手术器械清洁方法国内研究进展

医疗器械使用后,应进行彻底地清洁处理,去除附着在上面的血液、黏液和体液等有机物,这是预防和控制医院感染,保证医疗安全的重要环节。器械清洁方法正确与否,清洗质量合格与否,清洗后的维护和保养及如何通过物理和化学方法将器械上的有机物、无机物和微生物清除到安全的水平,对保证灭菌效果和控制交叉感染具有重要的作用［1］。在所有环节中,器械清洗是基础和前提,如果清洁不彻底,医疗器械上残留的有机物会在微生物的表面形成一层保护层,妨碍消毒灭菌因子与微生物接触或延迟其作用,影响消毒灭菌效果。因此,器械清洗质量是否合格尤为重要。     

固体清洗剂和多酶清洗剂清洗手术器械的效果比较

目的比较固体清洗剂和液体多酶清洗剂清洗手术器械的效果,并进行成本分析,为消毒供应中心提供新的清洗技术选择。方法将消毒供应中心4台清洗消毒机随机平分为实验组和对照组,实验组使用固体清洗剂,对照组使用液体多酶清洗剂对手术器械进行清洗。对两组手术器械的清洗效果,采用目测(裸眼和10倍光源放大镜）、ATP生物荧光检测和蛋白残留检测方法进行效果评价,并对两组的清洗成本以及产生的医疗废弃物进行统计分析。结果肉眼裸视评价清洗效果,实验组合格率为97.70%（4 678/4 788）,对照组为92.01%（5 075/5 516）;10倍光源放大镜评价清洗效果,实验组合格率为94.30%（2 546/2 700）,对照组为88.72%（2 453/2 765）;实验组合格率均高于对照组,差异具有统计学意义（P=0.000）。ATP荧光检测法评价清洗效果,实验组合格率为84.41%（996/1 180）,对照组为86.83%（1 042/1 200）,两组差异无统计学意义（P=0.092）。实验组蛋白残留检测阳性率为3.71%（26/700）,对照组为16.31%（106/650）,实验组蛋白残留检测阳性率比对照组低,差异有统计学意义（P=0.000）。实验组清洗成本为对照组的2/3;实验组产生医疗废弃物（塑料薄膜）0.40 kg,对照组（空桶）为12.30 kg。结论固体清洗技术可以高效去除手术器械的蛋白污染,并降低清洗成本,减少医疗废物的产生,是值得推广的新型清洗技术。     

Obésité : que nous dit l’épidémiologie ?

In most developed and developing countries, a regular increase of the prevalence of obesity has been documented during the last decade(s) of the xxth century. The last figure from the USA is for the first time discordant with this general trend by showing a clear slowing down since year 2000. In children likewise, a rapid increase in the prevalence of obesity took place in the second half of the xxth century but recent publications from France, Switzerland, UK, USA also report a stabilization of childhood overweight and obesity prevalences. The experience of developing countries clearly shows the impact of socioeconomic status improvement and urbanization on the prevalence of obesity. In developed countries like France, a striking element was the diffuse nature of the adult obesity epidemic observed from the 1990s. The general improvement of living conditions after the Second World War probably explains the diffuse nature of the epidemics. Specifically, the changes in the nutritional status of children that happened at that time have long lasting consequences for adult obesity epidemics. Indeed, a new current in epidemiology, lifecourse epidemiology, has prompted over the past decade a new approach of the pathophysiology of chronic diseases, including obesity. Lifecourse epidemiology considers factors affecting the susceptibility to diseases over the whole life with critical periods during developmental phases. Critical periods for the susceptibility to obesity have been documented in prenatal life, during the first 6 months of postnatal life and from 3 years on starting at the time of the adiposity rebound. Parental obesity is involved at each of the critical periods. The transgenerational transmission of obesity is explained by genetic factors, shared lifestyle but also epigenetics especially during the early developmental periods. The slowing down of the childhood obesity epidemics observed in several developed countries may signal that factors affecting the early susceptibility to obesity have recently changed.     

Associations Between Social Media Engagement and Vaccine Hesitancy

There has been a surge in vaccine hesitancy following the Coronavirus pandemic. This study measured the prevalence of and identified factors associated with vaccine hesitancy and social media use. An online survey was administered (n?=?1050) between May and July 2021. Chi-square tests were used to examine bivariate associations with vaccine hesitancy (partially vaccinated and unvaccinated participants). Logistic regression was used to identify associations between social media use and vaccine hesitancy. Chi-square tests showed women (69.7% vs 28.2% men, p_adjusted?=?.002), African American participants (52.3% vs 17.8% white, p_adjusted?<?.001), high school diploma (54.4% vs 38.6% college degree, p_adjusted?<?.001), political unaffiliated (15.8% vs 14.5% republican, p_adjusted?<?.001), Muslim (10.0% vs 0% Jewish, p_adjusted?<?.001), and never married/single (53.9% vs 17.0% married, p_adjusted?<?.001) were more likely to be vaccine hesitant. Controlling for all demographic variables (age, race, gender, and education), more frequent use of social media for reading news was associated with lower vaccine hesitancy (OR 0.35, 99% CI 0.20, 0.63, p?<?0.001). However, using social media as a source of vaccine information without any other trusted source (health department, doctor, CDC,) was associated with higher odds of being vaccine hesitant (OR 2.00, 99% CI 1.15, 3.46, p?=?0.001). People who use social media without referencing trusted sources may be particularly vulnerable to disinformation or vaccine hesitant persons are more likely exposed to non-trusted social media sites as their only information source.

     

医院感染阴沟肠杆菌多重耐药基因分析 FREE

目的了解医院感染阴沟肠杆菌的耐药性及其耐药基因,为防控感染提供依据。方法对40株临床分离的阴沟肠杆菌,以纸片扩散法和琼脂稀释法进行药敏试验,聚合酶链反应(PCR)及序列分析法分析12种耐药相关基因。结果40株阴沟肠杆菌仅对亚胺培南和美罗培南高度敏感,敏感率均为100.00%;对头孢吡肟耐药率较低,为15.00%;对其他15种抗菌药物耐药率较高,为42.00%～92.50%。共检出8种耐药基因,分别为TEM 1、SHV 2a、CTX M 3、CTX M 9、AmpC、aac(3′) Ⅰ、IntⅠ1、sul1,大多数菌株携带sul1+IntⅠ1型基因;耐药谱共分为A～I 9型,以C和D型为主。抗菌药物耐药谱分型和基因分型有一定相关性。结论阴沟肠杆菌呈现多重和高度耐药性,耐药机制复杂且呈多种耐药机制共同作用。     

Épidémiologie des patients porteurs d’entérobactéries sécrétrices de bêtalactamase à spectre élargi (EBLSE), à l’admission

Objective

The incidence of extended-spectrum beta-lactamase-producing enterobacteria (ESBLE) has regularly increased over the last few years. However, little is known about epidemiology of ESBLE carriers in France. The objective of this study was to determine the ESBLE carriers or infected patients profile, identified within 48 hours following hospital admission.

Design

This retrospective study included all patients admitted in 2006 and 2007 at the Necker–Enfants-Malades (NEM) teaching hospital, carrying or infected with ESBLE isolated within 48 hours following admission. The pediatric and adult populations were compared.

Results

There was no significant difference between pediatric and adult populations. Escherichia coli and Klebsiella pneumoniae were the two main species isolated, accounting respectively for 59.6 and 21.1 % of the 114 isolated strains. Among the 114 analyzed files, 24 patients (21 %) were known to be EBLSE carriers, 37 (32 %) were transferred from another hospital, including 16 from another country. Concerning the 54 (47 %) other patients, five (4 %) came from a country with high prevalence, and 44 (39 %) were treated for a chronic illness. Only five patients (4 %) carrying ESBLE did not have any usual risk factor for multidrug resistance (MDR) bacterial carriage.

Conclusions

In our study, 4 % of patients carrying ESBLE admitted had no usual risk factor for MDR bacteria. Targeted screening of previous carriers, patients with chronic illness, transferred patients, or patients coming from country with high prevalence, would help to limit the spread of ESBLE.     

痰涂片显微镜检查与培养结果的相关性分析 FREE

目的分析痰涂片显微镜检查（镜检）与培养结果的相关性。方法痰标本在进行细菌培养之前行涂片革兰染色、镜检;对培养出来的细菌进行革兰染色、镜检,对二者镜下染色的性质和形态进行比对;二者一致者作为病原菌进行下一步的鉴定和药敏试验。结果786份合格标本共检出病原菌540株,阳性率68.70%,其中革兰阳性球菌185株,革兰阴性杆菌316株,真菌39株。痰涂片镜检与培养鉴定结果的符合率为72.01%（566/786）,其诊断敏感性为77.78%,特异性为59.35%,阳性预测值为80.77%,阴性预测值为54.89%。结论痰涂片镜检结果与培养结果具有较高的符合率,痰涂片镜检可以提高痰标本病原菌的检出率。     

Érythème noueux unilatéral associé à une leishmaniose cutanée homolatérale

Objective

The authors wanted to report an uncommon etiology of erythema nodosum.

Case report

A 45-year-old woman presented with numerous encrusted nodular lesions on the left leg and arm. Leishmania was identified after a parasitological examination. Subcutaneous erythematous nodules developed later on the same leg. Erythema nodosum was diagnosed with a biopsy of the nodules. The patient was treated with systemic meglumine 60 mg/kg per day for 13 days. All lesions improved under treatment.

Discussion

This was the first reported case of unilateral erythema nodosum with cutaneous leishmaniasis. Clinical and laboratory exams were in the range of normal and led the authors to exclude common causes of erythema nodosum. Subcutaneous nodules occurred before the beginning of treatment with meglumine. Thus, drug allergy (previously reported) was excluded as an etiology of EN.     

Défaillance multiviscérale et infection disséminée à adénovirus

Background

Peripheral blood stem cell transplantation is a frequent option, especially for patients with hematological malignancies.

Case reports

A first patient received this treatment for acute myeloblastic leukemia, the second for Richter's syndrome (follicular lymphoma). In both cases, allograft (unrelated donor, non myeloablative conditioning) was followed by graft versus host disease (GVH) requiring an immunosuppressive treatment. Respectively 15 and three months after graft, these two patients presented with multiple organ failure including very severe hepatic dysfunction. The diagnosis was made according to positive blood PCR, positive BAL, and hepatic histological findings.

Discussion

Adenoviruses, frequent in pediatrics, can be responsible for extremely severe infections among immunocompromised adults. T lymphocyte depletion plays a key role.

Conclusion

Adenoviral infections can be fatal among immunocompromised patients. Diagnostic improvement should lead to early treatment, which however, remains to be clearly defined.     

698份法定传染病报告资料分析

收集威海市肿瘤医院2004年1月-2007年12月698份法定传染病报告卡资料进行分析。共报告法定传染病13种：肠道传染病399例（57．17％）,包括细菌性痢疾、甲型肝炎、戊型肝炎及感染性腹泻;血源及性传播传染病206例（29．51％）,包括乙型肝炎、丙型肝炎和淋病,其中乙型肝炎病例数最多（182例）;呼吸道传染病92例（13．18％）,包括结核、流行性感冒、流行性腮腺炎、风疹及水痘;其他传染病（急性出血性结膜炎）1例（0．14％）。成人以血源、性传播及肠道传染病为主,儿童以肠道及呼吸道传染病为主。肠道传染病主要发生于7～9月,呼吸道传染病多发生于12～3月。流动人口所占比率与前3年相比显著增加（均P〈0．001）。提示应加强对流动人口的管理,对婴幼儿及时接种相关疫苗,并针对季节特点采取措施,以减少传染病的发生。     

Rôle du préavis psychiatrique dans l’évaluation préopératoire des patients candidats à la chirurgie de l’obésité

The increase of obesity prevalence and severity, the failure of conservative treatment and the request for a long term efficient solution have given to surgery a rising role in the treatment of obesity. The psychiatric evaluation for bariatric surgery, the preparation and follow up of the patients are essential aims to reduce surgical risks and complications and improve the eating tolerance imposed by bariatric surgery.In this context the multidisciplinary team is very important, each complementary advice allowing the setting of strategies to better anticipate and manage post operative changes.The psychiatric evaluation includes the detection of formal contra-indications, the appreciation of relative indications and the assessment of eating disorders.     

Sexual dysfunctions in women with chronic pelvic pain. A modified sex-therapeutic model

Pelvic pain in women is frequently associated with sexual disturbances: inhibited sexual desire, excitement disorders (dyspareunia) and orgasmic dysfunctions. Women with chronic pelvic pain have a disturbed relationship with their own body. They lost the ability of living the body as a place of sensual joy and mutual communication. The goal of therapy is not only relieving from pain, but also that the women should learn (again) to enjoy life as much as the capacities allow this. Therapeutic measures include guidance and appropriate treatment: a biopsychosocially oriented approach. Formal psychotherapy, implying the working trough of deep, unconscious conflicts, anxieties, and angers from childhood, is not necessary and mostly not possible. Also formal sextherapy or psychosexual therapy (Kaplan) is not indicated. This paper describes the different steps of an appropriate and modified sextherapy on psychosomatic and psychodynamic lines. Difficulties, risks and chances of each step are demonstrated; a careful physical examination, information, counselling and emotional support, physical and psychological rest, drug therapy, the way of individual counselling and sexual enrichment program, couple sexual counselling and sextherapeutical sessions. Through these steps the woman can be accompanied to a new life style. The participation in a self-help group for women with emancipatoric goals opens some women's eyes for yet unused capacities and talents. Through these sessions both partners can learn how to live up a new partnership.     

990株临床非发酵菌的种群分布及耐药谱分析 FREE

目的了解某院临床标本分离的非发酵菌菌种分布及耐药谱,为临床用药提供依据。方法回顾性分析该院2004年1月-2008年12月临床各科室送检标本分离的990株非发酵菌资料。结果990株非发酵菌分为11个菌属,其中以不动杆菌属细菌最多,占43.43%（430/990）;假单胞菌属和窄食单胞菌属次之,分别为34.75%(344/990)和10.71%(106/990)。分离最多的前4种菌依次为铜绿假单胞菌（29.19%）、洛菲不动杆菌(20.61%)、醋酸钙-鲍曼不动杆菌复合种(13.74%)和嗜麦芽窄食单胞菌(10.71%)。标本中以痰液分离菌数最多,占79.80%(790/990),其次为咽拭子7.88%（78/990）、体液6.87%(68/990)。5年来,铜绿假单胞菌对替卡西林、头孢西丁、头孢噻肟、亚胺培南、奈替米星、复方磺胺甲口恶唑、培氟沙星、庆大霉素、呋喃妥因和妥布霉素的耐药率变化显著（P＜0.005或P＜0.05）,耐药率＜30%的抗菌药物有头孢他啶和亚胺培南;不动杆菌属对阿莫西林/克拉维酸、庆大霉素、妥布霉素和复方磺胺甲口恶唑的耐药率变化显著（P＜0.005或P＜0.05）,耐药率＜30%的抗菌药物有替卡西林、亚胺培南和奈替米星。结论非发酵菌为医院感染的主要病原菌,对常用抗菌药物的耐药率高,且多重耐药现象严重,应定期监测细菌变迁和耐药性变化,指导临床合理用药。     

Bactériémies à Kluyvera : à propos d’une épidémie dans un CHU au Maroc

Kluyvera Spp is an enterobacterium rarely isolated in medical microbiology, an opportunistic pathogen the clinical significance of which remains unclear. Four strains of Kluyvera Spp were isolated for the first time in the Ibn Rochd Teaching Hospital microbiology laboratory. These strains were isolated in hemocultures of four patients hospitalized in the same medical ward, at the same time, and presenting with bacteriemia. An antibiotic susceptibility study allowed identifying the wild phenotype in the first isolate, the three next isolates had acquired resistance to trimethoprim-sulfamethoxazole, gentamycin, tobramycin, and ciprofloxacin, and produced broad-spectrum betalactamase. The epidemiological investigation in the patients’ environment made after isolating the fourth strain was negative. The four patients evolved uneventfully without antibiotic treatment. This raises the question of the real pathogenic capacity of these strains, their epidemic power, and their ability to acquire resistance.