Medicine by Alexandros G. Sfakianakis

Δευτέρα 30 Οκτωβρίου 2017

Performance of Rapid Diagnostic Testing in Patients with Suspected Malaria in Cambodia, a Low-Endemicity Country Aiming for Malaria Elimination

To the Editor—We read with interest the article by Ranadive et al [1] assessing the performance of malaria rapid diagnostic testing (RDT) vs polymerase chain reaction (PCR) in Swaziland, a low-transmission country aiming at elimination. Through a large regional data set collected from 37 health facilities over 2 years, they demonstrated the poor sensitivity of RDT (First Response Malaria Ag P. falciparum HRP-2 Detection Rapid Card Test, Premier Medical) for Plasmodium falciparum (Pf) diagnosis (51.7%), due to a high proportion of low-density infections among symptomatic subjects (54/162 [33.3%]), along with a low positive predictive value (PPV) (67.3% for all samples and 62.3% for ≥100 parasites/µL samples), due to the high proportion of false positivity (32.4%). To overcome some of the limitations of the study (eg, the decision to include only 10% of negative RDTs samples), the authors called for more inclusive analyses.

Reproductive Aging and Hepatic Fibrosis Progression in Human Immunodeficiency Virus/Hepatitis C Virus–Coinfected Women

Abstract

Background

Severity of hepatic fibrosis is greater in postmenopausal than in premenopausal women, perhaps owing to protective effects of estrogens. However, prior studies of estrogen and liver fibrosis lack serial fibrosis measures, adjustment for age, or longitudinal observations in coinfected populations.

Methods

In a longitudinal cohort of women coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), we assessed fibrosis progression across reproductive age, using validated serum fibrosis markers, aminotransferase platelet ratio index (APRI) and fibrosis 4 (FIB-4). Fibrosis rate was evaluated within each woman as she transitioned from pre- to postmenopause, defined by a biomarker of ovarian function.

Results

The median follow-up (n = 405) was 9.1 years (interquartile range, 5.0–15.2 years), with a median menopausal age of 49 years (47–52 years). When fully controlled for chronologic aging, the fibrosis progression rate was accelerated during perimenopause, as shown using FIB-4 (0.12 units per year faster than during premenopause; 95% confidence interval [CI], .02–.21; P = .01) and APRI (0.05 units per year faster; −.002 to .09; P = .06). Accelerated fibrosis was also observed during postmenopause compared with premenopause, for FIB-4 (0.14 units per year faster; 95% CI, −.01 to .29; P = .07) and APRI (0.07 units per year faster; −.003 to .15; P = .06). Accelerated fibrosis in perimenopause persisted after adjustment for Hispanic ethnicity, antiretroviral use, and alcohol (0.10 FIB-4 units per year faster than during premenopause; 95% CI, .008–.20; P = .03).

Conclusions

In HIV/HCV-coinfected women, hepatic fibrosis accelerates with reproductive aging. Accelerated fibrosis begins in perimenopause, highlighting a previously unrecognized group of women at increased risk for advanced fibrosis and associated complications. Longitudinal analyses of fibrosis rates across reproductive age should be conducted in non–HCV-related liver diseases, given potential implications in a broader spectrum of women.

Anti-infective Acquisition Costs for a Stewardship Program: Getting to the Bottom Line

Abstract

Background

Though antimicrobial stewardship programs (ASPs) are in place for patient safety, financial justification is often required. In 2016, the Infectious Diseases Society of America (IDSA) recommended that anti-infective costs be measured by patient-level administration data normalized for patient census. Few publications use this methodology. Here, we aim to compare 3 methods of drug cost analysis during 3 phases of an ASP as an example of this recommendation's implementation.

Methods

At a freestanding pediatric hospital, we retrospectively assessed anti-infective cost using pharmacy purchasing data, patient-level administration data from the electronic medical record (EMR), and patient-level administration data from the Pediatric Hospital Information Systems (PHIS) database, all normalized to patient census. Costs pre-ASP, while planning the ASP, and post-ASP were then compared for each method.

Results

Significant differences in costs between the methods were observed. Pharmacy purchasing endorsed minimal financial benefit (decrease planning to post-ASP of $590 dollars per 1000 patient-days), while the EMR and PHIS data endorsed a decrease of $12785 and $21380 per 1000 patient-days, respectively, for a total yearly cost savings of $54656 for pharmacy purchasing data, $1184336 for EMR data, and $2117522 for PHIS data.

Conclusions

Pharmacy purchasing data underestimated cost savings compared with EMR and PHIS data, while EMR and PHIS data were comparable in magnitude of savings. At Children's Hospital Colorado, savings justified the full cost of the ASP. EMR patient-level administration data, normalized to patient census, offers a readily available and standardized measure of anti-infective costs over time.

Public trust and ‘ethics review’ as a commodity: the case of Genomics England Limited and the UK’s 100,000 genomes project

Abstract

The UK Chief Medical Officer's 2016 Annual Report, Generation Genome, focused on a vision to fully integrate genomics into all aspects of the UK's National Health Service (NHS). This process of integration, which has now already begun, raises a wide range of social and ethical concerns, many of which were discussed in the final Chapter of the report. This paper explores how the UK's 100,000 Genomes Project (100 kGP)—the catalyst for Generation Genome, and for bringing genomics into the NHS—is negotiating these ethical concerns. The UK's 100 kGP, promoted and delivered by Genomics England Limited (GEL), is an innovative venture aiming to sequence 100,000 genomes from NHS patients who have a rare disease, cancer, or an infectious disease. GEL has emphasised the importance of ethical governance and decision-making. However, some sociological critique argues that biomedical/technological organisations presenting themselves as 'ethical' entities do not necessarily reflect a space within which moral thinking occurs. Rather, the 'ethical work' conducted (and displayed) by organisations is more strategic, relating to the politics of the organisation and the need to build public confidence. We set out to explore whether GEL's ethical framework was reflective of this critique, and what this tells us more broadly about how genomics is being integrated into the NHS in response to the ethical and social concerns raised in Generation Genome. We do this by drawing on a series of 20 interviews with individuals associated with or working at GEL.

A novel technique for clinical examination of buried head and neck free flaps

Abstract

Monitoring buried flaps within the head and neck presents a unique challenge to the microsurgeon. We conducted an independent review of the literature using Medline, PubMed and Q Read performed up to February 2017. This showed that head and neck free flaps have contemporary success rates of between 92 and 98%, which is similar to rates reported for all types of flaps (90–98%). Studies looking specifically at buried free flaps were scarce, with success rates (90–98%) precisely mirroring those of studies looking at all flaps. In studies in which both buried and non-buried flaps were stratified, buried flaps did have lower rates of success (93.5 vs. 98.2% and 93 vs. 98%). While overall success rates may have been similar, lower rates of salvage were clearly shown for buried flaps. Salvage rates ranged from 0 to 75%. The highest rate was achieved using implantable Doppler, which has been shown to increase salvage rates by up to 21%. However, this technique is associated with significant rates of false positives, which have been shown to be between 8 and 40.4% Another monitoring technique in use for buried flaps was externalised monitoring segments, which has been associated with higher rates of pharyngeal fistula in head and neck reconstruction. In this article, we present a variation of the Acland's empty-and-refill test which may be used to monitor buried flaps that have a venous anastomosis in an end-to-end fashion to the external jugular vein.

Level of Evidence: Level IV, diagnostic study.

42 Annual Congress of AOMSI Nagpur 16–18 Nov 2017

Panorama Dermatologische Praxis

Antibiotic stewardship: a European perspective

Abstract

Antibiotic stewardship programmes, which are a set of interventions aiming at prescribing antibiotics appropriately and responsibly, are one of the key strategies to tackle the current worldwide bacterial resistance crisis. We will present here some examples of international and national initiatives, with a focus on Europe, discuss the role of clinical microbiologists, and present some perspectives and future developments.Antibiotic stewardship (ABS) is one of the key strategies to tackle the current worldwide bacterial resistance crisis (http://ift.tt/2u2bzuV). It refers to a set of interventions aiming at prescribing antibiotics appropriately and responsibly, even though its precise definition is still a topic of debate (Dyar 2017a, Mendelson 2017).This Commentary will focus on antibiotic stewardship in human medicine, but we acknowledge the importance of a One Health approach, including veterinary medicine, agriculture and the environment.

Synechococcus plasticity under environmental changes

Abstract

Cyanobacteria are among the oldest photoautotrophic organisms on Earth, and have contributed to shaping the planet's biogeochemistry with their significant biomass and key metabolic activities. Synechococcus, the focus of this review, is one of the prevalent genera in the order Chroococcales, common in oceans and lakes and characterized by a coccoid unicellular or microcolony morphology. The evolution of its phycobilisomes is the key of the adaptation of this tiny photosynthetic cell to different light regimes and environmental conditions. Furthermore, Synechococcus strains are widely distributed from the equator to the poles, showing an extreme adaptability to high and low temperatures. Because of their structural plasticity and ecological adaptability, these cyanobacteria are particularly interesting in the current condition of fast climate change. Moreover, picocyanobacteria of the Synechococcus genus have a potentially vast impact on global cycles thanks to their significant role in the biogeochemical cycles of aquatic ecosystems. As increasing abundances are predicted for this genus worldwide, and in light of the connection between cyanobacteria and global change events, a better characterization of these organisms promises important and timely ecological insights. Here, I will summarize the morphological and genetic characteristics of Synechococcus strains and their distribution in freshwater lakes, also considering its marine counterpart.

Medicine by Alexandros G. Sfakianakis

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Δευτέρα 30 Οκτωβρίου 2017

Performance of Rapid Diagnostic Testing in Patients with Suspected Malaria in Cambodia, a Low-Endemicity Country Aiming for Malaria Elimination

Reproductive Aging and Hepatic Fibrosis Progression in Human Immunodeficiency Virus/Hepatitis C Virus–Coinfected Women

Anti-infective Acquisition Costs for a Stewardship Program: Getting to the Bottom Line

Public trust and ‘ethics review’ as a commodity: the case of Genomics England Limited and the UK’s 100,000 genomes project

Abstract

A novel technique for clinical examination of buried head and neck free flaps

Abstract

42 Annual Congress of AOMSI Nagpur 16–18 Nov 2017

Panorama Dermatologische Praxis

Antibiotic stewardship: a European perspective

Synechococcus plasticity under environmental changes

Book Review

Enfermedad de Darier lineal en 5 pacientes

Linfedema en ambos pies secundario a migración de silicona líquida

Utilidad de los métodos de imagen en el diagnóstico de las dermatosis

Reacciones cutáneas a fármacos en el paciente con leucemia/linfoma

Tratamiento del dolor en úlceras venosas crónicas

Rash familiar

Dermatología en la sala de urgencia. Diagnóstico y comentario

Rash familiar. Diagnóstico y comentario

Lesión nodular frontal de rápido crecimiento. Diagnóstico y comentario

Láser excimer 308nm en dermatología

Multifunctional Two-Dimensional Bi<sub>2</sub>Se<sub>3</sub> Nanodiscs for Anti-Inflammatory Therapy of Inflammatory Bowel Diseases