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To determine the effectiveness of ultraviolet (UV) environmental disinfection system on rates of hospital-acquired vancomycin-resistant enterococcus (VRE) and Clostridium difficile.
Using active surveillance and an interrupted time-series design, hospital-acquired acquisition of VRE and C. difficile on a bone marrow transplant (BMT) unit were examined before and after implementation of terminal disinfection with UV on all rooms regardless of isolation status of patients. The main outcomes were hospital-based acquisition measured through (1) active surveillance: admission, weekly, and discharge screening for VRE and toxigenic C. difficile (TCD) and (2) clinical surveillance: incidence of VRE and CDI on the unit.
Bone marrow transplant unit at a tertiary-care cancer center.
Stem cell transplant (SCT) recipients.
Terminal disinfection of all rooms with UV regardless of isolation status of patients.
During the 20-month study period, 579 patients had 704 admissions to the BMT unit, and 2,160 surveillance tests were performed. No change in level or trend in the incidence of VRE (trend incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.81–1.14; level IRR, 1.34; 95% CI, 0.37–1.18) or C. difficile (trend IRR, 1.08; 95% CI, 0.89–1.31; level IRR, 0.51; 95% CI, 0.13–2.11) was observed after the intervention.
Utilization of UV disinfection to supplement routine terminal cleaning of rooms was not effective in reducing hospital-acquired VRE and C. difficile among SCT recipients.
Chemoradiotherapy followed by monthly temozolomide (TMZ) is the standard of care for patients with glioblastoma multiforme (GBM). Case reports have identified GBM patients who experienced transient radiological deterioration after concurrent chemoradiotherapy which stabilized or resolved after additional cycles of adjuvant TMZ, a phenomenon known as radiographic pseudoprogression. Little is known about the natural history of radiographic pseudoprogression.
We retrospectively evaluated the incidence of radiographic pseudoprogression in a population-based cohort of GBM patients and determined its relationship with outcome and MGMT promoter methylation status.
Out of 43 evaluable patients, 25 (58%) exhibited radiographic progression on the first MRI after concurrent treatment. Twenty of these went on to receive adjuvant TMZ, and subsequent investigation demonstrated radiographic pseudoprogression in 10 cases (50%). Median survival (MS) was better in patients with pseudoprogression (MS 14.5 months) compared to those with true radiologic progression (MS 9.1 months, p=0.025). The MS of patients with pseudoprogression was similar to those who stabilized/responded during concurrent treatment (p=0.31). Neither the extent of the initial resection nor dexamethasone dosing was associated with pseudoprogression.
These data suggest that physicians should continue adjuvant TMZ in GBM patients when early MRI scans show evidence of progression following concurrent chemoradiotherapy, as up to 50% of these patients will experience radiologic stability or improvement in subsequent treatment cycles.
Western media coverage of the violence associated with the 2003 US-led invasion of Iraq has contrasted in magnitude and nature with population-based survey reports.
The purpose of this study was to evaluate the extent to which first-hand reports of violent deaths were captured in the English language media by conducting in-depth interviews with Iraqi citizens.
The England-based Iraq Body Count (IBC) has methodically monitored media reports and recorded each violent death in Iraq that could be confirmed by two English language media sources. Using the capturerecapture method, 25 Masters' Degree students were assigned to interview residents in Iraq and asked them to describe 10 violent deaths that occurred closest to their home since the 2003 invasion. Students then matched these reports with those documented in IBC. These reports were matched both individually and crosschecked in groups to obtain a percentage of those deaths captured in the English language media.
Eighteen out of 25 students successfully interviewed someone in Iraq. Six contacted individuals by telephone, while the others conducted interviews via e-mail. One out of seven (14%) phone contacts refused to participate. Seventeen out of 18 primary interviewees resided in Baghdad, however, some interviewees reported deaths of neighbors that occurred while the neighbors were elsewhere. The Baghdad residents reported 161 deaths in total, 39 of which (24%) were believed to be reported in the press as summarized by IBC. An additional 13 deaths (8%) might have been in the database, and 61 (38%) were absolutely not in the database.
The vast majority of violent deaths (estimated from the results of this study as being between 68–76%) are not reported by the press. Efforts to monitor events by press coverage or reports of tallies similar to those reported in the press, should be evaluated with the suspicion applied to any passive surveillance network: that it may be incomplete. Even in the most heavily reported conflicts, the media may miss the majority of violent events.
Leptomeningeal disease (LMD) is a late complication of malignant glioma, mostly of glioblastoma, that usually responds poorly to treatment and is rapidly fatal. A long surviving case led us to review our experience with LMD in patients with oligodendrogliomas.
A 15-year retrospective chart review was performed. Patients with both oligodendroglial tumors and LMD were identified. A single neuro-pathologist reviewed all histological sections, a single neuro-radiologist reviewed all available images and lp/19q status was assessed.
Seven out of 145 patients with oligodendroglioma were diagnosed with LMD. Six were male. Median age at tumor diagnosis was 41 years (range, 28-50). None had radiographic or pathological evidence of leptomeningeal or subependymal tumor at initial diagnosis. Most patients had pure anaplastic oligodendrogliomas (4/7); 6/7 had 1p/19q co-deletion. The median time to first relapse was 41 months (range, 19-127). The median time to LMD was 76 months (range, 19-151) from initial diagnosis and 28 months (range, 0-36) from first relapse, respectively. Leptomeningeal disease treatments included spinal radiation and intrathecal and systemic chemotherapy. After progression, some patients with LMD remained stable clinically. The median survival from initial diagnosis was 104 months (range, 19-183) and from LMD diagnosis was 32 months (range, 2-43).
Leptomeningeal disease is a complication of oligodendroglioma that may occur preferentially in long surviving patients with 1p/19q co-deletion. Leptomeningeal disease in patients with oligodendrogliomas appears to be relatively indolent which may have implications for their treatment and be related to 1p/19q status.
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