Non-pharmacological Prophylaxis Research Articles

Pharmacological and non-pharmacological prophylaxis in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a narrative review

Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for various gastrointestinal problems. Pancreatitis is a severe complication of the procedure. The main objective of this study was to address if post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis can be prevented and what are the various pharmacological and non-pharmacological options along with their efficacy. Keywords “post-ERCP” and “pancreatitis” were used to search articles in Pubmed. Randomized controlled trials on patients undergoing ERCP due to any disease using pharmacological or non-pharmacological intervention published in the last 7 years were included. Observational studies, descriptive studies, reviews, and studies with no full access were excluded. The primary outcome in the trials was a frequency of post-ERCP pancreatitis. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most effective drugs in reducing the incidence of pancreatitis. The preferred route was rectal. After NSAIDs, intravenous hydration and sublingual nitrate showed promising outcomes, especially when combined with rectal NSAIDs. Other drugs like magnesium sulfate and nafamostat mesilate did reduce the incidence, but the results were not statistically significant. Epinephrine spray on duodenal papilla showed no benefits and instead had a risk of increasing the incidence. Stent placement also reduced the incidence of pancreatitis. In conclusion, rectal NSAIDs alone or combined with IV hydration and sublingual nitrate significantly reduced the incidence of pancreatitis, and stent placement was comparable to pharmacological interventions. Thus, regular use of pharmacological interventions before the procedure can help to reduce the incidence of this grave complication.

Prevalence and self-management of migraine among neurologists and neurology residents in Turkey: do neurologists apply effective rational prophylaxis to their migraines?

The aim of the study to determine the migraine prevalence and self-management of migraine among the neurologists and neurology residents registered to the Turkish Neurological Society. This cross-sectional study includes 851 participants. Based on the "The International Classification of Headache Disorders, 3rd edition" and previous literature, an anonymous questionnaire was prepared and used to collect data online via Google Forms. The link to the study was posted on the website of the Turkish Neurological Society. Women (73.2%) and neurologists (77.4%) made up the majority of the participants. Of the participants, 37.9% met the diagnosis criteria for migraine. Being women and positive family history were associated with migraine compared to the tension-type headache (TTH) (both p values < 0.001). Comparing with the TTH sufferers, migraine significantly hindered work, social, and family life (all p values < 0.001). Participants with migraine had more magnetic resonance imaging (MRI) (47.4%) and electroencephalography (EEG) (4.3%) than those with TTH (both p values < 0.05). Participants with migraine received drug prophylaxis more frequently (20.1%) than those with TTH (2.3%) (p < 0.001), and these drugs were selective serotonin reuptake inhibitors(SSRIs) (7.1%), beta-blockers (5.9%), and serotonin-norepinephrine reuptake inhibitors (SNRIs) (5.3%) (all p values < 0.05). Participants with migraine received non-pharmacological prophylaxis for headache more frequently (25.7%) compared to those with TTH (p < 0.001). Migraine is common among neurologists and neurology residents. Identifying migraine self-management is important for preventing the loss of work and negative economic and social consequences that migraine may cause in these groups of physicians.

Evaluation of intestinal parasites present in vegetables sold in the city of imperatriz, maranhão, Brazil

Worldwide, diarrheal diseases caused by helminths and protozoa represent a public health problem. Despite the benefits that vegetables and fruits have as non-pharmacological prophylaxis against diseases, they are also sources of transmission of pathogens of fecal origin. The carelessness in planting and handling vegetables brings harm to human health if there is not adequate hygiene. Thus, the study aimed to analyze the presence of helminths and protozoa in leafy vegetables lettuce (Lactucasativa) and cauliflower (Brassica oleracea) sold in supermarkets and street markets in the city of Imperatriz, Maranhão, Brazil. A total of 30 samples were analyzed by the sedimentation method, all of which were collected in different months and at the same locations. Thus, the most common parasites in cauliflower and lettuce leaves were Balantidium coli, Strongyloidesstercoralis and Ascarislumbricoides. In addition, it was highlighted that all 30 samples were positive, and parasites such as Hymenolepisdiminuta, Trichuristrichiura, Enterobiusvermicularis, Entamoebahistolystica and Giardialamblia were also found. Based on the study, it is suggested that direct actions by specific government agencies are necessary for education and sanitary inspection, as errors in the production and commercialization of these foods represent a risk to the population.

O USO DA QUIMIOPROFILAXIA OU NÃO PARA TVP EM CIRURGIA DE COLUNA: REVISÃO SISTEMÁTICA

ABSTRACT Objective: To compare pharmacological and non-pharmacological prophylaxis in elective spine surgery to determine the risks of DVT, PTE, and epidural hematoma (EH) in both groups, as well as their respective treatment effectiveness. Methods: Systematic review and meta-analysis based on systematically searched articles, using combinations of MeSH terms related to chemoprophylaxis and non-chemoprophylaxis for prevention of deep vein thrombosis and pulmonary embolism in elective spine surgery. Adult patients were eligible for inclusion in the study, except for those with trauma, spinal cord injury, neoplasms, or those using vena cava filters. Results: Five studies were selected for this systematic review and meta-analysis: 3 retrospective studies, 1 prospective study, and 1 case series. Data analysis showed that 4.64% of patients treated with chemoprophylaxis had an unfavorable outcome regarding DVT, while this outcome occurred in 1.14% of patients not treated with chemoprophylaxis (p=0.001). Among patients using chemoprophylaxis, only 0.1% developed epidural hematoma and 0.38% developed PTE. Among those on non-pharmaceutical prophylaxis, 0.04% had EH (p=0.11) and 0.42% had PTE (p=0.45). Conclusions: No benefits were found for chemoprophylaxis as compared to non-chemoprophylaxis in preventing DVT in elective spine surgery, nor was there an increased risk of epidural hematoma or fatal thromboembolic events. Level of evidence III; Therapeutic studies; Investigation of treatment results.

Improving compliance of risk assessment and nonpharmacological interventions for deep venous thrombosis prevention in a respiratory ICU: a best practice implementation project.

To increase the compliance with deep venous thrombosis (DVT) nonpharmacologic prophylaxis best practice recommendations while ensuring appropriate and structured nonpharmacologic prophylaxis for patients in the respiratory ICU. DVT is a major problem for patients, with those who are critically ill representing a high-risk population for developing the condition. Nonpharmacologic prophylaxis is considered an effective intervention. However, the application of such interventions in practice has not been optimal to date. The current project was conducted in a respiratory ICU of a tertiary hospital. Audit criteria were developed on the basis of an evidence summary developed by the Joanna Briggs Institute, whereby the institute's Practical Application of Clinical Evidence System program to facilitate an audit and feedback cycle was utilized as an implementation framework. Baseline and follow-up audits on nonpharmacological DVT prophylaxis were conducted for 35 patients against five evidence-based recommendations. In addition, the nurses' knowledge and attitude regarding DVT prophylaxis were investigated both prior to and postimplementation. In the baseline audit, compliance with the five evidence-based audit criteria was less than 15%. After the implementation of strategies including education, person-centered care, financial and human-resource support, there was a significant improvement in all the audit criteria. In addition, improvements in the nurses' knowledge and attitude regarding DVT prophylaxis were reported. The rate of discharged patients due to a deterioration of their condition decreased from 31.4 to 5.7% in the follow-up cycle. One DVT patient occurred in the baseline data, whereas no new incidences of DVT were found in the follow-up data. The project not only improved nurses' knowledge and attitude regarding DVT prevention, but also remarkably improved the implementation of nonpharmacological DVT prophylaxis. The application of evidence-based nonpharmacological DVT prophylaxis may improve patients' outcomes in the ICU.

Urinary tract infections in pregnancy

Background. Urinary tract infections (UTI) are the most common infections during pregnancy. The feto-maternal complications linked to this pathology can be severe if untreated and the treatment has been a subject of interest hence the multiple drugs contraindications in pregnancy, the restraint panel of antibiotics that can be used and the antimicrobial resistance that is constantly increasing. The purpose of this article is to review the latest data from literature and guidelines regarding the best management of the urinary tract infections in pregnancy. Methods. It was undertaken a systematic electronic search for articles, reviews and guidelines using Cochrane Date Base, PubMed and the international protocols in use recommended by the Obstetrics and Gynecology societies (ACOG - American College of Obstetricians and Gynecologists, CNGOF – Collège National des Gynécologues et Obstétriciens Français, RCOG – Royal College of Obstetricians and Gynecologists). Results and conclusions. Special consideration should be given to urinary tract infections developed during pregnancy because they are related to serious fetal and maternal complications. Routine screening is recommended and the antibiotic therapy properly individualized. Emotional impact on the future mothers is particularly important and non-pharmacologic prophylaxis should always be discussed at the begging of pregnancy. Future research should be focused on finding the actual mechanism of pathogenesis that link UTI and the complications they associate.

Therapeutic management of obesity induced by antipsychotic drugs

The introduction of second-generation antipsychotic drugs (SGAs) has contributed to a more effective treatment of mental diseases and patients’ improved quality of life. Their particular superiority to first-generation antipsychotics (FGAs) includes better outcomes in treating "negative" symptoms, impact on mood and lower risk of motor side effects (1). Their increasing use, going beyond psychotic disorders, has highlighted the problem of medication-induced weight gain and obesity in patients. Obesity leads to increased cardiovascular morbidity and mortality, decreased quality of life, and poor adherence. This narrative review discusses the impact of various SGA on weight gain and related adherence to medication, as well as available pharmacological and non-pharmacological interventions to counteract these effects. Most SGA commonly cause weight gain but the risk appears to be highest with olanzapine and clozapine. The best preventative strategies are tailored antipsychotic drugs and close monitoring of body weight and other metabolic parameters. Switching from one SGA to another less likely to cause metabolic disturbances is an option but carries a risk of relapse. Non-pharmacological interventions in the form of dietary counseling, exercise programs, cognitive and behavioral strategies appear to be equally effective in both individual and group forms. Both non-pharmacological prophylaxis and intervention strategies showed little effect on weight. Of the additional weight loss medications, metformin appears to be the compound with the best documented efficacy. There is no evidence of benefit from the routine prescription of additional weight loss medications. Drawing conclusions is hampered by the high heterogeneity of research methodology, as well as the participation of other factors such as lifestyle, genetic and disease-related factors.

Thrombotic Complications in Gliomas.

Arterial and venous thromboses are common in glioma patients, both in the perioperative period and throughout the course of the disease. High-grade glioma patients harbor underlying hypercoagulability, which predisposes these high-risk patients with prolonged immobility and neurologic deficits to thrombotic events. Despite the high incidence and recurrent nature of these complications, there is no standardized approach to the management of glioma patients, and many challenges remain. Historically, the perceived risk of intracranial and intratumoral hemorrhage limited the use of anticoagulation, favoring nonpharmacological prophylaxis and treatment. Multiple studies have demonstrated the safety and efficacy of anticoagulation when indicated, with low molecular weight heparin as the preferred short- or long-term treatment. This review will discuss the epidemiology, risk factors, and therapeutic management of both venous and arterial thrombotic complications in glioma.

Interventions for Preventing Upper Gastrointestinal Bleeding in People Admitted to Intensive Care Units

What are the effectiveness and harms of interventions to prevent upper gastrointestinal bleeding (UGIB) in patients admitted to the intensive care unit (ICU)?Despite advancements in medical treatments and interventions, UGIB results in more than 300 000 hospital admissions annually in the United States and has a mortality rate of 3.5% to 14%.1,2 Upper gastrointestinal bleeding is frequently the result of stress ulcers—superficial damage of the mucosal lining of the stomach or intestines that can occur as the result of shock, sepsis, or trauma. With improvements in treatment options and standards of care, the incidence of UGIB in ICUs has been decreasing,3 yet stress ulcer prophylaxis is still commonplace. Because there are potential risks associated with stress ulcer prevention, this practice needs to be examined.The disadvantage of stress ulcer prophylaxis is that many of the interventions used to suppress gastric acid can alter the gastric flora and promote the colonization of bacteria, leading to infection. For example, stress ulcer prophylaxis is associated with ventilator-associated pneumonia (VAP). By inhibiting gastric acid secretion, the colonization of gastric bacteria can also lead to colonization of the pharynx, leading to aspiration and VAP.4 Hence, it is necessary to evaluate strategies that safely decrease the incidence of UGIB.The focus of previous systematic reviews related to stress ulcer prophylaxis and UGIB has been on either older therapies or the effects of a single drug class versus another. As such, a systematic review of the current pharmacologic and nonpharmacologic prophylaxis of UGIB, comparing them with no treatment or other treatments, was warranted to better understand the effectiveness and harms.This summary is based on a Cochrane systematic review by Toews et al5 that included data from 107 studies with a total of 15 057 patients. The review included 27 comparisons involving 14 different treatment modalities (most notably proton pump inhibitors and H2-receptor antagonists). The primary outcome of the review was clinically important gastrointestinal bleeding (as defined by the authors of the individual studies); the secondary outcomes were nosocomial pneumonia and VAP; death in the ICU; duration of ICU stay; duration of mechanical ventilatory support; number of patients requiring blood transfusions; number of units of blood transfused; and serious adverse events (eg, thrombocytopenia) of interventions.5 The authors independently assessed the risk of bias for each study, including selection bias, performance bias, detection bias, attrition bias, reporting bias, and publication bias; they resolved any disagreements by reviewing the data together and through discussion.5Risk ratio (RR) and mean difference with confidence intervals (CIs) were used as the measures of treatment effect between different comparisons and outcomes.5 The internationally approved Grades of Recommendation, Assessment, Development and Evaluation approach was used to provide a level of the quality of evidence for each outcome.6 The 4 levels are summarized as follows: (1) high-quality level indicates further research is very unlikely to change the confidence in the conclusions; (2) moderate-quality level indicates further research is likely to have an important impact on the confidence in the conclusion and may change the conclusion; (3) low-quality level indicates further research is very likely to have an important impact on the confidence in the conclusion and is likely to change the conclusion; and (4) very low-quality level means there is uncertainty about the conclusion.6The following points summarize the main results of the Toews et al5 review:In regard to the comparison of H2-receptor antagonists and proton pump inhibitors, results were the following:In their systematic review, Toews et al5 found evidence of moderate certainty that, compared with placebo or no prophylaxis, the stress ulcer prevention interventions examined might be effective in preventing UGIB in patients in the ICU. When any treatment was compared with no prophylaxis, the risk of VAP developing was about the same. There was evidence of low certainty to suggest that proton pump inhibitors might be more effective than H2-receptor antagonists.5 As such, decisions on what interventions to use should be based on clinician assessments of the patient’s needs and underlying conditions.The low quality of the evidence for several aspects of this review indicates larger and high-quality randomized controlled trials are warranted to confirm the results. Such studies include high-quality trials assessing the risk of VAP in patients receiving stress ulcer prevention medication.Nurses caring for critically ill patients should advocate for the best evidence-based treatment. We must always consider the best available evidence and understand the feasibility, appropriateness, meaningfulness, and effectiveness of any intervention to determine if it is the best approach to implement in our individual context.

Parasites of importance for human health on edible fruits and vegetables in Nigeria: a systematic review and meta-analysis of published data

Contamination of edible fruits and vegetables is now a global public health issue despite their health benefits as non-pharmacological prophylaxis against chronic diseases. Studies that will harness the extent of parasitic contaminations will ensure public health protection. Here, the prevalence and distribution of parasites of importance for human health on fruits and vegetables in Nigeria were determined through a systematic review and meta-analysis of published data. The random-effects model was used to determine pooled prevalence estimate (PPE). Heterogeneity was evaluated by the Cochran’s Q-test. Parasites overall PPE of 32.4% (95% CI: 0.73, 0.91) was observed from 19 eligible studies reported across 13 Nigerian states. Sub-groups PPEs ranged between 3.5% (95% CI: 0.45, 1.86) and 58.5% (95% CI: 1.40, 4.09). A high degree of heterogeneity 97.53% (95% CI: 0.30, 0.46, P: 0.000) was observed within studies and sub-groups. Cryptosporidium species were the most prevalent, while Ancylostoma duodenale and Ascaris lumbricoides had the widest geographical distribution. Pineapple (Prev: 41.3%, 95% CI: 0.40, 0.75) and lettuce (Prev: 51.5%, 95% CI: 0.37, 0.68) recorded the highest level of parasitic contamination. Parasites of importance for human health are prevalent on edible fruits and vegetables in Nigeria. Prevalence estimates were highest in the South-eastern region and during the most recent decade. Adequate washing of fruits and vegetables, on-farm irrigation of vegetables using good sources of water and adequate hygiene by food handlers will help the general public to maximize the health benefits associated with the intake of fruits and vegetables while minimizing the risk of acquiring parasitic infections.

Non-pharmacological interventions for the prevention of venous thromboembolism: a literature review.

To assess the relative clinical efficacy of different forms of non-pharmacological prophylaxis, intermittent pneumatic compression and graduated compression stockings in reducing the incidence of venous thromboembolism (VTE) in patients hospitalised following acute stroke. This was a thematic synthesis of literature retrieved from a structured bibliographic search of: Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Summon, British Nursing Index, NHS Evidence, Internurse.com, PubMed, Ovid and the websites of other health information resources, such as the Nursing and Midwifery Council, National Institute for Health and Care Excellence and the World Health Organization. Citations were also searched for using: Web of Science, Google Scholar, the Cochrane Central Register of Controlled Trials, Current Controlled Trials, Stroke Trials Registry and Clinical Trials. Intermittent pneumatic compression (IPC) showed a small but statistically significant (P = 0.001) reduction in rates of deep vein thrombosis (DVT), in both symptomatic and asymptomatic DVT, involving proximal or calf veins, with fewer adverse effects such as skin breakdown and ulcers attributed to IPC, as compared to graduated compression stockings. No single intervention was the most effective for VTE prevention. More reliable evidence is required. Clear and extensive guidelines are necessary to ensure high-quality care for patients with acute stroke to improve their quality of life, and reduce morbidity and mortality rates.

The effectiveness and safety of pharmacological prophylaxis against venous thromboembolism in patients with moderate to severe traumatic brain injury: A systematic review and meta-analysis.

Venous thromboembolism (VTE) is a common, potentially fatal complication after traumatic brain injury (TBI). The objective was to evaluate the effectiveness and safety of pharmacologic VTE prophylaxis in moderate to severe TBI patients, and its use in hospitals. A systematic review of the literature was conducted using Medline, Embase, Central database, Google scholar, and the SciELO from 1966 to 2014. All studies providing information on the following variables-use of VTE prophylaxis (both pharmacological and nonpharmacological), initiation of treatment, application of specific protocols, rates of VTE and hemorrhagic progression of the traumatic brain injury on computed tomographic scan-were included. The random effects model was used to calculate pooled effect estimates. Heterogeneity among studies was assessed using the Cochran Q homogeneity test. A forest plot was constructed, and aggregate odds ratio was computed. Potential publication bias was evaluated using funnel plots. A total of 12 retrospective observational studies were identified, totaling 8,747 patients. Six studies (3,325 patients) were used to analyze the safety and five (2,105 patients) to analyze the effectiveness of pharmacological versus nonpharmacological prophylaxis, without considering the timing of treatment. Four studies (1,371 patients) were used to evaluate early versus late pharmacologic prophylaxis, with results favoring early administration (odds ratio, 0.46; 95% confidence interval, 0.24-0.88; p < 0.05; I, 46%) and showing no significant differences regarding safety. Three studies (4,133 patients), used to analyze VTE prophylaxis protocols, showed significant heterogeneity (p < 0.01). When we compared mechanical and pharmacological prophylaxis, the results were heterogeneous; and thus, their potential differences could not be assessed. In some studies, the introduction of prophylaxis protocols in neurocritical patient care improved their effectiveness. Early pharmacologic prophylaxis, in the first 72 hours after TBI, was more effective than late, when there was no hemorrhagic progression within 24 hours after injury; no significant differences were found regarding safety. Systematic review/meta-analysis, level III.

Chapter 25 - Vertigo and dizziness in children

Vertigo and dizziness of at least moderate severity occur in >5% of school-aged children and cause considerable restrictions in participation in school and leisure activity. More than 50% of dizzy children also have headache. Vestibular migraine and benign paroxysmal vertigo as a migraine precursor are the most common diagnoses in dizziness clinics for children and adolescents. They account for 30-60% of diagnoses. Other common causes are somatoform, orthostatic, or posttraumatic dizziness. All other disorders that are known to cause vertigo and dizziness in adults also occur in children, but incidence rates are usually lower. The vestibular and balance systems are largely developed after 1 year of age. Therefore, clinical and laboratory testing is reliable. Brain magnetic resonance imaging to exclude severe conditions, such as a brainstem tumor, is necessary only if clinical - in particular, ocular motor - testing is abnormal. Most conditions causing vertigo and dizziness in childhood and adolescence are treatable. Nonpharmacologic prophylaxis should always be recommended in vestibular migraine. Behavioral support is useful in somatization. Evidence for the effectiveness of drug therapy is largely based on experience in adult populations. High-quality controlled studies in childhood cohorts are sparse. It is important to make a correct diagnosis early on, as counseling and appropriate treatment may avoid chronic illness.

A randomized controlled trial of ibandronate for the prevention of bone loss following allogeneic stem cell transplantation.

7029 Background: Bone mineral density (BMD) loss occurs rapidly within the first year following allogeneic hematopoietic stem cell transplantation (alloHCT), which can lead to fractures. Nonpharmacologic prophylaxis measures are inadequate in preventing bone loss following alloHCT and the effect of ibandronate has not been evaluated. Methods: We performed a phase 3 single-center open-label randomized controlled trial of intravenous ibandronate to prevent BMD loss in adult recipients of alloHCT at The University of Texas MD Anderson Cancer Center. The treatment group received 3 mg of intravenous ibandronate over 15–30 seconds starting within 45 days of alloHCT and at 3, 6, and 9 months after alloHCT. All patients received daily calcium (500 mg) and daily vitamin D (400 IU) oral supplements twice daily for 12 months. We compared changes in BMD in the lumbar spine, femoral neck, and total hip at 6 and 12 months following alloHCT relative to baseline between treatment and control groups. Results: Of 414 patie...

Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage

Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the most feared complication in patients suffering from spontaneous intracerebral hemorrhage (ICH). The balance between VTE risk and the risk of hematoma expansion and/or re-bleeding is the cornerstone of prophylaxis which is based on non-pharmacological and pharmacological strategies. In the latest years results of three randomized clinical trials on non-pharmacological prophylaxis in ischemic and hemorrhagic stroke have been published. Intermittent pneumatic compression has shown to be effective in ICH compared to placebo, whereas graduated compression stockings failed to show their superiority over placebo. Few and low quality studies reported on pharmacological prophylaxis in ICH. Overall, these studies showed that pharmacological prophylaxis could be safe, but whether it is more effective than other non-pharmacological methods remains unclear. A meta-analysis of four randomized controlled studies showed that pharmacological prophylaxis significantly reduces the rate of pulmonary embolism. Consequently, recommendations from Scientific Societies for VTE prevention in ICH are based on weak literature evidence. In the present article, the Authors provide a review on VTE prevention in ICH and propose a practical algorithm for clinical management of this topic.

Non-pharmacological Prophylaxis of Venous Thromboembolism in Acutely Ill Medical Patients

Non-pharmacological Prophylaxis of Venous Thromboembolism in Acutely Ill Medical Patients

Interventions for preventing infection in nephrotic syndrome

Infection is one of the most common complications and still remains a significant cause of morbidity and occasionally mortality in patients, especially children with nephrotic syndrome. Many different prophylactic interventions have been used or recommended for reducing the risks of infection in nephrotic syndrome in clinical practice. Whether the existing evidence is scientifically rigorous and which prophylactic intervention can be recommended for routine use based on the current evidence is still unknown. To assess the benefits and harms of any prophylactic intervention for reducing the risk of infection in children and adults with nephrotic syndrome. We searched the Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL) (in The Cochrane Library), MEDLINE and Pre-MEDLINE (from 1966), EMBASE (from 1980), China Biological Medicine Database (1979 to December 2009), Chinese Science and Technique Journals Database (to December 2009), China National Infrastructure (to December 2009), WangFang database (to December 2009), reference lists of nephrology textbooks, review articles, relevant studies and abstracts from nephrology meetings without language restriction.Date of last search: 6 February 2012 Randomised controlled trials (RCTs) and quasi-RCTs comparing any prophylactic interventions (pharmacological or non-pharmacological) for preventing any infection in children and adults with nephrotic syndrome. Two authors independently assessed and extracted information. Information was collected on methods, participants, interventions and outcomes (appearance of infection, mortality, quality of life and adverse events). Results were expressed as risk ratios (RR) for dichotomous outcomes or as mean differences (MD) for continuous data with 95% confidence intervals (CI). Twelve studies conducted in China, including 762 children with nephrotic syndrome were identified. No studies were identified in adults. All studies compared one kind of prophylactic pharmacotherapy (intravenous immunoglobulin (IVIG), thymosin, oral transfer factor, mannan peptide tablet, Bacillus Calmette-Guerin (BCG) vaccine injection, polyvalent bacterial vaccine (Lantigen B) and two kinds of Chinese medicinal herbs: a compound of Chinese medicinal herbs (TIAOJINING) and Huangqi (astragalus) granules) plus baseline treatment with baseline treatment alone. No RCTs were identified comparing antibiotics, non-pharmacological prophylaxis, or pneumococcal vaccination. Four studies showed a significantly beneficial effect of IVIG on preventing nosocomial or unspecified infection in children with nephrotic syndrome (RR 0.47, 95% CI 0.31 to 0.73). Thymosin (RR 0.50, 95% CI 0.26 to 0.97), oral transfer factor (RR 0.51, 95% CI 0.35 to 0.73), BCG vaccine injection (RR 0.68, 95% CI 0.48 to 0.95), Huangqi granules (RR 0.62, 95% CI 0.47 to 0.83) and TIAOJINING (RR 0.59, 95% CI 0.43 to 0.81) were also effective in reducing the risk of infection in children with nephrotic syndrome. However mannan peptide tablet (RR 0.46, 95% CI 0.21 to 1.01) and polyvalent bacterial vaccine (RR 0.24, 95% CI 0.06 to1.00) were not superior to baseline treatment in reducing the risk of infection for nephrotic children. No serious adverse events were reported. IVIG, thymosin, oral transfer factor, BCG vaccine, Huangqi granules and TIAOJINING may have positive effects on the prevention of nosocomial or unspecified infection with no obvious serious adverse events in children with nephrotic syndrome. However the methodological quality of all studies was poor, the sample sizes small, and all studies were from China, and thus there is no strong evidence on the effectiveness of these interventions.

Postoperative Atrial Fibrillation

Postoperative atrial fibrillation (POAF) is common among surgical patients and associated with a worse outcome. Pathophysiology of POAF is not fully disclosed, and several perioperative factors could be involved. Direct cardiac stimulation from perioperative use of catecholamines or increased sympathetic outflow from volume loss/anaemia/pain may play a role. Metabolic alterations, such as hypo-/hyperglycaemia and electrolyte disturbances, may also contribute to POAF. Moreover, inflammation, both systemic and local, may play a role in its pathogenesis. Strategies to prevent POAF aim at reducing its incidence and ameliorate global outcome of surgical patients. Nonpharmacological prophylaxis includes an adequate control of postoperative pain, the use of thoracic epidural analgesia, optimization of perioperative oxygen delivery, and, possibly, modulation of surgery-associated inflammatory response with immunonutrition and antioxidants. Perioperative potassium and magnesium depletion should be corrected. The impact of those interventions on patients outcome needs to be further investigated.

Malaria Prophylaxis in African and Asiatic Children Traveling to Their Parents' Home Country: A Florentine Study

The majority of malaria cases in Europe occur in immigrated adults and children settled in nonendemic countries but who had traveled to their home country to visit friends and relatives. We carried out a study on a sample of 71 parents immigrated from high-risk countries to investigate awareness of malaria risk and use of pharmacological and nonpharmacological (repellents, insecticides, nets, and insecticide-treated nets) prophylaxis. A questionnaire was administered to a convenience sample of immigrant parents who presented their children for acute care to the Emergency Department, Anna Meyer Children's University Hospital, Florence, Italy between August and November 2009. Fifty-nine out of 71 (83.1%) parents were aware of malaria risk in their native country. Forty-one (57.7%) children had traveled to their parents' home country. Nonpharmacological prophylaxis was used in 30 (73.1%) children. Eight (19.5%) children had received pharmacological prophylaxis, the mostly used drug being mefloquine in six out of eight (75%) patients. Seven out of eight (87.5%) children completed prophylaxis appropriately. Adverse drug reaction was reported in one (12.5%) patient. While abroad, eight (19.5%) parents and one (2.4%) child reported to have developed malaria. A significantly higher proportion of children traveling to Africa compared to children traveling to Asia (5/11 = 46% vs 3/30 = 10%, p = 0.036) had received pharmacological prophylaxis. Our data highlight the need for educational actions in Italy about malaria prophylaxis among immigrants. Larger epidemiological investigations are needed at this regard.

Preventing transmission of infectious agents in the pediatric in-patients hematology-oncology setting: what is the role for non-pharmacological prophylaxis?

The most intensive chemotherapy regimens were used in the past for leukemia patients who were the main focus of trials on infections; today there are increasing numbers of children with solid cancer and considerable risk of infection who do receive intensive standard-dose chemotherapy. Despite a continuous will to protect the immune-compromised child from infections, evidence-based indications for intervention by non-pharmacological tools is still lacking in the pediatric hematology-oncology literature. Guidelines on standard precautions as well as precautions to avoid transmission of specific infectious agents are available. As a result of a consensus discussion, the Italian Association for Pediatric Hematology-Oncology (AIEOP) Cooperative Group centers agree that for children treated with chemotherapy both of these approaches should be implemented and vigorously enforced, while additional policies, including strict environmental isolation, should be restricted to patients with selected clinical conditions or complications. We present here a study by the working group on infectious diseases of AIEOP.