Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure

BACKGROUND Delayed sternal closure(DSC)can be a lifesaving approach for certain patients who have undergone cardiac surgery.The value of the type of prophylactic antibiotics in DSC is still debatable.AIM To investigate clinical outcomes of different prophylactic antibiotic regimens in patients who had DSC after cardiac surgery.METHODS This was a retrospective observational single-center study.Fifty-three consecutive patients who underwent cardiac surgery and had an indication for DSC were included.Patients were subjected to two regimens of antibiotics:Narrow-spectrum and broad-spectrum regimens.RESULTS The main outcome measures were length of hospital and intensive care unit(ICU)stay,duration of mechanical ventilation,and mortality.Of the 53 patients,12(22.6%)received narrow-spectrum antibiotics,and 41(77.4%)received broad-spectrum antibiotics.The mean age was 59.0±12.1 years,without significant differences between the groups.The mean duration of antibiotic use was significantly longer in the broad-spectrum than the narrowspectrum group(11.9±8.7 vs 3.4±2.0 d,P<0.001).The median duration of open chest was 3.0(2.0-5.0)d for all patients,with no difference between groups(P=0.146).The median duration of mechanical ventilation was significantly longer in the broad-spectrum group[60.0(Δinterquartile range(IQR)170.0)h vs 50.0(ΔIQR 113.0)h,P=0.047].Similarly,the median length of stay for both ICU and hospital were significantly longer in the broadspectrum group[7.5(ΔIQR 10.0)d vs 5.0(ΔIQR 5.0)d,P=0.008]and[27.0(ΔIQR 30.0)d vs 19.0(ΔIQR 21.0)d,P=0.031].Five(9.8%)patients were readmitted to the ICU and 18(34.6%)patients died without a difference between groups.CONCLUSION Prophylactic broad-spectrum antibiotics did not improve clinical outcomes in patients with DSC post-cardiac surgery but was associated with longer ventilation duration,length of ICU and hospital stays vs narrow-spectrum antibiotics.

The effect of prophylactic antibiotics in acute upper gastrointestinal bleeding patients in the emergency department

BACKGROUND: Currently, prophylactic antibiotics are recommended only for cirrhotic patients with acute upper gastrointestinal bleeding(AUGIB);however, the benefit for other AUGIB patients remains undetermined. We aimed to compare the clinical outcomes between patients with AUGIB with and without prophylactic antibiotics to identify the population that requires this therapy.METHODS: Patients with AUGIB admitted between 1st January 2019 and 31st December 2021 in the Emergency Department of Peking Union Medical College Hospital were enrolled. Patients were divided into the antibiotic and non-antibiotic groups. The primary outcome was in-hospital mortality, and the secondary outcome was the onset of new infection. The risk factors for mortality and infection were analyzed, and stratification analysis of prophylactic antibiotics was performed. Continuous data were analyzed using the t-test or nonparametric rank sum test, and categorical data were analyzed using the Chi-square test or Fisher's exact test. Indicators with significant differences between the groups were included for logistic regression analysis. A P-value <0.05 was considered statistically significant. RESULTS: A total of 392 individuals were included, among them, 281 patients received prophylactic antibiotics, and 111 patients did not receive prophylactic antibiotics. The mortality rates were significantly lower in the antibiotic group than in the non-antibiotics group(6.41% vs. 17.12%, P=0.001). The risk factors for infection were varicose veins(P=0.045) and endotracheal intubation(P=0.005) in the prophylactic antibiotic group, and endoscopic treatment(P=0.010) in the non-prophylactic antibiotic group. Stratified analyses showed that patients with age ≥ 65 years, endotracheal intubation, endoscopic treatment, and AUGIB of variceal etiologies benefited from prophylactic antibiotics.CONCLUSION: AUGIB patients may benefit from prophylactic antibiotics to decrease mortality, especially those aged ≥ 65 years and those with endotracheal intubation, endoscopic treatment, and variceal etiologies.

Factors Affecting Cotrimoxazole Prophylactic Therapy Compliance in HIV Patients Attending a Care and Treatment Clinic at Bugando Medical Centre in Mwanza, Tanzania

Introduction: Cotrimoxazole Prophylactic Therapy (CPT) compliance lowers the risk of opportunistic infections and other Acquired Immune Deficiency Syndrome (AIDS)-related diseases. The aim of this study was to examine factors that influence compliance with CPT among HIV patients in the Care and Treatment Clinic (CTC) at Bugando Medical Centre (BMC) in Mwanza, Tanzania. Methods: A descriptive cross-sectional study was conducted at the BMC between April 1, 2021, and June 30, 2021. Data were collected using face-to-face interviews and a semi-structured questionnaire. Data are presented in frequency, percentages, and cross-tabulation tables. A P-value of less than 0.05 was considered statistically significant. Results: The prevalence of compliance with CPT by self-reported measurement was 158 (63.7%). Most CPT-compliant participants were more likely to have a spouse who is familiar with CPT, have a family member who is aware of their HIV status, and be aware of the benefits of CPT. The majority of participants who complied with CPT were more likely to have experienced counseling during refill, felt that the length of time spent seeing doctors for treatment was reasonable, and received accurate information from them. Conclusion: Most adult HIV patients attending CTC at BMC were reported to be in compliance with CPT. These findings suggest that improving social support and patient-provider communication may be effective strategies for improving compliance with CPT among HIV patients.

Prescription of Antibiotics in Oral-Dental Practice: Case of the Dental Practice at the Coyah Prefectoral Hospital in the Republic of Guinea 2019-2020

Introduction: Antibiotics are medications that have the property of destroying bacteria or preventing their proliferation. The aim of this study is to evaluate antibiotic prescriptions in oral practice: case of the dental office of the Coyah prefectural hospital. Methods: This is a descriptive cross-sectional study which took place from August 2019 to January 2020 inclusive, i.e. a duration of six (6) months, during which 400 patients were identified. Results: Our results revealed a frequency of 70% of antibiotic prescriptions. The 16 - 25-year-old age group was the most dismayed, at 47.25% and with an average age of 27.78 years. Men represent 55% compared to 45% of women, i.e. sex ratio of 1.22. Pulp gangrene was the most common pathology in 55% of cases. The most prescribed family was Betalactamine or 61.71% and the most represented molecules were Amoxicillin with 56.10% followed by Metronidazole or 34.16%. And the favorable prognosis was observed in 99% of cases. Conclusion: Prescription should always be based on the benefit-risk ratio. This prescription by practitioners aims to prevent or eradicate infections and pain in order to obtain a good therapeutic result.

Antimicrobial Activity of Some Commercial Toothpastes and Antibiotics on Two Oral Pathogenic Bacteria—An in-Vitro Study

Oral health problems such as periodontal diseases, dental caries, and endodontic infections have a significant negative impact on oral health and impose a substantial financial burden on the global population. The prevalence of these issues is increasing due to the buildup of bacterial plaque and the growing resistance of bacteria to antimicrobial treatments. The aims of this study to evaluate the anti-bacterial activity of four types of antibiotics (Amoxicillin, Augmentin, Azithromycin and Metronidazole) and four types of toothpastes (Sensodyne, ipana, denta and cariax Gingival Kin) on two oral pathogenic bacteria (Streptococcus mutans and Staphylococcus epidermidis). Bacterial samples of previously isolated Streptococcus mutans and Staphylococcusepidermidis were used as test organisms and the Kirby-Bauer disc diffusion method was employed to assess the antibacterial efficacy of various antibiotics and evaluate the impact of different toothpastes using a filter paper disc agar measurement technique. Each filter disc was saturated with toothpaste solution in a test tube for approximately 30 to 40 seconds, after which they were placed on Mueller-Hinton broth bacterial cultures in petri dishes. These Petri dishes were then incubated at 37°C for 24 hours, and the clear zone’s diameter (inhibition zone in mm) was subsequently measured and the results were recorded. The results demonstrated that Sensodyne toothpaste and Metronidazole antibiotic were ineffective against both types of bacteria, while Augmentin and Amoxicillin were effective by high diameter inhibition zones of growth against S. mutans and Azithromycine against S. epidermidis. Also Ipana, Denta, and Cariax Gingival Kin toothpastes exhibited a moderate effect against the two bacteria. This study suggests that certain antibiotics and toothpastes can effectively inhibit the growth of harmful oral bacteria, but not all of them are effective.

Single flow treatment degradation of antibiotics in water using falling-film dielectric barrier discharge

The environmental contamination caused by antibiotics is increasingly conspicuous due to their widespread manufacture and misuse. Plasma has been employed in recent years for the remediation of antibiotic pollution in the environment. In this work, a falling-film dielectric barrier discharge was used to degrade the antibiotic tetracycline(TC) in water. The reactor combined the gas-liquid discharge and active gas bubbling to improve the TC degradation performance. The discharge characteristics, chemical species’ concentration, and degradation rates at different parameters were systematically studied. Under the optimized conditions(working gas was pure oxygen, liquid flow rate was 100 mL/min, gas flow rate was 1 L/min,voltage was 20 kV, single treatment), TC was removed beyond 70% in a single flow treatment with an energy efficiency of 145 mg/(kW·h). The reactor design facilitated gas and liquid flow in the plasma area to produce more ozone in bubbles after a single flow under pure oxygen conditions, affording fast TC degradation. Furthermore, long-term stationary experiment indicated that long-lived active species can sustain the degradation of TC. Compared with other plasma treatment systems, this work offers a fast and efficient degradation method, showing significant potential in practical industrial applications.

Simultaneous Degradation, Dehalogenation, and Detoxification of Halogenated Antibiotics by Carbon Dioxide Radical Anions

Despite the extensive application of advanced oxidation processes(AOPs)in water treatment,the efficiency of AOPs in eliminating various emerging contaminants such as halogenated antibiotics is constrained by a number of factors.Halogen moieties exhibit strong resistance to oxidative radicals,affecting the dehalogenation and detoxification efficiencies.To address these limitations of AOPs,advanced reduction processes(ARPs)have been proposed.Herein,a novel nucleophilic reductant—namely,the carbon dioxide radical anion(CO_(2)^(·-))—is introduced for the simultaneous degradation,dehalogenation,and detoxification of florfenicol(FF),a typical halogenated antibiotic.The results demonstrate that FF is completely eliminated by CO_(2)^(·-),with approximately 100%of Cland 46%of Freleased after 120 min of treatment.Simultaneous detoxification is observed,which exhibits a linear response to the release of free inorganic halogen ions(R2=0.97,p<0.01).The formation of halogen-free products is the primary reason for the superior detoxification performance of this method,in comparison with conventional hydroxyl-radical-based AOPs.Products identification and density functional theory(DFT)calculations reveal the underlying dehalogenation mechanism,in which the chlorine moiety of FF is more susceptible than other moieties to nucleophilic attack by CO_(2)^(·-).Moreover,CO_(2)^(·-)-based ARPs exhibit superior dehalogenation efficiencies(>75%)in degrading a series of halogenated antibiotics,including chloramphenicol(CAP),thiamphenicol(THA),diclofenac(DLF),triclosan(TCS),and ciprofloxacin(CIP).The system shows high tolerance to the pH of the solution and the presence of natural water constituents,and demonstrates an excellent degradation performance in actual groundwater,indicating the strong application potential of CO_(2)^(·-)-based ARPs in real life.Overall,this study elucidates the feasibility of CO_(2)^(·-)for the simultaneous degradation,dehalogenation,and detoxification of halogenated antibiotics and provides a promising method for their regulation during water or wastewater treatment.

A novel Ag/ZnO core-shell structure for efficient sterilization synergizing antibiotics and subsequently removing residuals

The massive use of antibiotics has led to the aggravation of bacterial resistance and also brought environmental pollution problems.This poses a great threat to human health.If the dosage of antibiotics is reduced by increasing its bactericidal performance,the emergence of drug resistance is certainly delayed,so that there's not enough time for developing drug resistance during treatment.Therefore,we selected typical representative materials of metal Ag and semiconductor ZnO nano-bactericides to design and synthesize Ag/ZnO hollow core-shell structures(AZ for short).Antibiotics are grafted on the surface of AZ through rational modification to form a composite sterilization system.The research results show that the antibacterial efficiency of the composite system is significantly increased,from the sum(34.7%+22.8%-57.5%)of the antibacterial efficiency of AZ and gentamicin to 80.2%,net synergizes 22.7%,which fully reflects the effect of 1+1>2.Therefore,the dosage of antibiotics can be drastically reduced in this way,which makes both the possibility of bacterial resistance and medical expenses remarkably decrease.Subsequently,residual antibiotics can be degraded under simple illumination using AZ-self as a photocatalyst,which cuts off the path of environmental pollution.In short,such an innovative route has guiding significance for drug resistance.

Indication of conservative treatment by antibiotics for uncomplicated and complicated acute appendicitis

BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of conservative treatment for uncomplicated appendicitis is known,its efficacy for complicated appendicitis remains unknown,so are risk factors for the conservative treatment of appendi-citis.In our institution,conservative treatment has long been the first choice for most appendicitis cases,except for perforation.Therefore,this novel study inves-tigated the outcomes of conservative treatment for uncomplicated and compli-cated acute appendicitis and the risk factors associated with conservative treat-ment.treatment.The significant and independent predictors of resistance to conservative treatment were body temperature≥37.3°C,appendicolith and Douglas sinus fluid visible on computed tomography(CT).The rate of resistance to conservative treatment was 66.7%(6/9)for patients with the above three factors,22.9%(8/35)for patients with two factors(appendicolith and body temperature≥37.3°C),16.7%(2/12)for patients with two factors(Douglas sinus fluid and appendicolith)and 11.1%(1/9)for patients with two factors(Douglas sinus fluid and body temperature≥37.3°C).CONCLUSION A temperature≥37.3°C,appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.

Effectiveness of Prophylactic Transvaginal Cervical Cerclage in Improving Clinical Outcomes among Pregnant Women with Cervical Insufficiency: Meta-Analysis

Background: Cervical insufficiency is one of the major causes of preterm birth among pregnant women that leads to severe mortality and morbidity issues among newborns. Prophylactic cervical cerclage is a surgical procedure performed between 11 and 14 weeks of gestation upon diagnosis of cervix insufficiency among pregnant women. Aims & Objectives: In this study, we aimed to evaluate the effectiveness of prophylactic cervical cerclage in comparison to other interventions to treat cervical insufficiency among pregnant women using a meta-analysis approach. Methods: We searched the three databases (Coachrane Library, PubMed, and MEDLINE) that were used for articles related to research aims by using MeSH keywords. The timeline of research was set from January 2015 to January 2024. The methodological quality assessment of included studies was performed by the Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I). A recent meta-analysis was conducted by using Review Manager 5.4.0 software. Results: About 441 research articles were extracted from three electronic databases and only 125 articles were assessed for eligibility criteria. Finally, 8 studies were included in the analysis for a recent meta-analysis. Six out of eight included retrospective or pilot studies were graded as having a moderate risk of bias, and two studies had low risk on the basis of owning bias. About 1008 pregnant women with cervical insufficiency were analyzed in a recent meta-analysis. By pooled analysis, it was evaluated that significant difference found in prolongation of delivery weeks (Mean difference = 1.05;Cl: 0.81 to 1.29: p > 0.00001), number of deliveries > 37 weeks (OR = 0.59;Cl: 0.19 to 1.84: p > 0.006), and preterm birth (OR = 0.73;Cl: 0.42 to 1.28: p > 0.50) among pregnant women receiving prophylactic cervical cerclage as compared to other treatment strategies. Conclusion: Recent meta-analysis suggested the prophylactic cervical cerclage reduces the rates of preterm birth, abortion rates, number of deliveries > 37 weeks, and other complications as compared to the other cervical cerclage types and conservative treatments.

Current trends in nanomaterials-mediated biosensing platforms and signal amplification strategies for antibiotics detection in dairy products

Dairy products have become one of the most prevalent daily foods worldwide,but safety concerns are rising.In dairy farming,unscrupulous traders misuse antibiotics to treat some diseases such as mastitis in cows,leading to antibiotic residues in dairy products.Rapid,sensitive,and simple detection methods for antibiotic residues are particularly important for food safety in dairy products.Traditional detection technology can effectively detect antibiotics,but there are defects such as complicated pre-treatment and high cost.Biosensors are widely used in food safety due to fast detection speed,low detection cost,strong anti-interference ability,and suitability for the field application.Nevertheless,these sensors often fail to trigger the signal conversion output due to low target concentration.To cope with this issue,some high-efficiency signal amplification systems can be introduced to improve the detection sensitivity and linear range of biosensors.In this review,we focused on:(i)Sources and toxicity of major antibiotics in animal-derived foods.(ii)Nanomaterial-mediated biosensors for real-time detection of target antibiotics in animal-derived foods.(iii)Signal amplification techniques to increase the sensitivity of biosensors.Finally,future prospects and challenges in this research field are discussed.

Present and future of prophylactic antibiotics for severe acute pancreatitis

AIM: To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and metaanalyses. METHODS: An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT. RESULTS: Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR ) = 1.01, P = 0.98]. Funnel plot indi-cated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P < 0.05). However, the number needed to treat having a minor lower limit of the range (7-5096 patients) implied that certain SAP patients could still potentially prevent death by antibiotic prophylaxis. CONCLUSION: Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations.

Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding

Bacterial infections are common in cirrhotic patients with acute variceal bleeding,occurring in 20%within48 h.Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection.However,mortality from variceal bleeding is largely determined by the severity of liver disease.Besides a higher Child-Pugh score,patients with hepatocellular carcinoma are particularly susceptible to infections.Despite several hypotheses that include increased use of instruments,greater risk of aspiration pneumonia and higher bacterial translocation,it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis.Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures,but more recently,gram positives and quinolone-resistant organisms are increasingly seen,even though their clinical significance is unclear.Fluoroquinolones(including ciprofloxacin and norfloxacin)used for short term(7 d)have the most robust evidence and are recommended in most expert guidelines.Short term intravenous cephalosporin(especially ceftriaxone),given in a hospital setting with prevalent quinolone-resistant organisms,has been shown in studies to be beneficial,particularly in high risk patients with advanced cirrhosis.

Misuse of prophylactic antibiotics and prevalence of postoperative wound infection in obstetrics and gynecology department in a Sudanese hospital

Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751;of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR 2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions’ parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription’s parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.

Prophylactic antibiotics for variceal hemorrhage: Clostridium difficile infection still can be a risk

Bron et al presented a retrospective study regarding the prophylactic use of antibiotics for variceal hemorrhage. Antibiotics appeared to improve the survival rate of patients without increasing clostridium difficile infection (CDI). We argue against the conclusion of the authors and consider that this result may be simply due to concurrent use of metronidazole, a therapeutic agent against CDI.

The Role of Prophylactic Antibiotics for Percutaneous Procedures in Orthopaedic Surgery

Introduction This study investigates the current practice of surgeons in the United Kingdom with regards to their usage of prophylactic antibiotics for percutaneous orthopaedic procedures. Methods An electronic survey of 10 questions was devised and sent to all members of the British Orthopaedic Association. Three hundred and three replies were obtained (172 consultants, 131 trainees). Results Only half the numbers of orthopaedic surgeons would routinely use antibiotics for percutaneous K-wire fixation. Of the other half, 28% would never prescribe antibiotics and 22% would use them in special circumstances only. These ‘special circumstances’ were also not standardised. 92% of those who did prescribe antibiotics would administer single dose only and the majority (90%) would administer them during induction. There was no significant difference between trainees and consultants or between different orthopaedic procedures with regards to whether prophylactic antibiotics were prescribed or not. Discussion This survey highlights the split of opinion amongst practising orthopaedic surgeons as to the necessity or otherwise of antibiotic prophylaxis in percutaneous orthopaedic procedures. There are no reliable guidelines and further work should be carried out to investigate this subject.

A prospective randomized study to define the role of low dose continuous prophylactic antibiotics and anti-adherence agents in altering the microbial colonization related to indwelling double‐J stents

Objective:Despite conflicting evidence,it is common practice to use continuous antibiotic prophylaxis(CAP)in patients with indwelling double-J(DJ)stents.Cranberry extracts and d-mannose have been shown to prevent colonization of the urinary tract.We evaluated their role in this setting.Methods:We conducted a prospective randomized study to evaluate patients with indwelling DJ stents following urological procedures.They were randomized into three groups.Group A(n=46)received CAP(nitrofurantoin 100 mg once daily[OD]).Group B(n=48)received cranberry extract 300 mg and d-mannose 600 mg twice daily(BD).Group C(n=40)received no prophylaxis.The stents were removed between 15 days and 45 days after surgery.Three groups were compared in terms of colonization of stent and urine,stent related symptoms and febrile urinary tract infections(UTIs)during the period of indwelling stent and until 1 week after removal.Results:In Group A,9(19.5%)patients had significant bacterial growth on the stents.This was 8(16.7%)in the Group B and 5(12.5%)in Group C(p-value:0.743).However,the culture positivity rate of urine specimens showed a significant difference(p-value:0.023)with Group B showing least colonization of urine compared to groups A and C.There was no statistically significant difference in the frequency of stent related symptoms(p-value:0.242)or febrile UTIs(p-value:0.399)among the groups.Conclusion:Prophylactic agents have no role in altering bacterial growth on temporary indwelling DJ stent,stent related symptoms or febrile UTIs.Cranberry extract may reduce the colonization of urinary tract,but its clinical significance needs further evaluation.

Role of prophylactic central neck lymph node dissection for papillary thyroid carcinoma in the era of de-escalation

Thyroid cancer is the most common endocrine malignancy.While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer,there has been an overall rise in its incidence worldwide over the last few decades.Patients with papillary thyroid carcinoma(PTC)and clinical evidence of central(cN1)and/or lateral lymph node metastases require total thyroidectomy plus central and/or lateral neck dissection as the initial surgical treatment.Nodal status in PTC patients plays a crucial role in the prognostic evaluation of the recurrence risk.The 2015 guidelines of the American Thyroid Association(ATA)have more accurately determined the indications for therapeutic central and lateral lymph node dissection.However,prophylactic central neck lymph node dissection(pCND)in negative lymph node(cN0)PTC patients is controversial,as the 2009 ATA guidelines recommended that CND“should be considered”routinely in patients who underwent total thyroidectomy for PTC.Although the current guidelines show clear indications for therapeutic CND,the role of pCND in cN0 patients with PTC is still debated.In small solitary papillary carcinoma(T1,T2),pCND is not recommended unless there are high-risk prediction factors for recurrence and diffuse nodal spread(extrathyroid extension,mutation in the BRAF gene).pCND can be considered in cN0 disease with advanced primary tumors(T3 or T4)or clinical lateral neck disease(cN1b)or for staging and treatment planning purposes.The role of the preoperative evaluation is fundamental to minimizing the possible detrimental effect of overtreatment of the types of patients who are associated with low disease-related morbidity and mortality.On the other hand,it determines the choice of appropriate treatment and determines if close monitoring of patients at a higher risk is needed.Thus,pCND is currently recommended for T3 and T4 tumors but not for T1 and T2 tumors without high-risk prediction factors of recurrence.

Microbial Contents and Antibiotics Susceptibilities from Hand Washing Stations during COVID-19 Pandemic in Lagos, Nigeria

The COVID-19 pandemic put every government in the globe on red alert;safety protocol and long-standing infection prevention and control (IPC) measures such as hand and oral hygiene, social/ physical distancing, use of face mask were rigorously enforced. This study evaluated microbial (bacterial, fungal) contents of rinsate, bowl water, water from tap, and the neighborhood drainage in selected hand washing stations in Agege, Alimosho, Mainland, Island and Shomolu local government areas (LGAs) in Lagos, Nigeria. The identities of bacterial isolates were confirmed with 16S rRNA sequencing while the fungi were identified by colonial appearances. The antibiotics susceptibility testing (AST) of the bacteria against structurally unrelated antibiotics was performed and interpreted according to standard guidelines. Sixty-seven (67) bacterial and fifty-one (51) fungal isolates were recovered from mainly water bucket with tap and rinsates across all the LGAs. There were marked microbial loads (some too numerous to count at 10-3 dilution) across Alimosho, Lagos Island and Mainland. Forty (40) representative bacterial isolates were selected for 16S rRNA sequencing. The occurrence of microbial isolates in the samples was at varying degrees;Klebsiella spp. (37.5%), Bacillus spp. (32.5%), Enterobacter spp. (17.5%), were the predominant bacteria while Aspergillus spp. (46.2%), yeasts (34.6%), Sporothrix schenckii (11.5%) and Penicillium spp. (7.7%) constituted the fungal isolates. The biological weapon, B. anthracis was recovered from a water bucket with tap in Alimosho. The antibiotics susceptibility testing of the bacteria showed high degrees of resistance profile;45 (69.2%) to ampicillin, 41.5% amoxicillin/clavulanate while 47.6% were resistant to two (2) or more antibiotics. This study demonstrated high microbial load during the pandemic at the study LGAs, presence of environmental commensals reputed for debilitating opportunistic infections in man and risk of passing heavy load of these potential pathogens to the public.

Essential Oils as an Alternative to Antibiotics to Reduce the Incidence and Severity of Necrotic Enteritis in Broiler Chickens: A Short Review

Due to the removal of antibiotic growth promoters (AGPs) and consumer pressure for antibiotic-free (ABF) or no antibiotics ever (NAE) poultry production, there is a need for sustainable alternatives to prevent disease in commercial poultry operations. Without AGPs, there has been a rise in diseases that were traditionally controlled by subtherapeutic levels of antibiotics in the diet. This has impacted the health of commercial poultry and has been a significant cost to poultry producers. To mitigate this, the industry has started to investigate alternatives to antibiotics to treat these forthcoming health issues, such as necrotic enteritis (NE). NE is an enteric disease caused by an over proliferation of toxigenic Clostridium perfringens (CP) in the gastrointestinal tract. Although CP is a commensal in the avian intestinal tract, dysbiosis caused by inflammation and impaired intestinal integrity facilitates uncontrolled replication of CP. Infectious agents, such as Eimeria maxima, appear to be a predominant predisposing factor that promotes NE. However, non-infectious stressors, including dietary changes, have also been associated with NE to some degree. As a result of increased pressure to restrict the use of antibiotics, there is a need for research evaluating the efficacy of alternatives, such as plant-derived essential oils, as potential tools to mitigate NE in commercial poultry flocks. The aim of this study is to review the effects of essential oils as an alternative to antibiotics to reduce the incidence and severity of necrotic enteritis in broiler chickens.