ObjectiveThis study investigates the feasibility of delivering inspiratory muscle training as part of the physical therapy treatment for patients with post-COVID dyspnoea.DesignMixed-methods pilot study.Subjects/patientsPatients with complaints of dyspnoea after COVID-19 infection and their physical therapists.MethodsThe Amsterdam University of Applied Sciences and the Amsterdam University Medical Centers conducted this study. Participants performed daily inspiratory muscle training at home for 6 weeks, consisting of 30 repetitions against a pre-set resistance. The primary outcome was feasibility assessed as acceptability, safety, adherence and patient- and professional experience obtained through diaries and semi-structured interviews. The secondary outcome was maximal inspiratory pressure.ResultsSixteen patients participated. Nine patients and 2 physical therapists partook in semi-structured interviews. Two patients dropped out before initiating the training. Adherence was 73.7%, and no adverse events occurred. Protocol deviations occurred in 29.7% of the sessions. Maximal inspiratory pressure changed from 84.7% of predicted at baseline to 111.3% at follow-up. Qualitative analysis identified barriers to training: ‘Getting acquainted with the training material’ and ‘Finding the right schedule’. Facilitators were: ‘Support from physical therapists’ and ‘Experiencing improvements’.ConclusionDelivering inspiratory muscle training to patients with post-COVID dyspnoea seems feasible. Patients valued the simplicity of the intervention and reported perceived improvements. However, the intervention should be carefully supervised, and training parameters adjusted to individual needs and capacity.
BACKGROUND: The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA).METHODS: PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995.FINDINGS: We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I 2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis. INTERPRETATION: In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence.FUNDING: Dutch Association for Quality Funds Medical Specialists.
To treat microbial infections, antibiotics are life-saving but the increasing antimicrobial resistance is a World-wide problem. Therefore, there is a great need for novel antimicrobial substances. Fruit and flower anthocyanins have been recognized as promising alternatives to traditional antibiotics. How-ever, for future application as innovative alternative antibiotics, the full potential of anthocyanins should be further investigated. The antimicrobial potential of anthocyanin mixtures against different bacterial species has been demonstrated in literature. Preliminary experiments performed by our laboratories, using grape, rose and red cabbage anthocyanins against S. aureus and E. coli confirmed the antimicrobial potential of these substances. Hundreds of different anthocyanin entities have been described. However, which of these entities hold antimicrobial effects is currently unknown. Our preliminary data show that an-thocyanins extracted from grape, rose and red cabbage contain different collections of anthocyanin entities with differential antimicrobial efficacies. Our focus is on the extraction and characterization of anthocyanins from various crop residues. Grape peels are residues in the production of wine, while red rose and tulip leaves are residues in the production of tulip bulbs and regular horticulture. The presence of high-grade substances for pharmacological purposes in these crops may provide an innovative strategy to add value to other-wise invaluable crop residues. This project will be performed by the collaborative effort of our institute together with the Medi-cal Microbiology department of the University Medical Center Groningen (UMCG), 'Wijnstaete', a small-scale wine-producer (Lemelerveld) and Imenz Bioengineering (Groningen), a company that develops processes to improve the production of biobased chemicals from waste products. Within this project, we will focus on the antimicrobial efficacy of anthocyanin-mixtures from sources that are abundantly and locally available as a residual waste product. The project is part of a larger re-search effect to further characterize, modify and study the antimicrobial effects of specific anthocy-anin entities.
Water treatment companies are more and more interested in chemical-free water treatment. This is a solution that might not only decrease costs of chemicals, but also decrease possible formation of by-products and contribute to decreasing the introduction of emerging contaminants in the environment. A possible route for this is the use of magnetic fields based treatment. Magnetic fields exist around us (our planet is surrounded by such fields) but are not broadly used in water treatment. A reason for this situation isthe fact that water treatment is a rather traditional market and magnetic treatment, conversely, a rather controversial and (still) not completely understood. Even with such resistance, recently it has been shown that magnetic fields applied to drinking water resulted in significant structural change of its microbiome [1]. This community structural change was clearly detected with a newly developed flow cytometry method, where the phenotypic characteristics of the entire microbial community could be analysed instantly [2-9]. Lab-scale batch experiments have shown that magnetic fields can selectively boost the growth of smaller bacteria [1][3] and indicated as a next step that the same principle could be addressed in pilot scale tests. ISusMag is structured to apply the robust and instant flow cytometry method to examine the effect of magnetic fields on drinking water at pilot scale under realistic field conditions. For this purpose, groundwater will be evenly distributed into two (pipe)lines of the same length: one will be magnetically treated, and one will be used as control. Samples will be taken at the end of the two pipes for flow cytometry examination. Measurement results can help drinking water companies to understand whether a magnetic treatment is an alternative to control the growth of pathogenic bacteria instead of classical chemical treatment (disinfection).
Routine neuropathology diagnostic methods are limited to histological staining techniques or directed PCR for pathogen detection and microbial cultures of brain abscesses are negative in one-third of the cases. Fortunately, due to improvements in technology, metagenomic sequencing of a conserved bacterial gene could provide an alternative diagnostic method. For histopathological work up, formalin-fixed paraffin-embedded (FFPE) tissue with highly degraded nucleic acids is the only material being available. Innovative amplicon-specific next-generation sequencing (NGS) technology has the capability to identify pathogens based on the degraded DNA within a few hours. This approach significantly accelerates diagnostics and is particularly valuable to identify challenging pathogens. This ensures optimal treatment for the patient, minimizing unnecessary health damage. Within this project, highly conserved primers in a universal PCR will be used, followed by determining the nucleotide sequence. Based on the obtained data, it is then precisely determined which microorganism(s) is/are responsible for the infection, even in cases of co-infection with multiple pathogens. This project will focus to answer the following research question; how can a new form of rapid molecular diagnostics contribute to the identification of microbial pathogens in CNS infections? The SME partner Molecular Biology Systems B.V. (MBS) develops and sells equipment for extremely rapid execution of the commonly used PCR. In this project, the lectorate Analysis Techniques in the Life Sciences (Avans) will, in collaboration with MBS, Westerdijk Institute (WI-KNAW) and the Institute of Neuropathology (Münster, DE) establish a new molecular approach for fast diagnosis within CNS infections using this MBS technology. This enables the monitoring of infectious diseases in a fast and user-friendly manner, resulting in an improved treatment plan.
