The Efficacy of LRINEC Scoring in Patients with Necrotizing Fasciitis and its Correlation with the Outcomes.

<b><br>Introduction:</b> Necrotizing fasciitis (NF) is an expeditiously escalating inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. To aid diagnosis, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system was devised to stratify the likelihood of infection in patients on presentation.</br> <b><br>Aim:</b> The study aimed to investigate and quantify the relationships between the LRINEC scoring system and the outcomes such as the need for amputation, length of hospital stay, and mortality in patients with necrotizing fasciitis.</br> <b><br>Material and methods:</b> A total number of 90 patients were admitted with a provisional diagnosis of necrotizing fasciitis. LRINEC score was calculated for each case based on six laboratory variables at the time of presentation. Enrolled patients were divided into three groups on the basis of the LRINEC score. The differences in mortality, length of hospitalization, number of debridement procedures, and need for amputation between these groups were compared.</br> <b><br>Results:</b> Increasing age, male gender, and DM have a poor prognosis in necrotizing fasciitis patients. The amputation and mortality rates are better correlated with higher LRINEC scores.</br> <b><br>Conclusions:</b> The LRINEC score helps in stratifying the patients into three risk categories (low risk, moderate risk, and high risk) according to the severity in a much more organized way, and thus the appropriate management like surgical debridement can be introduced on time. LRINEC score is a robust index that is capable of detecting early cases of necrotizing fasciitis and is simple enough for routine use. It is a simplified bedside diagnostic tool for early diagnosis and prediction of outcomes in patients with necrotizing fasciitis.</br>.

Caries and white spot lesion trajectories of orthodontic patients across an observation period of 20 years.

OBJECTIVES: Fixed orthodontic appliances may increase the risk for caries and white spot lesions. The aim of this retrospective study was to determine the long-term associations between both in orthodontic patients. MATERIALS AND METHODS: 103 patients aged 36.6 ± 6.5 years whose fixed appliance orthodontic treatment had finished at least 15 years ago were included. Current clinical data and photographs (T3), panoramic x-ray and photographs from before treatment (T0), after debonding (T1) and at 2-year follow-up (T2) were available. Parameters of interest were dentine caries, "Missing/Filled Teeth" (MFT), "White Spot Lesion" (WSL) index and "Periodontal Screening and Recording" index (PSR; T3 only). RESULTS: At T0, 30.4% had no caries experience decreasing to 25.6%, 22.4% and 6.8% at T1, T2 and T3 resp. The median MFT (95% CI) at T0, T1, T2 and T3 was 2 (1;3), 3 (2;4), 3 (2;4) and 7 (6;9) resp. increasing significantly at each time point (p < 0.001 each); 30.1% had WSL at debonding. Patients with caries experience at T0 had a 2.4-fold increased risk of WSL at debonding. Dentine caries, caries experience and WSL at T1 were significantly associated with incident caries at T2, but not at T3. PSR at T3 had a significant association with previous caries incidence and WSL. CONCLUSIONS: Caries experience prior to orthodontic treatment may constitute a risk indicator for WSL, and caries experience and WSL at its end for caries incidence in the near term. CLINICAL RELEVANCE: Present caries and WSL may help identifying orthodontic patients with special need for prevention and counselling.

Prevalence and risk indicators of early childhood caries among toddlers in Caloocan City, Philippines: a cross-sectional study.

BACKGROUND: Limited published data exist on early childhood caries (ECC) among children 2 years old and below. The study aimed to determine ECC prevalence and its association with socio-demographic indicators, feeding practices and oral health behaviours among children aged 2 years and below in the Philippines. METHODS: A cross-sectional study observed young children aged 4-24 months in primary health centers. Each child's caregiver was interviewed and dental examinations were done on every child by one calibrated dentist using the ICDAS. Poisson regression using robust variance estimator analysis identified significant variables associated with ECC. RESULTS: Seven hundred three healthy children were observed at a mean age of 13.3 ± 2.4 months. ECC prevalence was 29.2% (95% confidence interval: 26.0-32.7) among toddlers who showed a mean number of 6.7 ± 3.1 erupted teeth. Multiple regression revealed that child's age (prevalence ratio, PR = 1.07), caregiver's educational level (PR = 1.43), continued breastfeeding (PR = 1.36), frequent eating (PR = 1.24), visible plaque observed by the caregiver (PR = 1.34) and in the oral examination (PR = 2.90) were significant to ECC prevalence. CONCLUSIONS: ECC is alarmingly prevalent in toddlers, marked by early onset and untreated decay. Prioritizing preventive measures in the first two years of life is crucial for understanding dietary impacts and promoting oral hygiene.

Evaluation of the ecological risk of pesticide residues from the European LUCAS Soil monitoring 2018 survey.

The 2018 LUCAS (Land Use and Coverage Area frame Survey) Soil Pesticides survey provides a European Union (EU)-scale assessment of 118 pesticide residues in more than 3473 soil sites. This study responds to the policy need to develop risk-based indicators for pesticides in the environment. Two mixture risk indicators are presented for soil based, respectively, on the lowest and the median of available No Observed Effect Concentration (NOECsoil,min and NOECsoil,50) from publicly available toxicity datasets. Two further indicators were developed based on the corresponding equilibrium concentration in the aqueous phase and aquatic toxicity data, which are available as species sensitivity distributions. Pesticides were quantified in 74.5% of the sites. The mixture risk indicator based on the NOECsoil,min exceeds 1 in 14% of the sites and 0.1 in 23%. The insecticides imidacloprid and chlorpyrifos and the fungicide epoxiconazole are the largest contributors to the overall risk. At each site, one or a few substances drive mixture risk. Modes of actions most likely associated with mixture effects include modulation of acetylcholine metabolism (neonicotinoids and organophosphate substances) and sterol biosynthesis inhibition (triazole fungicides). Several pesticides driving the risk have been phased out since 2018. Following LUCAS surveys will determine the effectiveness of substance-specific risk management and the overall progress toward risk reduction targets established by EU and UN policies. Newly generated data and knowledge will stimulate needed future research on pesticides, soil health, and biodiversity protection. Integr Environ Assess Manag 2024;00:1-15. © 2024 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Necrotising fasciitis with extensive necrosis caused by Lactobacillus: a case report.

BACKGROUND: Necrotising fasciitis (NF) is a life-threatening soft-tissue infection that rapidly destroys the epidermis, subcutaneous tissue, and fascia. Despite their low virulence, Lactobacillus spp. can cause NF, and because of its rare incidence, there is limited information about its molecular and clinicopathological characteristics. We report a rare case of NF in a patient with type 2 diabetes mellitus diagnosed on admission and severe obesity due to infection with two types of Lactobacillus spp. that manifested in extensive necrosis. CASE PRESENTATION: A 48-year-old woman was referred to our hospital with a complaint of difficulty walking due to severe bilateral thigh pain. She presented with mild erythema, swelling, and severe skin pain extending from the pubic region to the groin. The patient was morbidly obese, had renal dysfunction, and had diabetes mellitus diagnosed on admission.; her LRINEC (Laboratory Risk Indicator for Necrotising Fasciitis) score was 9, indicating a high risk of NF. An exploratory surgical incision was made, and NF was diagnosed based on fascial necrosis. Emergent surgical debridement was performed, and cultures of the tissue culture and aspirated fluid/pus revealed two types of Lactobacillus spp.: Lactobacillus salivarius and L. iners. The patient was admitted to the intensive care unit (ICU), where antibiotics were administered and respiratory and circulatory management was performed. Diabetic ketoacidosis was detected, which was treated by controlling the blood glucose level stringently via intravenous insulin infusion. The patient underwent a second debridement on day 11 and a skin suture and skin grafting on day 36. The patient progressed well, was transferred from the ICU to the general ward on day 41, and was discharged unassisted on day 73. CONCLUSIONS: Lactobacillus spp. are rarely pathogenic to healthy individuals and can scarcely trigger NF. However, these bacteria can cause rare infections such as NF in immunocompromised individuals, such as those with diabetes and obesity, and an early diagnosis of NF is imperative; surgical intervention may be required for the prevention of extensive necrosis. The LRINEC score may be useful for the early diagnosis of NF, even for less pathogenic bacteria such as Lactobacillus.

[Quantitative analysis of risk assessment indicators for re-introduction of imported malaria in China].

OBJECTIVE: To quantitatively analyze the risk indicators of re-introduction of imported malaria in China and their weighting coefficients, so as to investigate the difference in the contribution of risk indicators included in the current risk assessment framework for re-introduction of imported malaria in China to the risk assessment of re-introduction of imported malaria. METHODS: Publications pertaining to the risk assessment framework for re-introduction of imported malaria in China that reported the risk indicators and their weighting coefficients were retrieved in PubMed, Web of Science, CNKI, Wanfang Data, and VIP with terms of "malaria", "re-introduction/re-transmission/re-establishment", "risk assessment/risk evaluation/risk prediction" from the inception of the database through 3 August 2023, and literature search was performed in Google Scholar to ensure the comprehensiveness of the retrieval. Basic characteristics of included studies were extracted using pre-designed information extraction forms by two investigators, and data pertaining to risk indicators of re-introduction of imported malaria were cross-checked by these two investigators. The risk indicators included in the risk assessment framework for re-introduction of imported malaria in China and their weighting coefficients were visualized with the Nightingale's rose diagrams using the software R 4.2.1, and the importance of risk indictors was evaluated with the frequency of risk indicators included in the risk assessment framework and the ranking of weighting coefficients of risk indicators. In addition, the capability of risk indicators screened by different weighting methods was compared by calculating the ratio of the maximum to the minimum of the weighting coefficients of the risk indicators screened by different weighting methods. RESULTS: A total of 2 138 publications were retrieved, and following removal of duplications and screening, a total of 8 publications were included in the final analysis. In these 8 studies, 8 risk assessment frameworks for re-introduction of imported malaria in China and 52 risk indicators of re-introduction of imported malaria were reported, in which number of imported malaria cases (n = 8) and species of malaria vectors were more frequently included in the risk assessment frameworks (n = 8), followed by species of imported malaria parasites (n = 6) and population density of local malaria vectors (n = 6), and species of local malaria vectors (n = 6), number of imported malaria cases (n = 5) and species of imported malaria parasites had the three highest weighting coefficients (n = 4). The weighting methods included expert scoring method, combination of expert scoring method and analytic hierarchy process, and combination of expert scoring method and entropy weight method in these 8 studies, and the ratios of the maximum to the minimum of the weighting coefficients of the risk indicators screened by the expert scoring method were 1.143 to 2.241, while the ratios of the maximum to the minimum of the weighting coefficients of the risk indicators screened by combination of the expert scoring method and analytic hierarchy process were 34.970 to 162.000. CONCLUSIONS: Number of imported malaria cases, species of imported malaria parasites, species of local malaria vectors and population density of local malaria vectors are core indicators in the current risk assessment framework for re-introduction of imported malaria in China. Combination of the expert scoring method and analytic hierarchy process is superior to the expert scoring method alone for weighting the risk indicators.

Geochemical fractionation of trace metals and ecological risk assessment of surface sediments in Sepetiba Bay, Brazil.

The Sepetiba Bay (Southeast Brazil) is a known Cd- and Zn-contaminated site that received spills of a large slag pile leachate from a Zn smelter. With important harbors, Sepetiba Bay demands periodic dredging operations which affect the mobility of the metals. The main goal of this work was to assess metal mobility in sediments and its associated toxicity in a fictive dredging area, to evaluate the risks of the operation. To achieve this goal, 18 superficial sediment samples were collected and characterized for pH and Eh. Sediments were analyzed for grain size, organic carbon, and total nitrogen, and metal mobility was evaluated with a sequential extraction procedure, proposed by the European Community Bureau of Reference (BCR). The results demonstrate that Cd and Zn are mainly associated with the exchangeable fraction (mean concentrations 1.4 mg kg-1 and 149.4 mg kg-1, respectively) and reducible fractions (mean concentrations 0.3 mg kg-1 and 65.5 mg kg-1, respectively), while Fe, Cr, Cu, Ni, and Al were associated with the residual fraction. Metals in the residual fraction are probably associated with the mineral lattice of the sediment and should not represent an environmental risk for the biota. The application of the enrichment factor and three risk assessment indexes (Risk Assessment Code, Risky Pollution Index, and Bioavailability Risk Assessment Index) show that the sediments are considerably enriched in metals that constitute a relevant risk for the sediment biota. In the case of dredging operations, Cd and Zn should be released to the overlying waters and be available to organisms, threatening the whole ecosystem. The proposed approach was shown to be much more precise than what is frequently presented in the Environmental Impact Assessments that only consider the threshold limits of the legislation.

Risk indicators for gingival recession in the esthetic zone: A cross-sectional clinical, tomographic, and ultrasonographic study.

BACKGROUND: To evaluate the risk indicators associated with midfacial gingival recessions (GR) in the natural dentition esthetic regions. METHODS: Cone-beam computed tomography (CBCT) results of thirty-seven subjects presenting with 268 eligible teeth were included in the cross-sectional study. Clinical measurements included presence/absence of midfacial GR; the depth of the midfacial, mesial, and distal gingival recession; the recession type (RT); keratinized tissue width (KT); and attached gingiva width (AG). Questionnaires were utilized to capture patient-reported esthetics and dental hypersensitivity for each study tooth. Buccal bone dehiscence (cBBD) and buccal bone thickness (cBBT) were measured on the CBCT scans. High-frequency ultrasonography was performed to assess gingival thickness (GT) and buccal bone dehiscence (uBBD). Intraoral optical scanning was obtained to quantify the buccolingual position of each study site (3D profile analysis). Multilevel logistic regression analyses with generalized estimation equations were performed to assess the factors associated with the conditions of interest. RESULTS: The presence of midfacial GR was significantly associated with the history of periodontal treatment for pocket reduction (OR 7.99, p = 0.006), KT (OR 0.62, p < 0.001), cBBD (OR 2.30, p = 0.015), GT 1.5 mm from the gingival margin (OR 0.18, p = 0.04) and 3D profile 1 mm from the gingival margin (OR 1.04, p = 0.001). The depth of midfacial GR was significantly correlated to previous history of periodontal treatment (OR 0.96, p = 0.001), KT (OR -0.18, p < 0.001), presence of bone fenestration (OR 0.24, p = 0.044), and cBBD (OR 0.43, p < 0.001). The depth of midfacial GR was also the only factor associated with patient-reported esthetics (OR -3.38, p = 0.022), while KT (OR 0.77, p = 0.018) and AG (OR 0.82, p = 0.047) were significantly correlated with patient-reported dental hypersensitivity. CONCLUSIONS: Several risk indicators of midfacial and interproximal GR in the esthetic region were identified. The use of imaging technologies allowed for detection of parameters associated with the conditions of interest, and, therefore, their incorporation in future clinical studies is advocated. Ultrasonography could be preferred over CBCT for a noninvasive assessment of periodontal phenotype.

A combined approach for the estimation of groundwater leaching potential and environmental impacts of pesticides for agricultural lands.

Pesticide pollution can degrade the quality of land, water, and air, and imposes risks on people, flora and fauna. Pesticides are frequently chosen based on their agricultural effectiveness and cost, rather than their potential environmental impacts. The aim of this study is to present a combined approach to estimate the leaching potential and environmental impacts of pesticides for agricultural lands. The pilot study area (PSA) is the agricultural plain of the Lower Aksu Stream Basin in Antalya - Turkey. The groundwater of the agricultural plain contributes to around half of the flow rate of the stream. The first phase of the combined approach involved pesticide monitoring to screen the target pesticides, the second phase involved evaluating the physicochemical properties of the target pesticides and estimating their leaching potential using several indices, and the third phase involved environmental impact analysis of the target pesticides using the Environmental Impact Quotient (EIQ) risk indicator. Additionally, Principal Component Analysis was conducted to examine the correlations between physicochemical parameters of pesticides and the leaching potential index results. By the application of the combined approach, 45 target pesticides were identified for the PSA and the indices were consistent to estimate similar leaching potentials for the same pesticides. Moreover, the computed EIQ-Field Use Rates provided valuable information to rank target pesticides according to their environmental impacts on consumer, farmworker and ecology. The applied methodology provided a practical approach to select pesticides with the least leaching potential and environmental impacts to protect water quality and ecosystem health.

Women Victims of Intimate Partner Violence and Intimate Partner Homicide: A Typology Based on Victimization Variables.

Intimate partner violence against women (IPVAW) and intimate partner homicide against women (IPHAW) are multidimensional phenomena. The aim of this study was to identify typologies of Spanish IPHAW and IPVAW victims, based on the differences between their characteristics and the determinants of aggression. The sample consisted of 381 cases from the Spanish Integral Monitoring System in Cases of Gender Violence. The instrument used was a semi-structured interview. Results showed differences between IPHAW and IPVAW victims, and latent class analysis suggested a three-profile solution: 1-fatal victims, with low neuroticism, low isolation, and feelings of loneliness, less reconciliation with the aggressor, lower perception of risk and low suicidal ideation; 2-non-fatal victims, with the loss of a loved one and the role of caregiver as stressors, low psychoticism and alcohol abuse, high feelings of loneliness, risk perception, and suicidal ideation; 3-mixed profile, with high neuroticism and psychoticism, alcohol abuse, isolation, and greater reconciliations with the aggressor, and absence of bereavement and caregiver role as stressors. Knowing the differences between IPHAW and IPVAW victims allows the design of more specific instruments for risk assessment and the design of more individualized prevention and treatment programs. This also facilitates police work in identifying victims and deploying more intense protection measures.

La violencia de pareja contra la mujer (violencia de género, VdG) y el homicidio de pareja contra la mujer (feminicidio) son fenómenos multidimensionales. El objetivo de este estudio fue identificar las tipologías de las víctimas españolas de feminicidio y VdG, basado en las diferencias entre sus características y los determinantes de la agresión. La muestra constaba de 381 casos del Sistema Español de Seguimiento Integral de Casos de Violencia de Género. El instrumento utilizado fue una entrevista semiestructurada. Los resultados mostraron diferencias entre las víctimas de VdG y las víctimas de feminicidios y el análisis de clases latentes sugirió tres perfiles: 1-víctimas mortales, con bajo neuroticismo, bajo aislamiento y sentimientos de soledad, menor reconciliación con el agresor, menor percepción de riesgo y baja ideación suicida; 2-víctimas no mortales, con la pérdida de un ser querido y el rol de cuidador como estresores, bajo psicoticismo y abuso de alcohol, sentimientos de soledad elevados, percepción de riesgo e ideación suicida; 3-perfil mixto, con neuroticismo y psicoticismo elevados, abuso de alcohol, aislamiento y una mayor reconciliación con el agresor y ausencia de duelo y del rol de cuidador como estresores. Conocer las diferencias entre víctimas de feminicidio y de VdG permite el diseño de instrumentos más específicos para la evaluación del riesgo y el diseño de programas de prevención y tratamiento más individualizados. También facilita la labor policial en la identificación de las víctimas y el despliegue de medidas de protección más intensas.

Prevalence of Congenital Infections in Newborns and Universal Neonatal Hearing Screening in Santa Catarina, Brazil.

OBJECTIVE: to verify the frequency of congenital infections in newborns and their possible associations with the universal-neonatal-hearing-screening (UNHS) results, and evaluate a reference UNHS service in the Unified Health System (Sistema Único de Saúde-SUS), according to quality indicators. METHODS: Historical cohort study with data analysis of newborns attending prestigious hearing-health SUS services from January 2017 to December 2021, in Santa Catarina, Brazil. The quality of screening coverage was assessed based on the quality indicators proposed by the Brazilian neonatal-hearing-screening-care guidelines (Diretrizes de Atenção da Triagem Auditiva Neonatal-DATAN). Logistic-regression analysis, crude OR calculations, Cochran-Mantel-Haenszel OR calculation, and chi-square test were performed to estimate the association between risk indicators for hearing loss and UNHS failure. RESULTS: In the last five years, the prestigious services performed UNHS on 34,801 newborns and met the DATAN quality indicators. Congenital syphilis was the most frequent (1.59%) congenital infection in newborns, followed by HIV (0.87%), whereas the least frequent was rubella (0.029%). CONCLUSION: Prestigious UNHS services reached ≥95% hearing screening coverage. Considering all congenital infections, the prevalence was 2.87%, with congenital syphilis the most frequent. Newborns with congenital syphilis or HIV are more likely to fail UNHS.

Osteosarcoma transcriptome data exploration reveals STC2 as a novel risk indicator in disease progression.

BACKGROUND: Osteosarcoma has been the most common primary bone malignant tumor in children and adolescents. Despite the considerable improvement in the understanding of genetic events attributing to the rapid development of molecular pathology, the current information is still lacking, partly due to the comprehensive and highly heterogeneous nature of osteosarcoma. The study is to identify more potential responsible genes during the development of osteosarcoma, thus identifying promising gene indicators and aiding more precise interpretation of the disease. METHODS: Firstly, from GEO database, osteosarcoma transcriptome microarrays were used to screen the differential expression genes (DEGS) in cancer comparing to normal bone samples, followed by GO/KEGG interpretation, risk score assessment and survival analysis of the genes, for the purpose of selecting a credible key gene. Further, the basic physicochemical properties, predicted cellular location, gene expression in human cancers, the association with clinical pathological features and potential signaling pathways involved in the key gene's regulation on osteosarcoma development were in succession explored. RESULTS: Based on the selected GEO osteosarcoma expression profiles, we identified the differential expression genes in osteosarcoma versus normal bone samples, and the genes were classified into four groups based on the difference level, further genes interpretation indicated that the high differently level (> 8 fold) genes were mainly located extracellular and related to matrix structural constituent regulation. Meanwhile, module function analysis of the 67 high differential level (> 8 fold) DEGS revealed a 22-gene containing extracellular matrix regulation associated hub gene cluster. Further survival analysis of the 22 genes revealed that STC2 was an independent prognosis indicator in osteosarcoma. Moreover, after validating the differential expression of STC2 in cancer vs. normal tissues using local hospital osteosarcoma samples by IHC and qRT-PCR experiment, the gene's physicochemical property revealed STC2 as a cellular stable and hydrophilic protein, and the gene's association with osteosarcoma clinical pathological parameters, expression in pan-cancers and the probable biological functions and signaling pathways it involved were explored. CONCLUSION: Using multiple bioinformatic analysis and local hospital samples validation, we revealed the gain of expression of STC2 in osteosarcoma, which associated statistical significantly with patients survival, and the gene's clinical features and potential biological functions were also explored. Although the results shall provide inspiring insights into further understanding of the disease, further experiments and detailed rigorous clinical trials are needed to reveal its potential drug-target role in clinical medical use.

Women Victims of Intimate Partner Violence and Intimate Partner Homicide: A Typology Based on Victimization Variables 1 / Las mujeres víctimas de violencia y homicidio de pareja: una tipología basada en variables de victimización

Intimate partner violence against women (IPVAW) and intimate partner homicide against women (IPHAW) are multidimensional phenomena. The aim of this study was to identify typologies of Spanish IPHAW and IPVAW victims, based on the differences between their characteristics and the determinants of aggression. The sample consisted of 381 cases from the Spanish Integral Monitoring System in Cases of Gender Violence. The instrument used was a semi-structured interview. Results showed differences between IPHAW and IPVAW victims, and latent class analysis suggested a three-profile solution: 1-fatal victims, with low neuroticism, low isolation, and feelings of loneliness, less reconciliation with the aggressor, lower perception of risk and low suicidal ideation; 2-non-fatal victims, with the loss of a loved one and the role of caregiver as stressors, low psychoticism and alcohol abuse, high feelings of loneliness, risk perception, and suicidal ideation; 3-mixed profile, with high neuroticism and psychoticism, alcohol abuse, isolation, and greater reconciliations with the aggressor, and absence of bereavement and caregiver role as stressors. Knowing the differences between IPHAW and IPVAW victims allows the design of more specific instruments for risk assessment and the design of more individualized prevention and treatment programs. This also facilitates police work in identifying victims and deploying more intense protection measures. (AU)

La violencia de pareja contra la mujer (violencia de género, VdG) y el homicidio de pareja contra la mujer (feminicidio) son fenómenos multidimensionales. El objetivo de este estudio fue identificar las tipologías de las víctimas españolas de feminicidio y VdG, basado en las diferencias entre sus características y los determinantes de la agresión. La muestra constaba de 381 casos del Sistema Español de Seguimiento Integral de Casos de Violencia de Género. El instrumento utilizado fue una entrevista semiestructurada. Los resultados mostraron diferencias entre las víctimas de VdG y las víctimas de feminicidios y el análisis de clases latentes sugirió tres perfiles: 1-víctimas mortales, con bajo neuroticismo, bajo aislamiento y sentimientos de soledad, menor reconciliación con el agresor, menor percepción de riesgo y baja ideación suicida; 2-víctimas no mortales, con la pérdida de un ser querido y el rol de cuidador como estresores, bajo psicoticismo y abuso de alcohol, sentimientos de soledad elevados, percepción de riesgo e ideación suicida; 3-perfil mixto, con neuroticismo y psicoticismo elevados, abuso de alcohol, aislamiento y una mayor reconciliación con el agresor y ausencia de duelo y del rol de cuidador como estresores. Conocer las diferencias entre víctimas de feminicidio y de VdG permite el diseño de instrumentos más específicos para la evaluación del riesgo y el diseño de programas de prevención y tratamiento más individualizados. También facilita la labor policial en la identificación de las víctimas y el despliegue de medidas de protección más intensas. (AU)

Prospective Validation and Comparison of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and Site Other Than Lower Limb, Immunosuppression, Age, Renal Impairment, and Inflammatory Markers (SIARI) Scoring Systems for Necrotizing Fasciitis.

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressing infection of the soft tissues associated with high morbidity and mortality and hence it is a surgical emergency. Early diagnosis and treatment are of paramount importance. LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) and SIARI (Site other than lower limb, Immunosuppression, Age, Renal impairment, and Inflammatory markers) scoring systems have been established for early and accurate diagnosis of necrotizing fasciitis. This study compared the two scoring systems for diagnosing NF, predicting management, and elucidating the prognostic performance for re-operation and mortality. METHODS: This prospective study was conducted in PGIMER Chandigarh, India, between February 2020 and June 2021. The study was approved by the Institutional Review Board (No. INT/IEC/2020-90). The clinical presentation, laboratory parameters, and imaging were used to classify patients into NF or severe cellulitis groups. We also calculated the LRINEC and SIARI scores. Demographic variables and mortality were recorded. The area under the receiver operating characteristic was used to express the accuracy of both scores at a cut-off LRINEC and SIARI scores of ≥6 and ≥ 4, respectively. RESULTS: The study comprised 41 patients with NF and 11 with severe cellulitis. Informed written consent was taken from all the participants. At LRINEC score ≥6, the C-statistic for NF diagnosis was 0.839 (95% confidence interval [CI] 0.682-0.995, P 0.001), which was better than SIARI score at ≥ 4, C-statistic of 0.608 (95% CI 0.43-0.787, P 0.297). Both scores accurately predicted 30-day mortality. The LRINEC score showed a C-statistic of 0.912 (95% CI 0.798-1, P 0.001). Simultaneously, the SIARI score showed 70% sensitivity and 77% specificity, with a C-statistic of 0.805 (0.62-0.99, P = 0.017). CONCLUSIONS: LRINEC score is an effective diagnostic tool for distinguishing necrotizing fasciitis from severe cellulitis. Additional research is required to establish the SIARI score's external validity.

Quantitative analysis of risk assessment indicators for re-introduction of imported malaria in China / 中国血吸虫病防治杂志

Objective To quantitatively analyze the risk indicators of re-introduction of imported malaria in China and their weighting coefficients, so as to investigate the difference in the contribution of risk indicators included in the current risk assessment framework for re-introduction of imported malaria in China to the risk assessment of re-introduction of imported malaria. Methods Publications pertaining to the risk assessment framework for re-introduction of imported malaria in China that reported the risk indicators and their weighting coefficients were retrieved in PubMed, Web of Science, CNKI, Wanfang Data, and VIP with terms of “malaria”, “re-introduction/re-transmission/re-establishment”, “risk assessment/risk evaluation/risk prediction” from the inception of the database through 3 August 2023, and literature search was performed in Google Scholar to ensure the comprehensiveness of the retrieval. Basic characteristics of included studies were extracted using pre-designed information extraction forms by two investigators, and data pertaining to risk indicators of re-introduction of imported malaria were cross-checked by these two investigators. The risk indicators included in the risk assessment framework for re-introduction of imported malaria in China and their weighting coefficients were visualized with the Nightingale’s rose diagrams using the software R 4.2.1, and the importance of risk indictors was evaluated with the frequency of risk indicators included in the risk assessment framework and the ranking of weighting coefficients of risk indicators. In addition, the capability of risk indicators screened by different weighting methods was compared by calculating the ratio of the maximum to the minimum of the weighting coefficients of the risk indicators screened by different weighting methods. Results A total of 2 138 publications were retrieved, and following removal of duplications and screening, a total of 8 publications were included in the final analysis. In these 8 studies, 8 risk assessment frameworks for re-introduction of imported malaria in China and 52 risk indicators of re-introduction of imported malaria were reported, in which number of imported malaria cases (n = 8) and species of malaria vectors were more frequently included in the risk assessment frameworks (n = 8), followed by species of imported malaria parasites (n = 6) and population density of local malaria vectors (n = 6), and species of local malaria vectors (n = 6), number of imported malaria cases (n = 5) and species of imported malaria parasites had the three highest weighting coefficients (n = 4). The weighting methods included expert scoring method, combination of expert scoring method and analytic hierarchy process, and combination of expert scoring method and entropy weight method in these 8 studies, and the ratios of the maximum to the minimum of the weighting coefficients of the risk indicators screened by the expert scoring method were 1.143 to 2.241, while the ratios of the maximum to the minimum of the weighting coefficients of the risk indicators screened by combination of the expert scoring method and analytic hierarchy process were 34.970 to 162.000. Conclusions Number of imported malaria cases, species of imported malaria parasites, species of local malaria vectors and population density of local malaria vectors are core indicators in the current risk assessment framework for re-introduction of imported malaria in China. Combination of the expert scoring method and analytic hierarchy process is superior to the expert scoring method alone for weighting the risk indicators.

Morbidity and Mortality of Necrotizing Fasciitis and Their Prognostic Factors in Children.

Background: This is a prospective study of the clinico-etiologic profile and factors affecting outcomes in 40 children managed for necrotizing fasciitis (NF). Materials and Methods: Demographic details, clinical characteristics, and laboratory parameters were recorded, and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was calculated. Primary outcome (survival vs. nonsurvival) was noted, and prognostic factors were identified. Results: Initiating factors included boils (45%), i.v. cannula extravasations (22.5%), and blunt trauma (17.5%). Lesion (s) were predominantly on the lower limbs (35%) and trunk (25%). Twenty-two patients (55%) had <5% body surface area (BSA) involved. Severely deranged clinical and laboratory parameters were common. Ultrasound localized fluid collections. Pus cultures showed methicillin-resistant Staphylococcus aureus (52.5%), methicillin-sensitive S. aureus [27.5%], and polymicrobial growth (20%). Blood culture was positive in 24 patients (60%). Most isolates were sensitive to clindamycin and amoxy-clavulanate. Prognostic factors for mortality (n = 6; 15%) included categorization as "Sick," BSA involvement >10%, thrombocytopenia, raised serum creatinine, late debridement, and polymicrobial blood culture isolates. All six nonsurvivors had a LRINEC score of ≥8 and positive blood cultures. Six patients (20.7%) developed unsightly scars and 5 (17.24%) contractures across joints. Conclusions: Pediatric NF has significant morbidity and mortality. Patients with adverse prognostic factors can benefit from early referral to a facility with a critical care unit. Adequate wound management is essential to minimize residual deformity.

Asociación del índice triglicérido-glucosa con colesterol-no-HDL aumentado como indicador de riesgo cardiometabólico en estudios poblacionales / Association of the triglyceride-glucose index with increased non-HDL-cholesterol as an indicator of cardiometabolic risk in population studies / Associação do índice triglicerídeo-glicose com colesterol-não-HDL aumentado como indicador de risco cardiometabólico em estudos populacionais / Reconocimiento a la trayectoria del Prof. Dr. Juan Miguel Castagnino†

Resumen Se propone la asociación de dos indicadores para la detección de personas con riesgo cardiometabólico (RCM) en estudios poblacionales: triglicéridoglucosa (TyG) >8,75 y colesterol-no-HDL (C-no-HDL) ≥160 mg/dL, que se denominará indicador de RCM. La enfermedad cardiovascular aterosclerótica (ECVA) y la diabetes tipo 2 (DT2) son muy frecuentes. TyG aumentado es un estimador de insulinorresistencia y síndrome metabólico (SM) y está relacionado con la detección precoz de riesgo para DT2. C-no-HDL ≥160 mg/ dL ha sido recomendado informarlo en los estudios de laboratorio vinculados con el riesgo para ECVA, sus aumentos están relacionados con todas las lipoproteínas aterogénicas y es de mucho interés en hipertrigliceridemias y SM, por la presencia de lipoproteínas remanentes. En un estudio poblacional sobre 540 personas del sur argentino se halló un aumento significativo de RCM luego de los 20 años y luego de los 40 años de edad un tercio de la población lo tenía presente. El RCM se halló asociado con el índice de masa corporal (IMC), luego de ajustar para edad y género. Después de los 30 años, el RCM estaba presente en un tercio de las personas con IMC ≥27 kg/m2. En otro estudio realizado en personas con riesgo para DT2 con RCM presente, 65,8% tenían HOMA-IR (homeostasis model assessment-insulin-resistance) >2,1 y 61,8% SM. Se concluye que la asociación de TyG >8,75 y C-no-HDL ≥160 mg/dL (RCM) podría ser de interés para la detección de grupos poblacionales con alto riesgo cardiometabólico, en la prevención de ECVA y DT2.

Abstract The association of two indicators was proposed for the detection of people with cardiometabolic risk (CMR) in population studies: triglyceride-glucose (TyG) >8.75 and non-HDL-cholesterol (Non-HDL-C) ≥160 mg/dL, which will be called CMR indicator. Atherosclerotic cardiovascular disease (ACVD) and type 2 diabetes (T2D) are very common. Increased TyG is an estimator of insulin resistance and metabolic syndrome (MS) and is related to the early detection of risk for T2D. Non-HDL-C≥160 mg/dL has been recommended to be reported in laboratory studies related to the risk for CVA and its increases are related to all atherogenic lipoproteins and it is of great interest in hypertriglyceridemia and MS, due to the presence of lipoproteins remnants. In a population study of 540 people from Southern Argentina, a significant increase in CMR was found after 20 years of age, and after 40 years of age; a third of the population had it. CMR was found to be associated with body mass index (BMI), after adjusting for age and gender. After age 30 years, CMR was present in a third of the people with a BMI ≥27 kg/m2. In another study conducted in people at risk for T2D with CMR present, 65.8% had HOMA-IR (homeostasis model assessment-insulin-resistance) >2.1 and 61.8% MS. It is concluded that the association of TyG <8.75 and non-HDL-C ≥160 mg/dL (CMR) could be of interest for the detection of population groups with high cardiometabolic risk, in the prevention of ACVD and T2D.

Resumo A associação de dois índices é proposta para a detecção de pessoas com risco cardiometabólico (RCM) em estudos populacionais: triglicerídeo-glicose (TyG) >8,75 e colesterol-não-HDL (C-não-HDL) ≥160 mg/ dL, que será denominado indicador de RCM. A doença cardiovascular aterosclerótica (DCVA) e o diabetes tipo 2 (DT2) são muito comuns. TyG aumentado é um estimador de resistência à insulina e síndrome metabólica (SM) e está relacionado com a detecção precoce de risco para DT2. C-não-HDL ≥160 mg/dL tem sido recomendado para relatá-lo em estudos laboratoriais vinculados com o risco de DCVA e seus aumentos estão relacionados com todas as lipoproteínas aterogênicas e é de grande interesse na hipertrigliceridemia e SM devido à presença de restos de lipoproteínas. Em um estudo populacional de 540 pessoas do sul da Argentina, foi encontrado um aumento significativo de RCM após os 20 anos de idade e, depois dos 40 anos, um terço da população o apresentava. A RCM foi associada ao índice de massa corporal (IMC), após ajustar para idade e gênero. Após os 30 anos, a RCM estava presente em um terço das pessoas com IMC ≥27 kg/m2. Em outro estudo realizado em pessoas com risco para DT2 com RCM presente, 65,8% tinham HOMA-IR (homeostasis model assessment-insulin-resistance) >2,1 e 61,8% SM. Conclui-se que a associação de TyG >8,75 e C-não-HDL ≥160 mg/dL (RCM) poderia ser de interesse para a detecção de grupos populacionais com alto risco cardiometabolico, na prevenção de DCVA e DT2.

Congenital syphilis associated with hearing screening failure in southern Brazilian newborns

Abstract Objective: To estimate the association between congenital syphilis and neonatal hearing screening failure in the state of Santa Catarina between 2017 and 2019. Methods: This is a cross-sectional, retrospective, analytical study with secondary data of neonates from the state of Santa Catarina born between January 2017 and December 2019. We used logistic regression analysis to estimate the association between the main exposure (congenital syphilis) and the study outcome (failure in the Neonatal Hearing Screening). Results: The study included 21,434 newborns evaluated in a Brazilian hearing health care service. A total of 351 (1.6%) newborns failed the Neonatal Hearing Screening, and 364 (1.7%) had congenital syphilis. In the adjusted analysis, newborns with congenital syphilis were 3.25 times as likely to fail the Neonatal Hearing Screening as neonates without this disease (95% CI: 2.01; 5.26). As for maternal age, the sample had a higher prevalence (53.5%) of mothers aged 20-29 years. Conclusion: There was an association between congenital syphilis and failure in Universal Neonatal Hearing Screening in the sample studied. There is a need for investments in public policies to value and strengthen the hearing screening program in the state to provide early diagnosis and intervention. Level of evidence: 5

Suggested organism entry portal of necrotizing fasciitis with complete DNA from fascia, blood, and pharyngeal ulcers: A case report.

Introduction and importance: In approximately 50% of patients with necrotizing fasciitis, infection begins deep in the soft tissues. A history of trauma is often absent. The mechanism of spread has not been elucidated. We report a case of type II necrotizing fasciitis in which the streptococcal strain was identical to isolates from other locations in the same patient. Case presentation: A 42-year-old man presented with left leg pain. Two days prior, he had a non-penetrating injury to the left thigh while playing futsal. Workup revealed swelling of the left gastrocnemius. He was admitted to orthopaedics. On the third hospital day, he was referred to our department for hypotension, impending respiratory failure, and decreased sensorium, and subsequently admitted to the ICU. A biopsy was done on the left gastrocnemius fascia. He was diagnosed with necrotizing fasciitis. On the seventh hospital day, left hip amputation and extensive debridement of the trunk were done. Patient improved and eventually recovered. Clinical discussion: Group A streptococcus was isolated in from the fascia, blood, and pharyngeal ulcer. Pulsed field gel electrophoresis showed all isolates to be genetically identical. An oral route of infection was considered. Conclusions: This is the first report in which etiologic agent of necrotizing fasciitis is genetically identical with isolates from other parts in the absence of trauma.

First Reported Australian case of Fatal Streptococcal Group B Pneumonia (serotype 21) Necrotising fasciitis complicated by Toxic Shock Like Syndrome - A Case report and review.

Introduction: NF is a life-threatening infection and progressive disease resulting in widespread fulminant tissue destruction. It is rarely caused by Group B Streptococcus pneumonia. Early management with surgical removal of devitalized tissue and urgent antibiotic administration are key therapies. Aim: The aim of this report is to highlight the importance of atypical microorganisms seen in NF. Method: A case presentation and cohort summary of reported NF cases secondary to SPN from the year 2011 to 2020. Results: We report the case of a 67-year-old male, not on immune-suppressive medications, admitted to our intensive care unit with septic shock and multiorgan failure secondary to left leg NF following a 3-week history of cactus prick with an SPN bacteraemia and LRINEC score of 5 on admission. He required multiple surgical debridements and was commenced on appropriate antibiotics. Despite continuous vasopressor supportive therapy, high flux CRRT, and IVIG, our patient died after an 8-day inpatient stay. A 10-year review showed only 5 reported GBSPn NF cases with an associated mortality rate of 40%. Conclusion: A high clinical suspicion of SPN infections in NF is required to avoid high mortality with early diagnosis and targeted anti-microbial therapy. Severity scores may not align with clinical severity.