Mortality rate and length of stay of patients admitted to the intensive care unit in July

OBJECTIVE: At the beginning of each academic year in July, inexperienced residents and fellows begin to care for patients. This inexperience can lead to poor patient outcome, especially in patients admitted to the intensive care unit (ICU). The objective of this study was to determine the impact of July ICU admission on patient outcome. DESIGN: Retrospective, cohort study. SETTING: Academic, tertiary medical center. PATIENTS: Patients admitted to the ICU from October 1994 through September 2002. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographics, Acute Physiology and Chronic Health Evaluation (APACHE) III score and predicted mortality, admission source, admission date, intensity of treatment, ICU length of stay (LOS), and hospital mortality of 29,084 patients were obtained. The actual and predicted weighted ICU LOS and their ratio were calculated. Logistic regression analysis was used to compare the hospital mortality rate of patients admitted to the ICU in July with those admitted during the rest of the year, with adjustment for potentially confounding variables. The patients' mean age was 62.3 +/- 17.6 yrs; 57.3% were male and 95.5% white. Both the customized predicted and observed hospital mortality rates of the entire cohort were 8.2%. The majority (76.7%) of the patients were discharged home, and 15.1% were discharged to other facilities. When adjusted for potentially confounding variables, ICU admission in July was not associated with higher hospital mortality rate compared with any other month. There were no significant differences in the discharge location of patients between July and any one of the other months. There were no statistically significant differences in the weighted ICU LOS ratio between July and any of the other months. CONCLUSIONS: ICU admission in July is not associated with increased hospital mortality rate or ICU length of stay.     

FBXO4 loss facilitates carcinogen induced papilloma development in mice

Cyclin D1 is frequently overexpressed in esophageal squamous cell carcinoma (ESCC) and is considered a key driver of this disease. Mutations in FBXO4, F-box specificity factor that directs SCF-mediated ubiquitylation of cyclin D1, occur in ESCC with concurrent overexpression of cyclin D1 suggesting a potential tumor suppressor role for FBXO4. To evaluate the contribution of FBXO4-dependent regulation cyclin D1 in esophageal squamous cell homeostasis, we exposed FBXO4 knockout mice to N-nitrosomethylbenzylamine (NMBA), an esophageal carcinogen. Our results revealed that loss of FBXO4 function facilitates NMBA induced papillomas in FBXO4 het (+/−) and null (−/−) mice both by numbers and sizes 11 months after single dose NMBA treatment at 2mg/kg by gavage when compared to that in wt (+/+) mice (P < 0.01). No significant difference was noted between heterozygous or nullizygous mice consistent with previous work. To assess cyclin D1/CDK4 dependence, mice were treated with the CDK4/6 specific inhibitor, PD0332991, for 4 weeks. PD0332991 treatment (150mg/kg daily), reduced tumor size and tumor number. Collectively, our data support a role for FBXO4 as a suppressor of esophageal tumorigenesis.     

Glutamate neurons in the substantia nigra compacta and retrorubral field

Dopaminergic neurons of the substantia nigra compacta (SNC), ventral tegmental area (VTA) and retrorubral field (RRF) play a role in reward, motivation, learning, memory, and movement. These neurons are intermingled with GABAergic neurons. Recent evidence shows that the VTA contains glutamatergic neurons expressing vesicular glutamate transporter type 2 (VGluT2); some of them co‐express tyrosine hydroxylase (TH). Here, we used a combination of radioactive in situ hybridisation and immunohistochemistry to explore whether any of the vesicular glutamate transporters [vesicular glutamate transporter type 1 (VGluT1), VGluT2, or vesicular glutamate transporter type 3 (VGluT3)] were encoded by neurons in the SNC or RRF. We found expression of VGluT2 mRNA, but not of VGluT1 or VGluT3, in the SNC and RRF. These VGluT2 neurons rarely showed TH immunoreactivity. Within the SNC, the VGluT2 neurons were infrequently found at the rostral level, but were often seen at the medial and caudal levels intercalated in the mediolateral portion of the dorsal tier, at a ratio of one VGluT2 neuron per 4.4 TH neurons. At this level, VGluT2 neurons were also found in the adjacent substantia nigra reticulata and substantia nigra pars lateralis. Within the RRF, the VGluT2 neurons showed an increasing rostrocaudal gradient of distribution. The RRF proportion of VGluT2 neurons in relation to TH neurons was constant throughout the rostrocaudal levels, showing an average ratio of one VGluT2 neuron per 1.7 TH neurons. In summary, we provide evidence indicating that the SNC and RRF, which are traditionally considered to be dopaminergic areas, have neurons with the ability to participate in glutamate signaling.     

Religion-Based Emotional Social Support Mediates the Relationship between Intrinsic Religiosity and Mental Health

Although previous research suggests that increased religiosity is associated with better mental health and many authors have conjectured that religion-based social support may help explain this connection, scant research has directly examined whether religion-based support mediates religiosity and mental health. The present study examined whether various dimensions of religion-based support (social interaction, instrumental, and emotional) mediated the relationship between religiosity and mental health in college students in the Midwest United States. As expected, of the support dimensions, perceived emotional support was the strongest predictor of decreased hopelessness, depression, and suicide behaviors; and the relationships among intrinsic religiosity and the mental health variables were fully mediated by emotional support. These findings provide strong support to the notion that the relationship between religiosity and mental health can be reduced to mediators such as social support. Research and theoretical implications are discussed.     

Cluster of Norovirus Genogroup IX Outbreaks in Long-Term Care Facilities,Utah, USA, 2021

We report 5 clustered acute gastroenteritis outbreaks in long-term care facilities in Utah, USA, that were linked to healthcare employees working at multiple facilities. Four outbreaks were caused by norovirus genotype GIX. We recommend continued norovirus surveillance and genotyping to determine contributions of this genotype to norovirus outbreaks.     

Absceso retrofaríngeo. Revisión clínica de veinticinco años

IntroductionRetropharyngeal abscess is a serious condition. Its rare occurrence, thus sharing symptoms with other processes, make it a diagnostic challenge for the clinician. Therefore, it is critical to make an early diagnosis to prevent delaying treatment and avoid complications.ObjectivesTo gain knowledge of the epidemiology, pathogenesis, clinical manifestations, the most commonly implicated microorganisms, the type of treatment used, morbidity and mortality of retropharyngeal abscesses at a tertiary institution over the last 25 years.MethodsA retrospective study was conducted by reviewing medical records of all patients diagnosed with retropharyngeal abscess in a single centre between 1 January 1990 and 31 February 2016. Thirty-three patients were included in our study. Data such as personal history, present illness, diagnoses and treatment procedures were collected from the medical records.ResultsThe incidence during the years of study was 0.2 cases/100 000 inhabitants/year. Personal medical histories most often associated were alcoholism, smoking, diabetes and obesity. The most common aetiology found was impaction of a foreign body (especially fishbone). The most common presenting symptoms were odynophagia and neck pain accompanied by fever. Preventive tracheotomy was performed in the initial management of the patient in 9 cases (27%). The most frequent complication was descending necrotizing mediastinitis. Surgical drainage of the abscess was required in 27 patients (82%), especially with external approaches (17 cases). Two patients had sequelae: paralysis of unilateral vocal cord and Horner's syndrome. No mortality was observed in the patients of the study.ConclusionRetropharyngeal abscesses must be considered medical-surgical emergencies as they are likely to produce serious complications. We must pay attention to the warning symptoms such as odynophagia and cervical pain, associated or otherwise with dyspnoea, stridor, trismus, and neck stiffness. Advances in diagnostic and therapeutic procedures together with advances in critical care have been a key factor in improving the prognosis and mortality of these patients.