Implementation of an antibiotic checklist increased appropriate antibiotic use in the hospital on Aruba

Objectives: No interventions have yet been implemented to improve antibiotic use on Aruba. In the Netherlands, the introduction of an antibiotic checklist resulted in more appropriate antibiotic use in nine hospitals. The aim of this study was to introduce the antibiotic checklist on Aruba, test its effectiveness, and evaluate the possibility of implementing this checklist outside the Netherlands. Methods: The antibiotic checklist includes seven quality indicators (QIs) that define appropriate antibiotic use. It applies to adult patients with a suspected bacterial infection, treated with intravenous antibiotics. The primary endpoint was the QI sum score, calculated by the patient’s sum of performed checklist-items divided by the total number of QIs that applied to that specific patient. Outcomes before and after the introduction of the checklist were compared. Results: The percentage of patients with a QI sum score ≥50% increased significantly during the intervention (n = 173) compared to baseline (n = 150) (odds ratio 3.67, p < 0.001). However, performance did not improve on each individual QI. The checklist was used in 63.3% of the eligible patients. Conclusions: The introduction of the antibiotic checklist increased appropriate antibiotic use on Aruba. Additional initiatives are necessary for further improvement per QI. These results suggest that the antibiotic checklist could be used internationally

High rates of transmission of drug-resistant HIV in Aruba resulting in reduced susceptibility to the WHO recommended first-line regimen in nearly half of newly diagnosed HIV-infected patients

Background. In Western countries emergence of human immunodeficiency virus (HIV) drug resistance has tremendously decreased, and transmission of drug resistance has merely stabilized in recent years. However, in many endemic settings with limited resources rates of emerging and transmitted drug resistance are not regularly assessed. Methods. We performed a survey including all HIV-infected individuals who received resistance testing in 2010-2015 in Aruba, a highly endemic HIV area in the Caribbean. Transmitted HIV drug resistance was determined using World Health Organization (WHO) criteria. Transmission dynamics were investigated using phylogenetic analyses. In a subset, baseline samples were re-analyzed using next generation sequencing (NGS). Results. Baseline resistance testing was performed in 104 newly diagnosed untreated individuals (54% of all newly diagnosed individuals in 2010-2015): 86% were men, 39% were foreign-born, and 22% had AIDS at diagnosis. And 33% (95% CI: 24-42%) was infected with a drug-resistant HIV variant. The prevalence of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) reached 45% (95% CI: 27-64%) in 2015, all based on the prevalence of mutation K103N. NGS did not demonstrate additional minority K103N-variants compared to routine resistance testing. K103N-harboring strains were introduced into the therapy-unexposed population via at least 6 independent transmissions epidemiologically linked to the surrounding countries. Virological failure of the WHO-recommended first-line NNRTI-based regimen was higher in the presence of K103N. Conclusions. The prevalence of resistant HIV in Aruba has increased to alarming levels, compromising the WHO-recommended first-line regimen. As adequate surveillance as advocated by the WHO is limited, the Caribbean region could face an unidentified rise of NNRTI-resistant HIV

I nutraceutici nell'area metabolica

Le malattie cardiovascolari (CVD) sono la causa più comune di decesso nei paesi occidentali. Tra i parametri di rischio CVD, la dislipidemia è un fattore rilevante e modificabile: in particolare l’associazione di ipertrigliceridemia, bassi livelli di HDL-C, aumentate concentrazioni di LDL-C piccole e dense e di apoB, viene definita “dislipidemia aterogena” essendo molto pericolosa da un punto di vista metabolico. Le dislipidemie sono condizioni abbastanza diffuse e il loro riconoscimento e trattamento dei pazienti a rischio costituisce un intervento importante sia in prevenzione primaria che secondaria. Le modificazioni dello stile di vita e dell’alimentazione costituiscono la prima linea di intervento ma, quando non è possibile raggiungere i target terapeutici per ridurre il rischio CVD agendo su questi fattori, può apparire utile l’utilizzo di prodotti “nutraceutici”. I nutraceutici sono componenti alimentari attivi, che presentano attività terapeutica e di prevenzione, presenti negli alimenti funzionali ma generalmente utilizzati, a fini terapeutici, sotto forma di loro concentrati (pillole, capsule, fiale). Questa tesi è basata sui risultati di un protocollo di studio della durata di circa 3 anni che prevedeva la valutazione ed il confronto di più nutraceutici in commercio, con differenti concentrazioni di Monacolina K estratta da Riso Rosso Fermentato. L’obiettivo era quello di verificare se fosse presente un effetto dose-dipendente della Monacolina K sui parametri lipido- e glicometabolici in pazienti con Sindrome Metabolica, più specificamente nei dislipidemici e nei diabetici di tipo 2 con dislipidemia

Chikungunya virus infection in Aruba: Diagnosis, clinical features and predictors of post-chikungunya chronic polyarthralgia

BACKGROUND: Chikungunya virus (CHIKV) emerged in Aruba for the first time in 2014. We studied the clinical presentation of acute CHIKV infection and the contribution of serologic and molecular assays to its diagnosis. In a cohort of confirmed CHIKV cases, we analysed the frequency, duration and predictors of post-chikungunya chronic polyarthralgia (pCHIK-CPA), defined as joint pains lasting longer than 6 weeks or longer than 1 year. METHODOLOGY: Patient sera obtained within 10 days of symptom onset were tested for CHIKV, using an indirect immunofluorescence test for the detection of CHIKV-specific Immunoglobulin M (IgM) and post-hoc, by reverse-transcription polymerase chain reaction (RT-PCR). CHIKV was isolated from selected samples and genotyped. For confirmed CHIKV cases, clinical data from chart review were complemented by a Telephone survey, conducted 18-24 months after diagnosis. When joint pain was reported, the duration, presence of inflammatory signs, type and number of joints affected, were recorded. Joint involvement was scored according to the 2010 'American College of Rheumatology/ European League Against Rheumatism' criteria for seronegative rheumatoid arthritis (ACR-score). Risk factors for pCHIK-CPA were identified by logistic regression. PRINCIPAL FINDINGS: Acute CHIKV infection was diagnosed in 269 of 498 sera, by detection of IgM (n = 105), by RT-PCR (n = 59), or by both methods (n = 105). Asian genotype was confirmed in 7 samples. Clinical data were complete for 171 of 248 (69.0%) patients, aged 15 years or older (median 49.4 [35.0-59.6]). The female-to-male ratio was 2.2. The main acute symptoms were arthralgia (94%), fever (85%), myalgia (85%), headache (73%) and rash (63%). In patients with arthralgia (n = 160), pCHIK-CPA longer than 6 weeks was reported by 44% and longer than 1 year by 26% of cases. Inflammatory signs, stiffness, edema and redness were frequent (71%, 39% and 21%, respectively). Joints involved were knees (66%), ankles (50%), fingers (52%), feet (46%), shoulders (36%), elbows (34%), wrists (35%), hips (31%), toes (28.1%) and spine (28.1%). Independent predictors of pCHIK-CPA longer than 1 year were female gender (OR 5.9, 95%-CI [2.1-19.6]); high ACR-score (7.4, [2.7-23.3]), and detection of CHIKV-RNA in serum beyond 7 days of symptom onset (6.4, [1.4-34.1]. CONCLUSIONS: We identified 269 CHIKV patients after the first outbreak of Asian genotype CHIKV in Aruba in 2014-2015. RT-PCR yielded 59 (28%) additional CHIKV diagnoses compared to IgM antibody detection alone. Arthralgia, fever and skin rash were the dominant acute phase symptoms. pCHIK-CPA longer than 1 year affected 26% of cases and was predicted by female gender, high ACR-score and CHIKV-RNA detection beyond 7 days of symptom onset.status: publishe

Number of samples collected for chikungunya diagnostics per epidemiological week, during the outbreak in Aruba from October 2014 –March 2015 (n = 498).

<p>Note: epiweek 6 and 7 coincided with Carnival, Aruba’s public holiday.</p

Pattern of joint involvement, inflammatory symptoms and pain duration in chikungunya virus infected patients presenting with arthralgia (n = 160).

<p>Pattern of joint involvement, inflammatory symptoms and pain duration in chikungunya virus infected patients presenting with arthralgia (n = 160).</p

Characteristics of 171 patients with confirmed chikungunya infection.

<p>Characteristics of 171 patients with confirmed chikungunya infection.</p

Risk factors for chikungunya virus-associated long-term polyarthralgia (n = 160).

<p>Risk factors for chikungunya virus-associated long-term polyarthralgia (n = 160).</p