Prevalence, antibiotic susceptibility profiles and ESBL production in Klebsiella pneumoniae and Klebsiella oxytoca among hospitalized patients

Background and Purpose: Klebsiella pneumoniae and Klebsiella oxytoca are the two most common pathogens causing nosocomial infections in humans and are of great concern for developing multidrug resistance. In the present study, K. pneumoniae and K. oxytoca from clinical samples were evaluated for their antibiotic sensitivity patterns against commonly used antibiotics and production of extended-spectrum beta-lactamase (ESBL). Materials and Methods: The isolates were obtained from tracheal swabs, sputum, wound swabs, pus, blood and urine samples of hospitalized patients. Klebsiella pneumoniae and Klebsiella oxytoca were identified by cultural and biochemical methods. Antibiotic sensitivity test was performed by modified Kirby-Bauer disc diffusion technique. ESBL production in Klebsiella spp. was confirmed by double disc synergy test. Results and Conclusion: Out of 500 clinical isolates, 120 were found positive for Klebsiella among which 108 were K. pneumoniae and 12 were K. oxytoca based on indole test. Prevalence rate of Klebsiella was found more prominent in males aged over 50 years, mostly in urine samples. Overall resistance pattern of Klebsiella isolates to Ampicillin, Amoxicillin, Ceftriaxone, Ciprofloxacin, Co-trimoxazole, Gentamicin, Nalidixic acid, Tetracycline was 100%, 90%, 45%, 40%, 45%, 25%, 50%, 35% respectively. Multidrug resistance was found more common in K. pneumoniae (56%) than in K. oxytoca (50%). Prevalence rate of ESBL producing Klebsiella was found 45% among which K. pneumoniae (50%) were found more prominent than K. oxytoca (25%). All the ESBL producing Klebsiella isolates were found to be multidrug resistant, showing 100% resistance to Ampicillin, Amoxicillin, Ceftriaxone and Ciprofloxacin

Relationship between inter-arm blood pressure differences and predicted future cardiovascular risk in hypertensive patients

Background: Hypertension stands as a widely recognized significant risk factor for cardiovascular disease. In clinical practice, it is advisable to measure blood pressure (BP) in both arms. The increasing attention on inter-arm blood pressure difference (IABPD) stems from its association with cardiovascular disease. This study aimed to assess the relationship between inter-arm blood pressure differences and predicted future cardiovascular risk in hypertensive patients. Methods: This cross-sectional study was conducted at the department of cardiology, Chittagong Medical College Hospital from July 2020 to June 2021. The study included 428 cases of previously or newly diagnosed hypertension, selected through convenient sampling. Data analysis was conducted using Microsoft Office tools and statistical package for the social sciences (SPSS) version 23.0. Results: In this study, 8.2% of patients exhibited noteworthy systolic IAD, and 2.3% demonstrated notable diastolic IAD. Median 10-year cardiovascular risk, assessed by Framingham and ASCVD calculators, was 21% and 11% respectively. A positive correlation was observed between sIAD and 10-year cardiovascular risk (p=0.003) and sIAD and 10-year ASCVD risk (p=0.041). Patients with significant sIAD had a higher incidence of ischemic heart disease compared to those without (p=0.041). Multiple regression analysis revealed a significant correlation between 10-year Framingham cardiovascular risk and sIAD (p=0.003). Conclusions: A significant difference in systolic blood pressure between arms is linked to a higher 10-year cardiovascular risk and the presence of cardiovascular disease in well-managed hypertensive patients. So, monitoring sIAD could be an additional factor in predicting future cardiovascular events in patients receiving hypertension treatment

Forecasting wholesale price of coarse rice in Bangladesh: A seasonal autoregressive integrated moving average approach

Abstract This article attempts to develop the model and to forecast the wholesale price of coarse rice in Bangladesh. Seasonal Autoregressive Integrated Moving Average (SARIMA) models have been developed on the monthly data collected from July 1975 to December 2011and validated using the data from December 2010 to December 2011. The results showed that the predicted values were consistent with the upturns and downturns of the observed series. The model with non seasonal autoregressive 1, difference 1 and moving average 1 and seasonal difference 1 and moving average 1 that is SARIM

ES2009-90084 SIMULATION STUDY ON A HYBRID SOLID OXIDE FUEL CELL (SOFC) -HEAT RECOVERY STEAM GENERATOR (HRSG) -GAS TURBINE IN IGCC POWER PLANT

ABSTRACT The fuel cell model developed to this research is based on a solid oxide fuel cell (SOFC) integrated with a heat recovery steam generator (HRSG), a gas turbine (GT) and a steam turbine (ST). Three possible technological approaches are compared to suggest the desirable combine cycle. First approach indicates the generation of the required steam in the coupled SOFC and gas turbine cycle. Then the exhaust gas from gas turbine involves driving the HRSG. And the last one involves of using exhaust gases in the HRSG which drives the steam turbine by producing steam for additional power works. To achieve the more efficient conversation of the thermal energy to power output, the component design mainly HRSG and steam turbine have to be made in a great concern. And HRSG is considered as a triple pressure for the taken model. This article is also delineated the analysis of coal fed instead of normal methane gas fed, for the reforming power generation based on thermodynamic processes including CO 2 Capture. External reforming in SOFC-HRSG plants fueled by high quality coal enhances efficiency due to improved exhaust heat recovery and higher voltage produced by higher hydrogen partial pressure in the anode inlet. For improving the whole cycle efficiency, power output generation from both SOFC and conventional system (steam turbine and gas turbine) are described as combine system. This model is simulated by the ASPEN plus software which is able to provide thermodynamic and parametric analysis to evaluate the effects of various parameters like air flow rate, temperature, pressure and fuel flow rate on the system performance. Some MATLAB simulations are also added to provide strong opinion for this model through this paper

Factors associated with teenage marital pregnancy among Bangladeshi women

<p>Abstract</p> <p>Background</p> <p>Teenage pregnancy is a public health concern both in developed and developing world. In Bangladesh, most of the first pregnancies occur immediately after marriage, especially among teenagers. Although women aged 15-29 years are the most fertility contributing women in Bangladesh, studies are not yet conducted on teenage pregnancy within this group of women. In the current study, an attempt had been made to identify the factors affecting teenage marital pregnancy in women aged 15-29 years.</p> <p>Methods</p> <p>A cross sectional survey was carried out in 389 women, selected with a convenience sampling technique. Participants were selected on the basis of two criteria, such as married women and age within 15-29 years. We excluded women aged more than 29 years as we attempted to conduct study within high fertility contributing women and with the assumption that they may provide data subjected to relatively high level of recall bias as marital pregnancy may be a longer past event to them. In the analysis, we applied bi-variate and multi-variate logistic regression technique to find out odds ratio of teenage marital pregnancy.</p> <p>Results</p> <p>Result revealed that 72.5% of the participants experienced first marital pregnancy during their teenage, with a mean age of 17.88 years (SD = 2.813). Multivariate logistic regression analysis revealed that participants aged 20-24 years had higher likelihood (OR 1.971, 95% CI 1.132 to 3.434), whereas participants aged 25-29 years had lower likelihood (OR 0.054, 95% CI 0.016 to 0.190) of experiencing teenage marital pregnancy compared to participants aged 15-19 years. In addition, participants desired for >2 children had significant higher odds (OR 3.573, 95% CI 1.910 to 6.684) and participants born in urban area had significant lower odds (OR 0.458, 95% CI 0.228 to 0.919) for teenage marital pregnancy.</p> <p>Conclusions</p> <p>Based on the findings, we conclude that in order to reduce teenage marital pregnancy, consideration should be given on women's desired number of children and birth place so that women's desired number of children is limited to within two children, and that rural women get increased working and other related opportunities that may contribute in delaying teenage pregnancy.</p

Association of latent class analysis-derived multimorbidity clusters with adverse health outcomes in patients with multiple long-term conditions: Comparative results across three UK cohorts

Background It remains unclear how to meaningfully classify people living with multimorbidity (multiple long-term conditions (MLTCs)), beyond counting the number of conditions. This paper aims to identify clusters of MLTCs in different age groups and associated risks of adverse health outcomes and service use. Methods Latent class analysis was used to identify MLTCs clusters in different age groups in three cohorts: Secure Anonymised Information Linkage Databank (SAIL) (n = 1,825,289), UK Biobank (n = 502,363), and the UK Household Longitudinal Study (UKHLS) (n = 49,186). Incidence rate ratios (IRR) for MLTC clusters were computed for: all-cause mortality, hospitalisations, and general practice (GP) use over 10 years, using <2 MLTCs as reference. Information on health outcomes and service use were extracted for a ten year follow up period (between 01st Jan 2010 and 31st Dec 2019 for UK Biobank and UKHLS, and between 01st Jan 2011 and 31st Dec 2020 for SAIL). Findings Clustering MLTCs produced largely similar results across different age groups and cohorts. MLTC clusters had distinct associations with health outcomes and service use after accounting for LTC counts, in fully adjusted models. The largest associations with mortality, hospitalisations and GP use in SAIL were observed for the “Pain+” cluster in the age-group 18–36 years (mortality IRR = 4.47, hospitalisation IRR = 1.84; GP use IRR = 2.87) and the “Hypertension, Diabetes & Heart disease” cluster in the age-group 37–54 years (mortality IRR = 4.52, hospitalisation IRR = 1.53, GP use IRR = 2.36). In UK Biobank, the “Cancer, Thyroid disease & Rheumatoid arthritis” cluster in the age group 37–54 years had the largest association with mortality (IRR = 2.47). Cardiometabolic clusters across all age groups, pain/mental health clusters in younger groups, and cancer and pulmonary related clusters in older age groups had higher risk for all outcomes. In UKHLS, MLTC clusters were not significantly associated with higher risk of adverse outcomes, except for the hospitalisation in the age-group 18–36 years. Interpretation Personalising care around MLTC clusters that have higher risk of adverse outcomes may have important implications for practice (in relation to secondary prevention), policy (with allocation of health care resources), and research (intervention development and targeting), for people living with MLTCs. Funding This study was funded by the National Institute for Health and Care Research (NIHR; Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity)—NIHR202020)