Personalized analysis of pain-weather associations: a pilot study.

Background and purpose:

It is a wellknown belief that weather can influence human health, including pain sensation. However, the current data are controversial, which might be due to the wide range of interindividual differences. The present study aimed to characterize the individual pain–weather associations during chronic pain by utilizing several data analytical methods.

The study included 3-3 patients with (P1, P3, and P4) or without (P2, P5, P6) diabetes mellitus and signs of trigeminal neuralgia or low back pain. Subjective pain scores (0–10) and 12 weather parameters (terrestrial, geomagnetic, and solar) were recorded for one month repeated three times daily. Nonparametric Spearman’s correlation (Sp), multiple regression (Mx), and principal component (PCA) analyses were performed to evaluate associations between pain and meteorological factors obtained at the day of recorded pain value, 2 days before and 2 days after the recorded pain, and the changes in these parameters (5 × 12 parameters). Complex scores were calculated based on the results of these analyses.

While the temperature had the highest effects on the pain levels in most of the participants, huge interindividual dif­ferences in the degree and the direction of the associations between pain and weather parameters could be obtained. The analytic methods also revealed subjectspecific results, and the synthesis of different statistical methods as total scores provided a personalized map for each patient, which showed disparate patterns across the study participants. Thus, Participants 2 and 5 had higher scores for Mx compared to Sp; furthermore, certain factors showed opposite direction in their associations with the pain level depending on the type of analysis (Sp vs Mx). In contrast, P3 had a lower score for Mx compared to Sp, which might suggest a low level of weather sensitivity on the association between the different weather parameters in this subject. Furthermore, participants P4 and P6 had a very high level of weather sensitivity, while P1 had an opposite pattern. Regarding the time point-related effects on the pain level, most patients were sensitive to parameters obtained at the same day or two days before, except the P1 subject, who had the highest sensitivity to weather parameters detected two days after.

The present study highlights the importance of integrating different data analysis approaches to elucidate the individual connections between pain and most of the weather parameters. In conclusion, complex personalized profiling should be considered for the characterization of pain–weather associations by applying different data analytical approaches, which may provide feedback to physicians and patients. 

Pain and weather associations - Action mechanisms; personalized profiling.

It is a well-known hypothesis that weather can influence human health, including pain sensation. The primary meteorological factors are atmospheric pressure, wind, humidity, precipitation, and temperature, which vary from the climate and seasons, but the parameters of space weather (e.g., geomagnetic and cosmic ray activities) also may affect our body condition. Despite a significant number of experimental studies, reviews, and meta-analyses concerning the potential role of weather in pain sensitivity, the findings are heterogeneous and lack consensus. Therefore, rather than attempting a comprehensive analysis of the entire literature on the effects of weather on different pain types, this study highlights the potential action mechanisms of the meteorological factors, and the possible causes of the controversial results. The few data available about the individual evaluations are discussed in detail to reveal the significance of the personalized analysis of the possible relationships between the most available weather parameters and the pain scores. The use of special algorithms may enable the individual integration of different data for a precise outcome concerning the link between pain sensitivity and weather parameters. It is presumed that despite the high level of interindividual differences in response to meteorological parameters, the patients can be clustered in different groups based on their sensitivity to the weather parameters with a possible disparate treatment design. This information may help patients to control their daily activities and aid physicians to plan more valuable management for patients with pain states when the weather conditions change.

[Changes in antibiotic resistance in cholangitis. Our clinical experience]. / Az antibiotikumrezisztencia változása cholangitisben. Klinikai tapasztalataink.

Introduction: Due to the inappropriate use of antibiotics (AB), more pathogens become multiresistant. One of the most severe sources of sepsis is cholangitis. To avoid fatal outcome, an effective AB policy plays a key role. Aim: To investigate the AB resistance of bacteria causing cholangitis and the efficacy of AB treatment. Patients and method: Microbiological tests of bile samples collected during cholangitis-indicated endoscopic retrograde cholangiopancreatographies were analysed at the First Department of Medicine, University of Szeged, in 2006 and in 2016. Results: 29 and 111 patients had bile sample collection in 2006 and in 2016, respectively. Of that, 22 (75%) and 106 (95%) were positive. Mean age: 61 ± 14 vs. 71 ± 14 years, no difference between men/women ratio. In 2006, 10 cases empirical AB (ciprofloxacine with metronidazole or imipenem) were used. In 9 cases (90%), the AB was adequate based on the microbiological results. In 2016, in 88 cases empirical AB was applied (ciprofloxacine and metronidazole, ceftriaxone with metronidazole or imipenem with metronidazole). In 29 cases, the empirical AB was ineffective. The efficacy of ciprofloxacine decreased to 64% in 2016. The profile of the most frequent cholangitis-causing pathogens (Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae) was the same, but their resistency against ciprofloxacine increased. The rates of polymicrobal infections were 73% and 63%, respectively. Conclusion: The rates of positive bile samples were significantly higher in 2016. The profile of the most frequent pathogens was the same. The efficacy of the first-choice empirical AB ciprofloxacine decreased in 2016. The types of the most frequent cholangitis-causing bacteria are in line with the ones included in the Tokyo Guideline. Orv Hetil. 2019; 160(36): 1437-1442.

[Beliefs - Misbeliefs, answering essential questions about hand hygiene from the view of the evidences]. / Hitek és tévhitek, azaz vitatott esszenciális kérdések a kézhigiénérol az evidencia tükrében.

Contaminated hands can play pivotal role in the development and spread of healthcare-associated infections. Consequently hand hygiene practice performed with adequate technique and with adequate timing is an essential implement for patient safety. Inhibition of the practice of high level hand hygiene by the misconceptions or deficient knowledge of healthcare workers may lead to negative influence on the quality of patient care. Erroneous beliefs or "rumourous knowledge" acquired from colleagues can not only influence the attitude of healthcare workers, but can also give rise to insufficient hand hygiene compliance. Finding, interpreting and imparting the related evidence by delivering continuing education and lectures, highlighting the theoretical and practical know-how on hand hygiene could help to understand and imprint the evidence-based practice and adequate technique in the essential issue of hand hygiene. Orv. Hetil., 2017., 158(6), 212-219.

Successful elimination of extended-spectrum beta-lactamase (ESBL)-producing nosocomial bacteria at a neonatal intensive care unit.

BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are highly dangerous to neonates. At our Neonatal Intensive Care Unit (NICU), the presence of these bacteria became so threatening in 2011 that immediate intervention was required. METHODS: This study was conducted during a nearly two-year period consisting of three phases: retrospective (9 months), educational (3 months) and prospective (9 months). Based on retrospective data analysis, a complex management plan was devised involving the introduction of the INSURE protocol, changes to the antibiotic regimen, microbiological screening at short intervals, progressive feeding, a safer bathing protocol, staff hand hygiene training and continuous monitoring of the number of newly infected and newly colonized patients. During these intervals, a total of 355 patients were monitored. RESULTS: Both ESBL-producing Enterobacter cloaceae and Klebsiella pneumoniae were found (in both patients and environmental samples). In the prospective period a significant reduction could be seen in the average number of both colonized (26/167 patients; P=0.029) and infected (3/167 patients; P=0.033) patients compared to data from the retrospective period regarding colonized (72/188 patients) and infected (9/188 patients) patients. There was a decrease in the average number of patient-days (from 343.72 to 292.44 days per months), though this difference is not significant (P=0.058). During the prospective period, indirect hand hygiene compliance showed a significant increase (from the previous 26.02 to 33.6 hand hygiene procedures per patient per hospital day, P<0.001). CONCLUSION: Colonizations and infections were rolled back successfully in a multi-step effort that required an interdisciplinary approach.