The Effect of Extended-Spectrum-Beta-Lactamases Organisms in Appendectomy Cultures on Complication Rate in Pediatric Appendicitis

A previously healthy 8-year-old girl presented at our hospital with cervical pain and walking difficulty. Initial evaluation was unremarkable, but magnetic-resonance-imaging revealed extensive vertebral involvement. Surgery confirmed Mycobacterium tuberculosis infection and a nine-month antitubercular regimen was started. Early diagnosis, multi-drug therapy and surgery led to a favorable outcome, emphasizing the importance of a multidisciplinary approach in managing pediatric spinal tuberculosis.

This report documents the case of a 28-year-old male who developed widespread psoriasis following getting the second dose of the Pfizer-BioNTech COVID-19 vaccine in 2022. Despite half a year of treatment with Western medicine, there was no improvement in symptoms. In 2023, the patient sought Traditional Chinese Medicine (TCM) treatment. The initial examination by the Chinese medicine practitioner revealed that the psoriasis affected 17% of the Body Surface Area with a PASI (Psoriasis Area and Severity Index) score of 16.4. The TCM diagnosis identified the condition as predominated by dampness with spleen deficiency. The treatment plan involved the internal administration of Chinese herbal formulas, including Chai Hu Gui Zhi Gan Jiang Tang and Wu Ling San, along with the topical application of Indigo Naturalis gel. After six months of treatment, his psoriasis condition significantly improved, with the PASI score decreasing to 2.9. By January 2024, the condition had fully recovered. Globally, approximately 125 million adults are affected by psoriasis, and there has been an increase in cases of psoriasis worsening or emerging post-vaccination. This case demonstrates the effectiveness of TCM and herbal treatments in managing vaccine-induced psoriasis and COVID-19-related psoriasis. It also opens new avenues for research into applying alternative treatment in modern medical practices.

Background: Haemodialysis (HD) patients are particularly vulnerable to SARS-CoV-2 due to frequent healthcare exposure and multiple comorbidities. This study examines outcomes of HD patients infected with SARS-CoV-2 and evaluates risk factors for hospital admission, Intensive Care Unit (ITU) admission, length of stay, and 30-day mortality.

Methods: A retrospective cohort study was conducted in four HD centres at a major London hospital, including 249 SARS-CoV-2-positive HD patients from March 2020 to August 2021. Data on demographics, comorbidities, deprivation, and COVID-19 wave were collected. PCR was used for nasopharyngeal swabs, with genotypic analysis in waves 2 and 3. Logistic regression models assessed risk of hospital and ITU admissions, while a Cox proportional hazards model was applied for 30-day mortality.

Results: Of the HD population, 28.9% contracted SARS-CoV-2, 96% had at least one comorbidity, 40% required hospital admission, 11% needed ITU care, and 11% died within 30 days (median time-to-death: 14 days). Mortality was significantly higher in the second wave (p = 0.038), coinciding with the Alpha variant. Age was the only factor associated with hospital admission (OR 1.03, 95% CI 1.01–1.06, p = 0.008). In multivariate analysis, age, comorbidities, deprivation, and wave 2 infection were linked to increased mortality hazard, with lower deprivation significantly reducing risk (HR 0.50, 95% CI 0.26–0.95, p = 0.036).

Discussion: The findings underscore the increased vulnerability of HD patients to COVID-19, particularly with emerging variants. Although age was the main predictor of hospital admission, mortality was also influenced by comorbidities and deprivation, indicating socio-economic disparities despite uniform healthcare access.

Background: Viral load monitoring is the gold standard for monitoring adherence and confirming treatment response, while treatment failure is often caused by either therapeutic failure due to ART resistance or poor adherence to treatment. Assessment for viral load suppression (< 1000copies/ ml) is one of HIV indicators therefore monitoring and reporting outcome of ART is very important for the program implementation and monitoring. Therefore, the objective of this study is to assess factors associated with high viral load resuppression among HIV patients receiving antiretroviral therapy in Hawassa City public facilities.

Method: A retrospective cross-sectional study was conducted between September 1, 2017 and June 30, 2020, among people living with HIV (PLHIV) in three public facilities at Hawassa city, Ethiopia. Patients with a Viral Load (VL) > 1000 copies/ml received three sessions of Enhanced Adherence Counselling (EAC) one month apart, after which a repeat VL was done. The main outcome was viral re-suppression following EAC. Structured checklist was used to extract data by reviewing medical records focusing on patient related data (age, sex, and residence), monitoring response to ART (VL, CD4 count, WHO clinical staging), Co-morbidities, adherence, and duration of medication. Data was entered in EpiData version 3.1. and the analyses were done using SPSS for Windows version, 25.0.

Result: A total of 220 records of high viral load HIV seropositive were reviewed and 40% of viral re-suppression was observed. Odds of viral re-suppression observed among patients enrolled in to enhanced adherence counseling (AOR = 2.1, 95% (1.0-4.2)) and who had TB infection (AOR = 0.53, 95%CI (0.2-0.8)).

Conclusion: The study showed low viral load re-suppression prevalence among HIV high viral load patients. Enhanced Adherence Counseling (EAC) had great roll in viral re-suppression and TB infection decreases odds of HIV viral re-suppression. Enhanced Adherence Counseling (EAC) and TB infection prevention is recommended for all high viral load HIV patients

Pulmonary tuberculosis decreased remarkably by anti-tuberculous chemotherapy, but we have had a lot of patients associated with sequelae who need medical treatment for many symptoms. We also have a lot of patients diagnosed as an extra pulmonary tuberculosis where diagnosed is usually based on histological findings and treatment duration was based on expert opinion. Besides, some patients presented with extensive tuberculosis or with so many complications that predict nonresponsive to CAT-1 tuberculosis drugs. Moreover, in these days the delayed detection of pulmonary tuberculosis that is still an important problem may cause new sequelae.

Background: Melioidosis is not widely recognized in Bangladesh which is evident from the paucity of published reports on melioidosis from this region. Here, we summarize the clinical presentation, laboratory results, prevention and control policies and make important recommendations for patient management.

Case Presentation: A 35-years-old diabetic male forest officer from Gazipur Sadar located north-west of Dhaka city got admitted to Shaheed Suhrawardy Medical College Hospital, Dhaka with history of recurrent fever for last 1 year. Initially the fever was high grade (up to 1050F), intermittent nature and lasted for a few days to week. About five months back, the patient developed a parietal abscess over the left lumber region and was treated surgically accordingly. The patient then gradually recovered and remained afebrile for about one month. Fever again recurred, high grade, quotidian in nature and has been persistent for the last 3 months. The patient had also developed marked loss of appetite, altered bowel habit with occasional vomiting and lost about 15kg of his body weight. The patient noticed profuse watery diarrhea for last 2 days and got himself admitted. On examination, the patient was found wasted, conscious but slow mentation, dehydrated and moderately anaemic. His pulse was 116/min, blood pressure 80/60 mm Hg, respiration 24/min and oral temperature was 1030
F but no palpable lymph nodes. The patient had moderate hepato-splenomegaly with left sided pleural effusion and bilateral depressed ankle jerks. B.pseudomallei was isolated and identified by blood and urine culture as well as with serological test.

Conclusion: We should be more alert among the diabetic patients who are presented with fever with high ESR and neutrophilic leucocytosis, even if radiography or cytopathology is indicative of tuberculosis.

Background and Objective: In post-treatment phase of the Human African Trypanosomiasis (HAT), some clinical manifestations might imply a relapse resulting sometimes in unnecessary patient exposure to adverse effects of trypanocidal treatments. The aim of this study is to identify clinical and biological markers easily accessible for discrimination between relapse and non-relapse.

Methods: Retrospective analysis compared clinical and laboratory data of 20 subjects with suspected relapse and 53 non-relapses. For all of the participants the research of the trypanosome on CSF was negative by direct parasitological techniques, but they presented with abnormal clinical manifestations in post-treatment phase of HAT in stage-2. As appropriate, the following analyzes were applied with significance level of 5%: Fischer’s exact test, chi-square test of Pearson and U-test of Mann-Whitney.

Results: Relapse is more likely in patients with clinical signs of progressive installation after a lag of at least three months, associated with a Cerebrospinal Fluid (CSF) profile of meningitis type, and a leukocyte count of ≥120 cells/mm3 and a score >0. Non relapse seems more feasible when symptoms appeared earlier, regardless of clinical latency, the cytology and chemistry profile of the CSF showed increased albumin level in CSF with a normal leukocyte count of ≤5 cells/mm3 and a variable score. Different phenotypes are suggested in the latter group, whose validation is essential.

Conclusion: The present investigation strongly suggests that the analysis of clinical data and the cyto-biological profile of the CSF have a discriminatory power to differentiate between relapse and non-relapse when HAT parasitological tests are negative. Multicenter investigations should be considered to strengthen the power of the observed associations.

Background: One of the major clinical problems regarding Pseudomonas aeruginosa is attributed to the production of Metallo-Betalactamase (MBL) enzymes. This group of enzymes is members of beta-lactamases which constitute Ambler class B that hydrolyze-carbapenems. This study was carried out to find out the predominant resistance mechanisms among MDRPA and the prevalence of corresponding resistance genes.

Materials and methods: MDRPA isolates collected from various clinical samples for a period of one year from March 2015 to February 2016 were included to detect the predominant mechanism of resistance using phenotypic and molecular methods. Molecular characterization of all these isolates was done by Polymerase Chain Reaction (PCR) for the presence of blaVIM2, blaIMP-1, blaOXA-23, and blaNDM-1 genes with specific primers.

Results: Among 120 MDRPA isolates 70 (58.33%) were MBL producers. Molecular characterization studied by PCR showed 15 (12.5%) of vim2 gene and only 2 (1.66%) of IMP 1 gene. None of the 120 MDRPA has produced OXA 23 and NDM gene in our study.

Conclusion: The prevalence of MBLs has been increasing worldwide, particularly among P. aeruginosa, leading to severe limitations in the therapeutic options for the management. Thus, proper resistance screening measures and appropriate antibiotic policy can be strictly adopted by all the healthcare facility providers to overcome these superbugs.

Background: Candida albicans is the most prevalent yeast isolated from the human body and a natural part of the commensal microbiota; however, under the right conditions, C. albicans can cause candidiasis (oral thrush). The oral cavity is colonized by hundreds of bacterial species, and the relationship between these oral bacteria and C. albicans has been a topic of interest in understanding the development of candidiasis. Several studies have attempted to explain the bacteria-fungal relationship in the oral environment, but few have focused on single bacterial species inhibiting growth and morphogenesis of C. albicans. The aim of this study was to identify specific bacterial species, isolated from the healthy human oral cavity, can suppress C. albicans.

Materials and methods: Bacterial and yeast species were isolated and purified from the saliva samples of 12 healthy individuals. PCR was performed by using 16SrDNA and 18S rDNA as templates to identify bacterial and yeast species for all isolates, respectively. Real time qPCR and microscopic examination were carried out to determine the inhibitory effect of S. aureus on C. albicans.

Result: This study demonstrated that numerous bacterial isolates from the oral cavity of healthy humans could inhibit the growth of C. albicans oral isolates, including the model strain CS5314. Among these bacteria, one Staphylococcus aureus strain displayed the strongest inhibitory effect on the growth of yeasts. By qPCR assay, all isolated C. albicans strains were inhibited on the growth by S. aureus in various degrees. Mixed culture experiments also demonstrated suppression of C. albicans pseudo hyphae or hyphae formation by S. aureus but not by other bacterial species tested.

Conclusion: it is well known that C. albicans and S. aureus exist in a cooperative relationship and form substantial polymicrobial biofilm, thus, this is a first report about one clinical isolated S. aureus strain suppressing the growth and pseudohyphae/hyphae formation of C. albicans, indicating the complexity of interspecies interaction in human oral cavity

Introduction: Neonatal sepsis is currently one of the most serious and feared problems affecting infants ≤ 28 days of life due to its severity, morbidity and mortality among term and preterm newborns. Group B Streptococcus (GBS) is globally the main etiologic agent of Early Onset Sepsis (EOS) in neonates; Escherichia coli (E. coli) is actually estimated as the second cause of EOS in term infants and the main in preterms. E. coli is also associated with severe invasive infections and meningitis, and it is estimated as the main cause of sepsis related mortality in very low birth weight newborns. Moreover, newborns with E. coli sepsis have an higher risk to develop adverse outcomes, for example neurologic disabilities.

Methods: In a 4 years prospective observational study, all term newborns affected by sepsis with positive blood culture have been enrolled. Data on pre-delivery risk factors, birth, clinical presentation, blood culture, blood test, neonatal treatment, follow-up and outcome have been collected.

Results: E. coli resulted the main bacteria found as cause of EOS in our neonatal unit, affecting only term newborns. The calculated incidence of positive blood culture to E. coli in the first three days of life in term newborns was 0.69/1000 live births. An immediate recognition of septic signs and symptoms, diagnosis and prompt antibiotic treatment were essential for a positive outcome.