Empleo de antibióticos en cirugía electiva en el adulto mayor

Introducción: Los pacientes quirúrgicos geriátricos tienen afectación funcional y enfermedades asociadas, lo cual aumenta su riesgo quirúrgico con la edad. Objetivo: Determinar el comportamiento del uso de los antibióticos en pacientes geriátricos que requieren cirugía electiva atendidos en el Hospital Vladimir Ilich Lenin del 2018 al 2022. Métodos: Se realizó un estudio descriptivo, observacional, analítico y transversal a pacientes intervenidos por cirugía electiva con tratamiento con antibiótico. Los datos se obtuvieron de las historias clínicas y la entrevista aplicada. Se analizaron variables como edad, sexo, enfermedades asociadas, diagnóstico preoperatorio, tiempo quirúrgico, complicaciones, evolución, filtrado glomerular y dosis antibiótica perioperatoria. Resultados: El empleo de antibióticos fue más utilizado en los grupos de edades de 60 a 64 años y el sexo femenino; las comorbilidades que predominaron fueron la diabetes mellitus, la hipertensión arterial y la cardiopatía isquémica. Los motivos de consulta más frecuentes fueron por litiasis vesicular y por hernias dentro del grupo ASA I de la American Society of Anesthesiologists. Los antibióticos fundamentales fueron con dosis ajustada. Conclusiones: Se necesita de un trabajo diferenciado en cuanto a la atención al adulto mayor. La utilización de un protocolo o algoritmo de trabajo es necesario en la práctica diaria, sobre todo ante la necesidad de una cirugía electiva.

Introduction: Geriatric surgical patients have functional impairment and associated diseases, which increases their surgical risk with age. Objective: To determine the behavior of antibiotic use in geriatric patients requiring elective surgery attended at Hospital Vladimir Ilich Lenin Hospital from 2018 to 2022. Methods: A descriptive, observational, analytical and cross-sectional study was conducted on patients undergoing elective surgery with antibiotic treatment. The data were obtained from medical records and the applied interview. The analyzed variables included age, sex, associated diseases, preoperative diagnosis, surgical time, complications, evolution, glomerular filtration and perioperative antibiotic dose. Results: Antibiotic use was more frequent in the age group 60 to 64 years and in the female sex; the most frequent comorbidities were diabetes mellitus, arterial hypertension and ischemic heart disease. The most frequent reasons for consultation were vesicular lithiasis and hernias within the ASA I group of the American Society of Anesthesiologists. The fundamental antibiotics were adjusted by doses. Conclusions: An individualized work is needed in terms of care of the older adult. The use of a working protocol or algorithm is necessary in daily practice, especially when elective surgery is required.

Ceftaroline as salvage therapy for methicillin susceptible staphylococcus aureus complicated bacteremia / Ceftarolina como tratamiento de rescate para la bacteriemia complicada por Staphylococcus aureus sensible a la meticilina

Abstract Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with com plicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.

Resumen Las infecciones causadas por Staphylococcus aureus sensible a la meticilina (SASM) todavía se asocian con una morbilidad y mortalidad significativas. Se han informado fallas en el tratamiento de cefazolina (CFZ) probablemente relacionadas con efecto inóculo. Nuevos tratamientos son necesarios para estas infecciones y ceftarolina fosamil (CPT) podría ser una opción. Nuestro objetivo fue describir las características clínicas de cinco pacientes con bacteriemia por SASM complicada con falla a CFZ y que fueron exitosamente tratados con CPT. Realizamos una revisión retrospectiva de historias clínicas en un hospital de Buenos Aires, Argentina; en un período de 12 meses, cinco pacientes (24%) de 21 con bacteriemia por SASM experimentaron falla a CFZ y fueron tratados con CPT. La mediana de tiempo de la terapia con CFZ fue de 10 días antes de cambiar a CPT; cuatro pacientes presentaban evidencia de diseminación metastásica y 2 tenían endocarditis. Todos los pacientes experimen taron curación microbiológica y clínica con CPT, que se utilizó como monoterapia en 4 y en combinación con daptomicina en otro. Un paciente interrumpió CPT debido a neutropenia el día 23 de tratamiento. En enfermos con infecciones graves por SASM que fallan en la terapia actual, CPT podría ser una buena opción terapéutica.

Analysis of surveillance results of paragonimiasis in Zhejiang Province from 2005 to 2020 / 中华地方病学杂志

Objective:To ascertain the endemic status of paragonimiasis in Zhejiang Province.Methods:From 2005 to 2020, 2-3 villages in 1-2 counties (cities, districts, hereinafter refferred to as counties) in historical endemic areas of paragonimiasis in Zhejiang Province were selected for monitoring each year. In each village, 50 to 150 local residents were selected as monitoring subjects, venous blood samples were collected, and serum Paragonimus antibody was detected by enzyme-linked immunosorbent assay (ELISA). Fifty to 100 intermediate hosts crabs or crayfish were collected in each village, and the infection of Paragonimus metacercaria was detected by crushing precipitation. Results:The positive rate of Paragonimus antibody was 2.9% (94/3 297); 3 929 crabs or crayfish were divided into 2 749 groups, 790 of which were found to have Paragonimus metacercaria infection, with a Paragonimus metacercaria infection rate of 28.7%. Conclusions:Paragonimus transmission chain exists in some counties of Zhejiang Province, which still has the potential risk of Paragonimus epidemic. Therefore, it is necessary to strengthen monitoring and carry out extensive health education to improve residents' self-protection awareness.

Identifying susceptible exposure windows for ambient nitrogen dioxide before and during pregnancy and increased risks of small/large for gestational age / 环境与职业医学

Background Exposure to ambient nitrogen dioxide (NO2) could increase the risks of small for gestational age (SGA) and large for gestational age (LGA). Nevertheless, previous published studies usually use a time period over relatively long durations as the exposure window, such as trimester-specific or gestational months, to identify adverse pregnancy outcomes related susceptible exposure windows for ambient air pollution. At present, no study has explored associations of weekly-specific ambient air NO2 exposure around pregnancy with SGA and LGA. Objective To evaluate the associations of exposure to ambient NO2 over the preconception and entire pregnancy period with risks of SGA and LGA, as well as to explore critical windows of NO2 exposure by refining exposure period to specific weeks. Methods Based on a birth cohort established by the project Environmental and LifEstyle FActors iN metabolic health throughout life-course Trajectories (ELEFANT) situated in Tianjin, 10 916 singleton pregnant women whose dates of the last menstrual period and delivery were both between June 2014 and June 2016, and whose gestational age were within 24-42 completed gestational weeks were included in this study. Each pregnant woman's exposures to ambient NO2 throughout 12 weeks before pregnancy and pregnancy period were matched with daily average NO2 concentrations obtained from the Chinese air quality reanalysis datasets (CAQRA). Distributed lag models incorporated in Cox proportional hazard regression models were applied to explore the associations of maternal exposure to weekly ambient NO2 throughout 12 weeks before pregnancy and pregnancy period with risks of SGA and LGA after controlling for potential confounders including maternal age, ethnicity, educational level, occupation, body mass index before pregnancy, residence, times of gravidity and parity, smoking, alcohol consumption, husband smoking, and season of conception. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated per 3 μg·m−3 increase in ambient NO2 concentrations. Results The average levels of maternal exposure to NO2 over the preconception, first trimester, second trimester, third trimester, and entire pregnancy periods were (39.6±10.8), (42.7±10.5), (44.8±12.7), (37.7±11.1), and (41.6±4.8) μg·m−3, respectively. For a 3 μg·m−3 increase in NO2 over the first trimester, the risk of SGA increased by 19.0% (95%CI: 8.0%-32.0%). For a 3 μg·m−3 increase in NO2 over the preconception, first trimester, and entire pregnancy, the associated risks of LGA increased by 7.0% (95%CI: 1.0%-13.0%), 37.0% (95%CI: 29.0%-46.0%) and 19.0% (95%CI: 9.0%-31.0%), respectively. For SGA, the susceptible exposure windows for NO2 were observed during the 7th to 12th preconceptional weeks and the 6th to 12th gestational weeks, with the strongest association found at the 12th preconceptional week, when the risk of SGA increased by 6.0% (95%CI:3.2%-8.9%) for a 3 μg·m−3 increase in NO2. For LGA, the susceptible exposure windows for NO2 were observed during the 1st to 12th preconceptional weeks and the 1st to 6th gestational weeks, with the strongest association found at the 12th preconceptional week, when the risk of LGA increased by 6.1% (95%CI: 4.5%-7.8%) for a 3 μg·m−3 increase in NO2. Conclusion Exposure to ambient NO2 is associated with increased risks of both SGA and LGA, and the most susceptible weekly exposure windows are nested within the 12 weeks before pregnancy and early pregnancy.

Exploring early prevention and control of COVID-19 outbreak based on system dynamics model analysis / 浙江大学学报·医学版

To explore early prevention and control of coronavirus disease 2019 （COVID-19） outbreak based on system dynamics model analysis. The data of early outbreak of COVID-19 were collected from the World Health Organization，covering countries of the China，United States，United Kingdom，Australia，Serbia and Italy. The susceptible-exposed-infected-recovered （SEIR） model was generalized and then its parameters were optimized. According to the parameters in the basic infection number expression，the sensitivity in the system dynamics model was used to quantitatively analyze the influence of the protection rate，infection rate and average quarantine time on the early spread of the outbreak. Based on the analysis results，targeted prevention and control measures for the early outbreak of COVID-19 were proposed. The generalized SEIR model had a good fit for the early prediction and evaluation of COVID-19 outbreaks in six countries. The spread of COVID-19 was mainly affected by the protection rate，infection rate and average quarantine time. The improvement of the protection rate in the first ays was the most important:the greater the protection rate，the fewer the number of confirmed cases. The infection rate in the first 5 days was the most critical:the smaller the infection rate，the fewer the number of confirmed cases. The average quarantine time in the first 5 days was very important:the shorter the average quarantine time，the fewer the number of confirmed cases. Through the comparison of key parameters of six countries，Australia and China had implemented strict epidemic prevention policies，which had resulted in good epidemic prevention effects. In the early stage of the outbreak，it is necessary to improve the protection rate，shorten the average quarantine time，and implement strict isolation policies to curb the spread of COVID-19.

Predicting COVID-19 epidemiological trend by applying population mobility data in two-stage modeling / 浙江大学学报·医学版

:To predict the epidemiological trend of coronavirus disease 2019 (COVID-19) by mathematical modeling based on the population mobility and the epidemic prevention and control measures. : As of February 8，2020，the information of 151 confirmed cases in Yueqing，Zhejiang province were obtained，including patients' infection process，population mobility between Yueqing and Wuhan，etc. To simulate and predict the development trend of COVID-19 in Yueqing, the study established two-stage mathematical models，integrating the population mobility data with the date of symptom appearance of confirmed cases and the transmission dynamics of imported and local cases. : It was found that in the early stage of the pandemic，the number of daily imported cases from Wuhan (using the date of symptom appearance) was positively associated with the number of population travelling from Wuhan to Yueqing on the same day and 6 and 9 days before that. The study predicted that the final outbreak size in Yueqing would be 170 according to the number of imported cases estimated by consulting the population number travelling from Wuhan to Yueqing and the susceptible-exposed-infectious-recovered (SEIR) model; while the number would be 165 if using the reported daily number of imported cases. These estimates were close to the 170，the actual monitoring number of cases in Yueqing as of April 27，2020. : The two-stage modeling approach used in this study can accurately predict COVID-19 epidemiological trend.

Impact of Wuhan lockdown on the spread of COVID-19 in China: a study based on the data of population mobility / 浙江大学学报·医学版

This study aimed to quantitatively assess the effectiveness of the Wuhan lockdown measure on controlling the spread of coronavirus diesase 2019 (COVID-19). : Firstly，estimate the daily new infection rate in Wuhan before January 23，2020 when the city went into lockdown by consulting the data of Wuhan population mobility and the number of cases imported from Wuhan in 217 cities of Mainland China. Then estimate what the daily new infection rate would have been in Wuhan from January 24 to January 30th if the lockdown measure had been delayed for 7 days，assuming that the daily new infection in Wuhan after January 23 increased in a high，moderate and low trend respectively (using exponential, linear and logarithm growth models). Based on that，calculate the number of infection cases imported from Wuhan during this period. Finally，predict the possible impact of 7-day delayed lockdown in Wuhan on the epidemic situation in China using the susceptible-exposed-infectious-removed (SEIR) model. : The daily new infection rate in Wuhan was estimated to be 0.021%，0.026%，0.029%，0.033% and 0.070% respectively from January 19 to January 23. And there were at least 20 066 infection cases in Wuhan by January 23，2020. If Wuhan lockdown measure had been delayed for 7 days，the daily new infection rate on January 30 would have been 0.335% in the exponential growth model，0.129% in the linear growth model，and 0.070% in the logarithm growth model. Correspondingly，there would have been 32 075，24 819 and 20 334 infection cases travelling from Wuhan to other areas of Mainland China，and the number of cumulative confirmed cases as of March 19 in Mainland China would have been 3.3-3.9 times of the officially reported number. Conclusions: Timely taking city-level lockdown measure in Wuhan in the early stage of COVID-19 outbreak is essential in containing the spread of the disease in China.

Virulence genes profile and biofilm formation of Methicillin-resistant and Methicillin-susceptible Staphylococcus aureus isolates from diabetic foot infections

Aims@#Diabetic foot infections (DFIs) represent one of the most important risk factors for lower extremity amputation. One of the major infection agents that causes DFIs is Staphylococcus aureus. Staphylococcus aureus is an important human pathogen causing variety of clinical manifestations which can lead to invasive infections, sepsis and even death. Outcomes of antibiotic treatment of diabetic foot infections may depend not only on the antimicrobial susceptibility of the etiological agents, but also their ability to produce diverse virulence factors. This study was aimed to investigate biofilm production and the presence of various virulence genes among Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-susceptible Staphylococcus aureus (MSSA) isolates obtained from patients with DFIs. @*Methodology and results@#A total of 48 clinical MRSA and MSSA isolates obtained from diabetic foot patients were studied for their biofilm formation and the presence of 29 known virulence genes. The biofilm formation was observed, analyzed and quantified using the microtiter plate method. Biofilm production was observed as 95.50% and 92.00% in the MRSA and MSSA isolates, respectively. Among the 29 virulence genes tested on the 48 clinical isolates, 19 virulence genes were detected. It was found that aap (62.50%), etd (54.17%), icaD (50.00%), aae (50.00%), seh (31.25%) and icaADB (22.92%) were the most prevalent genes. A total of 10 virulence genes (etb, gehD, icaB, icaC, seb, hla_haem, hld_epid, altE, fbe and sesI) were absent in all the isolates used.@*Conclusion, significance and impact of study@#Virulence genes play important role in clinical infections. Our results showed the presence rates of biofilm formation and accumulation-associated factors that are high among MRSA as well as MSSA isolates from DFIs. These results confirmed the importance of biofilm formation as regarded for DFIs.

Propuesta de un modelo SYIR modificado para predecir la cinemática de la epidemia por COVID-19 / Proposal for a modified SYIR model to predict the kinematics of the COVID-19 epidemic

In late 2019, an infection in humans by the SARS-CoV-2 virus was detected for the first time in Wuhan, China. By February, several countries had sustained viral circulation. On March 11, the World Health Organization (WHO) declared a global pandemic. Initially, one of the main concerns regarding the spread of this pathogen was the possible lack of capacity of health systems to absorb the demand for resources in a pandemic situation. At the local level, on March 19 a measure of "social, preventive and mandatory isolation" was established, from March 20 to March 31, 2020, in order to protect public health, which was later extended until March 26 April through DNU 335/2020. MEDICUS is a private medicine company with representation throughout Argentina for 48 years. 85% of its affiliates reside in the Metropolitan Area of Buenos Aires (AMBA), Argentina. The objective of this study is to propose a modified SYIR (Susceptible-Contagious-Infective-Recovered) model, with the purpose of generating a monitoring tool that can anticipate the behavior of the COVID-19 pandemic in the AMBA population of a company prepayment, and the consequences of the measures adopted by the health authorities and their compliance over time. In the case of MEDICUS, for the optimistic scenario, a start of the peak of cases is expected in the first week of June and an end in late November, with a peak in early September; the pessimistic scenario begins the peak in mid-April, reaches its maximum in late May and ends in mid-June. It presents a much larger number of cases, more concentrated in time. The moderate scenario is an intermediate of both. The COVID-19 pandemic is a huge challenge for all health systems in the world, not just for Argentina. In our study, we forecast three possible scenarios for the behavior of the pandemic (optimistic, moderate and pessimistic) that will depend on the characteristics, adherence and persistence of the isolation measures in our country. Given the current dynamics and compliance with these measures, we estimate it possible that the real measure is somewhere between the optimistic and moderate scenarios.

A fines del año 2019, se detectó por primera vez en Wuhan, China, una infección en seres humanos por el virus SARS-CoV-2. Para febrero, varios países registraban circulación viral sostenida. El 11 de marzo la Organización Mundial de la Salud (OMS) declaró la pandemia mundial. Inicialmente, una de las principales preocupaciones ante la expansión de este patógeno fue la posible falta de capacidad de los sistemas sanitarios para absorber la demanda de recursos ante una situación de pandemia. En el ámbito local, el 19 de marzo se estableció una medida de "aislamiento social, preventivo y obligatorio", desde el 20 hasta el 31 de marzo de 2020, con el fin de proteger la salud pública, que luego se extendió hasta el 26 de abril mediante el DNU 335/2020. MEDICUS es una empresa de medicina prepaga con representación en toda la Argentina desde hace 48 años. El 85% de sus afiliados reside en el Área Metropolitana de Buenos Aires (AMBA). El objetivo de este trabajo es proponer un modelo SYIR (Susceptible-Contagiado-Infectante- Recuperado) modificado, con el propósito de generar una herramienta de seguimiento que pueda anticipar el comportamiento de la pandemia de COVID-19 en la población del AMBA de una empresa prepaga, y las consecuencias de las medidas adoptadas por las autoridades sanitarias y su cumplimiento a través del tiempo. En el caso de MEDICUS, para el escenario optimista se espera un inicio del pico de casos en la primera semana de junio y una finalización a fines de noviembre, con un máximo a comienzos de septiembre; el escenario pesimista inicia el pico a mediados de abril, llega a su máximo a fines de mayo y lo termina a mediados de junio. Presenta un número mucho mayor de casos, más concentrado en el tiempo. El escenario moderado es un intermedio de ambos. La pandemia de COVID-19 es un enorme desafío para todos los sistemas de salud del mundo, no solo para el argentino. En nuestro estudio, pronosticamos tres escenarios posibles de comportamiento de la pandemia (optimista, moderado y pesimista) que dependerán de las características, la adhesión y la persistencia de las medidas de aislamiento en nuestro país. Por la dinámica actual y el cumplimiento de estas medidas, estimamos posible que la real medida se sitúe en algún punto entre el escenario optimista y el moderado

Sero-prevalence of unvaccinated adolescent girls susceptible to rubella virus infection seen in a tertiary care hospital of Patna, Bihar, India

Background: Rubella infection occurring during early pregnancy results in congenital rubella syndrome (CRS).  WHO estimates that worldwide more than 100,000 children are born with CRS each year and most of them are in the developing countries. For assessing population immunity against rubella, sero-surveys are generally recommended among adolescent girls and reproductive age female. In India, sero-surveys conducted by different authors have indicated that about 10-30% of adolescent females are susceptible to rubella infection. Adolescent girls are selected because they are at a critical stage of child bearing age and their immunity against Rubella infection is the particular area of interest. objective of this study was to estimate the sero-prevalence of unvaccinated adolescent girls susceptible to Rubella virus infection attending a tertiary care hospital of Patna and then accordingly counsel for vaccination.Methods: A total 150 adolescent girls in the age group of 10-19 years who had not received MMR vaccine were included in the study. Serum IgG antibody titer for rubella was estimated by the ELISA method.Results: A total 65.33% of the adolescent girls were found to be rubella seropositive and (34.67%) were seronegative. The urban adolescent girls had a higher seropositivity of 85.2% as compared to rural adolescent girls.Conclusions: The study indicates that a substantial number of adolescents (34.67%) are seronegative and hence susceptible to rubella infection.

Varicela zoster / Varicela zoster

La varicela es una enfermedad infecto-contagiosa, producida por el virus varicela-zoster (VVZ); es un virus alfaherpes que se relaciona más estrechamente con el virus del herpes simple, se presenta cuando el virus entra en contacto con la mucosa del tracto respiratorio superior o la conjuntiva de una persona susceptible, la transmisión de persona a persona se puede presentar por contacto directo con lesiones de VZV o por propagación en el aire. La reinfección con VZV es rara. El período de incubación es de 10 a 21 días; los síntomas que generalmente se presentan son fiebre, malestar general, anorexia, dolor de cabeza y posteriormente vesículas claras, pruriginosas en las primeras etapas, llenas de líquido que evolucionan a costras. La complicación más común de la varicela es la sobreinfección bacteriana de las lesiones cutáneas causadas con mayor frecuencia por Staphylococcus aureus y Streptococcus del grupo A, pero también es posible encontrar linfadenitis y abscesos subcutáneos. Cuando la varicela se presenta durante los últimos días de gestación (<5 días) o 2 días después del parto, existe un riesgo aproximado de 20% de presentar varicela neonatal.

The Varicela is an infectious-contagious disease, caused by the varicella-zoster virus (VZV); It is an alphaherpes virus that is more closely related to the herpes simplex virus, it occurs when the virus comes into contact with the mucosa of the upper respiratory tract or the conjunctiva of a suscep-tible person, transmission from person to person can occur by contact Direct with VZV or airborne injuries. Reinfection with VZV is rare. The incubation period is from 10 to 21 days; The symptoms that generally appear are fever, general malaise, anorexia, headache and later clear, itchy vesicles in the early stages, filled with fluid that evolve to crusts. The most common complication of varicela is bacterial superinfection of the cutaneous lesions most frequently caused by group A Staphylococcus aureus and Streptococcus, but it is also possible to find lymphadenitis and subcutaneous abscesses. When chickenpox occurs during the last days of gestation (<5 days) or 2 days after delivery, there is an approximate 20% risk of developing neonatal varicela

Coronavirus disease 2019 epidemic trend prediction based on improved infectious disease dynamics susceptible-exposed-infected-recovered (SEIR) model / 第二军医大学学报

Objective To predict the coronavirus disease 2019 (COVID-19) epidemic situation based on the infectious disease dynamics susceptible-exposed-infected-recovered (SEIR) model, so as to provide guidance for effective control of the epidemic. Methods Python crawler automatic update function was used to collect the epidemic data released by the National Health Commission of China. An improved infectious disease dynamics SEIR model, which can automatically correct the COVID-19 basic reproductive number (R0), was constructed to predict the development trend of COVID-19 epidemic in Hubei Province of China and South Korea. Results The peak of the COVID-19 epidemic in Hubei Province of China predicted by the model would appear on Feb. 21, 2020. The number of confirmed COVID-19 cases would be about 50 000 on Feb. 19 and would fall to below 30 000 on Mar. 4, and the epidemic would end on May 10. According to the actual data released by the National Health Commission of China, the peak number of confirmed COVID-19 patients was 53 371. The model predicted that an epidemic peak in South Korea would be on Mar. 7, and would end at the end of April. Conclusion This improved infectious disease dynamics SEIR model established in the early stage of COVID-19 epidemic has achieved relatively accurate prediction. The timely and effective intervention by relevant government departments has significantly affected the development of the epidemic. The epidemic situation in other countries in East Asia, such as South Korea, is still on the rise in March, suggesting that China needs to be on guard against the risk of imported epidemic.

Research progress of patch infection after tension-free hernia repair / 解放军医学杂志

Inguinal hernia is one of the common diseases in general surgery, and tension-free hernia repair is the most common treatment for inguinal hernia. Patch infection is the common complication after hernia repair, confuses many of the general surgeons for its complex condition and long duration. The pathogenetic factors of patch infection can be roughly divided into three aspects, which include patients' physical condition, operation details, material and structure of patch. Prevention in advance of the susceptible factors of mesh infection can significantly improve the prognosis of patients. As for the treatment of patch infection, there is no unified standard yet, and individual treatment plans should be formulated according to the patient's condition and experience of the clinician. This article reviews the latest research progress of the occurrence, diagnosis, prevention and treatment of patch infection after tension-free hernia repair.

Susceptibility genes related to non-traumatic femoral head necrosis: Improving detection accuracy and developing new treatment strategy / 中国组织工程研究

BACKGROUND: Although the mechanism of femoral head necrosis has a series of explanations such as glucocorticoids, ethanol, decompression sickness, sickle cell anemia, and genetic susceptibility, the specific pathogenesis is still unclear. OBJECTIVE: To highlight the genetics of non-traumatic femoral head necrosis by combining recent genetic studies, thus providing new treatments for the repair and reconstruction of femoral head. METHODS: A computer-based online retrieval of CNKI, WanFang, PubMed and Web of Science databases was performed to search the related articles published from January 2000 to April 2019. The keywords were “non-traumatic femoral head necrosis, susceptibility genes, pathogenesis” in Chinese and English, respectively. According to the inclusion and exclusion criteria, the irrelevant and repetitive articles were excluded, and finally 49 eligible articles were included for analysis. RESULTS AND CONCLUSION: Non-traumatic femoral head necrosis is an extremely complex disease whose pathogenesis is caused by a combination of factors rather than a single genetic gene. COL2A1 genetic mutation is the high susceptibility gene to non-traumatic femoral head necrosis. High-coagulation and low-fibrinolytic state-related loci in the blood, interleukin-related gene loci in immune system and lipid-related loci become more and more important in inducing non-traumatic femoral head necrosis. With the deep understanding of human genetic technology, the accuracy of detecting susceptible genes will be continuously improved, which is conducive to the prevention, diagnosis and precise individualized treatment of non-traumatic femoral head necrosis.

Retrospective analysis of Chinese epidemic situation model based on elbow cluster analysis / 上海交通大学学报（医学版）

Objective • To explore the correlation patterns of the new coronavirus disease 2019 (COVID-19) epidemic in various provincial administrative regions in China at the early stage of the epidemic, and forecast the following development of epidemic situation. Methods • The data on the COVID-19 epidemic situation in various provincial administrative regions in China published by National Health Commission of People's Republic of China from Jan. 13 to Feb. 13, 2020, were retrospectively analyzed. The elbow cluster analysis method was used to cluster the provincial administrative regions. The SEIR (susceptible-exposed-infectious-recovered) model was used to calculate the basic infection number (R0) of different clusters, whose changing trends were also predicted. Results • According to the prevalence rates, the 34 provincial administrative regions were divided into four types of clusters: Cluster (22 provincial administrative regions), Cluster Ⅱ (9 provincial administrative regions), Cluster III (2 provincial administrative regions) and Cluster (Hubei). The prevalence rate of Hubei was higher than those of other clusters (P=0.000), but the differences in the cure rate and the case-fatality rate among the four clusters were not statistically significant; the R0 values based on the SEIR model of them were 2.764, 3.056, 3.899 and 3.984, respectively. By Feb. 13, 2020, except for Hubei, the cumulative prevalence curves of the other clusters tended to be stable and the cure rates increased. The prevalence rate and case-fatality rate of Hubei were still higher, and the cure rate was lower. Conclusion • From Jan. 13 to Feb. 13, 2020, 34 provincial administrative regions in China can be divided into four clusters according to the severity of the COVID-19 epidemic, and the prevalence rate of Cluster was significantly higher than those of other three clusters; by Feb. 13, 2020, the epidemic situations in the Cluster , Ⅱ and III has been alleviated, and the epidemic situation in Cluster areas were still severe.

Challenges to prevent and control the outbreak of Novel Coronavirus Pneumonia (COVID-19) / 中华流行病学杂志

An outbreak of severe pneumonia of unknown cause was reported in December 2019 in Wuhan, Hubei Province, China. The infectious virus was soon identified and named as 2019 novel coronavirus (2019-nCov). The name of the coronavirus infectious disease (COVID-19) was given by WHO on 11 February 2020. It has so far caused about 118 000 cases in 114 countries including China and was characterized as a pandemic by WHO on 11 March. We still face great challenges in control of the epidemic: uncertain initial source of infection, infected populations widely scattered, complex routs of transmission, populations generally susceptible, high contagiousness of the virus, and finally vaccines unlikely available in the near future.

Determination of MICs of Methicillin-resistant and Methicillin-susceptible Staphylococcus aureus Isolated from a Tertiary-care Hospital in Guyana

Objective:Previous studies done in the hospital setting in Guyana have shown that the frequency of isolation of methicillin-resistant Staphylococcus aureusisolates far exceeds the worldwide estimate of 50%. These past studies have been based on the use of the Kirby-Bauer disk diffusion methodology. The present study was conducted to determine the minimum inhibitory concentration of clinical isolates of methicillin-susceptible and methicillin-resistant S. aureususing the broth microdilution method.Design andMethods:A total of 101 consecutive, non-repetitive S. aureusisolates obtained from the GPHC medical lab during a six-week period were included in thestudy. These isolates were identified as MRSA and MSSA by laboratory personnel using the cefoxitin disk diffusion method. The oxacillin MICs for all isolates obtained were determined using prepared oxacillin broth microdilution trays with concentrations ranging from 4μg/ml to 256μg/ml. All results were interpreted according to CLSI guidelines.Results:The prevalence of MRSA at GPHC was found to be 65.35% with a majority of the isolates being high level oxacillin resistant strains with MICs > 256μg/ml (84.85%). In our study, most resistant isolates were collected from patients admitted to the FSW (16.67%), Paediatric Wards (13.65%), MSW (13.64%), and FMW (12.12%). Additionally, 35 (79.55%) MSSA were suspected oxacillin susceptible with MIC < 4μg/ml. Therelationship between the cefoxitin disc diffusion and oxacillin broth microdilution results was found to be statistically significant with a p < 0.001.Conclusion:Methicillin-resistance continues to be a major problem in the hospital setting, and this study has should that commonly used conventional techniques are unlikely to identify all of the potentially resistant isolates.Recommendation:The high prevalence and high oxacillin MIC of MRSA at GPHC suggests that more emphasis should be placed on infection control and surveillance programs within the hospital setting.

Clinical characteristics and prognosis analysis of patient with Methicillin-susceptible Staphylococcus aureus, or Methicillin-resistant Staphylococcus aureus Bacteremia / 中华急诊医学杂志

Objective To investigate the clinical characteristics and prognosis analysis of patient with bacteremia induced by Methicillin-susceptible Staphylococcus aureus (MSSA) or Methicillin-resistant Staphylococcus aureus (MRSA).Methods This retrospective study included 95 Staphylococcus aureus Bacteremia (SAB) patients admitted to Nanjing Drum Tower hospital from January 2012 to December 2017.According to the drug sensitivity tests,patients were divided into MSSA group and MRSA group.Clinical characteristics,systematic score and prognosis were compared between these two group.APACHE Ⅱ score and SOFA score were analyzed by independent-samples t test.The distribution of primary disease and basic disease,bacterium source,and prognostic factors were analyzed by Mann—Whitney U test or x2 test.The cumulative survival was calculated by the Kaplan-Meier method.Wilcoxon rank sum test was selected for survival rate comparison.Results There are 56 MSSA strain and 39 MRSA strain among the 95 SAB patients,the detection rate is 58.95％ and 41.05％,respectively.The most common primary disease of SAB is catheter-related infections(23 cases,24.21％).Compared with MSSA group,the catheter-related infections has higher detection rate of MRSA obviously (P＜0.01).The most common underlying disease of SAB is diabetes (35 cases,36.84％).Compared with MSSA,MRSA is more frequent appear in SAB patients combine with renal dysfunction (28 cases,29.47％).The third disease is cardiac insufficiency (22 cases,23.16％).The community-acquired SAB is fifty-two and the majority of strains is MSSA.The hospital-acquired SAB is forty-three and mainly of them is MRSA.The Sepsis related Organ Failure Assessment (SOFA) score of MRSA group are higher than MSSA significantly (t=2.203,P=0.024).However,there is no significant differences between MSSA and MRSA group in APACHE Ⅱ score,cases of hospitalized beyond 30 days and 28-days survival rate (P ＞ 0.05).Conclusions The majority of strains in the SAB patients is MSSA.In clinical characteristics,compared with MSSA,MRSA is more common in nosocomial infection,catheter related infection and renal dysfunction patients.There is no significant differences in prognosis between MSSA group and MRSA group.

Temporal evolution of antimicrobial resistance among Neisseria gonorrhoeae clinical isolates in the most populated South American Metropolitan Region

A total of 124 Neisseria gonorrhoeae isolates recovered during a 12-year period (2003-2015) from outpatients assisted at Centro de Referência e Treinamento DST/AIDS-CRT of São Paulo city, Brazil, were analysed. The following resistance rates were observed: penicillin-59.6%, ciprofloxacin-15.3%, and azithromycin-6.7%. Although reduced susceptibility to these drugs was observed since 2003, no ceftriaxone-resistant isolates were detected. Ciprofloxacin- and azithromycin non-susceptible isolates were grouped in 11 clusters. Mutations were detected in GyrA and ParC of isolates 124 and 260, and a C2611T substitution on 23S rRNA alleles was also observed in isolate 260. Both isolates belonged to ST1901/ST6210 (MSLT/NG-MAST schemes).