Soo Youn Lee has completed his M.D at the age of 26 years from Chosun University, colloege of Medicine. She is the director of ICU at Sejong General Hospital, Buchoen, Republic of Korea. She has published 6 papers in reputed.

Enterococci have become common nosocomial pathogens and are currently the third-leading causes of nosocomial bloodstream infection. Vancomycin-resistant enterocolli(VRE), mostly Enterococcus faecium, are increasingly involve, especially in critical patients with co-morbid condition.The options for treatment of VRE have improved over the years with the advent of oxazolidinone linezolid, the glycylcycline tigecycline, and the lipopiptide daptomycin. Nonetheless, toxicities my limit their use. We here report a case of VRE prosthetic valve endocarditis with daptomycin due to severe lactic acidosis complicated by linezolid. A 45 yars old female, who had undegone prosthetic aortic valve replacement 15 years back, presented with cardiogenic shock. Chest xray showed pulmonary edema. Pannus formation on a Hancock II 21mm aortic valve prosthetis in the aortic position as depicted by transthoracic ehocardiogram. Oliguria was developed and eGFR was rise. She underwent continous renal replacement therapy. Until waiting redo aortic valve replacement, abruptly fever was developed. Transthoracic echocardiography showed a vegetation at tricuspid valve. Urgent aortic valve replacement was done without complication. Blood cultures grew Enterocuccus faecium, which was resistant to vancomycin but susceptible to linezolid and daptomycin. However, tissue cultures showed no growth results. Treatment with intravenous linezolid was initiated. Her bacteremia initially cleared. After 16 days on treatment of linezolid, lactic acid was elevated up to 15mmol/L. We switched linezolid to daptomycin. Lactic acid was decreased to normal range after 8 days stopping linezolid. Severe lactic acidosis with linezolid present barriers to effective treatmetnt. Serial follow up of lactic acid during treatment with linezolid is crucial to managment patients with VRE.

My name is Chantal Mukandoli, I migrated to Canada from Rwanda in 2006. I was the representative of ICW Central Africa from 2003 to 2006. Before I migrated to Canada, my work with ICW, We- Act, Care International, and Presbyterian Church included: outreach, advocacy, activism, peer mentor and educator. I also participated in International advocacy platforms including demanding the formation of ICW in the early years. I represented Central Africa in fundraising efforts for various HIV-related projects. I also used my voice and personal stories to share my life living with HIV. In 2006, during the International AIDS Conference I submitted an abstract which was accepted, and presented on the health of women raped during genocide in Rwanda in 1994. The abstract highlighted women, who got infected by HIV, got stigmatized and discriminated, and those who were poor and disabled. I felt rejuvenated, more powerful and knowledgeable by engaging with other powerful women from diverse backgrounds. As a long-time survivor living with HIV, I had so much to share with other women, including newly diagnosed women. It was an opportunity to bring out a voice for women living with HIV in Canada. My dream is to end the stigma and discrimination I face as a woman living with HIV, and be the mentor for other women. It is my hope that women will be able to disclose their HIV status without fear of being discriminated, beaten, killed, and refused services or employment. In XXX I decide to get involved with the Toronto People With AIDS Foundation to give back and show appreciation for all that they did for me as a client. ** Chantal can you fill in all the programs that you are involved in?? ( circle of care, speakers bureau, etc.) PWA is a place where people can find a safe and welcoming place to talk about their issues, advocate for their rights, and participate meaningfully in programs and services.

This project engaged 40 HIV+ women 50+ in group exercises and skills-building activities at workshops The workshops were hosted in Toronto (n=10) and Hamilton, Ontario (n=10), and Montreal, Quebec (n=20). All workshops took place between July and November 2017, each lasting 4.5 hours.  The workshop participants identified themselves as follows: 87% as female, 13% identified as transwomen, and their age range was 45 – 50 (28%) and 50+ (72%)  Co-facilitated by two older adult women living with HIV, the workshops topics included:  Complexities of HIV stigma and discrimination and reduction strategies;  Self-care strategies;  Adherence to HIV medications;  HIV disclosure to children and other family members,  Healthy sexual relationships;  Social skills like cooking, knitting and sewing;  Basic skills in home-based care  English as a second language among others.

Abdulsalam Mohamad Kasim Al-Mukhtar has completeted his Ph.D. at age 37 years, from Salford University (England 1980), more than 30 research published in different journals,and he was working as lecturer in dept. of microbiologl,college of medicine, university of Mosul,Mosul, Iraq for 44 years ago.

Objective: Intestinal amebiasis is still an important health problem in developing countries of the world. One of the most issues for future biomedical research is the development of antimicrobial resistant, in order to search for alternative new antiamoebic drugs. A study was carried out to evaluate the efficacy of albendazol on the viability of Entamoeba histolytica clinical isolate from human which used for experimental animals. Material and Methods: All experimental animal models (30 albino mice and 30 rabbits),divided into 3 groups,each group with either 10 mouse or 10 rabbits, were orally infected with E. histolytica (clinical isolate), then after 7 days they were given drugs (Metronidazol or Albendazol) daily according to body weight prepared in advance for 5 days duration and in addition to the controls without drugs. Stool specimens of each group were examined microspically for viable trophozoites,and the number of these trophozoites were counted with haemocytometer chamber, as compared to untreated and treated groups. Statistical methods used was student t-test. Results: The results showed infection of E.histolytica was able to be intiated in rabbits only. Albendazol and metronidazol were highly effective(100%) on treatment of infected groups of rabbits ( table I ). Trphozoites of E. histolytica was highly sensitive to albendazol (25% viability), or to metronidazol (22.7% viability) at a dose of 400 mg / kg / day and 250 mg / kg / day respectively,which was significant in relation to the control 500% viability(table II). However, the differences were significant at the level (p

Background Visceral leishmaniasis (VL) or kala-azar is a systematic parasitic infection caused by two leishmanial species, L. donovani or L. infantum/ chagasi. The infection is transmitted by the bite of infected sand fly Phlebotomus argentipes. L. infantum/ chagasi infects mostly children and immunosupressed individuals(1). Methods This was a cross sectional, hospital-based study conducted from 20th of October to 25th of December 2018 to describe the clinical and epidemiological features of visceral leishmaniasis among patients admitted at AlGadarif teaching hospital. Results: 100 patients were included in the study. Age ranged from 1 year to 79 years. 40% were children , 38 % adult male , 27% adult females and 20% came from Om bielel . 57% were served with well water . Average number of latrines in 53%are zero . 62% illiterate . with average monthly income 1.500SDG . 42% use ITNs with 76% vary in sleeping habit . Clinical presentation included splenomegaly (77%), fever (96%) . Regarding children pallor in 67% and in adults splenomegaly in 93% .60% misdiagnosed and mistreated as Malaria and Typhoid. The mean values for laboratory variables were: hemoglobin 59%, leukocyte count 2500/mm³, and platelet count 135000 mm³.with lowest platelets record about 15000 Mainly the diagnosis through Serology in 47%The first line treatment used in 58% of the cases was combination of SSG and Parmomycin . Ambisome was used in 41%. Conclusions While there is an advance in prevention and management of visceral leishmaniasis our results indicate that VL is still a public health problem with its severe presentation among patients in eastern Sudan. High clinical suspicion is very important and introducing the preventive measures (prevention of transmission through vector control and community awareness) are needed to reduce the spread of the infection.

The paper by Brogen et al highlights some of the problems encountered in the laboratory identification of Streptococcus milleri.' Their conclusion that routine biochemical speciation of clinically significant streptococci should be a minimum standard for the identification of S milleri could be open to misinterpretation. As a result, diagnostic laboratories may increase their use of costly commercial streptococcal identification kits such as API 20 Strep, Rapid ID 32 Strep (BioMerieux) or BBL Crystal Gram Positive ID Kit (Becton Dickinson) when more simple and cost-effective identification protocols exist.2 The authors state that Lancefield grouping is of little help in recognising possible S milleri group cultures.' This is because only a quarter of S milleri isolates are thought to possess Lancefield group antigens A, C, F or G.' However, their study of clinically significant strains indicated that only 30 of 87 (34%) strains failed to group.' Hence Lancefield grouping does have a useful diagnostic role. As expected, group F was the most common Lancefield antigen detected (47%), which is indicative of S milleri. Group C and G S milleri can be differentiated rapidly and cheaply from other group C and G streptococci by their inability to degrade 13 D-glucuronide.4 Group A S milleri can be distinguished from Streptococcus pyogenes by its resistance to bacitracin. S milleri possessing group B antigen has not been described.3

David Ahn is a recent William & Mary graduate with a major in economics. His experiences focus on econometric data analysis for public health and sustainable energy initiatives. His work investigates disease prevention, public health, and efficient public policy programs.

Objectives: The Middle East Respiratory Syndrome (MERS-CoV) is a potentially fatal respiratory viral infection that has had outbreaks in the Middle East and Asia region starting in 2012. As recent as 2015, MERS had outbreaks in South Korea, resulting in 36 deaths among 186 infected patients. The purpose of this thesis is to gain an in-depth understanding of how this viral infection behaves in outbreaks and how it is spread around the globe. Methods: To gain insight, real time analysis was performed under a case study methodology based on pooled data from the Ministry of Health & Welfare of South Korea. We calculated a striated mortality rate based on gender, age, and the presence of pre-existing health conditions ranging from heart, lung, and kidney diseases. Results and Conclusion: We found that MERS outbreak follows the pattern of a point source outbreak, largely spurred by the patient-referral system under the universal healthcare system in South Korea. The purpose of this case is to discuss the benefits and challenges of such patient referral system, and to offer a possible solution in improving transparency between healthcare providers and the government under a universal healthcare system to prevent future outbreaks

BACKGROUND: Tuberculosis (TB) is a disease with a high prevalence and mortality worldwide. Currently used anti-TB medicines are effective in terms of effectiveness but cause various harmful effects. METHODS: The records of 222 patients with microbiologically or radiologically or hitologically suspected TB were retrospectively analyzed. The patients had initially received first-line anti-TB drugs. Patients were seen at least monthly by a nurse and treating physician. At the time of these visits, patients were questioned specifically regarding occurrence of common side effects to anti-TB drugs. RESULTS: Of the 222 patients, 122 were male and 100 were female and the mean age was 50 years. The diagnosis was pulmonary TB in 184 cases, lymph node TB in 19 cases, and tuberculous pleurisy in 9 cases. Among 222 patients treated with first-line anti-TB drugs, 188 adverse reactions occurred. The most common adverse event was nausea/vomiting (15.8%), followed by itching sensation (14.9%), rash (12.6%) (Table 2). Fourteen patients developed rug-induced heptotoxicity (DIH). CONCLUSION: The harmful effects of anti-TB drugs are diverse and common, so education and regular monitoring are important.