Antibiotics Metronidazole Research Articles

A modified QuEChERS method development to analyze tylosin and metronidazole antibiotics residue in shrimp (Penaeus monodon) using LC-ESI MS/MS

A modified QuEChERS method was developed for the simultaneous analysis of tylosin (Tyl) and metronidazole (MNZ) residues in shrimp samples using LC-ESI-MS/MS. The sample extraction procedure was based on modified QuEChERS, and the cleanup method was dispersive solid-phase extraction (dSPE). Octadecyl (C18) and primary secondary amine (PSA) sorbents were used in the dSPE cleanup. Analyte chromatographic separations were carried out using a ZORBAX RRHD Eclipse Plus C18 (100 × 2.1 mm, particle size 1.8 μm) column. The mobile phase consisted of dilluting 0.1% of formic acid with water and acetonitrile. The analyte was identified with multiple reaction monitoring and positive electrospray ionization. The analyte showed good linearity in the range of 0.5–50 μg/L for both analytes, and correlation coefficients (R2) were 0.9997 and 0.9998 for Tyl and MNZ, respectively. For the recovery study, three different concentration levels were spiked in triplicate. The recovery obtained a good result in the range of 81–85 % for Tyl with relative standard deviation (RSD) ≤ ± 4.9% and in the range of 85–88% for MNZ with RSD ≤ ± 4.07 %. The limit of detection (LOD) was estimated at 0.4 μg/kg for Tyl and 0.3 μg/kg for MNZ, and the limit of quantification (LOQ) was estimated at 1 μg/kg for Tyl and 0.9 μg/kg for MNZ. The linearity and recovery study showed that the method is validated and can be used to determine the Tyl and MNZ residues in shrimp. Finally, the method was applied to 25 real samples, which were collected from local markets and super shops in Dhaka and Khulna districts of Bangladesh, and only traces of Tyl were detected in one sample. This method is suitable for the regular analysis of Tyl and MNZ antibiotic residues in shrimp samples and can be used to ensure food safety in Bangladesh.

Infrequent intrahousehold transmission of Clostridioides difficile between pet owners and their pets.

Companion animals have been shown to carry Clostridioides difficile strains that are similar or identical to strains found in people, and a small number of studies have shown that pets carry genetically identical C. difficile isolates as their owners, suggesting inter-species transmission. However, the directionality of transmission is ultimately unknown, and the frequency with which animals acquire C. difficile following their owners' infection is unclear. The goal of this study was to assess how often pets belonging to people with C. difficile infection carry genetically related C. difficile isolates. We enrolled pet owners from two medical institutions (University of Pennsylvania Health System (UPHS) and The Ohio State University Wexner Medical Center (OSUWMC)) who had diarrhoea with or without positive C. difficile assays and tested their faeces and their pets' faeces for C. difficile using both anaerobic culture and PCR assays. When microorganisms were obtained from both the owner and pet and had the same toxin profile or ribotype, isolates underwent genomic sequencing. Faecal samples were obtained from a total of 59 humans, 72 dogs and 9 cats, representing 47 complete households (i.e. where a sample was available from the owner and at least one pet). Of these, C. difficile was detected in 30 humans, 10 dogs and 0 cats. There were only two households where C. difficile was detected in both the owner and pet. In one of these households, the C. difficile isolates were of different toxin profiles/ribotypes (A+/B+ / RT 499 from the owner, A-/B- / RT PR22386 from the dog). In the other household, the isolates were genetically identical (one SNP difference). Interestingly, the dog from this household had recently received a course of antibiotics (cefpodoxime and metronidazole). Our findings suggest that inter-species transmission of C. difficile occurs infrequently in households with human C. difficile infections.

Photocatalytic degradation of metronidazole (MNZ) antibiotic by CuO nanoparticles for environmental protection from pharmaceutical pollution

Metronidazole (MNZ) is one of the extensively consumed generic antibiotics, which, due to its high resistance to biological degradation, is considered a potent environmental contaminant. In this study, we use CuO nanoparticles (NPs) for photocatalytic degradation of MNZ. Photocatalytic NPs with a crystallinity of over 80% were synthesized using a facile co‐precipitation method followed by calcination at a temperature of 500°C for a duration of 1 h. NPs were characterized thoroughly to investigate their opto‐structural properties. We investigated the efficiency of photocatalytic degradation with the variation of MNZ concentration, NP loading and the pH of the MNZ solution. Experimental results revealed that the pH of the MNZ solution strongly controlled the photocatalytic degradation efficiency. As pH was increased from 7 to 11, the degradation rate was enhanced remarkably. Degradation efficiency was also found to be strongly dependent on the concentration of both MNZ solution and CuO NPs.

Endoscopic retrograde appendicitis therapy or antibiotics for uncomplicated appendicitis.

Although laparoscopic appendectomy is the common intervention for uncomplicated acute appendicitis, there are risks1. Guidelines from the World Society of Emergency Surgery suggest that antibiotic therapy is an option2, but recurrence is 15 to 39 percent at 5 years3. A mini-invasive technique called endoscopic retrograde appendicitis treatment (ERAT) was developed for uncomplicated appendicitis instead of antibiotics or surgery4. ERAT aims to relieve the obstruction or stenosis of the appendiceal lumen, to prevent recurrent episodes of the disease (92 to 95 percent have not had a recurrence to date)5–7. This multicentre study assessed ERAT versus antibiotics for the treatment of uncomplicated appendicitis. Data on adult patients treated with ERAT or antibiotics for imaging-confirmed uncomplicated appendicitis from five centres in China (May 2018 to June 2020) was assessed retrospectively. The ERAT procedure was performed as described4 (Appendix S1). The antibiotic group received intravenous metronidazole 500 mg q8h combined with ceftriaxone 2 g q12h, cefoperazone/sulbactam 2 g q12h, or piperacillin–tazobactam 4.5 g q8h. Oral antibiotics (metronidazole 500 mg q8h with levofloxacin 500 mg q24h, ciprofloxacin 500 mg q8h, or amoxicillin–clavulanic acid 625 mg q8h) were taken after a minimum 72 hours of intravenous antibiotics. Patients could take analgesics as needed. Appendicectomy was recommended if there was worsening pain or white cell count.

Study on the photocatalytic degradation of metronidazole antibiotic in aqueous media with TiO2 under lab and pilot scale

Nowadays, the increased consumption of antibiotics, such as metronidazole (MTZ), leads to their introduction in wastewater as well as in the receiving surface waters due to their incomplete removal by conventional wastewater treatment plants. Heterogeneous photocatalysis is a versatile technology that can efficiently degrade such organic contaminants. In the present research, the photocatalytic degradation of MTZ with TiO2 P25 was studied under lab and pilot (CPC reactor) conditions. The antibiotic was efficiently removed at high rates in both cases (100 % and 91 %) following pseudo-first order kinetics with rate constants equal to 0.0452 min−1 (±RSD% = 0.68 % - 2.57 %) and 0.0462 L KJ−1 (±RSD% = 8.94 % - 21.64 %) respectively. Also, by scavenging lab scale experiments, the contribution of the generated reactive species was investigated and hydroxy radicals (HO•) were proposed as the predominant species. By applying high resolution mass spectrometry techniques, the transformation products (TPs) were identified and possible transformation pathways were proposed. The ecotoxicity of the TPs was assessed in silico using the ECOSAR software with the results revealing that most of them were less toxic than the parent compound. Similarly, the mutagenicity, developmental toxicity and bioconcentration factors of the TPs were predicted by utilizing the T.E.S.T. software and in their majority, were found to be less mutagenic and developmentally toxic than MTZ. The ecotoxicity monitoring with the Vibrio fischeri bioassay in both laboratory and pilot scale experiments indicated that through heterogeneous photocatalysis it is possible to reduce the toxicity of wastewater containing MTZ. Finally, the stability and reusability of the photocatalyst was investigated through three consecutive catalytic cycles with the results showing that the performance of TiO2 decreased after each use. For the heterogeneous photocatalysis with TiO2 to be a “real life” applicable technique, further studies focusing on catalyst regeneration and optimization of the catalytic conditions must be conducted.

ASSOCIATION BETWEEN ANTIBIOTIC USE AND INFLAMMATORY BOWEL DISEASE OUTCOMES

Abstract OBJECTIVE Benefit of antibiotic use in Inflammatory Bowel Disease (IBD) is unclear and has been a subject of research. This study investigated the association between antibiotic use and treatment outcomes among IBD patients using real-world data. METHODS Data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) of Crohn’s & Colitis Foundation’s IBD Plexus program were used. Patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) since 2000 were included. The use of antibiotics (ciprofloxacin, metronidazole, rifaximin and vancomycin) for ≥7 days after enrollment was identified from electronic health records and case report forms. Disease activity scores were assessed at the time of enrollment (baseline) and during follow-up using 6-point Mayo score (6-pt MS) and short Clinical Disease Activity Index (sCDAI) for UC and CD, respectively. Patients’ demographic and clinical characteristics were also collected. Remission was defined as 6-pt MS of 0-1 for UC and sCDAI<150 for CD. The association between antibiotic use and outcome during follow-up was assessed in a subset of patients without remission at baseline using a multivariable Cox proportional hazards model. The model included the following covariates for adjustment: age, gender, race, family history of IBD, IBD surgery, disease activity at enrollment and other IBD drug use during follow-up. RESULTS A total of 2,959 IBD patients (UC=1,060; CD=1,899) were included. Mean age at diagnosis was 30±14 years (UC=32±15; CD=28±14). Forty-four percent of the patients were male (UC=49%; CD=41%) and 79% were White (UC=82%; CD=78%). Antibiotic use after enrollment was observed in 29% of the patients (UC=26%; CD=30%). About 60% of UC or CD patients were in remission at baseline. The antibiotic use group had significantly higher baseline disease activity (UC 6-pt MS: 1.7±1.8; CD sCDAI: 167±96) than patients without antibiotic use (UC 6-pt MS: 1.3±1.7; CD sCDAI: 137±89). In the subset of patients with mild, moderate or severe baseline IBD (6-pt MS>1 for UC; sCDAI≥150 for CD), the baseline disease activity scores were largely comparable between patients who used antibiotic and who did not (UC 6-pt MS: 3.6±1.3 vs 3.3±1.3, p-value=0.063; CD sCDAI: 248±83 vs 238±83, p-value=0.169), while patients who used antibiotics were less likely to experience remission during follow-up compared to those who did not use antibiotics (UC adjusted remission hazard ratio [aRHR] 0.39, 95% confidence interval [CI] 0.26-0.60; CD aRHR 0.60, 95% CI 0.46-0.79). CONCLUSION In this study, antibiotic use in patients with IBD was negatively associated with remission during follow-up. The effect of antibiotics on gut microbiome and optimal use of antibiotics in IBD patients need to be further explored.

Association Between Intestinal Changes and Systemic Cytokines in Mouse Dysbiosis Models

Background/Objective: Gut dysbiosis has been linked with the development of low-grade inflammation in part due to an increase in pro-inflammatory cytokines and a decrease in short chain fatty acid production. This project aims to study the effects of antibiotics-driven dysbiosis on host gene expression in murine ilea. Additionally, we will examine the ilea for morphological differences among treatment groups.
 Methods: Wild-type C57Bl/6J mice were given either an antibiotic (ampicillin, neomycin, vancomycin, or metronidazole) in water or water alone from 5 to 16 weeks of age. Mice were euthanized at 16 weeks, and the ilea were collected. RNA isolation and quantification were performed using the QIAgen RNeasy Lipid Tissue Mini Kit and BioTek Cytation 5 with Take3 plate, respectively.Histology of the ilea will be performed using hematoxylin and eosin (H&E) staining.
 Results: The average RNA yield was 3.91 ± 1.14 μg/mg of tissue, and the average RNA purity, reported as the 260/280 nm ratio, was 2.06 ± 0.02. A Kruskal-Wallis test revealed there was no statistically significant difference in the average RNA yield between experimental groups (p-value = 0.15). Transcriptomes of isolated samples will be sequenced, and results will be analyzed in association with 16S sequencing (Zymo) of bacterial communities of the gut. Based on prior murine studies, we expect upregulation of pro-inflammatory cytokines and downregulation of tight junction proteins, which contribute to inflammation and increased gut permeability.
 Conclusion and Scientific Impact: At this time, conclusions on the effects of antibiotics- driven dysbiosis on murine ileal gene expression and H&E staining cannot be made as further results and analysis are pending. However, the RNA sequencing and H&E results will be important to examine the impact of changes to the gut microbiome resulting from the administration of various antibiotics and further understand the relationship between antibiotics- driven dysbiosis and the microbe-host relationship

G-C3N4 as Photocatalyst for the Removal of Metronidazole Antibiotic from Aqueous Matrices under Lab and Pilot Scale Conditions

The presence of pharmaceuticals in water is a problem of utmost importance due to the various adverse effects that these compounds may have on aquatic organisms and also humans. Since conventional wastewater treatment plants fail to efficiently remove many of these compounds, new techniques such as heterogeneous photocatalysis have been developed that are capable of degrading them. In this study, graphitic carbon nitride (g-C3N4) was used as photocatalyst to remove metronidazole (MTZ), which is a widely prescribed antibiotic that has been reported as a potential carcinogen. The experiments were performed under lab and pilot scale conditions. During the lab scale experiments, 90.6% of the initial pharmaceutical concentration was removed after 360 min of irradiation and its removal followed a pseudo first order kinetic model with a degradation rate constant of k = 0.00618 min−1. Moreover, scavenging studies indicated that the indirectly produced hydroxy radicals contribute very little to the degradation mechanism. Through high precision mass spectrometry techniques, eight transformation products (TPs) were identified, and possible transformation pathways were suggested. Similarly, in the case of pilot scale experiments, 100 and 200 mg L−1 of g-C3N4 were used and the antibiotic’s removal also followed pseudo first order kinetics with k = 0.00827 min−1 and k = 0.00942 min−1, respectively. However, starting from low level inherent concentrations, only two TPs were identified. By using in silico tools (ECOSAR and T.E.S.T.), various ecotoxicological values were predicted for the TPs, which were generally found to be less toxic than the parent compound and with lower mutagenic and bioaccumulative potential. Moreover, the monitoring of the ecotoxicity with the in vitro Microtox bioassay showed that at the end of all the photocatalytic processes, the toxicity was reduced. In conclusion, this technique could have the potential to remove MTZ and other similar pharmaceuticals in full-scale applications. However, for this to happen with the highest possible efficiency, further studies must be conducted, focusing on improving the catalyst’s performance and reusability, improving the separation of catalyst as well as finding the optimum conditions for this process.

Optimized Antimicrobial Peptide Jelleine-I Derivative Br-J-I Inhibits Fusobacterium Nucleatum to Suppress Colorectal Cancer Progression.

Colorectal cancer (CRC) is a major health burden worldwide due to its high morbidity, mortality, and complex etiology. Fusobacterium nucleatum (Fn), a Gram-negative anaerobe found in 30% of CRC patients, promotes CRC carcinogenesis, metastasis, and chemoresistance. Effective antimicrobial treatment is an unmet need for the rising CRC burden. Antimicrobial peptides (AMPs) represent a new class of antimicrobial drugs. In our previous study, we did the structure-activity study of Jelleine-I (J-I) and identified several halogenated J-I derivatives Cl-J-I, Br-J-I, and I-J-I. To determine whether those J-I derivatives can be a new therapy for bacterial-associated CRC, here we tested the antibacterial activities of these AMPs against Fn and their effects on CRC development. We found that Br-J-I showed the highest anti-Fn activity and Br-J-I may target membrane-associated FadA for Fn membrane disruption. More importantly, Fn promoted the growth of CRC cells-derived xenograft tumors. Br-J-I suppressed Fn load, colon inflammation, and Fn-induced CRC growth. Of note, Br-J-I induced better anti-CRC effects than common antibiotic metronidazole and Br-J-I sensitized the cancer-killing effect of chemotherapy drug 5-fluorouracil. These results suggest that Br-J-I could be considered as an adjunctive agent for CRC treatment and AMPs-based combination treatment is a new strategy for CRC in the future.

Synthesis, Characterization and Antifungal Activity of Metal Chelates Based on 8-Hydroxyquinoline and Metronidazole

In the present study, 5-chloromethyl-8-hydroxyquinoline (CMQ) hydrochloride, a versatile derivative of 8-hydroxyquinoline is reacted with a potent antibiotic drug metronidazole in order to yield a novel ligand namely 5-((2-(2-methyl-5-nitro-1H-imidazol-1-yl) ethoxy) methyl)-8-hydroxyquinoline (NIHQ). The co-ordinate metal chelates of the ligand NIHQ were prepared using divalent metal ions viz., Cu2+, Co2+, Ni2+, Mn2+, Zn2+ and Cd2+ by simple method. The ligand NIHQ and its all metal chelates were duly characterized for elemental content, spectral features, M: L (metal: ligand) ratio, and magnetic moment. The results of electronic spectral studies and magnetic properties indicated octahedral geometry for all the metal chelates. Antifungal activity of all the samples was tested against plant pathogens such as Aspergillus niger, Botrydepladia thiobromine, Nigrospora Sp., and Fusarium oxyporium. The results showed promising antifungal activity of all the metal chelates.

Environmentally friendly loading of palladium nanoparticles on nanoporous PET track-etched membranes grafted by poly(1-vinyl-2-pyrrolidone) via RAFT polymerization for the photocatalytic degradation of metronidazole.

Nanoporous track-etched membranes (TeMs) are highly versatile materials that have shown promise in various applications such as filtration, separation, adsorption, and catalysis due to their mechanical integrity and high surface area. The performance of TeMs as catalysts for removing toxic pollutants is greatly influenced by the pore diameter, density, and functionalization of the nanochannels. In this study, the synthesis of functionalized poly(ethylene terephthalate) (PET) TeMs with Pd nanoparticles (NPs) as catalysts for the photodegradation of the antibiotic metronidazole (MTZ) was methodically investigated and their catalytic activity under UV irradiation was compared. Before loading of the Pd NPs, the surface and nanopore walls of the PET TeMs were grafted by poly(1-vinyl-2-pyrrolidone) (PVP) via UV-initiated reversible addition fragmentation chain transfer (RAFT)-mediated graft copolymerization. The use of RAFT polymerization allowed for precise control over the degree of grafting and graft lengths within the nanochannels of PVP grafted PET TeMs (PVP-g-PET). Pd NPs were then loaded onto PVP-g-PET using several environmentally friendly reducing agents such as ascorbic acid, sodium borohydride and a plant extract. In addition, a conventional thermal reduction technique was also applied for the reduction of the Pd NPs. The grafting process created a surface with high-sorption capacity for MTZ and also high stabilizing effect for Pd NPs due to the functional PVP chains on the PET substrate. The structure and composition of the composite membranes were elucidated by scanning electron microscopy (SEM), X-ray diffraction (XRD) analysis, thermogravimetry, contact angle measurements and energy dispersive X-ray (EDX), X-ray photoelectron (XPS) and Fourier transform infra-red (FTIR) spectroscopies. The effects of different types of reducing agents, pH, the amount of loaded catalyst and MTZ concentration on the MTZ catalytic degradation efficiency of the obtained composites were investigated. The efficiency of the catalyst prepared in the presence of ascorbic acid was superior to the others (89.86% removal at 30 mg L-1 of MTZ). Maximum removal of MTZ was observed at the natural pH (6.5) of the MTZ solution at a concentration of 30 mg per L MTZ. The removal efficiency was decreased by increasing the catalyst dosage and the initial MTZ concentration. The reaction rate constant was reduced from 0.0144 to 0.0096 min-1 by increasing the MTZ concentration from 20 to 50 mg L-1. The photocatalyst revealed remarkable photocatalytic activity even after 10 consecutive cycles.

Case series of Anaerococcus prevotii infection in road traffic accidents in New Delhi, India

ABSTRACT Anaerobic bacteria are part of the normal human skin flora. However, anaerobic infections could have different clinical courses with outcomes ranging from local abscesses to life-threatening conditions. Any long-term wound infection or a wound discharging pus with a foul smell is an indication of anaerobic infections. We present here a series of three cases of infection in patients injured in road traffic accidents (RTA) in which Anaerococcus prevotii was identified as the pathogen. Samples isolated from tissues of patients from three different RTAs were received in anaerobic conditions in Robertson Cooked Meat medium (RCM) within 2-4 h of collection. RCM was incubated for 24 h and then inoculated on three blood agars (BA) plates cultured anaerobically in a Gas Pack Jar, in a CO2 incubator, or aerobically. No growth was noted on the aerobically incubated plate. After 48 h, anaerobic plates were examined for growth and a Gram stain was performed. The identity of isolated colonies was confirmed by VITEK-2, and sensitivity testing was done by the pour plate method using Epsilon meter strips. All three tissue samples isolated from (1) the right leg, (2) the right inguinal region, and (3) the left thigh of patients revealed Anaerococcus prevotii, and two isolates showed resistance to the antibiotic metronidazole. Any injury with long-term infection, especially in patients suffered from RTAs, needs to be scrutinized for anaerobic infections since they are common in RTA related injuries. No random medication should be administered without prior culture sensitivity testing, because it might contribute to metronidazole or other antibiotics resistance.

Bee Sting-Inspired Inflammation-Responsive Microneedles for Periodontal Disease Treatment.

Periodontal lesions are common and frustrating diseases that impact life quality. Efforts in this aspect aim at developing local drug delivery systems with better efficacy and less toxicity. Herein, inspired by the sting separation behavior of bees, we conduct novel reactive oxygen species (ROS)-responsive detachable microneedles (MNs) that carry antibiotic metronidazole (Met) for controllable periodontal drug delivery and periodontitis treatment. Benefiting from the needle-base separation ability, such MNs can penetrate through the healthy gingival to reach the gingival sulcus's bottom while offering minimal impact to oral function. Besides, as the drug-encapsulated cores were protected by poly (lactic-co-glycolic acid) (PLGA) shells in MNs, the surrounding normal gingival tissue is not affected by Met, resulting in excellent local biosafety. Additionally, with the ROS-responsive PLGA-thioketal-polyethylene glycol MN tips, they can be unlocked to release Met directly around the pathogen under the high ROS in the periodontitis sulcus, bringing about improved therapeutic effects. Based on these characteristics, the proposed bioinspired MNs show good therapeutic results in treating a rat model with periodontitis, implying their potential in periodontal disease.

In vitro bacterial vaginosis biofilm community manipulation using endolysin therapy

Bacterial vaginosis (BV) affects approximately 26% of women of childbearing age globally, presenting with 3–5 times increased risk of miscarriage and two-fold risk of pre-term birth. Antibiotics (metronidazole and clindamycin) are typically employed to treat BV; however the success rate is low due to the formation of recalcitrant polymicrobial biofilms. As a novel therapeutic, promising results have been obtained in vitro using Gardnerella endolysins, although to date their efficacy has only been demonstrated against simple biofilm models.In this study, a four-species biofilm was developed consisting of Gardnerella vaginalis, Fannyhessea vaginae, Prevotella bivia and Mobiluncus curtisii. Biofilms were grown in NYC III broth and treated using antibiotics and an anti-Gardnerella endolysin (CCB7.1) for 24 h. Biofilm composition, viability and structure were assessed using colony counts, live/dead qPCR and scanning electron microscopy.All species colonised biofilms to varying degrees, with G. vaginalis being the most abundant. Biofilm composition remained largely unchanged when challenged with escalated concentrations of conventional antibiotics. A Gardnerella-targeted endolysin candidate (CCB7.1) showed efficacy against several Gardnerella species planktonically, and significantly reduced viable G. vaginalis within polymicrobial biofilms at 1 to 4X pMIC (p < 0.05 vs. vehicle control).Collectively, this study highlights the resilience of biofilm-embedded pathogens against the currently used antibiotics and provides a polymicrobial model that allows for more effective pre-clinical screening of BV therapies. The Gardnerella-specific endolysin CCB7.1 demonstrated significant activity against G. vaginalis within polymicrobial biofilms, altering the overall community dynamic and composition.

PENGARUH PEMBERIAN GLUCOMANNAN HYDROLYSATES (GMH) DAN LACTIC ACID (LA) TERHADAP PENINGKATAN JUMLAH KOLONI BAKTERI LACTOBACILLUS spp PADA BACTERIAL VAGINOSIS WANITA USIA SUBUR

Bacterial Vaginosis (BV) is an infection caused by an imbalance in the normal vaginal flora where lactobacillus spp., producing hydrogen peroxidase (H2O2) is replaced by anaerobic bacteria such as Gardnerella vaginalis, Mobiluncus spp., Prevotella spp., Bacterides, and Mycoplasma sp., which are generally occurs in women of childbearing age (WUS). Substitution of Lactobacillus spp., this causes a decrease in H2O2 which is generally characterized by the production of a lot of vaginal secretions, gray to yellow, thin, homogeneous, has a fishy odor, and there is an increase in pH. Glucomannan Hydrolysates (GMH) as a prebiotic is expected to provide nutrition to Lactobacillus spp so that it can multiply and increase in number, while BV gel containing Lactic Acid (LA) can reduce vaginal pH to become acidic so that pathogenic bacteria are not suitable for growing in an acidic environment. The type of research used is true experiment pretest - posttest. Respondents in the study totaled 28 people and were grouped into 4, namely 1) Given metronidazole antibiotics. 2) Given Antibiotics + GMH. 3) Given LA. 4) Given LA+GMH. The number of bacterial colonies through the streak plate method. Giving LA+GMH to BV women of childbearing age has a significant effect on increasing the number of Lactobacillus spp bacterial colonies. Therefore giving LA+GMH is useful in treating BV.

COST-EFFECTIVENESS ANALYSIS OF ANTIBIOTIC USAGE IN DIABETIC FOOT ULCUS PATIENTS IN DOKTER SOEKARDJO TASIKMALAYA HOSPITAL

Objective: Diabetic foot ulcers is sores on the skin surface until it penetrates the skin layer caused by infection, which is require high costs for treatment. This puts a considerable burden on the patient's family, health agencies and society in general. The purpose of this study was to describe the direct medical costs and cost-effective antibiotics for diabetic foot ulcer patients at Dokter Soekardjo Tasikmalaya Hospital. Methods: The research method is retrospectively with a purposive sampling technique. The research subjects included 24 hospitalized diabetic foot ulcer patients who received antibiotic treatment ceftriaxone with metronidazole or meropenem with metronidazole. The effectiveness of therapy was determined by the Length of Stay (LOS). Direct medical costs were obtained from medical costs, treatment costs, laboratory costs, and radiology costs. Results: The average direct medical cost for the combination of ceftriaxone and metronidazole antibiotics was Rp. 4 668 062 and for the combination of meropenem antibiotics with metronidazole was Rp. 9 093 830. The effectiveness of the antibiotic ceftriaxone with metronidazole was 47%. Conclusion: The cost-effective antibiotic was ceftriaxone with metronidazole which has the lowest ACER value Rp. 9 932 046 and the ICER value is Rp. 22 128 840.

High-entropy perovskite oxide washcoated porous alumina ceramic as a superb catalyst for activating peroxymonosulfate to eliminate refractory organic pollutants

Utilizing cobalt-containing oxides as catalysts is one of the most popular ways of activating peroxymonosulfate (PMS) to generate sulfate radical (SO4−) for elimination of organic pollutants. However, it still remains a great challenge to realize high activity, good stability, and easy recyclability at the same time. Herein, we demonstrate that high-entropy perovskite oxide (HEPO) washcoated porous alumina ceramic (La(Co0.2Al0.2Fe0.2Mn0.2Cu0.2)O3@PAC) is a superb catalyst for PMS activation. In particular, benefiting from unique multimetallic composition and entropy-stabilized structure, the La(Co0.2Al0.2Fe0.2Mn0.2Cu0.2)O3@PAC manifested high catalytic activity with a turnover frequency (TOF) up to 15.38 min−1 in activating PMS for degradation of antibiotic pollutant metronidazole (MNZ). Meanwhile, the high stability of HEPO gave rise to a significant decrease of cobalt leaching (0.111 mg L−1) in comparison with LaCoO3@PAC catalyst (1.71 mg L−1). Moreover, monolithic porous architecture of La(Co0.2Al0.2Fe0.2Mn0.2Cu0.2)O3@PAC could not only endow this catalyst with easy recyclability but ensure high permeability for rapid mass transfer of guest species. Our work exemplifies the superiority of HEPO-based monolithic catalyst as a new promising activator of PMS for water remediation.

Comparative biofilm-forming ability between Clostridioides difficile strains isolated in Latin America and the epidemic NAP1/027 strain.

One of the challenges in treating Clostridioides difficile infection (CDI) is that the bacterium forms biofilms, a critical virulence mechanism known to promote antibiotic resistance and, as a result, consequently, a higher recurrence of the disease. The goal of this study was to compare the ability of three MLST Clade 2 strains to form a biofilm in vitro: ICC-45 (ribotype SLO231/UK[CE]821), a ST41 toxinotype IXb isolated in Brazil; and two epidemic NAP1/027/ST01 strains: NAP1/027/ST01 (LIBA5756), isolated during a 2010 outbreak in Costa Rica and the reference epidemic strain NAP1/027/ST01 (R20291); and ATCC700057, a non-toxigenic strain. The ability of strains to form biofilm was evaluated using crystal violet staining. In addition, samples were stained with the Film Tracer biofilm matrix (Invitrogen®) and the biofilm matrix thickness was measured using confocal microscopy. The matrix architecture was determined using Scanning electron microscop. Confocal microscopy was used to detect the presence of toxin A (tcdA) using an anti-Clostridioides difficile TcdA antibody. The expression of virulence genes (tcdA, tcdB, tcdC, cdtB, spo0A, slpA, cwp66 and cwp84) was examined, as well as the effect of antibiotics metronidazole (MTZ) and vancomycin (VAN) on biofilm growth. All of the strains tested formed a moderate biofilm with 1.1 <DO570nm>3.5. After 72h, biofilm biomass of the NAP1/027/ST01 epidemic strains (LIBA5756 and R20291) was significantly higher than ICC-45 and ATCC 700057 biofilms, as confirmed by electron and confocal microscopy. At 120h, the LIBA5756 biofilm biomass decreased compared to other strains. The toxigenic strains R20291 or LIBA 5756 had higher expression of genes tcdA, tcdB, tcdC, cdtA, slpA and spo0A than ICC-45, but there were no significant differences in the expression levels of cdtB, cwp66 and cwp84. In epidemic strains, VAN and MTZ inhibited biofilm formation; however, in the ICC-45 strain, MIC concentrations of VAN and MIC and 4MIC of MTZ did not inhibit biofilm formation. The three MLST Clade 2 isolated from different rybotipes, two of which were isolated from Latin America, are competent biofilm-forming bacteria, indicating their ability to induce C. difficile infection recurrence, making treatment difficult.

Frequency of Healing of Fistula in Patients Undergoing Video Assisted Anal Fistula Treatment in High Lying Fistula in Ano

Background: Fistula-in-ano is an abnormal tract that usually connects rectal mucosa and perianal skin thus accounting upto 90% cases with an incidence of 5.6/100.000 in women while 12.3/100.000 in men. Aim: To determine the frequency of healing in patients with high lying fistlua in ano undergoing VAAFT. Study design: Cross-sectional study. Methodology: Patients (n=153) were enrolled during study. All enrolled patients had DRE and proctoscopy before start of treatment. Fistuloscope was used to diagnose high lying fistula during examination. Metronidazole antibiotic was given to all patients both pre and post-surgery. SPSS v.26 analyzed the data. Stratification of healing data was done with respect to age and gender. Post stratification Chi-Squire test was applied with P-value ≤0.05 was taken as significant. Results: Almost 77% were males while rest (23%) patients were females. Results showed healing in 70% of patients while 30% patients failed to heal. Practical Implication: This study showed that VAAFT procedure is safe as a treatment modality in comparison to Anal Fistula Plug and conventional Seton placement for complex fistulas or high anal fistulas thus advocated sphincter saving procedure in our setups. Conclusion: It was concluded that this new surgical technique has advantages like sphincter-saving with small surgical wounds. However, fistuloscopy identifies secondary tracts or chronic abscesses. Keywords: Healing, High Lying Fistlua and VAAFT.

Antibiotic Treatment foLlowing surgical drAinage of perianal abScess (ATLAS): protocol for a multicentre, double-blind, placebo-controlled, randomised trial

IntroductionPerianal fistula is a burdening disease with an annual incidence of 6–12/100 000 in Western countries. More than 90% of crypto-glandular fistulas originate from perianal abscess. Despite adequate drainage, up...