The Diversity of Wolbachia and Other Bacterial Symbionts in Spodoptera frugiperda

Bacterial symbionts associated with insects can be crucial in insect nutrition, metabolism, immune responses, development, and reproduction. However, the bacterial symbionts of the fall armyworm Spodoptera frugiperda remain unclear. S. frugiperda is an invasive polyphagous pest that severely damages many crops, particularly maize and wheat. Here, we investigated the infection, composition, abundance, and diversity of bacterial symbionts, especially Wolbachia, in different tissues of S. frugiperda female adults. The infection prevalence frequencies of Wolbachia in five provinces of China, namely Pu'er, Yunnan; Nanning, Guangxi; Sanya, Hainan; Yunfu, Guangdong; and Nanping, Fujian, were assessed. The results indicated that Proteobacteria, Firmicutes, and Bacteroidetes were the three most dominant bacterial phyla in S. frugiperda adults. At the genus level, the abundant microbiota, which included Enterobacter and Enterococcus, varied in abundance between tissues of S. frugiperda. Wolbachia was found in the ovaries and salivary glands of S. frugiperda adults, and was present in 33.33% of the Pu'er, Yunnan, 23.33% of the Nanning, Guangxi, and 13.33% of the Sanya, Hainan populations, but Wolbachia was absent in the Yunfu, Guangdong and Nanping, Fujian populations. Further phylogenetic analyses revealed that all of the Wolbachia strains from the different S. frugiperda populations belonged to the supergroup B and were named the wFru strain. Since there were Wolbachia strains inducing cytoplasmic incompatibility in supergroup B, these findings may provide a foundation for developing potential biocontrol techniques against S. frugiperda.

Infection of Leishmania donovani in Phlebotomus orientalis Sand Flies at Different Microhabitats of a Kala-Azar Endemic Village in Eastern Sudan

A study was carried out to compare the infection rates of Leishmania donovani in Phlebotomus orientalis sandflies at different microhabitats of a VL endemic village in Gedarif state, Sudan. DNA extracts of 1078 P. orientalis sand fly females sampled by CDC light traps from indoor, outdoor, peri-domestic, and sylvatic sites, in three transmission seasons, March-June 2016-18, in Helat-Belo village, were subjected to independent PCR amplifications targeting Leishmania kDNA and the cpb gene followed by ITS1 region sequencing. Leishmania kDNA was detected in 1.4% of the 1078 P. orientalis females captured in the area. Two of these specimens showed a characteristic 741 bp band of L. donovani after cpb gene amplification. The DNA sequence of the ITS1 region of the parasites matched the ITS1 L. donovani genotype F. There were no signficant differences between rates of infection of L. donovani in P. orientalis captured at different sites. Blood meals found in infected flies origninated from human (5 specimens), cattle (4 specimens) and donkey (2 specimens). The finding of fresh cow and donkey blood in the infected flies suggests the possible role of these animals in the zoopotentiation and/or zooprophylaxis against VL. The study provides important information for VL transmission models and control programs in East Africa.

Effect of closed incision negative pressure wound treatment in vascular surgery: A meta-analysis

The meta-analysis aimed to assess and compare the effect of closed-incision negative pressure wound (NPW) treatment in vascular surgery. Using dichotomous or contentious random or fixed effect models, the outcomes of this meta-analysis were examined, and the odds Ratio (OR) and the mean difference (MD) with 95% confidence intervals (CIs) were computed. Ten examinations from 2017 to 2022 were enrolled for the present meta-analysis, including 2082 personals with vascular surgery. Closed-incision NPW treatment had significantly lower infection rates (OR, 0.39; 95% CI, 0.30-0.51, p < 0.001), grade I infection rates (OR, 0.33; 95% CI, 0.20-0.52, p < 0.001), grade II infection rates (OR, 0.39; 95% CI, 0.21-0.71, p = 0.002), and grade III infection rates (OR, 0.31; 95% CI, 0.13-0.73, p = 0.007), and surgical re-intervention (OR, 0.49; 95% CI, 0.25-0.97, p = 0.04) compared to control in personal with vascular surgery. However, no significant differences were found between closed-incision NPW treatment and control in the 30-day mortality (OR, 0.54; 95% CI, 0.29-1.00, p = 0.05), antibiotic treatment (OR, 0.53; 95% CI, 0.24-1.19, p = 0.12), and length of hospital stay (MD, -0.02; 95% CI, -0.24-0.19, p = 0.83) in personnel with vascular surgery. The examined data revealed that closed-incision NPW treatment had significantly lower infection rates, grade I infection rates, grade II infection rates, and grade III infection rates, surgical re-intervention, however, there were no significant differences in 30-day mortality, antibiotic treatment, or length of hospital stay compared to control group with vascular surgery. Yet, attention should be paid to its values since some comparisons had a low number of selected studies.

Extraventricular Drain Care Bundle Decreases Cerebrospinal Fluid Infection Rates Associated With Extraventricular Drain-Related Procedures and Systemic Infection

BACKGROUND

Infection associated with extraventricular drain (EVD)-related procedures is well known.

OBJECTIVE

To investigate the impact of our institution's EVD care bundle on the infection rates associated with EVD-related procedures.

METHODS

A retrospective study was conducted from June 2022 to June 2023 to compare the infection rate six months before and six months after the implantation of the EVD care bundle.

RESULTS

A total of 58 patients were included in the study (n=33 patients in 2022 and n=25 patients in 2023). The infection rate was 21.2% (7/33) prior to the implementation of the EVD care bundle and 0.0% (0/25) afterward. The seven patients with cerebrospinal fluid (CSF) infection did not have a higher total number of EVD-related procedures compared to the other 26 patients without CSF infection (8.0 vs. 9.4, p=0.7364); however, the mean number of EVD replacements was higher in patients with CSF infection (1.4 vs. 3.4, p=0.0028). The total number of EVD-related procedures was not different between 2022 and 2023 (8.3 vs. 5.2, respectively, p=0.1892); however, the mean number of EVD replacements was lower in 2023 (1.8 vs. 1.0, p=0.0257). In 2022, 22/33 patients had systemic infection, among which 7/22 also had CSF infection. In 2023, 13/25 patients had a systemic infection, among which 0/13 had CSF infection.

CONCLUSIONS

The EVD care bundle consisting of standardizations, checklists, and monitoring reduces the CSF infection rates associated with EVD-related procedures and systemic infection.

Sarcocystis spp. Macrocysts Infection in Wildfowl Species in Eastern Baltic Region: Trends in Prevalence in 2011-2022

Wildfowl meat infected with S. rileyi macrocysts is not suitable for human consumption. Ducks are among the main game birds in Europe, and S. rileyi infections cause significant economic losses. In 2011-2022, a total of 2649 anseriforms collected in Lithuania and 619 Mallards (Anas platyrhynchos) hunted in the Kaliningrad region of Russia, Belarus, and Latvia were tested for macrocysts. In Lithuania, macrocysts were detected in 206 of 2362 Mallards (8.7%) and in two of 88 (2.3%) Eurasian Teals (Anas crecca). The prevalence of macrocysts in the other three countries, Belarus (5.9%), Russia (5.0%), and Latvia (3.1%), was similar. For species identification, macrocysts isolated from 37 Mallards (21 from Lithuania, 8 from Russia, 6 from Belarus, and 2 from Latvia) were subjected to sequencing of the ITS1 region. Based on DNA analysis, S. rileyi was confirmed in all tested birds. By comparing the infection rates of macrocysts in Mallards in Lithuania, significant differences were observed in different years (p = 0.036), and a significantly higher prevalence of infection was established in November-December than in September-October (p = 0.028). Given the amount of data per decade on the prevalence of S. rileyi, awareness of infection needs to be increased.

Molecular Detection and Characterization of Ehrlichia canis Isolates from Three Geographic Regions in Mexico: A Retrospective Study

Canine monocytic ehrlichiosis (CME) is the most common tick-borne disease affecting domestic dogs and other wild canids. It has a worldwide distribution and is associated with the presence of the brown dog tick. Few studies have been conducted in Mexico to identify and characterize Ehrlichia canis genetic variability. In the present study, 111 dogs of different sex, breed, and age from three geographic regions in Mexico were included. All of them had a previous history of tick infestation and/or the presence of one or more clinical signs compatible with CME. All dogs were tested by a commercial ELISA and nested PCR assay for the detection of E. canis. In addition, we analyzed the E. canis genetic diversity from the 16S rRNA gene sequences obtained in this study, along with 15 additional sequences described for E. canis in Mexico and obtained from GeneBank. Serological detection by commercial ELISA results showed overall infection rates of 85.58% (95/111), including 73.1% (30/41) in samples from Guerrero state; 75% (15/20) in Morelos; and 100% (50/50) in Chihuahua. On the other hand, molecular detection (nPCR assay) showed 31.5% (35/111) overall infection rate, with 41.4% (17/41) in Guerrero state; 55% (11/20) in Morelos; and 14% (7/50) in Chihuahua. We observed a high 16S rRNA gene sequence conservancy in most of the E. canis isolates in the three geographical areas from Mexico, including those analyzed in this research, suggesting a common geographic origin among isolates.

Protozoan Parasites of Sarcocystis spp. in Rodents from Commercial Orchards

Small mammals are an important group of wildlife that can transmit pathogens to humans and animals. There is a lack of comprehensive studies on the protozoan parasites of the genus Sarcocystis in agricultural areas. The aim of the current research was to evaluate the prevalence of Sarcocystis spp., and to identify the parasite species found in the skeletal muscles of rodents and insectivores from commercial orchards. A total of 679 muscle samples from small mammals, mainly rodents (n = 674), belonging to eight species were examined. Muscle samples were pooled into groups, then digested, and the presence of the Sarcocystis species was confirmed by molecular methods. The examined parasites were determined in five rodent species, Apodemus agrarius, A. flavicollis, Clethrionomys glareolus, Microtus arvalis, and M. oeconomus. The prevalence of Sarcocystis spp. was low: 2.23% in voles and 0.79% in mice. Based on a sequence comparison of cox1 and 28S rDNA, four species were identified: S. myodes, Sarcocystis cf. strixi, Sarcocystis sp. Rod1, and Sarcocystis sp. Rod2. This is the first report of S. myodes in A. agrarius, A. flavicollis, and M. arvalis. The identified species were most closely related to Sarcocystis spp., and were transmitted by predatory mammals and birds. Future studies are needed to describe the species morphologically, as well as to define the host spectrum and to evaluate their possible pathogenicity.

SARS-CoV-2 Variants and Age-Dependent Infection Rates among Household and Nonhousehold Contacts

To determine the effects of age and variants of concern on transmission of SARS-CoV-2, we analyzed infection rates among close contacts over 4 periods in Toyama Prefecture, Japan. Among household contacts, odds of infection were 6.2 times higher during the period of the Omicron variant than during previous periods, particularly among children and adolescents.

Etiologies of Extreme Leukocytosis

OBJECTIVE

The objective of this study was to determine the etiologies and co-morbidities associated with extreme leukocytosis, which is characterized by a white blood cell (WBC) count ≥ 35 × 10⁹ leukocytes/L.  Method: Retrospective chart review was conducted for all patients, aged 18 years and older, admitted to the internal medicine department between 2015 and 2021 with an elevated WBC count ≥ 35 × 10⁹ leukocytes/L within the first 24 hours of admission.  Results: Eighty patients were identified to have WBC count ≥ 35 × 10⁹ leukocytes/L. The overall mortality was 16% and increased to 30% in those presenting with shock. Mortality increased from 2.8% in patients with WBC count in the range of 35-39.9 × 10⁹ leukocytes/L to 33% in those with WBC count in the range of 40-50 × 10⁹ leukocytes/L. There was no correlation with underlying co-morbidities or age. Pneumonia was the most common infection (38%), followed by UTI or pyelonephritis (28%) and abscesses (10%). There was no predominant organism responsible for these infections. The most common etiology for WBC count between 35-39.9 × 10⁹ leukocytes/L and 40-50 × 10⁹ leukocytes/L was infections, while malignancies (especially chronic lymphocytic leukemia) were more common with WBC count > 50 × 10⁹ leukocytes/L.  Conclusion: For WBC counts in the range of 35-50 × 10⁹ leukocytes/L, infections were the main reason for admission to the internal medicine department. Mortality increased from 2.8% to 33% as WBC counts increased from 35-39.9 × 10⁹ leukocytes/L to 40-50 × 10⁹ leukocytes/L. Overall, mortality for all WBC counts ≥ 35 × 10⁹ leukocytes/L was 16%. The most common infections were pneumonia, followed by UTI or pyelonephritis and abscesses. The underlying risk factors did not correlate with WBC counts or mortality.

Incidence and Risk Factors of Infections Among Diffuse Large B-cell Lymphoma and Classical Hodgkin's Lymphoma Patients in a Tertiary Care Center in Saudi Arabia: A Retrospective Cohort Study

INTRODUCTION

 Non-Hodgkin's lymphoma (NHL) ranked fourth among all cancer types in Saudi Arabia, as reported by the Saudi Health Council in 2015. Diffuse large B-cell lymphoma (DLBCL) is the most common histological type of NHL. On the other hand, classical Hodgkin's lymphoma (cHL) ranked sixth and had a modest tendency to affect young men more frequently. Over recent decades, DLBCL patients were treated with cyclophosphamide, doxorubicin hydrochloride, oncovin, and prednisolone (CHOP) alone. Adding rituximab (R) to the standard regimen (CHOP) shows significant improvement in overall survival. However, it also has a considerable effect on the immune system, impacting complement-mediated and antibody-dependent cellular cytotoxicity and causing an immunosuppressive state through modulating T-cell immunity via neutropenia, which can let the infection spread.

AIMS AND OBJECTIVES

 This study aims to evaluate the incidence and risk factors associated with infections in DLBCL patients in comparison to patients with cHL treated with doxorubicin hydrochloride (Adriamycin), bleomycin sulfate, vinblastine sulfate, and dacarbazine (ABVD).

MATERIALS AND METHODS

 This study is a retrospective case-control study that included 201 patients acquired between January 1st, 2010, and January 1st, 2020. Sixty-seven patients had a diagnosis of cHL and had received ABVD, and 134 had DLBCL and had received rituximab. Clinical data were obtained from the medical records.

RESULTS

 During the study period, we enrolled 201 patients, of whom 67 had cHL, and 134 had DLBCL. DLBCL patients had a higher serum lactate dehydrogenase upon diagnosis than cHL (p = 0.005). Both groups have similar response rates with complete remission/partial remission. Compared to cHL, patients with DLBCL were more likely to have advanced disease when they first presented (stage III/IV, DLBCL: 67.3 vs. cHL: 56.5; p = 0.005). DLBCL patients had an increased risk of infection as compared to cHL patients (DLBCL: 32.1 % vs. 16.4%; p = 0.02). However, patients with a poor response to treatment had an increased risk of infection compared to patients with a favorable response regardless of the type of disease (odds ratio: 4.6; p = <0.001). When using multivariate analysis, it is revealed that unfavorable therapeutic response continues to be the only predictor raising the probability of infection in the population (odds ratio: 4.2; p = 0.003).

CONCLUSIONS

 Our study explored all potential risk factors for the occurrence of infection in DLBCL patients who received R-CHOP versus cHL. The most reliable predictor of an increased risk of infection during the follow-up period was having an unfavorable response to medication. To assess these results, additional prospective research is required.

A Retrospective Database Analysis of Before and After Social Distancing in Relation to Pediatric Infection Rate and Healthcare Services Usage During the Coronavirus Disease 2019 Pandemic

BACKGROUND

Social distancing policy was introduced in Israel in 2020 to reduce the spread of coronavirus disease 2019 (COVID-19). The aim of this study was to analyze the effect of social distancing on other infections in children, by comparing disease rate and healthcare utilization before and after social distancing.

METHODS

This was a before-and-after study. Within this retrospective database analysis of parallel periods in 2019 (periods 1 and 2) and 2020 (periods 3 [prelockdown period] and 4 [lockdown period]) we included all pediatric population registered in the electronic medical records of the Maccabi Healthcare Services, Israel, looking at the occurrence of non-COVID-19 infections, antibiotic purchasing, physician visits, ambulatory emergency care center visits, emergency department visits, and hospitalizations.

RESULTS

A total of 776 828 children were included from 2019, and 777 729 from 2020. We found a lower infection rate in 2020 versus 2019. We did not find a difference in infection rate between periods 1 and 2, while there was a significant difference between periods 3 and 4. We found a significant difference between periods 2 and 4, with a higher RR than for the comparison between periods 1 and 3. There was a modest decrease in ambulatory emergency care center visits in 2020, and lower increases in emergency department visits and hospital admissions. We found decreases in antibiotic purchasing between periods 1 and 3 and between periods 2 and 4, more pronounced in 2020 than in 2019.

CONCLUSIONS

Analysis of findings before and after social distancing and masking showed reduced prevalence of non-COVID-19 pediatric infections and reduced consumption of healthcare services and antibiotics related with the lockdown period.

Incidence, Prevalence, and Sources of COVID-19 Infection among Healthcare Workers in Hospitals in Malaysia

The COVID-19 pandemic introduced significant novel risks for healthcare workers and healthcare services. This study aimed to determine the prevalence, trends, characteristics, and sources of COVID-19 infection among healthcare workers during the early COVID-19 pandemic in Malaysian hospitals. A cross-sectional study used secondary data collected from a COVID-19 surveillance system for healthcare workers between January and December 2020. Two surges in COVID-19 cases among healthcare workers in Malaysia were epidemiologically correlated to a similarly intense COVID-19 pattern of transmission in the community. The period prevalence of COVID-19 infection and the mortality rate among healthcare workers in Malaysia were 1.03% and 0.0019%, respectively. The majority of infections originated from the workplace (53.3%); a total of 36.3% occurred among staff; a total of 17.0% occurred between patients and staff; and 43.2% originated from the community. Healthcare workers had a 2.9 times higher incidence risk ratio for the acquisition of COVID-19 infection than the general population. Nursing professionals were the most highly infected occupational group (40.5%), followed by medical doctors and specialists (24.1%), and healthcare assistants (9.7%). The top three departments registering COVID-19 infections were the medical department (23.3%), the emergency department (17.7%), and hospital administration and governance (9.1%). Occupational safety and health units need to be vigilant for the early detection of a disease outbreak to prevent the avoidable spread of disease in high-risk settings. The transformation of some tertiary hospitals to dedicated COVID-19 care, the monitoring of new procedures for the management of COVID-19 patients, and appropriate resource allocation are key to successful risk mitigation strategies.

Infections in secondary immunodeficiency patients treated with Privigen® or Hizentra®: a retrospective US administrative claims study in patients with hematological malignancies

B cell-derived lymphoproliferative disorders are associated with secondary immunodeficiency (SID); some patients require immunoglobulin replacement therapy (IgRT) to mitigate infections. Using IQVIA's PharMetrics^® Plus database, patients with SID who received IgPro10/IgPro20 in the 12 months post-diagnosis (IgRT users) were matched to patients with SID not receiving IgRT (non-IgRT users). The risk of severe infection was compared using within-patient change from baseline to follow-up as well as between cohorts. Overall, 277 IgRT users were matched to 1019 non-IgRT users. Before IgRT, more IgRT users experienced any bacterial infection (88.4% vs. 72.9%; p<.0001) or ≥1 severe bacterial infection (SBI) (42.2% vs. 31.8%; p=.0011) vs. non-IgRT users. During follow-up, risk of SBI among IgRT users (21.7%) reached parity with non-IgRT users (21.2%). IgRT was associated with a reduction in SBIs to levels comparable with the lower 'baseline infection risk' of non-IgRT users. These criteria help define SID patients who may benefit from IgRT.

First detection of Anaplasma phagocytophilum and Babesia divergens and high infection rates of Anaplasma marginale and Babesia bigemina in cattle in extensive grazing systems of Central Spain

Bovine vector-borne diseases have a considerable economic impact worldwide and affect health of humans and animals. However, different aspects of their epidemiology and their pathogenesis remain unclear. Despite the frequent description of clinical cases reported by practitioners attending cattle from Madrid, Central Spain, molecular prevalence of Anaplasma spp. and Babesia spp. has not been described. The aim of this study was to assess the positivity rate of A. phagocytophilum, A. marginale, A. centrale, B. bigemina and B. divergens in livestock of this area and to evaluate the existence of associations between these pathogens and haematological, biochemical and epidemiological data. Babesia divergens and A. phagocytophilum were detected for the first time in cattle from Madrid. Their positivity percentages were low (2.2% ± 1.4% and 1.8% ± 1.2%, respectively), but this description is of special interest, as these agents are potentially zoonotic. Both agents were found in areas of higher altitude and relative humidity and lower temperature. The detection of ticks in livestock during the moment of sampling was confirmed as a risk factor for these infections. Anaplasma marginale showed the highest molecular infection rate (30% ± 4.1%) in this study, followed by B. bigemina (21.9% ± 3.7%). Higher positivity rates of A. marginale and B. bigemina were found in the areas of mountain climate and warm-summer continental Mediterranean climate. The use of ectoparasiticide treatment was found as a risk factor for infection by A. marginale and B. bigemina. This finding could lead to reconsider the ectoparasiticide protocols that are used nowadays. Grazing on pastures with domestic or wild ruminants and the presence of wild carnivores were associated with higher rates of infection by these four agents and coinfections were frequently found.

Associations Between Structural and Social Determinants of Health With COVID Infection Rates at a Safety Net Hospital

Background: The reported disproportionate impact of COVID-19 infections on minority populations may be due to living in disinvested communities with a high level of poverty, pollution, inadequate unsafe employment, and overcrowded housing.

Objective: To determine the association of county, city, and individual risk factors with COVID-19 infection rates.

Methods: Retrospective chart review on COVID-19 tests performed from March through July 2020 at Arrowhead Regional Medical Center (ARMC), Colton, California.

Results: A total of 7104 tests were performed with 69% in the drive-through testing center. The mean duration of test-to-results time was 2.36 (+0.02) days. COVID-19 positive tests occurred in 1095 (15.4%). At least one symptom occurred in 414 (33%) with a sensitivity of 37.8, specificity of 86.02, a positive predictive value of 33.01, and a negative predictive value of 72.76. Individual factors significantly associated with testing positive for COVID-19 were diabetes, Hispanic ethnicity, and male gender. Younger age was significantly associated with testing COVID positive with the highest risk in children <10 years.

COVID-19 positive persons significantly resided in cities with higher population density, household members, poverty, non-English speaking homes, disability, lower median household income, lack of health insurance and decreased access to a computer and Wi-Fi services. County health rankings showed a significant positive association between testing positive for COVID-19 with increased smoking, air pollution, violent crimes, physical inactivity, decreased education, and access to exercise. 

Conclusion: Adverse county health rankings, socially and economically disadvantaged cities are associated with an increased risk of testing positive for COVD-19. This information can be used in strategic planning and invention mitigation.

Retrospective Analysis of COVID-19 Conversion Rate Among Anesthesiologists in Acute Care Centers

Brief description of the primary research objective

Among healthcare workers, anesthesiologists are regarded as frequently exposed frontline providers in the fight against COVID-19 due to their proximity to patient airways and involvement in aerosolized procedures. As such, the risk of contracting the COVID-19 virus as an occupational hazard is presumed to be higher. To date, in most published studies, all healthcare workers were grouped together, independent of specialty or profession. At the time that this survey was distributed, we did not find any peer-reviewed articles that differentiated COVID-19 infection rates among frontline, such as anesthesiologists vs. non-frontline healthcare workers. This retrospective survey’s primary research objective was to report the rate of COVID-19 infection among anesthesiologists compared to the general population of healthcare workers.

Methodology

A survey was sent among anesthesiology attendings and residents in Northern New Jersey and Brooklyn, New York hospitals on duty during the peak pandemic from March 2020 to May 2020. Questions in the survey focused on infection rates and adherence to standards of infection precaution and personal protective equipment (PPE) utilization.

Main Findings

This retrospective study highlights the rate of infection among anesthesiologists as a particularly vulnerable subgroup of frontline residents and physicians, as they are called to duty when emergent airway management is required. In our study, the reported rate of contracting COVID-19 among anesthesiologists was 16.7%. This statistic is higher than the infection rates published by studies by New York State and the CDC.

Conclusion

The survey sent to anesthesiologists is useful to understand the impact of COVID-19 on this subgroup of frontline providers and the importance of adhering to standards of infection protocol and the role of PPE.

Entomovirological Surveillance in Schools: Are They a Source for Arboviral Diseases Transmission?

Surveillance and control activities for virus-transmitting mosquitoes have primarily focused on dwellings. There is little information about viral circulation in heavily trafficked places such as schools. We collected and analyzed data to assess the presence and prevalence of dengue, chikungunya, and Zika viruses in mosquitoes, and measured Aedes indices in schools in Medellín (Colombia) between 2016-2018. In 43.27% of 2632 visits we collected Aedes adults, creating 883 pools analyzed by RT-PCR. 14.27% of pools yielded positive for dengue or Zika (infection rates of 1.75-296.29 for Aedes aegypti). Ae. aegypti was more abundant and had a higher infection rate for all studied diseases. Aedes indices varied over time. There was no association between Aedes abundance and mosquito infection rates, but the latter did correlate with cases of arboviral disease and climate. Results suggest schools are important sources of arbovirus and health agencies should include these sites in surveillance programs; it is essential to know the source for arboviral diseases transmission and the identification of the most population groups exposed to these diseases to research and developing new strategies.

Global Healthcare Resource Efficiency in the Management of COVID-19 Death and Infection Prevalence Rates

The scale of impact of the COVID-19 pandemic on society and the economy globally provides a strong incentive to thoroughly analyze the efficiency of healthcare systems in dealing with the current pandemic and to obtain lessons to prepare healthcare systems to be better prepared for future pandemics. In the absence of a proven vaccine or cure, non-pharmaceutical interventions including social distancing, testing and contact tracing, isolation, and wearing of masks are essential in the fight against the worldwide COVID-19 pandemic. We use data envelopment analysis and data compiled from Worldometers and The World Bank to analyze how efficient the use of resources were to stabilize the rate of infections and minimize death rates in the top 36 countries that represented 90% of global infections and deaths out of 220 countries as of November 11, 2020. This is the first paper to model the technical efficiency of countries in managing the COVID-19 pandemic by modeling death rates and infection rates as undesirable outputs using the approach developed by You and Yan. We find that the average efficiency of global healthcare systems in managing the pandemic is very low, with only six efficient systems out of a total of 36 under the variable returns to scale assumption. This finding suggests that, holding constant the size of their healthcare systems (because countries cannot alter the size of a healthcare system in the short run), most of the sample countries showed low levels of efficiency during this time of managing the pandemic; instead it is suspected that most countries literally "threw" resources at fighting the pandemic, thereby probably raising inefficiency through wasted resource use.

Ohio Response to COVID-19 and Its Impact on Interventional Pain Management Practices

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has drastically altered daily living and medical care for Ohio residents and the practice of medicine for the interventional pain management physician. As a state, Ohio tends to be demographically representative of the broader US population.

OBJECTIVE

Reviewing the efforts deployed by Ohio to flatten the COVID-19 infection curve and reduce the spread of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an important component of determining optimal procedures for mitigating the effects of the COVID-19 pandemic.

METHODS

Over the course of several announcements and orders during the months of March and April, new policies were put into place to prevent COVID-19 transmission, which included efforts to facilitate social distancing and ensure the health care system could manage the number of COVID-19 cases at peak infection rate. Efforts directed toward medical providers included delay of elective procedures, expansion of telehealth options, and new temporary guidance for prescribing controlled substances.

RESULTS

The Ohio COVID-19 containment approach resulted in a substantial reduction in COVID-19 cases compared with early models of disease spread, and the state has begun a phased reopening. Continued vigilance in applying social distancing and infection control measures will be a critical component of preventing or reducing the impact of a second wave of COVID-19 in Ohio.

LIMITATIONS

A narrative review with paucity of literature.

CoVid-19 Pandemic Trend Modeling and Analysis to Support Resilience Decision-Making

Policy decision-making for system resilience to a hazard requires the estimation and prediction of the trends of growth and decline of the impacts of the hazard. With focus on the recent worldwide spread of CoVid-19, we take the infection rate as the relevant metric whose trend of evolution to follow for verifying the effectiveness of the countermeasures applied. By comparison with the theories of growth and recovery in coupled socio-medical systems, we find that the data for many countries show infection rate trends that are exponential in form. In particular, the recovery trajectory is universal in trend and consistent with the learning theory, which allows for predictions useful in the assistance of decision-making of emergency recovery actions. The findings are validated by extensive data and comparison to medical pandemic models.

A Systematic Review and Meta-regression Analysis on the Impact of Increasing IgG Trough Level on Infection Rates in Primary Immunodeficiency Patients on Intravenous IgG Therapy

PURPOSE

We conducted a systematic review and meta-regression analysis to evaluate the impact of increasing immunoglobulin G (IgG) trough levels on the clinical outcomes in patients with PID receiving intravenous immunoglobulin G (IVIG) treatment.

METHODS

Systematic search was conducted in PubMed and Cochrane. Other relevant articles were searched by reviewing the references of the reviewed article. All clinical trials with documented IgG trough levels and clinical outcome of interest in patients receiving IVIG treatment were eligible to be included in this review. Meta-regression analysis was conducted using Comprehensive Meta-analysis Software. Additional sensitivity analyses were undertaken to evaluate the robustness of the overall results.

RESULTS

Twenty-eight clinical studies with 1218 patients reported from year 2001 to 2018 were included. The mean IVIG dose used ranges from 387 to 560 mg/kg every 3 to 4 weekly, and mean IgG trough obtained ranges from 660 to 1280 mg/dL. Random-effects meta-regression slope shows that IgG trough level increases significantly by 73 mg/dL with every increase of 100 mg/kg dose of IVIG (p < 0.05). Overall infection rates reduced significantly by 13% with every increment of 100 mg/dL of IgG trough up to 960 mg/dL (p < 0.05).

CONCLUSION

This meta-analysis concludes that titrating the IgG trough levels up to 960 mg/dL progressively reduces the rate of infections, and there is less additional benefit beyond that. Further studies to validate this result are required before it can be used in clinical practice.

Epichloë Endophyte Infection rates and Alkaloid Content in Commercially Available Grass Seed Mixtures in Europe

Fungal endophytes of the genus Epichloë live symbiotically in cool season grass species and can produce alkaloids toxic to insects and vertebrates, yet reports of intoxication of grazing animals have been rare in Europe in contrast to overseas. However, due to the beneficial resistance traits observed in Epichloë infected grasses, the inclusion of Epichloë in seed mixtures might become increasingly advantageous. Despite the toxicity of fungal alkaloids, European seed mixtures are rarely tested for Epichloë infection and their infection status is unknown for consumers. In this study, we tested 24 commercially available seed mixtures for their infection rates with Epichloë endophytes and measured the concentrations of the alkaloids ergovaline, lolitrem B, paxilline, and peramine. We detected Epichloë infections in six seed mixtures, and four contained vertebrate and insect toxic alkaloids typical for Epichloë festucae var. lolii infecting Lolium perenne. As Epichloë infected seed mixtures can harm livestock, when infected grasses become dominant in the seeded grasslands, we recommend seed producers to test and communicate Epichloë infection status or avoiding Epichloë infected seed mixtures.

Role of Prophylactic Antibiotics in Critical Care of Stroke Patients - A Preventive Approach to Post-stroke Infections?

Post-stroke complications are very common worldwide and the most common complication is infection. This contributes the most to the mortality rate in stroke patients. Among the infections, pneumonia and urinary tract infections are most common. Hyperthermia following stroke is associated with neuronal damage and worse outcomes. Post-stroke immunosuppression and activation of inflammatory mediators also cause infections. Based on the high mortality caused by post-stroke infections, various trials were done to seek the advantage that prophylactic antibiotics can give in the critical care of stroke patients. Antibiotics, including ceftriaxone (cephalosporin), levofloxacin (fluoroquinolone), penicillin, and minocycline (tetracycline), were used and the stroke patients were followed up to analyze the primary and secondary outcomes. It was concluded that early antibiotic therapy (mostly within 24 hours) leads to a reduced rate of post-stroke infections and reduced fever spikes, whereas follow-up for a longer period of time showed no better functional outcome. Furthermore, mortality and morbidity benefits were also not seen with prophylactic antibiotic therapy. This review helped us to put a nail in the coffin to the earlier thoughts that prophylactic antibiotics are necessary for the critical care of stroke patients.

A comparison of infection rates during skin cancer excisions using nonsterile vs sterile gloves: A prospective randomized pilot study

BACKGROUND

Standard surgical skin excision is a routine outpatient procedure commonly performed in Dermatology practice to treat nonmelanoma and melanoma skin cancer. Use of sterile gloves during this procedure has been the standard of care in most Dermatology offices.

OBJECTIVE

To determine whether the incidence of infection rates was affected when using nonsterile gloves (NSG) instead of sterile gloves (SG) during standard skin excisions in an outpatient Dermatology clinic setting.

METHODS

This prospective, subject-blinded, single-center trial randomized 93 patients presenting for routine skin cancer excisions into two groups. In the first group, 53 excisions were performed with NSG and in the second group 53 excisions were performed with sterile gloves. Degree of wound inflammation and wound infection at 48-72 hours postprocedure was measured.

RESULTS

One hundred and six total wounds were included. Zero of 53 were infected in the NSG group, and 0/53 were infected in the SG at the initial screening 48-72 hours postexcision procedure (P = 0.99). The average wound inflammation score was 0.321 for the NSG group and 0.245 for the SG group.

CONCLUSIONS

Our study suggests that NSG are safe to use for simple excisions of cutaneous skin cancers in an outpatient dermatology clinic setting.

Infection Rates and Alkaloid Patterns of Different Grass Species with Systemic Epichloë Endophytes

Symbiotic Epichloë species are fungal endophytes of cool-season grasses that can produce alkaloids with toxicity to vertebrates and/or invertebrates. Monitoring infections and presence of alkaloids in grasses infected with Epichloë species can provide an estimate of possible intoxication risks for livestock. We sampled 3,046 individuals of 13 different grass species in three regions on 150 study sites in Germany. We determined infection rates and used PCR to identify Epichloë species diversity based on the presence of different alkaloid biosynthesis genes, then confirmed the possible chemotypes with high-performance liquid chromatography (HPLC)/ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) and gas chromatography-mass spectrometry (GC-MS) measurements. Infections of Epichloë spp. were found in Festuca pratensis Huds. (81%), Festuca ovina L. aggregate (agg.) (73%), Lolium perenne L. (15%), Festuca rubra L. (15%) and Dactylis glomerata L. (8%). The other eight grass species did not appear to be infected. For the majority of Epichloë-infected L. perenne samples (98%), the alkaloids lolitrem B and peramine were present, but ergovaline was not detected, which was consistent with the genetic evaluation, as dmaW, the gene encoding the first step of the ergot alkaloid biosynthesis pathway, was absent. Epichloë uncinata in F. pratensis produced anti-insect loline compounds. The Epichloë spp. observed in the F. ovina agg. samples showed the greatest level of diversity, and different intermediates of the indole-diterpene pathway could be detected. Epichloë infection rates alone are insufficient to estimate intoxication risks for livestock, as other factors, like the ability of the endophyte to produce the alkaloids, also need to be assessed.IMPORTANCE Severe problems of livestock intoxication from Epichloë-infected forage grasses have been reported from New Zealand, Australia, and the United States, but much less frequently from Europe, and particularly not from Germany. Nevertheless, it is important to monitor infection rates and alkaloids of grasses with Epichloë fungi to estimate possible intoxication risks. Most studies focus on agricultural grass species like Lolium perenne and Festuca arundinacea, but other cool-season grass species can also be infected. We show that in Germany, infection rates and alkaloids differ between grass species and that some of the alkaloids can be toxic to livestock. Changes in grassland management due to changing climate, especially with a shift toward grasslands dominated with Epichloë-infected species such as Lolium perenne, may result in greater numbers of intoxicated livestock in the near future. We therefore suggest regular monitoring of grass species for infections and alkaloids and call for maintaining heterogenous grasslands for livestock.

Characterizing lymphocyte counts and infection rates with long-term teriflunomide treatment: Pooled analysis of clinical trials

Background:

In Phase 3 studies, teriflunomide reduced relapse rates and disability progression compared with placebo; however, decreases in lymphocyte counts were also observed.

Objective:

To describe the effect of long-term teriflunomide treatment on lymphocyte counts and infection rates among patients in pooled analyses of Phase 3 core and extension studies.

Methods:

Four randomized trials (TEMSO, TOWER, TENERE, and TOPIC) compared teriflunomide 7 mg or 14 mg treatment with either placebo and/or subcutaneous interferon (IFN) β-1a 44 µg in patients with relapsing forms of multiple sclerosis (MS) (or first clinical episode suggestive of MS in TOPIC).

Results:

In 1895, patients ever exposed to teriflunomide, mean (standard deviation) absolute lymphocyte counts declined from Week 0 (1.89 (0.59)) to Week 24 (1.67 (0.52)) and then remained stable thereafter. In the core plus extension studies (up to 10.7 years), 7.3% and 2.2% experienced Grade 1 and Grade 2 lymphopenia, respectively. Infections were reported in 56.9% of patients without lymphopenia, 60.9% with Grade 1 lymphopenia, and 54.8% with Grade 2 lymphopenia. Serious infections occurred in 3.7%, 4.3%, and 7.1%, respectively.

Conclusion:

Long-term risk of lymphopenia and infections in patients who continue to receive teriflunomide is low, demonstrating a limited impact on adaptive and innate immunity.

Do Biologic Agents Increase the Risk of Infection in Patients Undergoing Lower Limb Arthroplasty Surgery?

BACKGROUND

Biologic agents have contributed significantly to the management of patients with in rheumatoid arthritis (RA). A significant proportion of patients with RA still require arthroplasty procedures however. It is unclear whether these agents increase the risk of post operative infection after lower limb arthroplasty.

METHOD

A literature search was performed for articles published over the last 10 years in the English language examining the association between anti-tumour necrosis factor inhibitors and the incidence of post operative infection in patients with RA undergoing hip and knee arthroplasty procedures.

RESULTS

One large meta-analysis has been published suggesting a 2-fold increase in infection rates following orthopaedic surgery in patients receiving biological agents. When subgroup analysis of arthroplasty cases alone was performed the finding failed to reach significance. However, several further studies have demonstrated both an increased risk for surgical site infection with the use of biological agents and several conflicting articles argue the opposite.

CONCLUSION

There is no current consensus on this topic. The safety of continuation of perioperative anti-TNF-α therapy in patients undergoing lower limb arthroplasty procedures is unclear. There is also little robust guidance from specialist rheumatologic societies. There is need for large scale multicentre randomised controlled trials to address this issue.

High Infection Rates for Adult Macaques after Intravaginal or Intrarectal Inoculation with Zika Virus

Unprotected sexual intercourse between persons residing in or traveling from regions with Zika virus transmission is a risk factor for infection. To model risk for infection after sexual intercourse, we inoculated rhesus and cynomolgus macaques with Zika virus by intravaginal or intrarectal routes. In macaques inoculated intravaginally, we detected viremia and virus RNA in 50% of macaques, followed by seroconversion. In macaques inoculated intrarectally, we detected viremia, virus RNA, or both, in 100% of both species, followed by seroconversion. The magnitude and duration of infectious virus in the blood of macaques suggest humans infected with Zika virus through sexual transmission will likely generate viremias sufficient to infect competent mosquito vectors. Our results indicate that transmission of Zika virus by sexual intercourse might serve as a virus maintenance mechanism in the absence of mosquito-to-human transmission and could increase the probability of establishment and spread of Zika virus in regions where this virus is not present.

Infection Rates by Dengue Virus in Mosquitoes and the Influence of Temperature May Be Related to Different Endemicity Patterns in Three Colombian Cities

Colombia is an endemic country for dengue fever where the four serotypes of virus dengue (DENV1–4) circulate simultaneously, and all types are responsible for dengue cases in the country. The control strategies are guided by entomological surveillance. However, heterogeneity in aedic indices is not well correlated with the incidence of the disease in cities such as Riohacha, Bello and Villavicencio. As an alternative, molecular detection of dengue virus in mosquitoes has been proposed as a useful tool for epidemiological surveillance and identification of serotypes circulating in field. We conducted a spatiotemporal fieldwork in these cities to capture adult mosquitoes to assess vector infection and explain the differences between Breteau indices and disease incidence. DENV infection in females and DENV serotype identification were evaluated and infection rates (IR) were estimated. The relationship between density, dengue cases and vector index was also estimated with logistic regression modeling and Pearson’s correlation coefficient. The lack of association between aedic indices and dengue incidence is in agreement with the weak associations between the density of the mosquitoes and their infection with DENV in the three cities. However, association was evident between the IR and dengue cases in Villavicencio. Furthermore, we found important negative associations between temperature and lag time from two to six weeks in Riohacha. We conclude that density of mosquitoes is not a good predictor of dengue cases. Instead, IR and temperature might explain better such heterogeneity.

Postoperative nutrition practices in abdominal surgery patients in a tertiary referral hospital Intensive Care Unit: A prospective analysis

Background:

Benefit of early enteral feeds in surgical patients admitted to Intensive Care Units (ICUs) has been emphasized by several studies. Apprehensions about anastomotic leaks in gastrointestinal surgical patients prevent initiation of early enteral nutrition (EN). The impact of these practices on outcome in Indian scenario is less studied.

Aims:

This study compares the impact of early EN (within 48 h after surgery) with late EN (48 h postsurgery) on outcomes in abdominal surgical ICU patients.

Settings and Design:

Postabdominal surgery patients admitted to a tertiary referral hospital ICU over a 2-year period were analyzed.

Methods:

Only patients directly admitted to ICU after abdominal surgery were included in this study. ICU stay>3 days was considered as prolonged; with average ICU length of stay (LOS) for this ICU being 3 days. The primary outcome was in-patient mortality. ICU LOS, hospital LOS, infection rates, and ventilator days were secondary outcome measures. Acute Physiology and Chronic Health Evaluation II scores were calculated. SPSS and Microsoft Excel were used for analysis.

Results:

Of 91 ICU patients included, 58 received early EN and 33 late EN. Hospital LOS and infection rates were less in early EN group. Use of parenteral nutrition (odds ratio [OR] 5.25, 95% confidence interval (CI); P = 0.003) and number of nil-per-oral days (OR 8.25, 95% CI; P ≤ 0.001) were other predictors of prolonged LOS.

Conclusions:

Early EN in postabdominal surgery ICU patients was associated with reduced hospital LOS and infection rates. ICU LOS, duration of mechanical ventilation and mortality rates did not vary.

Comparative analysis of intestinal parasitic infections of outpatients in Guangxi medical university affiliated hospital in 2005 and 2013

OBJECTIVE

To understand the hospital's status and trends of intestinal parasitic infections and to provide a reference for prevention.

METHODS

Stool samples were treated by acid-ether centrifugation; iodine staining and direct-smearing were performed; intestinal parasites were examined under a microscope; characteristics of parasitic infections in population were analyzed using the descriptive epidemiological method.

RESULTS

10 kinds of parasites were detected; the infection rate of clonorchissinensis was the highest, followed by B. hominis, hookworm, whipworm and roundworm in order (x(2) = 131.188, 1261.928, 129.386, P < 0.01); The overall infection rates in 2013 and 2005 were 37.08% and 41.07% respectively, and the infection rate in 2013 was lower than that in 2005 (x(2) = 20.5003, P < 0.01); All the infection rates of clonorchissinensis, hookworm, whipworm and roundworm in 2013 were lower than those in 2005 (x(2) = 18.275, 45.449, 34.855, 12.435, P < 0.01); Both in 2005 and 2013, the male infection rate was higher than that in female (x(2) = 12.859, 24.924, P < 0.01); For male, the infection rate of clonorchissinensis was the highest, followed by B. hominis (x(2) = 313.621, 104.409, P < 0.01); for female, the infection rate of B. hominis was the highest, followed by clonorchissinensis (x(2) = 95.293, 43.357, P < 0.01). For male, the age group of 41~ had the highest infection rate of clonorchissinensis in 2005 (x(2) = 5.734, P < 0.05), and the age groups of 31~ and 41~ had the highest infection rate of clonorchissinensis in 2013 (x(2) = 8.908, P < 0.01); for female, both in 2005 and 2013, the age group of 21~, 31~, 41~ and 51~ had the highest infection rate of clonorchissinensis (x(2) = 6.508, 5.145, P < 0.05). There was no difference in male infection rate of B. hominis in 2005 (x(2) = 10.134, P > 0.05); in 2013, the age group of 0~ had the highest infection rate (x(2) = 3.825, P < 0.05); for women, it was the highest in the age groups of 11~, 21~ and 31~ in 2005 (x(2) = 10.459, P < 0.01), 0~ and 11~ in 2013 (x(2) = 53.669, P < 0.01). For Hookworm infection in male, the highest infection rate was found in the age group of 11~ 21~ and 61~ in 2005 (x(2) = 4.547, P < 0.05), 61~ and ≥ 71~ in 2013 (x(2) = 4.843, P < 0.05); for female, the highest infection rate was found in the age groups of 51~ and 61~ both in 2005 and 2013 (x(2) = 5.709, 5.958, P < 0.05).

CONCLUSION

In Nanning city, although there was a decline in the infection rate of intestinal parasites of attenders compared with 8 years ago, the infection rate was still high and intestinal parasites were various; The infection rate of geohelminthes had been reduced to a low level; Clonorchissinensis and B. hominis were still the insect species with the highest infection rate.

Prosthetic joint infection: managing infection in a bionic era

There is increasing demand for prosthetic joint surgery and patients are becoming more challenging due to an ageing population often with comorbidities and immunosuppression. While prosthetic joint infection (PJI) rates are generally low, infection can be catastrophic for the patient and hence prevention of infection is critical. Infection, when it does occur, is further complicated by the global rise in antimicrobial resistance. This article introduces a series of papers on the epidemiology of PJI, its diagnosis, use of novel inflammatory markers and molecular techniques, clinical presentation, importance of biofilms, treatment guidelines and, finally, various strategies and novel antibiotic treatment regimens.

Risk factors for hepatitis B infection in rural Vietnam

BACKGROUND

Hepatitis B virus (HBV) infection is a significant public health problem in Vietnam, yet few data exist about the extent of infection.

PURPOSE

To determine seroprevalence of HBV and the risk factors for HBV infection using a population-based epidemiological study in Vietnam.

METHODS

A 400 person survey for seroprevalence of hepatitis B surface antigen (HBsAg) and HBV infection was carried out in five hamlets in the Linhson village of Thainguyen province from June to August 2006. HBV infection was defined as the presence of antibodies to hepatitis core antigen (HBcAb) and/or HBsAg, with or without HBsAg. Potential risk factors for HBV transmission were determined by a structured questionnaire.

RESULTS

Of the 383 respondents aged 18-70 years, 34 (8.8%) tested positive for HBsAg, of whom 21 (61.8%) were HBeAg-negative and hepatitis Be antibody (HBeAb) positive, and 22 (64.7%) had normal alanine aminotransferase (ALT) levels. The prevalence of HBV infection was 51.8% and increased significantly with age. Only 5.2% showed evidence of vaccination. On multivariate analysis, five predictors were found for HBV infection: male gender (OR 1.6; 95% CI 1.3-1.7), age greater than 40 (OR 2.1; 95% CI 1.4-3.3), Kinh ethnicity (OR 1.8; 95% CI 1.1-2.7), a low level of education (OR 1.7; 95% CI 1.0-2.7), and a history of surgery (OR 1.9; 95% CI 1.0-3.5).

CONCLUSIONS

The observed high prevalence of current and past infection with HBV in rural Vietnam highlights the need for close monitoring.