bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Incidence but Low Burden of Coronaviruses and Preferential Associations between Respiratory Viruses
Authors: Lepiller Q. , Barth H. , Lefebvre F. , Herbrecht R. , Lutz P. , Kessler R. , Fafi-Kremer S. , Stoll-Keller F. 
Published: July 2013

ABSTRACT
Respiratory viruses are the leading cause of acute infections in humans. However, the burden of certain respiratory viruses, such as coronaviruses, and the relevance of viral coinfections remain unclear. In this study, we investigated the distribution and seasonal occurrences of respiratory viruses detected by multiplex molecular assay in 6,014 samples from 2008 to 2011 in a French hospital. We assessed the detection frequencies of 14 respiratory viruses and their clinical impact in immunosuppressed and nonimmunosuppressed patients. Furthermore, we explored the preferential association patterns between respiratory viruses in multiple infections. Our results indicated that human rhinovirus/enterovirus (HRV/EV) and coronavirus (HCoV) were frequently detected in respiratory samples (48.81% and 11.74% of infected samples, respectively), and the detection frequencies of these viruses were further increased in immunosuppressed patients. The most common subtypes of HCoV were HCoV-229E (33.80%) and HCoV-HKU1 (32.39%). A sharp increase in the detection frequencies of HCoV-229E and HCoV-HKU1 over several months suggested that these subtypes were epidemic in our population. In immunosuppressed patients, HCoV contributed to upper respiratory tract infections (52%). Evidence did not support lower respiratory tract infections exclusive to a unique HCoV infection. In multiply infected individuals, determined in 6.3% of samples, HRV/EV and HCoV were detected in 33.29% and 22.90% of samples, respectively. Interestingly, nearly 50% of HCoV infections were detected in association with another virus. Since the distributions of respiratory viruses in multiply infected patients were subject to preferential association patterns between viruses, we propose complex interactions between different respiratory viruses and host factors.
Sensitive and Specific Quantitative Detection of Rotavirus A by One-Step Real-Time Reverse Transcription-PCR Assay without Antecedent Double-Stranded-RNA Denaturation
Authors: Mijatovic-Rustempasic Slavica , Tam Ka Ian , Kerin Tara K. , Lewis Jamie M. , Gautam Rashi , Quaye Osbourne , Gentsch Jon R. , Bowen Michael D. 
Published: July 2013

ABSTRACT

A real-time quantitative reverse transcription-PCR (qRT-PCR) assay using the recombinant thermostable
Thermus thermophilus
(r
Tth
) enzyme was developed to detect and quantify rotavirus A (RVA). By using r
Tth
polymerase, significant improvement was achieved over the existing real-time RT-PCR assays, which require denaturation of the RVA double-stranded RNA (dsRNA) prior to assay setup. Using a dsRNA transcript for segment 7, which encodes the assay target NSP3 gene, the limit of detection for the improved assay was calculated to be approximately 1 genome copy per reaction. The NSP3 qRT-PCR assay was validated using a panel of 1,906 stool samples, 23 reference RVA strains, and 14 nontarget enteric virus samples. The assay detected a diverse number of RVA genotypes and did not detect other enteric viruses, demonstrating analytical sensitivity and specificity for RVA in testing stool samples. A XenoRNA internal process control was introduced and detected in a multiplexed qRT-PCR format. Because it does not require an antecedent dsRNA denaturation step, this assay reduces the possibility of sample cross-contamination and requires less hands-on time than other published qRT-PCR protocols for RVA detection.
Outbreak Caused by an Ertapenem-Resistant, CTX-M-15-Producing Klebsiella pneumoniae Sequence Type 101 Clone Carrying an OmpK36 Porin Variant
Authors: Poulou Aggeliki , Voulgari Evangelia , Vrioni Georgia , Koumaki Vasiliki , Xidopoulos Grigorios , Chatzipantazi Vasiliki , Markou Fani , Tsakris Athanassios 
Published: July 2013

ABSTRACT

Although numerous studies have documented outbreaks of carbapenem-resistant
Klebsiella pneumoniae
(CRKP) possessing various carbapenemases, reports on outbreaks due to CRKP possessing extended-spectrum β-lactamases (ESBLs) and/or AmpCs with porin lesions have been limited. Here, we describe an outbreak caused by an ertapenem-resistant, CTX-M-15-producing clonal
K. pneumoniae
strain expressing an OmpK36 porin variant. From May 2012 to November 2012, 37 ertapenem-resistant
K. pneumoniae
isolates phenotypically negative for carbapenemase production were recovered from 19 patients hospitalized in the intensive care unit of a Greek hospital. The isolates were either susceptible or intermediate to other carbapenems and resistant to all remaining β-lactams but cefotetan. Phenotypic and molecular analysis revealed the presence in all isolates of the
bla
CTX-M-15
gene on a conjugative 100-kb plasmid, disruption in the expression of the
ompK35
gene, and the production of an Ompk36 porin variant. The index case was a patient admitted from another hospital. Active surveillance upon admission and on a weekly basis was immediately initiated; environmental samples were also periodically tested. Molecular typing showed that all clinical isolates as well as two ertapenem-resistant environmental
K. pneumoniae
isolates belonged to the same clonal type and were assigned to multilocus sequence typing (MLST) sequence type 101 (ST101). As all colonized/infected patients were hospitalized during overlapping periods, cross-infection was considered the main route for the dissemination of the outbreak strain. Despite reinforcement of infection control measures and active surveillance, the outbreak lasted approximately 7 months. Identification of hidden carriers upon admission and by screening on a weekly basis was found valuable for early recognition and subsequent successful management of the outbreak.
Value of Superficial Cultures for Prediction of Catheter-Related Bloodstream Infection in Long-Term Catheters: a Prospective Study
Authors: Guembe M. , Martín-Rabadán P. , Echenagusia A. , Camúñez F. , Rodríguez-Rosales G. , Simó G. , Echenagusia M. , Bouza E. 
Published: July 2013

ABSTRACT
Cultures taken from the skin and from the hubs of short-term central venous catheters can help us to predict catheter-related bloodstream infections (C-RBSIs). The value of these cultures for such predictions has not been assessed in long-term catheters. Our objective was to assess the value of superficial cultures for the prediction of C-RBSI among patients with long-term catheters. Over a 2-year period, we prospectively obtained cultures from the skin overlying reservoir ports (group A) and from the skin insertion site and hubs of all tunneled catheters (group B). This routine was performed by vascular and interventional radiologists immediately before catheter removal (irrespective of the reason for withdrawal). Swabs were processed semiquantitatively. Catheter tips from both groups were cultured using Maki's semiquantitative technique and sonication. We also performed cultures of the reservoir ports at different sites. C-RBSI was defined as the isolation of the same species of microorganism(s) both in the colonized catheter and in at least 1 peripheral blood culture. We included 372 catheters (group A, 223; group B, 149) during the study period. The catheter colonization rate was 23.4% (87/372), and 28 patients had C-RBSI. Validity index values for the capacity of surface cultures to predict C-RBSI in groups A and B were, respectively, as follows: sensitivity, 23.5% and 45.5%; specificity, 59.7% and 63.0%; positive predictive value, 4.6% and 8.9%; and negative predictive value, 90.4% and 93.5%. Superficial cultures of patients with long-term catheters could help us to rule out the catheter as the portal of entry of bloodstream infections. Superficial cultures (from skin and hubs) proved to be a useful conservative diagnostic tool for ruling out C-RBSI among patients with long-term tunneled catheters and totally implantable venous access ports.
Point-Counterpoint: β-
d
-Glucan Testing Is Important for Diagnosis of Invasive Fungal Infections
Authors: Theel Elitza S. , Doern Christopher D. 
Published: July 2013

ABSTRACT

Invasive fungal infections are a significant cause of morbidity and mortality in patients who receive immunosuppressive therapy, such as solid organ and hematopoietic stem cell transplant (HSCT) recipients. Many of the fungi associated with these infections are angioinvasive and are best diagnosed by visualizing the organism in or culturing the organism from deep tissue. However, obtaining such tissue often requires an invasive procedure. Many HSCT recipients are thrombocytopenic, making such procedure too risky because of potential bleeding complications. Additionally, positive blood cultures are rare for patients with angioinvasive fungal infections, making this diagnostic strategy of little value. Undiagnosed fungal infections in these patient populations are a significant cause of mortality. Prophylactic use of antifungal agents, such as the echinocandins, during periods of neutropenia or graft-versus-host disease may prevent some fungal infections but increase the risk for others. Detection of fungal antigens in body fluids, including cryptococcus capsular polysaccharide, histoplasma antigen, galactomannan, and β-
d
-glucan, is viewed as being clinically useful for at least the presumptive diagnosis of invasive fungal infections. β-
d
-Glucan is an attractive antigen in that it is found in a broad range of fungal agents, including the commonly encountered agents
Candida
spp.,
Aspergillus
spp., and
Pneumocystis jirovecii.
Cross-reactions with certain hemodialysis filters, beta-lactam antimicrobials, and immunoglobulins, which raise concerns about false-positive tests, have also been described. As a result, the use of this testing must be closely monitored. In this point-counterpoint, we have asked Elitza Theel, who directs the Infectious Disease Serology Laboratory at the Mayo Clinic, to address why she believes that this test has value in the diagnosis of invasive fungal infections. We have asked Christopher Doern, Director of Clinical Microbiology at Children's Medical Center of Dallas, why he questions the clinical value of β-
d
-glucan testing.
Capsular warning syndrome
Authors: Nadarajan Vivek , Adesina Tolu 
Published: July 2013

We present a case of a 72-year-old man who presented with fluctuating right-sided weakness and numbness. This was characterised by episodic sudden onset weakness with resolution of symptoms in between. His symptoms and signs were becoming persistent despite the addition of dual antiplatelet therapy. The history we describe is classical of capsular warning syndrome. The patient went on to have further definitive neuroimaging which revealed a pontine infarct, rather than the expected capsular infarct. We discuss the importance of capsular warning syndrome, the proposed pathophysiological mechanisms and different locations of infarction in previous cases of capsular warning syndrome.We also discuss the lack of consensus (within the literature) in treatment options which are used to try and prevent a completed stroke occurring in cases of capsular warning syndrome.
Copenhagen hip and groin outcome score (HAGOS) in male soccer: reference values for hip and groin injury-free players
Authors: Thorborg Kristian , Branci Sonia , Stensbirk Frederik , Jensen Jesper , Hölmich Per 
Published: July 2013

Background/aimReference values are needed in order to interpret the Copenhagen Hip and Groin Outcome Score (HAGOS) in male soccer players with hip and groin pain. The aim of this study was to establish reference values for HAGOS in hip and groin injury-free male soccer players.MethodsWe included 444 groin injury-free soccer players from 40 clubs (divisions 1–4) in Eastern Denmark, mean age (SD) 23.6 (4.4), training soccer 3.4 (1) times per week. All players were hip and groin injury-free at the time of inclusion (beginning of season, 2011).ResultsOf the 444 hip and groin injury-free players, 301 reported no hip and/or groin pain in either the present or the previous season, and 143 reported that they had experienced hip and/or groin pain in the previous season. Players (n=143) with hip and groin pain in the previous season displayed lower scores than players without (n=301), for all HAGOS subscales (p<0.001). Age and playing level were not related to HAGOS. The 95% reference ranges for HAGOS subscales in hip and groin injury-free soccer players, with no pain in the previous or present season (n=301), are: pain: 80.1–100, symptoms: 64.3–100, activities of daily living: 80.3–100, sport and recreational activities: 71.9–100, participation in physical activity: 75–100 and quality of living: 75–100.ConclusionsLower HAGOS subscales are seen in soccer players who have experienced hip and/or groin pain in the previous season, compared with those who have not. Median HAGOS subscale scores in hip and groin injury-free soccer players are in proximity to the maximum score (100 points).
Defining quality outcomes for complex-care patients transitioning across the continuum using a structured panel process
Authors: Jeffs Lianne , Law Madelyn P , Straus Sharon , Cardoso Roberta , Lyons Renee F , Bell Chaim 
Published: July 2013

BackgroundNo standardised set of quality measures associated with transitioning complex-care patients across the various healthcare settings and home exists. In this context, a structured panel process was used to define quality measures for care transitions involving complex-care patients across healthcare settings.MethodsA modified Delphi consensus technique based on the RAND method was used to develop measures of quality care transitions across the continuum of care. Specific stages included a literature review, individual rating of each measure by each of the panelists (n=11), a face-to-face consensus meeting, and final ranking by the panelists.ResultsThe literature review produced an initial set of 119 measures. To advance to rounds 1 and 2, an aggregate rating of >75% of the measure was required. This analysis yielded 30/119 measures in round 1 and 11/30 measures in round 2. The final round of scoring yielded the following top five measures: (1) readmission rates within 30 days, (2) primary care visit within 7 days postdischarge for high-risk patients, (3) medication reconciliation completed at admission and prior to discharge, (4) readmission rates within 72 h and (5) time from discharge to homecare nursing visit for high-risk patients.ConclusionsThe five measures identified through this research may be useful as indicators of overall care quality related to care transitions involving complex-care patients across different healthcare settings. Further research efforts are called for to explore the applicability and feasibility of using the quality measures to drive quality improvement across the healthcare system.
Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study
Authors: Eichler Klaus , Hess Sascha , Chmiel Corinne , Bögli Karin , Sidler Patrick , Senn Oliver , Rosemann Thomas , Brügger Urs 
Published: July 2013

BackgroundEmergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated a quality improvement project of a Swiss urban hospital: In 2009, a triage system and a hospital-associated primary care unit with General Practitioners (H-GP-unit) were implemented beside the conventional hospital ED. This resulted in improved medical service provision with reduced process times and more efficient diagnostic testing. We now report on health-economic effects.MethodsFrom the hospital perspective, we performed a cost comparison study analysing treatment costs in the old emergency model (ED, only) versus treatment costs in the new emergency model (triage plus ED plus H-GP-unit) from 2007 to 2011. Hospital cost accounting data were applied. All consecutive outpatient emergency contacts were included for 1 month in each follow-up year.ResultsThe annual number of outpatient emergency contacts increased from n=10 440 (2007; baseline) to n=16 326 (2011; after intervention), reflecting a general trend. In 2007, mean treatment costs per outpatient were €358 (95% CI 342 to 375). Until 2011, costs increased in the ED (€423 (396 to 454)), but considerably decreased in the H-GP-unit (€235 (221 to 250)). Compared with 2007, the annual local budget spent for treatment of 16 326 patients in 2011 showed cost reductions of €417 600 (27 200 to 493 600) after adjustment for increasing patient numbers.ConclusionsFrom the health-economic point of view, our new service model shows ‘dominance’ over the old model: While quality of service provision improved (reduced waiting times; more efficient resource use in the H-GP-unit), treatment costs sustainably decreased against the secular trend of increase.
Comparison of intubation modalities in a simulated cardiac arrest with uninterrupted chest compressions
Authors: Tandon Navin , McCarthy Matthew , Forehand Brett , Carlson Jestin N 
Published: July 2013

BackgroundInterruptions in chest compressions during cardiopulmonary resuscitation can negatively impact survival. Several new endotracheal intubation (ETI) techniques including video laryngoscopy may allow for ETI with minimal or no interruptions in chest compressions. We sought to determine the impact of three different ETI techniques upon time to intubation (TTI) in a simulated cardiac arrest during uninterrupted chest compression.MethodsWe performed a randomised crossover study with a convenience sample of emergency physicians using three different ETI techniques: direct laryngoscopy (DL), GlideScope video laryngoscopy (GVL) and GlideScope video laryngoscopy with bougie (GVL-B). Providers performed ETI on a manikin on a hospital bed with concurrent chest compressions. Our primary outcome, TTI, was defined as the time from insertion of the laryngoscope blade until first breath. Given the correlated nature of the data, we used the paired t test to assess the differences in mean TTIs between GVL minus DL and GVL-B minus DL. We also ran the analysis stratified by provider experience.ResultsWe enrolled 20 providers with a median TTI (IQR) by device of: DL 27 s (20.3, 35.4), GVL 20.6 s (17.7, 27.1) and GVL-B 60.1 s (39.1, 99). The mean GVL—DL difference was −10.1 s (−17.9–2.3) while the mean GVL-B—DL difference was 45.6 s (19.8–71.4) (p<0.001). The GVL-B required the greatest TTI across providers of varying experience levels.ConclusionsIn this simulated model of cardiac arrest with uninterrupted chest compressions, TTI was shorter for GVL than DL while use of the GVL with bougie resulted in longer TTI.
Effect of elevated serum alcohol level on the outcome of severely injured patients
Authors: Scheyerer Max J , Dütschler Joel , Billeter Adrian , Zimmermann Stefan M , Sprengel Kai , Werner Clement M L , Simmen Hans-Peter , Wanner Guido A 
Published: July 2013

BackgroundThe influence of high blood alcohol level (BAL) on the outcome of severely injured patients and the corresponding pathophysiological changes is a controversial issue.ObjectiveTo carry out a prognostic study to compare the physiological values and short-term outcome of severely injured patients depending on their serum alcohol level.MethodsA total of 383 severely injured patients with an Injury Severity Score (ISS) ≥17 were admitted to the trauma division between October 2008 and December 2009 and enrolled into this study. Patients were grouped according to their BAL (>0.5‰,‘BAL positive’ vs <0.5‰,‘BAL negative’). Trauma mechanism, pattern of injury and its treatment, and a course of intensive care treatment, physiological parameters and outcome with respect to mortality were analysed.ResultsBoth groups had similar ISS. In comparison with the BAL-negative group, patients in the BAL-positive group had a significantly lower Glasgow Coma Scale score (9.64 vs 12 points; p=0.005) and, although not significant, a trend towards higher values of the Abbreviated Injury Score for the head (3.29 vs 2.81 points; p=0.146). Furthermore, significantly higher lactate (3.11 mmol/L vs 2.02 mmol/L; p<0.001) levels and lower median arterial pressure values (87.9 mm Hg vs 99.4 mm Hg; p=0.006) were seen in the BAL-positive group at day of admission. However, the overall in-hospital mortality was comparable to that in BAL-negative patients (19.6% vs 21.5%). Similarly, hospital stay (15.29 vs 17.55 days) and duration of intensive care unit treatment (8.53 vs 8.36 days) were not significantly affected by a high BAL upon admission.ConclusionsSeverely injured patients with a raised BAL have a higher incidence of severe traumatic brain injury and worse initial physiological parameters. However, the survival rate and in-hospital stay is not influenced. This supports the theory of a neuroprotective role of alcohol.
E-052 Ear Arteriovenous Malformation Management
Authors: Yakes W 
Published: July 2013

ObjectiveTo determine the efficacy of Ethanol Endovascular Repair of Ear Arteriovenous Malformation (AVMs).MethodsTen patients (7 female, 3 males; age range 6–39 years; mean age: 22 years) with ear AVMs presented for therapy. Two patients had failed prior embolisations (PVA/coils/nBCA/steroids) and 2 patients had other therapies (laser/excisions/grafting). All presented with grossly enlarged painful ear with intermittent bleeding. All patients underwent transcatheter direct puncture ethanol Rx (86 procedures).ResultsAll 10 patients were cured of the AVM at long-term follow-up (mean follow-up: 52 months). One patient had transient partial VII nerve palsy. Two patients had minor blisters and ear injuries.ConclusionsEthanol endovascular repair of Ear AVMs can effect cures in this vexing lesion that previously was treated with resection of the ear and high recurrence rates. This series documents long-term cures of AVMs of the ear and scalp. Only one publication on ethanol curative treatment of Ear AVMs (AJNR 2009; Oct; 30 (9):1679–84) exists in the world’s literature to whom I taught this technique. Their curative experience duplicates my experience. No recurrences occurred in my patient series as well.DisclosuresW. Yakes: None.
E-054 Mandibular AVM Diagnosis and Curative Treatment
Authors: Yakes W 
Published: July 2013

PurposeTo determine optimal management strategies for the treatment of mandibular AVM.Materials and MethodsTwelve patients (9 females, 3 males), age 9–14; mean age 10, underwent endovascular therapy to treat their mandibular AVMs. Nine patients had distinct intraosseous AVMs. Three had multiple facial and intra-maxillary AVMs requiring treatment. Outside institutions recommended massive hemifacial resections in these patients. Four patients had prior PVA and gel foam embolisation, one patient had a lip graft, one had prior mandible surgery, all that had failed.ResultsAll twelve patients have demonstrated MR and angiographic cure of their AVMs. One patient’s therapy is not completed and is on-going. The follow-up is 11 months-41 months, with a mean follow-up of 29 months. No complications were noted.ConclusionsEndovascular approaches to manage mandibular AVM can be curative. The intraosseous variety is largely a fistula between artery and vein within the bone. All respond well to endovascular ethanol therapy alone. Surgery was not required in any patient. Surprisingly, no complications were encountered in this patient series. Long-term cures are noted in this patient series with endovascular approaches alone. No massive surgical resections in any patient, even in patients with multiple AVMs of the soft tissues, mandible and maxilla, were required to effect cures.DisclosuresW. Yakes: None.