Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study

OBJECTIVES

The aim was to compare the burden of environmental shedding of toxigenic Clostridioides difficile among asymptomatic carriers, C. difficile-infected (CDI) patients and non-carriers in an inpatient non-epidemic setting.

METHODS

C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive two-step enzyme immunoassay/polymerase chain reaction (EIA/PCR) test in patients with more than three unformed stools/24 hr. C. difficile environmental contamination was assessed by obtaining specimens from ten sites in the patients' rooms. Toxigenic strains were identified by PCR. We created a contamination scale to define the overall level of room contamination that ranged from clean to heavy contamination.

RESULTS

One hundred and seventeen rooms were screened: 70 rooms inhabited by C. difficile carriers, 30 rooms by active CDI patients and 17 rooms by non C. difficile -carriers (control). In the carrier rooms 29 (41%) had more than residual contamination, from which 17 (24%) were heavily contaminated. In the CDI rooms 12 (40%) had more than residual contamination from which three (10%) were heavily contaminated, while in the control rooms, one room (6%) had more than residual contamination and none were heavily contaminated. In a multivariate analysis, the contamination score of rooms inhabited by carriers did not differ from rooms of CDI patients, yet both were significantly more contaminated than those of non-carriers odd ratio 12.23 and 11.16 (95% confidence interval 1.5-99.96 p 0.0195, and 1.19-104.49 p 0.035), respectively.

DISCUSSION

Here we show that the rooms of C. difficile carriers are as contaminated as those of patients with active CDI and significantly more than those of non-carriers.

Imaging the Spatiotemporal Dynamics of Cognitive Processes at High Temporal Resolution

This letter presents a noninvasive imaging technique that captures the exact timing and locations of cortical activity sequences that are specific to a cognitive process. These precise spatiotemporal sequences can be detected in the human brain as specific time-position pattern associated with a cognitive task. They are consistent with direct measurements of population activity recorded in nonhuman primates, thus suggesting that specific time-position patterns associated with a cognitive task can be identified. This imaging technique is based on estimating the amplitude of cortical current dipoles from MEG recordings. Although the spatial resolution of these estimations is poor (approximately 2 cm), the temporal resolution is high (milliseconds). We show that within these cortical current dipoles, time points of cortical activation can be identified as brief amplitude undulations and that sequences of these transients repeat with millisecond accuracy, hence making it possible to treat the timing of these transients as point processes. We illustrate the feasibility of finding spatiotemporal templates specific to the cognitive processes associated with following the rhythm of drumbeats that involve the activation at multiple cortical and cerebellar loci. These templates evolve at an accuracy of a few milliseconds. This approach can thus pave the way for new perspectives on the relationships between brain dynamics and cognition.

Cleaning MEG artifacts using external cues

Using EEG, ECoG, MEG, and microelectrodes to record brain activity is prone to multiple artifacts. The main power line (mains line), video equipment, mechanical vibrations and activities outside the brain are the most common sources of artifacts. MEG amplitudes are low, and even small artifacts distort recordings. In this study, we show how these artifacts can be efficiently removed by recording external cues during MEG recordings. These external cues are subsequently used to register the precise times or spectra of the artifacts. The results indicate that these procedures preserve both the spectra and the time domain wave-shapes of the neuromagnetic signal, while successfully reducing the contribution of the artifacts to the target signals without reducing the rank of the data.

Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections

The aim of this study was to evaluate the impact of carbapenem-resistant K. pneumoniae bloodstream infections on mortality. During the study period 42, 68 and 120 patients were identified with carbapenem-resistant, extended-spectrum β-lactamase producers (ESBL) and susceptible K. pneumoniae bloodstream infections, respectively. Patients with carbapenem-resistant K. pneumoniae had higher rates of prior antimicrobial exposure, other nosocomial infections, and use of invasive devices. Infection-related mortality was 48% for carbapenem-resistant, 22% for ESBL producers and 17% for susceptible K. pneumoniae. Independent risk factors for infection-related mortality were Pitt bacteraemia score, Charlson score and carbapenem resistance.

A low-cost, full-function picture archiving and communication system using standard PC hardware and the traditional 4-over-4 display format

OBJECTIVE

With a 12-year background of our completely digital nuclear medicine picture archiving and communication system (PACS), we have recently implemented a novel PACS, OpenPACS, which can be used for interpretation and display of CT, MR imaging, sonography, nuclear medicine, and computed and digital radiography studies. OpenPACS uses low-cost standard PC hardware and software that is widely available and is readily serviced and maintained. The OpenPACS application program is available over the Internet. CT or MR imaging slices from one or multiple studies can be presented simultaneously or in cine mode on a wall-sized multimonitor display. The assembly, with a total resolution of 6400 x 4800 pixels, resembles a traditional array of eight standard X-ray viewboxes. A wireless mouse is used to vary attenuation and other display parameters. Multiple backup and redundancy are provided. Currently, six CT and six MR imaging scanners of different vendors are networked to OpenPACS, which is also networked to our nuclear medicine PACS.

CONCLUSION

After only a brief introduction, radiologists rapidly become familiar with the system because it is based on the use of standard Windows icons and procedures and offers a display that resembles a standard X-ray film presentation.

High association of anticardiolipin antibodies with psychosis

BACKGROUND

Lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) are autoantibodies that can be detected in plasma or serum of patients with autoimmune-related diseases. The presence of these autoantibodies has been associated with recurrent arterial and/or venous thromboembolism as well as with recurrent fetal loss and thrombocytopenia. In recent years, other medical conditions such as dementia, chorea, psychosis, migraine, and peripheral neuropathy have been associated with these autoantibodies. An adverse response to neuroleptic treatment was reported to be associated with the presence of autoantibodies, but these patients rarely developed clinical vascular manifestations.

METHOD

We conducted a study of 34 unmedicated patients admitted to the hospital with acute psychosis in whom aCL and LA were examined before and after neuroleptic treatment to determine the presence of antibodies relative to the treatment condition.

RESULTS

32% (11/34) of the unmedicated psychotic patients had antiphospholipid antibodies: we detected elevated titers of IgG-aCL isotype in 24% (8/34) of unmedicated patients (p < .02 compared with 20 normal controls, none of whom tested positive), and 9% (3/34) had LA. Twenty-two patients were followed up after medication; 31.8% (7/22) of these patients showed moderate titers of IgG-aCL (p < .28), and 18.2% (4/22) were LA positive. Altogether, antiphospholipid antibodies were detected in 40.9% (9/22) of the medicated patients.

CONCLUSION

This study shows the increased incidence of LA and aCL antibodies in neuroleptic-treated psychotic patients and the possible association between psychosis and antiphospholipid antibodies.

Tardive dyskinesia in northern Israel: preliminary study

Tardive dyskinesia (TD) is an iatrogenic syndrome caused by long-term treatment with neuroleptics and is characterized by abnormal involuntary movements in the orofacial region, lingual dyskinesia and in some cases dyskinesia also in the extremities, head and trunk. In the present study we found 20% TD in chronic-neuroleptic-treated patients with a significantly greater prevalence in females (27% of the total population), and a higher frequency in older patients. In males, patients who received electroconvulsive therapy had a significantly lower prevalence of TD. 23 patients had seizures; 7 of these suffered from TD, all of them female.

Behcet disease: long-term follow-up of three children and review of the literature

Behcet disease is rare in children. There are only two reports of Behcet disease in childhood, describing seven patients. Three pediatric patients are described, in whom the age of onset ranged from 6 to 11 years. Aphthous stomatitis and arthritis were present in all of the patients; genital ulcers, iridocylitis, erythema nodosum, and CNS involvement were present in two patients. Other manifestations included Stevens-Johnson-like eruption, fever of unknown origin, and testicular involvement. All of the patients responded to glucocorticoids; two were also treated with colchicine and one was treated with chlorambucil. In two patients, follow-up of more than 10 years was done, with complete cure in one patient and benign course of illness in the other. Because of the rarity of the disease in childhood and the difficulty in making the diagnosis, there is not enough awareness by pediatricians concerning this disease.

Evaluation of routine telephone transmission of nuclear medicine studies

Rapid and reliable transmission of nuclear medicine studies using conventional telephone lines and commercially available modems and computer systems has been accomplished through use of software developed within the authors' hospital. Original digital images of all-night and weekend studies, acquired on any of the acquisition computers from different manufacturers, are now routinely sent for remote reading at the physician's home. Data, software, and letters are routinely exchanged using modems and standard telephone lines with a sister institution in Haifa, Israel. The software has been designed to achieve no loss data compression and minimal turnaround time loss. Thus, an average lung perfusion image or gallbladder study requires about 1-3 minutes of transmission time. Full analysis and display software is available on the remote computer.

Thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome in three siblings

Two brothers and one sister had three variants of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome (the 'TTP-HUS' complex). The sister had a chronic fatal variant of thrombotic thrombocytopenic purpura with severe neurological manifestation. One brother had a chronic relapsing disease but the kidneys were not affected, and the other brother had haemolytic uraemic syndrome. This occurrence in one family supports the hypothesis that haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura are actually two variants of the same disease.

Sacroiliitis as a sole manifestation of Brucella melitensis infection in a child

A case of a 12-year-old boy with sacroiliitis documented by positive Tc-99m MDP and Ga-67 scans is described. Isolation of brucella melitensis from the blood and bone marrow established the diagnosis. He responded promptly to docycycline therapy. Throughout the course of his disease this boy had neither fever nor other signs of brucellosis, and x-ray was normal.

Acid base balance in blood and cerebrospinal fluid

Thirty four infants were studied; 21 with acute gastroenteritis, dehydration, and metabolic acidosis and 13 who served as controls. All infants with metabolic acidosis and without neurological signs had a normal to near normal cerebrospinal fluid acid base balance, but five with metabolic acidosis and severe neurological signs had cerebrospinal fluid acid base disequilibrium. Acute metabolic acidosis in infants may lead to cerebrospinal fluid acid base imbalance causing cerebral dysfunction.

Reduced repeat length of nascent nucleosomal DNA is generated by replicating chromatin in vivo

Micrococcal nuclease digestion of nuclei from sea urchin embryos revealed transient changes in chromatin structure which resulted in a reduction in the repeat length of nascent chromatin DNA as compared with bulk DNA. This was considered to be entirely the consequence of in vivo events at the replication fork (Cell 14, 259, 1978). However, a micrococcal nuclease-generated sliding of nucleosome cores relative to nascent DNA, which might account for the smaller DNA fragments, was not excluded. In vivo [3H]thymidine pulse-labeled nuclei were fixed with a formaldehyde prior to micrococcal nuclease digestion. This linked chromatin proteins to DNA and thus prevented any in vitro sliding of histone cores. All the nascent DNAs exhibiting shorter repeat lengths after micrococcal nuclease digestion, were resolved at identical mobilities in polyacrylamide gels of DNA from fixed and unfixed nuclei. We conclude that these differences in repeat lengths between nascent and bulk DNA was generated in vivo by changes in chromatin structure during replication, rather than by micrococcal nuclease-induced sliding of histone cores in vitro.

Tc-99m colloid lung uptake in a rare case of toxoplasmosis with liver involvement

Intensive lung accumulation of colloid (Tc-99m phytate) was demonstrated in a child suffering from acquired toxoplasmosis with a rare manifestation of severe liver damage. The possible mechanism and clinical importance of colloid lung concentration in this case is briefly discussed, including a review of the literature on this subject.