An Understanding of the Drivers of Infectious Diseases in the Modern World Can Aid Early Control of Future Pandemics

Green Synthesis of Silver Nanoparticles with Extracts from Kalanchoe fedtschenkoi: Characterization and Bioactivities

In this work, the hexane, chloroform, and methanol extracts from Kalanchoe fedtschenkoi were utilized to green-synthesize silver nanoparticles (Kf1-, Kf2-, and Kf3-AgNPs). The Kf1-, Kf2-, and Kf3-AgNPs were characterized by spectroscopy and microscopy techniques. The antibacterial activity of AgNPs was studied against bacteria strains, utilizing the microdilution assay. The DPPH and H2O2 assays were considered to assess the antioxidant activity of AgNPs. The results revealed that Kf1-, Kf2-, and Kf3-AgNPs exhibit an average diameter of 39.9, 111, and 42 nm, respectively. The calculated ζ-potential of Kf1-, Kf2-, and Kf3-AgNPs were -20.5, -10.6, and -7.9 mV, respectively. The UV-vis analysis of the three samples demonstrated characteristic absorption bands within the range of 350-450 nm, which confirmed the formation of AgNPs. The FTIR analysis of AgNPs exhibited a series of bands from 3500 to 750 cm-1, related to the presence of extracts on their surfaces. SEM observations unveiled that Kf1- and Kf2-AgNPs adopted structural arrangements related to nano-popcorns and nanoflowers, whereas Kf3-AgNPs were spherical in shape. It was determined that treatment with Kf1-, Kf2-, and Kf3-AgNPs was demonstrated to inhibit the growth of E. coli, S. aureus, and P. aeruginosa in a dose-dependent manner (50-300 μg/mL). Within the same range, treatment with Kf1-, Kf2-, and Kf3-AgNPs decreased the generation of DPPH (IC50 57.02-2.09 μg/mL) and H2O2 (IC50 3.15-3.45 μg/mL) radicals. This study highlights the importance of using inorganic nanomaterials to improve the biological performance of plant extracts as an efficient nanotechnological approach.

Isolation of Endophytic Fungus from Leaves of Uncaria cordata (Lour.) Merr and Antibacterial Activity Against Propionibacterium acnes and Escherichia coli

Uncaria cordata (Lour). Merr (akar kaik-kaik) is one of the medicinal plants used as antibacterial because it contains bioactive compounds that can inhibit the growth of microorganisms. The plant is one of the sources of endophyte fungal isolates that can be developed as an alternative to producing antibacterial compounds. This research aimed to isolate the endophytic fungus from the leaves of U. cordata and know the antibacterial activity against Propionibacterium acnes and Escherichia coli by disc diffusion. The Fungi that were isolated from the leaves of U. cordata were 17 isolates. The isolates were continued for antibacterial activity testing: IFED 1 (Nigrospora sp.), IFED 2 (Aspergillus sp.), IFED 3 (Fusarium sp.), and IFED 4, whose genus was unknown. The results obtained were fungal isolates IFED 1 to IFED 4 had activity in inhibiting the growth of P. acnes with moderate category (18.16 mm) and weak categories (6.21, 6.16, and 6.68 mm) and in E. coli with moderate category (14.56 mm) and weak categories (6.53, 6.71, and 7.23 mm). The results of One-Way ANOVA and Tukey's test showed a significant difference (p <0.05) between the diameter of the inhibition zone with the type of endophytic fungus supernatant isolated from the leaves of U. cordata. The best isolate of endophytic fungi inhibiting P. acnes and E. coli bacteria was IFED 1 (Nigrospora sp).

Medication Adherence and Compliance: Recipe for Improving Patient Outcomes

The indices of patients’ health outcomes have historically included recurrence of symptoms, number of emergency visits, hospitalization and re-admission rates, morbidity, and mortality. As significant healthcare players, providers can influence these events, including the timeliness of diagnosis and disease management, the cost of treatment, access to health insurance, and medication adherence. Beyond healthcare availability and access, the ability of patients to adhere to providers’ treatment recommendations goes a long way to serve as a recipe for improving patient outcomes. Unfortunately, medication nonadherence has been prevalent, culminating in worsened health conditions, increased cost of care, and increased healthcare spending. This article provides some innovative ideas and good considerations for encouraging medication adherence. Improving providers’ and patients’ education and adopting active and passive communication, including consented reminders, could enhance compliance. Embracing partnerships between providers’ organizations and faith-based and community organizations could drive adherence. Adopting an income-based cap on out-of-pocket spending and adapting the physical properties, bioavailability, and dosage regimen of medications to accommodate diverse patient population preferences could encourage refills and compliance. Good medication adherence can culminate in improved patient outcomes.

An Unusual Presentation of Clostridioides Difficile Colitis in a Patient on Opioids

Clostridioides difficile colitis is an inflammation of the colon due to toxins produced by a gram-positive bacterium called Clostridioides difficile (also known as Clostridium difficile). Clostridioides difficile colitis is associated with an increased risk of morbidity and mortality in elderly patients. The infection develops because of the disruption of the microbiome that usually suppresses the overgrowth of Clostridioides difficile. Testing for Clostridium difficile infection is routinely recommended in patients with at least three loose bowel movements in a day. We present an unusual case of a 74-year-old woman on chronic opioids who presented with a three-day history of lower abdominal pain, constipation, hematochezia, with no diarrhea. Radiologic imaging showed evidence of colitis, and the patient was found to have Clostridium difficile colitis.

Correlation between Carbapenem Consumption and Carbapenems Susceptibility Profiles of Acinetobacter baumannii and Pseudomonas aeruginosa in an Academic Medical Center in Thailand

The emergent issue of carbapenem-resistant Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) is a major problem in Thailand. The wide use of carbapenems can increase selective pressure of bacterial resistance. The objective of this study was to determine the relationship between carbapenem consumption and the susceptibility rates of A. baumannii and P. aeruginosa, including multi-drug resistance (MDR) strains. This was a retrospective study. Carbapenem consumption and susceptibility profiles were collected from 2007 to 2013 at the Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Thailand. We found that the susceptibility rate of A. baumannii to imipenem and meropenem from the sputum and the bronchoalveolar lavage (BAL) specimens was significantly decreased during the study period, but no significant change was found in the P. aeruginosa data. The relationship between carbapenem consumption and the susceptibility rate of A. baumannii had a clear association with the use of ertapenem. We found a statistically significant negative correlation between ertapenem consumption and the susceptibility rate of A. baumannii to imipenem (r = −0.91; p = 0.004) and meropenem (r = −0.97; p = 0.000) in the data from the non-ICU wards. In addition, imipenem use had a moderate negative correlation with the MDR P. aeruginosa data but no statistical significance (r = −0.714; p > 0.05). In conclusion, our study suggested there is an association between carbapenem use and the susceptibility of A. baumannii and P. aeruginosa. Notwithstanding this, information on ecological factors should be considered for further study. These findings showed the need to optimize the carbapenem prescription policy. Avoiding carbapenem overuse and rethinking the appropriate initial therapy might decrease the rate of resistant organisms.