Intra-Abdominal Candidiasis

Intra-abdominal candidiasis (IAC) is the second most common form of invasive candidiasis after candidaemia. IAC is a broad term and can be classified on the basis of anatomical site (Candida peritonitis, pancreatic candidiasis, biliary tract candidiasis, gastrointestinal candidiasis, and hepatosplenic candidiasis) as well as clinical setting (community acquired versus nosocomial). The risk factors linked with IAC are candida colonisation, anastomotic leak, multiple instrumentation, long-term broad spectrum antibiotic use, total parenteral nutrition, and immunocompromised state. Clinically, IAC is not different from intraabdominal bacterial infection. Patients generally present with signs and symptoms of intra-abdominal sepsis after not responding to antibiotic therapy and with a background history of multiple surgical interventions or history of delayed source control. Radiological investigations, like ultrasonography and computed tomography scan, not only aid in diagnosis but also assist in differentiating medical from surgical cases. Microbiological diagnosis requires isolation of candida from an intra-abdominal specimen. Differentiation between colonisation and infection is difficult. Generally, progressive and persistent colonisation is associated with high risk of infection. Blood cultures have poor sensitivity for IAC. Non-culture based techniques used for diagnosis are mannan/anti-mannan assay, beta-D glucan assay, and validated polymerase chain reaction. Four types of antifungal strategies described in the literature are prophylaxis (risk factor driven), pre-emptive (colonisation or biomarker driven), empirical (fever driven), and targeted therapy (microbiology driven). Over recent years, global epidemiology has shown a shift from Candida albicans to non-albicans. Local epidemiology plays an important role in selection of the appropriate empirical therapy. The purpose of this review is to discuss different types of IAC based on their classification, risk factors, and management

Technology-Assisted Teachers' Training to Promote Socioemotional Well-Being of Children in Public Schools in Rural Pakistan.

BACKGROUND:The World Health Organization's (WHO) Eastern Mediterranean Regional Office (EMRO) developed a school mental health program (SMHP) to help reduce the burden of youth mental health problems. Designed in collaboration with international consultants, the SMHP draws on evidence-based interventions to train personnel to identify students in need, respond therapeutically, and engage families in seeking care. METHODS:Teams from Pakistan, Egypt, Iran, and Jordan collaborated with the WHO EMRO and British and U.S. universities to form the School Health Implementation Network: Eastern Mediterranean Region (SHINE), a National Institute of Mental Health-funded global mental health hub. SHINE partners used a "theory of change" process to adapt the SMHP to be more readily adopted by school personnel and replicated with fidelity. The adapted SMHP more directly addresses teachers' priorities and uses technology to facilitate training. RESULTS:A cluster-randomized implementation effectiveness trial enrolling 960 children ages 8-13 in 80 Pakistani schools will test the adapted SMHP against the original. Children who screen positive on first the teacher and subsequently the parent Strengths and Difficulties Questionnaires (SDQs) will be enrolled and tracked for 9 months. The primary trial outcome is reduction in parent-rated SDQ total difficulties scores. Secondary outcomes include children's well-being, academic performance, absenteeism, and perceived stigma; parent-teacher interaction; teachers' self-efficacy and subjective well-being; and school environment. Implementation outcomes include change in teachers' behavior and sense of program acceptability, cultural appropriateness, feasibility, penetration, and sustainability. NEXT STEPS:The trial began in October 2019, and the expected completion date is March 2021. Outcomes will inform dissemination of the SMHP in Pakistan and elsewhere

Structural, Surface, in vitro Bacterial Adhesion and Biofilm Formation Analysis of Three Dental Restorative Composites

This study was conducted to investigate the relationship between dental materials and bacterial adhesion on the grounds of their chemical composition and physical properties. Three commercially available dental restorative materials (Filtek™Z350, Filtek™P90 and Spectrum®TPH®) were structurally analyzed and their wettability and surface roughness were evaluated by using Fourier Transform Infrared Spectroscopy, Contact Angle Measurement and Atomic Force Microscopy, respectively. These materials were molded into discs and tested with three bacterial strains (Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia) for microbial attachment. The bacterial adhesion was observed at different time intervals, i.e., 0 h, 8 h, 24 h, 48 h and 72 h, along with Colony Forming Unit Count and Optical Density measurement of the media. It was found that all materials showed a degree of conversion with time intervals, i.e., 0 h, 8 h, 24 h, 48 h and 72 h, which led to the availability of functional groups (N–H and C–H) that might promote adhesion. The trend in difference in the extent of bacterial adhesion can be related to particle size, chemical composition and surface wettability of the dental materials

Technology-Assisted Teachers' Training to Promote Socioemotional Well-Being of Children in Public Schools in Rural Pakistan.

BACKGROUND The World Health Organization's (WHO) Eastern Mediterranean Regional Office (EMRO) developed a school mental health program (SMHP) to help reduce the burden of youth mental health problems. Designed in collaboration with international consultants, the SMHP draws on evidence-based interventions to train personnel to identify students in need, respond therapeutically, and engage families in seeking care. METHODS Teams from Pakistan, Egypt, Iran, and Jordan collaborated with the WHO EMRO and British and U.S. universities to form the School Health Implementation Network: Eastern Mediterranean Region (SHINE), a National Institute of Mental Health-funded global mental health hub. SHINE partners used a "theory of change" process to adapt the SMHP to be more readily adopted by school personnel and replicated with fidelity. The adapted SMHP more directly addresses teachers' priorities and uses technology to facilitate training. RESULTS A cluster-randomized implementation effectiveness trial enrolling 960 children ages 8-13 in 80 Pakistani schools will test the adapted SMHP against the original. Children who screen positive on first the teacher and subsequently the parent Strengths and Difficulties Questionnaires (SDQs) will be enrolled and tracked for 9 months. The primary trial outcome is reduction in parent-rated SDQ total difficulties scores. Secondary outcomes include children's well-being, academic performance, absenteeism, and perceived stigma; parent-teacher interaction; teachers' self-efficacy and subjective well-being; and school environment. Implementation outcomes include change in teachers' behavior and sense of program acceptability, cultural appropriateness, feasibility, penetration, and sustainability. NEXT STEPS The trial began in October 2019, and the expected completion date is March 2021. Outcomes will inform dissemination of the SMHP in Pakistan and elsewhere

Pattern of urinary albumin excretion in normotensive young and adolescent Indian women with polycystic ovary syndrome

Objective: Polycystic ovarian syndrome (PCOS) is a clinically heterogeneous endocrine disorder affecting up to 4-8% of women of reproductive age. The aim of this study was to evaluate the presence of microalbuminuria in women with PCOS and study its correlation with the various metabolic, clinical, and hormonal parameters. Materials and Methods: A cross-sectional study involving 69 PCOS women was carried out in a tertiary care center hospital. The diagnosis of PCOS was made according to the Rotterdam criteria. Blood samples were collected in the follicular phase of the menstrual cycle and analyzed for fasting luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), 17-hydroxyprogesterone (17-OHP), total testosterone (T), glucose, insulin, and lipid profile. Urinary albumin was measured in the first void spot urine sample. Results: The mean age of the subjects was 22.0 ± 4.1 years and 21.8 ± 4.7 years in normoalbuminuric and microalbuminuric groups, respectively. Urinary albumin excretion (UAE) varied from 5 mg/l to 100 mg/ml, with a median of 5 mg/l. Microalbuminuria was observed in 17/69 (24.6%) of subjects. The mean UAE was 3.65 ± 4.44 mg/l in the normoalbuminuria group versus 45.29 ± 22.74 mg/l in the microalbuminuria group. Upon univariate analysis, hip circumference, diastolic blood pressure, and fasting blood glucose showed significant correlations with urinary albumin concentration (r = 0.264, 0.264, and 0.551, respectively; P = 0.028, 0.029, and 0.000, respectively). No association between UAE and the usual cardiovascular risk factors could be found upon regression analysis. Conclusion: About 24.6% of women with PCOS showed presence of microalbuminuria in the first void spot urine sample. Screening for the presence of microalbuminuria can help in early identification of a subset of PCOS women with a high risk for future CVD, who can be subjected to preventive strategies at the earliest. However, further studies are needed before recommending routine use of UAE in PCOS cases for the detection of CVD risk