RESUMO
BACKGROUND: Patient and staff cohorting is part of a bundle approach in the response to multi-drug-resistant organisms, but its effectiveness is not fully clarified. This study compared the risks of acquiring vancomycin-resistant Enterococcus faecium (VREfm) at a hospital during a VREfm outbreak based on contact characteristics in order to better understand the effectiveness of cohorting. METHODS: Exposure came from contact with patients with VREfm (infectors), including existing patients with VREfm and patients who acquired VREfm during the study period. Contact was defined as length of contact time, degree of sharing space, and care by the same nurses as those caring for infectors between January and March 2018. The outcome was VREfm acquisition as determined through monthly stool or rectal screening cultures. Incidence rates were calculated based on contact patterns, and incidence rate ratios (IRRs) were compared. FINDINGS: Among 272 inpatients (4038 patient-days), 43 patients acquired VREfm with the same or similar pulsotype. Incidence rates were 8.45 per 1000 patient-days when susceptible inpatients were on the same ward as an infector but cared for by different nurses (reference), 16.96 when susceptible inpatients were on the same ward as an infector and cared for by the same nurses [IRR 2.01, 95% confidence interval (CI) 0.62-10.28], and 52.91 when susceptible inpatients shared a room with an infector (IRR 6.26, 95% CI 1.61-35.40). CONCLUSION: Compared with susceptible inpatients in a different room from infectors and not being cared for by the same nurses, the risk of VREfm acquisition could be six times higher for susceptible inpatients who are in the same room as infectors, and could be double for susceptible inpatients cared for by the same nurses as infectors.
Assuntos
Infecção Hospitalar , Enterococcus faecium , Infecções por Bactérias Gram-Positivas , Enterococos Resistentes à Vancomicina , Humanos , Vancomicina , Japão/epidemiologia , Estudos Retrospectivos , Surtos de Doenças/prevenção & controle , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controleRESUMO
The present work aims at modeling the entire convection flux ρuW¯ in the transport equation for a mean reaction rate ρW¯ in a turbulent flow, which (equation) was recently put forward by the present authors. In order to model the flux, several simple closure relations are developed by introducing flow velocity conditioned to reaction zone and interpolating this velocity between two limit expressions suggested for the leading and trailing edges of the mean flame brush. Subsequently, the proposed simple closure relations for ρuW¯ are assessed by processing two sets of data obtained in earlier 3D Direct Numerical Simulation (DNS) studies of adiabatic, statistically planar, turbulent, premixed, single-step-chemistry flames characterized by unity Lewis number. One dataset consists of three cases characterized by different density ratios and is associated with the flamelet regime of premixed turbulent combustion. Another dataset consists of four cases characterized by different low Damköhler and large Karlovitz numbers. Accordingly, this dataset is associated with the thin reaction zone regime of premixed turbulent combustion. Under conditions of the former DNS, difference in the entire, ρuW¯ , and mean, uρW¯ , convection fluxes is well pronounced, with the turbulent flux, ρu''W''¯ , showing countergradient behavior in a large part of the mean flame brush. Accordingly, the gradient diffusion closure of the turbulent flux is not valid under such conditions, but some proposed simple closure relations allow us to predict the entire flux ρuW¯ reasonably well. Under conditions of the latter DNS, the difference in the entire and mean convection fluxes is less pronounced, with the aforementioned simple closure relations still resulting in sufficiently good agreement with the DNS data.
RESUMO
A 71-year-old Japanese male with myelodysplastic syndrome progressing to overt leukaemia and hepatocellular carcinoma developed dyspnea and urticaria immediately after infusion of platelet concentrate (PC). He exhibited an identical reaction following blood transfusion. Serum haptoglobin was undetectable. The patient was determined to be homozygous for Hp(del) by polymerase chain reaction (PCR). Antibody to haptoglobin was detected by enzyme-linked immunosorbent assay (ELISA) and Western blot analysis. No antibodies against human leucocyte antigen (HLA) or platelet-specific antigens were detected. Washed PC and washed red blood cells were effective in preventing the transfusion-related anaphylactoid reactions.
Assuntos
Transfusão de Eritrócitos/efeitos adversos , Haptoglobinas/deficiência , Transfusão de Plaquetas/efeitos adversos , Idoso , Anafilaxia/etiologia , Anafilaxia/imunologia , Transfusão de Eritrócitos/normas , Deleção de Genes , Haptoglobinas/genética , Haptoglobinas/imunologia , Homozigoto , Humanos , Isoanticorpos/sangue , Masculino , Síndromes Mielodisplásicas/sangue , Síndromes Mielodisplásicas/terapia , Transfusão de Plaquetas/normasAssuntos
Antígenos/sangue , Crise Blástica/imunologia , Glicoproteínas/sangue , Leucemia Mielogênica Crônica BCR-ABL Positiva/imunologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Antígenos/genética , Antígenos de Neoplasias , Biomarcadores Tumorais/sangue , Crise Blástica/diagnóstico , Crise Blástica/patologia , Células da Medula Óssea/imunologia , Células da Medula Óssea/metabolismo , Células da Medula Óssea/patologia , Glicoproteínas/genética , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Monócitos/imunologia , Monócitos/metabolismo , Monócitos/patologia , Mucina-1 , Mucinas , RNA Mensageiro/sangue , RNA Neoplásico/sangue , Reação em Cadeia da Polimerase Via Transcriptase ReversaAssuntos
Neoplasias Hematológicas/sangue , Interleucina-18/sangue , Proteínas de Neoplasias/sangue , Adulto , Idoso , Linhagem Celular/efeitos dos fármacos , Linhagem Celular/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Glicoproteínas/sangue , Glicoproteínas/farmacologia , Humanos , Peptídeos e Proteínas de Sinalização Intercelular , Interferon gama/metabolismo , Interleucina-18/antagonistas & inibidores , Interleucina-18/farmacologia , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/antagonistas & inibidores , Proteínas de Neoplasias/farmacologiaAssuntos
Fator de Crescimento de Hepatócito/sangue , Histiocitose de Células não Langerhans/sangue , Interleucina-18/sangue , Glicoproteínas de Membrana/sangue , Proteínas de Neoplasias/sangue , Receptores da Transferrina/sangue , Receptor fas/sangue , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Infecções por Vírus Epstein-Barr/complicações , Proteína Ligante Fas , Feminino , Histiocitose de Células não Langerhans/etiologia , Histiocitose de Células não Langerhans/cirurgia , Humanos , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/cirurgia , Prednisona/administração & dosagem , Esplenectomia , Infecções Tumorais por Vírus/complicações , Vincristina/administração & dosagemAssuntos
Antígenos/sangue , Biomarcadores Tumorais/sangue , Glicoproteínas/sangue , Interleucina-18/sangue , Receptores da Transferrina/sangue , Adulto , Antígenos de Neoplasias , Doença Crônica , Histiocitose de Células não Langerhans/sangue , Doença de Hodgkin/sangue , Humanos , Leucemia Linfocítica Crônica de Células B/sangue , Leucemia Mieloide Aguda/sangue , Leucemia-Linfoma de Células T do Adulto/sangue , Linfoma não Hodgkin/sangue , Mucina-1 , Mucinas , Mieloma Múltiplo/sangue , Síndromes Mielodisplásicas/sangue , Transtornos Mieloproliferativos/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , SolubilidadeAssuntos
Interleucina-18/sangue , Linfoma não Hodgkin/sangue , Análise Atuarial , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Humanos , Linfoma não Hodgkin/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Indução de Remissão , Taxa de SobrevidaRESUMO
A 20 year-old male patient was admitted to our department for the treatment of recurrence of fever and pancytopenia developed despite of temporal remission of hemophagocytosis syndrome that had been treated with large doses of methylprednisolone in our hospital. Superficial lymph nodes were not palpable. CT scan and echography revealed neither findings of splenohepatomegalia or enlargement of intraabdominal lymph nodes. Bone marrow aspiration showed an increase of histiocytes, the cells phagocytizing erythrocytes and platelets, and a negative test for peroxidase stain. Analysis of surface antigens showed that 11.3% of cells were blast cells positive for CD10, CD19, CD20, CD34 and TdT. Bone marrow biopsy revealed a localized increase in tumor cells positive for L26, CD10 and negative for UCHL-1. Because of the absence of detectable tumor masses and the difficulty in differentiating between malignant lymphoma and lymphatic leukemia, we diagnosed the condition as B precursor lymphoblastic leukemia/lymphoma. If diagnosed with malignant lymphoma preceded by hemophagocytic syndrome(LAHS), he might have a rare type of LAHS-associated malignant lymphoma since histological examination did not reveal diffuse large cell lymphoma, a condition found in most patients with LAHS-associated malignant lymphoma. Whereas if diagnosed as ALL, he was the first adult patient with ALL with HPS at onset as far as we know. In any of these possibilities, the case was considered rare.
Assuntos
Histiocitose de Células não Langerhans/etiologia , Leucemia Linfoide/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adulto , Linfócitos B/patologia , Células da Medula Óssea/patologia , Evolução Fatal , Histiocitose de Células não Langerhans/patologia , Humanos , Leucemia Linfoide/diagnóstico , Leucemia Linfoide/patologia , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologiaRESUMO
A 25-year-old woman was admitted to our hospital because of dark red urine in 1993. A diagnosis of hemolytic uremic syndrome (HUS) because of findings of hemolytic anemia with fragmented erythrocytes, thrombocytopenia, and renal dysfunction. The patient achieved remission with steroids and diuretics. In 1998 she caught a cold and happened to take the nonsteroidal anti-inflammatory drug, pranoprofen. Six hours later, she was rehospitalized because of dark red urine. Hemolytic anemia, fragmented erythrocytes, thrombocytopenia and renal dysfunction were observed again, also. A diagnosis of HUS was made. The patient was treated with steroid pulse therapy, infusion of fresh plasma, and plasma exchange transfusion. She recovered completely. In 1993 she had taker pranoprofen just prior to her first HUS episode. This was a recurrent case of HUS induced by pranoprofen.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Benzopiranos/efeitos adversos , Síndrome Hemolítico-Urêmica/induzido quimicamente , Propionatos/efeitos adversos , Adulto , Anti-Inflamatórios/administração & dosagem , Feminino , Síndrome Hemolítico-Urêmica/terapia , Humanos , Metilprednisolona/administração & dosagem , Troca Plasmática , Recidiva , Resultado do TratamentoRESUMO
A 42-year-old woman underwent a myomectomy on March 31, 1998. On the 10th postoperative day, leukopenia and reticulocytopenia were observed. Bone marrow aspiration revealed severe erythroblastopenia with giant proerythroblasts, suggesting a recent parvovirus infection. Both anti-parvovirus B19 IgM antibody and IgG antibody seroconversion was observed, and human parvovirus B19 DNA was detected by polymerase chain reaction (PCR) methods. The hematologic data on the patient rapidly improved thereafter. It was determined that acute-phase serum had inhibited CFU-E and BFU-E derived colony formation. Based on these findings, parvovirus B19-induced aplastic crisis was diagnosed. Fibrin sealant, which is a typical hemostatic agent produced from blood, had been during the operation. Human parvovirus B19 DNA was detected in the fibrin sealant by PCR. Our case report documents the transmission of human parvovirus B19 by fibrin sealant.
Assuntos
Eritema Infeccioso/complicações , Adesivo Tecidual de Fibrina/efeitos adversos , Complicações Pós-Operatórias , Aplasia Pura de Série Vermelha/etiologia , Adesivos Teciduais/efeitos adversos , Doença Aguda , Adulto , Feminino , Humanos , Leiomioma/cirurgia , Neoplasias Uterinas/cirurgiaRESUMO
We report two patients with out-of-hospital cardiac arrest who recovered after hypothermia therapy. A 25-year-old man and a 16-year-old boy were transferred to our hospital after cardiopulmonary arrest due to idiopathic ventricular fibrillation and hypertrophic cardiomyopathy, respectively. We carried out hypothermia therapy using cooling blankets, and the patients were maintained at 32-33 degrees C for 96 and 36 h, respectively. After slow rewarming, they regained consciousness and recovered. During hypothermia, hypokalemia and arrhythmia occurred. Their arrest times (no spontaneous circulation and no CPR) were 10 min and 8 min, and CPR times (no spontaneous circulation while CPR was being performed) were 24 min and 20 min, respectively. In cases where the duration of ischemia is prolonged, the prognosis is expected to be poor. Therefore, we believe that hypothermia therapy is beneficial for such patients.
Assuntos
Parada Cardíaca/terapia , Hipotermia Induzida/métodos , Adolescente , Adulto , Cardiomiopatia Hipertrófica/complicações , Reanimação Cardiopulmonar , Parada Cardíaca/etiologia , Humanos , Masculino , Alta do Paciente , Fibrilação Ventricular/complicaçõesRESUMO
Twenty three consecutive cases of left ventricular aneurysm due to antero-septal myocardial infarction in normal sinus rhythm were studied to decide whether or not magnetic resonance imaging (MRI) can evaluate aneurysm of the left ventricular apex. The apex, as well as the base, of the left ventricle was clearly imaged in 21 out of 23 cases. Poor images were obtained in two cases who showed frequent premature ventricular beats during this procedure. Two-dimensional echocardiography has weak points when visualizing left ventricular apex because, for one thing, the sector angle is maximally 90 degrees, and for another, the cardiac apex is too near the probe for observation of the characteristic of the left ventricular apical wall. However, MRI can make up for the above weak points and can provide supportive information by visualizing the entire left ventricular apex.
Assuntos
Aneurisma Cardíaco/diagnóstico , Imageamento por Ressonância Magnética , Adulto , Ecocardiografia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Patients with Treacher Collins syndrome pose a serious problem to anaesthetists in maintaining their airway because of retrognathia. Two patients with Treacher Collins syndrome undergoing tympanoplasty are reported in whom a laryngeal mask was used in place of an endotracheal tube for airway maintenance.