An outbreak of Clostridioides difficile infections due to a 027-like PCR ribotype 181 in a rehabilitation centre: Epidemiological and microbiological characteristics.

Clostridioides difficile is one of the most important healthcare-associated pathogens. Recently, several new 027-like types have been found that all belong to the multilocus sequence typing (MLST) Clade 2. We report a rapidly spreading outbreak of C. difficile infections (CDI) due to a newly identified PCR ribotype (RT) 181 in a Rehabilitation Centre (RC). Genomic analysis revealed the outbreak strain, not previously identified in Greece, belonged to clade 2, sequence type (ST) 1 and had a 18bp deletion in tcdC at position 311 together with a single nucleotide deletion at position 117, similarly to RT 027. The presence of a clonal outbreak was confirmed by whole genome sequencing, yet the source of this ribotype remained unclear. The emergence and rapid spread of new C. difficile ribotypes highlights the need for ongoing C. difficile surveillance and better understanding of overall Clade 2 phylogeny.

Taste perception analysis using a semantic verbal fluency task.

A verbal fluency (VF) task is a test used to examine cognitive perception. The main aim of this study was to explore a possible relationship between taste perception in the basic taste categories (sweet, salty, sour, and bitter) and subjects' taste preferences, using a VF task in healthy and dysphagic subjects. In addition, we correlated the results of the VF task with body mass index (BMI). The hypothesis is that categorical preferences would be consistent with the number of verbal responses. We also hypothesized that higher BMI (>30 kg/m(2)) would correlate with more responses in either some or all four categories. VF tasks were randomly administered. Analysis criteria included number of verbally produced responses, number of clusters, number of switches, number and type of errors, and VF consistency with taste preferences. Sixty Greek-speaking individuals participated in this study. Forty-three healthy subjects were selected with a wide range of ages, sex, and education levels. Seventeen dysphagic patients were then matched with 17 healthy subjects according to age, sex, and BMI. Quantitative one-way analysis of variance (between groups as well as repeated measures), post hoc, and chi-square, and qualitative analyses were performed. In the healthy subjects' group, the differences among the mean number of responses for the four taste categories were statistically significant. When comparing the two matched groups of healthy and dysphagic subjects, there were no statistically significant differences in the mean number of responses in the four basic taste categories. However, for both groups, most responses were generated in the following descending order: sweet, salty, sour, and bitter. The bitter category presented the majority of errors for both groups. Obese subjects produced a greater mean number of responses for the "sweet," "sour," and "bitter" categories; conversely, underweight subjects produced a larger mean number of responses for the "salty" category, even though these differences were not statistically significant. The relationship of VF with taste perception and BMI could contribute to evidence-based knowledge that can be used for clinical practice.

Validity of the Dysexecutive Questionnaire (DEX). Ratings by patients with brain injury and their therapists.

OBJECTIVE: This study investigated the validity of the DEX-Questionnaire (both completed by patients, DEX-Self and by therapists, DEX-TH), included in the Behavioural Assessment of the Dysexecutive Syndrome (BADS), at identifying differences in the severity of dysexecutive symptoms according to lesion location. It also examined the strength of associations of the DEX-Self and the DEX-TH reports with the sub-tests of the BADS as well as two other real-life executive tasks, the Everyday Description Task and the Twenty Question Test. METHODS: This study compared 30 patients with anterior lesions (AL) to 22 patients with posterior lesions (PL). Twenty-nine healthy participants and their relatives were included as controls. RESULTS: Significant group differences were found only on the DEX-TH, but not on the DEX-Self, indicating poor insight in patients with AL. The DEX-TH were revealed accurate in detecting more severe dysexecutive symptoms in the AL group. Furthermore, only the DEX-TH reportings were significantly correlated with the above executive tests. Multiple regression analysis showed that the Modified Six Elements Test, a sub-test of the BADS, predicted DEX-TH as accurately as the total BADS. CONCLUSION: The DEX-TH reportings and the MSET can provide valuable information about the severity of daily executive dysfunctioning, with implications for cognitive rehabilitation.

Sensitivity, specificity and predictive value of the BADS to anterior executive dysfunction.

In this study we investigated the validity of the BADS subtests to adequately discriminate anterior lesions (AL) from posterior lesions (PL). Therefore, we compared the performances of 30 AL patients, 22 PL patients and 29 healthy controls (HC) on the BADS subtests. Seven standard executive test variables were also examined. Our multiple comparisons showed that the BADS Zoo Map-Part 1 was not indicative for AL, whereas Rule Shifting, Action Programme, Key Search, Zoo Map-total score, and BADS-total score were found to be sensitive to AL. More importantly, the Modified Six Element Test (MSET), and the Zoo Map-Part 2 were highly specific for AL. In both BADS subtests AL patients performed significantly worse than either the PL or the HC groups, whereas no significant differences on the same variables were found between PL and HC individuals. Further logistic regression analysis revealed that the BADSMSET was the best predictor for distinguishing AL from PL patients, correctly classifying 78.8% of the patients. These results suggest that the BADSMSET is an accurate screening tool for the detection of anterior pathology. Poor performance on this BADS subtest is a significant indicator of executive dysfunctioning after anterior brain damage.