bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of the Power of Nursing
TM
on Classroom Connectedness
Authors: Radwan LiliAnna Baz , Baudler Barbara , Scheller Suzanne
Published: September 2024

Background

The coronavirus disease 2019 pandemic brought awareness to the benefits of creating cultures of belonging and connection in academic and professional settings. The Power of Nursing
TM
(PON), a transformative course focusing on shared experiences, permits the exploration of classroom connectedness from a unique interpersonal perspective where teachers and students meet as equals. The purpose of this study is to measure senior-level nursing students' perceived connectedness following a 5-week PON program.

Method

Undergraduate senior-level nursing students' perceived connectedness was measured using the Connected Classroom Climate Inventory. Additionally, a qualitative thematic analysis was applied to responses post-course.

Results

Results indicated a significant difference in students' perceived connectedness scores, while thematic analysis supported this finding with key themes of generous nonjudgmental listening, vulnerability, sharing experiences, and a want for connection enhancing meaningful learning.

Conclusion

The PON provides an excellent platform for cultivating connections with peers and mentors. Students can effectively utilize the insight gained from this course to form and build meaningful connections with their future patients.

[
J Nurs Educ
. 2024;63(12):850–853.]
Bioethics and the Psychosphere
Authors: Sgreccia Elio
Published: September 2024

Bioethicshas so far considered, at least in a direct and prevalent sense, interventions in the biological and medical fields: from genetic engineering to the problems of euthanasia and ecology, the landscape of bioethics reflections has unfolded and is unfolding to reaffirm values, to enucleate criteria and performulate norms of behavior
The Sexual Violence Bill
Authors: De Rosa Giuseppe
Published: September 2024

Sexual violence has always been a sad social reality. It seems, however, that in recent years cases of sexual violence, both against women and minors, have multiplied. In fact, there is an increase in the number of reports of such crimes from one year to the next.
The criminal protection of prenatal life
Authors: Eusebi Luciano
Published: September 2024

Not available.
Criteria for indication of initiation or discontinuation of life-sustaining therapy
Authors: Manna Raffaele , Migliore Alberto
Published: September 2024

Most of the ethical problems involved in life-support therapy may stem from a different understanding of authority in health care and a non-univocal interpretation of the principle of proportionality. Particularly in Anglo-Saxon circles, the theory is established that authority in medical care lies exclusively with patients or their legal representatives.
Twenty years after the publication of ‘Humanae Vitae'
Authors: Sgreccia Elio
Published: September 2024

Not available.
The transmission of life in the teaching of John Paul II
Authors: Di Pietro Maria Luisa , Sgreccia Elio
Published: September 2024

Not available.
The human foetus as ‘donor’ of tissues and organs
Authors: Spagnolo Antonio G. , Sgreccia Elio
Published: September 2024

The possibility of using the foetus as a ‘donor’ of tissues and organs is coming up more and more frequently in the field of transplantation and is being considered by numerous institutional and national ethics committees, as well as by international bodies that have drawn up and are drawing up guidelines.
Recent scientific data on the treatment of female infertility of tubal origin
Authors: Marana Riccardo , Vanzetto Mariacristina , Mancuso Salvatore
Published: September 2024

In 1976 in the United States about 10-15% of couples failed to conceive after at least one year of marriage without the use of contraceptive methods. At the same time, the number of visits to private doctors for infertility problems increased from about 600,000 in 1968 to about 900,000 in 1980. This increased concern about infertility problems appears to be concentrated in that cohort of the American female population born after World War II, currently in their thirties or early forties.
Etiological diagnosis of prostatitis: current methods and ethical evaluation
Authors: Manna Raffaele , Migliore Alberto
Published: September 2024

The incidence of acute and chronic bacterial prostatitis in the juvenile and adult population is steadily increasing. This phenomenon is related to changing sexual habits. The clinical diagnosis of acute prostatitis is quite simple, both because of the characteristic symptomatology (fever with chills, sacral rachialgia, perineal pain) and the semeiological data of the rectal exploration. Prostate ultrasound may finally help to settle a doubt.
Molecular Identification of Mycobacterium leprae in the Leprosy Patients
Authors: Warka Utma Laela , Hatta Mochammad , Muslich Lisa Tenriesa , Syamsuri Fadhilah , Hamid Firdaus , Sultan Andi Rofian
Published: September 2024

Background:

Several discoveries about leprosy indicate that Mycobacterium leprae transmission mainly occurs by inhalation, and the nose is a major port of entry and exit. Molecular probes have shown certain potential for the detection and identification of M. leprae in patients. The aim of this study was to identify M. leprae in nasal swab specimens using polymerase chain reaction (PCR)-based assays followed by gene sequencing methods. This observational study examines 64 anterior nasal swab samples taken from pretreatment leprosy patients, on-treatment and completed leprosy treatment in Bulukumba, South Sulawesi, Indonesia.

Methods:

samples were analyzed by molecular detection methods according to the standard methods at the Clinical Microbiology Laboratory of Hasanuddin University. Descriptive statistics were utilized to summarize patient demographics and outcomes.

Results:

This study uses PCR to detect the M. leprae deoxyribonucleic acid (DNA) from nasal swab specimens. Data were collected from 64 patients with a percentage of male patients 51.54%. Based on the age category, the group 45–46 years was the most frequent (39.05%). PCR detection proline-rich antigen gene of a 531 bp DNA fragment from M. leprae, was positive in eight patients, and they were multibacillary. Furthermore, PCR was positive in 5 (31.25%) of 16 new leprosy patients, 2 (8.69%) of 23 on-treatment patients, and 1 (4%) of 25 treatment completed patients. Based on the results of the phylogenetic tree and analysis of 8 positive results detected by M. leprae from leprosy patients, almost all samples have a level of similarity, except for sample Ua7.

Conclusions:

M. leprae cannot grow in vitro, so molecular diagnostic tools were used to confirm the disease. This study predominantly of males with the age above 45 years of age being the most common. Eight M. leprae were positive from nasal swab leprosy patients. The sequencing findings provide insight into the genetic diversity of the genus M. leprae, so it is necessary to consider the detection of whole-genome sequence.
Two Cases of Testicular Tuberculosis and Review of the Recent Literature
Authors: Nakou Ifigeneia , Kotoulas Serafeim–Chrysovalantis , Sionidou Maria , Daios Stylianos , Manika Christina , Hadji-Mitrova Marija , Papadaki Eleni , Manika Katerina
Published: September 2024

In this review, two cases of testicular tuberculosis (TB) are presented, and another 58 cases published in PubMed between January 1, 2012, and July 31, 2023, are reviewed. Testicular TB remains a disease mainly of the developing world, with one notable exception – the infections caused as a result of Bacillus Calmette–Guérin infusion immunotherapy for bladder cancer. Its clinical course is subacute; however, it might get disseminated and become life–threatening; therefore, prompt diagnosis is very important. The diagnosis can be quite challenging, and testicular tissue is the sample with the highest diagnostic yield, either for microbiological or histopathological diagnosis. On the other hand, its treatment follows the standard guidelines for TB treatment; however, the avoidance of an unnecessary orchiectomy is important.
Affecting Factors Unfavorable Treatment Outcomes of Rifampicin-resistant/Multidrug-resistant Tuberculosis Patients Treated with Long-term Regimen
Authors: Babalik Aylin , Balikçi Ahmet , Turkar Ayla , Teke Nazli Huma , Demir Fatma Kübra , Yavuz Simge , Koç Emine Nur , Gündüz Senem , Ergeç Büşra , Alagöz Hasan Can , Sarioğlu Eren , Kiliçaslan Zeki
Published: September 2024

Background:

Drug-resistant tuberculosis (DR-TB) poses a significant threat to global TB control and remains a major public health issue. This study aims to evaluate treatment outcomes and identify risk factors for unfavorable outcomes in patients with multi-DR-TB (MDR-TB) treated at a major reference hospital in Istanbul.

Methods:

We conducted a retrospective analysis of 413 patients with rifampicin-resistant and MDR-TB who received treatment between January 1, 2013, and December 31, 2023, at the University of Health Sciences Süreyyapaşa Chest Diseases Training and Research Hospital. Patients were treated following the World Health Organization and national guidelines, with regimens tailored to individual drug resistance profiles and side effect management. Demographic data, comorbidities, microbiological follow-up, drug resistance patterns, treatment regimens, and radiological findings were analyzed.

Results:

Treatment success was achieved in 350 patients (84.74%). Thirty-two patients (7.74%) were lost to follow-up, and 32 patients (7.74%) died. Logistic regression analysis identified several factors associated with unfavorable treatment outcomes: comorbidities (odds ratio [OR]: 7.555, P = 0.001), quinolone resistance (OR: 3.695, P = 0.030), and bronchiectasis (OR: 4.126, P = 0.013). Additional significant factors included male gender (P = 0.007), foreign-born status (P = 0.013), age over 35 years (P = 0.002), previous treatment history (P = 0.058), and drug side effects (P = 0.012).

Conclusion:

The long-term regimen for MDR-TB was found to be highly successful, with an 84.74% treatment success rate. Effective treatment regimens, close patient follow-up, early recognition of side effects, and comprehensive management are crucial for achieving successful outcomes. Identifying and addressing risk factors such as comorbidities, drug resistance, and specific patient demographics can further improve treatment success rates. This study underscores the importance of tailored treatment strategies and robust patient management in combating MDR-TB.
Identification of Nontuberculous Mycobacterium Species by Polymerase Chain Reaction - Restriction Enzyme Analysis (PCR-REA) of rpoB gene in Clinical Isolates
Authors: Yadav Raj Narayan , Chowdary Yellanki Yashwanth , Bhalla Manpreet , Verma Ajoy Kumar
Published: September 2024

Background:

Nontuberculous mycobacteria (NTM) infections are an emerging global health concern with increasing incidence. Conventional identification methods for NTM species in clinical settings are prone to errors. This study evaluates a newer method, polymerase chain reaction-restriction enzyme analysis (PCR-REA) of the rpoB gene, for NTM species identification. The study identified NTM species in clinical samples using conventional biochemical techniques and compared the results with PCR-REA of the rpoB gene. This cross-sectional study was conducted at a tertiary health-care center in North India over 18 months, analyzing both pulmonary and extrapulmonary samples.

Methods:

Two hundred and forty-seven NTM isolates were identified using phenotypic and biochemical methods. The same isolates were subjected to rpoB gene amplification by PCR followed by REA using Msp I and Hae III enzymes.

Results:

Conventional methods identified 12 different NTM species (153 slow-growing and 94 rapid-growing), whereas PCR-REA identified 16 species (140 slow-growing, 107 rapid-growing). The Mycobacterium avium intracellulare complex was the most common species isolated. PCR-REA demonstrated higher resolution in species identification, particularly in differentiating within species complexes.

Conclusions:

PCR-REA of the rpoB gene proves to be a simple, rapid, and more discriminative tool for NTM species identification compared to conventional methods. This technique could significantly improve the diagnosis and management of emerging NTM infections in clinical settings.
Comparative Analysis of the Mass Spectra of Mycobacterium abscessus Complex Strains Isolated on Various Nutrient Media
Authors: Vyzhigina Ekaterina Vasilievna , Kovalyov Alexander Mikhailovich , Kokorev Daniil Andreevich , Borodulina Elena Alexandrovna , Ismatullin Danir Damirovich , Lyamin Artem Viktorovich
Published: September 2024

Background:

Mycobacterium abscessus complex (MABSc) causes chronic infection in patients with concomitant structural changes in the respiratory tract, which is especially important for patients with cystic fibrosis. To isolate an MABSc culture from clinical material, a variety of nutrient media are used. For species determination of microorganisms isolated on these media, additional identification methods are used, for example, polymerase chain reaction, sequencing, or mass spectrometry. The latter method is relatively easy to implement but requires improvement, due to the identification inaccuracy of nontuberculosis mycobacterias in general. Consequently, a set of nutrient media may be important for subsequent identification by mass spectrometry.

Methods:

The study was conducted on 64 strains of MABSc representatives: 56 strains were obtained from patients with cystic fibrosis and 8 strains from patients with pulmonary pathology unrelated to cystic fibrosis. The obtained MABSc strains were transplanted to the universal chromogenic medium and the selective medium for the Burkholderia cepacia complex (BCC) isolation. Species identification was carried out by mass spectrometry based on matrix-activated laser time-of-flight desorption/ionization (MALDI-ToF MS). Microbial identification is based on a comparison of the obtained mass spectra with reference spectra from the database. Microorganisms were identified based on the coincidence degree (Score value). Sample preparation for microbial identification by mass spectrometry was carried out by an extended direct application method. Fragments of the rpoB and hsp65 genes with lengths of 752 bp and 441 bp, respectively, were used as molecular markers for subspecific identification of MABSc strains.

Results:

A comparison of the peaks obtained after mass spectrometry of MABSc strains isolated on the studied nutrient media showed significant differences between these indicators selective medium for the BCC isolation with the supplement of iron polymaltose hydroxide (III) and universal chromogenic medium (P < 0.001) and selective medium for the BCC isolation with universal chromogenic medium (P < 0.001). Twenty-five strains of MABSc representatives were sequenced: results of subspecies determination in strains isolated on the universal chromogenic medium coincided with the results sequencing in 13 (86.6%) strains out of 15.

Conclusion:

MALDI-ToF mass spectrometry allows microbial identification in a short time and with minimal cost, but it does not yet allow the proper identification of the subspecies of certain microbial groups, such as MABSc. Cultivation methods need optimization and new approaches to the extraction process of the bacterial protein fraction.
Optimal Positive End-expiratory Pressure Levels in Tuberculosis-associated Acute Respiratory Distress Syndrome
Authors: Hashemian Seyed MohammadReza , Khoundabi Batoul , Bahrami Ashkan , Jamaati Hamidreza , Varahram Mohammad , Saljoughi Leila , Rahimi Payam , Eshraghi Reza
Published: September 2024

Background:

The objective is to assess lung compliance and identify the optimal positive end-expiratory pressure (PEEP) levels in patients with tuberculosis-associated Acute Respiratory Distress Syndrome (TB-ARDS) compared to non-TB-ARDS patients.

Methods:

This observational case–control study utilized electrical impedance tomography to evaluate lung mechanics in 20 TB-ARDS and 20 non-TB-ARDS patients. Participants underwent PEEP titration from 23 to 5 cm H2O in 2 cm H2O decrements. Lung compliance and the rates of hyperdistention and collapse were assessed at each PEEP level.

Results:

Delta impedance values showed higher amounts in a PEEP range of 11–17 cm H2O and in patients with TB-ARDS (P > 0.05). In addition, both hyperdistention and collapse rates were nonsignificantly higher in TB-ARDS patients (P > 0.05), and the compromised levels of hyperdistention and collapse rates were at 15–17 cm H2O, indicating the most favorable PEEP level.

Conclusions:

The observed patterns of hyperdistention and collapse rates across various PEEP levels provide valuable insights into the susceptibility of TB-ARDS patients to barotrauma. Notably, the identified optimal PEEP range between 15 and 17 cm H2O may guide ventilator management strategies in mitigating both hyperdistention and collapse; nonetheless, due to the high variability of lung compliances within groups, we strongly recommend individualized consideration for tailored respiratory support and evaluation.
Diagnostics Evaluation of Smart Sure™ Mycobacterium tuberculosis Screening Kit and Smart Sure™ Multidrug-resistant Tuberculosis Detection Kit on Nonsputum Specimens at a Tertiary Care Center of North India
Authors: Jorwal Pankaj , Singh Binit Kumar , Anand Ankita , Khan Faisal , Khandelwal Krisha , Sharma Payal , Nischal Neeraj , Soneja Manish , Sethi Prayas , Dhawan Shikha , Wig Naveet
Published: September 2024

Background:

Tuberculosis (TB) is caused due to the infection of Mycobacterium tuberculosis (MTB) and it can infect the various parts of the human body. The disease is highly prevalent and is the second most common cause of death worldwide after COVID-19. Apart from sputum specimen, it is exceedingly difficult to diagnose due to its paucibacillary nature. The current study was intended to evaluate the accuracy of Smart Sure™ MTB and multidrug-resistant-TB (MDR-TB) kits (Genetix Biotech Asia Pvt. Ltd., India) with Xpert ultra and Mycobacterium growth indicator tube (MGIT) culture on nonsputum specimens from TB suspects.

Methods:

A total of 205 nonsputum specimens were received between October 2023 and May 2024 at Intermediate Reference Laboratory, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. Xpert ultra and Smart Sure™ MTB and MDR-TB tests were done directly on samples. However, processed specimens were used for MGIT culture and drug-susceptibility testing (DST). Invalid and MGIT contaminated specimens were excluded from the final calculation.

Results:

Overall, sensitivity and specificity of Smart Sure™ MTB screening kit was 71.59% and 98.28%, respectively, with Xpert ultra and 68.35% and 90.83%, respectively, with MGIT culture. While comparing with both Xpert ultra and MGIT-DST to detect rifampicin (RIF) resistant, Smart Sure™ MDR-TB kits showed sensitivity of 75.0% and 100% of specificity. However, for isoniazid (INH) resistance, Smart Sure™ MDR-TB kits showed 100% of sensitivity and specificity with MGIT-DST.

Conclusion:

For the detection of MTB and its drug-resistance patterns (RIF and INH) in the specimens other than sputum, Smart Sure™ MTB and MDR-TB kits could play a vital role in TB endemic countries. While comparing the set-ups and skilled staffs, it required almost same as compared with previously approved WHO diagnostics used in resource-limited countries.
Factors Associated with Absence of Active Pulmonary Tuberculosis in HIV Patients with Latent Tuberculosis, Beyond Isoniazid Preventive Therapy
Authors: Yuniati Shinta Karina , Kusmiati Tutik
Published: September 2024

Background:

Tuberculosis (TB) is a leading cause of death in patients with human immunodeficiency virus (HIV)/AIDS. About 60% of HIV-positive individuals with latent TB infection (LTBI) develop active TB. Isoniazid preventive therapy (IPT) is recommended by the World Health Organization to prevent the progression of active TB in people living with HIV/AIDS (PLWHA). However, IPT implementation has been limited in some countries like Indonesia. The objective of this study was to assess the effect of IPT administration on the incidence of active TB in HIV patients with latent TB.

Methods:

This was a quasi-experimental prospective cohort study conducted in an academic hospital in Indonesia. Interferon-gamma release assay-positive HIV-TB patients were randomly divided into an IPT group (received 6 months of IPT) and a non-IPT group. The incidence of active pulmonary TB was compared between the two groups after 6 months of follow-up.

Results:

Of the 23 eligible patients, 22 were enrolled (10 in the IPT group, 12 in the non-IPT group). The incidence of active pulmonary TB was 0% in both groups. Factors associated with the absence of TB in both groups were the use of antiretroviral therapy for >4 years and a CD4+ T lymphocyte count >200 cells/μL. IPT was found to be safe with minimal adverse effects.

Conclusions:

In this setting, the use of long-term antiretroviral therapy and higher CD4+ counts, rather than just IPT, were the key factors associated with preventing active TB in latent HIV-TB patients. These findings suggest that comprehensive HIV management may be more important than IPT alone for TB control in PLWHA. Further research is needed to optimize TB prevention strategies in this high-risk population.
Diagnostic Utility of the “Lancet Consensus Scoring System” in Suspected Cases of Tuberculous Meningitis in Patients Attending a Tertiary Care Hospital in Central India
Authors: Patel Sakshi , Dadheech Malti , Sahu Pushpendra , Pathe Chandrashekhar , Singh Jitendra , Purwar Shashank , Rai Nirendra Kumar , Khadanga Sagar , Gupta Radha Sarawagi , Maurya Anand Kumar
Published: September 2024

Background:

Tuberculous meningitis (TBM) is a challenging condition to diagnose, and current laboratory methods have limitations, especially in developing countries. This study evaluated the diagnostic utility of the Lancet consensus scoring (LCS) system in suspected TBM cases at a tertiary care center in India.

Methods:

The clinical manifestations of 75 patients with suspected TBM were prospectively evaluated using the LCS system, which categorizes cases as “definite” (laboratory confirmed), “probable” (>10 points without imaging or > 12 points with imaging), and “possible” (6–9 points without imaging or 6–11 points with imaging). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the LCS system were compared to GeneXpert and mycobacterial growth indicator tube (MGIT) liquid culture, which are considered the gold standard tests.

Results:

Out of 75 recruited cases, 11 were confirmed as definite TBM cases. The LCS system correctly identified 8 of these as “probable” and 3 as “possible” cases. Compared to GeneXpert, the LCS system had a specificity of 100%, sensitivity of 54.55%, NPV of 92.7%, and PPV of 100%. Compared to MGIT liquid culture, the LCS system had a specificity of 100%, sensitivity of 81.82%, NPV of 96.97%, and PPV of 100%. The diagnostic accuracy was higher for MGIT liquid culture (97.33%) than GeneXpert (93.33%).

Conclusion:

The LCS system is a practical and easily applicable tool that can aid the diagnosis of suspected TBM cases, particularly in resource-limited settings. Despite some limitations, the LCS system demonstrated good diagnostic performance, suggesting its potential utility in improving TBM diagnosis and management.
Regional and National Trends in Tuberculosis Research in South Asian Association for Regional Cooperation Countries: Post-COVID-19 Pandemic Machine Learning Factorial Analysis
Authors: Ahmad Tauseef , Zyoud Sa’ed H. , Murad Manal Abdulaziz , Baig Mukhtiar
Published: September 2024

Background:

The number of tuberculosis (TB)-related morbidities and mortalities is still high in the South-east Asian region. This study was performed to characterize and visualize the post-coronavirus disease 2019 (COVID-19) TB research in South Asian Association for Regional Cooperation (SAARC).

Methods:

The Web of Science Core Collection database was utilized. A total of 4822 documents were included in the final analysis according to the predefined eligibility criteria. The data were exported to the R package and VOSviewer software for factorial analysis and network visualization, respectively.

Results:

The included documents were published in English between 2020 and 2024 in 1255 journals. These documents were authored by 17005 authors (3.53 authors/document). The authors collaboration index was noticed 3.61. In total, 74.16% documents were published as the article. The highest number of documents were published in 2022 (n = 1089). The documents published in 2020 received the highest number of mean total citations per article (n = 8.64). The most published journal was Cureus Journal of Medical Science (n = 228). The most prolific author was Gupta A (n = 115). The most active institution was the All India Institute of Medical Sciences (n = 587). The top most trending topics were Mycobacterium tuberculosis, TB elimination, molecular docking, extrapulmonary TB, Cartridge Based Nucleic Acid Amplification Test, and multidrug resistance. India was the most productive country and had the strongest research collaboration with the United States of America (USA), the United Kingdom (UK), and South Africa. Pakistan was mainly collaborating with the USA, the UK, Saudi Arabia, and China. The India and Pakistan collaboration was observed only in 66 documents.

Conclusion:

There is a poor output of scientific publication on TB in most SAARC countries. However, it is recognized that India has produced the highest number of scientific publications. The detection of undiagnosed post-COVID-19 pandemic TB cases is crucial to control further cases in the region. An effective regional cooperation should be established among institutions, universities, and countries to achieve the World Health Organization End TB goals.
Prevalence and Temporal Trends of Multidrug-resistant Tuberculosis in Iran from 1981 to 2023: A Systematic Review and Meta-analysis
Authors: Ayoubi Saman , Farnia Parissa , Farnia Poopak , Ghanavi Jalaledin , Velayati Ali Akbar
Published: September 2024

Background:

Multidrug-resistant tuberculosis (MDR-TB) is a serious threat to global tuberculosis (TB) control efforts. This study aims to investigate the trend of MDR-TB prevalence in Iran over 20 years.

Methods:

A systematic literature search was conducted in various databases, including PubMed, Embase, and Web of Science, from 1981 to 2023. Studies reporting the prevalence of MDR-TB in Iran were included in the meta-analysis. Statistical analysis was performed using Comprehensive Meta-Analysis software.

Results:

A total of 58 studies from different provinces of Iran were included in the meta-analysis. The majority of studies were from Tehran (n = 33), Kermanshah (n = 5), Mashhad (n = 4), and Tabriz (n = 4) provinces. Overall, 1885 cases of MDR-TB were reported in Iran during the study period. The highest number of MDR-TB cases was reported in 2000 (582 cases) and the lowest in 2001 (1 case). An increasing trend in MDR-TB prevalence was observed, particularly between 2018 and 2019. The pooled prevalence of MDR-TB in Iran was 12.31% (95% CI: 11.83–12.80) using the fixed-effects model and 20.21% (95% CI: 15.70–26.01) using the random-effects model. No evidence of publication bias was found.

Conclusion:

The results of this comprehensive meta-analysis highlight the increasing trend of MDR-TB in Iran over the past two decades. This underscores the urgent need for strengthening TB control strategies, including improved surveillance, case detection, treatment, and management of MDR-TB in the country. Developing diagnostic and treatment approaches for MDR-TB should be prioritized by Iranian medical universities and public health authorities.
Surgical Management of Tuberculosis-related Cerebral Disorders: A Retrospective Single-center Study
Authors: Seddighi Amir Saied , Seddighi Afsoun , Zali Alireza
Published: September 2024

Background:

Tuberculosis (TB) remains a significant global health concern, with extrapulmonary manifestations, including central nervous system involvement, posing substantial morbidity and mortality. While medical treatment with anti-TB drugs is the mainstay of therapy, certain TB-related cerebral complications, such as hydrocephalus, abscesses, and large symptomatic tuberculomas, may require surgical intervention. This study aimed to evaluate the outcomes of surgical management in patients with TB-related cerebral disorders.

Methods:

A retrospective analysis was conducted on 24 patients who underwent surgical intervention for TB-related cerebral disorders, including tuberculomas, hydrocephalus, and abscesses, at a tertiary care center between 2005 and December 2020. Demographic data, clinical presentations, radiological findings, surgical techniques, and treatment outcomes were analyzed.

Results:

The study cohort had a mean age of 35.8 ± 13.6 years, and the majority (62.5%) were male. Underlying immunodeficiency, primarily HIV infection, was present in 75% of the patients. The most common presenting symptoms were headache (83.3%), focal neurological deficits (75%), and altered mental status (54.2%). Radiological findings revealed 13 (54.2%) tuberculomas, 8 (33.3%) instances of hydrocephalus, and 3 (12.5%) abscesses. VP shunt inserted in 8 (33.3%) cases. Microscopic craniotomy performed in 7 (29.16%) cases. Aspiration through burr hole was done in 3 (12.5%) cases and stereotactic biopsy was performed in 6 (25%) cases. After 12 months of follow-up, favorable outcome achieved in 18 cases (75%) and the mortality occurred in 2 patients (8.3%). Surgical interventions included lesion resection (n = 10), stereotactic biopsy (n = 7), and ventriculoperitoneal (VP) shunt placement (n = 7). At 12-month follow-up, 18 (75%) patients had a favorable outcome, defined as clinical improvement or stabilization. Unfavorable outcomes were observed in 6 (25%) patients, including 2 deaths.

Conclusion:

Surgical management, in conjunction with appropriate anti-TB medical therapy, may be a valuable component of the comprehensive treatment approach for select patients with TB-related cerebral disorders. The favorable outcome rate observed in this study suggests that timely and tailored surgical intervention can contribute to improved patient outcomes. However, larger, prospective, multicenter studies are needed to further elucidate the role and long-term efficacy of surgical management in this patient population.
Pyrazinamide-induced Hyperuricemia in Pulmonary Tuberculosis Patients
Authors: Putra Oki Nugraha , Purnamasari Telly , Hamami Nindya Maskurisna
Published: September 2024

Background:

Pyrazinamide is one of the antitubercular drugs used for 2 months in the intensive phase. One of the adverse effects of pyrazinamide is hyperuricemia, with a symptom of arthralgia. This study aims to analyze the incidence of hyperuricemia and arthralgia and their causality in pulmonary tuberculosis (TB) patients undergoing treatment in the intensive phase.

Methods:

It was an analytic observational study with a prospective cohort design. Three ml of blood from each pulmonary TB patient was withdrawn to examine uric acid levels before and after 2 months of treatment with pyrazinamide. The Wilcoxon test was used to analyze changes in uric acid levels and the Chi-square test to analyze the association between uric acid levels and arthralgia. Naranjo algorithm is used to analyze the causality of hyperuricemia.

Results:

Twenty pulmonary TB patients met the inclusion criteria in this study. Eight out of 12 (60%) TB patients showed uric acid levels ≥7 mg/dl and 8 of them (66.6%) showed symptoms of arthralgia. The median uric acid level increased significantly before (5.14 mg/dl) and after 2 months of treatment (7.74 mg/dl), P-value = 0.001. Uric acid levels ≥7 mg/dl were significantly associated with arthralgia (P-value = 0.017; odds ratio 14.00; 95% confidence interval 1.25–156.61). Based on the Naranjo algorithm, those with hyperuricemia, eight and four patients had a total score of 7 and 8, respectively, which are classified as probable.

Conclusion:

Uric acid levels significantly increased during the intensive phase. Pulmonary TB patients with hyperuricemia are a risk factor for arthralgia.
Tuberculosis or Nontuberculosis? A Case of Mycobacterial Skin Infection
Authors: Vahabi Merve Mert , Bostancı Aylin , Taşbakan Selin Ece , Karaarslan Işıl , Çavuşoğlu Cengiz , Taşbakan Meltem
Published: September 2024

Bacteria other than Mycobacterium tuberculosis and Mycobacterium leprae are known as nontuberculous mycobacteria (NTM), and the frequency of clinically symptomatic forms is increasing day by day. Mycobacterium fortuitum, a rapidly reproducing NTM, causes various clinical signs such as skin soft-tissue infection, surgical site infection, and disseminated infection in immunosuppressed patients. Although progress can be made in terms of diagnosis when growth is detected in culture, it is quite difficult to distinguish between infection and contamination. There is no place for antituberculosis treatment in the treatment of M. fortuitum. Antibiotics such as quinolones, trimethoprim–sulfamethoxazole, linezolid, doxycycline, clarithromycin, azithromycin, imipenem, tigecycline, linezolid, and amikacin are recommended at least in dual combination therapy. In this case presentation, the diagnosis and treatment of a 2-year skin soft-tissue infection with M. fortuitum growth in culture will be discussed.
Methods for the Inactivation of Mycobacterium tuberculosis: a Systematic Review of the Literature
Authors: Vigo Aiko N. , Puyén Zully M. , Santos-Lázaro David , Perea Mary L. , Solari Lely
Published: September 2024

To systematize published laboratory methods to inactivate Mycobacterium tuberculosis (MTB) and to describe their effectiveness. We carried out a review of the scientific literature to identify the publications that reported methods for the inactivation of MTB, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search addressed inactivation methodologies used in Public health laboratories for the treatment of biological material and only included studies reporting the efficacy of the method. The database used were PubMed (National Library of Medicine) and LILACS (Latin American and Caribbean Literature in Health Sciences). We evaluated the quality of the studies with the JBI (Joanna Briggs Institute) Critical Instrument Appraisal Checklist. We included 14 publications meeting the established inclusion and exclusion criteria. These 14 studies actually described a total of 35 inactivation methods. Most of them combined heat treatment with some chemical or enzymatic agent, and there were very few applying a single strategy. Twenty-four (68.57%) methods demonstrated significant efficacy in inactivating MTB. The systematic review identified 35 methods of inactivation of MTB, published in 14 studies. Most of the methods combined physical treatment techniques, especially heat, with chemical and/or enzymatic treatment techniques, obtaining mostly good results in preventing the reproduction of the microorganism. PROSPERO (International Prospective Register of Ongoing Systematic Reviews) (Code CRD42024503621).
Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience
Authors: Liu Yu-Hong , Lin Tzu-Chiao , Chen Chao-Yang , Pu Ta-Wei
Published: September 2024

BACKGROUND

Stapled hemorrhoidopexy (SH) is currently a widely accepted method for treating the prolapse of internal hemorrhoids. Postoperative anal stenosis is a critical complication of SH. A remedy for this involves the removal of the circumferential staples of the anastomosis, followed by the creation of a hand-sewn anastomosis. Numerous studies have reported modified SH procedures to improve outcomes. We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.

AIM

To compare outcomes of staple removal at the 3- and 9-o’clock positions during modified SH in patients with mixed hemorrhoids.

METHODS

This was a single-center, retrospective, observational study. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included. The operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded.

RESULTS

Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015 and January 1, 2020, were included. Operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH. In the modified SH group, 54% of patients had previously undergone surgical intervention for hemorrhoids, compared with the 40.3% of patients in the standard SH group. The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis. There was a significant relationship between the rate of postoperative anal stenosis and the modified SH: 0.251 (0.085-0.741) and 0.211 (0.069-0.641) in multiple regression analysis. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.

CONCLUSION

The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.
Combined transarterial chemoembolization and tislelizumab for patients with unresectable hepatocellular carcinoma
Authors: Tan Bin-Bin , Fu Ying , Shao Ming-Hua , Chen Hai-Lei , Liu Ping , Fan Chao , Zhang Hui
Published: September 2024

BACKGROUND

Hepatocellular carcinoma (HCC) often presents as unresectable, necessitating effective treatment modalities. Combining transarterial chemoembolization (TACE) with immunotherapy and targeted therapy has shown promise, yet real-world evidence is needed.

AIM

To investigate effectiveness and safety of TACE with tislelizumab ± targeted therapy for unresectable HCC in real-world setting.

METHODS

This retrospective study included patients with unresectable HCC receiving combined treatment of TACE and tislelizumab. The clinical outcomes included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and disease control rate (DCR). All patients were evaluated according to the mRECIST criteria. The adverse event (AE) was also assessed.

RESULTS

In this study of 56 patients with median follow-up of 10.9 months, 7 had previous immunotherapy. Tislelizumab was administered before TACE in 21 (37.50%) and after in 35 (62.50%) patients, with 91.07% receiving concurrent targeted therapy. Median PFS was 14.0 (95%CI: 7.0-18.00) months, and OS was 28 (95%CI: 2.94-53.05) months. Patients with prior immunotherapy had shorter PFS (6 vs. 18 months, P = 0.006). Overall ORR and DCR were 82.14% and 87.50%. Grade ≥ 3 treatment-related AEs included increased alanine aminotransferase (8.93%), aspartate aminotransferase (10.71%), and total bilirubin (3.57%).

CONCLUSION

The combination of TACE and tislelizumab, with or without targeted therapy, demonstrated promising efficacy and safety in unresectable HCC, especially in immunotherapy-naive patients, warranting further prospective validation studies.
Perioperative chemotherapy improves survival of patients with locally advanced diffuse gastric cancer
Authors: Li Ze-Feng , Li Zheng , Zhang Xiao-Jie , Sun Chong-Yuan , Fei He , Du Chun-Xia , Guo Chun-Guang , Zhao Dong-Bing
Published: September 2024

BACKGROUND

Whether patients with diffuse gastric cancer, which is insensitive to chemotherapy, can benefit from neoadjuvant or adjuvant chemotherapy has long been controversial.

AIM

To investigate whether perioperative chemotherapy can improve survival of patients with locally advanced diffuse gastric cancer.

METHODS

A total of 2684 patients with locally advanced diffuse gastric cancer from 18 population-based cancer registries in the United States were analyzed.

RESULTS

Compared with surgery alone, perioperative chemotherapy improved the prognosis of patients with locally advanced gastric cancer. Before stabilized inverse probability of treatment weighting (IPTW), the median overall survival (OS) times were 40.0 months and 13.0 months (P < 0.001), respectively. After IPTW, the median OS times were 33.0 months and 17.0 months (P < 0.001), respectively. Neoadjuvant chemotherapy did not improve the prognosis of patients with locally advanced gastric cancer compared with adjuvant chemotherapy after IPTW. After IPTW, the median OS times were 38.0 months in the neoadjuvant chemotherapy group and 42.0 months in the adjuvant chemotherapy group (P = 0.472).

CONCLUSION

Patients with diffuse gastric cancer can benefit from perioperative chemotherapy. There was no significant difference in survival between patients who received neoadjuvant chemotherapy and those who received adjuvant chemotherapy.
Meningeal cryptococcosis in a pancreas transplant recipient requiring grafectomy: A case report
Authors: Lulic Ileana , Fingler Gorana , Lulic Dinka , Pavicic Saric Jadranka , Mikulic Danko , Filipec Kanizaj Tajana , Goluza Eleonora
Published: September 2024

BACKGROUND

Through continuous improvement in transplantation medicine, a wider range of solid organ transplant (SOT) recipients is considered suitable for complex procedures. Despite advances in modern transplantation practice, transpiring invasive fungal infections pose a substantial threat for SOT recipients. To our knowledge, cryptococcal infection confined amidst sole pancreas SOT recipients has not been described to date. Enforcement of a multidisciplinary transplant team approach in the management of pancreas SOT recipients presenting with complex cryptococcal complications is fundamental in improving patient outcomes.

CASE SUMMARY

We present the case of a female pancreas transplant recipient, with confirmed meningeal cryptococcosis, referred to our institution for further evaluation and treatment from the Regional Center for Infectious Diseases. On admission, the patient was weaned from the protocolized immunosuppression therapy for two consecutive weeks, in addition to tapering systemic corticosteroid remedial treatment. Our novel multidisciplinary transplant team approach embodied exhaustive discussions of possible complex and diverse multiple organ system physiologic and pathologic challenges associated with distinct management strategies in pancreas transplant recipients. Owing to the potentially devastating impact of invasive cryptococcosis in terms of morbidity and mortality, a definitive surgical intervention of pancreas transplant grafectomy was reinforced, as a pathway towards secure access to early meaningful expertise care. The patient was discharged to the Regional Center for Infectious Diseases 2 mo after the admittance further advancing to a clinical improvement.

CONCLUSION

The precision transplantation approach by tailoring complex medical interventions to individual needs proved indispensable in improving our patient’s outcomes.
BIODIVERSITY (UN)KNOWLEDGE: A SYSTEMATIZATION OF GAPS, LIMITATIONS, DEFICITS, BIASES, AND NOISE
Authors: Castro-Souza Rodrigo Antônio , Tessarolo Geiziane , Bosco Nicolas Silva , Santos Andréia de Carvalho , Kempner Afonso , Marques Thairik Mateus Silva , da Costa-Silva Vinícius , Diniz-Filho José Alexandre F. , Sobral-Souza Thadeu
Published: September 2024

With the advancements in bioinformatics and ecoinformatics tools, it has become feasible to utilize vast amounts of biodiversity information to describe biological patterns and attempt to assess the ecological and evolutionary processes underlying them, as well as to establish more effective and comprehensive conservation actions. However, existing information regarding biodiversity remains incomplete, with gaps, limitations, biases, deficits, and noise. In this regard, we acknowledge the need to discuss issues related to the use of large biodiversity databases and their quality, discussions that need to be conceptually structured. In this text, we will systematically describe the gaps, limitations, and biases in biodiversity knowledge, issues that are directly associated with the acquisition of species information in nature. Subsequently, we will outline the types of deficits and noise, which are problems associated with biodiversity databases. This is because the information present in primary records and large databases is frequently used inadequately. Additionally, we also point out perspectives on how to address these deficiencies in ecological/biogeographical work through appropriate database curation and the construction of maps of ignorance. Finally, we highlight future challenges, such as the need for new data collections, the training of new taxonomists, and the provision of financial support for the infrastructure and digitization of biological collections.
EDGE EFFECTS ON THE ABUNDANCE OF THE CRAB Ucides cordatus (DECAPODA: OCYPODIDAE) IN A NEOTROPICAL MANGROVE
Authors: dos Anjos Jean Nascimento , Dodonov Pavel
Published: September 2024

Mangroves are among the most productive and biologically important ecosystems in the world and are currently undergoing extensive habitat loss and fragmentation. Such habitat loss and fragmentation result in the creation of edges, which can cause edge effects on the remaining habitat, resulting in changes in abiotic conditions, alterations in ecosystem functioning, and loss of biodiversity. The crab Ucides cordatus (Linnaeus, 1763), locally known as “caranguejo-uçá,” is a species of great economic and ecological importance in these environments. This species is also considered an important indicator of environmental quality, being sensitive to various pollutants. Therefore, we evaluated how anthropogenic edges affect the U. cordatus population in a mangrove area and compared these patterns to those observed at natural edges. We found a positive effect of edge creation on crab abundance for the total number of burrows and the number of open burrows, but no effect on the number of closed burrows. Conversely, we detected a negative effect of natural edges on the quantity of closed burrows. Our findings suggest that anthropogenic edges may alter crab abundances, becoming the preferred habitat for young crabs. However, we emphasize that the interior of the mangrove is also crucial for species maintenance, especially for adult crabs and juveniles during molting.