Etiologicalagents of hospital-acquired infections in premature babies with gestationalage less than 32 weeks

Spital Clinic de Obstetrică-Ginecologie „Polizu” secţia neonatologie, Bucureşti, Institutul Naţional pentru Sănătatea Mamei şi Copilului „Alessandrescu-Rusescu”, Universitatea de Medicină şi Farmacie „Carol Davila”, Bucureşti, Facultatea de Medicină, Disciplina Obstetrică-Ginecologie, Facultatea de Moaşe şi Asistenţă medicală, Disciplina Pediatrie centrată pe nou-născutIntroducere. Morbiditatea prin infecţii nozocomiale, dificil de evaluat datorită tendinţelor de supraevaluare (colonizarea des interpretată ca infecţie) sau de subevaluare (infecţii nozocomiale nedeclarate) este o preocupare permanentă în neonatologie. Scop. Diminuarea morbidităţii şi mortalităţii neonatale. Obiective. Identificarea agenţilor etiologici ai infecţiilor nozocomiale survenite la prematuri cu vârsta de gestaţie <32 săptămâni. Material şi metodă. Studiu retrospectiv al prematurilor îngrijiţi în anul 2015 în Institutul Naţional pentru Sănătatea Mamei şi Copilului „Alessandrescu-Rusescu” - spitalul de Obstetrică Ginecologie – departamentul de neonatologie „Polizu”. Rezultate. Prematurii cu vârsta de gestaţie <32 săptămâni, reprezintă mai mult de 1/3 din totalul prematurilor îngrijiţi. Majoritatea infecţiilor nozocomiale au fost determinate de bacterii Gram negative (Enterobacter, Escherichia coli, Serratia) sau Gram pozitive (Staphylococcus aureus). Concluzii. Diminuarea morbidităţii şi a mortalităţii neonatale, a duratei de spitalizare şi implicit a costurilor deteminate de infecţiile nozocomiale, impun măsuri de prevenţie riguros aplicate, prima dintre acestea fiind igiena mâinilor.Introduction (Background). Nosocomial infections are a constant concern in neonatology, seeing the difficulty to evaluate the real incidence – either amplified (colonization falsely interpreted as infection) or underestimated (hospital-acquired infection remained unreported) Purpose. To diminish the neonatal morbidity and mortality Objectives. To identify the infectious agents in hospital-acquired infections of premature babies with GA under 32 weeks of gestation. Material and methods. The retrospective study realized in „The National Institute for the Health of the Mother and Child Alessandrescu-Rusescu, Polizu Hospital of Gynecology” regarding premature babies cared in the neonatology department during the year 2015. Results. Premature babies with GA under 32 weeks of gestation represent more than 1/3 of the number of premature babies born in our hospital. Most of the nosocomial infections have been caused by either Gram-negative (Enterobacter spp, E.Coli, Serratia) or Gram-positive (Staphylococcus aureus) bacteria. Conclusions. Lowering the neonatal morbidity and mortality, reducing the length of hospital stay and by that the costs associated with nosocomial infections do demand strict preventive measures, first of which should be hand hygiene

Toxocariasis: a silent threat with a progressive public health impact

Background: Toxocariasis is a neglected parasitic zoonosis that afflicts millions of the pediatric and adolescent populations worldwide, especially in impoverished communities. This disease is caused by infection with the larvae of Toxocara canis and T. cati, the most ubiquitous intestinal nematode parasite in dogs and cats, respectively. In this article, recent advances in the epidemiology, clinical presentation, diagnosis and pharmacotherapies that have been used in the treatment of toxocariasis are reviewed. Main text: Over the past two decades, we have come far in our understanding of the biology and epidemiology of toxocariasis. However, lack of laboratory infrastructure in some countries, lack of uniform case definitions and limited surveillance infrastructure are some of the challenges that hindered the estimation of global disease burden. Toxocariasis encompasses four clinical forms: visceral, ocular, covert and neural. Incorrect or misdiagnosis of any of these disabling conditions can result in severe health consequences and considerable medical care spending. Fortunately, multiple diagnostic modalities are available, which if effectively used together with the administration of appropriate pharmacologic therapies, can minimize any unnecessary patient morbidity. Conclusions: Although progress has been made in the management of toxocariasis patients, there remains much work to be done. Implementation of new technologies and better understanding of the pathogenesis of toxocariasis can identify new diagnostic biomarkers, which may help in increasing diagnostic accuracy. Also, further clinical research breakthroughs are needed to develop better ways to effectively control and prevent this serious disease

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P &lt;.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Intimate partner violence and receptive syringe sharing among women who inject drugs in Indonesia: A respondent-driven sampling study

Background: Intimate partner violence (IPV) and HIV are overlapping public health problems that disproportionately affect women who inject drugs. Little is known about the relationship between IPV and HIV-related unsafe injecting practices among women in low- and middle-income settings. This study investigated whether IPV victimisation was associated with increased odds of receptive syringe sharing among women who inject drugs in Indonesia. Methods: Respondent-driven sampling (RDS) was used to recruit 731 women aged ≥18 years, injecting drugs in the preceding 12 months, and residing in Greater Jakarta or Bandung, West Java. Population estimates were derived using the RDS-II estimator. Multivariate logistic regressions assessed relationships between different forms of past-year IPV (i.e. psychological abuse, physical and/or injurious assault, forced sex) and receptive syringe sharing, controlling for city differences and sociodemographic cofactors. Results: Overall, 21.1% of participants reported engaging in past-month receptive syringe sharing. In multivariate analyses controlling for all forms of IPV, receptive syringe sharing was significantly positively associated with experiencing psychological abuse (OR=1.86; 95% CI=1.06,3.24; p=0.030), physical and/or injurious assault (OR=1.73; 95% CI=1.04,2.89; p=0.034), and several covariates: injecting pharmaceuticals only (versus heroin only) (OR=3.58; 95% CI=1.66,7.69; p=0.001), experiencing unstable housing and/or homelessness (OR=2.89; 95% CI=1.41,5.95; p=0.004), and residing in Bandung, West Java (versus Greater Jakarta) (OR=2.33; 95% CI=1.40,3.90; p=0.001). Conclusion: IPV is a significant risk factor for HIV-related injecting risk among women who inject drugs in Indonesia. These findings indicate the urgent need to scale up harm reduction interventions and align existing programs with IPV prevention and support services, with specific efforts targeting the needs of female injectors