One of the severe complications of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is myocarditis. However, the characteristics of fulminant myocarditis with SARS-CoV-2 infection are still unclear. We systematically reviewed the previously reported cases of fulminant myocarditis associated with SARS-CoV-2 infection from January 2020 to December 2022, identifying 108 cases. Of those, 67 were male and 41 female. The average age was 34.8 years; 30 patients (27.8%) were ≤20 years old, whereas 10 (9.3%) were ≥60. Major comorbidities included hypertension, obesity, diabetes mellitus, asthma, heart disease, gynecologic disease, hyperlipidemia, and connective tissue disorders. Regarding left ventricular ejection fraction (LVEF) at admission, 93% of the patients with fulminant myocarditis were classified as having heart failure with reduced ejection fraction (LVEF ≤ 40%). Most of the cases were administered catecholamines (97.8%), and mechanical circulatory support (MCS) was required in 67 cases (62.0%). The type of MCS was extracorporeal membrane oxygenation (n = 56, 83.6%), percutaneous ventricular assist device (Impella®) (n = 19, 28.4%), intra-aortic balloon pumping (n = 12, 12.9%), or right ventricular assist device (n = 2, 3.0%); combination of these devices occurred in 20 cases (29.9%). The average duration of MCS was 7.7 ± 3.8 days. Of the 76 surviving patients whose cardiac function was available for follow-up, 65 (85.5%) recovered normally. The overall mortality rate was 22.4%, and the recovery rate was 77.6% (alive: 83 patients, dead: 24 patients; outcome not described: 1 patient).
{"title":"Fulminant Myocarditis with SARS-CoV-2 Infection: A Narrative Review from the Case Studies","authors":"Ryohei Ono, Togo Iwahana, Kaoruko Aoki, Hirotoshi Kato, Sho Okada, Yoshio Kobayashi","doi":"10.1155/2024/9000598","DOIUrl":"https://doi.org/10.1155/2024/9000598","url":null,"abstract":"One of the severe complications of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is myocarditis. However, the characteristics of fulminant myocarditis with SARS-CoV-2 infection are still unclear. We systematically reviewed the previously reported cases of fulminant myocarditis associated with SARS-CoV-2 infection from January 2020 to December 2022, identifying 108 cases. Of those, 67 were male and 41 female. The average age was 34.8 years; 30 patients (27.8%) were ≤20 years old, whereas 10 (9.3%) were ≥60. Major comorbidities included hypertension, obesity, diabetes mellitus, asthma, heart disease, gynecologic disease, hyperlipidemia, and connective tissue disorders. Regarding left ventricular ejection fraction (LVEF) at admission, 93% of the patients with fulminant myocarditis were classified as having heart failure with reduced ejection fraction (LVEF ≤ 40%). Most of the cases were administered catecholamines (97.8%), and mechanical circulatory support (MCS) was required in 67 cases (62.0%). The type of MCS was extracorporeal membrane oxygenation (<i>n</i> = 56, 83.6%), percutaneous ventricular assist device (Impella®) (<i>n</i> = 19, 28.4%), intra-aortic balloon pumping (<i>n</i> = 12, 12.9%), or right ventricular assist device (<i>n</i> = 2, 3.0%); combination of these devices occurred in 20 cases (29.9%). The average duration of MCS was 7.7 ± 3.8 days. Of the 76 surviving patients whose cardiac function was available for follow-up, 65 (85.5%) recovered normally. The overall mortality rate was 22.4%, and the recovery rate was 77.6% (alive: 83 patients, dead: 24 patients; outcome not described: 1 patient).","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140026119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. This study aimed to identify, assess, and isolate strong lactobacilli demonstrating broad antibacterial and anti-biofilm activity against drug-resistant strains of Acinetobacter baumannii. Additionally, the mechanism of inhibition of these organisms was to be determined. Methods. Over a 6-month period (from December 2021 to June 2022), 53 clinical A. baumannii strains were collected from clinical samples. Twenty probiotic strains were isolated from local dairy products. Antibacterial activity of Lactobacillus strains’ cell-free supernatant (CFS) was identified using the agar well diffusion method and the microbroth dilution test. Anti-biofilm effect was performed by the microtiter plate assay. The MTT assay was also used to look into the probiotics’ cytotoxic effects on the L929 fibroblast cell line. Results. During the 6-month period, 53 clinical A. baumannii strains were obtained and identified. Out of 20 lactobacillus strains, the CFS of a lactobacillus strain (named L9) showed an inhibitory effect against all A. baumannii strains. Using the broth microdilution method, it was shown that the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of CFS extracts of L9 strains against A. baumannii strains were both ¼ mg/mL. The result of the anti-biofilm showed that the selected probiotic could inhibit biofilm formation. The most common organic acid produced by all Lactobacillus strains, according to the HPLC method, was lactic acid, which was followed by acetic acid. The L929 fibroblast cell line was used in the cytotoxicity assay, which revealed that 100% of the cells in the L929 fibroblast cell line survived treatment with successive doses of CFSs for a full day. Conclusion. The probiotic strain isolated from local yogurt in this study showed potential anti-biofilm and antimicrobial properties against all drug-resistant Acinetobacter isolates. Given the increasing interest in probiotic microorganisms based on their high health benefits, further studies are recommended on the mechanisms of action between probiotics and A. baumannii strains to find new solutions for biological control and treatment of these infections without the use of antibiotics.
{"title":"Isolation and Identification of Effective Probiotics on Drug-Resistant Acinetobacter baumannii Strains and Their Biofilms","authors":"Zahra Abbasi, Seyed Mahdi Ghasemi, Yasaman Ahmadi, Dariush Shokri","doi":"10.1155/2024/8570521","DOIUrl":"https://doi.org/10.1155/2024/8570521","url":null,"abstract":"<i>Introduction</i>. This study aimed to identify, assess, and isolate strong lactobacilli demonstrating broad antibacterial and anti-biofilm activity against drug-resistant strains of <i>Acinetobacter baumannii</i>. Additionally, the mechanism of inhibition of these organisms was to be determined. <i>Methods</i>. Over a 6-month period (from December 2021 to June 2022), 53 clinical <i>A. baumannii</i> strains were collected from clinical samples. Twenty probiotic strains were isolated from local dairy products. Antibacterial activity of <i>Lactobacillus</i> strains’ cell-free supernatant (CFS) was identified using the agar well diffusion method and the microbroth dilution test. Anti-biofilm effect was performed by the microtiter plate assay. The MTT assay was also used to look into the probiotics’ cytotoxic effects on the L929 fibroblast cell line. <i>Results</i>. During the 6-month period, 53 clinical <i>A. baumannii</i> strains were obtained and identified. Out of 20 <i>lactobacillus</i> strains, the CFS of a <i>lactobacillus</i> strain (named L9) showed an inhibitory effect against all <i>A. baumannii</i> strains. Using the broth microdilution method, it was shown that the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of CFS extracts of L9 strains against <i>A. baumannii</i> strains were both ¼ mg/mL. The result of the anti-biofilm showed that the selected probiotic could inhibit biofilm formation. The most common organic acid produced by all <i>Lactobacillus</i> strains, according to the HPLC method, was lactic acid, which was followed by acetic acid. The L929 fibroblast cell line was used in the cytotoxicity assay, which revealed that 100% of the cells in the L929 fibroblast cell line survived treatment with successive doses of CFSs for a full day. <i>Conclusion</i>. The probiotic strain isolated from local yogurt in this study showed potential anti-biofilm and antimicrobial properties against all drug-resistant <i>Acinetobacter</i> isolates. Given the increasing interest in probiotic microorganisms based on their high health benefits, further studies are recommended on the mechanisms of action between probiotics and <i>A. baumannii</i> strains to find new solutions for biological control and treatment of these infections without the use of antibiotics.","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139978370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aurelie Dahlia Yemeli Piankeu, Siméon Pierre Chegaing Fodouop, Michel Noubom, Emmanuel Boris Gomseu Djoumsie, Georges Ful Kuh, Donatien Gatsing
Background. Enteric fever is a great public health problem associated with significant illness and death in many endemic countries, and its clinical diagnosis is still daunting. The aim of this study was to determine the prevalence and risk factors of S. Typhi among febrile patients in Bafoussam and to evaluate the diagnostic performances of Widal and Typhidot tests. Methods. This was a cross-sectional study among 336 participants visiting three hospitals in Bafoussam from August 1, 2021, to November 31, 2021. Widal test, Typhidot assay, and stool culture were used to screen for salmonellosis with the help of a structured questionnaire. Results. The prevalence of S. Typhi and S. Paratyphi was found to be 62.85% and 37.14%, respectively. The overall prevalence of typhoid fever using stool culture was 20.86%. The significant risk factors associated with enteric fever were lack or insufficient knowledge of typhoid fever, poor hand hygiene, and anorexia. Typhidot immunoassay was more sensitive (100%) and specific (82.3%) than the Widal test. Both were analytically inferior to stool culture. Conclusions. High prevalence of typhoid fever (20.86%) was observed which was largely associated with lack or insufficient knowledge of typhoid fever, poor hygiene measure, and anorexia as risk factors. The performances of the Widal and Typhidot test against a stool culture were inferior but with Typhidot better than the Widal slide agglutination.
{"title":"Epidemiology and Performances of Typhidot Immunoassay and Widal Slide Agglutination in the Diagnosis of Typhoid Fever in Febrile Patients in Bafoussam City, Cameroon: A Cross-Sectional Comparative Study","authors":"Aurelie Dahlia Yemeli Piankeu, Siméon Pierre Chegaing Fodouop, Michel Noubom, Emmanuel Boris Gomseu Djoumsie, Georges Ful Kuh, Donatien Gatsing","doi":"10.1155/2024/6635067","DOIUrl":"https://doi.org/10.1155/2024/6635067","url":null,"abstract":"<i>Background</i>. Enteric fever is a great public health problem associated with significant illness and death in many endemic countries, and its clinical diagnosis is still daunting. The aim of this study was to determine the prevalence and risk factors of <i>S.</i> Typhi among febrile patients in Bafoussam and to evaluate the diagnostic performances of Widal and Typhidot tests. <i>Methods</i>. This was a cross-sectional study among 336 participants visiting three hospitals in Bafoussam from August 1, 2021, to November 31, 2021. Widal test, Typhidot assay, and stool culture were used to screen for salmonellosis with the help of a structured questionnaire. <i>Results</i>. The prevalence of <i>S.</i> Typhi and <i>S.</i> Paratyphi was found to be 62.85% and 37.14%, respectively. The overall prevalence of typhoid fever using stool culture was 20.86%. The significant risk factors associated with enteric fever were lack or insufficient knowledge of typhoid fever, poor hand hygiene, and anorexia. Typhidot immunoassay was more sensitive (100%) and specific (82.3%) than the Widal test. Both were analytically inferior to stool culture. <i>Conclusions</i>. High prevalence of typhoid fever (20.86%) was observed which was largely associated with lack or insufficient knowledge of typhoid fever, poor hygiene measure, and anorexia as risk factors. The performances of the Widal and Typhidot test against a stool culture were inferior but with Typhidot better than the Widal slide agglutination.","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139925720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Medical staff in China faced great challenges and psychological and physiological changes of varying degrees during the omicron epidemic outbreak. It is important to recognize the potential impact of these challenges on the mental health of medical staff and to provide appropriate resources and support to mitigate their effects. Methods. A total of 354 medical staff in two obstetrics and gynecology hospitals of different grades were included in this survey using convenience sampling. The cross-sectional self-report questionnaires survey was conducted using the Basic Characteristics Questionnaire, Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Insomnia Severity Index (ISI). Results. There were 169 (47.7%) participants suffering from anxiety disorder. Working with fever, working in obstetrics, and working with protective clothing were the risk factors for anxiety in medical staff . One hundred and ninety-six (55.4%) participants were depressed. Working with fever and working in obstetrics were the risk factors for depression in medical staff
{"title":"Psychological Status of Medical Staff in Obstetrics and Gynecology Hospitals during the Omicron Pandemic Outbreak in China","authors":"Shuting Bao, Bangwu Chen, Ying Hu, Chee Shin Lee, Qi Wu, Menglin Zhou, Mengkai Du, Shuqi Zhu, Biao Xie, Jiuqiong Hu, Zhaoxia Liang","doi":"10.1155/2024/9164605","DOIUrl":"https://doi.org/10.1155/2024/9164605","url":null,"abstract":"<i>Background</i>. Medical staff in China faced great challenges and psychological and physiological changes of varying degrees during the omicron epidemic outbreak. It is important to recognize the potential impact of these challenges on the mental health of medical staff and to provide appropriate resources and support to mitigate their effects. <i>Methods</i>. A total of 354 medical staff in two obstetrics and gynecology hospitals of different grades were included in this survey using convenience sampling. The cross-sectional self-report questionnaires survey was conducted using the Basic Characteristics Questionnaire, Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Insomnia Severity Index (ISI). <i>Results</i>. There were 169 (47.7%) participants suffering from anxiety disorder. Working with fever, working in obstetrics, and working with protective clothing were the risk factors for anxiety in medical staff <span><svg height=\"12.7178pt\" style=\"vertical-align:-3.42947pt\" version=\"1.1\" viewbox=\"-0.0498162 -9.28833 23.471 12.7178\" width=\"23.471pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,4.498,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,15.84,0)\"></path></g></svg><span></span><span><svg height=\"12.7178pt\" style=\"vertical-align:-3.42947pt\" version=\"1.1\" viewbox=\"27.053183800000003 -9.28833 26.453 12.7178\" width=\"26.453pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,27.103,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,33.343,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,36.307,0)\"><use xlink:href=\"#g113-49\"></use></g><g transform=\"matrix(.013,0,0,-0.013,42.547,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,48.787,0)\"></path></g></svg>.</span></span> One hundred and ninety-six (55.4%) participants were depressed. Working with fever and working in obstetrics were the risk factors for depression in medical staff <span><svg height=\"12.7178pt\" style=\"vertical-align:-3.42947pt\" version=\"1.1\" viewbox=\"-0.0498162 -9.28833 23.471 12.7178\" width=\"23.471pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"><use xlink:href=\"#g113-41\"></use></g><g transform=\"matrix(.013,0,0,-0.013,4.498,0)\"><use xlink:href=\"#g113-113\"></use></g><g transform=\"matrix(.013,0,0,-0.013,15.84,0)\"><use xlink:href=\"#g117-91\"></use></g></svg><span></span><span><svg height=\"12.7178pt\" style=\"vertical-align:-3.42947pt\" version=\"1.1\" viewbox=\"27.053183800000003 -9.28833 26.453 12.7178\" width=\"26.453pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,27.103,0)\"><use xlink:href=\"#g113-49\"></use></g><g transform=\"matrix(.013,0,0,-0.013,33.343,0)\"><use xlink:href=\"#g113-47\"></use></g><g transform=\"matrix(.","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139925723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diana Lourdes Padilla-Bórquez, Mónica Guadalupe Matuz-Flores, Jorge Hernández-Bello, Gabriela Athziri Sánchez-Zuno, Samuel García-Arellano, Edith Oregon-Romero, Melva Guadalupe Herrera-Godina, Guillermo González-Estevez, Norma Patricia Adan-Bante, Jesús Alfredo Rosas-Rodríguez, José Francisco Muñoz-Valle
Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19). It is estimated that more than half of new infections are transmitted by asymptomatic people; therefore, the isolation of symptomatic people is not enough to control the spread of the disease. Methods. A total of 171 unvaccinated young adults (18–35 years) from Sonora, Mexico, who underwent a structured survey to identify prior COVID-19 infections, were included in this study. A qualitative determination of anti-SARS-CoV-2 antibodies in serum was performed by lateral flow immunoassay (Certum IgG/IgM Rapid Test™ cassette kit) and neutralizing antibodies were also determined (GenScript cPass assay). Results. A total of 36 people reported a history of COVID-19 infection, and 135 reported no history of COVID-19. In contrast, 49.6% (67/135) of individuals who had not reported a previous SARS-CoV-2 infection were seropositive to the rapid anti-SARS-CoV-2 antibody test, and 48.1% (65/135) of them had neutralizing antibodies. Conclusions. These results suggest that in young adults, SARS-CoV-2 infections could be asymptomatic in a high percentage of individuals, which could contribute in part to the slow control of the current pandemic due to the large number of asymptomatic cases that are contagious and that could be a silent spread of the virus.
{"title":"Seroprevalence of IgM/IgG and Neutralizing Antibodies against SARS-CoV-2 in Unvaccinated Young Adults from Mexico Who Reported Not Having Had a Previous COVID-19 Infection","authors":"Diana Lourdes Padilla-Bórquez, Mónica Guadalupe Matuz-Flores, Jorge Hernández-Bello, Gabriela Athziri Sánchez-Zuno, Samuel García-Arellano, Edith Oregon-Romero, Melva Guadalupe Herrera-Godina, Guillermo González-Estevez, Norma Patricia Adan-Bante, Jesús Alfredo Rosas-Rodríguez, José Francisco Muñoz-Valle","doi":"10.1155/2024/8871439","DOIUrl":"https://doi.org/10.1155/2024/8871439","url":null,"abstract":"<i>Background</i>. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19). It is estimated that more than half of new infections are transmitted by asymptomatic people; therefore, the isolation of symptomatic people is not enough to control the spread of the disease. <i>Methods</i>. A total of 171 unvaccinated young adults (18–35 years) from Sonora, Mexico, who underwent a structured survey to identify prior COVID-19 infections, were included in this study. A qualitative determination of anti-SARS-CoV-2 antibodies in serum was performed by lateral flow immunoassay (Certum IgG/IgM Rapid Test™ cassette kit) and neutralizing antibodies were also determined (GenScript cPass assay). <i>Results</i>. A total of 36 people reported a history of COVID-19 infection, and 135 reported no history of COVID-19. In contrast, 49.6% (67/135) of individuals who had not reported a previous SARS-CoV-2 infection were seropositive to the rapid anti-SARS-CoV-2 antibody test, and 48.1% (65/135) of them had neutralizing antibodies. <i>Conclusions</i>. These results suggest that in young adults, SARS-CoV-2 infections could be asymptomatic in a high percentage of individuals, which could contribute in part to the slow control of the current pandemic due to the large number of asymptomatic cases that are contagious and that could be a silent spread of the virus.","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mian Muhammad Awais, Bakhtawar Khadim, Masood Akhtar, Muhammad Irfan Anwar, Gohar Khadim, Abdul Sammad Ali Khan Shirwany, Halil Selcuk Biricik, Abdul Razzaq, Muhammad Sibtain Bhatti
Brucellosis is a widespread zoonotic disease of veterinary and public health importance with considerably higher prevalence in developing/underdeveloped countries. This study reports the prevalence and risk determinants of brucellosis in small ruminants of peri-urban and rural areas of district Multan, Southern Punjab, Pakistan. For this purpose, sera samples (n = 392) of small ruminants were collected and subjected to preliminary screening using commercially available RBPT reagents followed by serodetection of brucellosis using multispecies i-ELISA kit (ID.vet, France). All the ELISA positive samples were confirmed by PCR using genus-specific primers, and frequencies of Brucella species in positive samples were enumerated using species-specific primers. Results indicated seropositivity rates of 9.69, 9.95, and 10.20% in study population using RBPT reagents of IDEXX-USA, ID.Vet-France, and VRI-Pakistan, respectively, with a statistically nonsignificant difference . Results of ELISA showed an overall seroprevalence rate of 7.14% in target population with a slightly higher rate in sheep (7.65%) as compared to goat (6.63%) population (
{"title":"Epidemiology of Brucellosis in Small Ruminants of Rural and Peri-Urban Areas of Multan, Pakistan","authors":"Mian Muhammad Awais, Bakhtawar Khadim, Masood Akhtar, Muhammad Irfan Anwar, Gohar Khadim, Abdul Sammad Ali Khan Shirwany, Halil Selcuk Biricik, Abdul Razzaq, Muhammad Sibtain Bhatti","doi":"10.1155/2024/8898827","DOIUrl":"https://doi.org/10.1155/2024/8898827","url":null,"abstract":"Brucellosis is a widespread zoonotic disease of veterinary and public health importance with considerably higher prevalence in developing/underdeveloped countries. This study reports the prevalence and risk determinants of brucellosis in small ruminants of peri-urban and rural areas of district Multan, Southern Punjab, Pakistan. For this purpose, sera samples (<i>n</i> = 392) of small ruminants were collected and subjected to preliminary screening using commercially available RBPT reagents followed by serodetection of brucellosis using multispecies i-ELISA kit (ID.vet, France). All the ELISA positive samples were confirmed by PCR using genus-specific primers, and frequencies of <i>Brucella</i> species in positive samples were enumerated using species-specific primers. Results indicated seropositivity rates of 9.69, 9.95, and 10.20% in study population using RBPT reagents of IDEXX-USA, ID.Vet-France, and VRI-Pakistan, respectively, with a statistically nonsignificant difference <span><svg height=\"12.7178pt\" style=\"vertical-align:-3.42947pt\" version=\"1.1\" viewbox=\"-0.0498162 -9.28833 23.471 12.7178\" width=\"23.471pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,4.498,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,15.84,0)\"></path></g></svg><span></span><span><svg height=\"12.7178pt\" style=\"vertical-align:-3.42947pt\" version=\"1.1\" viewbox=\"27.053183800000003 -9.28833 26.453 12.7178\" width=\"26.453pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,27.103,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,33.343,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,36.307,0)\"><use xlink:href=\"#g113-49\"></use></g><g transform=\"matrix(.013,0,0,-0.013,42.547,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,48.787,0)\"></path></g></svg>.</span></span> Results of ELISA showed an overall seroprevalence rate of 7.14% in target population with a slightly higher rate in sheep (7.65%) as compared to goat (6.63%) population (<span><svg height=\"11.7782pt\" style=\"vertical-align:-3.42938pt\" version=\"1.1\" viewbox=\"-0.0498162 -8.34882 18.973 11.7782\" width=\"18.973pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"><use xlink:href=\"#g113-113\"></use></g><g transform=\"matrix(.013,0,0,-0.013,11.342,0)\"></path></g></svg><span></span><span><svg height=\"11.7782pt\" style=\"vertical-align:-3.42938pt\" version=\"1.1\" viewbox=\"22.555183800000002 -8.34882 28.184 11.7782\" width=\"28.184pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,22.605,0)\"><use xlink:href=\"#g113-49\"></use></g><g transform=\"matrix(.013,0,0,-0.013,28.845,0)\"><use xlink:href=\"#g113-47\"></use></g><g transform=\"matrix(.013,0,0,-0.013,31.809,0)\"></path></g><g transform=\"matrix(.013,0,0,","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kira Louisa Boldt, Myrto Bolanaki, Fabian Holert, Antje Fischer-Rosinský, Anna Slagman, Martin Möckel
The turn-around-time (TAT) of diagnostic and screening measures such as testing for SARS-CoV-2 can affect a patient’s length of stay (LOS) in the hospital as well as the emergency department (ED). This, in turn, can affect clinical outcomes. Therefore, a reliable and time-efficient SARS-CoV-2 testing strategy is necessary, especially in the ED. In this randomised controlled trial, n = 598 ED patients presenting to one of three university hospital EDs in Berlin, Germany, and needing hospitalisation were randomly assigned to two intervention groups and one control group. Accordingly, different SARS-CoV-2 testing strategies were implemented: rapid antigen and point-of-care (POC) reverse transcription polymerase chain reaction (rtPCR) testing with the Roche cobas® Liat® (LIAT) (group one n = 198), POC rtPCR testing with the LIAT (group two n = 197), and central laboratory rtPCR testing (group three, control group n = 203). The median LOS in the hospital as an inpatient across the groups was 7 days. Patients’ LOS in the ED of more than seven hours did not differ significantly, and furthermore, no significant differences were observed regarding clinical outcomes such as intensive care unit stay or death. The rapid and POC test strategies had a significantly () shorter median TAT (group one 00:48 h, group two 00:21 h) than the regular central laboratory rtPCR test (group three 06:26 h). However, fast SARS-CoV-2 testing strategies did not reduce ED or inpatient LOS significantly in less urgent ED admissions. Testing strategies should be adjusted to the current circumstances including crowding, SARS-CoV-2 incidences, and patient cohort. This trial is registered with DRKS00023117.
{"title":"Effects of Different SARS-CoV-2 Testing Strategies in the Emergency Department on Length of Stay and Clinical Outcomes: A Randomised Controlled Trial","authors":"Kira Louisa Boldt, Myrto Bolanaki, Fabian Holert, Antje Fischer-Rosinský, Anna Slagman, Martin Möckel","doi":"10.1155/2024/9571236","DOIUrl":"https://doi.org/10.1155/2024/9571236","url":null,"abstract":"The turn-around-time (TAT) of diagnostic and screening measures such as testing for SARS-CoV-2 can affect a patient’s length of stay (LOS) in the hospital as well as the emergency department (ED). This, in turn, can affect clinical outcomes. Therefore, a reliable and time-efficient SARS-CoV-2 testing strategy is necessary, especially in the ED. In this randomised controlled trial, <i>n</i> = 598 ED patients presenting to one of three university hospital EDs in Berlin, Germany, and needing hospitalisation were randomly assigned to two intervention groups and one control group. Accordingly, different SARS-CoV-2 testing strategies were implemented: rapid antigen and point-of-care (POC) reverse transcription polymerase chain reaction (rtPCR) testing with the Roche cobas® Liat® (LIAT) (group one <i>n</i> = 198), POC rtPCR testing with the LIAT (group two <i>n</i> = 197), and central laboratory rtPCR testing (group three, control group <i>n</i> = 203). The median LOS in the hospital as an inpatient across the groups was 7 days. Patients’ LOS in the ED of more than seven hours did not differ significantly, and furthermore, no significant differences were observed regarding clinical outcomes such as intensive care unit stay or death. The rapid and POC test strategies had a significantly (<span><svg height=\"11.7782pt\" style=\"vertical-align:-3.42938pt\" version=\"1.1\" viewbox=\"-0.0498162 -8.34882 18.973 11.7782\" width=\"18.973pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,11.342,0)\"></path></g></svg><span></span><span><svg height=\"11.7782pt\" style=\"vertical-align:-3.42938pt\" version=\"1.1\" viewbox=\"22.555183800000002 -8.34882 21.921 11.7782\" width=\"21.921pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,22.605,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,28.845,0)\"></path></g><g transform=\"matrix(.013,0,0,-0.013,31.809,0)\"><use xlink:href=\"#g113-49\"></use></g><g transform=\"matrix(.013,0,0,-0.013,38.049,0)\"></path></g></svg>)</span></span> shorter median TAT (group one 00:48 h, group two 00:21 h) than the regular central laboratory rtPCR test (group three 06:26 h). However, fast SARS-CoV-2 testing strategies did not reduce ED or inpatient LOS significantly in less urgent ED admissions. Testing strategies should be adjusted to the current circumstances including crowding, SARS-CoV-2 incidences, and patient cohort. This trial is registered with DRKS00023117.","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective/Purpose. Chronic contiguous osteomyelitis (CCO) is a well-recognized clinical condition. Causative factors include direct trauma, prior surgery, or underlying comorbidities like diabetes and vascular insufficiency. Staphylococci especially S. aureus, Streptococci especially beta-hemolytic Streptococci, Gram-negative bacilli, and anaerobes are the most common pathogens isolated. Corynebacterium striatum (C. striatum) is a ubiquitous Gram-positive rod that colonizes the skin and mucous membranes of normal hosts and hospitalized patients. The pathogenic potential of C. striatum has only been reported in immunocompromised hosts and in patients with retained foreign bodies and prosthetic devices. However, it is not a known causative agent of chronic contiguous osteomyelitis. Design/Method. We recognized seven cases of CCO whereby amidst polymicrobial growth, C. striatum appeared to be a true pathogen and required targeted treatment along with surgical intervention. Main Outcome Measures. A pre-post analysis was used to assess the outcome. Results. All patients were cured after successful completion of an antibiotic course with a resolution of infection. Cure was defined as granulation of the infected wound and resolution of clinical symptoms at outpatient follow-up between 6 and 8 weeks. Conclusion. This series emphasizes that C. striatum is often a true pathogen in the setting of CCO. When isolated in polymicrobial infections, a targeted antibiotic therapy towards this pathogen along with other causative pathogens accompanied by surgical intervention is typically required for a successful cure of CCO.
{"title":"Corynebacterium striatum: A True Pathogen in Chronic Contiguous Osteomyelitis","authors":"Grishma R. Trivedi, Shehzad S. Merchant","doi":"10.1155/2024/5020721","DOIUrl":"https://doi.org/10.1155/2024/5020721","url":null,"abstract":"<i>Objective/Purpose</i>. Chronic contiguous osteomyelitis (CCO) is a well-recognized clinical condition. Causative factors include direct trauma, prior surgery, or underlying comorbidities like diabetes and vascular insufficiency. <i>Staphylococci</i> especially <i>S</i>. <i>aureus</i>, <i>Streptococci</i> especially beta-hemolytic <i>Streptococci</i>, Gram-negative bacilli, and anaerobes are the most common pathogens isolated. <i>Corynebacterium striatum</i> (<i>C. striatum</i>) is a ubiquitous Gram-positive rod that colonizes the skin and mucous membranes of normal hosts and hospitalized patients. The pathogenic potential of <i>C. striatum</i> has only been reported in immunocompromised hosts and in patients with retained foreign bodies and prosthetic devices. However, it is not a known causative agent of chronic contiguous osteomyelitis. <i>Design/Method</i>. We recognized seven cases of CCO whereby amidst polymicrobial growth, <i>C. striatum</i> appeared to be a true pathogen and required targeted treatment along with surgical intervention. <i>Main Outcome Measures</i>. A pre-post analysis was used to assess the outcome. <i>Results</i>. All patients were cured after successful completion of an antibiotic course with a resolution of infection. Cure was defined as granulation of the infected wound and resolution of clinical symptoms at outpatient follow-up between 6 and 8 weeks. <i>Conclusion</i>. This series emphasizes that <i>C. striatum</i> is often a true pathogen in the setting of CCO. When isolated in polymicrobial infections, a targeted antibiotic therapy towards this pathogen along with other causative pathogens accompanied by surgical intervention is typically required for a successful cure of CCO.","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139662245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tohru Miyoshi-Akiyama, Do Van Thanh, Truong Thai Phuong, Nguyen Quang Huy, Pham Thi Phuong Thuy, Teruo Kirikae, Pham Hong Nhung, Norio Ohmagari
Introduction. Multidrug-resistant (MDR) Gram-negative bacilli including carbapenem-resistant Gram-negative Enterobacteriaceae (CRE) threaten global health. Little is known, however, about the distribution of antimicrobial resistance genes in MDR isolated from patients in Vietnamese hospitals. In this study, we collected MDR Escherichia coli, defined as E. coli resistance against all fluoroquinolones, aminoglycosides, and carbapenems. Aim. This study was designed to clarify the molecular epidemiology of Escherichia coli isolates resistant to carbapenems, fluoroquinolones, and aminoglycosides isolated from patients admitted to one of the largest hospitals in Vietnam in 2014–2019 based on both whole-genome sequencing (WGS) and phenotypic data. Methodology. Sixty-seven Vietnamese isolates screened by drug resistance by the disk test were subjected to WGS, and their sequences were analyzed to determine their multilocus sequence type (MLST), O-types, H-types, distribution of drug resistance genes, plasmid types, pathogenicity islands (PIs), virulence factor distribution, and phylogenetic evolution using the WGS data. Results. Among the STs detected, ST410 was relatively dominant. Dominant O-types and H-types were O102 and H9 and showed some links, such as those between O102 and H8. The most dominant plasmid type and carbapenemase type were 4 and NDM-5, respectively. MLST, O-types, H-types, plasmid types, and types of carbapenemases were very heterogeneous among the isolates, with no clear correlation between them. Dominant plasmid type carrying drug resistance gene was IncQ1_1. The percentage of isolates positive for drug resistance genes, such as anti-beta-lactams and aminoglycosides, was relatively high because the isolates screened were resistant to carbapenems, fluoroquinolones, and aminoglycosides. Conclusions. MDR E. coli isolates isolated at a high-volume Vietnamese hospital were very heterogeneous, suggesting that they were acquired from different sources, including nosocomial infection, animals, and water. Eradication of MDR E. coli from hospitals and other clinical environments is very challenging because a single measure may be ineffective.
{"title":"Molecular Epidemiology of Escherichia coli Resistant to Carbapenems, Fluoroquinolones, and Aminoglycosides Isolated from One of the Largest Hospitals in Vietnam in 2014–2019","authors":"Tohru Miyoshi-Akiyama, Do Van Thanh, Truong Thai Phuong, Nguyen Quang Huy, Pham Thi Phuong Thuy, Teruo Kirikae, Pham Hong Nhung, Norio Ohmagari","doi":"10.1155/2024/2711353","DOIUrl":"https://doi.org/10.1155/2024/2711353","url":null,"abstract":"<i>Introduction</i>. Multidrug-resistant (MDR) Gram-negative bacilli including carbapenem-resistant Gram-negative <i>Enterobacteriaceae</i> (CRE) threaten global health. Little is known, however, about the distribution of antimicrobial resistance genes in MDR isolated from patients in Vietnamese hospitals. In this study, we collected MDR <i>Escherichia coli</i>, defined as E. coli resistance against all fluoroquinolones, aminoglycosides, and carbapenems. <i>Aim</i>. This study was designed to clarify the molecular epidemiology of <i>Escherichia coli</i> isolates resistant to carbapenems, fluoroquinolones, and aminoglycosides isolated from patients admitted to one of the largest hospitals in Vietnam in 2014–2019 based on both whole-genome sequencing (WGS) and phenotypic data. <i>Methodology</i>. Sixty-seven Vietnamese isolates screened by drug resistance by the disk test were subjected to WGS, and their sequences were analyzed to determine their multilocus sequence type (MLST), O-types, H-types, distribution of drug resistance genes, plasmid types, pathogenicity islands (PIs), virulence factor distribution, and phylogenetic evolution using the WGS data. <i>Results</i>. Among the STs detected, ST410 was relatively dominant. Dominant O-types and H-types were O102 and H9 and showed some links, such as those between O102 and H8. The most dominant plasmid type and carbapenemase type were 4 and NDM-5, respectively. MLST, O-types, H-types, plasmid types, and types of carbapenemases were very heterogeneous among the isolates, with no clear correlation between them. Dominant plasmid type carrying drug resistance gene was IncQ1_1. The percentage of isolates positive for drug resistance genes, such as anti-beta-lactams and aminoglycosides, was relatively high because the isolates screened were resistant to carbapenems, fluoroquinolones, and aminoglycosides. <i>Conclusions</i>. MDR <i>E. coli</i> isolates isolated at a high-volume Vietnamese hospital were very heterogeneous, suggesting that they were acquired from different sources, including nosocomial infection, animals, and water. Eradication of MDR <i>E. coli</i> from hospitals and other clinical environments is very challenging because a single measure may be ineffective.","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139647146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. The potential role of cell envelope integrity proteins in mediating antibiotic resistance is not well understood. In this study, we investigated whether the cell envelope integrity protein D0Y85_RS06240 from the multiantibiotic resistant strain Stenotrophomonas sp. G4 mediates antibiotic resistance. Methods. Bioinformatics analysis was conducted to identify proteins related to the D0Y85_RS06240 protein. The D0Y85_RS06240 gene was heterologously expressed in Escherichia coli, both antibiotic MICs and the effect of efflux pump inhibitors on antibiotic MICs were determined by the broth microdilution method. A combination of antibiotic and efflux pump inhibitor was used to investigate bacterial killing kinetics, and binding of D0Y85_RS06240 to antibiotic molecules was predicted by molecular docking analysis. Results. Sequence homology analysis revealed that D0Y85_RS06240 was related to cell envelope integrity proteins. The D0Y85_RS06240 heterologous expression strains were resistant to multiple antibiotics, including colistin, tetracycline, and cefixime. However, the efflux pump inhibitor N-methylpyrrolidone (NMP) reduced the antibiotic MICs of the D0Y85_RS06240 heterologous expression strain, and bacterial killing kinetics revealed that NMP enhanced the bactericidal rate of tetracycline to the drug-resistant bacteria. Molecular docking analysis indicated that D0Y85_RS06240 could bind colistin, tetracycline, and cefixime. Conclusion. The cell envelope integrity protein D0Y85_RS06240 in Stenotrophomonas sp. G4 mediates multiantibiotic resistance. This study lays the foundation for an in-depth analysis of D0Y85_RS06240-mediated antibiotic resistance mechanisms and the use of D0Y85_RS06240 as a target for the treatment of multiantibiotic-resistant bacterial infections.
{"title":"The Cell Envelope Integrity Protein Homologue D0Y85_RS06240 of Stenotrophomonas Confers Multiantibiotic Resistance","authors":"Chuanqing Zhong, Xiaoqiang Deng, Aihua Jiang, Yayu Liu, Yuanyuan Liu, Jiafang Fu, Guangxiang Cao","doi":"10.1155/2024/7547514","DOIUrl":"https://doi.org/10.1155/2024/7547514","url":null,"abstract":"<i>Background</i>. The potential role of cell envelope integrity proteins in mediating antibiotic resistance is not well understood. In this study, we investigated whether the cell envelope integrity protein D0Y85_RS06240 from the multiantibiotic resistant strain <i>Stenotrophomonas</i> sp. G4 mediates antibiotic resistance. <i>Methods</i>. Bioinformatics analysis was conducted to identify proteins related to the D0Y85_RS06240 protein. The D0Y85_RS06240 gene was heterologously expressed in <i>Escherichia coli</i>, both antibiotic MICs and the effect of efflux pump inhibitors on antibiotic MICs were determined by the broth microdilution method. A combination of antibiotic and efflux pump inhibitor was used to investigate bacterial killing kinetics, and binding of D0Y85_RS06240 to antibiotic molecules was predicted by molecular docking analysis. <i>Results</i>. Sequence homology analysis revealed that D0Y85_RS06240 was related to cell envelope integrity proteins. The D0Y85_RS06240 heterologous expression strains were resistant to multiple antibiotics, including colistin, tetracycline, and cefixime. However, the efflux pump inhibitor N-methylpyrrolidone (NMP) reduced the antibiotic MICs of the D0Y85_RS06240 heterologous expression strain, and bacterial killing kinetics revealed that NMP enhanced the bactericidal rate of tetracycline to the drug-resistant bacteria. Molecular docking analysis indicated that D0Y85_RS06240 could bind colistin, tetracycline, and cefixime. <i>Conclusion</i>. The cell envelope integrity protein D0Y85_RS06240 in <i>Stenotrophomonas</i> sp. G4 mediates multiantibiotic resistance. This study lays the foundation for an in-depth analysis of D0Y85_RS06240-mediated antibiotic resistance mechanisms and the use of D0Y85_RS06240 as a target for the treatment of multiantibiotic-resistant bacterial infections.","PeriodicalId":501415,"journal":{"name":"Canadian Journal of Infectious Diseases and Medical Microbiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139508358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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