Leiomyosarcoma in a smallpox vaccination scar: case report and review of literature

The development of sarcomas in smallpox vaccination cars is very rare. Including this case, only five have been reported. This is the first report of a leiomyosarcoma arising in a smallpox vaccination sca

Spinal epidural abscess in clinical practice

Spinal epidural abscess (SEA) is a rare but severe infection requiring prompt recognition. The major prognostic factor for a favourable outcome is early diagnosis, leading to appropriate treatment. In clinical practice, a diagnosis of SEA is often not considered, particularly in the early stages of the disease when neurological symptoms are not apparent. Knowledge of persons at risk, clinical features and the required diagnostic procedures may decrease the number of initially misdiagnosed cases. Clinical signs, duration of symptoms and the rate of neurological deterioration show a high inter-individual variability, and the classic triad (spinal pain, fever and neurological deficit) is often not found, especially not at first presentation to a physician. However, most patients complain of severe localized back pain. Inflammatory parameters in the blood are generally elevated, but not specific. Gadolinium-enhanced magnetic resonance imaging is the most sensitive, specific and accurate imaging method. Although neurosurgical decompression is still the treatment of choice in the majority of cases, less invasive procedures (e.g. computed tomography-guided needle aspiration) or antimicrobial treatment alone can be applied in selected cases. The choice of the most appropriate therapy should be discussed immediately after a confirmed diagnosis in consultation with infectious disease, radiology and spinal surgery specialists. The outcome of SEA is largely influenced by the severity and duration of neurological deficits prior to surgery, stressing the importance of early recognitio

Invasive Group B Streptococcal Disease in Non-pregnant Adults: A Review with Emphasis on Skin and Soft-tissue Infections

Streptococcus agalactiae, commonly referred as group B Streptococcus (GBS), is a major cause of neonatal sepsis and infections in pregnant women. However, the number of invasive infections in non-pregnant adults is growing. Elderly patients and those with chronic underlying conditions, such as diabetes mellitus or compromised immune defence, are at increased risk of invasion. The spectrum of clinical manifestations is broad and includes necrotizing fasciitis and toxic shock syndrome. Although, primary bacteremia and skin and soft-tissue infections are the most frequently reported diagnosis. This article reviews the epidemiology, pathogenesis and treatment of invasive GBS disease in non-pregnant adults, with an emphasis on skin and soft-tissue infection

Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group 'Infection' of swissorthopaedics.

In this position paper, we review definitions related to this subject and the corresponding literature. Our recommendations include the following statements. Asymptomatic bacteriuria, asymptomatic leukocyturia, urine discolouration, odd smell or positive nitrite sediments are not an indication for antimicrobial treatment. Antimicrobial treatment of asymptomatic bacteriuria does not prevent periprosthetic joint infection, but is associated with adverse events, costs and antibiotic resistance development. Urine analyses or urine cultures in asymptomatic patients undergoing orthopaedic implants should be avoided. Indwelling urinary catheters are the most frequent reason for healthcare-associated urinary tract infections and should be avoided or removed as soon as possible

Geospatial analysis of regional climate impacts to accelerate cost-efficient direct air capture deployment

Carbon dioxide (CO2) removal from the atmospheric will be essential if we are to achieve net-zero emissions targets. Direct air capture (DAC) is a CO2 removal method with the potential for large-scale deployment. However, DAC operational costs, and thus deployment potential, is dependent on performance, which can vary under different climate conditions. Here, to further develop our understanding of the impact of regional climate variation on DAC performance, we use high-resolution hourly based global weather profiles between 2016 and 2020 and weighted average capital costs to obtain DAC regional performance and levelized cost of DAC (LCOD). We found that relatively cold and drier regions have favorable DAC performance. Moreover, approximately 25% of the world’s land is potentially unsuitable due to very cold ambient temperatures for a substantial part of the year. For the remaining regions, the estimated LCOD is $320–$540 per tCO2 at an electricity cost of $50 MWh−1. Our results improve the understanding of regional DAC performance, which can provide valuable insights for sustainable DAC deployment and effective climate action

Analisis Pengaruh Perubahan Tutupan Lahan Terhadap Distribusi Suhu Permukaan Dan Keterkaitannya Dengan Fenomena Urban Heat Island

Cirebon city is one of area in West Java with a large population growth. The increasing population is one of the causes of land cover changes. It causes the increasing of residentials, the expansion of trade center and industries and also various types of infrastructures that support the citizens activities. Land cover changes, especially the changing of vegetation area into built-up area, affected the distribution of land surface temperature and causes the Urban Heat Island. Remote sensing method can be used to calculate land cover changes, vegetation index and land surface temperature distribution of Cirebon city and the surrounding area in 1999, 2007 and 2014 and to analyze the correlation with Urban Heat Island. In this study, analysis was performed using Landsat 5 satellite image in 1999 and in 2007 and Landsat 8 in 2014. The value of land surface temperature obtained from the processing of thermal band of Landsat satellite image which then correlated with land cover changes using simple regression test.The results show that in 1999, land surface temperature class that dominate is 29°C-30°C, but this class decrease in 2007 and 2014 because the increses of built-up area and causing 33°C-34°C class dominate. A simple regression test between built-up area with land surface temperature obtained the value of the coefficient regression (R2) of 99%. A simple regression test between rice field area with land surface temperature obtained the value of the coefficient regression (R2) of 99%. The high temperature that occur in the urban area which then decreases towards suburban to rural, prove that Urban Heat Island occur in Cirebon City

Antibiotic Prophylaxis During Dental Procedures in Patients with Prosthetic Joints.

In patients with artificial joints, the need for antimicrobial prophylaxis during dental procedures is often raised. The present document describes the pathogenic mechanisms and epidemiological data on the subject of periprosthetic joint infections (PJI) after dental procedures. The document reflects the opinion and recommendations of the expert group 'Infection' of Swiss Orthopaedics. Microorganisms belonging to oral flora can seed haematogenously to an artificial joint. The proof of a causative relation with dental procedures is not possible, because the responsible bacteraemia can originate from the oral cavity at any time, irrespective of when the dental procedure occurs. Good oral hygiene is associated with a lower risk for PJI. Transient bacteraemia occurs during daily oral hygiene activity (e.g., tooth brushing) and thus the cumulative risk for a haematogenous PJI from tooth brushing is higher than that from a dental procedure. PJI after a dental procedure are rarely reported. On the basis of an epidemiological model, several thousand patients with artificial joints must receive antimicrobial prophylaxis to prevent a single PJI. Considering this ratio, the number of adverse events due to the antimicrobial compound exceeds the benefit of administering it by a large magnitude. Therefore, as a rule for the vast majority of cases, antimicrobial prophylaxis during dental procedures is not recommended. It is important that a patient has a good oral health status before joint implantation and that good oral hygiene is continuously maintained in patients with artificial joints