European ST80 community-associated methicillin-resistant Staphylococcus aureus orbital cellulitis in a neonate

<p>Abstract</p> <p>Background</p> <p>Methicillin-resistant <it>Staphylococcus aureus</it> is a serious cause of morbidity and mortality in hospital environment, but also, lately, in the community. This case report is, to our knowledge, the first detailed description of a community-associated methicillin-resistant <it>S. aureus</it> ST80 orbital cellulitis in a previously healthy neonate. Possible predisposing factors of microbial acquisition and treatment selection are also discussed.</p> <p>Case presentation</p> <p>A 28-day-old Caucasian boy was referred to our hospital with the diagnosis of right orbital cellulitis. His symptoms included right eye proptosis, periocular edema and redness. Empirical therapy of intravenous daptomycin, rifampin and ceftriaxone was initiated. The culture of pus yielded a methicillin-resistant <it>S. aureus</it> isolate and the molecular analysis revealed that it was a Panton-Valentine leukocidine-positive ST80 strain. The combination antimicrobial therapy was continued for 42days and the infection was successfully controlled.</p> <p>Conclusions</p> <p>Clinicians should be aware that young infants, even without any predisposing condition, are susceptible to orbital cellulitis caused by community-associated methicillin-resistant <it>S. aureus.</it> Prompt initiation of the appropriate empirical therapy, according to the local epidemiology, should successfully address the infection, preventing ocular and systemic complications.</p

Association between perceived social support and occupational burnout in Greek nurses: A preliminary study

Purpose: To examine the relationship between perceived social support and burnout among nurses. Materials and methods: The participants of this study were 42 Greek nurses of a general hospital which were randomly selected. Data was collected using the Greek version of Maslach’s Burnout Inventory for burnout assessment and the Greek version of ‘The Multidimensional Scale of Perceived Social Support’ for the assessment of participants’ levels of perceived social support. A self-administered questionnaire with questions about socio-demographic and work-related characteristics was used. Descriptive statistics and Spearman’s rho correlation coefficient analysis were conducted. Results: The results showed a negative association between emotional exhaustion, depersonalization and perceived social support, especially from friends. Social support from significant others found to have the highest impact while family support found to have the least impact in nurses’ social support. Conclusions: Findings could be applied to the assessment of burnout in Greek nurses and to future prevention of burnout through the enhancement of perceived social support

Domino-style earthquakes along blind normal faults in Northern Thessaly (Greece): kinematic evidence from field observations, seismology, SAR interferometry and GNSS

Here we present a joint analysis of the geodetic, seismological and geological data of the March 2021 Northern Thessaly seismic sequence, that were gathered and processed as of April 30, 2021. First, we relocated seismicity data from regional and local networks and inferred the dip-direction (NE) and dip-angle (38°) of the March 3, 2021 rupture plane. Furthermore, we used ascending and descending SAR images acquired by the Sentinel-1 satellites to map the co-seismic displacement field. Our results indicate that the March 3, 2021 Mw=6.3 rupture occurred on a NE-dipping, 39° normal fault located between the villages Zarko (Trikala) and Damasi (Larissa). The event of March 4, 2021 occurred northwest of Damasi, along a fault oriented WNW-ESE and produced less deformation than the event of the previous day. The third event occurred on March 12, 2021 along a south-dipping normal fault. We computed 22 focal mechanisms of aftershocks with M≥4.0 using P-wave first motion polarities. Nearly all focal mechanisms exhibit normal kinematics or have a dominant normal dip-slip component. The use of InSAR was crucial to differentiate the ground deformation between the ruptures. The majority of deformation occurs in the vertical component, with a maximum of 0.39 m of subsidence over the Mw=6.3 rupture plane, south and west of Damasi. A total amount of 0.3 m horizontal displacement (E-W) was measured. We also used GNSS data (at 30-s sampling interval) from twelve permanent stations near the epicentres to obtain 3D seismic offsets of station positions. Only the first event produces significant displacement at the GNSS stations (as predicted by the fault models, themselves very well constrained by InSAR). We calculated several post-seismic interferograms, yet we have observed that there is almost no post-seismic deformation, except in the footwall area (Zarkos mountain). This post-seismic deformation is below the 7 mm level (quarter of a fringe) in the near field and below the 1 mm level at the GNSS sites. The cascading activation of the three events in a SE to NW direction points to a pattern of domino-style earthquakes, along neighbouring fault segments. The kinematics of the ruptures point to a counter-clockwise change in the extension direction of the upper crust (from NE-SW near Damasi to N-S towards northwest, near Verdikoussa)

The efficacy of iron chelator regimes in reducing cardiac and hepatic iron in patients with thalassaemia major: a clinical observational study

<p>Abstract</p> <p>Background</p> <p>Available iron chelation regimes in thalassaemia may achieve different changes in cardiac and hepatic iron as assessed by MR. The aim of this study was to assess the efficacy of four available iron chelator regimes in 232 thalassaemia major patients by assessing the rate of change in repeated measurements of cardiac and hepatic MR.</p> <p>Results</p> <p>For the heart, deferiprone and the combination of deferiprone and deferoxamine significantly reduced cardiac iron at all levels of iron loading. As patients were on deferasirox for a shorter time, a second analysis ("Initial interval analysis") assessing the change between the first two recorded MR results for both cardiac and hepatic iron (minimum interval 12 months) was made. Combination therapy achieved the most rapid fall in cardiac iron load at all levels and deferiprone alone was significantly effective with moderate and mild iron load. In the liver, deferasirox effected significant falls in iron load and combination therapy resulted in the most rapid decline.</p> <p>Conclusion</p> <p>With the knowledge of the efficacy of the different available regimes and the specific iron load in the heart and the liver, appropriate tailoring of chelation therapy should allow clearance of iron. Combination therapy is best in reducing both cardiac and hepatic iron, while monotherapy with deferiprone or deferasirox are effective in the heart and liver respectively. The outcomes of this study may be useful to physicians as to the chelation they should prescribe according to the levels of iron load found in the heart and liver by MR.</p

Beta-thalassemia

Beta-thalassemias are a group of hereditary blood disorders characterized by anomalies in the synthesis of the beta chains of hemoglobin resulting in variable phenotypes ranging from severe anemia to clinically asymptomatic individuals. The total annual incidence of symptomatic individuals is estimated at 1 in 100,000 throughout the world and 1 in 10,000 people in the European Union. Three main forms have been described: thalassemia major, thalassemia intermedia and thalassemia minor. Individuals with thalassemia major usually present within the first two years of life with severe anemia, requiring regular red blood cell (RBC) transfusions. Findings in untreated or poorly transfused individuals with thalassemia major, as seen in some developing countries, are growth retardation, pallor, jaundice, poor musculature, hepatosplenomegaly, leg ulcers, development of masses from extramedullary hematopoiesis, and skeletal changes that result from expansion of the bone marrow. Regular transfusion therapy leads to iron overload-related complications including endocrine complication (growth retardation, failure of sexual maturation, diabetes mellitus, and insufficiency of the parathyroid, thyroid, pituitary, and less commonly, adrenal glands), dilated myocardiopathy, liver fibrosis and cirrhosis). Patients with thalassemia intermedia present later in life with moderate anemia and do not require regular transfusions. Main clinical features in these patients are hypertrophy of erythroid marrow with medullary and extramedullary hematopoiesis and its complications (osteoporosis, masses of erythropoietic tissue that primarily affect the spleen, liver, lymph nodes, chest and spine, and bone deformities and typical facial changes), gallstones, painful leg ulcers and increased predisposition to thrombosis. Thalassemia minor is clinically asymptomatic but some subjects may have moderate anemia. Beta-thalassemias are caused by point mutations or, more rarely, deletions in the beta globin gene on chromosome 11, leading to reduced (beta+) or absent (beta0) synthesis of the beta chains of hemoglobin (Hb). Transmission is autosomal recessive; however, dominant mutations have also been reported. Diagnosis of thalassemia is based on hematologic and molecular genetic testing. Differential diagnosis is usually straightforward but may include genetic sideroblastic anemias, congenital dyserythropoietic anemias, and other conditions with high levels of HbF (such as juvenile myelomonocytic leukemia and aplastic anemia). Genetic counseling is recommended and prenatal diagnosis may be offered. Treatment of thalassemia major includes regular RBC transfusions, iron chelation and management of secondary complications of iron overload. In some circumstances, spleen removal may be required. Bone marrow transplantation remains the only definitive cure currently available. Individuals with thalassemia intermedia may require splenectomy, folic acid supplementation, treatment of extramedullary erythropoietic masses and leg ulcers, prevention and therapy of thromboembolic events. Prognosis for individuals with beta-thalassemia has improved substantially in the last 20 years following recent medical advances in transfusion, iron chelation and bone marrow transplantation therapy. However, cardiac disease remains the main cause of death in patients with iron overload

A large genome-wide association study of age-related macular degeneration highlights contributions of rare and common variants.

This is the author accepted manuscript. The final version is available from Nature Publishing Group via http://dx.doi.org/10.1038/ng.3448Advanced age-related macular degeneration (AMD) is the leading cause of blindness in the elderly, with limited therapeutic options. Here we report on a study of >12 million variants, including 163,714 directly genotyped, mostly rare, protein-altering variants. Analyzing 16,144 patients and 17,832 controls, we identify 52 independently associated common and rare variants (P < 5 × 10(-8)) distributed across 34 loci. Although wet and dry AMD subtypes exhibit predominantly shared genetics, we identify the first genetic association signal specific to wet AMD, near MMP9 (difference P value = 4.1 × 10(-10)). Very rare coding variants (frequency <0.1%) in CFH, CFI and TIMP3 suggest causal roles for these genes, as does a splice variant in SLC16A8. Our results support the hypothesis that rare coding variants can pinpoint causal genes within known genetic loci and illustrate that applying the approach systematically to detect new loci requires extremely large sample sizes.We thank all participants of all the studies included for enabling this research by their participation in these studies. Computer resources for this project have been provided by the high-performance computing centers of the University of Michigan and the University of Regensburg. Group-specific acknowledgments can be found in the Supplementary Note. The Center for Inherited Diseases Research (CIDR) Program contract number is HHSN268201200008I. This and the main consortium work were predominantly funded by 1X01HG006934-01 to G.R.A. and R01 EY022310 to J.L.H

WSES guidelines for management of Clostridium difficile infection in surgical patients

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.Peer reviewe