Increasing incidence of Clostridium difficile infections: results from a 5-year retrospective study in a large teaching hospital in the Italian region with the oldest population.

Limited information is available on the incidence of Clostridium difficile infections (CDIs) in Italian hospitals. In this study, we assessed the changes in the incidence of CDI over a 5-year period in a teaching hospital in Liguria, the Italian region with the oldest population. Secondary endpoints were the development of severe CDI and 30-day mortality. The annual incidence of CDI/10000 patient-days significantly increased from 0·54 in 2010 to 3·04 in 2014 (χ 2 for trend, P < 0·001). The median age of patients with CDI was 81 years. As many as 81% and 89% of these patients had comorbid conditions and previous exposure to antibiotics, respectively. In the multivariate analysis of risk factors for severe CDI, previous therapy with histamine 2 blockers and low serum albumin were associated with severe CDI, while diabetes appeared to be protective. In the multivariate model of risk factors for 30-day mortality, high leukocyte count, low serum albumin, and increased serum creatinine were unfavourably associated with outcome. Strict adherence to infection control measures was of utmost importance to counteract the increasing incidence of CDI in our hospital, particularly because of the advanced age of the patients and their very high frequency of chronic conditions and use of antibiotics, which readily predispose them to the development of CDI.

Efecto de una intervención formativa en urgencias en la mejora del manejo y el tratamiento de la insuficiencia cardiaca aguda / Emergency-department training course on improving the management of acute heart failure: evaluation of effectiveness

Introducción y objetivos: Existe un escaso seguimiento de las recomendaciones de las guías de manejo diagnóstico y terapéutico de los pacientes con insuficiencia cardiaca aguda (ICA) en los servicios de urgencias hospitalarios (SUH). Se evalúa si un programa de intervención sobre urgenciólogos permite mejorar el cumplimiento de estas guías. Método: Se diseñó un estudio de intervención cuasi-experimental sin grupo control y con una comparación pre y post-intervención. En una primera fase, se incluyeron de forma consecutiva a 708 pacientes que acudieron al SUH de 6 hospitales españoles durante un mes con el diagnóstico principal de ICA. En una segunda fase, se realizaron diferentes programas de formación sobre el manejo de la ICA según las guías vigentes. Tras la intervención, se volvió a incluir, siguiendo la misma metodología, a 613 pacientes que acudieron de ICA. Las variables principales fueron aquéllas que estudios previos habían detectado una mayor desviación de las recomendaciones de las principales guías (determinación de troponinas plasmáticas y BNP o pro-BNP, uso de furosemida en perfusión continua o nitroglicerina endovenosa y utilización de ventilación no invasiva-VNI). Resultados: Hubo escasas diferencias entre los grupos pre y postintervención en sus características demográficas, clínicas o en el tratamiento (en el grupo postintervención, existía un mayor porcentaje de pacientes con enfermedad cerebrovascular, neumopatíacrónica, disfunción sistólica y tratamiento ambulatorio con bloqueadores beta-adrenérgicos; p < 0,05 para todos ellos). Se detectó un aumento significativo en (..) (AU)

Background and objective: Current guidelines on the diagnostic and therapeutic management of acute heart failure have not been strictly followed in hospital emergency departments. This study aimed to assess whether a training course for emergency physicians improved compliance with recommended practices. Methods: A quasi-experimental study, without a control group, was designed to compare compliance pre- and posttraining. In the first phase, we included data for 708 consecutive patients who received a principal diagnosis of acute heart failure at 6 Spanish hospitals within 1 month. In the second phase, we organized guidelines-based training on the management of acute heart failure. After the intervention, we included data for 613 consecutive patients following the same methodology. The main outcome variables were the ones that previous studies had identified as deviating most from current guidelines (determination of serum levels of troponin, brain natriuretic peptide [BNP], and N-terminal prohormone-BNP [NT-pro-BNP]; use of furosemide in continuous perfusion or intravenous nitroglycerin; and use of noninvasive ventilation). Results: Few statistically significant differences in patient, clinical, or outpatient treatment characteristics were detected between the pre- and post-training patient groups, although there was a slightly greater percentage of cerebrovascular disease, chronic respiratory disease, systolic dysfunction, and outpatient treatment with â-blockers in the postintervention group. BNP or NT-pro-BNP determinations were performed significantly more often after training (absolute increased in score, 44.7%; 95% confidence interval [CI], 39.9-49.5; (..) (AU)

Purification and molecular characterization of rat intestinal brush border membrane dipeptidyl aminopeptidase IV.

Dipeptidyl aminopeptidase IV (EC 3.4.14.-) was solubilized from a particulate membrane fraction of rat intestinal mucosa with Triton X-100. The solubilized enzyme was purified to homogeneity following ammonium sulfate fractionation, chromatography on DEAE-Sepharose and hydroxyapatite, gel filtration and preparative polyacrylamide gel electrophoresis. The final enzyme preparation had a specific activity of 55 units/mg protein representing a 1373 fold purification over the starting material. Purity was judged by polyacrylamide gel electrophoresis and double immunodiffusion. The molecular weight of the native undenatured enzyme was estimated to be 230000 by gel filtration and polyacrylamide gel electrophoresis. Electrophoresis under denaturing conditions (sodium dodecyl sulfate) indicated that the protein consists of two identical 98 kDa subunits. Dipeptidyl aminopeptidase IV is a glycoprotein containing approx. 8% carbohydrate by weight. A detailed analysis of the individual sugar components demonstrated that fucose, galactose, glucose, mannose, sialic acid and hexosamine sugars were present. The nature of the constituent asparagine linked oligosaccharide side chains was further examined following cleavage from the peptide backbone by hydrazinolysis. Following high voltage paper electrophoresis approx. 80% of the isolated oligosaccharide was found with the neutral fraction while the remaining 20% consisted of a single acidic component. Gel filtration of the neutral oligosaccharide fraction indicated that it contains approx. 19 sugar residues.