ABSTRACT
The latest acute heart failure (AHF) consensus document from the Spanish Society of Cardiology (SEC, for its initials in Spanish), Spanish Society of Internal Medicine (SEMI), and Spanish Society of Emergency Medicine (SEMES) was published in 2015, which made an update covering the main novelties regarding AHF from the last few years necessary. These include publication of updated European guidelines on HF in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding AHF such as early treatment, intermittent treatment, advanced HF, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to AHF and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.
Subject(s)
Cardiology , Heart Failure , Acute Disease , Consensus , Heart Failure/therapy , Hospitalization , HumansABSTRACT
El último consenso sobre insuficiencia cardíaca aguda de la Sociedad Española de Cardiología, la Sociedad Española de Medicina Interna y la Sociedad Española de Medicina de Urgencias y Emergencias se elaboró en 2015, por lo que era necesaria una actualización para revisar las diversas novedades relacionadas con la temática de insuficiencia cardíaca aguda que han ido apareciendo los últimos años. Entre ellas están la publicación de las nuevas guías europeas sobre insuficiencia cardíaca en el 2016, nuevos estudios sobre el manejo farmacológico de los pacientes durante la hospitalización y novedades sobre diversos aspectos relacionados con la insuficiencia cardíaca aguda, tales como el abordaje precoz, terapia intermitente, insuficiencia cardíaca avanzada y congestión refractaria. Por ello, este consenso se elaboró con la intención de actualizar todos los aspectos relacionados con la insuficiencia cardíaca aguda y proporcionar un documento que detallase de manera completa el diagnóstico, tratamiento y manejo de esta enfermedad (AU)
The latest acute heart failure consensus document from the Spanish Society of Cardiology, Spanish Society of Internal Medicine, and Spanish Society of Emergency Medicine was published in 2015, which made an update covering the main novelties regarding acute heart failure from the last few years necessary. These include publication of updated European guidelines on heart failure in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding acute heart failure such as early treatment, intermittent treatment, advanced heart failure, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to acute heart failure and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease (AU)
Subject(s)
Humans , Heart Failure/diagnosis , Heart Failure/therapy , Comprehensive Health Care , Quality of Health Care , Acute DiseaseABSTRACT
The latest acute heart failure consensus document from the Spanish Society of Cardiology, Spanish Society of Internal Medicine, and Spanish Society of Emergency Medicine was published in 2015, which made an update covering the main novelties regarding acute heart failure from the last few years necessary. These include publication of updated European guidelines on heart failure in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding acute heart failure such as early treatment, intermittent treatment, advanced heart failure, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to acute heart failure and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.
ABSTRACT
RESUMEN El liquen plano es una enfermedad inflamatoria crónica mucocutánea, que puedeafectar piel, pelo, uñas y mucosas. La afectación concomitante de la mucosa oral y vaginal, conocida como síndrome vulvovaginal-gingival del liquen plano, es una variante infrecuente y grave del liquen plano caracterizada por erosiones o descamación de las mucosas: vulvar, vaginal ygingivo-oral, con predilección por la formación de cicatrices y estenosis. De curso evolutivo benigno, aunque en ocasiones puede sufrir una degeneración maligna. Presentamos el caso de una paciente de sexo femenino de 68 años con diagnóstico de Síndrome vulvovaginal-gingival.
ABSTRACT Lichen planus is a chronic mucocutaneous inflammatory disease, which can affect the skin, hair, nails, and mucosa. Concomitant involvement of the oral and vaginal mucosa, known as vulvovaginal-gingival syndrome of lichen planus, is an infrequent and severe variant of lichen planus characterized by erosions or peeling of the mucosa: vulvar, vaginal, and oral gingival, with a predilection for formation of scars and stenosis. Of benign evolutionary course, although sometimes it can suffer a malignant degeneration. We present the case of a 68-year-old female patient diagnosed with vulvovaginal-gingival syndrome.
ABSTRACT
Mutualistic interactions between bees and flowering plants have been widely recognized as one of the most important for the maintenance of these communities throughout ecosystems. Consequently, understanding how these interactions occur is highly important, especially in seasonal dry tropical forest (SDTF), one of the most endangered ecosystems in northern South America. In this study, we analyzed the changes between interaction networks across two well-defined seasons, dry and wet, in a SDTF of the Colombian Caribbean in Taganga, Magdalena. We also determined changes in species composition and their role in interaction networks. To study this system, we compared two approaches: (1) networks constructed with data from direct collections in flowering plants, and (2) networks constructed with pollen data obtained from bees' bodies. A total of 44 species were collected in 18 species of flowering plants; also, we registered 16 additional plants presented in the records only as pollen types. We found that network metrics, connectance, nestedness, specialization (H2'), and interaction strength asymmetry remain stable through seasons. However, when the two types of approximations were compared, there were significant differences. Networks constructed with pollen data are more connected, less specialized, and with lower values of interaction strength asymmetry. The major difference between seasons relied on the interacting species composition, due to a high species turnover. Bee community was more diverse in dry season. Apidae family, mainly eusocial species, persisted in the community, being more abundant and relevant in wet season. For dry season, Megachile and other solitary species from Apidae and Halictidae families were better represented and relevant for the community. We found that Fabaceae is an important resource for bees in both seasons. In addition, herbaceous species from Asteraceae and Convolvulaceae were preferred in wet season, while shrub and tree species from Fabaceae and Polygonaceae were the main resource in dry season.
Subject(s)
Bees/physiology , Forests , Pollen/classification , Seasons , Animals , Bees/classification , Caribbean Region , Colombia , Plants/classification , Tropical ClimateABSTRACT
RESUMEN La dermatitis actínica crónica (DAC) - dermatitis por fotosensibilidad, reacción solar persistente o su variante extrema el reticuloide actínico- es una fotodermatosis crónica, propia del adulto más frecuente en el sexo masculino provocada por rayos ultravioletas (UVB), (UVA) y luz visible. El diagnóstico es clínico, caracterizado por placas eccematosas y liquenificadas pruriginosas en aéreas expuestas al sol. Se cree que el DAC se debe a la fotosensibilización secundaria de un antígeno endógeno de la piel.
ABSTRACT Chronic actinic dermatitis (ACD) - photosensitivity dermatitis, persistent solar reaction or its extreme variant actinic reticuloid - is a chronic photodermatosis, typical of the adult male caused by ultraviolet (UVB), (UVA) and visible light. The diagnosis suggested by clinical researchers, characterized by eczematous and lichenified pruritic plaques in areas exposed to the sun. It is believed that DAC is due to the secondary photosensitization of an endogenous skin antigen.
Subject(s)
Humans , Male , Middle Aged , Photosensitivity Disorders/diagnosis , Photosensitivity Disorders/therapy , Dermatitis/physiopathology , Diagnosis, DifferentialABSTRACT
OBJECTIVES: To determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors' influence on survival. METHODS: Prospective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, haemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up. RESULTS: The study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95%CI: 1.270-2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95%CI: 0.307-0.560) was associated with lower mortality. CONCLUSIONS: Sarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.
ABSTRACT
Eleven new dinuclear and tetranuclear compounds of general formulae [Zn(µ-L)(µ-X)Ln(NO3)2]·nS, [Zn2Dy2(µ3-L')2(µ-sal)2(NO3)(CH3OH)](NO3)·5CH3OH and [Zn2Er2(µ3-L')2(µ-sal)2(CH3OH)2](NO3)2·4CH3OH (X = benzoate, anthracenate, diclofenac, salicylate, 2,6-dihydroxybenzoate; Ln = Dy, Er; S = water, acetonitrile, methanol) were prepared from the N,N'-dimethyl-N,N'-bis(2-hydroxy-3-formyl-5-bromobenzyl)ethylenediamine compartmental ligand (H2L). Complexes 1-6 and 9-11 consist of diphenoxido-carboxylate triply bridged compounds, which differ mainly in the carboxylate bridging ligand. It should be noted that the acidic character of the salicylic acid promotes, in the presence of methanol, the methoxylation of the H2L ligand thereby yielding a hemiacetal H3L', which is able to connect the Ln(iii) ions of two ZnLn dinuclear units forming the Zn2Ln2 tetranuclear complexes 7 and 8. All compounds display SMM behaviour in the presence of an external field with effective energy barriers (Ueff) as high as 61 K. Magneto-structural data for these complexes reveal that their SMM behaviour is not only significantly affected by the type of Ln(iii) ion but also by the carboxylate bridging ligand connecting the Zn(ii) and Ln(iii) ions. Photoluminescence properties have also been accomplished, showing that the ligands are able to sensitize lanthanide centred emissions in the visible and near-infrared regions with variable capacity. Moreover, the analysis of the luminescence decay curves reveals emission lifetimes in the range of few microsecond or hundreds of nanoseconds for Dy(iii)-based or Er(iii)-based luminophores, respectively.
ABSTRACT
One of the most traumatic events that a person can ever experience in their lifetime is being detained. The prison dog programmes are the most successful prison rehabilitation programmes in the United States of America and consist of detainees training service dogs for other people to assist with different types of disability. It is a typical win-win system: inmates win as they connect with their deepest feelings of affection and solidarity while acquiring a concrete skill for their future release; people with disabilities win because they receive a dog to support their day-to-day activities; the dogs win (especially adopted street dogs) because their lot in life is improved; institutions win because they are enabled to meet their objective more fully; and society wins because they gain a concrete tool to aid the social rehabilitation of detainees. This article describes the operation and achievements of Huellas de Esperanza (Traces of Hope), the Argentine prison dog programme, which has been implemented by the Federal Penitentiary Service since 2010 using State resources. A total of 85 inmates have participated in the programme, which has delivered more than a dozen assistance dogs to people with disabilities and many more dogs to elderly people to provide them with affection and companionship. The article also describes the programme methodology and the way it has decreased prison unrest and led to a low reoffending rate among programme participants.
La privation de liberté est l'une des situations les plus traumatisantes qu'un être humain puisse connaître au cours de son existence. De tous les programmes de réhabilitation appliqués dans les prisons aux États-Unis d'Amérique, Prison Dog Programme est celui qui donne les meilleurs résultats ; il consiste à confier aux détenus la tâche de dresser des chiens en vue d'en faire des chiens aidants qui rendront des services à d'autres personnes atteintes de divers types de handicap. Il s'agit d'un système typiquement « gagnant-gagnant ¼ : le détenu est gagnant, car il renoue avec des sentiments positifs d'affection et de solidarité, tout en recevant un outil concret pour sa vie future une fois libéré ; la personne handicapée est gagnante, car elle reçoit un chien qui l'aidera à vivre au quotidien ; le chien est gagnant, surtout s'il était un chien errant avant d'être adopté, car il accède à une vie meilleure ; enfin, les institutions sont gagnantes car leurs objectifs sont mieux remplis, de même que la société, qui grâce à cet outil concret facilite, la réinsertion sociale des personnes privées de liberté. Les auteurs décrivent le fonctionnement et les réussites de la version argentine de ce programme, intitulée « Traces d'espérance ¼ (Huellas de Esperanza). Le programme a été mis en place par le système pénitentiaire fédéral en 2010 et doté de véritables ressources étatiques; au total, 86 détenus en ont bénéficié et plus d'une douzaine de chiens aidants ont été remis à des personnes handicapées, en plus du grand nombre de chiens dressés et remis à des centres de gériatrie pour apporter un réconfort aux pensionnaires. Les auteurs expliquent la méthodologie suivie, ainsi que la réduction des conflits en milieu carcéral et le faible taux de récidives parmi les ex-détenus ayant participé au programme.
Una de las situaciones más traumáticas que puede atravesar un ser humano a lo largo de su existencia es la privación de su libertad. Los Prison Dog Programmes son los sistemas de rehabilitación carcelaria más exitosos de EE.UU., y consisten en el adiestramiento de perros por parte de personas privadas de la libertad, que los preparan como perros de servicio para apoyo de distintos tipos de discapacidad en otras personas. El sistema es un típico win-win-win: gana el interno conectándose con sus mejores sentimientos de afecto y solidaridad al tiempo que recibe una herramienta concreta para su futuro en libertad; gana la persona con discapacidad que recibe un perro como apoyo para su desempeño cotidiano; gana el perro, sobre todo si se trata de perros vagabundos adoptados que obtienen un destino mejor; ganan las instituciones, que cumplen mejor su objetivo, y gana la sociedad, que facilita, con una herramienta concreta, la reinserción social de las personas privadas de libertad. El presente trabajo describe la operatoria y logros de Huellas de Esperanza, la versión argentina de este Programa, que se desarrolla en el Servicio Penitenciario Federal desde 2010 con recursos estatales genuinos; por este programa han pasado más de 85 internos y ha permitido entregar más de una docena de perros de asistencia a personas con discapacidad y muchos perros a geriátricos para compañía afectiva. Se describe también la metodología y la disminución de la conflictividad intracarcelaria, así como la escasa reiteración de sus participantes.
Subject(s)
Dogs , Prisoners/psychology , Prisons/organization & administration , Animal Assisted Therapy , Animals , ArgentinaABSTRACT
OBJECTIVES: Atrial fibrillation (AF) has been associated with higher mortality. We aimed to identify the baseline predictors of in-hospital mortality among elderly patients with non-valvular AF (NVAF) hospitalised for any reason. METHODS: Observational, prospective and multicentre study was carried out on patients with NVAF over the age of 75, who had been admitted for any acute medical condition to Internal Medicine departments in Spain. RESULTS: We evaluated 804 patients with a mean age of 85±5.1years, of which 53.9% were females. During the hospitalization 10.1% (n=81) of the patients died. The patients who died were older, had a greater percentage of institutionalization, worse previous basic functional status (Barthel Index), worse cognitive performance at admission and greater proportion of frailty and sarcopenia. Logistic regression multivariate analysis identified that the strongest determinants of in-hospital mortality were the baseline functional status (Barthel Index) (OR for total dependency 4.73, 95% CI 2.32-9.63), and admissions for stroke (OR 3.55, 95% CI 1.41-8.90) and acute renal failure (OR 1.93, 95% CI 1.12-3.32). CONCLUSION: The overall in-hospital mortality of elderly patients with NVFA is high. Among all factors evaluated in the global geriatric assessment the baseline functional status was the strongest predictor for in-hospital mortality on this population.
Subject(s)
Acute Kidney Injury/epidemiology , Atrial Fibrillation/complications , Atrial Fibrillation/mortality , Hospitalization/statistics & numerical data , Stroke/epidemiology , Acute Disease , Acute Kidney Injury/etiology , Aged , Aged, 80 and over , Female , Geriatric Assessment , Hospital Mortality , Humans , Logistic Models , Male , Multivariate Analysis , Prospective Studies , Registries , Spain/epidemiology , Stroke/etiologyABSTRACT
BACKGROUND: Mexico's 2009 "narcomenudeo reform" decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP) improved officers' drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge. METHODS: Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar's tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers' ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform. RESULTS: Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001) in their technical understanding of syringe possession (56 to 91%) and drug amounts decriminalized, including marijuana (9 to 52%), heroin (8 to 71%), and methamphetamine (7 to 70%). The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96%) (p < 0.001), marijuana (16 to 91%), heroin (11 to 91%), and methamphetamine (11 to 89%). In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4-3.2) and decriminalization for heroin (aOR 2.7, 95% CI 1.3-4.3), methamphetamine (aOR 2.2, 95% CI 1.4-3.2), and marijuana (aOR 2.5, 95% CI 1.6-4). CONCLUSIONS: Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating formal laws to policing practice. To close such gaps, PEP initiatives bundling occupational safety information with relevant legal content demonstrate clear promise. Our findings underscore additional efforts needed to raise technical knowledge of the law among personnel tasked with its enforcement. Police professionalization, including minimum educational standards, appear critical for aligning policing with harm reduction goals.
Subject(s)
Police/education , Public Policy , Adult , Cannabis , Female , Harm Reduction , Heroin , Humans , Illicit Drugs , Knowledge , Law Enforcement , Male , Methamphetamine , Mexico , Needle-Exchange Programs , Socioeconomic FactorsABSTRACT
BACKGROUND: Cytoreductive-surgery for peritoneal-malignancy (PM) involves extensive intra-abdominal surgery and a massive post-operative systemic-inflammatory-response (SIRS). It is often challenging to differentiate SIRS that are solely surgery-associated from those of post-operative infections. White-Cell-Counts (WCC) and C-Reactive-Protein (CRP) are routinely used as markers for infection, but are non-specific and their elevation is often delayed in PM cases. Other markers need to be evaluated to assist early identification/prediction of post-operative infections. METHODOLOGY: Prospective evaluation of serum procalcitonin (PCT), CRP and WCC in 50 patients pre-operatively (Day0), and on post-operative days (POD) 1, 3 & 6, following cytoreductive-surgery with or without splenectomy. RESULTS: Day0 PCT, CRP and WCC values were within normal limits, but increasing physiologically in post-operative period without infection, with noticeable higher PCT in splenectomized patients. In our cohort post-operative infections were diagnosed in 14 patients, often within 48 h. There was a trend for faster rise in serum PCT on POD1 compared to CRP and WCC, and faster PCT decline following appropriate therapy on POD3 and POD6 when infected cases were clinically resolving while WCC and CRP continued to rise, particularly in non-spelenectomised patients. The AUC on POD1 was significantly higher for PCT (0.689) vs. WCC (0.476) and CRP (0.477) (p = 0.04). Sensitivity, specificity, positive-predictive-value and negative-predictive-values for PCT ranged between (57%-100%), (22%-74%), (33%-47%) & (81%-100%), for CRP (28%-78%), (5.5%-86%), (18%-44.4%) & (40%-75.5%) and for WCC (14%-26.5%), (65.5-80.5%), (22%-25%), (67%-70%) respectively. CONCLUSION: PCT, like WCC and CRP, needs to be interpreted with extreme cautions in the context of infections post-cytoreductive-surgery and should only be used in association with other clinical and investigational findings.
Subject(s)
Calcitonin/blood , Cytoreduction Surgical Procedures/adverse effects , Infections/blood , Infections/diagnosis , Peritoneal Neoplasms/surgery , Protein Precursors/blood , Systemic Inflammatory Response Syndrome/diagnosis , Adult , Aged , Area Under Curve , Biomarkers/blood , C-Reactive Protein/metabolism , Calcitonin Gene-Related Peptide , Diagnosis, Differential , Female , Humans , Infections/etiology , Intraabdominal Infections/blood , Intraabdominal Infections/diagnosis , Intraabdominal Infections/etiology , Leukocyte Count , Male , Middle Aged , Peritoneal Neoplasms/blood , Pneumonia, Bacterial/blood , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/etiology , Predictive Value of Tests , Prospective Studies , Sepsis/blood , Sepsis/diagnosis , Sepsis/etiology , Splenectomy/adverse effects , Surgical Wound Infection/blood , Surgical Wound Infection/diagnosis , Surgical Wound Infection/etiology , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/etiology , Time FactorsABSTRACT
AIM: Cardiac rhythm alterations are a frequent cause of hospital admission. However, we do not know their characteristics and economic costs. We have analyzed the epidemiology and cost of hospitalizations due to cardiac arrhythmias in the National Health System. METHODS: The characteristics and costs were reviewed in patients admitted with a principal diagnosis of cardiac arrhythmia (1997-2010;diagnosis related groups [DRG] -138 and 139 of the National Health System minimum data base set). Atrial fibrillation/flutter accounted for 65% of these DRGs. The secondary diagnoses prevalent in such DRGs were also reviewed. RESULTS: Hospitalizations due to cardiac arrhythmias were approximately 26.000 per year and close to 1.6% for mortality. In 2010 there were 26.421 hospitalizations with an estimated cost of 65 million Euros. Frequent comorbidities were recorded, such as hypertension (43%), heart failure (12%) or diabetes mellitus (20%). A total of 43% were admitted to cardiology and 36% to internal medicine. CONCLUSIONS: During the period 1997-2010, there was a significant annual number of hospitalizations for cardiac arrhythmias (mainly atrial fibrillation), with measurable costs, in Spain. More than one third were attended by internists.
Subject(s)
Arrhythmias, Cardiac/economics , Patient Admission/economics , Adolescent , Adult , Aged , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/therapy , Costs and Cost Analysis , Female , Humans , Male , Middle Aged , Patient Admission/statistics & numerical data , Spain , Young AdultABSTRACT
Norovirus (NoV) is a leading cause of outbreaks of gastroenteritis worldwide, and a major burden for healthcare facilities. This study investigated the NoV genotypes responsible for outbreaks in Edinburgh healthcare facilities between June 2008 and July 2011, and studied their temporal distribution to enable a better understanding of the epidemiology of the outbreaks. A total of 287 samples positive for NoV genogroup II (GII) RNA by reverse transcription-polymerase chain reaction (RT-PCR) during routine diagnostic testing were investigated. Nested RT-PCR (nRT-PCR) and sequencing was used to genotype the NoV strains. Overall, a total of 69 NoV strains belonging to six different genoclusters (GII.1, GII.2, GII.3, GII.4, GII.6, GII.13) were detected. The predominant genotype was GII.4 that included four variants, GII.4 2006a, GII.4 2006b, GII.4 2007 and GII.4 2010. Importantly, increases in NoV activity coincided with the emergence of new GII.4 strains, highlighting the need for an active surveillance system to allow the rapid identification of new strains.
Subject(s)
Caliciviridae Infections/epidemiology , Disease Outbreaks , Gastroenteritis/epidemiology , Health Facilities , Norovirus/genetics , RNA, Viral/genetics , Caliciviridae Infections/virology , Capsid Proteins/genetics , Gastroenteritis/virology , Genetic Variation , Genotype , Humans , Molecular Epidemiology , Norovirus/classification , Phylogeny , Reverse Transcriptase Polymerase Chain Reaction , Scotland/epidemiologyABSTRACT
Healthcare-associated gastroenteritis outbreaks are becoming more common and are recognized challenges in hospital and community settings. In Edinburgh [NHS (National Health Service) Lothian], all the hospitals and the community were actively monitored for outbreaks of gastroenteritis from September 2007 to June 2009. In total, 1732 patients and 599 healthcare staff were affected in 192 unit outbreaks. In the acute sector, 1368 patients (0.99 cases/1000 inpatient bed-days) and 406 healthcare staff (0.29 cases/1000 inpatient bed-days) were affected in 155 unit outbreaks (0.23 unit outbreaks/day). Noroviruses were detected in 142 outbreaks (74%); 50 were not laboratory confirmed but were presumed to be noroviruses on epidemiological grounds. The closure of affected units to new admissions resulted in the loss of 3678 bed-days. By extrapolation, lost bed-days and staff absence due to gastroenteritis outbreaks cost NHS Lothian £1.2 million for the two norovirus seasons. Outbreaks in which the affected unit was closed within the first three days of recognizing the index case were contained in a mean of six days, and outbreaks in units that were closed later persisted for a mean of seven days; this difference was not statistically significant. Rapid implementation of control measures was effective in the control of outbreaks.
Subject(s)
Caliciviridae Infections/economics , Caliciviridae Infections/epidemiology , Cross Infection/economics , Cross Infection/epidemiology , Disease Outbreaks , Norovirus/isolation & purification , Caliciviridae Infections/therapy , Cross Infection/therapy , Gastroenteritis/economics , Gastroenteritis/epidemiology , Gastroenteritis/therapy , Humans , Scotland/epidemiologyABSTRACT
A total of 1204 meticillin-resistant Staphylococcus aureus (MRSA) screens (3340 individual swabs) were tested to evaluate a staphylococcal cassette chromosome mec (SCCmec) real-time PCR. In total, 148 (12.3â%) of the screens were MRSA-positive, where 146 (12.1â%) were MRSA-positive by the SCCmec real-time PCR assay. In contrast, 128 (10.6â%) screens were MRSA-positive by culture. One hundred and twenty-six (10.5â%) of the screens were positive by both culture and PCR. Twenty of the 1204 screens (1.66â%) were negative by culture but positive by PCR; these samples were sequenced. In 14 of the cases, a homology search confirmed the sequence as SCCmec, indicating that these samples could be considered true positives. Two of the 1204 (0.2â%) screens were positive by culture and negative by PCR. The mean turnaround time (TAT) for PCR-negative swabs was 6 h 12 min and for PCR-positive swabs was 6 h 48 min. In comparison, for culture-negative swabs the mean TAT was 29 h 30 min and for culture-positive swabs was 69 h. The cost per swab for routine culture was £0.41 (0.48) and that of the real-time PCR assay was £2.35 (2.75). This optimized, in-house, inexpensive, real-time PCR test maintained a very high sensitivity and specificity when evaluated under real-time laboratory conditions. The TAT of this real-time PCR assay was substantially lower than that of chromogenic culture. It was also maintained throughout the entire process, which can be taken as an indirect measure of test performance. This study showed that implementation of a molecular test can be achieved with limited resources in a standard microbiology laboratory.
Subject(s)
Bacteriological Techniques/methods , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Polymerase Chain Reaction/methods , Staphylococcal Infections/diagnosis , Agar , Bacteriological Techniques/economics , Chromogenic Compounds , Culture Media/chemistry , DNA, Bacterial/chemistry , DNA, Bacterial/genetics , Genes, Bacterial , Humans , Polymerase Chain Reaction/economics , Sensitivity and Specificity , Sequence Analysis, DNA , Staphylococcal Infections/microbiology , Time FactorsABSTRACT
In the UK, meticillin-resistant Staphylococcus aureus (MRSA) is frequently endemic on intensive care units (ICUs), yet our understanding of the local epidemiology of MRSA within the ICU is poor and the best methods for preventing MRSA acquisition remain controversial. Newer molecular typing methods may aid epidemiological investigation of local MRSA strains. We applied Staphylococcal Protein A (spa) typing to MRSA strains collected from patients in a UK ICU. spa typing allowed better discrimination than multilocus sequence typing (MLST) but 73% of strains were either spa type t032 or t018 (associated with the prevalent UK MRSA strains, EMRSA-15 and EMRSA-16). MRSA infections were preceded by MRSA colonisation in 72% of patients, and in 88% of these, both commensal and disease-causing strains had identical MLST and spa types. spa typing helped elucidate the transmission of MRSA between patients for 19 strains with unusual spa types, although the high incidence of EMRSA-15 and -16 types t032 and t018 prevented its use for the majority of strains. Surprisingly, only four (9%) of 45 new MRSA isolates occurring within 28 days of isolation of an unusual spa type could have been due to cross-contamination. These results suggest that prompt transmission of MRSA between patients is rare in our ICU, at least for those strains with unusual spa types.
Subject(s)
Carrier State/epidemiology , Cross Infection/epidemiology , Methicillin-Resistant Staphylococcus aureus/classification , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Staphylococcal Protein A/classification , Bacterial Typing Techniques , Carrier State/microbiology , Cross Infection/prevention & control , Humans , Infection Control , Intensive Care Units , London/epidemiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Sequence Analysis, DNA , Staphylococcal Infections/prevention & control , Staphylococcal Protein A/isolation & purificationABSTRACT
The study assessed the differences in electromyographic (EMG) activity recorded during clenching in women with chronic unilateral temporomandibular disorders (TMDs) as compared to control subjects. Seventy-five full dentate, normo-occlusion, right-handed, similarly aged female subjects were recruited. Twenty five subjects presented with right side TMD, 25 presented with left side TMD and 25 pain-free control subjects participated. Using integrated surface EMG over a 1 s contraction, the anterior temporalis and masseter muscles were evaluated bilaterally while subjects performed maximum voluntary clenching. Lower EMG activation was observed in patients with TMD as compared to control subjects (temporalis: 195.74+/-18.57 vs. 275.74+/-22.11, P=0.011; masseters: 151.09+/-17.37 vs. 283.29+/-31.87, P<0.001). An asymmetry index (SAI) was calculated to determine ratios of right to left sided activation. Patients with right-sided TMD demonstrated preferential use of their left-sided muscles (SAI -5.35+/-4.02) whereas patients with left-sided TMD demonstrated preferential use of their right-sided muscles (SAI 6.95+/-2.82), (P=0.016). This unilateral reduction in temporalis and masseter activity could be considered as a specific protective functional adaptation of the neuromuscular system due to nociceptive input. The asymmetry index (SAI) may be a useful measure in discriminating patients with right vs. left-sided TMD.
Subject(s)
Arthralgia/physiopathology , Bruxism/physiopathology , Masticatory Muscles/physiopathology , Muscle Contraction , Temporomandibular Joint Disorders/physiopathology , Adolescent , Arthralgia/etiology , Bruxism/complications , Chronic Disease , Electromyography/methods , Female , Humans , Temporomandibular Joint Disorders/complications , Young AdultSubject(s)
Infection Control/methods , Intensive Care Units , Methicillin Resistance/drug effects , Safety Management/methods , Staphylococcus aureus/drug effects , Cross Infection/prevention & control , Equipment Contamination/prevention & control , Glycopeptides/pharmacology , Humans , Microbial Sensitivity Tests/methodsABSTRACT
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