Correlation between carriers of Methicillin-resistant Staphylococcus aureus and the incidence of MRSA surgical site infections in orthopedic surgery patients.

OBJECTIVE: Surgical site infection (SSI) is a devastating complication in orthopedic surgery. Methicillin-resistant Staphylococcus aureus (MRSA) is a notorious organism in SSI, especially in orthopedic patients. We aimed to understand the association between MRSA carriers and the rate of SSI caused by MRSA in orthopedic patients. PATIENTS AND METHODS: We prospectively performed a cohort investigation on patients admitted to the Department of Orthopedic between April and August 2023. Samples were taken preoperatively from the nose and post-operatively in surgical wounds. All samples were grown in MeReSa Agar and defined as positive with MRSA characteristics. Data analysis was performed using SPSS Statistics. A significant difference between groups was assessed using either the Chi-square test or Fisher's exact test. Statistical significance was set at p<0.05. RESULTS: We obtained 526 nasal swabs of patients, and 140 (26.6%) samples were positive for MRSA. Our study revealed significant associations between MRSA carriers and the following factors: history of recent hospitalization (OR: 1.81; 95% CI: 1.172-2.795; p=0.007), smoking history (OR: 1.55; 95% CI: 1.011-2.383; p=0.044), and antibiotic exposures (OR: 2.19; 95% CI: 1.305-3.703; p=0.003). Our findings showed a significant association between SSI and the following factors: history of antibiotic exposures (OR: 2.89; 95% CI: 1.264-6.566; p=0.003), blood loss volume >500 ml (OR: 2.522; 95% CI: 1.245-5.108; p=0.008) and contaminated surgical wounds (OR: 5.97; 95% CI: 2.907-12.266; p=0.001). Patients with MRSA carriers tended to have an increased risk of having an MRSA SSI with an odds ratio of 3.44 (95% CI: 1.13-10.48; p=0.047). CONCLUSIONS: Our study highlights the increased risk of MRSA carriage in patients with a history of smoking, recent hospital admission, or antibiotic exposure. Our reports also identify potential risk factors for SSI, such as previous antibiotic exposure, blood loss, and contaminated wounds. Furthermore, our research establishes an association between MRSA colonization and MRSA SSI, which emphasizes the criticality of decolonization strategies. A further prospective multicenter study is needed to elaborate on our study findings.

Pandemic-related health behavior: repeat episodes of influenza-like illness related to the 2009 H1N1 influenza pandemic.

The Houston Health Department (HHD) in Texas tracks influenza-like illness (ILI) in the community through its Influenza Sentinel Surveillance Program, which began in 2008. After the influenza A(H1N1) pandemic (pH1N1) in 2009, investigators sought to assess the feasibility of this program as a non-traditional data source for tracking and monitoring care-seeking activities. Through the process of characterizing and describing patients who had 'return visits', or who were considered the heaviest ILI-related care-utilizers, the investigators sought to understand the strengths and limitations of this data source. Data used for this study were obtained from a multispecialty clinic in Houston, Texas between August 2008 and January 2011 across three phases: pre-pH1N1, pH1N1, and post-pH1N1. The data, which comprised of 4047 patient visits, yielded 150 return visits. We found an increase in the number of visits for ILI and proportion of return visits during the pandemic phase (pH1N1), as well as differences in the likelihood of a return visit between genders and age groups. More broadly, the findings of this study provide important considerations for future research and expose important gaps in using surveillance data to assess sick-role behaviors.

Growth performance and starch utilization in common carp (Cyprinus carpio L.) in response to dietary chromium chloride supplementation.

A nutrition trial was conducted on juvenile common carp (Cyprinus carpio), initial mean body weight 15 ± 0.4 g within a controlled facility at 25 ± 0.5°C. Six diets containing various levels of supplementary Cr (0, 0.2, 0.5, 1.0, 1.5, and 2.0) mg Cr/kg of diet as Cr chloride hexahydrate were fed to carp for a period of 10 weeks. Lower growth performance was observed in fish fed on the control diet and the diet supplemented with the highest level of Cr (2.0mg Cr/kg). Although fish fed 0.5mg Cr/kg showed the best growth performance, this was not significantly different (P>0.05) from fish fed 1.0mg Cr/kg. The regression of plasma glucose concentration was linear (R(2)=0.97 and P value=0.001) as the Cr content of the diet increased (up to 1.5mg Cr/kg). Cr carcass content was elevated with an increasing level of dietary Cr supplementation up to 1.5mg Cr/kg; but fish fed on the diet supplemented with the highest level of Cr (2.0mg Cr/kg) showed a decrease in Cr carcass content. Histological examination to evaluate the impact of different Cr supplementation on liver and gut tissues showed notable changes. The higher level of Cr (2.0mg Cr/kg) in the diet gave rise to elevated hepatocyte vacuolization and changes in gut tissue morphology. It appeared that Cr chloride significantly improved growth within a defined range (0.2-1.5) mg Cr/kg without any negative impact, while 2.0mg Cr/kg in carp diet seems to be the threshold for the initiation of toxicity.

The effect of dietary organic chromium on specific growth rate, tissue chromium concentrations, enzyme activities and histology in common carp, Cyprinus carpio L.

A 63-day feeding trial was carried out to investigate the effect of three levels of Cr yeast (0.5, 1.0 and 2.0 mg Cr/kg) on the utilization of diets containing 38.5 % of maize starch or dextrin in common carp, Cyprinus carpio L. (initial mean body mass 14 ± 0.3 g) in an auto circulator system at 25 ± 0.5 °C. A two-way analysis of variance (ANOVA) showed that the final body mass (FBM), percentage mass gain (%MG), specific growth rate (SGR) and feed conversion ratio (FCR) were significantly (P < 0.05) affected by the two sources of variation (carbohydrate source and Cr level). In general, fish fed on a diet containing starch and fortified with 0.5 mg Cr/kg performed significantly higher FBM (47.23 g), %MG (225.11), SGR (1.91) and lower value of FCR (1.24) compared to fish fed on the other diets. Carp fed on 2.0 mg Cr/kg with maize starch and 1.0 mg Cr/kg with dextrin-based diet showed a significant reduction (P < 0.05) in whole body lipid content as confirmed by a two-way ANOVA. Fish fed on a maize starch-based diet supplemented with 0.5 and 1.0 mg Cr/kg recorded the highest activities for hexokinase enzyme. Glucose-6-phosphate dehydrogenase activity was neither affected by Cr concentration nor by dietary carbohydrate source. Fish fed on dextrin-based diets accumulated higher Cr in the whole tissue compared to fish fed on starch-based diets. Normal histological structures in the liver and gut tissues were observed in all groups. The present data clearly showed that dietary Cr yeast was safe in the fish diet at the levels tested.

The efficacy of chromium as a growth enhancer for mirror carp (Cyprinus carpio L): an integrated study using biochemical, genetic, and histological responses.

A growth trial was conducted on juvenile mirror carp (Cyprinus carpio L.) for 8 weeks to compare the efficacy of three chromium (Cr) compounds (Cr chloride, Cr picolinate, and Cr yeast) at a level 0.5 mg/kg as a potential growth enhancer. In addition, a high level of Cr (2.0 mg/kg) as Cr chloride has also been added in parallel for comparison. All Cr fortified diets at a level 0.5 mg/kg produced superior growth for carp compared to the control group and the group fed the high level of Cr chloride (2.0 mg/kg). Metabolic indicators measured included two of the key liver enzymes (hexokinase, HK) and (glucose-6-phosphate dehydrogenase, G6PD) activity. The results validated the positive effect of Cr at a level 0.5 mg/kg on enzyme activity and carbohydrate utilization producing significantly better growth performance for mirror carp. The study also included measurement of DNA strand breaks in the erythrocytes using the comet assay which revealed significantly (P < 0.05) increased DNA damage in fish fed on high level of Cr chloride (2.0 mg/kg) but the other treatments were not significantly different (P > 0.05) from the control groups. The concentration of Cr in the liver, gut, and whole fish tissues increased with increasing dietary Cr supplementation. Overall, Cr supplementation at a level 0.5 mg/kg from different sources may affect growth performance in carp by activation of some key liver enzymes (HK and G6PD).

Risk factors for encephalitis from West Nile Virus: a matched case-control study using hospitalized controls.

We conducted a case-control study to determine risk factors for developing encephalitis among West Nile virus cases when compared with age-, gender and race/ethnicity-matched hospitalized controls. In the multivariable conditional logistic regression analysis, we identified the following independent risk factors associated with being an encephalitis case: hypertension (OR 4.0; P = 0.005), immunosuppressing conditions (OR 5.6; P = 0.001) and cardiovascular disease (OR = 28.3; P < 0.001). Individuals with these comorbidities should be targeted for education on protecting themselves from mosquito exposures.

Condom use among high-risk heterosexual women with concurrent sexual partnerships, Houston, Texas, USA.

Concurrent sexual partnerships allow for enhanced transmission of sexually transmitted infections (STIs). Condom use dynamics in this context may be an important factor for transmission of HIV. We conducted a cross-sectional study to describe the frequency of concurrency among high-risk heterosexual women in Houston, Texas and determine the factors associated with condom use. A total of 553 participants were recruited using respondent-driven sampling and completed an anonymous questionnaire; 256 (49%) were identified as having a concurrent partnership. The prevalence of condom use at last sexual encounter was 26%. Women were significantly more likely to use condoms if their sexual encounter was with a casual partner and if alcohol and/or drugs were not used. The high prevalence of concurrent partnerships suggests the presence of a dense sexual network which may enable the rapid spread of STIs and HIV. The risk of transmission may be additionally increased due to the low prevalence of condom use.

Clinical investigation of hospitalized human cases of West Nile virus infection in Houston, Texas, 2002-2004.

The objective of this study was to describe the clinical features of cases hospitalized with West Nile virus (WNV) infections and identify clinical parameters that could potentially predict poor outcome (death). Retrospective medical chart reviews were completed for 172 confirmed cases of WNV infection hospitalized in the Houston, Texas, metropolitan area between 2002 and 2004. Of the 172 patients, 113 had encephalitis which resulted in 17 deaths, 47 had meningitis, and 12 had uncomplicated fever. Risk factors associated with progression from encephalitis to death were absence of pleocytosis in the cerebrospinal fluid, renal insufficiency, requiring intubation and mechanical ventilation, presence of myoclonus or tremors, and loss of consciousness. These findings can aid physicians in evaluating their patients suspected of WNV infection and determining outcomes in their patients with confirmed WNV neuroinvasive disease.

Synthesis of a new series of heterocyclic scaffolds for medicinal purposes.

A new series of substituted 8-fluro-4H-pyrimido[2,1-b] [1,3]benzothiazole-4-ones () substituted 7-methyl-4H-isoxazolo[2,3-a]pyrimidin-4-ones, and substituted 2-methyl-5,6,7,8-tetrahydro-9H-isoxazolo[2,3-a]pyridopyrimidin-9-ones, compounds I-VII, have been prepared via condensation of beta-keto esters with 2-aminopyridine derivatives, in the presence of polyphosphoric acid. The same technique has also been used to prepare diazepine compounds, VIII-X, by condensation of a gamma-keto ester with 2-aminopyridine derivatives. Details of synthetic procedures are shown. The new compounds have been characterized by elemental analysis, GC-MS, FT-IR and NMR spectrometry. Antibacterial, antifungal and anticancer (cytotoxic) activities, for three of these compounds, have been investigated and are presented.

Risk factors for encephalitis and death from West Nile virus infection.

We conducted a nested case-control study to determine potential risk factors for developing encephalitis from West Nile virus (WNV) infection. Retrospective medical chart reviews were completed for 172 confirmed WNV cases hospitalized in Houston between 2002 and 2004. Of these cases, 113 had encephalitis, including 17 deaths, 47 had meningitis, and 12 were fever cases; 67% were male. Homeless patients were more likely to be hospitalized from WNV compared to the general population. A multiple logistic regression model identified age [odds ratio (OR) 1.1, P<0.001], history of hypertension, including those cases taking hypertension-inducing drugs (OR 2.9, P=0.012), and history of cardiovascular disease (OR 3.5, P=0.061) as independent risk factors for developing encephalitis from WNV infection. After adjusting for age, race/ethnicity (being black) (OR 12.0, P<0.001), chronic renal disease (OR 10.6, P<0.001), hepatitis C virus (OR 23.1, P=0.0013), and immunosuppression (OR 3.9, P=0.033) were identified as risk factors for death from WNV infection.

Cross-sectional survey of the extent and indicators of hepatitis C virus infection in Houston Department of Health and Human Services' sexually transmitted disease clinics.

To evaluate the prevalence and indicators of hepatitis C virus (HCV) infection in Houston and determine the effectiveness of targeted HCV screening in sexually transmitted disease (STD) clinics. We performed a cross-sectional survey in low-risk and high-risk groups in Houston. This included a blinded survey of HCV conducted in 1010 STD clinic clients having serological syphilis tests, and 1885 multi-speciality group practice patients having metabolic blood work. This was followed with a targeted hepatitis C survey of 822 high-risk clients from STD clinics. The seroprevalence of hepatitis C infection in the blinded survey was 3.9% (95% CI 3.0-4.8) in the multi-speciality group and 5.0% (95% CI 3.7-6.3) in the STD clinics. Prevalence of hepatitis C infection among targeted STD clinic clients was significantly higher at 15.3% (95% CI 12.7-17.7). Risk factors that correlated with HCV infection after logistic regression included: injection drug use (OR = 10, 95% CI = 3.4-30.3), heroin use (OR = 6.6, 95% CI = 2.2-20.5), non-transfusion/ transplantation blood exposure (OR = 3.0, 95% CI = 1.3-6.9), sharing equipment to snort drugs (OR = 2.5, 95% CI 1.2-5.4), and age above 25 years (OR = 51, 95% CI = 9-47). This study demonstrates that targeting clients in STD clinics for known risk behaviours is an effective way to identify cases of HCV infection. STD clinics allow access to clients with both drug use and sexual risk behaviours and are a useful location for targeting hepatitis C screening and prevention efforts.

Potency trends of delta9-THC and other cannabinoids in confiscated marijuana from 1980-1997.

The analysis of 35,312 cannabis preparations confiscated in the USA over a period of 18 years for delta-9-tetrahydrocannabinol (delta9-THC) and other major cannabinoids is reported. Samples were identified as cannabis, hashish, or hash oil. Cannabis samples were further subdivided into marijuana (loose material, kilobricks and buds), sinsemilla, Thai sticks and ditchweed. The data showed that more than 82% of all confiscated samples were in the marijuana category for every year except 1980 (61%) and 1981 (75%). The potency (concentration of delta9-THC) of marijuana samples rose from less than 1.5% in 1980 to approximately 3.3% in 1983 and 1984, then fluctuated around 3% till 1992. Since 1992, the potency of confiscated marijuana samples has continuously risen, going from 3.1% in 1992 to 4.2% in 1997. The average concentration of delta9-THC in all cannabis samples showed a gradual rise from 3% in 1991 to 4.47% in 1997. Hashish and hash oil, on the other hand, showed no specific potency trends. Other major cannabinoids [cannabidiol (CBD), cannabinol (CBN), and cannabichromene (CBC)] showed no significant change in their concentration over the years.

Illness and reservoirs associated with Giardia lamblia infection in rural Egypt: the case against treatment in developing world environments of high endemicity.

A longitudinal investigation of the health effects and reservoirs of Giardia was undertaken during 1984-1985 in 40 households located in the rural Nile Delta region of Egypt. Stool specimens obtained once weekly for six months from 2-4-year-old children were cyst- or trophozoite-positive in 42% of the 724 examined. Only one child remained Giardia-negative during the study. The mean duration of excretion in Giardia-positive children was seven and one-half weeks with a range of one to 17 weeks. Mucus was present in 52% of all stools collected, and fecal leukocytes were observed with surprising frequency in the absence of identifiable pathogens. Clinical symptoms of illness were frequently observed within a month before or after Giardia excretion in stool of children, but a statistical inference of association was not demonstrated. Seventeen per cent of 697 specimens obtained from their mothers were Giardia-positive for a mean duration of four weeks and a range of one to 18 weeks. A total of 962 specimens were collected from 13 species of household livestock. Giardia was detected in 22 specimens from cows, goats, sheep, and one duck. Giardia cysts were detected in three of 899 samples of household drinking water. The ubiquity of the protozoan as well as the failure to show an association between infection and symptomatic illness argue against the administration of Giardia-specific drugs to children in settings where the risk of reinfection is high and for whom intestinal insults are both varied and constant.

The detection of enteropathogens in acute diarrhea in a family cohort population in rural Egypt.

In 8 villages of rural northeastern Egypt, a 2-year study of the etiologic agents associated with episodes of diarrhea was carried out. Stool specimens (3,243) from 3,513 episodes of diarrhea were processed for enteropathogens. The most commonly identified agents in the group with diarrhea were Giardia lamblia (44%), heat stable enterotoxin (ST)-producing enterotoxigenic Escherichia coli (ETEC) (15%), heat labile toxin (LT)-producing ETEC (12%), enteropathogenic E. coli (EPEC) (4%), rotavirus (3%), Shigella (2%) and Salmonella (1%). Isolation rates were increased in cases compared to controls for all agents except G. lamblia and EPEC strains. Rotavirus, Salmonella and ST-producing ETEC were more frequently isolated during cooler months and Shigella and LT-ETEC occurred more commonly in warmer months. Campylobacter, EPEC, Giardia and E. histolytica did not show a discernable seasonal pattern. Rotavirus was primarily associated with diarrhea in infants only. Forty-four percent of children experienced at least 1 bout of rotavirus diarrhea by the age of 3 years. Vomiting was reported in 65% of cases of rotavirus infection. Dehydration was reported in greater than 40% of those with rotavirus-, Salmonella-, Campylobacter-, LT-ETEC- and EPEC-associated illness and in those without an identifiable agent. While rotavirus was implicated in 3% of cases overall, when vomiting or vomiting plus dehydration occurred, rotavirus was identified with a rate of 10% and 12%, respectively. Dysentery was common only in Shigella cases, occurring in 24%. A decrease in occurrence of rotavirus, Campylobacter and possibly EPEC illness was seen in the infants less than 6 months of age who were breast-fed when compared to those who were not.

The incidence of diarrheal disease in a defined population of rural Egypt.

A prospective study of diarrheal illness was conducted for 2 years in 309 families who were part of an epidemiologic research center population in rural Egypt. The rates of illness peaked in the first year of life with between 5 and 6 episodes per person year at risk. Although no seasonal variation in reported diarrhea was demonstrated for the total population, age-specific differences in seasonal occurrence were noted. The incidence did not consistently vary by village size, nor did rates vary by sex.