Microbiological profile and risk factors for in-hospital mortality of infective endocarditis in tertiary care hospitals of south Vietnam.

OBJECTIVES: We aimed to evaluate the microbiological characteristics and risk factors for mortality of infective endocarditis in two tertiary hospitals in Ho Chi Minh City, south Vietnam. MATERIALS AND METHODS: A retrospective study of 189 patients (120 men, 69 women; mean age 38 ± 18 years) with the diagnosis of probable or definite infective endocarditis (IE) according to the modified Duke Criteria admitted to The Heart Institute or Tam Duc Hospital between January 2005 and December 2014. RESULTS: IE was related to a native valve in 165 patients (87.3%), and prosthetic valve in 24 (12.7%). Of the 189 patients in our series, the culture positive rate was 70.4%. The most common isolated pathogens were Streptococci (75.2%), Staphylococci (9.8%) followed by gram negative organism (4.5%). The sensitivity rate of Streptococci to ampicillin, ceftriaxone or vancomycin was 100%. The rate of methicillin resistant Staphylococcus aureus was 40%. There was a decrease in penicillin sensitivity for Streptococci over three eras: 2005-2007 (100%), 2008-2010 (94%) and 2010-2014 (84%). The in-hospital mortality rate was 6.9%. Logistic regression analysis found prosthetic valve and NYHA grade 3 or 4 heart failure and vegetation size of more than 15 mm as strong predictors of in-hospital mortality. CONCLUSION: Streptococcal species were the major pathogen of IE in the recent years with low rates of antimicrobial resistance. Prosthetic valve involvement, moderate or severe heart failure and vegetation size of more than 15 mm were independent predictors for in-hospital mortality in IE.

Investigation of Kryptonite™ bone cement in hybrid screw configurations of locking plate humeral midshaft fixation: A study of surrogate bone model.

PURPOSE: Locking compression plates (LCP) allow trauma and orthopedic surgeons to have a variety of options for utilizing locking and non-locking screw features. In this study, the hybrid constructs of mixed unicortical and bicortical screws were investigated for humerus midshaft fractures. The locking and non-locking features were also incorporated into the hybrid LCP constructs. Kryptonite™ bone cement is biocompatible with low exothermic properties and strong metal adhesion. This novel bone cement was incorporated into the non-locking screw feature to compare its mechanical effect with that of a traditional locking screw feature. METHODS: A total of 24 synthetic bones (Sawbones(®) Inc., USA) were equally divided into three groups (n = 8). The control group obtained traditional LCP fixation (JSM Medimax Inc., India) with bicortical screws, while the hybrid locking constructs employed a mix of bicortical and unicortical screws. The two bicortical screws in hybrid constructs were placed at the end holes of the LCP constructs and the unicortical screws were placed into the remaining holes. The hybrid locking (HL) group contained locking unicortical screws, whereas the hybrid non-locking group (HNK) utilized non-locking screw features incorporating the Kryptonite™ bone cement in the plate/screw bone construct. Specimens were tested by dynamic and static analysis. The eight total constructs were equally divided into two subgroups (n = 4) to conduct axial compression and torsion test individually. The low cyclic test was conducted for dynamic analysis, which included 10,000 cycles at 1 Hz frequency with a cyclic loading of 0-500 N of axial force for the axial compression test and 0-20° of angular displacement for the torsion test. The static analysis was run by a failure test with a nondestructive strain rate of 0.1 mm/s for the axial compression test and 0.5° s(-1) for the torsional test. The construct stiffness of axial compression and torsion were derived from the linear portion of the load-displacement curves. The yield strength of axial compression and torsion was determined by using offset methods. The results of stiffness and yield strength were compared by using both one-way ANOVA and Scheffe and Games-Howell post hoc tests to analyze statically significant differences among the three groups. RESULTS: Specimens completed 10,000 cycles in the dynamic analysis of axial and torsional cyclic tests without major deformation. To compare with the control group in static analysis, the HL and HNK groups achieved positive effect in axial stiffness, 12.3% and 10.5% greater than the control group respectively. HL obtained axial yield strength about 12% less than the control group. The HNK group was equivalent with the control group in axial yield strength. The torsional stiffness and yield strength were found similar in three groups, which indicated torsional equivalence among them. The stiffness and yield strength from axial compression and torsion were found statically non-significant among three groups. CONCLUSIONS: Hybrid LCP constructs were initially showed to maintain equivalent axial and torsional stability with the traditional method. Kryptonite™ hosted mechanical and biological advantages for internal plate/screws (PLT) fixation.

Efficacy of communication skills training on colorectal cancer screening by GPs: a cluster randomised controlled trial.

Colorectal cancer (CRC) mass screening has been implemented in France since 2008. Participation rates remain too low. The objective of this study was to test if the implementation of a training course focused on communication skills among general practitioners (GP) would increase the delivery of gaiac faecal occult blood test and CRC screening participation among the target population of each participating GP. A cluster randomised controlled trial was conducted with GP's practice as a cluster unit. GPs from practices in the control group were asked to continue their usual care. GPs of the intervention group received a 4-h educational training, built with previous qualitative data on CRC screening focusing on doctor-patient communication with a follow-up of 7 months for both groups. The primary outcome measure was the patients' participation rate in the target population for each GP. Seventeen GPs (16 practices) in intervention group and 28 GPs (19 practices) in control group participated. The patients' participation rate in the intervention group were 36.7% vs. 24.5% in the control group (P = 0.03). Doctor-patient communication should be developed and appear to be one of the possible targets of improvement patients adherence and participation rate in the target population for CRC mass screening.