Sepsis-induced autoimmune hemolytic anemia in the elderly

Autoimmune hemolytic anemia (AIHA) secondary to hematological malignancy is well-known and common in the elderly. AIHA associated with infection is less commonly reported in the elderly. We are reporting a case of AIHA in an elderly female with comorbidities, probably secondary to Gram-negative infection. The case was admitted and treated during the peak of the second wave of the COVID pandemic. The treatment of AIHA also had an impact on the progress and outcome of the underlying disease, leading to readmission in a short span of time. The patient also developed a thrombotic complication known to be associated with AIHA.

Early outcome of culture-negative infection in open fractures of the lower limb: A prospective study

Background: Culture-negative infections in open long bone fractures are frequently encountered in clinical practice. We aimed to identify the rate and outcome of culture-negative infections in open long bone fractures of lower limb. Methodology: A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long bone fractures of the lower limb. Demographic data, injury details, time from injury to receiving antibiotics and index surgical procedure were noted. Length of hospital stay, number of additional surgeries and occurrence of complications were also noted. Patients with infected open fractures were grouped as culture positive or culture negative depending on the isolation of infecting microorganisms in deep intraoperative specimen. The clinical outcome of these two groups was statistically analysed. Results: A total of 231 patients with 275 open fractures involving the femur, tibia or fibula were studied. There was clinical signs of infection in 84 patients (36.4%) with 99 fractures (36%). Forty-three patients (51.2%) had positive cultures and remaining 41 patients had negative cultures (48.8%). The rate of culture-negative infection in open type III long bone fractures in our study was 17.7%. There was no statistical difference in the clinical outcome between culture-negative and culture-positive infections. Conclusion: Failure to identify an infective microorganism in the presence of clinical signs of infection is routinely seen in open fractures and needs to be treated aggressively.

A retrospective study on the outcome of children with extensively drug-resistant gram-negative infection treated with Colistin vs. other Antimicrobials

Introduction@#The increasing trend of extensively drug-resistant gram-negative infections led to the reconsideration of colistin as a valuable therapeutic option.@*Objectives@#To describe the clinical profile and treatment response of children with extensively drug resistant (XDR) Gram-negative infections given colistin versus other antimicrobials.@*Methods@#This retrospective descriptive study involved patients treated for XDR Gram-negative infections from January 2014 to June 2017 in a tertiary hospital in Metro Manila. Descriptive statistics were used to summarize clinical characteristics of subjects. Treatment response to colistin versus other antimicrobial agents were compared in terms of success, failure, and toxicity. The Fisher-exact and Mann Whitney U tests were used to assess statistical differences between the colistin and non-colistin groups. @*Results@#Majority of patients with XDR Gramnegative infections had previous antibiotic exposure. More patients in the colistin group received TPN 43.2% vs 23.7% (p=0.035), had a longer hospital stay prior to the onset of XDR Gram-negative infection, 27 days vs. 15.5 days (p=0.001), and had a longer total hospital stay with a median of 52 days vs 30 days (p < 0.001). Treatment success was significantly higher in the colistin group at 70.3%, as against 46.5% in the non-colistin group (p=0.014). There was no difference in the treatment duration of both groups. The colistin group had longer time to clinical response, with a mean of 6.27 (+ 3.57) days compared with those from the non-colistin group, with a mean of 4.36 (+ 1.77)(p=0.008). The colistin group had more fungal infections during the course of treatment (p=0.001).@*Conclusion@#Based on our institutional experience, colistin is considered relatively effective and safe in treating XDR Gram-negative infections in children.

Comparison between Resectable Helicobacter pylori-Negative and -Positive Gastric Cancers

BACKGROUND/AIMS: Controversy exists regarding the characteristics of Helicobacter pylori infection-negative gastric cancer (HPIN-GC). The aim of this study was to evaluate clinicopathologic features of HPIN-GC compared to H. pylori infection-positive gastric cancer (HPIP-GC) using a comprehensive analysis that included genetic and environmental factors. METHODS: H. pylori infection status of 705 resectable gastric cancer patients was determined by the rapid urease test, testing for anti-H. pylori antibodies, histologic analysis and culture of gastric cancer tissue samples, and history of H. pylori eradication. HPIN-GC was defined as gastric cancer that was negative for H. pylori infection based on all five methods and that had no evidence of atrophy in histology or serology. RESULTS: The prevalence of HPIN-GC was 4% (28/705). No significant differences with respect to age, sex, smoking, drinking, family history of gastric cancer or obesity were observed between the two groups. HPIN-GC tumors were marginally more likely to involve the cardia (14.3% for HPIN-GC vs 5.3% for HPIP-GC, p=0.068). The Lauren classification, histology, and TNM stage did not differ according to H. pylori infection status. Microsatellite instability was not different between the two groups, but p53 overexpression in HPIN-GC was marginally higher than in HPIP-GC (56.0% for HPIN-GC vs 37.0% for HPIP-GC, p=0.055). CONCLUSIONS: The prevalence of HPIN-GC was extremely low, and its clinicopathologic characteristics were similar to HPIP-GC.

Expression of TLR4 and TLR2 mRNA in the peripheral blood mononuclear cells of the patients with Gram negative or Gram positive infections / 中国免疫学杂志

Objective:To investigate the expression of TLR4 mRNA?TLR2 mRNA in the peripheral blood mononuclear cells (PBMC) from the patients with Gram positive and Gram negative infections.Methods:TLR4 and TLR2 mRNA were detected in the patients with Gram negative infections ( n =20) and the patients with Gram positive infections ( n =15) and the normal persons as control ( n =24) with the method of Taqman Real-time PCR.Results:TLR4 mRNA expression in the patients with Gram negative infections were significantly higher than Gram positive infections patients and the normals ( P 0.05).Conclusion:The results showed that the increased expression levels of TLR4 mRNA in PBMC from the Gram negative infectious patients are associated with Gram negative infections and the detection of TLR4 mRNA expression may be a method of diagnosis for Gram negative infections in the early stage.