Articles

Background: Hospital-acquired infections (HAIs) caused by multidrug resistant (MDR) bacteria are a major public health problem especially in resource-limited settings. Local data on antimicrobial resistance (AMR) are crucial to inform empirical therapy and infection prevention. Objectives: To identify bacterial pathogens causing HAIs, determine their AMR profiles and independent risk factors for MDR infections in a tertiary hospital in Erbil City, Iraq. Materials and Methods: A cross-sectional study was done at Hawler Teaching Hospital between January and June 2026. Standard microbiological methods were used to analyse 200 clinical specimens from patients with HAIs (≥48 hr after admission). Antimicrobial susceptibility testing was performed according to CLSI 2024 guidelines. MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial classes. Multivariate logistic regression was used to assess independent risk factors. Results: Bacterial growth was obtained in 149 of 200 specimens (74.5%). The major pathogens were Escherichia coli (31.5%), Klebsiella pneumoniae (23.5%), Staphylococcus aureus (21.5%), Pseudomonas aeruginosa (14.1%) and Acinetobacter baumannii (6.1%). In total, 69.1% of the isolates were MDR, with the highest rates in K. pneumoniae (80.0%) and A. baumannii (77.8%). Independent predictors of MDR infection were previous antibiotic use (AOR=4.45), ICU admission (AOR=3.92), and hospitalization >7 days (AOR=3.10). Conclusion: This study documented a significant burden of MDR-HAIs in Erbil City and determined modifiable clinical risk factors. The findings provide evidence to support antimicrobial stewardship, infection prevention and AMR surveillance in Iraqi healthcare settings.

Heterotaxy syndrome comprises a group of congenital anomalies resulting from disrupted left-right axis patterning during embryonic development, leading to an abnormal arrangement of the thoracic and abdominal organs [1]. It is a rare condition, with an estimated prevalence of approximately 1 per 10,000 live births, and is frequently associated with complex congenital heart defects, making it a life-threatening disorder with significant morbidity and mortality [1]. Clinically, heterotaxy syndrome is classified into right atrial isomerism (Ivemark syndrome) and left atrial isomerism. Ivemark syndrome represents the most severe form and is primarily characterized by asplenia, complex cardiovascular anomalies, and abnormal positioning of the thoracoabdominal organs [2]. In this condition, paired organs exhibit right-sided morphology bilaterally, commonly accompanied by functionally univentricular physiology, extensive septal defects, dextrocardia, and extracardiac malformations such as intestinal malrotation and congenital absence of the spleen [2,3]. Asplenia is a hallmark feature that markedly increases susceptibility to overwhelming bacterial infections, while the associated congenital heart defects account for the high morbidity and mortality observed during the neonatal period [2]. Herein, we report the case of a male neonate with clinical and imaging findings consistent with Ivemark syndrome who experienced a rapidly progressive and fatal clinical course during the first week of life. A comprehensive review of the available literature identified only a limited number of published cases and scarce documented evidence. Therefore, this case report is supported primarily by the currently available international literature.

Background: Gallibacterium anatis is an opportunistic pathogen, mainly associated with infections in poultry. Infections in humans have only been described four times (in France and China). Case presentation: We report the case of a 62-year-old non-immunocompromised male patient with a gastric bypass in his medical history, presenting with cholecystitis in whom Gallibacterium anatis was isolated from the blood, besides an Escherichia coli. Identification of the G. anatis was achieved using MALDI-TOF MS and confirmatory 16s RNA sequencing. The patient was successfully treated with piperacillin-tazobactam, resulting in clinical improvement. In the context of impaired host defenses due to acute cholecystitis with an E. coli bacteremia, it is conceivable that G. anatis entered the bloodstream through bacterial translocation from the gastrointestinal tract. Conclusion: This case highlights the importance of advanced identification techniques and awareness of rare pathogens in clinical practice. Gallibacterium anatis, particularly drug-resistant strains, may represent a potential infectious agent and should therefore be considered in diagnostic work-up.

Background: In Systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease, central nervous system infections are uncommon, affecting about 1% of cases. However, diagnosis is often challenging due to overlapping autoimmune and infectious features, nonspecific neurological symptoms, and limited diagnostic specificity, which may delay appropriate treatment and worsen outcomes. Case Report: An 80-year-old male with a five-year history of systemic lupus erythematosus (SLE) presented with a two-day history of generalized weakness that subsequently progressed to recurrent focal seizures and later to generalized seizures accompanied by a profound decline in consciousness. Despite adequate administration of antiepileptic and sedative therapy, persistent seizure activity was observed. Meningitis Panel evaluation confirmed herpes simplex virus type 1 (HSV-1) encephalitis, complicated by severe systemic inflammation, anemia, thrombocytopenia, renal dysfunction, and respiratory acidosis findings indicative of multi-organ failure. Magnetic resonance imaging of the brain revealed bilateral asymmetric hyperintense lesions involving the insular regions, medial temporal lobes, and frontal cortices, consistent with viral encephalitis. The patient underwent comprehensive intensive care management, including intravenous antiviral, antimicrobial, corticosteroid, and supportive therapies. However, his clinical condition progressively deteriorated, culminating in death on the fourth day of hospitalization. Discussion: This case illustrates the diagnostic and therapeutic complexity of herpes simplex virus type 1 (HSV-1) encephalitis in a patient with systemic lupus erythematosus (SLE), a rare but fatal complication. In immunocompromised individuals, atypical clinical and cerebrospinal fluid findings may obscure diagnosis and delay treatment. Immunosuppressive therapy and underlying immune dysregulation further increase vulnerability to opportunistic infections and multi-organ failure. Early recognition of viral encephalitis in SLE patients with acute neurological symptoms is therefore crucial to optimize outcomes. Conclusion: Encephalitis in SLE is a rare but serious complication with overlapping autoimmune and infectious features. Early recognition and timely antiviral immunosuppressive therapy are essential to improve outcomes.

Objective: This systematic review aimed to identify, synthesize, and critically analyze the available evidence on clinical protocols used for the prevention and treatment of prosthetic joint infection (PJI) in total hip arthroplasty (THA), based on studies published between 2000 and 2025. Methods: The review was conducted according to PRISMA guidelines. Electronic searches were performed in PubMed (MEDLINE), Scopus, Web of Science, and Embase between January and April 2025. Eligible studies included clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses published in English that addressed either preventive or therapeutic strategies for PJI in THA. Study selection, data extraction, and quality assessment were carried out independently by two reviewers. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Results: A total of 32 studies were included. Preventive measures identified in the literature comprised combined antibiotic prophylaxis (cefazolin and gentamicin), multimodal perioperative protocols such as ACERTO, nasal decolonization for Staphylococcus aureus, silver-impregnated dressings, and structured post-discharge surveillance. Treatment strategies included DAIR (Debridement, Antibiotics, and Implant Retention), the DAPRI technique, one-stage and two-stage revision surgeries, muscle flap reconstructions, and protocols without spacers. These interventions were associated with significantly reduced infection rates and improved clinical outcomes when applied appropriately and in accordance with patient-specific factors. Conclusion: Effective prevention and treatment of PJI in total hip arthroplasty require a systematic and evidence-based approach. Integrated protocols—spanning preoperative optimization, meticulous intraoperative techniques, and rigorous postoperative monitoring—have proven effective in reducing infection incidence. In cases of established infection, surgical management must be tailored to the timing of infection, microbial profile, and host conditions. Two-stage revision remains the gold standard for complex infections, while one-stage revision and emerging techniques like DAPRI offer promising results in selected cases. This review contributes to the standardization of clinical practice and supports improved patient outcomes.

Effective infection control requires a close fit between the mask and face to minimize gaps. This study investigated whether surgical mask performance varies with face shape and mask size. Three facial models were 3D-printed using head-related transfer function data. Two mask sizes were tested on each model, and 3D measurements were taken at five facial points: the nose, cheeks, and chin to assess mask-to-face gaps. To simulate droplet emission, an aqueous sodium chloride solution was released from a pseudo-oral cavity in the models, and air leakage was measured using a mask-fitting tester. A two-way analysis of variance (ANOVA) was used to examine the effects of face and mask size on leakage. Small face models showed significantly higher leakage than medium and large ones (p < 0.001), and S-sized masks leaked more than M-sized masks regardless of face size (p = 0.038). Linear regression showed a positive correlation between chin gaps and leakage when using S-sized masks (p < 0.05). These results suggest that medium-sized masks offer better overall performance. However, for small faces, fit—especially at the chin, requires particular attention.

Lemierre’s syndrome (LS) is a rare clinical condition characterized by septic thrombophlebitis of the internal or external jugular vein, usually following an oropharyngeal infection. Here, we present a 20-year-old male patient who developed diarrhea, nausea, and vomiting after receiving clarithromycin for an upper respiratory tract infection. On admission, he had fever, hypotension, and elevation in acute phase reactants (WBC: 20,410/µL, CRP: 197 mg/L). Empirical treatment with ceftriaxone and metronidazole was initiated. Stool and throat cultures were negative. On the second day, abdominal tenderness developed; direct abdominal radiograph showed dilated bowel loops, but toxic megacolon was excluded during follow-up. Thoracic CT revealed septic emboli in the lungs. Due to persistent fever despite ceftriaxone and metronidazole therapy, treatment was escalated to meropenem on the fifth day. On the same day, blood cultures grew Fusobacterium necrophorum, raising suspicion of LS. Doppler ultrasound detected a thrombus in the left external jugular vein. Anticoagulant therapy with low-molecular-weight heparin and clopidogrel was initiated. The fever resolved by the seventh day of full antibiotherapy After three weeks of intravenous therapy, follow-up imaging showed regression of the thrombus. The patient completed a four-week course of antibiotics and anticoagulants and was discharged with full recovery. This case highlights the diagnostic challenge of LS presenting with gastrointestinal symptoms and emphasizes the importance of early blood cultures and imaging. External jugular vein involvement due to F. necrophorum is rare and should be considered in patients presenting with septic emboli.

Avian influenza is a very lethal disease caused by influenza viruses that normally circulate among birds, and contains well-known subtypes are A(H5N1) and A(H7N9). Human infection is rare and occurs through close contact with infected poultry, therefore, confirming a history of such contact is important. The same treatment as for seasonal influenza is recommended, such as the neuraminidase inhibitors, cap endonuclease inhibitors, and RNA polymerase inhibitor. The avian influenza patients are regulated by the Infectious Diseases Control Law in Japan, we should manage the avian influenza appropriately.

This article presents a mathematical model designed to simulate the impact of targeted interventions aimed at preventing HIV transmission among female sex workers (FSWs) and their clients, while also analyzing their effects on the health of the general population. The compartmental model distinguishes between high-risk populations (FSWs and their clients) and low-risk populations (sexually active men and women in the general population), and links prevention efforts in high-risk groups to the evolution of the epidemic in the low-risk population. The fundamental properties of the model, such as the positivity of solutions and the boundedness of the system, have been verified, and the basic reproduction number R₀ has been calculated. Finally, the stability of the model was studied using Varga’s theorem and the Lyapunov method. Simulation results show that targeted prevention among FSWs and their clients reduces HIV incidence in the general population. This framework provides a valuable tool for guiding policymakers in the design of effective strategies to combat the epidemic, especially relevant in the context of suspension of USAID funding.

Legionnaires' disease became widely known following an outbreak of pneumonia in the United States in 1976. It is often caused by infection from artificial water sources such as cooling towers, water supply and heating systems, and recirculating hot tubs. To effectively implement infection prevention measures for Legionnaires' disease, collaboration among healthcare workers, water supply and heating system managers, building hygiene personnel, and other relevant parties is essential. It is important to note that outbreaks of Legionnaires' disease continue to occur frequently both domestically and internationally. While the number of reported cases of Legionnaires' disease in Japan has increased, the mortality rate has decreased but has stabilized at a lower level. Caution is also required as reports have been made in association with disasters and travel, in addition to artificial environmental water.

Objective: This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. Methods: A systematic review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar, targeting studies published between 2015 and 2025. Articles were selected based on their contribution to understanding the clinical, microbiological, and surgical aspects of PJI in THA. Fifty-five studies met the inclusion criteria and were analyzed descriptively. Results: PJI in THA is influenced by multifactorial risk profiles, including obesity, diabetes, and immunosuppression. Staphylococcus aureus, particularly MRSA, remains the most frequently isolated pathogen, followed by Gram-negative organisms and fungal species. Diagnostic innovations such as next-generation sequencing have enhanced pathogen detection, while two-stage revision remains the gold standard for chronic infections. Emerging strategies—such as antimicrobial coatings, tailored antibiotic protocols, and multidisciplinary care models—demonstrate promise in improving clinical outcomes. Conclusion: Managing PJI in THA necessitates a comprehensive and individualized approach, integrating early and accurate diagnosis, pathogen-specific treatment, and advanced preventive measures. The integration of emerging technologies and personalized care pathways is critical to optimizing outcomes and reducing the clinical and economic burden of PJI.

Respiratory syncytial virus (RSV) is commonly known as a pathogen of the bronchiolitis in children, however, recently also as a pathogen of the severe virus pneumonia in adults, especially elderly persons, and vaccines for elderly persons have been developed. There are two vaccines, such as the vaccines targeted for subgroup A with the adjuvant, and that targeted for both subgroup A and B but not included the adjuvant in Japan. Both vaccines are considered effective to prevent not only the incident of RSV infection/pneumonia, but also the exacerbations of the elderly persons with underlying diseases including chronic cardiopulmonary diseases.

COVID-19 vaccines have demonstrated efficacy in reducing the prevalence of serious illnesses. The relative risk of hospitalization and mortality for patients who get breakthrough infections after immunization versus those who develop reinfections after a prior spontaneous infection is examined in this correspondence. Based on a study on U.S. Veterans who were not vaccinated and experienced reinfections had a much higher risk of experiencing severe illness outcomes compared to those who had received immunizations and experienced breakthrough infections, even if the rates of reinfection and breakthrough infection were similar. Our findings highlight the value of immunization in reducing severe COVID-19 outcomes, even in the presence of reinfections.

Background: Peripartum cardiomyopathy (PPCM) is a life-threatening heart muscle disease of unknown aetiology that affects women during the peripartum period, particularly in sub-Saharan Africa. While many studies have observed normal blood pressure (BP) in PPCM patients, none have explored whether their BP is appropriate for their body size. This study investigated the correlation between body anthropometric parameters and BP in PPCM patients, comparing the findings with those of age-matched normal peripartum controls. Methods: A cohort of 105 women, each from PPCM and matched normal peripartum control groups, were recruited from three healthcare facilities in Sokoto. Blood pressure (BP) parameters were assessed in relation to their anthropometric measurements, and the findings were compared between the two groups. Results: The PPCM patients were significantly smaller in body weight (57.0 ±11.6 Kg vs 66.8 ±13.8 Kg, P <.0001), body mass index (BMI) (21.9 ±4.1 Kg/m2 vs 25.4 ±5.4 Kg/m2, P <.0001, body surface area (BSA) (1.3 ±0.7 m2 vs 1.7 ±0.2 m2, P <.0001), Lean body mass (LBM) (45.3 ±7.0 Kg vs 49.4 ±4.1 Kg, P <.0001) and Percentage body fat (BF) (23.5 ±10.9 % vs 31.2 ±6.9 %, P <.0001). Similarly, PPCM patients had significantly higher systolic BP (SBP), Pulse pressure (PP) and Mean arterial blood pressure (MABP) compared to the normal peripartum PPCM control. Further, linear regression analysis showed that there was higher slope of the relationship between anthropometric indices and SBP and PP in the PPCM cohort, compared to the normal peripartum control group. A similar trend of the slope was seen in the Pearson’s coefficient of the relationship of the anthropometries and BP parameters. Conclusions: This study found that women with peripartum cardiomyopathy (PPCM) exhibited disproportionately higher systolic blood pressure (SBP) and pulse pressure (PP) for each unit increase in anthropometric measurements compared to normal peripartum controls. Notably, PPCM patients had significantly lower anthropometric measures, potentially attributable to poverty and chronic undernutrition. Additionally, the effects of poor antenatal care, lack of immunization and recurrent infection should be considered. These findings suggest an abnormal relationship between anthropometry and blood pressure in PPCM patients, which may have detrimental effects on their cardiovascular health. This abnormal relationship may contribute to the development of heart failure (HF) in PPCM patients and potentially increase the risk in women susceptible to PPCM. Even-though our assumption, yet to be proven. To address this concerning trend in vulnerable populations, improvements in nutritional status, socioeconomic determinants health, adequate antenatal care (ANC), immunization, and infection prevention should be considered.

Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among mothers of neonates in Sherpur District, Bangladesh, and identify factors associated with knowledge levels. Methods: A descriptive cross-sectional study was conducted from July to October 2020 at Sherpur Sadar Hospital. A total of 193 mothers of neonates were recruited using a non-randomized purposive sampling method. Data was collected through a pre-tested, semi-structured, interviewer-administered questionnaire. Knowledge levels were categorized as "Good" (>6) or "Poor" (≤6) based on responses to 10 structured questions. Statistical analyses, including chi-square tests and crude odds ratios (COR), were performed to identify socio-demographic factors associated with knowledge levels. Results: Of the 193 participants, 48.7% demonstrated "Good" knowledge, while 51.3% had "Poor" knowledge. Education level (p = 0.01), occupation (p = 0.02), family type (p < 0.001), and family size (p = 0.04) were significantly associated with knowledge levels. Mothers with higher education and those from joint families exhibited better knowledge. However, 28.5% of respondents were unaware of the typical umbilical cord-shedding timeframe, and 44% could not identify signs of infection. Unsafe practices, such as using medications (14.5%) or hot compression (7.2%) for drying the cord, were reported. Conclusion: The study reveals significant gaps in maternal knowledge regarding umbilical cord care in Sherpur District, driven by socio-demographic disparities and cultural practices. Targeted health education programs, emphasizing evidence-based cord care practices and leveraging local social structures, are urgently needed to improve neonatal health outcomes in similar resource-limited settings. Future research should evaluate the effectiveness of these interventions to inform policy and practice.

The purpose of this study was to assess different periodontitis groups affected with mild, moderate and severe alveolar bone levels and treated using the Sandwich’s procedures. A total of 53 subjects, who had taken two sets of full-mouth standarized paralleling radiographs with mean observation time was 10.18±3.89 years and (ranges: 5.1 to 18.3 years) were collected for the past 20 years. The radiographic alveolar bone levels (RABL) at mesial and distal aspects of teeth were assessed by measuring the distance between cemento-enamel junction (CEJ) and the bone crest using an electronic digimatic caliper (EDC) under 7.5 magnified radiographs. The patients, who presented with SAP, were between 24 and 84 years of age, with a mean age of 54.8±10.2years. Although, the treatment of angular defects in molars with guided tissue regeneration, emdogain has been reported and has exhibited significant and predictable results, however, afforded very limited and less predictable results in the treatment of advanced class II and III maxillary furcation defects. The majority of root resection procedures are commonly recommended for treating advanced molar furcation, in particular located at molars with class III furcation involvement, there is still some controversy regarding the long-term prognosis after different treatment modalities. In general, the root resection procedure is a surgical approach for simultaneously performing a periodontal flap operation at first and followed by the amputation and/or resection of maxillary root(s). There are some complications and disadvantages, such as post-operative pain and bleeding, swelling, infection, etc. The present report is to describe the combination of therapeutic provisional prosthesis (TPP), fixed prosthesis, non-surgical procedure using root separation and/or resection (RSR) and for the treatment of advanced Class II and III furcation-Involved molars. In addition, evidenced-based clinical trials of retrospective and longitudinal data were also prescribed here. The purpose of this study was to present treatment procedures of Sandwich’s technique and retrospectively to evaluate the long-term clinical trials of this method in treating molar teeth with SAP and molar FI who were diagnosed as guarded and/or hopeless prognosis.

Central line-associated bloodstream infections (CLABSIs) are important hospital-acquired infections that are related to increased mortality in cardiac intensive care units (CICUs). To determine the risk factors for CLABSIs, a case-control study was conducted in the CICU of our hospital. Emergency surgery (odds ratio: 9.6, 95% confidence interval: 1.633-56.926) was the strongest risk factor comparing the case group (n=11) to the control group (n=22). In addition, the indwelling period was significantly longer in the case group than in the control group (median 9 days versus 7 days, p=0.004). An intervention for the insertion of central lines was then started, with 1) thorough use of chlorhexidine-impregnated dressings (also known as chlorhexidine patches, CHG patches) in the insertion of central lines before emergency surgery, and 2) exchange of the central line 7 days after emergency surgery. After the intervention, the CLABSI incidence rate decreased from 6.8 to 0.8/1,000 device-days. These data suggest the usefulness of CHG patches and the importance of the early exchange of central lines in the CICU in patients following emergency surgery.

Respiratory virus co-infections have been suggested to happen frequently and exacerbate patients’ conditions, but little is known about the detailed rates and the combinations of viruses during the COVID-19 pandemic period. A total of 255 symptomatic patients who underwent multiplex PCR tests were analyzed, and it was found that 6 (6/255=2.4%) patients were infected with multiple viruses. The patients ranged in age from 1 to 38 years, and one female patient was pregnant. Of the 6 patients, 4 had fever, and 5 had human rhinovirus/enterovirus and another virus. These data suggested that the rate of respiratory virus co-infection was low, and the combination of SAS-CoV-2 and other viruses was rare even during the COVID-19 pandemic.

The study is a follow-up of the study "Coronavirus in pregnant patients and their clinical outcomes – results of a case-control study" conducted by R.Kadriu et al (2023) in which,in addition to the pregnant patients whose outcome is now being investigated,a control group of patients who were not pregnant,conducted with pregnant patients and a control group that were non-pregnant patients.This study was conducted 6 months after the discharge of the patients and their newborns,and highlights the impact of COVID-19 on their health as well as the health of the newborns. The aim of the study is to follow up the patients after 6 months of their hospitalization as COVID-19 patients and after their delivery.In the COVID study, none of the health indicators showed statistically significant differences between the population before and after hospitalization.Patient data were collected at the case level summarized in their respective groups.For secondary objectives, several comparative analyzes were performed regarding comorbidity-related parameters and available risk factors.A significance level (α) of 0.05 was used for statistical significance. While these results may be reassuring regarding the stability of health status, one should be aware of the limitations of the study, including sample size and specific population characteristics.

Background: The titers of SARS-COV-2 antigens are frequently used as markers of viral activity and threshold for release from quarantine and treatment. COVID-19 patients were treated with several antiviral agents, including remdesivir (RDV) and ensitrelvir (ESV), which is a novel anti-SARS-CoV-2 agent recently suggested to have strong antiviral activity. Cases: We present the cases of two patients whose SARS-CoV-2 antigens were successfully decreased by oral administration of ESV after they could not be decreased by RDV drip infusion. Case 1 was a 74-year-old man who was admitted with SARS-CoV-2 infection and had been infected by the virus a month earlier and relapsed twice. He had been treated with rituximab for diffuse B cell lymphoma and not received vaccination for SARS-CoV-2. RDV was administered intravenously two weeks earlier and again 4 days earlier, but it failed to control the infection, and he was transferred to our hospital (day 1). Intravenous RDV was restarted on day 1, but viral antigens remained high until day 5. The RDV was then switched to oral ESV, and viral antigen titers were successfully decreased on days 8, 10, and 12. Case 2 was an 81-year-old man who was admitted with SARS-CoV-2 infection on day 0. He had heart failure and diabetes mellitus, and had not received vaccination for SARS-CoV-2. Intravenous RDV was started on day 1, but viral antigens were still high until day 8. He was then switched from RDV to oral ESV, and viral antigen titers were successfully decreased on day 11. Conclusions: These cases suggest that ESV might be more effective than RDV for reducing viral activity, and it is easy to administer orally.