Social cohesion among healthcare workers during COVID-19: Qualitative research in Indonesia, Nepal, and Vietnam.

Existing literature has portrayed numerous challenges that healthcare workers (HCWs) faced during the COVID-19 pandemic, such as heightened risks of transmission against the scarcity of protective equipment, burgeoning workload, and emotional distress, to name a few. However, most studies explored HCWs' experiences at the individual level rather than examining the collective responses. Exploring these experiences could reveal the social-cultural locality of the pandemic while identifying the system constraints in public health emergencies. As part of a mixed-method study on COVID-19 pandemic impacts, we analysed qualitative interview data with 129 HCWs and health-related staff to explore their experiences during the pandemic between 2020 and 2021 in Vietnam, Indonesia, and Nepal. Using Bahers' sociological framework, Community of Fate, we describe five themes reflecting the formation of a community of HCWs and the social cohesion underlying their efforts to survive hardship. The first three themes characterise the HCW community of fate, including (1) Recognition of extreme work-related danger, (2) physical and figurative closures where HCWs restrict themselves from the outside world, (3) chronic ordeals with overwhelming workload and responsibilities, encompassing recurrent mental health challenges. Against such extreme hardship, cohesive bonding and social resilience are reflected through two additional themes: (4) a mutual sense of moral and professional duty to protect communities, (5) the vertical and horizontal convergence among HCWs across levels and among government departments. We discuss these HCWs' challenges in relation to systemic vulnerabilities while advocating for increasing investment in public health and collaboration across government sectors to prepare for emergency situations.

Exploring the Mechanism of Subjective Social Status on Compulsive Shopping Behavior: A Moderated Mediation Model of Self-compassion and Depression.

The present study aimed to explore the mediating role of depression in the relationship between subjective social status (SSS) and compulsive shopping behavior (CSB) and whether self-compassion (SC) played a moderating role in this model. The study was designed based on the cross-sectional method. The final sample includes 664 Vietnamese adults (Mage = 21.95, SD = 5.681 years). Participants completed an online survey, including questionnaires about SSS, CSB, depression, SC, and basic demographic information. First, the study results showed that SSS did not directly affect CSB (p > .05, 95% CI includes zero). Second, a mediating role of depression and a moderating role of SC in the research model was discovered (p < .001, 95% CI does not contain zero). Results indicated that individuals with a higher SSS experienced lower depression. Moreover, during a depressive episode, having a higher level of SC increases CSB. The study highlighted meaningful recommendations to promote consumers' mental health and healthy shopping behaviors.

Determinants of Frailty among Patients with Type 2 Diabetes In Urban Hospital.

Objectives: Frailty and diabetes are on the rise due to the aging population. This study was conducted to examine frailty conditions among patients with Type 2 diabetes (T2DM) in Hanoi, Vietnam, as well as determine its associated factors. Methods: A cross-sectional study on T2DM patients at an urban hospital. This study assessed the frailty status using the FRAIL questionnaire. Socio-demographic, clinical, and paraclinical characteristics were obtained. Multivariate regression models were performed to detect factors associated with frailty. Results: Of 379 patients, the FRAIL scale results showed that 8/379 patients were at the frailty level (2.1%), and 33/379 patients were at the pre-frailty level (8.7%). Patients who had above high school education and were retired were at lower risk of pre-frailty/frailty than those with high school education or below, and self-employed, respectively. Conversely, patients with a higher number of comorbidities were more likely to develop pre-frailty and frailty. Conclusion: This study showed a low prevalence of pre-frailty and frailty among T2DM patients. It is necessary to manage diabetes carefully and strictly control the comorbidities in this population. Interventions should focus on higher risk populations, such as those with low education levels and self-employment.

Feasibility, acceptability, and bacterial recovery for community-based sample collection to estimate antibiotic resistance in commensal gut and upper respiratory tract bacteria.

Vietnam has high rates of antibiotic use and resistance. Measuring resistance in commensal bacteria could provide an objective indicator for evaluating the impact of interventions to reduce antibiotic use and resistance. This study aimed to evaluate the feasibility, acceptability, and bacterial recovery for different sampling strategies. We conducted a cross-sectional mixed methods study in a rural community in Ha Nam Province, northern Vietnam, and collected structured interviews, samples, and in-depth interviews from households. Out of 389 households invited, 324 participated (83%), representing 1502 individuals. Samples were collected from these individuals (1498 stool, 1002 self-administered nasal swabs, and 496 HW-administered nasopharyngeal swabs). Pneumococci were recovered from 11.1% (128/1149) of the total population and 26.2% (48/183) of those under 5-years. Recovery was higher for health-worker (HW)-administered swabs (13.7%, 48/350) than self-administered swabs (10.0%, 80/799) (OR 2.06, 95% CI 1.07-3.96). Cost per swab was cheaper for self-administered ($7.26) than HW-administered ($8.63) swabs, but the overall cost for 100 positive samples was higher ($7260 and $6300 respectively). Qualitative interviews revealed that HW-administered nasopharyngeal swabs took longer to collect, caused more discomfort, and were more difficult to take from children. Factors affecting participation included sense of contribution, perceived trade-offs between benefits and effort, and peer influence. Reluctance was related to stool sampling and negative perceptions of research. This study provides important evidence for planning community-based carriage studies, including cost, logistics, and acceptability. Self-administered swabs had lower recovery, and though cheaper and quicker, this would translate to higher costs for large population-based studies. Recovery might be improved by swab-type, transport medium, and better cold-chain to lab.

Texture-Modified Diets Need to be Improved in Vietnamese Hospitals.

Purpose : The aim of this study is to compare the nutritional status of older adult inpatients consuming Texture-Modified Diets (TMD) to older adult inpatients consuming a regular diet. Methods : The study was designed as cross-sectional and was conducted in three large hospitals in northern Vietnam. The data for 344 older adult inpatients were collected in 2021 by dietitians. Results : The result showed 104 subjects were prescribed TMD. The textures of hospital diets have still not been adequately developed. In particular, the hospitals had not yet developed pureed meals. All older adult inpatients (74.7 ±â€…6.8 years old, 52.9% female) had 28.8% malnutrition by the GLIM criteria. The TMD group had a malnutrition prevalence two times higher than the regular diet group. Total energy intake from hospital meal and outside snacks in the regular diet group was higher than in the TMD group, about 150 kcal. Although energy provided from the hospital diet in both groups was similar, hospital meal wastage in the TMD group was higher than in the regular diet group. Conclusion : The older adult inpatients on TMD may have a nutritional status worse than those consuming a regular diet. Hospital diets need to be improved in texture and quality. J. Med. Invest. 69 : 230-236, August, 2022.

Validity testing of the conspiratorial thinking and anti-expert sentiment scales during the COVID-19 pandemic across 24 languages from a large-scale global dataset.

In this study, we tested the validity across two scales addressing conspiratorial thinking that may influence behaviours related to public health and the COVID-19 pandemic. Using the COVIDiSTRESSII Global Survey data from 12 261 participants, we validated the 4-item Conspiratorial Thinking Scale and 3-item Anti-Expert Sentiment Scale across 24 languages and dialects that were used by at least 100 participants per language. We employed confirmatory factor analysis, measurement invariance test and measurement alignment for internal consistency testing. To test convergent validity of the two scales, we assessed correlations with trust in seven agents related to government, science and public health. Although scalar invariance was not achieved when measurement invariance test was conducted initially, we found that both scales can be employed in further international studies with measurement alignment. Moreover, both conspiratorial thinking and anti-expert sentiments were significantly and negatively correlated with trust in all agents. Findings from this study provide supporting evidence for the validity of both scales across 24 languages for future large-scale international research.

Challenges and Lessons Learned in the Development of a Participatory Learning and Action Intervention to Tackle Antibiotic Resistance: Experiences From Northern Vietnam.

Antibiotic use in the community for humans and animals is high in Vietnam, driven by easy access to over-the counter medicines and poor understanding of the role of antibiotics. This has contributed to antibiotic resistance levels that are amongst the highest in the world. To address this problem, we developed a participatory learning and action (PLA) intervention. Here we describe challenges and lessons learned while developing and testing this intervention in preparation for a large-scale One Health trial in northern Vietnam. We tested the PLA approach using community-led photography, and then reflected on how this approach worked in practice. We reviewed and discussed implementation documentation and developed and refined themes. Five main themes were identified related to challenges and lessons learned: understanding the local context, stakeholder relationship development, participant recruitment, building trust and motivation, and engagement with the topic of antibiotics and antimicrobial resistance (AMR). Partnerships with national and local authorities provided an important foundation for building relationships with communities, and enhanced visibility and credibility of activities. Partnership development required managing relationships, clarifying roles, and accommodating different management styles. When recruiting participants, we had to balance preferences for top-down and bottom-up approaches. Building trust and motivation took time and was challenged by limited study team presence in the community. Open discussions around expectations and appropriate incentives were re-visited throughout the process. Financial incentives provided initial motivation to participate, while less tangible benefits like collective knowledge, social connections, desire to help the community, and new skills, sustained longer-term motivation. Lack of awareness and perceived importance of the problem of AMR, affected initial motivation. Developing mutual understanding through use of common and simplified language helped when discussing the complexities of this topic. A sense of ownership emerged as the study progressed and participants understood more about AMR, how it related to their own concerns, and incorporated their own ideas into activities. PLA can be a powerful way of stimulating community action and bringing people together to tackle a common problem. Understanding the nuances of local power structures, and allowing time for stakeholder relationship development and consensus-building are important considerations when designing engagement projects.

Malnutrition is associated with dysphagia in Vietnamese older adult inpatients.

BACKGROUND AND OBJECTIVES: The number of older adults is increasing rapidly in Vietnam. They suffer from various health problems, including malnutrition and dysphagia. By using a simple screening questionnaire such as the Mini Nutritional Assessment - Short Form (MNA-SF) and 10-item Eating Assessment Tool (EAT-10), nutritional and dysphagic status were screened in this study. The study aimed to determine the prevalence of and relationship between malnutrition and dysphagia in Vietnamese older adult inpatients. METHODS AND STUDY DESIGN: The study was designed as a cross-sectional study and conducted in three large hospitals in northern Vietnam. The data about nutritional status and dysphagia status of 1007 older inpatients were collected by dietitians. RESULTS: There were 71.6% of subjects at malnourished (MNA-SF score <8) and risk of malnutrition (MNA-SF score: 8-11). The prevalence of dysphagia by EAT-10 was 24.6%. The risk of dysphagia was independently associated with higher risk of malnutrition, with an odds ratio of 3.21 (95% CI: 1.93-5.31, p<0.001). In addition, malnutrition was also an independent predictor for risk of dysphagia, with an odds ratio of 3.09 (95% CI: 1.84- 5.17, p<0.001). CONCLUSIONS: Malnutrition and dysphagia prevalence were high; and malnutrition and dysphagia have a strong relationship among older adult inpatients in Vietnam. Therefore, nutritional and dysphagia screening at hospital admission are very important and recommended.

Decreasing Salt in Hospital Meals Reduced Energy Intake in Elderly Japanese Inpatients.

Japanese salt consumption is high, about 10 g salt/d. Low salt intake reduces the risk of hypertension and cardiovascular disease. However, saltiness is an important taste in daily meals, greatly influencing eating habits. When hospital admission is short-term, reducing salt supply may have an adverse effect on food intake. The aim of this study is to find the effect of sudden change in dietary salt content on energy intake in elderly Japanese inpatients. The study is an observational study of 83 patients and was conducted in a hospital in Tokyo, Japan. The research period was three weeks, and included 8 g salt/d meals for the 1st week, 7 g salt/d meals for the 2nd week, and 7 g salt/d meals with total 1 g/d salt packs that patients were allowed to use freely for the 3rd week. The energy supply satisfied the individuals' energy requirements and was the same throughout the three weeks. Nutrition surveys and blood pressure measurements during the three weeks were conducted by dietitians and nurses, respectively. The results showed that energy intake of patients was reduced by about 90 kcal/d in the 2nd week compared with the 1st week and increased about 130 kcal/d in the 3rd week compared with the 2nd week. Blood pressure did not change during the research period. When high salt intake has become a habit, reducing salt supply suddenly in a short time period may lead to decreased energy intake in elderly inpatients but does not affect blood pressure.

Stress and worry in the 2020 coronavirus pandemic: relationships to trust and compliance with preventive measures across 48 countries in the COVIDiSTRESS global survey.

The COVIDiSTRESS global survey collects data on early human responses to the 2020 COVID-19 pandemic from 173 429 respondents in 48 countries. The open science study was co-designed by an international consortium of researchers to investigate how psychological responses differ across countries and cultures, and how this has impacted behaviour, coping and trust in government efforts to slow the spread of the virus. Starting in March 2020, COVIDiSTRESS leveraged the convenience of unpaid online recruitment to generate public data. The objective of the present analysis is to understand relationships between psychological responses in the early months of global coronavirus restrictions and help understand how different government measures succeed or fail in changing public behaviour. There were variations between and within countries. Although Western Europeans registered as more concerned over COVID-19, more stressed, and having slightly more trust in the governments' efforts, there was no clear geographical pattern in compliance with behavioural measures. Detailed plots illustrating between-countries differences are provided. Using both traditional and Bayesian analyses, we found that individuals who worried about getting sick worked harder to protect themselves and others. However, concern about the coronavirus itself did not account for all of the variances in experienced stress during the early months of COVID-19 restrictions. More alarmingly, such stress was associated with less compliance. Further, those most concerned over the coronavirus trusted in government measures primarily where policies were strict. While concern over a disease is a source of mental distress, other factors including strictness of protective measures, social support and personal lockdown conditions must also be taken into consideration to fully appreciate the psychological impact of COVID-19 and to understand why some people fail to follow behavioural guidelines intended to protect themselves and others from infection. The Stage 1 manuscript associated with this submission received in-principle acceptance (IPA) on 18 May 2020. Following IPA, the accepted Stage 1 version of the manuscript was preregistered on the Open Science Framework at https://osf.io/g2t3b. This preregistration was performed prior to data analysis.

Nutritional Status and Feeding Practice among Dysphagic Older Adult Inpatients in Vietnam.

The Vietnamese older adult population has increased rapidly on an annual basis and dysphagia has become a common issue. The nutritional status of older adults in general and of dysphagic older adults in particular has not received adequate attention. The automatic solution for cases of serious choking/aspiration is still a prescription for tube feeding. In developed countries, oral intake is a priority alternative for dysphagia and has positive consequences. This study aimed to investigate the nutritional status of and feeding practices for dysphagic older adult inpatients in some Vietnamese hospitals. The study was designed as a cross-sectional study and was conducted in three large hospitals in northern Vietnam. The data for 1007 older inpatients (58.3% were females, mean age was 75.5±7.3 y) about their dysphagic status, nutritional status and feeding practices were collected by dietitians. About 29% of the older adult inpatients suffered from malnutrition and 54% had a risk of malnutrition. Half of the dysphagia group had malnutrition and 42% were at risk of malnutrition. About 78% of the dysphagic older adults had oral intake of soft foods/regular foods and the remainder had tube feeding. Almost all dysphagic patients had reduced food intake over the prior 3 mo. The rate of pneumonia was quite high among dysphagic patients. The nutritional status of Vietnamese older adult inpatients in general and of dysphagic older adults specifically was poor. Oral intake of a texture-modified diet should be a method with priority over tube feeding or soft foods/regular foods for dysphagic patients.

Anti-cancer Effect of Xao Tam Phan Paramignya trimera Methanol Root Extract on Human Breast Cancer Cell Line MCF-7 in 3D Model.

BACKGROUND: Cancer is one of the leading causes of death in the world. A great deal of effort has been made to discover new agents for cancer treatment. Xao tam phan (Paramignya trimera) is a traditional medicine of Vietnam used in cancer treatment for a long time, yet there is not much scientific evidence proving its anticancer potency. The study aimed to evaluate the toxicity of Paramignya trimera extract (PTE) on multicellular tumor spheres (MCTS) of MCF-7 cells using hanging drop technique. METHODS: Firstly, MCF-7 cells were seeded on hanging drop plates, spheroid size was tracked, and growth curve was measured by MTT assay and AlamarBlue® assay. The necrotic core of MCTS was evaluated by propidium iodide (PI) staining. Toxicity of doxorubicin (DOX) and tirapazamine (TPZ) was then tested on 3D model compared to 2D culture condition. RESULTS: The results showed that the IC50 of DOX on 3D MCF-7 cells was nearly 50 times greater than monolayer MCF-7 cells. In contrast, TPZ (an agent which is specifically toxic under hypoxic conditions) had significantly lower IC50 in 3D condition than in 2D. The toxicity tests for PTE showed that PTE strongly inhibited MCF-7 cells in both 2D and 3D conditions. Interestingly, the IC50 of PTE in 3D model was remarkably lower than in 2D (IC50 value was 168.9 ± 11.65 µg/ml compared to 260.8 ± 16.54 µg/ml, respectively). The invasion assay showed that PTE completely inhibited invasion of MCF-7 cells at 250 µg/mL concentration. Also, flow cytometry results indicated that PTE effectively induced apoptosis in MCF-7 spheroids in 3D condition at 250 µg/mL concentration. CONCLUSION: The results from this study emphasize the promise of PTE in cancer therapy.

Okara Improved Blood Glucose Level in Vietnamese with Type 2 Diabetes Mellitus.

Diabetes mellitus (DM) has been increasing rapidly in Vietnam. We hypothesized that the main reason may be low fiber intake. Regarding sources, fiber comes mainly from vegetables. However, vegetables popular in Vietnam have low fiber (<2 g fiber/100 g vegetable), so it is difficult to supply sufficient fiber only from vegetables. Therefore, in this study we tried to increase fiber intake a day by using 60 g of Okara foods, containing about 6 g of fiber per day, and assess the effects on the blood glucose levels of DM patients. We contacted 300 type 2 DM outpatients at a hospital and selected 60 of them. We formed 30 pairs matched by gender, age, BMI and years with DM and divided them randomly into an intervention group and a control group. The intervention group consumed about 6 g of fiber from Okara per day for 2 wk. At the baseline and final periods, anthropometric measurements, blood withdrawal and a 3-d weighing method nutrition survey were conducted. Dietary fiber intake increased from 6.9 to 12.6 g (p<0.01) in the intervention group, but there was no change in the control group. Fasting blood glucose and fructosamine in the intervention group dropped from 6.3 to 5.4 mmol/L (p<0.05) and from 319 to 301 µmol/L (p<0.05), respectively but they remained unchanged in the control group. Vietnamese people consumed about 60 g of Okara per day from various menus and increased fiber intake to 6 g/d in 2 wk, which improved blood glucose in DM patients.

The effect of rat strain and stress exposure on performance in touchscreen tasks.

Patients suffering from depression-associated cognitive impairments often recover incompletely after remission from the core symptoms of depression (lack of energy, depressed mood and anhedonia). This study aimed to set the basis for clinically relevant testing of cognitive impairments in a preclinical model of depression. Hence, we used the chronic mild stress (CMS) model of depression, which provokes the core symptom of anhedonia in a fraction of the stress exposed animals, while others remain resilient, and assessed the entire CMS groups' cognitive performance on the touchscreen operant platform. Specifically, we applied the pairwise discrimination (PD) and reversal task including a retention phase on Wistar and Long Evans controls and CMS exposed Long Evans rats. We observed differences between the albino Wistar and the pigmented Long Evans strain regarding performance in the PD and reversal task as well as in memory consolidation. CMS exposure did not alter learning and memory in the PD and reversal task, even though it altered affective behaviours in the elevated plus-maze and open field test. This is likely due to the heterogeneity of the CMS group, in which stress exposure elicited the expected range of phenotypes from anhedonic-like to resilient shown with the sucrose consumption test. Thus, our study suggests that pigmented rat strains, such as Long Evans, are superior to albino rats in the vision-based touchscreen studies. Furthermore, we propose investigation of the CMS subgroups in more complex, hippocampus-dependent tasks to refine a translational preclinical model of depression-induced cognitive impairments. Hence, this study increased awareness of strain-specific differences in touchscreen performance and added to the literature regarding the sensitivity of the PD and reversal task to stress-induced cognitive alterations.

Neuronal substrates underlying stress resilience and susceptibility in rats.

BACKGROUND: Stress and stressful life events have repeatedly been shown as causally related to depression. The Chronic Mild Stress rat model is a valid model of stress-induced depression. Like humans, rats display great heterogeneity in their response to stress and adversity. Hence some individuals are stress-sensitive and prone to develop depression-like behaviour in response to modest stressors, while others are stress-resilient and remain essentially symptom free. OBJECTIVES: Compared to the large body of research, which describes stress-induced maladaptive neurobiological changes, relatively little attention has been devoted to understand resiliency to stress. The aim of the present study was to identify changes in neuronal activity, associated with stress-resilient and stress-susceptible chronic mild stress endophenotypes, by examining c-Fos expression in 13 different brain areas. Changes in c-Fos expression have been reported as associated to stressful conditions. METHODS: Stress-induced modulation of neuronal activation patterns in response to the chronic mild stress paradigm was mapped using the immediate early gene expression c-Fos as a marker. Quantification of the c-Fos-like immunoreactivity responses was done by semi-automated profile counting procedures and design-based stereology. RESULTS: Exposure to chronic mild stress significantly altered c-Fos expression in a total of 6 out of 13 investigated areas. Chronic mild stress was found to suppress the c-Fos response within the magnocellular ventral lateral geniculate nucleus of both stress subgroups. In the the lateral and ventral orbital cortices of stress-resilient rats, the c-Fos like immunoreactivity response was also repressed by stress exposure. On the contrary the c-Fos response within the amygdala, medial habenula, and infralimbic cortex was increased selectively for the stress-susceptible rats. CONCLUSIONS: The study was initiated to characterize neuronal substrates associated with stress-coping mechanisms. Six areas, all of which represents limbic structures, were found to be sensitive to stress exposure. The effects within these areas associate to the hedonic status of the rats. Hence, these areas might be associated to stress-coping mechanisms underlying the chronic mild stress induced segregation into stress-susceptible and stress-resilient endophenotypes.

The touchscreen operant platform for assessing cognitive functions in a rat model of depression.

In the present study we assessed alterations in cognitive functions in a chronic mild stress (CMS) rat model of depression. Cognitive functions were assessed in two different tasks applying the translational operant platform touchscreen technology; the visual discrimination/acquisition task was used to assess the ability to perceive and distinguish visual stimuli and to assess associative stimulus-reward learning. The visual discrimination/reversal learning task was used to assess functional brain plasticity or reprogramming of previously acquired stimulus-reward associations. These tasks permit the dissociation of multiple cognitive domains. The CMS model is a validated depression model with the useful feature that rats upon stress exposure show a graduated, individual stress response allowing the segregation of rats into different phenotypes including stress-resilient and anhedonic-like subgroups. Anhedonic-like rats are less likely to acquire the pairwise discrimination task, and they have a slower acquisition rate than controls. In the reversal learning task, resilient rats performed significantly better than anhedonic-like rats over time and 50% passed criterion as opposed to 25% for controls and only 14% for anhedonic-like rats. This indicates that resilient rats have higher cognitive flexibility than anhedonic-like rats. Thus they perform better in learning a novel task, which at the same time potentially implies an increased ability to inhibit previously rewarded behavior.

Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units.

BACKGROUND: Vietnam is a lower middle-income country with no national surveillance system for hospital-acquired infections (HAIs). We assessed the prevalence of hospital-acquired infections and antimicrobial use in adult intensive care units (ICUs) across Vietnam. METHODS: Monthly repeated point prevalence surveys were systematically conducted to assess HAI prevalence and antimicrobial use in 15 adult ICUs across Vietnam. Adults admitted to participating ICUs before 08:00 a.m. on the survey day were included. RESULTS: Among 3287 patients enrolled, the HAI prevalence was 29.5% (965/3266 patients, 21 missing). Pneumonia accounted for 79.4% (804/1012) of HAIs Most HAIs (84.5% [855/1012]) were acquired in the survey hospital with 42.5% (363/855) acquired prior to ICU admission and 57.5% (492/855) developed during ICU admission. In multivariate analysis, the strongest risk factors for HAI acquired in ICU were: intubation (OR 2.76), urinary catheter (OR 2.12), no involvement of a family member in patient care (OR 1.94), and surgery after admission (OR 1.66). 726 bacterial isolates were cultured from 622/1012 HAIs, most frequently Acinetobacter baumannii (177/726 [24.4%]), Pseudomonas aeruginosa (100/726 [13.8%]), and Klebsiella pneumoniae (84/726 [11.6%]), with carbapenem resistance rates of 89.2%, 55.7%, and 14.9% respectively. Antimicrobials were prescribed for 84.8% (2787/3287) patients, with 73.7% of patients receiving two or more. The most common antimicrobial groups were third generation cephalosporins, fluoroquinolones, and carbapenems (20.1%, 19.4%, and 14.1% of total antimicrobials, respectively). CONCLUSION: A high prevalence of HAIs was observed, mainly caused by Gram-negative bacteria with high carbapenem resistance rates. This in combination with a high rate of antimicrobial use illustrates the urgent need to improve rational antimicrobial use and infection control efforts.

Metallic gold beads in hyaluronic acid: a novel form of gold-based immunosuppression? Investigations of the immunosuppressive effects of metallic gold on cultured J774 macrophages and on neuronal gene expression in experimental autoimmune encephalomyelitis.

Multiple sclerosis (MS) is a neurodegenerative disease caused by recurring attacks of neuroinflammation leading to neuronal death. Immune-suppressing gold salts are used for treating connective tissue diseases; however, side effects occur from systemic spread of gold ions. This is limited by exploiting macrophage-induced liberation of gold ions (dissolucytosis) from gold surfaces. Injecting gold beads in hyaluronic acid (HA) as a vehicle into the cavities of the brain can delay clinical signs of disease progression in the MS model, experimental autoimmune encephalitis (EAE). This study investigates the anti-inflammatory properties of metallic gold/HA on the gene expression of tumor necrosis factor (Tnf-α), Interleukin (Il)-1ß, Il-6, Il-10, Colony-stimulating factor (Csf)-v2, Metallothionein (Mt)-1/2, Bcl-2 associated X protein (Bax) and B cell lymphoma (Bcl)-2 in cultured J774 macrophages and in rodents with early stages of EAE. Cells grew for 5 days on gold/HA or HA, then receiving 1,000 ng/mL lipopolysaccharide (LPS) as inflammatory challenge. In the EAE experiment, 12 Lewis rats received gold injections and control groups included 11 untreated and 12 HA-treated EAE rats and five healthy animals. The experiment terminated day 9 when the first ten animals showed signs of EAE, only one of which were gold-treated (1p = 0.0367). Gene expression in the macrophages showed a statistically significant decrease in Il-6, Il-1ß and Il-10-response to LPS; interestingly HA induced a statistically significant increase of Il-10. In the EAE model gene expression of inflammatory cytokines increased markedly. Compared to EAE controls levels of Tnf-α, Il-1ß, Il-10, Il-6, IL-2, Ifn-γ, Il-17, transforming growth factor (Tgf)-ß, superoxide dismutase (Sod)-2, Mt-2 and fibroblast growth factor (Fgf)-2 were lower in the gold-treated group. HA-treated animals expressed similar or intermediate levels. Omnibus testing for reduced inflammatory response following gold-treatment was not significant, but tendencies towards a decrease in the Sod-2, Fgf-2, Il-1ß response and a higher Bdnf and IL-23 gene expression were seen. In conclusion, our findings support that bio-liberation of gold from metallic gold surfaces have anti-inflammatory properties similar to classic gold compounds, warranting further studies into the pharmacological potential of this novel gold-treatment and the possible synergistic effects of hyaluronic acid.