Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study

BACKGROUND@#Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates.@*METHODS@#Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being.@*RESULTS@#86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (β = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (β = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (β = -0.096, 95% CI -0.176, -0.033), multiple ACEs (β = -0.338, 95% CI -0.498, -0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being.@*CONCLUSIONS@#Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems.

Effectiveness of Intravenous Immunoglobulin for Children with Severe COVID-19: A Rapid Review

BackgroundIntravenous immunoglobulin (IVIG) is usually used as supportive therapy, but the treatment of COVID-19 by IVIG is controversial. This rapid review aims to explore the clinical effectiveness and safety of IVIG in the treatment of children with severe COVID-19. MethodsWe systematically searched the literature on the use of IVIG in patients with COVID-19, Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS), including both adults and children. We assessed the risk of bias and quality of evidence and reported the main findings descriptively. ResultsA total of 1519 articles were identified by initial literature search, and finally six studies, included one randomized controlled trial (RCT), four case series and one case report involving 198 patients. One case series showed the survival of COVID-19 patients with acute respiratory distress syndrome (ARDS) was not improved by IVIG. One case report showed high-dose IVIG could improve the outcome of COVID-19 adults. Three observational studies showed inconsistent results of the effect of IVIG on SARS patients. One RCT showed that IVIG did not reduce mortality or the incidence of nosocomial infection in adults with severe SARS. The quality of evidence was between low and very low. ConclusionsThe existing evidence is insufficient to support the efficacy or safety of IVIG in the treatment of COVID-19.

Efficacy and Safety of Antibiotic Agents in Children with COVID-19: A Rapid Review

BackgroundThe aim of this review was to evaluate the efficacy and safety of antibiotic agents in children with COVID-19, as well as to introduce the present situation of antibiotics use and bacterial coinfections in COVID-19 patients. MethodsWe searched Cochrane library, Medline, Embase, Web of Science, CBM, Wanfang Data and CNKI from their inception to March 31, 2020. In addition, we searched related studies on COVID-19 published before March 31, 2020 through Google Scholar. We evaluated the risk of bias of included studies, and synthesized the results using a qualitative synthesis. ResultsSix studies met our inclusion criteria. Five studies on SARS showed an overall risk of death of 7.2% to 20.0%. One study of SARS patients who used macrolides, quinolones or beta lactamases showed that the mean duration of hospital stay was 14.2, 13.8 and 16.2 days, respectively, and their average duration of fever was 14.3, 14.0 and 16.2 days, respectively. One cohort study on MERS indicated that macrolide therapy was not associated with a significant reduction in 90-day mortality (adjusted odds ratio [OR] 0.84, 95% confidence interval [CI] 0.47-1.51, P = 0.56) and improvement in MERS-CoV RNA clearance (adjusted hazard ratio [HR] 0.88, 95% CI 0.47, -1.64], P = 0.68). According to the findings of 33 studies, the proportion of antibiotics use ranged from 19.4% to 100.0% in children and 13.2% to 100.0% in adults, despite the lack of etiological evidence. The most commonly used antibiotics in adults were quinolones, cephalosporins and macrolides and in children meropenem and linezolid. ConclusionsThe benefits of antibiotic agents for adults with SARS or MERS were questionable in the absence of bacterial coinfections. There is no evidence to support the use of antibiotic agents for children with COVID-19 in the absence of bacterial coinfection.

Clinical Characteristics of Children with COVID-19: A Rapid Review and Meta-Analysis

BackgroundMost guidelines on COVID-19 published so far include recommendations for patients regardless of age. Clinicians need a more accurate understanding of the clinical characteristics of children with COVID-19. MethodsWe searched studies reporting clinical characteristics in children with COVID-19 published until March 31, 2020. We screened the literature, extracted the data and evaluated the risk of bias and quality of evidence of the included studies. We combined some of the outcomes (symptoms) in a single-arm meta-analysis using a random-effects model. ResultsOur search retrieved 49 studies, including 25 case reports, 23 case series and one cohort study, with a total of 1667 patients. Our meta-analysis showed that most children with COVID-19 have mild symptoms. Eighty-three percent of the children were within family clusters of cases, and 19% had no symptoms. At least 7% with digestive symptoms. The main symptoms of children were fever (48%, 95% confidence interval [CI]: 39%, 56%) and cough (39%, 95% CI: 30%, 48%). The lymphocyte count was below normal level in only 15% [95% CI: 8%, 22%] of children which is different from adult patients. 66% [95% CI: 55%, 77%] of children had abnormal findings in CT imaging. ConclusionsMost children with COVID-19 have only mild symptoms, and many children are asymptomatic. Fever and cough are the most common symptoms in children. Vomiting and diarrhea were not common in children. The lymphocyte count is usually within the normal range in children.

Multilevel model for influencing factors of the selection of first diagnosed agencies among residents reporting illness within two weeks in Hubei Province / 重庆医学

Objective To explore the selection of medical unit and the major influencing factors among residents in Hubei province,to allocate reasonably the health resources and provide reference for developing medical policy.Methods With the method of multi-stage stratified cluster sampling,household survey were done.The multilevel statistical model was used to analyze the influencing factors of the first diagnosed agencies.Results The proportions of residents who chose primary medical institutions as the first diagnosed agencies were 64.5％ in urban areas and 84.3％ in rural areas,and the visiting rate decreased as the level of health care institutions increased.The selection of first diagnosed agencies among patients were related to district (city or village,OR=0.463,95％CI..0.254-0.842),age (OR=1.023,95％CI:1.010-1.036),the educational attainment (OR＞1.000),illness duration in days (OR=0.945,95％CI:0.917-0.973) and number of days in bed (OR=0.854,95 ％ CI:0.825-0.884).Conclusion The residents who chose primary medical institutions as the first diagnosed agencies took a large proportion.District,age,the educational attainment and the illness duration in days had influence on the selection of the first diagnosed agencies among residents.

Rapid Identification of Multiple Bacteria on a Microfluidic Chip / 分析化学

We developed a microfluidic device to integrate sample introduction, bacteria culturing and results reading. The identification of multiple bacteria was achieved by combining the spatial resolution of the arrayed bacteria culture chambers and the color resolution benefited from the bacteria specific chromogenic media. A set of 4 common pathogenic bacteria responsible for urinary tract infection were used as a model to test the microfluidic assay. Our results showed that the bacteria identification assay can be completed in 15 h, with a limit of detection (LOD) of bacteria density down to 10 cfu / mL. Clinical sample testing using the microchip approach showed a coincidence rate of 96. 3% as compared with the conventional method. The developed microfluidic approach is simple and rapid, thus hold the potential to serve as a powerful tool for detection of multiple bacteria.

Detection and homology analysis of virulence genes in pandrug-resistant Pseudo-monas aeruginosa / 中国感染与化疗杂志

Objective To study the prevalence and sequence homology of virulence genes exoU and exoS in 53 strains of pan-drug-resistant Pseudomonas aeruginosa .Methods The virulence genes exoU and exoS were detected by PCR.Sequence homo-logy was analyzed by BOX-PCR.Results Of the 53 clinical isolates of pandrug-resistant Pseudomonas aeruginosa ,the exoS+/exoU- genotype was identified in 40 strains,exoU+/exoS - genotype in 10 strains,exoS +/exoU+ genotype in 1 strain, and exoS-/exoU- genotype in 2 strains.BOX-PCR results showed that 41 exoS+ isolates belonged to 24 genotypes,and 11 exoU+ strains could be grouped into 7 genotypes.Conclusions The prevalence of virulence genes is high in clinical isolates of pandrug-resistant Pseudomonas aeruginosa .BOX-PCR fingerprint analysis combined with sequence homology analysis is help-ful for effective monitoring and control of hospital pandrug-resistant pseudomonas aeruginosa infection.

Clinical epidemioiogical analysis of hospital-associated pneumonia in senile patiens in Guangzhou strict / 中国基层医药

Objective To determine the distribution and antibiotic resistance of hospital - associated pneu-monia(HAP) in senile patient,and the high risk factors of HAP,pathogenic bacterium and prognosis,so as to instruct the clinic prevention and treatment. Methods Patients with age over 60 years old,who were diagnosed of HAP with confirmed pathogens. Pathogens were identified, then the antibiotic resistance was determined by Kirty-Baucer disk dif-fusion assay. High risk factors of HAP, pathogenic bacterium and prognosis were analyzed by Logistic regression analy-sis. Results The first 10th pathogens of HAP patients were pseudomonas aeruginosa( 16.1% ),staphylococcus au-reus( 14.6% ) ,klebsiella pneumonia( 10.2% ), escherichia coil (8.8%) ,staphylococcus hemolyticus (7.3%). MR-SA accounted for 90% in staphylococcus aureus. The drug resistance of pseudomonas aeruginosa to imipenem was 29.5%. The high risk factors of HAP were acute brain accident, hypoalbuminemia, tracheal intubation or mechanical ventilation, rennal failure,COPD, gastric tube, anaemia,liver disfunction,long length of stay ( all P < 0.05 ). The mor-tality of senile HAP was 29.2%. Conclusion There are high antibiotic resistance and high mortality of HAP in se-nile patients. Measures should be taken to modify the risk factors.

Surveillance of bacterial resistance and study on ?-lactamases in cefoxitin-resistant Klebsiella pneumoniae isolates / 中国医师进修杂志

Objective To investigate the resistance and ?-lactamase of cefoxitin-resistant Klebsiella pneumoniae. Methods The minimal inhibitory concentrations were determined by standard agar dilution.Isoelectric focusing was used to measure the PI(s) of an isolate,s ?-lactamase,AmpC and ESBLs activity was confirmed by a three-dimensional extract method. Results The resistant rates of 40 strains were as follows: imipenem and meropenem 0.0%,cefepime 20.6%,cefotaxime(22.5%),ceftazidime 60.0%.The most isolates were demonstrated two or more ?-lactamase bands by IEF.Of 39 strains tested,ESBLs was detected in 31(70.5%) strains and AmpC-type?-lactamase in 16(41.0%) strains by three dimensional extract test. Conclusions These cefoxitin-resistant Klebsiella pneumoniae produced two or more ?-lactamases.It is imperative for clinical microbiology laboratories to detect and research ?-lactamases,especially AmpC enzyme.

Rapid Detection of Antibiotic Resistance of Klebsiella pneumoniae by Denaturing High-performance Liquid Chromatography (DHPLc) / 中华医院感染学杂志

OBJECTIVE To type the genes of plasmid DNA in 54 clinical Klebsiella pneumoniae isolates producing extended -spectrum beta-lactamases (SHV) by denaturing high-performance liquid chromatography (DHPLc) and evaluate their sensitivity and specificity, and explore a rapid and convenient method for detecting the antibiotic resistance of K. pneumoniae. METHODS Plasmid DNA from each extended-spectrum beta-lactamase (SHV) producing strain was subjected to PCR amplification. After we performed DNA sequencing of these amplicons and identification of mutation and their genotype, DHPLc was undertaken to investigate whether its results correlate the distinctive chromatogram with each genotype. RESULTS All the strains were found abnormal elution peaks (two or three peaks) which were different from each other. The result of DNA sequencing demonstrated that all the strains had DNA mutation in comparison with SHV-1. Moreover, DHPLc could produce specific peak patterns that correlate with genotype. CONCLUSIONS The sensitivity of DHPLc is 100% in this study. And each genotype is corresponded to specific peak pattern. So we can use DHPLc technique to type the genes of plasmid DNA in K. pneumoniae and detect mutations rapidly. DHPLc not only has high accuracy , but also is a convenient and rapid technique for the detection of mutation in the bacterial genome. It has a great potential clinical value.

Antimicrobial Agents Including Cefmetazole Against Extended-spectrum Beta-lactamases-producing Enterobacteriaceae:An in vitro Susceptibility Investigation / 中华医院感染学杂志

OBJECTIVE To investigate in vitro activities of 12 antimicrobial agents including cefmetazole against extended-spectrum beta-lactamases-producing Escherichia coli(528 strains),Klebsiella pneumoniae(311 strains) and Proteus mirabilis(15 strains).METHODS They all collected from 15 teaching hospitals in China during 2005 and 2006 and included in the study.The levels of minimal inhibitory concentration(MIC) of 12 antimicrobial agents were determined by agar dilution method.WHONET 5.4 Software was used to analyze the data.RESULTS Against ESBLs-producing E.coli and ESBLs-producing K.pneumoniae,carbapenems were the most active antimicrobial agents(all 100.0% susceptible),followed by cephamycins(80.1-97.3%).Piperacillin/tazobactam(78.5-95.1%)showed a higher activity than cefoperazone/sulbactam(44.1-56.2%).The susceptible rate to ceftazidime against ESBLs-producing E.coli was remarkably higher than the other three cephalosporins,however the differences did not happen to ESBL-producing K.pneumoniae obviously.The susceptible rate to cefuroxime was below 1.6%.ESBLs-producing K.pneumoniae showed high sensitivity to carbapenems,cephamycins and ?-lactam/lactamase inhibitor combinations(all 100% susceptible),however the susceptible rates to cephalosporins were relatively lower.CONCLUSIONS Carbapenems and cephamycins remain the relatively high activity against ESBLs-producing Enterobacteriaceae.

Antimicrobial Resistance Surveillance on Hospital-and Community-acquired Pathogens in 10 Teaching Hospitals in China / 中华医院感染学杂志

OBJECTIVE To investigate the antimicrobial resistance of hospital-and community-acquired pathogens collected from 10 teaching hospitals located at different areas in China in 2006.METHODS According to the study protocol,the strains of Streptococcus pneumoniae,meticillin-susceptible Staphylococcus aureus(MSSA),Escherichia coli and Klebsiella pneumoniae were collected and sent to the central lab for reidentification and susceptibility testing.The minimal inhibitory concentrations(MICs) of antimicrobial agents against Str.pneumoniae were determined by Etest method and MICs of antimicrobial agents against S.aureus,E.coli and K.pneumoniae strains were determined by agar dilution method.WHONET5.4 software was used to analyze the data.RESULTS Among 353 Str.pneumoniae strains,74.2% were penicillin-susceptible(PSSP),9.6% were penicillin-intermediate(PISP) and 16.2% were penicillin-resistant(PRSP).Strains from different hospitals showed different sensitivity to penicillin.Among ?-lactam antibiotics,cefuroxime showed the lowest susceptibility rate of 0%(for PRSP) to 76.7%(for PSSP).The susceptibility rate to ceftriaxone and amoxicillin-clavulanic acid was 98.1% and 98.9% in PSSP group,61.8% and 64.7% in PISP group,and 15.8% and 10.5% in PRSP group.The ESBLs rate was 56.2% among 267 Escherichia strains and 42.7% among 206 K.pneumoniae strains.For ESBLs-producing strains,the susceptibility rates to cefotaxime and ceftriaxone were low and the rate to ceftazidime was relatively high among ?-lactam antibiotics.73.4% MSSA strains produced ?-lactamase.?-Lactam antibiotics tested showed high susceptibility against MSSA strains.The susceptibility rate was 98.9-100%.The susceptibility rate to ciprofloxacin and levofloxacin was 80.8% and 88.1%,separately.CONCLUSIONS Fluoroquinolones show high susceptibility against Str.pneumoniae.Ceftriaxone and amoxicillin-clavulanic acid have relatively high susceptibility among ?-lactams.For MSSA and non-ESBLs-producing E.coli and K.pneumoniae strains,?-lactams show high susceptibility.For ESBLs-producing E.coli and K.pneumoniae strains,the susceptibility rates to cefotaxime and ceftriaxone are low and that to ceftazidime,cefepime and cefoperazone-sulbactam are relatively high.

Detection of 16S rRNA methylase genes in Klebsiella pneumoniae / 临床检验杂志

Objective To investigate the prevalence of 16S rRNA methylase genes in Klebsiella pneumoniae isolates from Guangzhou.Methods K-B test was used to determine the resistant rates of these stains.Five 16S rRNA methylase genes,armA,rmtA,rmtB,rmtC,and rmtD,were detected by PCR.Results All 55 K.pneumoniae isolates showed resistant to arbekacin,gentamicin,tobramycin,and neomycin.Susceptibility rates were 5.5%,20.0%,72.7%,and 100% to ceftazidime,ciprofloxacin,piperacillin/tazobactam,and imipenem respectively.ESBLs were positive in 52 of 55 (94.5%) isolates.Among 55 K.pneumoniae isolates,34 were positive for armA and 1 for rmtB.Conclusions In K.pneumoniae resistant to arbekacin,the positive rate of 16S rRNA methylase genes was high,predominantly with armA positive.These strains were highly resistant to some antibiotics.

Resistance to Antibiotics of Clinical Isolates of Klebsiella pneumoniae Producing TEM-116 ?-Lactamases / 中华医院感染学杂志

OBJECTIVE To understand characteristics of TEM-116 ?-lactamases through comparative study on resistance to antibiotics of clinical isolates of Klebsiella pneumoniae producing TEM-116 ?-lactamases.METHODS K.pneumoniae susceptibility to ?-lactamases was determined by disk diffusion tests,and their isoelectric points(PI) were detected using analytic isoelectric focusing(IEF),and resistance to antibiotics of clinical isolates of K.pneumoniae producing TEM-116 and TEM-1?-lactamases was studied.RESULTS Both of K.pneumoniae producing TEM-116 ?-lactamases and producing TEM-1 ?-lactamases were 100% resistant to AMP,and highly resistant to the first and second generation cephalosporin,but greatly susceptible to FEP and IPM.There was greatly difference between resistance to AMC,TZP,AMK,and GEN of clinical isolates of K.pneumoniae producing TEM-116 ?-lactamases and that of K.pneumoniae producing TEM-116 ?-lactamases,the TEM-116 isolates were higher resistant than TEM-1 isolates.Analytic IEF results showed that PI of TEM-116 ?-lactamases was 5.4,and most strains of K.pneumoniae TEM-116 ?-lactamases displayed two electrophoresis bands or more,only one strain of them just displayed one band,resistant to majority of antibiotics.CONCLUSIONS The results show that K.pneumoniae producing TEM-116 ?-lactamases are more resistant to antibiotics than K.pneumoniae producing TEM-1 ?-lactamases,and indicate TEM-116 ?-lactamases work as ESBLs.