Dendron based antifouling, MRI and magnetic hyperthermia properties of different shaped iron oxide nanoparticles.

Owing to the great potential of iron oxide nanoparticles (NPs) for nanomedicine, large efforts have been made to better control their magnetic properties, especially their magnetic anisotropy to provide NPs able to combine imaging by MRI and therapy by magnetic hyperthermia. In that context, the design of anisotropic NPs appears as a very promising and efficient strategy. Furthermore, their bioactive coating also remains a challenge as it should provide colloidal stability, biocompatibility, furtivity along with good water diffusion for MRI. By taking advantage of our controlled synthesis method of iron oxide NPs with different shapes (cubic, spherical, octopod and nanoplate), we demonstrate here that the dendron coating, shown previously to be very suitable for 10 nm sized iron oxide, also provided very good colloidal, MRI and antifouling properties to the anisotropic shaped NPs. These antifouling properties, demonstrated through several experiments and characterizations, are very promising to achieve specific targeting of disease tissues without affecting healthy organs. On the other hand, the magnetic hyperthermia properties were shown to depend on the saturation magnetization and the ability of NPs to self-align, confirming the need of a balance between crystalline and dipolar magnetic anisotropies.

[Living in abundance in the ancient and modern worlds from a medical and cultural-historical point of view]. / Weiterleben im Uberfluss in der antiken und modernen Welt aus medizin- und kulturhistorischer Sicht.

Comparative investigations centre on attitudes of demand and consumption in ethnic groups living in affluence, beginning with the first pre-Christian century in the Roman Empire on the one hand and in Western countries in the post-industrial age of hight-tech in times of far advanced globalization on the other. In this context medical, psycho-social and socio-economical aspects will be treated considering ideal and cultural breaks. Renowned Roman and Greek historians, physicians and philosophers are vouching as witnesses of the times for developments in the antique world with their literary works, in excerpts and verbatim. Obviously general moral decay is a side effect of any affluence. Even in the antiquitiy the "ideology of renewal" proclaimed by the Emperor Augustus died away mostly in emptiness just as do the appeals for improving one's state of health for surviving directed to all citizens in our time. With the rise of Rome as a world power general relative affluence was widespread to such an extent that diseases caused by affluence have occured as mass phenomena. The old Roman virtues of temperance and frugality turned into greed and addiction to pleasure. In this way the Roman people under the banner of affluence degenerated into a society of leisure time, consumption, fun and throwaway mentality. The decline of the Empire was predetermined. The promise of affluence which modern Europe is addicted to is demanding its price following the principle of causality. "How the pictures resemble each other!"

[Of bugs and joints. Oligoarthritis caused by Tropheryma whipplei]. / Oligoarthritis durch Tropheryma whipplei. "Of bugs and joints".

Whipple's disease is a rare, chronic infection caused by Tropheryma whipplei, an ubiquitary gram positive bacterium. The disease is associated with a high mortality in absence of an antibiotic treatment. The disease can be detected in affected tissues and body fluids by light and electron microscopy, as well as by polymerase chain reaction (PCR). Musculoskeletal symptoms such as arthralgia and arthritis frequently represent the first manifestation of this multi-system disease; typical subsequent symptoms are weight loss, diarrhea, and abdominal pain. Symptoms of central nervous system involvement are present in 10-40% of cases. We report on a 67 year-old male with a history of migratory oligoarthritis over three decades in whom the causative agent was detected by PCR in synovial fluid only. This case illustrates that searches for the characteristic PAS-positive macrophages and PCR in biopsies from the duodenum may be insufficient and that diagnostic efforts should be complemented with PCR assays from affected tissues or body fluids. It is recommended that antibiotic treatment be carried out with an agent that penetrates well into the cerebrospinal fluid, e.g. ceftriaxone, followed by cotrimoxazole. Antibiotics should be maintained over several months to years. It is prudent to document the disappearance of the pathogen in the affected compartments prior to the discontinuation of the antibiotic therapy.

Revised recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic - what a difference a year makes.

BACKGROUND: During the early part of the COVID-19 pandemic, the Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force published recommendations on performance of tracheotomy. Since then, our understanding of the virus has evolved with ongoing intensive research efforts. New literature has helped us better understand various aspects including patient outcomes and health care worker (HCW) risks associated with tracheotomy during the COVID-19 pandemic. Accordingly, the task force has re-evaluated and revised some of the previous recommendations. MAIN BODY: Based on recent evidence, a negative reverse transcription polymerase chain reaction (RT-PCR) COVID-19 swab status is no longer the main deciding factor in the timing of tracheotomy. Instead, tracheotomy may be considered as soon as COVID-19 swab positive patients are greater than 20 days beyond initial symptoms and 2 weeks of mechanical ventilation. Furthermore, both open and percutaneous surgical techniques may be considered with both techniques showing similar safety and outcome profiles. Additional recommendations with discussion of current evidence are presented. CONCLUSION: These revised recommendations apply new evidence in optimizing patient and health care system outcomes as well as minimizing risks of COVID-19 transmission during aerosol-generating tracheotomy procedures. As previously noted, additional evidence may lead to further evolution of these and other similar recommendations.

Stronger correlation between antibiotic use and the incidence of Clostridium difficile determined by culture results instead of faecal toxin detection only.

The detection of Clostridium difficile in previous studies evaluating antibiotic use as a risk factor was limited to toxin assay tests. The reported associations may have been misleading due to the low sensitivity of toxin assay tests compared to culture results. Antibiotic use and the incidence of C. difficile of 19 units (wards) over 5 years were analysed. Stool samples were tested for toxin A/B and cultured. The correlation of antibiotic use with the incidence of C. difficile determined by culture results was compared to the correlation determined by toxin assay results. Additionally, single antibiotics were analysed as risk factors. Of 5,772 faecal samples tested for C. difficile, 154 single-first cases were detected by the toxin assay and 251 additional single-first cases by culture. Antibiotic use was a significantly stronger risk factor in the correlation based on the culture results (R² = 0.63) versus toxin assay results (R² = 0.40). Multivariate analysis did not improve the correlation significantly and only the group of broad-spectrum beta-lactams was identified as an independent risk factor. The correlation between antibiotic use and C. difficile incidence rates significantly improves if detection is not limited to faecal toxin assays. Therefore, antibiotic pressure was previously underestimated as a risk factor.

Eradication of an epidemic methicillin-resistant Staphylococcus aureus (MRSA) from a geriatric university hospital: evidence from a 10-year follow-up.

We report on a successful eradication of methicillin-resistant S. aureus (MRSA) after an epidemic in 1992 in the geriatric ward of a tertiary-care hospital. After identification of MRSA in seven patients, all patients and staff members in the geriatric ward underwent screening. A multifaceted intervention plan was implemented: contact isolation, optimization of infection control and decolonization of all MRSA carriers. Thirty-two patients and five staff members were found to be MRSA carriers. Twenty one of 32 (66%) patients and all five staff members were successfully decolonized. Seven of 32 (22%) patients died during the epidemic before decolonization. A couple was discharged with persisting MRSA colonization and two individuals were lost to follow-up. The eradication of the epidemic clone was proven by systematic screenings in 1995 and 1997. Since then, the strain has no longer been identified in our institution, based on epidemiological surveillance and molecular typing of all MRSA strains obtained from any specimen. This study provides strong evidence that long-term eradication of an MRSA epidemic in a hospital is feasible, and endemicity of MRSA after an outbreak can be avoided. The successful bundle approach for eradication of MRSA during an epidemic is expensive, but the long-term benefits likely outweigh the initial heavy use of resources.

How much money can be saved by applying intravenous antibiotics once instead of several times a day?

BACKGROUND: The preparation, administration and monitoring of intravenous (IV) applications are time consuming and require human resources. We estimated the potential time and cost savings by replacing antibiotics given 3-4 times daily with antibiotics with similar spectrum and efficacy given once daily. METHODS: The savings of indirect costs were estimated based on the antibiotic consumption data of a two-year period (i.e. 2007 and 2008), a nurse's mean workload per application and the average nurse's salary in Switzerland. RESULTS: The consumption of IV antibiotics in 2007 and 2008 at the University Hospital of Basel was 29.0 and 32.2 defined daily doses (DDD) per 100 patient days, respectively. Nurses spent an estimated 13,786 h on the application of the estimated 82,715 does of IV antibiotics. A total of 56,404 applications or nursing staff time costs of 338,436 Swiss Francs (CHF; 236,669 ), equal to 16% of the overall costs spent on purchasing antibiotics in the year 2008, may have been saved by switching multiple-dose antibiotics to a hypothetical once-daily antibiotic. Including disposable materials, 21% or 456,884 CHF (319,499 ) could be saved annually (purchase costs not taken into account). CONCLUSION: We found a potential cost saving of 21% of the purchase costs in a 750-bed institution. Hence, indirect costs should be included in the calculation of the total cost for the application of broad-spectrum IV antibiotics. Switching from a 3-4 times daily application to a once-daily antibiotic should be considered if a once-daily antibiotic is deemed equally effective and has a similar spectrum.

CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on return to Otolaryngology - Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada.

The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.

Development of a tool to assess evidence for causality in studies implicating sink drains as a reservoir for hospital-acquired gammaproteobacterial infection.

BACKGROUND: Decades of studies document an association between Gammaproteobacteria in sink drains and hospital-acquired infections, but the evidence for causality is unclear. AIM: We aimed to develop a tool to assess the quality of evidence for causality in research studies that implicate sink drains as reservoirs for hospital-acquired Gammaproteobacterial infections. METHODS: We used a modified Delphi process with recruited experts in hospital epidemiology to develop this tool from a pre-existing causal assessment application. FINDINGS: Through four rounds of feedback and revision we developed the 'Modified CADDIS Tool for Causality Assessment of Sink Drains as a Reservoir for Hospital-Acquired Gammaproteobacterial Infection or Colonization'. In tests of tool application to published literature during development, mean percent agreement ranged from 46.7% to 87.5%, and the Gwet's AC1 statistic (adjusting for chance agreement) ranged from 0.13 to 1.0 (median 68.1). Areas of disagreement were felt to result from lack of a priori knowledge of causal pathways from sink drains to patients and uncertain influence of co-interventions to prevent organism acquisition. Modifications were made until consensus was achieved that further iterations would not improve the tool. When the tool was applied to 44 articles by two independent reviewers in an ongoing systematic review, percent agreement ranged from 93% to 98%, and the Gwet's AC1 statistic was 0.91-0.97. CONCLUSION: The modified causality tool was useful for evaluating studies that implicate sink drains as reservoirs for hospital-acquired infections and may help guide the conduct and reporting of future research.

International Society of Cardiovascular Infectious Diseases Guidelines for the Diagnosis, Treatment and Prevention of Disseminated Mycobacterium chimaera Infection Following Cardiac Surgery with Cardiopulmonary Bypass.

Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention (field of hospital epidemiology), clinical management (infectious disease specialists, cardiac surgeons, ophthalmologists, others), laboratory diagnostics (microbiologists, molecular diagnostics), device management (perfusionists, cardiac surgeons) and public health aspects.

Flour beetles: responses to extracts of their own pupae.

Two species of flour beetles, Tribolium confusum and Tribolium castaneum, respond to neutral pith disks impregnated with aqueous extracts of their pupae in such a way that the adults and larvae tend to select the extract of the other species. These findings have implications for the population ecology of Tribolium.

Secular trend and risk factors for antimicrobial resistance in Escherichia coli isolates in Switzerland 1997-2007.

BACKGROUND: Antibacterial resistance in Escherichia coli isolates of urinary infections, mainly to fluoroquinolones, is emerging. The aim of our study was to identify the secular trend of resistant E. coli isolates and to characterize the population at risk for colonization or infections with these organisms. PATIENTS AND METHODS: Retrospective analysis of 3,430 E.coli first isolates of urine specimens from patients admitted to the University Hospital Basel in 1997, 2000, 2003, and 2007. RESULTS: Resistance to ciprofloxacin, trimethoprim/sulfamethoxazole, and amoxicillin/clavulanate has increased over the 10-year study period (from 1.8% to 15.9%, 17.4% to 21.3%, and 9.5% to 14.5%, respectively). A detailed analysis of the 2007 data revealed that independent risk factors for ciprofloxacin resistance were age (5.3% < 35 years of age to 21.9% in patients > 75 years; odds ratio [OR] 1.29 per 10 years, 95% confidence interval [CI] 1.15-1.45, p < 0.001) and male gender (OR 1.59, 95% CI 1.05-2.41, p = 0.04). In contrast, nosocomial E. coli isolates were associated with lower odds of ciprofloxacin resistance (OR 0.51, 95% CI 0.28-0.67, p < 0.001). The frequency of resistant isolate rates was not influenced by the clinical significance (i.e., colonization vs urinary tract infection, UTI) or by whether the urine was taken from a urinary catheter. Importantly, the increase in ciprofloxacin resistance paralleled the increase in ciprofloxacin consumption in Switzerland (Pearson's correlation test R(2)= 0.998, p = 0.002). Of note, resistance was less frequent in isolates sent in by general practitioners. However, after adjustment for age and gender, only resistance against amoxicillin/clavulanate was found to be less frequent (OR 0.34, 95% CI 0.16-0.92, p = 0.03). CONCLUSION: Our study reveals that resistance rates have been increasing during the last decade. Published resistance rates may lack information due to important differences regarding age, gender, and probable origin of the isolates. Empirical therapy for UTI should be guided more on individual risk profile and local resistance data than on resistance data banks.

[The evolutionary and revolutionary genesis of affluence and its consequences]. / Die evolutionäre und revolutionäre Entstehungsgeschichte von Wohistand und Folgeerscheinungen.

In the course of the "Neolithic Revolution", while the warming after the glacial period about 13,000 years ago was starting, the crucial evolution of mankind took place, which has consequences to this day. With the beginning of agriculture and metallurgy a transition from an accidental outlook on life to a deliberate shaping of life set in. A chance from almost egalitarian tribal societies oriented solely towards consumption into production societies organized in a hierarchically complex way was not solely the result of an adaptation to climatic conditions, but also of a positively selecting evolution of the intellect. Following the socially relevant upheavals connected with this, the prerequisites for starting modest prosperity only for a privileged few across millenniums were created. Problems and future prospects of today's global distribution of affluence are discussed.

[Philosophy of the mutual biotic system of man-environment]. / Philosophie des gemeinsamen biotischen Systems Mensch-Umwelt.

With regard to environmental changes, outstanding importance is meanwhile to be attached to the cultural side of human evolution. The evolution both of mankind and of its environment are mutually dependent as processes of change and together they form a complete biotic system. First disorders of balance concerning the close relationship network between mankind and environment eventually developed following man's change from the biosphere to the "noosphere" created by him. In the course of the "neolithic revolution" mankind, while becoming more and more settled, began to become increasingly estranged from its ecological surroundings. Environmental problems caused by man led to climatic changes already about 8,000 years ago. So far they have caused an extraordinary climatic stability following the Ice Age. "Environmental art" i. e. an improved evolution - is required to escape an imminent "collapse" caused by pollution. Nowadays mankind is on the way to being the almost exclusive carrier of future evolution of this planet.

Resistance patterns of Enterobacteriaceae in urines are similar in symptomatic and asymptomatic patients.

Antibiograms of urine cultures are being used to guide empiric treatment for urinary tract infections (UTIs). However, roughly 50% of urine cultures are from patients with asymptomatic bacteriuria (ABU). It is unclear whether Enterobacteriaceae in ABU patients have similar resistance patterns as UTI patients. Hence, we aimed to compare the antimicrobial resistance patterns in patients with ABU to patients with symptomatic UTI. We found no major differences in resistance patterns, and therefore empiric treatment choices can be guided by antibiograms that include ABU patients.

Erratum to: Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).

[This corrects the article DOI: 10.1186/s13017-016-0089-y.].