Outbreak of JK diphtheroid infections associated with environmental contamination.

The group JK diphtheroid organism is a multiply resistant opportunistic pathogen which infects immunocompromised patients sporadically. We describe the first reported outbreak of JK diphtheroid infections, in which four cases of bacteremia and one Hickman catheter site infection occurred during 4 weeks on a hematology ward. On this ward, JK diphtheroid was recovered from 17 of 39 patients, 10 of 17 30-ft3 (0.840-m3) air samples, surfaces in 9 of 13 patient rooms, and hands of 4 of 22 personnel. Previously identified risk factors for JK diphtheroid sepsis (male gender, broad-spectrum antibiotic therapy, granulocytopenia, and prolonged hospital stay) were present in infected patients but did not distinguish them from patients who were only colonized. Emphasis on aseptic practices was associated with termination of the outbreak and negative hand cultures from personnel, despite continued patient colonization and environmental contamination.     

The kidney in streptozotocin diabetic rats. Morphologic, ultrastructural, and function studies.

In order to study the nephropathy associated with experimental streptozotocin diabetes, serila morphologic, ultrastructural, immunohistologic, and functional studies were done in diabetic Lewis rats to study the course of the nephropathy. Early in the course of diabetes, these animals developed an increase in mesangial matrix, with electron-dense material, IgG, and C3 in the mesangium. These alterations were progressive. Mesangial bars, proximal tubular vacuolization, and myeloid bodies were also present. Progressive increase in protein excretion and increase in creatinine clearance were observed. Hyperglycemia was accompanied by weight loss, persistent glycosuris, hyperphosphaturia, and hypercalcuria. Urinary glomerular basement membrane-like protein and major urinary protein were decreased. Normal age-matched controls showed no abnormalities. Some of the changes observed in diabetic rats are present in human diabetes.     

Myocardial hypertrophy and enhanced left ventricular contractility in Zucker diabetic fatty rats.

Heart failure is known to be a complication of insulin-dependent (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) even in the absence of coronary heart disease or hypertension. The mechanisms leading to diabetic cardiomyopathy are unknown. The aim of the study was to characterize structural and functional alterations in hyperinsulinemic Zucker diabetic fatty (ZDF) rats treated with or without insulin. Diabetic animals showed a twofold increase in cardiomyocyte volume with increased left ventricular ANP but not BNP mRNA levels in spite of a reduced plasma renin activity (PRA) 2 months after onset of diabetes compared to nondiabetic littermates. These changes were associated with an increase in left ventricular performance as assessed by echocardiography. Insulin treatment led to a significant increase in body weight (BW), total heart weight, myocardial protein content, and left ventricular mass (LVM). Perivascular fibrosis and laminin thickness were significantly augmented in diabetic rat myocardium irrespective of insulin treatment, whereas interstitial collagen I and fibronectin were similarly found in diabetic and control myocardium. Initial stages of diabetic cardiomyopathy in hyperinsulinemic rats are characterized by cardiomyocyte hypertrophy and enhanced cardiac contractility. It is suggested that hyperinsulinemia may be involved in cardiac hypertrophy.     

The AMDP scales in a phase II evaluation of psychotropic drugs

Four multicentre double blind trials (two studies comparing placebo to a marketed activating drug and two comparing placebo to a new drug with central adrenergic modulating properties) were pooled, totalling 77 placebo Ss, 30 reference drug Ss and 73 study drug Ss. The AMDP-4 and -5 scales were filled out at day 0 and 7 by trained raters. Four statistical analyses were performed on the pre- vs. postdrug differences: an analysis of variance, a principal components factor analysis, a discriminant analysis and a cluster analysis. The results indicate that 9 out of the 14 AMDP factor scores significantly decrease within 1 week while the factor Mania-Agitation increases, without differences between both active compounds; on the item level, the "inhibition of drive" is specifically improved by the study drug; the discriminant analysis confirms that the two most improved items are "Inhibition of drive" and "Hopelessness". Three factor scores significantly improve on placebo (Depression, Retardation, Psycho-organic Symptoms), which points to the necessity of placebo-controlled studies in clinical trials of new drugs.     

Mundgesundheitskompetenz von Menschen mit Migrationshintergrund – Erste Auswertungen der MuMi-Studie

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Erste Studien heben den Migrationshintergrund von Menschen in Deutschland als eigenständigen Risikofaktor für eine...     

Attitudes and career experiences of male and female healthcare executives

While the expression "battle between the sexes" may be a cliche, the question being asked in business and healthcare management circles focuses on who is rising to the top of the management hierarchy--the male or the female executive. Previous research has shown a smaller percentage of women than men make it to the senior levels of management in business.     

Native and activated antithrombin inhibits TMPRSS2 activity and SARS-CoV-2 infection

Host cell proteases such as TMPRSS2 are critical determinants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tropism and pathogenesis. Here, we show that antithrombin (AT), an endogenous serine protease inhibitor regulating coagulation, is a broad-spectrum inhibitor of coronavirus infection. Molecular docking and enzyme activity assays demonstrate that AT binds and inhibits TMPRSS2, a serine protease that primes the Spike proteins of coronaviruses for subsequent fusion. Consequently, AT blocks entry driven by the Spikes of SARS-CoV, MERS-CoV, hCoV-229E, SARS-CoV-2 and its variants of concern including Omicron, and suppresses lung cell infection with genuine SARS-CoV-2. Thus, AT is an endogenous inhibitor of SARS-CoV-2 that may be involved in COVID-19 pathogenesis. We further demonstrate that activation of AT by anticoagulants, such as heparin or fondaparinux, increases the anti-TMPRSS2 and anti-SARS-CoV-2 activity of AT, suggesting that repurposing of native and activated AT for COVID-19 treatment should be explored.     

Merging managed care with the German model

Since public officials in the United States may lack the courage and political will to significantly raise payroll taxes or the contain Social Security, Medicare and Medicaid benefits, Americans can anticipate that; (a) future generations increasingly will pay for these entitlements; (b) additional cutbacks to providers in Medicare, Medicaid and health maintenance organization reimbursement will hasten the current thrust of hospitals, physicians and insurers in forming huge health networks with their powerful managed care plans; and, (c) many of these new alliances will function as virtual monopolies--eventually resulting in the public proposing that state health services commissions be established. This article then suggests that future modifications in how the United States health delivery system be organized and financed preferably should be along the lines of the German multi-player, multi-tier, self-governing, decentralized, quasi-private, quasi-public model; and, also patterned after experiences of the State of Arizona's Medicaid program. It concludes that what America needs most is a hybrid of the European global budgetary targets to constrain total health expenditures, and the competitive managed care concept to curtail use patterns and to enhance quality.