Significant Difference In Infection Rate Research Articles

Clinical, seroepidemiological and hematological study of Buffaloes Babesiosis in Basrah, Iraq

Objective: Babesiosis is one of the important diseases in cattle and buffaloes, the current study conducting to diagnoses and evaluate the infection by B.pigeamina in buffaloes during the period of November 2022 to September 2023. Methods: The study included 210 animals of both sexes and varied ages. The blood sampling from 220 water buffaloes (Bubalus Bubalis) in the north of Basrah governorate during the period of November 2022 to September 2023; the samples collected from both sexes and different ages ranged between 1 to 5 years. At these ten months 20 blood samples was randomly collected each month to compared with the control 10 animals. Results: The blood smear from infected buffaloes show the parasite clearly while the clinical signs reported as: babesiosis confirm 16% (32 affected animals) represented by fever, emaciation, anorexia, low milk production, jaundice of mucous membrane, corneal opacity and hemoglobinuria. The subclinical infected buffaloes which represented 41% (82 affected animals) appear healthy with no clinical signs. Also indicate that were no significant differences (P less than 0.05) between the infected and control group. The hematological parameters show significant differences (P less than 0.05) in RBCs count, total WBC count, deferential LC, Hb concentration and PCV in the infected buffaloes compare to the control animals while there were no significant differences (P less than 0.05) between the subclinical and control buffaloes except the RBCs count. The serological examination revealed to significant differences (P less than 0.05) in the infected group in posit to the control especially the liver enzymes and kidney function test enzymes which include: AST, ALT, ALP, BUN, creatinine and TP. Moreover, According the season and months the study detects the high infection rate in the summer while there were decrease in the infection rate in the mild or cold weather months. Moreover, the study indicates the high infection percentage in females compare to the male sex. Conclusion: Babesiosis is very important disease in Buffaloes in north of Basrah and there are no significant differences in infection rates between male and female.

Outcome of Locked Reamed Intramedullary Nail v/s K-NAIL Plus Augmented Plating in Aseptic Distal Femur Non-Union

Background: Aseptic nonunion of the distal femur presents a significant challenge in orthopedic surgery, affecting patient outcomes and healthcare systems. Traditional treatments include locked reamed intramedullary nailing (LRIN) and K-nail with augmented plating, with varied reported efficacies. Objective: The study aimed to compare the outcomes of LRIN versus K-nail plus augmented plating in the treatment of aseptic nonunion of the distal femur, focusing on union rates, operative time, complications, and functional recovery. Methods: In this prospective comparative study, 50 patients with aseptic nonunion of the distal femur were randomly assigned to undergo either LRIN (Group A) or K-nail plus augmented plating (Group B). The primary outcome measures included the modified Radiographic Union Score for Tibial fractures (mRUST) and rates of implant failure and infection. Secondary outcomes considered operative time and intraoperative blood loss. Statistical analysis was performed using SPSS version 25, with a p-value of less than 0.05 deemed significant. Results: Group A exhibited higher mRUST scores at 12 weeks (4.84 vs. 4.16, p=0.010), 24 weeks (6.40 vs. 5.48, p<0.001), and 36 weeks (8.12 vs. 7.00, p<0.001). Nonunion rates at 36 weeks were lower in Group A (12% vs. 36%, p=0.047), with no significant differences in infection rates. Operative time was significantly longer for Group A (159.40±5.82 minutes) compared to Group B (123.96±6.20 minutes, p<0.001), but there was no significant difference in blood loss between the groups. Conclusion: LRIN outperformed K-nail plus augmented plating in promoting bone union in aseptic nonunion of the distal femur, with a lower nonunion rate and higher mRUST scores, despite a longer operative time.

Characterizing antibiotic prophylaxis practices in pediatric deformity spinal surgery and impact on 30-day postoperative infection: an NSQIP pediatric database study.

The aim of this study was to characterize antibiotic prophylaxis practices in pediatric patients who have received posterior arthrodesis for spinal deformity and understand how these practices impact 30-day postoperative infection rates. This was a retrospective cohort study using the National Surgical Quality Improvement Program Pediatric database for year 2021. Patients 18years of age or younger who received posterior arthrodesis for scoliosis or kyphosis correction were included. The outcome of interest was 30-day postoperative infection. Fisher's exact test and multivariable regression analysis were used to analyze the impact of intravenous antibiotic prophylaxis, intraoperative intravenous antibiotic redosing after 4h, postoperative antibiotic prophylaxis, intraoperative topical antibiotics on 30-day postoperative infection, and various antibiotic prophylaxis regimens. A total of 6974 patients were included in this study. The 30-day infection rate was 2.9%. Presurgical intravenous antibiotic (11.5% vs. 2.7%, p = 0.005), postoperative antibiotic (5.7% vs. 2.4%, p < 0.01), and intraoperative topical antibiotic (4.0% vs. 2.7%, p = 0.019) were associated with significantly reduced infection rates. There was no significant difference in infection rates between patients that received cefazolin versus vancomycin versus clindamycin. The addition of Gram-negative coverage did not result in significant differences in infection rates. Multivariable regression analysis found postoperative intravenous antibiotics and intraoperative topical antibiotics to reduce infection rates. We found the use of presurgical intravenous antibiotics, postoperative intravenous antibiotics, and intraoperative topical antibiotics to significantly reduce infection rates. Results from this study can be applied to future research on implementation of standardized infection prevention protocols. Level II.

Prevalence and molecular characterization of Trichomonas gallinae from pigeons in Anhui, China

Trichomonas gallinae, a protozoan parasite causing avian trichomonosis, exhibits a widespread global prevalence. It primarily affects the upper digestive tract of birds and has resulted in significant ecological problems worldwide. This study aimed to investigate the prevalence and genotypes of T. gallinae in Anhui Province, China. A total of 1612 oropharyngeal swab samples were collected from pigeon farms in Anhui Province to determine the prevalence of T. gallinae infection. The results revealed 565 (35.1%) positive samples of T. gallinae. Significant differences in infection rates were observed among different regions and age groups. Furthermore, the ITS1/5.8 S/ITS2 region was amplified, sequenced, and subjected to phylogenetic analysis. Genotypes A and B of T. gallinae were identified, and genotype B was the dominant genotype in Anhui Province. This is the first report on the prevalence and molecular characterization of T. gallinae in Anhui Province, China. Additionally, we integrated reports on the prevalence and genotype of T. gallinae in relevant provinces in China.

An evaluation of driveline dressing protocols and infection rates for left ventricular assist devices across UK transplant centres

Background/Aims Left ventricular assist devices are used to improve the quality of life of people waiting for heart transplantation. Driveline infections are a significant complication of these devices, occurring in 30–40% of cases, which could lead to life threatening sepsis. This study aimed to review UK driveline dressing protocols and infection rates to determine if national standardisation is possible. Methods Six UK heart transplant centres were asked to share their driveline dressing protocols for comparison. National driveline infection data were obtained from the NHS Blood and Transplant database. Infection rates, patient demographics and device types were compared using Chi squared tests, with a P value of &lt;0.05 indicating statistical significance. Results The study found 38 driveline infections over a 3-year period, with an average infection rate was 4.4% per year. There were no significant difference in infection rates between device types. Dressing protocols varied between centres, but all centres followed international guidance. The timepoint where the highest number of infections were diagnosed was 12 months post implantations, accounting for 23.7% of infections. There were no significant differences in infection rates between centres in 2019–20 or 2021–22, but a significant difference was observed for 2020–21 (P=0.013). Conclusions UK driveline infection rates are below the average reported in the literature. Despite some differences in dressing protocols, all centres examined in this study maintained a level of infection comparable to reported rates. The feasibility of national standardisation remains uncertain, and further research is needed to determine the most effective dressing protocols for preventing driveline infections.

Does Anterior Plating of Pelvic Ring Fractures Increase Infection Risk in Patients With Bladder or Urethral Injuries?

Evaluate the effect of anterior fixation on infection in patients with operative pelvic fractures and bladder or urethral injuries. Retrospective. Eight centers. Adult patients with closed pelvic fractures with associated bladder or urethral injuries treated with anterior plating (AP), intramedullary screw (IS), or no anterior internal fixation (NAIF, including external fixation or no fixation). Deep infection. There were 81 extraperitoneal injuries and 57 urethral injuries. There was no difference in infection between fixation groups across all urologic injuries (AP: 10.8%, IS: 0%, NAIF: 4.9%, P = 0.41). There was a higher rate of infection in the urethral injury group compared with extraperitoneal injuries (14.0% vs. 2.5%, P = 0.016). Among extraperitoneal injuries, specifically, there was no difference in deep infection related to fixation (AP: 2.6%, IS 0%, NAIF: 2.9%, P = 0.99). Among urethral injuries, there was no statistical difference in deep infection related to fixation (AP: 23.1%, IS: 0%, NAIF: 7.4%, P = 0.21). There was a higher rate of suprapubic catheter (SPC) use in urethral injuries compared with extraperitoneal injuries (57.9% vs. 4.9%, P < 0.0001). In the urethral injury group, SPC use did not have a statistically significant difference in infection rate (SPC: 18.2% vs. No SPC: 8.3%, P = 0.45). Early removal of the SPC before or during the definitive orthopaedic intervention did not significantly affect infection rate (early: 0% vs. delayed: 25.0%, P = 0.16). Surgeons should approach operative pelvic fractures with associated urologic injuries with caution given the high risk of infection. Further work must be done to elucidate the effect of anterior implants and SPC use and duration. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Sympatry in a nightingale contact zone has no effect on host-specific blood parasite prevalence and lineage diversity

Parasites are a key driving force behind many ecological and evolutionary processes. Prevalence and diversity of parasites, as well as their effects on hosts, are not uniform across host species. As such, the potential parasite spillover between species can significantly influence outcomes of interspecific interactions. We screened two species of Luscinia nightingales for haemosporidian blood parasites (Plasmodium, Leucocytozoon and Haemoproteus) along an approximately 3000 km transect in Europe, incorporating areas of host distant allopatry, close allopatry and sympatry. We found significant differences in infection rates between the two host species, with common nightingales having much lower parasite prevalence than thrush nightingales (36.7% versus 83.8%). This disparity was mostly driven by Haemoproteus prevalence, which was significantly higher in thrush nightingales while common nightingales had a small, but significantly higher, Plasmodium prevalence. Furthermore, we found no effect of proximity to the contact zone on infection rate in either host species. Despite having lower infection prevalence, common nightingales were infected with a significantly higher diversity of parasite lineages than thrush nightingales, and lineage assemblages differed considerably between the two species, even in sympatry. This pattern was mostly driven by the large diversity of comparatively rare lineages, while the most abundant lineages were shared between the two host species. This suggests that, despite the close evolutionary relationships between the two nightingales, there are significant differences in parasite prevalence and diversity, regardless of the distance from the contact zone. This suggests that spillover of haemosporidian blood parasites is unlikely to contribute towards interspecific interactions in this system.

Corticosteroid Injection in the Operative Hand Prior to a Trigger Finger or Carpal Tunnel Release: If It Is Not at the Surgical Site Then What Is the Big Deal?

Patients who have had a corticosteroid injection at the surgical site within 90 days of trigger finger release (TFR) or carpal tunnel release (CTR) have an elevated risk of postoperative infection. Currently, it remains unknown if a preoperative injection in proximity to the surgical site for a separate complaint alters the risk of a postoperative infection. A retrospective chart review was performed on all patients who underwent TFR or CTR between 2010 and 2022. Patients who had a corticosteroid injection at or near the surgical site within 90 days of surgery were included. Outcome measures included uncomplicated healing, superficial infection requiring antibiotics, and deep infection (DI) requiring surgical debridement. There were 564 cases in which a corticosteroid injection was performed within 90 days of TFR or CTR. Superficial infections occurred in 12 (2.1%), and DIs occurred in 6 (1.1%) cases. There was no significant difference in infection rates between the two groups relative to the location of the injection nor timing of the injection (0-30, 31-60, or 61-90 days prior to surgery). Patients who had an injection at the surgical site within 90 days of TFR or CTR had an elevated rate of postoperative infection compared with published rates in the literature. This study is unique in that preoperative injections at an adjacent site in the palm also correlated with an elevated rate of infection, similar to patients who had an injection at the surgical site. Level 4.

Treatment of cerebrospinal fluid leakage with prolonged use of subfascial epidural drain and antibiotics in patients of thoracic myelopathy after posterior decompression surgery.

Cerebrospinal fluid leakage (CSFL) is a prevalent and vexing complication associated with spine surgery. No standard protocol is available guiding CSFL management, especially for thoracic CSFL. The aim of this study was to retrospectively evaluate the efficacy of prolonged use of subfascial epidural drain and antibiotics to treat CSFL after posterior thoracic decompression surgery. Fifty-six patients with an average age of 52.3 years (24-76 years), who underwent thoracic decompression with CSFL (group A) and 65 patients with an average age of 54.9 years (25-80 years) without CSFL (group B) were retrospectively reviewed. Patients in group A had prolonged use of subfascial drainage and antibiotics and patients in group B were treated with conventional methods. The surgical results and rate of wound related complications was compared between the two groups. The average subfascial drainage time was 7.0 ± 2.7 days (2-16 days) and 3.8 ± 1.4 days (2-7 days) in group A and B, respectively. Higher occupation rate (>49%), presence of dural ossification and higher MRI grade (>2) were more likely to presented with CSFL. In group A, four patients (7.1%) presented with deep wound infection and were successfully managed with wound debridement or intravenous antibiotics. In group B, one patient (1.5%) had a superficial wound infection and was treated with antibiotics. No patients presented with wound dehiscence, wound exudation or CSF fistulation. The occupation rate of ossified mass and presence of dural ossification were the major risk factors of CSFL. No significant difference in infection rates was observed between the patients in group A and B.

The impact of the COVID-19 pandemic on the prevalence and genotype distribution of HPV infection in Beijing, China.

Human papillomavirus (HPV) is one of the most common sexually transmitted infections nationwide. The COVID-19 pandemic has greatly influenced on the HPV prevention project. The objective of this study was to examine the influence of the pandemic on HPV prevalence and genotype distribution in Beijing, China. A total of 44 401 genital swabs were obtained from outpatients at Peking Union Medical College Hospital during two distinct periods: the prepandemic stage from January 2017 to December 2019 and the pandemic stage from January 2020 to December 2022. During the prepandemic and pandemic stages, a total of 33 531 and 10 870 swabs were respectively collected. Fifteen high-risk HPV(HR-HPV) DNA type and a combination of two low-risk (LR-HPV) types (6/11) of genital swabs were detected to compare the HPV infection rates and genotype distributions in two stages. The results showed that the pandemic period witnessed a decrease in the overall HPV infection rate from 33.43% (11 245/33 531) to 29.43% (5527/18 780) compared to the prepandemic. There were statistically significant differences in infection rates between females and males (p < 0.05). Single infection was the predominant type while multiple infection was more prevalent in males than females in both prepandemic and pandemic periods. HR-HPV infection constituted the majority of infections and cannot be disregarded. The distribution of HR-HPV genotypes exhibited little variation before and after the outbreak, but there were some differences between females and males. HPV 16, 52, 58, 56, and 66 were the most commonly detected genotypes in females, whereas HPV 16, 52, 51, 58, and 18 were frequently detected in males. Additionally, HPV 6/11 exhibited a higher prevalence in males than in females. Notably, the age group of 31-40 years old exhibited the highest prevalence of HPV and the lowest infection rate was detected among individuals aged ≤20 years (p < 0.05), which remained relatively consistent before and during the pandemic. These findings underscore the importance of monitoring the trend of HPV epidemic and offer valuable insights for the prevention, treatment, and scientific investigation of HPV in the post-COVID-19 era.

No significant association between non-Helicobacter pylori Helicobacter infection with gastritis-related indices and gastric cancer

BackgroundNon-Helicobacter pylori Helicobacter (NHPH) has recently been linked to various gastric diseases. However, the relationship between NHPH infection and gastric cancer remains controversial. This study aimed to identify the effect of NHPH infection on gastritis and gastric cancer development. Materials and methodsFormalin-fixed paraffin-embedded tissues were obtained from 73 patients with gastric cancer, of whom 21 cases were Helicobacter pylori (Hp) current infection, 37 cases were Hp previous infection, and 15 cases were Hp naïve infection, and were screened for NPHPs using polymerase chain reaction. The results were compared with NHPH infection rates in the patients with gastritis-related diseases reported in the previous study. We evaluated the association of NHPH infection with gastritis and clinicopathological features of gastric cancer. ResultsNHPH infection rates were 4/21 (19%) in “Hp current” patients, 4/37 (11%) in “Hp previous” infection patients, and 1/15 (7%) in “Hp naïve” patients, showing no significant difference in infection rates based on Hp infection status. NHPH infection rates in gastric cancer patients were similar to those in the patients with gastritis-related diseases reported in the previous study. A comparison of NHPH-positive and negative patients showed no significant differences in atrophic gastritis status, serum gastritis markers, or clinicopathological characteristics of gastric cancer, such as localization, size, gross type, differentiation, or depth. ConclusionsThe association between gastric cancer and NHPH infection would have important implications for gastric cancer prevention, diagnostics, and treatment, however, no significant association was found in this particular population.

The Effects of Vitamin D Supplementation on Respiratory Infections in Children under 6 Years Old: A Systematic Review.

Childhood respiratory tract infections (RTIs) pose a significant health burden, especially in children under six years old. The main objective of this systematic review was to assess the effectiveness of vitamin D supplementation in the prevention of RTI in this population while also exploring potential effect modifiers such as age, baseline vitamin D status, and type of respiratory infection. A systematic review of the literature published up to February 2023 was conducted according to PRISMA guidelines, searching PubMed, Web of Science, Cochrane, and Scopus databases. Eight studies met the inclusion criteria, which investigated the association between vitamin D supplementation and respiratory infections in children between zero and five years old. The included studies were conducted between 2012 and 2021, encompassing a total of 2189 children from five randomized trials, two case-control studies, and one prospective cohort study. The relationship between vitamin D supplementation and the prevention of childhood RTI was not consistently observed across all included studies. Pooled results demonstrated varied effects of vitamin D supplementation on respiratory infection incidence, severity, and symptoms. Three studies reported statistically significant associations between low vitamin D levels and respiratory infections (OR = 4.90, OR = 6.97), while one study found that children who received vitamin D supplementation of 800 UI/day for 3 months during the cold season had fewer episodes of respiratory symptoms (RR = 0.55) and recovered more quickly from acute RTI. Lastly, according to one study, vitamin D intake < 80 IU/kg/day was significantly associated with the risk of acquiring pneumonia (OR 7.9) but not bronchiolitis. The remaining five studies found no statistically significant differences in infection rates or severity (p-value > 0.050). The available evidence on the effectiveness of vitamin D supplementation for preventing and treating respiratory infections in children under six years old is limited, with only a few favorable effects being reported. In some cases, a dose of 80 UI/kg/day was found to provide significant protection for acute respiratory infections, although in the major trials the only benefit was a quicker recovery and fewer respiratory symptoms, with no impact on incidence and severity of respiratory infections. Nevertheless, the study protocol, the supplementation dose, and duration of supplementation had significant variations between studies, leading to inconclusive findings.

MRNA versus inactivated virus COVID-19 vaccines in multiple sclerosis: Humoral responses and protectivity-Does it matter?

COVID-19 vaccines are recommended for people with multiple sclerosis (pwMS). Adequate humoral responses are obtained in pwMS receiving disease-modifying therapies (DMTs) after vaccination, with the exception of those receiving B-cell-depleting therapies and non-selective S1P modulators. However, most of the reported studies on the immunity of COVID-19 vaccinations have included mRNA vaccines, and information on inactivated virus vaccine responses, long-term protectivity, and comparative studies with mRNA vaccines are very limited. Here, we aimed to investigate the association between humoral vaccine responses and COVID-19 infection outcomes following mRNA and inactivated virus vaccines in a large national cohort of pwMS receiving DMTs. This is a cross-sectional and prospective multicenter study on COVID-19-vaccinated pwMS. Blood samples of pwMS with or without DMTs and healthy controls were collected after two doses of inactivated virus (Sinovac) or mRNA (Pfizer-BioNTech) vaccines. PwMS were sub-grouped according to the mode of action of the DMTs that they were receiving. SARS-CoV-2 IgG titers were evaluated by chemiluminescent microparticle immunoassay. A representative sample of this study cohort was followed up for a year. COVID-19 infection status and clinical outcomes were compared between the mRNA and inactivated virus groups as well as among pwMS subgroups. A total of 1484 pwMS (1387 treated, 97 untreated) and 185 healthy controls were included in the analyses (male/female: 544/1125). Of those, 852 (51.05%) received BioNTech, and 817 (48.95%) received Sinovac. mRNA and inactivated virus vaccines result in similar seropositivity; however, the BioNTech vaccination group had significantly higher antibody titers (7.175±10.074) compared with the Sinovac vaccination group (823±1.774) (p<0.001). PwMS under ocrelizumab, fingolimod, and cladribine treatments had lower humoral responses compared with the healthy controls in both vaccine types. After a mean of 327±16 days, 246/704 (34.9%) of pwMS who were contacted had COVID-19 infection, among whom 83% had asymptomatic or mild disease. There was no significant difference in infection rates of COVID-19 between participants vaccinated with BioNTech or Sinovac vaccines. Furthermore, regression analyses show that no association was found regarding age, sex, Expanded Disability Status Scale score (EDSS), the number of vaccination, DMT type, or humoral antibody responses with COVID-19 infection rate and disease severity, except BMI Body mass index (BMI). mRNA and inactivated virus vaccines had similar seropositivity; however, mRNA vaccines appeared to be more effective in producing SARS-CoV-2 IgG antibodies. B-cell-depleting therapies fingolimod and cladribine were associated with attenuated antibody titer. mRNA and inactive virus vaccines had equal long-term protectivity against COVID-19 infection regardless of the antibody status.

Prevalence and Genotype Distribution of Human Papillomavirus in 92,932 Cases in Shanghai, China

Aim: Human papillomavirus (HPV) is the most common cause of high-grade lesions and carcinogenesis such as cervical intraepithelial neoplasia (CIN) and cervical cancer (CC). The prevalence and genotype distribution of HPV infection varies greatly in different geographical areas. Patients &amp; methods: This study enrolled 92,932 patients from January 2017 to December 2021 and analyzed the prevalence and distribution of HPV genotypes. Results: 18038 (19.41%) specimens were HPV-positive. No significant difference in infection rates between men and women (19.05 vs 19.41%). The most prevalent HPV subtypes are HPV52, HPV58, HPV16, HPV53, HPV51 and HPV81. Single infection of HPV has dominated in HPV-positive patients. Conclusion: Our results show that the prevalence and distribution of HPV subtypes have obvious region-specific and age-specific characteristics.

High-rise buildings: A risk factor in the COVID-19 Omicron epidemic period

ObjectivesThis study aimed to investigate possible viral transmission scenarios inside a high-rise building during the Omicron phase of the COVID-19 pandemic. Study designCross-sectional study design. MethodsIn order to determine the pathogenicity of the Omicron variant of SARS-CoV-2, demographic, vaccination and clinical data were collected from COVID-19 positive cases during an outbreak in a high-rise residential building in Shenzhen, China, in early 2022. The pattern of viral transmission inside the building was determined through field investigation and engineering analysis. The results highlight the risk of Omicron infection in high-rise residential buildings. ResultsSymptoms of infection with the Omicron variant are predominantly mild. Younger age has a greater impact on the severity of disease than vaccination status. Each floor of the high-rise building investigated contained 7 apartments, numbered 01 to 07, positioned in the same layout on each floor. The drainage system included vertical pipes from the ground to the roof of the building. There were statistically significant differences in infection rates at different time points and incidence ratios between apartment numbers ending in 07 (type 07) and other apartments (P < 0.001). Households with early disease onset were concentrated in apartment type 07 and the severity of their disease was more severe. The incubation period of the outbreak was 5.21–5.31 days and the time-dependent reproduction number (Rt) was 12.08 (95% confidence interval [CI] 7.66, 18.29). Results suggest both non-contact and contact viral transmission may have contributed to the outbreak. The drainage system in the building allows aerosol regurgitation, thus indicating that the structure of the building may have led to spread of the virus from the sewage pipes. Infections in other apartments may have been as result of viral transmission in the elevators and intimate family contact. ConclusionsResults from this study suggest that Omicron transmission was likely to be via the sewage system, supplemented by contact transmission in the stairs and elevators. The environmental spread of Omicron needs to be highlighted and prevented.

P057 Immunosuppression doubles the risk of COVID-19 infection in a large vaccinated cohort of 898 patients with rheumatic diseases: implications for future practice

Abstract Background/Aims It is recognised that immunosuppressive medications, often relied upon in the management of autoimmune rheumatic disease, inhibit vaccine-induced immunity against the SARS-CoV-2 virus. A key challenge for rheumatologists is maximising immunity provided by the vaccine in their patients. Recent data has implicated methotrexate (MXT), a commonly used disease modifying anti-rheumatic drug (DMARD), in reducing patients’ vaccine-induced immunity against the virus and studies have demonstrated the effectiveness of pausing MXT medication for 2-weeks after receiving the vaccine in boosting patients’ immunity. There is a lack of data exploring the impact of concurrent biologic-DMARD (b-DMARD) use with MXT on COVID-19 infection rates in vaccinated individuals. This analysis forms part of a larger programme of research (clinicaltrials.gov NCT04542031) exploring COVID-19 in patients with rheumatic disease. Here we provide a comparative analysis of COVID-19 infection rates between patients taking MXT either with or without b-DMARD therapy and those on no immunosuppression. Methods We distributed two web-based questionnaires via SMS-messaging in April 2020 and December 2021 and two interim monitoring questionnaires in December 2020 and June 2021. All rheumatology patients with a valid mobile telephone number under follow up at the Royal Wolverhampton Trust were invited to participate in the study; those that consented received follow up questionnaires. We collected information on demographics, rheumatology diagnosis and treatment, vaccination status, and COVID-19 infection rates. Data were collected 7-days following questionnaire distribution. Results Initial questionnaires were sent to 7911 active follow up patients, 1636/7911 (21%) responded and consented to further follow up; 906/1636 (55.4%) provided a complete response to the final survey which was subsequently linked to survey one enabling analysis. Responders were female (622/906, 68.7%), white (865, 95.5%), 60 years or above (519, 57.3%), and vaccinated (898/906; 99.1%). Of those vaccinated significantly more patients that were on any immunosuppressive therapy compared to those on no immunosuppression (92/530 (17.4%) vs. 26/368 (7.1%); p &amp;lt; 0.001), and more in the MXT monotherapy group compared to no immunosuppression (33/222 (14.9%) vs. 26/368 (7.1%); p = 0.001) contracted COVID-19. Similar numbers in the MTX and b-DMARD and b-DMARD without MXT groups (23/140 (16.4%) vs. 36/168 (21.4%); p = 0.23) contracted COVID-19. Conclusion Recent trial data from the VROOM study has demonstrated that omitting a patients MXT therapy for a 2-week period following administration of the COVID-19 vaccine doubles their antibody response. This data highlights that the risk of COVID-19 infection in vaccinated rheumatology patients is doubled in patients on any immunosuppressive medication compared to those on no immunosuppression, while there is no significant difference in infection rates between patients on MXT and a b-DMARD and b-DMARD therapy without MXT. Further work exploring the impact of different types of immunosuppression on COVID-19 vaccine-induced immunity and simple interventions to maximise this immunity in immunosuppressed individuals is required. Disclosure N. Cox: None. J. Bateman: None.

MP15-16 SINGLE DOSE ANTIBIOTICS AT THE TIME OF TRANSPERINEAL PROSTATE BIOPSY ARE EQUIVALENT TO OUTPATIENT ANTIBIOTIC PROPHYLAXIS IN PREVENTING INFECTION

You have accessJournal of UrologyCME1 Apr 2023MP15-16 SINGLE DOSE ANTIBIOTICS AT THE TIME OF TRANSPERINEAL PROSTATE BIOPSY ARE EQUIVALENT TO OUTPATIENT ANTIBIOTIC PROPHYLAXIS IN PREVENTING INFECTION Maxwell Sandberg, Wyatt Whitman, Janmejay Hingu, Parth Thakker, Caleb Bercu, Anita Rong, Jacob Greenberg, Ronald Davis, Ashok Hemal, and Matvey Tsivian Maxwell SandbergMaxwell Sandberg More articles by this author , Wyatt WhitmanWyatt Whitman More articles by this author , Janmejay HinguJanmejay Hingu More articles by this author , Parth ThakkerParth Thakker More articles by this author , Caleb BercuCaleb Bercu More articles by this author , Anita RongAnita Rong More articles by this author , Jacob GreenbergJacob Greenberg More articles by this author , Ronald DavisRonald Davis More articles by this author , Ashok HemalAshok Hemal More articles by this author , and Matvey TsivianMatvey Tsivian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There has been a trend towards transperineal (TP) prostate biopsy over transrectal (TR) due to a reduced rate of infection. In response, there is now an ongoing debate as to the need for prophylactic antibiotics during TP biopsy. The objective of this study was to argue for the non-inferiority of single-dose antibiotics at the time of biopsy to outpatient antibiotics in preventing infection, regardless of antibiotic class chosen. METHODS: Biopsies were performed using TP technique under TR ultrasound guidance with anesthesia. All patients from 2012-present who underwent TP biopsy were identified and retrospectively chart reviewed. Infection was defined as at least one of the following: fever (≥38.3 °C) or positive urine culture (>10^5 CFU) within 72 hours post-biopsy. Patients were divided into 2 groups, those who received antibiotics at the time of biopsy along with outpatient antibiotics either before/after biopsy (group 1) and those who only received intraoperative antibiotics at the time of biopsy (group 2). Antibiotic choice and duration were at the discretion of the treating physician. Pearson’s Chi Squared was run to evaluate the difference in infection rate between the 2 groups. Fisher’s exact test evaluated the relationship between type of antibiotic and infection rate. RESULTS: A total of 767 biopsies were included in the study. Group 1 had 327 patients and group 2 had 440 patients. Infection rate post-TP biopsy was 1.97% (N=15). The infection rate for group 1 was 1.83% (N=6) and 2.05% (N=9) in group 2. No significant difference in infection rate existed between group 1 and group 2 (p=0.835). Secondary analysis was performed to evaluate infection rates based on antibiotic agent. TP biopsies with multiple antibiotics used at the same time were excluded from analysis. The type of antibiotic administered did not change infection rates within group 1 (p>0.99), group 2 (p=0.673), or between groups 1 and 2 (p>0.99). CONCLUSIONS: Based on our data, it appears that single dose antibiotics at the time of TP prostate biopsy are equivalent to outpatient antibiotic prophylaxis in preventing infection. Further, the class of antibiotic does not seem to affect infection rates. Given the overall low rate of infection, antibiotic regimens should be further evaluated for their utility. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e198 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maxwell Sandberg More articles by this author Wyatt Whitman More articles by this author Janmejay Hingu More articles by this author Parth Thakker More articles by this author Caleb Bercu More articles by this author Anita Rong More articles by this author Jacob Greenberg More articles by this author Ronald Davis More articles by this author Ashok Hemal More articles by this author Matvey Tsivian More articles by this author Expand All Advertisement PDF downloadLoading ...

A Prospective Study Comparing the Infection Rate Between Buried vs Exposed Kirschner Wires in Hand and Wrist Fixations.

Kirschner wires (K-wires) are used in fracture fixations but are often associated with pin tract infections. This prospective study compared the infection rate between buried and exposed K-wires in closed injuries of the wrist and hands in individuals with no comorbidities. Fifteen patients were recruited with a total of 41 K-wires (21 buried K-wires; 20 exposed K-wires). Clinical and radiographic evidence of infection was assessed at three months based on the Modified Oppenheim classification. Two out of 21 wires in the buried group developed grade 4 infection, while 20 wires in the exposed group did not have any significant infection. No significant difference in infection rate based on K-wire size or number in both groups. There is no significant difference ininfection rate between buried and exposed K-wires in healthy individuals with closed injuries of the wrist and hand.

Correction of Breast Ptosis in Immediate Prosthetic Breast Reconstruction after Nipple-Sparing Mastectomy

Objective: Nipple-sparing mastectomy (NSM) is psychologically advantageous and can result in superior cosmetic outcomes. Pre-existing ptosis can result in suboptimal shape of reconstructed breast with lateral nipple displacement. To prevent this deformity, skin tightening with nipple lift are indicated. However, concurrent mastopexy with NSM may lead to ischemic complications. This study reviewed outcomes of breast ptosis correction in immediate prosthetic breast reconstruction after NSM. Methods: All patients who underwent immediate breast reconstruction with tissue expander (TE) or direct-to-implant (DTI) after NSM by the senior author between April 2010 and January 2021, were included in this study. Procedures were stratified into Lift or No-Lift cohorts. Irrespective of Lift or No-Lift, prepectoral and subpectoral implant placement was also analyzed, as was ADM use versus No-ADM. Complications within 30 days were analyzed. Minor complications included erythema, seroma, flap necrosis, nipple necrosis, and prescription of extra antibiotics. Major complications included hematoma, dehiscence, infection, hospitalization, necrosis requiring surgery, any surgical intervention, capsular contracture, and implant loss. Ecchymosis was individually measured. Results: A total of 143 patients underwent immediate reconstruction of 228 breasts after NSM. In 23 patients and 34 breasts, correction of breast ptosis was performed. The remaining 120 patients and 194 breasts did not undergo NAC elevation. Implants were placed in prepectoral position in 119 procedures and submuscular plane in 109. Mean patient age was 49 ± 10 years and BMI 25.9 ± 4.8. Average ptosis grade was 1 ± 1, and mastopexy lift was 3.73 ± 2.12 cm. There was no significant difference in infection rates (8.8% vs 10.3%, p = NS), nor other major (57.7% vs 47.1%, p = NS) and minor complications (76.5% vs 74.7%, p = NS) between Lift and No-Lift groups. Ecchymoses were increased with No-Lift (43.3% vs 11.8%, p < 0.001). All reconstructions were also analyzed based on anatomic plane of implant placement, which demonstrated no difference in major complications. However, loss of implant (27.7% vs 16.5%, p = 0.042) and seroma formation requiring in-office aspiration (28.6% vs 10.1%, p < 0.001) as individual outcomes did occur more with prepectoral than subpectoral planes, as did ecchymoses (56.3% vs 19.3%, p < 0.001). As another distinct analysis, ADM use was associated with more nipple necrosis (26% vs 14.5%, p = 0.049), but this was partial thickness necrosis which did not require operative intervention. Conclusion: Mastopexy at the time of immediate prosthetic breast reconstruction after NSM is safe, with complications similar to a no-nipple-lift technique irrespective of plane of implant placement or ADM use. Corresponding Author: Elizabeth Bushong, 15 Michigan St NE, Grand Rapids, MI 49503, [email protected], (760) 285-4085

Prevalence of Liver Flukes in Some Areas of Salahalddin Province

The present study aimed to diagnosis liver flukes in sheep in Tikrit and Balad districts and compare between prevalence of liver flukes that infect sheep through prevalence of infection and severity of infection. The present study included examination of 951 sheep of both sexes, and aged ranges between less than 1 year and more than 2 years through December 2017 to the end of June 2018. Flukes were isolated directly from liver of sheep. Infected sheep in Tikrit was 97 sheep with prevalence of infection 17.54% and in Balad there was 35 infected sheep with prevalence of infection 8.79%. The highest prevalence of infection in Tikrit recorded in January30.58% and the lowest prevalence of infection recorded in June10% while highest severity of infection was in December it was 2.3 and the lowest severity of infection was in January 1.07 . In Balad discrete highest prevalence of infection recorded in December 13.33% and the lowest prevalence of infection recorded in June 3.84% while highest severity of infection was in December 2.75 and the lowest severity of infection was in January 1.75. The statistical analysis shows that there is no significant difference in infection rate between Tikrit and Balad. &#x0D; &#x0D;