Surveillance of the Middle East respiratory syndrome (MERS) coronavirus (CoV) infection in healthcare workers after contact with confirmed MERS patients: incidence and risk factors of MERS-CoV seropositivity.

Given the mode of transmission of Middle East respiratory syndrome (MERS), healthcare workers (HCWs) in contact with MERS patients are expected to be at risk of MERS infections. We evaluated the prevalence of MERS coronavirus (CoV) immunoglobulin (Ig) G in HCWs exposed to MERS patients and calculated the incidence of MERS-affected cases in HCWs. We enrolled HCWs from hospitals where confirmed MERS patients had visited. Serum was collected 4 to 6 weeks after the last contact with a confirmed MERS patient. We performed an enzyme-linked immunosorbent assay (ELISA) to screen for the presence of MERS-CoV IgG and an indirect immunofluorescence test (IIFT) to confirm MERS-CoV IgG. We used a questionnaire to collect information regarding the exposure. We calculated the incidence of MERS-affected cases by dividing the sum of PCR-confirmed and serology-confirmed cases by the number of exposed HCWs in participating hospitals. In total, 1169 HCWs in 31 hospitals had contact with 114 MERS patients, and among the HCWs, 15 were PCR-confirmed MERS cases in study hospitals. Serologic analysis was performed for 737 participants. ELISA was positive in five participants and borderline for seven. IIFT was positive for two (0.3%) of these 12 participants. Among the participants who did not use appropriate personal protective equipment (PPE), seropositivity was 0.7% (2/294) compared to 0% (0/443) in cases with appropriate PPE use. The incidence of MERS infection in HCWs was 1.5% (17/1169). The seroprevalence of MERS-CoV IgG among HCWs was higher among participants who did not use appropriate PPE.

Pulmonary tuberculosis among patients hospitalised with community-acquired pneumonia in a tuberculosis-prevalent area.

SETTING: A suburban teaching hospital in a tuberculosis (TB) prevalent area. OBJECTIVES: To evaluate the proportion of pulmonary TB among patients hospitalised with suspected community-acquired pneumonia (CAP), and to develop a diagnostic index for identifying TB among these patients. DESIGN: TB cases confirmed using 1) sputum culture, or 2) both sputum acid-fast bacilli smear and polymerase chain reaction for Mycobacterium tuberculosis, were compared with non-tuberculous CAP by demographic, clinical, laboratory and radiographic information. Using multiple logistic regression analysis, risk factors for TB were identified. A diagnostic index was developed by summing up their simplified regression coefficients. Its performance was checked using c-statistic. RESULTS: TB was the second leading cause of CAP (37/528, 7.0%). Risk factors were initial symptoms >7 days, serum albumin <3.5 g/dl, cavitary/nodular infiltrates and upper lobe involvement (1 point for each). The c-statistic of the index was 0.856 (95%CI 0.789-0.923), and for bootstrapping samples of 1000 repetitions it was 0.856 (95%CI 0.791-0.921). For scores ≥2, sensitivity and specificity were respectively 81.1% and 75.8%. CONCLUSION: TB is one of the leading causes of CAP in TB-prevalent areas. Our diagnostic index may help clinicians identify TB immediately from CAP and initiate appropriate isolation and optimal treatment.

2009 H1N1 influenza infection in Korean healthcare personnel.

Healthcare personnel (HCP) can acquire influenza and transmit it to patients and other hospital staff. The aim of this study was to evaluate the attack rate of HCP by the 2009 H1N1 influenza virus during the 2009 pandemic influenza season in Korea. HCP infected with H1N1 virus were asked to fill out a questionnaire, which included job type, method of diagnosis, facility type, history of contact with patients infected by H1N1 virus, vaccination status, and use of personal protective equipment. A total of 328 HCP (female 68.6%, 225/328) were infected with H1N1 virus at the nine study centers. The highest attack rate was in physicians, followed by nurses and nurses' aides. Transmission occurred primarily after contact with outpatients (27.8%), followed by contact with inpatients (21.6%). Most (77.3%) of the infected HCP never used an N95 mask during contact with patients. Surgical masks were always used by 29.4% of the subjects and usually or intermittent used by 46.9%. The peak incidence of the H1N1 infection among HCP preceded that among the general population. Among HCPs, physicians, nurses, and nurses' aides were at the greatest risk of H1N1 infection. HCP should be more vigilant and protect themselves with appropriate personal protective equipment during the influenza season.

Measurement of transepidermal water loss from clipped and unclipped anatomical sites on the dog.

OBJECTIVES: To establish a standardised clipping method for the measurement of transepidermal water loss (TEWL) with a VapoMeter in Beagle dogs and to identify the optimal anatomical site for TEWL measurement. PROCEDURE: TEWL values obtained from skin sites on five healthy Beagles clipped using two different blade angles (standard vs non-standard) were compared. TEWL values for 48 h were also obtained from seven different anatomical sites that had differing hair density. The hair was clipped in the intensively haired anatomical sites (head, lower and upper back and tail), but not clipped in the sparsely haired sites (ear, inguinal region, footpad). RESULTS: The TEWL values for the standard and non-standard clipping sites were 6.3 +/- 1.31 and 27.2 +/- 1.11 g/h/m(2), respectively. We found the upper back among the clipped sites was the most appropriate site for TEWL measurement over 48 h after clipping, whereas among the unclipped sites the ear was the most appropriate, because the TEWL values from those anatomical sites had the least fluctuation and were less affected by movement. CONCLUSION: The clipping method and anatomical site should be standardised in order to minimise the experimental variation in TEWL measurement in dogs.

Clinical outcomes and risk factors of community-acquired pneumonia caused by gram-negative bacilli.

To identify specific risk factors and clinical outcomes of community-acquired pneumonia (CAP) caused by gram-negative bacilli (GNB), we compared the clinical features and outcomes of patients with CAP due to GNB with those of patients with non-GNB pneumonia. We performed a prospective observational study of 912 cases of adult CAP in Asian countries from January 2002 to December 2004. Systemic laboratory evaluation for determining the etiology and clinical evaluation were performed. Of 912 cases with CAP, 93 (10.1%) cases were caused by GNB: 59 with K. pneumoniae, 25 P. aeruginosa, 7 Enterobacter species, 1 Acinetobacter baumannii, and 1 Serratia marcescens. CAP caused by GNB was more frequently associated with septic shock, malignancy, cardiovascular diseases, smoking, hyponatremia, and dyspnea, according to multivariate analysis (P < 0.05). Overall 30-day mortality rate was 7.3% (65/885). Mortality was significantly higher in the GNB group than in the non-GNB group [18.3% (17/93) vs. 6.1% (48/792); P < 0.001]. GNB as a causative microorganism was found to be one of the independent risk factors for mortality (adjusted OR = 2.63, 95% CI 1.02-6.78, P = 0.046) with nursing home residence, mechanical ventilation, cardiovascular disease, respiratory rate > 30/min, and hyponatremia (all P < 0.05). GNB was not only a frequent etiology of severe CAP but also an independent risk factor for mortality. Data suggest that an initial empirical antimicrobial coverage of GNB including P. aeruginosa should be seriously considered in cases of severe pneumonia, especially in patients with underlying malignancy, underlying cardiovascular diseases, smoking, septic shock, and hyponatremia.

Intracranial aspergillosis involving the internal auditory canal and inner ear in an immunocompetent patient.

We report the MR imaging findings in a case of intracranial aspergillosis involving the internal auditory canal (IAC) and inner ear in an immunocompetent patient. The presence of rim enhancement of the vestibulocochlear nerve, abnormal signal intensity involving the labyrinth, and adjacent meningeal enhancement might help clinicians to make a correct diagnosis in patients with a mass in the IAC and previous history of ear surgery.

Effect of flame cleaning of ceramic surface on the bond strength of composite to ceramic.

This study tested the hypothesis that flame cleaning of ceramic surface would increase the bond strength of composite to ceramic than pressure-vaporized steam cleaning. Eris and IPS-Empress ceramic blocks were fabricated, polished (control), airborne-particle abraded with 50-microm alumina particle (A), etched with 5% hydrofluoric acid gel for 2 min (E), or treated with a combination of A and E (AE). They were subjected to either steam cleaning for 20 s or flame cleaning over a gas burner for 2 s. Followed by an application of an adhesive resin, a composite was built-up. Twenty micro-tensile test specimens (approximately 0.9 x 0.9 x 16 mm) were obtained from each group and loaded to failure under tensile force using a universal testing machine at a crosshead speed of 0.5 mm min(-1). anova showed statistically significant differences in the mean bond strength by ceramic, surface roughness, and cleaning method (P < 0.0001). The groupings of the mean bond strength were as follows: flame-cleaned > steam-cleaned; IPS-Empress > Eris; and AE > E > A for IPS-Empress and AE > E approximately A for Eris (Duncan's multiple analysis; alpha = 0.05). This in vitro study suggests that mechanical bond of composite to ceramic can be improved with flame cleaning of ceramic surface.

Effect of fentanyl on TNF-alpha and IL-1beta levels during global ischemia/reperfusion in rats.

To reduce surgical stress, fentanyl is frequently used for neurosurgical procedures in which focal and/or global ischemia may occur. However, the effect of fentanyl on cytokine levels during ischemia/reperfusion is still uncertain. The goal of this study was to evaluate the effect of fentanyl infusion on levels of the proinflammatory cytokines, tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta, during global cerebral ischemia/reperfusion in rats using the intracerebral microdialysis technique. Forty male Sprague-Dawley rats weighing 280-320 g were randomly assigned to each of four groups: group 1 (no fentanyl infusion and only ischemia/reperfusion); group 2 (1.5 ng/ml of fentanyl infusion during ischemia/reperfusion) and group 3 (3 ng/ml of fentanyl infusion during ischemia/reperfusion) (n=5 in each group). The rats were anesthetized with an intraperitoneal injection of pentobarbital (50 mg/kg). They were then intubated and ventilated with room air using an animal ventilator. A CMA-12 probe was inserted into the left hippocampal CA-1 region according to the guidelines. Artificial cerebrospinal fluid was run from the inserted microdialysis probe and infused with or without fentanyl at 3 microl/min using a microinjection syringe pump during ischemia/reperfusion. Ischemia was induced by clamping the carotid arteries. Hemorrhagic hypotension was induced for 17 min via the femoral artery, and reperfusion was accomplished by unclamping the sling and reinfusing the blood via the femoral artery. After 2 h of stabilization, the microdialysate was collected 10 times every 17 min, just before ischemia (control), after ischemia (I) and after reperfusion (R1-R8), and stored at -80 degrees C until analysis using high-performance liquid chromatography During global ischemia/reperfusion, TNF-alpha and IL-1beta significantly increased at reperfusion (R5) compared with the control value (p < 0.05). However, in both cases of fentanyl infusion, TNF-alpha and IL-1beta showed no increase compared with the control value. Fentanyl inhibited an increase of the proinflammatory cytokines, TNF-alpha and IL-1beta levels, during global cerebral ischemia/reperfusion in rats.

Wear of enamel and veneering ceramics after laboratory and chairside finishing procedures.

PURPOSE: This in vitro study compared the wear of enamel against 3 types of ceramics with high esthetic potential (designed for layering techniques): feldspathic porcelain (Creation), aluminous porcelain (Vitadur alpha), and low-fusing glass (Duceram-LFC). Laboratory finishing (glazing/polishing) and chairside polishing with a Dialite kit were simulated to compare their respective effects on wear. METHODS: Tooth-material specimen pairs were placed in an artificial mouth using closed-loop servohydraulics. Constant masticatory parameters (13.5 N occlusal force, 0.62 mm lateral excursion; 0.23 second cuspal contact time) were maintained for 300, 000 cycles at a rate of 4 Hz. The occlusal surface of each pair was mapped and digitally recorded before and after each masticatory test. Quantitative changes were measured in terms of depth and volume of wear. Quantitative wear characteristics were assessed by SEM. RESULTS: Significant differences were observed (2-factor ANOVA, P <.05). Duceram-LFC generated increased volume loss of enamel (0.197 mm(3)) compared with Creation (0.135 mm(3)) and Vitadur alpha (0.153 mm(3)). Creation exhibited the lowest ceramic wear and lowest combined volume loss (0.260 mm(3); the sum of the data for enamel and the opposing material) compared with Duceram-LFC (0.363 mm(3)) and Vitadur alpha (0.333 mm(3)). The most significant differences among materials were observed in volume loss, not in depth of wear. For all 3 ceramic systems, qualitative SEM evaluation revealed an abrasive type of wear. Wear characteristics of chairside polished specimens were similar to those of laboratory finished specimens (glazed and polished). CONCLUSION: Duceram-LFC was the most abrasive ceramic for the antagonistic tooth. Creation ceramic was the least abrasive material and most resistant to wear. Defects, brittleness, and the possibly insufficient toughness of LFC may explain its increased abrasiveness. Laboratory and chairside finishing procedures generated similar results.

Brachial plexopathy caused by subclavian artery aneurysm in Behçet's disease.

As the cause of brachial plexopathy, an aneurysm of the subclavian artery is rare and mostly related to trauma. Early diagnosis and treatment is very important because the arterial aneurysm itself is life-threatening and nerve injury can be reversible in cases of early treatment. We report a patient with Behçet's disease having a right brachial plexopathy caused by a nontraumatic aneurysm of the right subclavian artery.