Recent changes in candidemia trends in a tertiary hospital (2011–2018)

BackgroundThe epidemiology of candidemia has changed over the last decades and varies widely among geographic areas.AimsWe examined in children (aged 0–14) with candidemia the trends in the incidence rate of this infection, as well as the clinical characteristics of the patients, in order to optimize the prognosis and the control measures of this serious disease.MethodsA retrospective cohort study of candidemia in the period 2011–2018 in the neonatal intensive care unit (NICU), pediatric ICU (PICU) and pediatric wards of a tertiary hospital, was conducted. The clinical course, Candida species isolated, antifungal susceptibility, outcome and incidence rates were analyzed and compared.ResultsWe diagnosed 68 episodes of candidemia in 62 children, 48% occurred in the NICU, 31% in the PICU and 21% in pediatric wards. Candida albicans was the most frequent species isolated in NICU infants (53%), and Candida parapsilosis predominated among PICU patients (59%) and pediatric wards (50%). One third of NICU infants had invasive candidiasis (IC), most of them having extremely low birth weight (ELBW) (35%). All isolates were susceptible to the antifungal administered. Over time, the incidence of candidemia decreased in the PICU (from 2.2 to 0.3 episodes/1000 patient-days, OR = 0.6; 95%CI 0.5–0.8), whereas in the NICU and in the wards remained stable. Mortality occurred mostly in NICU patients (26%), predominated in ELBW infants and did not change over time.ConclusionsThe higher incidence and mortality of candidemia and IC observed in preterm infants requires a continuous evaluation of practices and diagnostic methods which will allow improving the prognosis of this most vulnerable population.     

Impact of non-pharmaceutical interventions during the COVID-19 pandemic on common childhood respiratory viruses – An epidemiological study based on hospital data

Considering common childhood respiratory viruses and SARS-CoV-2 share similar transmission routes, non-pharmaceutical interventions (NPIs) to prevent SARS-CoV-2 may affect the epidemiology of respiratory viruses. Therefore, our study aimed to observe the epidemiologic characteristics of common childhood respiratory viruses in 2020 (after the pandemic) compared with 2019 (before the pandemic) in Hangzhou, China. The data were compared between 2019 and 2020 based on age and month, respectively. One or more viruses were detected in 3135/21452 (14.61%) specimens in 2019, which was significantly lower in 1110/8202 (13.53%) specimens in 2020. Respiratory syncytial virus (RSV) was the most commonly detected virus in 2019 and 2020. The positive rate of adenovirus (ADV), parainfluenza virus (PIV)1, PIV2, and PIV3 in 2020 was significantly decreased in 2019. In 2020, RSV replaced ADV as the most predominant virus in children aged 1–6 years, and the positive rate of influenza virus A (FluA), influenza virus B (FluB), PIV1, and PIV2 was not correlated to age. FluA, FluB, and PIV2 were not almost detected from February 2020. The positive rates of ADV and PIV1 were uncorrelated to the month in 2020. By strict NPIs, besides controlling the COVID-19 pandemic, incredible progress has been made to reduce the prevalence of common childhood respiratory viruses.     

The impact of informal and formal care disruption on older adults’ psychological distress during the COVID-19 pandemic in UK

This paper investigates how formal and informal caregiving disruptions-due to the U.K. government’s non-pharmaceutical interventions (NPIs) aimed at reducing transmission of the SARS-CoV-2 virus-may have affected the likelihood of psychological distress among older individuals. We model the association between disruption of formal and informal care and mental health of the elderly during the first wave of the COVID-19 pandemic using a recursive simultaneous - equation model for binary variables. Our findings reveal that public interventions, which are most essential for reducing the pandemic spread, influenced the provision of formal and informal care. The lack of adequate long-term care following the COVID-19 outbreak has also had negative repercussions on the psychological well-being of these adults.     

A mathematical model to optimize the available control measures of COVID – 19

In the absence of valid medicine or vaccine for treating the pandemic Coronavirus (COVID-19) infection, other control strategies like; quarantine, social distancing, self- isolation, sanitation and use of personal protective equipment are effective tool used to prevent and curtail the spread of the disease. In this paper, we present a mathematical model to study the dynamics of COVID-19. We then formulate an optimal control problem with the aim to study the most effective control strategies to prevent the proliferation of the disease. The existence of an optimal control function is established and the Pontryagin maximum principle is applied for the characterization of the controller. The equilibrium solutions (DFE & endemic) are found to be locally asymptotically stable and subsequently the basic reproduction number is obtained. Numerical simulations are carried out to support the analytic results and to explicitly show the significance of the control. It is shown that Quarantine/isolating those infected with the disease is the best control measure at the moment.     

The molecular epidemiology of Stenotrophomonas maltophilia bacteraemia in a tertiary referral hospital in the United Arab Emirates 2000–2004

Background

Methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly prevalent worldwide since it was first reported in a British hospital. The prevalence however, varies markedly in hospitals in the same country, and from one country to another. We therefore sought to document comprehensively the prevalence and antimicrobial susceptibility pattern of MRSA isolates in Trinidad and Tobago.

Methods

All Staphylococcus aureus isolates encountered in routine clinical specimens received at major hospitals in the country between 2000 and 2001 were identified morphologically and biochemically by standard laboratory procedures including latex agglutination test (Staphaurex Plus; Murex Diagnostics Ltd; Dartford, England); tube coagulase test with rabbit plasma (Becton, Dickinson & Co; Sparks, MD, USA), and DNase test using DNase agar (Oxoid Ltd; Basingstoke, Hampshire, England). MRSA screening was performed using Mueller-Hinton agar containing 6 μg oxacillin and 4% NaCl, latex agglutination test (Denka Seiken Co. Ltd, Tokyo, Japan) and E-test system (AB Biodisk, Solna, Sweden). Susceptibility to antimicrobial agents was determined by the modified Kirby Bauer disc diffusion method while methicillin MICs were determined with E-test system.

Results

Of 1,912 S. aureus isolates received, 12.8% were methicillin (oxacillin) resistant. Majority of the isolates were recovered from wound swabs (86.9%) and the least in urine (0.4%) specimens. Highest number of isolates was encountered in the surgical (62.3%) and the least from obstetrics and gynaecology (1.6%) facilities respectively. Large proportions of methicillin sensitive isolates are >85% sensitive to commonly used and available antimicrobials in the country. All MRSA isolates were resistant to ceftriaxone, erythromycin, gentamicin and penicillin but were 100% sensitive to vancomycin, rifampin and chloramphenicol.

Conclusion

There is a progressive increase in MRSA prevalence in the country but the present rate is still low in comparison to values in some other countries. Vancomycin is still the drug of choice for treating multidrug resistant MRSA infections. Further use of molecular studies to monitor the epidemiology of MRSA in these hospitals in the country is highly recommended too.     

No substantial excess all-cause mortality among cardiac implantable electronic device patients during the first COVID‑19 lockdown in the Leiden area

Netherlands Heart Journal - In the Netherlands, the coronavirus disease 2019 (COVID?19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for...     

Molecular epidemiology of PER-1 extended spectrum β-lactamase among gram-negative bacteria isolated at a tertiary care hospital

The bla(PER-1) presence was sought by PCR in 289 ceftazidime resistant Gram-negative bacteria isolated at Dokuz Eylul University Hospital (Turkey) between 1998 and 2003. PER-1 production rates were 32.3, 33.9, 14.9 and 37.9% in the 1998-2000 period, 2001, 2002 and 2003, respectively. bla(PER-1) was detected in 46.2 and 35.9% of ceftazidime-resistant Pseudomonas aeruginosa and Acinetobacter baumannii isolates, respectively. ERIC-PCR results revealed that dissemination of two endemic clones for both P. aeruginosa (X and Y) and A. baumannii (A and B) was responsible for the high prevalence. Results of the conjugation tests and plasmid curing experiments suggested that bla(PER-1) was located on the chromosome in the representative strains. It was also shown for the first time that bla(PER-1) in a clinical isolate was associated with class-1 integron which could facilitate dissemination of bla(PER-1) among bacteria.     

Teaching and learning of postgraduate medical physics using Internet-based e-learning during the COVID-19 pandemic – A case study from Malaysia

PurposeWe present the implementation of e-learning in the Master of Medical Physics programme at the University of Malaya during a partial lockdown from March to June 2020 due to the COVID-19 pandemic.MethodsTeaching and Learning (T&L) activities were conducted virtually on e-learning platforms. The students' experience and feedback were evaluated after 15 weeks.ResultsWe found that while students preferred face-to-face, physical teaching, they were able to adapt to the new norm of e-learning. More than 60% of the students agreed that pre-recorded lectures and viewing videos of practical sessions, plus answering short questions, were beneficial. Certain aspects, such as hands-on practical and clinical experience, could never be replaced. The e-learning and study-from-home environment accorded a lot of flexibility. However, students also found it challenging to focus because of distractions, lack of engagement and mental stress. Technical problems, such as poor Internet connectivity and limited data plans, also compounded the problem.ConclusionWe expect e-learning to prevail in future. Hybrid learning strategies, which includes face-to-face classes and e-learning, will become common, at least in the medical physics programme of the University of Malaya even after the pandemic.     

The impact of outdoor air pollutants on outpatient visits for respiratory diseases during 2012–2016 in Jinan,China

Background

Few studies have investigated the associations between outdoor air pollution and outpatient visits for respiratory diseases (RDs) in general population.

Methods

We collected daily outpatient data of primary RDs from five hospitals in Jinan during January 2012 and December 2016, as well as daily measurements of air pollutants from the Jinan Environmental Monitoring Center and daily meteorological variables from the China Meteorological Data Sharing Service System. A generalized additive model (GAM) with quasi-Poisson regression was constructed to estimate the associations between daily average concentrations of outdoor air pollutants (PM_2.5,PM₁₀, SO₂, NO₂, CO and O₃) and daily outpatient visits of RDs after adjusting for long-time trends, seasonality, the “day of the week” effect, and weather conditions. Subgroup analysis stratified by gender, age group and the type of RDs was conducted.

Results

A total of 1,373,658 outpatient visits for RDs were identified. Increases of 10?μg/m³ in PM_2.5, PM₁₀, NO₂, CO and O₃ were associated with0.168% (95% CI, 0.072–0.265%), 0.149% (95% CI, 0.082–0.215%), 0.527% (95% CI, 0.211–0.843%), 0.013% (95% CI, 0.003–0.023%), and 0.189% (95% CI, 0.032–0.347%) increases in daily outpatient visits for RDs, respectively. PM_2.5 and PM₁₀ showed instant and continuous effects, while NO₂, CO and O₃ showed delayed effects on outpatient visits for RDs. In stratification analysis, PM_2.5 and PM₁₀ were associated with acute RDs only.

Conclusions

Exposure to outdoor air pollutants including PM_2.5, PM₁₀, NO₂, CO and O₃ associated with increased risk of outpatient visits for RDs.

     

Is social distancing a boon or bane for persons who stutter during COVID-19 pandemic?

The Covid-19 pandemic is an ongoing crisis and is colloquially known as the corona virus pandemic. As no specific treatment protocol are available for this viral infection, social distancing is considered as one of the remedies to prevent the infection. This study aimed to investigate the anxiety issues in persons who stutter (PWS). A total of 110 (55 PWS and 55 Neuro-typical Adults) were enrolled for the study. A questionnaire comprising of two parts on social anxiety and consequences of social distancing was administered on the participants. The results showed that PWS felt more socially anxious. PWS opined that they were comfortable during the corona virus lockdown period, as the situation demanded them to speak minimally to strangers. Neuro-typical adults, on the other hand, reported that they did not observe any change with respect to the social communication skills during lockdown.     

War in Ukraine – Changing the Polish paediatric population as a consequence of forced migration (a preliminary study)

The study aimed to briefly analyse the basic anthropometric characteristics of Ukrainian adolescents against their Polish counterparts. The study was school-based, carried out April–June 2022 and followed a cross-sectional model. It included 642 children from Poland and Ukraine (aged 10–15) who attended ten randomly selected primary schools in Kraków (Poland). Noticeable differences between Polish and Ukrainian adolescents were observed. As the analysed characteristics included features such as the amount and distribution of body fat, they can be crucial in the indirect assessment of health status, particularly the risk of cardiovascular and metabolic diseases. This in turn, can help to properly accommodate the changing needs of the population.     

Managing mosquitoes and ticks in a rapidly changing world – Facts and trends

Vector-borne diseases transmitted by mosquitoes and ticks are on the rise. The effective and sustainable control of these arthropod vectors is a puzzling challenge for public health worldwide. In the present review, I attempted to provide a concise and updated overview of the current mosquito and tick research scenario. The wide array of control tools recently developed has been considered, with special reference to those approved by the World Health Organization Vector Control Advisory Group (WHO VCAG), as well as novel ones with an extremely promising potential to be exploited in vector control programs. Concerning mosquitoes, a major focus has been given on genetically modified vectors, eave tubes, attractive toxic sugar baits (ATSB) and biocontrol agents. Regarding ticks, the recent development of highly effective repellents and acaricides (including nanoformulated ones) as well as behavior-based control tools, has been highlighted. In the second part of the review, key research questions about biology and control of mosquitoes and ticks have been critically formulated. A timely research agenda outlining hot issues to be addressed in mosquito and tick research is provided. Overall, it is expected that the present review will contribute to boost research and applications on successful mosquito and tick control strategies, along with an improved knowledge of their biology and ecology.     

Assessment of diagnostic accuracy of SanketLife – A wireless,pocket-sized ECG biosensor,in comparison to standard 12 lead ECG in the detection of cardiovascular diseases in a tertiary care setting

BackgroundThe SanketLife is a low cost, portable, pocket sized 12 lead ECG mechanised by SanketLife app running on compatible iOS and Android phones that connect wirelessly via Bluetooth technology to the device.ObjectiveThe current study was conducted to assess the diagnostic accuracy of SanketLife ECG in comparison to standard 12 lead ECG (GE-2000) in detection of cardiovascular diseases.Research design and methodsThis was a prospective diagnostic test accuracy trial conducted in outpatient settings of a tertiary cardiac care centre in India. A total of 100 patients, attended cardiology OPD, were included in the study. Consecutive ECGs were taken by 12 lead standard ECG as well as by SanketLife ECG. Diagnostic accuracy variables such as sensitivity, specificity, negative and positive predictive value, negative and positive likelihood ratios were estimated. Ethical permission was taken from the Institutional ethical committee.Results & conclusionThe analysis showed a high degree of agreement and accuracy of SanketLife in detecting major cardiovascular conditions (Major Minnesota codes) such as Left and right bundle branch block, ST-segment elevation and ST-segment depression, AV conduction block. SanketLife showed high sensitivity (98.15%) and specificity (100%) in diagnosing major cardiovascular conditions.     

Changing the epidemiology of carbapenem-resistant Pseudomonas aeruginosa in a Brazilian teaching hospital: the replacement of São Paulo metallo-β-lactamase-producing isolates

In Brazil, carbapenem-resistant Pseudomonas aeruginosa isolates are closely related to the S?o Paulo metallo-β-lactamase (SPM) Brazilian clone. In this study, imipenem-resistant isolates were divided in two sets, 2002/2003 and 2008/2009, analysed by pulsed field gel electrophoresis and tested for the Ambler class B metallo-β-lactamase (MBL) genes blaSPM-1, blaIMP and blaVIM. The results show a prevalence of one clone related to the SPM Brazilian clone in 2002/2003. In 2008/2009, P. aeruginosa isolates were mostly MBL negative, genetically diverse and unrelated to those that had been detected earlier. These findings suggest that the resistance to carbapenems by these recent P. aeruginosa isolates was not due to the spread of MBL-positive SPM-related clones, as often observed in Brazilian hospitals.     

Survival of patients treated with intra-aortic balloon counterpulsation at a tertiary care center in Pakistan – patient characteristics and predictors of in-hospital mortality

Background

In most western countries 20% of adults have hypertension. Reports in the literature suggest that from 31 to 86% of treated patients are not at recommended target levels. However it is important to consider how we are determining whether targets are unmet and the degree to which they are unmet. Our underlying hypothesis is that white coat effect is partially responsible for the reported low rates of control of hypertension by primary care practitioners.

Methods

The study population consists of 1142 patients who are being assessed for enrolment in two community-based randomized controlled trials. Patients must have essential hypertension, be on antihypertensive medication, and must not have met their blood pressure targets. We are reporting on the proportion of patients who have not achieved target, and the degree to which they have not achieved their target. We also report on the mean daytime blood pressures on 24 hour ABPM and compare these to mean blood pressures found on the patients' charts.

Results

We identified 3284 patient charts of patients with hypertension. Of these, 1142 were determined to be "out of control" (did not achieve target) and 436 agreed to undergo 24 hour ABPM for final determination of eligibility. Overwhelmingly (95.8% of the time) it was the systolic blood pressure that was not under control. However, most of the patients who had not achieved target according to our criteria were within 10 mmHg of the recommended targets. Isolated systolic blood pressure was the best predictor of elevated mean daytime blood pressure on 24 hour ABPM.

Conclusions

At least 35% of patients had not achieved target blood pressure levels and this is primarily due to lack of control of systolic blood pressure. The best predictor of continuing hypertension on 24 hour ABPM was the mean systolic blood pressure on the patients chart. However, only 69% of patients who were uncontrolled according blood pressures recorded in the chart were uncontrolled according to 24 hour ABPM criteria. This suggests that the white coat effect makes blood pressure measurements in the doctor's offices, at least as currently done, not sufficiently accurate for determining treatment endpoint.     

Disease and fertility: Evidence from the 1918–19 influenza pandemic in Sweden

What are the consequences of a severe health shock like an influenza pandemic on fertility? Using rich administrative data and a difference-in-differences approach, we evaluate fertility responses to the 1918–19 influenza pandemic in Sweden. We find evidence of a small baby boom following the end of the pandemic, but we show that this effect is second-order compared to a strong long-term negative fertility effect. Within this net fertility decline there are compositional effects: we observe a relative increase in births to married women and to better-off families. Several factors – including disruptions to the marriage market and income effects – contribute to the long-term fertility reduction. The results are consistent with studies that find a positive fertility response following natural disasters, but we show that this effect is short-lived.