Excess burden associated with Clostridioides difficile infection in haematological patients occurring during hospitalization with induction chemotherapy in the USA.

BACKGROUND: Patients with haematological diseases are at high risk of developing Clostridioides difficile infection (CDI). AIM: The study aim was to describe excess length of stay and costs associated with CDI during the hospital stay for induction chemotherapy in the United States (USA). METHODS: A retrospective analysis was conducted utilizing data from US databases of Truven Health Analytics®. Comprehensive hospitalization data of patients with induction chemotherapy due to acute myeloid leukaemia (AML), acute lymphoblastic leukaemia, Hodgkin lymphoma and non-Hodgkin lymphoma (NHL) were analysed. Patients with CDI occurring during the hospital stay were compared to controls through a case-control comparison of the direct treatment costs and length of stay was performed with an exact matching algorithm. FINDINGS: A total of 2611 patients were included between January 2014 and December 2017. NHL (43.5%) and AML (38.4%) were the predominant underlying diseases and 15% of patients received a stem cell transplantation. During the matching, 105 CDI cases (CDI+) were compared with 801 controls (CDI-). On average, hospitalization costs were increased by US$36,113 in CDI+ compared to CDI- patients (P=0.009) and patients with CDI spent on average 8.9 additional days in hospital (P=0.003). CONCLUSIONS: The findings highlight a significant burden associated with CDI in haematological patients undergoing induction chemotherapy in the USA. There is an important need for prevention of CDI in this specific patient population.

Burden of Clostridium (Clostridioides) difficile infection during inpatient stays in the USA between 2012 and 2016.

BACKGROUND: The healthcare burden of Clostridium (Clostridioides) difficile infection (CDI) is high but not fully characterized. AIM: To assess hospitalization costs, length of hospital stay (LOS) and in-hospital mortality attributable to CDI in the USA by analysing nationwide hospital discharge records over the 2012-2016 period. METHODS: A retrospective, observational study based on the Truven Health MarketScan Hospital Drug Database was conducted, in which 46,097 inpatient stays with a diagnosis of CDI were analysed. Costs, LOS and in-hospital mortality were studied for patients with either a principal or secondary (comorbidity) diagnosis of CDI, and for patients re-admitted because of CDI. If CDI was a comorbidity, its attributable burden was estimated by coarsened exact matching, comparing 17,273 CDI stays with 84,164 stays in a control group without a CDI diagnosis. FINDINGS: Inpatients for whom CDI was the main reason for hospitalization incurred mean costs of US$10,528 and an average LOS of 5.9 days. For CDI as a comorbidity, the mean additional cost was US$11,938 and the additional LOS was 4.4 days. CDI also increased the in-hospital mortality rate by 4.1%, on average. CONCLUSION: This study is consistent with previous publications which demonstrated the high economic burden of CDI for healthcare settings and health insurance systems. When recorded as a comorbidity, CDI significantly increased hospital costs and LOS. These results highlight the need for innovative therapeutic approaches in the prevention and treatment of CDI.

Effectiveness of praziquantel for treatment of peritoneal larval cestodiasis in dogs: a case report.

Peritoneal larval cestodiasis (PLC) was incidentally identified in an adult female mixed-breed dog by explorative celiotomy done in response to abnormal blood values found during a routine work-up in preparation for an ovariohysterectomy. Ten days after ovariohysterectomy, treatment with fenbendazole began (50mg/kg, per os, every 12h, for 21 days). Two weeks after the end of treatment, samples of peritoneal fluid were obtained by paracentesis and examined. Motile peritoneal tetrathyridia were still evident. Fenbendazole was discontinued. After 10 days of withdrawal from fenbendazole, the dog was treated with a subcutaneous administration of injectable praziquantel (5mg/kg). The administration was repeated after a 15 days interval. Two weeks after the second administration, samples of peritoneal fluid were obtained again by paracentesis. Motile peritoneal tetrathyridia were not detected. Fourteen months after the last administration of praziquantel, the dog remained still free of peritoneal tetrathyridia as determined by abdominal ecography. Therefore, praziquantel was effective to eliminate peritoneal tetrathyridia definitely. Practitioners should be aware of PLC in order to early recognize this condition in case of incidental finding and implement adequate therapy as soon as possible.

Is quantum brain dynamics involved in some neuropsychiatric disorders?

In this paper we review the evidence for quantum phenomena underlying neuropsychiatric disorders. Existing data can be explained only by resorting to non-local correlations within brain activity, such as the ones predicted by quantum theory. Such a situation suggests that perhaps a quantum description may be the best description of interrelationships between neural and cognitive phenomena.

Simulating prosopagnosia through a lesion of lateral connections in a feed-forward neural network.

We show that particular features of prosopagnosic impairment can be simulated by a connectionist model trained with an unsupervised learning procedure. In particular we describe a Kohonen's neural network which is able to correctly recognize and categorize a series of digitized pictures of faces when learning is characterized by certain parameter values, but which shows a prosopagnosic behavior when lateral connections are lesioned. We discuss the relationship between this result and some neurophysiological hypotheses about prosopagnosia.

Comparison of aminosidine (paromomycin) and sodium stibogluconate for treatment of canine leishmaniasis.

Twelve dogs naturally infected with Leishmania infantum were treated subcutaneously with aminosidine at a dose of 10 mg kg-1 per day for four weeks. Antimonial compounds were used as reference drugs in twelve Leishmania-infected dogs. Eleven of the twelve dogs submitted to aminosidine therapy responded within 30 days. The treatment with the aminoglycoside antibiotic presented a marked decrease of anti-Leishmania antibody titres than the controls. Aminosidine also reduced urinary protein, serum IgG, and circulating immune complex concentrations. Side effects were observed only in a dog with pre-existent renal lesions. This study proved that aminosidine is an effective, tolerable and safe drug for the treatment of canine leishmaniasis and that it could be used as a suitable substitute for antimonial therapy.