Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment.

An association between diabetes and infection has been recognised for many years, with infection being an important cause of death and morbidity in people with diabetes. The COVID-19 pandemic has re-kindled an interest in the complex relationship between diabetes and infection. Some infections occur almost exclusively in people with diabetes, often with high mortality rates without early diagnosis and treatment. However, more commonly, diabetes is a complicating factor in many infections. A reciprocal relationship occurs whereby certain infections and their treatments may also increase the risk of diabetes. People with diabetes have a 1.5- to 4-fold increased risk of infection. The risks are the most pronounced for kidney infection, osteomyelitis and foot infection, but are also increased for pneumonia, influenza, tuberculosis, skin infection and general sepsis. Outcomes from infection are worse in people with diabetes, with the most notable example being a twofold higher rate of death from COVID-19. Hyperglycaemia has deleterious effects on the immune response. Vascular insufficiency and neuropathy, together with altered skin, mucosal and gut microbial colonisation, contribute to the increased risk of infection. Vaccination is important in people with diabetes although the efficacy of certain immunisations may be compromised, particularly in the presence of hyperglycaemia. The principles of treatment largely follow those of the general population with certain notable exceptions.

Management of postinfectious inflammatory arthritis.

PURPOSE OF REVIEW: Postinfectious inflammatory arthritis can result from various pathogens, including bacteria, viruses, fungi, and parasites. Prompt identification and treatment of acute infection is vital, but some cases progress to chronic arthritis despite successful treatment of infection. Postinfectious inflammatory arthritis varies from mild, self-limited arthralgia to severe, refractory arthritis, necessitating ongoing disease-modifying treatment. This review explores the spectrum of postinfectious inflammatory arthritis to provide insights into effective management. RECENT FINDINGS: Research continues regarding the benefit of antimicrobial therapy, beyond treatment of the acute infection, to diminish the severity of postinfectious inflammatory arthritis. Following treatment of acute infection, most cases are self-limited so treatment is symptomatic. However, a difficult-to-predict fraction of cases develop chronic postinfectious inflammatory arthritis that can be challenging to manage. Recently, as more biologic, and targeted synthetic DMARDs have become available, treatment options have expanded. SUMMARY: In this article, we use the term 'postinfectious inflammatory arthritis' rather than 'reactive arthritis' because it describes a broader spectrum of diseases and emphasizes the common pathogenesis of a postinfectious inflammatory process. We summarize the conventional therapies and recent management developments for the most frequently encountered postinfectious inflammatory arthritides.

Detection and Analysis of Commonly Used Infection Indicators in Patients with Acute Urticaria.

INTRODUCTION: In this study, we investigated the correlation and clinical significance of peripheral blood leukocytes, neutrophils, C-reactive protein (CRP), and procalcitonin (PCT) in patients with acute urticaria. METHODS: Complete blood count with differential, CRP, and PCT tests were conducted on patients with acute urticaria. A total of 614 patients with acute urticaria were divided into three groups: the first group consisted of patients with elevated leukocyte and neutrophil count, the second group consisted of patients with normal leukocyte and neutrophil count, and the third group consisted of patients with abnormal leukocyte and neutrophil count. A correlation analysis was conducted to investigate the levels of leukocytes, neutrophils, CRP, and PCT in the three groups. RESULTS: The results of Kruskal-Wallis' nonparametric test revealed statistically significant variations in leukocytes, neutrophils, CRP, and PCT among the three groups (p < 0.001). However, CRP and PCT showed no statistically significant differences between the second and third groups (p < 0.001, p = 0.0041, p = 0.0032). Additional multiple comparisons in Spearman correlation analysis indicated statistically significant differences (p = 0.55). Across all groups, there was a statistically significant difference in the correlation between CRP-PCT and leukocytes-neutrophils (p = 0.53). CONCLUSION: Leukocytes and neutrophils are sensitive to the impact of medications and stress on the body. Combining CRP and PCT, as well as routine blood test, may be a comprehensive assessment of infection presence and severity in patients, providing guidance for antibiotic treatment.

Current perspective on infections and mitigation strategies in primary systemic vasculitis.

PURPOSE OF REVIEW: The purpose of this review is to summarize and evaluate most recent evidence on the epidemiology of infections and associated risk factors in patients with primary systemic vasculitides (PSV), as well as discuss mitigation strategies including the risk of antibiotic prophylaxis. RECENT FINDINGS: Infections remain one of the leading causes of mortality in patients with PSV, with rates of severe infection ranging from 16 to 40% in different cohorts. Older age, frailty, renal and pulmonary involvement, and higher burden of comorbidities have been recognized as important patient-associated risk factors. Treatments including higher cumulative doses of glucocorticoids are associated with an increased risk of infections, and recent studies show the potential benefit of interventions such as reduced-dose glucocorticoid regimens. Existing mitigation strategies include screening, vaccination, and infection prophylaxis. The latter remains particularly important for Pneumocystis jirovecii pneumonia; however, the benefit-risk ratio seems to be less clear outside of induction phase (i.e., high dose of glucocorticoids) and optimal treatment duration remains less clear. Patients with PSV are at increased risk of infections, due to disease itself, comorbidities, and treatment side effects. Awareness of the timing and types of infection, as well as mitigation strategies are imperative to ensure treatment success and survival for patients.

Updated Recommendations on the Prevention and Treatment of Infections in Children With Asplenia/Hyposplenism.

Children with congenital or acquired asplenia or hyposplenism have an increased risk for severe and even life-threatening infections mainly due to encapsulated bacteria. Current practice focuses on preventing severe infections with timely administration of vaccinations, antibacterial prophylaxis when indicated, and urgent evaluation and treatment of febrile events. As new vaccines are now available for both children and adults with asplenia/hyposplenism, we present an up-to-date recommendation on the prevention and management of acute infections in children with asplenia/hyposplenism.

Clinical and Prognostic Features of Diabetic Ketoacidosis According to the Trigger of the Syndrome.

BACKGROUND: Diabetic ketoacidosis (DKA) is an acute metabolic, life-threatening complication of diabetes mellitus with a mortality rate that now stand at less than 1%. Although mortality is coupled with the etiology of DKA, literature on the influence of DKA etiology on patient outcome is scarce. OBJECTIVES: To study different triggers for DKA and their effect on outcomes. METHODS: We conducted a retrospective study that include 385 DKA patients from 2004 to 2017. The study compared demographics, clinical presentation, and mortality rates by different precipitating factors. RESULTS: Patients with DKA due to infections had a higher risk to develop in-hospital mortality after controlling for age and sex (odds ratio 4.40, 95% confidence interval 1.35-14.30), had a higher Charlson Comorbidity Index score, a higher risk of being mechanical ventilated (14% vs. 3%, P < 0.01), and a longer duration of hospitalization (5 days vs. 3 days, P < 0.001). CONCLUSIONS: It is crucial to find the triggers that precipitate DKA and start the treatment as early as possible in addition to the metabolic aspect of the treatment especially when the trigger is an infectious disease.

[Advances in the role of infection in the development of benign tracheal stenosis].

Benign tracheal stenosis (BTS) is a refractory disease with a complex pathogenesis and limited therapeutic drug effects. The management of benign tracheal stenosis remains a major challenge for the interventional physiologist. In recent years, the role of infection in the occurrence and development of tracheal stenosis has attracted some attention, but there is still some controversy. A clear understanding of the relationship between infection and tracheal stenosis is essential to elucidate the pathogenic mechanism of BTS, and then to improve early prevention and management of BTS. This article reviewed the research progress on BTS associated with infection to explore new effective interventions that can reduce the BTS.

Definition, diagnosis and classification of infection-related movement disorders: Consensus proposal.

BACKGROUND: Infection-related movement disorders (IRMD) present a complex diagnostic challenge due to the broad phenotypic spectrum, the variety of possible infectious aetiologies, and the complicated underlying mechanisms. Yet, a comprehensive framework for classifying IRMD is lacking. METHODS: An international consensus panel under the directives of the Movement Disorders Society Infection-Related Movement Disorders Study Group developed a comprehensive definition and a consensus classification system. Case scenarios were used for validation. RESULTS: A definition for IRMD and a two-axis-based classification system consisting of six descriptors are proposed, intended as tools for researchers and clinicians. Collected information on clinical characteristics, investigational findings, the infectious organism and presumed pathogenesis facilitate the evaluation of diagnostic certainty. CONCLUSION: The proposed framework will serve for optimised diagnostic algorithms, systematic aggregation of informative datasets across studies, and ultimately improved care and outcome of patients with IRMDs.

Association between early manifestations of infection or sepsis and prognosis in a high complexity hospital in the city of Medellín.

OBJECTIVE: To identify the first symptoms and signs of patients with suspected infection or sepsis and their association with the composite outcome of admission to the Intensive Care Unit (ICU) or mortality. DESIGN: Prospective cohort study between June 2019 and March 2020. SETTING: Hospital Universitario San Vicente Fundación, Colombia. PATIENTS: Over 18 years of age with suspicion or confirmation of sepsis, which required hospitalization. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Symptoms and signs associated with infection, with their time of evolution, specified in the study. RESULTS: From 1005 eligible patients, 261 were included. After multivariable adjustment with a logistic regression model, the main factors for ICU admission or mortality were heart rate (OR 1.04 with 95% CI 1.04-3.7), respiratory rate (OR 1.19 with 95% CI 1.0-1.4) and capillary refill time (OR 3.4 with 95% CI 1.9-6.1). CONCLUSIONS: Heart rate, respiratory rate, and capillary refill may behave as early predictors of ICU admission and mortality in cases of sepsis.

Does Anterior Plating of Pelvic Ring Fractures Increase Infection Risk in Patients With Bladder or Urethral Injuries?

OBJECTIVES: Evaluate the effect of anterior fixation on infection in patients with operative pelvic fractures and bladder or urethral injuries. DESIGN: Retrospective. SETTING: Eight centers. PATIENT SELECTION CRITERIA: Adult patients with closed pelvic fractures with associated bladder or urethral injuries treated with anterior plating (AP), intramedullary screw (IS), or no anterior internal fixation (NAIF, including external fixation or no fixation). OUTCOME MEASURES AND COMPARISONS: Deep infection. RESULTS: There were 81 extraperitoneal injuries and 57 urethral injuries. There was no difference in infection between fixation groups across all urologic injuries (AP: 10.8%, IS: 0%, NAIF: 4.9%, P = 0.41). There was a higher rate of infection in the urethral injury group compared with extraperitoneal injuries (14.0% vs. 2.5%, P = 0.016). Among extraperitoneal injuries, specifically, there was no difference in deep infection related to fixation (AP: 2.6%, IS 0%, NAIF: 2.9%, P = 0.99). Among urethral injuries, there was no statistical difference in deep infection related to fixation (AP: 23.1%, IS: 0%, NAIF: 7.4%, P = 0.21). There was a higher rate of suprapubic catheter (SPC) use in urethral injuries compared with extraperitoneal injuries (57.9% vs. 4.9%, P < 0.0001). In the urethral injury group, SPC use did not have a statistically significant difference in infection rate (SPC: 18.2% vs. No SPC: 8.3%, P = 0.45). Early removal of the SPC before or during the definitive orthopaedic intervention did not significantly affect infection rate (early: 0% vs. delayed: 25.0%, P = 0.16). CONCLUSIONS: Surgeons should approach operative pelvic fractures with associated urologic injuries with caution given the high risk of infection. Further work must be done to elucidate the effect of anterior implants and SPC use and duration. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Severe infections in systemic necrotizing vasculitis.

Infections in patients with systemic vasculitis represent one of the main causes of mortality. Corticosteroid use, immunosuppressive therapy, age, associated organic involvement and dialysis dependence are risk factors of infection. OBJECTIVES: To determine the prevalence of severe infection and associated factors in patients diagnosed with ANCA-associated vasculitis (AAV) and Polyarteritis Nodosa (PAN). METHODS: retrospective study was conduced in a single rheumatology center (2000-2018). We included patients diagnosed with AAV (Granulomatosis with Polyangiitis (GPA), Eosinophilic Granulomatosis with Polyangiitis (EGPA) and Microscopic Polyangiitis (PAM) and Polyarteritis nodosa (PAN). Serious infectious events requiring hospitalisation or prolonged antibiotic/antiviral treatment, recurrent infection of Herpes Zoster Virus or opportunistic infections were evaluated. Sites of infection, isolated microorganisms and mortality related were analyzed. RESULTS: 105 patients were analyzed, follow-up time median 18 m, 58.7% were women and median age was 52 years. Types of vasculitis: 41.9% PAM, 16.2% EPGA, 40% GPA, 1.9% PAN. Constitutional, pulmonary, renal and otorhinolaryngology manifestations were the most frequent. PREVALENCE OF INFECTION: 34.2%, with a median of 3 months from diagnosis of vasculitis to the infectious event. Low respiratory tract (42.8%), sepsis (31.4%), and urinary tract (14.3%) were the most common sites of infections. Bacterial aetiology was the most prevalent (67.7%). Mortality at the first event was 14.3% and a 72.2% of patients were in the induction phase of treatment. Infectious events were significantly associated with age > 65 years (p = 0.030), presence of lung (p = 0.016) and renal involvement (p = 0.001), BVASv3 > 15, mortality (p = 0.0002). CONCLUSIONS: The prevalence of infection was 34.2%. Lower airway infections, septicemia and urinary tract infections were the most prevalent. Infections were associated with renal and pulmonary involvement, age older than 65 years and score BVAS > 15. Severe infections were associated with mortality, especially in elderly patients.

Intercurrent infection as a risk factor for disease flares in patients with systemic lupus erythematosus.

OBJECTIVE: To determine whether intercurrent infections are a risk factor for subsequent disease flares in systemic lupus erythematosus (SLE). METHODS: Demographic and clinical characteristics of 203 patients with SLE participating in the Amsterdam SLE cohort were collected at baseline and during follow-up. Collection of data on infections and SLE flares was registry-based and infections and flares were categorised as minor or major, based on predefined criteria. Proportional hazard models with recurrent events and time-varying covariates were used to estimate the HR of SLE flares. RESULTS: The incidence rates of major and minor infections were 5.3 per 100 patient years and 63.9 per 100 patient years, respectively. The incidence rates of flares were 3.6 and 15.1 per 100 patient years for major flares and minor flares, respectively.In the proportional hazard model, intercurrent infections (major and minor combined) were associated with the occurrence of SLE flares (major and minor combined; HR 1.9, 95% CI: 1.3 to 2.9). The hazard ratio for a major SLE flare following a major infection was 7.4 (95% CI: 2.2 to 24.6). Major infections were not associated with the occurrence of minor flares. CONCLUSIONS: The results of the present study show that intercurrent infections are associated with subsequent SLE flares, which supports the hypothesis that infections may trigger SLE flares.

Insuficiência cardíaca em cão / Congestive heart failure in a dog / Insuficiencia cardíaca congestiva en un perro

A insuficiência cardíaca congestiva é considerada, atualmente, a principal causa de óbitos em cães, sendo resultante da degeneração mixomatosa da válvula mitral, processo que inviabiliza o fechamento total da mesma durante a sístole. Apesar de se tratar de uma doença progressiva, os efeitos patológicos podem ser reduzidos significativamente e concomitantemente prolongar a vida do animal, desde que haja protocolos de tratamentos específicos e descritos por profissionais capacitados na área médica animal. Esse estudo teve como objetivo relatar um caso de insuficiência congestiva em um animal da espécie canina, sem raça definida, sexo masculino resgatado pela prefeitura do município de Botucatu, São Paulo, Brasil. Durante a necropsia foi observado os seguintes achados macroscópicos: neoplasias cutâneas aderidas ao tecido, tártaro dentário, pneumonia intersticial hemorrágica, companhias de fibrose e enfisema pulmonar hemorrágico, metástase calcificada circular em lobo pulmonar direito, necrose pulmonar, cardiomiopatia hipertrófica concêntrica, insuficiência cardíaca congestiva, aderência de pericárdio na cavidade torácica, fígado em aspecto de noz moscada, metástase hepática, hepatite, esplenomegalia, dilatação entérica multifocal, intussuscepção, necrose intestinal, hipertrofia de pelve renal e aderência de cápsula renal. Esses achados demonstram o comprometimento de todos os órgãos do animal, demonstrando que a causa mortis foi em decorrência de uma insuficiência respiratória de origem infecciosa que ocasionou a insuficiência cardíaca congestiva.(AU)

Congestive heart failure is currently considered the main cause of death in dogs, resulting from myxomatous degeneration of the mitral valve, a process that prevents its total closure during systole. Despite being a progressive disease, the pathological effects can be significantly reduced and, at the same time, prolong the animal's life, as long as there are specific treatment protocols described by trained professionals in the field of animal medicine. This study aimed to report a case of congestive insufficiency in an animal of the canine species, mixed breed, male, rescued by the municipality of Botucatu, Sao Paulo, Brazil. During the necropsy, the following macroscopic findings were observed: skin neoplasms adhered to the tissue, dental tartar, hemorrhagic interstitial pneumonia, fibrosis and hemorrhagic pulmonary emphysema, circular calcified metastasis in the right pulmonary lobe, pulmonary necrosis, concentric hypertrophic cardiomyopathy, congestive heart failure, adherence of pericardium in the thoracic cavity, nutmeg liver, liver metastasis, hepatitis, splenomegaly, multifocal enteric dilation, intussusception, intestinal necrosis, renal pelvis hypertrophy and renal capsule adherence. These findings showed the involvement of all tissues, demonstrating that the cause of death was due to respiratory failure of infectious origin that caused congestive heart failure.(AU)

Actualmente se considera la insuficiencia cardíaca congestiva como la principal causa de muerte en perros, resultante de la degeneración mixomatosa de la válvula mitral, proceso que impide su cierre total durante la sístole. A pesar de ser una enfermedad progresiva, los efectos patológicos pueden reducirse significativamente y, al mismo tiempo, prolongar la vida del animal, siempre y cuando existan protocolos de tratamiento específicos descritos por profesionales capacitados en el campo de la medicina animal. Este estudio tuvo como objetivo reportar un caso de insuficiencia congestiva en un animal canino, mestizo, macho, rescatado por el municipio de Botucatu, São Paulo, Brasil. Durante la necropsia se observaron los siguientes hallazgos macroscópicos: neoplasias cutáneas adheridas al tejido, sarro dental, neumonía intersticial hemorrágica, compañías de fibrosis y enfisema pulmonar hemorrágico, metástasis circular calcificada en lóbulo pulmonar derecho, necrosis pulmonar, miocardiopatía hipertrófica concéntrica, insuficiencia cardíaca, adherencia del pericardio en la cavidad torácica, hígado de nuez moscada, metástasis hepática, hepatitis, esplenomegalia, dilatación entérica multifocal, intususcepción, necrosis intestinal, hipertrofia de la pelvis renal y adherencia de la cápsula renal. Estos hallazgos demuestran la afectación de todos los órganos del animal, demostrando que la causa de la muerte se debió a una insuficiencia respiratoria de origen infeccioso que provocó una insuficiencia cardíaca congestiva.(AU)

Experiencia en el manejo y tratamiento de lesiones tipo degloving en el Centro Nacional de Quemados, Montevideo, Uruguay / Experience in the management and treatment of degloving injuries at the National Burn Center, Montevideo, Uruguay

Introducción. Las lesiones tipo degloving o avulsiones extensas de partes blandas representan un desafío para el equipo médico tratante. Es fundamental el adecuado manejo de estos pacientes dada la alta morbilidad. Objetivos. Estudio de las lesiones tipo degloving de partes blandas tratados en el Centro Nacional de Quemados, su manejo y tratamiento en los últimos 18 años. Analizar la situación actual de estas heridas a fin de proporcionar herramientas para el desarrollo de estrategias de prevención y tratamiento. Materiales y métodos. Estudio retrospectivo período enero 2004 - enero 2022, análisis de base de datos del Centro Nacional de Quemados del Hospital de Clínicas, Montevideo, Uruguay, incluyendo todos los ingresos por degloving extensos de partes blandas Resultados. La población estuvo compuesta por 38 pacientes, en su mayoría con lesiones por siniestro de tránsito (92,1%) en rol peatón (57,9%). Se encontró una tasa de complicaciones de 55,3% y una mortalidad de 15,8%. Se vio asociación entre complicaciones infecciosas y mortalidad y entre cultivo positivo al ingreso y demora en el ingreso al centro de quemados. Conclusiones. Las lesiones graves de miembros inferiores se han presentado con elevada tasa de mortalidad y de complicaciones infecciosas. Estas complicaciones se asociaron con un mayor tiempo de internación. Las complicaciones infecciosas a su vez se asociaron con la mortalidad, igual que la extensión lesional.

Introduction. Degloving injuries or extensive soft tissue avulsions represent a challenge for the medical team. Proper management of these patients is essential given the high morbidity. Objectives. To study of soft tissue degloving injuries treated at the National Burn Center, their management and treatment in the last 18 years. To analyze the current situation of these injuries in order to provide tools for development of prevention and treatment strategies. Materials and methods. Retrospective study from January 2004 to January 2022, database analysis of the National Burn Center of "Hospital de Clínicas" (Montevideo-Uruguay), including all admissions for extensive soft tissue degloving. Results. The population consisted of 38 patients, mostly with injuries due to traffic accidents (92.1%) of which 57.9% were pedestrians. A complication rate of 55.3% and a mortality of 15.8% were found. An association arised between infectious complications and mortality and between a positive culture on admission and a delay in time to enter to the National Burn Center. Conclusions. Lower limbs severe injuries have presented a high rate of mortality and infectious complications. These complications were associated with a longer hospital stay. Infectious complications, in turn, were associated with mortality, as well as the extent of lesions.

Screening complications in the postoperative period of orthopedic surgeries by video arthroscopy

To analyze the prevalence and characteristics of late postoperative complications of orthopedic surgeries by video arthroscopy.This was a descriptive cross-sectional study that evaluated, through its own instrument, local and systemic postoperative complications of patients undergoing orthopedic surgeries by video arthroscopy. The study included 270 patients, who were evaluated on days 30(without prosthesis) and 90(with prosthesis placement) of the postoperative period, by telephone service. The selection of participants occurred sequentially and population-based, within the data collection period, from February to July 2020, in a large hospital for medium and high complexity surgeries. Of the 270 procedures performed in the period, 4.4% (n = 12) presented late postoperative infection. The most frequent complications were erythema (83%), edema (75%) and secretion (67%) in the surgical wound. Most used antibiotic therapy (92%) and anti-inflammatory drugs (67%). Hospital readmission was not necessary concerning the complications. Only 50% required medical evaluation before the scheduled time.The need for practices that ensure the quality of perioperative care and improve the active search to assess surgical outcomes is reinforced.

Children's Nutritional Rehabilitation Program in Beira, Mozambique: A Retrospective Study

Malnutrition is still a major public health issue in sub-Saharan Africa and Mozambique. The main aim of this study was to evaluate the adherence to the nutritional rehabilitation program (NRP) and its impact on the growth of malnourished children in Beira, Mozambique. The secondary aim was to verify the prevalence of HIV infection in malnourished children at the time of admission to the NRP. A retrospective observational study in Beira Central Hospital and 10 health centers in Beira, Mozambique, was conducted. All children 0 to 5 years of age with acute malnutrition admitted to the outpatient services of the NRP from March 2016 until February 2017 were included in the study. A total of 1,231 children with the following characteristics have been enrolled: 58% female; 33% severely malnourished; and 16.5% HIV-positive. Of the 198 (21.7%) children who completed the program, 177 (89.4%) recovered from malnutrition and 21 (10.6%) did not. Ten (1.1%) were hospitalized and 706 (77.2%) dropped out of the program. Among children who completed the program, the median weight-for-length and weight-for-height z-scores at admission were $ 23 and , 22; at discharge, these median z-scores were $ 21 (P , 0.001). Children with HIV infection and who were male had a higher prevalence of severe acute malnutrition (P, 0.001).Weight gain wasfound to be significant after 23 days (P 5 0.004) of consuming supplements(readyto-use therapeutic food). A diagnosis of the degree of malnutrition was accurate at admission for 70.5%; at discharge, this diagnosis was accurate for 67.2%. The NRP seems to be successful if correctly followed, even if it is limited by adherence problems. However, its effectiveness requires further investigation.