Annals of clinical and laboratory science
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Ann. Clin. Lab. Sci. · Jan 2007
Clostridium difficile infection in an urban medical center: five-year analysis of infection rates among adult admissions and association with the use of proton pump inhibitors.
C. difficile-associated diarrhea (CDAD) has become a major cause of morbidity in hospitalized patients. In this study of five-year (2001-2005, inclusive) trends of incidence of CDAD among adults in an inner-city medical center, the overall annual incidence increased from 5.08 to 8.42 cases/10(3) admissions (p = 0.0005). Age distribution remained fairly constant for 2001-2004 but decreased significantly in 2005 (p = 0.005); no significant change was observed for gender. ⋯ After controlling for the effect of antibiotic use, PPI either pre- or during admission was associated with CDAD (odds ratio, OR (adjusted) = 2.75, 95% CI = 1.68 to 4.52; p = 0.0001); the association with H2A was not significant (OR (adjusted) = 0.95, 95% CI = 0.39 to 2.34; p = 0.9153). If only first-time use during hospital stay is considered, PPI were also strongly associated with CDAD (OR (adjusted) = 1.88, 95% CI: 1.07 to 3.31; p = 0.0283) and H2A were not associated with CDAD (OR (adjusted) = 0.73, 95%CI: 0.26 to 2.06; p = 0.5520). These data suggest that the widespread prescription of PPI for stress ulcer prophylaxis in acute care facilities may contribute to the increased incidence of CDAD.
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Ann. Clin. Lab. Sci. · Jan 2007
Effects of intrathecal injection of prednisolone acetate on expression of NR2B subunit and nNOS in spinal cord of rats after chronic compression of dorsal root ganglia.
N-methyl-D-aspartate receptor subunit 2B (NR2B) and neuronal nitric oxide synthase (nNOS) play important roles in the mechanism of neuropathic pain. To elucidate how glucocorticoids affect this mechanism, we studied the effects of intrathecal (it) injection of prednisolone acetate (PA) on a nociceptive stimulus and the changes of nNOS and NR2B subunit expression in the spinal dorsal horn of Sprague Dawley rats following chronic compression of the dorsal root ganglia (CCD). Paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured for 15 days postoperatively. ⋯ Chronic compression of the dorsal root ganglia induced time-dependent upregulation of nNOS and NR2B subunits of N-methyl-D-aspartate receptor within the spinal cord dorsal horn ipsilateral to CCD. Both upregulations were significantly diminished by it administration of PA (2.0 mg/kg), but not by lower doses of PA (0.5 or 1.0 mg/kg). The results suggest that PA upregulation of neuronal nitric oxide synthase and NR2B subunit expression in the spinal dorsal horn contributes to PA inhibition of hyperalgesia induced by chronic compression of dorsal root ganglia.
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Ann. Clin. Lab. Sci. · Jan 2006
Donor-derived type II pneumocytes are rare in the lungs of allogeneic hematopoietic cell transplant recipients.
Lung injury is a common cause of death and disability. Stem cell-related therapies are widely viewed as offering promise for people suffering from various types of pulmonary diseases, and gender-mismatched bone marrow transplant recipients serve as natural populations in which to study the role of bone marrow-derived stem cells in recovery from pulmonary injury. We evaluated the extent of lung repopulation by type II pneumocyte descendents of adult bone marrow-derived stem cells in allogeneic hematopoietic cell transplant recipients. ⋯ No donor-derived type II pneumocytes were found in samples from the other three patients. In conclusion, repopulation by bone marrow-derived stem cells or their progeny occurs at a low frequency in the lungs of hematopoietic cell transplant recipients. Conversely, proliferation by local stem cell populations appears to be more important for recovery from alveolar injury.
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Ann. Clin. Lab. Sci. · Jan 2006
Case ReportsExtramedullary hematopoiesis in breast after neoadjuvant chemotherapy for breast carcinoma.
We report incidental extramedullary hematopoiesis (EMH) in breasts of 2 patients following neoadjuvant chemotherapy for locally advanced breast cancer. Neither of the patients had a history of hematologic disorders. After chemotherapy, one of the patients had a complete pathologic response and the other had residual carcinoma. ⋯ In the patient with residual carcinoma, EMH was observed in the contralateral prophylactic mastectomy specimen. EMH should be considered a diagnostic pitfall in the differential diagnosis of unusual cellular infiltrates in breast after neoadjuvant chemotherapy. To our knowledge, the association of EMH and neoadjuvant chemotherapy has not been previously reported.
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Ann. Clin. Lab. Sci. · Jan 2006
Betamethasone affects cerebral expressions of NF-kappaB and cytokines that correlate with pain behavior in a rat model of neuropathy.
The objective of this study was to investigate whether corticosteroids modulate neuropathic pain by altering cerebral expression of nuclear factor-kappa B (NF-kappaB) and specific cytokines. The effects of topical betamethasone on neuropathic pain and cerebral expression of NF-kappaB and cytokines were studied in a rat model of L5 spinal nerve transaction. Behavioral testing was undertaken on days 1, 3, 7, 14, and 21 post-operation using the von Frey and Hargreaves tests. ⋯ The results suggest that topical betamethasone injection inhibits the development and maintenance of neuropathic pain. Betamethasone may act by regulating the expression of NF-kappaB, TNFalpha, IL-1beta and IL-10 in the brain. This study yields new insight into the mechanisms of corticosteroid action in neuropathic pain and may provide a basis for clinical pain control.