Objectives: This study aims to determine the healthcare workers’ (HCWs) attitudes, perceptions, and practices regarding Antimicrobial Stewardship (AMS) at the Philippine Children's Medical Center (PCMC). Materials and Methods: This cross-sectional study employed a validated online survey. Results: The study included 288 healthcare workers, predominantly female (77.35% ) and aged 31-40 years (47.74%), with physicians being the largest professional group (57.14%). HCWs had positive attitudes toward AMS. They perceived moderate to high antimicrobial resistance (AMR) levels in different contexts but believed the hospital had lower AMR levels than the country. HCWs agreed that AMR impacts antimicrobial choices, patient outcomes, and safety. Contributors to AMR were prescribing inappropriate antimicrobials, unnecessary prescriptions, poor patient adherence, and inadequate infection control measures. HCWs, except medical technologists, were aware of the Antimicrobial Stewardship Program (ASP) and its interventions. Only nurses and pharmacists were aware of the hospital policies against AMR. Barriers to AMS implementation include inadequate training in antimicrobial use, lack of infectious disease/ microbiology services, lack of electronic medication management services, and personnel shortages. HCWs had high self-reported AMS practices, but a practice gap in single-dose surgical antibiotic prophylaxis was identified, with low physician adherence (50.6%). Conclusion This study revealed positive attitudes and high self-reported AMS practices among HCWs. They also perceived moderate to high AMR in different contexts but believed that the hospital has lower AMR levels than the country. Addressing the identified barriers to implementation and practice gaps is crucial for achieving antimicrobial stewardship goals.
Antimicrobial Stewardship ; Viperidae ; Health Personnel

BACKGROUND/AIMS: Acoustic radiation force impulse (ARFI) elastography predicts the presence of esophageal varices (EVs). We investigated whether an ARFI-based prediction model can assess EV bleeding (EVB) risk in patients with cirrhosis. METHODS: The records of 262 patients with cirrhosis who underwent ARFI elastography and endoscopic surveillance at two institutions in 2008 to 2013 were retrospectively reviewed, and ARFI spleen diameter-to-platelet ratio scores (ASPS) were calculated. RESULTS: The median patient age (165 men, 97 women) was 56 years. The median ARFI velocity, spleen diameter, platelet count, and ASPS were 1.7 m/sec, 10.1 cm, 145×10⁹/L, and 1.16, respectively. During the median 38-month follow-up, 61 patients experienced EVB. Among all patients (179 without EVs and 83 with EVs), the cutoff value that maximized the sum of the sensitivity (73.1%) and specificity (78.4%) (area under receiver operating characteristic curve [AUROC], 0.824) for predicting EVB was 2.60. The cumulative EVB incidence was significantly higher in patients with ASPS ≥2.60 than in those with ASPS <2.60 (p<0.001). Among patients with EVs (n=83), 49 had high-risk EVs (HEVs), and 22 had EVB. The cumulative EVB incidence was significantly higher in HEV patients than in low-risk EV patients (p=0.037). At an ASPS of 4.50 (sensitivity, 66.7%; specificity, 70.6%; AUROC, 0.691), the cumulative EVB incidence was significantly higher in patients with a high ASPS than in those with a low ASPS (p=0.045). A higher ASPS independently predicted EVB (hazard ratio, 4.072; p=0.047). CONCLUSIONS: ASPS can assess EVB risk in patients with cirrhosis. Prophylactic management should be considered for patients with HEVs and ASPS ≥4.50.
Acoustics ; Elasticity Imaging Techniques ; Esophageal and Gastric Varices ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Liver Cirrhosis ; Male ; Platelet Count ; Retrospective Studies ; Risk Assessment ; ROC Curve ; Sensitivity and Specificity ; Spleen ; Viperidae

PURPOSE: Agenesis of the septum pellucidum (ASP) is a very rare disease that can be isolated or associated with other brain abnormalities. The neurological prognosis of isolated ASP remains controversial. The aim of this study was to evaluate the clinical outcome of neonates with ASP. METHODS: We retrospectively analyzed the medical records of 12 neonates with isolated ASP or ASP combined with other brain abnormalities who were born at Cheil General Hospital & Women's Healthcare Center between January 2007 and December 2017. RESULTS: Of the 12 neonates, six were identified prenatally and six were identified postnatally. Isolated ASP was found in eight neonates; of these, four were detected antenatally. ASP associated with other brain abnormalities was found in four neonates. ASP was complete in nine neonates, including six with isolated ASP, and partial in three, including two with isolated ASP. Six of the eight neonates with isolated ASP had normal neurological development, except two who were lost to follow-up. Among the four neonates with other associated brain abnormalities, two had delayed motor development and a seizure, one had normal development, and one was lost to follow-up. In all neonates, ophthalmological examination revealed no optic nerve abnormalities. CONCLUSION: Isolated ASP seems to have a good neurological prognosis without ocular problems. This result needs to be confirmed by larger prospective studies over a longer developmental timeline.
Brain ; Delivery of Health Care ; Hospitals, General ; Humans ; Infant, Newborn ; Lost to Follow-Up ; Medical Records ; Optic Nerve ; Prognosis ; Prospective Studies ; Rare Diseases ; Retrospective Studies ; Seizures ; Septum Pellucidum ; Viperidae

Members of genus Acanthamoeba are widely distributed in the environment. Some are pathogenic and cause keratitis and fatal granulomatous amoebic encephalitis. In this study, we isolated an Acanthamoeba CJW/W1 strain from tap water in Wuxi, Jiangsu Province, China. Its 18S rDNA was sequenced and a phylogenetic tree was constructed. The isolated cysts belonged to morphologic group II. Comparison of 18S rDNA sequences of CJW/W1 strain and other isolates showed high similarity (99.7%) to a clinical isolate Asp, KA/E28. A phylogeny analysis confirmed this isolate belonged to the pathogenic genotype T4, the most common strain associated with Acanthamoeba-related diseases. This is the first report of an Acanthamoeba strain isolated from tap water in Wuxi, China. Acanthamoeba could be a public health threat to the contact lens wearers and, therefore, its prevalence should be monitored.
Acanthamoeba ; China ; DNA, Ribosomal ; Encephalitis ; Genotype ; Keratitis ; Phylogeny ; Prevalence ; Public Health ; Trees ; Viperidae ; Water

The present study evaluated the effects of Androctonus amoreuxi scorpion venom, Cerastes cerastes snake venom and their mixture on prostate cancer cells (PC3). An MTT assay was used to determine the anti-proliferative effect of the venoms, while quantitative real time PCR was used to evaluate the expression of apoptosis-related genes (Bax and Bcl-2). Furthermore, colorimetric assays were used to measure the levels of malondialdehyde (MDA) and antioxidant enzymes. Our results show that the venoms significantly reduced PC3 cell viability in a dose-dependent manner. On the other hand, these venoms significantly decreased Bcl-2 gene expression. Additionally, C. cerastes venom significantly reduced Bax gene expression, while A. amoreuxi venom and a mixture of A. amoreuxi & C. cerastes venoms did not alter Bax expression. Consequently, these venoms significantly increased the Bax/Bcl-2 ratio and the oxidative stress biomarker MDA. Furthermore, these venoms also increased the activity levels of the antioxidant enzymes, catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase, and glutathione-S-transferase. Overall, the venoms have cytotoxic and anti-proliferative effects on PC3 cells.
Apoptosis ; Catalase ; Cell Survival ; Gene Expression ; Genes, bcl-2 ; Glutathione Peroxidase ; Glutathione Reductase ; Hand ; Humans* ; Malondialdehyde ; Oxidative Stress ; Prostate* ; Prostatic Neoplasms* ; Real-Time Polymerase Chain Reaction ; Scorpion Venoms ; Scorpions* ; Snake Venoms* ; Snakes* ; Superoxide Dismutase ; Venoms ; Viper Venoms ; Viperidae*

STUDY DESIGN: Retrospective clinical cohort study. PURPOSE: To investigate whether the combined use of dynamic pedicle screws and polyaxial pedicle screws was effective on adjacent segment pathology (ASP). OVERVIEW OF LITERATURE: Various screw and rod models have been recently developed for preventing adjacent segment disease, and hybrid systems have been described along with posterior instrumentation in the fusion segment. In the literature, although the success of dynamic systems has been demonstrated in non-fusion posterior instrumentation, it remains unclear whether the addition of a screw-based dynamic system to a fusion segment would successfully prevent ASP in the long term. METHODS: The study included 101 patients who underwent surgery for degenerative spine diseases between 2007 and 2014 with lumbar stabilization that used either polyaxial pedicle screws alone or polyaxial pedicle screws plus dynamic stabilization screws (with hinged screw heads). These two patient groups were compared using retrospectively obtained postoperative new clinical findings, Oswestry disability index (ODI) scores, visual analog scale (VAS) scores, and radiological data. RESULTS: The proportion of patients with ASP who were radiologically assessed was low (p <0.01) in the group that underwent lumbar stabilization along with dynamic screws. Treatment outcomes were clinically successful in both groups according to ODI and VAS scores, and no significant difference was determined between the groups in terms of clinical ASP (p >0.05). CONCLUSIONS: Although the combined use of dynamic screws and the static system was radiologically found to be effective for preventing ASP in patients who underwent lumbar fusion with posterior instrumentation, it did not completely eliminate ASP or result in a significant improvement in clinical ASP.
Cohort Studies ; Humans ; Pathology* ; Pedicle Screws* ; Retrospective Studies ; Spine* ; Viperidae ; Visual Analog Scale

BACKGROUND: Early conversion from intravenous to oral antibiotics plays an important role in lowering the risk of catheter-associated infections, reducing the workload of nurses, decreasing direct and indirect costs, and shortening hospital stays. In August 2015, an antimicrobial stewardship program (ASP) was implemented to facilitate conversion from intravenous to oral administration of fluoroquinolones in our institute. This study evaluated the clinical and economic impact of the intervention. MATERIALS AND METHODS: Data were retrospectively collected by reviewing electronic medical records. All hospitalized patients aged 18 and older who met the study inclusion criteria for the conversion were included between August and November 2015. We computed the physicians’ adherence rate to the ASP recommendations. We also measured the total use of fluoroquinolones, length of hospital stay, and medication costs. RESULTS: During 4 months, 129 cases were enrolled in the study. The adherence rate was 79.8%. The average total prescription volume of intravenous fluoroquinolones, the length of hospital stay, and the total cost of the fluoroquinolones statistically significantly decreased in the intervention-adherent group. CONCLUSION: Intervention to facilitate conversion from intravenous to oral administration has reduced excess use of intravenous fluoroquinolones and length of hospital stay. With these findings, further implementations of the ASP extending to other antibiotics may be warranted.
Administration, Oral ; Anti-Bacterial Agents ; Catheter-Related Infections ; Electronic Health Records ; Fluoroquinolones* ; Humans ; Length of Stay ; Prescriptions ; Retrospective Studies ; Viperidae

The study was conducted to evaluate the Antibiotic Stewardship Program (ASP) in Korean hospitals compared with the previous two surveys in 2006 and 2012. The information on ASPs was collected through an online-based survey sent by e-mail to 192 infectious diseases specialists in 101 Korean hospitals in September 2015. Fifty-four hospitals (53.5%, 54/101) responded to the online survey. One infectious diseases specialist was employed in 30 (55.6%) of the 54 hospitals, and they were in charge of ASPs in hospitals with the program. Fifty of the 54 hospitals (92.6%) had ASPs and the same number of hospitals was conducting a preauthorization-of-antibiotics-use program. Although most hospitals adopted preauthorization strategies for more antibiotics in 2015 than in 2012 (median 14 in 2015; 13 in 2012), a limited number of antibiotics were under control. The number of per oral and parenteral antibiotics available in hospitals in 2015 decreased compared to 2006 and 2012. The number of hospitals performing a retrospective or prospective qualitative drug use evaluation of antibiotic use increased from 2006 to 2015. Manpower in charge of antibiotic stewardship in most hospitals was still very limited and ASPs heavily depended on preauthorization-of-antibiotics-use programs in this survey. In conclusion, there leaves much to be desired in ASPs in Korea in 2015.
Anti-Bacterial Agents ; Communicable Diseases ; Electronic Mail ; Korea* ; Prospective Studies ; Retrospective Studies ; Specialization ; Viperidae

Novelty seeking (NS) and antisocial personality (ASP) are commonly exhibited by those who suffer from addictions, such as substance abuse. NS has been suggested to be a fundamental aspect of ASP. To investigate the neurobiological substrate of NS and ASP, we tested the relationship between regional cerebral glucose metabolism and the level of NS, determining the differences between individuals with and without ASP. Seventy-two healthy adults (43 males, mean age±SD=38.8±16.6 years, range=20~70 years; 29 females, 44.2±20.1 years, range=19~72 years) underwent resting-state brain positron emission tomography (PET) 40 minutes after 18F-fluorodeoxyglucose (FDG) injection. Within 10 days of the FDG PET study, participants completed Cloninger's 240-item Temperament and Character Inventory (TCI) to determine NS scores. Participants with and without ASP were grouped according to their TCI profiles. Statistical parametric mapping analysis was performed using the FDG PET and TCI profile data. NS scores positively correlated with metabolism in the left anterior cingulate gyrus and the insula on both sides of the brain and negatively correlated with metabolism in the right pallidum and putamen. Participants with ASP showed differences in cerebral glucose metabolism across various cortical and subcortical regions, mainly in the frontal and prefrontal areas. These data demonstrate altered regional cerebral glucose metabolism in individuals with NS and ASP and inform our understanding of the neurobiological substrates of problematic behaviors and personality disorders.
Adult ; Antisocial Personality Disorder* ; Brain ; Electrons* ; Female ; Globus Pallidus ; Glucose* ; Gyrus Cinguli ; Humans ; Male ; Metabolism* ; Personality Disorders ; Positron-Emission Tomography* ; Putamen ; Substance-Related Disorders ; Temperament ; Viperidae

PURPOSE: The purpose of this study is to investigate the influence of radiotherapy (RT) on anorectal function and radiation-induced toxicity in patients with prostate cancer. MATERIALS AND METHODS: Fifty-four patients who were treated with RT for prostate cancer (T1c-4N0-1M0) were evaluated. To assess the changes in anorectal function, two consecutive anorectal manometry readings were performed in patients, before and after 4-6 months of RT. Late gastrointestinal (GI) toxicity was defined as symptoms occurring more than 6 months after RT. The median radiation dose was 70.0 Gy (range, 66.0 to 74.0 Gy). Whole pelvis field RT was performed in 16 patients (29.6%). Grade of late radiation toxicity was defined in accordance to the severity of symptoms (Gulliford's scoring system). RESULTS: The median follow-up period was 60 months. Resting anal pressure (p=0.001), squeeze pressure (p < 0.001), and urge to defecate volume (p=0.025) were significantly reduced after RT. Fourteen patients (25.9%) experienced late GI toxicities. Among them, nine (16.7%) showed severe (grade > or = 2) late toxicities. Elevated resting and squeeze external anal sphincter pressure prior to RT and large urge to defecate volumes after RT were associated with the occurrence of late GI toxicities. CONCLUSION: RT caused symptomatic anorectal dysfunction and resulted in a weakened anal sphincter. Increased urge to defecate volumes after RT were related to late GI toxicities. Elevated resting and squeeze anal sphincter pressure prior to RT rodcan be used to identify patients with an increased risk of late GI toxicities.ConclusionRT caused symptomatic anorectal dysfunction. An increased anal pressure prior to RT and urge to defecate volume after RT was related to an occurrence of late GI toxicities. Application of ARM for screening patients who have an elevated ASP prior to RT could be helpful in identifying patients with an increased risk of late GI toxicities.
Anal Canal ; Arm ; Follow-Up Studies ; Humans ; Manometry* ; Mass Screening ; Pelvis ; Prostate* ; Prostatic Neoplasms* ; Radiotherapy ; Reading ; Viperidae