Significant Difference In Infection Research Articles

Characteristics of Helicobacter pylori infection in a National Referral Hospital in Bhutan

Introduction: Helicobacter pylori (H. pylori) is a bacterium causing chronic gastric infection and may cause gastric cancer. It was necessary to see the trend of infection, especially in symptomatic patients. This retrospective descriptive study was aimed to describe the characteristics of H. pylori infection in Bhutanese patients referred for an endoscopy to the National Referral Hospital, Thimphu. Methods: The sample of the study was randomized 380 medical records of the patients who underwent upper gastrointestinal endoscopy and Rapid Urea Test for symptomatic dyspepsia and peptic ulcer. Data was collected using a survey form designed by the researchers. Data analysis was done using descriptive statistics and either Chi-square or Fisher’s exact test. Results: The prevalence of H. pylori infection was very high (76.6%). The mean age of the infection was 42 with a range from 15 to 84 years. The highest prevalence of infection was observed in the age group 20-29 years (82.7%) and lowest in the oldest age group 70-84 years (66.7%). The analysis showed no significant difference in infection amongst age groups, gender, and endoscopic findings to the positive results at 5% significant level except for monthly prevalence (p<0.001). Gastritis was the commonest endoscopy finding (153/380) and gastro-duodenitis had the highest positivity rate (88.9%). Conclusion: The prevalence of infection was relatively high compared with previous studies. Young and middle-aged adults had a high prevalence and this group needs to be given priority for screening and eradication treatment considering limited resources to prevent associated gastric cancer in Bhutan.

Impact of twice- or three-times-weekly maintenance hemodialysis on patient outcomes

Aim:Maintenance hemodialysis (MHD) frequency is associated with survival and complication rates. Achieving the optimal balance between healthcare, quality of life (QOL), and medical costs is challenging. We compared complications, inflammatory status, nutritional status, and QOL between patients with different MHD frequencies.Material and Methods:This was a multicenter randomized trial of patients treated between May 2011 and August 2017 at 3 tertiary hospitals in Wenzhou. Patients were grouped according to their treatment schedule over 1 year: twice-weekly or 3-times-weekly. Complications, biochemistry parameters, and QOL (KDQOL-SFTM 1.3 scale) were assessed.Results:One hundred forty patients were included aged 29 to 68 years (mean age, 50.9 ± 4.3 years). There were no significant differences in infection, heart failure, or cerebral hemorrhage complications between the 2 groups (P = .664). Pre-dialysis hemoglobin, high-sensitivity C-reactive protein, serum albumin, total cholesterol, triglyceride, calcium, phosphate, parathyroid hormone, and ejection fraction were similar in both groups (P > .05). After 1 year of MHD, both groups exhibited significant improvements in these parameters (all P < .05) with no significant differences between groups. Serum creatinine, blood urea nitrogen (BUN), and weekly standard hemodialysis treatment adequacy did not improve after treatment (all P > .05), although a difference in BUN was observed between the 2 groups (P < .001). QOL was superior in the twice-weekly group than in the 3-times-weekly group (all P < .05), except for social support, which was slightly better in the 3-times-weekly group than in the twice-weekly group.Conclusions:Twice- and 3-times-weekly MHD resulted in comparable inflammatory and nutritional clinical outcomes and adverse events. QOL was better for the twice-weekly schedule. Even for patients with economic constraints, twice- or 3-times-weekly MHD should be selected with caution after consideration of BUN levels at baseline.

PD20-10 EFFECT OF ANTIMICROBIAL DIPPING SOLUTIONS ON POST-OPERATIVE INFECTION RATES IN DIABETIC PATIENTS UNDERGOING PRIMARY INSERTION OF A COLOPLAST TITAN INFLATABLE PENILE PROSTHESIS

INTRODUCTION AND OBJECTIVE: Penile prostheses (PP) that are dipped in antimicrobial solutions can be specially selected by the implanter and tailored towards the patient. The best choice for antimicrobial solution is widely debated and remains a surgeon’s preference. We conducted a multi-institutional study of diabetic patients undergoing primary Coloplast Titan PP implantation and compared post-operative outcomes based on the antimicrobial solutions used for dipping. METHODS: Between April 2003 and May 2018, data was collected from 18 different institutions, and charts of 473 patients with diabetes receiving primary PP implantation with Coloplast Titan devices were reviewed. Antibiotics and antifungals used for device impregnation were recorded for each patient. Primary outcome was post-operative infection rate and secondary outcomes were explantation and revision rates. Patients had a median follow-up time of 7 months (range: 0 – 157). Patients were included in the analysis only if they had complete information regarding peri-procedural antimicrobial dip use and the above mentioned outcomes. Univariate comparisons of proportions were completed for rates of infection, explantation, and revision between different antimicrobial regimens. RESULTS: Overall, 468 patients had complete information and were included. The total number of infections, explantations, and revisions were 15 (3.3%), 18 (4.0%), and 27 (6.0%), respectively. Vancomycin + Gentamicin dipping solution was used in 276 devices, 177 devices were dipped in Gentamicin + a different antibiotic solution, of which 143 were dipped in Rifampin + Gentamicin. When comparing the number of infections, those dipped with Vancomycin + Gentamicin had significantly lower infections (1.4%) than those with Gentamicin + a different antibiotic (5.6%, p = 0.014), and those with Rifampin + Gentamicin (5.6%, p=0.014). There was no significant difference in infections when comparing implants that were dipped in Rifampin (158) vs. no Rifampin (310), (p = 0.057). In our cohort, 190 patients had an antifungal used in their dipping solution (Amphotericin) and 278 did not. In the group that had antifungals, there were 5 (2.6%) recorded infections compared to 11 (4.0%) in the group of patients that did not receive any antifungals (p = 0.414). CONCLUSIONS: The use of a Vancomycin + Gentamicin antibiotic dip seems to provide the greatest protection against post-operative infections compared to other antibiotic dips in diabetic patients. The use of antifungal dips, however, does not seem to provide an increased protection against post-operative infections in diabetic patients. Source of Funding: None

Effect of vaginal douching on vaginal flora and genital infection

Objective:This study aimed at examining the effect of vaginal douching (VD), which is a traditional and cultural application, on the vaginal flora and genital infections.Material and Methods:This descriptive study included 190 women including those who did or did not perform VD. A questionnaire survey and vaginal sampling were employed. The collected samples were transported within 8 h for laboratory testing.Results:There was no significant difference between the two groups in terms of vaginal flora. In the VD group, only a few patients reported a history of Sexually Transmitted disease (STD), but none in the non-VD group had STDs (p<0.05). No significant difference in infections was noted. However, there was a significant relationship between the history of infections and VD (p<0.01).Conclusion:Women who performed VD are at risk for vaginal infections. Further studies are warranted in the future for clinical application.

Prevalence of Opportunistic Intestinal Protozoan Infection Among HIV/AIDS Patients in Jalingo Metropolis

Opportunistic protozoans parasitic infection occur frequently in individuals with weakened immune system including people with HIV/AIDS. The study sought to determine the prevalence of opportunistic intestinal protozoan infection in HIV/AIDS patients in Jalingo metropolis. The procedure of wet mount technique and faecal concentration techniques processed the faeces collected. The CD⁴⁺ count of patients were determined using the Partee Cyflow Counter, which determines the percentage of CD⁴⁺ cells of individuals. A total of eight hundred and fifty (850) faecal samples were collected from sero-positive and sero-negative HIV/AIDS persons in Jalingo metropolis. Out of the 850 subjects 650 (76.47%) were sero-positive while 200 (23.53%) were sero-negative (Control). The sero-positive subjects showed higher prevalence of 118 (18.15%) of opportunistic parasitic protozoan infection according to the following hospital locations: Government House, 12 (25.71%); Ummah Clinic, 8 (21.82%); Taraba State Specialist Hospital, 50 (18.18%) and Federal Medical Centre, 38 (15.20%). The prevalence was higher among female positives, 68 (l9.60%) than the male, 50 (16.50%) with no significant difference (p>0.05). The infection based on age groups revealed that the age group 10-15 years had the highest prevalence of 27 (48.21%) while the age group 41-45 years had the least prevalence of 2 (2.63%). Subjects involved in farming had higher prevalence 30 (46.15%) while the least was found among those of trading/business, 33 (13.86%) with no significant difference in infection (p>0.05). <i>C. parvum</i> had the highest prevalence, 46 (24.46%) among the sero-positive individuals while <i>E. coli</i> the highest among sero-negative, 9 (60.00%). It is recommended that clinicians caring for HIV/AIDS patients should request for routine stool examination for the specific diagnosis of opportunistic intestinal parasites infections.

Mild hypothermia can delay the occurrence of post-stroke infection: a propensity score matched-cohort study

To evaluate the effect of mild hypothermia on the incidence of post-stroke infection and explore the relationship between mild hypothermia and outcome of stroke patients by using propensity score matching. Patients hospitalized in department of intensive care unit (ICU), neurology and neurosurgery in the First Affiliated Hospital of Guangxi Medical University due to stroke from March 2012 to April 2018 were retrospectively analyzed. According to whether or not mild hypothermia was provided, they were divided into the normal thermic group (NT group) and mild hypothermia treatment group (MHT group). The MHT group patients were matched with the NT group patients by the propensity score matching method at a ratio of 1:1. The observation period was within the first 7 days after admission. Baseline characteristics including age, gender, type of stroke, comorbidities, acute physiology and chronic health evaluation II (APACHE II) score and Glasgow coma score (GCS) on admission, surgical operation, dysphagia, invasive procedures and outcomes of these patients had been analyzed. The primary outcome was incidence of post-stroke infection, and the secondary outcomes included the time of initial infection (TII, the duration from stroke to initial infection), hospital mortality, sequential organ failure assessment (SOFA) at discharge, incidence of complications such as arrhythmia, coagulation dysfunction and multiple organ dysfunction syndrome (MODS). 201 stroke patients were enrolled, 41.8% (84/201) of whom underwent mild hypothermia. Comparison with NT group before matching, there were more males in MHT group (71.4% vs. 56.4%), the proportion of surgical operation, mechanical ventilation, deep vein catheterization and gastric catheterization were higher (78.6% vs. 54.7%, 84.5% vs. 39.3%, 90.5% vs. 37.6%, 98.8% vs. 70.9%), and so as incidence of infection (90.5% vs. 72.6%), in-hospital mortality (27.4% vs. 12.8%) and TII [hours: 62.00 (35.25, 93.00) vs. 42.00 (28.50, 69.50)]. All the differences were statistically significant (all P < 0.05). Fifty-three patients in the MHT group were matched with 53 patients in the NT group. After matching, there was no significant difference in 15 baseline characteristics between two groups. Significant differences in infection and hospital mortality between the MHT group and NT groups disappeared (92.5% vs. 88.7%, 22.6% vs. 26.4%, both P > 0.05), while TII of MHT group was longer than that of the NT group [hours: 62.00 (40.75, 92.25) vs. 40.00 (28.00, 63.00), P = 0.000]. There were no statistically significant differences in SOFA score or complications between the two groups either before or after matching. Mild hypothermia had no significant effect on the incidence of post-stroke infection and hospital mortality, it could delay the occurrence of infection and provide longer duration of treatment.

Sealing the Intramedullary Femoral Canal for Blood Loss in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials.

Blood loss after total knee arthroplasty (TKA) is a potentially serious medical problem since it leads to anemia, increased need for transfusion, and prolonged hospitalization. Some studies have reported that sealing of the intramedullary femoral canal during TKA may decrease postoperative blood loss. The purpose of this study is to determine the effects of sealing of the intramedullary femoral canal during TKA on blood loss and transfusion rate. Electronic databases, PubMed, EMBASE, the Cochrane Library, Web of Science, and Chinese Biomedical Database, were systematically searched. Only randomized controlled trials (RCTs) that compared the sealing group with the control group during TKA were included up to March 2019. Two reviewers independently extracted data and assessed the quality of included studies. The statistical analysis was performed by using Review Manager 5.3 software. Cochrane Risk of Bias tool was used for quality assessment. Overall, eight RCTs involving 996 patients met our criteria and were analyzed. The results of meta-analysis showed that patients in the sealed group had less total blood loss, less total drain output and less hidden blood loss, less transfusion rates, a lower drop of hemoglobin level at day 1 postoperatively, and less hematoma than the control group. On the other hand, there were no significant differences in infection, deep vein thrombosis, and redness of incision between sealed and control group. Current meta-analysis found that sealing the femoral canal during TKA was an effective method for the control of blood loss.

Autologous Platelet-Rich Plasma and Fibrin Glue Decrease Pain Following Excision and Primary Closure of Pilonidal Sinus.

Pilonidal sinus is one of the most complicated chronic wounds common in younger adults. This disabling condition affects the natal clefts of the buttocks and often requires surgery. To investigate the effect of autologous platelet-rich plasma and fibrin glue (PRP-FG) on pain reduction and the healing process of pilonidal sinus after excisional surgery with primary closure. This randomized clinical trial study included 40 patients with pilonidal sinus admitted to a surgical ward. Patients were randomly divided into two groups: the control group, who underwent wide excision of the sinus with primary closure, and the case group, who had wide excision of the sinus with primary closure along with injection of autologous PRP-FG into the wound. For 6 months, patients were followed up for their severity of pain, wound healing process, the time it took them to get back to normal activities, infection, and other complications. In the first and second week after surgery, the severity of pain in the case group was reduced significantly in comparison with the control group. Healing time decreased but not significantly. There was no significant difference in infection and recurrence between the two groups. The addition of PRP-FG has the potential to reduce pain significantly in primary closure of pilonidal sinus.

Infection after penetrating brain injury-An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas.

Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ and Wilcoxon's rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF (p = 0.8) nor did trajectory through the oropharynx (p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics (p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = <0.001) and in patients with surgical intervention (10% vs. 3%; p < 0.001). There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. Therapeutic, level IV.

Crenosoma vulpis in red foxes (Vulpes vulpes) in Northern Italy.

Crenosoma vulpis, the fox lungworm, is a nematode parasite of wild and domestic canids belonging to the super-family Metastrongyloidea. A survey of infection was carried out examining 88 red foxes (Vulpes vulpes) obtained during the regular hunting season (2014-2015) from the Emilia-Romagna region of Italy. Carcasses were stored frozen (- 21°C) prior to necropsy. Lungs were examined for the presence of adult worms by dissection of the trachea, bronchi, and bronchioles, and then the lung tissue was examined for first-stage larvae (L1) by the Baermann method. No adult stages were detected, but L1, identified based on morphology as Crenosoma vulpis, were recovered from 28.4% (25/88) of the fox lungs. No significant differences in infection were found based on sex or geographical distribution. A brief review on C. vulpis report in red foxes in Italy and other European countries was also carried out.

Clinical Presentation, Management, and Outcomes of Cardiovascular Implantable Electronic Device Infections Due to Gram-Negative Versus Gram-Positive Bacteria

ObjectiveTo describe and compare the clinical presentation, management, and outcomes of cardiovascular implantable electronic device (CIED) infections due to gram-negative bacteria (GNB) and CIED infections due to gram-positive bacteria (GPB). Patients and MethodsWe retrospectively reviewed all CIED infection cases at Mayo Clinic from January 1, 1992, through December 31, 2015. Cases were classified based on positive microbiology data from extracted devices or blood cultures. ResultsOf the 623 CIED infections during the study period, 31 (5.0%) were caused by GNB and 323 (51.8%) by GPB. Patients in the GNB group were more likely to present with local inflammatory findings at the pocket site (90.3% vs 72.4%; P=.03). All patients with bacteremia due to GNB had concomitant pocket infection compared with those with GPB (100% vs 33.9%; P=.002). After extraction, 41.9% of patients in the GNB group were managed with oral antibiotics vs 2.4% in the GPB group (P<.001). There were no statistically significant differences in infection relapse/recurrence or 1-year survival rates between the 2 groups. ConclusionCompared with CIED infections caused by GPB, those due to GNB are more likely to present with pocket infection. Device-related GNB bacteremia almost always originates from the generator pocket. After extraction, oral antibiotic drug therapy may be a reasonable option in select cases of pocket infections due to GNB. No difference in outcomes was observed between the 2 groups.

Prevalence of Urinary Schistosomiasis among primary school children in three rural communities of Kano State, Nigeria

This study was carried out among pupils of three primary schools in Dawakin Kudu Local Government Area of Kano State, Nigeria between May and July, 2018. Three hundred and twenty (320) pupils were examined for the presence of schistosome eggs in urine. Out of the 320 pupils examined only 34 (10.6%) were found to be infected with S haematobium. Males have higher prevalence of 26 (12.1%) compared to females 8(7.6%). The age group 8-10 years has the highest infection rate 13 (15.85%) while the age group 5-7 the least with 1(4.6%). Although sample sizes were not equal, among the communities Fallau with 65 has the highest infection rate with a prevalence of 11(16.9%), Gano with 135 has 14 (10.4%) followed by Danbagina, 120 with a prevalence of 9(7.5%). All infections were light (&lt;50eggs/10ml of urine).There was a significant difference in infection among the different villages examined χ2= 8.94, df = 2, p&lt;0.05.Statistically there was also a significant difference in infection among the different age groups χ2= 2.9356, df = 3, p&lt;0.05. It was concluded that S. haematobium is present in these study areas and unless health education on the mode of transmission of the disease, provision of safe and adequate water supply and sanitation which will help in curtailing the infection is provided, there is the likelihood of a rise in infection rate. This is the first time this type of study was carried out in these study areas.

Detection of respiratory syncytial virus & Mycoplasma pneumoniae in paediatric lower respiratory tract infections.

Background & objectives:Respiratory syncytial virus (RSV) and Mycoplasma pneumoniae are considered common cause of lower respiratory tract infections (LRTIs) in children. The present study was conducted to detect M. pneumoniae and RSV in paediatric LRTIs employing serology, polymerase chain reaction (PCR) and reverse transcriptase PCR (RT-PCR) analysis.Methods:Seventy five children aged one month to five years with acute LRTIs were investigated for M. pneumoniae antibodies and RSV antigen using immunochromatographic test, RT-PCR for RSV and M. pneumoniae by PCR on nasopharyngeal aspirates.Results:RSV infection was observed in 33 (44%) and M. pneumoniae was positive in 26 (35%) children. No significant difference in infection was noted between male and female children. Clinical and radiological features among RSV and M. pneumoniae positive and negative cases were similar. Considering RT-PCR for RSV as gold standard, RSV antigen immunochromatography was 90.90 per cent sensitive and 100 per cent specific.Interpretation & conclusions:Our study showed the presence of RSV and M. pneumoniae infection in 44 and 35 per cent children, respectively with community-acquired LRTIs and aged less than five years.

Molecular Study of Toxoplasma gondii and its Relation to Blood Features in Aborted Women in Al-Qadisiyah Province

The aim of this study was to determine the prevalence of toxoplasmosis and its relation to different blood groups and blood changes associated with toxoplasma gondii infection, In terms of the number of red blood cells, white blood cells, and the rate of hemoglobin in infected females. The study included the collection of 240 samples of married females who suffer from one or more abortion or have congenital and dead birth deform. Their ages ranged from 15–45 years. These samples were divided into three age groups (15–25 years), (25–35), and (35–45) years. After the diagnosis, the results showed that there were 75 parasitic infections from the examined samples. The highest number was 40 cases in the age group (15–25) years. The results also showed significant differences in infection by blood groups, and the highest number was 30 cases inthe blood group O, The lowest number of 10 cases in the blood type B. The results showed a decrease in red blood cells (3.30, 3.50, 4.23). and hemoglobin (8.83, 9.11, 8.92), respectively in the three age groups. As well as a significant increase in the rates of white blood cells in the three age groups (5.81, 6.13, 6.92).

Retrospective analysis of Hepatitis B serology profiles of a co hort of Hepatitis B Surface antigen positive patients, Sri Lanka

Retrospective analysis of Hepatitis B serology profiles of a cohort of Hepatitis B Surface antigen positive patients, Sri Lanka Wirasinghe K1 , Abeynayake JI2 , Perera PADMP 1 , Galagoda G2, Nanayakkara SSJ2, Pradeepa SK2 2 Department of Virology, Medical Research Institute, Colombo 08, Abstract Introduction: Currently more than 350 million people are estimated to be chronically infected with Hepatitis B (HBV). The prevalence of HBV in Sri Lanka is estimated to vary between 0.1‐2.5 %. A detailed descriptive statistical analysis has not yet been performed on the available HBV serology profiles in Sri Lanka. Objective: To describe the serology profiles of Hepatitis B surface antigen positive (HBsAg+) patients tested at the medical research institute of Sri Lanka during 2007-2017 Method: A sample of 517 test reports of patients with positive HBsAg was extracted during the period from 2007 to 2017 for analysis. The serology profiling had been done using ELISA technique available at the time of testing. The data collected for each patient consisted of available data on the MRI request form which included age and gender. Results: The mean age of the sample was 36 years (Mdn=36, 95% CI=36‐38 years) and 5% of them were 20 years was 72%, 22% and 20% respectively. There was a significant difference in infectivity (p Conclusions: More than1/5 of HBV infected is of high infectivity. HBeAg positivity appears to be higher in the age group

Age matters when comparing hemiarthroplasty and total hip arthroplasty for femoral neck fractures in Medicare patients.

The optimal treatment of patients with a displaced intracapsular femoral neck fracture remains controversial. We utilised a national database of Medicare patients to determine if there was any difference in complications and reoperation rate of patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for femoral neck fractures. This study utilised the PearlDiver Patient Records Database, a national for-fee database of Medicare patient procedure and diagnosis records from 2005 to 2012. Outcome procedures and diagnoses including revision, dislocation, infection, and cardiovascular events that occurred during the study time period were also identified over the entire study period as well as 90 days and 2 years. We identified 275,439 patients with femoral neck fractures who underwent HA and 26,017 patients who underwent THA, respectively. Patients undergoing HA had significantly lower rates (p < 0.0001) of revision 2.48% versus 3.85% (OR = 0.633; 95% CI, 0.592-0.678), dislocation 1.76% versus 3.39% (0.512; 0.476-0.551), infection 3.44% versus 4.87% (0.694; 0.657-0.737). There was no statistical significant difference in 2-year cardiac morbidity (p = 0.252). However, when controlling for age, patients 65-69 years showed no significant difference in infection or revision over the study period or at 2 years. In this study, patients who underwent THA for femoral neck fractures had a higher rate of dislocations, infections and increased rates of repeat surgery than those who underwent HA but this difference was not significant in patients 65-69 years. Hemiarthroplasty may result in fewer complications in older Medicare patients although this difference may not be present in younger Medicare patients.

Divergent parasite infections in sympatric cichlid species in Lake Victoria.

Parasitism has been proposed as a factor in host speciation, as an agent affecting coexistence of host species in species-rich communities and as a driver of post-speciation diversification. Young adaptive radiations of closely related host species of varying ecological and genomic differentiation provide interesting opportunities to explore interactions between patterns of parasitism, divergence and coexistence of sympatric host species. Here, we explored patterns in ectoparasitism in a community of 16 fully sympatric cichlid species at Makobe Island in Lake Victoria, a model system of vertebrate adaptive radiation. We asked whether host niche, host abundance or host genetic differentiation explains variation in infection patterns. We found significant differences in infections, the magnitude of which was weakly correlated with the extent of genomic divergence between the host species, but more strongly with the main ecological gradient, water depth. These effects were most evident with infections of Cichlidogyrus monogeneans, whereas the only host species with a strictly crevice-dwelling niche, Pundamilia pundamilia, deviated from the general negative relationship between depth and parasitism. In accordance with the Janzen-Connell hypothesis, we also found that host abundance tended to be positively associated with infections in some parasite taxa. Data on the Pundamilia sister species pairs from three other islands with variable degrees of habitat (crevice) specialization suggested that the lower parasite abundance of P.pundamilia at Makobe could result from both habitat specialization and the evolution of specific resistance. Our results support influences of host genetic differentiation and host ecology in determining infections in this diverse community of sympatric cichlid species.

Comparison between patient specific implants and conventional mini-plates in Le Fort I osteotomy with regard to infections: No differences in up to 3-year follow-up

Individually designed osteotomies and milled or printed patient-specific osteosynthesis materials are rapidly becoming a standard in maxillofacial reconstructive surgery. The benefits of using patient-specific implants (PSIs) in orthognathic surgery are especially clear in complex cases, and for this reason they are rapidly becoming common practice. We have earlier reported the benefits related to the use of PSIs as reposition and fixation system in Le Fort I osteotomy. The aim of this study was to compare complications associated with fixation with PSIs (31 patients) versus conventional mini-plates (37 patients) in Le Fort I osteotomy. No statistically significant differences in infection, reoperations or soft tissue problems were observed between the two systems used. Interestingly, three of the 37 patients in the mini-plate group underwent reoperation due to insufficient advancement or malocclusion, whereas none of the patients in the PSI group needed reoperation. In conclusion, PSIs are reliable for use in orthognathic surgery, with no signs of infection associated complications.

Comparison of second and third generation total ankle arthroplasty learning curves

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has evolved over the past decades with later generation implants being associated with improved instrumentation and hardware. There have been multiple reports of the “learning curve” associated with total ankle arthroplasty. These report higher complication rates during the initial procedures performed by an inexperienced surgeon. To our knowledge, there is no comparison of the 2nd generation and 3 rd generation implant learning curves. Methods: The clinical outcomes of the first 15 cases (8/2002-4/2005) of a 2nd generation fixed bearing prosthesis (Agility Total Ankle System) and the first 15 cases (6/2007-3/2009) of a 3 rd generation fixed bearing prosthesis (Salto Talaris® TotalAnkle Prosthesis) performed by a single surgeon were retrospectively reviewed to determine complication incidence. The initial cases with each system were also independently reviewed to determine if there was a significant learning curve in regards to complications. Reoperation, infection, gutter impingement, fracture, persistent pain, and periprosthetic cyst formation were included for comparison of complication rates. Results: The overall complication rates for the Agility were 54.9% (28/51) and 35.7% (25/70) for Salto Talaris. There was no significant difference in reoperation rates when comparing the first 15 Agility cases (8/15, 53%) to the remainder of Agility cases (11/36, 30.6%) p=0.2. The initial 15 Salto Talaris cases also demonstrated no significant difference in reoperation rates (1/15, 8%) when compared to the remaining Salto Talaris replacements (7/55, 12.7%) p=1. Reoperation rates were higher in the initial 15 Agility cases (8/15, 53%) compared to the initial 15 Salto cases (1/15, 8%) p=0.01. There was no significant difference in infection, hardware failure, and medial malleolus fracture rates for any of the groups. Conclusion: While this series demonstrated no significant learning curve for each individual total ankle system, there was a significantly higher reoperation rate in the initial cases for the 2nd generation TAA when compared to the initial cases of the 3 rd generation implants. This could be attributed to improved instrumentation and hardware and/or surgeon experience.

Human pegivirus persistence in human blood virome after allogeneic haematopoietic stem-cell transplantation

ObjectivesBecause commensal viruses are defined by the immunologic tolerance afforded to them, any immunomodulation, such as is received during haematopoietic stem-cell transplantation, may shift the demarcation between innocuous viral resident and disease-causing pathogen. MethodsWe analysed by deep-sequencing the plasma virome of 40 allogeneic haematopoietic stem-cell transplantation patients 1 month after transplantation. Because human pegivirus (HPgV) was highly prevalent, we performed a 1-year screening of 122 plasma samples by specific real-time reverse transcription PCR assay. We used the log-rank test and the Gray test to assess association with outcomes, and the Mann-Whitney test and multivariable linear regression model to assess association with T-cell reconstitution. ResultsPolyomaviruses (PyV) (20/40 patients), anelloviruses (16/40), pegiviruses (14/40) and herpesviruses (14/40) were most frequently identified, including ten cytomegalovirus; three Epstein-Barr virus; two herpes simplex virus type 1; one human herpesvirus 6b and one human herpesvirus 7; 18 Merkel cell–PyV; two BK-PyV; three PyV-6; and one JC-PyV. Papillomavirus and adenovirus were identified in 11 and two patients, respectively. The HPgV specific real-time reverse transcription PCR screening identified 51 of 122 positive samples, high virus loads and persistent infections up to 1 year after transplantation. Comparison between patients with or without HPgV infection at time of transplantation did not reveal a significant difference in infections, engraftment, survival, graft vs. host disease, relapse or immune reconstitution. ConclusionsThe blood virome after allogeneic haematopoietic stem-cell transplantation includes several DNA viruses, notably herpesviruses and PyV. Among RNA viruses, HPgV is highly prevalent and persists for several months, and it thus may deserve special attention in further research on immune reconstitution.