Japanese Encephalitis—A Pathological and Clinical Perspective

Japanese encephalitis (JE) is the leading form of viral encephalitis in Asia. It is caused by the JE virus (JEV), which belongs to the family Flaviviridae. JEV is endemic to many parts of Asia, where periodic outbreaks take hundreds of lives. Despite the catastrophes it causes, JE has remained a tropical disease uncommon in the West. With rapid globalization and climatic shift, JEV has started to emerge in areas where the threat was previously unknown. Scientific evidence predicts that JEV will soon become a global pathogen and cause of worldwide pandemics. Although some research documents JEV pathogenesis and drug discovery, worldwide awareness of the need for extensive research to deal with JE is still lacking. This review focuses on the exigency of developing a worldwide effort to acknowledge the prime importance of performing an extensive study of this thus far neglected tropical viral disease. This review also outlines the pathogenesis, the scientific efforts channeled into develop a therapy, and the outlook for a possible future breakthrough addressing this killer disease

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Bacteria Colonizing the Ocular Surface in Eyes With Boston Type 1 Keratoprosthesis: Analysis of Biofilm-Forming Capability and Vancomycin Tolerance.

PURPOSE: To analyze the bacterial microbiota colonizing the ocular surface of patients with Boston type 1 keratoprostheses (K-Pros) for antibacterial resistance patterns and capacity to form biofilms. METHODS: Twenty-seven eyes with a Boston type 1 K-Pro and 16 fellow control eyes from 26 patients were enrolled. The surface of the K-Pro optic and/or the inferior conjunctival fornix was swabbed and plated separately on culture media. Positive cultures were processed to assess for biofilm-forming capability. Microtiter plate adherence assay and polymerase chain reaction for ica and atlE genes were used. An in vitro assay of vancomycin tolerance was performed on isolated strains and compared to standard controls with and without biofilm-forming capability. RESULTS: Eighty-five percent of K-Pro eyes and 69% of control eyes had positive cultures (P = 0.20). All Gram-positive strains exhibited susceptibility to vancomycin by standard testing. Biofilm-forming bacterial isolates were detected in 57.7% of K-Pro eyes and 53.3% of control eyes. A vancomycin tolerance assay showed that the antibiotic susceptibility of coagulase-negative staphylococcus (CNS) within biofilms was significant in only three of five biofilm-forming strains (P < 0.05). In all strains, bacterial cells in planktonic form were more susceptible to vancomycin than in biofilm form (P < 0.001). CONCLUSIONS: Coagulase-negative staphylococcus can be isolated from K-Pro surfaces despite the use of vancomycin prophylaxis. In this study, the majority of isolated strains had biofilm-forming capability. In vitro vancomycin tolerance assays suggest that biofilm formation decreases susceptibility to vancomycin. This may contribute to higher rates of infectious complications observed in these patients