Management of KPC-Producing Klebsiella pneumoniae Infections

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas

Time series modelling of landings in Northwest Mediterranean Sea

14 pages, 9 figures, 4 tables, Appendix 1Univariate seasonal ARIMA and intervention models were developed to forecast monthly catches of 53 commercial species in the northwestern Mediterranean Sea, up to one year in advance. In general terms, there was good agreement between forecasts and observed catches of target demersal species. By contrast, models fitted to non-target demersal species and pelagic species were unsatisfactory in terms of explained variability and predicting power. Large commercial size classes were better explained than the small size classes. Intervention analysis was used to identify the significance, magnitude and form of structural shifts (interventions) of the time series for each species. Most of the fitted interventions appeared in small commercial size classes and indicated a decrease in the mean level of the catch. Seasonality of demersal species, caught mainly by trawlers, was mainly attributed to changing availability and recruitment. By contrast, gear type explained the seasonal variation in landings of pelagic and some coastal species. Catch declines of two species were also compared with the variations of their respective seasonal patternsOur sincere thanks to many people of the Polytechnical University of Catalonia and the Institute of Marine Sciences-CSIC which contributed to the elaboration of this paper, and to the Organization of Fishermen of Roses fish market for providing the data. We are indebted to Dr Michael Chadwick and Dr Konstantinos I. Stergiou for reviewing the manuscript. Josep Lloret was financially supported by the D.G. Research of the Government of CataloniaPeer reviewe

Fluctuations of landings and environmental conditions in the north-western Mediterranean Sea

18 pages, 7 figures, 3 tables.Most of the monthly catches and CPUE of 13 studied commercial species in the coastal waters of the northwestern Mediterranean were signi®cantly positively correlated with run-off of local rivers (RhoÃne and Muga) and the wind mixing index during the spawning season, with time lags of less than a year (transfer function analyses). RhoÃne and Ebre interannual ¯uctuations in run-off were synchronous and were related to the North Atlantic Oscillation (NAO), river runoffs being negatively correlated to high NAO episodes. The fluctuations of river discharges and the wind mixing index were cyclic but not related. The results showed that enhanced hydroclimatic conditions in the NW Mediterranean were favourable for the productivity of the ®sh and invertebrate stocks, and suggest the presence of linkage between recruitment of Mediterranean species and local (river discharges, wind conditions) and global (NAO) environmental conditionsThis research was funded in part by the D.G. XIV of the European Union under project `Impact of fishery and environment on hake recruitment in northwestern Mediterranean' (contract FAIR CT-97). Josep Lloret was ®nancially supported by the D.G. Research of the Government of Catalonia. Our sincere thanks to many people of the Polytechnical University of Catalonia and the Institute of Marine Sciences±CSIC who contributed to the development of this paper. We especially thank Dr Albert Prat and Dr Josep Mã Catot for providing the software and Josep Pascual, RomaÁ Corcoll, Fco. PeÂrez, MeÂteÂo-France, the Catalan Meteorological Of®ce, the Catalan Hydrological Service, the Ebre's Hydrological Confederation and the Fishermen's Organization of Roses for providing dataPeer reviewe

An Exceptional Use of Two Gloves Technique During COVID-19 Pandemic

no abstrac

Neuraminidase inhibitors are effective and safe in reducing influenza complications:meta-analysis of randomized controlled trials

Abstract Background: There is scarce evidence verifying the impact of neuraminidase inhibitors (NAIs) in reducing influenza complications. The aim was to evaluate the available evidence from randomized-controlled trials (RCT) regarding the efficacy and safety of NAIs in reducing influenza complications. Methods: A systematic search of the literature was performed in the Cochrane Library, PubMed and Web of Science databases (2006–2019). Eligibility criteria were RCT that enrolled patients of any age or clinical severity with seasonal influenza (H₁N₁, H₃N₂, or B) or influenza-like syndrome and receiving NAIs comparing to placebo therapy. Results: Eighteen RCTs (9004 patients) were included: nine focused on oral oseltamivir, six on inhaled zanamivir, and three on intravenous peramivir. Administration of NAIs therapy significantly decreased the time to clinical resolution (median difference: -17.7 hours; and total influenza-related complications (OR: 0.64, 95%CI: 0.51–0.82). In addition, NAIs significantly decreased acute otitis media complication (OR: 0.50, 95%CI: 0.31–0.82) and need for antibiotic treatment (OR: 0.64, 95%CI: 0.46–0.90); and showed a trend towards a reduced occurrence of pneumonia (OR: 0.44, 95%CI: 0.10–2.00), bronchitis (OR: 0.80, 95%CI: 0.43–1.48), sinusitis (OR: 0.73, 95%CI: 0.40–1.32), asthma exacerbations (OR: 0.57, 95%CI: 0.28–1.16), and hospitalizations (OR: 0.57, 95%CI: 0.24–1.38). The overall proportion of AEs tend to increase with NAIs treatment (OR: 1.16, 95%CI: 0.92–1.47). Use of NAIs was associated with a significant increase of nausea and vomiting (OR: 1.61, 95%CI: 1.04–2.50) and a decrease on diarrhea (OR: 0.81, 95%CI: 0.65–1.00). Conclusions: NAIs are effective in reducing time to clinical resolution, total influenza-related complications, otitis media, and need of antibiotic administration. Reductions on mortality, pneumonia, asthma exacerbations or hospitalization rates only did demonstrate a trend benefit in favor of NAIs. The only significant AE is the increased occurrence of nausea and vomiting

Evaluation of the quality of evidence supporting guideline recommendations for the nutritional management of critically ill adults

Aims: The primary aim of this study was to evaluate the quality of evidence supporting the 2019 European Society for Clinical Nutrition and Metabolism (ESPEN) and 2016 American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations for medical nutrition therapy in critically ill patients. Secondary objectives are to assess the differences between 2019 ESPEN and 2016 ASPEN recommendations and to inform relevant stakeholders of areas requiring improvement in the research. Methods: The 2019 ESPEN and 2016 ASPEN guidelines were identified and downloaded from the official websites. The level of evidence and strength of recommendations from the guidelines were standardised to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Level of evidence was classified as high-quality (randomised controlled trials (RCTs) without important limitations), moderate-quality (downgraded RCTs or upgraded observational studies) or low-quality (observational studies without specific strengths or important limitations, case series, case reports). In addition, good practice points (GPP; recommendations based on the clinical experience of the guideline development group) were considered. Strength of recommendation was reported as strong or weak. Results: From 152 total recommendations, only five (3.3%) were supported by high-quality evidence, with 14 being strong recommendations. A total of 79 (52.0%) recommendations were GPPs. Overall, the proportion of recommendations supported by high-quality (7% [ESPEN] vs. 1.1% [ASPEN], p < 0.05) and moderate-quality evidence (33.3% [ESPEN] vs. 8.4% [ASPEN], p < 0.01) was significantly higher in ESPEN guidelines. On the other hand, ASPEN guidelines reported a greater proportion of recommendations supported by GPPs (58.9% [ASPEN] vs. 40.4% [ESPEN], p = 0.03). In enteral and parenteral nutrition, the proportion of recommendations supported by moderate-quality evidence (50% [ESPEN] vs. 15.8% [ASPEN], p < 0.01) was significantly higher in ESPEN guidelines. Conclusion: Published guideline recommendations for the nutritional management of critically ill adults remain largely supported by expert opinion and only a minority by high-quality evidence. An urgent unmet clinical need for high-quality clinical trials is warranted

Quality of evidence supporting surviving sepsis campaign recommendations

Introduction: The Surviving Sepsis Campaign (SSC) guidelines, released in 2017, are a combination of expert opinion and evidence-based medicine, adopted by many institutions as a standard of practice. The aim was to analyse the quality of evidence supporting recommendations on the management of sepsis. Methods: The strength and quality of evidence (high, moderate, low-very low and best practice statements) of each recommendation were extracted. Randomised controlled trials were required to qualify as high-quality evidence. Results: A total of 96 recommendations were formulated, and 87 were included. Among thirty-one (43%) strong recommendations, only 15.2% were supported by high-quality evidence. Overall, thirty-seven (42.5%) recommendations were based on low-quality evidence, followed by 28 (32.2%) based on moderate-quality, 15 (17.2%) were best practice statements and only seven (8.0%) were supported by high-quality evidence. Randomised controlled trials supported 21.4%, 9.5% and 8.6% recommendations on mechanical ventilation, resuscitation, and management/adjuvant therapy, respectively. In contrast, none high-quality evidence recommendation supported antimicrobial/source control (82.4% were low-very low evidence or best practice statements), and nutrition. Conclusions: In the SSC guidelines most recommendations were informed by indirect evidence and non-systematic observations. While awaiting trials results, Delphi-like approaches or multi-criteria decision analyses should guide recommendations