Increasing incidence of Clostridium difficile infections: results from a 5-year retrospective study in a large teaching hospital in the Italian region with the oldest population.

Limited information is available on the incidence of Clostridium difficile infections (CDIs) in Italian hospitals. In this study, we assessed the changes in the incidence of CDI over a 5-year period in a teaching hospital in Liguria, the Italian region with the oldest population. Secondary endpoints were the development of severe CDI and 30-day mortality. The annual incidence of CDI/10000 patient-days significantly increased from 0·54 in 2010 to 3·04 in 2014 (χ 2 for trend, P < 0·001). The median age of patients with CDI was 81 years. As many as 81% and 89% of these patients had comorbid conditions and previous exposure to antibiotics, respectively. In the multivariate analysis of risk factors for severe CDI, previous therapy with histamine 2 blockers and low serum albumin were associated with severe CDI, while diabetes appeared to be protective. In the multivariate model of risk factors for 30-day mortality, high leukocyte count, low serum albumin, and increased serum creatinine were unfavourably associated with outcome. Strict adherence to infection control measures was of utmost importance to counteract the increasing incidence of CDI in our hospital, particularly because of the advanced age of the patients and their very high frequency of chronic conditions and use of antibiotics, which readily predispose them to the development of CDI.

Jejunal arteriovenous malformation and multiple acquired extrahepatic portosystemic shunts in a juvenile dog, presenting with melena.

A juvenile dog referred with a 1-month history of persistent melena and severe anaemia, was diagnosed with a jejunal arteriovenous malformation, and multiple acquired extrahepatic portosystemic shunts. A midline coeliotomy was performed, the jejunal arteriovenous malformation was localised intraoperatively and was successfully removed via an enterectomy. Histopathology confirmed a true arteriovenous malformation. Despite the initial improvement, the patient developed seizure episodes secondary to hepatic encephalopathy 8 months after surgery. Fifteen months after surgery, the owner opted for euthanasia due to the ongoing seizure episodes. Post-mortem histologic examination of the liver showed features consistent with portal vein hypoplasia. A congenital arteriovenous malformation should be considered as a differential diagnosis in juvenile patients with a chronic history of haemorrhage from the gastrointestinal tract. In addition, acquired portosystemic shunts may occur in patients with portal vein hypoplasia and jejunal arteriovenous malformations.

Clinical presentation, treatment and outcome in 31 dogs with presumed primary colorectal lymphoma (2001-2013).

The objective of this multicentre retrospective study was to describe clinical presentation, treatment and outcome and to determine prognostic factors for dogs with presumed primary colorectal lymphoma (PCRL). A total of 31 dogs were included. The predominant features of PCRL were high grade (n = 18) and immunophenotype B (n = 24). Most dogs were substage b (n = 25) with higher prevalence of haematochezia (n = 20). One dog had surgery only. Thirty dogs received chemotherapy; amongst them 13 had surgery or radiotherapy. Progression free survival (PFS) was 1318 days and disease-related median survival time (MST) was 1845 days. Fourteen dogs were alive at the end of the study with a median follow-up time of 684 days (3-4678 days). Younger dogs had longer PFS (P = 0.031) and disease-related MST (P = 0.01). Presence of haematochezia corresponded with longer PFS (P = 0.02). Addition of local treatment to chemotherapy did not significantly improve the outcome (P = 0.584). Canine PCRL has considerably longer PFS and MST than other forms of non-Hodgkin's lymphoma.

Topical nonsteroidal anti-inflammatory drugs in uncomplicated cataract surgery: effect of sodium naproxen.

PURPOSE: To investigate whether topical nonsteroidal antiinflammatory drugs (NSAIDs) are useful, in the absence of concomitant corticosteroid therapy, in limiting postoperative inflammation after uncomplicated cataract surgery. METHODS: A total of 328 patients were enrolled in a prospective, randomized, double-masked, parallel-group, active-controlled study. Anterior chamber inflammation (ACI) was evaluated as the primary efficacy parameter. Only patients with moderate inflammation (ACI score of < or =4) the day after surgery were randomized and treated with NSAIDs. A novel topical formulation containing 0.2% sodium naproxen was compared with 0.1% diclofenac. Both were administered three times a day for 14 consecutive days. Ocular inflammation was measured after 7 and 14 days by using slit-lamp biomicroscopy. Safety parameters were also evaluated at the same time. RESULTS: Both treatments were equally effective in controlling postsurgical inflammation. No statistically significant differences between treatment groups were observed for the safety variables. No serious adverse events (AEs) occurred during the course of the study. The most frequent AE reported with naproxen was eye redness. CONCLUSIONS: NSAIDs can effectively be used without concurrent administration of corticosteroids to control postoperative inflammation after uncomplicated cataract surgery. In addition, naproxen ophthalmic solution may be considered a suitable alternative to the currently available NSAIDs.

[Streptococcus agalactiae in pregnant women. Prevalence at the Posadas Hospital]. / Streptococcus agalactiae en embarazadas. Prevalencia en el Hospital Nacional Alejandro Posadas.

Streptococcus agalactiae (Lancefield group B Streptococcus), is the most frequent microorganism involved in neonatal infections through the mother-fetus vertical transmission. It is also responsible for infections in pregnant women, and adults with underlying diseases. The objective of this work was to know the S. agalactiae carrier prevalence in pregnant women who attended to Posadas Hospital, and to study the susceptibility pattern of the isolates to penicillin, erythromycin and clindamycin. From 1203 pregnant women studied, S. agalactiae was recovered in 113, which means a prevalence of 9.39%. Antimicrobial susceptibility was tested to 87 isolates. All of them were susceptible to penicillin, and only 2 isolates were resistant to erythromycin and clindamycin (constitutive MLS mechanism). We emphasize the importance of knowing these last resistance, in the case of beta-lactam antibiotics allergic women.

Primary penile adenocarcinoma with concurrent hypercalcaemia of malignancy in a dog.

A 13-year-old male neutered Siberian husky crossbreed dog was presented with a 3-week history of haematuria and penile swelling. Clinical examination and computed tomography demonstrated a soft-tissue mass located at the base of the penis without signs of other primary tumours or metastasis. Clinicopathological findings revealed paraneoplastic hypercalcaemia. Fine-needle aspiration cytology of the mass suggested an epithelial tumour with several criteria of malignancy present. Following surgical excision of the mass, the hypercalcaemia resolved. Histopathology and immunohistochemistry revealed features consistent with an adenocarcinoma. Despite thorough examination, no perineal or anal sac tumour was found. To the authors' knowledge, this is the first reported case of a penile adenocarcinoma with hypercalcaemia of malignancy.

Predicting Outcome in dogs with Primary Immune-Mediated Hemolytic Anemia: Results of a Multicenter Case Registry.

BACKGROUND: Outcome prediction in dogs with immune-mediated hemolytic anemia (IMHA) is challenging and few prognostic indicators have been consistently identified. OBJECTIVES: An online case registry was initiated to: prospectively survey canine IMHA presentation and management in the British Isles; evaluate 2 previously reported illness severity scores, Canine Hemolytic Anemia Score (CHAOS) and Tokyo and to identify independent prognostic markers. ANIMALS: Data from 276 dogs with primary IMHA across 10 referral centers were collected between 2008 and 2012. METHODS: Outcome prediction by previously reported illness-severity scores was tested using univariate logistic regression. Independent predictors of death in hospital or by 30-days after admission were identified using multivariable logistic regression. RESULTS: Purebreds represented 89.1% dogs (n = 246). Immunosuppressive medications were administered to 88.4% dogs (n = 244), 76.1% (n = 210) received antithrombotics and 74.3% (n = 205) received packed red blood cells. Seventy-four per cent of dogs (n = 205) were discharged from hospital and 67.7% (n = 187) were alive 30-days after admission. Two dogs were lost to follow-up at 30-days. In univariate analyses CHAOS was associated with death in hospital and death within 30-days. Tokyo score was not associated with either outcome measure. A model containing SIRS-classification, ASA classification, ALT, bilirubin, urea and creatinine predicting outcome at discharge was accurate in 82% of cases. ASA classification, bilirubin, urea and creatinine were independently associated with death in hospital or by 30-days. CONCLUSIONS AND CLINICAL IMPORTANCE: Markers of kidney function, bilirubin concentration and ASA classification are independently associated with outcome in dogs with IMHA. Validation of this score in an unrelated population is now warranted.

Survey of the levels of antimicrobial resistance in Argentina: WHONET program--1991 to 1994.

The World Health Organization has implemented an international program of antibiotic resistance survey, called WHONET, with the participation of 121 laboratories from 41 countries around the world. Argentina joined WHONET program in 1989. Five hospitals from Buenos Aires are taking part, under the coordination of the National Institute of Microbiology 'Dr. C. Malbran'. From the results obtained between 1991 and 1994, the low level of susceptibility to aminopenicillins, cephalosporins and aminoglycosides is remarkable. On the other hand, vancomycin-resistant Enterococcus spp. and Staphylococcus spp. have not been detected and imipenem resistance in Pseudomonas aeruginosa, and Acinetobacter spp. isolates has not overcome 7% and 11%, respectively. Analytical programs utilizing these data aid in the understanding of the epidemiology of antibiotic resistance and in the development of rational antibiotic prescription practices and infection control procedures.

[Experimental model of infection of Helicobacter pylori in the mouse. A study of gastric damage caused by indomethacin]. / Modelo experimental de infección por Helicobacter pylori en el ratón. Estudio del daño gástrico producido por indometacina.

INTRODUCTION: The action of non-steroidal anti-inflammatory drugs (NSAIDs) on the Helicobacter Pylori (Hp) infected mucosa is a matter of debate. Some authors consider them to cause additive iatrogeny whilst others attribute a purportedly protective action to them. The development of on experimental animal model could help clarify this phenomenon. OBJECTIVES: 1--To develop an animal model of Hp gastric infection. 2--To evaluate the aggressiveness of NSAIDs in this model. MATERIALS AND METHODS: Male 6 month old BALC/C mice weighing 38 g were studied. Pylori Hp infection was ruled out. On three occasions, in the same week, 18 mice were inoculated intra-gastrically with 0.6 ml of Hp culture broth (brain-heart infusion) containing 1 x 10 8-1 x 10 9 CFU/ml. Another group of mice were inoculated with sterile saline. After two months the mice were killed and their stomachs studied. They were divided into groups: a) 6 Hp negative control mice. b) 8 Hp negative mice with prior intra-peritoneal injection of 25 mg/Kg indomethacin (24 hs.) c) 8 mice inoculated with Hp with indomethacin. d) 8 mice inoculated with Hp, without indomethacin. The stomachs were opened along the greater curvature and photographed macroscopically in order to map the necrotic area. The antrums were biopsied to test for urease and separate antrum and body specimens were send for staining with Warthin-Starry H & B and histopathology. RESULTS: All the mice inoculated with Hp acquired the infection. The necrotic area was larger in Group B: 55.5 +/- 7.87 mm than in Group C: 15 +/- 1.82 mm P < 0.00019. HISTOLOGY: Group A: normal mucosa. Group B: extensive coagulation necrosis and focal erosions. Group C: ulcers with inflammatory infiltrate and smaller necrotic area, presence of Hp on the surface epithelium. Group D: no ulcers, Hp present. CONCLUSION: An animal model of Hp infection was successfully developed Hp infection could play a potentially protective role against indomethacin aggression in the mouse.

[Acute and chronic diarrhea in AIDS: study of 435 (HIV+) patients, in Buenos Aires]. / Diarrea aguda y crónica en SIDA: estudio de 435 pacientes HIV(+), en Buenos Aires.

OBJECTIVE: Assessment of the rate of Diarrhoea in an infected HIV population of our medium. Assessment of its etiology, risk factors and response to treatment in both presentation of disease (Acute and chronic). DESIGN: This is a retrospective analysis of HIV and/or AIDS patients and diarrhea. The analytic points were: the clinical pattern of diarrhea (acute or chronic), risk factors, age, sex, etiology, stage of the disease, and response rate to treatment. PLACE: Hospital Prof. A. Posadas, that is situated in the greater Buenos Aires, and that functions as a referral centre for AIDS patients. PATIENTS AND METHODS: 435 case records that were followed up through June 1987/ March 1994 were reviewed; 109 of the total number suffered from diarrhea. RESULTS: The rate of diarrhoea in the studied population was 25% (109/435). This represented the first symptom of HIV infection in 18.3% of the patients (20/109), 49% had acute diarrhea and 51% had chronic diarrhea. An etiologic agent was established in 52.3% of the chronic diarrhoeas and in the 17.7% of the acute ones, with a 35.4% of a global isolation when basic stool test were made. Sixty three percent of the patients with chronic diarrhoea were in stage IV of HIV infection. The 78.3% of the acute diarrhoeas and 46% of the chronic ones were responsive to specific or symptomatic treatment. CONCLUSIONS: HIV antibodies determinations should be included in the study protocol of diarrhea, especially in young patients. Chronic diarrhea could be related to final stages of the disease, with lower response to treatment. Endoscopy studies should be useful when the stool tests are negative, specially in the Cytomegalovirus (CMV) and Mycobacterium complex avium intracellulare (MAI) search.

Proteinuria in canine patients with lymphoma.

OBJECTIVES: To determine if proteinuria is more common in dogs with lymphoma when compared with healthy dogs and to assess the severity and frequency of proteinuria in dogs with lymphoma. METHODS: Determination of urine protein:creatinine ratio in 32 dogs with lymphoma compared with 30 healthy dogs. RESULTS: Canine patients with lymphoma are more likely to be proteinuric compared with healthy dogs. Proteinuria is common in dogs with lymphoma, although in most cases it is not severe. The presence of proteinuria is not linked with the stage or substage of lymphoma. CLINICAL SIGNIFICANCE: Mild proteinuria is a common finding in dogs with lymphoma. The clinical impact of the proteinuria is probably low.

Dexamethasone-netilmicin: a new ophthalmic steroid-antibiotic combination. Efficacy and safety after cataract surgery.

PURPOSE: The purpose of this study was to evaluate both efficacy and safety of a new ophthalmic steroid-antibiotic fixed combination containing dexamethasone and netilmicin in the postsurgical management of cataract surgery. METHODS: In total, 223 patients were randomly treated with dexamethasone 1 mg/ml plus netilmicin 3 mg/ml (n=148), or dexamethasone 1 mg/ml plus tobramycin 3 mg/ml (n=75, TOBRADEX) four times in a day for 7+/-1 days starting immediately after surgery. Efficacy (anterior chamber (AC) inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia and tearing) and safety (burning, stinging, blurred vision, intraocular pressure, and visual acuity) were analysed in the operated eye after 1 and 7+/-1 days. A follow-up visit was performed at day 14+/-2. The extent of AC inflammation, measured by slit-lamp according to a standard scoring system, was used as primary efficacy parameter. RESULTS: At the primary end point (day 7) both fixed combinations were equally effective in reducing postoperative inflammation. The safety profile of the dexamethasone/netilmicin combination was excellent with no evidence of poor local tolerance or adverse reaction. CONCLUSIONS: A new fixed combination of dexamethasone and netilmicin was effective and safe in controlling ocular inflammation after cataract surgery.

Topical nonsteroidal anti-inflammatory drugs in uncomplicated cataract surgery: Effect of sodium naproxen.

PURPOSE: To investigate whether topical nonsteroidal antiinflammatory drugs (NSAIDs) are useful, in the absence of concomitant corticosteroid therapy, in limiting postoperative inflammation after uncomplicated cataract surgery. METHODS: A total of 328 patients were enrolled in a prospective, randomized, double-masked, parallel-group, active-controlled study. Anterior chamber inflammation (ACI) was evaluated as the primary efficacy parameter. Only patients with moderate inflammation (ACI score of <=4) the day after surgery were randomized and treated with NSAIDs. A novel topical formulation containing 0.2% sodium naproxen was compared with 0.1% diclofenac. Both were administered three times a day for 14 consecutive days. Ocular inflammation was measured after 7 and 14 days by using slit-lamp biomicroscopy. Safety parameters were also evaluated at the same time. RESULTS: Both treatments were equally effective in controlling postsurgical inflammation. No statistically significant differences between treatment groups were observed for the safety variables. No serious adverse events (AEs) occurred during the course of the study. The most frequent AE reported with naproxen was eye redness. CONCLUSIONS: NSAIDs can effectively be used without concurrent administration of corticosteroids to control postoperative inflammation after uncomplicated cataract surgery. In addition, naproxen ophthalmic solution may be considered a suitable alternative to the currently available NSAIDs. (Eur J Ophthalmol 2005; 15: 598-606).

Topical naproxen sodium for inhibition of miosis during cataract surgery. Prospective, randomized clinical trials.

PURPOSE: To assess corneal penetration of naproxen sodium and its efficacy in maintaining intraoperative mydriasis during cataract surgery. METHODS: Two double blind studies have been performed comparing the efficacy of naproxen ophthalmic solution to that of placebo or diclofenac in inhibiting pre-operative miosis. Study No. 1 was a placebo-controlled study and involved 194 patients undergoing extracapsular cataract extraction. Study No. 2 was an active-controlled study (vs diclofenac) concerning 214 patients undergoing phacoemulsification. In both studies treatment started the day before surgery. A balanced salt solution containing adrenaline was used in all patients. Pupil size was measured prior to the corneal section and at the end of surgery. An aqueous humor sample was taken immediately before corneal incision in a subset of 20 patients to measure naproxen aqueous concentration. RESULTS: In both studies the pupillary diameter decreased during surgery within each treatment group in a statistically significant manner (P < 0.001). Naproxen was more effective than placebo (P < 0.01) and as effective as diclofenac in controlling pupil diameter regression during cataract. Mean concentration level of naproxen in the aqueous humor was 372.3 ng/ml. CONCLUSIONS: Naproxen sodium ophthalmic solution penetrates the cornea and it is effective in maintaining intraoperative mydriasis.

Comparison of hypotonic and isotonic solutions containing sodium hyaluronate on the symptomatic treatment of dry eye patients.

This study was designed to compare the efficacy of two artificial tears both containing hyaluronic acid but differing in their osmolarity. A multicentric double-masked, crossover clinical trial was performed in which 158 subjects were randomized to receive either hypotonic or isotonic artificial tears up to 6 times a day. Both treatments were effective in improving signs and symptoms to a similar extent. No adverse events were reported. It was concluded that hypotonic and isotonic eye drops are comparable for the symptomatic treatment of patients suffering from dry eye syndrome.

Streptococcus agalactiae en embarazadas. Prevalencia en el Hospital Nacional Alejandro Posadas / [Streptococcus agalactiae in pregnant women. Prevalence at the Posadas Hospital]

Streptococcus agalactiae (Lancefield group B Streptococcus), is the most frequent microorganism involved in neonatal infections through the mother-fetus vertical transmission. It is also responsible for infections in pregnant women, and adults with underlying diseases. The objective of this work was to know the S. agalactiae carrier prevalence in pregnant women who attended to Posadas Hospital, and to study the susceptibility pattern of the isolates to penicillin, erythromycin and clindamycin. From 1203 pregnant women studied, S. agalactiae was recovered in 113, which means a prevalence of 9.39

. Antimicrobial susceptibility was tested to 87 isolates. All of them were susceptible to penicillin, and only 2 isolates were resistant to erythromycin and clindamycin (constitutive MLS mechanism). We emphasize the importance of knowing these last resistance, in the case of beta-lactam antibiotics allergic women.

Modelo experimental de infeccion por Helicobacter pylori en el raton. Estudio del dano gastrico producido por indometacina / Experimental model of infection of Helicobacter pylori in the mouse. A study of gastric damage caused by indomethacin

INTRODUCTION: The action of non-steroidal anti-inflammatory drugs (NSAIDs) on the Helicobacter Pylori (Hp) infected mucosa is a matter of debate. Some authors consider them to cause additive iatrogeny whilst others attribute a purportedly protective action to them. The development of on experimental animal model could help clarify this phenomenon. OBJECTIVES: 1--To develop an animal model of Hp gastric infection. 2--To evaluate the aggressiveness of NSAIDs in this model. MATERIALS AND METHODS: Male 6 month old BALC/C mice weighing 38 g were studied. Pylori Hp infection was ruled out. On three occasions, in the same week, 18 mice were inoculated intra-gastrically with 0.6 ml of Hp culture broth (brain-heart infusion) containing 1 x 10 8-1 x 10 9 CFU/ml. Another group of mice were inoculated with sterile saline. After two months the mice were killed and their stomachs studied. They were divided into groups: a) 6 Hp negative control mice. b) 8 Hp negative mice with prior intra-peritoneal injection of 25 mg/Kg indomethacin (24 hs.) c) 8 mice inoculated with Hp with indomethacin. d) 8 mice inoculated with Hp, without indomethacin. The stomachs were opened along the greater curvature and photographed macroscopically in order to map the necrotic area. The antrums were biopsied to test for urease and separate antrum and body specimens were send for staining with Warthin-Starry H & B and histopathology. RESULTS: All the mice inoculated with Hp acquired the infection. The necrotic area was larger in Group B: 55.5 +/- 7.87 mm than in Group C: 15 +/- 1.82 mm P < 0.00019. HISTOLOGY: Group A: normal mucosa. Group B: extensive coagulation necrosis and focal erosions. Group C: ulcers with inflammatory infiltrate and smaller necrotic area, presence of Hp on the surface epithelium. Group D: no ulcers, Hp present. CONCLUSION: An animal model of Hp infection was successfully developed Hp infection could play a potentially protective role against indomethacin aggression in the mouse.