bluuebunny/crossref_metadata_2025 huggingface dataset:
Snakebite-associated acute kidney injury in South Asia: narrative review on epidemiology, pathogenesis and management
Authors: Alvitigala Bhawani Yasassri , Gooneratne Lallindra Viranjan , Gnanathasan Christeine Ariaranee , Wijewickrama Eranga Sanjeewa
Published: January 2025

Snakebite-associated acute kidney injury (AKI) poses a significant health burden in the South Asia region, resulting in considerable morbidity and mortality. Multiple factors contribute to the pathogenesis of AKI following snakebites, including hypotension, intravascular haemolysis, disseminated intravascular coagulation, rhabdomyolysis, thrombotic microangiopathy (TMA) and direct nephrotoxicity. Clinical features manifest as anuria, oliguria, haematuria, abdominal pain and hypertension. Diagnosis is supported by elevated serum creatinine levels and urine output monitoring. Renal histology studies revealed a spectrum of lesions, including acute tubular necrosis, renal cortical necrosis, glomerulonephritis and TMA. Management strategies centre around timely administration of antivenom, fluid and electrolyte balance and dialysis to improve renal outcomes. While dialysis has demonstrated efficacy in reducing AKI-related mortality rates, the use of fresh frozen plasma and therapeutic plasma exchange may be the subject of some controversy. Understanding the pathophysiological link between coagulopathy, TMA and AKI is important for tailoring effective treatment approaches. Species-specific randomized controlled trials are imperative to evaluate targeted interventions. In tackling the complexities of snakebite-associated AKI and chronic kidney disease, a multidisciplinary approach integrating clinical management with rigorous research efforts is essential. This collaborative endeavour aims to confront the challenges posed by these conditions and improve patient outcomes in the affected regions.
Challenges of researching snakes in India
Authors: Kuttalam Sourish , Malhotra Anita
Published: January 2025

The ambitious WHO goal of halving snakebite mortality by 2030 is challenged by a number of logistical hurdles, none more so than in India where snakebite envenomation presents a multifaceted challenge. We have collaborated with several organizations focused on snakebite in India over the last 11 years, with an emphasis on fieldwork to collect samples from venomous snakes in various regions, particularly understudied regions in the northeast and western Himalayas. This programme has encountered several significant obstacles, including securing permits from government organizations to collect snake samples in the field, obtaining long-term research funding, coordinating multidisciplinary collaboration on snakebite projects and engaging with grassroots stakeholders who are most affected by snakebite incidents. We emphasize the necessity of adopting a nationally coordinated yet regionally diversified approach that accounts for the biogeographical and cultural complexity of the country.
The incidence of snakebite in South Africa and the challenges associated with lack of reporting
Authors: Naik Hiral , Alexander Graham J
Published: January 2025

Background

Snakebite is a public health challenge that has a substantial impact on humans and snakes. Annually, millions of people are affected by snakebite globally but there is a paucity of detailed data on snakebite incidences. The aim of this study was to assess the patterns of snakebite incidences in South Africa.

Methods

We collected data from hospital records, information from the National Snakebite Database and records from the AfriTox Telelog database from 2011 to 2024.

Results

The combined dataset showed that 3496 snakebite incidences have been recorded over 12.5 years. The prevalence was calculated to be 5.63 per 100 000 individuals of the population for South Africa, with the highest prevalence in KwaZulu-Natal (8.89). Males made up 65.9% of snakebite incidences and most incidences were recorded between November and March. The snake species responsible for most snakebite incidences was Bitis arietans.

Conclusion

Snakebite is generally well managed in South Africa with few recorded deaths despite the relatively high number of bites. However, incidents are often not recorded or have missing information particularly regarding the circumstances of the bite. Our study provides insight on the snake species responsible for snakebite incidences in South Africa and can be used to create prevention measures.
Treatment and treatment outcomes of snakebite envenoming in Uganda: a retrospective analysis
Authors: Nanyonga Stella Maris , Matafwali Scott Kaba , Kibira Denis , Kitutu Freddy Eric
Published: January 2025

Background

Snakebite envenoming is a neglected tropical disease that causes significant morbidity and mortality in rural sub-Saharan Africa. However, there is a notable lack of data concerning the management and treatment outcomes for those affected. This study addresses this gap by examining the management and treatment outcomes of snakebite victims in Uganda.

Methods

We reviewed retrospective data of 532 snakebite cases attending 16 Ugandan health facilities from January 2017 to December 2021. Demographic characteristics and clinical data were extracted from patient records and summarized using descriptive statistics.

Results

The snakebite victims had a median age of 26 y, most were male (55.3%) and had bites of unidentified snake species (92.3%). Among the 465 treated patients, 71.6% received antibiotics, 66.0% hydrocortisone, 36.3% analgesics and only 6.9% antivenom. No adverse antivenom reactions were documented. The majority (89.5%) were discharged; 1.3% died and 5.5% had unknown outcomes.

Conclusions

These results suggest that snakebite envenoming affects vulnerable Ugandans, particularly young males and children. Treatment is primarily supportive, with antibiotic overuse and infrequent antivenom administration. Health provider training on appropriate snakebite management is needed to optimize outcomes.
Snakebites, a neglected public health concern: an analysis of distribution, trends and incidence of snakebite cases reported to health facilities in the Volta Region of Ghana, 2018–2023
Authors: Bosoka Samuel Adolf , Jerela Joseph Yaw , Nambagyira Amatus , Bonsu Emmanuel Yaw , Korang Felix Kwame , Djokoto Senanu Kwesi , Kubio Chrysantus
Published: January 2025

Background

Snakebite affects 5.4 million people annually, causing up to 2.7 million envenoming cases and 137 880 deaths. Its rise has been linked to flooding. This study examines the distribution, trends and incidence of snakebite cases in the Volta Region and identifies snakebite outbreaks in flood-affected districts.

Methods

We undertook a descriptive secondary data analysis of 2018–2023 snakebite cases from the District Health Information and Management Systems II database for the Volta Region. Cumulative Sum was used to identify missed outbreaks. The results are presented in tables, graphs and maps.

Results

A total of 1637 snakebite cases were reported across the 6-y study period, with an overall incidence rate of 15.8 cases per 100 000 population and a case fatality rate of 0.4% (7/1637). Case patients aged 20–34 y were the most affected (26.7%; 437/1637). Most of the cases peaked in March during the rainy season. The incidence of snakebites decreased from 18 cases per 100 000 population in 2018 to 15.8 cases per 100 000 population in 2023. Each of the flood-affected districts reported snakebite outbreaks before the flooding event. No new outbreaks were detected during or after the floods as of December 2023.

Conclusions

While snakebite incidence has decreased overall in the Volta Region, the burden remains alarmingly high in Ketu North. Young adults are particularly vulnerable. Urgent efforts are needed to enhance education, emphasising the importance of protective attire during the wet season for community safety.
Snakebite envenomation-associated acute kidney injury: a South-Asian perspective
Authors: Rao P Sai Kameshwar , Priyamvada P S , Bammigatti Chanaveerappa
Published: January 2025

Snakebite is a neglected public health problem in tropical countries. Snakebite envenomation-associated acute kidney injury (SBE-AKI) is a major complication accounting for significant morbidity and mortality. The pathogenesis of SBE-AKI may be multifactorial, including prerenal AKI secondary to hemodynamic alterations, intrinsic renal injury, immune-related mechanisms, venom-induced consumptive coagulopathy and capillary leak syndrome. Epidemiological factors include snake species, duration and severity of snakebite, traditional healers and native medication and accessibility to modern healthcare and antisnake venom. Renal histopathology observed consist of acute tubular necrosis, interstitial nephritis, cortical necrosis, disseminated intravascular coagulation, rhabdomyolysis and thrombotic microangiopathy. Glomerular involvement is rare. Proteinuria can be present rarely, hematuria is more common, most often due to venom-induced coagulopathy or hemolysis; it is only rarely due to renal injury. Management includes supportive care and renal replacement therapy when indicated. Progression to chronic kidney disease remains one of the biggest concerns of SBE-AKI. Hence the role and timing of renal biopsy remain controversial, given the risk involved and the benefit obtained in cases of interstitial nephritis. Various biomarkers, including cystatin C, neutrophil gelatinase-associated lipocalin, clusterin and beta-2-glycoprotein, have shown a tendency to predict AKI and also predict progression to chronic kidney disease.
Utilising snake rescue data to understand snake–human conflict in Hooghly, West Bengal, India
Authors: Kuttalam Sourish , Owens John Benjamin , Santra Vishal , Ahmed Molla T , Das Biswajit , Das Surojit , Koley Ayan , Koley Rakesh , Barlow Axel , Malhotra Anita
Published: January 2025

Background

Snakebite envenoming, classified as a neglected tropical disease, poses a significant threat to life in India, where it is estimated to cause 58 000 fatalities as well as 140 000 morbidities annually. To reduce the occurrence of snakebite, we need a comprehensive understanding of human–snake conflict ecology. Snake rescue networks represent a vital resource for gathering such ecological data.

Methods

In this study, we utilised snake rescue data from 520 rescue encounters carried out by a local rescue network in Hooghly, West Bengal, from July 2020 to October 2022, to investigate patterns of human–snake conflict and the influence of climatic factors on these patterns.

Results

The spectacled cobra Naja naja was the most encountered of the five venomous species involved in 365 rescues. Our analysis revealed a significant correlation between rescue location and venomous/non-venomous encounters, with non-venomous encounters being more prevalent inside built-up locations. Rainfall on the previous day significantly increased encounters and influenced the species involved, while daily minimum temperature also influenced encounters with venomous species. We also found that both Bungarus (krait) species present were mostly encountered between 18:00 h and midnight.

Conclusions

This study highlights the multifaceted factors influencing human-snake conflicts in the region, including seasonality, geographic location, rainfall patterns, and temperature dynamics. It underscores the potential of snake rescue data as a valuable resource for deepening our understanding of regional variations in snake–human interactions.
Detection of diarrhoeagenic Escherichia coli in the abattoir wastewater-impacted Iyi-Etu River and other water types at the Amansea livestock market settlement, Anambra State, Nigeria: a matter of public health concern
Authors: Nfor Gilbert Karngong , Omatola Cornelius Arome , Emurotu Olubunmi Marvelous , Mofolorunsho Kehinde Charles
Published: January 2025

Background

Globally, diarrhoeagenic Escherichia coli (DEC) has been implicated in the spread of waterborne diseases and abattoir wastewater has played a role in its dissemination into watersheds. This study isolated and characterised DEC from the abattoir wastewater-impacted Iyi-Etu River and other water sources at the Amansea livestock market settlement.

Methods

A total of 96 water samples comprising river water (upstream, downstream 1, downstream 2), borehole, well, sachet and abattoir wastewater samples were tested for DEC. In the inoculation process, membrane filtration was used, and selective media such as Eosin Methylene Blue, Chromoselect agar and Sorbitol Maconkey agar were used to screen for E. coli and Shiga toxin-producing E. coli (STEC) O157. Escherichia coli pathotypes were characterised using molecular techniques.

Results

Overall, E. coli was presumptively detected in 28.1% (27/96) of all samples. Of the 27 isolates, three (11.1%) were non-sorbitol fermenters (typical of E. coli O157), while 20 (74.1%) were confirmed as E. coli based on uidA housekeeping gene positivity. The detected circulating pathotypes were enteropathogenic E. coli (EPEC) (35.0%; 7/20), enteroinvasive E. coli (EIEC) (40.0%; 8/20), enterotoxigenic E. coli (15.0%; 3/20), STEC (40.0%; 10/20) and enteroaggregative E. coli (5.0%; 1/20). Escherichia coli as well as EPEC, EIEC and STEC pathotypes were most prevalent at the downstream 1 sampling point compared with the upstream. EPEC, EIEC and STEC were also detected in borehole samples (5.0%, 1/20).

Conclusions

The Iyi-Etu River and borehole water sources used for domestic and drinking purposes, respectively, at Amansea livestock market settlement are contaminated with some pathotypes of E. coli and the level of pollution may pose a public health risk to humans and animals during contact. Thus, public health measures including proper treatment of wastewater before disposal and continuous monitoring may help to learn the associated effect of DEC pollution in the area.
Stimulating Medical Student Professional Identity Formation Through Mentored Longitudinal Partnerships With Patient Teachers
Authors: Busey Lydia , May Natalie , Martindale James R. , Bradley Elizabeth B. , Plews-Ogan Margaret , Kon Rachel H.
Published: January 2025

Problem

Longitudinal patient relationships can positively affect medical students’ professional identity formation (PIF), understanding of illness, and socialization within medical practice, but a longitudinal integrated clerkship (LIC) model is not always feasible. The authors describe the novel Patient Student Partnership (PSP) program, which provides authentic roles for students in mentored longitudinal patient relationships while maintaining a traditional block clerkship model.

Approach

The PSP program at the University of Virginia School of Medicine pairs all matriculating medical students with a patient living with chronic illness to follow across multiple health care settings until graduation. The 4-year required program is rooted in the conceptual frameworks of PIF, experiential learning, and communities of practice. This program evaluation used survey data collected from the first full cohort of students (Class of 2022) at 5 timepoints during the initial 4 years of implementation (2018–2022).

Outcomes

At graduation, 152 students had completed the PSP program. Students’ narrative responses on surveys indicated PSP participation helped them connect classroom learning to clinical practice, play meaningful roles in patient care, practice communication skills via electronic health records, and practice self-reflection about their future roles as physicians. On the survey administered as students approached graduation, 54/67 (80.6%) of responding students agreed or strongly agreed that the PSP program allowed them to observe the general trajectory of a patient’s chronic illness and its impact on daily life.

Next Steps

This initial evaluation demonstrates the feasibility of integrating a mentored longitudinal experience into an existing block curriculum. Future study of PIF development occurring during PSP activities is needed to explore whether the PSP program stimulates PIF in ways similar to LICs. Additionally, the authors plan to address variability in engagement between medical students and their patient teachers through further student and faculty development regarding role clarification.
Categorizing Stigma as a Barrier to Support Following Nonfatal Overdose: A Qualitative Study
Authors: Larsen Kaylee , Silverstein Sydney , Crawford Timothy , Hassan Shahidul , Mack Nathaniel , Perdue Tasha , Ray Bradley
Published: January 2025

Objectives

Stigma is known to be a major barrier to treatment for people who use drugs (PWUD). This study uses the Stigma and Health Discrimination Framework to analyze how different forms of stigma shape experiences in the wake of an overdose incident, and perceptions of the efficacy and utility of postoverdose interventions among a sample of PWUD in Dayton, Ohio—a location with a high overdose rate.

Methods

Interviews were conducted with 23 individuals who self-reported past-month illicit opioid, crack/cocaine, or methamphetamine use who had experienced or witnessed a drug overdose in the past 6 months. Interviews were recorded, transcribed, and thematically analyzed using Taguette software.

Results

Discrete forms of stigma were identified as barriers to postoverdose interventions intended to link PWUD with support and services to help them access treatment. Individuals identified experiences of enacted stigma through medical mistreatment, exploitation, and judgment. They identified anticipated stigma through mistrust and unsustainable treatment. Internalized stigma was identified through the effect of loss on mental health, feeling “stuck,” and the role of race on support-seeking behaviors. Experiences of structural stigma included desensitization of addiction as a disease and lack of feasible, long-term treatment options.

Conclusions

The results suggest that enacted, anticipated, internalized, and structural forms of stigma act as barriers to the efficacy of postoverdose outreach programs, and the initiation and sustainability of treatment. Understanding how each form of stigma adversely impacts PWUD can improve public health and clinical interventions to reduce stigma and overdose death.
Radiographic Predictors of Difficult Fiberscopic Intubation During General Anesthesia in Patients With a Cervical Collar to Simulate a Difficult Airway
Authors: Jo Woo-Young , Park Sang Joon , Shin Kyung Won , Park Hee-Pyoung , Oh Hyongmin
Published: January 2025

Background:

Predictors of difficult fiberscopic intubation have not been fully elucidated. This study focused on identifying radiographic predictors of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar.

Methods:

This retrospective study included unconscious patients who underwent orotracheal intubation using a flexible fiberscope while wearing a cervical collar to simulate a difficult airway. Easy fiberscopic intubation was defined as successful fiberscopic intubation within 120 seconds on the first attempt without desaturation below 90%. The patients were divided into easy (n=133) and difficult (n=24) fiberscopic intubation groups. Demographic, mask ventilation-related, upper airway-related, and radiographic variables measured on sagittal images of preoperative cervical x-ray and magnetic resonance imaging were analyzed.

Results:

The difficult fiberscopic intubation group had a smaller oral cavity area (2.1 [1.2-2.5] vs. 2.9 [2.1-3.7] cm2, P<0.001), higher tongue area divided by oral cavity area (9.3 [6.5-13.3] vs. 6.4 [4.6-8.3], P<0.001), smaller epiglottis angle (33±10° vs. 37±8°, P=0.02), and longer skin-glottis distance (1.3 [1.1-1.6] vs. 1.1 [1.0-1.3] cm, P=0.004). Tongue area/oral cavity area (odds ratio per 1 [95% CI]: 1.24 [1.09-1.40]) and skin-glottis distance (odds ratio per 1 cm [95% CI]: 13.0 [2.69-62.4]) were independently associated with the difficulty in fiberscopic intubation.

Conclusions:

High tongue area/oral cavity area and long skin-glottis distance were predictive of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar.
Learnings From an Audit of Anesthesia Information Management System for Neurosurgery Operating Room Utilization
Authors: Malhotra Rohit , Sriganesh Kamath , Venkataramaiah Sudhir , Chakrabarti Dhritiman
Published: January 2025

Background:

An anesthesia information management system (AIMS) can be used to assess operating room utilization. The aim of this study was to assess neurosurgery OR utilization patterns using an AIMS.

Methods:

This retrospective audit was performed at a tertiary neurosciences university hospital over a 1-year period. The time taken for various OR activities were identified from the timestamps recorded in the AIMS and used to assess whether the type of surgical procedure, patient’s American Society of Anesthesiologists (ASA) physical status score, case schedule order, or surgeons’ experience impacted operating room utilization.

Results:

Data from 1800 patients were available for analysis. Utilization times for various operating room activities were different based on the type of surgery, ASA grade, case order, and surgeon seniority. The main differences were found in the durations of surgery and anesthesia, and the time from the arrival of a patient into the operating room and the start of surgery, which were significantly impacted by the type of surgery, case order, and surgeon seniority (P<0.001), but not by ASA score.

Conclusions:

AIMS can effectively track and identify operating room utilization patterns by analyzing the durations of various operating room activities. Prospective multicenter studies are required to validate these findings in different surgical populations and centers.
Ring Fixator Bone Transport is Associated With Fewer Unplanned Major Reoperations than Masquelet in the Treatment of Segmental Bone Defects of the Tibia
Authors: Whitlock Keith G. , Brodke Dane J. , Khoury Philip H. , Li Vivian , Bell Alice , Okhuereigbe David , Sciadini Marcus F. , Nascone Jason W. , O’Toole Robert V. , O’Hara Nathan N. , Gage Mark J.
Published: January 2025

OBJECTIVE:

To determine whether bone transport or Masquelet results in higher rates of major unplanned reoperations for the treatment of segmental tibial bone defects ≥4 cm in length.

METHODS:

Design: Retrospective cohort.

Setting:

Level I trauma center.

Patient Selection Criteria:

Adult patients with segmental tibial defects (OTA/AO 41,42,43) ≥4 cm who underwent surgical treatment with ring fixator bone transport or Masquelet between 2011–2022 with a minimum 1-year follow-up were included.

Outcome Measures and Comparisons:

The primary outcome was a major unplanned reoperation after corticotomy (bone transport) or autografting (Masquelet), including below knee amputation, surgical debridement for deep infection, or surgical intervention for nonunion. Ring fixator bone transport and Masquelet were compared using multivariable logistic regression, adjusting for defect size as a potential confounder.

RESULTS:

24 patients treated with bone transport (mean age 40yo (18-66), 100% male) and 22 patients treated with Masquelet (mean age 42yo (22-71), 91% male) were included. Defect etiology was identified as acute traumatic in 25 patients (54%) and post-infectious in 21 patients (46%) (P = 0.23). The median defect size was 7.2 cm (IQR 6.1–10.1) for transport and 5.8 cm for Masquelet (IQR 4.7–8.0) (P = 0.08). Bone transport was associated with an 85% reduction in the odds of a major unplanned reoperation compared to treatment with the Masquelet technique (OR, 0.15; 95% CI, 0.03–0.58; P = 0.01). Bone transport patients underwent a mean of 0.38 major unplanned reoperations compared to 0.91 in the Masquelet group. Reoperation for deep infection occurred significantly less in the bone transport group (21%) compared to the Masquelet group (46%) (OR, 0.18; 95% CI, 0.03–0.76; P = 0.03).

CONCLUSION:

Bone transport was associated with a reduction in major reoperations compared to Masquelet for segmental tibial bone defects. This finding may have been driven by fewer surgeries for infection in the bone transport group.

LEVEL OF EVIDENCE:

Therapeutic Level III
Anesthesia and Pain Management for Scoliosis Surgery
Authors: Reysner Małgorzata , Kowalski Grzegorz , Geisler-Wojciechowska Alicja , Resyner Tomasz , Wieczorowska-Tobis Katarzyna
Published: January 2025

Study Design:

This was a narrative review.

Objective:

The objective of this review was to summarize the current evidence and knowledge gaps regarding anesthesia and pain management for scoliosis surgery, including multimodal analgesia, and identify the best anesthetic approach to scoliosis surgery that ensures patient safety and pain relief even in the postoperative period, with minimal influence on SSEP monitoring.

Summary of Background Data:

Spinal surgeries and fusions for scoliosis are associated with high pain levels. Inadequate analgesia can cause patient dissatisfaction, delay recovery, and increase the risk of chronic pain. Despite serious side effects, opioids are the mainstay of pain medication after scoliosis surgery. However, increasing emphasis on minimizing opioids and accelerating recovery has increased the adoption of multimodal analgesic therapy.

Materials and Methods:

The literature review was performed on standards of care, a pain management protocol, current therapeutic options, and innovative treatment options for patients undergoing scoliosis surgery. The literature was reviewed through 4 electronic databases: PubMed, Cochrane Library, Google Scholar, and Embase.

Results:

The initial search yielded 994 articles. Forty-seven relevant articles were selected based on relevance, recentness, search quality, and citations. Ten studies described the influence of different methods of anesthesia on neuromonitoring. Twenty-one researchers studied the effect of analgesics and coanalgesics on pain relief protocol. Nine studies treated regional anesthesia and its influence on pain management.

Conclusions:

The most suitable anesthetic approach that does not disturb the neuromonitoring is obtained by combining total intravenous anesthesia (TIVA) with remifentanil and propofol with regional anesthesia, particularly erector spinae plane block (ESPB), as a part of a multimodal analgesia protocol.

Level of evidence:

Level II.
Curbside Consult Optimizing Statin Therapy in the Elderly: A Personalized Approach to Cardiovascular Disease Prevention
Authors: Maheta Darshilkumar , Agrawal Siddharth Pravin , Patel Jinal , Patel Monit , Frishman William H. , Aronow Wilbert S.
Published: January 2025

Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) play a vital role in managing and preventing cardiovascular disease, particularly in elderly populations who face elevated risks for atherosclerosis and related conditions. This review delves into the mechanisms of statin action, emphasizing their impact on low-density lipoprotein cholesterol levels, anti-inflammatory properties, and potential genetic factors influencing efficacy and drug tolerability. Consideration is given to statin intolerance and management strategies, drug interactions, and guidelines for primary and secondary prevention of cardiovascular events. Patient-centered care and shared decision-making are highlighted as essential for effective therapy in elderly patients. This review also addresses the importance of personalized approaches in the context of genetic markers such as SLCO1B1 polymorphisms, optimizing patient outcomes and minimizing adverse effects. Finally, emerging areas of research are discussed, underscoring the need for further studies on the cognitive impact of statins and newer lipid-lowering agents. This analysis serves to inform clinical practice by balancing statins’ cardiovascular benefits against potential risks, aiming for a tailored approach in managing elderly patients with cardiovascular concerns.
Drusen Regression after Macula-involving Rhegmatogenous Retinal Detachment Repair
Authors: Green Kyle M. , Mohammed Taariq K. , Russell Jonathan F. , Boyce Timothy M.
Published: January 2025

Purpose:

To investigate the effect of macula-involving rhegmatogenous retinal detachment (RRD) repair on drusen regression.

Methods:

A retrospective review was performed of patients with drusen who underwent macula-involving RRD repair. Longitudinal optical coherence tomography scans were reviewed by three graders, and each case was grouped into one of three categories: drusen regression, drusen persistence, or mixed.

Results:

14 eyes with drusen that underwent macula-involving RRD repair were identified. Surgical repair consisted of pars plana vitrectomy (PPV) in 7 eyes, combined PPV and scleral buckle in 6 eyes, and primary buckle with cryotherapy in 1 eye. Regression of drusen occurred in 6 eyes (43%), persistence of drusen in 5 eyes (36%), and 3 eyes were categorized as mixed (21%). One patient with drusen regression with long-term follow up resulted in geographic atrophy.

Conclusion:

Although the course of drusen following repair of macula-involving RRDs was highly variable, roughly half of eyes demonstrated marked drusen regression.
A Perspective on Combination of Antibiotic Therapy for Extensively Drug-Resistance Bacterial Infections
Authors: Tuon Felipe Francisco , Zequinao Tiago , Morales Ronaldo , Telles Joao Paulo
Published: January 2025

Evaluation of clinical efficacy in epidemiological studies and even controlled studies with extensively drug-resistant (XDR) organisms is difficult, as it generally encompasses critically ill patients, who are usually prone to high mortality rate. Combination therapy has been used as a strategy to establish synergistic effect. However, the literature has been extremely controversial, and most recent studies have demonstrated that combination therapy should not be used routinely in XDR bacterial infections. This narrative review discusses the combination therapy on XDR bacteria using the pharmacokinetic and pharmacodynamic approach based on several systematic reviews with meta-analysis.
Intestinal Spirochetosis as a Cause of Persistent Rectal Abscess in a Patient With HIV/AIDS
Authors: Khazi-Syed Afeefah , Chi Zhikai , Kelesidis Theodoros
Published: January 2025

Brachyspira is a rare spirochetal infection that can cause a variety of gastrointestinal symptoms. Individuals with HIV/AIDS are at increased risk of developing persistent and severe infection. To our knowledge, rectal abscess due to Brachyspira have not previously been described. Here, we present a case of a HIV-positive patient presenting with chronic rectal pain and drainage over the span of 2 years, who was diagnosed with Brachyspira rectal abscess. We discuss the diagnostic challenge of Brachyspira rectal abscesses mimicking sexually transmitted disease and discuss the utility of prolonged metronidazole treatment due to both antibacterial and anti-inflammatory effects.
Streptococcus pyogenes Bacteremia at a Large Teaching Hospital
Authors: Rich Elizabeth , Hatch Stacy , Oravec Michael , Myers Joseph
Published: January 2025

Objectives

The aims of the study were to review Streptococcus pyogenes bacteremia (SPB) at our 570-bed teaching hospital from 2018 to 2022 and to report epidemiology, source of SPB, comorbidities, treatment, and mortality.

Methods

This was deemed to be an institutional review board–exempt quality improvement project of our internal medicine residency. We reviewed records of adults (≥16 years) with SPB admitted to hospital during 5-year period from 2018 to 2022. Age, gender, date and source of bacteremia, comorbidities, antimicrobial therapy, and mortality were recorded for each patient. Comparisons to data from our 2007–2016 study were performed using Fisher's exact test with 2-tailed P value.

Results

There were 102 episodes of SPB during the 5-year period: 64 men (62.7%) and 38 women (37.3%). Incidence was 4.39/104 hospital discharges (HD) in 2018, 6.79/104 HD in 2019, 6.67/104 HD in 2020, 6.16/104 HD in 2021 and 5.83/104 HD in 2022. Age range was 21–94 years with mean = 56.5 years. Sources of bacteremia: skin/soft tissue infection in 52/102 (51.0%), pneumonia in 15/102 (14.7%), bone/joint infection in 13/102 (12.7%), and primary infection in 8/102 (7.8%) episodes. Other sources were as follows: endometritis (3 patients), intra-abdominal infection (3 patients), mastoiditis (2 patients), endocarditis (1 patient), and miscellaneous (4 patients). Diabetes mellitus (36.2%), injection drug use (IDU) (29.8%), chronic obstructive pulmonary disease (24.5%), and chronic liver disease (23.4%) were the most common comorbidities. The mortality rate was 15.7%. All patients received appropriate/timely initial antimicrobial therapy.

Conclusions

SPB was more frequent in this 5-year period than during the preceding 10-year period. Skin/soft tissue infection (51.0%) and bone/joint infection (12.7%) were expected sources of SPB but pneumonia (14.7%) was an unexpectedly frequent cause. There was more episodes of bacteremia IDU-related, 29.8% in this study, than the 7.4% in our prior study (P = 0.0004). Mortality was higher (15.7%) than in our prior study (10.3%) but this difference did not achieve statistical significance (P = 0.3663). SPB is not uncommon, is frequently associated with IDU, causes pneumonia more often than expected, and has a 15.7% mortality rate.
Extracorporeal Shock Wave Therapy for Limb Dysfunction after Stroke: A Systematic Review and Meta-analysis
Authors: LIU Wen-fang , ZHANG Shuang-mei
Published: January 2025

Objective

Recently, extracorporeal shock wave therapy (ESWT) has emerged as a novel and noninvasive approach for alleviating spasticity and pain, improving motor dysfunction after stroke. To determine the effectiveness of ESWT and the effects of shock wave parameters in relieving spasticity, pain, and motor dysfunction following stroke.

Design

We conducted a systematic search of PubMed, EBSCOhost, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials on ESWT for limb dysfunction after stroke from inception until February 1, 2023. Two researchers independently searched and screened articles identified from each database, used RevMan v.5.4 analyzing data.

Results

This review included nine articles and 327 patients. ESWT improved the spasticity, pain, and motor function following stroke. They also improved the passive range of motion in the lower limbs. The treatment effect was highest when the shock wave frequency was <8 Hz and pressure was <2 bar. However, the effect was not significantly affected by treatment duration. Compared to focused extracorporeal shock waves, released extracorporeal shock waves were associated with better outcomes.

Conclusion

The treatment outcomes are optimal when a shock wave frequency < 8 Hz, pressure < 2 bar, and released extracorporeal shock waves are used.
Nasal Septal Abscesses: A Systematic Review
Authors: Shaari Ariana L. , Patil Disha , Youssef Victoria , Bebawy George , Shaari Diana S. , Schwartz Cynthia , Eloy Jean Anderson
Published: January 2025

Background:

Nasal septal abscesses (NSA) necessitate prompt recognition and management to prevent morbidity and long-term sequelae. To date, no comprehensive review of NSA alone has been conducted.

Objective:

To conduct a systematic review of the presentation and management of NSA and determine patients at risk of sequelae.

Methods:

Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. PubMed, Web of Science, Cochrane, and reference lists were searched. Patient demographic information, etiology, presentation, management, and outcomes were recorded and analyzed.

Results:

A total of 79 articles (90 cases) were included. The mean age was 32.86 years old with a slight male predominance. The most common signs were nasal pain (44.86%, N=48), trouble breathing (23.36%, N=25), and headache (15.89%, N=17). All cases were treated with intranasal drainage. Most patients (66.67%, N=60) were asymptomatic at last follow-up. Most abscesses (73.07%) were located in the anterior septum. Of those patients who experienced complications, common complications were saddle nose deformity (70.59%, N=24), nasal obstruction (5.88%, N=2), and septal perforation (5.88%, N=2). No significant association between age (P = 0.23), sex (P = 0.99), history of diabetes (P = 0.11), history of nasal trauma (P = 0.91), history of nasal/dental surgery (P = 0.14), location (P = 0.18), or postoperative nasal packing (P = 0.65) and NSA outcomes was found.

Conclusion:

Patients with or without a history of immunodeficiency, trauma, or nasal surgery are at risk of developing NSA. Without adequate treatment, NSA can be associated with functional and aesthetic sequelae.
Effectiveness and Safety of Glue-based Dural Closure in Cranial Surgery: A Retrospective Cohort Study
Authors: Li Chunhui , Wu Yingjie , Mo Qiulian , Yang Meijun , Liang Hao
Published: January 2025

Dural closure is a crucial step in cranial surgery, essential for preventing complications like cerebrospinal fluid leakage, wound infections, and meningitis. Traditional suturing techniques, however, pose challenges such as technical difficulty and the potential for tissue damage. This retrospective study aimed to assess the safety and effectiveness of a nonsuture dural closure method using medical glue for direct adhesion of a patch to the dura mater. It was conducted from September 2019 to September 2023, including 169 patients with supratentorial brain injuries who underwent nonsuture dural closure (glue group) and 209 patients who received suture dural closure (suture group). The study compared the operation time and material costs between the two groups, with patients followed for 3 months to monitor complications and adverse events. The results showed that the operation time for dural closure was significantly shorter in the glue group (8.4 ± 3.7 min) compared with the suture group (21.7 ± 4.1 min). Postoperative complications were significantly lower in the glue group. There were no significant differences in adverse events between the groups. These findings suggest that nonsuture dural closure with medical glue is a simple, efficient, and safe alternative to traditional suturing, effectively reducing postoperative complications.
Pseudonocardia spirodelae sp. nov., isolated from duckweed and formal proposal to reclassify Pseudonocardia antarctica as a later heterotypic synonym of Pseudonocardia alni and reclassify Pseudonocardia carboxydivorans as Pseudonocardia alni subsp. carboxydivorans
Authors: Butdee Waranya , Saimee Yuparat , Suriyachadkun Chanwit , Duangmal Kannika
Published: January 2025

A novel Pseudonocardia strain DW16-2T, isolated from duckweed (Spirodela polyrhiza), was taxonomically studied in detail. The analysis based on its 16S rRNA gene sequence revealed that the strain was most closely related to Pseudonocardia carboxydivorans Y8T (98.8%), followed by Pseudonocardia tropica YIM 61452T (98.7%), Pseudonocardia antarctica DVS 5a1T (98.7%) and Pseudonocardia alni DSM 44104T (98.7%). The average nucleotide identity (ANI) based on blast and digital DNA–DNA hybridization (dDDH) relatedness values between strain DW16-2T and their closest type strains were below the threshold values for identifying a novel species. Morphological, physiological and chemotaxonomic features of strain DW16-2T were typical for the genus Pseudonocardia by forming extensively branched substrate mycelium and aerial mycelium that fragmented into rod-shaped spore, with a smooth surface. The whole-cell hydrolysates of strain DW16-2T contained meso-diaminopimelic acid as the diagnostic diamino acid, and the whole-cell sugars were arabinose, galactose, glucose and a trace amount of ribose. The polar lipids contained phosphatidylethanolamine, phosphatidylcholine, phosphatidylglycerol and unidentified phospholipids. The menaquinone (MK) was MK-8(H4). The cellular fatty acids (>5 %) were iso-C16 : 0, iso-C16 : 1 H, summed feature 3: C16 : 1 ω7c/C16 : 1 ω6c; C16 : 1 ω6c/C16 : 1 ω7c, C17 : 1 ω8c and anteiso-C17 : 0. Characterization based on chemotaxonomic, phenotypic, genotypic and phylogenetic evidence demonstrated that strain DW16-2T represents a novel species of the genus Pseudonocardia, for which the name Pseudonocardia spirodelae sp. nov. (type strain DW16-2T = TBRC 16418T = NBRC 115857T) is proprosed. In addition, the comparison of the whole genome sequences suggested that P. alni and P. antarctica belong to the same species and P. carboxydivorans is a subspecies of P. alni. Therefore, it is proposed that P. antarctica Prabahar et al. 2004 is reclassified as a later heterotypic synonym of P. alni (Evtushenko et al. 1989) Warwick et al. 1994, and P. carboxydivorans Park et al. 2008 is proposed as a subspecies of P. alni (Evtushenko et al. 1989) Warwick et al. 1994.
International Committee on Systematics of Prokaryotes: minutes of the open plenary meeting, Tuesday, 22 October 2024, Sesto Fiorentino, Florence, Italy, and via Teams
Authors: Oren Aharon
Published: January 2025

A hybrid in-person and online open plenary meeting of the International Committee on Systematics of Prokaryotes (ICSP) was held on 22 October 2024 at the Consiglio Nazionale delle Ricerche, Sesto Fiorentino, Florence, Italy, and via Teams just prior to the IUMS 2024 Congress. To comply with Articles 4(d) and 5(d) (1) of the statutes of the ICSP, the minutes of this meeting are published here.
Vishniacozyma siamensis sp. nov., a new anamorphic tremellomycetous yeast species isolated from a mangrove forest in Thailand
Authors: Gungprakhon Pajongwan , Khammeankea Maneerat , Limtong Savitree , Khunnamwong Pannida
Published: January 2025

Six strains (DMKU-SG26, DMKU-SG42, DMKU-SYM22, DMKU-RG41, DMKU-RX317 and DMKU-RGM25) representing a novel basidiomycetous yeast species were isolated from leaf surfaces of mangrove plants collected in Thailand. Pairwise sequence analysis indicated that the six strains either had identical nucleotide substitution in the D1/D2 domains of the large subunit (LSU) rRNA gene sequences or differed by one to three nucleotide(s). They also had identical or differed by one to five nucleotide substitution(s) in the internal transcribed spacer (ITS) regions. blastn searches of the GenBank database revealed that the six strains were closely related to the holotype of type strains of Vishniacozyma peneaus, V. terrae, V. phoenicis, V. taiwanica and V. europaea, but with 6–15 (1.14–2.48%) and 16–26 (5.4–8.8%) nucleotide substitutions in the D1/D2 domains of the LSU rRNA gene and the ITS regions, respectively. Phylogenetic analysis based on the concatenated sequences of the ITS regions and D1/D2 domains of the LSU rRNA gene showed that these strains are placed in the Vishniacozyma clade but were at a distinctly different position from the other recognized species of the genus. Based on the phylogenetic analysis and phenotypic characteristics, these six strains are a novel species of the genus Vishniacozyma, for which the name Vishniacozyma siamensis sp. nov. is proposed to accommodate them. The holotype is TBRC 18499T and the ex-type culture is PYCC 10042 (=DMKU-SG26). The MycoBank number of the novel species is MB 855838.
Emendation of Recommendation 6(7), Rule 64 and Appendix 9 Section D of the International Code of Nomenclature of Prokaryotes to regulate the formation of prokaryote names from personal names
Authors: Oren Aharon
Published: January 2025

Following a proposal to emend Recommendation 6(7), Rule 64 and Appendix 9, Section D of the International Code of Nomenclature of Prokaryotes to regulate the formation of prokaryote names from personal names, I hereby report the outcome of the ballot on this proposal by the members of the International Committee on Systematics of Prokaryotes.
Adaptation shapes the representational geometry in mouse V1 to efficiently encode the environment
Authors: Dipoppa Mario , Nogueira Ramon , Bugeon Stéphane , Friedman Yoni , Reddy Charu B. , Harris Kenneth D. , Ringach Dario L. , Miller Kenneth D. , Carandini Matteo , Fusi Stefano
Published: January 2025

Sensory adaptation dynamically changes neural responses as a function of previous stimuli, profoundly impacting perception. The response changes induced by adaptation have been characterized in detail in individual neurons and at the population level after averaging across trials. However, it is not clear how adaptation modifies the aspects of the representations that relate more directly to the ability to perceive stimuli, such as their geometry and the noise structure in individual trials. To address this question, we recorded from a population of neurons in the mouse visual cortex and presented one stimulus (an oriented grating) more frequently than the others. We then analyzed these data in terms of representational geometry and studied the ability of a linear decoder to discriminate between similar visual stimuli based on the single-trial population responses. Surprisingly, the discriminability of stimuli near the adaptor increased, even though the responses of individual neurons to these stimuli decreased. Similar changes were observed in artificial neural networks trained to reconstruct the visual stimulus under metabolic constraints. We conclude that the paradoxical effects of adaptation are consistent with the efficient coding framework, allowing the brain to improve the representation of frequent stimuli while limiting the associated metabolic cost.
Tattoo ink induces inflammation in the draining lymph node and impairs the immune response against a COVID-19 vaccine
Authors: Capucetti Arianna , Falivene Juliana , Pizzichetti Chiara , Latino Irene , Mazzucchelli Luca , Schacht Vivien , Hauri Urs , Raimondi Andrea , Virgilio Tommaso , Pulfer Alain , Mosole Simone , Grau-Roma Llorenec , Bäumler Wolfgang , Palus Martin , Renner Louis , Ruzek Daniel , Levy Gabrielle Goldman , Foerster Milena , Chahine Kamil , Gonzalez Santiago F.
Published: January 2025

Despite safety concerns regarding the toxicity of tattoo ink, no studies have reported the consequences of tattooing on the immune response. In this work, we have characterized the transport and accumulation of different tattoo inks in the lymphatic system using a murine model. Upon quick lymphatic drainage, we observed that macrophages mainly capture the ink in the lymph node (LN). An initial inflammatory reaction at local and systemic levels follows ink capture. Notably, the inflammatory process is maintained over time as we observed clear signs of inflammation in the draining LN two months following tattooing. In addition, the capture of ink by macrophages was associated with the induction of apoptosis in both human and murine models. Furthermore, the ink accumulated in the LN altered the immune response against a COVID-19 vaccine. We observed a reduced antibody response following vaccination with a mRNA-based SARS-CoV-2 vaccine, which was associated with a decreased expression of the Spike protein in macrophages in the draining LN. Considering the unstoppable trend of tattooing in the population, our results are crucial in informing the toxicology programs, policymakers, and the general public regarding the potential risk of the tattooing practice associated with an altered immune response.