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Background. Solid organ transplant (SOT) candidates should be screened and treated for latent tuberculosis infection (LTBI) to prevent tuberculosis (TB) reactivation after transplantation. We aimed to assess the steps from positive QuantiFERON (QFT) through LTBI treatment (cascade of care) in the SOT population. Methods. We conducted a retrospective study of SOT recipients older than 18 y with a positive QFT during pretransplant evaluation at the Mayo Clinic from January 2010 to June 2023. We analyzed each cascade step to determine associated drop-out factors for LTBI management. Results. Of 629 patients who had positive QFT results, 587 (93%) were evaluated by an infectious disease (ID) specialist, 478 (76%) were recommended to start LTBI treatment, 473 (75%) initiated LTBI treatment, and 457 (73%) completed LTBI treatment. LTBI treatment was not recommended in 109 patients evaluated by infectious disease, most of whom had previously received either LTBI (n = 72) or TB (n = 14) treatment. LTBI treatment was initiated before or after transplantation for 45% and 55% of patients, respectively. Isoniazid monotherapy was the most common regimen (92%), and adverse events were rare (7%). Seven patients developed active TB infection posttransplantation under various circumstances (3 without LTBI treatment, 1 during LTBI treatment, and 3 after completing LTBI treatment). Conclusions. Our findings demonstrate the variability of LTBI management in SOT recipients with positive QFT. When recommended, most patients completed LTBI treatment successfully. Nonetheless, active TB was noted regardless of whether patients received LTBI treatment. This study highlights the importance of optimizing LTBI management in this population.

We reviewed invasive Nocardia infections in 3 noncontiguous geographic areas in the United States during 2011–2018. Among 268 patients with invasive nocardiosis, 48.2% were from Minnesota, 32.4% from Arizona, and 19.4% from Florida. Predominant species were N. nova complex in Minnesota (33.4%), N. cyriacigeorgica in Arizona (41.4%), and N. brasiliensis in Florida (17.3%). Transplant recipients accounted for 82/268 (30.6%) patients overall: 14 (10.9%) in Minnesota, 35 (40.2%) in Arizona, and 33 (63.5%) in Florida. Manifestations included isolated pulmonary nocardiosis among 73.2% of transplant and 84.4% of non–transplant patients and central nervous system involvement among 12.2% of transplant and 3.2% of non–transplant patients. N. farcinica (20.7%) and N. cyriacigeorgica (19.5%) were the most common isolates among transplant recipients and N. cyriacigeorgica (38.0%), N. nova complex (23.7%), and N. farcinica (16.1%) among non–transplant patients. Overall antimicrobial susceptibilities were similar across the 3 study sites.

Background: Despite the use of antiviral prophylaxis, cytomegalovirus (CMV) remains a common opportunistic infection following heart transplantation. This study analyzes the rates, risk factors, and outcomes of CMV among heart transplant recipients. Methods: A retrospective cohort study was conducted of adults who underwent heart transplantation between January 1, 2011, and March 31, 2019. The primary outcome was clinically significant CMV infection (csCMVi), defined as CMV disease or asymptomatic infection requiring pre-emptive therapy. The secondary outcome was all-cause mortality. Patients received valganciclovir prophylaxis up to 6 months, depending on CMV donor/recipient serostatus. Kaplan-Meier curve and multivariable Cox regression were used for outcome analysis. Results: Among 553 heart transplant recipients, 101 (18.3%) experienced csCMVi, including 35 (6.3%) with CMV disease. csCMVi was uncommon during prophylaxis. In multivariable analysis, CMV D+/R– status hazard ratio (HR 12.88, 95% CI 6.76-24.56; p

Introduction. The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature. Methods. We conducted a retrospective cohort study of 185 rejection (case) and 185 nonrejection (control) kidney transplant patients treated at our institution from 2014 to 2020 to understand the impact of rejection on infection development. Propensity scoring was used to match cohorts. We collected data for infections within 6 months of rejection for the cases and 18 months posttransplant for controls. Results. In 370 patients, we identified 466 infections, 297 in the controls, and 169 in the cases. Urinary tract infections (38.9%) and cytomegalovirus viremia (13.7%) were most common. Cumulative incidence of infection between the case and controls was 2.17 (CI 1.54–3.05); p

ABSTRACT: Objectives: Viridans group streptococci (VGS) have been previously linked to infective endocarditis (IE) in patients with mitral valve prolapse (MVP). The species identification of VGS is now available in clinical laboratories; however, it has not been examined in MVP IE. Therefore, we detailed the clinical profile, species designations, and antibiotic susceptibility of VGS isolates from patients with MVP IE. Methods: We retrospectively queried all adults with MVP and a definite or possible IE diagnosis seen at medical centers of the Mayo Clinic Enterprise from January 2009 to December 2021. Data, including clinical characteristics, comorbidities, microbiology, and outcomes, were extracted from electronic health records. VGS isolates from patients with MVP and IE were subclassified into mutans, salivarius, anginosus, sanguinis, and mitis groups. Results: A total of 38 patients with MVP with IE due to streptococcal species were included. Overall, median age was 62.4 years and 32% of patients were females. The most prevalent comorbidities were diabetes mellitus (26%), hypertension (21%), heart failure (16%), and malignancy (16%). A total of (37%) patients presented with an embolic event at the time of their IE diagnosis, 27 (66%) required valve surgery, and no patient died within the hospital stay. The Streptococcus mitis group was the predominant (n = 17, 45%) species designation; S. anginosus and S. sanguinis were identified in three (8%) each; S. mutans in two (5%); and S. salivarius in one (3%). Non-VGS streptococcal pathogens included S. agalactiae in three patients (8%), S. equi in two (5%), and S. dysgalactiae and S. bovis in one each (3%). VGS were identified in five (13%) patients, but species designation was not done. No penicillin resistance was identified among the isolates. Conclusion: The S. mitis group was the predominant species in our investigation. Continued evaluation of VGS species should be considered to profile the IE risk based on species identification.

We describe a case of life-threatening pulmonary hemorrhage in a boy with leukemia. He had episodes of massive hemoptysis for which he was intubated and resuscitated with multiple blood products, hemostatic measures (tranexamic acid and recombinant factor VIIa), and inotropes. Chest X-ray revealed left upper lobe homogeneous opacity. Within 12 h, in view of persistent massive pulmonary bleed and hypoxia, he was reintubated with a left-sided double-lumen endotracheal tube (DLT). Following reintubation with DLT, pulmonary bleed could be managed. He was treated for probable left upper lobe angioinvasive aspergillosis. He was weaned off ventilatory support and extubated after 48 h to high flow nasal canula (HFNC). This case is to highlight the importance of early use of DLTs in pulmonary hemorrhage due to suspected unilateral lung pathologies to facilitate isolation of diseased lung, improve ventilation, and prevent spillage of blood to the contralateral normal lung. It serves as a temporizing measure, while aggressive efforts to identify and control the bleed are underway.

Objective: To measure seasonal effects on semen quality profiles, seminal biochemical and oxidative stress attributes in fresh and liquid stored semen in monsoon and dry seasons. Methods: A total of 10 Teressa bucks (3-4 years) were selected from breeding farm, ICAR-Central Island Agricultural Research Institute, Port Blair, Andaman and Nicobar Islands, India. Semen samples (n=25 per season) were collected through artificial vagina method and preserved at refrigerated temperature (5°C) for 48 h using Tris citrate glucose based extender. We detected semen quality parameters [volume, mass activity, pH, sperm concentration, total motility, viability, total sperm abnormality, and plasma membrane, acrosomal and nuclear integrities], biochemical profiles [aspartate amino transferase (AST), alanine amino transferase (ALT) and total cholesterol], and oxidative stress markers [total antioxidant capacity (TAC) and malondialdehyde (MDA)] during monsoon and dry seasons. Results: Semen quality parameters significantly differed between seasons (P

Present study was designed to assess the effect of catalase on post-thaw semen quality parameters (SQPs), sperm kinematics, antioxidant and oxidative stress profiles and sperm cholesterol efflux in mithun (Bos frontalis). A total of 25 ejaculates were selected based on biophysical parameters and each sample was split into four equal aliquots and diluted (to get final concentration of 60 million spermatozoa per mL) with the TCG extender containing either 0 U/mL, 50 U/mL, 100 U/mL, and 150 U/mL catalase in the Group I, II, III and IV, respectively. Frozen-thawed samples were analysed for motility parameters (progressive forward and in bovine cervical mucus [BCMPT]), kinetic and velocity parameters by computer-assisted sperm analyser (CASA), viability, sperm morphological and nuclear abnormalities, acrosomal integrity, plasma membrane and nuclear integrities, sperm intra-cellular enzymatic leakage and seminal plasma biochemical (sperm cholesterol and oxidative stress markers) profiles. Study revealed an enhancement in viability, acrosomal integrity, plasma membrane integrity, motility (progressive and in cervical mucus), sperm cholesterol content and reduction in sperm morphological and nuclear abnormalities, leakage of intracellular enzymes in Group III. Moreover, intactness of acrosome and biochemical membranes were protected significantly in addition to significant improvement in kinetic and velocity profiles in extender containing 100 U/ml catalase. Correlation analysis revealed that sperm kinetic parameters, SQPs and antioxidant parameters had significant positive correlation with each other whereas these profiles were negatively correlated with sperm morphological abnormalities, enzymatic leakage and lipid peroxidation in catalase treated sperm. The results clearly indicated that inclusion of 100 U/ml catalase holds a clear advantage over control or 50 U/ml or 150 U/ml catalase in cryopreservation of mithun semen. It can be concluded from the present study that catalase supplementation in semen extender can be effectively utilized to reduce the oxidative stress and to improve the post-thaw semen quality in mithun.

Emphysematous pyelonephritis (EPN) is a severe, acute necrotizing infection that is defined by the presence of gas in the kidney parenchyma. Multiple case reports have described the radiological findings and clinical course of EPN. Herein, we report on EPN including the histopathological findings in a kidney transplant recipient. Our patient presented with EPN complicated by multiorgan failure and was successfully managed with transplant nephrectomy.

The present study was designed to assess the effect of superoxide dismutase (SOD) on post thaw semen quality parameters (SQPs), kinetic profiles and seminal biochemical profiles in mithun. A total of 25 ejaculates were selected and each was split into four equal aliquots after dilution with Tris-citrate-glycerol (TCG) extender such as Group I: control, Group II, III and IV contained 50, 100 and 150 U/ml of SOD, respectively. Cryopreserved and thawed samples were analysed for their motility parameters (progressive forward and in bovine cervical mucus penetration test [BCMPT]), kinetic and velocity parameters by computer assisted sperm analyser (CASA), viability, sperm morphological and nuclear abnormalities, acrosomal, plasma membrane and nuclear integrities and sperm enzymatic leakage and biochemical (sperm cholesterol and antioxidant and oxidative stress) profiles. Study revealed a significant (p

Introduction: A reproducible glide path provides guidance to fulfil the mechanical objective of cleaning and shaping root canals with minimal procedural errors. Debris expelled during this procedure contributes to inter-appointment flare-up. The objective of this in vitro study was to estimate and compare the quantity of debris extruded by; hand, rotary and reciprocating glide path preparation instruments. Materials and Methods: Seventy-five human single rooted, matured mandibular incisors with single canal and comparable lengths were randomly allocated into three groups (n = 25): group A – Stainless steel (SS) K-file (No 15), Group B – ProGlider, and Group C –WaveOne Gold Glider. Customized apparatus using Meyers and Montgomery method was utilized to accumulate the debris expelled apically in the Eppendorf tubes weighed priorly in digital analytical balance of 10−6 g accuracy. All groups were instrumented as per the manufacturer's guidelines. After instrumentation, teeth were detached from the Eppendorf tubes and tubes incubated at 70°C for 5 days to vaporize the irrigating solution. The tubes with dry debris were later weighed in the same weighing balance. The collected information was analyzed by one-way ANOVA and Tukeys honest significant difference post hoc test at significance level (P < 0.05). Results: The ProGlider group expressed statistically significant result with least quantity of extruded debris in the comparison to other groups (P < 0.0001). The SS group and WaveOne Gold Glider group exhibited no significant difference, but the debris expelled was less for WaveOne Gold Glider group than SS group. Conclusion: Glide path preparations with rotary ProGlider resulted in the minimal extrusion of debris in comparison to the reciprocating WaveOne Gold Glider and the manual stainless-steel K-files.

A study was conducted to assess the rhythmic changes of antioxidant and oxidative stress profiles (antioxidantand oxidative stressors together is called as oxidative stress biomarkers: OSBs) to understand their flow pattern in24 h during different seasons (winter, spring, summer and autumn) in intact adult mithun bulls (n=6; 5–6 years).Antioxidants [total antioxidant capacity (TAC), superoxide dismutase (SOD), glutathione (GSH), glutathionereductase (GSHR) and catalase (CAT)] and oxidative stressor [malondialdehyde (MDA)] were estimated at 4 hinterval for a whole day in different seasons. Analysis was done in two different ways with respect to time (0800,1200, 1600, 2000, 2400 and 0400 h) and day time (0800 to 1600 h) and night time (2000 to 0400 h) collections. Thelevels of OSBs differed significantly among the seasons, among the collection times and between day and nighttimes. Winter and spring had recorded significantly higher antioxidants and lower MDA than summer. Levels ofantioxidants were higher and MDA was lower during night as compared to day time collections. It was concludedthat spring and winter seasons had greater beneficial effects than summer on health and wellbeing of the mithun.

Background. The risk of donor-derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in solid organ (heart, lung, liver, kidney, pancreas, and intestine) transplant recipients is poorly understood. Since hematogenous transmission of SARS-CoV-2 has not been documented to date, nonlung solid organs might be suitable for transplantation since they likely portend a low risk of viral transmission. Methods. Abdominal solid organs from SARS-CoV-2–infected donors were transplanted into uninfected recipients. Results. Between April 18, 2021, and October 30, 2021, we performed transplants of 2 livers, 1 simultaneous liver and kidney, 1 kidney, and 1 simultaneous kidney and pancreas from SARS-CoV-2–infected donors into 5 uninfected recipients. None of the recipients developed SARS-CoV-2 infection or coronavirus disease 2019, and when tested, allograft biopsies showed no evidence of SARS-CoV-2 RNA. Conclusions. Transplanting nonlung organs from SARS-CoV-2–infected donors into uninfected recipients demonstrated no evidence of virus transmission.

Present study was designed to assess the effect of glutathione (GSH) on post thaw semen quality parameters (SQPs), sperm kinetic profiles, antioxidant and oxidative stress profiles and sperm cholesterol efflux in mithun. Ejaculates (25) were selected based on biophysical parameters for the present experiment. Each sample was split into four equal aliquots after dilution with the Tris-citrate-glycerol (TCG) extender, viz. Group I (control), Group II, III and IV contained 5, 10 and 15 mM of GSH, respectively. Cryopreserved and thawed samples were analysed for their motility parameters (progressive forward and in bovine cervical mucus penetration test [BCMPT]), kinetic and velocity parameters by computer assisted sperm analyser (CASA), viability, sperm and nuclear abnormalities, acrosomal integrity, plasma membrane and nuclear integrities, sperm enzymatic leakage and biochemical (sperm cholesterol and antioxidant and oxidative stress) profiles. Study revealed a significant enhancement in viability, sperm and nuclear normalities, acrosomal integrity, motility (progressive and in cervical mucus), sperm cholesterol content and reduction in leakage of intracellular enzymes in Group III. Moreover, intactness of acrosome and biochemical membranes were protected significantly in addition to significant improvement in kinetic and velocity profiles in extender containing 10 mM GSH. These results clearly indicate that though the cryopreservation of mithun’s spermatozoa in TCG was comparable with other species, inclusion of 10 mM GSH holds a clear advantage over control and 5 or 15 mM GSH. The study concludes that GSH supplementation in semen extender can be effectively utilized to reduce the oxidative stress and improve the antioxidant profiles with cascading beneficial effects on cryopreserved semen quality parameters in mithun bull.

Background: Smear layer removal from the apical third of the root canal is critical and the widely used chemical irrigants have been associated with detrimental effects. Hence, the study aimed to evaluate the smear layer removal efficacy of three herbal extracts used as endodontic irrigants in the apical third of the root canal. Materials and Methods: Forty-eight single-rooted premolars were divided into three experimental groups and a control group and were irrigated with Neem extract (Group 1), Orange peel extract (Group 2), Tulasi extract (Group 3), 5.25% sodium hypochlorite (Group 4) and their effect on smear layer removal was examined under the field-emission scanning electron microscope. Statistical Analysis: Kruskal–Wallis test followed by Mann–Whitney post-hoc analysis was done to compare the mean smear layer scores between the four groups in the apical third of the root sections. Results: The lowest mean remaining smear layer scores was shown by Neem extract (0.83), followed by sodium hypochlorite (1.08), orange peel extract (1.67), and the highest for Tulasi extract (2.42). On intergroup comparison, Neem extract showed statistically significant less smear layer scores in comparison to Orange peel extract (P = 0.006) and Tulasi (P = 0.001). Neem showed no statistically significant difference with sodium hypochlorite (P = 0.37). Conclusions: Neem extract can be considered as an efficient smear layer removal irrigant in the apical third of the root canal.

Present study was designed to evaluate the effect of slow release exogenous melatonin on endocrinological profiles in 24:00 hours in adult mithun bulls during different seasons (winter, spring, summer and autumn). Mithun bulls (n=12) were selected and divided into two groups, Gr I: Control (n=6) and Gr II: Treatment (n=6; melatonin implant @ 18 mg/50 kg bwt). Endocrinological profiles such as follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, cortisol, thyroxine (T4), insulin like growth factor-1 (IGF-1), prolactin and melatonin (MT) were estimated at 04:00 h interval (08:00, 12:00, 16:00, 20:00, 24:00 and 04:00 h) for one whole day in four seasons. Melatonin treated group had significantly higher FSH, LH, testosterone, IGF-1 and MT than control group; and MT significantly reduced the level of T4, cortisol and prolactin in different seasons at different collection times. The study concludes that MT has significantly improved the endocrine profiles in different seasons and collection times. MT treatment and spring and winter season had significantly greater beneficial effects on reproduction and artificial breeding programs in mithun species in the semi-intensive management in the present location.

Case Report. Aspergillus osteomyelitis is a destructive and progressive infection that has been described both in immunosuppressed and in immunocompetent hosts. We describe a case of lumbar vertebral osteomyelitis in a 61-year-old immunocompetent patient due to Aspergillus nidulans that was successfully treated with a combination of extensive surgical debridement, spinal stabilization, and a prolonged course of antifungal therapy. Imaging demonstrated findings consistent with L3 discitis. The biopsy grew Aspergillus fungus and was treated with vorconizole. Imaging showed progressive destructive osteomyelitis at L3-L4. Patient underwent anterior L3 and L4 partial corpectomies, anterior interbody fusion L3-L5, and posterior T11-S2 pedicle screw and rod fixation. Antifungal treatment resulted in resolution of infection. Aspergillus markers remain negative. One year following definitive treatment, the patient’s back pain remains resolved. Conclusion. Definitive surgical resection of the infection, spinal stabilization, and aggressive antifungal therapy were required to eradicate the infection.

Soft-tissue sarcomas (STSs) are rare neoplasms that can be initially evaluated by fine-needle aspiration cytology (FNAC). Although they are difficult to subtype, these sarcomas can be graded and classified based on cytomorphology. FNAC, with clinical and radiological correlation, can be effectively used in the diagnosis of STSs. Application of ancillary techniques is essential to arrive at the final diagnosis. The aim of the study was to determine the efficacy of FNAC in the initial diagnosis of STSs. Three patients who presented with softtissue masses were initially evaluated by ultrasound and/or magnetic resonance imaging and FNAC. Following which, all the three cases were operated on and studied on histopathology and immunohistochemistry to arrive at a final diagnosis. All the three cases were diagnosed as malignant on FNAC even when radiology findings differed or was not confirmatory in one case. FNAC diagnosis was appropriate in case of grading of tumors and classification based on morphology in all the three cases. FNAC of soft-tissue tumors (STTs) is a quick, reliable, and cost-effective mode of initial investigation for STTs. Although it is difficult to subtype the diagnosis, in majority of the cases, a diagnosis of benign or malignant and grade of the tumor can be assessed. [ABSTRACT FROM AUTHOR]