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Sample records for clinical experience infection

  1. Clinical presentation and management of Fasciola hepatica infection: Single-center experience

    Institute of Scientific and Technical Information of China (English)

    Muhsin Kaya; Remzi Be(s)ta(s); Sedat (C)etin

    2011-01-01

    AIM: To identify the characteristic clinical, laboratory and radiological findings and response to treatment in patients with fascioliasis.METHODS: Patients who were diagnosed with Fasciola hepatica infection were included in this prospective study. Initial clinical, laboratory and radiological findings were recorded. All patients were followed until a complete response was achieved or for 6 mo after treatment discontinuation.RESULTS: Fasciola hepatica infection was diagnosed in 30 patients (24 females; mean age: 42.6 years) between January 2008 and February 2011. Twenty-two (73%) patients had hepatic phase fascioliasis, 5 patients had biliary phase, and 3 patients had biliary phase associated with acute pancreatitis. Of the 8 patients with biliary phase fascioliasis, 2 patients displayed features that overlapped with both hepatic and biliary phase. Abdominal pain and right upper abdominal tenderness were the most prominent signs and symptoms in all patients. Eosinophilia was the most prominent laboratory abnormality in both patients with hepatic and biliary phase (100% and 50%, respectively).Multiple nodular lesions like micro-abscesses on abdominal computerized tomography were the main radiological findings in patients with hepatic phase. Small linear filling defects in the distal choledochus were the main endoscopic retrograde cholangiopancreatography (ERCP) findings in patients with biliary phase. Patients with hepatic phase were treated with triclabendazole alone, and patients with biliary phase were treated with triclabendazole and had live Fasciola hepatica extracted from the bile ducts during ERCP.CONCLUSION: Fasciola hepatica infection should be considered in the differential diagnosis of patients with hepatic or biliary disease and/or acute pancreatitis associated with eosinophilia.

  2. Test and treat: the early experiences in a clinic serving women at high risk of HIV infection in Kampala.

    Science.gov (United States)

    Mbonye, Martin; Seeley, Janet; Nalugya, Ruth; Kiwanuka, Thadeus; Bagiire, Daniel; Mugyenyi, Michelle; Namale, Gertrude; Mayanja, Yunia; Kamali, Anatoli

    2016-01-01

    At the end of 2013, the Government of Uganda issued guidance recommending provision of Anti-Retroviral Treatment (ART) to HIV-positive people in key populations, including female sex workers, regardless of CD4 cell count. We describe the implementation of this new guidance in a clinic serving women at high risk of HIV infection in Kampala. Between July and December 2015, we conducted repeat in-depth interviews with 15 women attending the clinic after the change in guidelines, to explore their perceptions regarding prompt ART initiation. The sample included some women who were HIV-negative and women who had both started and deferred ART. We conducted a data-led thematic analysis of the material from the interviews. A total of 257 of 445 eligible women had started ART; others were undecided or had not returned to the clinic after receiving the new information. Participants recounted varying experiences with the provision of prompt treatment. At an individual level, a history of treatment for opportunistic infections and other illnesses, coupled with relatively poor health, encouraged some to initiate ART promptly. However, knowledge of friends/relatives already on ART who had experienced side effects caused others to delay starting, fearing the same experience for themselves. A number of women questioned why they should start treatment when they were not sick. Situational factors such as work and residence (with many sharing single rooms) caused discomfort among newly diagnosed women who feared disclosure and stigma that would result from taking ART when they were not ill. Alcohol consumption and irregular working hours affected perceptions of future adherence, making prompt ART harder to embrace for some. Our findings show the challenges that influence the delay of treatment initiation, and/or the decision to defer receiving information on ART, with implications for the success of the test and treat programmes and guidelines. PMID:27421050

  3. [POLYGYNAX IN THE TREATMENT OF VAGINAL INFECTIONS IN PREGNANT AND NON-PREGNANT WOMEN--CLINICAL EXPERIENCE].

    Science.gov (United States)

    Popovski, N; Popovski, K; Nedelkovski, V

    2016-01-01

    Vaginal infections /VI/ represent some of the most common diseases by infection of FGS. The aim of this study is to analyze clinical and bacteriological efficacy of Polygynax in the treatment of vaginal infections and to take into account the correlation between the results of microbiological controls and reduction of clinical symptoms. The study included 100 patients, including 50 pregnant and non-pregnant 50 for a period of 3 months. All of them was diagnosed with vaginitis clinical examination, taken material from vagina for microbiological testing. The studied women was conducted targeted therapy Polygynax 12 capsules, in the form of vaginal capsules for 12 days, after which the sample control microbiology. Behind the subjective complaints of the patient and to reduce them as a result of treatment. The effective implementation of Polygynax 12 capsules is equally good as in non-pregnant and pregnant women. In a summary of the survey data to make relevant analyzes and conclusions from the results. PMID:27509660

  4. Trichinella infection and clinical disease

    DEFF Research Database (Denmark)

    Clausen, M R; Meyer, C N; Krantz, T;

    1996-01-01

    Trichinellosis is caused by ingestion of insufficiently cooked meat contaminated with infective larvae of Trichinella species. The clinical course is highly variable, ranging from no apparent infection to severe and even fatal disease. We report two illustrative cases of trichinellosis. Returning....... Life-threatening cardiopulmonary, renal and central nervous system complications developed. The patient recovered after several months. Her husband, who also ate the pork, did not have clinical symptoms, but an increased eosinophil count and a single larva in a muscle biopsy confirmed infection....... The epidemiology, clinical manifestations, diagnosis, treatment and prevention of trichinellosis are reviewed....

  5. Experience of acute hepatitis C and HIV co-infection in an inner city clinic in the UK

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    Christopher Ward

    2014-11-01

    Full Text Available Introduction: Acute hepatitis C infection (HCV is increasing in the HIV-infected population, particularly among men who have sex with men (MSM. Patients co-infected with HCV and HIV progress more rapidly to liver cirrhosis and are at higher risk of hepatocellular carcinoma. We looked at our management of acute HCV to assess treatment outcome. Materials and Methods: We performed a retrospective and prospective case note review of HIV-HCV co-infected patients attending a large inner city sexual health clinic from 2006-to date. Acute HCV infections (less than six months were identified and data was collected on demographics, transmission and treatment outcomes. Treatment regime was 48 weeks of weight-based ribavirin and pegylated interferon α2a. Results: Sixty-seven acute HCV infections were identified among 142 co-infected patients, all of whom were male and 66 (98.5% were MSM. Median age at diagnosis was 37 (range 20–59 and 58 (86.6% were White British. Sixty patients (89.6% were genotype 1, 3 (4.5% were genotype 4 and 2 (3.0% were genotype 2/3. A further 2 (3.0% were re-infections. A peak in new HCV diagnoses was seen in 2013 with 17 (25.4%. Route of transmission was sexual in all cases with 13 (19.4% also injecting drugs, pointing to mixed transmission routes. Nine (69.2% of these occurred in 2013. Nine (13.4% patients cleared HCV themselves. Of the 58 who didn’t clear HCV, 12 (20.7% were lost to follow up/transferred care, 4 (6.9% declined treatment awaiting newer agents, and 10 (17.2% are waiting to start. A total of 32 patients started treatment. Six (18.8% patients are currently on treatment and three (9.4% await a final sustained virological response (SVR test. Six out of twenty-four (25.0% stopped treatment due to lack of response and 1 stopped due to side effects. Fifteen (62.5% achieved SVR and 2 (8.3% failed to achieve SVR. Eight out of ten (80.0% patients who had an early virological response (EVR achieved SVR. Conclusions: Our

  6. Bone infected/inflamed conditions: Clinical experience with RP517, a Tc99m-leukotriene B4 receptor antagonist

    International Nuclear Information System (INIS)

    Full text: Objectives: Tc 99m- RP517- is a receptor antagonist of Leukotriene B4 (LTB4) labelling predominantly neutrophils, in whole blood. The aim of this clinical trial was to obtain the best acquisition protocol and performance of this agent in detecting bone, joint and soft tissue infected / inflamed pathologies. Methods: RP517 was labelled with 15-20 mCi (555-740MBq) Tc99m per doses. Twenty-six patients studied (F 14, M 12) with range ages 19- 93, suspected of bone, joint and soft tissue infection (25) and one with fever of unknown origin (FUO). Laboratory data, anatomical images and one other scintiscan (MDP, Ga-67 or Tc99m- ciprofloxacin) were evaluated. Acquisition protocol: flow, 30 min, 1, 2, 3, 4 - 24h planar or Spect images as required. Results documented with histology, cultures or clinical follow up. Scans were classified as positive when abnormal uptake persisted in the 24h images or negative when positivity faded, or not detected in later images. Results: Labeling efficiency 86-90%. No adverse reactions encountered. Image protocol modified to a flow, 30 min, 4 and 24h images. Ten-fifteen % of in vivo leucocyte labelling at 1h. Early bile and intestinal excretion did not improve with cleansing enemas or food restrain. Late bone marrow activity is less visible than with in vitro leucocyte labeling. Only 16 patients had proven biopsies and cultures with coincident images in 8 True Positive; other 6 cases were True Negative, 2 False Negative (with positive Ga-67 and Tc99m-ciprofloxacin) and no False Positive. Sensitivity 80%, Specificity 100%. Conclusions: A kit should be produced in order to make it easily available. Pharmaceutically manipulation altering the excretion route could validate studies in abdominal infections and FUO that are now disesteemed. Protocol images must include 24h scans. Advantage of RP517 is the lack of cell labeling manipulation. Larger series must be studied to obtain statistics on joint bone and soft tissue infection

  7. Transgressive first clinical experiences

    DEFF Research Database (Denmark)

    Jensen, Carsten Juul; Jeppesen, Lise Kofoed; Drachmann, Merete

    2014-01-01

    . The nursing students’ learning seems to be oriented towards socialization in the clinic as a workplace. This means that the nursing students seek to deal with overwhelming experiences concerning the naked bodies of patients and death, useful application of theoretical knowledge, the path from novice...... to advanced beginner, and adjusting to the workplace community. The conclusion is that the learning of nursing students during their first clinical in-service placement appears informal and not founded on evident best practice.......This Study seeks to comprehend learning experiences of nursing students during their first clinical in-service placement. This Paper is part of a longitudinal development project interviewing the Student Nurse after each one of the five clinical in-service placements and then one year after...

  8. Clinical Pearls in pediatric infections.

    Science.gov (United States)

    Singhi, Sunit; Mathew, Joseph; Jindal, Atul; Verma, Sanjay

    2011-12-01

    This series of Clinical Pearls presents four cases presenting with infection. Each of these cases had clinical clues to the correct diagnosis, which could be picked up on meticulous history, clinical examination, or basic laboratory investigations. The authors highlight the important lessons to be learnt from each case. The first is a 7 year old boy with recurrent respiratory tract infections since early life. Clinical examination revealed the presence of dextrocardia and situs inversus and bronchiectasis leading to a diagnosis of Primary Ciliary Dyskinesia. The second case is a 1.5-month-old infant who presented with meningitis and increasing head size since birth. CSF examination and CT scanning led to the correct diagnosis of congenital Toxoplasmosis. The next case is an infant with high grade fever and neck swelling. He had the rare Lemierre's syndrome comprising of oro-pharyngeal infection, suppurative thrompbophlebitis of the internal jugular vein and systemic dissemination of septic emboli. The fourth case is a 2-year-old infant with recurrent respiratory tract infections and discharging neck swellings from early life. Repeated testing for tuberculosis was negative. The diagnosis was Chronic granulomatous disease. The authors describe the clinical approach and investigations in these cases; along with an outline of the management.

  9. Streptococcus suis infection: Clinical manifestations

    OpenAIRE

    Dragojlović Julijana; Milošević Branko; Šašić Neda; Pelemiš Miomir; Šašić Milan

    2005-01-01

    Introduction Streptococcus suis is a bacterium causing a disease in pigs and rarely in humans. This zoonosis is mostly found as a sporadic disease in individuals that were in contact with the affected or infected pigs: farmers, veterinarians and workers engaged in fresh pork processing. It is assumed that the bacterium enters the body through a cut abrasion in the skin. Initially, the condition resembles a flu, followed by signs of bacteriemia and sepsis. The most frequent clinical manifestat...

  10. Streptococcus suis infection: Clinical manifestations

    Directory of Open Access Journals (Sweden)

    Dragojlović Julijana

    2005-01-01

    Full Text Available Introduction Streptococcus suis is a bacterium causing a disease in pigs and rarely in humans. This zoonosis is mostly found as a sporadic disease in individuals that were in contact with the affected or infected pigs: farmers, veterinarians and workers engaged in fresh pork processing. It is assumed that the bacterium enters the body through a cut abrasion in the skin. Initially, the condition resembles a flu, followed by signs of bacteriemia and sepsis. The most frequent clinical manifestation of Streptococcus suis infection is meningitis, leading to hearing loss in over 75% of patients, and subsequent arthritis, endophtalmitis, endocarditis and pneumonia. Toxic shock syndrome with hemorhagic manifestations rarely develops. Material and methods This study included five male patients aged 22 to 63 years treated in the Intensive Care Unit of the Institute of Infectious and Tropical Diseases in Belgrade, due to Streptococcus suis infection. The aim of this study was to point to the existence of this bacteria in our environment, to describe clinical manifestations of the disease and to point out the importance of its prevention. Results All patients had epidemiological evidence of being in contact with pork meat. There were no data about diseased pigs. The estimated incubation period was 4 to 8 days. All patients had meningeal signs. Clinical symptoms included shivering, fever, vomiting, headache, malaise, vertigo and tinitus. Three patients presented with alerterd level of awareness. Four patients developed very severe bilateral hearing impairemnt, whereas one endophtalmtis and one developed endocarditis. The cerebrospinal fluid (CSF was opalescent in four patients, and only one patient presented with clear CSF. CSF examination showed typical changes characeteristic for bacterial meningitis. Streptoccocus suis was isolated in CSF in all patients, and in one patient the bacteria was isolated in blood as well. All patients underwent treatment with

  11. Clinical features and outcome of bone and joint infections with streptococcal involvement: 5-year experience of interregional reference centres in the south of France.

    Science.gov (United States)

    Seng, P; Vernier, M; Gay, A; Pinelli, P-O; Legré, R; Stein, A

    2016-07-01

    Streptococcal bone and joint infections are less common than staphylococcal cases. Few studies have reported the cases with well-identified Streptococcus species. Their clinical features and prognosis are not clearly known to date. Moreover, no treatment regimen has yet been clarified. We reviewed the streptococcal bone and joint infection cases managed in our centres from January 2009 to December 2013. We described the epidemiology, clinical and microbiologic characteristics, treatment approach and outcome. Among the 93 cases, 83% of patients were men with a median age of 60 years, and 90% of patients had comorbidities or risk factors. Bacteraemia occurred in 14% of cases. Serious complications occurred in six patients, including severe sepsis (two cases) and infective endocarditis (two cases). Orthopaedic device infections were observed in 35% of cases, including 17 patients with internal osteosynthesis device infection, 14 with prosthetic joint infection and three with vertebral osteosynthesis device infection. The median time between orthopaedic device implantation and onset of infection was 447 days. Fourteen species of Streptococcus were identified, including 97 isolates using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and three isolates using molecular identification. The five most represented species included S. agalactiae (37%), S. dysgalactiae (12%), S. anginosus (11%), S. constellatus (10%) and S. pneumoniae (9%). Streptococci isolates were susceptible to amoxicillin, with the exception of one S. mitis isolate. Remission 1 year after the end of treatment was recorded in 83%. One patient died of infection; eight patients had infections that failed to respond to treatment; and seven patients experienced relapse. Twenty patients (22%) had an unfavourable functional outcome, including 19 amputations and one arthrodesis. Five significant prognostic factors associated with an unfavourable clinical outcome were identified

  12. Cumulative clinical experience from over a decade of use of levofloxacin in urinary tract infections: critical appraisal and role in therapy

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    Bush LM

    2011-10-01

    Full Text Available Larry M Bush1,2, Fredy Chaparro-Rojas3, Victor Okeh3, Joseph Etienne3 1Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL; 2University of Miami Miller School of Medicine, Miami, FL; 3Internal Medicine, University of Miami Miller School of Medicine Affiliated Program at JFK Medical Center, Atlantis, FL, USA Abstract: The treatment of urinary tract infections (UTIs continues to evolve as common uropathogens increasingly become resistant to previously active antimicrobial agents. In addition, bacterial isolates, which were once considered to be either colonizers or contaminants, have emerged as true pathogens, likely related to the more complex array of settings where health care is now delivered. Even though the reliability of many antimicrobial agents has become less predictable, the fluoroquinolone group of agents has remained a frequent, if not the most often prescribed, antimicrobial therapy for almost all types of UTIs. Levofloxacin has taken its position at the top of the list as one of the most regularly administered fluoroquinolone agents given to patients with a suspected or proven UTI. The authors review the clinical experience of the use of levofloxacin over the past decade and suggest that the use of levofloxacin for the treatment of UTIs, although still fairly dependable, is perhaps not the best use of this important antimicrobial agent. Keywords: fluoroquinolone, antimicrobial agent, UTI, resistance

  13. Periprosthetic Joint Infections: Clinical and Bench Research

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    Laurence Legout

    2013-01-01

    Full Text Available Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections.

  14. Infections acquired in clinical laboratories in Utah.

    OpenAIRE

    Jacobson, J.T.; Orlob, R B; Clayton, J L

    1985-01-01

    We reviewed laboratory-acquired infections occurring in Utah from 1978 through 1982. Written and telephone interviews of supervisors of 1,191 laboratorians revealed an estimated annual incidence of 3 laboratory-acquired infections per 1,000 employees. Infections, in order of frequency, included hepatitis B (clinical cases), shigellosis, pharyngitis, cellulitis, tuberculosis (skin test conversion), conjunctivitis, and non-A, non-B hepatitis. One-half of large laboratories (over 25 employees), ...

  15. On writing from clinical experience.

    Science.gov (United States)

    Scharff, J S

    2000-01-01

    Papers that present the life of the analytic session offer material through which analysts can together study analytic process and therapeutic action and arrive at consensus on how to improve psychoanalytic theory and practice. But some analysts have been deterred from publishing clinical material of that kind because of concerns about preserving confidentiality, protecting the therapeutic relationship, reporting accurately, being scrutinized, worrying about losing their colleagues' support, and not feeling authorized to present their views. Here conscious, preconscious, and unconscious constraints against writing and publishing are explored, and an example is given of successful self-analysis of a writing inhibition. The debate over the ethics of writing is reviewed and an argument made that detailed clinical description is useful in advancing analytic understanding. Finally, a clinical example shows how the analysand usefully analyzes the experience of reading what the analyst has written, and how the analyst's self-analysis may be promoted in resonance with the analysand's experience.

  16. Intracranial Infections: Clinical and Imaging Characteristics

    International Nuclear Information System (INIS)

    The radiologist plays a crucial role in identifying and narrowing the differential diagnosis of intracranial infections. A thorough understanding of the intracranial compartment anatomy and characteristic imaging findings of specific pathogens, as well incorporation of the clinical information, is essential to establish correct diagnosis. Specific types of infections have certain propensities for different anatomical regions within the brain. In addition, the imaging findings must be placed in the context of the clinical setting, particularly in immunocompromised and human immunodeficiency virus (HIV)-positive patients. This paper describes and depicts infections within the different compartments of the brain. Pathology-proven infectious cases are presented in both immunocompetent and immunocompromised patients, with a discussion of the characteristic findings of each pathogen. Magnetic resonance spectroscopy (MRS) characteristics for several infections are also discussed

  17. Clinical profile of HIV infection

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    Khopkar Uday

    1992-01-01

    Full Text Available HIV seropositivity rate of 14 percent was observed amongst STD cases. Heterosexual contact with prostitutes was the main risk factor. Fever, anorexia, weight loss, lymphadenopathy and tuberculosis were useful clinical leads. Genital ulcers, especially chancroid, were common in seropositivies. Alopecia of unknown cause, atypical pyoderma, seborrhea, zoster, eruptive mollusca and sulfa-induced erythema multiforme were viewed with suspicion in high risk groups. Purpura fulminans, fulminant chancroid, vegetating pyoderma and angioedema with purpura were unique features noted in this study.

  18. Clinical effects of rhinovirus infections.

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    Peltola, Ville; Waris, Matti; Osterback, Riikka; Susi, Petri; Hyypiä, Timo; Ruuskanen, Olli

    2008-12-01

    Rhinovirus is the major cause of common cold and frequently associates with acute wheezing, otitis media, sinusitis, and pneumonia. High prevalence of rhinovirus in hospitalized children and adults has been documented recently. We screened children > or =1 month of age, hospitalized for any infection, for the presence of rhinoviruses and recruited 24 families with > or =2 children for a 3-week follow-up study. Rhinovirus was detected in 46 (28%) of 163 hospitalizations by study children. Most rhinovirus-positive children (85%) had respiratory symptoms. During the follow-up, rhinoviruses were detected in virtually all children and in one-half of adults in families with a rhinovirus-positive index child, but commonly also in families with a rhinovirus-negative index child. Melting temperature and sequence analysis revealed the transmission routes of the viruses and showed that several virus types could circulate in the families simultaneously. Our studies corroborate the major contribution of rhinovirus to hospitalization of children, most often because of wheezing. Young children with respiratory symptoms are major spreaders of rhinovirus in family setting.

  19. Rotavirus infection in children: clinical and laboratory features and catamnesis

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    Mikhailova E.V.

    2013-09-01

    Full Text Available Purpose is to study the clinical, laboratory and instrumental characteristics of the course of rotavirus infection in children up to 3 years in the acute phase and during the convalescence period. Material and methods. A clinical, laboratory and instrumental examination of 320 children up to 3 years with moderate to severe rotavirus infection. Results. The presence of long-term persistence of rotavirus recovering from rotavirus infection. Identified functional disorders of the digestive system in the acute period and the period of convalescence in children up to 3 years with rotavirus infection. Conclusion. For a long period (up to 3 months, almost half of patients may experience intestinal dysfunction, possibly related to the long-term persistence of rotavirus.

  20. Clinical Practice Guidelines Infective Endocarditis Treatment.

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    Lázaro de la Cruz Avilés

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Infective Endocarditis Treatment. Infectious disease affecting the endocardium produces vegetations and could also affect the septum, the chordae tendinae or mural endocardium. It includes concept, risk factors, classification (and special groups and an update and review of the main clinical aspects, complications and treatment stressing the antibiotic therapy. It includes assessment guidelines focused on the most important aspects to be accomplished.

  1. Clinical aspects and outcomes of 70 patients with Middle East respiratory syndrome coronavirus infection: a single-center experience in Saudi Arabia

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    Mustafa Saad

    2014-12-01

    Conclusions: MERS-CoV can cause severe infection requiring intensive care and has a high mortality. Concomitant infections and low albumin were found to be predictors of severe infection, while age ≥65 years was the only predictor of increased mortality.

  2. Clinical practice: Helicobacter pylori infection in childhood.

    Science.gov (United States)

    Ertem, Deniz

    2013-11-01

    Helicobacter pylori infection is recognised as a cause of gastritis and peptic ulcer disease (PUD) and usually acquired during the first years of life. While there is a decline in the prevalence of H. pylori infection in northern and western European countries, the infection is still common in southern and eastern parts of Europe and Asia. Symptoms of H. pylori-related PUD are nonspecific in children and may include epigastric pain, nausea and/or vomiting, anorexia, iron deficiency anaemia and hematemesis. Besides, only a small proportion of children develop symptoms and clinically relevant gastrointestinal disease. H. pylori infection can be diagnosed either by invasive tests requiring endoscopy and biopsy or non-invasive tests including the (13)C-urea breath test, detection of H. pylori antigen in stool and detection of antibodies in serum, urine and saliva. The aim of treatment is at least 90 % eradication rate of the bacteria, and a combination of two antibiotics plus a proton pump inhibitor has been recommended as first-line treatment. However, frequent use of antibiotics during childhood is associated with a decline in eradication rates and the search for new treatment strategies as well. This is an overview of the latest knowledge and evidence-based guidelines regarding clinical presentation, diagnosis and treatment of H. pylori infection in childhood. PMID:23015042

  3. Predicting healthcare associated infections using patients' experiences

    Science.gov (United States)

    Pratt, Michael A.; Chu, Henry

    2016-05-01

    Healthcare associated infections (HAI) are a major threat to patient safety and are costly to health systems. Our goal is to predict the HAI performance of a hospital using the patients' experience responses as input. We use four classifiers, viz. random forest, naive Bayes, artificial feedforward neural networks, and the support vector machine, to perform the prediction of six types of HAI. The six types include blood stream, urinary tract, surgical site, and intestinal infections. Experiments show that the random forest and support vector machine perform well across the six types of HAI.

  4. Various clinical manifestations of brucellosis infection

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    Turkulov Vesna

    2008-01-01

    Full Text Available Introduction. Brucellosis is an acute, subacute or chronical disease, from the zoonosis group, caused by various types of bacteria belonging to genus Brucellae. It is transmitted to humans from domestic animals: goats, sheep, cattle, pigs and dogs. The course of the disease may either be asymptomatic, or produce a variety of clinical manifestations, ranging from light ones to extremely severe clinical forms. The aim of the study was to follow the clinical features of brucella infection in the hospital-treated patients, as well as its course and outcome. Material and Methods. The investigation included 15 patients, treated for brucella infection at the Clinic for infectious diseases during the last two years (2004 and 2005. Results. All patients were adults, their age ranged from 18 to 71, 49.96 on average. The epidemiological questionnaire was positive in all patients, confirming contacts with the ailing animals, or consumption of cheese made from milk of diseased animals. They all exhibited the classic symptoms - increased body temperature and shiver, fever, sweating, malaise and headache, the so called flu like state. The serum agglutination test was positive in respect to brucellosis, the titre ranged from 1:80 to 1:1280. Eight patients suffered excessive back pain, accompanied with impeded walk. In half of them magnetic resonance imaging confirmed the spondylodiscitis diagnosis. Three patients had clinical features of knee arthritis, two had bronchopneumonia, one pancreatitis, and one developed the signs of an acute kidney insufficiency. The outcome was favorable in all patients - They recuperated or healed completely. In one patient a relapse occurred, leading to the chronic course of the illness. Discussion. Although predominantly Mediterranean Brucellosis is a worldwide spread disease. During the last two years, an increased incidence of the disease has been observed. Conclusion. Due to the variety of clinical futures and the possibility

  5. Screening for Neurocognitive Impairment in HIV-Infected Individuals at First Contact after HIV Diagnosis: The Experience of a Large Clinical Center in Northern Italy

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    Emanuele Focà

    2016-03-01

    Full Text Available Neurocognitive disorders are emerging, probably underestimated, complications in HIV-infected people. The aim of the study was to assess neurocognitive profiles of newly detected HIV-infected patients. We performed an observational retrospective single-cohort study. Illiterates and patients with neurologic symptoms or previous psychiatric diagnosis were excluded. Neuropsychological profiles were assessed using a validated battery of neuropsychological tests. We included 206 patients; with males representing the majority of them (85%. Risk factors for HIV acquisition were unprotected sexual intercourse (homo/bisexual in 39.8% and heterosexual in 60.2%. Thirty-nine patients (18.9% were previous injection drug users, while 41 (19.9% were alcohol abusers. Mean education was 11.1 years (SD—standard deviation—3.7. A high prevalence of HIV-associated neurocognitive disorders (HAND, 47.1% was present in HIV-infected patients: particularly, asymptomatic neurocognitive impairment (ANI was found in 30.6%, mild neurocognitive disorder (MND in 15% and HIV-associated dementia (HAD in 1.5%. Male gender, low degree of education, AIDS diagnosis and gepatitis B virus (HBV co-infection were factors independently associated with HAND in a multivariable logistic regression model. Our data suggest that patient-specific factors and AIDS diagnosis have a certain kind of impact in HAND occurrence. A complete neuropsychological screening must be recommended in all patients at HIV-infection diagnosis.

  6. Fertility and contraceptive decision-making and support for HIV infected individuals: client and provider experiences and perceptions at two HIV clinics in Uganda

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    Wanyenze Rhoda K

    2013-02-01

    Full Text Available Abstract Background Some people living with HIV/AIDS (PLHIV want to have children while others want to prevent pregnancies; this calls for comprehensive services to address both needs. This study explored decisions to have or not to have children and contraceptive preferences among PLHIV at two clinics in Uganda. Methods This was a qualitative cross-sectional study. We conducted seventeen focus group discussions and 14 in-depth interviews with sexually active adult men and women and adolescent girls and boys, and eight key informant interviews with providers. Overall, 106 individuals participated in the interviews; including 84 clients through focus group discussions. Qualitative latent content analysis technique was used, guided by key study questions and objectives. A coding system was developed before the transcripts were examined. Codes were grouped into categories and then themes and subthemes further identified. Results In terms of contraceptive preferences, clients had a wide range of preferences; whereas some did not like condoms, pills and injectables, others preferred these methods. Fears of complications were raised mainly about pills and injectables while cost of the methods was a major issue for the injectables, implants and intrauterine devices. Other than HIV sero-discordance and ill health (which was cited as transient, the decision to have children or not was largely influenced by socio-cultural factors. All adult men, women and adolescents noted the need to have children, preferably more than one. The major reasons for wanting more children for those who already had some were; the sex of the children (wanting to have both girls and boys and especially boys, desire for large families, pressure from family, and getting new partners. Providers were supportive of the decision to have children, especially for those who did not have any child at all, but some clients cited negative experiences with providers and information gaps for

  7. Clinical experience of the 23-valent capsular polysaccharide pneumococcal vaccination in HIV-1-infected patients receiving highly active antiretroviral therapy: a prospective observational study.

    Science.gov (United States)

    Hung, Chien-Ching; Chen, Mao-Yuan; Hsieh, Szu-Min; Hsiao, Chin-Fu; Sheng, Wang-Hwei; Chang, Shan-Chwen

    2004-05-01

    To assess the impact of vaccination with 23-valent pneumococcal polysaccharide vaccine on the risks for development of pneumococcal disease, all-cause community-acquired pneumonia, HIV progression, and mortality and immunologic and virologic responses among HIV-1-infected patients treated with highly active antiretroviral therapy (HAART), we conducted a 2-year prospective observational cohort study at a university hospital in Taiwan. A total of 305 HIV-1-infected patients who received 23-valent pneumococcal vaccine (vaccinees) and 203 patients who did not (non-vaccinees) were prospectively observed between 1 June 2000 and 31 October 2002. Changes of CD4+ and plasma viral load (PVL) from baseline to week 4 of vaccination were assessed in 31 randomly selected vaccinees. The incidence of pneumococcal disease and bacteremia of vaccinees was 2.1 per 1000 patient-years (PY) (95% confidence interval (95% CI), 1.7-2.5 per 1000 PY) over the median observation of 641 days (range, 37-832 days) following vaccination while that of non-vaccinee was 21.8 per 1000 PY (95% CI, 20.1-23.7 per 1000 PY) and 7.3 per 1000 PY (95% CI, 7.0-7.6 per 1000 PY), respectively, over the observation of 500 days (range, 32-851 days), with an adjusted odds ratio (AOR) for developing pneumococcal disease of 0.085 (95% CI, 0.010-0.735) and for bacteremia of 0.22 (95% CI, 0.018-2.561). The median CD4+ count increased by 45 x 10(6) l(-1) (P = 0.01) and median PVL change was 0 log(10) copies/ml (range of decrease, -0.74 to 2.47 log(10) copies/ml) after 1 month of pneumococcal vaccination among the subgroup of 31 vaccinees receiving HAART. The median CD4+ count increase from baseline to the end of study was 149 x 10(6) l(-1) for vaccinees and 107 x 10(6) l(-1) for non-vaccinees (P = 0.21). The AOR of developing all-cause community-acquired pneumonia and new AIDS-defining opportunistic illnesses (OI) of vaccinees as compared to non-vaccinees was 1.876 (95% CI, 0.785-4.485) and 0.567 (95% CI, 0

  8. Dengue in HIV infected patients:clinical profiles

    Institute of Scientific and Technical Information of China (English)

    Beuy Joob; Viroj Wiwanitkit

    2014-01-01

    Dengue is an important tropical viral infection. It can present with acute febrile illness with possible hemorrhagic complication. Since it is a common infection in the tropical world, concomitance with other diseases can be expected. An important consideration is the co-presentation of dengue with HIV infection. In this specific report, the authors summarize the clinical profiles of dengue patients with HIV infection. Based on the present study, it can be seen that clinical profiles of dengue in any group of HIV infection is not different.

  9. New clinical experience with tramadol.

    Science.gov (United States)

    Sunshine, A

    1994-01-01

    The analgesic efficacy of tramadol has been recently reassessed as part of a new clinical development programme to support an application for registration in the USA. This article reviews the results of single dose and short term studies of oral tramadol 50, 75, 100 and 150 mg in various acute pain conditions. In a double-blind single dose study conducted in 161 patients with severe pain following caesarean section, tramadol 75 and 150 mg and the combination of paracetamol 650 mg with dextropropoxyphene napsylate 100 mg were shown to be effective and statistically superior to placebo. The results from this and 17 other similar studies in patients with pain after surgery (n = 1594) or dental extraction (n = 1859) including other comparators were included in a pooled analysis. Tramadol 100 mg was the optimal single dose for acute pain and tramadol 50 mg showed similar analgesic efficacy to codeine 60 mg. Multiple dose short term studies (n = 520) with tramadol 50, 75 and 100 mg demonstrated a statistically significant and dose-dependent reduction in the consumption of either ibuprofen or morphine as escape medication. New pharmacokinetic data show that steady-state plasma tramadol concentrations reached after oral administration of 50 mg doses every 6 hours are similar to those obtained after administration of a 100 mg single oral dose (250 micrograms/L). This rationale is supported by the results of long term studies in which the average daily dose of tramadol was approximately 250 mg. PMID:7517826

  10. Natural orifice surgery: initial clinical experience

    OpenAIRE

    Horgan, Santiago; Cullen, John P; Talamini, Mark A.; Mintz, Yoav; Ferreres, Alberto; Jacobsen, Garth R.; Sandler, Bryan; Bosia, Julie; Savides, Thomas; Easter, David W.; Savu, Michelle K.; Ramamoorthy, Sonia L.; Whitcomb, Emily; Agarwal, Sanjay; Lukacz, Emily

    2009-01-01

    Background Natural orifice translumenal endoscopic surgery (NOTES) has moved quickly from preclinical investigation to clinical implementation. However, several major technical problems limit clinical NOTES including safe access, retraction and dissection of the gallbladder, and clipping of key structures. This study aimed to identify challenges and develop solutions for NOTES during the initial clinical experience. Methods Under an Institutional Review Board (IRB)-approved protocol, patients...

  11. 临床药师参与药学会诊控制术后感染的体会%The experience of controling postoperative infection by pharmaceutical consulta-tion from clinical pharmacists

    Institute of Scientific and Technical Information of China (English)

    李莉霞

    2014-01-01

    Clinical pharmaceutical care for patients with postoperative infection had been carrying out by clinical pharmacy group and a suit of normalized pharmacy consultation on postoperative infection was summarized by using standardized consultation process and consultation method in our hospital for eight years .Postoperative infection , especially the serious infection , only through the normalized pharmacy consultation procedure , including standardized management or standardized service processes , the main con-tradiction and formulate feasible countermeasure could be quickly grasped , infection could be controlled in time , medication errors could be reduced even be eliminated .%临床药学组8年来通过采用规范化会诊流程和会诊方法,对术后感染的患者开展临床药学服务,总结术后感染规范化药学会诊的经验与体会。术后感染尤其是严重的感染,只有通过规范化药学会诊(规范化的管理、规范的服务流程等),才能迅速抓住主要矛盾,制定可行的对策,及时控制感染,减少甚至杜绝用药的失误,更好地救治患者。

  12. Hepatitis C virus infection as a traumatic experience.

    Directory of Open Access Journals (Sweden)

    Mychelle Morais-de-Jesus

    Full Text Available OBJECTIVE: The purpose of this study was to evaluate whether individuals consider their HCV infection to be a potentially traumatic experience. Additionally, we investigated its association with Post-Traumatic Stress Disorder (PTSD and the impact of PTSD diagnosis on health-related quality of life (HRQoL in HCV infected subjects. METHODS: We conducted a cross-sectional survey of 127 HCV-infected outpatients recruited at a University Hospital in Salvador, Brazil. All subjects answered an orally-administered questionnaire to gather clinical and socio-demographic data. We investigated traumatic experiences and the subject's perception of the disease using the Trauma History Questionnaire. PTSD and other psychiatric diagnoses were assessed through the Mini International Neuropsychiatric Interview-Brazilian Version 5.0.0 (M.I.N.I. PLUS. HRQoL was assessed using Short-Form 36 (SF-36. RESULTS: Approximately 38.6% of the patients considered hepatitis C to be a traumatic experience. Of these, 60.7% had a PTSD diagnosis. PTSD was associated with significant impairment in quality of life for individuals in seven SF-36 domains as shown bymultivariate analysis: Role-Physical (β: -24.85; 95% CI: -42.08; -7.61, Bodily Pain (β: -19.36; 95% CI: -31.28; -7.45, General Health (β: -20.79; 95% CI: -29.65; -11.92, Vitality (β: -11.92; 95% CI: -20.74; -3.1, Social Functioning (β: -34.73; 95% CI: -46.79; -22.68, Role-Emotional (β: -26.07; 95% CI: -44.61; -7.53, Mental Health (β: -17.46; 95% CI: -24.38; -10.54. CONCLUSION: HCV is frequently a traumatic experience and it is strongly associated with PTSD diagnosis. PTSD significantly impaired HRQoL.

  13. Dengue fever outbreak: a clinical management experience

    International Nuclear Information System (INIS)

    To determine the frequency of dengue as a cause of fever and compare the clinical and haematological characteristics of Dengue-probable and Dengue-proven cases. All patients with age above 14 years, who were either hospitalized or treated in medical outdoor clinic due to acute febrile illness, were evaluated for clinical features of Dengue Fever (DF), Dengue haemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS). Patients showing typical clinical features and haematological findings suggestive of Dengue fever (As per WHO criteria) were evaluated in detail for comparison of probable and confirmed cases of Dengue fever. All other cases of acute febrile illness, not showing clinical features or haematological abnormalities of Dengue fever, were excluded. The clinical and laboratory features were recorded on SPSS 11.0 programme and graded where required, for descriptive and statistical analysis. Out of 5200 patients with febrile illness, 107 (2%) presented with typical features of DF, 40/107 (37%) were Dengue-proven while 67/107 (63%) were Dengue-probable. Out of Dengue-proven cases, 38 were of DF and 2 were of DHF. Day 1 temperature ranged from 99-105 degreeC (mean 101 degree C). Chills and rigors were noticed in 86 (80%), myalgia in 67%, headache in 54%, pharyngitis in 35%, rash in 28%, and bleeding manifestations in 2% cases. Hepatomegaly in 1(0.5%), lymphadenopathy in 1 (0.5%) and splenomegaly in 12 (11.2%) cases. Leucopoenia (count 40 U/L in 57% cases. Frequency of clinically suspected dengue virus infection was 107 (2%), while confirmed dengue fever cases were 40 (0.8%) out of 5200 fever cases. Fever with chills and rigors, body aches, headache, myalgia, rash, haemorrhagic manifestations, platelet count, total leukocyte count, and ALT, are parameters to screen the cases of suspected dengue virus infection, the diagnosis cannot be confirmed unless supported by molecular studies or dengue specific IgM. (author)

  14. Infective endocarditis in chronic hemodialysis patients: Experience from Morocco

    Directory of Open Access Journals (Sweden)

    Dina Montasser

    2011-01-01

    Full Text Available Since the 1960s, regular hemodialysis (HD was recognized as a risk factor for the development of infective endocarditis (IE, particularly at vascular access sites. The present report describes our experience at the Etat Major General Agadir, Morocco, of taking care of IE in patients on regular dialysis. A retrospective analysis was made of five cases of IE in patients receiving re-gular HD having arteriovenous fistula as vascular access. They were sent from four private centers and admitted in our formation between January 2004 and March 2009. Infective endocarditis was detected after 34.5 months following initiation of dialysis. The causative organisms included Sta-phylococcus and Enterococcus in two cases each and negative blood culture in one case. A recent history of infection (<3 months of the vascular access was found in three cases. Peripheric embolic phenomena were noted in two cases. A pre-existing heart disease was common and contributed to heart failure. Mortality was frequent due to valvular perforations and congestive heart failure, making the medical treatment alone unsatisfactory. Two patients survived and three of our patients received a prosthetic valve replacement, with a median survival after surgery of 10.3 months/person. The clinical diagnosis of infective endocarditis in regularly dialyzed patients remains difficult, with the presence of vascular calcification as a common risk factor. The vascular catheter infections are the cardinal gateway of pathogenic organisms, which are mainly Staphlococcus. The prognosis is bad and the mortality is significant, whereas medical and surgical treatments are often established in these patients who have many factors of comorbidity.

  15. Postoperative wound infections after a proctectomy—Patient experiences

    Directory of Open Access Journals (Sweden)

    Karin Hassel

    2016-02-01

    Full Text Available Poor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical and psychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead to extended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possible chemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections following proctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nurse for these patients. Five women and five men (61–87 years, median age 71 years were included and interviewed. A qualitative content analysis of the interviews was carried out and the following main categories emerged: “Managing postoperative complications,” “Being independent,” “Feeling safe,” and “Accepting the situation.” A perineal wound infection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients’ lives turn into new daily routines, which force them to find new ways to live and to accept the situation. For many of them, the infections remained for several months and, sometimes, for years. The ability to lead an independent life is drastically reduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-care support are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed in clinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patient is discharged from the ward and continue until recovery.

  16. Canadian experience with structured clinical examinations.

    OpenAIRE

    Grand'Maison, P.; Lescop, J; Brailovsky, C. A.

    1993-01-01

    The use of structured clinical examinations to improve the evaluation of medical students and graduates has become significantly more common in the past 25 years. Many Canadian medical educators have contributed to the development of this technique. The Canadian experience is reviewed from the introduction of simulated-standardized patients and objective-structured clinical examinations to more recent developments and the use of such examinations for licensure and certification.

  17. Early experiences of accredited clinical informatics fellowships.

    Science.gov (United States)

    Longhurst, Christopher A; Pageler, Natalie M; Palma, Jonathan P; Finnell, John T; Levy, Bruce P; Yackel, Thomas R; Mohan, Vishnu; Hersh, William R

    2016-07-01

    Since the launch of the clinical informatics subspecialty for physicians in 2013, over 1100 physicians have used the practice and education pathways to become board-certified in clinical informatics. Starting in 2018, only physicians who have completed a 2-year clinical informatics fellowship program accredited by the Accreditation Council on Graduate Medical Education will be eligible to take the board exam. The purpose of this viewpoint piece is to describe the collective experience of the first four programs accredited by the Accreditation Council on Graduate Medical Education and to share lessons learned in developing new fellowship programs in this novel medical subspecialty. PMID:27206458

  18. The clinical experiences of dyslexic healthcare students

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Fred [Directorate of Radiography, School of Health Care Professions, University of Salford, Allerton Building, Salford, Greater Manchester M6 6PU (United Kingdom)], E-mail: f.j.murphy@salford.ac.uk

    2009-11-15

    This paper reflects on the experiences of healthcare students with dyslexia in order to raise awareness of the potential challenges for dyslexic student radiographers and their clinical educators. With widening participation policies it is likely that the number of student radiographers with specific learning difficulties such as dyslexia will continue to increase. A review of the literature associated with dyslexia in healthcare education was performed in order to provide an overview of the current position. Although Higher Education Institutions (HEIs) have embraced the support and learning opportunities for dyslexic students at university, evidence would suggest that this is not reflected in the clinical departments. The current literature strongly suggests that since the risk of errors with clinical information is far more significant within the clinical placement, there is an immediate requirement for greater understanding, robust support and risk assessment systems. This review considers the problems experienced by dyslexic students, coping strategies they employ and the possible implications for clinical radiography education.

  19. The clinical experiences of dyslexic healthcare students

    International Nuclear Information System (INIS)

    This paper reflects on the experiences of healthcare students with dyslexia in order to raise awareness of the potential challenges for dyslexic student radiographers and their clinical educators. With widening participation policies it is likely that the number of student radiographers with specific learning difficulties such as dyslexia will continue to increase. A review of the literature associated with dyslexia in healthcare education was performed in order to provide an overview of the current position. Although Higher Education Institutions (HEIs) have embraced the support and learning opportunities for dyslexic students at university, evidence would suggest that this is not reflected in the clinical departments. The current literature strongly suggests that since the risk of errors with clinical information is far more significant within the clinical placement, there is an immediate requirement for greater understanding, robust support and risk assessment systems. This review considers the problems experienced by dyslexic students, coping strategies they employ and the possible implications for clinical radiography education.

  20. Virology, Immunology, and Clinical Course of HIV Infection.

    Science.gov (United States)

    McCutchan, J. Allen

    1990-01-01

    Presents overview of medical aspects of human immunodeficiency virus Type 1 (HIV-1) disease. Addresses structure and replication of virus, current methods for detecting HIV-1 in infected persons, effects of the virus on immune system, and clinical course of HIV-1 disease. Emphasizes variable causes of progression through HIV-1 infection stages;…

  1. Primary cutaneous plasmablastic lymphoma revealing clinically unsuspected HIV infection.

    Science.gov (United States)

    Marques, Silvio Alencar; Abbade, Luciana P Fernandes; Guiotoku, Marcelo Massaki; Marques, Mariangela Esther Alencar

    2016-01-01

    Plasmablastic lymphoma is a rare subtype of diffuse large B-cell lymphoma more frequently diagnosed in immunosuppressed patients, mainly HIV-infected. Primary cutaneous plasmablastic lymphoma is extremely rare, and in this patient it was the first clinical manifestation of unsuspected HIV-infection. PMID:27579749

  2. Infections in orthopaedic surgery : clinical and experimental studies

    NARCIS (Netherlands)

    Vogely, Henri Charles

    2001-01-01

    The diagnostic difficulties, variability in outcome and the heterogeinity of the problem of orthopaedic infections stimulated the author to a study of the literature, and several clinical and experimental studies. The diagnosis prosthesis-related infection can only be reached with an acceptable d

  3. Primary cutaneous plasmablastic lymphoma revealing clinically unsuspected HIV infection*

    Science.gov (United States)

    Marques, Silvio Alencar; Abbade, Luciana P. Fernandes; Guiotoku, Marcelo Massaki; Marques, Mariangela Esther Alencar

    2016-01-01

    Plasmablastic lymphoma is a rare subtype of diffuse large B-cell lymphoma more frequently diagnosed in immunosuppressed patients, mainly HIV-infected. Primary cutaneous plasmablastic lymphoma is extremely rare, and in this patient it was the first clinical manifestation of unsuspected HIV-infection. PMID:27579749

  4. Clinical characteristics analysis of adult human adenovirus type 7 infection

    Institute of Scientific and Technical Information of China (English)

    张乃春

    2014-01-01

    Objective To investigate the clinical characteristics of patients infected with human adenovirus type 7 and to provide guidance for early diagnosis and timely control of the outbreak.Methods A total of 301 patients infected with the human adenoviruses who were quarantined in hospital from December 2012 to February 2013 were observed.Epidemiological questionnaires were used to collect data of clinical features of the disease including

  5. Clinical Practice Guidelines for Vascular Catheter Infections Treatment.

    Directory of Open Access Journals (Sweden)

    Belkys Rodríguez Llerena

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Vascular Catheter Infections Treatment. It has been defined as the presence of local or systemic signs without other obvious infection site, plus the microbiologic evidence involving the catheter. This document includes a review and update of concepts, main clinical aspects, and treatment and stresses the importance of prophylactic treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  6. Clinical Features of Infection in Older Adults.

    Science.gov (United States)

    Norman, Dean C

    2016-08-01

    The impact of infectious diseases on older adults is far greater than on younger adults because of significantly higher morbidity and mortality caused by infection. The reasons for this greater impact include factors such as lower physiologic reserve due to age and chronic disease, age-related changes in host defenses, loss of mobility, higher risk for polypharmacy and adverse drug reactions, and being on drugs that increase the risk for infection (e.g., anticholinergic and other sedating medications increase the risk for pneumonia). PMID:27394015

  7. Classical clinical signs in rats experimemtally infected with Trypanosoma brucei

    Institute of Scientific and Technical Information of China (English)

    Nwoha Rosemary Ijeoma Ogechi; Omamegbe Joseph Omolathebu

    2015-01-01

    Objective:To investigate clinical signs in Trypanosoma brucei infection in albino rats. Methods:Fourteen rats grouped into 2 with 7 rats in each group were used to determine classical clinical manifestation of Trypanosoma brucei infection in rats. Group A rats were uninfected control and Group B rats were infected with Trypanosoma brucei. Results:Parasitaemia was recorded in Group B by (3.86±0.34) d and the peak of parasitaemia was observed at Day 5 post infection. Classical signs observed included squint eyes, raised whiskers, lethargy, no weight loss, pyrexia, isolation from the other rats, and starry hair coat. Conclusions:These signs could be diagnostic or aid in diagnosis of Trypanosoma brucei infection in rats.

  8. Clinical efficacy of ciprofloxacin in lower respiratory tract infections.

    Science.gov (United States)

    Pedersen, S S

    1989-01-01

    The sputum pharmacokinetics and clinical efficacy of ciprofloxacin in lower respiratory tract infections is reviewed. Following intravenous administration, ciprofloxacin penetrates rapidly into bronchial tissue; the elimination half life is between 3 and 4 h and a dose dependency is seen. Following oral intake, the time to reach maximal concentrations is approximately two hours and after a dose of 750 mg the concentration may reach 1.7 mg/l in patients without cystic fibrosis and range from 0.5 to 3.4 mg/l in cystic fibrosis patients. Coadministration of ciprofloxacin increases serum levels and decreases total body clearance of theophylline. In controlled comparative clinical trials, ciprofloxacin has been found to have similar clinical efficacy as amoxycillin, ampicillin, cefalexin, doxycycline, co-trimoxazole, imipenem-cilastatin and ceftazidime for the treatment of a range of lower respiratory tract infections. Ciprofloxacin has been found to be superior in clinical efficacy to cefaclor. Experimental animal models suggest a role for ciprofloxacin in infections caused by Legionella pneumophila and Mycoplasma pneumoniae. The clinical and bacteriological efficacy of ciprofloxacin is less pronounced in lung infections caused by Pseudomonas aeruginosa, but is comparable to the combination of beta-lactams and aminoglycosides. Development of resistance is frequently observed during ciprofloxacin treatment of Ps. aeruginosa. Because of the availability of other oral and effective agents, ciprofloxacin is not recommended for empirical treatment of community acquired lower respiratory infections, but should be reserved for infections caused by multiply resistant organisms. PMID:2667111

  9. Infective endocarditis-experience in Nigeria.

    Science.gov (United States)

    Falase, A O; Jaiyesimi, F; Iyun, A O; Attah, E B

    1976-03-01

    Ninety cases of infective endocarditis seen over a 10-year-period at University College Hospital, Ibadan, are reviewed. The peak incidence was in the third decade and rheumatic heart disease was the commonest pre-existing lesion in 59 cases with subacute endocarditis. In most cases the source of infection was not known. In 41 of the 90 cases (44%) the diagnosis was made only at autopsy. The bacterial isolation rate was low, the commonest organisms being staphylococci, streptococci, micrococci and gramnegative bacilli. The overall mortality was 70%. A plea is made for increasing awareness of the disease and prompt institution of effective treatment. PMID:941246

  10. Prevention and Treatment of Postoperative Infections after Sinus Elevation Surgery: Clinical Consensus and Recommendations

    Directory of Open Access Journals (Sweden)

    Tiziano Testori

    2012-01-01

    Full Text Available Introduction. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone. Aim. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections. Materials and Methods. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus. Results and Conclusion. The incidence of postop infections is relatively low (2%–5.6%. A multidisciplinary approach is advisable. A list of clinical recommendation are given.

  11. First year clinical tutorials: students’ learning experience

    Directory of Open Access Journals (Sweden)

    Burgess A

    2014-11-01

    Full Text Available Annette Burgess,1 Kim Oates,2 Kerry Goulston,2 Craig Mellis1 1Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; 2Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Background: Bedside teaching lies at the heart of medical education. The learning environment afforded to students during clinical tutorials contributes substantially to their knowledge, thinking, and learning. Situated cognition theory posits that the depth and breadth of the students' learning experience is dependent upon the attitude of the clinical teacher, the structure of the tutorial, and the understanding of tutorial and learning objectives. This theory provides a useful framework to conceptualize how students' experience within their clinical tutorials impacts their knowledge, thinking, and learning. Methods: The study was conducted with one cohort (n=301 of students who had completed year 1 of the medical program at Sydney Medical School in 2013. All students were asked to complete a three-part questionnaire regarding their perceptions of their clinical tutor's attributes, the consistency of the tutor, and the best features of the tutorials and need for improvement. Both quantitative and qualitative data were collected and analyzed using descriptive statistics. Results: The response rate to the questionnaire was 88% (265/301. Students perceived that their tutors displayed good communication skills and enthusiasm, encouraged their learning, and were empathetic toward patients. Fifty-two percent of students reported having the same communications tutor for the entire year, and 28% reported having the same physical examination tutor for the entire year. Students would like increased patient contact, greater structure within their tutorials, and greater alignment of teaching with the curriculum. Conclusion: Situated cognition theory provides a valuable lens to view students' experience of learning within the

  12. Clinical Manifestations of Campylobacter concisus Infection in Children

    DEFF Research Database (Denmark)

    Nielsen, Hans Linde; Engberg, Jørgen; Ejlertsen, Tove;

    2013-01-01

    with Campylobacter jejuni/coli infection. RESULTS:: Two thousand three hundred and seventy-two diarrheic stool samples from 1,867 children were cultured for pathogenic enteric bacteria during the study period, and 85 and 109 children with C. concisus and C. jejuni/coli, respectively, were identified. Comparison......BACKGROUND:: There is only sparse information about the clinical impact of Campylobacter concisus infections in children. METHODS:: A study was performed during a two-year period to determine the clinical manifestations in C. concisus positive children with gastroenteritis. A case patient...... for more than two weeks and two-thirds of all children with C. concisus reported loose stools after six month follow-up. CONCLUSIONS:: Campylobacter concisus infection in children seems to have a milder course of acute gastroenteritis compared with C. jejuni/coli infection, but is associated with more...

  13. Clinical management of infected root canal dentin.

    Science.gov (United States)

    Love, R M

    1996-08-01

    Several hundred different species of bacteria are present in the human intraoral environment. Bacterial penetration of root canal dentin occurs when bacteria invade the root canal system. These bacteria may constitute a reservoir from which root canal reinfection may occur during or after endodontic treatment. The learning objective of this article is to review endodontic microbiology, update readers on the role of bacteria in pulp and periapical disease, and discuss the principles of management of infected root canal dentin. Complete debridement, removal of microorganisms and affected dentin, and chemomechanical cleansing of the root canal are suggested as being the cornerstones of successful endodontic therapy, followed by intracanal medication to remove residual bacteria, when required.

  14. Encephalitis in the clinical spectrum of dengue infection

    OpenAIRE

    Varatharaj Aravinthan

    2010-01-01

    Dengue viral infections are common worldwide. Clinical manifestations form a broad spectrum, and include uncomplicated dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. Encephalopathy has been well reported and has classically been thought to result from the multisystem derangement that occurs in severe dengue infection; with liver failure, shock, and coagulopathy causing cerebral insult. However, there is increasing evidence for dengue viral neurotropism, suggesting that, in...

  15. Clinical manifestations of CNS infections caused by enterovirus type 71

    OpenAIRE

    Cheol Soon Choi; Yun Jung Choi; Ui Yoon Choi; Ji Whan Han; Dae Chul Jeong; Hyun Hee Kim; Jong Hyun Kim; Jin Han Kang

    2011-01-01

    Purpose: Enterovirus 71, one of the enteroviruses that are responsible for both hand-foot-and-mouth disease and herpangina, can cause neural injury. During periods of endemic spread of hand-foot-andmouth disease caused by enterovirus 71, CNS infections are also frequently diagnosed and may lead to increased complications from neural injury, as well as death. We present the results of our epidemiologic research on the clinical manifestations of children with CNS infections caused by enteroviru...

  16. What Makes Oral Candidiasis Recurrent Infection? A Clinical View

    OpenAIRE

    Azmi M. G. Darwazeh; Darwazeh, Tamer A.

    2014-01-01

    Clinical oral Candida infection (candidiasis) is one of the common oral mucosal infections, and its management is usually frustrating due to either treatment failure or recurrence. Historically, oral candidiasis has been branded as disease of diseased. The unsuccessful management of oral candidiasis can due to either incorrect diagnosis, failure to identify (or correct) the underlying predisposing factor(s), or inaccurate prescription of antifungal agents. Failure to properly treat oral ca...

  17. Clinical manifestations of non-O1 Vibrio cholerae infections.

    Directory of Open Access Journals (Sweden)

    Yen-Ting Chen

    Full Text Available BACKGROUND: Infections caused by non-O1 Vibrio cholera are uncommon. The aim of our study was to investigate the clinical and microbiological characteristics of patients with non-O1 V. cholera infections. METHODS: The clinical charts of all patients with non-O1 V. cholera infections and who were treated in two hospitals in Taiwan were retrospectively reviewed. RESULTS: From July 2009 to June 2014, a total of 83 patients with non-O1 V. cholera infections were identified based on the databank of the bacteriology laboratories of two hospitals. The overall mean age was 53.3 years, and men comprised 53 (63.9% of the patients. Liver cirrhosis and diabetes mellitus were the two most common underlying diseases, followed by malignancy. The most common type of infection was acute gastroenteritis (n = 45, 54.2%, followed by biliary tract infection (n = 12, 14.5% and primary bacteremia (n = 11, 13.3%. Other types of infection, such as peritonitis (n = 5, 6.0%, skin and soft tissue infection (SSTI (n = 5, 6.0%, urinary tract infection (n = 3, 3.6% and pneumonia (2, 2.4%, were rare. July and June were the most common months of occurrence of V. cholera infections. The overall in-hospital mortality of 83 patients with V. cholera infections was 7.2%, but it was significantly higher for patients with primary bacteremia, hemorrhage bullae, acute kidney injury, acute respiratory failure, or admission to an ICU. Furthermore, multivariate analysis showed that in-hospital mortality was significantly associated with acute respiratory failure (odds ratio, 60.47; 95% CI, 4.79-763.90, P = 0.002. CONCLUSIONS: Non-O1 V. cholera infections can cause protean disease, especially in patients with risk factors and during warm-weather months. The overall mortality of 83 patients with non-O1 V. cholera infections was only 7.2%; however, this value varied among different types of infection.

  18. 临床药师参与足部G+粗大杆菌混合G-杆菌感染治疗体会%Experience of Clinical Pharmacists' Participation in the Drug Treatment of Foot G+ Gross Coli Mixed G- Bacillus Infections

    Institute of Scientific and Technical Information of China (English)

    邢颖; 高杰; 毛璐; 甄健存

    2012-01-01

    Objective: To investigate the effect of clinical pharmacists participation in the treatment of foot G+ gross coli mixed G- coli infections. Method: Clinical pharmacists took part in the therapy of a patient with foot G+ gross coli mixed G- coli infection. Pharmacists helped doctors choose anti-infective drugs under the consideration of the guide, drug susceptibility results, characteristics of drugs, self medication experience and drug adverse reactions. Result: The patients with gas gangrene and mixed infection was cured successfully by the operation and rational drug therapy. Conclusion: The participation of clinical pharmacists in the treatment of surgical infections can supplement the deficiency of antimicrobial drug knowledge in the surgeons. It is beneficial to improve the levels of clinical treatment and rational drug use.%目的:探讨临床药师在治疗足部G+粗大杆菌混合G-杆菌感染病例中的作用.方法:临床药师通过参与1例足G+粗大杆菌混合感染患者的救治工作,发挥自身药学特长,结合指南、药敏结果、药物特点、用药经验及药物不良反应等方面知识帮助临床医生合理选择抗菌药物,处理不良反应.结果:通过手术及合理的用药方案成功治疗气性坏疽及感染.结论:临床药师参与外科感染的治疗,可以弥补外科医生对抗菌药物知识的不足,有利于提高临床治疗水平,促进合理用药.

  19. Clinical application of FDG-PET/CT in metastatic infections

    NARCIS (Netherlands)

    Kouijzer, I.J.E.; Vos, F.J.; Bleeker-Rovers, Chantal P.; Oyen, W.J.G.

    2016-01-01

    FDG-PET/CT has proven its clinical value and cost-effectiveness in diagnosing metastatic infections in patients with Gram-positive bacteremia. In identification of metastatic foci, FDG-PET/CT is useful as a screening method when localizing symptoms are absent because it provides whole-body coverage.

  20. Clinical findings in cows after experimental infection with Ehrlichia phagocytophila.

    Science.gov (United States)

    Pusterla, N; Braun, U

    1997-09-01

    The goal of this study was to determine the clinical signs and course of disease in five lactating cows and in five dry cows after experimental infection with Ehrlichia phagocytophila. Ten clinically healthy Swiss Braunvieh cows, seronegative for E. phagocytophila, were injected with 50 ml of whole blood containing E. phagocytophila. The cows were examined daily for 21 days, and blood samples were collected for microscopic examination of leukocytes for the infective agent. All cows became ill with symptoms of tick-borne fever after an incubation period of 5 to 9 days. The most important clinical signs were pyrexia (40.2-41.7 degrees C), decreased milk production and mildly to moderately disturbed general condition. In addition, there were respiratory symptoms such as polypnea, nasal discharge, cough and abnormal lung sounds. Clinical signs returned to normal in all cows without treatment after an average of 8 days. E. phagocytophila bodies were seen in leukocytes 5-8 days after infection and were present for 6-14 days. The course of disease was more severe in dry cows than in lactating cows. It can be concluded that experimental infection of cows with E. phagocytophila generally has a mild course. However, the associated decrease in milk production may be of economic importance.

  1. Clinical studies on kalmegh (andrographis paniculata nees) in infective hepatitis.

    Science.gov (United States)

    Chturvedi, G N; Tomar, G S; Tiwari, S K; Singh, K P

    1983-04-01

    Infective hepatitis ia an acute inflamatory condition of liver. It is usually manifested in the form of Jaundice. In this clinical study Kalmegh(Andrographis paniculata Nees) was given in the decoction form to the patients of infective hepitis. The results were assessed on the basis of clinical and biochemical parameters. A marked symptomatic improvement in majority of the cases was observed. A statistically highly significant decrease was noted in various liver function tests viz., serum bilirubin, thymol turbidity, alkaline phosphatase, S.G.O.T.; S.G.P.T. and serum globulin fraction of protein. Moreover it increased significantly total serum globulin fraction of protien. Moreover it increased significantly total serum protein level along with albumin fraction. On the total assessment 80% cases of this series were cured and 20% patients were relieved. Therefore, Kalmegh appears to be a useful remedy for the treatment of infective hepatitis.

  2. Burkholderia Pseudomallei Causing Bone and Joint Infections: A Clinical Update.

    Science.gov (United States)

    Raja, Nadeem Sajjad; Scarsbrook, Christine

    2016-03-01

    Burkholderia pseudomallei (B. pseudomallei), a causative agent of an emerging infectious disease melioidosis, is endemic in the tropical regions of the world. Due to increased international travel, the infection is now also seen outside of the tropics. The majority of patients with identified risk factors such as diabetes mellitus, heavy alcohol use, malignancy, chronic lung and kidney disease, corticosteroid use, thalassemia, rheumatic heart disease, systemic lupus erythematosus and cardiac failure acquire this organism through percutaneous inoculation or inhalation. The clinical manifestations are variable, ranging from localized abscess formation to septicemia. Melioidotic bone and joint infections are rarely reported but are an established entity. The knee joint is the most commonly affected joint in melioidosis, followed by the ankle, hip and shoulder joints. Melioidosis should be in the differential diagnosis of bone and joint infections in residents or returning travelers from the endemic area. Melioidosis diagnosis is missed in many parts of the world due to the lack of awareness of this infection and limited laboratory training and diagnostic techniques. It also mimics other diseases such as tuberculosis. Delay in the diagnosis, or the initiation of appropriate and effective treatment against melioidosis, could worsen the outcome. Initial therapy with ceftazidime, or carbapenem with or without cotrimoxazole is recommended, followed by the oral eradication therapy (based on the antimicrobial susceptibility) with amoxicillin/clavulanic acid or cotrimoxazole. Surgical intervention remains important. This paper reviews current literature on the epidemiology, clinical features, diagnosis, and management of melioidotic bone and joint infections. PMID:26728713

  3. Clinical Experience in TCM Treatment of Insomnia

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ Insomnia is a sleeping disorder that affects 1 in 10 Americans and around 50% of the seniors. It is often more prevalent in women. Since September 11, 2005 these estimations have increased. Insomnia can affect not only your energy level and mood, but your health as well because sleep helps bolster your immune system. Insomnia is characterized by: 1) difficulty in falling asleep; 2) waking up frequently during the night with difficulty of returning to sleep; 3) waking up too early in the morning; and 4) with unrefreshing sleep, the patient has a low spirit, palpation, poor memory, viscera function disorder. All these seriously affect the patient's life and work. The following is an account of the authors' clinical TCM experience in treating insomnia.

  4. Clinical experience with the Sarns centrifugal pump.

    Science.gov (United States)

    Curtis, J J; Walls, J T; Demmy, T L; Boley, T M; Schmaltz, R A; Goss, C F; Wagner-Mann, C C

    1993-07-01

    Since October 1986, we have had experience with 96 Sarns centrifugal pumps in 72 patients (pts). Heparinless left atrial to femoral artery or aorta bypass was used in 14 pts undergoing surgery on the thoracic aorta with 13 survivors (93%). No paraplegia or device-related complications were observed. In 57 patients, the Sarns centrifugal pump was used as a univentricular (27 pts) or biventricular (30 pts) cardiac assist device for postcardiotomy cardiogenic shock. In these patients, cardiac assist duration ranged from 2 to 434 h with a hospital survival rate of 29% in those requiring left ventricular assist and 13% in those requiring biventricular assist. Although complications were ubiquitous in this mortally ill patient population, in 5,235 pump-hours, no pump thrombosis was observed. Hospital survivors followed for 4 months to 6 years have enjoyed an improved functional class. We conclude that the Sarns centrifugal pump is an effective cardiac assist device when used to salvage patients otherwise unweanable from cardiopulmonary bypass. Partial left ventricular bypass using a centrifugal pump has become our procedure of choice for unloading the left ventricle and for maintenance of distal aortic perfusion pressure when performing surgery on the thoracic aorta. This clinical experience with the Sarns centrifugal pump appears to be similar to that reported with other centrifugal assist devices.

  5. Nosocomial infections at Clinical Centre in Kragujevac: Prevalence study

    Directory of Open Access Journals (Sweden)

    Ilić Milena

    2010-01-01

    Full Text Available Introduction Nosocomial infections (NIs are a serious health problem in hospitals worldwide and are followed by a series of consequences, medical, judicial, ethical and economic. Objective The main aim of this study was to assess the magnitude of NIs at the Clinical Centre in Kragujevac. Methods A prevalence study of nosocomial infections was conducted from 16th till 20th May, 2005, within Second National Prevalence Study of Niš in the Republic of Serbia. Results The study included 866 patients. 40 patients had a NI, thus the prevalence of patients with NIs and prevalence of NIs was the same, 4.6%. Among NIs, the most frequent were urinary infections (45.0% followed by surgical-site infections (17.5%, skin and soft tissue infections (15% and pneumonia (12.5%. The rate of NIs was highest at departments of orthopaedics and traumatological surgery (12.0%, followed by intensive care units (8.0%. Overall, 67.5% (27/40 NIs were culture-proved; the leading pathogens were Escherichia coli (40.0%, followed by gram-negative bacteria (Pseudomonas species, Proteus mirabilis, Enterobacteriaceae with equal frequency of 8.0%. Nosocomial infections were significantly more frequent in patients aged ≥65 years (p<0.05, with longer hospitalization ≥8 days (p<0.00, in intensive care patients (p<0.05, patients with an intravenous catheter (p<0.00, urinary catheter (p<0.00, and those under antibiotic therapy (p<0.00. Conclusion This study showed that the prevalence of nosocomial infections in our hospital is similar to the prevalence in the developed countries. The study of prevalence provides a prompt insight into basic epidemiological and ethiological characteristics of nosocomial infections, hence identification of hospital priorities and the need to undertake appropriate prevention measures. .

  6. Nurses' experiences of clinical commissioning group boards.

    Science.gov (United States)

    Allan, Helen; O'Driscoll, Mike; Savage, Jan; Lee, Gay; Dixon, Roz

    2016-06-15

    Aim To explore the experience of governing body nurses appointed to clinical commissioning group (CCG) boards; how they perform their responsibilities; and their perceived effectiveness in ensuring safe, patient-centred care and the factors that influence their effectiveness. Method This was a small pilot study using a mixed methods approach. There were four phases of the study: literature review, qualitative data collection (interviews), quantitative data collection (survey), and final data analysis. Findings In the early stages of the formation of CCGs, few governing body nurses had relevant experience to meet the needs of a strategic role, and many of these nurses had no proper job description, too little time to carry out their responsibilities, little management support, and unequal access to training, development, formal support or supervision compared to GP colleagues. Two working patterns or models of work of governing body nurses emerged: the full-time integrated executive statutory role and the part-time non-executive statutory role. Quality and quality assurance were the most frequently cited roles or responsibilities of governing body nurses in CCGs, and their highest priority was to improve the population's health. Conclusion The role of governing body nurse has emerged at a time of organisational change, and following extensive criticism of nursing and nurses in the media. Nurses' roles and experiences are affected by these contextual events and by the emerging structures and diversity of CCGs. Further research is required into the leadership role of governing body nurses, succession planning, and the effectiveness of their relationships with other senior nurses. PMID:27305258

  7. Development of a clinical data warehouse for hospital infection control.

    Science.gov (United States)

    Wisniewski, Mary F; Kieszkowski, Piotr; Zagorski, Brandon M; Trick, William E; Sommers, Michael; Weinstein, Robert A

    2003-01-01

    Existing data stored in a hospital's transactional servers have enormous potential to improve performance measurement and health care quality. Accessing, organizing, and using these data to support research and quality improvement projects are evolving challenges for hospital systems. The authors report development of a clinical data warehouse that they created by importing data from the information systems of three affiliated public hospitals. They describe their methodology; difficulties encountered; responses from administrators, computer specialists, and clinicians; and the steps taken to capture and store patient-level data. The authors provide examples of their use of the clinical data warehouse to monitor antimicrobial resistance, to measure antimicrobial use, to detect hospital-acquired bloodstream infections, to measure the cost of infections, and to detect antimicrobial prescribing errors. In addition, they estimate the amount of time and money saved and the increased precision achieved through the practical application of the data warehouse.

  8. Clinical significance of occult hepatitis B virus infection

    Institute of Scientific and Technical Information of China (English)

    Miriam Romero; Antonio Madejón; Conrado Fernández-Rodríguez; Javier García-Samaniego

    2011-01-01

    Occult hepatitis B virus (HBV) infection (OBI) is defined as the presence of HBV DNA in the liver (with or without detectable HBV DNA in serum) for individuals testing HBV surface antigen negative. Until recently, the clinical effect of OBI was unclear on the progression of liver disease; on the development of hepatocellular carcinoma; and on the risk for reactivation or transmission of HBV infection. Several studies suggest a high prevalence of OBI among patients with cryptogenic chronic liver disease, but its role in the progression to cirrhosis remains unclear. Although OBI has been well documented in human immunodeficiency virus (HIV)-positive patients, especially among those coinfected with hepatitis C virus, further studies are needed to determine its current clinical impact in HIV setting.

  9. Clinical consequences of infected arteriovenous grafts in hemodialysis patients.

    Science.gov (United States)

    Minga, T E; Flanagan, K H; Allon, M

    2001-11-01

    Arteriovenous (AV) graft infection is a serious adverse event in hemodialysis patients; however, there is little published literature describing its consequences. We identified prospectively all AV graft infections occurring at our institution during a 4.5-year period. We analyzed immediate complications, as well as long-term consequences, including the need for subsequent vascular-access procedures and duration of catheter-dependent dialysis therapy. Ninety graft infections were identified in 78 patients, yielding a rate of 8.2 infections/100 graft-years. Patients with graft infection were much more likely to have a low serum albumin level (<3.5 g/dL) in the month preceding the infection compared with noninfected controls (73% versus 18%; P < 0.001). Infections occurred within 1 month of graft placement in 15%, at 1 to 12 months in 44%, and longer than 1 year from surgery in 41%. The pathogen was a gram-positive coccus in 97% of cases, particularly Staphylococcus aureus (60%) and Staphylococcus epidermidis (22%). The initial graft infection entailed hospitalization for a mean of 7.5 days. Eleven patients (12%) developed a total of 17 major complications, including death (5 patients), clinical sepsis requiring vasopressors (4 patients), septic arthritis (3 patients), epidural abscess (1 patient), endocarditis (1 patient), osteomyelitis (1 patient), myocardial infarction (1 patient), and cerebrovascular accident (1 patient). After removal of an infected graft, patients were catheter dependent for a median of 3.8 months. The duration of catheter dependence was less than 3 months in 36%, 3 to 6 months in 38%, 6 to 12 months in 14%, and greater than 1 year in 12%. During the period of catheter dependence, patients required a mean of 9.7 access procedures, including graft removal (1.0 procedure), nontunneled dialysis catheters (4.4 procedures), tunneled dialysis catheters (3.0 procedures), and new permanent accesses (1.4 procedures). In addition, patients averaged 0

  10. Transmyocardial laser revascularization. Early clinical experience

    Directory of Open Access Journals (Sweden)

    Oliveira Sérgio Almeida de

    1999-01-01

    Full Text Available OBJECTIVE: To analyze the initial clinical experience of transmyocardial laser revascularization (TMLR in patients with severe diffuse coronary artery disease. METHODS: Between February, 1998 and February, 1999, 20 patients were submitted to TMLR at the Heart Institute (InCor, University of São Paulo Medical School, Brazil, isolated or in association with conventional coronary artery bypass graft (CABG. All patients had severe diffuse coronary artery disease, with angina functional class III/IV (Canadian Cardiovascular Society score unresponsive to medical therapy. Fourteen patients were submitted to TMLR as the sole therapy, whereas 6 underwent concomitant CABG. Fifty per cent of the patients had either been previously submitted to a CABG or to a percutaneous transluminal coronary angioplasty (PTCA. Mean age was 60 years, ranging from 45 to 74 years. RESULTS: All patients had three-vessel disease, with normal or mildly impaired left ventricular global function. Follow-up ranged from 1 to 13 months (mean 6.6 months, with no postoperative short or long term mortality. There was significant symptom improvement after the procedure, with 85% of the patients free of angina, and the remaining 15 % of the patients showing improvement in functional class, as well as in exercise tolerance. CONCLUSION: This novel technique can be considered a low risk alternative for a highly selected group of patients not suitable for conventional revascularization procedures.

  11. Emerging Bacterial Infection: Identification and Clinical Significance of Kocuria Species.

    Science.gov (United States)

    Kandi, Venkataramana; Palange, Padmavali; Vaish, Ritu; Bhatti, Adnan Bashir; Kale, Vinod; Kandi, Maheshwar Reddy; Bhoomagiri, Mohan Rao

    2016-01-01

    Recently there have been reports of gram-positive cocci which are morphologically similar to both Staphylococci and the Micrococci. These bacteria have been identified as Kocuria species with the help of automated identification system and other molecular methods including 16S rRNA (ribosomal ribonucleic acid) evaluation. Kocuria belongs to the family Micrococcaceae which also includes Staphylococcus species and Micrococcus species. Isolation and clinical significance of these bacteria from human specimens warrant great caution as it does not necessarily confirm infection due to their ubiquitous presence, and as a normal flora of skin and mucous membranes in human and animals. Most clinical microbiology laboratories ignore such bacteria as laboratory and specimen contaminants. With increasing reports of infections associated with these bacteria, it is now important for clinical microbiologists to identify and enumerate the virulence and antibiotic susceptibility patterns of such bacteria and assist clinicians in improving the patient care and management. We review the occurrence and clinical significance of Kocuria species. PMID:27630804

  12. Clinical Features of Right-sided Infective Endocarditis

    Institute of Scientific and Technical Information of China (English)

    杨莉; 伍卫; 王景峰; 张燕; 张小玲

    2002-01-01

    Objective To discuss thepathogenesis, etiology, clinical manifestations, diagnosis, treatment and prognosis of right-sided infective endocarditis (RIE) . Methods To investigate retrospectively the clinical data of patients with RIE admitted in our hospital from Jan 1985 to Dec 2000.Results There were 17 cases of RIE (12 male, 5female, mean age 22 years), among which 7 with congenital heart disease, 1 with pacemaker implantation and 9 with a history of intravenous drug abuse but without underlying heart disease. Fever and multiple pulmonary emboli were the major clinical manifestations. Blood cultures were positive in 8 cases with Staphylococcus aureus as the predominant microorganism. Echocardiography detected right heart vegetations in all cases, with tricuspid valve as the structure most frequently affected. Most patients were successfully treated with antimicrobials. The outcome was favourable, with a mortality of 11.8 % . Conclusions The clinical features of RIE are different from that of left-sided infective endocarditis (LIE) . Echocardiography plays an important role in the diagnosis of RIE.

  13. Clinical course of primary HIV infection: consequences for subsequent course of infection

    DEFF Research Database (Denmark)

    Pedersen, C; Lindhardt, B O; Jensen, B L;

    1989-01-01

    seroconversion occurred within 12 months. PRIMARY OUTCOME MEASURE--Progression of HIV infection, defined as CD4 lymphocyte count less than 0.5 X 10(9)/l, recurrence of HIV antigenaemia, or progression to Centers for Disease Control group IV. MAIN RESULTS--Median follow up was 670 (range 45-1506) days. An acute...... of symptoms or had mild illness. All six patients who developed AIDS had had longlasting primary illnesses. Three year progression rates to a CD4 lymphocyte count less than 0.5 X 10(9)/l and to recurrence of HIV antigenaemia were significantly higher for those who had longlasting primary illnesses than those......OBJECTIVE--To investigate the impact of the clinical course of the primary HIV infection on the subsequent course of the infection. DESIGN--Prospective documenting of seroconversion, follow up at six month intervals, and analysis of disease progression by life tables. PATIENTS--86 Men in whom...

  14. CLINICAL SPECTRUM OF OPPORTUNISTIC INFECTIONS IN HIV POSITIVE PATIENTS

    Directory of Open Access Journals (Sweden)

    Usmani

    2015-03-01

    Full Text Available The human immunodeficiency virus (HIV infection leading to Acquired Immunodeficiency Syndrome (AIDS causes progressive decline in immunological response in people living with HIV/AIDS, making them susceptible to a variety opportunistic infections (OIs which are responsible for morbidity and mortality. Therefore early diagnosis and management of opportunistic infections reduce the mortality and morbidity in HIV positive patients. CONTEXT : AIMS : To study the demographic variables; spectrum of opportunist ic infections and its correlation with CD4 count in HIV patients. SETTING AND DESIGN : The study was conducted on 200 HIV patients either admitted to Sanjay Gandhi Memorial Hospital or attending ART Center, Sh y am Shah Medical College, Rewa (M.P from Januar y 2013 to October 2014. METHODS AND MATERIAL : A detailed history was recorded with emphasis on personal history, high risk behavior, history of migration, mode of transmission of infection and complete thorough clinical examination was done. Data analysis was done by calculating P value using Chi Square test. RESULTS : Out of 200 HIV patients, most of them (88% belonged to the age group 20 - 49 years, 66% were males and 34% were females. 45% were illiterates, 62% were from low socioeconomic class. Majority of patients were married (79% and 72.2% had seropositive spouse. Unprotected sexual route was the most common (85% mode of transmission; among which heterosexual route was the only mode of transmission. 59.4% of males contracted infection through unprotect ed sex with either commercial sex workers (44.8% or multiple sex partners (14.6%. 61% of patients had history of emigration. Tuberculosis was the most common opportunistic infection (51%, followed by oral candidiasis 30% and chronic diarrhea (9%.Pulmon ary Tuberculosis was the most common form of Tuberculosis (64.7%, followed by tubercular lymphadenopathy (15.7%. CONCLUSION : HIV/AIDS has no vaccine or cure, so prevention is the only

  15. Epidemiologic and Clinical Impact of Acinetobacter baumannii Colonization and Infection

    Science.gov (United States)

    Villar, Macarena; Cano, María E.; Gato, Eva; Garnacho-Montero, José; Miguel Cisneros, José; Ruíz de Alegría, Carlos; Fernández-Cuenca, Felipe; Martínez-Martínez, Luis; Vila, Jordi; Pascual, Alvaro; Tomás, María; Bou, Germán; Rodríguez-Baño, Jesús

    2014-01-01

    Abstract Acinetobacter baumannii is one of the most important antibiotic-resistant nosocomial bacteria. We investigated changes in the clinical and molecular epidemiology of A. baumannii over a 10-year period. We compared the data from 2 prospective multicenter cohort studies in Spain, one performed in 2000 (183 patients) and one in 2010 (246 patients), which included consecutive patients infected or colonized by A. baumannii. Molecular typing was performed by repetitive extragenic palindromic polymerase chain reaction (REP-PCR), pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). The incidence density of A. baumannii colonization or infection increased significantly from 0.14 in 2000 to 0.52 in 2010 in medical services (p < 0.001). The number of non-nosocomial health care-associated cases increased from 1.2% to 14.2%, respectively (p < 0.001). Previous exposure to carbapenems increased in 2010 (16.9% in 2000 vs 27.3% in 2010, p = 0.03). The drugs most frequently used for definitive treatment of patients with infections were carbapenems in 2000 (45%) and colistin in 2010 (50.3%). There was molecular-typing evidence of an increase in the frequency of A. baumannii acquisition in non-intensive care unit wards in 2010 (7.6% in 2000 vs 19.2% in 2010, p = 0.01). By MSLT, the ST2 clonal group predominated and increased in 2010. This epidemic clonal group was more frequently resistant to imipenem and was associated with an increased risk of sepsis, although not with severe sepsis or mortality. Some significant changes were noted in the epidemiology of A. baumannii, which is increasingly affecting patients admitted to conventional wards and is also the cause of non-nosocomial health care-associated infections. Epidemic clones seem to combine antimicrobial resistance and the ability to spread, while maintaining their clinical virulence. PMID:25181313

  16. Clinical manifestations of CNS infections caused by enterovirus type 71

    Directory of Open Access Journals (Sweden)

    Cheol Soon Choi

    2011-01-01

    Full Text Available Purpose: Enterovirus 71, one of the enteroviruses that are responsible for both hand-foot-and-mouth disease and herpangina, can cause neural injury. During periods of endemic spread of hand-foot-andmouth disease caused by enterovirus 71, CNS infections are also frequently diagnosed and may lead to increased complications from neural injury, as well as death. We present the results of our epidemiologic research on the clinical manifestations of children with CNS infections caused by enterovirus 71. Methods: The study group consisted of 42 patients admitted for CNS infection by enterovirus 71 between April 2009 and October 2009 at the Department of Pediatrics of 5 major hospitals affiliated with the Catholic University of Korea. We retrospectively reviewed initial symptoms and laboratory findings on admission, the specimen from which enterovirus 71 was isolated, fever duration, admission period, treatment and progress, and complications. We compared aseptic meningitis patients with encephalitis patients. Results: Of the 42 patients (23 men, 19 women, hand-foot-and-mouth disease was most prevalent (n=39, followed by herpangina (n=3, upon initial clinical diagnosis. Among the 42 patients, 15 (35.7% were classified as severe, while 27 (64.3% were classified as mild. Factors such as age, fever duration, presence of seizure, and use of intravenous immunoglobulin (IVIG were statistically different between the 2 groups. Conclusion: Our results indicate that patients with severe infection caused by enterovirus 71 tended to be less than 3 years old, presented with at least 3 days of fever as well as seizure activity, and received IVIG treatment.

  17. [Nitrofurantoin--clinical relevance in uncomplicated urinary tract infections].

    Science.gov (United States)

    Stock, Ingo

    2014-07-01

    The nitrofuran derivative nitrofurantoin has been used for more than 60 years for the antibacterial therapy of uncomplicated urinary tract infections (UTI). Despite its long application, this antibiotic retained good activity against Escherichia coli and some other pathogens of uncomplicated urinary tract infections such as Staphylococcus saprophyticus and Enterococcus species. Nitrofurantoin therapy has been shown to be accompanied by numerous adverse drug effects. Among these, there are also serious side effects such as pulmonary reactions and polyneuropathy, which mainly occur in long-term use. Recent studies, however, have shown a good efficacy and tolerability of short-term nitrofurantoin therapy comparable to previous established standard therapeutic regimens applying cotrimoxazole or quinolones. Because of these data and the alarming resistance rates of uropathogenic Escherichia coli to cotrimoxazole and quinolones that have been increased markedly in several countries, the clinical significance ofnitrofurantoin has been raised again. In many current treatment guidelines, e. g., the international clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women published by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases, nitrofurantoin has been recommended as one first-line antibiotic of empiric antibacterial treatment of uncomplicated cystitis in otherwise healthy women. In Germany, however, nitrofurantoin should only be applied if more effective and less risky antibiotics cannot be used. Nitrofurantoin is contraindicated in the last three months of pregnancy and in patients suffering from renal impairment of each degree. Despite compatibility concerns, nitrofurantoin has also been recommended for the re-infection prophylaxis of recurrent uncomplicated urinary tract infections in Germany and several other countries. PMID:25065160

  18. Analysis of clinical features and risk factors for infective endocarditis

    International Nuclear Information System (INIS)

    Objective: To analyze the clinical features of infective endocarditis (IE) and explore the risk factors for it's prognosis. Methods: Clinical data of 65 patients with IE were acquired retrospectively, and its causes, clinical characteristics, pathogenic microorganism, clinical outcomes were analyzed. Results: The major occurring heart diseases for IE in all patients were rheumatic heart disease, congenital heart disease, and there was no any previously known heart disease. The major clinical manifestations included fever and anemia. The major pathogenic bacteria is streptococcus, but percentage of other bacteria increased gradually. Thirteen patients were refractory, in hospital. Haematoglobin and seralbumin were significantly lower, and leucocyte, hsCRP, erythrocyte sedimentation were significantly higher in refractory group. Anaemia, lower seralbumin, higher hsCRP were independent predictors for bad prognosis. Conclusion: The proportion of rheumatic heart disease is decreasing as one of the risk factors for IE in recent years. Streptococcus is major pathogen of IE, and the mortality of IE is still very high. Anaemia, lower seralbumin, higher hsCRP are independent predictors for bad prognosis. (authors)

  19. Problem-oriented clinical microbiology and infection. 2nd. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Hilary Humphreys; William, L. Irving [Royal College of Surgeons (Ireland)

    2004-08-01

    This medical textbook is problem-based, in line with current medical teaching, and covers 70 clinical cases. This second edition has been updated to include new material on AIDS/HIV, emerging antibiotic-resistant bacteria and new viral pathogens such as SARS. Sections are headed; Skin and mucous membranes; Respiratory tract; Gastrointestinal system which includes a case study entitled: Bob, a 55-year-old retired coal miner with abdominal pain; Genito-urinary system; Central nervous system; Systemic infections; Pregnancy and the neonate; and Miscellaneous. 29 ills., 125 photos.

  20. Clinical impact of Achromobacter xylosoxidans colonization/infection in patients with cystic fibrosis

    OpenAIRE

    Firmida, M.C.; R.H.V. Pereira; E.A.S.R. Silva; E.A. Marques; A.J. Lopes

    2016-01-01

    The rate of diagnosis of colonization/infection of the airways with Achromobacter xylosoxidans has increased in cystic fibrosis patients, but its clinical significance is still controversial. This retrospective, case-control study aimed to evaluate the clinical impact of A. xylosoxidans colonization/infection in cystic fibrosis patients. Individuals who were chronically colonized/infected (n=10), intermittently colonized/infected (n=15), and never colonized/infected with A. xylosoxidans (n=18...

  1. Clinical Manifestations and Outcomes of West Nile Virus Infection

    Directory of Open Access Journals (Sweden)

    James J. Sejvar

    2014-02-01

    Full Text Available Since the emergence of West Nile virus (WNV in North America in 1999, understanding of the clinical features, spectrum of illness and eventual functional outcomes of human illness has increased tremendously. Most human infections with WNV remain clinically silent. Among those persons developing symptomatic illness, most develop a self-limited febrile illness. More severe illness with WNV (West Nile neuroinvasive disease, WNND is manifested as meningitis, encephalitis or an acute anterior (polio myelitis. These manifestations are generally more prevalent in older persons or those with immunosuppression. In the future, a more thorough understanding of the long-term physical, cognitive and functional outcomes of persons recovering from WNV illness will be important in understanding the overall illness burden.

  2. Clinical and microbiological characterization of KPC-producing Klebsiella pneumoniae infections in Brazil

    Directory of Open Access Journals (Sweden)

    Elisa Maria Beirão

    2011-02-01

    Full Text Available In 2008 isolates of KPC-producing Klebsiella pneumoniae (KPC-KPN were detected for the first time at Hospital Heliópolis, São Paulo, Brazil. The aim of this study was to characterize the clinical and microbiological outcomes of infections caused by KPC-KPN. A historical cohort of patients from whom KPC-KPN strains were isolated was performed. Isolates were identified as resistant to ertapenem by automated broth microdilution system and screened as carbapenemase producers by the modified Hodge test. The beta-lactamase resistance gene blaKPC was detected by PCR. The genetic relatedness of isolates was determined by PFGE. The study provides early clinical experience in treating KPC-KPN infections in a Brazilian tertiary center.

  3. Clinical Evaluation of Superficial Fungal Infections in Children

    Directory of Open Access Journals (Sweden)

    Ragıp Ertaş

    2015-12-01

    Full Text Available Objective: This retrospective study was referred to evaluate 51 cases of superficial mycoses, referred to our Pediatric Dermatology outpatient clinic in one year. Methods: We reviewed following data for all patients: age, gender, accompanied diseases, clinical types, localization and treatment. Superficial mycotic infections were diagnosed on the basis of clinical picture, direct microscopy and some of them were confirmed by fungal cultures. Results: Our patients comprised 33 boys (64.7% and 18 girls (35.3%, with an average age of 6.2 years (range 4 months to 17 years. Eighteen patients (35.3% had dermatophytes on the scalp. Clinical forms, in the order of frequency, were: tinea capitis profunda in 10 patients (19.6%, tinea capitis superficialis in 8 patients (15.8%, tinea unguium in 8 patients (15.8%. Tinea capitis (35.3% was the most frequent form of dermatomycosis. The most common symptom was the pruritus. Thirty (58% patients were treated with local antimycotics and 21 (42% patients were treated with systemic terbinafine or itraconazole. Conclusion: In this study it was found that, tinea capitis was the most frequent form of dermatomycosis and onychomycosis in children are not uncommon as it is mentioned. The data also suggest that topical antifungal agents may be effective and well-tolerated in the treatment of onychomycosis and tinea capitis in children.

  4. Overwhelming postsplenectomy infection syndrome in adults - A clinically preventable disease

    Institute of Scientific and Technical Information of China (English)

    Takehiro Okabayashi; Kazuhiro Hanazaki

    2008-01-01

    Overwhelming postsplenectomy infection (OPSI)syndrome is a rare condition, but is associated with high mortality. However, recognition and clinical management of OPSI is not well established. The prevalence of splenectomy increased recently because it was a clinically effective treatment for hepatitis C virus-associated thrombocytopenia before the introduction of the interferon/ribavirin combination therapy. We reviewed the literature characterizing the clinicopathological features of OPSI and assessed the most effective and feasible administration of the condition. A Medline search was performed using the keywords 'overwhelming','postsplenectomy infection', 'postsplenectomy sepsis','chronic liver disease', and/or 'splenectomy'. Additional articles were obtained from references within the papers identified by the Medilne search. Durations between splenectomy and onset of OPSI ranged from less than 1 wk to more than 20 years. Autopsy showed that many patients with OPSI also had Waterhouse-Friderichsen syndrome. Although the mortality rate from OPSI has been reduced by appropriate vaccination and education,the precise pathogenesis and a suitable therapeutic strategy remain to be elucidated. Protein energy malnutrition (PEM) is commonly observed in cirrhotic patients. Since the immune response in patients with PEM is compromised, a more careful management for OPSI should therefore be applied for cirrhotic patients after splenectomy. In addition, strict long-term follow up of OPST patients including informed consent will lead to a better prognosis.

  5. Clinical manifestations of human papillomavirus infection in nongenital sites.

    Science.gov (United States)

    Melton, J L; Rasmussen, J E

    1991-04-01

    Our knowledge of warts dates thousands of years. Most warts represent no more than a transient infection in the hands and feet of children and adults. With the relatively recent medical advances permitting the prolonged survival of immunocompromised hosts, however, HPV-induced lesions have become an important problem. In these patients, lesions represent a recurring, intractable infection that predisposes the patient to the development of skin cancer. Such problems have been appreciated for some time in patients with EV. Newer laboratory techniques have led to an increasing number of clinical entities linked with an HPV cause in the nonimmunosuppressed host. Although evidence incriminating HPV as a causative factor for genital cancers of the cervix and the skin continues to mount, such evidence for nongenital Bowen's disease, certain squamous cell carcinomas of the skin, keratoacanthomas, and other tumors of the skin also has begun to grow. It is to be hoped that continued advances in molecular biologic techniques will further delineate the relationship between HPV and these conditions, lead to an HPV classification scheme that is more utilitarian from a clinical point of view, and ultimately lead to improved treatment.

  6. Urinary tract nosocomial infections at the Clinical centre in Kragujevac

    Directory of Open Access Journals (Sweden)

    Đorđević Zorana

    2012-01-01

    Full Text Available Introduction. Urinary tract infections are the most frequent hospital infections and account for about 40% of total hospital infections. The main risk factor for their development is the use of catheters. Objective. Assessment of basic epidemiological and etiological characteristics of nosocomial urinary tract infections (NUTIs and investigation of differences in risk factors among the patients with NUTIs with and without the urinary catheter. Methods. The study comprised patients treated in chosen units/ of the Clinical Center in Kragujevac, in whom NUTI was registered during 2009. Differences in risk factors for NUTIs between the catheterized and uncatheterized patients were tested by the logistic regression analysis. Results. NUTIs was registered in 162 patients whose average age was 66.2±13.5 years with approximately equal gender participation (51.2% men and 48.8% women. Almost three quarters of the patients with NUITs had indwelling urinary catheter, 12.0±7.7 days on average (from 1 to 39 days. In the patients with urinary catheter, the risk for NUITs was significantly positively associated with emergency admission to hospital treatment (p=0.0185. The uncatheterized patients had a significant frequency of malignant tumours comparing to the patients with a urinary catheter (p=0.039. The compared groups did not differ in other risk factors. The most frequently isolated microbial agents was Klebsiella spp (37.3%, then Pseudomonas aeruginosa (14.1% and Proteus mirabilis (11.9%. Most of the bacteria showed a great level of resistance to frequently used antibacterial drugs, even up to 100%. Conclusion. It is necessary to define national recommendations for the prevention and control of NUTIs in the future.

  7. Clinical manifestations associated with human herpesvirus 7 infection.

    OpenAIRE

    Torigoe, S.; Kumamoto, T; Koide, W; Taya, K; Yamanishi, K

    1995-01-01

    Twenty two cases of human herpesvirus 7 (HHV-7) infection are described. HHV-7 infection occurred later than human herpesvirus 6 (HHV-6) infection and induced exanthem subitum in 47.1% of the children. HHV-7 infection was associated with exanthem subitum and the other symptoms that were observed in HHV-6 infection.

  8. Viral and atypical bacterial infections in the outpatient pediatric cystic fibrosis clinic

    DEFF Research Database (Denmark)

    Olesen, Hanne Vebert; Nielsen, Lars P; Schiotz, Peter Oluf

    2006-01-01

    BACKGROUND: Respiratory viral and atypical bacterial infections are associated with pulmonary exacerbations and hospitalisations in cystic fibrosis patients. We wanted to study the impact of such infections on children attending the outpatient clinic. METHODS: Seventy-five children were followed...

  9. Mesenchymal stem cells: from experiment to clinic

    Directory of Open Access Journals (Sweden)

    Otto William R

    2011-09-01

    Full Text Available Abstract There is currently much interest in adult mesenchymal stem cells (MSCs and their ability to differentiate into other cell types, and to partake in the anatomy and physiology of remote organs. It is now clear these cells may be purified from several organs in the body besides bone marrow. MSCs take part in wound healing by contributing to myofibroblast and possibly fibroblast populations, and may be involved in epithelial tissue regeneration in certain organs, although this remains more controversial. In this review, we examine the ability of MSCs to modulate liver, kidney, heart and intestinal repair, and we update their opposing qualities of being less immunogenic and therefore tolerated in a transplant situation, yet being able to contribute to xenograft models of human tumour formation in other contexts. However, such observations have not been replicated in the clinic. Recent studies showing the clinical safety of MSC in several pathologies are discussed. The possible opposing powers of MSC need careful understanding and control if their clinical potential is to be realised with long-term safety for patients.

  10. Improving Medical Residents' Attitudes toward HIV-Infected Persons through Training in an HIV Staging and Triage Clinic.

    Science.gov (United States)

    Orlander, Jay D.; And Others

    1994-01-01

    A study assessed the effectiveness of a weekly outpatient clinic for staging and triage of newly identified human-immunodeficiency-virus (HIV)-infected patients on 21 medical residents' attitudes and knowledge regarding HIV patient care, as compared with 20 control students. Results indicated that the experience positively affected student…

  11. Clinical Guidelines for the Antimicrobial Treatment of Bone and Joint Infections in Korea

    OpenAIRE

    ,

    2014-01-01

    There are many various diseases in the bone and joint infections, and we tried to make antimicrobial treatment guidelines for common infectious diseases based on available data for microbiology and clinical trials. This guidelines focused on the treatment of osteomyelitis and septic arthritis, which can be experienced by physicians at diverse clinical settings. This guidelines is not applicable to diabetic foot infections, postoperative infections or post-traumatic infections which need speci...

  12. Autoreactivity to sweat glands and nerves in clinical scabies infection

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    Michael S. Howard

    2010-01-01

    Full Text Available Context: Skin changes in pregnancy can be categorized as 1 physiological/hormonal, 2 alterations in pre-existing skin diseases, or 3 represent development of new dermatoses, some of which may be pregnancy specific. Case Report: We describe a 19 years old female at 27 weeks gestation who presented with a rash on the face and breast, with intense pruritis. Hematoxylin and eosin demonstrated Scabies mites within the epidermis, with an intense perivascular infiltrate of lymphohistiocytic cells around the superficial dermal blood vessels. By direct immunofluorescence (DIF, human fibrinogen was also detected in the perivascular areas. DIF also revealed deposits of human IgG and complement C5-9/MAC deposits in the sweat glands, as well as in nerves surrounding the sweat glands subjacent to the mites. Overexpression of ezrin and junctional adhesion molecule antibodies close to the scabies infection sites were also seen. Conclusion: Given that the hallmark of clinical scabies is intense pruritus and that very limited information is available regarding the pathophysiology of this symptom, we suggest that the itching sensation may be exacerbated by nerves and eccrine sweat glands in close proximity to the sites of infection.

  13. Non-immune hydrops fetalis: Clinical experience in newborn infants

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    Pejić Katarina

    2011-01-01

    Full Text Available Introduction. Non-immune hydrops fetalis is a condition of excessive accumulation of extravascular fluid without identifiable circulating antibody to erythrocytes membrane antigens. In newborn infants it is characterized by skin oedema and pleural, pericardial or peritoneal effusion. In the era of routine Rh immunization for the prevention of foetal erythroblastosis, non-immune pathophysiologic mechanisms are presented in 76-87% of all hydropic newborns. Non-immune hydrops fetalis can be associated with numerous and various disorders. The mortality rate may exceed 50%. This study was aimed at presenting our clinical experience in treating newborn infants with non-immune hydrops fetalis. Material and methods. A retrospective-prospective study included newborn infants with non-immune hydrops fetalis, who were treated in the Neonatal Intensive Care Unit of Mother and Child Health Institute of Serbia between January 1, 2001 and October 31, 2010. All valid data about aetiology, diagnosis, clinical course and outcome were recorded. Results. The diagnosis of non-immune hydrops fetalis was made in 11 newborns. The etiologic diagnosis was established in 8 patients: anaemia due to fetomaternal transfusion in 4 patients and conatal cytomegalovirus infection, intracranial haemorrhage, isolated pulmonary lymphangiectasia and diffuse skin and mediastinal lymphangiomatosis in the remaining 4 patients. Conclusion. Non-immune hydrops of newborn infant is associated with a high mortality rate and requires complex diagnostic and therapeutic procedures. An optimal management of neonates with non-immune hydrops fetalis demands a multidisciplinary approach to the treatment in a neonatal intensive care unit.

  14. The Detection and Management of Early HIV Infection: A Clinical and Public Health Emergency

    OpenAIRE

    Smith, M. Kumi; Rutstein, Sarah E.; Powers, Kimberly A; Fidler, Sarah; William C Miller; Eron, Joseph J.; Cohen, Myron S.

    2013-01-01

    This review considers the detection and management of early HIV infection (EHI), defined here as the first 6 months of infection. This phase is clinically important because a reservoir of infected cells formed in the individual renders HIV incurable, and the magnitude of viremia at the end of this period predicts the natural history of disease. Epidemiologically, it is critical because the very high viral load that typically accompanies early infection also makes infected individuals maximall...

  15. Throat Infection, Neck and Chest Pain and Cardiac Response: A Persistent Infection-Related Clinical Syndrome

    Institute of Scientific and Technical Information of China (English)

    Changqing ZHOU; Xiangning FU; Jiangtao YAN; Qiao FAN; Zhuoya LI; Katherine Cianflone; Daowen WANG

    2009-01-01

    Dizziness,chest discomfort,chest depression and dyspnea are a group of symptoms that are common complaints in clinical practice. Patients with these symptoms are usually informed that while neurosis consequent to coronary heart disease is excluded nonetheless they remain unhealthy with no rational explanation or treatment. 165 cases of these symptoms and 85 control subjects were reviewed and underwent further medical history inquiry,routine EKG test and cardiac ultrasound examination. Thirty-five patients received coronary artery angiography to exclude coronary heart disease. Serum myocardial autoantibodies against beta1-adrenoceptor,alpha-myosin heavy chain,M2-muscarinie receptor and adenine-nucleotide translocator were tested,and inflammatory cytokines and high sensitivity C-reaction protein were measured and lymphocyte subclass was assayed by flow cytometry. All patients had a complex of four symptoms or tetralogy: (1) persistent throat or upper respiratory tract infection,(2) neck pain,(3) chest pain and (4) chest depression or dyspnea,some of them with anxiety. Anti-myocardial autoantibodies (AMCAs) were present in all patients vs. 8% in and CD4-CD8+ lymphocytes were significantly higher and CD56+ lymphocytes lower in patients than those in controls (P<0.01). The ratio of serum pathogen antibodies positive against Coxsackie virus-B,cytomegalovirus,Mycoplasma pneumoniae and Chlamydia pneumoniae were all markedly higher in patients. These data led to identification of a persistent respiratory infection-related clinical syndrome,including persistent throat infection,neck spinal lesion,fib cartilage inflammation,symptoms of car-diac depression and dyspnea with or without anxiety.

  16. Insomnia: clinical experience with zolpidem (sanval

    Directory of Open Access Journals (Sweden)

    Yakov Iosifovich Levin

    2010-01-01

    Full Text Available The paper describes the present view of the problem of insomnia and gives a classification of sleep disorders and basic methods for their drug and non-drug therapy. Emphasis is placed on the role of the objective sleep study - polysomnography. The use of the current hypnotics belonging to a three Zs group and the minimization of administration of benzodiazepines are most important in pharmacotherapy for insomnia. The results of a clinical polysomnographic study of the effect of Zolpidem (Sanval in patients with insomnia are presented. The subjective evaluation of the beneficial effect of a 10-day course of Sanval is confirmed by the objective studies of the sleep pattern undergoing positive changes in the most important indicators, such as the process of falling asleep, the time of intrasleep awakenings, and the duration of Δ-sleep. The high safety and good tolerability of Sanval permit the latter to be assessed as an effective agent for the treatment of insomnia.

  17. Digital mammography: Experiences in clinical application

    International Nuclear Information System (INIS)

    Target: In 1989 in the Kantonal Hospital of Lucerne conventional film-screen mammography was replaced by digital mammography. With the support of a retrospective study, it was checked whether or not digital mammography represents an equally valid diagnostic procedure in daily routine. Methods: 1204 patients were examined using digital mammography. A reevaluation of these patients was carried out using clinical and r[iological routine controls. [ditionally a r[iological and histological examination was performed in 127 cases in which excisional biopsies h[ been done, paying particular attention to detail perception. Results: The sensitivity of digital mammography achieved a total of 85%, whereas the accuracy was 81%. With [ditional use of ultrasound and galactography the sensitivity attained 91%. By reevaluation the sensitivity amounted to 87%, the accuracy remaining at 81%. The positive predictive value was especially high with 76% and 77%. Conclusion: Digital mammography offers satisfactory diagnostic performance. (orig.)

  18. Nasopharyngeal Tuberculosis: Epidemiology, Mechanism of Infection, Clinical Manifestations, and Management

    Directory of Open Access Journals (Sweden)

    Chonticha Srivanitchapoom

    2016-01-01

    Full Text Available Nasopharyngeal tuberculosis (NPTB is a noteworthy disease especially in its worldwide spread of the Mycobacterium infection. Although NPTB has been identified in less than one percent of TB cases, recent multiple case reports indicate an either increased awareness or incidence of this disease. The most helpful diagnostic tool is an uncomplicated nasopharyngeal biopsy. However, NPTB is usually ignored because it has varied clinical manifestations and similar presentations with other more common head and neck diseases. Furthermore, the most common presenting symptom is cervical lymphadenopathy mimicking nasopharyngeal carcinoma, a more common and serious disease. Treatment outcomes of NPTB are good in both HIV-positive or HIV-negative patients. In addition, pulmonary tuberculosis association was reported in wide range between 8.3% and 82% which should be considered in a treatment program. In conclusion, early diagnosis and management in NPTB can be achieved by (1 increased awareness of this disease, (2 improvement in knowledge regarding clinical manifestations, and (3 improvement of diagnostic techniques.

  19. Common infections in clinical practice: dealing with the daily uncertainties.

    Science.gov (United States)

    Mossad, Sherif

    2004-02-01

    Common infections we see every day in the office--urinary tract infections, vaginitis, upper respiratory tract infections, and soft-tissue infections--present a number of diagnostic and treatment uncertainties. In this age of growing antibiotic resistance, these include if and when to start antibiotic therapy, and which agents to use. PMID:14982196

  20. Cartap hydrochloride poisoning: A clinical experience

    Directory of Open Access Journals (Sweden)

    Hari K Boorugu

    2012-01-01

    Full Text Available Cartap hydrochloride, a nereistoxin analog, is a commonly used low toxicity insecticide. We describe a patient who presented to the emergency department with alleged history of ingestion of Cartap hydrochloride as an act of deliberate self-harm. The patient was managed conservatively. To our knowledge this is the first case report of Cartap hydrochloride suicidal poisoning. Cartap toxicity has been considered to be minimal, but a number of animal models have shown significant neuromuscular toxicity resulting in respiratory failure. It is hypothesized that the primary effect of Cartap hydrochloride is through inhibition of the [ 3 H]-ryanodine binding to the Ca 2+ release channel in the sarcoplasmic reticulum in a dose-dependent manner and promotion of extracellular Ca 2+ influx and induction of internal Ca 2+ release. This results in tonic diaphragmatic contraction rather than paralysis. This is the basis of the clinical presentation of acute Cartap poisoning as well as the treatment with chelators namely British Anti Lewisite and sodium dimercaptopropane sulfonate.

  1. Eosinophilic gastroenteritis: Clinical experience with 15 patients

    Institute of Scientific and Technical Information of China (English)

    Ming-Jen Chen; Cheng-Hsin Chu; Shee-Chan Lin; Shou-Chuan Shih; Tsang-En Wang

    2003-01-01

    AIM: To evaluate the clinic features of eosinophilicgastroenteritis and to examine the diagnosis, treatment,long-term outcome of this disease.METHODS: Charts with a diagnosis of eosinophilicgastroenteritis from 1984 to 2002 at Mackay Memorial Hospital were reviewed retrospectively. There were 15 patients diagnosed with eosinophilic gastroenteritis. The diagnosis was established in 13 by histologic evaluation of endoscopic biopsy or operative specimen and in 2 by radiologic imaging and the presence of eosinophilic ascites.RESULTS: All the patients had gastrointestinal symptoms and 12 (80 %) had hypereosinophilia (absolute eosinophil count 1 008 to 31 360/cm3). The most common symptoms were abdominal pain and diarrhea. Five of the 15 patients had a history of allergy. Seven patients had involvement of the mucosa, 2 of muscularis, and 6 of subserosa. One with a history of seafood allergy was successfully treated with an elimination diet. Another patient improved spontaneously after fasted for several days. The remaining 13 patients were treated with oral prednisolone, 10 to 40 mg/day initially,which was then tapered. The symptoms in all the patients subsided within two weeks. Eleven of the 15 patients were followed up for more than 12 months (12 to 104 months,mean 48.7), of whom 5 had relapses after discontinuing steroids (13 episodes). Two of these patients required longterm maintenance oral prednisolone (5 to 10 mg/day).CONCLUSION: Eosinophilic gastroenteritis is a rare condition of unclear etiology characterized by relapses and remissions. Short courses of corticosteroids are the mainstay of treatment, although some patients with relapsing disease require long-term low-dose steroids.

  2. Ameloblastoma: Our clinical experience with 68 cases

    Directory of Open Access Journals (Sweden)

    Benjamin Fomete

    2014-01-01

    Full Text Available Introduction: In this environment, previous workers have reported on the challenges of managing large sized ameloblastoma of the jaws with less than adequate facilities. The aim of this review is to present the management of 68 cases of ameloblastoma with emphasis on surgical care. Materials and Methods: Retrospective survey of case notes of patients with histopathologic diagnosis of ameloblastoma (using the criteria of Barnes et al., 2005 seen between January 2006 and August 2010 at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria was undertaken. Data collected includes histopathological diagnosis, age, gender, clinical information on site of lesion, form of intubation and surgical procedure performed. Results: Out of 94 patients, 68 with histological diagnosis of ameloblastoma (59 mandibular and 9 maxillary were operated within the study period. The remainder (26 was not treated in hospital. Among 68 patients treated, more were males (38 than females (30, giving a male to female ratio of 1.3:1. The age range was between 14 and 74 years (mean-standard deviation. The duration of the symptoms ranged from 7 months to 24 years, most were follicular ameloblastoma (n = 13 followed by acanthomatous type (n = 7. Endotracheal intubation was the most common (n = 55 followed by fiber optic laryngoscopy (n = 8. The surgical approach most used was extended Risdon with intraoral (n = 24 followed by extended Risdon with lip split and intraoral (n = 17. Segmental resection (en block formed the bulk of our procedures (n = 22 followed by subtotal mandibulectomy (n = 16. Conclusion: The treatment of ameloblastoma remains controversial. Its destructive nature has left patients with wide defects difficult to reconstruct.

  3. CLINICAL EXPERIENCE WITH METABOLIC THERAPY FOR BRAIN ISCHEMIA

    Directory of Open Access Journals (Sweden)

    M. Kh. Shurdumova

    2013-01-01

    Full Text Available The paper describes clinical experience with metabolic therapy, including neuroprotective drugs and antioxidants, for cerebrovascular diseases.It gives the results of basic Russian and foreign clinical studies of ethylmethylhydroxypyridoxine succinate and choline alfoscerate and discusses their efficacy and routes of administration.

  4. CLINICAL EXPERIENCE WITH METABOLIC THERAPY FOR BRAIN ISCHEMIA

    Directory of Open Access Journals (Sweden)

    M. Kh. Shurdumova

    2014-07-01

    Full Text Available The paper describes clinical experience with metabolic therapy, including neuroprotective drugs and antioxidants, for cerebrovascular diseases.It gives the results of basic Russian and foreign clinical studies of ethylmethylhydroxypyridoxine succinate and choline alfoscerate and discusses their efficacy and routes of administration.

  5. Clinical disease severity of respiratory viral co-infection versus single viral infection: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Sandra A Asner

    Full Text Available Results from cohort studies evaluating the severity of respiratory viral co-infections are conflicting. We conducted a systematic review and meta-analysis to assess the clinical severity of viral co-infections as compared to single viral respiratory infections.We searched electronic databases and other sources for studies published up to January 28, 2013. We included observational studies on inpatients with respiratory illnesses comparing the clinical severity of viral co-infections to single viral infections as detected by molecular assays. The primary outcome reflecting clinical disease severity was length of hospital stay (LOS. A random-effects model was used to conduct the meta-analyses.Twenty-one studies involving 4,280 patients were included. The overall quality of evidence applying the GRADE approach ranged from moderate for oxygen requirements to low for all other outcomes. No significant differences in length of hospital stay (LOS (mean difference (MD -0.20 days, 95% CI -0.94, 0.53, p = 0.59, or mortality (RR 2.44, 95% CI 0.86, 6.91, p = 0.09 were documented in subjects with viral co-infections compared to those with a single viral infection. There was no evidence for differences in effects across age subgroups in post hoc analyses with the exception of the higher mortality in preschool children (RR 9.82, 95% CI 3.09, 31.20, p<0.001 with viral co-infection as compared to other age groups (I2 for subgroup analysis 64%, p = 0.04.No differences in clinical disease severity between viral co-infections and single respiratory infections were documented. The suggested increased risk of mortality observed amongst children with viral co-infections requires further investigation.

  6. Lagged Syndesmotic Fixation: Our Clinical Experience.

    Science.gov (United States)

    Kwaadu, Kwasi Yiadom; Fleming, Justin James; Salmon, Trudy

    2015-01-01

    Ankle fractures are very common, and although algorithms are in place for osseous management, consensus has not been reached regarding treatment of associated ligamentous injuries. Although tibiofibular syndesmotic stabilization can be done using different forms of fixation, the biomedical literature has long emphasized the risk of long-term restriction of ankle mobility with the use of lagged transfixation. However, when reduction cannot be maintained with positional fixation, we found that lagging the syndesmotic screw helped to maintain the reduction without causing functional restriction. In this report, we describe our experience with patients who had undergone lagged tibiofibular transfixation and were available for short- to intermediate-term follow-up to assess ankle function. A total of 31 patients (32.63% of 95 consecutive patients) were available at a mean of 34.87 (range 18 to 52) months to complete the American Orthopedic Foot and Ankle Society ankle-hindfoot questionnaire. The mean score was 88.38 (range 42 to 100) points at a mean follow-up interval of 34.87 (range 18 to 52) months. Of 31 patients, 19 had an AOFAS score of 90 points, 9 an AOFAS score of 80 to 89 points, 2 an AOFAS score of 60 to 69 points, and 1 an AOFAS score of ankle kinematics than positional syndesmotic fixation. PMID:25736445

  7. Clinical and Applied Experience in Rehabilitation Counselor Education

    Science.gov (United States)

    Tschopp, Molly K.; Chronister, Julie A.

    2008-01-01

    Applied training of pre-practicum, practicum, and internship are important gateway experiences for rehabilitation counselors-in-training. Counselor educators and supervisors must be aware of requirements and expectations of counselor-in-training supervision and common ethical issues specific to these clinical experiences of rehabilitation…

  8. Severe bacterial infections in patients with non-transfusion-dependent thalassemia: prevalence and clinical risk factors

    Directory of Open Access Journals (Sweden)

    Nattiya Teawtrakul

    2015-10-01

    Conclusion: The prevalence of bacterial infection in patients with NTDT was found to be moderate. Time after splenectomy >10 years, deferoxamine therapy, and iron overload may be clinical risk factors for severe bacterial infection in patients with NTDT. Bacterial infection should be recognized in splenectomized patients with NTDT, particularly those who have an iron overload.

  9. AN UNUSUAL CLINICAL PRESENTATION OF GROUP A STREPTOCOCCAL INFECTION

    OpenAIRE

    H.V., Prashanth; R.M, Saldanha Dominic; Shenoy, Shalini; Baliga, Shrikala

    2011-01-01

    After two decades of decline of Group A streptococcal infections, the recent years are witnessing a resurgence in the incidence and severity of infections caused by Group A Streptococcus including necrotizing fasciitis and streptococcal toxic shock syndrome sometimes with fatal outcomes. We present an unusual case of Group A streptococcal infection in a 4-year-old boy who did not have any predisposing factors for Group A streptococcal infection.

  10. Clinical and demographic trends in a sexually transmitted infection clinic in Mumbai (1994-2006: An epidemiologic analysis

    Directory of Open Access Journals (Sweden)

    Setia Maninder

    2010-01-01

    Full Text Available Background: People presenting to sexually transmitted infections (STIs clinics represent an important risk group for HIV infection; prevention strategies will depend on the clinical attendance. Aims: The demographic and clinical changes in clinic attendees in Mumbai, as well as the factors associated with HIV infection in this clinic over a 13-year period, were assessed. Methods: STI clinic data in 3417 individuals (1994 to 2006 were analyzed: clinical presentation, types of STIs, and serology over the 13-year period. We used a logistic regression model to assess socio-demographic and clinical associations with HIV infection. Results: The clinic evaluated 689 patients in 1994 and the number had dropped to 97 in 2006. In 1994, the majority of STIs seen in the clinic were bacterial (53%, 95% confidence interval [CI] 50% to 57%; however, this proportion had dropped in 2006 (28%, 95% CI: 19% to 38%. There was a proportional increase in viral STIs during the same time period. Although women attending the clinic were younger than men, they were more likely to be married. The overall seropositivity for HIV was 28%. Viral STIs were more likely to be associated with HIV than bacterial infections (odds ratio: 1.5, 95% CI: 1.2 to 1.9. Conclusions: Viral infections were the most common STIs in recent years in a tertiary care center in Mumbai. HIV prevalence was high in this population. Thus, these clinical data suggest that STI patients were and continue to be an important group for HIV prevention in the country.

  11. Clinical Positioning Space: Residents' Clinical Experiences in the Outpatient Oncology Clinic.

    Science.gov (United States)

    Williams, Lars H; Christensen, Mette K; Rytter, Carsten; Musaeus, Peter

    2015-09-01

    In this article, we present a case study of residents' clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights and duties. Drawing from seven qualitative interviews and six days of observation, we investigate the residents' social positioning and their conversations with patients or supervisors. Our focus is on how (a) relational shifts in authority depend on each situation and its participants; (b) storylines establish acts and positions and narratively frame what participants can expect from a medical consultation viewed as a social episode; and (c) the positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that residents and patients locate themselves in outpatient conversations as participants who jointly produce and are produced by patients' and nurses' storylines about who should take responsibility for treatment. PMID:25288406

  12. Clinical risk factors on survival among infected children born to HIV-positive mothers

    OpenAIRE

    S Chantutanon; S Phuntara; B Chaimay; Suwanna, K.; S Woradet

    2012-01-01

    Objective: The aim of this study was to investigate clinical risk factors on survival among infected children born to HIV-positive mothers in the southern region of Thailand. Methods: Data from routine prospective cohort studies from 1990–2010 were analyzed. In these studies, totally 1549 infected children born to HIV-positive mothers were enrolled at birth and followed longitudinally. Information on demographic, clinical manifestation, HIV infection status factors was collected. Survi...

  13. Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection.

    Science.gov (United States)

    Mitchell, Hazel; Katelaris, Peter

    2016-06-01

    Helicobacter pylori infection is a major cause of morbidity and mortality worldwide. More than 50% of the global population is estimated to be infected. Differences in prevalence exist within and between countries, with higher prevalence seen among people with lower socio-economic status. Most transmission of infection occurs early in life, predominantly from person to person in the family setting. H. pylori is the cause of most peptic ulcer disease, gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma and causes symptoms in a subset of patients with functional dyspepsia. Choice of diagnostic test depends on the clinical context; urea breath tests and endoscopy with biopsy are the major diagnostic tools. Evidence-based indications for eradication of H. pylori infection are well documented. The most widely used and recommended eradication therapy in Australia is triple therapy comprising a proton pump inhibitor, amoxycillin and clarithromycin, usually for 1 week. Effective alternative regimens are available for patients with proven allergy to penicillin. Antimicrobial resistance is the major determinant of the outcome of eradication therapy. Trends in antibiotic resistance need to be monitored locally, but individual patient susceptibility testing is not usually necessary as it rarely guides the choice of therapy. The outcome of treatment should be assessed not less than 4 weeks after therapy. This is usually done with a urea breath test if follow-up endoscopy is not required. When first-line therapy fails, several proven second-line therapies may be used. Repeat first-line therapy and ad hoc regimens should be avoided. Overall cumulative eradication rates should approach 99%. PMID:27256648

  14. Effect of the infection with the nematode Haemonchus contortus (Strongylida: Trichostrongylidae) on the haematological, biochemical, clinical and reproductive traits in rams.

    Science.gov (United States)

    Rouatbi, Mariem; Gharbi, Mohamed; Rjeibi, Mohamed R; Ben Salem, Imen; Akkari, Hafidh; Lassoued, Narjess; Rekik, Mourad

    2016-01-01

    This study aimed to investigate the effect of Haemonchus contortus infection on rams' haematological, biochemical and clinical parameters and reproductive performances. A total number of 12 Barbarine rams (control and infected) were included in the experiment. The infected group received 30 000 H. contortus third-stage larvae orally. Each ram's ejaculate was immediately evaluated for volume, sperm cell concentration and mortality rate. At the end of the experiment (day 82 post-infection), which lasted 89 days, serial blood samples were collected in order to assess plasma testosterone and luteinising hormone (LH) concentrations. There was an effect of time, infection and their interaction on haematological parameters (p rams, haematocrit, red blood cell count and haemoglobin started to decrease from 21 days post-infection. There was an effect of time and infection for albumin. For total protein, only infection had a statistically significant effect. For glucose, only time had a statistically significant effect. Concentrations were significantly lower in infected rams compared to control animals. A significant effect of infection and time on sperm concentrations and sperm mortality was observed. The effect of infection appears in time for sperm concentrations at days 69 and 76 post-infection. Sperm mortality rate was significantly higher in infected animals at day 46 post-infection when compared to control group (p rams when compared to control counterparts; none of these endocrine traits were affected for plasma LH. PMID:27608504

  15. Clinical data and CT findings of pulmonary infection caused by different pathogens after kidney transplantation

    International Nuclear Information System (INIS)

    Purpose: The overall objective was to review clinical data and CT findings of pulmonary infection caused by different pathogens after kidney transplantation in an attempt to help early clinical qualitative diagnosis. Materials and methods: 446 cases of clinically confirmed pulmonary infection after kidney transplantation in recent 10 years were evaluated with respect to the time of occurrence and 89 cases with complete CT data and pathogenic diagnosis were further analyzed for pathogen types and CT manifestations. Statistical analysis was performed using Fisher's exact test. Results: Pulmonary infection reached the peak in 3 months after transplantation. Bacterial infection and mixed infection were predominant between 1 and 6 months. And most tuberculosis occurred after one year. Bacterial (38.2%) and mixed infections (38.2%) were the common types. The next was fungal infection, tuberculosis and viral infection (10.1%, 7.9% and 5.6%, respectively). CT manifestations of pulmonary infections after kidney transplantation were diverse and complex, lacking characteristic signs. Conclusion: More than 3/4 of pulmonary infections after kidney transplantation can be attributed to bacteria and mixed pathogens. The combination of time course, clinical data and CT manifestations plays an important role in the early clinical qualitative diagnosis.

  16. Pre-clinical medical student experience in a pediatric pulmonary clinic

    Directory of Open Access Journals (Sweden)

    Thomas G. Saba

    2015-11-01

    Full Text Available Objective: Our objective was to evaluate the educational value of introducing pre-clinical medical students to pediatric patients and their families in a subspecialty clinic setting. Methods: First- and second-year medical students at the University of Michigan seeking clinical experience outside of the classroom attended an outpatient pediatric pulmonary clinic. Evaluation of the experience consisted of pre- and post-clinic student surveys and post-clinic parent surveys with statements employing a four-point Likert scale as well as open-ended questions. Results: Twenty-eight first-year students, 6 second-year students, and 33 parents participated in the study. Post-clinic statement scores significantly increased for statements addressing empathic attitudes, confidence communicating with children and families, comfort in the clinical environment, and social awareness. Scores did not change for statements addressing motivation, a sense of team membership, or confidence with career goals. Students achieved their goals of gaining experience interacting with patients, learning about pulmonary diseases, and observing clinic workflow. Parents felt that they contributed to student education and were not inconvenienced. Conclusions: Students identified several educational benefits of exposure to a single pediatric pulmonary clinic. Patients and families were not inconvenienced by the participation of a student. Additional studies are warranted to further investigate the value of this model of pre-clinical medical student exposure to subspecialty pediatrics.

  17. Clinical Needs Finding: Developing the Virtual Experience, A Case Study

    Science.gov (United States)

    Mittal, Vaishali; Thompson, Megan; Altman, Stuart M; Taylor, Peter; Summers, Alexander; Goodwin, Kelsey; Louie, Angelique Y

    2013-01-01

    We describe an innovative program at the University of California, Davis for students to engage in clinical needs finding. Using a team-based approach, students participated in clinical rotations to observe firsthand the needs of clinicians at the university affiliated medical center. The teams were asked to develop documentary-style videos to capture key experiences that would allow future viewers to use the videos as “virtual” clinical rotations. This was conceived as a strategy to allow students in prohibitively large classes, or students in programs at institutions without associated medical or veterinary school programs, to experience clinical rotations and perform needs assessments. The students' perspectives on the experience as well as instructor analysis of best practices for this type of activity are presented and discussed. We found that the internship experience was valuable to the students participating, by not only introducing the practice of needs finding but for increasing the students' confidence in the practice of engineering design and their ability to work independently. The videos produced were of such high quality that instructors from other institutions have requested copies for instructional use. Virtual clinical rotations through video experiences may provide a reasonable substitute for students who do not have the ability to participate in rotations in person. PMID:23483373

  18. Biotherapic T. cruzi 17DH when continuously used clinically improves mice infected with T. cruzi.

    Directory of Open Access Journals (Sweden)

    Silvana Marques de Araujo

    2011-09-01

    Full Text Available Introduction: In Trypanosoma cruzi infection, the pathogenesis is the result of a rupture in the host - parasite relationship [1]. This rupture is related to the imbalance of the vital force of the host, expressed through signs and symptoms, defined by Hahnemann (1995[2] as being the source of the disease. There is no research in the literature about the clinical evolution of mice experimentally infected with T. cruzi and treated in different ways using biotherapic. Therefore, this is an area to be studied in the future. Aim: To evaluate the effect of different ways of treatment using biotherapic T. cruzi 17 DH on clinical evolution of mice experimentally infected with T. cruzi. Materials and methods: A blind randomized controlled trial was performed, using 30 swiss male mice, aged 28 days, divided into groups according to the treatment: CONTROL - animals treated with 7% water-alcohol solution diluted in water given ad libitum in an amber bottle; GAVAGE – animals treated with medication highly diluted T. cruzi 17 DH from 4th to 9th day of infection by gavage; WATER -animals treated with highly diluted T. cruzi 17 DH in water ad libitum offered in an amber bottle until the end of the study period. The groups were infected with the Y strain of T. cruzi, intraperitoneal, 1400 blood trypomastigotes. The medicine was handled according to the Brazilian Homeopathic Pharmacopoeia [3] with microbiological test according to RDC n° 67 and in vivo biological risk. Parasitemic curve was determined by daily counting of the parasites [4]. Were measured temperature, weight, intake of water and feed, the ruffle fur and survival of mice. Statistical analysis was performed using the tests Fisher Exact and Log-Rank, with a significance of 5%. The experiment was approved under the protocol n° 030/2008 - Ethics in Animal Experimentation of the Universidade Estadual de Maringá. Results: The mice under different

  19. Clinical and diagnostic pathways in pediatric fungal infections

    Directory of Open Access Journals (Sweden)

    Elio Castagnola

    2013-07-01

    Full Text Available Generally speaking, in pediatrics the patients mostly affected by fungal infections are hematological patients, followed by those with solid tumors, and transplant recipients. Candida infections generally occur just after birth, whereas Aspergillus infections are age-related, and increase their incidence with age. However, among infections, the incidence of bacteremias are still greater than that of mycoses. In pediatrics, in Italy the immunocompromised patients – thus particularly susceptible to fungal infections – are mainly those with severe combined immunodeficiency, chronic mucocutaneous candidiasis, and chronic granulomatous disease. Particular Aspergillus or Scedosporium infections should be considered in peculiar kinds of patients, such as those affected by cystic fibrosis. Finally, different kinds of fungi should be considered in those who come from or spend a lot time in specific areas, such as South America (e.g. coccidioidomycoses, for which differential diagnosis is with tuberculosis.http://dx.doi.org/10.7175/rhc.v4i1S.859

  20. Clinical profile of disseminated cryptococcal infection-a case series

    Institute of Scientific and Technical Information of China (English)

    Vishwanath Sathyanarayanan; Ragini Bekur; Abdul Razak; Joydeep Chakraborty

    2010-01-01

    Objective:To study disseminated cryptococcal infection in a tertiary care hospital in Southern India.Methods:The clinical profile of 12 disseminated cryptococcosis patients with the age group of28-52years was retrospectively analyzed.Results:7(58.3%) presented with fever 30 days whereas2(16.7%)did not have fever. All the12(100%) had headache, 2(16.7%)had altered sensorium, one(8%)seizure.5(41.7%) had diarrhea and vomiting.6(50%) had oral candidiasis, and anemia.9(75%)had elevated erythrocyte sedimentation rate (ESR). 6(50%) had neck stiffness. Cerebrospinal fluid (CSF) pressure was elevated in all12(100%) patients. Blood culture positive for Cryptococcus neoformans(C. neoformans) in11(91.7%) andCSF culture positive in all12 (100%), one(8%)had urine culture positive. India ink preparation was positive in 10(83.3%). CD4 count was less than50/microl in 4 (33.3%), between 50-100 in6(50%)and2(16.7%) in the range of100-200. 6(50%) were treated with parenteral amphotericin B (0.7 mg/kg/d) during intensive phase followed by oral fluconazole400 mg/d for8 weeks then maintenance oral fluconazole 200 mg/d.5(41.6%) were treated with fluconazole alone.8(66.7%) improved and4(33.3%) patients died. Among those who succumbed to the illness,2(16.7%) received amphotericin and fluconazole,2(16.7%) patients received fluconazole alone.Conclusions: Disseminated cryptococcosis can cause considerable mortality inHIV patients and immunocompromised non-HIV individuals. At times, its presentation closely mimics that of Tuberculosis. Early diagnosis and appropriate treatment should be started as early as possible.

  1. Community based clinical program: the Medunsa physiotherapy students` experience

    Directory of Open Access Journals (Sweden)

    N. P. Taukobong

    2004-02-01

    Full Text Available Backgound: The aim of community based clinical training is tproduce graduates who are responsive to the health needs of their communit It is envisaged that upon completion of training graduates would go back an serve their respective communities following exposure to community need Program evaluation should therefore allow students to express the inadequacie and strengths of the program.Aim: To evaluate the community-based clinical program through student's experiences.Methodology: A qualitative research design was used. End of block students reports for both third (8 and fourth (15 year physiotherapy students (n = 23 were used to collect the data. Responses in the reports were grouped into the following categories for purpose of data analysis: feeling about the block, suggestion/s and supervision.Results: The students described the community based clinical program as an unique learning experience which equipped them with the understanding of life within communities. Sixty five percent (65% expressed satisfaction with the supervision given. The main complaints were amounts of paper work involved and clinical workload.Conclusion: The student's experiences indicated that the community-based clinical program within the MEDUNSA physiotherapy department realizes the goal of community-based clinical training as determined by WHO, except for inclusion of some multi-professional approaches and adaptation of the supervision provided.

  2. Clinical characteristics and outcomes of veterans hospitalised with purulent soft tissue infections with and without systemic signs of infection.

    Science.gov (United States)

    Gunderson, Craig G; Holleck, Jurgen; Chang, John J; Lin, Shin; Merchant, Naseema; Gupta, Shaili

    2016-07-01

    Objective To describe the frequency of systemic inflammatory response syndrome (SIRS) criteria in a cohort of patients hospitalised with purulent soft tissue infections and to determine their impact on clinical characteristics, microbiology and outcomes. Methods Retrospective cohort study of adults hospitalised at the West Haven Veteran's Hospital with purulent soft tissue infections between 1 October 2008 and 30 September 2013. Results A total of 173 patients were included with purulent soft tissue infections; 60 patients had no SIRS, 48 had one SIRS and 65 had ≥ 2 SIRS. Most clinical characteristics were similar between the different SIRS groups, although patients with SIRS were more likely to have severe sepsis and acute kidney injury and to already be on antibiotics at the time of hospitalisation. The microbiology of the infections was similar between SIRS groups. All patients received parenteral antibiotics when admitted and the majority of patients in all SIRS categories received antibiotics with broad Gram-negative activity. Outcomes were generally benign for all SIRS groups, although patients with SIRS had a longer length of stay and a trend towards more bacteremia. Conclusions SIRS are common in patients hospitalised with purulent soft tissue infections, although one third had no systemic signs of infection. Severe sepsis and septic shock are rare. Clinical characteristics, microbiology and antibiotic use are similar among patients in different SIRS groups, although the group without SIRS had a shorter hospitalisation and no episodes of bacteremia. Over-use of antibiotics is common in all SIRS categories. PMID:26950290

  3. The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection

    Directory of Open Access Journals (Sweden)

    Jung Lim Byun

    2010-02-01

    Full Text Available Purpose : To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR in childhood urinary tract infection (UTI. Methods : From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP, positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA scan and voiding cystourethrography (VCUG results. Results : VCUG was performed in 148 patients; of them, 37 (25.0% had VUR: 18 (12.2% had low-grade (I-II VUR, and 19 (10.5% had high-grade (III-V VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5% had cortical defects, of which 21 (63.6% had VUR: 10 (30.3%, low-grade (I-II VUR; and 11 (33.3%, high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0% had low-grade VUR and 6 (10.5% had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever (?#243;6 hours after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. Conclusion : Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.

  4. Clinical impact of Achromobacter xylosoxidans colonization/infection in patients with cystic fibrosis

    Directory of Open Access Journals (Sweden)

    M.C. Firmida

    2016-01-01

    Full Text Available The rate of diagnosis of colonization/infection of the airways with Achromobacter xylosoxidans has increased in cystic fibrosis patients, but its clinical significance is still controversial. This retrospective, case-control study aimed to evaluate the clinical impact of A. xylosoxidans colonization/infection in cystic fibrosis patients. Individuals who were chronically colonized/infected (n=10, intermittently colonized/infected (n=15, and never colonized/infected with A. xylosoxidans (n=18 were retrospectively evaluated during two periods that were 2 years apart. Demographic characteristics, clinical data, lung function, and chronic bacterial co-colonization data were evaluated. Of the total study population, 87% were pediatric patients and 65.1% were female. Individuals chronically colonized/infected with A. xylosoxidans had decreased forced expiratory volume in 1 s (51.7% in the chronic colonization/infection group vs 82.7% in the intermittent colonization/infection group vs 76% in the never colonized/infected group. Compared with the other two groups, the rate of co-colonization with methicillin-resistant Staphylococcus aureus was higher in individuals chronically colonized/infected with A. xylosoxidans (P=0.002. Changes in lung function over 2 years in the three groups were not significant, although a trend toward a greater decrease in lung function was observed in the chronically colonized/infected group. Compared with the other two groups, there was a greater number of annual hospitalizations in patients chronically colonized/infected with A. xylosoxidans (P=0.033. In cystic fibrosis patients, there was an increased frequency of A. xylosoxidans colonization/infection in children, and lung function was reduced in patients who were chronically colonized/infected with A. xylosoxidans. Additionally, there were no differences in clinical outcomes during the 2-year period, except for an increased number of hospitalizations in patients with A

  5. ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults.

    Science.gov (United States)

    Riddle, Mark S; DuPont, Herbert L; Connor, Bradley A

    2016-05-01

    Acute diarrheal infections are a common health problem globally and among both individuals in the United States and traveling to developing world countries. Multiple modalities including antibiotic and non-antibiotic therapies have been used to address these common infections. Information on treatment, prevention, diagnostics, and the consequences of acute diarrhea infection has emerged and helps to inform clinical management. In this ACG Clinical Guideline, the authors present an evidence-based approach to diagnosis, prevention, and treatment of acute diarrhea infection in both US-based and travel settings. PMID:27068718

  6. Clinical Manifestations of Cytomegalovirus-Associated Posterior Uveitis and Panuveitis in Patients Without Human Immunodeficiency Virus Infection

    NARCIS (Netherlands)

    Pathanapitoon, Kessara; Tesavibul, Nattaporn; Choopong, Pitipol; Boonsopon, Sutasinee; Kongyai, Natedao; Ausayakhun, Somsanguan; Kunavisarut, Paradee; Rothova, Aniki

    2013-01-01

    Importance: Little attention has been paid to clinical features of cytomegalovirus (CMV) infections in individuals without human immunodeficiency virus (HIV). Objective: To describe the clinical manifestations and comorbidities of patients without HIV infection who have CMV-associated posterior uvei

  7. The porcine acute phase protein response to acute clinical and subclinical experimental infection with Streptococcus suis

    DEFF Research Database (Denmark)

    Sørensen, Nanna Skall; Tegtmeier, C.; Andresen, Lars Ole;

    2006-01-01

    and apolipoprotein (Apo) A-I. The aim was to elucidate the differences in the acute phase behaviour of the individual APPs during a typical bacterial septicaemic, infection. Pigs were inoculated subcutaneously with live S. suis serotype 2 and blood was sampled before and on various days post inoculation (p...... the experiment with maximum levels around 10 times the day 0-levels, and pig-MAP was elevated on days 1-12 p.i. with peak levels of around seven times the day 0-levels. Apo A-I was decreased from days 1 to 8 and showed minimum levels of about 40% of day 0-levels around 1-2 days p.i. No clear pattern of changes...... signs and no arthritic lesions showed an APP response comparable to that of the other, clinically affected pigs. Thus, both acute clinical and subclinical S. suis infection could be revealed by the measurement of one or more of the APPs CRP, SAA, Hp, pig-MAP and Apo A-I. The combined measurement of two...

  8. Mixed Infections and Rifampin Heteroresistance among Mycobacterium tuberculosis Clinical Isolates.

    Science.gov (United States)

    Zheng, Chao; Li, Song; Luo, Zhongyue; Pi, Rui; Sun, Honghu; He, Qingxia; Tang, Ke; Luo, Mei; Li, Yuqing; Couvin, David; Rastogi, Nalin; Sun, Qun

    2015-07-01

    Mixed infections and heteroresistance of Mycobacterium tuberculosis contribute to the difficulty of diagnosis, treatment, and control of tuberculosis. However, there is still no proper solution for these issues. This study aimed to investigate the potential relationship between mixed infections and heteroresistance and to determine the high-risk groups related to these factors. A total of 499 resistant and susceptible isolates were subjected to spoligotyping and 24-locus variable-number tandem repeat methods to analyze their genotypic lineages and the occurrence of mixed infections. Two hundred ninety-two randomly selected isolates were sequenced on their rpoB gene to examine mutations and heteroresistance. The results showed that 12 patients had mixed infections, and the corresponding isolates belonged to Manu2 (n = 8), Beijing (n = 2), T (n = 1), and unknown (n = 1) lineages. Manu2 was found to be significantly associated with mixed infections (odds ratio, 47.72; confidence interval, 9.68 to 235.23; P < 0.01). Four isolates (1.37%) were confirmed to be heteroresistant, which was caused by mixed infections in three (75%) isolates; these belonged to Manu2. Additionally, 3.8% of the rifampin-resistant isolates showing no mutation in the rpoB gene were significantly associated with mixed infections (χ(2), 56.78; P < 0.01). This study revealed for the first time that Manu2 was the predominant group in the cases of mixed infections, and this might be the main reason for heteroresistance and a possible mechanism for isolates without any mutation in the rpoB gene to become rifampin resistant. Further studies should focus on this lineage to clarify its relevance to mixed infections.

  9. Early clinical experience: do students learn what we expect?

    NARCIS (Netherlands)

    Helmich, E.; Bolhuis, S.; Laan, R.F.J.M.; Koopmans, R.T.C.M.

    2011-01-01

    CONTEXT: Early clinical experience is thought to contribute to the professional development of medical students, but little is known about the kind of learning processes that actually take place. Learning in practice is highly informal and may be difficult to direct by predefined learning outcomes.

  10. Clinical, Pathological and Immunological Aspects of Transplacental PRRS Virus Infection

    DEFF Research Database (Denmark)

    Nielsen, Jens

    2011-01-01

    PRRSV in the previously unaffected Danish pig population. Acute PRRS like disease was observed in non-vaccinated as well as in vaccinated herds, and it was demonstrated that the vaccine strain had reverted to virulence. By experimental infection of late term pregnant sows, we demonstrated that a field...... isolate of PRRS vaccine-derived virus (VDV) could cause disease in swine consistent with PRRS, thus confirming the etiological role of VDV. Since the complex pathology following in utero infection with PRRSV indicates impairment of the immune system of congenitally infected pigs, we studied various aspect...

  11. A qualitative study of constructive clinical learning experiences.

    Science.gov (United States)

    van der Hem-Stokroos, H H; Daelmans, H E M; van der Vleuten, C P M; Haarman, H J Th M; Scherpbier, A J J A

    2003-03-01

    Little is known about the effectiveness of clinical education. A more educational structure is considered to be potentially beneficial. The following structured components were added to a surgical clerkship: logbooks, an observed student-patient encounter, individual appraisals, feedback on patient notes, and (case) presentations by students. The authors organized two focus-group sessions in which 19 students participated to explore their perceptions about effective clinical learning experiences and the newly introduced structured components. The analysis of the transcripts showed that observation and constructive feedback are key features of clinical training. The structured activities were appreciated and the results show the direction to be taken for further improvement. Learning experiences depended vastly on individual clinicians' educational qualities. Students experienced being on call, assisting in theatre and time for self-study as instructive elements. Recommended clerkship components are: active involvement of students, direct observation, selection of teachers, a positive learning environment and time for self-study. PMID:12745517

  12. Rapid enzyme analysis as a diagnostic tool for wound infection: Comparison between clinical judgment, microbiological analysis, and enzyme analysis

    NARCIS (Netherlands)

    Blokhuis-Arkes, Miriam H.E.; Haalboom, Marieke; Palen, van der Job; Heinzle, Andrea; Sigi, Eva; Guebitz, Georg; Beuk, Roland

    2015-01-01

    In clinical practice, diagnosis of wound infection is based on the classical clinical signs of infection. When infection is suspected, wounds are often swabbed for microbiological culturing. These methods are not accurate (clinical judgment in chronic wounds) or provide results after several days (w

  13. ENTEROVIRUS INFECTION: VARIETY OF ETIOLOGICAL FACTORS AND CLINICAL MANIFESTATIONS

    Directory of Open Access Journals (Sweden)

    O. I. Kanaeva

    2014-01-01

    Full Text Available Abstract. Enteroviruses are widely distributed human infectious pathogens. In spite of infection a disease does not manifest in majority number of cases. However, in some infected persons the different kind of symptoms can be observed; from common cold signs up to  aseptic (serous meningitis and myocarditis. Severe enteroviral cases with lethal outcomes are rarely reported. Ability of enteroviruses to cause large outbreaks and even epidemic distribution is very significant for health care systems. Taking in account a high genetic diversity of enteroviruses it is possible appearance of new highly pathogenic strains in the future. In some countries including the Russian Federation the permanent surveillance for enteroviral infections is provided besides of WHO polio elimination program. The laboratory diagnostics of enterovirus infections is complicated by numerous of pathogen serotypes. Thus, classical virological methods should be supported by molecular-biological tools to sequence pathogen genome and to define phylogenetic relations between different enterovirus strains.

  14. Experiences of UK patients with hepatitis C virus infection accessing phlebotomy: A qualitative analysis.

    Science.gov (United States)

    Clements, Amanda; Grose, Jane; Skirton, Heather

    2015-06-01

    This study provides an understanding of the experiences and perceptions of phlebotomy in people with infection who have venous damage related to injecting drug use with the aim of improving their care. Narrative interviews were conducted with 10 attendees of a phlebotomy service within an acute Trust in the south-west of England. The participants had hepatitis C infection and poor venous access due to current or former drug use. Interview audiotapes were analyzed, and the themes - conflict, emotional responses, the patient as expert, and offering solutions - were identified. In the context of this study, we discuss the difficulties associated with phlebotomy, which might explain why individuals with hepatitis C infection and venous damage disengage from health services and are less likely to undertake antiviral treatment. This research adds to the literature on phlebotomy for vulnerable groups, and recommends hepatitis C virus clinics within drug agencies, the need to review training and policy, and the development of "phlebotomy passports" to enable continuity of care between services.

  15. E-health stakeholders experiences with clinical modelling and standardizations.

    Science.gov (United States)

    Gøeg, Kirstine Rosenbeck; Elberg, Pia Britt; Højen, Anne Randorff

    2015-01-01

    Stakeholders in e-health such as governance officials, health IT-implementers and vendors have to co-operate to achieve the goal of a future-proof interoperable e-health infrastructure. Co-operation requires knowledge on the responsibility and competences of stakeholder groups. To increase awareness on clinical modeling and standardization we conducted a workshop for Danish and a few Norwegian e-health stakeholders' and made them discuss their views on different aspects of clinical modeling using a theoretical model as a point of departure. Based on the model, we traced stakeholders' experiences. Our results showed there was a tendency that stakeholders were more familiar with e-health requirements than with design methods, clinical information models and clinical terminology as they are described in the scientific literature. The workshop made it possible for stakeholders to discuss their roles and expectations to each other.

  16. Clinical Prediction and Diagnosis of Neurosyphilis in HIV-Infected Patients with Early Syphilis

    OpenAIRE

    Dumaresq, Jeannot; Langevin, Stéphanie; Gagnon, Simon; Serhir, Bouchra; Deligne, Benoît; Tremblay, Cécile; Tsang, Raymond S.W.; Fortin, Claude; Coutlée, François; Roger, Michel

    2013-01-01

    The diagnosis of neurosyphilis (NS) is a challenge, especially in HIV-infected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial. We retrospectively reviewed demographic, clinical, and laboratory data from 122 cases of HIV-infected patients with documented early syphilis who underwent an LP to rule out NS, and we evaluated 3 laboratory-developed validated real-time PCR assays, the Treponema pallidum particle...

  17. Serious Infection Following Acute Myocardial Infarction: Incidence, Clinical Features, and Outcomes

    Science.gov (United States)

    Truffa, Adriano A. M.; Granger, Christopher B.; White, Kyle R.; Newby, L. Kristin; Mehta, Rajendra H.; Hochman, Judith S.; Patel, Manesh R.; Pieper, Karen S.; Al-Khalidi, Hussein R.; Armstrong, Paul W.; Lopes, Renato D.

    2013-01-01

    Background Little is known about the incidence, location, etiologic organisms, and outcomes of infection in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Objectives To address this knowledge gap using the database of the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. We also assessed the association between serious infections and 90-day death or death/MI. Methods We analyzed data from 5745 STEMI patients enrolled in the APEX-AMI trial. Detailed information on infection was collected on all patients. We describe characteristics of patients according to infection and details of infection. Cox proportional hazards models were used to assess 90-day outcomes among patients with and without infections after adjusting for associated clinical variables and using infection as a time-dependent covariate. Results Overall, 138 patients developed a serious infection (2.4%), most of whom presented with a single-site infection. The median (25th, 75th percentile) time until diagnosis of infection was 3 (1, 6) days. The most commonly identified organism was Staphylococcus aureus, and the main location of infection was the bloodstream. These patients had more comorbidities and lower procedural success at index PCI than those without infections. Serious infection was associated with significantly higher rates of 90-day death (adjusted hazard ratio [HR] 5.6; 95% confidence interval [CI] 3.8-8.4) and death or MI (adjusted HR 4.9; 95% CI 3.4-7.1). Conclusion Infections complicating the course of patients with STEMI are uncommon but associated with markedly worse 90-day clinical outcomes. Mechanisms for early identification of these high-risk patients, as well as design of strategies to reduce their risk of infection, are warranted. PMID:22814783

  18. Does health care role and experience influence perception of safety culture related to preventing infections?

    Science.gov (United States)

    Braun, Barbara I; Harris, Anthony D; Richards, Cheryl L; Belton, Beverly M; Dembry, Louise-Marie; Morton, David J; Xiao, Yan

    2013-07-01

    Growing evidence reveals the importance of improving safety culture in efforts to eliminate health care-associated infections. This multisite, cross-sectional survey examined the association between professional role and health care experience on infection prevention safety culture at 5 hospitals. The findings suggest that frontline health care technicians are less directly engaged in improvement efforts and safety education than other staff and that infection prevention safety culture varies more by hospital than by staff position and experience.

  19. Prevalence of sexually transmitted infections among women attending antenatal clinics in Tanga, north eastern Tanzania

    DEFF Research Database (Denmark)

    Chiduo, M; Theilgaard, Z P; Bakari, V;

    2012-01-01

    This study aimed to determine the prevalence of sexually transmitted infections (STIs) among HIV-infected and uninfected pregnant women in Tanga, Tanzania. Retrospective data on syphilis and HIV status during 2008-2010 were collected from antenatal clinic (ANC) records. Prospective data were coll...

  20. Age-specificity of clinical dengue during primary and secondary infections

    NARCIS (Netherlands)

    K.T.D. Thai; H. Nishiura; P.L. Hoang; N.T.T. Tran; G.T. Phan; H.Q. Le; B.Q. Tran; N.V. Nguyen; P.J. de Vries

    2011-01-01

    This study aims to estimate the age-specific risks of clinical dengue attack (i.e., the risk of symptomatic dengue among the total number of dengue virus (DENV) infections) during primary and secondary infections. We analyzed two pieces of epidemiological information in Binh Thuan province, southern

  1. Definitions of CMV infection and disease in transplant patients for use in clinical trials

    DEFF Research Database (Denmark)

    Ljungman, Per; Boeckh, Michael; Hirsch, Hans H;

    2016-01-01

    Cytomegalovirus (CMV) infection and disease are important causes of morbidity and mortality in transplant recipients. For the purpose of developing consistent reporting of CMV outcomes in clinical trials, definitions of CMV infection and disease were developed and most recently published in 2002...

  2. Surgical site infection and clinical microbiology in orthopaedics surgeries in a rural hospital

    Institute of Scientific and Technical Information of China (English)

    Pradeep K. Singh; Sandeep Shrivastva; Rajesh Dulani; Abhishek Yadav

    2011-01-01

    @@ Infection and Clinical Microbiology in Orthopaedics Surgeries in Wound infections resulting from contamination during major orthopaedics surgery continues to be a vital issue.In this study, specimens of pus,draining fluids or suspected pus from the wounds of surgical patients who had been undergone major orthopaedics surgical procedure were cultured.

  3. A behavioral and cognitive profile of clinically stable HIV-infected children

    NARCIS (Netherlands)

    Nozyce, ML; Lee, SS; Wiznia, A; Nachman, S; Mofenson, LM; Smith, ME; Yogev, R; McIntosh, K; Stanley, K; Pelton, S

    2006-01-01

    OBJECTIVE. The purpose of this research was to characterize behavioral and cognitive profiles of clinically and immunologically stable antiretroviral-experienced HIV-infected children. METHODS. Two hundred seventy-four previously treated HIV-infected children aged 2 to 17 years were assessed for beh

  4. Herpes Simplex Virus Infection in a University Health Population: Clinical Manifestations, Epidemiology, and Implications

    Science.gov (United States)

    Horowitz, Robert; Aierstuck, Sara; Williams, Elizabeth A.; Melby, Bernette

    2010-01-01

    Objective: The authors described clinical presentations of oral and genital herpes simplex virus (HSV) infections in a university health population and implications of these findings. Participants and Methods: Using a standardized data collection tool, 215 records of patients with symptomatic culture-positive HSV infections were reviewed. Results:…

  5. A Large Outbreak of Hepatitis C Virus Infections in a Hemodialysis Clinic.

    Science.gov (United States)

    Nguyen, Duc B; Gutowski, Jennifer; Ghiselli, Margherita; Cheng, Tabitha; Bel Hamdounia, Shadia; Suryaprasad, Anil; Xu, Fujie; Moulton-Meissner, Heather; Hayden, Tonya; Forbi, Joseph C; Xia, Guo-Liang; Arduino, Matthew J; Patel, Ami; Patel, Priti R

    2016-02-01

    BACKGROUND In November and December 2012, 6 patients at a hemodialysis clinic were given a diagnosis of new hepatitis C virus (HCV) infection. OBJECTIVE To investigate the outbreak to identify risk factors for transmission. METHODS A case patient was defined as a patient who was HCV-antibody negative on clinic admission but subsequently was found to be HCV-antibody positive from January 1, 2008, through April 30, 2013. Patient charts were reviewed to identify and describe case patients. The hypervariable region 1 of HCV from infected patients was tested to assess viral genetic relatedness. Infection control practices were evaluated via observations. A forensic chemiluminescent agent was used to identify blood contamination on environmental surfaces after cleaning. RESULTS Eighteen case patients were identified at the clinic from January 1, 2008, through April 30, 2013, resulting in an estimated 16.7% attack rate. Analysis of HCV quasispecies identified 4 separate clusters of transmission involving 11 case patients. The case patients and previously infected patients in each cluster were treated in neighboring dialysis stations during the same shift, or at the same dialysis station on 2 consecutive shifts. Lapses in infection control were identified. Visible and invisible blood was identified on multiple surfaces at the clinic. CONCLUSIONS Epidemiologic and laboratory data confirmed transmission of HCV among numerous patients at the dialysis clinic over 6 years. Infection control breaches were likely responsible. This outbreak highlights the importance of rigorous adherence to recommended infection control practices in dialysis settings. PMID:26573412

  6. A Large Outbreak of Hepatitis C Virus Infections in a Hemodialysis Clinic.

    Science.gov (United States)

    Nguyen, Duc B; Gutowski, Jennifer; Ghiselli, Margherita; Cheng, Tabitha; Bel Hamdounia, Shadia; Suryaprasad, Anil; Xu, Fujie; Moulton-Meissner, Heather; Hayden, Tonya; Forbi, Joseph C; Xia, Guo-Liang; Arduino, Matthew J; Patel, Ami; Patel, Priti R

    2016-02-01

    BACKGROUND In November and December 2012, 6 patients at a hemodialysis clinic were given a diagnosis of new hepatitis C virus (HCV) infection. OBJECTIVE To investigate the outbreak to identify risk factors for transmission. METHODS A case patient was defined as a patient who was HCV-antibody negative on clinic admission but subsequently was found to be HCV-antibody positive from January 1, 2008, through April 30, 2013. Patient charts were reviewed to identify and describe case patients. The hypervariable region 1 of HCV from infected patients was tested to assess viral genetic relatedness. Infection control practices were evaluated via observations. A forensic chemiluminescent agent was used to identify blood contamination on environmental surfaces after cleaning. RESULTS Eighteen case patients were identified at the clinic from January 1, 2008, through April 30, 2013, resulting in an estimated 16.7% attack rate. Analysis of HCV quasispecies identified 4 separate clusters of transmission involving 11 case patients. The case patients and previously infected patients in each cluster were treated in neighboring dialysis stations during the same shift, or at the same dialysis station on 2 consecutive shifts. Lapses in infection control were identified. Visible and invisible blood was identified on multiple surfaces at the clinic. CONCLUSIONS Epidemiologic and laboratory data confirmed transmission of HCV among numerous patients at the dialysis clinic over 6 years. Infection control breaches were likely responsible. This outbreak highlights the importance of rigorous adherence to recommended infection control practices in dialysis settings.

  7. Experience of 2 dental clinics registered to ISO 9002.

    Science.gov (United States)

    Casas, Michael J; Kenny, David J; Johnston, Douglas H

    2003-04-01

    This paper describes the 3-year experience of managing 2 hospital-based dental clinics registered to ISO 9002:1994; it also examines the revision of previous quality management standards in 2 separate institutions to prepare for registration under the new ISO 9001:2000 standard. Daily equipment and process checks, combined with internal audits, were the backbone of the quality system at both locations. Corrective and protective actions had been underused, because of the partial duplication produced by 2 different institutionally mandated risk management and incident reporting systems. ISO 9002 registration provided both dental clinics with responsive quality systems, emphasizing patient satisfaction and providing measurable continuous quality improvement.

  8. Host response to nontuberculous mycobacterial infections of current clinical importance.

    Science.gov (United States)

    Orme, Ian M; Ordway, Diane J

    2014-09-01

    The nontuberculous mycobacteria are a large group of acid-fast bacteria that are very widely distributed in the environment. While Mycobacterium avium was once regarded as innocuous, its high frequency as a cause of disseminated disease in HIV-positive individuals illustrated its potential as a pathogen. Much more recently, there is growing evidence that the incidence of M. avium and related nontuberculous species is increasing in immunocompetent individuals. The same has been observed for M. abscessus infections, which are very difficult to treat; accordingly, this review focuses primarily on these two important pathogens. Like the host response to M. tuberculosis infections, the host response to these infections is of the TH1 type but there are some subtle and as-yet-unexplained differences.

  9. Nursing preceptors' experiences of two clinical education models.

    Science.gov (United States)

    Mamhidir, Anna-Greta; Kristofferzon, Marja-Leena; Hellström-Hyson, Eva; Persson, Elisabeth; Mårtensson, Gunilla

    2014-08-01

    Preceptors play an important role in the process of developing students' knowledge and skills. There is an ongoing search for the best learning and teaching models in clinical education. Little is known about preceptors' perspectives on different models. The aim of the study was to describe nursing preceptors' experiences of two clinical models of clinical education: peer learning and traditional supervision. A descriptive design and qualitative approach was used. Eighteen preceptors from surgical and medical departments at two hospitals were interviewed, ten representing peer learning (student work in pairs) and eight traditional supervision (one student follows a nurse during a shift). The findings showed that preceptors using peer learning created room for students to assume responsibility for their own learning, challenged students' knowledge by refraining from stepping in and encouraged critical thinking. Using traditional supervision, the preceptors' individual ambitions influenced the preceptorship and their own knowledge was empathized as being important to impart. They demonstrated, observed and gradually relinquished responsibility to the students. The choice of clinical education model is important. Peer learning seemed to create learning environments that integrate clinical and academic skills. Investigation of pedagogical models in clinical education should be of major concern to managers and preceptors. PMID:24512652

  10. Dynamics of interleukin-21 production during the clinical course of primary and secondary dengue virus infections.

    Science.gov (United States)

    Vivanco-Cid, H; Maldonado-Rentería, M J; Sánchez-Vargas, L A; Izaguirre-Hernández, I Y; Hernández-Flores, K G; Remes-Ruiz, R

    2014-09-01

    Previous studies have revealed the clinical relevance of pro-inflammatory cytokine production during dengue virus (DENV) infections. In this study, we evaluated the production of interleukin-21 (IL-21), a key soluble mediator mainly produced by CD4+ T cells. The aim of this study was to investigate the role of IL-21 production during the clinical course of primary and secondary DENV infections and the potential association of IL-21 serum levels with the disease pathogenesis. Blood samples from DENV-infected patients were collected on different days after the onset of symptoms. Patients were classified according to their phase of disease (acute vs. convalescent phases), the type of infection (primary vs. secondary), and the clinical severity of their disease (dengue fever (DF) vs. dengue hemorrhagic fever (DHF)). IL-21 levels were measured using a quantitative capture ELISA assay. The levels of IL-21 were significantly elevated in the disease group compared with the control group. IL-21 was detected in primary and secondary DENV infections, with a significantly higher concentration in the convalescent phase of primary infections. IL-21 levels were significantly higher in patients with secondary acute DHF infections when compared with those with secondary acute DF infection. There was a relationship between the elevated serum levels of IL-21 and the production of DENV-specific IgM and IgG antibodies. Taking together, our results show for the first time the involvement of IL-21 during the clinical course of DENV infections. We speculate that IL-21 may play a protective role in the context of the convalescent phase of primary infections and the acute phase of secondary infections.

  11. The clinical experience of cardiopulmonary bypass in pediatric congenital heart disease complicated by infective endocarditis%小儿先心病并感染性心内膜炎手术治疗中的体外循环技术

    Institute of Scientific and Technical Information of China (English)

    汪力; 皮名安; 龚立; 王涛

    2011-01-01

    目的 总结2002年1月至2011年4月作者收治的15例先天性心脏病合并感染性心内膜炎( infective endocarditis,IE)患儿手术治疗中的体外循环经验(cardiopulmonary bypass,CPB).方法 15例患儿均采用浅低温(28℃~30℃)、较高流量[2.4~3.2 L/(min·m2)]灌注.手术方式为畸形矫治(ASD/VSD修补、右室流出道重建)、赘生物摘除、瓣膜整形或置换术.心肌保护采用4℃冷含血晶体保护液顺行灌注.结果 15例患儿CPB总时间85~ 180 min,主动脉阻断时间40~120 min,均顺利脱离CPB.均获痊愈.1例术后2年死于肺部感染及心功能衰竭.结论 CPB中HCT及胶体渗透压的良好控制、采用平衡超滤结合改良超滤、肝素化后监测ACT、CPB中加入敏感抗生素等对患儿术后恢复至关重要.%Objective To summarize retrospectively the clinical experience of cardiopulmonary bypass (CPB)in pediatric congenital heart disease (CHD) complicated by infective endocarditis (IE) from January 2002 to April 2011(15 cases). Methods CPB was performed with Shallow low temperature(28℃ ~30℃) and high flow rate [2. 4 ~3.21/(min·M2) ] perfusion. Operation method for Correcting the heart abnormality (ASD/VSD repaired., Right ventricular outflow reconstructed), excrescence excision, valve plastic or replacement. 4℃ cold crystalloid with blood was perfused by antegrade perfusion for myocardial protection. Result-s Among the total time CPB 85 ~ 180 min, aortic blocking time 40 ~ 120 min, 15 cases of patients were smoothly disconnected from CPB. All cases recovered completely. 1 case died in lyear due to heart failure. Conclusion The important factors in CPB are the good adjustment in colloid osmotic pressure( COP) and hem-atocrit( HCT) ,Balance ultrafiltration( BUF) and modified ultrafiltration( MUF) .monitor of activated clotting time (ACT) .sensitive antibiotics used in priming liquid.

  12. Experimental human challenge infections can accelerate clinical malaria vaccine development

    NARCIS (Netherlands)

    Sauerwein, R.W.; Roestenberg, M.; Moorthy, V.S.

    2011-01-01

    Malaria is one of the most frequently occurring infectious diseases worldwide, with almost 1 million deaths and an estimated 243 million clinical cases annually. Several candidate malaria vaccines have reached Phase IIb clinical trials, but results have often been disappointing. As an alternative to

  13. SURGICAL SITE INFECTION IN ABDOMINAL SURGERIES: A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Amit

    2014-09-01

    Full Text Available Purpose: A prospective study of incisional surgical site infection in abdominal surgeries was conducted to find out incidence, common predisposing factors and microbiological profile. METHODS: 375 patients who underwent abdominal surgeries were studied in a span of 1 year. They were divided into two groups – group 1 – 316 cases who did not develop Surgical Site Infection (SSI, the 2nd group – 59 cases that developed SSI. These patients were studied by interviewing and examination according to a set proforma. The results were statistically analyzed by comparing averages using Chi square chart for finding significance of difference where applicable. RESULT: The overall SSI incidence was 15.7 % (59/375. In elective surgeries, the SSI rate was 5.7% and in emergency surgeries, it was 28.6%. It was found that SSI increased with increasing age linearly. Other significant factors involved were increasing class of wound (dirty > clean wound class, increased preoperative stay, presence of remote site infection, increased duration of surgery and use of drains. E. coli was found to be the most common organism causing SSI in abdominal operations. CONCLUSION: SSI can be reduced by decreasing the preoperative hospital stay, appropriate antibiotic administration policies, preoperative control of remote site infections, adequate preoperative patient preparation, reducing the duration of surgery to minimum, judicious use of drains and intraoperative maintenance of asepsis and following operation theatre discipline properly.

  14. Clinical and epidemiological features of patients with chronic hepatitis C co-infected with HIV

    Directory of Open Access Journals (Sweden)

    Braga Eduardo Lorens

    2006-02-01

    Full Text Available Co-infection with hepatitis C virus (HCV and human immunodeficiency virus (HIV is increasingly common and affects the clinical course of chronic hepatitis C. Highly active antiretroviral therapy has improved the life expectancy of HIV infected patients, but, by extending survival, it permits the development of HCV cirrhosis. This study tried to evaluate clinical and epidemiological features of patients with chronic hepatitis C co-infected with HIV. We evaluated 134 HCV-infected patients: i group A - 65 co-infected HCV/HIV patients, ii group B - 69 mono-infected HCV patients. The impact of HIV infection on HCV liver disease was analyzed using Child's score, ultrasound findings and liver histology. Patients were subjected to HCV genotyping and anti-HBs dosage. Patients mean age was 42.4 years (±9.1 and 97 (72.4% were males. Injected drug use and homo/bisexual practice were more frequently encountered in the co-infected group: 68.3% and 78.0%, respectively. Antibodies against hepatitis B virus (anti-HBs were found in only 38.1% of the patients (66.7% group A x 33.3% group B. Ten out of 14 individuals (71.4% who had liver disease (Child B or C and 25 out of 34 (73.5% who showed ultrasound evidence of chronic liver disease were in the co-infection group. HCV genotype-2/3 was more frequently encountered in co-infected patients (36.9% group A vs. 21.8% group B. Conclusions: a HIV infection seems to adversely affect the clinical course of chronic hepatitis C, b injected drug use, bi/homosexual practice and genotype-2/3 were more frequently encountered in co-infected patients, c immunization against HBV should be encouraged in these patients.

  15. Clinical Experience of Medical Students at University Sains Malaysia

    OpenAIRE

    Quah, Ban Seng; Malik, Alam Sher; Simpson, Hamish

    2000-01-01

    Experience of acute medical, surgical conditions, and clinical procedures of undergraduate students were assessed via a questionnaire survey during the final week of the 1993/1998 programme at the School of Medical Sciences, Univestiti Sains Malaysia. Individual performances were assessed by a scoring system. One hundred and twenty four students responded, (response rate 97%). More than 90% had seen myocardial infarction, cerebrovascular accident, pneumonia, respiratory distress, gastroenteri...

  16. Influence of light source and clinical experience on shade matching

    OpenAIRE

    GÁSPÁRIK, CRISTINA; TOFAN, ALINA; CULIC, BOGDAN; BADEA, MÎNDRA; DUDEA, DIANA

    2014-01-01

    Introduction Shade is one of the most important attributes when evaluating the success of a restoration. Several factors can influence the visual shade matching process, and therefore the outcome of the final restoration. Objectives 1. to assess the importance of clinical experience on shade matching accuracy; 2. to assess the influence of two standard light sources on the ability to match shade tabs; 3. to identify the area in a VITA Classical shade guide where matching errors are most likel...

  17. DNA-abzymes in autoimmune diseases in clinic and experiment

    Directory of Open Access Journals (Sweden)

    T E Naumova

    2003-01-01

    Full Text Available DNA-abzymes enzymes in autoimmune diseases in clinic and experiment T.E. Naumova, O.M. Durova, A.G. Gabibov, Z.S. Alekberova, S. V. Suchkov DNA-hydrolyzing autoantibodies (AAB or DNA-abzymes can be found in autoimmune diseases in clinic and experiment. Technology of serum express screening for presence of DNA abzymes is described. Comparative study of DNA-hydrolising activity in patients with different forms of systemic and organ-specific autoimmune diseases was performed. Blood of clinically healthy donors was usually free of IgG DNA-abzymes. DNA-abzymes were most often revealed in patients with systemic lupus erythematosus (SLE and rheumatoid arthritis (RA less often in patients with organ-specific forms of autoimmune disturbances. The results of the study confirm the hypothesis of autoimmune origin of IgG DNA abzymes and demonstrate the possibility to use them in clinical practice for monitoring to disease activity in SLE and RA.

  18. Clinical decision-making: physicians' preferences and experiences

    Directory of Open Access Journals (Sweden)

    White Martha

    2007-03-01

    Full Text Available Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1 physician preferences for different styles of clinical decision-making; 2 styles of clinical decision-making physicians perceive themselves as practicing; and 3 the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information. Methods Cross-sectional survey of a nationally representative sample of U.S. physicians. Results 1,050 (53% response rate physicians responded to the survey. Of these, 780 (75% preferred to share decision-making with their patients, 142 (14% preferred paternalism, and 118 (11% preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits. Conclusion Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.

  19. Catheter-associated urinary tract infections in Clinical Center of Banja Luka

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    Verhaz Antonija

    2003-01-01

    Full Text Available Introduction Catheter-associated urinary tract infections are the most common nosocomial infections of the urinary tract, and among the most common nosocomial infections in general. The major problems of these infections include antibiotic resistance and enormous direct and indirect cost of treatment. Material and methods A retrospective study on major causes of infections and antibiotic resistance was conducted at four clinics of the Clinical Center of Banja Luka. An anonymous questionnaire was distributed to nursing staff dealing with urinary catheters in order to get an overview of their clinical performance. Results The results showed that in 89% of cases (out of 198 patients with developed catheter-associated urinary tract infection infections were caused by gram-negative bacteria, in 7% by gram-positive bacteria and in 4% by Candida. The most common bacteria were: Escherichia coli (33.6%, Pseudomonas aeruginosa (14.1%, Proteus mirabilis (13.3%, and Enterobacter (10.5%. Majority of bacteria presented with extremely high resistance (72-100% to ampicillin, gentamycin and cotrimoxazole, and in some cases a significant resistance to ciprofloxacine, nalidixic acid, ceftriaxone and ceftazidime. The questionnaire showed that nursing staff did not follow guidelines for medical care of patients with urinary catheters. Conclusion It can be concluded that poor hygienic and epidemiological conditions, as well as irrational use of antibiotics contribute to uncontrolled development of urinary tract infections in catheterized patients.

  20. How Can Viral Dynamics Models Inform Endpoint Measures in Clinical Trials of Therapies for Acute Viral Infections?

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    Carolin Vegvari

    Full Text Available Acute viral infections pose many practical challenges for the accurate assessment of the impact of novel therapies on viral growth and decay. Using the example of influenza A, we illustrate how the measurement of infection-related quantities that determine the dynamics of viral load within the human host, can inform investigators on the course and severity of infection and the efficacy of a novel treatment. We estimated the values of key infection-related quantities that determine the course of natural infection from viral load data, using Markov Chain Monte Carlo methods. The data were placebo group viral load measurements collected during volunteer challenge studies, conducted by Roche, as part of the oseltamivir trials. We calculated the values of the quantities for each patient and the correlations between the quantities, symptom severity and body temperature. The greatest variation among individuals occurred in the viral load peak and area under the viral load curve. Total symptom severity correlated positively with the basic reproductive number. The most sensitive endpoint for therapeutic trials with the goal to cure patients is the duration of infection. We suggest laboratory experiments to obtain more precise estimates of virological quantities that can supplement clinical endpoint measurements.

  1. The clinical analysis of patients aged≥80 years with hospital infection of mycotic pneumonia

    Institute of Scientific and Technical Information of China (English)

    周春

    2012-01-01

    Objective To analyze the clinical characteristics of hospital-acquired mycotic pneumonia in elderly patients (aged≥80 years).Methods The clinical data were reviewed on 64 cases of elderly patients aged 80-93 years with hospital-acquired infection of mycotic pneumonia

  2. The clinical, pathological and microbiological outcome of an Escherichia coli O2:K1 infection in avian pneumovirus infected turkeys.

    Science.gov (United States)

    Van de Zande, S; Nauwynck, H; Pensaert, M

    2001-08-20

    The purpose of this study was to evaluate the effect of an Escherichia coli infection in avian pneumovirus (APV)-infected turkeys. One group of 2-week-old specific pathogen-free (SPF) and two groups of 3-week-old conventional (CON) turkeys were inoculated oculonasally with virulent APV subtype A alone, with E. coli O2:K1 alone or with both agents at varying intervals (1, 3, 5 or 7 days) between the two inoculations. The birds were followed clinically and examined for macroscopic lesions at necropsy. Titres of APV were determined in the turbinates, trachea, lungs and air sacs. The number of E. coli O2:K1were assessed in the turbinates, trachea, lungs, air sacs, liver and heart. In both SPF and CON turkeys, dual infection resulted in an increased morbidity and a higher incidence of gross lesions compared to the groups given single infections, especially with a time interval between APV and E. coli inoculations of 3 and 5 days. APV was isolated from the respiratory tract of all APV-infected groups between 3 and 7 days post inoculation. E. coli O2:K1 was isolated only from turkeys that received a dual infection. It was recovered from the turbinates, trachea, lungs, heart and liver. These results show that APV may act as a primary agent predisposing to E. coli colonization and invasion.

  3. Heteronormativity hurts everyone: experiences of young men and clinicians with sexually transmitted infection/HIV testing in British Columbia, Canada.

    Science.gov (United States)

    Knight, Rod; Shoveller, Jean A; Oliffe, John L; Gilbert, Mark; Goldenberg, Shira

    2013-09-01

    Heteronormative assumptions can negatively influence the lives of young gay and bisexual men, and recent sociological analyses have identified the negative impacts of heteronormativity on heterosexual men (e.g. 'fag discourse' targeted at heterosexual adolescents). However, insights into how heteronormative discourses may be (re)produced in clinical settings and how they contribute to health outcomes for gay, bisexual and heterosexual men are poorly understood. This analysis draws on in-depth interviews with 45 men (15-25 years old) and 25 clinicians in British Columbia, Canada, to examine how heteronormative discourses affect sexually transmitted infection testing. The sexually transmitted infection/HIV testing experience emerged as a unique situation, whereby men's (hetero)sexuality was explicitly 'interrogated'. Risk assessments discursively linked sexual identity to risk in ways that reinforced gay men as the risky 'other' and heterosexual men as the (hetero)normal and, therefore, relatively low-risk patient. This, in turn, alleviated concern for sexually transmitted infection/HIV exposure in heterosexual men by virtue of their sexual identity (rather than their sexual practices), which muted discussions around their sexual health. The clinicians also positioned sexual identities and practices as important 'clues' for determining their patients' social contexts and supports while concurrently informing particular tailored clinical communication strategies. These findings highlight how men's experiences with sexually transmitted infection/HIV testing can (re)produce heteronormative assumptions and expectations or create opportunities for more equitable gendered relations and discourses. PMID:23117592

  4. Clinical Profile of Dengue Infection in Patients with Hematological Diseases

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    Sanjeev Kumar Sharma

    2011-09-01

    Full Text Available Managing hematological disorders in a tropical country presents several unique diagnostic and management problems. Apart from the disease process, we need to be aware of infections that can exacerbate or mimic serious hematological problems. We present here a series of five patients with pre-existing hematological diseases who were infected by dengue virus. These cases highlight the need to keep a strong suspicion of common endemic diseases in tropical countries before considering extensive workup for the basic hematological disease. There was no mortality and all patients recovered without any significant impact on their pre-existing hematological condition inspite of their low baseline blood counts. There was no excessive bleeding, prolonged stay in the hospital or relapse of underlying hematological disease in these patients and the only major concern was the increased anxiety among both the patient and treating physician regarding the relapse/progression of pre-existing hematological disease.

  5. Burkholderia Pseudomallei Causing Bone and Joint Infections: A Clinical Update

    OpenAIRE

    Raja, Nadeem Sajjad; Scarsbrook, Christine

    2016-01-01

    Burkholderia pseudomallei (B. pseudomallei), a causative agent of an emerging infectious disease melioidosis, is endemic in the tropical regions of the world. Due to increased international travel, the infection is now also seen outside of the tropics. The majority of patients with identified risk factors such as diabetes mellitus, heavy alcohol use, malignancy, chronic lung and kidney disease, corticosteroid use, thalassemia, rheumatic heart disease, systemic lupus erythematosus and cardiac ...

  6. CLINICAL AND MICROBIOLOGICAL STUDY OF OTOMYCOSIS : OUR EXPERIENCE

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    Venugopal

    2015-06-01

    Full Text Available Otomycosis is fungal infection of external auditory canal, which is common throughout the world. Otomycosis may be refractory to treatment prescribed and hence challenges the clinician. AIM: To identify the organism causing otomycosis and to explore speci fic predisposing factors and treatment. MATERIALS AND METHODS: This is a descriptive study of cases of otomycosis attending ENT outpatient department of Govt. Medical College, Thiruvananthapuram which were evaluated clinically and microbiologically for one year. RESULT AND CONCLUSION: The commonest predisposing factor for otomycosis is trauma due to self - cleaning and water entering the ear. Common in females. Common presentation is itching of ear and ear ache. Commonest organism isolated is Aspergillus Nige r. Usually respond to treatment with topical antifungal agent especially clotrimazole. Most of the cases responded satisfactorily with topical clotrimazole.

  7. Clinical management considerations for dyslipidemia in HIV-infected individuals.

    Science.gov (United States)

    Kirchner, Jeffrey T

    2012-01-01

    Dyslipidemia is common in patients with human immunodeficiency virus (HIV) and may result in significant morbidity, including coronary heart disease (CHD). Treatment of dyslipidemia in these patients is generally based on the National Cholesterol Education Program Adult Treatment Panel III goals for individuals without HIV. For individuals with ≥ 2 cardiovascular risk factors, the risk of CHD should be evaluated using the Framingham risk calculator and managed accordingly. Switching to an antiretroviral regimen with a favorable lipid profile should be considered before pharmacologic management if virologic suppression can be maintained. Statins are the first-choice therapy for elevated low-density lipoprotein cholesterol, but in HIV-infected individuals, special consideration must be given to drug-drug interactions, specifically those between protease inhibitors and statins. Management of dyslipidemia in HIV-infected individuals is a challenging but important aspect of chronic disease management. Additional research, specifically related to the role of chronic inflammation, is needed to better define the relationship between HIV infection and cardiovascular disease.

  8. INFECTIVE ENDOCARDITIS: AETIOLOGY, CLINICAL FEATURES, PRINCIPLES OF TREATMENT AND PREVENTION

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    Coralia Bleotu

    2012-03-01

    Full Text Available Infective endocarditis (IE is characterized by pathogen colonization and endocardium invasion, causing the formation of vegetations - amorphous aggregates, composed of platelets, fibrin, microorganisms and inflammatory cells. IE microbiological aspects are variable from country to country, reason for which, the purpose of this review was to integrate some original data concerning the etiology and antimicrobial resistance markers in microbial strains isolated from infections occurred in patients with underlying cardiovascular diseases in the general microbiological picture IE (i.e. diagnosis, etiology and treatment. In our hospital, the etiology of positive blood cultures and prosthetic devices associated infections occurred in patients with cardiovascular diseases is dominated by Gram-positive cocci, especially S. aureus and coagulase-negative staphylococci (CNS, followed by Gram-negative fermentative and non-fermentative bacilli. The major concerns regarding the resistance markers of the isolated strains are the methicillin and macrolides lincosamides streptogramines resistance exceeding 50%, both in S. aureus and CNS and the aminoglycosides high level resistance (30% in E. faecium strains.

  9. Dengue infection in children in Ratchaburi, Thailand: a cohort study. II. Clinical manifestations.

    Directory of Open Access Journals (Sweden)

    Chukiat Sirivichayakul

    Full Text Available BACKGROUND: Dengue infection is one of the most important mosquito-borne diseases. More data regarding the disease burden and the prevalence of each clinical spectrum among symptomatic infections and the clinical manifestations are needed. This study aims to describe the incidence and clinical manifestations of symptomatic dengue infection in Thai children during 2006 through 2008. STUDY DESIGN: This study is a school-based prospective open cohort study with a 9,448 person-year follow-up in children aged 3-14 years. Active surveillance for febrile illnesses was done in the studied subjects. Subjects who had febrile illness were asked to visit the study hospital for clinical and laboratory evaluation, treatment, and serological tests for dengue infection. The clinical data from medical records, diary cards, and data collection forms were collected and analyzed. RESULTS: Dengue infections were the causes of 12.1% of febrile illnesses attending the hospital, including undifferentiated fever (UF (49.8%, dengue fever (DF (39.3% and dengue hemorrhagic fever (DHF (10.9%. Headache, anorexia, nausea/vomiting and myalgia were common symptoms occurring in more than half of the patients. The more severe dengue spectrum (i.e., DHF had higher temperature, higher prevalence of nausea/vomiting, abdominal pain, rash, diarrhea, petechiae, hepatomegaly and lower platelet count. DHF cases also had significantly higher prevalence of anorexia, nausea/vomiting and abdominal pain during day 3-6 and diarrhea during day 4-6 of illness. The absence of nausea/vomiting, abdominal pain, diarrhea, petechiae, hepatomegaly and positive tourniquet test may predict non-DHF. CONCLUSION: Among symptomatic dengue infection, UF is most common followed by DF and DHF. Some clinical manifestations may be useful to predict the more severe disease (i.e., DHF. This study presents additional information in the clinical spectra of symptomatic dengue infection.

  10. Infection of commercial laying hens with Salmonella Gallinarum: clinical, anatomopathological and haematological studies

    Directory of Open Access Journals (Sweden)

    OC Freitas Neto

    2007-06-01

    Full Text Available This study aimed at evaluating the susceptibility of commercial laying hens to Salmonella Gallinarum (SG. Two experiments were carried using a mutant strain of Salmonella Gallinarum resistant to nalidix acid (SGNALr. In the first trial, the resistance of birds was evaluated based on clinical signs, faecal shedding, and mortality. It was carried out with six lines of commercial layers being three light white layers, considered to be resistant to SG (W1, W2, W3, and three semi-heavy brown varieties (B1, B2, B3, considered susceptible to SG. Each group contained 15 one-day-old birds. Hens were inoculated in the crop at 5 days of age with 0.2 mL of SGNALr neat culture. In addition, to each brown variety, a new group of 15 birds was challenged with 0.2mL of the same SGNALr culture diluted at 10-3. At the end of the first experiment, the surviving birds were sacrificed, and microbiological culture of liver and spleen was performed. In the second experiment, white and brown birds were inoculated with neat culture at five days of age. Samples were collected for evaluation of blood parameters and histopathology assessment at 1, 3, 5, 7, 9, 12, and 14 days post-infection. The results of the first experiment showed higher resistance of white birds (p<0.05, although there was no uniformity in the responses against fowl typhoid among the birds within these groups. In the second experiment, there were differences between white and brown birds both in blood parameters and in organ lesion intensity.

  11. Developing a leadership pipeline: the Cleveland Clinic experience.

    Science.gov (United States)

    Hess, Caryl A; Barss, Christina; Stoller, James K

    2014-11-01

    The complexity of health care requires excellent leadership to address the challenges of access, quality, and cost of care. Because competencies to lead differ from clinical or research skills, there is a compelling need to develop leaders and create a talent pipeline, perhaps especially in physician-led organizations like Cleveland Clinic. In this context, we previously reported on a cohort-based physician leadership development course called Leading in Health Care and, in the current report, detail an expanded health care leadership development programme called the Cleveland Clinic Academy (CCA). CCA consists of a broad suite of offerings, including cohort-based learning and 'a la carte' half- or full-day courses addressing specific competencies to manage and to lead. Academy attendance is optional and is available to all physicians, nurses, and administrators with the requisite experience. Course selection is guided by competency matrices which map leadership competencies to specific courses. As of December 2012, a total of 285 course sessions have been offered to 6,050 attendees with uniformly high ratings of course quality and impact. During the past 10 years, Cleveland Clinic's leadership and management curriculum has successfully created a pipeline of health care leaders to fill executive positions, search committees, board openings, and various other organizational leadership positions. Health care leadership can be taught and learned. PMID:25082312

  12. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management.

    Science.gov (United States)

    O'Driscoll, Tristan; Crank, Christopher W

    2015-01-01

    Since its discovery in England and France in 1986, vancomycin-resistant Enterococcus has increasingly become a major nosocomial pathogen worldwide. Enterococci are prolific colonizers, with tremendous genome plasticity and a propensity for persistence in hospital environments, allowing for increased transmission and the dissemination of resistance elements. Infections typically present in immunosuppressed patients who have received multiple courses of antibiotics in the past. Virulence is variable, and typical clinical manifestations include bacteremia, endocarditis, intra-abdominal and pelvic infections, urinary tract infections, skin and skin structure infections, and, rarely, central nervous system infections. As enterococci are common colonizers, careful consideration is needed before initiating targeted therapy, and source control is first priority. Current treatment options including linezolid, daptomycin, quinupristin/dalfopristin, and tigecycline have shown favorable activity against various vancomycin-resistant Enterococcus infections, but there is a lack of randomized controlled trials assessing their efficacy. Clearer distinctions in preferred therapies can be made based on adverse effects, drug interactions, and pharmacokinetic profiles. Although combination therapies and newer agents such as tedizolid, telavancin, dalbavancin, and oritavancin hold promise for the future treatment of vancomycin-resistant Enterococcus infections, further studies are needed to assess their possible clinical impact, especially in the treatment of serious infections. PMID:26244026

  13. Clinical, serological, and parasitological analysis of snakes naturally infected with Cryptosporidium serpentis.

    Science.gov (United States)

    Paiva, Philipp Ricardo S O; Grego, Kathleen F; Lima, Valéria M F; Nakamura, Alex A; da Silva, Deuvânia C; Meireles, Marcelo V

    2013-11-15

    Infection by Cryptosporidium serpentis is one of the most important diseases in reptiles and is characterized by chronic clinical or subclinical infection and the presence of hypertrophic gastritis, food regurgitation, progressive weight loss, mortality, and intermittent or continuous shedding of oocysts in the feces. The objectives of this study were to standardize an indirect enzyme-linked immunosorbent assay (ELISA) to detect antibodies against C. serpentis and to evaluate the clinical, parasitological, and humoral immune response in snakes naturally infected with C. serpentis. Twenty-one snakes naturally infected with C. serpentis and housed at the Butantan Institute, São Paulo, Brazil, underwent clinical and parasitological analyses for C. serpentis infection through daily records of clinical signs and a monthly survey of fecal shedding of oocysts using the Kinyoun's acid-fast staining. The serological evaluation was performed monthly by indirect ELISA using crude total antigen from oocysts of C. serpentis to detect anti-C. serpentis antibodies. Clinical symptoms consisted of food regurgitation, inappetence, and progressive weight loss. The parasitological analysis revealed intermittent fecal shedding of a variable number of oocysts in all snakes, with positivity in 85.32% (157/184) of the samples. The indirect ELISA was positive in 68.25% (86/126) of the samples. A humoral immune response was observed in most animals; however, fluctuating antibodies levels, leading to alternating positive and negative results, were observed in most snakes.

  14. Characterization of bacteriophages infecting clinical isolates of Pseudomonas aeruginosa stored in a culture collection

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    C.C.S. Zanetti

    2013-08-01

    Full Text Available Some clinical isolates of Pseudomonas aeruginosa stored in our culture collection did not grow or grew poorly and showed lysis on the culture plates when removed from the collection and inoculated on MacConkey agar. One hypothesis was that bacteriophages had infected and killed those clinical isolates. To check the best storage conditions to maintain viable P. aeruginosa for a longer time, clinical isolates were stored at various temperatures and were grown monthly. We investigated the presence of phage in 10 clinical isolates of P. aeruginosa stored in our culture collection. Four strains of P. aeruginosa were infected by phages that were characterized by electron microscopy and isolated to assess their ability to infect. The best condition to maintain the viability of the strains during storage was in water at room temperature. Three Siphoviridae and two Myoviridae phages were visualized and characterized by morphology. We confirmed the presence of bacteriophages infecting clinical isolates, and their ability to infect and lyse alternative hosts. Strain PAO1, however, did not show lysis to any phage. Mucoid and multidrug resistant strains of P. aeruginosa showed lysis to 50% of the phages tested.

  15. Clinical spectrum of hypopituitarism in India: A single center experience

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    Abhay Gundgurthi

    2012-01-01

    Full Text Available Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India. Materials and Methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations. Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 - 76 years. There were 78 (69% males and 35 females (31%. There were 22 subjects aged ≤18 years (childhood and adolescence and 91 adults (>18 years. Visual disturbances were the most common presenting complaint (33%, though headache was the most common symptom (81%. Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97% was the most common abnormality seen followed by hypothyroidism (83.2%, hypoadrenalism (79.6%, growth hormone deficiency (88.1% of the 42 patients tested, and diabetes insipidus (13.3%. Panhypopituitarism was seen in 104 (92% patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors. Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases.

  16. Clinical risk factors on survival among infected children born to HIV-positive mothers

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    S Chantutanon

    2012-11-01

    Full Text Available Objective: The aim of this study was to investigate clinical risk factors on survival among infected children born to HIV-positive mothers in the southern region of Thailand. Methods: Data from routine prospective cohort studies from 1990–2010 were analyzed. In these studies, totally 1549 infected children born to HIV-positive mothers were enrolled at birth and followed longitudinally. Information on demographic, clinical manifestation, HIV infection status factors was collected. Survival analysis was used to determine risk factors associated with mortality. Results: The main result found that one-quarter of infected children died (434, 28.02% during the follow-up period. A total of 135,295 person-months of follow up was available. The incident rate was 1.03 times per 100 person-months (95% CI: 0.97 to 1.08. The median survival time among infected children born to HIV-positive mothers from diagnosis to death was 87.34 months (95% CI: 87.32 to 87.36. Infected children born to HIV-infected mothers were diagnosed to confirm as AIDS (88.44% and symptomatic HIV positive (11.56%, respectively. Regarding the clinical risk factor on survival among infected children born to HIV-positive mothers were found. Infected children born to HIV-positive mothers were more likely to die, who infected with candidiasis (HR: 1.47, 95% CI: 1.07 to 2.00, Mycobacterium tuberculosis (HR: 1.51, 95% CI: 1.26 to 1.81 and Pneumocystis carinii (HR: 1.50, 95% CI: 1.27 to 1.76, those compared to infected children without clinical manifestation. Conclusion: Mortality among infected children born to HIV-positive mothers contributed to high levels in the southern region of Thailand. Consequently, health service system related to prevent mother-to-child HIV transmission is needed to improve child survival by lowering HIV infection and mortality in children born to HIV-positive mothers.

  17. Safety of cyclosporin A in HCV-infected patients: experience with cyclosporin A in patients affected by rheumatological disorders and concomitant HCV infection.

    Science.gov (United States)

    Galeazzi, Mauro; Bellisai, Francesca; Giannitti, Chiara; Manganelli, Stefania; Morozzi, Gabriella; Sebastiani, Gian Domenico

    2007-09-01

    Because of the relatively high prevalence of both hepatitis C virus (HCV) infection and autoimmune disorders (ADs), it is not rare to encounter in daily clinical practice patients with ADs also carrying HCV. Corticosteroids and/or immunosuppressant drugs are needed to treat ADs, but they place HCV-infected patients at risk of worsening the infection. So, rheumatologists have often refrained from using corticosteroids or immunosuppressants in AD when HCV-RNA is also present. Cyclosporin A (CsA) is an immunosuppressive agent used to treat a wide range of ADs, but there is a large evidences in the literature, both in vitro and in vivo, suggesting that CsA also exerts an inhibitory effect on HCV replication at standard therapeutic dose. Therefore, this evidence has opened new ways to improve the therapy and the prognosis in patients with HCV-related liver diseases, including those with transplants. Recent reports, although limited in number, also suggest the safety of CsA in the treatment of patients with AD and concomitant HCV infection. In this review we also report our personal experience on the combination treatment with CsA and anti-TNF-alpha agents in rheumatoid arthritis.

  18. Clinical and Pathologic Evaluation of Chronic Bartonella henselae or Bartonella clarridgeiae Infection in Cats

    OpenAIRE

    Kordick, Dorsey L.; Brown, Talmage T.; Shin, KwangOk; Edward B Breitschwerdt

    1999-01-01

    Human Bartonella infections result in diverse medical presentations, whereas many cats appear to tolerate chronic bacteremia without obvious clinical abnormalities. Eighteen specific-pathogen-free cats were inoculated with Bartonella henselae- and/or Bartonella clarridgeiae-infected cat blood and monitored for 454 days. Relapsing bacteremia did not correlate with changes in protein profiles or differences in antigenic protein recognition. Intradermal skin testing did not induce a delayed type...

  19. Zika virus and the risk of imported infection in returned travelers: Implications for clinical care.

    Science.gov (United States)

    Goorhuis, Abraham; von Eije, Karin J; Douma, Renée A; Rijnberg, Noor; van Vugt, Michele; Stijnis, Cornelis; Grobusch, Martin P

    2016-01-01

    Since late 2015, an unprecedented outbreak of Zika virus is spreading quickly across Southern America. The large size of the current outbreak in The Americas will also result in an increase in Zika virus infections among travelers returning from endemic areas. We report five cases of imported Zika virus infection to The Netherlands. Although the clinical course is usually mild, establishing the diagnosis is important, mainly because of the association with congenital microcephaly and the possibility of sexual transmission.

  20. Clinical characteristics, diagnostic evaluation, and antibiotic prescribing patterns for skin infections in nursing homes

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    Norihiro Yogo

    2016-07-01

    Full Text Available Background: The epidemiology and management of skin infections in nursing homes has not been adequately described. We reviewed the characteristics, diagnosis and treatment of skin infections among residents of nursing homes to identify opportunities to improve antibiotic use. Methods: A retrospective study involving 12 nursing homes in the Denver metropolitan area. For residents at participating nursing homes diagnosed with a skin infection between July 1, 2013 and June 30, 2014, clinical and demographic information was collected through manual chart review.Results: Of 100 cases included in the study, the most common infections were non-purulent cellulitis (n=55, wound infection (n=27, infected ulcer (n=8, and cutaneous abscess (n=7. In 26 cases, previously published minimum clinical criteria for initiating antibiotics (Loeb criteria were not met. Most antibiotics (n=52 were initiated as a telephone order following a call from a nurse, and 41 patients were not evaluated by a provider within 48 hours after initiation of antibiotics. Nearly all patients (n=95 were treated with oral antibiotics alone. The median treatment duration was 7 days (interquartile range [IQR] 7-10; 43 patients received treatment courses of ≥ 10 days.Conclusions: Most newly diagnosed skin infections in nursing homes were non-purulent infections treated with oral antibiotics. Antibiotics were initiated by telephone in over half of cases, and lack of a clinical evaluation within 48 hours after starting antibiotics was common. Improved diagnosis through more timely clinical evaluations and decreasing length of therapy are important opportunities for antibiotic stewardship in nursing homes.

  1. Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens.

    Science.gov (United States)

    Walker, Emily; Lyman, Alessandra; Gupta, Kalpana; Mahoney, Monica V; Snyder, Graham M; Hirsch, Elizabeth B

    2016-10-01

    Urinary tract infections (UTIs) are among the most commonly treated bacterial infections. Over the past decade, antimicrobial resistance has become an increasingly common factor in the management of outpatient UTIs. As treatment options for multidrug-resistant (MDR) uropathogens are limited, clinicians need to be aware of specific clinical and epidemiological risk factors for these infections. Based on available literature, the activity of fosfomycin and nitrofurantoin remain high for most cases of MDR Escherichia coli UTIs. Trimethoprim-sulfamethoxazole retains clinical efficacy, but resistance rates are increasing internationally. Beta-lactam agents have the highest rates of resistance and lowest rates of clinical success. Fluoroquinolones have high resistance rates among MDR uropathogens and are being strongly discouraged as first-line agents for UTIs. In addition to accounting for local resistance rates, consideration of patient risk factors for resistance and pharmacological principles will help guide optimal empiric treatment of outpatient UTIs.

  2. Salvage of Theileria infected calves with clinical manifestation of exophthalmia.

    Science.gov (United States)

    Singh, Shanker K; Sudan, Vikrant; Sachan, Pratibha; Srivastava, Ashish

    2015-09-01

    Two crossbred female calves aged between 30 and 35 days were presented with bilateral exophthalmia, inappetence, pyrexia and cachexia since last 15 days. Clinical examination revealed mainly bilateral exophthalmia with dry and pulpy cornea, generalized enlargement of superficial lymph nodes, pallor mucous, petechiae, high rectal temperature and sternal recumbency. The calves were severely infested with Hyalomma anatolicum anatolicum ticks and thin layer blood smears revealed presence of piroplasm in the RBCs, while lymph nodes aspirate smear examination revealed presence schizonts in the mononuclear cells. The calves were treated with buparvaquone; meloxicam, nandrolone decanoate and vitamins A, D3, E and H. From day second post-therapy a remarkable improvement in the clinical condition was noticed and substantial reduction in the both protruded eyeballs was noticed by 7 days post-therapy in the both calves. Further at day 47 post-therapy the one calf was free from the parasite on blood smear examination and right eye was retracted in its orbits with full of sight. Moreover the left eye was also retracted in its orbit but there was loss of sight and opacity developed in this eye. While, the other calf also revealed remarkable improvement in the clinical condition and both eye balls retracted completely into the orbit at day 30 post-therapy. But, at day 86 the calf developed microphthalmia and complete loss of sight in both eyes. It can be concluded that adjunction of antioxidants and hematopoietic agents may salvage the calves suffering from fatal theileriosis. PMID:26345050

  3. Clinical spectrum and outcome of pulmonary nocardiosis: 5-year experience

    Science.gov (United States)

    Singh, Akashdeep; Chhina, Deepinder; Soni, RK; Kakkar, Chandan; Sidhu, US

    2016-01-01

    Background: Pulmonary nocardiosis is a rare but a life-threatening infection caused by Nocardia spp. The diagnosis is often missed and delayed resulting in delay in appropriate treatment and thus higher mortality. Aim: In this study, we aim to evaluate the clinical spectrum and outcome of patients with pulmonary nocardiosis. Methods: A retrospective, 5-year (2009–2014) review of demographic profile, risk factors, clinical manifestations, imaging findings, treatment, and outcome of patients with pulmonary nocardiosis admitted to a tertiary care hospital. Results: The median age of the study subjects was 54 years (range, 16–76) and majority of them (75%) were males. The risk factors for pulmonary nocardiosis identified in our study were long-term steroid use (55.6%), chronic lung disease (52.8%), diabetes (27.8%), and solid-organ transplantation (22.2%). All the patients were symptomatic, and the most common symptoms were cough (91.7%), fever (78%), and expectoration (72%). Almost two-third of the patients were initially misdiagnosed and the alternative diagnosis included pulmonary tuberculosis (n = 7), community-acquired pneumonia (n = 5), lung abscess (n = 4), invasive fungal infection (n = 3), lung cancer (n = 2), and Wegener's granulomatosis (n = 2). The most common radiographic features were consolidation (77.8%) and nodules (56%). The mortality rate for indoor patients was 33% despite treatment. Higher mortality rate was observed among those who had brain abscess (100.0%), HIV positivity (100%), need for mechanical ventilation (87.5%), solid-organ transplantation (50%), and elderly (age > 60 years) patients (43%). Conclusion: The diagnosis of pulmonary nocardiosis is often missed and delayed resulting in delay in appropriate treatment and thus high mortality. A lower threshold for diagnosing pulmonary nocardiosis needs to be exercised, in chest symptomatic patients with underlying chronic lung diseases or systemic immunosuppression, for the early diagnosis

  4. Running a postmortem service - a business case and clinical experience

    International Nuclear Information System (INIS)

    The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia. (orig.)

  5. Running a postmortem service - a business case and clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, Marta C.; Whitby, Elspeth; Fink, Michelle A.; Collett, Jacquelene M.; Offiah, Amaka C. [Western Bank, Academic Unit of Child Health, Sheffield Children' s NHS Foundation Trust, University of Sheffield, Sheffield (United Kingdom)

    2015-04-01

    The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia. (orig.)

  6. Dengue infection in children and adolescents: Clinical profile in a reference hospital in northeast Brazil

    Directory of Open Access Journals (Sweden)

    Roberto da Justa Pires Neto

    2013-12-01

    Full Text Available Introduction This study aimed to describe the clinical spectrum of dengue in children and adolescents from a hyperendemic region who were admitted for hospitalization. Methods A retrospective study was conducted on patients diagnosed with dengue infection upon admission to a reference center in Fortaleza, Brazil. Results Of the 84 patients included, 42 underwent confirmatory testing. The main symptoms were fever, abdominal pain and vomiting. The median level of serum aspartate aminotransferase was 143.5±128mg/dL. Conclusions A peculiar clinical profile was evident among children and adolescents with dengue infection in a reference center in northeast Brazil, including gastrointestinal symptoms and liver involvement.

  7. Clinicians’ experiences of becoming a clinical manager: a qualitative study

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    Spehar Ivan

    2012-11-01

    Full Text Available Abstract Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers

  8. European AIDS Clinical Society (EACS) guidelines for the clinical management and treatment of HIV-infected adults

    DEFF Research Database (Denmark)

    Clumeck, N; Pozniak, A; Raffi, F;

    2008-01-01

    A working group of the European AIDS Clinical Society (EACS) have developed these guidelines for European clinicians to help them in the treatment of adults with HIV infection. This third version of the guidelines includes, as new topics, the assessment of patients at initial and subsequent clinic...... visits as well as post-exposure prophylaxis. A revision of the 2005 guidelines based on current data includes changes in the sections on primary HIV infection, when to initiate therapy, which drug combinations are preferred as initial combination regimens for antiretroviral-naïve patients, how to manage...... country to another, especially in Central and Eastern parts of Europe. These guidelines are intended to help clinicians achieve the best care for their patients. In some countries, particularly where the quality of and access to care are not optimal, these guidelines should help AIDS societies...

  9. CLINICAL STUDY AND MANAGEMENT OF INCISIONAL HERNIAS: OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Narayanaswamy

    2013-11-01

    Full Text Available ABSTRACT: BACKGROUND: Incisional hernia, by definition represents a breakdown or loss of continuity of a fascial closure. Surgical management of incision al hernias has evolved over the last century. This study was performed to review clinical profile and management of incisional hernia in our institute. AIMS AND OBJECTIVES: To analyze the etiopathogenesis of incisional hernia with respect to patient variab le factors, types of surgical intervention. MATERIALS AND METHODS: This a prospective study conducted at our institute between February 2009 and January 2011(24 months. 100 patients were included and followed up for immediate post - operative complications. OBSERVATIONS AND RESULTS: Incisional hernia was found to occur more often in 31 - 40yr age group,and mostly in females. Most commonly occurred following gynecological operations, lower abdominal incisions, post operative wound infection. Most patients notic ed the incisional hernia only 1 to 5 years after the index surgery. Laparoscopic hernioplasty was the most commonly performed surgery. CONCLUSION: In Incisional hernias the choice of operative technique is crucial Incisional hernias occur more often in fem ales as they are more likely to undergo lower abdominal surgeries. Mesh repair is considered superior to anatomical repair alone and we recommend Laparoscopic Hernioplasty as the first line of treatment. KEYWORDS : Incisional hernia, ventral hernia, post op erative hernia, mesh repair,Laparoscopic Hernioplasty

  10. General Practitioners’ responses to global climate change - lessons from clinical experience and the clinical method

    Directory of Open Access Journals (Sweden)

    Blashki Grant

    2012-08-01

    Full Text Available Abstract Background Climate change is a global public health problem that will require complex thinking if meaningful and effective solutions are to be achieved. In this conceptual paper we argue that GPs have much to bring to the issue of climate change from their wide-ranging clinical experience and from the principles underpinning their clinical methods. This experience and thinking calls forth particular contributions GPs can and should make to debate and action. Discussion We contend that the privileged experience and GP way of thinking can make valuable contributions when applied to climate change solutions. These include a lifetime of experience, reflection and epistemological application to first doing no harm, managing uncertainty, the ability to make necessary decisions while possessing incomplete information, an appreciation of complex adaptive systems, maintenance of homeostasis, vigilance for unintended consequences, and an appreciation of the importance of transdisciplinarity and interprofessionalism. Summary General practitioners have a long history of public health advocacy and in the case of climate change may bring a way of approaching complex human problems that could be applied to the dilemmas of climate change.

  11. Spontaneous elimination of hepatitis C virus infection: A retrospective study on demographic, clinical, and serological correlates

    Institute of Scientific and Technical Information of China (English)

    Perdita Wietzke-Braun; Larissa Bettina M(a)nhardt; Albert Rosenberger; Angela Uy; Giuliano Ramadori; Sabine Mihm

    2007-01-01

    AIM: To find correlates to spontaneous clearance of hepatitis C virus (HCV) infection, this study compared individuals with self-limited and chronic infection with regard to clinical, demographic, and serological parameters.METHODS: Sixty-seven anti-HCV positive and repeatedly HCV RNA negative individuals were considered to have resolved HCV infection spontaneously. To determine the viral genotype these patients had been infected with HCV serotyping was performed. For comparison reasons,62 consecutive patients with chronic hepatitis C were enrolled. Cases and controls were compared stratified for age and sex.RESULTS: Retrospective analysis showed (1) a lower humoral reactivity to HCV in patients with self-limited compared to chronic HCV-infection and (2) that younger age, history of iv drug use, and acute/post-acute hepatitis A or B co-infections, but not viral genotypes,are independent correlates for spontaneous HCV clearance.CONCLUSION: The stronger humoral reactivity to HCV in patients with persistent infections and in those with a history of iv drug use is supposed to be due to continuous or repeated contact(s) to the antigen.Metachronous hepatitis A or hepatitis B infections might favor HCV clearance.

  12. Clinical and Morphological Studies on Spontaneous Cases of Pseudomonas aeruginosa Infections in Birds

    Directory of Open Access Journals (Sweden)

    I Dinev1, S Denev2* and G Beev2

    2013-07-01

    Full Text Available Clinical, pathoanatomical, histological, and bacteriological studies were performed on broiler chickens, growing broiler parents, and growing egg layers, in three different poultry farms, after an outbreak of Pseudomonas aeruginosa infections. The method of contamination of the birds was established. Several local and systemic clinico-morphological forms of spontaneous P. aeruginosa infections in various categories of stock birds were described: cases of P. aeruginosa infection resulting from injection of contaminated vaccines; case of P. aeruginosa infections through contaminated aerosol vaccine and cases of pododermatitis, periarthritis and arthritis in broiler chickens associated with P. aeruginosa infection. In different cases mortality range between 0.5 and 50%. The results showed that apart from embryonic mortality in hatcheries, and septicemic infections in newly hatched chickens, the pathogenicity of P. aeruginosa was associated with localized and systemic lesions in this category, as well as in young and growing birds. On one hand, these results have a theoretical significance, contributing for the confirmation and expansion of the wide array of clinico-morphological forms of P. aeruginosa infections in birds. On the other hand, the knowledge on these forms has a purely practical significance in the diagnostics of P. aeruginosa infections by poultry pathologists and veterinary practitioners.

  13. Psychometric validation of satisfaction with simulated clinical learning experience evaluation – corrections (SSCLEE-C

    Directory of Open Access Journals (Sweden)

    Desiree A. Díaz

    2016-03-01

    Originality/value: The Satisfaction with Simulated Clinical Learning Experience Evaluation – Corrections (SSCLEE-C is the only instrument available for ongoing assessment of correctional nurse satisfaction with simulated clinical learning experiences.

  14. The clinical importance of sweat chloride levels in children with repeated pulmonary infection or growth retardation

    Directory of Open Access Journals (Sweden)

    Enver Sancakdar

    2013-06-01

    Full Text Available Aim. Cystic fibrosis occurs as a consequence of mutations in the gene regulation of transmembrane message and shows autosomal recessive inheritance. The disease is more frequent among white people; Clinical findings and symptoms in cystic fibrosis can be very different due to the age of patients, type of mutation and complications. In our country, the most common complaints of cystic fibrosis patients in application to hospital are problems in respiratory tract and growth retardation. In this study, we aimed to findhe frequency of cystic fibrosis in children who applied to our clinic with growth retardation and/or recurrent pulmonary infections. Method. This prospective study was conducted between September 2009 and September 2010 in 218 children who applied to our clinic with symptoms of malnutrition and/or recurrent pulmonary infections and had not been diagnosed as cystic fibrosis before. These patients underwent sweat test and their clinical chracteristics were noted. The diagnosis of cystic fibrosis was made by using positive sweat test , appropriate clinical findings and by exclusion of other diseases that also cause recurrent pulmonary infections or malnutrition. Results. The mean age of children was 54.40 ± 48.70 months. Of all children, 100 (45.9% were male and 118 (54.1% were female. Positive sweat test was found in 9 (4.2% children. The frequency of cystic fibrosis was found to be 7.8% in children with recurrent pulmonary infections and 10.5% in children with weight percentile values <3 p. and 9.3% in children with height percentile values <3 p. Conclusion. Sweat test is clinically important for the early diagnosis of cystic fibrosis and in prevention of complications related to this disease in children with growth retardation or recurrent pulmonary infections.

  15. Correlation between Demographics, Clinical and Risk Factor for HIV infection with HIV/TB coinfected in Amertha Clinic Kerti Praja Foundation Denpasar

    OpenAIRE

    Yuneti Octavianus Nyoko

    2015-01-01

    Background and purpose: HIV infection increases the risk of developing tuberculosis (TB), as TB infection increases the progression of HIV. In Bali, HIV/TB coinfected patients have increased from 26% in 2012 to 30% in 2013. Study on factors related with the occurrence of HIV/TB coinfection is limited in Indonesia. This study aims to determine the correlation between demographics, clinical and risk factor for HIV infected with HIV/TB coinfected in Amertha Clinic Kerti Praja Foundation Bali.Met...

  16. BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection.

    Science.gov (United States)

    Vigil, Darlene; Konstantinov, Nikifor K; Barry, Marc; Harford, Antonia M; Servilla, Karen S; Kim, Young Ho; Sun, Yijuan; Ganta, Kavitha; Tzamaloukas, Antonios H

    2016-09-24

    Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy (BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research.

  17. BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection

    Science.gov (United States)

    Vigil, Darlene; Konstantinov, Nikifor K; Barry, Marc; Harford, Antonia M; Servilla, Karen S; Kim, Young Ho; Sun, Yijuan; Ganta, Kavitha; Tzamaloukas, Antonios H

    2016-01-01

    Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy (BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research. PMID:27683628

  18. Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice

    Science.gov (United States)

    Pannek, Juergen

    2011-01-01

    Objectives To investigate current clinical practice in the treatment of urinary tract infections (UTIs) in persons with spinal cord injury (SCI) in SCI centers where German is spoken and to compare it with current guidelines and evidence-based standards evaluated by a literature review. Methods A standardized questionnaire was mailed to 16 SCI rehabilitation centers. The results were compared with a literature review Results Of the 16 centers, 13 responded. Indications for UTI treatment, medications, and treatment duration differed substantially among the individual centers and from the existing guidelines. Antibiotic treatment is regarded as the method of choice. Compared with the existing literature, patients in two center were undertreated, whereas they were overtreated in seven centers. Conclusion Even in specialized centers, treatment of UTI in patients with SCI is based more on personal experience of the treating physicians than on published evidence. This may at least partly be due to the paucity of evidence-based data. The observed tendency toward overtreatment with antibiotics carries substantial future risks, as this strategy may well lead to the induction of multiresistant bacterial strains. Therefore, developing guidelines would be an important step toward a unification of the different treatment strategies, thus reducing unnecessary antibiotic treatment. Furthermore, evidence-based studies evaluating the success of antibiotic treatment as well as the usefulness of alternative strategies are urgently needed. PMID:21528621

  19. Virus and host factors affecting the clinical outcome of Bluetongue Virus infection

    NARCIS (Netherlands)

    Caporale, M.; Gialleonorado, L.; Janowicz, A.; Wilkie, G.; Shaw, A.; Savini, G.; Rijn, van P.A.; Mertens, P.; Ventura, M.; Palmarini, M.

    2014-01-01

    Bluetongue is a major infectious disease of ruminants caused by bluetongue virus (BTV), an arbovirus transmitted by Culicoides. Here, we assessed virus and host factors influencing the clinical outcome of BTV infection using a single experimental framework. We investigated how mammalian host species

  20. Cyanoacrylate Skin Microsealant for Preventing Surgical Site Infection after Vascular Surgery : A Discontinued Randomized Clinical Trial

    NARCIS (Netherlands)

    Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

    2014-01-01

    Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a cy

  1. A Randomized Clinical Trial of Alternative Stress Management Interventions in Persons with HIV Infection

    Science.gov (United States)

    McCain, Nancy L.; Gray, D. Patricia; Elswick, R. K., Jr.; Robins, Jolynne W.; Tuck, Inez; Walter, Jeanne M.; Rausch, Sarah M.; Ketchum, Jessica McKinney

    2008-01-01

    Research in psychoneuroimmunology suggests that immunosuppression associated with perceived stress may contribute to disease progression in persons with HIV infection. While stress management interventions may enhance immune function, few alternative approaches have yet been tested. This randomized clinical trial was conducted to test effects of…

  2. Clinical diagnosis of influenza virus infection : evaluation of diagnostic tools in general practice

    NARCIS (Netherlands)

    van Elden, LJR; van Essen, GA; Boucher, CAB; van Loon, AM; Nijhuis, M; Schipper, P; Verheij, TJM; Hoepelman, IM

    2001-01-01

    Background: With the development of new antiviral agents for influenza, the urge for rapid and reliable diagnosis of influenza becomes increasingly important. Respiratory virus infections are difficult to distinguish on clinical grounds General practitioners (GPs) however still depend on their clini

  3. Dasatinib first-line: Multicentric Italian experience outside clinical trials.

    Science.gov (United States)

    Breccia, Massimo; Stagno, Fabio; Luciano, Luigiana; Abruzzese, Elisabetta; Annunziata, Mario; D'Adda, Mariella; Maggi, Alessandro; Sgherza, Nicola; Russo-Rossi, Antonella; Pregno, Patrizia; Castagnetti, Fausto; Iurlo, Alessandra; Latagliata, Roberto; Cedrone, Michele; Di Renzo, Nicola; Sorà, Federica; Rege-Cambrin, Giovanna; La Nasa, Giorgio; Scortechini, Anna Rita; Greco, Giovanna; Franceschini, Luca; Sica, Simona; Bocchia, Monica; Crugnola, Monica; Orlandi, Esther; Guarini, Attilio; Specchia, Giorgina; Rosti, Gianantonio; Saglio, Giuseppe; Alimena, Giuliana

    2016-01-01

    Dasatinib was approved for the treatment of chronic phase (CP) chronic myeloid leukemia (CML) patients in first line therapy based on the demonstration of efficacy and safety reported in patients enrolled in clinical trials. We describe a multicentric Italian "real-life" experience of dasatinib used as frontline treatment outside clinical trials. One hundred and nine patients (median age 54 years) were treated from January 2012 to December 2013. Increased incidence of high risk patients were detected according to stratification (26% according to Sokal score, 19% according to Euro score and 16% according to EUTOS) when compared to company sponsored studies. Median time from diagnosis to start of dasatinib was 18 days. Ten patients received unscheduled starting dose (6 patients 50mg and 4 patients 80 mg QD), whereas 99 patients started with 100mg QD. At 3 months, 92% of patients achieved a BCR-ABL ratio less than 10%. At 6 months, the rate of CCyR was 91% and the rate of MR3 was 40%, with 8% of the patients reaching MR4.5. Ninety-three patients were evaluable at 12 months: the rate of MR3 was 62%, with MR4.5 being achieved by 19% of the patients. At a median follow-up of 12 months, 27 patients (24.7%) were receiving the drug at reduced dose. Two patients (1.8%) experienced a lymphoid blast crisis and the overall incidence of resistance was 8%. As regards safety, the major side effects recorded were thrombocytopenia, neutropenia and pleural effusions, which occurred in 22%, 10% and 8% of patients, respectively. Present results, achieved in a large cohort of patients treated outside clinical trials, further confirm the efficacy and safety of dasatinib as firstline treatment in CML. PMID:26643920

  4. Clinical experience of medical students at university sains malaysia.

    Science.gov (United States)

    Quah, B S; Malik, A S; Simpson, H

    2000-01-01

    Experience of acute medical, surgical conditions, and clinical procedures of undergraduate students were assessed via a questionnaire survey during the final week of the 1993/1998 programme at the School of Medical Sciences, Univestiti Sains Malaysia. Individual performances were assessed by a scoring system. One hundred and twenty four students responded, (response rate 97%). More than 90% had seen myocardial infarction, cerebrovascular accident, pneumonia, respiratory distress, gastroenteritis, coma, and snake bite. Less than 33% had witnessed acute psychosis, diabetic ketoacidosis, acute hepatic failure, status epilepticus, near drowning, hypertensive encephalopathy, acute haemolysis or child abuse.Acute surgical/obstetrics cases, seen by >90% students, included fracture of long bones, head injury, acute abdominal pain, malpresentation and foetal distress. Less than 33% had observed epistaxis, sudden loss of vision, peritonitis or burns. Among operations only herniorrhaphy, Caesarian section, internal fixation of fracture and cataract extraction were seen by >80% students. The main deficits in clinical procedures are in rectal and vaginal examinations, urine collection and microscopic examinations. The performance of individual students, assessed by a scoring system, showed 15 students had unacceptably low scores (181.4/230, 70%) and 5 had superior scores (197.6/230, 80%). PMID:22844212

  5. Dabigatran in Secondary Stroke Prevention: Clinical Experience with 106 Patients

    Directory of Open Access Journals (Sweden)

    Alicia DeFelipe-Mimbrera

    2014-01-01

    Full Text Available Introduction. Our aim was to analyze our clinical experience with dabigatran etexilate in secondary stroke prevention. Methods. We retrospectively included patients starting dabigatran etexilate for secondary stroke prevention from March 2010 to December 2012. Efficacy and safety variables were registered. Results. 106 patients were included, median follow-up of 12 months (range 1–31. Fifty-six females (52.8%, mean age 76.4 (range 50–95, SD 9.8, median CHADS2 4 (range 2–6, CHA2DS2-VASc 5 (range 2–9, and HAS-BLED 2 (range 1–5. Indication for dabigatran etexilate was ischemic stroke in 101 patients and acute cerebral hemorrhage (CH due to warfarin in 5 (4.7%. Dabigatran etexilate 110 mg bid was prescribed in 71 cases (67% and 150 mg bid was prescribed in the remaining. Seventeen patients (16% suffered 20 complications during follow-up. Ischemic complications (10 were 6 transient ischemic attacks (TIA, 3 ischemic strokes, and 1 acute coronary syndrome. Hemorrhagic complications (10 were CH (1, gastrointestinal bleeding (6, mild hematuria (2, and mild metrorrhagia (1, leading to dabigatran etexilate discontinuation in 3 patients. Patients with previous CH remained uneventful. Three patients died (pneumonia, congestive heart failure, and acute cholecystitis and 9 were lost during follow-up. Conclusions. Dabigatran etexilate was safe and effective in secondary stroke prevention in clinical practice, including a small number of patients with previous history of CH.

  6. Medical academia clinical experiences of Ward Round Teaching curriculum

    Directory of Open Access Journals (Sweden)

    Fariba Haghani

    2014-01-01

    Full Text Available Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members′ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9. Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation.Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability were employed (Guba and Lincoln. Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1 tangible teachings (analytic intelligence, technical intelligence, legal duties and (2 implied teachings (professionalism, professional discipline, professional difficulties. Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

  7. Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults.

    Directory of Open Access Journals (Sweden)

    Vernon J Lee

    Full Text Available BACKGROUND: Dengue and chikungunya are co-circulating vector-borne diseases with substantial overlap in clinical presentations. It is important to differentiate between them during first presentation as their management, especially for dengue hemorrhagic fever (DHF, is different. This study compares their clinical presentation in Singapore adults to derive predictors to assist doctors in diagnostic decision-making. METHODS: We compared 117 patients with chikungunya infection diagnosed with reverse transcription-polymerase chain reaction (RT-PCR with 917 dengue RT-PCR-positive adult patients (including 55 with DHF. We compared dengue fever (DF, DHF, and chikungunya infections by evaluating clinical characteristics of dengue and chikungunya; developing classification tools via multivariate logistic regression models and classification trees of disease etiology using clinical and laboratory factors; and assessing the time course of several clinical variables. FINDINGS: At first presentation to hospital, significantly more chikungunya patients had myalgia or arthralgia, and fewer had a sore throat, cough (for DF, nausea, vomiting, diarrhea, abdominal pain, anorexia or tachycardia than DF or DHF patients. From the decision trees, platelets <118 × 10(9/L was the only distinguishing feature for DF versus chikungunya with an overall correct classification of 89%. For DHF versus chikungunya using platelets <100 × 10(9/L and the presence of bleeding, the overall correct classification was 98%. The time course analysis supported platelet count as the key distinguishing variable. INTERPRETATION: There is substantial overlap in clinical presentation between dengue and chikungunya infections, but simple clinical and laboratory variables can predict these infections at presentation for appropriate management.

  8. Clinical features of bacterial vaginosis in a murine model of vaginal infection with Gardnerella vaginalis.

    Directory of Open Access Journals (Sweden)

    Nicole M Gilbert

    Full Text Available Bacterial vaginosis (BV is a dysbiosis of the vaginal flora characterized by a shift from a Lactobacillus-dominant environment to a polymicrobial mixture including Actinobacteria and gram-negative bacilli. BV is a common vaginal condition in women and is associated with increased risk of sexually transmitted infection and adverse pregnancy outcomes such as preterm birth. Gardnerella vaginalis is one of the most frequently isolated bacterial species in BV. However, there has been much debate in the literature concerning the contribution of G. vaginalis to the etiology of BV, since it is also present in a significant proportion of healthy women. Here we present a new murine vaginal infection model with a clinical isolate of G. vaginalis. Our data demonstrate that this model displays key features used clinically to diagnose BV, including the presence of sialidase activity and exfoliated epithelial cells with adherent bacteria (reminiscent of clue cells. G. vaginalis was capable of ascending uterine infection, which correlated with the degree of vaginal infection and level of vaginal sialidase activity. The host response to G. vaginalis infection was characterized by robust vaginal epithelial cell exfoliation in the absence of histological inflammation. Our analyses of clinical specimens from women with BV revealed a measureable epithelial exfoliation response compared to women with normal flora, a phenotype that, to our knowledge, is measured here for the first time. The results of this study demonstrate that G. vaginalis is sufficient to cause BV phenotypes and suggest that this organism may contribute to BV etiology and associated complications. This is the first time vaginal infection by a BV associated bacterium in an animal has been shown to parallel the human disease with regard to clinical diagnostic features. Future studies with this model should facilitate investigation of important questions regarding BV etiology, pathogenesis and

  9. Traumatic effects of political repression in Chile: a clinical experience.

    Science.gov (United States)

    Cordal, Margarita Díaz

    2005-10-01

    The author examines psychic trauma resulting from human rights violations in Chile. Starting from trauma theories developed by authors such as Ferenczi, Winnicott and Stolorow, she posits the relevance of the subject's emotionally significant environment in the production of the traumatic experience. She describes the characteristics of the therapeutic process on the basis of a clinical case. She emphasizes the need to recognize the damage that may be produced within the reliable link between patient and analyst, pointing out the risk of retraumatization if analysts distance themselves and apply 'technique' rigorously, leaving out their own subjective assessments. Therapists must maintain their focus on the conjunction of the patient's intersubjective context and inner psychic world both when exploring the origin of the trauma and when insight is produced. The author posits repetition in the transference as an attempt at reparation, at finding the expected response from the analyst that will help patients assemble the fragments of their history and achieve, as Winnicott would put it, a feeling of continuity in the experience of being.

  10. Perceptions and Experiences of Human Papillomavirus (HPV) Infection and Testing among Low-Income Mexican Women

    Science.gov (United States)

    León-Maldonado, Leith; Wentzell, Emily; Brown, Brandon; Allen-Leigh, Betania; Torres-Ibarra, Leticia; Salmerón, Jorge; Billings, Deborah L.; Thrasher, James F.; Lazcano-Ponce, Eduardo

    2016-01-01

    Background HPV infection causes cervical cancer, a major contributor to morbidity and mortality among low-income Mexican women. Human papillomavirus (HPV) DNA testing is now a primary screening strategy in Mexico’s early cervical cancer detection program (ECDP). Research on Mexican women’s perceptions of HPV and testing is necessary for establishing culturally appropriate protocols and educational materials. Here, we explore perceptions about HPV and HPV-related risk factors among low-income Mexican ECDP participants. Methods We conducted semi-structured interviews with 24 ECDP participants from two primary care health clinics in Michoacán state, Mexico. Interviews addressed women’s understandings of and experiences with HPV and HPV testing. Analysis was inductive and guided by the Health Belief Model with a focus on gender. Results Women’s confusion about HPV and HPV screening caused emotional distress. They understood HPV to be a serious disease that would always cause severe symptoms, often characterizing it as analogous to HIV or inevitably carcinogenic. Women also attributed it to men’s sexual behaviors, specifically infidelity and poor hygiene. Women described both sexes’ desire for sex as natural but understood men’s negative practices of masculinity, like infidelity, as the causes of women’s HPV infection. Some women believed dirty public bathrooms or heredity could also cause HPV transmission. Conclusions These results are consistent with prior findings that geographically and economically diverse populations lack clear understandings of the nature, causes, or symptoms of HPV, even among those receiving HPV testing. Our findings also reveal that local cultural discourse relating to masculinity, along with failure to provide sufficient education to low-income and indigenous-language speaking patients, exacerbate women’s negative emotions surrounding HPV testing. While negative emotions did not deter women from seeking testing, they could

  11. Perceptions and Experiences of Human Papillomavirus (HPV Infection and Testing among Low-Income Mexican Women.

    Directory of Open Access Journals (Sweden)

    Leith León-Maldonado

    Full Text Available HPV infection causes cervical cancer, a major contributor to morbidity and mortality among low-income Mexican women. Human papillomavirus (HPV DNA testing is now a primary screening strategy in Mexico's early cervical cancer detection program (ECDP. Research on Mexican women's perceptions of HPV and testing is necessary for establishing culturally appropriate protocols and educational materials. Here, we explore perceptions about HPV and HPV-related risk factors among low-income Mexican ECDP participants.We conducted semi-structured interviews with 24 ECDP participants from two primary care health clinics in Michoacán state, Mexico. Interviews addressed women's understandings of and experiences with HPV and HPV testing. Analysis was inductive and guided by the Health Belief Model with a focus on gender.Women's confusion about HPV and HPV screening caused emotional distress. They understood HPV to be a serious disease that would always cause severe symptoms, often characterizing it as analogous to HIV or inevitably carcinogenic. Women also attributed it to men's sexual behaviors, specifically infidelity and poor hygiene. Women described both sexes' desire for sex as natural but understood men's negative practices of masculinity, like infidelity, as the causes of women's HPV infection. Some women believed dirty public bathrooms or heredity could also cause HPV transmission.These results are consistent with prior findings that geographically and economically diverse populations lack clear understandings of the nature, causes, or symptoms of HPV, even among those receiving HPV testing. Our findings also reveal that local cultural discourse relating to masculinity, along with failure to provide sufficient education to low-income and indigenous-language speaking patients, exacerbate women's negative emotions surrounding HPV testing. While negative emotions did not deter women from seeking testing, they could be ameliorated with better health

  12. Occult hepatitis B virus infection: A complex entity with relevant clinical implications

    Institute of Scientific and Technical Information of China (English)

    Juan Ramon Larrubia

    2011-01-01

    Occult hepatitis B virus (HBV) infection is a world-wide entity, following the geographical distribution of detectable hepatitis B. This entity is defined as the persistence of viral genomes in the liver tissue and in some instances also in the serum, associated to negative HBV surface antigen serology. The molecular basis of the occult infection is related to the life cycle of HBV, which produces a covalently closed circular DNA that persists in the cell nuclei as an episome, and serves as a template for gene transcription. The mechanism responsible for the HBsAg negative status in occult HBV carriers is a strong suppression of viral replication, probably due to the host's immune response, co-infection with other infectious agents and epigenetic factors. There is emerging evidence of the potential clinical relevance of occult HBV infection, since this could be involved in occult HBV transmission through orthotopic liver transplant and blood transfusion, reactivation of HBV infection during immunosuppression, impairing chronic liver disease outcome and acting as a risk factor for hepatocellular carcinoma. Therefore it is important to bear in mind this entity in cryptogenetic liver diseases, hepatitis C virus/HIV infected patients and immunosupressed individuals.It is also necessary to increase our knowledge in this fascinating field to define better strategies to diagnose and treat this infection.

  13. Predictors for casual sex and/or infection among sexually transmitted disease clinic attendees in China

    OpenAIRE

    Lu, F.; Jia, Y.; Bin, S; C Li; Limei, S; Kristensen, S.; X. Sun; Xiao, Y.; Liu, J; Li, D.; Qu, S.; Vermund, S H

    2009-01-01

    To assess the risk factors for casual sex and infections among the sexually transmitted disease (STD) clinic attendees in two disparate Chinese cities, an STD clinic-based cross-sectional study was conducted to provide demographic and sexual behaviour information. Participants were recruited from nine STD clinics selected by mapping strategy. STD prevalence was 69.4% (68.6% of men and 65.2% of women). The most common diagnoses were non-gonococcal urethritis (22.2%), genital warts (13.2%), syp...

  14. Congenital cytomegalovirus infection in pregnancy: a review of prevalence, clinical features, diagnosis and prevention.

    Science.gov (United States)

    Naing, Zin W; Scott, Gillian M; Shand, Antonia; Hamilton, Stuart T; van Zuylen, Wendy J; Basha, James; Hall, Beverly; Craig, Maria E; Rawlinson, William D

    2016-02-01

    Human cytomegalovirus (CMV) is under-recognised, despite being the leading infectious cause of congenital malformation, affecting ~0.3% of Australian live births. Approximately 11% of infants born with congenital CMV infection are symptomatic, resulting in clinical manifestations, including jaundice, hepatosplenomegaly, petechiae, microcephaly, intrauterine growth restriction and death. Congenital CMV infection may cause severe long-term sequelae, including progressive sensorineural hearing loss and developmental delay in 40-58% of symptomatic neonates, and ~14% of initially asymptomatic infected neonates. Up to 50% of maternal CMV infections have nonspecific clinical manifestations, and most remain undetected unless specific serological testing is undertaken. The combination of serology tests for CMV-specific IgM, IgG and IgG avidity provide improved distinction between primary and secondary maternal infections. In pregnancies with confirmed primary maternal CMV infection, amniocentesis with CMV-PCR performed on amniotic fluid, undertaken after 21-22 weeks gestation, may determine whether maternofetal virus transmission has occurred. Ultrasound and, to a lesser extent, magnetic resonance imaging are valuable tools to assess fetal structural and growth abnormalities, although the absence of fetal abnormalities does not exclude fetal damage. Diagnosis of congenital CMV infection at birth or in the first 3 weeks of an infant's life is crucial, as this should prompt interventions for prevention of delayed-onset hearing loss and neurodevelopmental delay in affected infants. Prevention strategies should also target mothers because increased awareness and hygiene measures may reduce maternal infection. Recognition of the importance of CMV in pregnancy and in neonates is increasingly needed, particularly as therapeutic and preventive interventions expand for this serious problem. PMID:26391432

  15. Digital breast tomosynthesis (DBT): initial experience in a clinical setting

    International Nuclear Information System (INIS)

    false-positive findings. The side-by-side feature analysis showed higher conspicuity scores for tomosynthesis compared to conventional 2D for cancers presenting as spiculated masses and distortions. Conclusion: Tomosynthesis is a promising new technique. Our preliminary clinical experience shows that there is a potential for increasing the sensitivity using this new technique, especially for cancers manifesting as spiculated masses and distortions

  16. A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection.

    Science.gov (United States)

    Kestle, John R W; Holubkov, Richard; Douglas Cochrane, D; Kulkarni, Abhaya V; Limbrick, David D; Luerssen, Thomas G; Jerry Oakes, W; Riva-Cambrin, Jay; Rozzelle, Curtis; Simon, Tamara D; Walker, Marion L; Wellons, John C; Browd, Samuel R; Drake, James M; Shannon, Chevis N; Tamber, Mandeep S; Whitehead, William E

    2016-04-01

    OBJECT In a previous report by the same research group (Kestle et al., 2011), compliance with an 11-step protocol was shown to reduce CSF shunt infection at Hydrocephalus Clinical Research Network (HCRN) centers (from 8.7% to 5.7%). Antibiotic-impregnated catheters (AICs) were not part of the protocol but were used off protocol by some surgeons. The authors therefore began using a new protocol that included AICs in an effort to reduce the infection rate further. METHODS The new protocol was implemented at HCRN centers on January 1, 2012, for all shunt procedures (excluding external ventricular drains [EVDs], ventricular reservoirs, and subgaleal shunts). Procedures performed up to September 30, 2013, were included (21 months). Compliance with the protocol and outcome events up to March 30, 2014, were recorded. The definition of infection was unchanged from the authors' previous report. RESULTS A total of 1935 procedures were performed on 1670 patients at 8 HCRN centers. The overall infection rate was 6.0% (95% CI 5.1%-7.2%). Procedure-specific infection rates varied (insertion 5.0%, revision 5.4%, insertion after EVD 8.3%, and insertion after treatment of infection 12.6%). Full compliance with the protocol occurred in 77% of procedures. The infection rate was 5.0% after compliant procedures and 8.7% after noncompliant procedures (p = 0.005). The infection rate when using this new protocol (6.0%, 95% CI 5.1%-7.2%) was similar to the infection rate observed using the authors' old protocol (5.7%, 95% CI 4.6%-7.0%). CONCLUSIONS CSF shunt procedures performed in compliance with a new infection prevention protocol at HCRN centers had a lower infection rate than noncompliant procedures. Implementation of the new protocol (including AICs) was associated with a 6.0% infection rate, similar to the infection rate of 5.7% from the authors' previously reported protocol. Based on the current data, the role of AICs compared with other infection prevention measures is unclear.

  17. Clinical experience in the use of marginal donor hearts

    Institute of Scientific and Technical Information of China (English)

    XIE Ai-ni; DONG Nian-guo; ZHANG Kai-lun; XIA Jia-hong; XIAO Shi-liang; SUN Zong-quan

    2011-01-01

    Background Although heart transplantation has become a standard therapy for end-stage heart disease, there are few published studies regarding the use of transplant organs from marginal donors. Here we describe the clinical outcome we have obtained using marginal donor hearts.Methods We analyzed 21 cases of orthotropic heart transplantation for end-stage heart disease performed in our department between September 2008 and July 2010. Of these patients, six received hearts from marginal donors and the remainder received standard-donor hearts. The two groups were compared in terms of both mortality and the incidence of perioperative complications such as infection, acute rejection, and right heart insufficiency.Results The 1-year survival rate of both groups was 100%. Only one death was recorded in standard-donor group during follow-up. Patients who received marginal donor hearts (83%) experienced more early complications than did the standard-donor-heart group (13%), but the mortality of the two groups was the same. The duration of post-ICU stay was greater in the marginal donor group than in the standard-donor group, (35.5±17.4) days and (21.7±2.6) days, respectively (P <0.05).Conclusions The use of marginal donor hearts increases the number of patients who can receive and benefit from transplants. However, it may introduce an increased risk of early complications, thus care should be taken both in the choice of patients who will receive marginal donor hearts and in the perioperative treatment of those for whom the procedure is performed.

  18. The clinical application of procalcitonin, leukocyte count and C-reactive protein in elderly patients with infection

    Institute of Scientific and Technical Information of China (English)

    吴培

    2012-01-01

    Objective To analyze and compare the clinical application values of procalcitonin(PCT) ,leukocyte count (WBC) and C-reactive protein(CRP) in elder patients with infection. Methods In patients(age≥65 yrs,axillary temperature>38.0℃) with infection or suspected infection

  19. Role of previous hospitalization in clinically-significant MRSA infection among HIV-infected inpatients: results of a case-control study

    Directory of Open Access Journals (Sweden)

    Festa Anna

    2007-04-01

    Full Text Available Abstract Background HIV-infected subjects have high incidence rates of Staphylococcus aureus infections, with both methicillin-susceptible and methicillin-resistant (MRSA strains. Possible explanations could include the high burden of colonization, the behavioral risk factors, and the frequent exposures to health care facilities of HIV-infected patients. The purpose of the study was to assess the risk factors for clinically- significant methicillin-resistant Staphylococcus aureus (CS-MRSA infections in HIV-infected patients admitted to Infectious Diseases Units. Methods From January 1, 2002 to December 31, 2005, we conducted a retrospective case-control (1:2 study. We identified all the cases of CS-MRSA infections in HIV-infected patients admitted to the National Institute for Infectious Diseases (INMI "Lazzaro Spallanzani" in the 4-year study period. A conditional logistic regression model was used to identify risk factors for CS-MRSA infection. Results We found 27 CS-MRSA infections, i.e. 0.9 CS-MRSA infections per 100 HIV-infected individuals cared for in our Institute. At multivariate analysis, independent predictors of CS-MRSA infection were cumulative hospital stay, invasive procedures in the previous year, and low CD4 cell count. Particularly, the risk for CS-MRSA increased by 14% per an increase of 5 days hospitalization in the previous year. Finally, we identified a low frequency of community-acquired MRSA infections (only 1 of 27; 3.7% among HIV-infected patients. Conclusion Clinicians should be aware of the risk for CS-MRSA infection in the clinical management of HIV-infected patients, especially in those patients with a low CD4 cell count, longer previous hospital stay, and previous invasive procedures.

  20. Role of previous hospitalization in clinically-significant MRSA infection among HIV-infected inpatients: results of a case-control study

    Science.gov (United States)

    Drapeau, Cecilia MJ; Angeletti, Claudio; Festa, Anna; Petrosillo, Nicola

    2007-01-01

    Background HIV-infected subjects have high incidence rates of Staphylococcus aureus infections, with both methicillin-susceptible and methicillin-resistant (MRSA) strains. Possible explanations could include the high burden of colonization, the behavioral risk factors, and the frequent exposures to health care facilities of HIV-infected patients. The purpose of the study was to assess the risk factors for clinically- significant methicillin-resistant Staphylococcus aureus (CS-MRSA) infections in HIV-infected patients admitted to Infectious Diseases Units. Methods From January 1, 2002 to December 31, 2005, we conducted a retrospective case-control (1:2) study. We identified all the cases of CS-MRSA infections in HIV-infected patients admitted to the National Institute for Infectious Diseases (INMI) "Lazzaro Spallanzani" in the 4-year study period. A conditional logistic regression model was used to identify risk factors for CS-MRSA infection. Results We found 27 CS-MRSA infections, i.e. 0.9 CS-MRSA infections per 100 HIV-infected individuals cared for in our Institute. At multivariate analysis, independent predictors of CS-MRSA infection were cumulative hospital stay, invasive procedures in the previous year, and low CD4 cell count. Particularly, the risk for CS-MRSA increased by 14% per an increase of 5 days hospitalization in the previous year. Finally, we identified a low frequency of community-acquired MRSA infections (only 1 of 27; 3.7%) among HIV-infected patients. Conclusion Clinicians should be aware of the risk for CS-MRSA infection in the clinical management of HIV-infected patients, especially in those patients with a low CD4 cell count, longer previous hospital stay, and previous invasive procedures. PMID:17470274

  1. Health care experiences of HIV-infected women with fertility desires in Mexico: a qualitative study.

    Science.gov (United States)

    van Dijk, Marieke G; Wilson, Kate S; Silva, Martha; Contreras, Xipatl; Fukuda, H Dawn; García, Sandra G

    2014-01-01

    Increased access to antiretroviral therapy has enabled Mexican HIV-infected women to resume healthy sexual and reproductive lives and reduce the risk of mother-to-child transmission of HIV infection. However, little information is available on the experiences of HIV-infected women desiring children. In this qualitative study, we conducted in-depth interviews with 31 HIV-infected women in four Mexican cities. The findings indicated that most of the women were given limited information on their pregnancy options. With some exceptions, the women felt they were denied the option to have (or to have more) children and advised to undergo tubal ligations or abortions. The findings of this study indicate that ongoing efforts are needed to promote the reproductive rights of HIV-infected women in Mexico and to ensure that they receive options aligned with their fertility desires.

  2. Integrating Clinical Decision Making and Patient Care at the Paediatric Emergency Department -focusing on children with serious infections-

    NARCIS (Netherlands)

    E. De Vos-Kerkhof (Evelien)

    2016-01-01

    markdownabstractThe general aim of this thesis was to integrate clinical decision making and patient care in the clinical practice of the paediatric ED, focusing on children at risk for serious infections. Serious infections still cause morbidity and mortality and this underlines the importance of

  3. Clinical manifestations of cytomegalovirus-associated posterior uveitis and panuveitis in patients without human immunodeficiency virus infection

    NARCIS (Netherlands)

    K. Pathanapitoon (Kessara); N. Tesavibul (Nattaporn); P. Choopong (Pitipol); S. Boonsopon (Sutasinee); N. Kongyai (Natedao); S. Ausayakhun (Somsanguan); P. Kunavisarut (Paradee); A. Rothova (Aniki)

    2013-01-01

    textabstractImportance: Little attention has been paid to clinical features of cytomegalovirus (CMV) infections in individuals without human immunodeficiency virus (HIV). Objective: To describe the clinical manifestations and comorbidities of patients without HIV infection who have CMV-associated po

  4. How Clinical Instructors Can Enhance the Learning Experience of Physical Therapy Students in an Introductory Clinical Placement

    Science.gov (United States)

    Cole, Beverley; Wessel, Jean

    2008-01-01

    Purpose: There is little understanding of how physical therapy students are influenced by clinical instructors (CIs) particularly at the outset of their clinical learning. The purpose of this study was to evaluate physical therapy students' perceptions of their learning experiences during an introductory clinical placement. Methods: Subjects were…

  5. A Short Version of the Revised ‘Experience of Close Relationships Questionnaire’: Investigating Non-Clinical and Clinical Samples

    OpenAIRE

    Wongpakaran, Tinakon; Wongpakaran, Nahathai

    2012-01-01

    Aim: This study seeks to investigate the psychometric properties of the short version of the revised ‘Experience of Close Relationships’ questionnaire, comparing non-clinical and clinical samples. Methods: In total 702 subjects participated in this study, of whom 531 were non-clinical participants and 171 were psychiatric patients. They completed the short version of the revised ‘Experience of Close Relationships’ questionnaire (ECR-R-18), the Perceived Stress Scale-10(PSS-10), the Rosenberg ...

  6. Molecular Characterization and Antimicrobial Susceptibility of Staphylococcus aureus Isolates from Clinical Infection and Asymptomatic Carriers in Southwest Nigeria

    OpenAIRE

    Olayemi O Ayepola; Olasupo, Nurudeen A.; Egwari, Louis O; Becker, Karsten; Schaumburg, Frieder

    2015-01-01

    Few reports from Africa suggest that resistance pattern, virulence factors and genotypes differ between Staphylococcus aureus from nasal carriage and clinical infection. We therefore compared antimicrobial resistance, selected virulence factors and genotypes of S. aureus from nasal carriage and clinical infection in Southwest Nigeria. Non-duplicate S. aureus isolates were obtained from infection (n = 217) and asymptomatic carriers (n = 73) during a cross sectional study in Lagos and Ogun Stat...

  7. [Cowpox virus infection in an alpaca (Vicugna pacos) - clinical symptoms, laboratory diagnostic findings and pathological changes].

    Science.gov (United States)

    Goerigk, D; Theuß, T; Pfeffer, M; Konrath, A; Kalthoff, D; Woll, D; Vahlenkamp, T W; Beer, M; Starke, A

    2014-01-01

    Orthopoxvirus infections appear to be rare in South American Camelids, because only a few cases have been reported in the literature. Based on a generalized infection with cowpox virus in an alpaca, the clinical symptoms, laboratory diagnostic findings and the pathological changes are described. The case history showed a long treatment because of chronic skin lesions. The main clinical symptom was miliary papules over the entire skin. Furthermore, a bilateral mucopurulent conjunctivitis occurred as well as excessive salivation due to a severe erosive-ulcerative stomatitis. Although the animal received intensive treatment, it died 8 days after admission to the clinic. During necropsy, an erosive-ulcerative laryngitis as well as a necrotising pneumonia and lymphadenitis were observed. Histopathological examination of representative organ samples led to the diagnosis of a suspected orthopoxvirus infection. Electron microscopy and quantitative polymerase chain reaction (qPCR) of tissue samples confirmed this diagnosis. The virus could be isolated in tissue culture and a PCR with subsequent nucleotide sequencing identified cowpox virus as the causative agent for this generalised infection. PMID:24920091

  8. Non-invasive prenatal chromosomal aneuploidy testing--clinical experience: 100,000 clinical samples.

    Directory of Open Access Journals (Sweden)

    Ron M McCullough

    Full Text Available OBJECTIVE: As the first laboratory to offer massively parallel sequencing-based noninvasive prenatal testing (NIPT for fetal aneuploidies, Sequenom Laboratories has been able to collect the largest clinical population experience data to date, including >100,000 clinical samples from all 50 U.S. states and 13 other countries. The objective of this study is to give a robust clinical picture of the current laboratory performance of the MaterniT21 PLUS LDT. STUDY DESIGN: The study includes plasma samples collected from patients with high-risk pregnancies in our CLIA-licensed, CAP-accredited laboratory between August 2012 to June 2013. Samples were assessed for trisomies 13, 18, 21 and for the presence of chromosome Y-specific DNA. Sample data and ad hoc outcome information provided by the clinician was compiled and reviewed to determine the characteristics of this patient population, as well as estimate the assay performance in a clinical setting. RESULTS: NIPT patients most commonly undergo testing at an average of 15 weeks, 3 days gestation; and average 35.1 years of age. The average turnaround time is 4.54 business days and an overall 1.3% not reportable rate. The positivity rate for Trisomy 21 was 1.51%, followed by 0.45% and 0.21% rate for Trisomies 18 and 13, respectively. NIPT positivity rates are similar to previous large clinical studies of aneuploidy in women of maternal age ≥ 35 undergoing amniocentesis. In this population 3519 patients had multifetal gestations (3.5% with 2.61% yielding a positive NIPT result. CONCLUSION: NIPT has been commercially offered for just over 2 years and the clinical use by patients and clinicians has increased significantly. The risks associated with invasive testing have been substantially reduced by providing another assessment of aneuploidy status in high-risk patients. The accuracy and NIPT assay positivity rate are as predicted by clinical validations and the test demonstrates improvement in the

  9. Centralization of a Regional Clinical Microbiology Service: The Calgary Experience

    Directory of Open Access Journals (Sweden)

    Deirdre L Church

    1999-01-01

    Full Text Available Diagnostic laboratory services in Alberta have been dramatically restructured over the past five years. In 1994, Alberta Health embarked on an aggressive laboratory restructuring that cut back approximately 30% of the overall monies previously paid to the laboratory service sector in Calgary. A unique service delivery model consolidated all institutional and community-based diagnostic testing in a company called Calgary Laboratory Services (CLS in late 1996. CLS was formed by a public/private partnership between the Calgary Regional Health Care Authority (CRHA and MDS-Kasper Laboratories. By virtue of its customer service base and scope of testing, CLS provides comprehensive regional laboratory services to the entire populace. Regional microbiology services within CLS have been successfully consolidated over the past three years into a centralized high volume laboratory (HVL. Because the HVL is not located in a hospital, rapid response laboratories (RRLs are operated at each acute care site. Although the initial principle behind the proposed test menus for the RRLs was that only procedures requiring a clinical turnaround time of more than 2 h stay on-site, many other principles had to be used to develop and implement an efficient and clinically relevant RRL model for microbiology. From these guiding principles, a detailed assessment of the needs of each institution and extensive networking with user groups, the functions of the microbiology RRLs were established and a detailed implementation plan drawn up. The experience at CLS with regards to restructuring a regional microbiology service is described herein. A post-hoc analysis provides the pros and cons of directing and operating a regionalized microbiology service.

  10. Compliance with infection control practices in an university hospital dental clinic

    Directory of Open Access Journals (Sweden)

    Mutters, Nico T.

    2014-09-01

    Full Text Available [english] Aim: Compliance with infection control practices is the key to quality care and excellence in dentistry. Infection control remains one of the most cost-beneficial interventions available. However, implementing control procedures requires full compliance of the whole dental team. The aim of our study was to measure the compliance in daily clinical practice.Methods: The compliance with infection control practices in dentistry by dental health care personnel (DHCP in a German university dental clinic was observed during clinical work. In addition, a survey was conducted to assess the individual knowledge about infection control procedures. Contamination of the workplace during invasive dental procedures was tested, as well.Results: A total of 58 invasive dental treatments implying close contacts between HCWs and patients were scrutinized. All HCWs (100% wore gloves during dental work, but in some cases (female dentists: 14.3%; dental assistants: 28.6% gloves were neither changed nor hands were disinfected between different activities or patient contacts (female dentists: 68.6%; male dentists: 60.9%; dental assistants: 93%. Only 31.4% of female and 39.1% of male dentists carried out adequate hygienic hand disinfection after removing gloves. Male dentists wore significantly more often (100% protective eyewear compared to 77.1% of female dentists (p<0.05. In addition, most of female dentists (62.9% and dental assistants (80.7% wore jewelry during dental procedures. Conclusion: Despite the knowledge of distinct hygiene procedures only a small percentage of dental staff performs hygiene practices according to recommended guidelines. Strict audit is clearly needed in the dental setting to ensure compliance with infection control guidelines to prevent transmission of pathogens. Our results provide insights for the development of a targeted education and training strategy to enhance compliance of dental staff especially of dental assistants with

  11. Infected Lives: Lived Experiences of Young African American HIV-Positive Women.

    Science.gov (United States)

    Peltzer, Jill N; Domian, Elaine W; Teel, Cynthia S

    2016-02-01

    This hermeneutic phenomenological study explored the lived experiences of young African American HIV-infected women. Eleven women between the ages of 21 and 35 participated. One pattern, Infected Lives, and three themes--Living Alone With HIV, Living With Unresolved Conflicts, and Living With Multiple Layers of Betrayal--emerged. The pattern and themes portray the very complex and challenging experiences faced by these young women living with HIV infection. They have experienced isolation, abandonment, betrayal, and discrimination in their interpersonal and social systems. They often dealt with conflicts of hope and anguish in the relationships with their children, and portraying strength, while feeling fragile. These complexities negatively influence the ability to fully engage in self-care activities. Implications for future research include further investigation about the experiences of psychological distress experienced post-diagnosis, development and evaluation of holistic nursing interventions, and evaluative research on mass media educational campaigns to reduce HIV-related stigma. PMID:25239137

  12. Exploring masculinity and marginalization of male undergraduate nursing students' experience of belonging during clinical experiences.

    Science.gov (United States)

    Sedgwick, Monique G; Kellett, Peter

    2015-03-01

    Aggressive recruitment strategies used in Canadian undergraduate nursing programs have enjoyed only moderate success, given that male students represent a small percentage of the student population. To determine whether there were gender differences in their sense of belonging, undergraduate nursing students (n = 462) in southern Alberta were surveyed using the Belongingness Scale-Clinical Placement Experience questionnaire. No significant gender differences were found on two of the subscales. However, male students demonstrated significantly lower scores on the efficacy subscale (p = 0.02). This finding suggests that some men experience feelings of marginalization and discrimination. Nurse educators and students are encouraged to explore their worldviews related to gendered performances and teaching practices that create bias. Practice environments are encouraged to deinstitutionalize policies and procedures that accentuate femininities of care. Finally, men entering into the nursing profession are encouraged to reflect on how their gender performance may facilitate or detract from their feelings of belonging.

  13. Influences of intermittent preventive treatment and persistent multiclonal Plasmodium falciparum infections on clinical malaria risk.

    Directory of Open Access Journals (Sweden)

    Anne Liljander

    Full Text Available BACKGROUND: Intermittent preventive treatment (IPT of malaria involves administration of curative doses of antimalarials at specified time points to vulnerable populations in endemic areas, regardless whether a subject is known to be infected. The effect of this new intervention on the development and maintenance of protective immunity needs further understanding. We have investigated how seasonal IPT affects the genetic diversity of Plasmodium falciparum infections and the risk of subsequent clinical malaria. MATERIAL AND METHODS: The study included 2227 Ghanaian children (3-59 months who were given sulphadoxine-pyrimethamine (SP bimonthly, artesunate plus amodiaquine (AS+AQ monthly or bimonthly, or placebo monthly for six months spanning the malaria transmission season. Blood samples collected at three post-interventional surveys were analysed by genotyping of the polymorphic merozoite surface protein 2 gene. Malaria morbidity and anaemia was monitored during 12 months follow-up. RESULTS: Monthly IPT with AS+AQ resulted in a marked reduction in number of concurrent clones and only children parasite negative just after the intervention period developed clinical malaria during follow-up. In the placebo group, children without parasites as well as those infected with ≥2 clones had a reduced risk of subsequent malaria. The bimonthly SP or AS+AQ groups had similar number of clones as placebo after intervention; however, diversity and parasite negativity did not predict the risk of malaria. An interaction effect showed that multiclonal infections were only associated with protection in children without intermittent treatment. CONCLUSION: Molecular typing revealed effects of the intervention not detected by ordinary microscopy. Effective seasonal IPT temporarily reduced the prevalence and genetic diversity of P. falciparum infections. The reduced risk of malaria in children with multiclonal infections only seen in untreated children suggests that

  14. Associations between maternal helminth and malaria infections in pregnancy, and clinical malaria in the offspring

    DEFF Research Database (Denmark)

    Ndibazza, Juliet; Webb, Emily L; Lule, Swaib;

    2013-01-01

    %), Schistosoma mansoni (18%), and Plasmodium falciparum (11%). At age 5 years, 69% of the children were still under follow-up. The incidence of malaria was 34 episodes per 100 child-years, and the mean prevalence of asymptomatic malaria at annual visits was 5.4%. Maternal hookworm and M. perstans infections were...... associated with an increased rate of childhood clinical malaria (adjusted hazard ratio [aHR], 1.24 [95% confidence interval (CI), 1.10-1.41] and 1.20 [95% CI, 1.05-1.38], respectively). S. mansoni infection had no consistent association with childhood malaria.Conclusion. This is the first report...

  15. Off-label use of maraviroc in HIV-1-infected paediatric patients in clinical practice.

    Science.gov (United States)

    Palladino, Claudia; Gómez, María Luisa Navarro; Soler-Palacín, Pere; González-Tomé, María Isabel; De Ory, Santiago J; Espiau, María; Hoyos, Santiago Pérez; León-Leal, Juan Antonio; Méndez, María; Moreno-Pérez, David; Guasch, Claudia Fortuny; Sierra, Antoni Mur; Guruceta, Itziar Pocheville; Guillén, Santiago Moreno; Briz, Verónica

    2015-10-23

    Maraviroc (MVC) is not approved for HIV-1-infected paediatric patients. This is the first assessment of the use of MVC-based salvage therapy in vertically HIV-1-infected paediatric patients in clinical settings. The results suggest that MVC-based salvage therapy is useful in children and adolescents with extensive resistance profile leading to maintained virological suppression in up to 88% of the patients with CCR5-tropic virus. The likelihood of treatment success might increase when MVC is combined with other active drugs. PMID:26544580

  16. Clinical and Laboratory Characteristics of Dengue-Orientia tsutsugamushi co-Infection from a Tertiary Care Center in South India

    OpenAIRE

    Basheer, Aneesh; Iqbal, Nayyar; Mookkappan, Sudhagar; Anitha, Patricia; Nair, Shashikala; Kanungo, Reba; Kandasamy, Ravichandran

    2016-01-01

    Background Concurrent infection with multiple pathogens is common in tropics, posing diagnostic and treatment challenges. Although co-infections of dengue, malaria, leptospirosis and typhoid in various combinations have been described, data on dengue and scrub typhus co-infection is distinctly limited. Methodology This study was a retrospective analysis of dengue and scrub typhus co-infection diagnosed between January 2010 and July 2014 at a tertiary care center. Clinical and laboratory featu...

  17. CLINICAL AND LABORATORY CHARACTERISTICS OF DENGUE-ORIENTI TSUTSUGAMUSHI CO-INFECTION FROM A TERTIARY CARE CENTER IN SOUTH INDIA

    OpenAIRE

    Aneesh Basheer; Nayyar Iqbal; Sudhagar Mookkappan; Patricia Anitha; Shashikala Nair; Reba Kanungo; Ravichandran Kandasamy

    2016-01-01

    Background Concurrent infection with multiple pathogens is common in tropics, posing diagnostic and treatment challenges. Although co-infections of dengue, malaria, leptospirosis and typhoid in various combinations have been described, data on dengue and scrub typhus co-infection is distinctly limited. Methodology This was a retrospective analysis of dengue and scrub typhus co-infection diagnosed between January 2010 and July 2014 at a tertiary care center. Clinical and laboratory...

  18. [The occurrence of "Candidatus Mycoplasma haemolamae" infections in clinically asymptomatic South American Camelids in Austria].

    Science.gov (United States)

    Franz, Sonja; Spergser, Joachim; Schwendenwein, Ilse; Stanitznig, Anna; Lambacher, Bianca; Tichy, Alexander; Wittek, Thomas

    2016-01-01

    Reports of CMhl infections in South American Camelids in Europe are only available from the United Kingdom and Switzerland. Knowing that CMhl infections can lead to severe disease resulting in death if combined with other diseases or stress, it was the aim of this study to assess prevalence data from camelids in Austria. In comparison to the previous studies a representative number of camelids was investigated nationwide. Data were assessed due to differences in geographical region, age, sex, species, and origin. A relatively high prevalence of 25.8% was recorded. CMhl was detected significantly more often in alpacas (Vicunja pacos) than in llamas (Lama glama) and more frequently in animals younger than 2 years. Additionally regional differences have been observed, which might be due to climatic differences and/or variations in insect vectors. In this study apperantly clinical healthy animals were shown to be infected with CMhl. Camelids infected with CMhl are a pathogen reservoir. The results of this study indicate different risk levels of infection between llamas and alpacas and between younger and older animals. The data presented underline the necessity of further studies on CMhlI infections in South American Camelids.

  19. Clinical and Associated Immunological Manifestations of HFMD Caused by Different Viral Infections in Children

    Science.gov (United States)

    Wang, Jingjing; Pu, Jing; Liu, Longding; Che, Yanchun; Liao, Yun; Wang, Lichun; Guo, Lei; Feng, Min; Liang, Yan; Fan, Shengtao; Cai, Lukui; Zhang, Ying; Li, Qihan

    2016-01-01

    Hand, foot, and mouth disease (HFMD), with vesiculae on the hands, feet and mouth, is an infectious disease caused by many viral pathogens. However, the differences of immune response induced by these pathogens are unclear. We compared the clinical manifestations and the levels of immunologic indicators from 60 HFMD patients caused by different viral pathogens to analyze the differences in the immune response. It was shown that Th2 cytokines (IL-4 and IL-10) increased significantly in EV71-infected children; Th1 cytokines (IL-2 and IFN-γ) rose in CA16-infected children; both Th1 and Th2 cytokines elevated in non-EVG-infected children; only individual cytokines (such as IL-10) went up in EVG-infected children. Meanwhile, the antibodies induced by viral infection could not cross-interfere between the different pathogens. These differences might be due to variations in the immune response induced by the individual pathogens or to the pathogenesis of the infections by the individual pathogens. PMID:27336013

  20. Clinical and Associated Immunological Manifestations of HFMD Caused by Different Viral Infections in Children

    Directory of Open Access Journals (Sweden)

    Jingjing Wang MS

    2016-05-01

    Full Text Available Hand, foot, and mouth disease (HFMD, with vesiculae on the hands, feet and mouth, is an infectious disease caused by many viral pathogens. However, the differences of immune response induced by these pathogens are unclear. We compared the clinical manifestations and the levels of immunologic indicators from 60 HFMD patients caused by different viral pathogens to analyze the differences in the immune response. It was shown that Th2 cytokines (IL-4 and IL-10 increased significantly in EV71-infected children; Th1 cytokines (IL-2 and IFN-γ rose in CA16-infected children; both Th1 and Th2 cytokines elevated in non-EVG-infected children; only individual cytokines (such as IL-10 went up in EVG-infected children. Meanwhile, the antibodies induced by viral infection could not cross-interfere between the different pathogens. These differences might be due to variations in the immune response induced by the individual pathogens or to the pathogenesis of the infections by the individual pathogens.

  1. Genital ulcers: etiology, clinical diagnosis, and associated human immunodeficiency virus infection in Kingston, Jamaica.

    Science.gov (United States)

    Behets, F M; Brathwaite, A R; Hylton-Kong, T; Chen, C Y; Hoffman, I; Weiss, J B; Morse, S A; Dallabetta, G; Cohen, M S; Figueroa, J P

    1999-05-01

    Individuals presenting consecutively with genital ulcers in Kingston, Jamaica, underwent serological testing for human immunodeficiency virus (HIV) infection, chlamydial infection, and syphilis. Ulcer material was analyzed by multiplex polymerase chain reaction (M-PCR) analysis. DNA from herpes simplex virus (HSV), Haemophilus ducreyi, and Treponema pallidum was detected in 158 (52.0%), 72 (23.7%), and 31 (10.2%) of 304 ulcer specimens. Of the 304 subjects, 67 (22%) were HIV-seropositive and 64 (21%) were T. pallidum-seroreactive. Granuloma inguinale was clinically diagnosed in nine (13.4%) of 67 ulcers negative by M-PCR analysis and in 12 (5.1%) of 237 ulcers positive by M-PCR analysis (P = .03). Lymphogranuloma venereum was clinically diagnosed in eight patients. Compared with M-PCR analysis, the sensitivity and specificity of a clinical diagnosis of syphilis, herpes, and chancroid were 67.7%, 53.8%, and 75% and 91.2%, 83.6%, and 75.4%, respectively. Reactive syphilis serology was 74% sensitive and 85% specific compared with M-PCR analysis. Reported contact with a prostitute in the preceding 3 months was associated with chancroid (P = .009), reactive syphilis serology (P = .011), and HIV infection (P = .007). The relatively poor accuracy of clinical and locally available laboratory diagnoses pleads for syndromic management of genital ulcers in Jamaica. Prevention efforts should be intensified.

  2. Radiochemotherapy of malignant glioma in adults. Clinical experiences

    Energy Technology Data Exchange (ETDEWEB)

    Kortmann, R.D.; Jeremic, B.; Plasswilm, L.; Bamberg, M. [Dept. for Radiation Oncology, Univ. of Tuebingen (Germany); Weller, M. [Dept. of Neurology, Univ. of Tuebingen (Germany)

    2003-04-01

    Background: Standard treatment in patients with malignant glioma consists of surgery and postoperative radiotherapy. A high early recurrence rate, particularly in glioblastoma, has led to the investigation of additional chemotherapy. Material and Methods: Recent results of radiochemotherapy published in the literature were reviewed with respect to outcome in phase II and III trials. Based on these experiences, aspects of future strategies were discussed. Results: 3 decades of intensive research had, unfortunately, little impact on the overall results. While early prospective studies established adjuvant nitrosoureas, particularly BCNU, as suitable adjuvant to surgery and postoperative radiotherapy, further studies largely concentrated on combined chemotherapeutic protocols, mostly procarbazine, CCNU and vincristine (PCV), which was shown to prolong survival in anaplastic astrocytoma. The recent MRC study, however, showed no effect for adjuvant PCV in grade III and IV malignant glioma. Only in high-grade glioma with an oligodendroglial component, additional chemotherapy may be of a decisive benefit. The introduction of newer drugs such as paclitaxel, temozolomide, or gemcitabine demonstrated no decisive advantage. Different modes of application and sequencing of radiotherapy and chemotherapy are presently actively investigated, but failed to substantially improve outcome. Conclusions: Therefore, search for newer and more effective drugs continues, as well as for ''optimal'' administration and sequencing, especially from the standpoint of accompanying acute and late toxicity. Finally, recent endeavors focused on basic research such as angiogenesis, migration and invasion, or induction of cell differentiation, but these strategies are still away from broader clinical investigation. (orig.)

  3. Single photon emission computed tomography: A clinical experience

    International Nuclear Information System (INIS)

    In the past decade, single photon emission computed tomography (SPECT) has evolved from an experimental technique used only in academic settings to a routine clinical examination performed in many community hospitals. Responding to reports of increased diagnostic efficacy, many nuclear medicine physicians have chosen to make SPECT imaging a routine technique for bone, liver, spleen, heart, and brain imaging. However, the enthusiasm for SPECT is not universal. Most nuclear medicine physicians continue to rely primarily on planar imaging, with little or no routine use of SPECT. This milieu has left many physicians asking themselves the following practical questions: Can SPECT be done easily in my hospital? Will not doing SPECT reduce the competitiveness of my nuclear medicine laboratory? The authors' experience at an institution heavily committed to SPECT for over 5 years may be helpful in answering these types of questions. The first rotating gamma camera at the Milwaukee Regional Medical Center was installed in late 1981. At present the authors have eight gamma cameras, of which four routinely perform SPECT examinations. Between 1981 and 1986, over 4,000 SPECT examinations have been performed

  4. Normothermic donor heart perfusion: current clinical experience and the future.

    Science.gov (United States)

    Messer, Simon; Ardehali, Abbas; Tsui, Steven

    2015-06-01

    Following the first successful heart transplant in 1967, more than 100,000 heart transplants have been carried out worldwide. These procedures have mostly relied on cold ischaemic preservation of the donor heart because this simple technique is inexpensive and relatively reliable. However, the well-known limitations of cold ischaemic preservation imposes significant logistical challenges to heart transplantation which put a ceiling on the immediate success on this life-saving therapy, and limits the number of donor hearts that can be safely transplanted annually. Although the theoretical advantages of normothermic donor heart perfusion have been recognised for over a century, the technology to transport donor hearts in this state has only been developed within the last decade. The Organ Care System (OCS) which is designed and manufactured by TransMedics Inc. is currently the only commercially available device with this capability. This article reviews the history of normothermic heart perfusion and the clinical experience with the TransMedics OCS to date. We have also attempted to speculate on the future possibilities of this innovative and exciting technology. PMID:24853906

  5. Copy Numbers of Telomeric Repeat Sequences of Human Herpesvirus 6B in Clinical Isolates: Possibility of Mixed Infections

    OpenAIRE

    KATO, Yuri; Ihira, Masaru; Umeda, Mami; Higashimoto, Yuki; Kawamura, Yoshiki; Ohashi, Masahiro; Ishi, Junichi; Yoshikawa, Tetsushi

    2014-01-01

    In order to determine whether mixed infections of human herpesvirus 6B (HHV-6B) occur in immunocompetent and immunocompromised individuals, we examined the copy numbers of telomeric repeat sequences (TRS) of clinical isolates. In clinical isolates obtained from patients with exanthem subitum caused by primary HHV-6B infection, PCR products with HHV-6B TRS ranging between 400 and 800 bp were amplified. PCR products of various sizes were amplified in four clinical isolates from drug-induced hyp...

  6. The Quest for Anti-inflammatory and Anti-infective Biomaterials in Clinical Translation.

    Science.gov (United States)

    Griffith, May; Islam, Mohammad M; Edin, Joel; Papapavlou, Georgia; Buznyk, Oleksiy; Patra, Hirak K

    2016-01-01

    Biomaterials are now being used or evaluated clinically as implants to supplement the severe shortage of available human donor organs. To date, however, such implants have mainly been developed as scaffolds to promote the regeneration of failing organs due to old age or congenital malformations. In the real world, however, infection or immunological issues often compromise patients. For example, bacterial and viral infections can result in uncontrolled immunopathological damage and lead to organ failure. Hence, there is a need for biomaterials and implants that not only promote regeneration but also address issues that are specific to compromised patients, such as infection and inflammation. Different strategies are needed to address the regeneration of organs that have been damaged by infection or inflammation for successful clinical translation. Therefore, the real quest is for multifunctional biomaterials with combined properties that can combat infections, modulate inflammation, and promote regeneration at the same time. These strategies will necessitate the inclusion of methodologies for management of the cellular and signaling components elicited within the local microenvironment. In the development of such biomaterials, strategies range from the inclusion of materials that have intrinsic anti-inflammatory properties, such as the synthetic lipid polymer, 2-methacryloyloxyethyl phosphorylcholine (MPC), to silver nanoparticles that have antibacterial properties, to inclusion of nano- and micro-particles in biomaterials composites that deliver active drugs. In this present review, we present examples of both kinds of materials in each group along with their pros and cons. Thus, as a promising next generation strategy to aid or replace tissue/organ transplantation, an integrated smart programmable platform is needed for regenerative medicine applications to create and/or restore normal function at the cell and tissue levels. Therefore, now it is of utmost

  7. The Quest for Anti-inflammatory and Anti-infective Biomaterials in Clinical Translation

    Science.gov (United States)

    Griffith, May; Islam, Mohammad M.; Edin, Joel; Papapavlou, Georgia; Buznyk, Oleksiy; Patra, Hirak K.

    2016-01-01

    Biomaterials are now being used or evaluated clinically as implants to supplement the severe shortage of available human donor organs. To date, however, such implants have mainly been developed as scaffolds to promote the regeneration of failing organs due to old age or congenital malformations. In the real world, however, infection or immunological issues often compromise patients. For example, bacterial and viral infections can result in uncontrolled immunopathological damage and lead to organ failure. Hence, there is a need for biomaterials and implants that not only promote regeneration but also address issues that are specific to compromised patients, such as infection and inflammation. Different strategies are needed to address the regeneration of organs that have been damaged by infection or inflammation for successful clinical translation. Therefore, the real quest is for multifunctional biomaterials with combined properties that can combat infections, modulate inflammation, and promote regeneration at the same time. These strategies will necessitate the inclusion of methodologies for management of the cellular and signaling components elicited within the local microenvironment. In the development of such biomaterials, strategies range from the inclusion of materials that have intrinsic anti-inflammatory properties, such as the synthetic lipid polymer, 2-methacryloyloxyethyl phosphorylcholine (MPC), to silver nanoparticles that have antibacterial properties, to inclusion of nano- and micro-particles in biomaterials composites that deliver active drugs. In this present review, we present examples of both kinds of materials in each group along with their pros and cons. Thus, as a promising next generation strategy to aid or replace tissue/organ transplantation, an integrated smart programmable platform is needed for regenerative medicine applications to create and/or restore normal function at the cell and tissue levels. Therefore, now it is of utmost

  8. Excretion of (3H)prednisolone in clinically normal and experimentally infected bovine udders

    Energy Technology Data Exchange (ETDEWEB)

    Geleta, J.N.; Shimoda, W.; Mercer, H.D.

    1984-08-01

    The excretion rate of (3H)prednisolone from clinically normal and experimentally infected udders of 10 lactating cows was studied. Each quarter of 6 cows was injected with a single dose of (3H)prednisolone mixed with non-radioactive prednisolone equivalent to 10 mg in 10 ml of peanut oil base. Each of the remaining 4 cows was given 40 mg of nonradioactive prednisolone and (3H)prednisolone in 60% ethanol IV. Control and postadministration samples of blood, milk, and urine were examined for radioactivity. The effects of (3H)prednisolone were evaluated in the same cows, first in clinically normal udders, then 2 weeks later in udders experimentally infected with Streptococcus agalactiae. Absorption and elimination of prednisolone were the same before and after induced infection. Within 3 hours after intramammary injection, 95% of the labeled prednisolone was absorbed systemically, less than 5% of this dose was recovered in milk, and 29% was excreted in urine. After IV injection of (3H)prednisolone, less than 0.2% of the total radioactivity was recovered in milk and less than 46% was excreted in urine. Clinical mastitis induced by S agalactiae was moderate. Circulating blood leukocytes and somatic cells in the milk of normal cows remained essentially unchanged. The leukocyte response to induced infection was rapid in blood and milk. Large numbers of leukocytes were noticed in the milk and a severe leukopenia occurred. Prednisolone treatment did not alter the number of somatic cells in milk or reduce the inflammatory response of experimentally infected cows.

  9. Excretion of [3H]prednisolone in clinically normal and experimentally infected bovine udders

    International Nuclear Information System (INIS)

    The excretion rate of [3H]prednisolone from clinically normal and experimentally infected udders of 10 lactating cows was studied. Each quarter of 6 cows was injected with a single dose of [3H]prednisolone mixed with non-radioactive prednisolone equivalent to 10 mg in 10 ml of peanut oil base. Each of the remaining 4 cows was given 40 mg of nonradioactive prednisolone and [3H]prednisolone in 60% ethanol IV. Control and postadministration samples of blood, milk, and urine were examined for radioactivity. The effects of [3H]prednisolone were evaluated in the same cows, first in clinically normal udders, then 2 weeks later in udders experimentally infected with Streptococcus agalactiae. Absorption and elimination of prednisolone were the same before and after induced infection. Within 3 hours after intramammary injection, 95% of the labeled prednisolone was absorbed systemically, less than 5% of this dose was recovered in milk, and 29% was excreted in urine. After IV injection of [3H]prednisolone, less than 0.2% of the total radioactivity was recovered in milk and less than 46% was excreted in urine. Clinical mastitis induced by S agalactiae was moderate. Circulating blood leukocytes and somatic cells in the milk of normal cows remained essentially unchanged. The leukocyte response to induced infection was rapid in blood and milk. Large numbers of leukocytes were noticed in the milk and a severe leukopenia occurred. Prednisolone treatment did not alter the number of somatic cells in milk or reduce the inflammatory response of experimentally infected cows

  10. Clinical classification and prognosis of isolated right-sided infective endocarditis.

    Science.gov (United States)

    Ortiz, Carlos; López, Javier; García, Héctor; Sevilla, Teresa; Revilla, Ana; Vilacosta, Isidre; Sarriá, Cristina; Olmos, Carmen; Ferrera, Carlos; García, Pablo Elpidio; Sáez, Carmen; Gómez, Itziar; San Román, José Alberto

    2014-12-01

    From an epidemiologic point of view, right-sided infective endocarditis (RSIE) affects different types of patients: intravenous drug users (IDUs), cardiac device carriers (pacemakers and implantable automatic defibrillators), and the "3 noes" endocarditis group: no left-sided, no IDUs, no cardiac devices. Our objective is to describe and compare the clinical profile and outcome of these groups of patients. Every episode of infective endocarditis (IE) consecutively diagnosed in 3 tertiary centers from 1996 to 2012 was included in an ongoing multipurpose database. We assessed 85 epidemiologic, clinical, echocardiographic, and outcome variables in patients with isolated RSIE. A bivariated comparative analysis between the 3 groups was conducted.Among 866 IE episodes, 121 were classified as isolated RSIE (14%): 36 IDUs (30%), 65 cardiac device carriers (54%), and 20 "3 noes" group (16%). IDUs were mainly young men (36 ± 7 years) without previous heart disease, few comorbidities, and frequent previous endocarditis episodes (28%). Human immunodeficiency virus infection was frequent (69%). Cardiac device carriers were older (66 ± 15 years) and had less comorbidities (34%). Removal of the infected device was performed in 91% of the patients without any death. The "3 noes" endocarditis group was composed mainly by middle-age men (56 ± 18 years), health care related infections (50%), and had many comorbidities (75%). Whereas Staphylococcus aureus were the most frequent cause in IDUs (72% vs 34% in device carriers and 34% in the "3 noes" group, P = 0.001), coagulase negative Staphylococci predominated in the device carriers (58% vs 11% in drug users and 35% in the "3 noes", P < 0.001). Significant differences in mortality were found (17% in drug users, 3% in device carriers, and 30% in the "3 noes" group; P < 0.001). These results suggest that RSIE should be separated into 3 groups (IDUs, cardiac device carriers, and the "3 noes") and considered as independent entities as

  11. Cultural awareness: Enhancing clinical experiences in rural Appalachia.

    Science.gov (United States)

    Presley, Chaundel

    2013-01-01

    Students often work with clients from a cultural group different than their own. This is especially true for students completing clinical practica in Appalachia, where there is a culture unique to that geographic area. To prepare for this unique setting, common cultural scenarios experienced in the clinical setting must be addressed to help provide culturally appropriate patient care while developing required clinical competencies. Although applicable to most nursing students, the author discusses culturally specific approaches to clinical care of clients from Appalachia, specifically applied to nurse practitioner students, preceptors, and clinical faculty.

  12. CLINICAL AND IMMUNOLOGICAL CHARACTERISTICS OF PATIENTS WITH HERPES INFECTIONS OF VARYING SEVERITY

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    T. M. Lyuboshenko

    2014-01-01

    Full Text Available The peculiarities of clinical signs, immune and interferon status in 180 patients with laboratory confirmed infection of varying severity, caused by herpes simplex virus (VSHI have been studied. It was determined that frequency of bacterial infections is increased in patients with more severe clinical forms of VSHI. In patients with mild course furunculosis was more often detected than in other groups. In patients with moderate course of VSHI vaginal candidiasis was more common. In patients with severe VSHI course the combination of labial and genital herpes as well as infection caused by the human papilloma virus were more prevalent. In case of severe infection occurred an increased frequency of dysbiosis, fatigue, low grade temperature, iron deficiency anemia and malignancies. The highest frequency of allergic reactions is observed in patients with moderate course of VSHI. The autoimmune syndrome manifestations were not depend on the severity of VSHI. The degree of reduction of cell immunity and disorders in the system of interferon were closely related to severity of VSHI course.

  13. Changing Pattern of Clinical Epidemiology on Hepatitis C Virus Infection in Southwest China

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    Zehui Yan

    2012-03-01

    Full Text Available Background: The changing pattern of hepatitis C virus (HCV infection could have a significant impact on future medical prevention practices and therapies.Objectives: The purpose of this study was to describe the changing pattern of HCV infection in southwest China using clinical epidemiology, and to assess the association between the genotypes distribution and certain potential risk factors.Patients and Methods: A retrospective analysis which included 1 208 subjects with chronic HCV registered at the Southwest Hospital (Chongqing, Southwest China was performed. The information was reviewed and the data collected from clinical records and short telephone interviews when necessary. HCV genotypes were determined by nucleotide sequencing of the CE1 regions followed by phylogenic analysis with the published HCV genotype. HCV genotype distribution was analyzed according to the patients' age, gender, risk exposure, and the initial risk exposure.Results: Among the 1 208 patients, the HCV subtype 1b was the most prevalent (32.9%, followed by subtype 3b (18.9%, 6a (18.0%, 3a (12.8% and 2a (10.4%, while subtypes 1a and 6k accounted for cases of HCV infection in only 9 and 3 cases respectively. Individuals older than 40 years were mainly infected with subtypes 1b and 2a, whereas younger patients were predominantly infected with genotypes 3 and 6. Subtypes 1b and 2a were observed more frequently among 44.4% and 16.0% patients respectively, with a history of invasive operations. Subtypes 3b and 6a constituted the majority of HCV infections among intravenous drug users (IDUs (28.7% and 34.9%, respectively. A significant difference (P < 0.001 was observed between the HCV genotype distributions, according to the potential route of infection.Conclusion: In southwest China, the most common remaining subtype is the 1b genotype, but this has declined significantly among young patients. This is followed by subtype 3b and 6a which has increased significantly

  14. Nosocomial infections: knowledge and source of information among clinical health care students in Ghana

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    Bello AI

    2011-08-01

    Full Text Available Ajediran I Bello1, Eunice N Asiedu1, Babatunde OA Adegoke2, Jonathan NA Quartey1, Kwadwo O Appiah-Kubi1, Bertha Owusu-Ansah11Department of Physiotherapy, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana; 2Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, NigeriaBackground: This study determined and compared the knowledge of nosocomial infections among clinical health care students at the College of Health Sciences, University of Ghana.Methods: Two hundred undergraduate health care students from four academic programs participated in the study. The study sample was drawn from each academic program by a simple random sampling technique using the class directory from each course. The Infection Control Standardized Questionnaire (ICSQ was used to assess the knowledge of students about three main domains, ie, hand hygiene, nosocomial infections, and standard precautions. A maximum score of 50 was obtainable, and respondents with scores ≥70% were classified as having a satisfactory knowledge. The response on each item was coded numerically to generate data for statistical analysis. Comparison of knowledge on the domains among categories of students was assessed using the Kruskal–Wallis test, while associations between courses of study and knowledge about nosocomial infections were determined using the Chi-square test. All statistical tests had a significant level of 5% (P < 0.05Results: Overall mean percentage score of the participants on ICSQ was 65.4 ± 2.58, with medical, physiotherapy, radiography, and nursing students recording mean percentage scores of 70.58 ± 0.62, 65.02 ± 2.00, 64.74 ± 1.19, and 61.31 ± 2.35, respectively. The main source of information about the prevention of nosocomial infections as cited by participants was their routine formal training in class. There was no significant association (P > 0.05 between course of study and knowledge of

  15. Infection

    Science.gov (United States)

    ... Potential Hazards Exposure of employees to community and nosocomial infections, e.g., Methicillin-resistant Staphylococcus aureus (MRSA) . Nosocomial infections are infections that occur from exposure to infectious ...

  16. Clinical and epidemiological features of coryneform skin infections at a tertiary hospital

    Science.gov (United States)

    Pinto, Malcolm; Hundi, Ganesh Kamath; Bhat, Ramesh Marne; Bala, Nanda Kishore; Dandekeri, Sukumar; Martis, Jacintha; Kambil, Srinath M.

    2016-01-01

    Background: Skin infections caused by coryneform bacteria are common dermatological conditions. However, to the best of our knowledge, no studies are available on the clinical characteristics and epidemiological features of this group of disorders as one entity from India and abroad. Aims: To study the clinical and epidemiological features of coryneform skin infections Methods: A total of 75 patients presenting with clinically distinctive lesions of pitted keratolysis, erythrasma and trichobacteriosis to our hospital were included in the study. Cases were interviewed with particular emphasis on epidemiological features and the various clinical findings were recorded. Investigations like Gram's stain, Wood's light examination, 10% KOH scrapings, were done in selected cases to ascertain the diagnosis. Results: Pitted keratolysis was more common in the age group of 31-40 years (40%) with a male preponderance (76.7%), most commonly affecting pressure bearing areas of the soles with malodour (86.7%) and frequent contact with water (58.3%) constituting the most important presenting symptom and provocating factor respectively. Erythrasma affected both male and female patients equally and was more commonly detected in patients with a BMI > 23kg/m2 (62.5%) and in diabetics (50%). All patients with trichobacteriosis presented with yellow coloured concretions in the axillae. Bromhidrosis (71.4%) and failure to regularly use an axillary deodorant (71.4%) were the most common presenting symptom and predisposing factor respectively. Conclusion: Coryneform skin infections are common dermatological conditions, though epidemiological data are fragmentary. Hyperhidrosis is a common predisposing factor to all three coryneform skin infections. Asymmetrical distribution of pits has been reported in our study. Diabetic status needs to be evaluated in all patients with erythrasma. Woods lamp examination forms an indispensible tool to diagnose erythrasma and trichobacteriosis. PMID

  17. Clinical and epidemiological features of coryneform skin infections at a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Malcolm Pinto

    2016-01-01

    Full Text Available Background: Skin infections caused by coryneform bacteria are common dermatological conditions. However, to the best of our knowledge, no studies are available on the clinical characteristics and epidemiological features of this group of disorders as one entity from India and abroad. Aims: To study the clinical and epidemiological features of coryneform skin infections Methods: A total of 75 patients presenting with clinically distinctive lesions of pitted keratolysis, erythrasma and trichobacteriosis to our hospital were included in the study. Cases were interviewed with particular emphasis on epidemiological features and the various clinical findings were recorded. Investigations like Gram's stain, Wood's light examination, 10% KOH scrapings, were done in selected cases to ascertain the diagnosis. Results: Pitted keratolysis was more common in the age group of 31-40 years (40% with a male preponderance (76.7%, most commonly affecting pressure bearing areas of the soles with malodour (86.7% and frequent contact with water (58.3% constituting the most important presenting symptom and provocating factor respectively. Erythrasma affected both male and female patients equally and was more commonly detected in patients with a BMI > 23kg/m2 (62.5% and in diabetics (50%. All patients with trichobacteriosis presented with yellow coloured concretions in the axillae. Bromhidrosis (71.4% and failure to regularly use an axillary deodorant (71.4% were the most common presenting symptom and predisposing factor respectively. Conclusion: Coryneform skin infections are common dermatological conditions, though epidemiological data are fragmentary. Hyperhidrosis is a common predisposing factor to all three coryneform skin infections. Asymmetrical distribution of pits has been reported in our study. Diabetic status needs to be evaluated in all patients with erythrasma. Woods lamp examination forms an indispensible tool to diagnose erythrasma and trichobacteriosis.

  18. An analysis of clinical characteristics,etiologies and prognosis of 218 patients with infective endocarditis

    Institute of Scientific and Technical Information of China (English)

    谢红梅

    2014-01-01

    Objective To describe the profile of patients with infective endocarditis(IE)and assess prognostic factors of IE.Methods Clinical and etiology data of 218 patients with IE were collected retrospectively from January 2011to January 2013.The distribution and antimicrobial susceptibilities of pathogens causing IE were evaluated.Prognostic factors associated with IE were determined by univariate and multivariate regression analysis.Results

  19. An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.

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    Nawaz Hack

    Full Text Available BACKGROUND: To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD. METHODS: The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y score, and degree of response to clozapine therapy. RESULTS: There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus. The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15, disease duration of 17-240 months (mean 108.14±51.13 and H&Y score of 2 to 4 (mean 2.51±0.51. The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%, nursing home (NH placement (11% and leucopenia (8%. Responses to clozapine across the cohort were: complete (33%, partial (33%, absent (16%, and unknown (16%. Age (r = -0.36, p0.05. CONCLUSIONS: This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

  20. Surgical site infections in women and their association with clinical conditions

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    Maria Zélia de Araújo Madeira

    2014-07-01

    Full Text Available Introduction Surgical site infections (SSIs can affect body tissues, cavities, or organs manipulated in surgery and constitute 14% to 16% of all infections. This study aimed to determine the incidence of SSIs in women following their discharge from a gynecology outpatient clinic, to survey different types of SSIs among women, and to verify the association of SSIs with comorbidities and clinical conditions. Methods Data were collected via analytical observation with a cross-sectional design, and the study was conducted in 1,026 women who underwent gynecological surgery in a teaching hospital in the municipality of Teresina, in the northeast Brazilian State of Piauí, from June 2011 to March 2013. Results The incidence of SSIs after discharge was 5.8% among the women in the outpatient clinic. The most prevalent surgery among the patients was hysterectomy, while the most prevalent type of SSI was superficial incisional. Comorbidities in women with SSIs included cancer, diabetes mellitus, and hypertension. Conclusions Surveillance of SSIs during the post-discharge period is critical for infection prevention and control. It is worth reflecting on the planning of surgical procedures for patients who have risk factors for the development of SSIs.

  1. Laser Ablation Of Atrial Fibrillation: Mid-term Clinical Experience

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    Li Poa, MD

    2009-08-01

    Full Text Available Background: Atrial Fibrillation is known to account for one third of all the strokes caused in the US in the population above the age of 70. Patients treated with the surgical Cox MAZE operation have been shown to have a 150 fold decrease in the incidence of stroke over an 18 year period. However, the original Cox MAZE although extremely successful in treating atrial fibrillation and decreasing the incidence of strokes was not performed widely because of complexity and invasiveness of the procedure. A variety of alternative energy based curative ablation strategies are now available for more minimally invasive therapeutic management of atrial fibrillation (AF. In this communication, we report our clinical experience in AF therapy utilizing laser energy ablation technology. Methods: Fifty two consecutive AF patients underwent concomitant or isolated ablation prior to any coexisting cardiac procedures that included CABG (coronary artery bypass surgery, MV (mitral valve or AV (aortic valve repairs. All patients had an epicardially based ablation pattern with basic lesions being en bloc box type pulmonary vein isolation which included the antral surface of the left atrium, directed ganglionectomies of the the right anterior and inferior ganglions, posteriomedial ablation of the IVC ( inferior vena cava, and a right isthmus ablation. Twenty seven patients had ligation of their left atrial appendage, 14 patients had resection of the ligament of Marshall, and three patients had endocardial placed lesions of a mitral annular connecting type lesion. In order to maintain the patients in normal sinus rhythm (NSR, electrical cardioversion and anti-arrhythmic drugs were employed as required. Results: At a median follow-up of 250 days, 44 of the total 52 patients (84.6% exhibited NSR.. No complications or mortality were reported due to the laser procedure. Conclusion: Laser ablation was successfully and safely used for endocardial and epicardial AF ablation

  2. Enhancing quantity and quality of clinical experiences in a baccalaureate nursing program.

    Science.gov (United States)

    Andresen, Kathleen; Levin, Pamela

    2014-01-01

    Nursing programs encounter barriers to clinical education, which may include limited clinical capacity for nursing students. Congestion of clinical placements compounded by multiple external influences prompted a need to develop an alternative approach for meeting program standards pertaining to clinical education. A curriculum improvement project was implemented within a school of nursing with the primary goal of expanding clinical learning opportunities while maintaining program quality. The unique aspect of this project was a comprehensive evaluative design, including qualitative responses from students, faculty, and clinical site stakeholders, as well as standardized student test scores. Augmenting the tools and processes for evaluation of clinical learning required collaboration from the faculty. Project outcomes include expanded clinical capacity, increased variety of clinical learning experiences, and improved quality of the clinical experiences. Collaborative partnerships yielded valuable lessons, which have implications for other nursing programs challenged with clinical placements. PMID:25205733

  3. Clinical significance of infection with cag A and vac A positive helicobacter pylori strains

    Directory of Open Access Journals (Sweden)

    Sokić-Milutinović Aleksandra

    2004-01-01

    Full Text Available Clinical relevance of infection with different Helicobacter pylori strains was reviewed in this paper. Helicobacter pylori (H. pylori infection plays a role in pathogenesis of chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and MALT lymphoma. Extragastric manifestations of H. pylori infection most probably include acne rosacea and chronic urticaria, while the importance of H. pylori infection for pathogenesis of growth retardation in children, iron deficiency anemia, coronary heart disease, stroke and idiopathic thrombocytopenic purpura remains vague. The expression of two H. pylori proteins, cytotoxin associated protein (cag A and vacuolization cytotoxin (vac A is considered to be related with pathogenicity of the bacterium. It is clear that presence of cag A+ strains is important for development of peptic ulcer; nevertheless, it is also protective against esophageal reflux disease. On the other hand, cag A+ strains are common in gastric adenocarcinoma and MALT lymphoma patients, but it seems that certain subtypes of vac A cytotoxin are more important risk factors. Infection with cag A+ strains is more common in patients with acne rosacea, stroke and coronary heart disease.

  4. Screening of Molecular Virulence Markers in Staphylococcus aureus and Pseudomonas aeruginosa Strains Isolated from Clinical Infections

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    Veronica Lazar

    2010-12-01

    Full Text Available Staphylococcus (S. aureus and Pseudomonas (Ps. aeruginosa are two of the most frequently opportunistic pathogens isolated in nosocomial infections, responsible for severe infections in immunocompromised hosts. The frequent emergence of antibiotic-resistant S. aureus and Ps. aeruginosa strains has determined the development of new strategies in order to elucidate the different mechanisms used by these bacteria at different stages of the infectious process, providing the scientists with new procedures for preventing, or at least improving, the control of S. aureus and Ps. aeruginosa infections. The purpose of this study was to characterize the molecular markers of virulence in S. aureus and Ps. aeruginosa strains isolated from different clinical specimens. We used multiplex and uniplex PCR assays to detect the genes encoding different cell-wall associated and extracellular virulence factors, in order to evaluate potential associations between the presence of putative virulence genes and the outcome of infections caused by these bacteria. Our results demonstrate that all the studied S. aureus and Ps. aeruginosa strains synthesize the majority of the investigated virulence determinants, probably responsible for different types of infections.

  5. Clinical and pathological findings of concurrent poxvirus lesions and aspergillosis infection in canaries

    Institute of Scientific and Technical Information of China (English)

    Kheirandish Reza; Askari Nasrin; Salehi Mahmoud

    2013-01-01

    Objective:To investigate clinical, pathological and mycological findings in canaries, in which pox lesions and Aspergillus fumigatus (A. fumigatus) infection were observed simultaneously. Methods:This study was performed on a breeding colony (about 100 canaries) affected by fatal wasting disease. Necropsy was undertaken on 10 severely affected canaries, and gross lesions were recorded. Samples from internal organs displaying lesions were obtained for histopathological evaluation. Tracheal swap samples of internal organs of the all infected animals with lesions at necropsy were cultured in Sabouraud Dextrose Agar for mycological examination. Results: At necropsy, caseous foci were determined in the lungs, on the air sacs, liver, spleen, heart. Swelling of the eyelids, diffuse hemorrhages in the subcutaneous tissue with small papular lesions of the skin were other typical necropsy findings. Histopathologically, pathognomonic eosinophilic intracytoplasmic inclusion bodies, which called Bollinger bodies, in both skin cells and vacuolated air way epithelial cells confirmed canary pox infection. Moreover, histopathological examination of the white-yellowish caseous foci revealed necrotic granulomatous reaction consisting of macrophages, heterophil leukocytes and giant cells encapsulated with a fibrous tissue. After the culture of the tissue samples, the formation of bluish green colonies confirmed A. fumigatus infection. Conclusions:Canary pox has been known as the disease that can result in high losses in a short time, as a re-emerging disease that has not been present during recent years in canary flocks in Iran. So, the current paper provides useful information to prevent misdiagnosed of canary pox disease which can cause secondary mycotic infection.

  6. Usefulness of clinical data and rapid diagnostic tests to identify bacterial etiology in adult respiratory infections

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    Pilar Toledano-Sierra

    2015-01-01

    Full Text Available Respiratory tract infections are a common complaint and most of them, such as common cold and laryngitis, are viral in origin, so antibiotic use should be exceptional. However, there are other respiratory tract infections (sinusitis, pharyngitis, lower respiratory tract infections, and exacerbations of chronic obstructive pulmonary disease where a bacterial etiology is responsible for a non-negligible percentage, and antibiotics are often empirically indicated. The aim of the study is to identify the strength of the data obtained from the symptoms, physical examination and rapid diagnostic methods in respiratory infections in which antibiotic use is frequently proposed in order to improve diagnosis and influence the decision to prescribe these drugs. The review concludes that history, physical examination and rapid tests are useful to guide the need for antibiotic treatment in diseases such as acute sinusitis, acute pharyngitis, exacerbation of lower respiratory tract infection and chronic obstructive pulmonary disease. However, no isolated data is accurate enough by itself to confirm or rule out the need for antibiotics. Therefore, clinical prediction rules bring together history and physical examination, thereby improving the accuracy of the decision to indicate or not antibiotics.

  7. Infective endocarditis 1973-1984 at the Bergen University Hospital: clinical feature, treatment and prognosis.

    Science.gov (United States)

    Lien, E A; Solberg, C O; Kalager, T

    1988-01-01

    During the period 1973-1984, 72 patients with infective endocarditis (IE) were hospitalized in the medical department, Bergen University Hospital. The male/female ratio was 1.25/1, the mean age 55.3 years. 35 infections were caused by streptococci, 18 by staphylococci, 6 by other microorganisms and in 13 cases no causal organism was found. Only 13 patients had rheumatic heart disease. The overall mortality was 35%, and the mean age of the patients who died was 65 years. The case fatality rates for staphylococcal and streptococcal endocarditis were 61 and 24% respectively. In the period 1973-1978 the case fatality rate was 50% compared to 26% during 1979-1984. The proportion of patients with culture-negative endocarditis was reduced from 31 to 11% from the first to the second half of the study and the percentage of patients who received antibiotics before diagnosis decreased from 81 to 58%. Valve replacement was performed in 4 patients with staphylococcal and 15 with streptococcal infections. Seven cases (mean age 73.4 years) were diagnosed at necropsy; 3 with staphylococcal infections. With increased clinical awareness of IE, liberal use of blood cultures, better diagnostic tools and earlier surgical intervention, especially in staphylococcal infections, a further reduction in mortality should be possible. PMID:3406663

  8. Mini-FLOTAC, an innovative direct diagnostic technique for intestinal parasitic infections: experience from the field.

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    Beatrice Divina Barda

    Full Text Available BACKGROUND: Soil-transmitted helminths and intestinal protozoa infection are widespread in developing countries, yet an accurate diagnosis is rarely performed. The aim of this study was to evaluate the recently developed mini-FLOTAC method and to compare with currently more widely used techniques for the diagnosis of intestinal parasitic infections in different settings. METHODOLOGY/PRINCIPAL FINDINGS: The study was carried out in Dharamsala, Himachal Pradesh, India, and in Bukumbi, Tanzania. A total of 180 pupils from two primary schools had their stool analyzed (n = 80 in Dharamsala and n = 100 in Bukumbi for intestinal parasitic infections with three diagnostic methods: direct fecal smear, formol-ether concentration method (FECM and mini-FLOTAC. Overall, 72% of the pupils were positive for any intestinal parasitic infection, 24% carried dual infections and 11% three infections or more. The most frequently encountered intestinal parasites were Entamoeba coli, Entamoeba histolytica/dispar, Giardia intestinalis, hookworm, (and Schistosoma mansoni, in Tanzania. Statistically significant differences were found in the detection of parasitic infections among the three methods: mini-FLOTAC was the most sensitive method for helminth infections (90% mini-FLOTAC, 60% FECM, and 30% direct fecal smear, whereas FECM was most sensitive for intestinal protozoa infections (88% FECM, 70% direct fecal smear, and 68% mini-FLOTAC. CONCLUSION/SIGNIFICANCE: We present the first experiences with the mini-FLOTAC for the diagnosis of intestinal helminths and protozoa. Our results suggest that it is a valid, sensitive and potentially low-cost alternative technique that could be used in resource-limited settings--particularly for helminth diagnosis.

  9. HBV and HIV co-infection: Prevalence and clinical outcomes in tertiary care hospital Malaysia.

    Science.gov (United States)

    Akhtar, Ali; Khan, Amer Hayat; Sulaiman, Syed Azhar Syed; Soo, Chow Ting; Khan, Kashifullah

    2016-03-01

    According to WHO, Malaysia has been classified as a concentrated epidemic country due to progression of HIV infection in the population of injecting drug users. The main objectives of current study are to determine the prevalence of HBV among HIV-positive individuals in a tertiary care hospital of Malaysia and to assess the predictors involved in the outcomes of HIV-HBV co-infected patients. A retrospective, cross-sectional study is conducted at Hospital Palau Pinang, Malaysia. The collection of socio-demographic data as well as clinical data is done with the help of data collection form. Data were analyzed after putting the collected values of required data by using statistical software SPSS version 20.0 and P > 0.05 is considered as significant. Results show that the overall prevalence of HBV was 86 (13%) including 495 (74.5%) males and 169 (25.5%) females among a total of 664 HIV-infected patients. It was observed that there is a high prevalence of HIV-HBV co-infection in males 76 (11.4%) as compared to females 10 (1.5%) (P = 0.002). The median age of the study population was 39 years. The statistical significant risk factors involved in the outcomes of HIV-HBV co-infected patients were observed in the variables of gender, age groups, and injecting drug users. The findings of the present study shows that the prevalence of HBV infection among HIV-positive patients was 13% and the risk factors involved in the outcomes of HIV-HBV co-infected patients were gender, age, and intravenous drug users.

  10. Clinical presentation and prognostic factors of Streptococcus pneumoniae meningitis according to the focus of infection

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    Samuelsson Susanne

    2005-10-01

    Full Text Available Abstract Background We conducted a nationwide study in Denmark to identify clinical features and prognostic factors in patients with Streptococcus pneumoniae according to the focus of infection. Methods Based on a nationwide registration, clinical information's was prospectively collected from all reported cases of pneumococcal meningitis during a 2-year period (1999–2000. Clinical and laboratory findings at admission, clinical course and outcome of the disease including follow-up audiological examinations were collected retrospectively. The focus of infection was determined according to the clinical diagnosis made by the physicians and after review of the medical records. Results 187 consecutive cases with S. pneumoniae meningitis were included in the study. The most common focus was ear (30%, followed by lung (18%, sinus (8%, and other (2%. In 42% of cases a primary infection focus could not be determined. On admission, fever and an altered mental status were the most frequent findings (in 93% and 94% of cases, respectively, whereas back rigidity, headache and convulsion were found in 57%, 41% and 11% of cases, respectively. 21% of patients died during hospitalisation (adults: 27% vs. children: 2%, Fisher Exact Test, P P = 0.0005. Prognostic factors associated with fatal outcome in univariate logistic regression analysis were advanced age, presence of an underlying disease, history of headache, presence of a lung focus, absence of an otogenic focus, having a CT-scan prior to lumbar puncture, convulsions, requirement of assisted ventilation, and alterations in various CSF parameters (WBC P P = 0.005. Conclusion These results emphasize the prognostic importance of an early recognition of a predisposing focus to pneumococcal meningitis.

  11. CLINICAL PROFILE OF ACUTE LOWER RESPIRATORY TRACT INFECTIONS IN CHILDREN BETWEEN 2MONTHS TO 5 YEARS

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    Amitoj Singh Chhina

    2015-08-01

    Full Text Available BACKGROUND : Acute respiratory infections are a leading cause of morbidity and mortality in under - five children in developing countries. Hence, the present study was undertaken to study the various risk factors, clinical profile and outcome of acute lower respiratory tract infections (ALRI in children aged 2 month to 5 years. OBJECTIVE : clinical features, laborato ry assessment and morbidity and mortality pattern associated with acute lower respiratory tract infections in children aged 2 months to 5 years. METHODS: 100 ALRI cases fulfilling WHO criteria for pneumonia, in the age group of 2 month to 5 years were evaluated for clinical profile as per a predesigned proforma in a rural medical college. RESULTS : Of cases 61% were infants and remaining 39%12 - 60 months age group, males outnumbered females with sex ratio of 1.3;1. Elevated total leukocyte counts for age were observed in only 22% of cases, of these 3% were having pneumonia, 9% severe pneumonia and 10% very severe pneumonia. Significant association was found between leukocytosis and ALRI severity (p= 0.0001 Positive blood culture was obtained in 8% of cases and was significantly associated with ALRI severity (p=. 0.027. Among the ALRI cases, 84% required oxygen supplementation at any time during the hospital stay and 8% required mechanical ventilation. The mortality rate was 1%; with 99% of cases recovering and getting discharged uneventfully. CONCLUSION : Among the clinical variables, the signs and symptoms of ALRI as per the WHO ARI Control Programme were found in almost all cases. Regarding the laboratory profile, leukocytosis and blood culture positivity w ere observed in a small percentage, but significant association with ALRI severity was observed for both. Thus, clinical signs, and not invasive blood tests are a better diagnostic tools, though the latter may provide additional therapeutic and prognostic information in severe disease

  12. A comparative study of clinical manifestations, haematological and serological responses after experimental infection with Anaplasma phagocytophilum in two Norwegian sheep breeds

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    Sandstedt Karin

    2011-02-01

    Full Text Available Abstract Background It has been questioned if the old native Norwegian sheep breed, Old Norse Sheep (also called Norwegian Feral Sheep, normally distributed on coastal areas where ticks are abundant, is more protected against tick-borne infections than other Norwegian breeds due to a continuously high selection pressure on pasture. The aim of the present study was to test this hypothesis in an experimental infection study. Methods Five-months-old lambs of two Norwegian sheep breeds, Norwegian White (NW sheep and Old Norse (ON sheep, were experimentally infected with a 16S rRNA genetic variant of Anaplasma phagocytophilum (similar to GenBank accession number M73220. The experiment was repeated for two subsequent years, 2008 and 2009, with the use of 16 lambs of each breed annually. Ten lambs of each breed were inoculated intravenously each year with 0.4 ml A. phagocytophilum-infected blood containing approximately 0.5 × 106 infected neutrophils/ml. Six lambs of each breed were used as uninfected controls. Half of the primary inoculated lambs in each breed were re-challenged with the same infectious dose at nine (2008 and twelve (2009 weeks after the first challenge. The clinical, haematological and serological responses to A. phagocytophilum infection were compared in the two sheep breeds. Results The present study indicates a difference in fever response and infection rate between breeds of Norwegian sheep after experimental infection with A. phagocytophilum. Conclusion Although clinical response seems to be less in ON-lambs compared to NW-lambs, further studies including more animals are needed to evaluate if the ON-breed is more protected against tick-borne infections than other Norwegian breeds.

  13. Impact of Simulation and Clinical Experience on Self-efficacy in Nursing Students: Intervention Study.

    Science.gov (United States)

    Kimhi, Einat; Reishtein, Judith L; Cohen, Miri; Friger, Michael; Hurvitz, Nancy; Avraham, Rinat

    2016-01-01

    This study compared the effect of simulation and clinical experience timing on self-confidence/self-efficacy for the nursing process. Using a randomized, double-crossover design, self-efficacy was measured 3 times. Although self-efficacy was significantly higher at time 1 for students who had clinical experience, there was no difference between the groups at the end of the course (time 2). Thus, simulation increased self-confidence/self-efficacy equivalently if placed either before or after clinical experience.

  14. Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature.

    Science.gov (United States)

    Roy, Ujjawal; Panwar, Ajay; Pandit, Alak; Das, Susanta Kumar; Joshi, Bhushan

    2016-06-01

    Metronidazole is an antimicrobial agent mainly used in the treatment of several protozoal and anaerobic infections, additionally, is often used in hepatic encephalopathy and Crohn disease. Apart from peripheral neuropathy, metronidazole can also cause symptoms of central nervous system dysfunction like ataxic gait, dysarthria, seizures, and encephalopathy which may result from both short term and chronic use of this drug and is collectively termed as "metronidazole induced encephalopathy"(MIE). Neuroimaging forms the backbone in clinching the diagnosis of this uncommon entity, especially in cases where there is high index of suspicion of intoxication. Although typical sites of involvement include cerebellum, brain stem and corpus callosum, however, lesions of other sites have also been reported. Once diagnosed, resolution of findings on Magnetic Resonance Imaging (MRI) of the Brain along with clinical improvement remains the mainstay of monitoring. Here we review the key clinical features and MRI findings of MIE as reported in medical literature. We also analyze implication of use of this drug in special situations like hepatic encephalopathy and brain abscess and discuss our experience regarding this entity. PMID:27504340

  15. Cryptococcal meningitis in HIV infected: Experience from a North Indian tertiary center

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    Kumar Susheel

    2008-01-01

    Full Text Available Background: Cryptococcal meningitis is a common opportunistic infection in Human Immunodeficiency Virus (HIV-infected individuals. There is little information specifically addressing cryptococcal meningitis in HIV-infected patients from North India. Aims: To determine clinical presentation, hospital course, response to treatment, complications developed, in-hospital mortality, any recurrence of cryptococcal meningitis and reasons of recurrence during follow-up. Settings and Design: A retrospective observational study undertaken in a large tertiary care center. Materials and Methods: Patient′s demographic data, presenting clinical symptomatology, physical findings, laboratory parameters, cerebrospinal fluid (CSF examination findings, side-effects of treatment, development of any complications and hospital outcome were analyzed. During follow-up any recurrence of cryptococcal meningitis, possible reasons of recurrence, type of treatment received, complications developed and outcome was recorded as well. Results: Forty patients diagnosed to have cryptococcal meningitis were analyzed. Twenty-two (55% patients had acute/ subacute presentation. Thirty-six (90% patients presented with headache and 18 (45% had altered sensorium. Twenty (50% patients had no cells in the CSF. Hypoglycorrhchia was seen in 30 (75% patients. Cryptococcal meningitis was the first acquired immune deficiency syndrome (AIDS-defining illness in 30 (75% patients. Thirty-five patients developed some adverse effects to amphotericin-B. Thirty-three patients improved with treatment while three patients died. Four patients had recurrence of cryptococcal meningitis within six months of first episode. Non-compliance of fluconazole therapy was the reason for recurrence in all of these patients. Conclusions: Cryptococcal meningitis is a common initial AIDS-defining illness. Acute and/or subacute presentation of cryptococcal meningitis is not uncommon in HIV-infected individuals. An early

  16. Reproductive Counseling by Clinic Healthcare Workers in Durban, South Africa: Perspectives from HIV-Infected Men and Women Reporting Serodiscordant Partners

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    L. T. Matthews

    2012-01-01

    Full Text Available Background. Understanding HIV-infected patient experiences and perceptions of reproductive counseling in the health care context is critical to inform design of effective pharmaco-behavioral interventions that minimize periconception HIV risk and support HIV-affected couples to realize their fertility goals. Methods. We conducted semistructured, in-depth interviews with 30 HIV-infected women (with pregnancy in prior year and 20 HIV-infected men, all reporting serodiscordant partners and accessing care in Durban, South Africa. We investigated patient-reported experiences with safer conception counseling from health care workers (HCWs. Interview transcripts were reviewed and coded using content analysis for conceptual categories and emergent themes. Results. The study findings indicate that HIV-infected patients recognize HCWs as a resource for periconception-related information and are receptive to speaking to a HCW prior to becoming pregnant, but seldom seek or receive conception advice in the clinic setting. HIV nondisclosure and unplanned pregnancy are important intervening factors. When advice is shared, patients reported receiving a range of information. Male participants showed particular interest in accessing safer conception information. Conclusions. HIV-infected men and women with serodiscordant partners are receptive to the idea of safer conception counseling. HCWs need to be supported to routinely initiate accurate safer conception counseling with HIV-infected patients of reproductive age.

  17. Whole Blood Gene Expression Profiling in Preclinical and Clinical Cattle Infected with Atypical Bovine Spongiform Encephalopathy.

    Science.gov (United States)

    Xerxa, Elena; Barbisin, Maura; Chieppa, Maria Novella; Krmac, Helena; Vallino Costassa, Elena; Vatta, Paolo; Simmons, Marion; Caramelli, Maria; Casalone, Cristina; Corona, Cristiano; Legname, Giuseppe

    2016-01-01

    Prion diseases, such as bovine spongiform encephalopathies (BSE), are transmissible neurodegenerative disorders affecting humans and a wide variety of mammals. Variant Creutzfeldt-Jakob disease (vCJD), a prion disease in humans, has been linked to exposure to BSE prions. This classical BSE (cBSE) is now rapidly disappearing as a result of appropriate measures to control animal feeding. Besides cBSE, two atypical forms (named H- and L-type BSE) have recently been described in Europe, Japan, and North America. Here we describe the first wide-spectrum microarray analysis in whole blood of atypical BSE-infected cattle. Transcriptome changes in infected animals were analyzed prior to and after the onset of clinical signs. The microarray analysis revealed gene expression changes in blood prior to the appearance of the clinical signs and during the progression of the disease. A set of 32 differentially expressed genes was found to be in common between clinical and preclinical stages and showed a very similar expression pattern in the two phases. A 22-gene signature showed an oscillating pattern of expression, being differentially expressed in the preclinical stage and then going back to control levels in the symptomatic phase. One gene, SEL1L3, was downregulated during the progression of the disease. Most of the studies performed up to date utilized various tissues, which are not suitable for a rapid analysis of infected animals and patients. Our findings suggest the intriguing possibility to take advantage of whole blood RNA transcriptional profiling for the preclinical identification of prion infection. Further, this study highlighted several pathways, such as immune response and metabolism that may play an important role in peripheral prion pathogenesis. Finally, the gene expression changes identified in the present study may be further investigated as a fingerprint for monitoring the progression of disease and for developing targeted therapeutic interventions. PMID

  18. Whole Blood Gene Expression Profiling in Preclinical and Clinical Cattle Infected with Atypical Bovine Spongiform Encephalopathy.

    Science.gov (United States)

    Xerxa, Elena; Barbisin, Maura; Chieppa, Maria Novella; Krmac, Helena; Vallino Costassa, Elena; Vatta, Paolo; Simmons, Marion; Caramelli, Maria; Casalone, Cristina; Corona, Cristiano; Legname, Giuseppe

    2016-01-01

    Prion diseases, such as bovine spongiform encephalopathies (BSE), are transmissible neurodegenerative disorders affecting humans and a wide variety of mammals. Variant Creutzfeldt-Jakob disease (vCJD), a prion disease in humans, has been linked to exposure to BSE prions. This classical BSE (cBSE) is now rapidly disappearing as a result of appropriate measures to control animal feeding. Besides cBSE, two atypical forms (named H- and L-type BSE) have recently been described in Europe, Japan, and North America. Here we describe the first wide-spectrum microarray analysis in whole blood of atypical BSE-infected cattle. Transcriptome changes in infected animals were analyzed prior to and after the onset of clinical signs. The microarray analysis revealed gene expression changes in blood prior to the appearance of the clinical signs and during the progression of the disease. A set of 32 differentially expressed genes was found to be in common between clinical and preclinical stages and showed a very similar expression pattern in the two phases. A 22-gene signature showed an oscillating pattern of expression, being differentially expressed in the preclinical stage and then going back to control levels in the symptomatic phase. One gene, SEL1L3, was downregulated during the progression of the disease. Most of the studies performed up to date utilized various tissues, which are not suitable for a rapid analysis of infected animals and patients. Our findings suggest the intriguing possibility to take advantage of whole blood RNA transcriptional profiling for the preclinical identification of prion infection. Further, this study highlighted several pathways, such as immune response and metabolism that may play an important role in peripheral prion pathogenesis. Finally, the gene expression changes identified in the present study may be further investigated as a fingerprint for monitoring the progression of disease and for developing targeted therapeutic interventions.

  19. Scintillography utility with ciprofloxacin-Tc99m in the diagnosis of infection focus; our experience

    International Nuclear Information System (INIS)

    Purpose: Our goal is to evaluate the performance of the Ciprofloxacin-Tc99m Scintigraphy in the detection of infection sites in bones, joints and soft tissues. Material and Methods: We analyze 60 exams of Ciprofloxacin-Tc99m from 8-12-2001 to 16-04-2004 in our institution. 10 patients were discarded owing to lack of clinical data or bacteriologic confirmation. The 50 patients evaluated were divided in: 32 hips, 7 knees, 2 femur, 1 leg, 3 feet, 3 spines, and 2 soft tissues. We used a planar gamma camera (technicare omega 500) and a SPECT gamma camera (elscint spx-2) All the percentages concerning sensibility and specificity were obtained including only those patients with absolute confirmation. Results: From the 50 patients, 30 were diagnosed as positives for infection; 27 corresponding to true positives and 3 to false positives (2 knees and 1 foot), sensibility 84.4%; 20 were diagnosed negatives for infection, 15 corresponding to true negatives and 5 to false negatives (4 hips and 1 spine); specificity 83%. All the exams were evaluated separately by two specialists in Nuclear Medicine; and then discussed until reaching a consensus. Conclusions: Our study shows a good sensibility for diagnosing a great variety of bacterial infectious processes. We achieved a fast localization of the infection site in order to determine the surgical option or the drainage of the abscess; and also in the clinical aspect of the treatment, monitoring the response and the lapse of the antibiotic therapy. (author)

  20. Differential clinical outcome of dengue infection among patients with and without HIV infection: a matched case-control study.

    Science.gov (United States)

    Pang, Junxiong; Thein, Tun-Linn; Lye, David C; Leo, Yee-Sin

    2015-06-01

    Clinical characteristics and outcome among dengue patients with and without human immunodeficiency virus (HIV) infection remain elusive. A total of 10 dengue virus (DENV)-HIV Chinese patients were compared with 40 Chinese dengue patients without HIV, who were matched for age, gender, type of care received, methods, and year of dengue diagnosis from 2005 to 2008. Univariate and multivariate conditional logistics regression were applied. DENV-HIV patients were significantly associated with the World Health Organization (WHO) 2009 severe dengue (conditional odds ratio [COR] = 5.72; 95% confidence interval [CI] = 1.01-32.64) but not with the WHO 1997 dengue hemorrhagic fever/dengue shock syndrome (COR = 0.40; 95% CI = 0.09-1.71). This is mainly due to severe plasma leakage and the lack of hemorrhagic manifestations. Hospitalization duration was longer for DENV-HIV patients (10.5 days; interquartile range [IQR] = 5.5-26.3 days) compared with dengue patients (5 days; IQR = 4-6 days). There were no significant differences in presentation of clinical warning signs and symptoms at admission and during hospitalization, except for rash (adjusted COR [ACOR] = 0.06; 95% CI = 0.03-0.92). DENV-HIV patients were associated with higher pulse rate (ACOR = 1.13; 95% CI = 1.02-1.25), eosinophils proportion (ACOR = 3.07; 95% CI = 1.12-8.41) and lower hematocrit level (ACOR = 0.79; 95% CI = 0.64-0.98) compared with dengue patients. Even though DENV-HIV patients may present similarly to dengue patients, they may be more likely to have severe dengue outcome. Hence, close monitoring of DENV-HIV patients is highly recommended as part of dengue clinical care and management.

  1. Apoptosis and clinical severity in patients with psoriasis and HCV infection

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    Sami A Gabr

    2014-01-01

    Full Text Available Background: It has been proposed that hepatitis C virus (HCV antigens are involved in the pathogenesis of psoriasis and may contribute to severity of the disease. Increased expression of the apoptosis-regulating proteins p53 and tTG and decreased levels of bcl-2 in the keratinocytes of the skin of psoriatic patients have been reported. Aim: This study aims to identify the serum levels of apoptosis-regulating proteins in patients with psoriasis and without HCV infection and to study the relation between clinical severity of psoriasis and the presence of HCV infection. Materials and Methods: Disease severity was assessed by psoriasis area severity index score (PASI of 90 patients with psoriasis grouped as mild (n = 30, moderate (n = 30 and severe (n = 30; 20 healthy individuals were used as controls. All groups were subjected for complete history taking, clinical examination, and tests for liver function and HCV infection. The serum levels of apoptosis related proteins: p53, tTG and bcl-2 were estimated by enzyme linked immune sorbent assay (ELISA. Results: There was a statistically significant (P < 0.001 correlation between clinical severity of psoriasis and presence of HCV antibodies and HCV-mRNA. In addition, significantly (P < 0.001 raised serum p53 and tTG, and reduced bcl-2 were observed among HCV-positive patients as compared to HCV-negative patients and control patients. Conclusion: These results conclude that clinical severity of psoriasis is affected by the presence of HCV antibodies and overexpression of apoptotic related proteins. In addition, altered serum levels of apoptosis-regulating proteins could be useful prognostic markers and therapeutic targets of psoriatic disease.

  2. Occult Hepatitis C Virus Infection in Haemodialysis Unit: A Single-center Experience

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    Abdel Hamid A. Serwah1, Waleed S. Mohamed1, Mohamed Serwah1, Awateif Edreis2, Ahmad El Zaydi3

    2014-07-01

    Full Text Available Background & Aims: Detection of hepatitis C virus RNA in peripheral blood mononuclear cells (PBMC and/or hepatocytes in the absence of HCV RNA in serum, designated as ‘occult HCV infection’, has been a matter of controversy in the recent years. Occult hepatitis C virus (HCV infection has not been investigated in haemodialysis patients. We investigated for the first time the prevalence of occult HCV infection in large cohorts of chronic hemodialysis (CHD patients in a single heamodialysis center at Al-Taif, KSA. Methods: We enrolled 84 CHD patients, whose sera are negative for HCV markers. HCV RNA was tested in PBMC using a sensitive commercial real time assay. In this study, real-time PCR was used to test for the presence of genomic HCV-RNA in peripheral blood mononuclear cells of all of these patients. For comparison, 20 patients on HD with evidence of chronic hepatitis C virus infection were included as a control group. Results: In CHD patients, occult HCV infection, determined by the presence of genomic HCV-RNA in peripheral blood mononuclear cells (PBMNCs, was found in 13.4 % of the patients; 83 % of these patients had ongoing HCV replication, indicated by the presence of HCV-RNA. Patients with occult HCV infection had spent a significantly longer time on heamodialysis and had significantly higher mean alanine aminotransferase levels during the 3 months before study entry. Compared to CHCV patients, those with occult HCV have less elevated bilirubin, AST and ALT. Conclusions: The prevalence of occult HCV infection was moderate in our CHD patients, and it did not appear to be clinically relevant. Further studies in other geographic populations with high HCV endemicity are required to clarify the significance of occult HCV infection in these patient groups. Abbreviations HCV, Hepatitis C Virus ; antibody against HCV; PBMC, peripheral blood mononuclear cells; rRT-PCR, real time reverse transcriptase polymerase chain reaction; CHD, chronic

  3. Cancer, Warts, or Asymptomatic Infections: Clinical Presentation Matches Codon Usage Preferences in Human Papillomaviruses.

    Science.gov (United States)

    Félez-Sánchez, Marta; Trösemeier, Jan-Hendrik; Bedhomme, Stéphanie; González-Bravo, Maria Isabel; Kamp, Christel; Bravo, Ignacio G

    2015-08-01

    Viruses rely completely on the hosts' machinery for translation of viral transcripts. However, for most viruses infecting humans, codon usage preferences (CUPrefs) do not match those of the host. Human papillomaviruses (HPVs) are a showcase to tackle this paradox: they present a large genotypic diversity and a broad range of phenotypic presentations, from asymptomatic infections to productive lesions and cancer. By applying phylogenetic inference and dimensionality reduction methods, we demonstrate first that genes in HPVs are poorly adapted to the average human CUPrefs, the only exception being capsid genes in viruses causing productive lesions. Phylogenetic relationships between HPVs explained only a small proportion of CUPrefs variation. Instead, the most important explanatory factor for viral CUPrefs was infection phenotype, as orthologous genes in viruses with similar clinical presentation displayed similar CUPrefs. Moreover, viral genes with similar spatiotemporal expression patterns also showed similar CUPrefs. Our results suggest that CUPrefs in HPVs reflect either variations in the mutation bias or differential selection pressures depending on the clinical presentation and expression timing. We propose that poor viral CUPrefs may be central to a trade-off between strong viral gene expression and the potential for eliciting protective immune response. PMID:26139833

  4. Clinical presentation of infective endocarditis caused by different groups of non-beta haemolytic streptococci.

    Science.gov (United States)

    Nilson, B; Olaison, L; Rasmussen, M

    2016-02-01

    Streptococci are common causes of infective endocarditis (IE) and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has provided a practical tool for their species determination. We aimed to investigate if particular groups of non-beta heamolytic streptococci were associated with IE or to specific presentations thereof. The Swedish Registry of Infective Endocarditis was used to identify cases of IE caused by streptococci and a local database to identify cases of streptococcal bacteremia. The bacteria were grouped using MALDI-TOF MS and the clinical characteristics of IE caused by different groups were compared. We identified a group of 201 streptococcal IE isolates: 18 isolates belonged to the anginosus, 19 to the bovis, 140 to the mitis, 17 to the mutans, and seven to the salivarius groups. The mitis and mutans groups were significantly more common and the anginosus group less common among IE cases as compared to all cause bacteremia. Patients infected with the bovis group isolates were older, had more cardiac devices, and had more commonly prosthetic valve IE compared to IE caused by streptococci of the other groups. Twenty-one percent of patients needed surgery, and in-hospital mortality was 8% with no significant differences between the groups. Grouping of non-beta haemolytic streptococci using MALDI-TOF MS can provide a basis for decision-making in streptococcal bacteremia. IE caused by bovis group isolates have clinical characteristics distinguishing them from IE caused by other groups of Streptococcus. PMID:26610338

  5. Photoacoustic Imaging in Oncology: Translational Preclinical and Early Clinical Experience.

    Science.gov (United States)

    Valluru, Keerthi S; Wilson, Katheryne E; Willmann, Jürgen K

    2016-08-01

    Photoacoustic imaging has evolved into a clinically translatable platform with the potential to complement existing imaging techniques for the management of cancer, including detection, characterization, prognosis, and treatment monitoring. In photoacoustic imaging, tissue is optically excited to produce ultrasonographic images that represent a spatial map of optical absorption of endogenous constituents such as hemoglobin, fat, melanin, and water or exogenous contrast agents such as dyes and nanoparticles. It can therefore provide functional and molecular information that allows noninvasive soft-tissue characterization. Photoacoustic imaging has matured over the years and is currently being translated into the clinic with various clinical studies underway. In this review, the current state of photoacoustic imaging is presented, including techniques and instrumentation, followed by a discussion of potential clinical applications of this technique for the detection and management of cancer. (©) RSNA, 2016. PMID:27429141

  6. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

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    O. V. Gaisenok

    2014-01-01

    Full Text Available Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  7. Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: Diagnostic study

    NARCIS (Netherlands)

    R.G. Nijman (Ruud); Y. Vergouwe (Yvonne); M.J. Thompson (Matthew); M.V. Veen (Mirjam Van); A.H.J. van Meurs (Alfred); J. van der Lei (Johan); E.W. Steyerberg (Ewout); H.A. Moll (Henriëtte); R. Oostenbrink (Rianne)

    2013-01-01

    textabstractObjective: To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. Design: Prospective observational diagnostic study. Setting: Three paediatric em

  8. Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences: victimisation and non-clinical psychotic experiences

    OpenAIRE

    Lataster, Tineke; van Os, Jim; Drukker, Marjan; Henquet, Cécile; Feron, Frans; Gunther, Nicole; Myin-Germeys, Inez

    2006-01-01

    Victimisation in childhood may be associated with adult psychosis. The current study examined this association in the crucial developmental period of early adolescence and investigated whether (1) unwanted sexual experiences, and (2) being bullied, were associated with non-clinical delusional ideation and hallucinatory experiences in a general population sample of 14 year olds.

  9. Developing a leadership pipeline: the Cleveland Clinic experience

    OpenAIRE

    Hess, Caryl A.; Barss, Christina; Stoller, James K

    2014-01-01

    The complexity of health care requires excellent leadership to address the challenges of access, quality, and cost of care. Because competencies to lead differ from clinical or research skills, there is a compelling need to develop leaders and create a talent pipeline, perhaps especially in physician-led organizations like Cleveland Clinic. In this context, we previously reported on a cohort-based physician leadership development course called Leading in Health Care and, in the current report...

  10. Clinical profile of dengue fever infection in patients admitted in tertiary care centre Agroha, Hisar, Haryana, India

    OpenAIRE

    Mohd Younus Shah; Mohd Mubarak Naqash; Goel, R.K.; Deepak Galhan; Sunil Kumar; Vivek Chhabra; Abhishek Saini; K. L. Jaggal

    2016-01-01

    Background: Dengue infections can result in a wide spectrum of disease severity ranging from an influenza-like illness (dengue fever; DF) to the life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The study was aimed to compare the clinical profile of all patients diagnosed with dengue viral infection at MAMC. Methods: This retrospective study included 188 patients infected with dengue virus, age 6 years to 70 years. Laboratory and haematological data were include...

  11. Infectivity of seropositive dogs, showing different clinical forms of leishmaniasis, to Lutzomyia longipalpis phlebotomine sand flies.

    Science.gov (United States)

    Michalsky, Erika Monteiro; Rocha, Marília Fonseca; da Rocha Lima, Ana Cristina Vianna Mariano; França-Silva, João Carlos; Pires, Marize Quinhone; Oliveira, Fernanda Santos; Pacheco, Raquel Silva; dos Santos, Sara Lopes; Barata, Ricardo Andrade; Romanha, Alvaro José; Fortes-Dias, Consuelo Latorre; Dias, Edelberto Santos

    2007-06-20

    Visceral leishmaniasis (VL) is a growing zoonosis with an increasing number of new cases and a rapid geographical spreading of the disease. In the present study, a canine survey was carried out in the city of Montes Claros (320,000 inhabitants), an endemic area of American visceral leishmaniasis in the state of Minas Gerais, Brazil. A total number of 4795 dogs were examined by serology, which showed a rate of seropositivity of 5%. Isoenzymatic analysis confirmed Leishmania infantum chagasi as the local aetiological agent of CVL. Canine tissues were assayed for the presence of Leishmania parasite DNA using different techniques. The infectivity of asymptomatic, oligosymptomatic and symptomatic seropositive dogs was tested by xenodiagnosis using laboratory reared Lutzomyia longipalpis. Rates of infection of 5.4%, 5.1% and 28.4% were found for the phlebotomine sand flies that fed in asymptomatic, oligosymptomatic and symptomatic dogs, respectively. Our results indicate that, under experimental conditions, symptomatic dogs are about four times more infective to VL vectors than oligosymptomatic or asymptomatic animals. The lower infectivity rates of dogs displaying any of the last two clinical forms of leishmaniasis, however, must be taken into account in the epidemiology of CVL.

  12. Clinical and epidemiological aspects of parvovirus B19 infections in Ireland, January 1996-June 2008.

    LENUS (Irish Health Repository)

    Nicolay, N

    2009-01-01

    Parvovirus B19 infection may be mistakenly reported as measles or rubella if laboratory testing is not performed. As Europe is seeking to eliminate measles, an accurate diagnosis of fever\\/rash illnesses is needed. The main purpose of this study was to describe the epidemiological pattern of parvovirus B19, a common cause of rash, in Ireland between January 1996 and June 2008, using times series analysis of laboratory diagnostic data from the National Virus Reference Laboratory. Most diagnostic tests for presumptive parvovirus B19 infection were done in children under the age of five years and in women of child-bearing age (between 20-39 years-old). As a consequence, most of the acute diagnoses of B19 infection were made in these populations. The most commonly reported reasons for testing were: clinical presentation with rash, acute arthritis, influenza-like symptoms or pregnancy. The time series analysis identified seasonal trends in parvovirus B19 infection, with annual cycles peaking in late winter\\/spring and a six-year cycle for parvovirus B19 outbreaks in Ireland.

  13. Reversing Gut Damage in HIV Infection: Using Non-Human Primate Models to Instruct Clinical Research

    Directory of Open Access Journals (Sweden)

    Rosalie Ponte

    2016-02-01

    Full Text Available Antiretroviral therapy (ART has led to dramatic improvements in the lives of HIV-infected persons. However, residual immune activation, which persists despite ART, is associated with increased risk of non-AIDS morbidities. Accumulating evidence shows that disruption of the gut mucosal epithelium during SIV/HIV infections allows translocation of microbial products into the circulation, triggering immune activation. This disruption is due to immune, structural and microbial alterations. In this review, we highlighted the key findings of gut mucosa studies of SIV-infected macaques and HIV-infected humans that have revealed virus-induced changes of intestinal CD4, CD8 T cells, innate lymphoid cells, myeloid cells, and of the local cytokine/chemokine network in addition to epithelial injuries. We review the interplay between the host immune response and the intestinal microbiota, which also impacts disease progression. Collectively, these studies have instructed clinical research on early ART initiation, modifiers of microbiota composition, and recombinant cytokines for restoring gut barrier integrity.

  14. Human papillomavirus infection in the oromaxillofacial area: Clinical anatomy and histological considerations.

    Science.gov (United States)

    Ilea, Aranka; Boşca, Bianca; MiclĂuş, Viorel; Rus, Vasile; BĂbţan, Anida Maria; CÂmpian, Radu Septimiu

    2015-11-01

    Clinical manifestations of human papillomavirus (HPV) infection in the head and neck can range from benign lesions, which are the most frequent, to malignant lesions. The prevalence of head and neck cancer is increasing, despite currently decreasing trends in known risk factors such as smoking and alcohol use. A new patient profile has appeared in recent practice: most frequently a middle-aged male patient who does not smoke or drink alcohol, is sexually active (possibly having multiple partners), and presents with oral or cervicofacial lesions requiring diagnosis and treatment. Another risk factor that should be considered in these patients is HPV infection. The association of oral potentially malignant disorders (OPMD) with HPV is a challenge for the medical practitioner. The gold standard for diagnosis is histopathological examination, which can also yield evidence suggesting HPV infection. Determination of the viral genotype provides additional data for assessing the oncological risk of an HPV infection. Treatment of these patients is aimed at removing the lesions, in association or not with antiviral treatment and recurrence control. PMID:26331491

  15. Diagnostic utility and clinical application of imaging for pleural space infections.

    Science.gov (United States)

    Heffner, John E; Klein, Jeffrey S; Hampson, Christopher

    2010-02-01

    Timely diagnosis of pleural space infections and rapid initiation of effective pleural drainage for those patients with complicated parapneumonic effusions or empyema represent keystone principles for managing patients with pneumonia. Advances in chest imaging provide opportunities to detect parapneumonic effusions with high sensitivity in patients hospitalized for pneumonia and to guide interventional therapy. Standard radiographs retain their primary role for screening patients with pneumonia for the presence of an effusion to determine the need for thoracentesis. Ultrasonography and CT scanning, however, have greater sensitivity for fluid detection and provide additional information for determining the extent and nature of pleural infection. MRI and PET scan can image pleural disease, but their role in managing parapneumonic effusions is not yet clearly defined. Effective application of chest images for patients at risk for pleural infection, however, requires a comprehensive understanding of the unique features of each modality and relative value. This review presents the diagnostic usefulness and clinical application of chest imaging studies for evaluating and managing pleural space infections in patients hospitalized for pneumonia. PMID:20133295

  16. Immune reconstitution inflammatory syndrome in HIV-infected patients receiving antiretroviral therapy : pathogenesis, clinical manifestations and management

    DEFF Research Database (Denmark)

    Dhasmana, Devesh J; Dheda, Keertan; Ravn, Pernille;

    2008-01-01

    , this results in inflammatory responses that may result in clinical deterioration known as 'the immune reconstitution inflammatory syndrome' (IRIS). IRIS may be targeted at viable infective antigens, dead or dying infective antigens, host antigens, tumour antigens and other antigens, giving rise...

  17. An epidemiological survey to assess the clinical use of cephalosporins in community-acquired respiratory tract infections

    Directory of Open Access Journals (Sweden)

    Vikram Sobti

    2015-06-01

    Conclusion: In-clinic use of cefpodoxime as monotherapy is preferred in upper respiratory tract infections. However, clinicians recommend a combination therapy of cefpodoxime and levofloxacin in lower respiratory tract infections. [Int J Basic Clin Pharmacol 2015; 4(3.000: 547-550

  18. Clinical Trial and In Vitro Study for the Role of Cartilage and Synovia in Acute Articular Infection

    DEFF Research Database (Denmark)

    Langenmair, E. R.; Kubosch, E. J.; Salzmann, G. M.;

    2015-01-01

    Objective. Osteoarthritis is a long-term complication of acute articular infections. However, the roles of cartilage and synovia in this process are not yet fully understood. Methods. Patients with acute joint infections were enrolled in a prospective clinical trial and the cytokine composition o...

  19. Clinical profile of dengue fever infection in patients admitted in tertiary care centre Agroha, Hisar, Haryana, India

    Directory of Open Access Journals (Sweden)

    Mohd Younus Shah

    2016-06-01

    Conclusions: Significant differences in the clinical profile is possibly because of infection with different serotypes of dengue virus (DENV, concurrent/sequential infection of more than one serotype, and differences in host immune responses associated with host genetic variations. [Int J Res Med Sci 2016; 4(6.000: 2146-2149

  20. High prevalence of occult hepatitis B virus genotype H infection among children with clinical hepatitis in west Mexico

    Directory of Open Access Journals (Sweden)

    Griselda Escobedo-Melendez

    2014-09-01

    Full Text Available Studies on the prevalence of infection with hepatitis B virus (HBV among children are scarce in Latin American countries, especially in Mexico. This study was aimed to investigate the prevalence of HBV infection, occult hepatitis B infection (OBI and HBV genotypes among children with clinical hepatitis. In total, 215 children with clinical hepatitis were evaluated for HBV infection. HBV serological markers and HBV DNA were analysed. OBI diagnosis and HBV genotyping was performed. HBV infection was found in 11.2% of children with clinical hepatitis. Among these HBV DNA positive-infected children, OBI was identified in 87.5% (n = 21/24 of the cases and 12.5% (n = 3/24 were positive for both HBV DNA and hepatitis B surface antigen. OBI was more frequent among children who had not been vaccinated against hepatitis B (p < 0.05 than in those who had been vaccinated. HBV genotype H was prevalent in 71% of the children followed by genotype G (8% and genotype A (4%. In conclusion, OBI is common among Mexican children with clinical hepatitis and is associated with HBV genotype H. The results show the importance of the molecular diagnosis of HBV infection in Mexican paediatric patients with clinical hepatitis and emphasise the necessity of reinforcing hepatitis B vaccination in children.

  1. The spatial context of clinic-reported sexually transmitted infection in Hong Kong

    Directory of Open Access Journals (Sweden)

    Cheung Georgiana MT

    2010-09-01

    Full Text Available Abstract Background The incidence and prevalence of sexually transmitted infection (STI in China has been on the rise in the past decade. Delineation of epidemiologic pattern is often hampered by its uneven distribution. Spatial distribution is often a neglected aspect of STI research, the description of which may enhance epidemiologic surveillance and inform service development. Methods Over a one month-period, all first time attendees of 6 public STI clinics in Hong Kong were interviewed before clinical consultation using a standard questionnaire to assess their demographic, clinical and behavioural characteristics. A GIS (geographic information system-based approach was adopted with mapping performed. The cases attending the clinics in different locations were profiled. A comparison was made between neighbourhood cases (patients living near a clinic and distant cases (those farther off, by calculating the odds ratio for demographic, behavioural and geographic characteristics. Results Of the 1142 STI patients evaluated, the residence locations of 1029 (90.1% could be geocoded, of which 95.6% were ethnic Chinese and 63.4% male. Geographically only about a quarter lived in the same district as the clinic. STI patients aged 55 or above were more likely to be living in the vicinity of the clinic, located in the same or adjacent tertiary planning unit (a small geographic unit below district level. A majority of patients came from locations a few kilometers from the clinic, the distance of which varies between clinics. Overall, more syphilis cases were reported in patients residing in the same or adjacent tertiary planning unit, while distant cases tended to give a higher risk of inconsistent condom use. There were otherwise no significant clinical and epidemiologic differences between neighbourhood and distant STI cases. Conclusions There was no specific relationship between STI and the residence location of patients as regards their clinical and

  2. Clinical and morphological characteristics of chronic uretheroprostatitis associated with chlamydial and mycoplasmal infections

    Directory of Open Access Journals (Sweden)

    Yu. S. Kondratyeva

    2012-01-01

    Full Text Available The purpose of this study was to investigate the clinical symptoms, features of morphological structure of prostate in patients with chronic recurrent prostatitis associated with chlamydial and mycoplasmal infections. 60 male patients were examined. Anamnesis and interview data, results of laboratory and instrumental tests were analyzed. In 73.3% of cases cultural test and PCR allowed to identify M. hominis, U. urealiticum, M. genitalium, C. trachomatis in patients with chronic uretheroprostatitis. Out of 16 patients (26,6% of all examined with chronic recurrent uretheroprostatitis for whom neither chlamidial nor mycoplasmal infection was diagnosed by laboratory tests, for 14 patients (87,5% it was confirmed that patogenic urogenital infectious agents were localized intracellularly. Pathomorphological investigation of prostate bioptates allowed to estimate the type and degree of specific changes in the prostate tissue in cases of recurrent uretheroprostatitis resistant to the therapy and with frequent relapses.

  3. Treatment of helicobacter pylori infection; a controlled randomized comparative clinical trial

    International Nuclear Information System (INIS)

    Helicobacter pylori induces chronic inflammation of the underlying gastric mucosa and is strongly linked to the development of duodenal and gastric carcinoma. A study was conducted to evaluate the efficacy of Pylorex, a herbal formulation, for treatment of H. pylori infection as compared to triple allopathic therapy (Omeprazole, Amoxicillin, Metronidazole). The therapeutic evaluations of these medicines were conducted on 97 clinically and immunologically diagnosed cases of H. pylori infection. H. pylori was eradicated in 16 (32.6%) out of 49 patients by the use of triple allopathic therapy (Control drugs), and in 9 (18.7%) out of 48 patients by the use of Pylorex (Test drug). Pylorex possesses a therapeutic value for the treatment of H. pylori associated symptoms but the eradication rate is superior in triple allopathic therapy. (author)

  4. Cryptosporidium infection in ostriches (Struthio camelus in Brazil: clinical, morphological and molecular studies

    Directory of Open Access Journals (Sweden)

    MMAB Santos

    2005-06-01

    Full Text Available Avian cryptosporidiosis has been reported in more than 30 species of birds. To date, the species infecting birds are C. baileyi, C. galli and C. meleagridis. In this study, the morphological, clinical and molecular characteristics of a Brazilian ostrich isolate of Cryptosporidium are described. The oocysts of this Brazilian isolate are larger and more elongated than those of Cryptosporidium previously reported in ostriches, which were morphologically similar to C. meleagridis. Morphological, biological and molecular analyses demonstrated similarity of this ostrich isolate with C. baileyi, suggesting that there are at least two Cryptosporidium species infecting ostriches; one with molecular, biological and morphological characteristics related to C. baileyi, and another morphologically similar to C. meleagridis.

  5. Application of PCR-based methods for diagnosis of intestinal parasitic infections in the clinical laboratory.

    Science.gov (United States)

    Verweij, Jaco J

    2014-12-01

    For many years PCR- and other DNA-based methods of pathogen detection have been available in most clinical microbiology laboratories; however, until recently these tools were not routinely exploited for the diagnosis of parasitic infections. Laboratories were initially reluctant to implement PCR as incorporation of such assays within the algorithm of tools available for the most accurate diagnosis of a large variety of parasites was unclear. With regard to diagnosis of intestinal parasitic infections, the diversity of parasites that one can expect in most settings is far less than the parasitological textbooks would have you believe, hence developing a simplified diagnostic triage is feasible. Therefore the classical algorithm based on population, patient groups, use of immuno-suppressive drugs, travel history etc. is also applicable to decide when to perform and which additional techniques are to be used, if a multiplex PCR panel is used as a first-line screening diagnostic.

  6. Antimicrobial susceptibility of Acinetobacter clinical isolates and emerging antibiogram trends for nosocomial infection management

    Directory of Open Access Journals (Sweden)

    Muhammad Sohail

    2016-06-01

    Full Text Available Abstract: Introduction: The drug resistant Acinetobacter strains are important causes of nosocomial infections that are difficult to control and treat. This study aimed to determine the antimicrobial susceptibility patterns of Acinetobacter strains isolated from different clinical specimens obtained from patients belonging to different age groups. METHODS: In total, 716 non-duplicate Acinetobacter isolates were collected from the infected patients admitted to tertiary-care hospitals at Lahore, Pakistan, over a period of 28 months. The Acinetobacter isolates were identified using API 20E, and antimicrobial susceptibility testing was performed and interpreted according to Clinical and Laboratory Standards Institute (CLSI guidelines. RESULTS: The isolation rate of Acinetobacter was high from the respiratory specimens, followed by wound samples. Antibiotic susceptibility analyses of the isolates revealed that the resistance to cefotaxime and ceftazidime was the most common, in 710 (99.2% specimens each, followed by the resistance to gentamicin in 670 (93.6% isolates, and to imipenem in 651 (90.9% isolates. However, almost all isolates were susceptible to tigecycline, colistin, and polymyxin B. CONCLUSIONS: The present study showed the alarming trends of resistance of Acinetobacter strains isolated from clinical specimens to the various classes of antimicrobials. The improvement of microbiological techniques for earlier and more accurate identification of bacteria is necessary for the selection of appropriate treatments.

  7. [Specific clinical, epidemiological patterns and laboratory diagnostics of enterovirus infection in the Republic of Belarus].

    Science.gov (United States)

    Amvros'eva, T V; Poklonskaia, N V; Bogush, Z F; Kazinets, O N; Germanovich, F A; Fisenko, E G; Titov, L P; Kvacheva, Z B; Bezruchko, A A; Scheslenok, E P

    2005-01-01

    The clinical and epidemiological patterns as well as the results of the laboratory verification of the outbreak of enterovirus infection (EVI) in Minsk during the period of summer-autumn, 2000, are presented. During this outbreak a variety of clinical forms were observed, the serous meningitis being prevalent (57.5%). Practically simultaneous occurrence of infection on the territory of all administrative districts of the city, the predominant involvement of children aged up to 14 years into the outbreak, a high proportion of simultaneous casualities in the multiple foci. A number of circulating enteroviruses (EV)--ECHO 30, ECHO 6 of three serotypes and Coxsackie B5--were simultaneously isolated from clinical material. EV of the same serotypes were isolated from tap drinking water, and neutralizing antibodies to these serotypes were often detected in the patients blood sera. Infectious EV were also present in samples of bottled water and in water reservoirs used for bathing. The routes of EV transmission and the improvement of EVI control are discussed.

  8. How to Conduct Clinical Qualitative Research on the Patient's Experience

    Science.gov (United States)

    Chenail, Ronald J.

    2011-01-01

    From a perspective of patient-centered healthcare, exploring patients' (a) preconceptions, (b) treatment experiences, (c) quality of life, (d) satisfaction, (e) illness understandings, and (f) design are all critical components in improving primary health care and research. Utilizing qualitative approaches to discover patients' experiences can…

  9. Loss to clinic and five-year mortality among HIV-infected antiretroviral therapy initiators.

    Directory of Open Access Journals (Sweden)

    Jessie K Edwards

    Full Text Available Missing outcome data due to loss to follow-up occurs frequently in clinical cohort studies of HIV-infected patients. Censoring patients when they become lost can produce inaccurate results if the risk of the outcome among the censored patients differs from the risk of the outcome among patients remaining under observation. We examine whether patients who are considered lost to follow up are at increased risk of mortality compared to those who remain under observation. Patients from the US Centers for AIDS Research Network of Integrated Clinical Systems (CNICS who newly initiated combination antiretroviral therapy between January 1, 1998 and December 31, 2009 and survived for at least one year were included in the study. Mortality information was available for all participants regardless of continued observation in the CNICS. We compare mortality between patients retained in the cohort and those lost-to-clinic, as commonly defined by a 12-month gap in care. Patients who were considered lost-to-clinic had modestly elevated mortality compared to patients who remained under observation after 5 years (risk ratio (RR: 1.2; 95% CI: 0.9, 1.5. Results were similar after redefining loss-to-clinic as 6 months (RR: 1.0; 95% CI: 0.8, 1.3 or 18 months (RR: 1.2; 95% CI: 0.8, 1.6 without a documented clinic visit. The small increase in mortality associated with becoming lost to clinic suggests that these patients were not lost to care, rather they likely transitioned to care at a facility outside the study. The modestly higher mortality among patients who were lost-to-clinic implies that when we necessarily censor these patients in studies of time-varying exposures, we are likely to incur at most a modest selection bias.

  10. The approved pediatric drug suramin identified as a clinical candidate for the treatment of EV71 infection-suramin inhibits EV71 infection in vitro and in vivo.

    Science.gov (United States)

    Ren, Peijun; Zou, Gang; Bailly, Benjamin; Xu, Shanshan; Zeng, Mei; Chen, Xinsheng; Shen, Liang; Zhang, Ying; Guillon, Patrice; Arenzana-Seisdedos, Fernando; Buchy, Philippe; Li, Jian; von Itzstein, Mark; Li, Qihan; Altmeyer, Ralf

    2014-09-01

    Enterovirus 71 (EV71) causes severe central nervous system infections, leading to cardiopulmonary complications and death in young children. There is an urgent unmet medical need for new pharmaceutical agents to control EV71 infections. Using a multidisciplinary approach, we found that the approved pediatric antiparasitic drug suramin blocked EV71 infectivity by a novel mechanism of action that involves binding of the naphtalentrisulonic acid group of suramin to the viral capsid. Moreover, we demonstrate that when suramin is used in vivo at doses equivalent to or lower than the highest dose already used in humans, it significantly decreased mortality in mice challenged with a lethal dose of EV71 and peak viral load in adult rhesus monkeys. Thus, suramin inhibits EV71 infection by neutralizing virus particles prior to cell attachment. Consequently, these findings identify suramin as a clinical candidate for further development as a therapeutic or prophylactic treatment for severe EV71 infection.

  11. Methionine-enkephalin as immunomodulator therapy in human immunodeficiency virus infections: clinical and immunological effects.

    Science.gov (United States)

    Zunich, K M; Kirkpatrick, C H

    1988-03-01

    Enkephalins have been shown to enhance T cell-mediated immune responses and natural killer-cell activity in vitro. We have studied the effects of infusions of methionine-enkephalin on immune functions and clinical courses in seven patients with various stages of infection with human immunodeficiency virus (HIV). All patients were clinically stable at the time of entry into the study. Each received 10 micrograms/kg of methionine-enkephalin in an intravenous infusion three times weekly for up to 12 weeks. Evaluation of cellular immunity (T-cell subsets, in vitro interleukin-2 production and interleukin-2 receptor expression, T-cell responses to mitogens and antigens, and delayed-hypersensitivity skin tests) as well as clinical and toxicity monitoring was performed prior to treatment, at 2-week intervals during treatment, and after the cessation of treatment. Increases in interleukin-2 receptor expression were seen on lymphocytes collected on one occasion from each of two patients 30 min postinfusion. Studies done 24 hr after infusions revealed increases in interleukin-2 production in one patient, but when pre- and posttreatment values were compared there were no significant changes in numbers of circulating T cells of any phenotype or in T-cell responses to mitogens or antigens. None of the patients with Kaposi's sarcoma had regression of tumor; one patient dropped out of the study at week 5 because of deteriorating clinical status and progression of tumor. There were no adverse reactions or evidence of toxicity. We conclude that methionine-enkephalin appears to enhance temporarily selected immune responses in patients with HIV infection, however, in the schedule used in this study it was not clinically efficacious.

  12. Health care associated infections, antibiotic resistance and clinical outcome: A surveillance study from Sanandaj, Iran

    Science.gov (United States)

    Soltani, Jafar; Poorabbas, Bahman; Miri, Neda; Mardaneh, Jalal

    2016-01-01

    AIM: To study the antibiotic susceptibility patterns of gram-negative healthcare associated bacterial infections at two tertiary hospitals in the Sanandaj city, Kurdistan Province, Iran. METHODS: From January 2012 to December 2012, all positive cultures from potentially sterile body fluids were gathered. They sent to professor Alborzi clinical microbiology center in Shiraz for further analysis and susceptibility testing. The antibiotic susceptibility was determined using the Kirby-Bauer method (disk diffusion technique). The Results were interpreted according to Clinical and Laboratory Standards Institute guidelines against a series of antimicrobials. World Health Organization definitions for Healthcare associated infections were followed. RESULTS: Seven hundred and thirty-two positive cultures were reported from both hospitals. Seventy-nine isolates/patients fulfilled the study criteria for health-care associated gram-negative infections. The most frequent bacterial cultures were from the pediatric wards (52%). Serratia marcescens (S. marcescens) (38%) Escherichia coli (E. coli) (19%), Klebsiella pneumoniae (K. pneumoniae) (19%), Acinetobacter baumannii (6%), Enterobacter species (6%), Serratia odorifera (4%) and Pseudomonas species (5%) were the most frequently isolated organisms. The susceptibility pattern of common isolates i.e., S. marcescens, E. coli and K. pneumoniae for commonly used antibiotics were as follows: Ampicillin 3.3%, 6.7%, 20%; gentamicin 73.3%, 73.3%, 46.7%; ceftazidim 80%, 73.3%, 33.3%; cefepim 80%, 86.7%, 46.7%; piperacillin/tazobactam 90%, 66.7%, 86.7%; ciprofloxacin 100%, 73.3%, 86.7%; imipenem 100%, 100%, 100%, respectively. CONCLUSION: The most effective antibiotics against gram-negative healthcare associated infections are imipenem followed by ciprofloxacin. The resistance rate is high against ampicillin and cephalothin. The high mortality rate (46.1%) associated with S. marcescens is alarming. PMID:26989670

  13. Epidemiologic and clinical impact of Acinetobacter baumannii colonization and infection: a reappraisal.

    Science.gov (United States)

    Villar, Macarena; Cano, María E; Gato, Eva; Garnacho-Montero, José; Miguel Cisneros, José; Ruíz de Alegría, Carlos; Fernández-Cuenca, Felipe; Martínez-Martínez, Luis; Vila, Jordi; Pascual, Alvaro; Tomás, María; Bou, Germán; Rodríguez-Baño, Jesús

    2014-07-01

    Acinetobacter baumannii is one of the most important antibiotic-resistant nosocomial bacteria. We investigated changes in the clinical and molecular epidemiology of A. baumannii over a 10-year period. We compared the data from 2 prospective multicenter cohort studies in Spain, one performed in 2000 (183 patients) and one in 2010 (246 patients), which included consecutive patients infected or colonized by A. baumannii. Molecular typing was performed by repetitive extragenic palindromic polymerase chain reaction (REP-PCR), pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). The incidence density of A. baumannii colonization or infection increased significantly from 0.14 in 2000 to 0.52 in 2010 in medical services (p < 0.001). The number of non-nosocomial health care-associated cases increased from 1.2% to 14.2%, respectively (p < 0.001). Previous exposure to carbapenems increased in 2010 (16.9% in 2000 vs 27.3% in 2010, p = 0.03). The drugs most frequently used for definitive treatment of patients with infections were carbapenems in 2000 (45%) and colistin in 2010 (50.3%). There was molecular-typing evidence of an increase in the frequency of A. baumannii acquisition in non-intensive care unit wards in 2010 (7.6% in 2000 vs 19.2% in 2010, p = 0.01). By MSLT, the ST2 clonal group predominated and increased in 2010. This epidemic clonal group was more frequently resistant to imipenem and was associated with an increased risk of sepsis, although not with severe sepsis or mortality. Some significant changes were noted in the epidemiology of A. baumannii, which is increasingly affecting patients admitted to conventional wards and is also the cause of non-nosocomial health care-associated infections. Epidemic clones seem to combine antimicrobial resistance and the ability to spread, while maintaining their clinical virulence. PMID:25181313

  14. T-cell exhaustion, co-stimulation and clinical outcome in autoimmunity and infection.

    Science.gov (United States)

    McKinney, Eoin F; Lee, James C; Jayne, David R W; Lyons, Paul A; Smith, Kenneth G C

    2015-07-30

    The clinical course of autoimmune and infectious disease varies greatly, even between individuals with the same condition. An understanding of the molecular basis for this heterogeneity could lead to significant improvements in both monitoring and treatment. During chronic infection the process of T-cell exhaustion inhibits the immune response, facilitating viral persistence. Here we show that a transcriptional signature reflecting CD8 T-cell exhaustion is associated with poor clearance of chronic viral infection, but conversely predicts better prognosis in multiple autoimmune diseases. The development of CD8 T-cell exhaustion during chronic infection is driven both by persistence of antigen and by a lack of accessory 'help' signals. In autoimmunity, we find that where evidence of CD4 T-cell co-stimulation is pronounced, that of CD8 T-cell exhaustion is reduced. We can reproduce the exhaustion signature by modifying the balance of persistent stimulation of T-cell antigen receptors and specific CD2-induced co-stimulation provided to human CD8 T cells in vitro, suggesting that each process plays a role in dictating outcome in autoimmune disease. The 'non-exhausted' T-cell state driven by CD2-induced co-stimulation is reduced by signals through the exhaustion-associated inhibitory receptor PD-1, suggesting that induction of exhaustion may be a therapeutic strategy in autoimmune and inflammatory disease. Using expression of optimal surrogate markers of co-stimulation/exhaustion signatures in independent data sets, we confirm an association with good clinical outcome or response to therapy in infection (hepatitis C virus) and vaccination (yellow fever, malaria, influenza), but poor outcome in autoimmune and inflammatory disease (type 1 diabetes, anti-neutrophil cytoplasmic antibody-associated vasculitis, systemic lupus erythematosus, idiopathic pulmonary fibrosis and dengue haemorrhagic fever). Thus, T-cell exhaustion plays a central role in determining outcome in

  15. An Enzymatic Clinical Chemistry Laboratory Experiment Incorporating an Introduction to Mathematical Method Comparison Techniques

    Science.gov (United States)

    Duxbury, Mark

    2004-01-01

    An enzymatic laboratory experiment based on the analysis of serum is described that is suitable for students of clinical chemistry. The experiment incorporates an introduction to mathematical method-comparison techniques in which three different clinical glucose analysis methods are compared using linear regression and Bland-Altman difference…

  16. Clinical review: Noninvasive ventilation in the clinical setting – experience from the past 10 years

    OpenAIRE

    Antonelli, Massimo; Pennisi, Mariano Alberto; Montini, Luca

    2004-01-01

    This brief review analyses the progress of noninvasive ventilation (NIV) over the last decade. NIV has gained the dignity of first line intervention for acute exacerbation of chronic obstructive pulmonary disease, assuring reduction of the intubation rate, rate of infection and mortality. Despite positive results, NIV still remains controversial as a treatment for acute hypoxemic respiratory failure, largely due to the different pathophysiology of hypoxemia. The infection rate reduction effec...

  17. Laboratory diagnosis, clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli: a Chinese consensus statement.

    Science.gov (United States)

    Guan, X; He, L; Hu, B; Hu, J; Huang, X; Lai, G; Li, Y; Liu, Y; Ni, Y; Qiu, H; Shao, Z; Shi, Y; Wang, M; Wang, R; Wu, D; Xie, C; Xu, Y; Yang, F; Yu, K; Yu, Y; Zhang, J; Zhuo, C

    2016-03-01

    Extensively drug-resistant (XDR) Gram-negative bacilli (GNB) are defined as bacterial isolates susceptible to two or fewer antimicrobial categories. XDR-GNB mainly occur in Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. The prevalence of XDR-GNB is on the rise in China and in other countries, and it poses a major public health threat as a result of the lack of adequate therapeutic options. A group of Chinese clinical experts, microbiologists and pharmacologists came together to discuss and draft a consensus on the laboratory diagnosis, clinical management and infection control of XDR-GNB infections. Lists of antimicrobial categories proposed for antimicrobial susceptibility testing were created according to documents from the Clinical Laboratory Standards Institute (CLSI), the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the United States Food and Drug Administration (FDA). Multiple risk factors of XDR-GNB infections are analyzed, with long-term exposure to extended-spectrum antimicrobials being the most important one. Combination therapeutic regimens are summarized for treatment of XDR-GNB infections caused by different bacteria based on limited clinical studies and/or laboratory data. Most frequently used antimicrobials used for the combination therapies include aminoglycosides, carbapenems, colistin, fosfomycin and tigecycline. Strict infection control measures including hand hygiene, contact isolation, active screening, environmental surface disinfections, decolonization and restrictive antibiotic stewardship are recommended to curb the XDR-GNB spread. PMID:26627340

  18. Sporotrichosis in childhood: clinical and therapeutic experience in 25 patients.

    Science.gov (United States)

    Bonifaz, Alexandro; Saúl, Amado; Paredes-Solis, Vanessa; Fierro, Leonel; Rosales, Alejandra; Palacios, Carolina; Araiza, Javier

    2007-01-01

    Sporotrichosis in an uncommon mycoses in childhood and is generally associated with injuries received as a consequence of farm work. We undertook a retrospective study of sporotrichosis in children and adolescents seen over a 10-year period, focusing on their clinical, epidemiologic, and mycologic features as well as treatment. We included 25 children with a mean age of 9.3 years. Most of those affected were schoolchildren (84%) from rural areas. The main clinical variety of sporotrichosis seen was the lymphocutaneous form (64%), followed by the fixed cutaneous form (36%), and one instance of the disseminated cutaneous form. Most lesions were located on the upper limbs (40%) and the face (36%). Sporothrix schenckii was isolated in all patients and 24 of 25 had a positive sporotrichin skin test. Nineteen patients were treated and cured clinically and mycologically with potassium iodide, three were cured with itraconazole and one with heat therapy.

  19. Brazilian experience in EU-CORE: daptomycin registry and treatment of serious Gram-positive infections

    Directory of Open Access Journals (Sweden)

    Artur Timerman

    2013-12-01

    Full Text Available OBJECTIVES: To collect data about non-controlled prescribing use of daptomycin and its impact among Brazilian patients with serious Gram positive bacterial infection, as well as the efficacy and safety outcomes. MATERIALS AND METHODS: This is a multi-center, retrospective, non-interventional registry (August 01, 2009 to June 30, 2011 to collect data on 120 patients (44 patients in the first year and 76 patients in the second year who had received at least one dose of commercial daptomycin in Brazil for the treatment of serious Gram-positive bacterial infection. RESULTS: Right-sided endocarditis (15.8%, complicated skin and soft tissue infections (cSSTIwound (15.0% and bacteremia-catheter-related (14.2% were the most frequent primary infections; lung (21.7% was the most common site for infection. Daptomycin was used empirically in 76 (63.3% patients, and methicillin-resistant Staphylococcus aureus (MRSA was the most common suspected pathogen (86.1%. 82.5% of the cultures were obtained prior to or shortly after initiation of daptomycin therapy. Staphylococcus spp. - coagulase negative, MRSA, and methicillin-susceptible S. aureus were the most frequently identified pathogens (23.8%, 23.8% and 12.5%, respectively. The most common daptomycin dose administered for bacteremia and cSSTI was 6 mg/kg (30.6% and 4 mg/kg (51.7%, respectively. The median duration of inpatient daptomycin therapy was 14 days. Most patients (57.1% did not receive daptomycin while in intensive care unit. Carbapenem (22.5% was the most commonly used antibiotic concomitantly. The patients showed clinical improvement after two days (median following the start of daptomycin therapy. The clinical success rate was 80.8% and the overall rate of treatment failure was 10.8%. The main reasons for daptomycin discontinuation were successful end of therapy (75.8%, switched therapy (11.7%, and treatment failure (4.2%. Daptomycin demonstrated a favorable safety and tolerability profile

  20. Detection of soluble TRAIL in HBV infected patients and its clinical implications

    Institute of Scientific and Technical Information of China (English)

    Li-Hui Han; Wen-Sheng Sun; Chun-Hong Ma; Li-Ning Zhang; Su-Xia Liu; Qiu Zhang; Li-Fen Gao; You-Hai Chen

    2002-01-01

    AIM: To detect the expression of soluble TRAIL (TNF-related apoptosis inducing ligand, TRAIL) in the peripheral blood of HBV infected patients and try to elucidate whether the expression level of sTRAIL have any correlativity with the clinical staging, the expression level of HBV markers and the degree of liver damage.METHODS: 52 cases of HBV infected patients were investigated, induding 8 HBV carriers, 30 chronic hepatitis B, 11 drrhotics and 3 HBV infection related hepatocellular carcinoma. Expression of soluble TRAIL and markers of the hepatitis B were mearsured by enzyme-linked immunosorbent assay.RESULTS: The expression level of sTRAIL in the peripheral blood of the HBV infected patients was significantly higher than that of healthy controls (1378.35±540.23 pg/ml vs 613.75±175.80 pg/ml, P<0.001). In the group of chronic hepatitis, the expression level of sTRAIL was coincident with the status of the disease and was significantly correlated with the level of ALT. In the group of cirrhosis and liver cancer, its expression level was significantly higher than that of the healthy persons and HBV carriers, but lower than that of the hepatitis B patients; meanwhile, the expression of siRAIL did not have any correlativity with the functional indexes of the liver. CONCLUSION: The soluble TRAIL in the HBV infected people may participate in the liver damage. Our results indicated that the expression level of soluble TRAIL may reflect the ravage of liver caused by host immune reaction to a certain degree.

  1. Chronic hepatitis virus infection in patients with multiple myeloma: clinical characteristics and outcomes

    Directory of Open Access Journals (Sweden)

    Chung-Jen Teng

    2011-01-01

    Full Text Available OBJECTIVES: Cytotoxic agents and steroids are used to treat lymphoid malignancies, but these compounds may exacerbate chronic viral hepatitis. For patients with multiple myeloma, the impact of preexisting hepatitis virus infection is unclear. The aim of this study is to explore the characteristics and outcomes of myeloma patients with chronic hepatitis virus infection. METHODS: From 2003 to 2008, 155 myeloma patients were examined to determine their chronic hepatitis virus infection statuses using serologic tests for the hepatitis B (HBV and C viruses (HCV. Clinical parameters and outcome variables were retrieved via a medical chart review. RESULTS: The estimated prevalences of chronic HBV and HCV infections were 11.0% (n = 17 and 9.0% (n = 14, respectively. The characteristics of patients who were hepatitis virus carriers and those who were not were similar. However, carrier patients had a higher prevalence of conventional cytogenetic abnormalities (64.3% vs. 25.0%. The cumulative incidences of grade 3-4 elevation of the level of alanine transaminase, 30.0% vs. 12.0%, and hyperbilirubinemia, 20.0% vs. 1.6%, were higher in carriers as well. In a Kaplan-Meier analysis, carrier patients had worse overall survival (median: 16.0 vs. 42.4 months. The prognostic value of carrier status was not statistically significant in the multivariate analysis, but an age of more than 65 years old, the presence of cytogenetic abnormalities, a beta-2-microglobulin level of more than 3.5 mg/L, and a serum creatinine level of more than 2 mg/ dL were independent factors associated with poor prognosis. CONCLUSION: Myeloma patients with chronic hepatitis virus infections might be a distinct subgroup, and close monitoring of hepatic adverse events should be mandatory.

  2. Preparing an Academic Medical Center to Manage Patients Infected with Ebola: Experiences of a University Hospital

    OpenAIRE

    Schultz, Ch.; Koenig, KL; Alassaf, W

    2015-01-01

    © 2015 Society for Disaster Medicine and Public Health, Inc. As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population's health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered t...

  3. Clinical laboratory, virologic, and pathologic changes in hamsters experimentally infected with Pirital virus (Arenaviridae): a rodent model of Lassa fever.

    Science.gov (United States)

    Sbrana, Elena; Mateo, Rosa I; Xiao, Shu-Yuan; Popov, Vsevolod L; Newman, Patrick C; Tesh, Robert B

    2006-06-01

    The clinical laboratory, virologic, and pathologic changes occurring in hamsters after infection with Pirital virus (Arenaviridae) are described. Pirital virus infection in the hamsters was characterized by high titered viremia, leukocytosis, coagulopathy, pulmonary hemorrhage and edema, hepatocellular and splenic necrosis, and marked elevation of serum transaminase levels. All of the animals died within 9 days. The clinical and histopathological findings in the Pirital virus-infected hamsters were very similar to those reported in severe human cases of Lassa fever, suggesting that this new animal model could serve as a low-cost and relatively safe alternative for studying the pathogenesis and therapy of Lassa fever. PMID:16760527

  4. Dr. Lin Zhu's Clinical Experience in Treating Mental Disorders

    Institute of Scientific and Technical Information of China (English)

    Ma Xueqing; Wang Xinzhong

    2005-01-01

    @@ Mental disorders are mainly caused by the emotional factors. Chief physician Lin Zhu, a famous TCM doctor in Beijing, is very good at treating this kind of disorders. The following is a summary of Prof. Lin's experience in this aspect.

  5. Differences in Clinical Experiences of ADN and BSN Students.

    Science.gov (United States)

    Oermann, Marilyn H.

    1998-01-01

    In a study of 211 associate degree (AD) and 204 baccalaureate nursing students, AD students reported significantly higher stress in clinical practice. Stress for both groups increased as they progressed. Instructors were the predominant source of stress. Students had the most difficulty coping with the demands of patient care and the clinical…

  6. Clinical Experience in TCM Treatment of Chronic Cervicitis

    Institute of Scientific and Technical Information of China (English)

    周宜强; 范宏宇

    2002-01-01

    @@ Chronic cervicitis is a common disease in the female reproductive system, which may be the inducing factor for carcinoma of uterine cervix. It is clinically manifested by sticky and foul leukorrhagia, contact hemorrhage, pain in the lower limbs or lumbosacral region, dysmenorrhea and infertility.

  7. Managing University Clinical Partnership: Learning from International Experience

    Science.gov (United States)

    Davies, Stephen; Smith, Tom

    2004-01-01

    Dialogue between the leaders of academic clinical organisations in different countries has revealed that the core elements of the partnership between universities and health care systems are remarkably consistent across national boundaries. There is now an impetus to move beyond analysis of common challenges and towards strategies for success that…

  8. Clinical forms and outcome of tuberculosis in HIV-infected patients in a tertiary hospital in São Paulo - Brazil

    OpenAIRE

    Giselle Burlamaqui Klautau; Tuba M. Kuschnaroff

    2005-01-01

    Tuberculosis (TB)/HIV co-infection significantly changes the natural history of both diseases. Proper comprehension and clinical management of co-infected TB/HIV patients is still a challenge, particularly in places like Brazil, where both types of infection are prevalent. OBJECTIVES: Evaluate the frequency of the clinical forms of TB in HIV-infected patients; correlate the clinical forms of TB with the level of immunodeficiency; evaluate the response to therapy with different regimens for th...

  9. Infections of cardiovascular implantable electronic devices: 14 years of experience in an Italian hospital.

    Science.gov (United States)

    Salmeri, Mario; Sorbello, Maria Grazia; Mastrojeni, Silvana; Santanocita, Angela; Milazzo, Marina; Di Stefano, Giuseppe; Scalia, Marina; Addamo, Alessandro; Toscano, Maria Antonietta; Stefani, Stefania; Mezzatesta, Maria Lina

    2016-06-01

    The aim of the study was to describe the microbial aetiology of infections from cardiovascular implantable electronic devices (CIEDs) between 2001 and 2014 at The Centro Cuore Morgagni Hospital (Catania, Italy). In this 14-year retrospective study on pacemaker isolates 1,366 patients were evaluated and clinical data were collected. CIEDs were analyzed and isolates tested by routine microbiological techniques. The presence of bacterial biofilm was assessed by means of scanning electron microscopy. Of the patients, fifty-three had catheter-related infections (3.9%), mainly resulting from Staphylococci (4 S. aureus, 32 S. epidermidis, 15 S. hominis, 3 S. haemolyticus, 1 S. warnerii, 1 S. schleiferi, 1 S. lentus and 1 S. capitis) that covered the cardiac catheter with biofilm. Overall, oxacillin-resistance was 55.1%, especially among S. epidermidis, while all isolates were susceptible to vancomycin, teicoplanin, tigecyclin, rifampin, trimethoprim/sulfamethoxazole, linezolid, moxifloxacin, tobramycin and gentamicin. Coagulase-negative staphylococci were the most frequently isolated and S. epidermidis was largely the main single agent. Only four Gram negatives caused polymicrobial infections with Staphylococci. Despite improvements in CIED design and implantation techniques, infection of cardiac devices remains a serious problem. PMID:27367323

  10. Challenges in linking preclinical anti-microbial research strategies with clinical outcomes for device-associated infections

    Directory of Open Access Journals (Sweden)

    TF Moriarty

    2014-09-01

    Full Text Available Infections related to implanted medical devices have become a significant health care issue in recent decades. Increasing numbers of medical devices are in use, often in an aging population, and these devices are implanted against a background of increasing antibiotic-resistant bacterial populations. Progressively more antibiotic resistant infections, requiring ever more refined treatment options, are therefore predicted to emerge with greater frequency in the coming decades. Improvements in the prevention, diagnosis and treatment of these device-associated infections will remain priority targets both for clinicians and the translational research community charged with addressing these challenges. Preclinical strategies, predictive of ultimate clinical efficacy, should serve as a control point for effective translation of new technologies to clinical applications. The development of new anti-infective medical devices requires a validated preclinical testing protocol; however, reliable validation of experimental and preclinical antimicrobial methodologies currently suffers from a variety of technical limitations. These include the lack of agreement or standardisation of experimental protocols, a general lack of correlation between in vitro and in vivo preclinicalresults and lack of validation between in vivo preclinical implant infection models and clinical (human results. Device-associated infections pose additional challenges to practicing clinicians concerning diagnosis and treatment, both of which are complicated by the biofilms formed on the medical device. The critical challenges facing both preclinical research and clinical laboratories in improving both diagnosis and treatment of medical device-associated infections are the focus of this review.

  11. Clinico-Mycological Study Of Superficial Fungal Infection In Children In An Urban Clinic In Kolkata

    Directory of Open Access Journals (Sweden)

    Barbhuiya Joyashree Nath

    2002-01-01

    Full Text Available Seventy children up to the age of 12 years who were suffering from dermatophytosis, candidiasis or pityriasis versicolor were studied clinically and mycologically. Dermatophytosis was the major group, which constituted 52.86% of children. It was followed by candidiasis that constituted 40% of children and pityriasis versicolor was the least, being 7.14% of children. Amongst the clinical types of dermatophytosis, tinea capitis was the commonest (32.43% followed by tinea corporis (27.03%. Candidial intertrigo was the commonest (42.86% from of candidiasis, followed by diaper dermatitis (32.14%. Most susceptible age group was school going children. Peak incidence of infection was during the months of June to September. T rubrum was the commonest dermatophyte isolated in culture. C. albicans was the most common species of candida isolated in culture.

  12. INFECTIVE ENDOCARDITIS IN A RHEUMATOLOGIST’S PRACTICE: ISSUES OF ITS CLINICAL PRESENTATION AND DIAGNOSIS

    Directory of Open Access Journals (Sweden)

    B. S. Belov

    2015-01-01

    Full Text Available At present, the problem of infective endocarditis (IE remains relevant for clinicians of different specialties, including rheumatologists. The distinctive feature of present-day IE is its polyetiological pattern due to a broad spectrum of pathogens. The lecture highlights in detail clinical picture of the disease, laboratory and instrumental findings. It presents current international diagnostic criteria for IE. The obvious clinical polymorphism, subtle symptoms, and monosyndromic onset as masks, all increases the significance of differential diagnosis of IE, in early disease stages in particular. Main approaches to differentiating IE from diseases posing the greatest differentially diagnostic challenges are set forth.

  13. Proton spectroscopy of the brain in HIV infection: correlation with clinical, immunologic, and MR imaging findings.

    Science.gov (United States)

    Chong, W K; Sweeney, B; Wilkinson, I D; Paley, M; Hall-Craggs, M A; Kendall, B E; Shepard, J K; Beecham, M; Miller, R F; Weller, I V

    1993-07-01

    Abnormalities at cerebral proton spectroscopy occur in patients with the acquired immunodeficiency syndrome (AIDS). N-acetyl aspartate (NAA) is believed to be a neuronal marker, and neuronal loss is thought to underlie the human immunodeficiency virus (HIV)-associated cognitive/motor complex. The proton spectra in 103 HIV-seropositive patients and 23 control subjects were compared and correlated with clinical, immunologic, and radiologic measures of HIV infection. Significant (P suppression and neurologic signs. Significant increases in the Cho/Cr ratios were seen in patients with low CD4 lymphocyte counts and abnormal magnetic resonance (MR) images. Reduced NAA ratios correlated with diffuse but not focal MR imaging abnormalities. Combined MR imaging and spectroscopy provides closer relationships to clinical and immunologic measures of disease than either modality alone. Spectroscopy is an adjunct to MR imaging and augments the value of an MR imaging study. PMID:8099750

  14. Filarial-specific antibody response in East African bancroftian filariasis: effects of host infection, clinical disease, and filarial endemicity

    DEFF Research Database (Denmark)

    Jaoko, Walter G; Simonsen, Paul E; Meyrowitsch, Dan W;

    2006-01-01

    The effect of host infection, chronic clinical disease, and transmission intensity on the patterns of specific antibody responses in Bancroftian filariasis was assessed by analyzing specific IgG1, IgG2, IgG3, IgG4, and IgE profiles among adults from two communities with high and low Wuchereria......:IgE ratios were higher in infection-positive individuals than in infection-negative ones, and higher in the high endemicity community than in the low endemicity one. Overall, these results indicate that specific antibody responses in Bancroftian filariasis are more related to infection status than...

  15. Opportunities and Possibilities from Illness: Volunteer Experiences among People Infected with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Lirio del Carmen Gutiérrez Rivera

    2007-07-01

    Full Text Available All illnesses can be interpreted. In the case of HIV/AIDS, experience and interpretation are intercepted by meanings that recluse, insulate and morally expose patients and their social networks. Volunteers stand out in these networks, because they are the only ones that continue to have contact with patients. In many cases, they are stigmatized. This article is about the experience of female volunteers with people infected with HIV/AIDS. The phenomenological experience allows studying their perceptions, verifications and modifications of the disease. The results show the following: first, HIV/AIDS is an opportunity to thank a past event; second, it is an opportunity to construct, through altruism, a space of opportunity for them and their patients; third, HIV/AIDS shows social shortages. Although this experience does not construct political identities or legal discourse, it confronts and inverts negative perceptions of the disease through actions of care whose essential component is love, altruism and brotherhood.

  16. Clinical and microbiological characterization of Clostridium difficile infection in a tertiary care hospital in Shanghai, China

    Institute of Scientific and Technical Information of China (English)

    Dong Danfeng; Peng Yibing; Zhang Lihua; Jiang Cen; Wang Xuefeng; Mao Enqiang

    2014-01-01

    Background Over the last decade,Clostridium difficile infection (CDI) has emerged as a significant nosocomial infection,yet little has been reported from China.This study aimed to characterize the clinical and microbiological features of CDI from a hospital in Shanghai.Methods Patients with CDI seen between December 2010 and March 2013 were included in this study,of which clinical data were retrospectively collected.The microbiological features of corresponding isolates were analyzed including genotype by multi-locus sequence typing (MLST),antimicrobial susceptibility,toxin production,sporulation capacity,biofilm formation,and motility.Results Ninety-four cases of CDI were included during this study period,12 of whom were severe cases.By reviewing the clinical data,all patients were treated empirically with proton pump inhibitor or antibiotics or both,and they were distributed widely across various wards,most frequently to the digestive ward (28/94,29.79%).Comparing the severe with mild cases,no significant differences were found in the basic epidemiological data or the microbiological features.Among the 94 isolates,31 were toxin A-negative toxin B-positive all genotyped as ST37.They generated fewer toxins and spores,as well as similar amounts of biofilm and motility percentages,but exhibited highest drug resistance to cephalosporins,quinolones,macrolide-lincosamide and streptogramin (MLSB),and tetracycline.Conclusions No specific clinical genotype or microbiological features were found in severe cases; antimicrobial resistance could be the primary reason for epidemic strains leading to the dissemination and persistence of CDI.

  17. Juvenile nasopharyngeal angiofibroma: Clinical diagnosis and treatment experience

    Directory of Open Access Journals (Sweden)

    Sladoje Radmila

    2002-01-01

    Full Text Available Juvenile nasopharyngeal angiofibroma is an infrequent epi-pharyngeal tumor necessitating particular diagnostic and therapeutic procedures in comparison to other benign epipharyngeal tumors due to its expansive growth tendency. Our retrospective study is aimed at presenting clinical casuistry of the tumor in order to evaluate modern diagnostic and therapeutic possibilities. The study included 13 male patients, aged 13-24 years, who were hospitalized, diagnostically assessed and surgically treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia over the period 1990 - June 2001. The following parameters were analyzed: sex, age groups, preoperative symptoms of the disease, diagnostic methods, embolization, local tumor spreading, number and time of tumor relapses and surgical approach.

  18. Emphysematous infections of the kidney and urinary tract: A single-center experience

    Directory of Open Access Journals (Sweden)

    Vineet Behera

    2014-01-01

    Full Text Available Emphysematous pyelonephritis (EPN is a group of potentially life-threatening conditions seen particularly in diabetics, leading to high morbidity and mortality. Our aim was to study the profile of emphysematous infections of the kidney and urinary tract and evaluate the effect of early surgical intervention on mortality. This is an observational study conducted in a tertiary care hospital between January 2009 and January 2013, in which the clinical, laboratory, microbiological and radiological profiles of patients with EPN (diagnosed based on clinical, laboratory and imaging findings was studied. A total of 12 patients were studied, including 10 with diabetes. A total of 66.6% had pyelonephritis, 25% had both cystitis and pyelonephritis and 8.3% had only cystitis; involvement of the left kidney was more common and bilateral involvement was seen in two cases. The clinical features seen in the patients included fever (100%, features of urinary infection (66.6% and flank pain (50%. Culture positivity was seen in only 50% of the cases. Ten patients underwent percutaneous drainage (PCD within 24 h, and two of these patients required nephrectomy subsequently. All patients were followed-up for one month. There was one death (mortality 8.3%, and all other patients responded well and reco-vered. Our study suggests that EPN is a potentially life-threatening condition that requires aggressive and prompt medical therapy with early PCD to reduce morbidity and mortality. Nephrectomy should be reserved for cases that do not respond to PCD.

  19. Clinical course of ectopic pregnancy: A single-center experience

    OpenAIRE

    Aqueela Ayaz; Sameh Emam; Mian Usman Farooq

    2013-01-01

    OBJECTIVES: The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP) in a general hospital. MATERIALS AND METHODS: This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome...

  20. The First Experience of Clinical Practice on Psychology Students’ Imaginary

    OpenAIRE

    Sueli Regina Gallo-Belluzzo; Elisa Corbett; Tania Maria Jose Aiello-Vaisberg

    2013-01-01

    Considering the academic development of the psychologist as a complex process which articulates the transmission of scientific knowledge and changes in imaginative activity, we psychoanalytically investigate the collective imaginary of Psychology students regarding the first clinical consultation. We conducted a group interview with 52 undergraduate students, using the Thematic Story-Drawing Procedure as a way to open a dialogical field. The material obtained, through the psychoanalytical met...

  1. A Multi-Center Prospective Derivation and Validation of a Clinical Prediction Tool for Severe Clostridium difficile Infection.

    LENUS (Irish Health Repository)

    Na, Xi

    2015-04-23

    Prediction of severe clinical outcomes in Clostridium difficile infection (CDI) is important to inform management decisions for optimum patient care. Currently, treatment recommendations for CDI vary based on disease severity but validated methods to predict severe disease are lacking. The aim of the study was to derive and validate a clinical prediction tool for severe outcomes in CDI.

  2. Knowledge Management: Experiences in Academic and Clinic Environments

    Directory of Open Access Journals (Sweden)

    Martha Torres Narváez

    2014-05-01

    Full Text Available This article describes the knowledge management practices derived from clinical research, and some hospitals and academic institutions in Colombia. The profile of these institutions and the variables involved in knowledge management and research are presented. Objective: Exploring the practices that some Colombian institutions have to build or strengthen their capacity to con-duct clinical research. Materials and methods: We conducted an exploratory study by consulting a convenience sample, the use of specific practices in knowledge management. In a documentary analysis on knowledge management. The information was obtained of primary sources by semi-structured interview applied to selected key players. Results: In the institutions that participated in the study, it was observed as determinants in knowledge management: structure and strategic management, intellectual capital, technological resources, and the continuity and sustainability of the processes. Conclusion: Include research processes in services delivery institutions is criti¬cal to improving the quality of health care and encourage their intellectual capital. Colombia has institutions working with determination to the generation of knowledge from clinical practice.

  3. Improving biological relevancy of transcriptional biomarkers experiments by applying the MIQE guidelines to pre-clinical and clinical trials.

    Science.gov (United States)

    Dooms, M; Chango, A; Barbour, E; Pouillart, P; Abdel Nour, A M

    2013-01-01

    The "Minimum Information for the Publication of qPCR Experiments" (MIQE [3]) guidelines are very much targeted at basic research experiments and have to our knowledge not been applied to qPCR assays carried out in the context of clinical trials. This report details the use of the MIQE qPCR app for iPhone (App Store, Apple) to assess the MIQE compliance of one clinical and five pre-clinical trials. This resulted in the need to include 14 modifications that make the guidelines more relevant for the assessment of this special type of application. We also discuss the need for flexibility, since while some parameters increase experimental quality, they also require more reagents and more time, which is not always feasible in a clinical setting. PMID:22910527

  4. HIV/Tuberculosis Co-Infection among Patients Attending a Referral Chest Clinic in Nasarawa State, Nigeria

    Science.gov (United States)

    Umeh, E. U.; Ishaleku, D.; Iheukwumere, C. C.

    Human immunodeficiency virus (HIV) and Mycobacterium tuberculosis (TB) coinfection rate was investigated among patients referred to a chest clinic in Nasarawa State, Nigeria. Out of the 344 patients who presented with respiratory problems at the clinic, 44.8% had M. tuberculosis infection, 24.7% HIV infection and 12.8% HIV/tubercle bacilli co-infection. Coinfection rate in HIV infected persons (HIV+) was 51.8 and 28.6% in those with M. tuberculosis infection. The relative risk of HIV positive persons being coinfected was 1.075, while it was 0.401 for TB infected persons. The estimated Odds Ratio (OR) shows that the risk of co-infection was 2.68 times higher among HIV+ persons than among those with tuberculosis. The attributable risk was 45% and shows the extent to which co-infection could be attributed to HIV infection. A key socio-economic variable, eating in groups, was significantly correlated with coinfection (r = 0.107; p< 0.05). The results of this study may provide a useful policy guide in the formulation of HIV and tuberculosis control measures in Nigeria.

  5. A Comparison of a Traditional Clinical Experience to a Precepted Clinical Experience for Baccalaureate-Seeking Nursing Students in Their Second Semester

    OpenAIRE

    Linda Dune; Renae Schumann; Kristin Ownby; David Kohne

    2012-01-01

    The shortage of nursing faculty has contributed greatly to the nursing workforce shortage, with many schools turning away qualified applicants because there are not enough faculty to teach. Despite the faculty shortage, schools are required to admit more students to alleviate the nursing shortage. Clinical groups in which preceptors are responsible for student learning extend faculty resources. Purpose. To determine the effectiveness of an alternative clinical experience (preceptorship). Meth...

  6. [Pregnancy, children, clinical trials and HIV infection. Ethical limitations and therapeutical implications].

    Science.gov (United States)

    Gouveia-Andrade, Luís

    2003-01-01

    In what concerns women and children infected with HIV, clinical investigation related ethical issues are both unavoidable and controversial. Different arguments are presented by different partners, and policies and laws are made in order to protect women and children, who, in spite of all that, keep suffering the effects of all this controversy, protection and legislation. Evidence based Medicine is responsible for new and demanding challenges and the same ethics that requires that new drugs are used only after unquestionable safety and efficacy are presented, tends to protect children, pregnant women and other vulnerable groups from being exposed to investigational drugs. This is why there are so few therapeutical options for HIV-infected children and pregnant women. So, ironically, in times of evidence based medicine, these two special populations are treated in an empirical way, because the same Medicine that wants to protect them, offers wide-open doors to the most terrible infections that mankind has ever faced. In this article, ethical dilemmas, philosophical principles, epidemiological context and different perspectives concerning this painful, yet extremely important, subject will be presented. The purposes will be to broaden horizons, to stimulate discussion and to provide some light into a subject still so restrict, still so unspoken, still so left in the shadows of something that we like to describe as modern medicine.

  7. [Pulmonary vasculitis as a clinical mask of HCV infection: efficiency of interferon-free antiviral therapy].

    Science.gov (United States)

    Stelmakh, V V; Kozlov, V K; Sukhanov, D S; Skipsky, I M

    2014-01-01

    The paper describes a clinical case of pulmonary vasculitis caused by hepatitis C virus (HCV). Its diagnosis was established on the basis of in-depth laboratory testing and an investigation of the molecular biological markers of viremia (polymerase chain reaction--PCR--HCV RNA) in peripheral blood mononuclear cells. By taking into account of extrahepatic HCV replication and contraindications to interferon therapy, the female patient was given an interferon-free antiviral therapy cycle using an interferonogenic inductor in combination with ribavirin. Pathogenic therapy (methylpred and ursodeoxycholic acid) was additionally performed. An interferon-free regimen of cycloferon + ribavirin led to sustained remission of HCV infection running with its systemic manifestations. The therapy could improve the function of not only the liver, but also the lung. In suspected extrahepatic HCV infections, an investigation of molecular biological markers for viremia (HCV RNA PCR) in the peripheral blood mononuclear cells is an essential diagnostic technique. Interferonogenic inductors, cycloferon in particular, should be used in combination with ribavirin when a chronic hepatitis C patient with the extrahepatic manifestations of HCV infection has contraindications to conventional therapy with recombinant interferon-α. PMID:25715495

  8. Circulating Antigens Levels in Different Clinical Forms of the Schistosoma mansoni Infection

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    Yerkes Pereira e Silva

    1999-01-01

    Full Text Available With the aim to evaluate the circulating cathodic antigen (CCA levels in relation to the different clinical phases of Schistosoma sp. infection a sandwich ELISA using monoclonal antibody 5H11 was performed. The sera of three groups of 25 Brazilian patients with acute, intestinal and hepatosplenic forms of S. mansoni infection were tested and compared to a non-infected control group. Patients and control groups were matched for age and sex and the number of eggs per gram of feces was equally distributed among the three patient groups. Sensitivity of 100%, 72%, 52% of the assay was observed for the intestinal, hepatosplenic and acute toxemic groups respectively. The specificity was 100%. Intestinal and hepatosplenic groups presented CCA levels significantly higher in comparison to those observed for acute patients (F-ratio = 2,524; p = 0.000 and F-ratio = 6,314; p = 0.015 respectively. There was no significant difference of CCA serum levels between hepatosplenic and intestinal groups (F-ratio = 1,026; p = 0.316.

  9. Predictive Value of IL-8 for Sepsis and Severe Infections After Burn Injury: A Clinical Study.

    Science.gov (United States)

    Kraft, Robert; Herndon, David N; Finnerty, Celeste C; Cox, Robert A; Song, Juquan; Jeschke, Marc G

    2015-03-01

    The inflammatory response induced by burn injury contributes to increased incidence of infections, sepsis, organ failure, and mortality. Thus, monitoring postburn inflammation is of paramount importance but, so far, there are no reliable biomarkers available to monitor and/or predict infectious complications after burn. As interleukin 8 (IL-8) is a major mediator for inflammatory responses, the aim of our study was to determine whether IL-8 expression can be used to predict postburn sepsis, infections, and mortality. Plasma cytokines, acute-phase proteins, constitutive proteins, and hormones were analyzed during the first 60 days after injury from 468 pediatric burn patients. Demographics and clinical outcome variables (length of stay, infection, sepsis, multiorgan failure [MOF], and mortality) were recorded. A cutoff level for IL-8 was determined using receiver operating characteristic analysis. Statistical significance is set at P Patients were grouped according to their average IL-8 levels relative to this cutoff and stratified into high (H) (n = 133) and low (L) (n = 335) groups. In the L group, regression analysis revealed a significant predictive value of IL-8 to percent of total body surface area burned and incidence of MOF (P inflammatory and acute-phase responses compared with the L group (P burn patients.

  10. Clinical, microbiological and pathological findings of Mycobacterium ulcerans infection in three Australian Possum species.

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    Carolyn R O'Brien

    Full Text Available BACKGROUND: Buruli ulcer (BU is a skin disease caused by Mycobacterium ulcerans, with endemicity predominantly in sub-Saharan Africa and south-eastern Australia. The mode of transmission and the environmental reservoir(s of the bacterium and remain elusive. Real-time PCR investigations have detected M. ulcerans DNA in a variety of Australian environmental samples, including the faeces of native possums with and without clinical evidence of infection. This report seeks to expand on previously published findings by the authors' investigative group with regards to clinical and subclinical disease in selected wild possum species in BU-endemic areas of Victoria, Australia. METHODOLOGY/PRINCIPAL FINDINGS: Twenty-seven clinical cases of M. ulcerans infection in free-ranging possums from southeastern Australia were identified retrospectively and prospectively between 1998-2011. Common ringtail possums (Pseudocheirus peregrinus, a common brushtail possum (Trichosurus vulpecula and a mountain brushtail possum (Trichosurus cunninghami were included in the clinically affected cohort. Most clinically apparent cases were adults with solitary or multiple ulcerative cutaneous lesions, generally confined to the face, limbs and/or tail. The disease was minor and self-limiting in the case of both Trichosurus spp. possums. In contrast, many of the common ringtail possums had cutaneous disease involving disparate anatomical sites, and in four cases there was evidence of systemic disease at post mortem examination. Where tested using real-time PCR targeted at IS2404, animals typically had significant levels of M. ulcerans DNA throughout the gut and/or faeces. A further 12 possums without cutaneous lesions were found to have PCR-positive gut contents and/or faeces (subclinical cases, and in one of these the organism was cultured from liver tissue. Comparisons were made between clinically and subclinically affected possums, and 61 PCR-negative, non-affected individuals

  11. Acute HIV infection (AHI in a specialized clinical setting: case-finding, description of virological, epidemiological and clinical characteristics

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    Adriana Ammassari

    2014-11-01

    Full Text Available Introduction: Diagnosis of HIV infection during early stages is mandatory to catch up with the challenge of limiting HIV viral replication and reservoirs formation, as well as decreasing HIV transmissions by immediate cART initiation. Objectives: Aims were to describe (a virological characteristics of AHI identified, (b epidemiological and clinical factors associated with being diagnosed with AHI. Methods: Cross-sectional, retrospective study. All individuals diagnosed with AHI according to Fiebig's staging between Jan 2013 and Mar 2014 at the INMI “L. Spallanzani” were included. Serum samples reactive to a fourth generation HIV-1/2 assay (Architect HIV Ag/Ab Combo, Abbott were retested with another fourth generation assay (VIDAS DUO HIV Ultra, Biomérieux and underwent confirmation with HIV-1 WB (New Lav I Bio-Rad and/or with Geenius confirmatory assay (Bio-Rad. WHO criteria (two env products reactivity were used to establish positivity of confirmatory assays. In case of clinically suspected AHI, HIV-1 RNA (Real time, Abbott and p24 assay (VIDAS HIV P24 Bio-Rad were also performed. Avidity test was carried out, on confirmed positive samples lacking p31 reactivity, to discriminate between recent (true Fiebig V phase and late infections; to avoid possible misclassifications, clinical data were also used. Demographic, epidemiological, clinical and laboratory data are routinely, and anonymously recorded in the SENDIH and SIREA studies. Results: During the study period, we observed 483 newly HIV diagnosed individuals, of whom 40 were identified as AHI (8.3%. Fiebig classification showed: 7 stage II/III, 13 stage IV, 20 stage V. Demographic, epidemiological, and clinical characteristics of patients are shown in the Table. Overall, the study population had a median S/Co ratio at fourth generation EIA (Architect of 49.50 (IQR, 23.54–98.05: values were significantly lower in Fiebig II-IV than in Fiebig V (38.68 [IQR, 20.08–54.84] vs 75.72 [IQR

  12. Microbiologic characterization of isolates from a dalbavancin clinical trial for catheter-related bloodstream infections.

    Science.gov (United States)

    Goldstein, Beth P; Jones, Ronald N; Fritsche, Thomas R; Biedenbach, Douglas J

    2006-02-01

    Dalbavancin, a new-generation semisynthetic lipoglycopeptide in phase 3 clinical development, has been documented to be more active than vancomycin or teicoplanin against Gram-positive bacteria, including multidrug-resistant strains, by in vitro testing and in animal models. The human pharmacokinetics of dalbavancin predicts efficacy at weekly dosing intervals. In a phase 2 open-label clinical trial, dalbavancin exhibited superiority when compared with vancomycin against catheter-related bloodstream infection (CR-BSI). The majority of pathogens identified in this study as in clinical practice were coagulase-negative staphylococci (CoNS), necessitating rigorous characterization of duplicate isolates to rule out contaminants and to validate cases for study evaluations. At follow-up for the intent-to-treat population, overall pathogen eradication was 92.3% for dalbavancin and 75.9% for vancomycin. We describe the details of organisms isolated, their epidemiologic/genetic characterization, susceptibility patterns against glycopeptides, and the eradication rates by organism group. In conclusion, dalbavancin was active against all isolated pathogens associated with CR-BSI (CoNS, Staphylococcus aureus and Enterococcus faecalis; all MIC results, < or = 0.25 microg/mL) and achieved significant (P < 0.05) clinical success when compared with vancomycin. PMID:16458124

  13. Epidemiology, clinical manifestations, and outcomes of Streptococcus suis infection in humans.

    Science.gov (United States)

    Huong, Vu Thi Lan; Ha, Ngo; Huy, Nguyen Tien; Horby, Peter; Nghia, Ho Dang Trung; Thiem, Vu Dinh; Zhu, Xiaotong; Hoa, Ngo Thi; Hien, Tran Tinh; Zamora, Javier; Schultsz, Constance; Wertheim, Heiman Frank Louis; Hirayama, Kenji

    2014-07-01

    Streptococcus suis, a bacterium that affects pigs, is a neglected pathogen that causes systemic disease in humans. We conducted a systematic review and meta-analysis to summarize global estimates of the epidemiology, clinical characteristics, and outcomes of this zoonosis. We searched main literature databases for all studies through December 2012 using the search term "streptococcus suis." The prevalence of S. suis infection is highest in Asia; the primary risk factors are occupational exposure and eating of contaminated food. The pooled proportions of case-patients with pig-related occupations and history of eating high-risk food were 38.1% and 37.3%, respectively. The main clinical syndrome was meningitis (pooled rate 68.0%), followed by sepsis, arthritis, endocarditis, and endophthalmitis. The pooled case-fatality rate was 12.8%. Sequelae included hearing loss (39.1%) and vestibular dysfunction (22.7%). Our analysis identified gaps in the literature, particularly in assessing risk factors and sequelae of this infection.

  14. Clinical and laboratory observations in 91 dogs infected with Dirofilaria immitis in northern Greece.

    Science.gov (United States)

    Polizopoulou, Z S; Koutinas, A F; Saridomichelakis, M N; Patsikas, M N; Leontidis, L S; Roubies, N A; Desiris, A K

    2000-04-15

    The medical records of 91 dogs with heartworm (Dirofilaria immitis) infection were reviewed, and diagnoses were established by using parasitological and immunological methods. Twenty-one animals were asymptomatic (stage I), 57 had mild to moderate clinical signs (stage II), and 13 had the severe form of the disease including right congestive heart failure and the caval syndrome (stage III). Thoracic radiography revealed right ventricular enlargement in 38 of the dogs, pulmonary vascular enlargement in 43, and parenchymal lesions in 27. Only the cardiac and vascular changes were correlated positively with the clinical stages. D. immitis microfilaraemia was detected in 75 of 85 dogs. Occult infection occurred only in eight stage II and two stage III dogs. Thirty-two of the dogs were treated with thiacetarsamide and 39 were treated with melarsomine, and no differences were found in terms of drug efficacy or complication rate; nine stage II dogs suffered pulmonary thromboembolism and one suffered acute liver disease and there were six fatalities. The 50 treated dogs in stages II and III which were followed up for six months all recovered completely. The performance of 38 of 61 working dogs was completely restored, and the performance of another four was partially restored. PMID:10819132

  15. Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals

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    Stephen Trzeciak MD, MPH

    2016-03-01

    Full Text Available Objective: In 2015, the Centers for Medicare and Medicaid Services (CMS released new summary star ratings for US hospitals based on patient experience. We aimed to test the association between CMS patient experience star ratings and clinical outcomes. Methods: We analyzed risk-adjusted data for more than 3000 US hospitals from CMS Hospital Compare using linear regression. Results: We found that better patient experience was associated with favorable clinical outcomes. Specifically, a higher number of stars for patient experience had a statistically significant association with lower rates of many in-hospital complications. A higher patient experience star rating also had a statistically significant association with lower rates of unplanned readmissions to the hospital within 30 days. Conclusion: Better patient experience according to the CMS star ratings is associated with favorable clinical outcomes. These results support the inclusion of patient experience data in the framework of how hospitals are paid for services.

  16. Medical students' emotional development in early clinical experience: a model.

    Science.gov (United States)

    Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Dornan, Tim; Koopmans, Raymond

    2014-08-01

    Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others. During a first-year nursing attachment in hospitals and nursing homes, students wrote daily about their most impressive experiences, explicitly reporting what they felt, thought, and did. In a subsequent interview, they discussed those experiences in greater detail. Following a grounded theory approach, we conducted a constant comparative analysis, collecting and then interpreting data, and allowing the interpretation to inform subsequent data collection. Impressive experiences set up tensions, which gave rise to strong emotions. We identified four 'axes' along which tensions were experienced: 'idealism versus reality', 'critical distance versus adaptation', 'involvement versus detachment' and 'feeling versus displaying'. We found many factors, which influenced how respondents relieved those tensions. Their personal attributes and social relationships both inside and outside the medical community were important ones. Respondents' positions along the different dimensions, as determined by the balance between attributes and tensions, shaped their learning outcomes. Medical students' emotional development occurs through active participation in medical practice and having impressive experiences within relationships with patients and others on wards. Tensions along four dimensions give rise to strong emotions. Gaining insight into the many conditions that influence students' learning about emotions might support educators and supervisors in fostering medical students' emotional and professional development. PMID:23949724

  17. Elizabethkingia anophelis bacteremia is associated with clinically significant infections and high mortality

    Science.gov (United States)

    Lau, Susanna K. P.; Chow, Wang-Ngai; Foo, Chuen-Hing; Curreem, Shirly O. T.; Lo, George Chi-Shing; Teng, Jade L. L.; Chen, Jonathan H. K.; Ng, Ricky H. Y.; Wu, Alan K. L.; Cheung, Ingrid Y. Y.; Chau, Sandy K. Y.; Lung, David C.; Lee, Rodney A.; Tse, Cindy W. S.; Fung, Kitty S. C.; Que, Tak-Lun; Woo, Patrick C. Y.

    2016-01-01

    Unlike Elizabethkingia meningoseptica, the clinical importance of E. anophelis is poorly understood. We determined the clinical and molecular epidemiology of bacteremia caused by Elizabethkingia-like species from five regional hospitals in Hong Kong. Among 45 episodes of Elizabethkingia-like bacteremia, 21 were caused by Elizabethkingia, including 17 E. anophelis, three E. meningoseptica and one E. miricola; while 24 were caused by other diverse genera/species, as determined by 16S rRNA gene sequencing. Of the 17 cases of E. anophelis bacteremia, 15 (88%) were clinically significant. The most common diagnosis was pneumonia (n = 5), followed by catheter-related bacteremia (n = 4), neonatal meningitis (n = 3), nosocomial bacteremia (n = 2) and neutropenic fever (n = 1). E. anophelis bacteremia was commonly associated with complications and carried 23.5% mortality. In contrast, of the 24 episodes of bacteremia due to non-Elizabethkingia species, 16 (67%) were clinically insignificant. Compared to non-Elizabethkingia bacteremia, Elizabethkingia bacteremia was associated with more clinically significant infections (P < 0.01) and positive cultures from other sites (P < 0.01), less polymicrobial bacteremia (P < 0.01), and higher complication (P < 0.05) and mortality (P < 0.05) rates. Elizabethkingia bacteremia is predominantly caused by E. anophelis instead of E. meningoseptica. Elizabethkingia bacteremia, especially due to E. anophelis, carries significant morbidity and mortality, and should be considered clinically significant unless proven otherwise. PMID:27185741

  18. Regulatory T cell induction during Plasmodium chabaudi infection modifies the clinical course of experimental autoimmune encephalomyelitis.

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    Alessandro S Farias

    Full Text Available BACKGROUND: Experimental autoimmune encephalomyelitis (EAE is used as an animal model for human multiple sclerosis (MS, which is an inflammatory demyelinating autoimmune disease of the central nervous system characterized by activation of Th1 and/or Th17 cells. Human autoimmune diseases can be either exacerbated or suppressed by infectious agents. Recent studies have shown that regulatory T cells play a crucial role in the escape mechanism of Plasmodium spp. both in humans and in experimental models. These cells suppress the Th1 response against the parasite and prevent its elimination. Regulatory T cells have been largely associated with protection or amelioration in several autoimmune diseases, mainly by their capacity to suppress proinflammatory response. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we verified that CD4(+CD25(+ regulatory T cells (T regs generated during malaria infection (6 days after EAE induction interfere with the evolution of EAE. We observed a positive correlation between the reduction of EAE clinical symptoms and an increase of parasitemia levels. Suppression of the disease was also accompanied by a decrease in the expression of IL-17 and IFN-γ and increases in the expression of IL-10 and TGF-β1 relative to EAE control mice. The adoptive transfer of CD4(+CD25(+ cells from P. chabaudi-infected mice reduced the clinical evolution of EAE, confirming the role of these T regs. CONCLUSIONS/SIGNIFICANCE: These data corroborate previous findings showing that infections interfere with the prevalence and evolution of autoimmune diseases by inducing regulatory T cells, which regulate EAE in an apparently non-specific manner.

  19. HIV-1 subtype D infections among Caucasians from Northwestern Poland--phylogenetic and clinical analysis.

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    Miłosz Parczewski

    Full Text Available BACKGROUND: HIV-1 subtype D infections, which are associated with a faster rate of progression and lymphocyte CD4 decline, cognitive deficit and higher mortality, have rarely been found in native Europeans. In Northwestern Poland, however, infections with this subtype had been identified. This study aimed to analyze the sequence and clinical data for patients with subtype D using molecular phylogeography and identify transmission clusters and ancestry, as well as drug resistance, baseline HIV tropism and antiretroviral treatment efficacy. METHODS: Phylogenetic analyses of local HIV-1 subtype D sequences were performed, with time to the most recent common ancestor inferred using bayesian modeling. Sequence and drug resistance data were linked with the clinical and epidemiological information. RESULTS: Subtype D was found in 24 non-immigrant Caucasian, heterosexually infected patients (75% of females, median age at diagnosis of 49.5 years; IQR: 29-56 years. Partial pol sequences clustered monophyletically with the clades of Ugandan origin and no evidence of transmission from other European countries was found. Time to the most common recent ancestor was 1989.24 (95% HPD: 1968.83-1994.46. Baseline drug resistance to nucleoside reverse transcriptase inhibitors was observed in 54.5% of cases (mutations: M41L, K103N, T215S/D with evidence of clustering, no baseline integrase or protease resistance and infrequent non-R5 tropism (13.6%. Virologic failure was observed in 60% of cases and was associated with poor adherence (p<0.001 and subsequent development of drug resistance (p = 0.008, OR: 20 (95%CI: 1.7-290. CONCLUSIONS: Local subtype D represented an independently transmitted network with probably single index case, high frequency of primary drug resistance and evidence of transmission clusters.

  20. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review

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    Antonio M. Esquinas

    2014-12-01

    Full Text Available The aim of this article was to review the role of noninvasive ventilation (NIV in acute pulmonary infectious diseases, such as severe acute respiratory syndrome (SARS, H1N1 and tuberculosis, and to assess the risk of disease transmission with the use of NIV from patients to healthcare workers. We performed a clinical review by searching Medline and EMBASE. These databases were searched for articles on ‘‘clinical trials’’ and ‘‘randomised controlled trials’’. The keywords selected were non-invasive ventilation pulmonary infections, influenza-A (H1N1, SARS and tuberculosis. These terms were cross-referenced with the following keywords: health care workers, airborne infections, complications, intensive care unit and pandemic. The members of the International NIV Network examined the major results regarding NIV applications and SARS, H1N1 and tuberculosis. Cross-referencing mechanical ventilation with SARS yielded 76 studies, of which 10 studies involved the use of NIV and five were ultimately selected for inclusion in this review. Cross-referencing with H1N1 yielded 275 studies, of which 27 involved NIV. Of these, 22 were selected for review. Cross-referencing with tuberculosis yielded 285 studies, of which 15 involved NIV and from these seven were selected. In total 34 studies were selected for this review. NIV, when applied early in selected patients with SARS, H1N1 and acute pulmonary tuberculosis infections, can reverse respiratory failure. There are only a few reports of infectious disease transmission among healthcare workers.

  1. Pathophysiology, clinical manifestation and management of angioedema - our experience

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    Aleksić Aleksandra

    2015-01-01

    Full Text Available Introduction. Angioedema is characterized by subcutaneous and/or submucosal swelling usually localized to the lips, eyelids, tongue, oral cavity, larynx and pharynx. Various types of angioedema, caused by different pathophysiologic mechanisms, can have the same or very similar clinical picture and require different diagnostic and therapeutic procedures. The immediate threat to life as a result of rapidly developed edema of the pharynx and larynx with airway obstruction requires endotracheal intubation or emergency tracheotomy. Standard therapy, which includes epinephrine, second-generation antihistamines and steroids, is not effective in the treatment of all types of angioedema. Objective. On the basis of the clinical presentation and course of angioedema, this retrospective study was aimed at contributing to a better understanding of the etiopathogenesis of the disease and at helping determine the most effective available treatment modalities. Methods. This retrospective study included patients treated under the diagnosis of angioedema of the upper aerodigestive tract between 2000 and 2012 in the Department of Otorhinolaryngology, Clinical Center of Banja Luka. Results. A total of 76 subjects were included in the study. The average age was 62.8 years. There were 40 (52.6% male and 36 (47.4% female patients. The largest number of patients (44.7% had type II angioedema. Almost half of the patients or 36 patients (47.4% were on treatment with an angiotensinconverting enzyme inhibitor (ACEi, but there was no statistically significant difference under the total number of patients (p=0.678. Conclusion. Better understanding of pathophysiologic mechanisms and the adoption of diagnostic protocols contributes to more effective treatment of angioedema.

  2. Antiarrhythmic treatment with flecainide (Tambocor). Clinical experience from 107 patients

    DEFF Research Database (Denmark)

    Frandsen, F; Pless, P; Mickley, H;

    1990-01-01

    The long-term clinical effect of oral flecainide treatment was evaluated in 107 pts (10-82 yrs). Indications for treatment were: atrial fibrillation 38%, atrial flutter 16%, ventricular tachycardia 24%, ventricular ectopic beats 10% and supraventricular tachycardia 12%. Daily flecainide dosage...... pts due to: insufficient effect in 28, side effects in 17 and for other reasons in 5. The side effects indicating flecainide withdrawal (pts) were: cerebral symptoms (4), gastrointestinal complaints (2), bradyarrhythmias (2), heart failure (3) and suspected pro-arrhythmia (4). (Ventricular tachycardia...

  3. Lokomat: Clinical training and experience in a neurorehabilitation hospital

    DEFF Research Database (Denmark)

    Riberholt, Christian Gunge

    2014-01-01

    This presentation aims to give insight into the daily work of walking rehabilitation of patients with severe acquired brain injury (ABI) using the Lokomat© system. The lokomat system offers a high number of repetitions (steps) pr. training session with less physical stress on therapists compared to...... literature lack randomized controlled trials in ABI. Furthermore few trials have specifically investigated the most optimal training strategy for different groups of neurological patients This presentation aims at highlighting some of the strategies and clinical challenges using an evidence-based approach to...

  4. Predictive Value of IL-8 for Sepsis and Severe Infections after Burn Injury - A Clinical Study

    Science.gov (United States)

    Kraft, Robert; Herndon, David N; Finnerty, Celeste C; Cox, Robert A; Song, Juquan; Jeschke, Marc G

    2014-01-01

    The inflammatory response induced by burn injury contributes to increased incidence of infections, sepsis, organ failure, and mortality. Thus, monitoring post-burn inflammation is of paramount importance but so far there are no reliable biomarkers available to monitor and/or predict infectious complications after burn. As IL-8 is a major mediator for inflammatory responses, the aim of our study was to determine whether IL-8 expression can be used to predict post-burn sepsis, infections, and mortality other outcomes post-burn. Plasma cytokines, acute phase proteins, constitutive proteins, and hormones were analyzed during the first 60 days post injury from 468 pediatric burn patients. Demographics and clinical outcome variables (length of stay, infection, sepsis, multiorgan failure (MOF), and mortality were recorded. A cut-off level for IL-8 was determined using receiver operating characteristic (ROC) analysis. Statistical significance is set at (p<0.05). ROC analysis identified a cut-off level of 234 pg/ml for IL-8 for survival. Patients were grouped according to their average IL-8 levels relative to this cut off and stratified into high (H) (n=133) and low (L) (n=335) groups. In the L group, regression analysis revealed a significant predictive value of IL-8 to percent of total body surface area (TBSA) burned and incidence of MOF (p<0.001). In the H group IL-8 levels were able to predict sepsis (p<0.002). In the H group, elevated IL-8 was associated with increased inflammatory and acute phase responses compared to the L group (p<0.05). High levels of IL-8 correlated with increased MOF, sepsis, and mortality. These data suggest that serum levels of IL-8 may be a valid biomarker for monitoring sepsis, infections, and mortality in burn patients. PMID:25514427

  5. Clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei infection

    Institute of Scientific and Technical Information of China (English)

    LU Pu-xuan; ZHU Wen-ke; ZHAN Neng-yong; LIU Yan; CHEN Xin-chun; YE Ru-xin; CAI Li-sheng; ZHU Bo-ping

    2006-01-01

    Objective To investigate the clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei (PM) infection. Methods A total of 12 patients with AIDS complicated with disseminated PM infection were collected and the symptoms, signs, laboratory examination results and image manifestations of these patients were analyzed retrospectively. Results (1) The diagnosis of PM infection in all the 12 cases were confirmed by peripheral blood culture.All the 12 cases (100%) had irregular fever (38-41 ℃) and enlarged lymph nodes, 8 cases (66%) had skin rashes; 8 cases (66%) had hepatomegaly; 9 cases (75%) had splenomegaly while 8 cases (66%) had anemia. (2) Imaging manifestation: Five cases manifested bilateral pulmonary disseminated miliary nodular shadows or lattice signs; 1 case showed enlarged hilar lymph node and 2 zases showed patchy shadow with pleuritis. One case presented sub-pleural curve line shadow at the posterior part of the right lower lung,and adhesion between the intestinal wall and intestinal mesentery in mass form in the abdomen by CT examination. Conclusion Patients suffering from AIDS (CD4T lymphocytes <50/μ L) with impaired immunity might be susceptible to complication of disseminated PM infection, which presents mainly damage of multiple organs and symptoms such as fever; enlargement of liver,spleen and lymph nodes, as well as specific skin maculopapular rashes. Imaging manifestations in the lungs were revealed as miliary nodular shadows and lattice-like shadows. Intensified abdominal CT might reveal presence of several enlarged postperitoneal lymph nodes and intestinal adhesion in shape of "cakes".

  6. Induction Immunosuppression and Clinical Outcomes in Kidney Transplant Recipients Infected With Human Immunodeficiency Virus.

    Science.gov (United States)

    Kucirka, L M; Durand, C M; Bae, S; Avery, R K; Locke, J E; Orandi, B J; McAdams-DeMarco, M; Grams, M E; Segev, D L

    2016-08-01

    There is an increased risk of acute rejection (AR) in human immunodeficiency virus-positive (HIV+) kidney transplant (KT) recipients. Induction immunosuppression is standard of care for those at high risk of AR; however, use in HIV+ patients is controversial, given fears of increased infection rates. We sought to compare clinical outcomes between HIV+ KT recipients who were treated with (i) anti-thymocyte globulin (ATG), (ii) IL-2 receptor blocker, and (iii) no induction. We studied 830 HIV+ KT recipients between 2000 and 2014, as captured in the Scientific Registry of Transplant Recipients, and compared rates of delayed graft function (DGF), AR, graft loss and death. Infections and hospitalizations were ascertained by International Classification of Diseases, Ninth Revision codes in a subset of 308 patients with Medicare. Compared with no induction, neither induction agent was associated with an increased risk of infection (weighted hazard ratio [wHR] 0.80, 95% confidence interval [CI] 0.55-1.18). HIV+ recipients who received induction spent fewer days in the hospital (weighted relative risk [wRR] 0.70, 95% CI 0.52-0.95), had lower rates of DGF (wRR 0.66, 95% CI 0.51-0.84), less graft loss (wHR 0.47, 95% CI 0.24-0.89) and a trend toward lower mortality (wHR 0.60, 95% CI 0.24-1.28). Those who received induction with ATG had lower rates of AR (wRR 0.59, 95% CI 0.35-0.99). Induction in HIV+ KT recipients was not associated with increased infections; in fact, those receiving ATG, the most potent agent, had the lowest rates. In light of the high risk of AR in this population, induction therapy should be strongly considered. PMID:27111897

  7. ‘This wound has spoilt everything’: emotional capital and the experience of surgical site infections

    Science.gov (United States)

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-01-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to ‘germs’ or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system. PMID:25470322

  8. 'This wound has spoilt everything': emotional capital and the experience of surgical site infections.

    Science.gov (United States)

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-11-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to 'germs' or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system.

  9. 'This wound has spoilt everything': emotional capital and the experience of surgical site infections.

    Science.gov (United States)

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-11-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to 'germs' or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system. PMID:25470322

  10. Conducting Family Nursing in Heart Failure outpatient clinics: Nurses experiences

    DEFF Research Database (Denmark)

    Voltelen, Barbara; Konradsen, Hanne; Østergaard, Birte

    Aim: This study aimed to explore what was documented during structured Family Nursing (FN) conversations with patients diagnosed with Heart Failure and their families, and to gain knowledge about the nurses’ experiences conducting FN. Background: Patients with HF face many challenges, and so do...... throughout the FN intervention and a Focus group interview with 6 nurses who were conducting the conversations. Content analyses of all text material dealt with both manifest and latent content, and were analyzed through a deductive and inductive process. Results: Enabling bonding emerged as the overall...... theme for the FN conversations, and was made possible through two subthemes; “strengthening family bonds” and “creating an enabling context for FN”. Conducting the FN conversations was challenging due to the use of new communication skills. Optimal setting, experience, retraining and professional...

  11. Clinical experiences in fungal keratitis caused by Acremonium

    Directory of Open Access Journals (Sweden)

    Kim SJ

    2014-01-01

    Full Text Available Seong-Jae Kim,1,2 Yong-Wun Cho,1 Seong-Wook Seo,1,2 Sun-Joo Kim,2,3 Ji-Myong Yoo1,21Department of Ophthalmology, 2Gyeongsang Institute of Health Science, 3Department of Laboratory Medicine, Gyeongsang National University, College of Medicine, Jinju, KoreaPurpose: To report the predisposing risk factors, clinical presentation, management, and therapeutic outcomes of fungal keratitis caused by Acremonium.Methods: This is a retrospective study of cases with Acremonium fungal keratitis that presented to our tertiary referral center between January 2006 and August 2012. Patient demographic and clinical details were determined and reported.Results: Five cases of fungal keratitis from Acremonium species were identified in five patients (three males, two females. The mean age of the patients was of 73.4±5.46 years, with a mean follow-up time of 124±72 days. All patients had a history of corneal trauma with vegetable matter. Four cases were unresponsive to initial treatment (0.2% fluconazole, 0.15% amphotericin B and required topical 5% natamycin, and, in two out of five cases, topical 1% voriconazole.Conclusion: The most common risk factors for Acremonium fungal keratitis was ocular trauma. When a corneal lesion is found to be unresponsive to the initial treatment, we should consider adding or substituting topical natamycin or voriconazole for treatment.Keywords: Acremonium, fungal keratitis, natamycin, prognosis, voriconazole

  12. Nursing experience in clinical endovascular treatment for renal artery aneurysms

    International Nuclear Information System (INIS)

    Objective: To discuss the standardized clinical nursing measures for patients receiving endovascular treatment of renal artery aneurysms. Methods: The clinical data of 9 patients with renal artery aneurysm, who were admitted to authors' hospital during the period from Jan. 2010 to Aug. 2011 and received endovascular treatment, were retrospectively analyzed. The related nursing points as well as the received endovascular. Results: A total of 9 cases with renal artery aneurysm were treated nursing measures were summarized. Results: A total of 9 cases with renal artery aneurysm were with interventional management, including embolization (n = 6), stent implantation (n = 2) and stent implantation together with coil embolization (n = 1). The mean hospitalization time was (10±2) days. Postoperative retention of urine was observed in one patient and postoperative retroperitoneal hemorrhage occurred in another patient. Neither nursing-related nor operation-related complications occurred. Conclusion: Standardized perioperative nursing care for patients with renal artery aneurysm can surely help enhance the patient's tolerance to the surgery, and effectively prevent the complications. (authors)

  13. [First clinical experiences with ceramic ball attachments for overdentures].

    Science.gov (United States)

    Büttel, Adrian E; Schmidli, Fredy; Marinello, Carlo P; Lüthy, Heinz

    2008-01-01

    In this prospective clinical study on 40 patients with similar clinical conditions (edentulous jaw with 2 interforaminal implants) commercially available ceramic ball attachments (ruby) were compared to commercial titanium ball attachments. The primary aim of the study was to measure the wear of the ball attachments after being 1 year in function. However, in the course of the study already after 7 to 12 months multiple failures with ceramic ball attachments occurred. Twelve (28%) of 43 ceramic ball attachments had to be replaced, mostly because of fractures (8) of the ceramic ball. It seems that ceramic ball attachments of the investigated design are not able to withstand normal intraoral stresses. The short-term susceptibility to fractures didn't allow to examine the ceramic-inherent features such as compressive strength and wear resistance. Furthermore, a secure connection between a titan base and a ceramic ball seems to be challenging. Based on these results, in implant-retained removable prosthesis the use of metal-based retainers is still recommended, although during maintenance a higher wear has to be expected. This wear can be compensated by either activating or changing the matrix or the patrix. PMID:18293602

  14. [Enterovirus nosocomial infections in a neonatal care unit: from diagnosis to evidence, from a clinical observation of a central nervous system infection].

    Science.gov (United States)

    Farcy, C; Mirand, A; Marque Juillet, S; Henquell, C; Neulier, C; Foucaud, P; Peigue-Lafeuille, H

    2012-09-01

    Although enteroviruses generally cause asymptomatic or mild disease, neonates are at higher risk for severe illnesses, among which systemic disease characterized by multiorgan involvement is a potentially fatal condition. Enterovirus neonatal infections may be the source of nosocomial infections in neonatology or in pediatric intensive care units. We report central nervous system infections due to Echovirus 11 in two neonates and the molecular evidence of nosocomial transmission of this strain in a neonatal unit by enterovirus genotyping and phylogenetic analysis. This report illustrates the importance of including enterovirus genome detection in the sepsis screening concomitantly with bacteriological investigations performed at admission of a neonate. Rapid diagnosis and subsequent genotyping could have a beneficial impact on clinical practices at the individual level (reducing the length of antibiotic therapy) and public health policy at the collective level by reinforcing hygiene measures to prevent nosocomial infections, with nurseries and neonatal units being at greater risks.

  15. Translating comparative effectiveness research into clinical practice: the UK experience.

    Science.gov (United States)

    Walley, Tom

    2012-01-22

    Comparative effectiveness research (CER) is not new but its potential to improve the effectiveness of healthcare has not yet been exploited in the US. Other countries such as the UK have more experience of this. Key points of the UK experience are summarized here and some possible pointers for the US are drawn. These include the following: how to go beyond the evidence and apply judgements to make recommendations with authority and in a timely manner; how to implement these recommendations; how to identify suitable topics; and how to be open and transparently fair to all stakeholders. The quality of the science of CER is key but this needs developing, and not just in biomedical or statistical terms but also in how to understand public expectations, and how to implement its recommendations. A key issue is the role of health economics, which seems to have been marginalized by the CER legislation, but perhaps this is more apparent than real. Clearly this is a matter for much further debate. It is hard to see how CER can deliver its potential without active consideration of both benefits and costs. Although other countries have more experience of this than does the US, the context for such work is always very specific and the US will have to find its own way, while trying to avoid some of the errors made elsewhere. PMID:22268389

  16. Clinical presentation, convalescence, and relapse of rocky mountain spotted fever in dogs experimentally infected via tick bite.

    Directory of Open Access Journals (Sweden)

    Michael L Levin

    Full Text Available Rocky Mountain spotted fever (RMSF is a tick-borne disease caused by R. rickettsii in North and South America. Domestic dogs are susceptible to infection and canine RMSF can be fatal without appropriate treatment. Although clinical signs of R. rickettsii infection in dogs have been described, published reports usually include descriptions of either advanced clinical cases or experimental infections caused by needle-inoculation of cultured pathogen rather than by tick bite. The natural progression of a tick-borne R. rickettsii infection has not been studied in sufficient detail. Here, we provide a detailed description of clinical, hematological, molecular, and serological dynamics of RMSF in domestic dogs from the day of experimental exposure to infected ticks through recovery. Presented data indicate that neither the height/duration of fever nor detection of rickettsial DNA in dogs' blood by PCR are good indicators for clinical prognosis. Only the apex and subsequent subsidence of neutrophilia seem to mark the beginning of recovery and allow predicting a favorable outcome in Rickettsia-infected dogs, even despite the continuing persistence of mucosal petechiae and skin rash. On the other hand the appropriate (doxycycline antibiotic therapy of sufficient duration is crucial in prevention of RMSF relapses in dogs.

  17. Clinical presentation, convalescence, and relapse of rocky mountain spotted fever in dogs experimentally infected via tick bite.

    Science.gov (United States)

    Levin, Michael L; Killmaster, Lindsay F; Zemtsova, Galina E; Ritter, Jana M; Langham, Gregory

    2014-01-01

    Rocky Mountain spotted fever (RMSF) is a tick-borne disease caused by R. rickettsii in North and South America. Domestic dogs are susceptible to infection and canine RMSF can be fatal without appropriate treatment. Although clinical signs of R. rickettsii infection in dogs have been described, published reports usually include descriptions of either advanced clinical cases or experimental infections caused by needle-inoculation of cultured pathogen rather than by tick bite. The natural progression of a tick-borne R. rickettsii infection has not been studied in sufficient detail. Here, we provide a detailed description of clinical, hematological, molecular, and serological dynamics of RMSF in domestic dogs from the day of experimental exposure to infected ticks through recovery. Presented data indicate that neither the height/duration of fever nor detection of rickettsial DNA in dogs' blood by PCR are good indicators for clinical prognosis. Only the apex and subsequent subsidence of neutrophilia seem to mark the beginning of recovery and allow predicting a favorable outcome in Rickettsia-infected dogs, even despite the continuing persistence of mucosal petechiae and skin rash. On the other hand the appropriate (doxycycline) antibiotic therapy of sufficient duration is crucial in prevention of RMSF relapses in dogs. PMID:25542001

  18. Clinical Evaluation of ERCP and Naobiliary Drainage for Biliary Fungal Infection--A Report of Five Cases of Severe Combined Bacterial and Fungal Infection of Biliary Tract

    Institute of Scientific and Technical Information of China (English)

    ZHAO Qiu; LIAO Jiazhi; QIN Hua; WANG Jialong

    2005-01-01

    This study studied the use of ERCP and nasobiliary tube in the diagnosis of fungal infection of biliary tract and the efficacy of combined use of local administration via nasobiliary tube and intravenous antifungal treatment for severe biliary tract fungal infection. 5 patients in our series,with age ranging from 47 to 68 y (mean 55.8), were diagnosed as having mixed bacterial and fungal infection of biliary tract as confirmed by smear or/and culture of bile obtained by ERCP and nasobiliary drainage. Besides routine anti-bacteria therapy, all patients received local application of fluconazole through nasobiliary tube and intravenous administration of fluconazole or itraconazole in terms of the results of in vitro sensitivity test. The mean duration of intravenous fluconazole or itraconazole was 30 days (24-40 days), and that of local application of fluconazole through nasobiliary drainage tube was 19 days (8-24 days). During a follow-up period of 3-42 months, all patient's fungal infection of biliary tract was cured. It is concluded that on the basis of typical clinical features of biliary tract infection, fungal detection of smear/culture of bile obtained by ERCP was the key for the diagnosis of fungal infection of biliary tract. Local application antifungal drug combined with intravenous anti-fungal drugs might be an effective and safe treatment for fungal infection of biliary tract.

  19. Mycoplasma bovis infections and co-infections with other Mycoplasma spp. with different clinical manifestations in affected cattle herds in eastern region of Poland

    Directory of Open Access Journals (Sweden)

    Szacawa Ewelina

    2015-09-01

    Full Text Available The aim of the study was to evaluate the presence of Mycoplasma bovis infection and co-infections with other Mycoplasma spp. infections in cattle. The tested population was one in the eastern region of Poland containing 66 dairy cows and 23 calves showing different clinical signs and suffering from pneumonia, mastitis, and arthritis. The incidence of M. bovis in co-infections with other Mycoplasma spp. was examined using serological traditional mycoplasma culture methods, and the molecular methods - PCR and polymerase chain reaction/denaturing gradient gel electrophoresis (PCR/DGGE. The PCR/DGGE method for detecting Mycoplasma spp. in cattle was used for the first time in Poland. The seroprevalence of M. bovis in the affected cattle herds in the eastern region of Poland was 47.8% in calves and 19.7% in dairy cows. The direct detection and identification of M. bovis from nasopharyngeal swabs by PCR revealed that 56.5% of calves were positive, but all of the dairy cows were negative. The PCR/DGGE identified eight (34.8% instances of M. arginini and eight (26.1% instances of M. bovirhinis co-infecting with M. bovis in ten calves. The seroprevalence of M. bovis in the tested population was 33.7%. Any future attempts to control mycoplasma infections require an insight into the current epidemiological situation of M. bovis infection and its relationship to other mycoplasmas in causing clinical disease in cattle. Using these diagnostic methods we have demonstrated that mycoplasmal infections are often caused by multiple species of Mycoplasma and not just the primary M. bovis pathogen.

  20. Clinical Experience in Acupuncture Treatment of Allergic Rhinitis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yan-qiu

    2009-01-01

    Objective:To observe the clinical effects of acupuncture for allergic rhinitis.Methods:The body acupuncture, auricular seed-embedding and microwave irradiation were adopted for treatment of allergic rhinitis due to various causative factors, such as cold and insufficiency of the lung-qi weakening the body resistance, insufficiency of the spleen-qi with lucid yang failing to rise, insufficiency of the kidney-yang failing to warm the body surface, and the heat accumulated in the lung channels giving invading the nose.Results:After treatment, the symptoms and signs disappeared in all illustrative cases, with no recurrence found after a one-year follow-up.Conclusion:Acupuncture may help to improve the blood rheology indexes with an increased volume of blood flow, and regulate the immunological function of the human body, thus giving therapeutic effects for allergic rhinitis.

  1. Clinical Experience in Application of the Point Wangu

    Institute of Scientific and Technical Information of China (English)

    杨西永

    2002-01-01

    Wangu (GB 12) is a point of the Gallbladder Channel of Foot Shaoyang, located in the depression posteroinferior to the temporal process. And it is a hui point of Foot Taiyang and Shaoyang Channels, with the effects of eliminating pathogenic wind and heat, and tranquilizing the mind. This point is located superior to the attachment point of the sternocleidomastoid muscle, in which there distribute the stem of the lesser occipital nerve, and branches of the posterior auricular artery and vein. It can be needled perpendicularly 0.5-1 cun deep. In clinical practice, the author has applied the point for treatment of various diseases, and obtained quite satisfactory therapeutic results. The following is a report of some illustrative cases.

  2. Selecting clinical diagnoses: logical strategies informed by experience.

    Science.gov (United States)

    Stanley, Donald Edward; Campos, Daniel G

    2016-08-01

    This article describes reasoning strategies used by clinicians in different diagnostic circumstances and how these modes of inquiry may allow further insight into the evaluation and treatment of patients. Specifically, it aims to make explicit the implicit logical considerations that guide a variety of strategies in the diagnostic process, as exemplified in specific clinical cases. It focuses, in particular, in strategies that clinicians use to move from a large set of possible diagnoses initially suggested by abductive inferences - the process of hypothesis generation that creates a diagnostic space - to a narrower set or even to a single 'best' diagnosis, where the criteria to determine what is 'best' may differ according to different strategies. Experienced clinicians should have a diversified kit of strategies - for example, Bayesian probability or inference to a lovely explanation - to select from among previously generated hypotheses, rather than rely on any one approach every time.

  3. Experience in the Clinical Application of Naokong (GB19)

    Institute of Scientific and Technical Information of China (English)

    陆汎

    2005-01-01

    @@ Naokong (GB19) is located 1.5 cun above Fengchi (GB20) and at the level with Naohu (GV17) in the depression of the lateral side of the external occipital protuberance. It belongs to the Gallbladder Channel of Foot Shaoyang, and is a crossing point of the Foot Shaoyang Channel and the Yangwei Channel. As is said in A Collection of Gems in Acupuncture and Moxibustion, Naokong (GB19) is indicated for emaciation due to over strain and stress, fever, neck rigidity, unbearable pain in the head, heavy eyes and palpitation as well as xenophthalmia and rhinalgia caused by epileptic seizure in severe cases. In clinical practice, the author has adopted Naokong (GB 19) as the main point in treating some obstinate diseases and obtained quite good therapeutic effects.

  4. [Subantral augmentation with porous titanium in experiment and clinic].

    Science.gov (United States)

    Sirak, S V; Shchetinin, E V; Sletov, A A

    2016-01-01

    The article discusses the use of porous titanium for subantral augmentation. Experimental study was conducted on 12 yearling rams. Subantral augmentation using porous titanium was performed in 33 patients. In the control group consisting of 14 patients calcium phosphates and bone collagen based agents ("Bio-Оss" and "Collost") were used. In the main and control groups 46 and 32 implant were placed, respectively. Pilot histological and clinical studies proved that the granules of porous titanium are biocompatible with bone tissue, provide the optimal surface microrelief, thus creating good conditions for adhesion, expansion and migration of osteoforming cells, have negligible kinetics of resorption, are porous to ensure effective neovascularization of de novo formed bone tissue. Porous titanium is an effective alternative material for subantral bone augmentation for dental implantation and reconstructive operations on the maxillary sinus.

  5. [Subantral augmentation with porous titanium in experiment and clinic].

    Science.gov (United States)

    Sirak, S V; Shchetinin, E V; Sletov, A A

    2016-01-01

    The article discusses the use of porous titanium for subantral augmentation. Experimental study was conducted on 12 yearling rams. Subantral augmentation using porous titanium was performed in 33 patients. In the control group consisting of 14 patients calcium phosphates and bone collagen based agents ("Bio-Оss" and "Collost") were used. In the main and control groups 46 and 32 implant were placed, respectively. Pilot histological and clinical studies proved that the granules of porous titanium are biocompatible with bone tissue, provide the optimal surface microrelief, thus creating good conditions for adhesion, expansion and migration of osteoforming cells, have negligible kinetics of resorption, are porous to ensure effective neovascularization of de novo formed bone tissue. Porous titanium is an effective alternative material for subantral bone augmentation for dental implantation and reconstructive operations on the maxillary sinus. PMID:26925568

  6. Evidence of protection against clinical and chronic hepatitis B infection 20 years after infant vaccination in a high endemicity region.

    Science.gov (United States)

    Poovorawan, Y; Chongsrisawat, V; Theamboonlers, A; Leroux-Roels, G; Kuriyakose, S; Leyssen, M; Jacquet, J-M

    2011-05-01

    Vaccination against hepatitis B virus (HBV) immediately after birth prevents neonatal infection by vertical transmission from HBV carrier mothers. There is an ongoing debate whether infant vaccination is sufficient to protect against infection when exposed to HBV later in life. We studied 222 Thai infants born to HBsAg -/+ and HBeAg -/+ mothers who were vaccinated with recombinant hepatitis B vaccine at 0-1-2-12 months of age. A subset of 100 subjects received a booster dose at age 5 years. Blood samples collected yearly for 20 years were examined for anti-HBs antibodies and serological markers of hepatitis B infection (anti-HBc, HBsAg, and in selected cases HBeAg, anti-HBe, HBV DNA). During the 20-year follow-up, no subject acquired new chronic HBV infection or clinical hepatitis B disease. During the first decade, possible subclinical breakthrough HBV infection (anti-HBc seroconversion) was only observed in subjects born to HBsAg +/HBeAg + mothers (6/49 [12.2%]). During the second decade, breakthrough HBV infections were detected in all groups (18/140 [12.8%]). Increases in anti-HBs concentrations that were unrelated to additional HBV vaccination or infection were detected in approximately 10% of subjects in each decade. Primary infant vaccination with a recombinant hepatitis B vaccine confers long-term protection against clinical disease and new chronic hepatitis B infection despite confirmed hepatitis B exposure. PMID:20384962

  7. Factors in Dry Period Associated with Intramammary Infection and Subsequent Clinical Mastitis in Early Postpartum Cows

    Science.gov (United States)

    Leelahapongsathon, Kansuda; Piroon, Tipapun; Chaisri, Wasana; Suriyasathaporn, Witaya

    2016-01-01

    The objective of this study was to determine cow characteristics and farm management factors during the dry period associated with early postparturient intramammary infection (IMI) and subsequent clinical mastitis (CM). Data were collected three times: before drying off (P1), during the dry period (P2), and 5 to 14 days after calving (P3), using questionnaires and farm investigation. Milk samples were aseptically collected for bacterial identification at P1 and P3. Factors associated with IMI and CM were analyzed using multiple logistic regression models. The final model showed that IMI in early postpartum was significantly associated with full insertion of dry cow antibiotic, dry cows in barns with a combination of tie and free stalls, body condition score (BCS) in dry period and after calving, and milk yield before drying off. For IMI cows, factors significantly associated with clinical expression of mastitis were having daily barn cleaning, teat disinfected with alcohol before administration of dry cow therapy, BCS before drying off, milk yield before drying off, and days in milk at drying off. In conclusion, both cow and farm management factors are associated with the IMI rate and subsequent expression of clinical signs of mastitis in early postpartum cows. PMID:26949960

  8. Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium.

    Science.gov (United States)

    Somers, Annemie; Claus, Barbara; Vandewoude, Koen; Petrovic, Mirko

    2016-03-01

    This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers. PMID:26922733

  9. Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium.

    Science.gov (United States)

    Somers, Annemie; Claus, Barbara; Vandewoude, Koen; Petrovic, Mirko

    2016-03-01

    This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers.

  10. EPID based in vivo dosimetry system: clinical experience and results.

    Science.gov (United States)

    Celi, Sofia; Costa, Emilie; Wessels, Claas; Mazal, Alejandro; Fourquet, Alain; Francois, Pascal

    2016-01-01

    Mandatory in several countries, in vivo dosimetry has been recognized as one of the next milestones in radiation oncology. Our department has implemented clinically an EPID based in vivo dosimetry system, EPIgray, by DOSISOFT S.A., since 2006. An analysis of the measurements per linac and energy over a two-year period was performed, which included a more detailed examination per technique and treat-ment site over a six-month period. A comparison of the treatment planning system doses and the doses estimated by EPIgray shows a mean of the differences of 1.9% (± 5.2%) for the two-year period. The 3D conformal treatment plans had a mean dose difference of 2.0% (± 4.9%), while for intensity-modulated radiotherapy and volumetric-modulated arc therapy treatments the mean dose difference was -3.0 (± 5.3%) and -2.5 (± 5.2%), respectively. In addition, root cause analyses were conducted on the in vivo dosimetry measurements of two breast cancer treatment techniques, as well as prostate treatments with intensity-modulated radiotherapy and volumetric-modulated arc therapy. During the breast study, the dose differences of breast treatments in supine position were correlated to patient setup and EPID positioning errors. Based on these observations, an automatic image shift correc-tion algorithm is developed by DOSIsoft S.A. The prostate study revealed that beams and arcs with out-of-tolerance in vivo dosimetry results tend to have more complex modulation and a lower exposure of the points of interest. The statistical studies indicate that in vivo dosimetry with EPIgray has been successfully imple-mented for classical and complex techniques in clinical routine at our institution. The additional breast and prostate studies exhibit the prospects of EPIgray as an easy supplementary quality assurance tool. The validation, the automatization, and the reduction of false-positive results represent an important step toward adaptive radiotherapy with EPIgray. PMID:27167283

  11. Evaluation of mupirocin ointment in control of central venous catheter related infections: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Rezaei J

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Central venous catheter (CVC related infections are important complications of cathter application. This study assessed the usefulness of mupirocin in prevention and control of these infections."n"nMethods: In this randomized clinical trial, consecutive surgical patients requiring central venous catheter (for more than 2 days in Amir-Alam Hospital from 2006-2008 were enrolled. Patients were divided in two groups; in "case group" patients received topical mupirocin 2% every 48 hours at the time of insertion of catheter and dressing change and for "control group" mupirocin was not used. All of the patients received chlorhexidine and enoxoparin as complementary treatments. Two groups were comparable in regard of age, sex and risk factors."n"nResults: One hundred eighteen patients enrolled in the study (57 in case and 61 in control group completed the study. 84 catheters in case group and 88 catheters in control group were inserted. The catheters in 90% of patients were inserted in jugular vein. At the end of study 29(16.8% patients (16 in control versus 13 in case group had catheter colonization (p=NS. Catheter related bloodstream infection was observed in 16(9.3% patients (6 in

  12. Vitamin D deficiency in a cohort of HIV-infected patients: clinical analysis

    Directory of Open Access Journals (Sweden)

    B Vandercam

    2012-11-01

    Full Text Available Purpose of the study: Observational studies have noted very high rates of low serum 25-hydroxyvitamin D [25(OHD3] levels in both general and HIV-infected populations. In HIV-infected patients, low 25(OHD3 levels are secondary to a combination of usual risk factors and HIV-specific risk factors, like antiretroviral therapy [1]. The objective of our study is to analyse the magnitude of vitamin D deficiency or insufficiency and the role of various factors such as age, sex, ethnicity, season, and antiretroviral medications in our cohort of HIV-infected patients. Methods: We prospectively collected data on 25-hydroxyvitamin D levels sampled between January 2009 and June 2011 from our cohort of 930 HIV-infected patients. Vitamin D dosage was performed using immunoassay (‘Diasorin’ - Saluggia, Italy. We divided vitamin D levels into 3 categories: 25-hydroxyvitamin D levels <20 mg/nl were considered deficient, insufficient between 20 and 29 ng/ml. Levels ≥30 ng/ml were defined as normal [2]. Data on demographic features (age, ethnicity, season, heterosexuality vs homosexuality, clinical features and laboratory findings (CD4 cell count, viral load, HAART, BMI were collected from patients’ medical records using our institutional database ‘Medical explorer v3r9, 2009’. Summary of results: Overall, 848 patients were included in our study (Table 1. Low levels of serum 25(OHD3 were seen in 89.3% of the study population, from which 69.5% were deficient and 19.8% were insufficient. On univariate analysis, female sex, high BMI, black African, heterosexuality, undetectable viral load and antiretroviral treatment were all predictors of vitamin D deficiency and insufficiency. Treatment with efavirenz and tenofovir were the most associated with low vitamin D levels. On multivariate analysis (multiple linear regression model only female sex (OR=1.14; 95% CI 0.84–0.96; p<0.001, dosage during winter months (OR=1.14; 95% CI 1–1.15; p<0.05 and HAART (OR=1

  13. Immune reconstitution inflammatory syndrome in HIV-infected patients receiving antiretroviral therapy : pathogenesis, clinical manifestations and management

    DEFF Research Database (Denmark)

    Dhasmana, Devesh J; Dheda, Keertan; Ravn, Pernille;

    2008-01-01

    The use of antiretroviral therapy (ART) to treat HIV infection, by restoring CD4+ cell count and immune function, is associated with significant reductions in morbidity and mortality. Soon after ART initiation, there is a rapid phase of restoration of pathogen-specific immunity. In certain patients......, this results in inflammatory responses that may result in clinical deterioration known as 'the immune reconstitution inflammatory syndrome' (IRIS). IRIS may be targeted at viable infective antigens, dead or dying infective antigens, host antigens, tumour antigens and other antigens, giving rise...... to a heterogeneous range of clinical manifestations. The commonest forms of IRIS are associated with mycobacterial infections, fungi and herpes viruses. In most patients, ART should be continued and treatment for the associated condition optimized, and there is anecdotal evidence for the use of corticosteroids...

  14. Student Pharmacists’ Clinical Interventions in Advanced Pharmacy Practice Experiences at a Community Nonteaching Hospital

    OpenAIRE

    Shogbon, Angela O.; Lundquist, Lisa M.

    2014-01-01

    Objective. To assess student pharmacists’ clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used.

  15. 42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

    Science.gov (United States)

    2010-10-01

    ... center. (3) A pancreas transplant center is not required to comply with the clinical experience... pancreas transplants performed at the center. (4) A center that is requesting initial Medicare approval...

  16. The significance of clinical experience on learning outcome from resuscitation training-a randomised controlled study

    DEFF Research Database (Denmark)

    Jensen, Morten Lind; Lippert, Freddy; Hesselfeldt, Rasmus;

    2008-01-01

    CONTEXT: The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. AIM: To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome ...... but statistically significant impact on the retention of learning, but not on the immediate learning outcome Udgivelsesdato: 2008/12/4......CONTEXT: The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. AIM: To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome...... and retention of learning. MATERIALS AND METHODS: This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS...

  17. Minimally invasive transforaminal lumbar interbody fusion—indications and clinical experience

    Directory of Open Access Journals (Sweden)

    Akshay Hari

    2016-01-01

    Conclusions: Our clinical experience along with a review of the medical literature indicates that TLIF can be effectively and safely performed in a minimally invasive fashion for a wide variety of indications.

  18. Summary on Clinical Experience of Acupuncture Treating Dry Eye Syndromes

    Institute of Scientific and Technical Information of China (English)

    马晓芃; 杨玲; 莫文权; 施征; 赵粹英

    2009-01-01

    @@ Dry eye syndromes(DES)refer to discomfort in the eye region,visual disturbance,poor stability of lacrimal film,inflammation of eve surface and its potential iniury due to many factors of abnonnal lacrimation[1].Patients with this condition can experience a dry sensation in the eyes,foreign body sensation,burning and itching sensation in the eyes,and blurred vision.The lingering pathological change can lead to decreased transparency of the cornea and hypopsia,affecting the work,study and life,and even resulting in blindness.With popularization of computers,and change in lifestyles,the incidence of DES rises gradually and tends to occur in young age.

  19. [Brain-Computer Interface: the First Clinical Experience in Russia].

    Science.gov (United States)

    Mokienko, O A; Lyukmanov, R Kh; Chernikova, L A; Suponeva, N A; Piradov, M A; Frolov, A A

    2016-01-01

    Motor imagery is suggested to stimulate the same plastic mechanisms in the brain as a real movement. The brain-computer interface (BCI) controls motor imagery by converting EEG during this process into the commands for an external device. This article presents the results of two-stage study of the clinical use of non-invasive BCI in the rehabilitation of patients with severe hemiparesis caused by focal brain damage. It was found that the ability to control BCI did not depend on the duration of a disease, brain lesion localization and the degree of neurological deficit. The first step of the study involved 36 patients; it showed that the efficacy of rehabilitation was higher in the group with the use of BCI (the score on the Action Research Arm Test (ARAT) improved from 1 [0; 2] to 5 [0; 16] points, p = 0.012; no significant improvement was observed in control group). The second step of the study involved 19 patients; the complex BCI-exoskeleton (i.e. with the kinesthetic feedback) was used for motor imagery trainings. The improvement of the motor function of hands was proved by ARAT (the score improved from 2 [0; 37] to 4 [1; 45:5] points, p = 0.005) and Fugl-Meyer scale (from 72 [63; 110 ] to 79 [68; 115] points, p = 0.005). PMID:27188145

  20. [Cystinic nephrolythiasis: clinical experience and new diagnostic and therapeutic perspectives].

    Science.gov (United States)

    Gentili, Anna; Ria, Paolo; Lupo, Antonio; Fabris, Antonia

    2016-01-01

    Cystinuria is an inherited autosomal recessive disease with a prevalence 1:7000 and typical age of onset in the second decade of life. This nephrolithiasis is not always well known and well studied and for this reason it is often underdiagnosed. Cystinuria is characterized by increased urinary excretion of cystine and dibasic amino acids (lysine, ornithine, arginine) caused by defective transport of these amino acids across the luminal membrane of proximal tubule and small intestine cells. Two mutated genes responsible of this tubular defect are SLC3A1 on chromosome 2 and SLC7A9 on chromosome 19. Clinical manifestations of cystinuria are essentially those related to stones formation and their movement across the urinary tract, like flank pain/abdomen pain and hematuria, as occurred in other nephrolithiasis types. Diagnosis is based on biochemical urine analysis, stone analysis and imaging. Genetic study of this disease may be a new and stimulating approach to better understand the defects and identify new therapeutic targets. A wider knowledge and a more detailed approach to cystinuria may help to ameliorate patients quality of life, to prevent recurrences and complications and to develop more specific and adequate treatments. PMID:27374390

  1. Student service learning and dementia: bridging classroom and clinical experiences.

    Science.gov (United States)

    Corwin, Melinda; Owen, Donna; Perry, Carolyn

    2008-01-01

    University students in speech-language pathology and nursing were involved in a community service learning project with residents of a long-term care facility who had dementia. Nursing students were asked to interact and converse with residents to the best of their ability (control group, n = 28). Speech-language pathology students were instructed to design a personalized, multi-modality "connection kit" for residents based on the tenets of cognitive linguistic stimulation and facilitative styles of interaction, which were included within course content (experimental group, n = 25). Post-project surveys were administered in an attempt to answer the following research question: Do students perceive benefits from participating in a service learning project involving long-term care residents with dementia? Results revealed that the experimental/trained group of speech-language pathology students reported greater academic and clinical benefits compared to the control group of nursing students. Overall implications were that students benefited from a service learning project, especially when explicit instruction was provided.

  2. Clinical experience with apixaban in atrial fibrillation: implications of AVERROES

    Directory of Open Access Journals (Sweden)

    De Caterina R

    2011-07-01

    Full Text Available Raffaele De CaterinaInstitute of Cardiology and Center of Excellence on Aging, G d’Annunzio University, Chieti, G Monasterio Foundation, Pisa, ItalyAbstract: Atrial fibrillation is an extremely common arrhythmia, which substantially increases the risk of stroke and thromboembolism. Prevention of stroke and thromboembolism is therefore an important part of the management of atrial fibrillation. Guidelines until now have recommended that patients with atrial fibrillation receive some form of antithrombotic therapy, ie, a vitamin K antagonist or aspirin, with a preference for anticoagulants in most cases. However, current treatments are suboptimal, and despite the recommendations, many patients do not receive adequate thromboprophylaxis, because they are considered, for various reasons, “unsuitable” to receive a vitamin K antagonist. In this patient population, apixaban, a new oral anticoagulant inhibiting activated coagulation factor X, administered in fixed doses and without anticoagulation monitoring, has undergone testing against aspirin in the recently published AVERROES trial. This paper addresses the strengths and limitations of this trial and the practical relevance of the new clinical information it provides.Keywords: atrial fibrillation, apixaban, thromboprophylaxis 

  3. The First Experience of Clinical Practice on Psychology Students’ Imaginary

    Directory of Open Access Journals (Sweden)

    Sueli Regina Gallo-Belluzzo

    2013-09-01

    Full Text Available Considering the academic development of the psychologist as a complex process which articulates the transmission of scientific knowledge and changes in imaginative activity, we psychoanalytically investigate the collective imaginary of Psychology students regarding the first clinical consultation. We conducted a group interview with 52 undergraduate students, using the Thematic Story-Drawing Procedure as a way to open a dialogical field. The material obtained, through the psychoanalytical method, resulted in the creation/gathering of four affective-emotional meaning fields: “I came, I saw and I conquered”, “I know that I (do not know”, “I survived and I will save” and “I am and I do”, from which we see an emotionally immature imaginary about the meeting with the patient, since students are more self-centered than concerned with the patient. The overall situation indicates the need for care regarding student academic development, in order to encourage a more mature approach toward the suffering of the other.

  4. The South African Military Nursing College Pupil Enrolled Nurses’ experiences of the clinical learning environment

    OpenAIRE

    Ernestina M. Caka; Sebi Lekalakala-Mokgele

    2013-01-01

    The study focused on the clinical learning experiences of Pupil Enrolled Nurses (PENs) within the military health service. The purpose of the research was to explore and describe the learning experiences of PENs within the Military health clinical learning environment. An explorative, descriptive, contextual design which is qualitative in nature was used to guide the study. The military as a training institution prides itself on preparing nurses both as soldiers and nurses, this could be both...

  5. Eating disorders - knowledge, attitudes, management and clinical experience of Norwegian dentists

    OpenAIRE

    Johansson, Ann-Katrin; Johansson, Anders; Nohlert, Eva; Norring, Claes; Åstrøm, Anne N; Tegelberg, Åke

    2015-01-01

    Background The purpose of this study was to investigate knowledge, attitudes and clinical experience with regard to patients with eating disorders (ED) among Norwegian dentists. Methods In 2010, a questionnaire was sent to all dentists in Norway (N = 4282) comprising 33 questions related to demographics of the participating dentists, their knowledge of ED (general and oral health aspects), clinical experience, attitudes and perceived management preferences. Results The participation rate was ...

  6. Eating disorders - knowledge, attitudes, management and clinical experience of Norwegian dentists

    OpenAIRE

    Johansson, Ann-Katrin; Johansson, Anders; Nohlert, Eva; Norring, Claes; Åstrøm, Anne N; Tegelberg, Åke

    2015-01-01

    Background: The purpose of this study was to investigate knowledge, attitudes and clinical experience with regard to patients with eating disorders (ED) among Norwegian dentists. Methods: In 2010, a questionnaire was sent to all dentists in Norway (N = 4282) comprising 33 questions related to demographics of the participating dentists, their knowledge of ED (general and oral health aspects), clinical experience, attitudes and perceived management preferences. Results: The participation rate w...

  7. Gender Is a Major Determinant of the Clinical Evolution and Immune Response in Hamsters Infected with Leishmania spp.

    OpenAIRE

    Bruno L. Travi; Osorio, Yaneth; Melby, Peter C.; CHANDRASEKAR, BYSANI; Arteaga, Lourdes; Saravia, Nancy G.

    2002-01-01

    In regions where leishmaniasis is endemic, clinical disease is usually reported more frequently among males than females. This difference could be due to disparate risks of exposure of males and females, but gender-related differences in the host response to infection may also play a role. Experimental studies of the influence of gender on Leishmania infection have not included parasites of the subgenus Viannia, which is the most common cause of cutaneous leishmaniasis in the Americas. Mice a...

  8. The Epidemiology, Virology and Clinical Findings of Dengue Virus Infections in a Cohort of Indonesian Adults in Western Java

    OpenAIRE

    Herman Kosasih; Bachti Alisjahbana; Nurhayati,; Quirijn de Mast; Irani F Rudiman; Susana Widjaja; Ungke Antonjaya; Harli Novriani; Susanto, Nugroho H.; Hadi Jusuf; Andre van der Ven; Beckett, Charmagne G.; Blair, Patrick J; Burgess, Timothy H.; Maya Williams

    2016-01-01

    Background Dengue has emerged as one of the most important infectious diseases in the last five decades. Evidence indicates the expansion of dengue virus endemic areas and consequently the exponential increase of dengue virus infections across the subtropics. The clinical manifestations of dengue virus infection include sudden fever, rash, headache, myalgia and in more serious cases, spontaneous bleeding. These manifestations occur in children as well as in adults. Defining the epidemiology o...

  9. Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection

    OpenAIRE

    Lee, Sun Young; Cheng, Vincent; Rodger, Damien; Rao, Narsing

    2015-01-01

    Background Ocular syphilis is reemerging as an important cause of uveitis in the new era of common co-infection with HIV. This study will reveal the clinical and laboratory characteristics in the group of individuals co-infected with ocular syphilis and HIV compared with HIV-negative individuals. In this retrospective observational case series, medical records of patients diagnosed with ocular syphilis with serologic support from 2008 to 2014 were reviewed. Ocular and systemic manifestation a...

  10. Clinical experience of surgical intervention for severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Xu Yuan; Shao Qinshu; Yang Jin; Yu Xiaojun; Xu Ji

    2014-01-01

    Background The controversy on the treatment strategy for severe acute pancreatitis (SAP) has never stopped for the past century.Even now surgical procedures play a decisive role in the treatment of SAP,especially in managing the related complications,but the rational indications,timing,and approaches of surgical intervention for SAP are still inconclusive.Methods Clinical data of 308 SAP patients recruited during January 2000-January 2013,including 96 conservatively treated cases plus 212 surgically intervened cases,were comparatively analyzed.Based on the initial surgical intervention time,the surgical intervention group was split into two:early intervention group (within 2 weeks) 103 cases,and late intervention group (after 2 weeks) 109 cases.Results In the conservative treatment group,the cure rate was 82.29% (79/96),the death rate was 13.54% (13/96),and 4 cases self-discharged,while in the surgical intervention group,the cure rate was 84.43% (179/212) and the death rate was 10.85% (23/212) with 10 cases self-discharged.The difference was of no statistical significance between these two groups (P >0.05).In surgical intervention group,the death rate 15.53% (16/103) in the early surgical intervention group was higher than that of late surgical intervention group 6.42% (7/109),and the difference was statistically significant (P <0.05).Conclusions Both conservative treatment and surgical intervention play important roles in the treatment of SAP,and the indication,timing,and procedure should be strictly followed.Surgery earlier than 2 weeks after onset of the disease is not recommended in patients with necrotizing pancreatitis only when there are specific indications,such as multiple organ failure,which does not improve despite active treatment,and in those who develop abdominal compartment syndrome.

  11. Clinical trial experience using erythropoietin during radiation therapy

    International Nuclear Information System (INIS)

    Oncologists have several reasons for trying to maintain or increase hemoglobin levels in their patients during therapy. Relief of the symptoms of anemia, including fatigue and dyspnea, are traditional, well-accepted indications. A newer rationale is to enhance the efficacy of radiation therapy and/or chemotherapy in controlling tumors. A laboratory animal study found that administration of recombinant human erythropoietin (rHuEPO) increased intratumoral median oxygen levels and diminished the proportion of measurements in the very low (<3 mm Hg) range. Hemoglobin level is a strong independent prognostic factor for tumor control by radiation therapy. The hemoglobin level at the end of radiation therapy is a stronger prognostic factor than is the hemoglobin level at the start of therapy. Numerous clinical trials have utilized rHuEPO during radiation with or without concurrent chemotherapy. All 4 trials which enrolled patients with low hemoglobin levels (<12 to 13.5 g/dl) found that rHuEPO significantly increased hemoglobin within 2 weeks and that hemoglobin levels continued to rise until the end of rHuEPO treatment. rHuEPO was efficacious in limiting the decrease in hemoglobin and use of packed red blood cell transfusion in the one reported trial in which it was used in patients with initially normal hemoglobin levels during intensive concurrent radiation and chemotherapy. One trial found a statistically significant improvement in complete pathologic response rate after neoadjuvant chemoradiotherapy with the use of rHuEPO. rHuEPO has a potentially large role to play in the care of the cancer patient. (orig.)

  12. Methyldibromo glutaronitrile: clinical experience and exposure-based risk assessment.

    Science.gov (United States)

    Zachariae, Claus; Rastogi, Suresh; Devantier, Charlotte; Menné, Torkil; Johansen, Jeanne Duus

    2003-03-01

    In the year 2000, the level of methyldibromo glutaronitrile (MDGN) allergy in dermatology clinics in Europe exceeded the level of allergies to all other preservatives, with a prevalence of 3.5%. In the present study, cases of primary sensitization and elicitation to MDGN due to cosmetic products were collected over an 8-month period at the Department of Dermatology, Gentofte University Hospital. The aim was to identify the products related to hand eczema, assess exposure to MDGN in these products and relate the findings to results from a newly developed updated risk assessment model for contact allergy. Out of 24 patients with a positive patch test to MDGN, 17 patients with hand eczema were identified. In 11 of these patients, cosmetic products used in relation to the onset of the disease were shown to contain MDGN (65%). In 8 of these 11 cases, primary sensitization was probable, 5 due to hand/body lotions and 3 due to lotions and/or liquid hand soap. Chemical analysis of 12 products showed that lotions contained 149-390 ppm of MDGN, liquid hand soap 144-399 ppm, a rinsing cream 293 ppm and shampoos 78-79 ppm. The shampoo exposure was not of certain relevance to the eczema. Applying the newly developed updated risk assessment model showed that the concentrations of MDGN in lotions of 149-390 ppm exceeded the calculated maximum acceptable exposure level for MDGN, which would be expected to lead to sensitization in consumers using such products, as seen in the current study. The present cases and updated exposure-based risk assessment process add to the evidence and need for re-defining safe-use concentrations of MDGN in cosmetic products.

  13. Continuous intra-arterial blood gas monitoring. A clinical experience.

    Science.gov (United States)

    Paolillo, G; Tosoni, A; Mariani, M A; Venturino, M

    1994-01-01

    Miniaturized sensors, based upon the principles of optical fluorescence, can measure in vivo the pH, pCO2 value and pO2 value of blood. In this report we studied continuous intra-arterial blood gas monitoring in 27 patients undergoing cardiac surgery (no. 16 coronary artery by-pass grafting, no. 2 valvular surgery) and major vascular surgery (no. 9 abdominal aortic aneurysms). Total duration of continuous intra-arterial blood gas monitoring was 677 hours, with a ratio of 25.0 +/- 14.8 hours/patient (range 4-96 hours). The in vitro values of pH, pCO2 and pO2 were compared to simultaneous records from the fiberoptic sensor for each of the 283 arterial blood gas samples obtained, by means of linear regression and Bland-Altman method, in order to test the correlation and the agreement between the two methods of measuring. For pH average bias was -0.023 and intersensor precision was 0.028, with a strong correlation (R = 0.92; p sensor precision was 2.65, with a slight decrease in correlation (R = 0.89; p < 0.001) and agreement. For pO2 average bias was -2.69 and the intersensor precision was 12.16, with a strong correlation (R = 0.97; p < 0.001) and agreement. In addition, we tested the reliability of the system for values of pO2 above 100 mmHg and we found a strong correlation (R = 0.96; p20.001) and agreement even for these clinical conditions, largely out of physiologic parameters. This study demonstrates the feasibility and reliability of continuous intra-arterial three-component PB 3300 (Puritan Bennett) blood gas monitoring. PMID:7800182

  14. Clinical course of ectopic pregnancy: A single-center experience

    Directory of Open Access Journals (Sweden)

    Aqueela Ayaz

    2013-01-01

    Full Text Available Objectives: The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP in a general hospital. Materials and Methods: This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome of management. Data were analyzed using Microsoft Office Excel (version 2007. Results: Out of total 7564 pregnancies, 44 (0.58% patients were diagnosed as EP. Out of 44, 22 (50% patients presented within 24 h of onset of symptoms. Mean age was 28 ± 7 years. Multigravida were predominant in 25 (57%, and 21 (48% had gestational age of 6-8 weeks at the time of presentation; the common presenting features were amenorrhea (41, 93.2%, abdominal pain (39, 88.6%, and tenderness (38, 86%. Previous pelvic surgery (13, 29.5%, infertility treatment (11, 25%, and pelvic inflammatory disease (10, 22.7% were the common predisposing factors. Twenty-five (57% presented with ruptured EP and were operated within 24 h, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, 12/19 underwent laparoscopy, whereas 7/19 received medical treatment. Surgery confirmed fallopian tube pregnancies in 35 (94.5%. No mortality was observed. Conclusion: Previous pelvic surgeries were the major etiological factor for EP. Other factors were infertility treatment and pelvic inflammatory disease. The most common site of EP was fallopian tubes.

  15. Clinical Experience with Chitosan Matrix and Cultured Fibroblasts for Burns

    Directory of Open Access Journals (Sweden)

    Gaziza Danlybayeva

    2014-12-01

    Full Text Available Introduction. Burns are an important public health challenge due to the frequency of getting burns in day-to-day life, occupational hazards, and catastrophes. Treatment of burns is complex and is associated with high morbidity and mortality. Duration and complexity of burn treatment require finding new ways of curing and rehabilitating burns. The result of burn treatment plays a significant role in post-traumatic status of a patient and his or her consequent adaptation in society. Chitosan is a natural safe non-toxic product compatible with human tissues, characterized by hydrosorbid, anticoagulant, antibacterial, and wound healing features. The study aims to  show a clinical application of chitosan-pectin scaffold with cultured human skin fibroblasts in the treatment of deep burns.Methods. The substrate was prepared by dissolving 3% chitosan in 0.5N acetic acid, which was then mixed with 3% solution of pectin dissolved in distillated water. Chitosan film was formed in a Petri dish for 20-24 hours at 20-25 °C. After drying the film, cultured allogeneic fibroblasts (patent number RK-25091 were seeded on its surface.Results. The results from an in vitro culture study showed that human allogeneic fibroblasts could adhere well and grow on the selected scaffold with a typical morphology. During autodermoplasty surgery, cultured allogeneic fibroblasts were applied on granulating wounds of 9 patients with IIIA to IVB degree burns and limited donor resources. Wounds treated with the fibroblast-seeded scaffold among all patients provided the highest level of re-epithelialization (day 5, in comparison to cell-free scaffold (day 7 and untreated surface of wounds (day 10.Conclusion. Our results indicate the potential use of chitosan for wound healing due to its allogenic fibroblast adherence to scaffolding as well as high epithelization. This warrants further studies on chitosan for use in wounds resulting from third and fourth degree burns.

  16. Respiratory dynamic CT of the lung: initial clinical experience

    International Nuclear Information System (INIS)

    We applied spiral CT to evaluate the dynamic changes of regional ventilation of the lung in normal subjects and abnormal patients. This study includes normal subjects (n = 5) and patients with chronic obstructive pulmonary disease (n = 4), small air-way disease (n = 3), diffuse panbronchiolitis (n = 4), and tracheobronchial tuberculosis (n = 2). Time-continuous scan data at a fixed level during forced vital capacity maneuver (10-12 seconds) were obtained and images were reconstructed retrospectively by using 0.67 second scan data per image. The reconstructed images were displayed in a cine mode. Time-density curves were plotted and were correlated with clinical diagnosis. In normal subjects, mean attenuation difference between full inspiration and full expiration was 145.8 HU and mean time interval between 20% expiration and 80% expiration was 2.04 seconds. In chronic obstructive lung disease, mean attenuation difference between full inspiration and full expiration was 21.2 HU and mean time interval between 20% expiration and 80% expiration was 3.63 seconds. In small air-way disease, mosaic-pattern hyperlucency and normal portion of lung showed mean attenuation differences between 20% expiration and 80% expiration to be 49.8 HU and 167.0 HU, respectively. In diffuse panbronchiolitis, centrilobular region and normal portion of lung showed mean attenuation differences between 20% expiration and 80% expiration to be 35.4 HU and 79.3 HU, respectively. Respiratory dynamic CT is an updated technique which enable imaging of the functional status of the lung parenchyma. It may be useful in differentiation and quantitation of variable obstructive lung diseases

  17. High Human Herpesvirus 8 (HHV-8) Prevalence, Clinical Correlates and High Incidence among Recently HIV-1-Infected Subjects in Sao Paulo, Brazil

    OpenAIRE

    Mariana Dias Batista; Suzete Ferreira; Sauer, Mariana M.; Helena Tomiyama; Maria Teresa Maidana Giret; Pannuti, Cláudio S.; Diaz, Ricardo S.; Sabino, Ester C; Esper G Kallas

    2009-01-01

    BACKGROUND: Human herpesvirus 8 (HHV-8) is the etiological agent for Kaposi Sarcoma, which occurs especially in HIV-infected subjects. HHV-8 infection and its clinical correlates have not been well characterized in recently HIV-1-infected subjects, especially men who have sex with men (MSM). METHODOLOGY/ PRINCIPAL FINDINGS: We assessed the HHV-8 seroprevalence, clinical correlates, and incidence after one year of follow-up in a cohort of 228 recently HIV-1-infected individuals, of whom 83.6% ...

  18. Psychotic experiences in a mental health clinic sample : implications for suicidality, multimorbidity and functioning

    NARCIS (Netherlands)

    Kelleher, I.; Devlin, N.; Wigman, J. T. W.; Kehoe, A.; Murtagh, A.; Fitzpatrick, C.; Cannon, M.

    2014-01-01

    Background Recent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service,

  19. Students' Experiences of Clinic-Based Learning during a Final Year Veterinary Internship Programme

    Science.gov (United States)

    Matthew, Susan M.; Taylor, Rosanne M.; Ellis, Robert A.

    2010-01-01

    This study investigated veterinary students' experiences of clinic-based learning (CBL) during a comprehensive final year internship programme. Open-ended surveys (n = 93) were used to gather qualitative data about students' conceptions of what is learned during CBL and their approaches to learning in clinics. Phenomenography was used for detailed…

  20. Children's Views Matter Too! A Pilot Project Assessing Children's and Adolescents' Experiences of Clinical Psychology Services

    Science.gov (United States)

    Gordon, Michael; Russo, Kate

    2009-01-01

    This pilot study explored the experiences and understanding of clinical psychology practices and services of children and adolescents attending clinical psychology outpatient appointments. Fifteen young participants took part in the study. A content analysis indicated that young children and adolescents have an appropriate understanding of the…

  1. Experiences of Student Speech-Language Pathology Clinicians in the Initial Clinical Practicum: A Phenomenological Study

    Science.gov (United States)

    Nelson, Lori A.

    2011-01-01

    Speech-language pathology literature is limited in describing the clinical practicum process from the student perspective. Much of the supervision literature in this field focuses on quantitative research and/or the point of view of the supervisor. Understanding the student experience serves to enhance the quality of clinical supervision. Of…

  2. Clinical characteristics and laboratory findings in Danish children hospitalized with primary Epstein-Barr virus infection

    DEFF Research Database (Denmark)

    Topp, Sofie Kathrine; Rosenfeldt, Vibeke; Vestergaard, Hanne;

    2015-01-01

    were included (n = 95). RESULTS: Children aged 1-2 years were the age group most commonly hospitalized with acute EBV infection (27% of the cohort), followed by teenagers aged 14-15 years (23%). Fever, cervical lymphadenopathy, tonsillitis and fatigue were the most common physical findings overall....... Dividing the children into three age groups (0-4 years, 5-10 years and 11-15 years) revealed that the oldest age groups significantly more often suffered from headache, tonsillitis, sore throat, abdominal pain and nausea. Young children typically presented with a runny nose, fever, fatigue and cervical....... METHODS: All immunocompetent children hospitalized at Hvidovre University Hospital, Copenhagen between 2002 and 2013, who presented with clinical features that prompted a laboratory test for EBV, and who tested positive by presence of EBV-specific antibodies, heterophile antibodies or a positive EBV PCR...

  3. Helicobacter pylori infection and ischemic heart disease: could experimental data lead to clinical studies?

    Science.gov (United States)

    Ribaldone, Davide G; Fagoonee, Sharmila; Hickman, Ingrid; Altruda, Fiorella; Saracco, Giorgio M; Pellicano, Rinaldo

    2016-12-01

    Despite the remarkable advances made in primary prevention and treatment, ischemic heart disease (IHD) remains the leading cause of death and a significant cause of disability in developed countries. Since traditional cardiovascular risk factors failed to predict all cases of IHD, there is an intensive research to explore other potential etiologic factors. Among these, numerous studies have considered the theoretical link between IHD and chronic infections, including Helicobacter pylori (H. pylori). Considering that epidemiologic studies have produced conflicting results, due to geographical variations of IHD and H. pylori prevalence as well as heterogeneity of study designs, an alternative way to analyze this topic is to assess if consistency for a biological plausibility exists. In this review we critically analyzed the experimental data on this topic, to assess whether their results could lead future clinical studies. PMID:27603552

  4. Mild Clinical Course of Severe Fever with Thrombocytopenia Syndrome Virus Infection in an Elderly Japanese Patient

    Directory of Open Access Journals (Sweden)

    Yuko Ohagi

    2014-01-01

    Full Text Available Severe fever with thrombocytopenia syndrome (SFTS is an emerging infectious and hemorrhagic disease recently described in China and western Japan. A 71-year-old healthy Japanese woman noticed a tick biting her after harvesting in an orchard and removed it herself. She developed diarrhea, anorexia, and chills eight days later. Because these symptoms continued, she visited a primary care physician 6 days after the onset. Laboratory data revealed thrombocytopenia, leukocytopenia, and elevated liver enzymes. She was then referred to our hospital. Although not completely fulfilling the diagnostic criteria used in a retrospective study in Japan, SFTS was suspected, and we detected SFTS virus in the patient’s blood using RT-PCR. However, she recovered without intensive treatment and severe complications 13 days after the onset. In this report, we present a mild clinical course of SFTS virus infection in Japan in detail.

  5. Bloodstream infection among children presenting to a general hospital outpatient clinic in urban Nepal.

    Directory of Open Access Journals (Sweden)

    Rahul Pradhan

    Full Text Available BACKGROUND: There are limited data on the etiology and characteristics of bloodstream infections in children presenting in hospital outpatient settings in South Asia. Previous studies in Nepal have highlighted the importance of murine typhus as a cause of febrile illness in adults and enteric fever as a leading bacterial cause of fever among children admitted to hospital. METHODS: We prospectively studied a total of 1084 febrile children aged between 2 months and 14 years presenting to a general hospital outpatient department in Kathmandu Valley, Nepal, over two study periods (summer and winter. Blood from all patients was tested by conventional culture and by real-time PCR for Rickettsia typhi. RESULTS: Putative etiological agents for fever were identified in 164 (15% patients. Salmonella enterica serovar Typhi (S. Typhi was identified in 107 (10%, S. enterica serovar Paratyphi A (S. Paratyphi in 30 (3%, Streptococcus pneumoniae in 6 (0.6%, S. enterica serovar Typhimurium in 2 (0.2%, Haemophilus influenzae type b in 1 (0.1%, and Escherichia coli in 1 (0.1% patient. S. Typhi was the most common organism isolated from blood during both summer and winter. Twenty-two (2% patients were PCR positive for R. typhi. No significant demographic, clinical and laboratory features distinguished culture positive enteric fever and murine typhus. CONCLUSIONS: Salmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever in Kathmandu Valley. Extension of immunization programs against invasive bacterial disease to include the agents of enteric fever and pneumococcus could improve the health of children in Nepal.

  6. Incidence, Clinical Characteristics and Attributable Mortality of Persistent Bloodstream Infection in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Hsu, Jen-Fu; Chu, Shih-Ming; Lee, Chiang-Wen; Yang, Pong-Hong; Lien, Reyin; Chiang, Ming-Chou; Fu, Ren-Huei; Huang, Hsuan-Rong; Tsai, Ming-Horng

    2015-01-01

    Background An atypical pattern of neonatal sepsis, characterized by persistent positive blood culture despite effective antimicrobial therapy, has been correlated with adverse outcomes. However, previous studies focused only on coagulate-negative staphylococcus infection. Methods All episodes of persistent bloodstream infection (BSI), defined as 3 or more consecutive positive blood cultures with the same bacterial species, at least two of them 48 hours apart, during a single sepsis episode, were enrolled over an 8-year period in a tertiary level neonatal intensive care unit. These cases were compared with all non-persistent BSI during the same period. Results We identified 81 episodes of persistent BSI (8.5% of all neonatal late-onset sepsis) in 74 infants, caused by gram-positive pathogens (n=38, 46.9%), gram-negative pathogens (n=21, 25.9%), fungus (n=20, 24.7%) and polymicrobial bacteremia (n=2, 2.5%). Persistent BSI does not differ from non-persistent BSI in most clinical characteristics and patient demographics, but tends to have a prolonged septic course, longer duration of feeding intolerance and more frequent requirement of blood transfusions. No difference was observed for death attributable to infection (9.8% vs. 6.5%), but neonates with persistent BSI had significantly higher rates of infectious complications (29.6% vs. 9.2%, P < 0.001), death from all causes (21.6% vs. 11.7%, P = 0.025), and duration of hospitalization among survivors [median (interquartile range): 80.0 (52.5-117.5) vs. 64.0 (40.0-96.0) days, P = 0.005] than those without persistent BSI. Conclusions Although persistent BSI does not contribute directly to increased mortality, the associated morbidities, infectious complications and prolonged septic courses highlight the importance of aggressive treatment to optimize outcomes. PMID:25875677

  7. Antimicrobial therapies for odontogenic infections in children and adolescents. Literature review and clinical recomendations.

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    Inés Caviglia

    2014-03-01

    Full Text Available ABSTRACT Oral infections are caused by an imbalance in the patient’s indigenous flora which changes from commensal to opportunistic. Odontogenic infections are the most common reason for consultation in children and adolescents. Rational use of antibiotics is the best strategy to avoid microbial resistance. Dental infections should first receive proper local treatment, which can also be complemented with a systemic method. Appropriate drug selection and dosing should be made. Amoxicilin is the first choice for antimicrobial agents in pediatric dentistry. Clindamycin and clarithromycin are the best alternative for patients with penicillin hypersensibility. In this literature review, the authors intended to establish clear clinical management guidelines for emergency treatment and subsequent final resolution. RESUMEN Las infecciones bucales son producidas por un desequilibrio de la flora indígena del paciente que pasa de comensal a oportunista. Las consultas más frecuentes en niños y adolescentes son las infecciones odontogénicas. El uso racional de antibióticos, es la estrategia más importante para evitar la resistencia microbiana. Las infecciones dentarias deben recibir en primera instancia el tratamiento local correspondiente y a veces complementarse con tratamiento sistémico seleccionando y dosificando adecuadamente el fármaco. El antimicrobiano de primera elección en odontopediatría es la amoxicilina y para pacientes con hipersensibilidad a las penicilinas, se indican claritromicina o clindamicina. Esta revisión de la literatura busca establecer pautas de manejo clínico claras para el tratamiento de urgencia y su posterior resolución definitiva.

  8. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early Syphilis.

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    Dumaresq, Jeannot; Langevin, Stéphanie; Gagnon, Simon; Serhir, Bouchra; Deligne, Benoît; Tremblay, Cécile; Tsang, Raymond S W; Fortin, Claude; Coutlée, François; Roger, Michel

    2013-12-01

    The diagnosis of neurosyphilis (NS) is a challenge, especially in HIV-infected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial. We retrospectively reviewed demographic, clinical, and laboratory data from 122 cases of HIV-infected patients with documented early syphilis who underwent an LP to rule out NS, and we evaluated 3 laboratory-developed validated real-time PCR assays, the Treponema pallidum particle agglutination (TPPA) assay, the fluorescent treponemal antibody absorption (FTA-ABS) assay, and the line immunoassay INNO-LIA Syphilis, for the diagnosis of NS from cerebrospinal fluid (CSF) samples of these patients. NS was defined by a reactive CSF-VDRL test result and/or a CSF white blood cell (WBC) count of >20 cells/μl. Thirty of the 122 patients (24.6%) had early NS. Headache, visual symptoms, a CD4 cell count of RPR) titers were not associated with early NS (P = 0.575). For the diagnosis of NS, the PCR, FTA-ABS, TPPA, and INNO-LIA assays had sensitivities of 58%, 100%, 68%, and 100%, specificities of 67%, 12%, 49%, and 13%, and negative predictive values of 85%, 100%, 84%, and 100%, respectively. Visual disturbances, headache, uncontrolled HIV-1 viremia, and a CD4 cell count of syphilis, while blood serum RPR titers were not; therefore, RPR titers should not be used as the sole criterion for deciding whether to perform an LP in early syphilis. When applied to CSF samples, the INNO-LIA Syphilis assay easily helped rule out NS. PMID:24088852

  9. REVIEW OF CLINICAL CASES OF DRUG ALLERGIC REACTIONS IN PATIENTS WITH ACUTE RESPIRATORY VIRAL INFECTIONS

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    Sydorchuk A.S.

    2015-05-01

    Full Text Available Introduction. Problem of drug-induced allergic reaction is especially actual both in well-developing countries as well as in countries of Eastern European region. By the WHO data, distribution of allergy is up to 30 %, and main reasons for that are increasing of pharmaceuticals consumption by a person, change of nutrition style towards more chemicals synthetic substitutions. Generally, a quantity of Europeans with allergy reach 150 mln. Reactions of hypersensitivity to medications is so serious discussion question among physicians and their patients, since it is the most important reason to stop treatment and for refuse remedies. Authors hope, that presenting here clinical material will bring benefit both clinicians and patients like cases of drug-induced allergic reactions due to self-prescribed treatment (antipyretics, antibiotics. Thus, this research paper aimed to analyze the clinical cases of drug-induced allergy in patients with acute respiratory illnesses, which had admitted to Infectious diseases department of Municipal Clinical Hospital of Chernivtsi city (Ukraine. Materials & Methods. Descriptional clinical study enrolled six clinical cases of drug-induced allergy in male patients admitted in different time to the Infectious Diseases Department of Municipal Clinical Hospital of Chernivtsi city (Ukraine with clinical manifestation and epidemiological data of acute respiratory viral infections. Mostly cases of drug-induced allergy confirmed by the indirect immune-termomistry for determination of role of a drug. Results & discussion. First case in male 52 years old patient with signs of polymorphic exudative erythema induced by pills against common cold named «Coldflu». Patient had manifestation clinical features of acute respiratory viral infection and was hospitalized to the Department of Droplet infections for detoxicative and desensitization treatment. Within few days his infectious problem had solved, nevertheless skin rash still

  10. Hepatitis C infection: A multi-faceted systemic disease with clinical, patient reported and economic consequences.

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    Younossi, Zobair M; Birerdinc, Aybike; Henry, Linda

    2016-10-01

    Hepatitis C virus infection (HCV) affects approximately 170-200 million individuals globally. HCV is one of the primary causes of hepatocellular carcinoma (HCC) and cirrhosis and has been identified as the leading indication for liver transplantation in most Western countries. Because HCV is a systemic disease with hepatic, extrahepatic, economic and patient reported consequences, it is important for healthcare practitioners to understand the comprehensive and multi-faceted picture of this disease. In this context, it is important to fully appreciate the impact of HCV on the individual patient and the society. With the recent advent of the new generation of direct antiviral agents, the long standing goal of eradicating HCV in most infected patients has been accomplished. Therefore, now more than ever, it is critical to assess the total benefits of sustained virological response in a comprehensive manner. This should not be limited to the clinical benefits of HCV cure, but also to account for the improvement of patient reported health and economic outcomes of HCV cure. It is only through this comprehensive approach to HCV and its treatment that we will understand the full impact of this disease and the tremendous gains that have been achieved with the new antiviral regimens.

  11. The clinical and cellular basis of contact lens-related corneal infections

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    Danielle M Robertson

    2008-08-01

    Full Text Available Danielle M Robertson, H Dwight CavanaghDepartment of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, USAAbstract: Microbial keratitis (MK is the most visually devastating complication associated with contact lens wear. Pseudomonas aeruginosa (PA is highly invasive in the corneal epithelium and is responsible for more than half of the reported cases of contact lens-related MK. To protect against Pseudomonas-mediated MK, the corneal epithelium has evolved overlapping defense mechanisms that function to protect the ocular surface from microbial invasion. Research has shown that contact lens wear disrupts these protective mechanisms through breakdown of normal homeostatic surface renewal as well as damaging the corneal surface, exposing underlying cell membrane receptors that bind and internalize PA through the formation of lipid rafts. Human clinical trials have shown that initial adherence of PA with resulting increased risk for microbial infection is mediated in part by contact lens oxygen transmissibility. Recently, chemical preserved multipurpose solutions (MPS have been implicated in increasing PA adherence to corneal epithelial cells, in addition to inducing significant levels of toxic staining when used in conjunction with specific silicone hydrogel lenses. This review summarizes what is currently known about the relationship between contact lenses, the corneal epithelium, MPS, and infection.Keywords: cornea, epithelium, contact lens, microbial keratitis

  12. Hepatitis C infection: A multi-faceted systemic disease with clinical, patient reported and economic consequences.

    Science.gov (United States)

    Younossi, Zobair M; Birerdinc, Aybike; Henry, Linda

    2016-10-01

    Hepatitis C virus infection (HCV) affects approximately 170-200 million individuals globally. HCV is one of the primary causes of hepatocellular carcinoma (HCC) and cirrhosis and has been identified as the leading indication for liver transplantation in most Western countries. Because HCV is a systemic disease with hepatic, extrahepatic, economic and patient reported consequences, it is important for healthcare practitioners to understand the comprehensive and multi-faceted picture of this disease. In this context, it is important to fully appreciate the impact of HCV on the individual patient and the society. With the recent advent of the new generation of direct antiviral agents, the long standing goal of eradicating HCV in most infected patients has been accomplished. Therefore, now more than ever, it is critical to assess the total benefits of sustained virological response in a comprehensive manner. This should not be limited to the clinical benefits of HCV cure, but also to account for the improvement of patient reported health and economic outcomes of HCV cure. It is only through this comprehensive approach to HCV and its treatment that we will understand the full impact of this disease and the tremendous gains that have been achieved with the new antiviral regimens. PMID:27641981

  13. Correlations between Clinical Features and Mortality in Patients with Vibrio vulnificus Infection.

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    Hong Zhao

    Full Text Available Vibrio vulnificus is a common gram-negative bacterium, which might cause morbidity and mortality in patients following consumption of seafood or exposure to seawater in Southeast China. We retrospectively analyzed clinical data of patients with laboratory confirmed V. vulnificus infection. Twenty one patients were divided into a survival group and a non-surviving (or death group according to their clinical outcome. Clinical data and measurements were statistically analyzed. Four patients (19.05% died and five patients gave positive cultures from bile fluid, and 16 other patients gave positive culture from blood or blisters. Ten patients (47.62% had an underlying liver disease and marine-related events were found in sixteen patients (76.2%. Patients with heavy drinking habits might be at increased mortality (p = 0.028. Clinical manifestations of cellulitis (47.6%, septic shock (42.9% and multiple organ failure (28.6% were statistically significant when comparing survivors and non-survivors (p = 0.035, p = 0.021 and p = 0.003, respectively. The laboratory results, including hemoglobin < 9.0 g/L (p = 0.012, platelets < 2.0 × 109 /L, prothrombin time activity (PTA <20%, decreased serum creatinine and increased urea nitrogen were statistically significant (p = 0.012, p = 0.003, p = 0.028 and p = 0.028, respectively. Patients may be at a higher risk of mortality under situations where they have a history of habitual heavy alcoholic drink consumption (p = 0.028, OR = 22.5, 95%CI 1.5-335.3, accompanied with cellulitis, shock, multiple organ failure, and laboratory examinations that are complicated by decreased platelets, hemoglobin and significantly prolonged prothrombin time (PT.

  14. Clinical and microbiologic characteristics of tcdA-negative variant clostridium difficile infections

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    Kim Jieun

    2012-05-01

    Full Text Available Abstract Background The tcdA-negative variant (A-B+ of Clostridium difficile is prevalent in East Asian countries. However, the risk factors and clinical characteristics of A-B+C. difficile infections (CDI are not clearly documented. The objective of this study was to investigate these characteristics. Methods From September 2008 through January 2010, the clinical characteristics, medication history and treatment outcomes of CDI patients were recorded prospectively. Toxin characterization and antibiotic susceptibility tests were performed on stool isolates of C. difficile. Results During the study period, we identified 22 cases of CDI caused by tcdA-negative tcdB-positive (A-B+ strains and 105 cases caused by tcdA-positive tcdB-positive (A+B+ strains. There was no significant difference in disease severity or clinical characteristics between the two groups. Previous use of clindamycin and young age were identified as significant risk factors for the acquisition of A-B+ CDI (OR = 4.738, 95% CI 1.48–15.157, p = 0.009 and OR = 0.966, 95% CI 0.935–0.998, p = 0.038, respectively in logistic regression. Rates of resistance to clindamycin were 100% and 69.6% in the A-B+ and A+B+ isolates, respectively (p = 0.006, and the ermB gene was identified in 17 of 21 A-B+ isolates (81%. Resistance to moxifloxacin was also more frequent in the A-B+ than in the A+B+ isolates (95.2% vs. 63.7%, p = 0.004. Conclusions The clinical course of A-B+ CDI is not different from that of A+B+ CDI. Clindamycin use is a significant risk factor for the acquisition of tcdA-negative variant strains.

  15. Completion of treatment for latent tuberculosis infection with monthly drug dispensation directly through the tuberculosis clinic.

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    Claudia C Dobler

    Full Text Available SETTING: An Australian metropolitan TB clinic where treatment for latent tuberculosis infection (LTBI comprises six months of isoniazid, self-administered but dispensed monthly by the clinic. OBJECTIVE: To determine the proportion of patients who complete treatment for LTBI and to identify factors associated with non-completion. METHODS: Clinical files of all patients receiving treatment for LTBI between 01/2000 and 12/2010 were reviewed. The study population comprised all patients who were commenced on isoniazid as treatment for LTBI. Odds ratios (OR for completing treatment were estimated by logistic regression. RESULTS: Of 216 patients who commenced isoniazid treatment for LTBI, 163 (75% completed six months treatment [corrected]. Fifty-three percent of the 53 patients who did not complete treatment dropped out after three months treatment. The mean (SD age of the patients was 27 (16 years and 123 (57% were female. The majority of patients (59% were born overseas and 69% received treatment for LTBI because they were contacts of patients with TB. Patients' sex, age, country of birth, time since immigration for overseas born people, health care worker status, TST conversion status, chest x-ray findings, language, employment status and the indication for which treatment of LTBI was prescribed were not significantly related to treatment completion. CONCLUSION: In a setting where isoniazid is dispensed monthly by the TB clinic, a relatively high proportion of patients who commence treatment for LTBI complete the six month scheduled course of treatment. The study did not identify any patient characteristics that predicted treatment completion. Interventions to improve completion rates should extend over the whole duration of treatment.

  16. Correlation between fundamental binding forces and clinical prognosis of Staphylococcus aureus infections of medical implants

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    Yongsunthon, Ruchirej; Fowler, Vance; Lower, Brian H.; Vellano, Francis P.; Alexander, Emily; Reller, L. Barth; Corey, G. Ralph; Lower, Steven

    2007-02-01

    Implanted medical devices (e.g., prosthetic heart valves, permanent pacemakers) significantly improve the quality of life for many humans. However, a common clinical observation is that such devices become colonized with potentially life-threatening Staphylococcus aureus biofilms, which are difficult to combat with host defenses or antibiotics. This study attempts to draw a correlation between the clinical outcome of patients with implanted cardiac devices and the fundamental binding forces ultimately responsible for the initiation of an S. aureus biofilm in-situ. Atomic force microscopy was used to measure forces between a fibronectin-coated probe (simulating a prosthetic implant) and 15 different strains of S. aureus isolated from either patients with infected cardiac devices (invasive population) or healthy human subjects (control population). The fibronectin-coated probe was repeatedly brought into and out of contact with a bacterium’s surface, “fishing” for a reaction with the cell’s fibronectin-binding proteins. More than 40,000 force profiles were measured on 5-10 different cells for each of the 15 clinical strains. A unique force-signature was observed for a binding event between the fibronectin-coated probe and the bacteria. When grouped by the frequency of this force-signature, there was a strong distinction (p=0.01) between the invasive and control populations of S. aureus. This discovery suggests that biofilm forming bacteria may be classified according to their “force taxonomy”, which could have a positive effect on health care as it bridges the long-standing disconnect between macroscopic, clinical investigations and nanometer-scale forces ultimately responsible for a bond between S. aureus and the surface of a prosthetic device.

  17. Stem Cell Therapy for Cardiovascular Disorders - Our Clinical Experience

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    Jayakrishnan AG

    2011-01-01

    Full Text Available Background: Autologous Bone Marrow stem Cell transplantation is a viable therapeutic option for patients with end stage heart failure due to cardiomyopathy of varied etiology as there are only limited treatment options other than cardiac transplantation. The rationale behind the application of stem cells in these patients include • Stem cells directly replace the affected cells by differentiation into the damaged cell type • Stem cells also exert Paracrine effects by secre tion of growth factors (VGEF,FGF-1to stimu late local cell growth•In addition to the above, stem cells release signaling factors which recruit stem cells from elsewhere by modulating the immune system.Materials and Methods: In this presentation we describe our study on a series of 13 patients who received isolated and expanded CD 34 cells from the bone marrow. Seven had ischemic dysfunction, three had dilated cardiomyopathy and three had primary pulmonary hypertension. Five patients received the stem cells via intracoronary injection, three directly into the myocardium and three intrapulmonary. Results: All patients showed functional improvement of the myocardium recorded by non-invasive investigations and improvement in the quality of life. Follow up period ranged from 6 months to 2 years. Conclusion: Our experience with bone marrow derived stem cells in patients with cardiomyopathy has been encouraging. More studies are planned in the future.

  18. Viral etiology and clinical profiles of children with severe acute respiratory infections in China.

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    Chen Zhang

    Full Text Available BACKGROUND: No comprehensive analysis is available on the viral etiology and clinical characterization among children with severe acute respiratory infection (SARI in China during 2009 H1N1 pandemic and post-pandemic period. METHODS: Cohort of 370 hospitalized children (1 to 72 months with SARI from May 2008 to March 2010 was enrolled in this study. Nasopharyngeal aspirate (NPA specimens were tested by a commercial assay for 18 respiratory viral targets. The viral distribution and its association with clinical character were statistically analyzed. RESULTS: Viral pathogen was detected in 350 (94.29% of children with SARI. Overall, the most popular viruses were: enterovirus/rhinovirus (EV/RV (54.05%, respiratory syncytial virus (RSV (51.08%, human bocavirus (BoCA (33.78%, human parainfluenzaviruse type 3 (PIV3 (15.41%, and adenovirus (ADV (12.97%. Pandemic H1N1 was the dominant influenza virus (IFV but was only detected in 20 (5.41% of children. Moreover, detection rate of RSV and human metapneumovirus (hMPV among suburb participants were significantly higher than that of urban area (P<0.05. Incidence of VSARI among suburb participants was also significant higher, especially among those of 24 to 59 months group (P<0.05. CONCLUSION: Piconaviruses (EV/RV and paramyxoviruses are the most popular viral pathogens among children with SARI in this study. RSV and hMPV significantly increase the risk of SARI, especially in children younger than 24 months. Higher incidence of VSARI and more susceptibilities to RSV and hMPV infections were found in suburban patients.

  19. Diversity of Meq gene from clinical Marek’s disease virus infection in Saudi Arabia

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    Mahmoud H. A. Mohamed

    2016-06-01

    Full Text Available Aim: The aim of this study was to demonstrate the genomic features of Meq gene of Marek’s disease virus (MDV recently circulating in Saudi Arabia (SA. Materials and Methods: Two poultry flocks suffering from mortalities and visceral tumors were presented to the Veterinary Teaching Hospital, King Faisal University, SA. Subjected to different diagnostic procedures: Case history, clinical signs, and necropsy as well as polymerase chain reaction followed by Meq gene sequence analysis. Results: Case history, clinical signs, and necropsy were suggestive of MDV infection. The Meq gene was successfully detected in liver and spleen of infected chickens. A 1062 bp band including the native Meq ORF in addition to a 939 bp of S-Meq (short isoform of Meq were amplified from Saudi 01-13 and Saudi 02-13, respectively. The nucleotide and deduced amino acids sequences of the amplified Meq genes of both Saudi isolates showed distinct polymorphism when compared with the standard USA virulent isolates Md5 and GA. The sequence analysis of the S-Meq gene showed a 123 bp deletion representing 41 amino acids between two proline-rich areas without any frameshift. The Meq gene encoded four repeats of proline-rich repeats (PRRs sequences, whereas the S-Meq contains only two PRRs. Interestingly, the phylogenetic analysis revealed that both of SA MDV isolates are closely related to the MDV strains from Poland. Conclusion: The two MDV isolates contain several nucleotide polymorphisms resulting in distinct amino acid substitutions. It is suggested that migratory and wild birds, as well as world trading of poultry and its by-products, have a great contribution in the transmission of MDVs overseas.

  20. Diversity of Meq gene from clinical Marek’s disease virus infection in Saudi Arabia

    Science.gov (United States)

    Mohamed, Mahmoud H. A.; El-Sabagh, Ibrahim M.; Al-Habeeb, Malik A.; Al-Hammady, Yousef M.

    2016-01-01

    Aim: The aim of this study was to demonstrate the genomic features of Meq gene of Marek’s disease virus (MDV) recently circulating in Saudi Arabia (SA). Materials and Methods: Two poultry flocks suffering from mortalities and visceral tumors were presented to the Veterinary Teaching Hospital, King Faisal University, SA. Subjected to different diagnostic procedures: Case history, clinical signs, and necropsy as well as polymerase chain reaction followed by Meq gene sequence analysis. Results: Case history, clinical signs, and necropsy were suggestive of MDV infection. The Meq gene was successfully detected in liver and spleen of infected chickens. A 1062 bp band including the native Meq ORF in addition to a 939 bp of S-Meq (short isoform of Meq) were amplified from Saudi 01-13 and Saudi 02-13, respectively. The nucleotide and deduced amino acids sequences of the amplified Meq genes of both Saudi isolates showed distinct polymorphism when compared with the standard USA virulent isolates Md5 and GA. The sequence analysis of the S-Meq gene showed a 123 bp deletion representing 41 amino acids between two proline-rich areas without any frameshift. The Meq gene encoded four repeats of proline-rich repeats (PRRs sequences), whereas the S-Meq contains only two PRRs. Interestingly, the phylogenetic analysis revealed that both of SA MDV isolates are closely related to the MDV strains from Poland. Conclusion: The two MDV isolates contain several nucleotide polymorphisms resulting in distinct amino acid substitutions. It is suggested that migratory and wild birds, as well as world trading of poultry and its by-products, have a great contribution in the transmission of MDVs overseas. PMID:27397979

  1. E-Learning Practices on Healthcare Associated Infections (HAI: Report of Brazilian Experience

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    Eduardo Alexandrino Servolo Medeiros

    2008-01-01

    Full Text Available To develop a teaching and learning environment, on-line and free, to provide technical information with health professional team from Epidemiological Health Surveillance and Nosocomial Infection Control Groups in Brazil. The first Brazilian experience of e-learning was carried out through a partnership between the National Health Surveillance Agency (ANVISA and Federal University of São Paulo (UNIFESP. The course supported by different approaches: internet, telephone, books and CD (compact disk. The course had five topics: legislation, epidemiological surveillance, investigation of outbreaks and prevention of infections, occupational risk and isolation, with 20 days each topic and 250 h. Each topic finished with an evaluation and one classroom course. The student’s number was 236, with 188 selected, 97.7% enrolled in the course and with 3% of non-approval. The students characteristics were: mean age 41.9 years, female gender majority 84.50 and 54.3% nursing, 15.9% physicians and 10.4% pharmacists. In Brazil, with difficulties to have access to knowledge opportunities, HAI’s course would be an alternative to teach about infection control.

  2. Stimulation of viral infection of bacterioplankton during a mesoscale iron fertilization experiment in the Southern Ocean

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    Weinbauer, M. G.; Arrieta, J.-M.; Herndl, G. J.

    2003-04-01

    A mesoscale iron fertilization in the Southern Ocean (Eisenex ) induced a phytoplankton bloom within three weeks observation as well as in an increased bacterial abundance and production. Viral abundance and viral production were stimulated as well. A virus-dilution approach was used to estimate the frequency of infected cells (FIC) and the frequency of lysogenic cells (FLC), i.e. cells with a dormant viral genome. While the FLC did not vary strongly within the iron-enriched patch and did not differ from waters outside the patch, FIC increased significantly within the iron fertilized patch. This suggests that induction of the lytic cycle in lysogenic cells was not significant. Rather, the stimulated bacterial production and abundance within the patch resulted in higher and more successful encounters between viruses and hosts and thus in higher FIC values. Consequently, the iron fertilization enhanced the influence of viral infection in the microbial food web. According to the current model, this should result a stimulation of bacterial production, since lysed bacterial cells cannot be consumed up by protists and transferred to higher trophic level; lysis products can be taken up by bacteria and thus organic carbon spins within this viral loop. Viral infection is a significant and previously overlooked factor in the carbon flow during iron fertilization experiments.

  3. Clinical diagnostic value of assessment of helicobacter pylori infection with 14C-UBT in gastrointestinal and other diseases

    International Nuclear Information System (INIS)

    Objective: To investigate clinical diagnostic value of assessment of HP infection with 14C-Urea breath test (14C- UBT) in gastrointestinal and other diseases. Methods: The rate of HP infection was detected with 14C-UBT in 2050 patients with gastrointestinal disease, 510 patients with other diseases and 70 healthy controls. Results: (1) The positive rate and rate of moderate and advanced degree of HP infection in patients with gastrointestinal disease were significantly higher than those in controls (86% vs 51%, P14C-UBT is of high sensitivity and specificity. This test is cheap and can be readily performed, and is one of the best methods available. (authors)

  4. Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India

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    Ramesh YK

    2005-11-01

    Full Text Available Abstract Background Control of sexually transmitted infections (STIs is an important part of the effort to reduce the risk of HIV/AIDS. STI clinics in the government hospitals in India provide services predominantly to the poor. Data on the cost and efficiency of providing STI services in India are not available to help guide efficient use of public resources for these services. Methods Standardised methods were used to obtain detailed cost and output data for the 2003–2004 fiscal year from written records and interviews in 14 government STI clinics in the Indian state of Andhra Pradesh. The economic cost per patient receiving STI treatment was calculated, and the variations of total and unit costs across the STI clinics analysed. Multivariate regression technique was used to estimate incremental unit costs. The optimal number of STIs that could be handled by the clinics was estimated. Results 18807 STIs were diagnosed and treated at the 14 STI clinics in fiscal year 2003–2004 (range 323–2784, median 1199. The economic cost of treating each STI varied 5-fold from Indian Rupees (INR 225.5 (US$ 4.91 to INR 1201.5 (US$ 26.15 between 13 clinics, with one other clinic having a very high cost of INR 2478.5 (US$ 53.94. The average cost per STI treated for all 14 clinics combined was INR 729.5 (US$ 15.88. Personnel salaries made up 76.2% of the total cost. The number of STIs treated per doctor full-time equivalent and cost-efficiency for each STI treated had a significant direct non-linear relation (p 2 = 0.81; power function. With a multiple regression model, apart from the fixed costs, the incremental cost for each STI detected and cost of treatment was INR 55.57 (US$ 1.21 and for each follow-up visit was INR 3.75 (US$ 0.08. Based on estimates of optimal STI cases that could be handled without compromising quality by each doctor full-time equivalent available, it was projected that at 8 of the 14 clinics substantially more STI cases could be

  5. Facilitative and obstructive factors in the clinical learning environment: Experiences of pupil enrolled nurses

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    Eucebious Lekalakala-Mokgele

    2015-02-01

    Full Text Available Background: The clinical learning environment is a complex social entity that influences student learning outcomes in the clinical setting. Students can experience the clinical learning environment as being both facilitative and obstructive to their learning. The clinical environment may be a source of stress, creating feelings of fear and anxiety which in turn affect the students’ responses to learning. Equally, the environment can enhance learning if experienced positively.Objectives: This study described pupil enrolled nurses’ experiences of facilitative and obstructive factors in military and public health clinical learning settings.Method: Using a qualitative, contextual, exploratory descriptive design, three focus group interviews were conducted until data saturation was reached amongst pupil enrolled nurses in a military School of Nursing.Results: Data analysed provided evidence that acceptance by clinical staff and affordance of self-directed learning facilitated learning. Students felt safe to practise when they were supported by the clinical staff. They felt a sense of belonging when the staff showed an interest in and welcomed them. Learning was obstructed when students were met with condescending comments. Wearing of a military uniform in the public hospital and horizontal violence obstructed learning in the clinical learning environment.Conclusion: Students cannot have effective clinical preparation if the environment is not conducive to and supportive of clinical learning, The study shows that military nursing students experience unique challenges as they are trained in two professions that are hierarchical in nature. The students experienced both facilitating and obstructing factors to their learning during their clinical practice. Clinical staff should be made aware of factors which can impact on students’ learning. Policies need to be developed for supporting students in the clinical learning environment.

  6. Pregnancy-Related Group A Streptococcal Infections: Temporal Relationships Between Bacterial Acquisition, Infection Onset, Clinical Findings, and Outcome

    OpenAIRE

    Stephanie M Hamilton; Stevens, Dennis L.; Bryant, Amy E.

    2013-01-01

    The development and outcome of pregnancy-related group A streptococcal infections are dependent upon the stage of pregnancy or puerperium, epidemiologic factors of the patient's home and hospital environments, and virulence of the prevalent pathogens.

  7. Multiple Embolism in a Female Patient with Infective Endocarditis: Low Back Pain and Hematuria as the Initial Clinical Manifestations

    Directory of Open Access Journals (Sweden)

    Vieira Marcelo Luiz Campos

    2002-01-01

    Full Text Available A 59-year-old female patient with mitral valve prolapse and a previous history of lumbosacral spondyloarthrosis and lumbar disk hernia had an episode of infective endocarditis due to Streptococcus viridans, which evolved with peripheral embolism to the left kidney, spleen, and left iliac artery, and intraventricular cerebral hemorrhage. Her clinical manifestations were low back pain and hematuria, which were initially attributed to an osteoarticular condition. Infective endocarditis is a severe polymorphic disease with multiple clinical manifestations and it should always be included in the differential diagnosis by clinicians.

  8. [Therapeutic experience with cefadroxil syrup in acute infections, especially scarlet fever, in pediatric field (author's transl)].

    Science.gov (United States)

    Minamitani, M; Hachimori, K; Nakazawa, H; Tomori, N

    1981-02-01

    Clinical effects were investigated on cefadroxil powder for syrup (containing 100 mg of cefadroxil per 1 g) for acute bacterial infections (mostly scarlet fever) in the field of pediatrics, and the results were obtained as follows. Cefadroxil was applied in 100 cases of scarlet fever. Among 49 cases administered 30-39 mg/kg/day, the results were excellent in 34 cases and good in 15 cases, efficacy ratio being thus 100%. Among 38 cases administered 40-49 mg/kg/day, the results were excellent in 33 cases, and good in 5 cases, efficacy ratio being thus 100%. Out of 4 cases administered 20-29 mg/kg/day, the results were excellent in 3 cases and good in 1 case, while out of 9 cases administered 50-59 mg/kg/day, excellent in 4 cases and good in 5 cases. Among 78 cases of scarlet fever from which beta-hemolytic Streptococcus was proven from swab liquid of palatal tonsil, 67 cases received cefadroxil at a daily dose of 30-49 mg/kg, and the bacteria turned to negative the next day of administration in 72 cases, 2 days later in 6 cases. Cefadroxil was administered at a daily dose of 46 mg/kg for 7 days in 1 case of SSS syndrome of which Staphylococcus aureus was proven from skin lesion, and local bacteria turned to negative, as well as clinical effect was excellent. No pathogen was proven in 1 case of acute tonsillitis, maybe because ampicillin (ABPC) and cefazolin (CEZ) were administered before cefadroxil treatment, and yet a clinical efficacy was judged by administering cefadroxil at a daily dose of 46 mg/kg, though no clinical improvement was observed with the prior antibiotics. As to the side effects of cefadroxil in 102 cases, a slight vomiting was noticed in 6 cases, though the administration could be continued, and a slight rise of GOT or GPT was observed respectively in 3 cases and 1 case, all of which were recovered without abnormal clinical findings. Among the patients of scarlet fever, after beta-hemolytic Streptococcus became negative, reelimination or recurrence

  9. Clinical trial experience using erythropoietin during radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lavey, R.S. [Radiation Oncology Program, Childrens Hospital Los Angeles, Univ. of Southern California, CA, Los Angeles (United States)

    1998-12-01

    Oncologists have several reasons for trying to maintain or increase hemoglobin levels in their patients during therapy. Relief of the symptoms of anemia, including fatigue and dyspnea, are traditional, well-accepted indications. A newer rationale is to enhance the efficacy of radiation therapy and/or chemotherapy in controlling tumors. A laboratory animal study found that administration of recombinant human erythropoietin (rHuEPO) increased intratumoral median oxygen levels and diminished the proportion of measurements in the very low (<3 mm Hg) range. Hemoglobin level is a strong independent prognostic factor for tumor control by radiation therapy. The hemoglobin level at the end of radiation therapy is a stronger prognostic factor than is the hemoglobin level at the start of therapy. Numerous clinical trials have utilized rHuEPO during radiation with or without concurrent chemotherapy. All 4 trials which enrolled patients with low hemoglobin levels (<12 to 13.5 g/dl) found that rHuEPO significantly increased hemoglobin within 2 weeks and that hemoglobin levels continued to rise until the end of rHuEPO treatment. rHuEPO was efficacious in limiting the decrease in hemoglobin and use of packed red blood cell transfusion in the one reported trial in which it was used in patients with initially normal hemoglobin levels during intensive concurrent radiation and chemotherapy. One trial found a statistically significant improvement in complete pathologic response rate after neoadjuvant chemoradiotherapy with the use of rHuEPO. rHuEPO has a potentially large role to play in the care of the cancer patient. (orig.) [Deutsch] In der Onkologie bestehen zahlreiche Gruende, die Haemoglobinkonzentration der Patienten waehrend der Therapie zu halten oder sogar anzuheben. Als anerkannte Indikation gilt hierbei die Besserung anaemiebedingter Symptome wie Muedigkeit und Dyspnoe, wobei jedoch neuere Ergebnisse darauf hinweisen, dass auch die Effizienz der Strahlen- und

  10. RESULTS OF A PILOT CLINICAL TRIAL OF DENDRITICCELL BASED VACCINES FOR TREATMENT OF RECURRENT HERPESVIRUS INFECTION

    Directory of Open Access Journals (Sweden)

    O. Yu. Leplina

    2016-01-01

    Full Text Available Chronic recurrent infections caused by herpes simplex virus (HSV types 1 and 2 represent a serious medical and social challenge. Given an important role of immune system in surveillance of viral infections, an induced enhancement of antigen-specific immune response seems to be a promising approach to treatment of recurrent HSV infections, in particular, using dendritic cell (DCs vaccines. The present paper contains results of an open pilot study evaluating efficacy and safety of dendritic-cell vaccines in the patients with recurrent HSV infections. Twenty-nine patients including 14 persons with labial herpes, and 15, with genital herpes have been enrolled in this study. DCs were generated in presence of GM-CSF and IFNα and then loaded with recombinant viral proteins (HSV1gD or HSV2gD. These cells were applied in 2 rounds of vaccination performed within 9 months. Immunotherapy with DCs did not induce sufficient side effects, and was accompanied by more than two-fold decrease in relapse rate and increased length of remissions during the 9-month period of treatment. Later on, we revealed a reduced frequency of relapses, and a 3-fold increase in remission duration over the subsequent 6-month follow up. The clinical effect during the treatment and at later terms (a half-year observation was noted with both labial and genital herpes, as registered in the majority of patients, being associated with induction of antigen-specific proliferative response and normalization of reduced mitogenic responsiveness of mononuclear cells towards ConA. The patients’ survey at longer terms (more than 24 months has shown that the beneficial effect of immunotherapy, in terms of reduced relapse rates, was maintained in 77.8% of the respondents by 48 months (a median follow-up term. At this time, the antigen specific proliferative response was maintained in 66.7% of patients. The data obtained suggest that the dendritic-cell vaccines may be a promising approach to the

  11. Transitions from Clinical Experiences to Clinical Questions and then Research: Songwriting with Bereaved Pre-adolescent Children

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    Melina Roberts

    2006-11-01

    Full Text Available The purpose of this article is to describe the author’s personal transition from her clinical experiences working with bereaved children and adolescents, to clinical questions that arose during this time, and then to her current phase whereby she has commenced research to examine songwriting with bereaved children. This article includes relevant literature that discusses bereavement in childhood, songwriting in music therapy, and music therapy support for bereaved children and adolescents. A description about the author’s current research, that integrates the three areas highlighted in the literature, is also discussed.

  12. Nursing students’ perception of clinical learning experiences as provided by the nursing staff in the wards

    Directory of Open Access Journals (Sweden)

    N. R. C. TIakula

    1993-05-01

    Full Text Available A descriptive survey was carried out, using convenience and systematic sampling in order to better understand the manner in which student nurses perceive their clinical experience in the hospital. Data were collected from 80 subjects in 4 nursing colleges using a critical incident technique. Positive and negative experiences are described,

  13. Comprehensive Experiment--Clinical Biochemistry: Determination of Blood Glucose and Triglycerides in Normal and Diabetic Rats

    Science.gov (United States)

    Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

    2015-01-01

    For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a…

  14. A Mandala: A Diagram of the Clinical Education Experience in Athletic Training

    Science.gov (United States)

    Cernohous, Steve; West, Sharon

    2007-01-01

    Objective: The objective of this paper is to present the practical use of a Mandala that: 1) provides opportunities for athletic training students to explore, reflect on and appreciate their clinical experiences; 2) provides educators with a model to understand and value athletic training student experiences; 3) organizes and captures factors and…

  15. Radiography students' clinical placement experiences in MRI: A phenomenological study

    International Nuclear Information System (INIS)

    Purpose: The purpose of this study was to gain an insight into radiography students' clinical practice experiences within an MRI unit of a large teaching hospital in Malta. The underlying objectives of the study were to identify and explore the descriptions and meanings of the MRI clinical experiences of students. Methods: Five students, independently undergoing their clinical placements in MRI were asked to write a diary about their daily experiences. Each student then participated in a follow up interview. Data analysis was based on Husserls' phenomenological approach. Results: Eight themes emerged from the data analysed. Students described their experience as one mainly based on observation, where, during their placements, they observed radiographers at work. In this respect, students described their experience as lacking ‘hands on practice’. Students indicated that they felt uncomfortable, unsupervised and unwelcome most of the time. They also expressed the need to feel useful and part of the MRI team during their placement and so they tried to help the team in areas such as patient screening. This helped them build confidence. Learning in MRI was specifically based on the university tasks prescribed and possibly there was no motivation to learn more. The students also described their experience as varied and different when compared to other placements. Conclusion: This study provides a rare insight into radiography students' placement experiences in MRI and should enable the supervising radiographer and educator to obtain a deeper appreciation of the clinical placement experience

  16. Particularities of tuberculosis in HIV-infected patients: 10-year experience of a Portuguese hospital

    Directory of Open Access Journals (Sweden)

    S Nunes

    2012-11-01

    Full Text Available The incidence of tuberculosis (TB has dramatically increased since the advent of the human immunodeficiency virus (HIV pandemic. In Portugal, tuberculosis is still common in HIV-negative patients, despite earlier diagnosis and countrywide directly observed therapy strategies. With the purpose of comparing some demographic and clinical aspects of TB in HIV-infected and uninfected patients, the authors reviewed the files of patients admitted with a diagnosis of tuberculosis between January 2002 and December 2011. During this time period, there were 234 cases of tuberculosis, 43 (18% of which occurred in HIV-infected patients. In this group, 74% of patients were male, with a mean age of 38±11 years and the majority (51% acquired HIV from heterosexual risk behavior. The most common site of infection was the lung, in both groups, but cases of extrapulmonary TB were significantly higher in the HIV-infected group (67% versus 39%, p<0.01. Disseminated TB was the most common extrapulmonary diagnosis in the former group (28% and lymph node TB (8% in the latter. The duration of hospitalization was not statistically different between the two groups (mean of 26±16 days in HIV-infected patients and 21±15 days in the HIV-negative group, p=0.21. The mean CD4 count at TB diagnosis was 180±177/mm3. In 11 (26% of the patients, HIV was diagnosed during the TB episode and in 5 cases, the diagnosis of tuberculosis occurred with immune reconstitution syndrome. In the majority of patients (60%, TB was the first AIDS-defining condition. In 26 (60% of patients there was microbiologic confirmation of TB, mainly by direct observation (69%, positive culture (46% and molecular diagnostic technics (27%. While most patients were treated with the 4-drug standard regimen, 16 (37% of cases received alternative treatment. The mean duration of treatment was 8.5±4.8 months and the majority of patients (58% were considered cured. About one-third of patients were lost to follow

  17. Sequencing of Simulation and Clinic Experiences in an Introductory Pharmacy Practice Experience

    OpenAIRE

    Leon, Nicholas; Hajjar, Emily; DeSevo Bellottie, Gina

    2015-01-01

    Objective. To examine how the intrasemester sequencing of a simulation component, delivered during an ambulatory care introductory pharmacy practice experience (IPPE), affects student performance on a series of 3 assessments delivered during the second professional (P2) year.

  18. Imaging tissue hypoxia: clinical and pre-clinical experience with {sup 123}IAZA

    Energy Technology Data Exchange (ETDEWEB)

    Wiebe, L.I. [University of Alberta, Edmonton (Canada). Noujaim Institute for Pharmaceutical Oncology Research, Faculty of Pharmacy and Pharmaceutical Sciences

    1997-10-01

    The molecular mechanisms that underline the selective binding of iodazomycin arabinoside, IAZA, and related nitromidazoles are reviewed as a basis for interpretation of preclinical and clinical data for hypoxic binding of radioiodinated IAZA. Clinical data are presented for {sup 123}IAZA uptake in a number of pathologies including metastatic tumours, peripheral vascular disease in diabetes, muscle stress and rheumatoid arthritis. The results of studies to determine the influence of tumour type on uptake of {sup 123} I-IAZA in patients with a variety of deep-seated solid tumours will be presented. Correlations of hypoxia-dependent binding with {sup 99m}Tc-HMPAO perfusion images will be reviewed and early correlations of uptake to treatment response in cancer will be presented. Unusual features of {sup 123}I-IAZA biodistribution will also be discussed together with detailed pharmacokinetic and radiation dosimetry data for `2{sup 123}I- IAZA in normal volunteers 27 refs., 1 fig.

  19. Imaging tissue hypoxia: clinical and pre-clinical experience with 123IAZA

    International Nuclear Information System (INIS)

    The molecular mechanisms that underline the selective binding of iodazomycin arabinoside, IAZA, and related nitromidazoles are reviewed as a basis for interpretation of preclinical and clinical data for hypoxic binding of radioiodinated IAZA. Clinical data are presented for 123IAZA uptake in a number of pathologies including metastatic tumours, peripheral vascular disease in diabetes, muscle stress and rheumatoid arthritis. The results of studies to determine the influence of tumour type on uptake of 123 I-IAZA in patients with a variety of deep-seated solid tumours will be presented. Correlations of hypoxia-dependent binding with 99mTc-HMPAO perfusion images will be reviewed and early correlations of uptake to treatment response in cancer will be presented. Unusual features of 123I-IAZA biodistribution will also be discussed together with detailed pharmacokinetic and radiation dosimetry data for '2123I- IAZA in normal volunteers

  20. Pseudomonas aeruginosa infection in patients with cystic fibrosis: scientific evidence regarding clinical impact, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    Luiz Vicente Ribeiro Ferreira da Silva Filho

    2013-06-01

    Full Text Available Evidence-based techniques have been increasingly used in the creation of clinical guidelines and the development of recommendations for medical practice. The use of levels of evidence allows the reader to identify the quality of scientific information that supports the recommendations made by experts. The objective of this review was to address current concepts related to the clinical impact, diagnosis, and treatment of Pseudomonas aeruginosa infections in patients with cystic fibrosis. For the preparation of this review, the authors defined a group of questions that would be answered in accordance with the principles of PICO–an acronym based on questions regarding the Patients of interest, Intervention being studied, Comparison of the intervention, and Outcome of interest. For each question, a structured review of the literature was performed using the Medline database in order to identify the studies with the methodological design most appropriate to answering the question. The questions were designed so that each of the authors could write a response. A first draft was prepared and discussed by the group. Recommendations were then made on the basis of the level of scientific evidence, in accordance with the classification system devised by the Oxford Centre for Evidence-Based Medicine, as well as the level of agreement among the members of the group.

  1. Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections.

    Science.gov (United States)

    Gidengil, Courtney A; Linder, Jeffrey A; Beach, Scott; Setodji, Claude M; Hunter, Gerald; Mehrotra, Ateev

    2016-01-01

    Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. Our objective was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. We surveyed physicians (n = 78) and retail clinic clinicians (n = 109) between January and September 2013. We surveyed clinicians using a set of ARI vignettes and linked the responses to electronic health record data for all ARI visits managed by these clinicians during 2012. We then created a new measure of antibiotic prescribing, the comprehensive ARI management rate. This was defined as not prescribing antibiotics for antibiotic-inappropriate diagnoses and prescribing guideline-concordant antibiotics for antibiotic-appropriate diagnoses (and also included appropriate use of streptococcal testing for the pharyngitis vignettes). We compared the vignette-based and chart-based comprehensive ARI management at the clinician level. We then identified the combination of vignettes that best predicted comprehensive ARI management rates, using a partitioning algorithm. Responses to 3 vignettes partitioned clinicians into 4 groups with chart-based comprehensive ARI management rates of 61% (n = 121), 50% (n = 47), 31% (n = 12), and 22% (n = 7). Responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts. PMID:27098876

  2. Characteristics of substance abuse treatment programs providing services for HIV/AIDS, hepatitis C virus infection, and sexually transmitted infections: the National Drug Abuse Treatment Clinical Trials Network.

    Science.gov (United States)

    Brown, Lawrence S; Kritz, Steven Allan; Goldsmith, R Jeffrey; Bini, Edmund J; Rotrosen, John; Baker, Sherryl; Robinson, Jim; McAuliffe, Patrick

    2006-06-01

    Illicit drug users sustain the epidemics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis C (HCV), and sexually transmitted infections (STIs). Substance abuse treatment programs present a major intervention point in stemming these epidemics. As a part of the "Infections and Substance Abuse" study, established by the National Drug Abuse Treatment Clinical Trials Network, sponsored by National Institute on Drug Abuse, three surveys were developed; for treatment program administrators, for clinicians, and for state and District of Columbia health and substance abuse department administrators, capturing service availability, government mandates, funding, and other key elements related to the three infection groups. Treatment programs varied in corporate structure, source of revenue, patient census, and medical and non-medical staffing; medical services, counseling services, and staff education targeted HIV/AIDS more often than HCV or STIs. The results from this study have the potential to generate hypotheses for further health services research to inform public policy. PMID:16716846

  3. Staphylococcus aureus and Pseudomonas aeruginosa co-infection is associated with cystic fibrosis-related diabetes and poor clinical outcomes.

    Science.gov (United States)

    Limoli, D H; Yang, J; Khansaheb, M K; Helfman, B; Peng, L; Stecenko, A A; Goldberg, J B

    2016-06-01

    Cystic fibrosis-related diabetes (CFRD) patients suffer from accelerated rates of pulmonary decline compared to cystic fibrosis (CF) patients with normal glucose tolerance (NGT). However, the mechanisms underlying this difference are unknown. While CFRD is associated with increased respiratory infections, a link between infection and enhanced pulmonary dysfunction remains unclear. The development of glucose intolerance is spectral, resulting in impaired glucose tolerance (IGT) prior to the diagnosis of CFRD. Inclusion of IGT patients within the NGT group may diminish the ability to identify correlations with CFRD. With this in mind, this study aimed to determine if the association between CFRD and respiratory infections is correlated with pulmonary decline. Respiratory cultures from 234 CF patients with confirmed diagnosis of NGT or CFRD were analyzed to measure rates of infection, focusing on the two most prevalent bacteria in CF, Staphylococcus aureus and Pseudomonas aeruginosa. Infection status was correlated with pulmonary function and confounding clinical variables including age, gender, blood glucose levels, and CF transmembrane conductance regulator (CFTR) phenotype were considered in multivariate analyses. CFRD patients, particularly those with extremely high blood glucose levels, were more likely than NGT patients to be co-infected with S. aureus and P. aeruginosa, compared to infection with only one pathogen. Co-infection was associated with decreased lung function and increased frequency of pulmonary exacerbations, even after adjustment for confounding variables. Alterations in the microbial community composition, as opposed to the presence of a single pathogen, may account for greater pulmonary decline in CFRD patients. PMID:26993289

  4. Molecular and Clinical Characteristics of Hospital and Community Onset Methicillin-Resistant Staphylococcus aureus Strains Associated with Bloodstream Infections

    OpenAIRE

    Wang, Shu-Hua; Hines, Lisa; van Balen, Joany; José R Mediavilla; Pan, Xueliang; Hoet, Armando E; Kreiswirth, Barry N.; Pancholi, Preeti; Stevenson, Kurt B.

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) are classified epidemiologically as health care-associated hospital onset (HAHO)-, health care-associated community onset (HACO)-, or community-associated (CA)-MRSA. Clinical and molecular differences between HAHO- and HACO-MRSA BSI are not well known. Thus, we evaluated clinical and molecular characteristics of MRSA BSI to determine if distinct features are associated with HAHO- or HACO-MRSA strains. Molecular ge...

  5. Utilization of the Nursing Process to Foster Clinical Reasoning During a Simulation Experience

    Directory of Open Access Journals (Sweden)

    Amanda Lambie

    2015-11-01

    Full Text Available Nursing practice includes complex reasoning and multifaceted decision making with minimal standardized guidance in how to evaluate this phenomenon among nursing students. Learning outcomes related to the clinical reasoning process among novice baccalaureate nursing students during a simulation experience were evaluated. Nursing process records were utilized to evaluate and foster the development of clinical reasoning in a high-fidelity medical-surgical simulation experience. Students were unable to describe and process pertinent patient information appropriately prior to the simulation experience. Students’ ability to identify pertinent patient cues and plan appropriate patient care improved following the simulation. The learning activity afforded a structured opportunity to identify cues, prioritize the proper course of nursing interventions, and engage in collaboration among peers. The simulation experience provides faculty insight into the students’ clinical reasoning processes, while providing students with a clear framework for successfully accomplishing learning outcomes.

  6. Impact of clinical awareness and diagnostic tests on the underdiagnosis of Clostridium difficile infection.

    Science.gov (United States)

    Alcalá, L; Reigadas, E; Marín, M; Martín, A; Catalán, P; Bouza, E

    2015-08-01

    A multicenter study of Clostridium difficile infection (CDI) performed during 2008 in Spain revealed that two of every three episodes went undiagnosed or were misdiagnosed owing to nonsensitive diagnostic tests or lack of clinical suspicion and request. Since then, efforts have been made to improve the diagnostic tests used by laboratories and to increase the awareness of this disease among both clinicians and microbiologists. Our objective was to evaluate the impact of these efforts by assessing the current magnitude of underdiagnosis of CDI in Spain using two point-prevalence studies performed on one day each in January and July of 2013. A total of 111 Spanish laboratories selected all unformed stool specimens received for microbiological diagnosis on these days, and toxigenic culture was performed at a central reference laboratory. Toxigenic isolates were characterized both pheno- and genotypically. The reference laboratory detected 103 episodes of CDI in patients aged 2 years or more. Half (50.5 %) of the episodes were not diagnosed in the participating laboratories, owing to insensitive diagnostic tests (15.5 %) or the lack of clinical suspicion and request (35.0 %). The main ribotypes were 014, 078/126, 001/072, and 106. Ribotype 027 caused 2.9 % of all cases. Despite all the interventions undertaken, CDI remains a highly neglected disease because of the lack of sensitive diagnostic tests in some institutions and, especially, the absence of clinical suspicion, mainly in patients with community-associated CDI. Toxigenic C. difficile should be routinely sought in unformed stools sent for microbiological diagnosis, regardless of their origin.

  7. Clinical features of patients with type 2 diabetes mellitus and hepatitis C infection

    Directory of Open Access Journals (Sweden)

    L.F. Greca

    2012-03-01

    Full Text Available The objective of the present cross-sectional study was to assess the prevalence and the clinical and laboratory features of hepatitis C virus (HCV-positive patients with type 2 diabetes mellitus (DM attending either an outpatient clinic or hemodialysis units. Serologic-HCV testing was performed in 489 type 2 DM patients (303 outpatients and 186 on dialysis. A structured assessment of clinical, laboratory and DM-related complications was performed and the patients were then compared according to HCV infection status. Mean patient age was 60 years; HCV positivity (HCV+ was observed in 39 of 303 (12.9% outpatients and in 34 of 186 (18.7% dialysis patients. Among HCV+ patients, 32 were men (43.8%. HCV+ patients had higher serum levels of aspartate aminotransferase (0.90 ± 0.83 vs 0.35 ± 0.13 µKat/L, alanine aminotransferase (0.88 ± 0.93 vs 0.38 ± 0.19 µKat/L, gamma-glutamyl transferase (1.57 ± 2.52 vs 0.62 ± 0.87 µKat/L; P < 0.001, and serum iron (17.65 ± 6.68 vs 14.96 ± 4.72 µM; P = 0.011, and lower leukocyte and platelet counts (P = 0.010 and P < 0.001, respectively than HCV-negative (HCV- patients. HCV+ dialysis patients had higher diastolic blood pressure than HCV- patients (87.5 ± 6.7 vs 81.5 ± 6.0 mmHg; P = 0.005 and a lower prevalence of diabetic retinopathy (75 vs 92.7%; P = 0.007. In conclusion, our study showed that HCV is common among subjects with type 2 DM but is not associated with a higher prevalence of chronic diabetic complications.

  8. Microbial Pathogens Implicated in Reproductive Health Infections in a Special Treatment Clinic in Ibadan, Nigeria

    Directory of Open Access Journals (Sweden)

    Adenike Ogunshe

    2009-03-01

    Full Text Available Objective: The lack of adequate recognition of health importance of non-HIV reproductive health infections (RHIs in Nigeria has led into this study, which was to determine clinical pathogens in non-HIV RHI in Nigeria using a tertiary health facility as case study.Materials and Methods: A nine-year investigation was carried out between 1997 and 2005 on 4047 (n = 1626 males; n = 2421 females patients presenting at Special Treatment Clinic (STC of University College Hospital (UCH Ibadan, Nigeria. Routine laboratory procedures using appropriate culture media, culture conditions, and current phenotypic taxonomic tools for classification of isolated pathogens were employed.Results: Age (p = 0.019 and gender (p<0.0001 were related to the recovery rates of pathogens Candida species (55.6 %, Neisseria gonorrhoae (11.1%, Gardenella vaginalis (10.3%, Escherichia coli (9.2 %, Klebsiella sp. (4.2%, streptococci (4.0%, Staphylococcus aureus (2.3%, Proteus sp., (1.8%, Haemophilus ducreyi (0.5%, Trichomonas vaginalis (0.44% and Pseudomonas aeruginosa (0.18%. Candida and Gardenella vaginalis species were mostly recovered from female patients, while N.gonorrhoeae were mostly isolated from male patients. Age brackets for the recovery of pathogens were Neisseria gonorrhoeae (16-30 years; Gardenella vaginalis (21-25 and 31-35 years and C.albicans (21-30 years.Conclusion: Candida, Neisseria gonorrhoea and Gadrenella vaginalis were the most recovered pathogens from patients presenting at Special Treatment Clinic of a tertiary health institution in Nigeria, and the relationship between age, gender and the aetiological agents was statistically significant.

  9. Clinical and Laboratory Characteristics of Dengue-Orientia tsutsugamushi co-Infection from a Tertiary Care Center in South India

    Science.gov (United States)

    Basheer, Aneesh; Iqbal, Nayyar; Mookkappan, Sudhagar; Anitha, Patricia; Nair, Shashikala; Kanungo, Reba; Kandasamy, Ravichandran

    2016-01-01

    Background Concurrent infection with multiple pathogens is common in tropics, posing diagnostic and treatment challenges. Although co-infections of dengue, malaria, leptospirosis and typhoid in various combinations have been described, data on dengue and scrub typhus co-infection is distinctly limited. Methodology This study was a retrospective analysis of dengue and scrub typhus co-infection diagnosed between January 2010 and July 2014 at a tertiary care center. Clinical and laboratory features of these cases were compared with age and gender-matched patients with isolated dengue fever and isolated scrub typhus. Positive test for dengue non-structural 1 (NS1) antigen was considered diagnostic of dengue whereas scrub typhus was diagnosed by IgM scrub antibodies demonstrated by ELISA. Results There were 6 cases of dengue-scrub co-infection during the review period which fitted clinical and laboratory profile with a mean age of 42.5 years. Fever, headache, and arthralgia were common. Normal hemoglobin, significant thrombocytopenia, transaminitis, and hypoalbuminemia were identified in these patients. Compared to patients with isolated dengue, those with co-infection had higher pulse rate, lower systolic blood pressure, normal leucocyte counts, higher levels of liver enzymes, greater prolongation of partial thromboplastin time (aPTT) and lower serum albumin. Co-infection was characterized by a lower nadir platelet count compared to scrub typhus, and lesser time to nadir platelet count and longer duration of hospital stay compared to either isolated dengue or scrub typhus. Conclusion Dengue-scrub typhus co-infection may be under-diagnosed in tropics, particularly confounded during dengue epidemics. Normal leukocyte counts, early drop in platelets and hypoalbuminemia in dengue patients could be clues to concurrent scrub typhus infection. Prompt recognition and treatment of scrub typhus in such cases may reduce unnecessary hospital stay and cost. PMID:27413521

  10. Clinical outcome and risk factors related to extended-spectrum beta-lactamase-producing Klebsiella spp. infection among hospitalized patients

    Directory of Open Access Journals (Sweden)

    Fernando Bellíssimo-Rodrigues

    2006-06-01

    Full Text Available Over the past two decades, nosocomial infections caused by extended-spectrum beta-lactamase (ESBL-producing Klebsiella spp. have become a major problem all around the world. This situation is of concern because there are limited antimicrobial options to treat patients infected with these pathogens, and also because this kind of resistance can spread to a wide variety of Gram-negative bacilli. Our objectives wereto evaluate among in-patients at a publicuniversity tertiary-care hospital with documented infection due to Klebsiella spp., which were the risk factors (cross-sectional analysis and the clinical impact (prospective cohort associated with an ESBL-producing strain. Study subjects were all patients admitted at the study hospital between April 2002 and October 2003, with a clinically and microbiologically confirmed infection caused by Klebsiella spp. at any body site, except infections restricted to the urinary tract. Of the 104 patients studied, 47 were infected with an ESBL-producing strain and 57 with a non-ESBL-producing strain. Independent risk factors associated with infection with an ESBL-producing strain were young age, exposure to mechanical ventilation, central venous catheter, use of any antimicrobial agent, and particularly use of a 4th generation cephalosporin or a quinolone. Length of stay was significant longer for patients infected with ESBL-producing strains than for those infected with non-ESBL-producing strains, although fatality rate was not significantly affected by ESBL-production in this cohort. In fact, mechanical ventilation and bacteremia were the only variables withindependent association withdeath detected in this investigation.

  11. Treating infected diabetic wounds with superoxidized water as anti-septic agent: a preliminary experience

    International Nuclear Information System (INIS)

    To evaluate the effectiveness of superoxidized water (MicrocynTM) in diabetic patients with different wounds. One hundred known diabetic patients were enrolled. Half were randomized to the intervention group (those whose wounds were managed with superoxidized water) and half to the control group (whose wounds were treated with normal saline) using a table of random numbers. The two groups were matched for age, gender, duration of diabetes and category of wound. All patients received appropriate surgical treatment for their wounds as required. Local wound treatment was carried out daily using superoxidized water soaked gauzes on twice daily basis in the intervention group and normal saline in the control group. The treatment was continued until wound healing. The main outcome measures were duration of hospital stay, downgrading of the wound category, wound healing time and need for interventions such as amputation. Statistically significant differences were found in favour of the superoxidized water group with respect to duration of hospital stay, downgrading of the wound category and wound healing time. Although the initial results of employing superoxidized water for the management of infected diabetic wounds are encouraging, further multicentre clinical trials are warranted before this antiseptic is recommended for general use. It may offer an economical alternative to other expensive antiseptics with positive impact on the prevailing infection rates, patient outcomes and patient satisfaction. (author)

  12. Pulmonary infections caused by non-tuberculous mycobacteria−single centre experience

    Directory of Open Access Journals (Sweden)

    Adžić-Vukičević Tatjana N.

    2013-01-01

    Full Text Available Introduction. Non-tuberculosis mycobacteria are environmental organisms found in soil and water worldwide, and an infection caused by non-tuberculosis mycobacteria is less frequently found than the one associated with Mycobacterium tuberculosis. This study was designed to evaluate data relating to non-tuberculosis mycobacteria in patients with clinical importance. Material and Methods. Of 12 patients (pts admitted to the Department of Pulmonology, Clinical Centre of Serbia in Belgrade during 2010- 2011, seven (58.33% were men and five (41.67% were women. Bacteriological and radiographic findings, co−morbidity, treatment management and outcome were evaluated from medical records. Results. Using GenoType® Mycobacterium CM/AS (Hain Lifescience assays for identification of isolated cultures of NTM M.xenopi was found in six (50% pts, M.avium complex in two (16.67% pts, M.kansasii and M.xenopi in one (8.33%, M. gordone, M.abscessus and M.peregrinum in one (8.33% patient each. Cavitary lesions were most frequently determined on high resolution computed tomography in five (41.67% pts, followed with consolidation in two (16.67% pts, cavitation with fibronodular lesions and bronchiectasis in one (8.33% patient each. Comorbidities were noticed in nine (75% pts, with chronic obstructive pulmonary diseases most frequently found in six (50% pts. According to American Thoracic Society definition and criteria, treatment was administered in nine (75% pts. Conclusion. In order to find the right treatment, it is important to identify non-tuberculosis mycobacteria lung infection by culture methods, at least two positive, accompanied with high resolution computed tomography changes.

  13. Association of FcγRIIa Polymorphism with Clinical Outcome of Dengue Infection: First Insight from Pakistan.

    Science.gov (United States)

    Mohsin, Saima Naz; Mahmood, Saqib; Amar, Ali; Ghafoor, Farkhanda; Raza, Syed Mohsin; Saleem, Mahjabeen

    2015-10-01

    Dengue illness has been a major health concern in Pakistan during the last decade. Dengue infection can result in a spectrum of clinically distinct outcomes, ranging from asymptomatic infection to potentially life-threatening forms of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). A single-nucleotide polymorphism in FcγRIIa (rs1801274) results in altered affinity of the receptor for different subclasses of immunoglobulin G, and is a key player in determining the susceptibility to or protection from severe clinical infection of dengue. In this study, we analyzed the allelic and genotypic distribution of rs1801274 in subjects of Pakistani origin with subclinical dengue infection (n = 40), dengue fever (DF) (n = 40), and DHF/DSS (n = 30). We found that HH homozygotes and heterozygotes were significantly more likely to develop clinical dengue (odds ratio [OR] = 3.21, 95% confidence interval [CI] = 1.29-7.97, P = 0.009), either DF (OR = 2.82, 95% CI = 1.00-7.97, P = 0.045) or DHF/DSS (OR = 3.90, 95% CI = 1.13-13.07, P = 0.024) than the asymptomatic dengue infection. Results of allelic distribution comparisons and logistic regression analysis also supported the same relationship. The results suggest complex nature of interacting factors in determining the course for severe dengue illness.

  14. Expertise in Clinical Psychology. The Effects of University Training and Practical Experience on Expertise in Clinical Psychology

    OpenAIRE

    Vollmer, Sabine; Spada, Hans; Caspar, Franz; Burri, Salome

    2013-01-01

    How do university training and subsequent practical experience affect expertise in clinical psychology? To answer this question we developed methods to assess psychological knowledge and the competence to diagnose, construct case conceptualizations, and plan psychotherapeutic treatment: a knowledge test and short case studies in a first study, and a complex, dynamically evolving case study in the second study. In our cross-sectional studies, psychology students, trainees in a certified postgr...

  15. [Clinical and bacteriological profiles of the urinary infections associated the VIH/AIDS in hospital area of Bamako, Mali].

    Science.gov (United States)

    Dao, S; Oumar, A A; Dembele, J P; Noutache, J L; Fongoro, S; Maiga, I; Bougoudogo, F

    2007-01-01

    The syndrome of immunodepression is the bed of multiple infections of which urinary infections. The goal of this study was to determine the aspects clinical and bacteriological urinary infections during the AIDS with the service of the infectious diseases of the hospital of the Point G of February 1, 2003 to June 30 2005. The diagnosis of the urinary infection was retained on the basis of bacteria number > or =10(4) bacteriury and or leucocytes count > or =10(5)/mm3. The prevalence of the urinary infection was estimated at 8.85%. The principal clinical aspects were a symptomatic pyelonephritis 73.5%, the leucocytiury 11.8%, the cystitis 8.8%, and acute prostatitis 5.9%. Escherichia coli was the most frequent bacterium (46.7%). The sensitivity of the germs was 91.7% with the aminosides, 90.9% with the fluoroquinolones, from 63.6 to 80% respectively with the cephalosporines of first and second generation. Resistance to ampicilline, chloramphenicol and sulfamides was about 72 and 80%. The systematic research of the urinary infection is necessary during the AIDS and the antibiotherapy of choice in first intention in absence of etiologic possibility of diagnosis should be the aminosides and or the fluoroquinolones.

  16. Gene therapy of T helper cells in HIV infection: mathematical model of the criteria for clinical effect

    DEFF Research Database (Denmark)

    Lund, O; Lund, O S; Gram, G;

    1997-01-01

    This paper presents a mathematical analysis of the criteria for gene therapy of T helper cells to have a clinical effect on HIV infection. The analysis indicates that for such a therapy to be successful, it must protect the transduced cells against HIV-induced death. The transduced cells...

  17. Skin and Environmental Contamination in Patients Diagnosed With Clostridium difficile Infection but Not Meeting Clinical Criteria for Testing.

    Science.gov (United States)

    Kundrapu, Sirisha; Sunkesula, Venkata; Tomas, Myreen; Donskey, Curtis J

    2015-11-01

    Of 134 patients diagnosed with Clostridium difficile infection, 30 (22%) did not meet clinical criteria for testing because they lacked significant diarrhea or had alternative explanations for diarrhea and no recent antibiotic exposure. For these patients, skin and/or environmental contamination was common only in those with prior antibiotic exposure.

  18. Clinical effects of sinus surgery and adjuvant therapy in cystic fibrosis patients - can chronic lung infections be postponed?

    DEFF Research Database (Denmark)

    Aanaes, K; Johansen, H K; Skov, M;

    2013-01-01

    The paranasal sinuses can be a bacterial reservoir for pulmonary infections in patients with cystic fibrosis (CF) METHODOLOGY: In this prospective, non-randomised, uncontrolled, intervention cohort study, the clinical effect of sinus surgery followed by two weeks` intravenous antibiotics, 6 months...

  19. Improved BVDV1b challenge model for evaluating efficacy of protection against clinical signs following acute infection

    Science.gov (United States)

    Introduction: Efficacy of bovine viral diarrhea virus (BVDV) vaccines in preventing acute infections is evaluated based on reduction of clinical disease. While high virulence BVDV2 strains are used in U.S. vaccine efficacy studies, the BVDV1 strain, NY-1, made available by the USDA as a challenge ...

  20. Clinical and molecular features of one case of human infection with Anaplasma phagocytophilum from Podlaskie Province in eastern Poland

    Directory of Open Access Journals (Sweden)

    Renata Welc-Falęciak

    2015-09-01

    Full Text Available The article focuses on the clinical and laboratory diagnosis of human granulocytic anaplasmosis (HGA caused by [i]Anaplasma phagocytophilum[/i] infection in one of 28 patients (3.6%; n=1/28 tested samples with early Lyme borreliosis. The clinical and laboratory results of a 42-year-old patient fulfilled criteria of confirm anaplasmosis and suggest an acute stage of illness. The described case provides strong presumptive evidence that infection in this patient was acquired with a pathogenic strain of [i]A. phagocytophilum[/i] through a tick bite. A positive DNA with PCR for A. phagocytophilum infection was sequenced and analyzed phylogenetically. Physicians should consider the possibility of anaplasmosis in patients with early Lyme borreliosis, and [i]A. phagocytophilum[/i] should be considered as a differential diagnosis in all patients from an endemic region of potential high risk factors for tick-borne diseases.

  1. Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines.

    Science.gov (United States)

    Lytvyn, Lyubov; Mertz, Dominik; Sadeghirad, Behnam; Alaklobi, Faisal; Selva, Anna; Alonso-Coello, Pablo; Johnston, Bradley C

    2016-08-01

    BACKGROUND Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. OBJECTIVE To analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. DESIGN AND SETTING We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1-7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%-79.6%); scope and purpose, 74.1% (68.5%-85.2%); editorial independence, 63.9% (47.2%-66.7%); applicability, 43.1% (19.4%-55.6%); stakeholder involvement, 40.7% (38.9%-44.4%); and rigor of development, 18.1% (17.4%-35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. CONCLUSION CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence. Infect Control Hosp Epidemiol 2016;37:901-908. PMID:27267201

  2. Reduction in Clinical Response to Empiric Antimicrobial Therapy of Febrile Granulocytopenic Patients Receiving TMP/SMX Infection Prophylaxis

    Directory of Open Access Journals (Sweden)

    Eric J Bow

    1992-01-01

    Full Text Available In the course of a multicentre clinical trial evaluating two antibacterial regimens for the empiric treatment of suspected infection in febrile neutropenic cancer patients, a suboptimal response was noted among recipients of antibacterial prophylaxis with trimethoprim/sulphamethoxazole (TMP/SMX. Multivariate analysis identified TMP/SMX prophylaxis as a predictor of poor outcome independent of other variables such as classification of infection, marrow recovery, neutrophil count at first fever, indwelling central venous catheter use, and underlying disease. This effect appeared to be restricted to recipients of tobramycin plus ticarcillin (TT. TMP/SMX suppresses potentially pathogenic aerobic Gram-negative bacilli and allows colonization and subsequent infection by Gram-positive microorganisms against which TT-like regimens have limited activity. Recognition of this phenomenon may permit a more appropriate selection of antibacterial agents for the therapy of suspected infection in the neutropenic patient.

  3. Non-specific effect of BCG vaccination at birth on early childhood infections. A randomized, clinical multicenter trial

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper; Birk, Nina M; Nissen, Thomas N;

    2016-01-01

    vaccinated. From 3 to 13 months there were 7028 vs. 6791 events, IRR = 1.02 (0.97 to 1.07).ConclusionsThis study did not find a non-specific public health benefit of BCG on parent reported infections. BCG may have reduced the incidence of infections in children of BCG vaccinated mothers during the first 3......BackgroundChildhood infections are common and Bacillus Calmette-Guérin (BCG) vaccination at birth may prevent these via non-specific effects.MethodsA randomized, clinical multicenter trial. All women planning to give birth (n = 16521) at the three study sites were invited during the recruitment...... period. Participating children were randomized to receive BCG within seven days of birth or to a no intervention control group. Parent reported infections (events) were collected using telephone interviews at 3 and 13 months. Data collectors were blinded to allocation.ResultsThe analyses included 4224...

  4. Clinical characteristics and risk factors of severe respiratory syncytial virus-associated acute lower respiratory tract infections in hospitalized infants

    Institute of Scientific and Technical Information of China (English)

    Xiao-Bo Zhang; Li-Juan Liu; Li-Ling Qian; Gao-Li Jiang; Chuan-Kai Wang; Pin Jia; Peng Shi; Jin Xu; Li-Bo Wang

    2014-01-01

    Background: To investigate the clinical characteristics and analyze risk factors for severe respiratory syncytial virus (RSV) infection in hospitalized infants with acute lower respiratory tract infections (ALRIs). Methods: A retrospective review of the medical records of infants with RSV-associated ALRIs between March 1st, 2011 and February 29th, 2012 was conducted. Subjects were followed up over the phone or by outpatient visit six and twelve months after discharge. Results: Among 913 RSV-associated ALRIs infants, 288 (31.5%) had severe infections, which accounted for 4.2% of hospitalized children. The hospital RSV mortality rate was 1.0%. The proportions of cases with tachypnea, apnea, cyanosis, and fine rales were significantly higher in the severe ALRIs group (all P Conclusions: Younger age, low birth weight and underlying disease are associated with severe RSVassociated ALRIs. Furthermore, severe RSV infections may be associated with a higher frequency of subsequent bronchitis, pneumonia and re-hospitalization in the following year.

  5. Incidence and impact on clinical outcome of infections with piperacillin/tazobactam resistant Escherichia coli in ICU: A retrospective study

    Directory of Open Access Journals (Sweden)

    Mounier Roman

    2008-05-01

    Full Text Available Abstract Background Escherichia coli infections are frequent in ICU patients. The increased resistance to fluoroquinolones and amoxicillin/clavulanate of this pathogen mandates the prescription of broad-spectrum antibiotics such as piperacillin/tazobactam (PIP-TAZ or third generation cephalosporins (3GC. Methods To assess incidence and impact on clinical outcome of infections with PIP-TAZ resistant E. coli in ICU patients, we conducted a retrospective cohort study with infections due to PIP-TAZ resistant (PIP-TAZ R or to PIP-TAZ susceptible strains (PIP-TAZ S between 1 January 2002 and 30 June 2004. Results Of 83 strains, 13 were PIP-TAZ R: 2 strains produced an extended-spectrum β-lactamase (2%, 11 produced a high level penicillinase (13%. Prior amoxicillin or amoxicillin/clavulanate prescription was reported in 7 cases (54% of infections with PIP-TAZ R isolates and in 15 cases (21% of infections with PIP-TAZ S isolates (p = 0.03. Time of onset of the infection from hospital admission was longer in case of infections with PIP-TAZ R than with PIP-TAZ S isolates (22 ± 32 vs 10 ± 21 days, p = 0.01. The overall ICU mortality rate was 38%. Mortality and length of stay in ICU were similar in case of infections with PIP-TAZ R isolates and with PIP-TAZ S isolates. Conclusion Infections with PIP-TAZ R E. coli are frequent in ICU patients. No prognostic impact of this pattern of resistance was found. Prescription of PIP-TAZ for empirical treatment of E. coli infections in ICU however exposes to inappropriate therapy.

  6. Emerging fungal infections among children: A review on its clinical manifestations, diagnosis, and prevention.

    Science.gov (United States)

    Jain, Akansha; Jain, Shubham; Rawat, Swati

    2010-10-01

    The incidence of fungal infections is increasing at an alarming rate, presenting an enormous challenge to healthcare professionals. This increase is directly related to the growing population of immunocompromised individuals especially children resulting from changes in medical practice such as the use of intensive chemotherapy and immunosuppressive drugs. Although healthy children have strong natural immunity against fungal infections, then also fungal infection among children are increasing very fast. Virtually not all fungi are pathogenic and their infection is opportunistic. Fungi can occur in the form of yeast, mould, and dimorph. In children fungi can cause superficial infection, i.e., on skin, nails, and hair like oral thrush, candida diaper rash, tinea infections, etc., are various types of superficial fungal infections, subcutaneous fungal infection in tissues under the skin and lastly it causes systemic infection in deeper tissues. Most superficial and subcutaneous fungal infections are easily diagnosed and readily amenable to treatment. Opportunistic fungal infections are those that cause diseases exclusively in immunocompromised individuals, e.g., aspergillosis, zygomycosis, etc. Systemic infections can be life-threatening and are associated with high morbidity and mortality. Because diagnosis is difficult and the causative agent is often confirmed only at autopsy, the exact incidence of systemic infections is difficult to determine. The most frequently encountered pathogens are Candida albicans and Aspergillus spp. But other fungi such as non-albicans Candida spp. are increasingly important.

  7. Emerging fungal infections among children: A review on its clinical manifestations, diagnosis, and prevention

    Directory of Open Access Journals (Sweden)

    Akansha Jain

    2010-01-01

    Full Text Available The incidence of fungal infections is increasing at an alarming rate, presenting an enormous challenge to healthcare professionals. This increase is directly related to the growing population of immunocompromised individuals especially children resulting from changes in medical practice such as the use of intensive chemotherapy and immunosuppressive drugs. Although healthy children have strong natural immunity against fungal infections, then also fungal infection among children are increasing very fast. Virtually not all fungi are pathogenic and their infection is opportunistic. Fungi can occur in the form of yeast, mould, and dimorph. In children fungi can cause superficial infection, i.e., on skin, nails, and hair like oral thrush, candida diaper rash, tinea infections, etc., are various types of superficial fungal infections, subcutaneous fungal infection in tissues under the skin and lastly it causes systemic infection in deeper tissues. Most superficial and subcutaneous fungal infections are easily diagnosed and readily amenable to treatment. Opportunistic fungal infections are those that cause diseases exclusively in immunocompromised individuals, e.g., aspergillosis, zygomycosis, etc. Systemic infections can be life-threatening and are associated with high morbidity and mortality. Because diagnosis is difficult and the causative agent is often confirmed only at autopsy, the exact incidence of systemic infections is difficult to determine. The most frequently encountered pathogens are Candida albicans and Aspergillus spp. But other fungi such as non-albicans Candida spp. are increasingly important.

  8. Chest radiographic appearances in adult inpatients admitted with swine flu infection: local experience in Melbourne

    International Nuclear Information System (INIS)

    The influenza A virus (H1N1) pandemic began in Mexico in March 2009. As of July 2009, there were 5298 reported cases in Australia including 10 deaths. The aim of this review is to demonstrate the local chest radiographic findings in adult inpatients with proven H1N1, to assess the radiological disease progression and resolution, and to evaluate whether the severity of chest X-rays findings had a bearing on the length of admission and need for intensive care admission. Eleven H1N1 patients (5 males and 6 females, mean age of 36), presenting with cough (64%), fever (55%) and shortness of breath (55%), were admitted to our hospital between 13 August and 1 November 2010. Details of radiographic features, risk factors, clinical course including length of stay, doubling time of consolidation and time for 50% resolution of consolidation were recorded and analysed. Seventy-three per cent of our patients presented with bilateral mid and/or lower zone alveolar consolidation. One patient with underlying cystic fibrosis had only bilateral upper zone consolidation. No pleural effusion, lymphadenopathy or cardiomegaly was noted on any of the plain chest radiographs. The mean doubling time of consolidation was 1.5 days. The mean time for 50% resolution of consolidation after antiviral treatment was 10.5 days. The average length of stay in hospital was 22 days. Ninety-one per cent of our patients required intensive-care unit admission with 50% of those requiring intubation. Rapid progression of bilateral mid and lower zone air-space opacities in relatively young unwell patients, with lack of pleural effusion, pericardial effusion or lymphadenopathy on plain radiographs, should raise the clinical suspicion of H1N1 infection. Patients requiring hospital admission usually show slow clinical and radiological improvement, and require prolonged hospital stays.

  9. Effect of Culicoides sonorensis salivary proteins on clinical disease outcome in experimental bluetongue virus serotype 8 infection of Dorset sheep.

    Science.gov (United States)

    Drolet, Barbara S; Reister, Lindsey M; Lehiy, Christopher J; Van Rijn, Piet A; Bowen, Richard A

    2015-01-01

    The severity of bluetongue clinical disease in ruminants varies greatly depending on the outbreak serotype/strain, animal species/breed, and immune status of the herd. To predict disease risk from any of the 26 bluetongue virus (BTV) serotypes identified to date, experimental animal susceptibility studies are often conducted. Although sheep are the most susceptible livestock species in the US, infection of domestic breeds by injection of field isolates rarely produces the level of clinical disease observed in natural Culicoides midge‑transmitted outbreaks. Thus, outbreak risk assessments based on experimental animal infections can underestimate the severity posed by a potential outbreak with a given virus serotype or strain. The aim of this study was to determine whether secreted Culicoides salivary proteins injected simultaneously with virus, to more closely mimic midge‑delivered virus, would affect clinical disease outcome in a BTV‑8 sheep susceptibility study. Eight sheep were intradermally inoculated with BTV‑8; 4 received virus mixed with secreted Culicoides salivary proteins (BTV‑8 + Cu SP), 4 received virus alone. Clinical signs were monitored daily for type, severity and duration. In sheep receiving the BTV‑8 + Cu SP inoculum, clinical signs were more varied, more severe, and duration was three times longer compared to sheep receiving virus alone. These results suggest that Culicoides salivary proteins may play a contributing role in BTV pathology and that use of these proteins in experimental animal infections may allow development of a more robust target‑host animal model. PMID:26741250

  10. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

    OpenAIRE

    Doyle, Cathal; Lennox, Laura; Bell, Derek

    2013-01-01

    Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence ...

  11. Clinical Engeneering Experience at the Hospital of the State University of Londrina

    OpenAIRE

    Ernesto Fernando Ferreyra Ramírez

    2002-01-01

    This paper describes the four-year experience of implementation of Clinical Engineering services at the Hospital of the State University of Londrina (HURNP/UEL). It was performed by the Electrical Engineering Department (DEEL), through a project involving lecturers and students from the Electrical and Civil Engineering Courses of the same university. The main objectives were the formation of human resources in the Clinical Engineering area and a positive contribution to the healthcare service...

  12. Journey through the clinics - The experience of a woman with BRCA2.

    Science.gov (United States)

    Abernethy, Kathy

    2015-12-01

    Being told that you carry the gene abnormality for breast cancer is hard enough, then being told that you need surgery that will render you menopausal at a young age makes life even harder. Trying to navigate through the NHS, the genetics service, the gynaecology clinics, the gynaecology surgery, primary care services and finally menopause clinics has highlighted the need for cohesive and consistent advice for such women. This woman reports on her personal, generally positive, experience of this journey. PMID:26612439

  13. Practical Experience with Continuous Subcutaneous Insulin Infusion Therapy in a Pediatric Diabetes Clinic

    OpenAIRE

    O'Connell, Michele A.; Cameron, Fergus J.

    2008-01-01

    Continuous subcutaneous insulin infusion therapy (CSII) is an increasingly popular form of intensive insulin administration in pediatric patients. The use of CSII commenced at our large tertiary referral diabetes clinic as recently as 2002. In the intervening years, demand and enthusiasm from both patients and physicians alike have resulted in a steady ongoing increase in CSII use at our clinic. We currently have >200 active patients using insulin pump therapy. This article reviews our experi...

  14. Retrospective study of clinical and hematological aspects associated with dogs naturally infected by Hepatozoon canis in Ludhiana, Punjab, India

    Institute of Scientific and Technical Information of China (English)

    Sushma Chhabra; Sanjeev Kumar Uppal; Lachhman Das Singla

    2013-01-01

    To evaluate clinical and hematological aspects of dogs naturally infected withHepatozoon canis (H. canis) presented at the Small Animal Clinics of Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana. Methods: Blood films of 34 naturally infected dogs were examined for haematological alterations and parasitaemia. Signalment and clinical signs were recorded from the animals. Clinical histories were filled out during the consultation. Results: Of the 34 positive dogs by Giemsa stained peripheral blood films, 88.23% presented parasitaemia by H. canis only, while 11.77% had the combination ofH. canis, Babesia sp. and Ehrlichia sp. Young male dogs less than one-year-old, of non-descript breed, were the most commonly affected. And 26.47% were presented with anorexia/inappetence as the only clinical symptom. Other clinical symptoms were mild to moderate fever, pale mucosae and lethargy; a few were also showing the signs of vomiting and diarrhoea. Haematological alterations showed mainly normochromic-normocytic anaemia, leukocytosis and neutrophilia. Conclusions: The findings of this study substantiate that H. canis caused clinical and haematological alterations of the varied intensity in dogs, even with low parasitaemia, should be taken into consideration.

  15. Faecal culturable microbiota, growth and clinical parameters of calves supplemented with lactic acid bacteria and lactose prior and during experimental infection with Salmonella Dublin DSPV 595T

    Directory of Open Access Journals (Sweden)

    LP Soto

    2015-01-01

    Full Text Available The aim of this study was to evaluate the probiotic inoculum + lactose effect on weight, intestinal culturable microbiota, morbidity and mortality of young calves challenged with Salmonella Dublin DSPV 595T. Twenty eight calves were used, divided in control group (CG and probiotic group (PG. The PG was provided with 100 g lactose.calf-1.d-1 and 10(10 CFU.calf-1.d-1 of each strain of a probiotic inoculum composed of Lactobacillus casei DSPV 318T, Lactobacillus salivarius DSPV 315T and Pediococcus acidilactici DSPV 006T throughout the experiment. The pathogen was administered on day 11 of the experiment, at an oral dose of 10(9 CFU.calf-1. Lactobacillus and yeast populations were modified in PG because of inoculum + lactose administration. Severity of diarrhea was lower in PG. No differences were found on the rest of clinical sings, live weight and mortality between the two groups analysed. The periodic administration of a probiotic inoculum of bovine origin and lactose, favoured the establishment of a more stable and balanced intestinal culturable microbiota, even during an infection with Salmonella. The generated model of acute infection gave opportunity to the probiotic to exert its beneficial effect on severity of diarrhea. However, the use of lower doses of S. Dublin DSPV 595T are recommended for future studies, to generate less severe model in order to evaluate if the inoculum is able to exert a differential response in the clinical symptoms of young calves.

  16. Major challenges in clinical management of TB/HIV co-infected patients in Eastern Europe compared with Western Europe and Latin America

    DEFF Research Database (Denmark)

    Efsen, Anne Marie; Schultze, Anna; Post, Frank;

    2014-01-01

    INTRODUCTION: Rates of both TB/HIV co-infection and multi-drug-resistant (MDR) TB are increasing in Eastern Europe (EE). Data on the clinical management of TB/HIV co-infected patients are scarce. Our aim was to study the clinical characteristics of TB/HIV patients in Europe and Latin America (LA...

  17. Marriage as a risk factor for HIV: learning from the experiences of HIV-infected women in Malawi.

    Science.gov (United States)

    Mkandawire-Valhmu, Lucy; Wendland, Claire; Stevens, Patricia E; Kako, Peninnah M; Dressel, Anne; Kibicho, Jennifer

    2013-01-01

    The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage. PMID:23350930

  18. Marriage as a risk factor for HIV: learning from the experiences of HIV-infected women in Malawi.

    Science.gov (United States)

    Mkandawire-Valhmu, Lucy; Wendland, Claire; Stevens, Patricia E; Kako, Peninnah M; Dressel, Anne; Kibicho, Jennifer

    2013-01-01

    The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.

  19. Cytokine profile and clinical metabolic alterations in HIV-1 infected individuals with and without lipodistrophy

    Directory of Open Access Journals (Sweden)

    L. C. R. Pontes-Cardoso

    2007-01-01

    Full Text Available The extensive use of Highly Active Antiretroviral Therapy (HAART has transformed HIV infection into a chronic condition. Thus, metabolic alterations including lipodystrophy and dyslipidemia have been associated with the use of such medications. The objective of the present study was to analyze clinical metabolic alterations and the profile of TNF-alpha, IFN-Y, IL-2, IL-10, and TNF-alpha type II soluble receptor in serum of HIV-1 individuals with and without lipodystrophy. Eighty-four adults were evaluated, 42 males and 42 females, mean age 37 years, and HAART time of at least 15 months. Two groups were formed, G1: 42 individuals with lipodystrophy, and G2: 42 without lipodistropy. From the HAART used, stavudine was more associated with the lipodystrophy group and zidovudine with the non-lipodystrophy group. CD4 and CD8 values, viral load, glucose, albumin, and lipids were not different between groups, except for triglycerides, which were high in the lipodystrophy group, and HDL, whose concentration was reduced in G1. TNF-alpha, TNF-RII, and IL-10 profiles were high and had positive correlation; IL-2 and IFN-gamma had reduced levels in the lipodystrophy group. High TNF-alpha and its receptor levels seem to be associated with lipodystrophy development in individuals under HAART therapy.

  20. Diagnosis and clinic-pathological findings of influenza virus infection in Brazilian pigs

    Directory of Open Access Journals (Sweden)

    Daniela S. Rajão

    2013-01-01

    Full Text Available Influenza A virus (IAV is a respiratory pathogen of pigs and is associated with the porcine respiratory disease complex (PRDC, along with other respiratory infectious agents. The aim of this study was to diagnose and to perform a clinic-pathological characterization of influenza virus infection in Brazilian pigs. Lung samples from 86 pigs in 37 farrow-to-finish and two farrow-to-feeder operations located in the States of Minas Gerais, São Paulo, Paraná, Rio Grande do Sul, Santa Catarina, and Mato Grosso were studied. Virus detection was performed by virus isolation and quantitative real time reverse-transcription PCR (qRT-PCR. Pathologic examination and immunohistochemistry (IHC were performed in 60 lung formalin-fixed paraffin-embedded tissue fragments. Affected animals showed coughing, sneezing, nasal discharge, hyperthermia, inactivity, apathy, anorexia, weight loss and growth delay, which lasted for five to 10 days. Influenza virus was isolated from 31 (36.0% lung samples and 36 (41.9% were positive for qRT-PCR. Thirty-eight (63.3% lung samples were positive by IHC and the most frequent microscopic lesion observed was inflammatory infiltrate in the alveoli, bronchiole, or bronchi wall or lumen (76.7%. These results indicate that influenza virus is circulating and causing disease in pigs in several Brazilian states.