Kofoedvedel1149

The technique to creating transplantable organs: coming from blastocyst complementation to be able to interspecies chimeras.

BACKGROUND The Infectious Diseases Society of America recommends either a fluoroquinolone or a macrolide as a first line antibiotic treatment for Legionella pneumonia, but it is unclear which antibiotic leads to optimal clinical outcomes. We compare the effectiveness of fluoroquinolone versus macrolide monotherapy in Legionella pneumonia using a systematic review and meta-analysis. METHODS We conducted a systematic search of literature in PubMed, Cochrane, Scopus and Web of Science from inception to June 1, 2019. Randomized controlled trials and observational studies comparing macrolide vs. fluoroquinolone monotherapy using clinical outcomes in patients with Legionella pneumonia were included. Twenty-one publications out of an initial 2,073 unique records met the selection criteria. Following PRISMA guidelines, two reviewers participated in data extraction. The primary outcome was mortality. Secondary outcomes included clinical cure, time to apyrexia, length of hospital stay (LOS), and the occurrence of complications. RESULTS Twenty-one publications with 3,525 patients met inclusion criteria. The mean age of the population was 60.9 years and 67.2% were men. The mortality rate for patients treated with fluoroquinolones was 6.9% (104/1512) compared to 7.4% (133/1790) among those treated with macrolides. The pooled OR assessing risk of mortality for patients treated with fluoroquinolones vs macrolides was 0.94 (95% CI 0.71-1.25, I2=0%, p= 0.661). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ for patients treated with fluoroquinolones vs. macrolides. GSK-3 cancer CONCLUSIONS We found no difference in the effectiveness of fluoroquinolones vs. macrolides in reducing mortality among patients with Legionella pneumonia.Systematic Review Registration number (PROSPERO CRD42019132901). © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.INTRODUCTION Epidemics and pandemics from zoonotic respiratory viruses, such as the 2019 novel coronavirus, can lead to significant global intensive care burden as patients progress to acute respiratory distress syndrome (ARDS). A subset of these patients develops refractory hypoxaemia despite maximal conventional mechanical ventilation and require extracorporeal membrane oxygenation (ECMO). This review focuses on considerations for ventilatory strategies, infection control and patient selection related to ECMO for ARDS in a pandemic. We also summarize the experiences with ECMO in previous respiratory pandemics. METHODS A review of pertinent studies was conducted via a search using MEDLINE, EMBASE and Google Scholar. References of articles were also examined to identify other relevant publications. RESULTS Since the H1N1 Influenza pandemic in 2009, the use of ECMO for ARDS continues to grow despite limitations in evidence for survival benefit. There is emerging evidence to suggest that lung protective ventilation for ARDS can be further optimized while receiving ECMO so as to minimize ventilator-induced lung injury and subsequent contributions to multi-organ failure. Efforts to improve outcomes should also encompass appropriate infection control measures to reduce co-infections and prevent nosocomial transmission of novel respiratory viruses. GSK-3 cancer Patient selection for ECMO in a pandemic can be challenging. We discuss important ethical considerations and predictive scoring systems that may assist clinical decision-making to optimize resource allocation. CONCLUSION The role of ECMO in managing ARDS during respiratory pandemics continues to grow. This is supported by efforts to redefine optimal ventilatory strategies, reinforce infection control measures and enhance patient selection.INTRODUCTION Recovery from psychosis relates to connectedness, hope for the future, identity, meaning in life and empowerment. The process of recovery is often described as a gradual and non-linear, with many stages and turning points, without a definitive end point. This qualitative study aimed to understand what recovery means to clients, to better understand their unique recovery process and what helps in recovery among clients with lived experience of first episode psychosis (FEP) in a developed Asian setting. MATERIALS & METHODS The study design and interview guide development included inputs from persons with psychosis, following which seven focus group discussions were conducted with 40 FEP clients of a tertiary care psychiatric institute. RESULTS Thematic qualitative analysis identified three themes - (i) Meaning of recovery - where participants expressed their views on what recovery meant to them, (ii) Recovery as a journey - due to the constant ups and downs in the long process of recovery, it was often articulated as a 'journey', and (iii) Facilitators of recovery - these related to resources, practices and experiences that supported their recovery. CONCLUSIONS The emergent themes provide an understanding of the meaning of recovery to persons with first episode psychosis, their experiences as they proceed with their recovery journey and factors they found helpful. The importance of acceptance of the condition and the personal role the individual plays in his or her own recovery was evident in the narratives of the participants. The study suggests a need to incorporate recovery-relevant approaches right from the first episode of psychosis.STUDY OBJECTIVE To compare live birth rates, cost analysis and a survey of patient attitudes between laparoscopic tubal re-anastomosis and IVF in patients with previous tubal ligation Design Retrospective cohort review and survey. SETTING Single Reproductive Medicine and IVF unit in Singapore. PATIENTS Retrospective study Patients who underwent previous tubal ligation and currently seeking fertility. Survey Patients attending the subfertility clinic. INTERVENTIONS Retrospective study Laparoscopic tubal re-anastomosis or IVF, from January 2011 to December 2016. Survey Questionnaire and information sheet on both IVF and tubal re-anastomosis. MEASUREMENTS Retrospective study First live birth after treatment. Interval to first pregnancy, miscarriages and ectopic pregnancies were also reported. Survey Choice of treatment before and after reading the information on laparoscopic tubal re-anastomosis and IVF. RESULTS Retrospective study Twelve patients underwent tubal re-anastomosis while 31 patients underwent IVF treatment.