Hand hygiene compliance and associated factors among healthcare workers in selected tertiary-care hospitals in Bangladesh.

BACKGROUND: Hand hygiene (HH) is a fundamental element of patient safety. Adherence to HH among healthcare workers (HCWs) varies greatly depending on a range of factors, including risk perceptions, institutional culture, auditing mechanisms, and availability of HH supplies. AIMS: This study aimed to evaluate HH compliance and associated factors among HCWs in selected tertiary-care hospitals in Bangladesh. METHODS: During September 2020 to May 2021, we conducted non-participatory observations at 10 tertiary-care hospitals using the WHO's '5-moments for hand hygiene tool' to record HH compliance among physicians, nurses and cleaning staff. We also performed semi-structured interviews to determine the key barriers to complying with HH. RESULTS: We observed 14,668 hand hygiene opportunities. The overall HH compliance was 25.3%, the highest among nurses (28.5%), and the lowest among cleaning staff (9.9%). HCWs in public hospitals had significantly higher odds of complying with HH practices than those in private hospitals (adjusted odds ratio: 1.73, 95% CI: 1.55-1.93). The odds of performing HH after touching a patient were 3.36 times higher compared with before touching a patient (95% CI: 2.90-3.90). The reported key barriers to performing HH were insufficient supplies (57.9%), skin reactions (26.3%), workload (26.3%) and lack of facilities (22.7%). Overall, observed HH supplies were available in 81.7% of wards for physicians and 95.1% of wards for nurses, however, no designated HH facilities were found for the cleaning staff. CONCLUSIONS: HH compliance among HCWs fell significantly short of the standard for safe patient care. Inadequate HH supplies demonstrate a lack of prioritizing, promoting and investing in infection prevention and control.

Synthesis, characterization, anti-mycobacterial activity and in silico study of new 2,5-disubstituted-1,3,4-oxadiazole derivatives.

A series of new 2,5-disubstituted-1,3,4-oxadiazole derivatives (5a-j and 6a-j) have been designed and synthesized in four-steps. Sixteen compounds among the twenty compounds are reported for the first time. The compounds were characterized and confirmed by the FTIR, 1D- and 2D-NMR and HRMS analyses, and were tested against Mycobacterium smegmatis and Mycobacterium tuberculosis H37Ra. Compound 5d was the most active against M. smegmatis with MIC value of 25 µM, and exhibited cidal activity with MBC of 68 µM, respectively. The time-kill assay showed the good killing rate at 77% with the combination of isoniazid (INH). In addition, checkboard assay confirmed the interaction of compound 5d was categorised as additive. Docking simulation has been performed to position 5d into the pantothenate synthetase active site with binding free energy value -8.6 kcal mol-1. It also occupied the same active site as that of standard native ligand with similar interactions, which clearly indicate their potential as pantothenate synthetase inhibitor.

Synthesis, characterization, anti-mycobacterial activity and in silico study of new 2,5-disubstituted-1,3,4-oxadiazole derivatives

@#A series of new 2,5-disubstituted-1,3,4-oxadiazole derivatives (5a-j and 6a-j) have been designed and synthesized in four-steps. Sixteen compounds among the twenty compounds are reported for the first time. The compounds were characterized and confirmed by the FTIR, 1D- and 2D-NMR and HRMS analyses, and were tested against Mycobacterium smegmatis and Mycobacterium tuberculosis H37Ra. Compound 5d was the most active against M. smegmatis with MIC value of 25 µM, and exhibited cidal activity with MBC of 68 µM, respectively. The time-kill assay showed the good killing rate at 77% with the combination of isoniazid (INH). In addition, checkboard assay confirmed the interaction of compound 5d was categorised as additive. Docking simulation has been performed to position 5d into the pantothenate synthetase active site with binding free energy value –8.6 kcal mol-1. It also occupied the same active site as that of standard native ligand with similar interactions, which clearly indicate their potential as pantothenate synthetase inhibitor.

Severe anti-D haemolytic disease of fetal and newborn in rhesus D negative primigravida.

INTRODUCTION: Anti-D alloimmunisation may occur from the blood transfusion or fetomaternal haemorrhage which can lead to haemolytic disease of fetal and newborn (HDFN). The morbidity and mortality of HDFN related to anti-D is significantly reduced after introduction of anti-D prophylaxis and furthermore, anti-D HDFN in RhD negative primigravida is uncommonly seen. CASE REPORT: A case of unusual severe HDFN due to anti-D alloimmunisation in undiagnosed RhD negative primigravida Malay woman is reported here. This case illustrates the possibility of an anamnestic response from previous unknown sensitisation event or the development of anti-D in mid trimester. The newborn expired due to hydrops fetalis and severe anaemia. Antenatally, the mother was identified as RhD positive and thus there was no antenatal antibody screening, antepartum anti-D prophylaxis or close fetal monitoring for HDFN. DISCUSSION: The thorough antenatal ABO and RhD blood grouping with antibody screening is mandatory as part of prevention and early detection of HDFN especially due to anti-D alloimmunisation. Improper management of RhD negative women might lead to severe HDFN including in primigravida.

Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution.

BACKGROUND: We undertook a prospective longitudinal study of patients with end-stage fecal incontinence who were undergoing transposition of the gracilis muscle as a neo-anal sphincter with external low-frequency electrical stimulation of the nerve to the gracilis combined with biofeedback. METHODS: A total of 31 patients (21 male, 10 female: median age: 22 years; range: 4-77 years) underwent this procedure for treatment of traumatic disruption (11 patients, 35%), congenital atresia (11 patients, 35%), iatrogenic injury (6-20%), and perineal sepsis (3 patients, 10%). The gracilis muscle was transposed at operation in an alpha or gamma configuration. Low-frequency (7 Hz) transcutaneous electrical stimulation commenced 2 weeks after operation and was continued for up to 12 weeks. Biofeedback therapy, which consisted of supervised neosphincter squeeze exercises, commenced simultaneously and continued for up to 28 weeks. Outcome was assessed by clinical examination, anal manometry, the Cleveland Clinic Florida continence score (CCFS), and the Rockwood quality of life scale (FIQL). Successful outcome was defined by improvement in clinical outcome, patient satisfaction, a positive result on anal manometry, and/or CCFS < 9, or FIQL > or = 4. RESULTS: At median follow-up of 67 months, overall improvement was seen in 22 (71%). Maximum resting pressure (MRP) and maximum squeeze pressure (MSP) improved significantly after operation [MRP pre versus post, mean (SD), cm water-13.8 (9.6) versus 20.9 (11.3); P = 0.01; and MSP 36.6 (22.4) versus 95.4 (71.2), P = 0.001]. In a subset of 18 patients who showed improvement after operation, the CCFS score (mean, SD) improved from 19.2 (3.4) to 5.2 (5.6); P = 0.0001. FIQL (mean, SD) showed significant improvement in all four domains in 14 patients who reported improvement since the year 2000. CONCLUSIONS: A modified dynamic gracilis neoanal sphincter for end-stage fecal incontinence helps restore and sustain continence with improvement in quality of life in the majority of patients. The procedure was most effective as augmentation in those who had suffered a traumatic injury, when compared with patients with congenital atresia and sepsis that had resulted in loss of the native anal sphincter.

Emergence of fractal behavior in condensation-driven aggregation.

We investigate the condensation-driven aggregation model that we recently proposed whereby an initial ensemble of chemically identical Brownian particles are continuously growing by condensation and at the same time undergo aggregation upon collision. We solved the model exactly by using scaling theory for the case when a particle, say of size x , grows by an amount alphax over the time it takes to collide with another particle of any size. It is shown that the particle size spectra exhibit transition to scaling c(x,t) approximately t;{-beta}varphi(xt{z}) accompanied by the emergence of a fractal of dimension d {f}=1/(1+2alpha) . A remarkable feature of this model is that it is governed by a nontrivial conservation law, namely, the d {f}th moment of c(x,t) is time invariant. The reason why it remains conserved is explained. Exact values for the exponents beta , z , and d{f} are obtained and it is shown that they obey a generalized scaling relation beta=(1+d{f})z .

Condensation-driven aggregation in one dimension.

We propose a model for aggregation where particles are continuously growing by heterogeneous condensation in one dimension, and solve it exactly. We show that the particle size spectra exhibit a transition to dynamic scaling c(x,t) approximately t-beta phi(x/tz) . The exponents beta and z satisfy a generalized scaling relation beta=(1+q)z where the value of q is fixed by a nontrivial conservation law. We show that the value of 1+q is always less than the value 2 for aggregation without condensation.

Effect of spermine on lipid profile and HDL functionality in the streptozotocin-induced diabetic rat model.

This study aimed to investigate the effect of spermine (Spm) as a chemical chaperone and glycation inhibitor on the lipid profile and HDL functionality in the short- and long-term treatment of the STZ-induced diabetic rats. Male Wistar rats were divided into 4 groups (control, n=7; diabetic, n=9). Two groups (named 2 and 3) were injected intraperitoneally with streptozotocin. Control rats (named 1 and 4) were injected with vehicle alone. The treatment of diabetic and control animals (groups 3 and 4) with 60 micromol/l of Spm in drinking water was begun. The study continued up to the end of the fifth month. The serum glucose and insulin level, AGE formation, lipid profile, paraoxonase 1 (PON1), and lecithin: cholesterol acyl transferase (LCAT) activities were measured. Significantly lower plasma PON1, and LCAT activities and higher serum AGE, TG, TC and LDL-c, and lower HDL-c were seen in diabetic rats as compared to control groups (P<0.01). The increased AGE, TG, TC and LDL-c levels in diabetic groups decreased gradually after receiving Spm. In addition, due to Spm administration, an increase in the HDL-c level was observed after the first month of the experiment (P<0.01). The increase in the PON1 and LCAT activities in the diabetic group that received Spm was significant after the second and the forth month of the experiment, P<0.02 and P<0.05, respectively. In conclusion, spermine administration attenuated the changed parameters to near normal values in diabetic rats. Spermine, despite a lack of significant changes on glucose metabolism and insulin secretion, was found to improve diabetes complications.

The improvement effect of L-Lys as a chemical chaperone on STZ-induced diabetic rats, protein structure and function.

BACKGROUND: L-Lysine (L-Lys) has been known as an inhibitor of protein glycation; however, its long-term use for diabetes treatment considering different aspects of diabetic complication is not seen in the literature. In addition, the effect of L-Lys, as a chemical chaperone, was considered on protein folding and activity. METHODS: The streptozotocin-induced diabetic rats were used as a model of diabetes. Normal and diabetic rats were studied for 5 months with and without 0.1% of L-Lys in drinking water. Serum glucose, advanced glycation end product (AGEs), haemoglobin A(1C) (HbA(1c)), triglyceride, total cholesterol, HDL-cholesterol, antioxidant activity, advanced oxidation protein products, fasting insulin level and body weight were determined at 4-week intervals. Heat shock protein (HSP)70, Lecithin: cholesterol acyl transferase (LCAT) and paraoxonase activity were determined 1 week after diabetes induction (time 0), and after 3 and 5 months. The structure of glycated and normal serum albumin (Alb) in the presence and absence of L-Lys was also investigated in an in vitro study using spectrofluorometry and circular dichroism (CD). RESULTS: We found that L-Lysine therapy prevented diabetic- induced increases in Glc, AGE, HbA(1c), triglyceride, total- and LDL- cholesterol, and it caused an increase in the decreased antioxidant capacity, HDL-c, HDL functionality and HSP70. L-Lys had no effect on serum insulin level. The conformation of Alb changed due to glycation and L-Lys retained it similar to the native. CONCLUSIONS: L-Lys, not only as an inhibitor of glycation but also as a chemical chaperone and a protein chaperone inducer, causes effective changes in many parameters of the model animals. However, it is not enough to achieve complete improvement.