Cycle of Perpetual Vulnerability for Women Facing Homelessness near an Urban Library in a Major U.S. Metropolitan Area.

BACKGROUND: Homelessness among women and the multiple vulnerabilities they endure (sexual exploitation/human trafficking, violence, and mental health issues) is a perpetually unresolved issue in the U.S. and globally. METHODS: This study is based on qualitative in-depth interviews accompanied by brief socio-demographic surveys conducted among 32 total participants, consisting of cisgender females (n = 17) and cisgender males (n = 15) experiencing homelessness at a large public library. RESULTS: Of the women, 35% were White, 35% Latina, 18% African American/Black, and 18% LGBT. Half of all participants said in qualitative interviews that they witnessed violence against women, and/or experienced unwanted harassment/sexual exploitation; one in three described suspected human trafficking. Of the women interviewed, half struggled with mental health symptoms, feelings of hopelessness, and nearly all reported isolation; approximately one-third had substance use issues. Many described an inadequate number of emergency and long-term shelters Available for women facing homelessness; many had to wait or saw other women waiting to get into shelters and faced abuse on the streets in the meantime. CONCLUSION: The emergent themes showed that women face a "cycle of perpetual vulnerability" with three relational pathways: iterated trauma from chronic abuse/violence inflicted on them, a state of paralysis due to inadequate availability of supportive services, shelters, and mental health resources to cover all women living on the streets, leaving women susceptible to being a target phenotype for predators.

Application of bluetongue Disabled Infectious Single Animal (DISA) vaccine for different serotypes by VP2 exchange or incorporation of chimeric VP2.

Bluetongue is a disease of ruminants caused by the bluetongue virus (BTV). Bluetongue outbreaks can be controlled by vaccination, however, currently available vaccines have several drawbacks. Further, there are at least 26 BTV serotypes, with low cross protection. A next-generation vaccine based on live-attenuated BTV without expression of non-structural proteins NS3/NS3a, named Disabled Infectious Single Animal (DISA) vaccine, was recently developed for serotype 8 by exchange of the serotype determining outer capsid protein VP2. DISA vaccines are replicating vaccines but do not cause detectable viremia, and induce serotype specific protection. Here, we exchanged VP2 of laboratory strain BTV1 for VP2 of European serotypes 2, 4, 8 and 9 using reverse genetics, without observing large effects on virus growth. Exchange of VP2 from serotype 16 and 25 was however not possible. Therefore, chimeric VP2 proteins of BTV1 containing possible immunogenic regions of these serotypes were studied. BTV1, expressing 1/16 chimeric VP2 proteins was functional in virus replication in vitro and contained neutralizing epitopes of both serotype 1 and 16. For serotype 25 this approach failed. We combined VP2 exchange with the NS3/NS3a negative phenotype in BTV1 as previously described for serotype 8 DISA vaccine. DISA vaccine with 1/16 chimeric VP2 containing amino acid region 249-398 of serotype 16 raised antibodies in sheep neutralizing both BTV1 and BTV16. This suggests that DISA vaccine could be protective for both parental serotypes present in chimeric VP2. We here demonstrate the application of the BT DISA vaccine platform for several serotypes and further extend the application for serotypes that are unsuccessful in single VP2 exchange.

Fatal Escherichia coli skin and soft tissue infections in liver transplant recipients: report of three cases.

Gram-negative bacilli are unusual agents of skin and soft tissue infections. Most previous cases have been reported in cirrhotic or immunocompromised patients, including a single case in a liver transplant recipient. The present report describes 3 cases of fatal skin or soft tissue infections caused by Escherichia coli that occurred in the postoperative course of liver transplantation. The 3 patients were profoundly immunosuppressed as a result of pre-transplant cirrhosis and the postoperative administration of a potent immunosuppressive therapy. Skin and soft tissue infections developed within the first week after liver transplantation, while graft liver function was satisfactory. The 3 patients presented with fever and skin lesions with or without bullae. Despite prompt appropriate antibiotic therapy and surgical debridement, the outcome was rapidly fatal (24 h on average). E. coli was isolated from subcutaneous tissues in 2 cases and from several blood cultures in the third one. The 3 isolates belonged to distinct phylogenetic groups, and did not harbor most of the virulence factors usually reported in extraintestinal pathogenic E. coli isolates. Our report suggests that E. coli can cause severe skin or soft tissue infection in the postoperative course of liver transplantation. The onset of infection is very early and the outcome is extremely poor, despite prompt adapted medical and surgical treatment. Host factors, rather than E. coli bacterial virulence potential, appear to be the major determinants of severity in these patients.

Microbiological findings of culture-positive preservation fluid in liver transplantation.

Bacterial and fungal infections are the leading cause of mortality in liver transplant (LT) recipients. Few studies have examined the incidence of culture-positive preservation fluid (PF) and the outcome of related recipients. The aim of this study was to determine the incidence and the microbiologic findings of PF positive cultures, and to evaluate the impact on morbidity and mortality of LT recipients. A retrospective analysis of PF cultures performed after 477 LTs from cadaveric grafts between January 2001 and February 2008 was conducted. Forty-five (9.5%) PFs were found to be positive with 1 or 2 pathogens. The demographic profiles of recipients of PF with positive or negative cultures were similar. Enterobacteriaceae species were the most frequent organisms (n = 30), followed by Staphylococcus aureus (n = 5), coagulase-negative staphylococci (n = 5), enterococci (n = 4), and yeasts (n = 3). Mortality rate at 1 month was not significantly different in recipients with positive or sterile PF cultures (88.1% vs. 87.7%, respectively). The rate of bacteremia among LT recipients with positive or negative PF cultures was not statistically different. Systemic infections caused by the pathogen cultured from the PF occurred in 8 (18%) of the 45 recipients, including bacteremia (4/8) or intra-abdominal sepsis (5/8). Causative organisms were Enterobacteriaceae species (n = 5), Candida species (n = 2), and Enterococcus faecium (n = 1). Among the 8 patients who developed infection with the PF organism, 4 (50%) died in the intensive care unit (ICU) vs. an ICU mortality rate of 8% (3/37) in those who did not develop infection with the PF organism (P < 0.05). Infection occurred less frequently in recipients who received antimicrobial therapy with activity against the PF isolate than in those without appropriate treatment (41% vs. 3.8%, P < 0.005). Those who develop infection with organisms recovered from PF cultures appear to have high early mortality rates; therefore, appropriate antimicrobial therapy against organisms cultured from PF should be given.

Sulfur mustard-induced skin burns in weanling swine evaluated clinically and histopathologically.

Histopathological indicators and clinical observations were used to evaluate wound severity, depth and degree of healing on days 2 and 8 for full-skin-thickness sulfur-mustard (HD)-induced burns in weanling swine. Six female weanling swine were exposed for 2 h to 400 microl of HD at each of six dose sites on the hairless abdominal skin. Biopsy samples (8 mm) were taken from the periphery and from the center of the wound on day 2, and the wound was excised on day 8. Histopathological indicators evaluated were epidermal necrosis, follicular necrosis, dermal necrosis, vascular necrosis, depth of injury, ulceration (loss of epidermis), granulation tissue response, neovascularization, re-epithelialization (hyperplasia) and completeness of healing. Wounds were more severe from anterior to posterior. Histopathological assessment of epidermal ulceration and necrosis of epidermis, dermis, basal epithelium, adnexal structures and subcutaneous tissue were useful indicators of wound development on day 2. Granulation tissue response (observed as early as day 8) and re-epithelialization were good indicators of wound healing. Clinical evaluations were performed on day 2 prior to and after debriding, and on study day 8. Clinical observations on study day 2 were for wound size and for exudation, erythema, edema, necrosis and eschar. Clinical observations on study day 8 were for the previous parameters and for re-epithelialization, granulation and infection. Wound size and severity increased from anterior to posterior position. Size, exudation and edema were useful indicators of wound development. These histological and clinical observation parameters will be used in future experiments to compare various treatments for HD-induced burns.

A cutaneous full-thickness liquid sulfur mustard burn model in weanling swine: clinical pathology and urinary excretion of thiodiglycol.

Sulfur mustard (bis(2-chloroethyl)sulfide, HD) is a well-known blistering chemical warfare agent. We have developed a cutaneous full-thickness HD burn model in weanling pigs for efficacy testing of candidate treatment regimens. This report addresses clinical pathology findings and the urinary excretion profile of a major HD metabolite (thiodiglycol, TDG) in this model. Six female Yorkshire pigs were exposed to HD liquid on the ventral surface for 2 h, generating six 3-cm diameter full-thickness dermal lesions per pig. Blood samples were collected throughout a 7-day observation period for hematology and serum chemistry examinations. Urine was collected in metabolism cages. Routine urinalysis was performed and the urine analyzed for TDG using gas chromatography/mass spectrometry. Examination of clinical pathology parameters revealed subtle HD-related changes that are suggestive of a mild hemolytic episode. No other signs of clinically significant systemic toxicities were noted, including bone marrow suppression. Thiodiglycol was detected at the earliest time point tested (6-8 h post-exposure) at levels ranging from 0.66 to 4.98 microg ml(-1) with a mean of 2.14 microg ml(-1). Thiodiglycol concentrations were the highest for half of the animals at this earliest time point and at 24-48 h for the others. By the evening of day 3, the mean level had reached 50 ng ml(-1). Mean levels remained 10-40 ng ml(-1) for the remainder of the 7-day observation period, with the highest individual concentration noted during this period of 132 ng ml(-1). Our results are in general agreement with the TDG excretion profiles previously described for rodent models and humans. Urinary excretion of absorbed HD in our weanling pig wound healing model appears to follow the same pattern as is seen in other laboratory animals models. In general, urinary excretion of TDG appears to peak within the first 1-4 days following exposure, with detectable levels after 1 week. Relatively high urinary TDG levels may thus indicate agent exposure within the previous 96 h. Low levels significantly above natural background levels may indicate either exposure to low levels of agent or exposure that occurred more than 4 days prior to collection of the sample.

[Areactive unilateral mydriasis after diagnostic celioscopy under general anesthesia]. / Mydriase unilatérale aréactive au décours d'une coelioscopie diagnostique sous anesthésie générale.

A unilateral areactive mydriasis occurred in a 49-year-old ASA I woman after a coelioscopic procedure while anaesthesia was maintained for an associated procedure. The various causes of brain stem damage were considered. The inability to perform a complete neurologic assessment resulted in the indication of a cerebral computerised tomography (CT) scan. The diagnosis of Adie's tonic pupil was made a posteriori, taking into consideration: 1) complete recovery without neurologic deficit; 2) unremarkable CT scan; 3) previous transient episodes of unilateral areactive mydriasis.

Morphological aspects of necrosis as a guideline for treatment of necrotizing pancreatitis. A brief report about 50 patients.

In a retrospective study, 50 patients with obvious necrotizing pancreatitis (NP) were allocated in four groups according to the morphological aspects of the necrosis. Appearance of ascite (N1), extrapancreatic spread of necrosis towards neighboring organs (N2), a large amount of necrosis (N3), and infected necrosis (N4), appears to be an easy and useful guideline for the management of NP patients. Organ failures (72%) and mortality rate (36%) are higher when the process is infected. In the other groups, organic dysfunctions were frequent, but all the patients except one survived. The majority (80%) of patients were operated on. Only 20% of patients had successful nonsurgical treatment and they were in N3 group. This percentage may increase through a morphological approach to treating necrosis, with the use of endoscopic treatment for the disruption of pancreatic duct, and better accuracy in the management of patients with noninfected necrosis, whenever organ failures are present.

Antiemetic effect of subhypnotic doses of propofol after thyroidectomy.

Postoperative nausea and vomiting (PONV) are unpleasant, often underestimated side effects of anaesthesia and surgery, not devoid of medical complications. Prevention with antiemetics is only partially effective. Propofol has been shown recently to possess antiemetic properties in several situations. In this prospective, randomized, controlled trial, we have compared the antiemetic efficacy of subhypnotic doses of propofol, with Intralipid as placebo, after thyroidectomy. We studied 64 patients of both sexes, aged 22-71 yr, ASA I or II, undergoing thyroidectomy. After premedication with a benzodiazepine, balanced anaesthesia was produced with isoflurane and nitrous oxide in oxygen, and supplementary analgesia with fentanyl i.v. as required. Postoperative analgesia was provided with non-opioids, and piritramide 0.25 mg kg-1 i.m. on demand. Patients were allocated randomly and blindly to receive a 20-h infusion of either propofol or 10% Intralipid 0.1 ml kg-1 h-1. Intralipid, the excipient of propofol, was chosen as placebo as it is devoid of antiemetic effects. Sedation scores, respiratory and cardiovascular variables, and incidence of PONV were assessed every 4 h for 24 h. Pulse oximetry and ECG were monitored continuously. Both groups were comparable in characteristics, surgical and anaesthesia procedures, amount of opioids given during and after operation, and total amount of the study drug infused after operation. Occurrence of PONV was similar before the start (propofol 41%, Intralipid 50%) and after completion (propofol 0.64%, Intralipid 1.6%) of infusion and decreased with time in both groups during the infusion. However, symptoms were reduced to nil with propofol but persisted and were more severe with Intralipid during infusion (P < or = 0.01). The overall incidence of PONV during infusion was 10% (three of 32 patients) in the propofol group and 65% (21 of 32 patients) in the Intralipid group. Cardiovascular and respiratory variables, and SpO2 were unaltered, and sedation decreased similarly with time in both groups. We conclude that propofol, given at subhypnotic doses, effectively reduced the incidence of PONV without untoward sedative or cardiovascular effects.

[Is early extubation after surgery for esophageal cancer possible?]. / L'extubation précoce après chirurgie du cancer de l'oesophage est-elle possible?

In a series of 50 patients undergoing elective oesogastrectomy through a laparotomy and a right thoracotomy, the avoidance of overnight ventilatory support was made possible by the agreement of anaesthetists and surgeons on suitable policies. The attempt to extubate the patients immediately postoperatively differentiated two groups. For the first group (32 patients; 64%), early extubation could be performed and only one patient was reintubated and required prolonged ventilation. A second group comprised 18 patients who could not be extubated early (36%). For most of the patients in this second group extubation was only delayed until the next day, and recovery was otherwise uneventful. In three cases, however, pulmonary atelectasis with infection was a major problem, and these patients required broncho-endoscopies, and prolonged ventilatory support. Nevertheless, morbidity and mortality after oesophagectomy were significantly reduced in this series, compared with a previous study in the same hospital. Careful postoperative assessment of the patient is essential. The main factors leading to the decision for early extubation appeared to be: absence of serious cardiovascular history, absence of peroperative surgical complications, adequate rewarming, normal chest X-ray, and the presence of clinical criteria for extubation along with adequate arterial blood gases. If the above criteria can be achieved, then early extubation should be routine and can be safely performed in the majority of cases.

EPR/spin-label technique as an analytical tool for determining the resistance of reactive topical skin protectants (rTSPs) to the breakthrough of vesicant agents.

Ointment formulations of reactive topical skin protectants (rTSPs) or topical skin protectants (TSPs) based on perfluorinated polyether material (PFPE, i.e., fomblin RT-15) were prepared and spin labeled. Four N-oxyl-4-4'-dimethyloxazolidine derivatives of stearic acid, 5-NS, 7-NS, 12-NS, and 16-NS, were used as spin probes. The spin-labeled vehicle, fomblin-RT-15, and vehicle containing chloroamide (S-330, an antivesicant) were exposed to various concentrations of half-mustard gas. The order parameter (S) was dependent on the depth of penetration of the paramagnetic group into the vehicle (fomblin) and on the chemical composition of the reactive antivesicant under investigation. The net change of the viscosity of the vehicle and the chemical composition were seen to affect the penetration profile. This will provide a useful in vitro screening technique to develop antivesicant TSPs.