History Of Previous Use Research Articles

Comparative study of antibiotic sensitivity pattern of bacterial isolates from ocular infections among patients with and without diabetes mellitus

Antibiotic sensitivity pattern of bacterial isolates varies from place to place and time to time. This study is aimed at determining the sensitivity patterns in our setup. In the era of emerging resistance to antibiotics, there is a need to determine the antibiotic sensitivity pattern of bacterial isolates from ocular infections and to compare the antibiotic sensitivity pattern of bacterial isolates in ocular infections among patients with and without diabetes mellitus. 1. To determine the antibiotic sensitivity pattern of bacterial isolates in ocular infections. 2. To compare the antibiotic sensitivity pattern of bacterial isolates from ocular infections among patients with and without diabetes mellitus. 3. To study the predisposing factors for development of the multidrug resistant bacteria in ocular infections.: It was a hospital based cross-sectional study carried out among the patients presenting to Outpatient department of Hassan Institute of Medical Sciences, Hassan, Karnataka from January 2022 to June 2022. The aims and objectives of the intended study were explained to the subjects and informed written consent was taken. Institutional ethical clearance was obtained. Data was collected as per the proforma sheet. 110 samples were divided into two groups- Diabetics (Group A) & Non diabetics (Group B). Majority70(63.6%) of samples sent were from ocular pathology Chronic dacryocystitis. Positivity rate of cultures was 31.8%. Most common isolate in both groups was Staphylococcus aureus. 89% of positive culture patients had history of antibiotic abuse. Highest sensitivity was seen with aminoglycosides and resistance was seen with macrolide like azithromycin and fluroquinolone like ciprofloxacin. Antibiotic sensitivity and resistance patterns of bacterial isolates in ocular infections was similar in both Diabetics (Group A) and Non diabetics (Group B). Highest sensitivity was seen for Amikacin, Gentamicin and Tobramycin in both groups. Highest resistance was seen for Azithromycin, Amoxicillin clavulanic acid, Ciprofloxacin in both groups.Multidrug resistance was due to previous history of use of antibiotics, injudicious use of antibiotics for viral, allergic and other conditions, incomplete treatment for ocular infections and extended duration of antibiotic usage.

Vertebrobasilar dolichoectasia in patients with cerebrovascular ischemic stroke: does it have a role in cerebral microbleeds?

Abstract Background Vertebrobasilar dolichoectasia (VBD) may account for cerebral microbleeds (CMBs) in ischemic cerebrovascular stroke. Objectives To examine whether VBD is associated with the involvement of CMBs in any region and, if so, whether it is associated with CMBs among ischemic stroke patients located in posterior circulation territory. For patients with VBD, we also studied ischemic stroke subtypes, and checked whether dolichoectasia was linked to vascular risk factors. Methods Two hundred ischemic stroke patients in whom detailed clinical data and brain MRI sequences were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed. Results The mean age of patients was (65.22 ± 12.88), male patients were more frequent (67.5%); dyslipidemia was the most frequent risk factor (55%). Cardio-embolic stroke subtype was the most frequent (37%) and (71.5%) of patients had no history of previous use of antithrombotic drugs. Ectasia was found in 28 (14%), dolichosis was found in 50 (25%) and vertebrobasilar dolichoectasia was found in 19 (9.5%) of patients. Cerebral microbleeds were detected in 114 (57%) patients. Mild degree CMBs was the most prevalent among patients 69 (61%) and were located predominantly in both anterior and posterior territories 41 (36%). CMBs were significantly more frequent in hypertensive and older patients. Conclusions In patients with VBD, severe degree CMBs were more common and were located as a vascular territory supplied by vessels originating from dolichoectatic parent vessels in the posterior region.

Major Hemorrhage Risk Associated with Direct Oral Anticoagulants in Non-Valvular Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Real-world, observational studies have investigated the safety profile of Direct Oral Anticoagulants (DOACs) on Major Hemorrhage (MH) used for stroke prevention in Non-Valvular Atrial Fibrillation (NVAF). We performed a systematic review and meta-analysis to investigate the comparative safety of DOACs versus other DOACs and versus Vitamin K Antagonists (VKAs) adhering to PRISMA guidelines. We defined MH according to the International Society on Thrombosis and Haemostasis statement or as the composite outcome of intracranial, gastrointestinal, genitourinary, respiratory, cavitary and musculoskeletal bleeding in case of studies using International Statistical Classification of Diseases codes for patient selection. We systematically investigated two databases (Medline, Embase) until April of 2021, gathered observational studies and extracted hazard ratios (HRs) with 95% confidence intervals (CI) on our outcome of interest. Additional subgroup analyses according to DOAC dosing, prior diagnosis of chronic kidney disease, prior diagnosis of stroke, history of previous use of VKA, the users' age, the users' gender and study population geographic region were conducted. All analyses were performed with a random-effects model. From this search, 55 studies were included and 76 comparisons were performed. The MH risk associated with Rivaroxaban use was higher than the risk with Dabigatran use (HR: 1.32, 95% CI: 1.21-1.45, : 12.39%) but similar to VKA use (HR: 0.94, 95% CI: 0.87-1.02, : 76.57%). The MH risk associated with Dabigatran use was lower than the risk with VKA use (HR: 0.75, 95% CI: 0.64-0.90, : 87.57%). The MH risk associated with Apixaban use was lower than the risk with Dabigatran use (HR: 0.75, 95% CI: 0.64-0.88, : 58.66%), with Rivaroxaban use (HR: 0.58, 95% CI: 0.50-0.68, : 74.16%) and with VKA use (HR: 0.60, 95% CI: 0.55-0.65, : 58.83%). Our aforementioned subgroup analyses revealed similar results. All in all, Apixaban was associated with a reduced MH risk compared to Dabigatran, Rivaroxaban and VKA. Dabigatran was associated with a reduced MH risk compared to both Rivaroxaban and VKA.

Streptococcus agalactiae is resistant to β-lactam antibiotics in a diabetic patient with foot infection: a case report

Introduction: Diabetic foot infection is a complication that often occurs in people with diabetes mellitus. Staphylococcus aureus is the most common microorganism found in diabetic foot infections. In addition, coagulase-negative staphylococci, Enterococcus faecalis, Streptococcus agalactiae, and Pseudomonas aeruginosa can also be demonstrated. Diabetic foot infection treatment usually takes a long time which may increasing the risk of antibiotic resistance. This article will present a unique and interesting case about Streptococcus agalactiae resistant to β-lactam infection. Case description: A 56-year-old man presented with a long history of diabetes mellitus but had not taken anti-diabetic drugs and had no history of previous use of antibiotics. Since 2016 his right foot had a recurring wound that he routinely treated. Microbiology culture of the wound swab obtained three bacteria namely Streptococcus agalactiae, Proteus mirabilis and Klebsiella pneumoniae which is resistant to β-lactam antibiotics. Conclusion: The identification of Group B Streptococcus bacteria (Streptococcus agalactiae) which are resistant to β-lactam antibiotics (penicillin, third and fourth generation cephalosporins) which were found in this case, reminds all medical personnel to be more careful and prudent in the rational use of antibiotics.

COVID‐19–associated mucormycosis, diabetes and steroid therapy: Experience in a single centre in Western Mexico

BackgroundCOVID‐19–associated mucormycosis (CAM) has emerged as a challenging complication as the current pandemic has increased the population requiring treatment with corticosteroids. CAM has caused a massive outbreak in India, reported to be causing cases in Iran, Egypt and The Netherlands.ObjectivesTo describe CAM cases occurring in a single centre in Western Mexico.MethodsOur group carried out a retrospective study from May 2020 to May 2021 to identify CAM cases in patients with previous COVID‐19 diagnosis.ResultsSix CAM cases occurred in a single centre in Western Mexico during the study period, most of them with diabetes (n = 5/6) and all received corticosteroid therapy even when only three had severe COVID‐19. After analysing local COVID‐19 burden, it was estimated that in this region, CAM was 300 times more frequent among COVID individuals than the estimates for general population.ConclusionSimilar to large reports in India and other countries, CAM cases reported in this study were diagnosed in individuals with diabetes, hyperglycaemic status and with history of previous use of corticosteroids. Identifying these individuals at risk can help the early identification of CAM. In addition, strict glycaemic control and avoidance of unnecessary corticosteroid in non‐severe COVID‐19 cases could help in preventing this complicated fungal infection.

Species of plasmodium (P. Falciparum and P. Vivax) involved in children with malaria: An experience from a tertiary childcare hospital.

Objective: To find out different species of plasmodium (P. falciparum and P. vivax) involved in children with malaria at a tertiary childcare hospital. Study Design: Descriptive, Cross-sectional study. Setting: Department of Paediatric Medicine, The Children’s Hospital and Institute of Child Health, Multan. Period: October 2019 to March 2020. Material & Methods: A total of 281 cases of either gender, aged 1 to 12 years and patients with malaria were enrolled. A special template was designed to record study information. Venous blood as five ml sample was drawn and dispatched to institutional laboratory for ICT malaria, complete blood count and giemsa stain smear and observed under light microscope. Data analysis was performed employing SPSS version 24.0. Results: Out of a total of 281 cases, 177 (63.0%) were male ande 104 (37.0%) female. Mean age of study participants was 4.29±2.48 years. A total of 135 (48.0%) children belonged to rural areas and 197 (70.1%) had monthly family income < 25000 rupees. Mean duration of illness was 4.21 ± 2.12 days. Previous history of use of anti-malarial drugs was noted in 62 (22.1%) of our study cases. Plasmodium falciparum was observed in 52 (18.5%) cases and plasmodium vivax in 229 (81.5%). Conclusion: Plasmodium vivax is predominantly more prevalent in our population as compared with plasmodium falciparum in children with malaria. Plasmodium falciparum and plasmodium vivax were significantly linked with age and disease duration. Malaria was noted to be more prevalent among poor families living in slum areas having inadequate sanitation facilities.

A drug repurposing screen identifies hepatitis C antivirals as inhibitors of the SARS-CoV2 main protease.

Effective SARS-CoV-2 antiviral drugs are desperately needed. The SARS-CoV-2 main protease (Mpro) appears as an attractive target for drug development. We show that the existing pharmacopeia contains many drugs with potential for therapeutic repurposing as selective and potent inhibitors of SARS-CoV-2 Mpro. We screened a collection of ~6,070 drugs with a previous history of use in humans for compounds that inhibit the activity of Mpro in vitro and found ~50 compounds with activity against Mpro. Subsequent dose validation studies demonstrated 8 dose responsive hits with an IC50 ≤ 50 μM. Hits from our screen are enriched with hepatitis C NS3/4A protease targeting drugs including boceprevir, ciluprevir. narlaprevir, and telaprevir. This work suggests previous large-scale commercial drug development initiatives targeting hepatitis C NS3/4A viral protease should be revisited because some previous lead compounds may be more potent against SARS-CoV-2 Mpro than boceprevir and suitable for rapid repurposing.

Retrobulbar Cryptococcoma Mimicking Tumor in a Labrador Retriever

Background: Cryptococcosis is a systemic mycotic disease caused by encapsulated yeasts C. neoformans and C. gattii. Cryptococcus neoformans is predominantly found in soils and feces of pigeons and psittacids. Infection occurs mainly through the respiratory tract, through the inspiration of fungal propagules (basidiospores and/or desiccated yeast cells). The main lesions observed are in the nasal cavity and lungs, but in dogs, the central nervous system and eyes are widely affected. Despite some previously mentioned reports, the retrobulbar form has not been described in the literature. Therefore, the purpose of this report is to describe a case of retrobulbar cryptococcoma mimetizing a tumor in a young bitch. Case: A 2-year-old female Labrador Retriever, was admitted to one Veterinary Hospital with exophthalmia on the left eye for 15 days and other signs included negative retropulsion, mydriasis, and abscence of menace and pupillary reflexes. Ocular ultrasound imaging revealed a hyperecotic and heterogeneous retrobulbar mass in the mid-dorsal region compressing the optic nerve. Computed tomography of the skull showed the presence of proliferation of neoplastic tissue in a locally invasive retrobulbar region promoting moderate rostrolateral displacement of the left ocular bulb, discrete osthelysis in maxillary bone, palatine, medial wall of the orbital bone and frontal bone, with destruction of cribiform plate adjacent to the dorsal region of the orbital wall and presence of mild contrast uptake in the region of the left olfactory bulb lobe, characterizing a picture compatible with neoplasia with malignancy and locally invasive characteristics. Exenteration and excision of part of the frontal bone were performed and histopathological examination revealed granulation with the presence of fibroblasts and numerous typical blastoconidia of Cryptococcus neoformans. The patient was treated with Itraconazole [10 mg/kg, v.o, SID, for 90 days] and one year after diagnosis, X-ray was performed to control the lesion and radiographic aspects were within normal limits.Discussion: Cryptococcus sp. is an environmental fungus that has the potential to be pathogenic to humans and animals. Fungus present as a basidiospores in pigeon droppings. The patient described had a history of contact with free-living pigeons, making it a risk factor for the occurrence of cryptococcosis, being the possible cause of the infection. In dogs, the disease is mainly described in immunosuppressed animals, which was not the case of the patient, who presented clinical and laboratory results within the normal range and without a previous history of use of immunosuppressants. The alterations described in the computed tomography, such as destruction of the cribriform plate adjacent to the dorsal region of the left orbital wall and the presence of slight contrast uptake in the left olfactory bulb lobe region, are compatible with the main entry point for propagules of Cryptococcus sp. In the present case, no periocular and ocular alterations were observed as described in the literature, and the lesion was restricted to the retrobulbar space. Ultrasonography and computed tomography revealed a neoformation mimicking a malignant neoplasm and the diagnosis of cryptococcoma was revealed by histopathology. Based on the present case, cytology through aspiration of retrobulbal neoformations is imperative as a diagnostic method, especially in endemic areas for fungal diseases that can mimic ocular neoplasms. Keywords: cryptococcosis, fungus, Cryptococcus sp., dog. Descritores: criptococose, fungo, Cryptococcus sp., cão.

PATTERN AND BURDEN OF ANTIMICROBIAL RESISTANCE AMONG CAUSATIVE ORGANISMS OF SPONTANEOUS BACTERIAL PERITONITIS.

Background; Spontaneous bacterial peritonitis is a common bacterial infection in patients with cirrhosis and ascities with in-hospital mortality rates ranging from 20 to 30%. Early diagnosis and a prompt antibiotic therapy have considerably decreased the mortality rate and this study was done to determine drug resistance pattern among causative organisms of SBP. Material and Methods; All the cases (n = 183) of Cirrhosis of liver with ascities, fulfilling inclusion criteria were recruited from Department of Medicine Akhtar Saeed Trust Hospital Lahore and Nishtar Hospital, Multan. All selected patients were subjected to ascitic fluid tap, under aseptic measures by inserting a needle of 22 / 18 gauge in the left flank of abdomen. Ten ml of ascitic fluid was aspirated in a heparinised disposable syringe; which was immediately inoculated into blood culture bottle at bedside and send for bacterial culture and causative organisms was tested for their antibiotic drug resistance pattern. Data was entered and analyzed by computer program SPSS-18. Results; Of these 183 study cases, 103 (56.3%) were male patients while 80 (43.7%) were female patients. Mean age of our study cases was 51.73 ± 9.28 years. Previous history of use of antibiotics before 72 hours was noted in 103 (56.3%), anti – HCV was positive in 103 (56.3%) while HBs Ag was positive in 13.7% of our study cases. Among these study cases, E.coli was noted in 135 (73.8%), Staph. Aureus in 17.5% and Klebsiella was noted in 8.7%. Chloramphenicol was resistant in 24 (13.1%), ampicillin was resistant in 143 (78.1%), co – trimoxazole in 61.2%, ciprofloxacin in 55.7%, Ofloxacin in 56.3%, Cefotaxime was resistant in 78.1% and amoxicillin was resistant in 74.9%. Conclusion; High degree of drug resistance was observed among these strains in our study which points towards well directed efforts of our health policy makers to adopt certain guidelines regarding use of these drugs in our population. Our study results have indicated that E.coli was major causative organisms among patients with spontaneous bacterial peritonitis having cirrhosis of liver followed by staphylococcus aureus and klebsiella. Keywords; Cirrhosis, spontaneous bacterial peritonitis, E. coli. DOI: 10.7176/JMPB/67-07 Publication date: August 31 st 2020

CTX-M-producing Escherichia coli in pigs from a Czech farm during production cycle.

We evaluated the prevalence and epidemiology of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli isolates in pigs during production cycle on a Czech farm with the history of previous use of ceftiofur. ESBL-producing E. coli isolates were obtained from rectal swabs from pigs of different age groups (suckling piglets, weaned piglets, growers and sows). Collected samples were directly cultivated on MacConkey agar with cefotaxime (2mgl-1 ), whereas intestinal swabs of slaughtered pigs and surface swabs from pig carcasses were also pre-enriched in buffered peptone water without antimicrobials before the cultivation. Clonal relationship of selected isolates was determined by XbaI pulse-field gel electrophoresis and multi-locus sequence typing. The transferability of plasmids carrying blaCTX-M genes was tested by conjugation experiments. From all examined samples, 141 (43·7%, n=323) were positive for ESBL-producing E. coli. All ESBL-producing isolates showed resistance to multiple antimicrobials and were positive for blaCTX-M genes. The blaCTX-M-1 was carried by conjugative IncN/ST1 plasmids (c.40-45kb) while the blaCTX-M-15 was located on conjugative F plasmids with F:18:A5:B1 formula (c.165kb). This study demonstrated the persistence of CTX-M-positive E. coli isolates 2months after banner of ceftiofur usage and indicated possible risk of transmission of these isolates to humans via the food chain.

Cult paraphernalia or everyday items? Assessing the status and use of the flint artefacts from Nahal Hemar Cave (Middle PPNB, Judean Desert)

Since its discovery in the 1980s, Nahal Hemar Cave has been interpreted as a cult site where ceremonies were performed, as indicated by the extremely selected and highly symbolic repertoire of objects found in the cave (e.g., stone masks, modelled skulls, bone figurines, etc.). The finds, dated to the 8th millennium cal. BC and assigned to the Pre-Pottery Neolithic B (PPNB) period, also consisted of other artefacts often found in contemporaneous sites, such as flint tools or stone beads. In this paper, the status and use of the unique lithic assemblage found in the cave is assessed through a comprehensive approach integrating techno-typological and use-wear analyses and, secondly, contextualized within current lithic research and in the broader context of the Middle/Late PPNB in the southern Levant. The study resolves some of the major questions concerning the production, use and meaning of the flint tools, also bringing some light to the ritual, spiritual or unconventional activities associated with the use of the cave. It concludes that the flint assemblage found in the cave was the result of a series of episodes of deposition of objects over a relatively lengthy period of time, that a varied group of social agents was involved in the production of the said tools and, finally, that the tool producers, and likely, the cave users, were farmers from the agricultural villages in the Mediterranean woodland region. In addition, use-wear analysis indicates that the flint tools found at the cave had a previous history of use before being abandoned/deposited in the cave and some of them may have participated in the ritual activities. Finally, we propose that, in the particular case of the Nahal Hemar knives, they could be related to the processing/dismembering of human bodies, a hypothesis further supported by the remains of 23 individuals (mostly cranial) found in the cave.

Predictors of Unmet Need for Family Planning among HIV Positive Women in Care in Federal Teaching Hospital Gombe, Nigeria

Background: Elimination of mother-to-child transmission (EMTCT) of Human Immunodeficiency Virus (HIV) requires adequate and continuous use of family planning commodities among women of reproductive age. This can be made possible by reducing the proportion of HIV positive women with unmet need for family planning. The study aims to determine the factors associated with having unmet need among women in HIV care.
 Methods: A cross sectional study was conducted using an interviewer administered questionnaire to study 325 women on HIV care. Cluster sampling technique was used to select the study respondents from the clinic.
 Results: Less than half of the respondents (40%) were currently using family planning, 35% had unmet need for family planning with 53.6% having unmet need for spacing while 46.4% having unmet need for limiting. Women with no history of previous use of family planning were fifteen times more likely to have unmet need for family planning than those with history of previous use of family planning (p value <0.001, CI 2.511-15.770). Also women with more than five deliveries were eight times more likely to have unmet need for family planning (p value 0.004, CI 0.001-0.279) while women with 2-5 deliveries are four times likely to have unmet need for family planning (p value 0.035, CI 0.005-0.832).
 Conclusion: A high proportion of women receiving ART care still have unmet need for family planning despite incorporating this service in HIV care. It is therefore important to target high risk groups to reduce the proportion of women with unmet need for family planning which will invariable reduce mother to child transmission of HIV.

P719 Effectiveness and safety of ustekinumab induction therapy in ulcerative colitis: A GETAID real-world cohort study

Abstract Background Phase III trials have demonstrated the efficacy and safety of ustekinumab in moderate-to-severe ulcerative colitis (UC), but no real-life data is currently available. Methods Between January and September 2019, all consecutive patients with UC treated with ustekinumab in 20 French GETAID centres were included. The primary outcome was steroid-free clinical remission (partial Mayo Clinic score ≤ 2) at weeks 12–16 without rectal bleeding subscore > 1. Results One hundred and three patients were included with a median age and disease duration of 39.3 [interquartile range (IQR), 29.1–52.3] and 7.6 [3.6–12.9] years, respectively. Most of the patients had left sided colitis (41.8%) or pancolitis (52.4%). History of immunomodulator, anti-TNF and vedolizumab therapies was noted in 84.5%, 99.0% and 85.4% of the cases, respectively. Steroid-free clinical remission and clinical remission rates were 35.0% and 39.8% at weeks 12–16, respectively. Normalisation of rectal bleeding and stool frequency (subscore 0 for both outcomes) was noted in 19.4% of patients whereas normalisation of rectal bleeding (subscore 0) with a stool frequency subscore of 0 or 1 was noted in 39.8%. Two patients discontinued ustekinumab before the weeks 12–16 visit and were referred to surgery. Predictors of therapeutic failure at weeks 12–16 were a partial Mayo Clinic score > 6 at week 0 (HR = 10.0, 95%CI [1.11––100.0], p = 0.04) and an history of previous use of anti-TNF and vedolizumab (HR = 33.3, 95%CI [2.4–100.0], p = 0.01). Improvement in endoscopic activity of UC at weeks 12–16 was observed according to Ulcerative Colitis Endoscopic Index of Severity (5.0 ± 1.2 vs. 3.8 ± 1.9, p < 0.001). Adverse events occurred in 7.8% and serious adverse events in 3.9%. Conclusion In this first real-life cohort study of refractory UC patients treated with ustekinumab, clinical remission without corticosteroids was observed in one-third of cases at weeks 12–16. Clinical severity and previous use of anti-TNF and vedolizumab were associated with therapeutic failure.

Nurse empowerment through Pharmacogenetics.

Objective:to verify the existence of elements that justify the use of pharmacogenetics by the Brazilian nurse.Method:this is a quantitative, cross-sectional, observational, descriptive study, whose final sample was 67 individuals. The participants were healthy at the time of the study and reported a history of previous use and the occurrence of adverse effects by drugs commonly used and metabolized by CYP2C9. We collected 4 mL of venous blood for subsequent DNA extraction by salting out method and genotyping of the CYP2C9*2 and CYP2C9*3 polymorphisms, using Polymerase Chain Reaction in real time using Taqman assays.Results:the use of drugs metabolized by CYP2C9 was frequent (more than 75% of the individuals have already used between 2 or 4 of these drugs). Regarding adverse events, there were 19 perceived symptomatic occurrences associated with drugs metabolized by CYP2C9. The allele frequency of the polymorphism * 2 and * 3 in the population studied was 11.1% and 7.5%, respectively, and there was a coincidence between the presence of alleles of low enzyme activity and the occurrence of adverse effects.Conclusion:there are elements that justify the adoption of pharmacogenetics in the nursing care to reduce the occurrence of adverse reactions to drugs metabolized by CYP2C9.

Occurrence and faecal shedding of extended-spectrum beta-lactamase-producing Escherichia coli in sows and their offspring

The aim of the present study was to monitor the presence of extended-spectrum beta-lactamase (ESBL) producing E. coli on farm A with the history of previous use of ceftiofur in suckling pigletsand to analyse the risk factors of selection and dissemination of ESBL producers in the production herd. In the year of 2014, a total of 411 samples (rectal swabs or faeces)from pigs of various age categories (sows, gilts and suckling piglets) were collected. The sampling was performed more than 24 months after the ban of ceftiofur on the farm.The sows and gilts were sampled repeatedly before and after farrowing. All collected samples were directly cultivated on MacConkey agar (MCA) containing cefotaxime (2 mg/l) and obtained sub-cultures were tested for ESBL production by double disc synergy test. According to our results, all gilts were negative for ESBL-producing E. coli in the introduction period, however, the excretion of ESBL-producing E. coli was observed before and after delivery. Most of the new-born piglets from positive sows and gilts shed ESBL-producing E. coli early after birth. All tested ESBL-producing isolates were resistant to multiple antimicrobials, suggesting that antibiotics from other groups used for therapy co-select for ESBL producers in pigs on the studied farm. Intestinal colonization of lactating sows and their offspring as well as survival of ESBL-producing E. coli in the farm environment should be recognised as important risk factors of circulation and long-time persistence of ESBL producers in the herd.

EP1.01-03 Real World Outcome of Crizotinib for Anaplastic Lymphoma Kinase-Positive Non-Small Cell Lung Cancer Patients

Crizotinib has shown its superiority in clinical trials compared to conventional chemotherapy in patients with anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC) patient, but its use and outcomes in real-world settings are yet to be investigated. This study aimed to assess treatment patterns and outcomes of crizotinib therapy in ALK-positive NSCLC patients, as well as to seek factors associated with progression-free survival and overall survival of ALK-positive NSCLC patients. A retrospective medical record review of 176 patients who are diagnosed as metastatic or recurred NSCLC from January 1st, 2006 to June 30th, 2018 and treated with crizotinib was performed. Descriptive analyses were conducted to assess treatment patterns and objective response rate (ORR). Survival analysis to estimate progression-free survival (PFS) and overall survival (OS) was performed. Comparison of the treatment outcomes by the setting of crizotinib initiation was done. Cox regression analysis was used to find predictive factors associated with PFS and OS from initiation of crizotinib. Median age was 55.7 (ranged 20 to 84) years and 85 patients (48.3%) were male. Seventy-two (40.9%) patients died at the time of analysis. Seventy-eight patients initiated crizotinib as first-line therapy. Overall response rate was 54.5% (50.0% for first-line recipients, 58.2% for second-/later-line). Median (95% CI) PFS from crizotinib initiation and OS from first dose of chemotherapeutic agent were 14.3 (11.6-17.0) and 41.7 (25.4-58.1) months, respectively. No significant difference of ORR, OS, and PFS, according to the setting of crizotinib initiation was observed. Multivariate Cox analysis showed poor performance status (HR 3.472, p-value <0.001) and number of metastatic organs (≥3, HR 1.648, p-value 0.017) were independently associated to shorter PFS and OS, while history of getting pemetrexed before use of crizotinib (HR 0.638, p-value 0.039) was independently related to longer OS.Tabled 1All patientsSetting of Crizotinib Initiation(n = 176)First-Line (n = 78)Second- or Later-Line (n = 98)P valueProgression-free survival0.699Mean (SE)25.0 (3.1)28.0 (6.4)16.6 (1.5)Median (95% CI)14.3 (11.6-17.0)15.8 (10.0-21.6)13.1 (9.1-17.0)Q1, Q35, 275, 225, 27Overall survival0.137Mean (SE)54.1 (4.2)40.6 (6.1)57.8 (4.9)Median (95% CI)41.7 (25.4-58.1)26.3 (14.7-37.9)43.9 (25.7-62.1)Q1, Q318, 10917, 7719, 1091- and 2-year survival ratesPercent still alive at 1 year after diagnosis (95% CI)87.1 (86.7-87.5)85.4 (84.3-86.5)88.5 (87.8-89.2)0.483Percent still alive at 2 years after diagnosis (95% CI)65.7 (65.0-66.4)55.4 (51.9-58.9)69.0 (68.0-70.0)0.213 Open table in a new tab Outcomes for crizotinib recipients were in line with previous trials, with PFS and OS appearing more favorable. Poor performance status and number of metastatic organs correlated to worse PFS and OS, while history of previous use of pemetrexed before crizotinib correlated to better OS.

Use of Smokeless Tobacco Among Students in the City of Chabahar: A Cross-Sectional Study

: The purpose of this study was to determine the prevalence of types of smokeless tobacco use between students in the city of Chabahar. A total of 105 students were selected from the schools of Chabahar city. The sample size was calculated using the G*Power software. For a questionnaire by the test-retest exam for knowledge and attitude structures, the reliability of the test (Pearson correlation coefficient’s) was 98% and 94%. The Cronbach alpha of these structures was about 74%. The CVR for these structures was 93% for knowledge and 88% for the structure of the attitude. Data was analyzed using the SPSS16 software. In this study, 14 students (13%) had a history of previous use and 48 students (45.7%) reported having had tobacco use at least once, 30 days before studying. The Pearson Correlation Test indicated a significant relationship between smokeless tobacco use with the family number (-0.224), mother's literacy (0.219), and father’s literacy (0.224). The number of smokeless tobacco users who had consumed at least once in the last month of the study were Pan 26 (24.8%), Gutkah 9 (8.6%), and Biti 5 (4.8%). The results of the study show that the prevalence of smokeless tobacco use in students around the city of Chabahar is high.

BURDEN OF MULTI-DRUG RESISTANCE IN SALMONELLA TYPHI ISOLATES OF ENTERIC FEVER.

Objective; To determine burden of multi-drug resistance among Salmonella typhi isolates of enteric fever at a tertiary care hospital. Material and methods; Consecutive 161 children with enteric fever were included in this study. This cross – sectional study was done at Department of Pediatric Medicine, Nishtar Medical University and Hospital, Multan from June 2017 to December 2018. Venous blood sample (3-5 ml) was drawn and it was immediately transported to Microbiology laboratory of Pathology Department, Nishtar Hospital Multan for blood culture and sensitivity test. Antibiotic drug resistance was determined after measuring diameter of zone of inhibition of a specific drug on Salmonella isolates on Mueller Hinton agar plates by modified Kirby baur disc diffusion method. Coated tongue, pain abdomen, anorexia and headache was assessed clinically. All the data were entered and analyzed using SPSS-11. Results; Of these 161 study cases, 91 (56.5%) were boys and 70 (43.5%) were girls. Mean age of our study cases was 5.79 ± 2.45 years (with minim age was 2 years while 12 years was maximum age). Previous history of use of antibiotics before 48 hours of the culture and sensitivity test was present in 93 (57.8%) of our study cases. Majority of our study cases having enteric fever presented with abdominal pain 65 (40.4%), headache 28 (17.4%) and diarrhea 17.4 % of our study cases. Chloramphenicol was sensitive in 40 (24.8%) of the Salmonella typhi isolates, Ampicillin was sensitive in 20 (12.4%), Co-trimoxazole in 20 (12.4%), Ciprofloxacin was sensitive in 88 (54.7%) isolates, Ofloxacin was sensitive in 101 (62.7%), Gentamycin was sensitive in 28 (17.4 %), Amoxycillin was sensitive in 36 (22.4 %). Multi – drug resistant strains were 71 (44%) in our study cases. Conclusion; Our study results have indicated that S. typhi isolates of enteric fever showed higher degree of antibiotic drug resistance. Multidrug resistant strains were more prevalent in our study which points towards well directed efforts of our health policy makers to adopt certain guidelines regarding use of these drugs in our population. Keywords; Enteric fever, Multi drug resistance, Salmonella typhi. DOI : 10.7176/JMPB/55-09 Publication date :May 31 st 2019

Post-Autotransplant Hepatitis B Virus (HBV) Reactivation in Lymphoma and Multiple Myeloma Patients with Hepatitis B Surface Antigen-Positive or Resolved HBV Infection

Background: Although hepatitis B virus (HBV) reactivation in patients with hepatitis B surface antigen (HBsAg)-positive or resolved HBV infection (HBsAg-negative and hepatitis B core antibody [anti-HBc]-positive) undergoing anticancer therapy with or without rituximab has been frequently reported, few studies have evaluated the risk of HBV reactivation in patients receiving autologous stem cell transplantation (ASCT). We studied the rate of hepatitis and HBV reactivation after ASCT in lymphoma and multiple myeloma (MM) patients with HBsAg-positive or resolved HBV infection.Methods & Materials: Medical records of patients who diagnosed with lymphoma or MM and received ASCT between November 2005 and April 2014 in Severance hospital were retrospectively analyzed. HBV status was screened routinely at ASCT and when viral-related hepatitis was suspected after ASCT. Hepatitis was defined as a 3-fold or greater increase in serum alanine transaminase (ALT) that exceeded the reference range (>46 IU/L) or an absolute increase of ALT to more than 100 IU/L. HBV reactivation was defined as elevation of serum HBV-DNA level more than 1 log IU/L from baseline in HBsAg(+) patients. In case of resolved HBV patients, positive conversion of HBsAg (reverse seroconversion) with or without increase of ALT was defined as HBV reactivation. Hepatitis and HBV reactivation occurred before 1 year after ASCT was considered ASCT-related in this study.Result: A total of 297 patients (196 lymphoma and 101 MM) were studied. Median age at diagnosis was 47 years (range 16-64). A male to female ratio was 1.36:1. Most common subtype of lymphoma was diffuse large B-cell lymphoma (DLBCL, n=111). The median duration from diagnosis to ASCT was 475 days (range 105-5230) and 175 days (range 39-5400) in lymphoma and MM patients, respectively. Busulfan-based (n= 161, 82.1%) conditioning regimens were commonly used in lymphoma patients and melphalan-based (n=101, 100%) conditioning regimens were used in MM patients. The patients with HBsAg(-) did not received a routine anti-HBV prophylaxis regardless of the presence of anti-HBc. Nine patients did not tested for HBV at ASCT.Among 274 patients with HBsAg(-), 110 patients were anti-HBc(+) (resolved HBV infection) and 161 patients were anti-HBc(-). Within 1 year after ASCT, 48 of anti-HBc(+) and 71 of anti-HBc(-) patients experienced hepatitis (43.6% vs. 44.1%, p>0.999). The most common cause of hepatitis was drug-related (n= 81, 66.9%). There was no HBsAg reverse seroconversion within 1 year after ASCT. After 1 year, Only one patient with anti-HBc(+) experienced HBV reactivation at days 763 after ASCT and 3 patients with anti-HBc(-) showed HBsAg reverse seroconversion at days 406, 457 and 1172 post-transplant.In the subset of 178 lymphoma patients with HBsAg(-), 90 patients had a history of previous use of anti-CD20 monoclonal antibody, of whom 37 patients were anti-HBc(+). Twelve of anti-HBc(+) and 24 of anti-HBc(-) patients experienced hepatitis (32.4% vs. 45.3%, p=0.276) but there was no HBV reactivation related hepatitis within 1 year after ASCT.Among 14 patients with HBsAg(+) at ASCT, 13 patients received rituximab-containing chemotherapy before ASCT. They had received prophylactic HBV therapy with lamivudine (n=6), telbivudine (n=4), clevudine (n=2), adefovir (n=1) and tenofovir (n=1). Among them, 3 patients with telbivudine (n=1, 25%), clevudine (n=1, 50%) and lamivudine (n=1, 16.7%) experienced HBV reactivation at days 36, 161 and 204 after ASCT.Conclusion: Our data suggest that ASCT-related HBV reactivation is rare in lymphoma and MM patients with resolved HBV infection regardless of previous anti-CD20 therapy. Routine anti-HBV prophylaxis is not necessary for patients with resolved HBV infection. In case of HBsAg(+) patients, antiviral prophylaxis with lamivudine, clevudine, or telbivudine may not be sufficient to prevent HBV reactivation after ASCT. More potent antiviral agents such as adefovir or tenofovir should be considered. [Display omitted] Characteristics of 7 patients with HBV reactivation or HBsAg reverse seroconversion after ASCT. DisclosuresNo relevant conflicts of interest to declare.

Levofloxacin resistant Escherichia coli sepsis following an ultrasound‐guided transrectal prostate biopsy: Report of four cases and review of the literature

Fluoroquinolones are the most commonly used prophylactic antimicrobials for ultrasound-guided transrectal prostate biopsy due to their broad pathogen spectrum, pharmacokinetics, bioavailability and ease of oral administration. However, although Escherichia. coli (E. coli) is the most common pathogen associated with infections after transrectal prostate biopsy, the prevalence of fluoroquinolone resistant strains of E. coli is increasing. Levofloxacin resistant E. coli sepsis occurred in four (0.6%) of 665 patients who received oral levofloxacin prophylaxis and underwent transrectal prostate biopsy from July 2002 to December 2006 in this institute. All patients had obstructions of the lower urinary tract and three of the four had a history of previous use of quinolones. Although two of the four patients developed septic shock, all of the patients were treated with carbapenems immediately and made a complete recovery. Since a case of multiresistant E. coli sepsis and fatal anaerobic sepsis after transrectal prostate biopsy had been reported, intravenous carbapenem is recommended as antimicrobial therapy for sepsis after transrectal prostate biopsy.