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Brunet Garcia L, Hajra A, Field E, Wacher J, Walsh H, Norrish G, Manzur A, Muntoni F, Munot P, Robb S, Quinlivan R, Scoto M, Baranello G, Sarkozy A, Starling L, Kaski JP, Cervi E. Cardiac Manifestations of Myotonic Dystrophy in a Pediatric Cohort. Front Pediatr 2022; 10:910660. [PMID: 35757141 PMCID: PMC9218560 DOI: 10.3389/fped.2022.910660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Myotonic dystrophy type 1 (DM1) is the most prevalent inherited neuromuscular dystrophy in adults. It is a multisystem disease with cardiac manifestations. Whilst these are well-defined in adults, there are scarce published data in the pediatric population. This study aimed to investigate the yield and progression of cardiac disease in pediatric DM1 patients, focusing on congenital DM1 (cDM1). METHODS A retrospective observational study of all pediatric DM1 patients referred to our center (December 2000-November 2020) was conducted. Patients were classified into DM1 forms according to age of symptom onset and disease severity. Patients underwent clinical and cardiac evaluation with 12-lead ECG, transthoracic echocardiography and 24-h ECG Holter monitoring. RESULTS 67 DM1 pediatric patients were included: 56 (83.6%) cDM1 and 11 (16.4%) non-cDM1. Median follow-up time of cDM1 patients was 8.0 [3.25-11.0] years. 49 (87.5%) cDM1 patients had baseline 12-lead ECG and 44 (78.6%) had a follow-up 12-lead-ECG, with a median follow-up time from diagnosis to baseline ECG of 2.8 [1.0-8.5] years and to follow-up ECG of 10.9 [5.7-14.2] years. Overall, 43 (87.8%) presented ECG abnormalities, most commonly in the form of asymptomatic conduction disease (n = 23, 46.9%), of which 21 (42.9%) had first degree atrioventricular block (1st AVB). There was an increase of prevalence from baseline to follow-up ECG in low QRS voltage (16.7%), poor R wave progression (13.9%), abnormal repolarisation (11.9%) and 1st AVB (7.6%). one patient (1.8%) underwent pacemaker implantation for syncope in the context of progressive conduction disease. No patients developed left ventricular systolic dysfunction. 4 (7.1%) cDM1 patients died during follow up, including three who died suddenly with no clear cause of death. CONCLUSIONS This study is the first to analyse the prevalence and progression of ECG abnormalities in cDM1 pediatric patients. The high prevalence of abnormal findings, progressive changes and number of potentially associated events (1 pacemaker implantation and 3 unexplained sudden deaths) stresses the importance of systematic and continued cardiac evaluation of these patients.
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Affiliation(s)
- Laia Brunet Garcia
- Hospital de Mataró, Barcelona, Spain.,Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Ankita Hajra
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Ella Field
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Joseph Wacher
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Helen Walsh
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Gabrielle Norrish
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Adnan Manzur
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Francesco Muntoni
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Pinki Munot
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Stephanie Robb
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | | | | | | | - Anna Sarkozy
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Luke Starling
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Juan Pablo Kaski
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Elena Cervi
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
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Zarpellon MN, Gales AC, Sasaki AL, Selhorst GJ, Menegucci TC, Cardoso CL, Garcia LB, Tognim MCB. Survival of vancomycin-intermediate Staphylococcus aureus on hospital surfaces. J Hosp Infect 2015; 90:347-50. [PMID: 25986166 DOI: 10.1016/j.jhin.2015.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/06/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Contaminated surfaces play an important role in the transmission of certain pathogens that are responsible for healthcare-associated infections. Although previous studies have shown that meticillin-resistant Staphylococcus aureus (MRSA) can survive on dry surfaces at room temperature, no published data regarding vancomycin-intermediate S. aureus (VISA) are available to date. AIM To compare the survival time on different types of surfaces, cell-surface hydrophobicity, adherence to abiotic surfaces and biofilm formation of meticillin-susceptible S. aureus (MSSA), MRSA and VISA. METHODS Survival of the S. aureus strains was tested on latex, cotton fabric, vinyl flooring and formica. Cell-surface hydrophobicity was determined using the hydrocarbon interaction affinity method. Adhesion to abiotic surfaces was tested on granite, latex (gloves), glass, vinyl flooring and formica. Biofilm formation was evaluated at 6, 12, 24 and 48 h. FINDINGS All of the samples survived on the vinyl flooring and formica for at least 40 days. VISA survived on both surfaces for more than 45 days. All of the strains were highly hydrophobic. VISA adhered to latex, vinyl flooring and formica. Biofilm formation increased for all of the tested strains within 6-24 h. CONCLUSION VISA present high survival, adherence and cell-surface hydrophobicity. Therefore, as the treatment of patients with VISA is a significant challenge for clinicians, greater care with cleaning and disinfection of different types of surfaces in healthcare facilities is recommended because these may become important reservoirs of multi-resistant pathogens.
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Affiliation(s)
- M N Zarpellon
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, PR, Brazil; Hospital Universitário de Maringá, Universidade Estadual de Maringá, PR, Brazil
| | - A C Gales
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - A L Sasaki
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, PR, Brazil
| | - G J Selhorst
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, PR, Brazil
| | - T C Menegucci
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, PR, Brazil
| | - C L Cardoso
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, PR, Brazil
| | - L B Garcia
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, PR, Brazil
| | - M C B Tognim
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, PR, Brazil.
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Garcia LB, Fonseca ME, Benchetrit LC. Effect of Penicillin on Surface Carbohydrate, Hemolysin and Morphology ofStreptococcus pyogenesDuring and After the Post-Antibiotic Phase. J Chemother 2013; 16:238-43. [PMID: 15330318 DOI: 10.1179/joc.2004.16.3.238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The post-antibiotic effect (PAE) of penicillin was measured in vitro against a group A streptococcal strain by the kinetic growth method. The duration of the effect was 2.8 h. The bacterial morphology and some streptococcal products were analyzed during and after the PAE, after being exposed to penicillin in a concentration of 1xMIC for 2 h. Bacteria not previously exposed to penicillin were used as a control culture. Morphological changes and increases in the size of treated streptococci were observed by electronic microscope during the post-antibiotic phase. The post-penicillin effect on the production of cell-bound hemolysin and free hemolysin was examined using sheep red blood cells. Production of cell-bound hemolysin rose sharply, but was inhibited by the antimicrobial agent. The free lysin diminished significantly, and concomitantly with a higher production of free toxin by the treated cells. No effect was observed on the specific carbohydrate group when the antigen was tested with streptococcal group A antiserum.
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Affiliation(s)
- L B Garcia
- Department of Clinical Analyses, Universidade Estadual de Maringá, Maringá, PR, Brazil.
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Guelfi KC, Tognim MCB, Cardoso CL, Gales AC, Carrara-Marrone FE, Garcia LB. In vitro evaluation of the antimicrobial activity of meropenem in combination with polymyxin B and gatifloxacin against Pseudomonas aeruginosa and Acinetobacter baumannii. J Chemother 2008; 20:180-5. [PMID: 18467243 DOI: 10.1179/joc.2008.20.2.180] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The antimicrobial activity of meropenem combined with either polymyxin B or gatifloxacin was evaluated by the checkerboard method against Pseudomonas aeruginosa (10 strains) and Acinetobacter baumannii (10 strains). In addition, the triple combination of polymyxin B, gatifloxacin, and meropenem was also studied as well as the polymyxin B and gatifloxacin combination. A partial synergism interaction between meropenem and polymyxin B was observed for 80% of the A. baumannii strains. In contrast, this combination showed an indifferent effect for 80% of the P. aeruginosa strains tested. The combination of meropenem and gatifloxacin showed synergism only for two strains of A. baumannii, and partial synergism and additive effect for seven strains and indifference for four strains of both species. For the strains of P. aeruginosa, the double combination of polymyxin B and gatifloxacin and the triple combination of meropenem, polymyxin B and gatifloxacin were indifferent for the majority of the strains tested, that is, 90 and 80% respectively.
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Affiliation(s)
- K C Guelfi
- Department of Clinical Analyses, Universidade Estadual de Maringá, Maringá, PR, Brazil
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Guilhermetti M, Hernandes SE, Fukushigue Y, Garcia LB, Cardoso CL. Effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from contaminated hands. Infect Control Hosp Epidemiol 2001; 22:105-8. [PMID: 11232870 DOI: 10.1086/501872] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The effectiveness of hand-cleansing agents in removing a hospital strain of methicillin-resistant Staphylococcus aureus from artificially contaminated hands of five volunteers was studied. DESIGN The products used were plain liquid soap, ethyl alcohol 70% (by weight), 10% povidone-iodine liquid soap (PVP-I), and chlorhexidine gluconate (4%) detergent. The experiments were performed using a Latin square statistical design, with two 5x4 randomized blocks. The removal rates of S aureus cells from contaminated fingertips were estimated by analysis of variance, the response variable being the log10 reduction factor (RF), ie, log10 of the initial counts minus log10 of the final counts. In the first and second blocks, the fingertips of the volunteers were contaminated in mean with 3.76 log10 colony-forming units ([CFU] light-contamination hand) and 6.82 log10 CFU (heavy-contamination hand), respectively. RESULTS In the first block, there were significant differences between treatments (P<.05). The 10% PVP-I (RF, 3.76) and 70% ethyl alcohol (RF, 3.51) had significantly higher removal rates than plain liquid soap (RF, 1.96) and 4% chlorhexidine (RF, 1.91). In the second block, 10% PVP-I (RF, 4.39) and 70% ethyl alcohol (RF, 3.27) also were significantly more effective than plain liquid soap (RF, 1.77) and 4% chlorhexidine (RF, 1.37; P<.05). Plain liquid soap was significantly more effective than chlorhexidine (4%) detergent. CONCLUSIONS The results suggest that 10% PVP-I and 70% ethyl alcohol may be the most effective hand-cleansing agents for removing methicillin-resistant S aureus strain from either lightly or heavily contaminated hands.
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Affiliation(s)
- M Guilhermetti
- Department of Clinical Analyses, State University of Maringá, Paraná, Brazil
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Garcia LB, Safriet S, Russell DC. Pay-for-performance compensation: moving beyond capitation. Healthc Financ Manage 1998; 52:52-7. [PMID: 10180895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Although capitation has been instrumental in lowering healthcare costs, it also has generated growing concern about quality of and access to healthcare services. Shifting to pay-for-performance compensation programs, however, allows health plans and physicians to balance economic incentives and operational outcomes, which in turn encourages improved performance and benefits providers, payers, and patients alike. A successful pay-for-performance program requires selection of appropriate performance criteria, accurate assessment of the financial impact, development of an effective means of communication between the health plan and physicians, and gradual implementation of the plan.
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Affiliation(s)
- L B Garcia
- BDC Advisors, LLC, San Francisco, CA, USA
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Abstract
Microbial growth in a Todd-Hewitt broth has been followed to determine the in-vitro post-antibiotic effects of penicillin in a Lancefield group A streptococcal strain. Bacteria were exposed for 2 h at 37 degrees C to 1 x MIC of penicillin. Following antibiotic removal, inactivation with penicillinase and regrowth in a drug-free broth, the duration of the effect was found to be 2.8 h. By studying the affinity of streptococci for xylene in the post-antibiotic phase we observed that the penicillin treatment had no effect on the cell surface hydrophobicity. The ability of the same streptococci to adhere to human buccal epithelial cells was greatly reduced. Streptococci exposed to penicillin produced much more deoxyribonuclease and hyaluronidase than control bacteria.
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Affiliation(s)
- L B Garcia
- Institute of Microbiology, Faculty of Medicine, Federal University, Rio de Janeiro, Brazil
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Abstract
A ocorrência de Clostridium difficile foi analisada em amostras de fezes de 175 crianças com idade variando de 1 a 35 meses. Para o isolamento primário do microrganismo foi empregado o meio de cultura seletivo diferencial "CCFA" (cicloserina-cefoxitina-frutose-agar). Num grupo de 67 crianças sem distúrbios gastrintestinais e que não estavam sob uso de agentes antimicrobianos a ocorrência do C. difficile foi de 22,4%, enquanto que num outro grupo de 28 crianças nas mesmas condições, porém, sob tratamento com antimicrobianos a ocorrência do microrganismo foi de 50%. Num terceiro grupo de 58 crianças com diarréia e sob antibiótico-terapia a ocorrência de C. difficile atingiu 13,8%. Este mesmo percentual foi encontrado num quarto grupo de 22 crianças com diarréia, porém, sem tratamento com agentes antimicrobianos. De um modo geral, os maiores índices de ocorrência de C. difficile foram encontrados em crianças com idade variando entre 1 a 12 meses (28,1%). Índices inferiores foram verificados entre crianças com idade superior a 1 ano. Outrossim, os resultados evidenciam que crianças com distúrbios gastrintestinais apresentam menor incidência deste microrganismo nas fezes. Por outro lado. não houve diferença estatísticamente significativa entre os grupos de crianças com e sem terapia antimicrobiana.
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