Antimicrobial resistance in bacteria causing ventilator-associated pneumonia in a tertiary care hospital: one year prospective study

Background: Ventilator-associated pneumonia (VAP) is the most common infection diagnosed in intensive care units (ICUs). The causative organisms of VAP vary among different populations and are increasingly associated with resistance against various antimicrobial agents. Objective of current study was to determine the bacteriological etiology of VAP, antimicrobial susceptibility pattern of the isolates and detect the presence of extended-spectrum b-lactamases (ESBL), metallo β-lactamases (MBL) and AmpC b-lactamases in multidrug resistant isolates causing VAP in the medical ICU.Methods: A prospective study was carried out over a year to know the various etiological agents of VAP and their drug susceptibility patterns. ESBL, MBL and AmpC b-lactamases were detected in various isolates by combination disk method, imipenem-EDTA combined disk method and AmpC disk method respectively.Results: The majority of bacterial isolates causing VAP were found to be gram negative bacilli. Acinetobacter spp accounted for 34.28% of VAP cases followed by Pseudomonas aeruginosa which was responsible for 25.71% cases. Other gram negative bacilli isolated were Klebsiella pneumoniae, Citrobacter freundii, Enterobacter spp, and Escherichia coli. Out of the total 70 isolates, 67 (95.7%) were multidrug resistant and not even a single isolate was sensitive to all the drugs tested.Conclusions: Most of the pathogens causing VAP in our institute were multidrug resistant and in many isolates this resistance was due to production of ESBL, MBL, and AmpC β-latamases. Polymixin-B and colistin were found to be highly effective against multidrug resistant Acinetobacter spp and P. aeruginosa.

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M>70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0<e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

Silicosis with bilateral spontaneous pneumothorax

Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax.The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature

Assessment of Allergenicity to Fungal Allergens of Rohtak City, Haryana, India

Fungal spores are known as one of the important bioparticles causing allergic manifestation in human beings. Hence, knowledge of season and prevalence of the airborne allergens to which the patients are exposed is a prerequisite for proper diagnosis and treatment of allergic disorders in hypersensitive individuals. Keeping this in view, aerial survey was performed in the atmosphere of Rohtak city for 2 consecutive years (March 2008-February 2010), using a volumetric petri plate sampler. A total of 45 fungal spore types were recorded during the survey period. In the present study, February-April and July-November were identified as the peak seasons for Rohtak city. Cladosporium was the main contributor to the total fungal load with 25.14% followed by Alternaria (18.05%), Aspergillus niger (7.66%), Curvularia (5.31%), and Epicoccum (5.29%). Fifteen dominant viable fungal spore types were represented in the form of a fungal calendar. An attempt has also been made to assess the allergenicity of some of the fungal types recorded from the atmosphere of Rohtak city. The magnitude of variations observed in markedly positive skin reactions (2+ and above) varied from 17.3 to 2.3%. Penicillium oxalicum showed a markedly positive reaction in maximum number of patients (26; 17.3%) followed by Rhizopus nigricans (23; 15.3%). ELISA was performed with the sera of patients showing markedly positive skin reactions and the sera were classified into four groups based on percent binding. The majority of the sera showed 0–15% binding to different antigenic extracts, while sera showing >60% binding were least in number. Greater than 30% binding was observed against antigens of Rhizopus nigricans, Epicoccum purpurascens, Penicillium oxalicum, Curvularia lunata, Aspergillus flavus, Candida albicans and Neurospora sitophila. The concordance between positive skin reaction and serum-specific IgE antibodies ranged from 16.7 to 69.2%

Silicosis with bilateral spontaneous pneumothorax

Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax. The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature

Rationale Based Selection and Prioritization of Antiviral Drugs for COVID-19 Management

Infection with SARS-CoV-2 has resulted in COVID-19 pandemic and infected more than 5million individuals with around 0.35 million deaths worldwide till May 2020 end. Severalefforts are on in search of therapeutic interventions, but the preferred way is drugrepurposing due to the feasibility and urgency of the situation. To select and prioritizeapproved antiviral drugs and drug combinations for COVID-19, 61 antiviral drugs havingproven safety profile in humans were subjected to virtual screening for binding to threeselect targets namely human angiotensin-converting enzyme receptor-2 receptor-bindingdomain (hACE-2) involved in virus entry, SARS-CoV-2 RNA dependent RNA polymerase(RdRp) responsible for viral RNA replication and SARS-CoV-2 main protease (MPro) causingproteolytic processing of viral polyprotein slab. Targeting multiple ‘disease pathogenesisspecific proteins’ within a close network of interaction or having dependent functionality canprovide effective intervention. Ledipasvir, Daclatasvir, Elbasvir, Paritaprevir, Rilpivirine andIndinavir were identified as candidate drugs of interest for COVID-19 based on a derivedcombined activity score, pharmacokinetic and pharmacodynamic parameters. Ledipasvir andDaclatasvir and their approved marketed combination with Sofosbuvir emerged as leadingcandidate drugs/drug combinations for SARS-CoV-2. These candidates have the potentialfor the antiviral activity for SARS-CoV-2 infection better than the investigational drugRemdesivir and other antiviral drugs/drug combinations being evaluated. Thesedrugs/combinations merit systematic fast track preclinical and clinical evaluation for COVID-19 management. The present work brings back attention to the potential usefulness ofapproved antiviral drugs/drug combinations, commonly available with established safetyprofile, currently not in focus for COVID-19. It provides a rationale based approach for theselection of drugs with potential antiviral activity against SARS-CoV-2 highlighting thedesired properties.</div