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Purpose: This study assesses the effects of enteral nutrition on gastric mucosal perfusion measurements (pHi). Background: Optimizing gastric mucosal perfusion has become an important aspect in the care of critically [...]

Background: Annual chlamydia screening is recommended for all sexually active women aged <25 years. Substantial limitations exist in ascertaining chlamydia trends. Reported case rates have increased likely due to increased screening and improved test technology. Other data suggest that prevalence has decreased.Methods: Data from the Infertility Prevention Project (IPP), a national chlamydia screening program, were used to assess trends in chlamydia positivity from 2004 to 2008 among women aged 15 to 24 years who were tested in family planning clinics reporting data to IPP. Using the clinic as the unit of analysis, a correlated, longitudinal data analysis with a random intercept was conducted among clinics reporting ≥3 years of data during the analysis timeframe. Sensitivity analyses were performed to address the impact of various clinic participation levels in addition to the assessment of various correlation structures.Results: Over 5 million chlamydia tests were reported to IPP family planning clinics from 2004 to 2008. A majority of tests were conducted among white women (clinic-specific mean: 63.2%, interquartile range: 37.6%-91.5%); the clinic-specific mean percent of tests conducted among black women was 17.9% (interquartile range: 0.8%-25.7%). Overall chlamydia positivity from 2004 to 2008 was 7.0%. The odds ratio associated with a single year change (1.00; 95% confidence interval: 0.99, 1.00) suggested that chlamydia positivity did not change from 2004 to 2008, after controlling for clinic-specific population factors (age, race, test usage, and geography).Conclusions: Findings support previous analyses suggesting that chlamydia prevalence is not increasing despite apparent increasing rates based on case reports. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of pumpless extracorporeal arteriovenous carbon dioxide removal (AVCO2R) in subjects with acute respiratory failure and hypercapnia. Design: A phase I within-group time series trial in which subjects underwent up to 72 h of support with AVCO2R in intensive care units of two university hospitals. Patients: Eight patients with acute hypercapnic respiratory failure or hypoxemic respiratory failure managed with permissive hypercapnia. Interventions: Extracorporeal CO2 removal was achieved through percutaneous cannulation of the femoral artery and vein, and a simple extracorporeal circuit using a commercially available membrane gas exchange device for carbon dioxide exchange. Measurements and results: Measurements of hemodynamics, blood gases, ventilatory settings, and laboratory values were made before initiation of AVCO2R, and at subsequent intervals for 72 h. PaCO2 decreased significantly from 90.8±7.5 mmHg to 52.3±4.3 and 51.8±3.1 mmHg at 1 and 2 h, respectively. This decrease occurred despite a decrease in minute ventilation from a baseline of 6.92±1.64 l/min to 4.22±.46 and 3.00±.53 l/min at 1 and 2 h. There was a normalization of pH, with an increase from 7.19±.06 to 7.35±.07 and 7.37±.05 at 1 and 2 h. These improvements persisted during the full period of support with AVCO2R. Four subjects underwent apnea trials in which AVCO2R provided total carbon dioxide removal during apneic oxygenation, resulting in steady-state PaCO2 values from 57 to 85 mmHg. Hemodynamics were not significantly altered with the institution of AVCO2R. There were no major complications attributed to the procedure. Conclusion: Pumpless extracorporeal AVCO2R is capable of providing complete extracorporeal removal of carbon dioxide during acute respiratory failure, while maintaining mild to moderate hypercapnia. Applied in conjunction with mechanical ventilation and permissive hypercapnia, AVCO2R resulted in normalization of arterial PCO2 and pH and permitted significant reductions in the level of mechanical ventilation. [ABSTRACT FROM AUTHOR]

The treatment of patients with infection secondary to carbapenem-resistant Acinetobacter baumannii with emerging cefiderocol resistance remains challenging and unclear. We present a case of in vivo emergence of pandrug-resistant A baumannii that was successfully treated with the compassionate use of investigational sulbactam-durlobactam-based antibiotic regimen. We also performed a longitudinal genomic analysis of the bacterial isolates and showed the development of resistance and genetic mutations over time., Competing Interests: Potential conflicts of interest. S. L. A. serves on the advisory boards for Entasis, GSK, Basilea, bioMérieux, AstraZeneca, Melinta, Shionogi, Ferring, and F2G. S. H. M. is a current employee of Innoviva Specialty Therapeutics, Inc. All other authors report no potential conflicts., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background/significance: The 10-point Adverse Childhood Experiences (ACEs) score measures childhood exposure to traumatic events. An ACEs score of 4 or higher has been associated with long-term physical and mental health problems, and increased mortality. It is unclear if the rates of undergraduate nursing students experiencing ACEs is different from the general population, and what impact ACEs has on nursing students' depression, anxiety and stress., Purpose: The purpose of this study was to assess the rate of ACEs in nursing students and to examine the relationship between ACEs and perceived depression, anxiety, and stress among undergraduate nursing students., Methods: This is a descriptive correlational study to determine Adverse Childhood Experiences (ACEs) scores and Modified Depression Anxiety and Stress Scale (DASS-21) scores for undergraduate pre-licensure students at a private mid-western college. Students' ACEs scores were correlated with DASS-21 scores and demographic data., Results: 409 students volunteered to participate in the study. Seventeen percent of students had high ACEs scores (≥4). Those students with high ACEs scores also scored statically significantly higher on the DASS-21 items relating to depression, anxiety, and stress., Conclusion/implications: Results from this study demonstrated that many nursing students have experienced ACEs and nursing students with ACEs scores of 4 or higher had higher rates of depression, anxiety, and stress. These findings should drive faculty in nursing programs to acknowledge the prevalence of ACEs among their nursing students and recognize that impact on the mental health of students., (Copyright © 2021 Elsevier Inc. All rights reserved.)

In 2018, 21 (41%) jurisdictions had begun reporting gender identity for sexually transmitted disease case notifications sent to the Centers for Disease Control and Prevention. Among jurisdictions with ≥70% of cases with reported gender identity and sex, 1.0% of primary and secondary syphilis cases were identified as transgender and 71% of transgender women with syphilis were concurrently coded as being male sex.

Main Conclusion: This is a first report of an Ala-205-Phe substitution in acetolactate synthase conferring resistance to imidazolinone, sulfonylurea, triazolopyrimidines, sulfonylamino-carbonyl-triazolinones, and pyrimidinyl (thio) benzoate herbicides. Resistance to acetolactate synthase (ALS) and photosystem II inhibiting herbicides was confirmed in a population of allotetraploid annual bluegrass (Poa annua L.; POAAN-R3) selected from golf course turf in Tennessee. Genetic sequencing revealed that seven of eight POAAN-R3 plants had a point mutation in the psbA gene resulting in a known Ser-264-Gly substitution on the D1 protein. Whole plant testing confirmed that this substitution conferred resistance to simazine in POAAN-R3. Two homeologous forms of the ALS gene (ALSa and ALSb) were detected and expressed in all POAAN-R3 plants sequenced. The seven plants possessing the Ser-264-Gly mutation conferring resistance to simazine also had a homozygous Ala-205-Phe substitution on ALSb, caused by two nucleic acid substitutions in one codon. In vitro ALS activity assays with recombinant protein and whole plant testing confirmed that this Ala-205-Phe substitution conferred resistance to imidazolinone, sulfonylurea, triazolopyrimidines, sulfonylamino-carbonyl- triazolinones, and pyrimidinyl (thio) benzoate herbicides. This is the first report of Ala-205-Phe mutation conferring wide spectrum resistance to ALS inhibiting herbicides.

Objective: To describe a case of left vagal nerve stimulation (VNS) resulting in immediate cessation of status epilepticus (SE) with good neurological outcome., Case Description: A 30-year-old man with medically intractable seizures including episodes of SE was successfully treated using left VNS. After requiring discontinuation of phenytoin, valproic acid, carbamazepine, and topiramate because of severe allergic reactions resembling Stevens-Johnson syndrome, the patient required pentobarbital coma along with phenobarbital, tiagabine, and levetiracetam for seizure frequency reduction. He underwent left vagal nerve stimulator placement after nearly 9 days of barbiturate-induced coma, with stimulation initiated in the operating room. On the following day, electroencephalography revealed resolution of previously observed periodic lateral epileptiform discharges and the patient was free of seizures. Prestimulation seizure frequency was recorded at 59 times a day, with some seizures enduring 45 minutes despite barbiturate coma. Poststimulation, the patient has been free of seizures for 19 days and is presently taking only levetiracetam and phenobarbital, from which he continues to be successfully weaned without seizures. He is awake, alert, and can recall events leading up to his seizures, with good long-term memory and residual left upper extremity and lower extremity weakness., Conclusion: This case illustrates the role of left vagal stimulation in the treatment of SE and otherwise medically intractable seizures caused by allergic reactions. To our knowledge, this is the first case in the world literature for adults reporting cessation of SE after VNS. Another case with a similar improvement has been reported in the pediatric population.

Dandy-Walker syndrome, a congenital malformation of the hindbrain involving the cerebellum and the fourth ventricle, is a rare cranial abnormality that commonly occurs before the sixth or seventh week of development. It is usually diagnosed at birth or in early childhood; however, an occasional patient may first become symptomatic in adult life. A case of Dandy-Walker syndrome in a 58-year-old woman is reported because of the older age at presentation and relatively long asymptomatic period after birth.

To explore the feasibility and operating limits of arteriovenous extracorporeal CO2 removal (AVCO2R) for support of acute respiratory failure, the authors developed a mathematical model to simulate (AVCO2R), evaluate the effects of several parameters used in its application, and predict the feasibility and necessary conditions for total CO2 removal. The mathematical model incorporated compartments representing blood, pulmonary alveoli, pulmonary capillaries, peripheral tissues and capillaries, and an extracorporeal gas exchange device. The model was validated against an animal model of extracorporeal CO2 removal. This model consisted of anesthetized and mechanically ventilated piglets. An extracorporeal CO2 removal device was placed by cannulation of a femoral artery and vein. Dynamic and steady state measurements of CO2 transfer were made and compared with simulations using the mathematical model. There was good agreement between experimental and simulated data, validating the mathematical model under a variety of conditions. The mathematical model was used to determine operating parameters for total CO2 removal. Relationships between extracorporeal blood flow, device diffusing capacity, and device gas sweep flow were established for CO2 removal at various levels of CO2 production. These simulations indicate that it is possible to achieve total CO2 removal using an extracorporeal shunt fraction of 10%-15% of cardiac output, a device diffusing capacity of 0.5 ml x min(-1) x torr(-1) (kg body weight)(-1), and a gas:blood flow of 5 or greater.

Study Objective: To characterize the physiologic response to, and safety of, intravenacaval membrane oxygenation and carbon dioxide removal., Design: Interventional before-after study., Setting: University teaching hospital ICU., Patients: Twenty-two patients with severe acute respiratory distress syndrome (ARDS)., Interventions: Implantation of a hollow-fiber membrane oxygenator (IVOX; CardioPulmonics; Salt Lake City, Utah) into the superior and inferior venae cavae by venotomy of the right femoral or right internal jugular vein for a duration of up to 20 days., Measurements: Hemodynamic measurements using pulmonary artery and systemic artery catheters, ventilator settings (FIO2, minute ventilation, peak inspiratory pressure, and positive end-expiratory pressure), arterial and mixed venous blood gases (pH, PCO2, PO2, and measured saturation), and clinical laboratory determinations (CBC, fibrinogen, plasma hemoglobin, complement C3 and C5) were obtained. Calculations of PaO2/FIO2 ratio and PaCO2-VE product were used to assess gas exchange efficacy. Microbiologic cultures were obtained from the device and wound following explantation. Survival to ICU discharge and hospital discharge were recorded., Results: Implantation was successful in 20 of 22 patients. Gas exchange rates averaged 50.4 +/- 15.8 mL.min-1 for carbon dioxide and 71.1 +/- 20.2 mL.min-1 for oxygen. A reduction in FIO2 from 0.78 +/- 0.16 to 0.63 +/- 0.21 and in VE from 177 +/- 94 mL.kg-1.min-1 to 127 +/- 58 mL.kg-1.min-1 was possible within 4 h post-implantation. By 12 h, FIO2 was reduced to 0.57 +/- 0.18. Indices of gas exchange improved significantly after implantation, with PaO2/FIO2 ratio increasing from 79 +/- 20 to 112 +/- 47 and PaCO2-VE product decreasing from 7.6 +/- 4.2 to 4.9 +/- 2.5 within 4 h. A significant reduction in peak inspiratory pressure was achieved (45 +/- 10 to 38 +/- 9 cm H2O). Major complications were blood loss during implantation requiring transfusion in 11 patients, a retroperitoneal bleed in 1 patient, and femoral deep venous thrombosis in 4 patients, but there were no long-term sequelae or IVOX-related deaths. The ICU and hospital survival were 10/20 (50%) and 8/20 (40%), respectively., Conclusions: Intravenacaval membrane oxygen and carbon dioxide removal can provide partial respiratory support during severe respiratory failure and permit reductions in the level of mechanical ventilator support, with an acceptable safety profile.

The optimal approach to the recognition, management, and prevention of nosocomial pneumonia is evolving. A broad spectrum of potential pathogens is recognized in the hospital setting, and more invasive procedures have been developed in attempts to improve diagnostic accuracy. Newer, broad spectrum antimicrobial agents are continually introduced, yet the presence of resistant organisms is increasingly recognized. The reports released in the past year show physicians are making advances toward gaining a better understanding of this common infection.