Search Results (154)

Millions of healthcare workers experience percutaneous exposure to bloodborne communicable infectious disease pathogens annually, with the risk of contracting occupationally acquired infections. In this study, we aimed to assess the status of occupational safety and outbreak preparedness in Congolese nurses and laboratory technicians in Kongo central and the Katanga area, amidst multiple ongoing public health emergencies in the Democratic Republic of the Congo (DRC). This was a multicenter analytical cross-sectional study conducted in five referral hospitals located in Kongo central province and the Katanga area between 2019 and 2020 amidst Ebola, Yellow fever, Cholera and Chikungunya outbreaks. Participants were adult A0 grade nurses, A1 nurses, A2 nurses and medical laboratory technicians (N = 493). They answered a structured, self-administered questionnaire related to hospital hygiene and standard precautions for occupational infection prevention. The majority of the respondents were females (53.6%), and 30.1% of them have never participated in a training session on hospital infection prevention during their career. The proportions of those who have been immunized against hepatitis B virus (HBV) was markedly low, at 16.5%. Of the respondents, 75.3% have been using safety-engineered medical devices (SEDs), whereas 93.5% consistently disinfected medical devices after use. Moreover, 78% of the respondents used gloves during medical procedures and 92.2% wore masks consistently. A large majority of the respondents, 82.9%, have been recapping the needles after use. Regarding participation in outbreak response, 24.5% and 12.2% of the respondents were Chikungunya and Cholera epidemic responders, respectively; 1.8% have served in Ebola outbreak sites. The proportion of the respondents who sustained at least one percutaneous injury by needlestick or sharp device, blood/body fluid splash or both in the previous 12-month period was high, 89.3% (41.8% for injury, 59.2% for BBF event), and most of them (73%) reported over 11 events. Compared to laboratory technicians, nurses had higher odds for sustaining percutaneous injury and BBF events [OR = 1.38 (0.16); p < 0.01], whereas respondents with longer working experience were less likely to sustain those events [OR = 0.47 (0.11); p < 0.001]. Findings from this study suggest that Congolese nurses and laboratory technicians experience a high frequency of injury and BBF events at work, and remain at high risk for occupationally acquired infection. There is a need for periodic capacity-building training for the healthcare workforce to improve infection prevention in health settings, the provision of sufficient and appropriate PPE and SEDs, post-exposure follow-up and keeping records of occupational injuries in hospitals in Congolese healthcare settings. Full article

Background: Ischemic heart disease is the primary contributor to global mortality. The QRS-T angle at the anterior aspect of the heart serves as a significant biomarker of the heterogeneity in myocardial repolarization and the electrophysiological instability of the cardiac myocytes. A wide frontal QRS-T angle is associated with proximal vascular disease, coexistence of three-vessel disease, and increased mortality. Hereby, we aimed to examine the relationship between collateral circulation and frontal QRS-T angle in patients with chronic total occlusion (CTO). Methods: A cohort comprising 120 patients (17 females, 14.1%) who received a diagnosis of chronic total occlusion (CTO) subsequent to the administration of coronary angiography conducted for the evaluation of stable angina pectoris was incorporated into the investigation. The electrocardiographs of the patients were evaluated in detail, and the frontal QRS-T angle was calculated. The patients were categorized into two groups: subjects exhibiting an increased frontal QRS-T angle (>110° for men, >90° for women) and those presenting with a normative frontal QRS-T angle. Coronary angiographies of the patients were analyzed, and coronary collateral circulation was classified according to Rentrop classification. Results: Serum albumin level (OR = 0.711, 95% CI 0.564–0.896; p = 0.004) and poor collateral flow (OR = 17.7, 95% CI 12.2–85.3; p < 0.001) were significant predictors of raised frontal QRS-T angle. Conclusions: The frontal QRS-T angle is a novel parameter that is more reliable, consistent, and less sensitive to miscalculation and misidentification than other conventional electrocardiographic myocardial repolarization parameters. Revealing the bad collateral relationship with the frontal QRS-T angle may enable physicians to take more stringent precautions and change the risk factors related to the increased QRS-T angle in advance. Full article

Background: Large-volume paracentesis (LVP) of the peritoneal and pleural cavities is a common diagnostic and therapeutic intervention in patients with liver cirrhosis or advanced heart failure, which are both frequently associated with ascites or pleural effusion. Although generally regarded as a low-risk procedure, LVP may lead to complications such as intrapleural or intra-abdominal hemorrhage, and more commonly abdominal wall bleeding, as well as organ puncture and infection. Performing LVP in patients with coagulopathy or bleeding disorders, whether disease-related or due to anticoagulant therapy, poses a significant clinical challenge. The safety thresholds for such procedures remain inconsistent, and strategies to mitigate bleeding risk are still debated among professional societies. Methods: This review integrates institutional experience with a systematic synthesis of the current international literature to identify the safest and most effective approaches for performing LVP in patients with coagulopathy. The methodological framework included a comparative analysis of existing professional guidelines, as well as a critical evaluation of published evidence regarding risk stratification, pre-procedural correction strategies, and peri-procedural management. The evidence grading was assessed with the STAIR checklist. Results: Analysis of the evidence revealed substantial variability among professional recommendations concerning acceptable platelet and INR thresholds, as well as differing approaches to the management of patients receiving anticoagulant or antiplatelet therapy. Despite these discrepancies, the aggregated data support the conclusion that LVP can be performed safely in most patients with mild-to-moderate coagulopathy, provided that appropriate risk assessment and technical precautions are implemented. Conclusions: The resulting evidence-informed suggestions provide a practical framework for clinicians performing LVP in high-risk patients. By emphasizing systematic pre-procedural evaluation, individualized management of coagulopathy, and adherence to standardized procedural techniques, this work aims to promote safety, consistency, and confidence in the performance of large-volume paracentesis across diverse clinical settings. Full article

Background: Dental professionals were thought to have the most significant risk of coronavirus infection during the pandemic. Since the first Coronavirus Disease 2019 (COVID-19) patient was detected in Japan in January 2020, Japan has faced several waves of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections. However, no cluster of SARS-CoV-2 infections associated with dental procedures has been reported in Japan. In this study, we aimed to investigate the actual status of SARS-CoV-2 infection during the pandemic through antibody testing for dental professionals. We further investigated saliva and oral management-related aerosol to estimate the risk of virus transmission during dental procedures. Methods: SARS-CoV-2 antibody titer in the blood of dental professionals and their families was determined during the pre-vaccinated period of the SARS-CoV-2 wave to see the history of infection in Japan. Viral loads in saliva and in the aerosol generated during the oral management of COVID-19 patients were detected by RT-qPCR. Results: The antibody testing of dental healthcare providers during the early phases of the pandemic in Japan revealed low antibody positivity, which supported the low incidence of infection clusters among dental clinics. The aerosol generated during dental procedures may contain trace levels of SARS-CoV-2, indicating the risk of transmission through dental procedures is limited. Therefore, SARS-CoV-2 did not spread through dental clinics. Conclusions: Very few SARS-CoV-2 infections were observed in dental professionals who took appropriate infection control measures in the early period of the pandemic. Performing dental procedures using standard precautions seems to be sufficient to prevent SARS-CoV-2 infections. Full article

Campylobacteriosis has been described as an ever-changing disease and health issue that is rather dangerous for different population groups all over the globe. The World Health Organization (WHO) reports that 33 million years of healthy living are lost annually, and nearly one in ten persons have foodborne illnesses, including Campylobacteriosis. This explains why there is a need to develop new policies and strategies in the management of diseases at the intergovernmental level. Within this framework, an advanced stochastic fractional delayed model for Campylobacteriosis includes new stochastic, memory, and time delay factors. This model adopts a numerical computational technique called the Grunwald–Letnikov-based Nonstandard Finite Difference (GL-NSFD) scheme, which yields an exponential fitted solution that is non-negative and uniformly bounded, which are essential characteristics when working with compartmental models in epidemic research. Two equilibrium states are identified: the first is an infectious Campylobacteriosis-free state, and the second is a Campylobacteriosis-present state. When stability analysis with the help of the basic reproduction number $R_0$ is performed, the stability of both equilibrium points depends on the $R_0$ value. This is in concordance with the actual epidemiological data and the research conducted by the WHO in recent years, with a focus on the tendency to increase the rate of infections and the necessity to intervene in time. The model goes further to analyze how a delay in response affects the band of Campylobacteriosis spread, and also agrees that a delay in response is a significant factor. The first simulations of the current state of the system suggest that certain conditions can be achieved, and the eradication of the disease is possible if specific precautions are taken. The outcomes also indicate that enhancing the levels of compliance with the WHO-endorsed SOPs by a significant margin can lower infection rates significantly, which can serve as a roadmap to respond to this public health threat. Unlike most analytical papers, this research contributes actual findings and provides useful recommendations for disease management approaches and policies. Full article

Background/Objectives: Healthcare-associated infections (HAIs), including sepsis, represent a major challenge in clinical practice owing to their impact on patient outcomes and healthcare systems. Large language models (LLMs) offer a potential solution by analyzing clinical documentation and providing guideline-based recommendations for infection management. This study aimed to evaluate the performance of LLMs in extracting and assessing clinical data for appropriateness in infection prevention and management practices of patients admitted to an infectious disease ward. Methods: This retrospective proof-of-concept study analyzed the clinical documentation of seven patients diagnosed with sepsis and admitted to the Infectious Disease Unit of San Bortolo Hospital, ULSS 8, in the Veneto region (Italy). The following five domains were assessed: antibiotic therapy, isolation measures, urinary catheter management, infusion line management, and pressure ulcer care. The records, written in Italian, were anonymized and paired with international guidelines to evaluate the ability of LLMs (ChatGPT-4o) to extract relevant data and determine appropriateness. Results: The model demonstrated strengths in antibiotic therapy, urinary catheter management, the accurate identification of indications, de-escalation timing, and removal protocols. However, errors occurred in isolation measures, with incorrect recommendations for contact precautions, and in pressure ulcer management, where non-existent lesions were identified. Conclusions: The findings underscore the potential of LLMs not merely as computational tools but also as valuable allies in advancing evidence-based practice and supporting healthcare professionals in delivering high-quality care. Full article

Dietary fiber is present in many food categories (fruits, cereals, vegetables, legumes), and is considered a beneficial component of adult and children’s diets. It is now well-established that dietary intervention is the first line of treatment for childhood dyslipidemia, both as a curative intervention (Familial Hyperchylomicronemia Syndrome, Sitosterolemia) and as an appropriate lifestyle aimed at improving the lipid profile in dyslipidemia, which is associated with early atherosclerosis and an increased risk of cardiovascular disease in adulthood (Familial Hypercholesterolemia, overweight- and obesity-related dyslipidemia). In this paper, we reviewed the main consensus documents to determine the current indications for its use in children and adolescents, and analyzed the few specific papers on the subject in the literature to assess how fiber is currently used in the treatment of pediatric dyslipidemia, what precautions should be taken, and what the main benefits of fiber are on the lipid profile and cardiovascular risk. Full article

Mpox (formerly known as monkeypox), the major public health concern of 2022, has elicited much attention globally. In addition to the usual symptoms observed in smallpox virus infections, infected mothers were found to hold a possible risk of transmission to newborns during delivery. This review aimed to summarize recent clinical trials that involved antiviral therapy, vaccines, immunoglobulin therapy, and other pharmacological interventions specifically for treating infected pregnant women. A comprehensive search was performed using databases such as PubMed, Google Scholar, and Medline to find appropriate disease management strategies. Amongst the vaccines and antivirals being used for treatment, vaccines such as Modified Vaccinia Ankara (MVA/MVA-BN) and Lister clone 16-medium pocket size-8 (LC16m8), while prophylactically effective, have been deemed unsafe for pregnant and lactating females. Antivirals like Tecovirimat, on the other hand, are considered to be a better alternative, but they are not without risks that may outweigh the potential benefits. Additionally, efforts to reduce maternal and fetal complications include administering the MVA-BN vaccine and awareness campaigns regarding herd immunity. Therefore, necessary precautions, prophylactic vaccinations in high-risk outbreak regions, and symptomatic treatment in pregnant and lactating females currently appear to be more feasible approaches against the mpox virus. Full article

Crop failure is defined as crop production that is significantly lower than anticipated, resulting from plants that are harmed, diseased, destroyed, or influenced by climatic circumstances. With the rise in global food security concern, the earliest detection of crop diseases has proven to be pivotal in agriculture industries to address the needs of the global food crisis and on-farm data protection, which can be met with a privacy-preserving deep learning model. However, deep learning seems to be a largely complex black box to interpret, necessitating a prerequisite for the groundwork of the model’s interpretability. Considering this, the aim of this study was to follow up on the establishment of a robust deep learning custom model named CropsDisNet, evaluated on a large-scale dataset named “New Bangladeshi Crop Disease Dataset (corn, potato and wheat)”, which contains a total of 8946 images. The integration of a differential privacy algorithm into our CropsDisNet model could establish the benefits of automated crop disease classification without compromising on-farm data privacy by reducing training data leakage. To classify corn, potato, and wheat leaf diseases, we used three representative CNN models for image classification (VGG16, Inception Resnet V2, Inception V3) along with our custom model, and the classification accuracy for these three different crops varied from 92.09% to 98.29%. In addition, demonstration of the model’s interpretability gave us insight into our model’s decision making and classification results, which can allow farmers to understand and take appropriate precautions in the event of early widespread harvest failure and food crises. Full article

The safety precautions required for certain pathogens are different in clinical laboratories and patient-facing healthcare settings, causing confusion for laboratorians and infection preventionists. The current review aims to summarize information from reputable Government of Canada guidance commonly used in clinical laboratories in Canada, including the Government of Canada Human Pathogens and Toxins Act and Regulations, the ePATHogen—Risk Group Database, biosafety directives and advisories, Transportation of Dangerous Goods Regulations, and the Canadian Biosafety Standard (2022). Guidelines from the Centers for Disease Control and Prevention’s (CDC) Biosafety in Microbiological and Biomedical Laboratories (2020), Clinical and Laboratory Standard Institution’s (CLSI) M29 Protection of Laboratory Workers from Occupationally Acquired Infections (2014), and Association of Public Health Laboratories’s Biothreat Agent Bench Cards for the Sentinel Laboratory (2018) were also used to supplement specific details. In comparison, information regarding infection prevention and control practices in patient-facing healthcare settings was summarized: Public Health Agency of Canada: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings (2017) and CDC Infection Control Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007). Contrasting levels of precautions exist between laboratories and patient-facing settings, especially for endemic fungi and certain security-sensitive biological agents. Acknowledging this contrast may facilitate risk communication relative to the counterparts to minimize the threat and disease effects and ensure public confidence. Full article

Background: Despite kidney transplantation being a life-saving procedure, patients experience a high risk of developing fungal infections (FIs), with an increased risk of both morbidity and mortality, especially during the first year after transplant. Methods: We herein conducted a narrative review of the most common FIs in kidney transplant recipients (KTRs), with a focus on prevalence, risk factors, mortality, and prevention strategies. Results: The most common fungal pathogens in KTRs include Candida species (up to 70% of the overall FIs), Aspergillus species, Pneumocystis jiroveci, and Cryptococcus species. Fungal colonization, diabetes mellitus, chronic liver disease, malnutrition, and pre-existing lung conditions should all be acknowledged as possible predisposing risk factors. The mortality rate can vary from 25 to 50% and according to different settings and the types of FIs. Preventive strategies are critical for reducing the incidence of FIs in this population. These include antifungal prophylaxis, environmental precautions, and infection control measures. The use of novel tools (such as PCR-based molecular assays and NGS) for rapid and accurate diagnosis may play an important role. Conclusions: Early recognition, the appropriate use of antifungal therapy, and preventive strategies are essential for improving graft loss and fatal outcomes in this vulnerable population. Future research is needed to optimize diagnostic tools, identify novel antifungal agents, and develop better prophylactic strategies for high-risk transplant recipients. Full article

In light of the demographic shift towards an aging population, there is an increasing prevalence of dementia among the elderly. The negative impact on mental health is preventing individuals from taking proper care of themselves. For individuals requiring hospital care, those receiving home care, or as a precaution for a specific individual, it is advantageous to utilize monitoring equipment to track their biological parameters on an ongoing basis. This equipment can minimize the risk of serious accidents or severe health hazards. The objective of the present research project is to design an armband with an accurate location tracking system. This is of particular importance for individuals with dementia and Alzheimer’s disease, who frequently leave their homes and are unable to find their way back. The proposed armband also includes a fingerprint identification system that allows only authorized personnel to use it. Furthermore, in hospitals and healthcare facilities the biometric identification system can be used to trace periodic medical or nursing visits. This process improves the reliability and transparency of healthcare. The test results indicate that the armband functions in accordance with the desired design specifications, with performance evaluation of the main features including fall detection, where a hit rate of 100% was obtained, a fingerprint recognition test demonstrating accuracy from 88% to 100% on high-quality samples, and a GPS tracking test determining position with a difference of between 1.8 and 2.1 m. The proposed solution may be of benefit to healthcare professionals, supported housing providers, elderly people as target users, or their family members. Full article

Background: Creutzfeldt–Jakob disease (CJD) is a rare, fatal, and transmissible neurodegenerative disorder caused by prion proteins. Handling specimens from individuals with suspected or confirmed cases presents a safety challenge to hospital workers including clinical laboratory staff. As no national guidelines exist, the clinical pathology laboratory must establish protocols for handling these specimens to ensure sufficient protective measures. This study aims to explore how various medical institutions manage CJD specimens, as a first step toward developing standardized preanalytical protocols for safe specimen handling by health care professionals. Methods: An electronic survey was generated and disseminated to diplomats of the American Board of Clinical Chemistry and was posted on the Listserv platform of the American Society for Microbiology and the Artery forum of the Association for Diagnostics and Laboratory Medicine. The survey evaluated various procedures and precautions implemented, the nature of the specimens processed, and whether they are processed in-house or sent to reference laboratories. Results: A total of 49 responses were collected. Most respondents (64%) noted their laboratories process specimens with a clinical suspicion of CJD regardless of the level of suspicion, 13% handled specimens only if the degree of suspicion was low, and 16% did not process specimens in-house at all. Among those who process CJD specimens, practices varied greatly, including different levels of precautions, use of biological safety cabinets, aliquoting, disposal, and disinfection procedures. Conclusions: A lack of standardization across laboratories exists for the handling of specimens of patients with suspected CJD. This study summarizes the approaches reported by survey respondents, providing a rationale for developing protocols for the safe handling of these specimens and highlighting the need to develop uniform universal standardized processing procedures. Full article

The study of microRNAs (miRNAs) has emerged in recent decades as a key approach to understanding the pathophysiology of many diseases, exploring their potential role as biomarkers, and testing their use as future treatments. Not only have neurological, cardiovascular diseases, or cancer benefited from this research but also infertility. Female infertility, as a disease, involves alterations at multiple levels, such as ovarian and uterine alterations. This review compiles the latest studies published in humans that link female disorders that affect fertility with altered miRNA profiles. Studies on ovarian alterations, including diminished ovarian reserve (DOR), poor ovarian response to stimulation (POR), premature ovarian insufficiency (POI), and polycystic ovary syndrome (PCOS), are summarized and classified based on the expression and type of sample analyzed. Regarding uterine disorders, this review highlights upregulated and downregulated miRNAs primarily identified as biomarkers for endometriosis, adenomyosis, decreased endometrial receptivity, and implantation failure. However, despite the large number of studies in this field, the same limitations that reduce reproducibility are often observed. Therefore, at the end of this review, the main limitations of this type of study are described, as well as specific precautions or safety measures that should be considered when handling miRNAs. Full article

Infliximab (IFX) is a recombinant DNA-derived chimeric IgG monoclonal antibody protein that inhibits tumor necrosis factor alpha (TNF-α). IFX, like other agents derived from foreign proteins, can cause infusion reactions both during and after the infusion. The incidence of infusion reactions ranges between 0% and 15% in pediatric patients. The potential underlying mechanisms for these reactions may include anaphylaxis and anaphylactoid reactions, cytokine release syndrome, serum sickness-like reactions, and the development of antibodies against IFX. Several precautions can help reduce the risk of a new infusion reaction, such as a gradual increase in the infusion rate, scheduled infusions, and administering premedication or immunomodulators alongside IFX. Acute mild to moderate reactions often resolve spontaneously after a temporary cessation of the infusion or reduction in the infusion rate. Strategies like graded dose challenges and premedication can be utilized to prevent recurrence. In cases of severe reactions, desensitization or switching to an alternative biologic may be considered. This article aims to review the most recent guidelines for managing IFX-related infusion reactions in pediatric patients with inflammatory bowel disease (IBD), relying on the best available evidence. Full article