Single Case Of Infection Research Articles

Paraumbilical hernial repair by mesh plug under local anesthesia

Back ground and objectives : The standard method of repair of paraumbilical hernia is by the mayo's technique,using a doublebreasted flap of the rectus sheath. The present study describes and evaluates the application of a prolen mesh plug in the paraumbilical repair.The use of a mesh plug in hernial repair is not a new concept with previous investigators yielding consistently excellent results in the repair of femoral and inguinal hernia. Patients and Methods: The study is prospective analysis of 36 patients having undergone PUH repair using the mesh plug technique in the period April 2004-April 2007. The study was conducted in Al-yarmouk teaching hospital .There were 16 males and 20 females with a median age of 50 years. ( range 30-80 years). Seventy percentage of the patient sample was obese (median BMI 30). whenever possible local anesthesia was used. Principal outcome measures were post –operative complications, recurrences,length of stay in hospital, analgesia, drain, return to normal activities and patient satisfaction.
 Results: post operative complications encountered included one case of seroma and a single case of wound infection. Ninety eight persent [35 ] of patients were satisfied with procedure.Conclusion : Mesh plug repair can be performed with minimal post operative pain , minimal postoperative complications ,low recurrence rate and achieving excellent patient satisfaction. Prosthetic mesh plug repair under local anesthesia could become the standard treatment for PUH in adults.

A Multicentre Study on the Efficacy, Safety and Pharmacokinetics of IqYmune\xae, a Highly Purified 10% Liquid Intravenous Immunoglobulin, in Patients with Primary Immune Deficiency

This multicentre, open-label, prospective, single-arm study was designed to evaluate the efficacy, pharmacokinetics, and safety of IqYmune®, a highly purified 10% polyvalent immunoglobulin preparation for intravenous administration in patients with primary immunodeficiency. IqYmune® was administered to 62 patients (aged 2–61 years) with X-linked agammaglobulinemia or common variable immune deficiency at a dose from 0.22 to 0.97 g/kg every 3 to 4 weeks for 12 months with an infusion rate up to 8 mL/kg/h. A pharmacokinetic study was performed at steady state between the 8th and the 9th infusion. A single case of serious bacterial infection was observed, leading to an annualized rate of serious bacterial infections/patient (primary endpoint) of 0.017 (98% CI: 0.000, 0.115). Overall, 228 infections were reported, most frequently bronchitis, chronic sinusitis, nasopharyngitis and upper respiratory tract infection. The mean annualized rate of infections was 3.79/patient. A lower risk of infections was associated with an IgG trough level > 8 g/L (p = 0.01). The mean annualized durations of absence from work or school and of hospitalization due to infections were 1.01 and 0.89 days/patient, respectively. The mean serum IgG trough level before the 6th infusion was 7.73 g/L after a mean dose of IqYmune® of 0.57 g/kg. The pharmacokinetic profile of IqYmune® was consistent with that of other intravenous immunoglobulins. Overall, 15.5% of infusions were associated with an adverse event occurring within 72 h post infusion. Headache was the most common adverse event. In conclusion, IqYmune® was shown to be effective and well tolerated in patients with primary immunodeficiency.

Role of centro-medullary nailing in fractures of the distal quarter of the leg: about 30 cases

Les fractures du quart distal de la jambe, sont des fractures dont le trait est situé au niveau du quart inférieur du tibia. Elles sont réputées graves et posent à la fois des problèmes de consolidation, de contention et de stabilité. Nous présentons l'expérience du service de traumatologie orthopédie de l'Hôpital militaire Avicenne de Marrakech, concernant 30 fractures fermées du quart inférieur de la jambe, sur une période de 10 ans (de Janvier 2001 à Décembre 2010) ayant reçu un enclouage centromédullaire. Le montage était verrouillé à 80% des cas et simple dans les autres cas. La moyenne d'âge de nos patients était de 36 ans. Il existait une nette prédominance masculine avec 27 hommes pour 3 femmes. La consolidation a été obtenue dans un délai normal de 17 semaines en moyenne et les résultats fonctionnels était satisfaisants. Un seul cas d'infection est survenu à 6 mois du geste chirurgical soit 3,3% et aucune autre complication n'a été mentionnée. Un cal vicieux a été retrouvé chez 30% de nos patients. Nos données épidémiologiques et nos résultats sont presque identiques à ceux de la littérature. Quant aux résultats angulaires, ils sont nettement inférieurs aux séries de plaques, à l'opposé, leurs résultats infectieux portent à la prudence et certains séries de clous rapportent d'excellents résultats angulaires à condition d'avoir un montage stable. A la lumière de ces résultats, nous sommes en droit de conclure au grand intérêt d'élargir les indications classiques de l'enclouage centromédullaire verrouillé à la prise en charge des fractures du quart distal de la jambe, à condition d'avoir un montage stable par un double verrouillage distal et une ostéosynthèse primaire des fractures distales de la fibula.

Understanding Spatio-Temporal Variability in the Reproduction Ratio of the Bluetongue (BTV-1) Epidemic in Southern Spain (Andalusia) in 2007 Using Epidemic Trees.

Andalusia (Southern Spain) is considered one of the main routes of introduction of bluetongue virus (BTV) into Europe, evidenced by a devastating epidemic caused by BTV-1 in 2007. Understanding the pattern and the drivers of BTV-1 spread in Andalusia is critical for effective detection and control of future epidemics. A long-standing metric for quantifying the behaviour of infectious diseases is the case-reproduction ratio (Rt), defined as the average number of secondary cases arising from a single infected case at time t (for t>0). Here we apply a method using epidemic trees to estimate the between-herd case reproduction ratio directly from epidemic data allowing the spatial and temporal variability in transmission to be described. We then relate this variability to predictors describing the hosts, vectors and the environment to better understand why the epidemic spread more quickly in some regions or periods. The Rt value for the BTV-1 epidemic in Andalusia peaked in July at 4.6, at the start of the epidemic, then decreased to 2.2 by August, dropped below 1 by September (0.8), and by October it had decreased to 0.02. BTV spread was the consequence of both local transmission within established disease foci and BTV expansion to distant new areas (i.e. new foci), which resulted in a high variability in BTV transmission, not only among different areas, but particularly through time, which suggests that general control measures applied at broad spatial scales are unlikely to be effective. This high variability through time was probably due to the impact of temperature on BTV transmission, as evidenced by a reduction in the value of Rt by 0.0041 for every unit increase (day) in the extrinsic incubation period (EIP), which is itself directly dependent on temperature. Moreover, within the range of values at which BTV-1 transmission occurred in Andalusia (20.6°C to 29.5°C) there was a positive correlation between temperature and Rt values, although the relationship was not linear, probably as a result of the complex relationship between temperature and the different parameters affecting BTV transmission. Rt values for BTV-1 in Andalusia fell below the threshold of 1 when temperatures dropped below 21°C, a much higher threshold than that reported in other BTV outbreaks, such as the BTV-8 epidemic in Northern Europe. This divergence may be explained by differences in the adaptation to temperature of the main vectors of the BTV-1 epidemic in Andalusia (Culicoides imicola) compared those of the BTV-8 epidemic in Northern Europe (Culicoides obsoletus). Importantly, we found that BTV transmission (Rt value) increased significantly in areas with higher densities of sheep. Our analysis also established that control of BTV-1 in Andalusia was complicated by the simultaneous establishment of several distant foci at the start of the epidemic, which may have been caused by several independent introductions of infected vectors from the North of Africa. We discuss the implications of these findings for BTV surveillance and control in this region of Europe.

Aerococcus Viridians: Under-Recognized Cause of Pyomyositis

Introduction: Aerococcal infection is a rarely described pathogen in the literature. Aerococcus species may be isolated from urine, blood or other sources. Several sites of infection caused by aerococcal infection have been reported including arthritis, UTI, endocarditis and meningitis. However, to our knowledge there is not a single case of soft tissue infection caused by this germ. Case presentation: We report a case of middle aged patient with multiple comorbidities, presenting with right supraclavicular mass following chest trauma. Imaging study showed multilobulated collection involving thoracic and neck muscles and invading the clavicle. Intraoperative drainage of the pus grew exclusively Aerococcus viridens. Conclusion: Aerococcus viridans is unusual cause of soft tissue infection, but should be considered in the differential diagnosis when evaluating patients with suspected deep soft tissue infection. A. viridens infection is underestimated because of technical difficulties in the identification of this organism. The introduction of matrixassisted laser desorption ionization time-of-flight mass spectrometry carried great success in accurate identification, as early identification of the offending organism guides physicians to appropriate treatment.

Assessment of sanitary conditions and prevalence of enteric parasitic infections among school children of Visakhapatnam

Background: Sanitation in schools is the significant factor that holds an important role in children’s health and their performance. Recent studies in southern India revealed that the prevalence of soil-transmitted helminths was almost 7.8% varying from school to school. Objective: To assess the sanitary facilities in the government-aided schools and the prevalence of parasitic enteric infections in school children. Materials and Methods: A total of 2,250 stool samples were taken from the children of age group ranging 6–13 years and examined using the formalin–ethyl acetate concentration method. Result: Among the 2,250 children, a total of 288 children were infected with one or more enteric parasitic infections. There was predominance in single infection (204 cases) in relation to multiple infections (84 cases). Of the 204 single infection cases, 143 pupils were infected with protozoa infections and 61 pupils with helminths infections. The highest prevalent helminths was “hook worm” (0.6%) and protozoan “Blastocystis hominis”(2.5%). Conclusion: All the children are vulnerable to the risk of enteric parasitic infections. The reasons might be owing to improper sanitation facilities in schools, lack of awareness about enteric infections, and no provision for safe disposal fecal matter. First, a periodic treatment should be given to students once or twice a year. This intervention can reduce the morbidity of parasitic infections. Second, the provision of health and hygiene components such as promotion of handwashing and improved sanitation can reduce the prevalence of parasitic infections.

Detection of Quiescent Infections with Multiple Elephant Endotheliotropic Herpesviruses (EEHVs), Including EEHV2, EEHV3, EEHV6, and EEHV7, within Lymphoid Lung Nodules or Lung and Spleen Tissue Samples from Five Asymptomatic Adult African Elephants.

More than 80 cases of lethal hemorrhagic disease associated with elephant endotheliotropic herpesviruses (EEHVs) have been identified in young Asian elephants worldwide. Diagnostic PCR tests detected six types of EEHV in blood of elephants with acute disease, although EEHV1A is the predominant pathogenic type. Previously, the presence of herpesvirus virions within benign lung and skin nodules from healthy African elephants led to suggestions that African elephants may be the source of EEHV disease in Asian elephants. Here, we used direct PCR-based DNA sequencing to detect EEHV genomes in necropsy tissue from five healthy adult African elephants. Two large lung nodules collected from culled wild South African elephants contained high levels of either EEHV3 alone or both EEHV2 and EEHV3. Similarly, a euthanized U.S. elephant proved to harbor multiple EEHV types distributed nonuniformly across four small lung nodules, including high levels of EEHV6, lower levels of EEHV3 and EEHV2, and a new GC-rich branch type, EEHV7. Several of the same EEHV types were also detected in random lung and spleen samples from two other elephants. Sanger PCR DNA sequence data comprising 100 kb were obtained from a total of 15 different strains identified, with (except for a few hypervariable genes) the EEHV2, EEHV3, and EEHV6 strains all being closely related to known genotypes from cases of acute disease, whereas the seven loci (4.0 kb) obtained from EEHV7 averaged 18% divergence from their nearest relative, EEHV3. Overall, we conclude that these four EEHV species, but probably not EEHV1, occur commonly as quiescent infections in African elephants. Acute hemorrhagic disease characterized by high-level viremia due to infection by members of the Proboscivirus genus threatens the future breeding success of endangered Asian elephants worldwide. Although the genomes of six EEHV types from acute cases have been partially or fully characterized, lethal disease predominantly involves a variety of strains of EEHV1, whose natural host has been unclear. Here, we carried out genotype analyses by partial PCR sequencing of necropsy tissue from five asymptomatic African elephants and identified multiple simultaneous infections by several different EEHV types, including high concentrations in lymphoid lung nodules. Overall, the results provide strong evidence that EEHV2, EEHV3, EEHV6, and EEHV7 represent natural ubiquitous infections in African elephants, whereas Asian elephants harbor EEHV1A, EEHV1B, EEHV4, and EEHV5. Although a single case of fatal cross-species infection by EEHV3 is known, the results do not support the previous concept that highly pathogenic EEHV1A crossed from African to Asian elephants in zoos.

Lipofilling en reconstruction mammaire. Étude rétrospective de la satisfaction et de la qualité de vie à propos de 68 patientes

Evaluate the aesthetic clinical results, satisfaction and quality of life related to health in patients who underwent breast reconstruction by exclusive lipofilling or in addition to other surgical techniques. A retrospective observational study was carried between 2009and 2014in four groups of patients who underwent a lipofilling by the same operator either after a conservative treatment (group1), or exclusively (group2), or after a flap (group3) or implants (group4). The sociodemographic data related to lipofilling or tumor pathology were collected and reported in a software designed for this study. Satisfaction and quality of life after lipofilling was assessed using the questionnaire Q BREAST(©) postoperative reconstruction module. One hundred and seventy lipofilling procedures were performed in 68patients. The average volume transferred was 1421.2cm(3)for the exclusive lipofilling group and the average number of sessions was 4.9spread over a period of 15.6months on average. In adjuvant technique or conservative surgery, the average total volume transferred was 212.2cm(3)and the average number of sessions was 1.4. The abdomen was the site most used donor and the posterior thigh exclusively used in exclusive reconstruction. The cytosteatonecrosis rate was 8.8% (n=6). A single case of infection was noted. The tumor recurrence at ten months after lipofilling concerned two patients. The response rate was 80.8%. The lipofilling improves the final cosmetic result with a rate of 91.1% of patients satisfied or very satisfied with their breast. In all, 95.4% of patients in the exclusive lipofilling group found a secondary benefit after surgery. Quality of life after lipofilling is also improved socially and sexually in the four groups with better results in patients who underwent conservative treatment. The lipofilling is a simple, reliable technique, requiring a learning curve, improving the final aesthetic result and the quality of life it is used exclusively or to complement other techniques.

Outcome of relapsing Clostridium difficile infections do not correlate with virulence-, spore- and vegetative cell-associated phenotypes

One of the main clinical challenges of Clostridium difficile infections (CDI) is the high rate of relapse episodes. The main determinants involved in relapse of CDI include the presence of antibiotic-resistant C. difficile spores in the colonic environment and a permanent state of dysbiosis of the microbiota caused by antibiotic therapy. A possible scenario is that phenotypes related to the persistence of C. difficile spores might contribute to relapsing infections. In this study, 8 C. difficile isolates recovered from 4 cases with relapsing infection, and 9 isolates recovered from single infection cases were analyzed for PCR ribotyping and the presence of tcdA, tcdB and cdtAB genes. Factors associated to spore persistence, sporulation, spore adherence and biofilm formation and sporulation during biofilm formation were characterized. We also evaluated motility and cytotoxicity. However, we observed no significant difference in the analyzed phenotypes among the different clinical outcomes, most likely due to the high variability observed among strains within clinical backgrounds in each phenotype and the small sample size. It is noteworthy that C. difficile spores adhered to similar extents to undifferentiated and differentiated Caco-2 cells. By contrast, spores of all clinical isolates tested had increased germination efficiency in presence of taurocholate, while decreased sporulation rate during biofilm development in the presence of glucose. In conclusion, these results show that, at least in this cohort of patients, the described phenotypes are not detrimental in the clinical outcome of the disease.

ANTIBIOTICOPROFILAXIS PARA LA INFECCION DE CUPULA EN LA HISTERECTOMIA VAGINAL

Se realizó un estudio prospectivo de dos grupos de cincuenta pacientes cada uno. El objetivo del trabajo fue evaluar la administración de antibióticos en la histerectomía vaginal para la prevención de las infecciones de cúpula vaginal. La selección fue ramdomnizada formando muestras independientes, bajo criterios establecidos. El grupo estudio recibió cefalotina sódica un gramo endovenoso antes de ingresar a sala de operaciones y luego dos dosis más a intervalos de seis horas. El grupo control no recibió nada. En el análisis de los resultados, apreciamos que no existió un solo caso de infección de cúpula en ambos grupos, tanto en el de estudio como en el de control. Aplicando la prueba "T" de significación estadística para el estudio del contraste de dos muestras independientes, nos permite afirmar que la administración de antibióticos no es necesario en estos casos. Lo preparación vaginal en el pre-operatorio es fundamental.

Comparison of Extrapleural Anterolateral Decompression and Transthoracic Anterior Decompression for Tuberculosis of The Dorsal Spine

Background: Spinal tuberculosis (TB) comprises 50% of all skeletal tuberculosis and it affects body of the vertebra in about 98% of the cases, hence surgical decompression when needed should be anterior. There are a number of studies describing transthoracic approach but very few describing extrapleural anterolateral approach and none were comparative trial. Therefore, the present study was conducted to compare extrapleural anterolateral decompression and transthoracic anterior decompression for tuberculosis of dorsal spine. Aims and Objectives: To compare the duration of surgery, amount of blood loss, neurological recovery and complication rate. Design: Prospective Randomised controlled Trial Setting: The study was performed in Department of Orthopedics, NMCH,Biratnagar, Nepal Material and methods: The patients with tuberculosis of dorsal spine those required surgical decompression were randomly allocated into two groups. For the first group we performed extrapleural anterolateral decompression and for the second group we performed transthoracic anterior decompression We excluded patients with ischemic heart disease, end stage renal disease, immunocom promised stage. We did follow up for one year with comparing outcome in terms of duration of surgery, amount of blood loss neurological recovery and complication rate. Results: 60 patients were left after exclusion. We found duration of surgery, amount of blood loss were significantly higher in transthoracic anterior decompression group. There was single case of wound infection (3.3%)in the transthoracic anterior decompression group. 3 cases of transthoracic anterior decompression had to convert into anterolateral decompression because of adhesion of pleura to lung. There was no significant difference in neurological recovery and development of kyphotic deformity. Conclusion: We found anterolateral decompression did better than transthoracic anterior decompression in terms of duration of surgery, amount of blood loss, postoperative morbidity but similar neurological recovery rate.DOI: http://dx.doi.org/10.3126/jonmc.v3i1.12237Journal of Nobel Medical CollegeVol. 3, No.1 Issue 6, 2014, Page: 46-51

Effect of Ebola progression on transmission and control in Liberia.

The Ebola outbreak that is sweeping across West Africa is the largest, most volatile, and deadliest Ebola epidemic ever recorded. Liberia is the most profoundly affected country, with more than 3500 infections and 2000 deaths recorded in the past 3 months. To evaluate the contribution of disease progression and case fatality on transmission and to examine the potential for targeted interventions to eliminate the disease. Stochastic transmission model that integrates epidemiologic and clinical data on incidence and case fatality, daily viral load among survivors and nonsurvivors evaluated on the basis of the 2000-2001 outbreak in Uganda, and primary data on contacts of patients with Ebola in Liberia. Montserrado County, Liberia, July to September 2014. Ebola incidence and case-fatality records from 2014 Liberian Ministry of Health and Social Welfare. The average number of secondary infections generated throughout the entire infectious period of a single infected case, R, was estimated as 1.73 (95% CI, 1.66 to 1.83). There was substantial stratification between survivors (RSurvivors), for whom the estimate was 0.66 (CI, 0.10 to 1.69), and nonsurvivors (RNonsurvivors), for whom the estimate was 2.36 (CI, 1.72 to 2.80). The nonsurvivors had the highest risk for transmitting the virus later in the course of disease progression. Consequently, the isolation of 75% of infected individuals in critical condition within 4 days from symptom onset has a high chance of eliminating the disease. Projections are based on the initial dynamics of the epidemic, which may change as the outbreak and interventions evolve. These results underscore the importance of isolating the most severely ill patients with Ebola within the first few days of their symptomatic phase. National Institutes of Health.

Molecular characterization of Cryptosporidium parvum from two different Japanese prefectures, Okinawa and Hokkaido

Infectious diarrhea is the most frequent cause of morbidity and mortality in neonatal calves. Cryptosporidium parvum is one of the main pathogens associated with calf diarrhea. Although diarrhea is a symptom of infection with various pathogens, investigations to detect the types of pathogens have never been performed in Japan. This study investigated the prevalence of four major diarrhea-causing pathogens in calves: C. parvum, rotavirus, coronavirus, and enterotoxigenic Escherichia coli (E. coli K99). Commercial immunochromatography testing of all four pathogens and molecular analysis of C. parvum with diarrhea in calves from southernmost Okinawa and northernmost Hokkaido, Japan, were conducted. The frequencies of C. parvum, rotavirus, coronavirus, and E. coli (K99) in Okinawa were 50%, 28%, 2.3%, and 4.7%, respectively. Watery fecal stools were significantly correlated with C. parvum (p<0.05). In oocyst calculations for C. parvum, no significant difference was observed between the single-infection cases and the mixed-infection cases with rotavirus. Interestingly, molecular analyses targeting small subunit ribosomal RNA as well as glycoprotein 60 (GP60) genes revealed that the C. parvum nucleotide sequences from the two prefectures were identical, indicating that C. parvum with a uniform characteristic is distributed throughout Japan. GP60 subtyping analysis identified C. parvum from Okinawa and Hokkaido as belonging to the IIaA15G2R1 subtype, a known zoonotic subtype. Hence, control of cryptosporidiosis is important not only for pre-weaned calves, but also for human health.

No evidence for LGV transmission among heterosexuals in Amsterdam, the Netherlands.

BackgroundIn recent years a few cases of lymphogranuloma venereum (LGV) in heterosexuals in Europe have been reported. It is not known whether LGV transmission among heterosexuals occurs on a wider scale.MethodsHeterosexual male and female STI clinic clients (n = 587) in Amsterdam, the Netherlands, with a positive nucleic acid amplification test (NAAT) result for Chlamydia trachomatis (CT) were screened for IgA anti-MOMP in serum. If the value was above the cut-off index (2.0) the patient’s CT positive urogenital, ocular or rectal sample(s) were selected and tested for LGV by an in-house LGV-specific NAAT.ResultsSera of 126 patients were above 2.0 COI. Some patients had >1 CT positive sample. Samples could not be retrieved from 15 of the 126 persons, and 7 samples that were found positive for CT in the diagnostic amplification process could not be confirmed and hence not typed. We did not find a single case of LGV infection in 123 urogenital, ocular or rectal samples from 104 patients.ConclusionWe found no indications for significant spread of LGV infection in heterosexuals in Amsterdam. Surveillance in females with cervical or anal CT infection is indicated to monitor LGV occurrence in heterosexuals.

Rheumatoid arthritis and pregnancy

Tumour necrosis factor inhibitors (TNFi) and other biologic response modifiers are being increasingly used for the treatment of rheumatoid arthritis (RA) among women of childbearing age, raising concerns regarding the potential safety of inadvertent or intentional exposure of these agents to the developing fetus. TNFi and other biologics whose constructs contain a functional IgGFc piece are actively transported across the placenta during the second and third trimesters of pregnancy. Very little drug passively diffuses to the fetal circulation during the first trimester, when organogenesis occurs. Cumulative data from both the rheumatology and gastroenterology literature suggest that the rate of birth defects following antenatal TNFi exposure does not appear to be higher than that seen in the general population. There are very little data available on pregnancy outcomes following antenatal exposure to other biologic medications for RA. Cumulative evidence suggests that TNFi use during pregnancy carries low risk for teratogenicity. A single case of fatal BCG infection in an exposed neonate following live virus vaccination highlights the potential need to defer live virus vaccines for at least 6 months in exposed neonates until more data of risk factors for infection susceptibility are available.

Equilibrium frequency of endosymbionts in multiple infections based on the balance between vertical transmission and cytoplasmic incompatibility.

Cytoplasmic incompatibility (CI)-inducing endosymbiotic bacteria, such as Wolbachia and Cardinium, have been well studied through field data and validations on the basis of numerical simulations. However, the analytically derived equilibrium frequency of multiple infections has not yet been determined, although the equilibrium for cases of single infection has been reported. In this study, we considered the difference equation for endosymbionts using three parameters: the probability of the failure of vertical transmission (), CI strength (), and the level of host inbreeding (). To analyze this model, we particularly focused on , i.e., the frequency of host individuals completely infected with all -bacterial strains in the population. , at the equilibrium state, was analytically calculated in the cases where and is any arbitrary value. We found that can be described using two parameters: and , which is identical to . has a larger value in a system with a smaller . In addition, determines the maximum number of strains that infect a single host. Our results revealed the following: i) three parameters can be reduced to a single parameter, i.e., and ii) the threshold of the maximum number of infections is defined by , which prevents additional invasions by endosymbionts.

The contralateral subgaleal sliding flap for the single-stage reconstruction of large defects of the temple and lateral forehead

Due to the relative lack of a mobile tissue reservoir, the flap repair of large defects of the temple and lateral forehead is challenging. To present our experience of the contralateral subgaleal sliding (CLASS) flap for the single-stage aesthetic repair of such defects. Data were collated on all patients at one regional Mohs centre in whom the CLASS flap had been performed since 2011. The CLASS flap was performed on 16 patients (11 male, five female) with an average age of 63years (range 42-90). The average defect size was 2·8×3·1cm. A single case of postoperative infection occurred, which settled with appropriate therapy with no adverse sequelae. All patients rated their outcome as good or excellent. The CLASS flap is a reliable, aesthetic, single-stage reconstructive technique for large defects of the lateral forehead and temple.

Prognosis of joint infections in growing and adult sheep: a 3-year study

In a 3-year study of joint infections, undertaken by the author, bacterial infection of a single joint caused severe lameness in 39 sheep older than 6 months; another 15 sheep had polyarthritis consistent with erysipelas. All cases had proven unresponsive to antibiotic therapy administered by the farmer. A penetration wound was responsible for single cases of septic stifle, shoulder, and fetlock; the remaining 36 cases of single joint infection were presumed to have originated from a bacteraemia. Radiography added little additional information except to reveal origin of infection from a growth plate (five cases), and osteophyte formation and erosion of articular surfaces in neglected cases. Necropsy findings were characterised by pronounced synovial membrane proliferation and, in neglected cases, erosion of articular cartilage. Most infected joints contained only small amounts of a pannus. A single treatment success was achieved with arthroscopy and joint lavage from four cases that had been lame for less than 1 week. Sheep with joint infections that remain lame after an appropriate course of antibiotic treatment should be euthanased for welfare reasons.

Frequency and Type-distribution of Human Papillomavirus from Paraffin-embedded Blocks of High Grade Cervical Intraepithelial Neoplasia Lesions in Thailand

Cervical cancer is the most important female gynecological cancer, the second leading cause of cancer mortality in women worldwide and the second most common cancer in Thai women. The major cause of cervical cancer is persistent infection of human papillomavirus (HPV), leading to abnormal epithelial lesions, with progression to precancerous and invasive cancer. This study was conducted to investigate the frequency and type distribution of HPV in Thai women who had abnormal cytology. HPV detection from FFPE confirmed abnormal of high grade cervical intraepithelial lesions were for SPF-10-Innogenic Line Probe Assay. HPV-positivity was detected in 320/355 cases (90.14%) and HPV-negativity in 35/355 (9.86%). HPV-positive was found 147/320 cases (41.4%) of single infection, whereas 173/320 cases (48.7%) showed the multiple HPV infection. The most common seven types were HPV-16, -52, -18, -11, -51, -31 and -33, in that order. HPV 16 and 18, the important oncogenic HPV type, were observed in 64.8% of HSIL cases. Interestingly, a high proportion of multiple infections was found in this study and more than ten types could be detected in one case. Therefore, HPV infection screening program in women is essential, particularly in Thailand. Effective primary and secondary prevention campaigns that reinforce HPV screening for HPV detection and typing may be decrease the incidence and mortality of cervical cancer in the future and may lead to significantly improve the quality of life in Thai women.

Retesting for latent tuberculosis in patients with inflammatory bowel disease treated with TNF‐α inhibitors

Patients treated with TNF-α inhibitors (TNFi) are at high risk of reactivation of latent tuberculosis (LTB). Prospective studies on monitoring of TB reactivation and/or infection in this risk group are lacking. To test the conversion and reversion rate of screening tests for latent TB serial tuberculin skin test (TST) and interferon-γ release assay (IGRA) under ongoing TNFi therapy. We retested consecutive patients with IBD receiving TNFi therapy for a minimum of 5 months for LTB using IGRA and TST. A detailed patient history and concomitant therapy were recorded for each subject. After a median of 34.9 weeks (20.7–177.7), IGRA was retested in 184/227 patients (81.1%; Crohn's disease n = 139, ulcerative colitis n = 45) still under index TNFi. TST was available in 144/184 subjects (78.2%). The majority of patients were TNFi naïve (147/184, 79.9%). In a subgroup of patients who received isoniazid due to diagnosis of latent TB at baseline (n = 32), 6/13 patients (46.2%) with baseline positive IGRA and 3/22 patients (13.6%) with baseline positive TST reverted to negative at retesting. In patients without diagnosis of LTB at baseline no permanent IGRA conversion was observed, but there were 6/144 (4.2%) TST conversions from negative to positive. No single case of TB reactivation or infection was recorded during the observation period. During treatment TNF-α inhibitors conversion was observed for tuberculin skin test, but not interferon-γ release assay. As compared with tuberculin skin test, interferon-γ release assay reverted in nearly half of isoniazid-treated patients for latent tuberculosis. However, the fact that patients in whom the interferon-γ release assay test result remained positive did not develop active tuberculosis during follow-up questions the utility of interferon-γ release assay as a monitoring tool during chemoprevention.