Observational Study Evaluating the Seroprotection of HepB-alum Vaccine and HepB-CpG Vaccine in People With HIV.

Background: Hepatitis B virus (HBV) vaccine seroprotection rates with conventional aluminum adjuvanted recombinant HBV vaccines, Engerix-B (HepB-alum) vaccine, among people with HIV (PWH) are varied. Heplisav-B (HepB-CpG) vaccine, a novel adjuvanted recombinant HBV vaccine, has shown higher seroprotection rates in immunocompetent patients but is not well studied in PWH. There are no published studies comparing seroprotection rates between HepB-alum and HepB-CpG in PWH. This study aims to evaluate and compare the seroprotection incidence of HepB-alum vs HepB-CpG in PWH at least 18 years of age. Methods: This retrospective, observational cohort study included adults diagnosed with HIV who received a complete series of HepB-alum or HepB-CpG at a community health center in Phoenix, Arizona. Patients had a hepatitis B surface antibody <10 IU/L at the time of the first vaccine dose. The primary outcome was a comparison of seroconversion incidence between HepB-CpG and HepB-alum. Secondary outcomes included identifying factors associated with likelihood of response to HBV vaccination. Results: A total of 120 patients were included in this study, 59 in the HepB-alum cohort and 61 in the HepB-CpG cohort. In the HepB-alum cohort, 57.6% achieved seroconversion, compared with 93.4% in the HepB-CpG cohort (P < .001). Those without diabetes were more likely to have response to a vaccine. Conclusions: Among PWH at a single community health center, HepB-CpG provided a statistically higher incidence of seroprotection against HBV compared with HepB-alum.

The Potential Clinical Benefit of Tocilizumab Therapy for Patients with HHV-8-infected AIDS-related Multicentric Castleman Disease: A Case Report and Literature Review.

Castleman disease (CD), also known as angiofollicular hyperplasia, is a rare disorder characterized by nonmalignant mediastinal lymph node enlargement provoked by excess interleukin-6 (IL-6) secretion. It could be unicentric or multicentric (MCD). Here, we describe a 27-year-old man with a prior history of AIDS, Kaposi sarcoma (KS), and latent syphilis who presented to the ED for persistent fatigue, fever, chills, night sweats, and productive cough. Infectious workup was negative, and the patient continued to have a high fever despite empiric antibiotic therapy. Bone marrow biopsy was performed and was negative for malignancy. The patient eventually underwent a left clavicular lymph node biopsy, which showed a plasma cell variant CD with positive immunostaining for human herpesvirus 8 (HHV-8), and high HHV-8 viral load. We started the patient on rituximab and liposomal doxorubicin, but unfortunately, the patient had a severe anaphylactic reaction to the rituximab, so we could not proceed with this treatment. We, therefore, started tocilizumab treatment, which improved the patient's general condition, and he was eventually discharged from our hospital. Upon follow-up 11-months later, a repeat CT scan of the chest and abdomen showed a near-complete treatment response with decreased lymphadenopathy throughout and hepatosplenomegaly. IL-6 overproduction in patients with CD is linked to the production of inflammatory cytokines and has a role in tumor angiogenesis, which makes it potential for IL-6 targeted therapy. The diagnosis of CD, especially MCD, requires a high index of suspicion, and a lymph node biopsy is essential in the diagnosis. Tocilizumab, an IL-6 receptor antibody, could potentially be considered as a practical therapeutic approach in managing HHV-8 positive MCD patients who do not tolerate or respond to initial rituximab therapy.

Unexpected pathogen presenting with purulent meningitis.

Herein we report a case of a 67-year-old man with chronic lymphocytic leukaemia who developed acute onset of fever and altered mental status while receiving ibrutinib therapy. He was eventually found to have Capnocytophaga canimorsus meningitis. Timely diagnosis and appropriate antimicrobial therapy was associated with a favourable outcome. We describe challenges associated with appropriate identification of, and briefly review infections caused by Capnocytophaga sp. To our knowledge, this is the first case of invasive C. canimorsus infection in the setting of ibrutinib therapy, and adds to the growing list of serious infections that have been associated with this agent.

Robotic radical prostatectomy with concomitant repair of inguinal hernia: is it safe?

Robotic radical prostatectomy (RARP) is well established as a safe and effective treatment for prostate cancer. According to published studies, patients undergoing RARP are at increased risk of being diagnosed with an inguinal hernia after RARP and are four times more likely to have an inguinal hernia repair (IHR) following RARP. Several studies have demonstrated the effectiveness and safety of IHR during RARP. Overall, it has been observed that IHR adds on average, 12-15 min in total surgical time and there were no significant differences between RARP with or without IHR with respect to postoperative complications. This study analyzes a large series of patients undergoing RARP (1100) and compares them to a group that underwent RARP with IHR (39). Between December 2008 and January 2015, 1139 patients underwent RARP at Florida Hospital in Celebration, FL. Of the total patients, 39 underwent concomitant IHR. All procedures were performed by the same surgeons (urologist and general surgeon), using the same techniques of RARP and TAPP inguinal hernia repair. After 30 days, the differences were evaluated between groups regarding surgical time, EBL and postoperative complications. The average age of patients undergoing the procedure was 61.65 years. The mean procedure time was approximately 120 min (min), with an additional period of 68 min for IHR (mean = 188; p = 0.0001). There was a significant difference in BMI between the groups, 28.3 kg/m2 for patients undergoing RARP and 26.8 kg/m2 for those who underwent RARP and IHR (p = 0.028). The EBL averaged 110.87 mL, with no significant difference between groups (p = 0371). There was no significant association between clinical stage of the patient and the type of procedure performed (p = 12:35). There was no significant difference in the presence of comorbidities and the operation preformed. There were 61 events recorded postoperatively, 57 (5.2%) among patients who underwent only RARP and 4 (10.26%) among those who had both. Taken together, the small amounts of complications in both groups prevent statistical significance. This study compared two groups of patients undergoing RARP: those with IHR and those without. Our study demonstrated an increase in surgical time; however, there was no increase in postoperative complications. From the data presented, we suggest that the performance of both procedures concomitantly is feasible and safe.

Vancomycin Taper and Risk of Failure of Fecal Microbiota Transplantation in Patients With Recurrent Clostridium difficile Infection.

We retrospectively analyzed a cohort of 109 subjects treated for recurrent Clostridium difficile infection with fecal microbiota transplantation (FMT) at a tertiary referral center between 2011 and 2014 to determine risk factors for FMT failure. In a multivariate analysis, failure to use an oral vancomycin taper preceding FMT was associated with a significant risk of FMT failure (odds ratio, 0.15; 95% confidence interval, .007-.40).

Factores de riesgo de infección del sitio quirúrgico / Risk factors for surgical site infection

La infección del sitio quirúrgico constituye la complicación poso-peratoria más frecuente. Este artículo de revisión evalúa los aspec-tos más resaltantes para el manejo preoperatorio y peroperatoriodel paciente y la prevención de infección del sitio quirúrgico(AU)

Surgical site infections constitutes the most frequent postoperativecomplication. This review article evaluates the most outstandingaspects for the preoperative and peroperative management of thepatient and the prevention of surgical site infections(AU)

Treatment considerations in pulmonary coccidioidomycosis.

INTRODUCTION: Coccidioidomycosis is an endemic fungal infection caused by the soil-dwelling fungi, Coccidioides species. Coccidioidal infections may be asymptomatic in up to two-thirds of infected persons. Pulmonary coccidioidomycosis is the most common form of symptomatic infection. Fluconazole is the antifungal agent typically used to treat pulmonary coccidioidomycosis. Other azoles and amphotericin B products may be prescribed to treat nuanced aspects of coccidioidomycosis. AREAS COVERED: This review discusses current literature regarding medical treatment options, including the various triazoles and amphotericin B products. In addition, we discuss uncomplicated and complicated pulmonary infections and their sequelae and the approach to managing coccidioidomycosis in certain populations of patients, such as pregnant women, transplant recipients, individuals infected with human immunodeficiency virus, and recipients of tumor necrosis factor-α inhibitors. Expert commentary: Symptomatic coccidioidomycosis can present physicians with a number of challenges, including the lack of sensitivity and specificity of diagnostic tests and lack of a standard treatment approach for all patients with the infection. Ongoing and future clinical trials will determine the optimal diagnostic, therapeutic, and prophylactic approaches, particularly for patients with comorbid conditions.

Evaluation of space adequateness of shrimp farms in Southern Brazil

In Rio Grande do Sul State, there are four marine shrimp (Litopenaeus vannamei) farms in the municipal districts of São José do Norte and Rio Grande, and other four with previous license for operation. Thus, the present study aimed to identify and characterize areas for marine shrimp farming located in the Southern portion of the Patos Lagoon estuary (32º00'S 52º00'W) by employing the analysis of satellite remote sensing (Landsat TM and ETM+/Google Earth), airborne remote sensing (35mm system ADAR 1000), terrestrial remote sensing (RICOH 500SE), and field expeditions, integrating data in a Geographical Information System (IDRISI Andes). As a result, the enterprises were built on coastal fields or in obliterated dune areas, which are favorable for cultivation. The proximity of possible consuming markets and local labor, relatively good access roads and local technical support also favor the projects. However, there must be caution in terms of changes in the original projects, which could cause environmental impacts and noncompliance of environmental norms, such as the occupation of salt marsh areas. Based on the obtained information, instruments can be created to help inherent legal decision-making to manage the activity for futures enterprises.

No estado do Rio Grande do Sul existem quatro fazendas produtoras de camarões (Litopenaeus vannamei) marinhos nos municípios de São José do Norte e Rio Grande, e outras quatro fazendas já possuem licença prévia. Assim, o presente estudo propôs identificar e caracterizar as áreas destinadas a cultivos de camarões marinhos localizadas na porção sul do estuário da lagoa dos Patos (32º00'S 52º00'W), empregando análises de sensoriamento remoto orbital (ETM+/Landsat, Google Earth), aéreo (35mm/sistema ADAR 1000), terrestre (RICOH 500SE) e de saídas de campo, integrando os dados num Sistema de Informação Geográfica (IDRISI Andes). Resultados apontaram que os empreendimentos foram construídos sobre campos litorâneos ou em regiões de dunas obliteradas, regiões estas propícias para o cultivo. A proximidade dos possíveis mercados consumidores e mão de obra local, estradas de acesso relativamente boas e suporte técnico local também favorecem os projetos. No entanto, deve haver cautela em termos de mudanças nos projetos originais, o que poderia causar impactos ambientais e descumprimento das normas ambientais, tais como a ocupação de áreas de marismas. A partir das informações obtidas, podem ser criados instrumentos que auxiliarão na tomada de decisões legais para gerenciar a atividade em futuros empreendimentos.

Evaluation of space adequateness of shrimp farms in Southern Brazil.

In Rio Grande do Sul State, there are four marine shrimp (Litopenaeus vannamei) farms in the municipal districts of São José do Norte and Rio Grande, and other four with previous license for operation. Thus, the present study aimed to identify and characterize areas for marine shrimp farming located in the Southern portion of the Patos Lagoon estuary (32º00'S 52º00'W) by employing the analysis of satellite remote sensing (Landsat TM and ETM+/Google Earth), airborne remote sensing (35mm system ADAR 1000), terrestrial remote sensing (RICOH 500SE), and field expeditions, integrating data in a Geographical Information System (IDRISI Andes). As a result, the enterprises were built on coastal fields or in obliterated dune areas, which are favorable for cultivation. The proximity of possible consuming markets and local labor, relatively good access roads and local technical support also favor the projects. However, there must be caution in terms of changes in the original projects, which could cause environmental impacts and noncompliance of environmental norms, such as the occupation of salt marsh areas. Based on the obtained information, instruments can be created to help inherent legal decision-making to manage the activity for futures enterprises.