125 research outputs found
CSF HSV PCR Testing in Adults and Children with Meningitis and Encephalitis
No full textAbstract
Background
Herpes simplex virus (HSV) is a common treatable cause of meningitis and encephalitis. Delayed antiviral therapy is associated with worse clinical outcomes in HSV encephalitis.
Objectives
To determine the utilization of a cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) and identify predictors for a positive HSV PCR result.
Methods
A retrospective review of 751 adults and children with meningitis and encephalitis at 9 hospitals in Houston TX from January 1 2005 to December 31 2010.
Results
Of 751 patients, 331 (44%) underwent CSF HSV PCR testing. Adults were more commonly tested than children (84% vs. 69%, P <0.0001). Additionally, patients with more comorbidities and clinical findings of encephalitis (e.g., altered mental status, focal neurological findings, seizures) were more commonly tested for HSV (P <0.001). Patients tested for HSV were also more likely to be evaluated for West Nile Virus, receive empiric acyclovir and have worse outcomes (P < 0.001). In total, 48 of 331 (14.5%) patients tested had a positive CSF HSV PCR. Predictors for a positive CSF HSV PCR on logistic regression analysis were stiff neck (odds ratio [OR], 2.181 [1.090–4.366]; P = 0.028, lymphocytic pleocytosis >50% lymphocytes (OR, 6.187 [1.412–27.11] P = 0.016, and CSF protein > 100mg/dl (OR, 3.279 [1.105–9.731] P = 0.032.
Conclusion
CSF HSV PCR is underutilized in community acquired meningitis and encephalitis and is done more frequently in adults and in those with an encephalitis presentation.
Disclosures
R. Hasbun, Biomeriaux: Consultant, Consulting fee Biofire: Speaker’s Bureau, Speaker honorarium Merck: Speaker’s Bureau, Speaker honorarium Pfizer: Speaker’s Bureau, Speaker honorarium Medicine’s Co: Speaker’s Bureau, Speaker honorarium
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¿Cómo recuperar ríos en Costa Rica? Propuesta metodológica para la recuperación socioambiental de la microcuenca del río Guararí
No full textLos ríos de Costa Rica presentan altos niveles de degradación socioambiental y una persistente incapacidad colectiva para revertir la problemática. Este trabajo final de investigación aplicada propone una metodología participativa y multisectorial para la recuperación socioambiental de la microcuenca del río Guararí, ubicada en Barva y Santa Bárbara de Heredia. Se plantea un prototipo de intervención que articula saberes técnicos y comunitarios, con base en soluciones innovadoras basadas en la naturaleza.
La metodología de investigación combina revisión documental, entrevistas a especialistas, mapeo participativo con actores locales y análisis geoespacial. El estudio caracteriza el contexto histórico y socioambiental de la microcuenca, sistematiza buenas prácticas nacionales e internacionales, y diseña un prototipo estructurado en cinco fases: comprender, idear, probar, monitorear y escalar. Se enfatiza la importancia priorizar proyectos demostrativos de bajo costo, alto impacto y potencialmente escalables. La propuesta metodológica busca ser replicable y adaptable en otras microcuencas con condiciones similares, contribuyendo al desarrollo de estrategias efectivas y sostenibles para la recuperación de ríos.Costa Rica’s rivers face severe environmental degradation and a persistent lack of coordinated effective action to address the issue. This applied research proposes a participatory, multisectoral methodology for the socio-environmental restoration of the Guararí River micro-watershed, located in Barva and Santa Bárbara, Heredia. The study introduces an intervention prototype that integrates technical expertise and community knowledge through innovative, nature-based solutions.
The methodology combines documentary review, expert interviews, participatory mapping with local stakeholders, and geospatial analysis. The research characterizes the historical and socio-environmental context of the micro-watershed, systematizes relevant national and international best practices, and develops a five-phase prototype: understand, ideate, test, monitor, and scale. Particular emphasis is placed on the identification of low-cost, high-impact, and potentially scalable pilot projects. The proposed methodology aims to serve as a replicable model for other micro-watersheds with similar conditions, contributing to the development of effective and sustainable river restoration strategies.UCR::Vicerrectoría de Investigación::Sistema de Estudios de Posgrado::Ingeniería::Maestría Profesional en Desarrollo Urbano y Gestión Territoria
A Reluctant Genre: The Limits Of The Literary And The Quotidian In Three Contemporary Latin American Diaries [Ribeyro, Walsh, Milla´N]
No full text
Diagnostic accuracy of CSF cell index and corrected CSF white blood cell count in healthcare-associated ventriculitis and meningitis after intracranial hemorrhage
No full textAbstract
Background
The diagnosis of healthcare-associated meningitis and ventriculitis (HCAMV) in patients with intracranial hemorrhage (ICH) is challenging. The purpose of this study was to evaluate the diagnostic accuracy of routine cerebrospinal fluid (CSF) studies including a cell index and a corrected white blood cell (WBC) count.
Methods
Case control study of adult patients with the diagnosis of ICH and HCAMV at a large tertiary care hospital in Houston, Texas from 2003 to 2016. Cases were defined as patients with ICH and HCAMV as documented by a positive CSF culture. Controls were selected as patients with ICH without evidence of HCAMV, no previous antibiotic therapy and a negative CSF culture. Cases and controls were matched 1:2 by age, Glasgow Coma Scale (GCS) and Apache II scores. Cell index was calculated using the following formula: (CSF leukocytes / CSF erythrocytes) / (blood leukocytes / blood erythrocytes). Corrected WBC count was calculated using the following formula: CSF leukocytes - (CSF erythrocytes/1,000). Area under the curve of receiver operating characteristic (AUC-ROC) and 95% confidence interval (CI) for CSF cell index greater than or equal to absolute value of 1, corrected CSF WBC count greater than 5 K/uL, CSF lactate greater than 4 mmol/L, and CSF glucose less than 40 mmol/L, respectively, were calculated in order to determine the accuracy of these studies.
Results
A total of 120 patients with ICH were included in this study; 40 patients had proven HCAMV whereas 80 patients had ICH with no evidence of HCAMV. Matching of cases and controls by age, GCS, and Apache II score was appropriate (p&gt;0.05). The AUC-ROC values for CSF cell index, corrected CSF WBC count, CSF lactate, and CSF glucose were all low at 0.609 (95% CI = 0.449–0.768), 0.731 (95% CI = 0.589–0.872), 0.719 (95% CI = 0.573–0.864), and 0.609 (95% CI = 0.449–0.768), respectively.
Conclusion
This study demonstrated poor accuracy of CSF cell index, corrected CSF WBC count, CSF lactate, and CSF glucose in diagnosis of HCAMV after ICH.
Disclosures
R. Hasbun, Biomeriaux: Consultant, Consulting fee. Biofire: Speaker’s Bureau, Speaker honorarium. Merck: Speaker’s Bureau, Speaker honorarium. Pfizer: Speaker’s Bureau, Speaker honorarium. Medicine’s Co: Speaker’s Bureau, Speaker honorarium.
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Semantic Memory in HIV-Associated Neurocognitive Disorders: an Evaluation of the "Cortical" versus "Subcortical" Hypothesis
No full textWhile HIV- associated neurocognitive disorders (HAND) have historically been characterized as a subcortical process, there is some evidence to suggest that the cortical regions that support semantic memory may also be affected. The current study examined the effects of HAND on semantic memory. Participants were (N = 459) separated into three groups based on neurocognitive status defined by the Frascati criteria: HIV+ individuals with HAND (n = 85), HIV+ individuals without HAND (n= 191), and HIV negative individuals (n=183). All participants completed the Boston Naming Test (BNT) and the Famous Faces subtest of the Kauffman Adolescent and Adult Intelligence Test (KAIT). Analyses of errors committed on the BNT were conducted to further characterize the nature of semantic memory differences across groups. Linear regressions revealed a significant adverse effect of HAND on total scores on the BNT and the KAIT (all ps .10). Findings regarding the cognitive correlates of semantic memory show that executive (rs = -.24, p = .02), speed of processing (rs = -.31, p = .004), and learning (at trend level) domains were shown to be associated with BNT performance, while only the learning domain (rs = -.28, p = .01) was significantly related to KAIT scores within the HAND+ group. Results suggest that HAND may impose adverse effects on individuals’ object naming and identification abilities and suggest that there are mild semantic deficits in HAND that parallel traditional cortical diseases such as Alzheimer’s Disease.Psychology, Department o
Future and Past Autobiographical Memory in HIV Disease
No full textAccording to the constructive episodic simulation hypothesis, the ability to imagine the future relies on the construction of simulated events from details of past autobiographical memories. Episodic future thinking is impaired in some clinical populations with memory deficits and is associated with activation in prefrontal and temporal regions. Older adults also demonstrate more difficulty with episodic future thinking compared to younger individuals. While HIV disease commonly leads to episodic memory impairment, the ability of people with HIV (PWH) to describe future and past autobiographical events is not well understood. The present study was designed to determine the effects of HIV-associated neurocognitive disorders (HAND) on future and past autobiographical memory and to establish the neurocognitive and everyday functioning correlates of autobiographical memory in HIV disease. Participants included adults aged 50 years and older (24 PWH with HAND, 39 PWH without HAND, and 28 HIV− participants) who completed experimental measures of future and past autobiographical memory in addition to clinical tests of retrospective episodic memory, prospective memory, and executive functions. Overall, participants provided more detailed descriptions when describing past events as compared to future events. Results did not support a significant effect of HAND on future or past autobiographical memory performance, although participants with HIV produced numerically fewer details than seronegative participants at the level of small-to-medium effect sizes. Future and past autobiographical memory were not associated with neurocognitive measures or everyday functioning among participants with HIV. Overall, results do not support the presence of a large HAND-related deficit in autobiographical memory performance, although additional work in this area could help clarify the mechanisms underlying episodic future thinking in older PWH.Psychology, Department o
Cranial Imaging Before Lumbar Puncture in Adults With Community-Acquired Meningitis: Clinical Utility and Adherence to the Infectious Diseases Society of America Guidelines
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