Excess body weight and age associated with the carriage of fluoroquinolone and third-generation cephalosporin resistance genes in commensal Escherichia coli from a cohort of urban Vietnamese children.

PURPOSE: Antimicrobial-resistant bacterial infections in low- and middle-income countries (LMICs) are a well-established global health issue. We aimed to assess the prevalence of and epidemiological factors associated with the carriage of ciprofloxacin- and ceftriaxone-resistant Escherichia coli and associated resistance genes in a cohort of 498 healthy children residing in urban Vietnam. METHODOLOGY: We cultured rectal swabs onto MacConkey agar supplemented with resistant concentrations of ciprofloxacin and ceftriaxone. Additionally, we screened meta-E. coli populations by conventional PCR to detect plasmid-mediated quinolone resistance (PMQR)- and extended-spectrum β-lactamase (ESBL)-encoding genes. We measured the associations between phenotypic/genotypic resistance and demographic characteristics using logistic regression.Results/Key findings. Ciprofloxacin- and ceftriaxone-resistant E. coli were cultured from the faecal samples of 67.7 % (337/498) and 80.3 % (400/498) of children, respectively. The prevalence of any associated resistance marker in the individual samples was 86.7 % (432/498) for PMQR genes and 90.6 % (451/498) for β-lactamase genes. Overweight children were significantly more likely to carry qnr genes than children with lower weight-for-height z-scores [odds ratios (OR): 1.24; 95 % confidence interval (CI): 10.5-1.48 for each unit increase in weight for height; P=0.01]. Additionally, younger children were significantly more likely to carry ESBL CTX-M genes than older children (OR: 0.97, 95 % CI: 0.94-0.99 for each additional year, P=0.01). CONCLUSION: The carriage of genotypic and phenotypic antimicrobial resistance is highly prevalent among E. coli in healthy children in the community in Vietnam. Future investigations on the carriage of antimicrobial resistant organisms in LMICs should focus on the progression of carriage from birth and structure of the microbiome in obesity

Spatiotemporal evolution of SARS-CoV-2 Alpha and Delta variants during large nationwide outbreak of COVID-19, Vietnam, 2021

We analyzed 1,303 SARS-CoV-2 whole-genome sequences from Vietnam, and found the Alpha and Delta variants were responsible for a large nationwide outbreak of COVID-19 in 2021. The Delta variant was confined to the AY.57 lineage and caused >1.7 million infections and >32,000 deaths. Viral transmission was strongly affected by nonpharmaceutical interventions

Optimization of Minimum Quantity Lubricant Conditions and Cutting Parameters in Hard Milling of AISI H13 Steel

As a successful solution applied to hard machining, the minimum quantity lubricant (MQL) has already been established as an alternative to flood coolant processing. The optimization of MQL parameters and cutting parameters under MQL condition are essential and pressing. The study was divided into two parts. In the first part of this study, the Taguchi method was applied to find the optimal values of MQL condition in the hard milling of AISI H13 with consideration of reduced surface roughness. The L9 orthogonal array, the signal-to-noise (S/N) ratio and analysis of variance (ANOVA) were employed to analyze the effect of the performance characteristics of MQL parameters (i.e., cutting fluid type, pressure, and fluid flow) on good surface finish. In the results section, lubricant and pressure of MQL condition are determined to be the most influential factors which give a statistically significant effect on machined surfaces. A verifiable experiment was conducted to demonstrate the reliability of the results. In the second section, the optimized MQL parameters were applied in a series of experiments to find out cutting parameters of hard milling. The Taguchi method was also used to optimize the cutting parameters in order to obtain the best surface roughness. The design of the experiment (DOE) was implemented by using the L27 orthogonal array. Based on an analysis of the signal-to-noise response and ANOVA, the optimal values of cutting parameters (i.e., cutting speed, feed rate, depth-of-cut and hardness of workpiece) were introduced. The results of the present work indicate feed rate is the factor having the most effect on surface roughness

Study on the Fatigue Strength of Welding Line in Injection Molding Products under Different Tensile Conditions

The fatigue performance of polypropylene (PP) at various amplitudes and frequencies on fatigue cycles under tensile test conditions is investigated in this study. The results show that increasing the frequency leads to a decrease in fatigue cycles due to increased cycle time. The decline rate can be divided into two stages, between 1 and 5 Hz. The first stage rapidly decreases fatigue performance as the frequency increases from 1 Hz to 2 Hz or 3 Hz. The second stage has a lower reduction rate, which occurs between 2 Hz or 3 Hz and 5 Hz due to the strengthening effect of increasing frequency. Furthermore, increasing the amplitude from 0.1 mm to 0.4 mm reduces the fatigue cycle due to the higher deformation rate. In summary, expanding both amplitude and frequency reduces the fatigue performance of the PP material. Moreover, according to the scanning electron microscope microstructure, increasing the frequency results in more microcracks in the polymer matrix

Optimization of Dressing Parameters for Minimum Surface Roughness and Maximum Material Removal Rate in Internal Grinding of SKD11 Tool Steel

This paper introduces a study on multi-objective optimization of dressing parameters in internal grinding of SKD 11 tool steel using Grey based Taguchi method. The L27 orthogonal array of the Taguchi method was selected to design the experiments. The input parameters of the dressing process are the depth of fine, the time of fine dressing, the depth of coarse dressing, the time of coarse dressing, non-feeding dressing, and dressing feed rate. The output factors are surface roughness (SR) and material removal rate (MRR). A grey relation grade was determined by using the signal-to-noise ratio. The ANOVA was applied to find out the effect of input factors on the grey relation grade. In conclusion, the fine dressing times is the parameter that has the strongest impact on multiple performance characteristics, followed by the coarse dressing times. Also, the optimum dressing parameters to get minimum SR and maximum MRR is the depth of coarse dressing of 0.03mm, the time of coarse dressing of 2 times, the depth of fine dressing of 0.01 mm, the time of fine dressing of 2 times, non-feeding dressing of 2 times, and dressing feed rate of 1.2mm/min

Timing of initiation of antiretroviral therapy in human immunodeficiency virus (HIV)--associated tuberculous meningitis

The optimal time to initiate antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-associated tuberculous meningitis is unknown. We conducted a randomized, double-blind, placebo-controlled trial of immediate versus deferred ART in patients with HIV-associated tuberculous meningitis to determine whether immediate ART reduced the risk of death. Antiretroviral drugs (zidovudine, lamivudine, and efavirenz) were started either at study entry or 2 months after randomization. All patients were treated with standard antituberculosis treatment, adjunctive dexamethasone, and prophylactic co-trimoxazole and were followed up for 12 months. We conducted intention-to-treat, per-protocol, and prespecified subgroup analyses. A total of 253 patients were randomized, 127 in the immediate ART group and 126 in the deferred ART group; 76 and 70 patients died within 9 months in the immediate and deferred ART groups, respectively. Immediate ART was not significantly associated with 9-month mortality (hazard ratio [HR], 1.12; 95% confidence interval [CI], .81-1.55; P = .50) or the time to new AIDS events or death (HR, 1.16; 95% CI, .87-1.55; P = .31). The percentage of patients with severe (grade 3 or 4) adverse events was high in both arms (90% in the immediate ART group and 89% in the deferred ART group; P = .84), but there were significantly more grade 4 adverse events in the immediate ART arm (102 in the immediate ART group vs 87 in the deferred ART group; P = .04). Immediate ART initiation does not improve outcome in patients presenting with HIV-associated tuberculous meningitis. There were significantly more grade 4 adverse events in the immediate ART arm, supporting delayed initiation of ART in HIV-associated tuberculous meningitis. Clinical Trials Registration. ISRCTN6365909

No Clinical Benefit of Empirical Antimicrobial Therapy for Pediatric Diarrhea in a High-Usage, High-Resistance Setting

BACKGROUND: Pediatric diarrheal disease presents a major public health burden in low- to middle-income countries. The clinical benefits of empirical antimicrobial treatment for diarrhea are unclear in settings that lack reliable diagnostics and have high antimicrobial resistance (AMR). METHODS: We conducted a prospective multicenter cross-sectional study of pediatric patients hospitalized with diarrhea containing blood and/or mucus in Ho Chi Minh City, Vietnam. Clinical parameters, including disease outcome and treatment, were measured. Shigella, nontyphoidal Salmonella (NTS), and Campylobacter were isolated from fecal samples, and their antimicrobial susceptibility profiles were determined. Statistical analyses, comprising log-rank tests and accelerated failure time models, were performed to assess the effect of antimicrobials on disease outcome. RESULTS: Among 3166 recruited participants (median age 10 months; interquartile range, 6.5-16.7 months), one-third (1096 of 3166) had bloody diarrhea, and 25% (793 of 3166) were culture positive for Shigella, NTS, or Campylobacter. More than 85% of patients (2697 of 3166) were treated with antimicrobials; fluoroquinolones were the most commonly administered antimicrobials. AMR was highly prevalent among the isolated bacteria, including resistance against fluoroquinolones and third-generation cephalosporins. Antimicrobial treatment and multidrug resistance status of the infecting pathogens were found to have no significant effect on outcome. Antimicrobial treatment was significantly associated with an increase in the duration of hospitalization with particular groups of diarrheal diseases. CONCLUSIONS: In a setting with high antimicrobial usage and high AMR, our results imply a lack of clinical benefit for treating diarrhea with antimicrobials; adequately powered randomized controlled trials are required to assess the role of antimicrobials for diarrhea