Total knee arthroplasty in schizophrenia patients: early complications and cost in a propensity-matched national database study.

INTRODUCTION: Studies investigating the link between mental health disorders and complications following total knee arthroplasty (TKA) have found worse outcomes in individuals with such disorders. Therefore, risk factors and outcomes following TKA in patients with schizophrenia should be better understood. This study aims to investigate cost and duration of hospital stay, inpatient complications, and mortality associated with TKA in patients with schizophrenia. MATERIALS AND METHODS: Utilizing the NIS database from 2016 to 2019, patients that underwent TKA were selected using ICD-10 codes. The selected patients were classified into a schizophrenia or control group and cost, hospitalization length, complications, and mortality rates were compared between the two groups in an unmatched and matched analysis. RESULTS: Our study dataset consisted of 558,371 patients that underwent a TKA during 2016 to 2019. 1,015 (0.2%) patients in the sample had a diagnosis of schizophrenia while the remaining 557,357 (99.8%) patients had no record of schizophrenia. An unmatched analysis found that schizophrenia patients had longer duration of hospital stay and greater charges incurred. Acute renal failure, myocardial infarction (MI), blood loss anemia, pneumonia, DVT, periprosthetic fracture, prosthetic dislocation, and periprosthetic infections were post-op complications with higher rates in the schizophrenia group. A matched cohort analysis found that schizophrenia patients still had longer duration of hospital stay and greater charges incurred. However, only acute renal failure, blood loss anemia, and pneumonia were found at higher rates in the schizophrenia group following TKA. CONCLUSIONS: Schizophrenia patients had a significantly longer hospital stay and increased charges acquired during their stay compared to the control group following TKA. Acute renal failure, blood loss anemia, and pneumonia were medical complications with an increased risk following TKA in patients with schizophrenia in a matched analysis. Increased care during the perioperative period following TKA in individuals with schizophrenia is thus warranted.

Identifying outbreaks in sewer networks: An adaptive sampling scheme under network's uncertainty.

Motivated by the implementation of a SARS-Cov-2 sewer surveillance system in Chile during the COVID-19 pandemic, we propose a set of mathematical and algorithmic tools that aim to identify the location of an outbreak under uncertainty in the network structure. Given an upper bound on the number of samples we can take on any given day, our framework allows us to detect an unknown infected node by adaptively sampling different network nodes on different days. Crucially, despite the uncertainty of the network, the method allows univocal detection of the infected node, albeit at an extra cost in time. This framework relies on a specific and well-chosen strategy that defines new nodes to test sequentially, with a heuristic that balances the granularity of the information obtained from the samples. We extensively tested our model in real and synthetic networks, showing that the uncertainty of the underlying graph only incurs a limited increase in the number of iterations, indicating that the methodology is applicable in practice.

Risk of blood transfusion following total hip arthroplasty: A national database study from 367,894 patients.

Purpose: A growing elderly population in the United States coupled with improvement in surgical techniques have resulted in more elderly individuals undergoing total hip arthroplasty (THA). As such, risk factors associated with increased risk of blood transfusion following THA, which has been linked to various detrimental outcomes, must be better understood. This study aims to identify co-morbidities associated with blood transfusion following THA. Methods: Using the Nationwide Inpatient Sample (NIS) database, we selected patients that received a THA from 2016 to 2019 using ICD-10CMP codes. Patients were classified into a "blood transfusion" or "no transfusion" groups and data pertaining to demographics, co-morbidities, and events during hospital stays were compared between the groups. Results: Our study dataset included 367,894 patients from the NIS database that underwent a THA from 2016 to 2019. 12,900 (3.5 %) patients received a blood transfusion after their THA and were classified as "blood transfusion group." The remaining 354,994 patients were classified as the "no transfusion group." Elective admission was found to decrease the odds of a blood transfusion following a THA (compared to nonelective THA: odd's ratio 0.283; p value < 0.001). Multivariate analysis demonstrated sickle cell disease, liver cirrhosis, and dialysis exhibited the greatest increase in odds of blood transfusion after a THA by 4.81- (p < 0.001), 3.02- (p < 0.001), and 2.22-fold (p < 0.001), respectively. Looking at patient demographics, male sex increased odds of postoperative transfusion by 1.99 (p < 0.001) while Caucasian ethnicity decreased odds of postoperative transfusion by 0.65 (p < 0.001). Conclusion: Blood transfusion has a low occurrence in the early post-operative period following THA (3.6 % of patients). Sickle cell disease, liver cirrhosis, dialysis, SLE, and heart pathologies were the comorbidities found to be most significantly associated with an increased risk of blood transfusion after a THA. Additionally, both mortality and non-elective admissions were significantly more prevalent in the "blood transfusion" group.

Standardized Models for Identification and Intervention for Emergency Department Patients at Risk for Alcohol Use Disorder.

Alcohol use disorder (AUD) is chronic, lasting a person's lifetime. An increase in driving under the influence of alcohol, as well as emergency department (ED) visits, has been reported. The Alcohol Use Disorder Identification Test Consumption (AUDIT-C) is utilized to assess hazardous drinking. The Screening, Brief Intervention, Referral to Treatment (SBIRT) model assists in early intervention and referral for treatment. The Transtheoretical Model standardized instrument assesses individual readiness to change. These tools may be used by nurses and nonphysicians in the ED to help reduce alcohol use and the consequences of its use.

Implementing Effective Interventions Against Workplace Violence.

Workplace violence (WPV) is widespread and increasing in health care organizations. The purpose of this performance improvement (PI) project was to understand what measures could effectively be implemented to decrease the incidence of WPV events in an acute inpatient health care facility. The A3 problem-solving methodology was utilized. The current state and countermeasures to decrease gaps in the current processes were examined. The methodology engaged all stakeholders in problem-solving and continuous improvement. PI members implemented the house-wide interventions in January 2019 and in financial year 2019 assault with injuries decreased to 39. Further research is needed to support effective interventions against WPV.

Occipital encephalocele associated with Dandy-Walker malformation: a case-based review.

INTRODUCTION: Occipital encephalocele is a brain malformation that has been remotely associated with Dandy-Walker; only case reports and very small series have been published so far; therefore, their behavior and management are still under investigation. The goal of the present case-based review is to provide a summary of the state of the art in this association. METHODS AND RESULTS: The pertinent literature has been reviewed, and an exemplary case has been reported (an 11-month-old female with Dandy-Walker malformation and occipital encephalocele). So far, 33 cases have been described, with a mean age at surgery of 5, 1 day). The majority of the cases tend to present with hydrocephalus. There are no specific surgery approaches or global consensus about this association. The management possibly relies on surgery with shunt or encephalocele excision but without a dedicated protocol yet. CONCLUSIONS: The clinical research on occipital encephalocele in association with Dandy-Walker malformation is just at the beginning. New targets and wide-ranging clinical trials are needed to get an optimal management protocol.

Pulsed radiofrequency of superior cervical ganglion for treatment of painful post-traumatic trigeminal neuropathy (PTTN): A case series report.

Objective: Painful post-traumatic trigeminal neuropathy (PTTN) is a clinical pain syndrome that occurs due to injuries to the peripheral branches of the trigeminal nerve and is characterized by a deep burning pain and accompanied by positive and negative neurological signs. In patients with recalcitrant PTTN, the sympathetic nervous system is a potential therapeutic target. The aim of this study was to investigate the therapeutic response of PTTN patients to pulsed radiofrequency treatment (PRF) of the superior cervical sympathetic ganglion (SCG).Methods: Thirty-five patients with PTTN who had a history of severe disabling facial neuropathic pain underwent PRF of the SCG under a new lateral fluoroscopic approach.Results: The patients' pain intensity post-PRF was 3.94 (± 3.11), compared with 8.82 (± 1.27) pre-PRF (p < 0.001).Conclusion: PRF of the SCG could be an effective method to treat chronic PTTN.

Perampanel-Induced Psychosis in a Young Woman: A Case Report.

OBJECTIVES: A case of perampanel-induced psychosis in a young woman is reported, a side effect that has only rarely been reported in the literature. METHODS: We describe a case of a young woman with epilepsy and no psychiatric history with perampanel-associated altered behavior and psychotic symptoms, requiring hospitalization in an acute psychiatry ward. We also provide a literature review on the possible neurobiological pathways implicated. RESULTS: Perampanel is believed to block a small proportion of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor current, retarding epileptiform discharges while sparing most normal synaptic transmission. Most common adverse events are related to central nervous system (including dizziness, drowsiness, blurred vision and imbalance) and psychiatric symptoms have been reported. CONCLUSIONS: The biological vulnerability to psychiatric and behavioral adverse reactions of antiepileptic drugs is multifactorial and different mechanisms and clinical predisposing factors may interact. For this reason, patients starting these antiseizure drugs need long-term and comprehensive clinical monitoring.

Identification of Genetic Variants of Human Papillomavirus in a Group of Mexican HIV/AIDS Patients and Their Possible Association with Cervical Cancer.

Infections caused by the human immunodeficiency virus (HIV) and human papillomavirus (HPV) cause thousands of deaths worldwide each year. So far, there has been no consensus on whether there is a direct relationship between the incidence of neoplasms and the immunosuppression caused by HIV that could help understand if coinfection increases the likelihood of cervical cancer. The objective of the study was to identify the presence of genetic variants of HPV in a group of HIV-positive women and their possible association with cervical cancer. Cervical samples were taken from HIV-positive patients for cytological analysis to identify the HPV genotype by polymerase chain reaction (PCR) and sequencing. The most prevalent L1 capsid protein mutations in the HPV genotype were analyzed in silico. Various types of HPV were identified, both high-risk (HR) and low-risk (LR). The most prevalent genotype was HPV51. Analysis of the L1 gene sequences of HPV51 isolates showed nucleotide variations. Of the samples analyzed in Puebla, Mexico, HPV51 had the highest incidence (17.5%, 7/40). Different mutations, which could be used as population markers, were detected in this area, and they have not been reported in the L1 databases for HPV51 in Mexico. Genotypes 6, 14, 86, 87, 89, and 91, not detected or reported in samples from patients with HPV in Mexico, were also identified. Data from the population analyzed suggest no direct relationship between HIV immunosuppression and cervical cancer, regardless of the high- or low-risk HPV genotype. Furthermore, it is possible to develop regional population markers for the detection of HPV based on the mutations that occur in the sequence of nucleotides analyzed.

Tuberculosis transmission across three states: The story of a solid organ donor born in an endemic country, 2018.

Transmission of tuberculosis (TB) from a deceased solid organ donor to recipients can result in severe morbidity and mortality. In 2018, four solid organ transplant recipients residing in three states but sharing a common organ donor were diagnosed with TB disease. Two recipients were hospitalized and none died. The organ donor was born in a country with a high incidence of TB and experienced 8 weeks of headache and fever prior to death, but was not tested for TB during multiple hospitalizations or prior to organ procurement. TB isolates of two organ recipients and a close contact of the donor had identical TB genotypes and closely related whole-genome sequencing results. Donors with risk factors for TB, in particular birth or residence in countries with a higher TB incidence, should be carefully evaluated for TB.

Isolation and characterization of violacein from an Antarctic Iodobacter: a non-pathogenic psychrotolerant microorganism.

Violacein is an intensely purple pigment synthesized by various genera of bacteria that has been discovered to have a wide range of interesting biological activities which range from anticarcinogenic to antibacterial. One of the hindrances for its real-life application is that the first microorganisms found to produce the compound may act as opportunistic pathogens. Here, we report the isolation and characterization of violacein from a non-pathogenic Antarctic Iodobacter strain. Its anti-microbial properties were also tested. The method proposed here for the purification of violacein shows high yields, indicating that this Antarctic microorganism could be a valuable source for this important pigment. This is the first characterization of violacein from an Antarctic Iodobacter strain and here we also present a viable method to obtain this pigment for potential biotechnological applications.

Differential Effects of Purinergic Signaling in Gastric Cancer-Derived Cells Through P2Y and P2X Receptors.

Gastric cancer (GC) is the one of the most prevalent cancers and one of the leading causes of cancer-induced deaths. Previously, we found that the expression of purinergic P2Y2 receptor (P2Y2R) is increased in GC samples as compared to adjacent healthy mucosa taken from GC-diagnosed patients. In this work, we studied in detail purinergic signaling in the gastric adenocarcinoma-derived cell lines: AGS, MKN-45, and MKN-74, and compared them to a nontumoral epithelial cell line: GES-1. In GC-derived cells, we detected the expression of several purinergic receptors, and found important differences as compared to GES-1 cells. Functional studies revealed a strong contribution of P2Y2Rs in intracellular calcium increases, elicited by adenosine-triphosphate (ATP), uridine-triphosphate (UTP), and the P2Y2R agonist MRS2768. Responses were preserved in the absence of extracellular calcium and inhibited by P2Y2R antagonists. In GES-1 cells, ATP and UTP induced similar responses and the combination of P2X and P2Y receptor antagonists was able to block them. Proliferation studies showed that ATP regulates AGS and MKN-74 cells in a biphasic manner, increasing cell proliferation at 10-100 µM, but inhibiting at 300 µM ATP. On the other hand, 1-300 µM UTP, a P2Y2R agonist, increased concentration-dependent cell proliferation. The effects of UTP and ATP were prevented by both wide-range and specific purinergic antagonists. In contrast, in GES-1 cells ATP only decreased cell proliferation in a concentration-dependent manner, and UTP had no effect. Notably, the isolated application of purinergic antagonists was sufficient to change the basal proliferation of AGS cells, indicating that nucleotides released by the cells can act as paracrine/autocrine signals. Finally, in tumor-derived biopsies, we found an increase of P2Y2R and a decrease in P2X4R expression; however, we found high variability between seven different biopsies and their respective adjacent healthy gastric mucosa. Even so, we found a correlation between the expression levels of P2Y2R and P2X4R and survival rates of GC patients. Taken together, these results demonstrate the involvement of different purinergic receptors and signaling in GC, and the pattern of expression changes in tumoral cells, and this change likely directs ATP and nucleotide signaling from antiproliferative effects in healthy tissues to proliferative effects in cancer.

First Detection of TR34 L98H and TR46 Y121F T289A Cyp51 Mutations in Aspergillus fumigatus Isolates in the United States.

Azole resistance in Aspergillus fumigatus is an increasing problem. The TR34 L98H and TR46 Y121F T289A mutations that can occur in patients without previous azole exposure have been reported in Europe, Asia, the Middle East, Africa, and Australia. Here, we report the detection of both the TR34 L98H and TR46 Y121F T289A mutations in confirmed A. fumigatus isolates collected in institutions in the United States. These mutations, other mutations known to cause azole resistance, and azole MICs are reported here.

Potentially-toxic and essential elements profile of AH1N1 patients in Mexico City.

During spring of 2009, a new influenza virus AH1N1 spread in the world causing acute respiratory illness and death, resulting in the first influenza pandemic since 1968. Blood levels of potentially-toxic and essential elements of 40 pneumonia and confirmed AH1N1 were evaluated against two different groups of controls, both not infected with the pandemic strain. Significant concentrations of potentially-toxic elements (lead, mercury, cadmium, chromium, arsenic) along with deficiency of selenium or increased Zn/Cu ratios characterized AH1N1 cases under study when evaluated versus controlled cases. Deficiency of selenium is progressively observed from controls I (influenza like illness) through controls II (pneumonia) and finally pneumonia-AH1N1 infected patients. Cases with blood Se levels greater than the recommended for an optimal cut-off to activate glutathione peroxidase (12.5 µg/dL) recovered from illness and survived. Evaluation of this essential element in critical pneumonia patients at the National Institutes is under evaluation as a clinical trial.

Absence of human papillomavirus sequences in epithelial breast cancer in a Mexican female population.

The role of human papillomavirus (HPV) in breast cancer is controversial. We evaluated 118 breast carcinomas and two paraffin-embedded tissues of lesions of the nipple of Mexican patients for HPV sequences. No carcinoma sample exhibited koilocytosis, in contrast to lesions of the nipple. We subjected purified DNAs to PCR employing two HPV16/E6 or GP5/6 primer set oligonucleotides. Results showed that HPV DNA sequences were absent in the breast tissues. Absence of HPV in breast carcinoma failed to support an association between HPV infection and this carcinoma.

Spatial and seasonal mercury distribution in the Ayapel Marsh, Mojana region, Colombia.

Geographical and temporal changes of total mercury (T-Hg) concentrations in sediments, macrophytes and fish were evaluated in the Ayapel Marsh, Mojana, Colombia. Sampling was conducted during 2006-2007, including both rainy and dry seasons, and T-Hg was measured using atomic absorption spectroscopy. Distribution of T-Hg in sediments and the macrophyte Eichhornia crassipes showed that higher concentrations were found along the flooding pathway of the Cauca River. Hg has also polluted the food chain. Highest T-Hg concentrations in fish were detected for the carnivorous Pseudoplatystoma fasciatun (0.432 ± 0.107 µg/g, fresh weight [fw]), and lowest in the non-carnivorous Prochilodus magdalenae (0.143 ± 0.053 µg/g, fw), with differences between trophic levels. T-Hg for fish samples (0.298 ± 0.148 µg/g, fw) did not exceed the limit consumption level (0.50 µg/g, fw). It is concluded that mercury-polluted sediments from the Cauca River, contribute to Hg deposition into the Ayapel Marsh. Accordingly, interventions must be conducted to decrease Hg accumulation in fish.

Reducing falls in a Definitive Observation Unit: an evidence-based practice institute consortium project.

Fall prevention poses a major challenge to healthcare personnel. Fall prone patients must be accurately identified and staff must adhere to evidence-based practices that have distinct value for preventing falls. This article describes a Definitive Observation Unit (DOU) and its evidence-based fall-prevention protocol based on nationally recognized standards. Despite the adoption of the protocol, fall occurrence rates remained above California Nursing Outcomes Coalition benchmarks. There were variations among nurses, physicians and physical therapists in regard to the value of fall prevention program components such as pre-formatted orders, physical therapy referrals and documentation. This authors report results of a study using an evidence-based practice (EBP) framework for evaluating an interdisciplinary, multifactorial fall prevention protocol. Results indicated that staff champions and resources are essential elements for changing practices that are vital to fall reduction.

[The PQQ-dehydrogenases. A novel example of bacterial quinoproteins]. / Las PQQ-deshidrogenasas. Un novedoso ejemplo de quinoproteínas bacterianas.

The word "quinoprotein" describes four groups of different enzymes which have cofactors containing o-quinones. Pyrrolo-quinoline quinone (PQQ) is not covalently attached. PQQ is the cofactor of several quinoprotein bacterial dehydrogenases including glucose dehydrogenase (G-DH), alcohol dehydrogenase (A-DH) and aldehyde dehydrogenase (AL-DH). These dehydrogenases are located in the periplasm of Gram-negative bacteria. This report summarises the structural properties of quinoprotein dehydrogenases, such as the biological functions and biotechnological aspects more important.