Surveillance on meticillin-sensitive Staphylococcus aureus colonization and infection in a neonatal intensive care unit.

BACKGROUND: Meticillin-sensitive Staphylococcus aureus (MSSA) infection is a significant health concern in neonatal intensive care units (NICUs). Bacterial colonization increases the risk of subsequent infection, leading to morbidity and mortality. AIM: To report the findings of a retrospective cohort study on the surveillance of MSSA colonization and infection in NICU patients. METHODS: The weekly microbial surveillance results for MSSA colonization in the throat, nose, anus, and groin, as well as invasive and non-invasive MSSA infections, were analysed from November 2020 to June 2022. The MSSA infection and colonization risk were compared after adjustment for confounders by stepwise logistic regression analysis. FINDINGS: Three hundred and eighty-three neonates were screened; 42.8% (N=164) were MSSA colonized. Significant risk factors for MSSA colonization were length of stay, vaginal delivery and extreme low gestational age <28 weeks (ELGAN) (all P<0.05). The surveillance detected 38 (9.9%) mild MSSA infections and 11 (2.9%) invasive MSSA infections. Neonatal colonization with MSSA is a major risk factor for MSSA infection overall (29.3% in colonized/infected vs 70.7% colonized/not-infected and 0.5% in not-colonized/infected vs 99.5% in not-colonized/not-infected infants) and invasive MSSA infections (6.1% in colonized/infected vs 93.9% in colonized/not-infected and 0.5% in non-colonized/infected vs 99.5% not-colonized/not-infected infants). Also, extreme low birth weight (<1000 g), ELGAN and invasive ventilation were significant risk factors for MSSA infections (all, P<0.05). CONCLUSIONS: The link between postnatal MSSA colonization and subsequent MSSA infection offers possibilities for prevention. Additional research is needed to explore the association between vaginal birth and the pathogenesis of neonatal MSSA colonization.

Compliance with international prevention guidelines for central-line-associated bloodstream infections in neonatal intensive care units in Belgium: a national survey.

BACKGROUND: Central-line-associated bloodstream infections (CLABSIs) are a preventable cause of morbidity among patients in neonatal intensive care units (NICUs). AIMS: To assess compliance with international guidelines for prevention of CLABSIs in Belgian NICUs, and to study unit characteristics contributing to CLABSIs. METHODS: A survey was undertaken to measure the adherence of various NICUs to the CLABSI prevention guidelines related to catheter insertion, catheter maintenance and quality control measurements. A Poisson regression model was used to estimate the CLABSI adjusted relative risk for each prevention guideline item implemented. Multi-variable linear regression was used to estimate associations between guideline compliance rate and facility characteristics and the incidence of CLABSIs for 2015-2016. FINDINGS: In Belgium, the overall CLABSI incidence density was 8.48/1000 central-line-days, and was higher in larger NICUs: 10.87‰ vs 6.69‰ (P<0.05). Adherence was highest for prevention items at catheter insertion (64%), and low for catheter maintenance and quality control items (47% and 50%, respectively). Superior adherence to insertion items (P=0.051) and quality performance items (P=0.004) was associated with decreased risk of CLABSIs, but this was not found for maintenance prevention items (P=0.279). After adjustment for guideline adherence, the size of the NICU was found to be an independent determinant for CLABSIs (P=0.002). CONCLUSIONS: In Belgium, the adherence of NICUs to international CLABSI prevention guidelines is moderate to poor. Compliance of NICUs with the guidelines is significantly associated with decreased CLABSI rates. The reasons for the gap between current practice in Belgian NICUs and international prevention guidelines need further investigation.

Cladocera of the Lençóis Maranhenses (NE - Brazil): faunal composition and a reappraisal of Sars' Method.

We studied the Cladocera of a group of ephemeral interdunal pools in the Lençóis Maranhenses, Maranhão State (NE - Brazil) and recorded 34 species. The fauna was overwhelmingly neotropical, with no evidence of invasive species. Species composition differed in Lagoa da Colher, an acid system. We provide notes on behaviour, morphology and taxonomy of some lesser-known anomopods, with emphasis on the Chydoridae. We figure male Oxyurella longicaudis, Chydorus eurynotus, Disparalona leptorhyncha, Alonella dadayi and A. clathratula. We provide notes on the "Sars' Method", hatching of freshwater crustaceans from dry mud, a simple technique that complements the information of hit-and-run surveys. About half of the total species number (44%) was revived through this method; 18% of species were additional to field-collected samples. The Sars' method also yielded abundant specimens of rare species, useful for identification and studies on behaviour.

Cladocera of the Lençóis Maranhenses (NE - Brazil): faunal composition and a reappraisal of Sars' Method

We studied the Cladocera of a group of ephemeral interdunal pools in the Lençóis Maranhenses, Maranhão State (NE - Brazil) and recorded 34 species. The fauna was overwhelmingly neotropical, with no evidence of invasive species. Species composition differed in Lagoa da Colher, an acid system. We provide notes on behaviour, morphology and taxonomy of some lesser-known anomopods, with emphasis on the Chydoridae. We figure male Oxyurella longicaudis, Chydorus eurynotus, Disparalona leptorhyncha, Alonella dadayi and A. clathratula. We provide notes on the "Sars' Method", hatching of freshwater crustaceans from dry mud, a simple technique that complements the information of hit-and-run surveys. About half of the total species number (44%) was revived through this method; 18% of species were additional to field-collected samples. The Sars' method also yielded abundant specimens of rare species, useful for identification and studies on behaviour.

Os cladóceros de um grupo de lagoas temporárias dulcícolas interdunares nos Lençóis Maranhenses, Maranhão (NE - Brasil) foram estudados e registraram-se 34 espécies. A fauna foi tipicamente neotropical, sem evidências de espécies invasoras. A composição de espécies foi diferenciada na Lagoa da Colher, que constitui um sistema ácido. Informações sobre comportamento, morfologia e taxonomia de alguns anomópodes menos conhecidos são fornecidas, com ênfase nos membros da família Chydoridae. Os machos das espécies Oxyurella longicaudis, Chydorus eurynotus, Disparalona leptorhyncha, Alonella dadayi e A. clathratula foram registrados com desenhos. Foram dadas informações sobre o "método de Sars", o qual consiste na eclosão de microcrustáceos de água doce a partir de ovos de dormência presentes no sedimento seco, uma técnica simples, que complementa as informações de coletas realizadas em limitados intervalos de tempo e espaço. Aproximadamente metade das espécies encontradas (44%) também estava presente nas culturas; 18% das espécies foram registradas apenas nas culturas e complementaram as amostras obtidas no campo. Com o "método de Sars", também se registraram abundantes espécimes de espécies raras, o que se mostra útil para a identificação e estudos sobre comportamento.

Detection algorithm for single motor unit firing in surface EMG of the trapezius muscle.

BACKGROUND: Work-related musculoskeletal disorders (MSD) of the neck and the shoulders are a growing problem in society. An interesting pattern of spontaneous muscle activity, the firing of a single motor unit, in the trapezius muscle is observed during a laboratory study in a rest state or a state with a mental load. OBJECTIVE: In this study, we report on the finding of the single motor unit firing and we present a detection algorithm to localize these single motor unit firings. METHODS: A spike train detection algorithm, using a nonlinear energy operator and correlation, is presented to detect burst of highly correlated, high energetic spike-like segments. RESULTS: This single motor unit was visible in 65% of the test subjects on one or both trapezius muscles although there was no change in posture of the test subjects. All the segments in the data that were determined as single motor unit firings were detected by the algorithm. DISCUSSION: The physiological meaning of this firing pattern is a very low and subconscious contraction of the muscle. A long-term contraction could lead to the exhaustion of the muscle fibers, thus resulting in musculoskeletal disorders. The detection algorithm is able to localize this phenomenon in a sEMG measurement. The ability of detecting these firings is helpful in the research of its origin. CONCLUSION: The detection algorithm can be used to gain insight in the physiological origin of this phenomenon. In addition, the algorithm can also be used in a biofeedback system to warn the user for this undesired contraction to prevent MSD.

Ethical aspects of human placental perfusion: interview of the mothers donating placenta.

Within the EU project "NewGeneris" human placental perfusion has been used for assessing in utero fetal exposure to food carcinogens. Within the work package of ethical aspects of the research, we were interested in the way mothers who donated placentas for perfusion perceived their participation in the study. Thematic interviews were conducted with 25 mothers who had donated the placenta for placental perfusion studies. The main themes covered during the interviews were recruitment for placental perfusion studies, informed consent, risks and benefits, handling and confidentiality of personal information and societal meaning of the placental perfusion studies. Data were analysed qualitatively using thematic content analysis. Mothers, when rightly informed about the purpose of the placental perfusion study were very interested in the study and supported the use of the placenta for such purpose. Overall, this study revealed several points of particular interest in placental perfusion studies. First, the recruiters' involvement with and commitment to the research project and its ethical conduct were of utmost importance for handling the informed consent procedure correctly. Second, the timing of the recruitment was important since it considerably affected the understanding of the given information, women in labour being obviously less receptive to such information. Third, the trust of participants depended on the multidisciplinary collaboration between the researchers and hospital personnel and this trust was enhanced by a thorough, objective and fair informed consent procedure.

Testicular dysfunction is responsible for low sperm quality in Belgian Blue bulls.

In a previous study, we demonstrated that Belgian Blue (BB) bulls have a higher prevalence of small scrota and poorer semen morphology compared to the Holstein Friesian (HF) breed in Belgium. The present study tested the hypothesis that the underlying reason for these BB traits negative to fertility was testicular degeneration, associated with an eventual hypoplastic background. At culling, sperm quality and testicular histology of BB bulls were assessed and compared to that of HF bulls. Besides semen quality being generally poorer in the BB breed, significantly more degenerative changes were encountered in BB compared to HF testicles (degeneration index: 37.7+/-11.9 versus 29.3+/-9.9 for BB and HF bulls, respectively; P=0.053). These results correlated to the percentage of normal spermatozoa (r=-0.44; P=0.024) and primary abnormalities (r=0.38; P=0.053). Moreover, the relative amount of collagen fibers present in the testicular interstitial connective tissue was correlated with % normal sperm (r=-0.47; P=0.017), primary defects (0.48; P=0.014), and the degeneration results (r=0.63; P<0.001). The % testicular interstitial collagen fibers differed significantly between breeds (10.6+/-4.0% for the BB versus 7.6+/-1.9% for the HF bulls; P=0.016). This increased amount of connective tissue in BB testes might hypothetically be responsible for the poorer sperm quality. This condition can be defined as a mild form of testicular hypoplasia, and might, in turn, be responsible for the higher sensitivity to testicular degeneration, which is encountered in the BB breed.

Relation between telomerase activity, hTERT and telomere length for intracranial tumours.

Human linear chromosomes are capped by specialized DNA-protein structures called telomeres. The present study analysed the telomerase activity, hTERT protein and telomere length in meningiomas and gliomas in relation to their WHO grading. Fifty-three freshly dissected tumour biopsies were analysed for telomerase activity, hTERT protein expression and telomere length. Telomerase activity was examined in 41 of the 53 biopsies. Telomerase activity was detected in 3 of 35 (8.6%) screened meningiomas (1 benign, 1 atypical and 1 malignant meningioma). For hTERT expression, 56.4% of meningiomas were positive with a mean labelling index (hTERT LI) of 31.3% (SD=26.5) for the hTERT positive meningiomas. The mean telomere length for meningiomas was 6.983 kb (SD=1.969). For gliomas, no active telomerase was detected in 2 low-grade astrocytomas, whereas three of the four screened glioblastomas were positive for telomerase activity. The only hTERT protein positive astrocytoma had a mean labelling index of 9.0%. On the other hand, the hTERT LI for glioblastomas was 53.6% (SD=28.0). The two low-grade astrocytomas had a telomere length of 14.310 and 9.236 kb. The anaplastic astrocytoma had a telomere length of 4.903 kb and the glioblastomas 5.767 kb (SD=2.042). The normal meningeal and neuronal tissue is negative for telomerase activity and hTERT. The length was +/-10.000 kb. These results indicate that telomere shortening may be a critical step in pathogenesis of atypical and malignant meningiomas and gliomas. Critical telomere shortening in vitro was shown to activate telomerase.

Temporal trends in sexually transmitted infection prevalence and condom use following introduction of the female condom to Madagascar sex workers.

We followed 1000 sex workers in Madagascar for 18 months to assess whether adding female condoms to male condom distribution led to increased protection levels and decreased sexually transmitted infections (STIs). For months 1-6, participants had access to male condoms only; in the final 12 months, they had access to male and female condoms. We interviewed participants about condom use every two months and tested for chlamydia, gonorrhoea and trichomoniasis every six months. Following six months of male condom distribution, participants used protection in 78% of sex acts with clients. Following female condom introduction, protection at months 12 and 18 rose to 83% and 88%, respectively. Aggregate STI prevalence declined from 52% at baseline to 50% at month 6. With the female condom added, STI prevalence dropped to 41% and 40% at months 12 and 18, respectively. We conclude female condom introduction is associated with increased use of protection to levels that reduce STI risk.

Acceptability and feasibility of continuous diaphragm use among sex workers in Madagascar.

OBJECTIVES: The diaphragm, a woman controlled, reusable contraceptive device, might prevent some sexually transmitted infections (STIs). We assessed the acceptability and feasibility of use of silicone Wide-Seal Arcing Diaphragms (Milex Products, Chicago, IL, USA) by sex workers in Madagascar. METHODS: Over 8 weeks, we evaluated method acceptability by examining patterns of and problems with women's diaphragm use. We also evaluated several measures of study feasibility, including recruitment and follow up methods. RESULTS: 91 women from three cities (Antananarivo, Tamatave, and Mahajanga) participated, and 87 (96%) completed follow up. At enrolment, participants reported a median of six sex acts with five clients in the previous week. During the follow up period, participants reported a median of three sex acts with three clients during the previous 2 days, and self reported continuous diaphragm use during the previous day increased from 87% to 93%. Seven women became pregnant (incidence 53 pregnancies per 100 woman years). Self reported use of male condoms and diaphragms was fairly constant over the study period: women reported condom use in 61% to 70% of acts and diaphragms in 95% to 97% of acts. The number of participants reporting diaphragm problems decreased from 15 (16%) at the first visit to six (7%) at the final visit. 20 women (22%) needed replacement devices during follow up because their original diaphragms were lost, were the wrong size, or became seriously damaged. CONCLUSIONS: Given the high use and steady decrease in reported problems during the study, we believe diaphragms are acceptable and feasible in this resource poor, low education sex worker population.

The importance of the health education in life quality improvement in patients with psoriasis.

PURPOSE: The aim of the study was to determine the influence of the psoriatic patient knowledge of the disease on the quality of life. MATERIAL AND METHODS: The study was carried out in 149 patients with psoriasis. All patients answered on anonymous questionnaire, in according to Psoriasis Disability Index (PDI). RESULTS: Almost 43% patients could not show any factor which provoked their disease, 31.5% could not tell any recommendations for cure and care of the psoriatic lesions and 32.2% patients could not point out any methods to avoid psoriatic lesions spread. Almost 60% of the group admitted that their quality of life fell because of the disease. At the same time, patients who did not have enough information concerning the disease had lower quality of life index. CONCLUSIONS: The level of the disease knowledge in the patients with psoriasis influences their quality of live. Therefore it is indicated for the patiens and their families to be involved in the proper educational program.

Results of a randomised trial of male condom promotion among Madagascar sex workers.

OBJECTIVES: To test the effect of supplementing peer promotion of male condom use with clinic based counselling, measured in terms of STI prevalence and reported male condom use. METHODS: 1000 female sex workers in Madagascar were randomised to two study arms: peer education supplemented by individual risk reduction counselling by a clinician (peer + clinic) versus condom promotion by peer educators only (peer only). STI testing was conducted at baseline and 6 months. Behavioural interviews were administered at baseline, 2, 4, and 6 months. RESULTS: At baseline, women in the peer only arm had prevalences of 16.0%, 23.6%, and 12.1% for chlamydia, gonorrhoea, and trichomoniasis respectively, with an aggregate prevalence of 38.2%. Baseline STI prevalences for the peer + clinic arm were slightly lower and 34.1% in aggregate. At 6 months, aggregate STI prevalence increased in the peer only arm to 41.4%, whereas the aggregate prevalence diminished slightly to 32.1% in the peer + clinic arm. In logistic regression analyses, the estimated odds ratios (ORs) for chlamydia, gonorrhoea, trichomoniasis, and aggregate STI were 0.7 (95% confidence interval 0.4 to 1.0), 0.7 (0.5 to 1.0), 0.8 (0.6 to 1.2), and 0.7 (0.5 to 0.9) respectively, comparing the peer + clinic arm with the peer only arm. The logistic regression OR for reported condom use with clients in the past 30 days increased from 1.1 at 2 months to 1.8 at 6 months, comparing the peer + clinic arm with the peer only arm, and was 1.4 overall (1.1 to 1.8). Adjustment for baseline factors changed the regression results little. CONCLUSIONS: The impact of male condom promotion on behaviour can be heightened through more concentrated counselling on risk reduction. Persistently high STI prevalence despite increases in reported condom use by sex workers supports the need for multidimensional control programmes.

[Ethical considerations on the planning, assessment and management of biological monitoring data]. / Aspetti etici sull'impostazione, valutazione e gestione dei test di monitoraggio biologico.

If a society aims at preserving its socio-ethical values, practices concerning the planning, assessment and management of biomonitoring tests in occupational health surveillance and research should not conflict with these values. Protecting both health and employment of every candidate or employee must be the aim of the occupational health physician. For assessing ethical acceptability of occupational health surveillance practices, their accuracy, relevance, need or necessity, and consequences must first be analysed. This analysis must constitute the basis for any societal democratic decision making process, which cannot be substituted for simply by individual informed consent. A physician trained in occupational health is the professionalism required for doing the testing and assuring the protection of the confidentiality of medical data, in accordance with strict legal and deontological rules. In biological monitoring studies and, in general, in any occupational health research settings, however, the principle of individual, really informed consent must be used, whenever possible. This may also considerably contribute to the committment of study subjects to the research goals. On the other hand, this committment would also contribute to promoting impartial research which is needed to improve the knowledge in occupational health and to increase health protection and prevention.

Current scientific, ethical and social issues of biomonitoring in the European Union.

Occupational health regulations and practices in EU Member States have been directed, to a large extent, by the principle of social protection, aiming to protect both the health and the employment of every (candidate) worker. Medical and biomonitoring practices have played a major role in identifying health problems at work and also in establishing preventive measures. Lately, a new tendency is occurring that reduces health protection to compliance with a limited set of standards for workplaces and individuals. According to this approach, 'predictive' medical tests might be used for the selection of the fittest workers. At a time when the labor market is evolving towards less stable forms of work, such a 'standardization approach' may lead to an unequal occupational health policy: the better off being more protected, the more exposed being less protected and the more susceptible being excluded. Instead, biomonitoring tools should only be developed as part of medical surveillance and used for those who need it most.

In vitro susceptibility of Enterococcus faecium isolated from food to growth-promoting and therapeutic antibiotics.

A total of 76 E. faecium strains, isolated at retail level from raw poultry meat, cheese, raw pork, and preparations of cheese and raw pork, were tested for their susceptibility and resistance to growth-promoting antibacterials used in animals and antibiotics used therapeutically in humans. All strains were uniformly susceptible to the growth promoters bambermycin and avilamycin. Resistance against bacitracin, virginiamycin and narasin was high among strains from poultry meat. With tylosin, a macrolide antibiotic used therapeutically and for growth promotion, resistance was mainly detected in strains originating from poultry meat, though also in some strains from pork and from pork and cheese preparations. The therapeutic antibiotic dalfopristin/quinupristin did not show full cross-resistance with the growth-promoting antibiotic virginiamycin. With dalfopristin/quinupristin two different levels of resistance were found. Only one E. faecium strain isolated from poultry was resistant to the glycopeptides avoparcin and vancomycin. Only one poultry meat strain was highly resistant to ampicillin. However, nearly all poultry meat strains showed decreased sensitivity. Only 3 out of 24 poultry strains were susceptible to minocycline, while all strains from other origins were susceptible to this tetracycline antibiotic. High-level streptomycin resistance was seen in strains of all origins, though infrequently. High-level gentamicin resistance was not found.

Individual susceptibility and prevention of occupational diseases: scientific and ethical issues.

Genetic testing of employees is controversial; objections have been raised with regard to privacy, right to work, and the relevance of the tests. A study is being conducted on "the ethical, social, and scientific problems related to the application of genetic screening and genetic monitoring for employees in the context of a European approach to health and safety at work." A conceptual model is proposed of the complex interactions between exposure, acquired and inherited susceptibility, and risk for disease. The validity of tests for determining genotype and phenotype and their relevance for disease must be evaluated critically to provide an objective basis for ethical discussions. The acceptability of such tests is related to a number of issues, which are identified and discussed.

The use of midazolam and diazepam for sedation following aorto-coronary bypass surgery.

The new water-soluble benzodiazepine midazolam was compared in a randomized study to diazepam for postoperative sedation in fifty patients following aortocoronary bypass surgery with a sufentanil-anesthesia. Midazolam and diazepam were administered intravenously in repeated doses in conjunction with an opioid infusion (piritramide) from the end of surgery during a twelve-hour study period, patients being artificially ventilated. Midazolam scored better than diazepam for quality of sedation and cardiovascular stability during the period of mechanical ventilation and for respiration during the weaning period and after extubation, although no difference was found in weaning time from artificial ventilation and time of extubation. Hemodynamic tolerance for both drugs was good. The administration of a loading dose of midazolam 5 mg caused a slight, transient decrease in mean arterial pressure. Midazolam appeared to be a more effective sedative agent than diazepam for short-term administration during mechanical ventilation. No evidence of cumulation and prolonged recovery was seen.