Alta View Hospital

BACKGROUND: Remifentanil is a short-acting opioid whose pharmacokinetics have been characterized in detail. However, the impact of obesity on remifentanil pharmacokinetics has not been specifically examined. The goal of this study was to investigate the influence of body weight on remifentanil pharmacokinetics. METHODS: Twelve obese and 12 matched lean subjects undergoing elective surgery received a 1-min remifentanil infusion after induction of anesthesia. Arterial blood samples were collected for determination of remifentanil blood concentrations. Each subject's pharmacokinetic parameters were estimated by fitting a two-compartment model to the concentration versus time curves. Nonlinear mixed-effects population models examining the influence of lean body mass (LBM) and total body weight (TBW) were also constructed. Clinical simulations using the final population model were performed. RESULTS: The obese patient cohort reached substantially higher remifentanil concentrations. The individual pharmacokinetic parameters of a two-compartment model were not significantly different between the obese versus lean cohorts (unless normalized to TBW). The final population model scaled central clearance and the central and peripheral distribution volumes to LBM. The simulations illustrated that remifentanil pharmacokinetics are not grossly different in obese versus lean subjects and that TBW based dosing in obese patients can result in excessively high remifentanil concentrations. CONCLUSIONS: The essential findings of the study are that remifentanil's pharmacokinetics are not appreciably different in obese versus lean subjects and that remifentanil pharmacokinetic parameters are therefore more closely related to LBM than to TBW. Clinically this means that remifentanil dosing regimens should be based on ideal body weight (or LBM) and not TBW.

The Alexon-Trend, Inc. (Ramsey, Minn.), ProSpecT Campylobacter microplate assay was compared with culture on a Campy-CVA plate (Remel, Lenexa, Kans.) and blood-free campylobacter agar with cefoperazone (20 microg/ml), amphotericin B (10 microg/ml), and teicoplanin (4 microg/ml) (CAT medium; Oxoid Limited, Hampshire, England) with 631 patient stool samples. The CAT medium was used to isolate Campylobacter upsaliensis. The enzyme immunoassay (EIA) had a sensitivity and a specificity of 89 and 99%, respectively, and the positive and negative predictive values were 80 and 99%, respectively. Even though we extensively looked for C. upsaliensis in stool samples from patients from the greater Salt Lake City area, we did not isolate this species during the study period. The overall excellent specificity of the EIA allows rapid detection and treatment of positive patients; however, a negative result should be confirmed by culture when clinical suspicion is high.

OBJECTIVE: To determine signalments, clinical features, clinicopathologic variables, imaging findings, treatments, and survival time of cats with presumed primary copper-associated hepatopathy (PCH) and to determine quantitative measures and histologic characteristics of the accumulation and distribution of copper in liver samples of cats with presumed PCH, extrahepatic bile duct obstruction, chronic nonsuppurative cholangitis-cholangiohepatitis, and miscellaneous other hepatobiliary disorders and liver samples of cats without hepatobiliary disease. DESIGN: Retrospective cross-sectional study. ANIMALS: 100 cats with hepatobiliary disease (PCH [n = 11], extrahepatic bile duct obstruction [14], cholangitis-cholangiohepatitis [37], and miscellaneous hepatobiliary disorders [38]) and 14 cats without hepatobiliary disease. PROCEDURES: From 1980 to 2013, cats with and without hepatobiliary disease confirmed by liver biopsy and measurement of hepatic copper concentrations were identified. Clinical, clinicopathologic, and imaging data were compared between cats with and without PCH. RESULTS: Cats with PCH were typically young (median age, 2.0 years); clinicopathologic and imaging characteristics were similar to those of cats with other liver disorders. Copper-specific staining patterns and quantification of copper in liver samples confirmed PCH (on the basis of detection of > 700 μg/g of liver sample dry weight). Six cats with PCH underwent successful treatment with chelation (penicillamine; n = 5), antioxidants (5), low doses of elemental zinc (2), and feeding of hepatic support or high-protein, low-carbohydrate diets, and other hepatic support treatments. One cat that received penicillamine developed hemolytic anemia, which resolved after discontinuation of administration. Three cats with high hepatic copper concentrations developed hepatocellular neoplasia. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that copper accumulates in livers of cats as primary and secondary processes. Long-term management of cats with PCH was possible.

Significant variations and inconsistency in both the physician's and nurse's approach to the treatment of neonates with a "rule-out sepsis" (R/O sepsis) diagnosis is seen as both high cost and low quality. Because R/O sepsis is seen as a diagnostic dilemma for practicing clinicians, there has been a widespread tendency to readily initiate antibiotic treatment, without adequate consideration of the high financial and morbidity costs associated with the complications of treating the noninfected infant. This study demonstrates that the use of an agreed upon risk profile facilitated the collaborative standardization of diagnosis and treatment of the R/O sepsis patient, improved quality, and reduced costs (by minimizing over treatment) without increasing risk. This collaborative approach enhanced nurse-physician relationships, resulting in significant cost savings as well as diminished anxiety and confusion among the parents of neonates diagnosed with R/O sepsis.

This study assessed the final nursing orientation for hospital release in what refers to the medicamental therapeutics in a clinic of hospital internment. The sample was comprised of 38 patients that had hospital release in December of 2001, February of 2002 and of the nurses who oriented them. The technique used for collecting data was non-participant observation. The results obtained were: inadequate places for orientation, few written information, short time for orientation and no use of strategies that confirm the comprehension of the orientation on the part of the patient. The conclusion is that those problems may be contributing for the occurrence of errors in the use of medicines at home, after hospital release.

Documented cases of anomic aphasia in childhood are rare, due to their low prevalence and relatively subtle clinical manifestations and because of probable referral bias. Such cases are important, however, because they may shed light on the nature of lesions that produce anomia in children and because they may contribute to our understanding of brain-behavior relations in children. This case involves a 10-year-old girl who experienced a left temporoparietal hematoma. Recovery over an 8-month period was good, with near normal verbal-expressive (Verbal IQ = 86) and normal perceptual-motor abilities (Performance IQ = 100). Reading, spelling, and repetition were preserved. Spontaneous speech was good, although initially circumlocutory and marked by obvious word-finding difficulty. Consistent with reports involving adults, there was significant disturbance in naming characterized by frequent literal and semantic paraphasias. Although she had significant difficulty on confrontational naming, she could accurately spell and read the name of the objects presented to her. This case is discussed relative to localization of lesions producing anomic aphasia and regarding the course of recovery in childhood.

Myophosphorylase deficiency (McArdle's disease) may present with episodic renal failure following exertion. We present a case of adult-onset myophosphorylase deficiency in which recurrent bouts of renal failure could not be associated with any exertional events until a tonic seizure was witnessed after the fourth episode of renal failure. In the absence of a clear exertional cause for myoglobinuria, an occult seizure disorder should be suspected.

The students are the group most vulnerable to disasters, especially children with disability. Teachers
\nshould have the skills to handle disasters when they occur. The low preparedness of School-Based Disaster
\nPreparedness/Sekolah Siaga Bencana (SSB) teachers in disaster risk reduction can lead to increased
\nvulnerability of teachers in dealing with disaster threats. This study was conducted to analyse the relationship
\nof the role of the teachers in the implemented curriculum SSB in Vulnerability of school teachers with
\ndisability in Malang City. This research is a quantitative study, using correlative analytic observational
\ndesign and cross sectional approach with a sample of 30 teachers taken from elementary schools and junior
\nhigh schools with disability. The results of bivariate analysis using gamma correlation test obtained the
\nresults of knowledge factors (p = 0.005; r = 0.47) attitude (p = 0.000; r = 0.75), means of infrastructure (p =
\n0.000; r = 0.98), and disaster information (p = 0.000; r = 0.59) for SSB teachers’ preparedness.

Resumo Objetivo Identificar os métodos utilizados na vigilância de infecção do sítio cirúrgico pós-alta hospitalar. Métodos Revisão integrativa, realizada nas bases de dados PubMed, Cinahl, Lilacs, Embase e Web of Science, com estudos publicados até julho de 2022, utilizando os descritores controlados: Infecção da Ferida Cirúrgica, Vigilância, Alta do Paciente, Controle de Infecções e Profissionais Controladores de Infecções. Foram identificados 2.054 títulos relevantes e destes 17 foram selecionados. Utilizou-se análise descritiva e síntese do conhecimento produzido em cada estudo. Resultados [...]

INTRODUCTION: Cervical Sympathetic Chain Schwannomas (CSCS) of the carotid sheath are rare neoplasms that can be misdiagnosed on imaging. The following case documents a rare incident of a misdiagnosed CSCS with unusual outcomes of permanent Horner's syndrome and facial pain. PRESENTATION OF CASE: A 36-year-old female presented with a slow-growing neck mass. CT and MRI led to a preoperative diagnosis of vagus nerve schwannoma (VNS). However, surgical treatment revealed the mass to be involved with the cervical sympathetic chain rather than the vagus nerve. The diagnosis was corrected to CSCS and the nerve was resected with the mass. The patient presented postoperatively with Horner's syndrome and severe facial pain. These symptoms persisted despite two years of medical management. DISCUSSION: Studies indicate that imaging trends used for distinction between VNS and CSCS show inconsistencies in making preoperative diagnoses. Recent literature reveals helpful criteria for improving diagnostic standards that assist with preoperative patient counseling. In addition, postoperative outcomes, such as temporary, asymptomatic Horner's syndrome are common in CSCS. The following case report exemplifies the difficulties in diagnosis and addresses the unique complications of facial pain and permanent Horner's syndrome. CONCLUSION: This case report examines postoperative outcomes and improves clinician awareness of the potential for misdiagnosis of a rare neoplasm and the recently improved diagnostic measures, providing for higher quality preoperative counseling. Future research is recommended to confirm and improve diagnostic guidelines and accuracy. Additional studies may focus on evaluating the effects of incorrect preoperative diagnosis on postoperative complication rates.

Abstract Background The natural history of CDI recurrence after antibiotics may be helpful to understand the window of opportunity for microbiome repair. ECOSPOR III evaluated the efficacy of SER-109, an investigational microbiome therapeutic, compared to placebo with rates of rCDI as the primary endpoint. SER-109 was superior to placebo in reducing the rate of rCDI following standard-of-care antibiotics at 8 weeks (12.4% vs 39.8%, respectively; P < 0.001). Herein, we describe results from the secondary endpoint, time to recurrence, in this well-characterized study population. Methods A total of 182 C. difficile toxin+ adults with ≥ 3 CDI episodes and symptom resolution on CDI antibiotics were randomly assigned to SER-109 (4 capsules orally x 3 days) or placebo. Recurrence for this analysis was defined as ≥ 3 unformed stools/day for ≥ 48 hours, ± C. difficile stool toxin test, and an investigator decision to treat. Time to CDI recurrence was analyzed using observed data and Kaplan-Meier methods. Data were not imputed for subjects lost to follow-up or discontinued from study. Subjects who did not have a CDI recurrence were censored on the date of study completion, study discontinuation or death. Results Through 24 weeks, 11/89 (12.4%) SER-109 and 36/93 (38.7%) placebo subjects had rCDI (P < 0.001). Of all recurrence events in the study population, 16/47 (34.0%) were observed within 1 week; 30/47 (63.8%) within 2 weeks; and 34/47 (72.3%) within 4 weeks after randomization, highlighting the rapid onset of recurrence. On the other hand, 12/47 (25.5%) recurrences occurred between 4 and 12 weeks, highlighting late onset of recurrence in a subset of patients (Table). Significantly lower rates of recurrence in patients on SER-109 compared to placebo was maintained throughout the 24-week follow-up (Figure). Time of rCDI K-M Plot Conclusion SER-109, an investigational oral microbiome therapeutic, maintained significant efficacy in reducing rCDI vs placebo through 24 weeks. About two-thirds of all recurrences occurred within 14 days of antibiotic completion highlighting the need for rapid repair of the disrupted microbiome. However, the significant number of late recurrences in the placebo arm also highlights that rCDI trials limited to 4 weeks of follow-up after treatment completion may underestimate recurrences. Disclosures Thomas J. Louie, MD, Artugen (Advisor or Review Panel member)Crestone (Consultant, Grant/Research Support)Da Volterra (Advisor or Review Panel member)Finch Therapeutics (Grant/Research Support, Advisor or Review Panel member)MGB Biopharma (Grant/Research Support, Advisor or Review Panel member)Rebiotix (Consultant, Grant/Research Support)Seres Therapeutics (Consultant, Grant/Research Support)Summit PLC (Grant/Research Support)Vedanta (Grant/Research Support, Advisor or Review Panel member) Matthew Sims, MD, PhD, Astra Zeneca (Independent Contractor)Diasorin Molecular (Independent Contractor)Epigenomics Inc (Independent Contractor)Finch (Independent Contractor)Genentech (Independent Contractor)Janssen Pharmaceuticals NV (Independent Contractor)Kinevant Sciences gmBH (Independent Contractor)Leonard-Meron Biosciences (Independent Contractor)Merck and Co (Independent Contractor)OpGen (Independent Contractor)Prenosis (Independent Contractor)Regeneron Pharmaceuticals Inc (Independent Contractor)Seres Therapeutics Inc (Independent Contractor)Shire (Independent Contractor)Summit Therapeutics (Independent Contractor) Richard Nathan, DO, none (Other Financial or Material Support, I am PI on several clinical trials. If you need that information, I would be happy to supply it.) Princy N. Kumar, MD, AMGEN (Other Financial or Material Support, Honoraria)Eli Lilly (Grant/Research Support)Gilead (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)GSK (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)Merck & Co., Inc. (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria) Elaine E. Wang, MD, Seres Therapeutics (Employee) Elaine E. Wang, MD, Seres Therapeutics (Employee, Shareholder) Robert Stevens, PharmD, Seres Therapeutics (Employee, Shareholder) Kelly Brady, MS, Seres Therapeutics (Employee, Shareholder) Barbara McGovern, MD, Seres Therapeutics (Employee, Shareholder) Lisa von Moltke, MD, Seres Therapeutics (Employee, Shareholder)

No abstract available for this article.

Data tracking in the office setting focuses on a narrow spectrum of the entire patient safety arena; however, when properly executed, data tracking increases staff members' awareness of the importance of patient safety. Data tracking is also a high-volume event and thereby continues to loop back on the consciousness of providers in all aspects of their practice. Improvement in date tracking will improve the collateral areas of patient safety such as proper medication usage, legibility of written communication, effective delegation of patient safety initiatives, and a collegial effort at developing teams for safety design processes.

Background: Dengue virus (DENV) infection is currently one of the most significant vector-borne viral diseases in terms of global morbidity and mortality. Climate change studies have demonstrated the association between dengue virus transmission and variations in ambient temperature. We performed a mini review to evaluate whether there are differences in the association between the increase in ambient temperature and the incidence of dengue among the different dengue serotypes. Methods: For this systematic review we searched MEDLINE and PubMed databases for studies published within the last 15 years, from database inception to the exception of this review, focusing on the association between dengue incidence of serotypes and temperature variations globally. We excluded studies that involved reviews, modeling with only prospective data, prediction, or predictive models. The quality of the evidence was assessed using the Newcastle-Ottawa Scale (NOS). Findings: There is a significant association between temperature and DENV infection due to global warming. No specific dengue serotypes were identified as predominant in the reviewed studies. Aedes aegypti and Aedes Albopictus, the primary dengue vectors of DENV, have different behaviors in response to temperature changes. Discussion: The findings of this review emphasize the strong relationship between temperature and dengue incidence. Expanding the geographical scope and including more prospective studies would enhance the understanding and generalizability of these findings. Conclusion: This review showed a significant relationship between temperature increases (in the context of global warming) and dengue infection, leading to potential outbreaks. A more thorough analysis of serotypes is recommended for future studies.

Background Burn wound infections (BWIs) represent a major cause of morbidity and mortality among hospitalized burn patients. Pseudomonas aeruginosa is recognized for its ability to acquire multidrug resistance (MDR) and form biofilms that enhance virulence and antimicrobial tolerance. Objective This study investigated the association between biofilm formation and multidrug resistance among P. aeruginosa isolates from burn wound infections in Sana’a City, Yemen. Methods A cross-sectional study was conducted at Republic Hospital, Sana’a City, Yemen, from October 2023 to December 2024. A total of 424 burn wound samples were collected and processed using standard microbiological techniques. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines (CLSI, 2022). Biofilm production was assessed by the microtiter plate method, and polymerase chain reaction (PCR) was used to detect biofilm-associated genes (algD, pslD, and pelF). Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 26.0, with p ≤ 0.05 considered significant. Results Of 424 burn wound samples, P. aeruginosa was the predominant isolate (39.6%), followed by Klebsiella pneumoniae (27.1%) and Staphylococcus aureus (19.3%). Significant risk factors associated with bacterial isolation included prior antibiotic use ( χ 2 = 16.4, p = 0.001), wound debridement ( χ 2 = 21.6, p = 0.001), and surgical skin grafting ( χ 2 = 11.7, p = 0.001). P. aeruginosa showed high resistance to ceftazidime (89.8%), cefepime (90.4%), ticarcillin (92.2%), and meropenem (61.9%), while remaining largely sensitive to colistin (97%). Among isolates, 13% were MDR, 21% extensively drug-resistant (XDR), and 51% pan-drug-resistant (PDR) strains. Biofilm formation was observed in 66.4% of P. aeruginosa isolates—19.7% strong, 47.0% moderate, and 33.3% non-producers. The biofilm-associated genes algD, pslD, and pelF were detected in 38, 35, and 27% of isolates, respectively. A significant association was observed between strong biofilm formation and the presence of the pslD gene ( χ 2 = 4.8, p = 0.03), but not with MDR status ( p > 0.05). Conclusion P. aeruginosa remains the leading cause of burn wound infections in Sana’a City, Yemen, exhibiting alarmingly high levels of carbapenem and cephalosporin resistance. Although biofilm formation was common, no significant association was found between biofilm production and multidrug resistance. The high prevalence of PDR strains underscores the urgent need for antimicrobial stewardship, routine susceptibility testing, and infection control measures in burn centers.

Introdução: O transplante de células-tronco hematopoiéticas (TCTH) visa corrigir

Understanding which active transportation facilities have a high potential for shifting car trips to active modes is a potent metric of success for funders seeking to make high impact transportation investments. This paper documents the development and validation of a traveler alignment analysis tool that evaluates the orientation, proximity, and magnitude of trips by distance in origin–destination (OD) desire line data to evaluate mode shift potential at the segment level. This alignment analysis operates by using line features created by a Utah statewide OD matrix of vehicle trips taken from the Replica Places activity-based modeling data platform. Additionally, the research tests the implementation of jittering, a previously proposed method for OD line disaggregation, and the impact on traveler alignment performance. To tune parameters related to proximity, angle, and trip distance, a sensitivity analysis was conducted comparing similar mode shift potential trips generated by the proposed Traveler Alignment tool and 25 StreetLight Data pass-through zone analyses. This sensitivity analysis used a mean absolute error metric to minimize estimation error and understand how altering parameters and applying jittering affected tool performance. A Pearson correlation test indicates a significant, positive linear relationship (p < 0.01) between Traveler Alignment tool outputs and results of the select-link analysis, indicating that this method produces reasonable results that may be used to evaluate different projects comparatively for their active mode shift potential.

Introduction The widespread prevalence of neck pain does not mean that one should stoically endure suffering. There is some truth in the fact that many people have such problems, but it is not true that one should not go to the doctor for such trivial reasons. Therefore, if pain in neck occurs, you should go to a neurologist immediately. This is especially true in cases where episodes of pain are repeated, they are persistent or intensify. Objectives There are many causes of neck pain: Fractures, dislocations, injuries to the vertebrae, joints, muscles and ligaments in the neck. Infections that cause inflammation of bone and cartilage tissue, muscles, cervical lymph nodes and nerves (osteomyelitis, abscess, shingles). Radiating pain in diseases of the heart, lungs, stomach, esophagus, and other organs. Rheumatological diseases (arthritis, myalgia, fibromyalgia). Methods Statistical analysis was performed. Results Neuroendocrine pathologies, non-specific factors (herniated and displaced intervertebral discs, problems with intervertebral joints, narrowing of the spinal canal, arthrosis, muscle spasms, osteochondrosis, problems caused by insufficient muscle activity), Intracranial diseases (benign or malignant neoplasms of the brain, stroke, abscess), and also psychosomatics. Conclusions There are several reasons that cause depression due to depletion of cartilage tissue. First of all, we are talking about the disruption of cerebral circulation associated with disorders in the cervical spine. Lack of blood flow, and therefore oxygen, leads to starvation of various parts of the brain responsible for certain important functions of the body. This is how nervous system disorders begin to develop: depression, aggression, panic attacks and insomnia. Disclosure of Interest None Declared