Epidemiology, aetiology and clinical characteristics of clostridial bacteraemia: a 6-year population-based observational study of 386 patients.

The objective of this study is to provide a population-based clinical, epidemiological and microbiological overview of clostridial bacteraemia. All cases of bacteraemia in the Skåne Region between 2014 and 2019 with a species currently belonging to the Clostridium genus were identified in the regional clinical microbiology database. Clinical data were retrieved by medical chart-review. A total of 386 unique episodes of clostridial bacteraemia were found resulting in an incidence rate of 4.9/100.000 person-years. The median age was 76 with 56% males. The incidence rate ratio was 34.3 for those aged 80 + vs 0-59. The minimum inhibitory concentrations varied between species but were universally low for metronidazole and carbapenems. Malignancy was the most common co-morbidity, in 47% of patients and most pronounced for C. septicum. Criteria for sepsis and septic shock were met in 69% and 17%, respectively. The 28-day mortality was 26%. High age, absence of fever, high C-reactive protein and high SOFA-score were all significantly associated with mortality. We present the highest incidence rate of clostridial bacteraemia to date. Clostridial bacteraemia is a severe condition with acute onset, affecting elderly with co-morbidities, most pronounced malignancies. Mortality is related to acute manifestations rather than to background factors.

Pre-treatment health-related quality of life parameters have prognostic impact in patients >65 years with newly diagnosed mantle cell lymphoma: The Nordic Lymphoma Group MCL4 (LENA-BERIT) experience.

Mantle cell lymphoma (MCL) is a rare, often aggressive type of B-cell lymphoma with poor survival and no cure. Cancer and cancer treatment has a negative impact on health-related quality of life (HRQOL) both during active disease and in the long term, and improvement of HRQOL is a crucial objective of cancer therapy in older patients and no curative intent. Baseline HRQOL has in other lymphoma populations been shown to be predictive of outcome. Here, we explored HRQOL, and its association with survival, by the EORTC QLQ-C30 questionnaire, before, during and after chemotherapy in a patient cohort with MCL, treated within the NLG-MCL4 trial, designed to evaluate the addition of lenalidomide (LEN) to rituximab-bendamustine (R-B) as first-line treatment. Fifty-one patients were enrolled, median age was 71 years (range 62-84), 37 were men (73%). Pre-treatment HRQOL was similar to scores from the reference population with healthy individuals. During treatment, HRQOL deteriorated, but reverted to the same level as the reference population after treatment. There was a correlation between physical function (p = 0.001) and role function (p = 0.006) at baseline and WHO performance status, but not with other clinical or genetic prognostic factors. None of the baseline factors were predictive for treatment related to HRQOL in this cohort. Pre-treatment physical (p = 0.011) and role function (p = 0.032) were independent factors associated with overall survival, and physical function (p = 0.002) was also associated with progression free survival. These findings may possibly be used to design support during treatment and improve rehabilitation. Further investigations are needed for assessment of long-term HRQOL.

[Sepsis with intravascular hemolysis caused by Clostridium perfringens]. / Bakteriemi med C perfringens ­ ovanligt men livshotande tillstånd.

Clostridium perfringens is a gram-positive anaerobic rod commonly found in our natural environment as well as in human intestinal and vaginal microflora. Due to its production of several toxins it may cause numerous infections of varying degrees of severity. Bacteremia, albeit uncommon, is potentially lethal owing to the disruption of red blood cells leading to hemolysis and septic shock in which mortality is very high. Immunosuppression, malignancy and diabetes are the most common risk factors for developing bacteremia induced by C. perfringens.  The most effective treatment is most likely a combination of a beta-lactam antibiotic and clindamycin or metronidazole and, if possible, surgical drainage.  This case study presents a female 67-year old patient with undiagnosed diabetes who developed septic shock with massive intravascular hemolysis caused by C. perfringens. The status of the patient was rapidly deteriorating and death followed three hours after her arrival at the emergency department. An autopsy was performed during which a liver abscess was discovered and assessed to be the source of infection. Diabetes is a well-known risk factor for both liver abscess and C. perfringens infection.  Conclusively it can be stated that the combination of hemolysis and infection should lead to consideration of C. perfringens as the possible pathogen and thus immediate suitable antibiotic treatment must ensue.

Sepsis Incidence: A Population-Based Study.

BACKGROUND: Although sepsis is a major health problem, data on sepsis epidemiology are scarce. The aim of this study was to assess the incidence of sepsis, based on clinical findings in all adult patients treated with intravenous antibiotic in all parts of all hospitals in an entire population. METHODS: This is a retrospective chart review of patients ≥18 years, living in 2 regions in Sweden, who were started on an intravenous antibiotic therapy on 4 dates, evenly distributed over the year of 2015. The main outcome was the incidence of sepsis with organ dysfunction. The mean population ≥18 years at 2015 in the regions was 1275753. Five hundred sixty-three patients living in the regions were started on intravenous antibiotic treatment on the dates of the survey. Patients who had ongoing intravenous antibiotic therapy preceding the inclusion dates were excluded, if sepsis was already present. RESULTS: Four hundred eighty-two patients were included in the study; 339 had a diagnosed infection, of those, 96 had severe sepsis according to the 1991/2001 sepsis definitions, and 109 had sepsis according to the sepsis-3. This is equivalent to an annual incidence of traditional severe sepsis of 687/100000 persons (95% confidence interval [CI], 549-824) or according to the sepsis-3 definition of 780/100000 persons (95% CI, 633-926). Seventy-four patients had sepsis according to both definitions. CONCLUSIONS: The incidence of sepsis with organ dysfunction is higher than most previous estimates independent of definition. The inclusion of all inpatients started on intravenous antibiotic treatment of sepsis in a population makes an accurate assessment of sepsis incidence possible.

Dizzy - why not take a walk? Low level physical activity improves quality of life among elderly with dizziness.

BACKGROUND: Dizziness is a very common complaint. The frequency of dizziness increases with age. It affects quality of life negatively for older persons in several ways. OBJECTIVES: This study intended to investigate which variables (physical activity, loneliness, health complaints, need of help for daily living and falls) differed between those with and without dizziness and also to investigate which factors affected quality of life among older persons with dizziness. METHOD: An age-stratified, randomised sample of senior citizens - aged 75 or older - living in the south of Sweden (n = 4,360) answered a questionnaire concerning demographic data, social network, health complaints and diseases, feelings of loneliness, quality of life (Short Form 12), frequency of falls and activities. RESULTS: Dizziness was associated with an increased risk of falling. Falls in the last 3 months were reported in 31% of the subjects with dizziness compared to 15% among those without (p < 0.001). Dizziness also correlated with depression, with 42.5% feeling depressed among the elderly reporting dizziness as compared with 13.2%. Exercise, both light (i.e. go for a walk) or heavy (i.e. work in the garden), correlated with reduced risk of low quality of life among older, dizzy persons, both mental (light exercise OR 0.58; heavy OR 0.48) and physical (light OR 0.62; heavy OR 0.21). The proportion of dizzy persons doing light exercise was 75.6% versus 87.4% among the not dizzy (p < 0.001). Exercise reduces the risk of falling and the risk of being depressed, and increases quality of life. CONCLUSION: Even light exercise seems beneficial both for improving quality of life and to decrease the risk of falling, which in turn will lower the mortality rate. Older persons reporting dizziness should be encouraged and perhaps helped to exercise. If one could increase physical activity among the elderly, it would reduce the number of falls, diminish medical costs, suffering for the individual, and be of paramount medicosocial importance for society.

Dynamics, bifurcations and chaos in coupled lasers.

Experiments and numerical modelling on two different class B lasers that are subjected to external optical light injection are presented. This presentation includes ways of measuring the changes in the laser output, how to numerically describe the systems and how to construct diagrams of the dynamical states in the plane frequency detuning between lasers and injection strength. The scenarios for the semiconductor laser include an area of frequency locking and islands of chaotic behaviour embedded in and mixed with periodic doubling regimes. Using a rate equation model, the largest Lyapunov exponent is calculated as a measure of the stability of equilibriums and the amount of chaos in chaotic regimes. In the solid-state laser case, different dynamical regions were clearly observed. The found boundaries were identified experimentally, using an identification method, and numerically, from bifurcation analysis, as Hopf, saddle-node, period-doubling and torus bifurcations.

Modulation and the linewidth enhancement factor of a diode-pumped Nd:YVO4 laser.

A technique based on an FM/AM method is proposed for measuring the linewidth enhancement factor a of a diode-pumped Nd:YVO4 laser. A standard rate equation model is complemented with temperature effects to explain the observed behavior under pump modulation. The result alpha = 0.25 +/- 0.13 agrees with values deduced from recent optical injection experiments.

Assessment of leukotriene B4 production in leukocytes from horses with recurrent airway obstruction.

OBJECTIVE: To determine the ex vivo leukotriene (LT) biosynthesis in peripheral blood neutrophils (PBNs) and inflammatory cells in bronchoalveolar lavage fluid (BALF) obtained from horses affected with recurrent airway obstruction (RAO). ANIMALS: 6 RAO-affected and 6 control horses. PROCEDURES: Before and 6, 24, and 48 hours after stabling, disease severity was determined subjectively by clinical and mucus scores and measurement of the maximal change in pleural pressure (deltaPpl(max)); PBNs were isolated and BALF samples were examined cytologically. The PBN and BALF cells were activated with a calcium ionophore in the presence of arachidonic acid, and production of LTC4 and LTB4 was measured per 10(6) cells. RESULTS: Clinical and mucus scores and deltaPpl(max) increased during stabling in RAO-affected horses, but not in control horses. In neutrophils and BALF cells from both groups, production of LTB4 exceeded that of LTC4. At all times, LTB4 production by PBNs was less in RAO-affected horses than it was in control horses. Before stabling, LTB4 production by cells in BALF was low in RAO-affected horses, but increased considerably after 6 hours of stabling. This increase coincided with the migration of neutrophils into the airways. In control horses, production of LTB4 did not change during stabling. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested increased production of LTB4 in airways of RAO-affected horses, compared with control horses, that may contribute to the infiltration of neutrophils into the lungs and the sustained inflammation associated with RAO.

Evaluation of leukotriene biosynthetic capacity in lung tissues from horses with recurrent airway obstruction.

OBJECTIVE: To evaluate leukotriene (LT) biosynthetic capacity in lung tissue from healthy horses and horses with recurrent airway obstruction (RAO). SAMPLE POPULATION: Lung parenchyma and airway specimens from 8 RAO-affected and 5 healthy horses. PROCEDURE: Horses were stabled for > or = 72 hours. Blood was drawn before euthanasia, after which lung specimens were collected. Tissue strips from small airways and parenchyma were incubated in organ baths with the precursor LTA4 or stimulated with calcium ionophore A23187 or the tripeptide N-formyl-Met-Leu-Phe (fMLP), with or without exogenous arachidonic acid, in the presence of isolated blood neutrophils. RESULTS: Stabling induced typical clinical signs of airway obstruction in RAO-affected horses but not control horses. When lung parenchyma or airway specimens from both groups of horses were incubated with calcium ionophore, with or without arachidonic acid, they did not form LT. In contrast, addition of LTA4 to both tissues resulted in conversion to LTB4, although concentrations of LTC4 were negligible in airways and parenchymal strips from healthy and RAO-affected horses. Incubation of airway and parenchymal strips with suspensions of autologous neutrophils did not influence formation of LT stimulated by calcium ionophore or fMLP, with or without exogenous arachidonic acid. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that lung parenchyma and airway tissues themselves are not of substantial importance for LT formation in the lungs, although these tissues possessed some LTA4 hydrolase activity, enabling LTB4 formation. It may be speculated that LTB4 originates primarily from neutrophils and may play a role in the inflammatory events of RAO.