RESUMO
BACKGROUND: The threat posed by antibiotic resistance is of increasing concern in low- and middle-income countries (LMICs) as their rates of antibiotic use increase. However, an understanding of the burden of resistance is lacking in LMICs, particularly for multidrug-resistant (MDR) pathogens. METHODS: We conducted a retrospective, 10-hospital study of the relationship between MDR pathogens and mortality in India. Patient-level antimicrobial susceptibility test (AST) results for Enterococcus spp., Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. were analyzed for their association with patient mortality outcomes. RESULTS: We analyzed data on 5103 AST results from 10 hospitals. The overall mortality rate of patients was 13.1% (n = 581), and there was a significant relationship between MDR and mortality. Infections with MDR and extensively drug resistant (XDR) E. coli, XDR K. pneumoniae, and MDR A. baumannii were associated with 2-3 times higher mortality. Mortality due to methicillin-resistant S. aureus (MRSA) was significantly higher than susceptible strains when the MRSA isolate was resistant to aminoglycosides. CONCLUSIONS: This is one of the largest studies undertaken in an LMIC to measure the burden of antibiotic resistance. We found that MDR bacterial infections pose a significant risk to patients. While consistent with prior studies, the variations in drug resistance and associated mortality outcomes by pathogen are different from those observed in high-income countries and provide a baseline for studies in other LMICs. Future research should aim to elucidate the burden of resistance and the differential transmission mechanisms that drive this public health crisis.
Assuntos
Bactérias , Infecções Bacterianas , Farmacorresistência Bacteriana Múltipla , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/patogenicidade , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
The endothelium is a thin innermost layer of flat cells which release various mediators including endothelin-1 (ET-1), prostanoids, von Willebrand factor (vWF) and endothelium-derived relaxing factor (EDRF; nitric oxide) to regulate vascular tone. Endothelial nitric oxide synthase (eNOS) is a key enzyme that generates nitric oxide (NO). NO maintains vascular homeostasis and cardiac functions by influencing major vascular protective properties such as anti-platelet, anti-proliferative, anti-migratory, antioxidant and anti-inflammatory action in vessels. Abnormal endothelial production and release of NO lead to vascular endothelial dysfunction (VED) and further leads to pathogenesis in myocardial and other tissues. Numerous pharmacological agents such as angiotensin-converting enzyme inhibitors, statins, calcium channel blockers, ET-1 receptor antagonists, insulin sensitizers, antioxidants and supplements like tetrahydrobiopterin, arginine and folate have been implicated in the treatment of VED, but their therapeutic potency was restricted due to some unavoidable adverse effects. The new era with advances in nanotechnology and its ability to target a specific disease, nano-medicine explored an innovative gateway for advanced therapy for VED. The present commentary reveals the various available, pipeline nano-medicine, their interaction with endothelium and in other associated pathological conditions and their delivery strategies for target-specific treatment of VED.
Assuntos
Fármacos Cardiovasculares/administração & dosagem , Doenças Cardiovasculares/tratamento farmacológico , Endotélio Vascular/efeitos dos fármacos , Nanomedicina/métodos , Nanopartículas , Tecnologia Farmacêutica/métodos , Animais , Fármacos Cardiovasculares/química , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Portadores de Fármacos , Composição de Medicamentos , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Humanos , Transdução de Sinais/efeitos dos fármacosRESUMO
BACKGROUND: Coronary artery disease (CAD) outcomes consistently improve when they are routinely measured and provided back to physicians and hospitals. However, few centers around the world systematically track outcomes, and no global standards exist. Furthermore, patient-centered outcomes and longitudinal outcomes are under-represented in current assessments. METHODS AND RESULTS: The nonprofit International Consortium for Health Outcomes Measurement (ICHOM) convened an international Working Group to define a consensus standard set of outcome measures and risk factors for tracking, comparing, and improving the outcomes of CAD care. Members were drawn from 4 continents and 6 countries. Using a modified Delphi method, the ICHOM Working Group defined who should be tracked, what should be measured, and when such measurements should be performed. The ICHOM CAD consensus measures were designed to be relevant for all patients diagnosed with CAD, including those with acute myocardial infarction, angina, and asymptomatic CAD. Thirteen specific outcomes were chosen, including acute complications occurring within 30 days of acute myocardial infarction, coronary artery bypass grafting surgery, or percutaneous coronary intervention; and longitudinal outcomes for up to 5 years for patient-reported health status (Seattle Angina Questionnaire [SAQ-7], elements of Rose Dyspnea Score, and Patient Health Questionnaire [PHQ-2]), cardiovascular hospital admissions, cardiovascular procedures, renal failure, and mortality. Baseline demographic, cardiovascular disease, and comorbidity information is included to improve the interpretability of comparisons. CONCLUSIONS: ICHOM recommends that this set of outcomes and other patient information be measured for all patients with CAD.
Assuntos
Consenso , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/terapia , Hospitalização/estatística & dados numéricos , Inquéritos e Questionários/normas , Idoso , Causas de Morte , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Surgical site infections are a threat to patient safety. However, in India, data on their rates stratified by surgical procedure are not available. METHODS: From January 2005 to December 2011, the International Nosocomial Infection Control Consortium (INICC) conducted a cohort prospective surveillance study on surgical site infections in 10 hospitals in 6 Indian cities. CDC National Healthcare Safety Network (CDC-NHSN) methods were applied and surgical procedures were classified into 11 types, according to the ninth edition of the International Classification of Diseases. RESULTS: We documented 1189 surgical site infections, associated with 28 340 surgical procedures (4.2%; 95% CI: 4.0-4.4). Surgical site infections rates were compared with INICC and CDC-NHSN reports, respectively: 4.3% for coronary bypass with chest and donor incision (4.5% vs 2.9%); 8.3% for breast surgery (1.7% vs 2.3%); 6.5% for cardiac surgery (5.6% vs 1.3%); 6.0% for exploratory abdominal surgery (4.1% vs 2.0%), among others. CONCLUSIONS: In most types of surgical procedures, surgical site infections rates were higher than those reported by the CDC-NHSN, but similar to INICC. This study is an important advancement towards the knowledge of surgical site infections epidemiology in the participating Indian hospitals that will allow us to introduce targeted interventions.
Assuntos
Infecção Hospitalar/epidemiologia , Hospitais , Infecção da Ferida Cirúrgica/epidemiologia , População Urbana , Feminino , Humanos , Índia/epidemiologia , Controle de Infecções , Estudos ProspectivosRESUMO
BACKGROUND: The primary objective of this study was to compare the effect of ventilation using the ProSeal™ laryngeal mask airway (PLMA) with facemask and oropharyngeal airway (FM), prior to laryngoscopy, on arterial oxygenation in morbidly obese patients undergoing bariatric surgery. METHODS: Forty morbidly obese patients were randomly recruited to either PLMA or FM. After pre-oxygenation (FiO2 1.0) in the ramp position with continuous positive airway pressure of 10 cm H2O for 5 min, anaesthesia was induced. Following loss of jaw thrust oropharyngeal airway, the FM and PLMA were inserted. On achieving paralysis, volume control ventilation with PEEP (5 cm H2O) was initiated. The difficulty in mask ventilation (DMV) in FM, number of attempts at PLMA and laryngoscopy were graded (Cormack and Lehane) in all patients. Time from onset of laryngoscopy to endotracheal tube confirmation was recorded. Hypoxia was defined as mild (SpO2 ≤95%), moderate (SpO2 ≤90%) and severe (SpO2 ≤85%). RESULTS: Significant rise in pO2 was observed within both groups (P=0.001), and this was significantly higher in the PLMA (P=0.0001) when compared between the groups. SpO2 ≥ 90% (P=0.018) was seen in 19/20 (95%) patients in PLMA and 13/20 (65%) in FM at confirmation of tracheal tube. A strong association was found between DMV and Cormack Lehane in the FM group and with number of attempts in the PLMA group. No adverse events were observed. CONCLUSION: ProSeal™ laryngeal mask airway as conduit prior to laryngoscopy in morbidly obese patients seems effective in increasing oxygen reserves, and can be suggested as a routine airway management technique when managing the airway in the morbidly obese.
Assuntos
Aneurisma Aórtico/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Monitorização Intraoperatória/métodos , Idoso , Dissecção Aórtica/etiologia , Aneurisma Aórtico/etiologia , Humanos , Masculino , UltrassonografiaRESUMO
Of the few preserved areas in the northeast of United States, the soil in the Pine Barrens Forests presents a harsh environment for the microorganisms to grow and survive. In the current study we report the use of clustering methods to scientifically select the sampling locations that would represent the entire forest and also report the microbial diversity present in various horizons of the soil. Sixty six sampling locations were selected across the forest and soils were collected from three horizons (sampling depths). The three horizons were 0-10 cm (Horizon O); 11-25 cm (Horizon A) and 26-40 cm (Horizon B). Based on the total microbial substrate utilization pattern and K-means clustering analysis, the soil in the Pine Barrens Forest can be classified into four distinct clusters at each of the three horizons. One soil sample from each of the four clusters were selected and archaeal and bacterial populations within the soil studied using pyrosequencing method. The results show the microbial communities present in each of these clusters are different. Within the microbial communities present, microorganisms involved in nitrogen cycle occupy a major fraction of microbial community in the soil. High level of diversity was observed for nitrogen fixing bacteria. In contrast, Nitrosovibrio and Nitrosocaldus spp are the single bacterial and archaeal population respectively carrying out ammonia oxidation in the soil.