The Science of Antimicrobial Awareness November Edition 2021
Introduction Dear readers, Every year, from the 18th to the 24thof November, the World Antimicrobial Awareness Week is celebrated. This year’s theme is ”Spread Awareness, Stop Resistance”. Antimicrobial resistance is the ability of microorganisms to inhibit an antimicrobial from working effectively. Incorrect use and frequent utilization of antimicrobials can provide microorganisms with the opportunity to become resistant, leading to the inability to use antimicrobials for the treatment of infections in the future. As future pharmacists, we can contribute to preventing this perspective. To spread awareness and support stopping antimicrobial resistance, students from the Polish Pharmaceutical Students’ Association have conducted research on this topic and have shared their results with us. In this edition, you will read how sleep and sound waves fight bacteria. Furthermore, the difference between the resistance and tolerance of antibiotics will be explained. And did you know that food can prevent bacterial infections? If not, read further. Lastly, we will delve into a very recent topic, the covid pandemic, and also how hand hygiene and antiseptic procedures started to rule the world. Enjoy your reading!
Yong Xin Cao Science Coordinator 2021/2022
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Polish Pharmaceutical Students’ Association (PPSA) Polish Pharmaceutical Students’ Association (PPSA) is the largest independent pharmacy students’ organisation in Poland. We are a non-profit, non-governmental, non-political and non-religious association, driven by a deep commitment to personal development, social responsibility and care for the image of pharmacy and pharmacists. PPSA represents over 1500 pharmacy students from 11 cities across the country. Our goal is to elevate the prestige of the pharmaceutical profession and the status of pharmacy students, to assist pharmacy students in gaining practical experience and theoretical knowledge and promote the idea of pharmaceutical care and clinical pharmacy in Poland and to integrate pharmacy students at local, national and international level. One of our main projects is ”Antimicrobial therapy under the scrutiny of pharmacists”. Each year, in October, our Members prepare lessons at schools across the country, where they educate students on the proper use of antibiotics, what antimicrobial resistance is and how we can prevent it. Last year in 2020, our students in 11 cities delivered 156 hours of lessons with a total reach of 5500 students.
PPSA, Poland Member Association
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Sleep and sound wave as natural forces to fight bacteria Abstract There are many methods thatare useful to decrease and kill microorganisms. Sleep plays a regenerative role in our bodies. It also turned out that it influences the growth of bacteria. Various studies have been carried out using different strains of bacteria. Sound waves, which are used in aesthetic medicine as well as in ultrasonography, have found application in bactericidal therapy and the production of metabolites which are helpful in the creation of drugs.
What is sleep and what is it related to?
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Sleep is an indispensable element of a proper life. Its absence is associated with a number of dysfunctions. When we are sleep deprived , our body is unable to produce such amounts of hormones to live properly. Studies have shown that sleep has an enormous influence on obesity, glucose tolerance, ghrelin, insulin, cortisol, leptin levels and appetite. The main part of our body, which generates the circadian rhythm, is the suprachiasmatic nuclei of the anterior hypothalamus. With the assistance of this structure, signals are sent by neurons to the brain and to other parts of the body through appropriate secretion of many hormones, including melatonin. It has been proven that a significant concentration of leptin and ghrelin is released during sleep. Leptin is a satiety hormone, which increases its level with food intake. While ghrelin is a hunger hormone. Both substances have shown a greater amount during the night when we sleep than during the day. Cortisol, one of the steroid hormones secreted by the adrenal cortex, causes an increase of glucose in the blood during stressful situations. Its maximum concentration is reached while awakening, then the amount is reduced during the day, and the lowest concentration is shown in the first phase of sleep. As it might be seen, when someone is sleep-deprived, there is a problem with cortisol and glucose deficiency. It all comes down to the worst and most common diseases in our world:. obesity, atherosclerosis, cardiovascular diseases, stress, and also diabetes. In addition, if we do not sleep enough, our body has less energy. Therefore, pathogens can enter our body and begin to multiply, which leads to infection. Sleep is correlated with hormones like melatonin, which are helpful during inflammation and bacteria.
Sleep, and what is the next step?
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The hormone that has a major influence on the sleep-wake process is melatonin. It is secreted by the pineal gland during sleep. When we are asleep, we obviously close our eyes, but when the light does not enter the retina, the nerve pathways, which go through the perivascular spaces to the pinealocytes, are activated. These structures are located in the pineal gland in which melatonin biosynthesis takes place.
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Antibacterial effects of melatonin
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Melatonin also affects the regulation of immunity, anti-inflammatory, antioxidant and anticancer functions. Recent studies have shown that melatonin is useful in fighting bacterial infection. It has a major influence on PGPB (pathogenic gram-positive bacteria) and PGNB (pathogenic gramnegative bacteria). Various bacterial strains were incubated for 24 and 48 hours with melatonin. Conducting an experiment on Staphylococcus aureus, scientists found that by melatonin, the number of this species decreased significantly and its development was inhibited. Pseudomonas aeruginosa strains that are resistant to carbapenems (the β-lactam group of antibiotics) were also tested. Growth was inhibited by CBR-4830, a tricyclic indole analogue that is highly similar to melatonin.
Image 1 The relationship between microorganisms and melatonin. Melatonin has already been convenient for combating bacteria that are dangerous to us. An example of great application is the therapy against Acinetobacter baumannii. It is a bacterium that has an important influence on sepsis, meningitis, bacteremia or pneumonia. It also quickly developed resistance to drugs. The use of melatonin resulted in a reduction in the number of bacterial strains.
Studies with melatonin have shown a significant value on septic shock in animals by inhibiting its effects. A study was conducted on mice in which melatonin and luzindole (a selective antagonist for melatonin receptors) were used. Cecal Ligation Puncture or like scientists say (CLP) – induced sepsis brought a massive number of bacterial colony forming units which initiate infection in the cecum. Melatonin was reported to reduce mortality in mice. Also, bacterial colonies which had grown in various tissues such as the lungs and the liver were greatly reduced.
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What is the influence of sound waves in antibacterial therapy?
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There are many sounds among us that are pleasing and calming for our ears. There are also high-frequency sounds that can hurt us. In medicine, ultrasound has already been used in ultrasonography which is called USG. It is applied in lithotrity, where ultrasound waves break up kidney stones. Probably you have heard ofHIFU, or High Intensity Focused Ultrasound, used in aesthetic medicine to stimulate the skin. Ultrasound has a frequency near 1 MHz, which is inaudible for us. On the other hand, it was considered how sound waves can act on microorganisms. Ultrasonic waves have been shown to kill pathogens by destroying their membranes, by high heat production or by the formation of free radicals. However, this technique has a defect which is the genotoxic activity. Scientists developed a low-intensity ultrasound test against Staphylococcus aureus. The colony was divided into a control and research group on a culture medium. After 20 minutes of exposure to sounds, there was a significant reduction in the number of bacteria, but their genome structure or susceptibility to antibiotics did not change. However, a bactericidal effect was achieved. SAW, which means low-frequency surface acoustic waves, were also used to conduct research on the level of species such as Escherichia coli, Staphylococcus aureus or Pseudomonas aeruginosa. It has been shown that as much as 85% of the bacteria have been killed. Classical Indian music with a frequency range of 38-689 Hz showed an effect in growth, production of metabolites and bacterial sensitivity to antibiotics. There was an increase of 3.8118.69% of antibiotic sensitivity after the use of music. It also caused an increase in the production of prodigiosin and violacein. Prodigiosin is a compound that is produced by the bacteria Serratia marcescens. This music caused the growth while simultaneously increasing the pigments. In medicine, prodigiosin has antimalarial and antifungal properties and is used in antibiotics. It is also used to fight malignant forms of cancer cells, causing their apoptosis. Violacein, produced by various classes of bacteria, is used in the fight against Staphylococcus aureus and is one of the cytotoxic agents against cancer cells. The activity consisting in the production of factors that are important for antibacterial and even anticancer treatment has been presented. Also, the efficacy of tobramycin is increased by sound waves.
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Conclusion Sleep can influence a significant decrease of the population of bacteria by the production of melatonin. The fact is that it is not released in such a huge amount to fight all pathogens in the infected organism. As already mentioned, sound waves don’t have an enormous advantage in fighting microorganisms but with other therapies such as melatonin, they can bring new opportunities for future branches of medicine.
Patryk Pabich Fifth year of Pharmacy The Medical University of Lodz
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What are the differences between resistance and tolerance to antibiotics?
Since the discovery of penicillin by Alexander Fleming in 1928, antibiotics have been constantly used in medicine. For almost 100 years, these drugs have saved countless lives. Unfortunately, every coin has two sides and the consequences are two dangerous phenomena: ‘resistance’ and ‘tolerance’. Both reduce the effect of antibiotics and pose a risk to human life and health, but what are the differences between resistance and tolerance to antibiotics? Antibiotic resistance is caused by inherited mutations, which allow bacteria and fungi to survive and multiply in high concentrations of antibiotics, regardless of the duration of the therapy. The quantitative indicator that determines resistance is the minimum inhibitory concentration (MIC). MIC is the lowest concentration of an antimicrobial agent that inhibits the visible in-vitro growth of microorganisms. The resistant strain has a much higher MIC than the susceptible strain. The usual dose is no longer effective, so it should be increased if it doesn’t cause negative effects1.
Image 2: Graphical depiction of susceptible, resistant, tolerant.
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On the other hand, tolerance is the ability of microorganisms, inherited or conferred by environmental conditions, to withstand temporary exposure to high levels of antibiotics. Tolerance has no effect on bacteriostatic antibiotics. The MIC for tolerant strains is unchanged and the characteristic indicator is the minimum duration for killing for 99% of bacterial cells in the population MDK99. Tolerance increases MDK99, thus the duration of therapy is extended and this increases the risk of treatment failure for the patient.(2) Although both phenomena weaken the action of antibiotics, they differ significantly from each other, starting from the causes and ending with the effects. We need to distinguish between the two abilities and figure out how to prevent them so that antibiotics can serve us just as well for years.
Image 3: Distinguishing between resistance and tolerance to antibiotic
Kamil Szupryczyński Fifth Year Pharmacy Student Nicolaus Copernicus University in Toruń
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Low-microbial diets for a weak immune system – How can a diet prevent infection?
Image 4: Many backteria are found on everday kitchen items. Low-microbial diets are dedicated to people with medical conditions which make them vulnerable to foodborne disease. This way of nutrition is based on providing or obtaining food with low amounts of bacteria. A healthcare professional can recommend a low-microbial diet if the patient’s immune system is compromised. Patients after cancer treatments, organ transplantations, treatments with immunosuppressive drugs or with low neutrophil count are in the high-risk group of infection. It is advised to reduce exposure to pathogenic microorganisms when a patient's body cannot produce enough white blood cells. Many hospitals serve food for such susceptible people, which is less likely to contain pathogens. A low-microbial diet is also known as a ‘’neutropenic diet’’. Food can be contaminated with various microbes. A healthy person with adequate amounts of white blood cells will not get an infection. Exposed individuals can protect themselves by consuming food with as few microbes as possible. Everyone can minimize the risk of developing foodborne illness by consciously avoiding high-risk food, choosing safe products, preparing and storing food safely. Some types of foods may pose a greater risk than others1.
Foods to avoid2-5 •
Meat and meat alternatives • Raw or undercooked meat, poultry, eggs, fish; • Hot dogs, deli meats that have not been reheated; • Any products containing raw or undercooked eggs; • Sushi (raw fish). Raw meat and poultry can contain microorganisms such as Salmonella spp., Shiga toxin– producing, Escherichia coli. Campylobacter spp., Yersinia enterocolitica, T. gondii, hepatitis E virus (HEV) and Trichinella spp. Raw fish may be contaminated by Vibrio spp., Salmonella spp., Shigella spp., Staphylococcus aureus and L. monocytogenes.
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Dairy products • Unpasteurized or raw milk; • Cheese, yoghurt made of unpasteurized milk; • Cheese comprised of herbs or other uncooked vegetables; • Cheeses with moulds. Raw milk can include pathogens such as Campylobacter spp., Salmonella spp., L. monocytogenes, and Brucella spp. Cheese can cause infection with Salmonella spp., L. monocytogenes, S. aureus.
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Vegetables and fruits • Raw vegetables, including lettuce/salads; • Raw vegetable sprouts; • Salad from restaurants; • Unwashed vegetables and fruits; • Unpasteurized juice. Vegetables and fruits may be contaminated by Salmonella spp. especially in seeds, tomatoes, peppers, and melons. Hepatitis A virus can occur in frozen raspberries, strawberries, and blueberries. Unpasteurized orange juice might comprise Salmonella spp., Shigella spp., enterotoxigenic E. coli, and hepatitis A virus.
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Bakery products and cereals • Cakes with cream or with nuts or dried fruits added after baking; • Uncooked cereal products; • Bakery products with unheated additions.
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Water • Water that has not been boiled; • water from coolers or water fountains. Tap water is pathogen-free, but it does not mean there is no bacteria. Water distribution systems may contaminate water with pathogenic microorganisms such as Legionella spp., Pseudomonas aeruginosa, Stenotrophomonas maltophilia or other Gram-negative bacteria.
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Other food • Raw or unpasteurized honey; • Herbal medicines.
Lower-risk alternative food •
Meat and meat alternatives
Prevention of contamination includes cooking at a specific temperature. 70 oC for at least 2 minutes should be reached in all parts of food. Moreover, it is important to keep raw and cooked food separately. It is forbidden to defrost meals at room temperature. Instead, it is supposed to
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be done in a bowl of water in the fridge. Egg’s white and yolk should be hard. Hot dogs and deli meats should be reheated before eating. •
Dairy products
It is allowed to eat pasteurized milk and other products that are made of it. Pasteurization is a process that heats food to eliminate microorganisms. Dairy products should always be kept cold and it is necessary to check the expiration date before using the product. •
Vegetables and fruits
Only use fresh vegetables and fruits. Always remember to wash them, even if they are peeled, with cold, running water twice. There is no problem with eating cooked, canned vegetables or drinking pasteurized juice. The best option is to peel fruits before using them and wash them after peeling. •
Bakery products and cereals
Bakery products or heated cereals are accepted for susceptible people. They are supposed to be served without cream or custard unless they are freshly made. Low bacterial food also contains cooked rice, packaged snacks like pretzels and popcorn. •
Water
Water filters can provide drinking water for a person with a weak immune system only if the filter is changed appropriately. It is advised to boil tap water and drink bottled mineral or spring water. •
Other food
Ice should be made of boiled and cooled water. Regarding the consumption of condiments such as ketchup, mustard, barbecue sauce, soy sauce, they must be refrigerated after opening. It is allowed to eat homemade cakes and cookies.
How to prepare food? It is essential to thoroughly wash the dishes, pots and boxes so that no food residues are left in them. Always wash and rinse the dishes with warm water. The sponge should be changed weekly and the towel should be changed daily. All surfaces that come into contact with food are supposed to be cleaned. Food cannot stay at room temperature for more than two hours. It should be defrosted in a microwave or refrigerator. Wash your hands before preparing a meal. The cutting board must be separate for meat and vegetables. It is better to cook longer than less to ensure that all microorganisms have been eliminated. It is best to monitor the cooking temperature with a special thermometer. Do not use the same spoon for food and taste while it is being cooked. Throw food out of the refrigerator after 2-3 days5.
Image 5: In every food you can find microbiome of bateria.
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Eating-out In the restaurant, avoid the food that was mentioned earlier. To minimize the risk, choose restaurants where the food is well-cooked and prepared just before it's served. Furthermore, avoid the salad bar, the dinner buffet and ice cream machines. All food should be freshly made. Spices such as ketchup and mustard can contain many bacteria, so susceptible people should not touch them. If possible, better eat-out when the restaurant is less likely to be busy. It is better to choose take-out or pick-up than delivery because delivery food may not be freshly cooked. Low bacteria diets can prevent infection. It is especially important for susceptible people with a compromised immune system. The consequences of consuming no microbiological safe food can be fatal for these people. Evidence from outbreaks and from sporadic cases of foodborne infection in vulnerable people indicates the need for a low-microbial diet5.
Paulina Przybył Third Year Pharmacy Student Poznan University of Medical Science
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How hand hygiene and antiseptic procedures started to rule the world Introduction COVID-19 pandemic gave worldwide society high awareness about hand hygiene and antiseptic procedures1. It's very hard to believe that this common habit was underrated two centuries ago. In 1867, Joseph Lister initially published his work about hygiene procedures in hospitals in "The Lancelet" and the "British Medical Journal". This work changed antimicrobial awareness to the level that we have reached today, and yet still we are learning2.
How it happened? Before Lister’s revolutionary discovery, healthcare workers didn't attach a role to the disinfection as they do today. They used to work in their ordinary clothes which sometimes were on them when they were doing autopsy before baby delivery or surgery. Scalpels were not sterile and single-use as they are at present. They were usually cleaned before they were stored or if there was a need. It’s worth mentioning that it was done by simply wiping on the surgeon's coat. We can generally say that medical equipment was used on many patients before they were cleaned but the word "clean" in this case is a huge understatement2. Lister’s major study was about inflammation which in these days was known as the single disease, not the response of the healthy tissues to the microorganisms. Also, it seemed to cause susceptibility to the microbes. He also worked on blood coagulation and vessel changes when an infection occured2. After he read Louis Pasteur "Recherches sur la putréfaction" Lister suggested that the same process causing fermentation can cause sepsis. He created with his wife Agnes the first methods of the eradication of the bacteria. The first one used carbolic acid applied on the wound or hand acting as an antiseptic agent. The origin of this idea was creosote which was used to clean sewage from microbes. Lister also built a dispenser creating an aerosol of liquid in order to easily put the acid on the wound or hands2. Joseph Lister started the cascade of new antiseptic solutions development. For example, Joseph Lawrance developed a solution based on alcohol. This mixture also included thymol, menthol, methyl salicylate and eucalyptol. If we think for a while, alcohol-based antiseptic solutions are very common at present2.
The revolution that could start a little bit earlier A few decades before Lister’s publication, Ignaz Semmelweis and Oliver Wendell Holmes assumed that hospital-acquired diseases were transmitted by healthcare workers. Semmelweis was a house officer in one of two obstetric clinics at the University of Vienna Allgemeine Krankenhaus. He observed that the maternal mortality ratio is very different between them (16% vs 7%). Mainly, deaths were caused by puerperal fever. Semmelweis also noticed that doctors have a very unpleasant odour on the hands after leaving the autopsy room despite having them washed with soap and water3. His hypothesis said that there are "cadaverous particles" which are responsible for the high mortality ratio. He implemented a method thathelped to get rid of these particles and keep the hands clean. This method was about scrubbing the hands with the chlorinated lime solution after
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leaving the autopsy room and before every patient contact. This caused a decrease in the maternal mortality ratio up to 3%, and it stayed low3. Unfortunately, Holmes and Semmelweis didn't notice the persistent change of doctors’ habits. Their work has been forgotten and health care workers behaviour stayed mostly the same until Lister’s publication. We can only wonder how many lives could be saved.
Summary We can conclude that antimicrobial awareness is a quite fresh issue because it started only almost 2 centuries ago. Another thing is the fact that we have made enormous progress in antiseptic procedures. We can see perfectly during the COVID-19 pandemic, how big our knowledge is. It is also worth remembering the Lister, Semmelweis, Holmes surnames and what they did, because their discoveries saved many lives and the counter doesn't stop.
Mikołaj Grabia Fifth Year Pharmacy Student Medical University of Lodz
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Antimicrobial resistance in the context of COVID-19 Each year during November the whole world stops for a while and people are encouraged to speak about the problem connected with antimicrobial resistance (AMR). It is the moment when we can share our thoughts and raise awareness about this issue, as research shows that by 2050 three hundred and fifty million deaths could be caused by AMR1. However, since the beginning of the COVID-19 pandemic, the problem has been neglected and the actions which were created to raise the awareness of AMR were forced to slow down, not only because of the isolation (the prohibition of big meetings and the difficulties connected to organising gatherings), but also due to scientists focusing more on coronavirus research. Moreover, the coronavirus pandemic is making the issue of AMR even bigger because of improper patient care. Unfortunately, it is common for people to take antibiotics on their own when they feel sick, usually without the supervision of the physician. Instead of seeking medical attention, they are trying to medicate themselves with antibiotics, which is a threat not only for their health, but can also increase the chances of microbes developing the systems which protect them from medications. If the patients with COVID-19 infection decide to take antibiotics, it is not going to help them cure themselves and it also will have an impact on the resistance of the other microbes. Over time, their body will no longer respond to the treatment and it will be harder to cure even basic infections, as ahigher dosage of antibiotics will be needed to fight them. The demand for using higher doses of medications will also increase the chances of the appearance of side effects. Instead of blindly choosing the way of treatment, it is recommended to make a proper diagnosis based on trustful evidence, for example, PCR test. Accurate diagnosis is significant in that case because it helps distinguish bacterial infections from those caused by viruses, such as SARSCov-2 before the treatment is even introduced. It is very important to know if the patient is infected by a bacteria or virus, due to the crucial difference in the treatment in those two cases. The structural distinctions between bacteria and viruses include replication systems which could be a possible target for the medicines used against them. Antibiotics are not going to work in case of SARS-CoV-2 infection, because they work by targeting the replication system in the bacteria, which is not present in the structure of a virus. However, if the patients with COVID-19 also develop bacterial infections, qualified healthcare professionals may prescribe proper antibiotics to treat them. Even though the coronavirus pandemic and AMR may not seem relevant for some people, they both require similar behaviour changes that need to be made by society in order to improve the situation. The restrictions which were made by many countries in order to stop COVID-19 infectivity (travel restrictions, quarantining, physical distancing) as well as highlighting the importance of infection prevention measures - good hand hygiene, were one of the most effective ways to reduce the spread of many infections. It also helped to reduce the health risk of AMR1. According to research published in May 2020, potentially high use of antimicrobials in the treatment of COVID-19 patients may also shift gains in short-term COVID-19 mortality to an increase in long-term AMR mortality1. It is believed that actions like a collaboration between countries and rapid development of new techniques, treatment and vaccines should be taken in order to fight AMR, just like they were implemented when the pandemic started. Without the collaboration between nations, it will be impossible to overcome this issue. Before the pandemic, it was claimed that such effective communication and unification would not be possible. But the urgency showed that countries all around the world are able to consolidate in order to react properly in such a
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situation. Seriousness Of the AMR problem is as big as the urgency of the pandemic. The decisions which were taken quickly in the case of COVID-19 show that responses tackling AMR could have been done faster.
Aleksandra Kowalska Third Year Pharmacy Student Medical University of Warsaw
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References Sleep and sound wave as natural forces to fight bacteria [1] Leproult Rachel i Van Cauter Eve. Role of sleep and sleep loss in hormonal release and metabolism. Maghnie M. Endocrine Development. 2010, Vol. 17, pages 11 - 21. [2] Pradhan Geetali, Samson Susan L. i Sun Yuxiang. Ghrelin: much more than a hunger hormone. November 2013, Vol. 16, 6, pages 619 - 624. [3] Cassoobhoy Arefa, MD i MPH. What Is Cortisol? December 2020. [4] Suni Eric. Melatonin and Sleep. 2020. [5] Dawson Drew i Encel Nicola. Melatonin and sleep in humans. 15 Journal of Pineal Research, 1993. pages 1 - 12. [6] Xu Li i inni. Protective Effect of Melatonin Against Polymicrobial Sepsis Is Mediated by the Anti-bacterial Effect of Neutrophils. June 2019. [7] Carbapenems. drugs.com. [Online] https://www.drugs.com/drug-class/carbapenems.html. [8] Tekbas Omer Faruk i inni. Melatonin as an antibiotic: new insights into the actions of this ubiquitous molecule. Journal of Pineal Research, October 2007. Vol. 44, 2, pages 222 - 226. [9] Dubocovich ML. Luzindole (N-0774): a novel melatonin receptor antagonist. The Journal of Pharmacology and Experimental Therapeutics, September 1988. Vol. 3, 246, pages 902 - 910. [10] Pinealocyte. sciencedirect.com. [Online] https://www.sciencedirect.com/topics/veterinaryscience-and-veterinary-medicine/pinealocyte. [11] He Feng and others. Bacteriostatic Potential of Melatonin: Therapeutic Standing and Mechanistic Insights. May 2021, Vol. 12. [12] Choi Seong Yeol and others. Violacein: Properties and Production of a Versatile Bacterial Pigment. 2015. [13] Sarvaiya Niral i Kothari Vijay. Effect of audible sound in form of music on microbial growth and production of certain important metabolites. Microbiology. April 2015, 84, pages 227 - 235. [14] Bandara H M H N and others. Sound waves effectively assist tobramycin in elimination of Pseudomonas aeruginosa biofilms in vitro . December 2014, Vol. 6, 15, pages 1644 - 54. [15] Kopel Moran, Degtyar Elena i Banin Ehud. Surface acoustic waves increase the susceptibility of Pseudomonas aeruginosa biofilms to antibiotic treatment. July 2011, Vol. 7, 27, pages 701 711. [16] Ayan Irfan and others. The effect of low-intensity pulsed sound waves delivered by the Exogen device on Staphylococcus aureus morphology and genetics. 2008, Vol. 4, 42, pages 272 - 277.
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What are the differences between resistance and tolerance to antibiotics? [1] Brauner, Asher, Ofer Fridman, Orit Gefen, i Nathalie Q. Balaban. Distinguishing between Resistance, Tolerance and Persistence to Antibiotic Treatment. Nature Reviews Microbiology 14, nr 5 (maj 2016): 320–30. https://doi.org/10.1038/nrmicro.2016.34. [2] Westblade, Lars F., Jeff Errington, i Tobias Dörr. Antibiotic Tolerance. PLOS Pathogens 16, nr 10 (15 październik 2020): e1008892. https://doi.org/10.1371/journal.ppat.1008892.
Low-microbial diets for a weak immune system – How can a diet prevent infection? [1] Barbara M. Lund, Microbiological Food Safety and a Low-Microbial Diet to Protect Vulnerable People, 2014, FOODBORNE PATHOGENS AND DISEASE [2] New Zealand Food Safety. Food for people with low immunity. Available at: https://www.mpi.govt.nz/food-safety-home/people-low-immunity/ Updated: 21.09.2021 [3] Education website AboutKidsHealth. Foods to avoid on a low-bacteria diet. Available at: https://www.aboutkidshealth.ca/article?contentid=1546&language=english. Updated: 10.04.2019 [4] Drugs.com [Internet]. Low Bacteria Diet. Available at: https://www.drugs.com/cg/lowbacteria-diet.html#. Updated: 1.11.2021. [5] Shereen Lehman, MS. Low-Bacteria Diet for a Compromised Immune System. Available at: https://www.verywellhealth.com/low-bacteria-diet-for-a-compromised-immune-system2507149 Updated: 13.01.2021.
How hand hygiene and antiseptic procedures started to rule the world [1] Israel S, Harpaz K, Radvogin E, et al. Dramatically improved hand hygiene performance rates at time of coronavirus pandemic. Clin Microbiol Infect. 2020;26(11):1566-1568. doi:10.1016/j.cmi.2020.06.002 [2] Halperin EC. The History of Medicine on Postage Stamps Joseph Lister, 1st Baron Lister. Am J Med Sci. 2021 Jul;362(1):3-4. doi: 10.1016/j.amjms.2021.02.021. Epub 2021 Feb 27. PMID: 33651973. [3] WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. 4, Historical perspective on hand hygiene in health care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK144018/
Antimicrobial resistance in the context of COVID-19 [1] Nieuwlaat R, Mbuagbaw L, Mertz D, et al. Coronavirus Disease 2019 and Antimicrobial Resistance: Parallel and Interacting Health Emergencies. Clin Infect Dis. 2021;72(9):1657-1659. [2] https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
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References for pictures: Front page image: https://www.stocklib.com/media-124929808/woman-taking-pill-close-uphealthcare-concept.html?keyword=antibiotic Image 1: https://pubmed.ncbi.nlm.nih.gov/34135911/ Image 2: https://doi.org/10.1371/journal.ppat.1008892 Image 3: https://doi.org/10.1038/nrmicro.2016.34 Image 4: https://badgut.org/information-centre/a-z-digestive-topics/food-and-microbes/ Image 5: https://www.news-medical.net/news/20190305/Isolating-Bacterial-Pathogen-DNAfrom-Food-Samples.aspx
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