Evaluation of fungaemia infections in a Hungarian university hospital between 1996 and 2009

The incidence of Candida species causing bloodstream infections in the University Hospital of Szeged, Hungary, between 1996 and 2009, and the susceptibilities of these isolates to antifungal agents were evaluated.Automated blood culture systems (Vital, bioMérieux, Marcy-l'Etoile, France; and BACTEC 9120, Becton-Dickinson Diagnostic Systems, Sparks, USA) were used. The in vitro susceptibilities of the yeast isolates to antifungal agents were determined by the Etest method (AB Biodisk, Solna, Sweden).Bloodstream infections were caused by yeast strains in 231 cases during this period, and 226 Candida strains were cultured from 216 candidaemia patients. Bloodstream infections caused by multiple Candida spp. were diagnosed almost every year. Of the 216 patients, 67 were children; and 55 infants needed intensive care. In 2005, C. glabrata caused an increase in the incidence of invasive fungal infections in the Neonatal Intensive Care Unit. The PFGE analysis of 12 isolates distinguished 4 different karyotypes. The incidence of bloodstream infections caused by fungi did not change during the 14-year study period. The most frequent species cultured from blood samples were C. albicans and C. glabrata. The incidence of resistant isolates remained constant. The local trends of fungaemia must be monitored and compared with global reports.     

Diagnosis of active tuberculosis in a university hospital

Active tuberculosis was diagnosed in 100 patients at Sunnybrook Medical Centre during the five-year period 1968-72. These cases were studied to find out if any delay had taken place in establishing the diagnosis and starting treatment. Delay was found most frequently when patients presented with atypical disease or when microbiological investigations were negative or misinterpreted. However, in nine patients with positive Ziehl-Neelsen smears the diagnosis was delayed more than one week. Usually such delays were caused by a failure to send specimens promptly for examination for acid-fast bacilli. Lack of communication between the laboratory and the clinician was found to be responsible for delays in starting treatment in several patients. It is essential that the clinician in a general hospital be alert to the possibility of tuberculosis and that there be close cooperation between the clinical staff and the diagnostic services.     

Avoiding diagnostic errors in psychosomatic medicine: a case series study

Background

Non-organic lesions or diseases of unknown origin are sometimes misdiagnosed as “psychogenic” disorders or “psychosomatic” diseases. For the quality of life and safety of patients, recent attention has focused on diagnostic error. The aim of this study was to clarify the factors that affected misdiagnoses in psychosomatic medicine by examining typical cases and to explore strategies that reduce diagnostic errors.

Case presentation

The study period was from January 2001 to August 2017. The data of patients who had visited the Department of Psychosomatic Medicine, Kindai University Hospital and its branches, Sakai Hospital and Nihonbashi Clinic, were collected. All patients were aged 16 years or over. Multiple factors, such as age, sex, presenting symptoms, initial diagnosis, final diagnosis, sources of re-diagnosis and types of diagnostic errors were retrospectively analyzed from the medical charts of 20 patients. Among them, four typical cases can be described as follows. Case 1; a 79-year-old woman, initially diagnosed with psychogenic vomiting due to depression that was changed to gastric torsion as the final diagnosis. Case 2; a 24-year-old man, diagnosed with an eating disorder that was later changed to esophageal achalasia. Case 10; a 60-year-old woman’s diagnosis changed from conversion disorder to localized muscle atrophy. Case 19; a 68-year-old man, appetite loss from depression due to cancer changed to secondary adrenal insufficiency, isolated ACTH deficiency (IAD).

Conclusion

This study showed that multiple factors related to misdiagnoses were combined and had a mutual influence. However, they can be summarized into two important clinical observations, diagnostic system-related problems and provider issues. Provider issues contain mainly cognitive biases such as Anchoring, Availability, Confirmation bias, Delayed diagnosis, and Representativeness. In order to avoid diagnostic errors, both a diagnostic system approach and the reduction of cognitive biases are needed. Psychosomatic medicine doctors should pay more attention to physical symptoms and systemic examination and can play an important role in accepting a perception of patients based on a good, non prejudicial patient/physician relationship.

     

Experience with fetal monitoring in a university teaching hospital.

Fetal monitoring during labour may be expected to decrease perinatal losses and the number of infants born with brain damage. In a prospective study of intrapartum fetal monitoring in selected high-risk pregnancies in a Winnipeg hospital the monitoring rate was 26.5% and the cesarean section rate in the monitored group was 22.0%. The fetal outcome in the monitored group was better than in the unmonitored group. The establishment of a fetal intensive care unit is believed to be strongly desirable in improving fetal surveillance during labour. Fetal monitors should be stationed in the delivery room as well as in the first-stage room.     

Evolution of antimicrobial resistance of Acinetobacter baumannii in a university hospital

Aims: To investigate the susceptibility pattern and the molecular epidemiology of Acinetobacter baumannii isolates in two periods (1994–1996 and 2004–2007) in Londrina University Hospital. Methods and Results: Antimicrobial susceptibility of 150 A. baumannii isolates was assessed by disc diffusion and agar dilution methods. Genetic similarity amongst the isolates was evaluated by ERIC–PCR. Resistance of A. baumannii to carbapenems increased from 2% (1994–1996) to 73% (2004–2007). Thirty‐eight clones were detected. Conclusions: The results of the study suggest that the high prevalence of carbapenem resistance amongst Acinetobacter baumannii organisms in this institution is not caused by the spread of a predominant clone. Significance and Impact of the Study: This work reinforces the importance monitoring antimicrobial susceptibility rates.     

Sexual behaviours and contraception among university students in Turkey

The aim of this study was to evaluate the sexual attitudes and behaviours of university students. An anonymous questionnaire was administered to 550 final-year university students aged 20-25 years in Izmir, Turkey. Male students opposed premarital sexual intercourse for both genders more than female students did. The frequency of sexual intercourse among male students (61.2%) was higher than that among female students (18.3%). The mean age of first sexual intercourse was lower among male than among female respondents. The rate of condom use at first sexual intercourse was 47.4%. The frequency of having two or more past sexual partners and masturbation was higher among males than females. It was found that there were culture-specific and gender-dependent differences in sexual attitudes and behaviours of the university students. These results may help in the planning of education and health policies in Turkey.