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Search Results: 1 - 10 of 176559 matches for " Matthew E. Falagas "
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Unique Author Identification Number in Scientific Databases: A Suggestion
Matthew E Falagas
PLOS Medicine , 2006, DOI: 10.1371/journal.pmed.0030249
Percutaneous Exposure Incidents of the Health Care Personnel in a Newly Founded Tertiary Hospital: A Prospective Study
Matthew E. Falagas, Ioannis Karydis, Ilektra Kostogiannou
PLOS ONE , 2007, DOI: 10.1371/journal.pone.0000194
Abstract: Background Percutaneous exposure incidents (PEIs) and blood splashes on the skin of health care workers are a major concern, since they expose susceptible employees to the risk of infectious diseases. We undertook this study in order to estimate the overall incidence of such injuries in a newly founded tertiary hospital, and to evaluate possible changes in their incidence over time. Methodology/Principal Findings We prospectively studied the PEIs and blood splashes on the skin of employees in a newly founded (October 2000) tertiary hospital in Athens, Greece, while a vaccination program against hepatitis B virus, as well as educational activities for avoidance of injuries, were taking place. The study period ranged from October 1, 2002 to February 28, 2005. Serologic studies for hepatitis B (HBV) and C virus (HCV) as well as human immunodeficiency virus (HIV) were performed in all injured employees and the source patients, when known. High-titer immunoglobulin (250 IU anti-HBs intramuscularly) and HBV vaccination were given to non-vaccinated or previously vaccinated but serologically non-responders after exposure. Statistical analysis of the data was performed using Mc Nemar's and Fisher's tests. 60 needlestick, 11 sharp injuries, and two splashes leading to exposure of the skin or mucosa to blood were reported during the study period in 71 nurses and two members of the cleaning staff. The overall incidence (percutaneous injuries and splashes) per 100 full-time employment-years (100 FTEYs) for high-risk personnel (nursing, medical, and cleaning staff) was 3.48, whereas the incidence of percutaneous injuries (needlestick and sharp injuries) alone per 100 FTEYs was 3.38. A higher incidence of injuries was noted during the first than in the second half of the study period (4.67 versus 2.29 per 100 FTEYs, p = 0.005). No source patient was found positive for HCV or HIV. The use of high-titer immunoglobulin after adjustment for the incidence of injuries was higher in the first than in the second half of the study period, although the difference was not statistically significant [9/49 (18.37%) vs 1/24 (4.17%), p = 0.15]. Conclusions/Significance Our data show that nurses are the healthcare worker group that reports most of PEIs. Doctors did not report such injuries during the study period in our setting. However, the possibility of even relatively frequent PEIs in doctors cannot be excluded. This is due to underreporting of such events that has been previously described for physicians and surgeons. A decrease of the incidence of PEIs occurred during the
Colistin: recent data on pharmacodynamics properties and clinical efficacy in critically ill patients
Argyris S Michalopoulos, Matthew E Falagas
Annals of Intensive Care , 2011, DOI: 10.1186/2110-5820-1-30
Abstract: Colistimethate sodium (CMS) is an inactive prodrug of colistin that exhibits a low level of protein binding. It is not stable in vitro and in vivo and is hydrolyzed in human plasma, creating a complex mixture of partially sulphomethylated derivatives with the potential to produce up to 32 different products, including colistin [1]. After administration of CMS, colistin appears in plasma rapidly. Colistin is approximately 50% bound to human plasma. Peak serum levels after intravenous (i.v.) administration are achieved within 10 min. They appeared higher but declined more rapidly than those achieved after i.m. administration [2].Colistin (base) is more active than CMS. Serum half-life of CMS is approximately 1.5-2 hours (h) after i.v. administration and 2.75 to 3 h after i.m. administration in healthy subjects, whereas serum half-life for CMS administered i.v. is more than 4 h. Old reports have suggested that colistin is poorly distributed to the pleural cavity, lung parenchyma, bones, and cerebrospinal fluid (CSF) (15% to 25%).CMS is eliminated predominantly by the kidneys. It should be noted that after CMS i.v. administration, approximately 60% of CMS is excreted unchanged in the urine via glomerular filtration during the first 24 h. In renal failure, the renal excretion of CMS is decreased resulting in a higher conversion to colistin and prolongation of half-life [3]. On the contrary, colistin is eliminated predominantly by the nonrenal route by means of mechanisms not yet fully understood [4]. However, in humans, colistin is not absorbed from the gastrointestinal tract and no biliary excretion has been reported.The pharmacodynamic (PD) properties of colistin, such as minimal inhibitory concentration (MIC), mutation prevention concentration, population analysis profile, bacterial-killing kinetics, and the postantibiotic effect (PAE) against multidrug-resistant (MDR) Gram-negative bacteria (GNB), such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiell
Attributable mortality of Acinetobacter baumannii: no longer a controversial issue
Matthew E Falagas, Petros I Rafailidis
Critical Care , 2007, DOI: 10.1186/cc5911
Abstract: Infections due to Acinetobacter baumannii have been frequently considered by clinicians and researchers not to be associated with considerable mortality [1]. Indeed, A. baumannii has been placed in the list of low-virulence pathogens [2]. These beliefs have generated relative widespread beliefs among members of the medical community that this microorganism is not a cause of considerable mortality in hospitalized patients, and have generated controversy on the issue of attributable mortality of A. baumannii infections [1,3]. We recently performed a systematic review of the literature of cohort and case–control studies that focused on the issue [4]. The reviewed data suggest that infection with A. baumannii is associated with considerable mortality. In addition, we provided data regarding the impact of inappropriate empirical treatment of A. baumannii infections [5].During the first 3 months of 2007, four new studies were added to the relevant literature. Specifically, investigators from the United States of America [6], Israel [7], Australia [8] and Korea [9] have provided their findings regarding the effect of A. baumannii infections in patients treated in the intensive care unit setting and also on medical and surgical wards. Another recent study from Israel compared A. baumannii bacteremia with Klebsiella pneumoniae bacteremia [10]. We summarize the findings of these five newer studies in Table 1.The result of the main analysis of the latter study showed that A. baumannii remained significantly associated with mortality after adjustment for other important risk factors was performed [10]. Subgroup analyses in the same study again confirmed the association of A. baumannii with increased mortality in those patients not mechanically ventilated in the 30 days prior to bacteremia (multivariate analysis: odds ratio = 3.98, 95% confidence interval = 1.25–12.62) and in those patients not presenting with septic shock (odds ratio = 4.62, 95% confidence interval = 1.74–12.22
Oral decontamination with chlorhexidine reduces the incidence of nosocomial pneumonia
Ilias I Siempos, Matthew E Falagas
Critical Care , 2007, DOI: 10.1186/cc5129
Abstract: In detail, Koeman and colleagues [6] enrolled intensive care unit patients requiring mechanical ventilation in a large, multicenter, double-blind, three-arm RCT. Ventilator-associated pneumonia developed in 13 out of 127 (10%) patients treated with 2% CHX paste, in 16 out of 128 (13%) subjects treated with 2% CHX and 2% colistin paste, and in 23 out of 130 (18%) placebo recipients. One additional RCT (in fact, a pilot study) conducted by Bopp and colleagues [7] in patients intubated in the intensive care unit reported that neither of two (0%) patients treated with 0.12% CHX gluconate and one out of three (33%) patients who received standard oral care (with soft foam swab and hydrogen peroxide) developed NP.We used data from the four RCTs [2-5] included in the meta-analysis by Pineda and colleagues [1] as well as data from the two RCTs published later [6,7] to estimate the pooled odds ratio (OR) and 95% confidence intervals (CIs) for the incidence of NP. Both the Mantel–Haenszel fixed-effect model and the DerSimonian–Laird random effects model were employed. Heterogeneity between RCTs was assessed using both a chi-square test and the I2 statistic. Statistical analyses were performed using the 'S-PLUS 6.1' software.Oral application with CHX in mechanically ventilated patients was associated with reduced incidence of NP compared with control individuals (fixed-effect model, OR = 0.55, 95% CI = 0.36–0.84; random effects model, OR = 0.56, 95% CI = 0.36–0.86; data from six trials [2-7], Figure 1). No heterogeneity was detected between the trials (P = 0.48, I2 = 0, 95% CI = 0–0.75). It should be mentioned that we omitted patients treated with CHX and antibiotic from our analysis in an attempt to avoid confounding. In addition, we performed a subgroup analysis by excluding RCTs conducted in a cardiac surgery population [2,5]. The rationale for this subanalysis was that cardiac surgery patients were at lower risk of developing NP than intensive care unit patients due to the
Reaction to the threat of influenza pandemic: the mass media and the public
Matthew E Falagas, Ismene J Kiriaze
Critical Care , 2006, DOI: 10.1186/cc4910
Abstract: Surprisingly, after the overwhelming coverage of the possibility of an influenza pandemic from the media during October 2005, the follow-up on the issue was almost complete silence during November and December 2005 (this manuscript was written prior to the occurrence of human cases of avian influenza in Turkey in January 2006). The alarmed state was replaced by a silence of equivalent intensity and the public was left with the impression that the possibility of influenza pandemic crisis was over. This phenomenon, namely the initial over-reaction and subsequently the under-reaction of the public, was probably not unique to Greece; instead, we believe that a similar sequence of events related to the threat of influenza pandemic occurred in many other countries.Important conclusions may be derived from this experience that may become a classic example for the mass media to avoid in the coverage of public health risks [1,2]. We believe that public health agencies should have operational plans towards the delivery of information to the public that are promptly implemented. They should make use of all types of mass media in a timely manner, before the media presents potentially unfiltered information to the public regarding a health-related risk such as the influenza pandemic.Effective risk communication is a priority early in an outbreak. Both the mass media and public health authorities have the responsibility to deliver correct information to the public. The fear-based approach and over-reaction towards a potential influenza pandemic may be hazardous to the general public, because it encourages solutions that inhibit the ability to properly respond to a potential pandemic.The authors declare that they have no competing interests.Both authors contributed to the writing of the manuscript and approved its final version.
Toxicity of polymyxins: a systematic review of the evidence from old and recent studies
Matthew E Falagas, Sofia K Kasiakou
Critical Care , 2005, DOI: 10.1186/cc3995
Abstract: We reviewed old and recent evidence regarding polymyxin-induced toxicity by searching Pubmed (from 1950 until May 2005).It was reported in the old literature that the use of polymyxins was associated with considerable toxicity, mainly nephrotoxicity and neurotoxicity, including neuromuscular blockade. However, recent studies showed that the incidence of nephrotoxicity is less common and severe compared to the old studies. In addition, neurotoxic effects of polymyxins are usually mild and resolve after prompt discontinuation of the antibiotics. Furthermore, cases of neuromuscular blockade and apnea have not been reported in the recent literature.New evidence shows that polymyxins have less toxicity than previously reported. The avoidance of concurrent administration of nephrotoxic and/or neurotoxic drugs, careful dosing, as well as more meticulous management of fluid and electrolyte abnormalities and use of critical care services may be some of the reasons for the discrepancy between data reported in the old and recent literature.Polymyxins were discovered in 1947 from different species of Bacillus polymyxa [1,2]. Although the effectiveness of polymyxins against most Gram-negative bacteria, including Pseudomonas aeruginosa and Acinetobacter baumannii, has not been questioned, early administration of polymyxins was associated with reports of adverse renal and neurological effects in a considerably large number of patients [3,4]. Thus, compounds of this class of antibiotics were gradually withdrawn from clinical practice as newer antibiotics with the same or broader antibacterial spectra and reportedly lower toxicity were introduced, except for patients with cystic fibrosis who suffer from recurrent pulmonary infections due to multidrug-resistant bacteria [5-7]. However, the emergence of Gram-negative bacteria that are resistant to almost all classes of available antibiotics except polymyxins, especially Pseudomonas aeruginosa and Acinetobacter baumannii strains, and t
A bibliometric analysis in the fields of preventive medicine, occupational and environmental medicine, epidemiology, and public health
Elpidoforos S Soteriades, Matthew E Falagas
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-301
Abstract: All articles published by different world regions in the above mentioned scientific fields and cited in the Journal Citation Reports (JCR) database of the Institute for Scientific Information (ISI) during the period 1995 and 2003, were evaluated. The research production of different world regions was adjusted for: a) the gross domestic product in 1995 US dollars, and b) the population size of each region.A total of 48,861 articles were retrieved and categorized. The USA led the research production in all three subcategories. The percentage of articles published by USA researchers was 43%, 44% and 61% in the Preventive Medicine, Epidemiology, and Public Health subcategories, respectively. Canada and Western Europe shared the second position in the first two subcategories, while Oceania researchers ranked second in the field of Public Health.USA researchers maintain a leadership position in the production of scientific articles in the fields of Preventive Medicine, Occupational/Environmental Medicine and Epidemiology, at a level similar to other scientific disciplines, while USA contribution to science in the field of Public Health is by all means outstanding. Less developed regions would need to support their researchers in the above fields in order to improve scientific production and advancement of knowledge in their countries.The fields of Preventive Medicine, Occupational/Environmental Medicine, Epidemiology and Public Health constitute scientific fields, along with clinical medicine, which play an important role on people's health around the world [1-3]. Research performed in the above fields provides the basis for identifying significant health problems in the population and supports the development of knowledge-based interventions to educate people on health issues, promote health, and protect people's vulnerability to different health hazards [4-6]. Furthermore, published scientific articles on such topics promote public dialogue and provide opportunities for
e-meducation.org: an open access medical education web portal
Vangelis G Alexiou, Matthew E Falagas
BMC Medical Education , 2008, DOI: 10.1186/1472-6920-8-6
Abstract: Directories of the relevant WWW resources have been compiled and others are being currently under development to cover most medical fields. A custom-built medical search engine was created. Really Simple Syndication (RSS) feeds and video sharing services were reviewed for their quality and were presented along with case-based educational presentations through a user-friendly web portal interface. A directory of guidelines database is currently under development.The educational portal "e-meducation" available at http://www.e-meducation.org/ webcite has been launched in December 2006 and at the moment, provides links to more than 800 educational web-pages, more than 2100 clinical practice guidelines, 32 news feeds, and 14 educational videos. The web site also hosts 40 case-based presentations and a custom medical search engine.Based on the incorporation of simple and tested educational strategies such as case based instruction and interactive learning, e-meducation.org aims to become a prototype platform that offers a more convenient interface to existing products, resources and medical contents.The use of the World Wide Web (WWW) had major impact on almost every aspect of human life and activity including medical education. Internet can serve in opening the door to a brand new world of high quality medical information. However, the chaotic size of data available on the WWW, estimated to almost 532 terabytes in 2002 [1] is often misleading.Open access (OA) is a relatively new movement in medicine and science in general that came with the advent of Internet, bringing immediate, free and unrestricted online access to digital scholarly material [2]. Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities [3] in October 2003 provided the current definition of OA. OA means free availability on the WWW with permition to read, download, copy, redistribute, print, and to any other legitimate use. OA does not have any financial, legal and technical limita
Continuous versus Conventional Infusion of Amphotericin B Deoxycholate: A Meta-Analysis
Matthew E. Falagas, Drosos E. Karageorgopoulos, Giannoula S. Tansarli
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077075
Abstract: Background Treatment with Amphotericin B (AmB) deoxycholate, which is still used widely, particularly in low-resource countries, has been challenged due to nephrotoxicity. We sought to study whether continuous infusion of AmB deoxycholate reduces nephrotoxicity retaining, however, the effectiveness of the drug. Methods PubMed and Scopus databases were systematically searched to identify studies comparing the outcomes of patients receiving 24-h infusion of AmB (“continuous group”) and those receiving 2–6-h infusion of AmB (“conventional group”). Nephrotoxicity and all-cause mortality were the primary outcomes of the review, while treatment failure was the secondary outcome. Results Five studies met the inclusion criteria; one randomized controlled trial, two prospective cohort studies, and two retrospective cohort studies. The majority of patients were neutropenic with an underlying hematologic malignancy. All 5 studies (392 patients) provided data regarding the development of nephrotoxicity. A non-significant trend towards lower nephrotoxicity was observed for patients receiving continuous infusion of AmB compared with those receiving conventional infusion [RR = 0.61 (95% CI 0.36, 1.02)]. Four studies (365 patients) provided data regarding mortality; no relevant difference was detected between patients receiving continuous and those receiving conventional infusion of AmB [RR = 0.81 (95% CI 0.36, 1.83)]. Data on treatment failure of the two methods of administration was insufficient for meaningful conclusions. Conclusion The available evidence from mainly non-randomized studies suggests that continuous infusion of AmB deoxycholate might offer an advantage over the conventional infusion regarding the development of nephrotoxicity, without compromising patient survival. Further randomized studies are needed to investigate this issue.
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