Bacterial Spectrum and Antimicrobial Profile of Pediatric Blood Stream Infection at a Tertiary Care Hospital in Pakistan

Objectives Blood stream infections(BSIs)are the main cause of morbidity and mortality in children worldwide.The present study was carried out to determine the prevalence of BSI with a focus on the identification of the causative agent of BSI,and to further evaluate the antibiotic susceptibility profile of the causing bacterial pathogens.Methods A cross-section study was carried out at the tertiary care hospital in Peshawar,Pakistan from January to December,2018.Blood samples were collected in BACTEC™botdes and standard microbiological protocols were applied for the isolation and identification of bacterial strains.The antibiotic susceptibility tests were performed using disc diffusion method as per the 2014 guideline of Clinical Laboratory Standard Institute(CLSI).Results Of 567 blood cultures in total,111(19.6%)were positive for BSI.Male children were 64%(71/111)and female children were 36%(40/111).For the causative predominant group of microorganisms,Gramnegative bacteria were identified in 79(71.1%)isolates,and Gram-positive bacteria in 32(28.9%)isolates.The common bacteria of isolates were S.typhi(n=35,31.5%),E.coli(n=19,17.1%),S.aureus(n=18,16.2%),K.pneumonia(n=12,10.8%),and Enterococcus species(n=7,6.3%).The 36.7%(29/79)isolates of Gram-negative bacteria were ESBL producers,and 61.1%(11/18)of S.aureus isolates were methicillin resistant.Overall,72.9%isolates were multidrug resistant.Conclusions Gram-negative bacteria were the main cause of pediatric BSIs,where the predominant microorganism was S.卯hi.Remarkably,majority of the S.typhi isolates were resistant to ciprofloxacin.

Investigation of the Clinical Diagnostic Significance of the T-Cell Test for Tuberculosis combined with Erythrocyte Sedimentation Test in Pulmonary Tuberculosis

Objective:To investigate the clinical diagnostic significance of peripheral blood T-cell test(T-spot test)for tuberculosis(TB)infection combined with erythrocyte sedimentation rate(ESR)in pulmonary TB.Methods:41 patients with a clinical diagnosis of TB during hospitalization from January 2020 to April 2023 in our hospital were selected as the experimental group,and 45 patients without TB(bronchopneumonia patients)were selected as the control group.The diagnostic specificity,sensitivity,and accuracy of the T-spot TB test,ESR test,and the combined test of the two were calculated respectively.Results:The sensitivity,specificity,and accuracy of the T-spot TB test combined with ESR for the diagnosis of TB in the experimental group were significantly higher than the individual results of the T-spot TB test and ESR test alone(P<0.05).Conclusion:The T-spot TB test combined with the ESR test for TB diagnosis has greater clinical value than carrying out the tests individually.

Involvement of TLR2-My D88 in Abnormal Expression of mi R-146a in Peripheral Blood Monocytes of Patients with Chronic Hepatitis C

miR-146 a is an immunoregulatory micro RNA closely associated with viral infection. This study investigated the expression changes of mi R-146 a in peripheral blood monocytes of HCV-infected patients and the mechanism by which the THP-1 cells were stimulated with HCV core protein in vitro. It was found that in the peripheral blood monocytes of HCV-infected patients, mi R-146 a expression was upregulated. After treated by interferon/ribavirin, mi R-146 a expression was decreased when HCV RNA became undetectable. HCV core could directly stimulate THP-1 cells to produce mi R-146 a. Silencing TLR2 and My D88 could significantly inhibit the expression of mi R-146 a. It was concluded that the expression of mi R-146 a in peripheral blood monocytes of HCV-infected patients was abnormally increased. The TLR2-My D88 signaling pathway may take part in the overexpression of mi R-146 a in monocytes stimulated with HCV core protein.

The Slippery Slope of Sepsis

Mortality, morbidity, early recognition, and treatment of sepsis remain a diagnostic dilemma for clinicians, in addition, the timely diagnosis of sepsis represents an ongoing clinical challenge. This review looks at the challenges of early recognition, the scope of the problem, the immunologic basis of the sepsis cascade, new frontiers related to interventions, and the role of antibiotics in an era of antimicrobial resistance. In Figure 1, once a patient is on the slippery slope of sepsis, the ability to reverse the momentum is challenging;hoping antibiotics, fluid resuscitation, vasopressors may buy time for the immunologic cascade to equilibrate to its homeostatic balance. While the development of septic shock is much more complex than pathogen proliferation, our understanding of the pathogenesis and ability to therapeutically intervene is in its infancy. Patients with sepsis frequently present for urgent medical care with undifferentiated infection and nonspecific symptoms. As 80% of patients with sepsis are initially treated in an Emergency Department, the burden of early recognition and intervention falls squarely on the shoulders of Emergency Department Clinicians. [1] This is an entity that occurs in all age groups, without regard to race, geography, or health status. Survival and mortality related to this clinical entity are poorly understood. Our understanding of sepsis needs to expand beyond the downstream effects and collateral damage of multiorgan dysfunction and failure. Immunologically, the antigenic triggers, be it invasive infection, severe injury, and systemic inflammation without concomitant infection, elicit similar pattern recognition receptors and innate host responses. If you are lucky enough to have survived an acute episode of sepsis, patients with sepsis often develop new adverse sequelae after treatment, a concept called persistent critical illness or post sepsis syndrome, characterized by long-term disability, and worsening chronic health conditions requiring re-hospitalization. [2]

Fatal hemolysis due to clostridium perfrigens blood stream infection

Here we reported a 59-year-old woman with diabetes who was found to have massive hemolysis associatedwith clostridium （C.） perfringens blood stream infection. She died 13 hours after admission in spite of aggressive treatment. The lady referred to our hospital with high fever, chills, body ache and right hypochondriac pain for 1 day. Physical examination revealed a temperature of 39, heart rate of 110 beats/min, blood pressure of 101/69 mmHg, and a respiratory rate of 25 breaths/min. Pulse oximetry was 94% on room air. Chest auscultation revealed good air movement without rales. Tenderness of right upper abdomen was found. Abnormal laboratory results included white blood cell （WBC） count of 20x109/L with 90.9% neutrophils,

Novel Application of High Voltage Electrostatics Corona Ions Discharge Related to Treatment, Sanitization and Disinfection of Biological Matter Such HIV-AIDS Infected Blood

A novel high-voltage electrostatics corona ions pre-charger apparatus and methods were invented earlier by Hamade related to treat various types of receptors such as but not limited to electret polymer, air filters, particulates, catalytic converters, bioaerosols, fluids, pollutants, virus, and bacteria. It is shown in this article that his work led to the construction of various prototype chargers, customized differently for each type of a receptor. In particular his recent development of biological matter corona charger(BMCC) prototype related to expose, treat, sanitize, and disinfect bioaerosols, virus, bacteria, and contaminated fluids and blood such as human immunodeficiency virus(HIV)-acquired immune deficiency syndrome(AIDS). It is shown in this paper that each previous investigated research contemplated ionized corona charger attendant to a charging process and the corona, imparts and provides enough treatment charges to receptors including the aforementioned receptors.Researchers often relied on adopting prior corona charger methods that do not necessarily and effectively solve the problems associated with them or utilize them for optimum treatment effect. The inventor exhaustively studied the characteristics of corona discharge, and has found that the greatest difficulty in corona discharge has to do with the maintenance of the corona, particularly when the receptor is being charged. This is due to variations in either the dielectric value between the corona electrode and a grounded base or flaws in the design as the receptor passes there between suppressing or hindering corona and its effectiveness. What is needed in-the-art is an apparatus and method to achieve maximum possible charge on a receptor, a charge order of magnitude greater than that used by other investigators. This often requires customizing each apparatus and method and does not just merely use one type of a charger to satisfy all applications. To satisfy this need, we build a low cost prototype BMCC that generates self-sustaining charge corona, eliminates many previous design flaws such as spark over, and make it ready for testing remotely or with apparatus.

Modeling of micropipette aspiration and optical tweezers stretching of erythrocytes with or without Malaria parasite

The erythrocytes play an important role in the human body. The healthy erythrocytes can undergo extremely large deformation while passing through small capillaries. Their infection by Malaria Plasmodium falcipurum （P.f.） will lead to capillary blockage and blood flow obstruction. Many experimental and computational methods have been applied to study the increase in stickiness and decrease in deformability of the Malaria （P.f.） infected erythrocytes. The novelty of this paper lies in the establishment of an multi-component model for investigating mechanical properties of Malaria （P.f.） infected erythrocytes, especially of their enclosed parasites. Finite element method was applied to simulate the erythrocytes＇ deformation in micropipette aspiration and optical tweezers stretching using the computational software ABAQUS. The comparisons between simulations and experiments were able to quantitatively conclude the effects of stiffness and stickiness of the parasitophorous vacuole membrane on the cells＇ deformation, which could not be obtained from experiments directly.

Immune evasion by Plasmodium falciparum parasites: converting a host protection mechanism for the parasite′s benefit

Immune evasion is a strategy used by pathogenic microbes to evade the host immune system in order to ensure successful propagation. Immune evasion is particularly important for the blood stages of Plasmodium falciparum, the causative agent of the deadly disease malaria tropica. Because Plasmodium blood stage parasites require human erythrocytes for replication, their ability to evade attack by the human immune system is essential for parasite survival. In order to escape immunity-induced killing, the intraerythrocytic parasites have evolved a variety of evasion mechanisms, including expansion of plasmodial surface proteins, organ-specific sequestration of the infected red blood cells and acquisition of immune-regulatory proteins by the parasite. This review aims to highlight recent advances in the molecular understanding of the immune evasion strategies by P. falciparum, including antigenic variation, surface protein polymorphisms and invasion ligand diversification. The review will further discuss new findings on the regulatory mechanisms applied by P. falciparum to avoid lysis by the human complement as well as killing by immune factors of the mosquito vector.