The impact of intensive staff education on rate of Clostridium difficile-associated disease in hospitalized geriatric patients

BACKGROUND

Toxin-producing Clostridium difficile is the most common cause of nosocomial diarrhea in geriatric units.

AIM

The purpose of study was to check the impact of intensive staff education on rate of Clostridium difficile-associated disease in hospitalized geriatric patients.

METHODS

The sampling frame was all patients suffering from diarrhea checked for Clostridium difficile toxin during the years 2017-2018. Clostridium difficile-positive patients were compared to a similar number of Clostridium difficile toxin-negative patients. The data were compared to our previous study, followed by medical staff's educational program for Clostridium difficile control and prevention.

RESULTS

Among 217 patients with diarrhea, 60 (27.6%) were positive for Clostridium difficile toxin. The study group tended to be of older age (p = 0.06), and showed higher rate of functional impairment (p < 0.001) and mortality (p < 0.001) than Clostridium difficile toxin negative patients. The rate of Clostridium difficile toxin-positive patients did not significantly differ between the previous and current studies (20.0% and 27.6%, respectively).

CONCLUSIONS AND DISCUSSION

In spite of findings, that patients tended to be older, with high rate of mortality, the rate of Clostridium difficile did not change from the previous study.

Future scenarios of marine resources and ecosystem conditions in the Eastern Mediterranean under the impacts of fishing, alien species and sea warming

Using a temporal-dynamic calibrated Ecosim food web model, we assess the effects of future changes on marine resources and ecosystem conditions of the Israeli Mediterranean continental shelf. This region has been intensely invaded by Indo-Pacific species. The region is exposed to extreme environmental conditions, is subjected to high rates of climate change and has experienced intense fishing pressure. We test the impacts of a new set of fishing regulations currently being implemented, a continued increase in sea temperatures following IPCC projections, and a continued increase in alien species biomass. We first investigate the impacts of the stressors separately, and then we combine them to evaluate their cumulative effects. Our results show overall potential future benefits of fishing effort reductions, and detrimental impacts of increasing sea temperature and increasing biomass of alien species. Cumulative scenarios suggest that the beneficial effects of fisheries reduction may be dampened by the impact of increasing sea temperature and alien species when acting together. These results illustrate the importance of including stressors other than fisheries, such as climate change and biological invasions, in an ecosystem-based management approach. These results support the need for reducing local and regional stressors, such as fishing and biological invasions, in order to promote resilience to sea warming.

Three-dimensional time-of-flight (3D TOF) magnetic resonance angiography (MRA) and contrast-enhanced MRA of intracranial aneurysms treated with platinum coils

BACKGROUND

Contrast-enhanced magnetic resonance angiography (CE-MRA) is less prone to flow-related signal intensity loss than three-dimensional time-of-flight (3D TOF) MRA and may therefore be more sensitive for detection of residual patency in platinum coil-treated intracranial aneurysms.

PURPOSE

To compare MRA and CE-MRA in the follow-up of intracranial aneurysms treated with platinum coils.

MATERIAL AND METHODS

CE-MRA and 3D TOF MRA (pre- and postcontrast injection) of the intracranial vasculature was performed at 1.5T in 38 patients (47 aneurysms) referred for DSA in the follow-up of coiled intracranial aneurysms.

RESULTS

DSA showed aneurysm patency in 22/47 investigations. Patent aneurysm components were observed with CE-MRA in 18/22 cases, and with 3D TOF MRA in 21/22 cases. There was no significant difference in patent aneurysm component size between CE-MRA and 3D TOF MRA. In addition, CE-MRA showed six, 3D TOF MRA before contrast injection showed seven, and 3D TOF MRA after contrast injection showed eight cases with patent aneurysm components not observed on DSA.

CONCLUSION

3D TOF MRA was highly sensitive for detection of patent aneurysm components, and at least as sensitive as CE-MRA. Residual aneurysm patency seems to be better visualized with MRA than with DSA in some cases.

Balloon-assisted coiling through a single 6F guiding catheter

The new version of the 6F Envoy guiding catheter, with its enlarged inner diameter of 0.070 inch, is capable of simultaneously accommodating both a 0.014-inch microcatheter and a balloon microcatheter for balloon-assisted coiling (BAC). We report our experience using this guiding catheter for access in BAC in 48 patients. The guiding catheter allowed for easy manipulations of 2 microcatheters, while providing sufficient quality of control angiograms during the procedure. In cases in which BAC is indicated, a larger guiding catheter (7F) or the commonly used bifemoral approach is no longer necessary, making the procedure technically simpler for the operator and less traumatic to the vessel wall.

Olanzapine, risperidone and haloperidol in the treatment of adolescent patients with schizophrenia

OBJECTIVES

To evaluate and compare the drug response and side effects of adolescents with schizophrenia treated with olanzapine, risperidone, and haloperidol.

METHODS

Forty-three patients were treated with olanzapine (n = 19), risperidone (n = 17) and haloperidol (n = 7) for 8 weeks in an open clinical trial. Clinical improvement was evaluated with the Positive and Negative Syndrome Scale (PANSS), and side effects with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale.

RESULTS

Significant clinical improvement was observed by week 4 for all medications. Olanzapine and haloperidol induced fatigability more frequently than risperidone. Haloperidol was associated with a higher frequency of depression and more severe extrapyramidal symptoms.

CONCLUSIONS

To the best of our knowledge this is the first study in adolescents to compare the efficacy and side effects of three most commonly prescribed antipsychotic medications. Olanzapine, risperidone and haloperidol appear to be equally effective for the treatment of schizophrenia in adolescent inpatients but have different side effect profiles.

The effects of electrolytic lesion to the shell subterritory of the nucleus accumbens on delayed non-matching-to-sample and four-arm baited eight-arm radial-maze tasks

The effects of bilateral electrolytic lesions of the "shell" subterritory of the nucleus accumbens in the rat were examined on 2 tasks known to be sensitive to hippocampal damage. Experiment 1 tested the effects of shell lesion on delayed non-matching-to-sample (DNMS) task in a T-maze. The maze was rotated 180 degrees after the end of acquisition. Experiment 2 used a 4-arm baited, 4-arm unbaited, 8-arm radial-maze task and its reversal. Shell lesion led to impaired acquisition of DNMS in a T-maze and of 4-arm baited, 4-arm unbaited, 8-arm radial maze tasks, suggestive of mnemonic deficits. Following analysis of animals' choice pattern in both tasks, the deficit was interpreted as being largely due to an extensive use of response strategy. The results suggest that the inappropriate use of response strategy by shell animals was a result of their inability to switch from initial response strategy to a later, more appropriate, memory-dependent strategy.

The effects of electrolytic lesion to the shell subterritory of the nucleus accumbens on delayed non-matching-to-sample and four-arm baited eight-arm radial-maze tasks

The effects of bilateral electrolytic lesions of the "shell" subterritory of the nucleus accumbens in the rat were examined on 2 tasks known to be sensitive to hippocampal damage. Experiment 1 tested the effects of shell lesion on delayed non-matching-to-sample (DNMS) task in a T-maze. The maze was rotated 180 degrees after the end of acquisition. Experiment 2 used a 4-arm baited, 4-arm unbaited, 8-arm radial-maze task and its reversal. Shell lesion led to impaired acquisition of DNMS in a T-maze and of 4-arm baited, 4-arm unbaited, 8-arm radial maze tasks, suggestive of mnemonic deficits. Following analysis of animals' choice pattern in both tasks, the deficit was interpreted as being largely due to an extensive use of response strategy. The results suggest that the inappropriate use of response strategy by shell animals was a result of their inability to switch from initial response strategy to a later, more appropriate, memory-dependent strategy.

Differential involvement of the shell and core subterritories of the nucleus accumbens in latent inhibition and amphetamine-induced activity

Latent inhibition (LI) consists of retardation in conditioning to a stimulus as a consequence of its prior non-reinforced pre-exposure. In view of findings that LI is disrupted in acute schizophrenic patients and evidence from animal experiments pointing to the involvement of the mesolimbic dopamine (DA) system in this phenomenon, the present study investigated the effects of electrolytic lesions to the shell and core subterritories of the nucleus accumbens on LI in rats (Expt. 1). LI was indexed by the amount of suppression of drinking in the presence of a tone that was either pre-exposed or not prior to its pairing with reinforcement (a foot shock). Expt.2 tested the effects of the DA antagonist, haloperidol, on LI in shell- and core-lesioned animals. Expt. 3 tested the effects of shell and core lesions on spontaneous and amphetamine-induced locomotion. In Expt. 1, LI, i.e., lower suppression of drinking in the pre-exposed as compared to the non-pre-exposed animals, was obtained in the sham-operated condition. Core and shell lesions produced distinct effects on LI. Animals with core lesions developed LI, but exhibited an overall lower suppression of drinking in comparison to the sham-operated animals. In contrast, shell lesions led to a disappearance of LI. Expt. 2 replicated the differential effects of shell and core lesions on LI, although in this experiment, core lesion did not attenuate suppression of drinking. Haloperidol prevented shell-induced abolition of LI. In Expt. 3, shell- but not core-lesioned animals were more active than sham controls following amphetamine administration. These results provide evidence for functional differences between the shell and core subregions, as well as for the involvement of the mesolimbic DA system in LI.

Developmental arrest of tooth bud after correction of mandibular fracture

A case of multiple fractures of the mandible following a car accident in a five-year-old patient is reported. The fracture line passed distal to the first molar tooth bud. The fracture was treated by wire osteosynthesis and skeletal fixation. During the ensuing 18 months, a gradual arrest of the development of the first molar tooth bud was radiologically observed. The eruption process had not been disturbed, and the tooth erupted at the age of 6 1/2 years. Since the distal root had completely failed to develop and the mesial roots showed a diminished size, the tooth was extracted. Histopathological examination revealed disturbed dentin apposition, there was almost complete obliteration of the pulp chamber by globular dentin, and evidence of root resorption.

Head and neck manifestations of tumoral calcinosis

Intraoral facial and laryngeal features of tumoral calcinosis are reviewed in six patients of Jewish-Yemenite descent. Extraoral features included calcified masses, erythematous patches, and angular cheilitis. Oral soft tissue findings included papillary hyperplasia of the lip vermilion and velvety-red macules on the tongue, palate, and buccal mucosa. Gingival findings included advanced periodontitis and an erythematous marginal gingivitis. In all patients, orthognathic evaluation revealed a concave profile, retruded maxilla, and relative mandibular prognathism. Although previously reported clinical dental abnormalities were not present, extracted teeth demonstrated abnormal dentin. Hoarseness was present in all patients and was the earliest appearing feature in two patients. The appearance of these head and neck findings preceded the classical manifestations of tumoral calcinosis and may be helpful in the early diagnosis of this entity. The varied reported features of tumoral calcinosis support the notion that this disease may present multiple formes frustes with variable clinical expressivity.

Techniques for ensuring the lateral position of the proximal segment following intraoral vertical ramus osteotomy

Continual refinements of the surgical technique and instrumentation for the intraoral vertical ramus osteotomy have made it a preferred procedure for mandibular setback, especially in asymmetrical cases. However, there may be intraoperative difficulty in lateral positioning of the proximal segment, which is frequently trapped medially. Three techniques for lateral relocation of the medially displaced proximal segment are described. Techniques designed to prevent this medial displacement also are presented.

Different types of false positive anti-HIV reactions in patients on haemodialysis

Serum samples of 589 haemodialysis patients were screened for HIV antibody by ELISA methods. Of these, 36 samples were found to be repeatedly reactive. None of the 36, however, could be confirmed by competitive enzyme immunoassays and Western blot; therefore, they were considered to be false positive. The sera could be divided in two groups. The sera of Group 1 were designated as the usual type of false positivity, caused most probably by anti-lymphocyte antibodies. In 19 sera, however, a special type of false positivity was found. These sera reacted strongly with the plates coated with the supernatants of HIV-infected cells but not with those of uninfected H9 cells. Three and two sera showed, respectively, positive immunofluorescence reaction with the HIV-infected, but not with the uninfected, H9 and CEM cells. Reactivity to HIV-infected H9 cells could be adsorbed from a part of these samples with lesser amounts of HIV-infected than uninfected H9 cells. This special type of false positivity was observed frequently (7/65) in patients who rejected a kidney graft. These findings suggest that this type of anti-HIV false positivity is due to antibodies reacting with cellular antigens present in HIV-infected but not in uninfected lymphocytes. Their appearance seems to be associated with the immunological activation occurring at graft rejection.

Aerosol distributions in maritime air and predicted scattering coefficients in the infrared

An empirical model has been developed which describes maritime aerosol distributions as a function of several parameters. A number distribution was empirically derived as a function of altitude (0-5 km), wind velocity (0-16 m sec(-1)), relative humidity, visibility, and aerosol radius. Predictions of the model are found to agree reasonably well with available experimental data. Infrared scattering coefficients calculated from the aerosol model are also presented.