Escalamiento de antimicrobianos con la inclusión de una lista de verificación en la unidad de cuidados intensivos pediátricos / Antibiotic escalation with the inclusion of a checklist in the pediatric intensive care unit

Resumen Introducción: La vigilancia de la administración de los antimicrobianos mejora su prescripción. Objetivo: Disminuir el escalamiento en el uso de antimicrobianos a las 48 h del inicio, en la unidad de cuidados intensivos pediátricos (UCIP). Material y Métodos: Estudio de cohortes ambispectivo, realizado en una UCIP e incluyó pacientes ingresados que recibieron antibioterapia, implementando una lista de verificación del uso de antimicrobianos (checklist) en forma prospectiva, Se comparó con una cohorte histórica previa al checklist. Fueron evaluados el escalamiento de antimicrobianos a las 48 h, la consulta con infectólogos y la indicación de vancomicina .La comparación de las variables entre las dos cohortes se realizó con la prueba de χ2, el test de Fischer y la U de Mann Whitney. Los resultados principales se expresaron en RR y RAR. Estudio aprobado por el Comité de Ética institucional. Resultados: Ingresaron 70 pacientes en la etapa del checklist, y fueron comparados con 124 pacientes de la cohorte histórica. La introducción del checklist redujo el escalamiento de antimicrobianos a las 48 h, desde 56,4 a 21,4% (p < 0,0001) con una RAR de 35%; la prescripción de la vancomicina desde 64,5 a 40% (p < 0,001), RAR 24,5% e incrementó la consulta con infectólogo en 23%, (desde 9,6 a 32,8%) (p < 0,0001). No hubo diferencias en la mortalidad y duración de la antibioterapia a los 10 días. Conclusiones: El checklist permitió disminuir el escalamiento de antimicrobianos a las 48 h del inicio, la indicación de vancomicina y aumentó la consulta con infectólogos.

Abstract Background: Antibiotic surveillance improves the appropriate antibiotic therapy. Aim: To decrease the antibiotic scaling, 48 hours after starting prescription in the pediatric intensive care unit (PICU). Methods: A ambispective cohort study was performed in the PICU including patients admitted in whom antibiotic therapy was started and a checklist was applied prospectively. They were compared with a historical cohort, prior the checklist. The main outcome was the antibiotic scaling 48 hours after starting and the secondary endpoints were consultation with infectious diseases (ID) specialist and vancomycin prescription. To compare the variables between the two cohorts, the χ2 test, Fischer test and U Mann-Whitney test were used. The results of the main variables were expressed in RR and RAR. The study was approved by the institution's Ethics Committee. Results: 70 patients were admitted in the checklist cohort and they were compared with 124 patients of the historical cohort. The checklist implementation decreased the antibiotic scaling at 48 h after starting from 56.4 to 21.4% (p < 0.0001) ARR = 35% and vancomycin prescription from 64.5 to 40% (p < 0.001) ARR =24.5%. The consultation with ID specialist increased from 9.6 to 32.8% (p < 0.0001). There were no differences in mortality and duration of antibiotic therapy at 10 days of hospitalization. Conclusion: The checklist implementation decreased the antibiotic scaling,48 hs after starting and the vancomycin prescription while the ID specialist consultation increased.

Elettaria Cardamom Extract Synergistically Enhaning Sorafenib-Induced Apoptosis in HepG2 Cells

Introduction: Liver cancer is ranked as the second most common cause of death globally as a result of its poorprognosis. It can be treated with sorafenib, but its use is limited due to its toxicity and adverse reactions. Lowerdoses of sorafenib with other complementary agents are recommended to minimize toxicity. Cardamom seeds areone of the most common ingredients of Indian and Chinese traditional medicine, and different studies havesuggested that cardamom extract can display anti-cancer activities. Aim: this study aims to investigate theefficiency of Elettaria Cardamom Extract (ECE) on enhancement of Sorafenib-induced apoptosis in HepG2.Methods: Human liver cancer cell line (HepG2) were exposed to increasing concentrations of individual andcombined treatments of Sorafenib and ECE for 24 h. The viability of cells was examined using MTT Assay.Clonogenicity and cell migration assays were carried out. Reactive oxygen species (ROS) generation andmitochondrial membrane potential (MMP) level were determined by DCFH-DA and JC-1 dye, respectively.Agarose gel electrophoresis and comet examinations were carried out to estimate the DNA damage. Results:Combined treatment of ECE with sorafenib suppressed the proliferation, colony formation and cell migration ofHepG2 cells more than the sorafenib did alone. The half maximal inhibitory concentration (IC50), after 24h ofincubation were 15 µM of sorafenib and 9 and 7.3 µM of sorafenib enhanced by 5 and 10 µg / 100 µl of ECErespectively. HepG2 treated cells displayed biochemical features of apoptotic cell death. The combined treatmentincreased the ROS production, reduced the level of MMP, increased Comet tail length and induced DNAfragmentation more than sorafenib did alone. Conclusions: These findings demonstrate that ECE enhanced thesorafenib effect in HepG2 cells and suggest that the ECE may be a promising agent for reducing sorafenib sideeffects in hepatocellular carcinoma (HCC).

Evaluation of Metabolic Syndrome in Primary Health Care

Background: Metabolic syndrome includes atherogenic dyslipidemia, obesity, hypertension, hyperglycemia, andinsulin resistance. This complex of metabolic abnormalities is a risk factor for DM2, stroke, adverse cardiacevents, and hepatic necrosis. In the last few years, studies showed a significant high prevalence of this syndromeamong Saudi males. Central visceral adiposity is thought to be the primary trigger of most pathogenic eventsinvolved in the advent of the syndrome. Objectives: In this paper, our aim is to discuss metabolic syndrome, itsdefinitions, pathophysiology, diagnosis, screening, and the management done for such patients in general withspecial focus to primary healthcare. Methodology: PubMed database was used for articles selection. Conclusion:The syndrome is linked with significant impacts on the patient health; as a result, the health care providers shallbe alarmed on how to screen, diagnose and manage such disease. Prevention of childhood obesity is criticalthrough screening and early diagnosis to save major burden and prevent future complications. Thus, nowadays,the new trend is towards incorporating screening of this syndrome in primary health care centers.

Impact of chronic administration of lead and cadmium on the activity of monoamine oxidase in different CNS regions of male guinea pigs

The present study was undertaken to investigate the effect of chronic administration of lead and cadmium on the activity of monoamine oxidase [MAO] in different central nervous system regions [CNS] of male guinea pigs. Lead and cadmium was intraperitoneally injected at dose level [30 mg/kg. body weight]and[1 mg/kg.] respectively as lead acetate and cadmium chloride daily for, two, four, six and eight weeks. The activity of monoamine oxidase [MAO] was determined in the cerebral cortex, caudate putamen, thalamus, hypothalamus, superior colliculus, inferior colliculus cerebellum, pons, medulla and spinal cord in male guinea pig CNS. Lead and cadmium induced a general variable changes in the level of the membrane bound enzyme [MAO] in most CNS regions and in turn affecting both cholinergic and adrenergic neurotransmitters. These results suggest that lead and cadmium may exerts neurotoxic effect by altering certain membrane bound enzymes and may cause oxidative stress that could lead to neurodegenerative diseases

Effect of treatment with neem [azadirachta indica] compared with baycox drug on the caecum of chicken experimentally infected with eimeria tenella

The study evaluated the therapeutic efficacy of Neem herb in chicken experimentally infected with E. tenella compared to Baycox as a reference anticoccidial drug. 120 broiler chicks were enrolled, randomly divided to 4 groups, [A, B, C and D] non-infected non-treated [naive control], [B] infected with 10[4] E. tenella oocysts [infected control], [C] infected and treated with Baycox [7 mg/kg b.w. for 2 days] and [D] infected and treated with Neem leaves water extract [100 mg/kg b.w. for 9 days]. Evaluation was by clinical signs, performance data [gain weigh, food consumption oocyst shed/gram feaces [OPG]], in addition to histopathological changes in all chickens. The results revealed that chicks of GA had the best performance data compared to GB, GC and GD. In GC and GD there were a remarkable improvement in the data performance, clinical signs, gross and microscopically cecal lesions compared to GB. The efficacy of Baycox [GC] was shown to be superior to that of Neem [GD] compared to GB but an additive histopathological toxic effect besides those produced by E. tenella infection could be recorded. In contrast, Neem appeared to have a remarkable improvement on cecal integrity

Topical diclofenac versus dexamethasone after strabismus surgery: a double-blind randomized clinical trial of anti-inflammatory effect and ocular hypertensive response.

BACKGROUND: Compared to steroids non-steroidal anti-inflammatory drugs offer comparable anti-inflammatory action without ocular side-effects. AIM: To compare the anti-inflammatory effect and effect on IOP (Goldmann) of topical diclofenac 0.1% with dexamethasone 0.1% after strabismus surgery. DESIGN: Prospective, randomized, double-blind, single-center, clinical trial. MATERIALS AND METHODS: Forty-three cases of constant horizontal strabismus, qualifying for standard uniocular recession-resection surgery on two horizontal rectus muscles were randomized to either the dexamethasone or diclofenac group. They were excluded if they had previous ocular surgery, recently used anti-inflammatory drugs and had a neurological, systemic or an ocular inflammatory condition. In addition all received ciprofloxacin 0.3% four times daily. Assessment was done on the first postoperative day and at two and four weeks. The inflammatory characteristics graded from nil (0) to severe (3) were: discomfort, chemosis, injection, discharge and drop-intolerance. Their sum provided the total inflammatory score (TIS). RESULTS: Dexamethasone group (n=21) was comparable in age, gender, preoperative IOP, strabismus, anesthesia administered and baseline IOP, to diclofenac (n=22). There were no significant differences in the inflammatory characteristics and TIS. The dexamethasone group had IOP significantly higher at two weeks (95% CI 0.17 to 3.25) and four weeks (95% CI 1.09 to 4.24) compared to diclofenac group and the net change of IOP at four weeks (95% CI 0.60 to 3.14). Compared to the baseline IOP. CONCLUSION: Topical diclofenac is comparable to dexamethasone in providing anti-inflammatory and analgesic effect with the advantage of significantly lesser IOP rise and should be preferred after strabismus surgery.

Silent myocardial ischemia and cardiac autonomic neuropathy in diabetics.

OBJECTIVE: To evaluate the association of silent myocardial ischemia (SMI) with cardiac autonomic neuropathy in asymptomatic diabetic patients. MATERIAL AND METHODS: Two hundred asymptomatic patients of diabetes mellitus were assessed for evidence of cardiac autonomic neuropathy. Of these, 30 (15 males, 15 females; mean age 44.7 +/- 8.8 years) were found to have cardiac autonomic neuropathy. Thirty (30) age and sex matched diabetic patients (mean age 42.4 +/- 7.6 years) who had no evidence autonomic neuropathy were included in the study as control group. Both the groups of patients were evaluated for SMI by 24 hour ambulatory electrocardiographic (ECG) monitoring. RESULTS: Incidence of SMI was significantly higher in patients with autonomic neuropathy 12/30 (40%) compared to those without 3/30 (10%) p < 0.001. Duration of diabetes was more (13 +/- 1.59 years) in patients with autonomic neuropathy compared to the control group (8.66 +/- 1.55 years) p < 0.001. Serum cholesterol and triglyceride levels were significantly higher in patients with autonomic neuropathy in comparison to control group < 0.05 and < 0.01, respectively. There was no difference in the pattern of SMI in the two groups (p = N.S). CONCLUSION: Cardiac autonomic neuropathy predisposes patients with diabetes mellitus to SMI. Twenty four hour ambulatory ECG monitoring provides useful diagnostic information in early detection and evaluation of SMI in asymptomatic diabetic patients.

effect of sport massage at rest period on the cardiac work reperformance

The present study investigated the effect of sportmassage at rest period, after submaximal workload [800 m. running], on the cardiac work reperformance. Thirty seven college females ran 800 m. twice and got 5 minute sport massage in between 20 m rest period. Before and after running, subjects were measured. Physiological response was reduced significantly, which imply less cardiovascular requirements after sportmassage despite the same workload performed. Therefore, it was concluded that sportmassage is recommended as an effective procedure in improving cardiovascular fitness