Since publication of the Society for Healthcare Epidemiology of America position paper on Clostridium difficile infection in 1995, significant changes have occurred in the epidemiology and treatment of this infection. C. difficile remains the most important cause of healthcareassociated diarrhea and is increasingly important as a community pathogen. A more virulent strain of C. difficile has been identified and has been responsible for more-severe cases of disease worldwide. Data reporting the decreased effectiveness of metronidazole in the treatment of severe disease have been published. Despite the increasing quantity of data available, areas of controversy still exist. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management.

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Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)

Background Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease. Methods We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described. Results The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively). Conclusions Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.

/pdf/epidemiology-and-outcome-of-zygomycosis-a-review-of-929-5d2xmysi26.pdf

Epidemiology and Outcome of Zygomycosis: A Review of 929 Reported Cases

A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

/pdf/clinical-practice-guidelines-for-clostridium-difficile-4hs0j01jnf.pdf

Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

Once a rarely used subset of medical treatments, protein therapeutics have increased dramatically in number and frequency of use since the introduction of the first recombinant protein therapeutic--human insulin--25 years ago. Protein therapeutics already have a significant role in almost every field of medicine, but this role is still only in its infancy. This article overviews some of the key characteristics of protein therapeutics, summarizes the more than 130 protein therapeutics used currently and suggests a new classification of these proteins according to their pharmacological action.

Protein therapeutics: a summary and pharmacological classification

This article reviews the pathogenesis, epidemiology, diagnosis, and treatment of this nosocomial and potentially fatal infectious diarrhea, as well as the associated risk factors New treatments include fecal microbiota transplantation for disease that is resistant to vancomycin

http://unmhospitalist.pbworks.com/w/file/fetch/95983922/nejmra1403772.pdf

Clostridium difficile Infection

The use of fibrin glue in mucous membrane grafting of the fornix.

A 6-month-old boy presented with recurrent, poorly differentiated orbital sarcoma diagnosed as nonrhabdomyosarcoma soft tissue sarcoma, as pathologic and immunohistochemical evaluation was inconsistent with rhabdomyosarcoma or other specific sarcoma subtypes. He responded favorably to a treatment regimen for poorly differentiated sarcomas.

Undifferentiated Nonrhabdomyosarcoma Soft Tissue Sarcoma of the Orbit.

Optic nerve sheath decompression, more commonly known as optic nerve sheath fenestration (ONSF), is a surgical procedure performed to decompress the optic nerves and relieve vision-threatening papilledema in the setting of elevated intracranial pressure (ICP). Performance of this procedure is generally in cases of pseudotumor cerebri syndrome (PTC), where patients are rapidly losing vision from significantly elevated ICP, or in cases of progressive vision loss in patients who do not respond to medical therapy or are non-adherent with therapy. The exact mechanism by which fenestration relieves papilledema is not entirely understood at this time; however, both decompression of the perioptic subarachnoid space with filtration of cerebrospinal fluid (CSF) out of the subarachnoid space through the dural opening as well as scarring of the surgical site that prevents further accumulation of CSF are felt to be contributing factors. Optic nerve sheath decompression does not treat the source of the elevated ICP itself, but the procedure does diminish the associated visual sequelae.

Optic Nerve Decompression

The Greek word for eyelid is “blepharon,” from which is derived the prefix "belpharo," which has been in use since antiquity. The Greek for an eyelash is “blepharida” which is not used in medicine today. The Latin for eyelid is “palpebra” and that for eyelash is “cilium” a word only in use since the early 18 century.Eyelashes and eyebrows are important anatomical structures which are central not only in the face but central to all perceived human interactions. Eyebrow movement conveys emotions (sad, happy, angry, surprise, pensive, etc.) and eyebrows protect the eyes by relaxing the “curtain rods” that they effectively are when tired, thereby relaxing the upper eyelid skin and contributing to lid closure and eye protection. Eyebrow hair direction serves to protect the eyes from particulate matter and sweat.Eyelashes and eyebrows have always been an essential part of facial beauty. They have been plucked, accentuated and modified in innumerable ways to enhance the beauty of the face and eyes in particular in many cultures. The Egyptians and the Indians have used materials like kohl to enhance brows and lashes for centuries. The emphasis of the eyes manifests in the modern world through the use of mascara, eyeliner, and eyeshadow. Curlers are used to exaggerate the natural curve of lashes. Although long lashes are prized in most cultures, certain cultures (the Hazda, the last of the hunter-gatherer tribes of Tanzania) trim their lashes. Comparative Anatomy Mammals have eyelashes; some, like the camel, have profoundly long lashes, long used to accentuate features in cartoons. Cows have long straight lashes which are medially oriented. A description of “cow lash deformity” is used when seen as a complication of blepharoplasty, often affecting the lateral third of the upper eyelid. Other large mammals like horses also have similar long, relatively straight lashes.The eyelash viper is said by some in South America to wink after striking its victim. The “lashes” are not lashes, but modified scales above the eyes. And, of course, snakes cannot wink as they have no eyelids!

Anatomy, Head and Neck, Eyelash

The emergence of the femtosecond laser has revolutionized the field of laser refractive surgery. Since its creation in 2003, the femtosecond laser has been widely adopted in procedures such as laser in situ keratomileuses (LASIK) and has allowed for the creation of newer refractive surgeries such as femtosecond lenticule extraction (FLEx). FLEx, first performed in 2007, was unique in that it only required the use of a single platform, the femtosecond laser, rather than the two platforms as are necessary for LASIK.[1][2] As such, FLEx was found to reduce procedural time and provide cost reductions to the institution. Whereas LASIK involves the formation of a corneal flap and photoablation of the corneal stroma, FLEx similar creates a corneal flap, but there is no ablation of the corneal stroma. Instead, intrastromal dissection and extraction of a refractive lenticule occur.[2] Small incision lenticule extraction (SMILE), a newer laser refractive procedure, avoids flap creation and instead forms a small peripheral corneal incision through which the lenticule gets extracted. By avoiding corneal flap formation, SMILE was hypothesized to improve corneal biomechanical stability compared to LASIK or FLEX due to minimal disruption of the peripheral collagen networks in the anterior stroma that account for approximately 60% of the total corneal tensile strength.[3] This small-incision approach was also thought to reduce injury to the subbasal nerve plexus and avoid flap-related complications.[4] Since its first use in 2008, SMILE has developed growing popularity among ocular surgeons and has the potential to become the standard of care for surgical correction of visual refractive errors.[5]

Bhupendra C. Patel

Papers

The use of fibrin glue in mucous membrane grafting of the fornix.

Undifferentiated Nonrhabdomyosarcoma Soft Tissue Sarcoma of the Orbit.

Optic Nerve Decompression

Anatomy, Head and Neck, Eyelash

Small Incision Lenticule Extraction (SMILE)