Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients

ABSTRACT: Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers were engaged in selecting appropriate articles in line with the above protocol. Our search protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive.     

Enhanced activity of punicalagin delivered via polymeric implants against benzo[a]pyrene-induced DNA adducts

We investigated the effect of punicalagin (PC) on benzo[a]pyrene (BP)-induced DNA adducts in vitro and in vivo. Incubation of BP (1 μM) with rat liver microsomes, appropriate co-factors and DNA in the presence of vehicle or punicalagin (1-40 μM) showed dose-dependent inhibition of the resultant DNA adducts, with essentially complete (97%) inhibition at 40 μM. However, PC failed to inhibit anti-BPDE-induced DNA adducts when tested in an in vitro non-microsomal system, suggesting that the inhibition of the microsomal BP-DNA adducts occurred due to inhibition of P450 1A1 by PC. To determine its efficacy in vivo, female S/D rats were administered punicalagin via the diet (1500 ppm; approximately 19 mg/day/animal) or subcutaneous polymeric implants (two 2-cm, 200mg with 20% drug load; 40 mg PC/implant) and then treated with continuous low-dose of BP by a subcutaneous polymeric implant (2 cm, 200mg with 10% load; 20mg BP/implant) and euthanized after 10 days. Analysis of the lung DNA by (32)P-postlabeling showed significant (60%; p=0.029) inhibition of DNA adducts by PC administered via the implants; the dietary route showed modest (34%) but statistically insignificant inhibition. Furthermore, total PC administered by implants was approximately 38-fold lower compared with the dietary route. Analysis of the lung microsomes showed significant inhibition of cytochrome P450 1A1 activity and induction of glutathione. Release of PC from the implants was found to be biphasic starting with a burst release, followed by a gradual decline. Ultra performance liquid chromatography analysis showed no detectable PC in the plasma but its hydrolyzed product, ellagic acid was readily detected. The plasma concentration of ellagic acid was over two orders of magnitude higher (589 ± 78 ng/mL) in the implant group compared with diet (4.36 ± 0.83 ng/mL). Together, our data show that delivery of PC by implants can reduce its effective dose substantially, and that the inhibition of DNA adducts in vivo occurred presumably due to the conversion of PC to ellagic acid.     

Comment on "The role of wildlife (wild birds) in the global transmission of antimicrobial resistance genes"

DEAR EDITOR, We read with interest the article by Wang and colleagues regarding the role of wildlife in the transmission of antimicrobial resistance (AMR) (Wang et al.,2017).Although we appreciate the efforts in reviewing this important topic,we would like to comment on some statements that we believe are not up-to-date or properly cited. The authors mentioned only two reports of Escherichia coil carrying plasmid-mediated colistin resistance gene mcr-1 in wild birds in their review.     

Prevention of prostate cancer through custom tailoring of chemopreventive regimen

One practical way to control cancer is through chemoprevention, which refers to the administration of synthetic or naturally occurring agents to block, reverse or delay the process of carcinogenesis. For a variety of reasons, the most important of which is human acceptance, for chemopreventive intervention naturally occurring diet-based agents are preferred over synthetic agents. For a long time, the prevailing mantra of cancer chemoprevention has been: "Find effective agents with acceptable or no toxicity and use them in preventing cancer in relatively healthy people or individuals at high risk for developing cancer". In pursuing this goal many naturally occurring phytochemicals capable of affording protection against carcinogenesis in preclinical settings in experimental animals have been described. However, clinical trials of single agents have yielded disappointing results. Since carcinogenesis is a multistage phenomenon in which many normal cellular pathways become aberrant, it is unlikely that one agent could prove effective in preventing cancer. This review underscores the need to build an armamentarium of naturally occurring chemopreventive substances that could prevent or slow down the development and progression of prostate cancer. Thus, the new effective approach for cancer prevention "building a customized mechanism-based chemoprevention cocktail of naturally occurring substances" is advocated.     

Gas Exchange Characteristics and Water Relations in Some Elite Okra Cultivars Under Water Deficit

Thirty-days-old plants of two cultivars of okra (Hibiscus esculentus L.), Sabzpari and Chinese-red, were subjected for 30 d to two water regimes (100 and 60 % field capacity). Leaf water potential and osmotic potential of both lines decreased significantly with the imposition of drought. Both the leaf pressure potential and osmotic adjustment were much lower in Chinese-red than those in Sabzpari. Chlorophyll (Chl) b content increased, whereas Chl a content remained unchanged and thus Chl a/b ratios were reduced in both lines. Drought stress also caused a significant reduction in net photosynthetic rate (P _N), transpiration rate (E), stomatal conductance (g _s), and water use efficiency (WUE) especially in cv. Sabzpari. The lines did not differ in intrinsic WUE (P _Ng_s) or intercellular/ambient CO₂ ratio. Overall, the growth of two okra cultivars was positively correlated with P _N, but not with g _s or P _N/E, and negatively correlated with osmotic adjustment.     

Impact of chelator-induced phytoextraction of cadmium on yield and ionic uptake of maize

Enhanced phytoextraction uses soil chelators to increase the bioavailability of heavy metals. This study tested the effectiveness of ethylenediaminetetraacetic acid (EDTA) and citric acid in enhancing cadmium (Cd) phytoextraction and their effects on the growth, yield, and ionic uptake of maize (Zea mays). Maize seeds of two cultivars were sown in pots treated with 15 (Cd₁₅) or 30 mg Cd kg^?1 soil (Cd₃₀). EDTA and citric acid at 0.5 g kg^?1 each were applied 2 weeks after germination. Results demonstrated that the growth, yield per plant, and total grain weight were reduced by exposure to Cd. EDTA increased the uptake of Cd in shoots, roots, and grains of both maize varieties. Citric acid did not enhance the uptake of Cd, rather it ameliorated the toxicity of Cd, as shown by increased shoot and root length and biomass. Cadmium toxicity reduced the number of grains, rather than the grain size. The maize cultivar Sahiwal-2002 extracted 1.6% and 3.6% of Cd from soil in both Cd+ EDTA treatments. Hence, our study implies that maize can be used to successfully phytoremediate Cd from soil using EDTA, without reducing plant biomass or yield.     

Comparative damage and digestive enzyme activity of Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae) on 12 tomato cultivars

The damage caused by the tomato leaf miner Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae) to 12 tomato cultivars was investigated under greenhouse conditions. The 2 cultivars Korral and CH Falat experienced lower damage in terms of all parameters investigated, whereas the cultivars Valouro and Cal JN3 were categorized as the most susceptible host plants. The larvae feeding on CH Falat and Korral cultivars reached the lowest final weight (1.82 and 1.93 mg, respectively), whereas those reared on the Valouro and Cal JN3 cultivars reached the highest body weight (3.42 and 3.33 mg, respectively). The highest proteolytic and amylolytic activity was detected in larvae feeding on the Korral cultivar, whereas larvae reared on the Valouro cultivar had the lowest enzyme activity for both third and fourth instar larvae. Altogether, the Korral and CH Falat cultivars were classified as relatively resistant cultivars, whereas the 2 cultivars Valouro and Cal JN3 were categorized as highly susceptible to infection by T. absoluta. Therefore, the resistant cultivars can be considered as candidates for use in integrated management programs of the tomato leaf miner in Iran.