Comparison of mortality due to direct exposure to outdoor particles versus indoor exposure to particulates of outdoor origin.

<p>Comparison of mortality due to direct exposure to outdoor particles versus indoor exposure to particulates of outdoor origin.</p

Mortality attributable to indoor exposure to particulates of outdoor origin.

<p>Mortality attributable to indoor exposure to particulates of outdoor origin.</p

Comparison of mortality due to indoor exposure to particles of outdoor origin, according to maximum/minimum duration of outdoor exposure.

<p>Comparison of mortality due to indoor exposure to particles of outdoor origin, according to maximum/minimum duration of outdoor exposure.</p

Table_1_Dispensing of antibiotics for tuberculosis patients using standardized patient approach at community pharmacies: results from a cross-sectional study in Pakistan.DOCX

BackgroundPakistan is among top countries for antibiotic consumption around the globe and patients often receive antibiotics directly from community pharmacies. Thus, our aim was to assess the drug dispensing practices of pharmacies for presumed and confirmed tuberculosis by using standardized patients’ method in Pakistan.MethodsIn this cross-sectional study, we adopted two standardized patient cases in pharmacies of three cities of Punjab. The first case involved a presumed tuberculosis patient presenting with 2–3 weeks of cough and fever (Case-1), and the second case involved a confirmed tuberculosis patient carrying microbiologically confirmed tuberculosis results (Case-2). The ideal management for Cases-1 and Case-2 is referral of standardized patients to a healthcare provider without dispensing antibiotics or steroids, or both. The differences in antibiotic use, steroid use, and the number of medicines dispensed in referred and non-referred patients between Case-1 and Case-2 were analyzed using descriptive statistics.ResultsBetween April 1, 2020, and July 31, 2020, standardized patients completed 575 out of 598 interactions among community pharmacies in Lahore, Rawalpindi, and Sialkot. We recorded ideal management in 115 (37.7%) of the 305 Case-1 interactions and 130 (48.1%) of the 270 Case-2 interactions. Antibiotic dispensing was higher in Case-1, with 71 out of 305 instances (23.3%), than in Case-2 interactions, with 27 out of 270 instances (10.0%). Anti-tuberculosis drugs were dispensed to 1 patient in Case-1 (0.3%) and to 19 patients (7.0%) in Case-2.ConclusionSlightly more than one-third of pharmacies in Punjab, Pakistan, ideally managed patients with presumed tuberculosis, but almost half of them ideally managed cases of confirmed tuberculosis. The presence of confirmed diagnosis slightly changes the behavior in the correct management of patients.</p

Colonization prevalence and antibiotic susceptibility of Group B <i>Streptococcus</i> in pregnant women over a 6-year period in Dongguan, China

<div><p>This study investigated the prevalence of recto-vaginal Group B <i>Streptococcus</i> (GBS) colonization, serotype distribution, and antimicrobial susceptibility patterns among pregnant women in Dongguan, China. Recto-vaginal swabs were collected from pregnant women at gestational age 35–37 weeks between January 1^st 2009 and December 31^st 2014. Isolates were serotyped by latex-agglutination and were tested against seven antimicrobials by disk diffusion. Of 7,726 pregnant women who completed GBS testing, 636 (8.2%) were GBS carriers. Of 153 GBS isolates available for typing, 6 serotypes (Ia, Ib, III, V, VI and VIII) were identified with type III being predominant, while 9 (5.9%) were non-typable isolates. All isolates were sensitive to penicillin, ceftriaxone, linezolid and vancomycin, whereas 52.4% were resistant to clindamycin, 25.9% were resistant to levofloxacin and 64.9% were resistant to erythromycin. This study showed the recto-vaginal colonization prevalence of GBS in Dongguan is significant. Due to 100% susceptibility to penicillin of all GBS samples, penicillin remains the first recommendation for treatment and prevention against GBS infection. Susceptibility testing should be performed for women allergic to penicillin in order to choose the most appropriate antibacterial agents for treatment and prevention of vertical transmission to neonates. In addition, we suggest establishing standard processes for GBS culture and identification in China as early as possible.</p></div

Prevalence of GBS antibiotic resistance (with linear trend lines), by year, of 636 isolates.

<p>The proportion GBS isolates resistant to erythromycin decreased between 2009 and 2014 (z = 0.665, <i>P</i> = 0.506), while an increase in clindamycin and levofloxacin resistance was observed over the same period (z = 2.097, <i>P</i> = 0.036, and z = 2.857, <i>P</i> = 0.004, respectively).</p

GBS antimicrobial sensitivity patterns.

<p>GBS antimicrobial sensitivity patterns.</p

Serotype distribution of GBS strains from 2013 and 2014.

<p>Serotype distribution of GBS strains from 2013 and 2014.</p

Prevalence of GBS colonization of perinatal pregnant women from 2009 to 2014.

<p>Prevalence of GBS colonization of perinatal pregnant women from 2009 to 2014.</p

Additional file 1: Figure S1. of Epidemiology of invasive group B streptococcal disease in infants from urban area of South China, 2011–2014

Partial sequence diagram for seven house-keeping genes. adhP gene(A), pheS gene(B), atr gene(C), glnA gene(D), sdhA gene(E), glcK gene(F), tkt gene(G). (DOCX 849 kb