Enzyme-Triggered Transforming of Assembly Peptide-Modified Magnetic Resonance-Tuned Probe for Highly Sensitive Imaging of Bacterial Infection In Vivo.

Confirming bacterial infection at an early stage and distinguishing between sterile inflammation and bacterial infection is still highly needed for efficient treatment. Here, in situ highly sensitive magnetic resonance imaging (MRI) bacterial infection in vivo based on a peptide-modified magnetic resonance tuning (MRET) probe (MPD-1) that responds to matrix metallopeptidase 2 (MMP-2) highly expressed in bacteria-infected microenvironments is achieved. MPD-1 is an assembly of magnetic nanoparticle (MNP) bearing with gadolinium ion (Gd3+ ) modified MMP-2-cleavable self-assembled peptide (P1 ) and bacteria-targeting peptide (P), and it shows T2 -weighted signal due to the assemble of MNP and MRET ON phenomenon between MNP assembly and Gd3+ . Once MPD-1 accumulates at the bacterially infected site, P1 included in MPD-1 is cleaved explicitly by MMP-2, which triggers the T2 contrast agent of MPD-1 to disassemble into the monomer of MNP, leading the recovery of T1 -weighted signal. Simultaneously, Gd3+ detaches from MNP, further enhancing the T1 -weighted signal due to MRET OFF. The sensitive MRI of Staphylococcus aureus (low to 104 CFU) at the myositis site and accurate differentiation between sterile inflammation and bacterial infection based on the proposed MPD-1 probe suggests that this novel probe would be a promising candidate for efficiently detecting bacterial infection in vivo.

Agents and robots for collaborating and supporting physicians in healthcare scenarios.

Monitoring patients through robotics telehealth systems is an interesting scenario where patients' conditions, and their environment, are dynamic and unknown variables. We propose to improve telehealth systems' features to include the ability to serve patients with their needs, operating as human caregivers. The objective is to support the independent living of patients at home without losing the opportunity to monitor their health status. Application scenarios are several, and they spread from simple clinical assisting scenarios to an emergency one. For instance, in the case of a nursing home, the system would support in continuously monitoring the elderly patients. In contrast, in the case of an epidemic diffusion, such as COVID-19 pandemic, the system may help in all the early triage phases, significantly reducing the risk of contagion. However, the system has to let medical assistants perform actions remotely such as changing therapies or interacting with patients that need support. The paper proposes and describes a multi-agent architecture for intelligent medical care. We propose to use the beliefs-desires-intentions agent architecture, part of it is devised to be deployed in a robot. The result is an intelligent system that may allow robots the ability to select the most useful plan for unhandled situations and to communicate the choice to the physician for his validation and permission.

Infectious Disease Clinical Research Program: Building the Bench.

The role of physicians in the U.S. Armed Forces is diverse, encompassing a wide array of skills and responsibilities to provide superior healthcare to their patients and to advance military medicine. In addition to healthcare delivery and medical education, military physicians are engaged in public health, operational medicine, and cutting-edge medical research. Thus, clinical research is a crucial component of Graduate Medical Education (GME) and supports critical thinking (knowledge, skills, and abilities) and the development of leadership skills among U.S. military physicians. The Infectious Disease Clinical Research Program (IDCRP) education mission was established in 2005 with the overall goal of supporting the development and training of the next generation of clinical researchers in infectious diseases and related public health disciplines in the Armed Forces using several strategies, including didactic learning, mentored research, and research engagement. Through involvement in the IDCRP, infectious disease fellows, residents (e.g., surgical, internal medicine, and pediatrics), and Master of Public Health (MPH) students have continued their education and gained valuable skills related to clinical research. Trainees either conduct research with IDCRP mentors or participate in IDCRP-led practicum experiences, with research projects ranging from epidemiologic studies to microbiological assessments. Consistent with the needs of the Military Health System (MHS), and in accordance with Accreditation Council for Graduate Medical Education goals, the IDCRP provides opportunities for medical and graduate students, residents, and infectious disease fellows to conduct mentored research within the MHS, as well as gain important leadership skills in the conduct of clinical research. Overall, IDCRP continues to further infectious disease research through the support and education of the next generation of active-duty infectious disease researchers in the MHS.

Research Electronic Data Capture (REDCap®) used as an audit tool with a built-in database.

The aim of this study was to develop an audit tool with a built-in database using Research Electronic Data Capture (REDCap®) as part of an antimicrobial stewardship program at a regional hospital in the Central Denmark Region, and to analyse the need, if any, to involve more than one expert in the evaluation of cases of antimicrobial treatment, and the level of agreement among the experts. Patients treated with systemic antimicrobials in the period from 1 September 2015 to 31 August 2016 were included, in total 722 cases. Data were collected retrospectively and entered manually. The audit was based on seven flow charts regarding: (1) initiation of antimicrobial treatment (2) infection (3) prescription and administration of antimicrobials (4) discontinuation of antimicrobials (5) reassessment within 48 h after the first prescription of antimicrobials (6) microbiological sampling in the period between suspicion of infection and the first administration of antimicrobials (7) microbiological results. The audit was based on automatic calculations drawing on the entered data and on expert assessments. Initially, two experts completed the audit, and in the cases in which they disagreed, a third expert was consulted. In 31.9% of the cases, the two experts agreed on all elements of the audit. In 66.2%, the two experts reached agreement by discussing the cases. Finally, 1.9% of the cases were completed in cooperation with a third expert. The experts assessed 3406 flow charts of which they agreed on 75.8%. We succeeded in creating an audit tool with a built-in database that facilitates independent expert evaluation using REDCap. We found a large inter-observer difference that needs to be considered when constructing a project based on expert judgements. Our two experts agreed on most of the flow charts after discussion, whereas the third expert's intervention did not have any influence on the overall assessment.

Research on Modularized Design and Allocation of Infectious Disease Prevention and Control Equipment in China.

For the prevention and control of newly emergent or sudden infectious diseases, we built an on-site, modularized prevention and control system and tested the equipment by using the clustering analysis method. On the basis of this system, we propose a modular equipment allocation method and 4 applications of this method for different types of infectious disease prevention and control. This will help to improve the efficiency and productivity of anti-epidemic emergency forces and will provide strong technical support for implementing more universal and serialized equipment in China. (Disaster Med Public Health Preparedness. 2017;11:375-382).

Mobile infectious disease references: from the bedside to the beach.

Point-of-care access to current medical information is easily available to the practitioner through the use of smartphones, iPads, and other personal digital assistants. There are numerous mobile applications (apps) that provide easy-to-use and often well-referenced medical guidance for the infectious diseases practitioner. We reviewed 6 commonly utilized mobile apps available for handheld devices: the Emergency Medicine Residents' Association's (EMRA's) Antibiotic Guide, Epocrates Deluxe, Johns Hopkins Antibiotic Guide, Sanford Guide, the Medscape mobile app, and the Infectious Diseases Compendium. We evaluated several basic infectious diseases topics (including but not limited to endocarditis, vancomycin, and Acinetobacter infection) and attempted to objectively score them for metrics that would help the provider determine which mobile app would be most useful for his or her practice. The Johns Hopkins Antibiotic Guide and the Sanford Guide had the highest cumulative scores, whereas EMRA scored the lowest. We found that no single app will meet all of the needs of an infectious diseases physician. Each app delivers content in a unique way and would meet divergent needs for all practitioners, from the experienced clinician to the trainee. The ability to rapidly access trusted medical knowledge at the point of care can help all healthcare providers better treat their patients' infections.

El test de Tzanck en pacientes inmunocomprometidos: una metodología emergente y reemergente / The Tzanck test in immunocompromised patients: an emerging and re-emerging methodology

El test de Tzanck es un método útil para verificar la infección por Herpesvirus desmostrando la presencia de células gigantes multinucleadas (80% muestras de vesículas y 20% en úlceras). Sin embargo, esto puede cambiar en los inmunocomprometidos de manera dramática, donde las lesiones ulcerosas predominan. Conocer la eficacia del test de Tzanck como herramienta diagnóstica en pacientes inmunocomprometidos con lesiones dermatológicas úlcerosas y vesiculares, intentando rescatar esta técnica como un apoyo en la esfera diagnóstica. Estudio retrospectivo y comparativo basado en informes d laboratorio de la Unidad de Microbiología Médica del Centro Ortopédico Podológico, años 2005-2009 de pacientes a quienes se les practicó el test en muestra de secreción de úlceras y decapitación de vesículas, con algún tipo de diagnóstico de inmunocompromiso. Estudiamos 40 vesículas y 94 úlceras de 134 pacientes con diagnóstico de infección VIH/SIDA (34), neoplasias sólidas (60), diabetes mellitus (22) patologías autoinmunes (12) y probables leucemias (6). Predominaron las lesiones ulcerosas genitales seguidas por cavidad oral. El test de Tzanck fue positivo en 90/134 pacientes (67,16%), con diferencia estadísticamente significativas según el tipo de muestra (úlceras 76/94 vs. vesículas 14/40) (X² P< 0,001). No se demostraron diferencias estadísticamente significativas en el análisis de los subgrupos según tipo de inmunocompromiso. El test de Tzanck sigue siendo un método diagnóstico en lesiones ulcerosas de etiología viral en pacientes inmunocomprometidos y en lesiones vesiculares; además es una técnica diagnóstica fácil, económica y rápida.

Taznck`s test is a quick diagnostic method to corroborate Herpesvirus infection following demostration of multinucleate giant cells. Positivy is near 80% in vesicle samples, but as low as 20% in ulcer samples. To know Tzanck`s test ultility as a diagnostic method in immunocompromised patients with dermatological injuries as vesicles or ulcers, in order to rescue it as an emergence & re-emergence diagnostic technique. We studied the records of the Medical Microbiology Unit of the Centro Ortopédico Podológico between 2005-2009, selecting all immunocompromised patients in who Tzanck`s test was performed. 134 patients with 94 ulcers and 40 vesicles; with immunocompromise diagnosis as HIV/AIDS (34), solid tumors (60), diabetes mellitus (22), autoimmune diseases (12) and hematologic tumors (6). Genital lesions were positive in 90/134 patients (67,16%), with extremely statistical significance diference according to type of sample (76/94 ulcers vs. 14/40 vesicles) (X² P> 0,001). No statistical significance was observed when immnocompremised subgroup was analyzed. In immunocompromised patients, Tzanck`s test is an important method for differential diagnosis in suspected viral ulcers, and confirm diagnosis; it is cheap, fast & easy to perform.