Background: Antimicrobial resistance has emerged as a global public health challenge, leading to higher mortality rates from infections that were once treatable with antibiotics. In this study, we assessed the susceptibility of Escherichia coli strains isolated from clinical samples to carbapenems and fluoroquinolones and screened for genetic determinants mediating resistance. Materials and Methods: This retrospective study included 46 E. coli isolates retrieved from the stock culture collection at the Molecular Biology and Biotechnology Department of the Nigerian Institute of Medical Research.Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and molecular techniques were employed to detect genetic determinants of antimicrobial resistance. Results: The E. coli isolates exhibited high resistance to fluoroquinolones, with 72% resistant to ciprofloxacin and 52% to levofloxacin. Resistance to carbapenems was relatively low, with 4% resistant to imipenem and 11% to meropenem. The prevalence of the genetic determinants gyrA, gyrB, and parC, which mediate fluoroquinolone resistance, was 26%, 24%, and 15%, respectively. bla OXA-48 and bla NDM , which mediate carbapenem resistance, were detected in only two isolates. Some isolates harbored plasmids ranging from 5 kb to 16 kb; however, no plasmidmediated genetic determinants conferring fluoroquinolone resistance were identified. Conclusion This study revealed a high level of resistance to fluoroquinolones, emphasizing the need for judicious use of antibiotics, particularly those with low resistance rates. Continuous surveillance is essential to monitor emerging trends in resistance among bacterial pathogens.

Background: Antimicrobial resistance has emerged as a global public health challenge, leading to higher mortality rates from infections that were once treatable with antibiotics. In this study, we assessed the susceptibility of Escherichia coli strains isolated from clinical samples to carbapenems and fluoroquinolones and screened for genetic determinants mediating resistance. Materials and Methods: This retrospective study included 46 E. coli isolates retrieved from the stock culture collection at the Molecular Biology and Biotechnology Department of the Nigerian Institute of Medical Research.Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and molecular techniques were employed to detect genetic determinants of antimicrobial resistance. Results: The E. coli isolates exhibited high resistance to fluoroquinolones, with 72% resistant to ciprofloxacin and 52% to levofloxacin. Resistance to carbapenems was relatively low, with 4% resistant to imipenem and 11% to meropenem. The prevalence of the genetic determinants gyrA, gyrB, and parC, which mediate fluoroquinolone resistance, was 26%, 24%, and 15%, respectively. bla OXA-48 and bla NDM , which mediate carbapenem resistance, were detected in only two isolates. Some isolates harbored plasmids ranging from 5 kb to 16 kb; however, no plasmidmediated genetic determinants conferring fluoroquinolone resistance were identified. Conclusion This study revealed a high level of resistance to fluoroquinolones, emphasizing the need for judicious use of antibiotics, particularly those with low resistance rates. Continuous surveillance is essential to monitor emerging trends in resistance among bacterial pathogens.

Background: Antimicrobial resistance has emerged as a global public health challenge, leading to higher mortality rates from infections that were once treatable with antibiotics. In this study, we assessed the susceptibility of Escherichia coli strains isolated from clinical samples to carbapenems and fluoroquinolones and screened for genetic determinants mediating resistance. Materials and Methods: This retrospective study included 46 E. coli isolates retrieved from the stock culture collection at the Molecular Biology and Biotechnology Department of the Nigerian Institute of Medical Research.Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and molecular techniques were employed to detect genetic determinants of antimicrobial resistance. Results: The E. coli isolates exhibited high resistance to fluoroquinolones, with 72% resistant to ciprofloxacin and 52% to levofloxacin. Resistance to carbapenems was relatively low, with 4% resistant to imipenem and 11% to meropenem. The prevalence of the genetic determinants gyrA, gyrB, and parC, which mediate fluoroquinolone resistance, was 26%, 24%, and 15%, respectively. bla OXA-48 and bla NDM , which mediate carbapenem resistance, were detected in only two isolates. Some isolates harbored plasmids ranging from 5 kb to 16 kb; however, no plasmidmediated genetic determinants conferring fluoroquinolone resistance were identified. Conclusion This study revealed a high level of resistance to fluoroquinolones, emphasizing the need for judicious use of antibiotics, particularly those with low resistance rates. Continuous surveillance is essential to monitor emerging trends in resistance among bacterial pathogens.

BACKGROUND: When critically ill patients require specialized treatment that exceeds the capability of the index hospitals, patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care. Therefore, appropriate and efficient care for patients during the process of transport between two hospitals (interfacility transfer) is an essential part of patient care. While medical adverse events may occur during the interfacility transfer process, there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport. METHODS: We conducted searches from the PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and Scopus databases up to June 2022. Two reviewers independently screened the titles and abstracts for eligibility. Studies that were not in the English language and did not involve critically ill patients were excluded. RESULTS: The search identified 75 articles, and we included 48 studies for our narrative review. Most studies were observational studies. CONCLUSION: The review provided the current evidence-based management of diverse disease states during the interfacility transfer process, such as proning positioning for respiratory failure, extracorporeal membrane oxygenation (ECMO), obstetric emergencies, and hypertensive emergencies (aortic dissection and spontaneous intracranial hemorrhage).

Objective: To determine the adverse effect of pre- and postnatal exposure to carbamate (propoxur) and pyrethroid pesticides on children's cognitive functions at 4 and 6 years of age. Method: As part of a prospective cohort study among children with known pre- and postnatal exposure to propoxur and pyrethroids, children were examined at time points, 4 and 6 years, to determine the adverse effect of pesticide exposure on neurocognitive function, i.e., intelligence (IQ) using the WPPSI-III test. Pre- and postnatal pesticide exposures were measured by meconium and hair analysis, respectively, using gas chromatography-mass spectrometry (GCMS). Results: Seven hundred twenty-four (724) maternal/children dyads were seen at four years and 717 at six years of age. Their mean (SD) full-scale IQ was low on average: 83.9 (10.2) at four years and 83.6 (8.6) at six years. Prenatal but not postnatal exposure to propoxur (-0.139, p=0.01) and pyrethroids (-0.097, p=0.05) were significantly correlated (negative) with full-scale IQ at four years but not at six years. The confounders that were significantly correlated to full-scale IQ at four and/or six years of age were maternal IQ, child’s weight, height, head circumference, socio-economic status, child environment, and stimulation at home (HOME) violence or abuse at home. Regression analysis of pesticides and confounders showed similar results, except for weight and head circumference. Conclusion We conclude that prenatal exposure to propoxur and pyrethroids had a negative effect on the children’s IQ at four years but no longer at six years. Thus, the ability of the child’s IQ to recover from the adverse effect of intrauterine pesticide insult may be attributable to the neuronal plasticity of its brain. Similarly, confounders to these outcome measures are multiple and are essential to address when evaluating the effect of pesticides on neuro-cognitive development in children.
carbamate

BACKGROUND:When critically ill patients require specialized treatment that exceeds the capability of the index hospitals,patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care.Therefore,appropriate and effi cient care for patients during the process of transport between two hospitals(interfacility transfer)is an essential part of patient care.While medical adverse events may occur during the interfacility transfer process,there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport.METHODS:We conducted searches from the PubMed,Cumulative Index of Nursing and Allied Health(CINAHL),and Scopus databases up to June 2022.Two reviewers independently screened the titles and abstracts for eligibility.Studies that were not in the English language and did not involve critically ill patients were excluded.RESULTS:The search identified 75 articles,and we included 48 studies for our narrative review.Most studies were observational studies.CONCLUSION:The review provided the current evidence-based management of diverse disease states during the interfacility transfer process,such as proning positioning for respiratory failure,extracorporeal membrane oxygenation(ECMO),obstetric emergencies,and hypertensive emergencies(aortic dissection and spontaneous intracranial hemorrhage).

Cell clusters are a histological hallmark feature of intervertebral disc degeneration. Clusters arise from cell proliferation, are associated with replicative senescence, and remain metabolically, but their precise role in various stages of disc degeneration remain obscure. The aim of this study was therefore to investigate small, medium, and large size cell-clusters. For this purpose, human disc samples were collected from 55 subjects, aged 37–72 years, 21 patients had disc herniation, 10 had degenerated non-herniated discs, and 9 had degenerative scoliosis with spinal curvature <45°.15 non-degenerated control discs were from cadavers. Clusters and matrix changes were investigated with histology, immunohistochemistry, and Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Data obtained were analyzed with spearman rank correlation and ANOVA. Results revealed, small and medium-sized clusters were positive for cell proliferation markers Ki-67 and proliferating cell nuclear antigen (PCNA) in control and slightly degenerated human discs, while large cell clusters were typically more abundant in severely degenerated and herniated discs. Large clusters associated with matrix fissures, proteoglycan loss, matrix metalloproteinase-1 (MMP-1), and Caspase-3. Spatial association findings were reconfirmed with SDS-PAGE that showed presence to these target markers based on its molecular weight.Controls, slightly degenerated discs showed smaller clusters, less proteoglycan loss, MMP-1, and Caspase-3. In conclusion, cell clusters in the early stages of degeneration could be indicative of repair, however sustained loading increases large cell clusters especially around microscopic fissures that accelerates inflammatory catabolism and alters cellular metabolism, thus attempted repair process initiated by cell clusters fails and is aborted at least in part via apoptosis.

Chronic Painful Temporomandibular Disorders (TMD) are challenging to diagnose and manage due to their complexity and lack of understanding of brain mechanism. In the past few decades' neural mechanisms of pain regulation and perception have been clarified by neuroimaging research. Advances in the neuroimaging have bridged the gap between brain activity and the subjective experience of pain. Neuroimaging has also made strides toward separating the neural mechanisms underlying the chronic painful TMD. Recently, Artificial Intelligence (AI) is transforming various sectors by automating tasks that previously required humans' intelligence to complete. AI has started to contribute to the recognition, assessment, and understanding of painful TMD. The application of AI and neuroimaging in understanding the pathophysiology and diagnosis of chronic painful TMD are still in its early stages. The objective of the present review is to identify the contemporary neuroimaging approaches such as structural, functional, and molecular techniques that have been used to investigate the brain of chronic painful TMD individuals. Furthermore, this review guides practitioners on relevant aspects of AI and how AI and neuroimaging methods can revolutionize our understanding on the mechanisms of painful TMD and aid in both diagnosis and management to enhance patient outcomes.
Humans ; Facial Pain/diagnostic imaging* ; Artificial Intelligence ; Temporomandibular Joint Disorders/diagnostic imaging* ; Neuroimaging/methods* ; Pain Measurement/methods*

PURPOSE: Spinal injuries resulting in neurological damage cause significant morbidity. Swift neurosurgical intervention can mitigate negative outcomes. However, variable mechanisms of injury may be associated with inappropriate transport (IAT), which may delay necessary surgical interventions. Patients with near shore spinal injuries (NSSI) presented with unique mechanisms, so we investigated factors associated with IAT in patients with NSSI. METHODS: We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006 - 2017. We excluded patients transferred to other facilities, and those not injured in the water. Primary outcome was IAT, defined as patients with NSSI requiring transfer to another trauma center. To avoid heterogeneity in our analysis, we further excluded patients without NSSI who were inappropriately transported to a level I trauma center. We used multivariable logistic regression to assess association of independent variables (such as demographic, environmental, and clinical factors) with outcome. RESULTS: We analyzed 278 patients with suspected NSSI, and found 14 (5.0%) had IAT. Compared to appropriately transported patients, diving was associated with higher percentages of IAT (28.6% vs. 3.9%, p = 0.014) and more were transported by air (50.0% vs. 20.6%, p = 0.01). In multivariable regression, patients' oxygenation saturation (odds ratio [OR] = 0.8, 95% confidence intervals [CI]: 077-0.98) and diving (OR = 7.5, 95% CI: 1.2-46) were significantly associated with IAT. CONCLUSION Rate of IAT for patients with NSSI was low. However, first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.

Background: To determine patient factors that lead to treatment of meniscal tears with osteoarthritis (OA) with knee arthroscopy (KA) or physical therapy only (PT-only); and to assess differences in clinical outcomes including the time to knee arthroplasty. Methods: Patients aged ≥ 45 years with OA at meniscal tear diagnosis were followed up from the date of surgery (KA) or first PT visit (PT-only) until partial/total knee replacement surgery, death, disenrollment, or end of study. Demographic and clinical characteristics were compared and used to derive propensity scores. A Cox proportional hazards model was used to estimate the risk of knee replacement surgery and greater healthcare utilization associated with KA vs. PT-only. Results: Among 7,026 patients (KA, 69%; PT-only, 31%), 27% had partial or total knee replacement surgery during follow-up.PT-only patients were older and more likely to be women and had more comorbidities. After accounting for differences between groups, the cumulative incidence of knee replacement was modestly but significantly higher for those who received KA than those who underwent PT-only (hazard ratio, 1.30; 95% confidence interval, 1.17–1.44; p < 0.001), although there was no significant difference in health service utilization, narcotic medication dispenses, or knee injections after initiating treatment. Conclusions For patients with meniscal damage complicated by OA, those who underwent KA were 30% more likely to have partial or total knee replacement surgery at any given time than those who had PT alone.