Infectious Diseases Hospital Research Articles

Cerebral disorders as a complication of whooping cough in a child under one year old

Whooping cough is a widespread infectious disease, the manifestations of which vary from nonspecific cough to life-threatening conditions with the development of apnea, hypoxic damage to the central nervous system, and respiratory failure, especially in young children. Against the background of a severe form of whooping cough, hemorrhages of various types can be observed, including in the brain. The team of authors describes a clinical case of cerebral impairment in a child under one year of age, which is associated with whooping cough. A day after discharge from the infectious diseases hospital, the child developed a generalized convulsive attack. Clinical, instrumental and objective data allowed us to establish a diagnosis: acute disorder of cerebral and spinal circulation of the hemorrhagic type. Subarachnoid hemorrhage. Severe anemia. Convulsive syndrome. Whooping cough. Subsequently, the development of signs of hydrocephalus was observed over time, with the further formation of multiple cysts and hemiatrophy of the right hemisphere of the brain.

A Severe Case of Plasmodium falciparum Malaria in a 44-Year-Old Caucasian Woman on Return to Western Romania from a Visit to Nigeria

Malaria is currently the most prevalent life-threatening infectious disease in the world. In this case report, we present a 44-year-old Caucasian woman with a low level of education and no significant past medical history who presented to the emergency room of the Emergency County Hospital of Arad, Romania, with a general affected state, a fever of 38.5 °C, chills, weakness, headache, muscle pain, nausea, icterus, and watery diarrheal stool. A viral infection was initially suspected, and the patient was transferred to the Infectious Diseases Department. The anamnesis revealed that the patient traveled to Nigeria (Ado Ekiti) and returned to Romania 14 days before presenting to the hospital without following antimalarial prophylaxis. A peripheral blood smear was conducted and revealed parasitemia with ring forms of Plasmodium falciparum (P. falciparum) of 10–15% within the red blood cells. Parasitemia increased within a day to 15–18%, and her health rapidly deteriorated. She was transferred to the Victor Babeș Infectious Disease Hospital in Bucharest for the urgent initiation of antimalarial treatment. The patient’s condition continued to worsen rapidly, and she succumbed to her illness due to multi-organ failure. This report details the first documented case of malaria imported from Nigeria to Romania. People traveling to malaria-endemic areas should be educated about preventing this parasitic infection, both by adopting measures to reduce the risk of mosquito bites and by using appropriate chemoprophylaxis. In the context of resuming travel after the COVID-19 pandemic, understanding and adhering to prophylactic measures is crucial to avoid tragic situations, as highlighted in this case report.

The Great Tularemia Outbreak in Sivas: Evaluation of 205 Cases

This study aimed to report a tularemia outbreak in Sivas and describe the epidemiological and diagnostic characteristics of the patients. Patients aged 18 and over followed up with a diagnosis of tularemia in Sivas Cumhuriyet University Hospital, Sivas Numune State Hospital, and Sivas State Hospital Infectious Diseases Outpatient Clinics and wards between November 2023 and May 2024 were evaluated. 205 adult patients with tularemia were included. The most common symptoms were sore throat (73.2 %, n=150), swelling in the neck (70.2 %, n = 144), and fatigue (55.1 %, n = 113). The most common form was oropharyngeal (82.4 %, n = 169) and glandular (14.6 %, n = 30). Lymphadenopathy was detected in 182 (88.8 %) patients, the most is cervical lymphadenopathy (60 %, n = 123). Lymph node drainage/excision was performed on 50 patients (24.3 %). There have been no deaths in this outbreak. This study presents patient data from the tularemia outbreak in Sivas.

Study of the Microbiological Efficiency of a Hospital Ventilation System With Hepa Filtration in the Prevention of Airborne Pathogens

Objective: To evaluate the microbiological efficiency in air conditioning systems with HEPA filtration in an infectious disease hospital. Theoretical Framework: Air conditioning in intensive care units and wards must consider the spread of microorganisms through respiratory pathways, as both patients and healthcare professionals are exposed to infectious agents transmitted by bioaerosols. Due to the possibility of environmental infection, there is a growing recognition that poorly designed air conditioning systems enhance the transmission of pathogens in areas with constant flow of individuals, particularly immunocompromised patients, who are more susceptible to infections. Air conditioning with HEPA filtration is a hospital engineering technique that shows great potential for filtering airborne contaminants, thereby reducing their dispersion in the environment. Method: Air samples were collected using the active impaction method over a 32-week period in the intensive care unit and wards of a reference hospital for infectious diseases. Results and Discussion: In the hospital environment, 67% of fungi and 33% of bacteria were identified, along with their respective subcategories. The colony-forming unit count exceeded the standards established by current regulations. The study highlights that hospital air is a pathway for the transmission and persistence of pathogenic microorganisms. Research Implications: The importance of ensuring a safe and healthy hospital environment is emphasized. Originality/Value: There are few studies addressing pathogens transmitted by bioaerosols. This study contributes to expanding knowledge on this topic and suggests the need for a review of current regulatory standards.

CLINICAL FEATURES OF COVID-19 INFECTION IN NEWBORNS: A RETROSPECTIVE ANALYSIS

Background. The COVID-19 pandemic has significantly impacted all age groups, including newborns. During the fifth surge, the prevalence of the Omicron variant among infants increased dramatically. While SARS-CoV-2 is generally milder in children than adults, newborns are vulnerable due to their immature immune systems. Clinical manifestations in newborns can range from asymptomatic to severe cases with respiratory distress or multi-organ dysfunction. Purpose of study. Description of clinical manifestations, course and outcomes of coronavirus infection in newborns. Materials and methods of study. A retrospective analysis was conducted on 110 newborns with COVID-19 admitted to the Children’s Clinical Infectious Diseases Hospital of Almaty between 2021 and early 2022. The study used electronic medical records as the source of research data. Demographic data such as age and sex were collected, along with epidemiological data including international or domestic travel within two weeks prior to the onset of the disease, known exposure to a person with positive SARS-CoV-2 infection, and a history of pregnancy. Results. The infants’ mean age was 17 days, with 44 boys (40%) and 66 girls (60%). Four newborns were admitted to the hospital at less than seven days of life. When analyzing the severity of the cases, the following proportions of newborns were observed: (3/110, 2.7%) were asymptomatic, (44/110, 40%) had mild symptoms, (57/110, 51.8%) were moderately severe, (4/110, 3.6%) severe, and (2/110, 1.8%) had very severe illness. The majority (68.4%) were hospitalized within three days of symptom onset. Fever was common, and all infants underwent chest CTs. Despite some severe cases, 99% had favorable outcomes, with only one fatality. Conclusion. This study indicates that most COVID-19 infections in newborns were contracted from household contacts. Clinical symptoms in infants included fever, catarrhal symptoms, and signs of intoxication, with some showing normal temperatures. Laboratory findings varied, with common changes including monocytosis and neutrophilia. Respiratory complications, such as bronchitis and pneumonia, were prevalent. Comorbidities, particularly congenital disorders, increased the risk of severe outcomes and mortality. Most newborns recovered within 1-2 weeks, though viral carriage persisted in many.

Efficacy and safety of favipiravir and remdesivir in COVID-19 patients: Clinical data

Aim. To evaluate the efficacy and safety of favipiravir and remdesivir in the infectious disease hospital of the Volgograd region in 2022. Materials and methods. In total, 559 medical records of patients prescribed favipiravir or remdesivir in 2022 were studied. Long-term results of the drug use and disease outcomes after discharge or transfer to another medical institution were assessed using the Federal registry of people with COVID-19. Results. Favipiravir was more frequently prescribed in mild cases of the disease. After excluding patients without signs of lung injury from the analysis, there were no significant differences in mortality and improvement. Patients receiving favipiravir had lower odds of ALT elevations above 5 upper limits of normal and developing drug-induced liver injury with a possible RUCAM score compared with patients receiving remdesivir (OR = 0.40, 95CI 0.20–0.80 and OR = 0.30, 95 CI 0.08–1.08). Conclusion. The limited experience of the use of favipiravir for COVID-19 necessitates further research into its efficacy and safety, particularly when prescribing warfarin and high doses of direct anticoagulants simultaneously.

Application of γδ T cells with different memory phenotypes in clinical diagnosis of active pulmonary tuberculosis

ObjectiveTo investigate the application and clinical significance of different memory phenotypes of γδ T-cell subsets in the clinical diagnosis of pulmonary tuberculosis. MethodsIn total, 42 patients with tuberculosis (TB) according to the diagnostic criteria for tuberculosis (WS288-2017) who were treated at the Infectious Diseases Hospital affiliated with Soochow University from February 2023 to July 2023 were enrolled. Additionally, 16 patients with latent TB infection (LTBI) and 20 healthy controls (HCs) were included. Flow cytometry was used to measure the expression levels of γδ T cells, Vδ1 T-cell subsets/Vδ2 T-cell subsets, naive (CD45RA+CD27+) cells, central memory (CD45RA-CD27+) cells, effector memory (CD45RA-CD27-) cells, and terminally differentiated (CD45RA+CD27-) cells in the peripheral blood. The expression levels at different stages of TB infection were compared. ResultsThere were no significant differences in peripheral blood γδ T cells or Vδ1 T cells among the HC, LTBI and TB groups. The proportion of CD45RA-CD27+Vδ2 T cells in TB patients was significantly lower than that in HCs and LTBI patients, but the proportion of CD45RA+CD27-Vδ2 T cells was greater. ROC curve analysis revealed that CD45RA-CD27+Vδ2 T cells (AUC), CD45RA+CD27-Vδ2 T cells (AUC), and the combination of both (AUC) were effective in differentiating TB patients from LTBI patients. ConclusionThe proportions of CD45RA-CD27+Vδ2 T cells and CD45RA+CD27-Vδ2 T cells are potential biomarkers for the diagnosis of active TB infection and are helpful for distinguishing active TB infection from LTBI.

Effectiveness and safety of olokizumab and levilimab in patients with COVID-19 in 2022: a cohort study

A single-center observational cohort study of the use of levilimab and olokizumab in patients with COVID-19 was conducted. Purpose was to evaluate the effectiveness and safety of olokizumab and levilimab in the infectious diseases hospital of the Volgograd region in 2022. Materials and methods: We analyzed 182 medical records of patients who were prescribed genetically engineered biological drugs in 2022. Long-term results of the use of drugs and disease outcomes after discharge or transfer to another medical fascility were assessed using the federal register of people with COVID-19. Results: There were no significant differences in the effectiveness of levilimab and olokizumab. The chance of detecting signs of bacterial infection/sepsis was significantly higher by 2.7 times in patients receiving levilimab compared with olokizumab (OR=2.7, 95 % CI 1.43-5.17).

Human immunodeficiency virus-1 genome from patient with fever, Nepal.

A patient with fever presented to the referral infectious disease hospital in Kathmandu, Nepal. Metagenomic sequencing of the patient's serum recovered a near-complete genome of human immunodeficiency virus-1 (HIV-1), distinct from previous HIV-1 genomes from Nepal in GenBank. It shared 92.48% nucleotide identity with an HIV-1 subtype C isolate from India.

The Incidence and Characteristics of Oral Candidiasis in Patients Hospitalized for SARS-CoV-2 Infection During the Circulation of Alpha, Beta, and Delta Variants

Background: Oral candidiasis has been documented in patients with SARS-CoV-2 infection, with varying prevalence rates across geographic regions and patient demographics. This study aimed to ascertain the incidence, characteristics, and risk factors associated with the development of oral candidiasis in patients hospitalized for SARS-CoV-2 infection in a tertiary infectious diseases hospital in Romania. Methods: A retrospective analysis was conducted on adult patients hospitalized between March 2020 and December 2022 with moderate or severe forms of SARS-CoV-2 infection, for whom a culture of lingual scrapings for Candida spp. was performed. Results: A total of 294 patients were deemed eligible for inclusion in the analysis, with an incidence rate of oral candidiasis of 17.0%. The incidence of oral candidiasis was 4.2 times higher in patients with severe forms of SARS-CoV-2 infection compared to those with moderate forms. Patients with a diagnosis of COVID-19 and oral candidiasis were more likely to receive antibiotics (98.0% vs. 86.1%, p = 0.017) and corticosteroids (100% vs. 83.6%, p = 0.003) than those without oral candidiasis. These findings were associated with a 19% higher relative risk of developing oral candidiasis for patients who received corticosteroid therapy compared to those who did not, and a 13% higher relative risk for those who were administered antibiotics compared to those who were not. The presence of respiratory insufficiency increased the odds of oral candidiasis association 4.7-fold (88.0% vs. 61.1%, p < 0.001). Conclusions: Although the data have been analyzed retrospectively, we have shown that individuals with severe forms of COVID-19 exhibited an elevated risk of developing oral candidiasis. The administration of antibiotics and corticosteroids was identified as a positive predictor for the development of oral candidiasis. The data presented here suggest that a key aspect of the therapeutic management of patients with SARS-CoV-2 infection should include the implementation of preventive measures to minimize the risk of secondary fungal infections.

Changing epidemiology and antimicrobial susceptibility of bloodstream infections at a Vietnamese infectious diseases hospital (2010–2020)

Bloodstream infection (BSI) poses a global health problem, with diverse organisms and rising antimicrobial resistance (AMR). Here, we characterized trends in BSI prevalence, AMR, and antibiotic use at a Vietnamese infectious diseases hospital from 2010 to 2020. Among 108,303 cultured blood samples, 8.8% were positive, yielding 7995 pathogens. Of 7553 BSI cases, 86.4% were community-acquired. BSI prevalence varied from 17 to 35 cases/1000 admissions/year, highest in HIV/hepatitis wards and patients >60. The in-hospital mortality or hospice discharge outcome was 21.3%. The top three pathogens, E. coli (24%), K. pneumoniae (8.7%) and S. aureus (8.5%) exhibited increasing prevalence and multidrug resistance. Pathogens like Cryptococcus neoformans (8.4%), Talaromyces marneffei (6.7%), and Salmonella enterica (6.5%) declined. E. coli and K. pneumoniae were prevalent in older adults with community-acquired BSIs. Antibiotic use reached 842.6 DOT/1000 PD and significantly reduced after an antibiotic control policy. Enhanced surveillance and antimicrobial stewardship are crucial for managing BSIs in Vietnam.

FORMATION OF PROFESSIONAL COMPETENCE OF FOREIGN STUDENTS AT THE DEPARTMENT OF CHILDREN INFECTIOUS DISEASES

The article highlights the experience of professional competence formation of foreign medical students with an English-language form of education at the Department of Children Infectious Diseases of the Ivano-Frankivsk National Medical University. Traditional and interactive teaching methods used during classroom work with students are described. Professional competence involves the ability to use knowledge, skills and abilities in practice effectively. For future doctors, it includes mastering diagnostic methods, emergency situations management, and using modern technics of diagnosis and treatment. Aim. The aim is to describe and analyze methods of professional competence formation of foreign students at the Department of Children Infectious Diseases during classroom work. Research results. At the Department of Children Infectious Diseases, foreign students study children infectious diseases and elective disciplines - immunoprophylaxis of infectious diseases, clinical parasitology and tropical medicine. When teaching medical disciplines to foreign students, it is necessary to take into account their insufficient level of Ukrainian language proficiency, which is an obstacle to communicating with patients and fully mastering the method of taking anamnesis when working in the hospital near the patient’s bedside. Therefore, the teacher also plays the role of an interpreter. During practical classes control of the input level of knowledge is carried out with the use of multiple choice questions. The final level of knowledge is monitored using situational tasks. Work with the theoretical material takes place in the form of a discussion, the "round table" method with "brainstorming". The main part of the practical class is conducted at the patient's bedside in the departments of the infectious disease hospital. The teacher translates during direct communication between students and patients, corrects the techics of the examination. During classes, students receive structured mini-cases with a description of a clinical case and work in small groups. During case discussions, the teacher is liberal, ready to listen to various opinions and ways of solving a problem situation. Students of the fifth year visit lectures, during which teachers demonstrate multimedia presentations with graphs, schemes of pathogenesis, photos of patients. Combining the lecturer's comments with video information and animation greatly enhances the attention of the audience. Demonstration of clinical cases during the lecture, followed by a discussion in a dialog mode, is valuable. During the lectures, information about the epidemiological situation regarding a particular disease in the countries from which the students came is presented and discussed. Conclusion. For professional competence formation of future doctors, a combination of traditional and interactive teaching methods is effective. In the process of the professional competence formation, all its components should be taken into account: cognitive, motivational and personal. The use of the case method increases cognitive interest, promotes the development of communication skills and clinical thinking. A competent, highly qualified teacher who is fluent in English and uses modern information sources, is an active organizer and participant in the educational process.

Epidemiology of Morbidity and Mortality of COVID-19 Patients During the Period of June 2020-September 2021 in Sulianti Saroso Infectious Disease Hospital, Indonesia.

The increasing mortality rate of COVID-19 has remained an international public health concern. Limited studies on clinical treatment and morbidity in hospital settings are available in Indonesia. This present study aims to analyse demographic characteristics, clinical signs and treatment in COVID-19 patients and their association to the mortality case in Sulianti Saroso Infectious Disease Hospital. The study applied a retrospective cohort approach to all COVID-19 inpatients confirmed by polymerase chain reaction (PCR) testing in Sulianti Saroso Infectious Disease Hospital from 1 June 2020 to 30 September 2021. Overall survival rates until the end of the study were calculated using the Kaplan-Meier method and compared using the log-rank test. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors. We collected 1,970 inpatient data that met our inclusion and exclusion criteria. Most of them were 19 years old-59 years old (73.2%) and male (52.6%), and 966 (49%) patients had comorbidities. Approximately 63.9%, 89.2%, 89.8%, 82%, and 14.1% of the patients had ferritin levels ≤ 800, received antiviral treatment, were treated in non-intensive wards, had a moderate or mild clinical stage and did not survive, respectively. In the adjusted analysis, mortality was associated with sex (hazard ratio [HR]: 1.12; 95% CI: 1.02, 1.23), presence of comorbidity (HR: 1.19; 95% CI: 1.08, 1.30) and favipiravir (FPV) plus azithromycin treatment (HR: 1.21; 95% CI: 1.06,1.39). FPV treatment (HR: 1.35; 95% CI: 1.04, 1.75) was associated with higher mortality. Tailored approaches to treatment, considering individual risk factors and comorbidities, are crucial in improving patient outcomes.

Acute Approach to Central Nervous System Infections in Kazakhstan

Background Neuroinfections in children are a socially significant problem of our time, as they can lead to disability and death of the patient, which actualizes the need for their early clinical diagnosis. The purpose of the study: to identify patterns of clinical manifestations of central nervous system lesions in children with neuroinfections. Materials and methods The cases of neuroinfections in 101 children treated at the “City Clinical Infectious Diseases Hospital” (Shymkent) in the period from 2018 to 2022 were analyzed, of which 37 patients with viral neuroinfections, 64 with bacterial ones. Results The predominance of bacterial neuroinfections over viral ones was revealed, with a predominance among young boys. Headache or its equivalents (in children under one year old) were observed in 72.5%; most often in children with viral infections of the nervous system (81.2%), less often in patients with bacterial infections (65.4%), p 0.01. In most cases, the disease manifested with the phenomena of fever and vomiting. When assessing the neurological status, the duration of preservation of two frequently occurring meningeal signs (rigidity of the occipital muscles, Kernig’s symptom) was taken into account, which was 6 ± 1.3 days and 5 ± 1.1 days in the group with bacterial neuroinfections, and 4 ± 1.8 and 5 ± 1.7 days, respectively, in the group with viral neuroinfections (p 0.05). With pneumococcal etiology, the most severe and protracted cases of the course of neuroinfections are recorded. Frequent emergency conditions in infectious lesions of the central nervous system in the form of cerebral edema, septic shock, which occur more often in bacterial neuroinfections, have been identified. Conclusion Neuroinfections are characterized by a symptom complex of clinical manifestations, which should be interpreted by doctors in a timely and correct manner in order to diagnose early and minimize adverse outcomes of the disease. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1206-1212

Hospital crisis management in the epidemic: A qualitative study.

Despite the advances in medical science, the epidemic of infectious diseases has faced serious challenges to the health system of countries, so the purpose of this study was to identify obstacles and management strategies to prepare for planning preventive measures and better care in dealing with infectious diseases in hospitals. The current qualitative research was of the grounded theory type, which was conducted in 2023. The semistructured interview questions were obtained from experts. The initial selection of the sample was made from experts in the field of health and treatment from all over the country. The snowball method was used to increase the sample volume until it reached sufficient Value. After analyzing the data through MAXQDA2020 software, this research reached saturation by interviewing 20 experts. Four main areas, 15 subthemes, and 93 codes were identified in the management of epidemics, which included leadership and management (planning, physical structure, information management, financial resources, manpower, medicine and equipment, and internal and external coordination), Stewardship (macro policy and syndromic care system), safety and resilience (crisis management and emergency and disaster risk management), management of infectious diseases (instructions, education, infection prevention and control, treatment management). This study presents the strategies of the health system in dealing with the epidemic of infectious diseases to overcome the obstacles and challenges of preparation and response, which can help health managers in designing future programs, and finally, it shows that hospitals should have a plan for resilience in crises.

Pseudo-outbreak of Bacillaceae species associated with poor compliance with blood culture collection recommendations.

This study describes a pseudo-outbreak of Bacillaceae spp. bloodstream infections that spanned five months starting in May 2023 and the infection prevention measures implemented to control it. This retrospective study was conducted at a tertiary infectious disease hospital in Bucharest, Romania. An observational audit of the blood culture collection practice in our hospital was performed, and the materials used during blood culture collection were sampled. Bacterial colonies were identified using MALDI Biotyper. The Bacillaceae blood culture positivity rates in the previous four years were compared using the Kruskal‒Wallis rank test. Bacillaceae spp.-positive blood cultures were recovered from 60 patients over a five-month period. In the case of 58 patients, Bacillaceae spp.-positive blood cultures were considered contaminated. Two patients were treated for Bacillus spp. bacteraemia. The audit revealed significant variation during the preparation of the venipuncture site step and the use of nonsterile medical cotton wool. Medical cotton wool contaminated with species of Bacillaceae was found in 10 out of 12 wards. The control measures included repeated training on the blood culture collection procedure and the removal of Bacillaceae spp.-contaminated cotton wool. The pseudo-outbreak was caused by the unjustified use of medical cotton wool for disinfection of the skin and blood culture bottle septums. The investigation of this pseudo-outbreak highlighted a gap in blood culture collection practices at our facility and thus allowed for its improvement.

Assessing the Psychological Well-being of Healthcare Workers During the COVID-19 Pandemic

During the COVID-19 pandemic, working in any medical organization is associated with the risk of coronavirus infection. This applies first and foremost to specialized medical organizations dealing with the treatment of patients infected with coronavirus. Medical workers experiencing increased psychological stress are at an increased risk of infection with the SARS-CoV-2 virus while providing medical care. Therefore, studying the psychological states of medical workers – doctors, nurses, orderlies - is of particular importance and relevance. Our research goal is to investigate the psychological responses of medical professionals amid the COVID-19 pandemic. The research focused on the Aktobe Medical Center (AMC), which hosts the regional pulmonology center for COVID-19 patients and the Regional Clinical Infectious Diseases Hospital (RCIDH). The study is a selective, single-stage cross-sectional analysis. To assess the psychological reactions of medical workers, standardized questionnaires are used, including the PSM-25, GAD-7, and MFI-20. Statistical analysis of the data is conducted using the STATISTICA 10.0 software package from StatSoft, Inc., USA. An analysis of the research results indicates that medical personnel, nurses, and administrative staff in medical organizations associated with the risk of coronavirus infection are susceptible to adverse psychophysiological disorders. The study revealed that stress levels, anxiety, and asthenia in doctors and nursing staff are significantly higher compared to those in nurses and administrative personnel. Medical workers at risk of COVID- 19 clearly require support measures, as the potential for occupational infection has been definitively established. Additionally, the psychological risk is largely influenced by the nature of their work and their direct contact with the population and patients infected with the coronavirus. Senior and mid-level medical workers at the forefront of combating coronavirus infection is at a high risk of experiencing psycho-emotional and psychophysiological health issues. Doctors and nurses have been found to exhibit high levels of physical and mental asthenia, anxiety, and moderate-to-high levels of stress. Evaluating potential risk factors for psychophysiological disorders among healthcare workers not only provides an objective assessment of their health status, but also aids in the effective and rational organization of their work.

Characteristics and Trends of Workplace Violence towards Frontline Health Workers under Comprehensive Interventions in a Chinese Infectious Disease Hospital.

This study investigated workplace violence (WPV) toward frontline health workers under comprehensive interventions to improve the occupational safety and health management system in a Chinese infectious disease hospital. The risk assessment of WPV using an international questionnaire was conducted in 2018 and 2021 to compare the perceived levels of exposure to WPV and intervention measures before and after the intensification of anti-violence measures in the hospital context. Additionally, qualitative data were collected in 2021 through semi-structured and unstructured interviews, providing complementary information about WPV toward frontline health workers (HWs). After establishing the occupational safety and health management system (OSHMS), the total incidence rate of WPV decreased from 60.90% in 2018 to 34.44% in 2021. Psychological violence declined significantly from 60.90% in 2018 to 33.89% in 2021. The endorsement of precautionary measures increased significantly from 2018 to 2021, including patient screening recognition, patient protocol, shift or rota changes, etc. A thematic analysis of several subthemes shows that HWs had an in-depth understanding of WPV, recognizing its multifaceted consequences in the context of complex risk factors. This study demonstrates a significant decrease in WPV, psychological violence, verbal abuse, bullying/mobbing, and ethnic discrimination after implementing the comprehensive OSHMS.

Xylazine-induced Skin Necrosis, Emerging Public Health Crisis and the Ethical Considerations in Surgical Reconstruction: A Case Report

Xylazine, a non-opioid veterinary sedative, is increasingly being used to adulterate illicit fentanyl. Injection into the extremities causes progressive necrotic wounds, resulting in a compromised limb and life. Managing xylazine-induced skin necrosis may require extensive surgical intervention, including serial debridements and soft tissue reconstruction. Moreover, managing these complex wounds requires a multi-disciplinary approach, including hospital medicine, infectious disease, psychiatry, addiction medicine, pain/palliative care, ethics, wound care, orthopedic surgery, and plastic surgery. A 38-year-old female with a history of intravenous drug use presented with severe bilateral dorsal forearm wounds, and despite initial non-compliance with surgical debridement, she eventually underwent successful skin grafting after extensive treatment, including antibiotics and negative pressure therapy, but was later lost to follow-up. She relapsed into fentanyl use, leading to severe bilateral lower extremity wounds requiring further debridement and skin grafting, and later returned with new forearm wounds, at which point further reconstruction was deemed inappropriate without addressing her addiction; she refused inpatient rehabilitation and ultimately being lost to follow-up again.

Etiological structure of acute respiratory viral infections in children hospitalized in infectious diseases hospitals in Saint Petersburg in 2017–2022

Etiological structure of acute respiratory viral infections in children hospitalized in infectious diseases hospitals in Saint Petersburg in 2017–2022