Catheter Related Bloodstream Infection (CR-BSI) in ICU Patients: Making the Decision to Remove or Not to Remove the Central Venous Catheter

Background Approximately 150 million central venous catheters (CVC) are used each year in the United States. Catheter-related bloodstream infections (CR-BSI) are one of the most important complications of the central venous catheters (CVCs). Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI. Methods We reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU) from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi quantitative (\u3e15 CFU) culture of a catheter segment from where the same organism was isolated. The conservative method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and one of the following: (1) differential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or (2) simultaneous quantitative blood culture with 5:1 ratio (CVC versus peripheral). Results 53 CR-BSI (37 diagnosed by the standard method and 16 by the conservative method) were diagnosed during the study period. There was a no statistically significant difference in the in-hospital mortality for the standard versus the conservative method (57% vs. 75%, p = 0.208) in ICU patients. Conclusion In our study there was a no statistically significant difference between the standard and conservative methods in-hospital mortality

Malacological survey of Biomphalaria snails in municipalities along the Estrada Real in the southeast of the State of Minas Gerais, Brazil

INTRODUÇÃO: O aumento das práticas de ecoturismo e turismo rural, em Minas Gerais, Brasil, evidencia a importância de se realizarem estudos sobre a ocorrência de hospedeiros intermediários do Schistosoma mansoni, no estado. O presente trabalho objetivou a busca e identificação das espécies de caramujos Biomphalaria encontrados em municípios mineiros pertencentes à Estrada Real, um importante projeto de turismo brasileiro. MÉTODOS: Os moluscos foram coletados em 36 municípios da Estrada Real, no sudeste de Minas Gerais. A pesquisa foi realizada de agosto de 2005 a setembro de 2009 e todos os locais visitados foram georreferenciados com o uso de GPS. RESULTADOS: Dos 36 municípios estudados, 30 apresentaram a ocorrência de pelo menos uma entre as seis espécies de Biomphalaria: glabrata, tenagophila, straminea, peregrina, occidentalis e schrammi. As três primeiras espécies citadas, reconhecidas como hospedeiras intermediárias do S. mansoni, estavam presentes em 33,3%, 47,2% e 8,3% dos municípios estudados, respectivamente. Os moluscos foram encontrados em diferentes tipos de coleções hídricas e em nenhum deles foi detectada infecção pelo S. mansoni. Houve maior ocorrência de Biomphalaria na área referente ao Caminho Novo (Diamantina/MG ao Rio de Janeiro/RJ). CONCLUSÕES: Considerando-se a ocorrência da esquistossomose, no Estado de Minas Gerais, e as repercussões socioeconômicas que envolvem o projeto Estrada Real, este trabalho aponta para a vulnerabilidade das coleções hídricas devido à presença de moluscos Biomphalaria e enfatiza a necessidade de vigilância epidemiológica e medidas educativas e sanitárias integradas com a comunidade local e setores de turismo.INTRODUCTION: The increasing practice of ecotourism and rural tourism in the State of Minas Gerais, Brazil, highlights the importance of studies concerning the occurrence of potential intermediate hosts of Schistosoma mansoni. This study aimed to identify species of Biomphalaria snails in municipalities along the Estrada Real, an important Brazilian tourism project. METHODS: The specimens were collected in different water collections of 36 municipalities along the Estrada Real in the southeast of the State of Minas Gerais. Biomphalaria species were characterized using both morphological and molecular approaches. The research was conducted between August 2005 and September 2009 and all the sites visited were georeferenced using GPS. RESULTS: Six Biomphalaria species were found in 30 of the 36 municipalities studied: glabrata, tenagophila, straminea, peregrina, occidentalis and schrammi. The first three species of Biomphalaria, recognized as intermediate hosts of S. mansoni, were present in 33.3%, 47.2% and 8.3% of the municipalities studied, respectively. The mollusks were found in different types of water collections and no infection by S. mansoni was detected. The highest occurrence of Biomphalaria concentration was verified in the area covered by the Caminho Novo route (Diamantina/MG to Rio de Janeiro/RJ). CONCLUSIONS: Considering the occurrence of schistosomiasis in the State of Minas Gerais and the socioeconomic repercussions involved in the Estrada Real Project, this work focuses on the vulnerability of water collections due to the presence of Biomphalaria mollusks and emphasizes the need for epidemiological surveillance and sanitary and educational measures integrated with the local community and tourism sectors

Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%), "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%), "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%), and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%).CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest

Association of HCV with diabetes mellitus: an Egyptian case-control study

<p>Abstract</p> <p>Background</p> <p>The highest Hepatitis C Virus (HCV) prevalence in the world occurs in Egypt. Several studies from different parts of the world have found that 13% to 33% of patients with chronic HCV have associated diabetes, mostly type II Diabetes Mellitus (DM). In Egypt the prevalence of DM is 25.4% among HCV patients. Therefore, it is important to identify the magnitude of the problem of diabetes in order to optimize the treatment of chronic hepatitis C.</p> <p>Methods</p> <p>The objective of this case-control study was to evaluate the prevalence of DM and other extrahepatic (EH) manifestations among patients with different HCV morbidity stages including asymptomatic, chronic hepatic and cirrhotic patients. In this study, 289 HCV patients older than 18 were selected as cases. Also, 289 healthy controls were included. Laboratory investigations including Liver Function tests (LFT) and blood glucose level were done. Also serological assays including cryoglobulin profile, rheumatoid factor, antinuclear antibody, HCV-PCR were performed.</p> <p>Results</p> <p>Out of 289 HCV cases, 40 (13.84%) were diabetic. Out of 289 healthy controls, 12 (4.15%) were diabetic. It was found that the diabetic HCV group mean age was [48.1 (± 9.2)]. Males and urbanians represented 72.5% and 85% respectively. Lower level of education was manifested in 52.5% and 87.5% were married. In the nondiabetic HCV group mean age was [40.7 (± 10.4)]. Males and urbanians represented 71.5% and 655% respectively. secondary and higher level of education was attained in 55.4% and 76.7% were married. Comparing between the diabetic HCV group and the non diabetic HCV group, age, residence and alcohol drinking were the only significant factors affecting the incidence of diabetes between the two groups. There was no significant difference regarding sonar findings although cirrhosis was more prevalent among diabetic HCV cases and the fibrosis score was higher in diabetic HCV patients than among the non diabetic HCV cases.</p> <p>Conclusion</p> <p>The diabetic patients in the HCV group were older, more likely to have a history of alcohol drinking than the non diabetic HCV cases. Age and alcohol drinking are factors that could potentially contribute to the development of type 2 diabetes. Logistic regression analyses showed that age and residence in urban regions were the predictive variables that could be associated with the presence of diabetes. Alcohol consumption was not a significant predictive factor.</p

The Gender Congruency Effect across languages in bilinguals: A meta-analysis

In the study of gender representation and processing in bilinguals, two contrasting perspectives exist: integrated vs. the autonomous (Costa, Kovacic, Fedorenko, & Caramazza, 2003). In the former, cross-linguistic interactions during the selection of grammatical gender values are expected; in the latter, they are not. To address this issue, authors have typically explored the cross-linguistic Gender Congruency Effect (GCE: a facilitation on the naming or translation of second language [L2] nouns when their first language [L1] translations are of the same gender, in comparison to those of a different gender). However, the literature suggests that this effect is sometimes difficult to observe and might vary as a function of variables such as the syntactic structure produced to translate or name the target (bare nouns vs. noun phrases), the phonological gender transparency of both languages (whether or not they have phonological gender cues associated with the ending letter [e.g., “–a” for feminine words and “–o” for masculine words in Romance languages]), the degree of L2 proficiency, and task requirements (naming vs. translation). The aim of the present quantitative meta-analysis is to examine the robustness of the cross-linguistic GCE obtained during language production. It involves 25 experiments from 11 studies. The results support a bilingual gender-integrated view, in that they show a small but significant GC effect regardless of the variables mentioned above.This paper was funded through the state budget with reference IF / 00784/2013 / CP1158 / CT0013. The study has also been partially supported by the FCT and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). Government of Spain—Ministry of Education, Culture and Sports—through the Training program for Academic Staff (Ayudas para la Formación del Profesorado Universitario, FPU grant BOE-B-2017-2646), the research project (reference PSI2015-65116-P) granted by the Spanish Ministry of Economy and Competitiveness, and the grant for research groups (reference ED431B 2019/2020) from the Galician Government, as well as by the FCT (Foundation for Science and Technology, Portugal) through the state budget (reference IF / 00784/2013 / CP1158 / CT0013). Finally, the study has also been partially supported by the FCT and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653