Emergence of mcr-1 Gene in Colistin-Resistant Escherichia coli Isolates from Chicken in Chitwan, Nepal.

The escalating prevalence of colistin-resistant Escherichia coli in poultry has emerged as a significant concern. This study aimed to assess the occurrence of the mcr-1 gene in colistin-resistant E. coli isolates from poultry samples. A cross-sectional study was conducted at National Avian Disease Investigation Laboratory, Nepal, on 210 chicken meat samples, including liver, heart, and spleen. E. coli was isolated and identified by conventional cultural methods. Antibiotic resistance pattern was assessed by the Kirby-Bauer disc diffusion method. The mcr-1 gene was detected by conventional polymerase chain reaction. The average viable count in chicken meat samples was log 6.01 CFU (colony-forming unit)/g, whereas the average coliform count was log 3.85 CFU/g. Coliforms were detected in at least one sample from 48.01% of total samples. The prevalence of E. coli in all meat samples was 39.52%. Liver accounted for the largest fraction of E. coli isolates (45.45%). Cefepime was the most effective antibiotic. Among all isolates, 45 (54.21%) were multidrug-resistant E. coli, 17 (20.48%) were colistin-resistant E. coli, and 11 (64.70%) harbored the mcr-1 gene. High prevalence of multidrug-resistant E. coli isolates, colistin-resistant isolates, and mcr-1 gene-carrying isolates indicates a serious concern, as it could potentially lead to colistin resistance in human pathogens through horizontal transfer of resistant genes from poultry to humans.

Preparing for success in final summative medical specialist examinations: The case for RACE.

BACKGROUND: Failure rates on medical specialist final summative examinations in Australia are high, regardless of speciality. Examination failure can have detrimental psycho-social, financial and job security effects on the trainee, while delays in completion of training adversely impacts workforce growth and health outcomes for the community. The study aimed to explore the preparation factors that contribute to ophthalmology trainee success in their final summative examination. METHODS: Semi-structured in-depth interviews were conducted with 29 participants via telephone or Zoom with ophthalmology trainees and Fellows. To be eligible, interviewees had to have sat the Royal Australian and New Zealand College of Ophthalmologists Advanced Clinical Examination (RACE) within the past five years or were providing supervision to trainees preparing for RACE. Interviews were audio-recorded, transcribed and thematically analysed. RESULTS: Examination success was underpinned by six themes relating to preparation: (i) 'Those who fail to plan, plan to fail', which related to development and adherence to a study plan; (ii) 'It takes a village' encompassed trainees establishing and activating personal and professional supports; (iii) 'Get to know your opponent', which encompassed developing an understanding of the examination construct, format and requirements; (iv) 'There is no substitute for hard work', which related to intensive study over a period of 12-18 months; (v) 'Keep pace with the herd', which referred to benchmarking preparation efforts and progress against peers; and (vi) 'Don't jump the gun', which related to ensuring readiness to sit. CONCLUSIONS: Maximising medical specialist examination pass rates is in the best interest of trainees, training Colleges, health care systems and communities. Recognising and facilitating preparation approaches that foster success in final summative examinations are the collective responsibility of trainees, specialist training Colleges, training networks and health systems. Trainees need to plan for examination success, be self-determined to commit to intensive study over an extended time period and be realistic about their readiness to sit.

Beyond the 'big smoke': Enabling supervision of ophthalmology trainees in regional, rural and remote Australia.

OBJECTIVE: Expansion of opportunities for ophthalmology training beyond the 'big smoke' is anticipated to support the future distribution of ophthalmologists in regional, rural and remote areas of Australia. However, little is known about what enables supervision outside of metropolitan tertiary hospital settings that would contribute to positive training experiences for specialist medical trainees and encourage them to leave the 'big smoke' once qualified. The aim of this study was therefore to explore the perceived enablers of ophthalmology trainee supervision in regional, rural and remote health settings across Australia. SETTING: Australia. PARTICIPANTS: Ophthalmologists working in regional, rural or remote health settings with experience and/or interest in supervising ophthalmology trainees (n = 16). DESIGN: Qualitative design involving semistructured interviews. RESULTS: Seven key enablers of ophthalmology trainee supervision in regional, rural and remote health settings were identified: adequate physical infrastructure, resources and funding to host a trainee; availability of online curriculum and teaching resources so as to ensure equity of training opportunities; pre-established training posts, driven by supervision 'champions'; a critical mass of ophthalmologists to help share the supervisory load; relationships and support between training posts, the training network and the Specialist Medical College; alignment of trainee competence and attitude with the needs of the training setting; and the recognition of reciprocal benefits for supervisors through supporting trainees, including workforce support and renewal. CONCLUSION: With training experiences beyond the 'big smoke' anticipated to influence future ophthalmology workforce distribution, implementation of enablers of trainee supervision should occur in regional, rural and remote health settings wherever possible.

Benefits and challenges to ophthalmology training via the Specialist Training Program.

INTRODUCTION: The Specialist Training Program (STP) is a commonwealth funding initiative to support specialist medical training positions in regional, rural and remote areas, and in private settings. The program helps to improve the skills and distribution of the specialist medical workforce by providing trainees experience of a broader range of healthcare settings. OBJECTIVE: To examine the benefits and challenges of ophthalmology training delivered by the STP in regional, rural, remote, and/or private settings across Australia. DESIGN: Qualitative design involving semi-structured in-depth interviews with thirty-two participants experienced in the delivery of ophthalmology training at STP posts including ophthalmology trainees (n = 8), STP supervisors and clinical tutors (n = 16), and other stakeholders (n = 8). FINDINGS: Training delivered at STP posts was reportedly beneficial for ophthalmology trainees, their supervisors and the broader community given it enabled exposure to regional, rural, remote and private settings, access to unique learning opportunities, provided workforce support and renewal, and affordable ophthalmic care. However, all participants also reported challenges including difficulties achieving work/life balance, unmet training expectations, a lack of professional support, and financial and administrative burden. Malalignment between trainee preferences for STP posts, low STP literacy and limited regional, rural and remote training experiences were also seen as missed opportunities to foster future rural ophthalmic workforce development. DISCUSSION: The STP improves access to ophthalmic care in underserved populations while enabling valuable rural and/or private practice exposure for medical specialist trainees and workforce support for supervising ophthalmologists. CONCLUSION: Efforts are needed to improve the quality of training experiences provided at STP posts and post sustainability. Although research is needed to investigate the longer-term benefits of the STP to rural and/or private workforce recruitment and retention, RANZCO should develop further regional, rural and remote STP posts to help realise future rural practice intention amongst ophthalmology trainees.

The Impact of Prior Infection and Age on Antibody Persistence After Severe Acute Respiratory Syndrome Coronavirus 2 Messenger RNA Vaccine.

Determining the duration of immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines is critical for informing the timing of booster immunization. Many genetic and environmental factors could influence both the magnitude and persistence of the antibody response. Here, we showed that SARS-CoV-2 infection before vaccination and age affected the decay of antibody responses to the SARS-CoV-2 messenger RNA vaccine.

Single-cell analysis of immune cell transcriptome during HIV-1 infection and therapy.

BACKGROUND: Cellular immune responses are phenotypically and functionally perturbed during HIV-1 infection, with the majority of function restored upon antiretroviral therapy (ART). Despite ART, residual inflammation remains that can lead to HIV-related co-morbidities and mortality, indicating that ART does not fully restore normal immune cell function. Thus, understanding the dynamics of the immune cell landscape during HIV-1 infection and ART is critical to defining cellular dysfunction that occurs during HIV-1 infection and imprints during therapy. RESULTS: Here, we have applied single-cell transcriptome sequencing of peripheral blood immune cells from chronic untreated HIV-1 individuals, HIV-1-infected individuals receiving ART and HIV-1 negative individuals. We also applied single-cell transcriptome sequencing to a primary cell model of early HIV-1 infection using CD4+ T cells from healthy donors. We described changes in the transcriptome at high resolution that occurred during HIV-1 infection, and perturbations that remained during ART. We also determined transcriptional differences among T cells expressing HIV-1 transcripts that identified key regulators of HIV-1 infection that may serve as targets for future therapies to block HIV-1 infection. CONCLUSIONS: This work identified key molecular pathways that are altered in immune cells during chronic HIV-1 infection that could remain despite therapy. We also identified key genes that are upregulated during early HIV-1 infection that provide insights on the mechanism of HIV-1 infection and could be targets for future therapy.

Humoral immune responses during SARS-CoV-2 mRNA vaccine administration in seropositive and seronegative individuals.

BACKGROUND: The global pandemic of coronavirus disease 2019 (COVID-19) is caused by infection with the SARS-CoV-2 virus. Currently, there are three approved vaccines against SARS-CoV-2 in the USA, including two based on messenger RNA (mRNA) technology that has demonstrated high vaccine efficacy. We sought to characterize humoral immune responses, at high resolution, during immunization with the BNT162b2 (Pfizer-BioNTech) vaccine in individuals with or without prior history of natural SARS-CoV-2 infection. METHODS: We determined antibody responses after each dose of the BNT162b2 SARS-CoV-2 vaccine in individuals who had no prior history of SARS-CoV-2 infection (seronegative) and individuals that had previous viral infection 30-60 days prior to first vaccination (seropositive). To do this, we used both an antibody isotype-specific multiplexed bead-based binding assays targeting multiple SARS-CoV-2 viral protein antigens and an assay that identified potential SARS-CoV-2 neutralizing antibody levels. Moreover, we mapped antibody epitope specificity after immunization using SARS-CoV-2 spike protein peptide arrays. RESULTS: Antibody levels were significantly higher after a single dose in seropositive individuals compared to seronegative individuals and were comparable to levels observed in seronegative individuals after two doses. While IgG was boosted by vaccination for both seronegative and seropositive individuals, only seronegative individuals had increased IgA or IgM antibody titers after primary immunization. We identified immunodominant peptides targeted on both SARS-CoV-2 spike S1 and S2 subunits after vaccination. CONCLUSION: These findings demonstrated the antibody responses to SARS-CoV-2 immunization in seropositive and seronegative individuals and provide support for the concept of using prior infection history as a guide for the consideration of future vaccination regimens. Moreover, we identified key epitopes on the SARS-CoV-2 spike protein that are targeted by antibodies after vaccination that could guide future vaccine and immune correlate development.

Potential roles of medicinal plants for the treatment of viral diseases focusing on COVID-19: A review.

The whole world is entangled by the coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), people are dying in thousands each day, and without an actual medication, it seems not possible for the bringing this global health crisis to a stop. Natural products have been in constant use since ancient times and are proven by time to be effective. Crude extract or pure compounds isolated from medicinal plants and/or herbs such as Artemisia annua, Agastache rugosa, Astragalus membranaceus, Cassia alata, Ecklonia cava, Gymnema sylvestre, Glycyrrhizae uralensis, Houttuynia cordata, Lindera aggregata, Lycoris radiata, Mollugo cerviana, Polygonum multiflorum, Pyrrosia lingua, Saposhnikoviae divaricate, Tinospora cordifolia etc. have shown promising inhibitory effect against coronavirus. Several molecules, including acacetin, amentoflavone, allicin, blancoxanthone, curcumin, daidzein, diosmin, epigallocatechin-gallate, emodin, hesperidin, herbacetin, hirsutenone, iguesterin, jubanine G, kaempferol, lycorine, pectolinarin, phloroeckol, silvestrol, tanshinone I, taxifolin, rhoifolin, xanthoangelol E, zingerol etc. isolated from plants could also be potential drug candidates against COVID-19. Moreover, these could also show promising inhibitory effects against influenza-parainfluenza viruses, respiratory syncytial virus, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome coronavirus (MERS-CoV). Here, we have reported 93 antiviral drug candidates which could be a potential area of research in drug discovery.

Extended spectrum ß-lactamase producing uropathogenic Escherichia coli and the correlation of biofilm with antibiotics resistance in Nepal.

BACKGROUND: Urinary tract infection (UTI) is one of the frequently diagnosed infectious diseases which is caused mainly by Escherichia coli. E. coli confers resistance against the two major classes of antibiotics due to the production of extended spectrum ß-lactamase enzymes (ESBL), biofilm, etc. Biofilm produced by uropathogenic E. coli (UPEC) protects from host immune system and prevent entry of antimicrobial compounds. The main objective of this cross-sectional study was to determine the correlation of biofilm production and antibiotic resistance as well as to characterize the pgaA and pgaC genes responsible for biofilm formation among uropathogenic ESBL producing E. coli. METHODS: A total of 1977 mid-stream urine samples were examined and cultured for bacterial strain identification. ESBL was detected by combined disc method following CLSI whereas biofilm formation was analyzed by semi-quantitative method. Furthermore, the pgaA and pgaC genes responsible for biofilm formation in UPEC were detected by multiplex PCR. All the statistical analyses were done via IBM SPSS Statistics 21 where Pearson's correlation test were used to determine correlation (-1 ≥ r ≤ 1). RESULTS: E. coli was the predominant causative agent, which accounted 159 (59.3%) of the Gram-negative bacteria, where 81 (50.9%) E. coli strains were found to be ESBL producers. In addition, 86 (54.1%) E. coli strains were found to be biofilm producers. Both the pgaA and pgaC genes were detected in 45 (93.7%) the UPEC isolates, which were both biofilm and ESBL producers. Moreover, there was a positive correlation between biofilm and ESBL production. CONCLUSION: The analyses presented weak positive correlation between biofilm and ESBL production in which biofilm producing UPEC harbors both pgaA and pgaC genes responsible for biofilm formation.

Dose response relationship between program attendance and children's outcomes in a community based weight management program for children and their families.

INTRODUCTION: The Go4Fun program in New South Wales, Australia is a community based weight management program for overweight and obese children aged 7-13 years and their families. This study assessed the impact of the number and type of sessions attended on body mass index (BMI) z-score, fruit and vegetable intake and physical activity and sedentary behaviours to determine the number of sessions required to achieve optimal program outcomes. METHODS: Secondary analysis was conducted on pre and post participant program data collected over 3.5 years. Relationships between session attendance and program outcomes were assessed using Spearman's correlation and multivariate analyses of variance and multivariate regression. Number of sessions required to achieve optimal program outcomes was determined using piecewise linear regression. RESULTS: For 3090 participants (48.5% of registrants) who attended at least five sessions, outcome measures improved significantly at post program compared with pre (p < 0.01). No relationships were seen between number and type of sessions attended and outcome measures. Children of mothers without a post-school qualification (university degree or vocational qualification) were more likely to achieve lower levels of improvements in BMI z-score (p = 0.02) and vegetable intake (P < 0.01) than those children with post-school qualified mothers (F = 3.68, p = 0.03). Children of mothers without post-school education that attended seven sessions or more achieved significantly better BMI z-score outcomes (p < 0.01) than those who attended fewer sessions. CONCLUSIONS: Maternal educational attainment influences program attendance and health and behavioural outcomes in a family based obesity treatment program.

Evaluation of Get Healthy at Work, a state-wide workplace health promotion program in Australia.

BACKGROUND: Workplace health programs (WHPs) may improve adult health but very little evidence exists on multi-level WHPs implemented at-scale and so the relationship between program implementation factors and outcomes of WHPs are poorly understood. This study evaluated Get Healthy at Work (GHaW), a state-wide government-funded WHP in Australia. METHODS: A mixed-method design included a longitudinal quasi-experimental survey of businesses registered with GHaW and a comparison group of businesses surveyed over a 12-month period. Semi-structured interviews and focus groups with key contacts and employees of selected intervention group businesses and the service providers of the program were conducted to assess program adoption and adaptation. RESULTS: Positive business-level changes in workplace culture were observed over time among GHaW businesses compared with the control group. Multilevel regression modelling revealed perceptions that employees were generally healthy (p = 0.045 timeXgroup effect) and that the workplace promoted healthy behaviours (p = 0.004 timeXgroup effect) improved significantly while the control group reported no change in work culture perceptions. Changes in perceptions about work productivity were not observed; however only one third of businesses registered for the program had adopted GHaW during the evaluation period. Qualitative results revealed a number of factors contributing to program adoption: which depended on program delivery (e.g., logistics, technology and communication channels), design features of the program, and organisational factors (primarily business size and previous experience of WHPs). CONCLUSIONS: Evaluation of program factors is important to improve program delivery and uptake and to ensure greater scalability. GHaW has the potential to improve workplace health culture, which may lead to better health promoting work environments. These results imply that government can play a central role in enabling prioritisation and incentivising health promotion in the workplace.

Piloting a Telephone Based Health Coaching Program for Pregnant Women: A Mixed Methods Study.

Objectives Get Healthy in Pregnancy (GHiP) is a telephone based lifestyle coaching service for pregnant women, in New South Wales, Australia. GHiP had two service options; a telephone-based health coaching program consisting of up to 10 calls and information only (including one call). This study sought to compare the outcomes of the two GHiP options, to determine the characteristics of women likely to use the service and to explore the feedback from women and health professionals. Methods A pragmatic stratified clustered randomised controlled trial was conducted. Two metro and three rural hospitals were randomised into health coaching or information only arms. Self-reported measures of height and weight and health behaviours (dietary and physical activity) were collected at baseline and 36 weeks gestation. Process evaluation included descriptive analysis of routine program data, and semi-structured interviews with participants and health professionals. Results Of 3736 women screened, 1589 (42.5%) were eligible to participate, and of those eligible, 923 (58.1%) were recruited. More women in the health coaching arm gained weight within the target range for their BMI at 36 weeks gestation (42.9%) compared with information only (31.9%). Women found GHiP to be useful and supportive and midwives and doctors said that it facilitated conversations about weight with pregnant women. Conclusions for Practice Telephone-based lifestyle programs integrated with routine clinical care show promise in helping pregnant women achieve healthy gestational weight gain, but in this case was not significantly different from one information telephone call. Strong positive feedback suggests that scaled-up service delivery would be well received. TRIAL REGISTRATION: ACTRN12615000397516 (retrospectively registered).

Using the knowns to discover the unknowns: MS-based dereplication uncovers structural diversity in 17-hydroxygeranyllinalool diterpene glycoside production in the Solanaceae.

Exploring the diversity of plant secondary metabolism requires efficient methods to obtain sufficient structural insights to discriminate previously known from unknown metabolites. De novo structure elucidation and confirmation of known metabolites (dereplication) remain a major bottleneck for mass spectrometry-based metabolomic workflows, and few systematic dereplication strategies have been developed for the analysis of entire compound classes across plant families, partly due to the complexity of plant metabolic profiles that complicates cross-species comparisons. 17-hydroxygeranyllinalool diterpene glycosides (HGL-DTGs) are abundant defensive secondary metabolites whose malonyl and glycosyl decorations are induced by jasmonate signaling in the ecological model plant Nicotiana attenuata. The multiple labile glycosidic bonds of HGL-DTGs result in extensive in-source fragmentation (IS-CID) during ionization. To reconstruct these IS-CID clusters from profiling data and identify precursor ions, we applied a deconvolution algorithm and created an MS/MS library from positive-ion spectra of purified HGL-DTGs. From this library, 251 non-redundant fragments were annotated, and a workflow to characterize leaf, flower and fruit extracts of 35 solanaceous species was established. These analyses predicted 105 novel HGL-DTGs that were restricted to Nicotiana, Capsicum and Lycium species. Interestingly, malonylation is a highly conserved step in HGL-DTG metabolism, but is differentially affected by jasmonate signaling among Nicotiana species. This MS-based workflow is readily applicable for cross-species re-identification/annotation of other compound classes with sufficient fragmentation knowledge, and therefore has the potential to support hypotheses regarding secondary metabolism diversification.

Sero-epidemiology study of leptospirosis in febrile patients from Terai region of Nepal.

BACKGROUND: Leptospirosis is a re-emerging zoonotic disease caused by pathogenic strains of bacteria belonging to genus Leptospira whose symptoms can range from mild clinical manifestations to a severe life threatening illness. This disease may be under-recognized in resource poor settings like Nepal where many clinical laboratories lack appropriate equipment, technology and personnel for proper diagnosis. METHODS: We used IgM ELISA to estimate the sero-prevalence of leptospirosis in a group of febrile patients in a western region of Nepal. We also tested for possible co-infection with two other common febrile diseases endemic to Nepal including dengue and typhoid fever. RESULTS: Among samples from 144 febrile patients, 30 (21%) were positive for leptospiral IgM. In univariate analysis, leptospirosis was significantly associated with being of working age (p = 0.019), farming (p = 0.045) and water and animal contact (p = 0.0001). Widal and dengue serological study showed that the majority of leptospirosis infections did not have an alternative diagnosis. CONCLUSION: As indicated by the study, regular surveillance of animal reservoirs in collaboration with veterinary department and inclusion of leptospirosis as a differential diagnosis of febrile illness is thus recommended based on the current findings.

Pragmatic cluster randomised trial of a free telephone-based health coaching program to support women in managing weight gain during pregnancy: the Get Healthy in Pregnancy Trial.

BACKGROUND: Excessive gestational weight gain can result in poor maternal and child health outcomes. Estimates from single studies indicate the prevalence of excessive gestational weight gain in Australia could lie between 38 and 67 %. The risk of excessive weight gain can be reduced through healthy eating and exercise. We describe the rationale and methods of the Get Healthy in Pregnancy Service, a trial service which aims to support women in achieving appropriate gestational weight gain through an existing telephone-based health coaching service. METHODS/DESIGN: This study aims to compare the effectiveness of a telephone-based health coaching program versus provision of information only in supporting pregnant women to achieve appropriate gestational weight gain. A pragmatic stratified clustered randomised controlled trial will be conducted with 710 women who present to 5 hospitals for their first antenatal appointment during the recruitment period (6-8 months), have a pre-pregnancy body mass index (BMI) ≥ 18.50 (healthy weight or above), are 18 years and over, singleton gestation, English speaking, have no pre-existing medical conditions that may limit their ability to exercise or require a restricted diet and are 18 weeks or less gestation. Hospitals will be randomised into one of two intervention models: a) information only; or b) information plus 10 telephone-based health coaching sessions with a university qualified coach. Both interventions will set a weight-range target with pregnant women. The women attending antenatal clinics at participating hospitals will be screened at their initial hospital appointment to assess their eligibility. Women recruited to the trial will have a number of measures recorded including anthropometrics (self-reported height and weight) and dietary and physical activity scores during and following pregnancy. These measurements will be collected at baseline (prior to 18 weeks gestation), 36 weeks gestation and 12 months post-birth. DISCUSSION: This study responds to a need for an effective intervention that targets excessive gestational weight gain at a population level. This study investigates the potential for an innovative intervention combining two existing services; a free state-wide telephone-based health coaching service and hospital-based antenatal care to support pregnant women to achieve healthy weight gain during pregnancy. The use of existing services provides the potential for immediate post-study implementation. While the impacts of telephone-based lifestyle programmes have been tested in a number of settings, there are few studies which evaluate the effectiveness and acceptability of telephone support in achieving healthy gestational weight gain in association with routine antenatal care. TRIAL REGISTRATION: ACTRN12615000397516 (Registration date: 26 June 2014, retrospectively registered).

Evaluation of the implementation of Get Healthy at Work, a workplace health promotion program in New South Wales, Australia.

Issue addressed Get Healthy at Work (GHaW) is a statewide program to reduce chronic disease risk among NSW workers by helping them make small changes to modifiable lifestyle chronic disease risk factors and create workplace environments that support healthy lifestyles. It has two primary components: a workplace health program (WHP) for businesses and online or face-to-face Brief Health Checks (BHCs) for workers. In this paper, we discuss our evaluation to identify areas for improvement in the implementation of WHP and to assess the uptake of BHCs by workers. Methods Routinely collected WHP and BHC program data between July 2014 and February 2016 were analysed. A baseline online survey regarding workplace health promotion was conducted with 247 key contacts at registered GHaW worksites and a control group of 400 key contacts from a range of businesses. Seven telephone interviews were conducted with service provider key contacts. Results As at February 2016, 3133 worksites (from 1199 businesses) across NSW had registered for GHaW, of which 36.8% started the program. Similar proportions of GHaW (34.0%) and control (31.7%) businesses had existing WHPs. BHCs were completed by 12740 workers, and of those whose risks were assessed, 78.9% had moderate or high risk of diabetes and 33.6% had increased or high risk of cardiovascular disease. Approximately half (50.6%) of eligible BHC participants were referred to Get Healthy Information and Coaching Service (GHS) and 37.7% to Quitline. The uptake of face-to-face BHCs compared with online was significantly higher for males, people aged over 35 years, those undertaking less physical activity and those less likely to undertake active travel to work. Service providers suggested that the program's structured five-step pathway did not offer adequate flexibility to support worksites' progress through the program. Conclusions During the evaluation period, a substantial number of NSW worksites registered for GHaW but their progress was slow because of the limited flexibility offered by the program model. So what? Workplace-based health promotion programs have potential to reach people at risk of chronic disease, but the implementation of such programs need to be more flexible than traditional health promotion programs in terms of delivery modes and timeframes.

Antibiotic resistance determinants among carbapenemase producing bacteria isolated from wastewaters of Kathmandu, Nepal.

The emergence of carbapenem resistant bacteria (CRB) possesses a remarkable threat to the health of humans. CRB and carbapenem resistance genes (CRGs) have frequently been reported in clinical isolates from hospitals, however, their occurrence and distribution in wastewaters from various sources and river water have not been emphasized in Nepal. So, this study aimed to detect carbapenem resistant bacterial isolates and their resistance determinants in river water and different types of wastewaters. River water and both untreated and treated wastewater samples from hospitals, pharmaceutical industries, and municipal sewage were collected in summer and winter seasons. From 68 grab wastewater samples, CRB were detected only in 16 samples, which included eight hospital wastewater, and four each from untreated municipal sewage and river water. A total of 25 CRB isolates were detected with dominance of E. coli (44.0%) and K. pneumoniae (24.0%). The majority of the isolates harbored blaNDM-1 (76.0%), followed by blaOXA (36.0%) and blaKPC (20.0%) genes. Hospital wastewater majorly contributed to the presence of blaNDM-1, blaKPC, and blaOXA along with intI1 genes compared to river water and untreated municipal sewage, especially during the winter season. However, CRB were not detected in treated effluents of hospitals and municipal sewage, and both influents and effluents from pharmaceutical industries. The combined presence of each blaNDM-1 & blaOXA and blaKPC & blaOXA occurred in 16.0% of the bacterial isolates. The increased minimum inhibitory concentration (MIC) of meropenem was significantly associated with the presence of CRGs. The results of this study highlight the significance of carbapenem resistance in bacteria isolated from wastewater and river water, and underscore the necessity for efficient monitoring and control strategies to prevent the dispersion of carbapenem resistance in the environment and its potential consequences on human health.

Extended-spectrum ß-lactamase-producing bacteria and their resistance determinants in different wastewaters and rivers in Nepal.

Wastewaters serve as significant reservoirs of antibiotic resistant bacteria. Despite the evidence of antimicrobial resistance in wastewaters and river water in Kathmandu, direct linkage between them is not discussed yet. This study investigated the prevalence of extended-spectrum ß-lactamase (ESBL)-producing bacteria and associated resistance genes in wastewaters and river water. Out of 246 bacteria from wastewaters, 57.72% were ESBL producers and 77.64% of them were multidrug resistant (MDR). ESBL producing E. coli was dominant in municipal and hospital wastewaters (HWW) as well as in river water while K. pneumoniae was common in pharmaceutical wastewater. The blaSHV and blaTEM genes were prevalent and commonly co-occurred with aac(6')-Ib-cr in K. pneumoniae isolated pharmaceutical wastewater. blaCTX-M carrying E. coli from hospital co-harbored aac(6')-Ib-cr while that from municipal influent and river water co-harbored qnrS. Whole genome sequencing data revealed the presence of diverse ARGs in bacterial isolates against multiple antibiotics. In average, an E. coli and a K. pneumoniae isolate contained 55.75 ± 0.96 and 40.2 ± 5.36 ARGs, respectively. Multi-locus sequence typing showed the presence of globally high-risk clones with wider host range such as E. coli ST10, and K. pneumoniae ST15 and ST307 in HWW and river indicating frequent dissemination of antimicrobial resistance in wastewater of Kathmandu. Whole genome sequence data aligned with phenotypic antibiograms and resistance genes detected by PCR in selected isolates. The presence of significant plasmid replicons (IncF, IncY) and mobile genetic elements (IS903, IS26) indicate high frequency of spreading antibiotic resistance. These findings indicate burden and dissemination of antimicrobial resistance in the environment and highlight the need for effective strategies to mitigate the antibiotic resistance.

Effectiveness of a national approach to prescribing education for multiple disciplines.

AIMS: To evaluate the effectiveness of a national approach to prescribing education on health professional students' prescribing and therapeutics knowledge, across multiple disciplines. METHODS: In a university examination setting, 83 medical, 40 pharmacy and 13 nurse practitioner students from three different universities completed a set of multiple choice questions (MCQs) before and after completing an online module from the National Prescribing Curriculum (NPC). To minimize overestimation of knowledge, students had to indicate the level of certainty for each answer on a three-point scale. MCQs were scored using a validated certainty-based marking scheme resulting in a composite score (maximum 30 and minimum -60). Students were asked to rate their perception of usefulness of the module. RESULTS: At the pre-module phase, there were no significant differences in the composite MCQ scores between the medical (9.0 ± 10.3), pharmacy (10.2 ± 10.6) and nurse practitioner (8.0 ± 10.7) students. The scores improved significantly for all groups at the post-module phase (P < 0.01 for all groups) by similar extents (post-module results: medical, 14.5 ± 9.6; pharmacy, 14.4 ± 9.9; nurse practitioner, 12.1 ± 9.6). 39.4% of the MCQs answered incorrectly with high level of certainty at the pre-module phase were still answered incorrectly with high level of certainty at the post-module phase. Almost all students (with no significant difference between the groups) found the NPC modules, post-module MCQs and feedback useful as a learning tool. CONCLUSIONS: A national online approach to prescribing education can improve therapeutics knowledge of students from multiple disciplines of health care and contribute towards streamlining interdisciplinary learning in medication management.

Unilateral proptosis in a patient with thyroid eye disease: A case report.

Unilateral proptosis is an abnormality in which one eye sticks out forward more than the other. Bulging of the eye is commonly seen in Graves' ophthalmopathy, but it's mostly bilateral. Thyroid eye disease presents as the most common extrathyroidal manifestation of Graves' disease, and rarely leads to unilateral proptosis. A 25-year-old female with a history of weight loss, menstrual irregularities, and palpitations presented with progressive right eye bulging, which was further confirmed by magnetic resonance imaging and biochemical investigations. Magnetic resonance imaging of the orbit revealed unilateral extraocular muscle enlargement and enhancement with sparing of the tendons. Timely therapy is crucial for reversing the ocular manifestations of thyroid eye disease.