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1.
Int J Infect Dis ; 100: 123-131, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32712427

RESUMO

Surgical site infection (SSI) rates in low- and middle-income countries (LMICs) range from 8 to 30% of procedures, making them the most frequent healthcare-acquired infection (HAI) with substantial morbidity, mortality, and economic impacts. Presented here is an approach to surgical site infection prevention based on surveillance and focused on five critical areas identified by international experts. These five areas include 1. Collecting valid, high-quality data; 2. Linking HAIs to economic incapacity, underscoring the need to prioritize infection prevention activities; 3. Implementing SSI surveillance within infection prevention and control (IPC) programs to enact structural changes, develop procedural skills, and alter healthcare worker behaviors; 4. Prioritizing IPC training for healthcare workers in LMICs to conduct broad-based surveillance and to develop and implement locally applicable IPC programs; and 5. Developing a highly accurate and objective international system for defining SSIs, which can be translated globally in a straightforward manner. Finally, we present a clear, unambiguous framework for successful SSI guideline implementation that supports developing sustainable IPC programs in LMICs. This entails 1. Identifying index operations for targeted surveillance; 2. Identifying IPC "champions" and empowering healthcare workers; 3. Using multimodal improvement measures; 4. Positioning hand hygiene programs as the basis for IPC initiatives; 5. Use of telecommunication devices for surveillance and healthcare outcome follow-ups. Additionally, special considerations for pediatric SSIs, antimicrobial resistance development, and antibiotic stewardship programs are addressed.


Assuntos
Monitoramento Epidemiológico , Infecção da Ferida Cirúrgica/prevenção & controle , Gestão de Antimicrobianos , Países em Desenvolvimento , Guias como Assunto , Higiene das Mãos , Pessoal de Saúde , Humanos , Pobreza , Infecção da Ferida Cirúrgica/epidemiologia
2.
AIDS Res Hum Retroviruses ; 19(1): 65-71, 2003 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-12596725

RESUMO

The current case study provided an unusual setting to track the evolution of HIV-1 envelope gene over a maximum period of 6 years in two asymptomatic spouses undergoing suppressive highly active antiretroviral therapy. For this purpose, proviral DNA samples taken from uncultured peripheral blood mononuclear cells and spanning the C2-V5 regions of env were analyzed at three sampling points per subject. Two distinct topological patterns were observed in the phylogenetic reconstructions of the genetically linked sequences of the couple: an intermingled pattern and a sequentially shifting pattern in the virus populations of the male index case and his spouse, respectively. Application of three evolutionary models for the amino acid-encoded sites, using the maximum likelihood approach, indicated the operation of positive selection in the region only at the second time point in the woman, before receiving therapy. These findings reinforce the evidence of a crucial role for host-selective constraints on HIV-1 env evolution in vivo.


Assuntos
Terapia Antirretroviral de Alta Atividade , Evolução Molecular , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Cônjuges , DNA Viral/análise , DNA Viral/genética , Feminino , Genes env , Infecções por HIV/virologia , Humanos , Funções Verossimilhança , Masculino , Dados de Sequência Molecular , Filogenia , Seleção Genética , Análise de Sequência de DNA , Resultado do Tratamento
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