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1.
Clin Nucl Med ; 48(3): e110-e111, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36723893

RESUMO

ABSTRACT: A 37-year-old man presented with a 2-week history of abdominal pain, headaches, nausea, vomiting, and leukocytosis. Medical history includes congenital hydrocephalus, with a ventriculoperitoneal shunt placed several years ago. Radionuclide cerebrospinal fluid cisternography shows curvilinear activity in the abdomen, in the pattern of small and large bowel loops, suggesting that the tip of the catheter is inside a small bowel loop. No activity is seen in the intraperitoneal compartment. CT of the abdomen and pelvis followed by laparoscopic surgery confirmed the findings.


Assuntos
Abdome , Hidrocefalia , Masculino , Humanos , Adulto , Derivação Ventriculoperitoneal/efeitos adversos , Dor Abdominal , Cateteres , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Radioisótopos
6.
BMC Infect Dis ; 23(1): 11, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36609225

RESUMO

BACKGROUND: The prevalence of resistant hospital infections in the intensive care unit (ICU) increases mortality and antibiotic resistance. COVID-19 pandemic may have unintended impact on nosocomial infections (NI) and the prevalence of resistant microorganism. METHODOLOGY: The present non-interventional study was performed by a pre and a post survey each lasting 8 months before (March-October 2019) and after (March-October 2020) the onset of COVID-19 pandemic in three ICU's, not allocated to COVID-19 patients, in Nemazee Hospital, Shiraz, Iran. The rates of the following nosocomial infections were compared at pre- and post-pandemic period: ventilator associated pneumonia (VAP), central line associated blood stream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and incidence of multiple drug resistance (MDR) pathogens. RESULTS: Pre-pandemic and pandemic incidence of VAP was 23.5 and 17.2 cases per 1000 device-days, respectively; an absolute decrease of 27%. The main reason for the decrease in the rate of VAP during the pandemic was a significant decrease in the rate of VAP caused by Acinetobacter baumannii; from 39 to 17% in total VAP episodes. The rate of VAP associated with other microorganisms remained relatively unchanged from 14.2 cases in pre-pandemic period to 14.3 cases per 1000 MV-days during the pandemic (P = 0.801). Pre-pandemic incidence of CLABSI was 7.3 cases and, in pandemic period, was 6.5 cases per 1000 device-days (IRR = 0.88, 95% CI 0.43-1.73, P = 0.703). Pre-pandemic incidence of CAUTI was 2 and in pandemic period, was 1.4 cases per 1000 device-days (IRR = 0.70, 95% CI 0.22-1.98, P = 0.469). CONCLUSION: The results of the present study showed a decrease in the incidence of VAP in critically ill non-COVID-19 patients during the pandemic compared to before the pandemic, especially regarding Acinetobacter baumannii.


Assuntos
Acinetobacter baumannii , COVID-19 , Infecções Relacionadas a Cateter , Infecção Hospitalar , Pneumonia Associada à Ventilação Mecânica , Infecções Urinárias , Humanos , Infecção Hospitalar/epidemiologia , Pandemias , Incidência , Estudos Prospectivos , COVID-19/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Hospitais de Ensino , Infecções Urinárias/epidemiologia , Resistência a Múltiplos Medicamentos , Cateteres
7.
BMC Pediatr ; 23(1): 21, 2023 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-36639748

RESUMO

BACKGROUND: A peripherally inserted central catheter (PICC) with its tip preferably in the vena cava is essential in caring for patients with chronic conditions in general pediatrics. However, PICC-related complications are concerning and warrant further investigations. OBJECTIVES: To share the experience of a nurse-inserted peripherally inserted central catheters (PICC) program initiated in a general pediatric department. METHODS: A retrospective descriptive cohort study based on a prospectively collected database was conducted. All PICCs inserted in the departments of gastroenterology and pulmonology in a tertiary pediatric center from Dec. 2015 to Dec. 2019 were included in the study. Complications and risk factors were analyzed by comparing cases with and without complications. We also reported arm movements in correcting mal-positioned newly-inserted PICCs. RESULTS: There were 169 cases with a median (IQR) age of 42(6, 108) months who received PICC insertion during a 4-year period. Inflammatory bowel disease was the leading diagnosis accounting for 25.4% (43/169) of all cases. The overall complication rate was 16.4 per 1000 catheter days with malposition and occlusion as the two most common complications. Multivariate models performed by logistic regression demonstrated that young age [p = 0.004, OR (95%CI) = 0.987(0.978, 0.996)] and small PICC diameter (1.9Fr, p = 0.003, OR (95%CI) = 3.936(1.578, 9.818)] were risk factors for PICC complications. Correction of malpositioned catheters was attempted and all succeeded in 9 eligible cases by using arm movements. CONCLUSION: The nurse-inserted PICC program in general pediatrics is feasible with a low rate of complications. PICC tip malposition and occlusion were two major PICC-related complications when low age and small catheter lumina were major risk factors. Furtherly, arm manipulation potentially is an easy and effective approach for correcting malpositioned newly-inserted PICC catheters.


Assuntos
Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Humanos , Criança , Pré-Escolar , Cateterismo Venoso Central/efeitos adversos , Estudos de Coortes , Estudos Retrospectivos , Fatores de Risco , Cateteres , Cateterismo Periférico/efeitos adversos , Infecções Relacionadas a Cateter/etiologia
8.
Rev. Rol enferm ; 46(1): 41-47, ene. 2023. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-214916

RESUMO

El término “catéter” es muy conocido para las enfermeras, sin embargo, el manejo de las vías para los pacientes con fallo renal es un tema que ofrece cierta dificultad.Las facetas específicas con relación a este tipo de catéteres y el tratamiento depurativo renal son el objetivo de este capítulo. Se analiza cómo hacer el cálculo del flujo de sangre, cómo elegir un buen catéter según su morfología, cuál es la técnica mejor para conservarlo y de qué forma sellarlo cuando se deje en reposo, sin tratamiento depurativo.Estos y otros conocimientos fundamentales se describirán, a partir de la evidencia hallada en la literatura. (AU)


The word catheter is well known to nurses, however, its management for patients with renal failure is a subject that offers some difficulty.The problems with this specific catheter and the renal purifying treatment are the objective of this paper. It analyses how to calculate the blood flow, how to choose a good catheter according to its morphology, what is the best technique to preserve it and how to lock it when it is left at rest, without any purifying treatment.These and other fundamental knowledge will be described, based on the evidence founded in the literature. (AU)


Assuntos
Humanos , Cateteres , Insuficiência Renal , Enfermagem , Unidades de Terapia Intensiva
9.
Cir. pediátr ; 36(1): 28-32, Ene. 2023. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-214577

RESUMO

Introducción: Existen diversas alternativas para el drenaje de la pelvis renal tras una pieloplastia. Una de ellas es la utilización de un catéter de derivación interno-externo que, según nuestro protocolo, se anuda a las 48 horas posoperatorias previas al alta y se retira a los siete días de forma ambulatoria en consulta, sin necesidad de sedoanalgesia. Objetivos: Analizar los resultados de los pacientes menores de un año intervenidos mediante pieloplastia abierta, asociando un catéter de derivación interno-externo de manejo ambulatorio. Material y métodos: Análisis descriptivo retrospectivo de 28 pacientes (31 unidades renales) intervenidos entre los años 2011 y 2021. Se evaluaron métodos diagnósticos, indicaciones, abordaje quirúrgico y evolución posoperatoria. Resultados: Veintiocho pacientes (23 varones) con diagnóstico prenatal de hidronefrosis confirmado con ecografía y/o renograma, fueron intervenidos mediante pieloplastia a una mediana de edad de tres meses (15 días-11 meses). Se realizó pieloplastia según técnica de Anderson-Hynes o pieloplastia desmembrada en 28 unidades renales y según técnica de Culp-DeWeerd o colgajo en espiral en 3. En todos los casos se utilizó un catéter de derivación interno-externo según protocolo. El tiempo medio de ingreso fue 3,5 días (2-7 días) con buena evolución posoperatoria. Dos pacientes presentaron complicaciones (infección urinaria que requirió antibioterapia intravenosa y pionefrosis que requirió repieloplastia). Conclusiones: Asociar un catéter de derivación interno-externo a la pieloplastia en pacientes menores de un año con estenosis de la unión pieloureteral es una opción sencilla y segura que permite un alta precoz con manejo ambulatorio y evita una segunda anestesia general para la retirada del catéter de drenaje.(AU)


Introduction: There are various alternatives available for renal pelvis drainage following pyeloplasty. One of them is the use of an internal-external diversion stent, which according to our protocol, is knotted 48 hours following surgery, prior to discharge, and removed 7 days later on an outpatient consultation basis, with no sedation or analgesia required. Objective: To analyze the results of patients under one year of age who underwent open pyeloplasty associated with an outpatient internalexternal diversion stent. Materials and methods: A retrospective, descriptive analysis of 28 patients (31 renal units) undergoing surgery from 2011 to 2021 was carried out. Diagnostic methods, indications, surgical approach, and postoperative progression were assessed. Results: 28 patients (23 male) prenatally diagnosed with hydronephrosis confirmed by ultrasonography and/or renogram underwent pyeloplasty at a median age of 3 months (15 days-11 months). Pyeloplasty was conducted according to the Anderson-Hynes technique or dismembered pyeloplasty in 28 renal units, and according to the Culp-DeWeerd technique or spiral flap in 3. In all cases, an internal-external diversion stent was used according to our protocol. Mean hospital stay was 3.5 days (2-7 days), with a good postoperative progression. 2 patients had complications (urinary infection requiring intravenous antibiotics, and pyonephrosis requiring re-pyeloplasty). Conclusions: Using an internal-external diversion stent following pyeloplasty in patients under 1 year of age with ureteropelvic junction obstruction is a simple and safe option that allows for early discharge with outpatient management. It also avoids a second general anesthesia for drainage catheter removal purposes.(AU)


Assuntos
Humanos , Masculino , Recém-Nascido , Lactente , Cateteres , Procedimentos Cirúrgicos Operatórios , Ultrassonografia Pré-Natal , Hidronefrose , Procedimentos Cirúrgicos Urológicos , Estudos Retrospectivos , Pediatria , Cirurgia Geral
10.
Blood Coagul Fibrinolysis ; 34(1): 40-46, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36598377

RESUMO

Ultrasound-assisted catheter directed thrombolysis (US-CDT) is frequently used for the treatment of pulmonary embolism. Due to the variety of thrombolytic and anticoagulant dosing utilized in practice, patients with pulmonary embolism who undergo US-CDT may be at an increased risk of bleeding. The primary objective of this study was to determine factors associated with major bleeding occurring with US-CDT. Secondary outcomes included in-hospital mortality and ventilator-free days. This multicentre retrospective cohort study evaluated inpatients diagnosed with pulmonary embolism and treated with US-CDT and systemic anticoagulation. A total of 173 patients were included. Most patients receiving US-CDT had a submassive pulmonary embolism with a median Pulmonary Embolism Severity Index (PESI) score of 85. Major bleeding events occurred in 37 of the 173 patients (21%). In-hospital mortality occurred in four (11%) of the patients who experienced major bleeding and three (2%) patients who did not experience major bleeding (P = 0.04). Factors associated with a higher risk of major bleeding included female sex and anticoagulation strategy. The odds of major bleeding were 3.3 times higher for women than for men (odds ratio = 3.32, 95% confidence interval 1.29-8.54). In addition, for each second increase in goal aPTT the odds of major bleeding increased by 5% (odds ratio = 1.05, 95% confidence interval 1.02-1.09). In patients with pulmonary embolism treated with US-CDT, major bleeding may be underestimated. In this analysis, major bleeding was associated with female sex and higher goal aPTT levels. In addition, bleeding with US-CDT was associated with a higher risk of in-hospital mortality.


Assuntos
Embolia Pulmonar , Terapia Trombolítica , Masculino , Humanos , Feminino , Terapia Trombolítica/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Embolia Pulmonar/complicações , Fibrinolíticos/uso terapêutico , Hemorragia/induzido quimicamente , Cateteres , Anticoagulantes/uso terapêutico
13.
Proc Natl Acad Sci U S A ; 120(4): e2212694120, 2023 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-36652481

RESUMO

Multidrug-resistant Acinetobacter baumannii infections are an urgent clinical problem and can cause difficult-to-treat nosocomial infections. During such infections, like catheter-associated urinary tract infections (CAUTI), A. baumannii rely on adhesive, extracellular fibers, called chaperone-usher pathway (CUP) pili for critical binding interactions. The A. baumannii uropathogenic strain, UPAB1, and the pan-European subclone II isolate, ACICU, use the CUP pili Abp1 and Abp2 (previously termed Cup and Prp, respectively) in tandem to establish CAUTIs, specifically to facilitate bacterial adherence and biofilm formation on the implanted catheter. Abp1 and Abp2 pili are tipped with two domain tip adhesins, Abp1D and Abp2D, respectively. We discovered that both adhesins bind fibrinogen, a critical host wound response protein that is released into the bladder upon catheterization and is subsequently deposited on the catheter. The crystal structures of the Abp1D and Abp2D receptor-binding domains were determined and revealed that they both contain a large, distally oriented pocket, which mediates binding to fibrinogen and other glycoproteins. Genetic, biochemical, and biophysical studies revealed that interactions with host proteins are governed by several critical residues in and along the edge of the binding pocket, one of which regulates the structural stability of an anterior loop motif. K34, located outside of the pocket but interacting with the anterior loop, also regulates the binding affinity of the protein. This study illuminates the mechanistic basis of the critical fibrinogen-coated catheter colonization step in A. baumannii CAUTI pathogenesis.


Assuntos
Acinetobacter baumannii , Infecções Urinárias , Humanos , Adesinas Bacterianas/genética , Adesinas Bacterianas/metabolismo , Infecções Urinárias/microbiologia , Cateteres , Acinetobacter baumannii/genética , Fibrinogênio/metabolismo
14.
Zhonghua Xin Xue Guan Bing Za Zhi ; 51(1): 45-50, 2023 Jan 24.
Artigo em Chinês | MEDLINE | ID: mdl-36655241

RESUMO

Objective: To investigate the timing of pericardial drainage catheter removal and restart of the anticoagulation in patients with atrial fibrillation (AF) suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran. Methods: A total of 20 patients with pericardial tamponade, who underwent AF catheter ablation with uninterrupted dabigatran in Beijing Anzhen Hospital from January 2019 to August 2021, were included in this retrospective analysis. The clinical characteristics of enrolled patients, information of catheter ablation procedures, pericardial tamponade management, perioperative complications, the timing of pericardial drainage catheter removal and restart of anticoagulation were analyzed. Results: All patients underwent pericardiocentesis and pericardial effusion drainage was successful in all patients. The average drainage volume was (427.8±527.4) ml. Seven cases were treated with idarucizumab, of which 1 patient received surgical repair. The average timing of pericardial drainage catheter removal and restart of anticoagulation in 19 patients without surgical repair was (1.4±0.7) and (0.8±0.4) days, respectively. No new bleeding, embolism and death were reported during hospitalization and within 30 days following hospital discharge. Time of removal of pericardial drainage catheter, restart of anticoagulation and hospital stay were similar between patients treated with idarucizumab or not. Conclusion: It is safe and reasonable to remove pericardial drainage catheter and restart anticoagulation as soon as possible during catheter ablation of atrial fibrillation with uninterrupted dabigatran independent of the idarucizumab use or not in case of confirmed hemostasis.


Assuntos
Fibrilação Atrial , Tamponamento Cardíaco , Ablação por Cateter , Humanos , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/uso terapêutico , Tamponamento Cardíaco/terapia , Tamponamento Cardíaco/complicações , Anticoagulantes/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Drenagem/efeitos adversos , Cateteres/efeitos adversos
15.
Inn Med (Heidelb) ; 64(1): 40-49, 2023 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-36625924

RESUMO

Pulmonary embolism is a frequent cardiovascular disease which in recent years has shown a reduction in the mortality but an increase in the incidence. Due to the optimization of clinical probability scores and the interpretation of the D­dimer test, unnecessary examinations using computed tomography with respect to the exclusion of an acute pulmonary embolism can be avoided, also in pregnant women. The evaluation of the right ventricle contributes to a risk-adapted treatment. Treatment consists of anticoagulation, alone or in combination with reperfusion treatment, such as systemic thrombolysis and also catheter-assisted or surgical treatment. In addition to acute treatment of pulmonary embolisms, an adequate aftercare is important, particularly for the early detection of long-term sequelae. This review article summarizes the current recommendations of international guidelines for patients with pulmonary embolism, accompanied by clinical case examples and a critical discussion.


Assuntos
Embolia Pulmonar , Terapia Trombolítica , Gravidez , Humanos , Feminino , Terapia Trombolítica/métodos , Embolia Pulmonar/diagnóstico , Cateteres , Doença Aguda , Progressão da Doença
18.
J Thromb Haemost ; 21(1): 76-82, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36695399

RESUMO

BACKGROUND: Central venous catheters are prone to clotting, particularly in patients with cancer. Although low-molecular-weight heparin and direct oral anticoagulants, such as apixaban and rivaroxaban, have been evaluated for the prevention of catheter thrombosis, their efficacy remains uncertain. OBJECTIVES: Compare apixaban and rivaroxaban with enoxaparin for the prevention of catheter-induced clotting in vitro. METHODS: To address this uncertainty, we used a well-established microplate-based assay to compare the effects of enoxaparin, apixaban, and rivaroxaban on catheter-induced thrombosis and thrombin generation in human plasma. RESULTS: Consistent with our previous findings, catheter segments shortened the clotting time and promoted thrombin generation. When compared at concentrations with similar anti-factor Xa activity as enoxaparin, apixaban and rivaroxaban were >20-fold less potent than enoxaparin for the prevention of catheter-induced clotting and thrombin generation. CONCLUSION: The prevention of catheter thrombosis in patients with cancer is challenging. Clinical trials are needed to compare the efficacy of low-molecular-weight heparin with that of direct oral anticoagulants both for the prevention and treatment of catheter thrombosis.


Assuntos
Neoplasias , Trombose , Humanos , Enoxaparina/farmacologia , Enoxaparina/uso terapêutico , Rivaroxabana/uso terapêutico , Anticoagulantes/uso terapêutico , Trombina , Piridonas/farmacologia , Piridonas/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Trombose/etiologia , Trombose/prevenção & controle , Cateteres , Neoplasias/tratamento farmacológico , Inibidores do Fator Xa/uso terapêutico
19.
Biosensors (Basel) ; 13(1)2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36671946

RESUMO

A rapid and intuitive method for detecting Vibrio parahaemolyticus (VP) was established by a designed reaction vessel which coupled CRISPR/Cas12a with loop-mediated isothermal nucleic acid amplification (LAMP). There were two spaces in the vessel-holding LAMP reaction solution and CRISPR reaction solution, respectively, which were separated with a polyvinyl alcohol (PVA) membrane. The PVA membrane could be dissolved with a water solution. The thermolabile hemolysin (TLH) gene of VP was employed as the detection target. After the target sequence of the TLH gene was amplified with LAMP, the PVA membrane would be dissolved and the CRISPR reaction solution mixed with the LAMP reaction solution. In this way, amplicons could be detected with CRISPR/Cas12a in the reaction vessel. The fluorescent signals produced by the positive samples were clearly identified by the naked eye under a UV light, while the negative samples were dark. The whole detection procedure could be finished within 35 min with a detection limit of 100 copies/µL. The designed reaction vessel is easy to produce and can effectively prevent contamination due to the opening of the reaction vessel after the LAMP reaction. Thus, it will have the potential to provide a new solution for rapid detection in the field.


Assuntos
Álcool de Polivinil , Vibrio parahaemolyticus , Sistemas CRISPR-Cas , Técnicas de Amplificação de Ácido Nucleico/métodos , Vibrio parahaemolyticus/genética , Cateteres
20.
Int J Mol Sci ; 24(2)2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36675063

RESUMO

Coagulase-negative staphylococci (CoNS) and especially Staphylococcus epidermidis are responsible for health care infections, notably in the presence of foreign material (e.g., venous or central-line catheters). Catheter-related bacteremia (CRB) increases health care costs and mortality. The aim of our study was to evaluate the impact of 15 days of antibiotic exposure (ceftobiprole, daptomycin, linezolid and vancomycin) at sub-inhibitory concentration on the resistance, fitness and genome evolution of 36 clinical strains of S. epidermidis responsible for CRB. Resistance was evaluated by antibiogram, the ability to adapt metabolism by the Biofilm Ring test® and the in vivo nematode virulence model. The impact of antibiotic exposure was determined by whole-genome sequencing (WGS) and biofilm formation experiments. We observed that S. epidermidis strains presented a wide variety of virulence potential and biofilm formation. After antibiotic exposure, S. epidermidis strains adapted their fitness with an increase in biofilm formation. Antibiotic exposure also affected genes involved in resistance and was responsible for cross-resistance between vancomycin, daptomycin and ceftobiprole. Our data confirmed that antibiotic exposure modified bacterial pathogenicity and the emergence of resistant bacteria.


Assuntos
Bacteriemia , Daptomicina , Infecções Estafilocócicas , Humanos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Vancomicina/farmacologia , Daptomicina/farmacologia , Staphylococcus epidermidis , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Cateteres/microbiologia , Testes de Sensibilidade Microbiana , Biofilmes
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