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Objective:To investigate the appropriate pretreatment methods for single cell RNA sequencing of airway aspirate cells.Methods:Four fresh airway aspirate specimens were collected from four patients with acute respiratory tract infections. These specimens were digested with airway aspirate digester and prepared into single cell suspension. The cells were used for library construction directly (DE), or fixed with 10×Genomics Chromium Next GEM Single Cell Fixed RNA Sample Preparation Kit and then mixed to construct the library (DF), or cryopreserved, thawed, fixed (FF) before mixed to construct the library. All three methods were treated with oil emulsion using 10 4 cells and subjected to single-cell sequencing using the 10×Genomics platform. The number of obtained cells, data quality, annotated cell types and expression of marker genes were analyzed. Differences in the expression of highly variable genes (HVGs) of the same cell subsets obtained by the three pretreatment methods were compared using Pearson correlation. Expression of the differentially expressed genes in the same cell subpopulation obtained by different pretreatment methods was also compared. The correlation of the expression of differentially expressed genes between the same cell subsets obtained by the three pretreatment methods was analyzed by Pearson correlation. Results:The median numbers of single cells obtained using DE, FF and DF methods were 2 733, 1 140 and 5 897 ( P>0.05). The unique molecular identifiers were higher than 500. The median numbers of genes obtained using the three methods were 801, 887 and 1 259 ( P>0.05). The cells with novelty score over 0.8 accounted for 99%, 87% and 93%, respectively. There were nine cell subsets obtained by the three methods, including squamous cells, secretory cells, ciliated cells, T cells, B cells, macrophages, plasma cells and neutrophils. DF and FF methods could obtain more basal cells with specific high expression of keratin 5 than DE method. The differentially expressed and highly variable genes in the same cell subsets obtained by the three pretreatment methods showed high consistency in their expression with a significant correlation ( P<0.001). Conclusions:Under the same sequencing data volume, the quality of data obtained from fixed airway aspirate single-cell suspensions using the method of probe hybridization and transcriptome sequencing was comparable to that obtained directly from fresh cells. This method was more suitable for the pretreatment of clinical samples used for single-cell RNA sequencing.
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Objectives: The objective is to observe the functional outcome of early stages of osteoarthritis knee treated with Bone marrow aspirate concentrate (BMAC) and Intraarticular steroid A total of 60 Methods: patients of both genders aged 45–60 years were included in the study. 5ml - 10ml of Bone marrow was aspirated under local anaesthesia from iliac crest, ipsilateral / contralateral to the knee, with a bone marrow aspiration needle and was centrifuged and processed. 40 mg of Triamcinolone was mixed with BMAC and was administered in the knee joint. This procedure was done under Day Care. At 6-month follow-up, BMAC injection with 40 mg triamcinolone signi?cantly improved knee pain and Results: function. BMAC injection with 40 mg triamcinolone signi?cantly improved knee pain and function in early stages of Conclusion: osteoarthritis knee
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SUMMARY: Bioactive glass (BG) induces osteogenesis of damaged bone, causing excessive bone formation. This study included a morphological and morphometrical data of the bone tissue regeneration by filling bone defects with BG with autologous native platelet rich plasma (PRP) or fibrin (PRF) and aspirate of bone marrow (ABM). The parameters of newly formed bone in rabbits bone defect were analyzed and compared with terms 4th and 12th week. The groups with ABM-BG, PRF-BG and PRP-BG have shown common tendency: development of newly formed bone tissue, the external contour of the bone has been enlarged; an additional trabecular bone has been formed under the cortical layer, which has often been limited by a solid compact bone from the bone marrow. The induced osteogenesis resulted in the appearance of a significant amount of bone tissue exceeding the original size of the defect. Increased density of the newly formed tissue at the defect level relative to ABM-BG was detected in the PRF-BG group at 12 weeks and PRP-BG at 4 and 12 weeks (p<0.05). In this case, the bone thickness in the substituted defect was greater in the ABM-BG group. The number of newly formed bone tissue in the ABM-BG group at 4 weeks also exceeded the value of the BG group, but the density of such bone did not differ between the groups. That is, ABM-BG stimulated greater trabecular bone formation and fibrous reticular tissue was located in the lacunae between trabeculae. These results indicate that the additional use of tissue technology (ABM, platelet plasma) facilitated osteogenesis, and the newly formed bone tissue was tightly coupled and remodeled to the cortical bone layer in the form of compact bone tissue. PRP, to a greater extent than ABM, promoted the formation of compact bone tissue.
RESUMEN: El vidrio bioactivo (VB) induce la osteogénesis del hueso dañado, provocando una formación excesiva de hueso. Este estudio incluyó datos morfológicos y morfométricos de la regeneración del tejido óseo mediante el llenado de defectos óseos con VB con plasma rico en plaquetas (PRP) nativo autólogo o fibrina (PRF) y aspirado de médula ósea (AMO). Se analizaron los parámetros de hueso recién formado en el defecto óseo de conejos y se compararon a las 4 y 12 semanas. Se observó una tendencia similar en los grupos con AMO-VB, PRF-VB y PRP-VB: el desarrollo de tejido óseo recién formado, aumentó el contorno externo del hueso; formación de un hueso trabecular adicional debajo de la capa cortical, que a menudo ha estado limitada por un hueso sólido compacto de la médula ósea. La osteogénesis inducida dio como resultado la aparición de una cantidad significativa de tejido óseo que excedía el tamaño original del defecto. Se detectó un aumento de la densidad del tejido recién formado a nivel del defecto en relación con AMO-VB en el grupo PRF-VB a las 12 semanas y PRP-VB a las 4 y 12 semanas (p <0,05). En este caso, el grosor óseo en el defecto sustituido fue mayor en el grupo AMO-VB. El número de tejido óseo recién formado en el grupo AMO- VB a las 4 semanas también excedió el valor del grupo VB, pero la densidad de dicho hueso no cambió entre los grupos. Es decir, AMO-VB estimuló una mayor formación de hueso trabecular y se localizó en el tejido reticular fibroso en las lagunas entre trabéculas. Estos resultados indican que el uso adicional de tecnología de tejidos (AMO, plasma plaquetario) facilitó la osteogénesis, y el tejido óseo recién formado se acopló y remodeló estrechamente a la capa de hueso cortical en forma de tejido óseo compacto. El PRP, en mayor medida que el AMO, promovió la formación de tejido óseo compacto.
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Animals , Rabbits , Bone Regeneration , Bone Substitutes , Platelet-Rich Plasma , Glass/chemistry , Biocompatible MaterialsABSTRACT
Objective: To compare the outcomes of steroid-associated osteonecrosis of the femoral head in patients with systemic lupus erythematosus who underwent conservative treatment and concentrated autologous bone marrow aspirate transplantationMethods: Osteonecrosis of the femoral head was classified according to the Japanese Investigation Committee system. Concentrated autologous bone marrow aspirate transplantation was performed by aspirating the bone marrow from both iliac crests and then transplanting it to the necrotic area after the core decompression. Patients with >2-year follow-up after the concentrated autologous bone marrow aspirate transplantation in our institution (Group I) and those with >2-year follow-up after the first hospital visit in a cooperative institution (Group II) were included in this study. After a randomized matching based on age, sex, type, stage, and etiology, the collapse rate in pre-collapsed stages and total hip arthroplasty conversion rate in all stages were compared between the two groups.Results: After the matching adjustment, 33 pairs of hips were included. Preoperatively, 1, 2, 16, and 14 hips were classified as types A, B, C1, and C2, respectively, and 15, 13, 2, and 3 hips were classified as stages 1, 2, 3A, and 3B, respectively. The collapse rates in the pre-collapsed stages were 68% and 39% in Groups I and II, respectively. Total hip arthroplasty conversion rates were 33% and 45% in Groups I and II, respectively. However, Group I had significantly higher and lower conversion rates in stages 1 and 3, respectively (both P<0.05).Conclusion: Conservative treatment may be preferable in stage 1 hips. In addition, concentrated autologous bone marrow aspirate transplantation may prevent further collapse in stage 3.
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OBJECTIVES@#To study the consistency between nasopharyngeal aspirates (NPA) and bronchoalveolar lavage fluid (BALF) in pathogen detection in children with pneumonia@*METHODS@#A retrospective analysis was performed on the data of pathogens detected in 533 children with pneumonia from February 2017 to March 2020. The paired McNemar's test was used to compare the difference in pathogen detection between NPA and BALF groups. The @*RESULTS@#NPA had a sensitivity of 28%, a specificity of 74%, a positive predictive value of 14%, and a negative predictive value of 91% in detecting bacteria, and a @*CONCLUSIONS@#There is poor consistency between NPA and BALF in the detection of bacteria and viruses, and clinicians should be cautious in diagnosing lower respiratory tract infection based on bacteria or viruses detected in NPA. There is moderate consistency between NPA and BALF in the detection of
Subject(s)
Child , Humans , Bronchoalveolar Lavage Fluid , Mycoplasma pneumoniae , Pneumonia , Pneumonia, Mycoplasma , Respiratory Tract Infections , Retrospective StudiesABSTRACT
Background@#Pulmonary TB in children remains to be a burden in the Philippines. Diagnosis remains to be a challenge for pediatricians due to its paucibacillary nature, difficulty in obtaining specimens, cost of test as well as the varied sensitivity of the different tests available. Gastric aspirate (GA), commonly used for bacteriological diagnosis of pulmonary tuberculosis (PTB) in children, involves an invasive procedure that may cause discomfort and sometimes require admission. Nasopharyngeal aspirate (NPA), on the other hand, can be easily and non-invasively obtained but is currently not a recommended specimen for testing for PTB. @*Objectives@#This study aims to determine the accuracy of NPA GeneXpert in diagnosing PTB among pediatric patients 0-18 years old with presumptive TB using GA GeneXpert as the initial screening test and GA TB culture as gold standard. @*Methodology@#This prospective, cross-sectional diagnostic study involved collection of single NPA and GA specimens for GeneXpert and TB culture in 100 patients with presumptive PTB seen at a tertiary government hospital in the Philippines. @*Results@#Of the one hundred pediatric patients (mean age 6 ± 5.63 years) enrolled, 50 were clinically diagnosed PTB, 16 bacteriologically-confirmed and 34 were not PTB disease. Sensitivity, specificity and predictive values with 95% confidence intervals of the NPA GeneXpert were determined compared to GA GeneXpert and GA culture. Sensitivity, specificity, positive and negative predictive values of the NPA GeneXpert compared to GA GeneXpert were 70%, 96.67%, 70% and 96.67%, respectively. While NPA GeneXpert compared to GA TB culture were 40%,91.58%, 20% and 96.67%, respectively. @*Conclusion@#GeneXpert testing on a single NPA specimen is a highly specific and rapid test that can be used to diagnose PTB in pediatric patients, particularly where gastric aspiration or mycobacterial culture is not feasible.
Subject(s)
Tuberculosis, PulmonaryABSTRACT
Objective: To analyze the effectiveness of percutaneous injection of autologous concentrated bone marrow aspirate (cBMA) combined with platelet-rich plasma (PRP) in the treatment of delayed fracture healing. Methods: A prospective, randomized, controlled, single-blind case study was conducted. Between March 2016 and July 2018, 66 patients who met the inclusion and exclusion criteria for delayed fracture healing but had solid internal fixation of the fracture end were randomly divided into control group (31 cases, treated with percutaneous autogenous bone marrow blood injection) and study group (35 cases, treated with percutaneous autogenous cBMA+PRP injection). General data such as gender, age, body mass index, site of delayed fracture healing, length of bone defect at fracture end, and preoperative radiographic union score for tibia (RUST) showed no significant difference between the two groups ( P>0.05). Before injection, Kirschner wire was used in both groups to stimulate the fracture end and cause minor injury. The fracture healing time, treatment cost, and adverse reactions were recorded and compared between the two groups. Visual analogue scale (VAS) score was used to evaluate pain improvement. The tibial RUST score was extended to the tubular bone healing evaluation. Results: No infection of bone marrow puncture needle eyes occurred in both groups. In the control group, local swelling was obvious in 5 cases and pain was aggravated at 1 day after operation in 11 cases. In the study group, postoperative swelling and pain were not obvious, but 2 cases presented local swelling and pain. All of them relieved after symptomatic treatment. Patients in both groups were followed up, the follow-up time of the control group was 16-36 months (mean, 21.8 months), and the study group lasted 14-33 months (mean, 23.2 months). The amount of bone marrow blood was significantly lower in the study group than in the control group ( t=4.610, P=0.000). The degree of postoperative pain in the study group was less than that in the control group, and the treatment cost was higher than that in the control group. But the differences between the two groups in VAS score at 1 day after operation and treatment cost were not significant ( P>0.05). Fracture healing was achieved in 19 cases (61.3%) in the control group and 30 cases (85.7%) in the study group. The difference in fracture healing rate between the two groups was significant ( χ2=5.128, P=0.024). Fracture healing time and RUST score at last follow-up were significantly better in the study group than in the control group ( P<0.05). At last follow-up, RUST scores in both groups were significantly improved when compared with those before operation ( P<0.05). Conclusion: Autogenous cBMA combined with PRP percutaneous injection can provide high concentration of BMSCs and growth factors, and can improve the fracture healing rate and shorten the fracture healing time better than autogenous bone marrow blood injection.
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Background: The aim was to determine utility of Cartridge based nucleic acid amplification test (CBNAAT) in diagnosis of mycobacterium tuberculosis in children with neurotuberculosis diagnosed on the basis of clinical evaluation, CSF findings and neuroimaging.Methods: A prospective randomized controlled trial was conducted in Pediatric Department of RNT Medical College, Udaipur, Rajasthan, India from July 2017 to June 2018. Total 110 children of age group of 6 months to 18 years with the diagnosis of tubercular meningoencephalitis (TBME) on the basis of clinical evaluation, CSF examination and neuroimaging were included in the study.Results: A total 110 children were enrolled. Maximum number of cases admitted with TBME were among 1-5 years of age group (60.91%). CSF and gastric aspirate were examined by CBNAAT for MTB. 5 (4.55%) children had CBNAAT positivity in CSF. Gastric aspirate was positive among 16 (14.55%) children. None of the patient had CBNAAT positive result both in CSF and gastric aspirate.Conclusions: TBME is a major health problem in children below 5 years. Gene Xpert assay has the potential to significantly improve and escalate the diagnosis of smear-negative body fluid specimens. CBNAAT for mycobacterium tuberculosis was positive in 5 (4.55%) children from CSF and 16 (14.55%) from gastric aspirate. Negative CBNAAT should not prevent any patient with suspected features of TBME from starting anti tubercular treatment (ATT) as sensitivity of this test remains low. Final judgement to start ATT should be based on clinical, biochemical and radiological profile especially in CNS tuberculosis.
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Keratocystic odontogenic tumour (KCOT) is a cystic lesion of the jaws with tumourbehaviour. Its high prevalence rate makes it one of the commonest cystic lesions especially involving the lower jaw. The characteristic histologic features and aggressive nature corresponds to the high recurrence rate associated with KCOT. Lesion expands mostly in an anteroposterior direction and can cause extensive bone destruction before the appearance of any clinical symptoms. The characteristic radiological picture is that of a multilocular cystic lesion with the common differential diagnosis being dentigerous cyst and ameloblastoma. Here we are presenting a case of KCOT of the left lower jaw of size 10.9×7.86×8.54 cm. It is a huge multilocular cystic lesion extending from the right canine region to the left side involving the body, ramus, coronoid and condyle. Various management options are there ranging from enucleation and chemical cauterization to resection and reconstruction depending upon the size of the lesion. In this case we were not able to perform the ideal treatment option for the case because of the multiple drug allergy the patient was having, including most of the general anesthetic agents. Also the patient was not willing for any extensive procedure under general anesthesia. So we had to follow a compromised treatment plan aiming to reducethe size of the lesion, to improve the aesthetics and frequent follow up
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Background: Osteoarthritis (OA) of the knee is a very common musculoskeletal disorder. Although total knee replacement is a suitable option in the treatment of severe OA, it has some limitations when performed in the early stage and early age. Bone marrow aspirate concentrate (BMAC), which is rich in mesenchymal stem cells, is promising due to its potentially regenerative and symptomatic effects in many disorders of the musculoskeletal system. This study aims to investigate the efficacy of BMAC in terms of functional recovery in OA of the knee joint.Methods: Total of 52 patients with unilateral symptomatic knee OA but no inflammatory disease, advanced malalignment or instability were enrolled in this study. Bone marrow aspirate was collected from the iliac crest in one session, prepared using a manufactured kit and the patients received intra-articular injections of this BMAC. The mean age of the patients was 59.2±7.4 and the mean follow-up period was 22.1±3.6 months. Functional outcomes of the patients were evaluated using Modified Cincinnati and Tegner Lysholm scoring systems.Results: It was observed that both Lysholm and Cincinnati scores of the patients were statistically significantly higher throughout the follow-up period as compared to the period before the procedure (p=0.0001). There was no statistically significant difference in Lysholm and Cincinnati ratings between gender, side and body mass index groups throughout the follow-up period (p >0.05). It was found that the results of the patients with Kellgren-Lawrence Grade 4 severe joint arthrosis were statistically significantly lower (p <0.05).Conclusions: Considering the functional outcomes of the patients up to two years, it was observed that the application of concentrated bone marrow aspirate provided functional recovery in arthrosis of the knee joint.
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OBJECTIVE:Breast abscess is a significant cause of morbidity especially in young women of childbearing age. These abscesses are associated with physical, psychological disturbance, and long-term cosmetic consequences.MATERIALS AND METHODS:This was a prospective study that involved seventy cases of breast abscesses to identify etiological agents and their susceptibility patterns.RESULTS:Lactation was a risk factor in almost two-third of all cases. Others were diabetes mellitus, extremes of age, immunocompromised conditions, and tuberculosis. The most common bacterial isolate was Staphylococcus aureus (83.3%), almost half being methicillin-resistant S. aureus (MRSA). Others included coagulase-negative Staphylococcus, Enterococcus spp., Streptococcus spp., Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Candida spp., and acid-fast bacilli.CONCLUSIONS:The treatment of all such microorganisms is different, signifying that microbial diagnosis plays a pivotal role in management of such abscesses.
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The aim of the present study is to evaluate the utility of FNAC in diagnosing bone lesions especially bone tumours. Methods: A total of 120 cases were selected from patients attending OPD and admitted in IPD in MLB Medical College, Jhansi, presenting with complaints of swelling arising from bone. FNAC of the lesion was performed, with guidance of X-Ray reports when available, clinical details, history of present illness & other physical findings have also been noted, and considered while making the diagnosis, and the findings were compared with that of histolgical specimen whenever available. Results: The present study includes 355 malignant cases, of which 53.8% are primary neoplasms, 7.6% are metastatic lesions, and 38.4% are locally malignant lesions. The most common primary bone malignancy in this study is Osteosarcoma. Comparison of Cytological and Histological Diagnosis in all cases was done. 39 malignant lesions were reported on Cytological basis and all 39 were found correct on histological correlation, while 18 out of total 21 benign lesions were diagnosed correctly, as confirmed by subsequent histological examination. Out of total 51 inflammatory lesions 42 were diagnosed correctly, 9 aspirations were found inadequate for reporting. Conclusion: Fine Needle Aspiration Cytology (FNAC) is a very valuable procedure in patients with bone lesions. The complications are almost nil, the cost is very low, is minimally painfull, is an OPD procedure and informative reports are available within 12-48 hours.
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Background: Reactive lymphocytes can be presented with a different number of morphologies. The significance of evaluation of lymphocytes on peripheral smear tests and its clinical correlation are still neglected. Materials and methods: Clinical details along with other clinical investigations like cell counter results of patients presented with lymphocytosis and other hematological parameters including hemoglobin, total WBC count and platelet count, were collected from Department of Pathology, Dhanalakshmi Srinvasan Medical College and Hospital, India. Results: A total number of 120 cases were studied, out of which 82 patients showed absolute lymphocyte count more than 4000/ul. Out of the 120 patients, a total of 31 patients had history of smoking/tobacco chewing. 18(58%) of them showed reactive/ atypical lymphocyte morphology and 13(41%) of them showed mature lymphocytes. Of the 10 patients with alcoholism history, only 4 of them showed a normal morphology of lymphocytes, other 6 patients showed reactive lymphocyte morphology. Only one patient in the study population showed atypical lymphocytes and in peripheral smear and subjected to lymph node biopsy and rest of the patient failed to follow up after advised biopsy. Conclusions: Current study also reports that, lymphocytosis with reactive lymphocytes have a correlation with acute stress, smoking, and other ailments.
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Objective To investigate the difference between bronchoalveolar lavage fluid(BALF)and tracheal aspirate(TA)on the use of antibiotics in patients with severe pneumonia.Methods Patients with severe pneumonias admitted to the Department of General Intensive Care Unit of Second Affiliated Hospital of Zhejiang University School of Medicine,between December 2014 and March 2019 were retrospectively analyzed.The difference of effects of BLAF and TA on the use of antibiotics in patients with severe pneumonia were compared and analyzed,as well as the effects of antibiotic de-escalation on patient's mortality were evaluated.The quantitative data were analyzed by independent sample t test and the enumeration data were determined by Chi-square test or Fisher exact probability method.Results Among the 120 patients more bacteria were detected in BALF than in TA(82 vs 60,P＜0.05).More fungi were detected in BALF than in TA(20 vs 3,P＜0.05).Compared with TA,BALF results were more likely to guide the adjustment of antibiotic regimens(41 vs 16,P＜0.05),including guidance for antibiotics de-escalation(27 vs 9,P＜0.05).There was no significant difference in the 14-day mortality,28-day mortality,hospital stay and duration of mechanical ventilation between the two groups(al P＜0.05).Conclusions Compared with TA,BALF,as a pathogens detection method for severe pneumonia,has more advantages in guiding antibiotics administration,including antibiotic de-escalation,which will not increase the mortality of patients.
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Objective@#To investigate the difference between bronchoalveolar lavage fluid (BALF) and tracheal aspirate (TA) on the use of antibiotics in patients with severe pneumonia.@*Methods@#Patients with severe pneumonias admitted to the Department of General Intensive Care Unit of Second Affiliated Hospital of Zhejiang University School of Medicine, between December 2014 and March 2019 were retrospectively analyzed. The difference of effects of BLAF and TA on the use of antibiotics in patients with severe pneumonia were compared and analyzed, as well as the effects of antibiotic de-escalation on patient’s mortality were evaluated. The quantitative data were analyzed by independent sample t test, and the enumeration data were determined by Chi-square test or Fisher exact probability method.@*Results@#Among the 120 patients, more bacteria were detected in BALF than in TA (82 vs 60, P<0.05). More fungi were detected in BALF than in TA (20 vs 3, P<0.05). Compared with TA, BALF results were more likely to guide the adjustment of antibiotic regimens (41 vs 16, P<0.05), including guidance for antibiotics de-escalation (27 vs 9, P<0.05). There was no significant difference in the 14-day mortality, 28-day mortality, hospital stay and duration of mechanical ventilation between the two groups (all P<0.05).@*Conclusions@#Compared with TA, BALF, as a pathogens detection method for severe pneumania, has more advantages in guiding antibiotics administration, including antibiotic de-escalation, which will not increase the mortality of patients.
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@#Data on the accuracy of Xpert® MTB/RIF (Xpert) assay in detecting TB in lymph node aspirates in Papua New Guinea (PNG) is scanty. This study evaluated Xpert performance in diagnosing tuberculous lymphadenitis (TBLN) using lymph node needle aspirates at the Port Moresby General Hospital (PMGH). The objective of the study was to compare Xpert accuracy to acid fast bacilli (AFB) microscopy, cytomorphology, a composite reference test (CRS) and culture. A total of 107 eligible subjects were recruited out of 1080 clinic attendees. Results showed Xpert detected significantly more cases of TBLN than AFB microscopy (66 vs 35; p=0.001). Compared to AFB microscopy Xpert had a sensitivity of 45.4% (95% CI 33.1-58.1), specificity of 87.8% (95% CI 73.8-95.9), positive predictive value (PPV) of 85.7% (95% CI 71.6-93.4) and negative predictive value (NPV) of 50.0%% (95% CI 43.8-56.1). There was no difference between Xpert and cytomorphology (66 vs 60; p=0.5). Compared to cytomorphology Xpert had a sensitivity of 71.6% (95% CI 58.5-82.5), specificity of 51.1% (95% CI 35.7-66.3), PPV of 66.1% (95% CI 58.2-73.2) and NPV of 57.5% (95% CI 45.2-68.9). There was no difference between Xpert and CRS (66 vs 71; p=0.6). Compared to CRS Xpert had a sensitivity of 76.0% (95% CI 64.4- 85.3), specificity of 66.6% (95% CI 49.0-81.4), PPV of 81.8% (95% CI 73.5-87.9) and NPV of 58.4% (95% CI 46.7-69.4). Culture was completed on 24 subjects with positive isolates in 14 giving a culture yield of 58.3%. Of the 24 subjects, Xpert was positive in 21 subjects. There was no difference between Xpert and culture (21 vs 14; p=0.8). Compared to culture Xpert had a sensitivity of 100.0% (95% CI 76.8-100.0), specificity of 30.0% (95% CI 6.6-65.2), PPV of 66.6% (95% CI 57.1-75) and NPV of 100.0%. The results suggest Xpert is more sensitive than AFB microscopy but comparable to cytomorphology and CRS for TBLN diagnosis in the PNG context. Xpert can be used for diagnosing TBLN at PMGH
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Objective@#To determine the antibiogram of tracheal aspirate cultures (TACS) among intubated children aged 2 months to 5 years old with very severe community acquired pneumonia (CAP). @*Methodology@#A retrospective chart review using total enumerative sampling. @*Results@#66 out of the 343 patients had positive TACS. The top 5 most common isolates were Klebsiella pneumoniae(37.8%), Pseudomonas aeruginosa (25.7%), Acinetobacter baumanii (15.1%), Enterobacter cloacae (12.1%) and Methicillin Resistant Staphylococcus aureus (MRSA) (6%). The gram-negative isolates were highly sensitive to amikacin and carbapenems. Majority of these patients (92.42%) had history of Pentavalent immunization. Majority of patients who were TACS positive had history of antibiotic use prior to admission (92.42%), mostly second-generation cepahalosporin (cefuroxime, 32.42%). High rates of resistance to ampicillin and gentamicin were noted for patients with Klebsiella pneumoniae and Enterobacter cloacae isolates. Majority of patients with Klebsiella pneumoniae, Acinetobacter baumanii and MRSA expired. @*Conclusion/Recommendation@#Majority of those patients with positive isolates had MDR organisms thus for patients with very severe CAP who already received antibiotic as outpatient, broad spectrum antibiotics should be considered as empiric therapy and TACS be done on all patients with very severe CAP.
Subject(s)
PneumoniaABSTRACT
Abstract Introduction People with tracheostomies exhibit a higher risk of colonization of the lower respiratory tract, acute tracheitis and pneumonia. Despite this, the culture of tracheal secretions is not a routine inmost hospitals, and sometimes empiric therapy is based on personal experience, which is not an ideal situation. Objective To recognize the pathogens present in the tracheal secretions collected from people up to 18 years old with tracheostomies. Methods Prospective evaluation of patients under the age of 18 of a tertiary care hospital. A standardized questionnaire was completed, and tracheal secretion aspirates were sent for microbiological cultures and antibiograms. Results Twenty patients under 18 years of age were evaluated, 65% of whom were male. The microbiological culture was positive in 90% of the patients, and the most common microorganisms found were Pseudomonas aeruginosa (55.5%) and Staphylococcus aureus (27.7%). Discussion Tracheostomized children and adolescents have respiratory tracts colonized by pathogens, the most common of which is Pseudomonas aeruginosa. These patients must undergo tracheal secretion cultures, whether they present symptoms or not, to determine if there is a correlation between the colonization and the infections. This finding could guide the adequate treatment, avoiding the inappropriate use of antibiotics and indicating the better therapy in cases of laryngeal reconstruction. Conclusion In this sample, the culture of tracheal secretions was mainly positive, and the most common agent was P. aeruginosa. We suggest the routine access to Brazilian children and adolescents tracheal secretion cultures, which could help tomake a profile of these children and guide the use of antibiotics.
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Bone marrow aspirates concentrate (BMAC) transplantation is a well-known technique for cartilage regeneration with good clinical outcomes for symptoms in patients with osteoarthritis (OA). Magnetic resonance imaging (MRI) has an important role in evaluating the degree of cartilage repair in cartilage regeneration therapy instead of a second assessment via an arthroscopy. We experienced a case of hypertrophic regeneration of the cartilage and a presumed simultaneous regeneration of the posterior horn of the lateral meniscus after BMAC transplantation for a cartilage defect at the lateral tibial and femoral condyle. This report provides the details of a case of an unusual treatment response after a BMAC transplant. This report is the first of its kind to demonstrate a MR image that displays the simultaneous regeneration of the cartilage and meniscus with a differentiation ability of the mesenchymal stem cell to the desired cell lineage.
Subject(s)
Animals , Humans , Arthroscopy , Bone Marrow , Cartilage , Cell Lineage , Horns , Hypertrophy , Magnetic Resonance Imaging , Menisci, Tibial , Mesenchymal Stem Cells , Osteoarthritis , RegenerationABSTRACT
Abstract Objectives To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. Methods Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. Results Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p = 0.996), and fungi (p = 0.985) were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%), followed by Streptococcus spp. (18.5%), Acinetobacter spp. (15.9%), coagulase-negative staphylococci (11.2%), and Klebsiella spp. (8.6%). Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid) yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%), we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. Conclusions Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of species identified. However, we did not find significant differences in comparison with the traditional tracheal aspirate culture approach.