ABSTRACT
One of the initial steps in the preprocessing of digital fundoscopy images is the identification of pixels containing relevant information. This can be achieved through different approaches, one of them is implementing background extraction, reducing the set of pixels to be analyzed later in the process. In this work, we present a background extraction method for digital fundoscopy images based on computational topology. By interpreting binarized images as cubical complexes and extracting their homological groups in 1 and 2 dimensions we identify a subset of luminescence values that can be used to binarize the original grayscale image, obtaining a mask to achieve background extraction. This method is robust to noise and suboptimal image quality, facilitating the analytical pipeline in the context of computer aided diagnosis approaches. This method facilitates the segmentation of the background of a digital fundoscopy image, which allows further methods to focus on pixels with relevant information (eye fundus). This tool is best suited to be implemented in the preprocessing stages of the analytical pipeline by computational ophthalmology specialists.â¢It is robust to noise and low-quality images.â¢Output provides an ideal scenario for down-the-line analysis by facilitating only relevant pixels in a digital fundoscopy.
ABSTRACT
RESUMEN Objective. The misuse of prescription psychotropic drugs is a major health problem.
Subject(s)
Mental Disorders , Prescription Drugs , Humans , Prevalence , Prescriptions , Risk Factors , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Psychotropic Drugs/adverse effectsABSTRACT
Objetivo. El uso problemático de psicofármacos de prescripción es un creciente problema de salud. Uno de los grupos más expuestos al consumo de estas sustancias son las personas con un trastorno mental grave. El objetivo de esta revisión es analizar cuál es la prevalencia y los factores de riesgo, del uso problemático de fármacos psicoactivos, con prescripción médica, en pacientes con trastorno mental grave. Método. Se llevó a cabo una revisión sistemática siguiendo el protocolo PRISMA consultando las bases de datos científicas Medline, Web Of Science, SCOPUS, Proquest y PsycINFO. La revisión se realizó desde enero de 2011 hasta diciembre de 2021. De cada documento se extrajo la información relativa al uso problemático de los psicofármacos prescritos y sus niveles de gravedad. Resultados. De un total de 477 trabajos, 5 cumplían con los criterios de inclusión. Entre un 26% y un 48,7% de pacientes con trastorno mental grave hace un uso problemático de los psicofármacos prescritos y desarrollan dependencia. Los problemas de consumo de otras drogas, tener una historia de prescripción de benzodiacepinas, considerar esencial el uso del fármaco, un uso prolongado, la impulsividad y los comportamientos autolesivos se mostraron como factores de riesgo a la hora de desarrollar un uso problemático de los psicofármacos recetados. Conclusiones. La población con trastorno mental grave convive con factores que la hacen vulnerable al riesgo de desarrollar un uso problemático de las sustancias psicoactivas prescritas. Son necesarios futuros estudios, que profundicen en los efectos y el tratamiento del uso problemático, de los psicofármacos prescritos, en estos pacientes. (AU)
Objective. The misuse of prescription psychotropic drugs is a major health problem. One of the most exposed groups to the use of these substances is people with a severe mental illness. The aim of this review is to assess the prevalence and risk factors of problematic use of psychoactive prescription drugs in patients with SMI. Method. A systematic review was conducted following a PRISMA protocol through the scientific databases PubMed, Web Of Science, SCOPUS, ProquestPsycho and PsycInfo. The review was conducted from January 2011 to December 2021. Information on the misuse of prescribed psychotropic drugs and the levels of dependence generated in the severe mental illness population was examined. Results. A total of 477 studies were identified, and 5 were selected according to the established criteria. Between 26% and 48.7% of patients with severe mental illness misuse prescribed psychotropic drugs and develop dependence. Other drug use problems, having a history of benzodiazepine prescription, perceive drug use as essential, prolonged use, impulsivity and self-harm behaviors were shown as risk factors for developing misuse of prescribed psychotropic drugs. Conclusions. The severe mental illness population lives with several factors that make them vulnerable to the risk of developing misuse of prescribed psychoactive substances. Future studies are needed, since the current evidence is limited, and does not delve into the effects and treatment of misuse of prescribed psychotropic drugs in these patients. (AU)
Subject(s)
Humans , Prevalence , Risk Factors , Psychotropic Drugs/administration & dosage , Mental Disorders/complications , Mental Disorders/drug therapyABSTRACT
Fragaria chiloensis is a strawberry endemic from Chile with attractive white-pink fruit, pleasant aroma and taste. However, this fruit has a limited post-harvest period due to fast softening. Several transcription factors (TFs) are involved in the regulation of fruit ripening, and members of the NAC family have been implicated in cell wall remodeling. FcNAC1 was isolated from F. chiloensis fruit, coding a protein of 332 amino acid residues and displaying a characteristic NAC domain at the N terminus. FcNAC1 protein showed nuclear localization. An increase in transcript level was observed during ripening. A sequence of 1488 bp of FcNAC1 promoter was obtained. In silico analysis identified cis elements able to respond to some hormones and Secondary wall NAC binding elements (SNBE), and responding to auxin and ABA. A structural model of FcNAC1 provided evidence for interaction with DNA sequences containing SNBE, while a dual luciferase assay confirmed the transcriptional activation by FcNAC1 of the promoter of FcPL, a gene involved in cell wall remodeling in F. chiloensis fruit. The results suggest the participation of FcNAC1 during ripening development of strawberry fruit, by regulating pectin metabolism during softening.
Subject(s)
DNA-Binding Proteins/metabolism , Fragaria/physiology , Plant Proteins/metabolism , Transcription Factors/metabolism , Abscisic Acid/metabolism , Cell Wall/metabolism , Chile , Cloning, Molecular , DNA, Plant/chemistry , DNA, Plant/metabolism , DNA-Binding Proteins/chemistry , DNA-Binding Proteins/genetics , DNA-Binding Proteins/isolation & purification , Fruit/cytology , Fruit/metabolism , Gene Expression Regulation, Plant/physiology , Indoleacetic Acids/metabolism , Molecular Dynamics Simulation , Plant Proteins/chemistry , Plant Proteins/genetics , Plant Proteins/isolation & purification , Promoter Regions, Genetic/genetics , Protein Interaction Domains and Motifs , Transcription Factors/chemistry , Transcription Factors/genetics , Transcription Factors/isolation & purificationABSTRACT
Abstract: Patients' medical records have been originally based on paper and since 1865 the medical field recognized the need to improve the means for storing and retrieving disperse information. Electronic Health Records (EHR) systems face similar problems, with interoperability being one of them, it defined by IEEE standard glossary of software engineering terminology as: the ability among information systems to exchange data. Mainly, two perspectives of interoperability emerge: a) syntactic, which refers to the ability of an information system to import and validate grammar, as well as a set of construction rules utterances created by another system; and b) semantic, the ability to exchange data among systems and understand it in the same way, regardless of the source system, also called Semantic Interoperability on Information and Communication Technologies or SIICT. The use of standards, vocabularies and terminologies is a common practice for sharing data among heterogeneous EHR systems in order to face interoperability problems. This heterogeneity starts with the manner to collect and store data. This paper presents to e-health practitioners and researches relevant tools used to achieve interoperability in heterogeneous EHR systems, as well as challenges and future trends to manage EHRs with the intention to achieve SIICT.
Resumen: Los registros clínicos de pacientes se basaron en papel originalmente, desde el año de 1865 se reconoció en el entorno medico la necesidad de mejorar los medios para el almacenamiento y recuperación de información dispersa. Los Sistemas de Expediente Clínicos Electrónicos (ECE) enfrentan problemas similares, siendo uno de estos problemas, la interoperabilidad. La cual es definida por "IEEE standard glossary of software engineering terminology" como: la habilidad de intercambiar datos entre sistemas de información, donde dos perspectivas de interoperabilidad emergen: a) sintáctica, la cual se refiere a la habilidad de un sistema de información de importar y validar la gramática de datos, así como de un conjunto de reglas de expresiones creadas por otro sistema; y b) semántica, como la habilidad de intercambiar datos entre sistemas y de entenderlos de la misma forma, independientemente del sistema fuente, llamando a esto como Interoperabilidad Semántica sobre Tecnologías De La Información y Comunicación (ISTIC). El uso de estándares, vocabularios y terminologías es una práctica común para poder compartir datos entre sistemas ECE con el fin de enfrentar problemas de interoperabilidad. Esta heterogeneidad se da desde la forma en cómo se colecta y almacenan los datos. Este artículo presenta a los profesionales de salud e investigadores de e-salud acerca de herramientas relevantes utilizadas para lograr la interoperabilidad de sistemas ECE heterogéneos, así como retos y futuras tendencias para administrar sistemas ECE con la intención de lograr ISTIC.
ABSTRACT
Double J stents are used in Urology in an important number of pathologies. These devices contribute to solve very prevalent pathologies such as upper urinary tract lithiasis. However, there are very frequent symptoms associated with double J catheters that may produce a very important constraint on the quality of life of patients. Although theses symptoms are not severe in most cases, they require medical treatment to be solved in certain patients. Several types of drugs such as analgesics, anti-inflammatories, antibiotics, anticholinergics and alpha-blockers have been used for this pathology, with variable results depending on the authors. We consider the use of certain drugs may help patients to solve the symptoms associated with double J catheters, mainly the first days after insertion. In the mid term, urinary symptoms are associated with problems related to double J catheter, so it is necessary to establish the proper measures to have this devices not loose their physical characteristics, that may condition these adverse symptoms.
Subject(s)
Postoperative Complications/drug therapy , Postoperative Complications/etiology , Urinary Catheters/adverse effects , Equipment Design , Humans , Postoperative Complications/prevention & controlABSTRACT
Thyrotoxic hypokalemic periodic paralysis is an uncommon complication of thyrotoxicosis, characterized by attacks of generalized muscular weakness associated with hypokalemia in patients with hyperthyroidism, most frequently with Graves-Basedow disease. Treatment with antithyroid drugs and potassium supplements reversed the symptoms and the episodes of acute muscular weakness did not reappear.
Subject(s)
Hypokalemic Periodic Paralysis/etiology , Thyroid Crisis/complications , Humans , Male , Young AdultABSTRACT
La parálisis periódica hipopotasémica tirotóxica (PPT) es una rara complicación de la tirotoxicosis caracterizada por la aparición de episodios de debilidad muscular asociados a hipopotasemia en pacientes con hipertiroidismo, más frecuentemente con enfermedad de Graves-Basedow. El tratamiento con antitiroideos y suplementos de potasio revierte la sintomatología de debilidad muscular y evita la reaparición de estos síntomas (AU)
Thyrotoxic hypokalemic periodic paralysis is an uncommon complication of thyrotoxicosis, characterized by attacks of generalized muscular weakness associated with hypokalemia in patients with hyperthyroidism, most frequently with Graves-Basedow disease. Treatment with antithyroid drugs and potassium supplements reversed the symptoms and the episodes of acute muscular weakness did not reappear (AU)
Subject(s)
Humans , Male , Adult , Hypokalemia/complications , Hypokalemia/diagnosis , Hypokalemia/drug therapy , Paralysis/complications , Paralysis/diagnosis , Thyrotoxicosis/complications , Thyrotoxicosis/diagnosis , Antithyroid Agents/therapeutic use , Thyroid Crisis/complications , Thyroid Crisis/drug therapy , Muscle Weakness/complications , Muscle Weakness/diagnosis , Potassium/therapeutic use , Potassium, Dietary/therapeutic use , Potassium Compounds/therapeutic useABSTRACT
CLINICAL CASE: An 18 year-old-woman presented with abdominal pain, diarrhea, and ptosis in her left eye. Nuclear magnetic resonance imaging (NMRI) and the study of cerebrospinal fluid detected no abnormalities. Colonoscopy revealed a Crohn's disease (CD) confirmed by histological examination of biopsies. Ocular symptoms improved after appropriate treatment of the underlying CD. DISCUSSION: Inflammatory bowel disease (IBD) is associated with a wide variety of extra-intestinal manifestations, in fact it may be considered a systemic disorder with predominantly gastrointestinal tract manifestations. Extra-intestinal manifestations of inflammatory bowel disease (IBD) occur in one third of patients. Ocular complications are infrequent, occurring in less than 10% of cases, but can be associated with significant morbidity, including blindness. Ocular symptoms may precede a diagnosis of IBD. We report the first case of palpebral ptosis associated with Crohn's disease.
Subject(s)
Blepharoptosis/etiology , Crohn Disease/complications , Adolescent , Female , HumansABSTRACT
Forty-two year-old woman, with no relevant medical history, presented with 3-year burning epigastric pain radiating to right upper quadrant, accompanied by nausea and vomiting, food intolerance and estheatorrea. She was treated by 2 years with H2 blockers. Cholelithiasis was found and laparoscopic cholecystectomy was performed without changes in clinical picture. She presented upper gastrointestinal bleeding secondary to severe esophagitis and gastritis. Proton pump inhibitors at high doses were added to the treatment with partial improvement. Abdominal ultrasound showed tumor in pancreatic head but it was not confirmed by computed tomography. High levels of serum gastrin (17,251 µg/L) were detected. Patient underwent laparotomy and with the aid of ultrasound the mass in the head of the pancreas was localized and resected. Recovery was uneventful. The pathology report was a gastrinoma. At one year follow up, patient remains asymptomatic.
Subject(s)
Zollinger-Ellison Syndrome/diagnosis , Adult , Female , HumansABSTRACT
The purpose of this paper is to determine the incidence of fungal colonization and infection in non-neutropenic critically ill patients and to identify factors favoring infection by Candida spp. A total of 1,655 consecutive patients (>18 years of age) admitted for > or = 7 days to 73 medical-surgical Spanish intensive care units (ICUs) participated in an observational prospective cohort study. Surveillance samples were obtained once a week. One or more fungi were isolated in different samples in 59.2% of patients, 94.2% of which were Candida spp. There were 864 (52.2%) patients with Candida spp. colonization and 92 (5.5%) with proven Candida infection. In the logistic regression analysis risk factors independently associated with Candida spp. infection were sepsis (odds ratio [OR] = 8.29, 95% confidence interval [CI] 5.07-13.6), multifocal colonization (OR = 3.49, 95% CI 1.74-7.00), surgery (OR = 2.04, 95% CI 1.27-3.30), and the use of total parenteral nutrition (OR = 4.37, 95% CI 2.16-8.33). Patients with Candida spp. infection showed significantly higher in-hospital and intra-ICU mortality rates than those colonized or non-colonized non-infected (P < 0.001). Fungal colonization, mainly due to Candida spp., was documented in nearly 60% of non-neutropenic critically ill patients admitted to the ICU for more than 7 days. Proven candidal infection was diagnosed in 5.5% of cases. Risk factors independently associated with Candida spp. infection were sepsis, multifocal colonization, surgery, and the use of total parenteral nutrition.
Subject(s)
Critical Illness , Fungi/isolation & purification , Mycoses/epidemiology , Adult , Aged , Cohort Studies , Female , Fungi/classification , Humans , Incidence , Male , Middle Aged , Mycoses/microbiology , Mycoses/mortality , Prospective Studies , Risk Factors , SpainABSTRACT
We describe the kink solitary waves of a massive nonlinear sigma model with an S2 sphere as the target manifold. Our solutions form a moduli space of nonrelativistic solitary waves in the long wavelength limit of ferromagnetic linear spin chains.
ABSTRACT
INTRODUCTION: Mild cognitive impairment (MCI) is defined as a state of the ageing brain midway between normal cognition and dementia. Special attention has been paid to the electrophysiological substrate underlying Alzheimer's disease and MCI in order to identify as early as possible which subjects with MCI progress towards Alzheimer, which could be crucial for starting rehabilitation or pharmacological therapies. AIM: To perform a spectral characterisation of the electroencephalogram in subjects with MCI. PATIENTS AND METHODS: An electroencephalogram was carried out on 41 subjects with MCI in order to analyse the spectral measurements; apolipoprotein E genotype was also performed. RESULTS: In all, 94.8% of the sample displayed a significant increase in energy, and in 66.6% of them this was observed in the theta and delta bands, or both. Significant differences were found in the spectral measurements between carriers and non-carriers of the apolipoprotein E epsilon4 allele in the theta and alpha bands; there was also a statistically significant association between the years of schooling and being a carrier of this allele or not. An increase in the theta-alpha bands was observed in the left temporal region in subjects with a below-average number of years of schooling and carriers of the epsilon4 allele. CONCLUSIONS: In subjects with MCI and carriers of the epsilon4 allele, the alpha and theta cortical rhythms can be affected by similar pathological mechanisms and may be expressed earlier in subjects who have a lower level of schooling.
Subject(s)
Cognition Disorders/physiopathology , Electroencephalography , Aged , Aged, 80 and over , Apolipoprotein E4/genetics , Cognition Disorders/genetics , Female , Humans , Male , Severity of Illness IndexABSTRACT
El deterioro cognitivo leve (DCL) se define como un estado del cerebro envejecido intermedio entrela cognición normal y la demencia; se ha prestado una especial atención al sustrato electrofisiológico de la enfermedad de Alzheimer y el DCL con la finalidad de identificar lo antes posible qué sujetos con DCL progresan a Alzheimer, lo cual podríaser crucial para el inicio de terapias de rehabilitación o farmacológicas. Objetivo. Caracterización espectral del electroencefalograma en sujetos con DCL. Pacientes y métodos. Se estudió a 41 sujetos con DCL a los cuales se les realizó electroencefalograma para el análisis de las medidas espectrales; además se realizó genotipo de apolipoproteína E. Resultados. El 94,8% de la muestra reveló un incremento significativo de energía; en el 66,6% de ellos se observó en las bandas theta y delta,o ambas. Se encontraron diferencias significativas en las medidas espectrales entre portadores y no portadores del alelo epsilon4 de la apolipoproteína E en las bandas theta y alfa, y además existió una asociación estadísticamente significativa entre los años de escolaridad y ser portador o no de dicho alelo. Se observó un incremento en las bandas theta-alfa en la región temporal izquierda en los sujetos por debajo de la media de años de escolaridad y portadores del alelo epsilon4. Conclusiones. En los sujetos con DCL y portadores del alelo epsilon4, los ritmos corticales alfa y theta pueden verse afectados por mecanismospatológicos similares, y puede expresarse de forma más precoz en los sujetos que presentan un nivel de escolaridad bajo
Mild cognitive impairment (MCI) is defined as a state of the ageing brain midway between normalcognition and dementia. Special attention has been paid to the electrophysiological substrate underlying Alzheimers disease and MCI in order to identify as early as possible which subjects with MCI progress towards Alzheimer, which could be crucial forstarting rehabilitation or pharmacological therapies. Aim. To perform a spectral characterisation of the electroencephalogram in subjects with MCI. Patients and methods. An electroencephalogram was carried out on 41 subjects with MCI in order to analyse the spectral measurements; apolipoprotein E genotype was also performed. Results. In all, 94.8% of the sampledisplayed a significant increase in energy, and in 66.6% of them this was observed in the theta and delta bands, or both. Significant differences were found in the spectral measurements between carriers and non-carriers of the apolipoprotein E epsilon4 allele in the theta and alpha bands; there was also a statistically significant association between the years of schoolingand being a carrier of this allele or not. An increase in the theta-alpha bands was observed in the left temporal region in subjects with a below-average number of years of schooling and carriers of the epsilon4 allele. Conclusions. In subjects withMCI and carriers of the epsilon4 allele, the alpha and theta cortical rhythms can be affected by similar pathological mechanisms and may be expressed earlier in subjects who have a lower level of schooling
Subject(s)
Humans , Cognition Disorders/diagnosis , Electroencephalography/methods , Apolipoproteins E/analysis , Alzheimer Disease/epidemiology , Dementia/epidemiology , AllelesABSTRACT
Reporte de de un caso de edema pulmonar en el postoperatorio inmediato de uan cirugia laparascópica ginecológica. La etiología del edema pulmonar en este caso no pudo ser determinada con precisión, pero se plantea con precisión, pero se plantearon dos posibles causas que lo explicaran. La primera sería un aumento súbito del retorno venoso luego de la remoción del CO2 de la cavidad peritoneal, lo que a su vez producira una sobre carga de liquidos. La segunda sería un aumento en la permeabilidad capilar pulmonar que podria resultar...
Subject(s)
Humans , Anesthesia, Inhalation , Anesthesia, Obstetrical , Blood Pressure , Insufflation , Laparoscopy , Pneumoperitoneum/pathology , Pulmonary EdemaABSTRACT
Agrobacterium is widely considered to be the only bacterial genus capable of transferring genes to plants. When suitably modified, Agrobacterium has become the most effective vector for gene transfer in plant biotechnology. However, the complexity of the patent landscape has created both real and perceived obstacles to the effective use of this technology for agricultural improvements by many public and private organizations worldwide. Here we show that several species of bacteria outside the Agrobacterium genus can be modified to mediate gene transfer to a number of diverse plants. These plant-associated symbiotic bacteria were made competent for gene transfer by acquisition of both a disarmed Ti plasmid and a suitable binary vector. This alternative to Agrobacterium-mediated technology for crop improvement, in addition to affording a versatile 'open source' platform for plant biotechnology, may lead to new uses of natural bacteria-plant interactions to achieve plant transformation.
Subject(s)
Bacteria/classification , Bacteria/genetics , Gene Transfer Techniques , Plants/genetics , Plants/microbiology , Transformation, Genetic/genetics , Arabidopsis/genetics , Arabidopsis/microbiology , Base Sequence , Biotechnology/methods , DNA, Bacterial/genetics , Genetic Vectors/genetics , Genotype , Oryza/genetics , Oryza/microbiology , Plant Leaves/genetics , Plant Leaves/microbiology , Plants, Genetically Modified , Plasmids/genetics , Rhizobium/genetics , Symbiosis , Nicotiana/genetics , Nicotiana/microbiologyABSTRACT
A review of current literature on mammalian hosts' sexual dimorphism (SD) in parasitic infections revealed that (1) it is a scarcely and superficially studied biological phenomenon of considerable significance for individual health, behavior, and lifestyles and for the evolution of species; (2) there are many notable exceptions to the rule of a favorable female bias in susceptibility to infection; (3) a complex network of molecular and cellular reactions connecting the host's immuno-neuroendocrine systems with those of the parasite is responsible for the host-parasite relationship rather than just an adaptive immune response and sex hormones; (4) a lack of gender-specific immune profiles in response to different infections; (5) the direct effects of the host hormones on parasite physiology may significantly contribute to SD in parasitism; and (6) the need to enrich the reductionist approach to complex biological issues, like SD, with more penetrating approaches to the study of cause-effect relationships, i.e., network theory. The review concludes by advising against generalization regarding SD and parasitism and by pointing to some of the most promising lines of research.
Subject(s)
Endocrine System/physiology , Immune System/physiology , Mammals/parasitology , Parasitic Diseases/immunology , Parasitic Diseases/metabolism , Sex Characteristics , Animals , Cysticercosis/immunology , Cysticercosis/metabolism , Female , Gonadal Steroid Hormones/physiology , Host-Parasite Interactions , Humans , Male , Neurosecretory Systems/physiologyABSTRACT
Objetivo. Demostrar la eficacia de la unidad de cirugía mayor ambulatoria (CMA) en el coste-proceso de la patología hallux valgus en la gestión de los recursos sanitarios. Material y método. Se analizó el proceso hallux valgus en pacientes intervenidos durante el año 1995 mediante ingreso rutinario y en el año 1999 a través de ingreso por la unidad de CMA bajo los parámetros de coste por proceso de acuerdo con la unidad ponderada asistencial (UPA) y la calidad asistencial evaluando el dolor, nauseas o vómitos, fiebre, sangrado y grado de satisfacción en las primeras 24 horas. Resultados. Se objetivó que el coste por proceso en los pacientes ingresados de forma rutinaria fue de 2,5 UPA médicas frente a 0,25 UPA médicas en los ingresados por CMA, no encontrándose diferencias en cuanto a los parámetros evaluados en el control de calidad. Conclusiones. El proceso hallux valgus debe incluirse dentro de la cartera de servicios de Traumatología en la unidad de CMA, ya que reduce de una forma considerable el coste sanitario. No se apreció ninguna diferencia en relación con la calidad asistencial y el grado de satisfacción en los pacientes intervenidos mediante CMA o mediante ingreso convencional. Es esencial la correcta selección del paciente, la información que se le ofrece y la motivación de los profesionales (AU)
Subject(s)
Humans , Hallux Valgus/surgery , Ambulatory Surgical Procedures/methods , Ambulatory Surgical Procedures/economics , Health Care Costs/statistics & numerical dataABSTRACT
OBJECTIVE: To determine a method for the early diagnosis of candidiasis in non-neutropenic critically ill patients in order to reduce mortality. METHODS: A prospective study in non-neutropenic critically patients in whom Candida spp. were detected, was made in an intensive care unit (ICU) during an 8-year period from 3389 patients admitted. A diagnostic and therapeutic protocol was designed. Invasive candidiasis was defined according to dissemination and multifocality. RESULTS: Candida spp. were found in 145 cases (4.3%): 120 (83%) were considered as invasive candidiasis and 25 as colonisation (17%). The hospital mortality was 46% (67/145). A post-mortem study was carried out in 54% (36/67) of hospital deaths. Candida albicans was the most frequently isolated species (87%), followed by Candida glabrata (18%). There were 24 candidemias and three cases of endophtalmitis. Digestive and respiratory samples and non-C. albicans yeasts were risk factors for invasive candidiasis. The mortality rate was related statistically to invasive candidiasis and inversely to the appropriate antifungal treatment. CONCLUSIONS: Invasive candidiasis is related to digestive and respiratory samples and to the presence of non-C. albicans species. A simpler definition of invasive candidiasis in non-neutropenic critically ill patients will permit more rapid and accurate specific antifungal therapy.
Subject(s)
Candida albicans/growth & development , Candidiasis/diagnosis , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Candidiasis/microbiology , Candidiasis/mortality , Cohort Studies , Critical Care , Critical Illness , Female , Guidelines as Topic , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
Microbial colonization and the incidence of catheter-related bloodstream infections (CR-BSI) associated with Oligon Vantex silver central venous catheters (CVC) in critically ill patients were determined. A prospective, randomized, controlled 17-month trial was carried out in an intensive care unit (ICU). All patients requiring a triple-lumen CVC for four days or longer were enrolled. Patients were randomized to receive a standard polyurethane CVC or an Oligon Vantex silver CVC. Before removal of the catheter either due to discharge from the ICU or suspected infection, blood for cultures was taken via the CVC and a peripheral site. Skin and hub swabs and catheter-tips were also cultured. Two hundred and six catheters, 103 in both groups, were evaluated. In the control group (CG) 45/103 (44%) and in the silver group (SG) 30/103 (29%) were colonized or had a CR-BSI (P=0.04). The SG was less likely to be colonized than the CG when the catheter remained in situ for eight days or less (P=0.03) or over 15 days (P=0.01); a second or subsequent catheter was present in the same patient (P=0.002), or if the CVC was placed in the internal jugular vein (P=0.05). Multivariate logistic-regression showed predisposing factors for catheter colonization were jugular and femoral sites, second or subsequent catheter, and being a member of the CG. CR-BSI occurred in five cases (four in CG). Rates of CR-BSI per 1000 catheter-days in the CG were 2.8 and in the SG, 0.8 (P<0.001). The Oligon Vantex silver catheter reduced the incidence of catheter-colonization and may decrease the risk of CR-BSI.
