1,721,002 research outputs found
Novel negative pressure wound therapy with instillation and the management of diabetic foot infections
No full textPurpose of review The use of negative pressure wound therapy with instillation (NPWTi) in complex or difficult-to-treat acute and chronic wounds has expanded rapidly since the introduction of commercially available NPWTi systems. We summarize the evidence related to NPWTi and particularly focus on the application of this technology in diabetic foot ulcers, diabetic foot infections and postoperative diabetic wounds. Recent findings The benefits of negative pressure wound therapy (NPWT) are well documented in the treatment of complex acute and chronic wounds, including noninfected postoperative diabetic wounds and diabetic foot ulcers. Combining intermittent wound irrigation with NPWT may offer additional benefits compared to NPWT alone, including further reduction of wound bed bioburden, increased granulation tissue formation and provision of wound irrigation in a sealed environment, thus preventing potential cross-contamination events. Recently, available evidence suggests that adjunctive NPWTi may be superior to standard NPWT in the management of diabetic infections following surgical debridement and may promote granulation tissue formation in slow-to-heal wounds. Summary Available evidence relating to the utilization of NPWTi in diabetic foot infections is promising but limited in quality, being derived mostly from case series or small retrospective or prospective studies. In order to confirm or refute the potential benefits of NPWTi in this patient cohort, well designed randomized controlled studies are required that compare NPWTi to NPWT or standard wound care methodologies
Extra-intestinal pathogenic Escherichia coli (ExPEC): Disease, carriage and clones
Full text linkExtra-intestinal pathogenic Escherichiacoli (ExPEC) have a complex phylogeny, broad virulence factor (VF) armament and significant genomic plasticity, and are associated with a spectrum of host infective syndromes ranging from simple urinary tract infection to life-threatening bacteraemia. Their importance as pathogens has come to the fore in recent years, particularly in the context of the global emergence of hyper-virulent and antibiotic resistant strains. Despite this, the mechanisms underlying ExPEC transmission dynamics and clonal selection remain poorly understood. Large-scale epidemiological and clinical studies are urgently required to ascertain the mechanisms underlying these processes to enable the development of novel evidence-based preventative and therapeutic strategies. In the current review, we provide a concise summary of the methods utilised for ExPEC phylogenetic delineation before exploring in detail the associations between ExPEC VFs and site-specific disease. We then consider the role of ExPEC as an intestinal colonist and outline known associations between ExPEC clonal variation, specific disease syndromes and antibiotic resistance
The induction of anti-meningococcal B cell responses following controlled human infection with wild-type and genetically modified strains of Neisseria lactamica
No full textNeisseria lactamica is a non-pathogenic upper respiratory tract commensal that protects against N. meningitidis colonisation and disease. If the mechanisms underpinning this protective effect were elucidated they could be utilised to guide the development of novel strategies to prevent meningococcal disease. It was hypothesised that anti-meningococcal adaptive cellular immune responses induced following N. lactamica colonisation were responsible for this effect. Furthermore, it was posited that the anti-meningococcal adaptive cellular immune responses mounted following N. lactamica colonisation could be enhanced through genetic modification (GM) of N. lactamica to express heterologous meningococcal antigen. To address these hypotheses, two controlled human infection experiments (CHIME) were performed, the first using wild-type (WT) N. lactamica, and the second using GM N. lactamica expressing the meningococcal adhesin, Neisserial adhesin A (NadA). Data from the first CHIME revealed that colonisation with WT N. lactamica induced N. lactamica-specific IgA, IgM and IgG-secreting plasma cells, and IgG memory B-cells, that were cross reactive with N. meningitidis. Additional post-hoc analyses revealed two particularly interesting findings: (1) that cross-reactive plasma cell and IgG memory B cell responses were only detected amongst volunteers with anti-meningococcal IgG memory B-cell responses at baseline, and (2) that increasing frequencies of N. meningitidis-specific IgG memory B cells at baseline inversely correlated with N. lactamica colonisation density. Together, these findings raised the possibility that pre-existing anti-meningococal IgG memory B cell responses were being boosted by N. lactamica colonisation and were negatively affecting N. lactamica colonisation density. Data derived from the second CHIME confirmed that colonisation with GM N. lactamica expressing NadA was safe and induced NadA-specific IgG plasma cell and memory B-cell responses. Together, data from the CHIMEs supported the conclusions that the protective effect of N. lactamica colonisation on N. meningitidis colonisation and disease may have an immunological basis, and demonstrated that the anti-meningococcal responses induced following N. lactamica colonisation could be enhanced by genetic modification of N. lactamica
Infectious Hepatitis
No full textInfectious hepatitis is a systemic infection that predominantly affects the liver. The clinical course of the disease is variable and ranges from asymptomatic acquisition through to severe acute hepatitis resulting in fulminant liver failure. A number of patients can develop chronic infection from either the hepatitis B or C virus. This article will consider the diagnosis, management and prevention of the most-common forms of infectious hepatitis, the management of hepatitis in pregnancy, and the management of occupational exposure in the primary care setting
Percutaneous breast implant herniation: a rare complication of miliary TB.
No full textWe describe the case of a 46-year-old female patient treated for disseminated tuberculosis (TB) infection involving the lungs, urinary tract and skin. Following initiation of antituberculous therapy, the patient's right breast implant eroded through the overlying skin and was seen to be herniating through the resulting defect. The breast implant was removed under local anaesthetic and histological analysis of the resected tissue demonstrated granuloma formation consistent with periprosthetic TB. Wound healing following implant removal was poor and future breast augmentation surgery was only considered following completion of 12 months anti-TB treatment. This case constitutes the first report in the literature of percutaneous breast implant herniation resulting from periprosthetic infection with TB. A high index of suspicion is required to ensure early detection and timely management of TB and, in cases where periprosthetic pus aspirate is sterile, mycobacterial infection must be actively excluded
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Genetic susceptibility to meningococcal infection
No full textMeningococcal disease is caused by a limited range of clonal complexes of Neisseria meningitidis. The disease occurs in people who lack bactericidal antibodies to this pathogen, and therefore the patients are reliant on innate immunity or components of acquired immunity other than bactericidal antibodies. Gene variants that influence the function of innate and acquired immune response components have been associated with altered host susceptibility to meningococcal disease, and some genetic factors have also been associated with more severe disease. Identification of genetic factors associated with meningococcal disease will enhance our understanding of this rare but dangerous condition which causes death and serious morbidity in young, previously fit individuals. Genetic variations in the gene cluster encoding IL-1 and in key genes including TNF, SP-A2 and CFH have been associated with susceptibility to meningococcal disease. Understanding the mechanisms underlying genetic susceptibility to meningococcal disease will permit the development of novel therapeutic measures for the treatment of Gram-negative sepsis. To enable the discovery of new mechanisms of the disease, future research will move away from small-scale association studies and instead include analysis of large patient cohorts with accurately linked clinical and demographic information
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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