Objectives Hospital-acquired infections (HAIs) are significant problems as public health issues which need attention. Such infections are significant problems for society and healthcare organizations. This study aimed to carry out a systematic review and a meta-analysis to analyze the prevalence of HAIs globally. Methods We conducted a comprehensive search of electronic databases including EMBASE, Scopus, PubMed and Web of Science between 2000 and June 2021. We found 7031 articles. After removing the duplicates, 5430 studies were screened based on the titles/ abstracts. Then, we systematically evaluated the full texts of the 1909 remaining studies and selected 400 records with 29,159,630 participants for meta-analysis. Random-effects model was used for the analysis, and heterogeneity analysis and publication bias test were conducted. Results The rate of universal HAIs was 0.14 percent. The rate of HAIs is increasing by 0.06 percent annually. The highest rate of HAIs was in the AFR, while the lowest prevalence were in AMR and WPR. Besides, AFR prevalence in central Africa is higher than in other parts of the world by 0.27 (95% CI, 0.22–0.34). Besides, E. coli infected patients more than other micro-organisms such as Coagulase-negative staphylococci, Staphylococcus spp. and Pseudomonas aeruginosa. In hospital wards, Transplant, and Neonatal wards and ICU had the highest rates. The prevalence of HAIs was higher in men than in women. Conclusion We identified several essential details about the rate of HAIs in various parts of the world. The HAIs rate and the most common micro-organism were different in various contexts. However, several essential gaps were also identified. The study findings can help hospital managers and health policy makers identify the reason for HAIs and apply effective control programs to implement different plans to reduce the HAIs rate and the financial costs of such infections and save resources.

/pdf/global-prevalence-of-nosocomial-infection-a-systematic-2e87jawy.pdf

Global prevalence of nosocomial infection: A systematic review and meta-analysis

Scalp-recorded somatosensory evoked potentials (SEPs) have been successfully used in neonatal assessment for several decades. The current routine SEP paradigm is markedly predictive for future cerebral palsy (CP) or other neurocognitive sequelae in brain-injured babies. Recent advances in basic science have dramatically increased our knowledge about structural-functional development of SEP-related brain mechanisms. It has thereby become apparent that preterm SEP differs from that in more mature counterparts in that it also comprises responses from transient brain structures, and hence being unique to the preterm period. It is now obvious also that several aspects in the current SEP paradigm, ranging from the type of stimulation to the methods of recording and analysis, are suboptimal for preterm babies. Recent progress in recording and analysis techniques have made it possible to combine SEP studies with EEG recordings, as well as to implement advanced analyses (e.g. time-frequency analysis) into routine practice. This review summarizes literature from relevant areas in basic science, and proposes a novel, integrated approach in neonatal SEP studies in order to significantly increase the fidelity of testing somatosensory system.

Neonatal SEP – Back to bedside with basic science

Distribution of fipronil in humans, and adverse health outcomes of in utero fipronil sulfone exposure in newborns.

Background and purpose To the best of our knowledge, no information is available regarding the treatment of vulvovaginal candidiasis in gynecological practices. The goal of this study was to analyze the prevalence of vulvovaginal candidiasis (VVC) and the drugs prescribed for the treatment of this condition in women followed in gynecological practices in Germany. Materials and methods All the women followed in 262 gynecological practices between November 2014 and October 2016 were included in this study. The first outcome was the prevalence of patients diagnosed with VVC during this period. The second outcome was the prevalence of women with VVC who received an appropriate vaginal or systemic antimycotic prescription within 30 days after their first VVC diagnosis. Covariables included the use of gynecological/systemic antibiotics, consumption of oral/vaginal contraceptives, cancer, pregnancy, diabetes, and psychiatric diseases including depression, anxiety, and adjustment and somatoform disorders. Results Between 2014 and 2016, 954,186 women were followed in gynecological practices, and 50,279 (5.3%) women were diagnosed with VVC during the same period. The use of gynecological antibiotics (OR=2.88), systemic antibiotics (OR=1.45), oral contraceptives (OR=1.74), and vaginal contraceptives (OR=1.84) were associated with an increase in the risk of VVC diagnosis. Cancer (OR=1.20) and pregnancy (OR=1.59) were additional risk factors. Approximately 75% of women diagnosed with VVC received an antimycotic prescription. The three most frequently prescribed drugs were clotrimazole (72%), fluconazole (14%), and nystatin (6%). Conclusion More than 5% of women were diagnosed with VVC and the majority of them received an appropriate prescription.

https://cmm.mazums.ac.ir/article_90372_a292c3f53c2e70481a576403fa0381e7.pdf

Prevalence of vulvovaginal candidiasis in gynecological practices in Germany: A retrospective study of 954,186 patients.

Purpose The aim of the present study was to compare the effect of muscle length on the level of voluntary activation (VA) at short and long muscle lengths between children and adults. Methods Thirteen prepubertal boys (10.2 ± 1.1 yr) and 10 men (23.9 ± 2.9 yr) performed 5-s maximal isometric voluntary contractions of the knee extensor muscles at three muscular angles (20°, 90°, 100°; 0°, full extension) interspersed with at least 60-s passive recovery periods. Single magnetic stimulations were delivered to the femoral nerve during maximal isometric voluntary contractions to determine the level of VA using the twitch interpolation technique. The specific torque was calculated as the absolute torque divided by thigh muscle mass, as assessed using dual-energy x-ray absorptiometry. Finally, the theoretical specific torque that could be produced with a complete (i.e., 100%) activation level (specific torque at 100% VA) was estimated from the values of specific torque and VA. Results Results showed a higher specific torque in adults at 90° and 100° but not at 20°. Accordingly, VA was significantly higher in adults at 90° (94% ± 4% vs 88% ± 8%, P Conclusions The lower ability of children to fully activate their motor units at long muscle length could account for their lower specific torque because no difference in theoretical specific torque was observed between groups at 90° and 100°.

Effect of muscle length on voluntary activation level in children and adults

UNLABELLED Vulvovaginal candidiasis is the second most common cause of vaginitis worldwide (after bacterial candidiasis). Maternal vulvovaginal candidiasis is a major risk factor for Candida colonization and infection of the infant where prognosis depends on different predisposing factors. The aim of this study was to determine the incidence and the etiological structure of vulvovaginal candidiasis in pregnant women and its impact on Candida colonization of newborns. MATERIALS AND METHODS Samples of vaginal secretions from 80 healthy pregnant women who were clinically suspicious for Candida vaginitis were collected within 48 hours before delivery. Samples for probable Candida colonization from the oral mucosa and feces were collected from their newborns within 47-72 hours after birth. Samples were plated on Sabouraud agar, followed by species identification by API Candida yeast assay. RESULTS Twenty-three (28.75 ± 5.06%) of the evaluated pregnant women were positive for Candida spp. Positive samples for Candida colonization were found in 18 (22.22 ± 4.62%) of the examined 81 newborns (one pair of twins) from mothers who were clinically suspicious for vaginal candidiasis. Isolates of the newborns were 100% identical to those of the mothers' vaginal secretion. Candida albicans was the predominant species identified in the pregnant women (91.67 ± 0.06%) and in the neonates (83.33±8.78%).

/pdf/vulvovaginal-candidiasis-in-pregnant-women-and-its-cbazmuxfju.pdf

Vulvovaginal Candidiasis in Pregnant Women and its Importance for Candida Colonization of Newborns.

Background A low Apgar score at 5 minutes has been shown to be a risk factor for development of retinopathy of prematurity (ROP). Aim To examine the prognostic value of Apgar score at 5 minutes for development and progression of ROP. Materials and methods The study included 132 preterm infants who were screened from 4th week of life onward. Of these, 118 newborns were given Apgar score at 5 minutes. The prognostic significance of this index was studied as an absolute value and as a value ≤ 6. The patients were divided into two groups: group I had no evidence of ROP (n=82) and group II had some signs of ROP (n = 36). Group II was further divided into group IIA - spontaneously regressed cases (n=22), and group IIB with cases which progressed to treatment stages (n=14). We investigated 15 maternal and 20 newborn presumable risk factors for development and progression of ROP. Mann-Whitney U test, χ2 or Fisher's exact test were used in the statistical analysis. Logistic regression was performed to find significant and independent risk factors for manifestation and progression of ROP. Results A low 5-minute Apgar score and an Apgar score of 6 or less at 5 minutes were not statistically significant risk factors of ROP (р=0.191, р=0.191, respectively), but were significant risk factors for the manifested ROP to progress to stages requiring treatment (p=0.046, р=0.036, respectively). Conclusion An Apgar score at 5 minutes of 6 or less was a significant and independent risk factor for progression of ROP to stages requiring treatment.

/pdf/the-5-minute-apgar-score-as-a-prognostic-factor-for-51le59vg8a.pdf

The 5-minute Apgar Score as a Prognostic Factor for Development and Progression of Retinopathy of Prematurity.

Introduction Nosocomial infections (NI) are frequent complications in neonatal intensive care units (NICU) which result in high morbidity and mortality. Aim To determine and analyze the incidence, risk factors and etiologic agents of NI in newborns admitted in the NICU to help plan-ning future surveillance and prevention strategies. Materials and methods A prospective cohort study was carried out at the NICU of St George University Hospital, Plovdiv, Bul-garia from January 1, 2017 to June 31, 2018. The number of neonates included in the study was 507. Descriptive statistics such as count, percent, mean and standard deviation was used. Chi-square test was performed to prove associations. Odds ratios, with 95% confidence intervals, were computed from the results of the binominal logistic regression analyses. Results Of the 507 hospitalized newborns in NICU, 48 presented with 54 NI. The incidence and the density incidence rates were 9.5% and 7.67 per 1,000 patient-days, respectively. Nosocomial infections were detected in neonates from all birth weight (BW) classes, but it was low BW and premature neonates that were at major risk to acquire them. The most common infection sites were ventilator-asso-ciated pneumonia (VAP) (67.27%), bloodstream infection (23.64%) and conjunctivitis (9.09%). Major pathogens were Gram-negative such as Klebsiella pneumoniae, E. coli, Pseudomonas aeruginosa and Acinetobacter baumannii. In the multivariate logistic regression analysis NIs were strongly associated with intubation, presence of a venous catheter, the duration of antibiotic treatment and increased CRP> 10 mg/l. Conclusions This report highlights the burden of NIs, identifies the major focus for future NI control and prevention programs.

Surveillance of Nosocomial Infections in a Bulgarian Neonatal Intensive Care Unit.

AIM The aim of the study was to investigate the configuration and latency of the somatosensory evoked potentials (SEPs) in healthy children for the time from the neonatal period to adolescence. MATERIAL AND METHODS SEPs were recorded in 67 healthy children--37 boys and 30 girls from 0 to 16 years of age by means of median nerve stimulation. The active electrode was placed above the contralateral parietal cortex on places C3' and C4' and the reference electrode--on Fpz. The filters were 10-1000 Hz and the frequency of the electric stimulus--3 Hz. RESULTS The depression of the potential in the neonatal period is accounted for by the wide base and low amplitude of SEPs. The configuration of SEPs is identical with that of adult individuals after 3 years of age. The latencies of the waves P15, N20 and P25 decrease progressively with age and lengthen in the period from 9 to 16 years of age, with the increase of height. The interpeak latencies P15 - N20, N20 - P25 and P15 - P25 decrease with age, while the amplitude N20/P25 increase with age. We found significant variability in the amplitude of the potential, most pronounced in the neonatal period. It gradually decreases by 10-14 months of age and after that remains unchanged. We did not find any differences at stimulation between the left and the right hand. CONCLUSION The age-related changes in SEPs reflect the trends of the development and the maturation of the neural pathways and their better myelinization.

Age-related changes of the somatosensory evoked potentials in healthy children.

It is known that control of procedural pain in newborns is an ethical act and requires treatment. It includes homeopathic agents used in certain clinical conditions in neonatology. The purpose of this prospective study is to determine the effect of administration of the preparation of Arnica D30 to reduce the severity of procedural pain induced by pricking the heel of the newborn in neonatal screening. Performed in a clinical study of 124 full-term infants aged 72-84 hours divided into two groups: the first group (A) n=67 infants, that do not apply anesthesia and a second group (B) n=57 infants receiving Arnica D30 in the form of an oral solution three times on the day of the procedure and a time in the range 12-24 hours after the procedure. The results are reported in: 30th sec. and the 5th minute after the puncture of the heel. The same indices were followed in the interval 12-24 hours after the screening. The 30th second after the penetration in the heel in Group A and Group B children did not reveal any credible differences on any of the scale indicators as well as the overall assessment of the severity of procedural pain. Comparison between the two groups of the 5th minute after the procedure found lower estimates in group ? (with analgesia). These differences between the groups are also valid for the overall score, which showed lower levels for those who have received an Arnica. The use of Arnica D30 affects the severity of procedural pain in neonates.

/pdf/possibilities-of-arnica-d30-for-reducing-the-procedural-pain-2mjo768xiv.pdf

Possibilities of arnica D30 for reducing the procedural pain in the neonatal period

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