Malnutrition and Length of Stay - A Relationship?

The admission nutrition status of 135 consecutive general medical patients admitted to a single nursing unit was evaluated using a simple questionnaire and available laboratory studies. A statistical analysis of the data obtained indicates that prolonged length of stay may be related to admission nutritional status

A Prospective Randomized Comparison of a Single Antibiotic (Moxalactam) Versus Combination Therapy (Gentamicin and Clindamycin) in Penetrating Abdominal Trauma

From July 1 to December 31, 1983, 50 consecutive patients undergoing abdominal exploration for penetrating abdominal trauma from stab and gunshot wounds were prospectively randomized to receive postinjury, preoperative antibiotic coverage with moxalactam (2 g intravenously every 12 hours) or a combination of gentamicin (3 to 5 mg/kg/day in three equal doses administered every eight hours) and clindamycin (600 mg intravenously every six hours). No intraabdominal abscesses or wound infections developed, and no direct evidence of toxicity of the antibiotic regimens developed in either group. In the study group, moxalactam therapy was an effective alternative to the combination antibiotic regimen. The subsequently documented incidence of moxalactam-induced bleeding episodes precludes its use as a primary preventive antibiotic; however, other less toxic cephalosporins may demonstrate similar effectiveness

Rare Dravet-like epileptic encephalopathy with a novel mutation of PCDH19 gene

Mutacija gena PCDH19, koji kodira protokaderin 19 na kromosomu Xq22, rezultira epilepičkim sindromom s početkom napadaja u dojenačkoj dobi, s blagim do teškim intelektualnim oštećenjem i autističnim obilježjima ili bez njih. Ovaj poremećaj pokazuje neobičan obrazac X- vezanog nasljeđivanja, koji zahvaća heterozigotne žene, ali štedi hemizigotne muškarce. Smatra se da se temeljni odgovorni mehanizam odnosi na „celularnu interferenciju“. Postoji široki klinički spektar napadaja, uglavnom s početkom u dojenačkom ili ranom dječjem razdoblju. Dio bolesnika pokazuje fenotip nalik na sindrom Dravet. Napadaji se uglavnom javljaju u kratkim serijama, već kod blago do umjereno povišene tjelesne temperature. U početnoj fazi primjena antiepileptičkih lijekova relativno slabo utječe na smanjenje napadaja. No s napredovanjem bolesti, učestalost napadaja i njihova farmakorezistencija opadaju. Mogu se javiti smetnje ponašanja, kao što su autistična, opsesivna ili agresivna obilježja. Prikazana je devetogodišnja djevojčica koja od rane dječje dobi boluje i liječi se od farmakorezistentne epilepsije, koja se klinički prezentirala serijom žarišnih motoričkih napadaja praćenih strahom i vrištanjem. Ponavljani interiktalni i iktalni elektroencefalogrami, u budnosti i spavanju, bili su bez specifi čnih abnormalnosti, kao i slikovni prikaz mozga magnetskom rezonancijom visoke rezolucije (3T). Analizom cerebrospinalnog likvora isključene su upalne bolesti središnjeg živčanog sustava, a opsežnom metaboličkom obradom rijetke bolesti s epileptičkim napadajima. Nakon prvih napadaja preporučen je fenobarbiton, a nakon recidiviranja bila je na terapiji s više kombinacija različitih antiepileptika i nijedna nije bila učinkovita. Potpuna kontrola napadaja nikad nije postignuta. Genskom analizom pronađena je nova heterozigotna nonsense mutacija (c.1630C>T;p. Q544X) u egzonu 1 gena PCDH 19 na Xq22.1. U terapiju je uključen perampanel uz valproat i levetiracetam. Željeli smo upozoriti na rijedak oblik epileptičke encefalopatije od koje obolijevaju samo ženska djeca i na koju treba obratiti pozornost u diferencijalnoj dijagnozi nekontroliranih epileptičkih sindroma vezanih za febrilna stanja.Mutation in PCDH 19 gene, encoding prothocadherin 19 on chromosome Xq22, results in an epileptic syndrome with seizure onset in infancy, with or without mild to severe intellectual impairment or autistic features. This disorder demonstrates an unusual pattern of X-linked inheritance, aff ecting heterozygous female but sparing hemizygous male individuals. The underlying responsible mechanism is considered to be a ‘cellular interference’. There is a wide clinical spectrum of seizures, generally starting in infancy or early childhood. A portion of patients manifest a phenotype resembling Dravet syndrome. The seizures mostly occur in brief clusters even at mild to moderately elevated temperature. In the initial course of the disease, the seizures become relatively resistant to antiepileptic drugs. However, as the disease progresses, the frequency of seizures and their pharmacoresistance tend to decrease. There may be behavioral diffi culties such as autistic, obsessive or aggressive features. The aim of this paper is to describe clinical features and unusual way of inheritance of PCDH19 gene related epilepsy in a 10-year-old girl, with special reference to early disease characteristics and treatment effi cacy. From early childhood, this 10-year-old girl suff ered from and was treated for resistant epilepsy, clinically presenting with a series of focal motor seizures accompanied by fear and screaming. On many occasions, repeated interictal waking and sleeping EEGs, as well as high resolution brain MRI (3T) were normal. Analysis of cerebrospinal fl uid excluded infl ammatory diseases of the central nervous system. Rare metabolic diseases with epileptic seizures were excluded by metabolic tests. After the fi rst seizure, phenobarbital was recommended, and after recurrence she received therapy with multiple combinations of various antiepileptic drugs, none of which was eff ective. Complete seizure control was never achieved. Genetic analysis revealed novel heterozigous nonsence mutation (c.1630C>T;p. Q544X) in exon 1 of PCDH19 gene on Xq22.1. Therapy included perampanel with valproate and levetiracetam. The authors want to warn of this rare form of epileptic encephalopathy that aff ects only female children and to emphasize its importance in the diff erential diagnosis of uncontrolled epileptic syndromes associated with febrile conditions

Wastewater Surveillance for SARS-CoV-2 on College Campuses: Initial Efforts, Lessons Learned, and Research Needs

Wastewater surveillance for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging approach to help identify the risk of a coronavirus disease (COVID-19) outbreak. This tool can contribute to public health surveillance at both community (wastewater treatment system) and institutional (e.g., colleges, prisons, and nursing homes) scales. This paper explores the successes, challenges, and lessons learned from initial wastewater surveillance efforts at colleges and university systems to inform future research, development and implementation. We present the experiences of 25 college and university systems in the United States that monitored campus wastewater for SARS-CoV-2 during the fall 2020 academic period. We describe the broad range of approaches, findings, resources, and impacts from these initial efforts. These institutions range in size, social and political geographies, and include both public and private institutions. Our analysis suggests that wastewater monitoring at colleges requires consideration of local information needs, sewage infrastructure, resources for sampling and analysis, college and community dynamics, approaches to interpretation and communication of results, and follow-up actions. Most colleges reported that a learning process of experimentation, evaluation, and adaptation was key to progress. This process requires ongoing collaboration among diverse stakeholders including decision-makers, researchers, faculty, facilities staff, students, and community members

A framework for monitoring the safety of water services: from measurements to security

The sustainable developments goals (SDGs) introduced monitoring of drinking water quality to the international development agenda. At present, Escherichia coli are the primary measure by which we evaluate the safety of drinking water from an infectious disease perspective. Here, we propose and apply a framework to reflect on the purposes of and approaches to monitoring drinking water safety. To deliver SDG 6.1, universal access to safe drinking water, a new approach to monitoring is needed. At present, we rely heavily on single measures of E. coli contamination to meet a normative definition of safety. Achieving and sustaining universal access to safe drinking water will require monitoring that can inform decision making on whether services are managed to ensure safety and security of access

Complex Fluids and Hydraulic Fracturing

Nearly 70 years old, hydraulic fracturing is a core technique for stimulating hydrocarbon production in a majority of oil and gas reservoirs. Complex fluids are implemented in nearly every step of the fracturing process, most significantly to generate and sustain fractures and transport and distribute proppant particles during and following fluid injection. An extremely wide range of complex fluids are used: naturally occurring polysaccharide and synthetic polymer solutions, aqueous physical and chemical gels, organic gels, micellar surfactant solutions, emulsions, and foams. These fluids are loaded over a wide range of concentrations with particles of varying sizes and aspect ratios and are subjected to extreme mechanical and environmental conditions. We describe the settings of hydraulic fracturing (framed by geology), fracturing mechanics and physics, and the critical role that non-Newtonian fluid dynamics and complex fluids play in the hydraulic fracturing process

A Greater Means to the Greater Good: Ethical Guidelines to Meet Social Movement Organization Advocacy Challenges

Existing public relations ethics literature often proves inadequate when applied to social movement campaigns, considering the special communication challenges activists face as marginalized moral visionaries in a commercial public sphere. The communications of counter-hegemonic movements is distinct enough from corporate, nonprofit, and governmental organizations to warrant its own ethical guidelines. The unique communication guidelines most relevant to social movement organizations include promoting asymmetrical advocacy to a greater extent than is required for more powerful organizations and building flexibility into the TARES principles to privilege social responsibility over respect for audience values in activist campaigns serving as ideological critique

Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

BACKGROUND: We sought to determine torso injury rates and sensitivities associated with fluid-positive abdominal ultrasound, metabolic acidosis (increased base deficit and lactate), and impaired pulmonary physiology (decreased spirometric volume and PaO(2)/FiO(2)). METHODS: Level I trauma center prospective pilot and post-pilot study (2000–2001) of stable patients. Increased base deficit was < 0.0 in ethanol-negative and ≤ -3.0 in ethanol-positive patients. Increased lactate was > 2.5 mmol/L in ethanol-negative and ≥ 3.0 mmol/L in ethanol-positive patients. Decreased PaO(2)/FiO(2 )was < 350 and decreased spirometric volume was < 1.8 L. RESULTS: Of 215 patients, 66 (30.7%) had a torso injury (abdominal/pelvic injury n = 35 and/or thoracic injury n = 43). Glasgow Coma Scale score was 14.8 ± 0.5 (13–15). Torso injury rates and sensitivities were: abdominal ultrasound negative and normal base deficit, lactate, PaO(2)/FiO(2), and spirometric volume – 0.0% & 0.0%; normal base deficit and normal spirometric volume – 4.2% & 4.5%; chest/abdominal soft tissue injury – 37.8% & 47.0%; increased lactate – 39.7% & 47.0%; increased base deficit – 41.3% & 75.8%; increased base deficit and/or decreased spirometric volume – 43.8% & 95.5%; decreased PaO(2)/FiO(2 )– 48.9% & 33.3%; positive abdominal ultrasound – 62.5% & 7.6%; decreased spirometric volume – 73.4% & 71.2%; increased base deficit and decreased spirometric volume – 82.9% & 51.5%. CONCLUSIONS: Trauma patients with normal base deficit and spirometric volume are unlikely to have a torso injury. Patients with increased base deficit or lactate, decreased spirometric volume, decreased PaO(2)/FiO(2), or positive FAST have substantial risk for torso injury. Increased base deficit and/or decreased spirometric volume are highly sensitive for torso injury. Base deficit and spirometric volume values are readily available and increase or decrease the suspicion for torso injury

Wastewater-Based Epidemiology: Global Collaborative to Maximize Contributions in the Fight against COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), a novel member of the Coronaviridae family, has been identified as the etiologic agent of an ongoing pandemic of severe pneumonia known as COVID-19. To date there have been millions of cases of COVID-19 diagnosed in 184 countries with case fatality rates ranging from 1.8% in Germany to 12.5% in Italy. Limited diagnostic testing capacity and asymptomatic and oligosymptomatic infections result in significant uncertainty in the estimated extent of SARS-CoV-2 infection. Recent reports have documented that infection with SARS-CoV-2 is accompanied by persistent shedding of virus RNA in feces in 27% to 89% of patients at densities from 0.8 to 7.5 log10 gene copies per gram. The presence of SARS-CoV-2 RNA in feces raises the potential to survey sewage for virus RNA to inform epidemiological monitoring of COVID-19, which we refer to as wastewater-based epidemiology (WBE), but is also known as environmental surveillance

Minimizing errors in RT-PCR detection and quantification of SARS-CoV-2 RNA for wastewater surveillance

Wastewater surveillance for pathogens using reverse transcription-polymerase chain reaction (RT-PCR) is an effective and resource-efficient tool for gathering community-level public health information, including the incidence of coronavirus disease-19 (COVID-19). Surveillance of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) in wastewater can potentially provide an early warning signal of COVID-19 infections in a community. The capacity of the world's environmental microbiology and virology laboratories for SARS-CoV-2 RNA characterization in wastewater is increasing rapidly. However, there are no standardized protocols or harmonized quality assurance and quality control (QA/QC) procedures for SARS-CoV-2 wastewater surveillance. This paper is a technical review of factors that can cause false-positive and false-negative errors in the surveillance of SARS-CoV-2 RNA in wastewater, culminating in recommended strategies that can be implemented to identify and mitigate some of these errors. Recommendations include stringent QA/QC measures, representative sampling approaches, effective virus concentration and efficient RNA extraction, PCR inhibition assessment, inclusion of sample processing controls, and considerations for RT-PCR assay selection and data interpretation. Clear data interpretation guidelines (e.g., determination of positive and negative samples) are critical, particularly when the incidence of SARS-CoV-2 in wastewater is low. Corrective and confirmatory actions must be in place for inconclusive results or results diverging from current trends (e.g., initial onset or reemergence of COVID-19 in a community). It is also prudent to perform interlaboratory comparisons to ensure results' reliability and interpretability for prospective and retrospective analyses. The strategies that are recommended in this review aim to improve SARS-CoV-2 characterization and detection for wastewater surveillance applications. A silver lining of the COVID-19 pandemic is that the efficacy of wastewater surveillance continues to be demonstrated during this global crisis. In the future, wastewater should also play an important role in the surveillance of a range of other communicable diseases