Outbreak of KPC-producing Klebsiella pneumoniae at a Portuguese university hospital: Epidemiological characterization and containment measures.

Background: KPC-producing K pneumoniae (KPC-Kp) is a public health problem with important clinical and epidemiological implications. We describe an outbreak of KPC-Kp at vascular surgery and neurosurgery wards in a central hospital in Porto, Portugal. Methods: A case of KPC-Kp was considered to be a patient positive for KPC-Kp with strong epidemiological plausibility of having acquired this microorganism in the affected wards and/or with genetic relationship ≥92% between KPC-Kp isolates. Active surveillance cultures (ASCs) and real-time polymerase chain reaction were used for the detection of carbapenemase genes through rectal swab in a selected population. Molecular analysis was performed using pulsed-field gel electrophoresis at the National Reference Laboratory. Patient risk factors were collected from the electronic medical record system. Information regarding outbreak containment strategy was collected from the Infection Control Unit records. Results: Of the 16 cases, 11 (69%) were identified through active screening, representing 1.4% of the total 766 ASCs collected. The most frequent risk factors identified were previous admission (63%), antibiotic exposure in the past 6 months (50%), and immunodepression (44%). The length of stay until KPC-Kp detection was high (0-121 days, mean 35.6), as was the total length of stay (5-173 days, mean 56.6). Three patients (19%) were infected by KPC-Kp, 2 of whom died. One previously colonized patient died later because of KPC-Kp infection. Conclusions: Multifactorial strategy based on contact precautions (with patient and healthcare professional cohorts) and ASC, as well as Antibiotic Stewardship Program reinforcement, allowed to contain this KPC-Kp outbreak.

Effect of progressive self-focus meditation on attention, anxiety, and depression scores.

This study evaluated the effects of Progressive Self-focus Meditation with 42 volunteers (M age = 46.0 yr., SD = 14.1) allocated to two groups: one that had weekly 1-hr. training sessions in the practice for 5 wk. and one waiting-list group. Participants were evaluated before and after 5 wk. on the Beck Anxiety Inventory, Beck Depression Inventory, the Digit Symbol subtest of the Wechsler Adult Intelligence Scale, and the Mindfulness Attention Awareness Scale. After 5 wk., a significant reduction in scores on depression was found in the Meditation group as well as an increase in attention in comparison with the waiting-list Control group.

Identificação computadorizada de crises tipo ausência no eletrocorticograma de ratos / Automatized identification of absence-like seizures in electrocorticogram of rats

Crises tipo epilepsia de ausência são expressas no eletrocorticograma de ratos como surtos paroxísticos de descargas espícula-onda. O objetivo do presente trabalho foi desenvolver e testar um sistema automatizado de identificação de crises. O princípio do sistema é distinguir sinais de crise dos demais sinais pela análise da potência na faixa de frequência entre 7 e 11 Hz, que é alta apenas durante as crises. A rotina, elaborada no Matlab®, é informada com um intervalo de registro em que não ocorreram crises (crivo), a fim de estabelecer o critério de identificação. O sistema compara, por meio da transformada rápida de Fourier, o crivo com o registro inteiro. A saída do programa é uma tabela informando a presença de crises nesses intervalos. Quatro ratos Wistar geneticamente portadores de crises tipo ausência e implantados com eletrodos corticais tiveram eletrocorticograma por 80 minutos. As crises foram quantificadas manualmente minuto a minuto. O registro e a quantificação das crises de um animal foram usados no refinamento do sistema. Os valores da quantificação automatizada foram bastante similares aos da quantificação manual para o animal usado na elaboração do sistema. Os registros dos demais animais foram usados para testar o sistema e apresentaram padrão similar. O sistema é capaz de quantificar com grande fidelidade as descargas eletrocorticográficas espícula-onda, mostrando-se como potente instrumento na análise de registros em estudos com modelos animais dessa patologia. Adicionalmente, pequenas adaptações permitem identificar outros padrões encontrados em registros eletroencefalográficos (sono, vigília, manifestações patológicas). A rotina está disponível para download em www.ib.usp.br/~rpavao.

Absence-like seizures are presented in rat electrocorticogram as paroxistics spike-wave discharges. The aim of this study was to develop and test an automatized system for seizures identification. System fundament is to distinguish seizure signals from others by power analysis in frequency range between 7 and 11 Hz, which is high only during seizures. Routine, elaborated at Matlab®, is inputted with an interval without seizures (sample) in order to set up the criterion of identification. The system compares, through the Fourier fast transformed, the sample with the entire recording. Program output is a table that reports the presence of seizures in such intervals. Four Wistar rats genetically prone to show absence-like seizures with implanted cortical electrodes were submitted to 80 minutes of electrocorticogram. Seizures were counted manually minute by minute. Recording and seizure quantification of one animal were used to refine the system. Automatized quantification was very similar to manual quantification for the animal used as sample. Recordings of the other animals, used to test the system, shows similar pattern. The system is able to quantify with high fidelity the spike-wave discharges, so that it is a powerful instrument to analyze electroencephalogram in studies with animal models of this pathology. Additionally, minor changes allow identifying other patterns found in electrophysiological recordings (sleep, wakefulness, pathological manifestations etc). The routine is available for download at www.ib.usp.br/~rpavao.