Efficient management and maintenance of ultrasonic nebulizers to prevent microbial contamination

AIM: To seek the cause of Burkholderia cepacia complex (Bcc) infection outbreak and evaluate the efficacy of new methods for nebulizer maintenance.METHODS: We investigated the annual number of Bcc isolates recovered from clinical samples in our hospital between 1999 and 2013. Swab samples were randomly collected for bacterial culture before patient use from 10 each of the two machine types in August 2001; these included 20 samples from each of the following: Drain tubes, operating water chambers, oscillators, and nebulizing chambers. In addition, 10 samples each of nebulizer solutions before and after use were cultured. For environmental investigation, 10 samples were collected from sinks in the nurse stations of the wards where patients positive for Bcc were hospitalized. Numbers of Bcc isolates were compared before and after introduction of new methods for nebulizer maintenance in October 2001. In addition, randomly amplified polymorphic DNA (RAPD) assay was applied to find the genetic divergence of the Bcc isolates obtained from clinical samples and nebulizers.RESULTS: From January 1999 to December 2013, a total of 487 Bcc isolates were obtained from clinical specimens from 181 patients. Notably, 322 (66.1%) Bcc isolates were obtained from clinical specimens from 1999 to 2001, including 244 (115 patients) from sputum and 34 (11 patients) from blood. During this period, 14 isolates were obtained from nebulizer components. Among these, six were derived from nebulizer drain tubes, five from operating water chambers, and one from the oscillator before patient use, and two from nebulizer solutions after patient use. When Bcc was isolated from the nebulizer solution after patient use, Bcc was simultaneously detected in other parts of the nebulizer. Bcc was not isolated from any nebulizer solution before use. RAPD assays revealed similar DNA profiles in isolates obtained from patients and nebulizers. Investigation revealed damaged diaphragms in many nebulizers. The new maintenance methods for nebulizers, including restriction of the usage period, thorough disinfection, and routine check for diaphragm breakage, remarkably reduced Bcc isolation (165 isolates from patients in 12 years and 0 isolate from nebulizers in periodical sampling). In particular, Bcc has been isolated from blood from only one patient since the new methods were introduced.CONCLUSION: Appropriate maintenance of ultrasonic nebulizers is crucial for preventing Bcc contamination of nebulizers and subsequent respiratory tract and blood infections.     

Usefulness of exchanging a tunneled central venous catheter using a subcutaneous fibrous sheath

Objectives

The reserve of the venous route to the central veins is important for long-term parenteral nutrition (PN). Frequent catheter-related bloodstream infection (CRBSI) induces occlusion of the venous routes. Therefore, a modified exchange procedure using a tunneled central venous catheter (CVC) with a fibrous sheath was developed to preserve the route to the central veins.

Methods

Seven patients who required long-term PN received the modified exchange procedure and the outcome of exchanged CVC was retrospectively reviewed.

Results

The procedure was performed 10 times in seven patients. The venous routes were either the subclavicular or the internal jugular vein in all patients. The exchange of the catheter was due to CRBSI or occlusion in almost all patients. The mean duration of new catheter use was 296.2 days following the exchange. Four catheters continued to be used, and the remaining ones were removed. The reasons for removal were severe CRBSI and occlusion, each of which occurred in two catheterized patients, while the reason for removing the remaining catheters was because the patients no longer needed the catheters.

Conclusion

The modified catheter exchange using fibrous sheath, even in patients with CRBSI, appears to be an effective procedure for reserving the venous route to the central veins in patients who require either long-term PN or other treatments.     

Cytologic diagnosis of vulvar Paget's disease by means of brushing smear: Report of a case

Paget's disease of the vulva is a rare entity; since it may show the same clinical symptoms as benign chronic vulvitis, it may result in a delayed diagnosis. A 63‐year‐old woman was found to have an eczematoid pink to red lesion located in the vulva. Scraping cytology of the vulva showed isolated malignant cells of Paget type. The patient underwent wide local excision of the vulvar tumor and histopathological examination of resected specimens revealed that Paget cells were distributed singly or tended to form small nests in the epidermis. We consider vigorous brushing cytology to be a useful initial study for cancer screening of patients for any suspicious vulvar lesions. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Oesophageal atresia with a terminal deletion of chromosome 2q37.1

We herein report the case of a newborn girl with oesophageal atresia associated with cardiac and gastrointestinal anomalies, including patent ductus arteriosus, tracheomalacia, and gastro-oesophageal reflux with hiatus hernia. In addition, she had a terminal deletion of the long arm of chromosome 2, with a breakpoint of 2q37.1. The patient died following a cardiac arrest at 90 days of age. No cause of death was identified at autopsy.     

Structural relationship of curcumin derivatives binding to the BRCT domain of human DNA polymerase lambda

We previously reported that phenolic compounds, petasiphenol and curcumin (diferuloylmethane), were a selective inhibitor of DNA polymerase lambda (pol lambda) in vitro. The purpose of this study was to investigate the molecular structural relationship of curcumin and 13 chemically synthesized derivatives of curcumin. The inhibitory effect on pol lambda (full-length, i.e. intact pol lambda including the BRCA1 C- terminal [BRCT] domain) by some derivatives was stronger than that by curcumin, and monoacetylcurcumin (compound 13) was the strongest pol lambda inhibitor of all the compounds tested, achieving 50% inhibition at a concentration of 3.9 microm. The compound did not influence the activities of replicative pols such as alpha, delta, and epsilon. It had no effect on pol beta activity either, although the three-dimensional structure of pol beta is thought to be highly similar to that of pol lambda. Compound 13 did not inhibit the activity of the C-terminal catalytic domain of pol lambda including the pol beta-like core, in which the BRCT motif was deleted from its N-terminal region. MALDI-TOF MS analysis demonstrated that compound 13 bound selectively to the N-terminal domain of pol lambda, but did not bind to the C-terminal region. Based on these results, the pol lambda-inhibitory mechanism of compound 13 is discussed.     

Digestion and absorption of patients with autoimmune pancreatitis

BACKGROUND/AIMS: In patients with autoimmune pancreatitis, radiological, serological and pancreatic functional abnormalities usually improve with steroid therapy. However, no studies have specifically focused on digestion and absorption in such patients. This study aims to investigate digestion and absorption, in addition to pancreatic endocrine and exocrine function, and their responses to steroid therapy in patients with autoimmune pancreatitis. METHODOLOGY: Ideal body weight index, levels of serum albumin, total cholesterol and glucose, or glycosylated hemoglobin values were investigated in 22 patients with autoimmune pancreatitis. N-benzoyl-L-tyrosyl-paraminobenzoic acid excretion test was performed in 9 patients. In 10 patients treated with steroids, these factors were examined again about 2 months after medication. RESULTS: Levels of serum albumin decreased, while ideal body weight index and levels of serum albumin and cholesterol significantly increased after steroid therapy. Eleven (50%) patients showed evidence of diabetes mellitus, but this improved in 6 of 8 patients treated with steroids. Pancreatic exocrine function was reduced in 88% of patients. Impaired pancreatic exocrine function improved after steroid therapy in 3 of 7 patients treated. CONCLUSIONS: Mild malnutrition as well as impaired pancreatic endocrine and exocrine function were frequently detected in patients with autoimmune pancreatitis. Steroid therapy was occasionally effective for these conditions.     

Post-infectious IBS

Irritable bowel syndrome (IBS) is a mulitifactorial disease. Bacterial gastroenteritis has been known as a risk factor of IBS. Current evidence shows a strong association between colonic infection and inflammation with development of IBS.     

Case of temporal arteritis: FDP-PET ((18)F-fluorodeoxyglucose-positron emission tomography) was useful for early diagnosis and treatment

A 61-year-old woman with a continuous left temporal headache and a fever of 39°C for about one month was admitted to our hospital. The physical examination was not remarkable, except for slight tenderness of the left temporal side of her head. Laboratory data on admission revealed an increase of leucocytes (9,700/μl), blood platelets (59.4×10(4)/μl), and serum c-reactive protein (CRP) (10.9 mg/dl). The erythrocyte sedimentation rate (ESR) was also elevated (88 mm/1 h). After gallium scintigraphy, a gallium-67 uptake was weakly detected at the left temporal side of her head. However, after FDG-PET examination, a high FDG uptake was detected in her temporal artery, abdominal aorta, and bilateral femoral arteries. Moreover, Doppler sonography showed a hypoechoic halo around her left temporal artery. After treatment with oral prednisolone (40 mg/day), her headache disappeared and her serum CRP level returned to normal. Finally, the patient had pathological temporal arteritis proven by a biopsy. It is difficult to make an early diagnosis of temporal arteritis if the dilatation or swelling of the temporal arteries is not present. FDG-PET is considered a useful examination not only for the exploration of tumors, but also for the evaluation of the inflammation of large vessels.