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Background: There is wide variation in the availability and training of specialists in the diagnosis and management of infections across Europe. Objectives: To describe and reflect on the current objectives, structure and content of European curricula and examinations for the training and assessment of medical specialists in Clinical (Medical) Microbiology (CM/MM) and Infectious Diseases (ID). Sources: Narrative review of developments over the past two decades and related policy documents and scientific literature. Content: Responsibility for curricula and examinations lies with the European Union of Medical Specialists (UEMS). The ID Section of UEMS was inaugurated in 1997 and the MM Section separated from Laboratory Medicine in 2008. The sections collaborate closely with each other and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Updated European Training Requirements (ETR) were approved for MM in 2017 and ID in 2018. These comprehensive curricula outline the framework for delivery of specialist training and quality control for trainers and training programmes, emphasizing the need for documented, regular formative reviews of progress of trainees. Competencies to be achieved include both specialty-related and generic knowledge, skills and professional behaviours. The indicative length of training is typically 5 years; a year of clinical training is mandated for CM/MM trainees and 6 months of microbiology laboratory training for ID trainees. Each Section is developing examinations using multiple choice questions to test the knowledge base defined in their ETR, to be delivered in 2022 following pilot examinations in 2021. Implications: The revised ETRs and European examinations for medical specialists in CM/MM and ID provide benchmarks for national authorities to adapt or adopt locally. Through harmonization of postgraduate training and assessment, they support the promotion and recognition of high standards of clinical practice and hence improved care for patients throughout Europe, and improved mobility of trainees and specialists. Nick J. Beeching, Clin Microbiol Infect 2021;27:1581 (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Diabetes mellitus is a serious condition, causing multiple health problems due to the disease itself, but also to the complications that these patients are predisposed to. Being a current health problem, many patients tend to disregard the doctor's recommendations concerning the necessary measures to maintain adequate and continuous control of the glycaemia levels. This, in turn, may cause complications, which include neuropathy, microangiopathy and a predisposition to infections due to weak local defence mechanisms. In otorhinolaryngology, the infectious pathology is one of the most often causes for presentation to the physician. Ranging from common otitis, acute pharyngitis or laryngitis and sinusitis, these different entities will cause significant discomfort for the patient, prompting the need for medical care. In patients with diabetes, the natural course of the disease is altered, with more severe symptoms, a more extended period of recovery and the predisposition for aggravated cases with the tendency to complications. Such complications may be life-threatening if we take into account the complications associated with acute sinusitis for example, which include orbital or cerebral abscesses. Our paper aims to present the authors experience on the complete approach of patients with infectious pathology concerning the sinuses associating diabetes mellitus. Always, we must keep in mind that patients with diabetes represent a particular class of patients that require a personalized approach. They are predisposed to a vicious circle, in which the infection causes diabetes imbalance, which in turn decreases the defense mechanism and predisposes to complications. The correct management must always include a proper control of diabetes, a complete evaluation that will determine if complications are already present and aggressive management of the infection, with regular check-ups to determine the evolution of the patient.

Background: Many countries have attempted to miti-gate and control COVID-19 through non-pharma-ceutical interventions, particularly with the aim of reducing population movement and contact. However, it remains unclear how the different control strategies impacted the local phylodynamics of the causative SARS-CoV-2 virus. Aim: We aimed to assess the dura-tion of chains of virus transmission within individual countries and the extent to which countries exported viruses to their geographical neighbours. Methods: We analysed complete SARS-CoV-2 genomes to infer the relative frequencies of virus importation and exportation, as well as virus transmission dynamics, in countries of northern Europe. We examined virus evolution and phylodynamics in Denmark, Finland, Iceland, Norway and Sweden during the first year of the COVID-19 pandemic. Results: The Nordic coun-tries differed markedly in the invasiveness of control strategies, which we found reflected in transmission chain dynamics. For example, Sweden, which com-pared with the other Nordic countries relied more on recommendation-based rather than legislation-based mitigation interventions, had transmission chains that were more numerous and tended to have more cases. This trend increased over the first 8 months of 2020. Together with Denmark, Sweden was a net exporter of SARS-CoV-2. Norway and Finland implemented legis-lation-based interventions; their transmission chain dynamics were in stark contrast to their neighbour-ing country Sweden. Conclusion: Sweden constituted an epidemiological and evolutionary refugium that enabled the virus to maintain active transmission and spread to other geographical locations. Our analysis reveals the utility of genomic surveillance where moni- toring of active transmission chains is a key metric. ; De två första författarna delar förstaförfattarskapet.

Burn wounds can create significant damage to human skin, compromising one of the key barriers to infection. The leading cause of death among burn wound patients is infection. Even in the patients that survive, infections can be notoriously difficult to treat and can cause lasting damage, with delayed healing and prolonged hospital stays. Biofilm formation in the burn wound site is a major contributing factor to the failure of burn treatment regimens and mortality as a result of burn wound infection. Bacteria forming a biofilm or a bacterial community encased in a polysaccharide matrix are more resistant to disinfection, the rigors of the host immune system, and critically, more tolerant to antibiotics. Burn wound-associated biofilms are also thought to act as a launchpad for bacteria to establish deeper, systemic infection and ultimately bacteremia and sepsis. In this review, we discuss some of the leading burn wound pathogens and outline how they regulate biofilm formation in the burn wound microenvironment. We also discuss the new and emerging models that are available to study burn wound biofilm formation in vivo. ; Funding Agencies|British Society for Antimicrobial Chemotherapy [BSAC-2018-0095]; Innovate UK Smart Grant [37800]; FRAME, Young European Research University Network Mobility Award, NC3Rs PhD Studentship [NC/V001582/1]; BBSRC New Investigator AwardUK Research & Innovation (UKRI)Biotechnology and Biological Sciences Research Council (BBSRC) [BB/V007823/1]; Academy of Medical Sciences/the Wellcome Trust/ the Government Department of Business, Energy and Industrial Strategy/the British Heart Foundation/Diabetes UK Springboard Award [SBF006\1040]

A COVID-19 pandemic was declared on March 11 by the World Health Organization (WHO). The first cases of COVID-19 were confirmed on January 31 in Sweden and on February 26 in Norway. Despite being similar countries with universal healthcare systems, the governmental approaches to mitigation of the epidemic have varied considerably. Norway initiated a societal lockdown effective from March 12, the same day as the first confirmed death. Sweden has initiated a more laxed and gradual strategy based on the appeal for a strong personal sense of responsibility to mitigate the viral spread. In both countries, the first weeks of preparation has seen a strong reduction in elective surgery, with several implemented principles to mitigate SARS-CoV-2 spread and prepare for surgical care for COVID-19 diseases as needed. This invited leading article gives a brief overview of some of the early experiences of the outbreak in two Scandinavian countries.

The use of conventional antibiotics has substantial clinical efficacy, however these vital antimicrobial agents are becoming less effective due to the dramatic increase in antibiotic-resistant bacteria. Novel approaches to combat bacterial infections are urgently needed and bacteriocins represent a promising alternative. In this study, the activities of the two-peptide bacteriocin PLNC8 alpha beta were investigated against different Staphylococcus spp. The peptide sequences of PLNC8 alpha and beta were modified, either through truncation or replacement of all L-amino acids with D-amino acids. Both L- and D-PLNC8 alpha beta caused rapid disruption of lipid membrane integrity and were effective against both susceptible and antibiotic resistant strains. The D-enantiomer was stable against proteolytic degradation by trypsin compared to the L-enantiomer. Of the truncated peptides, beta 1-22, beta 7-34 and beta 1-20 retained an inhibitory activity. The peptides diffused rapidly (2min) through the bacterial cell wall and permeabilized the cell membrane, causing swelling with a disorganized peptidoglycan layer. Interestingly, sub-MIC concentrations of PLNC8 alpha beta substantially enhanced the effects of different antibiotics in an additive or synergistic manner. This study shows that PLNC8 alpha beta is active against Staphylococcus spp. and may be developed as adjuvant in combination therapy to potentiate the effects of antibiotics and reduce their overall use. ; Funding Agencies|Foundation of Magnus Bergvalls [2015-00823]; Knowledge Foundation [20150244, 20150086]; Swedish Research CouncilSwedish Research Council [2016-04874, 2017-04475]; Swedish Cancer SocietySwedish Cancer Society [17 0532]; Swedish Government Strategic Research Area in Materials Science on Functional Materials at Linkoping University [2009-00971]; Swedish Foundation for Strategic ResearchSwedish Foundation for Strategic Research [RMX18-0039]; orebro University

Background: Aciclovir is effective in herpesvirus infections of the CNS. Aciclovir-induced neuropsychiatric symptoms (AINS) have been reported and are associated with high CSF concentrations of aciclovir metabolite 9-carboxymethoxymethylguanine (CMMG). Risk factors except for renal failure have not been explored, and disruption of the blood-brain barrier (BBB) in acute CNS infection may be of interest. Objectives: To investigate the impact of risk factors on aciclovir and CMMG concentrations, and to relate the results to AINS. Methods: We investigated 21 consecutively included, consenting patients treated with aciclovir or valaciclovir for herpesvirus CNS infection. Regression models were constructed to study the impact of risk factors including BBB disruption, as measured with CSF:serum albumin ratio, on CSF aciclovir and CMMG concentrations. Medical records were assessed retrospectively to identify patients with AINS. Results: Increased CSF:serum albumin ratio, as well as decreased renal function and high aciclovir doses, was associated with increased aciclovir and CMMG concentrations in the CSF. We identified five patients with new neuropsychiatric symptoms; four of those were considered to have AINS and had increased CSF CMMG concentrations. Only one patient without suspicion of AINS had an increased CSF CMMG concentration. Conclusions: In patients with herpesvirus CNS infections, BBB disruption is associated with increasing aciclovir and CMMG CSF concentrations. We also found an unexpectedly high number of patients with AINS. Evaluation of CSF:serum albumin ratios, renal function and CSF concentrations of aciclovir and CMMG may all contribute to the optimization of aciclovir dosing and avoidance of AINS. ; Funding Agencies|Swedish government [ALFBGB-74050]; Swedish country councils, the ALF [ALFBGB-74050]

Objectives: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts. Design: A comparative case study approach, analysing variation in outcomes across different settings. Setting: Studies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case. Participants: 28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria. Interventions: The interventions included different mRDT training packages, supervision, supplies and community sensitisation. Outcome measures: Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial). Results: Outcomes varied widely across cases: 12-100% mRDT uptake; 44-98% adherence to positive mRDTs; 27-100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs. Conclusions: Basic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities. As mRDTs become established, the intensity of supporting interventions required seems likely to reduce.

The prospects for developing countries are shaped by a wide range of issues. Domestic questions of governance and politics are important, but there are also a number of externally driven issues. Aid is one, but there are many more. As a result of globalisation, it is the "beyond aid" issues such as trade, investment, innovation and technology that play an increasingly important role in shaping the prospects of developing countries. There is a strong relationship between the development prospects of a country and its health systems. The key question we ask in the OECD policy coherence for development (PCD) context is: Are the policies of OECD countries impacting the efforts of developing countries to improve their health systems positively or negatively? And are OECD countries' science, technology and health policies coherent with their development commitments, including the key Millennium Development Goals (MDGs) that deal directly with health: reduce child mortality (MDG 4), improve maternal health (MDG 5), combat HIV/AIDS, malaria and other diseases (MDG 6). The OECD's agenda on policy coherence for development promotes whole-of-government approaches, and the design of policy instruments available to the OECD countries that take account of potential impacts on health development objectives. In an interdependent world, achieving policy coherence is increasingly in the interest of both developed and developing countries. Infectious diseases are one of the primary causes of mortality in the world and in developing countries they are a major barrier to economic development, social progress and human health. Nearly 1 billion humans suffer from a neglected infectious disease, according to the World Health Organization. Yet, less than 1% of the new drugs placed on the market since 1975 up to today were developed for these diseases. The health innovation system is failing to deliver the new medicines, vaccines and diagnostics that are required for neglected infectious diseases.