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1.
Sci Rep ; 13(1): 12477, 2023 08 31.
Artículo en Inglés | MEDLINE | ID: mdl-37652925

RESUMEN

Ancient Egyptian mummification was practiced for nearly 4000 years as a key feature of some of the most complex mortuary practices documented in the archaeological record. Embalming, the preservation of the body and organs of the deceased for the afterlife, was a central component of the Egyptian mummification process. Here, we combine GC-MS, HT-GC-MS, and LC-MS/MS analyses to examine mummification balms excavated more than a century ago by Howard Carter from Tomb KV42 in the Valley of the Kings. Balm residues were scraped from now empty canopic jars that once contained the mummified organs of the noble lady Senetnay, dating to the 18th dynasty, ca. 1450 BCE. Our analysis revealed balms consisting of beeswax, plant oil, fats, bitumen, Pinaceae resins, a balsamic substance, and dammar or Pistacia tree resin. These are the richest, most complex balms yet identified for this early time period and they shed light on balm ingredients for which there is limited information in Egyptian textual sources. They highlight both the exceptional status of Senetnay and the myriad trade connections of the Egyptians in the 2nd millennium BCE. They further illustrate the excellent preservation possible even for organic remains long removed from their original archaeological context.


Asunto(s)
Ambiente , Espectrometría de Masas en Tándem , Humanos , Cromatografía Liquida , Egipto , Arqueología
2.
Ann R Coll Surg Engl ; 2022 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-36263909
3.
J Hosp Infect ; 111: 162-168, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33539934

RESUMEN

BACKGROUND: Pseudomonas aeruginosa is a common opportunistic pathogen and molecular typing in outbreaks has linked patient acquisition to contaminated hospital water systems. AIM: To elucidate the role of P. aeruginosa transmission rates in non-outbreak augmented care settings in the UK. METHODS: Over a 16-week period, all water outlets in augmented care units of four hospitals were sampled for P. aeruginosa and clinical isolates were collected. Outlet and clinical P. aeruginosa isolates underwent whole-genome sequencing (WGS), which with epidemiological data identified acquisition from water as definite (level 1), probable (level 2), possible (level 3), and no evidence (level 4). FINDINGS: Outlets were positive in each hospital on all three occasions: W (16%), X (2.5%), Y (0.9%) and Z (2%); and there were 51 persistently positive outlets in total. WGS identified likely transmission (at levels 1, 2 and 3) from outlets to patients in three hospitals for P. aeruginosa positive patients: W (63%), X (54.5%) and Z (26%). According to the criteria (intimate epidemiological link and no phylogenetic distance), approximately 5% of patients in the study 'definitely' acquired their P. aeruginosa from their water outlets in the intensive care unit. This study found extensive evidence of transmission from the outlet to the patients particularly in the newest hospital (W), which had the highest rate of positive outlets. CONCLUSIONS: The overall findings suggest that water outlets are the most likely source of P. aeruginosa nosocomial infections in some settings, and that widespread introduction of control measures would have a substantial impact on infections.


Asunto(s)
Infección Hospitalaria , Infecciones por Pseudomonas , Microbiología del Agua , Abastecimiento de Agua , Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Brotes de Enfermedades , Contaminación de Equipos , Hospitales , Humanos , Unidades de Cuidados Intensivos , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/transmisión , Pseudomonas aeruginosa , Reino Unido
4.
J Intern Med ; 289(5): 688-699, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33210357

RESUMEN

BACKGROUND: COVID-19 is caused by the coronavirus SARS-CoV-2, which uses angiotensin-converting enzyme 2 (ACE-2) as a receptor for cellular entry. It is theorized that ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) may increase vulnerability to SARS-CoV-2 by upregulating ACE-2 expression, but ACE-I/ARB discontinuation is associated with clinical deterioration. OBJECTIVE: To determine whether ACE-I and ARB use is associated with acute kidney injury (AKI), macrovascular thrombosis and in-hospital mortality. METHODS: A retrospective, single-centre study of 558 hospital inpatients with confirmed COVID-19 admitted from 1 March to 30 April 2020, followed up until 24 May 2020. AKI and macrovascular thrombosis were primary end-points, and in-hospital mortality was a secondary end-point. RESULTS: AKI occurred in 126 (23.1%) patients, 34 (6.1%) developed macrovascular thrombi, and 200 (35.9%) died. Overlap propensity score-weighted analysis showed no significant effect of ACE-I/ARB use on the risk of occurrence of the specified end-points. On exploratory analysis, severe chronic kidney disease (CKD) increases odds of macrovascular thrombi (OR: 8.237, 95% CI: 1.689-40.181, P = 0.009). The risk of AKI increased with advancing age (OR: 1.028, 95% CI: 1.011-1.044, P = 0.001) and diabetes (OR: 1.675, 95% CI: 1.065-2.633, P = 0.025). Immunosuppression was associated with lower risk of AKI (OR: 0.160, 95% CI: 0.029-0.886, P = 0.036). Advancing age, dependence on care, male gender and eGFR < 60 mL min-1 /1.73 m2 increased odds of in-hospital mortality. CONCLUSION: We did not identify an association between ACE-I/ARB use and AKI, macrovascular thrombi or mortality. This supports the recommendations of the European and American Societies of Cardiology that ACE-Is and ARBs should not be discontinued during the COVID-19 pandemic.


Asunto(s)
Lesión Renal Aguda , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , COVID-19 , Hipertensión , Insuficiencia Renal Crónica , Trombosis , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Factores de Edad , Anciano , COVID-19/diagnóstico , COVID-19/mortalidad , COVID-19/fisiopatología , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Tasa de Filtración Glomerular , Mortalidad Hospitalaria , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Ajuste de Riesgo/métodos , SARS-CoV-2/aislamiento & purificación , Trombosis/diagnóstico , Trombosis/etiología , Reino Unido/epidemiología , Privación de Tratamiento/normas , Privación de Tratamiento/estadística & datos numéricos
5.
Curr Eye Res ; 46(7): 1002-1009, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33211556

RESUMEN

Purpose: The aim of this study was to investigate whether structural OCT changes, in specific retinal thickness, is associated with the vascular response within the nAMD CNV lesion. In other words, whether SSOCTA derived parameters may prove suitable to assess CNV activity in future.Methods: During the first 3 months patients were prospectively followed with visits at days 7, and 14 after each anti-VEGF treatment up to day 90. At baseline, day 30 and 60 Aflibercept was administered. OCT-derrived retinal thickness (RT) and OCTA-derived CNV lesion parameters (vessel area [VA]), total vessel length [TVL], total number of junctions [TNJ], junction density [JD]) were determined. Parameters were exported from SSOCT/A (PlexElite, Zeiss) images using the semi-automated AngioTool software. Additionally, the superficial and deep vascular plexus fractal dimension of the para- and perifoveal region were identified. Consequently, all OCTA derived parameters were correlated with RT.Results: 16 consecutive patients presenting with treatment-naïve, SSOCTA-positive CNV lesions were included. A weak to moderate statistically significant correlation was found between the mean RT of the inner as well as the outer ETDRS ring with the SSOCTA-derived vascular markers vessel area (VA; r2 = -0.38, p < .001; r2 = -0.47, p < .001, respectively), total vessel length, (TVL; r2 = -0.38, p < .001; r2 = -0.48, p < .001, respectively) and total number of junctions (TNJ; r2 = -0.35, p < .001; r2 = -0.44, p < .001, respectively). Junctions density (JD), and all variables based on fractal dimension (FD) did not show statistically significant correlations with retinal thickness measurements.Conclusions: In summary, we could confirm a moderate, however, statistically significant correlation between mean para- and perifoveal retinal thickness and the SSOCTA derived vascular parameters VA, TVL, and TNJ. This leads us to the conclusion that an SSOCTA-based activity analysis of the CNV complex is not yet a substitute for retinal thickness or in-depth fluid analysis in patients with nAMD.


Asunto(s)
Neovascularización Coroidal/fisiopatología , Retina/patología , Vasos Retinianos/patología , Degeneración Macular Húmeda/fisiopatología , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/uso terapéutico , Neovascularización Coroidal/diagnóstico por imagen , Neovascularización Coroidal/tratamiento farmacológico , Angiografía por Tomografía Computarizada , Femenino , Angiografía con Fluoresceína , Humanos , Inyecciones Intravítreas , Masculino , Tamaño de los Órganos , Estudios Prospectivos , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Retina/diagnóstico por imagen , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia Óptica , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual , Degeneración Macular Húmeda/diagnóstico por imagen , Degeneración Macular Húmeda/tratamiento farmacológico
6.
BJS Open ; 4(6): 1084-1099, 2020 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-33052029

RESUMEN

BACKGROUND: Robot-assisted surgery (RAS) has potential panspecialty surgical benefits. High-quality evidence for widespread implementation is lacking. This systematic review aimed to assess the RAS evidence base for the quality of randomized evidence on safety and effectiveness, specialty 'clustering', and outcomes for RAS research. METHODS: A systematic review was undertaken according to PRISMA guidelines. All pathologies and procedures utilizing RAS were included. Studies were limited to RCTs, the English language and publication within the last decade. The main outcomes selected for the review design were safety and efficacy, and study purpose. Secondary outcomes were study characteristics, funding and governance. RESULTS: Searches identified 7142 titles, from which 183 RCTs were identified for data extraction. The commonest specialty was urology (35·0 per cent). There were just 76 unique study populations, indicating significant overlap of publications; 103 principal studies were assessed further. Only 64·1 per cent of studies reported a primary outcome measure, with 29·1 per cent matching their registration/protocol. Safety was assessed in 68·9 per cent of trials; operative complications were the commonest measure. Forty-eight per cent of trials reported no significant difference in safety between RAS and comparator, and 11 per cent reported RAS to be superior. Efficacy or effectiveness was assessed in 80·6 per cent of trials; 43 per cent of trials showed no difference between RAS and comparator, and 24 per cent reported that RAS was superior. Funding was declared in 47·6 per cent of trials. CONCLUSION: The evidence base for RAS is of limited quality and variable transparency in reporting. No patterns of harm to patients were identified. RAS has potential to be beneficial, but requires continued high-quality evaluation.

7.
Eur J Orthop Surg Traumatol ; 30(3): 553, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31586236

RESUMEN

The original version of this article unfortunately contained a mistake. David Morley was not listed among the authors.

8.
Ann Oncol ; 30(10): 1613-1621, 2019 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-31504118

RESUMEN

BACKGROUND: Chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPC) causes multi-lineage myelosuppression. Trilaciclib is an intravenous CDK4/6 inhibitor in development to proactively preserve HSPC and immune system function during chemotherapy (myelopreservation). Preclinically, trilaciclib transiently maintains HSPC in G1 arrest and protects them from chemotherapy damage, leading to faster hematopoietic recovery and enhanced antitumor immunity. PATIENTS AND METHODS: This was a phase Ib (open-label, dose-finding) and phase II (randomized, double-blind placebo-controlled) study of the safety, efficacy and PK of trilaciclib in combination with etoposide/carboplatin (E/P) therapy for treatment-naive extensive-stage small-cell lung cancer patients. Patients received trilaciclib or placebo before E/P on days 1-3 of each cycle. Select end points were prespecified to assess the effect of trilaciclib on myelosuppression and antitumor efficacy. RESULTS: A total of 122 patients were enrolled, with 19 patients in part 1 and 75 patients in part 2 receiving study drug. Improvements were seen with trilaciclib in neutrophil, RBC (red blood cell) and lymphocyte measures. Safety on trilaciclib+E/P was improved with fewer ≥G3 adverse events (AEs) in trilaciclib (50%) versus placebo (83.8%), primarily due to less hematological toxicity. No trilaciclib-related ≥G3 AEs occurred. Antitumor efficacy assessment for trilaciclib versus placebo, respectively, showed: ORR (66.7% versus 56.8%, P = 0.3831); median PFS [6.2 versus 5.0 m; hazard ratio (HR) 0.71; P = 0.1695]; and OS (10.9 versus 10.6 m; HR 0.87; P = 0.6107). CONCLUSION: Trilaciclib demonstrated an improvement in the patient's tolerability of chemotherapy as shown by myelopreservation across multiple hematopoietic lineages resulting in fewer supportive care interventions and dose reductions, improved safety profile, and no detriment to antitumor efficacy. These data demonstrate strong proof-of-concept for trilaciclib's myelopreservation benefits. CLINICAL TRAIL NUMBER: NCT02499770.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Quinasa 4 Dependiente de la Ciclina/antagonistas & inhibidores , Quinasa 6 Dependiente de la Ciclina/antagonistas & inhibidores , Neoplasias Pulmonares/tratamiento farmacológico , Células Mieloides/efectos de los fármacos , Carcinoma Pulmonar de Células Pequeñas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Neoplasias Encefálicas/enzimología , Neoplasias Encefálicas/secundario , Carboplatino/administración & dosificación , Cisplatino/administración & dosificación , Método Doble Ciego , Etopósido/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/enzimología , Neoplasias Pulmonares/patología , Masculino , Dosis Máxima Tolerada , Persona de Mediana Edad , Paclitaxel/administración & dosificación , Pronóstico , Pirimidinas/administración & dosificación , Pirroles/administración & dosificación , Carcinoma Pulmonar de Células Pequeñas/enzimología , Carcinoma Pulmonar de Células Pequeñas/patología , Tasa de Supervivencia , Distribución Tisular
9.
Hernia ; 23(3): 561-567, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30847720

RESUMEN

PURPOSE: Conscious sedation is regularly used in ambulatory surgery to improve patient outcomes, in particular patient satisfaction. We hypothesized that the addition of conscious sedation would provide greater patient satisfaction with inguinal hernioplasty compared to local anesthesia alone. METHODS: This trial was a single-centre, randomized, placebo-controlled, double-blinded trial where patients undergoing inguinal hernioplasty using local anaesthesia were randomized to receive local anaesthesia alone versus local anaesthesia and conscious sedation. The primary outcome of patient satisfaction was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS). The study was powered to detect a significant difference in ISAS scores between groups. Comparisons were made using T test and Chi square tests. A p value of less than 0.05 was considered significant. RESULTS: There were 149 patients randomized: 78 to the local anesthesia (LA) group and 71 to the local anaesthesia and conscious sedation (LACS) group. For the primary outcome measure of patient satisfaction, the mean ISAS score was significantly greater in the LACS group (p = 0.009). The experience of pain and pain severity was greater in the LA group (p = 0.016; p = 0.0162 respectively). No statistically significant difference was found between groups with respect to operative time, time to discharge or postoperative complications. CONCLUSION: The use of conscious sedation with local anesthesia for inguinal hernioplasty is safe, results in less pain experience and severity and is associated with better patient satisfaction. The use of conscious sedation does not delay patient discharge.


Asunto(s)
Anestesia Local , Sedación Consciente , Hernia Inguinal/cirugía , Herniorrafia/métodos , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad
10.
Sci Rep ; 9(1): 3698, 2019 03 06.
Artículo en Inglés | MEDLINE | ID: mdl-30842602

RESUMEN

Elemental analysis of biogeochemical archives is an established technique used to study climate in a range of applications, including ocean circulation, glacial/interglacial climates, and anthropogenic climate change. Data from mollusc archives are especially important because of their global abundance and sub-annual resolution. Despite this potential, they are underrepresented among palaeoclimate studies, due to enigmatic physiological influences skewing the elemental record. Understanding the patterns behind these influences will improve data interpretation and lead to the development of new climate proxies. Here, we show for the first time that extensive spatial mapping of multiple mollusc specimens using Laser Induced Breakdown Spectroscopy (LIBS) across a wider region can resolve enigmatic patterns within the elemental record caused by physiological influences. 2D elemental (Mg/Ca) maps of whole limpet shells (Patella caerulea) from across the Mediterranean revealed patterns of variability within individual mollusc records as well as within isochronous parts of specimens. By registering and quantifying these patterns, we established previously uninterpretable correlations with temperature (R2 > 0.8, p < 0.01). This outcome redefines the possibilities of accessing sub-annual climate proxies and presents the means to assess annual temperature ranges using oxygen isotope analysis requiring only 2 samples per shell.

11.
Phytopathology ; 108(12): 1420-1428, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29873608

RESUMEN

Citrus huanglongbing (HLB), associated with 'Candidatus Liberibacter asiaticus' (Las), disseminated by Asian citrus psyllid (ACP), has devastated citrus in Florida since 2005. Data on HLB occurrence were stored in databases (2005 to 2012). Cumulative HLB-positive citrus blocks were subjected to kernel density analysis and kriging. Relative disease incidence per county was calculated by dividing HLB numbers by relative tree numbers and maximum incidence. Spatiotemporal HLB distributions were correlated with weather. Relative HLB incidence correlated positively with rainfall. The focus expansion rate was 1626 m month-1, similar to that in Brazil. Relative HLB incidence in counties with primarily large groves increased at a lower rate (0.24 year-1) than in counties with smaller groves in hotspot areas (0.67 year-1), confirming reports that large-scale HLB management may slow epidemic progress.


Asunto(s)
Citrus/microbiología , Hemípteros/microbiología , Insectos Vectores/microbiología , Enfermedades de las Plantas/estadística & datos numéricos , Rhizobiaceae/fisiología , Animales , Florida , Enfermedades de las Plantas/microbiología , Análisis Espacio-Temporal , Árboles , Tiempo (Meteorología)
12.
West Indian med. j ; 67(2): 137-142, Apr.-June 2018. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1045821

RESUMEN

ABSTRACT Background: Sepsis causes significant paediatric morbidity and mortality in developing countries. This paper describes the outcome of paediatric sepsis in the University Hospital of the West Indies (UHWI), Jamaica, using administrative data from hospital records from 2010 to 2014. Objective: To provide baseline data on the burden and outcome of paediatric sepsis in a tertiary institution in Jamaica between 2010 and 2014 so as to embark on initiatives to build capacity to provide care in order to decrease the burden and improve the outcomes from sepsis in children. Methods: Data were abstracted from electronic discharge summaries of children hospitalized at the UHWI, a tertiary centre that accepts referrals for newborns and children with complex disorders. The medical records of children aged 0-16 years who were hospitalized with a diagnosis of sepsis, septicaemia and neonatal sepsis were reviewed, using the World Health Organization's International Classification of Diseases, 10th Revision (ICD-10). Demographic and outcome data were extracted. Results: Among 7011 children aged 0-16 years who were admitted, sepsis accounted for 801 hospitalizations in 782 children with a male to female ratio of 1.27 to 1. Neonates comprised 86% (n = 691), of which 36.2% (n = 250) were preterm. The median duration of hospitalization was 10 days (range: 0-366 days; interquartile range: 7-19 days). The sepsis-attributable mortality rate was 10.1% (n = 70) in neonates and was higher in preterm versus term neonates (18.4%, n = 46/250 versus 6.0%, n = 26/434, respectively). The annual crude mortality rate for paediatric sepsis was 9-11% (12 per 1000 paediatric hospitalizations). Conclusion: Sepsis accounted for a high number of admissions and consumed significant resources as evidenced by the long duration of hospitalization. The mortality rate for paediatric sepsis was high, especially in newborns. Targeted interventions are needed to reduce the sepsis-attributable burden and improve outcomes established by the Global Sepsis Alliance and United Nations' Sustainable Development Goals.


RESUMEN Anteceentes: La sepsis causa morbilidad y mortalidad pediátricas significativas en los países en desarrollo. Este artículo describe el resultado de la sepsis pediátrica en el Hospital Universitario de West Indies (HUWI), Jamaica, utilizando datos administrativos de registros hospitalarios de 2010 a 2014. Objetivo: Proporcionar datos de referencia sobre la carga y el resultado de la sepsis pediátrica en una institución terciaria en Jamaica entre 2010 y 2014, a fin de emprender iniciativas para aumentar la capacidad de prestar atención a disminuir la carga y mejorar los resultados de la sepsis en los niños. Métodos: Se obtuvieron datos de resúmenes de descargas electrónicas de niños hospitalizados en el HUWI, un centro terciario que acepta remisiones de recién nacidos y niños con trastornos complejos. Se realizó una revisión de las historias clínicas de niños de 0 a 16 años de edad que fueron hospitalizados con un diagnóstico de sepsis, septicemia y sepsis neonatal, utilizando la Clasificación Internacional de Enfermedades de la Organización Mundial de la Salud, 10th Revisión (ICD-10). Se obtuvieron datos en relación con la demografía y los resultados clínicos. Resultados: Entre los 7011 niños de 0 a 16 años de edad que fueron ingresados, la sepsis fue la causa de 801 hospitalizaciones en 782 niños, en una proporción varón-mujer de 1.27 a 1. Los neonatos abarcaron el 86% (n = 691), el 36.2% de los cuales (n = 250) eran prematuros. La duración promedio de la hospitalización fue de 10 días (rango: 0-366 días; rango intercuartil: 7-19 días). La tasa de mortalidad atribuible a la sepsis fue de 10.1% (n = 70) en los neonatos, y fue mayor entre los prematuros en comparación con los neonatos a término (18.4%, n = 46/250 frente a 6.0%, n = 26/434, respectivamente). La tasa de mortalidad bruta anual para la sepsis pediátrica fue de 9 a 11% (12 por cada 1000 hospitalizaciones pediátricas). Conclusión: La sepsis representó un elevado número de ingresos y consumió recursos significativos como se evidenció en la larga duración de la hospitalización. La tasa de mortalidad por sepsis pediátrica fue alta, especialmente en recién nacidos. Se necesitan intervenciones específicas para reducir la carga atribuible a la sepsis y mejorar los resultados establecidos por la Alianza Mundial contra la Sepsis y los Objetivos del Desarrollo Sostenible de las Naciones Unidas.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Mortalidad Hospitalaria , Sepsis/mortalidad , Jamaica/epidemiología , Tiempo de Internación
13.
HIV Med ; 19 Suppl 1: 52-57, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29488696

RESUMEN

OBJECTIVES: The aims of this study were to to assess the feasibility of simultaneous testing for the blood-borne viruses (BBV), HIV, hepatitis C (HCV) and hepatitis B (HBV), in the Emergency Department (ED) and ascertain the seroprevalence for these three viruses in this setting. METHODS: A pilot BBV testing program was undertaken as part of routine clinical care in the ED. All ED attendees aged between 16 and 65 years old who were able to consent were tested over a 55 week period on an opt out basis. Patients with positive test results were linked to clinical services. Interventions aimed at improving testing rates were implemented and evaluated by quality improvement (QI) methodology. RESULTS: Of 25,520 age-eligible ED attendees, 6108 (24%) underwent BBV testing; an additional 1160 (4.5%) underwent a standalone HIV test (total of 7268 (28%) individuals).There were 83/7268 (1.1%) non-negative (ie reactive or equivocal) results for HIV and 103/6108 (1.7%) and 32/6108 (0.52%) for anti-HCV IgG and HBsAg, respectively. Of these, 12 (0.17%), 16 (0.26%) and 8 (0.13%) were new reactive tests for HIV, HCV and HBV, respectively, which were able to be confirmed on a second test. Specific QI interventions led to temporary increases in testing rates. CONCLUSIONS: An opt out BBV testing program in the ED is feasible and effective at finding new cases. However, the testing rate was low at 24%. Although QI interventions led to some improvement in testing rates, further studies are required to identify ways to achieve sustained increases in testing in this setting.


Asunto(s)
Servicios de Diagnóstico/organización & administración , Servicios Médicos de Urgencia/métodos , Infecciones por VIH/diagnóstico , Hepatitis B/diagnóstico , Hepatitis C/diagnóstico , Adolescente , Adulto , Anciano , Servicio de Urgencia en Hospital , Femenino , Infecciones por VIH/epidemiología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estudios Seroepidemiológicos , Adulto Joven
14.
J Hosp Infect ; 99(2): 229-235, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29421340

RESUMEN

BACKGROUND: Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal protective equipment (PPE). Protection is acquired through the inherent safety of the PPE components, but also their safe and correct use, supported by adequate training and user familiarity. However, the evidence base for HCID PPE ensembles and any associated training is lacking, with subsequent variation between healthcare providers. AIM: To develop an evidence-based assessment and training tool for evaluating PPE ensembles and doffing protocols, in the assessment of patients with suspected HCIDs. METHODS: VIOLET (Visualising Infection with Optimised Light for Education and Training) comprises a healthcare mannequin adapted to deliver simulated bodily fluids containing UV-fluorescent tracers. On demand and remotely operated, the mannequin projectile vomits (blue), coughs (red), has diarrhoea (yellow) and is covered in sweat (orange). Wearing PPE, healthcare staff participate in an HCID risk assessment and examination of the 'patient', thereby becoming exposed to these bodily fluids. Contamination of PPE is visualized and body-mapped under UV light before and after removal. Observational findings and participant feedback, around its use as a training exercise, is also recorded. FINDINGS: Significant contamination from different exposure events was seen, enabling evaluation of PPE and doffing procedures used. Observational data and participant feedback demonstrated its strengths and success as a training technique. CONCLUSION: Simulation exercises using VIOLET provide evidence-based assessment of PPE ensembles, and are a valuable resource for training of healthcare staff in wearing and safe doffing of PPE.


Asunto(s)
Infección Hospitalaria/prevención & control , Educación Médica/métodos , Colorantes Fluorescentes/análisis , Personal de Salud , Control de Infecciones/métodos , Equipo de Protección Personal , Coloración y Etiquetado/métodos , Humanos , Estudios Retrospectivos , Reino Unido , Voluntarios
15.
Eur J Orthop Surg Traumatol ; 28(6): 1103-1109, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29423867

RESUMEN

BACKGROUND: Guidelines on the management of displaced intracapsular fractures recommend using an Orthopaedic Data Evaluation Panel-rated cemented implant. Prior to the National Institute for Health and Care Excellence guidelines, uncemented implants were commonly used in the UK. METHODS: We retrospectively examined the outcomes of patients with uncemented Thompson's hemiarthroplasties at our unit, between April 2005 and December 2010. Patients who underwent revision surgery before December 2011 were identified. Implant survival calculation utilised the primary outcome of revision to total hip arthroplasty, revision hemiarthroplasty or excision arthroplasty. Patients who died post-operatively were identified and censored. RESULTS: A total of 1445 patients received uncemented Thompson's implant. Patient mean age was 82 years with 76% female. Forty-six (3.2%) patients required revision with 15% performed within 30 days of surgery and 62% within 1 year. Reasons for revision were infection (0.83%), acetabular erosion (0.83%) and loosening (0.62%). Twenty-seven patients (59% of total revisions) underwent revision to THA, 14 (30%) to excision arthroplasty and 5 (11%) to revision hemiarthroplasty. Cumulative survival rate was 98% at 1 year and 95% at 5 years. Thirty-day mortality was 7.1%. One-year mortality was 28.1%. CONCLUSION: Current guidelines strongly favour cemented hemiarthroplasty. Recognition that fractured hip patients are a non-homogeneous group is important. In patients with limited life expectancy, an uncemented Thompson is a quick, simple, palliative solution to early mobilisation. Correct surgical technique avoids using cement in this cohort, which is most vulnerable to bone cement implantation syndrome. Cost-effective resource utilisation with an increasingly elderly population remains a surgical responsibility.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Fracturas del Cuello Femoral/cirugía , Hemiartroplastia/métodos , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/economía , Cementos para Huesos , Cementación , Análisis Costo-Beneficio , Femenino , Anciano Frágil , Fragilidad , Hemiartroplastia/economía , Fracturas de Cadera/cirugía , Prótesis de Cadera , Humanos , Masculino , Cuidados Paliativos/economía , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento
16.
J Hosp Infect ; 99(2): 218-228, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29325871

RESUMEN

BACKGROUND: Variations currently exist across the UK in the choice of personal protective equipment (PPE) used by healthcare workers when caring for patients with suspected high-consequence infectious diseases (HCIDs). AIM: To test the protection afforded to healthcare workers by current PPE ensembles during assessment of a suspected HCID case, and to provide an evidence base to justify proposal of a unified PPE ensemble for healthcare workers across the UK. METHODS: One 'basic level' (enhanced precautions) PPE ensemble and five 'suspected case' PPE ensembles were evaluated in volunteer trials using 'Violet'; an ultraviolet-fluorescence-based simulation exercise to visualize exposure/contamination events. Contamination was photographed and mapped. FINDINGS: There were 147 post-simulation and 31 post-doffing contamination events, from a maximum of 980, when evaluating the basic level of PPE. Therefore, this PPE ensemble did not afford adequate protection, primarily due to direct contamination of exposed areas of the skin. For the five suspected case ensembles, 1584 post-simulation contamination events were recorded, from a maximum of 5110. Twelve post-doffing contamination events were also observed (face, two events; neck, one event; forearm, one event; lower legs, eight events). CONCLUSION: All suspected case PPE ensembles either had post-doffing contamination events or other significant disadvantages to their use. This identified the need to design a unified PPE ensemble and doffing procedure, incorporating the most protective PPE considered for each body area. This work has been presented to, and reviewed by, key stakeholders to decide on a proposed unified ensemble, subject to further evaluation.


Asunto(s)
Infección Hospitalaria/prevención & control , Colorantes Fluorescentes/análisis , Personal de Salud , Investigación sobre Servicios de Salud/métodos , Control de Infecciones/métodos , Equipo de Protección Personal/estadística & datos numéricos , Coloración y Etiquetado/métodos , Humanos , Estudios Retrospectivos , Reino Unido , Voluntarios
17.
Plant Dis ; 102(3): 511-518, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30673490

RESUMEN

From 2013 to 2014, bacterial leaf spot epidemics incited by Pseudomonas syringae pv. syringae affected an estimated 3,000 ha of watermelon and squash in Florida, and caused foliar blighting and transplant losses in severely affected fields. To investigate the diversity of the causal agent, we isolated 28 P. syringae strains from diseased plants grown in 10 Florida and Georgia counties over the course of 2 years. Strains were confirmed as P. syringae through sequence analysis of the 16S ribosomal RNA, phenotypic, and biochemical profiling; however, 20 displayed an atypical phenotype by exhibiting nonfluorescent activity on King's medium B agar and being negative for ice-nucleating activity. Multilocus sequence analysis and BOX polymerase chain reaction revealed the presence of two haplotypes among the collected strains that grouped into two distinct clades within P. syringae phylogroup 2. Pathogenicity testing showed that watermelon, cantaloupe, and squash seedlings were susceptible to a majority of these strains. Although both haplotypes were equally virulent on cantaloupe, they differed in virulence on watermelon and squash. The distribution of one haplotype in 9 of 10 Florida and Georgia counties sampled indicated that these epidemics were associated with the recent introduction of a novel clonal P. syringae lineage throughout major watermelon production areas in Florida.


Asunto(s)
Citrullus/microbiología , Cucurbita/microbiología , Epidemiología Molecular , Enfermedades de las Plantas/microbiología , Pseudomonas syringae/aislamiento & purificación , ADN Bacteriano/química , ADN Bacteriano/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Florida , Tipificación de Secuencias Multilocus , Fenotipo , Filogenia , Enfermedades de las Plantas/estadística & datos numéricos , Hojas de la Planta/microbiología , Reacción en Cadena de la Polimerasa , Pseudomonas syringae/genética , Pseudomonas syringae/patogenicidad , ARN Ribosómico 16S/genética , Virulencia
18.
J Clin Microbiol ; 56(3)2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29237792

RESUMEN

The emergence of Clostridium difficile as a significant human diarrheal pathogen is associated with the production of highly transmissible spores and the acquisition of antimicrobial resistance genes (ARGs) and virulence factors. Unlike the hospital-associated C. difficile RT027 lineage, the community-associated C. difficile RT078 lineage is isolated from both humans and farm animals; however, the geographical population structure and transmission networks remain unknown. Here, we applied whole-genome phylogenetic analysis of 248 C. difficile RT078 strains from 22 countries. Our results demonstrate limited geographical clustering for C. difficile RT078 and extensive coclustering of human and animal strains, thereby revealing a highly linked intercontinental transmission network between humans and animals. Comparative whole-genome analysis reveals indistinguishable accessory genomes between human and animal strains and a variety of antimicrobial resistance genes in the pangenome of C. difficile RT078. Thus, bidirectional spread of C. difficile RT078 between farm animals and humans may represent an unappreciated route disseminating antimicrobial resistance genes between humans and animals. These results highlight the importance of the "One Health" concept to monitor infectious disease emergence and the dissemination of antimicrobial resistance genes.


Asunto(s)
Animales Domésticos/microbiología , Infecciones por Clostridium/transmisión , Enfermedades Transmisibles Emergentes/transmisión , Farmacorresistencia Bacteriana/genética , Zoonosis/transmisión , Animales , Clostridioides difficile/clasificación , Clostridioides difficile/genética , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/microbiología , Enfermedades Transmisibles Emergentes/microbiología , Genoma Bacteriano/genética , Humanos , Filogeografía , Zoonosis/microbiología
19.
J Environ Manage ; 206: 650-663, 2018 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-29132088

RESUMEN

There is an increasing interest in considering the effects of air pollution on ecosystem services supply in order to enhance cost-benefit analyses of air pollution policies. This paper presents a generic, conceptual approach that can be used to link atmospheric deposition of air pollutants to ecosystem services supply and societal benefits. The approach is applied in a case study in the Telemark county of Norway. First, we examine the potential effects of four European air quality policy scenarios on N deposition in the ecosystems of this county. Second, we analyse the subsequent impacts on the supply of three ecosystem services: carbon sequestration, timber production and biodiversity. Changes in the supply of the first two services are analysed in both physical and monetary units, biodiversity effects are only analysed in physical terms. The scenarios derive from work conducted in the context of the European National Emissions Ceilings Directive. In the 2010 base case the benefits of carbon sequestration are estimated at 13 million euro per year and the value of timber harvesting at 2.9 million euro per year. Under the examined policy scenarios aiming to reduce nitrogen emissions the societal benefits resulting from these two ecosystem services in Telemark are found to be reduced; the scenarios have little effect on terrestrial biodiversity. Such results cannot be scaled up, individual ecosystem services respond differently to changes in air pollution depending upon type of pollutant, type of ecosystem, type of service, and the magnitude of change. The paper further presents an analysis of the uncertainties that need to be considered in linking air pollution and ecosystem services including those in deposition rates, ecosystem responses, human responses and in the values of ecosystem services. Our conceptual approach is also useful for larger scale analysis of air pollution effects on ecosystem services, for example at national or potentially European scale.


Asunto(s)
Contaminación del Aire , Biodiversidad , Ecosistema , Contaminantes Atmosféricos , Humanos , Noruega
20.
Colorectal Dis ; 20(2): O39-O45, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29172236

RESUMEN

AIM: An airtight anastomosis on intra-operative leak testing has been previously demonstrated to be associated with a lower risk of clinically significant postoperative anastomotic leak following left-sided colorectal anastomosis. However, to date, there is no consistently agreed upon method for management of an intra-operative anastomotic leak. Therefore, we powered a noninferiority study to determine whether suture repair alone was an appropriate strategy for the management of an intra-operative air leak. METHOD: This is a retrospective cohort analysis of prospectively collected data from a tertiary care referral centre. We included all consecutive patients with left-sided colorectal or ileorectal anastomoses and evidence of air leak during intra-operative leak testing. Patients were excluded if proximal diversion was planned preoperatively, a pre-existing proximal diversion was present at the time of surgery or an anastomosis was ultimately unable to be completed. The primary outcome measure was clinically significant anastomotic leak, as defined by the Surgical Infection Study Group at 30 days. RESULTS: From a sample of 2360 patients, 119 had an intra-operative air leak during leak testing. Sixty-eight patients underwent suture repair alone and 51 underwent proximal diversion or anastomotic reconstruction. The clinically significant leak rate was 9% (6/68; 95% CI: 2-15%) in the suture repair alone arm and 0% (0/51) in the diversion or reconstruction arm. CONCLUSION: Suture repair alone does not meet the criteria for noninferiority for the management of intra-operative air leak during left-sided colorectal anastomosis. Further repair of intra-operative air leak by suture repair alone should be reconsidered given these findings.


Asunto(s)
Fuga Anastomótica/cirugía , Colon/cirugía , Recto/cirugía , Técnicas de Sutura , Adulto , Anciano , Aire , Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica/etiología , Femenino , Humanos , Íleon/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento
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