46,163 research outputs found

    Current Trends in Antimicrobial Resistance Patterns in Bacterial Pathogens among Adult and Pediatric Patients in the Intensive Care Unit in a Tertiary Care Hospital in Kolkata, India

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    Nosocomial infections by multidrug-resistant (MDR) bacteria are among the main causes of morbidity and death in patients hospitalized in intensive care units (ICUs) worldwide. Antibiotic resistance has become a major concern for treating the patients with nosocomial infections. The aim of this study was to describe the antibiotic resistance patterns of pathogens causing infections in adult and pediatric patients in the ICUs of a tertiary care hospital in Kolkata, India. A cross-sectional, retrospective study was conducted from January 2022 to October 2022 on a total of 139 adult and 146 pediatric patients. Depending on clinical symptoms of the patients, samples were collected and subjected to antibiotic sensitivity testing. The culture and sensitivity pattern of clinical isolates from blood, urine, sputum, endotracheal tube (ET) aspirate, and central line catheter insertion site swabs were analyzed. A total of 695 and 556 specimens were obtained from adult and pediatric ICU, respectively. Culture positivity rate among adults and pediatric patients were 37% and 40%, respectively. The most commonly isolated organisms were Gram-negative Enterobacterales and non-fermenters. Most of the bacterial isolates showed very high resistance against multiple antibiotics. Escherichia coli from adult and pediatricpatients were found to be resistant to second generation cephalosporins (95% and 96%, respectively), beta-lactams (95% and 63%, respectively), fluoroquinolones (95% and 81%, respectively), and cotrimoxazole (85% and 78%, respectively). Klebsiella spp. from adult patients were found to be resistant to aminoglycosides (75%), second generation cephalosporins (100%), beta-lactams (94%), fluoroquinolones (92%), carbapenems (88%), and cotrimoxazole (83%). Proteus spp., Acinetobacter baumannii, and Pseudomonas spp. werefound to be resistant to multiple antibiotics. Enterococcus spp. from ICUs showed more than 90% resistance against ampicillin and more than 75% resistance against fluoroquinolones. MDR bacterial infections are increasing in both adult and pediatric ICUs, leading to significant therapeutic challenges. A frequent study of antimicrobial resistance patterns is imperative for antibiotic stewardshipin combatting the deadly effect of the MDR bacteria in critically ill patients

    Extended spectrum beta lactamase (ESBL)-producing <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> in Indonesia and South East Asian countries: GLASS Data 2018

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    Antimicrobial resistance is the rising global health issue that should not be ignored. This problem needs to be addressed and professionally handled since it is starting to threaten global health, which eventually could lead to disaster. Extended spectrum beta lactamase (ESBL)-producing bacteria were found threatening lives, since most antibiotics were found to not be effective in treating patients with infections caused by those bacteria. ESBL-producing Escherichia coli and Klebsiella pneumoniae are the two most reported bacteria in causing the bacteremia and nosocomial infections worldwide. In this article, the prevalence of ESBL-producing E. coli and K. pneumoniae in causing blood stream and urinary tract infections in Indonesia were compared to the neighboring countries based on the global antimicrobial resistance surveillance system performed worldwide by World Health Organization (WHO). In this article, the prevalence of ESBL-producing E. coli and K. pneumoniae in Indonesia and its neighboring countries were assayed and compared in order to evaluate the antimicrobial resistances. By comparing the prevalence data to the neighboring countries, some insightful evidence and information was served to support improved health in Indonesia. Some hurdles and strategies in combating the antimicrobial resistances were further discussed. Eventually, an alternate solution to overcome the antimicrobial drug resistance should be well-provided, studied and implemented globally

    Pulmonary tuberculosis risks and challenges

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    Pulmonary Tuberculosis (PTB) is an airborne bacterial infection that can be deadly if not treated. PTB is most common in developing countries, ecologically problematic, where it kills about 1 million people each year. Pulmonary tuberculosis is a dreaded disease that can have a devastating impact on its victims. Tuberculosis is a serious respiratory infection caused by the bacterium Mycobacterium tuberculosis. It commonly affects the lungs but can also affect other parts of the body, such as the kidney, spine and brain. This review article discusses the PTB risks and challenges word wide. The global burden of TB remains high, with approximately one-third of the world's population being infected with the bacterium. Overall, more needs to be done to improve the management of TB worldwide in order to ensure that no person is left to suffer from the devastating effects of this disease

    Implementation of asthma herbal medicine as complementary or alternative treatment in chronic obstructive pulmonary disease

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    Asthma and chronic obstructive pulmonary disease (COPD) are extremely common non-communicable diseases (NCD) worldwide and require treatment to improve the quality of life of patients. There are currently multiple therapies for each condition, however, there are considerable side effects, issues with long term use, and co-morbidities. Safe, effective, and accessible novel complementary or alternative therapies are required for people worldwide. Herbal medicine constitutes the foundation of modern medicine and is used as complementary, or primary treatment in various parts of the world. Furthermore, it generally has a positive response from the population as it is often associated with fewer side effects and higher accessibility while providing considerable efficacy. Exploration of herbal extracts as complementary and/or alternative medicine in asthma and COPD may allow for development of novel, safe, and effective therapies accessible to a wide range of people worldwide. The objective of this thesis is to provide an understanding of the efficacy and safety of herbal derivatives that are suggested for use in asthma such as flavonoids, polyphenols, and boswellia as potential treatment in COPD as these conditions present similarly and share elements in their inflammatory cascade

    sj-docx-1-tar-10.1177_17534666231162244 – Supplemental material for A prospective study on the long-term storage of sputum and the recovery of nontuberculous mycobacteria

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    Supplemental material, sj-docx-1-tar-10.1177_17534666231162244 for A prospective study on the long-term storage of sputum and the recovery of nontuberculous mycobacteria by Byoung Soo Kwon, Jeong Su Park, Jung-A Shin, Eun Sun Kim, Sung Yoon Lim, Myung Jin Song, Yeon-Wook Kim, Hyung-Jun Kim, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho, Ho Yoon, Choon-Taek Lee and Jae Ho Lee in Therapeutic Advances in Respiratory Disease</p

    Studio Longitudinale dei volumi statici polmonari nella Discinesia Ciliare Primaria: valutazione di una casistica della Clinica Pediatrica negli ultimi dieci anni

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    La discinesia ciliare primaria (DCP) è una malattia rara, geneticamente eterogenea, abitualmente trasmessa con modalità autosomica recessiva, ma occasionalmente X-linked, caratterizzata da una alterazione del movimento delle ciglia dell’epitelio respiratorio. La compromissione del trasporto muco-ciliare favorisce infezioni batteriche ricorrenti e croniche delle vie aeree, che possono causare danni permanenti a carico dei bronchi e del parenchima polmonare, con un progressivo declino della funzione respiratoria. Tuttavia, è presente una considerevole variabilità nella gravità e progressione della patologia respiratoria ed emergono nuove correlazioni tra il genotipo ed il fenotipo della malattia. Pochi studi hanno correlato l’evoluzione a lungo termine della spirometria al difetto ultrastrutturale o al genotipo che sono alla base della DCP. Nessun studio ha, invece, mai valutato longitudinalmente i volumi polmonari statici, che potrebbero essere un indice più sensibile della compromissione delle vie aeree periferiche. Solo due studi cross-sectional hanno dimostrato in questa malattia la presenza di un incremento della capacità funzionale residua (FRC), del volume residuo (RV) e del rapporto RV/capacità polmonare totale (TLC) e uno soltanto documenta l’associazione tra RV ed infezione da Pseudomonas aeruginosa (P.a.). Anche la nutrizione e l’accrescimento potrebbero essere alterati, dato che sono stati fortemente associati alla funzione respiratoria. Lo scopo di questo studio era, pertanto, di valutare l’evoluzione correlata all’età dei volumi polmonari statici ed identificare la loro associazione con i difetti ultrastrutturali e le mutazioni genetiche responsabili della DCP. Volevamo, inoltre, valutare la relazione di tali parametri con l’indice di massa corporea (BMI) e con il cambiamento nella prevalenza delle infezioni batteriche delle vie aeree, in particolare di quelle sostenute da P.a., allo scopo di ampliare la conoscenza delle correlazioni genotipo-fenotipo. Per poter essere inclusi nello studio i pazienti, presentando una storia clinica compatibile, dovevano aver ricevuto la diagnosi di DCP dopo essere stati sottoposti ad esami ultrastrutturali e/o funzionali delle ciglia dell’epitelio respiratorio, alla ciliogenesi in coltura, alla misurazione dell’ossido nitrico nasale e/o della ricerca di mutazioni bialleliche a carico di uno dei geni responsabili della malattia. Inoltre, venivano inclusi nello studio tutti i pazienti afferenti all’U.O. Pediatria dell’Azienda Ospedaliero-Universitaria Pisana per 2 volte all’anno negli ultimi 10 anni, in grado di eseguire correttamente l’esame pletismografico. Il muco espettorato o raccolto mediante aspirazione faringea nei non collaboranti era utilizzato per le indagini microbiologiche. Nella elaborazione statistica, per valutare l’associazione tra morfologia ciliare, mutazioni genetiche e caratteristiche cliniche venivano utilizzati modelli lineari ad effetti misti. Venivano arruolati nello studio 118 pazienti di età ≥ 5 anni, che avevano eseguito complessivamente 1096 visite, in media 9 per paziente, nel corso di un follow-up medio di 5 anni. All’arruolamento, quasi tutti i parametri spirometrici e, specialmente negli adulti, anche pletismografici erano significativamente peggiori nei pazienti con assenza dei bracci interni di dineina, difetti dell’apparato centrale e disorganizzazione microtubulare (IDA/CA/MTD) rispetto ai pazienti con Normale Microscopia Elettronica (EM). Il trend medio di incremento nel tempo per RV era significativamente più elevato nei pazienti con IDA/CA/MTD rispetto a quelli con difetto dei bracci esterni di dineina (ODA) e con Normale EM (p=0.021 e p=0.022, rispettivamente). Il trend medio di RV/capacità polmonare totale (TLC) nel gruppo di pazienti con IDA/CA/MTD era significativamente peggiore che in tutti gli altri gruppi. L’incremento maggiore dei volumi polmonari veniva osservato nel gruppo con mutazioni bialleliche nel gene CCDC39 & CCDC40, mentre si rilevava un minore incremento dell’iperinsufflazione nei gruppi con mutazioni nei geni DNAH5 e DNAH11. Si registrava, inoltre, un aumento più ripido del RV/TLC nei pazienti con infezione da P.a. rispetto a quelli con altre infezioni batteriche (p=0.007), o senza infezione (p=0.003). Infine, non si osservava alcuna associazione statisticamente significativa tra variazioni dei volumi statici polmonari e BMI. Pertanto, con questo studio abbiamo confermato in maniera robusta la peggiore prognosi per alcuni difetti genetici ed ultrastrutturali (CCDC39 & CCDC40 o IDA/CA/MTD) rispetto ad altri (DNAH5 e DNAH11 o ODA e Normale EM), la cui associazione con una maggiore compromissione della funzione respiratoria finora si basava esclusivamente sulla spirometria. La valutazione dei volumi polmonari dovrebbe essere, quindi, sempre associata alla spirometria nel management clinico dei pazienti con DCP collaboranti. Primary ciliary dyskinesia (PCD) is a genetically heterogeneous, usually autosomal recessive, but occasionally X-linked, disorder, characterized by dysfunction of motile cilia. Impaired mucociliary clearance results in recurrent and chronic bacterial infection of the airways, eventually causing permanent bronchial and parenchymal damage, with progressive decline in lung function. However, there is considerable variability in the severity and progression of lung disease, and new genotype-phenotype relationships are emerging. A few studies have related long-term evolution of spirometry to the underlying ultrastructural defect or genotype. No longitudinal study has evaluated static lung volumes in PCD, which may be a more sensitive index of distal airway disease. A few cross-sectional studies demonstrated hyperinflation, with an increase in functional residual capacity (FRC), residual volume (RV) and RV/total lung capacity (TLC) ratio, in one study, worse hyperinflation was associated with Pseudomonas aeruginosa (P.a.) infection. Furthermore, both growth and nutrition are adversely affected in PCD patients and are both strongly associated with lung function. The aim of this study was to investigate the age-related evolution of static lung volumes and identify their association with ultrastructural defects, and individual gene mutations in a large cohort of adult and paediatric PCD patients. We also assessed the relationships of these parameters with body mass index (BMI) and the change in prevalence of bacterial airway infections, especially P.a., in order further to extend our knowledge of genotype-phenotype correlations. Participants had a confirmed diagnosis of PCD, based on ultrastructural and/or functional ciliary abnormalities, in vitro ciliogenesis and/or biallelic PCD disease-causing mutations, and nasal NO combined with compatible clinical features. Study visits occurred twice a year for up to 10 years. The current analysis was limited to patients who were able successfully to perform plethysmography. Expectorated sputum or pharyngeal aspirates were collected for microbiological analysis, as appropriate. Linear mixed effects models were used to assess associations between ciliary morphology, genetic mutations, and clinical features. One hundred and eighteen PCD patients, aged ≥ 5 years, met the inclusion criteria and were enrolled in the study. There were 1096 study visits, mean 9 per patient. Mean (range) followup was 5 years. At enrolment, almost all spirometric and, especially in adults, plethysmographic parameters were significantly worse in absent inner dynein arms, central apparatus defects, and microtubular disorganization (IDA/CA/MTD) compared with Normal Electron Microscopy (EM) patients. Mean trend increase with time for residual volume (RV) was significantly higher in IDA/CA/MTD compared to outer dynein arms (ODA) defect (p=0.021) and Normal EM (p=0.022) groups. Mean trend of RV/total lung capacity (TLC) in IDA/CA/MTD was significantly worse than in all other groups. The steepest rise in lung volumes was in CCDC39/CCDC40, while hyperinflation increased less in DNAH5 and DNAH11 groups. RV/TLC showed a significantly steeper rise in patients with Pseudomonas aeruginosa compared to other infections (p=0.007), or without infection (p=0.003). Therefore, PCD patients with IDA/CA/MTD defects or CCDC39/CCDC40 mutations had the greatest increase in hyperinflation, while those with ODA defect and Normal EM or DNAH11 and DNAH5 mutations had less severe changes. We have robustly confirmed the worse prognosis for some genetic and ultrastructural defects, which association hitherto rested solely on spirometry. Lung volumes evaluation should be always associated with spirometry in clinical management of collaborating PCD patients

    Competencies of Indian Medical Graduates in delivering Effective Tuberculosis care: A mixed method study among doctors at Chennai, India

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    Background: In spite of the various advances in the Tuberculosis (TB) management system in our country, we are still struggling to achieve the End TB strategy. Addressing the health provider difficulties in TB care will definitely be potential tool to control TB. Objective: To assess the competency, challenges and solutions of Indian medical graduates to provide effective Tuberculosis care. Method: It is a mixed methodological study conducted among the Bachelor of Medicine and Bachelor of Surgery (MBBS) graduates practising in various parts of Chennai, Tamil Nadu, India. The competency of the Indian medical graduates in delivering TB care was assessed using a content validated e-survey questionnaire disseminated through social media affinity groups andfree listing;pile sorting and in-depth interview was done in the qualitative part. Results:The proportion of participants having good, fair and poor competency in providing effective TB care was 35%,19% and 46%, respectively. Various challenges in attaining good competency were enlisted by the participants through free listing, a smaller number of TB patients in private medical college has attained the highest Smith S value followed by other eleven challenges. Based on the pile sorting and in-depth interview various solutions have been suggested, with most of them emphasizing on compulsory TB chest clinic posting followed by others measures. Conclusion:The major reason identified in difficulties in delivering TB care was inadequate exposure in managing TB patients, incomplete knowledge on notification,referral and followup system. These lacunae can be overturned by compulsory posting in TB clinics during internship period, provision of required personal protective equipment (PPE) for doctors and patients in TB wards and outpatient department, mandatoryteaching on updates of TB management

    Mycobacterium infection secondary to exogenous lipoid pneumonia caused by nasal drops: a case report and literature review

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    Abstract Background Exogenous lipoid pneumonia (ELP) is a rare disease and its diagnosis is often mistaken or delayed. Secondary infection with rapidly growing non-tuberculous mycobacteria is a rare complication of lipoid pneumonia. Case presentation A 38-year-old man presented with fever, cough, sputum, chest tightness, and shortness of breath. He had a 2-year history of allergic rhinitis and used liquid paraffin-containing menthol nasal drops daily. A chest CT scan showed multiple patchy ground glass opacities with blurred borders in both lungs, which were located in the inner pulmonary field and distributed along the bronchi. His ambient air PO2 was 63 mmHg. The patient was diagnosed with ELP by CT-guided lung biopsy. The nasal drops were discontinued, and systemic glucocorticoids were administered. During treatment, the pulmonary lesions deteriorated, and bronchoalveolar lavage was performed during bronchoscopy. Additionally, Mycobacterium abscessus was detected in the lavage fluid. Upon detection of a secondary M. abscessus infection, glucocorticoids were gradually discontinued, and anti-M. abscessus treatment was implemented. The patient’s symptoms rapidly ameliorated. After 11 months of anti-M. abscessus treatment, a repeat CT scan showed clear regression of the lung lesions. Conclusion Routine microbiological examination of samples, including sputum or alveolar lavage fluid, is necessary for patients with diagnosed or suspected ELP
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