Pre- and post-COVID-19 antimicrobial resistance profile of bacterial pathogens, a comparative study in a tertiary hospital.

INTRODUCTION: Antimicrobial resistance (AMR) is a natural evolutionary process in bacteria that is accelerated by selection pressure from the frequent and irrational use of antimicrobial drugs. This study aimed to determine the variations in AMR patterns of priority bacterial pathogens at a tertiary care hospital in the Gaza Strip during pre- and post-COVID-19 pandemic. METHODOLOGY: This is a retrospective observational study to determine the AMR patterns of bacterial pathogens at a tertiary hospital in the Gaza Strip in the post-COVID-19 pandemic period compared to the pre-COVID-19 period. Positive-bacterial culture data of 2039 samples from pre-COVID-19 period and 1827 samples from post-COVID-19 period were obtained from microbiology laboratory records. These data were analysed and compared by Chi square test using Statistical Package for Social Sciences (SPSS) Program. RESULTS: Gram-positive and Gram-negative bacterial pathogens were isolated. Escherichia coli was the most prevalent in both study periods. The overall AMR rate was high. There was a statistically significant increase in resistance to cloxacillin, erythromycin, cephalexin, co-trimoxazole and amoxicillin/clavulanic acid in the post-COVID-19 period compared to pre-COVID-19 period. There was also a significant decrease in resistance to cefuroxime, cefotaxime, gentamicin, doxycycline, rifampicin, vancomycin and meropenem in the post-COVID-19 period. CONCLUSIONS: During the COVID-19 pandemic, the AMR rates of restricted and noncommunity-used antimicrobials declined. However, there was an increase in AMR to antimicrobials used without medical prescription. Therefore, restriction on the sale of antimicrobial drugs by community pharmacies without a prescription, hospital antimicrobial stewardship and awareness about the dangers of extensive use of antibiotics are recommended.

Autoimmunity in Human CE: Correlative with The Fertility Status of The CE Cyst.

Cystic echinococcosis is speculated to exert several immune-evasion strategies involving autoimmune-phenomena. We evaluated the hypothesizes that the prevalence of autoantibodies increases in the sera of CE patients that may evidence the association between the parasite and autoimmune diseases. Sera from 63 subjects at distinct types of CE cyst fertility were investigated for antinuclear antibodies (ANA), and anti-CCP antibodies. Plasma levels and cellular production of IL-17A cytokine were specifically defined as being assumed to prime for autoimmunity. Healthy-controls were age and gender-matched to test sera. ANA expressions inside the surgically removed metacestode and adventitial layer were also assayed. Out of 63 patients, 35 % had fertile highly viable cysts (group-1), 41 % had fertile low viable cysts (group-2) and 24 % had non-fertile cysts (group-3). A four-fold increase in ANA sera-levels was detected in group-1 compared with their controls (p-value 0.001) while anti-CCP levels were of insignificant differences. In group-2 and group-3, no significant differences were detected between ANA and anti-CCP sera-levels in CE patients and their controls. IL-17A sera-levels in group-1 and group- 2 were significantly higher than their healthy-controls while being of insignificant differences in group-3, p-value= 0.300. No association was detected between sera-levels of IL-17A and ANA as well as anti-CCP antibodies. Interestingly, relative IL-17A cellular expression associated positive ANA deposition in the parasite cells and adventitial layer. Collectively, based on the parasite fertility, IL-17A and ANA seemed to be involved in the host immune defenses against CE. There is no association between CE and anti-CCP antibodies.

The Impact of Cell-free Plasma DNA on Metastatic and Nonmetastatic Prostate Cancer.

Intorductuion: Increased cell-free DNA (cfDNA) is observed in many diseases such as cancer, myocardial infarction, and autoimmune diseases. It has the ability to alter the receptor cell phenotype, triggering events related to malignant transformation. AIMS: Our study aims at assessing the use of cell-free plasma DNA in the diagnosis of metastatic and non-metastatic prostate cancer. METHODS: The study included 180 subjects who were classified into four groups: Group I (GI) included 50 perfect health subjects as the control group, Group II (GII) included 40 patients with prostatitis, group III (GIII) included 40 patients with benign prostatic hyperplasia (BPH) and Group IV (GIV) included 50 patients with pre-operative prostate cancer (PC). Evaluation of the plasma level of circulating cell-free DNA by real-time PCR and measurement of total PSA (tPSA) and free to total PSA percent (f/tPSA%) were carried out for all groups. RESULTS: Our study revealed that the level of tPSA was significantly higher in prostate cancer patients, while levels of f/t PSA were found to be significantly lower. The level of cfDNA was significantly higher in prostate cancer patients (399.9±88.6ng/ul) when compared to that of group I (12.1±1.5ng/ul) (p<0.01), group II (14.7±2.4 ng/ul) (p<0.01), and group III (26.6±45.6 ng/ul) (p<0.01) respectively. CONCLUSION: There was a statistically significant difference in yields of cfDNA between metastatic and non-metastatic groups (P=0.03) with a higher level in the metastatic group.

Colistin Resistance among Enterobacteriaceae Isolated from Clinical Samples in Gaza Strip.

Bacterial infections, especially drug-resistant infections, are a major global health issue. The emergence of multidrug-resistant (MDR) strains of Enterobacteriaceae and the lack of new antibiotics have worrisome prospects for all of humanity. Colistin is considered the last-line drug for MDR Gram-negative bacteria (GNB), and it is often used for treatment of respiratory infections caused by MDR-GNB. In recent years, there has been a marked increase in the incidence of colistin-resistant infections. The main objective of this study was to investigate the presence of colistin resistance among clinical GNB isolated from Gaza Strip hospitals. Clinical Enterobacteriaceae isolates (100) were obtained from microbiology laboratories of the hospitals of different geographical locations in Gaza Strip Governorate over a period of six months. Samples were cultured, and bacterial identification was performed by standard microbiological procedures. Enterobacteriaceae isolates were tested for their antimicrobial susceptibility by the disk diffusion method and the MIC method for colistin. Varying degrees of susceptibility were observed for the isolates against the tested antimicrobials even within members of the same antimicrobial class. Amikacin was the most effective drug (74%), followed by chloramphenicol (48%), fosfomycin, and gentamicin (45%). High resistance was recorded against trimethoprim (85%) and tetracycline (83%). Only 59% of the tested isolates were interpreted as susceptible, while 41% was classified as resistant. The highest resistance to colistin was found to be among the Proteus spp. (63.2%), followed by Serratia spp. (57.1%). The lowest resistance was observed among Klebsiella isolates (31.6%). Only 39.0% of meropenem-resistant Enterobacteriaceae was susceptible to colistin, while 45.8% of imipenem-resistant Enterobacteriaceae was susceptible to colistin. The overall resistance to colistin was high (41%) among tested clinical isolates. Furthermore, 89% was MDR. These limit and complicate treatment options for the infections caused by Enterobacteriaceae in Gaza Strip. This calls for immediate actions to control and monitor the use of antimicrobials in general and colistin in particular.

Biological Effects Assessment of Antibiofouling EDCs: Gaeta Harbor (South Italy) Benthic Communities' Analysis by Biodiversity Indices and Quantitative gpx4 Expression.

The most representative organisms of the Harbor of Gaeta Gulf in South Italy were analyzed for biofouling by visual census and confirmed later by molecular approach on an artificial Conatex panel dipped 3 m into a eutrophic area during the Covid-19 pandemic. Mitochondrial Cytochrome C oxidase subunit 1(COI) gene was sequenced from 20 different marine species (flora: 2 families, 2 orders; fauna: 16 families, 11 orders) to test whether the morphology-based assignment of the most common biofouling member was supported by DNA-based species identification. Twelve months of submersion resulted in generation of sufficient data to obtain a facies climax represented mainly by the bivalve mollusk, Mytilus galloprovincialis. Specific diversity and variations of the biofouling biomasses were analyzed using two different anti-biofouling paints: an endocrine disrupting chemical (EDC)-containing metal biocide, and a biocide-free paint. Also, their effects on detoxification and reproductive health of M. galloprovincialis were evaluated using glutathione S-transferase enzymatic activity and RTqPCR expression of the fertility antioxidant gene glutathione peroxidase 4 (gpx4). The obtained data provide useful indications on which future investigations may be focused and may become a potential management tool for a harbor biofouling database to assist local administrations in EDCs protection of autochthonous benthic communities and their fertility using innovative antifouling paints.

Carbapenem resistance among clinical and environmental Gram-negative isolates recovered from hospitals in Gaza strip, Palestine.

BACKGROUND: The world is threatened by the ongoing emergence of carbapenem resistant organisms, which are contributing to increasing morbidity and mortality rates. The main objective of this study was to highlight carbapenem resistance among clinical and environmental Gram-negative bacteria (GNB) isolates. METHODS: A cross-sectional study wherein 210 clinical isolates, 150 environmental swabs, and 110 air samples were collected from three major hospitals in Gaza strip: Al-Shifa, AlNaser and the European Gaza hospitals. The study lasted for seven months (September 2016 to March 2017). All isolates/samples were cultured and identified using conventional bacteriological methods. All GNB isolates were tested for their antimicrobial susceptibility using the disk diffusion method. Modified Hodge Test (MHT) was performed to investigate carbapenemases production. RESULTS: The overall percentage of carbapenem resistance among GNB was (30/247) 12.1%. Resistance to imipenem was (20/247) 8.1% while resistance to ertapenem and meropenem was (8/226) 3.5% and (2/247) 0.8%, respectively. The intensive care units exhibited the highest resistance rate 9/17 (52.9%). Carbapenem resistance among Enterobacteriaceae was (30/226) 13.2% while in Pseudomonas it was (0/21) 0%. Klebsiella spp. was the most resistant to carbapenems 13/90 (14.4%), followed by E. coli (9/91) 9.8%. Seven isolates out of 30 (23.3%) were positive for MHT. All Enterobacteriaceae isolates had a multiple antibiotic resistance (MAR) index higher than 0.2, while those of Pseudomonas had an average of 0.2. GNB were isolated from 19/110 (17.2%) and 21/150 (14%) of air and environmental samples, respectively. CONCLUSION: The resistance found, after a recent introduction of carbapenem use in Gaza, shows the need for policies to prevent misuse and overuse of carbapenems, the need for infection control procedures and screening policies for carbapenem resistance on a routine basis.

Stabilization of nano-structured ZnO particles onto the surface of cotton fibers using different surfactants and their antimicrobial activity.

ZnO NPs were prepared and deposited onto cotton fibers via ultrasound irradiation successfully. Different surfactants (SDS, HY, CTAB, TX-100) have been used to stabilize, homogenize the coated ZnO NPs and control their shape and size as encapsulated species. The use of surfactants has improved the durability of ZnO NPs and decreased its leaching in particular SDS. The small mean crystallite size for ZnO particles due to the use of surfactants is the main reason for decreasing the leached of ZnO particles from cotton substrate. SEM and XRD analysis revealed information about the shape and size of the coated ZnO nanoparticles. The use of SDS and HY surfactants in the synthesis of ZnO NPs coated fabrics showed the highest antibacterial and antifungal activities against different pathogenic bacterial and fungal species with high reduction reached over 90%.

Initial experience of surgical microwave tissue precoagulation in liver resection for hepatocellular carcinoma in cirrhotic liver.

Surgical hepatic resection has been considered as the first-line treatment which is most effective and radical treatment for HCC, however, HCC is usually associated with poor liver function owing to chronic hepatitis or liver cirrhosis. Techniques that can eradicate the tumor and also preserve liver function are needed. Moreover, hepatic resection, in the presence of cirrhosis, raises special problem of high risk as hemorrhage and liver failure, thus, good clinical results can only be achieved by minimizing operative blood loss, time of the intervention as well as the hepatic reserve. The tremendous progress in microwave technology has recently attracted considerable attention. This study evaluated the feasibility of this new liver transection technique demonstrating the high performance of this procedure, the accuracy in terms of squeeze effect on veins and portal branch and in terms of reducing the intra operative blood loss, and minimizing the operative time for safe hepatectomy. Twenty-six consecutive patients a first-time diagnosis of hepatocellular carcinoma (HCC) on top of liver cirrhosis were recruited for the study, from August 2011 to January 2013. All patients were subjected to full clinical examination, laboratory investigations, abdomen ultrasound (U/S), triphasic computed tomographic liver scan (CT) and dynamic magnetic resonance imaging (MRI) in some doubtful cases. Inclusion requirements were presence of resectable disease without vascular invasion or extrahepatic spread at imaging, Child-Pugh class A & B (Score 7) liver cirrhosis, (INR) < 1.6 or platelet count) 60 000/mm3 with no previous treatment. Patients were treated by applying pre-coagulation of the liver transection lines using microwave probe positioned in parallel to the line of resection by open approach after intra-operative U/S assessment for localization of the tumor and line of resection. The procedures were performed under general anesthesia. Mobilization of the liver was not necessary to be done in all cases. Intra-operative ultrasound (Aloka, Tokyo, Japan) was used to exclude lesions not detected pre-operatively (operative surprise), to define the location, number and size of the tumor and to identify large intra-hepatic large vascular and biliary structures, and guide insertion of the microwave applicator. Intraoperative ultrasound was used again, to assess that the line of resection was done. Primary endpoints documented were total operative time, time for liver parenchyma transection, intraoperative blood loss and blood transfusion requirements. Secondary endpoints included postoperative complications, mortality and intensive care unit (ICU) together with hospital stay.

Antimicrobial susceptibility of bacterial isolates from burn units in Gaza.

BACKGROUND: Bacterial infections continue to be a leading cause of morbidity and mortality among burn patients despite intensive prophylaxis and treatment. Often treatment is complicated by the emergence of antimicrobial resistance pathogens. There are no reports or published data on the susceptibility profiles of bacteria isolated from burn patients in the Gaza strip. PATIENTS AND METHODS: A cross sectional study was performed in the two burn units of Al-Shifa and Naser hospitals for 6 months from October 2010 to March 2011. A total of 118 wound samples from burn patients, 97 environmental samples and 28 samples from health care workers (HCWs) were collected and cultured according to the standard microbiological procedures. The bacterial isolates were identified by conventional methods and the antibiotic susceptibility profiles were determined by the standard disc diffusion method according to CLSI guidelines. RESULTS: The overall percentage of positive cultures from both hospitals was 45.8%, where Nasser burn unit revealed higher positive cultures than Al-Shifa burn unit. Pseudomonas aeruginosa was the most common pathogen isolated (50%) followed by Enterobacter cloacae (28.3%). Meanwhile, fingers and nasal samples that collected from HCWs showed 78.6% and 32.3% positive cultures respectively, where P. aeruginosa was the highest pathogen isolated (32.3%), followed by Coagulase Negative Staphylococci (CoNS) (29%). Environmental samples also showed higher isolation rate of Pseudomonas and CoNS. Pseudomonas isolates from patients samples were found to be resistant to most of antimicrobials used except for piperacillin-tazobactam. The family Enterobacteriaceae isolated from patients and environmental samples were resistant to most of the tested antimicrobials. However, the Enterobacteriaceae isolates from HCWs samples were sensitive to the most of the tested antimicrobials. The incidence of methicillin-resistant Staphylococci according to oxacillin sensitivity test was 60% in patient's samples, 77.8% in HCWs samples and 90% in environmental samples. CONCLUSION: High percentage of resistance was found among clinical isolates in general to the commonly used antibiotics with a notable increase in MRSA incidence among both patients and environmental samples as well as HCWs.

Prevalence and risk factors of hepatitis B and C viruses among haemodialysis patients in Gaza strip, Palestine.

BACKGROUND: The prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and its associated risk factors among haemodialysis (HD) patients in Gaza strip was investigated using serological and molecular techniques. RESULTS: The overall prevalence of HBV among the four HD centers was 8.1%. The main risk factors were HD center (p=0.05), history of blood transfusion (p<0.01), and treatment abroad (p=0.01). The overall prevalence of HCV among the four HD centers was 22%. The main risk factors were HD center (p<0.01), time duration on HD (p<0.01), history of blood transfusion (p<0.01), treatment abroad (p<0.01), and history of blood transfusion abroad (p<0.01). Serum aminotransferases levels decreased in HD patients compared with normal population but still there was a direct association between the activity of liver enzymes and both HBV (p<0.01) and HCV (p<0.01) infection. CONCLUSION: The much higher prevalence of Hepatitis viruses among HD patients compared to the normal population of Gaza strip indicates a causative relation between HD and hepatitis viruses transmission. Therefore extremely careful observation of preventive infection control measures is essential to limit Hepatitis viruses' transmission in HD centers.

Seasonal and spatial variation in the monitoring parameters of Gaza Beach during 2002-2003.

Seawater pollution problems are gaining interest worldwide because of their public health impact and other issues. Levels of pollutants at Gaza Beach determined the only recreational area for the inhabitants of Gaza were recently determined and shown to be high. Five bathing sites in the Middle Camps area along the Gaza Strip coastal area were monitored for 1 year (fortnightly). Seawater samples were subjected to microbiological analysis (fecal coliforms and fecal streptococci) and physiochemical analysis (water temperature, pH, electroconductivity, dissolved oxygen (DO), biochemical oxygen demand, total, Kjeldahlnitrogen, and ammonia). Results revealed seasonal and locational variation in all of the parameters studied. The highest levels of pollution were detected during winter, especially after a rainfall or after a discharge from Wadi Gaza. Locations associated with sewage discharge had the highest fecal indicator levels. Statistical analysis of the data demonstrated significant linear correlations between several parameters (e.g., DO and biochemical oxygen demand, biochemical oxygen demand and fecal coliforms, biochemical oxygen demand and fecal streptococci).

Microbiological beach sand quality in Gaza Strip in comparison to seawater quality.

Gaza beach is the only recreational area available for the local inhabitants. It is heavily polluted with treated, partially treated, and untreated sewage from point and nonpoint sources. The majority of the population is below the age of 15 years. This age group is vulnerable to gastrointestinal diseases and usually restricts their activities to beach sand at the swash zone. Five sampling points along the Gaza beach were selected and monitored for 1 year (fortnightly). Microbial sand content was evaluated for fecal coliforms (FC), fecal streptococci (FS), Salmonella, Shigella, and Vibrio. Seawater samples were subjected to similar evaluation. Pseudomonas, yeast, and mold counts were performed for all sand samples as possible sand pollution indicators. Higher fecal indicators (both FC and FS) were obtained in sand than in water in most locations. The frequency of Salmonella and Vibrio isolation was also higher in sand than in water despite the fact that only 10 g of sand were used while 1L of seawater was collected. Statistically significant correlations between FC and streptococci and between Salmonella and Vibrio were found. Similar correlation was also detected between Pseudomonas and Salmonella in sand samples.