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Objective Methicillin-resistant Staphylococcus aureus (MRSA) infection is a major cause of serious morbidity and mortality in the neonatal intensive care unit (NICU). There is no clear consensus on infection control measures. Some approaches to MRSA colonization management may be burdensome with unclear benefits. The objective of this study was to determine if stopping weekly MRSA surveillance with active detection and contact isolation (ADI) was associated with a change in infection rate. Study Design This is a retrospective cohort study of infants admitted to two affiliated NICUs. The ADI cohort infants received weekly nasal MRSA cultures and were placed in contact isolation if MRSA colonized for the duration of their hospitalization. The No Surveillance cohort infants were only placed in isolation if there was active MRSA infection or if MRSA colonization was identified incidentally. The rates of infection were determined between the cohorts. Results There were 8,406 neonates representing 193,684 NICU days in the comparison period. In the ADI cohort, MRSA colonization occurred in 3.4% of infants and infection occurred in 29 infants (0.4%). There were no differences between cohorts in the percent of infants with a MRSA infection at any site (0.5 vs. 0.5%, p = 0.89), rate of MRSA infections per 1,000 patient-days (0.197 vs. 0.201, p = 0.92), rate of bloodstream infections (0.12 vs. 0.26%, p = 0.18), or in the overall mortality rate (3.7 vs. 3.0% p = 0.13). ADI represented an annual cost of $590,000. Conclusion The rates of MRSA infection did not change when weekly ADI was discontinued and was associated with a decrease in cost and resource utilization. Key Points

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In the context of human microbiota, the vagina is a complex anatomical site with several species of microorganisms coexisting in a mutual relationship that contribute in the maintenance of normal vaginal environment necessary for a healthy state. Abnormal vaginal discharge is one of the most common clinical presentations among women of reproductive age and multiple etiologies exist with bacterial vaginosis (BV) being the commonest globally. Bacterial Vaginosis is a complex polymicrobial clinical syndrome which occurs usually in women of childbearing age due to imbalance in the resident flora notably Lactobacillus specie and Gardnerella vaginalis. Clinically BV generally present with copious, thin, homogeneous, milky, foul-smelling vaginal discharge. Vaginal pH of > 4.5 and presence of “clue cells” on microscopy are among the major diagnostic features. Generally, BV is associated with increased risk of acquiring sexually transmitted infections and other adverse outcomes. Gynecologic complications associated with the disease include cervicitis, salphingitis, endometritis, post-operative infections and pelvic inflammatory disease while obstetric complications include premature rupture of membranes, preterm deliveries, chorioamnionitis and postpartum endometritis. BV has been associated with poverty, smoking, increasing body mass index, misuse/abuse of antibiotics, race/ethnicity, increasing lifetime sex partners, various intravaginal practices (e.g. douching) and low level of education. The aim of this review is to highlight the clinical relevance of BV with emphasis on the role of numerous predisposing/risk factors in dis-stabilizing the vaginal flora and subsequent challenges associated with several complications and consequences including sexually transmitted infections in the context of being a prelude or sequelae., {"references":["Filho DS, Diniz CG, Silva VL. Bacterial vaginosis:Clinical, epidemiologic and microbiological features. HU Rev Juiz Fora. 2010;36:22330.","Venugopal S, Gopalan K, Devi A, Kavitha A.Epidemiology and clinico-investigative study oforganisms causing vaginal discharge. Indian J SexTransm Dis. 2017;38(1):6975.","Fox KK, Behets FM. Vaginal discharge. How topinpoint the cause. Postgrad Med. 1995 Sep; 98(3):8790, 936, 101, passim.","Sobel JD. Bacterial Vaginosis. Annu Rev Med.2000;51(1):34956.","Koumans EH, Sternberg M, Bruce C, McQuillan G,Kendrick J, Sutton M, et al. The prevalence of bacterialvaginosis in the United States, 2001-2004; associationswith symptoms, sexual behaviors, and reproductivehealth. Sex Transm Dis. 2007 Nov; 34(11):8649.","Bostwick DG, Woody J, Hunt C and Budd W.Antimicrobial resistance genes and modelling oftreatment failure in bacterial vaginosis: clinical study of289 symptomatic women. J Med Microbiol.2016;65:37786.","Beigi RH, Austin MN, Meyn LA, Krohn MA, HillierSL. Antimicrobial resistance associated with thetreatment of bacterial vaginosis. Am J Obstet Gynecol.2004 Oct;191(4):11249.","Kenyon C, Colebunders R, Crucitti T. The globalepidemiology of bacterial vaginosis: a systematicreview. Am J Obstet Gynecol. 2013 Dec; 209(6): 50523.","van de Wijgert JHHM, Jespers V. The global healthimpact of vaginal dysbiosis. Res Microbiol. 2017Dec;168(910):85964.","Bautista CT, Wurapa E, Sateren WB, Morris S,Hollingsworth B, Sanchez JL. Bacterial vaginosis: asynthesis of the literature on etiology, prevalence, riskfactors, and relationship with chlamydia and gonorrhea infections. Mil Med Res [Internet]. 2016 Feb 13 [cited 2020 Feb 8];3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC 4752809/","Francis SC, Looker C, Vandepitte J, Bukenya J,Mayanja Y, Nakubulwa S, et al. Bacterial vaginosisamong women at high risk for HIV in Uganda: high rateof recurrent diagnosis despite treatment. Sex TransmInfect. 2016 Mar;92(2):1428.","Girerd PH. What is the prevalence of bacterial vaginosis(BV) in the US? [Internet]. [cited 2020 Jan 28].Available from: https://www.medscape.com/answers/254342-40874/what-is-the- prevalence-of-bacterial-vaginosis-bv-in-the-us","Bitew A, Abebaw Y, Bekele D, Mihret A. Prevalence of Bacterial Vaginosis and Associated Risk Factors amongWomen Complaining of Genital Tract Infection. Int J Microbiol [Internet]. 2017 [cited 2017Aug 30];2017. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558670/","Ajayi VD, Sadauki HM, R A, awa, Afolabi BM.Bacterial Vaginosis is a Common Vaginal Infectionamong First-Time Antenatal Clinic Attendees: Evidencefrom a Tertiary Health Facility in NorthWest Nigeria. JPrev Infect Control [Internet]. 2016 Dec 2 [cited 2020Feb 8];2(2). Available from:http://infectioncontrol.imedpub.com/abstract/bac terial-vaginosis-is-a-common-vaginal-infectionamong-firsttime-antenatal-clinic-attendeesevidence-from-a-tertiary-health-facility-innorthwest-nigeria-17670.html","Sivapalasingam S, McClelland RS, Ravel J, Ahmed A, Cleland CM, Gajer P, et al. An Effective Interventionto Reduce Intravaginal Practices Among HIV-1Uninfected Kenyan Women. AIDS Res HumRetroviruses. 2014 Sep 29;30(11):104657.","Hassan WM, Lavreys L, Chohan V, Richardson BA,Mandaliya K, Ndinya-Achola JO, et al. Associationsbetween intravaginal practices and bacterial vaginosis in Kenyan female sex workers without symptoms of vaginal infections. Sex Transm Dis. 2007 Jun;34(6):3848.","Low N, Chersich MF, Schmidlin K, Egger M, FrancisSC, H. H. M. van de Wijgert J, et al. IntravaginalPractices, Bacterial Vaginosis, and HIV Infection inWomen: Individual Participant Data Meta-analysis.PLoS Med [Internet]. 2011 Feb 15 [cited 2020 Jan19];8(2). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039685/","Jun Z, George AT, Etel L. Vaginal Douching andAdverse Health Effects?: A Meta-Analysis. Am J PublicHealth. 1997;87(7):120711.","Wan BP, Jacobs CK. Does vaginal douching causebacterial vaginosis? Evid-Based Pract. 2018; 21(6):13.","Plummer EL, Vodstrcil LA, Fairley CK, Tabrizi SN,Garland SM, Law MG, et al. Sexual practices have asignificant impact on the vaginal microbiota of womenwho have sex with women. Sci Rep [Internet]. 2019 [cited 2020 Jan 19];9. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930205/","Abdul-Aziz M, Mahdy MAK, Abdul-Ghani R, AlhilaliNA, Al-Mujahed LKA, Alabsi SA, et al. Bacterialvaginosis, vulvovaginal candidiasis and trichomonalvaginitis among reproductive-aged women seekingprimary healthcare in Sana'a city, Yemen. BMC InfectDis. 2019 Oct 22;19(1):879.","Turovskiy Y, Noll KS, Chikindas ML. The aetiology ofbacterial vaginosis. J Appl Microbiol. 2011; 110(5):110528.","Brotman RM, Erbelding EJ, Jamshidi RM, KlebanoffMA, Zenilman JM, Ghanem KG. Findings associatedwith recurrence of bacterial vaginosis amongadolescents attending sexually transmitted diseasesclinics. J Pediatr Adolesc Gynecol. 2007 Aug; 20(4):22531.","Cherpes TL, Hillier SL, Meyn LA, Busch JL, KrohnMA. A delicate balance: risk factors for acquisition ofbacterial vaginosis include sexual activity, absence ofhydrogen peroxide-producing lactobacilli, black race,and positive herpes simplex virus type 2 serology. SexTransm Dis. 2008 Jan;35(1):7883.","Wilson J. Managing recurrent bacterial vaginosis. SexTransm Infect. 2004 Feb 1;80(1):811.","Martino JL, Youngpairoj S, Vermund SH. Vaginaldouching: personal practices and public policies. JWomen's Health 2002. 2004 Nov;13(9):104865.","Muzny CA, Schwebke JR. Pathogenesis of BacterialVaginosis: Discussion of Current Hypotheses. J InfectDis. 2016 Aug 15;214(Suppl 1):S15.","Trabert B, Misra DP. Risk factors for bacterial vaginosisduring pregnancy among AfricanAmerican women. AmJ Obstet Gynecol. 2007 Nov;197(5):477.e1-477.e8.","Brookheart RT, Lewis WG, Peipert JF, Lewis AL,Allsworth JE. Association between obesity and bacterialvaginosis as assessed by Nugent score. Am J ObstetGynecol. 2019 May;220(5):476.e1476.e11.","Bradshaw CS, Vodstrcil LA, Hocking JS, Law M,Pirotta M, Garland SM, et al. Recurrence of BacterialVaginosis Is Significantly Associated WithPosttreatment Sexual Activities and HormonalContraceptive Use. Clin Infect Dis. 2013 Mar 15; 56(6):77786.","Vodstrcil LA, Hocking JS, Law M, Walker S, TabriziSN, Fairley CK, et al. Hormonal Contraception IsAssociated with a Reduced Risk of Bacterial Vaginosis:A Systematic Review and Meta-Analysis. PLoS ONE[Internet]. 2013 Sep 4 [cited 2021 Mar 30];8(9).Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762860/","Marrazzo JM, Fiedler TL, Srinivasan S, Thomas KK,Liu C, Ko D, et al. Extravaginal Reservoirs of VaginalBacteria as Risk Factors for Incident BacterialVaginosis. J Infect Dis. 2012 May 15; 205(10): 15808.","Fredricks DN, Plantinga A, Srinivasan S, Oot A, WiserA, Fiedler TL, et al. Vaginal and Extra-VaginalBacterial Colonization and Risk for Incident BacterialVaginosis in a Population of Women Who Have SexWith Men. J Infect Dis [Internet]. 2020 May 7 [cited2021 Mar 30];(jiaa233). Available from: https://doi.org/10.1093/infdis/jiaa233","Ness RB, Soper DE, Holley RL, Peipert J, Randall H,Sweet RL, et al. Douching and Endometritis: ResultsFrom the PID Evaluation and Clinical Health (PEACH)Study. Sex Transm Dis. 2001 Apr; 28(4): 240.","Allsworth JE, Lewis VA, Peipert JF. Viral sexuallytransmitted infections and bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Surveydata. Sex Transm Dis. 2008 Sep; 35(9): 7916.","Bautista CT, Wurapa EK, Sateren WB, Morris SM,Hollingsworth BP, Sanchez JL. Association of BacterialVaginosis With Chlamydia and Gonorrhea AmongWomen in the U.S. Army. Am J Prev Med. 2017 May1;52(5):6329.","Abbai NS, Reddy T, Ramjee G. Prevalent bacterial vaginosis infection - a risk factor for incident sexually transmitted infections in women in Durban, SouthAfrica. Int J STD AIDS. 2016;27(14):12838.","Lu H, Jiang P-C, Zhang X-D, Hou W-J, Wei Z-H, LuJQ, et al. Characteristics of bacterial vaginosis infectionin cervical lesions with high risk human papillomavirusinfection. Int J Clin Exp Med. 2015 Nov15;8(11):210808.","Liang Y, Chen M, Qin L, Wan B, Wang H. A meta-analysis of the relationship between vaginal microecology, human papillomavirus infection andcervical intraepithelial neoplasia. Infect Agent Cancer.2019 Dec;14(1):18."]}

Osama Alshari,1 Yazan O Al Zu’bi,2 Ahmed H Al Sharie,2 Farouk H Wafai,2 Abdelwahab J Aleshawi,2 Farah H Atawneh,3 Hasan A Obeidat,2 Majd N Daoud,2 Mohammad Z Khrais,4 Dima Albals,5 Faize Tubaishat6 1Division of Oncology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan; 2Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan; 3Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Internal Medicine, King Hussein Cancer Foundation and Center, Amman, Jordan; 5Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan; 6Division of Oncology, Department of Internal Medicine, Al Bashir Hospital, Amman, JordanCorrespondence: Osama AlshariDivision of Oncology, Department of Internal Medicine, Faculty of Medicine, University of Science & Technology, P. O. Box: 3030, Irbid, 22110, JordanEmail osamasalshari@gmail.comObjective: Chemotherapy-induced febrile neutropenia is a common and serious oncological emergency which carries a substantial mortality and morbidity. The main objective of this study is to evaluate the usage of absolute monocyte count (AMC) at presentation as a prognostic factor for patients with chemotherapy-induced febrile neutropenia who were subsequently treated with granulocyte colony-stimulating factor (G-CSF).Study Design: The electronic medical records of our center were used retrospectively to identify patients diagnosed with unprecedented chemotherapy-induced febrile neutropenia treated with G-CSF between January 2010 to December 2020 and diagnosed with solid and hematological malignancies. Patient’s demographics, disease characteristics and laboratory investigations were extracted. Disease progression measures were statistically compared between the study groups in the short-term period of follow-up (six days) including absolute neutrophil count (ANC), ANC difference compared to the baseline readings, hospitalization period, and mortality.Results: A total of 80 patients were identified and categorized into two groups namely monocytopenia (n = 34) and non-monocytopenia (n = 46) with an AMC cutoff point of 0.1× 109 cells/L. The monocytopenia group exhibited a worse prognosis with lower ANC values and slower improvement illustrated by the low ANC difference values at all follow up points (P-value ≤ 0.05) apart from day 5. A statistically significant lower hospitalization period was also observed in the non-monocytopenia group (P-value = 0.006). Linear regression analysis evaluated the association between AMC values at admission and ANC values at admission along with subsequent days of follow up which were found to be statistically significant (P-value ≤ 0.05). Receiver operating characteristic curves suggest a satisfactory predictability of ANC changes by AMC values at admission, days1, 2, 3, 4 and 6.Conclusion: Monocytopenia holds a worse prognosis in chemotherapy-induced febrile neutropenia patients treated with G-CSF. In addition, AMC values at presentation represents a potential risk factor that can predict short-term changes regarding ANC measures.Keywords: febrile neutropenia, granulocyte colony-stimulating factor, G-CSF, chemotherapy, absolute monocyte count, monocytopenia, absolute neutrophil count

This study determined the effect of water salinity on the level of 17β-estradiol and the ovarian physiology (histological changes) of Scylla olivacea in captivity. Sixty newly mature crabs with immature ovaries (carapace width > 90.0 mm, Stage 1 ovary) were exposed to three salinity levels (10, 20 and 30 ppt) for 60 days. The level of 17β-estradiol peaked in the early days of each treatment for all salinity levels but decreased as the crabs matured. Stage 4 ovaries were most produced in the 20 ppt treatment, followed by the 10 ppt treatment, and then the 30 ppt treatment. No significant difference was found for the level of 17β-estradiol between salinity levels, but the oocyte size was observed to be significantly different between salinity levels. Meanwhile, there was a significant negative correlation between oocyte diameter size and the 17β-estradiol level. The study concludes that salinity can affect ovarian maturation but not 17β-estradiol levels.

Many crustacean species including mud crab, genus Scylla are incapable of natural maturation under captivity, thus putting high pressure on the wild catch. Therefore, to increase the availability of mature broodstocks in captivity, this study determined the effect of Eyestalk Ablation (EA) and Methyl Farnesoate (MF) administration on ovarian maturation stages of the orange mud crab, Scylla olivacea. The study was conducted using a control group (T1) consisting of 95% alcohol (widely used as a chemical solvent), and three treatment groups consisting of: 5 µl/g oral administrated MF in the diet (T2), EA (T3) and a combination of both treatments of MF and EA (T4). The highest percentage of ovarian maturation Stage 4 was found in the T4 treatment (20.8%) compared to the other treatments which were T1 (0%), T2 (8.33%) and T3 (12.5%). Ovarian development of the treated groups (T2, T3, and T4) was significantly different compared to the control group (T1) (p 0.05), but it was significantly different when compared to the combination group of MF and EA (T4) (p

In preterm infants on moderately high ventilator support, the addition of budesonide to surfactant lowered bronchopulmonary dysplasia (BPD) rates by 20% without increased morbidity or mortality. The aim of this cohort comparison was to determine the safety and efficacy of the combination in infants with milder respiratory distress syndrome (RDS).In August 2016 we began administering budesonide (0.25 mg/kg) mixed with surfactant (Survanta 4 mL/kg) to all infants ≤ 1250 g who failed CPAP and required intubation. Infants were compared to a historical cohort (2013-2016) who received surfactant alone.BPD or death did not change between the historical surfactant cohort (71%, n = 294) and the budesonide cohort (69%, n = 173). Budesonide was associated with a decrease in the need for continued mechanical ventilation, severe BPD type II or death (19-12%), grade III BPD or death (31-21%), and the median gestational age at discharge was 1 week earlier. Histologic chorioamnionitis was associated with decreased budesonide effects. Secondary morbidities (NEC, IVH, ROP, Sepsis) were similar.Overall BPD rates remained unchanged with the addition of budesonide. Budesonide was associated with decreased severity of BPD, decreased mechanical ventilation use, earlier discharge, and similar short-term outcomes.

BACKGROUND AND OBJECTIVE Mud crab from the genus Scylla are considered as one of the most demanded seafood items nowadays as their flesh has high quality, tasty and higher growth rate thus support and boosted expansion in aquaculture sector especially in Malaysia. Present study was designed to focus on the effect of water salinity on the ovarian maturation of orange mud crab, Scylla olivacea based on morphological characteristics. METHODOLOGY Samples were collected from Setiu wetlands, Terengganu, Malaysia from July-September, 2015. Ovarian maturation of S. olivacea was classified into four stages based on previous study which were: Immature (Stage 1), early mature (Stage 2), late mature (Stage 3) and fully mature (Stage 4). RESULTS Morphologically as the ovary develop the colouration start to change from translucent or whitish in colour and sometimes creamy to pale yellow, follow by light orange and lastly reddish orange. Stage 1 ovary was translucent and whitish in colour, stage 2 ovary was pale yellow in colour, stage 3 was light orange and stage 4 ovary was reddish orange in colour. Gonad Somatic Index (GSI) of S. olivacea remained low at stage 1 and 2 and began to increase started at stage 3. This present study involved three different salinities treatments, which treatment 1 (10 ppt), treatment 2 (20 ppt) and treatment 3 (30 ppt). Treatment 2 produce the highest number of stage 4 ovarian maturation based on colouration and the highest GSI recorded, follow by treatment 1 and lastly treatment 3. CONCLUSION This present study proved that salinity does affected the ovarian maturation of S. olivacea in captivity and provides important information regarding the effect of water salinity on ovarian maturation for further studies on reproductive biology of this species.