Fresh cell options with regard to bone renewal

CONCLUSIONS Although in this case the patient was a young adult, pituitary blastoma should be taken into consideration when children have an enhanced sellar and suprasellar mass with peripherally located cysts. Eye damage during invasive aspergillosis is rarely described and biological diagnosis remains challenging. Here we report the case of a heart transplant recipient with ocular aspergillosis complicating disseminated aspergillosis. Although voriconazole was rapidly given, a decrease in visual acuity of the right eye was consistent with endophthalmitis, resulting in an emergency vitrectomy. MitoTEMPO Diagnosis was rapidly confirmed lab results showed the presence of Aspergillus fumigatus on a vitreous sample. A series of systemic antifungal medication (liposomal amphotericin B, caspofungin and voriconazole), several liposomal amphotericin B ocular injections and pars plana vitrectomy allowed limited positive clinical outcome. Interestingly although standard mycological follow-up procedures were negative, Aspergillus antigen testing gave an index of 5.92 on vitreous humor, thus a new intraocular injection of L-AmB was performed and voriconazole reinitiated. Ten other vitreous samples from patients without fungal infections were also tested, all showing indexes inferior to 0.25. Although larger studies are needed, this case illustrates that galactomannan testing of vitreous humor could be useful for the diagnosis of fungal endophthalmitis if these data are confirmed in other patients, in particular, if standard mycology is negative and PCR is not available. OBJECTIVE To assess the diagnosis, treatment outcomes and predictors of mortality in adult tuberculosis (TB) patients in an urban setting with a high HIV prevalence. METHODS A retrospective cohort study was conducted of adult TB patients aged ≥ 15 years who were treated at Connaught Hospital in Freetown, Sierra Leone from January through December 2017. Multivariate logistic regression was used to identify predictors of mortality. RESULTS Of 1127 TB cases notified in 2017, 1105 (98%) were tested for HIV, yielding a TB/HIV co-infection rate of 32.0%. Only HIV-tested cases (n=1105) were included in the final analysis. The majority were male (69.3%), aged 25-34 years (29.2%) and had pulmonary TB (96.3%). Treatment outcomes were as follows cured (29.0%), completed (29.0%), treatment failure (0.5%), lost to follow up (24.3%), transferred/not evaluated(12.9%) and died (4.5%). The majority of deaths (80.0%, 40/50) occurred within 2 months of TB treatment initiation. Age 65 years or older [AOR, 3.48; (1.15-10.56) p=0.027] and HIV positive status [AOR, 3.50; (1.72-7.12); p=0.001] were independent predictors of mortality. CONCLUSION Sub-optimal TB treatment outcomes were observed in Sierra Leone in 2017. More local and international action is warranted to help achieve the 2035 global TB elimination targets. OBJECTIVE The outbreak of coronavirus disease 2019 (COVID-19) in China has been basically controlled. However, the global epidemic of COVID-19 is worsening. We established a method to estimate instant case fatality rate and cure rate of COVID-19 in China. METHODS We collected 82735 confirmed cases released officially by Chinese authorities from Dec 8, 2019 to April 18, 2020. The estimated diagnosis dates of deaths and cured cases were calculated based on median cure time or median death time of individual cases. Afterward, instant fatality rate was calculated according to the number of deaths and cured cases on the same estimated diagnosis date. RESULTS In China, the instant case fatality rate of COVID-19 was 3.8-14.6% from Jan 1 to Jan 17, and then gradually declined and stabilized at 5.7% in April. The average case fatality rate in China was 6.1%±2.9%. While, the case fatality rate was 1.0±0.4% in China except Hubei. The cure rates of COVID-19 were 93.9%±2.9% in China, and stabilized at 94.3%, while it was 99.0%±0.4% in China except Hubei. CONCLUSION The instant case fatality rate of COVID-19 in China was much higher than that in China except Hubei. The case fatality rate of COVID-19 in China was underestimated. OBJECTIVES To reduce childhood mortality from severe malaria by implementing the World Health Organization's standardized malarial treatment protocol. DESIGN Observational study comparing the mortality rate from malaria before and after the intervention. SETTING Inpatient pediatric ward in a district referral hospital of Sierra Leone. PARTICIPANTS A total of 1298 pediatric patients (age 0-13 years, male and female) received the intervention, representing 100% of the pediatric patients admitted with severe malaria during the dates of implementation (there were no exclusion criteria). INTERVENTIONS We implemented the World Health Organization's standardized malarial protocol on September 30, 2015. Based on monthly run reports of mortality and root cause analysis, we adapted the malaria protocol by adding sublingual glucose as a treatment to target hypoglycemia complications in March 2016. MAIN OUTCOME MEASURES Primary outcome was change in monthly percent mortality from severe malaria and secondary outcome was percent of mortality attributed to hypoglycemia. RESULTS The monthly average percent mortality from severe malaria dropped from 9% to 3.6% after the interventions which was borderline statistically significant (p 0.06, CI 95% 1.5 to 5.6). The secondary outcome, percent of malarial deaths attributable to hypoglycemia via chart reviews, reduced from 83% to 44%across the study period. There was an increase in the average number of admissions for severe malaria from 71 to 153 children per month in the second half of the year (range from 49-212 per month). CONCLUSION Implementing the WHO malaria treatment protocol with bedside tracking of protocol steps reduced malaria mortality and improved our ward's efficiency without adding any human or medical resources. Phaeohyphomycosis is a set of fungal infections caused by various dematiaceous fungi such as coelomycetes. These infections can occur either in immunocompetent or immunocompromised patients like solid organ transplants. Here we describe a nodular lesion of the right hallux that occurred in a kidney transplant patient. Microscopic examination of the biopsy revealed fungal hyphae and culture was positive to a grey to black mould that lacked characteristic elements to be identified. Nucleic acid sequencing targeting the internal transcribed spacer of the ribosomal DNA identified this mould as Medicopsis romeroi. The patient benefited of an antifungal therapy with voriconazole associated with surgical excision of the lesion. No relapse of the lesion was observed during a six-month follow-up. In solid organ transplants, phaeohyphomycosis caused by Medicopsis romeroi are very rare with only 12 cases reported. The clinical history should be well assessed since the lesion can appear several years after a cutaneous trauma that happened in a tropical region. Therapy generally combines antifungals with surgical excision of the lesion in order to avoid any relapse or dissemination of the infection. OBJECTIVE To evaluate the performance of whole genome sequencing (WGS) for predicting Mycobacterium tuberculosis (MTB) drug resistance. METHODS 276 rifampin-resistance tuberculosis (RR-TB) and 30 rifampicin-sensitive clinical isolates were randomly selected from patients with tuberculosis in Shanghai Pulmonary Hospital (SPH). Phenotypic drug susceptibility testing (DST) against 6 anti-TB drugs were performed, and WGS was performed to predict the drug resistance using an online 'TB-Profiler' tool. RESULTS Using phenotypic susceptibility as the gold standard, the overall sensitivity and specificity for WGS were 94.53% and 92.00% for isoniazid, 97.10% and 100.00% for rifampicin, 97.46% and 64.36% for ethambutol, 97.14% and 95.83% or streptomycin, 93.02% and 98.87% for ofloxacin, and 75.00% and 100.00% for amikacin, respectively. The concordances of WGS-based DST and phenotypic DST were shown as follows isoniazid (94.12%), rifampicin (97.39%), ethambutol (77.12%), streptomycin (96.73%), ofloxacin (96.41%) and amikacin (97.06%). CONCLUSIONS WGS could be a promising approach to predict resistance to isoniazid, rifampicin, ethambutol, streptomycin, ofloxacin and amikacin. BACKGROUND Whole genome sequencing (WGS) has been proposed to be a powerful tool to predict drug resistance for antitubercular drugs. However, the feasibility of WGS in predicting final treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) patients remains unclear. PATIENTS AND METHODS In the prospective observational study conducted from January 2014 to September 2016, MDR-TB patients were enrolled consecutively. Genotypic drug sensitivity testing was performed via WGS using the culture isolates. Patients were followed for two years to determine the treatment outcomes. Multivariate analysis was used to identify the association between information provided by WGS and the final treatment outcomes. RESULTS A total of 123 patients with MDR-TB were included in this study. The overall favorable treatment outcome rate was 60.2%. Multivariate analysis showed that independent risk factors associated with unfavorable treatment outcome including high-level moxifloxacin phenotypic resistance (OR, 4.362; 95%CI, 1.364-13.950; p=0.013), cycloserine phenotypic resistance (OR, 7.457; 95%CI, 1.644-33.819; p=0.009), mutations causing high level fluoroquinolones resistance (OR, 3.947; 95%CI, 1.195-13.034; p=0.024), and ethA mutation (OR, 3.817; 95% CI, 1.154-12.823; p=0.028). WGS costs for each patient are ¥450 ($63) and the average turnaround time was one week. CONCLUSIONS In summary, WGS showed a promising feasibility in predicting treatment outcomes for MDR-TB patients within a clinically relevant time frame. OBJECTIVE Metagenomic Next-Generation Sequencing (mNGS) has been applied as a novel method of detection pathogens for infectious diseases, but its value in the rapid diagnosis of tuberculous meningitis(TBM)had not been clarified based on large samples. METHODS A retrospective analysis was conducted on 51 inpatients with TBM suspected who underwent mNGS and other four tests in cerebrospinal fluid (CSF). RESULTS Among 51 included patients, 45 cases were diagnosed as TBM (38 definite, 5 probable, 2 possible) and 6 cases with not-TBM. Using final diagnosis as reference standard, the sensitivity, specificity, PPV (positive predictive value), NPV (negative predictive value) of mNGS in CSF for TBM were 84.44% (38/45, 69.94%-93.01%), 100%(6/6, 51.68%-100%), 100% (40/40, 88.57%-100%) and 46.15% (6/13, 20.40%-73.88%). The diagnostic sensitivity of mNGS (84.4%)was significantly higher than that of AFB (0%, P = 0.000), MGIT960 culture (22.2%, P = 0.000), MTB PCR (24.4%, P = 0.000) and Xpert MTB/RIF (40%, P = 0.000). The ROC curve showed that CSF protein quantification and CSF cells count might be valuable in the prediction of NGS positive detection of MTB (Mycobacterium tuberculosis). CONCLUSION CSF mNGS had high sensitivity, specificity and PPV in the diagnosis of TBM. Patients with significant increase in CSF cell number and protein quantification might be higher likelihood of positive MTB detection of NGS.