RESUMO
OBJECTIVE: The aim of this study was to examine the diversity, equity, and inclusion landscape in academic trauma surgery and the EAST organization. SUMMARY BACKGROUND DATA: In 2019, the Eastern Association for the Surgery of Trauma (EAST) surveyed its members on equity and inclusion in the #EAST4ALL survey and assessed leadership representation. We hypothesized that women and surgeons of color (SOC) are underrepresented as EAST members and leaders. METHODS: Survey responses were analyzed post-hoc for representation of females and SOC in academic appointments and leadership, EAST committees, and the EAST board, and compared to the overall respondent cohort. EAST membership and board demographics were compared to demographic data from the Association of American Medical Colleges. RESULTS: Of 306 respondents, 37.4% identified as female and 23.5% as SOC. There were no significant differences in female and SOC representation in academic appointments and EAST committees compared to their male and white counterparts. In academic leadership, females were underrepresented ( P < 0.0001), whereas SOC were not ( P = 0.08). Both females and SOC were underrepresented in EAST board membership ( P = 0.002 and P = 0.043, respectively). Of EAST's 33 presidents, 3 have been white women (9%), 2 have been Black, non-African American men (6%), and 28 (85%) have been white men. When compared to 2017 AAMC data, women are well-represented in EAST's 2020 membership ( P < 0.0001) and proportionally represented on EAST's 2019-2020 board ( P > 0.05). CONCLUSIONS: The #EAST4ALL survey suggests that women and SOC may be underrepresented as leaders in academic trauma surgery. However, lack of high-quality demographic data makes evaluating representation of structurally marginalized groups challenging. National trauma organizations should elicit data from their members to re-assess and promote the diversity landscape in trauma surgery.
Assuntos
Sociedades Médicas , Cirurgiões , Feminino , Humanos , Masculino , Negro ou Afro-Americano , Docentes de Medicina , Liderança , Estados UnidosRESUMO
Hepatitis infection in HIV positive individuals with liver diseases causes high mortality worldwide. HIV worsens the pathological effect of hepatitis viruses and potentiates reactivation of latent hepatitis infections due to reduced immunity. This research therefore aimed to study the occurrence of HIV and hepatitis viruses among liver diseases patients (LVDP) attending tertiary hospitals in Osun State, southwestern Nigeria. A total of 121 LVDP blood samples collected were tested for HIV and Hepatitis B, C, and E using and enzyme linked Immunossorbent assay (ELISA). Data were analyzed using packages within SPSS and P ≤ 0.05 was considered significant. Prevalence of 32.2%, 0.8%, 10.7%, and 18.2% for HBsAg, Anti-HCV, HEV-IgM, and HIV were found respectively. Marital status showed a significant association with HEV-IgM infection (χ2 = 9.869, P = .020). The prevalence of HBsAg, HEV, and HIV among LVDP in Osun State is alarming and health education among the patients and general populace is hereby advocated. High HEV-IgM seroprevalence implies that HEV routine screening should be incorporated into blood screening. Since HEV is associated with unhygienic practice, people should be enlightened on how to improve their living conditions.
Assuntos
HIV/imunologia , Hepacivirus/imunologia , Vírus da Hepatite B/imunologia , Vírus da Hepatite E/imunologia , Hepatopatias/imunologia , Adolescente , Adulto , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Soroepidemiológicos , Centros de Atenção Terciária , Adulto JovemRESUMO
BACKGROUND: The emergence of antibiotic resistance among pathogenic bacteria in clinical and environmental settings is a global problem. Many antibiotic resistance genes are located on mobile genetic elements such as plasmids and integrons, enabling their transfer among a variety of bacterial species. Water distribution systems may be reservoirs for the spread of antibiotic resistance. MATERIALS AND METHODS: Bacteria isolated from raw, treated, and municipal tap water samples from selected water distribution systems in south-western Nigeria were investigated using the point inoculation method with seeded antibiotics, PCR amplification, and sequencing for the determination of bacterial resistance profiles and class 1/2 integrase genes and gene cassettes, respectively. RESULTS: sul1,sul2, and sul3 were detected in 21.6, 27.8, and 0% of the isolates, respectively (n = 162). Class 1 and class 2 integrons were detected in 21.42 and 3.6% of the isolates, respectively (n = 168). Genes encoding resistance to aminoglycosides (aadA2, aadA1, and aadB), trimethoprim (dfrA15, dfr7, and dfrA1), and sulfonamide (sul1) were detected among bacteria with class 1 integrons, while genes that encodes resistance to strepthothricin (sat2) and trimethoprim (dfrA15) were detected among bacteria with class 2 integrons. CONCLUSIONS: Bacteria from these water samples are a potential reservoir of multidrug-resistant traits including sul genes and mobile resistance elements, i.e. the integrase gene.
Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Água Potável/microbiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Integrons/genética , Sulfonamidas/farmacologia , Aminoglicosídeos/farmacologia , Proteínas de Bactérias/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Nigéria , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/química , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/metabolismo , Análise de Sequência de DNA , Trimetoprima/farmacologiaRESUMO
BACKGROUND: Persistence of antibiotic resistant bacteria, including multidrug resistant (MDR) pseudomonads, is an important environmental health problem associated with drinking water distribution systems (DWDS) worldwide. There is paucity of data on the molecular characteristics of antibiotic resistance genes and their mode of transfer among pseudomonads from DWDS located in resource-challenged areas such as southwestern Nigeria. METHODS: MDR pseudomonads (n = 22) were selected from a panel of 296 different strains that were isolated from treated and untreated water in six DWDS located across southwest Nigeria. Primarily, the isolated pseudomonads strains were identified by 16S rDNA sequencing and antibiotic-resistance testing was completed using agar breakpoints assays. The final panel of strains of resistant to more than three classes of antibiotics (i.e. MDR), were further characterized by PCR genotyping, Sanger sequencing, and plasmid profiling. RESULTS: Pseudomonad resistance to gentamicin and streptomycin ranged from 22.7 to 54.6 % while resistance to tetracycline, ceftiofur and sulphamethoxazole ranged from 40.9 to 77.3 %. The most commonly detected antibiotic resistance genes were tet(A) (31.8 % of isolates), sul1 (31.8 %), bla TEM (40.9 %) and aph(3â³) (c) (36.4 %). Class 1 integron sequences were evident in 27.3 % of isolates and they harbored genes encoding resistance to aminoglycosides (aadA2, aadA1), trimethoprim (dfrA15, dfr7) and sulphonamide (sul1) while the plasmid ranged between 22 and 130 kb. CONCLUSIONS: Pseudomonas spp, isolated from these DWDS possess resistance genes and factors that are of public and environmental health significance. Therefore, has the potential of contributing to the global scourge of resistance genes transfer in human, animals and environments, thereby, useful in the epidemiology of antimicrobial resistance.
Assuntos
Água Potável/microbiologia , Farmacorresistência Bacteriana Múltipla , Pseudomonas/efeitos dos fármacos , Pseudomonas/genética , Antibacterianos/farmacologia , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Genes Bacterianos , Técnicas de Genotipagem , Humanos , Integrons , Testes de Sensibilidade Microbiana , Nigéria , Plasmídeos , Pseudomonas/isolamento & purificação , RNA Ribossômico 16S/genética , Análise de Sequência de DNARESUMO
BACKGROUND: Antibiotic resistance genes [ARGs] in aquatic systems have drawn increasing attention they could be transferred horizontally to pathogenic bacteria. Water treatment plants (WTPs) are intended to provide quality and widely available water to the local populace they serve. However, WTPs in developing countries may not be dependable for clean water and they could serve as points of dissemination for antibiotic resistant bacteria. Only a few studies have investigated the occurrence of ARGs among these bacteria including tetracycline resistance genes in water distribution systems in Nigeria. METHODOLOGY: Multi-drug resistant (MDR) bacteria, including resistance to tetracycline, were isolated from treated and untreated water distribution systems in southwest Nigeria. MDR bacteria were resistant to >3 classes of antibiotics based on break-point assays. Isolates were characterized using partial 16S rDNA sequencing and PCR assays for six tetracycline-resistance genes. Plasmid conjugation was evaluated using E. coli strain DH5α as the recipient strain. RESULTS: Out of the 105 bacteria, 85 (81 %) and 20 (19 %) were Gram- negative or Gram- positive, respectively. Twenty-nine isolates carried at least one of the targeted tetracycline resistance genes including strains of Aeromonas, Alcaligenes, Bacillus, Klebsiella, Leucobacter, Morganella, Proteus and a sequence matching a previously uncultured bacteria. Tet(A) was the most prevalent (16/29) followed by tet(E) (4/29) and tet30 (2/29). Tet(O) was not detected in any of the isolates. Tet(A) was mostly found with Alcaligenes strains (9/10) and a combination of more than one resistance gene was observed only amongst Alcaligenes strains [tet(A) + tet30 (2/10), tet(A) + tet(E) (3/10), tet(E) + tet(M) (1/10), tet(E) + tet30 (1/10)]. Tet(A) was transferred by conjugation for five Alcaligenes and two E. coli isolates. CONCLUSIONS: This study found a high prevalence of plasmid-encoded tet(A) among Alcaligenes isolates, raising the possibility that this strain could shuttle resistance plasmids to pathogenic bacteria.
Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Farmacorresistência Bacteriana Múltipla , Genes Bacterianos , Tetraciclina/farmacologia , Microbiologia da Água , Bactérias/genética , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Genótipo , Testes de Sensibilidade Microbiana , Nigéria , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Purificação da ÁguaRESUMO
Clostridioides difficile infection (CDI) is a major cause of antibiotic-associated diarrhea and an unappreciated contributor to child mortality in low- and middle-income countries where the diagnosis may be difficult. There is little information about the prevalence of CDI among infants, children, and adolescents in Africa. Using a cross-sectional design, seventy-six samples were collected from pediatric patients presenting with diarrhea, including infants (≤ 2 years old), children (2-12 years), and adolescents (13 ≤17 years) from three hospitals between January and December 2019. Demographic data, medical history, and prior antibiotic use were recorded. Toxigenic culture and PCR were used to detect and validate the presence of C. difficile in the samples. Data obtained were analyzed using descriptive and inferential statistics. A total of 29 (38.7%), 39 (52.0%) and 7 (9.3%) samples were from infants, children, and adolescents, respectively. The average age of the patients was 4.4 years. Of these samples, 31 (41%) were positive for C. difficile by culture and were verified by PCR amplification of C. difficile-specific genes (tcdA and tcdB). The most positive cases were children (53.3%) and infants (40.0%) with the majority of them residing in urban areas. Forty-nine (66.2%) of the patients had no known antibiotics exposure, whereas 29.0% and 29.7% reported the use of over-the-counter antibiotics at 14 and 90 days, prior to the hospital visit, respectively. CDI is relatively common among children with diarrhea in Northern Nigeria. Therefore, for effective management and treatment, more attention should be given to testing for C. difficile as one of the causative agents of diarrhea.
RESUMO
Background: Many adverse pregnancy outcomes (APOs) are associated with elevated cardiovascular disease (CVD) risk. However, APO data in the context of pre-existing CVD risk factors, and from diverse populations, are limited. We assessed the occurrence of APOs among individuals with and without prepregnancy CVD risk factors, overall and by race/ethnicity. Methods: We conducted a retrospective study using electronic medical record data from a large urban safety-net hospital. Individuals with prenatal care and delivery between 2016 and 2018 at the hospital were included, and data from prenatal intake through the delivery hospitalization were captured. The exposure, prepregnancy CVD risk factors (hypertension, diabetes, tobacco use, and obesity), and the outcome, APOs (hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, low birth weight, and stillbirth), were identified from electronic medical records. Results: We identified 3760 unique delivering individuals, of whom 55.1% self-identified as Black non-Hispanic and 17% as Hispanic. Prepregnancy CVD risk factor prevalence was 45.6%, most commonly obesity (26.6%). APO prevalence was 35.6%, most commonly a hypertensive disorder of pregnancy (20.1%). Overall, 45.7% of APOs occurred in the absence of recognized prepregnancy CVD risk factors, representing 16.3% of the total sample. Among individuals without prepregnancy CVD risk factors, APO prevalence was 30.0% and did not vary by race/ethnicity. Conclusions: In this racially and ethnically diverse hospital-based sample, APOs were present in one in three parous individuals without prepregnancy CVD risk factors-a group with potentially elevated CVD risk who might otherwise be missed by traditional CVD risk factor screening.
Assuntos
Doenças Cardiovasculares , Resultado da Gravidez , Gravidez , Recém-Nascido , Feminino , Humanos , Estudos Retrospectivos , Doenças Cardiovasculares/complicações , Provedores de Redes de Segurança , Fatores de Risco , Obesidade/epidemiologiaRESUMO
Challenges encountered in relapse of illness caused by resistance of microorganisms to antimicrobial agents (drugs) are due to factors of severe stress initiated by random use of antibiotics and insufficient beneficial approaches. These challenges have resulted to multiple drug resistance (MDR) and, subsequently, biofilm formation. A type of intercellular communication signal called quorum sensing (QS) has been studied to cause the spread of resistance, thereby enabling a formation of stable community for microorganisms. The QS could be inhibited using QS inhibitors (QSIs) called quorum-quenching (QQ). The QQ is an antibiofilm agent. Indole derivatives from plant sources can serve as quorum-quenching eradication approach for biofilm, as well as a promising nontoxic antibiofilm agent. In other words, phytochemicals in plants help to control and prevent biofilm formation. It could be recommended that combination strategies of these indoles' derivatives with antibiotics would yield enhanced results.
Assuntos
Anti-Infecciosos , Percepção de Quorum , Antibacterianos/farmacologia , Anti-Infecciosos/farmacologia , Biofilmes , Indóis/farmacologiaRESUMO
BACKGROUND: Helicopter transport (HT) is frequently used for interfacility transfer of injured patients to a trauma center. The benefits of HT over ground transport (GT) in this setting are unclear. By using a national sample, the objective of this study was to assess whether HT impacted outcomes following interfacility transfer of trauma patients. METHODS: Patients transferred by HT or GT in 2007 were identified using the National Trauma Databank (version 8). Injury severity, resource utilization, and survival to discharge were compared. Stepwise logistic regression was used to determine whether transport modality was a predictor of survival after adjusting for covariates. Regression analysis was repeated in subgroups with Injury Severity Score (ISS)≤15 and ISS>15. RESULTS: There were 74,779 patients transported by helicopter (20%) or ground (80%). Mean ISS was higher in patients transported by helicopter (17±11 vs. 12±9; p<0.01) as was the proportion with ISS>15 (49% vs. 28%; odds ratio [OR], 2.53; 95% confidence interval [CI], 2.43-2.63). Patients transported by helicopter had higher rates of intensive care unit admission (54% vs. 29%; OR, 2.86; 95% CI, 2.75-2.96), had shorter transport time (61±55 minutes vs. 98±71 minutes; p<0.01), and had shorter overall prehospital time (135±86 minutes vs. 202±132 minutes; p<0.01). HT was not a predictor of survival overall or in patients with ISS≤15. In patients with ISS>15, HT was a predictor of survival (OR, 1.09; 95% CI, 1.02-1.17; p=0.01). CONCLUSIONS: Patients transported by helicopter were more severely injured and required more hospital resources than patients transported by ground. HT offered shorter transport and overall prehospital times. For patients with ISS>15, HT was a predictor of survival. These findings should be considered when developing interfacility transfer policies for patients with severe injuries.
Assuntos
Resgate Aéreo/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Intervalos de Confiança , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Transferência de Pacientes/métodos , Respiração Artificial/estatística & dados numéricos , Análise de Sobrevida , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The Centers for Disease Control recently updated the National Trauma Triage Protocol. This field triage algorithm guides emergency medical service providers through four decision steps (physiologic [PHY], anatomic [ANA], mechanism, and special considerations) to identify patients who would benefit from trauma center care. The study objective was to analyze whether trauma center need (TCN) was accurately predicted solely by the PHY and ANA criteria using national data. METHODS: Trauma patients aged 18 years and older were identified in the NTDB (2002-2006). PHY data and ANA injuries (International Classification of Diseases, ninth revision codes) were collected. TCN was defined as Injury Severity Score (ISS)>15, intensive care unit admission, or need for urgent surgery. Test characteristics were calculated according to steps in the triage algorithm. Logistic regression was performed to determine independent association of criteria with outcomes. Receiver operating characteristic curves were constructed for each model. RESULTS: A total of 1,086,764 subjects were identified. Sensitivity of PHY criteria was highest for ISS>15 (42%) and of ANA criteria for urgent surgery (37%). By using PHY and ANA steps, sensitivity was highest (56%) and undertriage lowest (45%) for ISS>15. Undertriage for TCN based on actual treating trauma center level was 11%. CONCLUSION: Current PHY and ANA criteria are highly specific for TCN but result in a high degree of undertriage when applied independently. This implies that additional factors such as mechanism of injury and the special considerations included in the Centers for Disease Control decision algorithm contribute significantly to the effectiveness of this field triage tool.
Assuntos
Triagem/normas , Ferimentos e Lesões/classificação , Algoritmos , Distribuição de Qui-Quadrado , Protocolos Clínicos/normas , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Análise de Regressão , Estatísticas não Paramétricas , Centros de Traumatologia , Índices de Gravidade do Trauma , Triagem/métodos , Ferimentos e Lesões/cirurgiaRESUMO
BACKGROUND: The role of helicopter transport (HT) in civilian trauma care remains controversial. The objective of this study was to compare patient outcomes after transport from the scene of injury by HT and ground transport using a national patient sample. METHODS: Patients transported from the scene of injury by HT or ground transport in 2007 were identified using the National Trauma Databank version 8. Injury severity, utilization of hospital resources, and outcomes were compared. Stepwise logistic regression was used to determine whether transport modality was a predictor of survival or discharge to home after adjusting for covariates. RESULTS: There were 258,387 patients transported by helicopter (16%) or ground (84%). Mean Injury Severity Score was higher in HT patients (15.9 ± 12.3 vs. 10.2 ± 9.5, p < 0.01), as was the percentage of patients with Injury Severity Score >15 (42.6% vs. 20.8%; odds ratio [OR], 2.83; 95% confidence interval [CI], 2.76-2.89). HT patients had higher rates of intensive care unit admission (43.5% vs. 22.9%; OR, 2.58; 95% CI, 2.53-2.64) and mechanical ventilation (20.8% vs. 7.4%; OR, 3.30; 95% CI, 3.21-3.40). HT was a predictor of survival (OR, 1.22; 95% CI, 1.17-1.27) and discharge to home (OR, 1.05; 95% CI, 1.02-1.07) after adjustment for covariates. CONCLUSIONS: Trauma patients transported by helicopter were more severely injured, had longer transport times, and required more hospital resources than those transported by ground. Despite this, HT patients were more likely to survive and were more likely to be discharged home after treatment when compared with those transported by ground. Despite concerns regarding helicopter utilization in the civilian setting, this study shows that HT has merit and impacts outcome.
Assuntos
Resgate Aéreo/estatística & dados numéricos , Aeronaves , Avaliação de Resultados em Cuidados de Saúde , Transporte de Pacientes/estatística & dados numéricos , Ferimentos e Lesões/diagnóstico , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Taxa de Sobrevida , Centros de Traumatologia , Estados Unidos/epidemiologia , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapiaRESUMO
BACKGROUND: The mortality of traumatic brain injury (TBI) continues to decline, emphasizing functional outcomes. Trauma center designation has been linked to survival after TBI, but the impact on functional outcomes is unclear. The objective was to determine whether trauma center designation influenced functional outcomes after moderate and severe TBI. METHODS: Trauma subjects presenting to an American College of Surgeons (ACS) Level I or II trauma center with a Glasgow Coma Score (GCS) Assuntos
Atividades Cotidianas
, Lesões Encefálicas/mortalidade
, Lesões Encefálicas/reabilitação
, Continuidade da Assistência ao Paciente/normas
, Centros de Traumatologia/estatística & dados numéricos
, Adolescente
, Adulto
, Análise de Variância
, Lesões Encefálicas/diagnóstico
, Continuidade da Assistência ao Paciente/tendências
, Bases de Dados Factuais
, Serviço Hospitalar de Emergência/normas
, Serviço Hospitalar de Emergência/tendências
, Feminino
, Seguimentos
, Escala de Coma de Glasgow
, Humanos
, Escala de Gravidade do Ferimento
, Masculino
, Pessoa de Meia-Idade
, Alta do Paciente/estatística & dados numéricos
, Recuperação de Função Fisiológica
, Medição de Risco
, Taxa de Sobrevida
, Resultado do Tratamento
RESUMO
OBJECTIVES: Use of chloramphenicol or its veterinary analogue florfenicol can selectively favour antibiotic-resistant bacteria. Understanding how resistance is mobilised and disseminated among pathogens is vital in knowing how different bacterial taxa might serve as reservoirs of these genes for pathogenic bacteria. METHODS: Bacterial isolates (n=30) were selected on the basis of multidrug resistance and resistance to florfenicol from among 296 bacteria originally isolated from drinking water distribution systems in Southwestern Nigeria. Bacterial identification, minimum inhibitory concentration (MIC) determination for florfenicol, PCR detection of florfenicol resistance genes (floR, fexA and cfx) and sequence analysis were employed to characterise the isolates. RESULTS: According to sequence data (16S rDNA, v2-v3 region), 30strains were selected, includingPseudomonas spp. (43.3%), Serratia spp. (13.3%), Proteus spp. (26.7%), Acinetobacter spp. (13.3%) and Providencia rettgeri (3.3%). MICs ranged between >16µg/mL and >1024µg/mL. floR was the only resistance gene detected (11/30; 36.7%). The majority of floR-positive isolates (8/11; 72.7%) were Proteus spp. All floR sequences shared 100% identity and 1-2 synonymous substitutions relative to other published sequences. CONCLUSIONS: floR-positive strains in this study were originally selected randomly without antibiotics. Finding floR in four genera without selective enrichment is consistent with widespread distribution of this resistance trait in drinking water systems in Nigeria. Further work is needed to determine whether human and veterinary antibiotic use practices in Nigeria are contributing to proliferation of this important antibiotic resistance trait and to determine whether the presence of floR-producing strains is compromising human and animal health.
Assuntos
Água Potável , Animais , Bactérias/genética , Genes Bacterianos , Humanos , Nigéria , Providencia , Análise de Sequência de DNA , Tianfenicol/análogos & derivadosRESUMO
In this research, developed finite element codes were used to study the effective elastic modulus and stress-strain distribution profiles of epoxy resin filled with 6 wt. % microparticles of kaolinite. The random distribution of the particles was microstructurally regenerated with Digimat MSC software and random sequential algorithm codes in epoxy matrix. Stochastic representative volume element models of the composites were developed and analyzed under periodic boundary conditions. For validation, the predicted result by finite element analysis was compared with that of Mori-Tanaka's mean field homogenization scheme, selected micromechanical models and experiment. All the results indicated that 6 wt. % of kaolinite microparticles can improve the elastic modulus and load-bearing capacity of epoxy resin with <5 % error between predicted and actual results. The microstructure, phase identification and chemical characterization of the composite were also studied with scanning electron microscopy, x-ray diffraction spectroscopy and energy-dispersive x-ray spectroscopy, respectively. In addition, the particle size and distribution of the kaolinite in the epoxy matrix were experimentally investigated.
RESUMO
BACKGROUND: Prehospital spinal immobilization (PHSI) is routinely applied to patients sustaining torso gunshot wounds (GSW). Our objective was to evaluate the potential benefit of PHSI after torso GSW versus the potential to interfere with other critical aspects of care. METHODS: A retrospective analysis of all patients with torso GSW in the Strong Memorial Hospital (SMH) trauma registry during a 41-month period and all patients with GSW in the National Trauma Data Bank (NTDB) during a 60-month period was conducted. PHSI was considered potentially beneficial in patients with spine fractures requiring surgical stabilization in the absence of spinal cord injury (SCI). RESULTS: Three hundred fifty-seven subjects from SMH and 75,210 from NTDB were included. A total of 9.2% of SMH subjects and 4.3% of NTDB subjects had spine injury, with 51.5% of SMH subjects and 32.3% of NTDB subjects having SCI. No SMH subject had an unstable spine fracture requiring surgical stabilization without complete neurologic injury. No subjects with SCI improved or worsened, and none developed a new deficit. Twenty-six NTDB subjects (0.03%) had spine fractures requiring stabilization in the absence of SCI. Emergent intubation was required in 40.6% of SMH subjects and 33.8% of NTDB subjects. Emergent surgical intervention was required in 54.5% of SMH subjects and 43% of NTDB subjects. CONCLUSIONS: Our data suggest that the benefit of PHSI in patients with torso GSW remains unproven, despite a potential to interfere with emergent care in this patient population. Large prospective studies are needed to clarify the role of PHSI after torso GSW.
Assuntos
Serviços Médicos de Emergência , Imobilização , Traumatismos da Medula Espinal/terapia , Fraturas da Coluna Vertebral/terapia , Ferimentos por Arma de Fogo , Adulto , Serviços Médicos de Emergência/normas , Feminino , Humanos , Masculino , Sistema de Registros , Estudos Retrospectivos , Traumatismos da Medula Espinal/etiologia , Adulto JovemRESUMO
BACKGROUND: Patients who fail to wait for medical assessment in the emergency department (ED) have been referred to in the international literature as "did not wait" (DNW) or "left without being seen" (LWBS) patients or, indeed, simply as "walkouts". This is taken as a performance indicator internationally. In common with many countries, Ireland has very considerable problems in the delivery of ED care due largely to inadequate resources and the inappropriate use of EDs as holding bays for admitted patients. This is the first study of this size to profile the DNW phenomenon in Ireland. METHODS: The charts of DNW patients were identified and the DNW status was entered into the ED computer record. Data concerning age, sex, time of arrival, date of arrival, triage category and presenting complaint were recorded. RESULTS: In the study period there were 11 662 patient attendances, of whom 871 patients (7.47%) did not wait for assessment. Triage category was highly statistically significant, with those in the lowest triage category having the highest numbers not waiting to be seen (p<0.001). Those attending at night (p<0.001) and at the weekend (p = 0.03) were most likely to leave without being assessed. CONCLUSION: Failure to provide the service in a timely manner gives rise to patients leaving without receiving the medical assessment they came to obtain. This is a serious clinical problem and puts both those requiring care and those providing it at risk of adverse outcomes.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Hospitais de Ensino/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Lactente , Irlanda , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Estudos Prospectivos , Fatores de Tempo , Triagem/estatística & dados numéricos , Listas de Espera , Adulto JovemRESUMO
Progresses made in previous researches on syntheses of dithiocarbamates led to increase in further researches. This paper reviews concisely the challenges experienced during the synthesis of dithiocarbamate and mechanisms to overcome them in order to obtain accurate results. Aspects of its precursor's uses to synthesize adducts, nanoparticles, and nanocomposites are reported. Some common characterization techniques used for the synthesized products were assessed. Biological applications are also reported.
RESUMO
Background: Multi-drug Resistant (MDR) bacteria could lead to treatment failure of infectious diseases and could be transferred by non-potable water. Few studies have investigated occurrence of Antibiotic Resistance Genes (ARGs) among bacteria including Aminoglycoside Modifying Genes (AMGs) from Drinking Water Distribution Systems (DWDS) in Nigeria. Here, we aimed at characterization of AMGs from DWDS from selected states in southwestern Nigeria. Methods: One hundred and eighty one (181) MDR bacteria that had been previously characterized using 16S rDNA and showed resistance to at least one aminoglycoside antibiotic were selected from treated and untreated six water distribution systems in southwestern Nigeria. MDR bacteria were PCR genotyped for three AMGs:aph (3â³)c, ant (3â³)b and aph(6)-1dd. Results: Out of 181 MDR bacteria genotyped, 69(38.12%) tested positive for at least one of the genotyped AMGs. Highest (50, 27.62%) detected gene was ant (3â³)c followed by aph (3â³)c(33, 18.23%). Combination of aph(3â³)c and ant (3â³)b in a single bacteria was observed as the highest (14, 7.73%) among the detected gene combination. Alcaligenes sp showed the highest (10/20) occurrence of ant (3â³)b while aph(3â³)c was the highest detected among Proteus sp (11/22). Other bacteria that showed the presence of AMGs include: Acinetobacter, Aeromonas, Bordetella, Brevundimonas, Chromobacterium, Klebsiella, Leucobacter, Morganella, Pantoae, Proteus, Providencia, Psychrobacter and Serratia. Conclusions: High occurrence of ant (3â³)c and aph (3â³)c among these bacteria call for urgent attention among public health workers, because these genes can be easily disseminated to consumers of these water samples if present on mobile genetic elements like plasmids, integrons and transposons.
Assuntos
Aminoglicosídeos/farmacologia , Antibacterianos/farmacologia , Água Potável/microbiologia , Farmacorresistência Bacteriana/genética , Microbiologia da Água , Bactérias/efeitos dos fármacos , Bactérias/genética , Farmacorresistência Bacteriana Múltipla/genética , Técnicas de Genotipagem , NigériaRESUMO
The aim of this mini review was to report the molybdenum compound intervention to control cancer disease. The intervention explains its roles and progress from inorganic molybdenum compounds via organomolybdenum complexes to its nanoparticles to control oesophageal cancer and breast cancer as case studies. Main contributions of molybdenum compounds as anticancer agents could be observed in their nanofibrous support with suitable physicochemical properties, combination therapy, and biosensors (biomarkers). Recent areas in anticancer drug design, which entail the uses of selected targets, were also surveyed and proposed.