Candida growth in urine cultures: a contemporary analysis of species and antifungal susceptibility profiles.

BACKGROUND: Recent publications suggest the distribution of Candida species causing candiduria may vary geographically, which has implications for the continued efficacy of antifungal therapy and emerging resistance. AIM: To investigate the incidence of Candiduria at a university hospital in the UK. Further, to assess the distribution of species and the accompanying antifungal susceptibility profile, in order to monitor the clinical utility of current antifungal treatment guidelines for candiduria so that patients receive the best possible outcomes from the most up to date care. DESIGN: Retrospective audit. METHODS: From 1st January 2005 to 31st October 2014, we retrospectively reviewed 37 538 positive urine cultures recorded in a computerized laboratory results database. Identification and susceptibility testing was performed using the VITEK® 2 fungal susceptibility card (bioMérieux, Marcy d'Etoile, France). RESULTS: In total, 96 cultures were positive for Candida species, of which 69 (72%) were C.albicans, which translates to a prevalence of 2.6 per 1000 positive urine cultures. Candiduria was more common in younger patients, males and catheterized females. We report 94 and 73% of isolates of C.albicans and other non-C.albicans Candida species were susceptible to fluconazole. All isolates were susceptible to amphotericin B. CONCLUSIONS: Our results add weight to the evidence supporting current European and North American guidelines recommending fluconazole or amphotericin B for treatment of candiduria, if antifungal treatment is clinically indicated.

Collaboration and research as key elements for strengthening blood donation in developing nations: the case of Grenada, West Indies.

OBJECTIVE: The purpose of the study was to identify ways to strengthen the collaboration between the Grenadian Blood Bank, the St George's University (SGU) chapter of the American Medical Students Association, and St George's University Health Clinic in order to improve the promotion of blood drives and increase the number of volunteer donors. METHODS: The study had two phases. Phase 1: an assessment of the strengths and needs of the collaborators and of the blood drives. Phase 2 consisted of three student assessments: a cross-sectional survey of second year medical students, a cross-sectional survey of students in the School of Arts and Sciences and a case-control study of factors affecting student donation on the day of blood drives. Embedded within both phases were service-learning opportunities for students. Both phases received approval from SGU's Institutional Review Board. RESULTS: Preliminary achievements included a transient increase in blood donation of twenty per cent during five months though advertising of blood drives remains inadequate. Assessments reveal that most students lack knowledge about the drives, and time (medical students) and fear of needles and infection (Arts and Science students) are potential hindrances to blood donation. CONCLUSIONS: The Blood Bank needs to increase its profile on the university campus and develop a more effective promotion of the blood drives addressing the concerns of students. St George's University needs to continue supporting student involvement in health promotion activities and identify ways to ensure the sustainability and continuity of these activities. Collaboration and research are useful and effective means to promote blood donation. College students are potentially an excellent source of collaborators and donors if provided with the promotion skills and participation is made convenient.

Collaboration and research as key elements for strengthening blood donation in developing nations: the case of Grenada, West Indies / La colaboración y la investigación como elementos importantes para fortalecer la donación de sangre en las naciones en vías de desarrollo: el caso de Granada, West Indies

OBJECTIVE: The purpose of the study was to identify ways to strengthen the collaboration between the Grenadian Blood Bank, the St George's University (SGU) chapter of the American Medical Students Association, and St George's University Health Clinic in order to improve the promotion of blood drives and increase the number of volunteer donors. METHODS: The study had two phases. Phase 1: an assessment of the strengths and needs of the collaborators and of the blood drives. Phase 2 consisted of three student assessments: a cross-sectional survey of second year medical students, a cross-sectional survey of students in the School of Arts and Sciences and a case-control study of factors affecting student donation on the day of blood drives. Embedded within both phases were service-learning opportunities for students. Both phases received approval from SGU's Institutional Review Board. RESULTS: Preliminary achievements included a transient increase in blood donation of twenty per cent during five months though advertising of blood drives remains inadequate. Assessments reveal that most students lack knowledge about the drives, and time (medical students) and fear of needles and infection (Arts and Science students) are potential hindrances to blood donation. CONCLUSIONS: The Blood Bank needs to increase its profile on the university campus and develop a more effective promotion of the blood drives addressing the concerns of students. St George's University needs to continue supporting student involvement in health promotion activities and identify ways to ensure the sustainability and continuity of these activities. Collaboration and research are useful and effective means to promote blood donation. College students are potentially an excellent source of collaborators and donors if provided with the promotion skills and participation is made convenient.

OBJETIVO: El propósito del estudio fue identificar maneras de fortalecer la colaboración entre el Banco de la Sangre de Granada, la Universidad de San Jorge (SGU), la Asociación Médica Estudiantil Estadounidense, y la Clínica de la Salud de la Universidad de San Jorge, con el fin de mejorar las campañas de donación de sangre y aumentar el número de donantes voluntarios. MÉTODOS: El estudio tuvo dos fases. Fase 1: una valoración de las fortalezas y necesidades de los colaboradores y de las campañas de donación de sangre. Fase 2, consistente en tres valoraciones de estudiante: una encuesta transversal de los estudiantes de segundo año de medicina, una encuesta transversal de estudiantes en la Escuela de Artes y Ciencias, y un estudio de caso-control de los factores que afectan la donación del estudiante el día de la campaña de la donación de sangre. Insertadas entre ambas fases se encuentran las oportunidades de aprendizaje-servicio para los estudiantes. Ambas fases recibieron la aprobación de la Junta de Revisión Institucional de SGU. RESULTADOS: Los logros preliminares incluyeron un aumento transitorio de un veinte por ciento en donaciones de sangre por un período de cinco meses, si bien los anuncios de las campañas de donación de sangre continúan siendo inadecuados. Las evaluaciones revelan que a la mayoría de los estudiantes les falta conocimientos sobre las campañas de donación, y que el tiempo (estudiantes de medicina) y el miedo a las agujas y las infecciones (estudiantes de Artes y de Ciencia) constituyen obstáculos potenciales a la donación de sangre. CONCLUSIONES: El Banco de Sangre necesita aumentar su perfil en el campus universitario y desarrollar una promoción más eficaz de las campañas de donación de sangre sobre la base de prestar atención a las preocupaciones de los estudiantes. La Universidad de San Jorge necesita continuar apoyando la participación de los estudiantes en las actividades de promoción de la salud, así como identificar maneras de asegurar la sostenibilidad y continuidad de estas actividades. La colaboración e investigación son medios útiles y eficaces de promover la donación de sangre. Los estudiantes de la universidad son potencialmente una fuente excelente de colaboradores y donantes, si se les da la oportunidad de promover sus habilidades y participar de la manera más conveniente.

Central nervous system side effects associated with zolpidem treatment.

Zolpidem is one of the newer medications developed for the treatment of insomnia. It is an imidazopyridine agent that is an alternative to the typical sedative-hypnotic agents. Zolpidem use is gaining favor because of its efficacy and its side effect profile, which is milder and less problematic than that of the benzodiazepines and barbiturates used to treat insomnia. Still, side effects are not uncommon with zolpidem use. We report a series of cases in which the patients developed delirium, nightmares and hallucinations during treatment with zolpidem. We will review its pharmacology, discuss previous reports of central nervous system side effects, examine the impact of drug interactions with concurrent use of antidepressants, examine gender differences in susceptibility to side effects, and explore the significance of protein binding in producing side effects.

The effect of sertraline on routine blood chemistry values.

Sertraline is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Although SSRIs are believed to have a milder side effect profile than the tricyclic antidepressants, there are some potentially serious side effects. These include hyponatremia, which has been seen with each of the SSRIs. We reviewed the charts of 246 patients treated with sertraline at a veterans' hospital. We obtained values for each patient's basic chemistry panel (sodium, potassium, chloride, glucose, carbon dioxide, blood urea nitrogen, and creatinine) before and after institution of sertraline therapy. We studied the patients' ages and sertraline doses to see if there was a relationship between any laboratory value changes and these variables. We found no relationship between maximum sertraline dose, age, and changes in routine blood chemistry results with the exception of a small (0.5%) contribution of maximum sertraline dose to variance in serum creatinine levels. Sertraline therapy was not noted to cause any significant changes in serum sodium levels.

Muscle shortening induced by tenotomy does not reduce activity levels in rat soleus.

1. A slow postural muscle was tenotomized to determine the role of muscle stretch on chronic recruitment patterns in freely moving animals. 2. Different amounts of muscle shortening were induced in the soleus muscles of ten rats by severing the tendon of insertion (n = 3), the whole Achilles' tendon (n = 4) or the origins and insertions (n = 3). 3. Bipolar wire electrodes were implanted on each muscle to record the electromyographic activity (EMG) under control and tenotomized conditions. The complex interference pattern was continuously analysed to determine the number and amplitude of peak potentials (called turns). The numbers of these 'turns' and their amplitudes were determined during 4 control and at least 5 experimental days. Sham-operated controls and groups matched according to the type of tenotomy were analysed for length changes and pathological changes 5 and 10 days post-tenotomy. 4. The total activity levels in all three tenotomy conditions were not significantly changed when compared with their own control levels. No differences in total activity level were found between the three tenotomized conditions. 5. The normal diurnal patterns of muscle recruitment were preserved during the tenotomized conditions, with the highest levels consistently occurring during the first 3 h of the dark cycle. 6. Tenotomy of the soleus, whether induced by distal (ST), distal and proximal (DT) or Achilles' tenotomy (AT) resulted in muscle shortening (9-26 %). No muscle pathology was found in the ST or AT groups. Degeneration was found in the DT group after 5 days, with further increases at 10 days. 7. These data suggest that the absence of stretch had no discernible influence on the aggregate activity levels in the slow postural soleus muscle. Whether tenotomy caused changes in recruitment within individual step cycles was not evaluated.

Improved ankle function in children with cerebral palsy after computer-assisted motor learning.

The effect of biofeedback training on ankle function was studied in young children with cerebral palsy (CP) during a pilot study and a 6-week follow-up study. Patients underwent range of motion (ROM) and ankle dorsiflexor (DF) strength training in a laboratory 3 days per week, receiving auditory and visual feedback. An at-home programme used portable EMG units to help train DF muscle recruitment on the remaining days. Independent outcome measures included DF strength, active ROM, and tapping ability pretraining and 6 weeks and 14 months posttraining. Tapping ability increased significantly in the trained leg posttraining. It then fell significantly at the 6-weeks posttraining test, but remained significantly higher than pretest levels, and returned to pretraining levels by 14 months. Passive ROM was unchanged, but active ROM increased significantly in the trained leg. DF strength increased in most children posttraining in both the pilot and main study. Increased motor-unit recruitment is believed to explain the increases in DF strength and active ROM. These results suggest that biofeedback training can improve ankle function, and the implications for gait are discussed.

Factitious disorder presenting as bacteremia. Case report and literature review.

A factitious disorder is typically a chronic illness that can be frustrating for the clinical team because it often eludes early diagnosis. Case reports in the literature show that patients can simulate almost any illness or disease state with some resorting to injecting themselves with contaminated substances to produce infection. A case is reported of a patient with self-induced bacteremia who presented with multiple episodes of polymicrobial bloodstream infections. The various types of factitious disorders and a review of treatment options are discussed. The current criteria for factitious disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 4th edition are reviewed.