Diabetes and necrotizing soft tissue infections-A prospective observational cohort study: Statistical analysis plan.

BACKGROUND: Necrotizing soft tissue infections (NSTIs) are rare but carry a high morbidity and mortality. The multicenter INFECT project aims to improve the understanding of the pathogenesis, clinical characteristics, diagnosis, and prognosis of NSTIs. This article describes the study outline and statistical analyses that will be used. METHODS: Within the framework of INFECT project, patients with NSTI at 5 Scandinavian hospitals are enrolled in a prospective observational cohort study. The goal is to evaluate outcome and characteristics for patients with NSTI and diabetes compared to patients with NSTI without diabetes. The primary outcome is mortality at 90 days after inclusion. Secondary outcomes include days alive and out of ICU and hospital, SAPS II, SOFA score, infectious etiology, amputation, affected body area, and renal replacement therapy. Comparison in mortality between patients with diabetes type 1 and 2 as well as between insulin-treated and non-insulin-treated diabetes patients will be made. Clinical data for diabetic patients with NSTI will be reported. CONCLUSION: The study will provide important data on patients with NSTI and diabetes.

Laying hens behave differently in artificially and naturally sourced ammoniated environments.

Laying hens are chronically exposed to high levels of ammonia (NH3), one of the most abundant aerial pollutants in poultry houses. Tests for aversion to NH3 in laying hens have used artificially sourced NH3/air mixtures (i.e., from a gas cylinder) showing that birds prefer fresh air to NH3. However, artificially sourced NH3/air mixtures may not accurately reflect barn air conditions, where manure emits a variety of gases. Herein, we investigated whether laying hens differentiate between artificially and naturally sourced NH3/air mixtures and how exposure to NH3 affects foraging and aversive behavior. A total of 20 laying hens was exposed to artificially sourced [A] (from an anhydrous NH3 cylinder) and naturally sourced [N] (from conspecific laying hen excreta) gas mixtures. Hens were exposed to A and N mixtures with NH3 concentrations of 25 and 45 ppm, as well as fresh air [FA]. During the experiment, all birds were exposed to each treatment 3 times using a custom-built polycarbonate chamber, containing a foraging area (containing raisins, mealworms, and feed mix) and a gas delivery system. All testing sessions were video recorded, analyzed with INTERACT® software, and subjected to a GLIMMIX procedure in SAS. Our results showed that the laying hens spent less time foraging overall (P < 0.001) and were slower to commence foraging (P = 0.004) in ammoniated environments compared to the fresh air. Laying hens were more likely to forage for a longer time (with fewer interruptions) in N than in A treatments (P < 0.001). Laying hens also reacted with greater aversion towards treatment A compared to treatment N (P < 0.001). These findings suggest that the laying hens of our study preferred fresh to ammoniated air and that they behaved differently in artificially and naturally sourced NH3/air mixtures, possibly due to the presence of familiar stimuli from the excreta. These findings have implications for new developments in methodological approaches for behavioral testing and for recommendations regarding NH3 levels inside poultry barns.

Effects of season and distance during transport on broiler chicken meat.

This research aims to evaluate the microclimate of commercial loads of broiler chickens at different distances in the summer (rainy) and winter (dry) seasons and their effects on meat quality. Twelve broiler loads were monitored with a total of 24 crates per load. Data loggers were used to record temperature and relative humidity. The experiment followed a completely randomized design with 48 treatments in a factorial scheme (2 seasons: rainy and dry) x 2 (distances: short and long) x 12 (positions), with 3 replicates per experimental group. In the rainy season, meat quality was influenced by transport distance. For longer distances, it recorded the highest enthalpy comfort index (ECI), suggesting a tendency of dark, firm, and dry meat (DFD-like) and lower cooking losses (CL). The lowest ECI was recorded during the transport in dry season. Broiler chickens transported and slaughtered in the winter presented meat pH and L* (lightness) classified as "normal," but with higher cooking losses. For the shear force (SF), the seasons and distances had no significant influence on tenderness of the meat. Regarding the crate positioning in the load, no effect was observed during transport on this variable, given the meat quality characteristics of pH, L*, CL, and SF. These results suggest that the distance and the seasons present more influence on broiler meat quality than crate position in the truck.

Heyde syndrome in a 71-year-old man who underwent chest radiotherapy at young age.

We report the case of a 71-year-old man with diagnosis of aortic valve stenosis for ten years, who came to hospital because of breathlessness during the previous two months and recent low intestinal hemorrhage. On admission, laboratory tests and upper gastrointestinal endoscopy and colonoscopy revealed anemia and bleeding cecal angiodysplasia. The echocardiography study showed a severe aortic stenosis. Classical Heyde syndrome is described as the association of aortic stenosis, bleeding gastrointestinal angiodysplasia and secondary anemia. The antecedent of mediastinal radiotherapy for treatment of Hodgkin's disease during his youth, and eventual late cardiac adverse effects that may include aortic or mitral valve disturbances are highlighted. Electrocoagulation with argonium was performed on the sites of active bleeding during the colonoscopy. In sequence, surgical replacement by bioprothesis was done on the aortic valve. The patient remains asymptomatic, under long-term outpatient surveillance, with normal control evaluations. The aim of this case study is to emphasize difficulties related to diagnosis, and to highlight the role of endoscopy and imaging studies to confirm a hypothesis of this underestimated condition.

Two women with cerebral venous thrombosis: oral contraceptives?

Two cases of cerebral venous thrombosis are reported. Patients were apparently healthy 39 and 28-year old females with non-specific presenting features. Image findings were characteristic of cerebral sinus thrombosis. The younger patient received progesterone to treat placental abruption eight years previously; she had cerebral venous thrombosis while using oral contraception. Both patients had used contraceptive pills for a long time. Oral hormonal contraceptives may increase the risk of vascular events, even in people without personal or family history of venous thrombosis. Modern imaging methods have contributed to early diagnosis, but the possibility of under diagnosis still persists. This report aims to increase the awareness of health-workers about cerebral venous thrombosis in women, an entity often misdiagnosed, under diagnosed and under-reported.

Iliopsoas abscess and spondylodiscitis by Staphylococcus aureus: successful clinical treatment.

Although pyogenic abscess of the iliopsoas muscle is considered an uncommon condition, its incidence is on the increase. This abscess may be primary if it occurs without a causal factor; more frequently, it is secondary to gastrointestinal or genitourinary affections, or trauma. The main aetiological agents differ among primary (Staphylococcus aureus) and secondary (Escherichia coli, Klebsiella spp, Streptococcus spp, Bacteroides spp) abscess. We report the case of a 64-year-old man with iliopsoas abscess by S. aureus associated with spondylodiscitis in lumbar vertebrae (L4-L5). Our aim is to emphasize the successful treatment with exclusive intravenous antimicrobials, and highlight the role of control through imaging studies and laboratory tests.