Enhancing knowledge of hypertension among general practitioners in Pakistan through a Train-The-Trainer initiative.

Background: Hypertension (HTN) affects over a billion people worldwide, with most cases in low- and middle-income countries (LMICs) where awareness and control remain low. In Pakistan, general practitioners (GPs) are usually the initial contact for hypertensive patients. Through the Train the Trainer (TTT) initiative, a group of consultant cardiologists were trained as master trainers to conduct training for GPs across Pakistan.

Metagenomic changes in response to antibiotic treatment in severe orthopedic trauma patients.

We investigated changes in microbiome composition and abundance of antimicrobial resistance (AMR) genes post-antibiotic treatment in severe trauma patients. Shotgun sequencing revealed beta diversity (Bray-Curtis) differences between 16 hospitalized multiple rib fractures patients and 10 age- and sex-matched controls ( = 0.043), and between antibiotic-treated and untreated patients ( = 0.

Preoperative inflammatory biomarkers reveal renal involvement in postsurgical mortality in hip fracture patients: an exploratory study.

Background: Hip fractures in frail patients result in excess mortality not accounted for by age or comorbidities. The mechanisms behind the high risk of mortality remain undetermined but are hypothesized to be related to the inflammatory status of frail patients.

Methods: In a prospective observational exploratory cohort study of hospitalized frail hip fracture patients, 92 inflammatory markers were tested in pre-operative serum samples and markers were tested against 6-month survival post-hip fracture surgery and incidence of acute kidney injury (AKI).

Sociodemographic determinants of gender disparity in primary percutaneous coronary intervention in Pakistan.

Objectives: This study aims to contribute to the body of literature on gender disparities after acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI).

Methods: We identified all adult patients who had AMI between January 2017, and December 2022 and were in follow-up at our institute. We collected data on PPCI, revascularization strategy, sociodemographic characteristics, and in-hospital complications in the years following the procedure.

Social Determinants of Clinical Visits After Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting.

This study aims to investigate the social determinants of clinical visits after LM-PCI versus CABG and their impact on post-treatment care and outcomes. We identified all adult patients who underwent LM-PCI or CABG between January 1, 2015, and December 31, 2022, and were in follow-up at our institute. We collected data on clinical visits, including outpatient visits, emergency department visits, and hospitalizations, in the years following the procedure.

Bullying in Cardiology: Pakistan's Perspective.

This survey aimed to investigate the extent of bullying among junior physicians in cardiology departments, by way of an anonymous web-based questionnaire in Pakistan. A survey of Pakistan cardiology trainees was piloted as a cross-sectional qualitative survey of junior cardiologists (including resident physicians and senior registrars) from teaching institutes all over Pakistan. Negative Acts Questionnaire-Revised was used as the tool for monitoring and reporting bullying nationwide.

Social determinants of pacemaker reuse among patients and family members in Pakistan.

Objectives: This survey aimed to quantify the opinions of CIED reuse among patients and family members in Pakistan and to identify the social determinants which may predict these views.

Methods: A questionnaire formulating attitudes toward PPM reuse was administered to patients and family members at cardiology institutes in Pakistan from 1 July 2022 to 30 September 2022. The eligibility criteria (age > 18 years; inline for PPM placement) were taken into account and incomplete responses were excluded from the final analysis.

Development of dual anti-biofilm and anti-bacterial medical devices.

The rising occurrence of antimicrobial resistance demands new strategies for delivering antibiotics to ensure their effective use. In this study, a multi-functional strategy to address medical device associated infections is explored whereby an anti-attachment and an antibacterial mechanism have been combined. Silicone catheters impregnated with multiple antibiotics are coated with polyacrylate coatings previously shown to reduce bacterial attachment and biofilm formation.

Propidium monoazide-polymerase chain reaction for detection of residual periprosthetic joint infection in two-stage revision.

False negative culture results in periprosthetic joint infection (PJI) are not uncommon particularly when patients have received long term antibiotics. Polymerase chain reaction (PCR) has a lower specificity partly due to detection of residual DNA from dead bacteria. Propidium monoazide (PMA) prevents DNA from dead bacteria from being amplified during the PCR.

Validation and assessment of an antibiotic-based, aseptic decontamination manufacturing protocol for therapeutic, vacuum-dried human amniotic membrane.

Amniotic membrane (AM) is used to treat a range of ophthalmic indications but must be presented in a non-contaminated state. AM from elective caesarean sections contains natural microbial contamination, requiring removal during processing protocols. The aim of this study was to assess the ability of antibiotic decontamination of AM, during processing by innovative low-temperature vacuum-drying.

An external ventricular drainage catheter impregnated with rifampicin, trimethoprim and triclosan, with extended activity against MDR Gram-negative bacteria: an in vitro and in vivo study.

Background: External ventricular drainage (EVD) carries a high risk of ventriculitis, increasingly caused by MDR Gram-negative bacteria such as Escherichia coli and Acinetobacter baumannii. Existing antimicrobial EVD catheters are not effective against these, and we have developed a catheter with activity against MDR bacteria and demonstrated the safety of the new formulation for use in the brain.

Objectives: Our aim was to determine the ability of a newly formulated impregnated EVD catheters to withstand challenge with MDR Gram-negative bacteria and to obtain information about its safety for use in the CNS.

An antimicrobial impregnated urinary catheter that reduces mineral encrustation and prevents colonisation by multi-drug resistant organisms for up to 12 weeks.

Two major complications of indwelling urinary catheterisation include infection and mineral encrustation of the catheter. Our antimicrobial urinary catheter (AUC) impregnated with rifampicin, triclosan, and sparfloxacin has demonstrated long-term protective activity against major uropathogens. This study aimed to firstly assess the ability of the AUC to resist mineral encrustation in the presence and absence of bacteria.

Comparison of different human tissue processing methods for maximization of bacterial recovery.

Tissues are valuable microbiological samples that have proved superiority over swabs. Culture of tissue samples is used in the diagnosis of a variety of infections. However, as well as factors such as the site of obtaining the sample, the number of samples, and previous antibiotic use, the method of tissue processing may have an important effect on sensitivity.

Does release of antimicrobial agents from impregnated external ventricular drainage catheters affect the diagnosis of ventriculitis?

Objective: Recently concern has arisen over the effect of released antimicrobial agents from antibiotic-impregnated external ventricular drainage (EVD) catheters on the reliability of CSF culture for diagnosis of ventriculitis. The authors designed a laboratory study to investigate this possibility, and to determine whether there was also a risk of loss of bacterial viability when CSF samples were delayed in transport to the laboratory.

Methods: Three types of commercially available antibiotic-impregnated EVD catheters were perfused with a suspension of bacteria (Staphylococcus epidermidis) over 21 days.

Biomaterial modification of urinary catheters with antimicrobials to give long-term broadspectrum antibiofilm activity.

Catheter-associated urinary tract infection (CAUTI) is the commonest hospital-acquired infection, accounting for over 100,000 hospital admissions within the USA annually. Biomaterials and processes intended to reduce the risk of bacterial colonization of the catheters for long-term users have not been successful, mainly because of the need for long duration of activity in flow conditions. Here we report the results of impregnation of urinary catheters with a combination of rifampicin, sparfloxacin and triclosan.

Biofilm eradication with biodegradable modified-release antibiotic pellets: a potential treatment for glue ear.

Objective: To develop a biodegradable, modified-release antibiotic pellet capable of eradicating biofilms as a potential novel treatment for biofilm infections.

Design: Pellets containing poly(DL-lactic-co-glycolic acid) microparticles, rifampin and clindamycin hydrochloride (3.5%, 7%, or 28% antibiotic by weight), and carrier gel (carboxymethylcellulose or poloxamer 407) were tested in vitro.

Action of linezolid or vancomycin on biofilms in ventriculoperitoneal shunts in vitro.

Cerebrospinal fluid (CSF) shunts used to treat hydrocephalus have an overall infection rate of about 10% of operations. The commonest causative bacteria are Staphylococcus epidermidis, followed by Staphylococcus aureus and enterococci. Major difficulties are encountered with nonsurgical treatment due to biofilm development in the shunt tubing and inability to achieve sufficiently high CSF drug levels by intravenous administration.

Activity of an antimicrobial hydrocephalus shunt catheter against Propionibacterium acnes.

Shunt infection is a major complication affecting approximately 10% of procedures. Propionibacterium acnes, an anaerobic skin bacterium, is increasingly recognized as a shunt pathogen, causing up to 14% of infections. Though susceptible to penicillin and cephalosporins, P.

In vitro antimicrobial activity of silver-processed catheters for neurosurgery.

Objectives: To investigate the in vitro antibacterial activity of silver-processed catheters for use in neurosurgery using clinically predictive tests.

Methods: The antimicrobial activity of a commercially available silver-processed external ventricular drain catheter was evaluated against Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli and Propionibacterium acnes. Non-impregnated catheters were used as controls.