Antibiotic Resistance Trends of Gram-negative Bacteria Most Frequently Isolated from Inpatients in a Tertiary Care Hospital in Sana'a, Yemen

Objective: To determine the trends of antibiotic resistance of Gram-negative bacteria, most frequently isolated from inpatients at the University of Science and Technology Hospital (USTH) in Sana'a, Yemen. Methods: A retrospective, cross-sectional study on the antibiotic resistance of Gram-negative bacteria most frequently isolated from respiratory tract, pus, urine, blood and other types of specimens from inpatients admitted to the USTH. Data were retrieved from the hospital records of culture-positive inpatients in the period from January 2006 to December 2013, and annual trends of resistance were compared using chi-square test for trends at P values < 0.05. Results: Of 2005 Gram-negative bacterial isolates in the period from 2006 to 2013, the most frequently isolated species were Escherichia coli (41.6%), Acinetobacter species (26.7%), Klebsiella species (21.0%) and Pseudomonas aeruginosa (10.6%). Amikacin and carbapenems were the most active drugs against E. coli, with a decrease in the susceptibility of this species to the third- and fourth-generation cephalosporins and a variable resistance rate to quinolones that significantly increased in 2013. Acinetobacter species susceptibility to most antibiotics decreased significantly over the years of the study, where polymyxin B was the only one found to be effective against this species. On the other hand, the trend of Klebsiella species resistance to imipenem, piperacillin-tazobactam, cefepime, ceftazidime increased over the years of the study. Susceptibility of Klebsiella species to ciprofloxacin, levofloxacin and moxifloxacin showed fluctuations, while the susceptibility of aminoglycosides (amikacin and gentamicin) and ampicillin-sulbactam showed no difference. The resistance of P. aeruginosa to the majority of antibiotics was not dramatically changed over the years of the study period, but gentamicin resistance rate was considerably dropped from 77.8% in 2008 to 25.9% in 2013. Conclusions: Of the most frequently isolated Gram-negative bacteria in Sana'a, Acinetobacter species has the highest resistance rate to the most commonly used antibiotics, where only polymyxin B is effective against this species. P. aeruginosa shows an unchanging rate of resistance to antibiotics in the USTH despite being quite resistant to antibiotics on a global scale, which could be attributed to the smaller number of P. aeruginosa isolates tested over the study period. Further large-scale studies on the trends of antibiotic resistance rates in hospital-based settings and the best ways to counteract such resistance in Yemen are recommended. &nbsp

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

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

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

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

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

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

The Psychological Drivers of Entrepreneurial Resilience in the Tourism Sector

Although resilience is assumed to play a crucial role in entrepreneurship, the factors leading to entrepreneurial resilience in the tourism sector remain relatively unknown. To address this issue, this study adopts a novel configuration approach to assess psychological traits that are likely to result in resilient entrepreneurial behaviour in tourism. It approaches this by conceptualising personality traits through the big five model which is widely espoused in the psychology discipline. Then, using fuzzy-set analysis, a sample of 180 bazaar owner/managers in Egypt is investigated from which three distinct profiles likely to exhibit high levels of entrepreneurial resilience are determined. The findings of this paper advance scholars’ theoretical understanding and offer intelligence to policymakers and training institutions in the Egyptian tourism scene. Particularly, they help bazaar owner/managers reflect on their predispositions as a means for increasing resilience

The Psychological Drivers of Entrepreneurial Resilience in the Tourism Sector

Although resilience is assumed to play a crucial role in entrepreneurship, the factors leading to entrepreneurial resilience in the tourism sector remain relatively unknown. To address this issue, this study adopts a novel configuration approach to assess psychological traits that are likely to result in resilient entrepreneurial behaviour in tourism. It approaches this by conceptualising personality traits through the big five model which is widely espoused in the psychology discipline. Then, using fuzzy-set analysis, a sample of 180 bazaar owner/managers in Egypt is investigated from which three distinct profiles likely to exhibit high levels of entrepreneurial resilience are determined. The findings of this paper advance scholars’ theoretical understanding and offer intelligence to policymakers and training institutions in the Egyptian tourism scene. Particularly, they help bazaar owner/managers reflect on their predispositions as a means for increasing resilience

EnDuo, a novel derivative of Endostar, inhibits the migration of colon cancer cells, suppresses matrix metalloproteinase-2/9 expression and impedes AKT/ERK activation

Background/aims: Colon cancer remains a life-threating disease with increasing morbidity and mortality worldwide despite the advancement in modern medical treatment. Therefore, novel and effective anti-colon cancers drugs are urgently needed. In this study, we investigated the anti-metastatic property EnDuo, a modified version of Endostar, and the underlying mechanisms. Methods: Colon cancer cells were treated with different concentrations of EnDuo (50 μg/mL, 100 μg/mL, 200 μg/mL), and Endostar (100 μg/mL) as positive control. Cell Counting Kit-8 assay was performed to test the effect of EnDuo on cell viability. A scratch wound assay and transwell assay were employed to evaluate the relocation and motility of malignant colon cells following treatment with EnDuo. Western blot analysis was used to determine inhibitory effects of EnDuo by detecting the phosphorylation level of AKT and ERK proteins, and the expression of MMP-2 and MMP-9 proteins. Results: Our results showed that EnDuo impedes the migration of colon cancer cells in a dose-dependent manner. At the molecular level, EnDuo induced a significant reduction in the phosphorylation of AKT and ERK proteins, and inhibited the expression of MMP-2 and MMP-9 proteins. Conclusions: Collectively, these results demonstrate that EnDuo exhibits a comparable anti-metastatic effect by suppressing the migration of colon cancer cells. Possibly, EnDuo interrupts the PI3K/AKT/ERK signaling pathway to arrest cell migration. Our study provides a novel insight to the potential clinical applications of EnDuo against colon cancers in the future