Talaromyces amestolkiae Infection in an AIDS Patient with Cryptococcal Meningitis.

Concurrent infections caused by multiple fungal pathogens in immunocompromised patients can pose diagnostic and treatment challenges. Here, we presented the first reported case in Taiwan of an AIDS patient who had concurrent infection with Cryptococcus neoformans meningitis and Talaromyces amestolkiae lymphadenopathy. The patient presented with an enlarged inguinal lymph node and was diagnosed with T. amestolkiae lymphadenitis. The species T. amestolkiae was identified using DNA sequencing, which had the capability of differentiating it from other Talaromyces species. The patient was discharged from the hospital following treatment with amphotericin B and subsequent administration of voriconazole. This case highlights the importance of maintaining a suspicion of co-infections and utilizing appropriate diagnostic tools, such as DNA sequencing, to identify possible pathogens. Further studies are needed to determine the optimal treatment for T. amestolkiae and other co-infecting fungal pathogens.

Clinical metagenomics-assisted diagnosis of relapsed HIV-associated cryptococcal meningitis.

To date, the identification of crypotococcal relapse remains clinically challenging as it often has similar manifestation with paradoxical immune reconstitution inflammatory syndrome. This study reports on the use of metagenomics assisted next generation sequencing to aid in diagnosing recurrent cryptococcal meningitis in an person living with HIV experiencing recurring symptoms, despite negative culture results for Cryptococcus neoformans in the cerebrospinal fluid. Although fungal culture was negative, when reads from metagenomic and metatranscriptomic sequencing performed on the Day 308 cerebrospinal fluid sample were mapped onto the genome from the Day 4 isolate, 589 specific reads were identified. NCBI BLAST search also revealed Cryptococcus-specific 18S/25S/28S ribosomal RNA, indicating a relapse of the disease.

The Impact of the COVID-19 Pandemic on Respiratory Syncytial Virus Infection: A Narrative Review.

Respiratory syncytial virus (RSV) is one of the most common respiratory viruses. It not only affects young children but also the elderly and immunocompromised patients. After the emergence of SARS-CoV-2 and the corona virus disease 2019 (COVID-19) era, a dramatic reduction in RSV activity was found, which coincided with the implementation of public health and social measures (PHSMs). However, the correlation is more complicated than we initially thought. After PHSMs were gradually lifted, a seasonality shift and a delayed RSV outbreak with greater number of infected patients were found in numerous countries, such as Israel, Australia, South Africa, New Zealand, France, United States, and Japan. Several hypotheses and possible reasons explaining the interaction between SARS-CoV-2 and RSV were mentioned. Since RSV vaccinations are still under investigation, administration of palivizumab should be considered in high-risk patients. In the post-COVID-19 era, greater attention should be paid to a further resurgence of RSV. In this narrative review, we conducted a thorough review of the current knowledge on the epidemiology of RSV during the COVID-19 era, the out-of-season outbreak of RSV, and the data on co-infection with RSV and SARS-CoV-2.

Blood Culture Negative Endocarditis: A Review of Laboratory Diagnostic Approaches.

Infective endocarditis is a potentially fatal condition, and identifying the pathogen is crucial to optimizing antibiotic treatment. While a blood culture takes time and may yield negative results, it remains the gold standard for diagnosis, blood culture-negative endocarditis, which accounts for up to 20% of infective endocarditis cases, poses a clinical challenge with increasing mortality. To better understand the etiology of blood culture-negative infective endocarditis, we reviewed non-culture-based strategies and compared the results. Serology tests work best in limited pathogens, such as Coxiella burnetii and Bartonella infections. Most of the pathogens identified by broad-range PCR tests are Streptococcus spp, Staphylococcus spp and Propionibacterium spp. adding specific real-time PCR assays to the systematic PCR testing of patients with blood culture-negative endocarditis will increase the efficiency of diagnosis. Recently, metagenomic next-generation sequencing has also shown promising results.

Bilateral Lower Limbs Cellulitis: A Narrative Review of an Overlooked Clinical Dilemma.

Bilateral lower limbs cellulitis is a rare clinical condition, which has been overlooked for a long time. In daily clinical practice, bilateral cellulitis is a sporadically encountered condition; however, it remains a clinical challenge. There is a broad differential diagnosis for this clinical entity, and there is a lack of accepted international diagnostic criteria. Unnecessary antibiotic prescription is common, which has led to an emerging problem. In this review, we summarize case reports of bilateral lower limbs cellulitis and common pathogens that have been documented.

COVID-19 in Veterans: A Narrative Review.

Veterans are a special population that has been largely ignored during the corona virus disease 2019 (COVID-19) pandemic. Veterans with COVID-19 not only suffered symptoms from the disease but also had a higher risk of further development of in-hospital complications involving multiple organs. This article aims to review the current literature on the epidemiology, risk factors, diagnosis, clinical presentation, treatment, and outcome in veterans who contracted COVID-19 during the pandemic, using papers published between January 1, 2020 and August 1, 2021. Forty published papers were considered relevant to this review study. The COVID-19 pandemic not only caused a burden on health-care facilities but also affected the veterans population. Veterans with COVID-19 not only suffered symptoms from the disease but also had a higher risk of further development of in-hospital complications involving multiple organs. The dismal outcome might be attributed to old age and multiple comorbidities among veterans. Symptoms that may be seen in veterans with COVID-19 are comparable to those in the general population with fever, cough, and dyspnea, the most commonly reported. There are several approaches, such as self-assessment tools and virtual or telephone triage strategies, that can initially provide adequate evaluation of the symptoms related to COVID-19 in veterans. Adequate risk stratification could be carried out using the VA COVID-19 (VACO) Index, which predicts the risk of 30-day all-cause mortality after COVID-19 infection. There are several COVID-19 specific treatments that have been given to veterans; however, none of them have been proven to reduce the overall mortality in veterans. The overall mortality rate among veterans showed a declining trend. However, veterans suffering from chronic COVID-19 are at risk of dependence on activities of daily living after recovering from the illness. In summary, veterans are a special population that requires more attention especially during the COVID-19 pandemic.

Incorporating Exposure Measurement Data from Similar Exposure Scenarios to Inform Exposure Modeling Estimates: A Demonstration Using Cluster Analysis and Bayesian Modeling.

Addressing occupational health and safety concerns early in the design stage anticipates hazards and enables health professionals to recommend control measures that can best protect workers' health. This method is a well-established tool in public health. Importantly, its success depends on a comprehensive exposure assessment that incorporates previous exposure data and outcomes. Traditional methods for characterizing similar occupational exposure scenarios rely on expert judgment or qualitative descriptions of relevant exposure data, which often include undisclosed underlying assumptions about specific exposure conditions. Thus, improved methods for predicting exposure modeling estimates based on available data are needed. This study proposes that cluster analysis can be used to quantify the relevance of existing exposure scenarios that are similar to a new scenario. We demonstrate how this method improves exposure predictions. Exposure data and contextual information of the scenarios were collected from past exposure assessment reports. Prior distributions for the exposure distribution parameters were specified using Stoffenmanager® 8 predictions. Gower distance and k-Medoids clustering algorithm analyses grouped existing scenarios into clusters based on similarity. The information was used in a Bayesian model to specify the degree of correlation between similar scenarios and the scenarios to be assessed. Using the distance metric to characterize the degree of similarity, the performance of the Bayesian model was improved in terms of the average bias of model estimates and measured data, reducing from 0.77 (SD: 2.0) to 0.49 (SD: 1.8). Nevertheless, underestimation of exposures still occurred for some rare scenarios, which tended to be those with highly variable exposure data. In conclusion, the cluster analysis approach may enable transparent selection of similar exposure scenarios for factoring into design-phase assessments and thereby improve exposure modeling estimates.

Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid.

BACKGROUND: Previous thyroid or parathyroid surgery induces scarring or distorts anatomy, and increases the risk of recurrent laryngeal nerve (RLN) injury for a reoperation. The benefit of intraoperative nerve monitoring (IONM) for re-exploration (a second nerve exploration) and reoperation has not been established. METHODS: Two hundred and ten patients were given a thyroid or parathyroid reoperation at our hospital between 2001 and 2010. Using IONM, we re-explored 56 patients who had been operated on before June 2007. The injury rate in these patients was compared with that of the 15 patients re-explored without IONM between 2001 and 2006. RESULTS: Of the 70 nerves that were re-explored using IONM, only one was incidentally injured, significantly fewer than the three injured in the 15 nerves re-explored without using IONM (1.43% vs. 20%, P = 0.0164). CONCLUSIONS: IONM helped prevent RLN damage when re-exploring nerves during thyroid and parathyroid surgery. We recommend the routine use of IONM in thyroid and parathyroid reoperations.

Evaluating a leadership program: a comparative, longitudinal study to assess the impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women.

PURPOSE: The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) program provides an external yearlong development program for senior women faculty in U.S. and Canadian medical schools. This study aims to determine the extent to which program participants, compared with women from two comparison groups, aspire to leadership, demonstrate mastery of leadership competencies, and attain leadership positions. METHOD: A pre-/posttest methodology and longitudinal structure were used to evaluate the impact of ELAM participation. Participants from two ELAM cohorts were compared with women who applied but were not accepted into the ELAM program (NON) and women from the Association of American Medical Colleges (AAMC) Faculty Roster. The AAMC group was a baseline for midcareer faculty; the NON group allowed comparison for leadership aspiration. Baseline data were collected in 2002, with follow-up data collected in 2006. Sixteen leadership indicators were considered: administrative leadership attainment (four indicators), full professor academic rank (one), leadership competencies and readiness (eight), and leadership aspirations and education (three). RESULTS: For 15 of the indicators, ELAM participants scored higher than AAMC and NON groups, and for one indicator they scored higher than only the AAMC group (aspiration to leadership outside academic health centers). The differences were statistically significant for 12 indicators and were distributed across the categories. These included seven of the leadership competencies, three of the administrative leadership attainment indicators, and two of the leadership aspirations and education indicators. CONCLUSIONS: These findings support the hypothesis that the ELAM program has a beneficial impact on ELAM fellows in terms of leadership behaviors and career progression.