Form Of Prophylaxis Research Articles

Unlocking Insights: A Single Centre Patient-Reported Outcome Experience in Patients with Severe Hemophilia a without Inhibitors on Emicizumab

Introduction: Emicizumab (Hemlibra®) prophylaxis has been demonstrated to be more effective at decreasing bleeding episodes than the factor VIII infusions that had previously been used as bleeding prophylaxis. Emicizumab has been available in Canada for persons with hemophilia A with baseline FVIII <1% without inhibitors as a form of prophylaxis since October 2021. Previous work by our team used the Patient-Reported Outcomes, Burdens and Experiences (PROBE) survey to assess outcomes following the initiation of Emicizumab in our local population, which demonstrated a positive overall trend in composite scores generated by the survey following treatment initiation. The PROBE instrument includes the EQ5D5L instrument as a generic quality of life assessment, which consists of 5 dimensions. Aims: The explicit aim of this study was to assess changes in EuroQuol-5D-5L (EQ5D5L) index utility scores and dimensions as well as Visual Analog Scores (VAS) scores at 3 and 6 months following Emicizumab introduction to gain insight into the clinical impact beyond bleeding rates. Methods: In partnership with the PROBE Investigators, individualized non-identifying survey links were generated by the clinic and provided to all transitioning patients who then consented within the PROBE link to complete the survey. Responses were shared with the clinic and decoded to allow identification. Previously, composite scores for the relevant patients were identified at 0, 3 and 6 months to assess the patient-reported clinical trajectory following Emicizumab introduction. Here, the EQ5D5L scores were analyzed using descriptive statistics and the minimal clinically important difference (MCID) was calculated for each EQ5D5L dimensions (MCID is a change between 2-4) and the VAS (MCID is a change of 10). Results: 65/85 (76%) of eligible patients ≥ 18 years of age in British Columbia transitioned as of June 1, 2023. 54 patients (mean age 39.3, median 36 with a total age range of 19-59) completed a baseline PROBE survey as part of usual clinical care prior to the Emicizumab transition. 26 patients completed PROBE surveys at 0 and 3 months and 11 patients completed PROBE surveys at 0-, 3- and 6-month intervals. Mean baseline PROBE (/1), EQ5D5L (/1) and VAS (/100) scores were 0.779 (SD 0.15), 0.789 (SD 0.15) and 72.01 (SD 18.65), respectively. EQ5D5L domains are each scored /5 where higher numbers corresponded to worse outcomes; the 5 domains include mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. At 3 months, the MCID for EQ5D5L domains was met by 1 person in both usual activities and anxiety/depression. At 6 months, the MCID was met by 1 person in each of the subsections of the EQ5D5L and by 2 individuals in the usual activities dimension. Higher VAS scores correspond to better health. At 3 months, the MCID for VAS was met by 42% (11/26) with the majority (7/11) observed to have a higher VAS score than at baseline. At 6 months, the MCID was met by 45% (5/11) with the majority (4/5) having a higher VAS score than at baseline. Conclusion: Within our small cohort, EQ5D5L index utility scores consistently improved at 3 and 6 months from the time of Emicizumab initiation. Of the EQ5D5L domains, the MCID was met at 3 months in both usual activities and anxiety/depression by 1 person and in all parameters at 6 months by at least 1 person. Analysis of the VAS scores indicated a consistent perceived improvement by 42% at 3 months and in the majority participants at 6 months. Using the EQ5D5L was feasible to better understand the patient experience for those with Hemophilia A without inhibitors following Emicizumab introduction and provides insight into the specific patient-reported outcomes that are impacted by this treatment transition.

Venous thromboembolic prophylaxis: current practice of surgeons in Australia and New Zealand for major abdominal surgery

BackgroundSurgical prophylaxis for venous thrombo-embolic disease (VTE) includes risk assessment, chemical prophylaxis and mechanical prophylaxis (graduated compression stockings [GCS] and/or intermittent pneumatic compression devices [IPCD]). Although there is overwhelming evidence for the need and efficacy of VTE prophylaxis in patients at risk, only about a third of those who are at risk of VTE receive appropriate prophylaxis.ObjectiveThere is debate as to the best combination of VTE prophylaxis following abdominal surgery due to lack of evidence. The aim of this survey was to understand this gap between knowledge and practice.MethodsIn 2019 and 2020, a survey was conducted to investigate the current practice of venous thromboembolism (VTE) prophylaxis for major abdominal surgery, with a focus on colorectal resections. The study received ethics approval and involved distributing an 11-item questionnaire to members of two professional surgical societies: the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) and the General Surgeons Australia (GSA).ResultsFrom 214 surgeons: 100% use chemical prophylaxis, 68% do not use a risk assessment tool, 27% do not vary practice according to patient risk factors while > 90% use all three forms of VTE prophylaxis at some stage of treatment. Most surgeons do not vary practice between laparoscopic and open colectomy/major abdominal surgery and only 33% prescribe post-discharge chemical prophylaxis. 42% of surgeons surveyed had equipoise for a clinical trial on the use of IPCDs and the vast majority (> 95%) feel that IPCDs should provide at least a 2% improvement in VTE event rate in order to justify their routine use.ConclusionMost surgeons in Australia and New Zealand do not use risk assessment tools and use all three forms of prophylaxis regardless. Therfore there is a gap between practice and VTE prophylaxis for the use of mechanical prophylaxis options. Further research is required to determine whether dual modality mechanical prophylaxis is incrementally efficacious. Trial Registration- Not Applicable.

Sauna bathing and their properties – empirical research and awareness of people based on anonymous surveys

Introduction: Bathing at high temperatures has been a practice used for thousands of years in many cultures. High or low temperatures are considered a stress factor for the human body and are often a challenge to maintain homeostasis. Heat stress can be beneficial to human health, independent of other lifestyle factors.
 The aim of the study: The aim of the study was to assess the level of knowledge among people about sauna bathing, the benefits of its use and diseases that are contraindications to such bathing, as well as empirical research on sauna bathing habits based on anonymous surveys.
 Materials and methods: The research material was collected using an anonymous survey in May 2023. The obtained results were analyzed and verified on the basis of scientific literature and statistically processed using Microsoft Office Excel.
 Results: 87.5% of the respondents use the sauna, the majority - several times a year, and 15% - several times a week. For 77.1% of respondents using the sauna, it is a form of entertainment, but 15.2% treat it as a form of health prevention. Many respondents wrongly indicate contraindications to bathing in the sauna, and 73.3% of people do not know any effects of the sauna.
 Discussion and conclusions: Many respondents use the sauna, but most of them use it as a form of entertainment. Few people know the full effect of the sauna on the body and its multidirectionality. More than half of the respondents cannot name the contraindications to bathing in the sauna. As far as possible, the doctor should indicate people with, among others, increased cardiovascular risk, this form of prophylaxis.

Comparison of antimicrobial resistant Escherichia coli isolated from Irish commercial pig farms with and without zinc oxide and antimicrobial usage

BackgroundThe prophylactic use of antimicrobials and zinc oxide (ZnO) in pig production was prohibited by the European Union in 2022 due to potential associations between antimicrobial and heavy metal usage with antimicrobial resistance (AMR) and concerns regarding environmental pollution. However, the effects of their usage on the bacterial AMR profiles on commercial pig farms are still not fully understood and previous studies examining the effect of ZnO have reported contrasting findings. The objective of this study was to examine the effects of antimicrobial and ZnO usage on AMR on commercial pig farms. Faecal and environmental samples were taken on 10 Irish commercial farms, of which 5 farms regularly used ZnO and antimicrobials (amoxicillin or sulphadiazine-trimethoprim) for the prevention of disease. The other 5 farms did not use ZnO or any other form of prophylaxis. Escherichia coli numbers were quantified from all samples using non-supplemented and supplemented Tryptone Bile X-glucuronide agar.ResultsIn total 351 isolates were phenotypically analysed, and the genomes of 44 AmpC/ESBL-producing E. coli isolates from 4 farms were characterised using whole-genome sequencing. Phenotypic analysis suggested higher numbers of multi-drug resistant (MDR) E. coli isolates on farms using prophylaxis. Furthermore, farms using prophylaxis were associated with higher numbers of isolates resistant to apramycin, trimethoprim, tetracycline, streptomycin, and chloramphenicol, while resistance to ciprofloxacin was more associated with farms not using any prophylaxis. Thirty-four of the 44 AmpC/ESBL-producing E. coli strains harboured the blaCTX-M-1 resistance gene and were multi drug resistant (MDR). Moreover, network analysis of plasmids and analysis of integrons showed that antimicrobial and biocide resistance genes were frequently co-located on mobile genetic elements, indicating the possibility for co-selection during antimicrobial or biocide usage as a contributor to AMR occurrence and persistence on farms.ConclusionsThe results of this study showed evidence that antimicrobial and ZnO treatment of pigs post-weaning can favour the selection and development of AMR and MDR E. coli. Co-location of resistance genes on mobile genetic elements was observed. This study demonstrated the usefulness of phenotypic and genotypic detection of antimicrobial resistance by combining sequencing and microbiological methods.

Real-World Use of Octocog Alfa and Damoctocog Alfa Pegol in Women with Hemophilia a from the ATHNdataset

Background and rationale Women and girls with one or two abnormal alleles of clotting factor genes can experience hemophilia symptoms, but a lack of data exists on the treatment of women with hemophilia. We used the ATHNdataset to identify female patients who received octocog alfa (BAY 81-8973/Kovaltry®) or damoctocog alfa pegol (BAY 94-9027/Jivi®) between January 1, 2010 and April 30, 2022. Baseline demographics, treatment history and medical history of patients aged ≥12 years with hemophilia A for damoctocog alfa pegol and all ages for octocog alfa were collected. The HIPAA-compliant, de-identified database, ATHNdataset, is a national database sponsored by the American Thrombosis and Hemostasis Network. This repository contains patient data, including of those with hemophilia A, gathered from ATHN-affiliated hemophilia treatment centers across the United States. Results: A total of 354 and 205 patients receiving octocog alfa and damoctocog alfa pegol, respectively, were in the ATHNdataset at the time of data cutoff. Of these, 13 patients receiving octocog alfa and four receiving damoctocog alfa pegol were female. Of the patients receiving octocog alfa, there was one pediatric patient (<12 years), two adolescent patients (12-18 years), and ten adult patients (>20 years) of whom seven were older than 30 years. For damoctocog alfa pegol, there were two adolescent patients (12-18 years) and two adults (>50 years). These patients were treated as listed in Table 1. For the octocog alfa patients, out of 11 patients, only one was treated with octocog alfa for <1 year, and six patients were treated for >3 years. Data regarding length of treatment were missing for two patients. Two patients were treated with damoctocog alfa pegol for <1 year, and two for >1 year with one of them for >3 years (Table 2). Of the octocog alfa patients, there was one patient who had four bleeds; all bleeds were traumatic, including three joint bleeds. One patient receiving damoctocog alfa pegol had one traumatic bleed with no joint bleeds. All other patients had zero bleeds. Eight patients on octocog alfa with known data were previously treated with another product. Five of these eight patients were on a previous standard half-life product. Three of the eight had bleeding episodes, including spontaneous and joint bleeds, on their previous product; one patient with five bleeds had two traumatic bleeds and three joint bleeds. None of these patients had bleeds while using octocog alfa. All these patients were classified as having mild hemophilia; there was also one patient with moderate and two with severe hemophilia. Two patients on damoctocog alfa pegol with known data were previously treated with another product, one episodically with desmopressin and the other prophylactically with an extended half-life product. Neither had any bleed data listed in the dataset. Previous product usage of the patient with one traumatic bleed on damoctocog alfa pegol was unknown. Three patients receiving damoctocog alfa pegol had mild hemophilia and one severe. Conclusions: The real-world data obtained from the ATHNdataset confirm that some women and girls in all age groups are being treated with octocog alfa or damoctocog alfa pegol, and indicate the effectiveness of these treatments in this real-world setting. The majority have mild hemophilia A. Approximately 1/3 of the female patients were treated on some form of prophylaxis with 2/3 of these being classified as mild. Only traumatic bleeds, including traumatic joint bleeds, were noted. Three patients treated with different products before using octocog alfa had spontaneous, joint and traumatic bleeds on their previous therapies. More data are needed on the diagnosis and treatment of women with hemophilia A. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Efficacy of intermittent compression devices for thromboembolic prophylaxis in major abdominal surgery: a systematic review and meta-analysis.

The benefits of mechanical prophylaxis for the prevention of venous thromboembolism (VTE) in abdominal and pelvic surgery are uncertain, with different guidelines stating that graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCDs) can be used either alone or in combination. To review the efficacy of IPCDs in preventing VTE following abdominal and pelvic surgery. A systematic review was conducted, identifying relevant literature reporting clinical trials conducted in abdominopelvic surgery, comparing the effect of IPCDs alone or in combination with no prophylaxis, GCS and chemical prophylaxis. The review identified studies reported from 1966 to 2022 in Medline, Embase, PubMed and Cochrane databases for randomized controlled trials. Thirteen RCTs involving 1914 participants were identified. IPCDs were superior to placebo (OR VTE 0.39; 95% CI 0.20-0.76) but not superior to other forms of prophylaxis (OR 0.83; 95% CI 0.30-2.27) or to GCS alone (OR 0.9; 95% CI 0.24-3.36). The addition of IPCDs to GCS compared with GCS alone was beneficial (OR 0.45; 95% CI 0.23-0.91) as was the addition of IPCDs to standard perioperative chemoprophylaxis (OR 0.25; 95% CI 0.09-0.74). The overall quality and reliability of trials were low, with high risk of bias. IPCDs are more effective than placebo in reducing VTE rates but are not more effective than other forms of thrombo-prophylaxis (chemical or mechanical) following abdominal and pelvic surgery. There is poor quality evidence to suggest that they might have a role as additional prophylaxis when combined with GCS and chemical prophylaxis.

Real-world analysis of tumor lysis syndrome in patients started on venetoclax combination for acute myeloid leukemia.

Venetoclax is utilized with low-dose cytarabine or a hypomethylating agent for the treatment of acute myeloid leukemia. Clinical trials report a risk of tumor lysis syndrome and the package insert recommends a venetoclax dose ramp-up at the initiation. The purpose of this study was to evaluate the risk of tumor lysis syndrome in a large population of patients with acute myeloid leukemia outside of a clinical trial and evaluate the incidence of hospital-acquired complications during inpatient ramp-up. We performed a retrospective study of adult patients with acute myeloid leukemia receiving venetoclax with a hypomethylating agent or low-dose cytarabine. The primary outcome was the incidence of tumor lysis syndrome. Secondary outcomes included risk factors for tumor lysis syndrome, length of admission, and incidence of hospital-acquired complications. One hundred thirteen patients were included. Although all patients were given some form of prophylaxis, the incidence of tumor lysis syndrome was 8.8%. All were laboratory tumor lysis syndrome; one with hyperuricemia, nine with hypocalcemia, and ten with hyperphosphatemia. Six patients received sevelamer. Tumor lysis syndrome was resolved in all cases. No clinical tumor lysis syndrome occurred. Hepatic dysfunction, tumor lysis syndrome high-risk stratification, higher baseline white blood cell count, and lactate dehydrogenase levels were more common in the tumor lysis syndrome group. Hospital-acquired complications reached 13% in those directly admitted for dose ramp-up. Tumor lysis syndrome was uncommon and manifested as minor lab abnormalities. White blood cell count continues to be an indicator of risk for tumor lysis syndrome. Those who present with an elevated white blood cell or are otherwise at high risk for tumor lysis syndrome should be admitted for ramp-up. Otherwise, initiation and monitoring of venetoclax are feasible in the outpatient setting.

Szczepienia przeciw COVID-19 u dzieci 5–11-letnich ze szczególnym uwzględnieniem niepożądanych odczynów poszczepiennych

On December 10th, 2021, the Polish Minister of Health announced the beginning of vaccinations against COVID-19 in children aged 5–11. The introduction of vaccination against COVID-19 in people over 18 years of age and then 12 years of age has resulted that children aged 5–11 are the population with the highest incidence. Additionally, even after asymptomatic SARS-CoV-2 infection, children and adolescents are at risk of childhood multisystemic inflammatory syndrome. Vaccinations are the best form of prophylaxis. The vaccine developed by Pfizer/BioNTech (Comirnaty) in a pediatric dose of 10 μg/dose (0.2 ml) is the only one approved for vaccination of children between 5 and 11 years of age. The vaccination schedule consists of two doses of the vaccine given 3 weeks apart. The estimated efficacy of this vaccine from 7 days after the second dose was 90.7%. The vaccine was well tolerated, and adverse events were mild and temporary. Local reactions (pain and redness at the injection site and swelling) were common and were mostly mild to moderate. The systemic events were mainly fatigue, headache, myalgia, chills, pyrexia, and arthralgia and were more frequent after the second dose. Drugs that are recommended in case of pain or fever are paracetamol and non-steroidal anti-inflammatory drugs. Currently, paracetamol is the drug of first choice. In conclusion serious adverse reactions to the vaccine against COVID-19 are rare, but patients should always be informed and prepared for. Each doctor is obliged to follow all new information and update recommendations.

The Influence of the Use of Face Masks During the COVID-19 Pandemic on the Human Microbiome – A Mini-Review

The aim of this study was to draw attention to the possible consequences of improper, unhygienic use of mouth and nose covers in the context of prophylaxis against the spread of COVID-19 from the point of view of a family physician and focus on the risk of respiratory infections and skin lesions in patients, in different age groups. The use of protective masks may reduce the likelihood of infection but will not eliminate the risk of infection. However, it should be remembered that any mask, no matter how effective the filtration is or how well it seals, will have little effect if not used in conjunction with other preventive measures, including isolation of infected people, immunization, proper respiratory culture, regular, frequent replacement of masks, and hand hygiene. Additionally, certain risks associated with this form of prophylaxis should be taken into account, which, unfortunately, may also aggravate or even constitute a source of serious respiratory infections and lead to the development and aggravation of skin problems. Moreover, educating society not only on hand hygiene but also on the topic of the value of nose and mouth covers, as well as the frequency of their replacement and/or disinfection, is becoming a significant issue.

Diagnosis, prevention and treatment of central nervous system involvement in peripheral t-cell lymphomas.

Non-Hodgkin lymphomas with T-cell immunophenotype encompass a heterogeneous group of infrequent neoplasms that follow variable clinical courses but prevalently include aggressive behavior and high mortality rates. The involvement of the central nervous system (CNS) is an uncommon event in T-cell lymphomas, with wide variability among the different disease entities. CNS can be affected either at initial diagnosis or at recurrence, and both forms are considered "secondary CNS T-cell lymphoma". Given the low incidence of secondary CNS T-cell lymphoma, related literature is sparse, contradictory, and primarily constituted by small case series and single case reports. However, reported studies uniformly suggest high mortality rates related to this event. Therefore, to improve our ability to identify high-risk patients and offer them successful CNS prophylaxis or timely and effective treatment once the event has occurred may prevent CNS-related T-cell lymphomas deaths. For example, some entities like aggressive adult T-cell leukemia/lymphoma, extranodal natural killer/T-cell lymphoma, and other peripheral T-cell lymphomas with involvement of two or more extranodal organs are prone to CNS dissemination and should be considered for personalized CNS prophylaxis. The level of evidence suggesting an increased risk of CNS recurrence for other T-cell lymphomas and for other risk factors is lower. Published case series show that, following the example of aggressive B-cell lymphomas, patients with T-cell lymphomas and putative increased CNS risk receive different forms of prophylaxis, mostly methotrexate and cytarabine delivered by intrathecal and/or intravenous routes, with varied success. To date, achievements in the treatment of CNS involvement in patients with aggressive B-cell lymphoma were not replicated in secondary CNS T-cell lymphomas, and identification of effective therapies remains an urgent research target. This review is focused on clinical findings, diagnosis, treatment, and prognosis of patients with T-cell lymphoma experiencing CNS dissemination either at presentation or relapse. It aims to provide logical and, oftentimes, evidence-based answers to the most common questions on the most probable risk factors to CNS involvement in patients with T-cell lymphoma, the indications and strategies to prevent this life-threating event, and the management of patients with CNS disease.

The Incidence of Venous Thromboembolism in Patients Undergoing Anterior Lumbar Interbody Fusion: A Proposed Thromboprophylactic Regime

To determine the safety and efficacy of the proposed venous thromboembolism (VTE) prophylaxis regime in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are recognized complications after spine surgery, with rates in the literature ranging from 0% to 14% with some form of prophylaxis. Pharmacological thromboprophylaxis can cause postoperative bleeding and hematomas, which can result in significant neural compromise or permanent injury, and wound complications. ALIF surgery involves the handling and compression of major abdominal vessels during surgery and this adds to the risk of both arterial thrombosis and VTE. A retrospective review of data, which were prospectively collected to evaluate the incidence of VTE in 200 consecutive patients undergoing ALIF following our VTE prophylaxis protocol. All patients had low molecular weight heparin, tinzaparin 4500 units subcutaneously on the evening before surgery, then daily for 3 to 5 days, then aspirin (acetylsalicylic acid) 150 mg daily plus lansoprazole 30 mg daily for 4 weeks after surgery. All patients had intermittent pneumatic compression of their calves and thighs intraoperatively and for 24 hours postoperatively then had early mobilization and thromboembolic deterrent stockings for 6 weeks. There was no incidence of any symptomatic VTE in the any of the 200 patients and no loss to follow-up. There was a 0% incidence of injury to the iliac vessels, symptomatic arterial occlusion, wound hematoma, major intraoperative bleeding, need for transfusion, symptomatic GI bleed, or retroperitoneal hematoma requiring intervention. The proposed VTE prophylactic regime is safe and efficacious and may decrease the incidence of symptomatic VTE in patients undergoing an ALIF procedure, and despite the use of chemical thromboprophylaxis, there is no evidence of bleeding complications as a result of using this regime. 4.

Profilaxia pré e pós exposição ao Covid-19: Uma revisão sistemática

Introdução: Covid-19 é definida como a infecção respiratória causada pelo coronavírus SARS-CoV-2. A ausência de tratamentos específicos, a alta incidência da doença e a preocupação global com os efeitos socioeconômicos suscitam a necessidade de determinar medidas profiláticas para o combate a esta pandemia. Metodologia: Trata-se de uma revisão sistemática, realizada a partir de pesquisa nas bases Pubmed e DOAJ de trabalhos com os descritores “profilaxia” e “prevenção” em Covid-19. Os dados foram extraídos em planilha de Excel, organizados por nível de evidência e dispostos na classificação “profilaxia não medicamentosa” e “profilaxia medicamentosa”. O desfecho considerado foi Covid-19 confirmado laboratorialmente. A pesquisa forneceu 63 artigos da base PubMed e 388 resultados da base DOAJ, sendo selecionados 19 trabalhos. Das intervenções não farmacológicas, fechamento de escolas, quarentena obrigatória da comunidade, testagem em massa com isolamento de casos, isolamento obrigatória de imigrantes, distanciamento social superior a 1 metro, uso de máscaras descartáveis e higiene das mãos impactam significativamente no pico, quantidade total de casos e duração do surto, bem como no número de mortes. Triagem de sintomáticos em portos e aeroportos apresentou limitada efetividade. Das intervenções farmacológicas, apesar de ensaios pré-clínicos promissores, evidências atuais não apoiam uso profilático de vitamina D, zinco, cloroquina/hidroxicloroquina, ivermectina ou colchicina na prevenção do Covid-19. Conclusão: A pandemia atual é uma crise de saúde pública e econômica sem precedentes e as únicas formas de profilaxia eficazes foram as não medicamentosas.

A Concise Review of the Popularised Drugs Used For The Management of COVID-19 (SARS-CoV-2)

Background: Coronavirus disease 2019 (COVID-19) caused by SARS-COV-2 has been largely associated with many different therapeutic agents (both homeopathic & pharmaceutical) by the media and the general public but there is little evidence-based published material to support their claims. The purpose of this article is to provide a comprehensive review of the various therapeutic agents used for the treatment of COVID-19 which have been lauded by the media and the general public. Method: We conducted an in-depth review of the various case reports and retrospective clinical studies published on the therapeutic measures, both homeopathic and pharmaceutical, used for the management of COVID-19 using PubMed and Google Scholar as our primary sources. We analyzed the real-life implications of alternative therapies such as Ayurveda and Pranayama and herbal medications such as Sana Makki and Sangju yin being used as a form of prophylaxis, and add-on treatments. We’ve also assessed the therapeutic effects of various pharmaceutical agents currently being used in the management of COVID-19 and other drugs that have been popularized by various news outlets and social media. Conclusion: Research is still ongoing on the various drugs used in the management of COVID-19. Caution has to be taken when introducing a new medication into treatment regimens, whether it is allopathic or homeopathic, without proper evidence despite pressure from the media and/or the patients. As mismanagement can further strain the overwhelmed healthcare system. Patient and general public education should take precedence as no drug is a cure-all for this novel virus. New updates come every day and treatment protocols are refined throughout the world thanks to the flow of information and the joint effort of researchers and clinicians.

Conhecer para prevenir: complementação do conhecimento dos alunos do ensino fundamental sobre microbiologia e parasitologia em três escolas de Uberlândia-MG

O conhecimento sobre microbiologia e parasitologia é considerado abstrato, pois muitos agentes causadores de doenças não são vistos a olho nu, o que distancia os alunos da realidade. Assim, nossos objetivos foram promover ações educativas por meio de ferramentas didáticas lúdicas que possibilitassem a complementação do aprendizado dos alunos frente aos diferentes grupos de microorganismos e parasitos e das ações de profilaxia relacionadas aos mesmos, e avaliar se ao final eles tinham condições de discriminar os grupos e relacionar com as doenças e as formas de profilaxia. Para tanto, foram feitas entrevistas junto aos professores para levantamento das possíveis atividades a serem desenvolvidas. A ação foi definida e então dividida em três momentos (aula expositiva, jogo didático e mostra científica) realizados entre agosto e novembro de 2018, atingindo aproximadamente 350 alunos, de oitavos e nonos anos, de três escolas públicas da zona urbana e rural da cidade de Uberlândia-MG. Para avaliar o impacto da ação foi feita uma análise comparativa de questionários aplicados antes (pré-intervenção) e após a ação (pós-intervenção). O percentual das respostas corretas nos questionários pós-intervenção aumentou em duas escolas (p&gt;0,005). Quanto à análise por questões, as menores porcentagens de acertos foram observadas em perguntas relacionadas à distinção entre doenças bacterianas e virais, o reconhecimento dos sintomas e a associação das formas de transmissão com a profilaxia. Assim, este estudo reforça a importância da educação em saúde para que os alunos se mobilizem frente ao combate das doenças

Rising incidence of clostridium difficile infection and associated clinical outcomes in hospitalized cancer patients: A national perspective.

e19095 Background: Cancer patients are more prone to Clostridium difficile infection (CDI). Several factors such as increased exposure to antibiotics (either in the form of prophylaxis or treatment), being on chemotherapy, and frequent exposure to healthcare settings are responsible for this. Rate of CDI in these patients ranges from 10-20%. Here, we performed a retrospective analysis using the national inpatient sample to study the trend and to see whether CDI leads to poor outcomes in these patients. Methods: We have used National Inpatient Sample database from the year 2009 to 2015 to identify hospitalized adult patients with cancer using ICD-9 CM codes. Similarly, We also identified patients with concurrent CDI amongst all cancer patients. Our primary aims were to study the trend of CDI and associated outcomes in from of mortality, cost of hospitalization and length of stay. Incidence of CDI per 10,000 discharges in those patients over the study period was assessed. Outcomes related to CDI in cancer patients were compared with those without CDI. Categorical and continuous variables were compared between matched cohorts using Chi-square and Student’s t-test, respectively. Statistical significance level was set at &lt; 0.05. All analyses were performed with the use of SAS (version 9.4). Results: Total of 6,035,966 cancer patients was identified over the study period. Out of which, 57,167 (0.9%) had concurrent CDI. Age, sex and race were comparable in both the groups. Incidence of CDI increased from 89 cases to 101 cases per 10,000 cancer patients (p-trend: &lt; 0.05). Inpatient mortality was significantly higher in cancer patients with CDI compared to without CDI(12.1% vs 4.7%, p &lt; 0.0001). Cost of hospitalization was almost 3 times higher ($36,243 vs $12,910, p &lt; 0.0001).Median length of stay was almost four-fold longer (16 days vs 4 days, p &lt; 0.0001). Patients with Medicare and Medicaid had higher percentages of CDI cases while patients with private insurance had lower percentages. Conclusions: Incidence of CDI in cancer patients is on the rise. CDI lead to higher mortality, cost of hospitalization, and length of stay in cancer patients. Preventive strategies in form of judicious use of antibiotics and prompt identification with treatment may help with reducing mortality and associated healthcare burden.

AREAS OF MOBILE TECHNOLOGIES APPLICATION WHEN PREPARING THE POPULATION FOR ACTIONS DURING EMERGENCIES

In the circumstances when human life is intensively affected by many harmful environmental factors resulting from large-scale disasters of different origins and types, the issues of population training in emergency preparedness and response as well as public safety culture development in general are of great importance. According to the State Emergency Service of Ukraine, in 2018 168 people were killed and 839 were injured because of emergencies. In comparison with the same last year period, there is a steady death toll increase despite the fact that the total number of emergencies in Ukraine has decreased in contrast to the previous period. In addition, rescuers have considered fire safety and hygiene violations along with low-level control over the epidemic prevention measures implementation as main causes of natural and man-made emergencies in the country during recent years.&#x0D; Such state of affairs may indicate that very often the loss of life during emergency results from the lack of knowledge and failure to comply with the recommendations on life safety, and that the existing system of civil protection training is not able to cover all segments of the population. In addition, the complex technogenic and environmental, and military and political situations significantly increases the risk of dangerous incidents occurrence with casualties. Thus, modernization of knowledge dissemination system on the civil protection and life safety issues among the population are of particular relevance.&#x0D; The problem of mobile technologies for educational purposes is analyzed by the Ukrainian and foreign researchers, namely: V. Bykov, A. Struk, S. Smerikov, D. Kigan, A. Andreeva, etc. At the same time, the analysis of scientific and methodological literature and online sources shows that the problem of the use of mobile training for raising public awareness on civil protection issues has not been considered as a separate research subject before.&#x0D; The purpose of the article is to determine the peculiarities of the mobile technologies used for population emergency preparedness, as well as to present the developed social mobile application “SES Alphabet” and the prospects of its usage for population training.&#x0D; Under the rapid civilizational development of humanity, there will always be the possibility of various natural and manmade threats, and a certain part of the population will suffer from dangerous factors of the external environment. Therefore, the issue of citizen’s safety competence development and the culture of society safety in general will always remain urgent. According to the Ukrainian Constitution, human life and health, its protection against the impact of harmful man-made, natural, environmental and social factors are the highest social values, for which a unified state system of civil protection was created. One of the system’s components is the preparing of the population to behave properly under the conditions of potential emergencies.&#x0D; Taking into account the fact that the main task of public policy in the civil protection field is emergency prevention, preparing people to act under special circumstances is an effective form of prophylaxis, first and foremost, of human casualties caused by disasters. The basics of human behavior in extreme situations are formed because of constant training, which provides an adequate level of preparedness in case of emergency. Therefore, the training of the population on civil protection issues should be standardized and widespread.&#x0D; There is a natural question about effective tools for such training. In our opinion, it is possible to solve this problem by developing a suitable mobile application. Using of mobile devices for outreach activities on civil protection issues with the civilians and promotion of a safety culture in society have wide prospects because it addresses the major problem of accessibility and rapid provision of the adapted, easy-to-read educational information material. Mobile learning offers great opportunities for self-education of the population because the application allows you to remotely study in the field of life safety regardless of place and time. The high concentration and multimedia of the training material make it possible to focus on the main points, while the user-friendly interface allows you to navigate the vast array of civil protection information material very quickly.&#x0D; Considering the opportunities and advantages, mobile education, in our opinion, in the long run can be the most effective outreach activity for the population on socially significant issues, in particular informing citizens about emergency response. The use of mobile devices will create the conditions for accessible, inclusive and continuous education of the population on civil protection issues.&#x0D; International experience in the mobile applications in civil protection systems used to inform the public about emergency demonstrates the effectiveness of the mobile technologies in achieving the key tasks in the field of civil protection, namely the protection of life and health of citizens. The mobile application will provide useful and easy-to-read information about emergency procedures, which will help to avoid loss of human lives among the affected population.

Formulation and in vitro evaluation of a mucoadhesive metronidazole dental gel for oral application

Periodontitis is inflammation of the supporting tissues of the teeth caused by microorganisms found in plaque. Metronidazole is commonly used for the treatment of periodontal diseases like gingivitis and periodontitis. Treatment of periodontal disease orally using metronidazole tablets for a prolonged period can cause gastrointestinal disturbances in patients leading to poor patient compliance. This project aimed at formulating a mucoadhesive metronidazole dental gel preparation safe for use on the gums as a form of prophylaxis against infections caused by anaerobic bacteria after dental procedures. Formulation of the gel was carried out in the laboratory using different concentrations of Carbopol ® 971P NF. The gels obtained showed acceptable uniformity of content, pH, spreadability, in vitro diffusion characteristics as well as mucoadhesive and organoleptic properties. Keywords: Metronidazole, mucoadhesive gel, oral application

Study of needle stick injuries among healthcare providers: Evidence from a teaching hospital in India.

Background:Needle stick injuries (NSIs) are the injuries that are caused by needles, such as hypodermic needles, blood collection needles, intravenous stylets, and needles used to connect parts of intravenous delivery systems. NSIs are very common and in many instances unavoidable among healthcare providers when they are delivering patient care. Around 75% of the NSIs in developing countries are not reported. This study aimed to estimate the prevalence and other correlates and attributes of NSIs among healthcare providers in a tertiary care teaching hospital in South India.Methods:This is a cross-sectional study conducted in Narayana Medical College and Hospital in Nellore, Andhra Pradesh, between June 2012 and February 2013. Data using a structured questionnaire were collected among all the 1525 healthcare providers working in the teaching hospital.Results:Around 10.81% of the total healthcare providers in the teaching hospital were exposed to NSIs. Syringe needles (75%) were the most common devices leading to NSIs. Majority of NSIs took place in the wards of the different departments (75%). Morning shift (70%) was the most common time of the day for the occurrence of NSIs. Only 65% of the healthcare providers were wearing gloves at the time of injury. Majority (82%) took immediate treatment after NSIs.Conclusions:Establishment of formal reporting mechanisms, immediate reporting of NSIs, and the establishment of a comprehensive NSI prevention program will help in the reduction in the occurrence of NSIs and help in taking immediate remedial action in the form of prophylaxis and treatment.

Multicenter Review of Current Practices Associated With Venous Thromboembolism Prophylaxis in Pediatric Patients After Trauma.

Frequency of venous thromboembolism in pediatric trauma patients admitted to PICUs is not insignificant, ranging up to 6%. Risk factors have been identified in this population. However, there is little consensus of actual venous thromboembolism prophylaxis practice. We examined factors associated with venous thromboembolism prophylaxis in PICUs. A retrospective study evaluating associations with mechanical venous thromboembolism prophylaxis, pharmacologic venous thromboembolism prophylaxis, or dual therapy (DUAL) prophylaxis compared with no venous thromboembolism prophylaxis. Multivariable logistic regression explored the relationship between prophylaxis type and selected covariates with stepwise selection method to identify the independent predictors of venous thromboembolism prophylaxis utilization. Five level I/II pediatric trauma centers in the United States. Children less than 18 years from January 1, 2013, to December 31, 2013, admitted to the PICU after a trauma, identified through combined trauma registry and Virtual Pediatric Systems database. None. Six hundred ninety-two patients were included in the database, with 55 excluded for missing data. Of the remaining 637 patients, 538 (84.5%) had no venous thromboembolism prophylaxis by 48 hours, 77 (12.1%) had only mechanical venous thromboembolism prophylaxis, 11 (1.7%) had DUAL, and 11 (1.7%) had pharmacologic venous thromboembolism prophylaxis alone. Multivariable analysis showed increased age, and orthopedic procedure was associated with all forms of prophylaxis. Orthopedic procedures were associated with higher utilization of dual prophylaxis use (odds ratio, 5.2; 95% CI, 1.2-21.8), pharmacologic venous thromboembolism prophylaxis (odds ratio, 8.5; 95% CI, 2.3-31.7), and mechanical venous thromboembolism prophylaxis (odds ratio, 2.2; 95% CI, 1.1-4.2) alone. Brain/spinal cord procedures (odds ratio, 3.7; 95% CI, 1.9-7.3) and abdominal procedures (odds ratio, 6.6; 95% CI, 2.5-17.1) were associated with mechanical venous thromboembolism prophylaxis. Head injury was associated with a decreased use of any prophylaxis (odds ratio, 0.5; 95% CI, 0.3-0.9). Patient comorbidities were associated with decreased use of mechanical venous thromboembolism prophylaxis (odds ratio, 0.5; 95% CI, 0.3-1.0). Pharmacologic venous thromboembolism prophylaxis is not common in critically ill children after trauma. Patient age, orthopedic and vascular procedures, and higher injury severity are associated with pharmacologic venous thromboembolism prophylaxis.

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery.

Endophthalmitis is a severe inflammation of the anterior and/or posterior chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection.The objective of this review was to evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery.We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 October 2012. We also searched for additional studies that cited any included trials using the Science Citation Index.We included randomized controlled trials that enrolled adults undergoing cataract surgery (any method and incision type) for lens opacities due to any origin. Trials that evaluated preoperative antibiotics, intraoperative (intracameral, subconjunctival or systemic) or postoperative antibiotic prophylaxis for acute endophthalmitis were included. We did not include studies that evaluated antiseptic preoperative preparations using agents such as povidone iodine, nor did we include studies that evaluated antibiotics for treating acute endophthalmitis after cataract surgery.Two review authors independently reviewed abstracts and full-text articles for eligibility, assessed the risk of bias for each included study, and abstracted data.Four studies met the inclusion criteria for this review, including 100,876 adults and 131 endophthalmitis cases. While the sample size is very large, the heterogeneity of the study designs and modes of antibiotic delivery made it impossible to conduct a formal meta-analysis. Interventions investigated in the studies included the utility of adding vancomycin and gentamycin to the irrigating solution compared with standard balanced saline solution irrigation alone, use of intracameral cefuroxime and/or topical levofloxacin perioperatively, periocular penicillin injections and topical chloramphenicol-sulphadimidine drops compared with topical antibiotics alone, and mode of antibiotic delivery (subconjunctival versus retrobulbar injections). Two studies with adequate sample sizes to evaluate a rare outcome found reduced risk of endophthalmitis with antibiotic injections during surgery compared with topical antibiotics alone: risk ratio (RR) 0.33, 95% confidence interval (CI) 0.12 to 0.92 (periocular penicillin versus topical chloramphenicol-sulphadimidine) and RR 0.21, 95% CI 0.06 to 0.74 (intracameral cefuroxime versus topical levofloxacin). Another study found no significant difference in endophthalmitis when comparing subconjunctival versus retrobulbar antibiotic injections (RR 0.85, 95% CI 0.55 to 1.32). The fourth study which compared irrigation with balanced salt solution (BSS) alone versus BSS with antibiotics was not sufficiently powered to detect differences in endophthalmitis between groups. The risk of bias among studies was low to unclear due to information not being reported.Multiple measures for preventing endophthalmitis following cataract surgery have been studied. One of the included studies, the ESCRS (European Society of Cataract and Refractive Surgeons) study, was performed using contemporary surgical technique and employed cefuroxime, an antibiotic commonly used in many parts of the world. Clinical trials with rare outcomes require very large sample sizes and are quite costly to conduct; thus, it is unlikely that additional clinical trials will be conducted to evaluate currently available prophylaxis. Practitioners should rely on current evidence to make informed decisions regarding prophylaxis choices.