Conjunctival conveyance of SARS-CoV-2 in asymptomatic and non-severe symptomatic COVID-19 patients.

INTRODUCTION: The prevalence of ocular conveyance of SARS-CoV-2 has been well described for severe/hospitalized cases, but scarcely reported in asymptomatic and non-severe patients, who are unaware that they are carriers. MATERIAL & METHODS: This prospective cross-sectional study quantitatively evaluated SARS-CoV-2 shedding on the ocular surface (OS). Conjunctival testing was suggested to all hospital personnel being screened by nasopharyngeal (NP) SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR). Disease symptoms were evaluated using a standardized questionnaire and telephone follow-up 6±3 months later for disease evolution (recovery with/without severe disease). RESULTS: Four hundred and eighty seven patients were included. From 46 NP SARS-CoV-2-positive subjects (cycle threshold [CT]=24.2±7.1), 13% tested positive at the OS (CT=36.4±2.8). Most SARS-CoV-2-positive subjects were symptomatic (n=40, 87%), while 6 were asymptomatic (being tested as contact cases). Systemic symptoms were not significantly different in OS-positive vs OS-negative subjects, although headache tended to be more frequent in OS-positives (83% vs 54%, P=0.06). None of the OS-positive subjects reported ocular symptoms and none developed severe disease requiring hospitalization or oxygen therapy. CONCLUSION: SARS-CoV-2 shedding at the OS may occur in asymptomatic and non-severe COVID-19 individuals (including those absent of ocular symptoms). However, the high RT-PCR CT values attained may indicate a low risk of transmissibility via this route.

Efficient and automatic methods for flexible regression on spatiotemporal data, with applications to groundwater monitoring.

Fitting statistical models to spatiotemporal data requires finding the right balance between imposing smoothness and following the data. In the context of P-splines, we propose a Bayesian framework for choosing the smoothing parameter, which allows the construction of fully automatic data-driven methods for fitting flexible models to spatiotemporal data. An implementation, which is highly computationally efficient and exploits the sparsity of the design and penalty matrices, is proposed. The findings are illustrated using a simulation study and two examples, all concerned with the modelling of contaminants in groundwater. This suggests that the proposed strategy is more stable that competing methods based on the use of criteria such as generalised cross-validation and Akaike's Information Criterion. © 2015 The Authors. Environmetrics Published by John Wiley Sons Ltd.

Rural nurse job satisfaction.

INTRODUCTION: The lack of rural nursing studies makes it impossible to know whether rural and urban nurses perceive personal and organizational factors of job satisfaction similarly. Few reports of rural nurse job satisfaction are available. Since the unprecedented shortage of qualified rural nurses requires a greater understanding of what factors are important to retention, studies are needed. An analysis of the literature indicates job satisfaction is studied as both an independent and dependent variable. In this study, the concept is used to examine the intention to remain employed by measuring individual and organizational characteristics; thus, job satisfaction is used as a dependent variable. METHODS: One hundred and three rural hospital nurses, from hospitals throughout the Northwest region of the United States were recruited for the study. Only nurses employed for more than one year were accepted. The sample completed surveys online. The McCloskey/Mueller Satisfaction Scale, the Gerber Control Over Practice Scale, and two open-ended job satisfaction questions were completed. The qualitative analysis of the open-ended questions identified themes which were then used to support the quantitative findings. RESULTS: Overall alphas were 0.89 for the McCloskey/Mueller Scale and 0.96 for the Gerber Control Over Practice Scale. Rural nurses indicate a preference for rural lifestyles and the incorporation of rural values in organizational practices. Nurses preferred the generalist role with its job variability, and patient variety. Most participants intended to remain employed. The majority of nurses planning to leave employment were unmarried, without children at home, and stated no preference for a rural lifestyle. The least overall satisfied nurses in the sample were employed from 1 to 3 years. CONCLUSIONS: Several new findings inform the literature while others support previous workforce studies. Data suggest some job satisfaction elements can be altered by addressing organizational characteristics and by hiring nurses with rural connections, experience and preferences. Rural nurses considered lifestyle and personal life issues when choosing a job. Concepts like time away from work, rural lifestyle, recreation opportunities, climate and social activities influenced the intention to stay on the job. Rural nurses with the most job satisfaction preferred rural lifestyles and possessed rural backgrounds. Since the generalist nurse role requires autonomy and task variability, recruiting nurses who prefer these job characteristics might enhance nurse retention. Other findings were tied to rural health and nursing theories. It is unknown why the most dissatisfied nurses had 1-3 years of experience. Similar studies with larger samples are suggested.

Persistent overdose caused by a very small dose of intrathecal morphine in an elderly patient undergoing vaginal hysterectomy: a case report.

Intrathecal opioid administration is a well established, inexpensive and effective, widely used procedure in the elderly and has well known side effects. We report a case of an elderly woman who received small doses of intrathecal opioids (sufentanil 2.5 microg and morphine 60 microg) for gynecological surgery and thereafter developed severe neurological side effects. She required prolonged treatment with very high doses of naloxone (16 mg).

Epidemiology of overweight and obesity among school children and adolescents in three provinces of central Italy, 1993-2001: study of potential influencing variables.

OBJECTIVE: The prevalence of overweight and obesity was estimated among the school children and adolescents of three provinces of central Italy, and the role of several possible influencing factors was analysed. DESIGN, SUBJECTS AND MEASUREMENTS: Body mass index (BMI) was measured in 44 231 subjects, age 3-17.5 y, and a household questionnaire was filled out by the parents of 12 143 subjects to collect the following data: subjects, only child or firstborn status, prematurity, birth weight, type of feeding until the fifth month, menarche status in girls; parents, age at the time of the subject's birth; BMI (mean of the two parents) at the time the subject was measured, mother's age of menarche, socioeconomic status. BMI was measured in a subgroup of 10 795 subjects 1 y later to study the yearly sex- and age-related variations from the categories of normal weight to overweight or obesity and vice versa. All females aged 11-14 y were asked if they had their menarche. RESULTS: Striking differences in the proportions of overweight and obesity resulted from the use of two different criteria for defining cutoff points. The overall prevalence of overweight was 13.2 and 20.7% in males, and 13.7 and 18.6% in females, and the overall prevalence of obesity varied between 24.2 and 6.3% in males, and between 22.9 and 6.1% in females, respectively. Parents' BMI, birth weight, firstborn status and post-menarche status in girls showed a significant association with overweight and/or obesity in logistic regression models. CONCLUSIONS: A large prevalence of overweight and obesity was observed in school subjects from three provinces of central Italy. From the comparisons of the prevalence rate, the new internationally agreed criteria seem more appropriate for epidemiological studies in this population. SPONSOR: University of Perugia, Region of Umbria, Commune of Perugia.

Estudio comparativo de tres planes terapéuticos en la infección por Helicobacter pylori / Comparative study of three therapeutic plans for infection caused by helicobacter pylori

Objetivos: Comparar el test rápido de ureasa y la histología en el diagnóstico de la infección por H.P. y conocer la tasa de erradicación de la misma con diferentes planes terapéuticos en el Uruguay. Material y métodos: Se realizó un trabajo prospectivo, doble ciego aleatorizado, en el que se incluyeron 64 pacientes, a los que se les realizó endoscopía digestiva alta debido a síntomas referidos a dicha esfera, diagnosticándose infección por H.P. por test rápido de la ureasa y/o histología. Los pacientes fueron incluidos en tres grupos (L,A,C por diez días; L, C, o L, A por 14 días). Se realizó control clínico de los efectos colaterales de la medicación. La erradicación se controló mediante test de aire espirado con C13. Resultados: La histología diagnosticó el 100 por ciento de los pacientes, mientras que el test rápido de la ureasa lo hizo en el 77 por ciento de los casos. El plan con L, A, C, erradicó 85 por ciento (IT) y 95 por ciento (PP), el plan L, C, lo hizo en el 76 por ciento (IT y PP) y el plan L, A, 45 por ciento y 47 por ciento respectivamente. Los tres planes fueron bien tolerados con solamente tres pacientes que tuvieron que abandonar el tratamiento (dos del grupo L, A, C, y una del grupo L,A). Conclusiones: La histología fue superior al test rápido de la ureasa en el diagnóstico de la infección por H.P. El triple plan con L, A, C, por diez días fue superior a los dobles planes por dos semanas. Los tres planes fueron bien tolerados. El test del aire espirado con C13 es una herramienta útil en el control de la erradicación de la infección por H.P

Using obese-specific charts of height and height velocity for assessment of growth in obese children and adolescents during weight excess reduction.

OBJECTIVE: The influence of weight excess reduction on height and height velocity of obese subjects should be evaluated on the basis of appropriate standards, since the pattern of growth of obese subjects is different from that of normal weight subjects. DESIGN, SUBJECTS AND MEASUREMENTS: Height, weight and triceps skinfold thickness were recorded from 17987 school subjects (9256 males and 8731 females), 3-18 y of age, from three provinces of central Italy, and a growth reference curve of height was constructed. Using BMI (as computed using the tables of Rolland-Cachera et al) and triceps skinfold thickness, normal-weight subjects (NWS) and obese subjects (OS) were identified and specific reference curves (mean+/-s.d. every sixth month of age) were developed for both groups. Centiles of height were also calculated for OS. Various (2-4) measurements of height in school subjects were performed and a graph of height velocity (HV) was constructed in NWS and in OS using the JPPS method. The yearly mean +/-s.d. of HV was also calculated, based on square root transformed data (in order to realise a Gaussian distribution), deriving from successive measurements in total subjects, in NWS and in OS. The z-scores of height and of the square root of HV were calculated in 217 obese subjects (125 males and 92 females) before and during a weight excess reduction programme (WERP). Obese subjects in WERP who showed a reduction of z-score of BMI were considered as 'responsive'; those who either maintained or showed an increase of z-score of BMI were considered as 'non-responsive'. Obese subjects in WERP were followed for 1-4 y, giving the following results: 0-1 y, 142 responsives and 75 non-responsives; 0-2 y, 76 responsives and 33 non-responsives; 0-3 y, 35 responsives and 30 non-responsives; 0-4 y, 24 responsives and 18 non-responsives. RESULTS: Compared to NWS, OS showed a significantly greater HV in 4-9y males and in 4-8y females, but in older children the pubertal spurt was reduced and more precocious. As a result, the height of OS, which was greater in 3-13 year-old males and in 3-11.5 year-old females, subsequently showed a reduction, as compared to that of NWS, in 16-18 year-old males and in 13-18 year-old females. In both responsive and non-responsive groups of obese subjects in WERP, the z-scores of height showed a reduction during WERP when evaluated using the reference curve of the total school population. In contrast, when their growth was evaluated according to the obese-specific reference curve, no significant variation was observed comparing both z-scores before and during the WERP. CONCLUSIONS: More appropriate information on the growth of obese subjects may be obtained when evaluating the height and HV according to obese-specific reference standards from the same population of origin. Adopting this modality, no significant variation of height resulted during WERP in obese children.

Fasting serum leptin levels in the analysis of body mass index cut-off values: are they useful for overweight screening in children and adolescents? A school population-based survey in three provinces of central Italy.

OBJECTIVE: Body mass index (BMI) was determined in a population of school students from three provinces of central Italy. Fasting serum leptin concentrations were assayed in a large number of subjects from the same area, to determine their distribution as plotted against the standard deviation score (z-score) of BMI. DESIGN, SUBJECTS AND MEASUREMENTS: Height and weight were recorded from 31170 subjects (16175 male and 14995 female), aged 3-18 y, to construct BMI charts of children and adolescents from central Italy. Percentiles and z-score were calculated using the LMS method of Cole. Serum leptin concentrations were assayed in 1929 subjects (996 male and 933 female) after overnight fasting. RESULTS: BMI percentiles of central Italy were higher than those from standards of other European and USA populations. When plotted against the z-score of BMI, serum leptin values were distributed according to an exponential curve, showing a steep pattern and a wide distribution, as BMI values increased. The hypothesis of the existence of two subgroups, based on a different relation between leptin and BMI, was verified and a separation point between the two subgroups was identified using cluster analysis, discriminant analysis and a novel method developed by our group, hereafter referred to as 'regression clustering'. This method allows identification of the value of the independent variable (z-score of BMI) which can be taken as a separation point. This analysis provided the best results and indicated the following separation points: central Italy standard, z-score = 0.72 (76.4th percentile) for males and z-score = 0.69 (75.5th percentile) for females; French standard (the one suggested for a European population by the European Childhood Obesity Group, ECOG), z-score = 1.46 (92.8th percentile) for males and z-score = 1.96 (97.5th percentile) for females. Similar but variable results were obtained when the same analysis was performed on serum leptin concentration, subdivided according to pubertal development (stage I, stage II-III, stage IV-V). CONCLUSIONS: Children and adolescents from central Italy had greater BMI percentiles when compared to other European populations. Fasting serum leptin concentrations showed a distribution pattern related to z-score, thus allowing to identification of two different subgroups. The z-scores of BMI, identified as separation points, indicated a trend to leptin production by adipocytes that could be taken as indicators of significant increases of fat mass. This study proposes criteria and a statistical approach that could be useful in the identification of BMI cut-off values when screening children and adolescents for overweight.

Leptin serum levels in normal weight and obese children and adolescents: relationship with age, sex, pubertal development, body mass index and insulin.

OBJECTIVE: Leptin, the product of the ob gene, is present in higher concentrations in blood of obese subjects than of lean subjects. There is scarce information on the role of leptin in the pathogenesis of human obesity and little is known about leptin serum levels in obese children. DESIGN, SUBJECTS AND MEASUREMENTS: To evaluate the influences of age, sex, pubertal development and weight excess on serum leptin levels, we have studied 390 obese subjects (OS) and 320 normal weight subjects (NWS) aged 5-16 y. Fasting insulin concentrations were assayed in NWS, and an oral glucose tolerance test was carried out in OS and total insulin area under the curve (TIA) was calculated. RESULTS: Log-transformed values of leptin serum concentrations appeared to be distributed according to an acceptable Gaussian pattern. As observed in adults, serum leptin concentrations in children and adolescents were also increased (4-5 times) in OS as compared to NWS. In both males and females, subdivided according to pubertal stages, serum leptin varied significantly in stage IV-V as compared to the lower stages, with a reduction in males and an increase in females. On comparing the two sexes, greater serum leptin concentrations were observed in females of both NWS and OS. A significant linear correlation was found in both groups, subdivided according to sex and pubertal stage, between log values of serum leptin and standard deviation scores (SDS) of body mass index (BMI), and log-transformed relative body weight (RBW). Using partial correlation analysis in subjects subdivided according to sex and pubertal stages, log values of serum leptin and fasting insulin values, adjusted by age and SDS of BMI, correlated significantly with a weaker correlation in males than in females. In OS, the leptin concentrations correlated better with TIA than with fasting insulin. A weight reduction program (WRP) was carried out in 141 OS and significant reductions of serum leptin and fasting insulin were observed, showing a reduction of RBW. There was a correlation between the reduction of RBW and of serum leptin, but not of fasting insulin. No variation was found in non-responsive OS. RBW reduction correlated with leptin, but not with insulin (fasting and TIA), evaluated before the therapeutic program started. CONCLUSION: As observed in adults, obese children and adolescents have higher serum leptin concentrations. However, several conditions should be taken into account when evaluating leptin concentrations in children. There are differences, independent of BMI, relative to pubertal stage and sex, females having greater leptin concentrations than males. There is evidence of a possible role for leptin in the effectiveness of a weight reduction program in OS.

Blood cultures in adult patients released from an urban emergency department: a 15-month experience.

OBJECTIVE: To determine the frequency of positive blood cultures obtained from adult patients with potential occult bacteremia released from an urban ED and how often these positive cultures alter the subsequent patient course or management. METHODS: This retrospective case series study was conducted at the ED of a large, urban teaching hospital. The study population consisted of a convenience sample of adult patients who presented to the ED with evidence of fever or other clinical conditions suggesting the possibility of bacteremia. The records of all patients who had blood cultures done and who were not admitted to an inpatient service were reviewed. Follow-up was obtained for all patients for whom culture results were positive. A substantial influence on the medical management or clinical course by a (noncontaminant) positive blood culture result was defined as a positive result that directly led to: further diagnostic testing, hospital admission, initiation or alteration of antibiotic therapy, or a different diagnosis. Culture-positive patients who were noncompliant with requested ED follow-up were included in this estimate. An estimate of the laboratory charges per diagnosis of bacteremia also was derived. RESULTS: Only 24 of 1,350 patients (1.8% of the study population; 95% CI 1.1-2.5%) had true-positive blood cultures. Only 7 patients (0.52% of the population; 95% CI 0.14-0.90%) potentially had their medical management affected by the positive blood culture results. Based on the laboratory charges associated with all blood cultures for this patient group, the cost per clinically significant positive blood culture result was $ 11,570. CONCLUSIONS: The prevalence of bacteremia was 1.8% among the released patients who had blood cultures obtained in the ED. Furthermore, only 0.52% of the patients had positive blood cultures that potentially affected their medical management. Further study is warranted to identify specific criteria for selecting ambulatory patients for whom the use of blood cultures may be cost-effective.

[Are "behaviorally disordered" migrant children of "noncompliant" parents treatable? Interdisciplinary cooperation between system-oriented school psychology and psychoanalytically oriented therapy]. / Sind "verhaltensgestörte" Migrantenkinder "widerspenstiger" Eltern therapierbar? Interdisziplinäre Zusammenarbeit zwischen systemorientierter Schulpsychologie und psychoanalytisch orientierter Therapie.

This case presentation describes the cooperation between experts of different basic training and theoretical provenance. A system oriented school psychologist takes on the 'case' of a massively behaviourally abnormal, aggressive, and marginalized girl of working migrants from the lower stratum, prepares the way for psychotherapy and transfers the treatment to a psychoanalyst. In this case the role of the school psychologist consists of receiving a crisis situation which is slipping out of hand and redefining the problems with all parties involved. By expanding the perspective to the context of school-family-immigration society contradictions and breaks become evident. The culture shock of the first migration phase was reinacted by the parents in the difficult confrontation with the Swiss institutions. In contrast to psychosocial sees the contradictions as being logical-congruent and tries to build bridges and activate change. The transformation of rigid reality constructs is furthered and psychotherapeutic treatment is mediated, explained and accompanied during the process. The role of the psychoanalyst consists of taking up the relationship to the girl and establishing a serviceable working relationship with the parents. She has to recognize the girl's inner and unconscious conflicts which are actualized in transference and countertransference in the therapeutic process. After empathetic interpretative work she offers new forms of dealing with conflicts which take the girl's outer reality (family, school, migrant situation, cultural reality) into consideration. Accompanying the parents intensively at the same time broadens their competence in raising their daughter. In this case the neurotic developmental disorder is strongly connected with the migration problem.

Surgical considerations about the anterior syphon knee of the internal carotid artery. An anatomical study.

An anatomical study about the anterior knee of the intracavernous carotid artery is presented. Twenty cavernous sinuses (CS) were dissected in cadavers using microsurgical techniques. A fibrous ring around the internal carotid artery (ICA) at the CS roof was found in all specimens. This fibrous attachment could be dissected from the surrounding dura and a loose connective tissue could be demonstrated around the ICA. This anatomical finding makes possible the microsurgical approach to vascular lesions of this portion of the ICA, without opening the cavernous sinus.

A rare injury to the upper limb: elbow dislocation combined with Galeazzi fracture-dislocation.

The authors describe a rare instance of elbow dislocation associated with Galeazzi fracture-dislocation in a 16 year-old patient injured in a motor vehicle accident. They analyze the modalities of the trauma, the type of treatment employed, and the result after 2 years.

Delayed biliary-to-bowel transit in cholescintigraphy after cholecystokinin treatment.

The authors assessed the influence of cholecystokinin (CCK), administered before cholescintigraphy, on the biliary-to-bowel transit time (BBTT) of technetium-99m disofenin. Fourteen healthy volunteers underwent two separate cholescintigraphic studies with and without CCK treatment. BBTT was less than 1 hour in all 14 studies of subjects not treated with CCK. In 14 subjects treated with CCK, there was no tracer activity in the bowel up to 2 hours in seven (50%) (P = .006). Eighty-three cholescintigrams obtained in patients with suspected acute cholecystitis were also retrospectively analyzed. In 53 of 83 patients in whom the gallbladder was visualized within 1 hour, significantly delayed BBTT was found in 14 of 29 (48%) who received CCK, compared with the BBTT in one of 24 patients (4%) who did not receive CCK (P less than .001). In the 30 patients in whom the gallbladder was never visualized (n = 28) or was visualized after 1 hour (n = 2), BBTT was less than 30 minutes, regardless of whether patients were treated with CCK. Results show that CCK treatment causes significantly delayed BBTT in many cases, and this finding should not be interpreted as abnormal.

Blood glucose, plasma insulin and glucagon response to intravenous administration of glucose in premature infants during the first week of life.

Blood glucose, plasma insulin and plasma glucagon were determined during glucose infusion (lg/kg. bw/for 30 min) at 0,30 and 60 min, in 1 to 3 and 7 day infants. No significant differences were observed among average values of the three parameters before and after glucose. Plasma insulin increased slightly in the three groups in infants. Plasma glucagon response to glucose varied widely in the three groups of infants, the reduction of value at 30 min of the test being more evident in 7 day old infants. A significant difference (p less than 0,05) was observed between delta 0-30 average values when 1 day and 7 day infants were compared. These results suggest that the inhibitory mechanism of A-cell activity develops during the first week of life.