bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychometric Properties of the Turkish Version of the 42 Item Depression Anxiety Stress Scale (Dass-42) in a Clinical Sample
Authors: Hekimoglu Levent , Altun Zeren Ozturk , Kaya Emine Zeynep , Bayram Nuran , Bilgel Nazan
Published: February 2013

Objective:

To study the psychometric properties of the Turkish translation of the Depression Anxiety and Stress Scale (DASS-42) in a clinical group.

Methods:

Outpatients diagnosed with anxiety ( n = 138; mean age = 44.5 years; 74.6% female) or depression ( n = 112; mean age = 46.2 years; 77.7% female) from the psychiatric outpatient clinic of a public hospital were evaluated. A group of non-clinical volunteers ( n = 250; mean age = 37 years; 68% female) served as a community group for comparison. The participants completed the Turkish versions of the DASS-42, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).

Results:

The structure of the DASS-42 was analyzed in the clinical sample using principal components extraction. The three-factor solution accounted for 56% of the total variance, with eigenvalues of 17.6, 3.0, and 2.6. The range of factor loadings was 0.55–0.85 for depression, 0.47–0.62 for anxiety, and 0.49–0.74 for stress. The Cronbach alpha values for the DASS depression, anxiety, and stress subscales were 0.94, 0.88, 0.94 respectively. The concurrent validity of the DASS was satisfactory. The non-clincal participants scored lower on all three subscales than the individuals in all of the clinical groups.

Conclusion:

The Turkish version of the DASS-42 appears to be an excellent instrument for measuring features of depression, hyperarousal, and tension in clinical groups.
Anxiety and Depression Symptoms in Patients with Dengue Fever and Their Correlation with Symptom Severity
Authors: Hashmi Ali M. , Butt Zeeshan , Idrees Zaidan , Niazi Mehreen , Yousaf Zohaib , Haider Syed Furqan , Bhatti Muhammad R.
Published: February 2013

Objective:

To study the prevalence of anxiety and depression symptoms in patients with Dengue and to examine their correlation with symptom severity.

Methods:

In this cross sectional study, 531 consecutive patients who met the World Health Organization criteria for Dengue fever admitted to Mayo Hospital, Lahore between September and November 2011 were administered the Hospital Anxiety and Depression Scale (HADS). In addition to the HADS, the severity of their symptoms, like headache, myalgias/ arthralgias, fever, and retro/periorbital pain, was assessed on a 3-point scale (mild, moderate, and severe).

Results:

About 60% of the patients in our study met the criteria for anxiety and 62.2% of the patients met criteria for depression. Severity of fever, headache, myalgias and arthralgias, and retro/periorbital pain was positively correlated with both anxiety (Correlation coefficients: 0.148, 0.247, 0.184, 0.184 respectively and P < 0.01 for all) and depression scores (Correlation coefficients: 0.098, 0.154, 0.131, 0.125 respectively and P value < 0.01 for all). The strongest correlation was found between severity of headache and scores for both anxiety and depression. Both mean anxiety and depression scores were significantly higher in patients with platelet count below median (30,000/mm3) than in patients with platelet count above median (9.1 ± 4.7 vs 8.2 ± 4.7, P < 0.03, and 9.5 ± 4.5 vs 8.5 ± 4.5, P < 0.01, respectively).

Conclusion:

A majority of patients with Dengue have anxiety and depression symptoms. Psychiatric evaluation should be done in all Dengue patients so timely treatment can be initiated.
Cost-Efficiency of Laboratory Testing among Psychiatric Inpatients
Authors: Lopez-Castroman J. , Blasco-Fontecilla H. , Paz-Yepes M. , Montoya-Ferrer A. , De Leon-Martinez V. , Alvarez R. , Baca-Garcia E.
Published: February 2013

Background:

A set of tests to rule out medical conditions among psychiatric inpatients is still to be defined. A first step in this direction is to determine the utility of lab tests commonly used by psychiatrists.

Methods:

Biochemical tests have been routinely performed on inpatients in a psychiatric hospitalization unit from 2006 to 2009. This study examines the prevalence of abnormal values in 1,278 laboratory tests performed on 894 patients. The number of subjects screened and the direct expenditure needed to find results outside the normal range were computed. Differences in clinical profiles were compared between diagnostic groups according to main diagnosis.

Results:

We found high rates of seropositive patients for human immunodeficiency virus (14.3%) and hepatitis B virus (15.7%). Most patients met at least one criteria of metabolic syndrome (67.6%). The detection of hepatic abnormalities was very efficient (65.7I%), particularly for patients diagnosed with alcohol use disorders.

Conclusions:

The cost-efficiency of lab tests in psychiatric units is greatly variable. Though results of this study may not be generalized due to the different prevalence of medical conditions, the methodology can be easily implemented across psychiatric services. Cost-effectiveness and costbenefit analyses are warranted.
Hypohidrotic Ectodermal Dysplasia: A Multidisciplinary Approach
Authors: Bildik Tezan , Ozbaran Burcu , Kose Sezen , Koturoglu Guldane , Gokce Bulent , Gunaydin Asli , Altintas Inci
Published: February 2013

Hypohidrotic ectodermal dysplasia (HED; Christ-Siemens-Touraine syndrome) is a genetic disorder characterized by sparse hair, oligodontia with peg-shaped teeth, reduced sweating, and defects in a number of other ectodermal organs. A partial or complete absence of eccrine glands can lead to recurrent severe overheating that may cause seizures and neurological deficits. This clinical report presents a 14-year-old male patient with hypohidrotic ectodermal dysplasia, including the clinical and radiographic findings, and multidisciplinary treatment. The Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) was administered to patient along with mother to assess for any psychiatric disorders. The screening and rating scales completed by mother and two teachers to evaluate the severity of attention deficit hyperactivity disorder (ADHD) symptoms, and other behavioral problems. Patient's academic performance, adaptive functioning, and problem behavior was evaluated using The Teacher Report Form. Mental capacity was assessed with the Wechsler Intelligence Scale for Children (WISC-R). Illness Perception Questionnaire Revised was used to systematically assess illness representation attributes and emotional representations of illness. On the psychiatric diagnosis assessment using K-SADS-PL sub-threshold attention deficits and anxiety symptoms were determined. In this case we established a multidisciplinary approach in his treatment with pediatric, dermatological, and dental examinations, beside his psychiatric evaluation. The prosthetic rehabilitation included restoring upper teeth with copings and fabrication of upper and lower complete dentures. Metal framework was not incorporated in the partial denture design allowing modifications as the oral and maxillofacial development continued. Removable complete or partial dentures without metal framework is a treatment of choice until the completion of facial growth at which definitive treatment is considered.
Age and Remission of Personality Pathology in the Psychotic Disorders Compared to Mood and/or Anxiety Disorders
Authors: Zhang Tianhong , Good Mary-Jo D. , Good Byron J. , Chow Annabelle , Wang Lanlan , Dai Yunfei , Xiao Zeping
Published: February 2013

In order to explore age-related differences in personality pathology between psychotic disorder (PSD) and mood and/or anxiety disorder (MAD) among psychiatric outpatients, 2,354 subjects were sampled randomly from outpatients in Shanghai and divided into two groups: PSD ( N = 951) and MAD ( N = 1403). Dimensional scores for personality disorder (PD) traits were assessed by using a self-reported personality diagnostic questionnaire (PDQ4+). Significant age differences were observed in most of the PD traits in MAD patients. Cluster B and C PD traits displayed an apparent decrease with age in MAD group, but such decline trend was not evident in PSD group. In both groups, the decline of self-reported Cluster A PD traits were less visible than the other clusters. Age-related mellowing of some PD traits such as “dramatic, erratic, anxious” occurred primarily in MAD patients; however the same traits in PSD patients appear to be less resistant to aging. Besides, “old eccentric” PD traits in both MAD and PSD patients seem to be maintained and less modified by aging.
A Survey of Anxiety and Depression Symptoms among Primary-Care Physicians in China
Authors: Shen Liang-Liang , Lao Li-Min , Jiang Sun-Fang , Yang Hua , Ren Li-Min , Ying Derek Gard-Ching , Zhu Shan-Zhu
Published: February 2013

Objective:

Anxiety and depression disorder are the most prevalent mental health problems. However, few studies are available pertaining to these problems among Chinese doctors, especially the assessment of the anxiety and depression symptoms among primary-care providers. The aim of this study was to assess the anxiety and depression symptoms among Chinese primary-care physicians and their associated factors.

Methods:

A cross-sectional study was conducted among 451 primary-care physicians in Shanghai China (effective response rate was 79.8%). There were 177 male physicians and 274 female physicians with average age of 37.8 ( SD ± 11.1) years. Questionnaire pertaining to depression disorder was indicated by the Zung Self-Rating Depression Scale (SDS) and anxiety disorder was indicated by the Zung Self-Rating Anxiety Scale (SAS).

Results:

The average SAS and SDS standard scores of the primary-care physicians were 41.1 ± 11.5 and 46.5 ± 11.8 respectively. Both of the scale scores were higher than those of Chinese national norms ( P both < 0.001). SDS standard score ⩾ 53 and SAS standard score ⩾ 50 were regarded as screening-positive criteria. SAS and SDS screening positive rates of primary-care physicians were 18.0% and 31.7% respectively. In addition, married/cohabited and divorced/widowed physicians aged over 30 years with educational background of junior college had higher risks of anxiety and depression disorders.

Conclusions:

Chinese primary-care physicians were at considerably high risk of anxiety and depression disorders, which was worthy of attention during healthcare system reform in China.
Reducing Major Depression in Children at High Risk: Opportunities for Prevention
Authors: Keller Gary A. , Gottlieb Diane T.
Published: February 2013

Objective:

The profound negative impact of a parent's Major Depressive Disorder (MDD) on his or her children is of increasing concern to public health and mental health professionals. Children of a depressed parent have a markedly elevated risk for psychiatric illness, including a fourfold increased risk for MDD. The objective is to examine the scientific literature for ways to reduce this high risk to the offspring. First, we consider the relation between effective treatment of a parent's depression and reduced risk to the offspring, and review the effectiveness of treatments for adult MDD. We then review emerging evidence that risk for psychopathology can be reduced in children of depressed parents by preventive intervention, including targeting two pathways hypothesized as links between parental MDD and offspring psychopathology: parenting skills and child coping.

Data Sources:

Three 5-year PubMed searches, and a Cochrane Database search, and one Medline and two PsycLit searches (to 1970) were completed (search words in combinations included: depression, prevention, treatments, depression in families, family interaction, adolescents).

Study Selection:

Randomized controlled studies are included, and review studies and meta-analyses are highlighted to provide a critical overview of the considerable scientific literatures for specific steps that can be taken to reduce the high risk of depression to the offspring of parents with MDD.

Results:

A deliberate clinical focus on better treatment of MDD in parents is clearly needed and has the potential additional benefit of reducing psychopathology in their children. Altering clinical treatment to address MDD “co-occurring” in both parent and child is supported by the scientific literature. There is also good evidence that preventive intervention with high-risk adolescents reduces the incidence of MDD. Targeting parenting skills and teaching children how to better cope with a parent's illness that they cannot control, appears to reduce MDD in the offspring.
Analysis of associated diseases in patients with acute critical lower limb ischemia
Authors: Manojlovic Vladimir , Popovic Vladan , Nikolic Dragan , Milosevic Djordje , Pasternak Janko , Kacanski Milos
Published: February 2013

Introduction. Acute critical lower limb ischemia refers to the state of
severely impaired vitality of lower limbs due to acute occlusion of arterial
blood vessel by a thrombus or emboli. Surgical revascularization in the first
6-12 hours after the onset of symptoms gives the best results. However, a
high mortality rate and probability of limb loss make this problem more
debatable, and can be related with associated diseases. Material and Methods.
This research included 95 patients who had been operated within the first 12
hours after the onset of symptoms of critical limb ischemia. We collected the
following data: age and sex of patients, etiology of limb ischemia, type of
operation, associated diseases and outcome of treatment. Results and
Discussion. Most of the patients were 70 to 80 years old, both sexes being
equally represented. There was significantly more arterial embolism (70%)
than thrombosis on the prior arterial lesion. Most of the embolizations were
treated with Fogarty balloon catheter embolectomy (98%); however, a great
number of arterial thrombosis demanded more complex ?inflow? and ?outflow?
ensuring procedures such as thromboendarterectomy and bypass (33%). The
performed surgical procedures showed no statistical differences when final
outcome was analyzed. Amputation had to be performed in about 3% of the
patients and all of them were diabetics. Mortality rate in this research was
10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy
and metabolic decompensation. Conclusion. Acute critical lower limb ischemia
should be treated surgically as soon as possible. Negative outcomes are
associated with comorbidity and general condition of the patient.
The Virtual Close and Continuous Monitoring at Cisco
Authors: O'Leary Daniel E.
Published: February 2013

This case analyzes the implementation of a virtual close and continuous monitoring capability at Cisco. Cisco was among the first firms to implement such a system capability. This case traces the development of that virtual close capability and monitoring system through technology changes, accounting process changes, changes in accounting policies, implementation of standard accounting artifacts, and reorganization of the accounting and finance functions, and examines some of the resulting payoffs. The case also examines some of the limitations of the system. In addition, the case examines how expectations of these capabilities may have resulted in a class action suit against Cisco. The case is appropriate for accounting information system and business courses that examine issues related to enterprise resource planning systems. The case also can be used to address issues such as reengineering the finance function and potential control needs in a virtual close environment.
The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010
Authors: Stark Casagrande Sarah , Fradkin Judith E. , Saydah Sharon H. , Rust Keith F. , Cowie Catherine C.
Published: February 2013

OBJECTIVE

To determine the prevalence of people with diabetes who meet hemoglobin A1c (A1C), blood pressure (BP), and LDL cholesterol (ABC) recommendations and their current statin use, factors associated with goal achievement, and changes in the proportion achieving goals between 1988 and 2010.

RESEARCH DESIGN AND METHODS

Data were cross-sectional from the National Health and Nutrition Examination Surveys (NHANES) from 1988–1994, 1999–2002, 2003–2006, and 2007–2010. Participants were 4,926 adults aged ≥20 years who self-reported a previous diagnosis of diabetes and completed the household interview and physical examination (n = 1,558 for valid LDL levels). Main outcome measures were A1C, BP, and LDL cholesterol, in accordance with the American Diabetes Association recommendations, and current use of statins.

RESULTS

In 2007–2010, 52.5% of people with diabetes achieved A1C <7.0% (<53 mmol/mol), 51.1% achieved BP <130/80 mmHg, 56.2% achieved LDL <100 mg/dL, and 18.8% achieved all three ABCs. These levels of control were significant improvements from 1988 to 1994 (all P < 0.05). Statin use significantly increased between 1988–1994 (4.2%) and 2007–2010 (51.4%, P < 0.01). Compared with non-Hispanic whites, Mexican Americans were less likely to meet A1C and LDL goals (P < 0.03), and non-Hispanic blacks were less likely to meet BP and LDL goals (P < 0.02). Compared with non-Hispanic blacks, Mexican Americans were less likely to meet A1C goals (P < 0.01). Younger individuals were less likely to meet A1C and LDL goals.

CONCLUSIONS

Despite significant improvement during the past decade, achieving the ABC goals remains suboptimal among adults with diabetes, particularly in some minority groups. Substantial opportunity exists to further improve diabetes control and, thus, to reduce diabetes-related morbidity and mortality.
Second-Order Model and Capacity Drop at Merge
Authors: Parzani Celine , Buisson Christine
Published: February 2013

This study deals with the modeling of merge sections from a macroscopic point of view. It is well known that the first-order macroscopic model is not able to reproduce the capacity drop, that is, the fact that the maximal throughput just downstream of a merge is lower after the onset of congestion than just before. Second-order models, such as the one proposed recently by Bastin and Haut, claim to be able to reproduce this observed feature. The ability of this second-order model, chosen for its generality, to reproduce the capacity drop was studied by using numerical investigations. Definitions of the capacity drop are reviewed and some of the experimental observations are reported. The latest attempts to model the capacity drop are presented. Then the chosen model is presented briefly, and its numerical resolution is detailed. The study's main contribution can then be developed. From numerical experiments, it is shown that the studied approach allows the definition of a new framework for capacity drop modeling. Its limitations are also explored.
Stochastic Extension of Newell's Three-Detector Method
Authors: Laval Jorge A. , He Zhengbing , Castrillon Felipe
Published: February 2013

A stochastic extension of Newell's three-detector method is presented. The method predicts the traffic states at an intermediate location given boundary data from downstream and upstream detectors. The method presented takes into account day-to-day variations in the arrivals, sensor detection errors, and variability in the fundamental diagram parameters. The output is the probabilistic distribution of predicted cumulative counts, which can be used to obtain confidence bounds on any traffic variable. The method is tested with empirical data.
Time-Variant Travel Time Distributions and Reliability Metrics and Their Utility in Reliability Assessments
Authors: Alvarez Patricio , Hadi Mohammed
Published: February 2013

Several metrics of reliability have been recommended for use. These metrics may need to be calculated at relatively fine levels of aggregation of travel time data when used for advanced management strategies and transportation system modeling and analysis. This study investigates the variation of travel time distributions by time of day at fine temporal aggregation levels, the sensitivity of various reliability metrics to these variations, the effect of the aggregation level choices on the calculated metrics, and the amount of data required to estimate stable values of the reliability metrics. The investigation is made for a facility that has general purpose lanes and high-occupancy-toll lanes. The results show that the parameters of travel time distributions vary during the peak period, reflecting the effects of traffic congestion, traffic flow dynamics, and how much nonrecurrent factors, such as incidents, contribute to the unreliability of travel time on the investigated facility. Trends of variations are observed when reliability metrics are used to assess reliability as the congestion level changes during the peak period. The results also show that examining combinations of time-variant static distribution parameters and reliability metrics of the general purpose and high-occupancy-toll lanes can provide valuable information that cannot be obtained when the analysis is performed at higher aggregation levels. The study results suggest using at least one year of data to obtain stable values of reliability metrics.
Multianticipative Piecewise-Linear Car-Following Model
Authors: Farhi Nadir , Haj-Salem Habib , Lebacque Jean-Patrick
Published: February 2013

An extension of the piecewise-linear car-following model to multianticipative driving is proposed. As in the one-car-anticipative model, the stability and the stationary regimes are characterized through a variational formulation of the car dynamics. The homogeneous driving case is studied here, and it is shown that with the stationary regime the multianticipative model guarantees the same macroscopic behavior as that for the one-car anticipative model. Nevertheless, in transient traffic, the variance in car velocities and accelerations is mitigated by the multianticipative driving, and the car trajectories are smoothed. A parameter identification of the model is made on the basis of NGSIM data and using a piecewise-linear regression approach.
Exploring Properties of Networkwide Flow–Density Relations in a Freeway Network
Authors: Saberi Meead , Mahmassani Hani S.
Published: February 2013

The objective of this study is to investigate the properties of network-level traffic flow relationships in a freeway network with the use of commonly available loop detector data. The impact of the spatial and temporal distribution of congestion in a selected network on the shape and properties of the flow–density relation is investigated, with emphasis on the formation and characterization of hysteresis patterns. Accordingly, a path-dependent characterization of hysteresis patterns in freeway networks is introduced and illustrated conceptually as well as through empirical observations. Comparison of the spatial and temporal distribution of congestion throughout a selected subnetwork on different days suggests a relationship between the size of the hysteresis loop and the inhomogeneity of the traffic distribution. The maximum network average flow is not a constant value but varies across different days. In addition, for the same value of average network occupancy, the variation of occupancy is higher during the recovery period compared with the loading period. The observed large variation in network occupancy during recovery implies the formation of fragmented queues and traffic instability. A chaotic pattern is also to be expected in the networkwide flow–occupancy plane when the spatial distribution of link densities is inhomogeneous and the average network occupancy remains consistently high and roughly unchanged for successive time intervals. Overall, the study results provide a deeper understanding of the properties of networkwide relations on freeway networks.
Home Blood Pressure Measurement Lead to Improved Blood Pressure Control
Authors: Uddin Mohammad Farhad , Sohel Qamrul Huda Mohammed , Rahman Farzana
Published: February 2013

DOI: http://dx.doi.org/10.3329/cbmj.v1i2.13867 Community Based Medical Journal Vol.1(2) 2012 63-68
Role of Phenothiazines and Structurally Similar Compounds of Plant Origin in the Fight against Infections by Drug Resistant Bacteria
Authors: Dastidar Sujata , Kristiansen Jette , Molnar Joseph , Amaral Leonard
Published: February 2013

Phenothiazines have their primary effects on the plasma membranes of prokaryotes and eukaryotes. Among the components of the prokaryotic plasma membrane affected are efflux pumps, their energy sources and energy providing enzymes, such as ATPase, and genes that regulate and code for the permeability aspect of a bacterium. The response of multidrug and extensively drug resistant tuberculosis to phenothiazines shows an alternative therapy for the treatment of these dreaded diseases, which are claiming more and more lives every year throughout the world. Many phenothiazines have shown synergistic activity with several antibiotics thereby lowering the doses of antibiotics administered to patients suffering from specific bacterial infections. Trimeprazine is synergistic with trimethoprim. Flupenthixol (Fp) has been found to be synergistic with penicillin and chlorpromazine (CPZ); in addition, some antibiotics are also synergistic. Along with the antibacterial action described in this review, many phenothiazines possess plasmid curing activities, which render the bacterial carrier of the plasmid sensitive to antibiotics. Thus, simultaneous applications of a phenothiazine like TZ would not only act as an additional antibacterial agent but also would help to eliminate drug resistant plasmid from the infectious bacterial cells.
The Role of F-Box Proteins during Viral Infection
Authors: Correa Régis , Bruckner Fernanda , De Souza Cascardo Renan , Alfenas-Zerbini Poliane
Published: February 2013

The F-box domain is a protein structural motif of about 50 amino acids that mediates protein–protein interactions. The F-box protein is one of the four components of the SCF (SKp1, Cullin, F-box protein) complex, which mediates ubiquitination of proteins targeted for degradation by the proteasome, playing an essential role in many cellular processes. Several discoveries have been made on the use of the ubiquitin–proteasome system by viruses of several families to complete their infection cycle. On the other hand, F-box proteins can be used in the defense response by the host. This review describes the role of F-box proteins and the use of the ubiquitin–proteasome system in virus–host interactions.
The plastid genome of the hornwort Nothoceros aenigmaticus (Dendrocerotaceae): Phylogenetic signal in inverted repeat expansion, pseudogenization, and intron gain
Authors: Villarreal Juan Carlos , Forrest Laura Lowe , Wickett Norman , Goffinet Bernard
Published: February 2013

• Premise of the study: The previously sequenced plastome of the hornwort Anthoceros angustus differs from that of other bryophytes by an expanded inverted repeat (IR) and the presence of a type I intron in the 23S ribosomal RNA (rrn23) gene. We assembled the plastome of the hornwort Nothoceros aenigmaticus, contrasted its architecture to that of other bryophytes, and assessed the phylogenetic significance of genomic characters in hornwort evolution.

• Methods: The Nothoceros plastome was reconstructed from shotgun sequencing of genomic DNA. Comparison with the Anthoceros plastome revealed three structural differences. We sequenced these regions in taxa spanning the hornwort phylogeny.

• Key results: The Nothoceros plastome is colinear with other bryophyte plastomes, but differs from the Anthoceros plastome by several gene regions located within the IR in Anthoceros being in the large single‐copy region in Nothoceros, by the rrn23 gene lacking an intron, and by the rpl2 being a pseudogene. Comparisons across the hornwort phylogeny indicate that the first two characters are restricted to Anthocerotaceae, while rpl2 pseudogenization diagnoses the sister lineage to Anthocerotaceae.

• Conclusions: The Nothoceros plastome is structurally similar to that of most bryophytes. However, we identified more structural differences within hornworts than have been described within either the mosses or the liverworts. The distribution of the gene duplication involving the IR and an intron in the rrn23 gene are restricted to Anthocerotaceae. Occurrence of the intron and the conserved intron sequence between Anthoceros and distantly related chlorophyte algae may be due to horizontal gene transfer.
Detection of Cronobacter spp. (formerly Enterobacter sakazakii) from medicinal plants and spices in Syria
Authors: Belal Mouhammad , Al-Mariri Ayman , Hallab Lila , Hamad Ibtesam
Published: February 2013

Introduction: Cronobacter spp. (formerly Enterobacter sakazakii) is an emerging food-borne pathogen that causes severe meningitis, sepsis, and necrotizing enterocolitis in neonates and infants. These infections have been reported from different parts of the world. The epidemiology and reservoir of Cronobacter spp. are still unknown, and most strains have been isolated from clinical specimens and from a variety of foods, including cheese, meat, milk, vegetables, grains, spices, and herbs. Methodology: Our study aimed to detect and isolate Cronobacter spp. from different Syrian samples of spices, medicinal herbs and liquorices, depending on the pigment production and biochemical profile of isolates and PCR technique. This PCR method, which provides a powerful tool for rapid, specific, and sensitive detection of Cronobacter spp., is considered a reliable alternative to traditional bacteriological methods. Results and conclusions: This study revealed that the percentage of Cronobacter spp. was 94%, 52%, and 32% in liquorice, spices and medicinal herbs, respectively. In addition, it assured that the optimal enhancing growth temperature was 44°C, and optimal enhancing growth pH was 5.
Insight and educational intervention concerning hepatitis among roadside barbers and their clients in Karachi, Pakistan
Authors: Shahid Anjum , Nasim Sadia , Memon Ashfaque Ahmed
Published: February 2013

Introduction: This study aimed to determine perceptions of hepatitis and make available an educational intervention session regarding the infection among roadside barbers and their clients. Methodology: A cross-sectional study using convenience random sampling technique was conducted on all barbers and one each of their clients during January to June, 2011, in Karachi, Pakistan.  After informed consent was taken and confidentiality ensured, respondents answered an anonymous questionnaire of closed-ended questions regarding hepatitis. The interview was followed by an educational intervention session. Data was analyzed using SPSS version 17. Results: About 51% and 32% of the barbers and clients respectively had knowledge regarding hepatitis. Razors were recognized as agents for transmitting the infection by 12% and 42% of the barbers and clients respectively. Most (96%) barbers disinfected the razor before use and 49% of the clients confirmed that the razor was sterilized before shaving, while 79% insisted on new blade. Though 50% and 30% of the barbers and clients respectively knew that hepatitis is a preventable disease, only 2% and 7% of the respective barbers and clients were vaccinated against Hepatitis B. Reasons for not being vaccinated were non-awareness and cost of the HBV vaccine. Only half of the barbers and clients considered themselves to be at risk for hepatitis. Conclusions: In Karachi, barbers and clients have poor knowledge of hepatitis and the means of transmissions, as well as low vaccination rates against HBV infection. Hence barbers and their clients must be educated about hepatitis and its prevention.
Seroprevalence of antibodies (IgG) to Taenia solium among pig rearers and associated risk factors in Jos metropolis, Nigeria
Authors: Weka Rebecca Paul , Ikeh Eugene I , Kamani Joshua
Published: February 2013

Introduction: In Nigeria, Taenia solium cysticercosis is a problem in rural areas where most pigs are kept and in urban areas where infected pork can be consumed. Methodology: We performed enzyme linked immunosorbent assays on serum samples collected from pig rearers in Jos, Nigeria, to determine the prevalence of IgG antibodies. Results: Of 125 subjects tested, 12 (9.6%) were positive for T. solium. Seroprevalence did not differ significantly (P>0.05) according to education, age, occupation, study location, gender or whether the subjects consumed pork. However, a statistical difference (P<0.05) in seroprevalence was observed according to type and availability of toilet used, personal hygiene after using the toilet, and type of pig management practiced. Females were about two times more likely to be seroprevalent than males (OR=1.7; 95% CI= 0.43-6.67; P=0.4) and subjects who consumed pork were four times more likely to have anti T. solium antibodies than those who did not eat pork (OR=4.2; 95%CI=0.52-33.57; P=0.2). Those who defecated in the bush were 8.3 times more likely to suffer from T. solium infection than those who used water system toilets (OR=8.3; 95%CI=1.56-43.7; P=0.01). Subjects who did not wash their hands after defecating were 6 times more likely to contract T. solium compared to those who washed their hands with water ( OR=5.5; 95% CI=1.39-21.89; P=0.01). Conclusion: Our results show that using a toilet and practicing good personal hygiene can reduce cases of T. solium infection in a community.
Genotypic characterization of Egypt enterotoxigenic Escherichia coli isolates expressing coli surface antigen 6
Authors: El-Gendy Atef M , Mansour Adel , Shaheen Hind I , Monteville Marshall R , Armstrong Adam W , El-Sayed Nasr , Young Sylvia Y. N , Klena John D
Published: February 2013

Introduction: One approach to control enterotoxigenic Escherichia coli (ETEC) infections has been to develop vaccines focused on inducing protective immunity against surface expressed antigenic factors. One such factor is coli surface antigen 6 (CS6); ETEC isolates expressing CS6 may also simultaneously co-express surface antigens CS4 or CS5. However, there is little information regarding the inter-relationships of isolates expressing the CS6 antigen alone or in combination with CS4 or CS5. Methodology: A total of 62 CS6-associated ETEC isolates were evaluated for their antimicrobial susceptibility, mechanisms of resistance, toxin genes, colonization factor expression, and XbaI-pulsed-field gel electrophoretic profiles. Results: We observed 46 XbaI profiles; 31 were exclusive to ETEC expressing CS6 alone and 15 among the ETEC co-expressing CS4 or CS5. Nearly half (47%) of these isolates were resistant to ampicillin, a third (37%) of the isolates were resistant to trimethoprim-sulfamethoxazole, and 24% of the isolates were tetracycline-resistant. A blaTEM gene was detected in 24 (83%) ampicillin-resistant isolates. Trimethoprim-sulfamethoxazole-resistant isolates (n = 23) carried either sulI (n = 1, 4%), sulII (n = 8, 35%) or both genes (n = 10, 43%); 4 had no detectable sul gene. Conclusions: Our results show a lack of clonality among Egypt CS6 E. coli isolates and supports the use and the further research on vaccines targeting this cell surface antigen.
Characterization of Streptococcus pneumoniae isolates from India with special reference to their sequence types
Authors: Shariff Malini , Choudhary Jyoti , Zahoor Shazia , Deb Monorama
Published: February 2013

Introduction: Streptococcus pneumoniae is a major cause of mortality and morbidity in young children and the elderly. In the present study we evaluated antimicrobial susceptibilities, serotypes, and sequence types of pneumococcal isolates recovered in New Delhi, India. Methodology: A total of 126 clinical isolates of Streptococcus pneumoniae were investigated. They were subjected to disk diffusion susceptibility testing, broth microdilution testing, serotyping and multilocus sequence typing. Results: Broth microdilution assay showed that 5%, 20% and 23% of the isolates exhibited resistance to penicillin, erythromycin and ciprofloxacin, respectively. Serotypes19, 1 and 6 were more frequently isolated. Thirty per cent of the strains were comprised of serotypes 1, 3, 5, 19A and 7F, which are not included in the seven-valent vaccine. Fifty-nine isolates were typed using multilocus sequence typing. Thirty new sequence types were encountered in this study. Only one clonal complex with 4 isolates was seen; 11 clonal complexes and 96 sequence types (STs) were observed among 115 Indian isolates. Only 18 of the 96 STs were found globally, of which only 4 STs were found in many countries with larger numbers. Conclusions: This study identifies the non-vaccine serotypes of Streptococcus pneumoniae circulating in India. It is important that an appropriate vaccine which covers all serotypes is used in the region.
Serratia marcescens: an unusual pathogen associated with snakebite cellulitis
Authors: Subramani Parimala , Narasimhamurthy Gokul Bindiganavile , Ashokan Bhaskaran , Madappa Beena Prasavangada
Published: February 2013

This study reports a case of Serratia marcescens cellulitis following a snakebite in a 50-year-old woman. The bite was on the dorsum of the right hand with symptoms of envenomation. She developed swelling and cellulitis with tissue necrosis. Wound debridement was performed.  Pus and tissue biopsy cultures yielded Serratia marcescens sensitive to fluoroquinolones, aminoglycosides, third-generation cephalosporins and carbapenems. The patient responded to anti-snake venom (ASV) therapy, ciprofloxacin, local wound management and recovered uneventfully.
Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis
Authors: Kavuncuoğlu Sultan , Gürsoy Semra , Türel Özden , Aldemir Esin Yildiz , Hoşaf Emine
Published: February 2013

Introduction: We aimed to determine the incidence, etiology, risk factors and outcome of bacterial meningitis in neonates. Methodology: Neonates who developed bacterial meningitis between 2003 and 2010 in a tertiary hospital in Turkey were included in the study. Patients born in our hospital were defined as Group 1 and patients referred from other centres were defined as Group 2. Patients with evidence of congenital infections or central nervous system malformations were excluded. Demographic features, delivery type, time of onset of meningitis, co-morbidities, clinical features, blood and cerebrospinal fluid (CSF) analysis, cranial sonographic findings, and outcome of patients were recorded. Results: The study comprised 325 meningitis cases identified from 38,023 hospitalised patients in the neonatology unit among 11,8091 live births. Mean gestational age, birth weight, and hospital stay were 36.8±3.7 weeks, 2.480±924 g, and 26±12.4 days, respectively. Almost half (48%) of the patients were diagnosed in the first seven postnatal days and 52% at 8-30 days after birth. CSF culture findings were positive in 59 (18%) patients (28 in Group 1 and 31 in Group 2). Gram-positive bacteria were the responsible agents in 30 (51%) patients, whereas 26 (44%) patients had Gram-negative bacterial meningitis and 3 (5%) had Candida meningitis. Gram-negative bacteria were predominant in Group 1 whereas Gram positive bacteria were predominant in Group 2. Transfontanel ultrasonography revealed pathologic findings in 17.5% of patients. The total mortality rate was 2.5%. Conclusion: This large-scale study provides essential information about the etiology, characteristics, and outcome of neonatal bacterial meningitis in Turkey.
Viral load of human papillomavirus in women with normal and abnormal cervical cytology in Kuwait
Authors: Al-Awadhi Rana , Chehadeh Wassim , Al-Jassar Waleed , Al-Harmi Jehad , Al-Saleh Eyad , Kapila Kusum
Published: February 2013

Introduction: Human papillomaviruses (HPV) are the most commonly known sexually transmitted agents. Almost all cases of cervical cancer are caused by persistent infection. This study was conducted to ascertain whether there is a difference in HPV load in cervical samples with normal and abnormal cervical cytology reports in Kuwait. Methodology: HPV-positive abnormal ThinPrep samples (n = 206) and normal ThinPrep samples (n = 120) were taken from women attending gynecology clinics. Real-time PCR was used to measure the viral load for all HPV genotypes. Results: The median normalized viral load in samples with normal and abnormal cytology reports was 0.86 × 10-7 and 4.66 × 10-7, respectively (p = 0.001). Median normalized viral load of high-risk (HR), intermediate-risk (IR) and low-risk (LR) HPV was 4.04 × 10-7, 0.71 × 10-7 and 2.38 × 10-7, respectively, (p = 0.002). Conclusions: The findings suggest that, in the absence of a proper screening programme in Kuwait, quantification of HPV viral load could be considered as a surrogate virology test to identify women with abnormal cytology. Further population-based prospective studies are needed to include more women with high-grade and invasive carcinoma reports.
Intestinal parasitic and candida infection associated with HIV infection in Cameroon
Authors: Lehman Leopold Gustave , Kangam Lafortune , Mbenoun Marthe-Lilianne , Zemo Nguepi Eveline , Essomba Noël , Tonga Calvin , Bilong Bilong Charles Felix
Published: February 2013

Introduction: HIV causes progressive impairment of the cellular immune system leading to increased susceptibility to infectious agents. Parasitic infestations are common in HIV-infected patients and usually lead to diarrhoea. Few studies have addressed the issue of intestinal parasites among HIV-infected persons in Cameroon.  This investigation was conducted in Douala, Cameroon, to assess the prevalence of gastrointestinal parasites in HIV-infected patients, taking into account their immune status and treatment course. Methodology: Stool and blood samples were collected from 201 HIV-positive patients for the investigation of intestinal pathogens and CD4+ counts. Results: Fifty-six (27.9%) patients harbored pathogens. The most frequent pathogens were Candida spp. (14.9%), Cryptosporidium spp. (7.5%), Entamoeba histolytica, and Entamoeba dispar (3%). The presence of pathogens was significantly associated with diarrhoea, as they were found in 48.6% of diarrhoeic stools and 23.2% of non-diarrhoeic stools (OR = 3.14, p= 0.0018). Prevalence of pathogens and diarrhoea were significantly higher in patients with CD4+ counts ≤ 200 cells/µL (OR = 2.17, p = 0.0349 and OR = 8.46, p = 0.000019 respectively). Conclusions: This study highlights the need for investigating intestinal pathogens in HIV-infected patients presenting with diarrhoea, especially when their CD4+ counts are low.
Impact of infectious etiology on the outcome of Taiwanese patients hospitalized with community acquired pneumonia
Authors: Lee Yuan-Ti , Chen Shiuan-Chih , Chan Kuei-Chuan , Wu Tzu-Chin , Tsao Shih-Ming , Chan Chi-Ho
Published: February 2013

Introduction: This study aimed to assess the relationships between infectious etiology, empiric treatment, and outcomes in Taiwanese patients with community acquired pneumonia (CAP). Methodology: A retrospective analysis of the data of 208 adult patients from a single medical center was performed with patients classified as having low or high disease severity based on the Pneumonia Severity Index (PSI). Patients with PSI ≤ 90 (n=120) were classified as low severity and patients with PSI > 90 (n=88) were classified as high severity. Results: The low-risk group had significantly higher rates of infection with Chlamydia pneumoniae (C. pneumoniae) and Mycoplasma pneumoniae (M. pneumoniae), whereas the high-risk group had significantly higher rates of infection with Klebsiella pneumoniae (K. pneumoniae) and Pseudomonas aeruginosa (P. aeruginosa) (p < 0.05). Empiric treatment in both groups was in accordance with the 2007 guidelines issued by the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS). Twenty-nine of 208 patients (13.9%) died, one in the low-risk group and 28 in the high-risk group. The highest rates of mortality were in patients infected with P. aeruginosa or K. pneumoniae. Conclusions: In the present study, we demonstrated that the patients with different severity had different microbiologic etiology. In general, P. aeruginosa and K. pneumoniae were the most commonly isolated organisms in high-risk patients who died from CAP. We showed that use of the IIDSA/ATS guidelines for treatment of CAP in Taiwan resulted in a better outcome in the low PSI group.
Disease progression and antiretroviral therapy in newly seropositive HIV subjects in a tertiary care hospital in North India
Authors: Chadha Sanjim , Bhalla Preena , Jha Arun Kumar , Gautam Hitender , Saini Sanjeev , Anuradha S. , Dewan Richa
Published: February 2013

Introduction: In developing countries the standard methods used to monitor HIV disease progression and therapy response are clinical assessment, CD4+ T lymphocyte count measurement, and plasma viral load (PVL) quantification. These tests require expensive equipment and skilled technicians, so monitoring HIV in resource-limited countries remains challenging as few laboratories can offer these tests free of cost. Methodology: Newly diagnosed HIV seropositive subjects (n = 130) were categorized into three study groups: CD4 counts <200 cells/µl (group A, 43 subjects); 200-500 cells/µl (group B, 44 subjects); and >500 cells/µl (group C, 43 subjects). At recruitment, PVL estimation was performed for group A subjects only, who were then initiated on highly active antiretroviral therapy (HAART) and were followed up after six months for evaluation of response to HAART by measuring the CD4 counts and PVL. Groups B and C were followed up after six months to monitor disease progression by measuring only CD4 counts. Results: Among group A subjects, a rise in the median CD4 counts after six months of HAART was observed. At baseline, PVL ranged from 2636 to >750,000 copies/ml with a median PVL at baseline of 165,000 copies/ml. At follow-up, 90% of the study subjects had undetectable levels of viraemia. Among group B and C subjects, a fall in the CD4 counts at follow-up was observed. Conclusions: CD4 count is a powerful tool to determine response to antiretroviral therapy (ART) and monitor disease progression in HIV/AIDS. PVL is important to assess response to ART, especially in immunovirologic discordant responses.
Prevalence of multidrug-resistant enterococci in a tertiary care hospital in Mumbai, India.
Authors: Deshpande Vaibhav R , Karmarkar Mohan G , Mehta Preeti R
Published: February 2013

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Limited knowledge and practice of Chinese medical students regarding health-care associated infections
Authors: Huang Yuanchun , Xie Wenni , Zeng Jun , Law Frieda , Ba-Thein William
Published: February 2013

Introduction: Health-care associated infections (HCAIs) occur worldwide and affect both patients and health-care workers (HCWs), including medical students. This study aimed to investigate HCAI risks associated with clinical medical students attending Shantou University Medical College (SUMC) and the effectiveness of their learning resources. Methodology: Four cohorts (n = 272) of medical students participated in a questionnaire-based survey was done on (year 5 in the 5-year program and years 5 to 7 in the 7-year program) undergoing internship training in 14 teaching hospitals in Guangdong, China. Results: The mean overall score of the students was 52.54 ± 0.45 (mean ± SE). Students received fairly good scores in hand hygiene (77.57 ± 0.77) and HCAI source (63.16 ± 1.18); relatively weak scores in the isolation precautions (44.59 ± 0.55), HCW safety (45.59 ± 0.86), and personal protective equipment (57.64 ± 0.60); and the weakest scores in HCA-pathogen identification (27.44 ± 0.81). The year of education (r = 0.089, P = 0.144, n = 272) or internship placement (r = 0.077, P = 0.206, n = 272) had no significant influence on their level of knowledge. Conclusions: This study demonstrates that medical students at SUMC have limited knowledge and practice regarding HCAI due to substantial deficiencies in their learning resources. Review of medical curricula, improvement in preclinical and clinical training, and surveillance and monitoring of practicing HCWs are urgently needed to minimize risk of HCAIs in patients and HCWs.