We report the first documented isolation of Wohlfahrtiimonas chitiniclastica from a human in the United States. Initially misidentified as Acinetobacter lwoffii by Vitek-2, the isolate was subsequently identified as W. chitiniclastica by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing. While the clinical significance of the isolate in this case is unclear, it highlights the superior performance of MALDI-TOF MS for bacterial identification. CASE REPORTA 26-year-old morbidly obese male courier worker was admitted with worsening right leg swelling and draining ulcers. He had developed lymphedema of the right leg during the preceding year after undergoing surgical correction of a right lower extremity varus deformity. A few weeks prior to the current admission, he had noticed right leg ulcers draining yellowish green serosanguineous fluid. On admission, he was afebrile and his white blood cell count was 11,100/l. He was found to have right lower extremity cellulitis.A swab was collected from the right leg and sent to the microbiology laboratory for wound cultures. The sample was inoculated onto blood, chocolate, and MacConkey agars and incubated under aerobic conditions at 37°C. Gram staining revealed many Gram-negative bacilli and moderate Gram-positive cocci. Four different organisms were isolated from the swab after growth. Microbial identification of each isolate was performed by using routine biochemical tests, including automated identification by the Vitek 2 system (bioMérieux, Marcy l'Etoile, France). The organisms were identified as Proteus vulgaris, Klebsiella pneumoniae, Acinetobacter lwoffii, and Staphylococcus aureus. The isolates were subsequently analyzed in triplicate by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (RUO version 3.1, Bruker Biotyper; Bruker Daltonics, Bremen, Germany). Of note, the isolate identified as A. lwoffii by the Vitek 2 system was identified by MALDI-TOF MS as Wohlfahrtiimonas chitiniclastica, with identification log (score) values of 2.253, 2.296, and 2.229. Log (score)

The insertion of peripheral intravenous catheter is a common practice in hospitals. The present study is aimed to assess the incidence and factors associated with peripheral intravenous catheter failure. The objective were the estimation of the incidence of peripheral intravenous catheter failure among patient admitted in tertiary care setting and to assess the factors associated with it. The design used for this study was prospective survey. The data were collected from 294 participant with a semi structured interview schedule and an observation checklist. The findings of the study revealed that the incidence of peripheral intravenous catheter failure were 50.3% and mean dwell time were 71.7 hours. The factors associated with PIVC failure was gender, type of ward, duration of hospital stay, purpose of PIVC insertion.

In patients with Sickle Cell Disease (SCD), transfusion therapies have shown to reduce the risk of strokes in patients with abnormal cerebral blood flow. The current guidelines for pediatric patients with SCD recommend monthly transfusions using red cell exchange (RCE) to maintain the pediatric patient's sickle hemoglobin (HbS) below 30% between treatments. However, it is not clear how much RCE is needed to achieve this goal. Our objective was to find a target post-RCE HbS (post-HbS) level, following which our patients' HbS would remain below 30% between monthly RCE. We identified RCE events for pediatric patients ≤ 20 years old with the HbSS genotype and receiving monthly RCE therapy. HbS results were categorized into post-HbS and follow-up RCE HbS (F/u-HbS) from twenty two to forty days later. Two hundred and seventy two complete sets of data from 14 patients were identified from 2000 to 2015. No particular level of post-HbS accurately predicts the exact level of F/u-HbS. Of patients with post-HbS of 5-10%, 67% had F/u-HbS < 30%. Additionally only 20% of patients with post-HbS of 10-15% had F/u-HbS < 30%. Reduction of post-HbS to 5-10% was found to be the most effective in maintaining the HbS level < 30% between monthly RCE.

Reduction of peripheral blood stem cell collection sessions with extended-hour operation of the apheresis center Submit Manuscript | http://medcraveonline.com Abbreviations: BV, blood volume; PB CD34+, peripheral blood CD34+ cell count; MM, multiple myeloma; G-CSF, granulocyte colony stimulating factor; PY, product yield; PBSC, peripheral blood stem cell IntroductionAs healthcare expenses continue to increase, and healthcare funding becomes heavily reduced, hospitals are faced with the challenge of providing quality care while curtailing costs.1 Since nursing salaries account for the highest percentage of healthcare expenditure, many hospitals have restricted the size of their nursing workforce and restructured their rosters in a manner that would adequately allocate staff to meet patient needs, while simultaneously increasing operational efficiency.1,2 At the Mount Sinai Hospital Apheresis Center, full-time apheresis nurses previously worked on an 8.5-hour shift (8:00 am-4:30 pm), five days a week. Following the recommendation of a proposed guideline for autologous PBSC collection, the previous daily maximal processing volume for each patient was increased from 3 to 4 blood volumes (BV), except when the initial peripheral blood CD34+ cell count (PB CD34+) was >120 cells/mL. 3 The time required to process the 4 BVs varies between patients, and between collection sessions, based upon flow rate, health condition of the patient, and mobilization efficiency. Four BVs was usually the maximal blood volume that could be processed within the 8.5-hour limit of daily operation of the Apheresis Center.Autologous PBSC transplantation is performed to restore hematopoietic recovery in patients with hematological malignancies, including lymphomas, multiple myeloma (MM), Amyloidosis, and certain solid tumors, 4 after high dose chemotherapy. PBSC collections are done in preparation for an autologous transplant, in which the stem cells are infused back into the patient. PBSC collection involves the collection of mobilized stem cells in the patient's blood that are used for hematopoietic reconstitution in stem cell transplantation. To maximize collection, patients undergo stem cell mobilizing regimens that consist of chemotherapy and/or granulocyte colony stimulating factor (G-CSF; filgrastim), with or without additional mobilizing agent, plerixafor, to mobilize the highest possible population of stem cells into blood circulation.4-6 the collection procedure is to process several blood volumes in an apheresis instrument, in order to reach an optimal target number of cells collected. 7 The PBSC collection product yield (PY) rises with the increase of BVs processed. The number of collection days varies among patients, depending on the peripheral blood stem cell concentration and daily BV processed. AbstractBackground: With the rising cost of healthcare, and nurses' salaries accounting for a large percentage of hospital expenses, it is crucial to maximize the efficiency of nursing services, while minimizing operational cost and impr...