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Chicken eggshell, a poultry waste material, is a potential but poorly recognised source of calcium that can be used by humans to increase their dietary calcium intake by incorporating it into foods. This study was aimed at assessing the effects of eggshell powder supplementation at 5, 10, 15, and 20% levels on the chemical composition, sensory characteristics, and calorific value of the biscuits. Calcium absorption from supplemented biscuits was also determined. The inclusion of eggshell powder resulted in significant variations in the chemical composition of biscuits. It profoundly increased the mineral content, mainly calcium from 43.57 mg 100 g-1 to 1 054.7, 2 186.7, 2 941.6, and 3 843 mg 100 g-1 at 5, 10, 15 and 20% supplementation level, respectively. Substantial changes in the sensory quality of biscuits were also observed with corresponding rises in eggshell addition levels. Biscuits prepared with 5 and 10% supplementation levels were found acceptable in terms of sensory attributes. The in vivo study affirmed the absorption of calcium from eggshell powder and it was found highest (41.83%) at 5% supplementation level. Conclusively, supplementation of biscuits with eggshell powder might be an attractive source of dietary calcium intake without any significant adverse effects on biscuits quality up to 10% supplementation level. [ABSTRACT FROM AUTHOR]

Background: Short duration, antimicrobial prophylaxis that includes antistaphylococcal activity is recommended at the time of left ventricular assist device (LVAD) implantation to reduce infection‐related complications. There continues to be wide variability in surgical infection prophylaxis (SIP) regimens among implantation centers. The aim of this study is to characterize current SIP regimens at different LVAD centers. Methods: A survey study was conducted from 26 September 2017 to 25 October 2017. Surveys were distributed electronically to LVAD coordinators and infectious diseases specialists at 75 US medical centers identified as having an LVAD program. Data collection included information about antimicrobial selection, duration, Staphylococcus aureus screening, and decolonization procedures. Results: We received 29 survey responses. The majority of surveys were completed by infectious diseases physicians (72.4% [21 out of 29]). Most responding centers reported LVAD programs established for greater than 10 years (20 out of 29 [69%]). Cardiac transplantation was performed in 28 out of 29 (96%) centers. Of centers reporting a defined SIP regimen for non‐penicillin allergic patients (96% [28 out of 29]), 17.9% (5 out of 28) reported a four‐drug regimen, 35.7% (10 out of 28) reported a three‐drug regimen, and 46.4% (13 out of 28) reported a two‐drug regimen, while no centers reported a single‐drug regimen. Empiric fluconazole was common (50% [14 out of 28]) and 96.4% (27 out of 28) of regimens included vancomycin. Duration of antimicrobial prophylaxis (24 hours to 5 days), S. aureus screening, decolonization procedures, and alterations due to drug allergies varied across participating centers. Conclusions: Our survey results indicate wide variation in SIP regimens among participating LVAD centers. These results highlight the need for studies evaluating the implications of SIP regimens, and whether clinical factors that prolong antimicrobial duration impact postoperative infection rates. [ABSTRACT FROM AUTHOR]

Objective: To evaluate knowledge, attitudes and practices regarding infection control measures among dental students of Allied Hospital Faisalabad. Study Design: A questionnaire based descriptive cross-sectional study. Place and Duration of Study: The study was conducted in Dental Section of Allied Hospital Faisalabad, from Dec 2017 to Jan 2018. Material and Methods: A questionnaire-based descriptive cross-sectional study was conducted among 178 (1st, 2nd, 3rd & 4th) dental students at Allied Hospital Faisalabad and convenience sampling technique was used. The self-administered questionnaire was comprised of 7 knowledge based, 11 attitudes based and 4 practice- based questions regarding knowledge about various infectious diseases, use of barrier techniques, vaccination status, post exposure prophylaxis, attitude towards infection control and practices related to it. First and second year students were asked about only knowledge and attitude-based questions while third and final year students were asked about all three aspects (knowledge, attitude and practice). Data was analyzed using SPSS version 20. Variables were determined using chi square test, A p-value <0.05 was considered significant. Results: The response rate was 100% (all students were potential respondents). Results of the study revealed that 55.1%, 40.4% and 4.5% of the participants obtained poor, fair and satisfactory level of knowledge about infections and infection control in dentistry respectively. Most of the students showed positive attitude towards infection control measures. Overall, 97.8% of the students (3rd & 4th year) had been vaccinated for hepatitis B virus (nonsignificant difference, p=0.96) and only 56.2% were tested for post hepatitis B virus serology (non-significant difference p=0.94) while the vast majority 97.8% reported always wearing gloves, 71.9% wearing face mask, 58.4% wearing eye shield, 58.4% wearing head cap and 68.5% wearing gowns for all dental procedures with no significant difference between year of study. A significantly higher percentage of final year students (93.4%) showed positive attitudes towards the treatment of patients with infectious diseases as compared to only 81.3% of 3rd year, 71.7% of 2nd year and 62.7% of 1st years students (p=0.02). A great number of students reported nonsterile occupational percutaneous and mucous injuries while treating their patients. Conclusion: Our participants, had good attitude towards infection control in dentistry however they do not have satisfactory knowledge regarding infection control measures and their clinical practice also needs improvement. These findings highlight the necessity of continued infection control education among dental students of AHF. [ABSTRACT FROM AUTHOR]

We evaluated use of maribavir (MBV) for treatment of 15 episodes of refractory/resistant cytomegalovirus infection in 13 solid organ transplant recipients. Treatment failure due to treatment-emergent MBV resistance or early virological recurrence after MBV discontinuation occurred in 7 (47%) episodes. Sustained viral clearance was achieved in 6 (40%) episodes. [ABSTRACT FROM AUTHOR]

Introduction: Dentine Hypersensitivity (DH) is a common oral health issue of interlinking causes. It can affect one or more teeth and followers of any age group. It is a painful consequence of exposed dentinal tubules of a vital tooth. There is an increased cognizance that DH has become an important condition that requires investigation from the diagnostic and problem management paradigm. The objectives of this study are to estimate the frequency of dentine hypersensitivity, to investigate various factors associated with this health problem and to determine which teeth are commonly affected amongst patients visiting Allied Hospital Faisalabad (AHF). Study Design: Descriptive Cross-sectional study. Setting: Diagnostic Department of Allied hospital Faisalabad. Period: 1st December 2016 to 31th December 2016. Material and Methods: After taking permission from Head of Department and Medical Superintendent of Allied Hospital Faisalabad, two hundred patients were examined after taking verbal consent. Clinical examination form/questionnaire was used to investigate and diagnose dentine hypersensitivity. Data was analyzed using SPSS version 20 and variables were determined using Chi-square tests (p < 0.05 considered significant). Results: Out of two hundred patients, forty-seven were found be having dentine hypersensitivity, resulting frequency of dentine hypersensitivity in this sample was 23.5% and there was significant association between dentine hypersensitivity and factors i.e. erosion, attrition and gingival recession but near significant association for gastric reflux and no association for abrasion. It was more common in females and in age group of 18-30 years. Lower incisors were commonly affected teeth and predominantly affected site was buccal surface. Cold was the most common stimulus. Gingival recession was the most common factor. Conclusion: There was association between dentine hypersensitivity and its associated risk factors like gingival recession, attrition and erosion. Patients with hypersensitivity are more likely to be younger, to be female, to have a high prevalence of gingival recession and using horizontal tooth brushing technique. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Belatacept is a costimulatory blocker that can be used to prevent and treat rejection in lung transplant recipients (LuTRs). The epidemiology of infections in belatacept‐treated LuTRs has not been systematically evaluated.We performed a single‐center retrospective study of all adult LuTRs who received belatacept as prevention or treatment of antibody‐mediated rejection (desensitization) or as part of maintenance immunosuppression from January 1, 2011, to June 30, 2022. We assessed the epidemiology of infections that occurred within 12 months following the first belatacept dose.Fifty‐two LuTRs received at least one dose of belatacept as either desensitization (n = 32) or maintenance immunosuppression (n = 20). Among 45 patients who were cytomegalovirus (CMV) donor and/or recipient seropositive, nine (20%) developed CMV infection. Seven (77%) CMV infections occurred despite valganciclovir prophylaxis and four (44%) were associated with antiviral resistance. Three (6%) LuTRs developed Epstein‐Barr virus (EBV) associated post‐transplant lymphoproliferative disorder (PTLD). Twenty‐five (48%) LuTRs developed 43 bacterial infections and five (10%) developed proven or probable invasive fungal disease. Incidence rates of viral, bacterial, and fungal infections were similar between the desensitization and maintenance groups: incidence rate ratios (95% confidence interval) were 0.70 (0.32–1.57), 1.31 (0.70–2.46), and 2.82 (0.31–25.2), respectively. Infection/PTLD prompted belatacept discontinuation in eight (15%) patients.In the first year after belatacept initiation, LuTRs commonly developed CMV infections, EBV+ PTLD, and bacterial infections. Multicenter collaborations are needed to better understand infection risks in LuTRs treated with belatacept. [ABSTRACT FROM AUTHOR]

Objective: To describe the frequency and outcomes of acute kitchen burn patients who were admitted to the burn center. Study Design: Cross Sectional study. Setting: Allied Burn & Reconstructive Surgery Center, Faisalabad Medical University. Period: August 2019 to August 2020. Material & Methods: A total of 566 cases were registered. In 293 cases, accident took place in kitchen, 153 cases occurred in home settings, 51 cases occurred at workplace and other 27 cases were in industry. 42 cases were reported at other different places. Results: A total of 566 burn cases occurring at different places including kitchen, home settings, workplace, industry and others, were included in the study. In 293 cases (51.766%) accidents took place in kitchen. Other 153 cases (27.03%) occurred in home settings. 51 cases (0.9%) occurred at workplace, 27 cases (0.45%) were in industry and 42 other cases (19.845%) were in different places. In 2019, total 172 cases were reported. Out of which 113 (65.7%) were males and 59 (34.3%) were females. In 2020, total 394 cases were reported. Out of which 237 (60.15%) were males and 157(39.85%) were females. All ages and both sexes were included. Our results showed that maximum accidents (51.766%) took place in kitchen. Males (61.84%) were affected more than females (38.16%). Regarding age, the group of children (>10) was most to be effected (49%). Overall statistical analysis for patients was p < 0.046, df =4, 95% CI. Conclusion: Combined with the previous knowledge, our research work provided great insight into the risk factors and detailed knowledge of burn injuries at different levels especially at home kitchen level. [ABSTRACT FROM AUTHOR]

Objectives: The incidence of coronary heart disease in Pakistan is not well established. While the role of lifestyle risk factors and job-related conditions in the development of such diseases, still needs more clarification. Study Design: Cross-sectional study. Settings: Faisalabad Medical University, Faisalabad. Period: Jan, 2018 - Dec, 2018. Material & Methods: 30 office workers of FMU were approached including males & females. A semi-structured questionnaire was used. For evaluation of habitual physical activity Baecke questionnaire was used. Results: 30 office workers of FMU of age groups ranging from 20 above to 59 years (37.333±12.103) were being studied. A questionnaire to evaluate lifestyle and awareness of cardiovascular diseases and risk factor profile and prevalence was administrated to the participants with 23 males and 7 females. Among all, reported smokers were 19%. 47% participants had never performed exercise, overall statistical analysis for physical exercise was 1.4000 ± 0.62146, df =29, p < 0.000, 95% CI. Job strain intensity was assessed according to Job Strain Index (JSI) Scale. It was reported that 53% workers had hard intensity while overall we found JSI 3.3333 ± .75810, df=29, p < 0.000, 95% CI. Conclusion: Some flexibility regarding their job, proper awareness about Cardiovascular Diseases (CVDs) and their risk factors is the need of the day. [ABSTRACT FROM AUTHOR]

Background Risk factors for acquisition of vancomycin-resistant Enterococcus (VRE) include immunosuppression, antibiotic exposure, indwelling catheters, and manipulation of the gastrointestinal tract, all of which occur in liver transplant recipients. VRE infections are documented in liver transplantation (LT); however, only one single center study has assessed the impact of daptomycin-resistant Enterococcus (DRE) in this patient population. Methods We conducted a retrospective multicenter cohort study comparing liver transplant recipients with either VRE or DRE bacteremia. The primary outcome was death within 1 year of transplantation. Multivariable logistic regression analyses were performed to calculate adjusted odds ratios for outcomes of interest. Results We identified 139 cases of Enterococcus bacteremia following LT, of which 78% were VRE and 22% were DRE. When adjusted for total intensive care unit days in the first transplant year, liver-kidney transplantation, and calcineurin inhibitor use, patients with DRE bacteremia were 2.65 times more likely to die within 1 year of transplantation (adjusted odds ratio [aOR], 2.648; 95% CI, 1.025–6.840; P  = .044). Prior daptomycin exposure was found to be an independent predictor of DRE bacteremia (aOR, 30.62; 95% CI, 10.087–92.955; P  < .001). Conclusions In this multicenter study of LT recipients with Enterococcus bacteremia, DRE bacteremia was associated with higher 1-year mortality rates when compared with VRE bacteremia. Our data provide strong support for dedicated infection prevention and antimicrobial stewardship efforts for transplant patients. Further research is needed to support the development of better antibiotics for DRE and practical guidance focusing on identification and prevention of colonization and subsequent infection in liver transplant recipients at high risk for DRE bacteremia. [ABSTRACT FROM AUTHOR]

Synanthropic cockroaches are a public health concern, because they can carry pathogens and allergens. These insects inhabit urban spaces and must be constantly monitored in order to assess the pest emergence outbreaks. Here, we combined spatial population monitoring with microbiological testing to survey the main pest cockroach species found inside residences of the city of Quetta, Pakistan. We evaluated the distribution of pest cockroaches at two scales: landscape (neighborhood) and patch (inside houses). We found at least one of the following pest species in the 73.2% of the total residences surveyed (n = 112): Shelfordella lateralis 37.1%, Periplaneta americana 23%, Blatella germanica 16.7%, Blatta orientalis 13.4% and Polyphaga aegyptiaca 9.8%. At landscape scale, the most common was S. lateralis, presenting a clustered distribution in two sampled zones, also heavily urbanized. At indoor scale, S. lateralis were most frequently found in kitchens. When we studied the bacterial loads in this species, we found that S. lateralis carried several pathogenic bacteria. Susceptibility tests tested on these strains against 10 common formulations showed antibiotic resistance for some bacteria. For instance, Pasteurella spp was susceptible towards six antibiotics tested, while Helicobacter spp showed resistance against eight antibiotics tested. Our evidence suggests that S. lateralis have the potential to displace main cosmopolitan pests and, most concerning, also carry antibiotic‐resistant pathogenic bacteria. Considering that this emergent Asian‐native pest is now present in Europe and America, it may correspond to a relevant urban pest deserving further international public health attention. [ABSTRACT FROM AUTHOR]

Background Short duration, single-agent antimicrobial prophylaxis with anti-staphylococcal activity is recommended at the time of left ventricular assist device (LVAD) placement to prevent infection-related complications. Despite consensus guidelines, there continues to be wide variability in antimicrobial regimens among implantation centers. The aim of this study was to characterize current peri-operative antimicrobial prophylactic strategies at different LVAD implantation centers. Methods A survey study was conducted from September 26, 2017 to October 25, 2017. Surveys were distributed electronically to both LVAD coordinators and infectious diseases specialists at 75 US medical centers identified as having an LVAD program. Data collection included information about antimicrobial selection, duration, MRSA screening and decolonization procedures. Results We received 29 survey responses. The majority of surveys were completed by infectious diseases physicians [72.4% (21/29)]. Most responding centers reported LVAD programs established for >10 years [20/29 (69%)]. Cardiac transplantation was performed in 28/29 (96%) centers. Of centers reporting a defined antimicrobial prophylaxis regimen for nonpenicillin allergic patients [97% (28/29)], 17.9% (5/28) reported a four-drug regimen, 35.7% (10/28) reported a three-drug regimen, and 46.4% (13/28) reported a two-drug regimen, while no centers reported a single-drug regimen. Empiric fluconazole was common [50% (14/28)] and 96.4% (27/28) of regimens included Vancomycin. Duration of antimicrobial prophylaxis (24 h-5 d), MRSA screening, decolonization procedures, and alterations due to drug allergies varied significantly across participating centers. Conclusion Our survey results indicate a wide variation in the peri-operative antimicrobial prophylaxis regimens among participating LVAD centers. These results highlight the need for further studies evaluating the utility, toxicity, and stewardship implications of multi-drug regimens and whether specific clinical factors that prolong antimicrobial duration impact post-operative LVAD-related infection rates. Disclosures Rachel Miller, MD, Synexis: Research Grant. [ABSTRACT FROM AUTHOR]

Background Mycoplasma and Ureaplasma species can cause invasive infections early after lung transplant that are difficult to diagnose and associated with substantial morbidity, including hyperammonemia syndrome. Data on the epidemiology and clinical outcomes of these infections are needed to inform clinical management and screening protocols for donors and recipients. Methods We retrospectively collected clinical data on all patients who underwent lung transplantation at our hospital from January 1, 2010 to April 15, 2019 and subsequently had positive cultures or PCR studies for M. hominis or Ureaplasma spp. Patients with positive studies from only the genitourinary tract were excluded. We analyzed donor and recipient clinical characteristics, treatment courses, and outcomes for up to 2 years after transplant. Results Of 1055 total lung transplant recipients, 20 (1.9%) patients developed invasive infection with M. hominis or Ureaplasma spp. M. hominis caused the first 10 infections (2010–2016), and Ureaplasma spp. caused 10 subsequent infections (2017–2019). Date of first positive culture or PCR study occurred a median of only 19 days after transplant (range, 4–90 days). Median donor age was 31 years (range, 18–45 years), and chest imaging for 16 (80%) donors revealed airspace disease compatible with aspiration. Infection outside of the respiratory tract was confirmed for 13 (65%) recipients, including 8 patients with M. hominis empyemas (Figure 1). Ten (50%) patients developed altered mental status that was temporally associated with infection; 8 (80%) of these patients had elevated serum ammonia levels, including 3 patients with M. hominis infection. Median duration of therapy was 6 weeks (IQR, 4–9 weeks), consisting of combination antimicrobial regimens for nearly all patients. Additional postoperative complications were common, and 11 (55%) patients died within 1 year after transplant (median, 117 days; IQR, 65–255 days) (Figure 2). Conclusion Ureaplasma and M. hominis infections occurred early after lung transplant and were associated with substantial morbidity and mortality. Transplant clinicians should have low thresholds for performing specific diagnostic testing for these organisms. Protocols for donor and recipient screening and management need to be developed. Disclosures Rachel Miller, MD, Synexis: Research Grant. [ABSTRACT FROM AUTHOR]