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Few studies have analyzed community hospital-based parenteral anti-infective therapy (CohPAT). We aimed to assess the clinical impact of a pharmacist-led implementation of a clinical practice guideline (CPG) for CohPAT, and to determine the pharmacist’s role in CohPAT medication management. The prospective-period patients (post-implementation group) were compared with the historical control-period patients (pre-implementation group) for receiving a continuous antimicrobial parenteral injection. A CPG was used for laboratory testing for efficacy and safety, the monitoring of adverse drug events during admission, microbiology results coordination, and dosage adjustment. For any antimicrobial drug-related problems, the pharmacist consulted with the clinicians. Over 14 months, 50 participants were included in each group. In the pre-implementation period, 7 (14%) and 4 (8%) out of 50 patients received an inappropriate dosage and nonlaboratory monitoring for dose adjustment, respectively. The patients received the proper dosage of antimicrobial agents, which increased significantly from 78% pre- to 100% post-implementation (p = 0.000). The pharmacist’s interventions during the prospective-period were completely accepted by the clinicians, and significantly greater laboratory monitoring complying with CPG was given to the postimplementation group than the pre-implementation group (100% vs. 60%; p = 0.000). Significantly less patients with unfavorable outcomes (failure or in-hospital mortality) were observed in the post-implementation than in the pre-implementation (6% vs. 26%; p = 0.006) group. For the logistic regression analysis, lower respiratory infection (adjusted OR, aOR 3.68; 95%CI 1.13–12.06) and the post-implementation period (aOR 0.21; 95%CI 0.06–0.83) were significant risk factors that were associated with unfavorable outcomes. Given the better clinical outcomes and the improved quality of septic patient care observed after implementation, pharmacist-led implementation should be adopted in healthcare settings.

Background: Mortality from multidrug-resistant (MDR) pathogens is an urgent healthcare crisis worldwide. At present we do not have any simplified screening tools to predict the risk of mortality associated with MDR infections. The aim of this study was to develop a screening tool to predict mortality in patients with multidrug-resistant organisms.Methods: A retrospective cohort study to evaluate mortality risks in patients with MDR infections was conducted at Phrae Hospital. Univariable and multivariable analyses were used to classify possible risk factors. The model performance was internally validated utilizing the mean of three measures of discrimination corrected by the optimism using a 1000-bootstrap procedure. The coefficients were transformed into item scores by dividing each coefficient with the lowest coefficient and then rounding to the most adjacent number. The area under the receiver operating characteristic curve (AuROC) was used to determine the performance of the model.Results: Between 1 October 2018 and 30 September 2020, a total of 504 patients with MDR infections were enrolled. The ICU-SEPSA score composed of eight clinical risk factors: 1) immunocompromised host, 2) chronic obstructive pulmonary disease, 3) urinary tract infection, 4) sepsis, 5) placement of endotracheal tube, 6) pneumonia, 7) septic shock, and 8) use of antibiotics within the past 3 months. The model showed good calibration (Hosmer-Lemeshow χ2 = 19.27; p-value = 0.50) and good discrimination after optimism correction (AuROC 84.6%, 95% confidence interval [Cl]: 81.0%–88.0%). The positive likelihood ratio of low risk (score ≤ 5) and high risk (score ≥ 8) were 2.07 (95% CI: 1.74–2.46) and 12.35 (95% CI: 4.90–31.13), respectively.Conclusion: A simplified predictive scoring tool wad developed to predict mortality in patients with MDR infections. Due to a single-study design of this study, external validation of the results before applying in other clinical practice settings is warranted.

Poly(ethylene glycol) (PEG), a kind of “green” medium, was used to extract artemisinin from the Chinese herb Artemisia annua L. to replace the traditional volatile and explosive solvents like petroleum ether, diethyl ether, etc. PEGs, with different molecular weights, show excellent ability for artemisinin extraction, and the extraction efficiency decreased with the increase of molecular weight. It was also demonstrated that ultrasonic irradiation could further enhance extraction efficiency compared with conventional water bath heating. Results indicate that the extraction amount of artemisinin from one gram of the leaves could reach 15.8 mg/g under the optimal conditions with ultrasonic power of 100 W, the temperature of 50 °C, time of 1 h in PEG-200, which were optimized by response surface method. Compared with Soxhlet extraction using petroleum ether (PE), the method developed here shows higher extraction efficiency (15.8 mg/g for PEG vs. 14.9 mg/g for PE process) and shorter extraction time (1 h vs. ...

Background: Stenotrophomonas maltophilia is a multidrug-resistant bacteria that is difficult to treat in hospitals around the world. It has become a public health issue, as well as being linked to a high mortality rate. Several studies have shown a variety of treatment and clinical outcomes; however, the efficacy of combination therapy remains limited. Therefore, the purpose of this study is to investigate the effect of monotherapy and combination therapy for S. maltophilia infections on mortality outcome.Methods: We performed a systematic review and meta-analysis of combination therapy versus monotherapy in the treatment of S. maltophilia infections on mortality as a clinical outcome. Electronic databases, including Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, Scopus, and OpenGrey, were systematically searched from the inception of the database until September 3, 2021. Results: Of which 6,524 articles identified, a total of 13 studies and 2 cohort studies were included for systematic review of combination therapy and meta-analysis, respectively. The systematic review of combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection, especially in complex or severe infection. In the fixed-effects meta-analysis of the cohort study, monotherapy was surprisingly shown to have statistically significant effects on the decreased risk of mortality (hazard ratio 1.42; 95% confidence interval, 1.04-1.94). Conclusions: Our results found that the combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection and monotherapy has a trend toward improved better outcome than combination therapy on mortality for the treatment of S. maltophilia infections. A longitudinal study that further explores this association is warranted. Trial registration: This study was registered with the trial registration number ID: 210843 under the international prospective register of systematic reviews (PROSPERO: www.crd.york.ac.uk/PROSPERO).

Rosmarinic acid (RA), a phenolic compound with excellent antioxidant properties, is mainly from rosemary leaves. In this study, several biocompatible ionic liquids (BILs) were proposed as the additive to enhance the extraction efficiency for ultrasonic-assisted extraction of RA from Rosmarinus officinalis L. using ethanol as the solvent.&nbsp

Artemisinin is a kind of natural antimalarial drug exhibiting low toxicity and a very fast action against malaria. Solvent extraction is the most widely used method to separate artemisinin from the Chinese medicinal herb Artemisia annua L. In this study, a series of monoether-based solvents were investigated to extract artemisinin, and propylene glycol methyl ether (PGME) was found to be the most appropriate one for this extraction. Ultrasonic irradiation was demonstrated to be able to assist artemisinin extraction. Influence of extraction conditions, including liquid/solid ratio, extraction temperature, ultrasonic time, and ultrasonic power, on the extraction efficiency were discussed by single-factor experiments, and the main influencing factors were optimized by response surface methods. The extraction mechanism was explored using spectroscopic characterizations, and kinetics of this process was also studied. Results indicated that ultrasonic assisted extraction using PGME had faster extraction rate than conventional solvents, and ultrasonic could significantly enhance mass transfer. Compared with conventional extraction, the process developed here exhibited a higher efficiency (13.79 mg g−1vs. 13.29 mg g−1) and shorter extraction time (decreased from 8 h to 0.5 h) at a relatively low temperature. In addition, PGME had low toxicity and volatility, making the extraction process more safe and reliable. Therefore, this proposed method demonstrated that PGME-based ultrasonic assisted extraction is a rapid, efficient, simple and safe technique for natural product extraction.

A series of carbon-based materials were illustrated to be efficient additives to improve the product distribution of isobutane/butene alkylation catalyzed by H2SO4. Among the tested materials, graphene oxide (GO) was shown to be the most efficient additive. With the presence of trace amounts (e.g., 0.1 wt %) of GO sheet, the weight percentage of C8 in the product could increase by ∼11% and research octane number (RON) of the alkylate was enhanced by ∼2. The presence of GO in H2SO4 led to no obvious change of the acidity. The improved product distribution could be attributed to the enhanced emulsification and better dispersion of the reactants in the acid. The lifetime of the catalytic system was extended from 110 times (with no additive) to 140 times, as the formation of acid soluble oil was inhibited when the additive was present. This efficient and environmentally benign emulsifier could be a particularly promising additive for the current alkylation process catalyzed by H2SO4.

The efficacy of crude pineapple juice obtained from Ananus comosus in digesting fish for the harvesting of trematode metacercariae was investigated. No significant difference was found between the total number of metacercariae detected from fish (Cirrhina jullieni) digested by acid pepsin and those digested by freshly prepared pineapple juice that was kept for 15 days at a temperature of either -4 degrees C or -75 degrees C. However, fewer metacercariae were found when using juice that had been kept for more than 30 days. This study showed that freshly prepared pineapple juice kept frozen for 15 days could be used instead of commercial acid pepsin to digest fish for harvesting metacercariae, some of which could be used for further biological studies.

Seven species of fishes, 6 species of mollusks, 1 species of crab, and 1 species of shrimp were collected from 12 natural freshwater sites from 5 provinces: Lumpang, Phrae, Phayao, Chiang Rai and Chiang Mai during the Rainy season of 2000. Fishes, Channa striatus, Dermogenus pusillus, Oxyeleotris marmoratus, Trichogaster trichopterus and Trichopsis vittatus were examined for helminths and 34.69% (17/49) were infected. There were 2 genera of monogenean identified as follows: Dactylogyrus and Trianchoratus; 3 genera of metacercariae were as follows: Acanthostomum, Posthodiplostomum and Stellantchasmus. Furthermore, 1 genus of Acanthocephala was found from fishes to be Pallisentis sp. The prevalence of infection in mollusks was 6.20% (17/274); Pleurolophocercous and Furcocercous cercariae were observed only in one species of mollusks, Melanoides sp. A crab and a shrimp were negative.