Pan-resistant Acinetobacter infection in neonates in Karachi, Pakistan.

Background: Pan-resistant Acinetobacter infection has emerged as an important nosocomial pathogen in our inPatient neonates over the past few years. Methodology: We performed a retrospective chart review during a five-year period (July 2003 - June 2008) of all neonates hospitalized in our neonatal intensive care unit (NICU) who developed Acinetobacter infection to identify mortality-associated risk factors in Acinetobacter neonatal infection. Results: During the five-year study period, 122 cultures from 78 neonates grew Acinetobacter. Source sites of positive culture were in the following descending order: blood (n = 57), trachea (n = 55), tissue/wound/body fluids (n = 4), eye (n = 4), urine (n = 1), and cerebrospinal fluid (n = 1). Twenty-four (31%) Patients had Acinetobacter isolated from more than one site. At the time of admission the mean age was 2.08 +/- 4 days and mean weight was 1.77 +/- 0.88 kg, 75% were premature. Pan-resistance (87/122, sensitive only to Polymyxin) was present in 71% of Acinetobacter isolates. Crude mortality rate of this cohort was 47%, while 70% of Patients died within four days after positive Acinetobacter culture. We identified weight of less than 1 kg on admission (p 0.06, adjusted Odds Ratio (AOR) 1.53), gestational age 28 weeks or less (p 0.011, AOR 2.88), poor perfusion (p 0.007, AOR 2.4), thrombocytopenia (p 0.01, AOR 1.6) and metabolic acidosis (p 0.01, AOR 1.67) as predictors associated with poor outcome. Conclusion: Pan-resistant Acinetobacter infection is exceedingly fatal in newborns, particularly in premature and very low-birth weight neonates. Rational antibiotic use and vigilant infection control in NICUs are key to controlling multi-drug resistant Acinetobacter infection and improving clinical outcome

RSV associated hospitalizations in children in Karachi, Pakistan: Implications for vaccine prevention strategies

Major progress is being made in vaccines against Respiratory Syncytial Virus (RSV), with multiple vaccine candidates currently in the clinical phase of development. Making an investment case for public sector financing of RSV vaccine will require estimation of burden, cost-effectiveness, and impact. The aim of this study is to determine the proportion, age distribution and clinical spectrum of RSV associated hospitalizations in children in Karachi, Pakistan. A three years prospective study was conducted at the Aga Khan University Hospital in Karachi, a city of 20 million in south Pakistan, from August 2009 to June 2012. Children less than five years old admitted with acute respiratory infections (ARI) were enrolled. Throat swabs were collected and tested for RSV using real-time PCR. Multivariable log binomial regression analysis was performed to identify the associated factors of RSV infection. Out of 1150 children enrolled, RSV was detected among 223 (19%). Highest rate of RSV detection was in young infants less than 3 months of age (48/168, 29%), which accounted for 22% of all RSV detected. Most common diagnosis in RSV positive infants (age) was bronchiolitis followed by pneumonia, while in older children between the ages of one and 5 years of age, pneumonia and asthma were the most common diagnosis. Although identified year-round, RSV was most prevalent from August to October with peak in September, coinciding with the rainy season. This study identified RSV to be independently associated with younger age (P = 0.036), rainy season (P \u3c 0.001), post-tussive emesis (P = 0.008), intubation (P = 0.003), and discharge diagnosis of bronchiolitis (P = 0.004). Vaccines against RSV that target this age group are likely to yield remarkable benefit

Advantages of first-derivative reflectance spectroscopy in the VNIR-SWIR for the quantification of olivine and hematite

© 2020 Elsevier Ltd The focus of this paper is to study the application of the first order derivative method for the estimation of minerals rates in different mineral mixtures. The primary goal with this is to find robust spectral features of specific minerals that are not severely influenced by the spectral features of the other minerals in a mixture. Results were used to select appropriate spectral features to be applied for quantifying the minerals in upcoming studies. Mixtures of different terrestrial minerals equivalent to those dominating the Martian surface with a grain size \u3c0.25 ​mm were prepared and analyzed in the laboratory by reflectance spectroscopy in the VNIR-SWIR range. The first derivatives were computed and correlated with the mineral concentration at specific wavelengths using the Unscrambler X software. The results indicated the first derivatives near 2300 ​nm, that is a characteristic absorption feature of olivine rich in magnesium and iron silicate, correlate strongly to the olivine content for all the mixtures containing olivine, binary and ternary, with regression coefficients ranging between 0.93 and 0.98. Additionally, the main advantage of this work is that first derivative spectra of mixtures with different olivine ratio highlights in the overlapping regions of the spectra the wavelengths where the first derivative values correlate strongly to the amount of olivine in the mixtures. The region near 1050–1300 ​nm was identified as a promising one for hematite-olivine mixtures and 785–900 ​nm for magnetite olivine, with a regression coefficient mean of 0.97 and 0.98, respectively. The study of hematite-plagioclase mixtures demonstrates that wavelengths near 785–858 ​nm and 940–989 ​nm lying within the overlapping regions of hematite and plagioclase exhibit robust correlation to the hematite content with a regression coefficient mean of 0.98 for both areas

Administration of an intravenous perfluorocarbon contrast agent improves echocardiographic determination of left ventricular volumes and ejection fraction: comparison with cine magnetic resonance imaging

AbstractObjectives. The purpose of this study was to determine whether contrast-enhanced transthoracic echocardiography improves the evaluation of left ventricular (LV) volumes and ejection fraction (EF).Background. Echocardiographic assessment of LV volumes and EF is widely used but may be inaccurate when the endocardium is not completely visualized. Recently the intravenous (IV) administration of perfluorocarbon microbubbles has been shown to enhance opacification of the LV cavity, but the utility of these agents to improve the echocardiographic assessment of LV systolic function is unknown.Methods. In 40 subjects (29 men and 11 women, aged 24 to 81 years) an assessment of LV volumes and EF was performed with a magnetic resonance imaging examination, followed immediately by a transthoracic echocardiogram before and after the intravenous administration of 2% dodecafluoropentane emulsion (EchoGen; Sonus Pharmaceuticals, Bothell, Washington).Results. Contrast enhanced the echocardiographic assessment of LV end diastolic volume (p < 0.02), end systolic volume (p < 0.01) and LVEF (p < 0.03). The percentage of subjects in whom the correct echocardiographic classification EF was normal, mild to moderately depressed or severely reduced improved significantly after contrast enhancement (from 71% before contrast to 94% after, p < 0.03). These findings were most striking in the subjects with two or more adjacent endocardial segments not visualized at baseline.Conclusions. Administration of an intravenous contrast agent improves the ability to accurately assess LV volumes and EF in humans. Contrast enhancement is most useful in subjects with two or more adjacent endocardial segments not seen at baseline

Design of an integrated sub-6 ghz and mmwave mimo antenna for 5g handheld devices

The reported work demonstrates the design and realization of an integrated mid-band (sub-6 GHz) and mmWave multiple input, multiple output (MIMO) antenna for 5G handheld devices. The proposed prototype consists of the two-port MIMO configuration of the mid-band antenna placed at the top and bottom of the substrate, while the 4-port mmWave MIMO antenna is placed sideways. The MIMO configuration at the top and bottom consists of a two-element array to achieve high gain at the mid-band spectrum, while the antennas placed sideways are optimized to cover the 5G-mmWave band spectrum. The overall dimensions of the board were selected the same as the of smartphones, i.e., 151 mm x 72 mm. The mid-band antenna has an operational bandwidth of 2.73 GHz, whereas the mmWave antenna has an impedance bandwidth of 3.85 GHz with a peak gain of 5.29 and 8.57 dBi, respectively. Furthermore, the design is analyzed for the various MIMO performance parameters; it was found that the proposed antennas offer high performance in terms of envelop correlation coefficient (ECC), diversity gain (DG), mean effective gain (MEG) and channel capacity loss (CCL) within operational range. A fabricated prototype was tested and measured results show strong agreement with predicted results. Moreover, the proposed work is compared with state-of-the-art work for the same applications to demonstrate its potential for targeted application

Academic detailing in oral healthcare - results of the ADVOCATE Field Studies

Background: Academic detailing (AD) is a defined form of educational outreach that can be used to influence decision making and reduce unwarranted variation in healthcare delivery. This paper describes the results of the proof of concept phase of the ADVOCATE Field Studies. This study evaluated the feasibility, acceptability and usefulness of AD reinforced with feedback data, to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs). Methods: In the Field Studies, six groups of GDPs (n = 39) were recruited in The Netherlands, Germany and Denmark. Each group had four meetings reinforced with feedback data for open discussions on dental practice and healthcare delivery. Conventional and directed content analysis was used to analyze the qualitative data collected from focus group interviews, debriefing interviews, field notes and evaluation forms. Results: A total of nine themes were identified. Seven themes related to the process of the Field Studies and covered experiences, barriers and facilitators to AD group meetings, data collection and the use of an electronic dashboard for data presentation and storage. Two themes related to the outcomes of the study, describing how GDPs perceived they made changes to their clinical practice as a result of the Field Studies. Conclusions: The ADVOCATE Field Studies approach offers a novel way of collecting and providing feedback to care providers which has the potential to reduce variation oral healthcare delivery. AD plus feedback data is a useful, feasible approach which creates awareness and gives insight into care delivery processes. Some logistic and technical barriers to adoption were identified, which if resolved would further improve the approach and likely increase the acceptability amongst GDPs

The efficiency of natural plant extracts in improving storage stability, antioxidant activity, sensory evaluation, and physicochemical properties of date juice-based energy drink

Energy drinks (EDs) are a type of sweetened and non-alcoholic beverage with high content of caffeine. EDs were prepared from date juice enriched with different concentrations of ginger rhizomes extract, moringa leaf extract, and caffeine. Physicochemical properties (pH, TSS, and color parameters), total phenolic content (TPC), antioxidant activity, microbiological quality, and sensory characteristics were evaluated for freshly prepared EDs and during storage. The results showed that freshly prepared EDs from date juice and natural extracts revealed lower pH, higher TSS, and lower color parameters than the control. The inclusion of date juice and natural extracts improved the TPC, antioxidant activity, and microbiological quality of freshly prepared EDs. Storage studies exhibited that EDs containing date juice and natural extracts were more stable during storage in terms of all quality parameters estimated. However, the ED made from date juice, ginger extract, moringa extract, and caffeine was the best in terms of all parameters evaluated with higher stability during 3 months of storage at room temperature. In general, by date juice and natural plant extracts addition, a desirable ED can be prepared

Study of depression among patients with type 2 diabetes mellitus at a tertiary care hospital

Background: Diabetes and depression are two major issues related to community health. Diabetes patients frequently co-occur with depression. Diabetes patients frequently co-occur with depression, which calls for serious attention because delayed diagnosis and treatment can worsen the patients' complications. Assessing the prevalence of depression in diabetic patients and identifying the various factors associated with it were the objectives of this research study. Methods: In this study 70 adult patients suffering from type 2 DM participated in this 6-month prospective study. Sociodemographic data and clinical features of the participants were collected. The presence and severity of depressive symptoms in patients have been assessed by a PHQ9 questionnaire. Ethical approval was taken before the commencement of the study. SPSS (Version 20) was used for data analysis. Results: The majority of the patients were from 41-50 years of age group (32.9%) with a female predominance (58.6%), with no symptoms of depression before type 2 DM (92.9%). Most of them had primary education (32.9%) and majority were homemakers (44.3%) residing in urban are (65.7%) living joint family setup (68.6%). Most of them had 11 to 20 years of type 2 DM duration (745.8%) with a high family history of type 2 DM (75.7%). Majority of them were on Oral therapy (47.1%) with ophthalmic complications (32.9%). The majority of them had mild depression (5-9) i.e. 67.1%. Conclusions: Due to patient-specific diabetes management and inappropriate diabetes treatment, the majority of cases were found to have depressive disorders. This article focused on a few common factors and their relationships that lead to depression in people with diabetes

A comparative study between X-chromosome mapping of Sudanese and Egyptian Anopheles pharoensis theobald (Diptera: Culicidae) strains

Background: Current literature lacks information regarding Anopheles pharoensis malaria transmission patterns. Anopheles pharoensis succeeded in transmitting Malaria in Egypt. However, it was unsuccessful in doing the same in Sudan. From here arises these important questions: Why does it transmit malaria in Egypt but not in the Sudan or other Countries? Is it a Sibling species or a Sub-species? This investigation aimed to answer these questions by studying the genetics of Anopheles pharoensis collected from Egypt and Sudan.Methods: A comparative study was conducted in Egypt and Sudan to determine the population genetic structure of Anopheles pharoensis species based on chromosomal inversion of karyotypes. Fourth-stage larvae of Anopheles pharoensis were collected from Egypt (Faiyoum government) and from Sudan (Khartoum, Gezira and Sennar states).Result: Significant levels of differentiation were observed among the species studied.Conclusion: Investigations suggest that Anopheles pharoensis species collected from Egypt can transmit malaria due to the presence of an inversion in the X-chromosome. The lack of the aforementioned inversion probably prevented the transmission of malaria by Anopheles pharoensis in Sudan. The results above provide insight into malaria transmission patterns by Anopheles pharoensis. However, more needs to be done and hence it is recommended to undergo further research on genetics and morphological studies using molecular biological tool son Anopheles pharoensis in Sudan

Incidence and etiology of omphalitis in Pakistan: a community-based cohort study

Introduction: Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan. Methodology: Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing. Results: Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe, 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births, moderate-severe omphalitis 170.3 per 1000 live births, and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA), Streptococcus pyogenes 105 (18%), Group B beta-hemolytic streptococci 59 (10 %), Pseudomonas spp., 52 (8.9 %), Aeromonas spp. 19 (3.2%), and Klebsiella spp. 12 (2%). Conclusions: A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented