Clinical prediction tools for identifying antimicrobial-resistant organism (ARO) carriage on hospital admissions: a systematic review.

BACKGROUND: Increasing prevalence of antimicrobial-resistant organisms (AROs) is a growing economic and healthcare challenge. Increasing utilization of electronic medical record (EMR) systems and improvements in computation and analytical techniques afford an opportunity to reduce the spread of AROs through the development of clinical prediction tools to identify ARO carriers on admission to hospital. AIM: To identify existing clinical prediction tools for meticillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing organisms (CPOs), their predictive performance, and risk factors utilized in these tools. METHODS: The CHARMS checklist was followed. Medline, EMBASE, Cochrane SR, CRD databases (DARE, NHS EED), CINAHL and Web of Science were searched from database inception to 26th July 2021. Full-text articles were assessed independently, and quality assessment was conducted using the Prediction Model Risk of Bias Assessment Tool. FINDINGS: In total, 3809 abstracts were identified and 22 studies were included. Among these studies, risk score models were the most common prediction tool (N=16). Previous admission, recent antibiotic exposure, age and sex were the most common risk factors for ARO carriage. Prediction tools were commonly evaluated on sensitivity and specificity with ranges of 15-100% and 46-98.6%, respectively, for MRSA, and 30-81.3% and 79.8-99.9%, respectively, for CPOs. CONCLUSION: There is no gold standard ARO prediction tool. However, high-performance clinical prediction tools and identification of key risk factors for the early detection of AROs exist. Risk score models are easier to use and interpret; however, with recent improvements in machine learning techniques, highly robust models can be developed with data stored in an EMR.

Investigating the secondary care system burden of CRSwNP in sinus surgery patients with clinically relevant comorbidities using the HES database.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic condition that can adversely affect quality of life for patients. There is no cure for CRSwNP, and patients may require intermittent systemic corticosteroids (SCS) and surgery in addition to intranasal treatment throughout their lifetime. This places a significant burden on the NHS which can be compounded by comorbid conditions such as asthma or NSAID-exacerbated respiratory disease (NERD). Patients with comorbidities are likely to experience higher rates of surgery and more secondary care visits. The aim of this study was to evaluate revision rates and the associated burden for patients with CRSwNP undergoing surgery and compare this to sub-cohorts of patients with comorbidities. MATERIALS AND METHODS: This study has utilised the Hospital Episodes Statistics (HES) database across a ten-year time period (April 2010 to March 2020) to investigate the NHS resource use attributable to CRSwNP for all patients with the condition who have undergone sinus surgery, and to examine the burden of clinically relevant sub-groups. RESULTS: Our results showed that 101,054 patients underwent at least one sinus surgery in relation to their nasal polyps, with Kaplan Meier survival analysis estimating that the 10-year probability of revision is between 71-90% for comorbid patients, and 51% for non-comorbid patients. Patients with a relevant comorbid condition in addition to their CRSwNP were up to 4.7 times more likely to undergo at least one revision surgery during the ten-year analytical time window when compared to patients without a comorbidity. Further to this, comorbid patients had a higher tariff associated with their CRSwNP care across the analytical time window and were therefore likely to be more costly to the healthcare system. CONCLUSIONS: In conclusion, this study demonstrates that there is a high burden attached to CRSwNP-related sinus surgery and that comorbidities are a key driver of NHS resource use.

Mechanical Thrombectomy for Treatment of Cerebral Venous Sinus Thrombosis in Vaccine-Induced Immune Thrombotic Thrombocytopenia.

Reports of a rare form of cerebral venous sinus thrombosis with profound thrombocytopenia have emerged following introduction of the adenovirus-vectored coronavirus disease 2019 (COVID-19) vaccines. Between March and June 2021, seven cases of refractory vaccine-induced immune thrombotic thrombocytopenia were referred to our institution for mechanical thrombectomy. The condition of 1 patient deteriorated during interhospital transfer, and the remaining 6 underwent successful recanalization. No procedure-related adverse events were reported. At the time of this writing, 3 patients have been discharged with a good functional outcome (mRS 0-1), one required rehabilitation for mild dysarthria and vocal cord palsy (mRS 3), and 2 have died due to severe mass effect. Our anecdotal experience suggests that endovascular therapy may be safe and effective in reducing thrombus burden in selected cases of postvaccination cerebral venous sinus thrombosis.

Pituitary metastases: presentation and outcomes from a pituitary center over the last decade.

PURPOSE: Highlight and characterize manifestations, diagnostic/management approaches and outcomes in a contemporary cohort of patients with pituitary metastases (PM) from a large European pituitary center-over 10 years. METHODS: Retrospective review of PM cases between 1/2009 and 12/2018. Clinical, laboratory, imaging data at PM detection and during follow-up were analysed. RESULTS: 18 cases were identified (14 females; median age at diagnosis 61.5 years). Most common primary malignancies were lung (39%) and breast (32%). Most frequent presenting manifestation was visual dysfunction (50%). Gonadotrophin, ACTH, TSH deficiency were diagnosed in 85%, 67%, 46% of cases, respectively; diabetes insipidus (DI) was present in 17%. 33% of cases were detected during investigation for symptoms unrelated to PM. PM management included radiotherapy (44%), transsphenoidal surgery (17%), transsphenoidal surgery and radiotherapy (6%) or monitoring only (33%). One-year survival was 49% with median survival from PM detection 11 months (range 2-47). CONCLUSIONS: In our contemporary series, clinical presentation of PM has evolved; we found increased prevalence of anterior hypopituitarism, decreased rates of DI and longer survival compared with older literature. Increased availability of diagnostic imaging, improvements in screening and recognition of pituitary disease and longer survival of patients with metastatic cancer may be contributing factors.

Color Masking White Fluorotic Spots by Resin Infiltration and Its Quantitation by Computerized Photographic Analysis: A 12-month Follow-up Study.

OBJECTIVE: To manage three cases of mild to moderate fluorosis by resin infiltration technique and to quantify the tooth color changes by measuring CIE L*a*b* values of digital photographs and calculating ΔE00 based on the CIEDE2000 formula using Adobe Photoshop software. METHODS AND MATERIALS: Three cases of mild to moderate fluorosis were treated with a combination of bleaching and a resin infiltration technique. CIE L*a*b* values of 18 fluorosed spots were measured from digital photographs of these cases at four different stages-preoperative, postbleaching, postinfiltration and at 12-month follow-up-using Adobe Photoshop software, and ΔE00 was calculated based on the CIEDE2000 formula. The ΔE00 values of all 18 points obtained at different stages were submitted to statistical analysis (α=0.05). RESULTS: In all the cases reported, clinically as well as by the photographic color analysis, it was found that the technique masked the lesions, improving the patients' esthetics, which was maintained even at 12-month recall. Statistically significant difference in ΔE00 values was present between comparison of all stages (p<0.001) except between postinfiltration and the 12-month follow-up stage (p=0.642). CONCLUSION: A resin infiltration technique helped in the satisfactory management of white spot lesions of fluorosis, which were stable even at 12-month follow up. Quantitation of the changes was achieved using Adobe Photoshop software.

Patulous Eustachian tube obliteration using endovascular coils: a novel technique.

BACKGROUND: Patulous Eustachian tube is a distressing condition characterised by chronic patency of the Eustachian tube and its failure to close. Patients typically present with symptoms of autophony and aural fullness. In patients requiring surgical intervention, a variety of different procedures have been demonstrated (both transtympanic and endonasal), with limited success. Evidence of the effectiveness of a number of surgical interventions is limited to small case series only. OBJECTIVE: This paper describes a novel treatment for patulous Eustachian tube using a 3 mm VortX Diamond endovascular coil.Case reportA transnasal endoscopic approach was adopted, with cannulation of the Eustachian tube orifice using a Relieva sinus guide suction tube from a balloon sinuplasty set. The coil was deployed 1.5 cm deep into the Eustachian tube. Post-operative imaging was used to confirm correct positioning. Regular follow up was arranged. The patient reported complete resolution of her symptoms. CONCLUSION: The technique has so far proved highly effective and minimally invasive. It will be employed in more patients to fully establish its effectiveness in treating patulous Eustachian tube.

Linear accelerator radiosurgery for arteriovenous malformations: Updated literature review.

Arteriovenous malformations (AVMs) are the leading causing of intra-cerebral haemorrhage. Stereotactic radiosurgery (SRS) is an established treatment for arteriovenous malformations (AVM) and commonly delivered using Gamma Knife within dedicated radiosurgery units. Linear accelerator (LINAC) SRS is increasingly available however debate remains over whether it offers an equivalent outcome. The aim of this project is to evaluate the outcomes using LINAC SRS for AVMs used within a UK neurosciences unit and review the literature to aid decision making across various SRS platforms. Results have shown comparability across platforms and strongly supports that an adapted LINAC based SRS facility within a dynamic regional neuro-oncology department delivers similar outcomes (in terms of obliteration and toxicity) to any other dedicated radio-surgical platform. Locally available facilities can facilitate discussion between options however throughput will inevitably be lower than centrally based dedicated national radiosurgery units.

Embolization of Intracranial Dural Arteriovenous Fistulas Using PHIL Liquid Embolic Agent in 26 Patients: A Multicenter Study.

BACKGROUND AND PURPOSE: The introduction of liquid embolic agents has revolutionized endovascular approach to cranial vascular malformations. The aim of the study was to retrospectively assess the efficacy and safety of Precipitating Hydrophobic Injectable Liquid (PHIL), a new nonadhesive liquid embolic agent, in the treatment of patients with cranial dural arteriovenous fistulas. The primary end point was the rate of complete occlusion of dural arteriovenous fistulas. Secondary end points included the incidence of adverse events and clinical status at 3-month follow-up. MATERIALS AND METHODS: This was a retrospective multicenter study. Twenty-six consecutive patients with dural arteriovenous fistulas (de novo or previously treated) treated by injection of PHIL only or with PHIL in combination with other embolization products (such as Onyx or detachable coils) were included in the study. Recruitment started in August 2014 and ended in September 2015. RESULTS: Twenty-two (85%) patients were treated with PHIL only, with 3 patients treated with both PHIL and Onyx, and 1, with both PHIL and coils. Immediate complete angiographic occlusion was achieved in 20 (77%) patients. Of the 6 patients with residual fistulas, 3 were retreated with PHIL and 1 achieved angiographic cure. An adverse event was seen in 1 patient who developed worsening of preexisting ataxia due to acute thrombosis of the draining vein. CONCLUSIONS: PHIL appears to be safe and effective for endovascular treatment of cranial dural arteriovenous fistulas. Short-term angiographic and clinical results are comparable with those of Onyx, with the added advantage of easier preparation and improved homogeneous cast visualization. The use of iodine as a radio-opacifier also produces considerably less artifacts on CT compared with tantalum-based embolic materials.

Sickness absence of LU train drivers after track incidents.

BACKGROUND: Track incidents including near misses and those causing injury or death are a psychological hazard for train operators. No study has directly investigated how train operators are affected depending on track incident outcome and few studies have investigated the impact of near misses. AIMS: To compare sickness absence (SA) of London Underground train operators following track incidents categorized by outcome, including near misses. METHODS: This was an observational study using historical data of track incidents from April 2008 to October 2013. Track incidents were divided into four categories according to outcome (near miss on platform, near miss on track, significant injury and fatality). Additional information on age, gender and previous relevant history was collected. RESULTS: A total of 685 track incidents were analysed. There was a significant difference in SA taken after near misses ('no injury') incidents compared with significant injury and fatality ('injury') incidents (P < 0.001). There was also a significant difference in SA in train operators involved in a fatality incident compared with significant injury incidents (P < 0.05). CONCLUSIONS: SA in train operators following a track incident increases in line with the severity of the incident in terms of outcome. Fatal track incidents caused the highest level of SA followed by significant injury incidents. Near misses also caused substantial levels of SA.

Spectral and hydrodynamic studies on p-toluidine induced growth in cationic micelle.

The effect of p-toluidine (PTD) on the growth of cationic surfactant micelles in aqueous solutions was examined by viscosity, UV-visible spectroscopy, dynamic light scattering (DLS), (1)H NMR and nuclear Overhauser effect spectroscopy (NOESY). Viscosity and scattering results are used to follow the growth of the aggregates and examine the structural transitions that occur. The reduction of electrostatic repulsions between the surfactant headgroups in combination with the hydrophobicity of the additive caused micellar growth and viscoelasticity at high PTD concentration; the micellar growth was found to be more pronounced in the presence of salt. (1)H NMR chemical shift changes reflect the interaction of PTD molecules with surfactant micelles while 2D NOESY experiments reveal that PTD molecules insert themselves in micelles such that its -CH(3) group is in contact with the core region and the benzene ring resides near the palisade layer of micelle.

Intramedullary cysticercosis.

Intramedullary cysticercosis is a rare form of cysticercosis in the central nervous system. A 55-year-old woman was admitted with low back pain, urinary incontinence, paraparesis and sensory deficit. Her MRI showed a well-defined intramedullary cystic lesion at T7 vertebral level with peripheral enhancement on contrast. She underwent a T7-T8 laminectomy and excision of the lesion. Histopathology revealed the lesion to be a cysticercus granuloma. A postoperative course of albendazole was given. The patient showed significant neurological improvement at follow-up.

Diffusion-weighted magnetic resonance imaging: its uses in otolaryngology.

Over recent years, there has been an increase in otolaryngology publications concerning diffusion-weighted magnetic resonance imaging. The aims of this review paper are to summarise the basic principles of diffusion-weighted magnetic resonance imaging, and to provide an overview of current otolaryngological applications and areas of research. Diffusion-weighted magnetic resonance imaging is a radiological technique which has shown promising results in various areas of otolaryngology. However, studies of diffusion-weighted magnetic resonance imaging are difficult to compare, as different imaging parameters and techniques have been used. The role of this imaging modality within otolaryngology is yet to be fully elucidated. Diffusion-weighted magnetic resonance imaging may prove to be a useful adjunct in both the pre- and post-operative care of otolaryngology patients.

The crucial role of imaging in determining the approach to glomus tympanicum tumours.

Glomus tumours are rare vascular tumours arising within the lateral skull base, infratemporal fossa and upper neck. When they are confined to the middle ear cleft, they are termed glomus tympanicum tumours. Traditionally tympanicum tumours have been treated surgically and their removal has generally been regarded as quite straightforward. Our experience with these lesions however, is that they fall into two distinct categories, those with and those without hypotympanic involvement. This distinction can be determined by high resolution CT scanning in coronal and axial planes. Mesotympanic tumours are indeed typically straightforward in their removal and can be approached by a transcanal route. Hypotympanic extension requires additional evaluation by MRI, and a more extensive surgical approach. In this paper, we present our management approach based on a series of nine cases. We conclude that determining the tumour extension preoperatively by using modern imaging techniques is essential in planning the surgery.

Identification of the normal jugular foramen and lower cranial nerve anatomy: contrast-enhanced 3D fast imaging employing steady-state acquisition MR imaging.

SUMMARY: Conventional imaging protocols are unable to visualize the intraforaminal/canalicular segments of the lower cranial nerves (IX-XII). On the basis of previous successful demonstration of individual cranial nerves within the cavernous sinus by constructive interference in steady-state MR imaging, we describe the use of contrast-enhanced 3D fast imaging employing steady-state acquisition MR imaging to demonstrate normal in vivo intraforaminal and canalicular segments of cranial nerves IX-XII in 10 patients by using a standardized imaging protocol.

Enhanced PHB production and scale up studies using cheese whey in fed batch culture of Methylobacterium sp. ZP24.

Methylobacterium sp. ZP24 produced polyhydroxybutyrate (PHB) from disaccharides like lactose and sucrose. As Methylobacterium sp. ZP24 showed growth associated PHB production, an intermittent feeding strategy having lactose and ammonium sulfate at varying concentration was used towards reaching higher yield of the polymer. About 1.5-fold increase in PHB production was obtained by this intermittent feeding strategy. Further increase in PHB production by 0.8-fold could be achieved by limiting the dissolved oxygen (DO) levels in the fermenter. The decreased DO is thought to increase flux of acetyl CO-A towards PHB accumulation over TCA cycle. Cheese whey, a dairy waste product and being a rich source of utilizable sugar and other nutrients, when used in the bioreactor as a main substrate replacing the lactose, led to further increase in the PHB production by 2.5-fold. A total of 4.58-fold increase in the PHB production was obtained using limiting DO conditions with processed cheese whey supplemented with ammonium sulfate in fed batch culture of Methylobacterium sp. ZP24. The present investigation therefore reflects on the possibility of developing a cheap biological route for production of green thermoplastics.