Summary

Background
Cephalosporins are recommended as first-line antibiotic prophylaxis in total joint replacement surgery. Studies have shown an increased risk for periprosthetic joint infection (PJI) when non-cephalosporin antibiotics have been used. This study examines the effect of non-cephalosporin antibiotic prophylaxis on the risk for PJI.

Methods
Patients with a primary hip or knee replacement performed from 2012 to 2020 were identified (27 220 joint replacements). The primary outcome was the occurrence of a PJI in a one-year follow-up. The association between perioperative antibiotic prophylaxis and the outcome was examined using logistic regression analysis.

Discussion
Cefuroxime was used as prophylaxis in 26,467 operations (97.2%), clindamycin in 654 (2.4%) and vancomycin in 72 (0.3%). The incidence of PJI was 0.86% (228/26,467) with cefuroxime and 0.80% (6/753) with other prophylactic antibiotics. There was no difference in the risk for PJI with different prophylactic antibiotics in the univariate (OR 1.06, 95% CI 0.47–2.39) or multivariable analysis (OR 1.02, 95% CI 0.45–2.30).

Conclusion
Non-cephalosporin antibiotic prophylaxis in primary total joint replacement surgery was not associated with an increased risk for PJI.

Introduction

Periprosthetic joint infection (PJI) is one of the most feared complications after prosthetic joint surgery and therefore it is essential to prevent them. Perioperative antibiotic prophylaxis has a well-established role in the prevention of surgical site infections (SSIs) related to prosthetic joint surgery. First- or second-generation cephalosporins are recommended as first-line prophylactic antibiotics. [1].

The most common reasons to use non-cephalosporin prophylactic antibiotics are reported penicillin allergy and carriage of methicillin resistant Staphylococcus aureus (MRSA) [1]. The prevalence of a reported penicillin allergy among patients with prosthetic joint surgery has been between 2.5–17% [[2], [3], [4], [5]]. Cephalosporins are often avoided and other prophylactic antibiotics, such as clindamycin or vancomycin, are given prior to joint replacement surgery to patients with a reported penicillin allergy [2,4].

Studies have shown an association between a reported penicillin or beta-lactam allergy and an increased risk of SSI after joint replacement surgery [5], even though this association has not been evident in all studies [2]. The increased risk for SSI associated with reported penicillin allergy is postulated to be due to the use of non-cephalosporin prophylactic antibiotics [6]. The risk for infection after prosthetic joint surgery has been shown to be higher when clindamycin has been compared with cloxacillin [7] and when vancomycin has been compared with cefazolin [4,8]. Wyles et al. showed that the risk for infection after prosthetic joint surgery was significantly higher when non-cefazolin prophylactic antibiotics were used [3].

Results

The study population consisted of 27,220 primary joint replacement surgeries performed on 22,497 patients. Of these surgeries, 12,452 (46%) were hip replacements and 14 768 (54%) were knee replacements. In addition, 1450 (5%) of the joint replacement surgeries were bilateral.

vvCefuroxime was used as prophylaxis in 26,467 operations (97.2%), other antibiotics were used as follows: clindamycin 654 (2.4%), vancomycin 72 (0.3%) and other antibiotics in 27 (0.1%) operations. The proportion of women was higher, and patients were slightly younger, had a higher BMI and higher ASA scores among those receiving non-cefuroxime antibiotic prophylaxis than those receiving cefuroxime (Table I). Surgeries with non-cefuroxime antibiotic prophylaxis were longer in duration than those with cefuroxime prophylaxis (Table I).

Summary

Keywords

Introduction

Methods

Results

Discussion

Contributions

Declaration of interests

Acknowledgements

Data availability statement

Funding

Appendix. Supplementary materials

Reference

Summary

Background
The COVID-19 pandemic is rapidly evolving, with emerging variants and fluctuating control policies. Real-time population screening and identification of groups in whom positivity is highest could help monitor spread and inform public health messaging and strategy.

Methods
To develop a real-time screening process, we included results from nose and throat swabs and questionnaires taken 19 July 2020-17 July 2021 in the UK’s national COVID-19 Infection Survey. Fortnightly, associations between SARS-CoV-2 positivity and 60 demographic and behavioural characteristics were estimated using logistic regression models adjusted for potential confounders, considering multiple testing, collinearity, and reverse causality.

Findings
Of 4,091,537 RT-PCR results from 482,677 individuals, 29,903 (0·73%) were positive. As positivity rose September-November 2020, rates were independently higher in younger ages, and those living in Northern England, major urban conurbations, more deprived areas, and larger households. Rates were also higher in those returning from abroad, and working in healthcare or outside of home. When positivity peaked December 2020-January 2021 (Alpha), high positivity shifted to southern geographical regions. With national vaccine roll-out from December 2020, positivity reduced in vaccinated individuals. Associations attenuated as rates decreased between February-May 2021. Rising positivity rates in June-July 2021 (Delta) were independently higher in younger, male, and unvaccinated groups. Few factors were consistently associated with positivity. 25/45 (56%) confirmed associations would have been detected later using 28-day rather than 14-day periods.

Interpretation
Population-level demographic and behavioural surveillance can be a valuable tool in identifying the varying characteristics driving current SARS-CoV-2 positivity, allowing monitoring to inform public health policy.

Funding
Department of Health and Social Care (UK), Welsh Government, Department of Health (on behalf of the Northern Ireland Government), Scottish Government, National Institute for Health Research.

Highlights

Abstract

Keywords

1. Introduction

2. Materials

3. Methods

4. Experimental results and discussion

5. Conclusion

Declaration of competing interest

References

Abstract

Hydrocephalus is defined as the increase in Cerebro Spinal Fluid (CSF) volume, which is usually accompanied by high Intracranial Pressure (ICP). The most common treatment for hydrocephalus is ventriculoperitoneal shunt insertion. Shunt is a tube which drains CSF from the ventricular system to peritoneal cavity. Then, the CSF is absorbed from peritoneum. Infection is considered as one of the most complications of shunt systems, which can cause improper prognosis in patients, especially in children’s neuro development. Hence, identifying shunt infection predictive factors could improve the practice in preventing this event. This study used a dataset containing the features of 68 patients with a history of shunt infection and 80 patients without any history of shunt infection (control group) in Children’s Medical Center hospital of Tehran (Iran). The state-of-art techniques were applied to select the most informative predicting factors (features). The probability (accuracy) of shunt infection was determined with different intelligent and statistical classifiers. The results indicated that history of prematurity and intraventricular hemorrhage, age of the first shunt procedure, number of shunt revisions, brain tumor induced hydrocephalus, birth weight, and coinfection are the best descriptive features. In addition, the best classification results by different techniques varied in the accuracy range of 68%–81% in the dataset.

1. Introduction

Cerebro Spinal Fluid (CSF) is continuously made by Central Nervous System (CNS), which carries nutrients, washes away impurities, and acts as a cushion for CNS. After production, it flows through ventricles and sub-arachnoid space and is finally absorbed by brain venous blood stream. A precise balance between the production and absorption of CSF is necessary to maintain normal Intra-Cranial Pressure (ICP). There is an excessive amount of CSF in hydrocephalus intradural space, which could be related to an obstruction in CSF flow or a defect in absorption to brain blood flow [1].

In general, it occurs in 1–2 per 100 live births in children and adults. Several different situations such as tumors, infections, trauma, developmental abnormalities, and other factors can cause hydrocephalus. Hydrocephalus, as a neurosurgical emergency, increases head circumstance, decreases vision, less of consciousness and some other neurodevelopmental deficits. Ventricular shunt placement is considered as the most common treatment for symptomatic hydrocephalus. Shunt is an internal tube which drains CSF from ventricles to other places in the body in order to absorb the extra fluid and preserve normal ICP [2,3].

Shunt has several complications despite its numerous benefits, the most common complication of which is its infection, which has many morbidities, especially in the neurodevelopmental growth of the affected children and enormous economic costs for healthcare systems. The rate of shunt infection varies from 10% to 22%, and approximately 90% of the infections usually occur one month after surgery. There are some potential predisposing factors for shunt infection such as the patient’s age, etiology of hydrocephalus, hospitalization period, number of shunt revisions, surgeon’s experience, operation duration, surgical technique, manipulation of the indwelling device during surgery, and health insurance [4].

1.Introduction

2.Sepsis

3.Catheter-related bloodstream infection

4.Supplementary data

References

1. Introduction

Sepsis is one of the most serious conditions among all infectious diseases. To establish a sepsis treatment system as the basis of bacterial infection treatment, knowledge regarding infectious disease medicine/chemotherapeutics must be collected. Due to the recent appearance of various antimicrobial-drug-resistant bacteria, it is necessary to flexibly switch strategies to treat bacterial infection. This is not exceptional in the field of sepsis. It is also necessary to manage such infection, considering the involvement of antimicrobial-drug-resistant bacteria, including MRSA(methicillin resistant Staphylococcus aureus) and ESBL(extended spectrum β-lactamase)-producing bacteria. Antimicrobial-drug-resistant bacteria have been routinely detected in patients not only with nosocomial but also with community-acquired infection.

Sepsis is defined as a severe condition derived from a primary infection site. On the other hand, we often encounter patients with narrow-sense blood stream infection caused by intravascularly inserted catheters in clinical practice. Although there is a dissociation as a condition to be described in the “Sepsis” section, it was included in this section for convenience. In patients with sepsis, as a rule, a primary infected focus should be investigated, and treatment must be performed in accordance with the site of infection and condition. However, in the present guidelines, antimicrobial chemotherapy as empiric therapy is described, focusing on initial treatment with antimicrobial drugs for sepsis at a time point when a primary focus is unclear or inaccurate. In the “Catheter-related bloodstream infection” section, definitive therapy after the identification of causative bacteria is concretely described.

1. Introduction

2. Methods

3. Results

4. Discussion

References

Abstract

Introduction: Sources describing the global burden of emerging diseases accurately are still limited. We reviewed coronavirus infections reported by ProMED and assessed the reliability of the data retrieved compared to published reports. We evaluated the effectiveness of ProMED as a source of epidemiological data on coronavirus. Methods: Using the keyword “coronavirus” in the ProMED search engine, we reviewed all the information from the reports and collected data using a structured form, including year, country, gender, occupation, the number of infected individuals, and the number of fatal cases.

Results: We identified 109 entries reported between February 29, 2000 and January 22, 2020. A total of 966 cases were reported, with death reported in 188 cases, suggesting an overall case fatality rate (CFR) of 19.5%. Of 70 cases for which the gender was reported, 47 (67.1%) were male. Most of the cases were reported from China, the United Arab Emirates, and Saudi Arabia, with reports from other countries, including imported cases in Europe and North America.

Conclusions: Internet-based reporting systems such as ProMED are useful to gather information and synthesize knowledge on emerging infections. Although certain areas need to be improved, ProMED provided useful information about coronaviruses especially during outbreaks.

Introduction

Coronaviruses are enveloped non-segmented positive-sense RNA viruses belonging to the family Coronaviridae (subfamily Orthocoronavirinae) and the order Nidovirales and broadly distributed in humans and other mammals [1,2], including four genuses, Alphacoronavirus, Betacoronavirus, Deltacoronavirus, and Gammacoronavirus. Although most human coronavirus infections are mild, the previous epidemics of two betacoronaviruses, the severe acute respiratory syndrome coronavirus (SARS-CoV) [3–7] and Middle East respiratory syndrome coronavirus (MERS-CoV) [8–11], have caused more than 10,000 cumulative cases in the past two decades, with mortality rates of 10% for SARS-CoV and 37% for MERS-CoV. The coronaviruses already identified might only be the tip of the iceberg, with potentially more novel and severe zoonotic events to be revealed [1]. Now, the 2019 novel CoV (2019-nCoV) have led to more than 17,400 cases and 362 death till February 2, 2020.

The global burden of coronavirus needs to be determined. In 2018, the World Health Organization (WHO) held its annual review of the Blueprint List of Priority Diseases, where Coronaviruses were considered and included. These diseases, given their potential to cause a public health emergency and the absence of efficacious drug and vaccine, are considered to need accelerated research and development [12]. Given the current situation of the 2019nCoV in China and multiple countries in different continents affected, the WHO declared this outbreak as a Public Health Emergency of International Concern (PHEIC) on Thursday, January 30, 2020 [13,14].

Introduction

Marek’s disease virus

Avian leukosis virus subgroup J

Influenza A virus

Other viruses

Pathways significantly enriched by the targets of dysregulated miRNAs during viral infection

Conclusions

Acknowledgments

References

Abstract

In poultry, viral infections (e.g., Marek’s disease virus, avian leukosis virus, influenza A virus, and so on) can cause devastating mortality and economic losses. Because viruses are solely dependent on host cells to propagate, they alter the host intracellular microenvironment. Thus, understanding the virus-host interaction is important for antiviral immunity and drug development in the poultry industry. MicroRNAs are crucial posttranscriptional regulators of gene expression in a wide spectrum of biological processes, including viral infection. Recently, microRNAs have been identified as key players in virus-host interactions. In this review, we will discuss the intricacies involved in the virus-host cross-talk mediated by host and viral microRNAs in poultry (i.e., chicken and ducks), as well as recent trends and challenges in this field. These findings may provide some insights into the rapidly developing area of research regarding viral pathogenesis and antiviral immunity in poultry production.

Introduction

Many types of viruses will cause high mortality rates and enormous economic losses to the poultry industry. For example, Marek’s disease virus (MDV) and avian leukosis virus can induce neoplastic diseases in chickens. Moreover, influenza A virus (IAV) is highly variable and can spread across species, thereby resulting in a threat to global public health. Therefore, the cross-talk between the host (i.e., chickens) and viruses during infections is critical to understanding viral pathogenesis and antiviral immunity in chicken production. Over the past decade, studies have attempted to depict the cross-talk between the host and virus from different aspects (e.g., microRNA [miRNAs] perspective) and have made progress in this area (Li et al., 2014a; Skalsky and Cullen, 2010).

miRNAs Are short noncoding 18- to 25-nucleotidelong RNAs that regulate gene expression at the posttranscriptional level. Substantial evidence demonstrates that a single miRNA can have extensive and crucial effects on a range of fundamental biological processes, and miRNA dysregulation can result in biological dysfunction and diseases (Bartel, 2004; Ha and Kim, 2014). Pathogen-induced phenotypic changes in hosts are always accompanied by remarkable alterations at the transcriptional level (Jenner and Young, 2005). The miRNA expression profile is profoundly influenced by viral infection and contributes to the repertoire of virus-host interactions. Differential miRNA expression can be attributed to both host antiviral defenses and alterations in cellular environment that are affected by viral factors (Scaria et al., 2007; Skalsky and Cullen, 2010; tenOever, 2013; Harwig et al., 2014; Powdrill et al., 2016; Nejad et al., 2018). Moreover, miRNAs have been reported to be biomarkers of viral infections (Wang et al., 2014) and have roles in viral reactivation from latency (Hicks et al., 2019). Therefore, the identification of deregulated miRNAs in virally infected chickens will provide novel insight into understanding virus-host interaction. In this review, we will summarize recent advances into the critical role of virally influenced poultry and viral miRNAs in the cross-talk between the host and virus to help understand viral pathogenesis and antiviral immunity in the poultry industry.

1. Introduction

2. Methods

3. Results

4. Discussion

Appendix A. Supplementary data

References

Abstract

Background: From the first Zika virus (ZIKV) description, it has progressively widespread worldwide. We analyzed demographic, clinical, microbiologic and travel-related characteristic from returned patients from a ZIKV endemic country in a referral Tropical Medicine Unit.

Method: A prospective cohort study performed in a Spanish referral center with the aim of determining the significant factors associated with confirmed Zika virus (ZIKV) infection

Results: 817 patients, (56% women, median age 36 [IQR, Interquartile Range: 32–42]) were enrolled. Most had returned from Latin America (n = 486; 59.4%), travelled for tourism (n = 404; 49.4%) and stayed a median of 18 days (IQR: 10–30). 602 (73.6%) presented symptoms, but only 25 (4%) were finally diagnosed with confirmed ZIKV infection (including two pregnant women, without adverse fetal outcomes), 88% (n:22) presented with fever and 92% (n:23) with rash. 56% (n:14) arthralgia and/or myalgia and 28% (n:7) conjunctivitis. The presence of conjunctivitis, fever and rash were associated with an 8.9 (95% CI: 2.2–34.9), 6.4 (95% CI: 1.2–33.3) and 72.3 (95% CI: 9.2–563.5) times greater probability of confirmed ZIKV infection, respectively

Conclusion: Travel characteristics and clinical presentation may help clinicians to optimize requests for microbiological testing. Diagnosis of arboviriasis in travellers arriving form endemic areas remains a challenge for clinicians, but must be detected for the possible transmission outside endemic areas, where the vector is present.

Introduction

Zika virus (ZIKV) disease has emerged as one of the greatest public health threats worldwide, attracting media attention for its significance and repercussions. The shortage of reported cases in Africa and Asia since its first isolation in Uganda in 1947 [1] led to an initial lack of information about the disease. Characterization of patients during the outbreaks on Yap Island (2007) [2]and French Polynesia (2013) [3] enabled description of the primary characteristics of the disease. A more complete spectrum of ZIKV disease, however, including new routes of infection and associated complications, has been outlined while the infection has explosively spread across Americas since 2015 [4–6].

The growing numbers of investigators, publications and funded projects related to ZIKV infection in recent years reflect the importance of the disease for the scientific community. The identification of novel pathways in fetal microcephaly [7] and the development of a preventive ZIKV vaccine [8] are some examples of the exponential increase in ZIKV research. However, and despite the evident advances achieved, there are still areas of ignorance.

Diagnosis of ZIKV remains a challenge due to serologic cross-reactions and clinical similarity of ZIKV infection with other flaviviruses, e.g. dengue.This fact, together with limited access to diagnostic tests in endemic countries, has led to underdiagnosis in many cases, making it difficult to estimate the real risk of infection for both the endemic population and travelers [5].

2- Case Presentation

3- Discussion

4- Conclusions

References

Introduction

Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are common viral infections that share routes of transmission through unprotected sex and exchanging needles/syringes. HBV and HCV coinfections are widespread among HIV-infected patients worldwide, which cause long-term illness to chronic hepatitis and death. Viral hepatitis progresses faster in HIV-infected patients compared to those without HIV. Although the antiretroviral therapy (ART) extended the life expectancy of people with HIV, viral hepatitis associated with HBV and HCV becomes the primary cause of morbidity and mortality. As documented, 36.7 million people are living with HIV/AIDS, and 1 million died of HIV-related illness worldwide in 2016. Among them, 3.5 million people are covered by Southeast Asia [1]. In Nepal, 30,646 people are HIV positive, and common risk groups were client of sex workers (34.1%), IDU (10.5%), migrant workers (9.3%), spouse migrants (6.3%), sex workers (4.9%), men having sex with men (1.8%), blood/blood products (0.4%), and others (32.8%) [2]. *e estimated global prevalence of people living with chronic HBV and HCV infection was 240 and 184 million, respectively [3, 4]. *e burden and clinical severity of HBV/HCV coinfection in HIV-infected people are rare but require continued follow-up with frequent testing of serum markers as well as molecular detection and quantification of viral nucleic acids with careful observation. *e molecular testing of HBV and HCV coinfections in a key population of HIV patients is convincing to estimate the true prevalence that provides accurate and justifiable data. However, the data of HBV/HCV coinfection in Nepalese population are infrequently recognized, uneven quality, uncategorized, scattered, and rarely reported. In this case report, we present a rare case of HBV and HCV coinfections in an HIV-1-infected patient with an improved CD4+ count but detectable viral loads after ART. Such triple coinfections in the patient from developing countries like Nepal provide an opportunity to access the effects of viral hepatitis coinfection on immediate and longstanding outcomes after antiretroviral therapy. Also, coinfection could be an exciting model for viral interaction studies and their clearance in response to immune cells.

Numerous studies have demonstrated that exposure to live poultry or live poultry markets is the significant risk factor for human infection with avian influenza A(H7N9). However, the specific live poultry markets that are major infection sources for A(H7N9) human cases have not been explored in detail. In this study, we extract data associated with poultry farms, live poultry markets and farmers’ markets from Baidu Map using the JavaScript language and then construct the live poultry transport network. From this, we establish our A(H7N9) transmission model over the network based upon probabilistic discrete-time Markov chain. On the basis of the obtained network and model, we propose spatiotemporal backward detection and forward transmission algorithms to detect the most likely infection sources and to compute the first arrival times of the infection sources. Our simulations use these algorithms to identify the specific locations of the infection sources, the first arrival times of the infection sources and the most likely transmission map of the A(H7N9) virus along the live poultry transport network. The results reveal that, in addition to the hazards posed by the live poultry markets, backyard poultry also contributed to A(H7N9) human infections; this risk source was significant especially in the newly affected provinces, in the fifth wave of infection. In particular, by analyzing the temperature characteristics at a given location when the infection source arrived, we find that the risk of human infection with the influenza A(H7N9) virus was high under 9 ◦C∼19◦C; moderate under 0◦C∼9 ◦C or 19◦C∼25◦C; and low for temperatures < 0 ◦C or > 25◦C. Our results suggest that strengthening the supervision of the live poultry market system and immunizing poultry at both live poultry markets and the backyard poultry operations under the high risk temperature band of 9 ◦C∼19◦C, will be able to significantly contribute to the control of avian influenza A(H7N9) in the future.

Introduction

The novel avian influenza A(H7N9) virus emerged in 2013. It is a bird flu strain of the influenza virus A (avian influenza virus or bird flu virus) [1]. The avian influenza A(H7N9) virus is only transmitted between poultry or from poultry to human. Human can be infected through direct exposure to poultry, poultry secretions or excreta, inhalation of viral aerosols, and exposure to environments contaminated with the virus [2]–[4]. Human cases of A(H7N9) infection have occurred since 2013, during the annual winter-spring epidemics in mainland China [5], [6]. After peaking in 2013-2014, the human infection cohort in subsequent epidemics was generally smaller [7], but it sharply increased in the fifth epidemic wave in December 2016 [8]. This fifth epidemic wave (lasting from October 1st, 2016, to September 31st, 2017) was the most significant up until that point; 746 human cases were reported across 27 provinces in mainland China. The A(H7N9) virus strains circulating among poultry had been classified as low pathogenicity avian influenza (LPAI) in the previous four epidemic waves in China [9], but evolved to be highly pathogenic in poultry in the fifth epidemic wave [10]. The earlier start date, larger epidemic size, wider epidemic range and higher pathogenicity in the fifth epidemic wave A(H7N9) prompted panic and aroused public concern. Most of the confirmed A(H7N9) cases in human had an etiology involving a history of recent exposure to live poultry or potentially contaminated environments, especially the live poultry markets, where live poultry is sold [11], [12].

Gastrointestinal infections account for a large burden of acute and chronic disease worldwide. Diarrhea is defined as 3 or more stools in 24 hours and is the most common manifestation. It is defined as acute if lasting less than 7 days, prolonged if lasting 7 to 13 days, persistent if lasting 14 to 29 days, and chronic if lasting 30 days or longer.1 Common bacterial, viral, and parasitic pathogens are spread via food, via contaminated water, or from person to person. According to the World Health Organization, diarrhea is the cause of 4% of deaths globally and kills approximately 2.2 million people each year.2 Those in developing countries, and particularly children, are most affected. In the United States, not all cases are actively reported, but it is approximated that 179 million cases of acute diarrhea in adults occur each year, resulting in 500,000 hospitalizations and more than 5000 deaths.3 Nationally, children less than 5 years old account for the largest portion of infections, but those older than 65 years old account for greatest number of hospitalizations and deaths.4 Despite modern advances in food preparation and delivery, gastrointestinal infections in the United States are commonly caused by food-borne pathogens. In 2011, it was found that norovirus (58%) caused the most food-borne infections followed by nontyphoidal Salmonella spp (11%), Clostridium perfringens (10%), and Campylobacter spp (9%). Nontyphoidal Salmonella spp (35%) was the leading cause of hospitalization followed by norovirus (26%), Campylobacter spp (15%), and Toxoplasma gondii (8%). Nontyphoidal Salmonella spp (28%) also caused the most deaths followed by T gondii (24%), Listeria monocytogenes (19%), and norovirus (11%).3 Diarrhea also accounts for the largest number of travel-related illness in the United States, with acute diarrhea accounting for 22% of travel-related diagnoses in US residents.5 Areas with the highest risk of acquiring traveler’s diarrhea include Africa, South Asia, Latin America, and the Middle East. Risk is increased for those taking medications that lower gastric acid.6 Traveler’s diarrhea (Table 1) is more likely bacterial in contrast to infectious diarrhea acquired in the United States, which is most commonly viral. Protozoa are less common causes of traveler’s diarrhea but may result in longer duration or persistence of symptoms upon return to the United States.