Efficacy of Intravenous Colistin Monotherapy Versus Colistin Combined With Meropenem in Patients With Multidrug-Resistant Infections: A Retrospective Observational Study.

Background Intensive care units frequently contend with infections caused by highly drug-resistant organisms, particularly Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacterales (CRE), which often lead to high mortality rates. Colistin (colomycin) is employed to treat infections, notably extremely drug-resistant (XDR) bacteria. Antibiotic combination treatment is a frequently used tactic in this endeavour. However, the widespread use of antibiotics in synergy could result in the emergence of resistance and a rise in side effects, such as those linked to Clostridium difficile infection. The aim of the study was to assess and contrast the clinical results of intravenous colistin monotherapy with the combination of colistin and meropenem in patients experiencing MDR bacteremia resulting from Acinetobacter Baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacterales (CRE). Methods In this retrospective observational study, an analysis spanning two years, from June 2021 to June 2023, was conducted at a teaching hospital located in Karachi, Pakistan. The research involved the retrospective examination of medical records from 132 patients who had been diagnosed with MDR bacteremia. Patients were divided into two categories based on their treatment regimen, either intravenous colistin monotherapy or intravenous colistin combined with meropenem. Among the 132 patients included in the analysis, 66 underwent colistin monotherapy, while the other 66 received a combination of colistin and meropenem. The primary focus of evaluation in this study centered on the 14-day all-cause mortality, while secondary outcomes encompassed clinical success and microbiologic cure. Results The mean age of patients in both groups was comparable, and there were no noteworthy gender differences. Additionally, the distribution of infection types and the isolated pathogens showed no substantial distinctions between the two groups. The study revealed no statistically significant disparities in 14-day mortality, improvement in Sequential Organ Failure Assessment (SOFA) score, or the proportion of patients who were cured and survived between the two treatment groups. Conclusion The findings from this study lead to the conclusion that there exists no significant disparity in the efficacy of colistin monotherapy compared to the combination of colistin with meropenem in the treatment of MDR bacteremia stemming from Acinetobacter Baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacterales (CRE). The results provide a basis for future research and underscore the significance of ongoing endeavors to refine antibiotic treatment strategies in response to the worldwide issue of antibiotic resistance.

Non-Participatory Observation Of Integrated Management Of Childhood Illness Practices At Selected Basic Health Units Of District Abbottabad, Kp, Pakistan: A Qualitative Hermeneutic Study.

BACKGROUND: It was in 1995 when a strategy was devised to reduce under-five mortality in countries with a prevalence of child mortality above 40/1000 live births. This strategy is called "Integrated Management of Childhood Illness" (IMCI). Improvement in the skills of healthcare workers (HCWs) depends on the IMCI training received by them. To make IMCI training more effective and scale up, a global technical consultation committee in Geneva recommended implementing an innovative training approach in 2014: the distance learning IMCI (dIMCI). This study was conducted to observe qualitatively the practices of IMCI-trained HCWs at their respective workplaces. METHODS: This qualitative hermeneutic study was conducted through non-probability criterion sampling in the district Abbottabad of Pakistan on all 26 basic health units trained in IMCI (either standard or distance learning) from December 9, 2019, to March 9, 2020. Data collection was done by qualitatively observing consultations and interactions of caretakers of under-five children at basic health units. Inductive thematic analysis was used. This qualitative exploration was underpinned by Hans Georg Gadamer's philosophy of hermeneutics. RESULTS: Four themes emerged from the observation notes. These themes are gratification after consultation, altercation for medication, non-observance of protocol, and methodical consultation. CONCLUSIONS: Improvement in the skills of HCWs in the form of IMCI training, either through distance learning or the common eleven-day standard method, can improve caretakers' satisfaction. However, awareness at the community level is needed for better compliance.

Enhancement in the antibacterial activity of cephalexin by its delivery through star-shaped poly(ε-caprolactone)-block-poly(ethylene oxide) coated silver nanoparticles.

The antibacterial activity of silver nanoparticles (AgNPs) stabilized with a four-armed star-shaped poly(ε-caprolactone)-block-poly(ethylene oxide) copolymer [St-P(CL-b-EO)] and its application as a drug delivery vehicle for cephalexin (Cp) was evaluated against pathogenic Staphylococcus aureus. The prepared AgNPs were characterized by ultraviolet-visible spectroscopy, Fourier transform infrared spectroscopy, zeta sizer and atomic force microscopy (AFM). The antibacterial efficiency of Cp is enhanced several-fold by its delivery through complexation with St-P(CL-b-EO)-AgNPs, monitored by microplate assay and biofilm destruction studies. Finally, the visual destruction of bacterial cells and its biofilms by employing Cp and its conjugates at their minimum inhibitory concentration (MIC50) and minimum biofilm inhibitory concentration (MBIC50), respectively, is observed by topographic imaging by AFM. Enhanced antibacterial activity of St-P(CL-b-EO)-AgNPs loaded Cp is attributed to penetrative nature of the drug cargo St-P(CL-b-EO)-AgNPs towards the bacterial cell wall.

The selectivity of poly(2-vinylpyridine-block-methyl methacrylate) copolymer films: an AFM study.

In this study, the surface morphologies of poly(2-vinyl pyridine-block-methyl methacrylate), P(2VP-MMA), copolymer films were analyzed by atomic force microscopy. P(2VP-MMA) samples varying in total molar mass and individual block length were evaluated for variations in the surface morphologies of films cast from toluene on Si wafers. The incorporation of AuNPs into the polymer domain significantly influenced the surface morphology of the films. Variations in the surface morphology as a function of the polarity of the casting solvent were also examined. In this context toluene (a non-polar solvent), chloroform (of intermediate polarity) and ethyl acetate (a polar solvent) were employed as casting solvents. Toluene is a good solvent for PMMA compared to P2VP, chloroform has no preferential solvation, while ethyl acetate is a good solvent for P2VP compared to PMMA. The morphology of the films cast on substrates of distinctly different polarities, such as mica, Si wafers, and HOPG, were studied to appraise their selectivity. Finally, a detailed study of the effects of thermal annealing on the surface morphologies of P(2VP-MMA) and P(2VP-MMA)-AuNPs was conducted.

Enhanced electrochemical response of a modified glassy carbon electrode by poly(2-vinlypyridine-b-methyl methacrylate) conjugated gold nanoparticles for detection of nicotine.

Poly(2-vinylpyridine-b-methylmethacrylate) coated gold nanoparticles [P(2VP-MMA)-AuNPs] were prepared and characterized by UV-Vis, FTIR, AFM, and zetasizer analysis. Investigation of the potential of the synthesized poly(2-vinylpyridine-b-methylmethacrylate) coated gold nanoparticles [P(2VP-MMA)-AuNPs] for detection of nicotine is the main focus of the current study. P(2VP-MMA)-AuNPs were coated on a glassy carbon electrode (GCE) for electrochemical detection of nicotine by cyclic voltammetry. The effect of molar mass of individual P2VP blocks and total molar mass of the block copolymer is evaluated in the context of an enhanced electrochemical response of the modified GCE for its sensing ability of nicotine in both aqueous and organic media. The electrochemical detection of nicotine is significantly enhanced by modification of the GCE with P(2VP-MMA)-AuNPs.