Dendritic cells (DCs) play a key role in the regulation of cell-mediated immunity. Hence, manipulating DCs may offer a tremendous opportunity for intervention. The unique capacity of DCs to capture and process pathogens for presentation to the immune system, combined with their capacity to express costimulatory and adhesion molecules as well as cytokines and chemokines, renders them powerful antigen-presenting cells and key regulators of the host immune response. However, pathogens, cancer, autoimmunity and aging/stress dysregulate the DCs-functions and reduce or abolish their capacity to present antigens to T cells, leading to T cell exhaustion and B cell dysfunction. In order to regulate the adaptive immune response (T and B cell functions) in various conditions, we must fine tune (balance) the cellular immune response by targeting DCs. Based on the “Principals of Quantum Energy”, I am proposing a non-thermal, non-drug procedure, to regulate dendritic cells function without adversity to the targeted DCs. The central hypothesis named as “Poke & Rippling Effect” depicts that the “Defined Single Long Exponential Decay electric pulse (SLEDep) delivered to antigen-loaded DCs can significantly enhance DC maturation and antigen-presenting function without inducing cell death, thus, triggering antigen-specific T cell priming and activation”. The SLEDep mediated modulation of DCs functions offer a high-reward approach that differs fundamentally from traditional strategies for immune intervention. If successful, this approach will yield a game-changing pathway for improving public health for many immune system-related diseases (Infectious diseases, cancer and autoimmune disorders) and overall immune functions during aging and stress conditions.

Antimicrobial resistance or AMR is a serious global health emergency. The rapid spread of multi-drug resistant (MDR) and extremely drug resistant (XDR) bacteria across the globe has put the success of modern medicine in jeopardy. According to a report published by Jim O Neil in 2014, if no action is taken now then by the year 2050, 10 million people will die every year due to drug-resistant infections and this number would be greater than deaths caused by diabetes and cancer put together. Carbapenem resistant Enterobacteriacae (CRE). Carbapenem resistant Pseudomonas (CRPA) and Carbapenem resistant Acinetobacter (CRAB) have been identified by WHO as the priority pathogens for which new antibiotics are needed very soon. Focus on new rapid diagnostics, increasing coverage of vaccines, strengthening the national/regional epidemiological surveillance networks, developing novel alternates to antibiotics and suggesting ‘out of the box’ new drug development and commercialisation models are some of the measures proposed to counter AMR. The GAIN (Generating Antibiotic Incentives Now) Act - 2012, the PATH (Promise for Antibiotics and Therapeutics for Health) Act-2015 in US and ND4BB (new Drugs for Bad Bugs) 2013 by European Union are some of the well-known large initiatives taken to incentivise new antibiotic discovery.  Pharmaceutical industry   has also risen up to the challenge and the pipeline for breakthrough antibiotics targeted against critical gram negative pathogens is beginning to build up. Antimicrobial Stewardship (AMS) programs to optimise the clinical outcomes and minimise the unintended consequences of antibiotic use are being advocated at both hospital and community setting. All these measures plus increasing awareness and education on rational use of antibiotics raises hopes that there is light at the end of the tunnel, however if these efforts are not sustained and strictly enforced then this light at the end of the tunnel could be of an incoming train.

Statement of the Problem: Methicilin Resistant Staphylococcus aureus (MRSA) nasal colonization has recently become an issue of public health with major repercussion, for it has been proved to be the cause of multiple complications of a variety of systemic diseases, particularly infectious ones or at least a key factor for their worsening. The purpose of this study is to describe the pathologic mechanisms of this colonization condition and its progress and relationship with systemic disease, based on a model proposed in one of our studies that established its association with Health Care Associated Infections (HCAI) in hospitalized patients at the Internal Medicine Service number 3 of the Vargas Hospital (Caracas), during the period of march-july 2015. Methodology & Theoretical Orientation: a prospective descriptive prevalence study was conducted using a longitudinal design, with an intentional sample of 154 patients selected according to specific criteria. Nasal swab samplings were taken in order to determine nasal colonization by MRSA. We then observed them through time and determined whether or not they developed HCAI during their hospitalization. Afterwards, we proposed a theoretical model of pathogenesis that could explain this behavior of MRSA nasal colonization in HCAI and other systemic diseases. Conclusion & Significance: MRSA nasal colonization represents a clear risk for HCAIs and other systemic diseases. This risk increases in the presence of 1 or more past medical history components: we found a relative risk (RR) of 7 (p <0.05) for MRSA-HCAI and 2 (p <0.05) for history of coexisting conditions-MRSA-HCAI. Establishing a theoretical model for these complex interactions MRSA has with systemic diseases allows understanding Recommendations were made for treatment centers that deal with hospitalized patients with possible MRSA nasal colonization.

8% Year-On-Year Cyber Spend –
Source - Ensign, 2019

32,000 intrusion cyber attacks per day per organisation – Healthcare industry

14,300 per organisation – Other industries
Source - Forti Guard Labs, 2017

The connectivity of network systems have benefited both the users and the hackers, but with very different and obvious outcomes.

Amidst medical and scientific breakthroughs and continuous efforts to enhance quality, targeted treatment and speed in patient care delivery and recovery assisted by the ever changing technological landscapes, both public and private healthcare organisations have been keeping up with the trends and invested in medical devices that provide seamless connectivity between the patients and the hospitals in terms of data transfer and management.

Stolen and sold patient data is disastrous and may be remedied with penalty charges due to breach of privacy and data protection laws.

We must not forget that with inter-governmental and regional MOUs, Trade Agreements and Collaborations being forged at global level, transnational data transfers would be inevitable and will certainly pose higher level of security threats.

Failure of operational network systems arising from cyber attacks within a healthcare organisation with IoMTs (Internet of Medical Things) installed for the purposes stated above carry far reaching damages leading to delayed treatment, disrupted treatment codes and computations, medicinal dosages or simply a mixed up of a patient’s data with another in the aftermath of an attack, could have devastating if not deadly effects.

How do we then enhance patient data protection and strengthen network system security, moving forward?

In my opinion, all healthcare organisations might want to revisit traditional way of patient record keeping in paper, compact discs as back up plans and to prevent data theft and work with the manufacturer to segmentalise/decentralise all IoMTs from the main network systems which is the only path through which the cyber hackers conduct criminal acts. If we need the manpower to man all these traditional activities, so be it, as the long term effects are more sustainable.

Health care-associated infections (HCAI) are the most frequent adverse event in health-care delivery worldwide. Up to 16% of HCAI are Surgical Site infections (SSI).   Managing the risk of Surgical Site infection is complex. Many patients are affected by SSI each year, leading to significant mortality, morbidity and financial losses for health systems.

There are multiple sources of contamination and other variables that can increase the risk of SSI. Some of these variables can be controlled, and some of these variables are outside the control of the health care team.

Nowadays, implementing standard of care and best practices in surgical procedures become  part of patient safety strategies globally .It includes guidelines, protocols, Bundle of care and clinical evidence that can help to reduce risk of SSI. There is no doubt, that by standardizing the process of care, we enhance patient safety, outcomes and satisfactions as well as team work collaborations and communications.

Salmonella infection remains a major health concern across the world because of rise of multiple drug resistant strains and emergence of hyper infectious Salmonella strains leading to disease severity. The outcome of infection is the result of complex interaction of the bug with host immune system as well as in the non-host environments with which Salmonella encounters. We studied the evolutionary adaptation in Salmonella by repeatedly exposing to three different environmental conditions such as in-vitro in LB and F media and in-vivo in C. elegans. We report that this exposure has led to multiple phenotypic and genotypic changes in Salmonella. Compared to unpassaged strain, the passaged strain showed increased body size, increased number of flagella and increased motility that are associated with virulence of Salmonella. Resistance towards the oxidative and nitrosative stresses has also been increased in these strains. Besides, they showed increased invasion and proliferation in different mouse and human cell lines. Further the host colonization of the passaged strains as seen in C. elegans model was found to be more and caused early death of the worms infected with these strains. We looked forward to find the mechanism resulting in the above hyper infectivity phenotype and observed altered cytokine response in the cells infected with these strains along with reduction in the AMP production in the worms possibly leading to hyper proliferation and their early death. Gene expression study revealed that various SPI-I and SPI-II genes, flagellar, stress response and two component systems gene has been upregulated. Furthermore, whole genome sequencing analysis revealed a number of point and frame shifts mutations in the passaged strains. Collectively our study demonstrated the hyper pathogenicity of Salmonella that occurred due to repeated passaging causing disease severity and the genes responsible for the same can be targeted to combat Salmonella infection.