Adherence to nutritional interventions in head and neck cancer patients: a systematic scoping review of the literature.

BACKGROUND: Dietary counselling provided by a dietitian, with or without oral nutritional supplements, can impact on nutritional and clinical outcomes in head and neck cancer (HNC) patients undergoing radiotherapy. However, little is known about the role of adherence to oral nutritional interventions in this population. This review aimed to map the literature for evidence of adherence to oral nutritional interventions in HNC patients undergoing radiotherapy and to identify gaps in knowledge in this field. METHODS: A scoping review methodology was used to identify studies, extract data, and collate and summarise results. We searched Medline, Embase, Cochrane Central and CINAHL, from the earliest available time up to 8 January 2020. RESULTS: In total, 2315 unique articles were identified, 163 studies were assessed in full and niner were included in the scoping review. The use of different measures to assess adherence and variability in the timing of the assessments was noted across studies. Despite identifying studies that have measured adherence to oral nutritional interventions, very few studies monitored its influence on clinical and nutritional outcomes in HNC patients or reported factors related to adherence. CONCLUSIONS: A robust evidence base is lacking for adherence to oral nutritional intervention in HNC patients. Overall, further studies evaluating the impact of oral nutritional interventions in HNC patients undergoing radiotherapy should measure adherence to the intervention. Early recognition of non-adherence and the contributing factors could ensure intensification of nutritional support and better health outcomes.

Anxiety and burnout in young athletes: The mediating role of cognitive appraisal.

This study tested the relationship between trait anxiety, cognitive appraisal, and athletes' burnout proposing two hypotheses: (a) there is a direct relationship between athletes' trait anxiety and cognitive appraisal and burnout, and (b) cognitive appraisal mediates the relationship between trait anxiety and burnout, and this mediation occurs despite the competitive level and sport records of athletes. The study included 673 young athletes and provided measures of trait anxiety, cognitive appraisal, and burnout. Structural equation modeling indicated that cognitive appraisal mediates the relationship between trait anxiety and burnout, confirming hypothesis 2, and this model provided better fit than the direct model of hypothesis 1. However, the mediation also indicated that the direct relationship between trait anxiety and burnout should be considered. The mediating model was invariant according to competitive levels and sport records. In conclusion, cognitive appraisal is an important variable in explaining athletes' burnout.

Genotypic variation and relationships among nitrogen-use efficiency and agronomic traits in tropical maize inbred lines.

Improvement in nitrogen-use efficiency (NUE) on maize is among the best strategies to mitigate the problems of poor soil fertility in tropical conditions. The objectives of this study were: i) to quantify the genetic variability for NUE-components and agronomic traits in a set of tropical maize inbred lines; ii) to study the genetic divergence among tropical maize inbred lines under contrasting nitrogen (N) levels; iii) to identify the secondary traits associated with NUE in tropical maize inbred lines; and iv) to identify maize inbred lines efficient in NUE and its components. Sixty-four tropical maize inbred lines were evaluated in the field under low- and high-N conditions for NUE-components and agronomic traits. Genetic variability for NUE-components and agronomic traits was found; lines in eight different groups for each N condition were allocated, and N-efficient inbred lines were identified in different groups. Furthermore, we suggest flowering time traits and kernel number as great secondary traits for selecting tropical maize inbred lines for NUE under both N conditions, and chlorophyll content for selecting for NUE under N stress.

Variability of total and free IgE levels and IgE receptor expression in allergic subjects in and out of pollen season.

The inter- and intra-individual variability and seasonal variation of IgE, and high (FcεRI)- and low-affinity (CD23) IgE receptor expression in blood of seasonal allergic rhinitis (SAR) subjects, is not well studied. Thirty-two otherwise healthy subjects with a history of SAR to birch pollen and a positive skin prick test to birch pollen were sampled three times out of the pollen season and three times during the pollen season. FcεRI and CD23 expressions were analysed using flow cytometry. Total IgE was analysed using ImmunoCAP(®) and free IgE was analysed with a novel customised research assay using an IgG-FcεRI-chimera protein coupled to ImmunoCAP as capture reagent, ImmunoCAP-specific IgE conjugate and ImmunoCAP IgE calibrators. The performance of the free IgE assay was compared well with the reference ImmunoCAP total IgE assay. The working range of the assay was 0.35-200 kU/l IgE. FcεRI expression on basophils and CD23 expression on B cells showed low intrasubject variability both in and out of the pollen season (<10% CV). There was a small seasonal difference with lower total IgE levels (120 versus 128 kU/l; P = 0.004) and FcεRI expression (283 versus 325 mean fluorescence intensity (MFI); P < 0.001) during the pollen season. IgE, FcεRI expression and CD23 expression fulfilled biomarker and assay requirements of variability, and allergen exposure affected the biomarkers only to a minor degree. The free IgE assay may be used for measurement of free IgE levels in patients after anti-IgE antibody treatment.

Phase II trial of short-course radiotherapy followed by delayed surgery for locoregionally advanced rectal cancer.

AIM: A prospective phase II study to investigate the feasibility and the rate of complete pathological response (ypT0) after short-course radiotherapy (SCRT) followed by surgery at 8 weeks. METHOD: Operable patients with localized rectal cancer staged T3-4N0/+ or T2N+ were eligible and received 25 Gy (in one-third of patients, the gross tumor volume received a simultaneous integrated boost up to a total of 30 Gy) in five consecutive fractions to the posterior pelvis followed by surgery 8 weeks later. Pathological response and surgical toxicity were assessed in all patients. RESULTS: Fifty-two patients (median age 68 years) completed the study. The median distance of the tumour from the anal verge was 6.5 cm. The median interval to surgery was 52 days. Three-quarters of patients underwent a low anterior resection. All underwent complete surgical resection and 100% had pathological negative margins. Ten per cent had stage ypT0 after radiotherapy. The median length of hospital stay was 8 days. Toxicity was comparable with the rates reported in the literature. CONCLUSION: In this study, SCRT followed by delayed surgery was feasible and had acceptable toxicity. All patients underwent complete surgical resection and 100% had negative pathological margins. The rate of ypT0 was 10%.

Acute toxicity in patients with high-risk prostate cancer treated with stereotactic body radiation, with irradiation to the prostate and pelvic nodes.

PURPOSE: Stereotactic body radiation therapy has been used for prostate cancer. However, the bulk of published studies on stereotactic body radiation therapy for prostate cancer has involved the irradiation of the prostate alone, without irradiation of the pelvic lymph nodes. We report our preliminary experience with this approach. MATERIAL AND METHODS: The files of patients with biopsy-proven prostate cancer treated with stereotactic body radiation therapy in our institution were reviewed. Stereotactic body radiation was delivered with intensity modulated-volumetric arctherapy with daily image-guidance. The prostate planning target volume included the prostate plus a margin of 5mm in all directions. The pelvic planning target volume included pelvic nodes plus an expansion of 6 to 7mm in all directions. The prostate planning target volume received a total dose of 36.25Gy delivered in five fractions on alternate days. The nodal planning target volume received a dose of 25Gy in the same five fractions. Patients were followed during treatment, after 1, and 3 months and every 6 months thereafter. Gastrointestinal and genitourinary toxicity was prospectively graded according to Common Terminology Criteria for Adverse Events. RESULTS: Among the 188 patients, 80 received stereotactic body radiation to the prostate and the pelvic nodes, while 108 received stereotactic body radiation to the prostate target only. Grade 2 acute gastrointestinal toxicity was 4% in both groups, and grade 2 acute genitourinary toxicity was 27% and 20% (P=0.9) for prostate only versus prostate and pelvis respectively. There was no grade 3 or higher acute gastrointestinal or genitourinary toxicity. CONCLUSION: Stereotactic body radiation therapy in five fractions including the prostate and pelvic nodes, in patients with high-risk prostate cancer, has been feasible and safe in terms of acute toxicity.

Cartilage tissue engineering using electrospun PCL nanofiber meshes and MSCs.

Mesenchymal stem cells (MSCs) have been recognized for their ability to differentiate into cells of different tissues such as bone, cartilage, or adipose tissue, and therefore are of great interest for potential therapeutic strategies. Adherent, colony-forming, fibroblastic cells were isolated from human bone marrow aspirates, from patients undergoing knee arthroplasties, and the MSCs phenotype characterized by flow cytometry. Afterward, cells were seeded onto electrospun polycaprolactone nanofiber meshes and cultured in a multichamber flow perfusion bioreactor to determine their ability to produce cartilagineous extracellular matrix. Results indicate that the flow perfusion bioreactor increased the chondrogenic differentiation of hBM-MSCs, as confirmed either by morphological and RT-PCR analysis. Cartilage-related genes such as aggrecan, collagen type II, and Sox9 were expressed. ECM deposition was also detected by histological procedures. Collagen type II was present in the samples, as well as collagen type I. Despite no statistically significant values being obtained for gene expression, the other results support the choice of the bioreactor for this type of culture.

Short communication: effect of kefir grains on proteolysis of major milk proteins.

The effect of kefir grains on the proteolysis of major milk proteins in milk kefir and in a culture of kefir grains in pasteurized cheese whey was followed by reverse phase-HPLC analysis. The reduction of kappa-, alpha-, and beta-caseins (CN), alpha-lactalbumin (alpha-LA), and beta-lactoglobulin (beta-LG) contents during 48 and 90 h of incubation of pasteurized milk (100mL) and respective cheese whey with kefir grains (6 and 12 g) at 20 degrees C was monitored. Significant proteolysis of alpha-LA and kappa-, alpha-, and beta-caseins was observed. The effect of kefir amount (6 and 12 g/100mL) was significant for alpha-LA and alpha- and beta-CN. alpha-Lactalbumin and beta-CN were more easily hydrolyzed than alpha-CN. No significant reduction was observed with respect to beta-LG concentration for 6 and 12 g of kefir in 100mL of milk over 48 h, indicating that no significant proteolysis was carried out. Similar results were observed when the experiment was conducted over 90 h. Regarding the cheese whey kefir samples, similar behavior was observed for the proteolysis of alpha-LA and beta-LG: alpha-LA was hydrolyzed between 60 and 90% after 12h (for 6 and 12 g of kefir) and no significant beta-LG proteolysis occurred. The proteolytic activity of lactic acid bacteria and yeasts in kefir community was evaluated. Kefir milk prepared under normal conditions contained peptides from proteolysis of alpha-LA and kappa-, alpha-, and beta-caseins. Hydrolysis is dependent on the kefir:milk ratio and incubation time. beta-Lactoglobulin is not hydrolyzed even when higher hydrolysis time is used. Kefir grains are not appropriate as adjunct cultures to increase beta-LG digestibility in whey-based or whey-containing foods.

Elective Pelvic Nodal Irradiation With a Simultaneous Hypofractionated Integrated Prostate Boost for Localised Prostate Cancer: Ready for Prime Time?

External beam radiotherapy is a standard treatment option for localised prostate cancer and hypofractionation has become an alternative to conventionally fractionated radiotherapy. In patients who receive external beam radiotherapy, elective pelvic nodal irradiation is sometimes delivered, especially in patients with unfavourable disease who are at risk of micrometastatic spread of cancer into the regional nodes. One elegant approach to combine prostate hypofractionation with elective pelvic nodal irradiation is with a simultaneous integrated boost technique, where a radical hypofractionated dose is delivered to the prostate while the regional pelvic nodes receive a lower microscopic dose simultaneously in a single radiotherapy plan over the same number of treatment fractions. This article reviews the existing published literature evaluating such an approach.

Mixed-effects modelling for crossed and nested data: an analysis of dengue fever in the state of Goiás, Brazil.

Dengue fever is a viral disease transmitted by the mosquito Aedes aegypti. In order to avoid epidemics and deaths, this transmitting vector must be controlled. This work assembles, for the first time, data from multiple governmental bodies describing the number of dengue cases reported, and meteorological conditions in 20 cities in the Goiás state, Brazil, from 2008 to 2015. We then apply generalised linear mixed modelling to this novel data set to model dengue occurrences in this state, where the tropical climate favours the proliferation of the main transmitting vector of this disease. The number of reported dengue cases is estimated using meteorological variables as fixed effects, and city and year data are included in the model as random effects. The proposed models can cope with complex data structures, such as nested data, while taking into account the particularities of each year dependent on the city under analysis. The results confirm that precipitation, minimum temperature, and relative air humidity contribute to the increase of dengue cases number, while year and city location are determining factors. Public policies, based on these new results, together with joint actions involving local populations, are essential to combat the vector transmitting dengue and avoid epidemics.

The challenge of scoring radiation-induced lung toxicity.

AIMS: The increasing use of curative radiation treatment in lung cancer mandates accurate assessment of late lung toxicity. The Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) scoring schema combines clinical symptoms and radiological changes and may be confusing. Some have used a scoring scale modified from the National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 2 scale based on symptoms only. Clinical data using these two different scales have been compared as if they give similar results. The present study compared the outcomes using the two scales in the same group of patients. MATERIALS AND METHODS: The medical records and imaging of patients with non-small cell lung cancer who received definitive radiotherapy were reviewed. Eligible patients had a minimum follow-up of 12 months with no clinical signs of local relapse. Radiation-induced lung toxicity was scored using the RTOG/EORTC and the NCI-CTC scales. RESULTS: In total, 50 patients were analysed. All patients developed radiographic abnormalities after curative radiotherapy. Grade 0, 1, 2 and 3 toxicity was 0, 28, 49 and 23%, respectively, according to the RTOG/EORTC scale and 86, 7, 7 and 0%, respectively, according to the NCI-CTC scale, showing that the inclusion of radiographic abnormalities changes and significantly upgrades the toxicity scores. CONCLUSION: After curative radiotherapy, all patients presented some radiographic abnormality. There was no correlation with lung symptoms. The assessment of radiation-induced lung toxicity differs depending on the scoring system used. Comparison of reports that use different scoring scales should be made with caution. A scale based on symptoms only, such as the NCI-CTC scale, may be more appropriate to evaluate long-term toxicity after curative radiotherapy for lung cancer.

Chest wall pain following lung stereotactic body radiation therapy using 48Gy in three fractions: A search for predictors.

PURPOSE: Chest wall pain is an uncommon but bothersome late complication following lung stereotactic body radiation therapy. Despite numerous studies investigating predictors of chest wall pain, no clear consensus has been established for a chest wall constraint. The aim of our study was to investigate factors related to chest wall pain in a homogeneous group of patients treated at our institution. PATIENTS AND METHODS: All 122 patients were treated with the same stereotactic body radiation therapy regimen of 48Gy in three fractions, seen for at least 6 months of follow-up, and planned with heterogeneity correction. Chest wall pain was scored according to the Common Terminology Criteria for Adverse Events classification v3.0. Patient (age, sex, diabetes, osteoporosis), tumour (planning target volume, volume of the overlapping region between planning target volume and chest wall) and chest wall dosimetric parameters (volumes receiving at least 30, 40, and 50Gy, the minimal doses received by the highest irradiated 1, 2, and 5cm3, and maximum dose) were collected. The correlation between chest wall pain (grade 2 or higher) and the different parameters was evaluated using univariate and multivariate logistic regression. RESULTS: Median follow-up was 18 months (range: 6-56 months). Twelve patients out of 122 developed chest wall pain of any grade (seven with grade 1, three with grade 2 and two with grade 3 pain). In univariate analysis, only the volume receiving 30Gy or more (P=0.034) and the volume of the overlapping region between the planning target volume and chest wall (P=0.038) significantly predicted chest wall pain, but these variables were later proved non-significant in multivariate regression. CONCLUSION: Our analysis could not find any correlation between the studied parameters and chest wall pain. Considering our present study and the wide range of differing results from the literature, a reasonable conclusion is that a constraint for chest wall pain is yet to be defined.

Imaging and Staging of Endometrial Cancer.

Endometrial carcinoma is the most common female pelvic malignancy in the United States. Although endometrial cancer is staged according to the International Federation of Gynecology and Obstetrics surgical system, early and accurate diagnostic assessment of disease status of gynecologic malignancies is important for optimal treatment planning and outcome prediction. Preoperative imaging may assist in evaluation of local extent and detection of distant metastatic disease guiding the optimal course of treatment. Several imaging techniques such as transvaginal ultrasound, computed tomography, and magnetic resonance imaging have been used as tools for preoperative staging of endometrial cancer. Positron emission tomography/computed tomography and more recently, positron emission tomography/magnetic resonance imaging have also been used in the management of endometrial cancer. Cross-sectional imaging, especially MRI, may detect gross myometrial invasion or extension of tumor to the cervical stroma which can alter management. Imaging studies can also evaluate the presence of lymph nodal involvement, and detect local and distant metastatic disease at diagnosis. Additionally, imaging also plays a role in the monitoring of treatment and surveillance of the patients for detection of early recurrent disease. In this article, we will review the imaging and staging of endometrial cancer.

Uterine Carcinosarcomas.

Uterine carcinosarcoma (UCS) is a rare and aggressive variant of endometrial cancer, distinguished by its containment of both epithelial and sarcomatous elements. This article reviews the epidemiology, pathologic classification and staging of UCS, along with the typical findings seen on different imaging modalities. Prognosis and therapies will also be discussed.

Ischiorectal fossa: benign and malignant neoplasms of this "ignored" radiological anatomical space.

PURPOSE: To review the pertinent anatomy and the imaging features of common and uncommon benign and malignant neoplasms and masses of the ischiorectal fossa. RESULTS: The ischiorectal or ischioanal fossa is the largest space in the anorectal region. The benign neoplasms that develop in the ischiorectal originate from the different components that forms the fossa including vascular tumors such as aggressive angiomyxoma or hemangioma; neural tumors as plexiform neurofibroma or schwannoma; fat tumors as lipoma; skin/skin appendages tumors as hidradenoma papilliferum; smooth or skeletal muscle tumors as solitary fibrous tumor. The malignant neoplasms that develop in the ischiorectal fossa also originate from different components that forms the fossa including vascular tumors such as angiosarcoma, neural tumors as malignant granular cell tumor and malignant peripheral nerve sheath tumor; fat tumors as liposarcoma; smooth or skeletal muscle tumors as leiomyosarcoma, rhabdomyosarcoma, malignant PEComa, or undifferentiated pleomorphic sarcoma. Additionally, the ischiorectal fossa can also harbor secondary hematogenous metastases and be affected by direct invasion from neoplasms of adjacent pelvic organs and structures. Furthermore, other miscellaneous masses can occur in the ischiorectal fossa including congenital and developmental lesions, and inflammatory and infectious processes. CONCLUSION: Knowledge of the anatomy, and the spectrum of imaging findings of common and uncommon benign and malignant neoplasms of the ischiorectal fossa is crucial for the radiologists during interpretation of images allowing them to make contributions to the diagnosis and better patient management.

Tumor markers: myths and facts unfolded.

OBJECTIVE: The purpose of this article is to review the most commonly used tumor markers in abdominal and pelvic tumors, describe their limitations and explain how to use them in the context of known cancer in order to optimize multidisciplinary care of oncologic patients. CONCLUSION: Tumor markers are important for the diagnosis, staging, monitoring of treatment and detection of recurrence in many cancers. This knowledge is crucial in the daily interpretation of images of oncologic and non-oncologic patients. However, radiologists should also be aware of the limitations of the most commonly used tumor markers and they should not be used solely, but interpreted in conjunction with diagnostic imaging, clinical history and physical examination that will help optimize the multidisciplinary care and management of oncologic patients.

The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease.

AIM: To investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients. METHODS: A observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality. RESULTS: Data from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29-98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3-436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1-66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r2-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05). CONCLUSION: This study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.

[The seroprevalence of HCV in patients submitted to hemodialysis and health professionals in the State of Minas Gerais, southwest of Brazil]. / Seroprevalencia del virus de la hepatitis C en pacientes en hemodiálisis y en profesionales de la salud en el Estado de Minas Gerais, región Sudeste de Brasil.

UNLABELLED: Patients with chronic renal failure(CRF) in hemodialysis(HD) programs comprise a risk group for acquisition of hepatitis C virus(HCV) infection. The objectives were to evaluate the seroprevalence of HCV in patients submitted to HD in State of Minas Gerais(MG), southwest of Brazil; to correlate this seroprevalence with the time of treatment on HD; to investigate the anti-HCV seropositivity in health professionals, to investigate the existence of a correlation between mean HCV seroprevalence and the human development index (HDI). Patients from 66 healthcare units(HU) were studied using a validated questionnaire and considering the positive values of anti-HCV(Elisa III) tests performed in these units between january and december 2003. RESULTS: the majority of patients were male (56.2%), between 41 and 60 years old. The mean seroprevalence of HCV in the 66 healthcare units was 13+/-9.5%; the three-monthly seroprevalence was below 20%, 15% and 10% in 75%, 50% and 40% of healthcare units, respectively. When the HU were grouped according to HCV seroprevalence into low(<5%), medium(5-15%) and high seroprevalence(>15%), 20% of the units have low, 42% medium and 37.5% were found to have high seroprevalence. No correlation was found between HDI and HCV seroprevalence (r=0.42; p=0.174) but in the regions in which the HDI was higher, HCV seroprevalence was also higher. There was a positive correlation between HCV seroprevalence and time on HD in 884 patients in the 4 HU (p<0.001). The seroprevalence of HCV was investigated in 387 healthcare professionals(29%) working in 14 HU. They were divided into two groups according to their time of professional activity: <10 y (G1) and >10 y (G2). In G1, there were no cases of anti-HCV seropositivity. In G2, 3 members of the staff were anti-HCV seropositive. The mean time of work of the seropositive staff in the HU was 15.6 years. The seroprevalence of HCV was 0.8% when all the healthcare professionals were taken into consideration. There was no statistically significant difference with respect to HCV seroprevalence between G1 and G2 with respect to the time of occupational exposure (p=0.27). CONCLUSION: the seroprevalence of HCV in patients on HD in MG is 13+/-9.5% and was <10% in 40% of the HU; there was no statistically significant correlation between HDI and seroprevalence of HCV in the healthcare units evaluated; there was a statistically significant correlation between HCV seroprevalence and time of treatment on HD; HCV seroprevalence in the health professionals studied was 0.8% and similar to the literature.

Imaging findings of recurrent pancreatic cancer following resection.

Pancreatic cancer is a challenging malignancy to treat, largely due to aggressive regional involvement, early systemic dissemination, high recurrence rate, and subsequent low patient survival. Generally, 15-20% of newly diagnosed pancreatic cancers are candidates for possible curative resection. Eighty percent of these patients, however, will experience locoregional or distant recurrence in first 2 years. Although there is no strong evidence-based guideline for optimal surveillance after pancreatic cancer resection, careful comparison of surveillance follow-up multi-detector CT (MDCT) studies with a postoperative baseline MDCT examination aids detection of early recurrent pancreatic cancer. In this review article, we describe imaging findings suggestive of recurrent pancreatic cancer and review routine and alternative imaging options.

The first prevalence survey of nosocomial infections in the University Hospital Centre 'Mother Teresa' of Tirana, Albania.

A survey was conducted in the largest hospital in Albania to estimate the prevalence and risk factors for nosocomial infections (NIs). A one-day prevalence survey was carried out between October and November 2003 in medical, surgical and intensive care wards. Centers for Disease Control and Prevention definitions were used. Study variables included patient and hospital characteristics, surgical procedures, invasive devices, antibiotic treatment, microbiological and radiological examinations, infection signs and symptoms. Risk factors were determined using logistic regression. In all, 185 NIs were found in 163 of 968 enrolled patients. Urinary tract infections (33.0%), surgical site infections (24.3%), pneumonia (13.0%) and venous infections (9.2%) were the most frequent NIs. The prevalence of NIs was higher in intensive care units (31.6%) than in surgical (22.0%) and medical wards (10.3%). Overall, 132 NIs (71.4%) were confirmed by microbiological examination; the single most frequently isolated micro-organism was Staphylococcus aureus (18.2%). By means of logistic regression, the following independent risk factors were identified: age >40 years, length of hospital stay, 'trauma' diagnosis at admission, and invasive devices. Even though comparisons must be made with great caution, the prevalence of NIs was higher than in western European countries and in some developing countries.