Economic analysis of healthcare-associated infection prevention and control interventions in medical and surgical units: systematic review using a discounting approach.

Nosocomial or healthcare-associated infections (HCAIs) are associated with a financial burden that affects both patients and healthcare institutions worldwide. The clinical best care practices (CBPs) of hand hygiene, hygiene and sanitation, screening, and basic and additional precautions aim to reduce this burden. The COVID-19 pandemic has confirmed these four CBPs are critically important prevention practices that limit the spread of HCAIs. This paper conducted a systematic review of economic evaluations related to these four CBPs using a discounting approach. We searched for articles published between 2000 and 2019. We included economic evaluations of infection prevention and control of Clostridioides difficile-associated diarrhoea, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Gram-negative bacilli. Results were analysed with cost-minimization, cost-effectiveness, cost-utility, cost-benefit and cost-consequence analyses. Articles were assessed for quality. A total of 11,898 articles were screened and seven were included. Most studies (4/7) were of overall moderate quality. All studies demonstrated cost effectiveness of CBPs. The average yearly net cost savings from the CBPs ranged from $252,847 (2019 Canadian dollars) to $1,691,823, depending on the rate of discount (3% and 8%). The average incremental benefit cost ratio of CBPs varied from 2.48 to 7.66. In order to make efficient use of resources and maximize health benefits, ongoing research in the economic evaluation of infection control should be carried out to support evidence-based healthcare policy decisions.

Multi-scale investigation in the frequency domain of Ar/HMDSO dusty plasma with pulsed injection of HMDSO.

A combination of time-resolved optical emission spectroscopy measurements and collisional-radiative modeling is used to investigate the phenomena occurring over multiple time scales in the frequency domain of a low-pressure, axially-asymmetric capacitively-coupled RF argon plasma with pulsed injection of hexamethyldisiloxane (HMDSO, Si2O(CH3)6). The collisional-radiative model developed here considers the population of argon 1s and all ten 2p levels (in Paschen's notation). The presence of HMDSO in the plasma is accounted for in the model by quenching of the argon 1s states by species generated by plasma processing of HMDSO, including HMDSO-15 (Si2O(CH3)5), acetylene (C2H2) and methane (CH4). Detailed analysis of the relative populations of Ar 2p states reveals cyclic evolutions of the electron temperature, electron density and quenching frequency that are shown to be linked to the kinetics of dust formation in Ar/HMDSO plasmas. Penning ionization of HMDSO and its fragments is found to be an important source of electrons for the plasma maintenance. It is at the origin of the cyclic formation/disappearance of the dust cloud, without attenuation of the phenomenon, as long as the pulsed injection of HMDSO is sustained. The multi-scale approach used in this study further reveals the straightforward relation of the frequency of HMDSO pulsed injection, in particular the HMDSO duty cycle, with the frequency of dust formation/disappearance cycle.

Couple dissatisfaction and eating profile: a mediation effect of coping style.

Individuals' ways of coping with psychological stress have often been associated with body weight regulation through their impact on eating behaviours. In particular, emotion-oriented and distraction-oriented coping styles have been steadily related to disordered eating. Couple dissatisfaction may be experienced as an important psychological stressor and could therefore affect eating behaviours through the use of inadequate coping strategies. The study proposes 1) to compare women reporting a low vs a high level of couple satisfaction, and 2) to test mediational models including couple satisfaction, coping styles, and eating variables. Analyses were performed among 65 overweight/obese premenopausal women who reported being weight-preoccupied. Women exhibiting couple dissatisfaction (34.8%) showed a higher level of EDE-Q restraint, more intense concerns about eating and shape, a higher level of disinhibition and susceptibility to hunger and endorsed more often a distraction-oriented coping style, independently of their body weight. Furthermore, distraction- oriented coping style seemed to be a valid mediator of the relation between couple dissatisfaction and eating behaviours. Since non-normative eating behaviours, namely disinhibition and susceptibility to hunger, have been particularly linked to a higher body weight status, it is relevant to extend the scope of interest to more distal contributing factors, such as couple dissatisfaction.

Defined weight expectations in overweight women: anthropometrical, psychological and eating behavioral correlates.

OBJECTIVE: To examine associations between defined weight expectations and anthropometric profile and to identify psychological and eating behavioral factors that characterize women having more realistic weight expectations. METHODS: A nonrandom sample of 154 overweight/obese women completed the 'Goals and Relative Weight Questionnaire', which assessed four weight expectations: (1) dream weight (whatever wanted to weight); (2) happy weight (would be happy to achieve); (3) acceptable weight (could accept even if not happy with it); and (4) disappointed weight (would not view as a successful achievement). Psychological assessments evaluated dysphoria, self-esteem, satisfaction with one's body (i.e., body esteem) and weight-related quality of life. The 'Three-Factor Eating Questionnaire' assessed eating behaviors: (1) cognitive dietary restraint (control of food intake), (2) disinhibition (overconsumption of food with a loss of control), and (3) susceptibility to hunger (food intake in response to feelings and perceptions of hunger). RESULTS: Women's expectations for their dream (60.6+/-6.0 kg), happy (65.2+/-6.4 kg) and acceptable (67.9+/-6.8 kg) weights corresponded to higher percentages of weight loss (24.2+/-6.6% or 19.8+/-7.1 kg, 18.6+/-5.8% or 15.2+/-6.0 kg and 15.2+/-5.7% or 12.6+/-5.8 kg, respectively) than goals recommended for overweight individuals. Defined weight expectations were positively associated with current weight and body mass index (BMI; 0.37 < or = r < or = 0.85; P<0.0001). When women were matched one by one for their current BMI, but showing different happy BMI, women with a more realistic happy BMI were older (P=0.03) and were characterized by a greater satisfaction towards body weight (P=0.04), a higher score for flexible restraint (P=0.003) and a lower score for susceptibility to hunger (P=0.02) than women with a less realistic happy BMI. CONCLUSION: These findings suggest that having more realistic weight expectations is related to healthier psychological and eating behavioral characteristics.

Combined improvements in implantable pump technology and insulin stability allow safe and effective long term intraperitoneal insulin delivery in type 1 diabetic patients: the EVADIAC experience.

OBJECTIVE: To report a long-term multicentre experience with implantable insulin pumps in type 1 diabetic patients, and to test safety and accuracy of the systems following improvements in infused insulin solutions and peritoneal catheter. RESEARCH DESIGN AND METHODS: Forty MiniMed Implantable Pumps model 2001 were consecutively implanted over a two-month period in type 1 diabetic volunteers. The systems were equipped by a new compliant sideport catheter and were refilled at 45-day intervals with HOE 21 PH ETP insulin batches showing enhanced physical stability in vitro. Safety was assessed from the incidence of acute adverse events and effectiveness from quarterly HbA(1c) assays. Accuracy of delivery was measured at each pump refill by comparing residual insulin in the pump reservoir with expected amount according to programmed infusion. The study lasted until pump battery depletion or premature pump explantation. RESULTS: Cumulated experience was 106 patient-years. Premature explantations occurred in 3 cases, due to one electronic pump failure and two "pump-pocket" infections. Near-normal insulin delivery was sustained until expected battery depletion in 13 cases. Forty underdelivery events occurred in 24 pumps, but 36 among them were related to pump slowdowns due to insulin aggregation in pumps that were promptly solved by an outpatient NaOH rinse procedure. Only 4 underdeliveries were caused by catheter obstructions that required laparoscopy to remove peritoneal tissue overgrowth around the catheter. Over pump lifetime, HbA(1c) was 7.2 +/- 0.2% in the 13 patients with no underdelivery and 7.7 +/- 0.5% in the other ones. Only one severe hypoglycemia and one ketoacidosis occurred during the whole study. CONCLUSION: Our current experience with improved implantable pumps and insulin solutions shows both long-term safety and effectiveness of this treatment in type 1 diabetic patients following improvement in infused insulin solutions and catheter. This therapy may be a good alternative for patients that experience frequent severe hypoglycemia with intensive subcutaneous insulin therapy.

[Diabetes and pregnancy]. / Diabète et grossesse.

Pregnancies complicated with diabetes mellitus, either previously diagnosed, or appearing during pregnancy, gestational diabetes , present an increased maternofetal risk. An additional risk of fetal malformations exists when diabetes is present before the beginning of pregnancy. Hyperglycemia plays a role in the occurrence of these complications but other factors, more or less identified, could also be implicated. Pregnancy may favor the occurrence or aggravation of diabetic retinopathy and/or nephropathy in patients with pre-existing diabetes. The pathophysiology of gestational diabetes includes insulin resistance and decreased insulin secretion, suggesting some commune aspects with type 2 diabetes. There is no international consensus about screening for gestational diabetes nor for diagnostic criteria. For gestational diabetes as in cases of pre-existing diabetes, treatment principles relay on dietetics and insulin. The improvement in medical care of pregnancies complicated by diabetes includes improvement in scientific knowledge and a specialized medical care of these patients.

[Insulinoma with hyperproinsulinemia: a two cases report]. / Insulinome à proinsuline.

We report two cases of insulinoma with increased serum proinsulin levels and with normal insulin levels.Clinically, the two patients show typical symptoms of insulinoma, but serum insulin levels are normal. Only high levels of serum proinsulin allow us to retain the diagnosis of insulinoma. The new insulin assays using monoclonal antibodies are very specific for insulin and though can not detect isolated high proinsulin levels. So proinsulin assay is useful when diagnosing insulinoma.

Molecular characterization of human and bovine ceruloplasmin using MALDI-TOF mass spectrometry.

Using SDS-PAGE and MALDI-TOF mass spectrometry, we investigated the difference in the molecular structure between human and bovine ceruloplasmin. In both cases, we found that the protein is present in two majors forms of different molecular mass. The difference between human and bovine ceruloplasmin was more obvious when characterized by MALDI-TOF than with the SDS-PAGE analysis. Furthermore, we established that the N-glycoside content of both enzymes is dissimilar and that the N-glycosyl moieties are distributed in a distinctive fashion in two glycoproteins. Finally, it appeared that both proteins exhibited different cleavage patterns after treatment with trypsin. This study indicates that human and bovine ceruloplasmin differ not only in sugar composition but also in primary structure.

[Complete supernumerary breast on the thigh in a male patient]. / Sein surnuméraire complet de la cuisse chez un homme.

BACKGROUND: Supernumerary nipples are not rare but the developement of a complete supernumerary breast is exceptional. CASE REPORT: A 59-year-old man presented a progressively increasing ancient right- groin-masse. The histopathologic examination of the lesion confirmed the diagnostic of polymastia. DISCUSSION: The interest of this observation results from the very unusual occurence of polymastia (less than 1 p. 100 of supernumerary nipples), especially for a caucasian man. The prevalence appears to be higher in women and oriental people. Diagnostic of supernumerary nipple is difficult because of its atypical appearance and ectopic location. However, this diagnostic is important because ectopic breast tissue is subject to the same pathologic changes that occur in normally positioned breasts and it can be a marker for associated diseases such as urologic malformations or urogenital malignancies.

Macrophage activation in type 1 diabetic patients with catheter obstruction during peritoneal insulin delivery with an implantable pump.

OBJECTIVE: The purpose of this study was to evaluate the activation of macrophages in type 1 diabetic patients during peritoneal insulin delivery with an implantable pump against two types of insulin: that which was collected from the pump reservoir and that which came straight fromn the bottle (i.e., vial insltlin). Macrophage activation was studied in patients with and without cathcter obstruction and compared with activation in healthy subjects. RESEARCH DESIGN AND METHODS: Human insulin (21 PH, 400 U/ml; Hoescht) was collected from the pump reservoir (Minimed) of diabetic patients with (n = 3) or without (n = 7) catheter obstruction, as assessed by histological examination of the catheter tip. Monocytes were obtained from venous blood samples from both kinds of diabetic patients and from healthy subjects (n = 5) and were differentiated into monocyte-derived macrophages in culture. Their chemotaxis and tumor necrosis factor-alpha (TNF-alpha) release were studied with respect to both types of insulin, as previously stated. Formyl-methionyl-leucyl-phenylalanine (fMLP) and lipopolysaccharide (LPS) were used as controls. RESULTS: Neither insulin recovered from the pump reservoir nor vial insulin proved chemotactic to macrophages from either healthy subjects or those diabetic patients with and without catheter obstruction. The migration toward fMLP of macrophages from patients presenting a catheter obstruction was significantly higher than that observed with macrophages from either diabetic patients without obstruction or healthy subjects, the chemotactic index (mean +/- SD) was 3.81 +/- 0.36 vs. 2.30 +/- 0.89 and 2.60 +/- 0.80, respectively (P < 0.05). LPS significantly stimulated the TNF-alpha secretion of macrophages from diabetic subjects with a catheter obstruction, whereas both native and reservoir-recovered insulin had no effect on this release (144.83 +/- 67.25 vs. 5.15 +/- 2.93 and 5.27 +/- 2.43 pg/ml, P < 0.001). CONCLUSIONS: The human insulin used in implantable pumps, regardless of how long it had remained in the pump reservoir, did not induce macrophage activation in diabetic patients treated through intraperitoneal insulin delivery. In some of these diabetic patients, catheter obstruction could be explained by their high capacity of macrophage chemotaxis.

Current status and future prospects of parenteral insulin regimens, strategies and delivery systems for diabetes treatment.

A strong relationship between long term metabolic control and low frequency of chronic diabetes complications was shown in the Diabetes Control Complication Trial (DCCT). However, the subcutaneous intensive insulin therapy required to achieve the glycemic goals defined by the DCCT led to an unacceptable frequency of severe hypoglycemia and a significant weight gain. This limits the benefits of this therapy and excludes groups of patients such as young children, the elderly or hypoglycemia prone patients. The intensive therapy and self blood glucose monitoring (SMBG) necessary to limit hypoglycemia represent a heavy burden for the patients and their family. Improvements in parenteral insulin therapy are possible by either modifying subcutaneous insulin characteristics (analogs, adjunction of peptides such as amylin, GLP1, IGF1), or by developing better routes of administration and making SMBG easier, which is a key to intensive insulin therapy success. The ultimate goal remains the development of an automated, glucose controlled device.

Improvement of HbA1c and blood glucose stability in IDDM patients treated with lispro insulin analog in external pumps.

OBJECTIVE: To compare the efficacy of the short-acting insulin analog lispro (LP) with that of regular insulin in IDDM patients treated with an external pump. RESEARCH DESIGN AND METHODS: Thirty-nine IDDM patients (age, 39.4 +/- 1.5 years; sex ratio, 22M/17W; BMI, 24.4 +/- 0.4 kg/m2; diabetes duration, 22.5 +/- 1.6 years) who were treated by external pump for 5.1 +/- 0.5 years were involved in an open-label, randomized, crossover multicenter study comparing two periods of 3 months of continuous subcutaneous insulin infusion with LP or with Actrapid HM, U-100 (ACT). Boluses were given 0-5 min (LP) or 20-30 min (ACT) before meals. Blood glucose (BG) was monitored before and after the three meals every day. RESULTS: The decrease in HbA1c was more pronounced with LP than with ACT (-0.62 +/- 0.13 vs. -0.09 +/- 0.15%, P = 0.01). BG levels were lower with LP (7.93 +/- 0.15 vs. 8.61 +/- 0.18 mmol/l, P < 0.0001), particularly postprandial BG levels (8.26 +/- 0.19 vs. 9.90 +/- 0.20 mmol/l, P < 0.0001). Standard deviations of all the BG values (3.44 +/- 0.10 vs. 3.80 +/- 0.10 mmol/l, P = 0.0001) and of postprandial BG values (3.58 +/- 0.10 vs. 3.84 +/- 0.10 mmol/l. P < 0.02) were lower with LP. The rate of hypoglycemic events defined by BG < 3.0 mmol/l did not significantly differ between LP and ACT (7.03 +/- 0.94 vs. 7.94 +/- 0.88 per month, respectively), but the rate of occurrences of very low BG, defined as BG < 2.0 mmol/l, were significantly reduced with LP (0.05 +/- 0.05 vs. 0.47 +/- 0.19 per month, P < 0.05). At the end of the study, all but two (95%) of the patients chose LP for the extension phase. CONCLUSIONS: When used in external pumps, LP provides better glycemic control and stability than regular insulin and does not increase the frequency of hypoglycemic episodes.

p53 gene mutation pattern in rat liver tumors induced by vinyl chloride.

Vinyl chloride (VC) induces angiosarcomas of the liver (ASL) and hepatocellular carcinomas (HCCs) in humans and rodents. We examined the presence of p53 gene mutations in ASL and HCC induced by VC in Sprague Dawley rats; 25 ASL and eight HCCs were analyzed for point mutations in exons 5-8, using PCR amplification, single-strand conformation polymorphism analysis, and direct DNA sequencing. Mutations were found in 11 (44%) of the ASL and in 1 HCC. A 12-base pair deletion was found in one tumor; all others were base pair substitutions. Nine of the point mutations were observed at A:T base pairs (5 A:T --> T:A; 2 A:T --> G:C, and 2 A:T --> C:G), and of three G:C --> A:T transitions, only one was at a CpG site. In ASL, four mutations were found in exon 5, two in exon 6, and six in exon 7; the base pair substitution found in one HCC was in exon 8. One ASL exhibited two point mutations, including a silent one. Two ASL exhibited the same mutation in codon 203 and two other samples in codon 253. Codon 235 was found to be mutated in three ASL. These data show that p53 is often mutated in ASL induced by VC in rats and, as observed in ASL in humans exposed to VC, the majority of the missense mutations involved A:T base pairs. The characteristic patterns of mutations found suggest that a common mechanism operates in VC-induced p53 mutagenesis in both species, and these mutations are consistent with the formation of DNA etheno adducts by VC in the liver. The A:T --> T:A transversion observed in the first nucleotide of codon 253 in two rat ASL is equivalent to the A:T --> T:A transversion characterized previously in codon 255 in one human ASL associated with VC exposure.

Arginine biosynthesis and regulation in Lactobacillus plantarum: the carA gene and the argCJBDF cluster are divergently transcribed.

A cluster of citrulline biosynthetic genes has been cloned and sequenced from a fragment of Lactobacillus plantarum CCM 1904 (ATCC 8014) DNA isolated as complementing a Bacillus subtilis argF mutation. The gene order was carA-argCJBDF, with carA transcribed divergently from the arg cluster. Although other gram-positive bacteria show similar arg clusters, this arrangement for carA is thus far unprecedented. Downstream from the arg cluster, two open reading frames (ORF7 and ORF8) having unknown functions were found. Sequence analysis of the end of a 10.5-kb cloned DNA fragment showed that argF was 3.5 kb from the ldhL gene coding for L-(+)-lactate dehydrogenase. A tree representation of amino acid sequence clustering relationships of 31 ornithine carbamoyltransferases (OTCases) from various organisms revealed two prokaryotic groups: one with ArgF of L. plantarum and one with ArgF of B. subtilis, which are paralogous. This divergence was not observed in vivo because an L. plantarum argF mutant (AM 1215) harboring no OTCase activity was complemented by the argF genes of L. plantarum and B. subtilis. No OTCase activity was detectable when L. plantarum was grown in the presence of saturating amounts of arginine or citrulline. Arginine may repress the citrulline biosynthetic genes in L. plantarum by using 11 identified DNA motifs which resemble the Escherichia coli ARG box consensus and which are in most cases separated by multiples of 11 bp, corresponding to a DNA helical turn. The carA and argCJBDF genes are divergently transcribed. Their putative promoters are 6 bp apart and are partially overlapped by putative ARG boxes, suggesting concerted transcription regulation.

[Granulosis rubra nasi and pheochromocytoma]. / Granulosis rubra nasi et phéochromocytome.

INTRODUCTION: Granulosis rubra nasi, a papular red lesion of the nose associated with hypersudation is an uncommon dermatosis usually seen in children. CASE REPORT: A noradrenalin secreting pheochromocytoma was found in 19-year-old girl with hyperhidrosis, granulosis rubra nasi and tachycardia. Surgical exeresis of the pheochromocytoma was followed by involution of the hyperhidrosis, regression of the nasal dermatosis and normalization of urinary catecholamines. DISCUSSION: The diagnosis of pheochromocytoma should be entertained in patients with hypersudation and tachycardia. Granulosis rubra nasi could be a complication of hyperhidrosis.