ABSTRACT
INTRODUCTION AND OBJECTIVES: The novel coronavirus disease 2019 (COVID-19) has affected more than 5 million people globally. Data on the prevalence and degree of COVID-19 associated liver injury among patients with COVID-19 remain limited. We conducted a systematic review and meta-analysis to assess the prevalence and degree of liver injury between patients with severe and non-severe COVID-19. METHODS: We performed a systematic search of three electronic databases (PubMed/MEDLINE, EMBASE and Cochrane Library), from inception to 24th April 2020. We included all adult human studies (>20 subjects) regardless of language, region or publication date or status. We assessed the pooled odds ratio (OR), mean difference (MD) and 95% confidence interval (95%CI) using the random-effects model. RESULTS: Among 1543 citations, there were 24 studies (5961 subjects) which fulfilled our inclusion criteria. The pooled odds ratio for elevated ALT (ORâ¯=â¯2.5, 95%CI: 1.6-3.7, I2â¯=â¯57%), AST (ORâ¯=â¯3.4, 95%CI: 2.3-5.0, I2â¯=â¯56%), hyperbilirubinemia (ORâ¯=â¯1.7, 95%CI: 1.2-2.5, I2â¯=â¯0%) and hypoalbuminemia (ORâ¯=â¯7.1, 95%CI: 2.1-24.1, I2â¯=â¯71%) were higher subjects in critical COVID-19. CONCLUSION: COVID-19 associated liver injury is more common in severe COVID-19 than non-severe COVID-19. Physicians should be aware of possible progression to severe disease in subjects with COVID-19-associated liver injury.
Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Liver Diseases/epidemiology , Liver Diseases/virology , Pneumonia, Viral/complications , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Liver Diseases/diagnosis , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2ABSTRACT
ABSTRACT Purpose: To evaluate three superior oblique surgical weakening procedures for correcting A-pattern strabismus: tenectomy, superior oblique hang-back recession, and that involving the use of superior oblique suture spacers. Methods: The inclusion criteria were A-pattern strabismus ≥10Δ and horizontal deviation ≥10Δ, with no other ocular abnormality and a follow-up period of ≥6 months. The 24 patients (mean age, 16.3 ± 8.1 years; mean postoperative follow-up, 9.63 ± 3.11 months) were randomly divided into three groups of 8 patients each. Sigmascan® Pro 5.0 software was used to measure the degree of torsion pre- and postoperatively. Results: Preoperatively, the mean angles of A-pattern deviation were 19.33Δ° ± 3.53Δ° (tenectomy group), 15.71Δ° ± 1.11Δ° (hang-back recession group), and 14.62Δ° ± 1.18Δ° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean angles of A-pattern deviation were 4.67Δ° ± 0.67Δ° (tenectomy group), 6.29Δ° ± 1.48Δ° (hang-back recession group), and 4.38Δ° ± 1.03Δ° (suture spacers group), with no statistically significant difference in the correction in A-pattern strabismus among the three groups. Preoperatively, the mean torsional angles were +5.4° ± 3.9° (tenectomy group), +5.6° ± 4.9° (hang-back recession group), and +6.0° ± 3.3° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean torsional angles were + 0.3° ± 5.6° (tenectomy group), +0.5° ± 4.6° (hang-back recession group), and +0.2° ± 5.2° (suture spacers group), with no statistically significant difference in the intorsion correction among the three groups. Conclusion: All three superior oblique weakening procedures were effective for correcting A-pattern strabismus and fundus intorsion.
RESUMO Objetivo: Avaliar três procedimentos de debilitamento dos músculos oblíquos superiores para a correção de estrabismo com padrão em A: tenectomia, sutura em rédea (hang-back recession) e o uso de espaçadores de sutura oblíqua superior. Métodos: Os critérios de inclusão foram estrabismo padrão em A ≥10Δ e desvio horizontal ≥10Δ, sem outras anormalidades oculares e tempo de acompanhamento ≥6 meses. Os 24 pacientes (média de idade de 16,3 ± 8,1 anos; média de seguimento pós-operatório de 9,63 ± 3,11 meses) foram divididos aleatoriamente em três grupos de 8 pacientes cada. O programa Sigmascan® Pro 5.0 foi utilizado para medir o grau de torção no pré e pós-operatório. Resultados: No pré-operatório, a média e o desvio padrão dos ângulos de padrão em A foram de 19,33Δ° ± 3,53Δ° (grupo da tenectomia), 15,71Δ° ± 1,11Δ° (grupo da sutura em rédea), 14,62Δ° ± 1,18Δ° (grupo de espaçadores de sutura); esses valores não diferiram significativamente. No exame pós-operatório, a média e o desvio padrão dos ângulos de desvio do padrão em A foram de 4,67Δ° ± 0,67Δ° (grupo da tenectomia), 6,29Δ° ± 1,48Δ° (grupo da sutura em rédea), 4,38Δ° ± 1,03Δ° (grupo de espaçadores de sutura), sem diferença estatisticamente significativa na correção do estrabismo padrão em A entre os três grupos. No pré-operatório, os ângulos médios de torção foram de +5,4o ± 3,9° (grupo de tenectomia), +5,6° ± 4,9° (grupo da sutura em rédea), e +6,0° ± 3,3° (grupo de espaçadores de sutura), esses valores não diferiram significativamente. No pós-operatório, os ângulos médios de torção foram de +0,3° ± 5,6° (grupo da tenectomia), +0,5° ± 4,6° (grupo da sutura em rédea), e +0,2° ± 5,2° (grupo de espaçadores de sutura), sem diferença estatisticamente significativa na correção da intorção entre os três grupos. Conclusão: Os três procedimentos de debilitamento dos músculos oblíquos superiores foram efetivos para a correção do estrabismo com padrão em A e da intorção ocular observada na fundoscopia.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Young Adult , Ophthalmologic Surgical Procedures/methods , Strabismus/surgery , Oculomotor Muscles/surgery , Tendons/surgery , Visual Acuity , Strabismus/physiopathology , Prospective Studies , Preoperative Period , Fundus Oculi , Oculomotor Muscles/physiopathologyABSTRACT
PURPOSE: To evaluate three superior oblique surgical weakening procedures for correcting A-pattern strabismus: tenectomy, superior oblique hang-back recession, and that involving the use of superior oblique suture spacers. METHODS: The inclusion criteria were A-pattern strabismus ≥10Δ and horizontal deviation ≥10Δ, with no other ocular abnormality and a follow-up period of ≥6 months. The 24 patients (mean age, 16.3 ± 8.1 years; mean postoperative follow-up, 9.63 ± 3.11 months) were randomly divided into three groups of 8 patients each. Sigmascan® Pro 5.0 software was used to measure the degree of torsion pre- and postoperatively. RESULTS: Preoperatively, the mean angles of A-pattern deviation were 19.33Δ° ± 3.53Δ° (tenectomy group), 15.71Δ° ± 1.11Δ° (hang-back recession group), and 14.62Δ° ± 1.18Δ° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean angles of A-pattern deviation were 4.67Δ° ± 0.67Δ° (tenectomy group), 6.29Δ° ± 1.48Δ° (hang-back recession group), and 4.38Δ° ± 1.03Δ° (suture spacers group), with no statistically significant difference in the correction in A-pattern strabismus among the three groups. Preoperatively, the mean torsional angles were +5.4° ± 3.9° (tenectomy group), +5.6° ± 4.9° (hang-back recession group), and +6.0° ± 3.3° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean torsional angles were + 0.3° ± 5.6° (tenectomy group), +0.5° ± 4.6° (hang-back recession group), and +0.2° ± 5.2° (suture spacers group), with no statistically significant difference in the intorsion correction among the three groups. CONCLUSION: All three superior oblique weakening procedures were effective for correcting A-pattern strabismus and fundus intorsion.
Subject(s)
Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures/methods , Strabismus/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Fundus Oculi , Humans , Male , Oculomotor Muscles/physiopathology , Preoperative Period , Prospective Studies , Strabismus/physiopathology , Tendons/surgery , Visual Acuity , Young AdultABSTRACT
BACKGROUND: Bloodstream infections (BSIs) due to Enterococcus faecium (E. faecium), particularly those due to vancomycin-resistant enterococcus (VRE), are still a therapeutic challenge. AIM: To evaluate mortality from BSI due to E. faecium and VRE in central Taiwan. MATERIALS AND METHODS: We retrospectively analyzed cases of significant E. faecium BSI in the Changhua Christian Hospital System between January 1, 2010 and December 31, 2013. RESULTS: Of the 76 cases, 28 patients (36.8%) were admitted to intensive care units (ICUs) at the onset of BSI, 10 (13.2%) cases were associated with polymicrobial bacteremia, and 29 (38.2%) cases were associated with entry via the biliary tract. VRE was observed in 18 (23.7%) cases. The 30-day mortality rate was 13.1% (10/76). Multivariate logistic regression analysis showed that bacteremia of non-biliary tract origin (OR = 8.43, 95% confidence interval (95% CI) = 1.32-54.00, p = 0.002) and ICU admission (OR = 4.2, 95% CI = 1.7-10.0, p = 0.002) were significant risk factors for 30-day mortality, whereas appropriate antimicrobial therapy was a protective factor for 30-day mortality (OR = 0.33, 95% CI = 0.14-0.79, p = 0.013). CONCLUSIONS: Our results underscore the need to assist patients admitted to ICUs with E. faecium BSIs with a non-biliary tract origin. We emphasize the use of appropriate antimicrobial therapy for E. faecium BSI with the aim to rescue more patients with these infections.
Subject(s)
Bacteremia/microbiology , Bacteremia/mortality , Vancomycin-Resistant Enterococci/isolation & purification , Bacteremia/drug therapy , Female , Humans , Incidence , Male , Microbial Sensitivity Tests , Middle Aged , Retrospective Studies , Risk Factors , Taiwan/epidemiology , Vancomycin ResistanceABSTRACT
Background: Bloodstream infections (BSIs) due to Enterococcus faecium (E. faecium), particularly those due to vancomycin-resistant enterococcus (VRE), are still a therapeutic challenge. Aim: To evaluate mortality from BSI due to E. faecium and VRE in central Taiwan. Materials and Methods: We retrospectively analyzed cases of significant E. faecium BSI in the Changhua Christian Hospital System between January 1, 2010 and December 31, 2013. Results: Of the 76 cases, 28 patients (36.8%) were admitted to intensive care units (ICUs) at the onset of BSI, 10 (13.2%) cases were associated with polymicrobial bacteremia, and 29 (38.2%) cases were associated with entry via the biliary tract. VRE was observed in 18 (23.7%) cases. The 30-day mortality rate was 13.1% (10/76). Multivariate logistic regression analysis showed that bacteremia of non-biliary tract origin (OR = 8.43, 95% confidence interval (95% CI) = 1.32-54.00, p = 0.002) and ICU admission (OR = 4.2, 95% CI = 1.7-10.0, p = 0.002) were significant risk factors for 30-day mortality, whereas appropriate antimicrobial therapy was a protective factor for 30-day mortality (OR = 0.33, 95% CI = 0.14-0.79, p = 0.013). Conclusions: Our results underscore the need to assist patients admitted to ICUs with E. faecium BSIs with a non-biliary tract origin. We emphasize the use of appropriate antimicrobial therapy for E. faecium BSI with the aim to rescue more patients with these infections.
Antecedentes: Las infecciones del torrente sanguíneo por Enterococcus faecium, particularmente aquellas causadas por enterococos resistentes a vancomicina (ERV), representan aún un desafío para los tratamientos. Este estudio está orientado a la evaluación de la mortalidad debido a la infección del torrente sanguíneo (ITS) por E. faecium y por enterococos resistentes a vancomicina (ERV) en Taiwán central. Materiales y Métodos: Analizamos de forma retrospectiva casos de ITS causadas por E. faecium genuinas en el Sistema del Hospital Changhua Christian, entre los días 1 de enero de 2010 y 31 de diciembre de 2013. Resultados: De los 76 casos analizados, 28 pacientes fueron ingresados a las Unidades de Cuidados Intensivos (UCI) al comienzo de una ITS (36,8%), 10 casos fueron asociados a bacteriemia polimicrobiana (13,2%), y 29 casos tuvieron como puerta de entrada la vía biliar. En 18 casos se pudieron observar ERV (23,7%). La mortalidad a 30 días fue de 13,1% (10/76). El análisis multivariado mediante regresión logística mostró que la bacteriemia de origen no biliar (OR = 8,43, 95% intervalo de confianza (95% CI) = 1,32-54,00; p = 0,002), y el ingreso a la UCI (OR = 4,2; 95% CI = 1,7-10,0; p = 0,002), fueron factores de riesgo significativos para el rango de mortalidad de 30 días, así como un tratamiento de antimicrobiano apropiado constituye un factor protector en contra la mortalidad (OR = 0,33; 95% CI = 0,14-0,79; p = 0,013). Conclusiones: Nuestros resultados destacan la necesidad de asistir a los pacientes ingresados a la UCI con ITS por E. faecium con origen no biliar. Hacemos énfasis a la aplicación de una antibioterapia adecuada para sacar adelante a un mayor número de pacientes con este tipo de infecciones.
Subject(s)
Humans , Male , Female , Middle Aged , Bacteremia/microbiology , Bacteremia/mortality , Vancomycin-Resistant Enterococci/isolation & purification , Taiwan/epidemiology , Microbial Sensitivity Tests , Incidence , Retrospective Studies , Risk Factors , Bacteremia/drug therapy , Vancomycin ResistanceABSTRACT
BACKGROUND: Neonatal necrotizing enterocolitis is a common and often fatal gastrointestinal disease, especially in premature infants. To study potential mechanisms underlying the protective effect of breast milk on neonatal necrotizing enterocolitis, we induced intestinal inflammation in a Caco-2 cell model of neonatal necrotizing enterocolitis by hypoxia/re-oxygenation to investigate whether breast milk supernatant fluid inhibited the expression of proinflammatory cytokines interleukin-1ß, interleukin-6, and tumor necrosis factor-α. METHODS: Caco-2 cells were divided into normal (control) and neonatal necrotizing enterocolitis groups. Neonatal necrotizing enterocolitis was mimicked by exposing Caco-2 cells to hypoxia/re-oxygenation. Cells were independently maintained in minimal essential medium alone, minimal essential medium containing 5% breast milk supernatant, or 5% boiled breast milk supernatant. Production of interleukin-1ß, interleukin-6, and tumor necrosis factor-α was investigated in cell culture supernatants by ELISA, reverse transcription polymerase chain reaction, and immunofluorescence. RESULTS: Hypoxia/re-oxygenation significantly increased the expression of interleukin-1ß, interleukin-6, and tumor necrosis factor-α. In the normal group, breast milk supernatant and boiled breast milk supernatant markedly downregulated the expression of interleukin-1ß, interleukin-6, and tumor necrosis factor-α when compared with the minimal essential medium group, with the reduction in inter-leukin-1ß expression being more pronounced in the breast milk group. In Caco-2 cells undergoing hypoxia/re-oxygenation, both breast milk supernatant and boiled breast milk supernatant significantly reduced the expression of interleukin-1ß, interleukin-6, and tumor necrosis factor-α, where the decrease in interleukin-1ß expression was greater in the breast milk group. CONCLUSIONS: Breast milk supernatant fluid inhibited the expression of proinflammatory cytokines interleukin-1ß, interleukin-6, and tumor necrosis factor-α in Caco-2 cells, especially after hypoxia/re-oxygenation. This may be one of the mechanisms underlying the protective effect of breast milk on neonatal necrotizing enterocolitis.
Subject(s)
Cytokines/metabolism , Enterocolitis, Necrotizing/prevention & control , Inflammation Mediators/metabolism , Milk, Human/metabolism , Caco-2 Cells , Cooking , Down-Regulation/genetics , Enterocolitis, Necrotizing/physiopathology , Enzyme-Linked Immunosorbent Assay , Female , Fluorescent Antibody Technique , Humans , Hypoxia , Inflammation/metabolism , Inflammation/pathology , Interleukin-1beta/metabolism , Interleukin-6/metabolism , Oxygen/administration & dosage , Reverse Transcriptase Polymerase Chain Reaction , Tumor Necrosis Factor-alpha/metabolismABSTRACT
BACKGROUND: Patellar resurfacing after routine arthroplasty remains controversial. Few studies have specifically examined the effect of patellar resurfacing on outcomes after resection of the distal part of the femur and reconstruction with a megaprosthesis. Our objective was to compare the outcomes of megaprosthesis reconstructions of the distal part of the femur with and without patellar resurfacing after resection of a distal femoral tumor. METHODS: We retrospectively reviewed the clinical records of patients with a femoral tumor who underwent resection of the distal part of the femur and endoprosthetic reconstruction between 1993 and 2013. We excluded patients who had had extra-articular knee resection, patellectomy, revision, reconstruction with an expandable prosthesis, or a proximal tibial replacement associated with the distal femoral replacement. We compared demographic characteristics, surgical variables, anterior knee pain, range of motion, extensor lag, Insall-Salvati ratio, Insall-Salvati patellar tendon insertion ratio, impingement, patellar degenerative disease, additional patellar procedures, complications, and Musculoskeletal Tumor Society (MSTS) score between the patellar resurfacing and nonresurfacing groups. RESULTS: One hundred and eight patients--sixty without patellar resurfacing and forty-eight with patellar resurfacing--were included in the study. The mean age was 33.9 years (range, twelve to seventy-five years). There were fifty-four men and fifty-four women. The mean duration of follow-up was 4.5 years (range, 0.7 to twenty years). There was no significant difference in anterior knee pain between the groups (p = 0.51). Anterior knee pain did not significantly affect the range of motion, extensor lag, or reoperation or complication rate. Patellar degenerative disease occurred in 48% of the nonresurfaced knees but was not associated with focal pain. Complication rates were similar in the two groups, although peripatellar calcifications were significantly more common in the resurfacing group (19% versus 2%; p = 0.005). There was no significant difference in the mean MSTS score between the nonresurfacing (81%) and resurfacing (71%) groups (p = 0.34). CONCLUSIONS: There were no differences in anterior knee pain, range of motion, extensor lag, or MSTS score between the patients with and those without patellar resurfacing. There were no cases of patellar component loosening or revision. In light of the similar outcomes in the two groups, the decision to resurface should be left up to the individual surgeon, who should take into account preoperative peripatellar pain and the status of the patella at the time of resection. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Subject(s)
Femur/surgery , Patella/surgery , Prosthesis Implantation , Adolescent , Adult , Aged , Child , Female , Femoral Neoplasms/surgery , Follow-Up Studies , Humans , Male , Middle Aged , Pain/etiology , Patella/anatomy & histology , Postoperative Complications , Range of Motion, Articular , Retrospective Studies , Young AdultABSTRACT
INTRODUCTION: The patellar height can influence extensor mechanism and the knee function. Thus, during knee arthroplasty, the surgeon seeks to maintain the correct patellar height. However, it is more difficult to define and maintain the correct patella height in megaprosthesis reconstructions after tumor resections. The objective of this study was to evaluate patellar height after distal femur endoprosthesis reconstruction and its association to knee function. METHODS: This retrospective analysis included 108 patients who underwent distal femur resections and endoprosthesis reconstruction. The minimum follow-up was 1 year or until the patients underwent patellar resurfacing or endoprosthesis revision. Patellar height was calculated using Insall-Salvati ratio (ISR) and Insall-Salvati patellar tendon insertion ratio (PTR) at 2 different times: postoperatively and at the final follow-up. The postoperative ratio was calculated using the best postoperative radiograph taken at least 1 month after the procedure. The final measures were based on the radiograph available at the last follow-up consultation. The ISR and PTR were associated to anterior knee pain (AKP), range of motion (ROM), and extension lag (EXL). RESULTS: The average follow-up was 4.5years. The mean postoperative ISR was 1.02, and the mean ISR at final follow-up was 0.95 (P<.0001). The mean postoperative PTR was 1.45, and the mean PTR at final follow-up was 1.40 (P=.016). There was no association between patellar height and AKP, ROM, and EXL. Patellar height decreases significantly after distal femur resections but does not affect AKP, ROM, and EXL.
Subject(s)
Arthralgia/etiology , Femur/surgery , Knee Joint/physiology , Patella , Prosthesis Implantation/adverse effects , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Patellar Ligament/physiology , Range of Motion, Articular , Reoperation , Retrospective Studies , Tendons/surgery , Young AdultABSTRACT
Current resources to support genetic screening among the Uygur population in Xinjiang territory for atrial fibrillation (AF) have not been well established and large-scale epidemiological analyses are needed. Using patients from the Xinjiang Uygur population as subjects, and the delayed rectifier potassium channel KCNE1 and its associated polymorphism G38S (rs1805127) as the candidate gene, we analyzed the correlation between the G38S polymorphism and AF among the senior Uygur population in Xinjiang Province. Peripheral blood from AF Uygur patients (patient group) or non-AF Uygur patients (control group) from Xinjiang territory was collected (70 patients each). DNA was purified and tested by polymerase chain reaction-restriction fragment length polymorphism for the genotype and allelic distribution of KCNE1 (G38S). Correlation analysis between AF and multiple health-related factors was performed by logistic regression. Among patients with the KCNE1 G38S polymorphism, the genotypes AA, AG, and GG were present at frequencies of 17.14, 27.14, and 55.71%, respectively, in the patient group, compared with 24.29, 50, and 25.71%, respectively, in the control group. The difference between these two groups was shown to be statistically significant (P < 0.05), and the frequency of the G allele was significantly higher in the patient group (P < 0.05). Logistic regression showed that the GG genotype is correlated with the incidence of AF in Uygur seniors (P < 0.05). The incidence of AF among the senior Uygur population in Xinjiang territory was correlated with the KCNE1 (G38S) polymorphism, which may be an independent risk factor for Uygur AF patients.
Subject(s)
Alleles , Atrial Fibrillation/epidemiology , Atrial Fibrillation/genetics , Ethnicity/genetics , Genetic Association Studies , Genetic Predisposition to Disease , Polymorphism, Single Nucleotide , Potassium Channels, Voltage-Gated/genetics , Aged , Aged, 80 and over , Atrial Fibrillation/physiopathology , Case-Control Studies , China/epidemiology , Comorbidity , Female , Gene Frequency , Genotype , Humans , Male , Middle Aged , Odds RatioABSTRACT
Background Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. Methods This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors. Result Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H2O). Conclusions We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.(AU)
Subject(s)
Humans , Cryptococcosis/epidemiology , Meningitis, Cryptococcal/epidemiology , Taiwan/epidemiology , Cryptococcus neoformans , Cryptococcus gattiiABSTRACT
BACKGROUND: Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. METHODS: This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors. RESULTS: Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (≥250 mm H2O). CONCLUSIONS: We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.
ABSTRACT
OBJECTIVE: spa-typing of methicillin-resistant Staphylococcus aureus (MRSA) has been used widely in clinical diagnostics and epidemiological studies. The aim of this study was to evaluate high-resolution melting (HRM) as a rapid and cost-effective method, to replace DNA-sequencing, for spa-typing in a global collection of 50 MRSA isolates. METHODS: The polymorphic X region of the spa gene was amplified by colony PCR using the SensiMix HRM kit, and the melting temperature (Tm) and melting curves of the amplicons were analyzed in close tubes using a Rotor-Gene 6000 instrument. RESULTS: Fifteen out of 19 spa-types each had a distinct Tm, which was sufficient to unambiguously type each of these spa-types. The remaining four spa-types could not be separated by Tm alone: t008 and t2770 shared a Tm (80.3°C) and t021 and t311 shared a Tm (80.0°C). However, they could be separated based on the shapes of their melting curves. There are discrepancies between the findings of the present study and those of previous studies, suggesting that standardization remains a challenge for cross-referencing. CONCLUSION: HRM-based spa-typing is reproducible, simple, rapid, and cost-effective. t037 is prevalent in Brazil and Sudan, while diverse spa-types are found in Scotland and Saudi Arabia. Standardization is required for cross-referencing between laboratories globally.
Subject(s)
Methicillin-Resistant Staphylococcus aureus/classification , Molecular Typing , Staphylococcal Protein A/genetics , Brazil , Humans , Methicillin-Resistant Staphylococcus aureus/genetics , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Nucleic Acid Denaturation , Polymerase Chain Reaction , Saudi Arabia , Scotland , Sequence Analysis, DNA , SudanABSTRACT
Background Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. Methods This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors. Result Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H2O). Conclusions We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.
Subject(s)
Humans , Cryptococcosis/epidemiology , Cryptococcus gattii , Cryptococcus neoformans , Meningitis, Cryptococcal/epidemiology , Taiwan/epidemiologyABSTRACT
BackgroundCryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors.MethodsThis cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors.ResultsFifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H2O).ConclusionsWe strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.(AU)
Subject(s)
Prognosis , Meningitis, Cryptococcal/epidemiology , Meningitis , Risk FactorsABSTRACT
CONTEXT: Herbal preparation of Pao pereira [Geissospermum vellosii Allem (Apocynaceae)] has long been used by oncologic patients and Integrative Medicine practitioners in South America. However, its anticancer activities have not been systematically studied. OBJECTIVE: To investigate the anticancer effects of ß-carboline alkaloids-enriched extract from Pao pereira (Pao), either alone or in combination with carboplatin, in preclinical ovarian cancer models. MATERIALS AND METHODS: Cytotoxicity of Pao (0-800 µg/ml) against different ovarian cancer cell lines and an immortalized epithelial cell line was detected by flow cytometry, MTT assay and colony formation in soft agar. Combination of Pao and carboplatin, a primary chemotherapeutic drug for ovarian cancer, was evaluated using Chou-Talalay's methods. Mice bearing intraperitoneally spread ovarian cancer were treated with 20 or 50 mg/kg/day Pao by i.p. injection. Carboplatin at 15 mg/kg/week i.p. was compared and combined to Pao treatments. RESULTS: Pao selectively inhibited ovarian cancer cell growth with IC50 values of 180-235 µg/ml, compared to 537 µg/ml in normal cells. Pao induced apoptosis dose- and time-dependently and completely inhibited colony formation of tumor cells in soft agar at 400 µg/ml. Pao greatly enhanced carboplatin cytotoxicity, with dose reduction (DRIs) for carboplatin at 1.2-10 fold. In vivo, Pao alone suppressed tumor growth by 79% and decreased volume of ascites by 55%. When Pao was combined with carboplatin, tumor inhibition reached 97% and ascites was completely eradicated. DISCUSSION AND CONCLUSION: Pao possess potent antitumor activity and could enhance carboplatin effect, and therefore holds therapeutic potential in the treatment of ovarian cancer.
Subject(s)
Antineoplastic Agents, Phytogenic/pharmacology , Apocynaceae/chemistry , Ovarian Neoplasms/drug therapy , Plant Extracts/pharmacology , Animals , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Agents, Phytogenic/isolation & purification , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Apoptosis/drug effects , Carboplatin/administration & dosage , Cell Line, Tumor , Dose-Response Relationship, Drug , Female , Flow Cytometry , Humans , Injections, Intraperitoneal , Medicine, Traditional , Mice , Mice, Nude , Ovarian Neoplasms/pathology , Plant Extracts/administration & dosage , Plant Extracts/isolation & purification , South America , Time FactorsABSTRACT
Avian pathogenic Escherichia coli (APEC) infections are responsible for significant losses in the poultry industry worldwide. The disease might present as different local infections or as septicemia. Here, we present the draft genome sequences of three Brazilian APEC strains isolated from different kinds of infections. The availability of these APEC genome sequences is important for gaining a thorough understanding of the genomic features of E. coli, particularly those of this pathotype.
ABSTRACT
Avian-pathogenic Escherichia coli (APEC) strains cause extraintestinal diseases in avian species. Here, we present the draft genome of an APEC strain (SCI-07) from Brazil that was isolated from skin lesions (gelatinous edema) on the head and periorbital tissues of a laying hen with swollen head syndrome.