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Background: Candida auris has been associated with rapid transmission and high mortality. A novel PCR-based surveillance programme was initiated at a London teaching hospital from January 2018. The results of this implementation until March 2019 are presented along with the clinical, transmission and phylogenetic characteristics encountered in that setting.Methods: A real-time PCR assay for C. auris was developed, validated, and implemented for direct use on skin swabs and urine. Environmental swabs were also tested by PCR as an emergency outbreak-control measure. Clinical risk factors and outcomes of patients were determined. Environmental dispersal was assessed using 24 h settle plate cultures around nine colonized patients followed by air sampling around one colonized patient during high- and low-turbulence activities. Sequencing was performed using Illumina HiSeq and maximum likelihood phylogenies were constructed using rapid bootstrap analysis.Results: Twenty-one C. auris colonized patients were identified. Median turnaround time of colonization detection reduced from 141 h (5.8 days) to approximately 24 h enabling rapid infection-control precautions. Settle plates detected 70-600 cfu/m2 around colonized patients over 24 h and air sampling suggested dispersal during turbulent activities. C. auris DNA was detected from 35.7% environmental swabs. Despite being in a high-risk setting, no patients developed invasive infection. Sequencing analysis of isolates from this centre identified two introductions of the South Asian (Clade I) and one of the South African (Clade III) strain.Conclusion: The PCR offers a rapid, scalable method of screening and supports clinical risk reduction in settings likely to encounter multiple introductions. [ABSTRACT FROM AUTHOR]

Background: The sudden increase in COVID-19 admissions in hospitals during the SARS-CoV-2 pandemic of 2020 led to onward transmissions among vulnerable inpatients.Aims: This study was performed to evaluate the prevalence and clinical outcomes of healthcare-associated COVID-19 infections (HA-COVID-19) during the 2020 epidemic and study factors which may promote or correlate with its incidence and transmission in a Teaching Hospital NHS Trust in London, UK.Methods: Electronic laboratory, patient and staff self-reported sickness records were interrogated from 1st March to 18th April 2020. HA-COVID-19 was defined as COVID-19 with symptom onset within >14 days of admission. Test performance of a single combined throat and nose swab (CTNS) for patient placement was calculated. The effect of delayed RNA positivity (DRP, defined as >48 h delay), staff self-reported COVID-19 sickness absence, hospital bed occupancy, and community incidence of COVID-19 was compared for HA-COVID-19. The incidence of other significant hospital-acquired bacterial infections (HAB) was compared with previous years.Results: Fifty-eight HA-COVID-19 (7.1%) cases were identified. When compared with community-acquired admitted cases (CA-COVID-19), significant differences were observed in age (P=0.018), ethnicity (P<0.001) and comorbidity burden (P<0.001) but not in 30-day mortality. CTNS-negative predictive value was 60.3%. DRP was associated with greater mortality (P=0.034) and incidence of HA-COVID-19 correlated positively with DRP (R = 0.7108) and staff sickness absence (R = 0.7815). For the study period HAB rates were similar to the previous 2 years.Conclusions: Early diagnosis and isolation of COVID-19 patients would help to reduce transmission. A single CTNS has limited value in segregating patients into positive and negative pathways. [ABSTRACT FROM AUTHOR]

The article focuses on the conversion of labour epidural analgesia to surgical anesthesia for emergency intrapartum Caesarean section. Topics include the risk factors associated with the failure of conversion; the merits and limitations of the methods used to confirm the correct location of the epidural catheter; and the techniques used for evaluation regarding the adequacy of neuraxial blockade.

The article offers information on the adverse effects and safety of individual drugs used as perineural adjuncts to local anaesthetic agents for peripheral nerve blocks (PNB). It mentions a continuous PNB involves the percutaneous insertion of a catheter adjacent to a peripheral nerve, plexus, or fascial plane; and also mentions the use of 'perineural adjuncts' is an attractive and technically simple alternative strategy to continuous PNBs in order to extend the benefits of single-shot PNBs.

The article presents the role of physiological scoring systems in the critically ill severity scores. outcome prediction scores, and decision-support tools. It mentions the use of illness severity and outcome prediction scores to benchmark Intensive care units performance for quality assurance purposes and also highlights that tools can assist healthcare professionals in providing safe and effective care in acutely unwell patients.

Objectives: Flexible endoscopes are difficult to decontaminate, and endoscope-associated infections are increasing. This report describes an outbreak of multi-drug resistant Pseudomonas aeruginosa identified following an increase in incidence of clinical infections associated with flexible ureteroscopy at a tertiary care centre in the UK.Methods: Clinical, laboratory and central decontamination unit (CDU) records were reviewed to determine the extent of the problem, and links to the used endoscopes. Audits of the ureteroscopy procedure, endoscopy unit and CDU were performed. Endoscopes were sampled, cultured and examined for structural integrity. All available isolates were typed.Results: Thirteen patients developed clinical infections linked to two flexible ureteroscopes. The first ureteroscope was likely colonized from a known infected patient and the second ureteroscope after use on another patient infected by the first. Risk factors identified include surface cuts, stretching and puckering of the outer cover in both ureteroscopes, absence of bedside cleaning, overnight delay between the ureteroscopy and decontamination, inadequate drying after decontamination and non-traceability of connector valves.Conclusions: The adequacy of flexible endoscope decontamination depends on numerous steps. With the increasing global incidence of multi-drug resistant organisms, stringent monitoring of the flexible endoscopy process by users and decontamination units is essential. [ABSTRACT FROM AUTHOR]

Background: In view of newer techniques of preoxygenation and laryngoscopy and recent obstetric guidelines concerning the management of difficult intubation, we aimed to evaluate the current practice of rapid sequence induction for caesarean section in England.Methods: In 2017, 316 questionnaire surveys were posted to all 158 hospitals with caesarean section capabilities in England. At each hospital, one questionnaire was to be completed by the obstetric anaesthetic consultant lead and one by an anaesthetic trainee. Differences in responses between consultants and trainees, regardless of their place of work, were compared for all data using the chi-square and the Fisher's exact tests.Results: One-hundred-and-eighty complete questionnaires were returned, with an overall response rate of 57%, 98 (54%) from obstetric anaesthetic consultant leads and 82 (45.6%) from trainees). Both head up (57%) and ramped (56%) were the preferred positions for preoxygenation. Less than half of respondents (43%) preoxygenated until the surgeon was scrubbed. Cricoid pressure was used by almost all respondents (98%). Thiopentone (67%) was the most commonly chosen anaesthetic induction agent and most respondents (82%) supported a change to the use of propofol. Suxamethonium (92%) was the neuromuscular blocker of choice but more than half the respondents (52%) supported a change to rocuronium. In the event of a failed intubation, the rescue supraglottic airway device of choice was the i-gel® (65%).Conclusions: Our survey demonstrated the significant variation in the practice of rapid sequence induction for caesarean section in obstetrics in the United Kingdom. [ABSTRACT FROM AUTHOR]

The article focuses on the extended focused assessment with sonography in trauma (eFAST), which is a test for trauma patients. It discusses the specificity and sensitivity in FAST for adult trauma patients, and how to carry on a FAST exam including sonographic views pf right upper quadrant (RUQ), left upper quadrant (LUQ) and pelvic.

Acute Myeloid Leukemia (AML) is the most common malignancy in adults with a 5-year survival rate of 27% of the total affected population. For effective treatment and new drug discovery, cell lines are considered as a very important tool. Here we report an establishment of a continuous human cell line AML-004 with a hypo-diploid chromosome 44 and presence of both NK/NKT phenotypes. The cell line was isolated from the blood sample of myeloid NK cell acute leukemia patients and extensively characterized by flow cytometery, morphology, and cytogentic analysis. Cytotoxicity by standard chemotherapeutic drugs was also examined. As characterized by Giemsa staining, the predominant cell type in the culture had high nuclear/cytoplasmic ratio. Cytogenetic analysis revealed high chromosome instability and structural abnormalities confirming the source of cell line from a patient with AML. The karyotype of the isolated cells did not alter up to around 40 passages. These AML-004 cells lacked specific markers for B and T lymphoid cells, but expressed surface receptors for lymphoid/NK cells. Cells also lacked the presence of early progenitors. The proliferation of the isolated cells was inversely proportional to the IL-2 concentration confirming presence of NK phenotype. AML-004 was resistant against standard chemotherapeutic drugs excluding cisplatin. Thus, AML-004 cells provide a continuous source of human cells for designing novel therapies for patients with T-lymphoblastic leukemia/lymphoma. [ABSTRACT FROM AUTHOR]

BACKGROUND: Since 2008 there has been a substantial fall in the incidence of Clostridium difficile infection (CDI) in the UK, though it is unclear what contribution local and governmental interventions have made to this reduction. AIM: To assess the value of retrospective analysis using a segmented regression model and single factor analysis of variance (ANOVA) in assessing the impact of interventions to reduce hospital-acquired CDI. METHODS: A retrospective time-series analysis of 28 interventions implemented over an eight-year period by a large teaching hospital trust. Single factor ANOVA was used to analyse the association between CDI rates and changes in antibiotic usage and hand hygiene compliance data. FINDINGS: Whereas several interventions were associated with a reduction in CDI rates, insufficient time-points were available between interventions to allow meaningful interpretation of all the data. Reduction of cephalosporin and quinolone use was associated with reduction in CDI rates. There was little association between observed variations in hand hygiene compliance and CDI rates. CONCLUSION: Though several interventions were associated with a reduction in CDI, this study illustrates the inherent limitations of retrospective time-series methodology for the investigation of infection control measures where large numbers of interventions are introduced over a short time-period. Single factor ANOVA demonstrated an association between fall in CDI and restriction of high-risk antibiotic use. Little association was demonstrated between compliance rates documented in hand hygiene audits and CDI, though compliance was relatively high throughout the period of study. [ABSTRACT FROM AUTHOR]

In the present study, a novel series of 2-{5-[4-(1-aza-2-(2-thienyl)vinyl)phenyl](1,3,4-oxadiazol-2-ylthio)}-N-arylacetamides (IV)1-12 were synthesized and tested for their antimicrobial activity. Newly synthesized compounds were screened for their antibacterial and antifungal activities on Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus pyogenes, Candida albicans, Aspergillus niger and Aspergillus clavatus. The chemical structures of newly synthesized compounds were elicited by IR, 1H NMR, 13C NMR and mass spectral data. The synthesized bio-active compounds exhibited excellent to moderate antimicrobial activity. Compounds (IV)5, (IV)6 and (IV)7 possess excellent antibacterial activity whereas compounds (IV)6, (IV)9 and (IV)11 possess excellent antifungal activity. [ABSTRACT FROM AUTHOR]

Greek yogurt is currently the largest growing sector in the dairy industry. Because no standard of identity exists for Greek yogurts in the United States, and they can be made by a variety of methods, variability in sensory properties is expected. Knowledge of consumer perception and specific drivers of liking will be useful information for product developers. The objective of this study was to document the sensory properties of commercial Greek yogurts and to determine drivers of liking through descriptive profiling and consumer testing. Flavor and texture attributes of commercial Greek yogurts (n = 24) were evaluated in triplicate by a trained descriptive sensory panel. An online survey (n = 520) was used to collect consumer usage and attitude information for Greek yogurts before consumer acceptance testing. Consumer acceptance testing (n = 155) was then conducted on commercial Greek yogurts (n = 10). Univariate and multivariate statistical analyses were used for data analysis. Sensory properties of yogurt differed with fat content and manufacture (Greek vs. fortified Greek). Full-fat yogurts were characterized by firmness and denseness, whereas low- and non-fat yogurts lacked firmness, denseness, cohesiveness, and, after stirring, viscosity. Fortified Greek yogurts generally had more surface shine and jiggle and lower denseness compared with traditional Greek yogurts. Fewer flavor differences were observed among yogurts compared with texture differences. Fortified Greek yogurts displayed a burnt/beefy flavor not documented in traditional Greek yogurts, but this flavor was not evident in all fortified Greek yogurts. Consumer preferred Greek yogurts with firm, dense texture, moderate sweet aromatic, milkfat and dairy sour flavors, and moderate sour taste. Consumers were aware of the increased protein content of Greek yogurts but generally unaware of differences between strained and fortified Greek yogurts; both strained Greek and fortified Greek yogurts received the highest overall liking scores in blinded acceptance testing. Successful Greek yogurts can be manufactured using addition of dried dairy ingredients or by traditional straining and centrifugation. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid-cutaneous fistula is a rare complication associated with neuraxial procedures. Here, we describe a case of fistula formation related to combined spinal-epidural anaesthesia for elective caesarean delivery, where the epidural catheter was removed only two hours later. The clear fluid leaking persistently from the site of the skin puncture associated with the epidural insertion site was confirmed to be cerebrospinal fluid with an increased beta-trace protein, and the fistula was closed with skin sutures. Subsequently, the patient presented with neurological signs and symptoms consistent with meningitis and was treated empirically with intravenous antibiotics. Cerebrospinal fluid-cutaneous fistula formation with secondary meningitis is an exceptionally rare event in obstetric anaesthesia. [ABSTRACT FROM AUTHOR]

Abstract: The space environment consists of a varying field of radiation particles including high-energy ions, with spacecraft shielding material providing the only major protection to astronauts from harmful exposure. Unlike low-linear energy transfer (LET) or X-rays, the presence of shielding does not always reduce the radiation risks for energetic charged particle exposure, since the dose delivered by the charged particle increases sharply as the particle approaches the end of its range, a position known as the Bragg peak. The Bragg curve does not necessarily represent the biological damage along the particle traversal, and the “biological Bragg curve” is dependent on the energy and the type of the primary particle, and may vary for different biological endpoints. Here we used a unique irradiation geometry to measure the biological response across the Bragg curve in human fibroblasts exposed to 577MeV/nucleon incident Fe ions in vitro. Polyethylene shielding was used to achieve a Bragg curve distribution with the beam geometry parallel to a monolayer of fibroblast cells. Qualitative analyses of -H2AX fluorescence, a known marker of DSBs, indicated increased clustering of DNA damage before the Bragg peak, enhanced homogenous distribution at the peak, and provided visual evidence of high-LET particle traversal of cells beyond the Bragg peak in agreement with one-dimensional transport approximations. A quantitative biological response curve generated for micronuclei induction across the Bragg curve did not reveal an increased yield of micronuclei at the location of the Bragg peak. However, the percentage of mononucleated cells, which indicates inhibition in cell progression, increased at the location of the peak. These results confirm the argument that severely damaged cells at the Bragg peak, as observed by increased -H2AX formation, are likely to go through reproduction death. Depending on the LET value of the primary particles, the yield of the biological endpoint of interest (micronuclei formation in the present study) may or may not increase at the location of the Bragg peak. [Copyright &y& Elsevier]

Abstract: We investigated the spatial distribution of the induction of the phosphorylated form of the histone protein H2AX (γ-H2AX), known to be activated by DSBs. Following irradiation of human fibroblast cells with 600MeV/nucleon silicon and 600MeV/nucleon iron ions we observed the formation of γ-H2AX aggregates in the shape of streaks stretching over several micrometers in an x/y plane. Polyethylene shielding was used to achieve a Bragg curve distribution with beam geometry parallel to the monolayer of cells. We present data that highlights the formation of immunofluorescent γ-H2AX tracks showing the ion trajectories across the Bragg peak of irradiated human fibroblast cells. Qualitative analyses of these distributions indicated potentially increased clustering of DNA damage before the Bragg peak, enhanced γ-H2AX distribution at the peak, and provided visual evidence of high-linear energy transfer particle traversal of cells beyond the Bragg peak in agreement with one-dimensional transport approximations. Spatial assessment of γ-H2AX fluorescence may provide direct insights into DNA damage across the Bragg curve for high charge and energy ions including the biological consequences of shielding and possible contributors to bystander effects. [Copyright &y& Elsevier]

Space flight results in the exposure of astronauts to a mixed field of radiation composed of energetic particles of varying energies, and biological indicators of space radiation exposure provides a better understanding of the associated long-term health risks. Current methods of biodosimetry have employed the use of cytogenetic analysis for biodosimetry, and more recently the advent of technological progression has led to advanced research in the use of genomic and proteomic expression profiling to simultaneously assess biomarkers of radiation exposure. We describe here the technical advantages of the LuminexTM 100 system relative to traditional methods and its potential as a tool to simultaneously profile multiple proteins induced by ionizing radiation. The development of such a bioassay would provide more relevant post-translational dynamics of stress response and will impart important implications in the advancement of space and other radiation contact monitoring. [Copyright &y& Elsevier]

In a very brief period, the COVID-19 pandemic has swept across the planet leaving governments, societies, and healthcare systems unprepared and under-resourced. New York City now represents the global viral epicenter with roughly one-third of all mortalities in the United States. To date, our hospital has treated thousands of COVID-19 positive patients and sits at the forefront of the United States response to this pandemic. The goal of this paper is to share the lessons learned by our spine division during a crisis when hospital resources and personnel are stretched thin. Such experiences include management of elective and emergent cases, outpatient clinics, physician redeployment, and general health and wellness. As peak infections spread across the United States, we hope this article will serve as a resource for other spine departments on how to manage patient care and healthcare worker deployment during the COVID-19 crisis. [ABSTRACT FROM AUTHOR]