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An infectious trigger for childhood acute lymphoblastic leukemia is hypothesized and we assessed the association between the rate, type, and critical exposure period for infections and the development of acute lymphoblastic leukemia. We conducted a matched case-control study using administrative databases to evaluate the association between the rate of infections and childhood acute lymphoblastic leukemia diagnosed between the ages of 2-14 years from Ontario, Canada and we used a validated approach to measure infections. In 1600 cases of acute lymphoblastic leukemia, and 16 000 matched cancer-free controls aged 2-14 years, having >2 infections/year increased the odds of childhood acute lymphoblastic leukemia by 43% (odds ratio = 1.43, 95% confidence interval 1.13-1.81) compared to children with ≤0.25 infections/year. Having >2 respiratory infections/year increased odds of acute lymphoblastic leukemia by 28% (odds ratio =1.28, 95% confidence interval 1.05-1.57) compared to children with ≤0.25 respiratory infections/year. Having an invasive infection increased the odds of acute lymphoblastic leukemia by 72% (odds ratio =1.72, 95% confidence interval 1.31-2.26). Having an infection between the age of 1-1.5 years increased the odds of acute lymphoblastic leukemia by 20% (odds ratio = 1.20, 95% confidence interval 1.04-1.39). Having more infections increased the odds of developing childhood acute lymphoblastic leukemia and having an infection between the ages of 1-1.5 years increased the odds of childhood acute lymphoblastic leukemia.

Automated detection and classification of gastric infections (i.e., ulcer, polyp, esophagitis, and bleeding) through wireless capsule endoscopy (WCE) is still a key challenge. Doctors can identify these endoscopic diseases by using the computer-aided diagnostic (CAD) systems. In this article, a new fully automated system is proposed for the recognition of gastric infections through multi-type features extraction, fusion, and robust features selection. Five key steps are performed-database creation, handcrafted and convolutional neural network (CNN) deep features extraction, a fusion of extracted features, selection of best features using a genetic algorithm (GA), and recognition. In the features extraction step, discrete cosine transform, discrete wavelet transform strong color feature, and VGG16-based CNN features are extracted. Later, these features are fused by simple array concatenation and GA is performed through which best features are selected based on K-Nearest Neighbor fitness function. In the last, best selected features are provided to Ensemble classifier for recognition of gastric diseases. A database is prepared using four datasets-Kvasir, CVC-ClinicDB, Private, and ETIS-LaribPolypDB with four types of gastric infections such as ulcer, polyp, esophagitis, and bleeding. Using this database, proposed technique performs better as compared to existing methods and achieves an accuracy of 96.5%., (© 2020 Wiley Periodicals, Inc.)

Objective: To examine risk of emergency hospital admission and survival following adjuvant chemotherapy for early breast cancer., Methods: Linked data from New South Wales population-based and clinical cancer registries (2008-2012), hospital admissions, official death records and pharmaceutical benefit claims. Women aged ≥18 years receiving adjuvant chemotherapy for early-stage operable breast cancer in NSW public hospitals were included. Odds ratios (OR) for emergency hospitalisation within 6 months following chemotherapy initiation were estimated using logistic regression and survival using Kaplan-Meier and Cox proportional hazards methods., Results: A total of 3,950 women were included and 30.6% were hospitalised. The most common principal diagnosis at admission was neutropenia (30.8%). Women receiving docetaxel/carboplatin/trastuzumab (TCH) and docetaxel/cyclophosphamide (TC) were the most frequently hospitalised. After adjustment for demographic and clinical factors, the increased risk of hospitalisation for TCH and TC remained compared with doxorubicin/cyclophosphamide 3-weekly (OR 1.71, 95% confidence interval [CI] 1.24-2.37 and OR 1.47, 95% CI 1.17-1.85 respectively). Five-year overall survival was similar for women who were (92.2%, 95% CI 90.7-93.8) and were not hospitalised (93.1%, 95% CI 92.1-94.1)., Conclusion: Emergency hospitalisations following chemotherapy for early breast cancer were relatively common, especially following docetaxel-containing protocols. Further examination of reasons for admission is needed to inform actions to improve patient safety., (© 2019 John Wiley & Sons Ltd.)

Operators of paper machines may be exposed to bioaerosols containing both cultivable and non-cultivable microorganisms. A study was conducted in 11 paper mills to retrospectively examine the presence of symptoms related to infections in operators. The atmospheric concentrations of cultivable microorganisms in aerosols in the wet area of paper machines were determined by sampling on agar medium and typical microorganisms in the process waters from four of the largest mills were classified based on sequencing of 16S rDNA. Workers were assigned to groups based on the measurements and job tasks. Under the supervision of health care personnel a cohort of 781 exposed and 285 unexposed workers completed a questionnaire that provided data pertaining to the diagnosis of infectious diseases and the presence of associated symptoms. Operators of paper machines exposed to cultivable bioaerosols reported higher cumulative incidences of episodes with fever [odds ratio (OR) = 5.9, P < 0.01], gastrointestinal infections (OR = 4.1, P < 0.01) and the use of antibiotics against infections (OR = 1.7, P = 0.3) compared with a reference population of administrative workers. ORs among operators working close to aerosol-generating processes (n = 283) compared with operators in dry areas of mills (n = 229) were 2.6 (P < 0.01), 1.7 (P = 0.2) and 3.6 (P = 0.03), respectively. Excluding smokers and subjects using any local or systemic immune suppressing drugs from the cohorts only marginally affected the results. Microorganisms identified in the process waters from the paper machines were typically species of Rhanella, Erwinia, Enterobacter, Burkholderia, Pseudomonas and Agrobacterium. The concentrations of cultivable microorganisms in the process waters were in the range 104–106 colony forming units (c.f.u.)/ml and the atmospheric concentrations of bacteria in aerosols in the wet area of the paper machines typically ranged from 104 to >105 c.f.u./m3. [ABSTRACT FROM AUTHOR]

Operators of paper machines may be exposed to bioaerosols containing both cultivable and non-cultivable microorganisms. A study was conducted in 11 paper mills to retrospectively examine the presence of symptoms related to infections in operators. The atmospheric concentrations of cultivable microorganisms in aerosols in the wet area of paper machines were determined by sampling on agar medium and typical microorganisms in the process waters from four of the largest mills were classified based on sequencing of 16S rDNA. Workers were assigned to groups based on the measurements and job tasks. Under the supervision of health care personnel a cohort of 781 exposed and 285 unexposed workers completed a questionnaire that provided data pertaining to the diagnosis of infectious diseases and the presence of associated symptoms. Operators of paper machines exposed to cultivable bioaerosols reported higher cumulative incidences of episodes with fever [odds ratio (OR) = 5.9, P < 0.01], gastrointestinal infections (OR = 4.1, P < 0.01) and the use of antibiotics against infections (OR = 1.7, P = 0.3) compared with a reference population of administrative workers. ORs among operators working close to aerosol-generating processes (n = 283) compared with operators in dry areas of mills (n = 229) were 2.6 (P < 0.01), 1.7 (P = 0.2) and 3.6 (P = 0.03), respectively. Excluding smokers and subjects using any local or systemic immune suppressing drugs from the cohorts only marginally affected the results. Microorganisms identified in the process waters from the paper machines were typically species of Rhanella, Erwinia, Enterobacter, Burkholderia, Pseudomonas and Agrobacterium. The concentrations of cultivable microorganisms in the process waters were in the range 104-106 colony forming units (c.f.u.)/ml and the atmospheric concentrations of bacteria in aerosols in the wet area of the paper machines typically ranged from 104 to >105 c.f.u./m³. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) first emerged in China in November 2019. Most governments have responded to the COVID-19 pandemic by imposing a lockdown. Some evidence suggests that a period of isolation might have led to a spike in alcohol misuse, and in the case of patients with alcohol use disorder (AUD), social isolation can favour lapse and relapse. The aim of our position paper is to provide specialists in the alcohol addiction field, in psychopharmacology, gastroenterology and in internal medicine, with appropriate tools to better manage patients with AUD and COVID-19,considering some important topics: (a) the susceptibility of AUD patients to infection; (b) the pharmacological interaction between medications used to treat AUD and to treat COVID-19; (c) the reorganization of the Centre for Alcohol Addiction Treatment for the management of AUD patients in the COVID-19 era (group activities, telemedicine, outpatients treatment, alcohol-related liver disease and liver transplantation, collecting samples); (d) AUD and SARS-CoV-2 vaccination. Telemedicine/telehealth will undoubtedly be useful/practical tools even though it remains at an elementary level; the contribution of the family and of caregivers in the management of AUD patients will play a significant role; the multidisciplinary intervention involving experts in the treatment of AUD with specialists in the treatment of COVID-19 disease will need implementation. Thus, the COVID-19 pandemic is rapidly leading addiction specialists towards a new governance scenario of AUD, which necessarily needs an in-depth reconsideration, focusing attention on a safe approach in combination with the efficacy of treatment. [ABSTRACT FROM AUTHOR]

Purpose of Review: To review recent medical literature addressing antimicrobial stewardship in solid organ transplant (SOT) recipients., Recent Findings: Few studies with a strict focus on SOT patients have been published to date. Team-based antimicrobial stewardship interventions in SOT populations do have beneficial impacts on antimicrobial stewardship-relevant outcomes. Several studies have compared SOT-specific antibiograms to widely accepted hospital antibiograms; these studies all have found important differences in resistance rates among bacterial pathogens. Novel biomarkers like virome monitoring for assessing the net state of immunosuppression hold promise for individualized antimicrobial stewardship interventions., Summary: SOT patients are an understudied population with respect to antimicrobial stewardship interventions. Current antimicrobial stewardship interventions for SOT patients are largely extrapolated from studies in general patient populations and may not accurately reflect SOT-specific infection risks or outcomes. Antimicrobial stewardship interventions do impact SOT-relevant care goals but require significantly more research to achieve the depth and reach of antimicrobial stewardship interventions developed for general populations., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The 9th web-based European Conference on Infections in Leukemia (ECIL-9), held September 16-17, 2021, reviewed the risk of infections and febrile neutropenia associated with more recently approved immunotherapeutic agents and molecular targeted drugs for the treatment of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Novel antibody based treatment approaches (inotuzumab ozogamicin, gemtuzumab ozogamicin, flotetuzumab), isocitrate dehydrogenases inhibitors (ivosidenib, enasidenib, olutasidenib), FLT3 kinase inhibitors (gilteritinib, midostaurin, quizartinib), a hedgehog inhibitor (glasdegib) as well as a BCL2 inhibitor (venetoclax) were reviewed with respect to their mode of action, their immunosuppressive potential, their current approval and the infectious complications and febrile neutropenia reported from clinical studies. Evidence-based recommendations for prevention and management of infectious complications and specific alerts regarding the potential for drug-drug interactions were developed and discussed in a plenary session with the panel of experts until consensus was reached. The set of recommendations was posted on the ECIL website for a month for comments from members of EBMT, EORTC, ICHS and ELN before final approval by the panelists. While a majority of these agents are not associated with a significantly increased risk when used as monotherapy, caution is required with combination therapy such as venetoclax plus hypomethylating agents, gemtuzumab ozogamicin plus cytotoxic drugs or midostaurin added to conventional AML chemotherapy., (© 2022. The Author(s).)

The introduction to the 2022 Special Issue presents the 20 articles that discuss the demographic aspects and the consequences of the COVID-19 pandemic. It synthesises the main findings from the contributions, emphasising the demographic, social and economic characteristics that influenced the spread of infections and determined the number of deaths. We highlight the specific focus on measurement issues, often with a comparative framework across several countries, and at the regional level as well, both within and beyond Europe. We also summarise the impact of the measures imposed to contain the spread of the virus, such as lockdowns. Moreover, we explore the impact of the pandemic on the quality of relationships, the intention and the motivation to have children, and realised fertility. In addition, we present the authors' broader reflections on the risks faced by different communities of individuals, and the potential consequences for their life trajectories, including in relation to other current risks that overlap with the pandemic (recent armed conflicts), and for the achievability of the Sustainable Development Goals themselves. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of surgical debridement on the microbiology of resection margins of an infected diabetic foot ulcer and to compare the use of marginal sampling as a guide for antimicrobial therapy., Methods: Forty consecutive participants were studied. Tissue samples from infected diabetic foot ulcers were obtained at first contact by podiatrists. After surgical debridement to macroscopically healthy tissue, multiple samples were obtained from the margins of the residuum and also from excised non-viable tissue. Debridement was done by a single surgeon. Bacterial species were classified according to pathogenic potential a priori into Red Group-Definite pathogen causing infection, Yellow Group-Likely to be causing infection if present in more than one specimen and Green Group -Commensals, not causing infection., Results: There was a relative reduction of 49% (p = 0.002) in bacteria in the most pathogenic (red) group, and 59% (p = 0.002) in the yellow group in podiatry samples compared with resection specimen. Positive cultures from margins of the residuum were observed in 75% of cases. There was a relative reduction of 67% (p = 0.0001) in bacteria in the red and 48% (p = 0.06) in the yellow group in marginal samples from the residuum compared with podiatry samples., Conclusions: After surgical debridement to healthy tissue, positive cultures from marginal tissue samples provided vital information on the presence of pathogenic bacteria. This allowed antibiotics to be individualised post-surgical debridement., (© 2020 Diabetes UK.)

Liquid biopsy (LB) is defined as a sample of any of body fluids (blood, saliva, tear fluid, urine, sweat, amniotic, cerebrospinal and pleural fluids, cervicovaginal secretion, and wound efflux, amongst others), which can be ex vivo analysed to detect and quantity the target(s) of interest. LB represents diagnostic approach relevant for organ-specific changes and systemic health conditions including both manifested diseases and their prestages such as suboptimal health. Further, experts emphasise that DNA-based analysis alone does not provide sufficient information for optimal diagnostics and effective treatments. Consequently, of great scientific and clinical utility are molecular patterns detected by hybrid technologies such as metabolomic tools and molecular imaging. Future proposed strategies utilise multiomic pillars (generally genome, tanscriptome, proteome, metabolome, epigenome, radiome, and microbiome), system-biological approach, and multivariable algorithms for diagnostic, prognostic, and therapeutic purposes. Current article analyses pros and cons of the mass spectrometry-based technologies, provides eminent examples of a success story "from discovery to clinical application," and demonstrates a "road-map" for the technology-driven paradigm change from reactive to predictive, preventive and personalised medical services as the medicine of the future benefiting the patient and healthcare at large. © 2019 The Authors. Mass Spectrometry Reviews published by John Wiley & Sons Ltd. Mass Spec Rev., (© 2019 The Authors. Mass Spectrometry Reviews published by John Wiley & Sons Ltd.)

Daratumumab is approved for newly diagnosed or relapsed/refractory multiple myeloma (MM). The use of daratumumab has improved patient outcomes but has changed the frequency and epidemiology of infections. However, the optimal approach to prophylaxis and supportive therapy for daratumumab-emergent infections is unknown and represents an unmet clinical need in MM. Consequently, an expert panel convened to compose recommendations for optimal infection control in patient candidates to or under daratumumab treatment for MM. Scientific evidence on infections secondary to daratumumab was evaluated, and a consensus was developed by group discussion for key questions selected according to the clinical relevance. The following key issues were addressed: infectious risk assessment and risk stratification, infection mitigation strategies, and management of infectious complications in patients with MM treated with daratumumab. • Daratumumab is approved for newly diagnosed or relapsed/refractory multiple myeloma. • Although patient outcomes have improved, the frequency and epidemiology of infections has changed. • The optimal approach to manage daratumumab-emergent infections is unknown. • Recommendations for optimal infection control are discussed. • Key issues addressed include: infectious risk assessment and risk stratification, infection mitigation strategies, and the management of infectious complications. [ABSTRACT FROM AUTHOR]

Ruxolitinib has proved to be effective for the treatment of patients with myelofibrosis (either primary or secondary) and polycythaemia vera, and its approval led to a significant change in the current treatment algorithm. Despite its efficacy and beyond its well described haematological toxicity, a peculiar immunosuppressive effect emerged as our clinical experience grew, both within and outside of a clinical trial setting. Definite and negative interactions with multiple pathways of the immune system of patients have been reported so far, involving both adaptive and innate immune responses. These pathophysiological mechanisms may contribute to the increased risk of reactivation of silent infections (e.g., tuberculosis, hepatitis B virus and varicella zoster virus) that have been associated with the drug. Even though such infectious events may be fatal or may lead to significant impairment of organ function, compromising the eligibility of patients for an allotransplant procedure, there are no dedicated guidelines that may help us in assessing and managing the risk of developing serious infections. On this basis, our aim for the present work was to review the current knowledge on the pathophysiological mechanisms through which ruxolitinib may exert its immunosuppressive effect, and to illustrate our personal approach to the management of three peculiar clinical scenarios, for which a risk-based algorithm is suggested., (© 2019 British Society for Haematology and John Wiley & Sons Ltd.)

Infections continue to be a major cause of post-transplant morbidity and mortality, requiring increased health services utilization. Estimates on the magnitude of this impact are relatively unknown. Using national administrative databases, we compared mortality, acute care health services utilization, and costs in solid organ transplant (SOT) recipients to nontransplant patients using a retrospective cohort of hospitalizations in Canada (excluding Manitoba/Quebec) between April-2009 and March-2014, with a diagnosis of pneumonia, urinary tract infection (UTI), or sepsis. Costs were analyzed using multivariable linear regression. We examined 816 324 admissions in total: 408 352 pneumonia; 328 066 UTI's; and 128 275 sepsis. Unadjusted mean costs were greater in SOT compared to non-SOT patients with pneumonia [(C$14 923 ± C$29 147) vs. (C$11 274 ± C$18 284)] and sepsis [(C$23 434 ± C$39 685) vs. (C$20 849 ± C$36 257)]. Mortality (7.6% vs. 12.5%; P < 0.001), long-term care transfer (5.3% vs. 16.5%; P < 0.001), and mean length of stay (11.0 ± 17.7 days vs. 13.1 ± 24.9 days; P < 0.001) were lower in SOT. More SOT patients could be discharged home (63.2% vs. 44.3%; P < 0.001), but required more specialized care (23.5% vs. 16.1%; P < 0.001). Adjusting for age and comorbidities, hospitalization costs for SOT patients were 10% (95% CI: 8-12%) lower compared to non-SOT patients. Increased absolute hospitalization costs for these infections are tempered by lower adjusted costs and favorable clinical outcomes., (© 2019 Steunstichting ESOT.)

Introduction and aim. Prototheca is the only alga regarded as pathogenic. Much less frequently, infections can be also caused by Chlorella, which is a widely-known dietary supplement. Unlike Prothoteca algae, Chlorella contains chlorophyll and can be used in the production of biofuel as well as electric and thermal energy. The purpose of this review is to analyze cases of chlorella infection. Material and methods. The literature review was performed by analyzing research and review articles from the Pubmed and ScienceDirect databases published over the last 50 years. Analysis of literature. The first case of infection caused by Chlorella was reported in a lamb in 1973 and from then on infections in other species of mammals (mostly herbivorous), reptiles and fish have been observed. So far, two cases of chlorellosis in humans have been con- firmed, the last one in 2014 in Australia. Both infections were a result of a mechanical trauma in freshwater. In 2014 the patient developed aggressive Chlorella infection with necrosis of adipose tissue through bursa and into the paratenon of patellar tendon where it was necessary to perform debridement and bursectomy. It seems that in both cases negative pressure wound therapy brought about successful results. Conclusion. The studies on algae will open up perspectives for better prevention and treatment of infections caused by non-typical organisms such as Chlorella. [ABSTRACT FROM AUTHOR]

What tests to send and when? This article examines the evidence for common microbiological tests and discusses their limitations and interpretation. Urine tests, surface swabs, blood cultures and screening swabs are all discussed in the context of a fictional clinical case., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Bacteriophages, as ubiquitous bacterial viruses in various natural ecosystems, play an important role in maintaining the homeostasis of the natural microbiota. For many years, bacteriophages were not believed to act on eukaryotic cells; however, recent studies have confirmed their ability to affect eukaryotic cells and interact with the host immune system. Due to their complex protein structure, phages can also directly or indirectly modulate immune processes, including innate immunity, by modulating phagocytosis and cytokine reactions, as well as acquired immunity, by producing antibodies and activating effector cells. They can therefore have a profound impact on the course of bacterial infections by stimulating and at the same time inhibiting the systemic pro-inflammatory response. This review article presents a characterization of the processes by which bacteriophages affect selected immune mechanisms in selected animal species. The results of our own experiments using calves are also presented as examples. The paper contains many new examples of potential uses of bacteriophages and their effects on eukaryotic cells, especially in the course of bacterial infections, which are extremely important in experimental treatments exploiting phages as alternatives to antibiotics. The positive results of the effects of bacteriophages on eukaryotic cells during infections open up promising new prospects for their use as natural tools in the treatment of bacterial, fungal, and viral diseases in animals and humans. [ABSTRACT FROM AUTHOR]

Odontogenic infections, irrespective of regional economic conditions, are a global health concern. Some cases escalate to severe levels, complicating treatment, endangering lives, and reducing positive outcomes. Necrotizing fasciitis is particularly lethal, with purulent collections and infection-derived gases spreading to distant regions. Prompt surgical intervention is crucial, especially in patients with comorbidities like diabetes mellitus. This paper introduces a comprehensive treatment approach taken in Angola over the past 4 years. This protocol involves four key steps: combined antibiotic therapy (ceftriaxone, metronidazole, and aminoglycoside), prompt drainage with aggressive debridement, irrigation with sodium hypochlorite, and rapid removal of the infectious focus. This study reports its application in 13 patients over a 10-day period, demonstrating its efficacy in odontogenic necrotizing fasciitis. The protocol significantly reduced fatalities, and its success was acknowledged by the maxillofacial surgery department at Josina Machel Hospital. Challenges, such as a scarcity of maxillofacial surgeons, prompted innovative adaptations to treatment protocols. Although lacking statistical validation, the used protocol showcased effectiveness in treating odontogenic necrotizing fasciitis. Its emphasis on combined antibiotic therapy, aggressive surgical interventions, and specialized irrigation demonstrated notable success in reducing mortality rates. [ABSTRACT FROM AUTHOR]