Non-hospital Environment Research Articles

Klebsiella Pneumoniae – Taxonomy, Occurrence, Identification, Virulence Factors and Pathogenicity

Abstract Gram-negative bacilli Klebsiella pneumoniae are among the most important pathogens responsible for healthcare-associated infections (HAIs). These bacteria often have high pathogenic and epidemic potential, contributing to infection outbreaks worldwide. K. pneumoniae is part of the natural microbiota of humans. At the same time, as an opportunistic microorganism, when the host organism is weakened, it can cause serious infections such as pneumonia, urinary tract infections, septic infections and intra-organ abscesses. Widespread distribution in nature and exceptional adaptability provide K. pneumoniae with the opportunity to master new niches in the hospital environment, which poses a threat to hospitalized patients. Also, the bacteria are increasingly causing life-threatening infections in the non-hospital environment. The pathogenicity of K. pneumoniae is determined by the presence of many virulence factors such as capsular polysaccharide (CPS, K antigen), lipopolysaccharid (LPS, O antigen), fimbrial and non-fimbrial adhesins, siderophores (aero-bactin, enterobactin, salmochelin and yersiniabactin), heat-stabile and heat-labile enterotoxins, cytotoxins and biofilm-forming ability. Currently, hypervirulent strains of K. pneumoniae (hvKp) equipped with new virulence traits constitute a significant danger. The paper presents these bacteria concerning the global threat arising from the dynamic spread of hvKp strains in hospitals in Poland and worldwide.

LightSeizureNet: A Lightweight Deep Learning Model for Real-Time Epileptic Seizure Detection.

The monitoring of epilepsy patients in non-hospital environment is highly desirable, where ultra-low power wearable seizure detection devices are essential in such a system. The state-of-the-art epileptic seizure detection algorithms targeting such devices either rely on manual feature extractions, which can be biased due to the experience of experts, or deep neural networks, which suffer from high computation complexity. In this paper, we propose a lightweight deep learning model, LightSeizureNet (LSN), for real-time epileptic seizure detection based on raw EEG data in ultra-low power wearable seizure detection devices. The proposed LSN model includes a patient-independent version and a patient-specific version, both of which avoids manual feature extractions and high computation complexity, while maintaining good classification accuracy. Dilated one-dimensional (1D) convolution, global average pooling, and kernel-wise pruning are adopted to compress the LSN model. The proposed models are evaluated on the CHB-MIT scalp EEG database. The patient-independent LSN model achieves 97.09% accuracy with 6.2M MACs, while the patient-specific LSN model achieves 99.77% accuracy with 3.7 M MACs, which are competitive compared to the state of the art in terms of accuracy and complexity. Furthermore, the proposed model is highly interpretable, which is missing in many previous works. By using a uniform approach to explore the interpretability of the proposed model, fine-grained information such as the activated brain region and the frequency of brainwave during seizures is obtained for clinical diagnosis.

Quantification of phosphatidylethanol combining dried blood spots sampling with Orbitrap-based LC-HRMS platform: Method validation and proficiency testing

Phosphatidylethanols (PEth) are phospholipids specifically synthetised by an enzymatic reaction in presence of ethanol. PEth is a mid-term direct biomarker for alcohol consumption or abstinence, leading to a growing interest for forensic toxicology purposes. Blood deposition onto a filter paper card as dried blood spots (DBS) allows PEth stabilisation which is otherwise easily degraded at room temperature. The goal of this study was to develop and validate a procedure for the quantification of PEth 16:0/18:1, the most abundant analogue, in DBS samples benefiting from the selectivity brought by Orbitrap-based high-resolution mass spectrometry (HRMS). Calibration samples and quality controls (QCs) are volumetrically spotted (10 μL) onto filter paper card (Whatman 903 protein saver) either using HemaXis DB10™ device, or using laboratory micropipette. The whole DBS is manually punched out and the PEth is then directly extracted using an in vial approach with 100 μL of PEth 16:0/18:1-D5 in methanol. Analyses are then performed by LC-HRMS in PRM mode using a QExactive Orbitrap platform. Validation was carried out on with respect to the Food and Drug Administration (FDA) criteria, using three different QC concentrations (39, 87 and 350 ng/mL) over three non-consecutive days. To assess the robustness of our method, an interlaboratory proficiency testing was carried out using 3 different commercial standards at 4 levels (50, 100, 200, and 300 ng/mL) of quality controls (QCs) provided by ACQ Science (Germany). The method was fully validated according to guidelines set forth by the FDA. Calibration curve was built using a weighting factor of 1/x. Trueness was measured between 100.1 and 103.6% for the tested concentrations. Repeatability and intermediate precision were found to be lower than 5%. Linearity was evaluated between the lower limit of quantification of 20 ng/mL and the upper limit of quantification of 2000 ng/mL with an R2 greater than 0.998. Recovery (RE) and matrix effect (ME) evaluated at 2 concentrations ranged from 76 to 99% and 8 to 10%, respectively. During the proficiency test, precision was evaluated below 8.0%, while the accuracy ranged from 93.8% to 105.9% and from 101 to 104.5% when compared with the expected concentration and the mean measured value of all the labs participating respectively. The validation results demonstrate that the use of Orbitrap-based PRM quantification present an interesting alternative over triple quadrupole platforms considered as the gold standard for LC-MS/MS quantitative approaches. Indeed, multiple reaction monitoring (MRM) and PRM provide comparable performance in terms of sensitivity, linearity, dynamic range, precision and repeatability. Moreover, the use of PRM provides access to the full fragmentation spectra without any preanalytical considerations. The proficiency testing results confirm the suitability of PRM mode showing great quantification performances. In addition, those results and especially the repeatability exhibit the precision of the volume control provided by the use of HemaXis™ device. This tool enables the standardisation of the DBS collection at the fingertip in a non-hospital environment either by minimally-trained medical staff or by the patient himself. A rapid, sensitive, and robust method was developed and fully validated for the detection and quantification of PEth 16:0/18:1 in DBS samples. The results of the validation process and the proficiency testing confirm that the use of DBS associated with HRMS PRM-based analyses does not hinder the analytical performances, while providing full information over the MS-MS spectra. The development of analytical tools enabling the use of DBS microsampling that can be performed in almost every environment opens new opportunities toward clinical and forensic toxicological applications.

Understanding the need of Geriatric Medicine in Pakistan

Aim: To determine the common problems of advancing age and their plausible solutions. Study design: Prospective Observational Study. Setting: Pakistan Airforce Hospital Sargodha Duration of study: One year from 1st January 2020 till 31st December 2020. Methods: All elderly citizens both male and female were interviewed regarding the common difficulties faced by them in their day to day life to quantify the magnitude of the problem and consequently help finding easy plausible solutions . Results: All senior citizens approachable in person or on phone over the age of sixty five both males and females were interviewed. Interviews were carried out by using a specially designed short , crisp and easy to understand questionnaire. Common difficulties faced in this age group were listed and their magnitude was estimated so that strategies can be defined to help resolve those. Common difficulties were related to social life, relationships, self care , mobility, psychological and emotional health. In the wake of interviews we found majority of people highlighted that with advancing age the quality of care imparted to them diminishes although the demands made are minimized due to lack of reassurance and uncertainty. This instills a lack of confidence in them. Moreover the monotony over days, weeks and years causes a loss of self worth and self esteem. Conclusion: As an evolving society of a developed country we have the advantage of utilizing models of Geriatric Care already in place in the developed world. Whereby Geriatric Medicine is a specialty for addressing the needs of advancing age and Hospice looks after the terminally ill patients of any age in a nonhospital environment. Many solutions can be offered and exercised without a big resource may it be human, material or financial. Keywords: Geriatric Care, Senior Citizen, Home and Hospice

PO-697-06 INTERVENTIONAL ELECTROPHYSIOLOGY IN THE AMBULATORY SURGICAL CENTER DURING SARS-COV-2 PANDEMIC

The SARS-CoV-2 pandemic has resulted in major disruptions of patient care due to suspension or cancellation of elective hospital procedures. In response, the Center for Medicare and Medicaid Services (CMS) created the Hospitals Without Walls program and authorized Ambulatory Surgical Centers (ASC) to provide services as a hospital. Demonstrate how our first-in-nation dedicated ASC in cardiac electrophysiology was able to perform therapeutic procedures in patients with arrhythmias throughout the pandemic. The ASC consists of 4,961 square feet, with 2 procedure rooms equipped with imaging and 3D mapping systems and 6 recovery room beds. Patients with cardiac arrhythmias were evaluated in the outpatient office, had pre-admission labs including COVID-19 testing and were discharged on the same day of their intervention. This prospective study group consists of 1686 procedures in 1070 patients. A TEE/ Cardioversion was performed in 208. Device implantation was performed in 552 (Pacemakers:156, Defibrillators:70, Bi-Ventricular devices: 49). Radiofrequency Ablation (RFA) was done in 1134 patients (Supraventricular Tachycardia:374, Atrial Fibrillation:662, Ventricular tachycardia:180). Complications resulting in patients requiring hospital admission occurred in 4 patients (Protamine reaction in 1 patient, Pericardial Effusion in 1 patient and groin hematoma in 2 patients) During the continued pandemic, the ASC has provided an alternative non-hospital setting for patients with cardiac arrhythmias who require invasive procedures. As a novel concept in the health care delivery of patient with cardiac arrhythmias, a specialized ASC in cardiac electrophysiology can successfully and safely treat patients in a non-hospital and lower cost environment.

β3-Adrenoceptor, a novel player in the round-trip from neonatal diseases to cancer: Suggestive clues from embryo.

The role of the β‐adrenoceptors (β‐ARs) in hypoxia‐driven diseases has gained visibility after the demonstration that propranolol promotes the regression of infantile hemangiomas and ameliorates the signs of retinopathy of prematurity (ROP). Besides the role of β2‐ARs, preclinical studies in ROP have also revealed that β3‐ARs are upregulated by hypoxia and that they are possibly involved in retinal angiogenesis. In a sort of figurative round trip, peculiarities typical of ROP, where hypoxia drives retinal neovascularization, have been then translated to cancer, a disease equally characterized by hypoxia‐driven angiogenesis. In this step, investigating the role of β3‐ARs has taken advantage of the assumption that cancer growth uses a set of strategies in common with embryo development. The possibility that hypoxic induction of β3‐ARs may represent one of the mechanisms through which primarily embryo (and then cancer, as an astute imitator) adapts to grow in an otherwise hostile environment, has grown evidence. In both cancer and embryo, β3‐ARs exert similar functions by exploiting a metabolic shift known as the Warburg effect, by acquiring resistance against xenobiotics, and by inducing a local immune tolerance. An additional potential role of β3‐AR as a marker of stemness has been suggested by the finding that its antagonism induces cancer cell differentiation evoking that β3‐ARs may help cancer to grow in a nonhospital environment, a strategy also exploited by embryos. From cancer, the round trip goes back to neonatal diseases for which new possible interpretative keys and potential pharmacological perspectives have been suggested.

Capillary Lactate Level in Non-Severe and Severe CommunityAcquired Pneumonia Patients

Background: Community-acquired pneumonia is an inflammatory disease of the lung caused bymicroorganisms acquired from a non-hospital environment. The pneumonia severity index and ATS/IDSAseverity criteria are widely used to predict the severity of CAP. Lactate is a biomarker that can be measuredby point-of-care devices that provide results in a short of time. This study aimed to determine the differencein capillary lactate level between non-severe and severe pneumonia to provide an additional method toquickly stratify pneumonia severity and treat it accordingly.Methods: This cross-sectional study was performed in the emergency room of a regional research hospital.The pneumonia diagnosis was determined by the symptoms, physical examination and radiological findings.Capillary lactate level was measured with Accutrend Plus lactate point-of care device. Severity stratificationwas done according to ATS/IDSA criteria. The mean of lactate level in all subjects was 3.40±1.52, in nonsevere pneumonia subgroup was 2.25±0.94, and 4.56±1.01 in severe pneumonia subgroup. Lactate issignificantly higher in severe pneumonia subgroup. The cut-off point of lactate level for severity group was3.2 mmol/L (95.5% sensitivity, 86.4% specificity).Conclusion: The early prediction of CAP severity is essential to determine the need for admission in theintensive care unit and close follow up. The lactate level can be used for immediate severity stratification inemergency departments.

Contribution of the Freudian Theory of Psychosis in the Diagnosis of Mental Disorder

The article presents my research in psychoanalytic psychopathology on the psychic etiology of psychosis, carried out between 2012 and 2020 at Universidade Federal Fluminense (Volta Redonda, Brazil). In Brazil, patients with various mental disorders rely on the Brazilian Unified Health System which aimed at treatment and psychosocial rehabilitation services. These services are called Psychosocial Care Centers (CAPS). There is an innovation in mental health treatment because they replace the treatment model for mental disorders directed only at hospital admissions. The clinical treatment of mental disorders in CAPS is organized into unique therapeutic projects. It is characterized by a multidisciplinary team in an open, non-hospital environment, close to the patient’s place of residence. Since 1996, the SUS-Brazil diagnostic guidelines are used to conduct epidemiological studies, formulate public policies on mental health, and establish its funding for the mental health network. These manuals ignore the presence of etiological factors of a psychological nature and exclude the theoretical framework in the definition of disorders. The absence of consideration of etiological factors and the exclusion of theoretical frameworks is evident in the way the DSM-5 defines the spectrum of schizophrenia, resulting in the predominance of schizophrenia in the clarification of psychotic disorders and, consequently, in the weakening of the classic category of psychosis. My research aims to contribute to psychosis by examining the role of delusion in the onset of psychosis, triggering events, and stabilizing the psychotic structure. This article aims to present the hypothesis of the psychic etiology of psychosis from the contributions of Sigmund Freud. This theorizing is significant as it introduces the hypothesis of loss, restitution, and recovery into the psychiatric lexicon of the opposition between schizophrenia and paranoia. To this end, this article exhibits a survey of Freudian references to emphasize the construction of an original theory of psychosis, where: 1) The consideration of the functioning of drives is relevant in isolating psychic etiology from its triggers; 2) A redefinition of the concept of delusion signals the originality of the Freudian theory of the stabilization of psychoses: delusion is defined as a psychic effort of recovery, an attempt at reaching a cure.

Isolation and characterization of multiple drug-resistant bacteria from the waste of hospital and non-hospital environment

Antibiotics used in hospitals for patient care which potentially growing antibiotic resistant bacteria in hospital waste and simultaneously transmitting to non-hospital environments by drainage system. Total 20 samples were collected randomly and examined with different bacteriological, biochemical and molecular tests. 55 bacterial isolates were isolated from all samples, among them 32 (58.2%) were from hospital environment and 23 (42.1%) were from non-hospital environment. The result of total viable count showed that maximum countable bacteria (2.20×1010) CFUs/ml that were from MARCH and the minimum number of countable bacteria (1.0×1010) CFUs/ml were isolated from the sample of Kalitola. Among the isolates, E. coli, Pseudomonas spp, Klebsiellaspp, Salmonella spp, Staphylococcus spp and Vibrio spp were identified 16 (29%), 12 (21.8%), 9 (16.4%), 8 (14.5%), 5 (9%) and 5 (9%) respectively. Multidrug resistant (MDR) Pseudomonas aeruginosawas characterized from hospital wastewater by polymerase chain reaction assays targeting the virulence gene and 16S rRNA gene region was amplified with the universal primers. PCR amplification band was found at 1399 bp. The antibiotic sensitivity study revealed that among the hospital isolates, about (83.3%) were resistant against Ampicillin, followed by Amikacin, Kanamycin and Penicillin (77.8%). On the other hand, non- hospital isolates were resistant against Amoxicillin and Penicillin (66.7%) followed by Ampicillin and Vancomycin (58.3%). Both hospital and non-hospital isolates were sensitive to Gentamycin respectively 72.5% and 75%. The findings of the experiment suggested that hospital wastewater contained more MDR bacteria than non-hospital wastewater which are released into receiving water bodies that may cause a serious threat to public health. Reducing indiscriminate use of antibiotics in both hospital and non-hospital settings and the use of wastewater treatment plant (WTP) in a hospital may reduce this problem.
 Asian J. Med. Biol. Res. September 2020, 6(3): 460-468

An Effective Rehabilitation Center Model For Drug Addiction

Addiction is a process that has many negative consequences and negatively affects individuals, families and societies. Despite its negative consequences, addiction is increasing worldwide today. This increase leads countries to new approaches and different treatment options in the fight against addiction. One of these options is the Therapeutic Community approach, which is preferred by many countries and seen as an integral part of the rehabilitation process. Therapeutic Community approach; providing inpatient care in a non-hospital environment; a rehabilitation process that deals with the individual with his environment is an approach. In this study, the structure and functioning of the institution called Parceval, which provides rehabilitation services for children and young people with addiction and adopts the Therapeutic Community approach, is explained. The authors have observed, learned and gained experience at the relevant institution in Berlin for 3 months (between 01.06.2018 - 29.08.2018) within the scope of Erasmus + Program Internship Mobility. It is thought that the experiences gained will contribute to and support the rehabilitation process for drug addiction in our country by presenting a different perspective.

Comparison of the Antibiotic-Resistant <i>Enterobacteriaceae</i> Content in Conventional, Organic and Fresh-Cut Vegetables Sold in Valencia (Spain)

Bacterial content of fresh vegetables that are often eaten raw represents a risk factor for consumers, and the presence in these produce of antibiotic-resistant bacteria constitutes an additional food safety concern. We have compared the Enterobacteriaceae content, as well as the antibiotic resistances of bacterial isolates, in samples of different types of fresh vegetables (conventional an organic produce, fresh-cut vegetables and prepared salads) marketed in Valencia (Spain) in order to find possible differences among these vegetable types. Bacterial isolation, identification and resistance assays to eleven relevant chemotherapeutics agents were performed according to standard microbiological procedures. A total of 195 bacterial isolates (from 230 vegetable samples) were compared. All vegetable types carry a variety of opportunistic bacterial pathogens, with a significant frequency of resistant isolates to one or more (up to three, four or five antibiotics, depending on the vegetable type). Enterobacter spp. (mainly E. cloacae) and Klebsiella spp. (K. oxytoca and K. pneumoniae) were the most frequent in conventional, fresh-cut vegetables and prepared salads (60-77% of isolates), whereas in organic produce the most frequent species were Pantoea agglomerans (24%), Serratia marcescens (16%) and E. cloacae (13%). Fresh-cut produce had the highest content of bacterial burden and bacterial diversity, indicating that the sanitizing methods are not effective enough and should be improved. Organic vegetables showed a higher bacterial diversity and a lower frequency of antibiotic resistances, as compared with conventional produce, indicating that organic farming practices may favor microbial diversity and partially prevent selection and development of resistant bacteria. Therefore, it could be relevant to include the detection of antibiotic-resistant non-pathogenic Enterobacteriaceae species in fresh vegetables in the epidemiological surveillance routine to quantify dissemination of multi-resistances in non-hospital environment and to evaluate the potential role of consumption of fresh vegetables in spreading resistances into community.

Molecular characterization of multi-drug resistant coagulase negative cocci in non-hospital environment

Antibiotic resistance crisis occasioned by sporadic appearance of multi-drug resistance (MDR) in human pathogens to clinically applied antimicrobials is a serious threat to global health. In this study, we investigated the drug resistant phenotype of Gram-positive cocci isolates from environment. Staphylococcus capitis and Staphylococcus haemolyticus colonies were isolated on mannitol-salt agar plates supplemented with tetracycline. Antibiotic susceptibility profile of the isolates via minimum inhibitory concentration (MIC) determination was examined. Isolates showed decreased sensitivity to clinically applied antimicrobial agents: tetracycline, kanamycin, erythromycin, norfloxacin, teicoplanin, and ampicillin. Genomic analysis demonstrated the presence of multiple antibiotic resistant genes in these bacteria, suggesting the origin of the multiple antimicrobials resistant phenotype. Tetracycline resistance of these isolates was transduced to Staphylococcus aureus-RN4220 strain. These findings indicate the presence of multiple antimicrobials resistant S. capitis and S. haemolyticus strain in a non-hospital setting. Moreover, the presence of plethora of genes responsible for MDR suggest that these strains could present potential threat to human health by serving as reservoir for lateral transference of antimicrobial resistance conferring foreign genetic elements to other clinically relevant pathogens.

M-Health in the Surgical Context: Prospecting, Review and Analysis of Mobile Applications

Background m-Health initiatives can show an opportunity to improve the identification, prevention and management of certain diseases. Most health-care applications aims at chronic noncommunicable diseases care, and it is necessary to seek evidence from applications intended for surgical patient care, either before, during or after hospitalization. Objective: The Study Aims to identify and analyze, from the literature review and prospecting, applications for smartphones developed to assist the surgical patient. Methods: A descriptive-exploratory study developed in two sequential phases. The first one corresponded to an integrative review of the literature in the databases PubMed, Web of Knowledge, Europe PMC database and Cumulative Index to Nursing and Allied Health Literature database. The second phase corresponded to an exploration of applications in the European Patent Office, United States Patent and Trademark Office (USPTO), Free Patents Online, Canadian Intellectual Property Office and World Intellectual Property Organization. In both phases, we do not restrict the results by year of publication/registration or language. At each stage, the selected studies/patents were analyzed and pre-selected, according to the inclusion and exclusion criteria, by reading their titles and abstracts. Subsequently, we analyzed those with the potential of participation in the study, evaluating the answer to the research question, as well as the type of research, objectives, sample, method, outcomes, results and conclusion. Finally, the articles/patents record found were read in full. Results In the databases, 14 studies that presented some application for smartphone aimed at the surgical patient were selected. Most of them were in PubMed (64.3%), published in English (100%). Regarding origin, 28.6% of the texts are from the United States of America, 14.3 from Sweden and 14.3 from Canada. On the other hand, in patent databases, 10 registries were selected, 60% in the USPTO patent base, hosted in hybrid systems (iPhone and Android) and developed in the last 5 years (2014-1018) (80%). In general, there is a series of applications aimed at surgical patients, such as targets and/or users, mainly focused on the exchange of text and image messages but concentrated on assisting the physician/health team in the preparation of the patient during the procedure or post discharge. It is necessary to invest in the creation of technologies that aim to monitor these patients, especially in post discharge. Conclusion The characteristics of applications indicate a strong hospital centered tendency in relation to its purpose, having the surgeon as the main user and the surgical patient as the main target. The applications are still focused on optimizing diagnostics or functions, and no initiatives are identified to monitor the patient in a non-hospital environment.

Infectious diseases in Poland in 2017

The article contains an overview of epidemiological surveillance data on infectious diseases in Poland in 2017 with reference to data from 2016 and median from 2011-2015. This is another introductory article to the systematically conducted Epidemiological Chronicle of Epidemiological Review presenting the current epidemiological situation of selected infectious diseases. In justified cases, eg by cross-border threats, the study includes references to the epidemiological situation in other countries. The source data for this study are the applications of doctors to the State Sanitary Inspection, which in the form of summary lists or individual notifications are forwarded to the Department of Epidemiology of Infectious Diseases and Surveillance of NIPH-PZH and after being prepared they are included in the bulletins “Infectious diseases and poisoning in Poland in 2017 “and” Protective vaccinations in Poland in 2017“. Data on deaths due to infectious diseases come from a list of the Department of Demographic and Labor Market Research of the Central Statistical Office. Discussion of epidemiological data begins with the most prevalent diseases in Poland, which are upper respiratory tract infections and gastrointestinal infections. In the area of upper respiratory tract infections, attention is drawn to the increase in the number of reported cases in recent years, which may be at least partly related to the development of computerization of reports. The profile of gastrointestinal infections acquired in the non-hospital environment has been changing in recent years towards a clear predominance of infections with viral etiology in relation to bacterial infections. Regarding healthcareassociated infections, rotavirus infections predominate among children, and among adults, C. difficile infections constitute a serious, growing problem, which is largely associated with the use of antibiotics. Viral liver infections are still an important problem. B and C, and in 2017 also hepatitis A, which took the form of an epidemic. In other groups of diseases, there was no clear increase in threats compared to previous years. Despite a steady decline in incidence, tuberculosis has been the disease causing the highest number of deaths among infectious diseases for many years. In 2017, the highest number of deaths was caused by C. difficile infection.

HCV Elimination Campaign and Risk Factors of HCV Infection in Arkhangai Province in Mongolia

Background: Most viral hepatitis deaths in 2015 were due to chronic liver disease (720,000 deaths due to cirrhosis) and primary liver cancer (470,000 deaths due to hepatocellular carcinoma). Mongolia has a relatively high sero-prevalence of HCV nationally, approximately 6% (CDA Foundation/Polaris Observatory). Mongolia has a large burden of viral hepatitis, especially chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, which are associated with cancer and cirrhosis. Methods: All adults aged 40 - 65 years being tested for anti-HCV antibodies during the campaign of Arkhangai province. Risk assessment survey questionnaire that includes about behavioral and clinical factors potentially associated with HCV infection was used for optioning data. Statistical analysis that was done using SPSS version 21 was used for data analyzed. The relevant parametric and nonparametric tests were used for data analysis. Result: All 17,601 surveyed of individuals were tested for HCV by using ELISA test for detecting the anti-HCV Ab; 3289 of them were positive and 3049 of them had detected a viral load test. Most of screened population was female (9095, 52.0%), mainly herdsman (7206, 40.9%), married (15,425, 87.6%), educated secondary level school (11,997, 68.2%) and aged between (9289, 52.8%). Significantly high number of female (60.6%), retired people (31.4%), single (13.8%) and people aged 55 - 59 years (21.6%) were infected more HCV-positive than other groups. Patients with HCV were more likely than uninfected individuals to have undergone any kind of surgery, wound and bloodletting treatment in life time. In addition, individual’s job plays important role to get infected with HCV. Only 914 (5.2%) individuals were reported that had no risk factors. 16.6 percent of screened individual were reported they had at least 3 types of risk factors. In total 10,524 individuals were reported that they had more than 4 risk factors to possibility to getting infected with HCV. Conclusion: In total, 19.5 percent of screened individuals had anti-HCV antibody, and most of them was not known not only mothers and sexual partners but also own infection to HCV. Mongolian prevalence of anti-HCV was relatively high. As would be predicted based on accepted risk factors, HCV-positive participants were more likely to have used injection at the non-medical environment, and had any kind of dental procedure, received blood transfusion, been shared needles/injection at the non-hospital environment. Also variety of personal behaviors like having any kind of tattoos influenced significantly to infected to HCV.

Genotypic and Phenotypic Characterization of MBL Genes in Pseudomonas aeruginosa Isolates from the Non-hospital Environment

Genotypic and Phenotypic Characterization of MBL Genes in Pseudomonas aeruginosa Isolates from the Non-hospital Environment

The role of nursing stuff in the early identification, prophylaxis and treatment of sepsis in the light of the new definition of sepsis

Abstract Introduction. It is estimated that every year 31 million people suffer from sepsis and even 6 million cases of illness end up in the patient’s death. In 2016 the current definition of sepsis was established as a life-threatening multiorgan failure resulting from an abnormal immune response caused by patient infection. The pathobiological approach rejects the current method of diagnosing sepsis based on the occurrence of SIRS, because many other non-infectious diseases may also cause its occurrence. There was proposed a scale of progressive organ failure called SOFA and qSOFA. In May 2017, WHO released a resolution that obliges European Union countries to raise awareness about sepsis prevention, diagnosis, treatment and management. Results. A nurse is the person who spends the most time with a patient, thus becoming the best observer of changes in his/her vital functions and well-being. Nurses working in basic health care, hospital emergency ward and all departments not involved in intensive medical care, have an important role in prevention of infections, as over 70% of sepsis cases begins in a non-hospital environment, and the current level of public knowledge reaches only 14%.

Development of an Aqueous Ophthalmic Solution with an Enhanced-Solubility Enrofloxacin Crystal, and its Clinical Evaluation in Dogs.

The concern about the frequent use of ciprofloxacin in veterinary medicine is linked to increased antimicrobial resistance. The corresponding fluoroquinolone for veterinary use is enrofloxacin. A new solvate form of enrofloxacin, as dihydrate-hydrochloride (enro-C) with higher water solubility than the parent compound, was formulated as an ophthalmic solution (pH 5). A multicentre, longitudinal, non-inferiority clinical study in a non-hospital environment was designed to treat 36 dogs affected by tobramycin-unresponsive conjunctivitis with either the experimental 0.5% enro-C ophthalmic preparation (enro-CG) or a commercial preparation of ciprofloxacin (cipro-G). Other causes of conjunctivitis were ruled out. Pathogens were isolated and minimum inhibitory concentration (MIC) studies of tobramycin were carried out. Three blocks of bacterial resistance were set up, beginning at the established breakpoint i.e., 4 µg/mL; 8 µg/mL and 16 µg/mL. Eighteen dogs were randomly assigned to each block. The enro-CG group was treated with two drops of the referred preparation (10 mg/eye) twice a day for 7 days, and the cipro-G group was treated with four drops of a 0.3% commercially available ciprofloxacin eye-drop preparation (9 mg/eye) twice a day, also for 7 days. Clinical and bacteriological cure rates were evaluated. Enro-C-treated dogs achieved a clinical cure one day earlier than ciprofloxacin-treated dogs, and unlike this latter group, enro-CG achieved bacteriological cure in all cases. No side effects were observed in either group, but dogs treated with enro-C showed no discomfort, allowing easier treatment-compliance. This is the first study reported on the successful formulation of enrofloxacin as an ophthalmic solution. Clinical assessment reveals outstanding clinical efficacy. It is necessary to conduct further research on clinical efficacy and toxicity, with the chronic use of this preparation under different clinical challenges.

Bacteriological and antibiogram of AmpC producing Enterobacteriaceae isolated from abattoir.

Owing to the continued threat of antimicrobial resistance, it is critical that farmers and clinicians take the necessary steps to use antibiotics rationally in their respective practices, and only opt for it when all other options must have been exhausted. AmpC enzymes mediate bacteria resistance to the cephamycins such as cefotetan and cefoxitin which are important antibiotics used clinically to treat and manage bacterial related infections. This study phenotypically evaluated the prevalence and antibiogram of Enterobacteriaceae that produced AmpC enzymes. Fifty (50) anal swab samples from the anal region of cows in an abattoir in Abakaliki, Nigeria were bacteriologically analyzed. The isolation and identification of bacteria isolates were carried out using standard microbiology techniques. Antibiogram was evaluated using disk diffusion technique while AmpC enzyme production was detected using the ceftazidime imipenem antagonism test. Our results show that a total of 7 (14%) E. coli and 12 (24%) isolates of Klebsiella species was isolated. The antibiogram results showed that the isolated Klebsiella species and E. coli isolates exhibited reduced susceptibility to cloxacillin (100%), ertapenem (83.3%), cefoxitin (66.7%) and ceftazidime (58.3%) for Klebsiella species; and cefoxitin (71.4%), ertapenem (28.6%) and ceftazidime (28.6%) for isolates of E. coli. AmpC enzyme production was detected in 5 (71%) isolates of E. coli and 9 (75%) isolates of Klebsiella species. The AmpC producing E. coli and Klebsiella species were multiply resistant to over 4 antibiotics found in the class: fluoroquinolones, carbapenems, aminoglycosides and penicillins. Antibiotic usage in animal husbandry allows drug resistant bacteria such as those that produce AmpC enzymes to evolve and spread. This has implication for the general public since AmpC producing bacteria are notably resistant to 2nd generation cephalosporins which are used clinically for the treatment of serious bacterial infections. Continuous monitoring of the antibiotic resistance profile in abattoir and poultry isolates is recommended as a panacea to contain the problem of antibiotic resistance in the non-hospital environment.

Iatrogenic Perforations During Colonoscopy In a Portuguese Population: A Study Including In and Out-Of-Hospital Procedures

IntroductionThe risk of iatrogenic perforations in colonoscopy is not negligible. Experience with endoscopic closure of perforations is increasing and new devices for this purpose are being released, making endoscopy a therapeutic option. National data regarding iatrogenic perforations is scarce and the burden of iatrogenic perforations in out-hospital procedures is poorly characterized in the literature. ObjectiveEvaluation of iatrogenic perforations rate during colonoscopy, their characteristics, management and prognosis. MethodsRetrospective study of all patients with perforations secondary to in-hospital and non-hospital colonoscopies treated in a tertiary hospital between 01-01-2006 and 01-10-2014. Demographic, endoscopic, radiological and therapeutic data were analyzed. ResultsFifty-three perforations were identified, 20 occurring in colonoscopies performed in non-hospital environment (45% with therapeutic procedures) and 33 occurring in-hospital procedures (73% in therapeutic colonoscopies; representing 0.12% of all colonoscopies carried out in-hospital). Patients: male in 56%, average age of 71 years, history of previous abdominopelvic surgery in 31% and diverticulosis in 10%. Colonoscopy: elective in 93%, under deep sedation in 21%, with less than excellent/good bowel preparation in 56%. A resident was the first performer in 10 cases. Perforations: average size of 21mm (4–130mm), diagnosed during the procedure in 51% of cases and occurred in rectum-sigmoid transition in 58.5%. Regarding therapeutics, all patients with perforation occurring in non-hospital colonoscopies were managed by surgery. Concerning treatment of those in our unit: 2-conservative, 12-endoscopic (10 successfully), 21-surgical (including the 2 cases with failure of the endoscopic approach). Comparing endoscopic treatment (n=10, G1) versus surgery (n=21; G2): perforation size – 9mm (G1) versus 28mm (G2); perforation location – 7/10 in rectum-sigmoid (G1) versus 8/21 in rectum-sigmoid and 10/21 transverse/ascending colon/hepatic angle (G2). Morbidity: 1 infection in G1 and 13 complications in G2 (infection, hemorrhage, fistula). Mortality: no deaths in G1 and 2 deaths at 30 days due to septic shock in G2. ConclusionPerforations in colonoscopy are rare in our clinical practice. Endoscopic closure was effective, though limited to perforations found during the procedure. The mortality was relatively low and endoscopic management did not seem to worsen it. An additional effort is necessary in order to detect perforations during colonoscopy.