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Background: Healthcare-associated infections (HCAIs) are associated with increased morbidity and mortality and with excess costs. Central line-associated bloodstream infections (CLABSIs) are the most common HCAIs in neonates and children. Aim: To establish national benchmark data for rates of CLABSI in neonatal and paediatric intensive care units (NICUs and PICUs) and paediatric oncology units (ONCs). Methods: Active surveillance for CLABSI was conducted from June 2016 to February 2017. A collaborative of 14 NICUs, four PICUs, and six ONCs participated in the programme. Surveillance definitions of central line (CL), central line utilization (CLU) ratio, CLABSI event, and CLABSI rate were based on the Centers for Disease Control and Prevention's 2014 National Healthcare Safety Network criteria. Medical records were assessed daily for calculating CL-days, patient-days, and susceptibility of isolated organisms. Findings: A total of 111 CLABSI episodes were recorded. The overall mean CLABSI rate was 4.41 infections per 1000 CL-days, and the CLU ratio was 0.31. CLABSI rates were 6.02 in NICUs, 6.09 in PICUs, and 2.78 per 1000 CL-days in ONCs. A total of 123 pathogens were isolated. The most common pathogens were Enterobacteriaceae (36%), followed by Gram-positive cocci (29%), non-fermenting Gram-negative bacteria (16%), and fungi (16%). Overall, 37% of Gram-negative pathogens were resistant to third-generation cephalosporins and 37% to carbapenems. Conclusion: Nationally representative CLABSI rates were determined for paediatric patients. These data could be used to benchmark and serve as baseline data for the design and evaluation of infection control and antimicrobial stewardship interventions. © 2018 The Healthcare Infection Society

Background: The Neonatal Infant Pain Scale and the Premature Infant Pain Profile have been used widely in neonatal intensive care units for pain assessment. Aim: This study reports the evaluation and validation of these scales in full-term newborns who were hospitalized in two Greek neonatal intensive care units. Evaluation and validation of the Neonatal Infant Pain Scale and the Premature Infant Pain Profile in full-term newborns who were hospitalized in two Greek neonatal intensive care units. Materials and Methods: This is a cross-sectional study. Two neonatal intensive care units at a large General Children's Hospital in Greece. A total of 81 full-term newborns. This cross-sectional study was conducted in two neonatal intensive care units at a large General Children's Hospital in Greece. We studied 81 full-term newborns, who were exposed to various painful routine procedures. A single measurement was taken from each neonate. Two observers were present during each procedure and evaluated pain using both the Neonatal Infant Pain Scale and Premature Infant Pain Profile. Internal consistency coefficient Cronbach's α internal class agreement coefficient, and κ factor were appropriately measured. Results: The weighting of the Neonatal Infant Pain Scale and Premature Infant Pain Profile pointed out an excellent coherence between the two scales and agreement among the researchers. The internal consistency coefficient Cronbach's α was >.8 and the internal class agreement coefficient was >.98 for both scales, which indicates an excellent consistency between scales. The κ factor for Neonatal Infant Pain Scale was >.73 and for the Premature Infant Pain Profile it was >.6, which indicates a significant agreement among investigators. Conclusions: The Neonatal Infant Pain Scale and Premature Infant Pain Profile were successfully adjusted in Greek standards with reliability between the scales and among the researchers. Moreover, they constitute reliable tools for the evaluation of neonatal procedural pain in full-term newborns in Greece. © 2017 American Society for Pain Management Nursing

Objectives: Cardiac complications because of transfusional iron overload are the main cause of death in thalassaemia major. New chelators and iron monitoring methods such as cardiac magnetic resonance (CMR) became available after the year 2000. We evaluated the impact of these new management options on cardiac mortality and morbidity. Methods: The risk of cardiac death during 1990-1999 and 2000-2008 was compared. Furthermore, after 1999, morbidity, mortality and reversal of heart failure were evaluated according to chelation regime: desferrioxamine (DFO), deferiprone (DFP) and combination therapy of DFO and DFP. We also present preliminary results for deferasirox (DFX), a new oral chelator. Results: Three hundred and fifty-four patients were included in the de novo cardiac event evaluation, while 86 were included in the improvement component. The annual risk of cardiac death in patients aged between 20-30 and 30-40 reduced from 1.52% to 0.67% and 1.87% to 0.56%, respectively, before and after the year 2000. The risk for a de novo cardiac event for DFO was 9.1 times greater than that of DFP and 23.6 than with the combination of DFP and DFO. For DFX, there was one cardiac event over 269 patient-years. The risk of cardiac death was 9.5 per 1000 patient-years for DFO, 2.5 on DFP, 1.4 on combination. In the DFX group no cardiac deaths were recorded. The odds of improvement were 8.5 times greater with DFP and 6.1 with combination therapy compared to DFO. Conclusions: The new chelation regimes, together with CMR have contributed significantly to the reduction in cardiac morbidity and mortality in patients with thalassaemia major. © 2010 John Wiley & Sons A/S. Patients:The risk of cardiac death analysis: n=1124, 597 in 1990-1999 (only Desferal was available) and 527 in 2000-2008 (Desferal, DFP or combination of both were available). De novo cardiac event analysis: n=354; 343 were on Desferal (176 males and 167 females, mean age 21.2 years; 338 in 1999, 316 in 2000, 282 in 2001, 246 in 2002, 189 in 2003, 147 in 2004, 111 in 2005, 69 in 2006, 43 in 2007 and 33 in 2008), 97 DFP (46 males and 51 females, mean age 25.3 years; 2 in 2000, 16 in 2001, 18 in 2002, 42 in 2003, 63 in 2004, 58 in 2005, 50 in 2006, 35 in 2007 and 43 in 2008), and 166 Desferal/DFP combination (79 males and 87 females, mean age 26.7 years; 4 in 2000, 17 in 2001, 40 in 2002, 63 in 2003, 69 in 2004, 92 in 2005, 115 in 2006, 99 in 2007 and 98 in 2008). Improvement component analysis: n=86, 75 Desferal (51 males and 24 females, mean age 26.8 years; 39 in 2000, 42 in 2001, 32 in 2002, 21 in 2003, 19 in 2004, 11 in 2005, 7 in 2006, 5 in 2007 and 4 in 2008), DFP group (21 males and 14 females, mean age 31 years; 1 in 2000, 1 in 2001, 6 in 2002, 12 in 2003, 16 in 2004, 15 in 2005, 14 in 2006, 11 in 2007 and 9 in 2008) and 61 Desferal/DFP (36 males and 25 females, mean age 30.1 years; 1 in 2001, 14 in 2002, 24 in 2003, 24 in 2004, 34 in 2005, 38 in 2006, 36 in 2007 and 29 in 2008). Indications:An unspecified number of patients with transfusional iron overload and cardiac hemosiderosis (characterized by heart failure) and for the prevention of cardiac events. Coexisting disease was thalassemia in all patients. FreeText:All patients received blood transfusion. DFP was given at 75-100 mg/kg daily in 3 divided doses. An unspecified number of patients received DFP concomitantly. Combinations were given at similar doses as with monotherapy, 8-24 hourly infusions/3-7 times per week. Ferritin levels were evaluated. Cardiac (CMR) and hepatic magnetic resonance imaging (MRI) were used to evaluate the degree of cardiac and hepatic iron loading (liver iron concentration [LIC]). Cardiac function was assessed by symptomatology, clinical examination, chest X-rays, electrocardiograms (ECGs) and echocardiography. The risk of cardiac death between 1990-1999 and 2000-2008 was compared in all patients with thalassemia regardless of the chelation regime. The risk of cardiac death (CD) was evaluated in 2 age groups for each time period (20-30 years [yr] vs. 30-40 yr). The assessment of the incidence of de novo cardiac events (CEs) according to the chelation regime was conducted in patients with thalassemia older than 10 years. The development of a CE and the risk of CD in relation to the chelation regime were evaluated. The sum of patients in all groups was greater than the total number of patients in this study. DosageDuration:20-40 mg/kg per infusion with at least 3 (3-5) infusions per week. Duration: not stated. TypeofStudy:An open study evaluating the impact of chelation regimes (Desferal, deferiprone [DFP] and combination of both) on cardiac mortality and morbidity and reversal of heart failure in patients with thalassemia major from 1990-2008. An open, observational study from a large Greek Unit. ComparativeDrug:Deferiprone was given 75-100 mg/kg daily orally in 3 divided doses. Duration: not stated. Results:The risk of cardiac-related death during 1990-1999 vs. 2000-2008 for the 20-30 years (yr) old and 30-40 yr old were 15.2 and 18.7 vs. 6.7 and 5.6, respectively; the rate of death were 30 and 5 vs. 14 and 8, respectively. 63 de novo CEs were noted: 58 Desferal (16 in 1999, 8 in 2000, 13 in 2001, 7 in 2002, 5 in 2003, 6 in 2004, 1 in 2005, 2 in 2006, 1 in 2007 and 0 in 2008), 1 DFP (2003) and 1 Desferal/DFP (2006). Patients on DFP and Desferal/DFP had 9.1 times and 23.6 times, respectively, lower risk of de novo CE vs. Desferal. Patients on any DFP (DFP or Combination) showed 14 times lower risk vs. Desferal group. The odds ratio (OR) for the development of CEs of Desferal vs. DFP groups in patients with mild, moderate and severe hemosiderosis were 3, 3.2 and 10.3, respectively; in Desferal vs. Desferal/DFP groups, 8.9, 9.1 and 9.1, respectively. For Desferal/DFP, the effect was similar in all severities of iron load while for DFP the protective effect is more prominent in severe iron load. The rates of events were 3.3/100 person-years for Desferal (58 events median time on Desferal = 2.4 yr), 0.3/100 person-years for DFP (1 event in a patient after 4 yr on DFP), 0.6/100 person-years for Desferal/DFP (3 events in 3 patients who had been for 6 months, 73 and 35 days, respectively, on combination therapy). In all patients with cardiac improvement and those who have not been included as an improvement, the left ventricular ejection fraction normalized (>60%). Combined 9-yr data revealed that DFP patients were 8.5 times more likely to improve vs. Desferal patients, while those on combination had a 6.1 time greater likelihood. The patients on any DFP had a 6.7 times greater chance of improving vs. Desferal. Increasing level of hemosiderosis reduced the likelihood of improvement. The rates of improvement were 0.6/100 person-years for Desferal, 13.9/100 person-years for DFP, 6/100 person-years for Desferal/DFP. Overall, after 1999, 22 deaths occurred: 20 cardiac-related and 2 other causes (1 accident and 1 thromboembolic event). There were 18 CDs in the Desferal group over 1900 patient-years (risk = 9.5/1000 patients-years, median time of exposure = 2.6 yr), on the DFP group for 393 patient-years (risk = 2.5/1000 patients-years, the 1 death occurred in a patient after 1.3 yr on DFP) and 1 in the Desferal/DFP group over 709 patient-years (risk = 1.4/1000 patients-years, the 1 death occurred in a patient after 4.1 yr on combination therapy). When adjusted for sex and degree of hemosiderosis, the relative risks (RR) of experiencing CD were: Desferal 6.1 RR and 5.7 RR compared to DFP and combination, respectively (marginally non-significant). The RR for Desferal vs. DFP and Desferal/DFP was 5.2. AdverseEffects:No adverse events were mentioned. AuthorsConclusions:New chelation options in patients with thalassaemia have reduced cardiac morbidity and mortality. Cardiac deaths have reduced in many centres throughout the world since the year 2000. The newer chelation regimes demonstrate lower risk of cardiac events. In the past, the onset of cardiac failure in patients with thalassaemia usually progressed to death within a short period of time. This study clearly demonstrates that a significant proportion of patients who developed cardiac events, were able to regain normal cardiac function with appropriate therapy. The new regimes together with better non-invasive diagnostic facilities for identifying both hepatic and cardiac iron load are expected to improve survival even further and reduce incidence and severity of complications caused by haemosiderosis.

Background. Available iron chelation regimes in thalassaemia may achieve different changes in cardiac and hepatic iron as assessed by MR. The aim of this study was to assess the efficacy of four available iron chelator regimes in 232 thalassaemia major patients by assessing the rate of change in repeated measurements of cardiac and hepatic MR. Results. For the heart, deferiprone and the combination of deferiprone and deferoxamine significantly reduced cardiac iron at all levels of iron loading. As patients were on deferasirox for a shorter time, a second analysis ("Initial interval analysis") assessing the change between the first two recorded MR results for both cardiac and hepatic iron (minimum interval 12 months) was made. Combination therapy achieved the most rapid fall in cardiac iron load at all levels and deferiprone alone was significantly effective with moderate and mild iron load. In the liver, deferasirox effected significant falls in iron load and combination therapy resulted in the most rapid decline. Conclusion. With the knowledge of the efficacy of the different available regimes and the specific iron load in the heart and the liver, appropriate tailoring of chelation therapy should allow clearance of iron. Combination therapy is best in reducing both cardiac and hepatic iron, while monotherapy with deferiprone or deferasirox are effective in the heart and liver respectively. The outcomes of this study may be useful to physicians as to the chelation they should prescribe according to the levels of iron load found in the heart and liver by MR. © 2009 Berdoukas et al; licensee BioMed Central Ltd.

Background: There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma. Methods: The GA2LEN network has organized a multicentre case-control study in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12 months. Results: All cases and controls were selected from the same population defined by age and place of residence. Mean plasma selenium concentrations among the controls ranged from 116.3 μg/l in Palermo to 67.7 μg/l in Vienna and 56.1 μg/l among the children in Oslo. Random effects meta-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 μg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally significant adverse effect in Amsterdam (OR: 1.68; 95% CI: 0.98-2.90) and Ghent (OR: 1.35; 95% CI: 1.03-1.77). Conclusion: This study does not support a role for selenium in protection against asthma, but effect modification and confounding cannot be ruled out. © 2008 The Authors.

Udgivelsesdato: July BACKGROUND: There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma. METHODS: The GA(2)LEN network has organized a multicentre case-control study in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12 months. RESULTS: All cases and controls were selected from the same population defined by age and place of residence. Mean plasma selenium concentrations among the controls ranged from 116.3 microg/l in Palermo to 67.7 microg/l in Vienna and 56.1 microg/l among the children in Oslo. Random effects meta-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 microg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally significant adverse effect in Amsterdam (OR: 1.68; 95% CI: 0.98-2.90) and Ghent (OR: 1.35; 95% CI: 1.03-1.77). CONCLUSION: This study does not support a role for selenium in protection against asthma, but effect modification and confounding cannot be ruled out.