A reflection on bacterial resistance to antimicrobial agents at a major tertiary care center in Lebanon over a decade.

BACKGROUND: Antimicrobial resistance has been inflecting deleterious health and economic consequences locally and globally. This study addresses the patterns and trends of bacterial resistance to antimicrobial agents over a decade, at a major tertiary care center in Beirut. METHODS: Data on bacterial susceptibility patterns at the CAP accredited Clinical Microbiology Laboratory is analyzed from January 2000 to November 2011, along with related different studies conducted during this period. RESULTS: Increasing rates of ESBL-producing isolates were noted for Escherichia coli, Klebsiella pneumoniae, Salmonella spp. and Shigella spp. Resistance to carbapenems remains problematic in Acinetobacter spp, and Pseudomonas aeruginosa, and started emerging in E. coli and K. pneumoniae. Tigecycline and colistin maintained excellent activity against most ESBL and carbapenem resistant bacteria relevant to the treatment by these agents. Resistance to quinolones is being encountered in Streptococcus pneumoniae, Haemophilus influenzae, Salmonella spp. and Shigella spp. Methicillin resistant Staphylococcus aureus (MRSA), though remaining relatively high, showed decreasing trends of resistance, while vancomycin maintain uniform activity. Rare and sporadic vancomycin resistant strains in enterococci are encountered. Macrolide and clindamycin increasing rates of resistance is noted in S. pneumoniae, group A streptococci, S. aureus, viridans streptococci and some others. CONCLUSION: Physicians should be aware of the local epidemiology of antimicrobial resistance to properly guide the initial therapy. These resistance problems can be attributed to uncontrolled use of antimicrobial agents, thus, highlighting the need for antimicrobial stewardship to curb this threat.

Evaluation of professional role competency during psychiatry residency.

OBJECTIVE: The authors sought to determine psychiatry residents' perceptions on the current method of evaluating professional role competency and the use of multi-source feedback (MSF) as an assessment tool. METHOD: Authors disseminated a structured, anonymous survey to 128 University of Toronto psychiatry residents, evaluating the current mode of assessment of the professional role and the use of MSF. RESULTS: The overall response rate was 86%. Fewer than half (44%) of residents felt that their professional role is adequately evaluated, and 84% were in favor of incorporating MSF for the evaluation of this competency. Respondents believed their primary supervisor should have the largest proportional impact on the evaluation (50%), followed by allied heath staff (19%), patients (16%), co-residents (12%), self (11%), and administrative staff (9%). CONCLUSION: On the basis of this needs assessment and the Royal College recommendations, MSF may be considered a potential assessment tool for evaluating psychiatry residents in their professional role.

Photocatalytic oxidation of VX-simulation substance.

Experimental studies of photocatalytic oxidation (PCO) of VX-gas simulation substance cysteamine-S-phosphate sodium salt (NaHPO3S-CH2-CH2-NH2, CPSS) at various initial concentrations and pH were undertaken. PCO ultimately resulted in complete mineralisation of CPSS. The PCO byproducts of CPSS include acetate, oxalate and trace amounts of formate ions. The formation rates of acetate and phosphate were equal to the rate of degradation of CPSS, which indicates easy breakage of P-S, C-S and C-N bonds. Sulphate was formed more slowly due to stepwise oxidation of reduced sulphur. Amino group, generally transformed to ammonia, was partially oxidised to nitrite and nitrate in alkaline media. The fastest mineralisation in terms of both TOC degradation and phosphate formation was observed in neutral media. Under neutral media conditions, the PCO rate increased linearly with the CPSS concentration increase. The maximum efficiency by TOC degradation was observed as large as 77 mg per Wh of incident UV flux with quantum efficiency 3.8%.

The influence of unequal numbers of trials on comparisons of average event-related potentials.

Four studies examined (a) how event-related potentials (ERPs) change as the number of trials averaged increases and (b) the statistical implications of comparing ERPs composed of different numbers of trials. Experiment 1 utilized data from 7-year-old children performing an oddball task. The other three experiments used simulated data with different distributions of P3 peak latency. In all 4 experiments, peak amplitude decreased and the mean amplitude of the 300 to 900 msec interval remained stable as the number of trials averaged increased. The standard deviations of both measures decreased. These data show that the decrease in peak amplitude with increasing numbers of trials that has been found in other studies is not solely due to the elimination of residual noise but is likely to also involve a fundamental aspect of signal averaging and the algorithm used to select peaks. Furthermore, these experiments expose the possibility of statistical errors when investigators compare average ERPs composed of small versus large numbers of trials as is often done when the oddball paradigm is used.

Radioprotective Activity and Synthesis of Siladithioacetals and Germadithioacetals Derived from N-substituted Naphthylethylimidazoline.

A number of organosilicon and organogermanium derivatives and some related compounds including the N-substituted. 2-[1-naphthylmethyl]-2-imidazoline and 2-[1-(1-naphthyl)ethyl]-2-imidazoline have been prepared and the toxicity of some compounds have been determined in mice. In this paper we report the synthesis and the evaluation of the pharmacological activity of new organosilicon and organogermanium, compounds such as sila- and germadithioacetals derived from N-substituted naphthylimidazolne.

(Schiff base) divalent group 14 element species: manganese and iron complexes (Salen)M=Mn(Co)2(eta 5-C5H5) (M14 = Ge, Sn, Pb) and (Salen)Sn=Fe(CO)4.

Syntheses of the (divalent group 14 species)dicarbonyl(cyclopentadienyl)manganese (Salen)M=Mn(CO)2(eta 5-C5H5) [M = Ge (1), Sn (2), Pb (3)] and [(Salen)tin(II)]tetracarbonyliron (Salen)Sn=Fe(CO)4 (4) are reported. The structures of 2 and 4 were determined by X-ray crystallography. The observed Sn-Mn bond length, 2.4428(7) A, is the shortest distance observed for this type of bond and corresponds to considerable multiple bonding between these atoms. In complex 4, the iron atom has a slightly distorted trigonal-bipyramidal coordination sphere; the (Salen)tin(II) ligand occupies an axial site, indicating that it functions in this complex as a strong sigma-donor and weak pi-acceptor ligand. Crystal data for 2: orthorhombic, P2(1)2(1)2(1), a = 6.972(1) A, b = 15.678(2) A, c = 19.032(2) A, alpha = beta = gamma = 90 degrees, V = 2080.3(5) A3, T = 173(2) K, Z = 4. Crystal data for 4: triclinic, P1, a = 8.465(2) A, b = 9.795(3) A, c = 13.213(4) A, alpha = 105.55(3) degrees, beta = 105.15(3) degrees, gamma = 100.84(3) degrees, V = 978.7(5) A3, T = 173(2) K, Z = 2.

A Review on the Radioprotective Activity of organogermanium and Organosilicon Compounds.

The present review describes the work carried out during the last 20 years in the field of the radioprotective activity and toxicity of several classes of organosilicon and organogermanium compounds (i.e. metallathiazolidines, metalladithioacetals, metallatranes and germathianes).

Synthesis and radioprotective activity of new organosilicon and germanium compounds.

Silathiazolidine and metalladithioacetals (M = Si, Ge) have been prepared by the interaction of dialkyldichloro- or bis(diethylamino)dialkylsilanes and -germanes with 3-[N-(2- thioethyl)]amino-propanamide (WR-2529) and [1-thioethyl-2-(1-naphtylmethyl)]-2- imidazoline. The study of these compounds in the field of chemical radioprotection has shown a notable decrease in the toxicity and a rather large increase in the radioprotective activity of these new derivatives in comparison with the starting organic compounds.

Production and characterization of antibodies directed against organophosphorus nerve agent VX.

A strategy is described to raise high-affinity antibodies directed against the organophosphorus nerve agent VX [O-ethyl S-(2-diisopropylamino)ethyl)methyl phosponothionate]. Ten chemical derivatives of VX (haptens) have been synthesized. Their structures differ principally from VX structure by substitution of S-atom by an O-atom or CH2-group and by introduction of a reactive group (carboxylic acid, arylamine or primary amine) on the O-ethyl side chain. None of these haptens, except one, exhibit potential toxicity as tested by their inhability to inhibit acetylcholinesterase (E.C. 3.1.1.7.). After coupling with a protein carrier, they were injected intradermally to rabbits. Nine of these immunogenic conjugates led to the appearance of antibodies able to bind VX in a competitive solid phase immunoassay. The apparent titer and affinity of the antisera differed greatly depending on the hapten used. The highest affinity (9 nM) was observed with the VX derivative bearing O-S substitution and O-ethyl-carboxylic side chains. The antibodies appear specific for VX, since cross-reactivity with other nerve agents (Soman, Sarin or Tabun) was low. However, two haptens elicited antibodies with affinity to Soman or Sarin in the micromolar range. Antibodies were able to neutralize VX inhibition of acetylcholinesterase in vitro but not in vivo.