Vertebral destruction in tuberculous spondylitis correlates with Toll-like Receptor 4 (TLR-4) levels: a cross-sectional study

Background

Tuberculous (TB) spondylitis is a hazardous infectious disease causing significant spinal deformity. Increased toll-like receptor-4 (TLR-4) activity promotes more extensive infections in patients with TB spondylitis, so it has the potential to be used as a biomarker to predict the severity. This study aims to determine the relationship between TLR-4 levels and the degree of vertebral destruction in TB spondylitis patients.

Materials and methods

A cross-sectional study was conducted from May to October 2023. A total of 27 TB spondylitis samples were then measured for TLR-4 serum levels. Vertebral destruction is assessed based on the Spine At Risk Signs (SARS) criteria on X-ray and MRI examinations. Moreover, the degree of sensory and motor impairment was also assessed in this study. The Spearman correlation test assessed the correlation between TLR-4 levels and vertebral destruction.

Results

Most of the samples in this study were less than 30 years old (10 people, 37%), female (14 people, 51.9%), had spinal destruction at 1 level (11 people, 40.7%), had paraplegia (8 people, 29.6%), and had hypoesthesia (11 people, 40.7%). TLR-4 levels had a mean value of 8254.1±1076.1 ng/ml. TLR-4 levels were positively correlated with the degree of vertebral destruction (r=0.599, P=0.001), motor disorders (r=0.632.x, P=0.000), and sensory disorders (r=0.574, P=0.002).

Conclusion

TLR-4 levels are associated with the severity of vertebral destruction in TB spondylitis, so it has the potential to be used as a prognostic biomarker.

Single-nucleotide polymorphism of interleukin-10 promoter (IL-10 -819C/T) in leprosy patients with and without erythema nodosum leprosum, and healthy household contacts

Leprosy, caused by Mycobacterium leprae, is a chronic infectious disease that impacts the skin and peripheral nerves, causing long-term disability. The invasion of M. leprae into the body triggers immunologic responses and single single-nucleotide polymorphisms in cytokine-encoding genes may influence predisposition and susceptibility, possibly predicting the incidence of leprosy reactions. The aim of this study was to assess the gene polymorphism of interleukin-10 promoter IL-10 -819C/T in leprosy patients, leprosy patients with erythema nodosum leprosum (ENL) reaction, and household contacts. A total of 54 individuals were included, with 18 in each group. Skin smear and histopathologic examinations were used to confirm the diagnosis of leprosy and ENL. The polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) technique was used to determine the polymorphism. The results confirmed the presence of polymorphism of which all TT, CT, and CC genotypes presented. The TT genotype was most prevalent in household contacts (94.4%) followed by ENL (50%), and leprosy patients (44.4%). The CT genotype was most frequently detected in leprosy patients (50%), followed by ENL cases (44.4%), and household contacts (5.56%). In contrast, CC was mostly presented in ENL cases (5.56%), only 1% in leprosy patients, and absent among household contacts. Although the most prevalent allele in all three groups was the T allele, the C allele presented in 27% and 30% of ENL and leprosy patients, respectively and only 5% in household contact individuals. This study suggests that the polymorphism variations of IL-10 -819C/T are higher in leprosy and ENL patients compared to household contacts. Since this data is preliminary, larger studies are needed.

Bartholin’s Abscess with Bacterial Vaginosis Coinfection Successfully Treated with a Modified Word Catheter and Combined Antibiotics

BACKGROUND: Bartholin’s abscess is an infection of the Bartholin gland that often occurs in women of childbearing age. The prevalence of Bartholin’s abscess is 2% in the female population worldwide. Patients often complain dyspareunia with a high recurrence rate. Bacterial Vaginosis (BV) is a syndrome of changes in the vaginal ecosystem that occurs spontaneously in sexually active women. BV can contribute to the development of a Bartholin’s gland abscess. CASE REPORT: A 30-year-old woman came with the chief complaint of a 5 cm × 5 cm erythematous, tender, and mobile mass on the right side of the labia majora. In addition, the patient also experienced recurrent vaginal discharge. The patient was diagnosed with Bartholin’s abscess with BV coinfection that was successfully treated with a modified word catheter and combination of antibiotics that showed no recurrence. CONCLUSION: Combination of modified word catheter and antibiotics can be a simple yet effective way in treating Bartholin’s abscess.

Associated Factors of the Results of Pulmonary Tuberculosis Treatment During the COVID-19 Pandemic in Makassar City

BACKGROUND: A regimen directly observed treatment-short course is recommended by the World Health Organization as a strategy for controlling tuberculosis (TB). AIM: This treatment was carried out for 6 months despite the COVID-19 pandemic situation. The purpose of the study was to determine the factors associated with the treatment outcomes of pulmonary TB undergoing treatment during the COVID-19 pandemic, with the research target was Category I pulmonary TB patients. METHOD: The type of research was observational analytic with a cohort study design. This research was conducted at the Pulmonary Center in October 2020-May 2021 involved 62 samples. RESULTS: About 75.8% (47 respondents) successfully treated and 24.2% (15 respondents) decided unsuccessful. There was a significant association between diabetes status (p = 0.014), anemia status (p = 0.035), knowledge of TB (p = 0.009), knowledge of COVID-19 (p = 0.014), and family history of COVID-19 exposure (p = 0.011) to the treatment outcomes of pulmonary TB treatment during the pandemic. CONCLUSION: Associated factors to the outcome of treatment for pulmonary TB patients undergoing TB treatment during a pandemic included diabetes mellitus status, anemia status, knowledge of TB, knowledge of COVID-19, and family history of exposure to COVID-19.

Dynamic characteristic of SARS-CoV-2 and its antibody detection

To prevent excess morbidity and mortality of Covid-19, a prompt and accurate diagnosis is crucial. Antibody-based rapid diagnostic test (RDT) is a rapid, fairly reliable, and useful diagnostic testing solution for COVID-19. As a point-of-care test with fast turnaround time, the kit permits quick screening in hospitals to avoid the crowding of specimen collection. However, available RDTs kits have different sensitivity, specificity, and accuracy profiles due to antigen and antibody variability because of the sequence mutation of the SARS-CoV-2 gene. Therefore, it is strongly recommended to either re-measure the accuracy of a rapid test before using it in a different country or use tests developed based on local viral characteristics

Do the acute lymphoblastic leukemia and non-hodgkin lymphoma patients have a worse prognosis of COVID-19 infection in children?: a case report

Background: Coronavirus Disease 2019 (COVID-19) is a contagious disease caused by a new type of Coronavirus namely Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Children with tumors or autoimmune diseases are more susceptible, because of suppression of their immune system, chemotherapy, radiotherapy, or surgery on tumors. Case presentation: We present the clinical features 3 Acute Lymphoblastic leukemia and 1 Non-Hodgkin lymphoma patients who were infected with COVID-19 since July to August 2020 in our hospital. These were the first four cases identified as COVID-19 positive in Dr Wahidin Sudirohusodo Hospital. Case 1, 2, and 4 were diagnosed as moderate and common type of COVID-19, while case 3 was classified as severe type. They may be transmitted COVID-19 infection during hospitalization. All cases were recovered from COVID-19 after a combination therapy against virus, bacteria, and also respiratory support. Conclusion: Our case series of four pediatric cancer patients showed a good outcome after prompt treatment, suggesting that malignancy in children may not be a contributor factor for COVID-19 recovery. Keywords: COVID-19; acute lymphoblastic leukemia; non-hodgkin lymphoma; children   Abstrak Latar belakang: Covid-19 (Coronavirus disease 2019) adalah penyakit menular yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Anak yang menderita kanker atau penyakit autoimun lebih rentan tertular karena penurunan system kekebalan tubuh, dampak kemoterapi, radioterapi, atau operasi tumor. Penyajian kasus: Kami melaporkan 3 pasien leukemia limfoblastik akut  dan 1 pasien limfoma non-Hodgkin yang terinfeksi Covid-19 sejak Juli-Agustus 2020. Kasus tersebut adalah 4 kasus pertama yang teridentifikasi Covid-19 di Rumah Sakit Dr. Wahidin Sudirohusodo. Kasus 1,2, dan 4 terdiagnosis positif Covid -19 derajat sedang, sedangkan kasus 3 tergolong berat. Mereka kemungkinan terinfeksi Covid-19 saat perawatan. Semua kasus dinyatakan sembuh dari Covid-19 setelah pemberian obat anti virus, antibiotik, dan alat bantu pernapasan. Kesimpulan: Serial kasus dari 4 pasien kanker anak dengan outcome yang baik setelah pengobatan yang cepat mengindikasikan bahwa penyakit keganasan pada anak kemungkinan bukan faktor yang berkontribusi dalam kesembuhan Covid-19. Kata kunci:  COVID-19; leukemia limfoblastik akut; limfoma non-hodgkin; anak    

Coexistence of tuberculous chancre on a chronic nonhealing wound and bilateral submandibular scrofuloderma

Cutaneous tuberculosis is caused by Mycobacterium tuberculosis with varied clinical features depending on the dissemination route and host immune status. Scrofuloderma is a type of cutaneous tuberculosis that often occurs in locations where there is an infected lymph node or bone underneath, whereas tuberculous chancre often appears in sites that are prone to trauma. Although several cases have been reported, the coexistence of more than one type of cutaneous tuberculosis is very rare. We report a 21-year-old immunocompetent male with a chronic nonhealing lesion on the left tibia followed by bilateral purulent ulcers on the submandibular area. Acid-fast bacilli examination was positive for M. tuberculosis, and the patient was diagnosed with tuberculous chancre and scrofuloderma, respectively. This case showed the importance of high clinical suspicion of cutaneous tuberculosis and the possibility of the coexistence of more than one type of cutaneous tuberculosis in order to avoid misdiagnosis and delay in treatment.

The difference between C-reactive protein (CRP) level in mother with preterm rupture membranes (PROM) and mothers with prolonged labor

OBJECTIVE

This study aimed to compare CRP between mother with PROM and mother with prolonged labor.

METHODS

It was a Cross-Sectional Study and sampling technique used was consecutive sampling, sample size was 50 mothers, consist of 25 PROM mothers and 25 prolonged labor mothers. Inclusion criteria were pregnant women over 37 weeks with PROM or prolonged labor, not suffering from HIV/AIDS, Hepatitis B, preeclampsia, eclampsia, kidney and diabetes mellitus. Blood was collected in both groups through vein. The blood was centrifuged to obtain serum and CRP was examined by the ELISA method in the laboratory of the Hasanuddin University Makassar. Data analyzed using Chi-square and independent T-test.

RESULTS

The mean CRP level of maternal with PROM was 11.00mg/l while the mean CRP protein level in prolonged labor was 16.00mg/l. Maternal CRP levels with prolonged labor are higher at 5.00mg/l compared to CRP PROM levels and it is statistically significant (p=0.002, p<0.05).

CONCLUSION

CRP levels of prolonged labor is higher compared to CRP PROM levels.

Relationship between Vitamin D Level and Serum TNF-α Concentration on the Severity of Chronic Obstructive Pulmonary Disease

BACKGROUND:

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease and disturbed bacterial clearance. Vitamin D deficiency is sometimes observed in COPD patients and as significant roles in increasing inflammation of airway obstruction and systemic obstruction, increasing pro-inflammatory cytokine including TNF-α, reduction of bacterial clearance and increase exacerbation risk due to infection. Also, vitamin D plays significant roles in the metabolism of calcium and mineralisation of bones and regulation system of immune. TNF-α also has essential roles in pathogenesis and inflammation of COPD. Several studies that investigate the relationship between vitamin D level and serum TNF-α concentration in COPD patients are relatively uncommon, including in Indonesia.

AIM:

This study aimed to assess the relationship between vitamin D level and TNF-α concentration in patients on the severity of the chronic obstructive pulmonary disease.

METHODS:

This study was a hospital-based descriptive cross-sectional study. Total samples were 50 COPD patients with the average age of older than 60 years during their enrollments at the Department of Pulmonology and Respiratory Medicine of the Dr Wahidin Sudirohusodo General Hospital Makassar in September 2018-January 2019. All procedures of the present study were reviewed and approved by the Research Ethics Committee of Medicine Faculty of Hasanuddin University. The severity of COPD was assessed according to the combination of COPD assessment stages that referred to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guideline 2015 that consisted of the combination of scoring COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) questionnaire and results of the spirometry measurement. Assessment of airway obstruction levels referred to the GOLD spirometry criteria. Determination of thoracic photographs was conducted to verify the COPD diagnosis of the severity of COPD. Determination of serum TNF-α concentration and vitamin D3 [1,25(OH)2D3] level used the ELISA method.

RESULTS:

The majority of COPD patients were observed in the category of older than 60 years old accounted for 34 COPD patients (68%), and the majority of COPD patients were males accounted for 47 males with COPD (94%). The majority of COPD patients were observed in the group of D (38%). All the study subjects observed in this study were smokers, and 82% of them were in the category of heavy smokers. 21 study subjects had higher concentration of serum TNF-α (tertile 3 = 0.21-1.83 pg/dl), 20 study subjects and lower level of vitamin D (tertile 1 = 182.1-364.5 pg/dl). The majority of the study subjects (38%) were in the category of severe COPD (category D of the severity of COPD at the tertile 3) according to the GOLD Combine Assessment. Given the relationship between vitamin D level and serum TNF-α concentration on the airway obstruction, there were significant positive correlations between the increase of vitamin D levels and the increase of serum TNF-α concentrations on airway obstruction. Given the relationship between vitamin D level and serum TNF-α concentration on the severity of COPD, there were significant positive correlations between the increase of vitamin D levels (tertiles 1, 2 and 3) and the increase of serum TNF-α concentrations on the severity of COPD at p-value < 0.05. Overall, there were non-linear relationships between vitamin D level and serum TNF-α concentration on the severity of COPD.

CONCLUSIONS:

Serum TNF-α concentration was positively associated with airway obstruction level and severity of COPD. Low level of vitamin D was negatively associated with airway obstruction level and severity of COPD. Vitamin D3 level (1,25(OH)2D) was negatively associated with serum TNF-α concentration and airway obstruction level and severity of COPD.

Presence of a mutation in ponA1 of Neisseria gonorrhoeae in numerous clinical samples resistant to various beta-lactams and other, structurally unrelated, antimicrobials

The number of resistant strains in patients with Neisseria gonorrhoeae urethritis has been increasing, making effective treatment difficult. Chromosomally mediated penicillin-resistant N. gonorrhoeae arise through alterations in penicillin-binding proteins (PBPs) and a decrease in outer membrane permeability. To understand the occurrence of penicillin resistance in patients with N. gonorrhoeae infection, we performed this study. In addition, we studied minimum inhibitory concentrations (MICs) of antimicrobials against N. gonorrhoeae strains. We measured the MICs of penicillin G, other beta-lactams, and other kinds of antimicrobials against 53 clinical N. gonorrhoeae isolates from male patients with urethritis in Hyogo and Osaka, Japan. The ponA genes, encoding PBP 1 of these isolates, were sequenced. Of the 53 isolates tested, 41 strains showed some resistance to penicillin G. A mutation in the ponA (ponA1) gene was identified in 46 isolates. There was a tendency that ponA mutant (ponA1) in N. gonorrhoeae led to higher antimicrobial MICs of beta-lactam antimicrobial agents (including penicillin) than those of non-ponA mutants. However, we found lower than expected MICs of penicillin and beta-lactams even in ponA mutants. Therefore, we consider that detailed investigations for the further understanding of the effect of other genes, such as penC (which is reported to be related to ponA1 in achieving high-level penicillin resistance) should be our next step.