Maternal-fetal medicine specialists' experiences of conducting feticide as part of termination of pregnancy: a qualitative study.

OBJECTIVES: This study aimed to explore maternal-fetal medicine specialists' experiences of conducting feticide in late termination of pregnancy. METHODS: Participants were recruited via email. Purposeful sampling resulted in ten maternal-fetal specialists. Semistructured interviews were used to examine their experiences of conducting feticide. Interviews occurred across four English National Health Service hospitals. Interpretative phenomenological analysis was used. RESULTS: An ongoing doctor-patient relationship when conducting feticide facilitated participants' self-image as clinicians rather than technicians. Coping involved rationalisation, with feticide viewed as 'part of the job'. Supportive team relationships helped keep emotional expression within control. Participants were not distressed if they felt, through relationship-based decision-making, that the feticide aligned with their values and legal interpretation. To avoid negative judgements, they disclosed selectively, only telling trusted individuals that they conducted feticides. CONCLUSIONS: Participants experienced conducting feticides as difficult but necessary, eliciting pride from the skills involved. Some noted management of personal distress. Optimal conditions were involvement in the process from the initial decision-making and team support. Providing feticides was deemed as potentially stigmatising, with selective disclosure employed. Training in managing feticides and guidance on providing optimal service conditions may decrease selectivity of disclosures and enhance staff well-being and the quality of feticide provisions. © 2015 John Wiley & Sons, Ltd.

A 12-year study of fungal infections in Rio Grande do Sul, Southern Brazil.

BACKGROUND: The number of fungal infections has increased in recent years in Rio Grande do Sul (RS), Brazil. Epidemiological studies are important for proper control of infections. AIMS: To evaluate the etiology of fungal infections in patients in RS, from 2003 to 2015. METHODS: This is a retrospective and longitudinal study carried out at Mycology Department of Central Laboratory of RS; 13,707 samples were evaluated. The variables sex, age, site of infection, and etiologic agent were analyzed. Susceptibility of Candida to fluconazole was tested in isolates from samples collected in 2015 from 51 outpatients. RESULTS: Of the 13,707 samples, 840 cases (6.12%) of fungal infections were found and included in the analyses; female gender accounted for the 55.9% of the cases. The main fungus was Candida albicans (450 cases, 53.38%; p<0.001). Onychomycosis was the most frequent infection in superficial mycoses. Systemic mycoses accounted for 54.05% of the cases, from which 68.8% occurred in males, mainly HIV-positive (33.11%), and the main etiologic agent in these cases was Cryptococcus neoformans (73.13%). Among 51 samples tested for susceptibility to fluconazole, 78.43% of Candida isolates were susceptible; 5.88% were susceptible in a dose-dependent manner, and 15.69% were resistant. CONCLUSIONS: C. albicans is a common cause of fungal infections in RS, accounting for half of the cases; resistance to antifungals was found in non-hospitalized patients. In addition, women seem to be more susceptible to fungal infections than men, however men show more systemic mycoses than women. The nails are the most common site of infection.

Drug susceptibility in emerging fungal infections: tests with fluconazole, itraconazole, and amphotericin B.

The number of new cases of emerging fungal infections has increased considerably in recent years, mainly due to the large number of immunocompromised individuals. The objective of this study was to evaluate the susceptibility of emerging fungi to fluconazole, itraconazole and amphotericin B by disk diffusion method. In 2015, 82 emerging fungi were evaluated in IPB-LACEN/RS and 13 (15.8%) were resistant: 10/52 were from superficial mycoses and 3/30 from systemic mycoses. The data from the study point to the need for permanent vigilance regarding the careful evaluation in the prescription and clinical and laboratory follow-up of patients affected by fungal infections.

A 12-year study of fungal infections in Rio Grande do Sul, southern Brazil

Background: The number of fungal infections has increased in recent years in Rio Grande do Sul (RS), Brazil. Epidemiological studies are important for proper control of infections. Aims: To evaluate the etiology of fungal infections in patients in RS, from 2003 to 2015. Methods: This is a retrospective and longitudinal study carried out at Mycology Department of Central Laboratory of RS; 13,707 samples were evaluated. The variables sex, age, site of infection, and etiologic agent were analyzed. Susceptibility of Candida to fluconazole was tested in samples collected in 2015from 51 outpatients. Results: Of the 13,707 samples, 840 cases (6.12%) of fungal infections were found and included in the analyses; female gender accounted for the 55.9% of the cases. The main fungus was Candida albicans (450 cases, 53.38%; p < 0.001). Onychomycosis was the most frequent infection in superficial mycoses. Systemic mycoses accounted for 54.05% of the cases, from which 68.8% occurred in males, mainly HIVpositive (33.11%), and the main etiologic agent in these cases was Cryptococcus neoformans (73.13%). Among 51 samples tested for susceptibility to fluconazole, 78.43% of Candida isolates were susceptible; 5.88% were susceptible in a dose-dependent manner, and 15.69% were resistant. Conclusions: C. albicans is a common cause of fungal infections in RS, accounting for half of the cases;resistance to antifungals was found in non-hospitalized patients. In addition, women seem to be moresusceptible to fungal infections than men, however men show more systemic mycoses than women. Thenails are the most common site of infection. (AU)

A 12-year study of fungal infections in Rio Grande do Sul, Southern Brazil / Infecciones fúngicas en Rio Grande do Sul, Brasil: estudio de 12 años

Background: The number of fungal infections has increased in recent years in Rio Grande do Sul (RS), Brazil. Epidemiological studies are important for proper control of infections. Aims: To evaluate the etiology of fungal infections in patients in RS, from 2003 to 2015. Methods: This is a retrospective and longitudinal study carried out at Mycology Department of Central Laboratory of RS; 13,707 samples were evaluated. The variables sex, age, site of infection, and etiologic agent were analyzed. Susceptibility of Candida to fluconazole was tested in isolates from samples collected in 2015 from 51 outpatients. Results: Of the 13,707 samples, 840 cases (6.12%) of fungal infections were found and included in the analyses; female gender accounted for the 55.9% of the cases. The main fungus was Candida albicans (450 cases, 53.38%; p < 0.001). Onychomycosis was the most frequent infection in superficial mycoses. Systemic mycoses accounted for 54.05% of the cases, from which 68.8% occurred in males, mainly HIV-positive (33.11%), and the main etiologic agent in these cases was Cryptococcus neoformans (73.13%). Among 51 samples tested for susceptibility to fluconazole, 78.43% of Candida isolates were susceptible; 5.88% were susceptible in a dose-dependent manner, and 15.69% were resistant. Conclusions: C. albicans is a common cause of fungal infections in RS, accounting for half of the cases; resistance to antifungals was found in non-hospitalized patients. In addition, women seem to be more susceptible to fungal infections than men, however men show more systemic mycoses than women. The nails are the most common site of infection

Antecedentes: El número de casos de infecciones fúngicas ha aumentado en los últimos años en Rio Grande do Sul (RS), Brasil. Los estudios epidemiológicos son importantes para el control de estas infecciones. Objetivos: Evaluar la etiología de las infecciones fúngicas en pacientes de RS desde 2003 hasta 2015. Métodos: Este es un estudio retrospectivo y longitudinal realizado en el Departamento de Micología del Laboratorio Central de RS; se evaluaron 13.707 casos de infecciones. Se analizaron las variables sexo, edad, lugar de infección y agente etiológico. La sensibilidad de Candida al fluconazol se analizó en 51 aislamientos de muestras recogidas en el año 2015. Resultados: De las 13.707 muestras, 840 casos (6,12%) de infecciones fúngicas se incluyeron en el análisis; el 55,9% correspondieron a mujeres. El hongo predominante fue Candida albicans (450 casos, 53,38%; p < 0,001). La onicomicosis fue la infección más frecuente de las micosis superficiales. Las micosis sistémicas representaron el 54,05% de los casos; de estos, el 68,8% tuvieron lugar en hombres, principalmente VIH-positivos (33,11%), y el principal agente etiológico en estos casos fue Cryptococcus neoformans (73,13%). Entre las 51 muestras analizadas para determinar la sensibilidad al fluconazol, el 78,43% de los aislamientos de Candida fueron sensibles; el 5,88% fueron sensibles de forma dosis-dependiente y el 15,69% fueron resistentes. Conclusiones: C. albicans es una causa común de infecciones fúngicas en RS, pues representa la mitad de los casos; su resistencia a los antifúngicos se encontró entre pacientes ambulatorios. Además, parece que las mujeres son más susceptibles a las infecciones fúngicas que los hombres, mientras que los hombres presentan más micosis sistémicas que las mujeres; las uñas son el lugar más frecuente de infección

Drug susceptibility in emerging fungal infections: tests with fluconazole, itraconazole, and amphotericin B

Abstract: The number of new cases of emerging fungal infections has increased considerably in recent years, mainly due to the large number of immunocompromised individuals. The objective of this study was to evaluate the susceptibility of emerging fungi to fluconazole, itraconazole and amphotericin B by disk diffusion method. In 2015, 82 emerging fungi were evaluated in IPB-LACEN/RS and 13 (15.8%) were resistant: 10/52 were from superficial mycoses and 3/30 from systemic mycoses. The data from the study point to the need for permanent vigilance regarding the careful evaluation in the prescription and clinical and laboratory follow-up of patients affected by fungal infections.