RESUMEN
BACKGROUND: Rehabilitation clinics may vary widely in terms of type of care provided, duration of hospital stay, and case severity. Few data are available on prevalence of Clostridium difficile or extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) colonization in rehabilitation clinics in Germany. AIM: This study investigated the frequency of intestinal colonization by these pathogens among patients in rehabilitation clinics of different specialization. METHODS: In the scope of a point prevalence study, faecal samples and demographic and clinical data were collected in five rehabilitation clinics. Samples were screened for C. difficile and ESBL-E by culture. Isolates were characterized by polymerase chain reaction for C. difficile toxins A and B, for ß-lactamase genes, and by molecular typing including pulsed-field gel electrophoresis and PCR-based ribotyping. FINDINGS: Of 305 patients screened, 11.1% were colonized by toxigenic C. difficile and 7.5% by ESBL-E. Colonization rates differed markedly between facilities, ranging from 1.6% to 26.3% for C. difficile and from zero to 23.7% for ESBL-E. Prevalence of colonization by C. difficile and ESBL-E was higher in neurological rehabilitation clinics than in clinics with other specialties (P<0.001). Molecular typing revealed six patients from one neurological rehabilitation clinic harbouring a unique C. difficile strain (ribotype 017). CTX-M-15 was the most prevalent ESBL type. We detected several indistinguishable pairs of ESBL-E isolates within some facilities. CONCLUSION: Significant differences were found in the prevalence of C. difficile and ESBL-E between rehabilitation clinics. Facilities providing specialized medical care for critically ill patients had higher prevalence rates. These results may help to delineate the requirements for infection prevention and control in rehabilitation clinics.
Asunto(s)
Portador Sano/epidemiología , Infecciones por Clostridium/epidemiología , Infecciones por Enterobacteriaceae/epidemiología , Enterobacteriaceae/enzimología , beta-Lactamasas/metabolismo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Clostridioides difficile/clasificación , Clostridioides difficile/genética , Clostridioides difficile/aislamiento & purificación , Electroforesis en Gel de Campo Pulsado , Enterobacteriaceae/clasificación , Enterobacteriaceae/genética , Enterobacteriaceae/aislamiento & purificación , Heces/microbiología , Femenino , Alemania/epidemiología , Instituciones de Salud , Humanos , Masculino , Persona de Mediana Edad , Tipificación Molecular , Reacción en Cadena de la Polimerasa , Prevalencia , Factores de Riesgo , Adulto Joven , beta-Lactamasas/genéticaRESUMEN
After the first outbreak of Clostridium difficile PCR ribotype (RT) 027 in Germany in 2007, no further outbreaks were reported until the recent re-emergence of RT 027 in Hesse, a federal state with 6 million inhabitants located in south-west Germany. We undertook a survey to determine the prevalence of RT 027 and other strains in a prospective study. From January 2011 to July 2013, we analysed 291 specimens from patients diagnosed with C. difficile infection (CDI) in 40 healthcare facilities in Hesse. The mean incidence of CDI in hospitals including at least 10 patients in the survey was 9.9 per 10,000 patient days (range 4.8-22.8) in November 2012. We obtained 214 toxigenic C. difficile isolates. RT 001 was the most prevalent (31.8%). RT 027, the second most common type (26.6%), was prevalent in all hospitals (n=14) from which at least seven isolates were available for typing, but its frequency varied considerably (range: 9.170%). The annual frequency of RT 027 increased from 21.4% in 2011 to 30.0% in 2013 (p=0.04). Our study indicates that infections with C. difficile RT 027 are now prevalent in Hesse. It underscores the need for surveillance programmes to analyse the molecular epidemiology of C. difficile.
Asunto(s)
Clostridioides difficile/genética , Clostridioides difficile/aislamiento & purificación , Brotes de Enfermedades/estadística & datos numéricos , Enterocolitis Seudomembranosa/epidemiología , Ribotipificación , Clostridioides difficile/clasificación , Notificación de Enfermedades , Enterocolitis Seudomembranosa/diagnóstico , Enterocolitis Seudomembranosa/microbiología , Femenino , Alemania/epidemiología , Encuestas Epidemiológicas , Humanos , Incidencia , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Vigilancia de la Población , Prevalencia , Estudios ProspectivosRESUMEN
We investigated a cluster of shiga toxin-producing Escherichia coli (STEC) O104:H4 infections after a family party during a large STEC O104:H4 outbreak in Germany. To identify the vehicle we conducted a retrospective cohort study. Stool samples of party guests, and food and environmental samples from the catering company were tested for STEC. We defined cases as party guests with gastrointestinal symptoms and laboratory-confirmed STEC infection. We found 23 cases among 71 guests. By multivariable analysis consumption of salmon [odds ratio (OR) 15, 95% confidence interval (CI) 2.3-97], herb cream (OR 6.5, 95% CI 1.3-33) and bean salad (OR 6.1, 95% CI 1.4-26) were associated with STEC infection. STEC O104:H4 was detected in samples of bell pepper and salmon. The food handler developed STEC infection. Our results point towards transmission via several food items contaminated by a food handler. We recommend regular education of food handlers emphasizing their role in transmitting infectious diseases.
Asunto(s)
Brotes de Enfermedades , Infecciones por Escherichia coli/transmisión , Manipulación de Alimentos , Enfermedades Transmitidas por los Alimentos/microbiología , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Trazado de Contacto , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Heces/microbiología , Femenino , Enfermedades Transmitidas por los Alimentos/epidemiología , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
Objetivo: Establecer el grado de concordancia entre los diagnósticos clínicos y anatomopatológicos, y su relación con las características clínicas de los pacientes fallecidos. Diseño: Estudio retrospectivo, observacional y analítico de una cohorte de 99 pacientes fallecidos entre 2000 y 2008, en el Área de Cuidados Intensivos Pediátricos de un hospital pediátrico de alta complejidad. En este período, hubo 1491 óbitos, se autorizaron 120 autopsias y 99 cumplieron los criterios de inclusión. Se compararon los diagnósticos clínicos con los post mortem, se estableció su concordancia o discordancia y su relación con la edad, el peso, el género, la procedencia al ingresar en la Unidad de Cuidados Intensivos, la enfermedad preexistente, el motivo de ingreso clínico o quirúrgico, el diagnóstico principal y concomitante, la causa de muerte y el tiempo de estadía en la Unidad de Cuidados Intensivos. Resultados: En 35 pacientes, la autopsia mostró 37 hallazgos no diagnosticados clínicamente: 14 discordancias clase I, 9 clase II, 7 clase III y 7 clase IV, según criterios de Goldman y cols. En el 49% (17/35), se detectaron infecciones clínicamente inadvertidas. Setenta y tres pacientes tenían enfermedad preexistente. Los motivos más frecuentes de ingreso fueron shock (35 pacientes), insuficiencia respiratoria (29 casos) e insuficiencia hepática (13 casos). Conclusiones: La autopsia aportó información clínica relevante e identificó enfermedades no diagnosticadas en vida en el 35% de los pacientes. No se encontró asociación entre la presencia de discordancia y las variables analizadas.(AU)
Objective: To establish concordance or discordance between clinical and pathological diagnoses and its relationship with clinical features of deceased patients. Design: Retrospective, observational, and analytical cohort study of 99 patients who died between 2000 and 2008 in the Pediatric Intensive Care Unit of a pediatric tertiary care referral hospital. During the nine years of the study there were 1491 deaths, 120 autopsies were authorized and 99 met the inclusion criteria. Clinical diagnoses were compared to post mortem diagnoses. Agreement or disagreement between diagnoses, their relationship to age, weight, gender, origin at admission to Pediatric Intensive Care Unit, underlying disease, reason for admission (medical or surgical), primary diagnosis, concomitant diagnosis, cause of death and length of stay in the Pediatric Intensive Care Unit were assessed. Results: In 35 patients, the autopsy revealed 37 findings that were not clinically diagnosed. According to the classification by Goldman et al, class I discrepancies were found in 14, class II in 9, class III in 7, and class IV in 7. In 17 of 35 patients (49%), infections that were unknown clinically were detected at autopsy. Seventy three patients had underlying illness. The most frequent causes of admission were shock (35 patients), respiratory failure (29 patients) and liver failure (13 patients). Conclusions: Autopsy provided relevant clinical information and it identified undiagnosed illnesses in 35% of the patients in this sample. No differences were found when comparing discrepancies found at autopsy with any of the variables evaluated.(AU)
Asunto(s)
Humanos , Pediatría , Autopsia , Diagnóstico , Cuidados CríticosRESUMEN
During the recent outbreak of Shiga toxin-producing Escherichia coli (STEC) O104:H4 in Germany most cases notified in the State of Hesse (6 million inhabitants) were linked to satellite clusters or had travelled to the outbreak area in northern Germany. Intensified surveillance was introduced to rapidly identify cases not linked to known clusters or cases and thus to obtain timely information on possible further contaminated vehicles distributed in Hesse, as well to describe the risk of secondary transmission among known cases. As of 2 August 2011* [corrected], 56 cases of haemolytic uraemic syndrome (HUS) including two fatal cases, and 124 cases of STEC gastroenteritis meeting the national case definitions have been reported in Hesse. Among the 55 HUS and 81 STEC gastroenteritis cases thatmet the outbreak case definition, one HUS case and eight STEC gastroenteritis cases may have acquired their infection through secondary transmission. They include six possible transmissions within the family, two possible nosocomial and one possible laboratory transmission. Our results do not suggest an increased transmissibility of the outbreak strain compared to what is already known about E. coli O157 and other STEC serotypes.
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Brotes de Enfermedades/estadística & datos numéricos , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/transmisión , Gastroenteritis/microbiología , Síndrome Hemolítico-Urémico/microbiología , Adulto , Anciano , Diarrea/diagnóstico , Diarrea/epidemiología , Infecciones por Escherichia coli/virología , Composición Familiar , Femenino , Gastroenteritis/epidemiología , Alemania/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Serotipificación , Toxina Shiga/biosíntesis , Escherichia coli Shiga-Toxigénica/genética , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: Clostridium difficile is a major cause of health care associated infections in industrialized countries. During the past decade, the incidence and clinical severity of C. difficile infections (CDI) have increased markedly. This increase has been associated with the emergence of a possibly highly virulent strain, the C. difficile PCR ribotype 027. We investigated the emergence of severe CDI and the associated PCR ribotypes in Hesse, Germany. PATIENTS AND METHODS: We conducted a retrospective analysis of clinical information and ribotyping results of all cases of severe CDI that were reported to the Hesse State Health Office or sent to our microbiologic diagnostic laboratory for detection and molecular typing of C. difficile in severe cases of CDI from 01/2008 to 12/2009. The data of a of 88 patients and 50 isolates were analysed. RESULTS: 89% of patients were at least 65 years old; the mean age was 77 years. The clinical outcome was known in 85 patients. 27% had died within 30 days of the diagnosis of CDI. Ribotyping results were available in 39 and 11 patients from 2008 and 2009, respectively. The isolates were assigned to nine different ribotypes. RT 027 and RT 001 were the most frequent ribotypes with 31 and 10 isolates, respectively. All other ribotypes were isolated once or twice. CONCLUSION: Our data indicate that C. difficile RT 027 and RT 001 are prevalent in Hesse and are often associated with severe or notifiable CDI. The high prevalence of RT 027 among the reported CDI cases does not indicate a generally high prevalence of the latter strain in Hesse, because detection of RT 027 was a case definition criterion, a fact that may cause a bias in the reported data. Further investigation would help to improve our understanding of the molecular epidemiology of severe CDI and to improve the prevention strategies.
Asunto(s)
Enterocolitis Seudomembranosa/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Clostridioides difficile/genética , Clostridioides difficile/patogenicidad , Estudios Transversales , Notificación de Enfermedades , Enterocolitis Seudomembranosa/microbiología , Enterocolitis Seudomembranosa/mortalidad , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Ribotipificación , Virulencia/genética , Adulto JovenRESUMEN
From January 2008 to April 2009, 72 cases of severe Clostridium difficile infection were reported from 18 different districts in the state of Hesse, Germany. A total of 41 C. difficile isolates from 41 patients were subjected to PCR ribotyping. PCR ribotype (RT) 027 was the most prevalent strain accounting for 24 of 41 (59%) of typed isolates, followed by RT 001 (eight isolates, 20%), RT 017 and 042 (two isolates each), and RT 003, 066, 078, 081, and RKI-034 (one isolate each). Eighteen patients had died within 30 days after admission. C. difficile was reported as underlying cause of or contributing to death in 14 patients, indicating a case fatality rate of 19%. The patients with lethal outcome attributable to C. difficile were 59-89 years-old (median 78 years). Ribotyping results were available for seven isolates associated with lethal outcome, which were identified as RT 027 in three and as RT 001 and 017 in two cases each. Our data suggest that C. difficile RT 027 is prevalent in some hospitals in Hesse and that, in addition to the possibly more virulent RT 027, other toxigenic C. difficile strains like RT 001 and 017 are associated with lethal C. difficile infections in this region.
Asunto(s)
Clostridioides difficile/clasificación , Enterocolitis Seudomembranosa/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Toxinas Bacterianas/análisis , Clostridioides difficile/aislamiento & purificación , Clostridioides difficile/patogenicidad , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Enterocolitis Seudomembranosa/mortalidad , Enterotoxinas/análisis , Heces/microbiología , Femenino , Alemania/epidemiología , Humanos , Incidencia , Masculino , Notificación Obligatoria , Megacolon Tóxico/microbiología , Megacolon Tóxico/mortalidad , Megacolon Tóxico/cirugía , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Vigilancia de la Población , Ribotipificación , VirulenciaRESUMEN
A pesar de la implementación de la vacuna antipertussis en el Calendario Nacional continúan ocurriendo casos graves de coqueluche en Argentina. Objetivo: Identificar factores de riesgo de gravedad al ingreso hospitalario (definida como requerimientos de internación en Unidad de Cuidados Intensivos o fallecimiento). Métodos: Estudio de casos y controles: 32 casos de coqueluche vs. 89 casos no graves (enero el diciembre de 2004 y 2007). Todos los casos y controles fueron confirmados por PCR en SNF. Análisis estadístico (STATA 8.0). Resultados: 121 pacientes fueron incluidos (edad mediana 2 meses). Se observó contacto con adulto tosedor 35 por ciento vacunación en el 54 por ciento (1 dosis en 71 por ciento, 2 dosis en 21 por ciento, 3 dosis en 6 por ciento, 4 dosis en el 2 por ciento). Quince niños de los 32 que requirieron UCI fallecieron. Los motivos de admisión a UCI fueron falla respiratoria severa en 15 pacientes (47 por ciento) y asociada a falla hemodinámica in 17 p. (53 por ciento). Análisis multivariado la leucocitosis mayor a 50 por 10 3 (OR 4.46 IC 95 por ciento 1.66- 11.99) y la apnea (OR 4IC95 por ciento 1.53 - 10.91), al ingreso hospitalario fueron predictores de mal pronóstico. Conclusiones: Los niños pequeños sin edad suficiente para recibir la vacuna tienen riesgo de presentar formas graves. La leucocitosis y la apnea fueron predictores de mal pronóstico. Los pacientes con riesgo de enfermedad severa grave deben tener acceso a centros de alta complejidad. Se debe mantener alta sospecha disgnóstica y cobertura de vacunación adecuada.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Análisis Multivariante , Factores de Riesgo , Leucocitosis , Tos Ferina/complicaciones , Tos Ferina/prevención & control , Vacunación , Interpretación Estadística de Datos , Hospitales PediátricosRESUMEN
Introducción: el impacto que generan las bacteriemias asociadas a cvc es muy importante. Como parte de un programa de prevención de las bacteriemias asociadas a CVC se evaluó el exceso de costo atribuible a dichas infecciones y el costo beneficio del programa. Métodos: Se compararon las tasas de BI asociadas a CVC ocurridas en el período previo (PreI)y posterior a las intervenciones (PostI). Se utilizaron las definiciones desarrolladas por el NNIS. Se calculó el costo atribuible a través de la diferencia casos y controles. Se analizó el costo por infección y el total del período. Resultados: la tasa global anual de BI asociadas a CVC fue de 7.6 por 1000 pacientes días. La tasa de BI se redujo en Post I en forma significativa con una tasa de 5.7 BI/1000 pacientes día versus 10,2 BI/1000 en el período previo (p=0.03; RR 0.56 IC 95 por ciento 0.33, 0.95). La fracción prevenible es de 44 por ciento. IC 95 por ciento 5.44, 67.3. El numero de BI estimativamente evitadas en el Post I fue de 14. El exceso de costo promedio atribuible a las BI asociadas a CVC fue de U$S 5180. Conclusión: un programa de BI puede reducir las tasas de infección y dichas actividades son cruciales para reducir los costos extra asociados.Palabras clave: Bacteriemias asociadas, prevención
Asunto(s)
Lactante , Preescolar , Niño , Bacterias , Cateterismo Venoso Central , Catéteres de Permanencia , Análisis Costo-Beneficio , Incisión VenosaRESUMEN
Introducción: el impacto que generan las bacteriemias asociadas a cvc es muy importante. Como parte de un programa de prevención de las bacteriemias asociadas a CVC se evaluó el exceso de costo atribuible a dichas infecciones y el costo beneficio del programa. Métodos: Se compararon las tasas de BI asociadas a CVC ocurridas en el período previo (PreI)y posterior a las intervenciones (PostI). Se utilizaron las definiciones desarrolladas por el NNIS. Se calculó el costo atribuible a través de la diferencia casos y controles. Se analizó el costo por infección y el total del período. Resultados: la tasa global anual de BI asociadas a CVC fue de 7.6 por 1000 pacientes días. La tasa de BI se redujo en Post I en forma significativa con una tasa de 5.7 BI/1000 pacientes día versus 10,2 BI/1000 en el período previo (p=0.03; RR 0.56 IC 95 por ciento 0.33, 0.95). La fracción prevenible es de 44 por ciento. IC 95 por ciento 5.44, 67.3. El numero de BI estimativamente evitadas en el Post I fue de 14. El exceso de costo promedio atribuible a las BI asociadas a CVC fue de U$S 5180. Conclusión: un programa de BI puede reducir las tasas de infección y dichas actividades son cruciales para reducir los costos extra asociados.Palabras clave: Bacteriemias asociadas, prevención
Asunto(s)
Lactante , Preescolar , Niño , Incisión Venosa , Catéteres de Permanencia , Bacterias , Cateterismo Venoso Central , Análisis Costo-BeneficioAsunto(s)
Antígenos Nucleares , ADN Helicasas , Reparación del ADN , Ligasas/química , Ligasas/fisiología , Secuencia de Aminoácidos , Animales , Proteínas Bacterianas/química , Línea Celular , Daño del ADN , Proteínas de Unión al ADN/química , Autoantígeno Ku , Datos de Secuencia Molecular , Proteínas Nucleares/química , Estructura Terciaria de Proteína , Homología de Secuencia de AminoácidoAsunto(s)
Antígenos Nucleares , Bacterias/genética , ADN Helicasas , ADN Ligasas/genética , Proteínas de Unión al ADN/genética , Proteínas de Unión al ADN/metabolismo , Proteínas Nucleares/genética , Proteínas Nucleares/metabolismo , Secuencias de Aminoácidos/genética , Secuencia de Aminoácidos , Arabidopsis/genética , Bacillus subtilis/genética , Bacterias/metabolismo , Secuencia Conservada , Células Eucariotas , Autoantígeno Ku , Datos de Secuencia Molecular , Alineación de Secuencia , Homología de Secuencia de AminoácidoRESUMEN
The new fumigant carbonyl sulfide offers an alternative to both methyl bromide and phosphine as a grain fumigant. Separate mathematical models for levels of kill, based on quantitative toxicological studies were developed for adults and eggs of the rice weevil Sitophilus oryzae (L.). These models suggest that fumigation exposure times for carbonyl sulfide will be a compromise between those of methyl bromide (typically 24h) and phosphine (7-10d) to achieve a very high kill of all developmental stages. S. oryzae eggs were more difficult to kill with carbonyl sulfide fumigation than the adults. At 30 degrees C, a 25gm(-3) fumigation killed 99.9% of adults in less than 1d, but took 4d to kill the same percentage of eggs. Models were generated to describe the mortality of adults at 10, 15, 20, 25 and 30 degrees C. From these models it is predicted that fumigation with carbonyl sulfide for 1-2d at 30gm(-3) will kill 99.9% of adults. Furthermore the models illustrate that fumigations with concentrations below 10gm(-3) are unlikely to kill all adult S. oryzae. Significant variation was observed in the response of eggs to the fumigant over the temperature range of 10 to 30 degrees C. Models were generated to describe the mortality of eggs at 10, 15, 20, 25 and 30 degrees C. As the temperature was reduced below 25 degrees C, the time taken to achieve an effective fumigation increased. Extrapolating from the models, a 25gm(-3) fumigation to control 99.9% of S. oryzae eggs will take 95h (4d) at 30 degrees C, 77h (3.2d) at 25 degrees C, 120h (5d) at 20 degrees C, 174h (7.5d) at 15 degrees C and about 290h (11d) at 10 degrees C. The role of temperature in the time taken to kill eggs with carbonyl sulfide cannot be ignored. In order to achieve the desired level of kill of all developmental stages, the fumigation rates need to be set according to the most difficult life stage to kill, in this instance, the egg stage.
RESUMEN
OBJECTIVE: We determined the relative value of teleradiology and radiology resident coverage of the emergency department by measuring and comparing the effects of physician specialty, training level, and image display method on accuracy of radiograph interpretation. MATERIALS AND METHODS: A sample of four faculty emergency medicine physicians, four emergency medicine residents, four faculty radiologists, and four radiology residents participated in our study. Each physician interpreted 120 radiographs, approximately half containing a clinically important index finding. Radiographs were interpreted using the original films and high-resolution digital monitors. Accuracy of radiograph interpretation was measured as the area under the physicians' receiver operating characteristic (ROC) curves. RESULTS: The area under the ROC curve was 0.15 (95% confidence interval [CI], 0.10-0.20) greater for radiologists than for emergency medicine physicians, 0.07 (95% CI, 0.02-0.12) greater for faculty than for residents, and 0.07 (95% CI, 0.02-0.12) greater for films than for video monitors. Using these results, we estimated that teleradiology coverage by faculty radiologists would add 0.09 (95% CI, 0.03-0.15) to the area under the ROC curve for radiograph interpretation by emergency medicine faculty alone, and radiology resident coverage would add 0.08 (95% CI, 0.02-0.14) to this area. CONCLUSION: We observed significant differences between the interpretation of radiographs on film and on digital monitors. However, we observed differences of equal or greater magnitude associated with the training level and physician specialty of each observer. In evaluating teleradiology services, observer characteristics must be considered in addition to the quality of image display.
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Medicina de Emergencia , Docentes Médicos , Internado y Residencia , Intensificación de Imagen Radiográfica , Radiografía , Radiología , Película para Rayos X , Análisis de Varianza , Área Bajo la Curva , Huesos/diagnóstico por imagen , Intervalos de Confianza , Medicina de Emergencia/educación , Servicio de Urgencia en Hospital , Humanos , Variaciones Dependientes del Observador , Curva ROC , Radiografía Abdominal , Radiografía Torácica , Radiología/educación , Telerradiología , Grabación en Video/instrumentaciónRESUMEN
PURPOSE: We have used receiver operating characteristic (ROC) analysis to compare screen assessment of digitized radiographic films transmitted by a teleradiology system, with evaluation of the original radiographs on film. MATERIAL AND METHODS: The material contained 120 cases (about 50% with selected pathology) that were difficult to diagnose. Four radiologists each evaluated half of the cases on film, and half on computer screen. The screen display was 1024 x 836 pixels with 8 bits/pixel. RESULTS: We found the accuracy and sensitivity of the teleradiology system to be clearly inferior to film evaluation. CONCLUSION: Improvement is needed both in the teleradiology system, and in the training of radiologists to work on the electronic workstation.
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Telerradiología/instrumentación , Película para Rayos X , Baltimore , Huesos/diagnóstico por imagen , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Noruega , Curva ROC , Intensificación de Imagen Radiográfica/instrumentación , Radiografía Abdominal , Radiografía Torácica , Telerradiología/estadística & datos numéricos , Película para Rayos X/estadística & datos numéricosRESUMEN
PURPOSE: To compare accuracy of interpretation by radiologists and emergency medicine physicians of conventional radiographs and digitized images on a workstation. MATERIALS AND METHODS: One author selected 120 radiographs from the radiology department library, including 62 musculoskeletal, 20 abdominal, and 38 chest examinations. Analog radiographs were digitized. There were 60 positive and 60 control cases. Positive cases demonstrated clinically important disease and had a high degree of diagnostic difficulty. Thirty-one cases were judged to be critical to the patient's immediate care, requiring prompt accurate interpretation. Four groups of readers were used: staff radiologists and emergency medicine physicians and second-year radiology and emergency medicine residents. RESULTS: All reader groups performed better when interpreting conventional radiographs than digitized images. Differences in favor of radiograph reading were statistically significant for overall accuracy related to all cases and to critical cases (P < .05, one-tailed test). CONCLUSION: Results with the teleradiology system were found unacceptable for primary interpretation of the spectrum of radiographs seen in an emergency department.
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Intensificación de Imagen Radiográfica , Sistemas de Información Radiológica , Telemedicina , Baltimore , Medicina de Emergencia/educación , Servicio de Urgencia en Hospital , Humanos , Internado y Residencia , Variaciones Dependientes del Observador , Curva ROC , Radiología/educación , Sensibilidad y EspecificidadRESUMEN
Serum thyroid hormones, serum thyroxine-binding proteins and serum thyroid hormone fractions have been measured in children with congenital heart disease before and after open cardiac surgery. Twenty prepubertal patients, mean (+/- SD) age 3.6 +/- 3.7 yr, were studied before, immediately after, and 24 and 48 h after surgery. A control group of 6 normal prepubertal children was also studied in basal conditions. Serum TSH was normal in all samples collected. Significantly low mean levels of serum TBG (261 +/- 57 vs 456 +/- 71 nmol/L in normals), serum TBPA (2692 +/- 1119 vs 5999 +/- 2226 nmol/L), serum TBG-bound T4, serum TBPA-bound T4, serum TT3, serum TBG-bound T3 and free T3 were found before cardiac surgery in the patients. While serum binding proteins did not change after surgery, significant decrements in serum TT4, serum TBG-bound T4, serum TT3, serum TBG-bound T3, serum albumin-bound T3 and free T3 were observed after surgery. Free T4 and albumin-bound T4 remained normal. Our study shows that many features of nonthyroidal illness were present in our patients before surgery. In this context, the stress of surgery induced further alterations in several parameters of thyroid metabolism. It is concluded that the changes occurring in this model of chronic, as well as acute, nonthyroidal illness reflect adaptative changes, rather than altered thyroid function, as shown by normal serum free T4, serum albumin-bound T4 and serum TSH.
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Cardiopatías Congénitas/sangre , Proteínas de Unión a Tiroxina/análisis , Tiroxina/sangre , Triyodotironina/sangre , Niño , Preescolar , Femenino , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Masculino , Factores de TiempoRESUMEN
Linkage data and revised genetic maps for 72 autosomal loci in Lucilia cuprina are presented. Comparison of the linkage relationships of biochemically and morphologically similar mutations in Ceratitis capitata, Drosophila melanogaster, and Musca domestica supports the hypothesis that the major linkage elements have survived relatively intact during evolution of the higher Diptera. The relationship of the linkage groups of the mosquito Aedes aegypti to these species is less clear.
Asunto(s)
Mapeo Cromosómico , Dípteros/genética , Ligamiento Genético , Aedes/genética , Animales , Evolución Biológica , Cruzamientos Genéticos , Drosophila melanogaster/genética , Femenino , Moscas Domésticas/genética , Masculino , Mutación , Especificidad de la EspecieRESUMEN
Field-female killing (FK) systems based on deleterious mutations and Y-autosome translocations are being evaluated for genetic control of the Australian sheep blowfly, Lucilia cuprina. Experience during field trials has shown that mass-reared colonies of FK strains are subject to genetic deterioration, caused mainly by genetic recombination in males. A previous study found higher male recombination frequencies in two Y-linked translocation strains than in chromosomally normal males. However, the results of the present study indicate that breakage of the Y chromosome is neither sufficient nor necessary for increased levels of male recombination. The frequency of male recombination appears to be unrelated to the presence of specific chromosome rearrangements.