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1.
Mov Ecol ; 12(1): 5, 2024 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-38233871

RESUMO

BACKGROUND: Efficient movement and energy expenditure are vital for animal survival. Human disturbance can alter animal movement due to changes in resource availability and threats. Some animals can exploit anthropogenic disturbances for more efficient movement, while others face restricted or inefficient movement due to fragmentation of high-resource habitats, and risks associated with disturbed habitats. Mining, a major anthropogenic disturbance, removes natural habitats, introduces new landscape features, and alters resource distribution in the landscape. This study investigates the effect of mining on the movement of an endangered mesopredator, the northern quoll (Dasyurus hallucatus). Using GPS collars and accelerometers, we investigate their habitat selection and energy expenditure in an active mining landscape, to determine the effects of this disturbance on northern quolls. METHODS: We fit northern quolls with GPS collars and accelerometers during breeding and non-breeding season at an active mine site in the Pilbara region of Western Australia. We investigated broad-scale movement by calculating the movement ranges of quolls using utilisation distributions at the 95% isopleth, and compared habitat types and environmental characteristics within observed movement ranges to the available landscape. We investigated fine-scale movement by quolls with integrated step selection functions, assessing the relative selection strength for each habitat covariate. Finally, we used piecewise structural equation modelling to analyse the influence of each habitat covariate on northern quoll energy expenditure. RESULTS: At the broad scale, northern quolls predominantly used rugged, rocky habitats, and used mining habitats in proportion to their availability. However, at the fine scale, habitat use varied between breeding and non-breeding seasons. During the breeding season, quolls notably avoided mining habitats, whereas in the non-breeding season, they frequented mining habitats equally to rocky and riparian habitats, albeit at a higher energetic cost. CONCLUSION: Mining impacts northern quolls by fragmenting favoured rocky habitats, increasing energy expenditure, and potentially impacting breeding dispersal. While mining habitats might offer limited resource opportunities in the non-breeding season, conservation efforts during active mining, including the creation of movement corridors and progressive habitat restoration would likely be useful. However, prioritising the preservation of natural rocky and riparian habitats in mining landscapes is vital for northern quoll conservation.

2.
Blood ; 141(7): 713-724, 2023 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-36279417

RESUMO

Patients with hypomorphic mutations in the RAG1 or RAG2 gene present with either Omenn syndrome or atypical combined immunodeficiency with a wide phenotypic range. Hematopoietic stem cell transplantation (HSCT) is potentially curative, but data are scarce. We report on a worldwide cohort of 60 patients with hypomorphic RAG variants who underwent HSCT, 78% of whom experienced infections (29% active at HSCT), 72% had autoimmunity, and 18% had granulomas pretransplant. These complications are frequently associated with organ damage. Eight individuals (13%) were diagnosed by newborn screening or family history. HSCT was performed at a median of 3.4 years (range 0.3-42.9 years) from matched unrelated donors, matched sibling or matched family donors, or mismatched donors in 48%, 22%, and 30% of the patients, respectively. Grafts were T-cell depleted in 15 cases (25%). Overall survival at 1 and 4 years was 77.5% and 67.5% (median follow-up of 39 months). Infection was the main cause of death. In univariable analysis, active infection, organ damage pre-HSCT, T-cell depletion of the graft, and transplant from a mismatched family donor were predictive of worse outcome, whereas organ damage and T-cell depletion remained significant in multivariable analysis (hazard ratio [HR] = 6.01, HR = 8.46, respectively). All patients diagnosed by newborn screening or family history survived. Cumulative incidences of acute and chronic graft-versus-host disease were 35% and 22%, respectively. Cumulative incidences of new-onset autoimmunity was 15%. Immune reconstitution, particularly recovery of naïve CD4+ T cells, was faster and more robust in patients transplanted before 3.5 years of age, and without organ damage. These findings support the indication for early transplantation.


Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Recém-Nascido , Humanos , Doadores de Tecidos , Linfócitos T , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Diagnóstico Precoce , Efeitos Psicossociais da Doença , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Estudos Retrospectivos , Doadores não Relacionados , Condicionamento Pré-Transplante
3.
Artigo em Inglês | MEDLINE | ID: mdl-34089890

RESUMO

Evidence from mammals and aves alludes to a possibly conserved seasonal photoperiod induced neuroendocrine cascade which stimulates subsequent sexual maturation however our understanding of this mechanism in teleosts is lacking. Unlike all teleosts studied to date, the Atlantic cod (Gadus morhua) is a short day breeder with the reduction in day-length from the summer solstice stimulating gametogenesis. Cod specific orthologues of eya3, tshß and dio2 were identified and their expression was monitored in the brain and pituitary of cod held under either stimulated or inhibited photoperiod conditions. While no differential expression was apparent in brain dio2 & tshß and pituitary tshß, there was significant temporal variation in expression of pituitary eya3 under the SNP treatment, with expression level elevating in association with active gametogenesis. Under the LL treatment, sexual maturation was inhibited and there was a corresponding suppression of eya3 expression. In a second study the impact of size/energetic status on the initiation of sexual maturation was investigated. In the feed restricted population maturation was significantly suppressed (5% sexually mature) compared to the ab libitum fed stock (95% sexually mature) with there being a concomitant significant suppression in pituitary eya3 expression. Overall, these results suggest that pituitary eya3 has the potential to act as an integrator of both environmental and energetic regulation of sexual maturation of cod. Being the first account of eya3 induction in a short day breeding teleost, the conserved association with stimulation of reproduction and not seasonal state indicates that the upstream drivers which initiate the pathway differ among vertebrates according to their breeding strategies, but the pathway itself and its role in the reproductive cascade appears to be conserved across the vertebrate clade.


Assuntos
Fenômenos Fisiológicos da Nutrição Animal , Gadus morhua/fisiologia , Sistemas Neurossecretores , Fotoperíodo , Maturidade Sexual , Animais , Ritmo Circadiano/fisiologia , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Masculino , Filogenia , Hipófise/metabolismo , Reprodução/fisiologia , Estações do Ano , Fatores de Tempo , Vertebrados
5.
J Acoust Soc Am ; 140(3): 1992, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27914438

RESUMO

Dynamic sound scattering (DSS) is a powerful acoustic technique for investigating the motion of particles or other inclusions inside an evolving medium. In DSS, this dynamic information is obtained by measuring the field autocorrelation function of the temporal fluctuations of singly scattered acoustic waves. The technique was initially introduced 15 years ago, but its technical aspects were not adequately discussed then. This paper addresses the need for a more complete account of the method by describing in detail two different implementations of this sound scattering technique, one of which is specifically adapted to a common experimental situation in ultrasonics. The technique is illustrated by the application of DSS to measure the mean square velocity fluctuations of particles in fluidized suspensions, as well as the dynamic velocity correlation length. By explaining the experimental and analytical methods involved in realizing the DSS technique in practice, the use of DSS will be facilitated for future studies of particulate suspension dynamics and particle properties over a wide range of particle sizes and concentrations, from millimeters down to nanometers, where the use of optical techniques is often limited by the opacity of the medium.

7.
Aust Vet J ; 93(10): 381-4, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26412121

RESUMO

The presentation, treatment and outcomes of 33 ingluvial fibrous foreign bodies in cockatiels (Nymphicus hollandicus) are described. Vomiting, lethargy and weight loss were the most common presenting signs. Diagnosis was made on palpation of a mass in the crop (ingluvies). Both surgical and non-surgical treatment regimens were evaluated. The overall mortality rate was 33%, suggesting fibrous materials are not safe for cockatiels to groom or ingest and should not be offered as cage accessories.


Assuntos
Cacatuas , Papo das Aves , Corpos Estranhos/veterinária , Têxteis/efeitos adversos , Animais , Feminino , Corpos Estranhos/diagnóstico , Corpos Estranhos/mortalidade , Corpos Estranhos/terapia , Trato Gastrointestinal/lesões , Trato Gastrointestinal/cirurgia , Masculino , New South Wales , Queensland
8.
Aust Vet J ; 93(1-2): 46-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25622710

RESUMO

CASE REPORT: A mature, captive Krefft's river turtle (Emydura macquarii krefftii) was presented with severe proliferative and ulcerative lesions of the skin and shell. The areas were biopsied and histopathological examination demonstrated orthokeratotic hyperkeratosis with keratinocytes containing eosinophilic intranuclear inclusions. Molecular diagnostics confirmed the presence of a herpesvirus in the affected tissues. CONCLUSION: This is the first recorded case of herpesvirus infection in an Australian freshwater turtle species.


Assuntos
Exoesqueleto/virologia , Infecções por Herpesviridae/veterinária , Herpesviridae/isolamento & purificação , Tartarugas , Aciclovir/administração & dosagem , Animais , Antivirais/administração & dosagem , Austrália , Água Doce , Infecções por Herpesviridae/tratamento farmacológico , Infecções por Herpesviridae/patologia , Masculino , Resultado do Tratamento
9.
Aust Vet J ; 92(5): 171-6, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24766048

RESUMO

CASE REPORT: A domestic pigeon developed a sterile granuloma following vaccination with an oil-adjuvant, inactivated La Sota strain of Newcastle disease. The aim of vaccination was to provide protection against pigeon paramyxovirus-1 (PPMV-1), a disease previously considered exotic to Australia. Granuloma formation is considered a rare complication of vaccination against PPMV-1 in pigeons. Clinical signs consistent with neuropathic pain became apparent during the extensive management of the granuloma, which included surgical removal of foreign material, control of the pain and inflammation and protection against antimicrobial contamination. CONCLUSION: PPMV-1 is now considered endemic in Australia and protecting pigeons with vaccination is important. Until a product is registered for use, vaccination remains off-label and the risk of adverse reaction, including sterile granuloma, must be considered.


Assuntos
Columbidae , Granuloma/imunologia , Neuralgia/imunologia , Doença de Newcastle/imunologia , Vírus da Doença de Newcastle/imunologia , Vacinas de Produtos Inativados/imunologia , Animais , Austrália , Granuloma/terapia , Granuloma/virologia , Histocitoquímica/veterinária , Masculino , Neuralgia/terapia , Neuralgia/virologia , Doença de Newcastle/prevenção & controle , Vacinas de Produtos Inativados/efeitos adversos
11.
Forensic Sci Rev ; 26(1): 9-22, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26226968

RESUMO

On May 14, 2013, the National Transportation Safety Board (NTSB) recommended lowering the legal blood-alcohol limit to 0.05 g/dL for motor vehicle operators in the United States, in an effort to reduce the risk of injuries and deaths caused by a driver's alcohol impairment (NTSB/SR-13/01). This recommendation has prompted other organizations and agencies, including the National Safety Council, to evaluate and consider supporting this action. In order to determine the scientific and legal feasibility and advisability of lowering or establishing 0.05 per se laws, we examined 554 alcohol-related publications. Risk factors, instrument reliability, law enforcement, and adjudication issues were considered in this overview of the literature. The extensive scientific literature reviewed provides ample support for lowering the operation of motor vehicle alcohol limits to 0.05, and for supporting the NTSB recommendations. Research clearly demonstrates that impairment begins at very low concentrations, well below the recommended NTSB limit, and increases with concentration. Lowering the limit to 0.05 will save many lives and prevent injuries. Breath, blood, and saliva samples have proved to be accurate and reliable specimens for legal acceptability in a court of law.

12.
Clin Kidney J ; 7(2): 127-33, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25852860

RESUMO

BACKGROUND: Few studies have evaluated the prevalence of severe hyperkalaemia in unselected patient populations. We identified all episodes of severe hyperkalaemia occurring in 1 year, and described patient demographics, clinical response and outcome. We also assessed junior doctor knowledge of its causes and significance. MATERIALS AND METHODS: A retrospective interrogation of the database of the regional biochemical laboratory identified all episodes of severe hyperkalaemia (K≥ 6.5 mmol/L) occurring in 2011. The understanding of trainee doctors of the importance, causes and treatment of severe hyperkalaemia was assessed by structured questionnaire. RESULTS: Severe hyperkalaemia was recorded in 433 samples (365 patients) giving a prevalence of 0.11%. Thirty-six per cent of episodes occurred in patients under the care of a nephrologist, who were significantly younger than those not under the care of a nephrologist. In the nephrology cohort, 86% occurred in patients with chronic kidney disease (CKD), the majority of which had CKD Stage 5. In the non-nephrology cohort, only 65% occurred in the context of CKD, which was equally distributed between Stages 3 and 5 CKD. In both patient groups, roughly 50% of episodes occurred in association with acute kidney injury (AKI). Acute mortality (death within 48 h of documented severe hyperkalaemia) was higher in the non-nephrology compared with the nephrology cohort. Time to repeat serum potassium was influenced by the clinical setting with shorter time to repeat for acute care compared with ward settings. Assessment of trainee doctor's knowledge suggested significant deficiencies in relation to severe hyperkalaemia. CONCLUSIONS: The prevalence of severe hyperkalaemia was low and occurred predominantly in the context of CKD and/or AKI. The majority of episodes occurred in patients not under the care of a nephrologist. Variability in time to repeat serum potassium levels suggested deficiencies in care, and assessment of trainee doctor's knowledge suggests the need for further educational initiatives to highlight its importance.

13.
Exp Brain Res ; 231(2): 209-18, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24013788

RESUMO

The brain is able to determine angular self-motion from visual, vestibular, and kinesthetic information. There is compelling evidence that both humans and non-human primates integrate visual and inertial (i.e., vestibular and kinesthetic) information in a statistically optimal fashion when discriminating heading direction. In the present study, we investigated whether the brain also integrates information about angular self-motion in a similar manner. Eight participants performed a 2IFC task in which they discriminated yaw-rotations (2-s sinusoidal acceleration) on peak velocity. Just-noticeable differences (JNDs) were determined as a measure of precision in unimodal inertial-only and visual-only trials, as well as in bimodal visual-inertial trials. The visual stimulus was a moving stripe pattern, synchronized with the inertial motion. Peak velocity of comparison stimuli was varied relative to the standard stimulus. Individual analyses showed that data of three participants showed an increase in bimodal precision, consistent with the optimal integration model; while data from the other participants did not conform to maximum-likelihood integration schemes. We suggest that either the sensory cues were not perceived as congruent, that integration might be achieved with fixed weights, or that estimates of visual precision obtained from non-moving observers do not accurately reflect visual precision during self-motion.


Assuntos
Sinais (Psicologia) , Cinestesia/fisiologia , Percepção de Movimento/fisiologia , Autoimagem , Adulto , Algoritmos , Encéfalo/fisiologia , Simulação por Computador , Interpretação Estatística de Dados , Feminino , Humanos , Funções Verossimilhança , Masculino , Rotação , Vestíbulo do Labirinto/fisiologia , Percepção Visual/fisiologia , Adulto Jovem
14.
Bone Marrow Transplant ; 48(4): 508-13, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23178543

RESUMO

We conducted a prospective phase II trial utilizing the CliniMACs system to perform CD34(+)-cell selection of PBSCs from haploidentical donors to evaluate engraftment and hematoimmunological reconstitution. In total, 21 children with hematological malignancies or nonmalignant conditions underwent conditioning with 1200 cGy TBI, thiotepa, fludarabine and Thymoglobulin. Patients received megadoses of CD34(+) cells (median: 22 × 10(6)/kg) with a fixed dose of 3 × 10(4)/kg CD3(+) cells/kg, and engraftment occurred in 90% with prompt recovery of neutrophils and platelets. Grade II acute GVHD (aGVHD) was seen in 32% (95% confidence interval (CI), 15-54%) of evaluable patients, there was no grade III-IV aGVHD, and chronic extensive GVHD was seen in 35% (95% CI, 17-59%) of patients. The estimated 2-year EFS was 62% (95% CI, 48-83%) with a median survivor follow-up of 49 months (range: 18-119 months). Patients with nonmalignant diseases had an estimated 2-year EFS of 100% (95% CI, 56-100%) and patients with malignancies in remission had an estimated 2-year EFS of 56% (95% CI, 22-89%). Megadose CD34(+) cells with a fixed CD3(+) cell dose from haploidentical related donors resulted in good outcomes for pediatric patients with nonmalignant diseases and those with malignant diseases transplanted in remission.


Assuntos
Antígenos CD34 , Complexo CD3 , Família , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Hematopoéticas , Doadores de Tecidos , Condicionamento Pré-Transplante , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Sobrevivência de Enxerto , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/mortalidade , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/terapia , Humanos , Lactente , Masculino , Estudos Prospectivos , Taxa de Sobrevida , Transplante Homólogo
15.
Gen Comp Endocrinol ; 179(3): 384-99, 2012 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-23036731

RESUMO

In the present study, we developed and validated real-time quantitative RT-PCR assays for a suite of genes involved in the brain-pituitary gonadal axis in fish including kisspeptin genes and its receptor (Kiss1, kiss2, kissr4) and gonadotropin-releasing hormone genes (sbGnRH, sGnRH, cGnRHII) in the brain, and gonadotropin genes (fshß and lhß) in the pituitary. Sex steroid profiles (T and 11-KT) and gonadal development were also studied over a full annual reproductive cycle in adult male sea bass. The cDNA partial sequence of sea bass kissr4 encoding 185 amino acids showed a high degree of conservation with other fish kissr4 subtype. Results clearly showed a seasonal profile for Kiss1, kiss2 and kissr4 mRNAs. Kissr4, fshß and lhß levels increased gradually and peaked during spermatogenesis (January) while Kiss1, kiss2, cGnRH-II as well as steroids showed peaks during early spawning (March). No significant seasonal changes were observed for sbGnRH and sGnRH expression. These results support the possible involvement of the kiss genes and their receptor (kissr4) in the seasonal control sea bass reproduction. However, a lack of correlation between kiss genes and sbGnRH expression and the mismatch between kisspeptin and the onset of gonadotropin surge contrast with previous findings.


Assuntos
Bass/metabolismo , Kisspeptinas/metabolismo , Reprodução/fisiologia , Animais , Hormônio Liberador de Gonadotropina/metabolismo , Masculino , Estações do Ano
16.
Artigo em Inglês | MEDLINE | ID: mdl-22613785

RESUMO

In order to investigate the potential role of the kisspeptin system in the entrainment of reproduction in Atlantic cod, qPCR assays were developed for kiss2 and its receptor kissr4. mRNA expression was monitored in the brain over a full reproductive cycle in 2 populations of males and females: 1) a maturing population (exposed to simulated natural photoperiod, SNP) and 2) a maturation inhibited population (exposed to constant light, LL). Pituitary expression of gonadotropin subunit mRNA (fshß and lhß) was also measured. Results from this study indicated no clear temporal pattern in expression of kiss2 or kissr4 mRNAs in either population of cod, however acute elevations were apparent in maturing (SNP) individuals, namely an elevation in kiss2 in vitellogenic females and spermiating males and spikes in kissr4 during early vitellogenesis in females and spermatogenesis in males. Gonadotropin mRNA expression displayed strong amplitudinal changes over time with fshß and lhß mRNA expression increasing towards spawning in maturing individuals. No firm conclusions on the role of the kisspeptin system in cod puberty can be drawn at this stage, however mRNA increases in kiss2 and kissr4 may elude to conserved kisspeptin functions in cod and opens up interesting avenues on potential gender specific functions.


Assuntos
Gadus morhua/crescimento & desenvolvimento , Gadus morhua/genética , Gonadotropinas/genética , Kisspeptinas/genética , Fotoperíodo , Maturidade Sexual/genética , Animais , Clonagem Molecular , Feminino , Perfilação da Expressão Gênica , Masculino , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase , RNA Mensageiro/genética , Especificidade da Espécie
17.
Bone Marrow Transplant ; 47(3): 352-9, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21552297

RESUMO

Alpha-mannosidosis is a rare lysosomal storage disease. Hematopoietic SCT (HSCT) is usually recommended as a therapeutic option though reports are anecdotal to date. This retrospective multi institutional analysis describes 17 patients that were diagnosed at a median of 2.5 (1.1-23) years and underwent HSCT at a median of 3.6 (1.3-23.1) years. In all, 15 patients are alive (88%) after a median follow-up of 5.5 (2.1-12.6) years. Two patients died within the first 5 months after HSCT. Of the survivors, two developed severe acute GvHD (>=grade II) and six developed chronic GvHD. Three patients required re-transplantation because of graft failure. All 15 showed stable engraftment. The extent of the patients' developmental delay before HSCT varied over a wide range. After HSCT, patients made developmental progress, although normal development was not achieved. Hearing ability improved in some, but not in all patients. We conclude that HSCT is a feasible therapeutic option that may promote mental development in alpha-mannosidosis.


Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , alfa-Manosidose/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Oncologia/métodos , Estudos Retrospectivos , Transplante Homólogo/métodos , Resultado do Tratamento
18.
Aust Vet J ; 89(12): 520-3, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22103954

RESUMO

Osteosarcoma of the axial skeleton in an 18-month-old woma python (Aspidites ramsayi) is described. A subcutaneous mass overlying the costal arches enlarged progressively over a period of 5 months and, in that time, became ulcerated and more invasive of surrounding tissues. A punch biopsy of the lesion under general anaesthesia provided tissue for histopathology and diagnosis of low-grade osteosarcoma.


Assuntos
Boidae , Neoplasias Ósseas/veterinária , Osteossarcoma/veterinária , Animais , Neoplasias Ósseas/diagnóstico , Eutanásia Animal , Masculino , Osteossarcoma/diagnóstico , Animais de Estimação
19.
Eur J Neurosci ; 31(10): 1899-907, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20584195

RESUMO

Females have been reported to be more 'visually dependent' than males. When aligning a rod in a tilted frame to vertical, females are more influenced by the frame than are males, who align the rod closer to gravity. Do females rely more on visual information at the cost of other sensory information? We compared the subjective visual vertical and the perceptual upright in 29 females and 24 males. The orientation of visual cues presented on a shrouded laptop screen and of the observer's posture were varied. When upright, females' subjective visual vertical was more influenced by visual cues and their responses were more variable than were males'. However, there were no differences between the sexes in the perceptual upright task. Individual variance in subjective visual vertical judgments and in the perceptual upright predicted the level of visual dependence across both sexes. When lying right-side down, there were no reliable differences between the sexes in either measure. We conclude that heightened 'visual dependence' in females does not generalize to all aspects of spatial processing but is probably attributable to task-specific differences in the mechanisms of sensory processing in the brains of females and males. The higher variability and lower accuracy in females for some spatial tasks is not due to their having qualitatively worse access to information concerning either the gravity axis or corporeal representation: it is only when gravity and the long body axis align that females have a performance disadvantage.


Assuntos
Orientação/fisiologia , Adolescente , Adulto , Algoritmos , Sinais (Psicologia) , Feminino , Gravitação , Sensação Gravitacional , Humanos , Individualidade , Masculino , Estimulação Luminosa , Postura/fisiologia , Desempenho Psicomotor/fisiologia , Caracteres Sexuais , Percepção Espacial/fisiologia , Percepção Visual , Adulto Jovem
20.
Neurocrit Care ; 13(1): 87-92, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20443154

RESUMO

BACKGROUND: Clostridium difficile is an important cause of nosocomial infection on the intensive care unit. Little is known about infection rates on the neurocritical care unit (NICU). The purpose of this study was to determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired on the NICU. METHODS: Patients on NICU with a positive stool Clostridium difficile toxin assay, from August 2004 to February 2008, were identified by the Department of Microbiology. Each patient's medical notes and charts were reviewed in turn. Patients with a positive assay within 48 h of NICU admission were excluded. RESULTS: Twenty-one (0.6%) NICU patients developed CDAD. All were emergency admissions, 18 (86.0%) were neurosurgical. Subarachnoid hemorrhage was the most common diagnosis, 5 (23.8%) patients. Median age and APACHE II score on admission were 55 (IQR 40-66) and 21 (IQR 16-24), respectively. Thirteen (61.9%) patients were female. Median interval between NICU admission and diarrhea onset and CDAD diagnosis were 5 (3-8) days and 7 (4-12) days, respectively. At the time of diagnosis most, 11 (52.4%) patients, had moderate CDAD. Previously identified risk factors for ICU-acquired CDAD comprised: age > 65 (6), antibiotics (21), and medical device requirements (21). Five (23.8%) patients deteriorated clinically as a result of CDAD. The overall in-hospital mortality for those with NICU acquired CDAD was 19%. CONCLUSIONS: Although CDAD is rarely acquired on the NICU, up to one quarter of affected patients may experience complications. Prospective validation of severity definitions and treatment guidelines may help to reduce the complication rates.


Assuntos
Clostridioides difficile , Infecção Hospitalar , Enterocolite Pseudomembranosa/etiologia , Unidades de Terapia Intensiva , Adulto , Distribuição por Idade , Idoso , Antibacterianos/efeitos adversos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/fisiopatologia , Diarreia/diagnóstico , Diarreia/microbiologia , Serviço Hospitalar de Emergência , Enterocolite Pseudomembranosa/complicações , Enterocolite Pseudomembranosa/epidemiologia , Enterocolite Pseudomembranosa/fisiopatologia , Equipamentos e Provisões/efeitos adversos , Feminino , Departamentos Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/cirurgia , Neurocirurgia , Admissão do Paciente , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Hemorragia Subaracnóidea/cirurgia , Fatores de Tempo
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