Hepatitis B chronic infection among pregnant women attending the antenatal care in Bor State Referral Hospital, South Sudan

Introduction: Hepatitis B virus (HBV) is a major public health problem affecting 400 million people worldwide, and is a common cause of chronic liver failure (cirrhosis) and hepatocellular carcinoma. Sixty-eight percent of infected people are from the African and Pacific regions. Vertical transmission from mother to newborn baby is one of the mechanisms by which chronic hepatitis virus infection spreads, besides infections from contaminated needles and syringes and sexual contact. Hepatitis B chronic infection is endemic in many poor countries, especially in Africa. Method: A cross-sectional study was conducted between July and August 2021. Pregnant women attending the antenatal care (ANC) in Bor State referral hospital, South Sudan, were interviewed to collect information on their socio-demographic characteristics and risk factors for hepatitis B infection. The objective was to determine the seroprevalence of hepatitis B chronic infection through blood testing. Prevalence ratios for certain risk factors were calculated. Results: Two hundred pregnant women were enrolled. The Prevalence Rate for chronic infection with hepatitis B virus, diagnosed using the rapid immune-chromatographic assay for Hepatitis B surface antigen (HBsAg), was 8.5%. (95% CI; 4.7% - 12.3%). None of the suspected risk factors studied were found to be significantly associated with testing positive for HBV, except for a history of previous jaundice. Conclusion: The prevalence of HBV chronic infection among pregnant women in Bor, Jonglei State, is high hence there is a need for established public health interventions that can lead to a reduction of HBV vertical transmission. Treatment of pregnant women with HBV chronic infection using anti-viral medications during pregnancy might curb the vertical transmission rates.

Chronic infection of hepatitis B virus and cellular immunity / 中华微生物学和免疫学杂志

The persistent infection of hepatitis B virus (HBV) is the result of lacking specific immunity against the virus. This state is also called immune tolerance to HBV. In most cases, acute HBV infection in adults can induce specific immune response which can clear the virus. Perinatal HBV infection, however, usually progresses to chronic infection, indicating a defect in HBV-specific immune response. A typical specific immune response includes four processes, which were antigen presentation, specific CD4 + T cell activation, specific CD8 + T cell activation and B cell activation. There must be some dysfunctions in some or all of the four processes during chronic HBV infection. This article discussed the relationship between chronic HBV infection and cellular immunity, hoping to provide a reference for further study on the reconstitution of specific immunity against HBV.

Transient elastography technology role assessment during the diagnosis and treatment of patients with chronic hepatitis B virus infection / 中华肝脏病杂志

Objective: To explore the role of transient elastography technology in the assessment of disease staging and treatment in patients with chronic hepatitis B virus (HBV) infection. Methods: Patients who were clinically diagnosed with chronic HBV infection at Beijing Tsinghua Changgung Hospital from January 2018 to December 2021 was collected. Liver stiffness measurement (LSM) examination was performed more than once by transient elastography. The count data were expressed as cases (%) and the χ (2) test was made. Fisher's exact test was used with theoretical frequency less than 5. The measurement data between two groups was compared by t-test. Multiple groups were compared with an analysis of variance. Results: 1 055 patients were included in this study, including 669 (63.4%) males and 386 (36.6%) females. 757 (71.8%) patients were untreated. Among the untreated patients, the LSM value in the immune clearance (10.2 ± 3.8) kPa (187 cases, 40.4%), and the reactivation stages (9.1 ± 3.4) kPa (114 cases, 24.6%) was significantly higher than that in the immune tolerance (8.7 ± 3.6) kPa (78 cases, 16.8%) and immune control stages (8.4 ± 3.5) KPa (84 cases, 18.1%), and the difference between the four groups was statistically significant (F = 5.31 and P = 0.03). With ALT (male: 30 U/L, female: 19 U/L) as defined the normal value, the LSM value in the immune tolerance and the immune control stages were (5.8 ± 0.9) kPa and (7.1 ± 2.5) kPa, respectively, which were significantly lower than those of patients in the immune tolerance and immune control stages, and the difference was statistically significant (P < 0.01). There were 294 (38.8%) patients with uncertain period, excluding patients with fatty liver. Patients with uncertain periods were divided into four gray zone (GZ) groups: immune tolerance stage: LSM (5.1 ± 1.3) kPa was significantly lower than GZ-A (6.5 ± 2.4) kPa, t = 2.06, P = 0.03, and the difference was statistically significant; immune control stage: LSM was (5.6 ± 1.5) kPa, which was also lower than GZ-C (6.8 ± 1.3) kPa, t = 3.08, P = 0.02, and the difference was statistically significant; immune clearance stage: LSM > 8.0 kPa. LSM values showed a year-by-year reduction in patients with expanded indications who started antiviral treatment and were followed up for three years. Conclusion: The LSM value is significantly lower after the decrease of the defined high-normal ALT value in patients with the immune tolerance and immune control stages of chronic HBV infection. The LSM values of GZ-A and GZ-C in the uncertain periods of chronic HBV infection are higher than those of patients in the immune tolerance and immune control stages.

Correlation of peripheral myeloid-derived suppressor cells with hepatitis c virus infection / 中国输血杂志

【Objective】 To investigate the correlation of peripheral myeloid-derived suppressor cells (MDSC) with hepatitis c virus (HCV) infection. 【Methods】 109 voluntary blood donors who donated blood during February 2018 to September 2020 at Guangzhou Blood Center were recruited in this study. They were assigned to chronic hepatitis c (CHC) group (n=48), spontaneous clearance (SC) group (n=29) and healthy donors (control) group (n=32) according to the results of anti-HCV and HCV RNA tests. Blood samples were drawn from the participants and peripheral blood mononuclear cells (PBMC) were freshly isolated, followed by staining with fluorescently-labeled antibody against cell surface markers of MDSC, which were then applied to the detection of monocytic- (M) and polymorphonuclear (PMN)-MDSC by flow cytometry. Parameters for liver function including alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), total bilirubin (TBIL) and direct bilirubin (DBIL) were also measured. One-way ANOVA tests were applied to compare the differences of M- and PMN-MDSC and liver function between three study groups. For pairwise comparisons, P values were adjusted for multiple comparisons by Bonferroni correction (Pc). 【Results】 The frequencies of M-MDSC (%) in CHC, SC and HC were 1.39±0.86, 0.85±0.63 and 0.57±0.23, respectively (P0.05). In addition, AST (34.4±19.2 vs 23.0±7.78 U/L) and GGT (40.8±31.4 vs 22.3±7.40 U/L) level were higher in CHC compared with control (Pc<0.05 and Pc<0.01, respectively). 【Conclusion】 The level of peripheral M-MDSC was significantly elevated in chronic HCV infected donors, which would related to the progression of chronicity after HCV infection.

Neospora caninum DNA distribution in tissues of gerbils as experimental models of chronic neosporosis / [Distribuição do DNA de Neospora caninum em tecidos de gerbilos como modelos experimentais de neosporose crônica]

Neospora caninum is the main etiologic agent of neosporosis in domestic animals and its pathogenesis comprises two characteristic phases: acute and chronic. Rodents are used as experimental models to mimic acute and chronic bovine neosporosis. In this study, we inoculated a total of 27 female gerbils, with different doses of N. caninum tachyzoites aiming to induce chronic disease. DNA was extracted from different organs of each animal after spontaneous death or euthanasia. Encephalic tissues were submitted to a highly sensitive real time PCR aiming to detect chronically infected animals. All the other samples were submitted to standard PCR. A total of 11 gerbils died due to acute neosporosis, as confirmed by N. caninum DNA detection in organs. 5x103 tachyzoites/mL of N. caninum was the dosage of antigen that can induce chronic infection in gerbils. In the encephalon sections of some animals that showed clinical signs of persistent infection, we found 70% positive for the anterior encephalon section, suggesting this area as preferential for cyst formation. Therefore, we determined the doses of tachyzoites that cause acute or chronic infection and detection of positive tissues, preferably, systemic organs during acute and encephalon in chronic phases.(AU)

Neospora caninum é o principal agente etiológico da neosporose em animais domésticos, e sua patogênese compreende duas fases características: aguda e crônica. Roedores são usados como modelos experimentais para simular neosporose bovina aguda e crônica. Neste estudo, foi inoculado um total de 27 gerbilos, fêmeas, com diferentes doses de taquizoítos de N. caninum, visando induzir doença crônica. O DNA foi extraído de diferentes órgãos de cada animal após a morte espontânea ou a eutanásia. Os tecidos encefálicos foram submetidos à PCR em tempo real de alta sensibilidade para detecção de animais com infecção crônica. Todas as outras amostras foram submetidas à PCR padrão. Um total de 11 gerbilos morreu devido à neosporose aguda, como confirmado pela detecção de DNA de N. caninum nos órgãos. A dosagem de antígeno que pode induzir infecção crônica foi de 5x103 taquizoítos/mL de N. caninum. Em seções do encéfalo de alguns animais, que apresentaram sinais clínicos de infecção persistente, encontraram-se 70% de positividade para a seção do encéfalo anterior, sugerindo essa área como preferencial para a formação de cisto. Assim, foram determinadas,, em gerbilos, as dosagens de taquizoítos capazes de induzir infecção crônica ou aguda, bem como foram detectados tecidos positivos, preferencialmente, em órgãos sistêmicos, na fase aguda, e no encéfalo, na crônica.(AU)

Burkholderia cepacia complex: 11 years of surveillance in patients with Cystic Fibrosis in Posadas, Argentina

Abstract Cystic fibrosis patients with Burkholderia cepacia complex pulmonary infections have high morbidity and mortality. Worldwide, this disease is undergoing substantial epidemiological changes. Advances in the diagnosis and treatment have conditioned an increase in child sur-vival as well as in the proportion of affected adults. In order to know our reality, we refer to an epidemiological study in 64 CF patients during 11 years of surveillance, focusing on infections caused by Burkholderia species. Conventional and automated phenotypic tests, restriction fragment length polymorphism-recA, recA gene sequencing, and matrix-assisted laser desorp-tion ionization-time of flight (MALDI-TOF) mass spectrometry were applied. Bacterial isolates were also tested for antimicrobial susceptibility patterns. The prevalence of Burkholderia cepacia complex was 9.4%. Based on recA gene sequencing, the most common species identified were Burkholderia cenocepacia (67.3%) and Burkholderia vietnamiensis (20.3%). Ceftazidime and meropenem were the most active, inhibiting 53% and 46% of isolates, respectively. This report represents the first systematic study of Burkholderia infections in our CF population since beginning of monitoring and treatment and highlights the importance of continued longitudinal studies.

Resumen Los pacientes con fibrosis quística (FQ) con infecciones pulmonares causadas por especies del complejo Burkholderia cepacia tienen una alta morbimortalidad. En todo el mundo, esta enfermedad está experimentando cambios epidemiológicos sustanciales. Los avances en el diagnóstico y el tratamiento han condicionado un aumento en la supervivencia infantil, así como en la proporción de adultos afectados. Para conocer nuestra realidad, nos referimos a un estudio epidemiológico en 64 pacientes con FQ durante 11 años de vigilancia, focalizando las infecciones causadas por especies del género Burkholderia. Se aplicaron pruebas fenotípicas convencionales y automatizadas, polimorfismo de longitud de fragmentos de restricción-recA, secuenciación del gen recA y espectrometría de masa MALDI-TOF. Los aislados bacterianos también se analizaron para determinar los patrones de susceptibilidad antimicrobiana. La prevalencia de complejo B. cepacia fue del 9,4%. Con base en la secuenciación del gen recA, las especies más comunes identificadas fueron Burkholderia cenocepacia (67,3%) y Burkholderia vietnamiensis (20,3%). Ceftazidima y meropenem fueron los antibióticos más activos e inhibieron el 53 y el 46% de los aislamientos, respectivamente. Este informe representa el primer estudio sistemático de las infecciones por Burkholderia en nuestra población desde el comienzo de la monitorización y el tratamiento, y resalta la importancia de continuar los estudios de vigilancia longitudinales.

Clinical study on treatment of chronic infection of foot and ankle with lower extremity ischemic diseases by tibial transverse transport combined with antibiotic embedded bone cement / 中国修复重建外科杂志

Objective: To study the effectiveness of tibial transverse transport combined with the antibiotics embedded bone cement in the treatment of chronic infection of foot and ankle with lower extremity ischemic diseases. Methods: A retrospective analysis was performed on 28 patients with ischemic diseases of lower extremities associated with chronic foot and ankle infection who were treated with tibial transverse transport combined with antibiotic bone cement between August 2015 and October 2019. There were 22 males and 6 females, with an average age of 65.6 years (range, 41-86 years). There were 25 cases of diabetic foot, 2 cases of arteriosclerosis obliterans, and 1 case of thromboangiitis obliterans. The course of infection ranged from 1 to 27 years, with an average of 14.9 years. The healing condition and time of foot and ankle in all patients were recorded and compared, and the Wagner grading and WIFi (W: lower extremity wound classification; I: ischemic classification; Fi: foot infection classification) grading were compared before and at last follow-up. Results: The wound surface of 1 diabetic foot patient improved at 111 days after operation, without purulent secretion, and lost follow-up. The remaining 27 cases were followed up 5 to 21 months (mean, 8.4 months). There was no necrosis in the tibial osteotomy incision and the local flap. After operation, 21 cases showed needle reaction of external fixator, but the needle infection gradually improved after the corresponding treatment. Among the 24 patients with diabetic foot, 1 died of multiple organ failure due to pulmonary infection. Acute lower extremity vascular embolism occurred in 1 case, and the foot was amputated due to acute gangrene. In the remaining 22 cases, the wound healing time of foot and ankle was 2.5-11.0 months (mean, 4.6 months). At last follow-up, Wagner grading and WIFi grading of the patients were significantly improved when compared with those before operation ( P<0.05). One patient with thromboangiitis obliterans had foot and ankle healing at 6 months after operation. Two patients with lower extremity arteriosclerosis obliterans had foot and ankle healing at 16 and 18 months after operation, respectively. Conclusion: Tibial transverse transport combined with the antibiotics embedded bone cement is effective in treating chronic infection of foot and ankle with lower extremity ischemic diseases.

Recomendaciones en el tratamiento actual de la infección crónica por el virus de la hepatitis B / Current recommendations for the treatment of chronic hepatitis B infection

La infección crónica por el virus de la hepatitis B (VHB) se considera un problema de salud pública mundial. Se estima que al menos dos mil millones de personas han estado expuestas al VHB, y a pesar de una vacuna efectiva, 300 millones de personas están infectadas crónicamente a nivel mundial. Aunque el virus no es directamente citopático, la infección puede desencadenar cirrosis hepática y aun, carcinoma hepatocelular (CHC). El ADN circular cerrado covalentemente (ADNccc) en el núcleo de los hepatocitos y la incapacidad del sistema inmunitario para eliminar la infección crónica por el virus son los mecanismos más importantes de la infección por VHB. Las diferentes entidades, como la Asociación Europea para el Estudio del Hígado (EASL) y la Asociación Americana para el Estudio de las Enfermedades Hepáticas (AASLD), ponen a disposición las pautas para el manejo de esta enfermedad. A pesar de los avances en el tratamiento de la infección crónica por el VHB, en particular con el desarrollo de los análogos de los nucleótidos/ nucleósidos, quedan aún muchos interrogantes. Las investigaciones continúan para el desarrollo de nuevas opciones de tratamiento enfocadas principalmente en evitar que la suspensión de la terapia conlleve a un incremento de la carga viral, con el consecuente aumento del riesgo de progresión de la enfermedad hepática, y un eventual CHC.

Chronic hepatitis B virus (HBV) infection is considered a global public health problem. It is estimated that at least two billion people have been exposed to HBV, and despite an effective vaccine, 300 million people are chronically infected worldwide. Although the virus is not directly cytopathic, the infection can trigger liver cirrhosis and even hepatocellular carcinoma (HCC). Covalently closed circular DNA (cccDNA) in the nucleus of hepatocytes and the inability of the immune system to eliminate chronic virus infection are the most important mechanisms of chronic HBV infection. Different entities, such as the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), provide guidelines for the management of this disease. Despite advances in the treatment of chronic HBV infection, including the development of nucleotide and nucleoside analogs, many questions remain. Research continues for the development of new treatment options focused mainly on avoiding a relapse on viral load after therapy discontinuation, with an increased risk of liver disease progression, and an eventual CHC.

Vancomycin-Loaded Bone Cement Bullet for Treatment of Chronic Septic Arthritis Post ACL Reconstruction Surgery

Abstract@#The consequence of post-operative infection can be devastating despite its rare incidence. Common organisms causing post-operative infection are normal flora of the skin: Staphylococcus aureus and Staphylococcus epidermidis. Early diagnosis followed by arthroscopic debridement and antibiotic therapy with graft retention remains the main aim of treatment. However, there are certain cases where the infection persists despite early intervention. Vancomycin-loaded bone cement bullet inserted into bone tunnel can provide a high local concentration of vancomycin with bactericidal effect and low systemic complications to treat deep-seated infection.

Modernas metodologías diagnosticas para la detección del Virus del Papiloma Humano y prevención del cáncer de cuello uterino / Modern diagnostic methods for detection of Human Papillomavirus and cervical cancer prevention

RESUMEN Los Virus del Papiloma Humano (VPH) presentes en mucosa clasificados como de "alto riesgo" son agentes etiológicos de patologías oncológicas como cáncer de cuello uterino, ano, pene, vulva y cáncer orofaríngeo. Actualmente el principal método de tamizaje utilizado en Colombia para detección de cáncer de cuello uterino es la citología cervical, presentando una moderada cobertura en la población femenina y una sensibilidad cercana al 50%. El objetivo de este trabajo es describir las técnicas modernas utilizadas para la detección del VPH y prevención de los cánceres producidos por estos virus. Se llevó a cabo una revisión de literatura de las ultimas metodologías diagnosticas en la infección viral por VPH y marcadores de malignidad en muestras cervicales. La citología cervical es un recurso altamente específico y de bajo costo, pero poco sensible para la detección y prevención de cáncer de cuello uterino, que puede ser complementado con las tecnologías modernas revisadas con el objetivo de obtener un diagnóstico temprano del VPH como agente etiológico de estas enfermedades malignas.

ABSTRACT Human Papilloma Viruses (HPVs) types present in mucosa and classified as "high risk" are etiologic agents of several oncological diseases as cervical cancer, anus, penis, vulva, and oropharyngeal cancer. Currently the principal method of screening used in Colombia for detecting cervical cancer is cervical cytology, which presents a moderate coverage in the population and sensitivity close to 50%. The objetive of this work is to describe new techniques for detection of Human Papillomavirus and cancer prevention for these viruses. We carried out a literature review of the cutting edge diagnostic methods for HPV viral infection. Cervical cytology is a highly specific resource, low-cost but low sensitivity for preventing cervical cancer, which can be supplemented with the modern technologies checked in order to obtain an early diagnosis of HPV as an etiologic agent of those malignancies.

Research advances in chronicity of hepatitis E virus infection / 中华肝脏病杂志

Hepatitis E virus (HEV) infection usually causes acute hepatitis and has a self-limiting progression. The patients often recover within 6 months with good prognosis. Recent studies have found that HEV infection may become chronic in special situations, which manifests as persistent liver function abnormalities for at least 6 months after acute HEV infection and the presence of viral nucleic acid in serum, feces, and/or liver tissue. Chronicity of HEV infection mainly occurs in immunocompromised patients, and it is rare but very dangerous in clinical practice. An understanding of the pathogenesis, clinical manifestations, treatment methods, and preventive measures of chronicity of HEV infection helps clinical physicians develop an effective management regimen and improve patient prognosis. This article introduces related issues, in order to raise the awareness of this disease among clinical physicians.

Characteristics of CD8+ stem memory T cells in patients with chronic HIV-1 infection during antiretroviral therapy / 中华微生物学和免疫学杂志

Objective To investigate the characteristics of CD8+ stem memory T cells (CD8+Tscm) in patients with chronic HIV-1 infection before and after antiretroviral therapy (ART) and to analyze their associations with progression of HIV-1 infection.Methods Thirty-six patients with chronic HIV-1 infection and 20 healthy subjects were enrolled in this study.Flow cytometry was performed to detect the percentages and absolute numbers of CD8+Tscm in patients with chronic HIV-1 infection before and after antiretroviral therapy (ART) as well as in healthy subjects.Correlation analysis was used to demonstrate the relationships between CD8+Tscm and markers for progression of HIV-1 infection (CD4+T cell count, HIV-1 viral load and level of activated T cells).Results The percentages and the absolute numbers of CD8+Tscm in patients with chronic HIV-1 infection had no significant change before and after ART.They were respectively positively correlated with the percentages and the absolute numbers of CD4+Tscm.The percentage of CD8+Tscm was proportional to the percentage of CD8+ central memory T cells (CD8+Tcm), but was inversely proportional to the percentage of CD8+ effector memory T cells (CD8+Tem).In addition, the percentages of CD8+Tscm in patients with HIV-1 infection were negatively correlated with the viral loads before ART.Conclusion CD8+Tscm are responsible for maintaining the homeostasis of other CD8+T cell subsets.CD8+Tscm play an important role in inhibiting viral replication.

High seroconversion rates in Trypanosoma cruzi chronic infection treated with benznidazole in people under 16 years in Guatemala

Abstract INTRODUCTION: Geographical, epidemiological, and environmental differences associated with therapeutic response to Chagas etiological treatment have been previously discussed. This study describes high seroconversion rates 72 months after benznidazole treatment in patients under 16 years from a project implemented by Doctors without Borders in Guatemala. METHODS: An enzyme-linked immunosorbent assay was used to detect Trypanosoma cruzi IgG antibodies in capillary blood samples from patients 72 months after treatment. Fisher's exact test was used to establish association between characteristics, such as sex, age, and origin of patients, and final seroconversion. Kappa index determined concordance between laboratory tests. The level of significance was set to 5%. RESULTS: Ninety-eight patients, aged 6 months to 16 years, were available for follow-up. Sex and origin were not associated with seroconversion. Individuals older than 13 were more prone to maintain a positive result 72 months after treatment, although results were not highly significant. Laboratory tests presented elevated Kappa concordance (95% CI) = 0.8290 (0.4955-1), as well as high (97%) seroconversion rates. CONCLUSIONS: The high seroconversion rate found in this study emphasizes the importance of access to diagnosis, treatment, and follow-up of individuals affected by Chagas disease. Moreover, it contradicts the idea that it is not possible to achieve a cure with the currently available drugs. This study strongly supports expanding programs for patients infected with T. cruzi in endemic and non-endemic countries.

Risk factors and prophylactic strategies of hepatitis B virus vertical transmission / 上海预防医学

Chronic hepatitis B virus ( HBV) infection is a principal risk factor for liver cirrhosis and hepatocellular carcinoma in China , representing one of the major public health problems .Horizontal trans-mission of HBV in vaccinated children was greatly reduced due to widespread HBV vaccination in mainland China, which had limited effects on vertical transmission .Thus, vertical transmission became one of the main causes of HBV chronic infection .High HBV load (≥10 6 copies/mL ) and hepatitis B e antigen ( HBeAg )-positivity in maternal peripheral blood were independent risk factors for HBV intrauterine infection .Compared to HBV infection in early childhood and in adult , intrauterine HBV infection was more prone to developing chronic infection .To decrease vertical transmission of HBV , we recommend that young pregnant women with sero-positive for HBeAg and high serum HBV DNA level should receive antiviral treatment with nucleotide analogues since the 28 th gestation weeks .For newborns born to HBeAg-positive mother , hepatitis B immunoglobulin ( HBIG ) injection should be administrated in combination with HBV vaccination .

Distribution Characteristics of Persisters Isolated from Chronic Infected Patients / 现代检验医学杂志

Objective To investigate the clinical distribution characteristics of persisters isolated from the chronic infected pa-tients,so as to provide scientific basis for effective clinical measures to prevent,control and treat persister-associated chronic infection.Methods Clinical microbial samples cultured from Jan.2013 to Dec.2014 were analysed by WHONET5.6.Four bacteria species with the highest isolation rate were performed for screening of chronic infection.Concentration of bacteria were detected by viable plate count method and then the growth curve were drew of each sample under the presence of anti-biotics.Persisters were comfirmed according to the specific growth curve under the presence of antibiotics.Results Four highest isolated bacteria species of the clinical samples were Escherichia coli (1 3.2%),Klebsiella pneumoniae (9.6%), Pseudomonasaeruginosa (8%)and Staphylococcusaureus (6.6%).862 chronic infection samples were generated out of 14 216 microbial samples and 41 persisters (4 strains of Escherichia coli,23 strains of Klebsiella pneumoniae,8 strains of Pseudomonasaeruginosa and 6 strains of Staphylococcusaureus)were isolated finally.Conclusion With such a comprehen-sively retrospective analysis of the hospital clinical microbial samples,can tell that the ratio of persisters in chronic infection was not high.And chronic infections are mostly caused by gene-mutated drug-resistant bacteria.However,the isolation rate of Klebsiella pneumoniae was relatively high,of which more attention should be payed to the prevention and control.

Association Study of TNF-αand ALCAM Polymorphisms with Chronic HCV Infection in Yunnan Han Population / 昆明医科大学学报

Objective To discuss the association of allele polymorphisms SNP-rs1799724(C>T)in the TNF-αand SNP-rs11559013(G>A)in the ALCAM with HCV chronic infection in Han population in Yunnan province. Methods 434 HCV chronic infectious patients and 444 healthy individuals of Han Chinese population in Yunnan province were recruited. Two single nucleotide polymorphisms(SNPs)in the SNP-rs1799724(C>T) of TNF-αgene and SNP-rs11559013(G>A)of ALCAM gene were determined by real-time TaqMan polymerase chain reaction. We evaluated the associations of the two SNPs with HCV chronic infection. Results The distributions of allele and genotype of SNP-rs1799724(C>T)in the TNF-αand SNP-rs11559013(G>A)in the ALCAM between hepatitis C virus(HCV)chronic infectious patients and the healthy controls were not statistically significant(P > 0.05). Conclusion SNP-rs1799724(C>T)in the TNF-αand SNP-rs11559013(G>A) in the ALCAM have no association with HCV chronic infection in the Han population in Yunnan province.

Eficacia del destechado del túnel en infección crónica del catéter peritoneal / Tunnel unroofing effectiveness in chronic peritoneal catheter infection

Introducción: la infección crónica del catéter involucra generalmente la colonización del manguito de dacrón (ôcuffõ) externo; sin su remoción el tratamiento antibiótico es inefectivo, la técnica de destechado de catéter ha sido descrita como una alternativa a la extracción del catéter peritoneal. Material y métodos: Se analizaron datos en forma retrospectiva de 13 pacientes. Se evaluó la evolución luego del destechado, considerando como fracaso del tratamiento a la aparición de nueva infección en el orificio, túnel o peritonitis asociada al mismo germen. Resultados: Entre los años 1997-2014, se le practicó destechado a 13 pacientes. Edad promedio 46,23 años (IC 95%: 35,92 años û 56,54 años). Sexo masculino 9, 69,23% (IC 95%: 41,95% û 96,50%).Gérmenes estafilococo 7, pseudomona 2, polimicrobiano 1, cultivo negativo 3. Hubo curación en 9 pacientes, 69,23% (IC 95%: 41,95% û 96,06) no hubo asociación estadística entre sexo, edad, resultado microbiológico, presencia de hemodiálisis previa, tipo de catéter, técnica quirúrgica ni con el cirujano que realizó el procedimiento (p> 0.05). Discusión: La extracción del catéter implica la transferencia transitoria a hemodiálisis y una nueva cirugía de recolocación, si bien existe poca experiencia con la técnica de destechado, puede ser una alternativa válida, permitiendo a un grupo de pacientes continuar con el tratamiento de DP. Conclusión: La cirugía de destechado ha resultado beneficiosa en el 69,23% de los casos (9 pacientes) independientemente del tipo de germen presente, representando un tratamiento aceptable que evita la remoción del catéter permitiendo así la continuidad de la modalidad, disminuyendo la necesidad de emplear terapias más agresivas.

Introduction: chronic catheter infection usually involves external Dacron cuff colonization, without its removal, antibiotic treatment proved ineffective. Catheter unroofing technique has been described as an alternative to peritoneal catheter removal. Material and methods: We analyzed the data from 13 patients retrospectively. Evolution after unroofing was evaluated, considering as treatment failure the appearance of new infection in the hole, tunnel or peritonitis associated to the same germ. Results: Between 1997-2014 years, unroofing was performed on 13 patients. Mean age-rate: 46.2 (IC 95%: 35.9 years û 56.5 years) male sex 9, 69.23%. Germs: staphylococcus 7, pseudomona 2, polymicrobial 1, negative culture 3. Nine patiens healed: 69.2%; there was no statistical association among sex, age, microbiological result, previous hemodialysis use, type of catheter, surgical technique or with the surgeon who performed the procedure (p> 0.05). Discussion: Catheter removal implies transient transference to hemodialysis and new replacement surgery, although there is few experience with this technique, it could be an acceptable alternative, enabling a group of patients to continue with PD treatment. Conclusion: Unroofing technique proved to be beneficial in 69.2% of the cases (9 patients) independently of the type of germ present, representing an acceptable treatment which avoids catheter removal, enabling the procedure to continue, and decreasing the need to employ more aggressive therapies.

Fístula odontogénica: revisión de la literatura a propósito de un caso / Odontogenic sinus: a case report and literature review

Las fístulas odontogénicas son canalizaciones anormales originadas a partir de procesos infecciosos de los ápices radiculares, las cuales puede adoptar distintas morfologías en piel. Se presenta el caso de hombre de 40 años, con una lesión en mejilla derecha de 2 años de evolución. El estado de las piezas dentarias, a la inspección, era deficiente. Debido a la sospecha clínica, se solicitó una ecografía de partes blandas que fue compatible con una fístula odontogénica. Estas lesiones, muchas veces son subdiagnosticadas, lo cual limita y retrasa el tratamiento adecuado.

Odontogenic cutaneous sinus are abnormal tracts originated from infectious processes of the root canal, which can show different morphologies on the skin. We present a 40 year old man, who had a lesion on his right cheek of 2 years of duration. The tooth pieces were compromised. Due to the clinical suspicion, a soft tissue ultrasound was requested which result was consistent with odontogenic cutaneous sinus. These injuries are often underdiagnosed, limiting and delaying a proper treatment.

Role of Th17 and Treg during the Chronic Infection of Hepatitis C Virus

Hepatitis C virus (HCV) is one of the main causes of liver disease. 1~2% of the Korean people has been reported to be infected by HCV. Although HCV is less infectious than hepatitis B virus (HBV), it is more prone to develop chronic infection (~ 80%) which may link to cirrhosis and hepatocellular carcinogenesis. In addition, prevalence of hepatitis caused by HCV infection is gradually increased every year in Korea. Recently, a large number of clinical trials using direct-acting antiviral (DAA) drugs have been shown efficient therapeutic results for chronic HCV infections and some of them are on the market. However, there is still a concern on viral evasion to the DAAs and the effective mechanisms of immunological clearance of HCV remains to be elucidated. Here, we introduce the recent findings on the role of Th17-Treg axis which may play a critical role of the viral pathogenesis and/or immunological defense against HCV infection. The underlying regulatory mechanisms of Th17-Treg axis might be a potential candidate for the better control of HCV chronic infections.

Long-term treatment of persistent disseminated Nocardia cyriacigeorgica infection

In this paper a disseminated persistent Nocardia cyriacigeorgica infection in an immunocompetent patient is described. The patient's long-term treatment, as well as its implications for managing similar cases in the future, is emphasized. Presenting with high fever, multiple nodules, and ulcerative cutaneous lesions of body sites, the patient was treated with various antimicrobials. Under combined therapy, empyema and arthritis, leading to disseminated nocardiosis, were seen. The overall treatment course was 28 months. It can be concluded that the choice of the antibiotics and optimal duration of treatment are uncertain; therefore the treatment of nocardiosis requires expertise.