Checklist implementation in catheterization laboratory

-Introducción: El Checklist (CL) ha demostrado ser una herramienta que permite resumir información, disminuir los errores y mejorar los estándares de calidad, tanto en los procedimientos quirúrgicos como en la práctica clínica. -Objetivos: evaluar el cumplimiento de un CL adaptao a una sala de hemodinámica en los pacientes sometidos a procedimientos de cardiología intervencionista. -Materiales y métodos: diseño descriptivo transversal realizado en un hospital terciario. Se incluyeron consecutivamente a 400 pacientes sometidos a un procedimiento intervencionista desde noviembre del 2014 a febrero de 2015 y se llevó a cabo utilizando un cuestionario adaptado de la Organización Mundial de la Salud. -Resultado: el 70% fueron hombres con una media inferior a las mujeres. El diagnóstico de cardiopatía isquémica fue el más frecuente (64%), con una mayor prevalencia en varones (71% vs. 29%; p<0,0001) y en trasplantados cardiacos (92% vs. 8%; p=0,02). El acceso vascular de elección fue la vía femoral (64,5%). En más de un cuarto de los CL faltaban 4 o más ítems sin rellenar. El CL se cumplimentó íntegramente en un 18,5%. - Conclusiones: el CL es un registro útil para la consecucion de los acontecimientos; permite identificar situaciones de riesgo y eventos adversos. Los ítems del CL no registrados pueden deberse a la falta de conocimientos y de motivación, por lo que es necesario implementar estrategias para mejorar el cumplimiento de las prácticas recomendadas y para la seguridad de los pacientes.-Introduction: the checklist (CL) has proven to be a tool that allows to summarize information, reduce errors and improve quality standards both in surgical procedures and in clinical practice. -Objectives: to evaluate compliance with a CL adapted to a catheterazation laboratory in patients undergoing interventional cardiology procedures. - Material and methods: cross-sectional descriptive design conducted at a tertirary care hospital. Four hundrer patients who had underwent an interventional procedure from November 2014 to February 2015 were consecutively included therein, and it was carried out with the use of an adapted questionnaire from the World Health Organization (WHO). -Results: 70% were men with a mean age lower thanh women. Ischemic heart disease was the most frequent diagnosis (64%), with a higher prevalence in males (71% vs. 29%; p<0.0001) and in heart-transplanted patients (92% vs. 8%; p=0.02). The vascular approach of choice was the femoral one (64.5%). In more than a quarter of the CLs, 4 or more items remained uncompleted. The CL was completely complied with in a 18.5%. -Conclusion: the CL is a useful recording system for the achievement of the procedures; it allows to identify risk situations and adverse events. Unrecorded CL items may be due to the lack of knowledge and motivation, whereby approaches should be implemented in order to improve the compliance with the recommended practices and for patients' safety

The effect of early treatment with ivermectin on viral load, symptoms and humoral response in patients with non-severe COVID-19: A pilot, double-blind, placebo-controlled, randomized clinical trial.

Background Ivermectin inhibits the replication of SARS-CoV-2 in vitro at concentrations not readily achievable with currently approved doses. There is limited evidence to support its clinical use in COVID-19 patients. We conducted a Pilot, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of a single dose of ivermectin reduce the transmission of SARS-CoV-2 when administered early after disease onset. Methods Consecutive patients with non-severe COVID-19 and no risk factors for complicated disease attending the emergency room of the Clínica Universidad de Navarra between July 31, 2020 and September 11, 2020 were enrolled. All enrollments occurred within 72 h of onset of fever or cough. Patients were randomized 1:1 to receive ivermectin, 400 mcg/kg, single dose (n = 12) or placebo (n = 12). The primary outcome measure was the proportion of patients with detectable SARS-CoV-2 RNA by PCR from nasopharyngeal swab at day 7 post-treatment. The primary outcome was supported by determination of the viral load and infectivity of each sample. The differences between ivermectin and placebo were calculated using Fisher's exact test and presented as a relative risk ratio. This study is registered at ClinicalTrials.gov: NCT04390022. Findings All patients recruited completed the trial (median age, 26 [IQR 19-36 in the ivermectin and 21-44 in the controls] years; 12 [50%] women; 100% had symptoms at recruitment, 70% reported headache, 62% reported fever, 50% reported general malaise and 25% reported cough). At day 7, there was no difference in the proportion of PCR positive patients (RR 0·92, 95% CI: 0·77-1·09, p = 1·0). The ivermectin group had non-statistically significant lower viral loads at day 4 (p = 0·24 for gene E; p = 0·18 for gene N) and day 7 (p = 0·16 for gene E; p = 0·18 for gene N) post treatment as well as lower IgG titers at day 21 post treatment (p = 0·24). Patients in the ivermectin group recovered earlier from hyposmia/anosmia (76 vs 158 patient-days; p < 0.001). Interpretation Among patients with non-severe COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 72 h of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of self-reported anosmia/hyposmia, a reduction of cough and a tendency to lower viral loads and lower IgG titers which warrants assessment in larger trials. Funding ISGlobal, Barcelona Institute for Global Health and Clínica Universidad de Navarra

Prediction of poor outcome in clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle

Producción CientíficaClassification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thresholds (Ct) were independently associated with poor outcome CDI. Our objective was to perform a multicentre external validation of a PCR-toxin B Ct as a marker of poor outcome CDI. We carried out a multicentre study (14 hospitals) in which the characteristics and outcome of patients with CDI were evaluated. A subanalysis of the results of the amplification curve of real-time PCR gene toxin B (XpertTM C. difficile) was performed. A total of 223 patients were included. The median age was 73.0 years, 50.2% were female, and the median Charlson index was 3.0. The comparison of poor outcome and non–poor outcome CDI episodes revealed, respectively, the following results: median age (years), 77.0 vs 72.0 (p = 0.009); patients from nursing homes, 24.4% vs 10.8% (p = 0.039); median leukocytes (cells/μl), 10,740.0 vs 8795.0 (p = 0.026); and median PCR-toxin B Ct, 23.3 vs 25.4 (p = 0.004). Multivariate analysis showed that a PCR-toxin B Ct cut-off <23.5 was significantly and independently associated with poor outcome CDI (p = 0.002; OR, 3.371; 95%CI, 1.565–7.264). This variable correctly classified 68.5% of patients. The use of this microbiological marker could facilitate early selection of patients who are at higher risk of poor outcome and are more likely to benefit from newer and more costly therapeutic options

Magnetic and electronic properties of RNiO₃ (R = Pr, Nd, Eu, Ho and Y) perovskites studied by resonant soft x-ray magnetic powder diffraction

Soft x-ray resonant magnetic powder diffraction of the $(\frac {1}{2}~0~\frac {1}{2})$ reflection at the Ni L₂, ₃ edges is used to study the magnetic and electronic properties of a series of RNiO₃ materials (with R = Pr, Nd, Eu, Ho and Y) below the metal–insulator transition. The polarization and energy dependence of the reflection gives further support for a non-collinear magnetic structure and charge disproportionation in the whole RNiO₃ series. Only small changes in the spectra of the magnetic $(\frac {1}{2}~0~\frac {1}{2})$ reflection and in the absorption spectra could be detected. The results are discussed with comparison to charge transfer multiplet calculations. Our results emphasize that the lighter and heavier RNiO₃ compounds are very similar from the point of view of their local electronic and magnetic state despite the strong change of the metal-to-insulator transition temperature

Influencia del criterio de selección de pacientes para la toma de frotis en la estimación de la efectividad de la vacuna antigripal

Objetivo: Estimar la efectividad de la vacuna antigripal según el criterio de selección en la toma de frotis. Método: Estudio de casos y controles de casos confirmados (n = 909) y controles negativos para gripe (n = 732) en las temporadas 2010-2011 a 2012-2013 en Navarra. La efectividad ajustada de la vacuna se estimó incluyendo todos los frotis de pacientes con síndrome gripal y seleccionando sólo los dos primeros por médico y semana. Resultados: Los dos primeros pacientes por médico y semana estaban menos vacunados (7,9% frente a 12,5%, p = 0,021) y se confirmaron menos para gripe (53,6% frente a 66,4%, p <0,001), diferencias que se redujeron al ajustar por covariables. La efectividad de la vacuna calculada con todos los frotis fue del 49% (intervalo de confianza del 95% [IC95%]: 23-66%) y del 55% (IC95%: 27-72%) al analizar los dos primeros frotis semanales. Conclusión: La selección de los primeros pacientes semanales puede sesgar la efectividad de la vacuna antigripal, aunque en las temporadas analizadas este sesgo fue pequeño

HCV Diagnosis and Sequencing Using Dried Blood Spots from Patients in Kinshasa (DRC): A Tool to Achieve WHO 2030 Targets

The World Health Organization has established an elimination plan for hepatitis C virus (HCV) by 2030. In Sub-Saharan Africa (SSA) access to diagnostic tools is limited, and a number of genotype 4 subtypes have been shown to be resistant to some direct-acting antivirals (DAAs). This study aims to analyze diagnostic assays for HCV based on dried blood spots (DBS) specimens collected in Kinshasa and to characterize genetic diversity of the virus within a group of mainly HIV positive patients. HCV antibody detection was performed on 107 DBS samples with Vidas® anti-HCV and Elecsys anti-HCV II, and on 31 samples with INNO-LIA HCV. Twenty-six samples were subjected to molecular detection. NS3, NS5A, and NS5B regions from 11 HCV viremic patients were sequenced. HCV seroprevalence was 12.2% (72% with detectable HCV RNA). Both Elecsys Anti-HCV and INNO-LIA HCV were highly sensitive and specific, whereas Vidas® anti-HCV lacked full sensitivity and specificity when DBS sample was used. NS5B/NS5A/NS3 sequencing revealed exclusively GT4 isolates (50% subtype 4r, 30% 4c and 20% 4k). All 4r strains harbored NS5A resistance-associated substitutions (RAS) at positions 28, 30, and 31, but no NS3 RAS was detected. Elecsys Anti-HCV and INNO-LIA HCV are reliable methods to detect HCV antibodies using DBS. HCV subtype 4r was the most prevalent among our patients. RASs found in subtype 4r in NS5A region confer unknown susceptibility to DAA