Effectiveness of a novel, non-intrusive, continuous-use air decontamination technology to reduce microbial contamination in clinical settings: a multi-centric study.

BACKGROUND: Despite rigorous disinfection and fumigation, healthcare-associated infection (HAI) remains a significant concern in healthcare settings. We have developed a novel airborne-microbicidal technology 'ZeBox' which clears >99.999% of airborne microbial load under controlled laboratory conditions. AIM: To evaluate the clinical performance of ZeBox in reducing airborne and surface microbial load. METHODS: The study was conducted in single-bed and multi-bed intensive care units (ICUs) of two hospitals. Airborne and surface microbial loads were sampled pre and post deployment of ZeBox at pre-determined sites. Statistical significance of the reduction was determined using the Mann-Whitney U-test. FINDINGS: ZeBox brought statistically significant reduction of both airborne and surface bacterial and fungal load. In both hospital ICUs, airborne and surface bacterial load decreased by 90% and 75% on average respectively, providing a low bioburden zone of 10-15 feet diameter around the unit. The reduced microbial level was maintained during ZeBox's operation over several weeks. Most clinical bacterial isolates recovered from one of the hospitals were antibiotic resistant, highlighting ZeBox's ability to eliminate antimicrobial-resistant bacteria among others. CONCLUSION: ZeBox significantly reduces airborne and surface microbial burden in clinical settings. It thereby serves an unmet need for reducing the incidence of HAI.

Diagnostic accuracy of magnetic resonance imaging in detecting depth of invasion of tongue cancers.

The recent eighth edition of the American Joint Committee on Cancer (AJCC) staging system has introduced depth of invasion (DOI) as one of its important components. DOI is also important for deciding neck management in superficial tongue cancers. Magnetic resonance imaging (MRI) is mainly used to assess DOI, and in this study we have evaluated the efficacy of MRI to detect it. This is a retrospective study consisting of 60 treatment-naïve tongue cancer patients operated on between July 2017 and June 2019. Patients underwent MR imaging on an Optima MR450W 1.5T unit, and MRI was reported by two experienced head and neck radiologists. Postoperative histological DOI was considered the gold standard. The correlation coefficient was derived for postoperative DOI and MRI-detected DOI. A subgroup analysis of superficial tongue cancer was also done. The mean MRI DOI was 13.7 mm and the mean histological DOI 12.45 mm. The shrinkage factor was 0.6 mm. Pearson's correlation coefficient was 0.80 (p=<0.001) for Radiologist 1 and 0.85 (p=<0.001) for Radiologist 2. The interobserver variation was low, with a correlation coefficient between the two radiologists of 0.965 (p=<0.001). For superficial tongue cancers there was moderate correlation for MRI and histologically-detected DOI with a kappa value of 0.681 (p=0.03). As per the ROC curve, the cut-off value for MRI DOI to predict nodal metastasis was 4.6 mm. MRI has high reliability to predict the DOI of tongue cancers. The interobserver variation was low. The diagnostic accuracy in cases of superficial tongue cancer was moderate.

Reasons and correlates of contraceptive discontinuation in Kuwait.

OBJECTIVES: (1) To examine the probability of discontinuation of various methods within 1, 2, and three years of use and the reasons for discontinuation; 2) to analyse the socio-demographic correlates of discontinuation. METHODS: Data from a survey of Kuwaiti women in reproductive ages conducted in 1999 were used. Information on duration of use of modern and traditional methods, and reasons for discontinuation during the 72 months before the survey were analysed. Probabilities of discontinuation were estimated through multiple decrement life table analysis. RESULTS: After 1 year, 30% of modern and 40% of traditional method users had discontinued; after 3 years, discontinuation increased to 66 and 70%, respectively. After 36 months, only 40% of IUD users discontinued compared with 74% of oral contraceptive users. The desire to become pregnant was the leading reason for discontinuation of most modern methods, while method failure was an equally important reason for traditional methods. Discontinuation was significantly more frequent among higher parity, non-working and Bedouin women, and among those who said Islam disapproves of contraception. DISCUSSION: Contraception is used largely for spacing. More than two-thirds of the women studied had discontinued most methods after three years, except the IUD, which was used only by about 10% of them. Traditional methods are often discontinued due to method failure and may result in an unintended pregnancy. Better counselling is warranted for traditional methods. Health care for managing side effects of modern methods also needs improvement.

A profile of contraceptive non-use in Kuwait: implications for health and health care.

OBJECTIVES: To analyze the characteristics of women who have never used contraception, and do not intend to use it in the future; examine the factors affecting such behavior and intentions; and discuss their health implications. METHODS: Survey data from a nationally representative random sample of Kuwaiti households, collected in a study conducted in 1999 and containing 1502 currently married women, were analyzed using logistic regression analysis. RESULTS: Based on the present study, 19% of women had never used contraception and 50% were not using contraception when interviewed. Among current non-users, 42% did not intend to use contraception, and 31% were unsure about use during the following year. Negative attitudes of the respondents and their husbands were the critical factors in non-use and future intentions for non-use. Never-users were older (average age 37.8 years) and of higher parity (6.2) than other women. CONCLUSION: Being older and of higher parity, never-users constitute a high-risk group that may be in need of counseling. Also, negative attitudes towards contraception need modification.

Occurrence & detection of AmpC beta-lactamases at a referral hospital in Karnataka.

BACKGROUND & OBJECTIVES: AmpC beta-lactamases confer resistance to a wide variety of beta-lactam drugs except for cefepime, cefpirome and carbapenems. They are known to be responsible for nosocomial outbreaks, therapeutic failures and multidrug resistance. Although reported with increasing frequency the true rate of occurrence of these beta-lactamases in Enterobacteriaceae is not known. Hence the present study was undertaken to determine the occurrence of AmpC enzymes among clinical isolates. METHODS: A total of 520 consecutive, non-repeat clinical isolates were included in the present study. Twenty eight strains resistant to cefoxitin were tested for AmpC beta-lactamases by the modified 3-dimensional extract method. Isolates harbouring AmpC beta-lactamases were tested for inducible beta-lactamases by disc diffusion. RESULTS: Sixteen (3.3%) isolates were positive for AmpC beta-lactamases. Based on the species 9 (3.3%) Escherichia coli, 4 (2.2%) Klebsiella pneumoniae, 2 (5%) Citrobacter freundii and 1 (5.5%) isolate of Enterobacter aerogenes harboured AmpC enzymes. Nine (56.3%) of AmpC harbouring strains, were urinary isolates. All the isolates were sensitive to imipenem and variably sensitive to aminoglycosides and co-trimoxazole. INTERPRETATION & CONCLUSION: Our findings document the presence of AmpC enzymes in this region. Hence AmpC beta-lactamase detection should be undertaken in clinical isolates showing resistance to broad-spectrum cephalosporins.

Expression of rhodopsin and arrestin during the light-dark cycle in Drosophila.

PURPOSE: To determine the protein and transcript levels for rhodopsin (Rh1), arrestin 1 (Arr1), and arrestin 2 (Arr2) over a 12 h light/12 h dark cycle in the retina of the fruit fly, Drosophila melanogaster. This information is important for understanding the process of photoreceptor membrane turnover. METHODS: Drosophila were entrained for several generations to a daily 12 h light/12 h dark cycle. They were sacrificed at 4 h intervals, beginning at the time of onset of the light phase. Proteins were resolved by polyacrylamide gel electrophoresis (PAGE) and subjected to immunoblot analysis using antibodies directed to rhodopsin, NinaA, Arr1, and Arr2. Northern blots were incubated with riboprobes corresponding to the rhodopsin gene (ninaE), arrestin1 (arr1), and arrestin2 (arr2). RESULTS: In entrained Drosophila, protein and mRNA levels for rhodopsin, arrestin1, and arrestin2 were constant during a 12 h light/12 h dark cycle. CONCLUSIONS: These results indicate that rhodopsin and arrestin protein synthesis in Drosophila photoreceptors do not fluctuate on a daily cycle. These findings are similar to those obtained in Xenopus laevis, but in contrast to a variety of other vertebrate and invertebrate species.

Role of asparagine-linked oligosaccharides in rhodopsin maturation and association with its molecular chaperone, NinaA.

Many proteins require N-linked glycosylation for conformational maturation and interaction with their molecular chaperones. In Drosophila, rhodopsin (Rh1), the most abundant rhodopsin, is glycosylated in the endoplasmic reticulum (ER) and requires its molecular chaperone, NinaA, for exit from the ER and transport through the secretory pathway. Studies of vertebrate rhodopsins have generated several conflicting proposals regarding the role of glycosylation in rhodopsin maturation. We investigated the role of Rh1 glycosylation and Rh1/NinaA interactions under in vivo conditions by analyzing transgenic flies expressing Rh1 with isoleucine substitutions at each of the two consensus sites for N-linked glycosylation (N20I and N196I). We show that Asn(20) is the sole site for glycosylation. The Rh1(N20I) protein is retained within the secretory pathway, causing an accumulation of ER cisternae and dilation of the Golgi complex. NinaA associates with nonglycosylated Rh1(N20I); therefore, retention of nonglycosylated rhodopsin within the ER is not due to the lack of Rh1(N20I)/NinaA interaction. We further show that Rh1(N20I) interferes with wild type Rh1 maturation and triggers a dominant form of retinal degeneration. We conclude that during maturation Rh1 is present in protein complexes containing NinaA and that Rh1 glycosylation is required for transport of the complexes through the secretory pathway. Failure of this transport process leads to retinal degeneration.

Chain migration through the social network: experience of labour migrants in Kuwait.

PIP: "Labour migration to the Gulf countries is predominantly contract based and a majority of workers fall below the salary ceiling necessary for sponsoring family members. Despite this, social networks have expanded in Kuwait, primarily in the form of sponsorship of additional labour migrants by those already in the country. The objectives of the article are to describe how the process of arranging sponsorship works, to delineate the predictors of moving through a friend or relative, or arranging sponsorship for a subsequent labour migrant, and to assess the ¿multiplier' effect of the above process. The article is based on a survey among 800 South Asian skilled and unskilled male migrants, 200 each from Bangladesh, India, Pakistan and Sri Lanka." (EXCERPT)^ieng

Violence against women migrant workers: issues, data and partial solutions.

"Despite the creation of specific norms, procedures, and institutions to protect women migrant workers, serious gaps remain. Statistics for measuring violence are not compiled comprehensively or regularly. Two occupations that increase the risk of violence are domestic service and entertainment-related services. Migration through illegal channels and trafficking also increase the risk. This article suggests a list of indicators to measure violence of three major types: (1) economic, (2) social/psychological, and (3) physical/sexual. Evidence from several countries to document instances of violence is reviewed. Major policy issues for the sending and receiving countries are outlined, and some recommendations for addressing such violations are made."

Endogenous porphyrins in murine skin and transplanted PAM-212 squamous cell carcinoma tissues after injection of delta-aminolevulinic acid.

After intraperitoneal (IP) injection of delta-aminolevulinic acid (ALA), the endogenous porphyrins in murine skin and tumor tissues were determined by a method involving solvent and acid extractions. The results showed that the total amount of porphyrins in the tumor tissues after ALA injection was much higher than that in the skin from the same mice, although the amount of porphyrins in the skin from the ALA-injected mice was higher than that from the saline-injected (control) mice. The porphyrins in the tumor were mostly protoporphyrin and coproporphyrin, with only a small amount of uroporphyrin. The optimum period for porphyrin accumulation in the tumor as well as in the skin was 1 hour after the injection of ALA. As the period was extended to 3 and 6 hours, the amount of porphyrins in these tissues decreased considerably. These findings could be valuable for further application of ALA in the photodynamic therapy of skin cancer.

Depot drug delivery system for 5-fluorouracil after filtration surgery in the rabbit.

We investigated the potential value of 50:50 poly (DL glycolic acid-lactic acid) (PGLA) copolymer as a degradable depot delivery system for 5-fluorouracil (5-FU) after filtration surgery. Analysis of retrieved discs after implantation in 22 eyes of 22 pigmented rabbits showed a dual drug release profile and polymer mass loss characteristics. In a second group of pigmented rabbits implantation of PGLA discs impregnated with 5-FU (22 eyes) significantly lengthened the survival time of filtration fistulae compared with discs without 5-FU (18 eyes) or no disc (10 eyes) (p < 0.0001). Use of PGLA copolymer impregnated with 5-FU could prove valuable for patients undergoing glaucoma filtering surgery.

Ocular timolol levels after drug withdrawal: an experimental model.

Carbon 14-labelled timolol maleate was instilled into both eyes of 12 pigmented rabbits daily for 42 days. Drug levels in the aqueous humour and ocular tissues were measured up to 42 days after drug withdrawal. The results indicate that timolol concentrates mainly in melanotic tissues, with slow release. Even 42 days after withdrawal the drug was still present in pigmented ocular tissues. Timolol was detected in the aqueous up to 5 days after withdrawal. These findings explain the long-term depressant effect of topically administered timolol on aqueous production. We conclude that lower or less frequent doses of timolol should be considered in patients with glaucoma.

Fifty:fifty poly (DL glycolic acid-lactic acid) copolymer as a drug delivery system for 5-fluorouracil: a histopathological evaluation.

Fifty:fifty poly (DL glycolic acid-lactic acid) copolymer (PGLA) is a potentially useful depot drug delivery system for 5-fluorouracil (5-FU). The purpose of this study was to evaluate the fibroinflammatory reaction induced by this polymer. Polymer discs without 5-FU were inserted subconjunctivally in one eye of each of two guinea pigs and four pigmented rabbits (control group), and discs containing 20% 5-FU were inserted subconjunctivally in both eyes of nine pigmented rabbits (study group). The tissue reaction to the copolymer did not differ between rabbits and guinea pigs, with a mild mixed inflammatory reaction 1 week after implantation. At 2 weeks a thin fibrous capsule surrounded the discs, with no change in the amount of inflammation. At 4 weeks the disc had disintegrated, but residual polymer was seen within multinucleated giant cells in the episcleral tissue. Granulation tissue and inflammatory responses were mild. Less inflammation and fibrosis occurred in the study eyes, although the pattern of response was similar in the two groups. The inflammatory response to PGLA was markedly less than that to implanted collagen shields, and our findings suggest that PGLA implant is a promising ocular drug delivery system for 5-FU after filtration surgery.

Photoinduced cutaneous inflammatory response by psoralens.

Our studies describe the inflammatory response in rabbit skin induced by topical application of 8-methoxypsoralen (8-MOP) and UVA-visible irradiation (320-700 nm). Increase in vascular permeability (iVP) and accumulation of polymorphonuclear leucocytes (aPMN) at the test sites were quantitated using 125I-albumin and 51Cr-labelled PMNs respectively. Erythema was graded visually. 8-MOP cream was applied topically and irradiated. The erythemal response, aPMN and iVP at the test sites were quantitated at 6, 24, 48 and 72 h post-irradiation. The iVP and aPMN were maximal at 24 h; the erythemal response was the same at 24-48 h. The responses were dependent on 8-MOP concentration and irradiation dose. Topical application of 200 micrograms 8-MOP cream followed by irradiation for 2 h (9.4 J cm-2) produced 3-7 times iVP, 2-4 times aPMN and intense erythema at the test sites after 24 h. Neither aPMN nor iVP was detected before 6 h and erythemal response was not observable up to 16 h after irradiation. The aPMN and iVP gradually subsided in 72 h, although the erythemal response was still present. The repeated exposure of 8-MOP-treated sites for three consecutive days 24 h apart did not produce appreciable iVP or aPMN at 72 h or 24 h after the last exposure; however, erythema persisted. The 8-MOP-treated sites previously exposed for three consecutive days on reapplication of 8-MOP cream plus irradiation showed significantly less response compared with non-pretreated sites. Our results suggest that the erythemal response is not directly related to either iVP or aPMN.

Quantitative determination of the melanin contents in ocular tissues from human blue and brown eyes.

This paper deals with our findings on the quantities of melanin in the tissues from blue and brown eyes. The amount of melanin in the iris, ciliary body and retinal pigment epithelium-choroid was separately determined. The results are expressed as the amount of melanin in mg tissue as well as the amount of melanin in the whole tissue. The results showed that there was no statistically significant difference between the melanin content of the iris in blue and brown eyes. However the ciliary body and retinal pigment epithelium-choroid from brown eyes had more melanin than the corresponding tissues from blue eyes. Blue and brown eyes with higher colour intensity had more melanin than the corresponding eyes with lesser intensity of colour. It is suggested that the differences between brown and blue eyes in their melanin content may have relevance to the pharmacokinetics of drugs that bind to melanin. This would mean that the larger amounts of melanin would decrease the initial levels of the drugs and would increase the drug levels after prolonged periods.

Role of iron in the photosensitization by uroporphyrin.

The role of iron in the mechanism of photosensitivity due to uroporphyrin was investigated. There is frequently increased levels of Fe in the serum from patients with porphyria cutanea tarda, where the photosensitivity is due to uroporphyrin. It has been reported that H2O2 has a major role in the uroporphyrin induced photosensitivity. Hence we examined the hypothesis that Fe would catalyze the production of OH from H2O2 and the OH thus formed may have a significant role in the uroporphyrin photosensitivity. This was examined by studying the effects of the Fe chelating compound deferoxamine in an in vitro system. Our results show that deferoxamine inhibited the uroporphyrin photosensitivity, but not the photosensitivity due to protoporphyrin. This indicates that Fe may play a role in the uroporphyrin photosensitization in the skin, by accelerating the formation of OH, which may be a major reactive species responsible for the photosensitization in porphyria cutanea tarda.