QuantiFERON-TB Gold In-Tube as a Confirmatory Test for Tuberculin Skin Test in Tuberculosis Contact Tracing: A Noninferiority Clinical Trial.

Background: Screening strategies based on interferon-γ release assays in tuberculosis contact tracing may reduce the need for preventive therapy without increasing subsequent active disease. Methods: We conducted an open-label, randomized trial to test the noninferiority of a 2-step strategy with the tuberculin skin test (TST) followed by QuantiFERON-TB Gold In-Tube (QFT-GIT) as a confirmatory test (the TST/QFT arm) to the standard TST-alone strategy (TST arm) for targeting preventive therapy in household contacts of patients with tuberculosis. Participants were followed for 24 months after randomization. The primary endpoint was the development of tuberculosis, with a noninferiority margin of 1.5 percentage points. Results: A total of 871 contacts were randomized. Four contacts in the TST arm and 2 in the TST/QFT arm developed tuberculosis. In the modified intention-to-treat analysis, this accounted for 0.99% in the TST arm and 0.51% in the TST/QFT arm (-0.48% difference; 97.5% confidence interval [CI], -1.86% to 0.90%); in the per-protocol analysis, the corresponding rates were 1.67% and 0.82% in the TST and TST/QFT arms, respectively (-0.85% difference; 97.5% CI, -3.14% to 1.43%). Of the 792 contacts analyzed, 65.3% in the TST arm and 42.2% in the TST/QFT arm were diagnosed with tuberculosis infection (23.1% difference; 95% CI, 16.4% to 30.0%). Conclusions: In low-incidence settings, screening household contacts with the TST and using QFT-GIT as a confirmatory test is not inferior to TST-alone for preventing active tuberculosis, allowing a safe reduction of preventive treatments. Clinical Trials Registration: NCT01223534.

Efficacy of Povidone Iodine Against Microbial Biofilms in Breast Implants With Different Textures: Results From an in vitro Study.

Background: In the practice of breast augmentation and reconstruction, implant irrigation with various solutions has been widely used to prevent infection and capsular contracture, but to date, there is no consensus on the optimal protocol to use. Recently, application of povidone iodine (PI) for 30 min has shown in vitro to be the most effective irrigating formula in reducing contamination in smooth breast implants. However, as 30 min is not feasible intraoperatively, it is necessary to determine whether shorter times could be equally effective as well as to test it in both smooth and textured implants. Methods: We tested the efficacy of 10% PI at 1', 3', and 5' against biofilms of 8 strains (2 ATCC and 6 clinical) of Staphylococcus spp. on silicone disks obtained from Mentor® and Polytech® implants of different textures. We analyzed the percentage reduction of cfu counts, cell viability and bacterial density between treatment (PI) and control (sterile saline, SS) groups for each time of application. We consider clinical significance when > 25% reduction was observed in cell viability or bacterial density. Results: All textured implants treated with PI at any of the 3 exposure times reduced 100% bacterial load by culture. However, none of the implants reached enough clinical significance in percentage reduction of living cells. Regarding bacterial density, only 25-50 µm Polytxt® Polytech® implants showed significant reduction at the three PI exposure times. Conclusion: PI is able to inhibit bacterial growth applied on the surface of breast implants regardless of the exposure time. However, no significant reduction on living cells or bacterial density was observed. This lack of correlation may be caused by differences in texture that directly affect PI absorption.

Interhospital spread of NDM-7-producing Klebsiella pneumoniae belonging to ST437 in Spain.

This study describes an interhospital spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) producing NDM-7 carbapenemase that started in December 2013 in Madrid, Spain. NDM-7-producing CRKP were isolated from urine, rectal swabs or blood samples from seven patients admitted to three different hospitals (Hospital Universitario La Paz, Hospital de Cantoblanco and Hospital Central de la Cruz Roja). The isolates were resistant to all antimicrobials tested except colistin and fosfomycin. One blood isolate was susceptible to minocycline and tigecycline but was resistant to fosfomycin. All isolates were closely related by pulsed-field gel electrophoresis (PFGE) and DiversiLab(®) analysis and belonged to multilocus sequence typing (MLST) sequence type 437. In addition, blaNDM-7, blaTEM-1, blaCTX-M-15 and aac(3)-IIa were identified. Family contacts of the index case were negative for NDM-producing bacteria. The outbreak occurred in two separate waves and the cases associated with Hospital de Cantoblanco had been admitted to the same room. Environmental samples from the trap of a sink and a shower in this room were positive for NDM-7-producing CRKP. To our knowledge, this is the first reported worldwide outbreak of NDM-7-producing CRKP. No relationship with the Indian continent, the Balkans or the Middle East could be established. Frequent transfer of aged or chronically ill patients between the facilities involved may have favoured the spread of NDM-7-producing CRKP. The spread of the second wave in Hospital de Cantoblanco probably occurred as a result of transmission from an environmental reservoir.

Proyecto colaborativo Chile-Paraguay en formación de postgrado / A Chile - Paraguay collaborative project for postgraduate education

Resumen:

Objetivo: este artículo da a conocer el proyecto colaborativo entre la Escuela de Enfermería de la Pontificia Universidad Católica de Chile (PUC) y la Escuela de Enfermería de la Universidad Católica “Nuestra Señora de la Asunción” de Paraguay. El objetivo es el de mejorar la calidad del cuidado de la salud que se otorga a la población, a través del perfeccionamiento de enfermeras y enfermeros a nivel de postgrado. Metodología: se revisan los principales aspectos considerados en la creación y puesta en marcha del postgrado, y su estado actual a junio de 2014. La participación de la Escuela de Enfermería de la PUC en este proyecto responde al llamamiento de la Santa Sede “de fortalecer la red de universidades católicas” y es considerado un deber de contribuir con su experiencia y experticia al desarrollo de la enfermería de un país amigo. Resultados: como resultado de este proyecto se creó y puso en marcha, en el año 2007, un programa de magister en Enfermería desa­rrollado en la ciudad de Asunción, que en el año 2014 ha graduado a 29 profesionales y que están contribuyendo al desarrollo de la enfermería de Paraguay. Conclusión: el modelo diseñado para el desarrollo de este magister ha demostrado ser exitoso, como también el establecimiento de alianzas y colaboración entre las universidades, lo que aporta beneficios a las instituciones involucradas tanto en los ámbitos académicos y profesionales como personales.

Abstract:

Purpose: A collaborative project by Nursing School, Pontificia Universidad Católica, Chile (PUC) and Nursing School, Universidad Católica “Nuestra Señora de la Asunción”, Paraguay is described. The project is aimed at improving healthcare quality provided to the community by means of an improved postgraduate education for nurses.

Methods: The main aspects taken into account to create and develop postgraduate courses, along with their present condition in June 2014, are reviewed. The involvement of PUC's Nursing School in this project results from the Holy See's calling for "strengthening the Catholic Universities network"; and offering its experience and expertise to help nursing development in a friend country is considered to be a duty. Results: As a result from the project, in 2007 a Master Program in Nursing was created and implemented in Asunción city, with 29 professionals having achieved graduation in it until 2014; such professionals are currently contributing to nursing development in Paraguay. Conclusion: The model that was designed in order to develop this Master course has proved successful. Alliances and collaboration between universities have also been satisfactory, with benefits being obtained by involved institutions at academic, professional, and personal levels.

Introduçao: trabalho colaborador entre a Escola de Enfermagem da Pontifícia Universidade Católica de Chile (PUC) e a Escola de Enfermagem da Universidade Católica “Nossa Senhora da Assunção”, Paraguai. Objetivo: melhorar a qualidade do cuidado de saúde que se outorga a população, usando como estratégia o aperfeiçoamento de enfermeiras e enfermeiros em nível de pós-graduação. Resultado: como resultado deste projeto se criou e pôs em marcha, o ano de 2007, um Programa de Mestrado em Enfermagem desenvolvido na cidade de Assunção, que até 2014 havia graduado 29 profissionais que estão contribuindo ao desenvolvimento da Enfermagem de Paraguai.

Conclusão: o modelo desenhado deste Mestrado tem demonstrado ser exitoso, bem como também o estabelecimento de alianças e colaborações entre as universidades o que oferece contribuições benéficas ás instituições envolvidas tanto nos âmbitos acadêmicos, profissionais como pessoais.

Conocimientos y estigmas sobre salud mental en familiares de pacientes que acuden a consultorio externo del ôHospital Nacional Cayetano Herediaõ / Knowledge and prejudices about mental health in outpatients' relatives in Cayetano Heredia Hospital

Objetivos: Describir los conocimientos y estigmas sobre salud mental y evaluar la asociación entre características demográficas, conocimientos de salud y estigmas. Material y Método: Estudio descriptivo transversal. Se redactaron tres viñetas describiendo un caso típico de depresión, trastorno de pánico y esquizofrenia y se formularon preguntas sobre ellas. Las viñetas y sus preguntas se validaron por juicio de expertos. Se aplicó cada viñeta y sus preguntas a 151 familiares de pacientes no psiquiátricos de consulta externa, incluyéndose un total de 453 individuos. Resultados: Para el caso de trastorno de pánico, se prefirió que el paciente sea visto por un médico especialista no psiquiatra (76,0 %) y se consideró que podía morir de una enfermedad física no diagnosticada (57,3 %). Para el caso de depresión y esquizofrenia el profesional considerado como el más indicado para tratarlo fue el psicólogo (41,7 % y 45,0 %, respectivamente). Para el caso de esquizofrenia, se encontró asociación entre ir al psiquiatra o presentar una enfermedad mental y considerarlo una amenaza para los demás (p=0,003 y p.<.0,001, respectivamente). Conclusiones: Un alto porcentaje recomendaría que pacientes con sintomatología de esquizofrenia o depresión sean tratados por un psicólogo. Por otro lado, se considera con frecuencia, que pacientes con trastorno de pánico tienen una enfermedad física que no ha podido ser diagnosticada y deben ser tratados por un médico no psiquiatra.

Objectives: To describe knowledge and prejudices about mental health and to determine if there is any association between demographic characteristics, health knowledge and prejudices on mental health. Materials and Method: This is a cross-sectional descriptive study. Three vignettes describing typical cases of depression, panic disorder, and schizophrenia were elaborated, and questions were asked about them. Vignettes and their questions were validated by a group of experts. Each vignette and its questions were administered to 151 relatives of persons attending the outpatient clinic for conditions other than psychiatric disorders, so 453 individual vignettes were assessed. Results: For cases of panic disorder, interviewees preferred patients should be seen by a specialized non-psychiatrist physician (76,0%), and they also considered these patients might die because of an undiagnosed physical condition (57,3%). For cases of depression and schizophrenia, professionals chosen as the most adequate for managing these patients were psychologists (41,7% and 45,0%, respectively). For cases of schizophrenia, an association was found between going to the psychiatrist or having a mental disorder, and they also considered these subjects may represent a threat for their peers (p=0,003 and p<0,001, respectively). Conclusions: A high percentage of interviewees would recommend that patients with schizophrenia or depression should be treated by a psychologist. On the other hand, they also considered that patients with panic disorder may have an undiagnosed physical condition and that they should be treated by a non-psychiatrist physician.