A worsening scenario of drug-resistant tuberculosis has increased the need for new treatment strategies to tackle this worldwide emergency. There is a pressing need to simplify and shorten the current 6-month treatment regimen for drug-susceptible tuberculosis. Rifamycins and fluoroquinolones, as well as several new drugs, are potential candidates under evaluation. At the same time, treatment outcomes of patients with drug-resistant tuberculosis should be improved through optimizing the use of fluoroquinolones, repurposed agents and newly developed drugs. In this context, the safety and tolerance of new therapeutic approaches must be addressed.
Animals ; Antitubercular Agents/adverse effects/*therapeutic use ; *Drug Discovery ; *Drug Repositioning ; Drug Resistance, Bacterial ; Drug Therapy, Combination ; Extensively Drug-Resistant Tuberculosis/drug therapy/microbiology ; Humans ; Lung/*drug effects/microbiology ; Mycobacterium tuberculosis/*drug effects/pathogenicity ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/diagnosis/*drug therapy/microbiology ; Tuberculosis, Pulmonary/diagnosis/*drug therapy/microbiology

No abstract available.
Animals ; Hemorrhagic Fever with Renal Syndrome* ; Rats* ; Singapore*

INTRODUCTION: In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. METHODS: The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process. RESULTS: The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists. CONCLUSION These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.
Conscious Sedation ; Endoscopy, Gastrointestinal ; Hospitals ; Humans ; Hypnotics and Sedatives ; Singapore

Aims: Hundreds of uropathogenic Escherichia coli (UPEC) lineages with diverse virulence-associated traits have been reported worldwide. However, the complex interactions between the bacterial traits and host factors remain largely unexplored. This study was aimed to determine the distribution of virulence-associated traits, phylogenetic background and antimicrobial resistance profiles of the UPEC isolates in relation to the host factors. Methodology and results: Polymerase chain reactions (PCRs) were conducted to determine the prevalence of 32 virulence genes (VGs), eight pathogenicity island (PAI) markers and phylogroups of 105 UPEC isolates. The antimicrobial susceptibility testing was performed using the disc diffusion method. Results suggest that the virulenceassociated traits and antimicrobial resistance profiles of the UPEC strains were associated with phylogenetic background, host age and gender. Most of the virulence-associated traits tested were distributed prevalently in phylogroup B2, age group 40-59 and male gender, including papC, papG II_III, papG allele III, sfa/focDE, yfcV, hlyA, cnf1, cdtB, malX, PAI I536, PAI II536, PAI ICFT073, PAI IICFT073 and PAI IIJ96. Besides, higher rates of multidrug resistance (MDR) were significantly associated with non-phylogroup B2 (25/38; 65.8%; p<0.05) and age group 60-79 (29/42; 69.0%; p<0.05) but not with male gender (14/25; 56.0%; p=0.527). The UPEC strains collected from males and age 60-79 were significantly resistant to cefuroxime, cefotaxime and ceftazidime (all p<0.05). Conclusion, significance and impact of study Research findings elucidate the key molecular characteristics of the UPEC strains in relation to the host age and gender.