•Burkholderia gladioli was identified as a cause of healthcare-associated bacteremia.•The investigation traced to the contaminated multidose vials with saline solution.•Isolates from blood and saline ...showed the same susceptibility patterns.•Pulsed-field gel electrophoresis (PFGE) was used to genotype the strains.•PFGE profile of all B. gladioli isolates demonstrated clonal relatedness.
Burkholderia gladioli has been associated with infections in patients with cystic fibrosis, chronic granulomatous disease, and other immunocompromising conditions. The aim of this study was to better depict the outbreak of healthcare-associated bacteremia caused by B. gladioli due to exposure to contaminated multidose vials with saline solutions.
An environmental and epidemiologic investigation was conducted by the Infection Prevention and Control Team (IPCT) to identify the source of the outbreak in three Croatian hospitals.
During a 3-month period, 13 B. gladioli bacteremia episodes were identified in 10 patients in three Croatian hospitals. At the time of the outbreak, all three hospitals used saline products from the same manufacturer. Two 100-ml multidose vials with saline solutions and needleless dispensing pins were positive for B. gladioli. All 13 bacteremia isolates and two isolates from the saline showed the same antimicrobial susceptibility patterns and pulsed-field gel electrophoresis profile, demonstrating clonal relatedness.
When an environmental pathogen causes an outbreak, contamination of intravenous products must be considered. Close communication between the local IPCT and the National Hospital Infection Control Advisory Committee is essential to conduct a prompt and thorough investigation and find the source of the outbreak.
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Burkholderia gladioli has been associated with infections in patients with cystic fibrosis, chronic granulomatous disease and other immunocompromising conditions. The aim of this study was to better ...depict the outbreak of healthcare-associated bacteremia caused by Burkholderia gladioli due to contaminated multi-dose vials with saline solutions.
An environmental and epidemiological investigation was conducted by the Infection Prevention and Control Team (IPCT) in order to identify the source of the outbreak in three Croatian hospitals.
During a three-month period, a total of thirteen B. gladioli bacteremia episodes were identified in ten patients in three Croatian hospitals. At the time of the outbreak, all three hospitals used saline products from the same manufacturer. Two 100 ml multi-dose vials with saline solutions and needleless dispensing pins were B. gladioli positive. All thirteen bacteremia isolates, as well as two isolates from the saline, showed the same antimicrobial susceptibility patterns and pulsed-field gel electrophoresis profile demonstrating clonal relatedness.
When an environmental pathogen causes an outbreak, contamination of intravenous products must be considered. Close communication between local IPCT and the National Hospital Infection Control Advisory Committee is essential to conduct a prompt and thorough investigation and find the source of the outbreak.
Sposobnost bakterija da prežive na različitim površinama u bolničkoj sredini važan je čimbenik njihova prijenosa s bolesnika ili zdravstvenog djelatnika u okolinu te na drugu osobu ili bolesnika. Iz ...navedenih su razloga temeljito čišćenje i dezinfekcija okoline vrlo važni, budući da kontaminirana okolina može služiti kao rezervoar potencijalnih patogena. Dezinfekcija se može provoditi mehanički (ručno) ili aparatom. KB Dubrava posjeduje aparat za dekontaminaciju, GlosairTM 400, koji u prostor raspršuje vodikov peroksid te u određenom kontaktnom vremenu provodi dekontaminaciju prostora i površina.
Dekontaminacija prostora aparatom provodi se nakon prekida mjera izolacije u bolesničkim sobama, tj. nakon otpusta bolesnika kod kojeg je izoliran višestruko otporni mikroorganizam. Također se prema indikaciji provodi dekontaminacija operacijske sale i prostora tj. bolesničke sobe nakon provođenja zaštitne izolacije te kod provođenja protuepidemijskih mjera u slučaju pojave bolničkih epidemija. Tijekom aktivne faze dezinfekcije aparat ispušta vodikov peroksid te u prostoru stvara maglicu koja dezinficira svu opremu i prostor. Jedan ciklus dekontaminacije traje tri sata. Nakon dezinfekcije prostor je siguran za ulazak novog bolesnika i osoblja.
Prednosti su dekontaminacije površina u bolničkoj sredini aparatom koji raspršuje vodikov peroksid neoštećivanje medicinskog pribora i opreme: ne ostavlja rezidue, stoga se može dezinficirati i visokosofisticirana oprema. Provedena kontrola učinkovitosti vodikova peroksida na površinama pokazuje veliku djelotvornost. Sve su površine sterilne u usporedbi s analiziranim nalazima obrisaka površina nakon mehaničkog čišćenja, gdje sporadično zaostaje manji broj patogena. Provođenje procesa dekontaminacije prostora aparatom pokazalo se učinkovitim u kontroli i prevenciji bolničkih infekcija.
Objective: We can observe an increase in incidence and prevalence of patients with aortic valve stenosis
in the general population. The gold standard in aortic valve therapy is aortic valve ...replacement.
Preoperative planning is essential for good outcomes, as the severity of stenosis and calcifications can
sometimes be extremely progressive and even involve the aortic root and ascending aorta. There is not
enough research on comparation of CT scan analysis of aortic valve stenosis and echocardiography
which is the golden standard of disease diagnosis.1-3
Patients and Methods: We have analyzed 88 patients age: 70.01±9.066 (mean±SD); female: n=45, 51.1%.
Among the patients, 12 had bicuspid aortic valve leaflet structure while the rest of the patients (n=76,
86.4%) exhibited TAV stenosis. Degree of aortic stenosis was assessed according to mean pressure
gradient (MPG), peak pressure gradient (PPG), aortic valve area (AVA) indexed aortic valve area (AVAi)
and maximum speed through aortic valve (Vmax). These were compared with calcium score (AVCS)
calculated from CT scan. All of these patients were observed in the operating room during surgery and
valves analyzed after explantation. All of the patients underwent aortic valve replacement.
Results: Average AVCS values (median + IQ range) were 3306.3 (1995.4 – 4820.6) female: 2215 (1463.35
– 3372.85); male: 4093.5 (3133.3 – 5274.4). Average AVCS values for BAV patients were 3063.5 (3323.125 –
4868.9) and 3106.55 (1965.375) – 4780.125) for TAV patients. There were significant correlations between
AVCS and AVAi (Spearman’s ρ=−0.24, P=0.025), PPG (ρ= 0.38, P< 0.001), MPG (ρ= 0.36, P= 0.001) V max (ρ=
0.37, P < 0.001) and gender (ρ= 0.485, P < 0.001) while AVA values showed no significant correlation with
AVCS (ρ= -0.066, P = 0.540). Overall survival was similar not depending of severity of calcifications and
stenosis, however clamp time and surgery time were longer for patients with severely calcified valves
which means calcium scoring as a parameter should also be taken in consideration during preoperative
planning.
Conclusion: Careful preoperative planning is essential for good outcome of surgery, here we have
proven the connection between echocardiography parameters of aortic stenosis and calcium score
calculated by CT scan.
Pregledni rad o najznačajnijem društvenom problemu koji ima za cilj zainteresirati i pokrenuti društvo radi revitalizacije Gorskog kotara, ali na objektivnoj vrijednosti jednoga kraja koji su ...nazivali „Mala Švica“ (mala Švicarska), a danas ga zovu „Zeleno srce Hrvatske“. Slijedom takvih slogana koji idealiziraju jedan kraj, a stvarnost je depopulacija tog područja, pitanje je kako zaustaviti ta negativna kretanja. Odgovor je jednoznačan, treba krenuti od djece.
Main risk factor for the development of chronic obstructive pulmonary disease (COPD) is smoking, although only less than 1/3 of smokers develop clinically manifest COPD. COPD's progressive nature ...with high disability and mortality makes it plausible to detect it as early as possible thus allowing for an early intervention. The only tool for an early diagnosis that could be used on the global scale is spirometry, even though symptoms and deprivation of health related quality of life (HRQoL) precede relevant spirometric changes. Existing HRQoL questionnaires are too complicated or not developed for an early detection of COPD. The aim of our study was to develop a new simple HRQoL tool that will allow (alone or in combination with other markers) early detection of patients with COPD.
A multicenter prospective cohort study recruiting 500 subjects at risk for COPD (smokers/ex-smokers ≥20 pack-years, 40-65 years, both sexes, with no prior diagnosis of COPD) will be carried out in two phases: (1) cross-sectional - development and validation of a new questionnaire; and (2) prospective - follow-up of a cohort of patients at risk for COPD. Subjects were recruited by 25 GPs and assessed for COPD by dedicated pulmonologists in 7 hospital centers using a predefined protocol: HRQoL, history, physical, blood sampling, exhaled breath temperature (EBT), lung function, 6-min walk test (6MWT). Patients without COPD and those in GOLD stage 1 at initial assessment will be reassessed for disease progression by the same pulmonologist after 2 and 5 years.
This is one of the first cohort studies attempting to establish the incidence of COPD in the pre-symptomatic stage before significant end organ damage. We intend to assess the validity, predictability and discriminative power ('healthy' smokers vs. pre-symptomatic phase in newly developed COPD) of newly developed HRQoL tool alone or in combination with other markers; EBT, lung function, 6MWT, genomics, transcriptomics, proteomics). We expect that the results of this study can improve our understanding of the development of COPD, identify some new underlying pathophysiological pathways, and offer to sensitive smokers/ex-smokers new preventive and early intervention measures thus improving the management of COPD.
Clinicaltrial.gov NCT01550679 retrospectively registered February 28, 2012.
Aim To develop and do an initial validation of a new simple
tool (self-administered questionnaire) that would be sensitive
and specific enough to detect early changes in smokers
leading to future ...development of chronic obstructive pulmonary
disease (COPD).
Methods 224 consecutive participants (50.9% women), with
mean ± standard deviation age of 52.3 ± 6.7 years, 37.5 ± 16.7
pack-years smoking history (85.8% active smokers), and no
prior diagnosis of COPD were recruited. The MARKO questionnaire
was self-administered twice; at the general practitioner’s
office and after 2-4 weeks at the tertiary care hospital.
Participants were assessed for COPD by a pulmonologist
after filling in a quality of life (QoL) questionnaires, historytaking,
physical examination, lung function test, 6-minute
walk test, and laboratory tests. They were divided into four
subgroups: “healthy” smokers, symptomatic smokers, and
smokers with mild and moderately severe COPD.
Results Psychometric analyses indicated that the 18-item
questionnaire had a very good internal consistency (Cronbach’s
alpha = 0.91) and test-retest reliability for a four week
period (ρc = 0.89, 95% confidence interval CI 0.85-0.92, Lin’s
concordance). A significant correlations of MARKO scores
were found with two QoL questionnaires; r = 0.69 (P < 0.001)
and r = 0.81 (P < 0.001). Receiver operating characteristic
curve analysis showed an area under the curve of 0.753
(95% CI 0.691-0.808, P < 0.001), with a sensitivity of 71.83%
and specificity of 64.24% to discriminate “healthy” smokers
from other subgroups.
Conclusion Based on psychometric analyses and high convergent
validity correlation with already validated QoL questionnaires,
the newly developed MARKO questionnaire was
shown to be a reliable self-administered short health status
assessment tool.
Successful breastfeeding is not an automatism. Like other behavioral models, breastfeeding experience is forwarded from generation to generation. To analyze the influence of previous generation on ...offspring's breastfeeding. Research was carried out in three general pediatric offices in Croatian towns: Sibenik, Varazdin and Zagreb. Examinees were mothers of preschoolers older than 1 year, and totally 300 mothers were comprised by the questionnaires. Mothers who had been breastfed for longer period (more than 6 mo.) statistically significantly more frequently breastfeed their children over 6 months (chi 2 = 10.4; p = 0.0013), in comparison with mothers who had been breastfed for shorter period (up to 6 mo.). There is no significant difference in children breastfeeding duration (up to 6 mo. vs more than 6 mo.) with regard to whether the mothers lived in autonomous housekeeping, or if they lived in common housekeeping with their mothers, or mothers-in-law (chi 2 = 0.303; p = 0.86; d. f. = 2). The influence of examinees' mothers on decision to breastfeed is more frequently positive (63%) than neutral or negative, while, at the same time, positive influence on decision to breastfeed was exerted by significantly smaller number (40%) of mothers-in-law (chi 2 = 27.87; p < 0.001). The strongest influence on mother's decision to breastfeed was exerted by mass media. In the age of nuclear families, health workers should offer more support to breastfeeding mothers with the aim of achieving successful lactation.
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