Detection of pathogenic Leptospira species associated with phyllostomid bats (Mammalia: Chiroptera) from Veracruz,Mexico

The genus Leptospira encompass 22 species of spirochaetes, with ten pathogenic species that have been recorded in more than 160 mammals worldwide. In the last two decades, the numbers of records of these agents associated with bats have increased exponentially, particularly in America. Although order Chiroptera represents the second most diverse order of mammals in Mexico, and leptospirosis represents a human and veterinary problem in the country, few studies have been conducted to identify potential wildlife reservoirs. The aim of this study was to detect the presence and diversity of Leptospira sp. in communities of bats in an endemic state of leptospirosis in Mexico. During January to September 2016, 81 bats of ten species from three localities of Veracruz, Mexico, were collected with mist nets. Kidney samples were obtained from all specimens. For the detection of Leptospira sp., we amplified several genes using specific primers. Amplicons of the expected size were submitted to sequencing, and sequences recovered were compared with those of reference deposited in GenBank using the BLAST tool. To identify their phylogenetic position, we realized a reconstruction using maximum‐likelihood (ML ) method. Twenty‐five samples from three bat species (Artibeus lituratus , Choeroniscus godmani and Desmodus rotundus ) showed the presence of Leptospira DNA . Sequences recovered were close to Leptospira noguchii, Leptospira weilii and Leptospira interrogans . Our results include the first record of Leptospira in bats from Mexico and exhibit a high diversity of these pathogens circulating in the state. Due to the finding of a large number of positive wild animals, it is necessary to implement a surveillance system in populations of the positive bats as well as in related species, in order to understand their role as carriers of this bacterial genus.     

髋臼后方包容角法和Keith法评价髋臼后壁骨折稳定性的对比研究

目的探讨髋臼后方包容角法评价髋臼后壁骨折髋臼后方稳定性的临床价值。方法选取30例单侧髋臼后壁骨折患者,在CT上分别采用髋臼后方包容角法和Keith法评估髋臼后方的稳定性,并对判定结果进行对比。结果髋臼后方的完全包容角、稳定包容角和不稳定包容角的平均值分别为92.38°±10.53°、73.86°±9.36°、51.90°±6.43°,2名测量人员自身和两者之间的组内相关系数(ICC)均0.95,说明此方法的可信度高且可重复性好。Keith法和髋臼后方包容角法对髋臼后方稳定性的判定结果具有高度一致性,Kappa值为0.824。以髋臼后方稳定性试验为参照,髋臼后方包容角法判定髋臼后方稳定性的特异性、敏感性和准确率均高于Keith法,但差异无统计学意义(χ2=0.834、0.764、0.904,P0.05)。结论髋臼后方包容角法与传统的Keith法在髋臼后壁骨折稳定性的判定结果基本一致,但该法不需参照对侧,操作简单,实用性强,尤其适用于对侧髋臼合并骨折或有先天性畸形的患者。     

Factors associated with the prevalence of antibodies against Brucella abortus in water buffaloes from Santarém,Lower Amazon region,Brazil

We evaluated the factors associated with the prevalence of antibodies against Brucella abortus in buffaloes in the municipality of Santarém, Western Pará, northern Brazil. The study was conducted on 60 farms, representing 25.8% of the total buffalo farms in the region. From those farms, a total of 426 buffaloes were sampled, males of any age and females more than 24 months of age, to avoid a false‐positive reaction in the serological test due to vaccination. The Acidified Agglutination Serum Test was carried out on serum samples using B. abortus strain 1,119–3 as the antigen. Univariate and multivariate analysis were performed to investigate the association between brucellosis and potential risk factors. Of the 426 tested buffaloes, 29 were positive, resulting in an overall animal prevalence of antibodies against B. abortus at the animal level of 6.8% (4.6–9.6; 95% confidence interval). The herd level prevalence was 30% (18 of 60) and seroprevalence range within farms was from 0% to 100%. At the animal level, buffaloes raised in the floodplains tended (p = 0.06) to present a higher seroprevalence (9.70%) of antibodies against B. abortus than buffaloes raised in dry land (4.98%) and cows tended (p = 0.054) to have a higher seroprevalence than male buffaloes. Multivariate herd‐level analysis revealed association between farm type and brucellosis seroprevalence (p = 0.015); dairy farms were two times more likely to have seropositive buffalo than beef farms. Our survey demonstrated a high farm seroprevalence of B. abortus in buffalo raised in an Amazonian ecosystem with positive animals found in one third of sampled farms.     

The evaluation of nosocomial infection during 1-year-period in the burn unit of a training hospital in Istanbul,Turkey

An analysis of the burned patients, admitted to our eight bed burn unit and treated between 1 January and 31 December 2000, was performed. Prevalence, etiologic agents, length of hospitalization, cost of treatment and mortality rates caused by nosocomial infections (NIs) were studied. The study included 63 patients. Eighteen of these (Group-A) had 24 NI episodes. The most common NI observed was burn-wound infection (58.3%), followed by bacteraemia-sepsis (16.7%). NIs were not detected in the rest at all (Group B). The mean length of hospitalization was 38.5±19.7 days in Group A, and 20.3±7.6 days in Group B. The mean total burned surface area (TBSA) was 43±21 in Group A and 29±18 in Group B, while the most important independent risk factor for NI was TBSA in burned patients (OR, 1.08; CI₉₅, 0.93–1.24). NI prolonged the mean hospital stay to 18 days and increased the cost of treatment by US$ 502. The most common bacteria isolated was Pseudomonas aeruginosa (41.7%) and the second was methicillin resistant Staphylococcus aureus (MRSA-25.0%). All of the NI-free patients survived, while, five (28.5%) patients with NI died (P<0.01).

These findings emphasized the need for careful disinfection and conscientious contact control procedures in areas that serve immunosupressed individuals, such as burned patients.     

Factors associated with the prevalence of antibodies against Theileria equi in equids of Western Pará, Brazil

The State of Pará has one of the largest herds of equids (horse, donkey and mule) in Brazil, most of these animals are found on cattle farms. Equine theileriosis is a tick‐borne disease caused by the parasite Theileria equi and is characterized by fever, anaemia, icterus, intravascular haemolysis, haemoglobinuria, spleen and hepatomegaly, and even death. The present study aimed to determine the prevalence of antibodies against T. equi in equids in the western region of the State of Pará, Brazil, and to identify potential risk factors associated with parasite infection. A cross‐sectional study was conducted with cluster sampling of farm horses from 18 municipalities. In the cities visited, samples from sport and carthorses were also included. Serum was obtained to detect T. equi‐specific antibodies using an indirect enzyme‐linked immunosorbent assay (iELISA) based on a crude parasite antigen. In order to identify possible risk factors of the infection which are associated with the prevalence of antibodies, a chi‐squared test was carried out. Of 1,117 equids, 373 tested positive for T. equi antibodies with an overall prevalence of 33.4% (31.3%–37.0% for the 95% confidence interval). Sex, animal species and breed were found not to be associated with the presence of T. equi antibodies, whereas age, the presence of dogs or ticks were associated with seropositivity (p < 0.05). Horses with ticks were 2.4 more likely seropositive than horses without ticks. The presence of dogs in the equid habitat and the presence of ticks resulted in a higher T. equi seropositive rate probably because dogs are hosts for vector ticks of T. equi. Our study represents the first report of T. equi antibodies in equids of western Pará revealing a widespread distribution of seropositive animals.     

济宁市2006～2010年牛羊职业暴露人群布氏杆菌感染血清学调查

目的掌握现阶段济宁市牛羊职业暴露人群布氏杆菌病感染情况,早期发现感染患者,指导布氏菌病防控。方法应用血清流行病学的方法,对职业暴露人群进行布氏菌病感染检测。结果牛羊职业暴露人群5年平均布氏菌病感染率为5.12%,主要集中于青壮年人群,羊、牛两类不同职业接触人群感染率差异无统计学意义（x2=2.27,P〉0.05）,羊只屠宰人员感染率高于羊只贩运人员（x2=4.06,P〈0.05）,羊接触人群显性感染率高于牛接触人群（x2=31.46,P〈0.01）。结论牛羊职业暴露人群是布鲁氏菌病发生的高危人群,应加强宣传教育和定期监测,减少发病,降低病情危害。     

Bone mineral density and osteoporosis among a predominantly Caucasian elderly population in the city of São Paulo, Brazil

This cross-sectional study covered 301 individuals over 70 years of age—207 women (W) and 94 men (M)—living in the city of São Paulo, Brazil. Our aims were to evaluate the prevalence of low bone mineral density (BMD) in this population and the possible factors that influence BMD. The subjects were submitted to a bone densitometry scan (DXA) to evaluate the BMD at lumbar spine (LS), femoral neck (FN), trochanter (T), total femur (TF) and total body composition. At the time, the participants filled in a questionnaire about lifestyle habits, diet and medical history, as well as having blood samples taken to check hormone and biochemical levels. Anthropometric parameters were measured. Osteopenia and osteoporosis were defined in accordance with the criteria suggested by the World Health Organization. In the different sites studied, the prevalence of osteopenia and osteoporosis varied, in men ranging 33.3–57.4% and 6.4–16.1%, respectively, and in women ranging 36.6–56.5% and 22.2–33.2%, respectively. Weight was the variable that most strongly correlated with BMD at the proximal femur in both sexes (men, r =0.44–0.52; women, r =0.48–0.52) and with BMD at LS in women ( r =0.44). Height was the parameter that best correlated with BMD at LS in men ( r =0.34). In men follicle-stimulating hormone, growth hormone and glycemia correlated with BMD at T and TF, while plasma albumin only correlated with BMD at T. In women glycemia correlated with BMD at LS, and follicle-stimulating hormone correlated with BMD at FN, T and TF. In conclusion, we found a high prevalence of osteopenia and osteoporosis in this population, with weight being the best predictor of BMD. The prevalence of osteoporosis and osteopenia at FN was as high in men as that observed in women.     

Estimated Risk of Human Immunodeficiency Virus and Hepatitis C Virus Infection among Potential Organ Donors from 17 Organ Procurement Organizations in the United States

To prevent unintentional transmission of bloodborne pathogens through organ transplantation, organ procurement organizations (OPOs) screen potential donors by serologic testing to identify human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. Newly acquired infection, however, may be undetectable by serologic testing. Our objective was to estimate the incidence of undetected infection among potential organ donors and to assess the significance of risk reductions conferred by nucleic acid testing (NAT) versus serology alone. We calculated prevalence of HIV and HCV—stratified by OPO risk designation—in 13 667 potential organ donors managed by 17 OPOs from 1/1/2004 to 7/1/2008. We calculated incidence of undetected infection using the incidence‐window period approach. The prevalence of HIV was 0.10% for normal risk potential donors and 0.50% for high risk potential donors; HCV prevalence was 3.45% and 18.20%, respectively. For HIV, the estimated incidence of undetected infection by serologic screening was 1 in 50 000 for normal risk potential donors and 1 in 11 000 for high risk potential donors; for HCV, undetected incidence by serologic screening was 1 in 5000 and 1 in 1000, respectively. Projected estimates of undetected infection with NAT screening versus serology alone suggest that NAT screening could significantly reduce the rate of undetected HCV for all donor risk strata.     

Prevalence and correlates of HIV among men who have sex with men in Tijuana,Mexico

Introduction

Men who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims were to estimate the prevalence and examine correlates of HIV infection among MSM in this city.

Methods

We conducted a cross-sectional study of 191 MSM recruited through respondent-driven sampling (RDS) in 2012. Biological males over the age of 18 who resided in Tijuana and reported sex with a male in the past year were included. Participants underwent interviewer-administered surveys and rapid tests for HIV and syphilis with confirmation.

Results

A total of 33 MSM tested positive for HIV, yielding an RDS-adjusted estimated 20% prevalence. Of those who tested positive, 89% were previously unaware of their HIV status. An estimated 36% (95% CI: 26.4–46.5) had been tested for HIV in the past year, and 30% (95% CI: 19.0–40.0) were estimated to have ever used methamphetamine. Independent correlates of being infected with HIV were methamphetamine use (odds ratio [OR]=2.24, p=0.045, 95% CI: 1.02, 4.92) and active syphilis infection (OR=4.33, p=0.01, 95% CI: 1.42, 13.19).

Conclusions

Our data indicate that MSM are a key sub-population in Tijuana at higher risk for HIV. Tijuana would also appear to have the highest proportion among upper-middle-income countries of HIV-positive MSM who are unknowingly infected. More HIV prevention research on MSM is urgently needed in Tijuana.     

Incidence, Clinical Characteristics and Risk Factors of Late Infection in Solid Organ Transplant Recipients: Data from the RESITRA Study Group

Information describing the incidence and clinical characteristics of late infection (LI) in solid organ transplantation (SOT) is scarce. The aim of this study was to define the incidence, clinical characteristics and risk factors for LI (>6 months) as compared with infection in the early period (<6 months) after SOT. By the online database of the Spanish Network of Infection in Transplantation (RESITRA) we prospectively analyzed 2702 SOT recipients from September 2003 to February 2005. Univariate and multivariate analysis using logistic regression were performed to calculate the risk factors associated with the development of LI. A total of 131 patients developed 176 LI episodes (8%). Global incidence of LI was 0.4 per 1000 transplant-days, ranging from 0.3/1000 in kidney transplants to 1.4 in lung transplants. Independent risk factors for LI in were: acute rejection in the early period (OR 1.5; CI 95%: 1.1-2.3), chronic graft malfunction (OR 2; CI 95%: 1.4-3), re-operation (OR 1.9; CI 95%: 1.3-2.8) relapsing viral infection apart from CMV (OR 1.9; CI 95%: 1.1-3.5), previous bacterial infection (OR 1.8; CI 95%: 1.2-2.6) and lung transplantation (OR 4.5; CI 95%: 2.6-7.8). Severe LI occurs in a subgroup of high-risk SOT recipients who deserve a more careful follow-up and could benefit from prolonged prophylactic measures similar to that performed in the early period after transplantation.     

No effect of methacrylate-based bone cement CMW 1 on the plasmatic phase of coagulation,red blood cells and endothelial cells in vitro

The compatibility of a methacrylate-based bone cement (CMW 1, DePuy International Ltd, England) used for the fixation of joint prostheses was evaluated on plasma, an erythrocyte suspension and cultured human endothelial cells. The extract of the cement was tested, following 1 hour and 7 days of curing. After the contact in vitro of the extract with plasma, activated partial thromboplastin time, antithrombin III, thrombin-antithrombin complexes and fibrin degradation products were assayed. Hemolytic activity was tested by adding the cement extracts to a suspension of erythrocytes. After 4 hours of incubation at 37 °C, the hemoglobin concentration was determined on the supernatants by the colorimetric method. The effect of the cement on tissue factor and thrombomodulin production was evaluated on human umbilical vein endothelial cell cultures. Tissue factor was determined in cell lysates by enzyme immunoassay, following 4 hours' incubation of cultures with the cement extract. Thrombomodulin was assayed in cell lysates by enzyme immuno assay, after 24 hours' incubation with the cement extract. The response to all trans-retinoic acid (ATRA) was tested. The cement caused no significant modifications of the coagulation tests, had no hemolytic activity, did not determine tissue factor production and did not modify thrombomodulin, compared to the negative control. The response to stimulation with ATRA was similar to that of the negative control. We conclude that the cement extract does not affect the plasmatic phase of coagulation, has no effect on erythrocytes, does not induce the expression of procoagulant activity by endothelial cells and does not impair their antithrombotic property, within the limits of the tests performed.     

Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic

Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020–June 19, 2020) and late 2020 (June 20, 2020–December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p < .001). Crude 28-day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46–0.98, p = .016). Between the early and late periods, the use of corticosteroids (≥6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p < .001 and 50/571 [8.8%] vs. 213/402 [52.2%], p < .001, respectively), and the use of hydroxychloroquine and IL-6/IL-6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p < .001 and 73/571 [12.8%] vs. 5/402 [1.2%], p < .001, respectively). Mortality among SOTR hospitalized for COVID-19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study.

     

社区老年人社会隔离及抑郁孤独与生活质量的关系

目的探讨社区老年人社会隔离、抑郁孤独负性情绪与生活质量的关系,并分析抑郁孤独负性情绪在社会隔离与生活质量间的中介作用。方法采用Lubben社会网络量表-6、老年抑郁量表、孤独感量表及简明健康状况量表对592名社区老年人进行调查。结果社区老年人社会隔离、抑郁、孤独及生活质量得分依次为(14.95±4.58)、(5.19±3.13)、(42.06±8.53)和(113.02±10.56)分。社会隔离得分与抑郁和孤独呈负相关,与生活质量呈正相关;抑郁和孤独与生活质量呈负相关(均P0.01)。社会隔离可直接影响生活质量(β=0.558),还可通过抑郁、孤独的部分中介作用间接影响生活质量(β=0.367);抑郁和孤独的中介效应分别占总效应的24.86%和14.81%。结论社区老年人社会隔离风险较高。社会隔离可直接影响或通过抑郁、孤独负性情绪间接影响老年人生活质量,应促进老年人积极融入社会,从而改善其负性情绪,提高生活质量。     

Burden of traffic accidents among pedestrians of Fars province, southern Iran;estimate of years of life lost in a sample of Iranian population from 2009 to 2013

Purpose: Traffic injuries are among the leading causes of mortality and morbidity worldwide. Pedestrians have been considered as a high-risk group among road users, especially in middle- or low-income communities. This study attempted to determine the burden of pedestrians'' fatalities in Fars, the southern province of Iran using years of life lost (YLL) approach.Methods: The data used in this study were retrieved from Fars Forensic Medicine Organization database on pedestrian traffic accidents. The YLL from 2009 to 2013 was estimated using the method presented by World Health organization. Some epidemiological characteristics of pedestrians'' fatalities were analyzedby SPSS.Results: Although YLL among 1000 male pedestrians decreased from 2.5 in 2009 to 1.5 in 2013, it increased from 0.9 to 2.1 among 1000 females during the same period. Higher proportion of death was found in female, illiterate, and married pedestrians (p < 0.001). In addition, mortality was higher in pedestrians living the cities, during daytime, at home, and in hospitals (p < 0.001).Conclusion: Consistent with the global trends, burden of pedestrian accidents in Fars was also exceptionally high. Considering the national and cultural aspects of different countries, improving the safety of pedestrians demands a multi-dimensional approach with interventional factors concerning policies,rules, pedestrians, motor vehicles and environmental conditions taken into consideration.     

Molecular genetic analysis and clinical characterization of Rickettsia species isolated from the Republic of Korea in 2017

Rickettsia sp. CNH17‐7 was isolated from patients' blood and identified by gene analysis as a species distinct from Rickettsia japonica. In addition, similar rickettsial infection was confirmed in two species (Haemaphysalis longicornis and Ixodes nipponensis) of ticks and rodents in northeastern and southwestern provinces, Republic of Korea. Subsequently, the analysis of 16S rRNA, ompA, ompB and sca4 genes of isolate CNH17‐7 revealed 100%, 99.68%, 99.57% and 99.44% sequence similarity with Rickettsia sp. HlR/D91 and Candidatus R. longicornii ROK‐HL727. In this study, we report the isolation of a new Rickettsia sp. CNH17‐7 and infection of different types of ticks with the same rickettsial agents.     

Clinical relation among dural adhesion,dural ossification,and dural laceration in the removal of ossification of the ligamentum flavum

Background Context

Dural laceration frequently occurs during surgery in patients with ossification of the ligamentum flavum (OLF), mainly because of dural adhesion (DA) and dural ossification (DO) between the ligamentum flavum and the dura mater. However, the radiological predictive factors of DA in OLF have rarely been reported.

Promoting safe infant feeding practices – the importance of structural,social and contextual factors in Southern Africa

There has been significant progress towards the goal of eliminating vertical transmission of HIV by 2015. However, a question that remains is how we can most effectively prevent late postnatal transmission of HIV through infant feeding. Guidelines published by the World Health Organization in 2010 have been widely adopted. These guidelines place strong emphasis on exclusive breastfeeding, in some countries over‐turning a prior emphasis on formula feeding. Where available, provision of antiretroviral treatment for HIV‐positive mothers or prophylaxis for infants offers additional protection against vertical transmission through infant feeding. However, merely changing guidelines is not sufficient to change practice, particularly with regard to culturally sanctioned forms of feeding, such as mixed feeding. This commentary highlights structural, social and contextual barriers to effective implementation of the guidelines and suggests ways to address some of these barriers.     

Post‐transplant lymphoproliferative disorders,Epstein‐Barr virus infection,and disease in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the diagnosis, management, and prevention of post‐transplant lymphoproliferative disorders (PTLD) and other Epstein‐Barr virus (EBV) syndromes after solid organ transplantation. PTLD are a heterogeneous spectrum of predominantly B‐cell disorders, often extra‐nodal, with complex distinct pathogeneses and variable clinical presentations determined by pathologic subtype. Recent epidemiologic studies report a decrease in early EBV‐positive (+) PTLD and an increase in late EBV‐negative (?) PTLD. Pre‐transplant EBV‐seronegativity and primary EBV infection, often from donor‐transmitted infection, are an important risk factors for EBV syndromes and early EBV + PTLD. Low‐quality evidence supports preemptive prevention strategies for early EBV + PTLD in EBV‐seronegative recipients that involve EBV DNA measurement in peripheral blood using assays requiring further result harmonization, combined with interventions to lower viral load. Reduction in immunosuppression (RIS) is the best validated intervention. WHO pathology classification of a tissue biopsy remains the gold standard for PTLD diagnosis; optimal staging procedures are uncertain. Treatment of CD20⁺ PTLD with the response‐dependent sequential use of RIS, rituximab, and cytotoxic chemotherapy is recommended. Evidence gaps requiring future research and alternate treatment strategies including immunotherapy are highlighted.