Indwelling urinary catheter infections in small community hospital. Role of urinary drainage bag

Ninety cases of closed drainage urinary catheterization were studied by daily bacteriologic monitoring with Microstix. In 23 per cent of the patients bacteriuria developed, and 92.6 per cent of all catheter infections occurred within three days. These infections occurred primarily in postsurgical patients, and were probably related to initial contamination during catheter insertion. Only 1 patient had a positive drainage bag urine culture prior to the development of bladder bacteriuria. At our institution poor catheter technique was much more important as a risk factor of nosocomial urinary tract infection than an antiseptic drainage bag system.     

Argon laser intraocular photocoagulation

Argon laser intraocular photocoagulation is now available during vitreous surgery, to treat retinal breaks and to give panretinal photocoagulation. Twenty patients, including phakic patients with gas-filled eyes, were treated using a new operative contact lens without complication. This intraoperative technique allows controlled rapid application of laser lesions at a safe distance from the retina, and eliminated the need for attempting treatment through the often hazy media of an irritated postoperative eye. A group of five rhesus monkeys were treated with various power settings to assess the histopathologic features of these laser lesions.     

Castleman's disease]

CASE REPORT: A 25-year-old patient with fever, dysphagia, and reduced general condition was referred to our department by his dentist after 1 week of antibiotic therapy. He presented with a painful palpable mass in the right lower jaw that had developed 2 weeks before. The orthopantomogram showed a caries and periapical lesion at the right lower wisdom tooth. During extraction of the tooth and putative intra- and extraoral abscess incision, no pus could be drained and the mass persisted. CT scans then revealed lobulated soft tissue masses on both sides of the neck with the main focus on the right side. In an additional operation with excision of the mass, Castleman's disease of the hyaline vascular type was diagnosed. HISTOPATHOLOGIC FINDINGS: Staging could not detect further pathological findings and the patient's postoperative general condition improved continuously. The histological features of the hayline vascular type of Castleman's disease were characterized by multiple germinal centers surrounded by circumferentially arranged layers of small lymphocytes interconnected by a prominent vascular stroma with occasional plasma cells ("onion skin"). CONCLUSION: Castleman's disease is a rare and yet poorly understood disease, characterized by inhomogeneous growth of lymphoid tissue. Mostly benign it remains a diagnostic challenge before histological investigation. In unclear submandibular swellings and neck lumps assumed to be an abscess, this rare differential diagnosis must be considered. Facing recurrence and potential for malignancy, follow-up of the patients over several years is necessary.     

An evaluation of two dental simulation systems: virtual reality versus contemporary non-computer-assisted

Contemporary dental simulation systems were developed to improve dental students' transition from the preclinical laboratory to the clinic. The purpose of this study was to compare the efficacy of a virtual reality computer-assisted simulation system (VR) with a contemporary non-computer-assisted simulation system (CS). The objectives were to determine whether there were differences between the two systems in the quality of dental students' preparations and the amount of faculty instruction time. Students who completed their first year of dental school and had no previous experience preparing teeth were group matched according to their performance in the first-year Dental Anatomy laboratory course and assigned to VR (n=15) or CS (n=13). In the summer, they spent two weeks (approximately 3 hrs/day) executing amalgam and crown preparations on typodont teeth. Short presentations describing the preparations were given to both groups; however, preparation criteria were available on the computer for the VR group, while the CS group received handouts. Both groups could request feedback from faculty, although VR also obtained input from the computer. A log was kept of all student-faculty (S-F) interactions. Analysis of the data indicated significant differences between groups for the following variables: mean number of S-F interactions was sixteen for the VR group versus forty-two for the CS group; and mean time of S-F interactions was 1.9+/-2 minutes versus 4.0+/-3 minutes (p<0.001) for VR and CS, respectively. Faculty spent 44.3 hours "interacting" with twenty-eight students, averaging 0.5 hours per VR student and 2.8 hours per CS student. Thus, CS students received five times more instructional time from faculty than did VR students. There were no statistical differences in the quality of the preparations. While further study is needed to assess virtual reality technology, this decreased faculty time in instruction could impact the dental curriculum.     

Improving universal prenatal screening for human immunodeficiency virus

OBJECTIVE: To evaluate the effect of implementation of a human immunodeficiency virus (HIV) educational intervention on universal screening for HIV in a prenatal clinic setting. METHODS: In this retrospective cohort study, frequencies of offering and acceptance of HIV testing were compared before and after an educational intervention performed by an HIV-focused nurse. The records of 293 women seeking prenatal care before the intervention and 206 women seeking prenatal care after the intervention were reviewed for offering and acceptance of HIV testing. Fisher's exact test and logistic regression were used to evaluate the relationship between the educational intervention and the offering and acceptance of HIV testing. RESULTS: The frequency of HIV test offering at first visit and test acceptance before the educational intervention were 96.5% and 74.8%, respectively, and after the intervention were 99.5% and 84.3%, respectively. This improvement in offering (3% change) and acceptance (9.5% change) was statistically significant (offering at first visit: OR = 7.27, 95% CI = 1.02 to 316.9; test acceptance: OR = 1.82, 95% CI = 1.14 to 2.88). Test acceptance was statistically significantly improved in the post-intervention group after controlling for confounding variables (OR = 2.02, 95% CI = 1.2 to 3.39). CONCLUSION: The addition of an HIV-focused nurse to a clinic setting improved the frequency of test offering at first visit and of acceptance of HIV testing by pregnant women.     

Test-retest reliability of temporal and spatial gait characteristics measured with an instrumented walkway system (GAITRite<Superscript>®</Superscript>)

Background

The purpose of this study was to determine the test-retest reliability of temporal and spatial gait measurements over a one-week period as measured using an instrumented walkway system (GAITRite^®).

Methods

Subjects were tested on two occasions one week apart. Measurements were made at preferred and fast walking speeds using the GAITRite^® system. Measurements tested included walking speed, step length, stride length, base of support, step time, stride time, swing time, stance time, single and double support times, and toe in-toe out angle.

Results

Twenty-one healthy subjects participated in this study. The group consisted of 12 men and 9 women, with an average age of 34 years (range: 19 – 59 years). At preferred walking speed, all gait measurements had ICC's of 0.92 and higher, except base of support which had an ICC of 0.80. At fast walking speed all gait measurements had ICC's above 0.89 except base of support (ICC = 0.79),

Conclusions

Spatial-temporal gait measurements demonstrate good to excellent test-retest reliability over a one-week time span.

     

Discovery of novel phenolic antioxidants as inhibitors of vascular cell adhesion molecule-1 expression for use in chronic inflammatory diseases

Vascular cell adhesion molecule-1 (VCAM-1) mediates recruitment of leukocytes to endothelial cells and is implicated in many inflammatory conditions. Since part of the signal transduction pathway that regulates the activation of VCAM-1 expression is redox-sensitive, compounds with antioxidant properties may have inhibitory effects on VCAM-1 expression. Novel phenolic compounds have been designed and synthesized starting from probucol (1). Many of these compounds demonstrated potent inhibitory effects on cytokine-induced VCAM-1 expression and displayed potent antioxidant effects in vitro. Some of these derivatives (4o, 4p, 4w, and 4x) inhibited lipopolysaccharide (LPS)-induced secretion of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and IL-6 from human peripheral blood mononuclear cells (hPBMCs) in a concentration-dependent manner in vitro and showed antiinflammatory effects in an animal model. Compounds 4ad and 4ae are currently in clinical trials for the treatment of rheumatoid arthritis (RA) and prevention of chronic organ transplant rejection, respectively.     

Comparison of Escherichia coli Isolates from humans, food, and farm and companion animals for presence of Shiga toxin-producing E. coli virulence markers

The objective of this study was to characterize Escherichia coli isolates from dairy cows/feedlots, calves, mastitis, pigs, dogs, parrot, iguana, human disease, and food products for prevalence of Shiga toxin-producing E. coli (STEC) virulence markers. The rationale of the study was that, isolates of the same serotypes that were obtained from different sources and possessed the same marker profiles, could be cross-species transmissible. Multiplex polymerase chain reaction (PCR) was used to detect presence of genes encoding Shiga toxin 1 and 2 (stx1 and stx2), H7 flagella (flicC), enterohemolysin (hly) and intimin (eaeA) in E. coli isolates (n = 400). Shiga toxin-producing isolates were tested for production of Shiga toxins (Stx1 and Stx2 and enterohemolysin. Of the E. coli O157:H7/H- strains, 150 of 164 (mostly human, cattle, and food) isolates were stx+. Sixty-five percent of O157 STEC produced both Stx1 and Stx2; 32% and 0.7% produced Stx2 or Stx1, respectively. Ninety-eight percent of O157 STEC had sequences for genes encoding intimin and enterohemolysin. Five of 20 E. coli O111, 4 of 14 O128 and 4 of 10 O26 were stx+ . Five of 6 stx+ O26 and O111 produced Stx1, however, stx+ O128 were Stx-negative. Acid resistance (93.3%) and tellurite resistance (87.3%) were common attributes of O157 STEC, whereas, non-O157 stx+ strains exhibited 38.5% and 30.8% of the respective resistances. stx-positive isolates were mostly associated with humans and cattle, whereas, all isolates from mastitis (n = 105), and pigs, dogs, parrot and iguanas (n = 48) were stx-negative. Multiplex PCR was an effective tool for characterizing STEC pathogenic profiles and distinguished STEC O157:H7 from other STEC. Isolates from cattle and human disease shared similar toxigenic profiles, whereas isolates from other disease sources had few characteristics in common with the former isolates. These data suggest interspecies transmissibility of certain serotypes, in particular, STEC O157:H7, between humans and cattle.     

Multiple-marker screening in human immunodeficiency virus-positive pregnant women: Screen positivity rates with the triple and quad screens

OBJECTIVE: The study was undertaken to determine the screen-positive rates of multiple-marker screening tests in pregnant women who are positive for human immunodeficiency virus (HIV) at our institution for open neural tube defects and aneuploidy, for both triple (alpha-fetoprotein, human chorionic gonadotropin [hCG], unconjugated estriol) and quad (alpha-fetoprotein, hCG, unconjugated estriol, inhibin A) screens, and to compare these rates with a matched control group. STUDY DESIGN: A 1:1 matched case-control study was performed comparing multiple marker screening test results in 34 HIV-positive women with age- and race-matched HIV-negative controls. Individual serum markers and screen positive rates for both the triple and quad screens were compared among the cases and controls. RESULTS: In each group, there were 19 women with triple screens and 15 with quad screens. Serum hCG multiples of the median were significantly higher in the HIV-positive compared with the HIV-negative women (P=.033). There was no difference in screen positive rates between the cases and controls using the triple screen, but there was a significantly higher overall screen positive rate in the HIV-positive group when the quad screen was used (33% vs 7%, P=.046). CONCLUSION: There is a significantly higher rate of overall quad screen positivity on multiple-marker screening among HIV-positive women compared with a matched control group.