Detection of hepatitis E virus genotype 3 in an Algerian mouse (Mus spretus) in Portugal

Virus monitoring in small mammals is central to the design of epidemiological control strategies for rodent-borne zoonotic viruses. Synanthropic small mammals are versatile and may be potential carriers of several microbial agents. In the present work, a total of 330 fecal samples of small mammals were collected at two sites in the North of Portugal and screened for zoonotic hepatitis E virus (HEV, species Paslahepevirus balayani). Synanthropic small mammal samples (n = 40) were collected in a city park of Porto and belonged to the species Algerian mouse (Mus spretus) (n = 26) and to the greater white-toothed shrew (Crocidura russula) (n = 14). Furthermore, additional samples were collected in the Northeast region of Portugal and included Algerian mouse (n = 48), greater white-toothed shrew (n = 47), wood mouse (Apodemus sylvaticus) (n = 43), southwestern water vole (Arvicola sapidus) (n = 52), Cabrera's vole (Microtus cabrerae) (n = 49) and Lusitanian pine vole (Microtus lusitanicus) (n = 51). A nested RT-PCR targeting a part of open reading frame (ORF) 2 region of the HEV genome was used followed by sequencing and phylogenetic analysis. HEV RNA was detected in one fecal sample (0.3%; 95% confidence interval, CI: 0.01-1.68) from a synanthropic Algerian mouse that was genotyped as HEV-3, subgenotype 3e. This is the first study reporting the detection of HEV-3 in a synanthropic rodent, the Algerian mouse. The identified HEV isolate is probably the outcome of either a spill-over infection from domestic pigs or wild boars, or the result of passive viral transit through the intestinal tract. This finding reinforces the importance in the surveillance of novel potential hosts for HEV with a particular emphasis on synanthropic animals.

Experiences of moral distress in a COVID-19 intensive care unit: A qualitative study of nurses and respiratory therapists in the United States

The COVID-19 pandemic has placed extraordinary stress on frontline healthcare providers as they encounter significant challenges and risks while caring for patients at the bedside. This study used qualitative research methods to explore nurses and respiratory therapists' experiences providing direct care to COVID-19 patients during the first surge of the pandemic at a large academic medical center in the Northeastern United States. The purpose of this study was to explore their experiences as related to changes in staffing models and to consider needs for additional support. Twenty semi-structured interviews were conducted with sixteen nurses and four respiratory therapists via Zoom or by telephone. Interviews were transcribed verbatim, identifiers were removed, and data was coded and analyzed thematically. Five major themes characterize providers' experiences: a fear of the unknown, concerns about infection, perceived professional unpreparedness, isolation and alienation, and inescapable stress and distress. This manuscript analyzes the relationship between these themes and the concept of moral distress and finds that some, but not all, of the challenges that providers faced during this time align with previous definitions of the concept. This points to the possibility of broadening the conceptual parameters of moral distress to account for providers' experiences of treating patients with novel illnesses while encountering institutional and clinical challenges.

Encountering the social determinants of health on a COVID-19 ICU: Frontline providers' perspectives on inequality in a time of pandemic

Efforts to improve health equity may be advanced by understanding health care providers' perceptions of the causes of health inequalities. Drawing on data from in-depth interviews with nurses and registered respiratory therapists (RRTs) who served on intensive care units (ICUs) during the first surge of the pandemic, this paper examines how frontline providers perceive and attribute the unequal impacts of COVID-19. It shows that nurses and RRTs quickly perceived the pandemic's disproportionate burden on Black and Latinx individuals and families. Providers attribute these inequalities to the social determinants of health, and also raise questions about how barriers to healthcare access may have made some patients more vulnerable to the worst consequences of COVID-19. Providers' perceptions of inequality and its consequences on COVID-19 ICUs were emotionally impactful and distressing, suggesting that this is a critical moment for offering clinicians practical strategies for understanding and addressing the persistent structural inequities that cause racial inequalities in health.

Intensive care unit nurses living through COVID-19: A qualitative study

Aims

To understand how nurses experience providing care for patients hospitalized with COVID‐19 in intensive care units.

Background

As hospitals adjust staffing patterns to meet the demands of the pandemic, nurses have direct physical contact with ill patients, placing themselves and their families at physical and emotional risk.

Methods

From June to August 2020, semi‐structured interviews were conducted. Sixteen nurses caring for COVID‐19 patients during the first surge of the pandemic were selected via purposive sampling. Participants worked in ICUs of a quaternary 1,000‐bed hospital in the Northeast United States. Interviews were transcribed verbatim, identifiers were removed, and data were coded thematically.

Results

Our exploratory study identified four themes that describe the experiences of nurses providing care to patients in COVID‐19 ICUs during the first surge: (a) challenges of working with new co‐workers and teams, (b) challenges of maintaining existing working relationships, (c) role of nursing leadership in providing information and maintaining morale and (d) the importance of institutional‐level acknowledgement of their work.

Conclusions

As the pandemic continues, hospitals should implement nursing staffing models that maintain and strengthen existing relationships to minimize exhaustion and burnout.

Implications for Nursing Management

To better support nurses, hospital leaders need to account for their experiences caring for COVID‐19 patients when making staffing decisions.

Comparison of two arbitrary cast transfer systems with a kinematic facebow for mounting a maxillary cast on a semiadjustable articulator

STATEMENT OF PROBLEM

The Kois Dento-Facial Analyzer (KDFA) is used by clinicians to mount maxillary casts and to evaluate and treat patients. Limited information is available for understanding whether the KDFA should be considered as an alternative to an arbitrary facebow.

PURPOSE

The purpose of this clinical study was to evaluate and compare maxillary casts mounted by using the KDFA with casts mounted by using the Panadent Pana-Mount Facebow (PMF) and a kinematic axis (KA) facebow.

MATERIAL AND METHODS

Fifteen participants were enrolled in the study. Three maxillary impressions were made of each study participant. One cast from each study participant was mounted on an articulator by means of the KDFA, PMF, and KA. A standardized photograph of each mounting was made, and the condylar center-incisor distance and the occlusal and incisal plane angles were measured. A randomized complete block design analysis of variance (RCBD) (α=.05) and post hoc tests (Tukey-Kramer HSD) were used to evaluate the occlusal and incisal plane angles and the condylar center-incisor distance.

RESULTS

Compared with the occlusal plane angle (OPA), the KDFA mounted the maxillary cast at an angle that was statistically lower than those of PMF and KA (P<.001). The KDFA and the PMF condylar center-incisor distances were both significantly greater than that of KA (P=.01). No differences were found between the incisal plane angle (IPA) on maxillary casts mounted with the KDFA, KA, or PMF (P=.16).

CONCLUSIONS

The KDFA and PMF mounted the maxillary casts in a position that was farther from the axis when compared with the KA mounted casts. The KDFA resulted in a lower articulator OPA compared with both PMF and KA. No difference was found between the IPAs of the KDFA, PMF, and KA.

A low dose heparinized saline protocol is associated with improved duration of arterial line patency in critically ill COVID-19 patients

Purpose

Critically ill patients with Coronavirus Disease 2019 (COVID-19) have high rates of line thrombosis. Our objective was to examine the safety and efficacy of a low dose heparinized saline (LDHS) arterial line (a-line) patency protocol in this population.

Materials and Methods

In this observational cohort study, patients ≥18 years with COVID-19 admitted to an ICU at one institution from March 20–May 25, 2020 were divided into two cohorts. Pre-LDHS patients had an episode of a-line thrombosis between March 20–April 19. Post-LDHS patients had an episode of a-line thrombosis between April 20–May 25 and received an LDHS solution (10 units/h) through their a-line pressure bag.

Results

Forty-one patients (pre-LDHS) and 30 patients (post-LDHS) were identified. Baseline characteristics were similar between groups, including age (61 versus 54 years; p = 0.24), median Sequential Organ Failure Assessment score (6 versus 7; p = 0.67) and systemic anticoagulation (47% versus 32%; p = 0.32). Median duration of a-line patency was significantly longer in post-LDHS versus pre-LDHS patients (8.5 versus 2.9 days; p < 0.001). The incidence of bleeding complications was similar between cohorts (13% vs. 10%; p = 0.71).

Conclusions

A LDHS protocol was associated with a clinically significant improvement in a-line patency duration in COVID-19 patients, without increased bleeding risk.

•

Critically ill COVID-19 patients have frequent arterial line (a-line) thrombosis.

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A low dose heparinized saline (LDHS) a-line patency protocol was examined.

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Two a-line thrombosis cohorts were identified: “post-LDHS” and “pre-LDHS”.

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A-line patency was longer in post- vs. pre-LDHS patients (8.5 vs. 2.9 d; p < 0.001).

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Bleeding complications were similar between groups (13% vs. 10%, p = 0.7).

Immediate-release and extended-release formulations of second-generation antidepressants for the treatment of major depressive disorder in adults

Introduction

Extended-release formulations of antidepressants have been marketed as a strategy to increase patient adherence. Changes in the formulation of drugs, however, could be related to changes in efficacy and tolerability. Among second-generation antidepressants, bupropion, fluoxetine, mirtazapine, paroxetine, and venlafaxine are available in immediate- and extended-release formulations.

Objectives

To compare the efficacy, tolerability, and adherence of immediate- versus extended-release formulations of second-generation antidepressants for the treatment of major depressive disorder (MDD) in adults.

Aim

To provide an evidence base for clinicians when choosing immediate- or extended-release formulations of antidepressants for the treatment of MDD.

Methods

We conducted a comparative effectiveness review for the U.S. Agency for Healthcare Research and Quality searching PubMed, EMBASE, The Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two people independently reviewed the literature, abstracted data, and rated the risk of bias.

Results

Six RCTs and one observational study provided evidence about the comparative efficacy, tolerability, and adherence of bupropion SR (sustained release) versus bupropion XL (extended release), fluoxetine daily vs. fluoxetine weekly, paroxetine IR (immediate release) versus paroxetine CR (continuous release), and venlafaxine IR versus venlafaxine XR (extended release). Overall, no substantial differences in efficacy and safety could be detected. Open-label and observational evidence indicated better adherence for bupropion XL and fluoxetine weekly than for immediate-release medications. No differences in adherence could be detected between paroxetine IR and paroxetine CR.

Conclusions

Our findings indicate similar efficacy and tolerability between immediate- and extended-release formulations. Whether extended-release formulations lead to better adherence remains unclear.

[Pre- and postoperative results of spirography and blood gas analysis in patients with atrial septal defect or mitral stenosis]

In patients with atrial septum defect and mitral stenosis, respectively, the ventilation and blood gas parameters were compared before and after cardiac operation. In general postoperatively no reversibility of preoperatively proved pulmonary functional disturbances could be established. Only in individual cases a discrete improvement of some of the functional indicators could be observed. Therefore, the operative intervention on the heart should be performed possibly before the onset of irreversible pulmonary structural changes.