A case of cutaneous myiasis due to <Emphasis Type="Italic">Dermatobia hominis</Emphasis> in Japan

We report the 34th imported case of cutaneous myiasis caused by Dermatobia hominis in Japan, which is not a habitat of the fly. A 41-year-old Japanese man noticed an insect-sting-like papule on his left upper back during his stay in Ecuador in March 2004. After his return home, the lesion gradually increased to become a red subcutaneous nodule with a central pore from which serosanguineous fluid drained. Because antimicrobial treatment under a diagnosis of inflammatory atheroma was ineffective, the lesion was incised and a 3rd instar larva of D. hominis was then found and removed. We checked the literature on D. hominis myiasis reported from Japan, and noted the fact, which nobody had previously pointed out, that in Japan only one case of D. hominis myiasis had been diagnosed correctly before a larva was found, and most of the cases were misdiagnosed and inappropriately treated, including 11 cases given unnecessary resection of the nodules. Doctors in Japan should be aware of myiasis so that patients are neither anxious about the disease nor suffer pain, and doctors avoid performing unnecessary resections of the lesions.     

SCCmec相关的psm-mec在血液来源人葡萄球菌中的基因定位

目的了解SCCmec相关的psm-mec基因在血液来源人葡萄球菌中的基因定位特征,为深入研究psm-mec基因在人葡萄球菌中的功能奠定基础。方法收集临床血培养分离的人葡萄球菌25株,通过PCR扩增mecA基因和psm-mec基因,多重PCR对耐甲氧西林人葡萄球菌SCCmec分型,PCR扩增mecR1/psm-mec基因与psm-mec/xylR基因间隔序列及fudoh基因,探究psm-mec基因在SCCmec上的定位特点。结果 PCR检测显示,21株为耐甲氧西林人葡萄球菌,psm-mec基因的检出率为47.6%,4株为甲氧西林敏感人葡萄球菌,未检出psm-mec基因。多重PCR结果显示,10株psm-mec基因阳性菌株中,2株属典型SCCmecⅢ型,5株属类SCCmecⅢ型,3株属SCCmec新型别。基因间隔序列和fudoh基因检测显示,10株psm-mec基因阳性人葡萄球菌中,mecR1/psm-mec基因和psm-mec/xylR基因及fudoh基因均阳性。结论 SCCmec相关的psm-mec基因广泛存在于血液来源的人葡萄球菌中,主要分布在典型SCCmecⅢ型、类SCCmecⅢ型和SCCmec新型别上,定位于mecR1基因与xylR基因之间。     

深圳儿童医院就诊患儿人芽囊原虫感染情况初步调查

目的初步了解深圳儿童医院就诊患儿人芽囊原虫感染情况,分析儿童感染人芽囊原虫的临床特点,为采取相应的防治措施提供科学依据。方法随机选取2017年10月至2018年3月深圳儿童医院门诊和住院患儿共1 518例,进行粪便镜检,并对镜检发现人芽囊原虫患儿进行临床特点分析。结果检出人芽囊原虫感染者6例,感染率为0.40%,不同年龄、粪便性状、性别之间感染率差异无统计学意义(P均0.05);镜下人芽囊原虫以空泡型为主,繁殖多以二分裂为主,镜下形态易与粪便杂质相混淆;临床症状以腹痛、腹泻为主;治疗方案需结合感染程度、临床症状、免疫功能等因素综合分析。结论深圳儿童医院就诊患儿人芽囊原虫感染率较低。镜检是最简单、快捷、经济的诊断方法,但其形态学识别存在一定的困难,应加强寄生虫形态学培训,提高对人芽囊原虫感染的临床认识。     

Periprosthetic joint infection due to Mycoplasma hominis in a multiple sclerosis patient treated with fingolimod

Mycoplasma hominis is a commensal pathogen normally found in urogenital tract of humans and has been associated with a wide variety of extra-genitourinary infections, such as mediastinitis, bacteremia, and septic arthritis, particularly in immunocompromised patients. Here, we present a case of a 48-year-old male, who had been treated with fingolimod for relapsing multiple sclerosis and presented with fever and right-sided hip pain following total hip arthroplasty. CT scan revealed localized fluid collection in the right quadriceps femoris muscle adjacent to the joint cavity of right hip. The percutaneously aspirated fluid grew M. hominis, which was also isolated from blood culture. With diagnosis of periprosthetic joint infection, the patient underwent surgical debridement with retained prosthesis and was treated with antimicrobial agents. Infected granulation tissues excised from the hip was observed under an electron microscope, which revealed electron-dense rounded structures contained in neutrophils, consistent with Mycoplasma particles. Fingolimod, an immunomodulatory drug that acts on the sphingosine-1-phosphate receptor and prevents the egress of lymphocytes from lymph nodes, might increase host susceptibility to a systemic M. hominis infection.     

Mycetoma of the scalp due to Microsporum canis: hystopathologic, mycologic, and immunogenetic features in a 6-year-old girl

Dermatophytic mycetoma is an extremely rare subcutaneous mycosis. Here, we report the case of a 6-year-old girl with clinical, histologic, and mycologic findings consistent with a mycetoma of the scalp caused by Microsporum canis. To our knowledge, this is the first report showing the immunologic and immunogenetic features of a patient with a recalcitrant dermatophytic mycetoma.     

Metastasis from a primary angiosarcoma of the scalp to the colon: sonographic and CT findings

We report a case of metastasis to the colon from a primary angiosarcoma of the scalp in a 61-year-old Japanese man and describe the sonographic features and CT findings, with a brief discussion of the clinical and histopathologic findings. Although this entity is extremely rare, it should be considered when a patient with prior diagnosis of angiosarcoma in another organ has focal thickening with preserved compressibility of the wall of the colon.     

Registered nurses returning to school for a bachelors degree in nursing: Issues emerging from a meta-analysis of the research

This literature review was conducted to determine what is known about nurses' attitudes and perceptions about returning to school. There are four societal influences making nursing continuing education important: (1) Many nurses are still practicing with an Associate's degree or diploma and few continue their formal education; (2) Recent studies have indicated that there are improved patient outcomes in hospitals which employ higher educated nurses; (3) A poor economy during a nursing shortage means high demand and less incentive for nurses to return to school for higher education; and (4) The worsening faculty shortage means an increased need for nurses to advance their education. Understanding nurses' attitudes and perceptions may help identify gaps in our knowledge, determine ways to foster positive attitudes toward education learning among nurses, and allow us to entice nurses to return to school. It may also identify crucial steps to ensure the provision of quality healthcare.     

Increased self-awareness in the process of returning to work

Scand J Caring Sci; 2011; 25; 762–770
Increased self‐awareness in the process of returning to work Background: A group of employees on sick leave, living in the Oslo area, Norway, was offered participation in a counselling programme, based on Gestalt theory, mindfulness and phenomenological understanding of the body. Aims: To explore the participants’ processes of change related to their increased ability to work. Method design: This qualitative study is based on modified grounded theory. Method: A total of 12 female employees, all who had increased work ability 1 year after the programme, participated in open focus‐group interviews at the end of the programme. Findings: The participants’ experiences from processes of change are described through the following categories: becoming more aware of one’s own thoughts, emotions and bodily reactions; taking oneself seriously and accepting oneself; being secure enough to face being challenged; realizing new possibilities and choices and trying out new ways of acting. The participants further described what had been helpful in these processes. Experience of a secure setting and open‐minded listening seemed important for getting the courage to open up to all reactions. Then, they could explore new ways of thinking, communicating and behaving. Discussing existential issues such as their core values was important. This, together with being allowed to take their own emotions seriously and being challenged by the counsellors, had encouraged the processes of change. Conclusions: The women described how experiences of increased awareness contributed to reconstruction of their self‐understanding and opened up for new possibilities. This seemed to have provided them with new ways of communicating and acting, which enhanced participation in work. The context of the learning programme, the existential issues and counselling challenges appeared as essential in these processes of change. The findings give insights into aspects that may be important when designing rehabilitation programmes.     

2015-2022年连云港地区生殖道支原体感染情况及耐药变迁分析

摘要:目的调查连云港地区 泌尿生殖系统支原体感染情况和耐药性变迁,为临床合理用药提供依据。方法收集2015-2022年连云港市妇幼保健院疑似泌尿生殖道支原体感染的病例22889例,回顾性分析临床资料,统计生殖道支原体感染情况和药敏结果。结果生殖道 支原体阳性标本8943例,其中解脲脲原体(Uu)感染率最高,为33 .64%(7700/22 889) ,明显高于人型支原体(Mh)感染率3.91% (894/22 889)和混合(Uu+Mh)型感染率1.52%(349/22 889),差异具有统计学意义( P<0.05)。2015- -2022 年总体感染率和Uu感染率呈增长趋势。女性泌尿生殖道支原体感染率为42.42%,显著高于男性的22.47% (x2=534.21 , P<0.05);与小于20岁以及40岁以上年龄段人群相比,20~40岁人群感染率最高,达到40.84%(6 108/14 955)。泌尿 生殖道支原体对强力霉素、美满霉素及交沙霉素敏感性较高,耐药率均未超过5.00%;Uu感染者对红霉素、 氧氟沙星和环丙沙星的耐药率有增长趋势(P<0.05) ,Mh感染者对红霉素、罗红霉素、阿奇霉素和氧氟沙星的耐药率有增长趋势(P<0.05)。结论连云港地区泌尿生殖道支原体感染率呈逐年增长趋势,需加强相应的监控;强力霉素、美满霉素和交沙霉素适合作为本地区泌尿生殖道支原体感染治疗的首选临床用药,大部分喹诺酮类药物的耐药率较高,提示存在该类药物滥用情况,需加强临床 监管。     

An 8-year survey on the occurrence of imported malaria in a nonendemic area by microscopy and molecular assays

Our study aimed to describe the occurrence of imported malaria in a nonendemic area (Parma, Italy) during the period 2000 to 2007, comparing the data obtained by microscopy and molecular assays targeting plasmodial 18S subunit rRNA gene. The prevalence of imported malaria in Parma was 21.8% by microscopy and 22.7% by polymerase chain reaction (PCR). Plasmodium falciparum accounted for 81.1% of the cases, followed by Plasmodium ovale (8.8%), Plasmodium vivax (3.8%), and Plasmodium malariae (1.9%). Mixed infections accounted for 4.4% of the cases. In this study, PCRs proved to be more sensitive and specific than microscopy and changed the picture of malaria epidemiology in Parma, detecting additional cases of malaria undiagnosed by microscopy and allowing speciation of plasmodia in cases misidentified by microscopy. Generally, imported malaria cases reflect the number of immigrants who visit their native countries, in particular, West Africa, explaining the increased prevalence of P. ovale cases among non-P. falciparum infections in Parma.     

Increased lipolytic activity of sera from pre-eclamptic women due to the presence of a lysophospholipase

Endresen MJ, Lorentzen B, Henriksen T. Increased lipolytic activity of sera from pre-eclamptic women due to the presence of a lysophospholipase. Scand J Clin Lab Invest 1993; 53: 733-739.

Sera from pre-eclamptic women exhibit an increased lipolytic activity compared to sera of women with normal pregnancies. The null hypothesis of this study was that the increased release of free fatty acids (FFA) was due to hydrolysis of circulating triglycerides. The nature of the increased lipolytic activity was investigated by incubating sera from pre-eclamptic (PE) and normal pregnant women (C) with various lipid substrates radiolabeled in the FFA position.

The release of FFA in PE-sera was not due to hydrolysis of triglycerides or diglycerides. Lysophosphatidylcholine, however, served as substrate for the enhanced lipolytic activity. By using lysophosphatidylcholine with radiolabeled FFA in the sn-1-position we found that 32±10nmol FFAml^_1h^_1 was released in PE-sera, compared to 10±4nmol FFAmP'h^?1 in C-sera. This lysophospholipase activity appears independent of Ca²⁺ and other divalent cations. The increased release of FFA in sera of pre-eclamptic women can be explained by the presence of a lysophospholipase which releases the remaining fatty acid of lysophosphatidylcholine.     

Revisioning,reconnecting and revisiting: the psychosocial transition of returning home from hospital following a stroke

Abstract

Purpose: This study aimed to investigate and improve understanding of the experiences of patients and their carers during the first month at home following discharge from hospital, thereby enhancing appropriate care from a more informed perspective. Method: In-depth interviews and self-report diaries were used to capture data from 12 patient/carer dyads. Four survivors with marked communication problems were included in this number, two requiring the use of pictures and diagrams to express their views. Interpretative phenomenological analysis (IPA) was used to capture and interpret survivor and carer experiences. Findings: Three superordinate themes were derived from the data. Stroke survivors and their carers described the first month at home as a very dynamic time, recounting a process that involved revisioning (re-examining their identity and the reality of their new situation, including an awareness of their own mortality), reconnecting (with important relationships and previous activities) and revisiting (their past lives, and the stroke event and hospital experience). These three activities assisted in making and finding sense in their new situation; participants’ vision of their lives was revised and revisited as they attempted to reconnect with as much of their past selves and past activities as possible. Conclusions: This study contributes to understandings through in-depth individual accounts of the psychosocial transition of returning home. Details of how people make sense of their altered situation can make a valuable contribution to research, and the knowledge base for care provision.

• Implications for Rehabilitation

• Supporting people to revision their future can assist with psychosocial transition following a stroke.

• Assisting patients to reconnect and reintegrate in a way that is meaningful to them is an important part of the rehabilitation support that can be offered by professionals, and can be informed by awareness of their vision of what the future may now hold.

• Offering people the opportunity to reflect on what has occurred, either verbally or in the form of a diary, can assist adjustment and help people to make sense of their changed situation.

     

Emergence of a 23S rRNA mutation in Mycoplasma hominis associated with a loss of the intrinsic resistance to erythromycin and azithromycin

OBJECTIVES: Mycoplasma hominis is intrinsically resistant to 14- and 15-membered macrolides and to the ketolide telithromycin but is susceptible to josamycin, a 16-membered macrolide, and lincosamides. The aim of our study was to investigate the in vitro development of macrolide resistance in M. hominis and to study the impact of ribosomal mutations on MICs of various macrolides and related antibiotics. METHODS: Selection of macrolide-resistant mutants was performed by serial passages of M. hominis PG21 in broth medium containing subinhibitory concentrations of clindamycin, pristinamycin, quinupristin/dalfopristin and telithromycin. Stepwise selection of josamycin-resistant mutants was performed onto agar medium containing increasing inhibitory concentrations of josamycin. Resistant mutants were characterized by PCR amplification and DNA sequencing of 23S rRNA, L4 and L22 ribosomal protein genes. RESULTS: Various mutations in domain II or V of 23S rRNA were selected in the presence of each selector antibiotic and were associated with several resistance phenotypes. Josamycin was the sole antibiotic that selected for single amino acid changes in ribosomal proteins L4 and L22. Unexpectedly, the C2611U transition selected in the presence of clindamycin and the quinupristin/dalfopristin combination was associated with decreased MICs of erythromycin, azithromycin and telithromycin, leading to a loss of the intrinsic resistance of M. hominis to erythromycin and azithromycin. CONCLUSIONS: Ribosomal mutations were associated with resistance to macrolides and related antibiotics in M. hominis. Some mutants showed a loss of the intrinsic resistance to erythromycin and azithromycin.     

Aging and the elderly in the undergraduate nursing courses in Brazil: from the current situation to a proposal for the content of the program

The teaching nursing undergraduate was verified in 77 courses in Brazil about elderly's attention, hourly load and time of insert of this content in the curriculum. The authors suggest fundamental themes to the nurses' formation to act with elderly in the different contexts in their health's attention.     

1起由陪护人员引发呼吸道医院感染的启示

通过对1起由陪护人员引发的呼吸道医院感染暴发的调查和控制,提出降低医院感染发病率的对策,加强陪护人员的管理和教育,使陪护工作规范化;提高医院感染监测的敏感度,对出现医院感染的流行及时报告、及时控制,探索用症状监测的方式进行医院感染监控,做到早发现、早控制。     

Cardiac arrest due to aberrant left coronary artery originating from the right sinus of valsalva in a young girl

We report a 14-year-old girl who sustained a syncope followed by cardiac arrest. She was kept alive for three days by full cardiocirculatory support using left and right ventricular assist devices, but subsequently died in multiple organ failure. Autopsy revealed an anomalous origin of the left coronary artery (LCA) from the right sinus of Valsalva (RSV) and a major left anterior wall infarction. A cyclo-ergometric stress test performed two years before having been negative, we discuss its value in preventing sudden death due to coronary anomalies.