High Frequency of the EMRSA-15 Clone (ST22-MRSA-IV) in Hospital Wastewater

Hospital wastewaters often carry multidrug-resistant bacteria and priority pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA). Pathogens and antibiotic resistance genes present in wastewaters may reach the natural environment facilitating their spread. Thus, we aimed to isolate MRSA from wastewater of 3 hospitals located in the north of Portugal and to characterize the isolates regarding the antimicrobial resistance and genetic lineages. A total of 96 wastewater samples were collected over six months. The water was filtered, and the filtration membrane was immersed in BHI broth supplemented with 6.5% of NaCl and incubated. The inoculum was streaked in ORSAB agar plates for MRSA isolation. The isolates susceptibility testing was performed against 14 antimicrobial agents. The presence of resistance and virulence genes was accessed by PCR. Molecular typing was performed in all isolates. From the 96 samples, 28 (29.2%) were MRSA-positive. Most isolates had a multidrug-resistant profile and carried the mecA, blaZ, aac(6′)-Ie-aph(2″)-Ia, aph(3′)-IIIa, ermA, ermB, ermC, tetL, tetM, dfrA dfrG and catpC221 genes. Most of the isolates were ascribed to the immune evasion cluster (IEC) type B. The isolates belonged to ST22-IV, ST8-IV and ST105-II and spa-types t747, t1302, t19963, t6966, t020, t008 and tOur study shows that MRSA can be found over time in hospital wastewater. The wastewater treatment processes can reduce the MRSA load. The great majority of the isolates belonged to ST22 and spa-type t747 which suggests the fitness of these genetic lineages in hospital effluents.

Video-Urodynamic Characteristics and Predictors of Switching from Botulinum Neurotoxin a Injection to Augmentation Enterocystoplasty in Spinal Cord Injury Patients

Botulinum neurotoxin type A (BoNT-A) injection and augmentation enterocystoplasty (AE) are alternative and effective management strategies for neurogenic detrusor overactivity (NDO) refractory to pharmacotherapy. A great majority of patients with spinal cord injury (SCI) may, however, prefer BoNT-A injections to AE, due to the less invasive characteristics. In this study we evaluated the influence of various video-urodynamic study (VUDS) parameters in SCI patients who continuously received repeat BoNT-A detrusor injections or switched to AE to improve their bladder conditions. We compared the changes in the urodynamic parameters before and after each mode of treatment. In this retrospective study, all SCI patients with refractory NDO who had received at least one BoNT-A injection were enrolled. VUDS was performed before and after both BoNT-A injection and AE. All of the urodynamic parameters of the storage and micturition—including the bladder capacity of every sensation, maximal flow rate (Qmax), post-voiding residual volume, detrusor pressure at Qmax, and bladder contractility index—were recorded. A total of 126 patients, including 46 women and 80 men, with a mean age of 41.8 ± 13.1 years, were recruited for this study. All of the patients receiving either BoNT-A injection or AE had a statistically significant increase of bladder capacity at every time-point during filling and a decrease in detrusor pressure at Qmax during voiding. Patients who switched from BoNT-A to AE had greater improvements in their urodynamic parameters when compared with those who continued with BoNT-A injections. Accordingly, SCI patients receiving BoNT-A injections but experiencing few improvements in their urodynamic parameters should consider switching to AE to achieve a better storage function and bladder capacity.

Reporting characteristics of systematic review abstracts published in the proceedings of the SBPqO meeting

Aim: This study aimed to assess the reporting characteristics of systematic review abstracts published in the proceedings of the Sociedade Brasileira de Pesquisa Odontológica (SBPqO) meeting. Methods: We selected abstracts published in the SBPqO meeting proceedings of 2019 and 2020, mentioning that a systematic review was conducted in the title, objective or methods sections. One researcher performed the screening and the data extraction after a pilot test training. The following data were extracted: affiliation of the primary author, dental specialization, the term “systematic review” mentioned in the title, reporting of the objective, reporting of eligibility criteria, reporting of information sources, reporting of the number of included studies and if a meta-analysis was performed. A descriptive analysis of the data was performed with data summarized as frequencies. Results: We included 235 abstracts. A total of 20 studies were from the Universidade de Uberlândia (8.5%), and the main specialization was Restorative and Esthetic Dentistry, with 47 studies (20%). Most of the studies mentioned the term “systematic review” in the title (n=219; 93.2%) and reported the objective (n=231; 98.3%). A great majority of studies did not report the eligibility criteria (n=97; 41.3%) or it was classified as unclear (n=96; 40.8%). The great majority of studies only reported the databases searched (n=103; 43.8%) or databases and date of search (n=74; 31.5%). Most of the studies reported the number of included studies (n=204; 86.8%). Conclusion: Based on this study, the reporting characteristics of systematic review abstracts published in the proceedings of the SBPqO meeting are satisfactory. However, there is room for improvement.

Low in-hospital mortality rate in patients with COVID-19 receiving thromboprophylaxis: data from the multicentre observational START-COVID Register

COVID-19 infection causes respiratory pathology with severe interstitial pneumonia and extra-pulmonary complications; in particular, it may predispose to thromboembolic disease. The current guidelines recommend the use of thromboprophylaxis in patients with COVID-19, however, the optimal heparin dosage treatment is not well-established. We conducted a multicentre, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe clinical characteristic of patients at admission, bleeding and thrombotic events occurring during hospital stay. The strategies used for thromboprophylaxis and its role on patient outcome were, also, described. 1091 patients hospitalized were included in the START-COVID-19 Register. During hospital stay, 769 (70.7%) patients were treated with antithrombotic drugs: low molecular weight heparin (the great majority enoxaparin), fondaparinux, or unfractioned heparin. These patients were more frequently affected by comorbidities, such as hypertension, atrial fibrillation, previous thromboembolism, neurological disease, and cancer with respect to patients who did not receive thromboprophylaxis. During hospital stay, 1.2% patients had a major bleeding event. All patients were treated with antithrombotic drugs; 5.4%, had venous thromboembolism [30.5% deep vein thrombosis (DVT), 66.1% pulmonary embolism (PE), and 3.4% patients had DVT + PE]. In our cohort the mortality rate was 18.3%. Heparin use was independently associated with survival in patients aged ≥ 59 years at multivariable analysis. We confirmed the high mortality rate of COVID-19 in hospitalized patients in ordinary wards. Treatment with antithrombotic drugs is significantly associated with a reduction of mortality rates especially in patients older than 59 years.

Spectrum and Presentation of Urinary Bladder Growth: a Single-Center Retrospective Study

Introduction: Urinary bladder cancers are heterogeneous diseases consisting of a divergent group of tumors. Diseases of the urinary bladder, both neoplastic and nonneoplastic contribute to notable mortality and morbidity. Histopathology remains the gold standard of diagnosis. Bladder transurethral resection of the tumor is a therapeutic procedure that ensures the material necessary for histopathological diagnosis because it allows assessment of the degree of differentiation, depth of tumor invasion, parameters useful in the elaboration of diagnosis and prognosis assessment Material and Methods: All the urinary bladder biopsies submitted in the pathology laboratory during 1 year time period were included in the study. Results: Among the 51 total cases in the study, the male to female ratio was 4.67:1 with the age group of 22-96 years. Among the study population, 30 (52.7%) presented with hematuria, 10 (19.2%) with burning micturition, frequent urination, and lower abdominal pain. In the study, 44 (86%) showed neoplastic lesions while 7(14%) remaining were non-neoplastic lesions. Infiltrative urothelial carcinoma with low and high grades was diagnosed in 23% (12/51) Conclusions: This study has revealed that neoplastic lesions are more common than non-neoplastic lesions. A great majority of neoplastic lesions are of urothelial origin. Majority of which are invasive urothelial neoplasm. All urothelial neoplasms are more common in males. Cystoscopic studies and biopsies help in the early detection of bladder neoplasms and they form the mainstay of the diagnosis and follow-up.

Medicinal Plants Used in Ethnoveterinary Practices in Adea Berga District, Oromia Region of Ethiopia

In Ethiopia, locally available materials, mainly medicinal plants, are commonly utilized to manage livestock diseases. However, this practice is currently being threatened by several factors including loss of traditional knowledge and depletion of plant resources. This calls for an urgent need to document the ethnoveterinary knowledge in the country and conserve the associated medicinal plants. The purpose of this study was, therefore, to document traditional knowledge on use of medicinal plants in the Adea Berga district, Oromia region of Ethiopia, to manage livestock ailments. Ethnobotanical data were collected largely through semistructured interviews conducted with purposively selected traditional healers of the district. The study identified 59 medicinal plants used in ethnoveterinary practices in the district. The great majority (90.4%) of the medicinal plants were used in fresh forms, which were mainly administered orally. The majority (65.4%) of the medicinal plants were gathered from the wild. Data revealed that yoke sore (wound) had the highest informant consensus factor (ICF) value (1.00), followed by leech infestation (0.92) and endoparasite infections (0.90). The highest fidelity level (FL) (100%) and rank order priority (ROP) (100%) values were obtained for the plants Nicotiana tabacum, Malva parviflora, and Calpurnia aurea that were used to treat leech infestation, retained placenta, and snake poisoning, respectively. Priority for further pharmacological and phytochemical investigations needs to be given to the aforementioned three plants with the highest FL and ROP values as such values may indicate their higher potency against the respective ailments.

Automatic Identification of Addresses: A Systematic Literature Review

Address matching continues to play a central role at various levels, through geocoding and data integration from different sources, with a view to promote activities such as urban planning, location-based services, and the construction of databases like those used in census operations. However, the task of address matching continues to face several challenges, such as non-standard or incomplete address records or addresses written in more complex languages. In order to better understand how current limitations can be overcome, this paper conducted a systematic literature review focused on automated approaches to address matching and their evolution across time. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, resulting in a final set of 41 papers published between 2002 and 2021, the great majority of which are after 2017, with Chinese authors leading the way. The main findings revealed a consistent move from more traditional approaches to deep learning methods based on semantics, encoder-decoder architectures, and attention mechanisms, as well as the very recent adoption of hybrid approaches making an increased use of spatial constraints and entities. The adoption of evolutionary-based approaches and privacy preserving methods stand as some of the research gaps to address in future studies.

The «Empty Forest Syndrome» and the Herpetofaunal Communities in Laos (South-Eastern Asia)

Nowadays, Laos remains one of the scientifically least known countries of Asia in terms of herpetological knowledge. Here, we evaluate composition of species in freshwater ecosystems (main river courses) and terrestrial ecosystems (forests) in two distinct regions using Visual Encounter Surveys along designed transects, examination of fishers’ catches and standardized interviews. In Northern Laos, we recorded only 18 reptile individuals (2 turtle and 1 snake species). Interview surveys demonstrated that in Nam Xam River, fishers are more likely to hunt turtles and we identified one potential site where the world’s rarest turtle, Rafetus swinhoei, could be still present in the wild. In Nam Et Phou Louey National Park, we found 19 reptile species (8 lizard, 10 snake, 1 turtle species) in the different study sites, demonstrating a low species density in all different surveyed habitats. In Central/Southern Laos, we observed 30 species of reptiles (14 snake, 16 lizard, 35 amphibian species). Our study offers preliminary insights into the composition of amphibians and reptiles in Laos. The great majority of the species were non-threatened or not evaluated, and a few were threatened, suggesting that more research is needed to proper understand the conservation status of Laos’ herpetofauna. We highlighted, indirectly by interviews with local fishers, the possible presence of the turtle Rafetus swinhoei, thus providing a new hope for avoiding the extinction of this species. Finally, we observed a relatively low number of species in each habitat type, which is remarkably lower than in tropical forests of other continents or of nearby south-east Asian countries, indicating that the herpetofauna communities in Laos are depleted, reflecting an ‘empty forest syndrome’.

Provision of social-norms feedback to general practices whose antibiotic prescribing is increasing: a national randomized controlled trial

Aim The Chief Medical Officer of England writes an annual social-norms-feedback letter to the highest antibiotic-prescribing GP practices. We investigated whether sending a social-norms-feedback letter to practices whose prescribing was increasing would reduce prescribing. Subject and methods We conducted a two-armed randomised controlled trial amongst practices whose STAR-PU-adjusted prescribing was in the 20th–95th percentiles and had increased by > 4% year-on-year in the 2 previous financial years. Intervention practices received a letter on 1st March 2018 stating ‘The great majority (80%) of practices in England reduced or stabilised their antibiotic prescribing rates in 2016/17. However, your practice is in the minority that have increased their prescribing by more than 4%.’. Control practices received no letter. The primary outcome was the STAR-PU-adjusted rate of antibiotic prescribing in the months from March to September 2018. Results We randomly assigned 930 practices; ten closed or merged pre-trial, leaving 920 practices — 448 in the intervention and 472 in the control. An autoregressive and moving average model of first order ARMA(1,1) correlation structure showed no effect of the intervention (β < −0.01, z = −0.50, p = 0.565). Prescribing reduced over time in both arms (β < −0.01, z = −36.36, p < 0.001). Conclusions A social-norms-feedback letter to practices whose prescribing was increasing did not decrease prescribing compared to no letter. Trial registration NCT03582072.

How to promote the pragmatic awareness and avoid the fossilization phenomenon through a role play activity in English as a foreign language classes

Many people, even after spending a lifetime studying a foreign language are prone to get stuck in a certain grammatical domain no matter the efforts made and the amount of the target language input offered in the classroom. Unfortunately, the great majority who pursuits their dreams to be the closest possible to a native like speaker, the lack of ability to analyze and synthesize linguistic elements makes them persist in the same errors, establishing a phenomenon known as Fossilization in their learning process. In fact, Fossilization can occur in all learning process levels: phonological, grammatical, lexical and pragmatic and the errors made seem to be similar from individual to individual. In an attempt to avoid this Fossilization process concerning the pragmatically ability to communicate, this article aims to present a suggestion of a role-play activity involving strategies to enhance pragmatic awareness related to politeness theory.