rate of single pathogen, the proportion of each type of respiratory tract mixed infection and the positive detection rate of single pathogen in different ages and seasons were analyzed statistically. (1)Among 4804 children with respiratory tract infection, the total positive rate was 77.87% (3741/4804), the positive rate of single pathogen was 43.40% (1656/4804), Streptococcus pneumoniae, Rhinovirus and Respiratory syncytial virus were the highest, there were 2085 cases of mixed infection with two or more pathogens, the positive rate was 43.40%. (2) The positive rates of infection in infant group (0–1 years old), infant group (1–3 years old), preschool group and school age group (3 years old-) were roughly the same, the infection rates of Streptococcus pneumoniae, Respiratory syncytial virus and Parainfluenza virus in infant group, Rhinovirus in infant group, Influenza A virus, Chlamydia pneumoniae, Mycoplasma pneumoniae and Haemophilus influenzae in school age group were higher than those in other groups, the difference was statistically significant (P < 0.05). (3) The positive detection rates of spring, summer, autumn and winter groups were 43.58%, 38.64%, 33.73% and 29.27%, respectively, the positive rates of Streptococcus pneumoniae and Haemophilus influenzae in spring group, Mycoplasma pneumoniae in summer group, Rhinovirus, Respiratory syncytial virus and Influenza A virus in autumn group, Chlamydia pneumoniae, Boca virus and Influenza B virus in winter group were higher than those in other seasons, and the differences were statistically significant (P < 0.05). The pathogen detection rate of children varies with age and season, and the prevention and treatment of a certain respiratory pathogen infection must be combined with its raging season and age rule.

Unravelling heterogeneous malaria transmission dynamics in the Peruvian Amazon: insights from a cross-sectional survey

BackgroundMalaria remains a global health challenge, particularly in Peru's Loreto region. Despite ongoing efforts, high infection rates and asymptomatic cases perpetuate transmission. The Peruvian Ministry of Health’s “Zero Malaria Plan” targets elimination. This novel study combines microscopic, molecular, and serological techniques to assess transmission intensity, identify epidemiological risk factors, and characterize species-specific patterns across villages. The findings aim to inform targeted interventions and support broader malaria elimination efforts in line with the Zero Malaria Plan initiative.MethodsA cross-sectional malaria survey was conducted in the Zungarococha community, comprising the villages Llanchama (LL), Ninarumi (NI), Puerto Almendra (PA), and Zungarococha (ZG), using microscopic, molecular, and serological techniques to evaluate malaria transmission intensity. Statistical analysis, including multivariate-adjusted analysis, seroprevalence curves, and spatial clustering analysis, were performed to assess malaria prevalence, exposure, and risk factors.ResultsThe survey revealed a high prevalence of asymptomatic infections (6% by microscopy and 18% by PCR), indicating that molecular methods are more sensitive for detecting asymptomatic infections. Seroprevalence varied significantly between villages, reflecting the heterogeneous malaria transmission dynamics. Multivariate analysis identified age, village, and limited bed net use as significant risk factors for malaria infection and species-specific exposure. Seroprevalence curves demonstrated community-specific patterns, with Llanchama and Puerto Almendra showing the highest seroconversion rates for both Plasmodium species.ConclusionsThe study highlights the diverse nature of malaria transmission in the Loreto region, particularly nothing the pronounced heterogeneity as transmission rates decline, especially in residual malaria scenarios. The use of molecular and serological techniques enhances the detection of current infections and past exposure, aiding in the identification of epidemiological risk factors. These findings underscore the importance of using molecular and serological tools to characterize malaria transmission patterns in low-endemic areas, which is crucial for planning and implementing targeted interventions and elimination strategies. This is particularly relevant for initiatives like the Zero Malaria Plan in the Peruvian Amazon.

Comparative Analysis of Viral Load and Cytokines during SARS-CoV-2 Infection between Pregnant and Non-Pregnant Women

To better understand the vulnerabilities of pregnant women during the COVID-19 pandemic, we conducted a comprehensive, retrospective cohort study to assess differences in immune responses to SARS-CoV-2 infection between pregnant and non-pregnant women. Nasopharyngeal swabs and serum specimens from 90 pregnant and 278 age-matched non-pregnant women were collected from 15 March 2020 to 23 July 2021 at NewYork-Presbyterian Queens Hospital in New York City. Multiplex reverse transcription polymerase chain reaction, neutralizing antibody, and cytokine array assays were used to assess the incidence, viral load, antibody titers and profiles, and examine cytokine expression patterns. Our results show a lower incidence of SARS-CoV-2 infection in pregnant women compared with non-pregnant women. Pregnant women infected with SARS-CoV-2 exhibited a substantially lower viral load. In addition, the levels of both anti-spike protein receptor-binding domain IgG neutralizing antibodies and anti-N Protein IgG were elevated in pregnant women. Finally, cytokine profiling revealed differential expression of leptin across cohorts. These findings suggest that pregnancy is associated with distinct immune and virological responses to SARS-CoV-2 infection, characterized by lower infection rates, substantially lower viral loads, and enhanced antibody production. Differential cytokine expression indicates unique immune modulation in pregnant women.

Parasitic Contamination of Well Water Consumed in Awka, Anambra State, Nigeria

Contamination of water sources by infectious pathogens has been recognized as a global threat to public health especially in underdeveloped countries. This study was carried out to survey the parasitic load (eggs and cysts) of protozoan parasites found in well water sources in four different locations in Awka South Local Government area of Anambra state (Ifite-Awka, Amansea, Amaenyi and Temp site). A total of forty (40) well water samples were collected across the four locations and examined in the laboratory using centrifugation and sedimentation methods. Data obtained was analyzed using simple percentages and chi-square was used to test for differences in the parasites abundance in the different locations. A total abundance of 141 parasitic stages of Entamoeba histolytica, Giardia lamblia and Cryptosporidium parvum were found in the well water samples across the study locations. Among the study locations, Amansea recorded the highest prevalence of protozoa parasites 51(36.17%) while Amaenyi area revealed the least infection rate 23(16.31%). Giardia lamblia 72(51.06%) was more abundant in the well water samples examined followed by Entamoeba histolytica 64(45.39%) while Cryptosporidium parvum 5(3.55%) was the least abundant protozoa parasite. The result revealed that the highest abundance of parasites was recorded in Amansea 51(36.17%) followed by Temp site 38(26.95%) while Amaenyi had the least 23(16.31%). The results showed the extent of parasitic contamination of the well sources across the study areas and the susceptibility of the populace to water-borne diseases. Hence, water obtained from these wells should be properly boiled before drinking, to avoid being infected.

High infection rates and risk‐adapted prevention strategies in contemporary pediatric allogeneic hematopoietic stem cell transplantation

AbstractWith recent changes in hematopoietic stem cell transplantation (HSCT) practices, such as the increasing use of alternative donors and ex vivo T‐cell depletion, how various risk factors interplay and affect the timeline of infections have not been well elucidated. We retrospectively reviewed the first 100 consecutive HSCT from April 2019 to October 2021 in the only pediatric HSCT center in Hong Kong. We found that the vast majority of the allogeneic transplant recipients (69/74, 93.2%) had infections after HSCT, amongst which bacterial, viral, and fungal infection rates were 35.1%, 90.5%, and 9.5%, respectively. In contrast, only 30.8% (8/26) of autologous transplant recipients had infections (rate of bacterial, viral, and fungal infection were 19.2%, 15.4%, and 3.8%, respectively). Human herpesvirus 6 (HHV‐6) and BK virus (BKV) typically occurred early after HSCT, adenovirus (ADV) and varicella zoster virus (VZV) thereafter, and cytomegalovirus (CMV) and Epstein–Barr virus (EBV) throughout the entire 2.5‐year observation period. Ex vivo T‐cell depletion was a general risk factor for viral infection with HHV‐6 (hazard ratio [HR] = 3.03), BKV (HR = 3.36), CMV (HR = 4.45), and EBV (HR = 7.15); all p &lt; 0.02. Cancer in second‐complete remission compared with first‐complete remission was a risk factor for bacterial infection (OR = 6.0, 95% CI = 1.12–32.2, and p = 0.037). Patients with gut graft‐versus‐host disease were at risk for fungal infections (OR = 12.3, 95% CI = 1.33–114.4, and p = 0.027). The infection‐related mortality rate was 10.0%, which occurred only in allogeneic HSCT patients with hematological malignancies receiving cord blood (n = 4) or haploidentical HSCT (n = 6). Collectively, our findings in pediatric patients after contemporary HSCT support both time‐dependent and risk‐adapted measures against infective complications to improve transplant outcome.

COVID-19 severity, breakthrough infections and vaccine safety in young individuals with autoimmune diseases: insights from the COVAD study.

Notwithstanding the wealth of literature on COVID-19, studies focusing on young adults with autoimmune diseases (AD) are lacking. To determine early (within 7days) and late (after 7days) anti-SARS-CoV-2 vaccine-related adverse events (AEs), post-vaccine disease flares, COVID-19 severity and breakthrough infections (B-INFs) in young people with rheumatic diseases (RMDs) and non-rheumatic autoimmune diseases (nr-ADs) compared to healthy controls (HC). Data were captured through the international COVID-19 vaccination in autoimmune diseases (COVAD) 1 and 2 questionnaires. Of 20,685 complete responses, we identified 6010 from patients aged 18-35years (1692 RMD, 400 nrADs, 3918 HC) who received up to 4 vaccine doses. BNT162b2 was the most frequently administered vaccine and prior to vaccination, 7% of people with nrAD were taking immunosuppressants (IS) versus 80% in RMDs. Early mild AEs were more frequent in RMDs (93%) and nr-ADs (92%) compared to HC (85%). The frequency of late mild AEs was < 20% in all groups. Severe AEs were rare. SARS-CoV-2 infection rates were similar across all groups, however, RMD patients reported a single episode of infection more frequently than nrADs and HC, while nrADs reported multiple infections more frequently than RMD. Self-reported disease flares were reported by 10% or RMD and 7% of nrAD patients. Our study reinforces the safety of anti-SARS-CoV-2 vaccine also in young people with ADs, but it also highlights that among young individuals the number and clinical picture of SARS-CoV-2 infections is affected more by the type of AD rather than by coexisting IS therapy.

Impact of the COVID-19 and War Migration on HIV/AIDS Epidemiology in Poland

Objectives: This study analyzed trends in HIV/AIDS in Poland over the time period of 2009–2021 and the potential impact of COVID-19 and the migration of war refugees from Ukraine. Methods: Long-term trends were assessed by joinpoint regression using data from Polish HIV/AIDS registries. The HIV/AIDS burden was also compared before and during the pandemic and refugee migration. Results: In 2009–2021, the upward tendency in the rate of new HIV infections until 2017 and decrease after 2017 was accompanied by a downward trend in new HIV/AIDS diagnoses and mortality. From the pandemic’s beginning until March 2022, rates of new HIV/AIDS diagnoses dramatically decreased to later increase to pre-pandemic levels, which partially coincided with the wave of migration of refugees from Ukraine. Conclusions: Long-term analysis of HIV/AIDS in Poland showed a downward trend in new HIV/AIDS diagnoses and related mortality in 2009–2021. While the pandemic has reduced the number of detected HIV/AIDS cases, a subsequent increase in new HIV diagnoses in 2022 may be related to lifting the COVID-19 restrictions and war refugees’ migration. These observations have implications for the WHO European Region, seeking to end AIDS as a public health problem by 2030.

Mesh versus suture for elective primary umbilical hernia open repair: a systematic review and meta-analysis.

Recent guidelines indicate the use of mesh in UHR for defects > 1cm, as it reduces recurrence, with 10% recurrence rate compared to up to 54.5% with primary closure. However, Nguyen et al. shows that primary closure is still widely performed in UHR, especially for small defects (1-2cm), for which there is no published data to determine the optimal approach. In addition, previous meta-analysis by Madsen et al. comparing mesh repair with primary closure in UHR didn't exclude emergency conditions and recurrent hernias; also, didn't report subgroup analysis on hernia defect size. Thus, we aimed to perform a systematic review and meta-analysis comparing the mesh repairs vs. primary closure of the defect in an open elective primary UHR. We searched for studies comparing mesh with suture in open UHR in PubMed, Scopus, Cochrane, Scielo, and Lilacs from inception until October 2023. Studies with patients ≤ 18 years old, with recurrent or emergency conditions were excluded. Outcomes were recurrence, seroma, hematoma, wound infection, and hospital length of stay. Subgroup analysis was performed for: (1) RCTs only, and (2) hernia defects smaller than 2cm. We used RevMan 5.4. for statistical analysis. Heterogeneity was assessed with I² statistics, and random effect was used if I² > 25%. 2895 studies were screened and 56 were reviewed. 12 studies, including 4 RCTs, 1 prospective cohort, and 7 retrospective cohorts were included, comprising 2926 patients in total (47.6% in mesh group and 52.4% in the suture group). Mesh repair showed lower rates of recurrence in the overall analysis (RR 0.50; 95% CI 0.31 to 0.79; P = 0.003; I2 = 24%) and for hernia defects smaller than 2cm (RR 0.56; 95% CI 0.34 to 0.93; P = 0.03; I2 = 0%). Suture repair showed lower rates of seroma (RR 1.88; 95% CI 1.07 to 3.32; P = 0.03; I2 = 0%) and wound infection (RR 1.65; 95%CI 1.12 to 2.43; P = 0.01; I2 = 15%) in the overall analysis, with no differences after performing subgroup analysis of RCTs. No differences were seen regarding hematoma and hospital length of stay. The use of mesh during UHR is associated with significantly lower incidence of recurrence in a long-term follow-up compared to the suture repair, reinforcing the previous indications of the guidelines. Additionally, despite the overall analysis showing higher risk of seroma and wound infection for the suture repair, no differences were seen after subgroup analysis of RCTs. A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024476854).

Comparative risk of serious infection with vedolizumab vs anti-TNF in inflammatory bowel disease: results from nationwide Swedish registers.

We aimed to assess the risk of serious infection in inflammatory bowel disease (IBD) patients treated with vedolizumab, compared to those treated with anti-tumor necrosis factors (TNF) and the general population. In this Swedish cohort study, treatment episodes were identified from nationwide health registers. We used Cox regression with propensity score-matched cohorts to estimate hazard ratios (HRs) for incident serious infections, defined as infections requiring hospital admission. During 1376 treatment-episodes in Crohn's disease, the rate of serious infections per 100 person-years (PY) was 5.18 (95%CI=3.98-6.63) with vedolizumab vs 3.54 (95%CI=2.50-4.85) with anti-TNF; HR=1.72 (95%CI=1.12-2.65), partly explained by more gastrointestinal infections. Compared to the rate of 0.75/100 PYs (95%CI=0.59-0.92) in a matched general population cohort, vedolizumab demonstrated higher risk (HR=7.00; 95%CI=5.04-9.72).During 1294 treatment-episodes in ulcerative colitis, the corresponding rates were 3.74/100 PYs (95%CI=2.66-5.11) with vedolizumab vs 3.42/100 PYs (95%CI=2.31-4.89) with anti-TNF; HR=0.80 (95%CI=0.47-1.36) during the initial 1.1 years and HR=2.03 (95%CI=0.65-6.32) after 1.1 years (truncated due to non-proportional hazards). Pneumonia accounted for 40% of all infections among anti-TNF whereas no case was observed among vedolizumab episodes. Compared to the rate of 0.69/100 PYs (95%CI=0.53-0.87) in a matched general population cohort, vedolizumab showed an HR of 5.45 (95%CI=3.67-8.11). Vedolizumab was associated with increased risks of serious infections compared to anti-TNF in Crohn's disease, but not in ulcerative colitis. Nonetheless, the panorama of serious infections seemed to differ between the drugs. Our findings underscore the importance of clinical awareness of infections and the safety profile of the two therapies.

The enhancive effect of the 2014-2016 El Niño-induced drought on the control of soil-transmitted helminthiases without anthelmintics: A longitudinal study.

Soil-transmitted helminthiases (STHs) are common in tropical and subtropical regions. Southern Thailand experiences an extended rainy season, leading to persistently moist soil. This condition supports the life cycle of STHs, hindering effective control due to reinfection and low drug efficacy. We implemented a novel STH control strategy during the dry season aimed at decreasing reinfection rates without enhancing sanitation or hygiene practices. However, there were unexpected, prolonged droughts linked to El Niño events from 2014 to 2016. Additionally, we assessed the effects of these drought conditions on further control measures without the use of anthelmintics. A longitudinal study was conducted from 2012 to 2016. Stool samples collected from 299 participants were analyzed using the Kato-Katz and agar plate culture methods. Participants who tested positive for STHs received a single 400 mg dose of albendazole. The efficacy of the treatment was evaluated three weeks later. To confirm the control measures were implemented during the dry season, we monitored the number of rainy days following albendazole treatment for 52 days, of which 38 were without rain. Follow-up stool examinations were carried out in 2013 and 2016, with no additional doses of albendazole administered. Rainfall and rainy day data, which served as indicators of unexpected droughts due to El Niño, were collected from the nearest local meteorological stations. Before the drought, there was a decrease in STH prevalence in 2013-except for trichuriasis-attributable to the dry season control efforts. Despite these efforts, STH prevalence remained high. Remarkably, in 2016, following the drought period, the prevalence of trichuriasis, which had not changed previously, spontaneously declined without further albendazole treatment compared to 2013. Furthermore, the prevalence of strongyloidiasis remained unchanged likely due to its low susceptibility to drought conditions, as it can reproduce within hosts. Conversely, the prevalence of other STHs consistently declined. The drought and possible improvements in sanitation and hygiene practices contributed to this decrease by reducing rates of reinfection and new infection and by increasing the natural cure rate. Additionally, some participants infected with hookworms or Trichuris who were not cured by albendazole experienced natural remission. Control measures implemented during the dry season, combined with a 14-month-long drought induced by the El Niño event of 2014-2016, and some improvements in sanitation and hygiene practices, contributed to a decrease in both the prevalence and intensity of STHs, except for S. stercoralis. Over time, S. stercoralis is likely to become the predominant species among the STHs.

Prevalence of transfusion-transmitted infection and reactive donor response rate in a tertiary care hospital in South India: A retrospective observational study

Abstract Background: Transfusion-transmitted infections (TTIs) are a serious problem to our blood centers as they necessitate utilization of massive resources and labor to detect and remove infected blood donations and also turn out to be a source of great distress to the patients recieving blood components and the doctors treating them. The main diseases that are made mandatory by the government to be screened are hepatitis B virus, hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis. Adding to this, India does not have a centralized donor notification system to notify the donors of their TTI positivity status causing the blood centers to be blind and not having a system to verify the credentials of donors making sure they were not tested positive in other centers in the country. Materials and Methods: We have done a retrospective study that aims to analyze blood center samples and look for the number of TTI positivity in our donations and compare with the total number of donations during the period of January 2016 to March 2023. The data were collected from the blood donor questionnaire and data were put up in an Excel sheet which was later analyzed on the Statistical P program. Results: During the study period, 14,257 donors donated blood. Of which 11,674 (83%) were voluntary donors and 2413 (17%) were replacement donors. About 98.7% were male donors. Among the total donors, 182 (1.27%) were positive for transfusion-transmitted infections. Among the 182 serology-positive donors, 179 (98.3%) were males and 3 (1.7%) were females. Among the 14,257 donors, 160 (1.12%) were positive for hepatitis B surface antigen (HbsAg), 2 (0.014%) for HCV, 2 (0.014%) for HIV, and 18 (0.126%) for syphilis. Among the 182 positive TTI, 160 (87.9%) donors were positive for HBsAg, 18 (9.9%) were positive for syphilis, 2 (1.1%) donors with HIV, and 2 (1.1%) with HCV positivity. Among the 182 donors positive for TTI, 81 (44.5%) donors had donated previously in various hospitals and they were not aware of their positive status. Conclusion: This study mainly aims to bring awareness to the problems that blood centers face in TTI from having to screen every sample to independently verifying donors making sure that they have never tested positive for TTI and counseling them on further tests and referrals.

Early Post-Operative Water Exposure Does Not Increase Complications in Cutaneous Surgeries: A Randomized, Investigator-Blinded, Controlled Trial

Patients are often advised to keep the initial post-operative dressings dry and undisturbed for 24 to 72-hours. However, these requirements may result in significant disruption of patients' activities of daily living, such as bathing, leisure, and exercise. Compare standard management of keeping wounds dry and covered (48-hours) with early (6-hours) post-operative water exposure METHODS: Investigator-blinded, randomized (1:1), controlled trial evaluating rate of infection and additional outcomes of interest. Overall, 437 patients randomized to either the early (6-hour) water exposure (n = 218) intervention group or the standard cohort (n = 219). The incidence of culture-proven infection in the intervention group (1.8%) was similar to the standard group (1.4%) (p>0.99). There was also no difference in rates of bleeding or bruising. Scar assessment using the Patient and Observer Scar Assessment Scale (POSAS) revealed similar scar outcomes. Single site, academic center. Surgical wounds can be allowed to get wet in the immediate post-operative period with no increased incidence of infection or other complications and with similar cosmesis.