Nosocomial infections or healthcare associated infections occur in patients under medical care.These infections occur worldwide both in developed and developing countries.Nosocomial infections accounts for 7％ in developed and 10％ in developing countries,As these infections occur during hospital stay,they cause prolonged stay,disability,and economic burden.Frequently prevalent infections include central line-associated bloodstream infections,catheter-associated urinary tract infections,surgical site infections and ventilator-associated pneumonia.Nosocomial pathogens include bacteria,viruses and fungal parasites.According to WHO estimates,approximately 15％ of all hospitalized patients suffer from these infections.During hospitalization,patient is exposed to pathogens through different sources environment,healthcare staff,and other infected patients.Transmission of these infections should be restricted for prevention.Hospital waste serves as potential source of pathogens and about 20％-25％ of hospital waste is termed as hazardous.Nosocomial infections can be controlled by practicing infection control programs,keep check on antimicrobial use and its resistance,adopting antibiotic control policy.Efficient surveillance system can play its part at national and international level.Efforts are required by all stakeholders to prevent and control nosocomial infections.

Dural arteriovenous fistula (DAVF) of the transverse sinus with ophthalmic manifestations in young children are rare. We reviewed two cases of direct AVF of the transverse sinus with ocular manifestations managed at our institution. The first, a 2.5 years old male child presented with left exophthalmos. Angiography revealed AVF between the occipital artery and the transverse sinus. The second, a 2 years old female child, complained of left exophthalmos. Imaging studies showed bilateral direct AVFs of the transverse sinus with bilateral dysmaturation of the sigmoid sinus. Transarterial embolization was done in both cases. Clinical and radiological follow up revealed complete cure.This report suggests that DAVF of the transverse sinus supplied by the external carotid branches can present with ophthalmic manifestations especially if there is distal venous stenosis or obliteration involving sigmoid sinus. Transarterial embolization using coils and liquid embolic agents could be safe and feasible to obliterate the fistula.
Angiography ; Arteries ; Central Nervous System Vascular Malformations* ; Child ; Colon, Sigmoid ; Constriction, Pathologic ; Exophthalmos ; Female ; Fistula ; Follow-Up Studies ; Humans ; Male

Our objectives were to discuss a general overview on the description and recognition of heparin–induced thrombocytopenia (HIT) and present a critical review of the traditional and most recent advances in its pharmacotherapy. Computerized searches were done on MEDLINE and Iowa Drug Information Service (IDIS) databases from June 2001 until June 2007 and from May 2005 until May 2007, respectively. Search terms used included ‘heparin-induced thrombocytopenia’, ‘heparin-associated thrombocytopenia’, therapeutics, HIT, HAT. We largely selected publications within the timeframe above, but did not exclude commonly referenced and highly regarded older publications. The commonly referenced published articles were obtained through manual searches derived from bibliographic citations and retrievals from the authors’ personal files. Pertinent literatures (89 key articles) that were thought to have substantially contributed new information to the therapeutics of HIT within the last 6 years were identified, reviewed and presented. The following limits were used for the MEDLINE and IDIS searches: ‘human’, drug therapy’, ‘review’, ‘meta-analysis’, ‘clinical trial’, and case reports. The therapeutics of HIT is rapidly evolving and needs to consider an evidence – based approach. It is imperative that practitioners be aware of the associated risk and be up-to-date with the current advances in the management of this fatal clinical condition.

Objective: To determine antiacanthamoebic activity of natural and marketed honey samples.
Methods: Natural honey samples were collected directly from the bee hive and marketed honey samples were purchased from the local market in Karachi, Pakistan. Both honey samples were tested for their flavonoid content (quercetin equivalent per gram of the extract) and phenolic content (gallic acid equivalent per gram). Furthermore, their anti-oxidant activity was determined by measuring 2,2-diphenyl-1-picrylhydrazyl. Using amoebistatic and amoebicidal assays, the effects of honey samples were tested against growth and viability of Acanthamoeba parasites.
Results: Natural honey exhibited potent amoebistatic and amoebicidal effects, in a concentration-dependent manner. Honey-treated Acanthamoeba castellanii showed loss of acanthopodia, following which amoebae detached, rounded up, reduced in size, decreased in cytoplasmic mass and they were observed floating in the culture medium. Importantly, honey-treated amoebae did not revive when inoculated in fresh growth medium, however, glycerol-treated amoebae exhibited viable trophozoite and active growth. In contrast, marketed honey samples varied in their efficacy against Acantha-moeba castellanii. The proportion of flavonoid, as determined by quercetin measurements and the proportion of phenolic, as determined by gallic acid measurements was higher in natural honey compared with marketed honey. Similarly, the antioxidant activity, as determined by 2,2-diphenyl-1-picrylhydrazyl scavenging activity was higher in natural honey vs. marketed honey.
Conclusions: This study shows that natural honey has antiacanthamoebic properties and possesses higher flavonoid, phenolic and antioxidant properties compared with the marketed honey. These findings are of concern to the public, health officials, and to the manufacturers regarding production of honey for medical applications.

Aims: This study focused on new fish feed additives that could supply a nutritional value and inhibit or eliminate mycotoxins. Four novel feed additives, including Albizia lebbeck (L.), Leucaena leucocephala leaf extracts, Serendipita indica and Bacillus megaterium were applied to contaminated fish feed; besides investigating the toxicity of these new fish feed additives. Methodology and results : Our data exhibited that the different tested feed additives were not toxic for brine shrimp larvae or fish. Albizia lebbeck extract at a concentration 0.5% was highly effective in detoxifying mycotoxins with efficacy ratios of 88.01%, 93.89% and 92.89% for aflaB1, aflaG1 and CPA, respectively and L. leucocephala at 0.5% had efficacy ratios of 93.52% and 100% for aflaG1 and CPA, respectively. The addition of S. indica with a concentration of 0.75% was highly effective for the usage of good feed approximately free of mycotoxins, with efficacy ratios of 85.65%, 90.81% and 100% for aflaB1, aflaG1 and CPA, respectively. Moreover, B. megaterium, with a concentration of 0.75% was recommended for detoxification. Conclusion, significance and impact of study Studied new feed additives as feed additives in fish diets to eliminate mycotoxin with the potential of providing antioxidant activity. Results suggest that mycotoxins degradation can happen in vitro and in vivo by applying new fish feed additives in the fish diet.

Background: and Purpose Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. Methods: A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). Results: Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively).However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). Conclusions Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.

Background: s/Aims: No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods: Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018.IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results: Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56–4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19–4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.

Objective: This study investigated the impact of two stimulation protocols using highly purified human menopausal gonadotropin (HP-hMG) on the endocrine profile, follicular fluid soluble Fas levels, and outcomes of intracytoplasmic sperm injection (ICSI) cycles. Methods: This prospective clinical trial included 100 normal-responder women undergoing ovarian stimulation for ICSI; 55 patients received concomitant follicle-stimulating hormone (FSH) plus HP-hMG from the start of stimulation, while 45 patients received FSH followed by HP-hMG during mid/late follicular stimulation. The primary outcome was the number of top-quality embryos. The secondary outcomes were the number and percentage of metaphase II (MII) oocytes and the clinical pregnancy rate. Results: The number of MII oocytes was significantly higher in the concomitant protocol (median, 13.0; interquartile range [IQR], 8.5–18.0 vs. 9.0 [8.0–13.0] in the consecutive protocol; p=0.009); however, the percentage of MII oocytes and the fertilization rate were significantly higher in the consecutive protocol (median, 90.91; IQR, 80.0–100.0 vs. 83.33 [75.0–93.8]; p=0.034 and median, 86.67; IQR, 76.9–100.0 vs. 77.78 [66.7–89.9]; p=0.028, respectively). No significant between-group differences were found in top-quality embryos (p=0.693) or the clinical pregnancy rate (65.9% vs. 61.8% in the consecutive vs. concomitant protocol, respectively). The median follicular fluid soluble Fas antigen level was significantly higher in the concomitant protocol (9,731.0 pg/mL; IQR, 6,004.5–10,807.6 vs. 6,350.2 pg/mL; IQR, 4,382.4–9,418.4; p=0.021). Conclusion Personalized controlled ovarian stimulation using HP-hMG during the late follicular phase led to a significantly lower response, but did not affect the quality of ICSI.

Background: s/Aims: No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods: Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018.IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results: Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56–4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19–4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.

Background: s/Aims: No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods: Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018.IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results: Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56–4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19–4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.