A Rare Case of Invasive Central Nervous System Aspergillus niger in a Previously Immunocompetent Patient After Corticosteroid Treatment for COVID-19.

Aspergillus is a ubiquitous saprophyte found in air, soil, and organic matter. Humans inhale the spore form of the fungus, but manifestations of the disease are typically predominantly seen in immunocompromised patients. Invasive central nervous system (CNS) aspergillosis is even more uncommon, and epidemiological data is sparse, particularly in immunocompetent patients. We report the case of a 67-year-old previously immunocompetent female with no known comorbidities who was treated with corticosteroids for COVID-19 one month prior to admission for altered mental status (AMS). Subsequent imaging and biopsy demonstrated invasive CNS Aspergillus niger. Though a rare cause of AMS in immunocompetent patients, this report draws attention to the detrimental immunosuppressive effects of corticosteroid therapy in COVID-19.

A graftless maxillary sinus lifting approach with simultaneous dental implant placement: a prospective clinical study.

PURPOSE: This study aimed to introduce a graftless sinus lifting approach with simultaneous dental implant placement in the alveolus of the posterior maxilla and compare this approach's outcomes in freshly extracted sockets versus healed sockets. MATERIALS AND METHODS: A prospective study was conducted on 60 patients aged between 27 and 59 years old, requiring dental implants in the posterior maxilla, and diagnosed with reduced vertical bone height (30 with freshly extracted sockets (group A) and the remaining 30 with healed sockets (group B). Before the sinus lifting approach, a cone beam computed tomography (CBCT) was taken, followed by another CBCT at least one-year post-sinus lifting (range: 12-36 months). Biological and mechanical complications were assessed, and the primary implant stability was measured using the Implant Stability Quotient (ISQ). Parametric data were analyzed using an independent t-test for intergroup comparisons, with significance set at P < 0.05. RESULTS: No significant differences were found among groups concerning gender, placement side, and follow-up. All dental implants demonstrated high survival rates with no observed biological or mechanical complications. Moreover, the primary implant stability was satisfactory, and there was no statistically significant difference (P = 0.38). In terms of new intrasinus bone formation, both groups exhibited satisfactory and successful outcomes, with increased new bone formation in group A. However, there was no statistically significant difference (P = 0.26). Regarding the vertical sinus floor elevation without new bone formation, group B showed (0.11 ± 0.64) mm of intrasinus implant height without bone formation, while group A showed an increment of bone formation above the intrasinus implant (0.22 ± 0.33) mm, with no statistically significant difference between both groups (P = 0.30). CONCLUSION: Our approach proves to be predictable, low-cost, and efficient option for sinus lift procedures, demonstrating high survival rates with acceptable primary implant stability. Moreover, it yields satisfactory outcomes in terms of new intrasinus bone formation, both in freshly extracted and healed sockets. Consequently, our approach holds promise as a reliable procedure for sinus lifting with simultaneous dental implant placement.

Pancreatic cyst fluid interleukin-1 beta (IL-1ß) level in predicting the risk of malignancy in pancreatic cysts.

Pancreatic cystic lesions (PCLs) may be accidentally discovered in up to 13.5% of cases. These PCLs are of multiple types, including mucinous cysts (intra-ductal papillary mucinous neoplasms [IPMN] and mucinous cystic neoplasms [MCN]) that have a risk of malignant transformation. The difficulty in differentiation between the various PCLs and their unpredictable risk of malignant transformation makes their management difficult. The new diagnostic tools of PCLs often include endoscopic ultrasound guided fine needle aspiration (EUS-FNA) for pancreatic cyst fluid analysis. This study aimed to determine if cystic fluid IL-1ß can predict the risk of malignancy and the degrees of dysplasia of pancreatic cysts. The study included 50 PCL patients. They were subjected to radiological, biochemical, serological, and histopathological examinations. Pancreatic cyst fluid IL-1ß was analyzed using an ELISA. Our data indicated that cyst fluid IL-1 ß can differentiate between benign and malignant cysts at cut-off value >150 pg/ml; with sensitivity and specificity of 84.00% and 56.00% respectively. Also, cyst fluid IL-1 ß can differentiate between mucinous and non- mucinous pancreatic cysts at cut-off value >150 pg/ml; with a sensitivity and specificity of 83.33% and 53.78%, respectively. However, cyst fluid IL-1 ß cannot differentiate between degrees of dysplasia of IPMN. In conclusion, our study suggested that pancreatic cyst fluid IL-1ß can differentiate between.

The initial impact of a national BNT162b2 mRNA COVID-19 vaccine rollout

ObjectiveWe herein report the initial impact of a national BNT162b2 rollout on SARS-CoV-2 infections in Qatar. MethodsWe included all individuals who by 16 March 2021 had completed [≥]14 days of follow up after the receipt of BNT162b2. We calculated incidence rates (IR) and their 95% confidence intervals (CI), during days 1-7, 8-14, 15-21, 22-28, and >28 days post-vaccination. Poisson regression was used to calculate incidence rate ratios (IRR) relative to the first 7-day post-vaccination period. ResultsWe included 199,219 individuals with 6,521,124 person-days of follow up. SARS-CoV-2 infection was confirmed in 1,877 (0.9%), of which 489 (26.1%) were asymptomatic and 123 (6.6%) required oxygen support. The median time from first vaccination to SARS-CoV-2 confirmation was 11.9 days (IQR 7.7-18.2). Compared with the first 7-day post-vaccination period, SARS-CoV-2 infections were lower by 65.8-84.7% during days 15-21, days 22-28, and >28 days (P <0.001 for each). For severe COVID-19, the incidence rates were 75.7- 93.3% lower (P <0.001 for each) during the corresponding time periods. ConclusionOur results are consistent with an early protective effect of BNT162b2 against all degrees of SARS-CoV-2 severity.

Approaches to Assessing Burden in Caregivers of Patients with Cirrhosis.

Background and Aims: Being a caregiver for a patient with chronic liver disease (CLD) can be burdensome mentally, emotionally financially, and physically. The aim of this study was to systemically review the available tools and propose tools that can comprehensively evaluate caregiver burden for individuals caring for patients with CLD. Methods: We searched the PubMed database for all studies on the impact of patients with CLD on caregiver burden without timeframe restriction. Eligible studies included cohort studies, review studies, or cross-sectional studies. The number of patients and caregivers was isolated from each paper. Studies in the same categories were isolated and statistically compared. Results: A total of 13 studies meeting our inclusion criteria as stated in the methods sections were included. In total, 2528 caregivers were taking care of 2003 patients with CLD. Women made up the majority of caregivers at 78.2%, 95.7% of whom identified as the patient's spouse. Caregiver strain index is one of the most comprehensive tools; however, the questions are very general and do not fully elucidate financial strain. Beck depression and anxiety were correlated (p=0.0001), and both depression and anxiety were correlated with perceived caregiver burden (PCB) and Zarit Burden Interview (ZBI) (p=0.002). Depression scale correlated with Interpersonal Support Evaluation - Short Form, and Model for End-Stage Liver Disease score correlated with ZBI and PCB (total and in most domains; p=0.001). Patient's poorer cognitive performance correlated with higher ZBI and PCB (employed patients had higher cognitive performance and lower ZBI and PCB). Conclusions: Caregiver burden remains poorly understood due to the lack of uniformity in the assessment tools used to evaluate caregiver burden. None of the tools used to evaluate caregiver burden are comprehensive; however, most tools correlate statistically in the ability to identify caregiver burden. A comprehensive tool is lacking for identifying caregiver burden in patients with CLD.

Preferred Noninvasive Testing for Nonalcoholic Steatohepatitis.

BACKGROUND: There has been an increased interest in the use of noninvasive tests (NITs) to identify advanced liver fibrosis in patients with nonalcoholic fatty liver disease (NALFD). The aim of our study was to define the change in tests' characteristics (sensitivity and specificity) of different combinations of NITs to detect advanced fibrosis in NAFLD. METHODS: We stratified NITs into first and second tiers and compared two different strategies of combining NITs to screen for advanced fibrosis in patients with NAFLD. One strategy was using NITs in parallel, and the other was using NITs sequentially. Within both of these strategies, there were two ways of interpreting the overall results. The first way was called "the AND rule," where a positive result required both individual test results to be positive. The second way was called "the OR rule," where a positive result required only one individual test to be positive. Accuracy of NITs was obtained from the literature search. Combined accuracy and likelihood ratio (LR) were calculated. RESULTS: Combination testing with parallel and sequential order testing under the AND Rule resulted in overall higher specificity and LR+ then using the NITs alone. Specificity ranged from 0.91 to 0.99, and LR+ from 9.3 to 68.6. The subsequent use of MRE was associated with LR+ between 36 and 69. Sensitivity was higher with parallel and sequential order testing under the OR Rule. LR+ ranged from 1.4 to 7.5, and sensitivity from 0.82 to 0.98. CONCLUSION: Screening for advanced fibrosis should be performed sequentially, with positive results confirmed by additional testing. Specificity and LR+ were highest when MRE was employed as the confirmatory test.

Prevalence of Human Papillomavirus subtypes 16 and 18 among Yemeni Patients with Cervical Cancer

Background: The Human Papillomavirus (HPV) is a DNA tumor virus that causes epithelial proliferation. There are more than 100 HPV subtypes, of which 13 subtypes are regarded as high risk subtypes that can cause cancers of epithelial mucosal surfaces. High risk human papilloma viruses (HR-HPV) subtypes 16 and 18 plays a major role in the etiology of cervical cancer worldwide. Therefore, the aim of this study was to screen for the existence of HPV16 and HPV18 among Yemeni women with cervical lesions. Methodology: Formalin fixed paraffin wax processed tissue blocks were retrieved for 200 patients (150 were previously diagnosed with cervical cancer and the remaining 50 were diagnosed with different benign conditions). Results: Of the 200 cervical cancer tissue specimens, HR-HPV 16 was identified in 74/200 (37%) samples and couldn't be recognized in 126/200(63%) tissue samples. HR-HPV 18 was identified in 32/200 (16%) specimens and couldn't be recognized in 168/200(84%) tissue specimens. Conclusion: HR-HPV subtypes were prevalent among Yemeni women with cervical cancer, with significant increase of HR-HPV subtype 16 over the HR-HPV subtype 18.

Assessment of the bacterial contamination of hand air dryer in washrooms.

The present study was carried out, using standard techniques, to identify and count the bacterial contamination of hand air dryers, used in washrooms. Bacteria were isolated from the air flow, outlet nozzle of warm air dryers in fifteen air dryers used in these washrooms. Bacteria were found to be relatively numerous in the air flows. Bacterially contaminated air was found to be emitted whenever a warm air dryer was running, even when not being used for hand drying. Our investigation shows that Staphylococcus haemolyticus, Micrococcus luteus, Pseudomonas alcaligenes, Bacillus cereus and Brevundimonad diminuta/vesicularis were emitted from all of the dryers sampled, with 95% showing evidence of the presence of the potential pathogen S. haemolyticus. It is concluded that hot air dryers can deposit pathogenic bacteria onto the hands and body of users. Bacteria are distributed into the general environment whenever dryers are running and could be inhaled by users and none-users alike. The results provide an evidence base for the development and enhancement of hygienic hand drying practices.

Frequency of Human Papilloma Virus (HPV) subtypes 31,33,35,39 and 45 among Yemeni women with cervical cancer.

BACKGROUND: Identification of different HPV subtypes in unidentified communities provides sufficient information for screening and monitoring potential impact of a vaccination program. Therefore, the aim of this study was to screen for the presence of HPVs subtypes 31,33,35,39 and 45 among Yemeni women with Cervical Cancer. METHODOLOGY: A total of 200 (150 malignant and 50 benign) tissue samples were obtained from Yemeni women with cervical cancer, were investigated for the presence of HPV subtypes 31,33,35,39 and 45 by Polymerase Chain Reaction (PCR). RESULTS: Of the 150 cervical cancer tissue specimens, HPV 31, HPV 33, HPV35, HPV 39 and HPV45 were identified in 10/150 (6.7 %), 6/150 (4 %), 6/150 (4 %), 5/150 (3.3 %) and 10/150 (6.7 %), respectively. The frequency of these HPV subtypes among Yemeni women with cervical cancer was 24 %. CONCLUSION: HPV 31, HPV 33, HPV35, HPV 39 and HPV45 were prevalent among Yemeni women with cervical cancer.

Pattern of congenital heart disease in Southern Yemeni children referred for echocardiography.

OBJECTIVE: To study the distribution of age, gender, and the relative frequency of congenital heart defects at the time of the diagnosis in Southern Yemeni children. METHODS: This retrospective study focused on echocardiographic findings of 393 symptomatic children affected by congenital heart disease. It was conducted in the Echocardiography Department of a referral hospital for Aden city and surrounding governorates, Yemen, from January 2001 to December 2005. RESULTS: Out of 987 referred children, congenital heart defects were detected in 393 (39.8%); mean age was 3.45+/-4 years; of them, 48% males and 52% females. They were 85% non-cyanotic and 15% cyanotic. Patients comprised neonates, 5 (1.3%); infants under one year, 156 (39.7%), and children more than one year, 232 (59%). Most cyanotic patients (66%) presented during their first year of life, but only 8.5% were neonates. Most non-cyanotic (64%) presented after their first year mean age 3.9 years, none of them were neonates. The most frequent defects were: ventricular septal defect (26.5%), pulmonary stenosis (17.6%), patent ductus arteriosus (17.3%), and atrial septal defect (15.8%). Tetralogy of Fallot (8.9%) and transposition of great vessels (3.1%) were the most frequent cyanotic defects. CONCLUSION: The pattern of congenital heart diseases in Southern Yemen, is characterized by simple, potentially correctable heart defects, under-representation of cyanotic, and absence of critical defects that provokes high mortality during infancy.

Pattern of rheumatic heart disease in Southern Yemen.

OBJECTIVE: To determine the pattern of rheumatic heart disease in Aden city and surrounding areas by assessing its frequency distribution, severity and complications. METHODS: We conducted this research in a sole regional echocardiographic department for Southern Yemen governorates at a referral hospital located in Aden city, from January 1999 to December 2003. It was a retrospective study focused on echocardiographic findings in 805 patients affected by rheumatic heart disease. RESULTS: Out of 805 patients, 383 (47.6%) were male and 422 (52.4%) were female (age range, 4-70 years; mean age, 28.6 +/- 14.5). Heart valve damage was distributed among patients as follow: mitral 459 (57.1%), aorta 70 (8.7%) and both valves 276 (34.2%); isolated lesions 55.2% and multiple 44.8%; mitral regurgitation 464 (57.6%), mitral stenosis 405 (50.3%), aortic regurgitation 327 (40.6%) and aortic stenosis 54 (6.7%). All children aged less than 10 years had regurgitation. Stenosis and multiple valve lesions predominated in adolescents and young adults. Complications were detected in 20.8% of cases. Pulmonary hypertension was the most common complication (80.4%). Lesions with moderate and severe degree were detected in 51% cases. Only 34.8% of patients at severe stage were operated. CONCLUSION: Rheumatic heart disease takes an aggressive course in Southern Yemen. Children, adolescents and young adults of both gender are the victims. Complications appear early with scanty opportunity to reach advanced age. There is a little chance for palliative treatment.

Prolapso de la válvula mitral: complicaciones y conducta a seguir / Mitral valve prolapse: complications and behaviour to be followed

El prolapso de la válvula mitral constituye una de las afecciones valvulares que con mayor frecuencia diagnosticamos en la práctica cardiológica y es considerado, generalmente, como un proceso benigno; sin embargo, puede conducir a graves complicaciones y es la causa más frecuente de insuficiencia mitral pura, endocarditis infecciosa y arritmias cardiacas, muerte súbita, fenómenos tromboembólicos y ruptura de las cuerdas tendinosaas. En esta revisión presentamos una estratificación de los pacientes de acuerdo con su grado de riesgo que los agrupa en: bajo, intermedio y alto riesgo, lo cual nos facililtó elegir la conducta terapéutica de ellos. Se recomendó el seguimiento clínico periódico en los de bajo riesgo, el uso de betabloquedores si son muy sintomáticos y la profilaxis de la endocarditis infecciosa (cuando se realicen procederes invasivos) en los de riesgo intermedio,m y en los de alto riesgo se recomendó la profilaxis de la endocarditis siempre, tratamiento específico según la complicación y el tratamiento quirúrgico cuando la función del ventrículo izquierdo esté deteriorada

Prolapso de la válvula mitral: complicaciones y conducta a seguir / Mitral valve prolapse: complications and behaviour to be followed

El prolapso de la válvula mitral constituye una de las afecciones valvulares que con mayor frecuencia diagnosticamos en la práctica cardiológica y es considerado, generalmente, como un proceso benigno; sin embargo, puede conducir a graves complicaciones y es la causa más frecuente de insuficiencia mitral pura, endocarditis infecciosa y arritmias cardiacas, muerte súbita, fenómenos tromboembólicos y ruptura de las cuerdas tendinosaas. En esta revisión presentamos una estratificación de los pacientes de acuerdo con su grado de riesgo que los agrupa en: bajo, intermedio y alto riesgo, lo cual nos facililtó elegir la conducta terapéutica de ellos. Se recomendó el seguimiento clínico periódico en los de bajo riesgo, el uso de betabloquedores si son muy sintomáticos y la profilaxis de la endocarditis infecciosa (cuando se realicen procederes invasivos) en los de riesgo intermedio,m y en los de alto riesgo se recomendó la profilaxis de la endocarditis siempre, tratamiento específico según la complicación y el tratamiento quirúrgico cuando la función del ventrículo izquierdo esté deteriorada (AU)