Molecular characterization of nasal methicillin resistant Staphylococcus aureus isolates from workers of an automaker company in southeast Iran

Colonization of methicillin resistant Staphylococccus aureus (MRSA) can occur more commonly in healthy people who live in close together or are in close physical contact with each other. Having knowledge about the molecular characteristics of these strains provides considerable discernment into the epidemiology of this important microorganism. A total of 806 nasal swabs were collected from healthy workers of an automaker company in the southeast of Iran and were analyzed to detect MRSA isolates. Multilocus sequence typing (MLST), spa typing, and detection of staphylococcal cassette chromosome mec (SCCmec) were performed. The presence of genes encoding Panton‐Valentine Leukocidin (PVL) and Arginine Catabolic Mobile Element (ACME) were also investigated. Carriage rate of S. aureus was 20%. Among 10 identified MRSA, no acme was found while high prevalence of pvl (60%) was of great concern. Seven different spa types including five new ones were identified. The most frequent sequence type was the novel one; ST 3373 (n = 3), followed by each of ST22, ST88, ST859 (n = 2) and ST1955 (n = 1). MRSA isolates were clustered into two main clonal complexes; CC22 (n = 6) and CC88 (n = 4). Low genetic diversity with the dominance of CC22, SCCmecIV was found. Distribution of previously found hospital‐associated MRSA was demonstrated among our isolates.     

Qualitative assessment of the emotional and behavioural responses of haemophilia A carriers to negative experiences in their medical care

Summary. Previous discussions with haemophilia A (HA) carriers suggested that carriers may experience inappropriate care, resulting in poor relationships with healthcare providers (HCPs; principally physicians and nurses), and unfortunate and extreme emotional and behavioural responses. This was a qualitative study to explore medical experiences of HA carriers and their emotional and behavioural responses. Eleven HA carriers and five Haemophilia Treatment Centre nurses were interviewed. Themes were identified using QSR NVivo 8.0. Carriers and nurses reported HA‐related bleeding symptoms in carriers, including life‐threatening haemorrhage following injury or medical intervention. Menorrhagia was common and distressing. Negative carrier experiences were related in the determination of genotypic and phenotypic status, management, precautions and HCP attitude, including dismissing carriers’ symptoms, concerns or requests for care. Carriers responded with mistrust, lost confidence, disappointment, fear, anxiety, doubt of self or child, discussing experiences, avoidance of healthcare and self‐treatment. Dismissive HCP attitudes, ignorance about bleeding disorders in women and unique aspects of the carrier population appear to make errors more likely. This study indicates that carriers experience inappropriate care and encounter dismissive attitudes, and respond emotionally and behaviourally. Our model suggests that systematic medical errors aggravate a negative feedback loop leading to negative emotional and behavioural responses and worsening carrier care. Improved carrier care policies and increased awareness of women’s bleeding disorders may improve this situation. Further research is needed to determine whether the themes identified in this study accurately reflect the experiences of carriers in general.     

Preparation,characterization and biodistribution of nanostructured lipid carriers for parenteral delivery of bifendate

Nanostructured lipid carrier (NLC)-loaded bifendate (DDB) was prepared by melt-emulsification method to improve drug payloads and liver targeting. The particle size of the prepared formulation analysed by photon correlation spectroscopy (PCS) was 217.4?nm with a narrow polydispersity index (PI) lower than 0.2, meanwhile the loading capacity increased from 4.3% to 15.7% in comparison with DDB-loaded SLN reported in previous study. The zeta potential value was ?21.91?mV, and transmission electron microscopy studies revealed NLC of irregularly spherical shape. With respect to lipid polymorphism, a less ordered structure of NLC was confirmed by differential scanning calorimetry (DSC) and X-ray diffraction (XRD). In addition, tissue distribution of DDB-loaded NLC and DDB solution were carried out in Kunming strain mice. In tested organs, the distribution of DDB-loaded NLC to liver was higher than that of free drug. These results support the potential applications of NLC for the delivery of DDB.     

Physicochemical characterization and in vitro release studies of ascorbyl palmitate-loaded semi-solid nanostructured lipid carriers (NLC gels)

The aim of this study was to characterize the physicochemical properties and to study in vitro release of ascorbyl palmitate from semi-solid lipid nanoparticles based on nanostructured lipid carriers (NLC gels) systems with the desired viscosity for dermal delivery. NLC gels were obtained by a one-step production procedure employing a high pressure homogenization technique using different solid lipid matrices. Ascorbyl palmitate (AP) was selected as a lipophilic active ingredient due to its range of cosmetic applications. After the production, particles within the size range 170–250 nm having polydispersity index lower than 0.3 were obtained from all formulations. After the AP incorporation into the NLC gels, the zeta potential increased to values higher than |30 mV|. Almost 100% encapsulation efficiency was observed. The obtained SEM and AFM data revealed non-spherical shaped nanoparticles. From DSC and X-ray diffraction studies, it was shown that the lipid recrystallized in the solid state possessing a less ordered structure as compared to the bulk material. The release study of active-loaded NLC gel formulations using Franz diffusion cells revealed that the type of lipid matrix affects both the rate and the release pattern. The viscoelastic measurements revealed a more elastic than viscous behaviour of NLC formulations indicating a typical gel-like structure.     

Delivery strategies for antiparasitics

Optimisation of drug carrier systems and drug delivery strategies that take into account the peculiarities of individual infectious agents and diseases are key elements of modern drug development. In the following, different aspects of a rational design for antiparasitic drug formulation will be reviewed, covering delivery systems such as nano- and microparticles, liposomes, emulsions and microemulsions, cochleates and bioadhesive macromolecules. Functional properties for each carrier system will be discussed as well as their therapeutic efficacy for parasitic diseases, including leishmaniasis, human African trypanosomiasis, human cryptosporidiosis, malaria and schistosomiasis. Critical issues for the application of drug carrier systems will be discussed, focusing on biopharmaceutical and pathophysiological parameters such as routes of application, improvement of body distribution and targeting intracellularly persisting pathogens.     

A Meta-Analysis of Prehospital Care Times for Trauma

Background. Time to definitive care is a major determinant of trauma patient outcomes yet little is empirically known about prehospital times at the national level. We sought to determine national averages for prehospital times based on a systematic review of published literature. Methods. We performed a systematic literature search for all articles reporting prehospital times for trauma patients transported by helicopter andground ambulance over a 30-year period. Forty-nine articles were included in a final meta-analysis. Activation time, response time, on-scene time, andtransport time were abstracted from these articles. Prehospital times were also divided into urban, suburban, rural, andair transports. Statistical tests were computed using weighted arithmetic means andstandard deviations. Results. The data were drawn from 20 states in all four U.S. Census Regions andrepresent the prehospital experience of 155,179 patients. Average duration in minutes for urban, suburban, andrural ground ambulances for the total prehospital interval were 30.96, 30.97, and43.17; for the response interval were 5.25, 5.21, and7.72; for the on-scene interval were 13.40, 13.39, and14.59; andfor the transport interval were 10.77, 10.86, and17.28. Average helicopter ambulance times were response 23.25, on-scene 20.43, andtransport 29.80 minutes. Conclusions. Despite the emphasis on time in the prehospital andtrauma literature there has been no national effort to empirically define average prehospital time intervals for trauma patients. We provide points of reference for prehospital intervals so that policymakers can compare individual emergency medical systems to national norms.