ddcP, pstB, and excess D-lactate impact synergism between vancomycin and chlorhexidine against Enterococcus faecium 1,231,410

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens that cause life-threatening infections. To control hospital-associated infections, skin antisepsis and bathing utilizing chlorhexidine is recommended for VRE patients in acute care hospitals. Previously, we reported that exposure to inhibitory chlorhexidine levels induced the expression of vancomycin resistance genes in VanA-type Enterococcus faecium. However, vancomycin susceptibility actually increased for VanA-type E. faecium in the presence of chlorhexidine. Hence, a synergistic effect of the two antimicrobials was observed. In this study, we used multiple approaches to investigate the mechanism of synergism between chlorhexidine and vancomycin in the VanA-type VRE strain E. faecium 1,231,410. We generated clean deletions of 7 of 11 pbp, transpeptidase, and carboxypeptidase genes in this strain (ponA, pbpF, pbpZ, pbpA, ddcP, ldtfm, and vanY). Deletion of ddcP, encoding a membrane-bound carboxypeptidase, altered the synergism phenotype. Furthermore, using in vitro evolution, we isolated a spontaneous synergy escaper mutant and utilized whole genome sequencing to determine that a mutation in pstB, encoding an ATPase of phosphate-specific transporters, also altered synergism. Finally, addition of excess D-lactate, but not D-alanine, enhanced synergism to reduce vancomycin MIC levels. Overall, our work identified factors that alter chlorhexidine and vancomycin synergism in a model VanA-type VRE strain.

Assessment of vitamin D among Sudanese Patients with Hypothyroidism

Background: Vitamin D deficiency is a worldwide health issue and its role as an immune modulator has recently been emphasized. Evidence increasingly indicates the important role of vitamin D in reducing the incidence of autoimmune diseases. However, at this time the search for its role in autoimmune diseases and thyroid is not critical. Objectives: The study aimed to assess the relationship between vitamin D deficiency in Sudanese patients with hypothyroidism. Methods: Analytical case control hospital based study, conducted in Fadil Hospital and Police Hospital, Khartoum city, Khartoum state. The study carried out from March 2018 to September 2018. A total of 100 subjects were enrolled in the study. Vitamin D deficiency was set at levels below 20 ng / ml. Thyroid hormones (TSH, T3 and T4) were assessed in all participants using auto analyzer TOSOH AIA 313,while vitamin D was estimated using ELIZA. The data were analyzed using SPSS version (21). Results: The study included 76(76%) females and 24(24%) males, no significance differences between thyroid profile among study population.75 (75%) deficiency of vitamin D and 25(25%) normal vitamin D. vitamin D deficiency was significantly lower in female than male with( p =0.001). Conclusion: The results indicated that patients with hypothyroidism suffer from vitamin D deficiency significantly associated with the degree and severity of hypothyroidism. This encourages the desirability of vitamin D supplementation and recommends the detection of vitamin D deficiency for all hypothyroidism patients.

Abstract MP27: Telestroke Capacity and Outcomes for Patients With Stroke

Background: Telestroke is increasingly used by hospitals, but there has been limited research on its impact on treatment and outcomes. Methods: Using a 100% sample of traditional Medicare beneficiaries over a 10-year period, we compared the care patterns and outcomes of acute ischemic stroke admissions that first presented to hospitals with telestroke capacity to matched admissions in control hospitals without telestroke capacity. Matching was based on sociodemographic and clinical characteristics, hospital characteristics, and month and year of admission. Our primary outcomes were receipt of reperfusion treatment through thrombolysis with alteplase or thrombectomy, mortality at 30 days from admission, spending through 90 days from admission, and functional status as measured by days spent in community living after discharge. Results: Over the period January 2008 through June 2017, there were 87,338 ischemic stroke admissions cared for at 643 telestroke hospitals of which 76,636 (88%) were matched to an admission at a control hospital. Compared to control admissions, admissions that started in telestroke hospitals had higher rates of reperfusion treatment (6.76% and 5.98%; difference 0.78, 95% CI 0.54 to 1.03, p<.001) and lower mortality (mortality 30 days from admission was 13.12% vs 13.62%; difference 0.50, 95% CI 0.17 to 0.83, p=.003). There were no differences in functional status and spending. Increases in reperfusion treatment were largest in the lowest-volume hospitals, among rural residents, and patients age 85 years and older. Conclusions: Patients with ischemic stroke treated at hospitals with telestroke capacity were more likely to receive reperfusion treatment and had lower 30-day mortality.

Sistem Alarm Penggantian Cairan Infus Berbasis Mikrokontroler menggunakan Wireless

<p class="Abstrak">Terdapat kasus rumah sakit yang memiliki jumlah pasien yang lebih banyak daripada perawat jaga sehingga dapat menyebabkan kelalaian dalam pengontrolan sehingga menyebabkan adanya masalah pada sistem organ dikarenakan penggantian cairan infus dilakukan terlambat atau bahkan cairan infus tidak menetes akibat kesalahan alat, sehingga harus dibuat sistem notifikasi untuk pengontrolan cairan infus di rumah sakit menggunakan mikrokontroler dan terhubung secara <em>wireless</em> ke ruang perawat. Perancangan sistem alarm infus ini menggunakan photodioda dan inframerah sebagai pendeteksi ada tidaknya cairan infus yang menetes, serta untuk menghitung volume cairan infus. Sistem alarm ini akan terhubung ke sebuah <em>buzzer</em> yang terdapat di ruang jaga secara <em>wireless</em> dengan tipe nRF2401L dengan menggunakan sistem minimum arduino nano 328p. Sistem catu daya menggunakan baterai lithium yang dapat di charge melalui USB sehingga alat ini menjadi <em>portable</em> dengan bantuan modul TP4056. Alarm akan berbunyi pada dua kondisi yaitu ketika cairan tidak menetes dan ketika cairan &lt;100 mL. Hasil pengujian sistem untuk perhitungan tetesan/menit memiliki korelasi 0.9866 yang berarti korelasi sangat kuat dan linier antara nilai ukur dan nilai hitung. Sementara untuk pengujian sistem alarm berfungsi dengan baik ketika cairan tidak menetes dalam waktu 7 s alarm berbunyi dan ketika cairan &lt;100 mL alarm juga akan langsung berbunyi. Jarak efektif untuk pengiriman data melalui wireless yaitu pada jarak 4 m - 6 m.</p><p class="Abstrak"><em><strong>Abstract</strong></em></p><p class="Judul2"><em>Some hospitals that have a larger number of patients than nurse duty so as to cause negligence in controlling causing problems in the organs system due to fluid replacement is done late or even infusion fluid does not drip due to faulty tool, so we created notification system for control hospital infusion fluid using a microcontroller and wireless connected to the nurses room</em><em>. </em><em>The design of this infusion alarm system using photodioda and infrared as a detector of the presence of infusion fluids that drip, as well as to calculate the volume of intravenous fluids. This alarm system will connect to a buzzer contained in the duty space wirelessly with type nRF2401L using a minimum</em><em> system</em><em> arduino nano 328p. The power supply system uses lithium batteries that can be charged via USB so that the device becomes portable with the help of TP4056 module. The alarm will sound in two conditions when the liquid does not drip and when the liquid is &lt;100 mL. System test results for the calculation of droplets / minute has a correlation of 0.9866 which means the correlation is very strong and linear between the value of measuring and calculating value. As for testing the alarm system works well when the liquid does not drip within 7 s, alarm already sounds and when the fluid &lt;100 mL alarm will immediately sound. Effective distance for sending data via wireless which is at a distance of 4 m - 6 m.</em></p><p class="Abstrak"><em><strong><br /></strong></em></p>

A prospective hospital based study of relation between carotid artery intimal medial thickness in patients with type 1 diabetes

Background: The aim of this study was to found association between Type 1 Diabetes Mellitus and Carotid Arterial Intimal Thickness (CIMT).Methods: Study design: It was a prospective case control hospital-based study. One hundred type 1 diabetes patient between the age group 3-36 years were taken. The association between type 1 diabetes with CIMT was studied. All the measurements were standardized. 50 age and sex matched controls were taken for comparison.Results: There is positive correlation between type 1 diabetes and CIMT (p<0.0001). The correlation further extends between duration of diabetes, glycemic control, age of onset, frequency and severity of diabetic related complication with CIMT.Conclusions: Carotid atherosclerosis as measured by CIMT has definite association with type 1 diabetes.

Acute Cholecystitis and the Controversies of Treatment

Key Learning Points: 1. Acute cholecystitis is often a complication of gallstones disease 2. Most of patients with symptomatic gallstones disease are prone to further complications and cholecystectomy is indicated 3. Laparoscopic early cholecystectomy in acute cholecystitis is superior to delayed cholecystectomy in terms of symptom control, hospital stay and re-admissions, with similar morbidity and mortality and should be attempted in all cases of acute cholecystitis. Difficult cases should be managed by experienced surgeons, in advanced centers, and bail-out procedures should be attempted as per Tokyo guidelines. 4. Percutaneous cholecystostomy should only be used in patients unfit for surgery who fail to improve 5. The data available to support optimal antibiotical treatment is scarce, and local microbiology guidelines should be used.