Recurrent Infections Research Articles

AKT question relating to management of recurrent chest infections

AKT question relating to management of recurrent chest infections

Congenital Lung Anomalies in Adults.

Congenital lung anomaly (CLA) refers to a rare group of malformations that are typically identified prenatally or in early childhood. However, a significant proportion of cases evade detection until adulthood and either are incidentally discovered or manifest with symptoms of recurrent respiratory infection or pulmonary hemorrhage. While most CLAs have characteristic imaging findings at CT and MRI, they remain a diagnostic challenge due to the infrequency with which they are encountered in adults. Radiologists frequently play a pivotal role in suggesting the diagnosis and guiding appropriate management strategies, and recognition of characteristic imaging patterns is crucial for accurate diagnosis. The authors examine the imaging appearances and clinical manifestations in adult patients with CLA, with a focus on patients who have bronchopulmonary involvement and those with combined bronchopulmonary and vascular anomalies. Entities discussed include bronchogenic cyst, bronchial atresia, congenital lobar overinflation, congenital pulmonary airway malformation, proximal interruption of the pulmonary artery, bronchopulmonary sequestration, hypogenetic lung syndrome, placental transmogrification of the lung, and hybrid lesions. Common complications that may arise in these patients are discussed and illustrated. ©RSNA, 2024 Supplemental material is available for this article.

Detection and Eradication of a Demodex Infestation in Specific Pathogen-free High-barrier Laboratory Mouse Facility Housing Immunocompromised Animals.

Demodex mites are a common ectoparasite in nonlaboratory Mus musculus (mouse) populations. While infrequently reported in laboratory research mice, the prevalence is thought to be as high as 35% of all colonies. Here, we discuss an outbreak of Demodex within an SPF high-barrier vivarium housing laboratory mice first identified through commercial sentinel-free PCR testing. Consequently, in-house PCR-mediated identification of individually infected cages was conducted, and a successful method for eradication of secondary reemergent infection was generated via recurrent testing and empirical 12-wk treatment with 3 mg/kg moxidectin and 13 mg/kg imidacloprid. While we were unable to determine the source of our primary outbreak, the secondary outbreak was traced to nongenetically modified C57B6/J immunocompetent mice, which were capable of harboring subclinical infection below our PCR threshold. Our eventual successful eradication of Demodex confirmed, first, that in-house PCR detection is a cost-effective means of monitoring an outbreak; second, that treatment with 3 mg/kg moxidectin and 13 mg/kg imidacloprid does kill Demodex mites in laboratory mice; and third, that treatment of only PCR-positive mice is an insufficient way to control an outbreak. Taken together, our methodological approach for infestations such as Demodex suggests it is possible to eradicate them but that it requires a thorough, systematic, and aggressive treatment regimen. Moreover, we recommend that all cages derived from infected animals be treated as positive, regardless of PCR positivity, to prevent recurrent and/or persistent infections within an animal colony.

Evaluation of the efficacy of a live Escherichia coli biotherapeutic product (asymptomatic bacteriuria E. coli 212).

Recurrent bacterial cystitis, often referred to as recurrent urinary tract infection (UTI), can be difficult to manage and alternative treatments are needed. Intravesicular administration of asymptomatic bacteriuria (ASB) E. coli 212 will not be inferior to antimicrobial treatment for the management of recurrent UTI in dogs. Thirty-four dogs with >1 UTI in the 12 months before presentation. All dogs were deemed normal otherwise based on absence of abnormalities on physical examination, CBC, serum biochemical panel, and abdominal ultrasonography. Dogs were randomized to 1 of 2 treatment groups: Group 1 antimicrobials for 7 days or group 2 intravesicular administration of ASB E. coli 212. Owners were provided a voiding questionnaire regarding their dogs' clinical signs, which was completed daily for 14 days to assess clinical cure. Dogs were examined on days 7 and 14 to assess clinical cure, and urine specimens were submitted for urinalysis and bacterial culture. Clinical cure rates for ASB E. coli 212-treated dogs were not inferior to 7 days of antimicrobial treatment with a 12% margin of difference to determine non-inferiority. No significant difference was found between the treatment groups on days 7 and 14 in the proportion of dogs achieving ≥50% or ≥75% reduction in their clinical score compared with baseline. These data suggest that intravesicular administration of ASB E. coli 212 is not inferior to antimicrobials for the treatment of recurrent UTI in dogs. This biotherapeutic agent could help alleviate the need for antimicrobials for some dogs with recurrent UTI, improving antimicrobial stewardship.

AKT answer relating to management of recurrent chest infections

AKT answer relating to management of recurrent chest infections

Constraint on boric acid resistance and tolerance evolvability in Candida albicans.

Boric acid is a broad-spectrum antimicrobial used to treat vulvovaginal candidiasis when patients relapse on the primary azole drug fluconazole. Candida albicans is the most common cause of vulvovaginal candidiasis, colloquially referred to as a "vaginal yeast infection". Little is known about the propensity of C. albicans to develop BA resistance or tolerance (the ability of a subpopulation to grow slowly in high levels of drug). We evolved 96 replicates from eight diverse C. albicans strains to increasing BA concentrations to test the evolvability of BA resistance and tolerance. Replicate growth was individually assessed daily, with replicates passaged when they had reached an optical density consistent with exponential growth. Many replicates went extinct quickly. Although some replicates could grow in much higher levels of BA than the ancestral strains, evolved populations isolated from the highest terminal BA levels (after 11 weeks of passages) surprisingly showed only modest growth improvements and only at low levels of BA. No large increases in resistance or tolerance were observed in the evolved replicates. Overall, our findings illustrate that there may be evolutionary constraints limiting the emergence of BA resistance and tolerance, which could explain why it remains an effective treatment for recurrent yeast infections.

Impact of Dialysis Time on Long-term Outcomes in HLA-identical Living Donor Kidney Transplant Recipients.

Dialysis vintage is associated with worse outcomes after kidney transplantation. The reasons behind this observation include immunological and nonimmunological risk factors. To mitigate the influence of immunological factors, we examined the association between time on dialysis and clinical outcomes in a cohort of HLA-identical kidney transplant recipients. This retrospective study included 13 321 kidney transplant recipients between 1999 and 2016, of whom 589 were HLA identical followed for at least 5 y. Patient and graft survivals were compared according to dialysis time (<12 or >12 mo) using the log-rank test and Cox regression analysis. We compared surgical complications, cytomegalovirus infection, acute rejection, disease recurrence, and the trajectories of estimated glomerular filtration rate (eGFR). Median time on dialysis was 15 mo; 9.2% of patients received preemptive transplants, and 55.3% of patients were on dialysis for >12 mo. After a median follow-up time of 154 mo, there were no differences in unadjusted and adjusted patient and graft survivals (1, 5, 10, and 15 y) between the 2 groups. There were no differences in the incidence of surgical complications (6.2% versus 3.1%), acute rejection (6.1% versus 7.7%), cytomegalovirus infection (7.6% versus 4.0%), and disease recurrence (4.2% versus 4.0%), respectively. There were no differences in mean eGFR during 5 y or in the proportion of patients with an eGFR <30 mL/min at 5 y (9.9% versus 9.2%). In this low immunological risk cohort of HLA-identical kidney transplant recipients, we did not observe any association between dialysis vintage on patient survival and graft survival.

Clinical application of retroauricular hairline approach in submandibular gland resection assisted by endoscope

Objective:To investigate the clinical effect of retroauricular hairline approach in submandibular gland resection assisted by endoscope. Methods:A total of 18 patients with submandibular gland benign tumors treated in our hospital from September 2022 to September 2023 were selected. A 5 cm incision was designed in the retroauricular hairline, and the flap was turned over directly to the anterior edge of sternocleidomastoid muscle, then the flap was turned over to build the cavity through endoscopic surgery, and submandibular gland resection was completed with the assistance of endoscope. After operation, a negative pressure drainage was placed into the hairline, and the wound was closed by continuous intracutaneous suture. The clinical effect was evaluated after 3-6 months follow-up. Results:All patients underwent submandibular gland resection with endoscopic assistance as planned, and none of them converted to submaxillary incision during operation. The operation time was 65-97 min, with an average of 75 min. Intraoperative bleeding was 10-20 mL, with an average of 14 mL.No tongue numbness, wound infection, or tumor recurrence occurred after operation. However, there were 10 patients with ear numbness and discomfort of auricle after surgery, which gradually recovered after 6-9 months of follow-up. Two patients had crooked mouth after surgery, and the symptoms were gradually relieved after follow-up. All incisions healed in stage I and were concealed. Conclusion:Endoscopic retroauricular hairline approach is a choice for submandibular gland resection with good cosmetic effect, less trauma and fewer complications.

One-stage revision for reconstructing acetabular defects by trabecular metal acetabular revision system in periprosthetic joint infection

Objective: To investigates the clinical efficacy of the trabecular metal acetabular revision system (TMARS) in one-stage reconstruction of acetabular deficiencies associated with periprosthetic joint infection (PJI). Methods: This is a retrospective case series study,including the data of 59 patients with PJI underwent acetabular defect reconstruction by TMARS during one-stage revisions in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021. There were 32 males and 27 females, aged (59.5±14.6) years (range: 26 to 84 years). Among them, 29 cases used tantalum cups, 13 cases used tantalum cups and tantalum reinforcing blocks, 9 cases used cup-cage, and 8 cases used multi-cup reconstruction techniques. The surgery procedure, Harris Hip score (HHS), recovery of the hip rotation center, implant survival rate, postoperative reinfection rate, and complications were recorded. Data were compared using the Wilcoxon rank-sum test. Results: All of the 59 patients underwent the operations successfully. Operation time was (188.9±48.4) minutes (range: 110 to 340 minutes), and intraoperative bleeding volume was (M(IQR)) 1 000(400)ml (range: 600 to 1 800 ml). After a postoperative follow-up of 5.1 (2.6) years (range: 2.0 to 10.5 years), the prosthesis survival rate was 94.9% (56/59). Recurrence of infection occurred in 3 cases (5.1%), aseptic loosening in 1case(1.7%), and hip dislocation in 4 cases (6.8%). At the last follow-up, HHS improved significantly(84 (12) vs. 44 (9), Z=-6.671, P<0.01), and the center of rotation of the hips were recovered in all cases. Conclusions: In one-stage revision surgeries aimed at reconstructing acetabular defects, utilizing the TMARS can provide stable initial fixation, restore a more natural center of rotation, significantly enhance early postoperative hip joint function, and reduce the likelihood of infection recurrence. This approach stands as a reliable choice for addressing acetabular defects during revision surgeries for infected hip joints.

Immunoglobulins as Tools for Passive Immunization in Preventive Healthcare

Immunoglobulins have emerged as an important tool in passive immunization for the prevention and treatment of infectious diseases. Immunoglobulins are the proteins produced by B cells that bind to specific pathogens, neutralize them, and facilitate their removal by the immune system. In preventive healthcare, immunoglobulins are used for primordial, primary, secondary, tertiary, and quaternary prevention of infectious diseases. This work was designed to carry out an extensive literature search to provide useful information on immunoglobulins as the tools of passive immunization in preventive healthcare. Relevant and accurate literatures were sourced from the World Health Organization. Centers for Disease Control and Prevention, National Center for Disease Control, PubMed, Scopus, PLoS One, and NATURE journals: Primordial prevention aims to prevent the emergence and spread of risk factors for infectious diseases. Immunoglobulins can be used to prevent the spread of infectious diseases by targeting the pathogens that cause them. The primary prevention aims to prevent the initial infection of individuals at risk of acquiring infectious diseases. Immunoglobulins can be used as prophylaxis to prevent the onset of infection in high-risk individuals. The secondary prevention aims to reduce the severity and duration of infectious diseases. Immunoglobulins can be used to treat infectious diseases and prevent complications. The tertiary prevention aims to prevent the recurrence and complications of infectious diseases. Immunoglobulins can be used to prevent the recurrence of infections in individuals who have already been infected. Quaternary prevention aims to prevent the overuse, misuse, and abuse of medical interventions. Immunoglobulins can be used to prevent the development of antibiotic resistance by reducing the use of antibiotics. However, the use of immunoglobulins in preventive healthcare is not without challenges. The cost-effectiveness of immunoglobulin therapy, long-term safety, and the potential for cross-infection are some of the challenges that need to be addressed. Further research is needed to optimize the use of immunoglobulins in preventive health-care delivery. Immunoglobulins are valuable tools in passive immunization for the prevention and treatment of infectious diseases in preventive healthcare. Their use can help reduce the burden of infectious diseases and improve public health outcomes. Keywords: Immunoglobulins, passive immunization, preventive healthcare.

Using Association Rules to Obtain Sets of Prevalent Symptoms throughout the COVID-19 Pandemic: An Analysis of Similarities between Cases of COVID-19 and Unspecified SARS in São Paulo-Brazil.

The efficient recognition of symptoms in viral infections holds promise for swift and precise diagnosis, thus mitigating health implications and the potential recurrence of infections. COVID-19 presents unique challenges due to various factors influencing diagnosis, especially regarding disease symptoms that closely resemble those of other viral diseases, including other strains of SARS, thus impacting the identification of useful and meaningful symptom patterns as they emerge in infections. Therefore, this study proposes an association rule mining approach, utilising the Apriori algorithm to analyse the similarities between individuals with confirmed SARS-CoV-2 diagnosis and those with unspecified SARS diagnosis. The objective is to investigate, through symptom rules, the presence of COVID-19 patterns among individuals initially not diagnosed with the disease. Experiments were conducted using cases from Brazilian SARS datasets for São Paulo State. Initially, reporting percentage similarities of symptoms in both groups were analysed. Subsequently, the top ten rules from each group were compared. Finally, a search for the top five most frequently occurring positive rules among the unspecified ones, and vice versa, was conducted to identify identical rules, with a particular focus on the presence of positive rules among the rules of individuals initially diagnosed with unspecified SARS.

Immunodeficiency: Overview of primary immune regulatory disorders (PIRDs).

Primary immune regulatory disorders (PIRD) comprise a heterogeneous group of monogenic disorders that impact homeostatic control of inflammation and immune tolerance. Patients with a PIRD typically present to medical care with symptoms of autoimmunity or hyperinflammation as the dominant clinical feature, symptoms that include fever, rash, lymphadenopathy, organomegaly, arthritis, and colitis are commonplace. Notably, PIRDs are a distinct entity from primary immune deficiency disorders (PIDD), which are primarily defined by a qualitative or quantitative defect in immunity, which manifests as a susceptibility to recurrent infections. PIDDs and PIRDs can be challenging to differentiate because the clinical presentations can be similar. Red flags for PIRDs include multiple autoimmune diagnoses in the same patient, chronic lymphadenopathy, hepatomegaly, and/or splenomegaly, chronic colitis, hemophagocytic lymphohistiocytosis (HLH), Epstein Barr virus (EBV) susceptibility, recurrent or persistent fever, vasculitis, and sterile inflammation. For simplicity in this brief review, we limit our discussion of PIRDs to the following categories multiple autoimmune diseases, immune dysregulation with colitis, disorders with HLH and/or EBV susceptibility, autoinflammatory syndromes, type 1 interferonopathies, and disorders of sterile inflammation. Diagnosing a PIRD requires a broad immune evaluation for both immune system deficiencies and inflammation, along with genetic testing. Given the complex nature of these diseases, treatment often requires a team of subspecialists. Treatment, depending on the specific diagnosis, may be somewhat empiric with nonspecific immune modulators, symptom-directed therapies, and, in severe cases, hematopoietic stem cell transplantation; however, with the increasing number of biologics available, we are often able to use targeted immune therapy or even gene therapy.

Biodegradable annuloplasty rings: evolution, characteristics and surgical technique

Annulus remodeling and stabilization with a ring have been demonstrated to be a mandatory step in mitral and tricuspid valve repair to ensure effective leaflet coaptation and improve long-term results. The need for a degradable ring stems from two areas in which biodegradable ring annuloplasty can theoretically fill a void: 1 – valve repair in infected valve tissue to avoid colonization of permanent implanted ring device and infection recurrence, 2 – valve repair in children, where traditional annuloplasty rings can’t be used due to the risk of acquired stenosis for lack of growth. Prophylactic anticoagulation following biodegradable ring annuloplasty is not necessary, provided that the patient has no other indication for it, as the intraannular position of the ring protects against any «blood-biodegradable ring» interaction.

Antibiotic Lock Therapy for Port Catheter-Related Infections of Children with Acute Leukemia.

Port catheters facilitate the administration of chemotherapy, antibiotics, blood products, fluid, and parenteral nutrition to pediatric patients with hematological malignancies. However, as its use has become widespread, local and systemic, catheter-related infections have emerged as important causes of morbidity and mortality. In our study, we aimed to evaluate the success of antibiotic lock therapy in port catheter-related infections of pediatric patients followed up with acute leukemia. Port catheter cultures taken from a total of 182 pediatric patients with acute lymphoblastic/myeloblastic leukemia who were followed up at Ankara City Hospital Pediatric Hematology Clinic between August 2019 and August 2023 were evaluated retrospectively. Bacterial growth was identified in 739 port catheter culture specimens of 182 patients. Closure or removal of the port was required in 91, and removal of the port catheters in 49 patients due to port catheter-related infections. Antibiotic lock therapy was started in 56 patients with bacterial growth in the port catheter. With antibiotic lock therapy, port catheter-related infections of 42 patients were eradicated, and their catheters began to be used again. As a result, the port catheter-related infections of 42 of 56 (75%) patients whose ports were closed and also received systemic antibiotic therapy were eradicated, and no infection recurrence was observed. Adding antibiotic lock therapy to systemic antibiotics in pediatric patients may be beneficial in terms of catheter salvage.

Stanovenie mukociliárneho klírensu u pacientov so symptómami laryngofaryngeálneho refl uxu – preliminárne výsledky

Summary: Introduction: Mucociliary clearance represents an important protective mechanism of the respiratory tract. Results of multiple studies indicate that gastroesophageal reflux can participate in worsening mucociliary clearance leading to laryngopharyngeal reflux symptoms including recurrent upper respiratory tract infections. Thereby, we decided to provide ciliary beat frequency of the upper respiratory tract epithelium in patients with laryngopharyngeal reflux. Materials and methods: We enrolled 23 patients with laryngopharyngeal reflux symptoms. Control group consisted of 9 healthy volunteers. Patients were enrolled upon a positive questionnaire reflux symptom index (RSI &gt;13 points), with no proton pump inhibitor treatment. We obtained a nasopharyngeal swab and evaluated ciliary beat frequency of the respiratory epithelium using highspeed videomicroscopy and special sofware Ciliary Analysis. We compared the values of ciliary beat frequency with values from healthy volunteers. Results: We provided median, minimal and maximum values of ciliary beat frequency. Median ciliary beat frequency in healthy volunteers was significantly higher than in patients with laryngopharyngeal reflux symptomatology (10.86 ± 1.67 vs. 6.6 ± 2.2; P &lt;0.001). Maximum ciliary beat frequency was also significantly higher in healthy volunteers than in patients with LPR (17.9 ± 0.95 vs. 15.3 ± 2.39; P &lt;0.001). Minimal value had no significant difference. Correlation analysis showed an inverse correlation between median ciliary beat frequency of the respiratory epithelium and LPR symptoms (RSI value) (P &lt;0.04). Conclusion: Patients with laryngopharyngeal reflux symptoms had lower ciliary beat frequency compared to healthy volunteers. The degree of frequency defect correlates with the degree of their laryngopharyngeal symptoms. More studies are needed to confirm direct evidence of gastroesophageal reflux etiology in mucociliary clearance worsening. Key words: mucociliary clearance – laryngopharyngeal reflux – cilia

Effects of a Prophylactic Treatment with Horseradish Root and Nasturtium Herb on Urinary Tract Infections in Individuals with Chronic Neurogenic Lower Urinary Tract Dysfunction: A Retrospective Cohort Study

Introduction: Recurrent urinary tract infections (UTIs) are common in individuals with neurogenic lower urinary tract dysfunction (NLUTD) and greatly affect their quality of life. There is currently no established prophylactic measure based on evidence. We have therefore evaluated the effects of a horseradish root and nasturtium herb product on the frequency of UTIs in a retrospective cohort. Methods: Clinical data of patients with chronic NLUTD who were receiving the phytotherapeuticum for at least 12 months were analyzed. The number of UTIs was categorized as no UTIs, sporadic UTIs (1–2/year) and recurrent UTIs (≥3/year). The change in the annual number of patient-reported symptomatic UTIs and antibiotic prescriptions was investigated. Results: Data of 43 individuals (mean age 49 ± 13 years, median NLUTD duration 17.9 years) were analyzed. The proportion of individuals with recurrent UTIs decreased significantly (p < 0.0001) from 58.1% (42.1–73.0%) to 23.3% (11.8–38.6%) during phytotherapy, whereas the proportion of individuals without UTIs increased significantly (p = 0.001) from 14.0% (5.3–27.9%) to 39.5% (25.0–55.6%). In addition, there was a significant (p = 0.008) decrease in the number of antibiotic prescriptions. Conclusion: Prophylactic treatment with horseradish root and nasturtium herb seems to be a promising option for the prevention of UTIs.

In vitro efficacy of lavender oil, otological gel and gentamicin to eradicate biofilm produced by Pseudomonas aeruginosa.

Otitis externa (OE) is one of the most frequently diagnosed dermatological diseases in dogs, having a multifactorial aetiology. Among the bacterial agents associated with canine OE, Pseudomonas aeruginosa is of special concern owing to its frequent multidrug resistance profile and ability to form biofilms related to the infection's chronicity and recurrence. The main objective of this study was to evaluate and compare the antibiofilm activity of two innovative antimicrobials-an otological gel containing a synthetic antimicrobial peptide and Lavandula angustifolia essential oil-with gentamicin (a conventional antibiotic) using biofilm-producing P. aeruginosa isolates obtained from dogs with OE. The biofilm eradication capacity of gentamicin, otological gel and lavender oil was determined against a collection of 12 P. aeruginosa biofilm-producers among 35 clinical isolates obtained from the ear canals of dogs with OE. Also, the antimicrobial activity of the otological gel against P. aeruginosa biofilms was assessed in an invitro model of dog cerumen. Lavender oil showed the best effectiveness after 30 min of contact, eradicating 58.3% (seven of 12) of the isolates, and gentamicin showed full eradication (12 of 12) after 24 h. The otological gel acted more slowly than the lavender oil; yet at 24 h, the antibiofilm capacity of both compounds was similar, with no significant difference between them. It also was found that triglycerides from synthetic cerumen earwax had antipseudomonal activity and, when combined with the otological gel, led to the full eradication of P. aeruginosa. The results of this invitro study indicate that lavender oil and the otological gel may be effective topical treatments for canine OE promoted by P. aeruginosa biofilm-producers, as alternatives to gentamicin.

DEVELOPMENT OF AN ANDROID-BASED APPLICATION "BERAKSI" TO CONDUCT EARLY DETECTION OF STUNTING

Stunting is a condition of failure to thrive in children under five years of age (toddlers) due to chronic malnutrition and recurrent infections, especially during the window of opportunity, namely from the fetus to a child aged 23 months. Children are classified as stunted if their length or height is below minus two standard deviations of the size or height of children their age. Stunting handling must synergize between ministries/institutions, regional governments, and the business world/community. The BERAKSI application is expected to help and make it easier for Cadres and parents to monitor the growth and development of typical toddlers in general and stunted toddlers in particular. Cadres can conduct inspections on Integrated Service Post activities, and parents can monitor the development of babies and toddlers at any time through the application on their respective smartphones. The BERAKSI application displays four menu features, namely the inspection feature: 1) Growth, 2) Development, 3) Balanced Nutrition, and 3) Parenting. The advantage of the BERAKSI Program application compared to similar applications is that it has updates in the form of interventions providing balanced nutrition for toddlers who experience stunting and malnutrition with menus that have been consulted and recommended by nutritionists, as well as having a parenting menu that has been consulted and recommended by child psychologists. Field data input into the BERAKSI application can be saved and downloaded on Google Spreadsheet. The BERAKSI application can be downloaded without paying via Playstore using an Android-based mobile device connected to the internet network.

Probiotics in the Management of Vulvovaginal Candidosis.

Vulvovaginal candidosis (VVC) represents a frequent and cumbersome vaginal infection. Recurrent and/or persistent infections remain common among a significant number of patients despite the use of antifungals. Probiotics offer a promising adjunctive or alternative therapeutic strategy to antifungals in the management of VVC. We aimed to explore and thoroughly examine the various roles and potential applications of probiotics in VVC. A comprehensive literature search was conducted to identify relevant clinical trials and systematic reviews that examine the effectiveness of probiotics in the treatment and prevention of VVC and recurrent VVC (rVVC). Following the initial screening of 4563 articles, a total of 25 clinical studies and seven systematic reviews were finally included in this analysis. The studies reviewed provide a generally positive yet inconsistent view of the efficacy of probiotics in managing VVC, including clinical, mycological response, and prevention perspectives. Nonetheless, fluconazole remains more effective than probiotics in treating VVC, while the combination of the two seems to reduce recurrence and improve symptoms significantly. For prevention, probiotics seem to improve vaginal health and reduce symptoms, while safety and tolerability are consistently reported across the studies, affirming that probiotics represent a low-risk intervention. However, clear conclusions are difficult to establish since relative studies explore different clinical endpoints and follow-up times, variable populations are included, different probiotics are used, and diverse schedules and regimens are administered. We propose that future studies should study the benefit of probiotics in well-defined categories such as (1) treatment with acute probiotics instead of antifungals, (2) adjuvant probiotic therapy together or after antifungals, and (3) VVC recurrence prevention using probiotics.

Drug-Free "Triboelectric Immunotherapy" Activating Immunity for Osteomyelitis Treatment and Recurrence Prevention.

Treatment of osteomyelitis is clinically challenging with low therapeutic efficacy and high risk of recurrence owing to the immunosuppressive microenvironment. Existing therapies are limited by drug concentration and single regulatory effect on the immune network, and emphasize the role of anti-inflammatory effects in reducing osteoclast rather than the role of proinflammatory effects in accelerating infection clearance, which is not conducive to complete bacteria elimination and recurrence prevention. Herein, a direct-current triboelectric nanogenerator (DC-TENG) is established to perform antibacterial effects and modulate immunological properties of infectious microenvironments of osteomyelitis through electrical stimulation, namely triboelectric immunotherapy. Seeing from the results, the triboelectric immunotherapy successfully activates polarization to proinflammatory (M1) macrophages in vitro, accompanied by satisfying direct antibacterial effects. The antibacterial and osteogenic abilities of triboelectric immunotherapy are verified in rat cranial osteomyelitis models. The effects on the polarization and differentiation of immune-related cells in vivo are investigated by establishing in situ tibial osteomyelitis models and immunosurveillance models in C57 mice respectively, indicating the ability of activating immunity and producing immunological memory for in situ infection and secondary recurrence, thus accelerating healing and preventing relapse. This study provides an efficient, long-acting, multifunctional, and wearable triboelectric immunotherapy strategy for drug-free osteomyelitis treatment systems.