Preventing Fungal Sepsis in Preterm Infants: The Impact of Changing to Prophylactic Nystatin in a Tertiary Neonatal Unit

2021 ◽  
pp. 097321792110076
Author(s):  
Jennifer Peterson ◽  
Ranganath Ranganna
Keyword(s):  
Candida Albicans ◽  
Premature Infants ◽  
Candida Parapsilosis ◽  
Time Frame ◽  
Antifungal Prophylaxis ◽  
Neonatal Unit ◽  
Fungal Organisms ◽  
Life Threatening ◽  
Fungal Sepsis ◽  
The Impact

Fungal organisms pose a life-threatening risk to vulnerable premature infants. In this review, all cases of fungal sepsis in a large tertiary neonatal unit over the last 10 years (2008-2018) in premature neonates (<30 weeks gestation) were reviewed. This time frame spanned a change in prophylaxis policy from fluconazole to nystatin in 2012. The most common fungal organism causing sepsis was Candida albicans in 80% of cases and Candida parapsilosis in 13%. All fungal organisms cultured were fully sensitive; no resistant cases were seen in the last 10 years. Encouragingly, rates of infection were static (between 0 and 3 cases/year) over the last 10 years, despite the unit’s policy for antifungal prophylaxis changing from fluconazole to nystatin in 2012.

scholarly journals Sensory processing disorders in premature infants

Praxis medica ◽  
2021 ◽  
Vol 50 (1-2) ◽  
pp. 19-23
Author(s):  
Jelena Todorović ◽  
Mirjana Petrović-Lazić
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Sensory Processing ◽  
Relevant Literature ◽  
Sensory System ◽  
Neonatal Unit ◽  
Increased Risk ◽  
Sensory Processing Disorders ◽  
The Impact ◽  
Insight Into

Introduction. Children born prematurely have an increased risk of immediate medical complications, as well as socioemotional, cognitive, linguistic and sensory processing disorders later in life. Studies have examined the effects of prematurity on developmental outcomes, such as cognition, however, there is a need for a more detailed examination of sensory processing disorders in preterm infants. Not only is prenatal neurosensory development interrupted in utero, but these children may also experience intense stimulation in the neonatal unit, which can further alter the development and function of the sensory system. Objective. The paper presents an overview of research on sensory processing disorders in premature infants, with special emphasis on the impact of the environment of the neonatal unit. Method. Insight into the relevant literature was performed by specialized search engines on the Internet and insight into the electronic database. Results. Sensory processing disorders affect 39% to 52% of newborns born prematurely, with some evidence to suggest that children born before 32 weeks are most at risk. The literature to date has consistently reported difficulties in sensory modulation of preterm infants, within the tactile, vestibular, auditory, oral, and visual domains. Conclusion. Sensory processing disorders in preterm infants appear to occur as a result of their immature neurological and biological system and being in the environment of a neonatal intensive care unit, which is unable to meet the sensory needs of preterm infants. Altered sensory experiences, during periods of neurodevelopmental vulnerability and fragility, can result in sensory processing disorders, which may include enhanced responses or less response to stimuli (hyper or hyposensitivity).

scholarly journals The impact of the Fungus-Host-Microbiota interplay upon Candida albicans infections: current knowledge and new perspectives

2020 ◽  
Author(s):  
Christophe d'Enfert ◽  
Ann-Kristin Kaune ◽  
Leovigildo-Rey Alaban ◽  
Sayoni Chakraborty ◽  
Nathaniel Cole ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Current Knowledge ◽  
Fungal Host ◽  
Susceptibility To Infection ◽  
Life Threatening ◽  
Antifungal Immunity ◽  
Epithelial Barriers ◽  
Systemic Infections ◽  
Immune Defences ◽  
The Impact

Abstract Candida albicans is a major fungal pathogen of humans. It exists as a commensal in the oral cavity, gut or genital tract of most individuals, constrained by the local microbiota, epithelial barriers and immune defences. Their perturbation can lead to fungal outgrowth and the development of mucosal infections such as oropharyngeal or vulvovaginal candidiasis, and patients with compromised immunity are susceptible to life-threatening systemic infections. The importance of the interplay between fungus, host and microbiota in driving the transition from C. albicans commensalism to pathogenicity is widely appreciated. However, the complexity of these interactions, and the significant impact of fungal, host and microbiota variability upon disease severity and outcome, are less well understood. Therefore, we summarise the features of the fungus that promote infection, and how genetic variation between clinical isolates influences pathogenicity. We discuss antifungal immunity, how this differs between mucosae, and how individual variation influences a person's susceptibility to infection. Also, we describe factors that influence the composition of gut, oral and vaginal microbiotas, and how these affect fungal colonisation and antifungal immunity. We argue that a detailed understanding of these variables, which underlie fungal-host-microbiota interactions, will present opportunities for directed antifungal therapies that benefit vulnerable patients.

scholarly journals Molecular targets for antifungals in amino acid and protein biosynthetic pathways

Amino Acids ◽  
2021 ◽  
Author(s):  
Aleksandra Kuplińska ◽  
Kamila Rząd
Keyword(s):  
Amino Acid ◽  
Fungal Pathogens ◽  
Protein Biosynthesis ◽  
Molecular Targets ◽  
Antifungal Drugs ◽  
Vaginal Candidiasis ◽  
Genes Encoding ◽  
Fungal Organisms ◽  
Life Threatening ◽  
The Impact

AbstractFungi cause death of over 1.5 million people every year, while cutaneous mycoses are among the most common infections in the world. Mycoses vary greatly in severity, there are long-term skin (ringworm), nail or hair infections (tinea capitis), recurrent like vaginal candidiasis or severe, life-threatening systemic, multiorgan infections. In the last few years, increasing importance is attached to the health and economic problems caused by fungal pathogens. There is a growing need for improvement of the availability of antifungal drugs, decreasing their prices and reducing side effects. Searching for novel approaches in this respect, amino acid and protein biosynthesis pathways appear to be competitive. The route that leads from amino acid biosynthesis to protein folding and its activation is rich in enzymes that are descriptive of fungi. Blocking the action of those enzymes often leads to avirulence or growth inhibition. In this review, we want to trace the principal processes of fungi vitality. We present the data of genes encoding enzymes involved in amino acid and protein biosynthesis, potential molecular targets in antifungal chemotherapy, and describe the impact of inhibitors on fungal organisms.

Coming-of-Age Cinema in New Zealand

2017 ◽  
Author(s):  
Alistair Fox
Keyword(s):  
Coming Of Age ◽  
Belief Systems ◽  
Time Frame ◽  
New Wave ◽  
Art Cinema ◽  
Literary Sources ◽  
French New Wave ◽  
Significant Phenomenon ◽  
The Impact ◽  
New Zealanders

This book investigates the coming-of-age genre as a significant phenomenon in New Zealand’s national cinema, tracing its development from the 1970s to the present day. A preliminary chapter identifies the characteristics of the coming-of-age film as a genre, tracing its evolution and the influence of the French New Wave and European Art Cinema, and speculating on the role of the genre in the output of national cinemas. Through case studies of fifteen significant films, including The God Boy, Sleeping Dogs, The Scarecrow, Vigil, Mauri, An Angel at My Table, Heavenly Creatures, Once Were Warriors, Rain, Whale Rider, In My Father’s Den, 50 Ways of Saying Fabulous, Boy, Mahana, and Hunt for the Wilderpeople, subsequent chapters examine thematic preoccupations of filmmakers such as the impact of repressive belief systems and social codes, the experience of cultural dislocation, the expression of a Māori perspective through an indigenous “Fourth Cinema,” bicultural relationships, and issues of sexual identity, arguing that these films provide a unique insight into the cultural formation of New Zealanders. Given that the majority of films are adaptations of literary sources, the book also explores the dialogue each film conducts with the nation’s literature, showing how the time frame of each film is updated in a way that allows these films to be considered as a register of important cultural shifts that have occurred as New Zealanders have sought to discover their emerging national identity.

Alteraciones sistémicas y metabólicas producidas por lesión medular

2019 ◽  
Vol 1 (1) ◽  
pp. 59-75
Author(s):  
Gabriel Guízar Sahagún
Keyword(s):  
Spinal Cord ◽  
Daily Living ◽  
Autonomic Function ◽  
Clinical Presentation ◽  
Scientific Literature ◽  
International Standards ◽  
Therapeutic Approaches ◽  
Cord Injury ◽  
Life Threatening ◽  
The Impact

Besides the well-known loss of motor and sensory capabilities, people with spinal cord injury (SCI) experience a broad range of systemic and metabolic abnormalities including, among others, dysfunction of cardiovascular, respiratory, gastrointestinal, urinary, and endocrine systems. These alterations are a significant challenge for patients with SCI because such disorders severely interfere with their daily living and can be potentially life-threatening. Most of these disorders are associated with impairment of regulation of the autonomic nervous system, arising from disruption of connections between higher brain centers and the spinal cord caudal to the injured zone. Thus, the higher and more complete the lesion, the greater the autonomic dysfunction and the severity of complications.This article summarizes the medical scientific literature on key systemic and metabolic alterations derived of SCI. It provides information primarily focused on the pathophysiology and clinical presentation of these disorders, as well as some guides to prevent and alleviate such complications. Due to the impact of these alterations, this topic must be a priority and diffuse to those involved with the care of people with SCI, including the patient himself/herself. We consider that any collaborative effort should be supported, like the development of international standards, to evaluate autonomic function after SCI, as well as the development of novel therapeutic approaches.

Gendered Impact of Corruption in Healthcare Service Delivery in Nigeria

2013 ◽  
Vol 11 (1) ◽  
Author(s):  
Yetunde A. Aluko
Keyword(s):  
Service Delivery ◽  
Public Hospitals ◽  
Public Health Care ◽  
Women's Voices ◽  
Medical Supplies ◽  
Poor Women ◽  
Level Information ◽  
Life Threatening ◽  
Threatening Situation ◽  
The Impact

This paper supports the hypothesis that corruption and non-delivery of services in key sectors such as health have gender-specific poverty consequences. The study utilized qualitative micro-level information about the structures of corruption and its impact on poor women. Respondents expressed their perceptions on the occurrence of corrupt practices in public health care system and its wider impact on society. The findings revealed that the impact of corruption is felt disproportionately by women and the poor, who are most dependent on public services, and have no alternative even when facing corrupt practices in a life threatening situation, such as complicated birth delivery. Pregnant women denied access to doctors tended to deliver at home, which increased the likelihood of complications and maternal and child mortality. Medical supplies meant for public hospitals are sold to private clinics who charge more for drugs and supplies. There is need to strengthen sectoral oversight mechanisms and transparency as well as increase women’s voices in service delivery.

The management of Hemorrhoidal Disease by Dearterialization and Mucopexy.

2020 ◽  
Vol 15 ◽  
Author(s):  
Veronica De Simone ◽  
Francesco Litta ◽  
Angelo Parello ◽  
Paola Campennì ◽  
Raffaele Orefice ◽  
...  
Keyword(s):  
Postoperative Management ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Doppler Probe ◽  
Minimally Invasive Surgical ◽  
Bowel Movements ◽  
Excessive Strain ◽  
Life Threatening ◽  
Hemorrhoidal Prolapse ◽  
The Impact

: Several minimally invasive surgical procedures have been recently developed to treat hemorrhoids without any excision. About 25 years ago, a non-excisional procedure providing doppler-guided ligation of the hemorrhoidal arteries has been proposed - named “hemorrhoidal dearterialization”. The original technique has been modified over the years, and indications were expanded. In particular, a plication of the redundant and prolapsing mucosa/submucosa of the rectum (named “mucopexy”) has been introduced to treat hemorrhoidal prolapse, without excision of the hemorrhoidal piles. At present, the THD® Doppler procedure is one of the most used techniques to treat hemorrhoids. Aim of this technique is to realize a target dearterialization, using a Doppler probe with the final purpose to reduce the arterial overflow to the hemorrhoidal piles. In case of associated hemorrhoidal prolapse, a mucopexy is performed together with Doppler-guided dearterialization. The entity and circumferential extension of the hemorrhoidal prolapse guides the mucopexy, which can be considered tailored to a single patient; the dearterialization should be considered mandatory. Advantages of this surgical technique are the absence of serious and life-threatening postoperative events, chronic complications, and limited recurrence risks. The impact of the procedure on the anorectal physiology is negligible. However, a careful postoperative management is mandatory to avoid complications and to guarantee an improved long-term outcome. Therefore, regular physiologic bowel movements, excessive strain at the defecation and strong physical activity are advisable.

CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Statistical Significance ◽  
Treatment Procedure ◽  
Fetal Survival ◽  
Ex Utero Intrapartum Treatment ◽  
Life Threatening ◽  
Group 2 ◽  
Cd34 Immunostain ◽  
The Impact ◽  
Diaphragmatic Hernias ◽  
Group 1

AbstractShort CommunicationsEXIT (ex-utero intrapartum treatment) procedure is a fetal survival-increasing modification of cesarean section. Previously we found an increase incidence of fetal vascular malperfusion (FVM) in placentas from EXIT procedures which indicates the underlying stasis of fetal blood flow in such cases. This retrospective analysis analyzes the impact of the recently introduced CD34 immunostain for the FVM diagnosis in placentas from EXIT procedures.Objectives and MethodsA total of 105 placentas from EXIT procedures (48 to airway, 43 to ECMO and 14 to resection) were studied. In 73 older cases, the placental histological diagnosis of segmental FVM was made on H&E stained placental sections only (segmental villous avascularity) (Group 1), while in 32 most recent cases, the CD34 component of a double E-cadherin/CD34 immunostain slides was also routinely used to detect the early FVM (endothelial fragmentation, villous hypovascularity) (Group 2). 23 clinical and 47 independent placental phenotypes were compared by χ2 or ANOVA, where appropriate.ResultsThere was no statistical significance between the groups in rates of segmental villous avascularity (29 vs. 34%), but performing CD34 immunostain resulted in adding and/or upgrading 12 more cases of segmental FVM in Group 2, thus increasing the sensitivity of placental examination for FVM by 37%. There were no other statistically significantly differences in clinical (except for congenital diaphragmatic hernias statistically significantly more common in Group 2, 34 vs 56%, p=0.03) and placental phenotypes, proving the otherwise comparability of the groups.ConclusionsThe use of CD34 immunostain increases the sensitivity of placental examination for FVM by 1/3, which may improve the neonatal management by revealing the increased likelihood of the potentially life-threatening neonatal complications.

Sign in / Sign up

Export Citation Format

Share Document