All Articles

P Batra¹, P Mathur^1*, M. C. Misra², M Kumari¹, O Katoch¹, F Hasan¹

¹JPNATC, Department of Lab Medicine, All India Institute of Medical Sciences, New Delhi, India

²Department of Surgery, Mahatma Gandhi University of Medical Sciences & Technology, Rajasthan, India

Ventilator Associated Pneumonia (VAP) is the most commonly acquired ICU infection worldwide affecting nearly 10-30% of ventilated patients and accounting for nearly 25% of all types of ICU infections. VAP has been associated with increased morbidity, mortality, duration of ICU stay, duration of mechanical ventilation and nearly 50% of the ICU antibiotic prescription. After understanding the pathogenesis of VAP, various preventive measures have been tried by various authors. The currently accepted preventive measures are being used in most centres as the VAP prevention bundle. This includes: elevation of the head of the bed between 30^oand 45^o, daily sedation interruption and assessment of readiness to extubate, daily oral care with Chlorhexidine, peptic ulcer disease prophylaxis and deep vein thrombosis prophylaxis. In the current manuscript, we will be discussing the available preventive measures. Other measures which have been shown to be effective include selective oropharyngeal and digestive tract decontamination, use of antimicrobial coated ET tubes. However, more studies need to be done to see if these can be included in the VAP prevention bundle.

Junaid Jibran Jawed, Subrata Majumdar*

Division of Molecular Medicine, P-1/12, C.I.T. Scheme VII-M, Kolkata-700054, West Bengal, India

Leishmaniasis is a spectrum of disease caused by the infection of protozoan parasite Leishmania mainly affecting the antigen presenting cell of the host. The disease is although considered as neglected tropical disease still it is not completely eradicated. Majority of the issues related to the therapeutic approach is due to increased cytotoxicity of the drugs, less effectiveness, high cost and occurrence of drug resistance. Therefore, recent advancement in the field of parasitology has taken into consideration of the specific arms of immunity which can be triggered with the help of natural products, synthetic molecules or parasite specific ligands which helps in the restoration of host protective immunity and recovery from the infection. Therefore, in this review, we have highlighted the recent advancement in the field of Leishmania research taken into consideration of the therapeutic perspective. We have shown that apart from therapeutic potential of the available drugs and vaccination approach, the immune-therapy are emerging as the modern regime of treatment where the effectiveness of the therapy is significantly increased and making it safer and promising.

Vas Dev*

Senior Scientist (Retired), National Institute of Malaria Research, New Delhi, India

Long-lasting insecticidal nets are being promoted as evidence-based intervention for malaria vector control globally. In keeping with increased procurement and supplies, it was mandated to monitor and evaluate field-distributed nets for residual bio-efficacy and physical integrity. Towards this objective, a simplified study protocol is proposed which can be conveniently employed to assess the current bio-efficacy to help programme officials making informed decisions for additional logistics enabling net replacement in due time.

Albert Anastasio*, Kevin Farley

Emory University School of Medicine, Atlanta, Georgia, USA

Gyanshankar P. Mishra^1*, Jasmin D. Mulani²

¹Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

²Department of Biochemistry, Government Medical College, Nagpur, Maharashtra, India

Recently the report of the first National Anti-Tuberculosis Drug Resistance Survey (NDRS) from India was released on the occasion of World TB Day this year, i.e., 24th March 2018. The salient features were as follows: 1. MDR-TB is 6.19% (CI 5.54–6.90%) among all TB patients with 2.84% (CI 2.27–3.50%) among new and 11.60% (CI 10.21–13.15%) among previously treated TB patients. 2. Among MDR-TB patients, additional resistance to any fluoroquinolones was 21.82% (17.33–26.87%), and 3.58% (1.8–6.32%) to any second-line injectable drugs. 3. Among MDR-TB patients, additional resistance to at least one drug from each of the two classes, i.e., fluoroquinolone and second-line injectable drugs (XDR-TB) was 1.3% (0.36–3.30%). 4. Any first- or second line drug resistance among all TB patients is 28.0% (CI 26.77– 29.29%) with 22.54% (CI 21.10–24.10%) among new and 36.82% (CI 34.64–39.04%) among previously treated TB patients. 5. Any isoniazid resistance is 11.06% (CI 9.97–12.22%) and 25.09% (CI 23.1–-27.11%) among new and previously treated TB patients, respectively. 6. Any pyrazinamide resistance is 6.95% (CI 6.07–7.91%) and 8.77% (7.53–10.13%) among new and previously treated TB patients, respectively. The current article reviews the findings of the survey along with their practical implications in the present-day clinical scenario.

Mesele Damte Argaw^1,2*, Thandisizwe Redford Mavundla², Binyam Fekadu Desta^1,2, Wondwosen Shiferaw Abera¹, Kassa Daka Gidebo³, Temesgen Ayehu Bele⁴, Dereje Dillu⁴

¹USAID Transform: Primary Health Care, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia

²University of South Africa, Department of Health Studies, Pretoria, South Africa

³Welaita Sodo University, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo, Ethiopia

⁴Federal Ministry of Health, Addis Ababa, Ethiopia

Tanise V. Dalmolin^1,2, Daiana de Lima-Morales¹, Afonso L. Barth^1,2*

¹LABRESIS – Laboratório de Pesquisa em Resistência Bacteriana, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil

²Programa De Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

Polymyxins (polymyxin E/colistin and polymyxin B) are considered the last-resort therapy against carbapenem-resistant Enterobacterales; however, the resistance of Enterobacterales to polymyxins is increasing worldwide. Until 2015, this resistance was related to chromosomal mutations, but in November 2015, it was described in China the transferable colistin resistance in animals and humans isolates of E. coli and K. pneumoniae, mediated by the mcr-1 gene (mobile colistin resistance), located in a plasmid. Following the first description of the mcr-1 gene, it has been reported in several regions of the world, in different bacterial species, from different sources and others mcr variants have been described. Moreover, the co-occurence of the mcr gene and other antimicrobial resistance genes was reported. This discovery changed the scenario of resistance to polymyxins, as this gene could be promptly disseminated among Gram negative bacilli becoming a major concern for public health. This review summarizes recent data about the plasmid-borne mcr colistin resistance gene.

Erik De Clercq*

Rega Institute for Medical Research, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium

Harish C Gugnani*

Retd. Professor & Head, Division of Medical Mycology, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

Prahlad Rai Gupta*

Shalby Multispeciality Hospital, Jaipur, India

Arshad Altaf*

World Health Organization, Western Pacific Region, Manila, Philippines

Ashok Kuwal^1*, Naveen Dutt², Nishant Chauhan²

¹Department of Respiratory Medicine, Pacific Institute of Medical Sciences, India

²Department of Pulmonary Medicine, AIIMS Jodhpur, India

Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality among patients undergoing hematopoietic stem cell transplant (HSCT). The majority of cases are detected during the period of neutropenia (following conditioning regimen) or immunosuppression (treatment of graft versus host disease). Development of IPA after one-year post- HSCT is extremely rare. Here, we report a case of a 43-year-old male who developed IPA two years after an allogenic stem cell transplant and 406 days after stopping the immunosuppressive medication.

Jorge L Zirulnik*, Maria Sol Retamar, Hector M Perez

HIV/Infectious Diseases Division, JA Fernandez Hospital, Buenos Aires, Argentina

Aurora Brønstad*

Department of Clinical medicine, University of Bergen, Bergen, Norway

Eun-Jung Kim*

Department of Nursing, Pyeongtaek University, Gyung-gi, Korea

Background: This study will analyze the existing studies and provide the basis for immunity and immune duration that can be obtained by prophylactic chemotherapy.

Methods: Based on the data of the patients who take preventive chemotherapy (taking group) and those who do not (non-taking group), cost benefit analysis is conducted considering the direct and indirect benefits obtained by taking malaria treatment.

Results: The results of economic evaluation of preventive use of malaria chemoprophylaxis that higher malaria incidence rates of non-taking groups showed a (+) positive value for the NPV, a CBR of greater than 1 (1.34), so economically viable vaccine with a high benefit per cost.

Conclusion: Chemoprophylaxis could be cost-effective if the incidence of non-taking group in the risk area is maintained above 50%. Therefore, it will be possible to block the incidence of malaria in the future through analysis of the trend of incidence of malaria, and to inform the effect of the chemoprophylaxis method through educational and public relations activities.

Licia Torres^1#, Vinicius Dantas Martins^2#, Ana Maria Caetano Faria², Tatiani Uceli Maioli^1,2*

¹Departamento de Nutrição, Programa de Pós-Graduação em Nutrição e Saúde, Universidade Federal de Minas Gerais, Brazil

²Programa de Pós-Graduação em Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Brazil

^#Both authors contributed equally

The number of overweight people worldwide is steadily growing. Obesity has become a serious health problem even in developing countries where infectious diseases are still highly prevalent. However, the interactions between these two conditions are still unclear. It is known that, during obesity, lipid deposits induce metabolic alterations associated with increased pro-inflammatory status, which disrupts the body hemostasis and could impair the immune responses against microorganisms. Moreover, studies in humans and animal models with infectious diseases have demonstrated that obesity usually correlates with increased susceptibility to bacterial, viral and protozoa parasite infections. In this mini-review, we will discuss some few studies that characterized the interactions between obesity and infections to clarify why obesity-associated inflammation results in impaired protective immunity.

Guillermo Enrique Ramos*

Department of Intensive Care Medicine, Argerich Hospital, Buenos Aires City, Argentina

As nosocomial infections in burn patients are prevalent and dangerous, systemic antibiotic prophylaxis has been considered, beside other interventions. However, this kind of therapy has been questioned due to controversy related to its effectiveness and complications, such as drug toxicity and development of multidrug-resistance. This review includes evidence reported during the period 1966-2016. The quality of evidence and strength of recommendation of these guidelines are based on the GRADE system. Early post-burn prophylaxis showed no effectiveness for toxic shock syndrome or burn wound infection prevention (Grade 1C) in non-severe burn patients but it could be useful for those who had severe burns and require mechanical ventilation (Grade 2B). Perioperative prophylaxis would neither have indications for wound cleaning nor for devitalized tissue debridement of most burn patients (Grade 2B), but there is not enough evidence to make a strong recommendation to those who have extensive burns. Finally, prophylaxis could be used to prevent skin graft infections in selected procedures (Grade 2B).