Humans encounter mycobacterial species due to their ubiquity in different environmental niches. In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the ...innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. Cutaneous mycobacterial infections may cause a wide range of clinical manifestations, which are divided into four main disease categories: (i) cutaneous manifestations of
infection, (ii) Buruli ulcer caused by
and other related slowly growing mycobacteria, (iii) leprosy caused by
and
, and (iv) cutaneous infections caused by rapidly growing mycobacteria. Clinically, cutaneous mycobacterial infections present with widely different clinical presentations, including cellulitis, nonhealing ulcers, subacute or chronic nodular lesions, abscesses, superficial lymphadenitis, verrucous lesions, and other types of findings. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Cutaneous tuberculosis exhibits different clinical phenotypes acquired through different routes, including via extrinsic inoculation of the tuberculous bacilli and dissemination to the skin from other sites, or represents hypersensitivity reactions to
infection. In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma.
, a mycobacterial species related to
, is linked to diffuse lepromatous leprosy of Lucio and Latapí.
produces a mycolactone toxin that leads to subcutaneous tissue destruction and immunosuppression, resulting in deep ulcerations that often produce substantial disfigurement and disability.
, a close relative of
, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Among patients with advanced immunosuppression,
, the
complex, and
may cause cutaneous or disseminated disease. Rapidly growing mycobacteria, including the
group,
, and
, are increasingly recognized pathogens in cutaneous infections associated particularly with plastic surgery and cosmetic procedures. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Additionally, histopathological evaluation of skin biopsy specimens may be useful in identifying leprosy, Buruli ulcer, and cutaneous tuberculosis. Molecular assays are useful in some cases. The treatment for cutaneous mycobacterial infections depends on the specific pathogen and therefore requires a careful consideration of antimicrobial choices based on official treatment guidelines.
Abstract
Background
the coronavirus disease 2019 (COVID-19) is characterized by poor outcomes and mortality, particularly in older patients.
Methods
post hoc analysis of the international, ...multicentre, ‘real-world’ HOPE COVID-19 registry. All patients aged ≥65 years hospitalised for COVID-19 were selected. Epidemiological, clinical, analytical and outcome data were obtained. A comparative study between two age subgroups, 65–74 and ≥75 years, was performed. The primary endpoint was all cause in-hospital mortality.
Results
about, 1,520 patients aged ≥65 years (60.3% male, median age of 76 IQR 71–83 years) were included. Comorbidities such as hypertension (69.2%), dyslipidaemia (48.6%), cardiovascular diseases (any chronic heart disease in 38.4% and cerebrovascular disease in 12.5%), and chronic lung disease (25.3%) were prevalent, and 49.6% were on ACEI/ARBs. Patients aged 75 years and older suffered more in-hospital complications (respiratory failure, heart failure, renal failure, sepsis) and a significantly higher mortality (18.4 vs. 48.2%, P < 0.001), but fewer admissions to intensive care units (11.2 vs. 4.8%). In the overall cohort, multivariable analysis demonstrated age ≥75 (OR 3.54), chronic kidney disease (OR 3.36), dementia (OR 8.06), peripheral oxygen saturation at admission <92% (OR 5.85), severe lymphopenia (<500/mm3) (OR 3.36) and qSOFA (Quick Sequential Organ Failure Assessment Score) >1 (OR 8.31) to be independent predictors of mortality.
Conclusion
patients aged ≥65 years hospitalised for COVID-19 had high rates of in-hospital complications and mortality, especially among patients 75 years or older. Age ≥75 years, dementia, peripheral oxygen saturation <92%, severe lymphopenia and qSOFA scale >1 were independent predictors of mortality in this population.
Only three helminths (Schistosoma haematobium, Opisthorchis viverrini and Clonorchis sinensis) are directly associated with carcinogenesis in humans whereas the role of other parasites in cancer ...remains unclear. This study aimed to perform a systematic review to identify recent insights in the role of other parasite infections in carcinogenesis. We conducted systematic searches of MEDLINE and EMBASE on July 2015. Our primary outcome was the association between parasitic infections and carcinogenesis. Out of 1,266 studies, 19 were selected for detailed evaluation (eight for helminths and 11 for protozoa). The mechanisms of helminth‐induced cancer included chronic inflammation, sustained proliferation, modulation of the host immune system, reprogramming of glucose metabolism and redox signaling, induction of genomic instability and destabilization of suppressor tumor proteins, stimulation of angiogenesis, resisting cell death, and activation of invasion and metastasis. In addition to the current knowledge, the following parasites were found in cancers or tumors: Echinococcus, Strongyloides, Fasciola, Heterakis, Platynosomum and Trichuris. Additional parasites were found in this systematic review that could potentially be associated with cancers or tumors but further evidence is needed to elaborate a cause‐effect relationship.
What's new?
Certain parasites may do more than cause chronic health problems. They may also lead to cancer. Some of these infections, such as “snail fever” (schistosomiasis), are already known to be linked to cancer. In this study, however, the authors identified six additional parasitic infections that may also increase risk. The carcinogenic mechanisms triggered by these infections include chronic inflammation, DNA damage, altered gene expression and immune evasion. Because billions of people are infected with various parasites worldwide, these findings raise serious public health concerns, and further research is urgently needed.
The aim was to evaluate the effect of different feed additives on intake, performance, and fecal consistency index (FCI) of dairy calves from 6-60 d of age and its residual effect 15 d after weaning. ...Fifty Holstein calves (38 ± 1.0 kg BW) were fed 5 L/d of milk plus starter feed until weaning, and corn silage and concentrate after weaning. The treatments were: control (CON), monensin (MON; 30 mg/kg of starter), probiotic E. faecium (PROB; 70 mg/kg of starter), essential oils (EO; 300 mg/kg of starter), or PROB + EO (EOPROB). Fecal score and dry matter intake (DMI) were measured daily, and animals were weighed every 15 d. A DNA extraction from feces was performed to identify the presence of microorganisms (E. coli, Hafnia, Shiguella, Lactobacillus spp, Enterococcus spp, and Enterococcus faecium NCIMB 10415) by PCR. Two 72-h digestibility trials were performed at days 20-28 and 50-56, by total fecal collection. The DMI before weaning was greater for EO (903.0 g/d) compared with MON (794.3 g/d) and EOPROB (783.1 g/d). The FCI decreased during pre-weaning for EO and MON. Average daily gain (ADG) and feed efficiency (FE) did not differ among treatments before weaning. After weaning, DMI and FCI did not differ among treatments. The EO had greater ADG (917.5 g/d) compared with CON (615.8 g/d) and PROB (592.6 g/d). The FE improved with EO (0.72 g/g) over CON (0.36 g/g), MON (0.49 g/g), and PROB (0.36 g/g). The PCR results showed absence of E. faecium NCIMB 10415 in animals fed PROB and CON. Animals fed PROB had greater intake of CP and NDF than animals fed EOPROB. The EO can be added to the dairy calf ration to improve fecal score and increase DMI. The pre-weaning FCI decrease with MON and increase with PROB.
Intestinal protozoa are becoming increasingly recognized as significant pathogens in immunocompromised hosts. However, pathogenesis of infection is still poorly understood, diagnostic tests remain ...insensitive, and management continues to pose a challenge.
Invasion by intestinal protozoa can be facilitated by impaired host T-cell immune response, although the exact pathogenesis at the cellular level is unclear. HIV-infected and transplant patients have been reported to have the highest risk for developing severe disease. Cryptosporidium is the most common parasite encountered in the immunocompromised host, followed by Cyclospora and Isospora. In recent years, Microsporidia and Blastocystis have also emerged as important players, due in part to improved molecular diagnostic assays. Effective drugs against these parasites in immunocompromised patients have not been reported in recent years. When possible, reducing the level of immunosuppression seems to be the most effective treatment strategy in combination with adjunctive antiparasitic therapy.
Despite that intestinal protozoan infections cause greater morbidity and mortality in the immunocompromised host, their pathogenesis in the setting of immunosuppression is poorly understood and efforts to develop new therapeutic agents are rather limited. Improving detection and identification of species or subtypes by PCR will result in improved management decisions and a better understanding of the epidemiology of intestinal protozoa. Favorable clinical outcomes can be achieved by early detection and effective treatment of the infection. Further research on key aspects of pathogenesis at the cellular level in humans is needed.
Overweight and obesity have become global concerns in developed and developing countries due to their rise in recent years and their association with the prevalence of non-communicable diseases ...including diabetes, hypertension and cardiovascular diseases. In fact, it is estimated that roughly 39% of adults worldwide are overweight and 13% are obese. Ecuador is an example of a developing country concerned with the overweight and obesity problem, where it is estimated that 30% of children, 26% of teenagers and 63% of adults are either overweight or obese and where 1 in 4 deaths are attributed to chronic diseases. To address the overweight and obesity problem via the promotion of healthy eating habits, in 2013 the country approved technical regulation for the labelling of packed processed food products. The regulation included a mandatory traffic-light (TL) supplemental nutritional information labelling system to be displayed on the package of all processed foods for sale in the country. This new labelling system displays a traffic light panel for the product content of sugar, fat and salt in addition to the traditional nutrient declaration label. The objective of this paper was to evaluate the effect of the TL supplemental nutritional information on consumers' buying behavior in Ecuador. More specifically, we concentrated on the purchasing behavior of carbonated soft drinks. For our analysis, we used monthly aggregated purchase data (total expenditures, quantities and average prices) of carbonated soft drinks from January 2013 to December 2015 obtained from Kantar World Panel-Ecuador. We estimated a non-linear Almost Ideal Demand System where we model the demand for high sugar and low sugar carbonated soft drinks. We found that the introduction of the traffic light supplemental nutrition labelling did not have the expected effect of reducing purchases of carbonated soft drinks during its first year of implementation, especially those high in sugar. Additionally, we found that lower income-status households tend to spend more on and consume more calories from CSD than households with higher socio-economic status. Finally, we identified that over time purchases of high sugar soft drinks decreased while purchases of low and no sugar soft drinks increased. Beyond our contribution of evaluating the effect of the traffic light on the purchases of carbonated soft drinks, we also estimated price and income elasticities of carbonated soft drinks which can be useful in the evaluation of fiscal policies.
Fascioliasis has been sporadically associated with chronic liver disease on previous studies. In order to describe the current evidence, we carried out a systematic review to assess the association ...between fascioliasis with liver fibrosis, cirrhosis and cancer.
A systematic search of electronic databases (PubMed, LILACS, Scopus, Embase, Cochrane, and Scielo) was conducted from June to July 2015 and yielded 1,557 published studies. Among 21 studies that met inclusion and exclusion criteria, 12 studies explored the association of F. hepatica with liver fibrosis, 4 with liver cirrhosis, and 5 with cancer. Globally these studies suggested the ability of F. hepatica to promote liver fibrosis and cirrhosis. The role of F. hepatica in cancer is unknown. Given the heterogeneity of the studies, a meta-analysis could not be performed.
Future high-quality studies are needed to determine the role of F. hepatica on the development of liver fibrosis, liver cirrhosis, and cancer in humans.
•Tocilizumab was not associated with significantly reduced mortality in mechanically ventilated patients with COVID-19 pneumonia.•Patients who received tocilizumab were younger, presented with higher ...fever on the day of intubation, and had significantly fewer comorbidities than controls.•Elevated interleukin-6 was associated with greater mortality risk; interleukin-6 levels were similar in the treatment and control group.
The purpose of this study is to evaluate clinical outcomes in patients with critical COVID-19 pneumonia requiring invasive mechanical ventilation who were treated with tocilizumab
Single-center retrospective cohort study
Stony Brook University Hospital, a 600-bed academic tertiary medical center in Suffolk County, New York
Consecutive patients with COVID-19 confirmed by nasopharyngeal polymerase chain reaction (PCR) who were admitted to Stony Brook University Hospital between March 10 and April 2 2020 and required mechanical ventilation in any intensive care unit during their hospitalization
Treatment with tocilizumab while intubated
Overall mortality 30 days from the date of intubation
Forty-five patients received tocilizumab compared to seventy controls. Baseline demographic characteristics, inflammatory markers, treatment with corticosteroids, and sequential organ failure assessment (SOFA) scores were similar between the two cohorts. Patients who received tocilizumab had significantly lower Charlson co-morbidity index (2.0 vs 3.0,P = 0.01) than controls. There was a trend towards younger mean age in the tocilizumab exposed group (56.2 vs 60.6; P = 0.09). In logistic regression analysis there was no reduction in mortality associated with receipt of tocilizumab (odds ratio (OR) 1.04; 95% CI, 0.27–3.75). There was no observed increased risk of secondary infection in patients given tocilizumab (28.9 vs 25.7; OR 1.17; 95% CI, 0.51–2.71).
When controlling for age, severity of illness, and co-morbidities, tocilizumab was not associated with reduction in mortality in this retrospective cohort study of mechanically ventilated patients with COVID-19 pneumonia. Further studies are needed to determine the role of tocilizumab in the treatment of COVID-19.
In this work, a density-functional study of hydrogen storage in tin carbide monolayers (2DSnC) decorated with alkali metals atoms (AM) such as Li, Na, and K, is reported. The most stable adsorption ...site for these alkali metal atoms on the 2DSnC is above a tin atom. The results indicate that the alkali metal atoms are chemisorbed on the 2DSnC and that electronic charge is transferred from the decorating atom to the 2DSnC. In all the studied cases, the hydrogen molecules are physisorbed on the AM-2DSnC (AM = Li, Na, and K) complexes and then these systems could be used for hydrogen storage. In particular, it is found that the K-2DSnC monolayer has the highest hydrogen-storage capacity, where a single potassium atom can adsorb up to 6 hydrogen molecules, followed by Na-2DSnC with 5 hydrogen molecules and Li-2DSnC with 3 hydrogen molecules. Finally, it can be estimated that when the K, Na and Li adatom-coverings respectively attain 40%, 44% and 70%, the hydrogen-storage gravimetric capacities of AM-2DSnC could overcome the US-DOE recommended target of 5.5 wt% for onboard automotive systems.
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•H2 storage on alkali-metal-decorated SnC monolayers has been theoretically studied.•Li, Na and K atoms are chemisorbed on the Sn atom of 2DSnC.•Li, Na and K adatoms on 2DSnC can physisorb up to 3, 5 and 6 H2, respectively.•K, Na and Li coverings of 40%, 44% and 70% can overcome 5.5 wt% for H2 storage.•H2 adsorption energies on K-2DSnC lie between 0.1 eV and 0.2 eV.
Rare disease patients are more likely to receive a rapid molecular diagnosis nowadays thanks to the wide adoption of next‐generation sequencing. However, many cases remain undiagnosed even after ...exome or genome analysis, because the methods used missed the molecular cause in a known gene, or a novel causative gene could not be identified and/or confirmed. To address these challenges, the RD‐Connect Genome‐Phenome Analysis Platform (GPAP) facilitates the collation, discovery, sharing, and analysis of standardized genome‐phenome data within a collaborative environment. Authorized clinicians and researchers submit pseudonymised phenotypic profiles encoded using the Human Phenotype Ontology, and raw genomic data which is processed through a standardized pipeline. After an optional embargo period, the data are shared with other platform users, with the objective that similar cases in the system and queries from peers may help diagnose the case. Additionally, the platform enables bidirectional discovery of similar cases in other databases from the Matchmaker Exchange network. To facilitate genome‐phenome analysis and interpretation by clinical researchers, the RD‐Connect GPAP provides a powerful user‐friendly interface and leverages tens of information sources. As a result, the resource has already helped diagnose hundreds of rare disease patients and discover new disease causing genes.
The RD‐Connect Genome‐Phenome Analysis Platform (GPAP) is a scalable and interoperable online system which facilitates the collation, analysis, interpretation and sharing of integrated genome‐phenome datasets, with a particular focus on RD case diagnosis and novel gene discovery. It is free to use for all noncommercial members of the rare disease research community.
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