Early results from indirect drug susceptibility test for tubercle bacilli

The indirect susceptibility test results on L-J medium for tubercle bacilli against streptomycin, isoniazid and rifampicin were read at the end of 2 wk and compared with the results at 4 wk. It was found that drug resistance could be correctly predicted in over 70 per cent of cultures including multi-drug resistant tuberculosis (MDR TB) strains at the end of 2 wk. The susceptibility to para-nitrobenzoic acid (PNB) read at 2 wk was able to distinguish non-tuberculous mycobacteria from Mycobacterium tuberculosis cultures. The early detection of resistance by this procedure requires only minimum inputs, and can benefit the majority of patients harbouring drug resistant tubercle bacilli

Modeling the effects of extracellular potassium on bursting properties in pre-Bötzinger complex neurons

There are many types of neurons that intrinsically generate rhythmic bursting activity, even when isolated, and these neurons underlie several specific motor behaviors. Rhythmic neurons that drive the inspiratory phase of respiration are located in the medullary pre-Bötzinger Complex (pre-BötC). However, it is not known if their rhythmic bursting is the result of intrinsic mechanisms or synaptic interactions. In many cases, for bursting to occur, the excitability of these neurons needs to be elevated. This excitation is provided in vitro (e.g. in slices), by increasing extracellular potassium concentration (K[subscript out]) well beyond physiologic levels. Elevated K[subscript out] shifts the reversal potentials for all potassium currents including the potassium component of leakage to higher values. However, how an increase in K[subscript out], and the resultant changes in potassium currents, induce bursting activity, have yet to be established. Moreover, it is not known if the endogenous bursting induced in vitro is representative of neural behavior in vivo. Our modeling study examines the interplay between K[subscript out], excitability, and selected currents, as they relate to endogenous rhythmic bursting. Starting with a Hodgkin-Huxley formalization of a pre-BötC neuron, a potassium ion component was incorporated into the leakage current, and model behaviors were investigated at varying concentrations of K[subscript out]. Our simulations show that endogenous bursting activity, evoked in vitro by elevation of K[subscript out], is the result of a specific relationship between the leakage and voltage-dependent, delayed rectifier potassium currents, which may not be observed at physiological levels of extracellular potassium.National Institutes of Health (U.S.) (National Center for Complementary and Integrative Health (U.S). Grant R01 AT008632)National Institutes of Health (U.S.) (National Institute of Neurological Disorders and Stroke (U.S.). Grant R01 NS069220

Acute phase proteins in tuberculous patients

The serum concentrations of some acute phase proteins were determined on admission, during treatment, at the end of treatment and at 12 months after stopping treatment in 20 patients with pulmonary tuberculosis. Measurements were also made, on admission and at the end of treatment, in 19 patients with abdominal tuberculosis, and 11 children with tuberculous meningitis. All 20 patients with pulmonary TB had quiescent disease by the end of treatment and none had a bacteriological relapse during the followup period of 12 months. The response to treatment was considered favorable in 18 of the 19 patients with abdominal TB, and the CSF findings had returned to normal in 9 of 11 patients with TB meningitis. There was a significant decrease with treatment in the concentrations of C-reactive protein, ceruloplasmin, haptoglobin and a1 -acid glycoprotein in all 3 groups of patients. While there was an increase in the concentrations of transferrin in patients with pulmonary and abdominal TB, there was a significant decrease in those with TB meningitis, a2- macroglobulin did not appear to function as an acute phase reactant in any of the 3 groups. Amalgamating the findings in all 3 groups of tuberculous patients, the proportions of patients with abnormal values on admission and at the end of treatment were 62% and 14% for C-reactive protein, 78% and 50% for ceruloplasmin, 86% and 26% for haptoglobin and 92% and 6% for a1- acid glycoprotein, respectively

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

BACKGROUND: Malnutrition is a common problem in critically ill patients in UK NHS critical care units. Early nutritional support is therefore recommended to address deficiencies in nutritional state and related disorders in metabolism. However, evidence is conflicting regarding the optimum route (parenteral or enteral) of delivery. OBJECTIVES: To estimate the effect of early nutritional support via the parenteral route compared with the enteral route on mortality at 30 days and on incremental cost-effectiveness at 1 year. Secondary objectives were to compare the route of early nutritional support on duration of organ support; infectious and non-infectious complications; critical care unit and acute hospital length of stay; all-cause mortality at critical care unit and acute hospital discharge, at 90 days and 1 year; survival to 90 days and 1 year; nutritional and health-related quality of life, resource use and costs at 90 days and 1 year; and estimated lifetime incremental cost-effectiveness. DESIGN: A pragmatic, open, multicentre, parallel-group randomised controlled trial with an integrated economic evaluation. SETTING: Adult general critical care units in 33 NHS hospitals in England. PARTICIPANTS: 2400 eligible patients. INTERVENTIONS: Five days of early nutritional support delivered via the parenteral (n = 1200) and enteral (n = 1200) route. MAIN OUTCOME MEASURES: All-cause mortality at 30 days after randomisation and incremental net benefit (INB) (at £20,000 per quality-adjusted life-year) at 1 year. RESULTS: By 30 days, 393 of 1188 (33.1%) patients assigned to receive early nutritional support via the parenteral route and 409 of 1195 (34.2%) assigned to the enteral route had died [p = 0.57; absolute risk reduction 1.15%, 95% confidence interval (CI) -2.65 to 4.94; relative risk 0.97 (0.86 to 1.08)]. At 1 year, INB for the parenteral route compared with the enteral route was negative at -£1320 (95% CI -£3709 to £1069). The probability that early nutritional support via the parenteral route is more cost-effective - given the data - is < 20%. The proportion of patients in the parenteral group who experienced episodes of hypoglycaemia (p = 0.006) and of vomiting (p < 0.001) was significantly lower than in the enteral group. There were no significant differences in the 15 other secondary outcomes and no significant interactions with pre-specified subgroups. LIMITATIONS: Blinding of nutritional support was deemed to be impractical and, although the primary outcome was objective, some secondary outcomes, although defined and objectively assessed, may have been more vulnerable to observer bias. CONCLUSIONS: There was no significant difference in all-cause mortality at 30 days for early nutritional support via the parenteral route compared with the enteral route among adults admitted to critical care units in England. On average, costs were higher for the parenteral route, which, combined with similar survival and quality of life, resulted in negative INBs at 1 year. FUTURE WORK: Nutritional support is a complex combination of timing, dose, duration, delivery and type, all of which may affect outcomes and costs. Conflicting evidence remains regarding optimum provision to critically ill patients. There is a need to utilise rigorous consensus methods to establish future priorities for basic and clinical research in this area. TRIAL REGISTRATION: Current Controlled Trials ISRCTN17386141. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 28. See the NIHR Journals Library website for further project information

Effect Of Psychiatric Clinical Posting On Attitudes Among Student Nurses in University Malaysia Sabah

Students taking up nursing course, bring with them stereotypes and prejudice towards mentally-ill clients. Nurses harbouring such stigmatising attitude can have a profound effect on their subsequent therapeutic relationship and quality of care rendered for the mentally -ill client. Typically, students who harbour stigmatising views, develop positive mind-set after psychiatric posting. Objective: The purpose of this study was to examine whether attitudes towards psychiatric clients improved after psychiatric clinical posting intervention Method: This is a quasi-experimental study, designed to compare change in attitude among a cohort of nurses before and after psychiatry clinical posting. The study involved a convenient sample of all fifty one 5th - semester UMS nursing students undergoing psychiatric postings in Hospital Mesra Bukit Padang Sabah. A validated instrument, the Mental Health Nursing Questionnaire (Happel B, 2008,)was used for pre-post posting assessment. Data collection was done at 2 intervals (To and T1), at day 1 and on the last day (day 15,) of student`s posting. Paired t -test was used to analyse the difference in the attitudes between day 1 and day 15. Results: The nursing students had high scores on negative and positive attitude factors on day 1. On day 15, among 5 negative attitude factors, there was a significant positive change in the stereotypism factor. Conclusion: Nursing student`s placement in psychiatry setting reduces stigmatising attitudes, and as such, psychiatric posting need to remain as a essential practicum requisite incorporated into all levels of nurse training curricula

International Chinese Student Satisfaction towards University Malaysia Sabah’s Nursing Mobility Programme

Background: Over the last few years, Universiti Malaysia Sabah (UMS) as part of its global marketing initiative opened its doors to international students to take up elective as well full time programmes. In September 2017, 36 nursing students from a university in China completed a 12-week elective /mobility programme in UMS

Willingness and Perceived Barriers towards Organ Donation among Student Nurses in Universiti Malaysia Sabah

Organ transplant has become a main stream important medical procedure commonly used in hospitals. However, for organ transplant program to be successful, it heavily relies on the public to voluntarily register for organ procurement. Effort to promote awareness and register public as organ donors has been ongoing, but public response to commit and register as donors has been lukewarm. Arguably, healthcare personnel and nurses are in a key position to educate and advocate for organ donation but often, ironically healthcare personal themselves are reluctant or unwilling to commit as organ donors. Thus, in the context of student nurses in University Malaysia Sabah, the question arise, what is their stance and views regarding organ donation? Objective: The study aims to explore student nurses willingness and perceived barriers towards organ donation. Method: By design, this is a quantitative and descriptive cross-sectional study. Sampling, involved a convenient cohort of all 169 diploma nursing students currently studying in year 1, 2 and 3 in UMS. The study instrument used included a self-rated question adopted from a previous study to assess the willingness and perceived barriers towards organ donation. Findings: Among 169 respondents, only 5.9 % (n=10) were registered organ donors. Among perceived barriers included i) fear of medical side effects or disability (85.7% n=145), ii) religious taboo and beliefs (71.5 % , n=121), iii) family reluctance (65.6% , n=111) iv) and distrust of organ procurement process (51% n=87). Conclusion: There is a gap in commitment towards organ donation associated with a number of perceived barriers among student nurses in UMS. The paper will discuss some pragmatic strategies to address this gap

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Draft genome sequences of two extensively drug-resistant strains of acinetobacter baumannii isolated from clinical samples in Pakistan

Infections in immunocompromised patients that are caused by extensively drug-resistant (XDR) Acinetobacter baumannii strains have been increasingly reported worldwide. In particular, carbapenem-resistant A. baumannii strains are a prominent cause of health care-associated infections. Here, we report draft genome assemblies for two clinical XDR A. baumannii isolates obtained from hospitalized patients in Pakistan

Drones count wildlife more accurately and precisely than humans

Human activities are creating environmental conditions that pose threats and present opportunities for wildlife. In turn, this creates challenges for conservation managers. Some species have benefited from anthropogenic actions. For example, many invasive species profit from human‐assisted dispersal (Banks, Paini, Bayliss, & Hodda, 2015; Hulme, 2009), and mesopredators may thrive following human‐driven loss of top predators (Ritchie & Johnson, 2009). However, in many cases, wildlife populations are undergoing alarming declines, and extinction rates are now as high as 100‐fold greater than the background extinction rate (Ceballos et al., 2015). Ecological monitoring is essential for understanding these population dynamics, and rigorous monitoring facilitates informed management. The effectiveness of management decision‐making is often dependent on the accuracy and timeliness of the relevant ecological data upon which decisions are based, meaning that improvements to data collection methods may herald improved ecological outcomes from management actions