Hoovermacmillan1907

BACKGROUND Sepsis, a life-threatening immunological response to an infection, disproportionality affects allogeneic hematopoietic cell transplant (HCT) recipients and is challenging to define. Clinical criteria that predict mortality and intensive care unit endpoints in patients with suspected infections (SI) have been adopted in sepsis definitions, but their predictive value among immunocompromised populations is largely unknown. Here, we evaluate three criteria among allogeneic HCT recipients. METHODS We evaluated Systemic Inflammatory Response Syndrome (SIRS), quick-Sequential Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) criteria in relation to short-term mortality among HCT recipients with SIs. Data from the first 100-days post-transplant were analyzed for patients transplanted between September 2010 - July 2017. We used the following cut-points (qSOFA/SIRS 2+; NEWS 7+) and restricted to first SI per hospital encounter. RESULTS Of the 880 HCT recipients who experienced ≥ 1 SI, 58 (6.6%) died within 28 days and 22 (2.5%) within 10 days of a SI. In relation to 10-day mortality, SIRS was the most sensitive 91.3% (95% CI72.0 - 98.9%) but least specific 35.0% (32.6 - 37.5%) whereas qSOFA was the most specific 90.5% (88.9 - 91.9%) but least sensitive 47.8% (26.8 - 69.4%). NEWS was moderately sensitive 78.3% (56.3 - 92.5%) and specific 70.2% (67.8 - 72.4%). CONCLUSION NEWS outperformed qSOFA and SIRS, but all three criteria had low to moderate predictive accuracy and the magnitude of the known predictive limitations of qSOFA and SIRS were at least as large as in general populations. Our data suggest that population-specific sepsis criteria are needed for immunocompromised patients. selleck inhibitor © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.BACKGROUND We recently mitigated a clonal outbreak of hospital-acquired Mycobacterium abscessus complex (MABC), which included a large cluster of adult patients who developed invasive infection after exposure to heater-cooler units during cardiac surgery. Recent studies have detailed Mycobacterium chimaera infections acquired during cardiac surgery; however, little is known about the epidemiology and clinical courses of cardiac surgery patients with invasive MABC infection. METHODS We retrospectively collected clinical data on all patients who underwent cardiac surgery at our hospital and subsequently had positive cultures for MABC from 2013-2016. Patients with ventricular assist devices or heart transplants were excluded. We analyzed patient characteristics, antimicrobial therapy, surgical interventions, and clinical outcomes. RESULTS Ten cardiac surgery patients developed invasive, extrapulmonary infection from M. abscessus subsp. abscessus in an outbreak setting. Median time from presumed inoculation in thSociety of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.Humans are able to categorize things they encounter in the world (e.g., a cat) by integrating multisensory information from the auditory and visual modalities with ease and speed. However, how the brain learns multisensory categories remains elusive. The present study used functional magnetic resonance imaging to investigate, for the first time, the neural mechanisms underpinning multisensory information-integration (II) category learning. A sensory-modality-general network, including the left insula, right inferior frontal gyrus (IFG), supplementary motor area, left precentral gyrus, bilateral parietal cortex, and right caudate and globus pallidus, was recruited for II categorization, regardless of whether the information came from a single modality or from multiple modalities. Putamen activity was higher in correct categorization than incorrect categorization. Critically, the left IFG and left body and tail of the caudate were activated in multisensory II categorization but not in unisensory II categorization, which suggests this network plays a specific role in integrating multisensory information during category learning. The present results extend our understanding of the role of the left IFG in multisensory processing from the linguistic domain to a broader role in audiovisual learning. © The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.BACKGROUND Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be non-inferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB. METHODS Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were 1) production of B. burgdorferi specific antibodies in cerebrospinal fluid (CSF) or serum; or 2) B. burgdorferi DNA in the CSF; or 3) an erythema migrans during the past three months. Participants were randomized in 11 ratio to receive either oral doxycycline 100 mg twice a day for four weeks, or intravenous ceftriaxone 2 g daily for three weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months. RESULTS Between Sep 14, 2012 and Dec 28, 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n=104) or ceftriaxone (n=106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was -3.9 in the doxycycline group and -3.8 in the ceftriaxone group (mean difference 0.17 with 95% CI -0.59 - 0.92, which is within the pre-specified equivalence margins of -1 to 1 units). Participants in both groups improved equally. CONCLUSIONS Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.