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1.
researchsquare; 2024.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3900486.v1

ABSTRACT

Background In the German emergency medical services, 67 rescue helicopters and 12 helicopters for rescue and intensive care transport missions provide their services mostly under visual flight conditions. Of these, 10 helicopters are equipped with a rescue hoist. There is limited data on the frequency of hoist operations, tracer diagnoses, and influences such as weather and vacation periods. This study examines hoist deployment frequencies, tracer diagnostics, and the influence of vacation season at three German helicopter sites.Methods In the period from 01 Feb. 2018 to 31 Dec. 2021, a total of 1340 hoist missions were retrospectively examined descriptively for the helicopters Christoph 15 (n = 196), Christoph 1 (n = 316), and Christoph Murnau (n = 828) using their electronic mission documentation.Results 56.89% of the hoist missions were flown during the summer months, with vacation periods having a small effect on Christoph 1 only. Traumatological diagnoses clearly predominated on all three helicopters, with 75.0% on Christoph 15, 78.8% on Christoph 1, and 52.17% on Christoph Murnau. Among the traumatological indications, extremity trauma (39.29%) was the most frequent, followed by spinal injuries (10.71%), traumatic brain injuries (8.67%), and polytrauma (4.59%). Among internal medicine emergencies, collapse/syncope (5.61%) and cardiovascular arrest (3.06%) were the most common, followed by acute coronary syndromes, anaphylaxis, and hypothermia (2.55% each).Conclusions Despite the predominance of extremity injuries and syncope/collapse, where risk stratification was the primary concern and complex medical care was usually not required, there were also dynamic and complex emergency events, e.g., cardiovascular arrests, traumatic brain injuries, and anaphylaxis. Not even the Covid-19 pandemic led to a significant shift in distribution. Surprisingly, the influence of vacation periods on the frequency of operations was less pronounced even in tourism-oriented regions. For future research, other aspects need to be studied, such as the impact of severe weather on helicopter operations in the context of climate change, as well as personnel strategy (e.g., 3-person vs. 4-person crews).


Subject(s)
Hypothermia , Cardiovascular Diseases , Spinal Cord Injuries , COVID-19 , Wounds and Injuries , Brain Injuries , Extensively Drug-Resistant Tuberculosis , Syncope , Multiple Trauma
2.
Int J Mycobacteriol ; 11(4): 343-348, 2022.
Article in English | MEDLINE | ID: covidwho-2163901

ABSTRACT

Mycobacterium tuberculosis is the leading cause of mortality worldwide due to a single bacterial pathogen. Of concern is the negative impact that the COVID-19 pandemic has had on the control of tuberculosis (TB) including drug-resistant forms of the disease. Antimicrobial resistance increases the likelihood of worsened outcomes in TB patients including treatment failure and death. Multidrug-resistant (MDR) strains, resistant to first-line drugs isoniazid and rifampin, and extensively drug-resistant (XDR) strains with further resistance to second-line drugs (SLD), threaten control programs designed to lower TB incidence and end the disease as a public health challenge by 2030, in accordance with UN Sustainable Development Goals. Tackling TB requires an understanding of the pathways through which drug resistance emerges. Here, the roles of acquired resistance mutation, and primary transmission, are examined with regard to XDR-TB. It is apparent that XDR-TB can emerge from MDR-TB through a small number of additional resistance mutations that occur in patients undergoing drug treatment. Rapid detection of resistance, to first-line drugs and SLD, at the initiation of and during treatment, and prompt adjustment of regimens are required to ensure treatment success in these patients. Primary transmission is predicted to make an increasing contribution to the XDR-TB caseload in the future. Much work is required to improve the implementation of the World Health Organization-recommended infection control practices and block onward transmission of XDR-TB patients to contacts including health-care workers. Finally, limiting background resistance to fluoroquinolones in pre-XDR strains of M. tuberculosis will necessitate better antimicrobial stewardship in the broader use of this drug class.


Subject(s)
COVID-19 , Extensively Drug-Resistant Tuberculosis , Mycobacterium tuberculosis , Tuberculosis, Multidrug-Resistant , Humans , Extensively Drug-Resistant Tuberculosis/drug therapy , Extensively Drug-Resistant Tuberculosis/epidemiology , Extensively Drug-Resistant Tuberculosis/microbiology , Antitubercular Agents/pharmacology , Antitubercular Agents/therapeutic use , Pandemics , COVID-19/epidemiology , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/epidemiology , Tuberculosis, Multidrug-Resistant/microbiology , Mycobacterium tuberculosis/genetics , Drug Resistance, Microbial , Drug Resistance, Multiple, Bacterial
3.
Braz J Biol ; 84: e258258, 2022.
Article in English | MEDLINE | ID: covidwho-2054598

ABSTRACT

According to studies carried out, approximately 10 million people developed tuberculosis in 2018. Of this total, 1.5 million people died from the disease. To study the behavior of the genome sequences of Mycobacterium tuberculosis (MTB), the bacterium responsible for the development of tuberculosis (TB), an analysis was performed using k-mers (DNA word frequency). The k values ranged from 1 to 10, because the analysis was performed on the full length of the sequences, where each sequence is composed of approximately 4 million base pairs, k values above 10, the analysis is interrupted, as consequence of the program's capacity. The aim of this work was to verify the formation of the phylogenetic tree in each k-mer analyzed. The results showed the formation of distinct groups in some k-mers analyzed, taking into account the threshold line. However, in all groups, the multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains remained together and separated from the other strains.


Subject(s)
Extensively Drug-Resistant Tuberculosis , Mycobacterium tuberculosis , Tuberculosis, Multidrug-Resistant , Antitubercular Agents/pharmacology , Antitubercular Agents/therapeutic use , Cluster Analysis , Drug Resistance, Multiple, Bacterial/genetics , Extensively Drug-Resistant Tuberculosis/drug therapy , Extensively Drug-Resistant Tuberculosis/genetics , Extensively Drug-Resistant Tuberculosis/microbiology , Humans , Microbial Sensitivity Tests , Mycobacterium tuberculosis/genetics , Phylogeny , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/microbiology
5.
Copenhagen; World Health Organization. Regional Office for Europe; 2020. (WHO/EURO:2020-5618-45383-64942).
in English | WHOIRIS | ID: gwh-359728

ABSTRACT

WHO Regional Office for Europe held an online training session “Capacity-building for consultants on the new WHO recommendation for the treatment of drug-resistant tuberculosis” on 15–18 June 2020. The objectives of the training session included capacity-building of the new and existing regional Green Light Committee for the WHO European Region (rGLC/Europe) consultants on the new WHO guidelines; increasing the pool of consultants to enable the smooth continuation of support to countries with regard to the introduction of the latest treatment policies based on the latest WHO recommendations; and assisting countries in the operationalization of the new guidelines. Members of the rGLC/Europe, representatives from the Stop TB Partnership, the Global Drug Facility (GDF), staff from WHO Headquarters Global TB Programme and from the Joint Tuberculosis, HIV and Viral Hepatitis Programme of the WHO Regional Office for Europe took part in the training session. During the meeting, staff and core experts from the WHO Regional Office for Europe and rGLC experts shared updates on DR-TB treatment and related topics, in particular TB/HIV and paediatric TB and latent TB infection (LTBI) management and their implications for laboratory diagnosis, drug supply, infection control and clinical follow-up. The WHO Regional Office and Global TB Programme also addressed the challenge of COVID-19 pandemic, which is an overlapping threat hampering TB-related activities. Experienced and new rGLC members discussed the in-country mission Terms of Reference, expected results and possible complications.


Subject(s)
Tuberculosis , Tuberculosis, Multidrug-Resistant , Extensively Drug-Resistant Tuberculosis , Capacity Building , COVID-19 , Clinical Laboratory Techniques , Guideline , Europe
6.
BMC Infect Dis ; 22(1): 204, 2022 Mar 02.
Article in English | MEDLINE | ID: covidwho-1779608

ABSTRACT

BACKGROUND: There was a lack of information about prognostic accuracy of time to sputum culture conversion (SCC) in forecasting cure among extensively drug-resistant tuberculosis (XDR-TB) patients. Therefore, this study evaluated the prognostic accuracy of SCC at various time points in forecasting cure among XDR-TB patients. METHODS: This retrospective observational study included 355 eligible pulmonary XDR-TB patients treated at 27 centers in Pakistan between 01-05-2010 and 30-06-2017. The baseline and follow-up information of patients from treatment initiation until the end of treatment were retrieved from electronic nominal recording and reporting system. Time to SCC was analyzed by Kaplan-Meier method, and differences between groups were compared through log-rank test. Predictors of time to SCC and cure were respectively evaluated by multivariate Cox proportional hazards and binary logistic regression analyses. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 226 (63.6%) and 146 (41.1%) patients respectively achieved SCC and cure. Median time to SCC was significantly shorter in patients who achieved cure, 3 months (95% confidence interval [CI]: 2.47-3.53), than those who did not (median: 10 months, 95% CI: 5.24-14.76) (p-value < 0.001, Log-rank test). Patient's age > 40 years (hazards ratio [HR] = 0.632, p-value = 0.004), baseline sputum grading of scanty, + 1 (HR = 0.511, p-value = 0.002), + 2, + 3 (HR = 0.523, p-value = 0.001) and use of high dose isoniazid (HR = 0.463, p-value = 0.004) were significantly associated with early SCC. Only SCC at 6 month of treatment had statistically significant association with cure (odds ratio = 15.603, p-value < 0.001). In predicting cure, the sensitivities of SCC at 2, 4 and 6 months were respectively 41.8% (95%CI: 33.7-50.2), 69.9% (95%CI: 61.7-77.2) and 84.9% (95%CI: 78.1-90.3), specificities were respectively, 82.8% (95%CI: 76.9-87.6), 74.6% (95%CI: 68.2-80.4) and 69.4% (95%CI: 62.6-75.5) and prognostic accuracies were respectively 65.9% (95%CI: 60.7-70.8), 72.7% (95%CI: 67.7-77.2) and 75.8% (95%CI: 71.0-80.1). CONCLUSION: In forecasting cure, SCC at month 6 of treatment performed better than SCC at 2 and 4 months. However, it would be too long for clinicians to wait for 6 months to decide about the regimen efficacy. Therefore, with somewhat comparable prognostic accuracy to that SCC at 6 month, using SCC at 4 month of treatment as a prognostic marker in predicting cure among XDR-TB patients can decrease the clinicians waiting time to decide about the regimen efficacy.


Subject(s)
Extensively Drug-Resistant Tuberculosis , Mycobacterium tuberculosis , Tuberculosis, Multidrug-Resistant , Tuberculosis, Pulmonary , Adult , Antitubercular Agents/therapeutic use , Extensively Drug-Resistant Tuberculosis/diagnosis , Extensively Drug-Resistant Tuberculosis/drug therapy , Humans , Prognosis , Retrospective Studies , Sputum , Treatment Outcome , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy
8.
researchsquare; 2021.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-685126.v1

ABSTRACT

Objective: Description of the different isolated microorganisms and their prevalence in infections associated with health care, in addition to determining their patterns of resistance to antibiotics in patients admitted with a confirmed or suspected diagnosis of COVID-19 in the Intensive Care Unit, during a third-level medical center with hospital reconversion. Method: Patient demographic data was obtained from the clinical record, with defined criteria. Antibiotic resistance patterns were evaluated as well as the identification of isolated bacteria in cultures of expectoration, pleural fluid, catheter tips. For bacterial identification and resistance mechanisms, automated equipment and phenotypic tests were used, following the CLSI criteria.ResultsA total of 100 patients with bacterial infection added to the main COVID-19 picture were obtained, of which he represented pneumonia, urinary tract infection, catheter infections and bacteremia. A total of 100 strains were isolated, of which 84 are Extremely Drug Resistant, 12 Multidrug Resistant and only 4 variable sensitivity. The bacteria with the highest prevalence is Staphylococcus aureus with, followed by Peudonomas aeruginosa and Stenotrophomonas maltophilia . 100% of the patients admitted to the ICU had death.ConclusionThe increase in resistance to antibiotics in the COVID-19 pandemic has set off alarms due to the complication that this brings, and the improper use of drugs as prophylaxis or attempted treatment only generates selective pressure that leads to an increase in resistance as observed in the isolated strains in this study, where the vast majority present enzymes as well as other resistance mechanisms that confer them to be XDR


Subject(s)
Pneumonia , Bacterial Infections , Extensively Drug-Resistant Tuberculosis , COVID-19 , Bacteremia
9.
Disaster Med Public Health Prep ; 14(4): e9-e10, 2020 08.
Article in English | MEDLINE | ID: covidwho-636862

ABSTRACT

The incidence of extensively drug-resistant tuberculosis (XDR-TB) has been rising consistently in Pakistan, and the country is likely to experience another surge of cases in the midst of the COVID-19 crisis. It is imperative to consider how the rising proportion of XDR-TB is best tackled during the pandemic; this includes finding a solution to the problem of non-adherence at the level of community-based healthcare, the utility and practicality of simultaneous testing for COVID-19 and TB, and reconciliation of the World Health Organization's recommendation of home-based treatment with the need for frequent monitoring of anti-tubercular therapy in XDR-TB. Operational research is needed expeditiously to bypass these limitations.


Subject(s)
COVID-19/complications , Extensively Drug-Resistant Tuberculosis/transmission , Antitubercular Agents/therapeutic use , COVID-19/epidemiology , COVID-19/psychology , Extensively Drug-Resistant Tuberculosis/epidemiology , Extensively Drug-Resistant Tuberculosis/psychology , Humans , Incidence , Pakistan/epidemiology , Treatment Adherence and Compliance/statistics & numerical data
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