Neumatocele traumático: una presentación inusual del trauma cerrado de tórax en paciente de 21 años / Traumatic pneumatocele: an unusual presentation of blunt chest trauma in a 21-year-old patient

El neumatocele traumático, o pseudoquiste pulmonar traumático, es una complicación infrecuente del trauma cerrado de tórax, caracterizada por lesiones cavitadas únicas o múltiples de paredes fibrosas bien delimitadas, sin revestimiento epitelial. Representa un reto diagnóstico ante la prevalencia de etiologías más frecuentes de cavitación pulmonar, presentación clínica inespecífica y el carácter subreportado de la patología. Se presenta el caso de un paciente de 21 años, con cuadro clínico de fiebre y dolor torácico posterior a traumatismo contuso por accidente en motocicleta, con identificación de una lesión cavitada rodeada de vidrio esmerilado, ubicada en lóbulo superior derecho en tomografía de tórax. Se ofreció tratamiento antibiótico ante la sospecha clínica de sobreinfección. Sin embargo, se atribuyó la alteración pseudoquística pulmonar al antecedente traumático. En ocasiones las cavitaciones pulmonares postrauma no son identificadas en la atención inicial, por ende, es fundamental la evaluación clínica e imagenológica subsecuente.

Traumatic pneumatocele, or traumatic pulmonary pseudocyst, is a rare complication of blunt chest trauma, characterized by multiple or unique cavitary lesions, with well-defined fibrous walls without epithelial lining. It represents a diagnostic challenge due to the higher prevalence of other etiologies of lung cavities, nonspecific clinical features and the under-reported nature of this pathology. We present the case of a 21-year-old male with fever and chest pain after a blunt chest trauma in a motorcycle accident, with identification of a cavity in the right upper lobe, surrounded by ground glass opacities. Antibiotic therapy was administered after clinical suspicion of superinfection, however, the cavitary lesion was attributed to the trauma. Occasionally, traumatic pulmonary pseudocysts are not identified during initial assessment, therefore, clinical and imagenologic follow-up is essential.

Coinfecciones y sobreinfecciones en pacientes con diagnóstico de COVID-19 ingresados en terapia del Hospital Hermanos Ameijeiras / Behavior of coinfections and superinfections in COVID-19 patients admitted to the intensive care unit at Hermanos Ameijeiras Hospital

Introducción: La enfermedad COVID-19 se ha asociado a un incremento de los ingresos en terapia intensiva. La probabilidad de muerte se eleva con las coinfecciones y sobreinfecciones. Objetivo: Determinar la presencia de coinfecciones y aparición de sobreinfecciones en pacientes con COVID-19 ingresados en terapia, los factores asociados a esta y su relación con la mortalidad. Métodos: Se realizó un estudio analítico transversal donde se estudió a 79 pacientes positivos al virus SARS-CoV-2 en 8 meses en el servicio de la terapia del Hospital Hermanos Ameijeiras. Se estudiaron variables demográficas, clínicas y de manejo en terapia. Las variables categóricas se expresaron en frecuencias absoluta y relativa. Las variables cuantitativas se describieron según la mediana y sus rangos intercuartílicos. Se empleó la prueba de rangos de Wilcoxon, ji al cuadrado de Pearson y el modelo de regresión logística multinomial para determinar las variables predictoras independientes de la sobreinfección. Resultados: Presentaron sobreinfección 34 pacientes (43 %). Hubo una mortalidad del 43 % con 34 pacientes, de estos se sobreinfectaron 18 pacientes. Se obtuvo una asociación causal entre la sobreinfección y la estadía hospitalaria (OR: 1,56; IC: 95 %: 1,26-2,08; p < 0,001), el uso de ventilación mecánica invasiva (OR: 3,28; IC: 95 %: 1,30-8,73; p = 0,014) y el tiempo de empleada esta (OR: 1,37; IC: 95 %: 1,15-1,71; p< 0,001). Conclusiones: No se encontró asociación estadística entre la mortalidad y la sobreinfección en los pacientes estudiados. Hubo poca representación de coinfecciones. La estadía en terapia, el uso de ventilación mecánica invasiva y el tiempo de empleada esta fueron variables predictoras en la aparición de sobreinfección.

Introduction: COVID-19 is associated with an increase in the number of admissions to the intensive care units. The likelihood of fatality cases increases with coinfections and superinfections. Objective: To determine the presence of coinfections and the occurrence of superinfections in COVID-19 patients admitted to the intensive care unit, its associated factors and its relationship with mortality. Methods: It was conducted a cross-sectional analytic study in 79 patients with positive SARS-CoV-2 tests during eight months in the intensive care units at Hermanos Ameijeiras Hospital. Demographic, clinical and management variable were studied. Categorical variables were expressed in terms of absolute and relative frequencies. Quantitative variables were described based on their median and their interquartile ranges. The Wilcoxon rank test, Pearson's chi-squared test and the multinomial logistic regression model were used to determine the independent predictor variables of superinfection. Results: Superinfection occurred in 34 patients (43%). The mortality rate was 43% with 34 patients, of which 18 had superinfections. A causal association was established between superinfection and hospital stay (OR: 1.56; CI: 95%: 1.26-2.08; p < 0.001), the use of invasive mechanical ventilation (OR: 3.28; CI: 95%: 1.30-8.73; p = 0.014) and the time this procedure was used (OR: 1.37; CI: 95%: 1.15-1.71; p < 0.001). Conclusions: No statistical association was found between mortality and superinfection in the patients under study. There was low presence of coinfections. The stay in the intensive care unit, the use of invasive mechanical ventilation and the time this procedure was used were predictive variables for the occurrence of superinfection.

Severe pneumonia caused by complex bacterial infections: a case report and literature review / 中国基层医药

Objective:To investigate the diagnosis and treatment of severe pneumonia caused by unexplained complex infections by analyzing and summarizing the clinical data of one patient with severe pneumonia.Methods:We included one case of severe pneumonia who was cured in the Department of Critical Care Medicine of Anhui Provincial Cancer Hospital in 2018. We used descriptive methods to analyze the case data and reviewed pieces of literature related to clinical data collected during diagnosis and treatment.Results:The 34-year-old male patient had chest tightness and asthma attacks in December 2017. He received treatment in Departments of Respiratory Medicine and Critical Care Medicine, Class III Grade A hospitals outside Anhui Province. Chest CT scans showed atelectasis and consolidation of the right lung, and bilateral pleural effusion. Laboratory test results suggested widespread drug-resistant Acinetobacter baumannii, Aspergillus, and Candida infections. Cardiac color Doppler ultrasound images suggested pulmonary hypertension. He had recurrent respiratory failure. After mechanical ventilation, he had septic shock. These findings indicated severe pneumonia. Later, he was escorted by a 120 ambulance hospital transportation car from Guangzhou to the Department of Critical Care Medicine, Anhui Provincial Cancer Hospital to alleviate respiratory failure and shock. During hospitalization, the patient underwent nasal feeding because of an aspiration mistake. He was also subject to an active anti-infection, nutritional support, and airway management. The patient's condition improved, but respiratory failure could not be completely alleviated. After experimental anti-tuberculosis treatment, the patient was discharged because his condition improved. The patient was treated for a total of 102 days. Conclusion:A single pathogen or a single pathogenic factor is involved in community-acquired severe pneumonia in young and middle-aged patients. During diagnosis and treatment of severe pneumonia, laboratory test results have a guiding significance for judging the patient's condition. Diagnosis of severe pneumonia caused by unexplained complex infections does not simply rely on laboratory test results. Under the condition of infection by non-specific pathogens such as tuberculosis, severe pneumonia should be treated after analyzing clinical manifestations, asking the medical history in detail, carefully monitoring the changes in disease condition, paying attention to details, and finding the pathological factors.

Supervivencia en pacientes con neumonía grave por SARS-CoV-2 con sobreinfección en una Unidad de Cuidados Intensivos / Survival in patients with severe SARS-CoV-2 pneumonia with superinfection in an Intensive Care Unit / Sobrevivência em pacientes com pneumonia grave por SARS-CoV-2 com superinfecção em uma Unidade de Terapia Intensiva

Resumen: Introducción: La sobreinfección en pacientes con síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2) no está completamente entendida y requiere ser atendida para evitar el uso excesivo de antibióticos. Material y métodos: Estudio observacional, retrospectivo, longitudinal, comparativo, en pacientes con neumonía grave por SARS-CoV-2. Se calculó la probabilidad de supervivencia individual acumulada a lo largo de 90 días con el método de Kaplan Meier, en grupos con sobreinfección o ausencia de desarrollo de microorganismos aislados mediante cultivos de secreción bronquial, hemocultivos central y periférico, y urocultivos. Resultados: Se reclutaron 82 pacientes, 21 (25.6%) presentaron crecimiento bacteriano o fúngico en cultivos de secreción bronquial, ocho (9.7%) presentaron crecimiento bacteriano en hemocultivos periféricos, cinco (6%) tuvieron desarrollo bacteriano en hemocultivos centrales, y 16 (19.5%) presentaron crecimiento bacteriano o fúngico en urocultivos. La supervivencia en estos pacientes fue menor, sin ser significativa, con respecto a quienes no tuvieron sobreinfección (p = 0.352, 0.280, 0.119, 0.302 respectivamente). Conclusión: La sobreinfección en los pacientes con neumonía grave por SARS-CoV-2 no demostró ser un factor asociado a menor supervivencia y aunque la prevalencia de sobreinfección no es despreciable, no hay evidencia suficiente para respaldar el uso generalizado de antibióticos empíricos.

Abstract: Introduction: Superinfection in patients with severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2) is not completely understood and requires attention to avoid the excessive use of antibiotics. Material and methods: Observational, retrospective, longitudinal, comparative study in patients with severe SARS-CoV-2 pneumonia. The accumulated probability of individual survival over 90 days was calculated with the Kaplan Meier m ethod, in groups with superinfection or absence of development of isolated microorganisms using cultures of bronchial secretion, central and peripheral blood cultures, and urine cultures. Results: Eighty-two patients were recruited, 21 (25.6%) presented bacterial or fungal growth in cultures of bronchial secretion, eight (9.7%) presented bacterial growth in peripheral blood cultures, five (6%) had bacterial development in central blood cultures, and 16 (19.5%) presented bacterial or fungal growth in urine cultures. Survival in these patients was lower, without being significant, with respect to those who did not have superinfection, (p = 0.352, 0.280, 0.119, 0.302 respectively). Conclusion: Superinfection in patients with severe SARS-CoV-2 pneumonia has not been shown to be a factor associated with lower survival, and although the prevalence of superinfection is not negligible, there is insufficient evidence to support the generalized use of empirical antibiotics.

Resumo: Introdução: A superinfecção em pacientes com síndrome respiratória aguda grave pelo coronavírus 2 (SARS-CoV-2) não é totalmente compreendida e requer atenção para evitar o uso excessivo de antibióticos. Material e métodos: Estudo observacional, retrospectivo, longitudinal e comparativo em pacientes com pneumonia grave por SARS-CoV-2. A probabilidade acumulada de sobrevida individual em 90 dias foi calculada pelo método de Kaplan Meier, nos grupos com superinfecção ou ausência de desenvolvimento de microrganismos isolados por meio de cultura de secreção brônquica, hemocultura central e periférica e cultura de urina. Resultados: Foram recrutados 82 pacientes, 21 (25.6%) apresentaram crescimento bacteriano ou fúngico em culturas de secreção brônquica, 8 (9.7%) apresentaram crescimento bacteriano em hemoculturas periféricas, 5 (6%) apresentaram desenvolvimento bacteriano em hemoculturas centrais, e 16 (19.5%) apresentaram crescimento bacteriano ou fúngico nas culturas de urina. A sobrevida nesses pacientes foi menor, sem ser significativa, em comparação com aqueles que não tiveram superinfecção, (p = 0.352, 0.280, 0.119, 0.302 respectivamente). Conclusão: A superinfecção em pacientes com pneumonia grave por SARS-CoV-2 não demonstrou ser um fator associado a menor sobrevida e, embora a prevalência de superinfecção não seja desprezível, não há evidências suficientes para apoiar o uso generalizado de antibióticos empíricos.

Uso racional de antimicrobianos en tiempos de COVID-19 en Perú: rol de los programas de optimización del uso de antimicrobianos e intervenciones desde el punto de vista de control de infecciones

La resistencia antimicrobiana (RAM) es una pandemia adicional de lenta evolución que precede a la pandemia de COVID-19 y continuará cuando esta termine. Sin embargo, en países como Perú, donde existe un alto consumo y prescripción inadecuada de antimicrobianos, puede pasar desapercibida y se puede esperar, en el futuro, un escenario más desafiante. Los programas de optimización de uso de antimicrobianos (PROA) son equipos multidisciplinarios de profesionales que tienen como objetivo retardar la aparición de organismos multirresistentes a través de estrategias como la auditoría de prescripciones o la creación de algoritmos de tratamiento antimicrobiano basados en las tasas locales de RAM. La dificultad en el diagnóstico oportuno de coinfecciones o superinfecciones en el curso clínico y progresión de la COVID-19 predisponen al uso inadecuado de antimicrobianos, lo que obliga a los PROA a adaptar sus estrategias en este panorama cambiante. En Latinoamérica, los PROA no solo tienen que fomentar el cambio de comportamiento en los prescriptores de antimicrobianos, sino también luchar contra la epidemia de información falsa (infodemia) y las campañas de desinformación sobre la COVID-19. Además, la pobre cultura local de prevención y control de infecciones obliga a revisar estrategias para mitigar el impacto posterior en la RAM.

Antimicrobial resistance (AMR) is an additional slow-evolving pandemic that precedes the COVID-19 pandemic and will continue when it ends. However, in countries like Peru, where high consumption and inadequate prescription of antimicrobials occur, AMR may go unnoticed and a more challenging future scenario can be expected. Antimicrobial stewardship programs (ASPs) consist of multidisciplinary teams of professionals that aim to slow down the emergence of multidrug-resistant organisms through strategies such as prescription auditing or creation of antimicrobial treatment guidelines based on local AMR rates. The difficulty in the timely diagnosis of co-infections or superinfections in the clinical course and progression of COVID-19 leads to inappropriate use of antimicrobials, forcing ASPs to adapt their strategies in this changing scenario. In Latin America, ASPs not only have to promote behavior change in antimicrobial prescribers but also fight the epidemic of false information (infodemic) and disinformation campaigns on COVID-19. Furthermore, poor-quality infection prevention and control principles require evaluating strategies to mitigate the subsequent impact on AMR.

Superinfection exclusion studies using West Nile virus and Culex flavivirus strains from Argentina

In Argentina, many Flavivirus were recognised including West Nile virus (WNV). During 2009 several strains of Culex Flavivirus (CxFV), an insect-specific flavivirus, were isolated in the same region where circulation of WNV was detected. Hence, the objective of this study was to analyse the effect of co-infection in vitro assays using CxFV and WNV Argentinean strains in order to evaluate if CxFV could affect WNV replication. Our results showed that WNV replication was suppressed when multiplicity of infection (MOI) for CxFV was 10 or 100 times higher than WNV. Nevertheless, in vivo assays are necessary in order to evaluate the superinfection exclusion potential.

Concurrent hepatitis D virus infection increases risk of hepatocellular carcinoma in patients with chronic hepatitis B / 临床肝胆病杂志

Concurrent hepatitis D virus (HDV) infection accelerates the progression of liver disease in patients with chronic hepatitis B and particularly increases the risk of hepatocellular carcinoma (HCC). Further studies are still needed to explore the carcinogenic mechanism of HDV, related treatment methods, and their clinical effects. This article reviews the new epidemiological characteristics of HDV-related HCC, the new understanding of the pathogenic mechanism of HDV, and the advances in diagnosis and treatment, which is of great significance to promote the development of accurate HDV detection methods and effective drugs and reduce HDV-related HCC.

Hemorragia digestiva ocasional em criança por estrongiloidíase: importância do exame parasitológico / Occasional digestive hemorrhage in children due to strongyloidiasis: importance of parasitologic testing

RESUMO Objetivo: Descrever um caso incomum de infecção por Strongyloides stercoralis (S. stercoralis) em paciente de quatro meses de idade e ressaltar a importância do diagnóstico precoce. Descrição do caso: Paciente masculino, procedente e residente de Videira, Santa Catarina, Brasil, nasceu pré-termo, parto cesárea, peso de nascimento 1.655 g, e permaneceu na Unidade de Terapia Intensiva neonatal e intermediária por 20 dias. Aos quatro meses de idade, começou a evacuar fezes sanguinolentas e foi feita hipótese de alergia à proteína do leite de vaca, em razão da sintomatologia e do uso da fórmula infantil para o primeiro semestre, para o qual foi indicada a substituição por fórmula infantil com proteína hidrolisada. Foram solicitados a pesquisa de leucócitos e o exame parasitológico das fezes). Ambos se mostraram positivos e o parasitológico revelou a presença de larva rabditoide de S. stercoralis. O clínico manteve a hipótese inicial e a dieta, mas solicitou a coleta de três amostras de fezes, que resultaram em uma amostra para larvas rabditoide, em muda, de S. stercoralis. Como a criança apresentava dor abdominal, vômito e as fezes permaneciam sanguinolentas, foi iniciado o tratamento com tiabendazol - duas vezes/dia por dois dias -, repetido após sete dias, e, em seguida, realizado o exame parasitológico de fezes, tendo sido negativo. Comentários: A estrongiloidíase, apesar de ser uma infecção parasitária frequentemente leve, em pacientes imunocomprometidos pode se apresentar de forma grave e disseminada. Deve-se suspeitar desse agente em pacientes que vivem em áreas endêmicas, sendo o diagnóstico estabelecido por meio da pesquisa das larvas do S. stercoralis na secreção traqueal e nas fezes.

ABSTRACT Objective: To describe an uncommon case of infection by Strongyloides stercoralis (S. stercoralis) in a 4-month-old child and to highlight the importance of early diagnosis. Case description: The patient was a male child from the city of Videira, State of Santa Catarina, Southern Brazil, who was born preterm by Cesarean-section, weighing 1,655 g, and stayed in the neonatal intensive care unit for 20 days. At four months of age, the child started presenting blood in stools and the possibility of cow's milk protein allergy was considered, given the symptoms and the use of infant formula in his 1st semester of life, which was then replaced by infant formula with hydrolyzed protein. White blood cell count and a parasitological stool sample were requested. Both tested positive and the stool ova and parasite examination showed a rhabditoid larva of S. stercoralis. The clinician maintained the initial hypothesis and diet, but requested three new stool samples, which tested positive for rhabditoid larvae of S. stercoralis. Since the child presented abdominal pain and vomiting, and there was still blood in stools, treatment with thiabendazole was initiated twice a day for two days. Treatment was repeated after seven days along with a new parasitological examination, which was then negative. Comments: Although strongyloidiasis is usually a mild parasitic infection, it may be severe and disseminated in immunocompromised patients. This agent must be considered in patients who live in endemic areas, and the diagnosis should be established by searching S. stercoralis larvae in tracheal secretions and in stools.

Features and management of patients with hepatitis C virus/hepatitis B virus dual infection associated with the application of direct-acting antiviral agents / 临床肝胆病杂志

Dual infection with hepatitis C virus (HCV) and hepatitis B virus (HBV) has significantly different clinical,immunological,and virological features from single infection with HCV or HBV,which brings various challenges to clinical diagnosis/treatment and management.Direct-acting antiviral agents used for effective control of HCV infection may cause HBV activation,onset of hepatitis B,and even liver failure.Therefore,during the antiviral treatment of HCV infection,it is of great importance to select appropriate anti-HBV therapy and follow-up management strategies based on the status of HCV/HBV dual infection.

Treatment of HBV/HCV co-infected patients in DAA era / 临床肝胆病杂志

Asian-pacific area,especially China,is Hepatitis B high epidemic area.Since 2011,the first generation of oral direct anti-HCV agents (DAAs) came to clinical use,the treatment of chronic hepatitis C has switched from interferon-based regimen era to DAA era.There is an increased awareness of hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients coinfected with HBV treated with pan-oral direct-acting antivirals(DAAs).Compared with interferon-based regimen,HBV reactivation occurred earlier and more severe among patients received DAA regimen,and even fetal cases or case end up with liver transplantation was reported.Thus,association of liver diseases called to alert the occurrence of HBV reactivation among CHC patients who received DAAs regimen.It is hence important to have HBV serology screened in all CHC patients before initiation of pan-oral DAAs therapy and the usefulness of preemptive administration of effective anti-HBV nucleos(t) ide analogues in coinfected patients need to be further studied.

Efficacy of peginterferonα-2a plus ribavirin for the treatment of patients with hepatitis B virus and hepatitis C virus coinfection:a paired study / 中华传染病杂志

Objective To analyze the virologic responses of peginterferonα‐2a plus ribavirin (Peg IFNα‐2a/RBV) for patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection by a paired study . Methods Sixteen patients with HBV/HCV coinfection and 32 patients with HCV monoinfection were allocated . The virological response and biochemical response were compared between the two groups after Peg IFNα‐2a/RBV regimen treatment .Chi‐square analysis or Fisher exact analysis was used to compare the responses .Logistic analysis was conducted to evaluate factors associated with sustained virological response (SVR) .Results The median levels of HCV RNA were 6 .54 lg IU/mL in 16 patients with HBV/HCV co‐infection and 6 .98 lg IU/mL in 32 patients of HCV monoinfection ,which was statistically different (Z= 4 .124 , P0 .05) .The relapse rate in HBV/HCV‐coinfected patients was significantly higher than that in HCV‐monoinfected patients (35 .7% [5/16] vs 8 .7% [2/32];χ2=4 .142 , P= 0 .042) .In HBV/HCV coinfection group ,7 cases were HBV DNA detectable ,7 cases were hepatitis B e antigen (HBeAg ) positive , 13 cases were abnormal alanine aminotransferase (ALT) levels and 12 cases were abnormal aspartate aminotransferase (AST ) levels . After treatment ,only 4 patients were HBV DNA detectable ,5 cases were HBeAg positive ,4 cases were abnormal ALT levels and 5 cases were abnormal AST levels (P= 0 .458 ,0 .716 ,0 .004 and 0 .032 , respectively) .The median level of hepatitis B surface antigen (HBsAg) was 780 IU/mL and decreased to 250 IU/mL after treatment ,while the difference did not reach statistical significance (Z= 1 .826 ,P=0 .068) .A total of 4 patients achieved complete virologic response for HBV ,3 achieved partial virologic response;2 achieved HBeAg seroconversion .Logistic regression analysis showed that EVR was a positive factor for achieving SVR (OR=35 .2 ,95% CI=3 .55-349 .15 , P=0 .002) .Conclusions HCV remains at low replication level in patients with HBV/HCV coinfection .Virological responses can be achieved by Peg IFNα‐2a/RBV treatment .EVR might be a positive factor associated with SVR .

Advances in research on bacterial resistance mechanisms against bacteriophages / 军事医学

Bacteriophages are abundantly distributed viruses , which are able to infect bacteria .Bacteriophages are becoming a focus of attention for microbiologists , as they can cause pollution to the fermentation industry and might serve as alternative therapies for antibiotic-resistant pathogenic bacteria .Effective bacteriophage infection normally involves adsorp-tion, injection, replication, assembly and release , against which bacteria have developed various resistance strategies .The research progress in the bacteriophage resistance mechanisms is briefly reviewed in this paper .

Colonic complications following human bone marrow transplantation / Complicações do cólon após transplante de medula óssea humana

BACKGROUND: Human bone marrow transplantation (BMT) becomes an accepted treatment of leukemia, aplastic anemia, immunodeficiency syndromes, and hematologic malignancies. Colorectal surgeons must know how to determine and manage the main colonic complications. OBJECTIVE: To review the clinical features, clinical and pathological staging of graft vs host disease (GVHD), and treatment of patients suffering with colonic complications of human bone marrow transplantation. PATIENTS AND METHODS: We have reviewed the records of all patients that received an allogeneic bone marrow transplant and were evaluated at our Colon and Rectal Surgery department due to gastrointestinal symptoms, between January 2007 and January 2012. The study was carried out in patients who developed colonic complications, all of them with clinical, histopathological or laboratory diagnosis. RESULTS: The study group was constituted by 77 patients, 43 male and 34 female patients. We identified colonic complications in 30 patients (38.9%); five patients developed intestinal toxicity due to pretransplant chemotherapy (6.4%); graft vs. host disease was present in 16 patients (20%); 13 patients (16.8%) developed acute colonic GVHD, and 3 (3.8%) chronic GVHD. Infection was identified in 9 patients (11.6%). CONCLUSIONS: The three principal colonic complications are the chemotherapy toxicity, GVHD, and superinfection; the onset of symptoms could help to suspect the type of complication (0-20 day chemotherapy toxicity, 20 and more GVHD), and infection could appear in any time of transplantation. (AU)

EXPERIÊNCIA: O transplante de medula óssea humana (MOH) passou a ser um tratamento adotado para leucemia, anemia aplástica, síndromes de imunodeficiência e neoplasias hematológicas. Cirurgiões colorretais devem saber como determinar e tratar as principais complicações do cólon. OBJETIVO: Revisar as características clínicas, estadiamentos clínico e patológico da doença do enxerto versus hospedeiro (DEVH) e o tratamento de pacientes padecendo com as complicações colônicas do transplante de medula óssea humana. PACIENTES E MÉTODOS: Revisamos os registros de todos os pacientes que receberam um transplante de medula óssea alogênica e foram avaliados em nosso Departamento de Cirurgia do Cólon e Reto em função de sintomas gastrointestinais, entre janeiro de 2007 e janeiro de 2012. O estudo teve por base os pacientes que desenvolveram complicações do cólon, todos com diagnóstico clínico, histopatológico ou laboratorial. RESULTADOS: O grupo de estudo foi constituído por 77 pacientes, sendo 43 homens e 34 mulheres. Identificamos complicações do cólon em 30 pacientes (38,9%); cinco pacientes exibiam toxicidade intestinal por quimioterapia antes do transplante (6,4%); DEVH estava presente em 16 pacientes (20%), 13 pacientes (16,8%) foram acometidos por DEVH colônica aguda três pacientes (3,8%) DEVH crônica. Infecção foi detectada em 9 pacientes (11,6%). CONCLUSÕES: As três principais complicações do cólon são: toxicidade por quimioterapia, DEVH e superinfecção. O surgimento dos sintomas poderia ajudar a levantar suspeitas sobre o tipo de complicação (0-20 dias, toxicidade por quimioterapia; 20 ou mais dias, DEVH). Infecções podem ocorrer em qualquer momento do transplante. (AU)

A Case Report of Cutaneous Larvae Migrans with Associated Fungal Superinfection in Uyo, Nigeria.

Aims: To describe a case of Cutaneous Larvae Migrans (CLM) with associated fungal and bacterial superinfection seen in the Tuberculosis and Infectious Disease Unit of University of Uyo Teaching Hospital. Presentation of Case: A 31-year old male reported to the Tuberculosis and Infectious Disease Unit with a history of creeping eruptions, itching and right foot swelling following gardening. Investigations revealed associated bacterial and fungal super infection. Symptoms resolved after treatment with Albendazole, antibiotics and antifungals. Discussion: Although CLM is self-limiting, non- recognition and home treatment using local herbal remedies may lead to associated superinfection, mask the presentation and lead to delayed diagnosis. Conclusion: CLM is not frequently reported in the tropics and primary health care workers are likely unfamiliar with its presentation, which could delay the treatment. Associated use of local herbal remedies lead to superinfection as seen in the index case may lead to missed and delayed diagnosis. This calls for increased awareness of the condition and its treatment for primary care workers.

Genotyping of human papillomavirus among human immunodeficiency virus-positive populations / 中华皮肤科杂志

Objective To compare the prevalence and genotype distribution of human papillomavirus (HPV) between human immunodeficiency virus (HIV)-positive and-negative populations.Methods Patients with condyloma acuminatum or persons who recently had sexual contact with patients with condyloma acuminatum were enrolled into this study,and classified into HIV-positive group (n =62) and HIV-negative group (n =2 716).GeneChip analysis was performed to detect HPV and determine HPV genotypes in mucocutaneous samples collected from the external genitalia of these subjects.Statistical analysis was carried out by chi-square test using the SPSS software version 19.0.Results The prevalence rates of HPV infection,high-risk HPV types and low-risk HPV types were significantly higher in HIV-positive persons than in HIV-negative persons (74.19％ (46/62) vs.42.30％ (1 149/2 716),67.74％ (42/62) vs.29.57％ (803/2 716),58.06％ (36/62) vs.24.71％ (671/2 716),respectively,all P＜ 0.01).The detection rate of HPV was also increased in HIV-positive men compared with HIV-negative men (92.11％ (35/38) vs.37.38％ (382/1 022),x2 =45.98,P ＜ 0.01).Although the top three genotypes of low-risk HPV were types 6,43 and 11 in both HIV-positive and-negative groups,the prevalence rate of HPV 6 was 37.10％ (23/62) in HIV-positive group,but only 11.12％ (302/2 716) in HIV-negative group.The top five genotypes of high-risk HPV were types 16 (22.58％,14/62),52,66,58 and 18 in HIV-positive group,and types 16 (7.77％,211/2716),58,56,66 and 52 in HIV-negative group.Coinfections with multiple HPV subtypes were common in both groups,and the number of concurrent HPV genotypes was as high as 8 in HIV-positive group,and 9 in HIV-negative group.The prevalence rate of coinfections with three or more HPV genotypes in HIV-positive group was significantly higher than that in HIV-negative group (65.21％ (30/46) vs.16.71％ (192/1 149)).Conclusions Compared with HIV-negative populations,HIV-positive populations show elevated prevalence of HPV infection,high-risk HPV genotypes and low-risk HPV genotypes.Moreover,the prevalence of HPV is higher in HIV-positive men than in HIV-negative men.These findings are worthy of further attention in clinic.

Hidatidosis cerebral sobreinfectada en la infancia: a propósito de un caso / Overinfected cerebral hydatid disease in childhood: report of a case

La hidatidosis es una enfermedad parasitaria en la que el hombre es un huésped intermediario accidental, portador de la forma larvaria de Echinococcus granulosus. La forma más frecuente de hidatidosis es la hepática, seguida de la pulmonar. La localización en el sistema nervioso central es rara. La gran mayoría de los quistes hidatídicos cerebrales han sido diagnosticados en niños. Los quistes localizados en este sitio presentan diferentes e interesantes características en su evolución y diagnóstico. Las manifestaciones clínicas están en relación a su localización, y al síndrome de hipertensión endocraneana que las lesiones ocasionan por efecto de masa y/o por la hidrocefalia que puedan condicionar. Se presenta el caso de un paciente de 10 años de edad que presenta un cuadro de cefalea, vómitos y hemiparesia braquiocrural izquierda de 48 h de evolución. Fue evaluado con métodos diagnósticos imagenológicos, bioquímicos y serológicos, logrando el diagnostico de hidatidosis cerebral múltiple sobreinfectada. Es intervenido quirúrgicamente, resecando dos quistes hidatídicos de 5 cm en diferentes tiempos quirúrgicos. Se realiza una revisión bibliográfica sobre el tema y se discute sus principales características clínicas, diagnóstico, tratamiento y pronóstico.

Hydatid disease is a parasitic disease in which the man is an accidental intermediate host, carrying the larval form of Echinococcus granulosus. The most common form of liver hydatid disease is followed by the lung. Locating in the central nervous system is rare. The vast majority of cerebral hydatid cysts have been diagnosed in children. Cysts located on this site have different and interesting features in its evolution and diagnosis. The clinical manifestations are related to their location, and intracranial hypertension syndrome that injuries cause by mass effect and / or hydrocephalus that may condition. We report the case of a patient aged 10 years presented symptoms of headache, vomiting and left hemiparesis braquio 48 hours of evolution. It was evaluated with diagnostic imaging methods, biochemical and serological, making the diagnosis of multiple cerebral hydatid superinfected. The patient underwent surgery, resecting two hydatid cysts of 5 cm in different surgical times. We review the literature on the subject and discusses its main clinical features, diagnosis, treatment and prognosis.

Clinical features of patients with superinfection of HEV and HBV related acute on chronic liver failure / 重庆医学

Objective To investigate the clinical features of patients with superinfection of HEV and HBV related acute on chro-nic liver failure(ACLF) .Methods Clinical data of 35 patients diagnosed with superinfection of HEV and HBV related ACLF and 37 patients diagnosed with HBV related ACLF were collected for this retrospective study .The liver and kidney function ,HBV DNA level ,blood platelet count(BPC) ,coagulation function ,model for end-stage liver disease(MELD)score and mortality at 24 weeks were analyzed .Furthermore ,comparison of the clinical data between the survival patients and died patients in superinfection group was made .Unconditioned binary response logistic regression model was used to determine the corresponding risk factors .Results The level of total bilirubin(TBIL) ,MELD score ,incidence rate of hepatic encephalopathy and mortality at 24 weeks were signifi-cantly higher and prothrombin activity(PTA)was significantly lower in superinfection patients(P<0 .05) .The level of serum creat-inine(Cr) ,MELD score and incidence rate of hepatic encephalopathy were significantly higher and PTA was significantly lower in died patients than that of superinfection group(P< 0 .05) .Logistic regression analysis identified TBIL(P= 0 .024 ,OR= 1 .006) , BPC(P=0 .019 ,OR=0 .983) ,PTA(P=0 .001 ,OR=0 .795) ,MELD score(P=0 .005 ,OR=1 .497)and hepatic encephalopathy(P=0 .001 ,OR=4 .147)as prognostic factors for patients with superinfection of HEV and HBV related ACLF .Conclusion The clini-cal features of patients with superinfection of HEV and HBV related ACLF were more serious .The higher level of TBIL ,MELD score and hepatic encephalopathy and the lower level of BPC and PTA ,the worse prognosis .

Expressions of Toll-like receptor 2 and the downstream proteins in human immunodeficiency virus/Mycobacterium tuberculosis co-infection patients / 中华传染病杂志

Objective To explore the expressions of Toll-like receptor 2 (TLR2 ) and the downstream proteins in patients with human immunodeficiency virus /Mycobacterium tuberculosis (HIV /M TB) co-infection .Methods A total of 119 subjects were randomly enrolled .The subjects were divided into four groups :HIV group (n = 32) ,HIV /M TB group (n = 30) ,M TB group (n = 28) and healthy control group (n= 29) .Peripheral venous blood was collected and the HIV-1 viral load was determined by standard method .The expression levels of TLR2 mRNA in peripheral blood mononuclear cells (PBMC) were determined by real-time quantitative PCR (qPCR) and mean fluorescent intensity (MFI) of TLR2 protein was detected by flow cytometry .The plasma interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels were measured with enzyme-linked immunosorbent assay kits .The data were statistically analyzed by chi-square test ,students t test ,analysis of variance and rank sum test when appropriate .Results The viral load in HIV /M TB group ([5 .113 ± 1 .018] lg copy/mL ) was significantly higher than that in HIV group ([4 .416 ± 1 .020] lg copy/mL ; t = 3 .449 , P among HIV ,HIV/M TB ,M TB and healthy control groups were 1 .397 ± 0 .601 ,1 .463 ± 0 .702 ,1 .429 ± 0 .630 ,and 0 .970 ± 0 .488 ,respectively ,which was significantly different among the 4 groups (F =4 .197 , P= 0 .007) .The MFI of TLR2 protein expressions on PBMC among HIV ,HIV /M TB ,M TB and healthy control groups were 28 .12 ± 4 .55 ,38 .11 ± 11 .77 ,31 .13 ± 12 .10 and 23 .33 ± 5 .14 ,respectively . The TLR2 protein expression levels were significantly different among 4 groups (F= 13 .976 ,P< 0 .01) . The plasma IL-6 and TNF-α concentrations were significantly different among 4 groups (Z = 19 .088 , 15 .475 ,both P< 0 .01) .The IL-6 concentrations in three patient groups were higher than that in healthy control group ,but the TNF-α concentrations were lower than healthy control group .Conclusions The co-infection of HIV-1 and M TB may enhance the activation of TLR2 signaling pathway ,which leads to the increased expression of IL-6 .

Comparison of serum markers between pure hepatitis B infection and superinfection of hepatitis B together with hepatitis D / 国际检验医学杂志

Objective To understand the characteristics of the superinfection of hepatise B virus (HBV)together with hepatitis D virus(HDV)by comparing the differences of serum markers ALT,HBV DNA,HBVM,etc.In the pure HBV infection and the superinfection of HBV and HDV and to preliminarily invesitigate the pathogenesis of HDV.Methods The results of major bio-chemical indicators and hepatitis virus markers in 95 cases of HBV together with HDV infection and 100 cases of pure HBV infec-tion as the control group were statistically analyzed.Results Among 95 cases in the superinfection group,the incidence rate of chronic HBV was the highest,accounting for 66.32% and followed by liver cirrhosis.There was no statistical difference between the two groups according to the HBV DNA loads(P >0.05).The good positive correlation existed between the ALT abnormal rate of the liver function and HBV DNA in the superinfection group(r=0.90,P 250 IU/mL (P >0.05).According to HBsAg>250 IU/mL and HBeAg > 1 S/CO,the pure HBV infection group was higher than the super infec-tion group (P <0.05).The positive rate of HBcAb-IgM in the super infection group was significantly higher than that in the pure HBV group (P <0.05).Conclusion The superinfection of HBV together with HDV infection has the high occurrence rate in chro-nic hepatitis B.With the HBV DNA level increase,the abnormal rate of the liver function is also increased.HDV infection can inhib-it the HBeAg expression.The high positive rate of HBcAb-IgM in the superinfection patients might be related with chronic hepatitis B aggravation and recurrence.

Clinical Analysis of Testing Result of Hepatitis B Virus Markers and anti-HCV In 206 cases Primary Hepatic Cancer / 中国医师进修杂志

Objective To explore the relationship between primary hepatic cancer (PHC) and hepatitis B virus(HBV),hepatitis C virus(HCV),and discuss the relationship between PHC and HBV,HCV overlapping infection.Methods To examine hepatitis B virus markers (HBV-M) and anti-HCV in 206 cases PHC.Results In 206 cases,patients with HBV infection correlation is 93.20％.Most of cases (43.20％) showed the HBsAg,anti-HBe and anti-HBc positive,followed by HBsAg and anti-HBc positive (19.90％),and few of cases showed the other expression patterns in PHC HBV-M pattern.In 206 cases,patients with HCV infection correlation is 18.45％,overlapping infection patients are 24 cases (11.65％).Conclusion PHC are closely associated with HBV,HCV infection that are the important factors in the development of PHC occurrence.We should regular examine the patients who infect HBV and HCV,between 40 and 60 years old,especially with cirrhosis,we stive to make the PHC early detection,early treatment,in order to improve the survival rate of PHC.