Search

Abstract Survival has been considered the cornerstone for clinical outcome evaluation in critically ill patients admitted to intensive care unit (ICU). There is evidence that ICU survivors commonly show impairments in long-term outcomes such as quality of life (QoL) considering them as the most relevant ones. In the last years, the concept of patient-important outcomes has been introduced and increasingly reported in peer-reviewed publications. In the present systematic review, we evaluated how many randomized controlled trials (RCTs) were conducted on critically ill patients and reporting a benefit on survival reported also data on QoL. All RCTs investigating nonsurgical interventions that significantly reduced mortality in critically ill patients were searched on MEDLINE/PubMed, Scopus and Embase from inception until August 2021. In a second stage, for all the included studies, the outcome QoL was investigated. The primary outcome was to evaluate how many RCTs analyzing interventions reducing mortality reported also data on QoL. The secondary endpoint was to investigate if QoL resulted improved, worsened or not modified. Data on QoL were reported as evaluated outcome in 7 of the 239 studies (2.9%). The tools to evaluate QoL and QoL time points were heterogeneous. Four interventions showed a significant impact on QoL: Two interventions improved survival and QoL (pravastatin in subarachnoid hemorrhage, dexmedetomidine in elderly patients after noncardiac surgery), while two interventions reduced mortality but negatively influenced QoL (caloric restriction in patients with refeeding syndrome and systematic ICU admission in elderly patients). In conclusion, only a minority of RCTs in which an intervention demonstrated to affect mortality in critically ill patients reported also data on QoL. Future research in critical care should include patient-important outcomes like QoL besides mortality. Data on this topic should be collected in conformity with PROs statement and core outcome sets to guarantee quality and comparability of results.

This study investigated factors determining students' performance in the Introductory Accounting classes. It was carried out using a mixed-method approach. Three research hypotheses based on the results of prior studies were tested using regression analysis. Additionally, a qualitative approach using thematic analysis was used to identify factors influencing students' performance. The study involved 90 students who were selected using the purposive sampling method. Secondary data related to those students were gathered through a documentation procedure, whereas primary data were obtained through interviews and observation involving those sample students. The results of the quantitative analysis showed that motivation had a positive impact on students' performance in Introductory Accounting classes. It was also observed that female students had better performance than male students. However, this study did not find accounting educational background as a significant variable in determining students' performance. For the thematic analysis, the study observed nine factors influencing the students' performance in Introductory Accounting classes. Those factors were related to lecturers, learning method, classroom, family background, references, assignments, tutor, and group study. This study contributes to the upward literature in accounting education. It also provides an insight for the Accounting Study Program in higher education institutions in designing accounting curricula, for lecturers in designing learning processes, and for accounting students in understanding the determinants of their performance.

Itraconazole (ITZ) is one of the broad-spectrum antifungal agents for treating fungal keratitis. In clinical use, ITZ has problems related to its poor solubility in water, which results in low bioavailability when administered orally. To resolve the issue, we formulated ITZ into the inclusion complex (ITZ-IC) system using β-cyclodextrin (β-CD), which can potentially increase the solubility and bioavailability of ITZ. The molecular docking study has confirmed that the binding energy of ITZ with the β-CD was −5.0 kcal/mol, indicating a stable conformation of the prepared inclusion complex. Moreover, this system demonstrated that the inclusion complex could significantly increase the solubility of ITZ up to 4-fold compared to the pure drug. Furthermore, an ocular drug delivery system was developed through dissolving microneedle (DMN) using polyvinyl pyrrolidone (PVP) and polyvinyl alcohol (PVA) as polymeric substances. The evaluation results of DMN inclusion complexes (ITZ-IC-DMN) showed excellent mechanical strength and insertion ability. In addition, ITZ-IC-DMN can dissolve rapidly upon application. The ex vivo permeation study revealed that 75.71% (equivalent to 3.79 ± 0.21 mg) of ITZ was permeated through the porcine cornea after 24 h. Essentially, ITZ-IC-DMN exhibited no signs of irritation in the HET-CAM study, indicating its safety for application. In conclusion, this study has successfully developed an inclusion complex formulation containing ITZ using β-CD in the DMN system. This approach holds promise for enhancing the solubility and bioavailability of ITZ through ocular administration. [ABSTRACT FROM AUTHOR]

Objective Child sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. Methods The authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. Results Between 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. Conclusion The results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses. [ABSTRACT FROM AUTHOR]

Oritavancin (ORI) is a semisynthetic lipoglycopeptide approved as a single 1200 mg dose intravenous infusion for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) caused by Gram-positive organisms in adults. The pharmacokinetic/pharmacodynamic (PK/PD) linear kinetic profile and long terminal half-life (~393 h) of ORI make it therapeutically attractive for the treatment of other Gram-positive infections for which prolonged therapy is needed. Multidose regimens are adopted in real-world clinical practice with promising results, but aggregated efficacy data are still lacking. A comprehensive search on PubMed/Medline, Scopus, Cochrane and Google Scholar databases was performed to include papers published up to the end of January 2023. All articles on ORI multiple doses usage, including case reports, with quantitative data and relevant clinical information were included. Two reviewers independently assessed papers against the inclusion/exclusion criteria and for methodological quality. Differences in opinion were adjudicated by a third party. From 1751 potentially relevant papers identified by this search, a total of 16 studies met the inclusion criteria and were processed further in the final data analysis. We extracted data concerning clinical response, bacteriologic response, mortality and adverse events (AEs). From the 16 included papers, 301 cases of treatment with multidose ORIs were identified. Multidose regimens comprised an initial ORI dose of 1200 mg followed by 1200 mg or 800 mg subsequent doses with a varying total number and frequency of reinfusions. The most often treated infections and isolates were osteomyelitis (148; 54.4%), ABSSSI (35; 12.9%) and cellulitis (14; 5.1%); and MRSA (121), MSSA (66), CoNS (17), E. faecalis (13) and E. faecium (12), respectively. Clinical cure and improvement by multidose ORI regimens were observed in 85% (231/272) and 8% (22/272) patients, respectively. Multidose ORI was safe and well tolerated; the most frequent AEs were infusion-related reactions and hypoglycemia. A multidose ORI regimen may be beneficial in treating other Gram-positive infections besides ABSSSIs, with a good safety profile. Further studies are warranted to ascertain the superiority of one multidose ORI scheme or posology over the other.

Candida auris has become a major concern in critical care medicine due to the increasing number of immunocompromised patients and candidiasis is the most frequent cause of fungal infections. C. auris and other fungal pathogens are responsible for at least 13 million infections and 1.5 million deaths globally per year. In immunocompromised patients, infections can quickly become severe, causing wound infections, otitis and candidemia, resulting in high morbidity and mortality. The clinical presentation of C. auris is often non-specific and similar to other types of systemic infections; in addition, it is harder to identify from cultures than other, more common types of Candida spp. Some infections are particularly difficult to treat due to multi-resistance to several antifungal agents, including fluconazole (and other azoles), amphotericin B and echinocandins. This entails treatment with more drugs and at higher doses. Even after treatment for invasive infections, patients generally remain colonized for long periods, so all infection control measures must be followed during and after treatment of the C. auris infection. Screening patients for C. auris colonization enables facilities to identify individuals with C. auris colonization and to implement infection prevention and control measures. This pathogenic fungus shows an innate resilience, enabling survival and persistence in healthcare environment and the ability to rapidly colonize the patient’s skin and be easily transmitted within the healthcare setting, thus leading to a serious and prolonged outbreak.

Abstract Background Deep learning applied to ultrasound (US) can provide a feedback to the sonographer about the correct identification of scanned tissues and allows for faster and standardized measurements. The most frequently adopted parameter for US diagnosis of carpal tunnel syndrome is the increasing of the cross-sectional area (CSA) of the median nerve. Our aim was to develop a deep learning algorithm, relying on convolutional neural networks (CNNs), for the localization and segmentation of the median nerve and the automatic measurement of its CSA on US images acquired at the proximal inlet of the carpal tunnel. Methods Consecutive patients with rheumatic and musculoskeletal disorders were recruited. Transverse US images were acquired at the carpal tunnel inlet, and the CSA was manually measured. Anatomical variants were registered. The dataset consisted of 246 images (157 for training, 40 for validation, and 49 for testing) from 103 patients each associated with manual annotations of the nerve boundary. A Mask R-CNN, state-of-the-art CNN for image semantic segmentation, was trained on this dataset to accurately localize and segment the median nerve section. To evaluate the performances on the testing set, precision (Prec), recall (Rec), mean average precision (mAP), and Dice similarity coefficient (DSC) were computed. A sub-analysis excluding anatomical variants was performed. The CSA was automatically measured by the algorithm. Results The algorithm correctly identified the median nerve in 41/49 images (83.7%) and in 41/43 images (95.3%) excluding anatomical variants. The following metrics were obtained (with and without anatomical variants, respectively): Prec 0.86 ± 0.33 and 0.96 ± 0.18, Rec 0.88 ± 0.33 and 0.98 ± 0.15, mAP 0.88 ± 0.33 and 0.98 ± 0.15, and DSC 0.86 ± 0.19 and 0.88 ± 0.19. The agreement between the algorithm and the sonographer CSA measurements was excellent [ICC 0.97 (0.94–0.98)]. Conclusions The developed algorithm has shown excellent performances, especially if excluding anatomical variants. Future research should aim at expanding the US image dataset including a wider spectrum of normal anatomy and pathology. This deep learning approach has shown very high potentiality for a fully automatic support for US assessment of carpal tunnel syndrome.

Abstract Background Genetic alterations of somatic cells can drive non-malignant clone formation and promote cancer initiation. However, the link between these processes remains unclear and hampers our understanding of tissue homeostasis and cancer development. Results Here, we collect a literature-based repertoire of 3355 well-known or predicted drivers of cancer and non-cancer somatic evolution in 122 cancer types and 12 non-cancer tissues. Mapping the alterations of these genes in 7953 pan-cancer samples reveals that, despite the large size, the known compendium of drivers is still incomplete and biased towards frequently occurring coding mutations. High overlap exists between drivers of cancer and non-cancer somatic evolution, although significant differences emerge in their recurrence. We confirm and expand the unique properties of drivers and identify a core of evolutionarily conserved and essential genes whose germline variation is strongly counter-selected. Somatic alteration in even one of these genes is sufficient to drive clonal expansion but not malignant transformation. Conclusions Our study offers a comprehensive overview of our current understanding of the genetic events initiating clone expansion and cancer revealing significant gaps and biases that still need to be addressed. The compendium of cancer and non-cancer somatic drivers, their literature support, and properties are accessible in the Network of Cancer Genes and Healthy Drivers resource at http://www.network-cancer-genes.org/ .

The government prioritizes health as one of the areas in which it seeks to boost the country's growth, but the referral system in place has failed to deliver high-quality health care. The purpose of this study was to assess and empirically demonstrate the extent to which the health referral system has been implemented in Kendari Health Center and Bau-Bau City. The study was held in the Kendari City Health Center and the Bau-Bau City Health Center, and it lasted from February 2020 to February 2021. This research method is a qualitative approach based on postpositivism's theory, in which the researcher is the primary instrument, triangulation is used to collect data, inductive data analysis is used to analyze data, and qualitative research results emphasize meaning rather than generalization. Informants in this study amounted to 15 informants. Qualitative data were analyzed using the NVIVO 12 QSR application. The research findings indicate that there is a conceptual link between the health system and the concept of implementing a referral system. This research emphasizes to the health service center the importance of increasing the knowledge of health workers through training for both doctors and advocacy for policymakers regarding the improvement of health facilities.

In the Mediterranean, experiments and technical measures aimed at improving the selectivity of bottom trawl nets mostly concern modifications to the codend. Grids have been tested in various areas, but have not been adopted for management purposes so far. The present study aims to evaluate whether the adoption of diamond meshes turned by 90° (T90 configuration) and a selection grid with 2 cm bar spacing, both placed in the extension piece of a commercial bottom trawl net, can contribute in reducing the capture of specimens under the Minimum Conservation Reference Size (MCRS) for the main commercial species. The results indicated that the T90 configuration has no effect compared to the commercial net commonly used by fishers. The grid showed a reduction of the catches of European hake individuals between 11 and 19 cm Total Length (TL). However, the use of this device reduced the catch of many species, such as red mullet, deep-water rose shrimp and broad tail short fin squid. This reduction was observed also for specimens above MCRS. In conclusion, the T90 applied to the extension piece does not provide any improvement in selectivity, contrary to what has been observed when the T90 is placed at the codend. In contrast, the grid could be a possible way to increase selectivity. However, the use of grid should be further investigated to identify settings that can avoid the loss of a substantial fraction of commercial catch.

Background: Incomplete functional recovery following traumatic peripheral nerve injury is common, mainly because not all axons successfully regenerate and reinnervate target muscles. Exercise can improve functional outcomes increasing the terminal sprouting during the muscle reinnervation. However, exercise is not a panacea per se. Indeed, the type of exercise adopted dramatically impacts the outcomes of rehabilitation therapy. To gain insight into the therapeutic effects of different exercise regimens on reinnervation following traumatic nerve lesion, we evaluated the impact of different clinically transferable exercise protocols (EPs) on metabolic and functional muscle recovery following nerve crush.Methods: The reinnervation of soleus muscle in adult nerve-crushed rats was studied following 6 days of different patterns (continuous or intermittent) and intensities (slow, mid, and fast) of treadmill running EPs. The effects of EPs on muscle fiber multiple innervation, contractile properties, metabolic adaptations, atrophy, and autophagy were assessed using functional and biochemical approaches.Results: Results showed that an intermittent mid-intensity treadmill EP improves soleus muscle reinnervation, whereas a slow continuous running EP worsens the functional outcome. However, the mid-intensity intermittent EP neither enhanced the critical mediators of exercise-induced metabolic adaptations, namely, PGC-1α, nor improved muscle atrophy. Conversely, the autophagy-related marker LC3 increased exclusively in the mid-intensity intermittent EP group.Conclusion: Our results demonstrated that an EP characterized by a mid-intensity intermittent activity enhances the functional muscle recovery upon a nerve crush, thus representing a promising clinically transferable exercise paradigm to improve recovery in humans following peripheral nerve injuries.

The SARS-CoV-2 pandemic caused an increase in intensive care unit (ICU) hospitalizations with a rise in morbidity and mortality; nevertheless, there is still little evidence on the impact of the pandemic on antibiotic resistance in ICUs. This is a retrospective, monocentric epidemiological study. The aim of the study was to describe and analyze the impact of the SARS-CoV-2 pandemic on ICU bacterial resistance patterns. All bacteria isolated from all patients admitted to the E.O. Galliera ICU from January 2018 to December 2022 were included. Antibiotic resistance (AR) profiles were evaluated. A total of 1021 microorganisms were identified, of which 221 (12.47%) had a resistance pattern (resistant organisms; ROs). In this time, there were 1679 patients with a total of 12,030 hospitalization days. The majority of microorganisms were Gram-negative (79.66% in 2018, 77.29% in 2019, 61.83% in 2020, 62.56% in 2021, and 60.75% in 2022), but an increase in Gram-positive microorganisms was observed (20.34 to 39.25% between 2018 and 2022). The prevalence of AR was 19.44% in 2018, 11.54% in 2019, 38.04% in 2020, 34.15% in 2021, and 39.29% in 2022 for Gram-positive microorganisms and 19.86% in 2018, 13.56% in 2019, 18.12% in 2020, 12.41% in 2021, and 12.31% in 2012 for Gram-negative microorganisms. The incidence of ROs showed a COVID-19-related increase in 2020–2021, followed by a lowering trend since 2021, and a new increase in 2022. Possible explanations are antibiotic overtreatment and a decrease in containment measures. An interesting finding was the cumulative lowering trend of carbapenem-resistant K. pneumoniae and P. aeruginosa, probably due to different patient features.

Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely affects the possibility of safely performing DEN which increases the risk of complications. We present the case of a 63 years-old man who underwent an endoscopic ultrasound (EUS)-guided drainage of a WOPN, and who was readmitted one month after stent removal with clinical, endoscopic, and radiological signs of infected necrosis involving the splenic artery. A second EUS-guided drainage was performed, with clear visualization of the arterial vessel in the midst of a large amount of solid necrosis. Due to the high risk of major bleeding during DEN, a hybrid procedure in the angiographic room was performed, in order to identify and avoid, under fluoroscopic control, the splenic artery during the entire procedure guide, which was successfully performed using the EndoRotor system. We hereby review the current literature regarding DEN using the EndoRotor system. The case reported, with a literature overview, may help the management of these patients affected by benign but life-threatening conditions which involve a multidisciplinary setting.

Abstract Background It is encouraging to see a substantial increase in individuals surviving cancer. Even more so since most of them will have a positive effect on society by returning to work. However, many cancer survivors have unmet needs, especially when it comes to improving their quality of life (QoL). Only few survivors are able to meet all of the recommendations regarding well-being and there is a body of evidence that cancer survivors’ needs often remain neglected from health policy and national cancer control plans. This increases the impact of inequalities in cancer care and adds a dangerous component to it. The inequalities affect the individual survivor, their career, along with their relatives and society as a whole. The current study will evaluate the impact of the use of big data analytics and artificial intelligence on the self-efficacy of participants following intervention supported by digital tools. The secondary endpoints include evaluation of the impact of patient trajectories (from retrospective data) and patient gathered health data on prediction and improved intervention against possible secondary disease or negative outcomes (e.g. late toxicities, fatal events). Methods/design The study is designed as a single-case experimental prospective study where each individual serves as its own control group with basal measurements obtained at the recruitment and subsequent measurements performed every 6 months during follow ups. The measurement will involve CASE-cancer, Patient Activation Measure and System Usability Scale. The study will involve 160 survivors (80 survivors of Breast Cancer and 80 survivors of Colorectal Cancer) from four countries, Belgium, Latvia, Slovenia, and Spain. The intervention will be implemented via a digital tool (mHealthApplication), collecting objective biomarkers (vital signs) and subjective biomarkers (PROs) with the support of a (embodied) conversational agent. Additionally, the Clinical Decision Support system (CDSS), including visualization of cohorts and trajectories will enable oncologists to personalize treatment for an efficient care plan and follow-up management. Discussion We expect that cancer survivors will significantly increase their self-efficacy following the personalized intervention supported by the m-HealthApplication compared to control measurements at recruitment. We expect to observe improvement in healthy habits, disease self-management and self-perceived QoL. Trial registration ISRCTN97617326. https://doi.org/10.1186/ISRCTN97617326 . Original Registration Date: 26/03/2021.

Simultaneous observations of reproductive physiology and behaviour were conducted on a group of two male and two female belugas under professionally managed care for one year to explore potential mating strategies. Weekly blow sampling for progesterone in females was used to define the breeding season by detecting three oestrous cycles in one female. Twice weekly blow sampling for testosterone and twice monthly testes measurements via ultrasonography were used to detect reproductive seasonality in both males. Female–male association frequency varied longitudinally, with 70% of all interactions occurring during the 16-week breeding season. Male–male associations did not vary seasonally. Male display behaviours towards the female occurred 14.8 times more frequently during the breeding season (0.164 ± 0.188 behaviours/min) than outside of the breeding season (0.011 ± 0.042 behaviours/min). The cycling female responded variably to male display behaviours by altering swim speed or body orientation towards the male. Although this small sample size limits broad conclusions, the frequent display behaviours, low copulation rate and lack of serious male–male aggression are consistent with predictions for pre-copulatory female mate choice developed from the current knowledge of beluga reproductive physiology. These observations, which are not feasible for wild belugas, provide important management considerations because reduced opportunities for mate choice could limit the reproductive rate, especially in small populations.

Introduction: Roselle (Hibiscus sabdariffa L.) calyces possess natural antioxidants that may provide therapeutic benefits. This study aimed to investigate the protective effects of Roselle calyx water extract against isoniazid (INH) and rifampicin (RIF) induced liver and renal toxicities.Methods: Male Wistar rats (150-250 g) were designated into five groups: control group, INH-RIF group that was treated with INH-RIF at the toxic doses (50-100 mg/kg for 4 weeks, followed by 100-200 mg/kg for 2 weeks), and Roselle groups that were treated daily with Roselle extract at the doses 62.5, 125, and 250 mg/kg, respectively prior to INH-RIF administration. Blood samples were withdrawn weekly for 6 weeks before removing rats’ livers and kidneys for tissue malondialdehyde (MDA) and histopathological analysis.Results: The results showed all rats in the INH-RIF group experienced marked elevations of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, creatinine, and tissue MDA levels compared to the controls (P

Objective: To evaluate the effect of ellagic acid on the inhibition of matrix metalloproteinase by analyzing the quality of the adhesive interface with bond strength measures in periods of 24 hours and six months of storage. Method: 40 healthy human third molars were prepared with class I cavities (5x4x3mm). The teeth were divided into four experimental groups: Group 1- without application of ellagic acid and storage time of 24 hours; Group 2- with ellagic acid/24 hours; G3- without ellagic acid/six months; Group 4- with ellagic acid/six months. Then, the cavities were restored with Single Bond Universal adhesive and Z350 composite resin, with and without the previous application of ellagic acid. Subsequently, hourglass-shaped specimens were obtained and subjected to the bond strength (BS) test (n = 10) in a universal testing machine. The bond test was performed after 24 hours and six months of storage. For the standard evaluation (n = 3) the samples were infiltrated with silver nitrate and placed in a developing solution for analysis in a Scanning Electron Microscope (SEM). The data obtained were analyzed with the Kruskal-Wallis non-parametric test, showing a statistically significant difference. Results: The highest bond strength values were found for the 24-hour groups followed by the groups with six months of storage. For nano-infiltration, groups G1 and G2 showed lower infiltration than groups G3 and G4. Conclusion: The previous application of ellagic acid did not affect the BS of the adhesive interface of the adhesive system analyzed, regardless of storage time.

The aim of this randomized double-blinded study was to evaluate the enamel surface roughness and color change after one month of whitening toothpaste use and the color stability obtained 1 month after its interruption. 30 volunteers were divided into 3 groups (n = 10) corresponding to the dentifrices: 1) Colgate Total 12 Clean Mint (TD) (Control), 2) Colgate Luminous White (LW) and 3) Sensodyne Whitening Extra Fresh (SB). The volunteers were impression with addition silicone to obtain an epoxy resin replica of the upper central incisor for the initial surface roughness evaluation using a profilometer and the initial color of the incisors and canines was evaluated with a spectrophotometer after one week of wash-out. After 1 month, the color of the central incisors and canines was measured again, and the volunteers were molded to obtain a second replica to the final roughness analysis. Data were submitted to ANOVA-one way (p≤0.05). The results showed that there was no statistical difference between the dentifrices for color difference and surface roughness for all the studied conditions. It was possible to conclude that the whitening dentifrices used in this study were not able to alter the initial color of the teeth and did not cause changes in the surface roughness of enamel.

The emergence of pathogenic bacteria with β-lactam antibiotics-resistant profile has threatened the continued use of such antibiotics in the future. This research was conducted to investigate the antimicrobial activity of green tea ethanol extract (GTE) and its ability to improve the antibacterial action of several β-lactam antibiotics against Enterobacter cloacae clinical isolates. The simplicia of green tea was extracted by sonication for 30 minutes using 50% ethanol solvent, and the total phenolic content of the GTE was subsequently determined. Next, the GTE used in testing against two clinical isolates of E. cloacae was obtained from the Pathology Laboratory of Wahidin Sudiro Husodo Hospital in Makassar. The sensitivity of bacteria to GTE was confirmed using the agar diffusion method, the Vitek® rapid method, and the double-disk synergistic test. Antibacterial activity of antibiotics, GTE, and combination of antibiotics with GTE were then tested against clinical isolates of E. cloacae using the checkerboard microdilution assay. The results showed that GTE contained 51.64 ± 0.21 % measured as gallic acid equivalent and 37.95 + 5.17 % Epigallocatechin gallate (EGCG). The confirmatory test results indicated that one clinical isolate of E. cloacae (code 13/04) was resistant to amoxicillin-clavulanate but did not produce an extended-spectrum β-lactamase (ESBL). Another clinical E. cloacae isolate (code 275B/06) was indicated to produce ESBL and demonstrated to yield resistance to amoxicillin-clavulanate and cefotaxime. The minimum inhibitory concentration of GTE against the two clinical isolates of E. cloacae was >8000 ppm (8 mg/ml). In conclusion, GTE could not increase the antibacterial activity of amoxicillin and cefotaxime, but it was sufficient to improve the activity of imipenem against the tested isolates of E. cloacae.