Parasitic Protozoans: Exploring the Potential of N,N'-Bis[2-(5-bromo-7-azabenzimidazol-1-yl)-2-oxoethyl]ethylene-1,3-Diamine and Its Cyclohexyl-1,2-diamine Analogue as TryR and Pf-DHODH Inhibitors.

PURPOSE: Major human parasitic protozoans, such as Plasmodium falciparum and Trypanosoma brucei, cause malaria and trypanosomiasis also known as sleeping sickness. In anti-parasitic drug discovery research, trypanothione reductase (TryR) and P. falciparum dihydroorotate dehydrogenase (Pf-DHODH) enzymes are key drug targets in T. brucei and P. falciparum, respectively. The possibility of co-infection of single host by T. brucei and P. falciparum is because both parasites exist in sub-Saharan Africa and the problem of parasite drug resistance necessitates the discovery of new scaffolds, which are strange to the organisms causing these infectious diseases-new scaffolds may help overcome established resistance mechanisms of the organisms. METHOD: In this study, N,N'-bis[2-(5-bromo-7-azabenzimidazol-1-yl)-2-oxoethyl]ethylene-1,3-diamine and its cyclohexyl-1,2-diamine analogue were explored for their inhibitory potential against TryR and Pf-DHODH by engaging density functional study, molecular dynamic simulations, drug-likeness, in silico and in vitro studies RESULTS/CONCLUSION: Results obtained indicated excellent binding potential of the ligands to the receptors and good ADMET (adsorption, desorption, metabolism, excretion, and toxicity) properties.

Analysis of transmission-related third-generation cephalosporin-resistant Enterobacterales by electronic data mining and core genome multi-locus sequence typing.

BACKGROUND: To contain intra-hospital transmission of third-generation cephalosporin-resistant Enterobacterales (3GCR-E), contact isolation precautions are recommended. AIM: To quantify transmissions of 3GCR Escherichia coli and 3GCR Klebsiella pneumoniae within a hospital. METHODS: An automated outbreak detection system (AODS) was used to identify clusters (N≥2) of 3GCR Enterobacterales for the years 2016, 2018 and 2020. Clusters were defined by phenotypic agreement of microbiological results and spatial and temporal relationship. Core genome multi-locus sequence typing (cgMLST) was used to confirm whether the cluster isolates were transmitted between patients. FINDINGS: A total of 4343 3GCR E. coli and 1377 K. pneumoniae isolates were analysed. Among the 3GCR E. coli isolates, the AODS identified 304 isolates as cluster isolates, the median cluster size was two (range: 2-5). The cgMLST analysis revealed that a total of 23 (7.5%) 3GCR E. coli cluster isolates were transmission-associated, of which 20 isolates (87%) were detected in intensive care patients. Among the 3GCR K. pneumoniae isolates, the AODS identified 73 isolates as cluster isolates, the median cluster size was two (range: 2-4). CgMLST revealed that 35 (48%) 3GCR K. pneumoniae cluster isolates were transmission associated, of which 27 isolates (77%) were detected in intensive care patients. CONCLUSION: For 3GCR K. pneumoniae, cgMLST confirmed the AODS results more frequently than for 3GCR E. coli. Therefore, contact isolation precautions for 3GCR K. pneumoniae may be appropriate on intensive care units, but only in certain circumstances, such as outbreaks, for Enterobacterales with lower transmissibility, such as E. coli.

New enantioselective liquid chromatography method development and validation of dipeptidyl peptidase IV inhibitors using a macrocyclic glycopeptide (vancomycin) chiral stationary phase under polar ionic mode condition.

The direct separation of dipeptidyl peptidase IV (DPP-4) inhibitors such as Sitagliptin (STG), Linagliptin (LIG), and Saxagliptin (SAG) enantiomers in normal phase conditions have been achieved on immobilized polysaccharide-based chiral stationary phases (CSPs), as well as on the macrocyclic glycopeptide vancomycin chiral stationary phase (Chirobiotic V2) under polar ionic mode. The enantiomers of these targets could be separated completely (resolution factor Rs > 2) using the Chirobiotic V2 column in polar ionic mode with the mobile phase (MeOH/AcOH/TEA 100/0.3/0.1 v/v/v) in an isocratic elution at 1.0 ml min-1 . The effect of the mobile phase composition on separation, including buffer salts, acid-base modifiers, and analyte structures, was evaluated. The developed technique was validated in the polar ionic mode according to the International Conference on Harmonization (ICH) Q2R1 guidelines in terms of accuracy, precision, selectivity, linearity, limit of detection (LOD), and limit of quantification (LOQ). The calibration curve was linear in a concentration range from LOQ to 3.75 µg/ml. The LOD and LOQ of STG, LIG, and SAG were 0.15 and 0.45, 0.15 and 0.50, 0.16 and 0.50, respectively. The proposed method is said to be selective, accurate, and precise. Finally, the validated method was used successfully for the quantitative determination of DPP-4 enantiomers in pharmaceutical analytes.

Differentials in girl-child marriage and high fertility in Nigeria.

In a patriarchal and natural fertility society like Nigeria, girl-child marriage is synonymous with early sexual debut and a prolonged childbearing period, ultimately affecting fertility outcomes and behaviours. This study explored the differentials in child marriage in Nigeria across socio-economic and regional groups, and its association with fertility. The study analysed secondary data pertaining to women aged 15-49 who were currently or previously married from the 2018 Nigeria Demographic and Health Survey. About 54 percent of Nigerian women married before their eighteenth birthday. The prevalence of child marriage was high in the rural areas (61 percent), in the North West (78 percent) and the North East (70 percent) of Nigeria. Child-brides have higher fertility than women who entered marital life as adults (TFR 6.8 vs 5.9). The early entry into marriage by most women in Nigeria has a profound influence on overall fertility, given that an overwhelming majority of births in Nigeria take place within marriage. Through advocacy and social mobilization, families, communities, and religious leaders will understand the hazards of child marriage and their role and responsibility in eradicating it and empowering the girl-child through formal education.

Synthesis of 2-aryl-5-(arylsulfonyl)-1,3,4-oxadiazoles as potent antibacterial and antioxidant agents.

Ten novel 2-aryl-5-(arylsulfonyl)-1,3,4-oxadiazoles were produced and assessed for their in vitro antibacterial and antioxidant activities. Diverse spectroscopic methods like 1H NMR, 13C NMR, IR, and LCMS were used for the characterization of the prepared samples and all the data was in good agreement with the anticipated structures. The prepared compounds 6a-j were screened for their in vitro antibacterial activity against bacterial strains Pseudomonas aeruginosa, Enterobacter aerogenes, Escherichia coli (gram-positive), and Bacillus cerus, Staphylococcus aureus, Bacillus subtilis (gram-negative). The antimicrobial screening outcome revealed that the prepared 2-(3,4-dimethylphenyl)-5-tosyl-1,3,4-oxadiazole (6j), 2-(3-isopropylphenyl)-5-tosyl-1,3,4-oxadiazole (6c), and 2-(2-ethylphenyl)-5-tosyl-1,3,4-oxadiazole (6i) are most potent among all the examined compounds. Furthermore, the antioxidant activity of the prepared compounds was also investigated by DPPH radical scavenging method and the results showed that some of the compounds were moderately active.

Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia.

BACKGROUND: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their own FHR and alert a midwife of changes detected. METHODS: Four hundred seventy-four women admitted in labour without obstetric complications were approached. Four hundred sixty-one consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately 1 minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded. RESULTS: Four hundred sixty-one out of 474 women gave consent, of whom 431 of 461 (93%) completed the monitoring themselves. Three hundred eighty-seven of 400 women who gave comments, reported positive and 13 negative experiences. FHR changes were reported in 28 participants and confirmed in 26. Twenty-four of these 26 FHR changes were first identified by mothers. Fetal death was identified on admission during training in one mother. Thirteen neonates required resuscitation, with 12 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl's ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. CONCLUSIONS: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

Infections caused by extended-spectrum ß-lactamase-producing Enterobacterales after rectal colonization with ESBL-producing Escherichia coli or Klebsiella pneumoniae.

OBJECTIVES: Infections as a result of extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) are considered infections with a high public health burden. In this study, we aimed to identify incidences of and risk factors for healthcare-associated infections (HAIs) after rectal colonization with ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP). METHODS: This prospective cohort study was performed in 2014 and 2015. Patients colonized with ESBL-EC or ESBL-KP were monitored for subsequent HAI with ESBL-E and other pathogens. In the case of an ESBL-E infection, rectal and clinical isolates were compared using pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) for ESBL-KP isolates. Proportional hazard models were applied to identify risk factors for HAIs, and to analyse competing risks. RESULTS: Among all patients admitted to the hospital during the study period, 13.6% were rectally screened for third-generation cephalosporin-resistant Enterobacterales (3GCREB). A total of 2386 rectal carriers of ESBL-EC and 585 of ESBL-KP were included in the study. Incidence density (ID) for HAI with ESBL-E was 2.74 per 1000 patient days at risk (95% confidence interval (CI) 2.16-3.43) among carriers of ESBL-EC, while it was 4.44 per 1000 patient days at risk (95% CI 3.17-6.04) among carriers of ESBL-KP. In contrast, ID for HAI with other pathogens was 4.36 per 1000 patient days at risk (95% CI 3.62-5.21) among carriers of ESBL-EC, and 5.00 per 1000 patient days at risk (95% CI 3.64-6.69) among carriers of ESBL-KP. Cox proportional hazard regression analyses identified colonization with ESBL-KP (HR = 1.58, 95% CI 1.068-2.325) compared with ESBL-EC as independent risk factor for HAI with ESBL-E. The results were consistent over all competing risk analyses. CONCLUSIONS: Clinicians should be aware of the increased risk of ESBL-E infections among patients colonized with ESBL-KP compared with ESBL-EC that might be caused by underlying diseases, higher pathogenicity of ESBL-KP and other factors.

Can married or cohabiting women negotiate protective sex? Findings from Demographic and Health Surveys of two West African countries.

Can married or cohabitating women in patriarchal societies, who are often disproportionately affected by STI/HIV infections, negotiate protective sex when perceived necessary by refusing sex or asking for condom use during sex? Protective sex negotiation was examined through measures of power relations related to whether or not a woman has a say in sexual activities within marriage. The study hypothesis was that women who are more able to refuse sex or ask for condom use before sexual intercourse will be more able to discuss and reach agreement with their spouses on protective sex practices when needed. The study used data from DHS surveys conducted in Cote d'Ivoire and Nigeria in 2012 and 2013 respectively. Multivariate logistic regression models were used to predict women's ability to negotiate protective sex in Cote d'Ivoire and Nigeria. The findings show that moderately high percentages of women in both countries reported the ability to negotiate protective sex, with a higher percentage reporting the ability to refuse sex compared with the ability to ask partners to use a condom. The logistic regression results showed that, in the two countries, women's ability to refuse sex or ask their partners to use a condom, varied by gender- and power-mediating factors, women's characteristics and behavioural factors. The study draws attention to the need to intensify efforts to promote more-egalitarian relationships between partners through culturally appropriate interventions.

In vitro susceptibility to 19 agents other than ß-lactams among third-generation cephalosporin-resistant Enterobacteriaceae recovered on hospital admission.

Objectives: As part of the multicentre Antibiotic Therapy Optimisation Study, MIC values of 19 non-ß-lactam agents were determined for third-generation cephalosporin-resistant Escherichia coli , Klebsiella species and Enterobacter species (3GCREB) isolates collected in German hospitals. Methods: A total of 328 E. coli , 35 Klebsiella spp. (1 Klebsiella oxytoca and 34 Klebsiella pneumoniae ) and 16 Enterobacter spp. (1 Enterobacter aerogenes and 15 Enterobacter cloacae ) isolates were submitted to broth microdilution antimicrobial susceptibility testing with the MICRONAUT system. MICs of fluoroquinolones (levofloxacin and moxifloxacin), aminoglycosides (gentamicin, tobramycin, amikacin, streptomycin, neomycin and paromomycin), tetracyclines (tetracycline, minocycline and tigecycline), macrolides (erythromycin, clarithromycin and azithromycin) and miscellaneous agents [trimethoprim/sulfamethoxazole, chloramphenicol, nitrofurantoin, colistin and fosfomycin intravenous (iv)] were determined and reviewed against 2016 EUCAST breakpoints. Results: The MIC of levofloxacin was >2 mg/L for 128 of 328 E. coli and 8 of 35 Klebsiella spp., but only 1 of 16 Enterobacter spp. Rates of resistance to trimethoprim/sulfamethoxazole were high (>70%), except for Enterobacter spp. Rates of resistance to colistin and fosfomycin iv were still low. About 20% of the tested isolates were resistant to chloramphenicol. Only 1 (of 328) E. coli isolate had an MIC of amikacin >16 mg/L and only 33 of 328 E. coli and 1 of 35 Klebsiella spp. had an MIC of tobramycin >4 mg/L, whereas average gentamicin MICs were in general more elevated. A tigecycline MIC >2 mg/L was only found for 1 of 16 Enterobacter spp., but in none of the E. coli or Klebsiella spp. isolates. Conclusions: Our study gives insight into previously unreported non-ß-lactam MIC distributions of 3GCREB isolates.

The use of vouchers in HIV prevention, referral treatment, and care for young MSM and young transgender people in Dhaka, Bangladesh: experience from 'HIM' initiative.

INTRODUCTION: The study described the effectiveness of a voucher scheme to access sexual and reproductive health and HIV services among young MSM and transgender people aged 15-24 years in Dhaka, Bangladesh, a country with HIV prevalence of less than 0.1%. METHODS: Descriptive and analytical methods were used to assess the net effects of biodemographic factors of the respondents on the voucher scheme. Effectiveness of the scheme was contextualized as target population coverage, and turnaround time of voucher redemption to access services. RESULTS AND DISCUSSION: A total of 210 (87.9%) out of the 239 vouchers distributed were redeemed. The mean age of the identified young people was 19.6 years (SD = +2.6 years). The coverage of the scheme against the target population of 200 young MSM and 936 young transgender people was 88% (n = 175) and 4% (n = 35) respectively, with P < 0.001. The median turnaround time for voucher redemption was 7 days. The predictors of voucher turnaround time were age, education, and population group (P < 0.001). HIV testing and counselling was accessed by 160 (76%) respondents, one was positive and linked to antiretroviral treatment and 110 (52%) were diagnosed and treated for sexually transmitted infections. CONCLUSION: The voucher scheme was effective in linking young MSM with sexual and reproductive health and HIV services in Dhaka, Bangladesh. The findings are consistent with the low HIV prevalence in the country. The scheme is, however, not optimal for linking young transgender people with services.

Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities.

Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect-that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and strengthen services and systems in resource-limited countries.

Pediatric elbow injuries in athletes.

Elbow injuries in pediatric and adolescent population represent a spectrum of pathology that can range from medial tension injuries to posterior shear injuries. Elbow injuries in this population continue to rise in parallel with the increase in youth participation in sports both throughout the calendar year and across multiple sports. Many of these injuries are noncontact and are attributed to overuse. Evaluation and management of youth and adolescent athletic elbow injuries requires knowledge of developmental anatomy, injury pathophysiology, and established treatment algorithms. Furthermore, risk factors contributing to elbow injuries must be recognized, with education and recommendations for safe play continually advocated. This education--of parents, athletes, and coaches--is paramount in reducing the climbing incidence of elbow injuries in our youth athletes.

Optimal aspiration volume of vertebral bone marrow for use in spinal fusion.

BACKGROUND CONTEXT: Bone marrow aspirate (BMA) has shown promise as a bone graft option in spinal fusion. The vertebral body is a convenient source for marrow aspirate as it is accessed in routine course of pedicle screw instrumentation. Studies have relied on data from the iliac crest to determine optimal aspiration volume from the vertebral body. PURPOSE: This study is designed to determine the optimal aspiration volume for BMA taken from the vertebral body. STUDY DESIGN: Prospective clinical study. PATIENT SAMPLE: Data are drawn from 18 pedicles and 180 aspirations. The average age of the subjects was 50.3 years, and the subject pool comprised five men and seven women. OUTCOME MEASURES: Nucleated cell count and alkaline phosphatase staining colony forming units. METHODS: Ten 1 mL aliquots of BMA were incrementally aspirated through a cannulated pedicle tap for each instrumented vertebral body. The numbers of nucleated cells per mL of BMA were analyzed with a hemocytometer, and the percentage of osteoprogenitor cells per mL aspirate were estimated by an alk phos production assay. The study was funded through departmental funds, and none of the authors have any conflicts of interest to report related to the study. RESULTS: Nucleated cell count decreased with increasing aspirate number (p<.001). The average cell count for the first mL was 45.8 million cells. Cell counts did not differ by age or sex (p=.943 and p=.685, respectively). Likewise, osteoprogenitor cell percentage decreased with increasing aspirate number (p<.001). CONCLUSIONS: The 2 mL aspirate volume has been defined as ideal for the iliac crest, but there has been no analogous assessment of the effect of aspiration volume for other sources such as the vertebral body. This information is important for the clinical implementation of vertebral body aspirations if volume, cells, and presumably performance, of this potential bone graft option are to be optimized for spine cases. Our data show a direct relationship between increasing aspiration number and decreasing osteoprogenitor cellular concentration, with a drop to 50% of the original aspirate cell count by the 4th mL aspirate. The vertebral body is a potentially exciting source of osteoprogenitor cells that can be implemented for a variety of spinal uses.

Secular trends in nosocomial bloodstream infections: antibiotic-resistant bacteria increase the total burden of infection.

BACKGROUND: It is unknown whether rising incidence rates of nosocomial bloodstream infections (BSIs) caused by antibiotic-resistant bacteria (ARB) replace antibiotic-susceptible bacteria (ASB), leaving the total BSI rate unaffected. METHODS: We investigated temporal trends in annual incidence densities (events per 100 000 patient-days) of nosocomial BSIs caused by methicillin-resistant Staphylococcus aureus (MRSA), ARB other than MRSA, and ASB in 7 ARB-endemic and 7 ARB-nonendemic hospitals between 1998 and 2007. RESULTS: 33 130 nosocomial BSIs (14% caused by ARB) yielded 36 679 microorganisms. From 1998 to 2007, the MRSA incidence density increased from 0.2 to 0.7 (annual increase, 22%) in ARB-nonendemic hospitals, and from 3.1 to 11.7 (annual increase, 10%) in ARB-endemic hospitals (P = .2), increasing the incidence density difference between ARB-endemic and ARB-nonendemic hospitals from 2.9 to 11.0. The non-MRSA ARB incidence density increased from 2.8 to 4.1 (annual increase, 5%) in ARB-nonendemic hospitals, and from 1.5 to 17.4 (annual increase, 22%) in ARB-endemic hospitals (P < .001), changing the incidence density difference from -1.3 to 13.3. Trends in ASB incidence densities were similar in both groups (P = .7). With annual increases of 3.8% and 5.4% of all nosocomial BSIs in ARB-nonendemic and ARB-endemic hospitals, respectively (P < .001), the overall incidence density difference of 3.8 increased to 24.4. CONCLUSIONS: Increased nosocomial BSI rates due to ARB occur in addition to infections caused by ASB, increasing the total burden of disease. Hospitals with high ARB infection rates in 2005 had an excess burden of BSI of 20.6 per 100 000 patient-days in a 10-year period, mainly caused by infections with ARB.

Pet animals and foreign travel are risk factors for colonisation with extended-spectrum ß-lactamase-producing Escherichia coli.

OBJECTIVE: The purpose of this study was to determine the prevalence of extended-spectrum ß-lactamase (ESBL) and vancomycin-resistant enterococci (VRE) colonisation among healthy infection control personnel and to determine risk factors for ESBL or VRE colonisation within this group. METHODS: Participants were recruited at an infection control symposium in 2011. Volunteers were asked to perform a rectal swab and to fill in questionnaires on risk factors of ESBL or VRE carriage (report on diet, contact with domestic or production animals, travel, hospital stay and antibiotic use all within the last 12 months). Rectal swabs were inoculated onto ESBL and VRE chromogenic agar; species identification and susceptibility testing was done by using a VITEK 2 system. In the multivariable analysis, a logistic regression with stepwise forward variable selection was performed. RESULTS: Two hundred and thirty people participated in the study, i.e. 36 % of the symposium attendees (231/639). No VRE faecium or faecalis were isolated, whereas ESBL were isolated from 8 out of 231 individuals, i.e. 3.5 % (95 % confidence interval 1.5-6.7). In the multivariable analysis, travel to Greece or Africa and contact with pets were independently associated with ESBL positivity. The odds ratios were as follows: travel to Greece 15.2, travel to Africa 14.8 and for having a pet animal 6.7. CONCLUSION: This is the first report showing that contact with pets increases by almost seven-fold the chance to be colonised with ESBL Escherichia coli. A colonisation rate of 3.5 % with ESBL-producing enterobacteriaceae among infection control personnel is of concern and reflects probably less an occupational health risk but the reservoir of and the expansion into the community, especially in persons with pet animals and travel history to high-endemicity countries.

High prevalence of extended-spectrum-ß-lactamase-producing Enterobacteriaceae in organic and conventional retail chicken meat, Germany.

OBJECTIVES: To determine the prevalence of extended-spectrum ß-lactamase (ESBL) production in Enterobacteriaceae in retail chicken meat in Germany. METHODS: A total of 399 chicken meat samples from nine supermarket chains, four organic food stores and one butcher's shop in two geographically distinct regions (Berlin and Greifswald) were screened for ESBL production using selective agar. Phenotypic ESBL isolates were tested for bla(TEM), bla(CTX-M) and bla(SHV) genes using PCR and DNA sequencing. Antibiotic coresistances were determined and strain typing was performed using PCR-based phylogenetic grouping and XbaI-PFGE. RESULTS: A total of 185 confirmed ESBL isolates were obtained from 175 samples (43.9%) from all tested sources. The majority of isolates were Escherichia coli producing ESBL types SHV-12 (n = 82), CTX-M-1 (n = 77) and TEM-52 (n = 16). No differences could be observed in the prevalence of ESBL producers between organic and conventional samples. 73.0% of the ESBL producers showed coresistance to tetracycline, 35.7% to co-trimoxazole and 7.6% to ciprofloxacin. Strain typing of selected E. coli isolates from Berlin revealed identical macrorestriction patterns for several isolates from samples taken from the same stores. CONCLUSIONS: This is the first comprehensive study from Germany showing a high prevalence of TEM-, CTX-M- and SHV-type ESBLs in Enterobacteriaceae isolated from retail chicken meat. The high rate of coresistance to different classes of antibiotics in the ESBL producers might reflect the common veterinary usage of these and related substances. There is an urgent need to further evaluate the role of poultry in the transmission of highly resistant ESBL-producing bacteria in humans.

The effect of rigid cervical collar height on full, active, and functional range of motion during fifteen activities of daily living.

STUDY DESIGN: Laboratory biomechanical experiment. OBJECTIVE: To evaluate how different anterior cervical collar heights restrict full, active range of motion (ROM), and functional ROM during 15 activities of daily living. SUMMARY OF BACKGROUND DATA: Hard cervical collars are commonly used in the clinical setting. Collar fit is presumed to affect immobilization, making neck height an important variable. No prior study has evaluated how different collar heights affect full, active and functional ROM. METHODS: A previously validated electrogoniometer device was employed to quantify both full, active, and functional ROM. For each of 10 subjects, these ROM measurements were repeated without a collar and with an adjustable, hard collar (Aspen Vista) at each of 6 collar neck height settings. RESULTS: For each increase in collar height, there was a corresponding decrease in mean full, active ROM of 3.7% (3°) in the sagittal plane (R2 = 0.91, P = 0.003), 3.9% (3°) in the coronal plane (R2 = 0.88, P = 0.005), and 2.8% (4°) in the rotational plane (R2 = 0.86, P = 0.006). For each increase in collar height, there was a corresponding decrease in mean functional ROM across all of the tested activities of daily living of 1.1% (1°) in the sagittal plane (R2 = 0.90, P = 0.004), 0.4% (0.4°) in the coronal plane (R2 = 0.86, P = 0.007), and 0.6% (0.5°) in the rotational plane (R2 = 0.81, P = 0.014). For each increase in collar height, there was a 1.7° increase in mean neck extension while in the neutral position (R2 = 0.99, P < 0.001). CONCLUSION: This study suggests that greater cervical collar height for hard cervical collars will better restrict full, active, and functional cervical ROM. However, the change in functional ROM was only about one quarter to that of full active ROM and the clinical significance of this may be questioned. This must be balanced by the fact that this increased collar height forces the neck into greater extension which may not be the most clinical desired or functional position and may cause skin-related issues at the jaw or chest.

Soft and rigid collars provide similar restriction in cervical range of motion during fifteen activities of daily living.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To evaluate the relative efficacies of soft and rigid collars for restricting both the full, active and functional ranges of motion (ROM) of the cervical spine during 15 activities of daily living (ADLs). SUMMARY OF BACKGROUND DATA: Cervical collars are frequently used for the purpose of limiting cervical motion after surgical procedures or as a treatment for certain injuries. Rigid collars are generally believed to reduce cervical motion to a greater extent than soft collars but the latter are often preferred by patients because of their greater comfort. Although there are some data to suggest that soft collars restrict full, active ROM (i.e., the extremes of motion) to a lesser degree than rigid braces, there are currently no comparative studies that have assessed the effects of these 2 types of cervical collars on the functional ROM that is required to perform multiple ADLs. METHODS: In this investigation, a previously validated electrogoniometer device was used to quantify both the full, active ROM of 10 subjects as well as the functional ROM they exhibited during a series of 15 ADLs. For each individual, these ROM measurements were repeated after the application of both a soft collar and a rigid orthosis. RESULTS: The soft collar limited flexion/extension, lateral bending, and rotation by 27.1%+/-9.9% (mean+/-standard deviation), 26.1%+/-4.8%, and 29.3%+/-10.3%, respectively. The corresponding reductions in ROM with a rigid collar were 53.7%+/-7.2%, 34.9%+/-6%, and 59.2%+/-5.3%, respectively. The rigid collar resulted in significantly lower full, active ROM in both the sagittal and axial planes but not in the lateral bending plane. Compared with the soft collar, the rigid collar afforded no difference in motion during 13 of the 15 simulated ADLs. Greater motion was only noted with backing up a car and sitting from a standing position. CONCLUSION: Although subjects exhibited less full, active ROM of the cervical spine when immobilized in a rigid collar than when they were placed in a soft collar, the motion recorded during various functional tasks was not significantly different for nearly all of the ADLs in this study, regardless of which cervical device was applied. One potential explanation for this finding is that both collars may serve as proprioceptive guides, which allow patients to regulate their own cervical motion based on their level of comfort. Given the paucity of data supporting the use of postoperative bracing, especially after procedures which incorporate internal fixation, this study indicates that a rigid orthosis may be unnecessary in many cases because even a soft collar seems to be sufficient for restricting motion during routine activities until the normal, physiologic ROM of the cervical spine has been restored.

Outbreak of carbapenem-resistant Pseudomonas aeruginosa infection in a surgical intensive care unit.

Infection control personnel performing surveillance activities noticed a cluster of patients with isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the surgical intensive care unit (SICU) of a German University Hospital. An outbreak investigation including a descriptive analysis, a case-control study comparing 15 CRPA case patients with 18 patients with carbapenem-susceptible P. aeruginosa, environmental sampling and pulsed-field gel electrophoresis (PFGE) typing of P. aeruginosa isolates was carried out. Fifteen patients acquired CRPA in the SICU during the outbreak period between 1 July 2006 and 31 October 2006 and PFGE typing of 11 available patient isolates revealed two outbreak strains as well as sporadic CRPA isolates. Both outbreak strains were resistant to penicillins, cephalosporins, carbapenems, aminoglycosides and quinolones, and remained susceptible only to colistin. The most likely mode of transmission was cross-transmission between patients during postoperative wound care with abdominal and/or thoracic drains (odds ratio: 64.33; 95% confidence interval: 5.32-999) and therapy with quinolones (48.37; 3.71-999) being independent risk factors for acquisition of CRPA. No further clusters of CRPA cases were observed after implementation of contact isolation precautions and after healthcare workers were made aware of the likely mode of transmission. This study shows the complex epidemiology of CRPA in a SICU including cross-transmission of two CRPA strains related to postoperative wound care.