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A Rare Cause of Neonatal Hypoxemia. Indian J Pediatr 2023; 90:523. [PMID: 36826749 DOI: 10.1007/s12098-023-04519-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
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Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit (NICU): Epidemiology and Infection Prevention and Control Measures. Infect Dis Rep 2021; 13:411-417. [PMID: 34062713 PMCID: PMC8162345 DOI: 10.3390/idr13020039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
Infections due to carbapenemase-producing Enterobacterales (CPE) are increasing worldwide and are especially concerning in a neonatal intensive care unit (NICU). Risk factors for CPE gut colonization in neonates need to be clarified. In this work, we describe the epidemiological and clinical features of CPE-colonized newborns and the infection control measures in a Portuguese NICU. We performed a prospective, observational, longitudinal, cohort study for surveillance of CPE colonization. Maternal and neonatal features of colonized newborns and surveillance strategy were described. A statistical analysis was performed with SPSS23.0, and significance was indicated by p-value ≤ 0.05. Between March and November 2019, CPE was isolated in 5.8% of 173 admitted neonates. Carbapenemase-producing Klebsiella pneumoniae were the most frequently isolated. There was no associated infection. Birth weight, gestational age, length of stay, and days of central line were the identified risk factors for CPE colonization (bivariate analysis with Student's t-test or Mann-Whitney U test, according to normality). No independent risk factors for CPE colonization were identified in the logistic regression analysis. CPE colonization risk factors are still to be determined accurately in the neonatal population. Active surveillance and continuous infection control measures restrained the current cluster of colonized newborns and helped to prevent infection and future outbreaks.
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Efavirenz and Neuropsychiatric Effects–When the Treatment Complicates Matter Further. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionEfavirenz, a non-nucleoside analogue inhibitor of the reverse transcriptase, has become commonly used in the treatment of HIV infection. Although highly effective, efavirenz is associated with causing neuropsychiatric side effects in approximately 50% of patients.ObjectivesTo provide an overview of efavirenz-induced neuropsychiatric effects.MethodsLiterature review based on PubMed/Medline.ResultsThe neuropsychiatric side effects of efavirenz usually begin quickly, commonly peak in the first two weeks after the start of therapy, and can include depression, anxiety, sleep disturbances, impaired concentration, aggressive behavior, paranoia, psychosis. Generally, these events are mild to moderate in severity and time limited, however, in a small number of cases, are late, persistent or intolerable. They are often associated with a negative impact on treatment adhesion. Some factors are known to increase the risk of neuropsychiatric effects in HIV-positive patients. The behavioral effects of efavirenz appear to be dose-dependent and mediated predominately by the 5-HT2A receptor, a primary site of action of lysergic acid diethylamine (LSD). Importantly, the efavirenz-induced neuropsychiatric effects may be difficult to distinguish from HIV-related neuropsychiatric symptoms, preexisting mental disorder or substance use. The neuropsychiatric effects should be treated with non-pharmacologic or pharmacologic interventions, according to severity. The psychiatric status of patients should be closely monitored for at least the first 6 to 12 months of treatment.ConclusionTaking into account the high rates of neuropsychiatric side effects, it is crucial that the physicians are familiar with this important subject, and the decision to initiate efavirenz in psychiatric patients is individualized.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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[Peritoneal Dialysis in the First Two Years of Life: Experience of a Nephrology and Renal Transplantation Pediatric Unit]. ACTA MEDICA PORT 2016; 29:525-532. [PMID: 28060690 DOI: 10.20344/amp.6913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 02/23/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purpose was to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life. MATERIAL AND METHODS A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated. RESULTS Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%) had some type of neurodevelopmental delay. DISCUSSION Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers. CONCLUSION These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.
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Bacillus Calmette-Guérin reactivation as a sign of incomplete Kawasaki disease. BMJ Case Rep 2016; 2016:bcr-2015-213875. [PMID: 27033285 DOI: 10.1136/bcr-2015-213875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kawasaki disease (KD) is an acute, self-limited, systemic vasculitis of unknown aetiology, extremely rare in infants younger than 6 months old. Younger infants are more likely to present with incomplete KD (IKD) and are at higher risk of developing coronary abnormalities. An early and specific clinical sign, not included in the classical diagnosis criteria, but that can be very useful in the diagnosis of KD, is the reaction at the Bacillus Calmette-Guérin (BCG) inoculation site. We describe a case of a 4-month-old boy, fully immunised, whose BCG scar reactivation led to the diagnosis of IKD. This case-report emphasises the importance of BCG site reactivation in establishing a diagnosis of IKD that clinicians should be aware of, especially in countries where BCG vaccination is still part of the immunisation schedule.
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Apotemnophilia: Psychiatric disorder, neurological disorder or not a disease at all? Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionApotemnophilia or body integrity identity disorder (BIID) is defined by the uncontrollable desire to amputate one or more healthy limbs or to be paraplegic.Objectives/aimsWe reviewed the available studies of this condition in order to enhance the comprehension of this disorder and the possible need of a multidisciplinary assessment.MethodsRelevant papers from 2000 were identified using PubMed database, with the terms apotemnophilia, BIID and self-demand amputation.ResultsReports of the phenomenon of amputee attraction trace back to 1933 in a series of letters and articles published in journals and magazines by erotically-obsessed persons who wanted to become amputees themselves. The first scientific report of this issue only appeared in 1977, when John Money described two cases that requested an amputation of a healthy limb, a condition he named apotemnophilia. Would-be amputees – or “wannabes” – may appear in thousands and they have their own websites. Until now, the explanation of this phenomenon has been in favor of a psychiatric etiology: a pathological desire driven by a sexual compulsion. Recently, a neurological explanation has been proposed and defends that might exist a dysfunction of the right parietal lobe, leading to a distorted body image and a desire for an amputation.ConclusionsApotemnophilia is a rare, uncommonly studied condition, which blurs the limits between psychiatry and neurology. We must be aware that this disorder is more frequent in unusual places like websites and others. A better understanding of this condition is crucial for the development of effective treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Choosing an antipsychotic on a case of late-onset psychosis – A challenge on everyday practice. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionPsychosis with onset in late adulthood already constitutes a challenge on the differential diagnosis and treatment, especially in polypharmacy patients.Methods and aimsWe present a case report of a 61-year old woman with a late-onset psychosis and discuss the clinical evolution and the pharmacological treatment.ResultsThe patient suffered from obesity, type II diabetes mellitus with poor glycemic control, and hypertension. She had a first psychotic episode at the age of 56, having persecutory delusional ideas and auditory hallucinations with psychomotor agitation and insomnia. She was first medicated with an atypical antipsychotic (olanzapine) with little response and worsening of the glycemic control. A switch was performed to haloperidol with remission of symptomatology with low doses (4 mg/day). Through follow-up the doses of haloperidol was decreased and eventually suspended, but having a relapse a few months later. Haloperidol was again introduced and the symptoms remitted. Stability was maintained, but the patient started to show lower limbs symmetrical rigidity and psychomotor retardation. It was decided to switch haloperidol to risperidone, but the patient reported side effects with its use, and had to stop it. Haloperidol was again introduced, but had to be discontinued after motor symptoms got worse. Again the patient had another recurrence of psychotic symptoms and it was decided to introduce paliperidone (6 mg/day) with good response and tolerability.ConclusionsThe safety and tolerability of antipsychotic medication is variable. When choosing a treatment in a patient with comorbid medical conditions, it can severely influence the desirable outcome.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Facial swelling in newborn. ACTA ACUST UNITED AC 2014; 12:384-5. [PMID: 25184804 PMCID: PMC4872957 DOI: 10.1590/s1679-45082014ai2606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 12/02/2013] [Indexed: 11/22/2022]
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Characterization of the emerging clinically-relevant multidrug-resistant Salmonella enterica serotype 4,[5],12:i:- (monophasic variant of S. Typhimurium) clones. Eur J Clin Microbiol Infect Dis 2014; 33:2249-57. [PMID: 25022446 DOI: 10.1007/s10096-014-2180-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/01/2014] [Indexed: 11/30/2022]
Abstract
To better understand the recent success/emergence of Salmonella enterica serotype 4,[5],12:i:- we characterized the population diversity, fljAB deletion patterns, antibiotic resistance features and associated genetic elements of a comprehensive collection obtained in the last decade from Portugal (2002-2010). One hundred thirty-one isolates from human clinical specimens, food, environment and piggeries, verified by PCR as S. 4,[5],12:i:-, were studied for clonality (Pulsed-Field Gel Electrophoresis and Multilocus Sequence Typing), antibiotic resistance by phenotypic (disk diffusion and/or agar dilution) and genotypic (PCR/Restriction Fragment Length Polymorphism and sequencing, genomic location) methods and fljAB-deletions (PCR). Plasmid analysis included determination of size, content and characterization of the incompatibility group (PCR-Based Replicon Typing and I-CeuI/S1-hybridization). Results showed three multidrug-resistant (MDR) clones circulating and causing infections, associated with particular phenotypic and genotypic features. Most of the isolates belonged to the widespread European (ASSuT phenotype, RR1-RR2 resistance regions, ST34) and Spanish (carrying a sul3-type III integron within IncA/C plasmids, ST19) clones circulating in Europe. A third clone, here designated Southern European clone (carrying a sul3-type I integron within IncR plasmids, ST19), presents a fljAB region different from the previous clones and similar to the US strains, despite differences in the MDR mobile genetic platforms. The success of S. 4,[5],12:i:- might be related to the selective advantage offered by MDR profiles associated with stable genetic elements, also carrying virulence features, along with well adapted clones to the animal food production and causing human infections.
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Movement of children bodies in sport: An ethnographic study about gender behavior. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Health promotion practice: Effect of an exercise program on functionality and physicality in elderly women. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Vancomycin-resistant enterococci (VRE) first appeared in the late 1980s in a few European countries. Nowadays, six types of acquired vancomycin resistance in enterococci are known; however, only VanA and to a lesser extent VanB are widely prevalent. Various genes encode acquired vancomycin resistance and these are typically associated with mobile genetic elements which allow resistance to spread clonally and laterally. The major reservoir of acquired vancomycin resistance is Enterococcus faecium; vancomycin-resistant Enterococcus faecalis are still rare. Population analysis of E. faecium has revealed a distinct subpopulation of hospital-acquired strain types, which can be differentiated by molecular typing methods (MLVA, MLST) from human commensal and animal strains. Hospital-acquired E. faecium have additional genomic content (accessory genome) including several factors known or supposed to be virulence-associated. Acquired ampicillin resistance is a major phenotypic marker of hospital-acquired E. faecium in Europe and experience has shown that it often precedes increasing rates of VRE with a delay of several years. Several factors are known to promote VRE colonisation and transmission; however, despite having populations with similar predispositions and preconditions, rates of VRE vary all over Europe.
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Abstract
Nowadays, six types of acquired vancomycin resistance in enterococci are known; however, only VanA and to a lesser extent VanB are widely prevalent. Various genes encode acquired vancomycin resistance and these are typically associated with mobile genetic elements which allow resistance to spread clonally and laterally. The major reservoir of acquired vancomycin resistance is Enterococcus faecium; vancomycin-resistant Enterococcus faecalis are still rare. Population analysis of E. faecium has revealed a distinct subpopulation of hospital-acquired strain types, which can be differentiated by molecular typing methods (MLVA, MLST) from human commensal and animal strains. Hospital-acquired E. faecium have additional genomic content (accessory genome) including several factors known or supposed to be virulence-associated. Acquired ampicillin resistance is a major phenotypic marker of hospital-acquired E. faecium in Europe and experience has shown that it often precedes increasing rates of VRE with a delay of several years. Several factors are known to promote VRE colonisation and transmission; however, despite having populations with similar predispositions and preconditions, rates of VRE vary all over Europe.
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P688 Interhospital dissemination of glycopeptide resistance among enterococcal clinical isolates from Portugal is associated to spread of epidemic pMG1-like plasmids carrying diverse Tn1546 variants. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O24 Multi-drug resistant enterococci among Portuguese swine after growth promoter ban. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Analysis of 247 faecal enterococcal isolates from 99 healthy Portuguese individuals during 2001 revealed the presence of enterococci resistant to vancomycin (5%) and highly resistant to streptomycin (52%), kanamycin (40%) or gentamicin (11%). Most isolates were also resistant to tetracycline, erythromycin, ciprofloxacin and quinupristin-dalfopristin. The vanA (two Tn1546 types), vanC1, erm(B), aac(6')-aph(2'')-Ia, aph(3')-IIIa, vat(E) and vat(D) genes were detected. Enterococcus faecalis and Enterococcus faecium isolates with high-level resistance to gentamicin were related to Portuguese poultry isolates described previously. E. faecium isolates that were highly resistant to vancomycin or gentamicin harboured different housekeeping purK alleles associated previously with different hosts.
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High occurrence and persistence of antibiotic-resistant enterococci in poultry food samples in Portugal. J Antimicrob Chemother 2005; 56:1139-43. [PMID: 16221760 DOI: 10.1093/jac/dki360] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We determined the presence of antibiotic-resistant enterococci (ARE) in commercialized poultry samples from Portugal and analysed their clonal diversity and the resistance genes harboured by these strains. METHODS Ninety-nine retail poultry samples of 10 widely commercialized brands were studied (1999-2001). Samples were enriched and plated on selective media with and without vancomycin, gentamicin, streptomycin or kanamycin. Antibiotic susceptibility was established following standard criteria. Identification and detection of genes coding for resistance were determined by PCR. Clonal relatedness was established by PFGE. RESULTS A high percentage of samples contained vancomycin-resistant enterococci (VRE) (48%), or enterococci highly resistant (HLR) to gentamicin (34%), streptomycin (32%) or kanamycin (30%). Co-resistance to tetracycline, erythromycin, ciprofloxacin and quinupristin/dalfopristin was observed in most of these isolates. VRE were classified as VanA phenotype-vanA genotype (38% of samples), VanB phenotype-vanA (13%) or VanC phenotype-vanC1 (23%). All HLR to gentamicin isolates contained aac(6')-Ie-aph(2'')-Ia. We detected erm(B) in both erythromycin-resistant and -susceptible isolates. Some VRE and HLR to gentamicin strains were recovered from different samples and brands. Long-term persistence of particular VRE strains (>2 years), exhibiting different Van phenotypes, was observed. CONCLUSIONS High occurrence of ARE suggests maintenance of selective pressure by the use of antibiotics/other substances in the Portuguese poultry environment. Persistence of a number of widespread PFGE types containing different resistance genes might reflect environmental/host-adapted enterococcal strains that might contribute to the maintenance of antibiotic resistance, thus constituting a resistance reservoir that is non-sensitive to banning interventions.
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In vitro activity of daptomycin against enterococci from nosocomial and community environments in Portugal. J Antimicrob Chemother 2004; 54:964-6. [PMID: 15375109 DOI: 10.1093/jac/dkh432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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First report of the activity of linezolid against Portuguese enterococci from human, animal and environmental sources. J Antimicrob Chemother 2003; 51:1314-5. [PMID: 12697650 DOI: 10.1093/jac/dkg216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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First characterization of vancomycin-resistant enterococci from a Portuguese hospital. J Antimicrob Chemother 2002; 49:215-7. [PMID: 11751793 DOI: 10.1093/jac/49.1.215-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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