Nontyphoidal Salmonella causing focal infections in patients admitted at a Spanish general hospital during an 11-year period (1991-2001)

In focal infections (FI) caused by nontyphoidal Salmonella serotypes and recorded at a Spanish hospital 1991-2001, clinical and microbiological features were analyzed. Thirty-five revised episodes were related to infections of the digestive (10), urinary (10), pulmonar (4), vascular (4), osteoarticular (3) and central nervous (3) systems, and with a submaxillary lymph node. At least 16 episodes were associated with previous or concomitant gastroenteritis, 19 with primary or secondary bacteremia, and 18 with underlying diseases of different severity. Eighteen patients were male and 14 female (data were not available for three patients), while 1, 4, 12 and 15 patients were, respectively, categorized as children, young adults, senior adults and elderly. Sources of Salmonella strains were urine (13), blood (11), purulent abscess (8), cerebrospinal fluid (3), peritoneal fluid, pleural fluid, wound exudates, aneurism (2 of each), ascitic fluid, sputum, tracheal aspirate, needle aspirate, bone and lymph node (1 of each) samples. Only 28 Salmonella strains involved in FIs were available for further analysis. They were discriminated into 6 serotypes, and into 13 XbaI macrorestriction, 6 virulence, 11 antimicrobial resistance, 5 integron and 10 plasmid profiles. Broadly, the pattern of serotype distribution of salmonellas involved in FIs matched that of those causing gastroenteritis, with the pandemic Enteritidis and Typhimurium (18 and 6 strains, respectively) being clearly predominant. Within serotype, the same lineages (as revealed by XbaI-macrorestriction analysis as well as R- and V-profiles) were represented in both disease groups, with host-related factors apparently playing a more critical role than the individual strain in the outcome of the disease.     

Outcomes of online support and resources for cancer survivors: a systematic literature review

Objective

This study aims to review systematically the available literature on health outcomes of online cancer support and resources.

Methods

We searched major databases with the following selection criteria: (1) empirical study on use of online support or resources by cancer survivors, (2) reporting effects or outcomes of online support or resources, (3) focusing on adult cancer survivors, and (4) peer-reviewed articles published by 2010.

Results

A total of 24 studies (37 articles) were included in the review. Most studies were focused on breast cancer survivors and had small sample sizes. Fifteen studies employed a cross-sectional design including eight qualitative studies. Only five studies used pre-post design, and four employed RCT design. The outcome measures have focused on psychosocial effects; most studies reported positive effects, although none of the RCT studies reported significant outcomes.

Conclusion

Existing studies of online cancer support and resources have demonstrated preliminary but inconclusive evidence for positive outcomes. We call for additional studies with rigorous study designs and the inclusion of more diverse participants and cancer conditions.

Practice implications

Connecting diverse cancer survivors to culturally appropriate, evidence-based online support and resources is a strategy to enhance health outcomes.     

Nigerian Population Research on Environment,Gene and Health （NIPREGH）-objectives and protocol

Sub-Saharan Africa is currently undergoing an epidemiological transition from a disease burden largely attributable to communicable diseases to that resulting from a combination of both communicable and chronic non-communicable diseases.Data on chronic disease incidence,lifestyle,environmental and genetic risk factors are sparse in this region.This report aimed at providing relevant information in respect to risk factors that increase blood pressure and lead to development of intermediate cardiovascular phenotypes.We presented the rationale,objectives and key methodological features of the Nigerian Population Research on Environment,Gene and Health（NIPREGH） study.The challenges encountered in carrying out population study in this part of the world and the approaches at surmounting them were also presented.The preliminary data as at 20 November 2013 showed that out of the 205 individuals invited starting from early April 2013,160（72 women） consented and were enrolled;giving a response rate of 78%.Participants＇ age ranged from 18 to 80 years,with a mean（SD） of 39.8（12.4） years and they were of 34 different ethnic groups spread over 24 states out of the 36 states that constitute Nigeria.The mean（SD） of office and home blood pressures were 113.0（15.2） mm Hg systolic,73.5（12.5） mm Hg diastolic and 117.3（15.0） mm Hg systolic,and 76.0（9.6） mm Hg diastolic,respectively.Forty-three（26.8%） participants were hypertensive and 8（5.0%） were diabetic.In addition to having the unique potential of recruiting a cohort that is a true representative of the entire Nigerian population,NIPREGH is feasible and the objectives realisable.     

Nosocomial rotavirus gastroenterocolitis in a large tertiary paediatric hospital in Warsaw, 2006-2010

Introduction

Rotaviruses are the leading cause of community-acquired and nosocomial gastroenterocolitis in children. There are limited data concerning the epidemiology of nosocomial rotavirus gastroenterocolitis (NRVG) in Central European countries, including Poland. The aim of our study was to analyse the epidemiology of NRVG in a large tertiary hospital in Warsaw.

Material and methods

We analysed retrospectively data of 63 173 patients aged 0-18 years hospitalized in the period 2006-2010. Nosocomial rotavirus gastroenterocolitis was defined as acute gastroenterocolitis (> 3 loose, or looser than normal, stools in 24 h and/or vomiting), confirmed with rapid immunochromatographic test (BioMaxima, Poland), if symptoms developed > 48 h after admission.

Results

In total 575 cases of NRVG were diagnosed. The cumulative attack rate of NRVG was calculated as 0.91% (95% CI: 0.85-0.98%). The incidence density was 2.05/1000 bed-days (95% CI: 0.19-0.22/1000 bed-days). The mean proportion of NRVG among all rotavirus infections was 24%. The highest rates of NRVG were noted at wards where the mean duration of hospital stay was longer than 5 days (General Paediatrics and Neonatal Pathology). Seventy-one percent of children with NRVG were younger than 2 years. The mean duration of hospital stay of children with NRVG was longer than the average duration of hospitalization (11.6 days vs. 4.6 days, p < 0.01).

Conclusions

Our study showed a relevant incidence of NRVG, which can prolong the children''s hospital stay. Limiting the number of NRVG is important to improve patients’ safety and to avoid additional costs. Routine vaccination against rotavirus diseases could reduce the number of NRVG.     

A look at a Hispanic and African American population in an urban prenatal diagnostic center: referral reasons, amniocentesis acceptance, and abnormalities detected.

PURPOSE: To describe the Hispanic and African-American population referred to our inner city Los Angeles Prenatal Diagnostic Center. To evaluate trends in referral reasons, amniocentesis acceptance, and to assess the number and types of fetal abnormalities found from 1995 to 2001. METHODS: A retrospective study using the data from 3085 daily log entries on patients referred for prenatal counseling. The data included race, age, referral reason, amniocentesis decision and results, and fetal abnormalities. RESULTS: The population was 76% Hispanic and 22% African American. Most referrals were for advanced maternal age (42%) and maternal serum screening (28%). The overall amniocentesis acceptance rate was 52%; advanced maternal age amniocentesis acceptance rate was 46%, and maternal serum screen positive amniocentesis acceptance rate was significantly higher at 64%. There was a significant difference between the overall amniocentesis acceptance rate for Hispanics (48%) and African Americans (63%). There was also a significant downward trend in amniocentesis acceptance between 1995 (63%) and 2001 (39%). Amniocentesis acceptance was significantly greater among patients who were < 35 years of age (65%) than those who were older (47%). An incidence of 7% abnormalities was detected by ultrasound and amniocentesis. CONCLUSIONS: Acceptance of amniocentesis in the Hispanic and African American population in our prenatal diagnostic center is significantly lower than what has previously been reported in the literature for Caucasians and reported in California statewide prenatal diagnostic center data for non-MS-AFP. There was a significant decline in amniocentesis acceptance from 1995 to 2001. Our incidence of fetal abnormalities was higher than reported in California statewide data.     

Retrospective study of serological tests for syphilis diagnosis at Nantes University hospital, between 1999 and 2006

Since 2000, a resurgence of syphilis cases was observed in France and, particularly, in Paris area. The aim of this study was to evaluate the evolution of syphilis prevalence in Nantes area and its impact on our laboratory activity. Between 1999 and 2006, serological tests for syphilis performed at the laboratory were analysed according to the results of these tests, the age and patient sex and the wards. We treated about 32,000 serological tests, over an eight-year period. The number of tests increased by 7.5% per year and patients with a positive result were multiplied by three. These patients were men for 78%, with an average age of 43.4 years. The serological tests providing positive results were in general from two sectors, the anonymous and free detection center and the internal medicine ward and infectious diseases unit. Our study highlighted a strong increase in the number of positive tests, since 2001, with a clear orientation towards a sex male ratio in our area. This inclination currently did not show any decrease, at the opposite to what was observed by the InVS in Paris area.     

Eligibility for HIV/AIDS treatment among adults in a medical emergency setting at an urban hospital in Uganda

Background

Despite global effort to scale up access to antiretroviral therapy (ART), many people in need of HIV/AIDS care in Uganda have not been reached. HIV testing and ART are not widely offered as routine medical services and data on HIV/AIDS in emergency settings in Sub-Saharan Africa is limited.We determined the HIV prevalence and eligibility for ART in a medical emergency unit at Mulago hospital.

Methods

In a cross-sectional study, we interviewed 223 patients who were systematically selected from the patients'' register from October through December 2004. HIV testing was offered routinely and results were delivered within 30 minutes. We evaluated HIV infected patients for WHO clinical stage of disease and referred them for HIV/AIDS care.

Results

Out of 223 patients, 111 (50%) had HIV infection of whom 78 (70%) had WHO clinical stage 3 and 4 of disease thereby requiring ART. Overall, 84 out of 111 (76%) HIV positive patients had not received any specific HIV/AIDS care.

Conclusion

The burden of HIV infection in the medical emergency unit is high and majority of the patients who required ART had no prior HIV/AIDS care. We recommend scale up of HIV/AIDS care in acute care settings in order to increase access to ART.     

The emergence of community-associated methicillin-resistant Staphylococcus aureus at a London teaching hospital, 2000–2006

We used ciprofloxacin susceptibility as a phenotypic marker of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a London hospital collection of MRSA isolates from inpatients, outpatients and primary-care clinics during 2000–2006. Four-hundred and fifty-eight ciprofloxacin-susceptible (Cip-S) MRSA isolates were reported; antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCC mec ) type, spa type and the presence of Panton–Valentine leukocidin (PVL) genes were determined for all 194 surviving Cip-S MRSA isolates. Multilocus sequence typing and pulsed-field gel electrophoresis were performed on representative isolates. Clinical and epidemiological features of Cip-S MRSA infections were consistent with CA-MRSA, the incidence of which increased markedly during the study period from 49 in 2000 to 102 in 2006. Most (82.0%) of the surviving Cip-S MRSA isolates were SCC mec  IV and 25.3% were PVL-positive. Considerable clonal heterogeneity was noted among the recovered isolates, including the t044/ST80-IV European clone and the PVL-negative t127/ST1-IV clone; PVL-positive t008/ST8-IV (USA300) isolates were rare. Ciprofloxacin susceptibility is a useful screening marker of CA-MRSA strains in London, which are more frequent than previously thought and whose incidence is increasing.     

Factors associated with risky sexual behaviour among clients undertaking HIV testing and counselling services at a secondary referral hospital Lagos,Nigeria

BackgroundThis study determined the prevalence of risky sexual behaviour and its associated factors among clients who accessed HIV counselling and testing services at a secondary referral hospital in Lagos, Nigeria.MethodsA retrospective review of clients'' records was conducted. The Client Intake Form of people who accessed HIV counselling and testing services at Mainland Hospital in Lagos, Nigeria between July 1, 2016, and December 31, 2017, were reviewed. Multivariate analysis was conducted to determine the associated factors of risky sexual behaviour.ResultsA total of 4273 client''s records were analyzed, 3884 (90.9%) reported having sex before HIV counselling and testing (HCT). The prevalence of risky sexual behaviour among clients was 41.5%. More males and HIV positive clients had unprotected sex with a casual partner three months before HIV counselling and testing (p < 0.05). More singles than the married had unprotected sex with casual partners (p <0.001) and multiple sexual partners (p =0.002). The prevalence of risky sexual behaviour reduced with advancing age. Being single and having an HIV infection were associated with risky sexual behaviour in this study.ConclusionAge, marital status and HIV status were associated factors of risky sexual behaviour.     

Afebrile pneumonia (whooping cough) syndrome in infants at Hospital Universitario del Valle,Cali, 2001-2007

Introduction:

Afebrile pneumonia syndrome in infants, also called infant pneumonitis, pneumonia caused by atypical pathogens or whooping cough syndrome is a major cause of severe lower respiratory infection in young infants, both in developing countries and in developed countries.

Objective:

To describe children with afebrile pneumonia syndrome.

Methods:

Through a cross-sectional study, we reviewed the medical records of children diagnosed with afebrile pneumonia treated at Hospital Universitario del Valle, a reference center in southwestern Colombia, between June 2001 and December 2007. We obtained data on maternal age and origin, prenatal care, the childs birth, breastfeeding, vaccination status, symptoms, signs, diagnosis, treatment, and complications.

Results:

We evaluated 101 children with this entity, noting a stationary presentation: June-August and November- December. A total of 73% of the children were under 4 months of age; the most common symptoms were: cyanotic and spasmodic cough (100%), respiratory distress (70%), and unquantified fever (68%). The most common findings: rales (crackles) (50%), wheezing and expiratory stridor (37%); 66% were classified as mild and of the remaining 33%, half of them required attention in the intensive care unit. In all, there was clinical diagnosis of afebrile pneumonia syndrome in infants, but no etiologic diagnosis was made and despite this, 94% of the children received macrolides.

Conclusions:

These data support the hypothesis that most of these patients acquired the disease by airway, possibly caused by viral infection and did not require the indiscriminate use of macrolides.     

Invasive group A streptococcal infections in adults, France (2006-2010)

Severe invasive group A streptococcal diseases have re-emerged during the past 10-20 years. In order to provide a better insight into the current epidemiological situation in France, we analysed the questionnaires regarding all invasive strains received at the National Reference Center for Streptococci (CNR-Strep) between 2006 and 2010 from patients aged ≥ 18 and characterized them by emm typing, spe gene detection and antibiotic resistance. Among the 1542 invasive GAS strains studied, 78% (n=1206) were from blood cultures, and a streptococcal toxic shock syndrome (STSS) was described in 22% (n=340) of cases, mainly associated with necrotizing fasciitis (NF) and pleuro-pulmonary infections (p<0.001). The in-hospital fatality rate was 15%. A total of 83 different emm types were recovered but the three predominant emm types, representing almost 60% of the isolates, were emm1 (24%), emm28 (17%) and emm89 (15%). The preponderance of each emm type varied according to the year, with a significant constant increase of emm28 strains, whereas emm1 strains, representing approximately 32% of GAS invasive isolates in 2007 and 2008, dropped to <15% in 2010 (p<0.001). The distribution of phage-associated superantigen genes (speA, speC and ssa) was linked to certain emm types. Between 2006 and 2010, the percentage that was macrolide-resistant decreased from 11% to 5%, confirming the trend observed in 2007. Fortunately, emm1 strains associated with the most life-threatening clinical manifestations remain susceptible to all anti-streptococcal antibiotics.     

Feasibility and Safety of Laparoscopic Surgery for Obese Korean Women with Endometrial Cancer: Long-Term Results at a Single Institution

The purpose of this study was to evaluate the surgical feasibility of and survival outcome after laparoscopy in obese Korean women with endometrial cancer which has recently been increasing. We reviewed the medical records of the patients treated at our medical institution between 1999 and 2012. The patients were divided into three groups, non-obese (Body Mass Index [BMI]<25.0), overweight (BMI 25-27.99), and obese (BMI≥28.0). These patient groups were compared in terms of their clinical characteristics, treatment methods, as well as surgical and survival outcomes. In total, 55 of the 278 eligible patients were obese women. There were no differences in the three groups in terms of the proportion of patients who underwent lymphadenectomy, their cancer stage, histologic type, type of adjuvant treatment administered, intra-, post-operative, and long-term complications, operative time, number of removed lymph nodes, blood loss, and duration of hospitalization (P=0.067, 0.435, 0.757, 0.739, 0.458, 0.173, 0.076, 0.124, 0.770, 0.739, and 0.831, respectively). The Disease-Free Survival (DFS) times were 139.1 vs. 121.6 vs. 135.5 months (P=0.313), and the Overall Survival (OS) times were 145.2 vs. 124.8 vs. 139.5 months (P=0.436) for each group, respectively. Obese women with endometrial cancer can, therefore, be as safely managed using laparoscopy as women with normal BMIs.     

Epidemiology, presentation, management and outcome of candidemia in a tertiary care teaching hospital in the United Arab Emirates, 1995-2001.

Sixty episodes of candidemia among hospitalized patients in the United Arab Emirates (0.77/1000 discharges) in 1995-2001 were identified through case retrieval. All patients had malignancy (65%) or serious non-malignant disease (35%). Candida albicans accounted for 45% of isolates. Non-C. albicans Candida species occurred more frequently than C. albicans in adults (67%), hematologic-malignancy patients (58%), and cases of breakthrough candidemia (83%) and were prevalent overall in 2000-2001 (67-73%). C. tropicalis was identified in 15% of cases, C. glabrata in 5%, C. parapsilosis in 5%, C. inconspicua in 2%, C. famata in 2% and C. lusitaniae in 1%. Delayed diagnosis or treatment was common, as was Karnofsky scale < or = 40%, septic shock, and inadequate dosage or duration of antifungal drug therapy. Crude mortality was 50%, and mortality attributable to candidemia was 30%. Univariate analysis indicated patients were more likely to die (odds ratio for death [95% CI]) if they had been stationed in the intensive care unit (ICU) (4.76 [1.31-17.2]), had a Karnofsky scale < or = 40% (38.76 [4.66-322.47]), or suffered septic shock (9.88 [2.9-33.65]). They were more likely to survive in cases with concomitant bacteremia (0.25 [0.07-0.91]), adequate antifungal dose (0.28 [0.08-0.94]), and removal of central lines (0.26 [0.07-0.95]). The high association of bacteremia with candidemia (70% of cases) is unusual. The apparent survival benefit experienced by patients who had bacteremia (odds ratio for survival on multivariate analysis = 2.40 [0.28-20.17], P < 0.03) is novel.     

Adult autopsies in a French university hospital (CHU Amiens) for the period 1975-2005

We have reviewed the pathological reports of adult necropsies performed in Amiens hospital during the 1975-2005 period. 1,639 autopsies were performed in 1,049 men and 590 women. We distinguished three periods: 1975-1987 (period 1) with a high number of autopsies (86/year), 1988-1996 (period 2) with a huge decrease of autopsies performed (43/year) and 1997-2005 (period 3) with few autopsies performed (14/year). Patients were younger during period 3, 38% were less than 50 years old versus 26% and 29% during periods 1 and 2. The sex ratio M/F increased during period 3 (2.7 versus 1.7 and 1.9 during periods 1 and 2). Period 3 showed an increase of major diagnoses discovered during autopsies (36% versus 28% of autopsies performed during periods 1 and 2) and showed an increase of autopsies performed after iatrogenic events (20% versus 12% and 13% of autopsies of periods 1 and 2). Period 3 showed an increase of the delay between the death of patients and autopsy and a decrease of the delay of transmission of pathological reports. 2% of autopsies were never answered by the pathologists. In conclusion, our study confirms the major decline of autopsies during the last 30 years. Patients autopsied are currently young men and the autopsies are more frequently performed in potential forensic circumstances. Selection biases explain that major diagnoses are more frequently found at autopsies nowadays than 30 years ago.     

Spermiogenesis and spermatozoon ultrastructure of the diphyllidean cestode Echinobothrium euterpes (Neifar, Tyler and Euzet 2001) Tyler 2006, a parasite of the common guitarfish Rhinobatos rhinobatos

Spermiogenesis and the ultrastructural characters of the spermatozoon of Echinobothrium euterpes are described by means of transmission electron microscopy, including cytochemical analysis for glycogen. Materials were obtained from a common guitarfish Rhinobatos rhinobatos caught in the Gulf of Gabès (Tunisia). Spermiogenesis in E. euterpes is characterized by the orthogonal development of two unequal flagella followed by the flagellar rotation and the proximodistal fusion of these flagella with the median cytoplasmic process. The most interesting pattern characterizing the diphyllidean cestodes is the presence of a triangular body constituted by fines and dense granules without visible striation and assimilated at the striated rootlets. This pattern, only related in the Diphyllidea cestodes may be a synapomorphy of this order. Spermiogenesis is also characterized by the presence of a very short flagellum (around 1 μm long), observed in all the stages of spermiogenesis. This type of flagellum has never been commented in the diphyllidean cestodes and should be considered as an evolved character in this group. In the latest stage of spermiogenesis, this short axoneme probably degenerates. Thus, the mature spermatozoon of E. euterpes possesses only one axoneme of 9 + “1” trepaxonematan pattern. It also exhibits a single helical electron-dense crested body, a spiraled nucleus, few parallel cortical microtubules, and α-glycogen granules. Similitudes and differences between spermatozoa of diphyllideans are discussed.     

Factors associated with readiness to start antiretroviral therapy (ART) among young people (15–24 years) at four HIV clinics in Mulago Hospital,Uganda

IntroductionGlobally, the HIV burden continues to rise among young people despite the discovery of ART. This study assessed demographic and psycho-social factors among young people associated with readiness to be initiated on ART.MethodsA quantitative cross-sectional study was conducted among newly diagnosed HIV positive young people aged 15–24 years at 4 HIV clinics at Mulago Hospital. Readiness was measured as a self-report by the individual to the question, “How ready do you feel to start ART?ResultsOf the 231 young people enrolled, the mean age (SD) was 20.7years (+/-2.8) and most were female (66.2%). Majority were very ready (53.3%) and very motivated (51.1%) to start ART. Higher treatment readiness was associated with being female (95% CI [5.62, 8.31], p=0.003), thinking that ART cures HIV (95% CI [0.43, 0.86], p=0.005), history of having unprotected sex (95% CI [0.79, 0.87], p=<0.001), anticipating negative HIV results (95% CI [0.26, 0.88], p=0.017), internalized stigma (95% CI [0.83, 0.98], p=0.018) and knowledge of positive ART effects for others (95% CI [0.84, 0.93], p=<0.001).ConclusionsUnderstanding the underlying factors associated with ART readiness among young people can inform strategies to support and increase individuals'' readiness to initiate ART and early engagement in care.     

Clinical and microbiological characteristics of bacteremia caused by Eggerthella, Paraeggerthella, and Eubacterium species at a university hospital in Taiwan from 2001 to 2010

We describe 16 patients with bacteremia caused by Eggerthella lenta (n = 7), Paraeggerthella hongkongensis (n = 3), Eubacterium limosum (n = 4), Eubacterium callanderi (n = 1), and concomitant Eubacterium limosum/Eggerthella lenta (n = 1). Nine (56%) patients had polymicrobial bacteremia. The overall 60-day mortality rate was 19%, and all deaths occurred in patients with E. lenta bacteremia.