Prospective study of antibiotic use and bacterial resistance in hospitalized children

Rezistencija bakterija predstavlja veliki zdravstveni problem. Poznato je da je neracionalna upotreba antibiotika jedan od najznačajnijih uzroka porasta rezistencije. Posebno su ugrožena deca jer su najčešće izložena ovim lekovima. Cilj ove prospektivne jednogodišnje studije bio je da se utvrdi obim i struktura upotrebe antibiotika na Institutu za zdravstvenu zaštitu dece i omladine Vojvodine u Novom Sadu, kao i da se sagleda rezistencija i multirezistencija najčešće izolovanih bakterija kod dece u zavisnosti od uzrasta, pola, vrste bolesničkog materijala, godišnjih doba i klinike na kojoj su deca smeštena. Obim upotrebe antibiotika procenjen je primenom metode definisane dnevne doze (DDD) na 100 bolesničko-obskrbnih dana (BOD), uz primenu anatomsko-terapijsko-hemijske (ATC) klasifikacije lekova. Za procenu rezistencije i multirezistencije bakterija korišten je softver WHONET 5.4, razvijen od strane Svetske Zdravstvene Organizacije u svrhu ovakvih epidemioloških analiza. Rezultati su prikazani grafički i tabelarno uz statističku procenu razlika. Upotreba antibiotika: Prosečan obim upotrebe antibiotika na IZZZDIOV bio je 37,74 DDD/100BOD, s time što je na Klinici za hirurgiju bila 56,66, na Klinici za pedijatriju kod deca uzrasta do 2 godine 23,17, na Klinici za pedijatriju kod dece uzrasta 2-18 godina 44,10 i na Klinici za habilitaciju i rehabilitaciju 6,04 DDD/100BOD. Obim upotrebe antibiotika tokom zime na nivou celog IZZZDIOV bio je veći u odnosu na leto. Antibiotici su se koristili na svim klinikama i odeljenjima, bez izuzetaka. Bakteriološki nalazi: Od 11942 uzoraka poslatih na mikrobiološku analizu, 18,14% (2168/11952) bilo je bakteriološki pozitivno, s time da su najčešće analizirani bili uzorci krvi i urina. Značajno manje bakterija izolovano je zimi u odnosu na leto. Najčešće izolovana bakterija bila je Escherichia coli, a po učestalosti su sledili: Staphylococcus aureus, koagulaza negativni Staphylococcus spp, Klebsiella spp, Pseudomonas spp, Acinetobacter spp, Enterococcus spp i Enterobacter spp. Bakterije izolovane kod dece uzrasta do 2 godine u proseku su bile u većem procentu rezistentnije i multirezistentnije u odnosu na bakterije izolovane kod starije dece...Bacterial resistance represents a major healthcare issue. Irrational use of antibiotics is known to be one of the main causes of increase in bacterial resistance. Children are particularly sensitive as they are the most exposed population to antibiotics. The aim of this prospective one-year study was to determine the extent and structure of antibiotic utilization a t the I nstitute for C hild a nd Y outh H ealth C are o f Vojvodina (ICYHCV) in Novi Sad, as well as to examine the resistance and multidrug resistance of the most frequently isolated bacteria in children, depending on their age, gender, type of patient material, the seasons and the clinic where patients were hospitalized. The use of antibiotics was assessed by the method of defined daily dose (DDD) per 100 bed days (BD), using the Anatomical Therapeutic Chemical (ATC) classification of antibiotics. WHONET 5.4 software, developed by the World Health Organization for the purpose of epidemiological analysis, was used to assess resistance and multidrug resistance of the isolated bacteria. The results are shown using graphs and tables, with statistical evaluation of the noted differences. Utilization of antibiotics: The average consumption o f a ntibiotics a t t he ICYHCV w as 3 7.74 D DD/100BD, w ith t he c onsumption a t t he C linic for s urgery o f 56.66, at the Clinic for pediatrics of 23.17 (in children under the age of 2) and 44.10 (in children 2-18 years), and of 6.04 DDD/100BD at the Clinic for rehabilitation. Utilization of antibiotics at the entire ICYHCV during winter was higher compared to summer period. Antibiotics were used at all clinics and departments, without exception. Bacteriological findings: Out of 11942 specimens sent for microbiological analysis, 18.14% (2168/11952) were reported positive. The most frequently analyzed patient materials were blood and urine. Significantly fewer bacteria were isolated during winter compared to summer period. The most commonly isolated bacteria was Escherichia coli, followed by: Staphylococcus aureus, coagulase-negative Staphylococcus spp, Klebsiella spp, Pseudomonas spp, Acinetobacter spp, Enterococcus spp and Enterobacter spp..

Positive effects of naringenin on near-surface membrane fluidity in human erythrocytes

Purpose: Deformability/rheologic behavior of erythrocytes are related to near-surface membrane fluidity. Specific agents can increase erythrocyte membrane fluidity in order to adjust hemodynamics in cardiovascular diseases. Grapefruit flavanone naringenin has been proposed for potential use in an alternative therapy of cardiovascular conditions. In respect to this, we assessed here effects of two nutritionally relevant concentrations of naringenin (0.1 and 1 μg/ml) on near-surface membrane fluidity in human erythrocytes. Methods: We used electron paramagnetic resonance spectroscopy and fatty acid spin probes (5-DS and 7-DS), the spectra of which are dependent on membrane fluidity. Results: The results showed a significant (p = 0.029) increase of membrane fluidity near the hydrophilic surface in erythrocytes treated with higher concentration of naringenin. In the deeper layer, just below the erythrocyte membrane phospholipid heads, both lower and higher concentration of naringenin significantly increased membrane fluidity (p = 0.036 and p = 0.028, respectively). Conclusions: These data document the positive and dose dependent effect of naringenin on near-surface membrane fluidity in human erythrocytes, recommending its use in the cardiovascular conditions characterized by disturbed hemodynamics

The effects of chronic administration of cisplatin on oxidative stress in the isolated rat heart [Efekti hronične primene cisplatine na oksidacioni stres izolovanog srca pacova]

Taken into consideration that molecular and cellular mechanisms involved in cardiotoxicity are still not clear the aim of this study was to compare the production of oxidative stress parameters in the isolated rat heart between animals chronically treated with cisplatin and saline. The hearts of male Wistar albino rats (n = 24, 12 per group, age 8 weeks, body mass 250±50 g) were excised and perfused according to the Langendorff technique at gradually increased coronary perfusion pressures (40-120 cmH2O). We followed the production of superoxide anion radicals, hydrogen peroxide, and nitrites and also index of lipid peroxidation during the changes of coronary perfusion pressure (CPP) (from 40 to 120 cm H2O) in coronary venous effluent. Modifications CPP were performed in order to determined if oxidative stress is involved in coronary endothelium response in conditions of hypoxia (lower than 60 cm H2O) and hyperoxia (higher than 80 cm H2O). Based on the results of this research we can conclude that with enhancement of CPP the values of oxidative stress statistically increased. However, this increment is more prominent in control group as a result of preserved endothelium and its more powerful response to hyperoxia. On the other hand, damaged endothelium of cisplatin-treated animals had weaker response to hyperoxia, and also lower antioxidant capacity. © 2018, University of Kragujevac, Faculty of Science. All rights reserved

Associating Air Pollution with Cytokinesis-Block Micronucleus Assay Parameters in Lymphocytes of the General Population in Zagreb (Croatia).

Air pollution is recognized as one of the most serious public health issues worldwide and was declared to be a leading environmental cause of cancer deaths. At the same time, the cytokinesis-block micronucleus (CBMN) assay serves as a cancer predictive method that is extensively used in human biomonitoring for populations exposed to environmental contamination. The objective of this cross-sectional study is two-fold: to evaluate genomic instability in a sample (N = 130) of healthy, general population residents from Zagreb (Croatia), chronically exposed to different levels of air pollution, and to relate them to air pollution levels in the period from 2011 to 2015. Measured frequencies of CBMN assay parameters were in agreement with the baseline data for the general population of Croatia. Air pollution exposure was based on four factors obtained from a factor analysis of all exposure data obtained for the examined period. Based on the statistical results, we did not observe a significant positive association between any of the CBMN assay parameters tested and measured air pollution parameters for designated time windows, except for benzo(a)pyrene (B[a]P) that showed significant negative association. Our results show that measured air pollution parameters are largely below the regulatory limits, except for B[a]P, and as such, they do not affect CBMN assay parameters' frequency. Nevertheless, as air pollution is identified as a major health threat, it is necessary to conduct prospective studies investigating the effect of air pollution on genome integrity and human health

Air Pollution and Primary DNA Damage among Zagreb (Croatia) Residents: A Cross-Sectional Study.

More than eight million premature deaths annually can be attributed to air pollution, with 99% of the world's population residing in areas below recommended air quality standards. Hence, the present study aimed to examine the association between primary DNA damage and air pollution data among 123 participants enrolled between 2011 and 2015 in Zagreb, Croatia. While most measured air pollutants adhered to regulatory limits, benzo[a]pyrene concentrations bound to PM <sub>10</sub> exceeded them. Factorial analysis narrowed down air pollution data to four exposure factors (particulate matter, two metal factors, and other pollutants). Despite the absence of significant positive associations between modeled air pollution exposure factors and comet assay descriptors (tail length, tail intensity, tail moment, and highly damaged nuclei), the critical health implications of air pollution warrant further investigations, particularly with biomarkers of exposure and different biomarkers of effect in populations facing air pollution exposure

High intensity interval training protects the heart during increased metabolic demand in patients with type 2 diabetes: a randomised controlled trial

AimThe present study assessed the effect of high intensity interval training on cardiac function during prolonged submaximal exercise in patients with type 2 diabetes.MethodsTwenty-six patients with type 2 diabetes were randomized to a 12 week of high intensity interval training (3 sessions/week) or standard care control group. All patients underwent prolonged (i.e. 60min) submaximal cardiopulmonary exercise testing (at 50% of previously assess maximal functional capacity) with non-invasive gas-exchange and haemodynamic measurements including cardiac output and stroke volume before and after the intervention.ResultsAt baseline (prior to intervention) there was no significant difference between the intervention and control group in peak exercise oxygen consumption (20.36.1 vs. 21.75.5ml/kg/min, p=0.21), and peak exercise heart rate (156.3 +/- 15.0 vs. 153.8 +/- 12.5 beats/min, p=0.28). During follow-up assessment both groups utilized similar amount of oxygen during prolonged submaximal exercise (15.0 +/- 2.4 vs. 15.2 +/- 2.2ml/min/kg, p=0.71). However, cardiac function i.e. cardiac output during submaximal exercise decreased significantly by 21% in exercise group (16.2 +/- 2.7-12.8 +/- 3.6L/min, p=0.03), but not in the control group (15.7 +/- 4.9-16.3 +/- 4.1L/min, p=0.12). Reduction in exercise cardiac output observed in the exercise group was due to a significant decrease in stroke volume by 13% (p=0.03) and heart rate by 9% (p=0.04).Conclusion Following high intensity interval training patients with type 2 diabetes demonstrate reduced cardiac output during prolonged submaximal cardiopulmonary exercise testing. Ability of patients to maintain prolonged increased metabolic demand but with reduced cardiac output suggests cardiac protective role of high intensity interval training in type 2 diabetes.Trial registration ISRCTN78698481. Registered 23 January 2013, retrospectively registered

A machine learning-based risk stratification model for ventricular tachycardia and heart failure in hypertrophic cardiomyopathy

Background: Machine learning (ML) and artificial intelligence are emerging as important components of precision medicine that enhance diagnosis and risk stratification. Risk stratification tools for hypertrophic cardiomyopathy (HCM) exist, but they are based on traditional statistical methods. The aim was to develop a novel machine learning risk stratification tool for the prediction of 5-year risk in HCM. The goal was to determine if its predictive accuracy is higher than the accuracy of the state-of-the-art tools. Method: Data from a total of 2302 patients were used. The data were comprised of demographic characteristics, genetic data, clinical investigations, medications, and disease-related events. Four classification models were applied to model the risk level, and their decisions were explained using the SHAP (SHapley Additive exPlanations) method. Unwanted cardiac events were defined as sustained ventricular tachycardia occurrence (VT), heart failure (HF), ICD activation, sudden cardiac death (SCD), cardiac death, and all-cause death. Results: The proposed machine learning approach outperformed the similar existing risk-stratification models for SCD, cardiac death, and all-cause death risk-stratification: it achieved higher AUC by 17%, 9%, and 1%, respectively. The boosted trees achieved the best performing AUC of 0.82. The resulting model most accurately predicts VT, HF, and ICD with AUCs of 0.90, 0.88, and 0.87, respectively. Conclusions: The proposed risk-stratification model demonstrates high accuracy in predicting events in patients with hypertrophic cardiomyopathy. The use of a machine-learning risk stratification model may improve patient management, clinical practice, and outcomes in general

The effects of acute hyperhomocysteinemia induced by DL-homocysteine or DL-homocysteine thiolactone on serum biochemical parameters, plasma antioxidant enzyme and cardiac acetylcholinesterase activities in the rat

The aim of this study was to assess the effects of DL-homocysteine (DL-Hcy) and DL-homocysteine thiolactone (DL-Hcy TLHC) on selected serum biochemical parameters, markers of oxidative stress and the activities of antioxidant enzymes (catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD)) in the plasma, as well as on acetylcholinesterase (AChE) activity in the cardiac tissue homogenate in the rat. Male Wistar rats were divided into three groups as follows: control group (1 mL 0.9% NaCl, intraperitoneal (i.p.) injection), DL-Hcy group (8 mmol/kg body mass (b.m.), i.p.) or DL-Hcy TLHC group (8 mmol/kg b.m., i.p.). One hour after administration, the rats were euthanized, whole blood was collected for biochemical analysis, and the heart was excised. Following the i.p. administration of DL-Hcy and DL-Hcy TLHC, the activities of antioxidant enzymes were mostly significantly increased, while plasma malondialdehyde (MDA) was decreased. Administration of DL-Hcy and DL-Hcy TLHC significantly inhibited AChE activity in rat cardiac tissue. Our findings suggest that DL-Hcy and DL-Hcy TLHC exerted prooxidant effects; however, the decrease in MDA points to an inverse response to the increase in antioxidant enzyme activities. While both substances inhibited AChE activity in rat cardiac tissue, DL-Hcy TLHC induced stronger effects than DL-Hcy

Education level and physical functional limitations among Japanese community residents-gender difference in prognosis from stroke

<p>Abstract</p> <p>Background</p> <p>Little research has been conducted to examine the relationship between education level and functional limitations among Japanese community residents. We sought to examine the association between education level and physical functional limitations among Japanese men and women, and whether that association was modified by gender and history of stroke.</p> <p>Methods</p> <p>We examined prevalence of physical functional limitation by educational level using the data from a total of 29,134 Japanese men and women aged 50–69 years living in communities in 2000. The information of educational level (junior high school graduates, senior high school graduates, college and/or higher education) and physical functional limitations (no need for assistance, need for assistance when going outdoors, and need for assistance to carry out indoor activities) were obtained by self-administrated questionnaire.</p> <p>Results</p> <p>The proportions of the subjects reported their highest level of schooling were 48% for junior high school, 39% for high school, and 13% for college. Three hundred and twenty eight subjects (1% of total subjects) reported having some physical functional limitations. Multinomial logistic regression analyses showed that the odds ratio of needing assistance to carry out indoor activities were 4.84(95%CI:3.61,6.50) for lowest education level group and 2.21(95%CI:1.00,4.86) for middle education level group compared to highest education level group. The corresponding odds ratios of needing assistance when going outdoors were 2.36(95%CI: 2.03,2.72) and 1.08(95%CI:0.73,1.60), respectively. Further, the significant excess prevalence of having functional limitations associated with the low education level was identified for men regardless of history of stroke and for women without history of stroke.</p> <p>Conclusion</p> <p>Low education level was associated with the higher prevalence of physical functional limitations for both genders. That association among persons with history of stroke was observed for men but not for women probably due to gender differences in stroke subtypes and social support.</p

Vascular endothelial growth factor in children with neuroblastoma: a retrospective analysis

BACKGROUND: Despite aggressive therapy, advanced stage neuroblastoma patients have poor survival rates. Although angiogenesis correlates with advanced tumour stage and plays an important role in determining the tumour response to treatment in general, clinical data are still insufficient, and more clinical evaluations are needed to draw conclusions. The aim of this study was to evaluate vascular endothelial growth factor (VEGF) expression in patients with neuroblastoma, determine whether it correlates with other prognostic factors and/or therapeutic response, and to assess should VEGF be considered in a routine diagnostic workup. ----- MATERIALS AND METHODS: VEGF expression was determined by immunohistochemistry using anti-VEGF antibody in paraffin embedded primary tumour tissue from 56 neuroblastoma patients. Semiquantitative expression of VEGF was estimated and compared with gender, age, histology, disease stage, therapy, and survival. Statistical analyses, including multivariate analysis, were performed. ----- RESULTS: VEGF expression correlated with disease stage and survival in neuroblastoma patients. Combination of VEGF expression and disease stage as a single prognostic value for survival (P-value = 0.0034; odds ratio (OR) (95%CI) = 26.17 (2.97-230.27) exhibited greater correlation with survival than individually. Hematopoietic stem cell transplantation significantly improved survival of the advanced stage patients with high VEGF expression. ----- CONCLUSION: VEGF expression should be considered in a routine diagnostic workup of children with neuroblastoma, especially in those more than 18 months old and with advanced disease stage. High VEGF expression at the time of disease diagnosis is a bad risk prognostic factor, and can be used to characterize subsets of patients with an unfavourable outcome