Aspirate Culture Research Articles

Effects of immunocompromised status on diagnostic criteria in septic arthritis

IntroductionSeptic arthritis is an orthopaedic emergency, with permanent cartilage damage possible within hours of the onset of symptoms. Diagnostic criteria for septic arthritis in immunocompetent patients are well established, however, there is a paucity of literature evaluating diagnostic criteria in immunocompromised patients. The purpose of this retrospective case-control study was to evaluate the laboratory and clinical information of immunocompromised patients with septic arthritis and compare them to immunocompetent patients with septic arthritis to enable physicians to diagnose septic arthritis more accurately in this population. MethodsAll patients at our institution, a level I trauma center, with a clinical diagnosis of septic arthritis between January 1, 2006 and November 1, 2021 were identified and reviewed retrospectively. Patients 18 years old or older were screened for immunocompromised status and those meeting criteria were included for review. The control cohort was matched by the joint affected and age. Data were analyzed using the Shapiro-Wilk test, Turkey's test, Mann-Whitney U test, independent sample t-test, and chi-square analysis. A p-value of <0.05 was considered significant. ResultsA total of 36 patients with positive joint aspirate cultures were compared (18 immunocompetent and 18 immunocompromised). The immunocompromised group had a significantly longer length of hospital stay than the immunocompetent group (p = 0.044). There was no significant difference in erythrocyte sedimentation rate (ESR) (p = 0.852), peripheral white blood cell count (pWBC) (p = 0.696), joint aspirate white blood cell count (aWBC) (p = 0.901), polymorphonuclear cell percentage (PMN%) (p = 0.325), or total operations performed per patient (p = 0.365). ConclusionAt our institution, immunocompromised patients with septic arthritis did not have significantly different diagnostic laboratory values when compared to immunocompetent patients. This suggests that immunocompromised patients with suspicion of septic arthritis can be assessed with similar diagnostic criteria as immunocompetent individuals; however, a larger cohort study is needed to assess the difference more precisely in laboratory values.

Outcomes of Second-stage Reimplantation After Modular Knee Arthrodesis for Periprosthetic Joint Infection

Background:Modular knee arthrodesis (MKU) is a salvage treatment for recurrent periprosthetic joint infection (PJI) or PJI associated with notable bone loss. Reimplantation endoprosthetic reconstruction (REI) is an option in patients with MKU who have PJI clearance but are not satisfied with pain or functional outcomes with MKU. The purpose of this study was to evaluate the outcomes of MKU to REI conversion.Methods:This was a single-center retrospective cohort study of 56 patients who underwent MKU to REI from 2010 to 2019. All patients were staged according to the McPherson staging system. An infecting organism was documented based on pre-MKU aspiration or intraoperative cultures at the time of MKU. Rate ratios were calculated for relevant patient factors. Rate ratios were calculated using Poisson regression with a log link.Results:The mean REI patient age was 67 years, most of the patients were McPherson B hosts (62.5%) with a type 2 (46.4%) or type 3 (51.8%) limb score, and all PJI were chronic. The most common infecting organisms at the time of MKU were Staphylococcus epidermidis (23.2%) and Staphylococcus aureus (23.2%, MSSA 14.3%, MRSA 8.9%). The mean time from MKU to REI was 220 days. An 8.9% REI index hospitalization complication rate and a 21.4% overall complication rate (excluding reinfection) were observed. Sixty-seven percent of the patients remained infection-free at an average follow-up of 37 months, among those there was 96.4% implant survivorship. No notable association was observed between index PJI organism or McPherson staging and REI failure secondary to PJI.Discussion:Approximately two thirds of patients who undergo conversion from MKU to REI have infection-free survival at the midterm follow-up. An index infecting organism and a McPherson host type do not seem to be markedly associated with reinfection risk. These findings help guide expectations of PJI MKU conversion to REI.

Biliary aspirate culture: a necessity or a liability?

Biliary aspirate culture: a necessity or a liability?

Abdominal aortic endograft infection. A decade of experience and literature review

IntroductionAortic endograft infection is an infrequent but life-threatening complication after endovascular abdominal aortic repair (EVAR). There is no consensus on management of endograft infection and little evidence has been published in our country. Endograft explantation is considered the “gold standar” treatment whereas percutaneous or surgical perigraft and sac drainage associated to antibiotics should be considered and alternative therapy. MethodsWe carried out a retrospective and descriptive review of abdominal aortic endograft infections at our tertiary center (Hospital Universitario Cruces) during last ten years (2010–2019). ResultsWe describe the clinical and microbiological characteristics of 10 EVAR infections, their management and outcomes. The incidence of graft infection after EVAR was 3%. The mean time to the clinical presentation of infection was 16.9 months (median 4.5 months). The microbiological diagnosis was reached in 100% of cases (predominance of gram-positive species). The overall mortality rate was 50% (although the survival rate was 100% after surgical drainage of the sac). ConclusionPerigraft or aneurysm sac aspiration culture show their diagnostic utility as microbiological diagnosis was reached in all cases despite of blood cultures being only positive in 50% of the samples. Surgical drainage and endograft preservation combined with antibiotherapy show remarkable results. The high heterogeneity in our case series makes difficult to offer general recommendations, thus far, a tailored approach to treatment is suggested.

Antibiotic Susceptibility of Microorganisms Grown in Tracheal Aspirate Cultures of Pediatric Intensive Care Patients.

BackgroundMicroorganisms proliferating in the hospital setting cause infections with high morbidity and mortality rates. In intensive care units (ICUs), the rates of antibiotic resistance and microorganisms grown in cultures may vary by time period. Antibiotic sensitivity must be known for a correct empirical treatment approach. This study aimed to investigate the distribution and antibiotic resistance profiles of pathogenic microorganisms isolated from tracheal aspirate samples in the ICU.MethodologyThis study enrolled 100 tracheostomized patients aged one month to 18 years, regardless of gender, who were followed in the ICU of Dicle University for more than 72 hours. Medical data were retrospectively evaluated from the medical records. Care was taken to collect samples before changing antibiotics. Antibiotherapy was continued until after culture antibiogram results were obtained, or empirical antibiotic therapy was started by giving consideration to the potential source in patients with a suspected infection.ResultsAn analysis of the tracheal aspirate culture samples of the patients showed that Pseudomonas aeruginosa (54%), Acinetobacter baumannii (16%), and Staphylococcus aureus (8%) were the most common pathogens. An analysis of the culture antibiogram results of the tracheal aspirate samples obtained from the entire study population showed that P. aeruginosa was 100% resistant against vancomycin, clindamycin, and teicoplanin, but highly sensitive to colistin and amikacin. A. baumannii was highly resistant to almost all antibiotics but showed no resistance against colistin. Carbapenems being frequently preferred for cases where empirical therapy should be initiated for ICU infections can be one of the reasons for a high carbapenem resistance rate in our hospital.ConclusionsWe believe that starting empirical therapy with colistin when infections caused by Pseudomonas and Acinetobacter are suspected may be an appropriate initial therapy until culture antibiogram results become available. Microbiological data are crucial for a correct empirical treatment approach. In this way, intensive antibiotic usage and subsequent high antibiotic resistance can be adequately controlled.

Incremental Value of 18 F-FDG-Labeled Leukocytes PET/CT Over 18 F-FDG PET/CT Scan in the Detection of Occult Infection.

Differentiating infection and sterile inflammation is the main clinical concern of clinicians as they are closely related to each other. Although 18 F-FDG PET/CT imaging is widely used, its main disadvantage is its lack of specificity to discriminate aseptic from septic inflammation. 18 F-WBC PET/CT scan is a promising tool for the accurate diagnosis of infection owing to its high specificity. The aim of the present study is to determine the utility of 18 F-WBC PET/CT in the diagnosis of occult infections and to assess its incremental value over routine 18 F-FDG PET/CT scan. This prospective observational diagnostic accuracy study included 33 patients with fever of unknown origin or suspected periprosthetic infection and raised C-reactive protein and total leukocyte count. All the patients underwent both 18 F-WBC PET/CT scan and 18 F-FDG PET/CT scan using a standard protocol on 2 different days. Images of both the scans were evaluated by both visual analyses based on uptake intensity and quantitative grading based on lesion-to-background SUV max values. For interpretation of FDG PET/CT images, visual scoring of grade 0 (undetectable or no uptake), grade 1a (less than liver uptake), grade 1b (equivalent to liver uptake), grade 2 (higher than liver uptake), and grade 3 (higher than cerebellum uptake) was used. 18 F-WBC PET/CT images were also interpreted visually as grade 0 (undetectable or no uptake), grade 1a (significantly less than lumbar vertebrae or liver uptake for truncal lesions, and in case of extremity lesion slightly higher than neighboring soft tissue uptake or less than neighboring bone marrow uptake), grade 1b (equivalent to liver or lumbar vertebrae uptake for truncal lesions, and in case of extremity lesion significantly higher than neighboring soft tissue uptake or higher than neighboring bone marrow uptake), grade 2 (higher than liver or bone marrow uptake), and grade 3 (higher than twice the liver or bone marrow uptake). Similarly, a quantitative grading was also done based on lesion-to-background SUV max using a circular region of interest manually drawn. For both 18 F-FDG and 18 F-WBC PET/CT, the lesion-to-background ratio of <1.5 was recorded as grade 0, 1.5-2.5 as grade 1a, 2.5-3.5 as grade 1b, 3.5-4.5 as grade 2, and >4.5 as grade 3. Final diagnosis was made by histopathological, microbiological analysis, or clinical-radiological workup. Twenty-nine foci of suspected infection were found in 25/33 patients by either 18 F-FDG PET/CT or 18 F-WBC PET/CT scan. No abnormal uptake of either 18 F-FDG or 18 F-FDG WBC scan was seen in 8 patients. There was a concordance of 18 F-FDG PET/CT and 18 F-WBC PET/CT in 28 sites each using grade 1b of visual and quantitative analysis, respectively. Of the 29 suspicious infected foci, 18 were proven positive for infection (14/18 sites by the histopathological/microbiological culture and the rest 4/18 sites by clinical/radiological workup). Culture of aspirates or biopsy from 11/29 suspicious sites was proven noninfective. Seven of 11 suspicious sites were proven noninfective by clinical/radiological workup. The mean clinical follow-up was 8 months (1-15 months).Overall significantly higher diagnostic accuracy was demonstrated with 18 F-WBC PET/CT in comparison to 18 F-FDG PET/CT for the detection of infection ( P < 0.05). The highest diagnostic accuracy of 18 F-WBC PET/CT scan was reported with both grade 1b of visual as well as of quantitative analysis (lesion-to-background SUV max , 2.5-3.5) and grade 2 for both visual and quantitative analysis for 18 F FDG PET/CT. 18 F-WBC PET/CT has a higher diagnostic accuracy over 18 F-FDG PET/CT for the diagnosis of occult infection.

Histoplasma capsulatum, Toxoplasma gondii, Bartonella henselae and Bartonella clarridgeiae coinfections in an indoor-only Siamese cat

Case summary A 6-year-old male castrated Siamese cat was referred for acute-onset blindness and mydriasis. Physical examination revealed serous retinal detachment with panuveitis and systemic hypertension. Abdominal ultrasound showed suspected dilation of the cisterna chyli and abdominal lymphadenopathy. Aspirates of mesenteric lymph nodes revealed intrahistiocytic yeast organisms with mild-to-moderate pyogranulomatous inflammation. Fungal culture and ITS1 sequencing of the lymph node aspirates confirmed infection with Histoplasma capsulatum. PCR performed on whole blood was positive for Bartonella henselae and Bartonella clarridgeiae, and Toxoplasma gondii IgG and IgM antibodies were detected in serum. The cat was prescribed prednisolone (0.5 mg/kg PO q24h), itraconazole (10 mg/kg PO q24h), clindamycin (13 mg/kg PO q12h), amlodipine (0.625 mg PO q24h), prednisolone acetate 1% drops (q6h) and ophthalmic lubricant for both eyes (q6h). The cat was doing well at home after 2 weeks of prednisolone, itraconazole and clindamycin administration, and no abnormalities were detected on repeat abdominal ultrasound 3 months later. The retinal detachment showed mild-to-moderate improvement at that time, but vision was not regained. Relevance and novel information This is the first report of coinfection of H capsulatum, T gondii, B henselae and B clarridgeiae in an indoor-only cat living in a H capsulatum non-enzootic area with no known travel history.

Aberdeen, City of Culture?

Aberdeen, City of Culture?

Reviewing Measuring Health And Safety Management Performance In The Construction Industry

Purpose: The accidents on construction sites not only cause fatalities but also affect project performance severely in terms of delayed completion, cost overruns, reduced quality and eventually low productivity. This paper aims to identify the various components that form the measurement of a Health and Safety management performance framework for the construction industry.&#x0D; Design/Methodology/ Approach: This paper adopts an empirical research methodology based on literature review and secondary data gathered systematically from peer-reviewed journals. Content analysis was adopted in analysing the secondary data.&#x0D; Findings: Eight components of Key Performance Indicators in measuring Health and Safety management performance were identified in the literature and they are implementation of safety regulations, leadership, safety planning, safety compliance, performance measurement, risk assessment, safety inspection, and Safety Culture.&#x0D; Research Limitation/Implication: It focuses on the measurement of a Health and Safety management performance framework for the construction industry.&#x0D; Practical Implication: Compliance with the existing health and safety laws must be monitored regularly and effectively, and breaches of them should be taken much more seriously than it is at present. Management members must champion the crusade of good health and safety practices and motivate the employees through their visible leadership by wearing personal protective equipment, whenever they are at the construction site.&#x0D; Social Implication: Health and safety education programmes should be designed such that, they would consider individual cultural aspirations to try to shape them to suit the organizational safety culture.&#x0D; Originality/Value: Identification of components that influence the measurement of the Health and Safety management performance framework were reviewed.

Reflections on ‘Exceptionalism’ and ‘Acceptionalism’

Abstract In 1835, Alexis de Tocqueville introduced the concept of American Exceptionalism in his well known Democracy in America. Its subsequent use has been selective and politically pragmatic, serving a range of pens and purposes, most recently becoming a justification for exclusion and bigotry. This runs counter to the progress higher education has made to internationalize its curricula and to significantly expand the opportunities for students to study abroad over the recent decades at a time when the need for international awareness and understanding is at its greatest. The future success of international programming and institutional partnering will be judged by its ability to prepare students for the real life problems differing peoples are facing, going beyond the most common travel and culture programs which have come to characterize higher education for over 50 years. While the original educational and cultural aspirations for study-abroad, as well as the pragmatic bases for institutional partnerships certainly remain, both the dramatic changes in the delivery of higher education and the significance of the broader challenges societies are facing, call for an expansion and re-examination of the role of national and international partnerships and our expectations for undergraduate study-abroad. Furthermore, it is argued that through a greater application of a more experiential approach to study-abroad, students will develop a richer and more insightful understanding of why all cultures for reasons of their own should be considered exceptional; an understanding that is inclusionary – protagistically replacing exceptionalism with acceptionalism.

VIM, NDM, IMP, GES, SPM, GIM, SIM Metallobetalactamases in Carbapenem-Resistant Pseudomonas aeruginosa Isolates from a Turkish University Hospital

Background: Pseudomonas aeruginosa is an important opportunistic pathogen, and carbapenem resistance is an emerging problem. The determination of resistance genes is vital for epidemiological purposes, and the early determination of carbapenemase production methods is also recommended. Objectives: The present study aimed to investigate the presence of VIM, NDM, IMP, GES, SPM, GIM, and SIM genes in P. aeruginosa isolates. Methods: In this study, 200 carbapenem-resistant P. aeruginosa isolates were included. The DNA extraction of the carbapenem-resistant isolates was performed using the boiling method. Following the DNA extraction, optimization was conducted using the original primers. After optimization, the VIM, NDM, IMP, GES, SPM, GIM, and SIM genes were examined using the polymerase chain reaction (PCR) method. Results: The isolates were mainly identified from the tracheal aspirate cultures (34.5%). The PCR method revealed the presence of VIM in one of the P. aeruginosa isolates, and the NDM gene in one isolate using. None of the isolates was positive in terms of the IMP, GES, SPM, GIM, and SIM genes. Conclusions: In our study, two carbapenemase genes (VIM and NDM) were detected in the P. aeruginosa isolates.

Aseptic Abscess Syndrome With Ulcerative Colitis and Pyoderma Gangrenosum

A 76-year-old female patient was admitted to our hospital with buttock pain, difficulty in walking, watery diarrhea, melena, abdominal pain, and skin eruption in the lower limbs. Computed tomography revealed abscesses in the right subgluteus maximus and right pectineus. Two weeks of broad-spectrum antibiotics were not effective. The abscesses were still apparent on magnetic resonance imaging acquired at 2 weeks after initiation of antibiotics (Figure A). A lower gastrointestinal endoscopy revealed left-sided ulcerative colitis (Figure B). The skin eruption was diagnosed as pyoderma gangrenosum based on neutrophil-dominant inflammation seen in tissue from skin biopsy (Figure C). No significant bacterial growth was detected in aspiration cultures from the abscess. The final diagnosis was aseptic abscess syndrome by exclusion diagnosis, and subsequent corticosteroid medication resulted in rapid clinical improvement, disappearance of both abscesses (Figure D), and no relapse following immunosuppressive therapy with azathioprine. If multiple deep organ abscess formations occur in patients with inflammatory bowel disease complicated by a neutrophil-induced eruption, regardless of the activity of intestinal lesions, a good prognosis can be obtained by the prompt use of immunosuppressive agents, such as corticosteroids, rather than antibiotics or surgery, with consideration to the possibility of aseptic abscess syndrome. Statement of confirmation: Informed consent was obtained from the patient for the publication of their information and imaging.

Are Leukocyte Esterase (LE) strip and Alpha-Defensin kit reliable enough to diagnose peri-prosthetic joint infection, intra-operatively?

Background: Despite improvement in sterilization techniques, peri-prosthetic joint infection (PJI) is the most fearsome complication after hip and knee arthroplasties. Various strategies have been devised from time to time to diagnose and treat PJI. Recently, Leukocyte esterase and alpha-defensin are identified as markers of active infection in synovial fluid. Therefore, kits are designed to detect these two markers during surgery. If found reliable, these tests will increase the confidence of surgeons in situations, where the diagnosis of PJI is not established. Material and methods: This study was conducted on 132 patients in Lahore General Hospital; from August 2020 to December 2021. Leukocyte Esterase strip and Alpha-Defensin kit were used to detect infection in synovial samples taken just before performing arthrotomy, intra-operatively. Patients were divided into 2 groups, Group-A had 31 patients with peri-prosthetic joint infection (PJI) diagnosed as per Musculoskeletal Infection Society (MSIS) criteria, whereas in Group B 101 patients were present in whom PJI was not present. Synovial tissue and fluid samples were also sent to a laboratory for culture and histopathology; so that sensitivity and specificity of LE strips and Alpha-Defensin Kits could find out. Results: The mean age of patients in our study was 59.6 SD 11.90 years with a male to female ratio of 85:47. 31 patients were diagnosed as PJI after primary hip or knee arthroplasty based on serological investigations and culture of joint aspiration. The sensitivity and specificity of LE strips were 90.32% and 95.04%, whereas that of Alpha defensin was 93.54% and 100% respectively. The correlation coefficient between the LE strip test and synovial fluid polymorphonuclear neutrophils (PMN) counts was 0.811 and it was even higher when the Alpha-Defensin kit was used (0.845). Conclusion: Both LE and Alpha-Defensin kits are highly specific and sensitive in diagnosing PJI. Though Alpha-defensin is more accurate the cost-effectiveness of the LE strip makes it a more feasible option in diagnosing PJI, intra-operatively.

Colonization by kale: marginalization, sovereignty, and experiential learning in critical food systems education

ABSTRACT In increasingly cross-cultural global settings, the performance and promotion of healthy food, “good” food (comida saludable) have become conflated with a narrowing range of iconic vegetable and “superfood” trends that often reflect the health and dietary preferences of an affluent and/or aspirational consumer culture. These colonizing cultivars, and the haute cuisine trends they embody, often displace indigenous food knowledge, techniques, and products already compromised by the penetration of processed foods. Through experiential pedagogical examples from Guatemala and Vermont, this paper explores the ways in which participatory, indigenous food and seed sovereignty curricula can help decolonize these newest kinds of hegemonic impositions and reaffirm traditional food systems.

Effect of time, temperature and pH on Mycobacterium tuberculosis culture positivity of gastric aspirate: An experimental study

BackgroundThe culture of gastric aspirate (GA) has been used for bacteriological confirmation of pulmonary tuberculosis in children and patients who are unable to expectorate. Sodium bicarbonate neutralization of gastric aspirates is commonly recommended to increase culture positivity. We aim to study Mycobacterium tuberculosis (MTB) culture positivity of GA collected from confirmed case of pulmonary tuberculosis after storing it at different temperature, pH & time. MethodsGA specimens from 865 patients of either sex predominately non-expectorating children/adults with suspected pulmonary TB were collected. Gastric lavage was performed in the morning after an overnight fasting (at least 6hrs fasting). The GA specimens were tested by CBNAAT (GeneXpert) and AFB microscopy & those who were positive on CBNAAT were further processed with MTB culture on Growth Indicator Tube (MGIT™) culture. pH neutralized and non-neutralized CBNAAT positive GA specimens were culture within 2 hours of collection and 24 hours after storage at 4 °C & room temperature. ResultsMTB was detected in 6.8% of collected GA specimens by CBNAAT. Culture positivity of neutralized GA specimens when processed within 2 hours of collection, was higher compared to paired non-neutralized GA specimens. Neutralized GA specimens had higher contamination rate than non-neutralized GA specimens. Storage of GA specimens at $Deg C had better culture yield than those stored at room temperature. ConclusionEarly neutralization of acid in Gastric aspirate (GA) is essential for better culture positivity of M. tuberculosis (MTB). If there is a delay in processing GA, it should be kept at 4 °C after neutralization; however, positivity decreases with time.

Current and Future Approaches for Diagnosing Small Intestinal Dysbiosis in Patients With Symptoms of Functional Dyspepsia.

The development and application of next generation sequencing technologies for clinical gastroenterology research has provided evidence that microbial dysbiosis is of relevance for the pathogenesis of gastrointestinal and extra-intestinal diseases. Microbial dysbiosis is characterized as alterations of diversity, function, and density of the intestinal microbes. Emerging evidence suggests that alterations of the gastrointestinal microbiome are important for the pathophysiology of a variety of functional gastrointestinal conditions, e.g., irritable bowel syndrome (IBS) and functional dyspepsia (FD), also known as disorders of brain-gut axis interaction. Clinicians have for many years recognized that small intestinal bacterial overgrowth (SIBO) is typified by a microbial dysbiosis that is underpinned by abnormal bacterial loads in these sites. SIBO presents with symptoms which overlap with symptoms of FD and IBS, point toward the possibility that SIBO is either the cause or the consequence of functional gastrointestinal disorders (FGIDs). More recently, new terms including “intestinal methanogen overgrowth” and “small intestinal fungal overgrowth” have been introduced to emphasize the contribution of methane production by archea and fungi in small intestinal dysbiosis. There is emerging data that targeted antimicrobial treatment of SIBO in patients with FD who simultaneously may or may not have IBS, results in symptom improvement and normalization of positive breath tests. However, the association between SIBO and FGIDs remains controversial, since widely accepted diagnostic tests for SIBO are lacking. Culture of jejunal fluid aspirate has been proposed as the “traditional gold standard” for establishing the diagnosis of SIBO. Utilizing jejunal fluid culture, the results can potentially be affected by cross contamination from oropharyngeal and luminal microbes, and there is controversy regarding the best cut off values for SIBO diagnosis. Thus, it is rarely used in routine clinical settings. These limitations have led to the development of breath tests, which when compared with the “traditional gold standard,” have sub-optimal sensitivity and specificity for SIBO diagnosis. With newer diagnostic approaches–based upon applications of the molecular techniques there is an opportunity to characterize the duodenal and colonic mucosa associated microbiome and associated gut microbiota dysbiosis in patients with various gastrointestinal and extraintestinal diseases. Furthermore, the role of confounders like psychological co-morbidities, medications, dietary practices, and environmental factors on the gastrointestinal microbiome in health and disease also needs to be explored.

Settlement intentions among Taiwanese skilled migrants in Tokyo and Hong Kong

ABSTRACT While many countries now prioritise accepting skilled migrants to meet labour demand in a globalised economy, retaining them has been a challenge. Low retention is often attributed to immigration policy failures and/or skill mismatches in the labour market. This paper argues that besides career issues, skilled migrants’ cultural aspirations and their sense of ‘civic belonging’ are significant factors when evaluating migration outcomes and the prospect of staying. This paper is based on 44 in-depth interviews with Taiwanese college-educated migrants working in Hong Kong and Tokyo, two major Asian global cities known for attracting foreign talent. The paper found that ambivalence towards staying prevails, due to unfulfilled aspirations for cosmopolitanism—in the case of Tokyo—and frustrations with a limited ‘social contract’—in the case of Hong Kong. The implications of these findings could extend the scope of factors to be considered in investigating what shapes migrants’ settlement decisions in demographic research.

Crafting Enlightenment: Artisanal Histories and Transnational Networks. Edited by Lauren R. Cannady and Jennifer Ferng

This wide-ranging volume of essays brings together ten substantial pieces of research on the realm of the ‘artisanal’ in the seventeenth and eighteenth centuries. Several pieces focus on France, but each is paired with another examination and these pairings take in the Ottoman Empire, India, Spanish-colonial Mexico, China, colonial Virginia, and the goldfields of Australia. The editors have made a strong effort to order the materials in terms of fruitful juxtapositions and parallels; each of five pairs of pieces also has a reflective essay by a further noted scholar (although, as is sometimes the case with such endeavours, some of these are in practice little more than summaries of the preceding substantive pieces). The editors’ Introduction lays out some of the practical and theoretical challenges of engaging with the ‘artisanal’ in a historical and transnational context: the slippery nature, then and now, of the status of craft versus art, of rational reflection versus (imagined) static tradition; and the implicit and explicit Eurocentric biases of narratives around the movement between these conceptions. The essays themselves are the real strength of the collection, and it is pleasing to see them well illustrated, with seventy-six plates overall, most in full colour, allowing for a visual grasp of the objects under discussion. A short review cannot effectively summarize the wide range of topics on display, but there is much here to appreciate. The French chapters are perhaps among the most academically conventional, largely focusing on prestige projects (the language of sovereignty in the gardens of Versailles; interior design in speculative building; the social and cultural aspirations of the early Enlightenment Société des arts), although Valérie Nègre’s contribution on the subversively ‘useless’ writings of an eighteenth-century artisan carpenter is an intriguing sidelight on such approaches (p. 328). A piece on Ottoman urban festivals is particularly lavishly illustrated, and relates the participation of craft guilds in official processions to the methods of representing them in visual records of such events, and to the stylistic shifts of Ottoman art at an East–West crossroads. A piece on Mughal jasmine bowers and artisanal horticulture offers intriguing (though, due to the book’s organization, only implicit) contrasts and parallels with the consideration of Versailles. Dorothy Ko’s chapter on the near-thousand-year history of porcelain production at Jingdezhen, and the incorporation of material production techniques into folkloric stories amongst the different artisanal communities there, is remarkable. Dennis Carr’s piece introduces a particularly striking object, a Mexican eighteenth-century bookcase-desk that is both a metaphorical map of the bringing together of European and Asian decorative techniques, and a literal map of the estate for which it was made. Neil Kamil offers a tour de force over almost fifty pages that takes us from the mention of cane chairs in the journal of a Huguenot exile in 1715 to a global history of the rattan that formed such objects, interwoven with almost dizzying insights into the cultural worlds of exiles, traders, and workers who made, sold, and valued them.

A STUDY TO DETERMINE THE INCIDENCE OF BACTERIAL AND FUNGAL INFECTIONS IN ICU PATIENTS ON MECHANICAL VENTILATION AND ASSOCIATED OUTCOME

Background: Infection in intensive care unit (ICU) patients, occurring predominantly in patients whose lungs are ventilated, at a rate of 1% to 3% per day of mechanical ventilation. Bacterial and fungal pathogens from clinical cultures were evaluated to characterize community- and ICU infections, including describing temporal changes in predominant organisms on presentation and throughout hospitalization. Aims &amp; objective: To determine the incidence of bacterial and fungal infections in ICU patients on mechanical ventilation. Methods &amp; materials: The study was Prospective observational case study was conducted at Medicine department in SRN Hospital, Prayagraj, U.P. India between July 2020 to June 2021. Endotracheal aspirates were collected aseptically from 100 ICU patients The various patient data such as age, gender, address, date of admission ,level of consciousness, risk factors involved, underlying diseases, duration of mechanical ventilation, prior antibiotic therapy etc. were recorded. Result: In this study total 100 out of 81 patients show micro-organism infection, 76 patients had bacterial infections and 5 had fungal infections and 19 patients had no growth, as conrmed by endotracheal tube aspirate (ETA) culture growth. Participants in the Bacterial group ETA Gram Staining was 38.2% had no abnormality detected (NAD), 52.6% had Gram Negative Bacilli and 9.2% of the participants had Gram Positive Bacilli, 100.0% of the participants in the Fungal group ETA Gram Staining had NAD. There was a signicant difference between the various groups in terms of distribution of ETA Gram Staining (χ2 = 7.366, p = 0.028). In the Bacterial endotracheal tube (ET) aspirate culture 35.5% of the participants had Klebsiella, 25.0% had Staphylococcus, 18.4% had E. coli, 18.4% had Pseudomonas, 0.0% had Candida spp, 1.3% had Acinetobacter, 1.3% had Proteus. In the Fungal ET aspirate culture group 100.0% of the participants had Candida spp. There was a signicant difference between the various groups in terms of distribution of ET aspirate: Culture (χ2 = 81.000, p = &lt;0.001 Conclusion: Gram Negative Bacilli was the most common infection in patients on mechanical ventilation in gram staining. Klebsiella was the most common bacterial infection and Candida species was fungal infection. The poorest outcome occurred in patients with, E. coli, and Proteus group infection and good outcome occurred in Acinetobacter.

Telecosteño: Constructing a linguistic imaginary in popular Colombian soap operas

Linguistically, Colombia is divided into two macrovarieties of Spanish: cachaco (interior of the country) and costeño (from the coastal regions). This linguistic dichotomy can also be extended to the cultural ambit, with costeño varieties being negatively perceived in the Colombian sociolinguistic imaginary, which is in turn reflected in popular folk discourse on language. Thus, the present article explores how authenticity of the costeño macrodialect is constructed in Colombian telenovelas ‘soap operas’, examining the significance of the language ideologies behind these constructions.Data is presented from a corpus of popular telenovelas, with findings showing that the depiction of this diverse macro-variety is often ‘exaggerated’ or ‘inauthentic’, supporting popular suggestions of misrepresentation, as well as previous findings on a cachaco narration of the Other. Importantly, this reflects wider sentiment toward costeño varieties in terms of how deeply engrained language ideologies are manifested within the country, shedding light on the social structures behind these ideologies, contributing to studies on the role of popular media in constructing and perpetuating ideologies on variation.