Implementation Of Prevention Strategies Research Articles

Causes of Mediastinitis and Its Surgical Treatment

Mediastinitis remains a potentially fatal complication of cardiac surgery. This study reviews the risk factors for mediastinitis after cardiac surgery, and discusses current treatment and prevention of this complication. This review explores three major independent risk factors for mediastinitis including individual patient factors, surgical procedures and microbiology. The perioperative period is influenced by the utilization of the internal mammary artery in conjunction with coronary artery bypass grafting, sternal fixation, vacuum-assisted closure, and negative pressure wound therapy. Staphylococcus aureus and Staphylococcus epidermidis are frequently encountered microorganisms. Additionally, aerobic gram-negative microorganisms and other infrequent microorganisms are also exhibiting a rising trend. Since sternal fixation devices effectively enhance sternal stability, alleviate wound pain, and decrease the occurrence of postoperative mediastinitis, they have been specifically incorporated into certain therapeutic and prophylactic approaches for addressing this complication. Despite the heightened awareness regarding mediastinitis, the large proportion of individuals at risk underscores the crucial need for rigorous monitoring of potential risk factors, posing a significant challenge to the implementation of effective therapeutic and preventative strategies.

Clinical and echographic parameters as risk factors for atrial fibrilation in patients with hypertophic cardiomyopathy

Abstract Introduction Hypertrophic cardiomyopathy is the most prevalent inherited cardiomyopathy characterized by left ventricular hypertrophy and manifests with atrial fibrillation in 25% of patients, correlating with heightened morbidity and mortality rates. Purpose To investigate the clinical and echocardiographic parameters associated with the occurrence and progression of atrial fibrillation in patients diagnosed with hypertrophic cardiomyopathy. Material and Methods The study sample consisted of 72 patients with hypertrophic cardiomyopathy attending the Hereditary Heart Disease Unit at a tertiary cardiac surgery center. Thorough examination of patients' medical records was conducted. Results Myocardial fibrosis was observed in 68.1% of the patients. Analysis of the data revealed that atrial fibrillation (AF) episodes were more prevalent in older individuals (p=0.035) with a lower ejection fraction (p=0.003). Additionally, a larger left atrial diameter of 49.8mm (p<0.001), functional stage according to NYHA III (p=0.015), a history of syncope/pre-syncope events (p=0.018), patients with an implanted pacemaker/defibrillator (p=0.003), and those with known coronary artery disease factors (p=0.032), particularly dyslipidemia (p=0.049) and diabetes mellitus (p=0.027), were associated with higher AF incidence. Conclusions . This study underscores the importance of recognizing clinical and echocardiographic factors that contribute to atrial fibrillation risk in hypertrophic cardiomyopathy, enabling early identification of high-risk individuals and implementation of preventive strategies to reduce the frequency of atrial fibrillation episodes and associated complications.

Contrast-induced nephropathy: nursing interventions - a scoping review

Abstract Introduction Contrast-induced nephropathy (CIN) refers to a reduction in renal function following contrast administration, excluding other causes. It is characterized by na increase in creatinine levels of 0.5mg/dl or greater, or a 25% increase over baseline creatinine, occurring 48 to 72 hours post-contrast administration and lasting for 2 to 5 days (Santos et al., 2011). Antunes et al. (2013) refers that the CIN is the 3rd cause of acute renal insufficiency (ARI) and that CIN may develop in up to 55% of patients who receive contrast exposure during coronary angiography and of these may result in 12,6% requiring dialysis among high-risk groups following percutaneous coronary intervention (PCI) (Wu et al., 2022). Objective This review aims to map the available evidence regarding nursing interventions to prevent contrast-induced nephropathy in patients undergoing PCI. Methods The review follows the methodology proposed by the Joanna Briggs Institute guided by the PCC (Population, Concept, Context) strategy. Were identified 44 articles by MEDLINE Complete (via PubMed), CINAHL Complete (via EBSCO) e SciELO, and analyzed/ selected through PRISMA Scr flowchart. Four articles were included. Results These articles revealed that the incidence of CIN varies based on risk factors such as age, hypertension, and pre-existing chronic kidney disease. As there is no specific treatment for contrast-induced nephropathy, prevention strategies are essential. Nursing professionals have a significant and privileged role in the pre-, intra-, and post-procedural phases, and thus, are best positioned to implement prevention strategies for CIN. In general, hospitals that implemented improvement interventions reduced CIN by 21% compared to the pre-intervention phase. Compared to patients with pre-existing CKD, the reduction was 28% (Lambert et al., 2017). Teams also report important successes in implementing improvements, such as changing behavior with greater awareness of CIN prevention strategies, implementing the hydration protocol, standardizing medical prescriptions and minimizing the volume of contrast administered. Conclusions Nursing plays a crucial and privileged role in preventing CIN. Key interventions involve conducting a thorough initial assessment to identify individuals at risk for CIN (considering factors such as age, comorbidities, nephrotoxic medication, and dehydration). Pioli et al. (2023) found that oral hydration can be effective in the process of preventing CIN, before and after elective percutaneous procedures. It concluded that the oral hydration protocol carried out by nurses proved to be as effective as the hospital intravenous hydration protocol in protecting the kidneys of individuals at risk of developing CIN associated with elective coronary interventions (Picture 1). By implementing these strategies, nursing professionals can effectively contribute to reducing the incidence of contrast-induced nephropathy in patients undergoing PCI.

Incidence of Diabetes Mellitus in the Kyrgyz Republic and the World. Factors Influencing Its Course

In recent years, large-scale studies based on data from administrative databases have reported changes in diabetes incidence over time. Different countries show various trends: stable incidence, decreases, and increases. High-income countries have seen a decline in diabetes incidence, possibly linked to changes in diagnosis and screening practices. The number of children and adolescents with diabetes, particularly type 2, is increasing, significantly impacting society. Diabetes is a cause of premature mortality and disability, negatively affecting the economy. In the USA, premature mortality is estimated to cost 19.9 billion dollars annually. In Kyrgyzstan, the burden of non-communicable diseases, including type 2 diabetes, is growing. Measures to combat diabetes in the country include free provision of insulin and medications, the approval of clinical guidelines and protocols, and the implementation of national prevention and control programs. The State Guarantee Program ensures free medication assistance for diabetes patients. Despite these efforts, issues with funding and resource efficiency remain. Improving the quality of medical care, intersectoral cooperation, and increasing accountability for public health are necessary. Enhancing the quality of pharmaceutical care and the efficient use of public funds are also priorities for improving the diabetes situation in Kyrgyzstan. Early diagnosis and treatment of diabetes complications, as well as the implementation of new prevention strategies, are crucial for reducing incidence and improving the quality of life for patients.

New Insights into Molecular Characterization, Antimicrobial Resistance and Virulence Factors of Methicillin-Sensitive Coagulase-Positive Staphylococcus spp. from Dogs with Pyoderma and Otitis Externa

The first Tunisian national molecular survey of coagulase-positive staphylococci (CoPS) isolated from dogs with pyoderma and otitis externa was conducted to evaluate the prevalence of CoPS and identify its phenotypic and genotypic diversities. A total of 99 out of the 195 samples collected from 39 sick dogs were identified across multiple sites as methicillin-susceptible CoPS belonging to the species S. pseudintermedius (64.4%), S. aureus (20.2%), S. coagulans (10.1%), and S. hyicus (5%). Fifteen sampled dogs carried more than one Staphylococcus species. Their antibiotic resistance and virulence factors were determined using conventional and molecular methods. Of the S. pseudintermedius isolates found, 17.4% were multidrug-resistant, whereas high rates of virulence genes were observed among the S. aureus isolates. On polystyrene surfaces, 75% of S. aureus isolates were biofilm producers, of which 15% were classified as strong producers. The capsular polysaccharide cap8 genotype was predominant among them. A MultiLocus Sequence Typing (MLST) analysis clustered the S.aureus isolates into five distinct sequence types (STs), with four assigned for the first time. Our findings highlight the spread of CoPS among diseased dogs and, especially, the emergence of S. hyicus, S. coagulans, multidrug-resistant S. pseudintermedius and S. aureus isolates with high genetic variability. The precise characterization of these strains, as well as their continuous monitoring, is necessary for the implementation of preventive strategies given the significant public health risk.

Neurocognitive and clinical profile of male patients with substance use disorder in early remission phase with and without comorbid depression

Substance Use Disorder (SUD) represents one of the most frequent conditions worldwide which commonly coexists with major depressive disorder (MDD). This comorbidity (SUD + MDD) is one of the most prevalent with patients showing certain social and clinical characteristics that could lead to a worsening of their cognitive performance. However, despite these particularities, only a few studies have addressed the possible differences in cognitive performance between patients with SUD + MDD compared with those with SUD-only patients. Therefore, the aim of this study is to examine the clinical and cognitive profile of patients with SUD + MDD vs. SUD-only who are in early remission phase. For this purpose, 271 male patients underwent a clinical and neuropsychological assessment (SUD + MDD group: N = 101; SUD-only group: N = 170). Results indicated that SUD + MDD patients showed worse cognitive performance than SUD in visuospatial reasoning, verbal memory and learning, recognition, and processing speed even after a 3-month period of abstinence. Furthermore, these patients exhibited more self-reported prefrontal symptoms, as well as worse social and clinical conditions. This study indicates that the neurocognitive and clinical profile of patients with SUD + MDD could represent a risk since their characteristics have been associated with poorer recovery and prognosis. Our results could be helpful in clinical practice highlighting the need for cognitive remediation strategies in these populations, providing information that would allow the implementation of more appropriate treatments and preventive strategies.

Veteran suicide prevention learning collaborative: implementation strategy and processes.

The majority of Veterans who died by suicide in 2021 had not recently used Veterans Health Administration (VA) services. A public health approach to Veteran suicide prevention has been prioritized as part of the VA National Strategy for Preventing Veteran Suicide. Aligned with this approach, VA's Patient Safety Center of Inquiry-Suicide Prevention Collaborative piloted a Veteran suicide prevention learning collaborative with both clinical and non-clinical community agencies that serve Veterans. The VA COmmunity LeArning CollaboraTive (CO-ACT) uses a quality improvement framework and facilitative process to support community organizational implementation of evidence-based and best practice suicide prevention strategies to achieve this goal. This paper details the structure of CO-ACT and processes by which it is implemented. This includes the CO-ACT toolkit, an organizational self-assessment, a summary of recommendations, creation of a blueprint for change, selection of suicide prevention program components, and an action plan to guide organizations in implementing suicideprevention practices. CO-ACT pilot outcomes are reported in a previous publication.

Cardiovascular risk in young healthcare professionals: A cross-sectional study.

In the last years cardiovascular risk has decreased in grown adults and elderly while it seems to be rising among young adults. to assess the 10-year cardiovascular risk (CVR) in young healthcare professionals at the teaching hospital in Rome, using two scores, and identify possible determinants in order to design and implement preventive strategies. A cross-sectional study was carried out between January 2019 and July 2020. Participants underwent medical history collection, physical examination, and blood tests. CVR was calculated using CUORE and Framingham Risk Scores. A multiple linear regression analysis was conducted having the scores as dependent variables. Diagnostic tests were used for checking model assumptions. The study was carried out including 525 participants, 58.5% physicians and 32.1% nurses. Multivariate analysis was carried out only for men, since the pp plot for the whole population and for females for the dependent variables showed some evidence of non-normality, and the residual plot shows variance of the residuals was not constant across the range of fitted values. CVR, using the Framingham equation, directly correlated with age (β=0.260; p < 0.001). Using the CUORE score, qualification as a physician (p < 0.001) is associated with a lower risk of having a CVR, while age (p < 0.001) is directly proportional to this risk. Increasing age consistently emerges as a prominent factor, positively influencing both the Framingham risk score and CUORE score, but this association was found only for men. Being a doctor is a protective factor for the CUORE score.

Burden of six major types of digestive system cancers globally and in China.

Digestive system cancers constitute a significant number of cancer cases, but their burden is not uniform. As Global Cancer Observatory (GLOBOCAN) 2022 has recently updated its estimates of cancer burden, we aimed to investigate the burden of six major digestive system cancers both worldwide and in China, along with geographical and temporal variations in cancer-specific incidence and mortality. We extracted data on primary cancers of the esophagus, stomach, colorectum, liver, pancreas, and gallbladder from the GLOBOCAN database for 2022. Age-standardized incidence and mortality rates were calculated and stratified by sex, country, region, and human development index (HDI). We used the 2022 revision of the World Population Prospects (United Nations) to obtain demographic data for various age groups in China from 1988 to 2012 and used the joinpoint model and the average annual percentage change (AAPC) to analyze cancer incidence trends in China. In 2022, the estimated global incidence of digestive system cancers reached 4,905,882, with an estimated 3,324,774 cancer-related deaths. Colorectal cancer was most prevalent in terms of incidence and mortality. There was a significant correlation between the burden of gastrointestinal cancers and country HDI. From 1988 to 2012, the incidence of esophageal, gastric, and liver cancers declined in China, whereas colorectal and pancreatic cancer incidences continued to increase. By 2050, colorectal and liver cancers are projected to remain the leading cancer types in China in terms of incidence and mortality, respectively. Digestive system cancers remain a significant public health challenge globally and in China. Although progress has been made in the prevention and control of some cancers, the burden of digestive system cancers persists. The implementation of tertiary prevention strategies must be intensified to reduce the incidence and mortality of digestive system cancers, mitigating their impact on public health.

Violence in the emergency department: a quantitative survey study of healthcare providers in India

BackgroundWorkplace violence (WPV) in Emergency Departments (EDs) is an increasingly recognized challenge healthcare providers face in low-resource settings. While studies have highlighted the increased prevalence of WPV in healthcare, most of the existing research has been conducted in developed countries with established laws and repercussions for violence against healthcare providers. More data on WPV against ED providers practicing in low-resource settings is necessary to understand these providers’ unique challenges.ObjectiveThis study aims to gain insight into the incidence and characteristics of WPV among ED healthcare providers in India.MethodsThis study was conducted at two EDs in geographically distinct regions of India. A survey was designed to assess violence in EDs among healthcare providers. Surveys were distributed to ED workplace providers, completed by hand, and returned anonymously. Data was entered and stored in the RedCAP database to facilitate analysis.ResultsTwo hundred surveys were completed by physicians, nurses, and paramedics in Indian EDs. Most reported events involved verbal abuse (68%), followed by physical abuse (26%), outside confrontation (17%), and stalking (5%). By far, the most common perpetrators of violence against healthcare workers were bystanders including patient family members or other accompanying individuals. Notably, reporting was limited, with most cases conveyed to ED or hospital administration.ConclusionThese results underscore the prevalence of WPV among Indian ED healthcare providers. High rates of verbal abuse followed by physical abuse are of concern. Most perpetrators of WPV against healthcare providers in this study were patient family members or bystanders rather than the patients themselves. It is imperative to prioritize implementing prevention strategies to create safer work environments for healthcare workers.

Overhead and Wheelchair Sport-related injuries in Para Athletes: Interplay between disability and sport specific factors.

With the increasing opportunities for people with disabilities to engage in competitive Para sports, it becomes imperative to understand the injury consequences that may impact both sports participation and daily life activities. This narrative review aims to examine the intrinsic and extrinsic risk factors inherent in overhead and wheelchair summer Para sports, while also exploring prospective avenues for implementing prevention strategies. By understanding the injury epidemiology in this cohort of Para athletes, this review aims to explore the intricate interplay between the athletes' underlying disability with sport-specific factors, such as how wheelchair use might amplify injury susceptibility. Specifically, we highlight the impact of impairment, daily activity, and workload or discipline-induced overuse on injury occurrence, as well as how surveillance methods can be tailored to this population. In this regard, we propose practical injury surveillance methods that encompass a sensitive injury definition, severity assessment, incidence rate calculation, and the recording of adaptive equipment (e.g., type of wheelchair) and workload monitoring. It is worth noting that studies of prospective injury surveillance systems coupled with workload monitoring within a dedicated Para sport web-based platform are scarce. To establish a comprehensive understanding of Para athlete health, the monitoring framework should incorporate regular athlete follow-ups and facilitate knowledge transfer.

Risk factors associated with medical encounters in ultramarathon race starters – Data from 103,131 race starters over 90 km: SAFER XLI

ObjectivesTo identify the risk factors associated with all medical encounters (MEs) and serious/life-threatening MEs (SLMEs) during the Comrades Marathon. DesignProspective cohort study, with cross-sectional analyses. MethodsDuring the 2014–2019 Comrades Marathon, all MEs (including SLMEs) were recorded in 103,131 starters. For both all MEs and SLMEs, the following risk factors were explored: sex, age, route (“up” vs. “down” race), previous Comrades experience (yes/no), wet-blub globe temperature (WBGT) and race pace. Incidence (per 1000 starters; 95%CI), and the incidence ratio (IR; 95%CI) are presented. ResultsFor all MEs, being female was a significant risk factor (females vs. males IR = 1.47, p < 0.0001), and age was only marginally significant (p = 0.0167). Therefore factors for all MEs were adjusted for sex. Other factors significantly associated with all MEs were: higher WBGT (highest WBGT compared to lowest, IR = 1.33, p = 0.0003), race pace (highest risk for those who finish either among the first quarter [IR = 1.49] or last quarter [IR = 1.46] compared to middle pace; p < 0.0001) and the route (“down” vs. “up”: IR = 1.11; p = 0.0181). Factors associated with higher risk for SLMEs were: females (IR = 1.9; p = 0.0003), “down” vs. “up” route (IR = 1.37; p = 0.0306) and race pace (slower and faster runners vs. mid (6.4–7.1 min/km) race pace category (IR > 2.1, p < 0.0001)). ConclusionsIntrinsic (female, faster and slower race pace) and extrinsic (higher WBGT and the “down” route) are novel risk factors associated with all MEs at this event. These can be considered by the race organizers and the medical team to develop and implement prevention strategies.

Do inexperienced nurses in the lactation period experience workplace violence? A qualitative study.

Among clinical healthcare personnel, nurses face the highest proportion of workplace violence, which has a significant impact on their physical and mental well-being as well as their personal and professional lives. However, little is known about the effects of workplace violence on inexperienced breastfeeding nurses and their experiences during and after breastfeeding when they return to work. This study aimed to explore the experiences of inexperienced breastfeeding nurses who encountered workplace violence and its resulting impacts. This study employed a descriptive qualitative design. Semi-structured in-depth interviews were conducted with 20 nurses working in various positions and departments at three tertiary hospitals. Purposive and maximum variation sampling techniques were employed. The interview data were analyzed using Colaizzi's method, and the research findings were reported according to Consolidated Criteria for Reporting Qualitative Studies (COREQ)standards. Inferences regarding workplace violence and risks for inexperienced breastfeeding nurses included physical labor (such as lifting heavy objects and performing cardiopulmonary resuscitation), conflicts, inadequate job skills, role confusion, occupational exposure risks, patient violence, and pressure from older adults. An inductive thematic investigation revealed the "Challenges faced during breastfeeding," "Conflicting professional and family roles," "Out of balance," and "Coping strategies." Inexperienced breastfeeding nurses experience several negative consequences due to workplace violence. Therefore, it is essential to plan and implement preventive strategies and management programs that specifically target workplace violence among inexperienced breastfeeding nurses.

Effect of metabolic syndrome and its components on the risk and prognosis of cervical cancer: A literature review

Despite the global implementation of preventive strategies against Human Papilloma Virus (HPV) infection, the incidence of invasive cervical cancer rose by nearly 1.3-fold, from 471,000 annual cases in 2000 to 604,000 cases in 2020. With over 340,000 deaths annually, cervical cancer is the fourth leading cause of cancer mortality in women globally.There is a need to understand other factors besides HPV such as metabolic syndrome (MetS) that potentially influence the onset and progression of cervical cancer. In this narrative review, we describe evidence showing that Metabolic syndrome (MetS) increases the risk for cervical cancer and worsens its prognosis. Combined screening for MetS and cervical cancer has potential to significantly reduce morbidity and mortality in women with cervical cancer.

Scoping review on prevention of suicidal thoughts and behaviors in adolescents: methods, effectiveness and future directions

IntroductionDespite the extensive implementation of suicide prevention strategies targeting suicidal thoughts and behaviors (STB) in adolescents, there remains a concerning lack of improvement in the situation. In this comprehensive scoping review, our objective was to provide insights into prevention methods for suicidal thoughts and behaviors directed towards adolescents, including their effectiveness, public perception, and potential adaptations.MethodA scoping review was conducted, encompassing 71 articles including systematic review, clinical trials and qualitative studies for a wider understanding. Most articles included focus generally on adolescents aged 10–20.ResultsNo single intervention has shown expected effectiveness, collective efforts have laid a solid foundation for suicide prevention. Promising interventions include cognitive-behavioral therapy (CBT) and incorporating Technology-based interventions. However, challenges persist in promoting help-seeking behaviors and addressing barriers such as stigma, the natural impulsive nature of adolescents and difficulty in selecting and defining data and designs.DiscussionThis review underscores the need for a holistic approach to suicide prevention, integrating social, emotional, and psychological dimensions. Successful interventions target underlying issues like depression and loneliness rather than solely focusing on suicidal thoughts and behaviors (STB). Combining direct and indirect interventions is a sensible approach for both immediate and long-term results. Understanding Generation Z's unique needs, influenced by technology and diverse perspectives, is crucial for effective prevention.ConclusionInvolving adolescents and adopting patient-centered healthcare with outcome measures like Patient Perceived Outcome Measures can enhance suicide prevention efforts by prioritizing safety and patient experiences.

Anthracycline-Induced Cardiomyopathy in Cancer Survivors: Management and Long-Term Implications.

Recent advancements in personalized treatments, such as anthracycline chemotherapy, coupled with timely diagnoses, have contributed to a decrease in cancer-specific mortality rates and an improvement in cancer prognosis. Anthracyclines, a potent class of antibiotics, are extensively used as anticancer medications to treat a broad spectrum of tumors. Despite these advancements, a considerable number of cancer survivors face increased risks of treatment complications, particularly the cardiotoxic effects of chemotherapeutic drugs like anthracyclines. These effects can range from subclinical manifestations to severe consequences such as irreversible heart failure and death, highlighting the need for effective management of chemotherapy side effects for improved cancer care outcomes. Given the lack of specific treatments, early detection of subclinical cardiac events post-anthracycline therapy and the implementation of preventive strategies are vital. An interdisciplinary approach involving cardiovascular teams is crucial for the prevention and efficient management of anthracycline-induced cardiotoxicity. Various factors, such as age, gender, duration of treatment, and comorbidities, should be considered significant risk factors for developing chemotherapy-related cardiotoxicity. Tools such as electrocardiography, echocardiography, nuclear imaging, magnetic resonance imaging, histopathologic evaluations, and serum biomarkers should be appropriately used for the early detection of anthracycline-related cardiotoxicity. Furthermore, understanding the underlying biological mechanisms is key to developing preventive measures and personalized treatment strategies to mitigate anthracycline-induced cardiotoxicity. Exploring specific cardiotoxic mechanisms and identifying genetic variations can offer fresh perspectives on innovative, personalized treatments. This chapter aims to discuss cardiomyopathy following anthracycline therapy, with a focus on molecular mechanisms, preventive strategies, and emerging treatments.

Common clinical findings identified in working equids in low- and middle-income countries from 2005 to 2021.

Despite several millions of working equids worldwide, there are few published studies regarding the epidemiology of their health and welfare. Data collected by non-governmental organisations (NGOs) operating in the working equid sphere therefore have important epidemiological value and could be used towards animal health surveillance. The aim of this study was to identify common clinical findings and mortality patterns of working equids in low- and middle-income countries and investigate their epidemiology using data collected from an international NGO. A retrospective analysis was conducted to determine the proportion of clinical findings and mortality risk by equid species, year and region. Negative binomial regression models were generated to investigate differences in mortality risk and proportion of key clinical findings between equid species, hemispheres and calendar month. A total of 4,313,606 presentations were reported from 14 countries between January 2005 and March 2021 (mean 22,121; SD ± 7,858 per month). Wounds and abscesses were the most reported clinical finding for all equid species (mean proportion 35%; SD ±0.19 of all findings). A higher proportion of wounds (mean proportion 41.7%; SD±0.2) was recorded in donkeys than mules or horses (P<0.001). Mules had higher reported mortality risk (1.2%; 95% CI 0.94-1.46%) than horses (0.4%; 95% CI 0.36-0.55%; p<0.001) or donkeys (0.2%; 95% CI 0.14-0.22%). Work-related wounds were the predominant finding in working equids, particularly so in donkeys. Prevention strategies should focus on improvements to work equipment and practices for all equids. Future investigations required include refinement of diagnostic approaches for donkeys and investigation of risk factors to understand the higher mortality in mules. Routine monitoring of clinical findings reported by national or international NGOs could be included in animal health surveillance strategies, although standardisation of data for this purpose is needed so that changes in prevalence following implementation of prevention strategies can be monitored.

Identification of antibiotic-resistant, gram-negative bacteria in sewage and bioaerosols from a wastewater treatment plant: A genotypic and phenotypic study

ABSTRACT Antimicrobial resistance (AMR) is a growing global public health concern. This study aimed to investigate the presence of bacteria and antibiotic resistance genes in the environment, more specifically in sewage and bioaerosol samples collected at a Wastewater Treatment Plant (WWTP). Bacterial species were identified and tested for antibiotic sensitivity. In addition, bla CTX-M, bla SHV, bla TEM and bla KPC genotypes, including those related to resistance to carbapenems, were detected by PCR. The results of this research are extremely important for understanding the mechanisms involved in antimicrobial resistance and for preventing the dissemination of these antibiotic-resistant microorganisms. This study contributes to the identification of sources of antibiotic resistance in the environment and implementation of AMR control and prevention strategies while preserving the effectiveness of antibiotics and public health.

Prevention Strategies and Management of Necrotizing Enterocolitis

Abstract Necrotizing enterocolitis (NEC) is a serious intestinal disease which primarily affects preterm infants. The pathogenesis of NEC is multifactorial. Thus, it is complicated to study, prevent, and manage. Purpose of Review The purpose of this review is to provide a comprehensive summary of recent research and provide recommendations for the prevention and management of NEC. Currently, management is supportive and non-specific and long-term outcomes for surgical NEC are poor. Recent Findings The most important strategy to prevent NEC is to provide preterm infants with a human milk diet, minimize exposure to antibiotics and avoid medications that disturb the intestinal microbiome. Summary Strategies to optimize the infant’s intestinal microbiome are critical, as disturbances in the intestinal microbiome composition are a major factor in the pathogenesis of this disease. Optimizing maternal health is also vital to prevent prematurity and neonatal morbidity. Ongoing research holds promise for the implementation of new diagnostic modalities, preventive strategies, and medical treatment options to improve outcomes for premature infants.

A Comparison of Preoperative Predictive Scoring Systems for Postoperative Pancreatic Fistula after Pancreaticoduodenectomy Based on a Single-Center Analysis.

Background: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is associated with major postoperative morbidity and mortality. Several scoring systems have been described to stratify patients into risk groups according to the risk of POPF. The aim of this study was to compare scoring systems in patients who underwent a PD. Methods: A total of 196 patients undergoing PD from July 2019 to June 2022 were identified from a prospectively maintained database of the University Hospital Ghent. After performing a literature search, four validated, solely preoperative risk scores and the intraoperative Fistula Risk Score (FRS) were included in our analysis. Furthermore, we eliminated the variable blood loss (BL) from the FRS and created an additional score. Univariate and multivariate analyses were performed for all risk factors, followed by a ROC analysis for the six scoring systems. Results: All scores showed strong prognostic stratification for developing POPF (p < 0.001). FRS showed the best predictive accuracy in general (AUC 0.862). FRS without BL presented the best prognostic value of the scores that included solely preoperative variables (AUC 0.783). Soft pancreatic texture, male gender, and diameter of the Wirsung duct were independent prognostic factors on multivariate analysis. Conclusions: Although all predictive scoring systems stratify patients accurately by risk of POPF, preoperative risk stratification could improve clinical decision-making and implement preventive strategies for high-risk patients. Therefore, the preoperative use of the FRS without BL is a potential alternative.