Prudent Use of Blood Cultures for Hospitalized Patients With Cirrhosis.

Background No reliable risk stratification method is available to guide the extent of infectious work-up among hospitalized patients with cirrhosis. Therefore, we aimed to create a risk stratification method for obtaining blood cultures from hospitalized patients with cirrhosis. Methods This was a retrospective cohort study using the Healthcare Cost and Utilization Project - National Readmission Database 2019. Adult patients who were not immunocompromised comprised the final cohort. The primary outcome was the incidence of bacteremia among hospitalized patients with cirrhosis. Secondary outcomes included length of hospital stay, inpatient mortality, and 30-day readmission rate among cirrhosis patients with and without bacteremia. After propensity score matching, the χ2 test was used to assess the primary outcome and inpatient mortality. The Wilcoxon signed-rank test was used to compare the length of hospital stay. Readmission rates were compared via survival analysis. Concomitant bacterial infection, cirrhosis causes, and complications were assessed as potential risk factors for bacteremia using binomial regression. Results The risk ratio (RR) of bacteremia was 1.66 (95% confidence interval (CI): 1.55-1.78) among patients with cirrhosis compared to those without cirrhosis. A concomitant bacterial infection was found to have a strong association with bacteremia in patients with cirrhosis (RR: 3.3, 95% CI: 3.03-3.59). Among cirrhosis patients without concomitant bacterial infection, the incidence of bacteremia was 0.76% (<1%). Among the causes of cirrhosis, primary sclerosing cholangitis was found to have a strong association with bacteremia (RR: 3.88, 95% CI: 2.3-6.04, P < 0.001). Patients with cirrhosis who had bacteremia were hospitalized three days longer than those without bacteremia. There was no difference in inpatient mortality or 30-day readmission rates between cirrhotic patients with and without bacteremia. Conclusion This study suggests that, in the absence of another concomitant bacterial infection and primary sclerosing cholangitis, we can avoid unnecessary blood cultures among immunocompetent patients with cirrhosis. However, given some inherent limitations associated with the database (such as the unavailability of vitals or laboratory values), additional studies are needed to validate its findings.

A Rare Case of Parotid Stone Adherence to the Facial Nerve.

This case report details a complex case of parotid gland sialolithiasis with stones adherent to the facial nerve, a scenario that presents a significant surgical challenge. Traditional sialendoscopy failed to address the condition in a 23-year-old female patient, leading to the adoption of a combined endoscopic transcutaneous approach. This method successfully resolved the condition without intraoperative complications, maintaining intact facial nerve function postoperatively. The case emphasizes the importance of individualized surgical strategy and expert technique in advanced parotid surgery, advocating this approach for similarly complex sialolithiasis cases.

Outcomes with HLA-matched unrelated donor versus haploidentical hematopoietic cell transplantation.

We investigated the outcomes after adult haploidentical (haplo) and matched unrelated donor (MUD) hematopoietic cell transplantation (HCT) in a single-center study (n = 452) including 276 MUD and 176 haplo transplants. Myeloablative (37%) and reduced-intensity conditioning (63%) were performed. Graft sources included peripheral blood (50%) and bone marrow (50%). GVHD prophylaxis included tacrolimus/methotrexate (53%) and post-transplant cyclophosphamide-based (47%). In MUD versus haplo HCT recipients, a similar incidence of neutrophil engraftment (18 vs 17 days, p = 0.895), grade II-IV acute GVHD (51% vs 50%, p = 0.773), relapse (26% vs 23%, p = 0.578), non-relapse mortality (22% vs 23%, p = 0.817), 1-year disease-free survival (62% vs 63%. p = 0.921), and 1-year overall survival (73% vs 74%, p = 0.744) were observed. Earlier platelet engraftment (22 vs 27 days, p < 0.001) and higher chronic GVHD (45% vs 35%, p = 0.040) were noted in MUD as compared to haplo HCT. Allogeneic transplantation should be done promptly whenever indicated, utilizing either matched unrelated or haploidentical donors.

Comparison and process optimization of PLGA, chitosan and silica nanoparticles for potential oral vaccine delivery.

Aim: The study compared performance of nanoparticles prepared from synthetic organic, natural organic and inorganic materials as vaccine delivery platforms. Materials & methods: Various formulation (concentration, polymer/silica:surfactant ratio, solvent) and process parameters (homogenization speed and time, ultrasonication) affecting functional performance characteristics of poly(lactic-co-glycolic acid) (PLGA), chitosan and silica-based nanoparticles containing bovine serum albumin were investigated. Nanoparticles were characterized using dynamic light scattering, x-ray diffraction, scanning/transmission electron microscopy, Fourier transform infrared spectroscopy and in vitro protein release. Results: Critical formulation parameters were surfactant concentration (PLGA, silica) and polymer concentration (chitosan). Optimized nanoparticles were spherical in shape with narrow size distribution and size ranges of 100-300 nm (blank) and 150-400 nm (protein loaded). Protein encapsulation efficiency was 26-75% and released within 48 h in a sustained manner. Conclusion: Critical formulation and process parameters affected size of PLGA, chitosan and silica nanoparticles and protein encapsulation, while silica produced the smallest and most stable nanoparticles.