COVID-19 in an immunocompromised host: persistent shedding of viable SARS-CoV-2 and emergence of multiple mutations: a case report.

This article reports a case of a 21-year-old woman with refractory B-cell acute lymphocytic leukaemia who presented with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). She remained positive for SARS-CoV-2 by viral culture for 78 days and by polymerase chain reaction (PCR) for 97 days. Sequencing of repeat samples over time demonstrated an increasing and dynamic repertoire of mutations.

Pyelonephritis and Bacteremia Caused by following Renal Transplantation.

() is a Gram-negative organism genetically similar to () that can cause a variety of diseases in humans. Bacteremia due to is associated with a higher mortality rate than bacteremia with . Here, we describe a 65-year-old woman who developed pyelonephritis 2 months after receiving a renal transplantation following a longstanding history of end-stage renal disease secondary to polycystic kidney disease.

Laboratory Exposures from an Unsuspected Case of Human Infection with Brucella canis.

We report a case of human infection with a Brucella canis isolate in an adult in Canada who was receiving a biologic immunomodulating medication. We detail subsequent investigations, which showed that 17 clinical microbiology staff had high-risk exposures to the isolate, 1 of whom had a positive result for B. canis.

A Rare Case of Complex Septic Arthritis.

Bacteria of the complex have rarely been reported to cause septic arthritis. Cases have been reported in patients who were immunocompromised, at extremes of age or who had history of steroid injection or penetrating trauma. A 67-year-old man with a history of opioid use disorder, osteoarthritis, and gout but no known immunocompromise was admitted to hospital with pain and swelling of his right knee.

Continued low uptake of treatment for hepatitis C virus infection in a large community-based cohort of inner city residents.

Background & Aims: Despite advances in HCV treatment, recent data on treatment uptake is sparse. HCV treatment uptake and associated factors were evaluated in a community-based cohort in Vancouver, Canada.

Methods: The CHASE study is a cohort of inner city residents recruited from January 2003-June 2004.

Mortality in a large community-based cohort of inner-city residents in Vancouver, Canada.

Background: The Downtown Eastside is a robust and densely populated neighbourhood in Vancouver, Canada, that is characterized by low-income housing and drug use and a high prevalence of HIV infection. We evaluated mortality and excess mortality among the broader community of individuals living in this neighbourhood.

Methods: The Community Health and Safety Evaluation is a community-based study of inner-city residents in the Downtown Eastside who were recruited in 2003 and 2004.

Successful approach to treatment of Helicobacter bilis infection in X-linked agammaglobulinemia.

Helicobacter bilis, an unusual cause of chronic infections in patients with X-linked agammaglobulinemia (XLA), is notoriously difficult to diagnose and eradicate. Based on the limited number of cases reported worldwide, we highlight the typical features of H. bilis infection in XLA and provide a rational and successful approach to diagnosis and treatment of this challenging infection.

Influenza vaccines provide diminished protection but are cost-saving in older adults.

Influenza is associated with substantial morbidity and mortality in adults aged over 65 years. Although vaccination remains the most effective method of preventing influenza and its sequellae, current vaccination strategies provide less protection to older adults than to younger persons. Influenza vaccination in community-dwelling older adults is cost-effective, though there is room for improvement.

Rural/urban differences in accounts of patients' initial decisions to consult primary care.

In the UK, patients in urban areas consult primary health care more than rural patients for both trivial and serious conditions. This study, involving focus groups and interviews, examined rural/urban differences in accounts of patients' intentions around initial decisions to consult general practice. Findings suggest 'relationships' between doctors and patients and easier access to appointments could affect consulting in rural areas, while decision-making for urban patients tended to be more consumerist.

Management of ischaemic stricture at a gastro-jejunostomy by self-expanding metallic stent insertion.

This report details the use of a self-expanding metallic stent (SEMS) in the relief of an ischaemic stricture at a gastro-jejunostomy in a patient who was unfit for surgical intervention. Good initial results are reported, along with satisfactory long-term follow-up. A brief discussion of the current relevant literature is also included.

Pyomyositis mimicking right iliac fossa mass: review of the literature.

Pyomyositis is a pyogenic infection of skeletal muscle. Its incidence in temperate countries though low is rising. Most cases from the temperate region involve immuno-compromised patients.

Small bowel volvulus: a review.

Small bowel volvulus is a rare but life-threatening surgical emergency. The aetiology may be primary, as is often seen in Africa and Asia, while in Western countries other predisposing conditions usually initiate the volvulus. Early preoperative investigation and expedient surgical treatment is required if bowel infarction is to be prevented.

A measurement of the ability to drive after different types of inguinal hernia repair.

Recovery following different types of inguinal hernia repair has been objectively assessed by measuring reaction times when the subject performs an emergency stop in a driving simulator. A control group of patients who underwent varicose vein surgery to the groin under general anaesthetic without any muscle dissection demonstrated no alteration in response times. Eighty-two percent of those who underwent laparoscopic repair and 64% of those who underwent Lichtenstein repair returned to their preoperative times by 7 days after surgery.

Controlled trial of preperitoneal local anaesthetic for reducing pain following laparoscopic hernia repair.

Background: A prospective randomized trial was performed to determine whether local anaesthetic solutions injected into the preperitoneal space may provide additional pain relief following transabdominal preperitoneal laparoscopic hernia repair.

Methods: One hundred patients undergoing transabdominal preperitoneal laparoscopic hernia repair were allocated randomly to receive (1) bupivacaine 1.5 mg/kg, (2) bupivacaine 1.

Are complications of endoscopic sphincterotomy age related?

Background: Endoscopic retrograde cholangiopancreatography sphincterotomy is increasingly performed in younger patients undergoing laparoscopic cholecystectomy. However, the safety of endoscopic sphincterotomy in this age group, relative to that in older patients, is unknown.

Aim: To determine whether the development of short term complications following endoscopic sphincterotomy is age related.

Laparoscopic hernia repair (TAPP): a new method to reduce port-site-herniation.

This article describes a method of transperitoneal laparoscopic hernia repair to reduce port-site herniation by using one umbilical 12-mm port site and a 5-mm laparoscope.

A prospective study of adult inguinal hernia repairs using absorbable sutures.

A prospective study was conducted over a 5-year period to determine whether inguinal hernia repair could be safely performed with absorbable suture material (polydioxanone) with reference to recurrence rates, wound pain, haematoma formation and wound infection. Analysis is available for 111 operations involving 111 patients. Mean follow-up was 36 (range 21-66) months, with 81 procedures monitored for more than 2 years.

An audit of thyroid surgery in a general surgical unit.

A total of 143 patients undergoing thyroid surgery in a general surgical unit over an 8-year period were reviewed. In only two patients did thoracic inlet views or thyroid function tests alter clinical management. Fine-needle aspiration failed to detect one well-differentiated follicular carcinoma (false-negative rate 1.

Laparoscopic 'bikini mesh' repair of bilateral inguinal hernia.

Laparoscopic hernia repair using a single piece of mesh was performed in 150 patients with bilateral inguinal hernia. The median operating time was 43 (range 30-90) min with a median hospital stay of 1 (range 1-10) days. In all, 138 patients were discharged within 24 h of operation.

Amyloid tumour of the colon.

A case of amyloid tumour of the colon and the first in association with a carcinoma is reported. A previously healthy 65 year old man presented with non-specific symptoms of lower abdominal pain and flatulence without rectal bleeding. A clinical diagnosis of diverticular disease was made and colonoscopy performed.