Moraxella nonliquefaciens septic arthritis in a hematopoietic stem cell transplant patient a case report and review of the literature

Background: Septic arthritis is a common rheumatologic condition with myriad microbiological causative agents. Moraxella is one of the very rare causes of septic arthritis. We hereby present the third case of Moraxella nonliquefaciens septic arthritis and the first case in a hematopoietic stem cell transplant patient (HSCT) along with a brief review of the literature. Methods: We used PubMed with google search engine to search the literature for reported cases of moraxella septic arthritis. Results: Information on 19 other cases of moraxella infectious arthritis was found. M. catarrhalis was the most common species isolated. Only 2 reports on M. nonliquefaciens were found; the first one in a multiple myeloma patient and the second one in a diabetic patient on hemodialysis. Predisposing conditions included inflammatory arthritis, prosthetic joints, diabetes, Human Immunodeficiency Virus (HIV) infection, Hepatitis C, hemodialysis, esophageal cancer, valve replacements, alcoholism and Intravenous (IV) drug use. The age group of the reported cases ranged from 3 months to 78 years. Conclusion: Infectious arthritis with Moraxella spp. is a very rare entity which can occur in any age group and in the setting of various underlying medical conditions. Keywords: Moraxella nonliquefaciens, Septic arthritis, Hematopoietic stem cell transplan

Spontaneous nosocomial Proteus mirabilis meningitis in a Human Immunodeficiency Virus (HIV)-infected adult patient : a case report

Background: Gram-negative bacillary meningitis remains a rare occurrence, even in patients with human immunodeficiency virus. Current literature only describes anecdotal cases of spontaneous nosocomial Proteus mirabilis meningitis. This report describes the clinical manifestations and management of a patient with healthcare-associated spontaneous Gram-negative bacillary meningitis in a patient with advanced human immunodeficiency virus disease. Case presentation: A 23-year-old Congolese female was hospitalized in a human immunodeficiency virus specialized center for ongoing weight loss, chronic abdominal pain, and vomiting 9 months after initiation of treatment for tuberculosis meningitis. Hospitalization was complicated by healthcare-associated Gram-negative bacillary meningitis on day 18. Blood and cerebrospinal fluid cultures confirmed Proteus mirabilis. Antibiotic susceptibility testing showed extended spectrum beta-lactamase resistant to common antibiotics, and sensitive to meropenem. Despite initiation of high-dose meropenem by intravenous infusion (2 g every 8 hours), the patient did not improve, and died after 4 days of meropenem treatment. Gram-negative bacillary meningitis remains rare and is associated with an unfavorable prognosis. Conclusions: This case report highlights the importance of microbiological identification of pathogens in resource-limited settings. As Gram-negative bacillary meningitis does not present with pleocytosis in patients with advanced human immunodeficiency virus, a negative lumbar puncture cannot exclude this diagnosis. Access to clinical bacteriology in resource-limited settings is essential to enable correct antibiotic treatment and avoid overuse of antibiotics to which there is already resistance. It further plays an essential role in public health by identifying antibiotic susceptibilities. Infection prevention and control measures must be reinforced in order to protect patients from such avoidable healthcare-associated infections.</p

Questionnaire d’une évaluation nationale de la qualité des centres de physiothérapie: étude pilote au liban

Background: Lebanon still lacks a unified platform upon which private physiotherapy practitioners can base and apply their knowledge and practice. Accreditation of physiotherapy centres would promote collaboration, boost consistency and enhance quality of services. The Order of Physiotherapists in Lebanon is called on to provide a high quality of service by focusing on standards. Aims: The aim of this study was to assess the feasibility and applicability of a standard for the quality assessment of physiotherapy centres, and to assess the current status of a sample of centres in Lebanon. Methods: A questionnaire was developed by a panel of experts based on a review of international and national requirements in physiotherapy centres. A set of 14 items was generated covering 3 categories: qualifications of the team, facility and environmental status, and data collection and analysis. A pilot study was conducted from December 2013 to February 2014 in 6 Lebanese physiotherapy centres. Descriptive statistics are reported. Results: The highest median score and compliance score for the 6 centres were reported for the “Facility and environmental status” category (median = 8.0) and the lowest were reported in the “Data collection and analysis” category (median = 5.0). Conclusions: Further studies are needed to validate the quality assessment in physiotherapy centres questionnaire, and to implement it as a primary tool for assessing quality standards and for accreditation of physiotherapy centres.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

A novel emulsion fuel containing aqueous nano cerium oxide additive in diesel–biodiesel blends to improve diesel engines performance and reduce exhaust emissions: part I – experimental analysis

Improving fuel combustion in engines and consequently reducing environmentally-unfavorable emissions is of prominent importance in addressing some of the main challenges of the current century, i.e., global warming and climate change. Fuel additives are considered as efficient way for improving fuel properties and to diminish engine emissions. In line with this, the present research was focused on the simultaneous application of water (3, 5, and 7 wt%) and cerium oxide nano particles (90 ppm) as metal-based additive into biodiesel/diesel fuel blend (B5) and their impacts on the performance and emission characteristics of a single cylinder four stroke diesel engine were investigated. The findings revealed that the aqueous nano-emulsion of cerium oxide improved the overall combustion quality. More specifically, the brake specific fuel consumption (bsfc) of B5 containing 3% water and 90 ppm cerium oxide (B5W3m) was measured 5% and 16% lower than those of neat B5 and neat B5 containing 3% water (B5W3), respectively. Moreover, the B5W3m fuel blend increased brake thermal efficiency (bte) by over 23 and 11% compared with B5W3 and B5, respectively. B5W3m also considerably reduced CO, HC, and NOx emissions by 51, 45, and 27% compared with B5W3. To the best of our knowledge, this is the first report exploring the impacts of low-level water containing cerium oxide in B5 on engine performance and emission characteristics

Prevalence of Insomnia among Pancreatic Cancer Patients following Pancreaticoduodenectomy

Introduction. Sleep disturbances are more common in cancer patients than in the general population; however, there is limited research pertaining to the occurrence of such disturbances that subsequently impact patients’ quality of life. The aim of our study is to describe the prevalence of insomnia among pancreatic cancer patients who have recently undergone recent pancreaticoduodenectomy. Methods. We performed a 6-year (2014-2020) retrospective cohort analysis of all adult patients aged 18 and above with pancreatic cancer who underwent pancreaticoduodenectomy at our institution. Insomnia was characterized using the Pittsburgh Sleep Quality Index (PSQI). Symptoms of insomnia and the impact caused by these symptoms on daily lives were assessed with the Insomnia Severity Index (ISI), and patients were divided into mild insomnia (ISI 8–14) or moderate to severe insomnia (ISI≥15). Results. Out of forty patients with pancreatic cancer that have undergone pancreaticoduodenectomy, 19 (47.2%) reported that their sleep disturbances had a significant effect on their quality of life. A total of 22 (55.0%) patients reported insomnia, with 63.2% reporting mild insomnia. Chemotherapy was found to significantly increase the risk of moderate to severe insomnia. The mean ISI score was 7.2±6.9, and the mean PSQI score was 7.0±5.1. ISI and PSQI showed a strong positive correlation (r=0.78, p<0.01). Conclusion. Sleep disturbances such as insomnia following pancreatic cancer surgery are highly prevalent. Treating physicians and surgeons should recognize and routinely screen for sleep disorders through the management of a multidisciplinary team in order to alleviate some of the burden on the patients’ mental well-being

Malignant fibrous histiocytoma presenting with complete opacification of the hemithorax: A case report

BACKGROUND: Malignant fibrous histiocytoma, a subtype of primary lung sarcoma is a very rare disease. It usually presents as a lung nodules and the final diagnosis is made by immunohistochemical studies. METHODS: A 45-year-old patient presented with progressive dyspnea, dry cough and right shoulder pain. Chest X-ray revealed complete opacification of the right hemithorax. Chest computed tomography confirmed the presence of a heterogeneous lesion occupying the whole right hemithorax causing a mass effect on the trachea. Ultrasound guided biopsy was done and final pathology was suggestive of malignant fibrous histiocytoma. CONCLUSION: Progressive dyspnea in young otherwise healthy patients should be investigated early on. In our case the presence of right shoulder pain indicates advance disease illustrated by the singular imaging findings

Antimicrobial stewardship in primary health care programs in humanitarian settings: the time to act is now

Abstract Fragile and conflict-affected settings bear a disproportionate burden of antimicrobial resistance, due to the compounding effects of weak health policies, disrupted medical supply chains, and lack of knowledge and awareness about antibiotic stewardship both among health care providers and health service users. Until now, humanitarian organizations intervening in these contexts have confronted the threat of complex multidrug resistant infections mainly in their surgical projects at the secondary and tertiary levels of care, but there has been limited focus on ensuring the implementation of adequate antimicrobial stewardship in primary health care, which is known to be setting where the highest proportion of antibiotics are prescribed. In this paper, we present the experience of two humanitarian organizations, Médecins sans Frontières and the International Committee of the Red Cross, in responding to antimicrobial resistance in their medical interventions, and we draw from their experience to formulate practical recommendations to include antimicrobial stewardship among the standards of primary health care service delivery in conflict settings. We believe that expanding the focus of humanitarian interventions in unstable and fragile contexts to include antimicrobial stewardship in primary care will strengthen the global response to antimicrobial resistance and will decrease its burden where it is posing the highest toll in terms of mortality

Giant primary malignant mesothelioma of the liver: A case report

Introduction: Malignant mesothelioma is a rare neoplasm of mesothelial cells arising most frequently in the pleura or peritoneum and less frequently in the liver. Case presentation: We present a case of primary hepatic mesothelioma of 41 year old woman. She had no history of asbestos exposure or cancer. Abdominal computed tomography (CT) showed 21 cm intrahepatic mass in the right lobe with many cystic lesions and few small calcifications. Pathology showed a biphasic cellular pattern. In addition, the tumor cells were positive for Calretinin, Creatine Kinase (CK)5/6, CK7, CKAEI 1/3, Wilms Tumor protein (WT-1), and Vimentin, but were negative for Alpha Feto protein (AFP), Thrombotic Thrombocytopenic Purpura (TTP-1), Anti-Hepatocyte Specific Antigen (HSA), Synaptophysin, CK20, and Homeobox protein (CDx-2). Discussion: Primary intrahepatic mesothelioma (PIHMM) is not included in the classification of the World Health Organization classification of hepatic tumors. Mesothelial cells are not normally found in the liver, but some reported cases suggest it may grow from the mesothelial cells of the Glisson’s capsule. Conclusion: The probability of hepatic mesothelioma should not be ruled out, even in a young woman without a clear history of asbestos exposure

Objective olfactory evaluation of self-reported loss of smell in a case series of 86 COVID-19 patients

International audienceObjective: To investigate olfactory dysfunction (OD) in patients with mild coronavirus disease 2019 (COVID-19) through patient-reported outcome questionnaires and objective psychophysical testing. Methods: COVID-19 patients with self-reported sudden-onset OD were recruited. Epidemiological and clinical data were collected. Nasal complaints were evaluated with the sinonasal outcome-22. Subjective olfactory and gustatory status was evaluated with the National Health and Nutrition Examination Survey. Objective OD was evaluated using psychophysical tests. Results: Eighty-six patients completed the study. The most common symptoms were fatigue (72.9%), headache (60.0%), nasal obstruction (58.6%), and postnasal drip (48.6%). Total loss of smell was self-reported by 61.4% of patients. Objective olfactory testings identified 41 anosmic (47.7%), 12 hyposmic (14.0%), and 33 normosmic (38.3%) patients. There was no correlation between the objective test results and subjective reports of nasal obstruction or postnasal drip. Conclusion: A significant proportion of COVID-19 patients reporting OD do not have OD on objective testing