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We describe the case of an immunocompetent 75-year-old man with Capnocytophaga canimorsus bacteraemia and meningitis. C. canimorsus is commonly found in the oral flora of dogs with human infection typically occurring following a bite. Unusually, while our patient was a dog owner, there was no history of bite nor scratch mark. Admission blood cultures flagged positive for Gram-negative bacilli, but prolonged molecular analysis was required before C. canimorsus was isolated in blood and cerebrospinal fluid. There is a high mortality rate in invasive infection, and in our patient’s case, antibiotic therapy was commenced prior to laboratory confirmation with our patient making a complete recovery. This case highlights the importance of including C. canimorsus in the differential diagnosis of unwell patients who keep dogs, even without a bite. This case occurred amid heightened awareness of COVID-19, which may represent predisposition for zoonoses during social isolation and increased human–pet contact.

Generalităţi: Cura herniilor inghinale prin procedeele transabdominal preperitoneal (TAPP) şi total extraperitoneal (TEP) sunt recunoscute pentru scăderea riscului de durere cronică postoperatorie şi cu rate de recidivă acceptabile. Totuşi procedeele hibrid/combinate încă sunt o opţiune semnificativă în rândul chirurgilor. Scopul este de a compara tehnicile hibrid TIPP (hTIPP) folosind sistemul Ultrapro Hernia ® (UHS) şi TEP privind rezultatele şi satisfacţia pacienţilor şi de a analiza siguranţa şi eficienţa celor două procedee. Materiale şi Metode: Nouăzeci de pacienţi care au fost operaţi între anii 2013-2017 pentru hernie inghinală prin procedeele hTIPP sau TEP la spitalul Naas General Hospital, Irlanda au fost incluşi într-o bază de date şi analizaţi într-un studiu retrospectiv. Rezultate: Internarea postoperatorie neplanificată a fost comparabilă între cele două grupuri (3 pacienţi pentru hTIPP şi 3 pacienţi pentru TEP). Nu a fost nicio diferenţă statistică între complicaţiile imediat şi tardiv postoperatorii. Rata de recidivă a fost nulă în grupul hTIPP comparativ cu TEP unde a existat o recidivă. Pe baza chestionarului PROM şi scalei Likert, nu există diferenţe statistic semnificative privind satisfacţia pacienţilor între hTIPP şi TEP.Concluzii: Nu există diferenţă statistic semnificativă privind rata de complicaţii şi satisfacţia pacienţilor între hTIPP şi TEP. hTIPP este un procedeu sigur şi o alternativă validă. AbstractBackground: Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP) inguinal hernia repairs are largely acclaimed for their lower risk of chronic postoperative pain and acceptable recurrence rates. However, hybrid/combined open procedures are still a reliable option among surgeons. Our aim is to compare the outcomes and patients' satisfaction of hybrid TIPP (hTIPP) procedure using the Ultrapro Hernia System® with laparoscopic pre-peritoneal mesh repair approaches (TEP) to assess its safety and effectiveness. Patients and Methods: The study design is a single center, retrospective comparative study on 90 patients who had hTIPP and TEP inguinal hernia repair in the NAAS General Hospital, over a four-year period (2013-2017). Results: Unplanned postoperative hospital admission was comparable both groups, the figures were 3 patients for hTIPP and 3 patients for TEP. There was no statistically significant difference in the immediate, early and late postoperative pain and complications in both groups. The recurrence rate was nil in hTIPP group compared to one recurrent case in TEP. There is no statistical difference in the five outcomes of the PROM questionnaire and satisfaction rate between hTIPP and TEP. Conclusions: There is no significant difference between hTIPP and TEP in terms of postoperative outcomes and patient satisfaction. hTIPP approach is a safe and feasible alternative to TEP.

Introduction Chronic gastroduodenitis in adolescents is often accompanied by a decrease in bone density. The mechanisms of this relationship are not fully understood. Objective To study the level of 25 (OH)-vitamin D, vitamin D receptor gene polymorphisms and bone metabolism in adolescents with chronic gastroduodenitis in dependency of helicobacter pylori (HP) infection. Materials and methods 51 adolescents aged from 12 to 15 years old were examined. All patients had a morphologically checked chronic gastroduodenitis condition.Group 1 included 19 patients with HP infection and other 32 children without HP infection were put in a group 2. All children had a gastroenterological examination including urease test and taking a biopsy sample from the stomach. 25 (OH)-vitamin D in serum was determined by ELISA. Polymorphisms (ApaI, TagI, BsmI) of vitamin D receptor gene (VDR) were determined by PCR with restriction digest. Dual-energy x-ray absorptiometry of the lumbar region of the spine L1-L4 was carried out in all patients on a Hologic QDR 4500C densitometer equipped with pediatric reference base in order to study osteocalcin (OK) and b-Cross-Laps. Results A 25 (OH)-vitamin D deficiency was observed with an equal frequency in both groups (5.26% and 6.25%, p>0.05). The correlation between vitamin D levels and the presence of HP-infection was not found (r s = 0.417, p & gt; 0.05). At the same time, the frequency of occurrence of genotypes containing the allele B of the VDR BsmI gene was higher among patients without HP infection compared with children with Hp infection (p & lt; 0.05 c2 = 6.03). In both groups, the carriers of the VDR BsmI gene B had a significantly higher level of osteocalcin in comparison with children without it (90.43 ± 36.03 ng/ml and63.02 ± 34.12 ng/ml, p<0.005). The carriers of the ApaI gene A allele in both groups had high bone mineral density and high levels of 25 (OH)-vitamin D, osteocalcin, and b-cross-laps in comparison to children without this allele. Children with hp-infection, carriers of the t + genotype of the TagI gene of the VDR gene had a higher bone mineral density (p = 0.001). Conclusion In adolescents with chronic gastroduodenitis, the bone metabolism and the level of 25 (OH)-vitamin D are related to genetic polymorphism gene VDR, and the presence of HP-infection as well.