A REVIEW ON PATIENT-CONTROLLED ANALGESIA INFUSION SYSTEM

PCA is a patient-controlled analgesia infusion pump, which is used to infuse the medicine into the patients after surgery. It contains a syringe with pain medicine to infuse that is prescribed by the physician. The drugs used for pain control are high-alert medicines, since overmedication may cause death to the patients. These types of unbearable events may happen due to medical errors, prescription errors, adverse events (AEs), etc. Hence, it requires a precautionary attention or continuous monitoring for PCA pump infusion patients. However, always physicians or nurses may not monitor a patient continuously. To provide safety to the patient, the PCA pump needs a smart care process to alert the physician. This study represents the survey on PCA pump errors, AEs, and solutions for it to avoid them. The solution will automatically alert the infusion-related situation of the patients, those are taking the intravenous drug infusion at different procedure rooms in the hospitals. Moreover, it increases the safety to infusion pump with advances of decision-making in health, patient monitoring, alert notification to nursing, and productivity. This quality care can be achieved by integrating the PCA pump with other intelligent systems. Â

The mazEF toxin-antitoxin system as a novel antibacterial target in Acinetobacter baumannii

Although analysis of toxin-antitoxin (TA) systems can be instructive, to date, there is no information on the prevalence and identity of TA systems based on a large panel of Acinetobacter baumannii clinical isolates. The aim of the current study was to screen for functional TA systems among clinical isolates of A. baumannii and to identify the systems' locations. For this purpose, we screened 85 A. baumannii isolates collected from different clinical sources for the presence of the mazEF, relBE and higBA TA genes. The results revealed that the genes coding for the mazEF TA system were commonly present in all clinical isolates of A. baumannii. Reverse transcriptase-polymerase chain reaction analysis showed that transcripts were produced in the clinical isolates. Our findings showed that TA genes are prevalent, harboured by chromosomes and transcribed within A. baumannii. Hence, activation of the toxin proteins in the mazEF TA system should be investigated further as an effective antibacterial strategy against this bacterium

Iron and virulence in Stenotrophomonas maltophilia: all we know so far

Stenotrophomonas maltophilia is a multi-drug-resistant global opportunistic nosocomial pathogen, which possesses a huge number of virulence factors and antibiotics resistance characteristics. Iron has a crucial contribution toward growth and development, cell growth and proliferation, and pathogenicity. The bacterium found to acquire iron for its cellular process through the expression of two iron acquisition systems. Two distinct pathways for iron acquisition are encoded by the S. maltophilia genome-a siderophore-and heme-mediated iron uptake system. The entAFDBEC operon directs the production of the enterobactin siderophore of catecholate in nature, while heme uptake relies on hgbBC and potentially hmuRSTUV operon. Fur and sigma factors are regulators of S. maltophilia under iron-limited condition. Iron potentially act as a signal which plays an important role in biofilm formation, extracellular polymeric substances (EPS), extracellular enzymes production, oxidative stress response, diffusible signal factor (DSF) and siderophore production in S. maltophilia. This review summarizes the current knowledge of iron acquisition in S. maltophilia and the critical role of iron in relation to its pathogenicity

Clinicoepidemiological study of fixed drug eruption in tertiary care hospital

Background: Adverse cutaneous drug reactions pose diagnostic difficulties due to a varied clinical manifestations and broad categories of causative agents. Fixed drug eruptions (FDE) are one of them. Present study aims i) to record various clinical features of FDE, their causative agents and ii) to study the pattern of morbidity in patients with FDE in a tertiary care hospital, Rajkot, Gujarat, India.Methods: The 88 patients with FDEs attending department of dermatology, venereology and leprosy at PDU govt. medical college and hospital, Rajkot, Gujarat from September 2018 to September 2020 were included after informed consent. After taking thorough history, complete blood count and biochemical tests were done. HIV testing was done in severe reactions with generalised involvement. Appropriate treatment was given with counselling regarding the offending drug for prevention of reaction in future.Results: The male patients were more affected than female patients with M: F ratio of 1.3:1. The most common age group affected was 21-30 years (22.7%). Antimicrobials were the most common offending drugs (43.2%). None of the patients were HIV reactive in our study. No mortality was reported in our study.Conclusions: The patterns of FDE and the causative drugs are remarkably different in our study. Knowledge of patterns and the causative agents helps in prevention of same reactions in future in patients

The 'checkmate' for iron between human host and invading bacteria: chess game analogy

Iron is an essential nutrient for all living organisms with critical roles in many biological processes. The mammalian host maintains the iron requirements by dietary intake, while the invading pathogenic bacteria compete with the host to obtain those absorbed irons. In order to limit the iron uptake by the bacteria, the human host employs numerous iron binding proteins and withholding defense mechanisms that capture iron from the microbial invaders. To counteract, the bacteria cope with the iron limitation imposed by the host by expressing various iron acquisition systems, allowing them to achieve effective iron homeostasis. The armamentarium used by the human host and invading bacteria, leads to the dilemma of who wins the ultimate war for iron

Selective amplification of bacterial 16S rDNA sequence from clinical samples

Background: Conventional blood culture method is time consuming and less sensitive; when fastidious or un-culturalable organisms are involved. The use of PCR targeting the 16S rRNA allows detection of bacteria; however, these primers have ability to co-amplify human DNA. This Polymerase Chain Reaction (PCR) method is based on nucleic acid amplification test. Objective of the study: This study determined a method for selective amplification of bacterial DNA from clinical samples without co-amplification of human DNA. Materials and methods: Seventy one blood samples from clinically suspected cases of early onset neonatal sepsis were collected and analysed in parallel by culture and 16S rRNA amplification. DNA was extracted using commercial extraction QiAmp mini DNA kit and subjected to 16S rRNA amplification. The products were sequenced, analysed and compared with blood culture results. Positive and negative controls were used for extraction and amplification respectively. Results: Out of 71 samples analysed, 5 (7.0%) samples by blood culture were equally positive for 16S rRNA PCR; the PCR was also able to identified 16 (22.5%) more positive samples which blood culture could not identify, but only 1 (1.4%) sample was identified positive using blood culture while PCR identified it as negative. During the study, 7 (9.9%) samples were identified positive by conventional blood culture but later found to be contaminants. Conclusion: This study confirmed the presence of 16S rRNA among bacterial isolates and modification of PCR protocol with shorter denaturation temperature and time, leading to selective amplification of bacterial DNA. Therefore, there is need to carry-out this investigation on both culturable and unculturable specimens. Keywords:16SrRNA amplification; bacterial DNA; human DNA and Polymerase chai

Clinical Significance of Antibodies to Soluble Extractable Nuclear Antigens (Anti-ENA) in Autoimmune Connective Tissue Disorder

Introduction: Autoimmune diseases occur in 3-5% of the population. Alteration in immune system occurs due to various genetic & environmental factors leading to development of auto reactive phenomena that can be detected. Aims & objectives: 1) Clinical diagnosis & its serological correlation. 2) To diagnose the diseases at its earliest stage and to intervene before serious end organ damage occurs. 3) To assess the prognosis of the disease. Method: A group of 90 patients were studied who clinically showed signs of systemic autoimmune disease. All patients were subjected to Anti-ENA profile to see the possible correlation between clinical diagnosis and serological markers. Result: 90 patients enrolled in study presented with predominant clinical manifestation of polyarthritis, Raynaud’s phenomenon, fever and skin manifestations. Based on clinical examination various connective tissue disorder diagnosis was confirmed with serological testing in 63% cases while deferred in 37% cases. According to clinical diagnosis out of 90 patients, diagnoses were kept of Systemic Lupus Erythematosus (SLE) (43), Systemic sclerosis (SS) (34), Dermatomyositis (DM) (01), Overlap syndrome (12). After serological testing diagnosis found to be SLE (28), SS (22), Mixed connective tissue disease (MCTD) (29), DM (01), undifferentiated connective tissue disease (UCTD) (08), Overlap syndrome (02). Conclusion: From this study patients with one or more than one connective tissue disorder where diagnosed early. It is important to correlate clinical diagnosis with serological testing (Anti-ENA) so that disease can be treated early before end organ damage occurs and prognostic outcome is also determined

Humoral immune consequences of Staphylococcus aureus ST239-associated bacteremia

The humoral immune responses against 46 different staphylococcal antigens in 27 bacteremia patients infected by clonally related methicillin-resistant Staphylococcus aureus (MRSA) strains of a single sequence type (ST) 239 were investigated. A group of non-infected patients (n = 31) hospitalized for different reasons served as controls. All strains were confirmed as ST 239 by S. aureus and mecA-specific PCR, spa, and multi-locus sequence typing (MLST). In each bacteremia patient, a unique pattern of S. aureus antigen-specific immune responses after infection was observed. Antibody levels among bacteremia patients were significantly higher than controls for HlgB (P = 0.001), LukD (P = 0.009), LukF (P = 0.0001), SEA (P = 0.0001), SEB (P = 0.011), SEC (P = 0.010), SEQ (P = 0.049), IsaA (P = 0.043), IsdA (P = 0.038), IsdH (P = 0.01), SdrD (P = 0.001), SdrE (P = 0.046), EsxA (P = 0.0001), and SA0104 (P = 0.0001). On the other hand, the antibody levels were significantly higher among controls for SSL3 (P = 0.009), SSL9 (P = 0.002), and SSL10 (P = 0.007) when the IgG level on the day of infection was compared with that measured on the day of admission. Diversity was observed in the immune response against the antigens. However, a set of antigens (IsaA, IsdA, IsdH, SdrD, and HlgB) triggered a similar type of immune response in different individuals. We suggest that these antigens could be considered when developing a multi-component (passive) vaccine. SEA and/or its specific antibodies seem to play a critical role during ST239 MRSA bacteremia and SEA-targeted therapy may be a strategy to be considered

First report on methicillin-resistant Staphylococcus aureus of Spa type T037, Sequence type 239, SCCmec type III/IIIA in Malaysia

Methicillin-resistant Staphylococcus aureus (MRSA) from Malaysia were shown to possess staphylococcal cassette chromosome mec (SCCmec)-III and IIIA. Spa sequencing and multi-locus sequence typing (MLST) documented t037 and ST 239 (CC8) for 83.3% of the isolates. This confirms observations in several other Far Eastern countries and corroborates the epidemicity of this clone

Mec-associated dru typing in the epidemiological analysis of ST239 MRSA in Malaysia.

The usefulness of mec-associated dru typing in the epidemiological analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolated in Malaysia was investigated and compared with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and spa and SCCmec typing. The isolates studied included all MRSA types in Malaysia. Multilocus sequence type ST188 and ST1 isolates were highly clonal by all typing methods. However, the dru typing of ST239 isolates produced the clearest discrimination between SCCmec IIIa and III isolates, yielding more subtypes than any other method. Evaluation of the discriminatory power for each method identified dru typing and PFGE as the most discriminatory, with Simpson’s index of diversity (SID) values over 89%, including an isolate which was non-typeable by spa, but dru-typed as dt13j. The discriminatory ability of dru typing, especially with closely related MRSA ST239 strains (e.g., Brazilian and Hungarian), underscores its utility as a tool for the epidemiological investigation of MRSA