Prevalence of surgical-site infections and patterns of antimicrobial use in a large tertiary-care hospital in Ho Chi Minh City, Vietnam.

BACKGROUND: Few studies have been conducted in Vietnam on the epidemiology of healthcare-associated infections or antimicrobial use. Thus, we sought to determine the prevalence of and risk factors for surgical-site infections (SSIs) and to document antimicrobial use in surgical patients in a large healthcare facility in Vietnam. METHODS: We conducted a point-prevalence survey of SSIs and antimicrobial use at Cho Ray Hospital, Ho Chi Minh City, a 1,250-bed inpatient facility. All patients on the 11 surgical wards and 2 intensive care units who had surgery within 30 days before the survey date were included. RESULTS: Of 391 surgical patients, 56 (14.3%) had an SSI. When we compared patients with and without SSIs, factors associated with infection included trauma (relative risk [RR], 2.65; 95% confidence interval [CI95], 1.60 to 4.37; P < .001), emergency surgery (RR, 2.74; CI95, 1.65 to 4.55; P < .001), and dirty wounds (RR, 3.77; CI95, 2.39 to 5.96; P < .001). Overall, 198 (51%) of the patients received antimicrobials more than 8 hours before surgery and 390 (99.7%) received them after surgery. Commonly used antimicrobials included third-generation cephalosporins and aminoglycosides. Thirty isolates were identified from 26 SSI patient cultures; of the 25 isolates undergoing antimicrobial susceptibility testing, 22 (88%) were resistant to ceftriaxone and 24 (92%) to gentamicin. CONCLUSIONS: Our data show that (1) SSIs are prevalent at Cho Ray Hospital; (2) antimicrobial use among surgical patients is widespread and inconsistent with published guidelines; and (3) pathogens often are resistant to commonly used antimicrobials. SSI prevention interventions, including appropriate use of antimicrobials, are needed in this population.     

Dyspnea reproducibility in a rural Bangladesh population

Background and Aims: Dyspnea may signal serious disease with increased morbidity/mortality. Dyspnea screening would only be valid if reproducible. The study aim was to determine the reliability (reproducibility) of assessing dyspnea through a simple questionnaire among a rural population. Methods: Participants were recruited from a Health Effects of Arsenic Longitudinal Study in Araihazar, Bangladesh. Dyspnea assessment used a questionnaire among 129 participants at two time points: at baseline and after 2 weeks to 9 months by trained physicians. All subjects were asked about the presence/absence of dyspnea in the last 6 months. At the second interview, a physician (blinded to questionnaire) conducted a clinical heart/lung examination and obtained a pulse oximeter reading. Results: Dyspnea prevalence by baseline questionnaire was 2.4%. Overall dyspnea reliability was 94% (121 out of 129). If the initial response was ‘yes’ for the presence of dyspnea, reliability was 91% (49 out of 54). For an initial response of ‘no’ for the presence of dyspnea, reliability was 96% (72 out of 75). The pulmonary examination and pulse oximeter readings were significantly more likely to be abnormal in those with dyspnea (P < 0.01). Conclusions: The reliability of a simple question on dyspnea is very high when obtained by physicians. Although validity was not the primary outcome, the increased likelihood of an abnormal chest examination or low pulse oximeter saturation for those reporting ‘yes’ to the dyspnea question suggests more significant underlying cardiopulmonary disease in those reporting recent dyspnea. Please cite this paper as: Pesola GR, Parvez F, Jasmin S, Hasan AKM R and Ahsan H. Dyspnea reproducibility in a rural Bangladesh population. The Clinical Respiratory Journal 2009; 3: 222–228.     

Methicillin-resistant Staphylococcus aureus infection or colonization present at hospital admission: multivariable risk factor screening to increase efficiency of surveillance culturing

Identifying methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection present at admission has become important in reducing subsequent nosocomial transmission, but the most efficient surveillance methods remain to be defined. We performed anterior nares surveillance cultures of all patients upon admission to and discharge from the general internal medicine floor in our community hospital over a 7-week period, and patients completed a questionnaire on MRSA risk factors. Of the 401 patients, 41 (10.2%) had MRSA upon admission. Of the 48 risk measures analyzed, 10 were significantly associated with admission MRSA, and 7 of these were independently associated in stepwise logistic regression analysis. Factor analysis identified eight latent variables that contained most of the predictive information in the 48 risk measures. Repeat logistic regression analysis including the latent variables revealed three independent risk measures for admission MRSA: a nursing home stay (relative risk [RR], 6.18; 95% confidence interval [95% CI], 3.56 to 10.72; P < 0.0001), prior MRSA infection (RR, 3.97; 95% CI, 1.94 to 8.12; P = 0.0002), and the third latent variable (factor 3; RR, 3.14; 95% CI, 1.56 to 6.31; P = 0.0013), representing the combined effects of homelessness, jail stay, promiscuity, intravenous drug use, and other drug use. Multivariable models had greater sensitivity at detecting admission MRSA than any single risk measure and allowed detection of 78% to 90% of admission MRSA from admission surveillance cultures on 46% to 58% of admissions. If confirmed in additional studies, multivariable questionnaire screening at admission might identify a subset of admissions for surveillance cultures that would more efficiently identify most admission MRSA.     

Water arsenic exposure and intellectual function in 6-year-old children in Araihazar, Bangladesh

BACKGROUND: We recently reported results of a cross-sectional investigation of intellectual function in 10-year-olds in Bangladesh, who had been exposed to arsenic from drinking water in their home wells. OBJECTIVES: We present results of a similar investigation of 301 randomly selected 6-year-olds whose parents participated in our ongoing prospective study of the health effects of As exposure in 12,000 residents of Araihazar, Bangladesh. METHODS: Water As and manganese concentrations of tube wells at each home were obtained by surveying all study region wells. Children and mothers were first visited at home, where the quality of home stimulation was measured, and then seen in our field clinic, where children received a medical examination wherein weight, height, and head circumference were assessed. We assessed children's intellectual function using subtests drawn from the Wechsler Preschool and Primary Scale of Intelligence, version III, by summing weighted items across domains to create Verbal, Performance, Processing Speed, and Full-Scale raw scores. Children provided urine specimens for measuring urinary As and were asked to provide blood samples for blood lead measurements. RESULTS: Exposure to As from drinking water was associated with reduced intellectual function before and after adjusting for water Mn, for blood lead levels, and for sociodemographic features known to contribute to intellectual function. With covariate adjustment, water As remained significantly negatively associated with both Performance and Processing Speed raw scores; associations were less strong than in our previously studied 10-year-olds. CONCLUSION: This second cross-sectional study of As exposure expands our concerns about As neurotoxicity to a younger age group.     

STAT3 pathway regulates lung-derived brain metastasis initiating cell capacity through miR-21 activation

Brain metastases (BM) represent the most common tumor to affect the adult central nervous system. Despite the increasing incidence of BM, likely due to consistently improving treatment of primary cancers, BM remain severely understudied. In this study, we utilized patient-derived stem cell lines from lung-to-brain metastases to examine the regulatory role of STAT3 in brain metastasis initiating cells (BMICs). Annotation of our previously described BMIC regulatory genes with protein-protein interaction network mapping identified STAT3 as a novel protein interactor. STAT3 knockdown showed a reduction in BMIC self-renewal and migration, and decreased tumor size in vivo. Screening of BMIC lines with a library of STAT3 inhibitors identified one inhibitor to significantly reduce tumor formation. Meta-analysis identified the oncomir microRNA-21 (miR-21) as a target of STAT3 activity. Inhibition of miR-21 displayed similar reductions in BMIC self-renewal and migration as STAT3 knockdown. Knockdown of STAT3 also reduced expression of known downstream targets of miR-21. Our studies have thus identified STAT3 and miR-21 as cooperative regulators of stemness, migration and tumor initiation in lung-derived BM. Therefore, STAT3 represents a potential therapeutic target in the treatment of lung-to-brain metastases.     

Enhanced immunogenicity of recombinant hepatitis B vaccine in exposed family contacts of chronic liver disease patients

Close family contacts of hepatitis B virus (HBV)-related chronic liver disease patients have a high risk of exposure to HBV. Variable responses to vaccination have been reported in family contacts, especially in previously exposed contacts (IgG antiHBc-positive). Seventy-nine healthy family contacts, who were HBsAg-negative with normal alanine amino-transferase level and no evidence of liver disease, were vaccinated using a recombinant HBV vaccine, irrespective of past exposure status. A significantly higher number of previously exposed subjects (n = 25; Group I) developed early seroprotective anti-HBs titers with 2 initial doses of vaccine compared to the unexposed contacts (Group II; n = 54) (64% vs. 33%, respectively; P < 0.05). However, the responses were comparable on completion of the schedule (96% vs. 94%, respectively). HBV DNA was detected in 11 of 25 (44%) exposed and none of the unexposed contacts at baseline. Post-vaccination, 3 of 11 (27%) subjects became HBV DNA-negative and remained negative for the next 12 months. These results suggest that exposed family contacts achieve efficient seroprotection after HBV vaccination, irrespective of the IgG anti-HBc status. The response to vaccination resembles an anamnestic reaction and possibly demonstrates a therapeutic effect.     

Inducible supraventricular tachycardias in patients referred for catheter ablation of atrial fibrillation.

AIMS: To investigate the prevalence of underlying, inducible supraventricular arrhythmias in patients referred for ablation of atrial fibrillation (AF). METHODS AND RESULTS: Electrophysiology study reports of 409 consecutive patients (18% female), aged 55 +/- 9 years, who were referred for catheter ablation of AF, were studied. At electrophysiology study, arrhythmias other than AF were induced in 31 patients (7.6%). Cavotricuspid-dependent atrial flutter was induced in 15 patients (3.7%), slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) in seven patients (1.7%), atrioventricular re-entrant tachycardia (AVRT) due to an accessory pathway in five patients (1.2%), and atrial tachycardia (AT) in four patients (0.98%). Specific ablation aimed at elimination of the underlying arrhythmia only was performed in 13 patients, isolation of the pulmonary veins without additional ablation in three patients, and a combined procedure was performed in the remaining 15 patients. No significant association was observed between type of induced arrhythmia and type of ablation performed (P = 0.338). Slow pathway ablation without pulmonary vein isolation was more common among patients with AVNRT (five patients, 71%). AF recurrence was higher among patients in whom atrial flutter was induced at electrophysiology study (eight patients, 53%) compared to those with AVRT (no patient), AT (no patient), or AVNRT (one patient) (P = 0.03). CONCLUSION: Patients referred for ablation of paroxysmal AF should be investigated for evidence of underlying supraventricular arrhytmias. In patients with AVNRT, slow pathway ablation may be the only procedure that is necessary for cure of AF. Inducibility of atrial flutter appears to carry an increased risk of AF recurrence regardless of whether the cavotricuspid isthmus is also ablated.     

Emricasan to prevent new decompensation in patients with NASH-related decompensated cirrhosis

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Malaria control using permethrin applied to tents of nomadic Afghan refugees in northern Pakistan.

Malaria control among nomadic populations has, in the past, posed serious logistic difficulties. Presented in this article are the results of a pilot study in which permethrin was sprayed on the tents of over 26000 nomadic Afghan refugees in an area of Pakistan where seasonal malaria outbreaks occur. In this area Anopheles culicifacies and A. stephensi are the malaria vectors. Population surveys in the year of the study, before and at the end of the transmission season, showed that the increase in the Plasmodium falciparum prevalence among the Afghan nomads was on average significantly less (increase from 6.4% to 15.3%) than that among the resident Pakistani population (from 3.2% to 45.6%). Surveys at the end of the transmission season among primary schoolchildren the year before and the year of the permethrin trial showed that the P. falciparum prevalence among nomadic children decreased significantly (from 46.9% to 16.3%), whereas an increase was observed among the local Pakistani children. The results show that spraying tents with permethrin was a safe and culturally acceptable intervention for the Afghan refugees and that the findings warrant further investigation.     

Effect of NCO-700, an inhibitor of protease, on lysosomal rupture in the ischemic myocardium

The effect of NCO-700 (1), a protease inhibitor, on subcellular distribution of lysosomal enzymes was studied in the ischemic perfused rat heart. Ischemia was induced by lowering the afterload pressure of the working heart preparation. The subcellular distribution of lysosomal enzymes was estimated by the ratio of the activities of cathepsin D, beta,N-acetylglucosaminidase, and acid phosphatase in the cytoplasm to the total enzyme activities. Ischemia caused subcellular redistribution of lysosomal enzymes from the lysosomes to the cytoplasm, indicating the rupture of lysosomes. Compound 1 (1.75 x 10(-4) M) was provided for the heart 5 min before the onset of ischemia. Compound 1 appeared to inhibit the rupture of lysosomes being caused by ischemia. The mechanism by which 1 protects the myocardium against ischemic injury may involve the inhibition of lysosomal rupture in the ischemic myocardium.