Meningitis and spinal infections with Gram-negative bacteria after local injections for treatment of chronic back pain are rare. This study investigated an outbreak of Pseudomonas aeruginosa ...infections following computed tomography (CT)-guided spinal injections (SI).
A case was defined as a spinal infection or meningitis with P. aeruginosa after SI between 10th January and 1st March 2019 in the same outpatient clinic. Patients without microbiological evidence of P. aeruginosa but with a favourable response to antimicrobial therapy active against P. aeruginosa were defined as probable cases.
Twenty-eight of 297 patients receiving CT-guided SI during the study period developed meningitis or spinal infections. Medical records were available for 19 patients. In 15 patients, there was microbiological evidence of P. aeruginosa, and four patients were defined as probable cases. Two of 19 patients developed meningitis, while the remaining 17 patients developed spinal infections. The median time from SI to hospital admission was 8 days (interquartile range 2–23 days). Patients mainly presented with back pain (N=18; 95%), and rarely developed fever (N=3; 16%). Most patients required surgery (N=16; 84%). Seven patients (37%) relapsed and one patient died. Although the source of infection was not identified microbiologically, documented failures in asepsis when performing SI probably contributed to these infections.
SI is generally considered safe, but non-adherence to asepsis can lead to deleterious effects. Spinal infections caused by P. aeruginosa are difficult to treat and have a high relapse rate.
In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in ...complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program 'Palliative care in Pandemics' (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON).
Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified.
For a future "pandemic preparedness" national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.
Aim To evaluate the performance of digital tomosynthesis (DT) of the chest for detection of lung nodules in patients with colorectal cancer (CRC). Materials and methods The institutional review board ...approved this study, and all patients provided informed consent. A commercial caesium iodide/amorphous silicon (CsI/a-Si) flat-panel detector system was used to verify the performance of the DT and chest radiography (XR) methods. DT was performed in 142 patients with CRC. All 142 patients underwent chest computed tomography (CT) within a week of DT. As a reference standard, two radiologists reviewed the chest CT in consensus and recorded the presence of pulmonary nodules. Another two radiologists independently observed the DT images and recorded the presence of pulmonary nodules. The status of all lung nodules was assessed either histologically or by follow-up over a period of 1 year. The nodules were classified into metastasis, benign, and uncertain. Statistical analysis of the results was performed. Results Two hundred and thirty-seven nodules from 142 patients were found at CT. These included 71 proven metastases and 126 benign nodules; 40 nodules were uncertain. Observers detected 83% of all lung nodules and 93% of proven metastases using DT. Among 237 nodules, 147 nodules were larger than 4 mm in diameter on the CT images. Observers detected 87% of lung nodules that were larger than 4 mm. Conclusion Despite a reasonably low radiation dose, DT is a sensitive method, and is comparable to chest CT for the detection of lung nodules, particularly metastatic lung nodules in patients with CRC.
Access to finance to stay competitive is a salient challenge for small and medium-sized enterprises (SMEs). Few studies examine how cultures (i.e. social norms and customs) in different countries ...influence various channels for SMEs' external financing (i.e. formal and informal). In particular, gender inequality, such as in terms of gender disparities in health, empowerment, and the labor market in each country, can bias lenders' perspectives of female SME owners. By incorporating pecking order, information cost, and lack-of-fit theories, this study uses the Global Entrepreneurship Monitor dataset and other secondary datasets to investigate the impact of culture and gender inequality on tourism and hospitality SME owners' access to formal and informal financing. The results show that cultures that are more masculine than feminine encourage both formal and informal financing; however, cultures with high power distance boost informal financing and hinder formal financing. In addition, gender inequality moderates these cultural influences on access to finance. This study contributes to the SME literature and provides insights for governments and policymakers.
We report a complex case of a 53-year-old male patient with recurrent ischemic ventricular septal defect that had been occluded by a surgical patch. Treatment was accomplished utilizing a ...3-dimensional–printed model for preprocedural planning. In the future, printing of 3-dimensional models could offer new therapeutic strategies on an individual level. (Level of Difficulty: Intermediate.)
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Objectives
Non‐treponemal serological tests are used to monitor treatment response during syphilis infection. Syphilis‐ and HIV‐coinfected patients may experience incomplete resolution in ...non‐treponemal titres, which is referred to as the serofast state. The goal of this study was to evaluate risk factors for serofast state in HIV‐infected patients.
Methods
From November 2015 to June 2018, 1530 HIV‐positive patients were tested for syphilis using a Treponema pallidum particle agglutination (TPPA) assay. Among TPPA‐positive patients, medical records were reviewed for early syphilis infection. Serofast state was defined as a less than four‐fold decrease in non‐treponemal antibody titres during a 6‐month follow‐up period in the absence of symptoms of syphilis. Baseline characteristics were tested as predictive factors of serological response.
Results
In all, 515 patients (33.7%) tested positive in TPPA assays, and in 163 patients at least one previous syphilis infection was documented. A total of 61 out of 163 patients (37.4%) were in a serofast state. A history of previous syphilis infection (61 vs. 43%; P = 0.04) was more common in serofast patients than in patients with serological cure after 6 months. Non‐treponemal titres ≥ 1:32 before therapy (47 vs. 25%; P = 0.005) and adjunctive corticosteroids to prevent the Jarisch–Herxheimer reaction (35% vs 15%; P = 0.006) were associated with serological cure after 6 months, but corticosteroid therapy had no influence at 12 months. The intensity of syphilis treatment did not affect serological cure.
Conclusion
Corticosteroids for prevention of the Jarisch–Herxheimer reaction were associated with earlier serological cure. Although serological response is the accredited surrogate method to monitor syphilis treatment, the biological significance of the serofast state remains unclear.
Melasma is an acquired pigmentary disorder that most commonly occurs in women of child‐bearing age. Melasma is therapeutically challenging, and most commercially available hypopigmenting agents ...include tyrosinase inhibitors, which regulate the rate‐limiting step of melanogenesis. 4‐n‐Butylresorcinol has received considerable attention as a novel hypopigmenting agent in the last 15 years because it has an inhibitory effect against tyrosinase and tyrosinase‐related protein‐1. However, the hypopigmenting effect of 4‐n‐butylresorcinol in human subjects has only been shown in a few studies. Liposome encapsulation is known to improve stabilization and enhance penetration of the product. Therefore, this study was conducted to evaluate the hypopigmenting efficacy and safety of liposome‐encapsulated 4‐n‐butylresorcinol 0.1% cream in patients with melasma. This was a randomized, double‐blind, vehicle‐controlled and split‐face comparison study. Twenty‐three patients with a clinical diagnosis of melasma were included. 4‐n‐Butylresorcinol 0.1% cream or vehicle was applied to each side of the face twice daily for 8 weeks. Clinical and photographic evaluations, Mexameter measurements and assessment of patient satisfaction and side‐effects were performed at baseline, 4 and 8 weeks. All subjects completed the study. Mexameter measurements demonstrated that the melanin index of the 4‐n‐butylresorcinol‐treated side showed a significant decrease when compared with the vehicle‐treated side after 8 weeks (P = 0.043). No adverse reactions were observed throughout the study. Subjectively, 4‐n‐butylresorcinol was considered to be efficacious in more than 60% of the patients after 8 weeks of treatment. In conclusion, liposome‐encapsulated 4‐n‐butylresorcinol 0.1% cream was well tolerated and showed significant higher efficacy than vehicle alone for the treatment of melasma.
The leakage of radioactive materials generated at particle accelerator facilities is one of the important issues in the view of radiation safety. In this study, fire and flooding at particle ...accelerator facilities were considered as the non-radiation disasters which result in the leakage of radioactive materials. To analyse the expected effects at each disaster, the case study on fired and flooded particle accelerator facilities was carried out with the property investigation of interesting materials presented in the accelerator tunnel and the activity estimation. Five major materials in the tunnel were investigated: dust, insulators, concrete, metals and paints. The activation levels on the concerned materials were calculated using several Monte Carlo codes (MCNPX 2.7+SP-FISPACT 2007, FLUKA 2011.4c and PHITS 2.64+DCHAIN-SP 2001). The impact weight to environment was estimated for the different beam particles (electron, proton, carbon and uranium) and the different beam energies (100, 430, 600 and 1000 MeV/nucleon). With the consideration of the leakage path of radioactive materials due to fire and flooding, the activation level of selected materials, and the impacts to the environment were evaluated. In the case of flooding, dust, concrete and metal were found as a considerable object. In the case of fire event, dust, insulator and paint were the major concerns. As expected, the influence of normal fire and flooding at electron accelerator facilities would be relatively low for both cases.
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