Salmonella Ovarian Abscess in Young Girl Presented as Acute Abdomen – Case Report

Ovarian abscess in young sexually non-active girls can represent a diagnostic challenge. 15-years old girl was admitted to the Clinic for Gynaecology and Obstetrics under the suspicion of torsion of an ovarian cyst. Her clinical status deteriorated after the admission with development of acute abdomen. Laparoscopic exploration was performed and unilateral ovarian abscess was found without involvement of other pelvic structures. The surgical proceedure was minimal invasive for a young girl and Salmonella staleyville was isolated from pus. Solitary ovarian abscess can be of hematogenous origin and the causative pathogens are different from pathogens usually involved in pelvic inflammatory disease. To avoid later fertility problems it is of great importance to treat infections in pelvic region correctly according to the isolated microorganism and that surgery is the least invasive

Acute viral respiratory infections among nursing home residents and members of staff

S staranjem prebivalstva se veča število oseb s kroničnimi obolenji, upadom mentalnih in motoričnih funkcij ter posledično potrebo po institucionaliziranem varstvu. V Sloveniji prebiva v domovih starejših občanov (DSO) okoli 5% prebivalcev. Zaradi starostnega upada imunskih zmožnosti, pridruženih obolenj in bivalnih posebnosti (bivanja večjega ranljivih števila oseb v skupnih prostorih) predstavljajo okužbe v DSO poseben problem. Okužbe dihal (AOD) so med najpogostejšimi okužbami v DSO, predstavljajo tretjino vseh okužb v DSO, povezane so z največjim številom bolnišničnih obravnav in tudi z najvišjo smrtnostjo. Vodijo lahko v trajni upad fizičnih zmogljivosti starostnikov. Četudi pogostost virusnih AOD s starostjo pada, lahko te potekajo s težjim kliničnim potekom - z znaki akutne okužbe spodnjih dihal (AOSD). Prepoznavanje AOD je lahko pri starostnikih v DSO, zaradi pogosto neznačilne klinične slike, težavno. Poznavanje virusne etiologije in incidence AOD v DSO je pomembno, saj omogoča smiselno na rtovanje ukrepov za zmanjšanje obolevnosti oskrbovancev. Bolniki in metode V 6-mesečno prospektivno raziskavo smo vključili 90 oskrbovancev DSO ter 42 zaposlenih v enem izmed DSO-jev v mariborski regiji. Opazovali smo pojav AOD v obdobju od 5.decembra 2011 do 31. maja 2012 pri oskrbovancih DSO in osebju. AOD smo definirali po McGeer-ovih kriterijih. AOD so dnevno prepoznavale naučene medicinske sestre in potrdila zdravnica ob viziti pri obolelih oskrbovancih. Pridobili smo osnovne podatke, podatke o pridruženih obolenjih ter o cepljenju proti gripi pri vseh sodelujočih v raziskavi. Ob začetku in zaključku raziskave smo vsem sodelujočim odvzeli bris nosnega dela žrela za mikrobiološke preiskave, prav tako tudi ob vsaki epizodi AOD, kjer smo zabeležili tudi klinične simptome in znake obolenja. V brisu nosnega dela žrela smo s pomočjo molekularne preiskave določili prisotnost genoma virusov gripe A in B, parainfleunce 1-3, rinovirusov, respiratomega sincicijskega virusa, človeškega metapnevmovirusa, koronavirusov, adenovirusov, človeškega bokavirusa in enterovirusov. Prav tako smo v 6 mesečnem obdobju raziskave beležili tedensko število obiskovalcev v sobah sodelujočih oskrbovancev DSO. V statistični analizi smo uporabljali naslednje metode: 6-mesečno incidenčno stopnjo AOD, akutnih okužb zgornjih dihal (AOZD) in AOSD smo podali kot število AOD (oz. AOSD in AOZD) na 1000 oskrbnih dnikategorične spremenljivke smo primerjali s pomočjo hi-kvadrat testa ali Fisherjevega eksaktnega testakorelacijo med spremenljivkama smo preučili s pomočjo korelacijskega koeficienta Kendall τs pomočjo multivariantne Poissonove analize smo preučili vpliv različnih neodvisnih spremenljivk na incidenčno stopnjo AOD pri posameznem oskrbovancu DSO. Povezanost med številom obiskovalcev pri posameznih oskrbovancih in pojavom AOD pri le-teh smo preučevali s pomočjo Poissonove regresije. Kot statistično značilne smo upoštevali rezultate, pri katerih je bil p < 0,05. Rezultati V 6-mesečnem opazovalnem obdobju je bila incidenčna stopnja AOD 3,8/1000 oskrbnih dni pri oskrbovancih in 5,9/1000 oskrbnih pri zaposlenih, razlika je statistično pomembna. Starostniki so pogosteje obolevali z AOSD (73%), kot z AOZD (27%), med tem ko so zaposleni obolevali skoraj izključno za AOZD (97%). S pomočjo multivariantne Poissonove analize smo ugotovili, da nobena od vključenih neodvisnih spremenljivk (starost, cepilni status - cepljenje proti gripi, pomičnost in pridružena kronična obolenja (sladkorna bolezen, srčno-žilna, možgansko-žilna obolenja, kronična pljučna obolenja, demenca) ne vpliva na pojav AOD pri oskrbovancih, z izjemo demence. Dementni bolniki so kar 2,5 krat redkeje obolevali z AOD. Prav tako število obiskovalcev ni vplivalo na pojav AOD pri oskrbovancih. Ugotovili smo korelacijo med tedensko incidenčno stopnjo AOD pri zaposlenih in oskrbovancih. Viruse smo dokazali pri 60,7 % epizod AOD pri oskrbovancih DSO in pri 47,7 % epizod AOD pri zaposlenih. Pri osThe life expectancy has been increasing significantly in the last decades. People aged over 65 represented 17% of population of Slovenia and 5% of the elderly (about 19,500) resided in 96 long-term care facilities and nursing homes (NH). Ageing parallels with a decline of many functions and is accompanied by the increasing frequency of chronic illnesses, impaired mobility and the need for assistance in daily living. The inability to take care of oneself is a rather common reason for a decision to become a NH resident. Acute respiratory infections (ARI) are common among NH residents, representing about 1/3 of all infections, and are the most frequent reason for hospital admittance, and a significant cause of mortality. Nevertheless, the knowledge of infections with respiratory viruses in NH residents is incomplete. More information is available for the epidemic rather than for sporadic type of infections. Due to daily visitors and NH staff viral infections from the community can be introduced into the NH and affect residents with chronic illnesses, impaired consciousness, impaired mobility etc. In addition, scarce clinical symptoms combined with limited diagnostic facilities hamper the recognition of infections and consequently lead to delayed introduction of preventive measures. Participants and methods We accomplished a 6-months prospective surveillance study from 5 December 2011 to 31 May 2012 in a part of 208-bed three-floor NH in north-eastern Slovenia that encompassed 90 (43.3%) residents (i.e., 90/97 residents living in one of the sections of the NH), and 42/53 (79.2%) nursing care workers, who provided signed informed consent for participation. Nasopharyngeal swabs for virology studies were collected from all participants at the time of enrolment (5 December 2012) and at the end of the study (31 May 2012), as well as from each participant who developed ARI within the period of the study. Cases of ARI were defined according to McGeer criteria for infection surveillance in long-term care facilities. During the 6-months study period the detection of ARI was carried out daily by trained study nurses and the diagnosis was confirmed by a physician who conducted a physical examination in case of illness. Daily number of visitors (adults, schoolchildren and pre-school children, respectively) in each participant’s room was recorded during study period. Real-time PCR and real-time RT-PCR were performed detecting influenza A/B, adenovirus, parainfluenza viruses 1, 2 and 3, human rhinoviruses, respiratory syncytial virus, human metapneumovirus, human coronaviruses, human bocavirus in nasopharyngeal swab samples. Results were statistically analysed using chi-square test, Fisher exact test. Correlations were expressed using the Kendall Tau coefficient. Multivariate Poisson regression model was used for estimating the influence of independent variables on ARI incidence-rate. Results During the 6-months observational period 100 episodes of ARI were observed, 56 among residents and 44 among staff. The calculated incidence rate was 3.8 ARI/ 1000 persons-days for residents and 5.9 ARI/ 1000 persons-days for staff members. The weekly incidence rate of ARI in NH residents correlated with the weekly ARI incidence rate in NH staff. Using a multivariate Poisson model for the number of ARI occurrences, including age, influenza vaccination, mobility of residents and chronic underlying diseases as explanatory variables and controlling the length of exposure, we estimated that the relative incidence-rate ratio of ARI for patients without dementia was 2.5 times larger than that for patients with dementiathe other covariates were not statistically significantly associated with the number of ARI episodes. Respiratory viruses were detected in 55 out of 100 ARI episodes (55%): in 34/56 (60.7%) episodes of ARI in residents and in 21/44 (47.7%) cases of ARI in staff. Of 56 NH residents with ARI 41 (73.5%) fulfilled criteria for lower respiratory trac

Salmonella ovarian abscess in young girl presented as acute abdomen--case report [Salmonella ovarijski apsces u mlade djevojke sa slikom akutnog abdomena: prikaz slučajeva]

Ovarian abscess in young sexually non-active girls can represent a diagnostic challenge. 15-years old girl was admitted to the Clinic for Gynaecology and Obstetrics under the suspicion of torsion of an ovarian cyst. Her clinical status deteriorated after the admission with development of acute abdomen. Laparoscopic exploration was performed and unilateral ovarian abscess was found without involvement of other pelvic structures. The surgical procedure was minimal invasive for a young girl and Salmonella staleyville was isolated from pus. Solitary ovarian abscess can be of hematogenous origin and the causative pathogens are different from pathogens usually involved in pelvic inflammatory disease. To avoid later fertility problems it is of great importance to treat infections in pelvic region correctly according to the isolated microorganism and that surgery is the least invasive

Capnocytophaga canimorsus - an unusual cause of septic shock in a patient without a spleen

The paper describes the case of a 28-year-old patient without a spleen in whomhigh fever, vomiting, abdominal cramps, palpable purpura and peripheral cyanosis suddenly developed. Upon admission, he was in septic shock with multi-organ failure. He needed intubation, artificial ventilation and hemodynamic support. Blood culture samples grew gram-negative rods after four days of incubation, which were later identified as Capnocytophaga Canimorsus. In continuation, the differential diagnosis in patients without a spleen who suddenly develop a septic shock is discussed. The importance bf taking an exact exposure history to find the correct diagnosis is emphasized, including possible contacts with domestic animals.Opisan je primer 28-letnega moškega brez vranice, ki je nenadoma zbolel z visoko vročino, bruhanjem, krči v trebuhu, purpuro in periferno cianozo. Ob sprejemu je bil v septičnem šoku z odpovedjo več organov. Bolnik je potrebovalintubacijo, umetno predihavanje in hemodinamsko podporo. V krvnih kulturah so po štirih dneh inkubacije porasli po Gramu negativni bacili, ki smo jih kasneje identificirali kot Capnocytophaga canimorsus. V nadaljevanju je opisana diferencialna diagnoza pri bolnikih brez vranice, ki nenadoma zbolijo s septičnim šokom. Poudarjen je pomen natančnih podatkov o dejavnikih iz okolja pri postavitvi pravilne diagnoze, vključno z možnimi stiki z domačimi živalmi

Termoaktivne nitinolske kopče za primarno i sekundarno zatvaranje sternalnih osteotomija nakon kardiokirurških zahvata - prvo iskustvo u Sloveniji

Although there has been a trend towards minimally invasive and sternum-sparing procedures, median sternotomy is still a standard surgical approach in cardiac surgery. Many techniques and innovations for closure of sternal osteotomy have been developed with contradictory results. In this report, we present our first experience with the nitinol-made sternal closure system in the primary, as well as secondary closure of sternal osteotomy. A small series of 20 patients had their sternotomy closed with Flexigrip clips. In one case, the Flexigrip clips were used in secondary wound closure in a patient with deep sternal wound infection after full sternotomy and coronary bypass surgery. After 6-month follow-up, all patients were doing well with their sternums clinically stable and the sternotomy wounds completely healed. In conclusion, Flexigrip clips offered a stable alternative to steel wires in primary, as well as secondary sternal closure. Moreover, in secondary sternal closure, the thermoactive clips offered safety advantages over the standard wire cerclage technique because the need for dissection of the substernal adhesions could be avoided.Iako postoji trend primjene minimalno invazivnih procedura s očuvanjem sternuma, medijana sternotomija je još uvijek standardni kirurški pristup u kardiokirurgiji. Mnogo je tehnika i inovacija za zatvaranje sternalne osteotomije dosad razvijeno s proturječnim rezultatima. U ovom izvješću iznosimo naše prvo iskustvo sa sustavom sternalnog zatvaranja napravljenog od nitinola u primarnom kao i u sekundarnom zatvaranju sternalne osteotomije. Maloj seriji od 20 kardiokirurških bolesnika sternotomija je bila zatvorena kopčama Flexigrip. Kod jednog bolesnika kopče Flexigrip korištene su za sekundarno zatvaranje rane u slučaju duboke infekcije sternalne rane nakon pune sternotomije i operacije koronarnog premoštenja. Nakon 6-mjesečnog praćenja svi bolesnici bili su dobro, njihovi sternumi su bili klinički stabilni, a rane od sternotomije bile su zacijeljene. Kopče Flexigrip su nudile stabilnu alternativu čeličnim žicama u primarnom kao i u sekundarnom zatvaranju sternuma. Povrh toga, kod sekundarnog zatvaranja sternuma termoaktivne kopče imale su sigurnosne prednosti u odnosu na standardnu tehniku serklaže žicom, jer se mogla izbjeći potreba za disekciju supsternalnih adhezija

Forecasting COVID-19

The World Health Organization declared the coronavirus disease 2019 a pandemic on March 11th, pointing to the over 118,000 cases in over 110 countries and territories around the world at that time. At the time of writing this manuscript, the number of confirmed cases has been surging rapidly past the half-million mark, emphasizing the sustained risk of further global spread. Governments around the world are imposing various containment measures while the healthcare system is bracing itself for tsunamis of infected individuals that will seek treatment. It is therefore important to know what to expect in terms of the growth of the number of cases, and to understand what is needed to arrest the very worrying trends. To that effect, we here show forecasts obtained with a simple iteration method that needs only the daily values of confirmed cases as input. The method takes into account expected recoveries and deaths, and it determines maximally allowed daily growth rates that lead away from exponential increase toward stable and declining numbers. Forecasts show that daily growth rates should be kept at least below 5% if we wish to see plateaus any time soon—unfortunately far from reality in most countries to date. We provide an executable as well as the source code for a straightforward application of the method on data from other countries

Viral respiratory infections in a nursing home: a six-month prospective study

Abstract Background The knowledge on viral respiratory infections in nursing home (NH) residents and their caregivers is limited. The purpose of the present study was to assess and compare the incidence of acute respiratory infections (ARI) in nursing home (NH) residents and staff, to identify viruses involved in ARI and to correlate viral etiology with clinical manifestations of ARI. Methods The prospective surveillance study was accomplished in a medium-sized NH in Slovenia (central Europe). Ninety NH residents and 42 NH staff were included. Nasopharyngeal swabs were collected from all participants at enrollment (December 5th, 2011) and at the end of the study (May 31st, 2012), and from each participant that developed ARI within this timeframe. Molecular detection of 15 respiratory viruses in nasopharyngeal swab samples was performed. Results The weekly incidence rate of ARI in NH residents and NH staff correlated; however, it was higher in staff members than in residents (5.9 versus 3.8/1,000 person-days, P = 0.03), and was 2.5 (95 % CI: 1.36–4.72) times greater in residents without dementia than in residents with dementia. Staff members typically presented with upper respiratory tract involvement, whereas in residents lower respiratory tract infections predominated. Respiratory viruses were detected in 55/100 ARI episodes. In residents, influenza A virus, respiratory syncytial virus, and human metapneumovirus were detected most commonly, whereas in NH staff rhinovirus and influenza A virus prevailed. 38/100 ARI episodes (30/56 in residents, 8/44 in staff) belonged to one of three outbreaks (caused by human metapneumovirus, influenza A virus and respiratory syncytial virus, respectively). NH residents had higher chances for virus positivity within outbreak than HN staff (OR = 7.4, 95 % CI: 1.73–31.48, P < 0.01). Conclusions ARI are common among NH residents and staff, and viruses were detected in a majority of the episodes of ARI. Many ARI episodes among NH residents were outbreak cases and could be considered preventable. Trial registration The study was registered on the 1th of December 2011 at ClinicalTrials ( NCT01486160 )