Vitamin D Status in Neonatal Pulmonary Infections: Relationship to Inflammatory Indicators

AIM: The study aimed to evaluate serum vitamin D concentrations among neonates with pneumonia. METHODS: This case-control study enrolled 33 neonates with pneumonia in addition to 30 healthy controls. CBC, CRP, Serum vitamin D and Pentraxin 3 levels were measured for all participants. RESULTS: There was significant difference between patients and controls regarding Hemoglobin levels, TLC and CRP (p value < 0.01, = 0.002, < 0.01 respectively). Patients with pneumonia showed significant lower levels of Vit. D (9 ± 2.1) compared to controls (14.1 ± 2.8), P value < 0.01. However, patient group had significant higher levels of Pentraxin 3 (29.1 ± 4.8) compared with controls (12.6 ± 3), P value < 0.01. Moreover, mechanically ventilated patients revealed significant lower vit D (7.7 ± 1.8) and higher pentraxin 3 (32.2 ± 2.6) compared to patients on free oxygen (9.1 ± 2.1, 26.4 ± 3.7 respectively), P value = 0.05, 0.02 respectively. Regarding hospital stay, it had significant positive correlation with serum pentraxin 3 (r = 0.6, P value < 0.01) and significant negative correlation with serum vit D (r = -0.4, P value = 0.04). Finally a significant negative correlation between serum levels of vitamin D and Pentraxin 3 was found (r = -0.4, P value = 0.01). CONCLUSION: Lower concentration of serum vitamin D may be significantly associated with neonatal pneumonia. It also can predict the need for mechanical ventilation and duration of hospital stay in neonatal pneumonia. Similarly, higher levels of Pentraxin 3 may be used as an indicator for mechanical ventilation need and a longer hospital stay in neonates with pneumonia

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Gamma irradiation green synthesis of (polyacrylamide/chitosan/silver nanoparticles) hydrogel nanocomposites and their using as antifungal against Candida albicans and anti-cancer modulator

Abstract Silver nanoparticles-loaded hydrogel nanocomposites are exploited for medicinal and pharmaceutical applications. Hydrogel nanocomposites were prepared from acrylamide (Am), chitosan (CS) and AgNO3 utilizing gamma rays. Diverse variables were applied in preparation of silver nanoparticles-laoded hydrogel nanocomposites of (PAm/CS)-AgNPs such as influence of radiation dose and influnece of CS concentration. Diverse techniques were utilized to characterize hydrogel nanocomposites; Fourier transform infrared spectroscopy (FTIR), thermal gravimetric analysis (TGA), X-ray diffraction (XRD), Transmission electron microscopy (TEM), energy dispersive X-ray (EDX) and scanning electron microscopy (SEM). Results confirmed formation of silver nanoparticles-loaded hydrogel nanocomposites of (PAm/CS)-AgNPs. Antifungal activity of (PAm/CS)-AgNPs hydrogel nanocomposites on viability of C. albicans was esitmated. Results displayed the efficient microbial inhibition activity of treatment against C. albicans compared to control. Furthermore, (PAm/CS)-AgNPs hydrogel nanocomposite against cervical cancer HeLa cell line was investigated. Cytotoxicity of (PAm/CS)-AgNPs hydrogel nanocomposites on prior cancer cell line empolyed to prohibition of cell growth assesssed by MTT test. HeLa cancer cell is treated by (PAm/CS)-AgNPs for 48 h exposed a potential apoptotic activity by noticeable up-regulation of p53 gene expression. Moreover, anticancer activity was investigated by down-regulation of platelet-based growth variable receptor beta (PDGFR-β), Bcl2, Cathepsine, and MMP-2 gene expression. antioxidant activity was investigated and results showed antioxidant activity of (PAm/CS) hydrogel and (PAm/CS)-AgNPs hydrogel nanocomposite are 87.8% and 62.9%, respectively

Catalytic para-xylene maximization. Part X: Toluene disproportionation on HF promoted H-ZSM-5 catalysts

H-ZSM-5 zeolite catalysts were doped with 2%, 3% and 4%HF to be used for investigating their activities and selectivities for xylenes production and for para-xylene maximization at temperatures of 300–500 °C via toluene disproportionation. This doping caused pore size modification of the H-ZSM-5 catalyst. The reaction was carried out in a fixed bed flow type reactor. The ratio of produced para-xylene relative to its thermodynamic composition reached as high as 3.29 at 300 °C on the 4%HF doped H-ZSM-5 catalyst although this catalyst possessed the lowest amount of the largest pores (3.0–5.7 nm) and the smallest pores (0.4–1.7 nm). The overall activities of the catalysts were decreased with an increase in HF doping because of diffusion restriction. The kinetics of the reaction were simply treated and found to give Ea and ΔS∗ values compatible with the characterization data of the catalysts

Nurses and Physicians Interprofessional Collaboration during COVID-19 Pandemic in a Maternity Outpatient Department: A Mixed Method Approach

Objective The investigators aim to conduct mixed-method research to explore the Interprofessional Collaboration or IPC experience of both nurses and doctors in Women’s Wellness and Research Center or WWRC during the COVID-19 Pandemic. The IPC in OPD has made novel and dramatic changes in order to continue its operations during the pandemic; thus, new adaptive strategies were implemented which are worth exploring in this research.  Design Sequential Mixed-Method Research Design.  Method Using the Jefferson Scale of Attitude toward Interprofessional Collaboration (JeffSATIC), a cross-sectional online survey was conducted. The instrument is applicable to all health professions and allows group comparisons in different professional specialties. The tool comprises 20 items across two factors including working relationship and accountability. Seventy-five nurses and 83 doctors made up the 158 respondents who were drawn from a tertiary maternity facility in Doha, Qatar. The team also conducted series of Focused Group Discussions using open-ended questions to gain more in-depth understanding about their experience. The SPSS Version 26 was used to examine the data that were exported from SurveyMonkey, and multiple regression analysis was used to identify the predictors. Thematic analysis was done for the qualitative data. Both findings from the statistical and thematic analyst were mixed to gain provide comprehensive description and insights about IPC. Results The results show the IPC mean score for physicians (M= 103.56) was higher than nurses (M=63.00) including matters on working relationship (M= 60.86) and accountability (M= 42.71). Comparably, the reported IPC mean score (M= 84.21) during pandemic was lower than data from Australia (M=114) and USA (M= 119) without pandemic. Moreover, both Clinical Experience and Educational Attainment are the significant predictors (p-value Conclusions The attitude of both nurses and doctors toward IPC during a pandemic is predicted by knowledge gained through training and education, and duration of clinical experience. The IPC strengthen their partnership as care providers despite of the challenges and new ways of delivering patient care. Based on the findings, strategic planning about enhancing knowledge, clinical skills, and strengthening partnerships with IPC towards better maternity care outcomes during pandemic is recommended.</p

Nurses and Physicians Interprofessional Collaboration during COVID-19 Pandemic in a Maternity Outpatient Department: A Mixed Method Approach

Objective The investigators aim to conduct mixed-method research to explore the Interprofessional Collaboration or IPC experience of both nurses and doctors in Women’s Wellness and Research Center or WWRC during the COVID-19 Pandemic. The IPC in OPD has made novel and dramatic changes in order to continue its operations during the pandemic; thus, new adaptive strategies were implemented which are worth exploring in this research.  Design Sequential Mixed-Method Research Design. Method: Using the Jefferson Scale of Attitude toward Interprofessional Collaboration (JeffSATIC), a cross-sectional online survey was conducted. The instrument is applicable to all health professions and allows group comparisons in different professional specialties. The tool comprises 20 items across two factors including working relationship and accountability. Seventy-five nurses and 83 doctors made up the 158 respondents who were drawn from a tertiary maternity facility in Doha, Qatar. The team also conducted series of Focused Group Discussions using open-ended questions to gain more in-depth understanding about their experience. The SPSS Version 26 was used to examine the data that were exported from SurveyMonkey, and multiple regression analysis was used to identify the predictors. Thematic analysis was done for the qualitative data. Both findings from the statistical and thematic analyst were mixed to gain provide comprehensive description and insights about IPC. Results The results show the IPC mean score for physicians (M= 103.56) was higher than nurses (M=63.00) including matters on working relationship (M= 60.86) and accountability (M= 42.71). Comparably, the reported IPC mean score (M= 84.21) during pandemic was lower than data from Australia (M=114) and USA (M= 119) without pandemic. Moreover, both Clinical Experience and Educational Attainment are the significant predictors (p-value Conclusions The attitude of both nurses and doctors toward IPC during a pandemic is predicted by knowledge gained through training and education, and duration of clinical experience. The IPC strengthen their partnership as care providers despite of the challenges and new ways of delivering patient care. Based on the findings, strategic planning about enhancing knowledge, clinical skills, and strengthening partnerships with IPC towards better maternity care outcomes during pandemic is recommended.</p

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Extensively Drug-Resistant Typhoid Fever in Pakistan

The spread of extensively drug-resistant typhoid should be an alarming sign that the world is slowly moving towards a pre-antibiotic era because of widespread overuse of antibiotics. This has become a serious concern in developing nations such as Pakistan, where antimicrobial surveillance is poor and in urgent need of strengthening. Both governmental and non-governmental organisations in Pakistan need to actively promote vaccination campaigns and healthy hygiene habits and discourage irrational use of antibiotics to prevent the mortality and morbidity associated with increasing antibiotic resistance in pathogens