Bacterial contamination of multi-use tear drops, gels, and ointments

PURPOSE

This study aimed to investigate the bacterial contamination of multi-use tear drops, gels, and ointments that patients use at home.

METHOD

A total of 271 multi-use containers used by 168 patients were examined. Conjunctival culture samples were obtained from patients who used tear drops, gels, and ointments that were found to be contaminated.

RESULTS

Bacterial contamination was detected in 33 (12.2 %) out of the 271 containers. The contamination rate was 7.9 % in tear drops, 11.7 % in gels, and 32 % in ointments. A statistically significant difference was found between the drops, gels, and ointment groups (P = 0.04). Bacterial contamination was detected in 25 (18.9 %) out of 132 collapsible tubes and 8 (5.8 %) out of 139 plastic bottles (P = 0.01). Important bacteria, including Pseudomonas stutzeri, Pseudomonas aeruginosa, Bacillus licheniformis, Paenibacillus pabuli, Proteus mirabilis, Pantoea agglomerans, Morganella morganii, Serratia marcescens, and Serratia liquefaciens, were detected. Mucorales spp. fungus was seen in a gel. Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus, and M. morganii were found in the conjunctival microbiota of three patients.

CONCLUSION

The overall contamination rate of ocular lubricants was low (12.2%); however, a significant difference was found between the drops, gels, and ointments. The contamination rate was higher in gels and ointments than that in drops. The contamination rate was found to be increased in the collapsible tube. The use of ocular lubricants is safe; however, patients must be cautious when using multi-use tear drops, gels, and ointments to avoid contamination. Whenever possible, bottles should be preferred instead of collapsible tubes.

3D printed Styrax Liquidus (Liquidambar orientalis Miller)-loaded poly (L-lactic acid)/chitosan based wound dressing material: Fabrication, characterization, and biocompatibility results

The medicinal plant of Styrax liquidus (ST) (sweet gum balsam) which extracted from Liquidambar orientalis Mill tree, was loaded into the 3D printed polylactic acid (PLA)/chitosan (CS) based 3D printed scaffolds to investigate its wound healing and closure effect, in this study. The morphological and chemical properties of the ST loaded 3D printed scaffolds with different concentrations (1 %, 2 %, and 3 % wt) were investigated by Scanning Electron Microscopy (SEM) and Fourier Transform Infrared Spectroscopy (FT-IR), respectively. In addition, the mechanical and thermal properties of the materials were investigated by Tensile test and Differential Scanning Calorimetry (DSC), respectively. The antimicrobial activities of the ST loaded 3D printed scaffolds and their incubation media in the PBS (pH 7.4, at 37 °C for 24 h) were investigated on two Gram-positive and two Gram-negative standard pathogenic bacteria with the agar disc diffusion method. The colorimetric MTT assay was used to determine the cell viability of human fibroblast cells (CCD-1072Sk) incubated with free ST, ST loaded, and unloaded 3D printed scaffolds. The 1 % and 2 % (wt) ST loaded PLA/CS/ST 3D printed scaffolds showed an increase in the cell number. Annexin V/PI double stain assay was performed to test whether early or late apoptosis was induced in the PLA/CS/1 % ST and PLA/CS/2 % ST loaded groups and the results were consistent with the MTT assay. Furthermore, a wound healing assay was carried out to investigate the effect of ST loaded 3D printed scaffolds on wound healing in CCD-1072Sk cells. The highest wound closure compared to the control group was observed on cells treated with PLA/CS/1 % ST for 72 h. According to the results, novel biocompatible ST loaded 3D printed scaffolds with antimicrobial effect can be used as wound healing material for potential tissue engineering applications.

Gut microbiota-derived metabolite trimethylamine N-oxide and biomarkers of inflammation are linked to endothelial and coronary microvascular function in patients with inflammatory bowel disease

BACKGROUND

Inflammatory bowel disease (IBD), which is an umbrella term used for ulcerative colitis (UC) and Crohn's disease (CD), is associated with an increased risk for atherosclerotic cardiovascular disease (CVD). We aimed to investigate the association of local and systemic biomarkers of inflammation and gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) with endothelial and coronary microvascular dysfunction in IBD.

METHODS

A total of 56 patients with IBD (20 with UC and 36 with CD) and 34 age and gender matched controls were included. For all participants, samples were collected to analyze faecal calprotectin, and TMAO concentrations. Ultrasound-based examinations were done to measure flow-mediated vasodilatation (FMD) and coronary flow velocity reserve (CFVR).

RESULTS

Patients with IBD had lower CFVR (2.07 (1.82-2.40)) and FMD (8.7 ± 3.7) as compared to controls (2.30 (2.07-2.74), p = 0.005 and 11.9 ± 6.8, p = 0.03). In patients with IBD, TMAO concentration (r = -0.30, p = 0.03), C-reactive protein (r = -0.29, p = 0.03) and WBC count (r = -0.37, p = 0.006) had a significant negative correlation with CFVR, and TMAO (β = -0.27, 95 % CI: -0.23 to -0.02) and WBC count (β = -0.31, 95 % CI: -0.56 to -0.06) were significant predictors of CFVR after multivariate adjustment. None of the biomarkers of inflammation or TMAO showed significant correlations with FMD. In patients with UC, TMAO showed a significant correlation with both CFVR (r = -0.55, p = 0.01) and FMD (r = -0.60, p = 0.005) while only WBC count had a statistically significant correlation with CFVR (r = -0.49, p = 0.004) in patients with CD.

CONCLUSIONS

Gut microbiota-derived metabolite TMAO and biomarkers of systemic inflammation are associated with measures of endothelial/coronary microvascular dysfunction in patients with IBD.

Bacterial contamination of multi-use antibiotic steroid eye ointments and drops

PURPOSE

This comprehensive prospective study aimed to investigate the bacterial contamination of antibiotic steroid eye ointments and drops frequently used by eye patients.

METHOD

In this comprehensive prospective study, a total of 410 multi-use topical eye medications containing 15 different ingredients from 22 pharmaceutical companies used by 185 patients were analyzed. Four groups were formed as follows: group 1: antibiotic ointments (n: 109); group 2: antibiotic drops (n: 103); group 3: steroid ointments (n: 67); and group 4: steroid drops (n: 131). Topical multi-use eye drops and ointments used by patients at home for at least 1 week were randomly collected. The caps and contents were separately bacteriologically examined in a chocolate agar medium.

RESULTS

Our study detected bacterial contamination in 23 containers (5.6%) of the total 410 topical drugs. According to the groups, bacterial contamination was detected in 10 of 67 (14.9%) steroid ointments, 6 of 109 (5.5%) antibiotic ointments, 4 of 131(3.1%) steroid drops, and 3 of 103 (2.9%) antibiotic drops. While the bacterial contamination rate in ointments was 9.1%, this rate was 3% in drops. The difference between them was statistically significant (p = 0.015). According to the post-hoc pairwise comparisons, the difference between steroid drops and steroid ointment (p = 0.0023) was statistically significant. Among all drugs, contamination was detected in 12 of the 93 (12.9%) containers used after keratitis, conjunctivitis, and inflammatory conditions. It was determined that preservatives statistically reduced bacterial growth on the cap. The preservatives did not have a statistically significant effect on the bacterial contamination of the contents compared to the caps. While all contaminations were detected in illiterate and primary school graduates, no contamination was seen in the drugs used by any secondary school or university graduate.

CONCLUSION

Our study detected contamination in all topical ophthalmic drug groups. Contamination rates were found to be higher in ointments and steroids. Bacterial contamination was also seen in drugs containing preservatives. We should be careful in the use of topical medications. We do not recommend the bilateral use of ointments and drops in infected eyes, such as those with keratitis, or after intraocular surgeries, such as those for cataracts.

A comparison of machine learning algorithms in predicting COVID-19 prognostics

ML algorithms are used to develop prognostic and diagnostic models and so to support clinical decision-making. This study uses eight supervised ML algorithms to predict the need for intensive care, intubation, and mortality risk for COVID-19 patients. The study uses two datasets: (1) patient demographics and clinical data (n = 11,712), and (2) patient demographics, clinical data, and blood test results (n = 602) for developing the prediction models, understanding the most significant features, and comparing the performances of eight different ML algorithms. Experimental findings showed that all prognostic prediction models reported an AUROC value of over 0.92, in which extra tree and CatBoost classifiers were often outperformed (AUROC over 0.94). The findings revealed that the features of C-reactive protein, the ratio of lymphocytes, lactic acid, and serum calcium have a substantial impact on COVID-19 prognostic predictions. This study provides evidence of the value of tree-based supervised ML algorithms for predicting prognosis in health care.

Can Hemogram Parameters Predict a Positive PCR Result in COVID-19?

Objective: Quick diagnosis of COVID-19 has been an important factor to manage the ongoing pandemic at hospitals and other health facilities. We aimed to investigate the effects of PCR test on hemogram parameters in COVID-19 patients. Materials and Methods: We collected hemogram data of 120 nasopharyngeal and oropharyngeal combo swab PCR positive and 119 PCR negative patients admitted to our hospital’s COVID-19 clinics with COVID-19 symptoms between 1 April 2020 and 24 June2020. Results: Age, MPV and NLR were found to be higher; hemoglobin, neutrophil, lymphocytes, basophil, platelet, PCT, WBC levels were lower in PCR positive cases. The highest sensitivity, 75 % is found on WBC count with cut off 7.15. Conclusion:Lower leukocyte count than 7.15, lower neutrophil count than 4.91, greater NLR than 2.95, lower platelet than 221.5 may give an idea about the diagnosis of SARS-CoV-2 infection. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 391-397

Can Hemogram Parameters Predict a Positive PCR Result in COVID-19?

Objective: Quick diagnosis of COVID-19 has been an important factor to manage the ongoing pandemic at hospitals and other health facilities.We aimed to investigate the effects of PCR test on hemogram parameters in COVID-19 patients. Materials and Methods: We collected hemogram data of 120 nasopharyngeal and oropharyngeal combo swab PCR positive and 119 PCR negative patients admitted to our hospital’s COVID-19 clinics with COVID-19 symptoms between 1 April 2020 and 24 June2020. Results: Age, MPV and NLR were found to be higher; hemoglobin, neutrophil, lymphocytes, basophil, platelet, PCT, WBC levels were lower in PCR positive cases.The highest sensitivity, 75 % is found on WBC count with cut off 7.15. Conclusion: Lower leukocyte count than 7.15, lower neutrophil count than 4.91, greater NLR than 2.95, lower platelet than 221.5 may give an idea about the diagnosis of SARS-CoV-2 infection. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.118-124

Lactococcus lactis spp lactis infection in infants with chronic diarrhea: two cases report and literature review in children

Lactococcus lactis is a gram-positive, facultative anaerobic coccus that is occasionally isolated from human mucocutaneous surfaces such as the intestines. It is used in the dairy industry for milk acidification and is mostly nonpathogenic in immunocompetent humans, however a number of cases of infection with L. lactis have been reported in recent years. In this article, we describe two cases of infection due to L. lactis in patients with chronic diarrhea. The first case is a five-month-old boy who was operated on for volvulus on his first day of life and had ileostomy with subsequent diagnosis of chronic diarrhea and bacteremia due to L. Lactis. The second case is a six-month-old girl with the diagnosis of chronic diarrhea that developed after a catheter-related bloodstream infection. Both of the infections due to L. Lactis spp lactis were successfully treated with intravenous vancomycin therapy. Although Lactococcus species is mostly known as nonpathogenic, it should be kept in mind as a potential pathogen, especially in patients with gastrointestinal disorders.