Profile of co-infections & secondary infections in COVID-19 patients at a dedicated COVID-19 facility of a tertiary care Indian hospital: Implication on antimicrobial resistance

BackgroundThe COVID-19 pandemic has raised concerns over secondary infections because it has limited treatment options and empiric antimicrobial treatment poses serious risks of aggravating antimicrobial resistance (AMR). Studies have shown that COVID-19 patients are predisposed to develop secondary infections. This study was conducted to ascertain the prevalence and profiles of co- & secondary infections in patients at the COVID-19 facility in North India.MethodsWe studied the profile of pathogens isolated from 290 clinical samples. Bacterial and fungal pathogens were identified, and antimicrobial susceptibility was determined by the Vitek2® system. Additionally, respiratory samples were tested for any viral/atypical bacterial co-infections and the presence of AMR genes by FilmArray test. The clinical and outcome data of these patients were also recorded for demographic and outcome measures analyses.ResultsA total of 151 (13%) patients had secondary infections, and most got infected within the first 14 days of hospital admission. Patients aged >50 years developed severe symptoms (p = 0.0004) and/or had a fatal outcome (p = 0.0005). In-hospital mortality was 33%.K.pneumoniae (33.3%) was the predominant pathogen, followed by A. baumannii (27.1%). The overall resistance was up to 84%.Majority of the organisms were multidrug-resistant (MDR) harbouring MDR genes.ConclusionA high rate of secondary infections with resistant pathogens in COVID-19 patients highlights the importance of antimicrobial stewardship programs focussing on supporting the optimal selection of empiric treatment and rapid-de-escalation, based on culture reports.     

骨质疏松症动物模型的构建及实验方法研究进展

骨质疏松症是一种全身性骨代谢病,由多种因素引起,其特点是骨量、骨密度和骨组织的显微结构恶化,骨脆性增强和易发生骨折。骨质疏松症已严重威胁人类健康,最终将导致患者日常活动减少,生活质量降低,死亡率增加。针对不同的研究对象,选择一个正确、理想的动物骨质疏松的模型和实验方法以尽可能再现人类骨质疏松的状态,是开展动物实验的关键。我们综述了当前原发性和继发性骨质疏松等动物模型的构建,以及利用这些模型进行给药实验的研究方法,并对研发治疗骨质疏松的新型药物的选择提供了一些参考建议,以期对后续关于药物的作用机制、研发新药、药物的改良等研究提供思路。     

Retrospective analysis of clinical outcomes in bilateral cleft lip and palate patients after secondary alveolar bone grafting and premaxilla osteotomy,using a new dento-maxillary scoring system

Evaluation of relevant clinical outcomes in patients with bilateral cleft lip and palate (BCLP) after secondary aveolar bone grafting (SABG) and premaxilla osteotomy (PMO), through the use of a new scoring system.Data were collected retrospectively from all patients with BCLP who were operated on between 2004 and 2014, at the end of follow-up. The treatment protocol consisted of SABG + PMO in patients aged between 9 and 13 years. At the end of follow-up, the following parameters were scored: (un)interrupted dental arch, skeletal sagittal relationship, bone height using the Bergland/Abyholm criteria, and the presence of postoperative fistula. These parameters were combined to produce a dento-maxillary scoring system, giving a final score between 1 and 10. For statistical analysis, the independent t-test was used.Of 55 children, 45 were suitable for analysis. The mean age at time of surgery was 12.0 years (8.9–16.4 yrs), and the mean follow-up time was 11.7 years (5.8–15.8 yrs). The average number of surgeries executed under general anesthesia was 6 (range: 3–11). The average dento-maxillary score in this patient cohort was 7.6 (1–10; median: 8). Among these patients, 31 had an uninterrupted dental arch; the average Bergland/Abyholm score was 2.07; 30 patients exhibited an Angle class I incisor relationship; and, in 38 cases, the oronasal communication was closed after SABG + PMO treatment. A significant effect of fistulas was seen on dento-maxillary score (p = 0.001). Specifically, a significant effect of fistulas was seen on interrupted dental arch (p = 0.002) and on Bergland/Abyholm score (p = 0.037).The proposed dento-maxillary scoring system is a straightforward tool that can be used to describe and analyze the amount of dento-maxillary rehabilitation at the end of the treatment. Persistence of oronasal fistulas in patients with BCLP has a significant impact on interruption of the dental arch, and can influence dental results at the end of the second decade.     

基于16S rRNA测序研究葛根芩连汤对菌群失调性腹泻大鼠肠道菌群结构的影响

目的 采用16S rRNA技术研究葛根芩连汤对菌群失调性腹泻大鼠肠道菌群结构的影响。方法 将60只健康SD大鼠随机分为6组，分别为正常组、模型组、葛根芩连汤高、中、低剂量组，丽珠肠乐组，每组10只。除正常组外，每日按头孢拉定178.6 mg·kg^-1，硫酸庆大霉素31.25 mg·kg^-1混合抗生素进行灌胃造模，造模成功后，葛根芩连汤高、中、低剂量组灌胃葛根芩连汤（7.02，3.51，1.755 g·kg^-1），丽珠肠乐组按0.125 g·kg^-1灌胃，正常组与模型组给予无菌蒸馏水灌胃，体积分数均为10 mL·kg^-1，连续给药7 d，将大鼠麻醉后取大鼠结肠内容物，提取粪便DNA后进行16S rRNA高通量测序并分析其结果。结果 葛根芩连汤明显调节菌群失调性腹泻模型大鼠的物种数量及Alpha与Beta多样性，提高菌群生物丰富度指数与多样性指数，正向调节菌群失调性腹泻模型大鼠的3种差异菌门（厚壁菌门、变形菌门、拟杆菌门）与14种差异菌属（拟杆菌属、狄氏副拟杆菌属、布劳特氏菌属等）。结论 葛根芩连汤对菌群失调性腹泻模型大鼠肠道菌群有调节作用，揭示了肠道菌群与菌群失调性腹泻之间的生理病理机制。     

Efectividad de un programa de capacitación en cuidados integrales para la prevención secundaria cardiovascular en enfermeras de atención primaria

ObjectiveTo assess the effect of the “Program of Training in Integral Care for Secondary Cardiovascular Prevention in Primary Care Nursing” on the level of knowledge, the degree of application of comprehensive cardiovascular care, and on the continuity of care between the cardiac rehabilitation and primary care units, in relation to post-infarction patients.MethodsQuasi-experimental before-after study without control group. Comprised an ad-hoc survey prior to training via the Internet and a post-training survey; both the pre- and post-course surveys were anonymous. The program consisted of secondary cardiovascular prevention training, chronicity in the cardiovascular patient and adherence to the therapeutic plan, and follow-up protocol.ResultsOver one third of the respondents did not know the control objectives of the different cardiovascular risk factors, more marked regarding lipid control. The program significantly improved the knowledge of the objectives of blood pressure, total cholesterol and LDL cholesterol, and the self-perception of better monitoring of lipid parameters and waist circumference. In centers with a cardiac rehabilitation unit, 73% of respondents indicated that there was “no” communication with the unit before the course, reducing to 55% in the post-course survey.ConclusionThere are clear training needs of nurses for their involvement in these secondary prevention programs. A specific continuous training in secondary cardiovascular prevention for nurses in the field of primary care, improves and facilitates the acquisition of knowledge at this level, can improve the approach of patients with cardiovascular events during the first months of said event and communication with the reference cardiac rehabilitation units.     

The effect of universal adhesives on dentine collagen

ObjectivesThe purpose of the study was to evaluate the integrity of dentine type I collagen after self-etching (SE) treatments with strong and mild universal adhesives.MethodsCoronal dentine specimens (n = 10/product) were imaged by optical microscopy and analyzed by ATR-FTIR spectroscopy before and after treatment with 32% phosphoric acid gel (PA-negative control), 17% neutral EDTA (ED-positive control) conditioners and Adhese Universal (AD), Clearfil Universal Bond Quick (CQ), G-Premio Bond (GP), Prelude One (PR) and Scotchbond Universal (SB) adhesives. From the spectroscopic analysis the following parameters were determined: a) Extent of dentine demineralization (DM%) and b) percentage area of the Amide I curve-fitted components of β-turns, 3₁₀-helix/β-turns, α-helix, random coils, β-sheets and collagen maturation (R) index. Statistical analysis was performed by one-way ANOVA (DM%), paired t-test/Wilcoxon test (Amide I components) and Spearman correlation coefficient (DM% vs Amide I components) at an a = 0.05 level.ResultsPA, ED and GP removed the smear-layer and opened tubule orifices, whereas all other treatments removed only the intratubular smear-layer fraction. The ranking of the statistically significant differences in DM% was PA > GP > ED > AD, SB, CQ, PR, with AD being significantly different from PR. Regarding the Amide I components, PA demonstrated a significant reduction in β-turns, α-helices and an increase in β-sheets, GP a reduction in β-turns, AD an increase in β-turns and random coils, and CQ an increase in β-turns. PR, SB and ED showed insignificant differences in all the Amide I components. Significant correlations were found between DM%-random coils and DM%-R.SignificanceThe universal adhesives used in the SE mode induced none to minimal changes in dentine collagen structure, without evidence of the destabilization pattern observed after conventional phosphoric acid treatments.     

人参内生菌的研究进展

内生菌由细菌、真菌、古菌和原生生物组成，它们生活在植物的活体组织中，具有丰富的次级代谢产物多样性。人参内生菌在人参的生长发育、次级代谢产物的生成和环境适应等方面均有重要的促进作用，对人参的产量和品质有较大影响。随着人们在微生物领域研究的深入，高通量测序技术已经成为研究植物内生菌的重要方法。文章主要从人参内生菌分离与鉴定研究方法、人参内生菌的多样性、人参内生菌及其次级代谢产物的活性、人参内生菌对宿主的影响等4个方面对人参内生菌近年来的研究进展进行讨论，并对其发展方向提出展望，以期为药用植物内生菌研究和品质改良提供新思路、新方法。