Threshold for Synovial Cell Count and Neutrophil Differential in Diagnosis of Periprosthetic Knee Infection: A Multi-Institutional Study

Introduction: Synovial fl­uid analysis is an important tool in the work-up of suspected periprosthetic joint infection (PJI). Yet, there is confl­icting guidance for the analysis of synovial fl­uid aspiration, including a lack of uniform thresholds for white blood cell (WBC) count and neutrophil percentage (PMN%)1-3. Therefore, a multi-institutional study was undertaken to reassess these thresholds, compare preoperative versus intraoperative sample collection, and assess variation in results between institutions

Cutaneous Manifestations of Nutritional Deficiencies in the Context of Food Deserts of United States.

Food deserts exist due to a multitude of factors ranging from socioeconomic status, racial disparities, geography, cost, and healthful food access. Given the vast biological function of vitamins and minerals, the clinical presentation for nutritional deficiencies ranges from benign to life-threatening. Often, the first indicators of underlying nutritional deficiencies are cutaneous manifestations. The first patient case is a 36-year-old female at 25 weeks gestation with a pruritic and painful rash that began in the genital region and spread centrifugally to her legs. The second patient case is a 42-year-old male with a pruritic rash that began at his abdomen and progressed to his thighs. The third patient case is a 48-year-old female with scattered lower extremity ecchymoses in different healing stages and scattered perifollicular erythema with corkscrew hairs. All three patients were found to have nutritional deficiencies and lived in identified food deserts. Deficiencies of zinc, vitamin A, thiamine, pyridoxine, and vitamin C and their subsequent cutaneous manifestations have scarce documentation within food deserts. These cases provide further insight into nutritional deficiencies and offer an opportunity for providers to identify patients at risk. To promote wellness, patients suffering from food insecurity must be identified efficiently and connected with essential resources

Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic reviewof the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review.Atotal of 44 globally representativegroupmembersmet in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents

Neumonía Adquirida en la Comunidad por Streptococcus Pneumoniae Asociada a Tuberculosis Pulmonar en Adulto Mayor. Reporte de Caso

Community-acquired pneumonia is an infectious process of acute onset in the lung parenchyma caused by microorganisms, which affects the distal portion of the respiratory tract and sometimes involves the alveolar interstitium. This process generates an inflammatory cellular infiltrate of the alveolar space called consolidation, which alters gas exchange. Among the bacterial etiologies, the main one is S. pneumoniae. Regarding the clinical manifestations of the disease, in older adults it presents several signs and symptoms, which leads to a delay in diagnosis. The characteristic symptoms such as fever, cough and chest pain may not appear, which in some cases leads to confusion about the condition, non-specific malaise or detriment of the general condition. Its management depends on the etiology, and antibiotic therapy is indicated. We report the case of a 66-year-old male patient with a history of significant arterial hypertension diagnosed 12 years ago under continuous treatment, who came for 1 month reporting dyspnea on great exertion that evolved to minor exertion, accompanied by unquantified temperature rise and productive cough.La neumonía adquirida en la comunidad es un proceso infeccioso de instauración aguda en el parénquima pulmonar causado por microrganismos, el cual afecta la porción distal de las vías respiratorias y, en ocasiones, involucra el intersticio alveolar. Este proceso genera un infiltrado celular inflamatorio del espacio alveolar denominado consolidación, que altera el intercambio gaseoso, dentro de las etiologías bacterianas la principal es S. pneumoniae. Con relación a las manifestaciones clínicas de la enfermedad, en los adultos mayores presenta varios signos y síntomas, lo que conlleva a una demora en el diagnóstico. Los síntomas característicos como fiebre, tos y dolor torácico pueden no presentarse, lo que provoca en algunos casos a confusiones sobre el cuadro, el malestar inespecífico o el detrimento del estado general. Su manejo depende de la etiología, y se indica antibioticoterapia. Se Reporta el caso de un paciente masculino de 66 años con antecedentes de importancia, Hipertensión arterial diagnosticada hace 12 años en tratamiento continuo, acude por referir desde hace 1 mes disnea de grandes esfuerzos que evoluciona a pequeños esfuerzos, acompañada de alza térmica no cuantificada y tos productiva

Síndrome de WALLENBERG en Paciente Femenina de 65 Años, con Antecedente Patológico de Importancia. Reporte de Caso

Wallenberg syndrome is the most common vascular syndrome of the posterior circulation, which triggers a clinical picture characterized by damage to the lateral portion of the medulla where the affected structures are the spinal branch of the trigeminal nerve, the spinothalamic pathway, the nucleus ambiguus of the vagus, the inferior cerebellar peduncle and the descending sympathetic fibers, which manifests itself with easily recognizable signs of posterolateral injury. The risk factors for developing this syndrome are embolisms, atherosclerosis, and aneurysms. The bulb in its lateral region has a variable irrigation, for the most part it is irrigated by branches of the intracranial vertebral artery, followed in frequency by a dual irrigation by branches of the intracranial vertebral artery and the posteroinferior cerebellar artery and in a smaller proportion irrigation is provided only by the posterior inferior cerebellar artery. A case is reported of a 65-year-old female patient who reports nausea that leads to vomiting on several occasions (no number is reported) of food content, in addition to a very intense holocranial headache (Eva 10/10), pulsating type.El síndrome de Wallenberg es el síndrome vascular más frecuente de la circulación posterior, que desencadena un cuadro clínico caracterizado por daño de la porción lateral del bulbo donde las estructuras afectadas son la rama espinal del trigémino, la vía espinotalámica, el núcleo ambiguo del vago, el pedúnculo cerebeloso inferior y las fibras simpáticas descendentes, lo que se manifiesta con signos de lesión posterolateral fácilmente reconocibles. Los factores de riesgo para desarrollar este síndrome son embolias, ateroesclerosis, aneurismas. El bulbo en su región lateral tiene una irrigación variable, en su mayor parte es irrigada por ramas de la arteria vertebral intracraneal, le sigue en frecuencia una irrigación dual por ramas de la arteria vertebral intracraneal y de la arteria cerebelosa posteroinferior y en una proporción menor la irrigación está a cargo solamente por la arteria cerebelosa posteroinferior. Se Reporta un caso de una paciente femenina de 65 años que refiere nauseas que llegan al vomito por varias ocasiones (no refieren número) de contenido alimentario, además de cefalea holocraneana de gran intensidad (Eva 10/10), tipo pulsátil

Control of MRSA infection and colonisation in an intensive care unit by GeneOhm MRSA assay and culture methods

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major nosocomial pathogens. Due to the diffusion of MRSA strains in both hospital and community settings, prevention and control strategies are receiving increased attention. Approximately 25% to 30% of the population is colonised with S. aureus and 0.2% to 7% with MRSA. The BD GeneOhm MRSA real-time PCR assay offers quicker identification of MRSA-colonised patients than do culture methods. Ninety-five patients admitted to the Intensive Care Unit of IRCCS Policlinico San Matteo of Pavia (Italy) for a period > 24 h were screened for MRSA colonisation with both the culture method and the GeneOhm assay. Of the 246 nasal swabs collected from 95 patients, 36 samples were found to be positive by both methods (true-positive). 30% of colonised patients had developed the MRSA infection. Our results show that the GeneOhm MRSA assay is a valuable diagnostic tool for detecting MRSA quickly in nasal swabs. This study confirms that colonisation represents a high risk factor for MRSA infection, and that good MRSA surveillance in an Intensive Care Unit is therefore an excellent way to prevent MRSA infectio

The MUSE view of the host galaxy of GRB 100316D

The low distance, $z=0.0591$, of GRB 100316D and its association with SN 2010bh represent two important motivations for studying this host galaxy and the GRB's immediate environment with the Integral-Field Spectrographs like VLT/MUSE. Its large field-of-view allows us to create 2D maps of gas metallicity, ionization level, and the star-formation rate distribution maps, as well as to investigate the presence of possible host companions. The host is a late-type dwarf irregular galaxy with multiple star-forming regions and an extended central region with signatures of on-going shock interactions. The GRB site is characterized by the lowest metallicity, the highest star-formation rate and the youngest ($\sim$ 20-30 Myr) stellar population in the galaxy, which suggest a GRB progenitor stellar population with masses up to 20 -- 40 $M_{\odot}$. We note that the GRB site has an offset of $\sim$660pc from the most luminous SF region in the host. The observed SF activity in this galaxy may have been triggered by a relatively recent gravitational encounter between the host and a small undetected ($L_{H\alpha} \leq 10^{36}$ erg/s) companion

LSQ14efd: observations of the cooling of a shock break-out event in a type Ic Supernova

We present the photometric and spectroscopic evolution of the type Ic supernova LSQ14efd, discovered by the La Silla QUEST survey and followed by PESSTO. LSQ14efd was discovered few days after explosion and the observations cover up to ~100 days. The early photometric points show the signature of the cooling of the shock break-out event experienced by the progenitor at the time of the supernova explosion, one of the first for a type Ic supernova. A comparison with type Ic supernova spectra shows that LSQ14efd is quite similar to the type Ic SN 2004aw. These two supernovae have kinetic energies that are intermediate between standard Ic explosions and those which are the most energetic explosions known (e.g. SN 1998bw). We computed an analytical model for the light-curve peak and estimated the mass of the ejecta 6.3 +/- 0.5 Msun, a synthesized nickel mass of 0.25 Msun and a kinetic energy of Ekin = 5.6 +/- 0.5 x 10^51 erg. No connection between LSQ14efd and a GRB event could be established. However we point out that the supernova shows some spectroscopic similarities with the peculiar SN-Ia 1999ac and the SN-Iax SN 2008A. A core-collapse origin is most probable considering the spectroscopic, photometric evolution and the detection of the cooling of the shock break-out

A SEARCH for AN OPTICAL COUNTERPART to the GRAVITATIONAL-WAVE EVENT GW151226

We present a search for an electromagnetic counterpart of the gravitational-wave source GW151226. Using the Pan-STARRS1 telescope we mapped out 290 square degrees in the optical $i_{P1}$ filter, starting 11.5 hr after the LIGO information release and lasting for an additional 28 days. The first observations started 49.5 hr after the time of the GW151226 detection. We typically reached sensitivity limits of $i_{P1}$ = 20.3–20.8 and covered 26.5% of the LIGO probability skymap. We supplemented this with ATLAS survey data, reaching 31% of the probability region to shallower depths of $m \simeq$ 19. We found 49 extragalactic transients (that are not obviously active galactic nuclei), including a faint transient in a galaxy at 7 Mpc (a luminous blue variable outburst) plus a rapidly decaying M-dwarf flare. Spectral classification of 20 other transient events showed them all to be supernovae. We found an unusual transient, PS15dpn, with an explosion date temporally coincident with GW151226, that evolved into a type Ibn supernova. The redshift of the transient is secure at $z$ = 0.1747 ± 0.0001 and we find it unlikely to be linked, since the luminosity distance has a negligible probability of being consistent with that of GW151226. In the 290 square degrees surveyed we therefore do not find a likely counterpart. However we show that our survey strategy would be sensitive to NS–NS mergers producing kilonovae at $D_L \lesssim$ 100 Mpc, which is promising for future LIGO/Virgo searches.NASA (Grant IDs: NNX08AR22G, NNX12AR65G, NNX14AM74G, NNX12AR55G), EU/FP7-ERC (Grant IDs: 291222, 307260, 320360, 615929), a Weizmann-UK Making Connections Grant, STFC (Ernest Rutherford Fellowship), Alexander von Humboldt Foundation (Sofia Kovalevskaja Award), National Science Foundation (Grant ID: AST-1238877)This is the final version of the article. It first appeared from Institute of Physics Publishing via http://dx.doi.org/10.3847/2041-8205/827/2/L4