Parvovirus B19 viremia in children with systemic lupus erythematosus

Background: Parvovirus B19 infection may present with fever, rash, nonerosive arthritis, hepatitis, anemia, thrombocytopenia, leucopenia and positive ANA, B19 infection may be misdiagnosed as new onset systemic lupus erythematosus. At the same time, B19 infection and systemic lupus erythematosus may occur simultaneously in some patients. A casual relationship between B19 infection and classic idiopathic systemic lupus erythematosus has not been demonstrated yet. Objectives: This study was undertaken to investigate the seroprevalence of parvovirus B19 in SLE patients and to search for the different correlates of this viremia with positive results. Methods: This case-control study was conducted on 30 patients with SLE and 30 normal controls. All the children were subjected to detailed medical history, Clinical examination, laboratory estimation as sera from them were examined for parvovirus B19 infection by serological assays using nested polymerase chain reaction and IgG and IgM antiB19 antibodies by ELISA. Results: Parvovirus B19 DNA was detected in 11 of the 30 patients with SLE (33.3 percent) while it was not detected in any of our normal controls. Of the 11 patients with B19 DNA, only two had IgG anti-B19 antibody and one had IgM anti-B19 antibodies, whereas IgG and IgM anti-B19 antibodies were detected in 11(57.8%)and 9 (47.3%)of 19 SLE patients without B19 DNA respectively. B19 DNA was found more commonly in sera from SLE patients without anti-B19 antibodies than in those with anti-B19 antibodies (P < 0.05). Conclusions: parvovirus B19 might induce either idiopathic SLE in a person who is genetically susceptible or it might induce a SLE-like picture. Parvovirus B19 infection in patients with SLE may be due to lack of anti-B19 antibodies because of either the immunocompromised nature of the host or the use of immunosuppressive drugs. There was a higher prevalence of hypocomplementemia in patients with parvovirus B19 viremia than in those without parvovirus. Keywords: Human parvovirus B19, Systemic lupus erythematosus, Nested PCREgypt J Pediatr Allergy Immunol 2011;9(2):71-7

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Shock waves in magnetized electronegative plasma with nonextensive electrons

The nonlinear properties of ion acoustic shock waves in a magnetized electronegative plasma with nonextensive electrons and stationary dust grains are studied. The reductive perturbation technique is applied to derive the Zakharov–Kuznetsov Burgers (ZKB) equation. The Tanh method is used to obtain the shock wave solution. The present model is applied to four different electronegative plasma media which are found in space plasma, e.g. (H+, H−) plasma and (H+, ${\mathrm{O}}_2^{-}$) plasma, and laboratory experiments, e.g. (Xe+, ${\mathrm{SF}}_6^{-}$) plasma and (Ar+, ${\mathrm{O}}_2^{-}$) plasma. It is found that the concentration of negative ions and the electron nonextensive parameter have important effects on the features of the propagated ion acoustic shock waves

DNA fingerprinting and drug resistance patterns of active pulmonary Mycobacterium tuberculosis in Mansoura hospitals, Egypt

Increased application of DNA fingerprinting has advanced the understanding of the dynamics of TB epidemiology. Typing of MTB is important for case tracing, and identifying community outbreaks. Objective: We aim to detect pattern of drug resistance and molecular genotypes of MTB at Mansoura hospitals using PCR-RFLP. Methodology: 123 sputum samples obtained from ZN smear positive cases were cultivated on Lowenstein Jensen (LJ) medium, out of them 67 specimens (54.5%) were positive culture. Genotypic analysis was done by the RFLP method after DNA extraction and PCR amplification. The susceptibilities to isoniazid (INH), rifampicin (RIF), streptomycin (STR) and ethambutol (EMB) were determined by the indirect nitrate reductase assay. Results: The identified restriction patterns yielded 3 bands with different sizes and revealed 3 genotypes only. Restriction patterns are equal to 245/125/100 bp, and 245/125/80 bp fragments for Bst EII digests and 155/140/60 bp (MTC), 155/110/70 bp (intracellulare) and 160/140/70 bp (malmoense) fragments for Hae III digest. Genotyping of MTB detected that MTC was the commonest genotype among studied cases 49/67 (73.1%), followed by Mycobacterium intracellulare 14/67 (20.9%), while Mycobacterium malmoense had the least incidence 4/67. There was significant increased risk of resistance to STM, RIF, ETH and INH with M. intracellulare (p = 0.021, p < 0.001, p = 0.001, p < 0.001) while MTC showed lower resistance to STM, RIF, ETH and INH and all M. malmoense isolates showed no resistance. Conclusion: PCR-RFLP was found to be a simple and reproducible method for genotyping of MTB strains and for early detection of Mycobacterium tuberculosis infection

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)