Burnout levels among Portuguese family doctors: a nationwide survey

AIM: To characterise the prevalence of burnout syndrome in a sample of family doctors (FDs) working in the Portuguese National Health System. DESIGN: Cross-sectional survey. SETTING: Primary healthcare centres from the 18 continental districts and two archipelagos of Portugal. METHOD: The Portuguese version of the Maslach Burnout Inventory-Human Services Survey was sent to 40 randomly selected healthcare centres and distributed to the FDs employed. Socio-demographic and work-related data were also collected. Participants were classified as having high, average or low levels of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) dimensions of burnout. RESULTS: 371 questionnaires were sent, of which 153 (83 women, age range 29-64 years; response rate 41%) returned. One-quarter (25.3%, 95% CI 18.6% to 33.1%) of FDs scored high for EE, 16.2% (10.7% to 23.2%) for DP and 16.7% (11.1% to 23.6%) for lack of PA. On multivariate analysis, being married, of older age, having many years of practice or working in a personalised healthcare unit tended to be associated with increased burnout components. Men tended to present higher EE and DP but lower lack of PA than women. Finally, the prevalence (95% CI) of burnout ranged between 4.1% (1.5% to 8.6%) and 32.4% (25.0% to 40.6%), depending on the definition used. CONCLUSIONS: High burnout is relatively common among Portuguese FDs. Burnout relief measures should be developed in order to prevent a further increase of burnout syndrome among Portuguese FDs

Phage engineering for the detection of Pseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic Gram-negative bacterium. Due to its high antibiotic resistance and capacity to adapt and survive in hostile conditions, P. aeruginosa is responsible for a wide range of human infections, such as surgical site infections, bacteremia, urinary tract infections, and mostly, pneumonia. In COVID-19 patients, P. aeruginosa is a common co-infecting pathogen, associated with increased disease severity and worse clinical outcomes. Considering the slow turnover of conventional diagnostic methods and the problems associated with the molecular and immunogenic methods, this study aimed at assembling a bioluminescence-based reporter phage for the fast and sensitive detection of P. aeruginosa in clinical care. Phage vB_PaeP_PE3 was genetically engineered using the yeast-based phage engineering platform. The genome of this phage was previously reduced by deleting genes with unknown function, and here, this phage genome was used as a scaffold for the insertion of the NanoLuc® luciferase. The gene encoding NanoLuc was swapped with gene gp55, encoding a hypothetical protein with unknown function. The sensitivity of this phage-based detection system was evaluated through the infection of serial dilutions of P. aeruginosa suspensions with the synthetic phage, and subsequent quantification of luminescence (in relative light units, RLU). Our data showed that the reporter phage was able to reliably detect 10^2 CFU in 1 mL of contaminated sample in less than 8 h. Overall, the NanoLuc-based reporter phage allows for the rapid and sensitive detection and differentiation of viable P. aeruginosa cells using a simple protocol, 45 h faster than culture-dependent approaches. Therefore, this phage-based detection system is a promising alternative to the common methods for the accurate detection of P. aeruginosa in clinical settings.info:eu-repo/semantics/publishedVersio

CT-Proven Ischaemic Stroke as the First Manifestation of Occult Lung Cancer

Cancer is associated with a higher risk of stroke, and in rare cases stroke can be the first manifestation of occult neoplasia. We present the case of a 74-year-old woman hospitalized for ischaemic stroke with multiple cerebral infarctions in several vascular territories. The exclusion of other aetiologies and the simultaneous presence of thromboembolic events in other organs raised the suspicion of a hypercoagulable state, which upon investigation revealed occult neoplasia of the lung. There was rapid deterioration, with recurrent thrombotic events despite anticoagulation, which eventually led to the patient’s death

Fast and sensitive detection of pseudomonas aeruginosa in clinical settings using engineered reporter phages

P. aeruginosa is a bacterial pathogen responsible for a wide range of infections. As a result, the World Health Organization identified it as one of the top priority pathogens that urgently calls for the development of novel treatments. Bacteriophages have emerged as a promising therapeutic approach and their properties can be enhanced by phage-engineering. This opens an extensive variety of possibilities, allowing to assemble chimeric phages with new functions. Considering the slow turnover of conventional diagnostic methods and the problems associated with the molecular and immunogenic methods, this study aimed at assembling a bioluminescence-based reporter phage for the fast and sensitive detection of P. aeruginosa in clinical care. Using the yeast-based phage engineering platform, the phage vB_PaeP_PE3 was genetically modified by removing genes with unknown function (g1-g12) and then used as a scaffold for the insertion of the NanoLuc® luciferase gene that was swapped with gene g53. The assembled reporter phage (vB_PaeP_PE3gp1-gp12,gp53:NLuc) was then used for sensitivity and specificity assays. The detection limit was evaluated through the infection of serial dilutions of P. aeruginosa suspensions with the reporter phage, and subsequent quantification of luminescence. Our data showed that the assembled reporter phage was capable of reliably detect 500 CFU/mL within 7h or an average 1 CFU/mL after 24h, and no false positives were observed. Similar results were also obtained when the reporter phage was tested in blood, being capable of detecting an average of 8 CFU/mL within 24 hours. Overall, compared to culture-dependent methods, the NanoLuc-based reporter phage allows a fast and sensitive detection of P. aeruginosa cells using a simple protocol. Therefore, this phage-based detection system is a promising alternative to the common methods for the accurate detection of P. aeruginosa in clinical settings.info:eu-repo/semantics/publishedVersio

Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance

Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality