Significant decrease of facial cellulitis admissions during COVID-19 lockdown in France: A multicentric comparative study.

During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis.

Infecciones por Chlamydia trachomatis en un hospital portugués de atención terciaria: estudio retrospectivo de 11 años / Chlamydia trachomatis Infections in a Tertiary Care Portuguese Hospital: An 11-Year Retrospective Study

Antecedentes Las infecciones por Chlamydia trachomatis siguen siendo un problema de salud mundial. Los objetivos de este estudio fueron determinar el número de infecciones por C.trachomatis por año, caracterizar los rasgos demográficos de la población infectada e identificar las infecciones de transmisión sexual (ITS) asociadas. Con dicha finalidad se recogieron los casos diagnosticados en los últimos 11años en el principal centro hospitalario de Lisboa. Materiales y métodos Se incluyeron todas las infecciones causadas por C.trachomatis y confirmadas por el laboratorio entre el 1 de enero de 2009 y el 31 de diciembre de 2019. Resultados Se recogieron un total de 6.404 muestras, de las cuales 602 fueron positivas para C.trachomatis y correspondían a un total de 550 pacientes. El 60% de los casos fueron diagnosticados por dermatólogos-venereólogos. La mayoría de los casos se observaron en pacientes de sexo masculino (n=371; 67,5%), con una mediana de edad de 26,1años (desviación estándar: 7,98) y con un rango de edad que oscilaba entre los 13 y los 68años. Más de la mitad de los casos (51,3%) se diagnosticaron en pacientes menores de 25años. En 87 pacientes (15,8%) se hallaron antecedentes de otra ITS. En 198 pacientes (36%) se diagnosticaron además otras ITS concomitantes, y 43 pacientes (7,8%) presentaron una ITS posteriormente. En cuanto al seguimiento, 196 pacientes (correspondientes al 35,6% del total de pacientes) no acudieron a una reevaluación tras el diagnóstico. Conclusión El número de casos confirmados de C.trachomatis ha demostrado un incremento con el transcurso de los años, afectando principalmente a pacientes menores de 25años. La infección por C.trachomatis se asociará especialmente a la infección por Neisseria gonorrhoeae; sin embargo, las infecciones concomitantes por otras ITS serán también muy prevalentes. Teniendo en cuenta las posibles complicaciones de la infección por C.trachomatis (AU)

Background Chlamydia trachomatis infections remain a burden worldwide. The goals of this study were to determine the number of C.trachomatis infections per year, characterize the demographic traits of the infected population and identify the associated sexually transmitted infections (STI), over the last 11years, in Lisbon main Hospital Centre. Materials and methods Laboratorial confirmed C.trachomatis infections diagnosed between January 1st, 2009 and December 31st, 2019 were evaluated. Results A total of 6404 samples were collected, with 602 being positive for C.trachomatis, corresponding to 550 patients. 60% of diagnoses were made by dermatovenereologists and most cases occurred in males (n=371; 67.5%), with a median age of 26.1years (standard deviation 7.98), ranging from 13 to 68years. More than half the cases (51.3%) occurred below the age of 25years. In 87 patients (15.8%) there was previous history of STI, in 198 patients (36%) a concomitant STI was present and 43 patients (7.8%) developed a posterior STI. Concerning follow-up, 196 patients (corresponding to 35.6% of total patients) did not show for a re-evaluation after the diagnosis was made. Conclusion Confirmed cases of C.trachomatis infection have risen along the years, affecting mainly people younger than 25 years. C.trachomatis infection is especially associated with Neisseriagonorrhoeae infection, but other STI are also very prevalent. Considering the potential complications of C.trachomatis infection, screening and treatment are necessary. The high percentage of diagnoses made by dermatovenereologists support the pivotal role of dermatovenereology in diagnosing C.trachomatis infections (AU)

Estudio retrospectivo acerca de la evolución y el desarrollo de resistencias antimicrobianas en casos diagnosticados de gonorrea en un hospital de nivel terciario en Portugal durante 10 años / Gonorrhea in a Tertiary Care Portuguese Hospital: A 10-year Retrospective Study of the Evolution of Cases and Drug Resistance of the Isolates

INTRODUCCIÓN: Las infecciones de transmisión sexual siguen siendo un problema mundial de salud pública. Aunque tradicionalmente se considera una infección tratable, la aparición de resistencias de la Neisseria gonorrhoeae (N. gonorrhoeae) a los agentes antimicrobianos se ha convertido en un tema de vital importancia. El objetivo del presente estudio fue valorar tanto la incidencia como la resistencia frente a los agentes antimicrobianos desarrollada por las cepas de N. gonorrhoeae en un hospital portugués durante 10 años. MÉTODOS: Se incluyeron aquellos casos con confirmación en laboratorio de infecciones por N. gonorrhoeae diagnosticados entre los años 2009 y 2018. Se estudió además la sensibilidad frente a la penicilina, las tetraciclinas, el ciprofloxacino, la azitromicina y la cefotaxima, así como las características clínicas y demográficas relacionadas. RESULTADOS: Desde el año 2009 al 2018, en nuestro centro fueron detectados un total de 440 casos de infecciones por N. gonorrhoeae, evidenciándose además un incremento anual significativo en el número de casos (p < 0,05). La mayoría de los casos se observaron en pacientes del sexo masculino (97,9%), con una media de edad de 25 años. En el 88,7% de los casos el tratamiento utilizado fue la asociación de ceftriaxona con azitromicina. La resistencia objetivada frente a la penicilina, las tetraciclinas y el ciprofloxacino permaneció elevada durante todo el período del estudio. CONCLUSIONES: La resistencia antimicrobiana de la infección por N. gonorrhoeae apareció al poco tiempo después de la introducción del tratamiento antimicrobiano. Para poder combatir esta situación es necesario implantar una mayor vigilancia, así como realizar más estudios que busquen combinar tanto datos epidemiológicos como de sensibilidad. En nuestra población, la N. gonorrhoeae sigue siendo muy sensible a los tratamientos antibióticos que se recomiendan actualmente. Sin embargo, el tratamiento con ciprofloxacino, azitromicina (en monoterapia) y la penicilina se deben de evitar como tratamiento empírico

BACKGROUND: Sexually Transmitted Infections remain a major public health concern worldwide. Although traditionally considered treatable, the emergence of Neisseria gonorrhoeae resistance to antimicrobials is currently a serious problem. The goal of this study was to evaluate the incidence and trends of antimicrobial resistance over the last 10 years in N. gonorrhoeae isolates from a Portuguese Centre. METHODS: Laboratorial confirmed N. gonorrhoeae infections diagnosed between 2009 and 2018 were evaluated. Susceptibilities to penicillin, tetracycline, ciprofloxacin, azithromycin and cefotaxime were studied, along with demographic and clinical characteristics. RESULTS: From 2009 to 2018, 440 cases of N. gonorrhoeae infection were diagnosed in our center, with a significant yearly increase (p < 0.05). Most cases occurred in males (97.9%), with a median age of 25 years. In 88.7% of the cases, treatment with ceftriaxone plus azithromycin was used. Resistances to penicillin, tetracycline and ciprofloxacin remained high throughout the study period. CONCLUSIONS: Antimicrobial resistance of N. gonorrhoeae appeared shortly after the introduction of antimicrobials. To combat this problem, improved surveillance and more studies combining susceptibility and epidemiological data are needed. In our population, N. gonorrhoeae remains highly susceptible to the antibiotics currently recommended for its treatment, whereas ciprofloxacin, azithromycin (in monotherapy) and penicillin should be avoided as empirical treatment

Gonorrhea in a Tertiary Care Portuguese Hospital: A 10-year Retrospective Study of the Evolution of Cases and Drug Resistance of the Isolates. / Estudio retrospectivo acerca de la evolución y el desarrollo de resistencias antimicrobianas en casos diagnosticados de gonorrea en un hospital de nivel terciario en Portugal durante 10 años.

BACKGROUND: Sexually Transmitted Infections remain a major public health concern worldwide. Although traditionally considered treatable, the emergence of Neisseria gonorrhoeae resistance to antimicrobials is currently a serious problem. The goal of this study was to evaluate the incidence and trends of antimicrobial resistance over the last 10 years in N. gonorrhoeae isolates from a Portuguese Centre. METHODS: Laboratorial confirmed N. gonorrhoeae infections diagnosed between 2009 and 2018 were evaluated. Susceptibilities to penicillin, tetracycline, ciprofloxacin, azithromycin and cefotaxime were studied, along with demographic and clinical characteristics. RESULTS: From 2009 to 2018, 440 cases of N. gonorrhoeae infection were diagnosed in our center, with a significant yearly increase (p<0.05). Most cases occurred in males (97.9%), with a median age of 25 years. In 88.7% of the cases, treatment with ceftriaxone plus azithromycin was used. Resistances to penicillin, tetracycline and ciprofloxacin remained high throughout the study period. CONCLUSIONS: Antimicrobial resistance of N. gonorrhoeae appeared shortly after the introduction of antimicrobials. To combat this problem, improved surveillance and more studies combining susceptibility and epidemiological data are needed. In our population, N. gonorrhoeae remains highly susceptible to the antibiotics currently recommended for its treatment, whereas ciprofloxacin, azithromycin (in monotherapy) and penicillin should be avoided as empirical treatment.

Cutaneous metastases from solid neoplasms in the 21st century: a retrospective study from a Portuguese tertiary care center.

INTRODUCTION: Cutaneous metastases account for 2% of all skin cancers and are usually associated with widespread disease. The main of this retrospective study was to describe and illustrate clinicopathological features of cutaneous metastases diagnosed in our centre since the beginning of this century. METHODS: All cases of cutaneous metastases from solid neoplasms diagnosed in our Dermatopathology Department from January 2000 to December 2018 were included. Statistical analysis was performed with SPSS. RESULTS: A total of 164 patients were included, with a female to male ratio of 3:2. Malignancies that most commonly metastasized to the skin were melanoma (N = 58), breast cancer (N = 54) and lung cancer (N = 13). Immunohistochemical study was performed in 99 patients (60.4%). Time diagnosis of the primary tumour and appearance of cutaneous metastases was significantly higher in breast cancer, followed by melanoma and then by lung cancer (P < 0.05). Median survival after diagnosis of cutaneous metastases was 8 months. Survival after diagnosis of cutaneous metastases was also influenced by age of the patient, both at diagnosis of the primary tumour and at diagnosis of the cutaneous metastasis. DISCUSSION: Clinical presentation of cutaneous metastases is highly variable and non-specific, being easily mistaken for other dermatological conditions. Histopathological examination is essential in this setting, and the judicious use of an immunohistochemistry panel considered the appropriate morphologic and clinical context. Survival after the diagnosis of cutaneous metastases is influenced not only by the location of the tumour but also by the age of the patient. Dermatologists should therefore be to these clinical pictures, and a high degree of suspicion is, along with a careful clinical history and physical examination. Although being limited by its retrospective nature, we describe one of the largest European series of cutaneous metastases, with findings with most of the available literature.

The effect of profession on burnout in hospital staff.

Background: A high level of burnout has been described in health professionals. However, literature regarding other hospital employees is scarce. Aims: To assess the prevalence of burnout in different professional groups of hospital staff and how the professional category is associated with levels of burnout. Methods: Employees of a University Hospital in Portugal completed a self-administered online questionnaire in 2014-2015. We used the Portuguese version of the Maslach Burnout Inventory-Human Services Survey and scored three dimensions of burnout (emotional exhaustion, depersonalization, personal accomplishment) as low, average or high. We estimated odds ratios (OR) and 95% confidence intervals (95% CI) by logistic regression, adjusting for age, sex, use of anxiolytic/antidepressant drugs and job satisfaction. Results: There was a 10% response rate; 368 questionnaires were available for analysis. High levels of burnout due to emotional exhaustion were observed in all professional categories. Nurses, administrative staff and technicians more frequently scored higher levels of emotional exhaustion (59%, 50% and 50%, respectively) and lack of personal accomplishment (41%, 52% and 38%, respectively) than physicians and healthcare assistants. Not all professionals scored highly for depersonalization. Emotional exhaustion scores were significantly lower in healthcare assistants than nurses (adjusted OR 0.26, 95% CI 0.10-0.64). Conclusions: Burnout affects all professional categories of hospital staff. Future studies should use larger, more representative samples of hospital staff, perform longitudinal analyses and analyse data on specifics of each professional category and other potential confounders.

New portable instrument for the measurement of thermal conductivity in gas process conditions.

The development of high temperature gas sensors for the monitoring and determination of thermophysical properties of complex process mixtures at high temperatures faces several problems, related with the materials compatibility, active sensing parts sensitivity, and lifetime. Ceramic/thin metal films based sensors, previously developed for the determination of thermal conductivity of molten materials up to 1200 °C, were redesigned, constructed, and applied for thermal conductivity measuring sensors. Platinum resistance thermometers were also developed using the same technology, to be used in the temperature measurement, which were also constructed and tested. A new data acquisition system for the thermal conductivity sensors, based on a linearization of the transient hot-strip model, including a portable electronic bridge for the measurement of the thermal conductivity in gas process conditions was also developed. The equipment is capable of measuring the thermal conductivity of gaseous phases with an accuracy of 2%-5% up to 840 °C (95% confidence level). The development of sensors up to 1200 °C, present at the core of the combustion chambers, will be done in a near future.

Are standard heart rate variability measures associated with the self-perception of stress of firefighters in action?

Stress is a major factor for the degradation of cardiac health in first responder professionals such as firefighters. Monitoring stress during real events might be the key for controlling this problem. In this paper we inspect how standard heart rate variability (HRV) measures are associated with the self-perception of stress of firefighters in action, supported by an advanced technological solution to acquire this data. Results obtained from more than 94 hours of annotated ECG recordings of firefighters in action are promising, showing positive association with various standard HRV measures. Given the richness of the gathered data, we have also measured the association of the HRV measures with the stage of a firefighting event (pre, during, post), obtaining some interesting results that hint that the psychological impact of the post-event may be one of the most concerning situations for a firefighter, motivating further studies on this in the future.

Vital analysis: annotating sensed physiological signals with the stress levels of first responders in action.

First responders such as firefighters are exposed to extreme stress and fatigue situations during their work routines. It is thus desirable to monitor their health using wearable sensing but this is a complex and still unsolved research challenge that requires large amounts of properly annotated physiological signals data. In this paper we show that the information gathered by our Vital Analysis Framework can support the annotation of these vital signals with the stress levels perceived by the target user, confirmed by the analysis of more than 4600 hours of data collected from real firefighters in action, including 717 answers to event questionnaires from a total of 454 different events.

Clinical significance of brain natriuretic peptide in patients with postmyocardial infarction.

BACKGROUND: Risk stratification after acute myocardial infarction (AMI) includes the evaluation of left ventricular (LV) function. Natriuretic peptides, and particularly brain natriuretic peptide (BNP), emerged as a potential marker of ventricular function and prognosis after AMI. HYPOTHESIS: Brain natriuretic peptide levels are related to ventricular function, either systolic or isolated diastolic, and can give prognostic information in patients surviving AMI. METHODS: In all, 101 patients were enrolled. An echocardiographic (M-mode, two-dimensional, and pulsed Doppler) evaluation was performed and blood samples for BNP measurement were obtained. Clinical events were recorded during 12 months of follow-up. RESULTS: A negative correlation between BNP and LV ejection fraction was observed (r = -0.38; p < 0.001). The BNP levels were higher among patients with LV systolic dysfunction than in patients with isolated diastolic dysfunction (339.1 +/- 249.9 vs. 168.0 +/- 110.5 pg/ml, p = 0.001). The latter had higher levels of BNP than those with normal LV function (68.3 +/- 72.6 pg/ml, p < 0.001). The BNP accuracy to detect LV systolic dysfunction was good (area under the ROC curve [AUC] = 0.83) and increased when isolated diastolic dysfunction was also considered (AUC = 0.87). Brain natriuretic peptide had a very good accuracy in the prediction of death (AUC = 0.95) and the development of heart failure (AUC = 0.90). CONCLUSION: These results extend previous evidence relating BNP to systolic function after AMI. Furthermore, a relationship between BNP levels and diastolic function was found. Brain natriuretic peptide had a very good performance in detecting the occurrence of an adverse event. We conclude that BNP can detect high-risk patients and help select patients for more aggressive approaches.

The use of correspondence analysis in the assessment of morphologic changes during carcinogenesis.

Correspondence analysis is a statistical technique originally developed for the analysis of frequency and contingency tables. It may also be successfully applied to the problem of the assessment of the characteristics of samples of cytological material. The present article describes the use of this formalism on feature data measured on urothelial cells in populations obtained from rats at different time points after exposition to a carcinogenic agent. After the application of correspondence analysis, the projections of the samples corresponding to the different time points onto the plane spanned by the first two factorial axes constitute a trajectory, preserving the time ordering. The locations of the projections of cell samples of untreated animals (controls) with respect to this trajectory suggest that two different processes inducing different morphological changes are at work: Early abnormal samples are characterized by a lower-than-normal value of nuclear stain content, whereas late abnormals are mainly characterized by a higher-than-normal nuclear stain value. It is shown that populations of selected atypical cells show less variation throughout the carcinogenic process than populations of randomly selected cells.