scholarly journals Contamination of CSF Culture: Serious Risk to Patient Safety

2020 ◽  
Vol 41 (S1) ◽  
pp. s181-s181
Author(s):  
Rahul Garg
Keyword(s):  
High Sensitivity ◽  
Signs And Symptoms ◽  
Cost Effective ◽  
Medical Emergency ◽  
Acute Bacterial Meningitis ◽  
Contamination Rate ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Aerobic Culture ◽  
Acinetobacter Baumannii Complex

Background: Acute bacterial meningitis is a medical emergency, and early initiation of appropriate therapy is important to improving outcomes. Culture-based methods are still the standards for the detection of microorganisms in cerebrospinal fluid (CSF). Automated blood culture systems yield better results in cultures sterile body fluids, including CSF. However, the high sensitivity of this technology does not negate the danger of contamination compromising the final outcome. Thus, we tried to study the culture yield in suspected meningitis to determine the rate of contamination. Methods: We conducted a retrospective cohort study of CSF samples collected for culture over 1 year from January 2018 to December 2018 from patients who presented with signs and symptoms indicative of meningitis. The bacterial etiologies and rates of contamination were extracted from laboratory records. Descriptive statistics from Microsoft Excel software were used to analyze patient data. Limited statistical analysis (ie, the Fisher exact test) was performed using SPSS for Windows version 18 software. Results: In total, 1,053 CSF samples were received for aerobic culture, of which the most frequent were conventional cultures (685 of 1053, 65%), whereas BacT/ALERT cultures were requested for 368 of 1,053 cases (35%). Of 685 conventional CSF cultures, pathogens were isolated in 28 of 685 (4.1%), most commonly Acinetobacter baumannii complex (10 of 28, 35.7%). Contaminants were identified in 0.58% samples (4 of 685). In the 368 BacT/ALERT cultures, pathogens were detected in 15 (4.1%), most commonly Streptococcus spp (5 of 15, 33.3%). The contamination rate was 51.1% (188 of 368 cases). The overall rate of contamination was 18.2% (192 of 1,053 cases). The most CSF cultures were received from patients in neurosurgery (350 of 1,053, 33.2%) followed by medicine wards (270 of 1,053, 25.6%). Aerobic spore bacilli was by far the most common contaminant (109 of 1,053, 10.35%).Conclusions: We believe efforts to decrease contamination are among the most cost-effective, but targeted clinical re-evaluation for all patients with positive CSF cultures remains vital. Due to the high sensitivity of the automated culture system, it is a imperative to maintain strict aseptic conditions while collecting CSF samples. Failure to do so may lead to overgrowth of contaminants masking the growth of the true pathogens in culture.Disclosures: NoneFunding: None

scholarly journals Comparison of the Level of Awareness about the Transmission of Echinococcosis and Toxocariasis between Pet Owners and Non-Pet Owners in Greece

2020 ◽  
Vol 17 (15) ◽  
pp. 5292 ◽  
Author(s):  
Christina Kantarakia ◽  
Maria E. Tsoumani ◽  
Antonis Galanos ◽  
Alexander G. Mathioudakis ◽  
Eleni Giannoulaki ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Linear Regression Analysis ◽  
Signs And Symptoms ◽  
Knowledge Score ◽  
Fisher Exact Test ◽  
Pet Ownership ◽  
Cross Sectional ◽  
Exact Test ◽  
Pet Owners ◽  
Chi Squared

Ζoonotic parasitic diseases that can occur through animal contact pose risks to pets, their owners and to their bond. This study aims to assess the level of knowledge about zoonoses, specifically echinococcosis and toxocariasis, among cat/dog owners and non-pet owners in Greece. Multiple-choice questionnaires were designed to obtain data regarding the knowledge of pet and non-pet owners on echinococcosis and toxocariasis, including signs and symptoms of these zoonoses, ways of transmission and precautions that need to be taken into account in order to avoid it. A total of 185 questionnaires were retrieved and data was expressed as absolute (Ν) and relative frequencies (%). Associations between pet ownership, residence and outcome variables were evaluated using the Fisher exact test and Chi-squared test, respectively. Multifactorial linear regression analysis was used to investigate the cross-sectional association between demographic characteristics and the awareness of helminthic zoonoses. All tests were two-sided and statistical significance was set at p < 0.05. Our study revealed a disturbing lack of awareness of echinococcosis and toxocariasis (mean zoonotic knowledge score 8.11 ± 3.18) independently of pet ownership. Surprisingly, in some cases the ignorance of pet owners exceeded that of non-pet owners. Given the progressive impact of toxocariasis in public health and the high prevalence of echinococcosis in the Mediterranean region, measures should be taken to inform people about zoonoses and eliminate their putative transmission.

scholarly journals Comparative evaluation of clinical and radiographical assessment of manual and rotary technique during pulpectomy procedure in primary teeth – in vivo study

2019 ◽  
Author(s):  
Shruti Sharma ◽  
Ritu Khanduja ◽  
Updesh Masih ◽  
Sonal Gupta ◽  
Manisha Kaushik
Keyword(s):  
Sample Size ◽  
Success Rate ◽  
Root Resorption ◽  
File Systems ◽  
Signs And Symptoms ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Group B

Aim: To determine the clinical and radiographical success of pulpectomy treated teeth by comparing two different file systems using manual (K –file) and paediatric rotary file (Kedo-S). Methods: Fifty subjects were selected for pulpectomy procedure in the age group of 3 to 6 years divided into two groups, group A(25 sample size) pulpectomy performed using k-file AND group B( 25 sample size) where the pedo rotary kedo-S file system was used. Follow-up was done at 3, 6 and 9 months. Both clinical as well as radiographic signs and symptoms were evaluated and analysed by using Fisher Exact –test.. Results: The success rate for clinical evaluation found to be 100% with Kedo-S rotary files whereas it was 92% using K-files. The success rate for radiographical evaluation found to be 100% using Kedo-S rotary files for both periapical and furcation radiolucency while 92% for the root resorption. In case of K- files, both periapical and furcation radiolucency was found to be 92% while 80% was root resorption after a 9 month follow-up. After statistical analysis of both the file systems at 3, 6 and 9 months follow-up, the findings came as insignificant(p>0.05). Conclusion: Although the result of clinical and radiographical evaluation after respective follow-up was not that much clear by the present study but the success rate of pulpectomy treated cases was found to be 100% with Kedo-S pedo rotary file. Keywords: Pulpectomy, K-files, Kedo-S files.

scholarly journals FOXF1 as an Immunohistochemical Marker of Hilar Cholangiocarcinoma or Metastatic Pancreatic Ductal Adenocarcinoma. Single Institution Experience

2021 ◽  
Vol 27 ◽  
Author(s):  
Jan Hrudka ◽  
Zuzana Prouzová ◽  
Katarína Mydlíková ◽  
Kristína Jedličková ◽  
Michal Holešta ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Prognostic Significance ◽  
High Sensitivity ◽  
Ductal Adenocarcinoma ◽  
Fisher Exact Test ◽  
C Reactive Protein ◽  
Single Institution ◽  
Liver Malignancy ◽  
Exact Test ◽  
Reactive Protein

Cholangiocarcinoma (CCA) is a liver malignancy associated with a poor prognosis. Its main subtypes are peripheral/intrahepatic and hilar/extrahepatic CCA. Several molecular, morphological and clinical similarities between hilar/extrahepatic CCA and pancreatic ductal adenocarcinoma (PDAC) have been described. FOXF1 is a transcription factor which has been described to have prognostic significance in various tumors and it is involved in the development of bile ducts. The aim of this study is to determine occurrence of nuclear expression of FOXF1 in both subtypes of CCA and metastatic PDAC and assess its potential usefulness as a diagnostic marker. Secondary aims were to investigate the use of C-reactive protein (CRP) immunohistochemistry for diagnosing intrahepatic peripheral CCA and the significance of histological features in CCA subtypes. 32 archive specimens of CCA, combined hepatocellular carcinoma-CCA (HCC-CCA) and liver metastasis of PDAC were stained by FOXF1 and CRP immunohistochemistry and evaluated to determine histological pattern. The CCAs were classified radiologically into peripheral/intrahepatic and hilar subtype. Using Fisher exact test, we identified nuclear FOXF1 as a fairly specific (87%) but insensitive (65%) marker of hilar and extrahepatic CCA and metastatic PDAC (p = 0.005). CRP immunohistochemistry was characterized by a high sensitivity and specificity, of 79% and 88%, respectively (p = 0.001). We did not identify any histomorphological features associated with either types of CCA or metastatic PDAC. As a conclusion of novel finding, FOXF1 immunohistochemistry may be regarded as a specific but insensitive marker of hilar/extrahepatic CCA and metastatic PDAC and it may help distinguish them from peripheral CCA.

scholarly journals Validity of Ottawa Knee Rules at a Teaching Hospital of Eastern Nepal

2021 ◽  
Vol 6 (2) ◽  
pp. 1471-1475
Author(s):  
Bibhuti Nath Mishra ◽  
Santosh Nepal ◽  
Surya Bahadur Parajuli
Keyword(s):  
Teaching Hospital ◽  
Subjective Evaluation ◽  
Knee Injuries ◽  
High Sensitivity ◽  
Cross Sectional Study ◽  
Fisher Exact Test ◽  
X Rays ◽  
Cross Sectional ◽  
Exact Test ◽  
Acute Knee

Introduction: Knee injuries are encountered frequently in Orthopedic emergency and Outpatient departments. Radiographs are routinely ordered in them, but not all of them demonstrate clear fractures. The decision for radiography based on subjective evaluation can help to reduce cost, decrease waiting time, and unnecessary radiation exposure. We lack this information in our context. Objective: The objective of this study was to find the validity of the Ottawa knee rule (OKR) in patients presenting with acute knee injuries at a teaching hospital in eastern Nepal. Methodology: A cross-sectional study was conducted from March 2018 to February 2019 including 210 cases of acute knee injuries. The patients were evaluated as per OKR and their X-rays were evaluated too. Collected data were entered in MS Excel and analyzed by SPSS for validity.   Results: Out of the total of 210 eligible patients (122 males and 88 females) with a mean age of 43.97 years, the radiography rate was 100% but the yield rate was only 10.5%. Overall 69% of patients presented to the hospital within 24 hours of the injury and direct hit/trauma was the commonest mode of injury. Patella fractures were commonest followed by proximal tibia fractures. There was a high sensitivity of 100% and a specificity of 42.02%.  The rule yielded a Positive and Negative Predictive value of 16.79% and 100%, respectively. The OKR, if applied correctly, could result in radiography rate reduction by 37.61%. The Fisher exact test result was significant at p<0.05. Conclusion: OKRs is a valid tool to predict fractures in patients who has a history of acute knee injuries without chances of missing fractures. This rule can reduce unnecessary radiography in our setup as well.

scholarly journals EVALUATION OF SIGN AND SYMPTOMS RELATED TO INDWELLING URETERAL STENTS

2016 ◽  
Vol 23 (1) ◽  
Author(s):  
Joko anom Suryawan ◽  
H R Danarto ◽  
Nur Budiyono
Keyword(s):  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Ureteral Stent ◽  
Bivariate Analysis ◽  
Stent Insertion ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Dj Stent

Objective: To study factors that influence signs and symptoms related to stented ureter. Material & methods: This was a prospective-cross sectional study, from March 2014 to August 2014, to know factors that influence signs and symptoms of patients with ureteral stent. All patients were inserted ureteral stent participated in this study. Exclusion criteria were patients with malignancy, patients who had history of DJ stent placement previously, patients with bilateral DJ stents and patients with urinary tract infection. All patients completed IPSS questionnaire before inserted stents. After 1 month, when removal DJ stents performed, all patients completed IPSS, USSQ and VAS. All data was analyzed with Chi-square/fisher exact test, Pearson/Spearman correlation and Mann Whitney. Results: Fourty patients consisted of 23 man (57.5%) and 17 women (42.5%) completed this study. The mean age was 44.92 years old and length of stented ureter was 38.22 days. There was significance correlation between IPSS of DJ stent pre-insertion and post insertion (p < 0.001; r = 0.628). Of the patients reported dysuria (62.5%), frequency (55%), nocturia (52.5%), incomplete emptying (47.5%), hematuria (35%) and urgency (15%). On bivariate analysis, there was significance correlation between DJ stent position and frequency (p < 0.001), nocturia (< 0.001), urgency (p = 0.002), incomplete emptying (p = 0.049), dysuria (p = 0.030), hematuria (p = 0.026) and pain (p < 0.001). Conclusion: Previous urinary symptoms and DJ stent position were factors that influenced sign and symptoms related to ureteral stent insertion.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

Electronic cigarettes: How confident and effective are allergists, pulmonologists, and primary care physicians in their practice behavior?

2020 ◽  
Vol 41 (3) ◽  
pp. 192-197
Author(s):  
Sherry S. Zhou ◽  
Alan P. Baptist
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Electronic Cigarettes ◽  
The United States ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Knowledge And Beliefs ◽  
Tobacco Cigarette ◽  
Number Of Patients ◽  
Personal Use

Background: There has been a striking increase in electronic cigarette (EC) use in the United States. The beliefs and practices toward ECs among physicians are unknown. Objective: The purpose of this study was to investigate EC practice patterns among allergists, pulmonologists, and primary care physicians. Methods: An anonymous survey was sent to physicians. The survey contained 32 questions and addressed issues related to demographics, cessation counseling behaviors, personal use, and knowledge and beliefs about ECs. Statistical analysis was performed by using analysis of variance, the Pearson χ2 test, Fisher exact test, and logistic regression. Results: A total of 291 physicians completed the survey (222 primary care physicians, 33 pulmonologists, and 36 allergists) for a response rate of 46%. The allergists asked about tobacco cigarette use as frequently as did the pulmonologists and more than the primary care physicians (p < 0.001), but they rarely asked about EC use. The pulmonologists scored highest on self-reported knowledge on ECs, although all the groups answered <40% of the questions correctly. The allergists did not feel as comfortable about providing EC cessation counseling as did the pulmonologists and primary care physicians (p < 0.001). All three groups were equally unlikely to recommend ECs as a cessation tool for tobacco cigarette users. Conclusion: Allergists lacked knowledge and confidence in providing education and cessation counseling for EC users. As the number of patients who use these products continues to increase, there is an urgent need for all physicians to be comfortable and knowledgeable with counseling about ECs.

Perbedaan Kontaminasi Bacteria Staphylococcus sp di Denominasi Uang Kertas Rupiah di Warung Jalan Adi Sucipto Kota Pontianak

2018 ◽  
Vol 1 (2) ◽  
pp. 166
Author(s):  
Sutriswanto Sutriswanto ◽  
Sugito Sugito
Keyword(s):  
Research Method ◽  
Sampling Technique ◽  
Cluster Sampling ◽  
Fisher Exact Test ◽  
Infectious Agents ◽  
Exact Test ◽  
Purposive Sampling ◽  
Paper Money

Abstract: Staphylococcus is a cause of infection. Infection can be transmitted from a source by an indirect through fomite. Paper money can act as transmission of infectious agents, money acts as a fomite. Smaller denominations of value have higher contamination. This study aims to analyze differences in contamination bacterial Staphylococcus sp on denomination of paper money Rp.2.000, 5.000, Rp.10,000 and Rp.20.000 that currently shop on Adi Sucipto street town Pontianak. The research method used in this research is in the form of difference and the sample in this research is denomination of paper money curently with sampling technique using cluster sampling. Checkup of Staphylococcus spon denomination of paper money using rinse method. On these result of study, denomination of paper money Rp.2.000 that is contaminated staphylococcus sp is 80%, denomination of paper money Rp.5.000 that is contaminated staphylococcus sp is 70%, denomination of paper money Rp.10.000 and Rp.20.000 that is contaminated staphylococcus sp is 80%. The data from result of study has been obtained were analyzed statistically by using fisher exact test, the result of p (0,477) >α (0,05) which mean as H1 is rejected. So it can be concluded there is no difference of contamination bacteria staphylococcus sp on denominations of paper money rupiah.Abstrak: Staphylococcus merupakan penyebab terjadinya infeksi. Infeksi dapat ditularkan dari suatu sumber dengan mekanisme tidak langsung melalui fomite. Uang kertas dapat bertindak sebagai transmisi agens infeksius ,uang berperan sebagai fomite. Pecahan uang yang lebih kecil nilainya memiliki kontaminasi yang lebih tinggi. Penelitian ini bertujuan untuk menganalisis perbedaan cemaran bakteri Staphylococcus sp pada pecahan uang kertas Rp.2.000, 5.000, Rp.10.000 dan Rp.20.000 yang beredar di warung jalan Adi Sucipto kota Pontianak. Metode penelitian yang digunakan dalam penelitian berbentuk komperatif dan sampel pada penelitian ini adalah pecahan uang kertas rupiah dengan.teknik pengambilan sampel menggunakan purposive sampling. Pemeriksaan Staphylococcus sp pada pecahan uang kertas rupiah menggunakan metode rinse. Pada hasil penelitian pecahan uang kertas Rp.2.000 yang tercemar staphylococcus sp adalah 80%, pecahan uang kertas Rp.5.000 yang tercemar staphylococcus spadalah 70%, pecahan uang kertas Rp.10.000 dan Rp.20.000 yang tercemar staphylococcus spadalah 50%. Berdasarkan data dari hasil penelitian yang telah didapat dianalisis menggunakan uji statistik fisher exact, didapatkan hasil p (0,477) >α (0,05) yang diartikan sebagai H1 ditolak. Sehingga dapat disimpulkan tidak ada perbedaan cemaran bakteri staphylococcus sp pada pecahan uang kertas rupiah.

Characteristics of Physician Relocation Following Hurricane Katrina

2009 ◽  
Vol 95 (1) ◽  
pp. 6-12
Author(s):  
Kusuma Madamala ◽  
Claudia R. Campbell ◽  
Edbert B. Hsu ◽  
Yu-Hsiang Hsieh ◽  
James James
Keyword(s):  
Hurricane Katrina ◽  
Gulf Coast ◽  
General Medicine ◽  
The United States ◽  
Lessons Learned ◽  
Bivariate Analysis ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Factors Associated ◽  
The Impact

ABSTRACT Introduction: On Aug. 29, 2005, Hurricane Katrina made landfall along the Gulf Coast of the United States, resulting in the evacuation of more than 1.5 million people, including nearly 6000 physicians. This article examines the relocation patterns of physicians following the storm, determines the impact that the disaster had on their lives and practices, and identifies lessons learned. Methods: An Internet-based survey was conducted among licensed physicians reporting addresses within Federal Emergency Management Agency-designated disaster zones in Louisiana and Mississippi. Descriptive data analysis was used to describe respondent characteristics. Multivariate logistic regression was performed to identify the factors associated with physician nonreturn to original practice. For those remaining relocated out of state, bivariate analysis with x2 or Fisher exact test was used to determine factors associated with plans to return to original practice. Results: A total of 312 eligible responses were collected. Among disaster zone respondents, 85.6 percent lived in Louisiana and 14.4 percent resided in Mississippi before the hurricane struck. By spring 2006, 75.6 percent (n = 236) of the respondents had returned to their original homes, whereas 24.4 percent (n = 76) remained displaced. Factors associated with nonreturn to original employment included family or general medicine practice (OR 0.42, 95 percent CI 0.17–1.04; P = .059) and severe or complete damage to the workplace (OR 0.24, 95 percent CI 0.13–0.42; P &lt; .001). Conclusions: A sizeable proportion of physicians remain displaced after Hurricane Katrina, along with a lasting decrease in the number of physicians serving in the areas affected by the disaster. Programs designed to address identified physician needs in the aftermath of the storm may give confidence to displaced physicians to return.

Trends in Diagnosis for Active Tuberculosis Using Nanomaterials

2019 ◽  
Vol 26 (11) ◽  
pp. 1946-1959 ◽  
Author(s):  
Le Minh Tu Phan ◽  
Lemma Teshome Tufa ◽  
Hwa-Jung Kim ◽  
Jaebeom Lee ◽  
Tae Jung Park
Keyword(s):  
Sensitivity And Specificity ◽  
High Efficiency ◽  
Point Of Care ◽  
High Sensitivity ◽  
Signs And Symptoms ◽  
Diagnostic Methods ◽  
Advantages And Disadvantages ◽  
Treatment And Prevention ◽  
Clinical Tools ◽  
Diagnostic Applications

Background:Tuberculosis (TB), one of the leading causes of death worldwide, is difficult to diagnose based only on signs and symptoms. Methods for TB detection are continuously being researched to design novel effective clinical tools for the diagnosis of TB.Objective:This article reviews the methods to diagnose TB at the latent and active stages and to recognize prospective TB diagnostic methods based on nanomaterials.Methods:The current methods for TB diagnosis were reviewed by evaluating their advantages and disadvantages. Furthermore, the trends in TB detection using nanomaterials were discussed regarding their performance capacity for clinical diagnostic applications.Results:Current methods such as microscopy, culture, and tuberculin skin test are still being employed to diagnose TB, however, a highly sensitive point of care tool without false results is still needed. The utilization of nanomaterials to detect the specific TB biomarkers with high sensitivity and specificity can provide a possible strategy to rapidly diagnose TB. Although it is challenging for nanodiagnostic platforms to be assessed in clinical trials, active TB diagnosis using nanomaterials is highly expected to achieve clinical significance for regular application. In addition, aspects and future directions in developing the high-efficiency tools to diagnose active TB using advanced nanomaterials are expounded.Conclusion:This review suggests that nanomaterials have high potential as rapid, costeffective tools to enhance the diagnostic sensitivity and specificity for the accurate diagnosis, treatment, and prevention of TB. Hence, portable nanobiosensors can be alternative effective tests to be exploited globally after clinical trial execution.

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