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Staphylococcus aureus bacteremia is common and associated with fatality rates approximating 25%. We provide a brief overview of S. aureus bacteremia from a clinical and microbiological lens and review the relevant evidence and literature gaps in its management. Using a case-based approach, evidence and clinical judgement are meshed to highlight and justify the 5 core interventions that ought to be performed for all cases of S. aureus bacteremia: 1) appropriate anti-staphylococcal therapy, 2) screening echocardiography, 3) assessment for metastatic phenomena and source control, 4) decision on duration of antimicrobial therapy, and 5) Infectious Diseases consultation. [ABSTRACT FROM AUTHOR]

Bacterial prostatitis is a highly prevalent infection responsible for significant morbidity among men. The diagnosis and treatment for bacterial prostatitis remains complicated. The difficulty in diagnosis is in part owing to the paucity of high-quality evidence that guides a clinician's interpretation of patients' history, physical examination, and laboratory findings. Treatment is challenging because of the few antimicrobials capable of prostate penetration, growing antimicrobial resistance limiting effective treatment options, and the high risk of recurrence. We aimed to provide a useful resource for clinicians in effectively diagnosing and managing acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP). A PubMed literature search on prostatitis was performed with no restrictions on publication date. The epidemiology, pathophysiology, diagnosis, and treatment for ABP and CBP are explored using a clinical vignette as relevant context. Bacterial prostatitis can be diagnosed through a focused history and microbiological investigations. The Meares-Stamey 4-glass test or modified 2-glass test can help confirm the diagnosis if uncertainty exists. Typical uropathogens are common contributors to bacterial prostatitis but there is growing interest in exploring the role atypical and traditional non-pathogenic organisms may have. Fluoroquinolones remain first-line therapy, followed by trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline if the pathogen is susceptible. Fosfomycin has emerged as a repurposed and useful agent because of the increasing incidence of multidrug-resistant pathogens. Selection of appropriate antimicrobial regimens can be challenging and is dependent on the host, chronicity of symptoms, uropathogens' susceptibilities, antimicrobials' side effect profile, and the presence of prostatic abscesses or calcifications. ABP can typically be treated similar to other complicated urinary tract infections. However, CBP requires prolonged therapy, with a minimum of 4 weeks and up to 12 weeks of therapy. [ABSTRACT FROM AUTHOR]

This article from the Canadian Medical Association Journal discusses access site-related infections in patients receiving dialysis. Infection is a leading cause of hospital admission and the second most common cause of death in these patients. Hemodialysis and peritoneal dialysis access sites can serve as entry points for bacteremia and peritonitis. The incidence rates of these infections are 0.42 episodes per patient-year for hemodialysis-associated bacteremia and 0.3 episodes per patient-year for PD peritonitis. Staphylococcus species are the most common bacteria implicated in these infections, and empiric methicillin-resistant Staphylococcus aureus (MRSA) coverage is recommended. Treatment includes antimicrobial therapy and possible line removal, and consultation with infectious disease specialists can aid in treatment decisions. Catheter removal is reserved for certain cases of peritonitis. [Extracted from the article]

Background: Pyogenic liver abscess (PLA), although uncommon in North America, is associated with significant morbidity and mortality. We sought to re-examine the epidemiology, risk factors, and outcomes of PLA in a large, diverse Canadian health zone.Methods: All Calgary Health Zone (CHZ) residents aged ≥20 with PLA between 2015 and 2017 were identified. Incidence and mortality rates were calculated using census data. Risk factors for PLA were identified using a multivariate analysis. Data was compared to 1999-2003 data, also collected in the CHZ.Results: There were 136 patients diagnosed with PLA between 2015 and 2017. Incidence rate during this period increased significantly relative to 1999-2003 (3.7 vs 2.3 cases/100,000 population, p < 0.01), however, mortality rates remained similar. The microbiological composition of PLA did not change over this 15-year time period but the number of antimicrobial resistant isolates did increase (8% vs 1%, p = 0.04). The greatest risk factors for PLA relative to general populations included current malignancy, liver-transplant, end-stage renal disease, and cirrhosis. Thirty-day mortality was 7.4% and independent risk factors included polymicrobial bacteremia, absence of abscess drainage, congestive-heart failure, a history of liver disease, and admission bilirubin.Conclusions: Pyogenic liver abscess is a health concern with rising incidence rate. The increasing prevalence of comorbidities in our population and factors that are associated with risk of PLA suggests this will continue to be an emerging diagnosis of concern. Increasing prevalence of antibiotic resistant organisms compounding unclear optimal treatment regimens is an issue that requires urgent study. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) has been increasingly recognized as an important complication of Staphylococcus aureus bacteremia (SAB), leading to a low threshold for echocardiography and extended treatment with anti-staphylococcal agents. However, outside of IE, many indications for prolonged anti-staphylococcal therapy courses are present. We sought to determine the frequency in which findings from a transesophageal echocardiogram (TEE) changed clinical SAB management in a large Canadian health region. Residents (> 18 years) with SAB from 2012 to 2014 who underwent transthoracic echocardiogram (TTE) and TEE were assessed. Patients potentially benefiting from an extended course of anti-staphylococcal agents were defined a priori. Patient demographics, treatment (including surgical), and clinical outcomes were extracted and evaluated. Of the 705 episodes of SAB that underwent a screening echocardiogram, 203 episodes underwent both a TTE and TEE, of which 92.1% (187/203) contained an a priori indication for extended anti-staphylococcal therapy. Regardless of TEE results, actual duration of therapy did not differ in SAB episodes that had ≥ 1 extended anti-staphylococcal therapy criteria (36.7 days, IQR 23.4–48.6 vs. 43.8 days, IQR 33.3–49.5, p = 0.17). Additionally, there were no cases in which TEE was utilized as the sole reason to shorten duration of therapy or proceed to surgery for those with SAB. Routine performance of TEE may be unnecessary in all SAB as many patients have pre-existing indications for extended anti-staphylococcal therapy independent of TEE findings. An algorithm to selectively identify cases of SAB that would benefit from TEE can reduce resource and equipment expenditure and patient risks associated with TEE. [ABSTRACT FROM AUTHOR]

Presents a study that examined the zero-field muon-spin relaxation in (yttrium[sub1-x] praseodymium[subx]) barium[sub2 copper[sub3] oxygen[suby]. Methods; Discussion of muon-spin relaxation; Conclusion.

Background: Neurocysticercosis occurs when the eggs of the pork tapeworm (Taenia solium) migrate and hatch into larvae within the central nervous system. Neurocysticercosis is the most common cause of seizures in the developing world and is characterized on brain imaging by cysts in different stages of evolution. In Canada, cases of neurocysticercosis are rare and most of these patients acquire the disease outside of Canada. We report the case of a patient with multiple intracranial lesions whose history and diagnostic imaging were consistent with neurocysticercosis. Pathological investigations ultimately demonstrated that her brain lesions were secondary to malignancy. Brain metastases are considered to be the most common cause of intracranial cystic lesions. Case Presentation: We present the case of a 60-year-old Canadian-born Caucasian woman with a subacute history of ataxia, lower extremity hyper-reflexia, and otalgia who resided near a pig farm for most of her childhood. Computed tomography and magnetic resonance imaging showed that she had multiple heterogeneous intracranial cysts, suggestive of neurocysticercosis. Despite a heavy burden of disease, serological tests for cysticercosis were negative. This result and a lack of the central scolices on neuroimaging that are pathognomonic of neurocysticercosis prompted whole-body computed tomography imaging to identify another etiology. The whole-body computed tomography revealed right hilar lymphadenopathy associated with soft tissue nodules in her chest wall and abdomen. A biopsy of an anterior chest wall nodule demonstrated high-grade poorly differentiated carcinoma with necrosis, which stained strongly positive for thyroid transcription factor-1 and synaptophysin on immunohistochemistry. A diagnosis of stage 4 metastatic small cell neuroendocrine carcinoma was made and our patient was referred for oncological palliative treatment. Conclusions: This case illustrates the importance of the diagnostic approach to intracranial lesions. Our patient's diagnosis of neuroendocrine carcinoma was delayed because of her nontraditional presentation. Despite extensive metastatic burden, the lack of perilesional edema and the identification of lesions appearing to be in various stages of development led to a pursuit of neurocysticercosis as the diagnosis. The absence of constitutional symptoms should not discount the possibility of malignancy from the differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Pulmonary exacerbations (PEx) are critical events in cystic fibrosis (CF), responsible for reduced quality of life and permanent loss of lung function. Approximately 1/4 of PEx are associated with failure to recover lung function and/or resolve symptoms. Developing tools to optimize PEx treatment is of paramount importance. Methods: We retrospectively audited all adults infected with Pseudomonas aeruginosa, experiencing PEx necessitating parenteral antibiotic therapy from 2006-2012 from our center. Quantitative analysis of sputum at admission, twice-weekly during hospitalization, and end of therapy were compared to baseline (most recent healthy) and follow-up (after PEx) samples. Change in P. aeruginosa burden from baseline was assessed for any and all morphotypes (ALL), as well as mucoid (MUC) and non-mucoid (NON) isolates specifically. PEx were identified as failures if >90% of baseline pulmonary function was not recovered. Results: Forty-six patients meeting the above inclusion and exclusion criteria experienced 144 PEx during this time (median 3, IQR 2-6). Patients were treated for a median 14 days (IQR 13-16). No increase in ALL, MUC or NON were detected at PEx, nor was there an association between change in sputum density and magnitude of lung function decline. PEx failures were observed in 30% of events. Reductions of at least 1-log and 2 log P. aeruginosa sputum density was observed in 57% and 46% (ALL), 73% and 55% (MUC) and 58% and 46% (NON) of PEx, respectively. Factors associated with greater reduction of P. aeruginosa sputum density included choice of β-lactam antibiotic, antibiotics with in vitro predicted activity and treatment duration. PEx associated with reductions in P. aeruginosa sputum density were not associated with a reduced risk of PEx failure. Conclusions: Enhanced killing of P. aeruginosa during PEx does not predict improved clinical outcomes. Studies accounting for the polymicrobial nature of CF respiratory disease and the heterogeneity of P. aeruginosa causing chronic infection may enable the identification of a more appropriate pathogen(s) based biomarker of PEx outcomes. [ABSTRACT FROM AUTHOR]

Light emitting diode (LED) lamps with ac-input (50 or 60 Hz) usually require an electrolytic capacitor as the dc-link capacitor in the driver circuit to: 1) balance the energy between the input and output power, and 2) to minimize the low-frequency component of the output ripple across the LEDs. The lifetime of this capacitor, however, is much shorter than that of a LED. To maximize the potential lifetime of the LED lighting system, a new pulsating current driving LED driver that does not require any electrolytic capacitors or complicated control circuits to minimize the low-frequency (i.e., 100 or 120 Hz) output ripple is proposed in this paper. The proposed circuit is simple and a single-switch topology is designed to simplify the controller design. The proposed circuit is able to reduce the energy storage capacitance to a few microfarads range, so that film capacitor can be used to replace the unreliable electrolytic capacitor. The circuit operating principles and its theoretical analysis are provided in this paper. Simulation and experimental results are given on a 9-W LED lamp to highlight the merits of the proposed circuit. [ABSTRACT FROM AUTHOR]

With the global concerns on the issue of how to conserve the limited energy resources, compact fluorescent lamps (CFLs) have been forced in a lot of countries to replace the power-hungry incandescent lamps to reduce the energy cost. However, conventional passive power factor corrected electronic ballasts used in CFLs suffer two major drawbacks: 1) they are unable to achieve close-to-unity power factor and 2) they are unable to provide the same amount of light intensity under fluctuating line voltage. This paper proposed a simple lamp power regulation method for a very high-power factor single-switch electronic ballast, which allows the electronic ballast to maintain almost constant lamp power at its full-power condition for a wide range of the input voltage by controlling the dc-link voltage of the ballast power circuit through duty ratio control. When a TRIAC phase-cut dimmer is used to dim the CFL, the dc-link voltage regulation control loop is deactivated; so that the lamp power decreases accordingly during dimming. The analysis and operating principles of the controller are discussed in this paper. MATLAB, PSIM simulation, and experimental results are provided to highlight the merits of the proposed work. [ABSTRACT FROM AUTHOR]

Although compact fluorescent lamps (CFLs) have been on the market for a long time, many of them do not achieve the same power factor as the incandescent lamps do, which presents a significant problem for the utility with the current widespread use of CFLs for household lightings. A simple single-switch electronic ballast with passive valley-fill power factor correction is proposed in this paper for CFL application. The proposed single-switch ballast circuit is able to achieve zero current switching to maximize the circuit efficiency. A simple feedback circuit with duty ratio control is also proposed to improve the high lamp current crest factor caused by the valley-fill circuit. Detailed descriptions and analysis of the circuit operating principles are provided in this paper. Simulation and experimental results are given on a 13-W CFL tube from Osram Sylvania to highlight the merits of the proposed work. [ABSTRACT FROM PUBLISHER]

Background: Candidemia is increasing in frequency and is associated with high mortality. We sought to determine the burden of illness, the population it affects and its resistance profile in our region. Methods: The Calgary Zone (CZ) provides all care for residents of Calgary and surrounding communities (~ 1.69 million) via five tertiary hospitals each served by a common single laboratory for acute care microbiology. All adult patients in the CZ with at least one Candida spp.-positive blood culture between January 1, 2010, and December 31, 2018, were identified using microbiological data from Calgary Lab Services, the laboratory that processes > 95% of all blood culture samples in the CZ, were reviewed for the study. Results: The overall annual incidence of candidemia among individuals living in the CZ was 3.8 per 100,000 persons (Median age 61 years (IQR 48–72) and 221/455 (47.4%) were female). C. albicans was the most common species (50.6%), followed by C. glabrata, (24.0%). No other species accounted for more than 7% of cases. Overall mortality at 30, 90, and 365 days was 32.2, 40.1, and 48.1% respectively. Mortality rate did not differ by Candida species. Of individuals who developed candidemia, more than 50% died within the next year. No new resistance pattern has emerged in the most common Candida species in Calgary, Alberta. Conclusions: In Calgary, Alberta, the incidence of candidemia has not increased in the last decade. C. albicans was the most common species and it remains susceptible to fluconazole. [ABSTRACT FROM AUTHOR]

This paper proposes a novel multifunctional controller for a dimmable high-power-factor single-switch electronic ballast that can be used with standard phase-cut dimmers. Conventional dimmable electronic ballasts lack the ability to 1) provide smooth dimming and maintain high power factor when phase-cut dimmers are used and 2) regulate the lamp power when the input line voltage varies. A digital controller with multiple control functions is proposed in this paper. The proposed controller allows high power factor to be achieved by controlling the duty cycle during dimming with standard phase-cut dimmers. On the other hand, when dimming is not required, the lamp power is regulated through the regulation of the dc-link voltage. Additional control functions, such as lamp low-power cutoff operation, and protection function are also implemented inside the digital controller. The descriptions of the controller operating principles and its logic flow diagrams are provided in this paper. PSIM simulation and experimental results are provided on a 13-W compact fluorescent lamp to highlight the merits of the proposed work. [ABSTRACT FROM AUTHOR]

A novel dimmable high-power-factor compact fluorescent lamp (CFL) electronic ballast that is compatible with standard incandescent lamp dimmers is proposed in this paper. In the proposed system, the dimming controller uses the phase angle of the dimmer as the input feedforward parameter for the duty ratio control of the switch in the power circuit. As a result, a wide range of light output can be achieved with a small range of phase angles of the phase-cut dimmer. The ballast power circuit is a single-switch single-stage resonant inverter, which is essentially a fusion of a SEPIC converter and a single-switch current-fed inverter. Detailed operating principles of the proposed system will be discussed in this paper. System stability analysis that includes the effects of the phase-cut dimmer is also provided. Experimental results are given for a 13-W CFL to demonstrate and highlight the merits of the proposed work. [ABSTRACT FROM AUTHOR]

A novel single-stage single-switch electronic ballast topology with a unity power factor is presented in this paper. The proposed circuit consists of an integrated buck–boost stage that operates in the discontinuous conduction mode to provide a high power factor and a single-switch current-fed resonant inverter to stabilize the lamp current. The proposed topology presents a low cost and compact electronic ballast design method. The detailed descriptions of the circuit's operating principles are provided in this paper. The design equations and mathematical analysis regarding the proposed circuit are discussed in this paper. The proposed ballast has been tested with an 18-W compact fluorescent lamp, and the experimental results confirmed that a very high power factor of 0.995 and an efficiency of 83.4% have been achieved. [ABSTRACT FROM PUBLISHER]

A very high power factor electronic ballast that uses a single switch in the power circuit is proposed in this paper for compact fluorescent lamps (CFLs). The proposed power circuit is designed by integrating a SEPIC power factor corrector with a novel single-switch current-fed resonant inverter. The advantage of this single-switch electronic ballast is that it greatly simplifies the gate-drive circuit design due to the elimination of isolation devices that are otherwise required in the conventional half-bridge totem pole configuration. This topology features a reduction of at least two switches in the power stage compared to conventional two-stage approach for high-power-factor electronic ballasts. In addition, the proposed circuit is also able to achieve close-to-unity power factor by operating the integrated SEPIC power factor corrector in discontinuous conduction mode. The conduction loss of the switch in the proposed circuit is also significantly reduced compared to the conventional class-E single-switch resonant inverter. Experimental results are provided to justify all the theoretical analysis and highlight the features of the proposed circuit on a 13-W CFL. [ABSTRACT FROM AUTHOR]

A single-stage dimmable electronic ballast with very high power factor and high efficiency is presented in this paper. A compact lamp power circuit is designed by integrating a buck-boost power factor corrector with a current-fed resonant inverter. This integration produces a single power-processing unit that minimizes the number of circuit components. The proposed resonant inverter reduces the circulating current in the resonant tank and allows simple gate drivers to be used so that isolation devices can be eliminated. With the buck-boost stage operating in the discontinuous conduction mode (DCM), a close-to-unity power factor is achieved for different lamp-power conditions. A small-signal analysis is presented, and a simple variable frequency controller is developed using the modified 555 timer to provide dimming operations. Simulation and experimental waveforms are provided to highlight the merits of the proposed circuit for a 40-W compact fluorescent lamp. [ABSTRACT FROM AUTHOR]

Resonant inverters are connected to a high-frequency ac (HFAC) bus, where power is delivered to different locations for points-of-use power management. Such a power distribution system subjects to more perturbations and load uncertainties than inverters operating with single load. A novel voltage control method is proposed in this paper for a high-frequency full-bridge resonant inverter with series-parallel resonant tank. A modified one-cycle controlled phase-shift modulation is proposed to effectively compensate the input line variations. The uncertainty model of the high frequency resonant inverter is developed and analyzed with the resonant circuit component tolerance, input line and load variations taken into design considerations. The voltage feedback controller is designed based on the H∞ robust control theory and is implemented with analog discrete devices. The proposed control scheme has the advantages of fast response for both input line and load perturbations. It also ensures a wide range of system stability and guarantees robustness of the power converter. Both simulations and experimental results are provided to verify with the theoretical analysis through an experimental prototype of a full-bridge resonant inverter with an output power of 150-W operating at 1 MHz and an output voltage of 28 V (rms). [ABSTRACT FROM AUTHOR]

Background: Mucormycosis is a group of rare but life threatening angioinvasive infections caused by fungi of the order Mucorales that often occurs in immunocompromised patients and individuals with poorly controlled diabetes. Rhinocerebral mucormycosis can mimic sinusitis but can rapidly progress to deeper disease and cause facial necrosis. Facial vascular thrombosis is a rare complication of mucormycosis and can confound diagnosis of the disease.Case Presentation: We report the case of a 25-year-old female with poorly controlled type 1 diabetes mellitus who initially presented with symptoms of sinusitis but rapidly progressed with signs of left-sided facial necrosis due to occlusion of the left internal maxillary artery. Early surgical debridement did not yield a microbiological diagnosis. Deeper surgical debridements ultimately revealed angioinvasive fungal disease consistent with mucormycosis. The patient recovered after repeated surgical intervention and aggressive parenteral antifungal therapy.Conclusion: This case illustrates an atypical complication of mucormycosis, and emphasizes that a high index of suspicion in vulnerable patient populations aids in the diagnosis of this life-threatening infection. [ABSTRACT FROM AUTHOR]

A lack of clinical response to empiric antimicrobials behooves the clinician to reflect further on diagnostic considerations. When prescribing antibiotics, determining the correct dose, most optimal route of administration, and considering the pharmacokinetic properties of the drug with respect to clinical and patient factors are crucial. Improving antibiotic usage is paramount. Antibiotic prescribing is a purposeful process, requiring a clinical indication, determination of the optimal drug dosage/route of administration, and consideration of clinical pharmacokinetics in a patient. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Amebic liver abscesses should be considered in adult males with a liver abscess and a history of travel to endemic areas. Effective treatment includes metronidazole, followed by paromomycin. [ABSTRACT FROM AUTHOR]

A 61-year-old male with subacute headache was found to have cryptococcal meningitis despite a negative BioFire FilmArray meningitis/encephalitis panel. This case underscores the importance of liberal cryptococcal antigen testing, and that a negative FilmArray panel is inadequate in excluding cryptococcal meningitis, particularly in a HIV-negative host. [ABSTRACT FROM AUTHOR]