Scoping review of cytolytic vaginosis literature.

BACKGROUND: Cytolytic vaginosis (CV) is a little-known, controversial condition that is typically not considered for women presenting with vulvovaginitis symptoms. Objective: The objective of this scoping review was to identify and compile the global evidence on CV. METHODS: A medical librarian searched Prospero, Wiley Cochrane Library, Ovid Embase, Ovid Medline, EBSCO CINAHL, ProQuest Dissertations and Theses Global, and Scopus, from inception to April 4, 2019 and updated to October 17, 2021. Studies were eligible if they discussed CV. Two independent reviewers conducted study selection and data extraction. RESULTS: Sixty-four studies were identified, with 67% of studies (n = 43) published since 2007. Studies were from around the world, including the United States (28%, n = 18), Brazil (11%, n = 7), Portugal (11%, n = 7), and China (11%, n = 7). Fifty percent of studies (n = 32) were reviews; the remainder were observational; and of these, 78% (n = 25) were cross-sectional. The most frequent topics included: diagnosis (19%, n = 12), prevalence (17%, n = 11), and overview of CV (50%, n = 32). Evidence for prevalence in symptomatic women (median prevalence of 5%, interquartile range 3%-8%) was based only on 16% of studies (n = 10) with minimal evidence on prevalence in asymptomatic women and across different geographic regions. Microbiological findings, including abundant lactobacilli and fragmented epithelial cells, were found useful to distinguish between CV and vulvovaginal candidiasis, and Lactobacillus crispatus was noted to dominate the vaginal flora in women with CV. Most studies used subjective criteria to diagnose CV as the condition lacks gold-standard microscopic criteria. The suggested primary treatment (baking soda irrigations) was largely based on expert opinion, and there was minimal evidence on associations between CV and other conditions. CONCLUSION: Knowledge gaps currently exist in all realms of CV research. Additional research is needed to confirm the validity of CV and ensure that women are diagnosed and treated effectively.

Extractionless nucleic acid detection: a high capacity solution to COVID-19 testing.

We describe an extractionless real-time reverse transcriptase-PCR (rRT-PCR) protocol for SARS-CoV-2 nucleic acid detection using heat as an accurate cost-effective high-capacity solution to COVID-19 testing. We present the effect of temperature, transport media, rRT-PCR mastermixes and gene assays on SARS-CoV-2 gene amplification and limits of detection. Utilizing our heated methodology, our limits of detection were 12.5 and 1 genome copy/reaction for singleplex E- and N1-gene assays, respectively, and 1 genome copy/reaction by utilizing an E/N1 or Orf1ab/N1 multiplex assay combination. Using this approach, we detected up to 98% of COVID-19 positive patient samples analyzed in our various cohorts including a significant percentage of weak positives. Importantly, this extractionless approach will allow for >2-fold increase in testing capacity with existing instruments, circumvent the additional need for expensive extraction devices, provide the sensitivity needed for COVID-19 detection and significantly reduce the turn-around time of reporting COVID-19 test results.

Impact of an Unsolicited, Standardized Form-Based Antimicrobial Stewardship Intervention to Improve Guideline Adherence in the Management of Staphylococcus aureus Bacteremia.

BACKGROUND: Antimicrobial stewardship programs (ASPs) improve Staphylococcus aureus bacteremia (SAB) management. The objective of the current study was to evaluate the effect of unsolicited prospective audit and feedback (PAF) using a standardized SAB bundle form on the management of SAB. METHODS: Multicenter, pre-post quasi-experimental study of inpatients with SAB. The ASP developed an evidence-based SAB management bundle that included recommendations for infectious diseases consultation, blood culture clearance, appropriate empiric and definitive therapy, echocardiography, adequate treatment duration, and source control where applicable. ASP pharmacists performed PAF using a standardized form outlining bundle components. The primary outcome was bundle component adherence. Secondary outcomes were length of stay, 30-day readmission rate, and in-hospital and 30-day mortality rates. RESULTS: A total of 199 patients were included (preintervention group, 62; intervention group, 137). Bundle implementation with PAF resulted in significant improvements in infectious diseases consultation (56.5% in preintervention vs 93.4% in intervention group), appropriate definitive antibiotic therapy (83.9% vs 99.3%), ordering echocardiography (72.6% vs 95.6%), and adequate treatment duration (87.0% vs 100%) (all P < .001). Overall bundle adherence increased by 43.8% (P < .001). Readmission and 30-day mortality rates decreased, but this difference did not reach statistical significance. CONCLUSIONS: Unsolicited PAF using a standardized SAB management bundle significantly improved adherence to evidence-based recommendations. This simple yet effective ASP-driven intervention can ensure consistent management of a highly morbid infection.

CMOS Ultralow Power Brain Signal Acquisition Front-Ends: Design and Human Testing.

Two brain signal acquisition (BSA) front-ends incorporating two CMOS ultralow power, low-noise amplifier arrays and serializers operating in mosfet weak inversion region are presented. To boost the amplifier's gain for a given current budget, cross-coupled-pair active load topology is used in the first stages of these two amplifiers. These two BSA front-ends are fabricated in 130 and 180 nm CMOS processes, occupying 5.45 mm 2 and 0.352 mm 2 of die areas, respectively (excluding pad rings). The CMOS 130-nm amplifier array is comprised of 64 elements, where each amplifier element consumes 0.216 µW from 0.4 V supply, has input-referred noise voltage (IRNoise) of 2.19 µV[Formula: see text] corresponding to a power efficiency factor (PEF) of 11.7, and occupies 0.044 mm 2 of die area. The CMOS 180 nm amplifier array employs 4 elements, where each element consumes 0.69 µW from 0.6 V supply with IRNoise of 2.3 µV[Formula: see text] (corresponding to a PEF of 31.3) and 0.051 mm 2 of die area. Noninvasive electroencephalographic and invasive electrocorticographic signals were recorded real time directly on able-bodied human subjects, showing feasibility of using these analog front-ends for future fully implantable BSA and brain- computer interface systems.

Molecular profiling of Escherichia coli O157:H7 and non-O157 strains isolated from humans and cattle in Alberta, Canada.

Virulence markers in Shiga toxin-producing Escherichia coli (STEC) and their association with diseases remain largely unknown. This study determines the importance of 44 genetic markers for STEC (O157 and non-O157) from human clinical cases and their correlation to disease outcome. STEC isolated from a cattle surveillance program were also included. The virulence genes tested were present in almost all O157:H7 isolates but highly variable in non-O157 STEC isolates. Patient age was a significant determinant of clinical outcome.

Anaerobic urinary tract infection caused by Veillonella parvula identified using cystine-lactose-electrolyte deficient media and matrix-assisted laser desorption ionization-time of flight mass spectrometry.

We report a case of Veillonella parvula causing a urinary tract infection. The organism was isolated from urine using cystine-lactose-electrolyte deficient media and identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry confirmed by 16s RNA. This case highlights important clinical and microbiological considerations for urinary tract infections.

Comparison between ImmunoCard STAT!(®) and real-time PCR as screening tools for both O157:H7 and non-O157 Shiga toxin-producing Escherichia coli in Southern Alberta, Canada.

An increasing number of non-O157 Shiga toxin-producing Escherichia coli (STEC) infections and outbreaks have been reported. In this study, we evaluated the performance of ImmunoCard STAT!(®) (Meridian Bioscience, Inc., Cincinnati, OH, USA) as a method to screen stool specimens for STEC (O157 and non-O157). An in-house real-time PCR method was used as the "gold standard". We also evaluated the prevalence and clinical characteristics of STEC infections in the Alberta South West Zone. From July to November 2011, 819 stool specimens submitted for routine stool culture were tested. With our in-house real-time PCR, 7 O157:H7 and 10 non-O157 STEC isolates were identified for a total of 17 STECs. In comparison, ImmunoCard STAT!(®) identified a total of 6, resulting in a sensitivity and specificity of 35% and 99%, respectively (P < 0.05). Because of the low sensitivity, ImmunoCard STAT!(®) cannot be recommended as a routine screening test for STEC from enriched stool specimens. The rate of STEC positivity as detected by PCR was 2.08%, of which 0.86% was O157:H7 and 1.22% non-O157 STEC. Five of the 7 cases of STEC O157 infection experienced bloody diarrhea, and 1 developed hemolytic uremic syndrome.

Ocular microbiology trends in Edmonton, Alberta: a 10-year review.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as an increasingly common cause of nosocomial infections since the 1980s.(1) Reports of ocular infections due to MRSA are composed primarily of case reports. But a recent report from the United States suggests that ocular infections due to MRSA are about to become more common than methicillin-sensitive S. aureus (MSSA).(2) However, this observation is not consistent with anecdotal experience at the University of Alberta. The purpose of this study is to evaluate the ocular microbiology trends in a tertiary care eye center in Canada. METHODS: Cross-sectional study using a computer search of the DynaLIFE(DX) Diagnostic Laboratory Services database for all positive ocular microbiology cultures and in vitro antibiotic susceptibilities performed in the Edmonton area. RESULTS: Over a 10-year period, between 2000 and 2010, 6.4% of S. aureus isolates were MRSA; there were 2030 MSSA and 129 MRSA isolates, including 46 MSSA and 4 MRSA isolates from deep eye cultures. The prevalence of MRSA over the total number of S. aureus isolates, regardless of specimen source, steadily increased in the 10-year period, from 0.5% in 2002 to 12.6% in 2010. Gram-positive cocci were the most common organisms to cause ocular infections (82.6%). In vitro susceptibility of ocular MSSA and MRSA samples demonstrated 100% sensitivity to vancomycin. CONCLUSIONS: The prevalence of MRSA ocular infections, although still uncommon, appears to be increasing in Edmonton, Alberta.

Prevalence of shiga toxin-producing Escherichia coli as detected by enzyme-linked immunoassays and real-time PCR during the summer months in northern Alberta, Canada.

Shiga toxin-producing Escherichia coli (STEC) in northern Alberta was detected using two enzyme immunoassays and an in-house real-time PCR. Of 2,328 stool samples, 8 were positive for O157:H7 STEC and 13 were positive for non-O157 STEC. No significant gender (P = 0.17) or age (P = 0.81) differences between groups were seen. Most positive diarrheal stool samples were nonbloody.

Trends in nosocomial bloodstream infections following health care restructuring in Alberta between 1999 and 2005.

OBJECTIVE: A previous study at the University of Alberta Hospital/Stollery Children's Hospital in Edmonton, Alberta, revealed an increase in hospital-acquired bloodstream infection (BSI) rates associated with an increase in patient acuity during a period of public health care delivery restructuring between 1993 and 1996. The present study assessed trends in BSIs since the end of the restructuring. DESIGN: Prospective surveillance for BSIs was performed using Centers for Disease Control and Prevention (USA) criteria for infection. BSI cases between January 1, 1999, and December 31, 2005, were reviewed. Available measures of patient volumes, acuity and BSI risk factors between 1999 and 2005 were also reviewed from hospital records. SETTING: The University of Alberta Hospital/Stollery Children's Hospital (617 adult and 139 pediatric beds, respectively). PATIENTS: All pediatric and adult patients admitted during the above-specified period with one or more episodes of BSIs. RESULTS: There was a significant overall decline in the BSI number and rate over the study period between 1999 and 2005. The downward trend was widespread, involving both adult and pediatric populations, as well as primary and secondary BSIs. During this period, the number of hospital-wide and intensive care unit admissions, intensive care unit central venous catheter-days, total parenteral nutrition days and number of solid-organ transplants were either unchanged or increased. Gram-positive bacterial causes of BSIs showed significant downward trends, but Gram-negative bacterial and fungal etiologies were unchanged. CONCLUSIONS: These data imply that, over time, hospitals can gradually adjust to changing patient care circumstances and, in this example, control infectious complications of health care delivery.

Lupus vulgaris occurring in a locus minoris resistentiae.

BACKGROUND: The pathogenesis of lupus vulgaris, a form of cutaneous tuberculosis, is not always clear, especially in patients who do not have coexistent extracutaneous tuberculosis and in patients with single lesions. OBJECTIVES: To report a case of lupus vulgaris in a locus minoris resistentiae (a site of reduced resistance) and to use a unique set of clinical circumstances and laboratory tests to reconstruct the pathogenesis of the lesion and the response to treatment. CONCLUSION: Lupus vulgaris can occur in a locus minoris resistentiae; local trauma and possibly other factors, such as increased temperature, topical corticosteroids, and the virulence of the infecting strain, may facilitate the growth of Mycobacterium tuberculosis present at a locus minoris resistentiae as a result of a silent bacillemia.

Internalization and trafficking of opioid receptor ligands in rat cortical neurons.

The binding, internalization, and trafficking of the fluorescently labeled opioid peptides Fluo-dermorphin and Fluo-deltorphin were quantitatively studied by confocal microscopy in primary cortical neurons in culture. Specific binding of these selective ligands to neurons naturally expressing mu (mu) and delta (delta) opioid receptors (OR), respectively, resulted in their internalization into neuronal somas and processes, as indicated by the persistence of fluorescent labeling following removal of cell surface binding by hypertonic acid wash. This internalization was receptor-specific, as the fluorescent signal was completely abolished when the cells were concomitantly incubated with the opioid receptor antagonist naloxone. It also was clathrin-dependent, as it was totally prevented by the endocytosis inhibitor phenylarsine oxide. Accordingly, internalized ligands were detected inside small, endosome-like vesicles. These labeled vesicles accumulated within nerve cell bodies between 5-30 min of incubation with the fluorescent ligands. This accumulation was abolished after treatment with the antitubular agent nocodazole, suggesting that it was due to a microtubule-dependent, retrograde transport of the internalized ligands from processes to the soma. By contrast, there was no change in the compartmentalization of internalized (mu)OR or deltaOR, as assessed by immunocytochemistry, suggesting that the latter were recycled locally. The present results provide the first demonstration of receptor-mediated internalization of opioid peptides in cultured neurons. It is proposed that their retrograde transport into target cells might be involved in mediating some of the long-term, transcriptional effects of opioids.