In-vitro activity of β-lactams/trimethoprim-sulfamethoxazole combinations against different strains of Burkholderia pseudomallei

@#Trimethoprim-sulfamethoxazole is an active agent against Burkholderia pseudomallei and is being used in intensive and maintenance phases of melioidosis therapy. In this study, we evaluated the bactericidal activities of β-lactams (imipenem, ceftazidime and amoxicillinclavulanate) alone and in combinations with trimethoprim-sulfamethoxazole against B. pseudomallei. Four clinical strains of B. pseudomallei were selected based on different genotypes that are frequently found in Malaysia. The minimum inhibitory concentrations of trimethoprim-sulfamethoxazole, ceftazidime, imipenem and amoxicillin-clavulanate were determined using microdilution broth method. The bactericidal activities and synergy effects of β-lactams and/or trimethoprim-sulfamethoxazole were evaluated by checkerboard and static time-kill analyses at 1×MIC concentration of each antibiotic. Using checkerboard method, the β-lactam/trimethoprim-sulfamethoxazole combinations exhibited ΣFIC of 0.75-4.00. In time-kill analysis, ceftazidime/trimethoprim-sulfamethoxazole combination demonstrated synergy against three strains (less 2.25-2.41 log10CFU/mL compared to the most active antibiotic monotherapy) whereas imipenem/trimethoprim-sulfamethoxazole combination regimen showed synergy against one strain (less 3.32 log10CFU/mL). No antagonist effect or major re-growth was observed in all combination regimens, whereas 11 out of 12 of β-lactam monotherapy regimens were associated with re-growth of bacteria. However, all β-lactam monotherapy regimens exhibited rapid and stronger killing activities against BUPS/07/14, in the initial 12 hours compared to β-lactam/ trimethoprimsulfamethoxazole combination regimens. The combination of β-lactams with trimethoprimsulfamethoxazole demonstrated better killing effect at 24 hours compared to monotherapy and no major bacterial regrowth was observed. Nevertheless, delay in killing activities of β-lactam/trimethoprim-sulfamethoxazole combination regimens against BUPS/07/14 need further examination because this phenomenon can lead to treatment failure in some patients.

Prevalencia de paperas en Bagdad. Irak - 2015 y 2016 / Prevalence of Mumps in Baghdad, Iraq - 2015 & 2016

Antecedentes: las paperas son una infección viral que se transmite por contacto directo, gotitas y fómites. Irak es testigo de varias epidemias de paperas. Objetivo: Informar sobre la última epidemia de paperas 2015-2016. Métodos: El lado de Bagdad de Al-Rusafa fue seleccionado al azar de dos lados de Bagdad. Se llevó a cabo una revisión de los datos del Departamento de Salud Pública de la Dirección de Salud de Bagdad / Al-Rusafa. Los datos fueron todos los casos notificados de paperas para los años 2015-2016. Resultados: Los casos registrados de paperas fueron 9780 y 33728 para 2015 y 2016, respectivamente. La edad máxima en 2015 y 2016 fue de 5 a 14 años. Los picos de casos de paperas se registraron en octubre, diciembre de 2015 y enero de 2016, y desaparecieron en junio de 2016. Conclusiones: La epidemia de paperas fue clara en Bagdad. La lucha social juega un papel en el desarrollo de la epidemia.

Background: Mumps is a viral infection transmitted by direct contact, droplet infection and fomites. Iraq witnesses several epidemics of mumps. Objective: To report on last epidemic of mumps 2015- 2016. Methods: Al-Rusafa side of Baghdad was selected randomly from two sides of Baghdad. A review of data from department of public health, Directorate of Health of Baghdad / Al-Rusafa was carried out. The data was all the notification cases of mumps for the years 2015-2016. Results: The registered cases of mumps were 9780 and 33728 for 2015 and 2016, respectively. The peak age in 2015 and 2016 was 5-14 year. The peaks mumps cases were in October, December 2015 and January 2016, and disappear in June 2016. Conclusions: Epidemic of mumps was clear in Baghdad. Social strife plays a role in developing the epidemic.

Molecular characterization of goose parvovirus in geese of Turkey

ABSTRACT: Goose parvovirus (GPV), also called Derzsys disease, is a viral pathogen that causes high morbidity and mortality in goslings and ducklings. In this study, we perform the molecular characterization of the GPV in Turkey. The definition of similarity to the world of GPV isolates in Turkey and construction of a phylogenetic tree was aimed. For this purpose, the presence of GPV in the liver, spleen, and intestine tissues of nine goslings with symptoms such as dysphagia, bilateral ocular swelling, eye discharge, diarrhea, and fatigue were investigated by real-time PCR method and all samples were detected as positive. According to the data obtained by molecular characterization, phylogenetic analysis of GPV has been presented in Turkey. As a result of this study, it was determined that the GPVs available in Turkey are virulent strains.

RESUMO: O parvovírus do ganso (GPV), também chamado de doença de Derzsy, é um patógeno viral que causa alta morbidade e mortalidade em gansos e patinhos. Neste estudo, objetivou-se a determinação da caracterização molecular do GPV na Turquia, a definição da similaridade com o mundo dos isolados de GPV na Turquia e a construção de uma árvore filogenética. Para tanto, a presença de GPV no fígado, baço e tecidos do intestino de nove gansos com sintomas como disfagia, edema ocular bilateral, secreção ocular, diarreia e fadiga foram investigados pelo método de PCR em tempo real e todas as amostras foram detectadas tão positivo. À luz dos dados obtidos por caracterização molecular, a análise filogenética do GPV foi apresentada na Turquia. Como resultado deste estudo, foi determinado que os GPVs disponíveis na Turquia são cepas virulentas.

Molecular characterization of goose parvovirus in geese of Turkey / Caracterização molecular de parvovírus de ganso em gansos da Turquia

Goose parvovirus (GPV), also called Derzsy's disease, is a viral pathogen that causes high morbidity and mortality in goslings and ducklings. In this study, we perform the molecular characterization of the GPV in Turkey. The definition of similarity to the world of GPV isolates in Turkey and construction of a phylogenetic tree was aimed. For this purpose, the presence of GPV in the liver, spleen, and intestine tissues of nine goslings with symptoms such as dysphagia, bilateral ocular swelling, eye discharge, diarrhea, and fatigue were investigated by real-time PCR method and all samples were detected as positive. According to the data obtained by molecular characterization, phylogenetic analysis of GPV has been presented in Turkey. As a result of this study, it was determined that the GPVs available in Turkey are virulent strains.(AU)

O parvovírus do ganso (GPV), também chamado de doença de Derzsy, é um patógeno viral que causa alta morbidade e mortalidade em gansos e patinhos. Neste estudo, objetivou-se a determinação da caracterização molecular do GPV na Turquia, a definição da similaridade com o mundo dos isolados de GPV na Turquia e a construção de uma árvore filogenética. Para tanto, a presença de GPV no fígado, baço e tecidos do intestino de nove gansos com sintomas como disfagia, edema ocular bilateral, secreção ocular, diarreia e fadiga foram investigados pelo método de PCR em tempo real e todas as amostras foram detectadas tão positivo. À luz dos dados obtidos por caracterização molecular, a análise filogenética do GPV foi apresentada na Turquia. Como resultado deste estudo, foi determinado que os GPVs disponíveis na Turquia são cepas virulentas.(AU)

Reduced susceptibility of Burkholderia pseudomallei following exposure to carbapenem

@#Reduced susceptibility in Burkholderia pseudomallei during carbapenem therapy may lead to treatment failure. We isolated a clinical strain that had developed reduced susceptibility to carbapenems while on treatment. After reviewing the patient’s clinical notes, the initial isolate (BUPS01/14) was exposed to carbapenem in vitro to mimic the clinical scenario. The stability of susceptibility of the carbapenem-exposed strain (BUPS01/14R) was examined by serial subculture in antibiotic-free broth. Biochemical and morphological comparison was performed by the VITEK® system and electron microscopy. MICs increased 32-fold following carbapenem exposure and became stable in the antibiotic-free environment. On electron microscopic examination, the BUPS01/14R cells were smoother and less wrinkled compared to BUPS01/14 cells. This report highlights a potential anti-melioidosis treatment failure due to the emergence of resistance while on carbapenem monotherapy. Further study of this strain is necessary to understand the mechanism of resistance at a molecular level.

Screening of nematophagous-fungi from fresh faeces of grazing animals and soils

@#An investigation was undertaken for screening and isolating nematophagous-fungi from the faecal samples of various grazing animals and soils in Malaysia. Total of 111 faeces and 50 soil samples were collected and the samples were cultured on 2% water agar plates. The growth of nematophagous-fungi was stimulated by sprinkling-baiting technique. The conidia of suspected nematophagous-fungi were inoculated on 2% water agar plates. All isolated were maintained on 2% cornmeal agar plates. Verticillium spp., Fusarium spp. and Arthrobotrys spp. were identified from the faecal and soil samples. 62.5% of the faecal samples and 100% of the soil samples were shown to be positive with nematophagous-fungi. This study highlights the present of nematophagous-fungi population in faecal and soil samples. Much study remains to be done to better understanding some fungi especially their mode of action and their predatory behaviour against parasitic nematodes.

Airway management in newborn with Klippel-Feil syndrome / Manejo de vias aéreas em recém-nascido com síndrome de Klippel-Feil

Abstract Klippel-Feil syndrome (KFS) has a classical triad that includes short neck, low hair line and restriction in neck motion and is among one of the congenital causes of difficult airway. Herein, we present a 26-day, 3300 g newborn with KFS who was planned to be operated for correction of an intestinal obstruction. She had features of severe KFS. Anesthesia was induced by inhalation of sevoflurane 2-3% in percentage 100 oxygen. Sevoflurane inhalation was stopped after 2 min. Her Cornmack Lehane score was 2 and oral intubation was performed with 3.5 mm ID non-cuffed endotracheal tube in first attempt. Operation lasted for 45 min. Following uneventful surgery, she was not extubated and was transferred to the newborn reanimation unit. On the postoperative third day, the patient died due to hyperdynamic heart failure. This case is the youngest child with Klippel-Feil syndrome in literature and on whom oral intubation was performed. We also think that positioning of this younger age group might be easier than older age groups due to incomplete ossification process.

Resumo A síndrome de Klippel-Feil (SKF) envolve uma tríade clássica que inclui pescoço curto, linha de implantação dos cabelos baixa e restrição do movimento do pescoço e é uma das causas congênitas de via aérea difícil. Apresentamos o caso de uma recém-nascida, de 26 dias, 3.300 g de peso, com SKF, que foi agendada para cirurgia de correção de uma obstrução intestinal. A paciente apresentava características acentuadas da SKF. A anestesia foi induzida com inalação de sevoflurano a 2-3% em 100% de oxigênio. A inalação de sevoflurano foi interrompida após dois minutos. O escore de Cormack-Lehane da paciente era 2 e a intubação orotraqueal foi feita na primeira tentativa, com tubo endotraqueal de 3,5 mm ID sem balão. O tempo de cirurgia foi de 45 minutos. Após a cirurgia sem intercorrências, a paciente foi transferida para a unidade de reanimação neonatal ainda intubada. No terceiro dia de pós-operatório, foi a óbito por causa de uma insuficiência cardíaca hiperdinâmica. Esse caso apresenta a criança mais jovem com síndrome de Klippel-Feil na literatura e na qual a intubação orotraqueal foi feita. Acreditamos também que o posicionamento de pacientes dessa faixa etária mais jovem pode ser mais fácil do que o de pacientes de faixas etárias mais altas, por causa do processo de ossificação incompleto.

Association of Polymorphisms within the Serotonin Receptor Genes 5-HTR1A, 5-HTR1B, 5-HTR2A and 5-HTR2C and Migraine Susceptibility in a Turkish Population

OBJECTIVE: Migraine, a highly prevelant headache disorder, is regarded as a polygenic multifactorial disease. Serotonin (5-HT) and their respective receptors have been implicated in the patogenesis. METHODS: We investigated the 5-HT1A, 5-HT1B, 5-HT2A, and 5-HT2C receptor gene polymorphisms and their association with migraine in Turkish patients. The rs6295, rs1300060, rs1228814, rs6311, rs6313, rs6314, rs6318, rs3813929 (−759C/T) and rs518147 polymorphisms were analyzed in 135 patients with migraine and 139 healthy subjects, using a BioMark 96.96 dynamic array system. RESULTS: We found no difference in the frequency of the analyzed eight out of nine polymorpisms between migraine and control groups. However, a significant association was found between the rs3813929 polymorphism in the promoter region of 5-HTR2C gene and migraine. Also, the allele of rs3813929 was more common in the migraine group. CONCLUSION: This result suggests that the 5-HTR2C rs3813929 polymorphism can be a genetic risk factor for migraine in a Turkish population.

Any possible association between Behcet's disease and retinitis pigmentosa

Behcet's disease is a rare multisystem disease; it has many ocular features, and it is not known to be associated with dystrophic conditions such as retinitis pigmentosa [RP]. This is a case report of a Sudanese patient with Behcet's disease with ocular features and RP. A 28-year-old female with nyctalopia, skin hyper-pigmentation, and oral and genital ulcers was diagnosed as RP with Behcet's disease. She received a high dose of steroids and Azathioprine. She developed bilateral cataract and glaucoma. Pathergy test is negative. The patient is fulfilling the diagnostic criteria of both RP and Behcet's diseases. Behcet's disease is a rare condition; it is not common among Sudanese patients, and it has not been known to co-exist with RP

Nickel and chromium levels in the saliva of a Saudi sample treated with fixed orthodontic appliances

The aim of this study was to measure the amount of nickel [Ni] and chromium [Cr] released into the saliva of Saudi patients treated with fixed orthodontic appliances. Ninety salivary samples were collected in a cross-sectional manner. Forty samples were collected from patients [17 males, 23 females] with fixed orthodontic appliances after different periods of orthodontic treatment ranging from the first month and up to 32 months into treatment. The fixed orthodontic appliance consisted of 4 bands, 20 stainless steel brackets, and upper and lower nickel titanium or stainless-steel arch wires. The other 50 samples were collected from people without appliances [24 males, 26 females]. Samples were analyzed using Inductive Coupled Plasma/Mass Spectrometry and Inductively Coupled Plasma Optical Emission Spectroscopy to measure Ni and Cr levels, respectively. Student's t-test was used to compare Ni and Cr levels in the treated and untreated control groups. The mean Ni level was 4.197 microg/L in the experimental group and 2.3 ug/L in the control group [p < 0.05]. The mean Cr level was 2.9 microg/L in the experimental group and 3.3 microg/L in the control group [p < 0.05]. Fixed orthodontic appliances resulted in a non-toxic increase in salivary levels of Ni, but no change in Cr levels. Duration of orthodontic treatment did not affect Ni and Cr levels in the saliva

Frequency of central nervous system tumors in delta region, Egypt.

Introduction and Aim of Work: Central nervous system (CNS) tumors represent a major public health problem, and their epidemiological data in Egypt have been rather incomplete except for some regional reports. There are no available frequency-based data on CNS tumors in our locality. The objective of this study was to estimate the frequency of CNS tumors in east delta region, Egypt. Materials and Methods: The data were collected during the 8-year period from January 1999 to December 2007 from Pathology Department, Mansoura University, and other referred pathology labs. Examination of HandE stained sections from retrieved paraffin blocks were done in all cases for histopathologic categorization of C.N.S. tumors. Immunohistochemical studies were applied to confirm final histopathologic diagnosis in problematic cases. Results: Intracranial tumors represented 86.7% of cases in comparison to only 13.3% for spinal tumors. Gliomas were the CNS tumors of the highest frequency (35.2%), followed by meningioma (25.6%), pituitary adenoma (11.6%) and nerve sheath tumors (6.6%). 10.25% of tumors were of children <15 years. Conclusion: This study provides the largest series of the relative frequency of CNS tumors in Delta region in Egypt till now and may help to give insight into the epidemiology of CNS tumors in our locality.

Treatment Seeking in Reproductive Age Women with RTIs/STIs : A Community based Cross-sectional Study.

The socio-cultural and economic contexts in developing countries influence the epidemiology or STls and helps in making them an important public health priority. This study was carried out to explore the health care seeking pathway of the women suffering from RTls/STls. influence or major socio-demographic variables on treatment seeking pattern. This cross sectional study was carried out comprising or eight hundred reproductive age (15-49 years) women selected following a multistage sampling procedure. The information pertaining to health seeking behaviour were collected from them using a pre-designed pretested interview schedule. Quantum of RTls/STls in the study group was estimated and symptomatics were asked specially about time lag between appearance of symptoms and seeking acre; reason for not seeking care; outcome of treatment they have taken if any. Out of total 359 subjects with symptoms of RTls/STls only about one-third (37.3%) had sought treatment. Only a few (4.5%) had sought treatment within 1 month of appearance of symptoms. Considering it to be physiological about half of the subjects (45.3%) did not seek treatment. The treatment seeking pattern was highly associated with the level of education (p=0.000). Reluctance in seeking treatment, delay in its initiation, prelerencc for unqualified practitioners in first consultation and significant association between education and treatment seeking pattern emphasize BCC and service provision for control and prevention of RTls/STls.

An eight-year review of blood culture and susceptibility among sepsis cases in an emergency department in North eastern Malaysia

An understanding of common pathogens and their antibiotic sensitivity patterns is critical for proper management of sepsis in Emergency Department (ED). The goal of the study was to identify common organisms isolated from blood cultures of patients attended to ED and their antimicrobial susceptibility. Beginning from 2002, all cases of positive blood culture collected by the ED, Hospital Universiti Sains Malaysia (HUSM) were recorded and analysed. Over the period of eight years, we documented 995 cases of positive blood cultures. Of these samples, 549 (55.2%) were Gram-negative bacteria; 419 (42.1%) were Gram-positive bacteria; 10 (1.0%) were anaerobic organisms; 10 (1.0%) were fungus; and 7 (0.7%) cases were mixed organisms. Gram-negative bacteria were observed to develop more resistance to antimicrobial agents, especially those commonly used in an outpatient setting with less than 80% sensitivity to ampicillin, cotrimoxazole and ciprofloxacin. By contrast, there has been no marked change in the sensitivity trends of Gram-positive bacteria over the same period. In conclusion, ED physicians are more equipped to initiate empirical antimicrobial therapy especially when dealing with possibility of Gram-negative sepsis.

Seroepidemiology of five major zoonotic parasite infections in inhabitants of Sidoarjo, East Java, Indonesia.

We conducted a seroepidemiological survey of zoonotic parasite infection in inhabitants of East Java, Indonesia. The subjects of the survey were 244 persons selected from visitors to Sidoarjo City Hospital in East Java between May 1992 and October 1993. Ninety-seven had diarrhea and the rest came to the hospital for routine check-ups. All serum samples were tested for antibodies against five zoonotic parasites: Toxoplasma gondii, Entamoeba histolytica, Toxocara canis. Angiostrongylus cantonensis, and Anisakis species. Tests used were enzyme-linked immunosorbent assays (ELISA), latex agglutination (LA) test, indirect fluorescence antibody (IFA) test, hemagglutination (HA) test, and gel diffusion precipitation (GDP) test. Some 64% of the subjects had antibodies to T. gondii. The prevalence of antibodies to E. histolytica varied from 2 to 15% depending on the test, but the true rate was probably the 7% or 8% obtained by the HA and IFA tests. The proportions of subjects with positive results were 63% for T. canis, 17% for A. cantonensis, and 11% for the Anisakis spp. The prevalence of antibodies to T. gondii and T. canis was lower in subjects aged 1 to 9 years than in older subjects, probably because the persons in this group had less time to be infected. Antibody titers to A. cantonensis and the Anisakis spp. were high in the juvenile group, perhaps because recent changes in eating habits have increased opportunities for infection.

Beta-thalassaemia trait in Mosul

A prospective study was conducted in order to determine diagnostic parameters for Beta-thalassaemia trait in Mosul. Both elevated Hb-A2 and resistance to lysis using one tube osmotic fragility test at 0.36% NaCl concentration were found to discriminate accurately between the control and the obligatory Beta-thalassaemia carrier groups. Also more than three quarters of our patients were found to have an elevated Hb F level above 1% with a range of 1.7 to 3.3%. Our results compared favourably with other studies