Parvimonas micra a new potential pathogen in hospitalized patients: a case series from 2015–2022

European Journal of Clinical Microbiology & Infectious Diseases - Parvimonas micra isolations are usually part of polymicrobial infections and the pathogenic role of this microrganism is still...     

Does the proper intravenous immunoglobulin substitution in primary immunodeficiency protect against HBV infections?: a description of a case series

There are no recommendations concerning preoperative management of primary immunodeficiency patients in cases of emergency or planned surgery in relation to risk of hepatitis type B virus infection. To assess if immunodeficient patients regularly supplemented with immunoglobulins are protected against hepatitis B. IgG, IgM and IgA total levels and anti-HBs level were estimated in adult patients with primary humoral immunodeficiency before and after immunoglobulins supplementation according to a standardized schedule. Serum IgG and anti-HBs level significantly increased after immunoglobulin supplementation. Anti-HBs titer increased in all cases over 100 IU/L regardless of initial total IgG serum value, reaching a highly protective level. There was no correlation between increase in concentration of IgG (DeltaIgG) versus Deltaanti-HBs in the studied patients. Patients with primary hypogammaglobulinemia supplemented with immunoglobulin are protected against hepatitis type B.     

Skeletal muscle choristoma in the lung of a female Sprague–Dawley rat: A case report

In this report we describe a choristoma in the lung of a female placebo rat. The lesion was observed microscopically in the central part of the left lung lobe and was characterized by a nodule consisting of well-differentiated skeletal muscle cells. The muscle fibers were haphazardly organized giving the nodule a poorly demarcated border. Choristoma is a very rare lesion.     

Separation of bipartite patella in nail–patella syndrome: a case report

We report an unusual case of separation of bipartite patella in a patient with nail–patella syndrome. Arthroscopic lateral release and medial plication was carried out for anterior knee pain and patellar subluxation. During post-operative rehabilitation the bipartite patella separated. This was bone grafted and internally fixed by tension band wiring with good end results.     

Is the perimenopause a time of increased risk of recurrence in women with a history of bipolar affective postpartum psychosis? A case series

Summary There is increasing awareness of the influence of female reproductive life events on the course of bipolar disorder. Here, we describe the case histories of 5 women diagnosed with postpartum psychosis who subsequently experienced major mood disorders in relation to the perimenopause. This case series suggests that (a) the perimenopause may be a time of increased risk for women who experienced postpartum bipolar episodes and (b) periods of hormonal change represent a major trigger for bipolar episodes in some women. Correspondence: Ian Jones Ph.D., MRCPsych, Department of Psychological Medicine, Henry Wellcome Building for Biomedical Research in Wales, Cardiff University, Heath Park, Cardiff CF14 4XN, U.K.     

Dynamics of dendritic cell–T cell interactions: a role in T cell outcome

Antigen-specific dendritic cells (DC)–T cell encounters occur in lymph nodes (LNs) and are essential for the induction of both priming and tolerance. In both cases, T cells are rapidly activated and proliferate. However, the subsequent outcome of T cell activation depends on the modulation of different DC- and T cell-intrinsic signals. Recent advances in two-photon (2P) microscopy have furthered our understanding regarding the complex choreography of DCs and T cells in intact LNs, and established differences in the dynamics of DC–T cell contacts during priming and tolerance induction. The mechanisms that favour DC–T cell encounters, as well as the contribution of the frequency and the duration of such encounters in dictating the T cell response, are discussed in this review.     

Percutaneous reconstruction of patellar tendon using semitendinosus tendon in chronic patellar tendon injury — case series and outcome

BackgroundChronic patellar tendon injuries are rare. Patients with these debilitating injuries present with extension lag and quadriceps atrophy. Diagnosis is usually made on a clinical background. Various methods of reconstruction of torn patellar tendon have been described and the ideal method of treatment is a matter of debate.MethodsWe retrospectively reviewed the medical records of nine patients with chronic patellar tendon injury that came to us between June 2006 and July 2012. In all patients, the patellar tendon was reconstructed percutaneously using semitendinosus tendon. Picrusting of quadriceps was required in two patients to pull the patella down.ResultAverage follow-up was 4.5 years. At final follow-up Lysholm score, Siwek and Rao grading were good to excellent in all patients, and at 12 months, all patients showed quadriceps strength 80% or more of opposite quadriceps.ConclusionPercutaneous reconstruction of the patellar tendon in chronic patellar tendon injury using semitendinosus tendon gives excellent result. Picrusting of quadriceps along with lateral release may be required to pull the patella down.Level of evidenceLevel IV.     

Assessing the predictive value of HIV indicator conditions in general practice: a case–control study using the THIN database

Background

UK HIV guidelines identify 37 clinical indicator conditions for adult HIV infection that should prompt an HIV test. However, few data currently exist to show their predictive value in identifying undiagnosed HIV.

Aim

To identify symptoms and clinical diagnoses associated with HIV infection and assess their relative importance in identifying HIV cases, using data from The Health Improvement Network (THIN) general practice database.

Design and setting

A case–control study in primary care.

Method

Cases (HIV-positive patients) were matched to controls (not known to have HIV). Data from 939 cases and 2576 controls were included (n = 3515). Statistical analysis assessed the incidence of the 37 clinical conditions in cases and controls, and their predictive value in indicating HIV infection, and derived odds ratios (ORs) for each indicator condition.

Results

Twelve indicator conditions were significantly associated with HIV infection; 74.2% of HIV cases (n = 697) presented with none of the HIV indicator conditions prior to diagnosis. The conditions most strongly associated with HIV infection were bacterial pneumonia (OR = 47.7; 95% confidence interval [CI] = 5.6 to 404.2) and oral candidiasis (OR = 29.4; 95% CI = 6.9 to 125.5). The signs and symptoms most associated with HIV were weight loss (OR = 13.4; 95% CI = 5.0 to 36.0), pyrexia of unknown origin (OR = 7.2; 95% CI = 2.8 to 18.7), and diarrhoea (one or two consultations).

Conclusion

This is the first study to quantify the predictive value of clinical diagnoses related to HIV infection in primary care. In identifying the conditions most strongly associated with HIV, this study could aid GPs in offering targeted HIV testing to those at highest risk.     

Factors predisposing to acute and recurrent bacterial non-necrotizing cellulitis in hospitalized patients: a prospective case–control study

Acute non-necrotizing cellulitis is a skin infection with a tendency to recur. Both general and local risk factors for erysipelas or cellulitis have been recognized in previous studies using hospitalized controls. The aim of this study was to identify risk factors for cellulitis using controls recruited from the general population. We also compared patients with a history of previous cellulitis with those suffering a single episode, with regard to the risk factors: length of stay in hospital, duration of fever, and inflammatory response as measured by C-reactive protein (CRP) level and leukocyte count. Ninety hospitalized cellulitis patients and 90 population controls matched for age and sex were interviewed and clinically examined during the period April 2004 to March 2005. In multivariate analysis, chronic oedema of the extremity, disruption of the cutaneous barrier and obesity were independently associated with acute cellulitis. Forty-four (49%) patients had a -positive history (PH) of at least one cellulitis episode before entering the study. Obesity and previous ipsilateral surgical procedure were statistically significantly more common in PH patients, whereas a recent (<1 month) traumatic wound was more common in patients with a negative history (NH) of cellulitis. PH patients had longer duration of fever and hospital stay, and their CRP and leukocyte values more often peaked at a high level than those of NH patients. Oedema, broken skin and obesity are risk factors for acute cellulitis. The inflammatory response as indicated by CRP level and leukocyte count is statistically significantly more severe in PH than NH patients.     

Protective effects of N-acetylcysteine on myocardial injury induced by hindlimb ischaemia–reperfusion: a histological study in a rat model

This study evaluated the effects of N-acetylcysteine as a scavenger of radical oxygen species on myocardial injury as a remote organ after skeletal muscle ischaemia–reperfusion. Twenty male Wistar rats were allocated randomly into two experimental groups: ischaemia–reperfusion and ischaemia–reperfusion?+?N-acetylcysteine. All animals underwent 2 h of ischaemia by occlusion of the femoral artery followed by 24 h of reperfusion. Rats treated with N-acetylcysteine were given an intravenous dose of 150 mg/kg, immediately before reperfusion. After the reperfusion period, animals were euthanized and hearts harvested for histopathological analysis under light microscopy. In the ischaemia–reperfusion group, tissues showed histological changes with interstitial oedema, neutrophil infiltration and adhesion of neutrophils to the endothelium, haemorrhage and coagulative necrosis. Histopathologically, there was a significant difference (P?N-acetylcysteine significantly decreased myocardial injury induced by skeletal muscle ischaemia–reperfusion according to our histological findings.     

Illustrating ontogenetic change in the dentition of the Nile monitor lizard,Varanus niloticus: a case study in the application of geometric morphometric methods for the quantification of shape–size heterodonty

Many recent attempts have been made to quantify heterodonty in non-mammalian vertebrates, but the majority of these are limited to Euclidian measurements. One taxon frequently investigated is Varanus niloticus, the Nile monitor. Juveniles possess elongate, pointed teeth (caniniform) along the entirety of the dental arcade, whereas adults develop large, bulbous distal teeth (molariform). The purpose of this study was to present a geometric morphometric method to quantify V. niloticus heterodonty through ontogeny that may be applied to other non-mammalian taxa. Data were collected from the entire tooth row of 19 dry skull specimens. A semilandmark analysis was conducted on the outline of the photographed teeth, and size and shape were derived. Width was also measured with calipers. From these measures, sample ranges and allometric functions were created using multivariate statistical analyses for each tooth position separately, as well as overall measures of heterodonty for each specimen based on morphological disparity. The results confirm and expand upon previous studies, showing measurable shape–size heterodonty in the species with significant differences at each tooth position. Tooth size increases with body size at most positions, and the allometric coefficient increases at more distal positions. Width shows a dramatic increase at the distal positions with ontogeny, often displaying pronounced positive allometry. Dental shape varied in two noticeable ways, with the first composing the vast majority of shape variance: (i) caniniformy vs. molariformy and (ii) mesially leaning, ‘rounded’ apices vs. distally leaning, ‘pointed’ apices. The latter was twice as influential in the mandible, a consequence of host bone shape. Mesial teeth show no significant shape change with growth, whereas distal teeth change significantly due primarily to an increase in molariformy. Overall, heterodonty increases with body size concerning both tooth size and shape, but shape heterodonty changes in the mandible are much less pronounced. Although it is unclear to what degree V. niloticus specializes in hard prey items (durophagy), previous studies of varanid feeding behavior, along with research on analogous durophagous vertebrates, indicate a division of labor along the tooth row in adults, due to a possible transition to at least a partial durophagous niche. The geometric morphometric method proposed here, although not without its own limitations, may be ideal for use with a number of dental morphotypes in the future.     

The importance of being a pDC in antiviral immunity: the IFN mission versus Ag presentation?

Plasmacytoid pre-dendritic cells (pDCs) comprise a pivotal element of antiviral immune responses. They recognize viral components, leading to type I interferon (IFN) production, and affect adaptive defense strategies designed to eliminate viral pathogens. These strategies include the ability of pDCs to modulate virus-specific CD8(+) T-cell responses. Although a great deal has been learned recently about pDCs, our knowledge of whether, how and why pDCs might function as antigen-presenting cells is extremely limited, and now is a prime time for exploring the unknowns of this area. This Opinion will focus on the IFN production and T-cell priming capacity of pDCs, and will argue that IFN production (and not T-cell priming) is the main function of pDCs during viral infection.     

Autopsy on a case of Roberts syndrome reported in 1672: the earliest description?

We report a female infant with congenital lymphedema, facial anomalies, intestinal lymphangiectasia consistent with a diagnosis of Hennekam syndrome. At birth the patient presented with severe respiratory distress due to nonimmune hydrops fetalis, a congenital chylothorax (CC), and pulmonary lymphangiectasia. Hydrops fetalis may be present in newborns with the Hennekam syndrome. Lymphoscintigraphy can be useful in explaining pleural-pulmonary involvement of this generalized lymph vessel malformation syndrome.     

Predicting the risk of chronic kidney disease in the UK: an evaluation of QKidney? scores using a primary care database

Background

Chronic kidney disease is a major health concern that, if left untreated, may progress to end-stage kidney failure (ESKF). Identifying individuals at an increased risk of kidney disease and who might benefit from a therapeutic or preventive intervention is an important challenge.

Aim

To evaluate the performance of the QKidney® scores for predicting 5-year risk of developing moderate-severe kidney disease and ESKF in an independent UK cohort of patients from general practice records.

Design and setting

Prospective cohort study to evaluate the performance of two risk scores for kidney disease in 364 practices from the UK, contributing to The Health Improvement Network (THIN) database.

Method

Data were obtained from 1.6 million patients registered with a general practice surgery between 1 January 2002 and 1 July 2008, aged 35–74 years, with 43 186 incident cases of moderate-severe kidney disease and 2663 incident cases of ESKF. This is the first recorded evidence of moderate-severe chronic kidney and ESKF as recorded in general practice records.

Results

The results from this independent and external validation of QKidney scores indicate that both scores showed good performance data for both moderate-severe kidney disease and ESKF, on a large cohort of general practice patients. Discrimination and calibration statistics were better for models including serum creatinine; however, there were considerable amounts of missing data for serum creatinine. QKidney scores both with and without serum creatinine were well calibrated.

Conclusion

QKidney scores have been shown to be useful tools to predict the 5-year risk of moderate-severe kidney disease and ESKF in the UK.     

When is acute persistent cough in school-age children and adults whooping cough?: A prospective case series study

Background

Pertussis is a vaccine modified disease in most age groups and hence subtle in its presentation. Current diagnostic approaches require relatively invasive sampling.

Aim

To determine the incidence of B. pertussis infection among people aged 5–49 years identified in primary care with acute persistent cough using an oral fluid based diagnostic test.

Design and setting

Active surveillance of acute persistent cough of 2 weeks duration or greater was established in Auckland, New Zealand from May to October 2011. The 15 participating primary care practices provided care for a socioeconomically diverse population.

Method

Recent B. pertussis infection was determined by measurement of IgG antibodies to pertussis toxin (PT) in an oral fluid sample. An IgG antibody titre to PT of ≥70 arbitrary units defined recent infection. Participants reported symptoms at presentation and kept a cough diary.

Results

A total of 226 participants were enrolled: 70 (31%) were children (5–16 years) and 156 (69%) were adults (17–49 years). Oral fluid samples were obtained from 225 participants. Ten per cent (23/225) had recent B. pertussis infection including a larger proportion of children than adults (17% versus 7%, P = 0.003). Neither cough duration nor any individual symptom discriminated between those with and without recent B. pertussis infection.

Conclusion

Pertussis is a frequent cause of acute persistent cough presenting to primary care. Clinical differentiation of pertussis from other causes of acute persistent cough is difficult. An oral fluid based diagnostic test, which is less invasive than other diagnostic approaches, has high acceptability in primary care.     

The outcome and timing of death of 17,767 nosocomial bloodstream infections in acute care hospitals in Finland during 1999–2014

Few studies covering all patient groups and specialties are available regarding the outcome of nosocomial bloodstream infections (BSI). We analyzed the role of patient characteristics and causative pathogens of nosocomial BSIs reported by the hospitals participating in national surveillance in Finland during 1999–2014, in terms of outcome, with particular interest in those leading to death within 2 days (i.e. early death). National nosocomial BSI surveillance was laboratory-based and hospital-wide. Data on nosocomial BSIs was collected by infection control nurses, and dates of death were obtained from the national population registry with linkage to national identity codes. A total of 17,767 nosocomial BSIs were identified; 557 BSIs (3%) were fatal within 2 days and 1150 (6%) within 1 week. The 1-month case fatality was 14% (2460 BSIs), and 23% of the deaths occurred within 2 days and 47% within 1 week. The patients who died early were older than those who survived >?28 days, and their BSIs were more often related to intensive care. Gram-positive bacteria caused over half of the BSIs of patients who survived, whereas gram-negative bacteria, especially Pseudomonas aeruginosa, caused more often BSIs of patients who died early, and fungi BSIs of patients who died within 1 week. A significant portion of patients with nosocomial BSIs died early, which underlines the importance of rapid recognition of BSI. Hospital-wide surveillance data of causative pathogens can be utilized when composing recommendations for empiric antimicrobial treatment in collaboration with clinicians, as well as when promoting infection prevention.