Ceftriaxone-Related Encephalopathy in a Patient With End-Stage Renal Disease and High Ceftriaxone Concentrations in Cerebrospinal Fluid and Plasma: A Case Report.

Ceftriaxone (CTRX) does not require dose adjustment based on the renal function status and is used to treat infections. Recently, several studies reported the incidence of antibiotic-associated encephalopathy due to CTRX in patients with end-stage renal disease (ESRD). We experienced a case of CTRX-related encephalopathy in a patient on hemodialysis. When CTRX-related encephalopathy was discovered, the CTRX concentrations were measured in the blood and cerebrospinal fluid (CSF). The highest blood and CSF CTRX concentrations in this patient were 967 and 100.7 µg/mL, respectively, which were approximately 10 times higher than the CSF concentrations in a previously evaluated patient with CTRX encephalopathy. The concentration of CTRX may be increased in patients with ESRD. Hence, encephalopathy must be suspected in this patient group when CTRX is used.

Inhibitory effects of vaginal Lactobacilli on Candida albicans growth, hyphal formation, biofilm development, and epithelial cell adhesion.

Introduction: Antifungal agents are not always efficient in resolving vulvovaginal candidiasis (VVC), a common genital infection caused by the overgrowth of Candida spp., including Candida albicans, or in preventing recurrent infections. Although lactobacilli (which are dominant microorganisms constituting healthy human vaginal microbiota) are important barriers against VVC, the Lactobacillus metabolite concentration needed to suppress VVC is unknown. Methods: We quantitatively evaluated Lactobacillus metabolite concentrations to determine their effect on Candida spp., including 27 vaginal strains of Lactobacillus crispatus, L. jensenii, L. gasseri, Lacticaseibacillus rhamnosus, and Limosilactobacillus vaginalis, with inhibitory abilities against biofilms of C. albicans clinical isolates. Results: Lactobacillus culture supernatants suppressed viable fungi by approximately 24%-92% relative to preformed C. albicans biofilms; however, their suppression differed among strains and not species. A moderate negative correlation was found between Lactobacillus lactate production and biofilm formation, but no correlation was observed between hydrogen peroxide production and biofilm formation. Both lactate and hydrogen peroxide were required to suppress C. albicans planktonic cell growth. Lactobacillus strains that significantly inhibited biofilm formation in culture supernatant also inhibited C. albicans adhesion to epithelial cells in an actual live bacterial adhesion competition test. Discussion: Healthy human microflora and their metabolites may play important roles in the development of new antifungal agent against C. albicans-induced VVC.

Predicting the aggravation of coronavirus disease-19 pneumonia using chest computed tomography scans.

Presently, coronavirus disease-19 (COVID-19) is spreading worldwide without an effective treatment method. For COVID-19, which is often asymptomatic, it is essential to adopt a method that does not cause aggravation, as well as a method to prevent infection. Whether aggravation can be predicted by analyzing the extent of lung damage on chest computed tomography (CT) scans was examined. The extent of lung damage on pre-intubation chest CT scans of 277 patients with COVID-19 was assessed. It was observed that aggravation occurred when the CT scan showed extensive damage associated with ground-glass opacification and/or consolidation (p < 0.0001). The extent of lung damage was similar across the upper, middle, and lower fields. Furthermore, upon comparing the extent of lung damage based on the number of days after onset, a significant difference was found between the severe pneumonia group (SPG) with intubation or those who died and non-severe pneumonia group (NSPG) ≥3 days after onset, with aggravation observed when ≥14.5% of the lungs exhibited damage at 3-5 days (sensitivity: 88.2%, specificity: 72.4%) and when ≥20.1% of the lungs exhibited damage at 6-8 days (sensitivity: 88.2%, specificity: 69.4%). Patients with aggravation suddenly developed hypoxemia after 7 days from the onset; however, chest CT scans obtained in the paucisymptomatic phase without hypoxemia indicated that subsequent aggravation could be predicted based on the degree of lung damage. Furthermore, in subjects aged ≥65 years, a significant difference between the SPG and NSPG was observed in the extent of lung damage early beginning from 3 days after onset, and it was found that the degree of lung damage could serve as a predictor of aggravation. Therefore, to predict and improve prognosis through rapid and appropriate management, evaluating patients with factors indicating poor prognosis using chest CT is essential.

Alleviation of hand-skin roughness after use of alcohol-based hand rub with inhibitory effects on Staphylococcus aureus-producing δ-toxin.

INTRODUCTION: Staphylococcus aureus colonizes rough regions of the skin of the hand. Healing of S. aureus-mediated wounds is promoted by the application of RNA III inhibiting peptide, which inhibits the production of S. aureus virulence factors, including δ-toxin. Herein, we investigated the level of hand-skin roughness in healthcare professionals after they used an alcohol-based hand rub containing polyoxyethylene lauryl ether (formulation E), which inhibits S. aureus δ-toxin production. METHODS: The inhibition rate of S. aureus δ-toxin production by hand rubs, including formulation E, was calculated by quantifying S. aureus δ-toxin concentration in culture medium using high-performance liquid chromatography. Healthcare professionals used formulations E or S (reference alcohol-based hand rub) for 4 weeks. The surface evaluation of the scaliness (SEsc) value was used as an indicator of hand skin roughness. The ΔSEsc value was calculated by subtracting the SEsc value before using the alcohol-based hand rub from the SEsc value 4 weeks after use. RESULTS: The inhibition rates of S. aureus δ-toxin production by formulations E and S were 43% and 10%, respectively. Formulation E significantly reduced ΔSEsc. The difference in ΔSEsc values after using formulations E and S was significant. CONCLUSIONS: The inhibitory effect on S. aureus δ-toxin production was higher with formulation E than with formulation S. Compared to formulations S, formulation E was effective at reducing scaliness and alleviating hand-skin roughness. Furthermore, the inhibitory effect of formulation E on S. aureus δ-toxin production could be associated with a reduction in scaliness and alleviation of hand-skin roughness.

Investigation of the incidence of immunisation stress-related response following COVID-19 vaccination in healthcare workers.

INTRODUCTION: Safe vaccination worldwide is critical to end the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate adverse reactions to vaccination using a web-based questionnaire and examine the risk factors for the occurrence of immunisation stress-related response (ISRR). METHODS: We conducted a questionnaire survey using Google Form® among the employees of St. Marianna University Hospital who had received the COVID-19 vaccine between April 2021 and May 2021, 1 week after the first and second vaccinations. We developed and used a questionnaire to identify individuals with ISRR according to the World Health Organization diagnostic criteria. A generalised linear mixed model was constructed with ISRR onset as the dependent variable, subjects as the random factor, and each parameter as a fixed factor. A multivariate model was constructed using the forced imputation method with factors that were significant in the univariate analysis. RESULTS: We enrolled 2,073 and 1,856 respondents in the first and second questionnaire surveys, respectively. Fifty-five and 33 ISRR cases were identified in the first and second vaccinations, respectively. In the univariate analysis, strong pre-vaccination anxiety (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.30-4.12, p = 0·004) and history of allergy (OR, 1.6; 95% CI, 1.14-2.24, p = 0·007) were significant risk factors. Multivariate analysis also showed that strong pre-vaccination anxiety (OR, 2.1; 95% CI, 1.15-3.80, p = 0.016) and history of allergy (OR, 1.5; 95% CI, 1.09-2.15, p = 0.014) were significant risk factors. CONCLUSIONS: Confirmation of allergy prior to vaccination and subsequent action are essential for addressing ISRR.

Management of laryngeal cleft in mechanically ventilated children with severe comorbidities.

Laryngeal clefts are rare congenital malformations of the posterior part of the larynx. The severities are correlated with the downward extension of the cleft and can involve numerous clinical symptoms including dysphagia and respiratory distress. As significant comorbidities may be present, individual treatments depend on the child's general condition and type of cleft involved. Herein, we describe two cases of children with laryngeal clefts and severe comorbidities requiring mechanical ventilation. One child with type III laryngeal cleft was successfully managed with the lateral pharyngotomy approach. The other child with type II laryngeal cleft has not been able to undergo cleft-closure surgery because of severe general conditions, therefore has continued training for feeding and swallowing.