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Nosokomiale Infektionen (NKI) gehören zu den häufigsten Komplikationen eines Krankenhausaufenthaltes, insbesondere auf Intensivstationen mit einer Prävalenz von rund 18,65%. Die Folgen sind eine längere Verweildauer, erhöhte Morbidität und Letalität sowie höhere Kosten für das Gesundheitssystem. Die Erfassung NKI stellt einen wichtigen Qualitäts- Parameter für Intensivstationen dar. Ziel dieser Arbeit war es, die Übereinstimmung von nur nach KISS (Krankenhaus-InfektionsSurveillance System)- Definitionen erfassten Infektionen mit der klinisch diagnostizierten nosokomialen Infektion zu prüfen und den Zusammenhang zwischen ärztlicher Diagnose und den laborchemischen und klinisch erhobenen Kriterien darzustellen. Hierfür wurden auf einer interdisziplinären operativen Intensivstation nosokomiale Infektionen sowohl nach ITS- KISS (VAP, ZVK- assoziierte Infektionen und HWI), als auch nach ärztlicher Diagnose plus Beginn oder Eskalation einer Antibiotikatherapie erfasst. Zusätzlich zu den KISS-Parametern wurden laborchemische Entzündungsparameter (CRP und PCT) registriert. Es traten 32 Infektionen nach ITS- KISS und 69 Infektionen nach ärztlicher Diagnose auf. Acht Infektionen wurden ausschließlich nach KISS und 45 ausschließlich nach der ärztlichen Diagnose erfasst. Die Infektionsrate nach KISS für VAP lag bei 20,6, für ZVK bei 5,9 und für HWI bei 2 Infektionen, jeweils pro 1000 Devicetage. Spezifität und positiv prädiktiver Wert hinsichtlich der Vorhersage einer ärztlich diagnostizierten Infektion waren gering. Auch durch Kombination verschiedener Parameter wurden keine höheren prädiktiven Werte erreicht. Die geringe Übereinstimmung der beiden Methoden legt nahe, dass KISS die klinisch relevanten Infektionen nicht wesentlich erfasst und relevante Infektfoci nicht berücksichtigt werden, beispielsweise abdominelle Infektionen. Zudem erlauben die erfassten Laborparameter keine zuverlässige Diagnose bzw. Prädiktion einer nosokomialen Infektion. Die ärztliche Diagnose in Verbindung mit dem Beginn oder der Eskalation einer Antibiotikatherapie könnte eine vereinfachte Methode zur Surveillance nosokomialer Infektionen darstellen.

Magister Artium (Child and Family Studies) - MA(CFS) / HIV/AIDS is one of the major challenging illnesses globally and is increasingly recognised as an illness that affects families and not just the individual. While HIV/AIDS has brought many challenges to infected individuals and their families, the focus has primarily been on individuals with HIV/AIDS in relation to their needs. Families often provide most of the emotional and physical care to a family member with HIV/AIDS, placing a huge strain on them that could lead to tension between family members. There is a paucity of research exploring the phenomenon of being a member of a family affected by HIV/AIDS. Therefore, the aim of this study was to explore the lived experiences of family members adjusting to HIV/AIDS disclosure within their families.

Magister Curationis / The National Programme of Prevention of Mother to Child transmission (PMTCT) in relation to HIV/AIDS was introduced by the Department of Health in different sites per province in South Africa in 2001. The number of women has a chance to access antenatal clinic services during pregnancy but they start to attend usually in late gestation.

The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) that subsequently develops remain major health concerns even after three decades since the first cases were reported. Successful therapeutic measures to address HIV/AIDS consist mostly of combinations of drugs targeting viral enzymes including reverse transcriptase (RT), protease (PR) and integrase (IN) as well as entry steps of the viral life cycle. The remarkable benefits (e.g. improved quality of life) derived from the use of these agents are unfortunately limited by toxicity to the host and the development of drug resistant viral strains. Drug resistance limits the repertoire of drug combinations available. Unfortunately, because latent forms of the virus exists, therapy has to be life-long and with new infections occurring every day, resistant strains tend to spread. To circumvent these problems, new drugs that inhibit resistant strains or work against new viral targets have to be developed. The history of gold compounds as potential inhibitors of HIV prompted this study in which twenty seven compounds consisting of gold(I), gold(III) and precursors from five classes were tested for drug-likeness, anti-HIV and immunomodulatory effects using wet lab and in silico methodologies. Cytotoxicity determination was done using viability dyes and flow cytometry. Cell proliferation profiles were monitored using the carboxyflourescein succinimidyl ester dye dilution technology and a real time cell analyser for confirming viability dye findings. The compounds’ effects on viral enzymes was determined using direct enzyme assays and in silico molecular modelling techniques. H and P nuclear magnetic resonance spectroscopy studies for determining stability revealed that the backbone chemical shifts of the compounds were relatively unchanged after one week (-20 and 37 ºC) when dissolved in dimethylsulfoxide. Eight of the gold compounds had drug-like properties comparable to clinically available drugs when in silico predictions were performed. The 50% cytotoxic dose of the compounds in human cells was between 1 and 20 μM (clinically relevant concentrations for gold compounds). Three gold(I) compounds inhibited viral infectivity at non-toxic concentrations and two gold(III) compounds did so at cytostatic (anti-proliferative mechanism that is also antiviral) concentrations. In the immunomodulatory assay, cytokine levels were altered by five compounds with one gold(I) and a gold(III) compound significantly reducing the frequency of CD4+ cells (an anti-viral function) from HIV+ donors (p= 0.005 and 0.027 respectively) when multi-parametric flow cytometry was performed. Inhibition of RT activity was predicted in in silico studies to be through interactions with the ribonuclease (RNase) H site although with poor stereochemical orientation while favourable binding predictions with the IN cofactor binding site were observed for some gold(III) complexes. Compounds predicted to interact with the RNase H site of RT and the IN cofactor site require structural modification to improve drug-likeness and binding affinity. The drug-like compound(s) which inhibited viral infectivity and lowered CD4+ cell frequency have potential for incorporation into virostatic cocktails (combination of cytostatic and directly anti-viral agent). Cytostatic agents are known to be less prone to drug resistance and because they lower CD4+ cell frequency, such compounds can potentially limit HIV immune activation. / Thesis (PhD)--University of Pretoria, 2011. / Biochemistry / unrestricted

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Master of Public Health - MPH / Hospital acquired infections are a huge public health concern, contributing to increased hospitalisation and death in developing countries. Infection prevention and control (IPC) is a discipline which relies on practical evidence-based approaches to preventing both patients and health workers from hospital avoidable infections. However, most of these infections, in many developing countries including Zimbabwe can be attributed to lack of compliance with infection prevention and control measures by health care workers. / 2023

Study Objective: To compare the rates and severity of hospital-acquired Clostridium difficile infection (CDI) among patients taking proton pump inhibitors (PPIs) versus those not taking PPIs. Design: Retrospective, single-center, cohort study. Setting: Tertiary community hospital with a teaching service. Patients: A total of 41,663 patients with CDI who were hospitalized between January 2013 and May 2014; of those, 17,471 patients (41.9%) had received at least one dose of a PPI (PPI group), and 24,192 patients (58.1%) had no PPI exposure (control group). Measurements and Main Results: A total of 348 patients had CDI during the study period, with 269 cases present on admission. Hospital-acquired CDI was defined as CDI diagnosis occurring on or after the third calendar day of admission. After excluding those patients with CDI on admission, 65 (0.38%) of 17,302 patients later developed CDI in the hospital in the PPI group compared with only 14 (0.058%) of 24,092 patients in the control group. Of these patients, 36 patients (0.21%) in the PPI group met the definition of severe CDI compared with 8 (0.03%) in the control group. This demonstrated an unadjusted relative risk (RR) of 6.46 (95% confidence interval [CI] 3.63–11.51, p<0.0001) of developing hospital-acquired CDI and an unadjusted RR of 6.27 (95% CI 2.91–13.48, p<0.0001) of developing severe CDI while taking a PPI. When evaluating only patients who developed severe-complicated CDI, there were 22 cases in the PPI group and 2 cases in the control group, demonstrating an unadjusted RR of 15.3 (95% CI 3.6–65.13, p=0.0002) of developing severe-complicated CDI. Confounding variables were similar between groups. Conclusion: PPI use was associated with an increase in both the rate and severity of hospital-acquired CDI.

Salicylic acid (SA) is a key plant hormone that mediates host responses against microbial pathogens. Identification and characterization of SA-interacting/binding proteins is a topic which has always excited scientists studying microbial defense response in plants. It is likely that discovery of a true receptor for SA may greatly advance understanding of this important signaling pathway. SABP2 with its high affinity for SA was previously considered to be a SA receptor. Despite a great deal work we may still not have true a receptor for SA. It is also entirely possible that there may be more than one receptor for SA. This scenario is more likely given the diverse role of SA in various physiological processes in plants including, modulation of opening and closing of stomatal aperture, flowering, seedling germination, thermotolerance, photosynthesis, and drought tolerance. Recent identification of NPR3, NPR4 and NPR1 as potential SA receptors and α-ketoglutarate dehydrogenase (KGDHE2), several glutathione S transferases (GSTF) such as SA binding proteins have generated more interest in this field. Some of these SA binding proteins may have direct/indirect role in plant processes other than pathogen defense signaling. Development and use of new techniques with higher specificity to identify SA-interacting proteins have shown great promise and have resulted in the identification of several new SA interactors. This review focuses on SA interaction/binding proteins identified so far and their likely role in mediating plant defenses.

Health care-associated and hospital-acquired infections are two entities associated with increased morbidity and mortality. They are highly costly and constitute a great burden to the health care system. Vitamin D deficiency (< 20 ng/ml) is prevalent and may be a key contributor to both acute and chronic ill health. Vitamin D deficiency is associated with decreased innate immunity and increased risk for infections. Vitamin D can positively influence a wide variety of microbial infections. Herein we discuss hospital-acquired infections, such as pneumonia, bacteremias, urinary tract and surgical site infections, and the potential role vitamin D may play in ameliorating them. We also discuss how vitamin D might positively influence these infections and help contain health care costs. Pending further studies, we think it is prudent to check vitamin D status at hospital admission and to take immediate steps to address existing insufficient 25-hydroxyvitamin D levels.