Superior vena cava graft infection in thoracic surgery: a retrospective study of the French EPITHOR database.

OBJECTIVES: To report our experience on the management of superior vena cava graft infection. METHODS: Between 2001 and 2018, patients with superior vena cava synthetic graft or patch reconstruction after resection of intrathoracic tumours or benign disease were selected retrospectively from the French EPITHOR database and participating thoracic centres. Our study population includes patients with superior vena cava graft infection, defined according to the MAGIC consensus. Superior vena cava synthetic grafts in an empyema or mediastinitis were considered as infected. RESULTS: Of 111 eligible patients, superior vena cava graft infection occurred in 12 (11.9%) patients with a polytetrafluoroethylene graft secondary to contiguous contamination. Management consisted of either conservative treatment with chest tube drainage and antibiotics (n = 3) or a surgical graft-sparing strategy (n = 9). Recurrence of infection appears in 6 patients. Graft removal was performed in 2 patients among the 5 reoperated patients. The operative mortality rate was 25%. CONCLUSIONS: Superior vena cava graft infection may develop as a surgical site infection secondary to early mediastinitis or empyema. Graft removal is not always mandatory but should be considered in late or recurrent graft infection or in infections caused by aggressive microorganisms (virulent or multidrug resistant bacteria or fungi).

Severe COVID-19 is characterized by the co-occurrence of moderate cytokine inflammation and severe monocyte dysregulation.

BACKGROUND: SARS-CoV-2 has been responsible for considerable mortality worldwide, owing in particular to pulmonary failures such as ARDS, but also to other visceral failures and secondary infections. Recent progress in the characterization of the immunological mechanisms that result in severe organ injury led to the emergence of two successive hypotheses simultaneously tested here: hyperinflammation with cytokine storm syndrome or dysregulation of protective immunity resulting in immunosuppression and unrestrained viral dissemination. METHODS: In a prospective observational monocentric study of 134 patients, we analysed a panel of plasma inflammatory and anti-inflammatory cytokines and measured monocyte dysregulation via their membrane expression of HLA-DR. We first compared the results of patients with moderate forms hospitalized in an infectious disease unit with those of patients with severe forms hospitalized in an intensive care unit. In the latter group of patients, we then analysed the differences between the surviving and non-surviving groups and between the groups with or without secondary infections. FINDINGS: Higher blood IL-6 levels, lower quantitative expression of HLA-DR on blood monocytes and higher IL-6/mHLA-DR ratios were statistically associated with the risk of severe forms of the disease and among the latter with death and the early onset of secondary infections. INTERPRETATION: The unique immunological profile in patients with severe COVID-19 corresponds to a moderate cytokine inflammation associated with severe monocyte dysregulation. Individuals with major CSS were rare in our cohort of hospitalized patients, especially since the use of corticosteroids, but formed a very severe subgroup of the disease. FUNDING: None.

Salud mental y su relacion con las caracteristicas biosociodemograficas en pacientes hemodializados / Saúde mental e sua relação com as características biosociodemográficas em pacientes hemodiados / Mental health and its relationship with biosociodemographic characteristics in hemodialysed patients

Resumen:La Enfermedad renal crónica terminal es considerada una pandemia a nivel mundial. En Chile un 32% de los recursos económicos en salud son destinados a su tratamiento, siendo la hemodiálisis la terapia, más utilizada en estos usuarios. Esta patología modifica todo el equilibrio de la persona, sometiéndola a diversos factores estresantes y provocándole alteraciones en el ámbito físico, psicológico y social, repercutiendo directamente en la salud mental de estos usuarios. El objetivo de esta investigación fue identificar la salud mental y su relación con las características biosociodemográficas en los pacientes hemodializados en una unidad de cuidado en Talcahuano, Chile. Se realizó un estudio cuantitativo descriptivo, correlacional y transversal. Los datos se recolectaron a través de una entrevista. El instrumento utilizado fue la Escala de Golberg para medir salud mental más variables biosociodemográficas. Los resultados obtenidos mostraron que: de un total de 53 pacientes, un 58,5% presentó ausencia de psicopatología, 26,4% presencia y el 15,1% sospecha; un 56,6% varones y el 44,4% mujeres, un 62,3% se encontraba en pareja, un 50,9 % poseía estudios de nivel medio, el 83% se encontraban pensionado, la media del tiempo en hemodiálisis fue de 94,2 meses. La presencia de diabetes mellitus se relacionó con una mayor incidencia de sospecha psicopatología. Este estudió permitió concluir que, la sospecha y/o presencia de psicopatología se relacionó con edad avanzada, sexo femenino, ingresos económicos bajos, mayor tiempo en hemodiálisis, estar pensionado y padecer diabetes. La ausencia se relacionó con mayor nivel educacional y trabajo remunerado.

Resumo:A doença renal crônica terminal é considerada uma pandemia em todo o mundo. No Chile, uns 32% dos recursos econômicos em saúde são destinados ao seu tratamento, sendo a hemodiálise a terapia mais utilizadas nesses usuários. Essa patologia modifica todo o equilíbrio da pessoa, submetendo-a a diversos fatores extressantes e provocando alterações no estado físico, psicológico e social, repercutindo diretamente na saúde mental desses usuários. O objetivo desta pesquisa foi identificar a saúde mental e sua relação com as características biosociodemográficas em pacientes com hemodiálise, da Unidade Crônica do Hospital Las Higueras, Talcahuano. Foi realizado um estudo quantitativo, descritivo, correlacional e transversal. Os dados foram coletados por meio de entrevista. O instrumento utilizado foi a Escala de Golberg para medir a saúde mental mais variáveis ​​biosociodemográficas. Os resultados obtidos mostraram que: de um total de 53 pacientes, 58,5% apresentavam ausência de psicopatologia, 26,4% presença e 15,1% suspeita; 56,6% homens e 44,4% mulheres, 62,3% se encontraram em casais, uns 50,9% tinham estudos de nível médio, 83% eram aposentados, o tempo médio em hemodiálise foi de 94,2 meses. A presença de diabetes mellitus associou-se a maior incidência de suspeita de psicopatologia. Este estudo permitiu concluir que a suspeita e / ou presença de psicopatologia estaba relacionado com a idade avançada, sexo feminino, solteiro, renda econômica baixa, maior tempo em hemodiálise, estar aposentado e portador de diabetes. A ausência esteve relacionada ao maior nível de escolaridade e trabalho remunerado.

Abstract:End-stage renal disease is considered a pandemic worldwide. In Chile 32% of the economic resources in health are destined to its treatment, being the hemodialisys the most common treatment in those patients. This pathology modifies the entire balance of the person, subjecting it to various stressors and causing alterations in the physical, psychological and social behaviors, directly impacting the mental health of patients. The objective of this research was to identify mental health and its relationship with biosociodemographic characteristics in hemodialysis patients, from the Chronic Unit at Hospital Las Higueras, Talcahuano. A descriptive, correlational and transversal quantitative study was carried out. The data was collected through an interview. The instrument used was the Golberg Scale to measure mental health plus biosociodemographic variables. Out of 53 participants, 58.5% presented absence of psychopathology, 26.4% presence and 15.1% suspicion. There were 56.6% men and 44.4% women, 60.3% were un a relationship, 50.9% had medium level formal studies, 83% were pensioned, and the average time on hemodialysis was 94.2 months. It was also found that the presence of diabetes mellitus was associated with a higher incidence of suspected psychopathology. Therefore, this study allowed us to conclude that the suspicion and / or presence of psychopathology was related to advanced age, female gender, low economic income, longer time on hemodialysis, being pensioned and suffering from diabetes. The absence was related to a higher educational level and well paid jobs.

Comparison of microbiological results obtained from per-wound bone biopsies versus transcutaneous bone biopsies in diabetic foot osteomyelitis: a prospective cohort study.

Transcutaneous bone biopsy (TCB) is the gold standard for taking microbiological specimens in diabetic foot osteomyelitis (DFO), but this technique is not widely used in diabetic foot care centers. We aimed to evaluate the reliability of per-wound bone biopsy (PWB) cultures by comparing them with concomitant TCB cultures obtained through healthy skin. This is a prospective monocentric study including patients seen in consultation for clinical and radiological diabetic foot osteomyelitis with positive probe-bone tests between April 2015 and May 2018. Two bone biopsies were performed on each consenting patient: TCB through a cutaneous incision in healthy skin, and PWB, after careful debridement of the wound. A total of 46 paired cultures were available from 43 eligible patients. Overall, 16 (42%) of the PWB and TCB pairs had identical culture results, but the TCB cultures were sterile in 8 (17%) cases. For 38 paired cultures with positive TCB, the correlation between PWB results and TCB results was 58.4%. PWB revealed all microorganisms found in the transcutaneous specimen in 26/38 samples (68.5%). In patients with DFO, the culture results of specimens taken by per-wound biopsies did not correlate well with those obtained by TCB. PWB should be reserved for cases where the transcutaneous biopsy is sterile or not feasible.

Blood cultures after bone biopsy in diabetic foot osteomyelitis.

The value of blood cultures after bone biopsy in diabetic foot osteomyelitis was assessed through a prospective monocentric study. Blood cultures tested positive in 15.8% of patients. Risk factors were male gender, higher CRP levels, Streptococcus sp.-positive bone culture, and pre-existing valvulopathy.

Perfil biosociodemográfico y valoración de necesidades en pacientes en diálisis peritoneal / Biosociodemographic and needs assessment profile in patients on peritoneal dialysis

Objetivo: El siguiente estudio pretende conocer las características biosociodemográficas y la satisfacción de necesidades de los pacientes en tratamiento con diálisis peritoneal del Hospital Las Higueras de Talcahuano, Chile. Material y método: Estudio cuantitativo, descriptivo, de corte transversal; la población de estudio estuvo constituida por 40 pacientes, se realizó una entrevista utilizando un instrumento que incluyó la evaluación de satisfacción de necesidades básicas, según Virginia Henderson, y factores biosociodemográfics. Resultados: El grupo de estudio estuvo compuesto en igual parte por hombres y mujeres, el promedio de edad correspondió a 48 años, más de la mitad vive sin pareja y es jefe de hogar, la mayoría tiene hijos, predominando los grupos familiares integrados por 4 o más personas (57,5 por ciento). El mayor porcentaje de ellos ha cursado enseñanza media, el 22,5 por ciento se encuentra trabajando y recibe remuneración. Casi la totalidad cuenta con saneamiento básico en sus domicilios y vive en sector urbano. Las principales necesidades insatisfechas corresponden a "eliminar bien" y "evitar peligros", las restantes se encuentran satisfechas entre el 57,5 por ciento y 92,5 por ciento dentro de este rango las necesidades más afectadas fueron mantener la temperatura corporal y recrearse. Conclusión: Los resultados sugieren implementar y reforzar planes educativos más rigurosos a los ya existentes en nuestro centro asistencial, tendientes a evitar daños físicos y sicológicos, así como también mantener una buena eliminación corporal, a través de la retroalimentación en cada control o visita domiciliaria realizada al usuario a nuestro cuidado...

Objective: To know the biosociodemographic profile of patients on peritoneal dialysis Hospital Las Higueras in Talcahuano, Chile and the satisfaction of basic needs they have. Methods: Quantitative, descriptive and cross-sectional desing. The sample consisted of 40 patients, an interview was conducted, using an instrument that included evaluation of basic needs, according to Virginia Henderson and biosociodemographic factors. Results: The study group was composed in equal parts by men and women, average age corresponded to 48, more than half live without a partner and head of household, the majority have children, predominantly family groups consisting of 4 or more people (57.5 percent. The highest percentage of them have completed high school, 22.5 percent are working and receives remuneration. Almost all have basic sanitation in their homes and live in urban areas. Major unsatisfied needs are "good elimination" and "avoid danger", the rest are satisfied between 57.5 percent and 92.5 percent, within this range needs were maintaining body temperature and recreation. Conclusion: Results suggest, implementing and enforcing more stringent educational plans than the existing ones in our medical center designed to prevent physical and psychological damage as well as maintain good body elimination, through feedback in each control or home visit to the user under our care...

Calidad de vida en pacientes esquizofrénicos / Quality of Life in Schizophrenic Patients / Qualidade de vida em pacientes esquizofrênicos

La presente investigación tuvo como objetivo conocer la calidad de vida y los factores relacionados de los pacientes esquizofrénicos que se controlan en los servicios de salud Concepción y Arauco de Chile durante los meses de abril-junio de 2009. Estudio cuantitativo, descriptivo, correlacional de corte transversal. La población incluida en este trabajo comprendió al total de los pacientes esquizofrénicos (40) bajo régimen de corta estadía. El instrumento utilizado fue la variable principal -calidad de vida (CV)-, que se midió a través del cuestionario SF-36, además se incorporaron variables sociodemográficas y de apoyo social, esta última medida a través del cuestionario Duke- UNC-11. Los resuiltados del estudio reflejan aceptable calidad de vida, lo cual puede asociarse con las condiciones socioculturales de la región.

The objective of this study was to identify quality of life and related factors in schizophrenic patients who were being monitored by health-care services in Concepción and Arauca (Chile) during April-June 2009. It is a quantitative, correlational, cross-sectional descriptive study. The population in question included all schizophrenic patients (40) who were subject to a short-term stay. The principal variable-quality of life (QOL) was the instrument used and was measured with the SF-36 questionnaire. Socio-demographic and social support variables were included as well, the latter through application of the Duke-UNC-11 questionnaire. The findings of the study reflect an acceptable quality of life, which may be associated with the socio-cultural conditions in the region.

Este estudo teve como objetivo determinar a qualidade de vida e os fatores relacionados de pacientes esquizofrênicos controlados nos serviços de saúde de Concepción e Arauco no Chile durante os meses de abril a junho de 2009. Estudo quantitativo, descritivo, correlacional, transversal. Neste estudo, a população incluiu os pacientes com esquizofrenia (40) sob o regime de curta permanência. O instrumento utilizado foi a variável principal - a qualidade de vida (QV) -, medida através do questionário SF-36. Também se integraram variáveis sócio-demográficas e de suporte social. Esta última foi medida pelo questionário Duke-UNC-11. Os resultados do estudo mostram uma qualidade de vida aceitável. Isso pode associar-se com as condições socioculturais da região.

Valoración psicométrica de los componentes físicos (CSF) y mentales (CSM) del SF-36 en pacientes insuficientes renales crónicos en tratamiento con hemodiálisis / Psychometric assessment of the physical and mental components of the SF-36 in chronic renal insufficiency failure patients in treatment with haemodyalisis

La calidad de vida relacionada con la salud es un constructo que se está utilizando cada vez con más frecuencia para evaluar las variables relacionadas con la salud desde la perspectiva del individuo. En este trabajo se analizaron las características descriptivas de las escalas resumidas de componentes de salud físico (CSF) y componentes de salud mental (CSM), provenientes del SF-36 V2 en pacientes insuficientes renales crónicos terminales sometidos a tratamiento con hemodiálisis. Se trata de un estudio cuantitativo de corte transversal cuya población estuvo compuesta por los pacientes de la patología antes citada controlados en los centros de diálisis de la Comuna de Concepción, Chile, en el año 2005. La muestra incluyó a 270 pacientes, que corresponden a un 65 por ciento del universo. El instrumento principal utilizado estuvo constituido por el SF-36, para medir la variable principal Calidad de Vida y se agregaron variables sociodemográficas. El instrumento demostró una alta confiabilidad para los componentes de salud física y mental con un alfa de Cronbach de 0,86 para cada uno. En términos generales los instrumentos CSF y CSM provenientes del SF-36 permiten capturar apropiadamente la situación de vida por la que están atravesando las personas, como es el caso de los pacientes nefrópatas en tratamiento con hemodiálisis, que fueron objeto de este estudio.

The quality of life related to health is a construct that is being used with increasing frequency to evaluate the variables related to health from the perspective of the individual. In this study we analyzed the characteristics of the summarized descriptive scales of physical health components (CSF) and mental health components (MSC) from the SF-36 V2 in terminal patients with chronic renal insufficiency treated with hemodialysis. This is a cross sectional quantitative study with a population of patients with the previously quoted pathology controlled in the dialysis facilities in the area of Concepción, Chile in 2005. The sample consisted of 270 patients, which is 65 percent of the universe. The main instrument was the SF-36 for measuring the quality of life main variable. Socio-demographic variables were added. The instrument showed a high reliability for the components of physical and mental health with a Cronbach's alpha of 0.86, for each one. In general terms, the instruments CSF and MSC from the SF-36 properly capture the life conditions that people are experiencing, as is the case with nephropathy patients undergoing hemodialysis treatment, who were the subject of this study.

[Vancomycin-resistant Enterococcus in an epidemic situation: screening at admission for patients at risk of carriage]. / Entérocoques résistant aux glycopeptides dans un contexte endémo-épidémique. Stratégie d'isolement àl'admission des patients à risque.

OBJECTIVES: To evaluate a strategy based on screening and isolation at admission to a department of infectious diseases during an epidemic of vancomycin-resistant Enterococcus (VRE) at the University Hospital of Clermont-Ferrand. METHODS: Systematic screening for VRE by anal swabs began on November 15, 2004. Patients were isolated on admission if (a) they had been hospitalized more than 24 h in an at-risk department of our hospital or (b) they had received a course of wide-spectrum antimicrobial therapy for longer than 48 h in the three months preceding admission. Patients hospitalized in our department were screened weekly if they were treated with wide-spectrum antibiotics, had a urinary catheter left in place for one week, or were neutropenic. RESULTS: Through May 15, 2005, 12 (3.5%) of 341 swabs were found to be positive for VRE: eight were detected on admission and four during hospitalization. In all, 81 patients were isolated on admission. A case-control study confirmed that the criteria for patient isolation were indeed risk factors for VRE. Isolation was well accepted when it was clearly explained. No new case has been detected since March 2005. CONCLUSION: An isolation strategy based on known risk factors for VRE with systematic screening on admission appears to be an effective way to control an outbreak of VRE, perhaps in part because it helps to keep the medical staff alert to this problem. Isolation is well tolerated as long as it is explained clearly.

Calidad de Vida en pacientes renales hemodializados / Quality of life on patients hemodialysis

Estudio descriptivo de corte transversal, cuyo propósito fue conocer las características personales y calidad de vida de pacientes con insuficiencia renal crónica en tratamiento sustitutivo con hemodiálisis . El grupo de estudio estuvo constituido por 90 pacientes de dos centros de diálisis de la ciudad de Concepción, Chile. La calidad de vida se midió a través del cuestionario genérico de salud SF-36. Aproximadamente la mitad de los pacientes tenían entre 45 y 64 años, la distribución por sexo fue prácticamente similar, tres cuartas partes de los sujetos se declararon con pareja , más de la mitad poseía baja escolaridad y todos poseían algún sistema previsional. El valor más alto de calidad de vida fue 81,8 y el más bajo 3,25. Por lo que se pudo concluir que aproximadamente la mitad de las personas encuestadas tenía una calidad de vida por sobre el nivel promedio.