Healthcare-associated infections and antibiotic use in long-term care residents from two geographical regions in Switzerland.

BACKGROUND: The burden of healthcare-associated infections (HAIs) and antimicrobial use in Swiss long-term care facilities (LTCFs) is currently unknown. This study assessed the prevalence of HAIs and antibiotic use among LTCF residents in Switzerland. METHODS: A point-prevalence study was undertaken in LTCFs in eastern and western Switzerland from August to October 2019 according to the 'Healthcare-associated infections in long-term care facilities' (HALT) protocol. Characteristics of residents (age, sex, wounds, dementia, indwelling catheters) and institutions (specific factors, geographic region) were assessed. LTCF residents were screened for HAIs and current antibiotic treatment. Personal and institutional factors associated with HAIs were assessed. RESULTS: In total, 1185 residents from 16 LTCFs (eight per geographic region) were screened for HAIs and antibiotic treatment. Median age was 87 years (interquartile range 79-91) and 71% were female. The prevalence of HAIs was 4.2% (west 4.3% vs east 4.2%; P=0.93), with mucocutaneous skin infections (36%) and respiratory tract infections (30%) being the most common. Independent risk factors for the presence of HAIs were presence of a chronic wound [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1-5.0; P=0.02] and being immobile (OR 1.8, 95% CI 1.0-3.3; P=0.04). Antibiotics were given to 2.9% of residents (west 3.9% vs east 1.8%; P=0.05) on the day of the survey. The most commonly prescribed antibiotics were amoxicillin-clavulanic acid and quinolones. CONCLUSIONS: The prevalence of HAIs in Swiss LTCFs is similar to that in other European countries, whereas antibiotic consumption is lower. Further point-prevalence surveys on a broader scale are recommended to improve understanding of the burden of HAIs and antibiotic consumption in this setting.

Synthetic aperture magnetometry and excess kurtosis mapping of Magnetoencephalography (MEG) is predictive of epilepsy surgical outcome in a large pediatric cohort.

OBJECTIVE: Resective surgery is the most effective treatment option for patients with refractory epilepsy; however identification of patients who will benefit from epilepsy surgery remains challenging. Synthetic aperture magnetometry and excess kurtosis mapping (SAM(g2)) of magnetoencephalography (MEG) is a non-invasive tool that warrants further examination in the pediatric epilepsy population. Here, we examined the utility of MEG with SAM(g2) to determine if MEG epileptiform foci correlates with surgical outcome and to develop a predictive model incorporating MEG information to best assess likelihood of seizure improvement/freedom from resective surgery. METHODS: 564 subjects who had MEG at the Children's Hospital of Philadelphia between 2010-2015 were screened. Clinical epilepsy history and prior electrographic records were extracted and reviewed and correlated with MEG findings. MEG assessments were made by both a neurologist and neuroradiologist. Predictive models were developed to assess the utility of MEG in determining Engel class at one year and five years after resective epilepsy surgery. RESULTS: The number of MEG spike foci was highly associated with Engel class outcome at both one year and five years; however, using MEG data in isolation was not significantly predictive of 5 year surgical outcome. When combined with clinical factors; scalp EEG (single ictal onset zone), MRI (lesional or not), age and sex in a logistic regression model MEG foci was significant for Engel class outcome at both 1 year (p = 0.03) and 5 years (0.02). The percent correctly classified for Engel class at one year was 78.43% and the positive predictive value was 71.43. SIGNIFICANCE: MEG using SAM(g2) analysis in an important non-invasive tool in the identification of those patients who will benefit most from surgery. Integrating MEG data analysis into pre-surgical evaluation can help to predict epilepsy outcome after resective surgery in the pediatric population if utilized with skilled interpretation.

Prevalence of negative CT scans in a level one trauma center.

PURPOSE: The rise of computed tomography (CT) use in trauma has become the subject of concern given the harms of CT including radiation, cost, over diagnosis and identification of incidental lesions. We developed a novel metric, the Negative CT Score, (∑CT-) which quantifies how often CT imaging identifies important injuries. Our objective was to describe the pattern of CT utilization in trauma at an urban academic level one trauma center using this novel metric. METHODS: This was a retrospective study of intermediate level trauma patients who received CT imaging over a 1-year study period at an urban level one trauma center. We applied the Negative CT Score, (∑CT-) to quantify the results of CT imaging. ∑CT- is computed by subtracting the number of non-extremity body regions (maximum four: head, neck, chest, abdomen) with an important positive CT finding (defined by a priori criteria) from the total number of non-extremity body regions scanned. RESULTS: Of the 552 cases reviewed during the study period, 410 (74.3%) were male and the mean age was 40.3 years [SD ± 21.2]. Four hundred eighty-six patients (88.0%) suffered blunt trauma; 66 (12.0%) suffered penetrating trauma. The average injury severity score for admitted patients was seven. Four hundred ninety-five cases had at least one CT performed. The average number of regions per patient that received CT imaging was 2.36 (SD ± 1.3), and the average ∑CT- was 2.10 (SD ± 1.2). Three hundred and sixty-seven (74.3%) patients had no important findings on CT imaging. CONCLUSIONS: In a consecutive series of 552 intermediate trauma patients at our urban trauma center, 2.36 body regions were scanned per patient; of these, 2.10 regions revealed no important CT findings. We hope that these results and the Negative CT Score can be used to identify trends, variations in practice, and outliers within and across departments so that CT utilization can be optimized.

Lessons learned from implementing the HIV infant tracking system (HITSystem): A web-based intervention to improve early infant diagnosis in Kenya.

OBJECTIVES: Guided by the RE-AIM model, we describe preliminary data and lessons learned from multiple serial implementations of an eHealth intervention to improve early infant diagnosis (EID) of HIV in Kenya. METHODS: We describe the reach, effectiveness, adoption, implementation and maintenance of the HITSystem, an eHealth intervention that links key stakeholders to improve retention and outcomes in EID. Our target community includes mother-infant pairs utilizing EID services and government health care providers and lab personnel. We also explore our own role as program and research personnel supporting the dissemination and scale up of the HITSystem in Kenya. RESULTS: Key findings illustrate the importance of continual adaptation of the HITSystem interface to accommodate varied stakeholders' workflows in different settings. Surprisingly, technology capacity and internet connectivity posed minimal short-term challenges. Early and sustained ownership of the HITSystem among stakeholders proved critical to reach, effectiveness and successful adoption, implementation and maintenance. CONCLUSIONS: Preliminary data support the ability of the HITSystem to improve EID outcomes in Kenya. Strong and sustained collaborations with stakeholders improve the quality and reach of eHealth public health interventions.

IMP2/p62 induces genomic instability and an aggressive hepatocellular carcinoma phenotype.

Hepatocellular carcinoma (HCC) represents the third leading cause of cancer-related deaths and commonly develops in inflammatory environments. The IGF2 mRNA-binding protein IMP2-2/IGF2BP2-2/p62 was originally identified as an autoantigen in HCC. Aim of this study was to investigate a potential pathophysiological role of p62 in hepatocarcinogenesis. Human HCC tissue showed overexpression of IMP2, which strongly correlated with the fetal markers AFP and DLK1/Pref-1/FA-1 and was particularly elevated in tumors with stem-like features and hypervascularization. Molecular classification of IMP2-overexpressing tumors revealed an aggressive phenotype. Livers of mice overexpressing the IMP2 splice variant p62 highly expressed the stem cell marker DLK1 and secreted DLK1 into the blood. p62 was oncogenic: diethylnitrosamine (DEN)-treated p62 transgenic mice exhibited a higher tumor incidence and multiplicity than wild types. Tumors of transgenics showed a more aggressive and stem-like phenotype and displayed more oncogenic chromosomal aberrations determined with aCGH analysis. DEN-treated p62 transgenic mice exhibited distinct signs of inflammation, such as inflammatory cytokine expression and oxidative stress markers, that is, thiobarbituric acid-reactive substance (TBARS) levels. Reactive oxygen species (ROS) production was elevated in HepG2 cells, which either overexpressed p62 or were treated with DLK1. p62 induced this ROS production by a DLK1-dependent induction and activation of the small Rho-GTPase RAC1, activating NADPH oxidase and being overexpressed in human HCC. Our data indicate that p62/IMP2 promotes hepatocarcinogenesis by an amplification of inflammation.

[Prenatal diagnosis of a right thoracic congenital ectopic kidney with a diaphragmatic hernia: a combination with a good prognosis]. / Diagnostic anténatal d'un rein droit thoracique et d'une hernie de coupole diaphragmatique droite: une association de bon pronostic.

Ectopic intrathoracic kidney is a rare congenital anomaly, usually asymptomatic. This anomaly is sometimes associated with a diaphragmatic hernia. Few cases of this combination have been described, often in the absence of a prenatal diagnosis. We report on the case of a female newborn infant who was diagnosed with an ectopic intrathoracic right kidney and a diaphragmatic hernia upon 33 weeks of gestation. The patient underwent surgery on the first day of life and the respiratory and renal outcomes were simple. We review the literature and discuss the seemingly good prognosis of this combination.

[Treatment of hindfoot instability in Charcot foot using a hybrid technique of internal and external fixation]. / Behandlung von Rückfußdestruktionen beim Charcot-Fuß durch Hybridtechnik mit interner Osteosynthese und Ringfixateur.

OBJECTIVE: The main problem of patients with Charcot foot is their inability to off-load. Therefore the risk of internal fixation failure is increased, especially in hindfoot instability (Sanders type IV) with osteonecrosis of the talus. Combination of internal and additional external fixation guarantees the reconstruction and improves surgical outcome. The main objective of this surgery is to obtain a resilient, plantigrade foot that is shoeable in custom-made orthopedic shoes. INDICATIONS: Charcot foot with instable collapse of the hindfoot with or without fragment dislocation, with or without (noninfected) ulceration not shoeable in custom-made orthopedic shoes. CONTRAINDICATIONS: Very poor general condition, non-reconstructible peripheral vascular disease, deep infection and defects in the region of surgery which makes amputation nescessary, and poor patient compliance. SURGICAL TECHNIQUE: Excision of the distal fibula and removal of the destroyed talus body using a lateral approach. Medial approach to remove the medial malleolus. Tibiocalcaneal fusion using screws for internal fixation. Fusion of the talus head to the anterior tibia. Ilizarov external fixateur to stabilize the internal fixation. POSTOPERATIVE MANAGEMENT: Off-loading for 3 months, then CT scan to verify bony fusion and according to the findings stepwise weight-bearing in a cast or walker over 4-6 weeks. Then custom-made orthopedic shoes with a high shaft and insoles for neuropathic patients and full weight-bearing. RESULTS: In a retrospective cohort study, 14 of 16 patients could be fitted in custom-made shoes after undergoing tibiocalcaneal fusion. During follow-up, 2 patients required below-knee amputation, 3 patients had stress fractures of the tibia, one related to a pin track infection. All patients had a bony fusion of calcaneus and tibia; 10 of 16 patients had fusion of midfoot/talus head and the distal tibia. The 10 patients who had an ulcer before surgery could be healed. In 1 patient, a heel ulcer developed due to talipes calcaneus.

[Management of midfoot instability in Charcot foot with the ring fixator : Use of a hybrid technique with internal and external stabilization]. / Behandlung von Fußwurzelinstabilitäten bei Charcot-Fuß mit dem Ringfixateur : Anwendung der Hybridtechnik mit interner und externer Stabilisierung.

OBJECTIVE: Combination of external and internal fixation for improvement of stabilization in midfoot arthrodesis. INDICATIONS: Charcot foot of the midfoot with/without (infection-free) ulceration. CONTRAINDICATIONS: Severe anesthesiological risks in multimorbid patients; untreated symptomatic peripheral arterial occlusive disease; severe soft tissue infection and defect with the necessity of amputation. SURGICAL TECHNIQUE: Performing subtractive resection arthrodesis of the midfoot with locking plates and screws combined with an external ring fixator of the foot and lower leg. POSTOPERATIVE MANAGEMENT: Postoperative partial weight bearing with sole contact and walking frame for 3 months. Then removal of external fixator, CT scan and based on the result, staged increasing of stress load with short-leg cast over a period of 4-6 weeks. Podomechanotherapy with full weight bearing. RESULTS: With this surgical procedure, sufficient stabilization with fully load bearing, plantigrade foot with podomechanotherapy with the help of a combined internal and external fixation is possible. Complications (pin-tract infection or dislocation) exist, but they can be controlled. High healing rate of ulceration was achieved by bony position correction and stabilization.

Variations in the excretion patterns of helminth eggs in two sympatric mouse lemur species (Microcebus murinus and M. ravelobensis) in northwestern Madagascar.

Many factors can influence the parasite load of animal hosts, but integrative studies that simultaneously investigate several factors are still rare in many taxonomic groups. This study investigates the influence of host species, host population density, parasite transmission mode, sex, and two temporal (month, year) factors on gastrointestinal parasite prevalence and fecal egg counts of two endemic primate species from Madagascar, Microcebus ravelobensis and Microcebus murinus. A total of 646 fecal samples were available and analyzed from three dry seasons. Six different helminth egg morphotypes were found, and these were Subulura sp. (14.51 % prevalence), strongyle eggs (12.95 %), Ascaris sp. (7.94 %), Lemuricola sp. (0.17 %), and two forms of tapeworms (Hymenolepis spp.) (1.73 and 0.69 %). Coinfection with more than one egg type was observed in 21.22 % of the samples containing eggs. Multivariate analyses revealed that host species and sex did neither explain significant variation in the prevalence and fecal egg counts of parasites with direct life cycles (Ascaris sp., strongyle egg type, Lemuricola sp.) nor of arthropod-transmitted parasites (Subulura sp.). However, fecal egg counts of Subulura sp. differed significantly between study sites, and the prevalence of Subulura sp. and of parasites with direct life cycles was influenced by temporal parameters, mainly by differences between study years and partly between months. When comparing the findings with the yearly and seasonal rainfall patterns in the area, most results are in accordance with the hypothesis of an increased vulnerability of the host toward infection under some sort of environmental challenge.

Distribution and Diversity of Salmonella Strains in Shipments of Hatchling Poultry, United States, 2013.

Multistate outbreaks of salmonellosis associated with live poultry contact have been occurring with increasing frequency. In 2013, multistate outbreaks of salmonellosis were traced back to exposure to live poultry, some of which were purchased at a national chain of farm stores (Farm store chain Y). This study was conducted at 36 stores of Farm store chain Y and was concurrent with the timing of exposure for the human outbreaks of salmonellosis in 2013. We used environmental swabs of arriving shipment boxes of hatchling poultry and shipment tracking information to examine the distribution, diversity and anti-microbial resistance of non-typhoidal Salmonella (NTS) across farm stores and hatcheries. Isolates recovered from shipment boxes underwent serotyping, anti-microbial resistance (AMR) testing and pulsed-field gel electrophoresis (PFGE). Postal service tracking codes from the shipment boxes were used to determine the hatchery of origin. The PFGE patterns were compared with the PFGE patterns of NTS causing outbreaks of salmonellosis in 2013. A total of 219 hatchling boxes from 36 stores in 13 states were swabbed between 15 March 2013 and 18 April 2013. NTS were recovered from 59 (27%) of 219 hatchling boxes. Recovery was not significantly associated with species of hatchlings, number of birds in the shipment box, or the presence of dead, injured or sick birds. Four of the 23 PFGE patterns and 23 of 50 isolates were indistinguishable from strains causing human outbreaks in 2013. For serotypes associated with human illnesses, PFGE patterns most frequently recovered from shipment boxes were also more frequent causes of human illness. Boxes positive for the same PFGE pattern most frequently originated from the same mail-order hatchery. Only one of 59 isolates was resistant to anti-microbials used to treat Salmonella infections in people. This study provides critical information to address recurrent human outbreaks of salmonellosis associated with mail-order hatchling poultry.

Morning stiffness of the joints is the sole predictor of short-term response to glucocorticoid treatment in active rheumatoid arthritis (RA).

Several studies show that the application of oral glucocorticoids in patients with active RA leads to fast resolution of disease activity. Treatment strategies that include the initial application of glucocorticoids seem to have a favourable outcome in terms of long-term control of disease activity. Moreover, when tapered down to low doses, glucocorticoids show disease-modifying actions such as the inhibition of progression of structural damage to the inflamed joints. The goal of this study was to examine the predictors of short-term response to intermediate-dose glucocorticoids in patients with active RA.

Anti-NMDA receptor encephalitis presenting with focal non-convulsive status epilepticus in a child.

A previously healthy 9-year-old girl presented to an emergency department (ED) with headache, dizziness, blurry vision, and abnormal visual perceptions. She was diagnosed with migraine, treated symptomatically, and discharged. Over the course of days, she became progressively somnolent, and returned to the ED, where she was found to have a right inferior quadrantanopsia and sixth nerve palsy. Magnetic resonance imaging (MRI) of the brain showed gyral swelling of the left parieto-occipital lobe. Continuous electroencephalogram (EEG) monitoring revealed focal non-convulsive status epilepticus (NCSE) in the left occipital region. Cerebrospinal fluid (CSF) was positive for antibodies directed against the N-methyl-d-aspartate receptor (NMDAR). This case is the first report of anti-NMDAR encephalitis presenting with focal non-convulsive status epilepticus (NCSE).

[First epidemiologic data about phloroglucinol exposure during first trimester of pregnancy]. / Premières données épidémiologiques sur le phloroglucinol et exposition au cours du premier trimestre de grossesse.

OBJECTIVE: Phloroglucinol is used to prevent gastric, intestine or urogenital spasms. In France, many pregnant women are exposed to phloroglucinol for which no data are available about its use in pregnancy. The present study, using EFEMERIS database, investigates potential teratogenic risk of phloroglucinol in pregnancy. MATERIALS AND METHODS: EFEMERIS is a database including prescribed and delivered drugs during pregnancy (data from Caisse Primaire d'Assurance Maladie of Haute-Garonne) and outcomes (data from Maternal and Infant Protection Service and from Antenatal diagnostic Centre). Women delivered from July 1st 2004 to June 30th 2008 in Haute-Garonne and registered in the French Health Insurance Service were included into EFEMERIS database. We compared pregnancy outcomes and newborn health between women exposed to phloroglucinol during organogenesis and non-exposed women. Malformations were classified according to Eurocat classification. RESULTS: Five thousand one hundred and thirty-two newborns (12.7%) exposed during organogenesis to phloroglucinol were compared to 35,223 controls (non exposed newborns). The mean number of different drugs prescribed during the first trimester of pregnancy per woman was higher in women exposed to phloroglucinol than in non-exposed women (6.4 ± 4.3 versus 2.4 ± 3.3, P < 10(-4)). Among newborns, 126 (2.5%) had a malformation versus 804 (2.3%) in control newborns (OR=1.1, [0.9-1.3]). The present study was powered to find a 1.3 fold increase in the overall rate of major anomalies. DISCUSSION AND CONCLUSION: This first epidemiologic study about phloroglucinol in pregnancy does not support evidence of a teratogenic risk for phloroglucinol in humans.

Micro-capsules in shear flow.

This paper deals with flow-induced shape changes of elastic capsules. The state of the art concerning both theory and experiments is briefly reviewed starting with dynamically induced small deformation of initially spherical capsules and the formation of wrinkles on polymerized membranes. Initially non-spherical capsules show tumbling and tank-treading motion in shear flow. Theoretical descriptions of the transition between these two types of motion assuming a fixed shape are at odds with the full capsule dynamics obtained numerically. To resolve the discrepancy, we expand the exact equations of motion for small deformations and find that shape changes play a dominant role. We classify the dynamical phase transitions and obtain numerical and analytical results for the phase boundaries as a function of viscosity contrast, shear and elongational flow rate. We conclude with perspectives on time-dependent flow, on shear-induced unbinding from surfaces, on the role of thermal fluctuations and on applying the concepts of stochastic thermodynamics to these systems.

United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III).

STUDY DESIGN: Multi-center, prospective, cohort study. OBJECTIVES: To assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in persons with spinal cord injury (SCI). SETTING: Inpatient rehabilitation hospitals in the United States (US). METHODS: Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM), the default functional measure currently used in most US hospitals, was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III. RESULTS: Total agreement between raters was above 70% on most SCIM III tasks and all κ-coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach's-α was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8 (P<0.001). For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM (P<0.0001). CONCLUSION: Overall, the SCIM III is a reliable and valid measure of functional change in SCI. However, improved scoring instructions and a few modifications to the scoring categories may reduce variability between raters and enhance clinical utility.

Baseline predictors of ninety percent or higher antiretroviral therapy adherence in a diverse urban sample: the role of patient autonomy and fatalistic religious beliefs.

The role of patient autonomy and influence of religious/spiritual beliefs on antiretroviral therapy (ART) adherence is to date not fully understood. This study assessed baseline predictors of high ART adherence (≥90%) measured by electronic drug monitors (EDM) at 12 and 24 weeks after enrollment in a randomized controlled trial testing behavioral interventions to improve ART adherence. Baseline data were collected with audio computer-assisted self interviews (ACASI) surveys among a diverse urban sample of HIV-infected participants (n = 204) recruited from community clinics in a large midwestern city. Baseline variables included a range of established ART adherence predictors as well as several less frequently studied variables related to patient autonomy and religious/spiritual beliefs. Statistically significant (p < 0.05) variables identified in univariate analyses were included in subsequent multivariate analyses predicting higher than 90% adherence at 12 and 24 weeks. Several baseline predictors retained statistical significance in multivariate analysis at 24 weeks. Baseline levels of autonomous support from friends and family, motivation to adhere, and having an active coping style were all positively associated with adherence, while the belief that God is in control of one's health was negatively associated with adherence. Results indicate that effective interventions should include a focus on promoting patients' autonomous regulation and religious/spiritual beliefs regarding ART adherence.