Candida auris Updates: Outbreak Evaluation through Molecular Assays and Antifungal Stewardship-A Narrative Review.

Candida auris was reported by the WHO as second to Cryptococcus neoformans, in the list of nineteen fungal priority pathogens, along with two species with a new nomenclature, Nakaseomyces glabrata (Candida glabrata) and Pichia kudriavzevii (Candida krusei). This novel classification was based on antifungal resistance, the number of deaths, evidence-based treatment, access to diagnostics, annual incidence, and complications and sequelae. We assessed which molecular assays have been used to diagnose Candida auris outbreaks in the last five years. Using "Candida auris; outbreak; molecular detection" as keywords, our search in PubMed revealed 32 results, from which we selected 23 original papers published in 2019-2024. The analyzed studies revealed that the detection methods were very different: from the VITEK® 2 System to MALDI TOF (Matrix-Assisted Laser Desorption Ionization-Time of Flight), NGS (Next-Generation Sequencing), WGS (Whole Genome Sequencing), and commercially available real-time PCR (Polymerase Chain Reaction) assays. Moreover, we identified studies that detected antifungal resistance genes (e.g., FKS for echinocandins and ERG11 for azoles). The analyzed outbreaks were from all continents, which confirms the capability of this yeast to spread between humans and to contaminate the environment. It is important that real-time PCR assays were developed for accurate and affordable detection by all laboratories, including the detection of antifungal resistance genes. This will allow the fast and efficient implementation of stewardship programs in hospitals.

Host mRNA Analysis of Periodontal Disease Patients Positive for Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Tannerella forsythia.

Periodontal disease is a frequent pathology worldwide, with a constantly increasing prevalence. For the optimal management of periodontal disease, there is a need to take advantage of actual technology to understand the bacterial etiology correlated with the pathogenic mechanisms, risk factors and treatment protocols. We analyzed the scientific literature published in the last 5 years regarding the recent applications of mRNA analysis in periodontal disease for the main known bacterial species considered to be the etiological agents: Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Tannerella forsythia. We identified new pathogenic mechanisms, therapeutic target genes and possible pathways to prevent periodontal disease. The mRNA analysis, as well as the important technological progress in recent years, supports its implementation in the routine management of periodontal disease patients.

Diagnostics of HNSCC Patients: An Analysis of Cell Lines and Patient-Derived Xenograft Models for Personalized Therapeutical Medicine.

Head and neck squamous cell carcinomas (HNSCC) are very frequent worldwide, and smoking and chronic alcohol use are recognized as the main risk factors. For oropharyngeal cancers, HPV 16 infection is known to be a risk factor as well. By employing next-generation sequencing, both HPV-positive and negative HNSCC patients were detected as positive for PI3K mutation, which was considered an optimal molecular target. We analyzed scientific literature published in the last 5 years regarding the newly available diagnostic platform for targeted therapy of HNSCC HPV+/-, using HNSCC-derived cell lines cultures and HNSCC pdx (patient-derived xenografts). The research results are promising and require optimal implementation in the management of HNSCC patients.

Merkel Cell Polyoma Virus and Cutaneous Human Papillomavirus Types in Skin Cancers: Optimal Detection Assays, Pathogenic Mechanisms, and Therapeutic Vaccination.

Oncogenic viruses are recognized to be involved in some cancers, based on very well-established criteria of carcinogenicity. For cervical cancer and liver cancer, the responsible viruses are well-known (e.g., HPV, HBV); in the case of skin cancer, there are still many studies which are trying to identify the possible viral etiologic agents as principal co-factors in the oncogenic process. We analysed scientific literature published in the last 5 years regarding mechanisms of carcinogenicity, methods of detection, available targeted therapy, and vaccination for Merkel cell polyomavirus, and beta human papillomavirus types, in relation to skin cancer. This review is targeted at presenting the recent findings which support the involvement of these viruses in the development of some types of skin cancers. In order to optimize the management of skin cancer, a health condition of very high importance, it would be ideal that the screening of skin cancer for these two analysed viruses (MCPyV and beta HPV types) to be implemented in each region's/country's cancer centres' molecular detection diagnostic platforms, with multiplex viral capability, optimal sensitivity, and specificity; clinically validated, and if possible, at acceptable costs. For confirmatory diagnosis of skin cancer, another method should be used, with a different principle, such as immunohistochemistry, with specific antibodies for each virus.

The Optimal Management of Neisseria gonorrhoeae Infections.

Neisseria gonorrhoeae is one of the most frequent etiologic agents of STDs (sexually transmitted diseases). Untreated asymptomatic gonococcal infection in women can lead to spreading of the infection in the sexually active population and could lead to late consequences, such as sterility or ectopic pregnancies. One important issue about N. gonorrhoeae is its increasing resistance to antibiotics. This paper summarized the newest molecular antimicrobial resistance (AMR) detection assays for Neisseria gonorrhoeae connected with the latest therapeutic antimicrobials and gonococcal vaccine candidates. The assays used to detect AMR varied from the classical minimal inhibitory concentration (MIC) detection to whole-genome sequencing. New drugs against multi drug resistant (MDR) N. gonorrhoeae have been proposed and were evaluated in vivo and in vitro as being efficient in decreasing the N. gonorrhoeae burden. In addition, anti-N. gonorrhoeae vaccine candidates are being researched, which have been assessed by multiple techniques. With the efforts of many researchers who are studying the detection of antimicrobial resistance in this bacterium and identifying new drugs and new vaccine candidates against it, there is hope in reducing the gonorrhea burden worldwide.

Postanesthetic skin erythema due to succinylcholine versus atracurium.

Intraoperative anaphylactic reactions may range from mild, erythema-like to anaphylactic shock, with tension crash and bronchospasm. The substances considered to be most responsible for the occurrence of intraoperative allergic reactions are neuromuscular blocking agents, antibiotics and latex. Recent studies have identified a new receptor, Mas-Related G-Protein-coupled Receptor X2 (MRGPRX2), considered as a target for some neuromuscular blockers such as atracurium, rocuronium or fluoroquinolone, resulting in pseudoallergic or anaphylactoid reactions. Induction of anesthesia can use both depolarizing myorelaxants, useful especially in emergency situations, in the patient with gastric plenitude or at high risk of intubation, and non-depolarizing myorelaxants such as atracurium, cisatracurium and rocuronium. Succinylcholine has a short time of action and it is rapidly metabolized. Atracurium, although having a slightly longer time to action, has the benefit of a low risk of increased levels of potassium in blood, which is extremely important in patients with cardiac pathology or associated kidney diseases. The present study compared the side effects of systemic anesthesia with succinylcholine vs. atracurium.

Update in pediatric primary brain tumors - from histology to genetically defined tumors.

In childhood and in adolescence, primary tumors of the central nervous system (CNS) are the second most common malignancy after leukemia. The most common entities are gliomas, craniopharyngiomas and embryonal tumors, including primitive neuroectodermal tumors of the CNS, such as medulloblastoma. Proper management of malignancies requires a histological diagnosis, especially in childhood, since diagnostic errors have a significant negative influence on the treatment and subsequently on the patient's care. Experimental research conducted in the last years regarding the genomic and epigenetic landscape of pediatric brain tumors has provided considerable help in understanding their pathogenesis. New mutations and new signaling pathways have been associated with pediatric neoplasia, according to recent studies. Current therapeutic protocols recommend triple therapy, consisting in the surgical resection of the tumor, radiotherapy and chemotherapy. However, the success of the therapy depends on the precociousness of establishing the diagnosis and initiating the treatment, age of the child, type of surgery (total∕partial), result of the histological examination, chemotherapy protocols and type of radiotherapy. Although immunotherapy and gene therapy continue to be a challenge, extensive studies are needed in order to confirm their promising role in the management of pediatric brain tumors.

Long-term survival in a patient with advanced gastric cancer and metachronous right-sided colon cancer.

Gastrointestinal carcinomas represent the most common cancers worldwide. The coexistence of gastric cancer with metachronous colon cancer represents a rare phenomenon, and the prognosis of the patient is poor. We present here a case of an elderly patient with primary gastric intestinal type well-differentiated adenocarcinoma (pT3N0, stage IIA) who developed a metachronous right-sided colon cancer diagnosed and treated after 11 years from the first surgical intervention. Histopathological and immunohistochemical examination revealed a well-differentiated adenocarcinoma (strongly positive staining for cytokeratin 20 and CDX2), pT3N0 stage IIA. The patient is still alive and active after 16 years from his first surgical intervention, even though no treatment has done after the removal of his second cancer. In conclusion, in any case of gastric cancer, first the surgeon, and then the general practitioner should be alert to recognize a second primary tumor with different origin and to perform complete postoperative control. The correct diagnosis could lead to the patients' best prognosis.

Surgical management of pulmonary hydatidosis in children.

UNLABELLED: Cystic echinococcosis (CE), the most common manifestation of the infestation with the larval form of the tapeworm Echinococcus granulosus, is a public health problem in endemic areas such as Moldavia. AIM: To retrospectively analyze pediatric patients who underwent surgery for pulmonary hydatid cyst over a 5-year period in order to assess the need for extensive lung resection. MATERIAL AND METHODS: In the interval January 2007 - January 2012 30 pediatric patients with pulmonary hydatid cyst were surgically treated in the Department of Pediatric Surgery at the Iasi "St. Maria" Children's Hospital. We retrospectively reviewed the medical records of these patients. RESULTS: Patient age ranged from 3 to 14 years, and 21 patients (70%) came from rural areas. Respiratory symptoms (cough, chest pain, hemoptysis, fatigue, and dyspnea) were the main complaints. Chest radiography, computed tomography and serological tests made the diagnosis in all cases. The most common location of cystic lesions was the left lower lobe (40%). All patients were treated by enucleation and capitonnage of the residual cavity. Postoperative complications occurred in 5 cases (16.67%) and in one case (3.33%) a new hydatid cyst was diagnosed in the right lung after 2 years. CONCLUSIONS: The surgical treatment of choice was cyst enucleation with capitonnage, thus sparing the pulmonary parenchyma. Major lung resections are to be avoided in children when no severe lung destruction is detected.

Epidemiological aspects of hydatidosis in children, in some areas of north-eastern Romania.

UNLABELLED: Hydatid cyst is a major public health problem in the pediatric population, both in terms of its frequency and of its endemic character in certain regions. The aim of the study was to present the incidence of hydatidosis in children who were hospitalized in pediatric clinics specialized in surgery of the Emergency Hospital for Children "St. Maria" from lasi. MATERIAL AND METHODS: Prospective study conducted in the interval 2008-2012 in a series of 194 children patients from Moldova, Romania. RESULTS: The peak incidence of the hydatid disease is located around the age of 11-14 years (33%) in male patients (55%) from rural areas (79%) and families with low socioeconomic level. The hepatic localization of the hydatid cyst (50.51%) among children was more common than pulmonary localization (16.49%). Liver and lung localization was found in 22.16% of cases. CONCLUSIONS: Hydatidosis remains a major health problem requiring drastic measures to limit the spread and transmission of the parasite in humans, primarily by reducing the number of stray dogs.

Correlation between asthma and Toxocara canis infection.

UNLABELLED: The aim of the current study was to examine the relationship between asthma and toxocariasis. MATERIAL AND METHODS: We have studied 76 patients with asthma and 88 controls (without asthma) aged 5-16 years. An ELISA test based on the detection of anti-Toxocara canis (E/S antigen) serum immunoglobulin G (IgG) and E (IgE) was done in both groups. Ordinary allergens and E/S antigen of T. canis infections were used to evaluate cutaneous reactivity. RESULTS: Seroprevalence in asthma patients was 68.42% and in the controls 13.63%. This difference was significant. The percentage of asthmatic patients with two anti-Toxocara antibodies was 26.31%, and of 4.54% in controls. All asthma patients with anti-Toxocara IgE had cutaneous reactivity to Ag E/S. CONCLUSIONS: Asthma patients with anti-Toxocara IgE and IgG may have toxocariasis.