Single Case Of Infection Research Articles

Modified hepatic left lateral lobe inversion in laparoscopic proximal gastrectomy: An analysis of 13 cases.

In laparoscopic proximal gastrectomy (LPG), the prolapse of the hepatic left lateral lobe near the lesser curvature and esophageal hiatus can obstruct the field of vision and operation. Therefore, it is necessary to retract or obstruct the hepatic left lateral lobe to ensure a clear field of vision. To investigate the safety and clinical efficacy of the modified hepatic left lateral lobe inversion technique for LPG. A retrospective analysis was conducted on the clinical data of 13 consecutive patients with early-stage upper gastric adenocarcinoma or adenocarcinoma of the esophagogastric junction treated with LPG from January to December 2023 at the Department of Gastrointestinal Surgery, Second Affiliated Hospital of Fujian Medical University. The modified hepatic left lateral lobe inversion technique was used to expose the surgical field in all patients, and short-term outcomes were observed. In all 13 patients, the modified hepatic left lateral lobe inversion technique was successful during surgery without the need for re-retraction or alteration of the liver traction method. There were no instances of esophageal hiatus occlusion, eliminating the need for forceps to assist in exposure. There was no occurrence of intraoperative hepatic hemorrhage, hepatic vein injury, or hepatic congestion. No postoperative digestive complications of Clavien-Dindo grade ≥ II occurred within 30 days after surgery, except for a single case of pulmonary infection. Some patients experienced increases in alanine aminotransferase and aspartate aminotransferase levels on the first day after surgery, which significantly decreased by the third day and returned to normal by the seventh day after surgery. The modified hepatic left lateral lobe inversion technique has demonstrated satisfactory results, offering advantages in terms of facilitating surgical procedures, reducing surgical trauma, and protecting the liver.

Analysis of Distribution and Drug Susceptibility Test Results of Pathogenic Bacteria in Diabetic Foot Ulcers.

This study aimed to determine the pathogen distribution and drug susceptibility of diabetic foot wound secretions in a tertiary hospital in a coastal area of southeastern China to guide clinical antibiotic selection. A retrospective analysis was conducted on 212 patients with diabetic foot hospitalized at Xiamen Third Hospital from 2018 to 2023, and foot wound secretions were collected for microbial culture and drug susceptibility testing. Among 212 cases of patients with diabetic foot wound secretions, 163 cases (76.9%) were cultured with pathogenic bacteria, and a total of 207 strains of pathogenic bacteria were cultured, including 75 strains (36.23%) of Gram-positive (G+) bacteria, 118 strains of Gram-negative (G-) bacteria (57.00%), 14 strains of fungi (6.76%), 120 cases of single microorganism infection (73.62%), 43 cases of mixed infection (26.38%), and 15 strains of multidrug-resistant bacteria (7.25%). The top three pathogenic bacteria were Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. G+ bacteria were dominated by S.aureus. Drug susceptibility results showed that G+ bacteria were highly susceptible to vancomycin, linezolid, tigecycline, quinupristin/dalfopristin, rifampicin, and furotoxin, and somewhat resistant to penicillin, erythromycin, clindamycin, and cefoxitin. Among G- bacterial infections, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Proteus were the major species. Drug susceptibility testing indicated that carbapenems such as imipenem and ertapenem were the most effective antibacterial drugs against G- strains, followed by amikacin, piperacillin, and tazabactams to which these bacteria were also relatively sensitive, while resistance to penicillins and first-generation cephalosporins increased significantly. We isolated one strain of pathogenic bacteria from a Wagner grade1 ulcer, which was G+ bacteria. In Wagner grade2 ulcers, the distribution of pathogenic bacteria was mainly G+ bacteria. In Wagner grade3 and 4 ulcers, the distribution of pathogenic bacteria was mainly G- bacteria, and the increased rate of mixed infection was mainly due to mixed infection of G+ and G-. Two strains of pathogenic bacteria were isolated at Wagner grade5, which were mixed infections of G+ and G-. Pathogenic bacteria in diabetic foot wounds are predominantly G- bacteria, followed by G+ bacteria. As the Wagner ulcer grade increases, the distribution of pathogenic bacteria changes from G+ bacteria to G- bacteria, and the mixed infection rate increases. G+ bacteria are highly susceptible to vancomycin, linezolid, tigecycline, quinupristin/dalfopristin, rifampicin, and furotoxin, and somewhat resistant to penicillin, erythromycin, clindamycin, and cefoxitin. G- bacteria are more sensitive to the antimicrobial drugs ertapenem, imipenem, amikacin, piperacillin tazobactam, and have high resistance to penicillin and first-generation cephalosporins.

(244) Optimization of Sperm Retrieval in Non-Obstructive Azoospermic Patients using Conventional TESE

Abstract Introduction Sperm retrieval in NOA patients remain to be the only hope for these patients for fatherhood using assisted reproductive techniques. Micro-TESE is the gold standard with the best retrieval rate. Microsurgical facilities are not available at every center and conventional TESE techniques are not standardized between different centers. Objective Our aim is To improve the spermatogenic function of NOA patients to enable the appearance of sperm in their ejaculate or to improve the chances of a successful retrieval from the testis for ICSI and To optimize and standardize our conventional TESE technique Methods Over last 7 years 94 cases of NOA patients were subjected to conventional TESE. We Exclude the cases of Obstructive Azoospermia, Cases with abnormal chromosomal analysis were referred for higher center for genetic counselling and diagnosis. Laboratory workup including at least two semen samples, hormonal valuation (FSH, LH, Prolactin, Testosterone) and chromosomal analysis (Karyotyping and Testing for Y chromosome micro-deletions. Pre-TESE medical Treatment: included Clomiphene citrate: 50 mg OD for 3–6 months, Anti-oxidant therapy (Vitamin E 200mg BID and Vitamin C, 1 gm, OD). 6 biopsies from each testis: upper pole 2(medial &Lateral), mid zone 2 (medial & Lateral), lower pole 2(medial &Lateral). Separate biopsy from each testis was sent for definitive histopathological correlation. Experienced embryologist attends each procedure examining each biopsy until sperms are retrieved. Samples taken were centrifuged and re-examined at lab for any missed sperm Results sperm retrieval was successful in 38patients (40.4%). All cases were done as day case No single case of wound infection or intra-testicular hematoma.Post-operative pain was tolerable and managed by paracetamol ±NSAID Negative cases for sperms were continued on higher dose of CC and referred for microTESE Conclusions Though of low-evidence, empiric Pre-TESE enhancement of spermatogenesis should be attempted whenever possible and after proper patients counselling. This systematic anatomical approach for biopsies yielded high SRR compared to other conventional TESE. Exact localization of + ve testicular site and side If patient needed Re-do TESE for more sperms in the future. Although micro TESE remains to be the best modality for SR in NOA, in our hands and in canters without Micro-TESE facilities, applying this standardized technique with pre-operative hormonal manipulation yields accepted rate of sperm retrieval Disclosure No.

Revisiting HPV infection pattern among urban Indonesian women in general population and its implication on health burden: A cross-sectional analysis from Indonesian Noncommunicable Disease Research 2016

Objective: To identify circulating HPV types among urban Indonesian women and their specific co-infection patterns in bid to curb HPV infection in the general population and minimize its complications. Methods: Urban Indonesian women from general population were selected as sample framework. Sample size and distribution across regions were determined by the Indonesian Bureau of Statistics (Badan Pusat Statistik, BPS), which represented the national level. Up to 35 408 cervical swab specimens were collected from August to September 2016 in 34 Indonesian provinces, categorized into six regions based on the development criteria set by the Ministry of National Development Planning (Badan Perencanaan Pembangunan Nasional, BAPPENAS). From all 1874 samples identified as HPV-positive, hybrid capture was implemented to evaluate type-specific HPV. This study analyzed descriptive data to determine the core-cluster of HPV combination. Co-occurrence HPV network was assessed using ‘qgraph’ package version 1.6.3 and computed in R version 3.6.3. Two-HPV association was analyzed in logistic regression using bias-reduction generalized linear model (brglm2) package version 0.5.1 adjusted by age and six main Indonesian regions. Results: The logistic regression analysis demonstrated that HPV type 52 had rare relationship despite its common co-occurrence, cementing its role in single HPV infection. HPV type 16 and 18 tended to form infection cluster and were strongly associated with other types. Conclusions: HPV type 52 was the most frequent HPV type among urban Indonesian women and accounted for most single infection cases. Concurrently, HPV 16 and HPV 18 accounted for most multiple infection cases and had strong tendency to attract other types, which may add further complications. However, due to lack of cytology and histological examination and information for other potential determinants, further in-depth studies are necessary to confirm whether these infection patterns truly connect to certain clinical outcomes.

Evaluation of performance for malaria diagnosis in health facilities by five provincial reference laboratories of China.

The provincial malaria diagnosis reference laboratories review and assess malaria cases diagnosed in health facilities for supporting the malaria elimination efforts and preventing re-transmission of imported malaria. The study aimed to evaluate the detection capability of malaria diagnosis in China from 2014 to 2021. Data on malaria cases reported in the provincial-level administrative divisions (PLADs) of Anhui, Henan, Hubei, Guangxi, and Zhejiang from 2014 to 2021 were collected and analyzed. In total, 5,770 malaria cases were reported from 2014 to 2021, and 99.05% (5,715/5,770) were submitted to the provincial malaria diagnosis reference laboratories. The median time between malaria cases being reported and the samples being received by reference laboratories was 6 days (Interquartile range, IQR:3-12 days) from 2017 to 2021. Diagnosis of 5,680 samples in the laboratory were confirmed by provincial reference laboratories, including 3,970 cases of Plasmodium falciparum, 414 of P. vivax, 1,055 of P. ovale, 158 of P. malariae, 1 of P. knowlesi, and 82 of mixed infections. Plasmodium species of 5,141 confirmed cases were consistent with the initial diagnosis, with a species accuracy rate of 90.53% (5,141/5,679). The accuracy of P. falciparum diagnosis in health facilities was higher than that of non-falciparum species. The inconsistency between microscopy and nested polymerase chain reaction (nPCR) results of confirmatory diagnosis was mainly in malaria-positive versus malaria-negative cases, as well as in mixed versus single infection cases. The provincial malaria diagnosis reference laboratories have played an important role in ensuring the accuracy and reliability of Plasmodium diagnosis in health facilities. However, the results of this study imply that capacity training for the identification of Plasmodium species in health facilities is warranted.

The Optimal Strategies to Be Adopted in Controlling the Co-Circulation of COVID-19, Dengue and HIV: Insight from a Mathematical Model

The pandemic caused by COVID-19 led to serious disruptions in the preventive efforts against other infectious diseases. In this work, a robust mathematical co-dynamical model of COVID-19, dengue, and HIV is designed. Rigorous analyses for investigating the dynamical properties of the designed model are implemented. Under a special case, the stability of the model’s equilibria is demonstrated using well-known candidates for the Lyapunov function. To reduce the co-circulation of the three diseases, optimal interventions were defined for the model and the control system was analyzed. Simulations of the model showed different control scenarios, which could have a positive or detrimental impact on reducing the co-circulation of the diseases. Highlights of the simulations included: (i) Upon implementation of the first intervention strategy (control against COVID-19 and dengue), it was observed that a significant number of single and dual infection cases were averted. (ii) Under the COVID-19 and HIV prevention strategy, a remarkable number of new single and dual infection cases were also prevented. (iii) Under the COVID-19 and co-infection prevention strategy, a significant number of new infections were averted. (iv) Comparing all the intervention measures considered in this study, it is possible to state that the strategy that combined COVID-19/HIV averted the highest number of new infections. Thus, the COVID-19/HIV strategy would be the ideal and optimal strategy to adopt in controlling the co-spread of COVID-19, dengue, and HIV.

Cervical carcinogenesis risk association of HPV33 E6 and E7 genetic variations in Taizhou, Southeast China

BackgroundHuman papillomavirus (HPV) 33 belongs to the Alphapapillomavirus 9 (α-9 HPV) species group, which also contains types 16, 31, 35, 52, 58 and 67. The purpose of this study was to investigate the genetic variations of HPV33 and to explore its carcinogenicity among women in Taizhou, Southeast China.MethodsExfoliated cervical cells were collected for HPV genotyping. Only single HPV33 infection cases were selected, and their E6 and E7 genes were sequenced using the ABI 3730xl sequencer and then analysed using MEGA X.ResultsFrom 2014 to 2020, a total of 185 single HPV33-positive specimens were successfully amplified. We obtained 15 distinct HPV33 E6/E7 variants, which were published in GenBank under accession numbers OQ672665-OQ672679. Phylogenetic analysis revealed that all HPV33 E6/E7 variants belonged to lineage A, of which 75.7% belonged to lineage A1. Compared with CIN1, the proportion of sublineage A1 in CIN2/3 was higher, but there was no significant difference (76.5% vs. 80.6%, P > 0.05). Altogether, 20 single nucleotide substitutions were identified, of which 6 were novel substitutions, including T196G (C30G), A447T, G458T (R117L), G531A, A704A, and C740T. In addition, no significant trends were observed between the nucleotide substitutions of HPV33 E6/E7 variants and the risk of cervical lesions.ConclusionThis study provides the most comprehensive data on genetic variations, phylogenetics and carcinogenicity of HPV33 E6/E7 variants in Southeast China to date. The data confirmed that cervical lesions among women in Taizhou are attributable to HPV33, which may be due to the high infection rate of sublineage A1 in the population.

Experience of following up couples affected by hiv and planning pregnancy with use of assisted reproductive technologies in sverdlovsk region

Objective. To analyze the structure of discordant (DC) and concordant (CC) pairs and outcomes of assisted reproductive technologies (ART) without taking into account the correlation of antiretroviral therapy in the Regional Center for AIDS during 2021.
 Materials and methods. A retrospective analysis of medical records of 210 couples who were consulted at the State Healthcare Institution "RC AIDS" was conducted in order to obtain a conclusion from the medical commission on the possibility of carrying out the ART procedure. The following data were analyzed: channel of infection in men and women, age composition, stage of HIV infection, duration of ART use, ART outcomes.
 Results. The procedures using ART are carried out in the same percentage as both DC and CC pairs. The outcomes of the ART procedure in PrEP: 2 women (6.9 %) had miscarriage,4 (13.8 %) regression of pregnancy,23 (79.3 %) childbirth; in CC 1 woman (7.7 %) had miscarriage, in the remaining 12 (92.3 %) the procedure was completed with childbirth.
 Conclusions. As a result of implementing the procedure with ART,35 children were born, not a single case of HIV infection in children was registered.

A cross-sectional study of human papillomavirus genotype distribution and integration status in penile cancer among Chinese population

Human papillomavirus (HPV) has been recognized as an important risk factor in penile cancer. This study aimed to investigate the HPV subtypes and integration status in Chinese patients. Samples were collected from 103 penile cancer patients aged 24–90 years between 2013 and 2019. We found that HPV infection rate was 72.8%, with 28.0% integration. The aging patients were more susceptible to HPV (p = 0.009). HPV16 was the most frequent subtype observed (52/75) and exhibited the highest frequency of integration events, with 11 out of 30 single infection cases showing integration positive. The HPV integrations sites in the viral genome were not randomly distributed, the breakpoints were enriched in the E1 gene (p = 0.006) but relatively scarce in L1, E6 and E7. Our research might provide some clues how HPV leads to the progression of penile cancer.

Sentinel cluster of locally acquired Japanese encephalitis in southern Australia.

Prior to January 2022, only a single case of infection with Japanese encephalitis virus (JEV) had been reported on the Australian mainland, acquired in the northern extremity on Cape York. We report the clinical characteristics of the sentinel cluster of cases that confirmed the local acquisition of JEV in southern Australia along the Murray River bordering New South Wales and Victoria.

Ibrutinib Alone or in Combination with R-CHOP Chemoimmunotherapy in Relapsed or Refractory Primary Central Nervous System Lymphoma (rrPCNSL): A «Real-Life» Study

Background. Patients (pts) with rrPCNSL have poor prognosis, with median survival after relapse (SAR) of 3.5 months. No standard of care exists in this setting and a few drugs showed activity, usually assessed in small prospective series. Ibrutinib (IBR) monotherapy was associated with an overall response rate (ORR) of 47%-77%, with a few cases of complete response (CR), and a median progression-free survival (PFS) shorter than 5 months in two studies on 30 and 13 pts with rrPCNSL [Soussain et al, EJC 2019; Grommes et al, Cancer Disc 2017]. Confirmatory real-life studies are lacking, and the poor efficacy shown by ibrutinib as single drug has prompted physicians to use this drug in combination with chemoimmunotherapy. The choice often fell on RCHOP on the base of phase III PHOENIX trial [Younes et al. JCO 2019], where IBR + RCHOP was associated with a survival benefit in young pts with non-GCB DLBCL, the prevalent phenotype of PCNSL. Moreover, IBR demonstrated a permeabilizing effect on CNS tumor vessels in preclinical models [Meeks et al. NeuroOncol, 2019], posing the rationale for its combination with R-CHOP in rrPCNSL. Herein, we report tolerability and activity of IBR, alone or combined with RCHOP, in pts with rrPCNSL treated in open access program or compassionate use between January 2021 and June 2022 in 15 Italian centres. Methods. HIV-negative pts with rrPCNSL eligible for IBR and previously treated with a prior line of high-dose-methotrexate (HDMTX)-containing chemotherapy were registered in a retrospective multicenter study and analyzed on intention-to-treat (ITT) principle. Diagnosis of DLBCL was histologically confirmed in all cases. Response and toxicity were assessed and graded according to standardized IPCG criteria [Abrey et al, JCO 2005] and CTCAE v5.0, respectively. ORR was the primary endpoint. Since the increased risk of invasive fungal infection (IFI) reported in previous studies, physicians used Isavuconazole as antifungal prophylaxis. IBR dose and schedule were based on physician's preference. Results: Twenty-seven pts (median age 65, range: 42-77; 8 males) were considered (see tables 1 and 2 for pts characteristics and treatment). Twenty-five (93%) pts received IBR, with the addition of RCHOP (I-RCHOP) in 18; two pts died of progressive lymphoma before to start IBR. The median time from relapse to first IBR dose was 30 (range 10-70) days. Sixteen pts completed at least 2 cycles of RCHOP (median 3, range 1-6), while the other two did not because of infectious complications. Grade≥3 hematological and non-hematological toxicities occurred in 13 (52%) and 7 (28%) pts, respectively; all episodes of grade ≥3 toxicity but one occurred in the I-RCHOP group. The first 11 pts were treated without anti-fungal prophylaxis, three of them had IFI, which was lethal in two. Accordingly, the following pts received isavuconazole as prophylaxis, which was associated with a single case of grade-3 fungal infection. The four IFI occurred in the I-RCHOP group. Isavuconazole was well tolerated, with a single case of transient grade-3 toxicity (liver). The best response was CR in 7 pts (26%) and PR in 8 (30%), with an ORR of 56% (95% CI= 37-75), 13 experienced progressive disease (PD). Six pts with responsive disease (all of them treated with I-RCHOP) received consolidation with ASCT (3), WBRT (1), and/or IBR maintenance (3). At a median follow-up of 15 months (range 2 - 23), 5 responders experienced relapse, 7 remained relapse-free and two died of toxicity while relapse free, with a 1-year PFS and SAR of 26% (95% CI 5-56) and 29% (95% CI 6-54), respectively. Nine pts are alive: 5 (28%) after I-RCHOP and 4 (57%) after IBR alone. Overall, 5 pts (19%) are progression-free ≥12 months, all but one treated with I-RCHOP. Conclusions: This is the first real-life experience on the use of ibrutinib in pts with rrPCNSL. Two thirds of pts treated with I-RCHOP achieved an objective response, which encouraged physicians to indicate consolidation/maintenance, with consequent durable remission in 19% of pts. New IBR-based combinations should be addressed in rrPCNSL pts. In this setting, isavuconazole prophylaxis should be added to prevent IFI, an important life-threatening complication. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Genetic characterization of dengue virus from patients presenting multi-serotypic infections in the Northern West Bengal, India.

Northern West Bengal, popularly known as North Bengal, is a dengue-endemic area, which has been severely affected by Dengue in the past few years resulting in massive hospitalizations and deaths. Genetic characterization of the circulating endemic dengue virus (DENV) serotypes is of paramount importance for the epidemiological understanding of the infection and subsequent vaccine development. The present study was conceived to characterize circulating dengue serotypes and to undertake phylogenetic study. EDTA blood samples of all (N = 83) NS1-positive cases of patients with acute febrile illness referred to different health care facilities were collected and processed for RNA isolation followed by the complementary DNA (cDNA) preparation. Serotype determination of dengue infection was done using conventional PCR by targeting the viral C-prM region. Phylogenetic tree was constructed by implementing the Maximum likelihood method. Out of 83 blood samples 17 were detected to be positive for the presence of dengue viral RNA. DENV3 was found to be the predominant serotype in the single-infection cases; however, we have detected multi-serotypic co-infections throughout the study. Joint pain was found to be the most valuable symptom for the prognosis of dengue. Sequence analyses suggested that both DENV1- and DENV3-circulating genotypes are in the genotype III group and remain closely related to the Indian clade. To the best of our knowledge, this is the first report on the genetic characterization of circulating DENVs in North Bengal, which may contribute to the study of dengue epidemic and pathogenesis.

The outcomes of pics technique for the management of end-stage peyronie's disease

To present the surgical, the functional and patients’ reported outcomes (PROs) of PICS technique in multicentric series of patients affected by end-stage PD. Patients underwent an IPP implantation followed by PICS technique were recruited in two European tertiary referral center. The primary endpoint of the study was the achievement of a complete straightening of the penis. The secondary endpoints were surgical, functional and PROs. The International Index of Erectile Function (IIEF-5), the Sexual Encounter profile questions 2 and 3 (SEP 2 and SEP 3) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) were used to assess patients’ erectile function. The PICS technique was used in 37 patients. Median patient age was 62 years (IQR 57-70 years). Residual curvature after IPP was 60° (IQR 50–70°). Operative time was 100 minutes (IQR 90–120). Median follow-up resulted of 14 months (IQR 12–17). 27 of 37 patients (72.9%) achieved a totally straight penis. 6 patients (16.2 %) experienced a residual penile curvature: of 10° in 3 patients, 15° in 1 patient and 20° in 2 patients. The residual curvature did not interfere with sexual intercourse in any of the cases. No intraoperative complications were detected. 9 of 37 patients (24.3%) developed an early postoperative complications: 3 (8.1%) manifested a transient fever and 6 (16.2%) experienced a genital hematoma. We detected a single case (2.7%) of acute infection requiring a removal of the IPP. No cases of IPP mechanical failure were described. Median IIEF-5 score increased from 10 (8-12) in postoperative settings to 23.5 (22.2-25) at 12 months follow-up. SEP 2-3 increased from 5 (13.5%) and 0 (0%) to 34 (91.9) in both domains. EDITS scored 25 (21.2-29.5) at 12 months follow-up. The PICS technique represents a safe and effective approach to manage residual penile curvature during IPP placement in patients with end-stage PD. None

Hepcidin as a Sensitive and Treatment-Responsive Acute-Phase Marker in Patients with Bacteremia: A Pilot Study.

Hepcidin regulates iron metabolism by inhibiting intestinal iron absorption and iron release from iron stores. In addition to iron overload, inflammatory conditions also up-regulate hepcidin synthesis, which may serve as an antimicrobial defense by reducing iron availability to the invading microbes. The purpose of this study is to test this hypothesis in human patients by determining serum hepcidin concentration by enzyme linked immunosorbent assay (ELISA) in healthy blood donors (n = 60) and patients hospitalized because of bacteremia (n = 50), before (day 0) and after seven days (day 7) of appropriate antibiotic treatment. Serum hepcidin was significantly increased in patients with bacteremia, both at day 0 and at day 7, compared to healthy controls. However, there was significant reduction of serum hepcidin after 7-day treatment, in concert with changes in serum C-reactive protein (CRP). The hepcidin changes were similar for both Gram-negative and Gram-positive single infection cases, while CRP was significantly reduced only in the former. In contrast to hepcidin, the levels of serum ferritin in the patients remained high after treatment, irrespective of infection type. These data confirm the stimulation of hepcidin secretion in human subjects upon different types of systemic microbial infection and suggest that hepcidin is a more sensitive and treatment-responsive acute-phase marker than ferritin in bacteremia, which needs to be explored with bigger-sized and better-matched patient cohorts.

On the fractional order model for HPV and Syphilis using non–singular kernel

Most dynamical systems employ the classical integer-order derivatives which yield good results. However, recent trends have shown that the application of arbitrary order derivatives, popularly known as fractional order derivatives produces better and more realistic results to a given real life scenario because they are non-local operators. In this work, a fractional order co-infection model for human papilloma virus (HPV) and Syphilis is considered and studied using the non-singular kernel derivative. With the aid of Banach and Schauder’s fixed point theorems, the existence and uniqueness of the solution is proven. The conditions for the existence and uniqueness of the solution of the model are also established. The model’s disease free equilibrium (DFE) is shown to be locally asymptotically stable when the reproduction number is below one. The fractional order model is shown to be generalized Ulam Hyers–Rassias stable, under some conditions. The predictor–corrector method with convergence of min2,1+φ was used for the numerical simulations. Simulations of the model showed that the fractional derivative greatly influenced the dynamics of both diseases and their co-infection. Furthermore, it was observed that control strategy for single infection (syphilis only prevention strategy or HPV only prevention strategy) did not result in reduction of single infection cases, instead reduces the co-infection of new cases.

Evaluation of Illizarov Principle of Infected Nonunion Tibia

Background: Among several treatment options for the management of infected nonunion tibia, Illizarov technique is a newer one.Illizarov technic has many good advantages and features. But in Bangladesh we have very few research-based information regarding the effectiveness and outcomes applyingIllizarov principle in treatinginfected nonunion tibia. Aim of the study: The aim of this study was to evaluate the effectiveness and outcomes Illizarov principle in treating infected nonunion tibia. Methods: This prospective observational study was conducted in the Department of Orthopedics, Holy Family Red Crescent Hospital Dhaka Bangladesh during the period from January 2018 to December 2019. In total 27 patients with infected nonunion tibia were selected as the study population. Illizarov technic was applied for all of the patients. Before starting data collectionproper written consentsfrom all the participants were taken. A pre-designed semi-structured questioner was used in collecting necessary patient data. All data were processed, analyzed and disseminated by MS Office and SPSS version 20.0 as per need. Results: In this study, as postoperative complications, local pain with motion, local oedema, painful tenting of skin and pin tract infection were found in 3.705, 7.41%, 14.81% and 18.51% participants respectively. There was not a single case of deep infection or unacceptable malunion or non-union. As the final outcomes of this technic as per the Karlstrom and Olerud criteria, the highest 59% patients got ‘excellent’ result. Then 30%, 7% and the rest 4% patients got ‘good’, ‘fair’ and ‘poor’ result respectively. Conclusion: For the management of infected nonunion tibia,Illizarov technic opened a new era. Considering the god features of this technic like less blood loss, lower complication rate, shorter duration of hospital staying and prompt healing physicians can take this principle as the method of choice in treating infected nonunion tibia.

Prevalence of Group B Streptococcus Colonization among Pregnant Women and Feto-Maternal Outcomes in a Tertiary Health Institution, North-Western Nigeria

Background: Group B Streptococcus (GBS) infection is a major cause of bacterial infections in the peri-natal period. These include amnionitis, urinary tract infections and endometritis. At birth, 50-60% of the neonates born to colonized mothers have positive cultures taken from mucus membranes and the skin. Aim: The aim of this study is to determine prevalence of GBS colonization and compare the maternal and perinatal outcomes among GBS positive and GBS negative women within 7 days postpartum. Methodology: This was a longitudinal study among pregnant women between 35-37 weeks gestation attending antenatal clinic at Usman Danfodiyo University Teaching Hospital, Sokoto. Vaginal and rectal swabs were taken from the participants and cultured for growth of Group B Streptococcus within 24 hours. The participants were followed up to 7 days post-delivery with their newborns to determine the maternal and early neonatal outcomes. Results: One hundred and eighty five (185) women were recruited and 159 (85.9%) participants were available for follow-up to determining feto-maternal outcomes. Among the participants, 3.8% (7) had GBS vaginal colonization. There was no single case of early neonatal infection, intensive neonatal resuscitation nor neonatal mortality among both GBS positive and GBS negative women. Conclusion: It has been found that the prevalence of maternal GBS colonization during pregnancy was low and neither GBS colonization nor GBS non-colonization was associated with poor maternal or poor fetal outcomes.

Cost yield of different treatment strategies against Clonorchis sinensis infection

BackgroundClonorchiasis is attributed to the ingestion of raw freshwater fish harboring Clonorchis sinensis. Morbidity control is targeted through the administration of antihelminthics. This study modelled the cost yield indicated by effectiveness and utility of different treatment strategies against clonorchiasis.MethodsAbout 1000 participants were enrolled from each of 14 counties selected from four provincial-level administrative divisions namely Guangxi, Guangdong, Heilongjiang and Jilin in 2017. Fecal examination was adopted to detect C. sinensis infection, while behavior of ingesting raw freshwater fish was enquired. Counties were grouped into four categories based on prevalence, namely low prevalence group (< 1%), moderate prevalence group (1–9.9%), high prevalence group (10–19.9%) and very high prevalence group (≥ 20%), while population were divided into three subgroups, namely children aged below 14 years old, adult female and adult male both aged over 14 years old. The average of cost effectiveness indicated by the cost to treat single infected cases with C. sinensis and of cost utility indicated by the cost to avoid per disability-adjusted life years (DALYs) caused by C. sinensis infection was calculated. Comparisons were performed between three treatment schedules, namely individual treatment, massive and selective chemotherapy, in which different endemic levels and populations were considered.ResultsIn selective chemotherapy strategy, the cost to treat single infected case in very high prevalence group was USD 10.6 in adult male, USD 11.6 in adult female, and USD 13.2 in children. The cost increased followed the decrease of endemic level. In massive chemotherapy strategy, the cost per infected case in very high prevalence group was USD 14.0 in adult male, USD 17.1 in adult female, USD 45.8 in children, which were also increased when the endemic level decreased. In individual treatment strategy, the cost was USD 12.2 in adult male, USD 15.0 in adult female and USD 41.5 in children in very high prevalence group; USD 19.2 in adult male, USD 34.0 in adult female, and USD 90.1 in children in high prevalence group; USD 30.4 in adult male, USD 50.5 in adult female and over USD 100 in children in moderate prevalence group; and over USD 400 in any population in low prevalence group. As to cost utility, the differences by treatment strategies, populations and endemic levels were similar to those in cost effectiveness.ConclusionsBoth cost effectiveness and cost utility indicators are highly impacted by the prevalence and population, as well as the treatment schedules. Adults especially men in the areas with a prevalence over 10% should be prioritized, in which selective chemotherapy was best and massive chemotherapy was also cost effective. In moderate endemic areas, the yield is not ideal, but selective chemotherapy for adult male may also be adopted. In low endemic areas, all strategies were high costly and new strategies need to be developed.Graphical

Modified induced membrane technique and pedicled skin (myocutaneous) flap for chronic tibial osteomyelitis in patients with diabetes

To investigate the effectiveness of modified induced membrane technique and pedicled skin (myocutaneous) flap for chronic tibial osteomyelitis in patients with diabetes. A clinical data of 22 diabetic patients with chronic tibial osteomyelitis between January 2017 and March 2019 was retrospectively analyzed. There were 15 males and 7 females with an average age of 52 years (range, 44-65 years). The course of diabetes was 3-12 years (mean, 6.1 years). The course of chronic osteomyelitis was 4 months to 7 years (mean, 3.3 years). The chronic osteomyelitis was rated as type Ⅲ in 9 cases and as type Ⅳ in 13 cases according to the Cierny-Mader classification criteria. Bacterial culture showed 21 cases of single bacterial infection and 1 case of mixed bacterial infection. Preoperative color Doppler ultrasound and CT angiography confirmed that the anterior and posterior tibial arteries were unobstructed. In the first stage of treatment, the bone and soft tissue defects were filled with antibiotic bone cement after the lesion was thoroughly debrided; the length of bone defect was 4-9 cm (mean, 5.6 cm), and the size of soft tissue defect was 5 cm×2 cm to 10 cm×7 cm. After 7-10 days, the bone cement was removed and a new antibiotic bone cement was filled into the bone defect. Meanwhile, the pedicled skin (myocutaneous) flap was performed to repair the wound. After 7-12 weeks, the inflammatory indexes returned to normal, autogenous iliac bone or combined with artificial bone was used to repair the bone defect in the second stage of treatment. The wound healing, bone defect healing, complications, and the number of successful treatments were recorded. The satisfaction of the skin flap efficacy and the function of the affected limb were evaluated. Local necrosis of the skin flap occurred in 3 cases after operation, leading to delayed healing of the wound; the other 19 flaps survived successfully, leading to primary healing of the wound. The skin grafts survived completely and the incisions healed by first intention. All cases were followed up 13-28 months with an average of 20 months. The infection recurred in 2 cases within 12 months after operation, and the bone defects healed after treated by modified induced membrane technique. The bone defect healing rate was 100%; the bone healing time was 6-10 months, with an average of 8.9 months; the infection control rate and successful treatment rate were 90.9% (20/22) and 90.9% (20/22), respectively. At 12 months after operation, according to the satisfaction evaluation standard of skin flap efficacy formulated by ZHANG Hao et al., all were satisfied. According to Johner-Wruhs adjacent joint function method, the limb function recovery was excellent in 13 cases, good in 7 cases, and fair in 2 cases, with an excellent and good rate of 90.9%. For the treatment of chronic tibial osteomyelitis in patients with diabetes without vascular occlusion, the modified induced membrane technique and pedicled skin (myocutaneous) flap can repair bone and soft tissue defects, and control the infection at the same time, the short- and medium-term effectiveness are good.

Exploring the Clinical Utility of Metagenomic Next-Generation Sequencing in the Diagnosis of Pulmonary Infection.

IntroductionWe aimed to explore the real-world clinical application value and challenges of metagenomic next-generation sequencing (mNGS) for pulmonary infection diagnosis.MethodsWe retrospectively reviewed the results of mNGS and conventional tests from 140 hospitalized patients with suspected pulmonary infections from January 2019 to December 2020. The sample types included bronchoalveolar lavage fluid, lung tissue by transbronchial lung biopsy, pleural effusion, blood, and bronchial sputum. Apart from the mNGS reports that our patients received, an extra comprehensive and thorough literature search was conducted.ResultsSignificant differences were noticed in the positive detection rates of pathogens between mNGS and conventional diagnostic testing (115/140, 82.14% vs 50/140, 35.71%, P < 0.05). The percentage of mNGS-positive patients was significantly higher than that of conventional testing-positive patients with regard to bacterial detection (P < 0.01), but no significant differences were found with regard to fungal detection (P = 0.67). Significant statistical differences were found between mixed infection cases (15, 22.70%) and single infection cases (4, 7.84%) in terms of diabetes (P = 0.03). The most frequent pattern of mixed infection was bacteria and fungi mixed infection (40, 40/89 = 44.94%), followed by bacteria mixed infection (29, 29/89 = 32.58%). The sensitivity of mNGS in pulmonary infection diagnosis was much higher than that of conventional test (89.17% vs 50.00%; P < 0.01), but the specificity was the opposite (75.00% vs 81.82%; P > 0.05).ConclusionmNGS is a valuable tool for the detection of pulmonary infections, especially mixed pulmonary infections. The most common combinations we found were bacterial–fungal coinfection and bacterial–bacterial coinfection. Still, there are many challenges in the clinical application of mNGS in the diagnosis of pulmonary infections. There is still a lot of work to be done in interpreting the mNGS reports, because both clinical judgment and literature analysis strategy need to be refined.