Associations between the genotypes of Staphylococcus aureus bloodstream isolates and clinical characteristics and outcomes of bacteremic patients

We investigated associations between the genotypic and phenotypic features of Staphylococcus aureus bloodstream isolates and the clinical characteristics of bacteremic patients enrolled in a phase III trial of S. aureus bacteremia and endocarditis. Isolates underwent pulsed-field gel electrophoresis, PCR for 33 putative virulence genes, and screening for heteroresistant glycopeptide intermediate S. aureus (hGISA). A total of 230 isolates (141 methicillin-susceptible S. aureus and 89 methicillin-resistant S. aureus [MRSA]) were analyzed. North American and European S. aureus isolates differed in their genotypic characteristics. Overall, 26% of the MRSA bloodstream isolates were USA 300 strains. Patients with USA 300 MRSA bacteremia were more likely to be injection drug users (61% versus 15%; P < 0.001), to have right-sided endocarditis (39% versus 9%; P = 0.002), and to be cured of right-sided endocarditis (100% versus 33%; P = 0.01) than patients with non-USA 300 MRSA bacteremia. Patients with persistent bacteremia were less likely to be infected with Panton-Valentine leukocidin gene (pvl)-constitutive MRSA (19% versus 56%; P = 0.005). Although 7 of 89 MRSA isolates (8%) exhibited the hGISA phenotype, no association with persistent bacteremia, daptomycin resistance, or bacterial genotype was observed. This study suggests that the virulence gene profiles of S. aureus bloodstream isolates from North America and Europe differ significantly. In this study of bloodstream isolates collected as part of a multinational randomized clinical trial, USA 300 and pvl-constitutive MRSA strains were associated with better clinical outcomes.     

涂阳肺结核患者诊断延误及影响因素分析

目的对2009年10~12月武汉市结核病防治所住院的痰标本直接涂片抗酸杆菌镜检阳性(涂阳)肺结核患者诊断延误及其影响因素进行研究。方法采用自行设计的问卷,对224例涂阳肺结核患者进行面访式调查。采用Wilcoxon符号秩和检验对首诊延误、卫生系统延误及诊断延误分别进行单因素分析,用逐步logistic回归法对3种延误分别进行多因素分析。结果首诊延误、卫生系统延误及诊断延误中位数分别为8、12及35 d;首诊延误的危险因素为:男性(OR=2.134,95%可信区间1.115~4.083),初中及以下文化(OR=1.879,95%可信区间1.048~3.368),无咯血(OR=2.194,95%可信区间1.056~4.559)及结核知识得分低(OR=4.060,95%可信区间2.232~7.385);卫生系统延误危险因素为:首诊为区以下医疗单位(OR=2.938,95%可信区间1.339~6.446),保护因素为:就诊次数≤1次(OR=0.056,95%可信区间0.025~0.126);诊断延误危险因素为结核知识得分低(OR=3.036,95%可信区间1.654~5.572),自卑及自我羞耻感水平高(OR=2.012,95%可信区间1.103~3.676),保护因素为:就诊次数≤1次(OR=0.216,95%可信区间0.117~0.396)。结论武汉市住院涂阳肺结核患者存在一定的诊断延误,但延误水平不高。应加强对人群特别是文化程度低的人群的结核相关知识宣教;加强基层医务人员对结核病的警觉性并提高诊断能力;应避免患者反复多次就诊于同一水平医疗机构,从而缩短诊断延误时间。     

Socioeconomic inequalities in self-reported chronic non-communicable diseases in urban Hanoi,Vietnam

This study measures and decomposes socioeconomic inequalities in the prevalence of self-reported chronic non-communicable diseases (NCDs) in urban Hanoi, Vietnam. A cross-sectional survey of 1211 selected households was carried out in four urban districts in both slum and non-slum areas of Hanoi city in 2013. The respondents were asked if a doctor or health worker had diagnosed any household members with an NCD, such as cardiovascular diseases, chronic respiratory, diabetes or cancer, during last 12 months. Information from 3736 individuals, aged 15 years and over, was used for the analysis. The concentration index (CI) was used to measure inequalities in self-reported NCD prevalence, and it was also decomposed into contributing factors. The prevalence of chronic NCDs in the slum and non-slum areas was 7.9% and 11.6%, respectively. The CIs show gradients disadvantageous to both the slum (CI?=??0.103) and non-slum (CI?=??0.165) areas. Lower socioeconomic status and aging significantly contributed to inequalities in the self-reported NCDs, particularly for those living in the slum areas. The findings confirm the existence of substantial socioeconomic inequalities linked to NCDs in urban Vietnam. Future policies should target these vulnerable areas.     

人体坐姿与坐椅界面间之生物力学分析

坐压一直都是复健和医学工程关心的主要课题之一。许多人因工作或生病需要长时间坐在椅子上,而造成不适,甚至于使得臀部受伤或产生压疮。为了解决上述问题及提供有效数据,本研究及设计一临床评估仪器,用来评估压力分布情形,最后能建议适当的姿势与座垫：此系统包括可调试座椅－－可适合不同身高本型特性的个体,量测界面压力系统及量测臀部轮廓系统。     

Simple Mobile Application for Calculating “Ergotrauma” Made Using an Excel Sheet

How to cite this article: Anand A, Saigal S, Panda R, Kodamanchili S, Shrivastava P, Das A, et al. Simple Mobile Application for Calculating “Ergotrauma” Made Using an Excel Sheet. Indian J Crit Care Med 2021;25(9):1081.     

Reanalyzing the Mortality Analysis of COVID-19 Deaths in a Tertiary Care Center in India

How to cite this article: Anand A, Panghal R, Kaler P, Saigal S, Panda R, Kodamanchili S, et al. Reanalyzing the Mortality Analysis of COVID-19 Deaths in a Tertiary Care Center in India. Indian J Crit Care Med 2021; 25(10):1211.

Sir,Recently, one of the most awaited publications by the premier government medical institute of our country, titled “Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center”, was a very delightful read.¹ All the intensivists of India look up to this institute for regular guidelines of management of COVID-19. It is a very informative and learning piece analyzing mortality among the patients admitted to one of the (intensive care units) ICU of this center.When compared with other similar studies across the globe, this paper does not provide supplementary data that could have answered questions like how many of the admitted patients were intubated in total and what was the mortality rate among the subgroup who were intubated.^2,3 Rather a retrospective approach of data representation has been employed, which tells that among the total 247 deceased patients, 24.2% were intubated and 30.3% of total deceased were intubated within 24 hours. Even this representation does not throw light on how many patients of total 654 patients were intubated during their ICU stay. The policy guiding intubation of patients should also be specified as if it was decided by the intensivist on duty or by any fixed institutional criteria.The incidence of pulmonary embolism (PE) among the deceased in the original paper is 2.8%, which is quite less than reported by Mahmoud et al. in a meta-analysis who reported the overall PE rate in ICU to be 19%, and on autopsy, 22% of deceased patients were found to have PE in COVID-19.⁴ The question that remains unanswered is how were those patients, who died in this published paper, diagnosed with PE. The diagnosis of PE was a clinical diagnosis or radiological diagnosis or by autopsy should have been specified. If the incidence of PE is so less than what was the antithrombotic practice of the institute as this piece of information can help to save many lives.