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Nigerian Journal of Clinical Practice Jun 2024Antimicrobial stewardship is an important action plan for curbing the rising trend of antimicrobial resistance (AMR). Surveillance of antimicrobial use and consumption...
BACKGROUND
Antimicrobial stewardship is an important action plan for curbing the rising trend of antimicrobial resistance (AMR). Surveillance of antimicrobial use and consumption is needed as baseline data and for monitoring the impact of antimicrobial stewardship interventions. The survey was done to understand the burden of AMR, in view of establishing an antimicrobial stewardship program in our hospital.
METHODS
A point prevalence survey (PPS) of antimicrobial use and consumption was conducted on all inpatients admitted before 8.00 am on the days of the survey using a standardized questionnaire. The collected data were entered online into the Global PPS web-based application (www.global-pps.com), for analysis.
RESULT
Of the 178 patients admitted during the survey period, 50.6% were on one or more antimicrobial agents. All the patients in adult intensive care units were on antibiotics (100%), followed by neonatal intensive care units (83.3%), with the least being adult medical wards (39.4%). Beta-lactam antibiotics were the most frequently prescribed antimicrobial for various infections, especially skin and soft tissue infections, 41.3%, which were the most common diagnoses treated with antibiotics. The infection was mostly community-acquired (81.6%), of which 94.9% were treated empirically. There was no written guideline in existence.
CONCLUSION
The present study revealed a poor prescribing habit because of a high rate of empirical treatment. The need for antimicrobial stewardship cannot be overemphasized as it will help streamline and improve the prescribing pattern.
Topics: Humans; Antimicrobial Stewardship; Nigeria; Female; Male; Tertiary Care Centers; Adult; Prevalence; Middle Aged; Surveys and Questionnaires; Anti-Bacterial Agents; Practice Patterns, Physicians'; Anti-Infective Agents; Drug Prescriptions; Aged; Adolescent; Young Adult; Drug Utilization
PubMed: 38943293
DOI: 10.4103/njcp.njcp_449_23 -
Journal of Cosmetic Dermatology Jun 2024The increasing quest for effective and safe antiaging skincare solutions has led to a surge in the exploration of natural compounds such as phenolic acids. Despite the...
BACKGROUND
The increasing quest for effective and safe antiaging skincare solutions has led to a surge in the exploration of natural compounds such as phenolic acids. Despite the proven efficacy of traditional antiaging ingredients like retinol, their associated side effects have necessitated the search for alternatives.
AIMS
This study aimed to assess the anti-wrinkle efficacy of a standardized phenolic acids polymer extract (PAPE) from propolis, employing both in vitro and clinical methodologies to explore its suitability as a novel antiaging skincare ingredient for sensitive and nonsensitive skin types.
PATIENTS/METHODS
The study comprised of evaluating PAPE effects on key skin health biomarkers in dermal fibroblasts and keratinocytes. A double-blind, randomized clinical trial involving female participants aged 30-70 years assessed the wrinkle-reducing effectiveness of face creams formulated with two concentrations of PAPE (1.5% and 3%) over a 28-day period.
RESULTS
In vitro studies indicated that PAPE could modulate inflammation and tissue remodeling biomarkers. The clinical trial demonstrated that applying PAPE-enriched cream resulted in significant wrinkle reduction, with 25% and 34% improvements for the 1.5% and 3% PAPE formulations, respectively. Subjective feedback from participants further validated the antiaging efficacy and overall satisfaction with the product.
CONCLUSION
Incorporating PAPE offers a compelling antiaging solution, significantly reducing wrinkle depth with a favorable safety profile. The study substantiates PAPE's potential as an effective and safe alternative to conventional antiaging ingredients, aligning with the cosmetic industry's shift toward natural, evidence-based formulations.
PubMed: 38943252
DOI: 10.1111/jocd.16405 -
Harm Reduction Journal Jun 2024Needle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are...
Economic evaluation of the effect of needle and syringe programs on skin, soft tissue, and vascular infections in people who inject drugs: a microsimulation modelling approach.
BACKGROUND
Needle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are the most common morbidities in people who inject drugs (PWID), the extent to which NSP are clinically and cost-effective in relation to SSTVI in PWID remains unclear. The objective of this study was to model the clinical- and cost-effectiveness of NSP with respect to treatment of SSTVI in PWID.
METHODS
We performed a model-based, economic evaluation comparing a scenario with NSP to a scenario without NSP. We developed a microsimulation model to generate two cohorts of 100,000 individuals corresponding to each NSP scenario and estimated quality-adjusted life-years (QALY) and cost (in 2022 Canadian dollars) over a 5-year time horizon (1.5% per annum for costs and outcomes). To assess the clinical effectiveness of NSP, we conducted survival analysis that accounted for the recurrent use of health care services for treating SSTVI and SSTVI mortality in the presence of competing risks.
RESULTS
The incremental cost-effectiveness ratio associated with NSP was $70,278 per QALY, with incremental cost and QALY gains corresponding to $1207 and 0.017 QALY, respectively. Under the scenario with NSP, there were 788 fewer SSTVI deaths per 100,000 PWID, corresponding to 24% lower relative hazard of mortality from SSTVI (hazard ratio [HR] = 0.76; 95% confidence interval [CI] = 0.72-0.80). Health service utilization over the 5-year period remained lower under the scenario with NSP (outpatient: 66,511 vs. 86,879; emergency department: 9920 vs. 12,922; inpatient: 4282 vs. 5596). Relatedly, having NSP was associated with a modest reduction in the relative hazard of recurrent outpatient visits (HR = 0.96; 95% CI = 0.95-0.97) for purulent SSTVI as well as outpatient (HR = 0.88; 95% CI = 0.87-0.88) and emergency department visits (HR = 0.98; 95% CI = 0.97-0.99) for non-purulent SSTVI.
CONCLUSIONS
Both the individuals and the healthcare system benefit from NSP through lower risk of SSTVI mortality and prevention of recurrent outpatient and emergency department visits to treat SSTVI. The microsimulation framework provides insights into clinical and economic implications of NSP, which can serve as valuable evidence that can aid decision-making in expansion of NSP services.
Topics: Humans; Substance Abuse, Intravenous; Needle-Exchange Programs; Cost-Benefit Analysis; Soft Tissue Infections; Quality-Adjusted Life Years; Vascular Diseases; Skin Diseases, Infectious; Canada; Computer Simulation; Harm Reduction; Female; Male; Adult; Models, Economic
PubMed: 38943164
DOI: 10.1186/s12954-024-01037-3 -
Pain Management 2024Conventionally, peripheral nerve stimulation (PNS) for treatment of chronic pain has involved a two-stage process: a short-term (e.g., 7 days) trial and, if significant... (Review)
Review
Conventionally, peripheral nerve stimulation (PNS) for treatment of chronic pain has involved a two-stage process: a short-term (e.g., 7 days) trial and, if significant pain relief is achieved, a permanent PNS system is implanted. A percutaneous PNS treatment is now available where a coiled lead may be implanted for up to 60 days with the goal of producing sustained relief. In the present review, published prospective trials using percutaneous PNS treatment were identified and synthesized. The collected evidence indicates that percutaneous PNS treatment for up to 60 days provides durable clinically significant improvements in pain and pain interference. Similar efficacy across diverse targets and etiologies supports the broad applicability for use within the chronic pain population using this nonopioid technology.
Topics: Humans; Chronic Pain; Transcutaneous Electric Nerve Stimulation; Pain Management; Peripheral Nerves; Prospective Studies; Treatment Outcome
PubMed: 38939963
DOI: 10.1080/17581869.2024.2352398 -
Oncology Letters Aug 2024Liver cancer near the deep diaphragm can be difficult to visualize due to the effects of lung gas, which presents a challenge for microwave ablation (MWA). The present...
Liver cancer near the deep diaphragm can be difficult to visualize due to the effects of lung gas, which presents a challenge for microwave ablation (MWA). The present study aimed to investigate the feasibility and efficacy of artificial ascites-assisted MWA for treating liver cancer near the deep diaphragm, as well as the significance of perioperative nursing. A retrospective analysis was conducted on patients who underwent artificial ascites-assisted MWA for liver cancer located near the deep diaphragm between January 2016 and December 2022. Normal saline was utilized as artificial ascites to safeguard the deep diaphragm during MWA. The study recorded the procedural success rate, incidence of major complications, technical efficacy of ablation and local tumor progression (LTP). A total of 62 lesions in 54 patients were included, with 44 men and 10 women, and a mean (± SD) age of 55.64±10.33 years. The ultrasound image quality scores for liver cancer before and after ascites were 3.57±0.79 and 4.89±0.33, respectively, showing a statistically significant difference between the two groups (t=16.324; P<0.05). No diaphragm injury, skin burns at the puncture site or abdominal hemorrhage occurred during the procedure. A single patient developed right-sided pleural effusion, which did not require drainage. The complete ablation rate was 94.4% (51/54) at 1 month post-ablation, with 3 patients experiencing recurrence and receiving additional MWA treatment. The median follow-up time for the patients in this study was 21 months (range, 12-45 months), with a LTP rate of 5.6% (3/54). In conclusion, MWA assisted by artificial ascites is a safe and effective treatment for liver cancer near the deep diaphragm. Furthermore, perioperative treatment and rehabilitation of the patients with high-quality nursing is beneficial.
PubMed: 38939625
DOI: 10.3892/ol.2024.14515 -
Journal of Pain Research 2024Herpes zoster (HZ) typically manifests in the acute phase with distinct blisters and severe neuropathic pain. Remarkably, a subset of patients initially presents with...
BACKGROUND
Herpes zoster (HZ) typically manifests in the acute phase with distinct blisters and severe neuropathic pain. Remarkably, a subset of patients initially presents with only a mild skin rash and moderate pain that gradually intensifies, following a parabolic pattern. Despite being frequently observed in clinical settings, the underlying causes of this trajectory and its potential connection with post-herpetic neuralgia (PHN) remain unclear.
METHODS
To investigate this phenomenon in-depth, we conducted a meticulous retrospective study involving 529 eligible HZ patients. All these patients sought medical care at the Third Central Hospital of Tianjin, China, between January 2020 and December 2023.
RESULTS
The research identified that 14.6% of the sample (77 patients) experienced pain scores aligning with a parabolic curve. This trend was significantly more prevalent in patients aged 60 and above, accounting for 90.9% of this group, and demonstrated a positive correlation with age. Moreover, 87.0% of these patients had pre-existing medical conditions, highlighting the potential role of comorbidities in influencing the pain trajectory. A concerning 45.5% of patients sought medical attention more than seven days after the onset of symptoms, a delay that could exacerbate neurological damage. Notably, among those following a parabolic pain pattern, 66.2% eventually developed PHN, a considerably higher rate compared to the broader patient population.
CONCLUSION
We emphasize that healthcare practitioners meticulously assess patients who initially report lower pain scores for high-risk factors potentially leading to parabolic pain increases, including being over 60 years old, having comorbid conditions, and delaying medical consultation beyond seven days from symptom onset. Early implementation of supplementary pain management therapies may mitigate the risk of PHN development and enhance the quality of life for patients. This study furnishes clinicians with a deeper understanding of the variations in HZ-related pain trajectories, promising to improve treatment approaches and prognoses for HZ patients while paving the way for enriched clinical practice in the future.
PubMed: 38939514
DOI: 10.2147/JPR.S461590 -
Aesthetic Surgery Journal. Open Forum 2024In the buttocks and thighs, skin quality, focal adiposity, volume deficiency, skin laxity, and/or textural issues each contribute to overall appearance. For patients...
Cellulite and the Aesthetic Management of the Buttocks and Thighs: 6 Cases Illustrating Targeted Verifiable Subcision as Part of a Multimodal Approach to Lower Body Rejuvenation.
BACKGROUND
In the buttocks and thighs, skin quality, focal adiposity, volume deficiency, skin laxity, and/or textural issues each contribute to overall appearance. For patients undergoing rejuvenation/beautification procedures, global improvement is desired, making multimodal treatment the standard of care to address these mechanistically distinct concerns. Resolution of cellulite depressions is central to patient satisfaction and aesthetic outcomes: without management, the overall aesthetic suffers, and patients are left partially unsatisfied with treatment results. With minimally invasive Targeted Verifiable Subcision (TVS; Avéli [Revelle Aesthetics, Inc., Mountain View, CA]), septa with a confirmed role in dimple formation can be released through mechanically verified subcision, permitting consistent outcomes.
OBJECTIVES
Discuss the application of TVS as part of a multimodal approach to buttock and thigh rejuvenation and share best practices for obtaining optimal improvement.
METHODS
A group of 6 experts in aesthetic plastic surgery and dermatology convened for a 2 h roundtable discussion of select case studies, best practices, and their approaches for obtaining optimal outcomes in clinical practice.
RESULTS
Clinical cases from 6 patients who presented for buttock and/or thigh rejuvenation/beautification are presented where TVS was applied as part of a multimodal approach. Before and after images, details of patient cases, and a discussion of best practices for patient education and evaluation, treatment planning, technique, safety, postprocedure care, and open research questions are included.
CONCLUSIONS
TVS is emerging as a valuable tool for the treatment of cellulite in the buttocks and thighs that may potentially be used alongside surgical and nonsurgical approaches, often on the same day.
PubMed: 38938926
DOI: 10.1093/asjof/ojae031 -
JACS Au Jun 2024MeXpose is an end-to-end image analysis pipeline designed for mechanistic studies of metal exposure, providing spatial single-cell metallomics using laser...
MeXpose is an end-to-end image analysis pipeline designed for mechanistic studies of metal exposure, providing spatial single-cell metallomics using laser ablation-inductively coupled plasma time-of-flight mass spectrometry (LA-ICP-TOFMS). It leverages the high-resolution capabilities of low-dispersion laser ablation setups, a standardized approach to quantitative bioimaging, and the toolbox of immunohistochemistry using metal-labeled antibodies for cellular phenotyping. MeXpose uniquely unravels quantitative metal bioaccumulation (sub-fg range per cell) in phenotypically characterized tissue. Furthermore, the full scope of single-cell metallomics is offered through an extended mass range accessible by ICP-TOFMS instrumentation (covering isotopes from / 14-256). As a showcase, an human skin model exposed to cobalt chloride (CoCl) was investigated. For the first time, metal permeation was studied at single-cell resolution, showing high cobalt (Co) accumulation in the epidermis, particularly in mitotic basal cells, which correlated with DNA damage. Significant Co deposits were also observed in vascular cells, with notably lower levels in dermal fibers. MeXpose provides unprecedented insights into metal bioaccumulation with the ability to explore relationships between metal exposure and cellular responses on a single-cell level, paving the way for advanced toxicological and therapeutic studies.
PubMed: 38938797
DOI: 10.1021/jacsau.4c00154 -
Journal of Burn Care & Research :... Jun 2024This study examines a rare case of frostbite on the hands caused by liquid nitrogen, focusing on the scar maturation process. Frostbite is typically less prone to...
This study examines a rare case of frostbite on the hands caused by liquid nitrogen, focusing on the scar maturation process. Frostbite is typically less prone to abnormal scarring compared to burns, and this report contrasts the differences in scar maturation between the two. A 31-year-old male hospital employee sustained first- to second-degree frostbite on his gloved hands from a 20-second exposure to liquid nitrogen while changing a cylinder. Conservative treatment was applied, and the patient was monitored for 9 months. The deeply affected area took 50 days to epithelialize but healed without hypertrophic scarring. A mild extension contracture was noted in the distal interphalangeal joint of the right index finger, but the skin remained supple and soft. Incidents of liquid nitrogen-induced frostbite are uncommon, with only 14 cases reported in PubMed® previously. In frostbite, the wound healing involves a slow replacement of damaged connective tissue, which acts as an internal splint, reducing wound contraction. This contrasts with burns, where rapid connective tissue replacement occurs, often leading to significant wound contraction due to the presence of myofibroblasts in granulation tissue. In the presented case, the slow healing process and minimal wound contraction led to mature scarring without abnormalities, underlining a distinctive healing trajectory in frostbite injuries compared to burns.
PubMed: 38938100
DOI: 10.1093/jbcr/irae127 -
Journal of Medical Radiation Sciences Jun 2024Magnetic resonance imaging (MRI) is a rapidly evolving modality, generally considered safe due to lack of ionising radiation. While MRI technology and techniques are... (Review)
Review
INTRODUCTION
Magnetic resonance imaging (MRI) is a rapidly evolving modality, generally considered safe due to lack of ionising radiation. While MRI technology and techniques are improving, many of the safety concerns remain the same as when first established. Patient thermal injuries are the most frequently reported adverse event, accounting for 59% of MRI incidents to the Food and Drug Administration (FDA). Surveys indicate many incidents remain unreported. Patient thermal injuries are preventable and various methods for their mitigation have been published. However, recommendations can be variable, fragmented and confusing. The aim of this systematic review was to synthesise the evidence on MRI safety and associated skin injuries and offer comprehensive recommendations for radiographers to prevent skin thermal injuries.
METHODS
Four journal databases were searched for sources published January 2010-May 2023, presenting information on MRI safety and thermal injuries.
RESULTS
Of 26,801 articles returned, after careful screening and based on the eligibility criteria, only 79 articles and an additional 19 grey literature sources were included (n = 98). Included studies were examined using thematic analysis to determine if holistic recommendations can be provided to assist in preventing skin burns. This resulted in three simplified recommendations: Remove any electrically conductive items Insulate the patient to prevent any conductive loops or contact with objects Communicate regularly CONCLUSION: By implementing the above recommendations, it is estimated that 97% of skin burns could be prevented. With thermal injuries continuing to impact MRI safety, strategies to prevent skin burns and heating are essential. Assessing individual risks, rather than blanket policies, will help prevent skin thermal injuries occurring, improving patient care.
PubMed: 38937923
DOI: 10.1002/jmrs.800