The incidence of acute renal failure and high mortality rate in elderly patients hospitalized with community acquired pneumonia.

Community acquired pneumonia is associated with high mortality and health care costs, especially in old age. The clinical presentation of pneumonia in the elderly may be asymptomatic or atypical. One of the known complication is an acute kidney injury. The purpose of our study was to estimate the incidence of this complication in elderly patients hospitalized with pneumonia in our geriatric hospital. From a group of 180 elderly patients hospitalized with community-acquired pneumonia 34.4 % developed acute kidney injury. In this group, 51.6 % of patients died compared to 14.4 % in the group of patients without acute kidney injury (p < 0.001). The lower level of e-GFR was significantly associated with mortality (p < 0.001): out of seven patients with e-GFR level of 15-29 mg/mmol, five patients died (71.4 %). Elderly patients with community-acquired pneumonia suffering acute kidney injury experienced worse in-hospital outcomes; mortality rate was significantly higher in our study. We found a relationship between low level of e-GFR and mortality. Clinicians should be alert for early detection and prevention of kidney injury in patients admitted with pneumonia.

[Experimental study of the effect of corneal hydration and its biomechanical properties on the results of photorefractive keratectomy]. / Vliyanie gidratatsii i biomekhanicheskikh svoistv rogovitsy na rezul'taty fotorefraktsionnoi keratektomii v eksperimente.

Water content in the cornea may affect the outcome of its excimer laser ablation, especially in presbyopic patients with myopic refraction. This hypothesis can be tested by scanning the cornea in the terahertz (THz) range to determine its hydration level. PURPOSE: To study the effect of hydration of the cornea determined by non-contact THz scanning and its biomechanical parameters on the results of photorefractive keratectomy (PRK) in an experiment. MATERIAL AND METHODS: PRK was performed using the Nidek EC-5000 QUEST excimer laser on 8 rabbit eyes. Corneal hydration was evaluated by determining the reflection coefficient (RC) in the THz electromagnetic radiation range before PRK, after 3-5 days, and after 1, 2, 3, and 4 months. Clinical examination included autorefractometry, assessment of corneal thickness and other anatomical and optical parameters of the anterior eye segment (Galilei G6, Ziemer Ophthalmic Systems AG 6.0.2, Switzerland), measurement of corneal hysteresis (CH) and corneal resistance factor (CRF) using the Ocular Response Analyzer (ORA; Reichert, USA), as well as tear production (Schirmer test). RESULTS: The initial water content in the cornea has a significant effect on the thickness of the removed layer, i.e. on the PRK effect, with correlation coefficient of Rs= -0.976 (p<0.01). The correlation between CH and the ablation depth is less pronounced (Rs=0.643), and CRF had no correlation with it (Rs= -0.089). Biomechanical indicators of the cornea depend on its hydration: changes in CH and CRF after excimer laser ablation qualitatively coincide with changes in RC, the correlation coefficient between RC and the initial value of CH is R= -0.619 (moderate negative correlation). CONCLUSION: THz scanning is an effective non-contact technology for monitoring corneal hydration level. The mismatch of the hypoeffect of keratorefractive excimer laser intervention planned for patients with presbyopia with the actual outcome can be caused by individual decrease in the initial water content in the cornea.

Tunnel field-effect transistors for sensitive terahertz detection.

The rectification of electromagnetic waves to direct currents is a crucial process for energy harvesting, beyond-5G wireless communications, ultra-fast science, and observational astronomy. As the radiation frequency is raised to the sub-terahertz (THz) domain, ac-to-dc conversion by conventional electronics becomes challenging and requires alternative rectification protocols. Here, we address this challenge by tunnel field-effect transistors made of bilayer graphene (BLG). Taking advantage of BLG's electrically tunable band structure, we create a lateral tunnel junction and couple it to an antenna exposed to THz radiation. The incoming radiation is then down-converted by the tunnel junction nonlinearity, resulting in high responsivity (>4 kV/W) and low-noise (0.2 pW/[Formula: see text]) detection. We demonstrate how switching from intraband Ohmic to interband tunneling regime can raise detectors' responsivity by few orders of magnitude, in agreement with the developed theory. Our work demonstrates a potential application of tunnel transistors for THz detection and reveals BLG as a promising platform therefor.

The impact of intensive staff education on rate of Clostridium difficile-associated disease in hospitalized geriatric patients.

BACKGROUND: Toxin-producing Clostridium difficile is the most common cause of nosocomial diarrhea in geriatric units. AIM: The purpose of study was to check the impact of intensive staff education on rate of Clostridium difficile-associated disease in hospitalized geriatric patients. METHODS: The sampling frame was all patients suffering from diarrhea checked for Clostridium difficile toxin during the years 2017-2018. Clostridium difficile-positive patients were compared to a similar number of Clostridium difficile toxin-negative patients. The data were compared to our previous study, followed by medical staff's educational program for Clostridium difficile control and prevention. RESULTS: Among 217 patients with diarrhea, 60 (27.6%) were positive for Clostridium difficile toxin. The study group tended to be of older age (p = 0.06), and showed higher rate of functional impairment (p < 0.001) and mortality (p < 0.001) than Clostridium difficile toxin negative patients. The rate of Clostridium difficile toxin-positive patients did not significantly differ between the previous and current studies (20.0% and 27.6%, respectively). CONCLUSIONS AND DISCUSSION: In spite of findings, that patients tended to be older, with high rate of mortality, the rate of Clostridium difficile did not change from the previous study.

Manifestation of plasmonic response in the detection of sub-terahertz radiation by graphene-based devices.

We report on the sub-terahertz (THz) (129-450 GHz) photoresponse of devices based on single layer graphene and graphene nanoribbons with asymmetric source and drain (vanadium and gold) contacts. Vanadium forms a barrier at the graphene interface, while gold forms an Ohmic contact. We find that at low temperatures (77 K) the detector responsivity rises with the increasing frequency of the incident sub-THz radiation. We interpret this result as a manifestation of a plasmonic effect in the devices with the relatively long plasmonic wavelengths. Graphene nanoribbon devices display a similar pattern, albeit with a lower responsivity.

Comparative characteristic of antimicrobial resistance in geriatric hospital: a retrospective cohort study.

BACKGROUND AND AIMS: To examine antimicrobial resistance of commonly isolated pathogens in elderly hospitalized patients. METHODS: Data regarding all clinically significant isolates from blood and urine cultures of patients admitted to a multilevel geriatric hospital during March 2015 to April 2016 were collected. Antimicrobial susceptibility testing was performed according to Clinical and Laboratory Standard Institute guidelines. RESULTS: Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae were the most common isolates, with proportions of extended spectrum beta-lactamase positivity of 60, 40, and 61% respectively. Adjusted logistic regression models indicated that resistance of Escherichia coli to ceftriaxone [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.5-5.1], ceftazidime (OR 2.8, 95% CI 1.5-5.1), ciprofloxacin (OR 2.2, 95% CI 1.2-4.0), amoxicillin/clavulanic acid (OR 2.3, 95% CI 1.2-4.3), and trimethoprim/sulfamethoxazole (OR 2.4, 95% CI 1.4-4.3) was significantly higher in skilled nursing wards than in acute geriatric wards. Resistance of Proteus mirabilis to ceftriaxone (OR 3.1, 95% CI 1.5-6.4) and Klebsiella pneumoniae to ciprofloxacin (OR 3.2, 95% CI 1.3-7.9) was significantly higher in skilled nursing wards than in acute wards. CONCLUSIONS AND DISCUSSION: Antimicrobial resistance was found to be high in a multilevel geriatric hospital, especially in skilled nursing wards. These findings call for rethinking of the empirical antimicrobial therapy and of the efforts for prevention of nosocomial infection.

Potential of a superconducting photon counter for heterodyne detection at the telecommunication wavelength.

Here, we report on the successful operation of a NbN thin film superconducting nanowire single-photon detector (SNSPD) in a coherent mode (as a mixer) at the telecommunication wavelength of 1550 nm. Providing the local oscillator power of the order of a few picowatts, we were practically able to reach the quantum noise limited sensitivity. The intermediate frequency gain bandwidth (also referred to as response or conversion bandwidth) was limited by the spectral band of a single-photon response pulse of the detector, which is proportional to the detector size. We observed a gain bandwidth of 65 MHz and 140 MHz for 7 × 7 µm2 and 3 × 3 µm2 devices, respectively. A tiny amount of the required local oscillator power and wide gain and noise bandwidths, along with unnecessary low noise amplification, make this technology prominent for various applications, with the possibility for future development of a photon counting heterodyne-born large-scale array.

Absorption engineering of NbN nanowires deposited on silicon nitride nanophotonic circuits.

We investigate the absorption properties of U-shaped niobium nitride (NbN) nanowires atop nanophotonic circuits. Nanowires as narrow as 20nm are realized in direct contact with Si3N4 waveguides and their absorption properties are extracted through balanced measurements. We perform a full characterization of the absorption coefficient in dependence of length, width and separation of the fabricated nanowires, as well as for waveguides with different cross-section and etch depth. Our results show excellent agreement with finite-element analysis simulations for all considered parameters. The experimental data thus allows for optimizing absorption properties of emerging single-photon detectors co-integrated with telecom wavelength optical circuits.

High-speed and high-efficiency travelling wave single-photon detectors embedded in nanophotonic circuits.

Ultrafast, high-efficiency single-photon detectors are among the most sought-after elements in modern quantum optics and quantum communication. However, imperfect modal matching and finite photon absorption rates have usually limited their maximum attainable detection efficiency. Here we demonstrate superconducting nanowire detectors atop nanophotonic waveguides, which enable a drastic increase of the absorption length for incoming photons. This allows us to achieve high on-chip single-photon detection efficiency up to 91% at telecom wavelengths, repeatable across several fabricated chips. We also observe remarkably low dark count rates without significant compromise of the on-chip detection efficiency. The detectors are fully embedded in scalable silicon photonic circuits and provide ultrashort timing jitter of 18 ps. Exploiting this high temporal resolution, we demonstrate ballistic photon transport in silicon ring resonators. Our direct implementation of a high-performance single-photon detector on chip overcomes a major barrier in integrated quantum photonics.

Acute inflammatory myopathy with severe subcutaneous edema, a new variant? Report of two cases and review of the literature.

Acute inflammatory myopathy with severe subcutaneous edema is extremely rare and has been reported in only a handful of cases. We describe two similar patients presenting with this disorder and generalized rash. Unlike the five previously reported cases, the clinical and histologic features of our two patients are more suggestive of dermatomyositis than polymyositis. Nevertheless, scrutinizing all seven reported patients, a number of specific characteristics could be defined. All patients were adult males. Dysphagia was present in four. In six patients, acute inflammatory myopathy was idiopathic while malignancy was present in one. Two patients died despite intensive therapy, three improved on corticosteroid treatment, and two recovered spontaneously. In all patients, limb involvement with marked subcutaneous edema was present, clinically mimicking deep vein thrombosis in both our patients. The presence of severe subcutaneous edema may be a hallmark of a distinctive variant of acute inflammatory myopathy. More cases are needed to discern subtypes of this general entity and to establish guidelines for treatment and prognosis.