Infection Rate Research Articles

Understanding the impact of non-linearity in the SIS model

The SIS model is a classic model from epidemiology that formalizes a variety of diffusion processes on networks, such as biological infections and information dissemination. In this model, vertices are either infected or susceptible to an infection. Infected vertices infect their neighbors independently at a rate λ>0, and each infected vertex becomes susceptible at a rate of 1. Overall, these dynamics imply that each susceptible vertex with exactly m infected neighbors becomes infected at rate λm, that is, linear in m. However, it has been observed that various processes exhibit a non-linear scaling of the infection rate with respect to m. For these kinds of processes, no fully rigorous guarantees exist so far.We address this shortcoming by considering a variant of the SIS model in which vertices get infected at a rate that scales polynomially in the number of their infected neighbors, weighted by the infection coefficient λ. We give the first fully rigorous results for thresholds of λ at which the expected survival time becomes super-polynomial. For cliques we show that when the infection rate scales sub-linearly, the threshold only shifts by a poly-logarithmic factor, compared to the standard SIS model. In contrast, super-linear scaling changes the process considerably and shifts the threshold by a polynomial term. For stars, sub-linear and super-linear scaling behave similar and both shift the threshold by a polynomial factor. Our bounds are almost tight, as they are only apart by at most a poly-logarithmic factor from the lower thresholds, at which the expected survival time is logarithmic.

The prophylactic application of low-dose rabbit antithymocyte globulin in matched siblings HSCT with high-risk factors for graft-versus-host disease

Relapse and graft-versus-host disease (GVHD) are currently the predominant causes of mortality post allogeneic hematopoietic stem cell transplantation (allo-HSCT). The contentious use of antithymocyte globulin (ATG) for preventing GVHD in matched sibling HSCT scenarios has been a topic of significant debate. A retrospective analysis was conducted on matched sibling HSCT cases with high-risk factors for GVHD in our center from January 2018 to June 2023. Our assessment revealed that the group administered with ATG exhibited a 30 % incidence of acute GVHD (aGVHD), in contrast to 81.8 % in the non-ATG cohort (P = 0.037) among matched sibling HSCT cases with high GVHD risk factors. Furthermore, chronic GVHD (cGVHD) occurred in 20 % of the ATG group and 72.7 % of the non-ATG group (P = 0.03). Notably, the administration of ATG did not significantly impact disease relapse (p = 0.149), infection rates (p = 0.64), granulocyte recovery time (p = 0.15), platelet recovery time (p = 0.12), overall survival (p = 0.889), or disease-free survival time (p = 0.787). The use of rabbit antithymocyte globulin (r-ATG) at a 5 mg/kg dosage demonstrated a notable reduction in aGVHD and cGVHD incidences within sibling matched HSCT cases with high-risk factors for GVHD, without increasing rates of disease recurrence or infections. These findings highlight the potential benefit of using low-dose r-ATG in high-risk of GVHD sibling matched allogeneic HSCTs, although further validation with a larger cohort is necessary.

Gastrointestinal cancer surgery in the elderly: The effects of preoperative oral nutritional supplements - A retrospective study.

The current study aimed to explore the effect of nutritional prehabilitation on the clinical prognosis of elderly patients undergoing abdominal cancer surgery. A retrospective study was conducted, where participants were divided into two groups based on whether they received oral nutritional supplementation at the first outpatient visit. The nutritional prehabilitation group (n=41) adopted a nutritional prehabilitation mode (a standard energy intake of 25-30 kcal/kg· d was recommended). While the control group (n=55) received routine care. All patients underwent laparoscopic surgery according to the National Comprehensive Cancer Network (NCCN) guidelines. Changes in nutritional status, complications, psychological status, symptoms, hospitalization days, and expenditures were compared between the two groups. Both groups of patients experienced weight loss. However, the decline in body weight in the prehabilitation group was less than that in the control group (-1.88 vs. -2.56 kg, p < 0.001). In the comparison of nutritional prehabilitation group and control group, significant improvements were observed in the Hospital Anxiety Scale scores (5 vs. 5, p = 0.01) and MD Anderson Symptom Inventory scores (3 vs. 0, p < 0.001) respectively. The infection rate in the nutritional prehabilitation group was lower than that in the control group (17.1% vs. 36.4%, p = 0.04). Additionally, patients in the nutritional prehabilitation group had significantly fewer hospitalization days at discharge (14.3 vs. 17.1 days, p = 0.03). In elderly patients undergoing abdominal cancer surgery, a nutritional prehabilitation model may help maintain better physical and mental status, reduce infection rates, and shorten hospitalization days.

Interleukin-6 Inhibitors for Neuromyelitis Optica Spectrum Disorder (NMOSD): a Systematic Review and Meta-analysis

BackgroundInterleukin-6 (IL-6) inhibitors recently emerged as a promising therapy for neuromyelitis optica spectrum disorder (NMOSD). ObjectiveWe performed a systematic review and meta-analysis comparing IL-6 inhibitors to placebo or traditional immunosuppressants in NMOSD. MethodsWe searched PubMed, Embase, and Cochrane Central for eligible studies. Efficacy endpoints included hazard ratio (HR) for relapse, annualized relapse ratio (ARR) and Expanded Disability Status Scale (EDSS) change over time. Safety outcomes comprised any adverse event, serious adverse events and infections. Statistical analysis was performed using RevMan Web and R studio package meta. Heterogeneity was assessed with I² statistics. ResultsFour studies involving 361 patients (228 treated with IL-6 inhibitors) were included. IL-6 inhibitors significantly reduced HR for relapse (HR 0.35; 95% CI 0.23, 0.55); p<0.00001; I²=0%) and ARR (mean difference -0.79 relapses/year; 95% CI -1.54, -0.03; p=0.04; I²=96%) compared to placebo or traditional immunosuppressants. No significant differences were observed in EDSS change over 24 weeks of follow-up (mean difference -0.18; 95% CI 0.41, 0.05; p=0.93; I²=0%), adverse events (odds ratio (OR) 1.59; 95% CI 0.45, 5.63; p=0.48; I²=48%), serious adverse events (OR 0.76; 95% CI 0.40, 1.44; p=0.50; I²=0%) and infection rates (OR 1.10; 95% CI 0.67, 1.79; p=0.71; I²=0%). ConclusionIL-6 inhibitors demonstrate superior efficacy in preventing relapses in NMOSD compared to placebo or traditional immunosuppressants, without a notable increase in safety risks.

The impact of diabetes and presurgical glycemic control on wound morbidity following open complex abdominal wall reconstruction: a single-center experience.

Numerous studies have identified diabetes mellites (DM) as a significant risk factor for postoperative wound morbidity, with suboptimal preoperative glycemic control (GC) posing an even greater risk. However, this data largely excludes ventral hernia patients. Our study examined the association between diabetes and preoperative GC and postoperative outcomes following open complex abdominal wall reconstruction (AWR). We identified diabetic patients who had undergone open, elective, clean VHR with transversus abdominis release (TAR) and permanent synthetic mesh at the Cleveland Clinic Foundation between January 2014 and December 2023. Their 30-day outcomes were compared to non-diabetic patients undergoing the same procedure. Subsequently, diabetic patients were categorized based on GC. status: "Optimal GC" (HbA1c < 7%), "Sub-optimal GC" (HbA1c 7-8.4%), and "Poor GC" (HbA1c ≥ 8.5%) and their outcomes were compared. 514 patients with DM who underwent clean elective TAR were identified, of which 431 met the inclusion criteria. GC was deemed optimal in 255 patients, sub-optimal in 128, and poor in 48 patients. Demographics were similar, except for anticoagulation treatment (p = 0.014). The entire study population exhibited significantly higher rates of wound morbidities and overall complications compared to non-diabetic patients. However, rates of surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), and reoperation did not differ significantly among the three cohorts of presurgical glycemic control (p = 0.82, p = 0.46, p = 0.51, p = 0.78), respectively. No occurrence of mesh removal was documented. In general, diabetes is a marker for increased wound morbidity and complications following complex abdominal wall reconstruction. However, we could not establish a hard cutoff to justify withholding surgery in symptomatic patients based on an arbitrary HbA1C level. We believe this data is important for shared decision-making when considering AWR for symptomatic ventral hernias in diabetic patients.

Retrograde intrarenal surgery with or without ureteral access sheath: a systematic review and meta-analysis of randomized controlled trials.

The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management. To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications. We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively. Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI -4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI -0.42 to 1.07 days; p=0.40). UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.

Deep infections after low-velocity ballistic tibia fractures are frequently polymicrobial and recalcitrant.

To identify risk factors for developing a fracture-related infection in operatively treated ballistic tibia fractures and to report the microbiologic results of intraoperative cultures. Retrospective review. Level 1 trauma center. One hundred thirty-three adults with operatively treated low-velocity ballistic tibia fractures, from 2011 to 2021. One dose of prophylactic cefazolin or equivalent as well as perioperative prophylaxis. Deep infection rate. The deep infection rate was 12% (16/134) with no significant difference in injury characteristics, index surgical characteristics, or time to antibiotics between the groups (P > 0.05). Patients who were slightly older (35.5 vs. 27 median years, P = 0.005) and with higher median body mass indexes (BMIs) (30.09 vs. 24.51, P = 0.021) developed a deep infection. 56.3% of patients presented with signs of infection within the first 100 days after injury. Nine patients had polymicrobial infections. There were 29 isolated organisms, 69% were uncovered by first-generation cephalosporin prophylaxis (anaerobes, gram-negative rods, Enterococcus, methicillin resistant Staphylococcus Aureus [MRSA]), and 50% of patients developed recalcitrant infection and required a second reoperation where 6 organisms were isolated, half of which were not covered by first-generation prophylaxis (Enterococcus, Staphylococcus Aureus MRSA). We found a deep infection rate of 12% among ballistic tibia fractures receiving standard-of-care antibiotic prophylaxis. Increased age and body mass index were associated with deep infections. Half became recalcitrant requiring a second reoperation. 66.7% of isolated organisms were not covered by first-generation cephalosporin prophylaxis. Consideration should be given to treatment options such as broader prophylaxis or local antibiotic treatment. IV.

Intrawound vancomycin powder in primary total knee arthroplasty: Does it reduce early postoperative infection?

BackgroundThe purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate prosthetic joint infection (PJI) within 90-days following primary total knee arthroplasty (TKA). MethodsFrom October 2021-September 2022, a prospective quality control project was undertaken in which 10 high-volume arthroplasty surgeons alternated between using IVP and not using IVP each month. Patients who received IVP were compared to those who did not. The primary outcome was culture positive PJI within 90-days following primary total knee arthroplasty. Secondary outcomes included overall reoperation rate, wound complications, and readmission within 90-days post-operatively. ResultsA total of 1,317 primary TKA patients were identified for analysis. Fifty-six and seven tenths percent (n = 747) of patients were included in the IVP group and 43.3% (n = 570) patients were included in the non-IVP group. The overall PJI rate was 0.5%. There was no difference in 90-day culture positive PJI rates between the groups (0.7% vs. 0.2%, p = 0.24). The overall reoperation rate did not differ between the IVP and non-IVP group (6.4% vs. 4.6%, p = 0.15). Reoperation for suspected infection was not statistically different by IVP administration (1.2% vs. 0.5%, p = 0.25). Additionally, there were no differences in the incidence of wound complications (p = 0.80) or readmissions (p = 0.15). ConclusionsThe overall infection rate for this cohort was low. IVP was not associated with decreased culture positive PJI, wound complications, reoperation or readmission rates. Further analysis of IVP use in TKA should be undertaken to fully determine its efficacy and safety profile.

Bacillus methylotrophicus influences on the virulence of Aeromonas hydrophila and probiotic applications in Ctenopharyngodon idella

Probiotics are alternatives to antibiotics that resist infection and benefit the host in several aspects. Here, we isolated and identified a novel strain of Bacillus methylotrophicus (XA-8) with a broad spectrum of activity against Aeromonas hydrophila AhX040 and other aquatic bacterial pathogens. The strain was non-pathogenic as it revealed no cytotoxic effects in hepatic L8824 cells or pathophysiological signs in the tissue of Ctenopharyngodon idella (grass carp). Using a co-culture approach, XA-8 (1×109 CFU mL−1) when co-cultivated with AhX040 (1×108 CFU mL−1) revealed a reduction in the cell density, cytotoxicity, and infection rate of AhX040. More interestingly, genes such as aer, act, hylA, lafA, hcp, and luxS, associated with the virulence of AhX040, were significantly down-regulated during co-cultivation (P<0.05). Furthermore, XA-8 as a feed supplement to grass carp up-regulated the immune-related genes in the liver, spleen, kidney, and intestine. The villi length and expression level of growth-related genes in the intestine were significantly higher (P<0.05) in the XA-8 supplemented grass carp. In addition to resisting infection (52.63 %), probiotic XA-8 modulated the gut microbiota of grass carp by increasing Fusobacteriota and Bacteroidota at the phylum level, while decreasing Aeromonas at the genus level. The whole genome sequence analysis showed the strain possesses multiple gene clusters for antimicrobial substances and metabolism. Our results demonstrate that B.methylotrophicus XA-8 is a novel probiotic with potential applications for aquaculture.

Renormalisation group methods for effective epidemiological models

Epidemiological models describe the spread of an infectious disease within a population. They capture microscopic details on how the disease is passed on among individuals in various different ways, while making predictions about the state of the entirety of the population. However, the type and structure of the specific model considered typically depend on the size of the population under consideration. To analyse this effect, we study a family of effective epidemiological models in space and time that are related to each other through scaling transformations. Inspired by a similar treatment of diffusion processes, we interpret the latter as renormalisation group transformations, both at the level of the underlying differential equations and their solutions. We show that in the large scale limit, the microscopic details of the infection process become irrelevant, safe for a simple real number, which plays the role of the infection rate in a basic compartmental model.

Evaluating the comparative risk of postoperative complications associated with infliximab and vedolizumab for patients with Crohn’s disease

Crohn’s disease is an inflammatory bowel disease that affects millions worldwide. Research indicates that people suffering from Crohn’s disease respond well to monoclonal antibody treatment aimed at characteristic immune cell markers. By targeting immune cell markers, the immune system is subsequently suppressed in a way such that an infection can evolve much quicker. Monoclonal antibody treatment has historically shown to result in increased rates of post-surgical infections in those taking it for Crohn’s disease. Many studies have assessed the increased rates of post-surgical infections following monoclonal antibody treatment for those with Crohn’s disease, but few have compared different treatments. A systematic review of a study that assessed the rates of postoperative infections for those with Crohn’s disease taking infliximab was then compared to the findings of another study which assessed the rates of postoperative infections in those with Crohn’s taking vedolizumab. The patients treated with vedolizumab did not have increased risk of overall postoperative infections or other complications compared with other matched controls. However, those who were treated with infliximab had an increased risk of surgical infections when compared to a control group. Monoclonal antibody treatment for Crohn’s diseases is widespread. It is critical that the side effects of these treatments are readily studied and compared to improve patient outcomes. For this review, infliximab seemed to have a statistically significant increased effect on postoperative infections whereas vedolizumab did not. Further studies with greater sample sizes assessing multiple other side effects of monoclonal antibody immunosuppression are needed.

Necessity of Using Drains in Thyroid Surgery: Systematic Review and Meta-Analysis

Thyroid surgery, characterized by its high risk due to the vascular nature of the thyroid gland, often leads to significant postoperative bleeding. This study assesses the efficacy of using drains to prevent complications such as hematomas, seromas, and bleeding, and their impact on infection rates and hospitalization duration post-thyroidectomy. Following the PRISMA guidelines, a systematic search was conducted across PubMed, Embase, and the Cochrane Library, including randomized controlled trials and published prospective studies on patients undergoing thyroidectomy by November 15, 2023. The analysis focused on postoperative complications and the length of hospital stay as primary outcomes. Thirty-five studies with 4283 participants (2162 with drains and 2121 without) were analyzed. The meta-analysis showed no significant reduction in hematomas, bleeding, or seroma formation in the drain group. However, drain usage was correlated with a higher infection rate (odds ratio 3.31; 95% confidence interval [CI] 1.92-5.70, p&lt;0.001) and longer hospital stays (mean difference=1.38 days, 95% CI 1.00-1.76, p&lt;0.001). The employment of drains in thyroid surgery does not significantly impact the prevention of typical surgical complications but is linked to increased infection risks and extended hospitalization. These findings challenge the conventional practice of utilizing drains in thyroidectomy, highlighting the necessity for a tailored approach based on individual patient assessments.

Prevalence of Helicobacter pylori infection in China from 2014-2023: A systematic review and meta-analysis

BACKGROUND Helicobacter pylori (H. pylori) stands as the predominant infectious agent linked to the onset of gastritis, peptic ulcer diseases, and gastric cancer (GC). Identified as the exclusive bacterial factor associated with the onset of GC, it is classified as a group 1 carcinogen by the World Health Organization. The elimination of H. pylori plays a crucial role in the primary prevention of GC. While the prevalence has declined in recent decades, H. pylori infection is still highly prevalent in China, accounting for a significant part of the disease burden of GC. Therefore, updated prevalence information for H. pylori infection, especially regional and demographic variations in China, is an important basis for the design of targeted strategies that will be effective for the prevention of GC and application of policies for H. pylori control. AIM To methodically evaluate the occurrence of H. pylori infection throughout China and establish a reference point for subsequent investigations. METHODS A systematic review and meta-analysis was conducted following established guidelines, as detailed in our methodology section. RESULTS Our review synthesized data from 152 studies, covering a sample of 763827 individuals, 314423 of whom were infected with H. pylori . We evaluated infection rates in mainland China and the combined prevalence of H. pylori was 42.8% (95%CI: 40.7-44.9). Subgroup analysis indicated the highest prevalence in Northwest China at 51.3% (95%CI: 45.6-56.9), and in Qinghai Province, the prevalence reached 60.2% (95%CI: 46.5-73.9). The urea breath test, which recorded the highest infection rate, showed a prevalence of 43.7% (95%CI: 41.4-46.0). No notable differences in infection rates were observed between genders. Notably, the prevalence among the elderly was significantly higher at 44.5% (95%CI: 41.9-47.1), compared to children, who showed a prevalence of 27.5% (95%CI: 19.58-34.7). CONCLUSION Between 2014 and 2023, the prevalence of H. pylori infection in China decreased to 42.8%, down from the previous decade. However, the infection rates vary considerably across different geographical areas, among various populations, and by detection methods employed.

Feasibility of Peroral Cholangioscopy in the Initial Endoscopic Retrograde Cholangiopancreatography for Malignant Biliary Strictures

Background: Peroral cholangioscopy (POCS) is valuable for assessing malignant biliary strictures; however, biliary drainage prior to POCS often hinders accurate diagnosis. Objectives: This retrospective study aimed to investigate the feasibility of POCS using a newly developed cholangioscope, CHF-B290, during initial endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary strictures. Methods: This multicenter retrospective study included patients who underwent initial ERCP for malignant biliary strictures at two institutions between January 2018 and March 2022. Patients who underwent initial ERCP with POCS were classified into the POCS group, and those without POCS were classified into the non-POCS group. To prevent post-POCS cholangitis, the original irrigation system for CHF-B290 was used in all POCS examinations. The primary endpoint was the rate of post-ERCP biliary infections, and the secondary endpoints were other ERCP-related complications, including pancreatitis, bleeding, and perforation. Results: Overall, 53 and 94 patients were included in the POCS and non-POCS groups, respectively. For the primary endpoint, the rate of post-ERCP biliary infection was not significantly different between the two groups (1.9% vs. 5.3%, p = 0.42). For the secondary endpoints, no significant differences were observed in the rates of post-ERCP pancreatitis (5.7% vs. 6.4%, p = 1.00) and other ERCP-related complications. The overall complication rate was 9.4% in the POCS group and 13% in the non-POCS group (p = 0.60). Conclusions: POCS during the initial ERCP for malignant biliary strictures is feasible.

Application of Submandibular Intubation as Alternative to Elective Short-Term Tracheotomy for Particular Cases of Oral and Maxillofacial Tumors Resection and Defects Reconstruction

Objective: To describe the cases of oral and maxillofacial tumors (OMFT) resection and defects reconstruction under submandibular intubation (SMI) performed in our institution; secondly, to systematically review and analyze the characteristics of studies about SMI in oral and maxillofacial surgery to estimate the incidence rate of complication. Method: Data related to all 6 patients included in this study were prospectively collected from November 2016 to November 2023. The tract for endotracheal tube was created by bluntly dissection from the submandibular area to the floor of mouth. We performed an exhaustive search for studies about SMI using Pubmed, Embase, Proquest, and Chinese Biomedical Literature Database. Meta-analysis of the incidence rate of complication and infection was performed using STATA 14.1. Results: There was a male predominance (87.3%); the mean age was 47.8±16.8 years; squamous cell carcinoma (SCC) was the most frequent diagnosis (33.3%); the mean time of the operation was 237.0±65.2 minutes; the SMI procedure mean time was 5.5±0.9 minutes; and the mean time to extubation 133.3±12.5 minutes. No accident or complication was observed intraoperatively and postoperatively. The systematic review included 22 out of 234 studies screened. The meta-analysis showed an overall complication rate and superficial infection rate of 5.7% and 3.7% in the last 15 years versus 20.2% and 10.6% in over 15 years ago. Conclusion: Submandibular intubation was found technically easy, safe, and effective alternative of elective short-term tracheotomy, orotracheal and nasotracheal intubations in our series of OMFT resection and defects reconstruction.

Self-poisoning in young Australians: The impact of COVID-19 and recent trends following easing of restrictions

Introduction: Self-poisoning is the most common form of hospitalised self-harm in young people and has been increasing over the last decade. The COVID-19 pandemic was associated with further increases in self-harm in adolescents. There are limited data on changes after pandemic restrictions ended. This study aimed to describe recent trends in self-poisoning in young people. Setting: Australia 2018–2023. Methods: A retrospective analysis of self-poisoning calls to Australia’s poisons information centres. Intentional poisoning exposures in people aged 5–19 years were included in the main analysis. We also examined intentional poisonings in people aged 20 and over for comparison. We used interrupted time-series analysis to estimate the impact of COVID-19 (March 2020) and ‘re-opening’ (December 2021), when many restrictions were lifted in Australia. We compared effects in the jurisdictions with most disruptions and lockdowns with other jurisdictions. Results: There were 201,755 self-poisonings documented, 64% female, with 19,946 children (aged 5–14, 9.9%) and 44,388 adolescents (aged 15–19, 22.0%). There was a steep increase in the rate of poisoning in female children and adolescents – with the annual increase being 1.361 (95% confidence interval = [1.074, 1.735]) and 1.154 (95% confidence interval = [1.049, 1.283]) times faster than pre-pandemic trends in these two groups between March 2020 and December 2021. Following relaxation of restrictions, there was a sudden drop and then slow decline in self-poisonings (despite rising COVID-19 infection rates). There was an overall 29.6% increase in intentional poisonings in young people over the study period. This is markedly more pronounced among young females (37.0%) vs males (11.2%). There were substantial jurisdictional variations, with larger increases in Victoria, Tasmania and the Australian Capital Territory. Conclusion: There has been a marked increase in child and adolescent female self-poisonings over the last 6 years, with increases strongly associated with COVID-19 pandemic restrictions but persisting after their removal.

Implications of Asymptomatic Carriers for Tuberculosis Transmission and Control in Thailand: A Modelling Approach

Tuberculosis (TB) is a regional and global bacterial illness that has been expanding and affecting individuals in every generation. An unknown percentage of asymptomatic hosts have TB, and the infection can spread while exhibiting no symptoms. These asymptomatic TB carriers, who contribute to the spread of the illness yet go mostly undetected, may make it more difficult to prevent transmission. In this study, we utilized the concept of symmetry to construct a manageable disease modelling framework for TB transmission and control. We developed a TB model to investigate the potential influence of asymptomatic carriers, symptomatic infections, and the entirety of TB prevalence on different approaches to treatment and prevention in Thailand. Annual TB incidence data from Thailand from 2000 to 2022 were used to calibrate the model parameters. We assessed the potential for reaching conflicting results about the management and spread of tuberculosis in Thailand. Our results showed that some TB strategies that were thought to be effective in reducing transmission may have the opposite impact, or that an intervention’s effectiveness might be overestimated, making it seem unfeasible in certain scenarios. For example, the objective of TB treatment, which attempts to decrease the occurrence of symptomatic TB infections, is to decrease the TB infection and propagation rates if the relative carrier (η) is less than one. Nonetheless, our results indicate that this strategy may increase the frequency of asymptomatic TB patients, symptomatic TB viral infections, and overall TB prevalence if η has been sufficiently understated. We also found that reducing only the progression rate of symptomatic TB infections cannot stop asymptomatic TB carriers and total TB prevalence, even when the relative infection of carriers (η) is less than unity. Our research provides a better understanding of the role of asymptomatic patients in spreading TB and highlights the need to accurately include bearers in models that guide Thailand’s TB control strategy.

Clinical and Immune Effects of Peri-Transplantation JAK Inhibition for Myelofibrosis.

Despite the introduction of JAK inhibitors, allogeneic hematopoietic cell transplant remains the only potentially curative treatment for patients with myelofibrosis but has considerable treatment-related complications. Whether the incorporation of JAK inhibition into the transplant algorithm leads to improved outcomes is still unclear. Here, we analyzed different transplant platforms in myelofibrosis patients undergoing a first transplant, comparing immune profiles and outcomes of (1) 33 patients continuing JAK inhibition at start of conditioning until stable engraftment (PERI-group), (2) 38 patients receiving JAK inhibition prior to transplant until start of conditioning (PRE-group), and (3) 38 patients that had never received JAK inhibition (NON-group). Patients in the PERI-group showed significantly higher early B-cell recovery as well as significantly increased late recovery of gamma-delta T cells and NK cells. We observed excellent neutrophil and platelet engraftment (100% for both) in the PERI-group and no hematotoxic effects or increased rates of infections following peri-transplant JAK inhibition. Cumulative incidence of acute graft-versus-host disease (GvHD) grade II-IV at day 100 after transplant was 15% in the PERI-group versus 29% in the PRE-group versus 34% in the NON-group. Cumulative incidence of relapse at 1 year after transplant was 9% in the PERI-group compared with 16% in the PRE-group and 18% in the NON-group. In conclusion, peri-transplant JAK inhibition was feasible with promising engraftment and acute GvHD rates, though deserves further investigation.

Laparotomy Versus Laparoscopy Cholecystectomy for Surgical Treatment in Patients with Gallstone Disease: A Comparative Cost-Effectiveness Analysis

Background: Due to the increasing costs of the healthcare system and limited financial resources, healthcare policymakers should adopt more cost-effective strategies. Objectives: This study aimed to compare the cost-effectiveness of laparotomy cholecystectomy with laparoscopy. Methods: This economic evaluation was conducted on patients with cholecystitis who were candidates for surgery in a private hospital in Ahvaz in 2021. Data collection tools consisted of four parts: (1) demographic information checklist; (2) clinical information checklist; (3) cost checklist; and (4) effectiveness assessment tool. SPSS22 and STATA14.2 were used for data analysis. One-way sensitivity analysis and Tornado diagrams were performed using Tree Age software. Results: The mean total effectiveness score in patients treated with laparoscopy was 83.44 (SD = 11.34), which was higher than those treated with laparotomy at 68.39 (SD = 13.61). This difference was statistically significant in all effectiveness criteria, except for postoperative infection rates and length of operation (P &lt; 0.001). The mean cost for patients undergoing laparoscopy was significantly higher than for those undergoing laparotomy ($481.43 vs. $459.49). However, overall, laparoscopic treatment (5.77) was more cost-effective than laparotomy (6.71). The laparoscopic procedure was approximately $1.47 per effectiveness unit cheaper than laparotomy, according to the ICER. One-way sensitivity analysis showed that the laparoscopic method remained more cost-effective, even when adjusting for cost and effectiveness components. Conclusions: Although laparoscopic cholecystectomy was more expensive than laparotomy cholecystectomy, it was generally more cost- effective. The results of this research may assist Iran’s healthcare policymakers and managers in promoting laparoscopic cholecystectomy in hospitals.

Effects of clindamycin and amoxycillin as prophylaxis against early implant failure: double-blinded randomized clinical trial.

The objective of this randomized controlled clinical trial (RCT) was to compare the frequency of early implant failure, postoperative infection, and pain/inflammation and the degree of implant stability between healthy non-penicillin-allergic individuals receiving a single prophylactic dose of 600mg clindamycin versus 2g amoxicillin at 1h before implant surgery. A single-center double-blinded RCT study with parallel groups was undertaken. Eighty-two patients fulfilled study inclusion criteria and were randomly assigned to the amoxicillin (n = 41) or clindamycin (n = 41) group. The primary outcome variable was early implant failure. The presence of infection was evaluated immediately after surgery and on days 7, 14, 30, and 90, and postoperative pain/inflammation was assessed daily on days 1 to 7 post-surgery. Resonance frequency analysis was used to measure primary and secondary implant stability. One early implant failure was observed (1/81), in a patient from the amoxicillin group. No statistically significant between-group differences were observed in early implant failure rate, postoperative infection rate up to 90 days, pain/inflammation scores during the first week post-surgery, or primary or secondary stability values. A single dose of 600mg clindamycin before implant surgery does not increase the risk of early implant failure or infection. These findings suggest that a single dose of 600mg clindamycin at 1h before implant surgery is a safe antibiotic prophylactic approach; however, when a more prolonged antibiotic therapy is required, it appears advisable to prescribe an alternative antibiotic to avoid adverse effects.