Rapid, culture-free detection of carbapenem-resistant Klebsiella pneumoniae in a case of bloodstream infection using genomics.

Timely diagnosis and treatment of sepsis is a major challenge faced by critical care specialists around the world. The traditional blood culture methods have a significant turnaround time which delays targeted therapy leading to poor prognosis. In the current study, we highlight the clinical utility of a genomics solution for diagnosis and management of bloodstream infections by combining the real-time DNA sequencing of Oxford Nanopore Technology with an automated genomic data analysis software. We identify a carbapenem-resistant Klebsiella pneumoniae directly from a blood sample in <24 hours and thereby prove the effectiveness of the test in early diagnosis of sepsis.

VOC source apportionment, reactivity, secondary transformations, and their prioritization using fuzzy-AHP method in a coal-mining city in India.

This study assessed the air quality status in different functional zones of Dhanbad-a coal-mining and industrial hub, based on the measurement of aromatic and halogenated volatile organic compounds (VOCs) using gas chromatography. The study encompasses source apportionment of VOCs and their chemical reactivity in terms of OH radical loss rate (LOH), ozone-forming potential (OFP), and their secondary organic aerosol forming potential (SOAp). Furthermore, prioritization of VOCs based on a fuzzy-analytical hierarchical process (F-AHP) has also been done. The results found xylene species to have the highest concentration in all three seasons across traffic-intersection and industrial zones and toluene at the institutional zone. The study identified four sources using positive matrix factorization (PMF) model, viz., mixed traffic exhaust (35%), coal combustion sources (30%), industrial (26%), and solvent usage (9%). LOH and SOAp were ~ 16 times more at the industrial and traffic-intersection zone than the institutional zone. The aromatic species contributed 97% to the OFP, and many species exhibited less contribution to the mixing ratio of VOCs but displayed a high contribution to LOH, OFP, and SOAp, suggesting the need to prefer reactivity-based strategies in addition to concentration-based strategies in the future for their regulation. The F-AHP-based priority component analysis identified 16 species out of 29 in the priority watch list (nine in tier-1, four in tier-2, and three in tier-3). The paucity of data and lack of ambient air quality standards on VOCs (except benzene) make it difficult to determine which aspect should be dealt with first and which species require more attention. Therefore, the F-AHP method used in this study could help identify the influencing parameters to be considered while devising efficient VOC management policies.

Health risk assessment from exposure to ambient VOCs and particulate matter in different functional zones in Dhanbad, India.

This study evaluates the non-cancer risks (NCR) and cancer risks (CR) in outdoor working personnel in Dhanbad city, exposed to volatile organic compounds (VOCs) and particulate matter (PM) present in the ambient air. Dhanbad is known for its coal mines and is one of the most polluted cities in India and the world. Sampling was conducted in different functional zones; namely, traffic intersections, industrial, and institutional areas, to estimate the concentration of different PM-bound heavy metals and VOCs in the ambient air using Inductively coupled plasma-optical emission spectrometry (ICP-OES) and gas chromatography (GC) respectively. Our results show that the concentration levels (of VOCs and PM) and health risks were maximum at the traffic intersection area, followed by the industrial and institutional areas. The major contribution to CR came from chloroform, naphthalene, and PM-bound chromium, while the contribution to NCR mainly came from naphthalene, trichloroethylene, xylenes, and PM-bound chromium, nickel, and cadmium. It was observed that CR and NCR from VOCs are quite comparable (average CRvoc 8.92E-05 and NCRvoc 6.82) to that from the PM-bound heavy metals (average CRPM 9.93E-05 and NCRPM 3.52). According to the sensitivity analysis performed using Monte-Carlo Simulation, it was also found that the output risk is most significantly influenced by the pollutant concentration followed by exposure duration and exposure time. The study reveals that Dhanbad city is not only a critically polluted area but also a highly hazardous and cancer-prone area due to the pollution arising from incessant coal mining activities and heavy vehicular movement. Given the paucity of data on exposure to VOCs in ambient air and their risk assessment pertaining to coal mining cities of India, our study provides useful information and insight for the regulatory and enforcing authorities to devise appropriate strategies for air pollution and health risk management in such cities.

Cephalometric evaluation of the cervical spine posture following fixed functional therapy with Forsus™ appliance.

Background: To investigate whether fixed functional therapy for mandibular advancement with the Forsus™ appliance would produce any changes in the cervical spine posture. Materials and Methods: This prospective clinical exploratory study was conducted on 12 patients (six females and six males) with a mean age of 15 ± 1.3 years, having mandibular retrusion, Class II malocclusion, who were treated with the Forsus™ appliance. Lateral cephalogram was taken twice, once at the baseline (T1) before the commencement of the treatment and once following termination of fixed functional treatment (T2). Eleven measurements representing the vertical and the sagittal craniofacial proportions, and the head posture, were taken into account. Data were analyzed using SPSS version 22. The variations between before and after treatment measurements were collated using paired t-test. P < 0.05 was considered statistically significant. Results: No significant differences were noticed in the angle linking the horizontal lines of the head and the superior crest of the spinal column before and after the treatment, with P = 0.73. The cervical curvature angle also failed to show any significant difference with P = 0.14. Conclusion: Fixed functional therapy with the Forsus™ device resulted in dentoalveolar and soft tissue alterations alone but did not alter the cervical spine posture.

Chemical properties of emissions from solid residential fuels used for energy in the rural sector of the southern region of India.

In the present study, we have estimated the emission factors (EFs) of particulate matter (PM), organic and elemental carbon (OC and EC), oxide of sulfur and nitrogen, and water-soluble ionic species emitted from residential fuels (fuelwood, crop residue, dung cake) used in the rural sector of five states (Kerala, Karnataka, Andhra Pradesh, Telangana, Tamil Nadu) of the southern region of India. Average EFs of PM, OC, and EC from fuelwood (FW), crop residues (CR), and dung cakes (DC) from southern region of India are estimated as follows: PM: 6.35 ± 5.64 g/kg (FW), 6.99 ± 5.46 g/kg (CR), 9.69 ± 3.73 g/kg (DC); OC: 1.60 ± 1.72 g/kg (FW), 1.50 ± 1.52 g/kg (CR), 3.54 ± 0.75 g/kg (DC); and EC: 0.46 ± 0.53 g/kg (FW), 0.29 ± 0.17 g/kg (CR), 0.21 ± 0.11 g/kg (DC), respectively. Similarly, the average EFs of SO2, NOx from FW, CR, and DC are determined to be as follows: SO2: 0.40 ± 0.37 g/kg (FW), 1.17 ± 0.25 g/kg (CR), and 0.18 ± 0.10 g/kg (DC); NOx: 1.11 ± 1.22 g/kg (FW), 0.69 ± 0.37 g/kg (CR), and 0.91 ± 0.54 g/kg (DC), respectively. PO43- shows the highest EF from FW (646.02 ± 576.35 mg/kg), CR (531.06 ± 678.29 mg/kg) among all anions followed by Cl- (FW: 512.91 ± 700.35 mg/kg, CR: 661.61 ± 865.46 mg/kg and DC: 104.16 ± 54.01 mg/kg); whereas, Na+ shows highest EF from FW (254.05 ± 298.50 mg/kg) and CR (249.36 ± 294.85 mg/kg) among all cations. The total emissions of trace gases, PM, and their chemical composition from FW, CR, and DC have been calculated using laboratory-generated EFs over the southern region of India. CR (1595.58 ± 14.24 Gg) contributes to higher emission of PM as compared to FW (218.78 ± 53.93 Gg), whereas the contribution from DC is negligible.

Reliability of Photogrammetric Landmarks to the Conventional Cephalogram for Analyzing Soft-Tissue Landmarks in Orthodontics.

BACKGROUND: Graber introduced facial photographs as an internal diagnostic aid. Facial photographs could serve as an important alternative assessment tool in the absence of equipment for cephalometric analysis. OBJECTIVES: The present study was aimed at assessing whether analyzing the photographs could have precision for assessing the landmarks appropriate for facial analysis. In addition, the relationship between frontal cephalogram and measurements on photographs was assessed. MATERIALS AND METHODS: Twenty individuals including both males and females within the age range of 18 years to 28 years were enrolled in the study. Frontal facial photographs, as well as frontal cephalograms, were obtained for all the included study participants. Various soft-tissue vertical and horizontal landmarks were marked on both radiographs and photographs. The data were collected and subjected to statistical analysis. RESULTS: The results showed a statistically insignificant difference between all the vertical and horizontal parameters on photographs and cephalograms. The reliability of the digital photographs was comparable to that of the cephalograms with nonsignificant differences in the recorded mean values using the one-way ANOVA test where the statistical significance level was kept at P ≤ 0.05. CONCLUSION: The present study concluded that photography is a cost-effective and reliable method for soft-tissue landmark identification, and allows recording the images of sufficient quantity for analysis. Low-cost and easily captured photographic images can replace costly radiographic procedures without causing any discomfort to the patients.

Antifungal susceptibility patterns, in vitro production of virulence factors, and evaluation of diagnostic modalities for the speciation of pathogenic Candida from blood stream infections and vulvovaginal candidiasis.

Candida spp. have emerged as successful pathogens in both invasive and mucosal infections. Varied virulence factors and growing resistance to antifungal agents have contributed to their pathogenicity. We studied diagnostic accuracy of HiCrome Candida Differential Agar and Vitek 2 Compact system for identification of Candida spp. in comparison with species-specific PCR on 110 clinical isolates of Candida from blood stream infections (54, 49%) and vulvovaginal candidiasis (56, 51%). C. albicans (61%) was the leading pathogen in VVC, while C. tropicalis (46%) was prominent among BSIs. HiCrome Agar and Vitek 2 Compact had good measures of agreement (κ) 0.826 and 0.895, respectively, in comparison with PCR. We also tested these isolates for in vitro production of proteinase, esterase, phospholipases, and biofilms. Proteinase production was more among invasive isolates (P = 0.017), while phospholipase production was more among noninvasive isolates (P = 0.001). There was an overall increase in the production of virulence factors among non-albicans Candida. Identification of clinical isolates of Candida up to species level either by chromogenic agar or by Vitek 2 Compact system should be routinely done to choose appropriate therapy.