Nevin Manimala

PLoS One. 2021 Nov 15;16(11):e0257272. doi: 10.1371/journal.pone.0257272. eCollection 2021.

ABSTRACT

INTRODUCTION: Hospital admitted patients are at increased risk of nosocomial infections (NIs) with multi-drug resistant (MDR) pathogens which are prevalent in the hospital environment. Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii) are common causes of NIs worldwide. The objective of this study is to determine antimicrobial resistance profiles and associated factors of Acinetobacter spp and P. aeruginosa NIs among hospitalized patients.

METHODS: A cross-sectional study was conducted at Dessie comprehensive specialized hospital, North-East Ethiopia, from February 1 to April 30, 2020. A total of 254 patients who were suspected of the bloodstream, urinary tract, or surgical site nosocomial infections were enrolled consecutively. Socio-demographic and other variables of interest were collected using a structured questionnaire. Specimens were collected and processed following standard microbiological procedures. Antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Data were analyzed with SPSS version 23 and p-value < 0.05 was considered statistically significant.

RESULTS: Overall, 13% of patients had nosocomial Acinetobacter spp and/or P. aeruginosa infections. The culture positivity rate was 16(6.3%) for Acinetobacter spp and 18(7.1%) for P. aeruginosa. Patients admitted in the surgical ward (Adjusted odds ratio (AOR):10.66;95% confidence interval (CI):1.22-93.23), pediatric ward (AOR:14.37;95%CI:1.4-148.5), intensive care unit (AOR:41.93;95%CI:4.7-374.7) and orthopedics (AOR:52.21;95%CI:7.5-365) were significantly at risk to develop NIs compared to patients admitted in the medical ward. Patients who took more than two antimicrobial types at admission were 94% (AOR:0.06; 95% CI:0.004-0.84) times more protected from NIs compared to those who did not take any antimicrobial. About 81% of Acinetobacter spp and 83% of P. aeruginosa isolates were MDR. Amikacin and meropenem showed promising activity against Acinetobacter spp and P. aeruginosa isolates.

CONCLUSION: The high prevalence of MDR Acinetobacter spp and P. aeruginosa nosocomial isolates enforce treating of patients with NIs based on antimicrobial susceptibility testing results.

PMID:34780494 | DOI:10.1371/journal.pone.0257272

PLoS One. 2021 Nov 15;16(11):e0259178. doi: 10.1371/journal.pone.0259178. eCollection 2021.

ABSTRACT

In confirmatory cancer clinical trials, overall survival (OS) is normally a primary endpoint in the intention-to-treat (ITT) analysis under regulatory standards. After the tumor progresses, it is common that patients allocated to the control group switch to the experimental treatment, or another drug in the same class. Such treatment switching may dilute the relative efficacy of the new drug compared to the control group, leading to lower statistical power. It would be possible to decrease the estimation bias by shortening the follow-up period but this may lead to a loss of information and power. Instead we propose a modified weighted log-rank test (mWLR) that aims at balancing these factors by down-weighting events occurring when many patients have switched treatment. As the weighting should be pre-specified and the impact of treatment switching is unknown, we predict the hazard ratio function and use it to compute the weights of the mWLR. The method may incorporate information from previous trials regarding the potential hazard ratio function over time. We are motivated by the RECORD-1 trial of everolimus against placebo in patients with metastatic renal-cell carcinoma where almost 80% of the patients in the placebo group received everolimus after disease progression. Extensive simulations show that the new test gives considerably higher efficiency than the standard log-rank test in realistic scenarios.

PMID:34780488 | DOI:10.1371/journal.pone.0259178

PLoS One. 2021 Nov 15;16(11):e0257941. doi: 10.1371/journal.pone.0257941. eCollection 2021.

ABSTRACT

BACKGROUND: Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients.

METHODS: A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission.

RESULTS: Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death.

CONCLUSION: Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality.

PMID:34780486 | DOI:10.1371/journal.pone.0257941

J Infect Dev Ctries. 2021 Oct 31;15(10):1489-1496. doi: 10.3855/jidc.12912.

ABSTRACT

INTRODUCTION: The conventional interferon therapy of hepatitis C virus has been substituted substantially with sofosbuvir and daclatasvir due to constraints in efficacy and tolerability. This study aimed diagnostically to monitor the effectiveness and side effects of direct-acting antivirals in the management of HCV infections.

METHODOLOGY: This prospective study was conducted on HCV-infected patients treated with sofosbuvir and daclatasvir. Different serological, biochemical, hematological, and molecular techniques were used for the assessment of patients. Only treatment-naive patients aged ≥ 18 to 75 years received 12 weeks of treatment. The primary endpoint was a sustained virologic response with undetectable HCV RNA in the patients’ serum at the end of the treatment.

RESULTS: We identified 229 cases of confirmed HCV infections by PCR, 94.3% of which had genotype 3. The study population comprised 66% females and 34% males with a median age of 42.2 ± 10.6 SD. Ninety-three percent of the patients accomplished SVR at week 12. The combined therapy of SOF/DAC achieved the highest efficacy rate (92.6%) among the different HCV genotype 3 patients. A statistically significant relationship was observed between low baseline viral load (p < 0.001; 95% CI = 1.2-3.1) and HCV genotype 3 with minor side effects, including lethargy, headache, nausea, insomnia, diarrhea, and fever.

CONCLUSIONS: HCV-infected patients can be treated well with an interferon-free SOF/DAC regimen, tolerated with generally mild adverse effects with a higher SVR.

PMID:34780372 | DOI:10.3855/jidc.12912

J Infect Dev Ctries. 2021 Oct 31;15(10):1443-1452. doi: 10.3855/jidc.13143.

ABSTRACT

INTRODUCTION: Tuberculosis remains a major health problem worldwide, killing thousand adults and children every year mainly in developing countries as Brazil. The disease is socially determined, caused mainly by inequalities as overcrowding, bad conditions of housing, unemployment, and limited access to health care. The aim of this study was to identify the social inequalities associated with the onset of tuberculosis in disease-prone territories in a city from the Northeast.

METHODOLOGY: This was an ecological study, which has gathered patients diagnosed with tuberculosis through secondary data source in a city from the northeast of Brazil. The GAMLSS statistical model has been applied considering as response variable the count of Tuberculosis cases and the independent variable, the social conditions. The double Poisson distribution was considered in the analysis. The best model fitted was selected according the Akaike information criterion value. For all tests, the p value < 0.05 was considered as statistically significant.

RESULTS: 460 patients with diagnosis of tuberculosis were identified, which represents an incidence of 36.3 cases/100,000 in males and 20.7 cases/100,000 in females. Regarding social inequality associated with tuberculosis, income (households with per capita income between 1/8 and 3 minimum wages), gender and age (Proportion of males under 15 years of age) were associated with the disease.

CONCLUSIONS: The findings evidenced the social determinants associated with tuberculosis, with a greater occurrence of the disease in areas with mostly male children and low-income families, these issues must be managed within and beyond the health sector, which is mandatory for the Tuberculosis elimination.

PMID:34780367 | DOI:10.3855/jidc.13143

J Infect Dev Ctries. 2021 Oct 31;15(10):1436-1442. doi: 10.3855/jidc.14966.

ABSTRACT

INTRODUCTION: Because of the adverse effects on human health of some antimicrobial ingredients in traditional toothpaste, consumers are increasingly turning to toothpastes with natural ingredients. This study evaluates the antimicrobial effect of toothpastes containing different natural active agents against three oral pathogens: Streptococcus mutans, Streptococcus sanguinis, and Enterococcus faecalis.

METHODOLOGY: This study tested one traditional toothpaste and seven different natural toothpastes containing theobromine, aloe vera, miswak, propolis, chitosan, enzymes and probiotics. The agar-well diffusion method was used to test the antimicrobial effect. Inhibition zones formed around toothpastes after 24 hours of incubation were measured and the data collected were statistically analyzed.

RESULTS: Toothpastes containing theobromine and chitosan and the traditional toothpaste showed antimicrobial efficacy for all tested bacteria. Toothpastes containing aloe vera, miswak, and propolis were only effective on S. mutans, while toothpastes containing probiotics and enzymes did not show any antimicrobial effect on the bacteria. Among toothpastes with natural ingredients, the theobromine-containing toothpaste showed the highest efficacy on S. mutans, while the aloe vera- and propolis-containing toothpastes had the lowest efficacy (p < 0.05).

CONCLUSIONS: Theobromine- and chitosan-containing toothpastes, which showed antimicrobial activity against all bacteria, can be recommended as alternatives to traditional toothpastes.

PMID:34780366 | DOI:10.3855/jidc.14966

J Infect Dev Ctries. 2021 Oct 31;15(10):1426-1435. doi: 10.3855/jidc.14047.

ABSTRACT

INTRODUCTION: Methicillin-Resistant Staphylococcus aureus (MRSA) is a S. aureus strain characterized by resistance to cloxacillin. Healthcare workers (HCWs), are recognized for their heightened risk for MRSA acquisition and possibly for MRSA nosocomial transmission. This cross-sectional study aimed to determine the prevalence and the associated risk factors of MRSA colonization among healthcare workers at Sultan Qaboos University Hospital (SQUH) in Oman.

METHODOLOGY: A total of 200 nasal swab samples were collected from the healthcare workers at SQUH during the period October 2nd 2018 to January 7th 2019. All nasal swab samples were examined microbiologically for the presence of MRSA using the standard method and the results were confirmed by detection of the mecA product (PBP2a). Data on associated risk factors for MRSA colonization was collected and analyzed.

RESULTS: Forty-one of the 200 screened healthcare workers (20.5%) were found to have nasal carriage of Staphylococcus aureus of which 63.4% were Methicillin Sensitive and 36.6% were Methicillin-Resistant (MRSA). Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from fifteen of the 200 screened healthcare workers giving a prevalence rate of nasal colonization with MRSA of 7.5%. We found no statistical association between healthcare worker MRSA nasal colonization and age, gender, HCWs specialty, hand hygiene practices, skin condition, previous MRSA infection, and previous exposure to antibiotics.

CONCLUSIONS: Identification of the prevalence and the associated risk factors of MRSA colonization in healthcare workers mandates continuous surveillance and the implementation of all possible preventive measures to reduce re-occurrences.

PMID:34780365 | DOI:10.3855/jidc.14047

Andrology. 2021 Nov 15. doi: 10.1111/andr.13130. Online ahead of print.

ABSTRACT

BACKGROUND: Sperm cryopreservation has been widely used in the field of reproductive biotechnology. It applies to certain males of economic and scientific values, including livestock breeds or endangered animal species. The development of a semen extender with a low cryoprotectant concentration and an appropriate amount of trehalose and boron can prevent the deterioration of sperm parameters.

OBJECTIVE: The main goal of this study is to establish a suitable ram extender model, by examining different combinations of high (5%) and low (3%) glycerol concentrations (to reduce its toxic effects on sperm freezing), a fixed amount of trehalose and an increased dose of boron to prevent the deterioration of sperm parameters, and investigate the levels of gene expressions MATERIALS AND METHODS: The Merino ram ejaculates were collected. The collected ejaculates providing the defined criteria were pooled. The pooled ejaculates were divided into eight aliquots and diluted with the Tris extender including different combinations of glycerol (5% and 3%) and boron (0.25, 0.5 and 1 mM) concentrations and a fixed amount of trehalose, then frozen. After freeze-thawing process, sperm motility, mitochondrial membrane activity, plasma membrane integrity, acrosomal membrane integrity, DNA damage (COMET and (TUNEL assays) as well as NAD(P)H quinone oxyreductase (NQO1), Glutamate – cycteine ligase (GCLC) and Glutathione S-transferaz (GSTP1) for molecular mechanisms of sperm cell response to oxidative stress were assessed for different extender groups following freeze-thawing process: 5% glycerol + 0 mM boron (G5B0.00), 5% glycerol + 0.25 mM boron (G5B0.25), 5% glycerol + 0.5 mM boron (G5B0.50), 5% glycerol + 1 mM boron (G5B1.00), 3% glycerol + 0 mM boron (G3B.00), 3% glycerol + 0.25 mM boron (G3B0.25), 3% glycerol + 0.5 mM boron (G3B0.50) and 3% glycerol + 1mM boron (G3B1.00).

RESULTS: G3B0.25 presented higher percentages of subjective motility, mitochondrial activity and viability of sperm comparing with G5B0.00 and groups with boron. Supplementation of 0.25 mM boron with and without trehalose (G3B0.25 and G5B0.25) showed higher acrosome integrity, compared with G5B0.00, G5B1.00, G3B0.50 and G3B1.00. For TUNEL analysis, G3B1.00 showed the highest DNA integrity among the experimental groups which was statistically significant only with G5B0.50 (P<0.05). The mRNA levels of NQO1 were significantly decreased in G5B1.00, G3B0.50 and G3B1.00, when compared to G5B0.00. In comparison with G5B0.00, supplementation of 1 mM boron with and without trehalose had significantly lower expression of GCLC. The level of GSTP1 gene was significantly lower (approximately 3 fold) in G3B1.00, compared to G5B0.00 (P<0.05).

DISCUSSION AND CONCLUSION: It can be assumed that the increase of the boron concentration in the extender may have important adverse effects on sperm parameters and antioxidant gene expression after thawing. The results obtained from this study will help to understand the toxicity limits of boron and eliminate the toxicity of glycerol in studies of gametes and tissue freezing. Therefore, it can be concluded that the use of sufficient boron can decrease cryodamages of cryopreservation of mammalian sperm as well tissue engineering. This article is protected by copyright. All rights reserved.

PMID:34779585 | DOI:10.1111/andr.13130

Top Cogn Sci. 2021 Nov 15. doi: 10.1111/tops.12589. Online ahead of print.

ABSTRACT

Traditional statistics instruction emphasizes a .05 significance level for hypothesis tests. Here, we investigate the consequences of this training for researchers’ mental representations of probabilities – whether .05 becomes a boundary, that is, a discontinuity of the mental number line, and alters their reasoning about p-values. Graduate students with statistical training (n = 25) viewed pairs of p-values and judged whether they were “similar” or “different.” After controlling for several covariates, participants were more likely and faster to judge p-values as “different” when they crossed the .05 boundary (e.g., .046 vs. .052) compared to when they did not (e.g., .026 vs. .032). This result suggests a categorical perception-like effect for the processing of p-values. It may be a consequence of traditional statistical instruction creating a psychologically real divide between so-called statistical “significance” and “nonsignificance.” Such a distortion is undesirable given modern approaches to statistical reasoning that de-emphasize dichotomizing the p-value continuum.

PMID:34779579 | DOI:10.1111/tops.12589

BJOG. 2021 Nov 15. doi: 10.1111/1471-0528.17014. Online ahead of print.

ABSTRACT

Even before the 1960’s and the introduction of the specialty of neonatology, and continuing to the present, numerous efforts have been made to understand the relationship between newborn birthweight and the risk of mortality. (1) With the development of neonatal intensive care units (NICUs), attention to survival rates and neurologic outcomes among those at the lowest birthweights and gestational ages (GA) has grown. (2).

PMID:34779557 | DOI:10.1111/1471-0528.17014