Abstract Introduction: Pandemic situation by severe acute respiratory syndrome coronavirus 2 and the associated disease (coronavirus disease 2019 [COVID-19]) presents broad challenges. Post-COVID-19 condition represents a continuum of persistent symptoms following the acute course. The World Health Organization (WHO) proposes a definition with at least one symptom persisting for 3 months postonset. Negative affection toward quality of life (QoL) is frequently reported. Patients with immune-mediated inflammatory diseases (IMIDs), such as inflammatory bowel disease (IBD) and rheumatic diseases (RDs) are of scientific interest as immunologic factors and immunosuppressive therapy might influence QoL in post-COVID-19 conditions. Methods: Adult IMID patients (≥18 years) were offered participation in this study at our university outpatient center. Data collection was questionnaire-based and recorded individual COVID-19 history and persisting symptoms. QoL has been assessed by several standardized and validated patient-reported outcome measures (Short IBD Questionnaire and Patient Health Questionnaire 4, 5Q-5D-5L). Results: A total of 156 patients were included (117 [75%] with IBD, 39 [25%] with RDs). Eighty-one patients (51%) reported a positive COVID-19 history, mostly with mild courses. Only two (2%) required hospitalization, one requiring intensive care. Seven (9%) reported no symptoms, while 20 (25%) met the WHO criterion for post-COVID-19 condition; 19 (23%) were still suffering from post-COVID-19 at the time of data acquisition. Mean/median global QoL scores (scale from 0 [=lowest] to 100 [=highest]) were 71.5/75 in patients without post-COVID-19, compared to 61.9/60 in those with the condition. A one-sided t -test showed a significant association between post-COVID-19 and lower QoL ( P = 0.03). Conclusions: A relevant fraction of IMID patients suffered from post-COVID-19 condition. This condition negatively impacted the individual QoL.
Abstract Introduction: Being harmful to patients, delayed diagnosis and treatment can spread tuberculosis (TB) in the community, posing a significant challenge to TB elimination efforts. This systematic review and meta-analysis aimed to estimate the median delays of TB care and the proportion of the Indian population experiencing these delays. Methods: Data extraction and screening were conducted from August 1, 2024, to September 30, 2024, using PubMed, Scopus, and DOAJ search engines. The pooled proportion of the Indian population experiencing the total delay in TB care was estimated, at a 95% confidence interval (CI), using a random-effects model that assumed potential heterogeneity. Results: Of the 14 studies, 92.85% ( n = 13) focused on drug-sensitive TB cases, and 7.15% ( n = 1) focused on drug-resistant cases. Similarly, 64.28% ( n = 9) of studies were cross-sectional, followed by 21.42% ( n = 3) of retrospective studies. The estimated median patient delay is 20.5 days (interquartile range [IQR]: 15.3–25.0), the median diagnosis delay is 32.5 days (IQR: 30.0–37.0), the median treatment delay is 7.50 days (IQR: 2.75–12.8), and the median total delay is 45.5 days (IQR: 37.1–58.5). The pooled proportion of the Indian population experiencing total delay is estimated at 39% (95% CI: 17%–64%). With the random-effects model, high heterogeneity (I2 = 99%) was observed among the studies. The regression test for funnel plot asymmetry did not show statistical significance (z = 0.204, P = 0.838). Conclusion: The findings of this study can help program managers design strategies that can help in reducing delays in TB care in India.
Abstract Introduction: Leptospirosis is a neglected zoonotic disease caused by Leptospira spirochetes and remains a significant public health concern in tropical and subtropical regions of India. The humid subtropical climate of Eastern Uttar Pradesh favors its transmission. Methods: To assess the occurrence, demographic characteristics, seasonal trends, and epidemiological distribution of leptospirosis in Eastern Uttar Pradesh. A cross-sectional study was conducted on 2430 clinically suspected cases. Serum samples were tested for Leptospira-specific IgM antibodies using enzyme-linked immunosorbent assay (ELISA). Demographic details, occupational exposure, seasonal variation, and district-wise distribution were analyzed. Results: Of 2430 suspected cases, 550 (22.6%) were IgM positive. Gender distribution was nearly equal (49.4% males; 50.5% females). The highest prevalence was observed in males aged 11–20 years and females aged 21–40 years, with overall higher positivity in the 11–30 years age group. Seasonal peaks occurred in October among males and November among females, correlating with monsoon and post-monsoon periods. Housewives, farmers, and students showed higher positivity rates, indicating domestic and agricultural risk factors. Cases were reported from 16 districts, with the highest positivity in Deoria (33.3%), Prayagraj (31.2%), and Azamgarh (23.6%). Increased seroprevalence was noted among residents living along the River Ganga in Varanasi. Conclusion: Leptospirosis is endemic in Eastern Uttar Pradesh with significant seasonal and occupational associations. Enhanced surveillance, early diagnosis, and targeted preventive strategies are essential to reduce disease burden in this subtropical region.
Introduction: Genital tuberculosis is a secondary form of extrapulmonary tuberculosis and represents a public health issue. This study aims to analyze the trend, impact, and collaboration in scientific activity related to genital tuberculosis. Methods: A descriptive bibliometric study was conducted on 237 articles published in Scopus-indexed journals addressing the topic of genital tuberculosis. The search employed MESH terms and logical operators; bibliometric metrics were estimated using the SciVal tool. In addition, the VOS viewer was used to represent a coauthorship network. Results: Journals in quartiles Q3 and Q4 had the highest number of publications, with the Indian Journal of Tuberculosis leading the field, although the Journal of Minimally Invasive Gynecology demonstrated greater impact. Indian institutions have conducted the most research, with the All India Institute of Medical Sciences being the most productive. Sharma Jai Bhagwan, followed by Singh Urvashi Balbir and Dharmendra Sona, had the highest number of citations, while J. Singh Neeta exhibited the greatest impact (18.6 citations per publication). National collaboration (44.3%) was the most common type of partnership, followed by institutional collaboration (42.6%), both of which also had more citations. However, international collaboration showed the greatest impact (6.7 citations per publication). Conclusion: Research on genital tuberculosis has remained steady and is primarily disseminated in Q3 journals. Collaboration is predominantly national and institutional, with India leading in research output.
Introduction: Native septic arthritis (SA) is rare, with an estimated annual incidence of 2 per 100,000 individuals. It poses a significant clinical burden due to rapid joint destruction and long-term functional impairment. This study presents a retrospective review of native knee, hip, and shoulder SA treated at a single academic medical center. The primary objective was to characterize the clinical, demographic, and microbiologic features of affected patients and to evaluate associations between patient-specific factors and the need for repeat surgical irrigation and debridement (I&D). Methods: This retrospective case series included patients with native SA of the knee, hip, and shoulder treated at a single academic institution between January 1, 2014, and December 31, 2022. Demographics, comorbidities, laboratory data, and culture results were collected for all cohorts. The analysis focused on identifying predictors for reoperation in the knee, hip, and shoulder cohorts. Results: Among the 62 knee cases, 48% had diabetes, with culture positivity observed in 54%. A formal I&D was performed in 97%, with 32% requiring repeat procedures. Multivariate analysis identified culture positivity (odds ratio [OR] 9.43, P = 0.02) and diabetes (OR 8.0, P = 0.03) as independent predictors of reoperation. Male gender was associated with decreased odds of reoperation (OR 0.18, P = 0.02). In the hip and shoulder cohorts, no significant predictors were found. Conclusion: Native SA at our institution is associated with significant comorbidities and treatment failure. In this study, diabetes mellitus and culture positivity were independently associated with increased odds of reoperation, whereas male gender was independently associated with decreased odds of reoperation in knee infections. Staphylococcus aureus was the most common pathogen across all joints. These findings highlight the importance of host and microbiologic factors in determining reoperation risk. Further studies are needed to validate these predictors across larger cohorts.
Introduction:Clostridium difficile infections (CDIs) are among the most common causes of hospital diarrhea and are associated with prolonged hospitalization and increased mortality. Aim:To evaluate the prevalence of nonthyroidal illness syndrome (NTIS) in hospitalized patients with CDI and its impact on the length of hospitalization and patient survival. Methods:A retrospective single-center study at a hospital in the Subcarpathian region of Europe. We reviewed the medical data of 370 patients with confirmed CDI who stayed at the hospital between January 1, 2015, and April 1, 2024. Demographic data, laboratory values, comorbidities, treatments, and clinical outcomes were also collected. We independently compared the data of patients with NTIS and euthyroidism and independently between survivors and nonsurvivors. The statistical test used were Mann-Whitney U-test and Chi-square test (with Pearson's or Yates' correction). Results:Of 370 patients, 113 (30%) were included in the study. Eighty-one (71.7%) patients presented with CDI accompanied by NTIS. The median age in both the CDI and NTIS groups was 82 years, and 51.8% of patients were female. NTIS was significantly associated with 3.7-fold higher odds of death compared to euthyroidism (odds ratio = 3.70; 95% confidence interval: 1.02-13.38; P = 0.036). Lower serum free triiodothyronine (FT3) levels were also significantly associated with increased mortality (P = 0.035). Conclusions:Low serum FT3 levels appear to be an independent marker of clinical deterioration and a predictor of mortality in patients with CDI and could be incorporated into the prognostic assessment of these patients.
Introduction: Infection prevention programs promote a set of recommendations for rational antimicrobial management, encouraging outpatient parenteral antimicrobial therapy (OPAT) or step-down transitions to oral administration, when possible. However, proper selection of the right patient is critical for safe dehospitalization. The aim of the study was to report on implementing an outpatient antimicrobial management project using an improvement science framework. Methods: A case report assessing a quality improvement initiative implementing an antimicrobial management project, DESOSP, in a Brazilian public tertiary hospital from July 2022 to June 2023. The intervention was implemented using a Breakthrough Series model, including plan-do-study-act cycles to promote OPAT and oral antimicrobial therapy (OAT) transitions. Clinical assistance outcomes were assessed from October 2022, including the dehospitalization rate of patients using antimicrobials in compliance with the eligibility criteria, the mean length of stay (MLS) of selected patients, and the hospital admission turnover rate. In addition, we used the financial data of OAT cases as a sample to estimate savings. Results: After 9 months, DESOSP increased the dehospitalization rate of eligible patients from 70% to 91%. The MLS of these patients dropped from 4.2 to 2.8 days. Turnover rate increased from 0.5 to 0.9. The readmission rates of patients receiving antibiotic therapy discharged for the same pathology within 30 days were not modified. Considering the OAT sample, we estimated savings of USD$76,949.86 (return on investment of 201.2%). Conclusion: Promoting a safe, structural, and systematic process, training, and engaging clinical teams seems feasible and valuable for promoting stewardship recommendations in the public healthcare system.
Introduction: Hepatitis B virus (HBV) infection remains a major public health issue in India, with a significant burden of undiagnosed asymptomatic carriers. Identifying such individuals is essential to achieve the World Health Organization’s goal of HBV elimination by 2030. Methods: The objectives of this study were to determine the prevalence of hepatitis B surface antigen (HBsAg) and HBV viral load among asymptomatic healthcare workers and patients undergoing elective surgeries and to evaluate the need for universal HBV screening in such populations. This was a hospital-based cross-sectional study conducted at a tertiary care center in Central India. Blood samples from 13,840 asymptomatic individuals were tested for HBsAg, and positives in HBsAg were further tested for hepatitis B e antigen (HBeAg) by enzyme-linked immunosorbent assay. HBV DNA quantification was performed using a real-time polymerase chain reaction-based method on selected samples. Results: Out of 13,840 individuals screened, 355 (2.57%) tested positive for HBsAg. Among these, 37 (10.42%) were HBeAg-positive, all of whom had HBV DNA levels > 2000 IU/ml. Notably, 48.64% of HBeAg-negative individuals also had significant viral loads. The average age of HBsAg-positive individuals was higher than negatives (42.38 ± 16.58 vs. 37.52 ± 18.92; P = 0.008). Males were more frequently infected (P < 0.001). Conclusion: The study highlights a significant proportion of asymptomatic individuals with elevated HBV viral loads, particularly among HBeAg-negative cases. These findings support the implementation of universal HBV screening in preoperative and occupational health settings as a vital strategy for early detection, treatment initiation, and achieving national and global HBV elimination targets.
Introduction:Pneumocystis jirovecii pneumonia (PJP) is a severe opportunistic infection in patients with weakened immune function, especially those infected with human immunodeficiency virus (HIV) and various non-HIV immunocompromised patients. Here, we retrospectively compared the clinical, laboratory, and imaging features of PJP between HIV-infected and non-HIV-immunodepressed patients in Jiangxi Province to improve diagnostic accuracy and guide clinical treatment. Statistical analysis using normality tests (Shapiro-Wilk), t-tests, and nonparametric tests highlighted major differences between the two groups. Methods:The study included patients diagnosed with PJP from January 2020 to December 2024 in a tertiary A hospital in Jiangxi Province. The patients were divided into two groups: HIV infection (n = 30) and non-HIV immunosuppression (n = 60). Clinical data, laboratory results, and imaging findings of the two groups were analyzed. Statistical tests including Shapiro-Wilk normality test, t-test for normally distributed variables, and nonparametric test were performed using SPSS version 26.0 to determine significant differences between groups. Results:Compared with the HIV group, non-HIV immunocompromised patients had a higher mechanical ventilation rate and a higher likelihood of intensive care unit admission (P < 0.05). HIV-infected patients are younger and exhibit more severe systemic and respiratory symptoms (fever, dyspnea, cough, and asthma). Blood analysis showed white blood cell (WBC), Neutrophilicgranulocyte (NE), blood urea nitrogen (blood urea nitrogen) in non-HIV group. BUN) and Creatine Kinase MB Isoenzyme (CK-MB) levels were significantly increased (p<0.05), suggesting that most of these patients were complicated with immune function disorders such as heart, lung and kidney. The level of albumin-globulin (GLB) in HIV was significantly reduced, suggesting that the disease involved the liver or kidney and may be advanced. Imaging studies showed mediastinal lymph nodes, pleural effusion, bilateral infiltration, and ground-glass shadow in both groups. However, bilateral small pulmonary nodules, ground-glass shadows, and mediastinal lymph nodes were predominant in HIV patients, suggesting that various opportunistic infections may have occurred. In non-HIV immunocompromised patients, bilateral small lung nodules, mixed low-density shadows, and pleural effusion were predominant, suggesting a variety of potential diseases. A state of immunosuppression can lead to increased susceptibility to infection, tumorigenesis, and an increase in autoimmune diseases. Conclusion:The majority of HIV-infected PJP patients in Jiangxi Province are young men, showing systemic symptoms and abnormal early lung imaging features. Non-HIV immunocompromised PJP patients showed nonsystemic symptoms and advanced lung imaging abnormalities. Basophils, total protein (TP), and GLB can reflect some states of the immune system. It can be used to preliminarily distinguish PJP patients with HIV infection from non-HIV immunocompromised patients. PJP co-infection with HIV usually involves complex immune responses and clinical manifestations, and relying on these indicators alone is not ideal for identification. A more accurate identification method should be combined with clinical symptoms, medical history, immune function tests (such as CD4+ T-cell count), viral load, and other indicators for comprehensive evaluation. Therefore, although the above indicators can provide a certain reference value for identification, they cannot be used as the only basis.
Epstein-Barr virus (EBV) encephalitis is a rare cause of encephalitis in India and has no pathognomic imaging findings described. Here, we describe the case of a 17-year-old male with fever, cerebellitis, and extrapyramidal involvement, followed by altered sensorium. Imaging showed T2/fluid-attenuated inversion recovery bilaterally symmetric hyperintensities with diffusion restriction in substantia nigra. Cerebrospinal fluid analysis and polymerase chain reaction were positive for EBV. Magnetic resonance imaging findings in EBV encephalitis are known to occur in cortical, subcortical regions, white matter, basal ganglia, thalamus, brain stem, and cerebellum. Isolated involvement of substantia nigra is less reported in the literature. Hence, this case highlights the clinical radiological correlation that can be seen in EBV encephalitis with secondary parkinsonism. The patient recovered after starting antivirals, steroids, and other symptomatic treatments.
The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 continues to be a global public health issue. Kidney disease is common, mainly presenting as acute kidney injury. Glomerular diseases have been reported in COVID-19. We are presenting a case of immune complex-mediated glomerulonephritis in a patient with COVID-19 infection and probable superimposed systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap who developed a pulmonary-renal syndrome. The patient responded well with a combination of plasma exchange, rituximab, and glucocorticoid therapy. The treatment was successful with resolution of the diffuse alveolar hemorrhage and prevention of potential end stage kidney disease. We would like to add this case to the literature as another example of the long-ranging potential autoimmune/autoinflammatory complications associated with COVID-19 disease.
Introduction: India bears the highest global burden of tuberculosis (TB), with multidrug-resistant TB (MDR-TB) posing substantial treatment challenges. Sputum culture conversion is a vital indicator of treatment response and an early predictor of success in drug-resistant TB (DR-TB). This study aimed to evaluate the time to early sputum culture conversion (within 6 months) in DR-TB patients and identify factors influencing this outcome across different resistance patterns: MDR, MDR with fluoroquinolone resistance, MDR with second-line injectable resistance, and extensively DR-TB (XDR-TB). Methods: This prospective cross-sectional observational study was conducted in India. Seventy-four DR-TB patients enrolled between January and October 2019 were assessed. Demographic data, comorbidities, and culture conversion times were analyzed using Chi-square tests and univariate logistic regression. P <0.05 was considered statistically significant. Results: Among the 74 patients (62.2% male; mean age 30 years), most MDR-TB patients (52%) achieved culture conversion within 3 months, while pre-XDR and XDR cases mostly converted within 2 months. Smoking (P = 0.03), low body mass index (BMI) (P = 0.025), cavitary lesions on chest X-ray (P = 0.01), and lower socioeconomic status (P = 0.02) were significantly associated with delayed conversion. Conclusion: Early sputum culture conversion is a key milestone in DR-TB treatment. Addressing modifiable risk factors such as smoking, undernutrition, and cavitary disease may improve outcomes. Further studies are needed to identify interventions to accelerate culture conversion and enhance treatment success.
Introduction: Sepsis remains a leading cause of global mortality. Despite established guidelines by the Surviving Sepsis Campaign (SSC), adherence to time compliance with the SSC bundle is often inconsistent. In New Brunswick hospitals, this compliance has not been studied. This study evaluates compliance with the SSC bundle in a regional community hospital in New Brunswick (NB), Canada, and its impact on clinical outcomes. Methods: A retrospective, single-center observational study was conducted to review sepsis and septic shock cases over 6 months. Patients were categorized into two groups: group A (sepsis or septic shock diagnosed at initial assessment) and Group B (diagnosed retrospectively based on SSC screening criteria and a Sequential Organ Failure Assessment score ≥2). The primary outcome was time compliance with SSC bundle components, while secondary outcomes included mortality, length of hospital stay, and quantity of crystalloid fluid administered. Results: Of 44 patient charts reviewed, 20 met inclusion criteria (13 Group A and 7 Group B). Initial ordering compliance for the SSC bundle within 1 h was 45%, but processing compliance was only 5%. In an extended analysis, the time frame for antibiotic administration was broadened to 3 h, increasing overall compliance with the SSC bundle to 15%. When the analysis was extended to 3 hours for all bundle measures, ordering compliance rose to 60%, and processing compliance increased to 40%. Median time to antibiotic administration was 188 min, and median time to fluid initiation was 69 min. No significant differences in primary or secondary outcomes were observed between Group A and Group B. Conclusions: Delays in processing SSC bundle components highlight critical gaps in sepsis care. Implementing standardized protocols, enhancing communication, and utilizing real-time alert systems could improve compliance and patient outcomes in NB hospitals.
Introduction: The splenic tuberculous involvement is common than other intra-abdominal solid organs such as the liver, pancreas, and kidney. The aim of this article is to present and share a review of the English-language literature on splenic tuberculosis (TB) to gain a better understanding of etiopathogenesis, epidemiological features, and diagnostic methods and provide guidelines for its management and to present our experience of six cases. Methods: The systematic search of the literature was performed on PubMed and Medline from 1950 to 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Fifty-two manuscripts were included in this systematic review. All resulting titles, abstract, and full text, whenever available, were read and kept for reference. Conclusion: Direct histopathological demonstration is the best diagnostic modality. Fine-needle aspiration cytology is the study of choice and polymerase chain reaction assay increases its sensitivity. The standard short course antitubercular therapy for 6 months is recommended for isolated splenic TB, and for widespread disease, 12-month therapy is recommended. Surgery is reserved for failure of medical therapy and complications such as abscess formation.
Introduction:Differentiating candidemia from bacteremia in intensive care unit (ICU) patients is critical for effective treatment but is often delayed by reliance on conventional diagnostics like blood cultures. This study evaluates the diagnostic utility of interleukin-6 (IL-6), C-reactive protein (CRP), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), individually and in combination, for distinguishing these bloodstream infections (BSIs). Methods:This prospective observational study included 74 ICU patients with BSIs admitted to a university-affiliated hospital between September 2023 and August 2024. Biomarker levels were measured on the 2nd day of ICU admission. Diagnostic performance was assessed using the Mann-Whitney U test, logistic regression, and receiver operating characteristic curve analysis. Results:Of the 74 patients, 54 (72.9%) had bacteremia and 20 (27.1%) had candidemia. IL-6 and sTREM-1 levels were significantly higher in candidemia (P < 0.001), whereas CRP alone did not show discriminatory power (P = 0.981). The combined biomarker model achieved an area under the curve of 0.818, demonstrating superior diagnostic performance compared to individual markers. Conclusions:IL-6 and sTREM-1 are effective biomarkers for distinguishing candidemia from bacteremia, with CRP providing additional value in a multibiomarker model. This approach may enhance diagnostic precision and improve clinical decision-making in ICU settings.
Introduction: The West Nile virus (WNV) has become a global concern, triggering major outbreaks in the United States and other regions. Effective surveillance and early detection are essential for controlling its spread. This study aims to assess the global landscape of WNV research, identify emerging trends, and analyze collaborative networks in the field. Methods: A comprehensive search was conducted in the Scopus database on July 14, 2024, covering publications from January 2019 to July 2024 that included specific keywords in their titles or abstracts. Metadata from 2305 documents were extracted and analyzed using SciVal and Bibliometrix, applying various indicators and metrics to evaluate research trends and collaborations. Results: The most prominent authors and institutions in this field include Ute Ziegler of the Friedrich-Loeffler Institute in Germany, Giovanni Savini of the Instituto Zooprofilattico Experimentale di Abruzzo e Molise in Italy, and Sylvie Lecollinet of the National Food Safety Agency, de l’Environnement et du Travail in France. The journals most central to WNV research include viruses and pathogens, the Journal of Medical Entomology, Vector-Borne and Zoonotic Diseases, and PLOS Neglected Tropical Diseases. The thematic evolution of WNV research reveals various key themes over time. Most publications were concentrated in the first quartile (Q1), although a decreasing trend was observed in the number of publications over time in all quartiles. The USA had the largest number of corresponding authors. Conclusion: These findings provide a comprehensive view of the scope, influence, and impact of WNV research, highlighting the importance of international collaboration in this field.
Introduction:Because of insufficient number of standardized negative-pressure isolation rooms to manage coronavirus disease 2019 (COVID-19), rapid deployment of a temporary isolation ward in our hospital was required. This report is intended to share our experience in the rapid deployment of a temporary isolation ward during a COVID-19 outbreak. Methods:We constructed a temporary hospital ward with 22 negative-pressure single-bed patient rooms to take care of COVID-19 patients. One-way traffic control for healthcare workers (HCWs) was designed. The temperature, humidity, and air changes per hour in each room were monitored. Each fan above ceiling of the nurse station was equipped with two ultraviolet-C (UV-C) 254 nm lamps to sterilize the environment and provide fresh air. All HCWs in the unit were tested for COVID-19 once a week by reverse transcriptase-polymerase chain reaction (RT-PCR) of nasopharyngeal samples. Results:During the period of May 31-June17, 2021, 55 patients with COVID-19 were admitted to this isolation ward, which was constructed in 2 days. The mean air changes per hour of the patient room were 11 times, and the temperature and humidity were 20.6°C and 74%, respectively. The pressure differential between the patient rooms and the corridor was 3 Pascals (Pa), lesser in the rooms. All of 966 PCR tests performed for HCWs were negative. Conclusion:The temporary COVID-19 isolation unit, constructed in 2 days, was effective for patient care and protection of HCWs.
