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Risk factors and outcomes of fungal superinfections in patients with severe COVID-19: an observational study from Pisa academic hospital. 重症COVID-19患者真菌重复感染的危险因素和结局:来自比萨学术医院的观察性研究
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3101-8
Giusy Tiseo, Valentina Galfo, Sara Occhineri, Arianna Forniti, Claudio Caroselli, Marco Falcone, Francesco Menichetti

Background: Superinfections acquired during the hospital course represent common complications in COVID-19 patients. Several studies reported an increasing incidence of COVID-19 associated pulmonary aspergillosis (CAPA) and candidaemia. The aim of this study is to describe fungal superinfections in a large cohort of hospitalized patients with COVID-19 and identify factors independently associated with the risk of fungal superinfections.

Methods: Observational study including patients with COVID-19 admitted to the tertiary-care, University Hospital of Pisa, Italy from April 2020 to May 2021. Patients with pneumonia and laboratory confirmed SARS-CoV-2 infection with a RT-PCR test on a nasopharyngeal swab, were eligible for the study. Patients who died within 24 hours from admission and those with missing data were excluded. Data about fungal superinfections were collected. To identify factors independently associated with the development of fungal superinfections, a multivariate regression analysis was performed.

Results: Among 983 patients with COVID-19, 52 (5.3%) fungal superinfections were detected. Fungal superinfections included: 24/52 (46%) CAPA, 27/52 (51.9%) episodes of candidaemia and 1 case of pulmonary pneumocystosis in a haematological patient. All patients with CAPA were cared for in intensive care unit (ICU). The majority of patients received liposomal amphotericin B as antifungal treatment (83.3%). In-hospital mortality was 41.7%. Among 27 episodes of candidaemia, 16 (59.3%) occurred in ICU while 11 (40.7%) in medical wards. In-hospital mortality was 14.8%. Overall, patients with fungal superinfections had a median age of 73 (IQRs 59-77) years and a median length of ICU stay of 40 (17-50) days. In-hospital mortality among all patients with superinfections was 28.8%. On multivariable analysis, ICU stay (OR 17.63, 95% CI 8.3-37.41, p<0.001), high-dose steroids (OR 13.48, 95% CI 6.68-27.26, p<0.001), and diabetes mellitus (OR 2.14, 95% CI 1.09-4.17, p=0.026) were factors independently associated with the risk of developing a fungal superinfection.

Conclusions: Fungal superinfections may complicate the hospital course of COVID-19 patients, especially of those admitted to ICU. Surveillance with detection of galactomannan on bronchoalveolar lavage in patients with clinical deterioration should be performed. A rational use of steroids is essential to avoid the risk of developing a fungal superinfection.

背景:住院期间获得的重复感染是COVID-19患者常见的并发症。几项研究报告了COVID-19相关肺曲霉病(CAPA)和念珠菌血症的发病率增加。本研究的目的是描述一大批COVID-19住院患者的真菌超感染情况,并确定与真菌超感染风险独立相关的因素。方法:观察性研究,纳入2020年4月至2021年5月意大利比萨大学医院三级医院收治的COVID-19患者。肺炎患者和经鼻咽拭子RT-PCR检测实验室确诊的SARS-CoV-2感染患者符合研究条件。入院后24小时内死亡的患者和数据缺失的患者被排除在外。收集真菌重复感染的数据。为了确定与真菌超感染发展独立相关的因素,进行了多变量回归分析。结果:983例新冠肺炎患者中,共检出52例(5.3%)真菌重复感染。真菌重复感染包括:24/52例(46%)CAPA, 27/52例(51.9%)念珠菌血症发作和1例血液学患者肺囊虫病。所有CAPA患者均在重症监护病房(ICU)接受治疗。大多数患者接受两性霉素B脂质体抗真菌治疗(83.3%)。住院死亡率为41.7%。27例念珠菌血症发生在ICU 16例(59.3%),内科病房11例(40.7%)。住院死亡率为14.8%。总体而言,真菌超感染患者的中位年龄为73岁(IQRs 59-77)岁,ICU的中位住院时间为40(17-50)天。所有重复感染患者的住院死亡率为28.8%。结论:真菌重复感染可能使COVID-19患者的住院过程复杂化,特别是ICU住院患者。临床恶化的患者应进行支气管肺泡灌洗监测,检测半乳甘露聚糖。合理使用类固醇是必要的,以避免发生真菌重复感染的风险。
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引用次数: 0
Role of tigecycline in the treatment of urinary tract infections: a systematic review of published case reports. 替加环素在尿路感染治疗中的作用:对已发表病例报告的系统回顾。
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3004-5
Reema Charles, Shreya Das Adhikari, Ankit Mittal, Souvik Chaudhuri, Mukund Gupta, Wasim Khot, Marco Schito, Nitin Gupta

Introduction: The emergence of multi-drug resistance has forced clinicians to occasionally use drugs that are not approved to treat urinary tract infections (UTIs). This systematic review aimed to evaluate the utility of tigecycline in patients with UTIs.

Methodology: A systematic review of case studies was used to retrieve articles between 1.1.1999 to 1.1.2021 from two databases, PubMed and Embase. The title-abstract screening was done for 198 articles, out of which 69 articles were included for full-text screening. A total of 18 articles with 27 cases were included for final analysis.

Results: Of the 27 cases, there were 13 cases with complicated UTI and five had catheter-associated UTI. The most common organisms were Klebsiella pneumoniae (n=11), Acinetobacter baumannii (n=9), and Escherichia coli (n=6). Tigecycline was used as monotherapy in 19 patients and as a combination therapy in 8 patients. The median duration of tigecycline was 13 (10-15) days. A favourable clinical or microbiological response at varying intervals was seen in 24/27 (88.9%). Within three months of a favourable response, recurrence of symptoms was seen in four patients.

Conclusion: In a small analysis of published case reports, tigecycline appeared to be a relatively effective treatment in patients with UTIs, caused by multidrug-resistant organisms. Where tigecycline is the only susceptible drug, it can be used for treatment. Further research, such as randomized controlled trials, is needed to fully assess the drug's efficacy in this context.

多药耐药的出现迫使临床医生偶尔使用未经批准的药物治疗尿路感染(uti)。本系统综述旨在评估替加环素在尿路感染患者中的效用。方法:对案例研究进行系统回顾,从PubMed和Embase两个数据库检索1999年1月1日至2021年1月1日之间的文章。对198篇文章进行标题-摘要筛选,其中69篇文章纳入全文筛选。共纳入18篇文章27例进行最终分析。结果:27例患者中合并尿路感染13例,导管相关性尿路感染5例。最常见的微生物是肺炎克雷伯菌(11例)、鲍曼不动杆菌(9例)和大肠杆菌(6例)。替加环素单独治疗19例,联合治疗8例。替加环素的中位持续时间为13(10-15)天。24/27例患者(88.9%)在不同的时间间隔内出现良好的临床或微生物反应。在出现良好反应的3个月内,有4名患者出现症状复发。结论:在一项对已发表病例报告的小型分析中,替加环素似乎是一种相对有效的治疗由多重耐药菌引起的尿路感染的方法。当替加环素是唯一的易感药物时,它可以用于治疗。在这种情况下,需要进一步的研究,如随机对照试验,以充分评估药物的疗效。
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引用次数: 1
The history of Gin and Tonic; the infectious disease specialist long drink. When gin and tonic was not ordered but prescribed. 杜松子酒汤力酒的历史;传染病专家长饮。当杜松子酒加汤力不是点的,而是开的。
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3004-18
Omar Simonetti, Carlo Contini, Mariano Martini

Winston Churchill statement promoting Gin and Tonic as a life saver during British Empire extension hides many truths. As a matter of fact, the modern cocktail is thought to be born in India where it was widely distributed by Royal Navy for its anti-malarial properties. The aim of the present work is to review and unveil the history of Gin and Tonic through the centuries. As a matter of facts, primitive Gin and Tonic protective effects were well understood by physicians far before the advent of the "germ theory" and its fortunate invention is one of the most fascinating approaches in the history of preventive medicine. Indeed, quinine, a compound with protective effects on the replicative cycle of Plasmodium spp was discovered in 18th Century and since 19th it become the main compound of tonic beverages such as Schweppe's ones. Interestingly, it was administered to British expatriates' seamen and soldiers in order to prevent febrile paroxysms. Soon after, British military doctors demonstrated that the addition of lime or lemon peels to tonics was effective in preventing scurvy. While, addition of alcoholic beverages and gin contributed to make more enjoyable the bitter and unpleasant taste of this beverages.

Results: The spectacular voyage of Gin and Tonic teaches us that a popular recreational drink of our Century was a powerful prophylaxis which certainly helped British colonial expansion.

温斯顿·丘吉尔在大英帝国扩张期间宣传杜松子酒和汤力水是拯救生命的说法掩盖了许多真相。事实上,现代鸡尾酒被认为是在印度诞生的,由于其抗疟疾的特性,它被皇家海军广泛分发。本作品的目的是回顾和揭示几个世纪以来杜松子酒和汤力酒的历史。事实上,早在“细菌理论”出现之前,医生们就已经很好地理解了原始杜松子酒和奎宁酒的保护作用,它的幸运发明是预防医学史上最迷人的方法之一。事实上,奎宁是一种对疟原虫的繁殖周期具有保护作用的化合物,早在18世纪就被发现了。自19世纪以来,奎宁就成为了诸如施韦普的饮料等滋补饮料的主要成分。有趣的是,它被用于英国侨民的海员和士兵,以防止发烧发作。不久之后,英国军医证明,在补品中加入酸橙或柠檬皮能有效预防坏血病。同时,添加酒精饮料和杜松子酒有助于使这种饮料的苦味和不愉快的味道更加愉快。结果:杜松子酒汤力的壮观航程告诉我们,本世纪流行的休闲饮料是一种强大的预防剂,无疑有助于英国的殖民扩张。
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引用次数: 0
Seroprevalence of Strongyloides infection among steroid recipients in a tertiary care centre in North India. 在印度北部的三级保健中心类固醇受体中,类圆线虫感染的血清流行率。
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3004-15
Aishwarya Ramprasad, Parul Kodan, Kirtana Jonnalagadda, Raunak Bir, Nishant Verma, Kanika Sahni, Naval K Vikram, Manish Soneja, Bijay Ranjan Mirdha, Naveet Wig

Background: Strongyloides stercoralis (S. stercoralis), a unique parasite, can cause mortal disease even years after the exposure. Iatrogenic use of steroids can complicate asymptomatic infections to a life-threatening hyperinfection and/or disseminated infection. Data regarding seroprevalence of strongyloidiasis remains scarce and this knowledge gap needs due attention in many endemic countries including India.

Aim: The present study is aimed at assessing the seroprevalence of Strongyloides infection and the need for routine screening among individuals receiving steroid therapy.

Methodology: Eighty patients receiving steroid therapy and thirty healthy volunteers who had not received any immunosuppressive drugs and/or anthelminthic therapy in last six months were enrolled as cases and controls respectively and they were screened by Strongyloides IgG ELISA.

Results: Among the 80 patients on steroids, the mean cumulative prednisolone equivalent dose received was 8.2 g (±11.2 g) for a mean duration of 184 days, 16 patients (20%, 95% CI 11.9-30) had a positive Strongyloides IgG serology. Only 4 controls (4/30, 13.3%, CI 3.8-30.7) tested positive (p=0.4).

Conclusions: Our study demonstrated a Strongyloides seroprevalence of 20% in the study population emphasizing the need for screening for Strongyloides infection prior to immunosuppressive therapy in order to prevent hyperinfection or possible dissemination.

背景:粪圆线虫(S. stercoralis)是一种独特的寄生虫,即使在接触数年后也可引起致命疾病。医源性使用类固醇可使无症状感染恶化为危及生命的重度感染和/或播散性感染。关于类圆线虫病血清患病率的数据仍然很少,在包括印度在内的许多流行国家,这一知识差距需要得到应有的重视。目的:本研究的目的是评估在接受类固醇治疗的个体中,类圆线虫感染的血清患病率和常规筛查的必要性。方法:选取80例接受类固醇治疗的患者和30例近6个月未接受任何免疫抑制药物和/或驱虫药治疗的健康志愿者,分别作为病例和对照组,采用ELISA法进行筛选。结果:80例接受类固醇治疗的患者中,平均累积泼尼松龙等效剂量为8.2 g(±11.2 g),平均持续时间为184天,16例患者(20%,95% CI 11.9-30)的蛔虫IgG血清学阳性。只有4个对照组(4/30,13.3%,CI 3.8-30.7)检测呈阳性(p=0.4)。结论:我们的研究表明,在研究人群中,类圆线虫的血清阳性率为20%,强调在免疫抑制治疗之前需要筛查类圆线虫感染,以防止过度感染或可能的传播。
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引用次数: 0
Antibiotic therapy for pan-drug-resistant infections. 对泛耐药感染的抗生素治疗。
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3004-6
Mahdi Asghari Ozma, Amin Abbasi, Mohammad Asgharzadeh, Pasquale Pagliano, Amedeo Guarino, Şükran Köse, Hossein Samadi Kafil

Antibiotic resistance occurs when microorganisms resist the drugs used against the infection caused by them and neutralize their effects over time using various mechanisms. These mechanisms include preventing drug absorption, changing drug targets, drug inactivating, and using efflux pumps, which ultimately cause drug resistance, which is named pan-drug-resistant (PDR) infection if it is resistant to all antimicrobial agents. This type of drug resistance causes many problems in society and faces the health system with difficulties; therefore their treatment is crucial and encourages doctors to develop new drugs to treat them. PDR Gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli are among the most significant resistant bacteria to many antimicrobial agents, and only a limited range of antibiotics, especially synergistically are effective on them. For the therapy of PDR A. baumannii, tigecycline in combination with colestimethate, imipenem, amikacin, and ampicillin-sulbactam are the most effective treatments. The utilization of β-lactamase inhibitors such as ceftolozane-tazobactam, ceftazidime-avibactam, or imipenem-cilastatin-relebactam has the most efficacy against PDR P. aeruginosa. The PDR K. pneumoniae has been treated in the last decades with tigecycline and colistin, but currently, nitrofurantoin, fosfomycin, and pivmecillinam seem to be the most effective agent for the therapy of PDR E. coli. While these drugs impressively struggle with PDR pathogens, due to the daily increase in antibiotic resistance in microorganisms worldwide, there is still an urgent need for the expansion of novel medicines and methods of combating resistance.

抗生素耐药发生在微生物抵抗由它们引起的感染的药物,并随着时间的推移利用各种机制中和它们的作用。这些机制包括阻止药物吸收、改变药物靶点、使药物失活和使用外排泵,这些最终导致耐药性,如果对所有抗微生物药物都具有耐药性,则称为泛耐药(PDR)感染。这种类型的耐药性在社会上造成了许多问题,使卫生系统面临困难;因此,他们的治疗是至关重要的,并鼓励医生开发新药来治疗他们。PDR革兰氏阴性菌,包括铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌和大肠杆菌,是对许多抗菌药物最重要的耐药菌,只有有限范围的抗生素,特别是协同作用对它们有效。对于PDR鲍曼杆菌的治疗,替加环素联合高estimate、亚胺培南、阿米卡星、氨苄西林-舒巴坦是最有效的治疗方法。β-内酰胺酶抑制剂如头孢唑嗪-他唑巴坦、头孢他啶-阿维巴坦或亚胺培南-西司他汀-雷乐巴坦对PDR铜绿假单胞菌最有效。在过去的几十年里,人们一直用替加环素和粘菌素治疗PDR肺炎克雷伯菌,但目前,呋喃妥因、磷霉素和哌美西林似乎是治疗PDR大肠杆菌最有效的药物。虽然这些药物与PDR病原体的斗争令人印象深刻,但由于世界范围内微生物的抗生素耐药性每天都在增加,仍然迫切需要扩大新的药物和对抗耐药性的方法。
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引用次数: 7
Tetanus secondary to oral and odontogenic infections: a case report and systematic literature review. 继发于口腔和牙源性感染的破伤风:1例报告和系统的文献复习。
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3101-13
Edinson Dante Meregildo-Rodriguez, Martha Genara Asmat-Rubio, Gustavo Adolfo Vásquez-Tirado

Objectives: Tetanus is a potentially lethal infection and remains a priority public health problem in countries with low vaccination coverage. We aim to synthesize the evidence on the clinical-epidemiologic characteristics of oral (odontogenic) tetanus.

Methods: We report a case of oral tetanus. Furthermore, we collected eligible articles about oral tetanus published to date. We performed a systematic review with an exhaustive search of the literature published up to June 30, 2022, in Medline (PubMed), Google Scholar, Scopus, EMBASE, Web of Science, and ScienceDirect.

Results: We analyzed 19 studies that enrolled 26 cases of oral tetanus. The mean age was 51.60 ± 21.95 (range 10-77) years. The frequency and lethality of odontogenic tetanus were higher in males than females. More than 60% of cases occurred in North America. Almost three-quarters of cases were associated with a dental procedure - mainly dental extraction - meanwhile, tooth decay accounted for 23% of cases. The median incubation period was 8.0 (IQR 10.0) days. The time between trismus and death was 4.25±1.89 (range 3-7) days. Clostridium tetani was isolated in only 11.54% of cases. Administration of anti-tetanus immunoglobulin alone or combined with anti-tetanus toxoid was reported in at least 42% of cases, and antibiotics in 32% of cases. Patients required tracheostomy and mechanical ventilation in 12% and 8% of cases, respectively. The mean hospital stay was 18.38±14.97 (range 4-53) days. The lethality of odontogenic tetanus was (30.77%).

Conclusion: Since the diagnosis of tetanus is merely clinical, it is crucial to have a high index of suspicion to diagnose this disease correctly. Although odontogenic tetanus is rare, it is potentially life-threatening.

目标:破伤风是一种潜在的致命感染,在疫苗接种覆盖率低的国家仍然是一个优先考虑的公共卫生问题。我们的目的是综合证据的临床流行病学特征的口腔(牙源性)破伤风。方法:报告1例口腔破伤风病例。此外,我们收集了迄今为止发表的关于口服破伤风的合格文章。我们对截至2022年6月30日在Medline (PubMed)、Google Scholar、Scopus、EMBASE、Web of Science和ScienceDirect上发表的文献进行了系统综述。结果:我们分析了19项研究,纳入了26例口服破伤风病例。平均年龄51.60±21.95岁(10 ~ 77岁)。男性患牙源性破伤风的频率和致死率均高于女性。60%以上的病例发生在北美。近四分之三的病例与牙科手术有关,主要是拔牙,同时,蛀牙占23%。中位潜伏期为8.0 (IQR 10.0)天。从牙关到死亡的时间为4.25±1.89(3 ~ 7)天。破伤风梭菌的检出率仅为11.54%。据报道,至少42%的病例单独使用抗破伤风免疫球蛋白或联合使用抗破伤风类毒素,32%的病例使用抗生素。分别有12%和8%的患者需要气管切开术和机械通气。平均住院时间18.38±14.97(4 ~ 53)天。牙源性破伤风致死率为30.77%。结论:由于破伤风的诊断仅停留在临床阶段,对该病的正确诊断必须有较高的怀疑指数。虽然牙源性破伤风很少见,但它可能危及生命。
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引用次数: 0
Impact of helminthiasis on gestational anemia in low- and middle-income countries: a systematic review and meta-analysis of more than 19,000 women. 蛔虫病对低收入和中等收入国家妊娠贫血的影响:对19,000多名妇女的系统回顾和荟萃分析
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3101-6
Juan Carlos Alvarado-Gonzalez, Nelson Rafael Alvis-Zakzuk, David Ernesto Castillo-Saavedra, Ivan David Lozada-Martinez, Yelson Alejandro Picón-Jaimes, Alexis Rafael Narvaez-Rojas, Josefina Zakzuk

Intestinal helminthiasis are a common public health problem in developed and developing countries. It is thought that they can influence pregnancy by causing gestational anemia. The aim of this study was to determine if there is a relationship between helminth infection and gestational anemia. A structured review of scientific literature was conducted through active search in the electronic databases MEDLINE® and LILACS® until December 2021, following 2020 PRISMA statement. The studies were reviewed independently by two authors, extracting the most relevant information from each study. Cross-sectional studies, case-control and ecological studies were included, with no date or language limit. Randomized clinical trials were excluded. A total of 38 studies were included in the systematic review. The study populations of all studies belonged to low- and middle-income countries: 28 studies from Africa, 6 from Asia, 3 from Latin America and 1 from Oceania. Overall, the average prevalence of gestational anemia among the included studies was 40% (95% CI 34-46%). Hookworm was the predominant species detected in most studies (19/38; 50%), followed by Ascaris lumbricoides (15/38; 39.5%). Gestational anemia was positively associated with A. lumbricoides (OR 1.86, 95% CI 1.12-3.08) and hookworms (OR 3.09, 95% CI 1.99-4.78). Prevalence of malaria was not associated with the magnitude of the effect of hookworm on anemia risk during meta-regression (p=0.5182). The results of this review indicate that there is a statistically significant association between helminthiasis and gestational anemia. Although hookworm is the main species associated with the outcome, prevalence of malaria was not associated with the magnitude of the effect of hookworm on anemia risk. The impact of other species needs to be defined given the expected bias that arises from polyparasitism when defining comparison groups.

肠蠕虫病是发达国家和发展中国家普遍存在的公共卫生问题。人们认为它们可以通过引起妊娠贫血来影响妊娠。这项研究的目的是确定是否有蠕虫感染和妊娠贫血之间的关系。在2020 PRISMA声明发布后,通过MEDLINE®和LILACS®电子数据库的主动检索,对科学文献进行结构化综述,直至2021年12月。这些研究由两位作者独立审查,从每项研究中提取最相关的信息。包括横断面研究、病例对照研究和生态学研究,没有日期和语言限制。排除随机临床试验。系统评价共纳入了38项研究。所有研究的研究人群都属于低收入和中等收入国家:28项研究来自非洲,6项来自亚洲,3项来自拉丁美洲,1项来自大洋洲。总体而言,纳入的研究中妊娠贫血的平均患病率为40% (95% CI 34-46%)。钩虫是多数研究的优势种(19/38;50%),其次是类蛔虫(15/38;39.5%)。妊娠期贫血与类蚓蚓(OR 1.86, 95% CI 1.12-3.08)和钩虫(OR 3.09, 95% CI 1.99-4.78)呈正相关。在meta回归中,疟疾患病率与钩虫对贫血风险的影响程度无关(p=0.5182)。本综述的结果表明,蠕虫病与妊娠贫血之间存在统计学意义上的关联。虽然钩虫是与结果相关的主要物种,但疟疾的流行程度与钩虫对贫血风险的影响程度无关。考虑到在定义比较组时多寄生所产生的预期偏差,需要确定其他物种的影响。
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引用次数: 2
Predictors for oesophageal candidiasis in patients with liver cirrhosis. 肝硬化患者食道念珠菌病的预测因素。
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3101-11
Siddheesh Rajpurohit, Balaji Musunuri, Pooja Basthi Mohan, R Vani Lakshmi, Ganesh Bhat, Shiran Shetty

Background and aim: Oesophageal candidiasis (OC) is one of the most common infections among patients with liver cirrhosis. The present study evaluates the potential predictors for OC among liver cirrhosis patients.

Methodology: This retrospective study was conducted in the tertiary care centre of coastal Karnataka from January 2016 to April 2022. Patients aged 18 and above with a confirmed diagnosis of liver cirrhosis were selected. Patients were equally divided into two groups, i.e., case and control, based on the presence and absence of OC.

Results: A total of 1513 patients with cirrhosis underwent upper gastrointestinal endoscopy. Of these, 50 (3.3%) were diagnosed with OC and taken into case group. An equal number of patients were selected in control group and matched for gender, age and etiology. Most participants were male (94%), with a mean age of 48.46±11.82 years. A lower serum creatinine value was noted among patients with OC. Binary logistic regression identified serum creatinine as an independent predictor for OC (OR: 7.65, 95% CI: 2.012-29.08; p-value: 0.003). The receiver operating characteristic curve for serum creatinine showed the highest significance with a cut-off of <0.86 mg/dL (AUC: 0.722).

Conclusion: Serum creatinine is the independent predictor for OC among liver cirrhosis patients. The possible mechanism is that cirrhosis is a catabolic state in which muscle protein breakdown exceeds synthesis, resulting in decreased muscle mass and low creatinine levels. However, more prospective studies are required to evaluate the role of sarcopenia with OC among liver cirrhosis patients.

背景与目的:食道念珠菌病(Oesophageal candidiasis, OC)是肝硬化患者最常见的感染之一。本研究评估了肝硬化患者的潜在预测因素。方法:本回顾性研究于2016年1月至2022年4月在卡纳塔克邦沿海三级保健中心进行。选择年龄在18岁及以上且确诊为肝硬化的患者。根据是否存在OC,将患者平均分为病例组和对照组。结果:1513例肝硬化患者行上消化道内镜检查。其中50例(3.3%)被诊断为OC并被纳入病例组。对照组选取同等数量的患者,性别、年龄、病因进行匹配。大多数参与者为男性(94%),平均年龄为48.46±11.82岁。OC患者血清肌酐值较低。二元logistic回归发现血清肌酐是OC的独立预测因子(OR: 7.65, 95% CI: 2.012-29.08;假定值:0.003)。结论:血清肌酐是肝硬化患者OC的独立预测因子。可能的机制是肝硬化是一种分解代谢状态,在这种状态下,肌肉蛋白质的分解超过了合成,导致肌肉量减少和肌酐水平降低。然而,需要更多的前瞻性研究来评估肌少症合并OC在肝硬化患者中的作用。
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引用次数: 0
West Nile Virus diffusion in temperate regions and climate change. A systematic review. 西尼罗病毒在温带地区的扩散与气候变化。系统回顾。
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3101-4
Chiara D'Amore, Pierantonio Grimaldi, Tiziana Ascione, Valeria Conti, Carmine Sellitto, Gianluigi Franci, Samadi Hossein Kafil, Pasquale Pagliano

West Nile virus (WNV) is a member of the Japanese encephalitis serocomplex, which was first described in 1937 as neurotropic virus in Uganda in 1937. Subsequently, WNV was identified in the rest of the old-world and from 1999 in North America. Birds are the primary hosts, and WNV is maintained in a bird-mosquito-bird cycle, with pigs as amplifying hosts and humans and horses as incidental hosts. WNV transmission is warranted by mosquitoes, usually of the Culex spp., with a tendency to spill over when mosquitoes' populations build up. Other types of transmissions have been described in endemic areas, as trough transplanted organs and transfused blood, placenta, maternal milk, and in some occupational settings. WNV infections in North America and Europe are generally reported during the summer and autumn. Extreme climate phenomena and soil degradation are important events which contribute to expansion of mosquito population and consequently to the increasing number of infections. Draught plays a pivotal role as it makes foul water standing in city drains and catch basins richer of organic material. The relationship between global warming and WNV in climate areas is depicted by investigations on 16,298 WNV cases observed in the United States during the period 2001-2005 that showed that a 5°C increase in mean maximum weekly temperature was associated with a 32-50% higher incidence of WNV infection. In Europe, during the 2022 season, an increase of WNV cases was observed in Mediterranean countries where 1,041 cases were reported based on ECDC data. This outbreak can be associated to the climate characteristics reported during this period and to the introduction of a new WNV-1 lineage. In conclusion, current climate change is causing an increase of mosquito circulation that supports the widest spread of some vector-borne virus including WNV diffusion in previously non-permissible areas. This warrant public health measures to control vectors circulation to reduce WNV and to screen blood and organ donations.

西尼罗病毒(WNV)是日本脑炎血清复体病毒的一种,1937年在乌干达首次被描述为嗜神经病毒。随后,西尼罗河病毒在旧世界其他地区被发现,并从1999年起在北美被发现。鸟类是主要宿主,西尼罗河病毒维持在鸟-蚊子-鸟的循环中,猪是扩增宿主,人类和马是附带宿主。西尼罗河病毒的传播是由蚊子保证的,通常是库蚊,当蚊子的数量增加时,有蔓延的趋势。在流行地区也有其他类型的传播,如通过移植器官和输血、胎盘、母乳以及在一些职业环境中传播。在北美和欧洲,西尼罗河病毒感染通常在夏季和秋季报告。极端气候现象和土壤退化是导致蚊子种群扩大从而导致感染人数增加的重要事件。干旱起着关键作用,因为它使城市排水渠中的污水和集水盆中含有更丰富的有机物质。全球变暖和气候区西尼罗河病毒之间的关系是通过对2001-2005年期间在美国观察到的16,298例西尼罗河病毒病例的调查来描述的,该调查表明,平均最高周温度每增加5°C,西尼罗河病毒感染的发病率就会增加32-50%。在欧洲,在2022年季节,地中海国家观察到西尼罗河病毒病例增加,根据ECDC数据,报告了1041例病例。这次暴发可能与这一时期报告的气候特征和新的1型西尼罗河病毒谱系的传入有关。总而言之,目前的气候变化正在导致蚊子传播的增加,这支持了一些病媒传播病毒的最广泛传播,包括西尼罗河病毒在以前不允许的地区的传播。这就需要采取公共卫生措施,控制媒介传播,减少西尼罗河病毒,并对献血和器官捐献进行筛查。
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引用次数: 2
Mapping Dengue in children in a Colombian Caribbean Region: clinical and epidemiological analysis of more than 3500 cases. 绘制哥伦比亚加勒比地区儿童登革热地图:3500多例临床和流行病学分析
Q2 Medicine Pub Date : 2022-01-01 DOI: 10.53854/liim-3004-16
Sandra Milena Ricardo-Rivera, Leidy Marcela Aldana-Carrasco, Ivan David Lozada-Martinez, Maria Paz Bolaño-Romero, Nicole Acevedo-Lopez, Walter Antonio Sajona-Leguia, Daniela Lucía Bula-García, Feraz Fady Zaghab-Zgieb, Juan Carlos Peralta Farak, Juliana López Ordóñez

Dengue continues to be a global public health problem due to its impact in terms of morbidity and mortality and economic burden on health systems, with severe effects mainly on children. Among the objectives of sustainable development is the control of infectious diseases; therefore, it is necessary to evaluate the impact of existing programs on the prevention and management of infectious diseases. The aim of this study was to analyze the epidemiological, clinical, and geospatial behavior of dengue in children in a region of the Colombian Caribbean. A retrospective cross-sectional study was carried out. The data provided by the Municipal Health Secretariat were taken and the cases of dengue and severe dengue in children aged 0 to 17 years reported in Sincelejo, Colombia, were extracted. The sociodemographic and clinical characteristics presented were analyzed and descriptive statistics were performed with tables and graphs of frequency and accumulated percentages. To locate the areas with the highest incidence of cases during the year, a geospatial location of the cases was carried out with the QGIS v.3.8 program. In 2019, there were 3611 cases of dengue fever in children aged 0 to 17 years. There were 1394 (38.6%) cases with warning signs, and 41 (1.1%) cases of severe dengue fever. Cases of severe dengue fever occurred more frequently in women. The incidence rate found was 3927 and 45.1 cases per 100,000 population, for dengue and severe dengue in children, respectively. The age ranges with the highest number of cases were children aged 4 to 9 years with 1778 cases. The clinical presentation was varied, with the most frequent symptoms, in all groups, being fever in 100% of cases, myalgias ≥71%, and arthralgias ≥64%. Only 9% (n=315) of the cases, corresponded to cases in the rural area. A very high incidence of cases of dengue and dengue with alarm signs in children was evidenced in the Colombian Caribbean region, mainly in the urban area, despite the existence of public health programs and strategies to control the burden of diseases transmitted by arbovirus vectors.

由于登革热在发病率和死亡率方面的影响以及对卫生系统的经济负担方面的影响,登革热仍然是一个全球公共卫生问题,严重影响主要是儿童。可持续发展的目标之一是控制传染病;因此,有必要评估现有方案对传染病预防和管理的影响。本研究的目的是分析哥伦比亚加勒比海地区儿童登革热的流行病学、临床和地理空间行为。进行回顾性横断面研究。采用了市卫生秘书处提供的数据,并提取了哥伦比亚Sincelejo报告的0至17岁儿童的登革热和严重登革热病例。对出现的社会人口学和临床特征进行分析,并用频率和累计百分比的表格和图表进行描述性统计。为了确定年内病例发病率最高的地区,使用QGIS v.3.8程序对这些病例进行了地理空间定位。2019年,0至17岁儿童中有3611例登革热病例。有警示信号1394例(38.6%),重症登革热41例(1.1%)。严重登革热病例在妇女中更为常见。儿童登革热和重症登革热的发病率分别为每10万人3927例和45.1例。发病人数最多的是4至9岁儿童,共有1778例。临床表现各不相同,所有组中最常见的症状为发热(100%),肌痛≥71%,关节痛≥64%。只有9% (n=315)的病例对应于农村地区的病例。尽管存在控制虫媒病毒传播疾病负担的公共卫生方案和战略,但哥伦比亚加勒比地区(主要是城市地区)的登革热病例和有警示迹象的登革热发病率非常高。
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引用次数: 0
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Infezioni in Medicina
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