Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India

SummaryObjectiveTo evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach on central line-associated bloodstream infection (CLABSI) rates in eight cities of India.MethodsThis was a prospective, before-and-after cohort study of 35650 patients hospitalized in 16 adult intensive care units of 11 hospitals. During the baseline period, outcome surveillance of CLABSI was performed, applying the definitions of the CDC/NHSN (US Centers for Disease Control and Prevention/National Healthcare Safety Network). During the intervention, the INICC approach was implemented, which included a bundle of interventions, education, outcome surveillance, process surveillance, feedback on CLABSI rates and consequences, and performance feedback. Random effects Poisson regression was used for clustering of CLABSI rates across time periods.ResultsDuring the baseline period, 9472 central line (CL)-days and 61 CLABSIs were recorded; during the intervention period, 80898 CL-days and 404 CLABSIs were recorded. The baseline rate was 6.4 CLABSIs per 1000 CL-days, which was reduced to 3.9 CLABSIs per 1000 CL-days in the second year and maintained for 36 months of follow-up, accounting for a 53% CLABSI rate reduction (incidence rate ratio 0.47, 95% confidence interval 0.31–0.70; p=0.0001).ConclusionsImplementing the six components of the INICC approach simultaneously was associated with a significant reduction in the CLABSI rate in India, which remained stable during 36 months of follow-up

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Volunteerism - Sowing seeds early

Volunteerism is a concept of social activity that is based on the philosophy of free will. The seeds of volunteerism need to be sown early in life to ensure that the future generations are empowered for social advocacy. This article throws light on the concept of volunteerism and its implications for social accountability of learners

A PROSPECTIVE STUDY EVALUATING PATIENT REPORTED OUTCOME MEASURES IN PATIENTS WHO HAVE UNDERGONE CHEST WALL PERFORATOR FLAPS

SUMMARY AIMS To evaluate Patient Reported Outcome Measures (PROMs) and surgical outcomes in patients undergoing Chest Wall Perforator Flaps (CWPFs). METHODS This was an observational single cohort study using an audit approach and a survey instrument. 84 patients who had undergone CWPFs in the last 5 years at the Department of Breast Surgery, City Hospital Birmingham, were identified from a pre-existing database. Surgical outcomes were recorded. Patients were contacted telephonically or in person at the time of follow up and were asked to fill up a PROMs questionnaire. RESULTS Out of 84 patients, 58 patients chose to respond. The average age of the patients was 51.3 years (± 8.2 years). The average follow up was 15.4 months (± 9.9 months). The most common histological subtype was Infiltrating ductal carcinoma (IDC)- Not otherwise specified 34/58 (58.6%). Majority of the patients had T2 cancers- 28/58 (48.3%). 26/58 (44.8%) were node negative. Eight patients (13.7%) had post-operative complications. No patient had total/partial flap loss. Nine patients (15.5%) had margin re-excision. One patient developed distant metastasis while 1 patient developed a second primary. Fifty-one patients (88%) were either satisfied or very satisfied with the post-operative appearance of the breasts. Thirty-six patients (62%) had no/little persistent pain or tenderness post-surgery. Eighty-six per cent (38/44) of the patients undergoing Lateral Intercostal Artery Perforator (LICAP) Flap and 16/18 (89%) of patients undergoing Anterior Intercostal Artery Perforator (AICAP) flap had no/little difficulty in carrying out normal activities at follow up. CONCLUSION CWPFs are associated with a low complication rate and a high patient satisfaction rate

Angiographic Profile of Type 2 Diabetic Patients with ST Elevation Myocardial Infarction: A Cross-sectional Study

Introduction: Coronary atherosclerosis is common in diabetics, and it is diffuse in form, with multivessel involvement. It demonstrates the involvement of multiple vessels rather than a single vessel. Aim: To evaluate the angiographic profile of diabetic patients with ST Elevation Myocardial Infarction (STEMI). Materials and Methods: The present study was a cross-sectional study which enrolled 104 diabetic patients presenting with STEMI from December 2019 to March 2020. Seventy percent or more stenosis in any major coronary artery or its major branches (>2.5 mm) was considered as significant. Results: Mean age of the patients was 55.61±11.32 years, with 75 subjects being males and 29 subjects being females. A total of 28 (26.92%) had Anterolateral Wall Myocardial Infarction (ALWMI), 4 (3.84%) had Anteroseptal Wall Myocardial Infarction (ASWMI) 39 (37.5%) had Anterior Wall Myocardial Infarction (AWMI), 1 (0.96%) had extensive AWMI, 2 (1.9%) had Inferolateral Wall Myocardial Infarction (ILWMI), while 30 (28.84%) patients had Inferior Wall Myocardial Infarction (IWMI). Furthermore, 51 (49.0%) were thrombolysed while 53 (50.96%) patients were non thrombolysed. Thirty eight (36.53%) had single vessel disease, 40 (38.46%) had double vessel disease, while 26 (25%) had triple vessel disease. Among these patients, Left Main Coronary Artery (LMCA) was involved in 3 (2.88%) of patients. Seventy three patients had a Glycated Haemoglobin (HbA1c) of greater than 8.5 and had multivessel involvement, whereas 31 had a HbA1c of less than 8.5. Major Adverse Cardiac Events (MACE) was observed during hospital stay in the form of death, recurrent myocardial infarction and cardiovascular stroke, which occurred in 20 (19.23%) patients of the total 104 diabetic patients. Conclusion: In the present study, the severity and extent of Coronary Artery Disease (CAD) and incidence of triple/multivessel disease was significantly high in diabetics. Diabetic patients with high HbA1c had more coronary vessel involvement. In this case, Coronary Artery Bypass Graft (CABG) is the mode of treatment

Novel functions of LHX2 and PAX6 in the developing telencephalon revealed upon combined loss of both genes

Abstract Patterning of the telencephalic neuroepithelium is a tightly regulated process controlled by transcription factors and signalling molecules. The cortical primordium is flanked by two signalling centres, the hem medially, and the antihem laterally. The hem induces the formation of the hippocampus in adjacent neuroepithelium. Therefore, the position of the hem defines the position of the hippocampus in the brain. The antihem is positioned at the boundary between the dorsal and ventral telencephalon and proposed to provide patterning cues during development. LIM-homeodomain (LIM-HD) transcription factor LHX2 suppresses both hem and antihem fate in the cortical neuroepithelium. Upon loss of Lhx2, medial cortical neuroepithelium is transformed into hem, whereas lateral cortical neuroepithelium is transformed into antihem. Here, we show that transcription factor PAX6, known to regulate patterning of the lateral telencephalon, restricts this tissue from transforming into hem upon loss of Lhx2. When Lhx2 and Pax6 are both deleted, the cortical hem expands to occupy almost the complete extent of the cortical primordium, indicating that both factors act to suppress hem fate in the lateral telencephalon. Furthermore, the shift in the pallial-subpallial boundary and absence of the antihem, observed in the Pax6 mutant, are both restored in the Lhx2; Pax6 double mutant. Together, these results not only reveal a novel function for LHX2 in regulating dorsoventral patterning in the telencephalon, but also identify PAX6 as a fundamental regulator of where the hem can form, and therefore implicate this molecule as a determinant of hippocampal positioning

Additional file 2: Figure S2. of Novel functions of LHX2 and PAX6 in the developing telencephalon revealed upon combined loss of both genes

Tamoxifen was administered at E8.5 to CreER;Lhx2 lox/lox ;Pax6 lox/lox animals and the embryos were harvested at E12.5. Near-complete recombination of Pax6 and Lhx2 is seen in a rostro-caudal series of sections adjacent to those examined for Wnt8b expression. (JPEG 807 kb

La Charente

21 septembre 18861886/09/21 (A15,N5666)-1886/09/21.Appartient à l’ensemble documentaire : PoitouCh