Clinical and microbiologic characteristics of tcdA-negative variant clostridium difficile infections

BACKGROUND: The tcdA-negative variant (A(-)B(+)) of Clostridium difficile is prevalent in East Asian countries. However, the risk factors and clinical characteristics of A(-)B(+)C. difficile infections (CDI) are not clearly documented. The objective of this study was to investigate these characteristics. METHODS: From September 2008 through January 2010, the clinical characteristics, medication history and treatment outcomes of CDI patients were recorded prospectively. Toxin characterization and antibiotic susceptibility tests were performed on stool isolates of C. difficile. RESULTS: During the study period, we identified 22 cases of CDI caused by tcdA-negative tcdB-positive (A(-)B(+)) strains and 105 cases caused by tcdA-positive tcdB-positive (A(+)B(+)) strains. There was no significant difference in disease severity or clinical characteristics between the two groups. Previous use of clindamycin and young age were identified as significant risk factors for the acquisition of A(-)B(+) CDI (OR = 4.738, 95% CI 1.48–15.157, p = 0.009 and OR = 0.966, 95% CI 0.935–0.998, p = 0.038, respectively) in logistic regression. Rates of resistance to clindamycin were 100% and 69.6% in the A(-)B(+) and A(+)B(+) isolates, respectively (p = 0.006), and the ermB gene was identified in 17 of 21 A(-)B(+) isolates (81%). Resistance to moxifloxacin was also more frequent in the A(-)B(+) than in the A(+)B(+) isolates (95.2% vs. 63.7%, p = 0.004). CONCLUSIONS: The clinical course of A(-)B(+) CDI is not different from that of A(+)B(+) CDI. Clindamycin use is a significant risk factor for the acquisition of tcdA-negative variant strains

Effects of Rhythmic Auditory Stimulation During Hemiplegic Arm Reaching in Individuals with Stroke: An Exploratory Study

SummaryObjective/BackgroundThis study investigated the effects of rhythmic auditory stimulation (RAS) on muscle activity and elbow motion during arm reaching with hemiplegic arm in participants with stroke.MethodsSixteen adults with stroke who resided in a community were recruited in this study. The RAS consisted of sound emitted from a digital metronome. While sitting upright in a chair, participants reached their arms towards a target (a switch on a table) both with and without RAS. The three-dimensional motion analysis system and surface electromyography system were used for measurements during the reaching tasks.ResultsWe found that RAS elicited better performance in reaching movements than those movements performed without RAS. RAS shortened the movement time (p = .002), reduced the change in acceleration (p = .001), increased the elbow extension range of motion (p = .001), increased muscle activation of the triceps brachii (p = .024), and reduced the co-contraction ratio (p = .015) of the affected arm.ConclusionRAS might be a useful technique to facilitate improvements in motor function of the affected arm in patients with stroke

Effect of Guizhifulingwan (Keishibukuryogan) on climacteric syndrome: study protocol for a randomized controlled pilot trial

SPIRIT 2013 checklist. (DOCX 51 kb

Psychotic Features as the First Manifestation of 22q11.2 Deletion Syndrome

The 22q11.2 deletion is a genetic disorder which is characterized by abnormalities in cardiac functioning, facial structure, neurobehavioral development, T cell functioning, and velopharyngeal insufficiencies. In the presented case study, 22q11.2 deletion was found in a patient who has psychotic symptoms only. A 25-year-old woman with a history of hypoparathyroidism and hypothyroidism presented with auditory hallucinations and persecutory delusions. After three months of treatment with antipsychotic medications, the patient was readmitted with generalized tonic-clonic seizures. The following week, the patient went into sepsis. A fluorescent in situ hybridization (FISH) analysis revealed the presence of a 22q11.2 microdeletion. This case study suggests that psychotic symptoms can develop prior to the typical symptoms of a 22q11.2 deletion. As such, psychiatrists should test for genetic abnormalities in patients with schizophrenia when these patients present with seizures and immunodeficiencies

Effects of Rating Training on Inter-Rater Consistency for Developing a Dental Hygiene Clinical Rater Qualification System

We tried to develop itemized evaluation criteria and a clinical rater qualification system through rating training of inter-rater consistency for experienced clinical dental hygienists and dental hygiene clinical educators. A total of 15 clinical dental hygienists with 1-year careers participated as clinical examination candidates, while 5 dental hygienists with 3-year educations and clinical careers or longer participated as clinical raters. They all took the clinical examination as examinees. The results were compared, and the consistency of competence was measured. The comparison of clinical competence between candidates and clinical raters showed that the candidate group's mean clinical competence ranged from 2.96 to 3.55 on a 5-point system in a total of 3 instruments (Probe, Explorer, Curet), while the clinical rater group's mean clinical competence ranged from 4.05 to 4.29. There was a higher inter-rater consistency after education of raters in the following 4 items: Probe, Explorer, Curet, and insertion on distal surface. The mean score distribution of clinical raters ranged from 75% to 100%, which was more uniform in the competence to detect an artificial calculus than that of candidates (25% to 100%). According to the above results, there was a necessity in the operating clinical rater qualification system for comprehensive dental hygiene clinicians. Furthermore, in order to execute the clinical rater qualification system, it will be necessary to keep conducting a series of studies on educational content, time, frequency, and educator level