Bacitracin Susceptibility has traditionally been accepted as a means of presumptive identification/differentiation of Group A Streptococcus (GAS) from other Beta haemolytic Streptococcal (BHS) strains. This means of identification may indeed be faulty as recent studies have shown that other BHS species are also highly susceptible to Bacitracin. These species and especially Group C (GCS) and Group G (GGS) BHS strains have increasingly been shown to play an important role in human streptococcal disease and in some populations carriage rates of GCS/GGS are higher than GAS rates. The continued use of Bacitracin for presumptive identification would lead to an over-estimation of GAS rates particularly in settings where there is a changing epidemiology of BHS infections.
Introduction: Antibiotic drug-related problems (DRPs) are relatively complex in intensive care units. The effectiveness of clinical pharmacists' collaborative practice on identification and resolution of antibiotic DRPs in the intensive care unit (ICU) had to be studied. Methods: A quasi-experimental study was conducted in an ICU of a tertiary-level care hospital in the UAE. On-duty clinical pharmacists performed medication reviews of antibiotics and interventions in collaboration with other healthcare professionals. The PCNE classification system V 9.0 was used to categorize antibiotic DRPs. An experienced clinical pharmacist verified the documented DRPs. Interventions were implemented primarily in collaboration with physicians. Results: A total of 103 patients on antibiotic prescriptions were reviewed; 28 (27.2%) patients had antibiotic DRPs. A total of 40 DRPs were identified in the 28 patients (1.43 DRPs per patient); 33 (82.5%) DRPs were associated with the restricted antibiotics. The majority of DRPs were related to treatment safety 24 (60%), followed by treatment effectiveness 13 (32.5%). The most common causes of DRPs were related to dose selection 21 (51.2%). A total of 80 interventions were proposed by clinical pharmacists, an average of 2 interventions per DRP. Out of 40 DRPs, 31 (77.5%) DRPs were fully resolved, 2 (5%) were partially resolved due to complexity of disease, and 5 (12.5%) were unresolved but monitored closely if any harm is happening for the patients. Outcome of 2 (5%) interventions were not known as data were inconclusive to categorize. Conclusion: DRPs are common with antibiotics, especially with restricted antibiotics. This study suggests that collaborative practice interventions of clinical pharmacists were effective in the identification and resolution of antibiotic DRPs.
It accounts for greater than a tenth of cases of chronic hepatitis in Nigerian children. Early detection is paramount as there is currently no vaccine for its prevention and approved treatment protocols are for older children. This study was done to determine the prevalence of HCV antibody and its associated risk factors in apparently well school children aged 5 to under 18 years in Nnewi, a city in South-East Nigeria. This was a cross–sectional study of 618 children from public and private nursery, primary and secondary schools across Nnewi. Two questionnaires were used to obtain social behavioral information from the children and their parents respectively. Three rapid diagnostic test strips were used to test blood samples for HCV antibodies. Data obtained was analyzed using SPSS21with the level of significance set at P ≤ 0.05. antibody in apparently well school children. Health enlightenment campaigns to sustain a reduction in and possible elimination of HCV infection in all categories of children are recommended.
Background: Nigella sativa may have the potency to complement integrally in conditions of uncertain core basic needs of COVID-19 treatment. The understanding of immune responses occurring in the mechanism of COVID-19 caused by SARS-CoV-2 infection has brought attention to the more specific demand on the potential drug targeted for the treatment of patients with COVID-19. Discussion: The core basic needs in the treatment of COVID-19, based on the immune responses, that encompassing all the stage of diseases going through preventive until curative aspects consist of increased immunity using interferon; lung protective function; anti-inflammatory by interferon-γ activation; and inhibition of hyaluronan-synthase-2 by 4-methylumbelliferone. Nigella sativa may give a role in all four core basic needs from the viewpoint of immune responses occurring in COVID-19 infection. Conclusions: Nigella sativa may have the potency as a complementary therapy that may be applied in all stages of the core basic needs of COVID-19 treatment, which the scientific community may more consider its broad-range potential benefit of use in the COVID-19 treatment research.
At more than 10 months after the first case of COVID-19 was documented, the understanding of the pathogenesis of this viral illness is growing on a daily basis. A massive pro-inflammatory response on infected individuals involving several cytokines seems to play a key role on disease. As a result, therapeutic efforts have focused on anti-inflammatory strategies to ameliorate the disease, in sight of a lack of a truly effective anti-viral agent. Pentoxifylline (PTX) has been proposed by multiple authors as a potential therapeutic ally, targeting a variety of mechanisms as it has been shown to have antiviral, anti-inflammatory and hemodynamic effects. Importantly, anti-inflammatory effects center on down-regulation of cytokines such as interleukins and tumor necrosis factor. In pre-pandemic studies, PTX has demonstrated to change the clinical course of inflammatory diseases such as acute respiratory distress syndrome, which is a hallmark of severe COVID-19. Researchers agree it is pertinent to experimentally evaluate the effect this drug has on COVID-19 patients. The objective of this review is to summarize all the proposed mechanisms by which PTX may aid in the treatment of COVID-19, as well as prevent its deadly complications. Our interpretation of the literature is that the benefits PTX may bring to a patient with COVID-19 outweigh the risks this drug might pose on them. As a result, there is consensus regarding the evaluation of PTX in further experimental studies to better characterize its effects on COVID-19 patients.
Background: Urinary tract infections (UTIS) are prevalent in clinical practice. Treatment options are narrowing down because of multidrug resistance (MDR) nature of some uropathogens. Objectives: To identify the bacterial etiology of urinary tract infections (UTI) among adult patients attending the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla Enugu and their antibiotic susceptibility pattern with emphasis on multidrug resistance (MDR). Materials and methods: the study was carried out on 260 adult urine samples in bacteriology laboratory of UNTH from March to November 2017. Standard microbiological methods were used to identify the isolates and the antimicrobial sensitivity testing was done using Kirby Bauer disc diffusion method. Results: Of the 260 urine samples analyzed, 96 yielded significant bacteria giving an overall prevalence of 36.92%. Gram negative bacteria were predominant 81(84.4%). Escherichia coli (32.29%) ranked highest and the least was Acinetobacter spp (1.04%). Antimicrobial susceptibility testing showed that majority of the isolates of E. coli were susceptibility to Nitrofurantoin, Meronem, Tigecyclin, Imipenem and Ciprofloxacin (71-93.5%). Most of the isolates showed high level of resistance to Augmentin, Cefuroxime, Ceftazidine and Carbanicillin. Prevalence of MDR was high in E.coli, 12(27.3%) isolates produced ESBL while 4(28.6%) isolates of Staphylococcus aureus were methicillin resistant Conclusion: Gram negative bacteria are the major cause of UTI and antimicrobial resistance had become a significant public health problem in Nigeria. Regular surveillance of antimicrobial susceptibility profile is imperative.
Purpose: Evaluate the effectiveness of vancomycin 20 – 25 mg/kg loading doses in achieving target therapeutic concentrations after one dose in patients with renal impairment. Methods: Pharmacists responsible for dosing vancomycin used larger loading doses of 20 – 25 mg/kg per our institution’s guidelines. The rate of attaining therapeutic concentrations after the intervention was collected and compared to pre-intervention data. The primary endpoint was rate of achieving target vancomycin concentrations preversus post-intervention. Secondary endpoints included time to next dose, timing of level following the dose and, using pooled data, success rate based on doses < 20 mg/kg versus ≥ 20 mg/kg. Results: One-hundred three patients were included in the pre-intervention (PRE) group and 97 in the post-intervention (POST) group. Average dose was significantly higher in the POST group (16.7 mg/kg ± 3.3 v 21.8 mg/kg ± 4.3, p < 0.0001). Overall, there was a non-significant increase in rate of attaining therapeutic levels following intervention (58.3 % (60/103) v 70.1 %, (68/97), p = 0.08). There was a significant increase in percent therapeutic vancomycin concentrations (34.1 % v 61.9 %, p = 0.006) when targeting 15-20 mcg/mL. When levels were within or below target range, average time to next dose was not different (6.1 hours ± 2.45 v 5.5 hours ± 2.0, p = 0.14). Doses ≥ 20 mg/kg were more likely to achieve therapeutic concentrations if used when targeting 15 – 20 mcg/mL (36.4 % [16/44] v 61.7 % [37/60], p = 0.011). Vancomycin concentrations were more likely to be therapeutic the quicker they were drawn following dose administration for both target concentrations. Conclusion: Utilization of larger loading doses of vancomycin in patients with renal impairment significantly increased the rate of achieving therapeutic concentrations after the first dose when targeting higher levels. Doses ≥ 20 mg/kg of total body weight were more likely to achieve higher target concentrations.
Objective: The objective of this study was to understand the level of awareness of Middle East respiratory syndromecoronavirus (MERS-CoV) among the Saudi population. Design: This was a cross-sectional survey. Setting: the study was conducted in Saudi Arabia (central, western and eastern regions) between September and December 2015. Participants: We assumed that about 50% of the Saudi population would have basic information about MERS, and the estimated sample size was calculated with 80% power, 95% confidence limit, design effect that equals 2, and 20 clusters. Our target was to recruit about 10,000 participants. A structured questionnaire regarding MERS-CoV was distributed electronically and manually among the general population between September and December 2015. We received responses from 8,159 participants (average response rate, 82%). Primary outcome measures: The main outcome of interest was a participant’s knowledge of MERS-CoV. Results: The majority of the participants (6,005; 73.6%) were female, and the most frequent age group was 21–30 years with 3,780 (46.3%) respondents, while the least frequent age group was >60 years with 48 (0.6%) respondents. About 71.2% of the respondents had university-level education. The majority of the respondents (45.1%) were from the central region. A relatively high number of respondents (39.2%) believed that camels are the source of the virus. Among the respondents, 21% claimed to have received sufficient, complete, and good information about MERS-CoV, while 72.2% claimed that they did not receive enough information from their healthcare centres. Conclusion: Awareness of MERS-CoV needs to be increased in the Saudi community. The Saudi healthcare system needs to distribute timely and complete information about the virus in order to prevent transmission of infection. Strengths and limitations of this study The strength of this study is that it is the largest study on Middle East respiratory syndrome-coronavirus awareness in the kingdom of Saudi Arabia. Additionally, the study assessed the entire community, unlike other studies that mainly focused on healthcare workers. The limitation of this study is that we could not assess the level of awareness among farmers and camel owners. Additionally, the presence of a high number of female participants, young participants, and participants with high education levels might have introduced bias in our research.
Objectives: To study the risk factors for pelvic abscess following cesarean section. Design: Case-control study with two-tailed univariate analysis of potential risk factors and multiple logistic regression to test the combined effects of these risk factors. Setting: Tertiary care teaching hospital in Jeddah, Saudi Arabia. Participants: 21 women with pelvic abscess following cesarean section and 21 matched controls who underwent cesarean section during the same time period but experienced no known surgical site infections. Risk factors considered: Body mass index (BMI), diabetes mellitus (DM) and hypertension, type of cesarean section (elective vs. emergency), number of previous cesarean sections, allocation to labor and delivery ward, timing of rupture of the membrane, antibiotic prophylaxis, and number of per-vaginal examinations before cesarean section. Results: All risk factors except hypertension and antibiotic prophylaxis were significant (p between 0.0001-0.05 based on Chisquare test) in the univariate analysis. In the multiple logistic regression analysis, the number of vaginal examinations (19/21 in cases vs. 11/21 in controls, odds ratio (OR) 8.6, 95% confidence interval (CI) 1.59-46.8, p = 0.01 based on student T test) and emergency cesarean section (17/21 vs. 9/21, OR 5.7, 95% CI 1.41-22.8, p = 0.01) resulted in the highest odds ratios, although allocation to the labor and delivery ward emerged as the statistically most significant risk factor (21/21 vs. 11/21, OR 2.0, 95% CI 1.27-2.87, p = 0.0001) Conclusions: Identification of the main risk factors will help prioritize appropriate infection control measures to those at highest risk of pelvic abscess following cesarean section
Ebola is a deadly disease with no cure; there is no vaccine developed yet. Many died during the 2014 outbreak in West Africa, and many healthcare professionals went to the virus infected area to treat the patients while placing their lives in danger. Not every medical professional placed in the field is a fully trained specialist, and sometimes one or two under-trained doctors are in charge of the entire clinic with some nurses and operating technicians. When unexpected outbreaks of the virus occur in the places, the doctor(s) would encounter medical and ethical dilemmas. Should they leave or stay? In fact, this dilemma is not confined to the Ebola pandemic but relevant to all similar cases. In this paper, three authors, a medical resident, a clinical bioethicist, and a theoretical bioethicist respond to the dilemma.
Purpose: Exposure to concomitant antibiotics during treatment for Clostridium difficile infection (CDI) is a major risk factor for relapse. This study compared the CDI relapse rates among patients who underwent CDI treatment while receiving concomitant antibiotics. Methods: This retrospective chart review evaluated consecutive adult patients with CDI who were receiving concomitant antibiotics at two acute care sites (Hamilton, Ontario) during 2011–2013. We compared the CDI relapse and mortality rates for regular CDI treatment (10–14 days) and extended CDI treatment (>14 days), and adjusted the analyses for several covariates. Results: We identified 457 patients with CDI, and 228 (50%) patients were considered eligible. A total of 101 (44.2%) patients were receiving regular CDI treatment and 127 (55.7%) patients were receiving extended CDI treatment. The relapse rates were similar for the regular and extended treatment groups in the univariate (17% and 23%, respectively; odds ratio [OR]: 1.4, 95% confidence interval [CI]: 0.7–2.7, p = 0.286) and multivariate analyses (OR: 0.7, 95% CI: 0.3–1.7, p = 0.425). A composite outcome (in-hospital mortality and/or CDI relapse) was higher for extended treatment (35% vs. 23%; OR: 1.9, 95% CI: 1.0–3.4, p = 0.039), although this difference was not significant in the multivariate analysis (OR: 1.2, 95% CI: 0.6–2.5, p = 0.648). Conclusions: We found no evidence to support extended CDI treatment among patients who are receiving concomitant antibiotics. However, further studies are needed to identify better methods for reducing the risk of relapse in this population.
In central Greece, during the influenza seasons from 2009-2012, type A influenza A (H1N1) viruses were the dominant subtype to circulate in the population. This viral subtype was detected in 100% of the positive samples assayed, during the 2009-10 and 2010-11 seasons, respectively. This finding coincides with the emergence of pandemic influenza A (H1N1) viruses, globally. The A (H1N1) viruses detected were identified as antigenically similar to the vaccine A (H1N1) pdm 09 viral strains of the respective periods. Overall, with the exemption of the 2011-12 season, where only influenza A (H3N2) and influenza B viruses were detected, in 61% and 39% of the samples assayed by real-time RT-PCR, respectively, A (H1N1) pdm 09 viral strains were isolated from 94% of the positive by real-time RT-PCR samples. These findings support the importance of continuous influenza laboratory surveillance and influenza vaccine formulation according to the antigenic profile of circulating viral strains.
Background: Urinary tract infections (UTIS) are prevalent in clinical practice.Treatment options are narrowing down because of multidrug resistance (MDR) nature of some uropathogens. Objectives:To identify the bacterial etiology of urinary tract infections (UTI) among adult patients attending the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla Enugu and their antibiotic susceptibility pattern with emphasis on multidrug resistance (MDR).Materials and methods: the study was carried out on 260 adult urine samples in bacteriology laboratory of UNTH from March to November 2017.Standard microbiological methods were used to identify the isolates and the antimicrobial sensitivity testing was done using Kirby Bauer disc diffusion method.Results: Of the 260 urine samples analyzed, 96 yielded significant bacteria giving an overall prevalence of 36.92%.Gram negative bacteria were predominant 81(84.4%).Escherichia coli (32.29%) ranked highest and the least was Acinetobacter spp (1.04%).Antimicrobial susceptibility testing showed that majority of the isolates of E. coli were susceptibility to Nitrofurantoin, Meronem, Tigecyclin, Imipenem and Ciprofloxacin (71-93.5%).Most of the isolates showed high level of resistance to Augmentin, Cefuroxime, Ceftazidine and Carbanicillin.Prevalence of MDR was high in E.coli, 12(27.3%)isolates produced ESBL while 4(28.6%)isolates of Staphylococcus aureus were methicillin resistant Conclusion: Gram negative bacteria are the major cause of UTI and antimicrobial resistance had become a significant public health problem in Nigeria.Regular surveillance of antimicrobial susceptibility profile is imperative.
Tuberculosis abscesses of the chest wall, though uncommon are not infrequently encountered in countries endemic to the disease. Tuberculosis (TB) of the chest wall constitutes 1% to 5% of all cases of musculoskeletal TB (1-3) which Musculoskeletal TB accounts for 1-2% of all types of tuberculosis (3-6). Isolated chest wall abscess without bone involvement is even rarer and to our knowledge only few cases were reported in the literature. We report a case of chest wall abscess without bone involvement in a young immunocompetent patient.
