Metallo-βeta-Lactamase Detection Comparative Evaluation of Double-Disk Synergy versus Combined Disk Tests

Objective: To establish (i) if carbapenemases are a major cause of carbapenem resistance in Enterobacteriaceae and belong to metallo- β-lactamases (ii) Which one is the best phenotypic method for the detection of metallo- β-lactamases. Patients and Methods: This cross-sectional study was conducted at pathology department, Punjab Institute of Cardiology Lahore. Samples were randomly enrolled from daily lab work and analysed. During the period of September 2016 to January 2017, a total of 2970 clinical samples were enrolled and processed for bacterial culture. Every isolate of Enterobacteriaceae was processed for detection of carbapenem resistance and for the detection of carbapenemases producers by modified Hodge test. Metallo- β-lactamases detection (MBL) was done by three different phenotypic techniques, (i) Combined disk technique (0.1 M EDTA), (ii) (0.5 M EDTA). (iii) Double disk synergy technique (DSST). Results: Out of total n=2970 samples, 38.7% (n=1150) were culture positive of which 40.5% (n=550) were Enterobacteriaceae. Among these, 9.0 % (n=50) were carbapenem-resistant; 98% (49/50) were carbapenemase producers (modified Hodge test -Positive). According to (i) Combined disk technique (0.1 M EDTA), 98% (48/49) were metallo- β-lactamases positive (ii) Combined disk technique (0.5 M EDTA), 86% (42/49) were metallo- β-lactamases, 2% (1/49) were non-determinable (iii) Double disk synergy technique (DDST) showed 100% (49/49) isolates were metallo- β-lactamases positive. Chloramphenicol and Tigecycline were found sensitive in 28% and 16% respectively; all other antimicrobials were highly resistant against carbapenem-resistant isolates. Conclusion: Carbapenemases are a major cause of carbapenem resistance in Enterobacteriaceae. Double-disk synergy technique is good for the detection of MBL as compared to other phenotypic methods. Each carbapenemresistant isolate of Enterobacteriaceae should be process for the detection of Carbapenemase especially MBL

Game Accessibility: Konzeption eines barrierearmen Serious Games

Serious Games schaffen positive spielerische Erfahrungen, wodurch sie Lernvorgänge unterstützen und so ein großes Potenzial für die zielführende Weiterentwicklung der Lehre bergen. Aufgrund von Barrieren, wie beispielsweise unzureichenden Farbkontrasten, hat jedoch nicht jede*r Lernende Zugang zu den Spielinhalten. Folglich können die spielerischen Lernaktivitäten nicht absolviert werden und der Mehrwert des spielerischen Lernens bleibt verwehrt. Um einen inklusiven Hochschulalltag zu erreichen, müssen Lernmaterialien jeder Form, spielerisch oder nicht, für alle gleichermaßen zugänglich sein. Zum Erreichen dieses Ziels stellt dieser Beitrag anleitende Maßnahmen und einen Workflow der Game Accessibility Guidelines (G A G) vor, welche die Anforderungen und Schritte des Entwicklungsprozesses eines barrierearmen Spiels definieren. Weiterführend wird der vorgestellte Prozess anhand eines an der Goethe-Universität entwickelten ernsthaften Lernspiels, „Lolas erstes Semester“, angewandt. Es wird dargelegt, dass die barrierearme Aufbereitung eines Spiels nicht nur Spielenden mit einer kognitiven oder physischen Beeinträchtigung zugutekommt, sondern vielmehr allen Spielenden

Inklusive Campuspläne: Anforderungen, State of the Art und Umsetzungsmöglichkeiten

Die Teilnahme am Bildungsalltag beginnt damit, dass man sich am Campus orientieren kann. Unter einem inklusiven Campusplan wird im Rahmen dieses Beitrags ein interaktiver und barrierefreier Online-Campusplan verstanden, der auf physische Barrieren hinweist und inklusive Angebote der Universität hervorhebt. Zu diesen Angeboten zählen beispielsweise Informationen zu barrierefreien Zugängen, Standorten von Beratungsstellen, Wickeltischen sowie (All-Gender-) Toiletten. Zudem muss der Plan in der Bedienung barrierefrei sein, sodass Nutzende von assistiven Technologien, wie z.B. einem Screenreader, einen gleichwertigen Zugang haben wie ihre Kommiliton*innen bzw. Kolleg*innen. Ein Ziel ist es, eine nachhaltige Lösung zur Umsetzung eines inklusiven Campusplans zu finden. Eine Untersuchung des State of the Art von barrierefreien Campusplänen gibt einen Überblick über die möglichen inhaltlichen Merkmale sowie die technischen Umsetzungen. Anschließend werden Problemstellungen und Lösungsansätze diskutiert, sodass dieser Beitrag eine Grundlage für die Umsetzung eines inklusiven Campusplans bietet

Enhanced Time-of-Use Electricity Price Rate Using Game Theory

The emergence of the Demand Response (DR) program optimizes the energy consumption pattern of customers and improves the efficacy of energy supply. The pricing infra-structure of the DR program is dynamic (time-based). It has rather complex features including marginal costs, demand and seasonal parameters. There is variation in DR price rate. Sometime prices go high (peak load) if the demand of electricity is more than the generation capacity. The main objective of DR is to encourage the consumer to shift the peak load and gets incentives in terms of cost reduction. However, prices remain the same for all the users even if they shift the peak load or not. In this work, Game Theory (GT)-based Time-of-Use (ToU) pricing model is presented to define the rates for on-peak and shoulder-peak hours. The price is defined for each user according to the utilize load. At first, the proposed model is examined using the ToU pricing scheme. Afterward, it is evaluated using existing day-ahead real-time pricing scheme. Moreover, shifting load from on-peak hours to off-peak hours may cause rebound peak in off-peak hours. To avert this issue, we analysis the impact of Salp Swam Algorithm (SSA) and Rainfall Algorithm (RFA) on user electricity bill and PAR after scheduling. The experimental results show the effectiveness of the proposed GT-based ToU pricing scheme. Furthermore, the RFA outperformed SSA

Prevalence of Secondary Hyperparathyroidism in Hemo- Dialysis Patients

Introduction: One persistent complication of chronic kidney disease is secondary hyperparathyroidism. Early diagnosis of this disease will reduce morbidity in patients undergoing hemodialysis. Aims & Objectives: To determine the prevalence of secondary hyperparathyroidism in chronic kidney disease patients at National Institute of Kidney Diseases, SZH Lahore. Place and Duration of Study: A cross sectional study was conducted at Nephrology Department of Shaikh Zayed Hospital (SZH) Lahore after getting approval from Institutional Review Board of National Health Research Complex (NHRC). It was conducted from September 2023 to November 2023 &140 hemo-dialysis patients were selected. Material & Methods: We measured serum parathyroid hormone, hemoglobin and other variables, at Biochemistry laboratory of Sheikh Zayed Hospital, in 140 hemodialysis patients. Serum samples were measured for PTH levels using ELISA method. The data was analyzed using SPSS version 20.P value ? 0.05 was considered significant. Results: Fifteen patients had secondary hyperparathyroidism out of 140 hemodialysis patients. Hyperparathyroidism was observed in 10.71 % of the patients. Hyperparathyroidism patients had significantly low calcium, hemoglobin levels & higher phosphate levels. Conclusion: The prevalence of secondary hyperparathyroidism is low at 10.71% of patients undergoing hemodialysis at National Institute of Kidney Disease, SZH Lahore

Applications of Metformin in Dentistry—A review

الملخص: الميتفورمين دواء متعدد الاستخدامات وله استخدامات عديدة في مجال الطب. في المقام الأول، يُعرف بأنه عقار مضاد لارتفاع سكر الدم، وقد أصبح الدواء الأول عن طريق الفم لخفض نسبة الجلوكوز في الدم لعلاج داء السكري من النوع الثاني على مستوى العالم. توضح الأدبيات الحالية أيضا استخدام الميتفورمين في مجموعة متنوعة من أمراض الفم وطب الأسنان بشكل عام. أفادت التجارب السريرية الحديثة عن فعالية التطبيق الموضعي المساعد للميتفورمين في تحسين معايير اللثة لمرضى السكري المصابين بالتهاب دواعم السن. بالإضافة إلى ذلك، أشارت الدراسات إلى أنه يضفي تمايزا سنيا وكذلك تخليقا معدنيا للخلايا الجذعية في لب الأسنان. كما أنه يحفز تكاثر بانيات العظم ويقلل من نشاط ناقضات العظم مع الميل إلى ممارسة تأثير تجديدي على عظم دواعم السن مما يجعله مرشحا حيويا لتجديد اللثة. كما يعزز العلاج الأحادي بالميتفورمين الاندماج العظمي للغرسات الداخلية بشكل كبير. وذكرت بعض الدراسات أيضا أن له آثارا مضادة للسرطان على سرطان الخلايا الحرشفية عن طريق إعاقة تطور الورم. كما توض1ح بعض الأدبيات أيضا تأثيره الإيجابي في تحسين حركة الأسنان التقويمية ومقاومة تآكل أجهزة تقويم الأسنان في النماذج الحيوانية. تهدف هذه المراجعة السردية الحالية إلى تقديم ملخص حديث للبحوث العلمية حول الاستخدامات المحتملة للميتفورمين فيما يتعلق بمجال طب الأسنان. Abstract: Metformin is a versatile drug with numerous medical uses. It is known primarily as an anti-hyperglycemic drug that has become the main oral blood-glucose-lowering medication for managing type 2 diabetes mellitus globally. Its use has been reported in a variety of oral conditions and dentistry in general. Recent clinical trials have indicated the effectiveness of adjunct topical application of metformin in improving the periodontal parameters of patients with diabetes and periodontitis. Additionally, studies have suggested that metformin stimulates odontogenic differentiation and mineral synthesis of stem cells in the tooth pulp. Metformin also stimulates osteoblast proliferation, decreases osteoclast activity and exerts regenerative effects on periodontal bone, thus making it a viable candidate for periodontal regeneration. Metformin monotherapy significantly enhances osseointegration of endosseous implants and has been reported to have anti-cancer effects on oral squamous cell carcinoma by impeding tumor progression. Animal studies have indicated that metformin improves orthodontic tooth movement and resists orthodontic appliance corrosion. This narrative review aims to provide a current summary of research highlighting the prospective uses of metformin in dentistry