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BACKGROUND Migrants from Africa are vulnerable to viral infections during their journey. METHODS Migrants who arrived in western Sicily were offered early screening for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection. A questionnaire was administered to evaluate risk factors, and antiviral therapy was offered to subjects with active infection. A multiple regression analysis and adjusted odds ratio were obtained to evaluate risk factors. RESULTS Overall, 2,639 of 2,751 (95.9%) migrants who arrived between 2015 and 2017 accepted screening and 1,911 (72.4%) completed the questionnaire. HBsAg was positive in 257 (9.7%) migrants, 24 (0.9%) were anti-HCV positive and 57 (2.2%) had HIV infection. The prevalence of HBV infection was higher in women (aOR 2.47,95%CI 1.90-3.20),p = 0.003) and in people who endured physical and/or sexual violence (aOR 2.24,95%CI 1.87-3.55,p

We aimed to evaluate the impact of the 10th version of European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints table, where most antipseudomonal drugs but meropenem are now categorised as "Susceptible, increased exposure" and labelled I, on meropenem prescription for Pseudomonas aeruginosa infections.In this retrospective single-centre observational study, we analysed antimicrobial therapies prescribed after susceptibility testing in all consecutive adult patients treated for P. aeruginosa infections between 01.08.2019 and 30.07.2020 in Lausanne University Hospital, Switzerland. We collected epidemiological, microbiological, clinical data, antimicrobial therapy, and infectious diseases specialists (IDs) consultations' data. The primary outcome was the prescription of meropenem to treat P. aeruginosa infections after release of susceptibility testing results. Secondary outcomes were: the use of increased dosage for non-meropenem anti-pseudomonal drugs, and IDs' consultations rates after susceptibility testing was made available.Among the 264 patients included, 40 (15.2%) received meropenem, 3.4% (5/148) before EUCAST update versus 30.2% (35/116) after (p 0.001). Supervision and counselling from IDs and the use of increased dosages of non-carbapenem antibiotics also increased respectively (40.5% (60/148) vs 62.9% (73/116), P 0.001); (55.5% (76/148) vs 88.9% (72/116), P 0.001). Factors associated with these increments could not be adequately modelled.The change to 2020 EUCAST criteria might be associated with increased odds of meropenem prescription for the treatment of P. aeruginosa infections stressing the need of prescribers' education and the importance of antibiotic stewardship interventions.

Liver transplantation (LT) from donors-with-HIV to recipients-with-HIV (HIV D+/R+) is permitted under the HOPE Act. There are only three international single-case reports of HIV D+/R+ LT, each with limited follow-up. We performed a prospective multicenter pilot study comparing HIV D+/R+ to donors-without-HIV to recipients-with-HIV (HIV D-/R+) LT. We quantified patient survival, graft survival, rejection, serious adverse events (SAEs), human immunodeficiency virus (HIV) breakthrough, infections, and malignancies, using Cox and negative binomial regression with inverse probability of treatment weighting. Between March 2016-July 2019, there were 45 LTs (8 simultaneous liver-kidney) at 9 centers: 24 HIV D+/R+, 21 HIV D-/R+ (10 D- were false-positive). The median follow-up time was 23 months. Median recipient CD4 was 287 cells/µL with 100% on antiretroviral therapy; 56% were hepatitis C virus (HCV)-seropositive, 13% HCV-viremic. Weighted 1-year survival was 83.3% versus 100.0% in D+ versus D- groups (p = .04). There were no differences in one-year graft survival (96.0% vs. 100.0%), rejection (10.8% vs. 18.2%), HIV breakthrough (8% vs. 10%), or SAEs (all p .05). HIV D+/R+ had more opportunistic infections, infectious hospitalizations, and cancer. In this multicenter pilot study of HIV D+/R+ LT, patient and graft survival were better than historical cohorts, however, a potential increase in infections and cancer merits further investigation.

Measles is a highly contagious infectious disease. Despite aggressive national initiatives to eradicate measles, outbreaks have occurred in recent years. We report three infants who presented to a tertiary care hospital in Muscat, Oman, in 2019 with measles and then developed pneumonitis, received intensive care treatment and made full recoveries. Infants can have an atypical presentation and develop severe symptoms. Pneumonitis is a serious complication and the management strategies are controversial. The early detection of measles and isolation of affected individuals play major roles in the elimination of measles outbreaks. Keywords: Measles; Pneumonitis; Infant; Respiratory Distress Syndrome; Vitamin; Case Report; Oman.

Background Coronavirus disease (COVID‐19) is a global infectious disease with a large burden of illness and high health care costs. This study aimed to compare clinical features among adult COVID‐19 patients in different age groups. Methods Laboratory‐confirmed adult COVID‐19 infection cases between December 31, 2019 to March 8, 2020 obtained from Neighboring Cities. Patients were divided into five age groups. Clinical characteristics were compared among different age groups. Results Of 299 cases, median age was 44 and 158 (53%) were male. A total of 53.3% of 30–40 years, 50% of 40–50 years, 36.6% of, Graphical abstract This study aimed to compare clinical features among adult COVID‐19 patients in different age groups. Among all the observed symptoms, only symptom of dyspnea was significantly different between the elderly group and other groups. Old age, high heart rate on admission, high respiratory rate on admission, and history of chronic heart disease were independently associated with severe or critical.

Актуальність. Незважаючи на стрімкий розвиток мікрохірургічної техніки, нейровізуалізації, антибактеріальної терапії, абсцеси головного мозку залишаються потенційно фатальним інфекційним захворюванням центральної нервової системи. Важливою особливістю цієї патології є те, що страждають люди молодого працездатного віку. Мета дослідження: провести аналіз ефективності хірургічного лікування хворих з абсцесами головного мозку. Матеріали і методи. Серед 242 пацієнтів з абсцесами головного мозку було 33 дитини та 209 дорослих. Серед дорослих осіб чоловічої статі було 143 (68,4 %), жіночої — 66 (31,6 %). Вік хворих коливався від 4 місяців до 74 років, у середньому 36,5 ± 13,8 року. Результати. Для оцінки ефективності лікування та ступеня неврологічного дефіциту у хворих з абсцесами головного мозку використовували шкалу результатів Глазго. Загалом на момент виписки або переведення хворого з нейрохірургічного відділення були отримані такі результати: 77 (32 %) — добре відновлення (5 балів); 90 (37 %) — задовільний результат (4 бали); 41 (17 %) — недостатнє покращення, глибока інвалідність (3 бали), 5 (2 %) — незадовільний результат (2 бали); у 29 (12 %) випадках був летальний результат (1 бал). Добрих результатів при застосуванні стереотаксичних технологій було отримано в 1,7 раза більше, а саме 30,8 % при традиційних нейрохірургічних втручаннях та 50 % при застосуванні нейронавігації та стереотаксії (Р < 0,05). Висновок. Аналізуючи результати за роками дослідження, ми прослідковуємо чітку тенденцію до зменшення частки летальних випадків з 20 % у 1995–1999 роках до 9,9 % у 2011–2014 роках та, відповідно, зростання позитивних результатів.

Annually in Ukraine, about 17 thousands of newborns are at risk of vertical infection with hepatitis B and C. Identification of infected women at the stage of family planning is the best way to prevent infection in newborns, and therefore it must be performed strictly in accordance with established norms. In case of detection of hepatitis, further tactics depend on the variant of the virus: in case of hepatitis C, pre-pregnancy treatment is preferable. In case of hepatitis B — pregnancy with subsequent simultaneous vaccination of the newborn. Antiviral therapy is possible in women with high viral load to prevent intrauterine infection. Similar tactics should be followed in case of in vitro fertilisation too. The text of the lecture is illustrated by clinical examples. The lecture is intended for infectious disease physicians and obstetrician-gynecologists.

Despite prevention strategies, cytomegalovirus (CMV) remains a common infection in pediatric solid organ transplant recipients (SOTR). We sought to determine the frequency, associations with, and long-term outcomes of CMV DNAemia in pediatric SOTR. We performed a single-center retrospective cohort study, including 687 first time SOTR ≤21 years receiving universal prophylaxis from 2011 to 2018. Overall, 159 (23%) developed CMV DNAemia, the majority occurring after completing primary prophylaxis. CMV disease occurred in 33 (5%) SOTR, 25 (4%) with CMV syndrome and 10 (1%) with proven/probable tissue-invasive disease. CMV contributed to the death of three (0.4%) patients (all lung). High-risk (OR 6.86 [95% CI, 3.6-12.9]) and intermediate-risk (4.36 [2.3-8.2]) CMV status and lung transplantation (4.63 [2.33-9.2]) were associated with DNAemia on multivariable analysis. DNAemia was associated with rejection in liver transplant recipients (p

Background: Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients. Methods: An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchio-litis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data. Results: Overall, 3.5 % (IQR: 3.4-3.5 %) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchitis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p < 0.001) and increased by 65.7 % from 1997 to 2018. A 41.2 % of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchitis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p < 0,001). In 89.1 % of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8 %, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7 %; p < 0.001) and doubled from 1997 to 2018 (5,257 deaths in 1997 and 10,514 in 2018). A 75.5 % of the deaths occurred amongst people over 74 years. Conclusions: LRTIs are associated with a high morbi-mortality in Spain. Effective measures that can contribute towards the prevention and treatment of LRTIs need to be adopted.

We herein report an unusual case of granulomatosis with polyangiitis (GPA) in a 65-year-old man in whom relapsed disease manifested as an anterior cheek nodule. Magnetic resonance imaging indicated the differential diagnoses of the subcutaneous nodule in the patient's anterior cheek to be inflammatory granulomatous lesions with GPA, malignancy, or infectious disease. A histopathological examination ruled out malignancy and infectious diseases, and necrotizing vasculitis was suspected. The subcutaneous nodule was successfully treated using rituximab, suggesting that it was associated with GPA, secondary to vasculitis. Clinicians should be aware of the possibility of such a rare manifestation of GPA.

Multisystem involvement has not been uncommon in SARS-CoV-2 infection. There has been reports of devastating neurological complication both during the infection and after the virus clears out. Here we present a rare case of sino-orbital mucormycosis, diagnosis of which was confirmed only on histopathology. Our patient presented with headache, 18 days after her recovery from SARS-CoV-2 infection and was extensively worked up for the cause. Initially she was treated as a severe sinusitis but failure to response to antibiotics treatment warranted for further investigations and imaging. Our patient had to undergo right eye enucleation plus debridement under general anesthesia under the care of ENT, Ophthalmology, Neurosurgery and Neurology. She is currently on anti-fungal treatment as advised by infectious disease department.

Objective The objective of this study was to evaluate the incidence of nosocomial infection and the impact of cross-transmission of SARS-CoV-2 among inpatients at a tertiary care teaching hospital. Methods This was a retrospective cohort study involving inpatients admitted to a tertiary university hospital in the city of Sao Paulo, Brazil, between March 2020 and February 2021. Cases were identified on the basis of a positive reverse-transcription polymerase chain reaction result for SARS-CoV-2 and the review of electronic medical records. Nosocomial transmission was defined by applying the criteria established by the Brazilian National Health Regulatory Agency. Results We identified 2146 cases of SARS-CoV-2 infection, 185 (8.6%) of which were considered cases of nosocomial transmission. The mean age was 58.3 years. The incidence density was 1.78 cases per 1,000 patient-days on the general wards, being highest on the cardiac surgery ward, and only 0.16 per 1,000 patient-days on the COVID-19 wards. Of the 185 patients evaluated, 115 (62.2%) were men, 150 (81.1%) cases had at least one comorbidity, and 104 (56.2%) evolved to death. Conclusions Despite the preventive measures taken, nosocomial transmission of SARS-CoV-2 occurred throughout our hospital. Such measures should be intensified when the incidence of community transmission peaks.

Coronavirus disease‐19 (COVID‐19) infection causing severe gastrointestinal complications is rare. A 9‐year‐old child after recovering from mild COVID‐19 infection developed small bowel gangrene due to superior mesenteric artery thrombosis. He required resection of entire necrotic small bowel along with caecum causing ultra‐short bowel syndrome. Reverse transcriptase‐polymerase chain reaction (RT‐PCR) done on the resected specimen was positive for COVID‐19. He was maintained on individualized parenteral nutrition for 3 months. A living donor intestinal transplant was performed using 200 cm of ileum donated by the patient's father. The graft function was satisfactory and was not complicated with thrombosis, infection, reactivation of latent COVID‐19 or rejection. He could be weaned off completely from parenteral nutrition by postoperative day 21. The donor had an uneventful recovery. Six month follow‐up was satisfactory with the child achieving complete enteral autonomy as well as target goal nutrition. Thrombotic phenomena associated with COVID‐19 infection can affect larger vessel‐like superior mesenteric artery leading to small bowel gangrene. Intestine transplant could be done safely after 3 months of recovery from COVID‐19 without any adverse outcomes. Further studies are required to establish optimal timing and safety of small bowel transplant in this situation.

Background and aims Healthcare for the increasing number of migrants in Europe, and particularly of unaccompanied minors (UMs) seeking asylum, has become a major challenge. We aimed to describe the health issues of UMs managed in a dedicated pediatric consultation service in a care center in Paris. Methods All UMs attending a dedicated migrant medical consultation service in Robert Debre Hospital, Paris, France, were included in a single-center retrospective observational study from September 1, 2017, to September 30, 2018. Results Out of the 107 UMs who were included, 87% had a health problem (n=93) and 52% had an infectious disease (n=56). The main infectious diagnoses were schistosomiasis (22%), latent tuberculosis (22%), intestinal parasitosis (16%), and chronic hepatitis B (8%). Posttraumatic stress disorder (PTSD) and overweight were common (35% and 20%, respectively). The median age was 15 years old (IQR, 14-16), the male/female ratio was 95/12. Most of the children were from sub-Saharan Africa (n=67), 46% had crossed Libya (n=49) and, when compared to the other migration routes, faced an increasing risk of violence (69%, p=0.04), imprisonment (53%, p=0.03), and forced labor (48%, p=0.02). The median duration of the trip before reaching France was 6 months (IQR, 2-13), the median time to consultation was 2 months (0-5) and was not associated with an increased risk of health problems. A total of 43 UMs were lost to follow-up. Conclusion Health problems, particularly infectious diseases and PTSD, are common among UMs and should prompt an early medical consultation with psychiatric evaluation. Follow-up is problematic and could be improved by an on-line health book.

The purpose of this survey is to explore changes in the management of COVID-19 during the first versus the second wave, with particular emphasis on therapies, antibiotic prescriptions, and elderly care. An internet-based questionnaire survey was distributed to European Society of Clinical Microbiology and Infectious Diseases (ESCMID) members. Therapeutic approach to patients with mild-to-moderate (PiO2/FiO2 200–350) and severe (PiO2/FiO2

The pandemic coronavirus disease 2019 (COVID-19), an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a significant and dramatic worldwide increase in morbidity and mortality rates throughout the year 2020. Although most patients present with respiratory symptoms such as cough, fever and shortness of breath, gastrointestinal symptoms have increasingly been reported and recognized as a major element of patients' presentation. It was found that angiotensin-converting enzyme 2 receptors (the entry receptors for SARS-CoV-2) are expressed in the pancreas in addition to the lungs, kidneys and the rest of the gastrointestinal tract, which raises the hypothesis that COVID-19 can stand as an etiology for acute pancreatitis in certain circumstances. Herein, we present a case of a COVID-19 patient who presented to the emergency room with clinical, laboratory and radiological findings of acute pancreatitis several days after being diagnosed with COVID-19 infection. He was admitted and treated conservatively. Several weeks following the initial episode, the patient developed a huge pancreatic pseudocyst, which was treated successfully with endoscopic cyst-gastrostomy. To the best of our knowledge, following a meticulous review of the current English literature, this is the second case of pancreatic pseudocyst development following acute pancreatitis due to COVID-19 infection.

Cryptococcus gattii infection is a rare cause of severe pulmonary disease and meningoencephalitis that has only recently been detected in the southeastern United States. We describe an organ transplant-associated outbreak of C. gattii infection involving an HIV-negative immunosuppressed donor in this region who died following new-onset headache and seizure of unknown cause. Retrospective cryptococcal antigen (CrAg) testing of donor serum was positive. Two of the three transplant recipients developed severe C. gattii infection 11 and 12 weeks following transplantation. One recipient died from severe pulmonary infection, identified on autopsy, and the other ill recipient survived following treatment for cryptococcal meningitis. This outbreak underscores the importance of considering cryptococcosis in patients with clinical findings suggestive of subacute meningitis or other central nervous system (CNS) pathology, and the potential benefit of routine pre-transplant donor CrAg screening using lateral flow assay to guide recipient antifungal prophylaxis. The case also adds to emerging evidence that C. gattii is a potential threat in the southeastern United States.

Hepatitis B remains an infectious disease causing a significant number of morbidity and mortality worldwide. Notably, the management of hepatitis B in persons who inject drugs (PWID) is a crucial part for hepatitis B virus (HBV) elimination. This narrative review summarizes the updated strategies of screening, prevention, and treatment for this special clinical setting. A PWID are associated with impaired immune responses and substantial vulnerability to parenteral HBV transmission with multiple co-infections, poor adherence, and social stigma. Multi-disciplinary support with integration of core strategies and healthcare systems provides better efficacy of prevention and treatment of HBV infection. A Periodic monitoring, treating co-existing risk factors, promoting harm reduction services, specialized protocol for HBV vaccination, and remodeling of values and practices are important for HBV elimination in PWID as well as the general population. Global and nationwide policies should be made and implemented to achieve above goals.

American cutaneous leishmaniasis is an endemic infectious disease in the country's public health. The disease is transmitted after the bite of females of the hematophagous mosquito, known as sand fly, and has several clinical manifestations, classified as cutaneous, cutaneous-mucosal and diffuse cutaneous, affecting all genders and age groups. The aim of this article is to report the clinical case of a patient, presenting an ulcerated lesion in the region of the face. The method used was the identification of Leishmania through the polymerase chain reaction associated with clinical response to treatment after intralesional application. As a result, immediate responses were obtained from the lesions that, despite studies showing spontaneous healing after months/years, facial lesions need a more aggressive protocol. It is concluded that the importance of the report is due to the fact that the therapeutic treatment consists of direct application in a location not authorized by the protocol of the Ministry of Health for American tegumentary leishmaniasis.

Letermovir is a new antiviral drug approved for the prophylaxis of CMV infection in allogeneic stem cell transplants. The aim of the study was to assess the therapeutic efficacy of letermovir in difficult to treat CMV infections in lung transplant recipients. All lung transplant recipients between March 2018 and August 2020, who have been treated with letermovir for ganciclovir-resistant or refractory CMV infection were included in the study and analysed retrospectively. In total, 28 patients were identified. CMV disease was present in 15 patients (53.6%). In 23 patients (82.1%), rapid response was noticed, and CMV-viral load could be significantly decreased (>1 log10 ) after a median of 17 [14-27] days and cleared subsequently in all of these patients. Five patients (17.9%) were classified as non-responder. Thereof, development of a mutation of the CMV UL56 terminase (UL-56-Gen: C325Y) conferring letermovir resistance could be observed in three patients (60%). Common side effects were mild and mostly of gastrointestinal nature. Mild adjustments of the immunosuppressive drugs were mandatory upon treatment initiation with letermovir. In addition to other interventions, letermovir was effective in difficult to treat CMV infections in lung transplant recipients. However, in patients with treatment failure mutation conferring letermovir, resistance should be taken into account.

Tetanus is a potentially fatal infectious disease caused by the toxins produced by the anaerobic bacterium, Clostridium tetani. Of major concern during the perioperative care of these patients is control of muscle spasms, skeletal rigidity, and autonomic dysfunction. Several of the modern sedative and opioid agents including remifentanil have not been fully evaluated in managing tetanus. We present the intraoperative use of remifentanil in a 75-year-old woman with generalized tetanus who required anesthetic care during placement of a tracheostomy. The end-organ involvement of tetanus is presented, previous reports of anesthetic care reviewed, and the potential utility of remifentanil explored.

Background: Condylomata acuminata (KA) or better known as genital warts disease is a genital area infectious disease caused by Human papilloma virus (HPV). The highest prevalence infection of the condylomata acuminata occurs during active sexual periods, namely age 17-33 years, with the peak occurring at the age of 20-24 years. Currently HPV 16 and 18 are known to cause malignancy in the genital and anogenital region including cervical cancer and anal cancer, while HPV 6 and 11 are the cause of 90% of condylomata acuminata. HPV is linked to the findings of 500,000 new cases of cervical cancer and 250,000 deaths from cervical cancer each year worldwide.1 Case report: One case of condylomata acuminata in a 19-year-old adolescent girl with a major complaint of warts around her genitals that felt itchy and gradually getting bigger since 2 weeks ago. Patient was a student and unmarried. History of sexual contact with men with genito-genital without using condoms since 5 months ago. Venereological state : on the vulva and perineal there were multiple vegetations with verucose surfaces with the largest size 0.8 cm x 0.5 cm x 0.1 cm and the smallest size 0.2 cm x 0.2 cm x 0.1 cm. Acetowhite examination result was positive and PCR examination results found positive HPV types 6,11,16 and 18. Discussion: Patients are diagnosed to condylomata acuminata with a history of free sex at an early age. The condylomata acuminata experienced by patients was type 6,11,16 and 18. These types of 16 and 18 HPV are know to cause malignancy in the genital and anogenital region including cervical cancer and anal cancer.

The purpose of this viewpoint is to provide a framework that is used within the Mayo Clinic to align recommendations from infectious disease experts, dental specialists, and orthopedic surgeons with regards to need for antibiotic prophylaxis prior to invasive dental procedures.

Manifestazioni nella cavità orale dell’infezione da COVID-19 – revisione della letteratura.I sintomi correlati all’infezione da SARS-CoV-2 si possono manifestare anche nella cavità orale, e potrebbe rivestire un ruolo cruciale nella diagnosi precoce della malattia. Abbiamo condotto una revisione della letteratura, riguardante le manifestazioni nella cavità orale dell’infezione da SARS-CoV-2. La cavità orale rappresenta uno dei punti di ingresso dei patogeni nel corpo umano e pertanto costituisce una potenziale sede di annidamento anche del SARS-CoV-2. ACE2 è il recettore principale che interagisce con la proteina spike del virus, ritrovata nei tessuti della mucosa orale. Sono stati osservati casi di lesioni della mucosa orale in pazienti con diagnosi di infezione da COVID-19. Sono state anche riportate alcune associazioni tra parodontite e gravità della malattia COVID-19. La mucosa orale, a causa della presenza dei recettori ACE2, è altamente suscettibile all’infezione da SARS-CoV-2. Tuttavia, le evidenze in questo settore sono ancora limitate e sono necessarie ulteriori ricerche e osservazione dei pazienti.COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a recently discovered coronavirus, which in 2020 led to a global pandemic. Clinical manifestations of COVID-19 are very diverse and symptoms range from mild to severe. Correlated symptoms might also manifest in the oral cavity, which is a potential pathway for viral infection, and therefore might be a potential pathway for SARS-CoV-2. In recent research among patients with SARS-CoV-2 infection, taste and olfactory disorders, dry mouth, drones and inflammation of mouth, bitter taste in mouth, difficulty in swallowing and burning sensations have been reported. There have been cases of oral mucosal lesions in patients diagnosed with COVID-19 disease. Some correlations between periodontitis and severity of COVID-19 disease have also been observed. Oral mucosa, due to occurrence of ACE2 receptors, is highly susceptible to SARS-CoV-2 infection. The occurrence of changes on oral mucosa should increase the alertness of dental practitioners. However, knowledge in this area is still limited and in the field of oral manifestations of COVID-19 more research and patient observations are required.

The article presents data on the features of hepatitis A, B, C, D, E in pregnant women, methods for screening verification of liver pathology, clinical and laboratory signs of extrahepatic manifestations of chronic viral hepatitis B and C. Diagnostically significant laboratory parameters of hemochromatosis, autoimmune hepatitis, intrahepatic cholestasis of pregnanсy, pernicious vomiting of pregnancy, acute fatty liver of pregnancy, HELLP syndrome were determined in the pre­sent work. The article describes modern methods for conduc­ting a laboratory “puncture-free” liver biopsy to evaluate fibrosis, hepatitis activity and liver steatosis. The lecture is intended for infectious disease doctors, obstetricians, gynecologists, gastroenterologists, family doctors.

Hepatitis B merupakan salah satu penyakit infeksi yang menyerang hati dapat bersifat akut dan kronik. Transfusi darah merupakan salah satu jalur penularan VHB secara horizontal yang sering terjadi. Pada pendonor yang menderita penyakit hepatitis B atau menjadi karier hepatitits B, maka darah yang mengandung virus hepatitis B tersebut dapat ditularkan kepada resipien melalui transfusi darah. Beberapa tindakan yang dilakukan untuk mencegah penularan hepatitis yaitu dengan adanya pemeriksaan HBsAg. Apabila HBsAg positif maka pendonor tidak diperbolehkan untuk mendonor. Tujuan penelitian ini adalah untuk mengetahui gambaran gambaran hasil pemeriksaan HBsAg pada pendonor di Unit Donor Darah Palang Merah Indonesia Kabupaten Kudus selama Tahun 2020. Pendonor di Unit Transfusi Darah Kabupaten Kudus selama Tahun 2020. Penelitian dilaksanakan pada bulan Januari 2021 bertempat di Unit Transfusi Darah Kabupaten Kudus. Uji diagnostik dilakukan dengan menggunakan Distribusi Frekuensi. Hasil Penelitian menunjukkan bahwa jumlah pendonor reaktif sebanyak 96 (0.60%) pendonor dari jumlah total 16.081 pendonor. Jumlah pendonor reaktif lebih banyak pada laki yaitu 78 (81.25%) dari total pendonor yang reaktif, sedangkan pada perempuan 18 (18.75%). Kasus HbsAg reaktif dengan pendonor terbanyak yaitu pada bulan februari 2020 dan kasus terendah pada bulan november 2020. Hpatitis B lebih banyak mengenai laki-laki daripada perempuan. Hal ini disebabkan oleh karena laki-laki umumnya lebih aktif dari pada perempuan sedangkan penularan hepatitis adalah melalui transmisi cairan tubuh yang mungkin bisa terjadi karena aktivitas, misalnya melalui luka yang didapat sewaktu bekerja atau saat bercukur.

Background and aims Over the past decades, people who inject drugs (PWID) have been impacted by the development of combination antiretroviral therapy (cART) to combat HIV/AIDS, the prescription opioid crisis, and increased use of lethal synthetic opioids. We measured how these dynamics have impacted mortality among PWID in an urban U.S. city. Design Prospective cohort study using data from the AIDS Linked to the Intravenous Experience (ALIVE) SETTING: Baltimore, Maryland, USA from 1988-2018. Participants 5,506 adult PWIDs (median age at baseline 37 years). Measurements Mortality was identified by linkage to National Death Index-Plus (NDI-Plus) and categorized into HIV/infectious disease (HIV/ID) deaths, overdose and violence-related (drug-related) deaths, and chronic-disease deaths. Person-time at risk accrued from baseline, and ended at the earliest of death or study period. All-cause and cause-specific mortality were calculated annually. Fine and Gray method was used to estimate the sub-distribution hazards of cause-specific deaths accounting for competing risks. Findings Among 5,506 participants with 84,011 person-years of follow-up, 43.9% were deceased by 2018. Among all deaths, 30.5% were HIV/ID-deaths, 24.4% drug-related deaths, and 33.3% chronic-disease deaths. Age-standardized all-cause mortality increased from 23 to 45 per 1000-person-years from 1988-1996, declined from 1996 through 2012, then trended upward through 2018. HIV/ID-deaths peaked in 1996 coincident with the availability of cART, then continuously declined. Chronic-disease deaths increased continuously as the cohort aged. Drug-related deaths declined until 2011, but increased over 4-fold by 2018. HIV/HCV infection and active injecting were independently associated with HIV/ID and drug-related deaths. Female and Black participants had higher risk of dying from HIV/ID deaths and a lower risk of dying from drug-related deaths than male and non-Black participants. Conclusions Deaths in Baltimore, Maryland, USA attributable to HIV/ID appear to have declined following the widespread use of combination antiretroviral therapy. Increases in the rates of drug-related deaths in Baltimore were observed prior to and continue in conjunction with national mortality rates associated with the opiate crisis.

Правець — це серйозне, потенційно небезпечне для життя інфекційне захворювання, що виникає в результаті попадання в рану спор Clostridium tetani, розвиток якого обмежується поствакцинальним імунітетом. Даний збудник виробляє один з найсильніших токсинів — тетаноспазмін, що обумовлює клінічні прояви. Найбільш частими симптомами захворювання є тризм, дисфагія, сардонічна посмішка та тетанічні судоми на тлі тонічного напруження м’язів. Смерть, як правило, настає внаслідок дихальної або серцевої недостатності. Лікування зазвичай проводиться в умовах відділення інтенсивної терапії з метою запобігання розвитку потенційних ускладнень, що загрожують життю людини. Це наочно ілюструє наведений у статті клінічний випадок правця в нещепленої 6-річної дитини з добрим результатом. Тривалість захворювання становила 64 доби. Націлювання лікарів первинної ланки на забезпечення імунізацією груп ризику допоможе запобігти розвитку правця.

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and has become a major health problem worldwide. Inflammation plays a vital role in the pathophysiology of COVID-19. Systemic Immune Inflammation Index (SII) is an index obtained from calculating the platelets counts, neutrophils, and lymphocytes, which can indicate the inflammation status and immunity. This study aimed to determine the potential of SII as a predictor of SARS-CoV-2 infection in suspected COVID-19 subjects. A retrospective study was carried out by obtaining medical record data in June 2020 at Sleman General Hospital. An unpaired T-test or the Mann-Whitney test was used to determine the statistical difference. A Receiver Operating Characteristic (ROC) curve was generated and used to get the cut-off values. Bivariate analysis was performed using Chi-Square. There were 84 subjects consisting of 46 (54.8%) males and 38 (45.2%) females with a mean age of 42.4±16.356 years. There was a significant difference in the neutrophils count (p=0.045), monocytes (p=0.001), and eosinophils (p=0.037) between subjects with positive and negative SARS-CoV-2 PCR. The median SII in the positive and negative SARS-CoV-2 PCR group was 780.12 (301.21-2178.90)x103/µL and 584.14 (117.79-1933.87)x103/µL (p=0.045), respectively. Bivariate analysis showed significant results at SII > 705 x103/µL in suspected COVID-19 patients to obtain a positive SARS-CoV-2 PCR result with Odds Ratio (OR) of 4.00 (95% CI 1.580-10.127), p=0.003. Patients with suspected SARS-CoV-2 infection with high SII levels had a greater risk of a positive SARS-CoV-2 in PCR test

A new coronavirus infection poses a challenge to infectious disease specialists, health care administrators, and subspecialty physicians in the search for the most eff ective treatment options. The past year has allowed us to clarify the main aspects of pathogenesis with a focus on the most severe versions of the COVID-19 course. Most signifi cant is to understand that the severe course is associated with prolonged viremia and T-cell lymphocyte defi ciency leading to activation of innate immunity, manifested by a burst of macrophage activity known as the “cytokine storm”. This inadequate response is a major factor in both pulmonary and multiple organ failure. Fever, pulmonary infi ltrates with leukocytosis and neutrophilia are traditionally perceived by doctors as indications for antibiotic therapy, which is nevertheless erroneous in the absence of signs of bacterial infection. We present a case that illustrates the severe course of pseudomembranous colitis and secondary myocarditis in an elderly woman with comorbid pathology and massive antibiotic therapy received during hospitalization for COVID-19.

Introduction Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19. Methods In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis. Results Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as ‘appropriate’). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis. Conclusion In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19. Trial Registration The study is registered at ClinicalTrials.gov (NCT04544072). Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00535-2.

Background: Coronavirus disease 2019 (COVID-19) is a pandemic infectious disease caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection by COVID-19 can result in a range of clinical outcomes, from asymptomatic to severe life-threatening course or death. The purpose of our research was to evaluate the presentation of COVID19 disease based on the clinical and radiological characteristics of our population. Materials and Methods: 100 COVID19 patients recorded by RTPCR. Clinical, biochemical and radiological data from April-May, 2021. Results: Of the 100 patients, in our study 66% were males and 26% patients had history of recent travel. Majority of patients were asymptomatic and don’t have comorbid illness. Thrombocytopenia and lymphopenia, increased levels of lactate dehydrogenase (LDH) and serum ferritin and C-reactive protein were common in these patients. CT finding were 63% had normal CT chest. Among the 37% patients who had CT chest findings, 25% had bilateral diseases, 8% patients had right lung involvement while 4% patients have left lung involvement. Conclusion: COVID-19 disease has a relatively mild course in this part of the subcontinent. Clinical and laboratory findings are similar to those found in viral diseases. Studies involving larger sample size and interventional trials are need of the hour. Keywords: Clinico-radiological, coronavirus disease 2019, Lymphopenia

Introduction and Aim:Corona virus disease 2019 (Covid-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has affected over 200 countries and territories. The aim of the present study is to evaluate the role of eosinopenia in differentiating COVID-19 suspect from other flu-like illnesses in an outpatient setting. Materials and Methods:It was a retrospective case control study in which data of 1252 suspected COVID 19 patients who visited the fever clinic were enrolled. Among this, 701 patients were found to have COVID-19 pneumonia and 551 had other flu-like illnesses. CBC (complete blood count) and CRP(C- reactive protein) were taken in all patients along with chest x-ray as routine protocol. Results:Among the 701 positive patients, eosinopenia was seen in 527 patients and had a sensitivity of 75.2 % and specificity of 68.6 %. When combined with other lab parameters such as the increased CRP and lymphopenia, the specificity rises up to 78.6 %. Conclusion:Our study shows that eosinopenia as an independent variable, is a reliable marker to differentiate COVID-19 suspect patients from other flu-like illnesses on outpatient basis, however when combined with other parameters like lymphopenia and CRP the specificity increases further.

World Health Organisation definitions of pneumonia severity are routinely used in research. In high income health care settings with high rates of pneumococcal vaccination and low rates of mortality, malnutrition and HIV infection, these definitions are less applicable. National guidelines from leading thoracic and infectious disease societies describe 'severe pneumonia' according to criteria derived from expert consensus rather than a robust evidence base. Contemporary cohort studies have used clinical outcomes such as intensive care therapy or invasive procedures for complicated pneumonia, to define severe disease. Describing severe pneumonia in such clinically relevant terms facilitates the identification of risk factors associated with worsened disease and the subsequently increased morbidity, and need for tertiary level care. The early recognition of children at higher risk of severe pneumonia informs site of care decisions, antibiotic treatment decisions as well as guiding appropriate investigations. Younger age, malnutrition, comorbidities, tachypnoea, and hypoxia have been identified as important associations with 'severe pneumonia' by WHO definition. Most studies have been performed in low-middle income countries and whilst they provide some insight into those at risk of mortality or treatment failure, their generalisability to the high-income setting is limited. There is a need to determine more precise definitions and criteria for severe disease in well-resourced settings and to validate factors associated with intensive care admission or invasive procedures to enhance the early recognition of those at risk.

Background: COVID-19 is an acute pulmonary infection caused by a coronavirus and characterized by several clinical characteristics ranging from asymptomatic to respiratory failure that required special care. Aim: Evaluate the impact management approach for caregivers regarding prevention and control strategies of COVID19 for their children undergoing hemodialysis. Study Design: Quasi-experimental design was used. Setting: The study was conducted at pediatrics dialysis units at Mansoura University Children’s Hospital. Subjects: A convenient sample of (34) children undergoing hemodialysis therapy & their caregivers who accompanied them. Tools: three tools used in this study; Tool (I): Include three parts: Socio-demographic characteristics of the studied children, Clinical information of the studied children undergoing hemodialysis, and Sociodemographic characteristics of children's caregivers. Tool (II): included two parts; Knowledge of caregivers related to hemodialysis, knowledge of caregivers related to COVID19, and Preventive and control strategies of Covid19 used by caregivers for their children undergoing hemodialysis therapy. Tool (III): Strategies and precautions followed by caregivers related to hemodialysis therapy and preventive and control strategies of Covid19 used by caregivers for their children undergoing hemodialysis therapy. Results: The results revealed that there was a statistically significant effect on caregiver’s knowledge regarding hemodialysis, COVID-19. In addition to there was a statistically significant difference in the application of COVID19 prevention precautions followed by caregivers for their children undergoing hemodialysis through the program phases with P

Cutaneous cryptococcosis, an infectious disease resulting from Cryptococcus neoformans, primarily affects immunodeficient individuals. Here, we report a case of mediastinal small cell carcinoma (MSCC) complicated with multiple skin and soft tissue infections mimicking erysipelas and cellulitis. Antibiotics for bacteria were ineffective and a culture of pus from the infected areas revealed Cryptococcus neoformans in this patient. The absence of any evidence indicative of systemic cryptococcal infection leads to a final diagnosis of primary cutaneous cryptococcosis (PCC). Following two weeks of fluconazole at 400 mg/day and 200 mg/day for the subsequent three months, combined with incision, irrigation and drainage, the wound gradually healed. An analysis and discussion of the clinical features of this patient are presented. This case alerts clinicians as to the possibility of Cryptococcus neoformans in patients with advanced malignant tumors complicated with multiple skin and soft tissue infections. While a timely diagnosis and treatment of PCC in this patient resulted in a favorable outcome, the patient succumbed to the malignant tumor at six months post-discharge.

Aims of this study were to define the prevalence of people with a substance use disorder (SUD) in Tuscan prisons and the relationship of such disorders with chronic viral hepatitis C or B (HCV, HBV) and human immunodeficiency virus (HIV). Of 3,291 adult prisoners, 3,100 were enrolled. Of the 3,100 inmates, 912 (29.4%) had at least one psychiatric disorder, 17.8% had a SUD/alcohol use disorder, 6.1% had adaptation disorder, and 5.5% had personality disorder. Of the drug users, 28.9% had at least one infectious disease such as HCV, HBV, and HIV. The probability of contracting HBV was higher in women than in men and in people over 50 years. The probability of contracting HCV was higher in prisoners aged 40-49, particularly among those who used opioids. Accurate national and global data on SUD and its association with HBV, HCV, and HIV are needed to permit accurate estimation of its impact in these settings.

Background: Diabetic foot osteomyelitis is a common infection where treatment involves multiple services, including infectious diseases, podiatry, and pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking. Methods: Representatives from infectious diseases, podiatry, and pathology interested in quality improvement developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to diabetic foot osteomyelitis (DFO). Knowledge acquisition was assessed by preintervention and postintervention surveys. Inpatients with forefoot DFO were retrospectively reviewed before and after intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses. Results: A postintervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the preintervention cohort (April 1, 2018, to April 1, 2019) and 32 patients in the postintervention cohort (November 5, 2019, to March 1, 2020), the latter truncated by changes in hospital practice during the coronavirus disease 2019 pandemic. Noncategorizable or equivocal disease reports decreased from before intervention to after intervention (27.0% versus 3.3%, respectively; P = .006). We observed nonsignificant improvement in correct bone margin definition (74.0% versus 87.5%; P = .11), unnecessary peripherally inserted central catheter line placement (18.3% versus 9.4%; P = .23), and unnecessary prolonged antibiotics (21.9% versus 5.0%; P = .10). In addition, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients. Conclusions: This quality improvement initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and nonsignificant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions.

Tuberculosis is an infectious disease caused by the bacteria Mycobacterium tuberculosis with various symptoms. It spreads through droplets of people infected with TB bacilli. Patients with pulmonary TB have several different complaints that can exacerbate respiratory difficulties, including shortness of breath. Inhalation is a form of treatment by supplying steam ventilation directly to the respiratory tract. EBN is developed to assess the potency of aromatherapy peppermint to minimize shortness of breath in patients with pulmonary tuberculosis. This EBN uses literature-based approaches to analyze study findings collected from method article filter searches using Google Scholar and PubMed databases. Results revealed that the use of peppermint aromatherapy was successful against shortness of breath in patients with pulmonary tuberculosis.

Coronavirus 2019-nCoV (COVID-19) is a global pandemic and highly infectious disease, with most of the symptoms being related to the respiratory tract. However, more extrapulmonary symptoms and complications are evolving and directly associated with COVID- 19 pathogenesis. A recognized clinical manifestation of COVID-19 is gastrointestinal and hepatic involvement. We reported a middle-aged man admitted to the intensive care unit (ICU) with severe COVID-19 pneumonia; he developed spontaneous bowel perforation. He had not received tocilizumab as the latter was reported to be associated with bowel perforation. Key words: Coronavirus 2019-nCoV (COVID-19, bowel perforation.

Corona virus disease 2019 (COVID-19) is an infectious disease severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The clinical scope of Covid-19 varies, from asymptomatic, mild symptoms, to clinical conditions characterized by acute respiratory failure. The most common comorbidities in patients with COVID-19 were hypertension (HTN) (56.2%), followed by diabetes mellitus (DM) (30.1%), and chronic kidney disease (CKD) (17.5%). Several studies suggest that diabetes is one of the main risk factors for COVID-19. Therefore, this literature review aims to determine the risk factors for the occurrence of COVID-19 in patients with diabetes mellitus so that it can be used as a consideration for controlling risk factors and better treatment of COVID-19 patients with comorbidities. The method used in this research is literature review and literature search is carried out through the NCBI, PubMed, and Google Scholar databases. This research involves as many as 24 library sources from 2020-2021. Several studies have shown that diabetes mellitus is a major risk factor for COVID-19. This condition is associated with several macrovascular and microvascular complications that ultimately impact the patient's survival. Diabetes which is a hyperinflammatory condition that can increase susceptibility to COVID-19 with possible mechanisms of chronic inflammation, hypercoagulable state, and activation of the renin-angiotensin-aldosterone system (RAAS) and dysregulation of the sympathetic nervous system. Future research is urgently needed to provide a better understanding of the pathophysiological mechanisms underlying the association between COVID-19 and diabetes, and their clinical management

Introduction: Peripheral lymphadenopathy is frequently due to a local or systemic benign infectious disease. However, it could be a manifestation of underlying malignancy. Fine needle aspiration cytology (FNAC) acting as a reliable diagnostic tool to find out the cause underlying the lymphadenopathy enables the clinician to plan appropriate management for each patient. Objective: The present study was undertaken to assess the utility of FNAC in evaluation of peripheral lymphadenopathy cases in different age groups and sex and to study the cytomorphological patterns in these cases. Materials and Methods: A retrospective and prospective observational study was conducted in the Department of Pathology, Hind Institute of Medical Sciences over the duration of 2 years. A total of 331 lymph node FNA aspirates were studied. Aspirated material was routinely stained with Haematoxylin & Eosin and Papanicolauo stains. Ziehl Neelsen stain was used wherever required. Results: Most of the patients were in the age group of ?15 years (117/331). Cervical lymphnodes were the most commonly involved sites (222/331). The largest group of lesions belonged to the non-neoplastic category (227/331). Only 54/331 cases were in the neoplastic category. Amongst the non-neoplastic lesions, granulomatous lymphadenitis comprised the majority (128/277). Amongst the neoplastic lesions, 8 cases showed features of non-Hodgkin’s lymphoma (NHL); where as 3 cases were of Hodgkin’s lymphoma (HL). Non-neoplastic lesions were more common in the younger age group (117/257); where as neoplastic lesions were more common in the older age group (27/54). Conclusion: FNAC is a reliable method of diagnosing the pathology underlying enlarged superficial lymph nodes; thus acting as a triage to distinguish the cases with a suspicion of significant disease. At the same time, it also provides material for ancillary studies especially in lymphoproliferative lesions. Keywords: FNAC, Cytomorphology, Peripheral lympha

Dengue fever virus is an infectious disease that can infect others if bitten by Aedes aegypti mosquito. The virus has the potential to attack cells in the hepar organs so that the hepar is inflamed, swollen, and liver function is disrupted, and there is severe bleeding. The increase in transaminase enzymes as well as hepatomegaly is a frequent sign in dbd sufferers, thus reinforcing the notion that the course of dengue hemorrhagic fever (DHF) disease can affect hepar or liver organs. The presence of such events will increase the level of Serum Glutamic Pyruvic Transaminase (SGPT) and Serum Glutamic Oxaloacetic Transaminase (SGOT) in dengue fever patients. The purpose of this study is to find out the epidemiological study of Dengue dengue fever with the increase in SGPT and SGOT levels in dengue fever patients at Aura Syifa Kediri Hospital. This research method uses descriptive research design and total sampling technique for 1 month. Samples obtained for 1 month amounted to 15 samples. The results showed that from a sample of 15 respondents as many as 3 samples (20%) for high SGPT levels above normal and normal results as many as 12 samples (80%). The conclusion of this study shows that the value of SGPT levels has increased by 20% and is still above normal, but still have to be alert to small values.

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum and characterized by a complex and variable clinical presentation. Cases of unexpected oral syphilis presenting as non-healing ulcers are uncommonly reported. We report 3 cases (one female and two males, aged 35, 35, and 56 years, respectively) in which patients presented with non-healing oral ulcers. Biopsies revealed surface ulceration and a significant neutrophilic infiltrate rather than the more conventional plasma cell infiltrate seen with most reported syphilis infections, potentially leading to an inaccurate diagnosis. Treponema pallidum immunohistochemistry highlighted spirochetes within the epithelium, with additional diagnostic confirmation by serum T. pallidum particle agglutination assay. Sexual history documentation by the clinician with nonspecific oral ulcers is paramount to aiding diagnosis and leading to proper management. Further, it is important to perform immunohistochemistry for T. pallidum in oral biopsies from non-healing ulcers, especially when clinical history raises the differential diagnosis or when other clinical manifestations may support this consideration.

Background: HIV/AIDS is an immunodeficiency disease with CD4 T lymphocytes as the main target. Although antiretroviral therapy has increased life expectancy of HIV patients, its adverse effect, lipodystrophy, causes a decrease in leptin production by adipose tissue and reduce leptin effect on T lymphocytes’ stimulation. Previous studies had examined the correlation between leptin levels and CD4 count, although the results were inconclusive. This study aims to assess the association between leptin levels and CD4 count in HIV patients receiving HAART. Methods: This is a cross sectional study conducted at the outpatient clinic of Tropical and Infectious Disease Haji Adam Malik General Hospital Medan between April and July 2020. Correlation between variables were assessed through Pearson’s or Spearman’s correlations. Data were analyzed using the SPPS program where p

Purpose Coronavirus disease-2019 (COVID-19) is a novel respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); there are few specific treatments. Convalescent plasma (CP), donated by people who have recovered from COVID-19, is an investigational therapy for severe or critically ill patients with COVID-19. Materials and methods This retrospective cohort study evaluated the effectiveness of CP therapy in patients with severe or life-threatening cases of COVID-19 at two hospitals in Seoul, Korea, between May and September 2020. Clinical outcomes were evaluated in 20 patients with CP therapy in a descriptive manner. Additionally, the changes in cycle threshold (Ct) values of 10 patients with CP therapy were compared to those of 10 controls who had the same (±0.8) initial Ct values but did not receive CP. Results Of the 20 patients (mean age 66.6 years), 18 received high-dose oxygen therapy using mechanical ventilators or high-flow nasal cannulas. Systemic steroids were administered to 19 patients who received CP. The neutralizing antibody titers of the administered CP were between 1:80 and 1:10240. There were two ABO-mismatched transfusions. The World Health Organization ordinal scale score and National Institutes of Health severity score improved in half of the patients within 14 days. Those who received CP showed a higher increase in Ct values at 24 h and 72 h after CP therapy compared to controls with similar initial Ct values (p=0.002). No transfusion-related side effects were observed. Conclusion CP therapy may be a potential therapeutic option in severe or critically ill patients with COVID-19.

Surgical incision infection of multidrug-resistant microorganisms (e.g., methicillin-resistant Staphylococcus aureus , MRSA) is a severe cause of poor wound healing, which is prevalent in healthcare facilities and constitutes a huge infectious disease burden in the world. The purpose of this study is to investigate the medical application and possible mechanisms of the cold atmospheric plasma jet on infected wounds. In this article, the New Zealand rabbit in vivo wound infected with MRSA is used as the wound healing animal model. The helium atmospheric-pressure dielectric-barrier-discharge (AP-DBD) plasma jet is employed to treat the wounds infected with MRSA. The wound healing, histological, and cytokine analyses are conducted to evaluate the efficacy of the helium AP-DBD plasma jet on the MRSA-infected wound healing process. The experimental results show that the helium AP-DBD plasma jet treatment on the wounds infected with MRSA can regulate the secretion of the cytokines, limit the inflammatory response and cell excessive proliferation, accelerate the process of re-epithelialization, and consequently, promote the wound healing process and the inactivation of the bacteria.

BackgroundHealthcare workers (HCWs) who care for patients with the novel coronavirus infectious disease (COVID-19) are at an increased risk and fear contracting the infection themselves. HCWs are chronically exposed to very intense stress, both and physically and mentally. Hospitals must reduce both the physical and mental burden of HCWs on the front lines and ensure their safety. No prospective study has focused on the physical health complaints among HCWs engaged in the care of critically ill COVID-19 patients. This study aimed to investigate the occupational risk among HCWs of experiencing physical symptoms during the current COVID-19 pandemic.MethodsA twice-weekly questionnaire targeting HCWs who care for COVID-19 patients was performed at Osaka City University Hospital from April 30 to May 31, 2020 using a shareable Research Electronic Data Capture tool. The demographic characteristics of the participants, frequency of exposure to at-risk care, and physical complaints were evaluated.ResultsA total of 35 doctors, 88 nurses, and 35 technicians were engaged in the care of these critically ill COVID-19 patients. 76 HCWs participated in this study, of whom 24 (31.6%) were doctors, 43 (56.6%) were nurses, and 9 (11.8%) were technicians. The frequency of experiencing any physical symptom was 25.0% among HCWs. Exposure to at-risk care was significantly higher among nurses than among doctors (p < 0.001); likewise, the frequency of experiencing physical symptoms was higher among nurses than among doctors (p < 0.01). The multivariate analysis revealed that nurses (odds ratio 8.29; p = 0.01) might be independently at risk of experiencing physical symptoms.ConclusionsOur results indicate that occupational health care at hospitals must be allocated to HCWs who are highly exposed to at-risk care, particularly nurses engaged in the care of COVID-19 patients.

Hepatitis C infection is responsible for high morbidity and mortality rates globally as well as for significant indirect costs. The disease burden caused by the hepatitis C virus (HCV) is comparable to the one caused by human immunodeficiency virus or tuberculosis. Today, simple detection methods, highly effective and easy to administer therapies and efficient preventative measures are available to combat hepatitis C. Nevertheless, in most countries around the world, the World Health Organization target of eliminating this infectious disease and its consequences by 2030 are not being met. Significant gaps in care for hepatitis C sufferers still exist, the shortcomings ranging from education and treatment to aftercare. Hepatitis C infection was and still is not on the radar of most politicians and health authorities. National programmes and strategies to combat the disease exist or are being developed in many countries. However, for these to be implemented efficiently and successfully, clear political commitment, strong civil society actors, well-functioning public health structures and the relevant support from global donors are needed.

Rats can transmit Streptobacillus moniliformis, which may cause rat-bite fever (RBF), a rare and potentially lethal zoonosis. Fastidious in vitro growth and unspecific symptoms, including fever, arthralgia, and polymorphous skin lesions, complicate the diagnosis. Rat-bite fever follows exposure to contaminated bodily fluids of infected rodents; however, reports on Streptobacillus moniliformis-related infections are few so far. A female patient presented with painful hemorrhagic pustules and purpuric lesions on hands and feet. She developed fever and migratory polyarthralgia. Blood culture yielded growth with Streptobacillus moniliformis. The patient owned rats and handled contaminated rat feces and urine, making this the most likely etiology of infection. We report a case of RBF due to Streptobacillus moniliformis in a rat handling-patient. Difficulties in clinical and microbiological diagnosis highlight the need for a thorough and complete history-taking and a greater understanding of this rare infectious disease.