Yellow-Cedar, Callitropsis (Chamaecyparis) nootkatensis, Secondary Metabolites, Biological Activities, and Chemical Ecology.

Yellow-cedar, Callitropsis nootkatensis, is prevalent in coastal forests of southeast Alaska, western Canada, and inland forests along the Cascades to northern California, USA. These trees have few microbial or animal pests, attributable in part to the distinct groups of biologically active secondary metabolites their tissues store for chemical defense. Here we summarize the new yellow-cedar compounds identified and their biological activities, plus new or expanded activities for tissues, extracts, essential oils and previously known compounds since the last review more than 40 years ago. Monoterpene hydrocarbons are the most abundant compounds in foliage, while heartwood contains substantial quantities of oxygenated monoterpenes and oxygenated sesquiterpenes, with one or more tropolones. Diterpenes occur in foliage and bark, whereas condensed tannins have been isolated from inner bark. Biological activities expressed by one or more compounds in these groups include fungicide, bactericide, sporicide, acaricide, insecticide, general cytotoxicity, antioxidant and human anticancer. The diversity of organisms impacted by whole tissues, essential oils, extracts, or individual compounds now encompasses ticks, fleas, termites, ants, mosquitoes, bacteria, a water mold, fungi and browsing animals. Nootkatone, is a heartwood component with sufficient activity against arthropods to warrant research focused toward potential development as a commercial repellent and biopesticide for ticks, mosquitoes and possibly other arthropods that vector human and animal pathogens.

Effect of plant sterols and tannins on Phytophthora ramorum growth and sporulation.

Elicitin-mediated acquisition of plant sterols is required for growth and sporulation of Phytophthora spp. This study examined the interactions between elicitins, sterols, and tannins. Ground leaf tissue, sterols, and tannin-enriched extracts were obtained from three different plant species (California bay laurel, California black oak, and Oregon white oak) in order to evaluate the effect of differing sterol/tannin contents on Phytophthora ramorum growth. For all three species, high levels of foliage inhibited P. ramorum growth and sporulation, with a steeper concentration dependence for the two oak samples. Phytophthora ramorum growth and sporulation were inhibited by either phytosterols or tannin-enriched extracts. High levels of sterols diminished elicitin gene expression in P. ramorum; whereas the tannin-enriched extract decreased the amount of 'functional' or ELISA-detectable elicitin, but not gene expression. Across all treatment combinations, P. ramorum growth and sporulation correlated strongly with the amount of ELISA-detectable elicitin (R (2) = 0.791 and 0.961, respectively).

Evolution and associated factors of hand hygiene compliance in a pediatric tertiary hospital.

BACKGROUND: The objective is to know the evolution of the Degree of Compliance with Recommendations (DCR) on hand hygiene (HH) and its associated factors in the pediatric care areas (PCAs) of a tertiary hospital. METHODS: Observational, cross-sectional study, repeated over time, with direct observation of the DCR on HH during the daily activity of health care workers. Over 13 years, 9226 HH opportunities were observed. Associations between DCR, PCA and other variables (eg, age, sex, and professional position) were examined using χ² and adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: DCR on HH in 9 PCAs was 64.3% (95% CI, 63.3-65.3), and in the group of non-pediatric areas it was 49.6% (95% CI, 49.1-50.1). The areas with the highest degree of compliance were Oncology 72.8% (95% CI, 69.2-76.4), Neonatology 73.2% (95% CI, 71.3-75.1), and Neonatal intensive care unit 70.0% (95% CI, 67.5-72.6). These were the areas with the strongest association with HH compliance, with aOR:2.8 (95% CI, 2.2-3.6); aOR, 3.0 (95% CI, 2.6-3.6) aOR:2.6 (95% CI, 2.1-3.1), respectively. Other associated factors were the indications "after an activity," aOR, 1.6 (95% CI, 1.5-1.8) and the availability of pocket-size alcohol-based solution, aOR, 2.1(95% CI, 1.9-2.3). CONCLUSIONS: The DCR on HH in PCAs is higher than in other areas, although there is still margin for improvement. We have identified modifiable factors that have an independent association with HH compliance in PCAs. Focusing on modifiable factors will increase compliance with HH with the ultimate goal of reducing healthcare associated infections.

Hematological, immunological and neurochemical effects of chronic amphetamine treatment in male rats.

In the present study, we have analyzed the effect of chronic amphetamine sulfate (AMPH) treatment on haematological, immunological and neurochemical parameters in the male rat. AMPH increased the total peripheral leukocyte count, and altered its differential counts, decreasing lymphocytes and increasing neutrophils. Flow cytometry study showed that the decline in circulating lymphocytes was caused by the loss of a particular lymphocyte subset, B-cell, which reduced both in percentage and in absolute number by 50%. T-cell population increased by 15% but not in absolute number, however there was no difference in either CD4+ or CD8+ T lymphocyte subsets between experimental groups. Neurochemically, AMPH reduced norepinephrine (NE) and serotonin (5-HT) contents in the hypothalamus and increased dopamine (DA) content in the striatum. Chronic AMPH increased in a dose-dependent manner serum corticosterone levels, had no effect on circulating catecholamines, reduced adrenal weights, and did not affect spleen weights although reduced their cellularities. These results show that chronic AMPH have important effects on immune function, particularly on humoral immune response because it reduced the circulating B cell population by half. In addition, AMPH plays an important role in the redistribution and trafficking of leukocytes, and both effects seem to be mediated by sympathetic innervation of the lymphoid organs.

[Evolution of treatment of syphilis through history]. / Evolución del tratamiento de la sífilis a lo largo de la historia.

In this article, we present a historical revision of syphilis treatment since the end of the XV century up until the current days. For centuries, it was understood that syphilis had been brought to Spain by Columbus after coming back from America. It became an epidemic soon after. Later on, it was spread all over Europe. The chronologic and geographic origin of this illness have been debated in recent years, however, there has been no agreement about it as yet. Mercury was the main used therapy for four and a half centuries, until the discovery of penicillin in 1943. This discovery changed the therapeutic approach to syphilis since then. Other remedies were used during this period. Guaiacum was one of them, but it was dismissed in the mid-sixteenth century. Iodides were also used, especially in the tertiary symptoms of the disease. The discovery of arsphenamine (Salvarsan) at the beginning of the XX century, used by itself at its onset and associated to mercury or bismuth later on, was a significant therapeutic contribution. Bismuth was in itself a great therapeutic asset. It displaced the use of mercury in an important way until 1943, when the appearance of penicillin became the treatment of choice.

Physiological and metabolic responses in newborn piglets associated with the birth order.

The objective of this study was to evaluate the effect of birth order on the physiological and metabolic responses of the newborn piglet the first hours after birth. A total of 281 randomly selected newborn piglets were included, classified according to birth order in 12 groups (L1-L12). The expulsion interval, neonatal vitality, latency in connecting to the maternal teat and physiological profile were recorded for each piglet. The number of piglets born alive and dead was also recorded. The blood gases, electrolytes and glucose levels of the neonates were obtained by means of an automatic blood gas and electrolyte analyzer. Groups L1, L2, L11, and L12 had the least score on the vitality scale, the longest expulsion intervals, and longest latency to connect with the maternal teat, as well as greater physiological alterations (hyperglycemia, hyperlactatemia and hypercapnia) compared to groups L4 to L9. Likewise, type-II stillbirths only occurred in the first and last quarter of the birth order of the litter. In conclusion, piglets born in the first and last quarter of the birth order of the litter had a greater risk of having physiological and behavioral alterations during farrowing.

Long-term fluctuation of standard automatic perimetry, pulsar perimetry and frequency-doubling technology in early glaucoma diagnosis.

PURPOSE: Analyze the stability and accuracy of 3 perimetric techniques. METHODS: A total of 104 stable eyes (65 subjects) with ocular hypertension and early glaucoma [group G, mean defect = 1.08 dB, SD = 2.0, in standard TOP automatic perimetry (SAP)] were examined 5 times during 18 months using: (a) SAP; (b) Pulsar temporal modulation perimetry (T30W), and (c) frequency-doubling technology (FDT N30). Ninety eyes from 90 normal controls were compared with the first set of examinations of group G. RESULTS: The learning effect was minimal in the 3 techniques but higher in Pulsar (1.0 src, p < 0.05) than in SAP and FDT (0.4 dB). Long-term fluctuation (F) was significantly higher in FDT (3.1 dB, SD = 1.4, p < 0.0001) than in SAP (2.3 dB, SD = 1.1) and in Pulsar (1.9 src, SD = 0.7). Pulsar and FDT reduce F when increasing the number of examinations. F seems equivalent in SAP and FDT and lower in Pulsar, considering small-scale differences of the 3 perimeters. CONCLUSIONS: A slight learning effect would be expected on FDT and SAP in patients with previous experience with SAP. The stability and sensitivity of Pulsar is greater than on the other 2 systems. For early diagnosis of glaucoma it is essential to prove the reproducibility and coincidence of perimetric results.

Topographical spatial summation in glaucoma.

PURPOSE: Stimulus luminance (L) and area (A) are related by the equation L x A(k)=constant. The authors evaluated the k value at 66 positions of the central visual field in patients with glaucoma, to modify L and A simultaneously in order to examine advanced glaucomas with a bigger dynamic range. METHODS: The luminance limitation of a computer screen with automatic photometric control was compensated for by increasing the stimulus area in the range between 0 and 17 dB, using the k topographic values previously calculated on normal subjects. Four initial series of 21, 12, 10, and 10 glaucomas were sequentially examined with the Octopus 311 in which the stimulus size cannot be freely changed during the examination, and with the experimental method (Pulsar-SAP) modifying stimulus sizes to equal the results. k Final estimation was verified in 60 new cases. RESULTS: k values increase progressively with defect deepness. Values higher than those of the normal population with equivalent topographic differences were obtained. Correlation between indices was as follows: MD: r=0.94 (p<0.0001); square root of the loss of variance (sLV): r=0.93 (p<0.0001). Frequency of local defects was similar in both procedures. Average topographic differences between thresholds were usually less than 1 dB. The average threshold difference favored Pulsar-SAP by 0.45 dB at those points where the average threshold of both examinations was less than 18 dB and 0.37 dB where such average was higher than or equal to 18 dB. CONCLUSIONS: k value is higher in patients with glaucoma than in normal subjects, although the topographic features are similar. It is feasible to design a scale combining stimulus luminance and sizes to use screens with relative low brightness as surfaces for visual field examination.

[Diagnostic capability of PULSAR, FDT y HRT-II in glaucoma suspects]. / Capacidad diagnóstica del HRT-II y de las perimetrías TOP, PULSAR y FDT en pacientes sospechosos de sufrir glaucoma.

PURPOSE: To determine the diagnostic capability of PULSAR-T30W, FDT-Threshold-N30 and HRT-II in glaucoma suspects. METHODS: Forty-seven eyes from 47 referred glaucoma suspects (GS) were examined twice with each technique. Cases with TOP-WW-MD>6dB were excluded. Results were compared with those of 70 eyes from 70 normal controls (C). RESULTS: Mean MD value using TOP-WW in the GS group (0.96dB. sd=1.7) was not significantly different from C (0.8dB. sd=1.77) (p>0.05). Disc area in GS group (2.12 mm(2). sd=0.34) was significantly greater than in C (1.97 mm2. sd=0.45) (p<0.01). For 95.7% specificity, PULSAR-sLV showed the highest sensitivity of 30.9% in individual examinations. The highest reproducible sensitivity in the two examinations was obtained using HRT-II maximum contour elevation (23.4%) and reference height (23.4%), and was 14.9% for various indices after correcting for the influence of disc area (cup area, cup/disc area ratio, maximum contour depression and mean RNFL thickness). Reproducible sensitivity of the perimetric indices was: PULSAR-MD=8.5%, PULSAR-sLV=17%, FDT-MD=6.4%, FDT-PSD=4.3%. The association of perimetric and HRT-II indices achieved high sensitivity but low diagnostic reproducibility. CONCLUSIONS: The most effective indices were maximum contour elevation, reference height and PULSAR-sLV, although the inclusion of the optic nerve head assessment in the selection of the GS sample may have favored the HRT-II results.

Diagnostic accuracy and reproducibility of tendency oriented perimetry in glaucoma.

PURPOSE: To evaluate the diagnostic capability of tendency oriented perimetry (TOP) in glaucoma. METHODS: A): The diagnostic accuracy of mean defect (MD), square-root of the loss variance (s LV), and number of pathologic points (NPP) was calculated in 295 normal and 414 glaucoma eyes (179 early, 112 moderate, and 123 advanced) examined with TOP. B): Threshold fluctuation (F) and its relationship with the loss variance (LV) was measured in 34 normal and 33 glaucoma eyes (mean MD=3 dB; SD=3.9) for TOP and for full-threshold perimetry (FT). C): Twenty-eight eyes with stable glaucoma (mean MD=9.5 dB; SD=7.2) were examined six times to quantify LV error. D): TOP and FT were tested with the simulation program PeriSim using different behavior models. RESULTS: A): The best diagnostic index in early glaucoma (MD<6dB) was sLV (specificity=90.2%, sensitivity=84.9). The three indices had similar precision in moderate and severe glaucoma. B): Threshold fluctuation and sLV were better correlated in TOP (r=0.72, p<0.01) than in FT (r=0.62, p<0.01). For normal subjects, in FT the incidence of F<2 dB was 8.82% and s LV<1.5 dB 5.88%. The same frequencies in TOP were 67.65% and 55.88%. C): Averaging six examinations reduced the sLV val ue by 22%. D): The threshold estimation error increased 1 dB in TOP in relation to FT for the same patient's behavior, but the error in TOP was lower than i n FT when the worst behavior was modeled. CONCLUSIONS: TOP is a good discriminator between glaucoma and normality. Perimetry results overestimate the real sLV value. TOP's high diagnostic ability is probably associated to the algorithm design and to less contaminating influences during the examination.

Bilateral solar retinopathy. Autofluorescence and optical coherence tomography. / Retinopatía solar bilateral. Autofluorescencia y tomografía de coherencia óptica.

CASE REPORT: A 33-year-old man referred decreased bilateral visual acuity for five years, with no history of interest. Military profession and probably previous sun exposure. Focal pigmented lesions in the macular area of the fundus were observed, with impairment of the photoreceptor layer in the fovea, observed by optical coherence tomography (OCT), in various sectors of the fovea. DISCUSSION: Solar retinopathy is associated with professions at risk of sun exposure. The diagnosis is based on autofluorescence and macular OCT, that later will provide key data to establish the cause.

[Spatial summation: its topography in the central visual field]. / Topografía de la sumación espacial en el campo visual central.

PURPOSE: Luminance (L) and area (A) of the stimulus are related by the equation LxAk=constant. We evaluated the k value in 66 positions of the central visual field. METHODS: Ten eyes of 10 healthy subjects were examined for conventional luminous thresholds at 66 positions of the central visual field with the TOP strategy using Goldmann sizes 4, 3.5, 3, 2.5 and 1.9 in the PULSAR perimeter. RESULTS: The k value increased in a lineal manner from the centre towards the periphery (slope=0.01 per degree, average k=0.616, r=0.98, p<0.01) but with unequal slopes at the different meridians. In the inferior hemi-fields it was higher (k=0.657) than in the superior hemi-fields (k=0.574). The k value at the supero-nasal hemifields is quite similar to that found at the paracentral region, and maximum at the temporal inferior region. CONCLUSIONS: Spatial summation in the central visual field has specific values for different positions.

Risk of oral cancer associated with tobacco smoking, alcohol consumption and oral hygiene: a case-control study in Madrid, Spain.

Oral cancer is a disease whose principal etiological factors are tobacco and alcohol consumption, which if controlled could help avoid many tumors. However, consumption has continued to grow for years. We have studied the risk of the principal factors established in the development of oral cancer and the influence of the oral hygiene level on the appearance of these tumors. Seventy-five cases of oral cancer and 150 controls from the Madrid community were interviewed on tobacco and alcohol consumption habits and their oral hygiene level. The Odds Ratio (OR) for consumption of 6-20 cigarettes/day is 3.1 and 7.96 for more than 20 cigarettes/day. When more than 50 g of alcohol/day is consumed the risk results in an OR of 5.3. Daily brushing is a protective factor (OR, 0.41). In conclusion, the most important risk factor for developing oral cancer is tobacco consumption followed by alcohol consumption.

Combined spatial, contrast, and temporal functions perimetry in mild glaucoma and ocular hypertension.

PURPOSE: To evaluate the diagnostic ability of a new perimetric procedure in glaucoma. METHODS: Pulsar perimeter shows white circular sinusoidal grating patterns with decreasing amplitude, 5 degrees in diameter, 500 msec in duration in 66 locations. The stimuli scale combines spatial resolution and contrast. The stimuli were shown with centrifugal wave motion at 8 cyl/deg (K6W) or pulse at 30 Hz (T30W). Fifty-six normal eyes and 82 eyes with ocular hypertension and mild glaucoma were included. These 82 cases were classified into four levels of diagnostic certainty, from 0 (ocular hypertension) to 3 (mild glaucoma). RESULTS: Mean examination time was 3:49 min. Specificity was 96.4% (T30W) and 94.6% (K6W). Sensitivities for levels 0 and 3 were 34.5% to 100% (T30W) and 24.1 % to 75% (K6W). The receiver operating characteristic (ROC) curve areas for T30W at levels 1, 2, and 3 were 0.88, 0.94, and 0.99. The ROC areas for K6W were 0.83, 0.91, and 0.97. There was good correlation between both Pulsar perimetries (r=0.88), but it was lower with conventional perimetry (r=0.58 for T30W and r=0.59 for K6W). CONCLUSIONS: The novel Pulsar T30W perimetry may be helpful for the study of mild glaucoma and ocular hypertension.

[Haptoglobin in cerebrospinal fluid as a marker of infectious process in central nervous system]. / Haptoglobina en líquido cefalorraquídeo como marcador de procesos infecciosos en el sistema nervioso central.

INTRODUCTION: Haptoglobin is a transport protein and protects organism against iron loss and it should be involved in central nervous system infectious process. PATIENTS AND METHODS: Simultaneous serum and cerebrospinal fluid were obtained of 39 pediatric patients, 14 suffering from viral meningoencephalitis and 25 from bacterial meningoencephalitis. Five control cases were examined too. Haptoglobin, IgG and albumin were quantified in both fluids by radial immunodiffusion. Haptoglobin cerebrospinal fluid/serum ratio, haptoglobin index and haptoglobin/IgG index were calculated. Local IgG intrathecal synthesis was determined by reibergram. RESULTS: Haptoglobin index was higher not statistically significant in viral meningoencephalitis in comparison with bacterial disease but both were statistically significant with respect to control group. Increased haptoglobin/IgG index were statistically significant in bacterial meningoencephalitis in relation with viral meningoencephalitis. There were no association between haptoglobin and polymorphonuclear cells count and globular sediment speed. CONCLUSION: Haptoglobin should be considered a relevant marker of central nervous system infectious process.

[Initial findings with pulsar perimetry in patients with ocular hypertension]. / Primeros hallazgos con perimetría pulsar en pacientes hipertensos oculares.

PURPOSE: To evaluate our first results with Pulsar perimetry in patients with ocular hypertension and compare them with normal individuals. METHODS: We studied 34 eyes of patients with ocular hypertension and normal G1 Octopus perimetry (mean age: 57.29 S.D. 10.55) and 41 eyes of normal individuals (mean age: 48.34 S.D. 13.71). A complete ophthalmologic examination, including Dr. González de la Rosa's Pulsar perimetry with TOP strategy, was performed for all patients. EXCLUSION CRITERIA: visual acuity <0.8, refractive defect 3 spheric dp or 1.5 astigmatic dp, pupil size <3 mm, ocular surgery or pathologies, non-controlled diabetes or neurological diseases. They all had previous perimetric experience. Results were analyzed with student t - test. RESULTS: For normal individuals, mean sensitivity (MS) for Pulsar perimetry was 21,25 src (spatial resolution and contrast units) with an S.D. of 2,70. Mean defect (MD) was 0,93 src S.D. 1,80 and loss variance (LV) was 6,11 src S.D. 4,30. For patients with ocular hypertension: MS was 18,65 src S.D. 2,79; MD was 2,73 src S.D. 2,30 and LV was 8,46 src S.D. 5,01. LV differences between the two groups were statistically significant (p<0.05) with 95% confidence limits of (-4.49; -0.20), and MS and MD differences, highly significant (p<0.01), with 99% confidence limits of (+0.92; +4.28;) and (-3.05; -0.54) respectively. CONCLUSIONS: Pulsar perimetry may have greater sensibility for the detection of early defects in patients with ocular hypertension than conventional perimetry.

[White-on-white, blue-on-yellow and blue-on-blue perimetry in normal subjects]. / Perimetrías blanco-blanco, azul-amarillo y azul-azul en sujetos normales.

PURPOSE: To compare blue-on-blue differential contrast perimetry (BB), in accordance with E. Land "Retinex" theory, with white-on-white (WW) and blue-on-yellow (BY) perimetries on normal subjects. METHODS: An Octopus 101 perimeter was modified for BB perimetry, using a 4cd/m2 background and stimulus Goldmann size V. Fifty healthy subjects (10 per decade, from 20 to 70 years) were examined twice with each type of perimetry (WW, BB, BY) using the TOP strategy. RESULTS: The results obtained with WW, BY and BB perimetry were respectively: Reduction of sensitivity per year: 0.13, 0.27 and 0.13 dB; correlation coefficient (r) of threshold with age (and error of estimation of Y over X): -0.63 (2.24 dB), -0.70 (3.77 dB) and -0.80 (1.32 dB); threshold fluctuation: 2.21, 3.03 and 2.03 dB; percentage of points deviated more than 5dB from the expected value for the patient age: 8.1, 16.0 and 4.2%. CONCLUSIONS: Perimetric results are more stable with BB strategy than with the other two types of perimetry. BY perimetry gives the worst results: threshold reduction with age is twice higher, individual fluctuation is 50% higher and points away from the mean value are much more frequent. Overlapping between blue and yellow filters is minimal in Octopus. Therefore, an absolute threshold is examined, which is much more unstable than WW or BB differential thresholds.

[Topographic classification of glaucomatous visual fields]. / Clasificación topográfica del campo visual glaucomatoso.

PURPOSE: To propose a classification of glaucoma visual fields based on affected ganglion cells axons on their way through the optic nerve head. MATERIAL AND METHOD: 255 Octopus 1-2-3 visual fields from glaucoma patients and glaucoma suspected patients were analyzed. Determination coefficients (r(2)) between the 10 points closest to the blind spot and the 73 reminding ones were calculated by linear regression. RESULTS: Significant correlation was found (r(2)>0.33) with very distant points sensitivity related to the ones closer to the optic disc due to the fibers path. Seven areas could be defined by this method: three of them are not affected or latterly affected by the disease: S1 and I1 corresponding to the upper and lower papillo-macular bundle and T, located on the temporal aspect of the blind spot. Areas S2 and L2 correspond to the nasal and para-central upper and lower sensitivities. Areas S3 and I3 are in the border of upper and lower nasal fields where axons enter the optic disc at the apical portion. CONCLUSIONS: There is a relationship between the anatomical arrangement of ganglion cells axons on their way to the optic nerve and topography of glaucoma defects which may justify this proposed classification.

[Development of an automatic discrimination system for glaucomatous visual fields based on neuro-fuzzy nets]. / Desarrollo de un sistema automático de discriminación del campo visual glaucomatoso basado en un clasificador neuro-fuzzy.

PURPOSE: To provide a useful tool in the diagnosis of glaucoma by developing an automatic system for visual field classification based on neuro-fuzzy rules. METHOD: A total of 212 visual fields (OCTOPUS 123 program G1X), from 198 patients, were analysed: 61 normal (controls) and 151 with glaucomatous damage (49% with incipient damage, 29.1% with moderate damage, and 21.9% advanced). Inclusion criteria for glaucomatous patients were: Visual acuity >0.5, IOP < 20 mm Hg (with treatment), refraction <5 Dp and previous perimetric experience. EXCLUSION CRITERIA: miotics, other ocular pathologies which could interfere with visual field examination, and for control subjects: visual acuity >0.5, no ocular pathologies and refraction < 5 Dp. A neuro-fuzzy classifier (NEFCLASS) is a system consisting in a series of fuzzy rules, obtained after a learning process, which attempts to assign to each piece of data input its corresponding output. Initially, the characteristics of each data input are established (input units). Then, based on previous knowledge, a set of rules are defined, and finally, the learning process allows the optimisation of the classifier parameters to generate an output. RESULTS: Input units were defined by using the mean defects calculated at specific areas of the visual field; five rules were then created which generated sensitivity and specificity values of 96.0% and 93.4% respectively. CONCLUSIONS: The use of neuro-fuzzy rules for visual field classification in normal vs glaucomatous can provide results which can match the quality of those obtained with other techniques such as discriminatory analysis or neural networks.

Catheter-related bloodstream infection: burden of disease in a tertiary hospital.

BACKGROUND: Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings. AIM: To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital. METHODS: A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers. FINDINGS: In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%. CONCLUSION: The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.