Bacterial coinfections in dengue virus disease: what we know and what is still obscure about an emerging concern

Dengue virus is the most frequent arthropod-borne viral infection worldwide. Simultaneously to the growth of its incidence, cases of bacterial coinfection in dengue have been increasingly reported. The clinical course of dual infections may worsen for reciprocal interactions and delays in the diagnosis, so that clinicians should be aware of this eventuality. Therefore, we reviewed literature to provide an overview of the epidemiological, clinical, and physiopathological issues related to bacterial coinfections and bacteremia in dengue.Clinical studies and case reports regarding bacteremia and bacterial coinfections in dengue and the interactions between the pathogens published on PubMed were reviewed.We found 26 case reports, only 3 studies on concurrent bacteremia and 12 studies reporting data on bacterial coinfections in dengue. According to the three available studies, the 0.18-7 % of dengue infections are accompanied by concurrent bacteremia, while the 14.3-44.4 % of dengue-related deaths seem associated to bacterial coinfections. Comorbidities, advanced age, and more severe dengue manifestations could be risk factors for dual infections. A longer duration of fever and alterations in laboratory parameters such as procalcitonin, hyponatremia, leukocyte count, and renal function tests can raise the suspicion.Despite the real burden and consequences of this emerging concern is still not computable accurately due to the lack of a significant number of studies on large cohorts, clinicians need a greater awareness about it to early recognize warning signs, to properly use available diagnostic tools and to readily start antibiotic treatment able to prevent worsening in mortality and morbidity

Multiple Regression Model to Predict Length of Hospital Stay for Patients Undergoing Femur Fracture Surgery at “San Giovanni di Dio e Ruggi d’Aragona” University Hospital

The economic cuts suffered by public health have in many cases led to the reduction of beds. In order to optimize the available resources, the length of stay (LOS) can be used as an efficiency parameter. The objective of this study is to predict the value of LOS using the clinical information that is generally supplied by a patient who is hospitalized following a fracture of the neck of the femur and to make a comparison with results obtained after the implementation of the new diagnostic-therapeutic-assistance pathway (DTAP). The analysis was conducted on data extrapolated from the information system of the University Hospital “San Giovanni di Dio and Ruggi d’Aragona” of Salerno (Italy). The results show promising outcome in the use of the proposed prediction models as a tool for determining an estimate of the LOS and support the decision making process and the management of hospital resources in advance. In addition, the comparison of between the two models can be used as an indicator to assess the efficiency of the implemented DTAP

Blood–brain barrier impairment in patients living with hiv: Predictors and associated biomarkers

Despite the substantial changes resulting from the introduction of combination antiretroviral therapy (cART), the prevalence of HIV-associated neurocognitive disorders (HAND) remains substantial. Blood–brain barrier impairment (BBBi) is a frequent feature in people living with HIV (PLWH) and it may persist despite effective antiretroviral treatment. A cross-sectional study was performed in PLWH who underwent lumbar puncture for clinical reasons or research protocols and several cerebrospinal fluid biomarkers were studied. BBBi was defined as cerebrospinal fluid-to-serum albumin ratio (CSAR) >6.5 (<40 years) or >8 (>40 years). We included 464 participants: 147 cART-naïve and 317 on cART. Male sex was prevalent in both groups (72.1% and 72.2% respectively); median age was 44 (38–52) years in naïve and 49 (43–57) years in treated subjects. BBBi was observed in 35.4% naïve and in 22.7% treated participants; the use of integrase inhibitors was associated with a lower prevalence (18.3 vs. 30.9%, p = 0.050). At multivariate binary logistic regression (including age and sex) nadir CD4 cell count (p = 0.034), presence of central nervous system (CNS) opportunistic infections (p = 0.024) and cerebrospinal fluid (CSF) HIV RNA (p = 0.002) in naïve participants and male sex (p = 0.021), a history of CNS opportunistic infections (p = 0.001) and CSF HIV RNA (p = 0.034) in treated patients were independently associated with BBBi. CSF cells and neopterin were significantly higher in participants with BBBi. BBBi was prevalent in naïve and treated PLWH and it was associated with CSF HIV RNA and neopterin. Systemic control of viral replication seems to be essential for BBB integrity while sex and treatment influence need further studies

Cascading Failures in Complex Networks

Cascading failure is a potentially devastating process that spreads on real-world complex networks and can impact the integrity of wide-ranging infrastructures, natural systems, and societal cohesiveness. One of the essential features that create complex network vulnerability to failure propagation is the dependency among their components, exposing entire systems to significant risks from destabilizing hazards such as human attacks, natural disasters or internal breakdowns. Developing realistic models for cascading failures as well as strategies to halt and mitigate the failure propagation can point to new approaches to restoring and strengthening real-world networks. In this review, we summarize recent progress on models developed based on physics and complex network science to understand the mechanisms, dynamics and overall impact of cascading failures. We present models for cascading failures in single networks and interdependent networks and explain how different dynamic propagation mechanisms can lead to an abrupt collapse and a rich dynamic behavior. Finally, we close the review with novel emerging strategies for containing cascades of failures and discuss open questions that remain to be addressed.Comment: This review has been accepted for publication in the Journal of Complex Networks Published by Oxford University Pres

Erratum to: Cascading failures in complex networks

n/

Cognitive Neuro-Rehabilitation of HIV-Associated Neurocognitive Disorders : Case Reports of A New Computer-Based Restorative Approach In 3 Hiv-Positive Cart-Treated Patients

At enrolment (T0) three on combination antiretroviral therapy (cART) HIV-positive patients with HIV Associated Neurocognitive Disorders (HAND) were enrolled to undergo a computer-based rehabilitation program (https://dynamicbrain.brainhq.com/) for 12 weeks, under the supervision of a physician. At the end (T1), the patients were tested again with a neuropsychological battery. Patient 1 (current CD4 T-cell count 405/mmc, HIV-RNA < 40UI/ml) had a diagnosis of mild neurocognitive disorders (MND) at T0 and normal evaluation at T1. Patient 2 (current CD4 T-cell count 366/mmc, HIV-RNA < 40UI/ml) had asymptomatic neurocognitive disorders (ANI) at T0 and normal performance at T1. Patient 3 (current CD4 T-cell count 522/mmc, HIV-RNA < 40UI/ml) had MND at T0 and normal performances at T1. Patients\u2019 adherence to the program was 100%. Our pilot experience with a computer-based restorative approach showed good results in term of improvement in neuropsychological performances in treated HIV+ patients. These data suggest the need to explore innovative ways to manage HAND

Myocardial interleukin-6 in the setting of left ventricular mechanical assistance: relation with outcome and C-reactive protein

Background: In left ventricular assist device (LVAD) recipients, plasma levels of interleukin (IL)-6 are associated with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles, reflecting postoperative risk. However, it is not clear how the cardiac. Conclusions: Cardiac IL-6 levels do not contribute to improve risk profile of LVAD recipients in relation to clinical inpatient post-implantation. Instead, plasma IL-6 and serum CRP concentrations are more effective in predicting the severity of the clinical course in the early phase of LVAD therapy. level of IL-6, detectable on the tissue samples at the time of implantation, can contribute to predict the post-operative outcome

Immunogenic Properties of Streptococcus agalactiae FbsA Fragments

Several species of Gram-positive bacteria can avidly bind soluble and surface-associated fibrinogen (Fng), a property that is considered important in the pathogenesis of human infections. To gain insights into the mechanism by which group B Streptococcus (GBS), a frequent neonatal pathogen, interacts with Fng, we have screened two phage displayed genomic GBS libraries. All of the Fng-binding phage clones contained inserts encoding fragments of FbsA, a protein displaying multiple repeats. Since the functional role of this protein is only partially understood, representative fragments were recombinantly expressed and analyzed for Fng binding affinity and ability to induce immune protection against GBS infection. Maternal immunization with 6pGST, a fragment containing five repeats, significantly protected mouse pups against lethal GBS challenge and these protective effects could be recapitulated by administration of anti-6pGST serum from adult animals. Notably, a monoclonal antibody that was capable of neutralizing Fng binding by 6pGST, but not a non-neutralizing antibody, could significantly protect pups against lethal GBS challenge. These data suggest that FbsA-Fng interaction promotes GBS pathogenesis and that blocking such interaction is a viable strategy to prevent or treat GBS infections