On the differentiation of dead from living Mycobacterium leprae

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Repercussion of biofilm and antibiotic resistance in ventilator associated pneumonia

Background: Ventilator associated pneumonia contributes nearly half of all cases of hospital-acquired pneumonia. Drug resistance among ventilator associated pneumonia has obligation of device withdrawal in order to achieve clinical and microbiological cure. Aim of the study was to determine the relationship between antibiotic resistance of Endotracheal tube biofilm and pulmonary pathogens in ventilator-associated pneumonia.Methods: A descriptive analytical study of 100 clinically suspected VAP patients was done. Patients were divided into group-I and Group-II based on intubation duration for 1-5 days and 6-10 days respectively. Endotracheal aspirate (ETA) was collected from clinically diagnosed cases and processed as per standard microbiological techniques. Bacterial counts ≥106 CFU/ml for quantitative cultures was considered significant. Biofilm production was detected by tissue culture plate, tube method and Congo red method. Multi-variant analysis was done to find out the association of the various factors.Results: Klebsiella pneumoniae was the predominant bacteria isolated followed by Acinetobacter baumannii. 45% of Gram negative bacteria were β lactamase producers. In Biofilm production by tissue culture method, 72% of the isolates showed either strong or moderate biofilm formation. Multivariate analysis revealed that bacteria isolated from VAP occurring after 5 days of mechanical ventilation among prior antibiotic-treated patients were resistant to all the antibiotics tested.Conclusions: Bacterial aetiology, biofilm formation and drug resistance has ramification on outcome of ventilator associated pneumonia. Hence, advised that it is crucial to remove ET tube in regular interval to prevent biofilm formation and sequential cultures to obtain the microbiological information which enables better patient care.

Distinct Clinicopathologic Clusters of Persons with TDP-43 Proteinopathy

To better understand clinical and neuropathological features of TDP-43 proteinopathies, data were analyzed from autopsied research volunteers who were followed in the National Alzheimer’s Coordinating Center (NACC) data set. All subjects (n = 495) had autopsy-proven TDP-43 proteinopathy as an inclusion criterion. Subjects underwent comprehensive longitudinal clinical evaluations yearly for 6.9 years before death on average. We tested whether an unsupervised clustering algorithm could detect coherent groups of TDP-43 immunopositive cases based on age at death and extensive neuropathologic data. Although many of the brains had mixed pathologies, four discernible clusters were identified. Key differentiating features were age at death and the severity of comorbid Alzheimer’s disease neuropathologic changes (ADNC), particularly neuritic amyloid plaque densities. Cluster 1 contained mostly cases with a pathologic diagnosis of frontotemporal lobar degeneration (FTLD-TDP), consistent with enrichment of frontotemporal dementia clinical phenotypes including appetite/eating problems, disinhibition and primary progressive aphasia (PPA). Cluster 2 consisted of elderly limbic-predominant age-related TDP-43 encephalopathy (LATE-NC) subjects without severe neuritic amyloid plaques. Subjects in Cluster 2 had a relatively slow cognitive decline. Subjects in both Clusters 3 and 4 had severe ADNC + LATE-NC; however, Cluster 4 was distinguished by earlier disease onset, swifter disease course, more Lewy body pathology, less neocortical TDP-43 proteinopathy, and a suggestive trend in a subgroup analysis (n = 114) for increased C9orf72 risk SNP rs3849942 T allele (Fisher’s exact test p value = 0.095). Overall, clusters enriched with neocortical TDP-43 proteinopathy (Clusters 1 and 2) tended to have lower levels of neuritic amyloid plaques, and those dying older (Clusters 2 and 3) had far less PPA or disinhibition, but more apathy. Indeed, 98% of subjects dying past age 85 years lacked clinical features of the frontotemporal dementia syndrome. Our study revealed discernible subtypes of LATE-NC and underscored the importance of age of death for differentiating FTLD-TDP and LATE-NC

Changing foreign policy: the Obama Administration’s decision to oust Mubarak

This paper analyses the decision of the Obama administration to redirect its foreign policy towards Egypt in the wake of the Arab Spring. It attempts to highlight the issue of how governments deal with decision-making at times of crisis, and under which circumstances they take critical decisions that lead to major shifts in their foreign policy track record. It focuses on the process that led to a reassessment of US (United States) foreign policy, shifting from decades of support to the autocratic regime of Hosni Mubarak, towards backing his ouster. Specifically, the paper attempts to assess to what extent the decision to withdraw US support from a longstanding state-leader and ally in the Middle East can be seen as a foreign policy change (FPC). A relevant research question this paper pursues is: how can the withdrawal of US support to a regime considered as an ally be considered, in itself, as a radical FPC

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Impaired contractile function of the supraspinatus in the acute period following a rotator cuff tear

Background: Rotator cuff (RTC) tears are a common clinical problem resulting in adverse changes to the muscle, but there is limited information comparing histopathology to contractile function. This study assessed supraspinatus force and susceptibility to injury in the rat model of RTC tear, and compared these functional changes to histopathology of the muscle. Methods: Unilateral RTC tears were induced in male rats via tenotomy of the supraspinatus and infraspinatus. Maximal tetanic force and susceptibility to injury of the supraspinatus muscle were measured in vivo at day 2 and day 15 after tenotomy. Supraspinatus muscles were weighed and harvested for histologic analysis of the neuromuscular junction (NMJ), intramuscular lipid, and collagen. Results: Tenotomy resulted in eventual atrophy and weakness. Despite no loss in muscle mass at day 2 there was a 30% reduction in contractile force, and a decrease in NMJ continuity and size. Reduced force persisted at day 15, a time point when muscle atrophy was evident but NMJ morphology was restored. At day 15, torn muscles had decreased collagen-packing density and were also more susceptible to contraction-induced injury. Conclusion: Muscle size and histopathology are not direct indicators of overall RTC contractile health. Changes in NMJ morphology and collagen organization were associated with changes in contractile function and thus may play a role in response to injury. Although our findings are limited to the acute phase after a RTC tear, the most salient finding is that RTC tenotomy results in increased susceptibility to injury of the supraspinatus

Pneumococcal infection of respiratory cells exposed to welding fumes; Role of oxidative stress and HIF-1 alpha

Colt Foundation: CF/05/12