Isolation of Elizabethkingia anophelis From COVID-19 Swab Kits

Purpose: To investigate and characterize the putative Elizabethkingia anophelis contaminant isolated from throat and anal swab samples of patients from three fever epidemic clusters, which were not COVID-19 related, in Shenzhen, China, during COVID-19 pandemic.Methods: Bacteria were cultured from throat (n = 28) and anal (n = 3) swab samples from 28 fever adolescent patients. The isolated bacterial strains were identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF/MS) and the VITEK2 automated identification system. Nucleic acids were extracted from the patient samples (n = 31), unopened virus collection kits from the same manufacturer as the patient samples (n = 35, blank samples) and from unopened throat swab collection kits of two other manufacturers (n = 22, control samples). Metagenomic sequencing and quantitative real-time PCR (qPCR) detection were performed. Blood serum collected from patients (n = 13) was assessed for the presence of antibodies to E. anophelis. The genomic characteristics, antibiotic susceptibility, and heat resistance of E. anophelis isolates (n = 31) were analyzed.Results: The isolates were identified by MALDI-TOF/MS and VITEK2 as Elizabethkingia meningoseptica. DNA sequence analysis confirmed isolates to be E. anophelis. The patients’ samples and blank samples were positive for E. anophelis. Control samples were negative for E. anophelis. The sera from a sub-sample of 13 patients were antibody-negative for isolated E. anophelis. Most of the isolates were highly homologous and carried multiple β-lactamase genes (blaB, blaGOB, and blaCME). The isolates displayed resistance to nitrofurans, penicillins, and most β-lactam drugs. The bacteria survived heating at 56°C for 30 min.Conclusion: The unopened commercial virus collection kits from the same manufacturer as those used to swab patients were contaminated with E. anophelis. Patients were not infected with E. anophelis and the causative agent for the fevers remains unidentified. The relevant authorities were swiftly notified of this discovery and subsequent collection kits were not contaminated. DNA sequence-based techniques are the definitive method for Elizabethkingia species identification. The E. anophelis isolates were multidrug-resistant, with partial heat resistance, making them difficult to eradicate from contaminated surfaces. Such resistance indicates that more attention should be paid to disinfection protocols, especially in hospitals, to avoid outbreaks of E. anophelis infection.

Environmental Surveillance of Legionella spp. in an Italian University Hospital Results of 10 Years of Analysis

The occurrence of Legionella spp. in the water distribution systems of large hospitals and other healthcare facilities is considered particularly dangerous, due to the critical nature of the hospitalized patients. The aim of this study is to present a pluri-annual environmental surveillance in a large university hospital assessing the prevalence of Legionella spp. and underlining its variability over the years. The samples of water were collected in accordance with the Italian National Guidelines and the sampling sites considered in this study were selected favoring wards with very high-risk patients and with patients at increased risk. The laboratory analyzed a total of 305 water samples deriving from 24 different sampling points. Legionella spp. were detected in 39.4% of samples, the majority of which were contaminated by Legionella pneumophila serogroups 2–14 (68.7%). Statistically significant differences were found among different seasons with a linear trend in positive proportion from summer to spring. Several experimental interventions to prevent and reduce Legionella colonization were attempted, but there is no a definitive method for the complete eradication of this microorganism. The permanent monitoring of hospital water distribution systems is fundamental to preventing the potential risk of nosocomial Legionellosis and to implementing procedures to minimize the risk of Legionella spp. colonization.

Interdisciplinary approach to surgical treatment for patients with hypertrophic obstructive cardiomyopathy

Hypertrophic cardiomyopathy (HCM) – is the most common genetically determined heart disease, characterized by symmetrical or asymmetrical myocardial thickening (≥15 mm), leading to progressive heart failure and a high risk of sudden cardiac death (SCD). Diagnosis, natural course and treatment of HCM have become sources of uncertainty, misunderstanding and debate due to the increasing complexity of diagnosis in clinical practice, international differences in strategic approaches, advances in the treatment of genetic diseases and cardiac imaging. The aim. To amplify the current concept of HCM pathogenesis and mechanisms of the left ventricular outflow tract (LVOT) obstruction as well as to highlight our own results of HCM surgical correction. Materials and methods. A total of 330 HCM patients underwent surgical correction (septal myectomy) in the National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine. The mean age of the patients was 49.7 ± 15.0 years, median – 53; 168 (50.9 %) were male. Results. Surgical correction of HCM significantly improves the quality of life (80 % of patients were in NYHA II functional class after correction), reduces the symptoms of heart failure (93 % of patients had minimal mitral regurgitation after septal myectomy), decreases LVOT systolic pressure gradient (SPG) (the mean SPG was 18.9 ± 8.5 mmHg versus preoperative 93.6 ± 23.2 mmHg) and lowers the high-risk for SCD in the patients (the mean percentage of high-risk group was 3.78 % after correction). Routine CT planning and intraoperative transesophageal echocardiography helps to avoid severe iatrogenic complications and resect the interventricular septum as accurately as possible, completely eliminating LVOT obstruction. Conclusions. Secondary abnormal chordal attachment cutting, papillary muscle realignment and anterior mitral leaflet plication along with septal myectomy allows to fully correct all phenotype of HCM, is the safe and effective procedure as well as the definitive method of this pathology treatment minimizing the risk of disease recurrence.

Craniofacial morphometric analysis as a differentiation tool in mystax group of Saguinus Hoffmannsegg, 1807 (Cebidae, Callitrichinae): a preliminary test

This study provides a quantitative assessment of the craniofacial variation among recognized species and subspecies in the Saguinus mystax species group and tests the reliability of the proposed method in detecting differences among taxa. Thirty measurements were taken of 66 tamarin specimens. We used non-parametric MANOVA to test for differentiation among species and among subspecies. Interspecific analyses showed significant variation among species, except for S. inustus. We detected significant differentiation between S. mystax mystax and S. m. pileatus, whereas no significant morphometric difference was found between S. imperator subspecies. Measurements presenting some differentiation among species were selected for subsequent analysis of variance. Univariate analyses detected significant differences among species only for three measurements. Our results suggest that the cranial morphometric variation has limited information to discriminate among the taxa in the S. mystax group. However, we cannot disregard the lack of statistical power due to small sampling in some taxa, absence of some subspecies in the analyses, or even lack of informativeness of the chosen measurements. Morphometric analyses was insufficient to demonstrate complete differentiation in Saguinus. The use of morphometric analyses should not be considered as a definitive method for taxa differentiation and delimitation in Saguinus.

Endobronchial Watanabe spigot complementing prophylactic balloon blocker in the management of post-transbronchial cryobiopsy bleeding

Transbronchial cryobiopsy (TBCB) is performed to aid diagnosis of interstitial lung disease, of which bleeding is a potentially life-threatening complication. Post-TBCB management involves temporary balloon blockade, bronchial artery embolisation (BAE) or surgery. Bronchial occlusion by endobronchial Watanabe spigot (EWS) as the definitive method of bleeding control post TBCB has not been described. A 56-year-old male underwent TBCB to aid diagnosis of interstitial lung disease. TBCB had been performed at RB4 (lateral segment of right middle lobe) with a prophylactic balloon blocker. However, prolonged bleeding was observed upon deflation of the balloon blocker. Haemostasis was secured with successful deployment of EWS into RB4, with no evidence of rebleeding in surveillance bronchoscopy and chest radiographs. EWS was kept in situ for four days and subsequently removed. The patient was discharged with good functional status. This case demonstrates that EWS placement may be considered for definitive management of low-volume post-TBCB bleeding, especially when BAE and surgical intervention are not possible.

Concentration, distribution and probabilistic health risk assessment of exposure to fluoride in drinking water of Hormozgan Province, Iran

In the present study, the health risk assessment of exposure to fluoride in drinking water of southern Iran province was performed with a definite and probabilistic approach. Monte Carlo simulation and sensitivity analysis were used for uncertainty in risk estimation. The results showed that fluoride concentration ranged between 0.1–0.9 mg/l with an average of 0.454 ± 0.205 mg/l. The distribution function followed the normal distribution. The highest fluoride concentration was observed in the central and northern regions of the province. Also, the lowest concentration was obtained 0.01 mg/l. In the definitive method, the non-carcinogenic risks associated with fluoride in drinking water were in acceptable range (HQ < 1). Conducting Monte Carlo simulation indicated that the potential non-carcinogenic risk for children in the 95th percentile exceeded the safe limit of 1, which showed that there were a potential non-carcinogenic in this group. Sensitivity analysis showed that fluoride concentration and water consumption had the most considerable effect in the model. Therefore, consumption of water and foods containing fluoride along with excessive consumption of tea may increase human's health risks. Therefore, continuous monitoring of water sources in terms of fluoride concentration along with proper diet training for residents of this province should be done.

Cytogenetic bio-dosimetry techniques in the detection of dicentric chromosomes induced by ionizing radiation: A review

Ionizing radiation is ubiquitous in the environment. Its source can be natural, such as radioactive materials present in soil and cosmic rays, or artificial, such as the fuel for nuclear power plants. Overexposure to ionizing radiation may damage living tissue and could cause severe health problems (i.e., mutations, radiation sickness, cancer, and death). Cytogenetic bio-dosimetry has the great advantage to take into account the inter-individual variation, and it is informative even when physical dosimetry is not applicable; moreover, it is the definitive method to assess exposure to ionizing radiation recommended by the World Health Organization (WHO). Such a procedure involves counting the frequency of dicentric chromosomes (DCs), which are the most studied chromosomal aberrations used as absorbed radiation biomarkers, during the metaphase of cells. A set of algorithms, tested on different programming languages to automatically identify DCs, is analyzed by the authors together with an Automated Dicentric Chromosome Identifying software (ADCI) mostly based on OpenCV programming libraries. The purpose of this work is to review the main results regarding the correlation between ionizing radiation and dicentric chromosomes in cytogenetic bio-dosimetry.

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. We review advancements over the last two decades in our understanding and management of VUR. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often involved. Some factors that increase the likelihood of persistence (e.g., high grade) also increase the risk of renal scarring. Voiding cystourethrography (VCUG) is generally considered the definitive method for diagnosing VUR, and helpful in determining the need for treatment. However, this procedure causes distress and radiation exposure. Therefore, strategies to reduce clinicians' reliance upon VCUG (e.g., after a VUR treatment procedure) have been developed. There are several options for managing patients with VUR. Observation is suitable only for patients at low risk of renal injury. Antibiotic prophylaxis can reduce the incidence of UTIs, but drawbacks such as antibiotic resistance and incomplete adherence mean that this option is not viable for long-term use. Long-term studies of endoscopic injection have helped us understand factors influencing use and the effectiveness of this procedure. Ureteral reimplantation is still performed commonly, and robot-assisted laparoscopic methods are gaining popularity. Over the last 20 years, there has been a shift toward more conservative management of VUR with an individualized, risk-based approach. For continued treatment improvement, better identification of children at risk of renal scarring, robust evidence regarding the available interventions, and an improved VUR grading system are needed.

Clinical, dermoscopic, and histopathological evaluations of patients with nail disorders

Objective: This study aimed to assess the possible role of dermoscopy in the diagnosis of different nail disorders compared with the clinical and histopathological diagnosis. Methods: This study included 104 patients with any nail disorders of both sex and any age. All the patients were subjected to a detailed medical history taken, clinical general examination, clinical and dermoscopic examinations of 20 nails. Potassium hydroxide examination was used to examine all patients with suspicious of onychomycosis. Histopathological evaluation was used to examine of clinically ambiguous nail disorders. Results: The most common nail diseases were onychomycosis (54.81%) followed by nail psoriasis (19.2%), and nail lichen planus (3.8%). Conclusion: Clinical evaluation was an important in diagnosis of different nail diseases. Nail dermoscopy could confirm clinical diagnosis and help in getting an accurate diagnosis of nail diseases and guide in the management of nail diseases by permitting better visualization of nail structure and pathology. Histopathological examination provided the most definitive method in reaching an accurate diagnosis due to it could provide etiologic, diagnostic, and prognostic information. There was good agreement between clinical, dermoscopic, and histopathological examinations for accurate diagnosis of different nail diseases.

Anatomical Analysis and Feasibility Study of Next-Generation Fenestrated or Branched Stent-Grafts for the Treatment of Arch Aneurysms

Purpose: To analyze the anatomical characteristics of arch aneurysms and evaluate the anatomical feasibility of 4 next-generation stent-grafts with either branched or fenestrated configurations. Materials and Methods: A retrospective analysis was conducted of 213 patients (mean age 75.0±7.1 years; 179 men) with arch aneurysms treated using total arch replacement or zone 0 or 1 thoracic endovascular aortic repair (TEVAR) from 2007 to 2017 at 2 Japanese hospitals. Anatomical analyses were performed using the centerline of flow technique on a 3-dimensional workstation. The anatomical feasibility of the Zenith A-branch, TAG Thoracic Branch Endoprosthesis (TBE), Terumo Aortic Relay Plus Double Branched (DB), and fenestrated Najuta stent-grafts were evaluated based on the instructions for use (IFU). Results: The mean lengths from the sinotubular junction (STJ) to the innominate artery (IA) and from the IA to the left common carotid artery were 114.9±15.9 and 12.8±5.6 mm, respectively. The mean aortic diameters at the STJ and IA were 31.3±3.4 and 34.1±5.3 mm, respectively. In terms of feasibility, 5.2% of patients were within the Zenith A-branch IFU, 40.8% for the TAG TBE, 24.9% for the Relay Plus DB, and 13.6% for the Najuta. Significant (>50% circumference) thrombus/calcification at the sealing zone affected nearly half of the patients, but there is currently no standardized definition or evaluation method for “significant” thrombus/calcification. Conclusion: Only 5% to 41% of arch aneurysm patients are anatomically suitable for TEVAR using any one of the next-generation branched or fenestrated stent-grafts. Furthermore, a definitive method of evaluating the thrombus/calcification burden needs to be established in future IFU.