Genome-wide study of association and interaction with maternal cytomegalovirus infection suggests new schizophrenia loci.

Genetic and environmental components as well as their interaction contribute to the risk of schizophrenia, making it highly relevant to include environmental factors in genetic studies of schizophrenia. This study comprises genome-wide association (GWA) and follow-up analyses of all individuals born in Denmark since 1981 and diagnosed with schizophrenia as well as controls from the same birth cohort. Furthermore, we present the first genome-wide interaction survey of single nucleotide polymorphisms (SNPs) and maternal cytomegalovirus (CMV) infection. The GWA analysis included 888 cases and 882 controls, and the follow-up investigation of the top GWA results was performed in independent Danish (1396 cases and 1803 controls) and German-Dutch (1169 cases, 3714 controls) samples. The SNPs most strongly associated in the single-marker analysis of the combined Danish samples were rs4757144 in ARNTL (P=3.78 × 10(-6)) and rs8057927 in CDH13 (P=1.39 × 10(-5)). Both genes have previously been linked to schizophrenia or other psychiatric disorders. The strongest associated SNP in the combined analysis, including Danish and German-Dutch samples, was rs12922317 in RUNDC2A (P=9.04 × 10(-7)). A region-based analysis summarizing independent signals in segments of 100 kb identified a new region-based genome-wide significant locus overlapping the gene ZEB1 (P=7.0 × 10(-7)). This signal was replicated in the follow-up analysis (P=2.3 × 10(-2)). Significant interaction with maternal CMV infection was found for rs7902091 (P(SNP × CMV)=7.3 × 10(-7)) in CTNNA3, a gene not previously implicated in schizophrenia, stressing the importance of including environmental factors in genetic studies

Habilidades gerenciales y desempeño laboral del personal asistencial de la Microred Ocobamba, Apurímac, 2022

Las habilidades gerenciales son un conjunto de capacidades y conocimientos de una persona para coordinar y dirigir la fuerza de trabajo en la organización, mientras que el desempeño laboral es la eficacia del personal que trabaja dentro de las organizaciones, el objetivo del presente trabajo es establecer la influencia de las Habilidades Gerenciales en el Desempeño Laboral del personal asistencial de la Microred Ocobamba, Apurímac, 2022, investigación de enfoque Cuantitativo, Descriptivo, Correlacional. La muestra de la investigación está constituida por 89 profesionales de la salud que laboran en la Microred Ocobamba, Apurímac, 2022. Como técnica de recolección la encuesta y como instrumento un cuestionario de habilidades gerenciales de Vera (2007), y otro cuestionario de desempeño laboral de Aliaga (2011). Resultados: variable habilidades sociales es regular en un 65.2% y alta con un 34,8%, desempeño laboral regular en un 71,9% y de alto nivel con un 28,1%,en resultados de correlación, existe relación directa entre las Habilidades gerenciales y el desempeño laboral en el personal profesional de la microred Ocobamba, Apurímac, 2022 (rho= 0,540; 0,000), existe relación directa entre las Habilidades técnicas y el desempeño laboral en el personal profesional de la Microred Ocobamba, Apurímac, 2022 (rho= 0,351; 0,001), existe relación directa entre las Habilidades humanas y el desempeño laboral en el personal profesional de la Microred Ocobamba, Apurímac, 2022 (rho= 0,542; 0,000), existe relación directa entre las Habilidades conceptuales y el desempeño laboral en el personal profesional de la Microred Ocobamba, Apurímac, 2022 (rho=0,442; 0,000), con lo que se concluye que existe relación directa entre las Habilidades gerenciales y el desempeño laboral en el personal profesional de la microred Ocobamba, Apurímac, 2022

Modos discontinuos y erráticos de transitar un hospital especializado en salud mental y adicciones de la Ciudad de Buenos Aires: la mirada de profesionales de la salud

The purpose of this study was to describe the perspective of health professionals regarding the discontinuous and erratic clinical trajectories of individuals with problematic substance use at a hospital specialized in mental health and addiction in the City of Buenos Aires. From October 2017 to October 2018, a qualitative exploratory study was carried out based on six case studies recovered from previous research. Medical records were analyzed and semi-structured interviews were conducted with the professionals involved. Among the principal results, we found that the definition of erratic clinical trajectories formulated was not very descriptive of the course of some cases, leading us to propose a new concept, that of the segment (el tramo). This concept accounts for the moment in which the clinical trajectory is sustained, even if that entails switching to a different health service. With respect to objectives and therapeutic strategies, we found a clear difficulty on the part of professionals to name and describe them. Lastly, we found alarmingly little systematization of in-hospital referrals among mental health treatment teams, compared to clinical medical consultations and referrals to other health care providers.El objetivo fue describir la perspectiva de las y los profesionales de la salud sobre los recorridos clínicos erráticos de personas con consumos problemáticos de sustancias que asistían a un hospital monovalente de la Ciudad de Buenos Aires, especializado en salud mental y adicciones. Entre octubre de 2017 y octubre de 2018, se realizó una investigación cualitativa de carácter exploratorio, basada en seis estudios de casos que se reponen desde una investigación previa. Para ello, se trabajó con la lectura y el análisis de historias clínicas y entrevistas semiestructuradas a las y los profesionales intervinientes. Entre los principales resultados se encontró que la definición de recorrido clínico errático resultaba poco descriptiva del recorrido de algunas personas usuarias de los dispositivos, por lo que se apeló a un nuevo concepto: el tramo. Esta noción recupera el momento en que la trayectoria se sostiene, aunque implique el pasaje por un dispositivo diferente. Con relación a los objetivos y las estrategias terapéuticas, se relevó una notoria dificultad, tanto para nombrarlos como para delimitarlos. Finalmente resultó llamativa la poca sistematización de las derivaciones intrahospitalarias entre equipos tratantes de salud mental, en comparación a las interconsultas médicas clínicas y derivaciones a otros efectores de salud

A Critical Review of Oxazolidinones: An Alternative or Replacement for Glycopeptides and Streptogramins?

OBJECTIVE: To review the available data on the oxazolidinones linezolid and eperezolid. DATA SELECTION: Published reports were obtained by searching MEDLINE for articles published between 1992 and 2000, inclusive. References of published papers were also obtained and reviewed. Abstracts from scientific proceedings were reviewed. DATA EXTRACTION: Due to the limited data available regarding these agents, the criteria for study inclusion were not restrictive. DATA SYNTHESIS: The oxazolidinones (eg, linezolid) are a new antimicrobial class with a unique mechanism of action. They are active against resistant Gram-positive cocci including methicillin-susceptible and -resistant Staphylococcus aureus (MRSA), methicillin-susceptible and -resistant Staphylococccus epidermidis, vancomycin-resistant enterococci (VRE) and penicillin-resistant Streptococcus pneumoniae (PRSP). Linezolid is active against anaerobes and displays modest activity against fastidious Gram-negative pathogens such as Haemophilus influenzae, but is not active against Enterobacteriaceae. Linezolid is available both orally and parenterally, and has a bioavailability of 100%. Clinical trials comparing linezolid with standard therapy have demonstrated similar bacteriological and clinical cures rates to standard therapy in community- and hospital-acquired pneumonia, uncomplicated and complicated skin and soft tissue infections, and infections caused by MRSA and VRE. Adverse effects have been minor and infrequent; however, platelets should be monitored in patients who have received more than two weeks of linezolid therapy. It is expected that these agents will have a bright future due to their excellent spectrum of activity against antibiotic-resistant Gram-positive organisms, such as MRSA, VRE and PRSP, and their excellent bioavailability. CONCLUSION: The oxazolidinones represent a new class of antimicrobials with a unique mechanism of action. They have excellent activity against susceptible and resistant Gram-positive organisms such as MRSA, methicillin-susceptible S epidermidis, VRE and PRSP, and a good adverse effect profile; they can be administered both intravenously and orally. Their potential use in Canada may be as an intravenous and oral alternative to glycopeptides and streptogramins

A Critical Review of Oxazolidinones: An Alternative or Replacement for Glycopeptides and Streptogramins?

OBJECTIVE: To review the available data on the oxazolidinones linezolid and eperezolid.DATA SELECTION: Published reports were obtained by searching MEDLINE for articles published between 1992 and 2000, inclusive. References of published papers were also obtained and reviewed. Abstracts from scientific proceedings were reviewed.DATA EXTRACTION: Due to the limited data available regarding these agents, the criteria for study inclusion were not restrictive.DATA SYNTHESIS: The oxazolidinones (eg, linezolid) are a new antimicrobial class with a unique mechanism of action. They are active against resistant Gram-positive cocci including methicillin-susceptible and -resistant Staphylococcus aureus (MRSA), methicillin-susceptible and -resistant Staphylococccus epidermidis, vancomycin-resistant enterococci (VRE) and penicillin-resistant Streptococcus pneumoniae (PRSP). Linezolid is active against anaerobes and displays modest activity against fastidious Gram-negative pathogens such as Haemophilus influenzae, but is not active against Enterobacteriaceae. Linezolid is available both orally and parenterally, and has a bioavailability of 100%. Clinical trials comparing linezolid with standard therapy have demonstrated similar bacteriological and clinical cures rates to standard therapy in community- and hospital-acquired pneumonia, uncomplicated and complicated skin and soft tissue infections, and infections caused by MRSA and VRE. Adverse effects have been minor and infrequent; however, platelets should be monitored in patients who have received more than two weeks of linezolid therapy. It is expected that these agents will have a bright future due to their excellent spectrum of activity against antibiotic-resistant Gram-positive organisms, such as MRSA, VRE and PRSP, and their excellent bioavailability.CONCLUSION: The oxazolidinones represent a new class of antimicrobials with a unique mechanism of action. They have excellent activity against susceptible and resistant Gram-positive organisms such as MRSA, methicillin-susceptible S epidermidis, VRE and PRSP, and a good adverse effect profile; they can be administered both intravenously and orally. Their potential use in Canada may be as an intravenous and oral alternative to glycopeptides and streptogramins.Peer Reviewe

IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023)

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the management and prevention of diabetes-related foot diseases since 1999. The present guideline is an update of the 2019 IWGDF guideline on the diagnosis and management of foot infections in persons with diabetes mellitus. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used for the development of this guideline. This was structured around identifying clinically relevant questions in the P(A)ICO format, determining patient-important outcomes, systematically reviewing the evidence, assessing the certainty of the evidence, and finally moving from evidence to the recommendation. This guideline was developed for healthcare professionals involved in diabetes-related foot care to inform clinical care around patient-important outcomes. Two systematic reviews from 2019 were updated to inform this guideline, and a total of 149 studies (62 new) meeting inclusion criteria were identified from the updated search and incorporated in this guideline. Updated recommendations are derived from these systematic reviews, and best practice statements made where evidence was not available. Evidence was weighed in light of benefits and harms to arrive at a recommendation. The certainty of the evidence for some recommendations was modified in this update with a more refined application of the GRADE framework centred around patient important outcomes. This is highlighted in the rationale section of this update. A note is also made where the newly identified evidence did not alter the strength or certainty of evidence for previous recommendations. The recommendations presented here continue to cover various aspects of diagnosing soft tissue and bone infections, including the classification scheme for diagnosing infection and its severity. Guidance on how to collect microbiological samples, and how to process them to identify causative pathogens, is also outlined. Finally, we present the approach to treating foot infections in persons with diabetes, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and bone infections; when and how to approach surgical treatment; and which adjunctive treatments may or may not affect the infectious outcomes of diabetes-related foot problems. We believe that following these recommendations will help healthcare professionals provide better care for persons with diabetes and foot infections, prevent the number of foot and limb amputations, and reduce the patient and healthcare burden of diabetes-related foot disease

Mycobacterium intermedium Granulomatous Dermatitis from Hot Tub Exposure

Nontuberculous mycobacteria, which are widespread in the environment, frequently cause opportunistic infections in immunocompromised patients. We report the first case of a patient with chronic granulomatous dermatitis caused by a rarely described organism, Mycobacterium intermedium. The infection was associated with exposure in a home hot tub