Using a Double Syringe Sterile System for MSK Aspiration/Injection Procedures Eliminates Risk of Iatrogenic Infection.

Introduction: Diverse musculo-skeletal pathology can be treated conservatively by different types of injections and in most cases, results are significantly better if the existing inflammatory fluid is aspirated prior to injection of medication solutions. The present study analyses an original technique which uses infusion therapy accessories to create two types of closed sterile double syringe systems, and compares the benefits of using such a system in aspiration/injection procedures to classic aspiration injection technique that implies changing and connecting multiple syringes to the same needle, thus increasing the risk for septic complications. The aim of the present study is to minimize therapeutic risk of iatrogenic septic complications during aspiration/injection procedures. Methods: 1024 patients underwent aspiration/injection procedures in our clinic using the double syringe system between 2015 and 2020. During the early stages of the study, the second type of assembly was rendered impractical so the study continued with analyzing a single type of double syringe system using a three way infusion therapy device which is readily available, and allows the assembly of a closed sterile system with a single, two-step procedure technique. Iatrogenic local septic complications were followed by means of a six week clinical follow-up evaluation with additional investigations only if necessary. Results: In 1024 procedures we report 0% incidence of iatrogenic septic complications, or other types of complications and recommend this technique in a vast array of rheumatic, orthopedic or traumatic conditions that require aspiration/injection procedures. Discussion: The double syringe system is practical, easy to use, it completely eliminates the risk of iatrogenic infection due to manipulation errors, and significantly simplifies the technique for sonography guided aspiration/injection procedures for musculo-skeletal pathology.

Surgical management of atypical mycobacterial cervical lymphadenitis in an outbreak of odontological infection.

INTRODUCTION: We report on our experience with surgical management of nosocomial Mycobacterium abscessus cervical lymphadenitis in the setting of an epidemic linked to a dental practice in the community. METHODS: This is an observational case series of children who required surgical treatment of cervical lymphadenitis as part of multidisciplinary management of nosocomial M. abscessus infections. We describe the criteria for surgical management of cervical lymphadenitis as well as patient characteristics and outcomes. RESULTS: Over 1000 children undergoing pulpectomies and pulpotomies at a local dental practice with a contaminated water source were identified as potentially susceptible to atypical mycobacteria infection, identified as M. abscessus. Between August 2016 and May 2017 108 children underwent inpatient evaluation at our institution by general pediatricians and pediatric infectious disease specialists. 90 children required at least 1 surgical intervention by pediatric otolaryngology and/or oral and maxillofacial surgery (OMFS). Children were evaluated by the Pediatric Otolaryngology service if computer tomography (CT) scan of the neck demonstrated lymph nodes of at least 1.5 cm in shortest dimension or lymph nodes with central hypolucencies suspicious for infection with central necrosis. Pediatric Otolaryngology intervened on 11 patients all of whom required selective cervical lymphadenectomy with or without curettage. These patients ranged in age from 3 to 8 years; 8 were male, 6 had concurrent pulmonary nodules. Two patients underwent curettage in addition to lymphadenectomy. Five patients required at least 2 surgical interventions by Pediatric Otolaryngology. CONCLUSION: We found M. abscessus to be an aggressive infection requiring early cervical lymphadenectomy in select patients.

Clinical value of hepatitis C virus core antigen levels in monitoring acute hepatitis C spontaneous clearance or treatment-induced clearance.

BACKGROUND AND AIM: To observe the clinical value of hepatitis C virus (HCV) core antigen (HCcAg) levels in monitoring acute HCV infection in patients with spontaneous clearance (SC) or clearance induced by antiviral therapy. METHODS: Patients with iatrogenic HCV infection (n = 104) were enrolled at the Shengjing Hospital, China Medical University, between 5 February 2013 and 3 April 2013. All cases were diagnosed with acute HCV infection, enrolled within 90 days of infection, and followed for 12 to 16 weeks. Blood was collected every month. HCV RNA and HCcAg levels were detected. From week 16, patients without SC were treated with pegylated-interferon and the HCV RNA and HCcAg levels were observed monthly. Follow-up was 7.5 (5.0 to 10.4) months. The Spearman correlation analysis was performed to determine the correlation between HCV RNA and HCcAg. Logistic regression analysis was used to determine the association of baseline HCV RNA and HCcAg levels with SC. RESULTS: Ten patients (9.62%) showed SC, with a negative conversion time of 57 (14 to 143) days. During follow-up, HCV RNA and HCcAg expression levels were positively correlated for each patient (except on the sixth month), but the levels of HCV RNA and HCcAg were not associated with HCV infection SC. CONCLUSIONS: HCcAg levels could be of value for monitoring the course early HCV infection, but could not predict SC of HCV infection.

The AIDS Pandemic: Searching for a Global Response.

Michael Merson, the second Director of the World Health Organization (WHO) Global Program on AIDS, and co-author Stephen Inrig have described, in gripping detail, the personal antagonisms, interpersonal wrangling, and bureaucratic intrigue that explained the failure of the first global response to the HIV epidemic (Merson & Inrig, 2018). However, I believe that the decision of WHO, Western researchers, and the media to ignore the role of reuse of contaminated syringes and needles in health care settings and to instead emphasize African people's sex with multiple partners was more critical in the explosion of HIV in Africa than personal animosities and bureaucratic disputes. Merson & Inrig (2018) euphemistically noted that.

Risk factors and clinical characteristics of deep knee infection in patients with intra-articular injections: A matched retrospective cohort analysis.

BACKGROUND: Deep knee infection (DKI), consisting of sepsis arthritis (SA) and chronic low-grade infection (CLGI), is a rare but catastrophic adverse event that can result from intra-articular (IA) injections. The purpose of this study was to assess the risk factors for DKI and describe the clinical characteristics of DKI in patients who received IA injections. METHODS: Fifty patients with IA injection-induced DKI who underwent surgical treatment between January 2010 and May 2016 served as cases and were matched with non-infected controls who received IA injections in a proportion of 1:5 based on age, gender, and date of admission. All IA injections (both cases and controls) were performed within 6 months of admission at our institution or at a referring institution. Risk factors for injection-induced DKI were analyzed, and the clinical characteristics between SA and CLGI were compared. RESULTS: The final multivariate logistic regression analysis demonstrated that body mass index ≥25kg/m2 [odds ratio (OR) = 2.3; 95% confidence interval (CI): 1.1-4.7], corticosteroid injections (OR = 3.21; 95% CI: 1.63-6.31), rheumatoid arthritis (OR = 2.61; 95% CI: 1.20-5.68) and injections performed by general practitioners (OR = 5.23; 95% CI: 2.00-13.67) increased the risk of DKI following IA injections. Of 50 cases, there were 21 SA cases and 29 CLGI cases. SA cases had significantly higher metrics in the categories of fever, local warmth, swelling, rest pain, night pain, limited motion, serum WBC, and CRP levels than CLGI cases. CONCLUSIONS: We identified risk factors and clinical characteristics of injection-induced DKI, which may offer improved guidance on IA injections and knowledge of DKI in patients with IA injections, especially in CLGI patients.

Research advances of hepatitis B virus transmission through tears / 国际眼科杂志(Guoji Yanke Zazhi)

·China has a large number of Hepatitis B virus carriers. Though hematogenous dissemination is the main transmission route, much remains unknown about the way the virus spreads. It is doubted that people may get the disease through various body fluids in daily activity. Some routine examinations in ophthalmology department such as Goldmann applanation tonometry could not avoid contact with patients' ocular surface and may cause virus spread due to the residual tears on the instrument. So it is quite necessary to inspect the tear infectiousness of Hepatitis B virus. This review summarized recent studies about hepatitis B virus transmission via tears.

Magnetic Resonance Imaging Findings of Early Spondylodiscitis: Interpretive Challenges and Atypical Findings.

MR findings of early infectious spondylodiscitis are non-specific and may be confused with those of other conditions. Therefore, it is important to recognize early MR signs of conditions, such as inappreciable cortical changes in endplates, confusing marrow signal intensities of vertebral bodies, and inflammatory changes in paraspinal soft tissues, and subligamentous and epidural spaces. In addition, appreciation of direct inoculation, such as in iatrogenic spondylodiscitis may be important, because the proportion of patients who have undergone recent spine surgery or a spinal procedure is increasing. In this review, the authors focus on the MR findings of early spondylodiscitis, atypical findings of iatrogenic infection, and the differentiation between spondylodiscitis and other disease entities mimicking infection.

Risk factors for measles in children younger than age 8 months: A case-control study during an outbreak in Guangxi, China, 2013.

BACKGROUND: Following a period (2009-2012) during which zero measles cases were reported, a measles outbreak occurred in 2013 in Bama County, Guangxi, China, that involved more than 100 children younger than age 8 months. We aimed to identify the pitfalls and risk factors while implementing the control measures. METHODS: An outbreak investigation and a case-control study was conducted among children younger than age 8 months. The serum specimens of the study subjects and their mothers were tested for measles immunoglobulin M and immunoglobulin G. RESULTS: The attack rate was 2.3/1,000 population. The median (interquartile range) age was 18.6 months (7.9-52.8 months). The coverage of 2-dose measles-containing vaccine was only 34%. The case-control study revealed 2 independent risk factors: low education level of main caregiver (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.31-6.22) and visiting a hospital 7-21 days before the date of symptoms onset (OR, 9.84; 95% CI, 4.27-22.67). The population attributable fraction of the latter was 52.8%. The mothers of the cases had nonsignificantly higher levels of immunoglobulin M and were significantly more likely to have protective levels of immunoglobulin G than those of the controls. This suggests a reactive rather than protective role of the antibody to the child's infection. CONCLUSIONS: In a near-elimination but low measles-containing vaccine coverage community, supplementary immunization activities should be emphasized for children and women who are potential future mothers. The minimum age of measles-containing vaccine should be further reduced. Hospital measles transmission must also be strictly prevented.

Magnetic Resonance Imaging Findings of Early Spondylodiscitis: Interpretive Challenges and Atypical Findings

MR findings of early infectious spondylodiscitis are non-specific and may be confused with those of other conditions. Therefore, it is important to recognize early MR signs of conditions, such as inappreciable cortical changes in endplates, confusing marrow signal intensities of vertebral bodies, and inflammatory changes in paraspinal soft tissues, and subligamentous and epidural spaces. In addition, appreciation of direct inoculation, such as in iatrogenic spondylodiscitis may be important, because the proportion of patients who have undergone recent spine surgery or a spinal procedure is increasing. In this review, the authors focus on the MR findings of early spondylodiscitis, atypical findings of iatrogenic infection, and the differentiation between spondylodiscitis and other disease entities mimicking infection.

Interferon-α plus ribavirin yields 98 % sustained virologic response in children aged 1-5 years with iatrogenic chronic hepatitis C.

BACKGROUND AND OBJECTIVES: The clinical features and efficacies of antivirals for children with hepatitis C virus (HCV) infections that are acquired through different transmission routines are poorly understood worldwide. This study investigated the clinical characteristics of children who were infected via iatrogenic means and analyzed the efficacy of antiviral therapy in children with chronic hepatitis C (CHC). METHODS: In total, 256 children with HCV infections aged 1 to 5 years were enrolled and surveyed. Interferon-α plus ribavirin was administered to 162 children with CHC for 24 or 48 weeks. The sustained virologic response (SVR) at 24 weeks post-treatment was determined. RESULTS: The median duration of infection was 11.5 (range 6-24) months. The median age was 2.7 years, and 64.5 % of the subjects were male. Ninety-three children (36.3 %, 93/256) exhibited spontaneous resolution of the HCV infection. The remaining 163 (63.7 %) were HCV RNA-positive and had HCV genotypes 1b and 2a, which were identified in 42 and 58 %, respectively, of the 133 tested children. Liver biopsies were performed in all HCV RNA-detectable children. A total of 23.9 % cases exhibited grade 2 activity, and 30.1 % exhibited stage 2/3 liver fibrosis. The serum HCV RNA levels were positively correlated with the aminotransferases. Of the 162 treated CHC children, 158 (97.5 %) achieved SVR. The side effects were mild, and 158 (97.5 %) of the treated patients tolerated the treatment well. CONCLUSIONS: This study revealed that histological liver disease can be present within 6-24 months of acquiring an HCV infection in children aged 1-5 years. Interferon-α plus ribavirin therapy is a highly effective and cost-effective means of managing children with early-stage chronic HCV infection.

Mycobacterial infection after cosmetic procedure with botulinum toxin a.

We report a case of mycobacterial infection at the sites of previous injections of botulinum toxin A in a 45-year-old woman. She presented with erythematous, swollen, warm, and tender plaques and nodules at the points of injection from which a biopsy was taken, demonstrating a deep dermal and hypodermal abscessified epithelioid granulomatous inflammatory infiltrate in which some acid-fast bacilli were identified with Ziehl-Neelsen and Fite-Faraco stains. The lesion was first treated with clarithromycin plus azithromycin, to which rifampicin was later added. A good therapeutic response was obtained.

Management of respiratory endoscope cleaning, disinfection and infection control / 中华实用儿科临床杂志

With the development of modern science,the updates of endoscopic technology,respiratory endoscopy has become essential means in the clinical diagnosis and treatment of respiratory disease in children.Due to the particularity of its complex structure and material,to strengthen the cleaning,disinfection and sterilization of respiratory endoscopy and attachment can ensure medical safety,prolong the service life of the endoscopic.It also was the primary guarantee to ensure that the treatment of respiratory endoscopy proceed smoothly and securely.

Use of a cyanoacrylate skin adhesive to reduce external ventricular drain infection rates.

UNLABELLED: OBJECT.: Ventriculitis related to external ventricular drain (EVD) placement is a significant source of morbidity in neurological intensive care patients. Current rates of EVD-related infections range from 2% to 45% in the literature. The authors sought to determine if a 2-octyl cyanoacrylate adhesive would result in lower infection rate than standard semiocclusive dressings. METHODS: The authors tracked ventriculitis rates via CSF cultures among 259 patients whose EVD sites were dressed with sterile semiocclusive dressings and underwent routine sterile dressing exchanges every 48 hours. They analyzed data obtained in an additional 113 patients whose EVD sites were dressed one time with a surgical adhesive, 2-octyl cyanoacrylate. RESULTS: Ventriculitis rate in patients with standard bioocclusive dressings and wound care was 15.1%, whereas that in patients with a 2-octyl cyanoacrylate dressing was 3.54% (p = 0.002). Staphylococcus genus accounted for 79.5% of instances of ventriculitis among patients with bioocclusive dressings and routine wound care, whereas it accounted for 25.0% of the instances of ventriculitis among patients with a liquid polymer sealant dressing. A 90% reduction in Staphylococcus infection completely accounts for the observed effect (p = 0.04). CONCLUSIONS: The one-time application of 2-octyl cyanoacrylate to EVD wounds and exit sites provided superior protection against EVD-related ventriculitis compared to conventional EVD-site wound care. Likely this protection results from a barrier to the entry of gram-positive skin flora along the EVD exit tract. The results should be validated in a randomized trial.

Effect comparison of different operation technique on the prevention of cross infection in department of stomatology / 中国实用护理杂志

Objective To describe the effect of four-handed technique on the prevention of cross infection in department of stomatology. Methods Patients (300 cases) in department of stomatology were collected and randomized into the observation group (using four-handed technique) and the control group (not using four-handed technique) with 150 cases in each group from May 2003 to October 2004. One patient was served by one doctor and one nurse in the treatment process. Sterilization isolation system was strictly implemented in order to prevent cross infection. The control group received routine treatment. The incidence rate of infection was compared in the two groups. Results Ten patients (6.7%) were infected in the control group. Only 3 patients (2.0%) were infected in the observation group, which was lower than that of the control group (P<0.05). Conclusions Four-handed technique played an important role in the prevention of cross infection by blocking the iatrogenic infection propagation.

Iatrogenic Spinal Infection after Injection Therapy in Spine / 대한척추외과학회지

STUDY DESIGNS: A retrospective study of clinical experience. OBJECTIVES: To investigate and report the iatrogenic form of spinal infections that occur after injection therapy in the spine. SUMMARY OF LITERATURE REVIEW: An iatrogenic infection after injection therapy in the spine is rarely reported to be a serious complication. However, an increase in the number of immunocompromised patients, the aging of the population, and particularly an increase in spinal procedureshave precipitated a rise in the incidence of spinal infections. MATERIALS AND METHOD: Iatrogenic spinal infections occurred in 8 patients after various injection therapy in the spine, which included an epidural steroid injection or trigger point injection for various spinal conditions. The medical records and images of these patients regarding the clinical findings, risk factors, and treatments were analyzed. RESULTS: The pathologic conditions of the spinal infection were discitis in four patients with a concomitant infection in the epidural space and paraspinal muscles, an epidural abscess, and solitary muscular abscess or myositis in the other 3 patients. The systemic risk factors contributing to the infections were diabetes mellitus, metastatic cancer, and chronic liver disease in four patients. For treatment, intensive antibiotic therapy was applied to all patients. Six of the 8 patients underwent surgical drainage for abscesses and/or fusion to stabilize the infected segments. The infections were eventually controlled in all patients. CONCLUSION: Iatrogenic pyogenic infections of the spine after injection therapy in the spine is a serious complication with regard morbidity and treatment. To avoid these serious complications, a specialist experienced in aseptic techniques should perform these spinal procedures, particularly in those patients with the risk factors.