Ampicillin-Sulbactam for the Treatment of Aspiration Pneumonia in Patients with Opioid Overdose: A Randomized Controlled Clinical Trial

Background: Aspiration pneumonia is among overdose complications, requiring timely appropriate treatment. The present study aimed to evaluate the effects of ampicillin-sulbactam, compared to our usual regimen ceftriaxone + clindamycin on aspiration pneumonia in opioid-poisoned patients.Methods: In a randomized-controlled clinical trial, opioid-poisoned patients with aspiration pneumonia were randomly divided into the experimental and control groups to receive ampicillin-sulbactam 3 g Intravenously (IV) every 6 hours (experimental group) and ceftriaxone 1 g IV every 12 hours + clindamycin 600 mg IV every 8 hours (control group) followed by co-amoxiclav 625 mg orally every 8 hours and cefixime 400 mg once daily + clindamycin 600 mg orally every 8 hours in experimental and control groups, respectively, to complete a 7-day course of therapy. White blood cell count and temperature (axillary) at baseline and the third day of the intervention and the treatment outcome on the third day of the intervention, defined as either complete response, partial response, or failure, were evaluated and recorded for all patients.Results: Except for the number of cases of leukocytosis on the third day of the intervention, i.e., lower in the control group (5 patients, 26.30%) than the experimental group (13 patients, 68.40%) (P=0.020), no significant difference was observed between the study groups regarding other outcome variables. Clinical response was similar between the study groups; so that, 10.50% and 63.20% of patients in the experimental group and 21.10% and 47.4% of patients in the control group presented complete and partial responses, respectively (P=0.550). Conclusion: The obtained data suggested that ampicillin-sulbactam is an effective antibiotic for the treatment of aspiration pneumonia in patients with opioid overdose, in which case, it has the same efficacy as the two-drug regimen of ceftriaxone + clindamycin

Evaluation of the Effect of Green Tea Extract on the Prevention of Gingival Bleeding after Posterior Mandibular Teeth Extraction: A Randomized Controlled Trial

Background. Removing tooth results in gingival bleeding. Several measures are taken to stop bleeding. In this study, the effect of green tea extract on cessation of bleeding and oozing after removing of mandibular molars was investigated. Methods. This was a randomized controlled clinical trial carried out on 62 patients who were referred for extraction of their mandibular molars. The volunteers were randomly and equally divided into treatment and control groups. In the first group, green tea extract-impregnated sterile gauze was used after removing the tooth while in the second group, green tea extract-free gauze was applied. Active bleeding and oozing monitoring was done every 5 minutes until cessation of bleeding and one hour after that, respectively. The results were compared using t-test. Results. The mean ± SD of bleeding duration in green tea group was significantly lower than control group (5.87±1.76 versus 10.09±3.61 minutes, P=0.001). In addition, the number of people with oozing one hour after surgery was significantly lower in the green tea group (6 versus 29 persons, P=0.001). Conclusion. This study showed that green tea extract contributes to significant decline in bleeding of the socket caused by tooth extraction as well as reduction of oozing

Study the effect of various wash-coated metal oxides over synthesized carbon nanofibers coated monolith substrates

In this research work, carbon nanofibers (CNFs) were synthesized on honeycomb monolith substrates using injection chemical vapor deposition (ICVD) technique. The effect of various wash-coated materials and catalyst promoter on the growth rate of CNFs on monolith substrates were examined. The characteristics of the synthesized CNFs-coated monolith composites were examined using Raman spectroscopy, Brunauer-Emmett-Teller (BET), thermogravimetric analysis (TGA), field emission scanning electron microscopy (FE-SEM), and Transmission electron microscopy (TEM) techniques. According to the textural characterization study, the specific surface area and pore volume of CNFs-coated monolith composites were significantly improved as compared to bare monolith which might be attributed to the growth of highly pure and aligned CNFs over monolith substrate. Besides that, the synthesized CNFs-coated monolith possessed extremely well thermal stability up to the temperature of 550 °C which was corresponded to the strong attachment of highly graphitized CNFs over monolith substrates

Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Background Osteoarthritis is the most common form of arthritis in adults, characterised by chronic pain and loss of mobility. Osteoarthritis most frequently occurs after age 40 years and prevalence increases steeply with age. WHO has designated 2021–30 the decade of healthy ageing, which highlights the need to address diseases such as osteoarthritis, which strongly affect functional ability and quality of life. Osteoarthritis can coexist with, and negatively effect, other chronic conditions. Here we estimate the burden of hand, hip, knee, and other sites of osteoarthritis across geographies, age, sex, and time, with forecasts of prevalence to 2050. Methods In this systematic analysis for the Global Burden of Disease Study, osteoarthritis prevalence in 204 countries and territories from 1990 to 2020 was estimated using data from population-based surveys from 26 countries for knee osteoarthritis, 23 countries for hip osteoarthritis, 42 countries for hand osteoarthritis, and US insurance claims for all of the osteoarthritis sites, including the other types of osteoarthritis category. The reference case definition was symptomatic, radiographically confirmed osteoarthritis. Studies using alternative definitions from the reference case definition (for example self-reported osteoarthritis) were adjusted to reference using regression models. Osteoarthritis severity distribution was obtained from a pooled meta-analysis of sources using the Western Ontario and McMaster Universities Arthritis Index. Final prevalence estimates were multiplied by disability weights to calculate years lived with disability (YLDs). Prevalence was forecast to 2050 using a mixed-effects model. Findings Globally, 595 million (95% uncertainty interval 535–656) people had osteoarthritis in 2020, equal to 7·6% (95% UI 6·8–8·4) of the global population, and an increase of 132·2% (130·3–134·1) in total cases since 1990. Compared with 2020, cases of osteoarthritis are projected to increase 74·9% (59·4–89·9) for knee, 48·6% (35·9–67·1) for hand, 78·6% (57·7–105·3) for hip, and 95·1% (68·1–135·0) for other types of osteoarthritis by 2050. The global age-standardised rate of YLDs for total osteoarthritis was 255·0 YLDs (119·7–557·2) per 100 000 in 2020, a 9·5% (8·6–10·1) increase from 1990 (233·0 YLDs per 100 000, 109·3–510·8). For adults aged 70 years and older, osteoarthritis was the seventh ranked cause of YLDs. Age-standardised prevalence in 2020 was more than 5·5% in all world regions, ranging from 5677·4 (5029·8–6318·1) per 100 000 in southeast Asia to 8632·7 (7852·0–9469·1) per 100 000 in high-income Asia Pacific. Knee was the most common site for osteoarthritis. High BMI contributed to 20·4% (95% UI –1·7 to 36·6) of osteoarthritis. Potentially modifiable risk factors for osteoarthritis such as recreational injury prevention and occupational hazards have not yet been explored in GBD modelling. Interpretation Age-standardised YLDs attributable to osteoarthritis are continuing to rise and will lead to substantial increases in case numbers because of population growth and ageing, and because there is no effective cure for osteoarthritis. The demand on health systems for care of patients with osteoarthritis, including joint replacements, which are highly effective for late stage osteoarthritis in hips and knees, will rise in all regions, but might be out of reach and lead to further health inequity for individuals and countries unable to afford them. Much more can and should be done to prevent people getting to that late stage

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Double-disk synergy test for detection of synergistic effect between antibiotics against nosocomial strains of staphylococcus aureus

Objective: Synergistic effect between commonly used antibiotics against nosocomial multidrug-resistant strains of Staphylococcus aureus, if present, could provide a viable option as an alternative therapy for infections due to this pathogen. The aim of this study was searching for any synergistic effect between several antibiotics against drug-resistant strains of S. aureus with nosocomial origin using double-disk synergy test and to determine the applicability of this test for such a purpose. Methods: Over a 6-month period, strains of S. aureus isolated from clinical specimens of hospitalized patients with documented nosocomial infection underwent disk diffusion test using antibiotic disks of oxacillin, cephalothin, clindamycin, ciprofloxacin, vancomycin, cotrimoxazole, rifampin, erythromycin, gentamicin and meropenem. Double-disk synergy test was performed for all isolates resistant to at least two of applied antibiotics. Combinations of all possible pairs of antibiotics (to which the microorganism was resistant) were tested by placing antibiotic disks at distance of 20 mm from each other (center to center). After 16- 20 hours of incubation, if synergistic effect was present among two antibiotics, an inhibition zone was formed between their disks. Findings: Among all of possible two-antibiotic combinations tested for 41 resistant isolates, only two cases of synergistic effect were detected; both effects were among rifampin and cotrimoxazole. Conclusion: The combination of rifampin and cotrimoxazole could provide a viable option for treatment of infections due to resistant strains of S. aureus; however, clinical trials are needed before any new recommendation. Also, double-disk synergy test seems to be capable of detecting the synergistic effect between antibiotics at in vitro level

Evaluation of Parenteral Opioid Analgesics Utilization in Patients Hospitalized in a Referral Teaching Hospital

Background: Opioid drugs are the most effective drugs for the treatment of moderate to severe pain. Rates of opioid use are influenced by a variety of factors. The aim of this study was to determine the pattern of use of parenteral opioid drugs in hospitalized patients in a referral teaching hospital. Methods: In a retrospective study, required data were extracted from medical records of adult patients who had received any parenteral opioid analgesic in the 6-month period from March 2013 to September 2013. The Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) system method was used for evaluation of opioid analgesic use in patients. Results: The overall usage of parenteral opioid analgesics was 730.51 DDDs with meperidine (Pethidine) having the most amounts of use (588.69 DDDs and 33.23 DDDs/100 bed-days). Overall, the male surgery ward and emergency department had the most amounts of use based on the number of DDDs (445.8 DDDs) and per 100 bed-days (1046 DDDs/100 bed-days), respectively. Methadone use was most in the infectious diseases ward. Conclusion: The trend of parenteral opioid analgesics consumption is increasing in this hospital. Therefore, better adherence to pain treatment guidelines by medical staff is necessary for rational use of these drugs

Antimicrobial susceptibility pattern of extended-spectrum β-lactamase-producing bacteria causing nosocomial urinary tract infections in an Iranian referral teaching hospital

Objective: Gram-negative bacilli are the most important cause of nosocomial urinary tract infections (UTIs). The production of extended-spectrum β-lactamase (ESBL) enzymes is a common mechanism of resistance among these bacteria. The aim of this study was to determine the rate of ESBL producing Gram-negative bacteria causing nosocomial UTI in a referral hospital as well as their susceptibility pattern to the most commonly used antibiotics. Methods: In a prospective cross-sectional study performed over a 6-month period, urinary specimens obtained from hospitalized patients with documented culture-proved nosocomial UTI (age range of 1-87 years). Isolated aerobic Gram-negative bacteria underwent further microbiologic tests for detection of ESBL, as well as antimicrobial susceptibility test using Kirby-Bauer (disk diffusion) and E-test methods. Findings: During the study period, 213 urine samples were detected to have growth of Gram-negative organism. Escherichia coli was the most frequently isolated organism (61%). ESBL was detected in 102 isolates including 38.5% of E. coli, 39.5% of Klebsiella pneumonia, 88.5% of Pseudomonas aeruginosa, and 100% of Acinetobacter baumannii strains. Imipenem and meropenem were the most effective antibiotics on E. coli and K. pneumoniae strains. P. aeruginosa and A. baumannii strains showed high resistance to all tested antibiotics. Conclusion: Large numbers of Gram-negative bacteria causing nosocomial UTIs produce ESBL with most being multidrug-resistant. Therefore, routine ESBL detection testing and subsequent antibiogram with disk diffusion method could be useful to determine the best treatment options for UTI