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1.
An Pediatr (Barc) ; 2020 Feb 07.
Artigo em Espanhol | MEDLINE | ID: mdl-32044198

RESUMO

OBJECTIVE: The aims of our study are to evaluate the effectiveness and security of CPAP (continuous positive airway pressure) in infants transferred with acute respiratory failure (ARF) and to compare their evolution in PICU between CPAP vs oxygen therapy. MATERIALS AND METHODS: We conducted a retrospective observational and analytical study by reviewing the health records of infants with ARF aged 0 to 12months that required interhospital transfer to the PICU. RESULTS: We included 110 patients: 71 transported with CPAP and 39 with oxygen therapy. The main cause of ARF was acute bronchiolitis (81.8%). The median level of CPAP was 7cmH2O (interquartile range, 6-7). Controlling by the previous values in specific multivariable models, CPAP produced a significant decrease in the Wood-Downes score (beta = -1.08; 95% CI = -1.76 to -0.40; P = .002) and the heart rate (beta = -19.64, 95% CI = -28.46 to -10.81; P < .001). No patients required endotracheal intubation during transport. During the PICU stay, the intubation rate was similar in the CPAP group (7%) and the oxygen therapy group (5.1%) (P=.689). The proportion of patients that required bilevel positive airway pressure within 6hours of admission to the PICU was higher in the oxygen therapy group: 100% (11/11) vs 69.2% (18/26), P=.04. CONCLUSIONS: Early administration of CPAP to infants with ARF was a safe respiratory support intervention during interhospital transport. During patient transport, the use of CPAP achieved greater decreases in the Wood-Downes score and heart rate compared to oxygen therapy.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31813835

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV) incidence should be calculated in cross-sectional studies using recent infection testing algorithms (RITA) that consider clinical variables and serological test results such as enzyme-linked immunosorbent assay (ELISA) and dried blood spot (DBS) analysis. METHODS: The correlation between serum samples and DBS was evaluated using two commercial ELISA kits: SediaTM BED HIV-1 Incidence EIA (BED-Sedia) and Maxim HIV-1 Limiting Antigen Avidity (LAg-Avidity). Eight different RITAs were developed; all of them included serological assays. A combination of the variables viral load, antiretroviral therapy (ART) and CD4 count was used to build the RITAs. The sensitivity, specificity, Youden index, predictive positive value, predictive negative value, false recent rate (FRR) and false long-term rate were evaluated. RESULTS: The correlations between serum samples and DBS were 0.990 and 0.867 for BED-Sedia and LAg-avidity, respectively. Using only serological assays, the Youden index was higher for LAg-avidity than BED-Sedia (82.1-83.0% versus 69.2-69.6%). The best RITA was ART-serology, which showed a Youden index of 91.2-93.9% and FRR of 1.8-2.2%. CONCLUSIONS: Using DBS samples to determine HIV incidence is a good tool for epidemiological surveillance. The RITA that included ART and serological tests (BED-Sedia or LAg-avidity) showed the highest sensitivity and specificity and a low FRR.

6.
Gac Sanit ; 2019 Nov 13.
Artigo em Espanhol | MEDLINE | ID: mdl-31733912

RESUMO

OBJECTIVE: To explore what are the perceptions and experiences of deaf women in relation to accessibility to the Basque Public Health System (Osakidetza). As a secondary objective, explore the experience of these women about gender violence. METHOD: A qualitative study with exploratory design is developed. The selection of the informants was carried out through intentional sampling. Deaf women were invited to participate through the Federation of Deaf People of the Basque Country. Four discussion groups were developed between October 2013 and July 2014, with duration of 90-120minutes. The discussion groups were recorded in video for their later literal transcription in which the service of interpreters of sign language of Euskadi participated. Thematic analyses carried out. RESULTS: Three main categories arise: 1) feelings of discrimination and limitation of the principle of autonomy; 2) barriers and facilitators in the accessibility to the health system; and 3) vulnerability of deaf women as a result of the lack of communication. CONCLUSIONS: Nowadays, deaf women continue having difficulties in accessing to the health system in our context. The results of this study can be the starting point for the development of health policies and institutional protocols.

7.
Crit Care ; 23(1): 335, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665092

RESUMO

BACKGROUND: The performance of blood biomarkers (mid-regional proadrenomedullin (MR-proADM), procalcitonin (PCT), C-reactive protein (CRP), and lactate) and clinical scores (Sequential Organ Failure Assessment (SOFA), National Early Warning Score (NEWS), and quick SOFA) was compared to identify patient populations at risk of delayed treatment initiation and disease progression after presenting to the emergency department (ED) with a suspected infection. METHODS: A prospective observational study across three EDs. Biomarker and clinical score values were calculated upon presentation and 72 h, and logistic and Cox regression used to assess the strength of association. Primary outcomes comprised of 28-day mortality prediction and delayed antibiotic administration or intensive care (ICU) admission, whilst secondary outcomes identified subsequent disease progression. RESULTS: Six hundred eighty-four patients were enrolled with hospitalisation, ICU admission, and infection-related 28-day mortality rates of 72.8%, 3.4%, and 4.4%, respectively. MR-proADM and NEWS had the strongest association with hospitalisation and the requirement for antibiotic administration, whereas MR-proADM alone had the strongest association with ICU admission (OR [95% CI]: 5.8 [3.1 - 10.8]) and mortality (HR [95% CI]: 3.8 [2.2 - 6.5]). Patient subgroups with high MR-proADM concentrations (≥ 1.77 nmol/L) and low NEWS (< 5 points) values had significantly higher rates of ICU admission (8.1% vs 1.6%; p < 0.001), hospital readmission (18.9% vs. 5.9%; p < 0.001), infection-related mortality (13.5% vs. 0.2%; p < 0.001), and disease progression (29.7% vs. 4.9%; p < 0.001) than corresponding patients with low MR-proADM concentrations. ICU admission was delayed by 1.5 [0.25 - 5.0] days in patients with high MR-proADM and low NEWS values compared to corresponding patients with high NEWS values, despite similar 28-day mortality rates (13.5% vs. 16.5%). Antibiotics were withheld in 17.4% of patients with high MR-proADM and low NEWS values, with higher subsequent rates of ICU admission (27.3% vs. 4.8%) and infection-related hospital readmission (54.5% vs. 14.3%) compared to those administered antibiotics during ED treatment. CONCLUSIONS: Patients with low severity signs of infection but high MR-proADM concentrations had an increased likelihood of subsequent disease progression, delayed antibiotic administration or ICU admission. Appropriate triage decisions and the rapid use of antibiotics in patients with high MR-proADM concentrations may constitute initial steps in escalating or intensifying early treatment strategies.

8.
J Immunol ; 203(8): 2210-2221, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31519862

RESUMO

HIV-1 infection expands large populations of late-stage differentiated CD8 T cells that may persist long after viral escape from TCR recognition. In this study, we investigated whether such CD8 T cell populations can perform unconventional innate-like antiviral effector functions. Chronic untreated HIV-1 infection was associated with elevated numbers of CD45RA+CD57+ terminal effector CD8 T cells expressing FcγRIIIA (CD16). The FcγRIIIA+ CD8 T cells displayed a distinctive transcriptional profile between conventional CD8 T cells and NK cells, characterized by high levels of IKZF2 and low expression of IL7R This transcriptional profile translated into a distinct NKp80+ IL-7Rα- surface phenotype with high expression of the Helios transcription factor. Interestingly, the FcγRIIIA+ CD8 T cells mediated HIV-specific Ab-dependent cellular cytotoxicity (ADCC) activity at levels comparable with NK cells on a per cell basis. The FcγRIIIA+ CD8 T cells were highly activated in a manner that correlated positively with expansion of the CD8 T cell compartment and with plasma levels of soluble mediators of antiviral immunity and inflammation such as IP-10, TNF, IL-6, and TNFRII. The frequency of FcγRIIIA+ CD8 T cells persisted as patients initiated suppressive antiretroviral therapy, although their activation levels declined. These data indicate that terminally differentiated effector CD8 T cells acquire enhanced innate cell-like characteristics during chronic viral infection and suggest that HIV-specific ADCC is a function CD8 T cells use to target HIV-infected cells. Furthermore, as the FcγRIIIA+ CD8 T cells persist in treatment, they contribute significantly to the ADCC-capable effector cell pool in patients on antiretroviral therapy.

9.
BMJ Open ; 9(5): e025405, 2019 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-31061025

RESUMO

INTRODUCTION: High-flow nasal cannula (HFNC) is a non-invasive form of respiratory support used increasingly in bronchiolitis. HFNC provides a variable amount of positive pressure similar to continuous positive airway pressure (CPAP). The positive pressure in CPAP can distend and loosen oesophageal sphincter pressure leading to increased reflux. It is unclear if HFNC causes a similar action. Feeding tubes are used to provide nutrition and hydration to patients that are unable to safely take oral feedings. If there is increased reflux from HFNC, this would increase the risk of aspiration. Our institution places nasoduodenal tubes (NDT) to eliminate this risk. The purpose of the study is to infer if there is a difference between NDT and nasogastric tube (NGT) feeding with regard to length of respiratory support, number of emesis, number of chest X-rays and readmission/emergency room revisit rates. METHODS AND ANALYSIS: Patients with bronchiolitis, on high-flow nasal cannula, and whose primary physicians have decided on feeding tube for nutrition/hydration will be approached for consent and enrolment. Patients will be randomised to NGT or NDT in variable block sizes and stratified into low- and high-risk groups. Outcomes will be analysed by both a frequentist and Bayesian statistical approach. ETHICS AND DISSEMINATION: The trial was approved by local institutional review board. Every attempt will be made to reduce to an absolute minimum the interval between completion of data collection and release of study results through appropriate dissemination mediums including abstracts, poster presentations and journal publications. TRIAL REGISTRATION NUMBER: NCT03346850; Pre-results.

10.
Nurs Ethics ; : 969733019843634, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113269

RESUMO

BACKGROUND: The decision whether to initiate cardiopulmonary resuscitation may sometimes be ethically complex. While studies have addressed some of these issues, along with the role of nurses in cardiopulmonary resuscitation, most have not considered the importance of nurses acting as advocates for their patients with respect to cardiopulmonary resuscitation. RESEARCH OBJECTIVE: To explore what the nurse's advocacy role is in cardiopulmonary resuscitation from the perspective of patients, relatives, and health professionals in the Basque Country (Spain). RESEARCH DESIGN: An exploratory critical qualitative study was conducted from October 2015 to March 2016. Thematic analysis was used to analyse the data. PARTICIPANTS: Four discussion groups were held: one with patients and relatives (n = 8), two with nurses (n = 7 and n = 6, respectively), and one with physicians (n = 5). ETHICAL CONSIDERATIONS: Approval was obtained from the Basque Country Clinical Research Ethics Committee. FINDINGS: Three significant themes were identified: (a) accompanying patients during end of life in a context of medical dominance, (b) maintaining the pact of silence, and (c) yielding to legal uncertainty and concerns. DISCUSSION: The values and beliefs of the actors involved, as well as pre-established social and institutional rules reduced nurses' advocacy to that of intermediaries between the physician and the family within the hospital environment. On the contrary, in primary health care, nurses participated more actively within the interdisciplinary team. CONCLUSION: This study provides key information for the improvement and empowerment for ethical nursing practice in a cardiac arrest, and provides the perspective of patients and relatives, nurses and physicians.

11.
Aten. prim. (Barc., Ed. impr.) ; 51(5): 269-277, mayo 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180875

RESUMO

Objetivo: Explorar la percepción acerca de la presencia de familiares durante la reanimación cardiopulmonar (RCP) en pacientes adultos, de los propios pacientes y familiares, enfermeras y médicos. Diseño: Se desarrolló un estudio cualitativo exploratorio y un análisis temático. Emplazamiento: Atención Primaria, Atención Hospitalaria y Servicio de Emergencias del Servicio Vasco de Salud. Participantes: La selección de los participantes se realizó a través de muestreo intencional. Se desarrollaron 4 grupos de discusión: uno de pacientes y familiares, 2 de enfermeras y uno de médicos. Método: Se realizó un análisis temático. Se utilizaron técnicas de triangulación entre investigadores e investigador-informante. Se utilizó el programa informático Open Code 4.1. Resultados: Se identificaron 3 categorías significativas: impacto de la actuación en la familia; peso de la responsabilidad ética y legal; poder, lugar donde sucede la parada y supuestos culturales. Conclusiones: La RCP es un constructo social influido por los valores de los contextos socioculturales específicos. En este estudio, los pacientes y familiares describieron temor y resistencia a presenciar la RCP. Por su parte, los profesionales sanitarios consideran que su decisión reviste complejidad, siendo necesario valorar cada caso de forma independiente e integrando a pacientes y familiares en la toma de decisiones. Como líneas de investigación futuras sería recomendable profundizar sobre la experiencia subjetiva de familiares que hayan presenciado la RCP y el impacto de los elementos contextuales y socioculturales en sus percepciones


Objective: To determine the perception of nurses, doctors, patients and family or relatives being present during cardiopulmonary resuscitation (CPR) in adult patients. Design: A qualitative exploratory study and thematic analysis were developed. Site: Primary Care, Hospital Care and Emergency Service of the Basque Health Service. Participants.The selection of the participants was made through intentional sampling. Four focus groups were developed: one of patients and family, 2 of nurses, and one of physicians. Method: Thematic analysis was performed. Triangulation techniques were used between investigators and investigator-participant member. The Open code 4.1 statistics software was used. Results: Three significant categories were identified: the impact on the family; the weight of ethical and legal responsibility; power, place of death, and cultural assumptions. Conclusions: CPR is a social construct influenced by values which are situated in specific socio-cultural contexts. In this study, patients and family members describe the fear and resistance to being present during CPR. Health professionals consider that their decision is complex, and each case must be assessed independently, and patients and relatives must be integrated into decision-making. Future research should explore in greater depth the subjective experience of relatives who have witnessed CPR and the impact of contextual and sociocultural elements from the perspectives of relatives


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Acompanhantes Formais em Exames Físicos/normas , Reanimação Cardiopulmonar/normas , Parada Cardíaca/terapia , Tratamento de Emergência/normas , Temas Bioéticos/normas , Percepção Social , Medo , Atitude do Pessoal de Saúde , Pesquisa Qualitativa , Grupos Focais/métodos
12.
JBI Database System Rev Implement Rep ; 17(4): 614-624, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30973528

RESUMO

OBJECTIVES: The objective of this project was to implement evidence-based recommendations for post-surgical pain management and improve quality of care for patients. INTRODUCTION: Inadequate approaches to postoperative pain can lead to the pain becoming chronic, which has an impact on the patient's quality of life. The focus of this project was to implement evidence-based recommendations to improve the effect or outcome of post-surgical pain management strategies and improve quality of care. METHODS: This implementation project was undertaken in a surgical unit of a tertiary hospital. The clinical audit was developed in three phases using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools for promoting change in healthcare practices and improving quality of care. A baseline audit was conducted with 27 patients that identified the barriers and strategies needed to improve the assessment and management of postoperative pain. Two follow-up audits audits were conducted, each comprising 40 patients. RESULTS: The baseline audit revealed the need to increase health education for patients and, or, their families on managing postoperative pain, with a special emphasis on non-pharmacological measures. This education was not recorded in the patients' medical histories at baseline and the aim was to rectify this.In follow-up audits, 100% of patients received individually tailored education about postoperative pain and its management. CONCLUSIONS: The aims and main objectives of the present project were achieved, including improvements in the quality of health education related to pain and the recording of pain data. In addition, variations in the clinical practice related to the management of post-surgical pain decreased.

13.
Arch. pediatr. Urug ; 90(2): 69-77, abr. 2019. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-1001259

RESUMO

Resumen: Introducción: las altas coberturas alcanzadas en el Programa Nacional de Vacunaciones (PNV) parecen indicar una adecuada adhesión al Certificado Esquema de Vacunación (CEV). No hay evaluaciones que reflejen lo percibido desde la comunidad. Objetivo: evaluar la confianza y satisfacción en Montevideo acerca de la vacunación y las estrategias actuales de comunicación social del PNV del Ministerio de Salud. Material y método: encuesta con preguntas cerradas con escala semicuantitativa a ≥de 18 años con un niño ≤de 5 años a cargo en Montevideo en el año 2016. Se evaluó la confianza, satisfacción con el PNV y las estrategias de comunicación social. Resultados: se encuestaron 384 personas. Consideró importante la vacunación para prevenir enfermedades de los niños el 92,7% de las personas encuestadas y el 81,5% de los adultos (p<0,01). Refirió satisfacción con las vacunas del CEV el 89,9% y con la información brindada por su médico el 82,8%. El 69% de los encuestados consideró que algunas vacunas son más importantes, de los cuales 62% evitaría al menos una, principalmente la vacuna antigripal y el antivirus del papiloma humano. El 43% refirió haber estado informado de alguna actividad sobre vacunas recientemente, 65% a través de las redes sociales. Conclusiones: estos resultados muestran niveles de confianza y satisfacción altos con el PNV. Es necesario fortalecer la importancia de la vacunación en adultos. Las redes sociales podrían ser una de las vías de comunicación privilegiadas para llegar a la población.


Summary: Objective: assess trust and satisfaction levels of the Uruguayan National Vaccination Program and its social communication strategies carried out by the Ministry of Health by the population of Montevideo. Material and method: a survey was carried out to ≥18 year- old adults in charge of a ≤5 year-old children. Closed questions were asked using a semi quantitative rating scale in Montevideo in 2016. Trust and satisfaction levels regarding the NIP and the social communication strategies used were assessed. Results: 384 people were surveyed. 92.7% considered vaccination was important to prevent diseases in children and in adults (81.5%) (p <0.01). 89.9% were satisfied with the Vaccination Program and 82.8% with the level of information provided by doctors. 69% considered some of the vaccines being most important, such as vaccines against Influenza or Human Papillomavirus. 43% reported having recently received any type of information regarding vaccines, and 65% received it through social networks. Conclusions: these results show high levels of trust and satisfaction with the NIP. It is necessary to stress the importance of vaccination compliance in adults. Social networks could be the main means of communication to reach such population.


Resumo: Objetivo: avaliar os níveis de confiança e satisfação do Programa Uruguaio Nacional de Vacinação e suas estratégias de comunicação social desenvolvidas pelo Ministério da Saúde por parte da população de Montevidéu. Material e método: Realizamos uma pesquisa a adultos ≥18 anos responsáveis por pelo menos uma criança com menos de 5 anos de idade. Fizemos perguntas fechadas e utilizamos uma escala de avaliação semi-quantitativa em Montevidéu em 2016. Avaliamos os níveis de confiança e satisfação em relação ao NIP e as estratégias de comunicação social utilizadas. Resultados: 384 pessoas foram pesquisadas. 92,7% consideraram a vacinação importante para prevenir doenças em crianças e adultos (81,5%) (p <0,01). 89,9% mostraram-se satisfeitos com o Programa de Vacinação e 82,8% com o nível de informação fornecido pelos médicos. 69% consideraram algumas das vacinas as mais importantes, como as vacinas contra Influenza ou Papiloma Vírus Humano. 43% relataram ter recebido recentemente algum tipo de informação sobre vacinas e 65% deles receberam a informação através de redes sociais. Conclusões: Estes resultados mostram altos níveis de confiança e satisfação com o NIP. É necessário enfatizar a importância da adesão à vacinação em adultos. As redes sociais poderiam ser o principal meio de comunicação para atingir essa população

14.
Sci Total Environ ; 670: 672-684, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-30909045

RESUMO

In this study the role of plastic debris as a pollution vector has been evaluated by determining the concentrations of hydrophobic organic contaminants in polymers from three Western Mediterranean coastal areas as well as their potential transfer to seawater. Plastic debris was sampled at three Iberian Peninsula Southeastern beaches, each affected by different predominant anthropogenic activities (tourism, agriculture, urban activities, transport and industry). Plastic debris was characterized by attenuated total reflection Fourier-transform infrared spectrometry. The organic contaminants were extracted from plastics by ultrasonic extraction with methanol and quantified by stir bar sorptive extraction coupled to gas chromatography-mass spectrometry (GC-MS). In two areas, the desorption of these contaminants from plastic debris to seawater during 24 h was also evaluated. The contaminant groups considered in this study (polycyclic aromatic hydrocarbons (PAHs), personal care products (PCPs), current use pesticides (CUPs), organochlorinated compounds (OCPs, including polychlorinated biphenyls and organochlorinated pesticides) and plastic additives were found in polymers from the three areas. The most abundant contaminants were plastic additives and PCPs, underlining the relevance of the leaching of plastic components, and urban and tourism activities as typical pollution sources in the coastal areas. In general, large piece-to-piece variability was found for all polymers and areas mainly as a consequence of their different origin, exposition time, use and surface-to-volume ratio. This fact difficulted the visualization of significant differences between polymers or areas, but for CUPs, whose concentrations were significantly higher in Cape Cope than in the other areas due to the influence of close agricultural activities. PCPs and CUPs were desorbed partially in seawater for 24 h, particularly the most hydrophilic compounds such as triazines and other CUPs. However, a significant fraction of other contaminants (mainly PAHs) was retained, which suggests they can be transported far away from their origin.


Assuntos
Cosméticos/análise , Monitoramento Ambiental , Praguicidas/análise , Plásticos/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Resíduos/análise , Poluentes Químicos da Água/análise , Praias , Água do Mar , Espanha
15.
Rev Fac Cien Med Univ Nac Cordoba ; 76(1): 37-46, 2019 02 27.
Artigo em Espanhol | MEDLINE | ID: mdl-30882340

RESUMO

Introduction: School environment must provide tools to encourage the construction of healthy habits. The impact of the Healthy School Program (HSP) 2016-2017 was evaluated. Methods: Student assessment (anonymous self-administered survey on eating habits, physical activity, movement and screen hours), teachers (anonymous self-test on eating habits) and school environment (scoring system to evaluate the promotion of healthy habits; healthy classroom and institutional challenges and habits. Ad hoc instruments. Descriptive statistics, pre and post unpaired comparison with X2 and mean / median difference for independent samples. Processing and analysis with SPSS v.23.0. Results: Score was increased at the primary level (single-day (SD) [p = 0.008], full-time (FT) [p=0.012]) and extended-day (ED) of the initial level (p=0.0027). In FT there was a difference in the Limitation of unhealthy food intake (p = 0.000), the absence of kiosk or whose offer is healthy (p=0.024) and the conformation of a Healthy Committee (p=0.038). In SD and in ED only the Limitation of income of unhealthy foods exclusively [(p= 0.004) (p=0.011) respectively]. Around 30% of the challenges were installed as classroom / institutional habit. In students, significant changes were observed in what they led to school for both healthy foods (fruit, water cereal bars) and unhealthy foods (snacks, sweets, sugary drinks). They did not report favorable modifications in the habitual consumption of fruits and vegetables, neither in physical activity nor screen hours. Among teachers, habits showed no significant difference. Conclusions: Addresing food-nutritional issue in schools is complex, requires sustainable actions over time to generate lasting impact


Assuntos
Comportamento Alimentar , Promoção da Saúde/métodos , Estilo de Vida , Serviços de Saúde Escolar , Estudantes , Argentina , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde
16.
J Antimicrob Chemother ; 74(5): 1244-1252, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753505

RESUMO

OBJECTIVES: To characterize the antimicrobial susceptibility, molecular epidemiology and carbapenem resistance mechanisms in Pseudomonas aeruginosa isolates recovered from respiratory tract samples from patients with ventilator-associated pneumonia enrolled in the MagicBullet clinical trial. METHODS: Isolates were collected from 53 patients from 12 hospitals in Spain, Italy and Greece. Susceptibility was determined using broth microdilution and Etest. MALDI-TOF MS was used to detect carbapenemase activity and carbapenemases were identified by PCR and sequencing. Molecular epidemiology was investigated using PFGE and MLST. RESULTS: Of the 53 isolates, 2 (3.8%) were considered pandrug resistant (PDR), 19 (35.8%) were XDR and 16 (30.2%) were MDR. Most (88.9%) of the isolates from Greece were MDR, XDR or PDR, whereas fewer of the isolates from Spain (33.3%) and Italy (43.5%) showed antibiotic resistance. Three Greek isolates were resistant to colistin. Overall, the rates of resistance of P. aeruginosa isolates to imipenem, ciprofloxacin, ceftolozane/tazobactam and ceftazidime/avibactam were 64.1%, 54.7%, 22.6% and 24.5%, respectively. All isolates resistant to ceftolozane/tazobactam and ceftazidime/avibactam (Greece, n = 10; and Italy, n = 2) carried blaVIM-2. Spanish isolates were susceptible to the new drug combinations. Forty-eight restriction patterns and 27 STs were documented. Sixty percent of isolates belonged to six STs, including the high-risk clones ST-111, ST-175 and ST-235. CONCLUSIONS: MDR/XDR isolates were highly prevalent, particularly in Greece. The most effective antibiotic against P. aeruginosa was colistin, followed by ceftolozane/tazobactam and ceftazidime/avibactam. blaVIM-2 is associated with resistance to ceftolozane/tazobactam and ceftazidime/avibactam, and related to highly resistant phenotypes. ST-111 was the most frequent and disseminated clone and the clonal diversity was lower in XDR and PDR strains.

17.
PeerJ ; 7: e6410, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30746310

RESUMO

Background: Nurses are often the first to activate the chain of survival when a cardiorespiratory arrest happens. That is why it is crucial that they keep their knowledge and skills up-to-date and their attitudes to resuscitation are very important. The main aim of this study was to analyse whether the level of theoretical and practical understanding affected the attitudes of nursing staff. Methods: A questionnaire was designed using the Delphi technique (three rounds). The questionnaire was adjusted and it was piloted on a test-retest basis with a convenience sample of 30 registered nurses. The psychometric characteristics were evaluated using a sample of 347 nurses using Cronbach's alpha. Descriptive analysis was performed to describe the sociodemographic variables and Spearman's correlation coefficient to assess the relationship between two scale variables. Pearson's chi-squared test has been used to study the relationship between two categorical variables. Wilcoxon Mann Whitney test and the Kruskal-Wallis test were performed to establish relationships between the demographic/work related characteristics and the level of understanding. Results: The Knowledge and Attitude of Nurses in the Event of a Cardiorespiratory Arrest (CAEPCR) questionnaire comprised three sections: sociodemographic information, theoretical and practical understanding, and attitudes of ethical issues. Cronbach's alpha for the internal consistency of the attitudes questionnaire was 0.621. The knowledge that nurses self-reported with regard to cardiopulmonary arrest directly affected their attitudes. Their responses raised a number of bioethical issues. Conclusions: CAEPCR questionnaire is the first one which successfully linked knowledge of cardiopulmonary resuscitation to the attitudes towards ethical issues Health policies should ensure that CPR training is mandatory for nurses and all healthcare workers, and this training should include the ethical aspects.

18.
J Virol ; 93(7)2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30700608

RESUMO

HIV infection is controlled immunologically in a small subset of infected individuals without antiretroviral therapy (ART), though the mechanism of control is unclear. CD8+ T cells are a critical component of HIV control in many immunological controllers. NK cells are also believed to have a role in controlling HIV infection, though their role is less well characterized. We used mass cytometry to simultaneously measure the levels of expression of 24 surface markers on peripheral NK cells from HIV-infected subjects with various degrees of HIV natural control; we then used machine learning to identify NK cell subpopulations that differentiate HIV controllers from noncontrollers. Using CITRUS (cluster identification, characterization, and regression), we identified 3 NK cell subpopulations that differentiated subjects with chronic HIV viremia (viremic noncontrollers [VNC]) from individuals with undetectable HIV viremia without ART (elite controllers [EC]). In a parallel approach, we identified 11 NK cell subpopulations that differentiated HIV-infected subject groups using k-means clustering after dimensionality reduction by t-neighbor stochastic neighbor embedding (tSNE) or linear discriminant analysis (LDA). Among these additional 11 subpopulations, the frequencies of 5 correlated with HIV DNA levels; importantly, significance was retained in 2 subpopulations in analyses that included only cohorts without detectable viremia. By comparing the surface marker expression patterns of all identified subpopulations, we revealed that the CD11b+ CD57- CD161+ Siglec-7+ subpopulation of CD56dim CD16+ NK cells are more abundant in EC and HIV-negative controls than in VNC and that the frequency of these cells correlated with HIV DNA levels. We hypothesize that this population may have a role in immunological control of HIV infection.IMPORTANCE HIV infection results in the establishment of a stable reservoir of latently infected cells; ART is usually required to keep viral replication under control and disease progression at bay, though a small subset of HIV-infected subjects can control HIV infection without ART through immunological mechanisms. In this study, we sought to identify subpopulations of NK cells that may be involved in the natural immunological control of HIV infection. We used mass cytometry to measure surface marker expression on peripheral NK cells. Using two distinct semisupervised machine learning approaches, we identified a CD11b+ CD57- CD161+ Siglec-7+ subpopulation of CD56dim CD16+ NK cells that differentiates HIV controllers from noncontrollers. These cells can be sorted out for future functional studies to assess their potential role in the immunological control of HIV infection.


Assuntos
Infecções por HIV/imunologia , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/virologia , Antígeno CD11b/imunologia , Antígeno CD56/imunologia , Antígenos CD57/imunologia , Linfócitos T CD8-Positivos/virologia , Linhagem Celular Tumoral , DNA Viral/imunologia , Infecções por HIV/virologia , HIV-1/imunologia , Humanos , Células K562 , Subfamília B de Receptores Semelhantes a Lectina de Células NK/imunologia , Receptores de IgG/imunologia , Viremia/imunologia , Viremia/virologia
19.
Surgeon ; 17(6): 351-359, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30704859

RESUMO

BACKGROUND: Current evidence shows that single-stage treatment of concomitant choledocholithiasis and cholelithiasis is as effective and safe as two-stage treatment. However, several studies suggest that single-stage approach requires shorter hospitalization time and is more cost-effective than the two-stage approach, even though it requires considerable training. This study aimed to evaluate the implementation of a protocol for managing concomitant choledocholithiasis and cholelithiasis using single-stage treatment. METHODS: A prospective cohort study of patients diagnosed with cholelithiasis and choledocholithiasis who were treated with the single-stage treatment - transcystic instrumentation, choledocotomy or intraoperative endoscopic retrograde cholangiopancreatography (ERCP) - between September 2010 and June 2017 was assessed. The primary outcomes were complications, hospital stay, operative time and recurrence rate. RESULTS: 164 patients were enrolled. 141 (86%) were operated laparoscopically. Preoperatively diagnosed stones were not found by intraoperative imaging or disappeared after "flushing" in 38 patients (23.2%). Surgical approach was transcystic in 45 patients (27.41%), choledochotomy in 74 (45.1%), intraoperative ERCP in 4 (2.4%), and bilioenteric derivation in 3 (1.8%). Mean hospitalization stay was 4.4 days. Mean operative time was 166 min 27 patients (16.5%) had complications and 1 patient was exitus (0.6%). Recurrence rate was 1.2%. CONCLUSIONS: Single-stage approach is a safe and effective management option for concomitant cholelithiasis and choledocolithiasis. Furthermore, a significant number of common bile duct stones pass spontaneously to duodenum or can benefit from a transcystic approach, with presumable low morbidity and cost-efficiency.

20.
Odontology ; 107(3): 409-417, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30758697

RESUMO

This study aimed to identify the aerobic and anaerobic causal microorganisms of odontogenic infections and their antibiotic sensitivity. Purulent exudates were taken from patients with odontogenic infections by transdermal puncture, and aerobic and anaerobic microorganisms were identified using biochemical tests. Susceptibility to antibiotics was tested using the Kirby-Bauer method; the inhibition halos were measured according to NCCLS, and based on the results, the microorganisms were classified as susceptible, intermediate or resistant to each antibiotic. Frequencies of species and percentages of resistance were calculated. The microorganisms associated with odontogenic infections were principally anaerobic (65.3% anaerobic vs. 35.7% aerobic), and the susceptibility to antibiotics was higher in anaerobic than in aerobic microorganisms. The majority of isolated microorganisms (82%) showed susceptibility to amoxicillin/clavulanic acid. The causal agents of odontogenic infections were anaerobic microorganisms, which exhibited high resistance to antibiotics.


Assuntos
Antibacterianos , Anaerobiose , Humanos , Testes de Sensibilidade Microbiana
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