Hand hygiene is the most effective preventive measure against the spread of nosocomial infections. Antimicrobial-resistant pathogens can be transmitted to patients through the hands of healthcare workers. Thus, strict adherence to hand-hygiene practices should be encouraged. Pharmacists’ compliance with hand-hygiene practices are lower than that of other healthcare workers, such as nurses and physicians. This study evaluated the effect of an infection-control team-led intervention for hand-hygiene compliance among ward pharmacists. In September 2018, ward pharmacists started carrying portable alcohol-based hand sanitizers that could be used immediately anywhere within the hospital. In January 2020, a training session, particularly on threat of antimicrobial resistance, aim of hand hygiene, and four key indications for hand hygiene—“After Room In, Before Room Out, Before ”—was developed by the infection-control team for the ward pharmacists to improve their compliance with hand-hygiene practices. The pre-training and post-training evaluations of the ward pharmacists, who were unaware of the assessment, were undertaken in December 2019 and February 2020, respectively, by trained pharmacy students who directly observed hand-hygiene compliance, and the compliance rates significantly improved for “After Room In, Before Room Out, and Before Touching a Clean Area” (62% vs. 95%, p < 0.001; 64% vs. 95%, p < 0.001; and 0% vs. 35%, p < 0.001, respectively). Regular direct observations by infection-control link nurses continued during the study period, and ascertained a significant improvement in compliance from 35.4% to 78.2% between July 2018 and January 2021 (p < 0.001). Thus, targeted interventions may contribute to induce better compliance with hand-hygiene practices by pharmacists.

Essential oils (EOs), which are complex biomolecules composed of volatile compounds, are being analyzed as tools to fight bacterial infections. Here, we report the modification of biodegradable wet-spun microfibers composed of cellulose acetate (CA) and polycaprolactone (PCL) with EOs, aiming at their localized, controlled release. Cinnamon leaf oil (CLO), cajeput oil (CJO), and clove oil (CO) were selected from a group of 20 EOs according to their minimal inhibitory concentration (MIC) against Staphylococcus aureus (<22.4 mg/mL) and Escherichia coli (<11.2 mg/mL). CA/PCL prepared at 10% and 14%wt in a 3/1 ratio in acetic acid and acetone were processed in the form of microfibers by wet-spinning at an extrusion rate of 0.5 mL/h directly into an ethanol coagulation bath. EOs were functionalized at the surface of the microfibers by physisorption. Here, microfibers were immersed in ethanol solutions containing EOs at 2xMIC and ampicillin (control antibiotic at 2xMIC, as well). After 72 h of immersion, fibers contained ampicillin at MIC but only 14%, 66% and 76% of MIC for CLO, CO and CJO, respectively. Incorporation was confirmed by UV-Visible spectroscopy, Fourier-transform infrared spectroscopy (FTIR) and thermogravimetry (TGA). Unloaded and loaded microfibers were characterized as uniform and homogeneous. Time-kill kinetics antimicrobial studies (ASTM-E2149-01) were conducted on the loaded fibers revealing their capability to eliminate more than 99.9% microbial cells after 24 h culture. Data showed that, even at small amounts, the EO-modified microfibers were effective against the bacteria S. aureus and E. coli. Considering the amount immobilized, CLO-containing fibers were deemed the most effective from the group, suggesting a superior affinity of the EOs active groups towards the CA/PCL matrix. These results indicate that CA/PCL microfibers loaded with EOs can be easily produced and applied in scaffolds for biomedical applications.

In December 2019, a novel strain of coronavirus, SARS-CoV-2, was identified. Infected patients revealed symptoms of fever, cough (dry), sore throat, and fatigue, which began manifesting after 5 days of incubation. Hoping to prevent transmission, many countries adopted a mandatory mask use in closed public spaces. However, most mask options display a passive action against COVID-19. To overcome such restrictions, this work proposes the incorporation of anti-viral essential oils (EOs) loaded onto a nanofibrous layer that can be adapted to both community and commercial masks.

Twenty EOs selected based on their antimicrobial nature were examined for the first time against the Escherichia virus MS2. The most effective were the lemongrass (LO), Niaouli (NO) and eucalyptus (ELO) with a minimum inhibitory concentration (MIC) of 356.0 mg/mL, 365.2 mg/mL and 586.0 mg/mL, respectively. Polycaprolactone (PCL) and cellulose acetate (CA) were prepared individually at 14 wt% in chloroform/dimethylformamide (DMF) and 10 wt% in acetone/DMF, respectively, and combined at 3:1 ratio. Polymeric solutions were then processed via eletrospinning with processing parameters being optimized to 24.7 kV, 3.2 mL/h and 21 cm. Uniform, beadless nanofibers were obtained. Mats were characterized as mechanically resilient, to endure movements arising from mask positioning, and hydrophobic in nature, to repel droplets coming from the exterior. Loading of the nanofibrous mats was accomplished via physisorption using the free -OH groups of the CA as linkers. Mats were loaded with the EOs at MIC concentration for 72 h (saturation). Presence of the EOs was confirmed along the mats. Antimicrobial testing via halo determination, verified their diffusion abilities. More importantly, time-kill kinetics testing of the loaded mats attested to the EOs capability to fight the virus MS2 even when bonded to the nanofibers. Data demonstrated the potential of these EOs-loaded PCL/CA nanofibers mats to work as COVID-19 active barriers for individual protection masks.

Dental adhesives procedures allow the recovery of dental esthetics and function after tissue loss by dental caries or fracture, color changes, and teeth shape or position correction. This study aimed to assess in vitro cytotoxicity for one of each commercially available adhesive strategies - Adper™ Scotchbond™ 1 XT (SB1, etch-and-rinse), Clearfil™ SE Bond 2 (CSE, self-etch) and Scotchbond™ Universal (SBU, universal).

Odontoblast-like cells (MDPC-23) were cultured and exposed to adhesives extracts. To access cell metabolic activity, viability, types of cell death and cell cycle, MTT, SRB, double labelling with annexin V and propidium iodide and labelling with propidium iodide/RNAse were performed. Cultures were stained with May-Grunwald for qualitative morphological grading of cytotoxicity.

The SB1, CSE and SBU extracts determined a significant reduction in cell metabolism and viability. This reduction was higher for prolonged exposures even for less concentrated extracts. CSE extracts significantly reduced cell’s metabolic activity at its higher concentrations, since 2 hours of exposure. At the lowest concentrations, after 24 and 96 hours, SB1 extracts reduced more or as equal the metabolic activity as CSE extracts. Regarding cell’s viability, SBU extracts were the least cytotoxic, and CSE were significantly more cytotoxic than SB1 and SBU. The adhesives determined a reduction in the number of viable cells and an increase in the number of apoptotic, late apoptosis/necrosis and necrotic cells. Moreover, a decrease in the number of cells in S and G2/M phases and an increase in the number of cells in Pre-G0 and G0/G1 phases was observed. These changes were dependent on the adhesive, its concentration and the time of incubation. CSE extracts were the most cytotoxic and were classified as having a higher degree of reactivity, leading to greater inhibition of cell growth, with destruction of the cell’s layers.

According to The Organization for Economic Cooperation and Development (OECD), 2.4 million people in Europe, North America and Australia may die in the next 30 years from infections caused by resistant microorganisms. S. aureus – a opportunistic pathogen resistant to multiple antibiotics – induced infections are among the most prevalent bacterial infections, being on the front of the line of the World Health Organization (WHO) concerns. In this study, we report the production of biodegradable microfibers composed of sodium alginate (SA) and gelatin (GN), via wet-spinning technique, and their subsequent functionalization via adsorption with Nisin Z. Nisin Z is an antimicrobial peptide which possess great antibacterial activity (mainly against Gram-positive bacteria) and low toxicity in humans, thus being a great candidate for the production of scaffolds with S. aureus eradication ability for infected wounds. SA/GN microfibers were successfully extruded at a 70/30% v/v polymer ratio, within a calcium chloride (CaCl₂) 2wt% coagulation bath. SA-free fibers were obtained through chemical modification (PBS concentrated solutions and subsequently, SAGN and SA-free fibers were crosslinked with glutaraldehyde (labeled as SAGNCL and GNCL, respectively). Finally, Nisin Z was functionalized onto the fibers at an average concentration of 178µg/mL. Fibers were characterized via Fourier transform infrared spectroscopy, thermal analysis and brightfield microscopy. Nisin Z degradation/release profiles (SBF, 28 days) were assessed. Antibacterial activity against S. aureus was detected via time-kill kinetics assessments. SAGNCL and GNCL loaded microfibers were capable of inhibit the grow of S. aureus up to 99% after 48 h of culture. The SA and SAGN loaded microfibers were not as effective, losing their action after 6 h. Bacteria elimination was consistent with the release kinetics of Nisin Z from the fibers. Overall, data revealed the potential of Nisin Z in fighting S. aureus-induced infections, while loaded onto biodegradable crosslinked polymeric scaffolds.

Background: Global pandemic COVID-19 has strongly affected all areas of life, particularly physical and mental health, as well as professional and economic status. This research aims to examine exposure to COVID-19 in areas of health, professional and economic status among university students in six European countries.

Methods: Cross-sectional study was conducted in a total sample of 1685 university students in European countries: Russia (n = 285, 17%), Germany (n = 270, 16%), Ukraine (n = 310, 18%), Poland (n = 301, 18%), Slovenia (n = 209, 13%), and Czech Republic (n = 310, 18%), including a total of 1160 (69%) female students.

Results: Overall, 10% of European university students experienced COVID-19 symptoms and observed infection among family, while 4% were tested, 6% were in strict quarantine, but a few individuals (0.2%) have been hospitalized. Nearly 1.5% of European university students experienced death among friends and family due to COVID-19. Over 22% of participants reported losing a job, and 44% declared deterioration of economic status due to a pandemic. German and Russian university students experienced significantly more COVID-19 symptoms, reported a higher prevalence of strict 14-days quarantine and infected friends and relatives. Russian participants were tested for COVID-19 the most frequently. They experienced the highest number of death cases within the family due to a pandemic. In contrast, in Poland and the Czech Republic, there were no death cases in students’ families. The highest percentage of university students or their families losing a job was observed in Poland and Ukraine, whereas the lowest in the Czech Republic.

Conclusions: There are significant differences in exposure to COVID-19 between university students from distinct European countries. The knowledge about exposure to coronavirus may help to explain mental health issues among university students and to develop prevention programs at universities.

Objectives: The study was conducted to determine the demographic factors associated with burnout syndrome among medical students at the Faculty of Medical Sciences in Kragujevac (University of Kragujevac, Serbia).

Materials and methods: A cross-sectional, analytical study was conducted in 2014, using the Maslach Burnout Inventory Student Survey and epidemiological questionnaire on basic socio-demographic characteristics (age, sex, completed secondary school, marital status, housing, study financing, etc). The study included 760 of 836 medical students from first to sixth year of studies who met the criteria for participation (response rate was 90.9%). Burnout syndrome was defined as a triad of symptoms: emotional exhaustion, cynicism, and academic inefficiency. Statistical evaluation was performed through Chi-square and t-test.

Results: Mean scores for the triad of burnout symptoms were: Emotional Exhaustion (12.8 ± 7.2; rank 0-30), Cynicism (3.6 ± 4.9; rank 0-24), and reverse Academic Efficacy (9.1 ± 8.3; rank 0-36). Gender was significantly associated with less cynicism, with fewer women showing a high level of cynicism compared to men (31.6% vs. 41.3%; P = 0.007). Age was significantly associated with all dimensions of burnout: while cynicism and academic inefficiency increased with age (P = 0.000), emotional exhaustion decreased significantly with age (P = 0.000). The self-financing way of studying was significantly associated with greater cynicism and academic inefficiency (P <0.05).

Conclusion: Our research confirmed the association of socio-demographic characteristics and the level of burnout syndrome in medical students.

Despite the numerous advances in modern medicine, cancer and bacterial diseases cause the death of 10 and 11 million people every year globally, respectively. Due to the significant heterogeneity associated with carcinogenesis and the constant emergence of resistant bacterial strains caused by the misuse of antibiotics, the search for new compounds of natural origin with bioactive properties related to tumor and bacterial diseases is growing every year. One of the most relevant compounds found in plants are the secondary metabolites, specifically phenolic compounds. There is vast literature on these molecules and their associated bioactivities, but the establishment of new trials revealing the therapeutic uses of these compounds is continually evolving. In this study, the identification and quantification of phenolic compounds from three species of the Amaranthaceae family (Alternanthera sessilis (L.) R., Dicliptera chinensis (L.) Juss. and Dysphania ambrosioides (L.) Mosyakin & Clemants) were carried out. The results showed a high flavonoid content in the three species, ranging 11.4 – 15.1 mg/g extract, being apigenin, luteolin and isorhamnetin derivates the most abundant compounds. Then, the cytotoxic and antibacterial activities of Amaranthaceae plants extract were determined. Different tumoral cell lines (Caco-2, MCF-7, NCI-H460) were cultivated in the presence of the extracts, and the results revealed high growth inhibitory concentration 50% (GI50) values, ranging from 263 ± 12 to 188 ± 14 µg/mL. In parallel, the antibacterial activity of extracts was assessed against different Gram-positive (Escherichia coli, Klebsiella pneumoniae, Morganella morganii, Proteus mirabilis and Pseudomonas aeruginosa) and Gram-negative (Enterococcus faecalis, Listeria monocytogenes and MRSA) strains. A. sessilis showed minimal inhibitory concentrations (MIC) of 5mg/mL against M. morganii, as well as D. abrosioides, and MRSA strain. These results showed a significant activity of the phenolic compounds present in these three species, exhibiting a high nutraceutical and pharmaceutical potential.

Acknowledgements

The research leading to these results was funded by Xunta de Galicia supporting the Axudas Conecta Peme, the IN852A 2018/58 NeuroFood Project and the program EXCELENCIA-ED431F 2020/12; to Ibero-American Program on Science and Technology (CYTED—AQUA-CIBUS, P317RT0003) and to the Bio Based Industries Joint Undertaking (JU) under grant agreement No 888003 UP4HEALTH Project (H2020-BBI-JTI-2019); by MICINN supporting the Ramón y Cajal grant for M.A. Prieto (RYC-2017-22891); by EcoChestnut Project (Erasmus+ KA202) that supports the work of B. Nuñez-Estevez,. The JU receives support from the European Union’s Horizon 2020 research and innovation program and the Bio Based Industries Consortium. The project SYSTEMIC Knowledge hub on Nutrition and Food Security, has received funding from national research funding parties in Belgium (FWO), France (INRA), Germany (BLE), Italy (MIPAAF), Latvia (IZM), Norway (RCN), Portugal (FCT), and Spain (AEI) in a joint action of JPI HDHL, JPI-OCEANS and FACCE-JPI launched in 2019 under the ERA-NET ERA-HDHL (n° 696295). Foundation for Science and Technology (FCT, Portugal) for financial support through national funds FCT/MCTES to the CIMO (UIDB/00690/2020). L. Barros and R. Calhelha thank the national funding by FCT, P.I., through the institutional scientific employment program-contract for their contracts.

Objectives: For malignant melanoma of skin, one of the most aggressive skin cancers, great differences in mortality across the world have been observed during the last decades. The purpose of this study was to assess the mortality of malignant melanoma of skin in Serbia in 1991-2019.

Materials and methods: This is a national-wide descriptive epidemiological study. Age-standardized rates (ASRs) for malignant melanoma of skin mortality were calculated (per 100000), and the average annual percent change (AAPC) with 95% confidence interval (CI) was used to evaluate trends. Joinpoint regression analysis was applied.

Results: Average annual ASR of malignant melanoma of skin mortality in men was higher than in women (11.2 per 100000 and 3.3 per 100000, respectively). In overall, a significantly decreasing trend for malignant melanoma of skin mortality was observed, but one joinpoint was observed: a significant decrease of malignant melanoma of skin mortality from 1991 to 2012 (by -1.6% per year, 95%CI=-2.0 to -1.2) was followed by a significantly sharp decrease to onwards (by -4.0% per year, 95%CI=-5.9 to -2.2). Trend from malignant melanoma of skin mortality rates significantly decreased both in men (AAPC=-1.6; 95%CI=-1.9 to -1.4) and women (AAPC=-3.5; 95%CI=-3.9 to -3.0). Mortality trends in men and women were not parallel (final selected model rejected parallelism, p=0.0002) and not coincident (final selected model rejected coincidence, p=0.0002).

Conclusion: The trend in malignant melanoma of skin mortality has been decreasing in Serbia in the last decades. Further research will allow a clarification of trends and help in future cancer control.

Background/Purpose: Over half of medical students meet criteria for medical student in distress and nearly one-quarter report considering or taking a leave of absence during their training. Little is known about the relationship between psychological stress and hair loss. This study sets out to identify demographic factors associated with stress-induced hair loss in a cohort of medical students.

Methods: A cross-sectional study of medical students at a diverse, metropolitan university was performed. A questionnaire was developed to assess potential sociodemographic indicators of hair loss, quantify perceived stress using the Perceived Stress Scale, and record experiences of telogen effluvium, trichotillomania, alopecia areata. A total of 303 responses were recorded. Data was coded and analyzed using IBM-SPSS and will include Pearson correlation (r), ANOVA, student t-test, and chi-square test. Statistical significance was assigned at p<0.05.

Results: Of the 303 responses, 20 students reported diagnosed hair loss by a medical professional (group 1), 167 students were not diagnosed but have reported having features of hair loss (group 2), and the remaining 116 reported no features of hair loss (group 3). Average stress scores for groups 1, 2, and 3 were 22 +/- 7, 21 +/- 5.7, and 18 +/- 5.8, respectively, which were significantly different (P<0.001). Average age for these groups were 25.4 +/- 2.9, 25.4 +/- 2.5 and 25.4 +/- 3.2, which were not significantly different (p=0.963). 60% of male participants and 62% of female participants reported some hair loss features or a clinical diagnosis of hair loss. Lower classmen (second and third year medical students) comprised 60% of group 1, 54.5% of group 2, and 55.2% of group 3. There was no significant association with hair loss and medical school class level (P=0.219).

Conclusions: Based on our results, there is an association between stress and hair loss. Stress scores for individuals with diagnosed hair loss (22 +/- 7) was similar to those who reported having features of hair loss with no diagnosis (21 +/- 5.7 ) (P<0.001). No statistical significance was found in the ages across the 3 groups (p=0.963). Further analysis needs to be performed to assess whether a relationship exists between the most common causes of stress-induced hair loss and these demographic characteristics (age, gender, class level, etc.).