The epidemiology of vancomycin-resistant Enterococcus faecium (VREfm) varies across different countries, with a steady global increase. In Portugal, however, epidemiological data on clinical VREfm have been scarce since the early 2000s. This long-term study investigates VREfm isolates from human infections collected at a Porto hospital between 2010 and 2021. Two hundred VREfm isolates, mostly urinary (39
BACKGROUND:Vancomycin-variable enterococci (VVE) are van-positive Enterococcus faecium strains with a vancomycin-susceptible phenotype that can revert to resistance upon exposure to vancomycin, posing an emerging diagnostic challenge. METHODS:We screened VVE within a large collection of E. faecium from hospitalised patients (n = 319) and healthy human volunteers (n = 60) during 2009-2022. VVE prevalence, antimicrobial resistance, plasmid replicases, virulence factors and bacteriocins were investigated using culture-based methods and WGS. vanA-carrying clusters and plasmids were analysed and compared with similar sequences available in GenBank. Reversion to a resistant phenotype was also evaluated. RESULTS:Seven VVE (2%) were identified, six from hospitalized patients (isolated in 2009 and 2011) and one from a healthy individual (2022). All isolates belonged to ST78 (5-CT230; 2-CT330) and carried a unique vanA-Tn1546 arrangement with truncated vanX, vanS, and transposase genes, located on large linear plasmids carrying a putative novel rep_pZY2 replicase from the Rep3 family. Such plasmids are spread across different countries representing a threat as drivers of silent van gene clusters. VVE reverted to a vancomycin-resistant phenotype after 48-72 hours (MIC > 32 mg/L) with high reversion rates (0.36-0.79); however, no underlying genetic mechanism could be identified to explain this shift. CONCLUSIONS:This study marks the first identification of VVE strains outside hospital settings, emphasizing the need for broader surveillance. The identification of unique Tn1546-type transposons on linear, broad-host-range plasmids in genetically related E. faecium strains from both hospital and community sources, alongside the detection of similar plasmids in international VVE strains, highlights the importance of routine van gene screening in phenotypically susceptible isolates to improve diagnostic accuracy, support antibiotic stewardship, and prevent future outbreaks.
The choice of vascular access (VA) plays a key role in the success of hemodialysis (HD). Despite their widespread use, central venous catheters (CVCs) are associated with higher rates of dysfunction, thrombosis, and catheter-related bloodstream infections (CRBSI). We investigated current practices in pediatric HD across European pediatric nephrology centers, focusing on VA choices, infection control measures, and CRBSI management. An online questionnaire was e-mailed to 119 members of the European Society for Pediatric Nephrology (ESPN) Dialysis Working Group and European Pediatric Dialysis Working Group (EPDWG). Descriptive statistics were used to summarize practices across centers, comparative analyses between centers in countries with Human Development Index (HDI) > 0.90 and < 0.90. Thirty-one centers across Europe participated in the survey. CVCs were the primary VA in 73.1
Hyperhidrosis (HH) is a condition characterized by excessive sweating beyond physiological needs, affecting patients’ quality of life. This study introduces an innovative technological solution focused on the development of a graphical application to support the clinical study of hyperhidrosis, a condition characterized by excessive sweating. The application, developed using Python, Raspberry Pi, and temperature sensors, enables real-time monitoring of thermal variations. This system provides a novel approach to clinical data collection, specifically focusing on how biometric data is measured and how visual and auditory alerts are generated. The application’s design and implementation, highlighting the integration of PyQt4 and Matplotlib for a Python-based GUI, are the primary focus of this paper.
BACKGROUND:Value-based healthcare emphasizes outcomes that matter to patients, and patient-centred outcomes sets are vital to its success. For psoriasis, initial work proposed a patient-centred outcomes set in Belgium, but it requires further validation to ensure international applicability. OBJECTIVES:This scoping study aimed to refine the outcomes set in collaboration with patient representatives and dermatologists, in preparation for international validation through a Delphi consensus process. METHODS:An international Working Group of patient representatives and dermatologists was established through the International Federation for Psoriasis Associations (IFPA) and the International Psoriasis Council (IPC). Experts participated in three discussion meetings and subsequent surveys to discuss and recommend outcomes important to people living with psoriasis, their measurement and case-mix variables. The systematic review of patient-relevant outcomes was updated as well and outcome measurement instruments were selected corresponding to the COSMIN criteria. RESULTS:The Working Group included 35 experts (12 patient representatives and 23 dermatologists) from 22 countries. A total of three discussion meetings and two subsequent surveys informed the refinement of the outcomes set. 'Acceptable costs of care for society' was excluded as an outcome, four outcomes were merged into 'psoriasis clearance' and 'social activity', and 'communication' and 'confidence in care' were reclassified as patient experiences. 'Feelings of stigmatization' and 'number of flare-ups' were added based on patient recommendations. These changes resulted in a revised set of 18 patient-relevant outcomes and 2 patient experiences. After selecting outcome measurement instruments, a heatmap was compiled to assess overlap, quality and feasibility. Finally, 50 case-mix variables were proposed based on the literature and expert opinions. CONCLUSIONS:This scoping study convened an international Working Group of patient representatives and dermatologists to establish the fundamentals for a patient-centred outcomes set. The subsequent Delphi process will finalize consensus, advancing value-based psoriasis management worldwide.
