Nosocomial infections in neonatal intensive care units: Cost-effective control strategies in resource-limited countries

Background: Nosocomial infections or hospital-acquired infectionsconstitute a global health problem. They lead to significant morbidity and mortality in both developed and resource-limited countries. The neonatal intensive care unit (NICU) is a suitable environment for disseminating these infections; underscoring the need for preventive intervention measures.Objectives: This review aims to highlight the global burden of nosocomialinfections in neonatal intensive care units (NICUs), to discuss their epidemiology and clinical spectrum, as well as the costeffective control strategies in resource-limited settings.Sources: Sources of information were from Google searches andPubMed- linked articles using the key words- nosocomial infections,neonatal intensive care unit, control. Related articles from hard copiesof medical literature and journals were also gathered.Results: Although paucity of data exists on the incidence of nosocomialinfections in NICUs in developing countries, reports from developedcountries indicate a range of 6% to 25%. Much higher figures were noted in some developing countries. Several risk factors for nosocomial infections were identified but varied in different NICUs surveyed. Effective control strategies have been recommended but hand washing or hand hygiene appears universally applicable in both developed and resource-limitedcountries. Economic analyses of these strategies in developed countrieshave established their costeffectiveness while the adaptability of hand hygiene program to resource-limited settings has been demonstrated in a World Health Organization pilot study in sub- Saharan Africa.Conclusion: Hand washing or hand hygiene by health-care personnelremains the most important evidence-based and cost-effective controlstrategy for the spread of nosocomial infections in NICUs in resource-limited countries.Key words: nosocomial infections; neonatal intensive care unit;control

Local majority dynamics on preferential attachment graphs

Suppose in a graph $G$ vertices can be either red or blue. Let $k$ be odd. At each time step, each vertex $v$ in $G$ polls $k$ random neighbours and takes the majority colour. If it doesn't have $k$ neighbours, it simply polls all of them, or all less one if the degree of $v$ is even. We study this protocol on the preferential attachment model of Albert and Barab\'asi, which gives rise to a degree distribution that has roughly power-law $P(x) \sim \frac{1}{x^{3}}$, as well as generalisations which give exponents larger than $3$. The setting is as follows: Initially each vertex of $G$ is red independently with probability $\alpha < \frac{1}{2}$, and is otherwise blue. We show that if $\alpha$ is sufficiently biased away from $\frac{1}{2}$, then with high probability, consensus is reached on the initial global majority within $O(\log_d \log_d t)$ steps. Here $t$ is the number of vertices and $d \geq 5$ is the minimum of $k$ and $m$ (or $m-1$ if $m$ is even), $m$ being the number of edges each new vertex adds in the preferential attachment generative process. Additionally, our analysis reduces the required bias of $\alpha$ for graphs of a given degree sequence studied by the first author (which includes, e.g., random regular graphs)

Developmental abnormalities of mid and hindbrain: A study of 23 Egyptian patients

Introduction: With the advent of neuroimaging modalities specifically, magnetic resonance imaging (MRI), recognition of developmental defects of posterior fossa has greatly improved. The Aim: Is to delineate the clinical, cytogenetics and radiological features of patients with mid-hindbrain anomalies. Patient and Methods: Twenty-three patients with mid-hind brain malformations were included in this study. Complete clinical evaluation, cytogenetic analysis and neuroradiological study were done for each patient. Patients\' sex ratio was (M: F/ 0.9:1) and the mean age was 2.17 years. Parental consanguinity was 86.9 % and positive family history was recorded in 7 families. Based on clinico-radiological findings, patients were categorized as Joubert syndrome and related cerebellar disorders (34.8%), pontocerebellar hypoplasia (26.1%), lissencephaly cerebellar hypoplasia (13%), isolated cobblestone lissencephaly with normal muscle and eye (8.7%), isolated vermian hypoplasia (13%) and retrocerebellar cyst (4.4%). Results: Cytogenetic analysis revealed abnormalities in 3 patients (13%); pericentric inversion of chromosome 8 in a patient with lissencephaly cerebellar hypoplasia, del 5p14.3-pter delineating Cri du chat syndrome and associated with vermian hypoplasia and del 18q21.1-qter in a patient with retrocerebellar cyst due to paternal balanced translocation t (4;18). FISH for specific locus and whole chromosomal painting were used to document the assigned aberrations. Although most of the cerebellar malformations are of Mendelian inheritance, this study emphasizes the importance of chromosomal analysis for patients with posterior fossa anomalies. With more researches describing clinico-radiological characterization of hind brain dysgenesis will allow better understanding of these disorders, further delineation of relevant syndromes and new genes identification. Keywords: Cerebellar, hindbrain, joubert syndrome, cobblestone lissencephalypontocerebellar hypoplasia, cri du chat syndrome- del 18q21.1-qterEgyptian Journal of Medical Human Genetics Vol. 9 (2) 2008: pp. 215-23

Structures and waves in a nonlinear heat-conducting medium

The paper is an overview of the main contributions of a Bulgarian team of researchers to the problem of finding the possible structures and waves in the open nonlinear heat conducting medium, described by a reaction-diffusion equation. Being posed and actively worked out by the Russian school of A. A. Samarskii and S.P. Kurdyumov since the seventies of the last century, this problem still contains open and challenging questions.Comment: 23 pages, 13 figures, the final publication will appear in Springer Proceedings in Mathematics and Statistics, Numerical Methods for PDEs: Theory, Algorithms and their Application

Left ventricular torsional mechanics and myocardial iron load in beta-thalassaemia major: a potential role of titin degradation

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An explicit total Lagrangian Fragile Points Method for finite deformation of hyperelastic materials

This research explored a novel explicit total Lagrangian Fragile Points Method (FPM) for finite deformation of hyperelastic materials. In contrast to mesh-based methods, where mesh distortion may pose numerical challenges, meshless methods are more suitable for large deformation modelling since they use enriched shape functions for the approximation of displacements. However, this comes at the expense of extra computational overhead and higher-order quadrature is required to obtain accurate results. In this work, the novel meshless method FPM was used to derive an explicit total Lagrangian algorithm for finite deformation. FPM uses simple one-point integration for exact integration of the Galerkin weak form since it employs simple discontinuous polynomials as trial and test functions, leading to accurate results even with single-point quadrature. The proposed method was evaluated by comparing it with FEM in several case studies considering both the extension and compression of a hyperelastic material. It was demonstrated that FPM maintained good accuracy even for large deformations where FEM failed to converge

Updated clinical recommendations for the use of tibolone in Asian women

Tibolone, which is indicated for the relief of climacteric symptoms and the prevention of osteoporosis in postmenopausal women, has a tissue-specific mode of action different to that of conventional hormone replacement therapy (HRT). A large proportion of Asian postmenopausal women experience symptoms that most frequently include musculoskeletal pain, insomnia, forgetfulness, hot flushes and sexual dysfunction, and there is a need to address their specific requirements. Recent studies show that, in comparison to HRT, tibolone is as effective in alleviating menopausal symptoms and preventing bone loss, has a greater positive effect on sexual dysfunction and is associated with less vaginal bleeding, but it is rarely mentioned in guidelines for menopausal treatment. Levels of awareness amongst women about treatments for menopausal symptoms vary between Asian countries but, even in countries where awareness is high, HRT usage is much lower than in the West. To provide a practical approach to the use of tibolone in Asian postmenopausal women, a panel of experts in the management of menopause from 11 Asia Pacific countries has developed recommendations for its use, based on the evidence from clinical studies published since 2005. However, as much of the clinical data reviewed are from international studies, the recommendations and the treatment algorithm presented here are widely applicable

Dynamic dyssynchrony and impaired contractile reserve of the left ventricle in beta-thalassaemia major: an exercise echocardiographic study

BACKGROUND: Performance of the left ventricle during exercise stress in thalassaemia patients is uncertain. We aimed to explore the phenomenon of dynamic dyssynchrony and assess contractile reserve in patients with beta-thalassaemia major and determine their relationships with myocardial iron load. METHODS AND RESULTS: Thirty-two thalassaemia patients (16 males), aged 26.8+/-6.9 years, without heart failure and 17 healthy controls were studied. Their left ventricular (LV) volumes, ejection fraction, systolic dyssynchrony index (SDI), and myocardial acceleration during isovolumic LV contraction (IVA) were determined at rest and during submaximal bicycle exercise testing using 3-dimensional and tissue Doppler echocardiography. Myocardial iron load as assessed by T2* cardiac magnetic resonance in patients were further related to indices of LV dyssynchrony and contractile reserve. At rest, patients had significantly greater LV SDI (p4.6%, control+2SD) increased from baseline 25% to 84% in patients. Delta SDI(exercise-baseline) correlated with exercise-baseline differences in LV ejection fraction (p<0.001) and stroke volume (p = 0.006). Compared with controls, patients had significantly less exercise-induced increase in LV ejection fraction, cardiac index, and IVA (interaction, all p<0.05) and had impaired contractile reserve as reflected by the gentler IVA-heart rate slope (p = 0.018). Cardiac T2* in patients correlated with baseline LV SDI (r = -0.44, p = 0.011) and IVA-heart rate slope (r = 0.36, p = 0.044). CONCLUSIONS: Resting LV dyssynchrony is associated with myocardial iron load. Exercise stress further unveils LV dynamic dyssynchrony and impaired contractile reserve in patients with beta-thalassaemia major.published_or_final_versio

Scale invariance and universality of force networks in static granular matter

Force networks form the skeleton of static granular matter. They are the key ingredient to mechanical properties, such as stability, elasticity and sound transmission, which are of utmost importance for civil engineering and industrial processing. Previous studies have focused on the global structure of external forces (the boundary condition), and on the probability distribution of individual contact forces. The disordered spatial structure of the force network, however, has remained elusive so far. Here we report evidence for scale invariance of clusters of particles that interact via relatively strong forces. We analyzed granular packings generated by molecular dynamics simulations mimicking real granular matter; despite the visual variation, force networks for various values of the confining pressure and other parameters have identical scaling exponents and scaling function, and thus determine a universality class. Remarkably, the flat ensemble of force configurations--a simple generalization of equilibrium statistical mechanics--belongs to the same universality class, while some widely studied simplified models do not.Comment: 15 pages, 4 figures; to appear in Natur