Perceptions of Carriership of Extended-Spectrum Beta-Lactamase (ESBL)-Producing Bacteria: A Qualitative Study.

The spread of antimicrobial resistance is a global health concern, and resistance mediated by Extended-Spectrum Beta-Lactamases (ESBLs) can cause major consequences. The aim of this study was to explore individuals' perceptions of their daily life and how they cope after being diagnosed with carriage of ESBL-producing bacteria. A qualitative study was conducted with a descriptive design. Data were collected through individual interviews with 24 persons having ESBL carriership, via a semi-structured interview guide. The data were analyzed using qualitative content analysis. The informants' perceptions on "Living with uncertainty about carriership that impacts oneself and others" were interpreted. Experiences of altered behaviors and sentiments due to ESBL carriership were described, as ESBL carriership was perceived to have a psychosocial impact on many informants. Ambiguous and inconsistent information tended to exacerbate these perceptions. The results of this study emphasize the importance of conveying individualized information, both at the time of diagnosis of ESBL carriage and thereafter. This study was not registered.

Clinical frailty scale as a predictor of disease severity in patients hospitalised with COVID-19 - an observational cohort study.

BACKGROUND: The coronavirus disease 2019 pandemic makes proper resource allocation and prioritisation important. Frailty increases the risk of adverse outcomes and can be quantified using the Clinical frailty scale. The aim of this study was to determine the role of the Clinical frailty scale, in patients ≥65 years of age with coronavirus disease 2019, as a risk factor either for critical coronavirus disease 2019 measured as intensive care unit admission or death or as a risk factor for death. METHODS: This was a retrospective observational study on patients ≥65 years hospitalised with coronavirus disease 2019 verified by polymerase chain reaction between 5 March 5 and 5 July 2020. The association between Clinical frailty scale and the composite primary outcome intensive care unit admission or death within 30 days post hospitalisation and the secondary outcome death within 30 days post hospitalisation was analysed using multivariable logistic regression models adjusting for gender, age, body mass index, hypertension, and diabetes. Clinical frailty scale was used as a categorical variable (fit score 1-4, frail score 5-6, and severely frail score 7-9). RESULTS: In total, 169 patients were included (47.3% women, mean age 79.2 ± 7.8 years). In the fully adjusted model, adjusted odds ratio for intensive care unit admission or death was 1.84 (95%-confidence interval 0.67-5.03, p = .234) for frail and 6.08 (1.70-21.81, p = .006) for severely frail compared to fit patients. For death, adjusted odds ratio was 2.81 (0.89-8.88, p = .079) for frail and 9.82 (2.53-38.10, p = .001) for severely frail compared to fit patients. CONCLUSIONS: A high Clinical frailty scale score was an independent risk factor for the composite outcome intensive care unit admission or death and for the secondary outcome death.

Swallowing Function in COVID-19 Patients After Invasive Mechanical Ventilation.

OBJECTIVE: To explore swallowing function and risk factors associated with delayed recovery of swallowing in patients with COVID-19 post-invasive mechanical ventilation using the Functional Oral Intake Scale (FOIS). DESIGN: Longitudinal cohort study. SETTING: Three secondary-level hospitals. PARTICIPANTS: Invasively ventilated patients (N=28) who were hospitalized with severe COVID-19 and referred to the hospitals' speech and language pathology (SLP) departments after mechanical ventilation between March 5 and July 5, 2020 for an evaluation of swallowing function before commencing oral diet. INTERVENTIONS: SLP assessment, advice, and therapy for dysphagia. MAIN OUTCOME MEASURES: Oral intake levels at baseline and hospital discharge according to the FOIS. Patients were stratified according to FOIS (1-5, dysphagia; 6-7, functional oral intake). Data regarding comorbidities, frailty, intubation and tracheostomy, proning, and SLP evaluation were collected. RESULTS: Dysphagia was found in 71% of the patients at baseline (79% men; age, 61±12y; body mass index, 30±8 kg/m2). The median FOIS score at baseline was 2 (interquartile range [IQR], 1) vs 5 (IQR, 2.5) at hospital discharge. Patients with dysphagia were older (64±8.5y vs 53±16y; P=.019), had a higher incidence of hypertension (70% vs 12%; P=.006), and were ventilated invasively longer (16±7d vs 10±2d; P=.017) or had a tracheostomy (9±9d vs 1±2d; P=.03) longer. A negative association was found between swallowing dysfunction at bedside and days hospitalized (r=-0.471, P=.01), and number of days in the intensive care unit (ICU) (r=-0.48, P=.01). CONCLUSION: Dysphagia is prevalent in COVID-19 patients after invasive mechanical ventilation and is associated with number of days in hospital and number of days in the ICU. Swallowing function and tolerance of oral diet improved at discharge (P<.001).

[Dengue caused life-threatening arrhythmia]. / Denguefeber orsakade arytmi.

Dengue is a mosquito-borne viral disease found in tropical and sub-tropical climates worldwide. Due to globalization and climate change dengue is an increasing global concern. Symptoms typically appear 3-14 days after inoculation by the Aedes mosquito and most commonly manifests as a self-limiting febrile illness. However, in severe dengue, plasma leakage may be profound and result in hemorrhage, disseminated intravascular coagulation and circulatory collapse. The dengue virus may also cause organ dysfunction. Cases of myocarditis, myocardial dysfunction and arrhythmias including atrioventricular block have been reported. The atrioventricular block often resolves spontaneously but pharmacological and pacing support may be required. We report a case of dengue in a patient who was admitted to a Swedish hospital after visiting India. In this case total atrioventricular block without ventricular escape rhythm resolved spontaneously and no pacemaker was necessary.

Statins and Neuropathic Pain: A Narrative Review.

The frequently prescribed drug class of statins have pleiotropic effects and have been implicated in neuropathic pain syndromes. This narrative review examines studies of statin-induced neuropathic pain which to date have been conducted only in animal models. However, the pathophysiology of diabetic neuropathy in humans may shed some light on the etiology of neuropathic pain. Statins have exhibited a paradoxical effect in that statins appear to reduce neuropathic pain in animals but have been associated with neuropathic pain in humans. While there are certain postulated mechanisms offering elucidation as to how statins might be associated with neuropathic pain, there is, as the American Heart Association stated, to date no definitive association between statins and neuropathic pain. Statins are important drugs that reduce cardiovascular risk factors and should be prescribed to appropriate patients with these risk factors but some of this population is also at elevated risk for neuropathic pain from other causes.

[Management of infective endocarditis]. / ABC om - Infektiös endokardit.

Infective endocarditis is an uncommon but potentially lethal disease, defined as an infectious lesion of the endocardium. The possibility of infective endocarditis should be considered in all patients with gram positive bacteremia. Particular consideration is recommended in case of Staphylococcus aureus bacteremia. Treatment consists of high doses of intravenous antibiotics, usually during four weeks, but shorter or longer treatments may be applicable based on the characteristics of the patient and the infecting pathogen. Furthermore, a significant portion of patients will require thoracic surgery in order to ensure a favorable outcome. The management of infective endocarditis is a complex challenge, requiring close collaboration between infectious disease specialists, cardiologists, thoracic surgeons, clinical physiologists, and clinical microbiologists.