Genetic Basis and Diagnostics of Extended-Spectrum Beta-Lactamases among Enterobacteriaceae in Finland

Since the introduction of antibiotic agents, the amount and prevalence of Beta-lactam resistant enterobacteria has become an increasing problem. Many enterobacteria are opportunistic pathogens that easily acquire resistance mechanisms and genes, which make the situation menacing. These bacteria have acquired resistance and can hydrolyse extended spectrum cephalosporins and penicillins by producing enzymes called extended-spectrum Beta-lactamases (ESBLs). ESBL-producing bacteria are most commonly found in the gastro-intestinal tract of colonised patients. These resistant strains can be found in both health-care associated and community-acquired isolates. The detection and treatment of infections caused by bacteria producing ESBLs are problematic. This study investigated the genetic basis of extended-spectrum Beta-lactamases in Enterobacteriaceae, especially in Escherichia coli and Klebsiella pneumoniae isolates. A total of 994 Finnish Enterobacteriaceae strains, collected at 26 hospital laboratories, during 2000 and 2007 were analysed. For the genetic basis studies, PCR, sequencing and pyrosequencing methods were optimised. In addition, international standard methods, the agar dilution and disk diffusion methods were performed for the resistance studies, and the susceptibility of these strains was tested for antimicrobial agents that are used for treating patients. The genetic analysis showed that blaCTX-M was the most prevalent gene among the E. coli isolates, while blaSHV-12 was the most common Beta-lactamase gene in K. pneumoniae. The susceptibility testing results showed that about 60% of the strains were multidrug resistant. The prevalence of ESBL-producing isolates in Finland has been increasing since 2000. However, the situation in Finland is still much better than in many other European countries.Siirretty Doriast

A comparison of factors affecting Estonian EFL learners’ idiom comprehension

The article discusses a study examining the facilitating effect that analysability (i.e. the degree of transparency) and similarity between English and Estonian equivalents have on Estonian EFL learners’ idiom comprehension. A group of (pre)adolescent L1 Estonian learners of English performed an idiom comprehension test, which consisted of idioms categorised into five groups on the basis of the degree of transparency (i.e. the degree to which their idiomatic meaning is inferable from the literal meanings of their constituents or from their figurativeness) and the degree of similarity to their Estonian equivalents. The results revealed that both transparency (in the form of a constituent to be taken literally) and identical L1 idioms facilitate EFL idiom comprehension nearly to the same degree, while the effect of semi-transparency (that is, figurativeness) seems to be clearly lower. However, opaque idioms with partially similar L1 equivalents appear to be even somewhat more difficult than opaque idioms without any L1–L2 similarity. *** "Inglise keele kui võõrkeele idioomide mõistmist hõlbustavatest teguritest" Artikkel analüüsib uurimust, mis võrdles kahte inglise keele kui võõrkeele idioomidest arusaamist hõlbustavat tegurit: esiteks sõnasõnalistel elementidel ja figuratiivsusel põhineva analüüsitavuse mõju ja teiseks inglise idioomidega sarnaste ja identsete eesti keele kui emakeele idioomide mõju. Rühm Eesti põhikooli kuuenda klassi õpilasi sooritas idioomidest arusaamise testi, milles idioomid olid liigitatud viide erinevasse kategooriasse: 1) läbipaistmatud idioomid, millel on identne eestikeelne vaste; 2) läbipaistmatud idioomid, millel on osaliselt sarnane eestikeelne vaste; 3) läbipaistmatud idioomid, millel pole eestikeelset vastet (või on see täiesti erineva sõnastusega); 4) läbipaistvad idioomid (milles on vähemalt üks sõnasõnaliselt võetav element) ilma eestikeelse vasteta ning 5) poolläbipaistvad idioomid (ilma sõnasõnalise elemendita, aga kergesti arusaadava kujundlikkusega) ilma eestikeelse vasteta. Ilmnes, et läbipaistvus ja identne eestikeelne vaste hõlbustavad arusaamist peaaegu samal määral. Samas näib poolläbipaistvuse (figuratiivsuse) hõlbustav mõju olevat selgelt madalam ja idioomid, millel on ainult osaliselt sarnane vaste eesti keeles, osutusid kõige keerulisemateks. Vastupidi identse vaste olemasolule, mõjub osaliselt sarnane eestikeelne vaste pigem segadust tekitavalt kui toetavalt ingliskeelsest idioomist arusaamisele

Gut microbial activity as influenced by fiber digestion: dynamic metabolomics in an in vitro colon simulator

Understanding the interaction between the gut microbial activity and the host is essential, and in vitro models are being used to test and develop hypotheses regarding the impact of food components/drugs on the human gut ecosystem. However, while in vitro models provide excellent possibilities for dynamic investigations, studies have commonly been restricted to analyses of few, targeted metabolites. In the present study, we employed NMR-based metabolomics combined with multilevel data analysis as a tool to characterize the impact of polydextrose (PDX) fiber on the in vitro derived fecal metabolome. This approach enabled us to identify and quantify the fiber-induced response on several fecal metabolites; we observed higher levels of butyrate, acetate, propionate, succinate, N-acetyl compound and a lower level of amino acids (leucine, valine, isoleucine, phenylalanine, and lysine), valerate, formate, isovalerate and trimethylamine among the PDX-treated sample compared to the control samples. In addition, by the application of multilevel data analysis we were able to examine the specific inter-individual variations, and caprylic acid was identified to be the main marker of distinct microbial compositions among the subjects. Our work is expected to provide a useful approach to understand the metabolic impact of potential prebiotic compounds and get deeper insight into the molecular regulation of gut-microbe activities in the complex gut system

Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index.

PURPOSE: Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. METHODS: All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. RESULTS: 259,399 patients met the study’s inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01–1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05–1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11–1.90), p = 0.006], compared to RCRI 0. CONCLUSION: An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population

Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study

Introduction: Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results: Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90 days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41-0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11-0.96), p = 0.045] complications could be detected when using energy devices. Conclusions: Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts

The effect of selected synbiotics on microbial composition and short-chain Fatty Acid production in a model system of the human colon.

Prebiotics, probiotics and synbiotics can be used to modulate both the composition and activity of the gut microbiota and thereby potentially affecting host health beneficially. The aim of this study was to investigate the effects of eight synbiotic combinations on the composition and activity of human fecal microbiota using a four-stage semicontinuous model system of the human colon.Carbohydrates were selected by their ability to enhance growth of the probiotic bacteria Lactobacillus acidophilus NCFM (NCFM) and Bifidobacterium animalis subsp. lactis Bl-04 (Bl-04) under laboratory conditions. The most effective carbohydrates for each probiotic were further investigated, using the colonic model, for the ability to support growth of the probiotic bacteria, influence the composition of the microbiota and stimulate formation of short-chain fatty acids (SCFA).The following combinations were studied: NCFM with isomaltulose, cellobiose, raffinose and an oat β-glucan hydrolysate (OBGH) and Bl-04 with melibiose, xylobiose, raffinose and maltotriose. All carbohydrates showed capable of increasing levels of NCFM and Bl-04 during fermentations in the colonic model by 10(3)-10(4) fold and 10-10(2) fold, respectively. Also the synbiotic combinations decreased the modified ratio of Bacteroidetes/Firmicutes (calculated using qPCR results for Bacteroides-Prevotella-Porphyromonas group, Clostridium perfringens cluster I, Clostridium coccoides - Eubacterium rectale group and Clostridial cluster XIV) as well as significantly increasing SCFA levels, especially acetic and butyric acid, by three to eight fold, as compared to the controls. The decreases in the modified ratio of Bacteroidetes/Firmicutes were found to be correlated to increases in acetic and butyric acid (p=0.04 and p=0.03, respectively).The results of this study show that all synbiotic combinations investigated are able to shift the predominant bacteria and the production of SCFA of fecal microbiota in a model system of the human colon, thereby potentially being able to manipulate the microbiota in a way connected to human health

Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective

Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods: Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15 years who underwent appendectomy for appendicitis (November 2020-May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results: Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management

Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk

IntroductionThe number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed &gt;24 h.MethodsAll patients registered in the 2013–2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality.ResultsA total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery &gt;24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57–4.09, p = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed &gt;24 h (95% CI: 0.90–8.40, p = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery &gt;24 h were 345 and 333, respectively.ConclusionDelaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk