Laboratory aid to the diagnosis and therapy of infection in the neonate

Despite the advances in perinatal and neonatal care and use of newer potent antibiotics, the incidence of neonatal sepsis remains high and the outcome is still severe. For years, investigators have sought a test or panel of tests able to identify septic neonates accurately and rapidly in order to obtain an early diagnosis and develop a specific effective treatment for a successful outcome. In addition to the standard procedures (blood, CSF, and urine cultures), such panels have included a combination of haematological investigations (total, differential and immature cell counts), and levels of acute-phase reactants (principally CRP and procalcitonin), and cytokines (such as IL-6 or neutrophil CD64). Furthermore, the science of proteomics and genomics has been applied to the search for bio-markers, production of protein profiles and genetic polymorphisms that can rapidly help the prediction, early diagnosis, and treatment of human diseases, but, for now, data are as yet insufficient to confirm their validity

Situación epidemiológica de la tuberculosis en la Región Sanitaria V de la provincia de Buenos Aires : Años 2000-2011

La tuberculosis (TB) en la República Argentina permanece como un tema prioritario de salud, siendo afectados principalmente los adultos jóvenes. Este trabajo tuvo como objetivo conocer la situación epidemiológica de la TB en la Región Sanitaria V (RSV), zona norte de la Provincia de Buenos Aires. Se realizó un análisis descriptivo de los datos de vigilancia a partir de un estudio de tendencias. Las tendencias calculadas se expresaron como variación anual promedio (VAP). Una VAP con signo negativo significa descenso. Cuando la declinación de la TI es menor al 5%, no resulta significativa estadísticamente, y corresponde a un Indicador de Alarma (IA) que deberá evaluarse junto a otros IA. Se analizaron el número de casos notificados y tasas de incidencia (TI) por 100.000 habitantes de todas las formas de TB, los casos de TB pulmonar (TBP) y TBP confirmados por bacteriología y por grupos de edad: 0- 14 (desagregados en dos subgrupos: 0-4 y 5-14); 15- 29 y mayores de 64 años, entre el 1º de enero de 2.000 al 31 de diciembre de 2.011. El estudio de tendencia mostró una VAP -2.71% para todas las formas de TB y -2.05% en los casos de TBP. Los de TBP y las TI más elevadas, se concentraron en el grupo de 15 a 29 años (VAP -0.44%) y con tendencia estable o ligeramente ascendente en la TBP confirmada bacteriológicamente en este grupo de edad (VAP +0.92%). El mismo comportamiento presentaron los casos de tuberculosis infantil pulmonar (TBIP) con confirmación bacteriológica (+2.0%). En cambio, la TI de la TBP y TBP confirmada bacteriológicamente en el grupo mayor de 64 años presentaron tendencia neta al descenso, -4.70% y -4.01% respectivamente. La persistencia de fuentes bacilíferas en la comunidad, la deficiente adhesión al tratamiento antituberculoso que no logra la meta definida por la Organización Mundial de la Salud (OMS), de curar por lo menos el 90% de los casos, la indicación de esquemas inadecuados o tratamientos irregulares sin la adecuada supervisión, pueden considerarse como principales causas que explican la presencia de tasas superiores entre las personas más jóvenes. La tardanza en el diagnóstico de las fuentes infecciosas y sin curación, conlleva a la aparición de nuevos casos de TB. Si existe un control adecuado de la enfermedad, el predominio de los casos ocurre entre los ancianos, siendo la causa fundamental en la producción de la enfermedad, la reactivación endógena de una infección en el pasado. La TB se mantiene como un riesgo de salud en la RSV, con persistencia de condiciones para la producción de nuevos casos por nuevas infecciones y que se asocian cuando no se ha logrado controlar la transmisión. Las medidas implementadas, no han producido el cambio necesario para el control de la TB, siendo necesario fortalecer e intensificar las intervenciones programáticas recomendadas para su control.Facultad de Ciencias Médica

mHealth intervention development to support patients with active tuberculosis

Background: Mobile Health (mHealth) based interventions have been increasingly used to improve a broad range of health outcomes. However, few researchers have reported on the process or the application of theory to guide the development of mHealth based interventions, or specifically for tuberculosis (TB) treatment management. Aims: To describe the steps, process, and considerations in developing a text messaging-based intervention to promote treatment adherence and provide support to patients with active TB. Methods: Traditional qualitative techniques, including semi-structured interviews, field notes, content analysis, iterative coding, and thematic analysis, were used to design and document the intervention development with a multidisciplinary team of researchers, clinicians, administrators, and patients who were in active TB treatment. The Information-Motivation-Behavioral Skills (IMB) model was used to guide the coding scheme for content analysis of patient-directed TB educational material and intervention development. Results: The development steps included: a) establishing intervention components, including justifications, considerations, timing and frequency of components; b) developing educational messages, including cultural adaption, text or short message service (SMS) formatting, and prioritizing message delivery order; and c) determining implementation protocol. A set of 16 IMB-based messages were developed for the educational component. Final intervention development was achieved in 3 months. Conclusion: A collaborative approach and application of a theory to guide the intervention design and development is supported. Although a collaborative approach was more time consuming, it resulted in a more responsive, culturally appropriate, and comprehensive intervention. Considerations for developing a text messaging based intervention are provided and may serve as a guide for similar interventions. Further empirical evidence is needed for applying the IMB model for adherence-promotion in TB efforts

A psychometric evaluation of the Italian short version of the Fear of Pain Questionnaire-III: Psychometric properties, measurement invariance across gender, convergent, and discriminant validity

IntroductionThe Fear of Pain Questionnaire-III (FPQ-III) is a self-assessment instrument developed specifically to measure fear based on various pain stimuli converging on three factors: severe pain, medical pain, and minor pain. It actually remains the most studied and internationally used tool even in its short versions. The aim of this work was to propose a new validation study oriented to confirm the good psychometric properties of a short model of the FPQ-III for the Italian context.MethodsA large sample of participants was recruited (n  = 1,064) and Exploratory Factor Analysis (EFA) as well as Confirmatory Factor Analysis (CFA) were performed. Measurement invariance of the FPQ-III across gender was also evaluated. In order to examine convergent validity, a further convenient sample (n  = 292) was used and variables related to the individual’s pain experience, locus of control and coping orientations were assessed. A final discriminant assessment using experimental manipulation through fear eliciting videos was performed.ResultsThe three factors structure of the 13-item version of the questionnaire was confirmed (χ2 = 148.092, CFI = 0.971, TLI = 0.962, RMSEA = 0.046, RMSEA 90% CI = 0.037–0.056) as well as the measurement invariance across gender. Item internal reliability was satisfactory. The results provided evidence of the good predictive validity of the FPQ-III and the discriminant assessment demonstrated that the instrument is suitable in detecting changes in fear of pain induced by specific situational conditions.DiscussionThe scale in this short version is suitable for quickly and efficiently gathering information about the perceived intensity of such anticipatory fears that might affect even the healthy person dysfunctionally

Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk

Off-label long acting injectable antipsychotics in real-world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction Information on the off-label use of Long-Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on- vs off-label LAIs and predictors of off-label First- or Second-Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off- or on-label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off-label group. Results SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on- and off-label use. Approximately 1 in 4 patients received an off-label prescription. In the off-label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off-label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co-morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns