Medical students could be a potential source of Staphylococcus aureus transmission to patients. This cross-sectional study involved samples collected from both nasal nostrils. Samples were processed ...for S. aureus recovery; the antimicrobial resistance (AMR) phenotype was determined by disc diffusion assays and the spa types and AMR genotypes by PCR/sequencing. A structured questionnaire was administered to students to collate data related to potential risk factors of nasal colonization. Ninety-eight students were included, 50 % were colonized by S. aureus and 12.2 % by MRSA. The mecA gene was detected in all MRSA isolates. The MSSA-CC398-IEC-type C lineage was found among 16.3 % of nasal carriers, of which t571 was the predominant spa-type. MRSA isolates were ascribed to spa types t2226 (CC5, 12 isolates) and t3444 (new spa type, 1 isolate). All MRSA were multi-drug resistant and MSSA were predominantly resistant to erythromycin-clindamycin (inducible-type, mediated by ermT gene). High rates of S. aureus and MRSA nasal carriages were observed in this study. The predominance of the CC398 lineage among MSSA (emergent invasive lineage) represent a relevant finding of public health concern. The role of medical students as potential source of MRSA and MSSA-CC398 transmissions in hospital and community needs to be elucidated in detail.
Debridement, antibiotic agents, and implant retention (DAIR) is a currently accepted approach for the treatment of early prosthetic joint infections (PJI). The success of a DAIR procedure has shown ...variable results throughout the published literature. Scoring systems such as the Kidney, Liver, Index surgery, Cemented prosthesis, and C-reactive protein value (KLIC) score for the selection of patients that are likely to benefit from DAIR have proved to be helpful in decision making. Our study aims to further validate the KLIC score using a large external multicentric cohort and to evaluate other risk factors for failure.
A retrospective analysis of patients with an early acute PJI who were treated with DAIR and recorded in a database of eight Spanish university hospitals was performed. According to pre-operative variables of the KLIC study, patients were categorized into five groups: group A, ≤2 points; group B, 2.5-3.5 points; group C, 4-5 points; group D, 5.5-6.5 points; and group E, ≥7 points. Failure rates were compared between groups at 60 days and after 60 days of DAIR. Further variables for risk of failure were also analyzed.
A total of 455 patients with early acute PJI were included in the analyses. At 60 days, patients presenting with pre-operative elevated C-reactive protein serum levels,
, and polymicrobial infections were associated with failure. Failure rates recorded were 12% for group A (n = 210), 18% for group B (n = 83), 26% for group C (n = 89), 24% for group D (n = 66), and 0% for group E (n = 7). Univariable analysis between consecutive groups of the KLIC score showed no differences for failure before 60 days of the DAIR procedure. Scheduled surgery and having the procedure performed by a specialized unit were also identified as important factors for DAIR success.
Our results suggest the KLIC score was not useful for predicting failure in our cohort. Furthermore, our results indicate a specialized unit should conduct DAIR procedures.
Introduction
Autogenic training consists of reaching a state of deep relaxation through mental representations of physical sensations in different parts of the body. It is a promising technique for ...improving the psychological well-being of people with chronic diseases, but there are no clinical practice guidelines recommending the use of autogenic training in this population. The aim of this work was to identify, critically evaluate, and synthesize the available evidence on the safety and effectiveness of autogenic training in the prevention and treatment of medical conditions.
Methods
We conducted a systematic search for systematic reviews and randomized controlled trials (RCTs) in MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials. The selection and assessment of risk of bias of the included studies was carried out independently by two reviewers.
Results
A total of 2,420 references were identified after eliminating duplicates. Of these, 141 were selected for reading the full text, and 13 systematic reviews and 18 RCTs were included. Compared with no intervention or delayed treatment, autogenic training significantly reduced levels of anxiety and depression as well as some physical symptoms (e.g., headaches and atopic dermatitis).
Conclusions
Autogenic training could be useful for improving the psychological well-being and physical symptoms of patients with chronic health conditions and as an additional element in multicomponent intervention programs. However, these conclusions are not definitive due to the low number of studies available for each health condition and their high or unclear risk of bias.
Meditation is defined as a form of cognitive training that aims to improve attentional and emotional self-regulation. This systematic review aims to evaluate the available scientific evidence on the ...effectiveness and safety of mantra-based meditation techniques (MBM), in comparison to passive or active controls, or other active treatment, for the management of mental health symptoms.
MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases were consulted up to April 2021. Randomised controlled trials regarding meditation techniques mainly based on the repetition of mantras, such as transcendental meditation or others, were included.
MBM, compared to control conditions, was found to produce significant small-to-moderate effect sizes in the reduction of anxiety (g = -0.46, IC95%: -0.60, -0.32; I
= 33%), depression (g = -0.33, 95% CI: -0.48, -0.19; I
= 12%), stress (g = -0.45, 95% CI: -0.65, -0.24; I
= 46%), post-traumatic stress (g = -0.59, 95% CI: -0.79, -0.38; I
= 0%), and mental health-related quality of life (g = 0.32, 95% CI: 0.15, 0.49; I
= 0%).
MBM appears to produce small-to-moderate significant reductions in mental health; however, this evidence is weakened by the risk of study bias and the paucity of studies with psychiatric samples and long-term follow-up.
•Hydroxychloroquine and azithromycin significantly prolong QT interval.•COVID-19 causes high levels of ferritin, D-dimer and C-reactive protein.•Troponin elevation seems to be uncommon in COVID-19 ...patients.•A protocol for electrocardiographic control may reduce the risk of sudden death.•Portable devices reduce contact to perform electrocardiogram in isolated patients.
Coronavirus Disease 2019 continues to spread and to date, no definitive treatment is available. Overcrowded and under-resourced healthcare centres have had to design different strategies to treat these patients, what includes the control of the electrocardiogram (ECG), as some drugs that have been used to treat this disease mayprolong the QT interval as a side effect. During the COVID-19 outbreak, we designed a protocol for monitoring the QT interval using a portable device with Bluetooth connectivity. After a validation study with 50 patients, we found a very good correlation between the QT interval measured both with this device and with the conventional body surface ECG. In this article, we provide a brief overview of the protocol and then analyse the QT changes observed in a group of patients during their hospitalization and treatment for SARS-CoV-2 infection. 81 patients with confirmed SARS-CoV-2 infection were enrolled in the protocol (age 63.4 SD 17.2 years; 70.3% men), while being treated with lopinavir/ritonavir, azithromycin and hydroxychloroquine, both individually or combined. Ten patients developed long drug-related QT interval, and the QT prolongation was statically significant for all treatment schemes. All patients with drug induced QT prolongation corrected the QT interval following the indications of the protocol, and no patients died of arrhythmic causes after its implementation. In our experience, a protocol for the electrocardiographic monitoring of these patients minimizes the risk of iatrogenic QT interval prolongation and consequently reduces sudden death events, and for that purpose, portable devices like the one used in this protocol may constitute a useful tool to minimize the contact with such patients.
Organ Donation: With Great Power Comes Great Responsibility González, Nerea Torres; Carmena, María Dolores García-Cosío; Moyano, Mercedes Ferrón ...
Transplantation proceedings,
November 2021, 2021-11-00, 20211101, Letnik:
53, Številka:
9
Journal Article
Recenzirano
Spain is a world leader in donation and transplantation. This model has been exported to other countries with favorable results. The objective of this study was to compare the actual donation ...intention rate with the effective donation figures, and analyze the main reasons why families decline organ donation. To estimate the current donation intention, we conducted 1065 surveys in March 2019, and to calculate effective donation figures in our hospital, we analyzed 1158 interviews conducted with relatives of potential organ donors between 1996 and 2018. Regarding the surveys to estimate donation intention, the mean (standard deviation) age was 51.6 (17-91) years. A total of 58% were women, 26% were health care professionals, and 5.1% were transplant recipients; 89.4% would donate their organs. In the multivariate analysis, having expressed the desire to donate to their family was independently related to the intention to donate (odds ratio, 3.4; 95% confidence interval, 2.2-5.2; P < .001). Regarding the interviews with relatives of potential donors, 79.4% were finally effective donors. The belief that the possible donor would have rejected the organ donation stands out among the causes of decline. However, only one-half of those surveyed expressed the wish to be a donor to their relatives. In the temporal evolution, a greater acceptance of donation is observed in the first period with a reduction over the last years (P > .001). It is our responsibility to improve transplantation rates because our model has shown to save lives and it is a role model for other nations, promoting information activities that encourage greater discussion of organ donation within families.
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