Pulmonary Hydatid Cyst with Complicating Aspergillus Infection Presenting as a Refractory Lung Abscess

Background Hydatid disease is rare in the United States. Rarely the hydatid cyst can become infected with mycotic organisms, such as Aspergillus . We describe a young male who presents with clinical features of suppurative lung abscess whose workup diagnosed hydatid cyst complicated by Aspergillus co-infection. Case presentation A 27-year-old Peruvian male was hospitalized because of fever, chills, and productive cough of three months’ duration. Clinical features were consistent with a suppurative lung abscess. Significant findings included leukocytosis with eosinophilia and a chest x-ray showing a large lingular lobe thick walled cavity with a wavy irregular fluid level. The patient ultimately underwent surgical resection of the lingular lobe. Examination of the surgical specimen revealed the cavity to be a hydatid cyst. Histologic examination of the cyst wall showed intense inflammation and several septate hyphae of Aspergillus species. The patient recovered fully and has remained in good health. Conclusion A thick-walled cavity and a wavy meniscus constitute unusual features for an ordinary pyogenic lung abscess and suggests other possibilities. Endogenous cases of hydatid disease are uncommon in the United States, with the majority of cases occurring in immigrants. There are few published case reports describing incidental findings of Aspergillus in a hydatid cyst. The rare occurrence of such a condition can lead to a delay in diagnosis and treatment

The Fragility of Gender Equality Policies in Spain

Within the last decade, Spain has become a model in legislative policies for gender equality at the international level. However, the economic crisis has led to a growth in inequality, which has revealed the weaknesses of the adopted instruments. Despite the large amount of legislation in this area, the social reality has not changed at all, even experiencing a setback over the past few years. This situation was exposed in our country by a report issued in 2015 by the UN Committee on the Elimination of Discrimination against Women (CEDAW). This report showed the negative effects of the economic crisis and austerity policies on women, even in a context necessitating increased efforts towards women’s rights. Therefore, it is imperative that the concept of gender mainstreaming and the adoption of instruments of “hard law” be revisited. The goal should be to achieve gender justice based on three elements—distribution, identity, and representation—and a real parity democracy

Delirium Reduction Strategies For The Critically Ill

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge. In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant view was that critically ill patients were too ill to mobilize. An extensive literature review suggested that early mobilization was extremely beneficial in delirium reduction. As a result, the goal of this performance improvement project was to reduce the prevalence and severity of delirium through progressive mobilization. Several barriers to preventing delirium were identified through a root cause analysis. Using improvement measures of operational excellence, a number of countermeasures were established. Several positive outcomes of this project were realized to include the development of an early mobility pathway and a bedside mobility assessment tool. Next steps include a prospective study of the effect this KPI might have on decreasing duration of ventilation days as well as overall length of hospital stay

Superficial Endobronchial Lung Cancer: Radiologic-Pathologic Correlation

Objective: To analyze the plain chest radiographic and CT findings of superficial endobronchial lung cancer and to correlate these with the findings of histopathology. Materials and Methods: This study involved 19 consecutive patients with pathologically proven lung cancer confined to the bronchial wall. Chest radiographs and CT scans were reviewed for the presence of parenchymal abnormalities, endobronchial nodules, bronchial obstruction, and bronchial wall thickening and stenosis. The CT and histopathologic findings were compared. Results: Sixteen of the 19 patients had abnormal chest radiographic findings, while in 15 (79%), CT revealed bronchial abnormalities: an endobronchial nodule in seven, bronchial obstruction in five, and bronchial wall thickening and stenosis in three. Histopathologically, the lesions appeared as endobronchial nodules in 11 patients, irregular thickening of the bronchial wall in six, elevated mucosa in one, and carcinoma in situ in one. Conclusion: CT helps detect superficial endobronchial lung cancer in 79 % of these patients, though there is some disagreement between the CT findings and the pathologic pattern of bronchial lesions. Although nonspecific, findings of bronchial obstruction or bronchial wall thickening and stenosis should not be overlooked, and if clinically necessary, bronchoscopy should be performed. Index terms: Lung, radiograph

The influence of date and place of birth on youth player selection to a National Football Association elite development programme

Aim: This study sought to examine whether the place and date of birth of elite youth Irish footballers influences their selection onto the Football Association of Ireland's primary development pathway; 12 regional centres of excellences called the “Emerging Talent Programme” (ETP). The proposed hypothesis was that players born earlier in the year would be over-represented compared to those born later in their age band. A secondary hypothesis was that access to the ETP would be independent of place of birth. Methods: The dates and place of birth of all elite youth footballers (n = 1936) selected onto the ETP since its inception were examined. χ2 tests were used to establish if the dates of birth differed from the expected population distribution. Odds ratios were used to identify spatial variation in relation to place of birth and talent production. Results: The results showed that admission to the ETP is not independent of quarter of birth (P .05, χ2 = 256.817, w = .388). Place of birth analysis showed an unequal geographical distribution of players gaining selection onto the ETP. Selection onto the ETP was not independent of place of birth (P < .05, χ2 = 149.457, w = .278). Footballers developed in counties that had an ETP centre were almost 50% more likely to gain selection than those without a centre (OR 1.455, 95% CI 1.314 -1.612). Conclusion: The current programme demonstrates inequitable distribution of opportunities to access elite development pathways due to biases related to date and place of birth

Prevalence and Risk Factors of Early-Stage Age-Related Macular Degeneration in Patients Examined at a Health Promotion Center in Korea

We evaluated the prevalence and risk factors for early age-related macular degeneration (AMD) in Koreans 50 yr of age or older who were examined at a single health promotion center. We retrospectively reviewed the records of 10,449 subjects who visited the center over a 6-month period. Fundus photography was performed on all subjects, and systematic risk factor analysis was conducted using a structured questionnaire. All patients (n = 322) were initially diagnosed with drusen or early AMD using fundoscopy; the control group (n = 10,127) were those yielding normal fundoscopy findings. The age- and gender-adjusted prevalence of early AMD was 3.08%. Advanced age, male gender, smoking status, hyperlipidemia, working outdoors, and residence in rural areas were all significantly associated with an increased risk for development of early AMD. Higher-level ingestion of fruit or herbal medication and an increased amount of exercise were associated with a lower risk of early AMD development. In our Korean cohort, consisting principally of relatively healthy, middle-class urban adults, the prevalence of early AMD was 3.08% that is similar to that reported in earlier epidemiological studies. Several modifiable risk factors such as smoking and hyperlipidemia are associated with the prevalence of early AMD in our cohort

Long-term acidification of pH neutral grasslands affects soil biodiversity, fertility and function in a heathland restoration

In the wider context of heathland restoration, we investigated how field scale experimental acidification with sulphur (sulfur)affected soil biodiversity, fertility and function over a period of 17 years. A field experiment was conducted in the Isle of Purbeck, England, using ferrous sulphate and elemental sulphur as acidifying agents. We tested the effects of acidification on soil fertility, plant communities, litter decomposition, microbiology (including fungi bacteria and actinomycetes), arbuscular and ericoid mycorrhizal colonisation, and soil fauna (including earthworms, nematodes, rotifers and tardigrades). We found that elemental sulphur had a considerable and persistent effect on soil pH, lowering it to levels found in the surrounding reference acid grassland and heathland sites. A newly adapted heathland restoration index based on soil chemistry, found that elemental sulphur was by far the most successful treatment leading to soil conditions similar to the heathlands. Overall, acidification caused a loss of base cations and an increase in toxic aluminium compounds. Consequently the more mesotrophic components of soil biology were reduced by acidification during the course of the experiment. This transformed the soil biological system into one typical of acid grasslands and heathlands. Concomitant litter decomposition was similarly inhibited by acidification, with the microbiota more strongly hindered in acidified soil than the macroscopic fauna. Acidification resulted in a reduction in nematode and rotifer abundance and earthworm biomass. The vegetation community was also strongly modified by the elemental sulphur treatments and, where grazing was restricted, soil acidification allowed a restored heathland community to endure. Arbuscular mycorrhizal colonisation of grasses was reduced where heather plants were established, while ericoid mycorrhizas had developed sufficient populations in the acidified pastures to match the colonisation rate in the native heathlands