infection

摘要： Viral hepatitis infections are a great burden in children who have received liver transplant.Hepatotropic viruses can cause liver inflammation that can develop into liver graft fibrosis and cirrhosis over the long term.Immunological reactions due to viral hepatitis infections are associated with or can mimic graft rejection,rendering the condition difficult to manage.Prevention strategies using vaccinations are agreeable to patients,safe,cost-effective and practical.Hence,strategies to eliminate viral hepatitis A and B focus mainly on immunization programmes for children who have received a liver transplant.Although a vaccine has been developed to prevent hepatitis C and E viruses,its use is not licensed worldwide.Consequently,eliminating hepatitis C and E viruses mainly involves early detection in children with suspected cases and effective treatment with antiviral therapy.Good hygiene and sanitation are also important to prevent hepatitis A and E infections.Donor blood products and liver grafts should be screened for hepatitis B,C and E in children who are undergoing liver transplantation.Future research on early detection of viral hepatitis infections should include molecular techniques for detecting hepatitis B and E.Moreover,novel antiviral drugs for eradicating viral hepatitis that are highly effective and safe are needed for children who have undergone liver transplantation.

摘要： BACKGROUND Symptomatic urachal anomalies are rare disorders.The management of urachal remnants has historically been surgical excision because of the connection between urachal remnants and risk of malignancy development later in life.However,recent literature suggests that urachal anomalies that do not extend to the bladder can be treated with conservative management.In this case,we report a newborn with an infected urachal remnant who was treated with a combination of antibiotics and a silver-based dressing and finally recovered well.CASE SUMMARY Female baby A,weighing 2.88 kg at 38^(+5) wk of gestational age,was referred to the hospital because of a red,swollen umbilicus approximately 2 cm×2 cm in size with yellow purulent exudate.Through physical and ultrasound examination,the baby was finally diagnosed with a urachal anomaly.We first used oxacillin to prevent infection for 3 d.On the 4^(th) day,microbiology testing of the umbilical exudate revealed the presence of methicillin-resistant Staphylococcus aureus(MRSA).We changed the treatment with oxacillin to vancomycin for systemic infection and treated the umbilical inflammation with a silver sulfate dressing.After 5 d,the symptoms of the umbilicus disappeared,and we discontinued silver dressing application.On the 12^(th) day,umbilical exudate testing was negative for MRSA.On the 14^(th) day,the baby's blood testing showed a white blood cell count of 14.7×10^(9)/L,neutrophil percentage of 27.8%,and C-reactive protein level of 1.0 mg/L,suggesting that the infection had been controlled.We stopped treatment,and the baby was discharged with no complications.In this case,the infected urachal anomaly was cured with silver dressing and antibiotic application instead of surgical methods,which was a different course from that of some other urachal remnant cases.CONCLUSION Anomalies that do not connect with the bladder can be treated with nonoperative management,including application of conservative antibiotics and local intervention with silver-based dressings.Silver sulfate dressings are absolutely safe for neonates with judicious use,and they play an established role in preventing infection without resistance,which is a common problem with other antibiotics and antiseptics.

摘要： BACKGROUND Acute kidney injury(AKI)in cirrhosis is important complication with poor outcomes.And infections are common cause for acute decompensation.Infections in cirrhosis lead to acute deterioration of hemodynamics leading to precipitation of AKI.AIM To study predictors of mortality in patients with infection-associated AKI in cirrhosis.METHODS This was a prospective,observational study conducted at Tertiary care centre from January 2018 till April 2019.Total 119 participants with cirrhosis of liver presenting with AKI were included into the study.AKI was defined as per international club of Ascites-AKI criteria 2015.Patients were grouped into infection AKI and non-infection AKI.Non-infection AKI included patients with diuretic induced AKI and pre-renal AKI.Logistic regression analysis was used to determine predictors of mortality at 28-d.RESULTS Out of 119 patients,alcohol(n=104)was most common etiology of cirrhosis.The infection AKI included 67(56%)patients and non-infection AKI(n=52)included pre-renal AKI in 36(30%)and diuretic-induced AKI in 16(14%)patients.Infection AKI had significantly higher bilirubin,higher international normalized ratio(INR),low serum sodium,higher total leukocyte count(TLC)and higher prevalence of hepatic encephalopathy(HE)as compared to non-infection AKI.Infection AKI had higher progression of AKI(19/67 vs 2/52;P=0.01)and 28-d mortality(38/67 vs 4/5;P≤0.01)as compared to non-infection AKI.At 28-d,non-survivors(n=42)had significantly higher bilirubin,higher INR,low serum sodium,higher TLC and higher prevalence of HE as compared to survivors(n=77).On subgroup analysis of Infection AKI group,on multivariate analysis,serum bilirubin as well as presence of HE were independent predictors of 28-d mortality.There was no significant difference of mortality at 90-d between two groups.CONCLUSION Infection AKI in cirrhosis has a dismal prognosis with higher 28-d mortality as compared to noninfection AKI.Serum bilirubin and presence of HE predict 28-d mortality in infection AKI.

摘要： Cytomegalovirus (CMV) infection is a common complication of liver transplantationin children. The CMV serostatus of recipients and donors is theprimary risk factor, and prophylaxis or pre-emptive strategies are recommendedfor high-risk patients. Graft rejection, coinfection and Epstein-Bar virusreactivation, which can lead to post-transplant lymphoproliferative disease, areindirect effects of CMV infection. Assessment of CMV infection viral load shouldbe routinely performed upon clinical suspicion. However, tissue-invasive CMVdisease is not associated with CMV viraemia and requires confirmation by tissuepathology. Oral valganciclovir and intravenous ganciclovir are equivalenttreatments, and the duration of treatment depends on factors including CMV viralload, tissue pathology, and clinical response. Risk stratification by donor andrecipient status prior to transplantation and post-transplantation antiviralprophylaxis or pre-emptive therapy are recommended. Adult guidelines havebeen established but additional study of the effectiveness of the preventiveguidelines in children is needed. This review summarizes the burden, risk factors,clinical manifestations, laboratory evaluation, treatment, and prevention of CMVinfection in children after liver transplantation.

摘要： Helicobacter pylori(H.pylori)infection is one of the most common chronic bacterial infections all over the world.University students are a group with strong comprehensive ability.Their cognition and behavior can exert great impact on society.However,up to now,reports on the awareness and attitudes regarding H.pylori infection among university students are scarce.This study aimed to survey dietary,habits,knowledge,and attitudes towards H.pylori infection.A total of 5794 participants,including undergraduates,postgraduates,and doctoral students,were recruited from the top 100 universities in China.A selfconstructed questionnaire was used to assess the knowledge and attitudes of students toward H.pylori infection and its impact.In our study,most of the population preferred dining in the canteen(69.6%),whereas 20.6% chose restaurants or takeaway.Up to 24.1% of the respondents had at least one lifestyle habit associated with H.pylori colonization.Almost half had at least one digestive symptom related to H.pylori infection.Most students were aware of its association with gastritis(84.4%)and peptic ulcer(86.6%).However,only half of them were aware of its association with gastric cancer(57.9%).Furthermore,only 14.1% of the respondents had been tested for H.pylori,and 25.1% of them tested positive.The H.pylori-detection rate was higher in Hunan province compared with Guangdong and Jilin provinces.Regarding knowledge of H.pylori,65.4% of the respondents had known about it,and 24.3% correctly answered all questions.When comparing the acquisition of H.pylori knowledge between tested and untested students,32.5% of the tested participants answered all questions correctly,which was significantly higher than the untested group(13.1%).There was no significant difference between genders in H.pylori knowledge and detection.University students are highly educated population.If they were fully aware of the harm of H.pylori infection,their parents,friends,and even future families would benefit,thus reducing the incidence of H.pylori infection,as well as gastric cancer and healthcare finances.This survey not only investigated but also spread the awareness of H.pylori among university students,which is of great medical,economic and sociological importance.

摘要： BACKGROUND Pulmonary infections often lead to poor prognoses in patients with chronic obstructive pulmonary disease(COPD).Activin A and CD64 play crucial pathological roles in the development of COPD.AIM To explore the bacterial spectrum via analysis of activing A levels,CD64 index,and related mechanisms in COPD patients complicated with pulmonary infection.METHODS Between March 2015 and January 2018,a total of 85 patients with COPD,who also suffered from pulmonary infections,were enrolled in this study as the pulmonary infection group.In addition,a total of 96 COPD patients,without pulmonary infection,were selected as the control group.Sputum samples of patients in the pulmonary infection group were cultivated for bacterial identification prior to administration of antibiotics.The neutrophil CD64 index was measured using flow cytometry,serum activin A levels were detected via an enzyme-linked immunosorbent assay,and activin A,Smad3,TLR4,My D88,and NFκB protein expression was analyzed by Western blotting.RESULTS Gram-negative bacteria were identified in 57.65%of the sputum samples in the pulmonary infection group.The most prevalent Gram-negative species were Pseudomonas aeruginosa and Klebsiella pneumoniae.Conversely,Gram-positive bacteria were identified in 41.18%of the sputum samples in the pulmonary infection group.The most common Gram-positive species was Streptococcus pneumoniae.Fungi were identified in 1.17%of the sputum samples in the pulmonary infection group.The CD64 index was significantly higher in the pulmonary infection group(0.91±0.38)than in the control group(0.23±0.14,P<0.001).The serum activin A levels were significantly higher in the pulmonary infection group(43.50±5.22 ng/m L),compared to the control group(34.82±4.16 ng/m L,P<0.001).The relative expression levels of activin A,Smad3,TLR4,My D88,and NFκB were all significantly higher in the pulmonary infection group,compared to the control group(all P<0.001).CONCLUSION Pulmonary infections in COPD patients are mainly caused by Streptococcus pneumoniae,Pseudomonas aeruginosa,and Klebsiella pneumoniae.Pulmonary infections can significantly increase neutrophil CD64 index and serum levels of activin A,thereby activating the activin A/Smad3 signaling pathway,which may positively regulate the TLR4/My D88/NFκB signaling pathway.

摘要： BACKGROUND Knot impingement as a complication after arthroscopic rotator cuff repair(ARCR)has been suggested as a cause of persistent pain with limited motion.We report on a case involving a patient who developed knot impingement after ARCR who complained of acute onset of pain with limited motion,which was confused with infection.CASE SUMMARY A 55-year-old female who complained of severe pain with limited motion of the right shoulder visited our emergency room.Passive range of motion could not be evaluated due to the patient’s severe pain.The patient had undergone ARCR using a suture-bridge technique at a local clinic four months ago for treatment of a small supraspinatus tear of the right shoulder.An erosive change of the undersurface of the acromion was observed on plain radiographs of the right shoulder,and a moderate amount of bursal fluid and synovial thickening with enhancement was observed by magnetic resonance imaging.Results of an analysis of the aspirated fluid showed that the WBC count was 3960 with 90% neutrophils.The arthroscopic view showed healing of the repaired supraspinatus tendon and loose suture threads and knots with severe subacromial bursitis were observed.Debridement of inflammatory tissues of the glenohumeral joint and subacromial space was performed for the removal of all suture materials.The patient’s symptoms subsided immediately after the surgical procedure.CONCLUSION Although the incidence of knot impingement is rare,the possibility of knot impingement after ARCR should be a consideration.

摘要： I would like to add new findings in support of a novel hypothesis stating that malaria infection may protect against COVID-19[1-3].As this might facilitate understanding the underlying mechanism behind this association,the discovery of better preventive measures and therapeutic agents for the management of this terrible pandemic.

摘要： Background: Surgical site infections (SSI) are expensive and potentially deadly infections;however, with evidence-based infection prevention techniques many can be prevented. The purpose of this quality improvement project is to describe our hospital’s experience achieving zero coronary artery bypass graft (CABG) deep incisional and organ/space SSI incidences from October 2016-July 2021. Methods: To prevent CABG deep incisional and organ/space SSI incidences our Infection Prevention and Epidemiology Department along with the Cardiothoracic and Vascular Surgery Department established SSI prevention bundle elements, continuous education, and monthly audits. Results: From quarter one of 2015 through quarter three of 2016 there were three deep incisional or organ/space SSI cases out of 317 CABG procedures. From quarter four of 2016 through quarter two of 2021 there have been 625 CABG procedures, zero of which developed into deep incisional or organ/space SSI incidences. CABG SSI prevention bundle element compliance ranged from 88.2% to 99.6% and operating room environment of care compliance was 94%. Conclusion: Our results show overall improvements in our quarterly CABG SSI SIR from quarter one of 2015 to quarter two of 2021. This experience demonstrates the importance of complying with SSI prevention bundle elements, education, and auditing in reducing and maintaining zero CABG deep incisional and organ/space incidences for over four years.

摘要： BACKGROUND Several strategies have been implemented to reduce or abolish the life-threatening risk of endoscopic retrograde cholangiopancreatography(ERCP)-related multidrug-resistant infections due to duodenoscopes contaminations;among those strategies,serial microbiologic tests,thorough reprocessing schedules,and use of removable scope cap have been adopted,but the potential cross-infection risk was not eliminated.AIM To review available evidence in the field of single-use duodenoscopes(SUD)use for ERCP.METHODS An overview on ongoing clinical studies was also performed to delineate which data will become available in the next future.RESULTS One bench comparative study and four clinical trials performed with EXALT model-D(Boston Scientific Corp.,United States)have been identified.Of them,one is a randomized controlled trial,while the other three studies are prospective single-arm,cross-over studies.Pooled technical success rate(4 studies,368 patients)was 92.9%[95%confidence interval(CI):89.9-95.5;I2:11.8%].Pooled serious adverse event(4 studies,381 patients)rate was 5.9%[3.7%-8.5%;I2:0.0%].CONCLUSION Although few clinical trials are available,evidence is concordant in identifying an absolute feasibility and safety and feasibility for SUD use for ERCP.The expertise and quality of evidence in this field are going to be improved by further large clinical trials;data on cost-effectiveness and environmental impact will be needed for a worldwide spread of SUD use for ERCP.