SURVEY OF SAFETY PRACTICES IN DIARRHEAL TREATMENT CENTERS: CHOLERA TREATMENT CENTERS IN YEMEN

Objectives:  Monitoring of Diarrheal treatment centers (DTCs) was conducted so as to assess the quality of care and help draw evidence-based decisions on the current and future support of DTCs and other cholera prevention interventions. Methods: This monitoring exercise was included 102 DTCs, data were collected by a trained team of 18 doctors, 18 nurses, and 2 supervisors during the month of June, 2019 to cover the center’s performance in the prior month i.e. May2019.  Specially designed forms were used for data collection applying mixed methods: direct observation, record review, direct and phone interviews with the staff and patients as well as discussions with the health offices and community leaders whenever feasible. Results: No more than 23% of DTCs have water for hand washing, showering and washing clothes at all times and in all important locations such as hand washers and toilets; and 76% have one toilet for every 50 patients, but only 57% of toilets are regularly disinfected. Hazardous practices ranged from 32 to 62% leading to cholera infection among 4 out of 10 health workers and 5 visitors of the DTCs. Around 27 % of the DTCs do not have a designated area to bury body excreta from severe cases; only 23% have an isolated area for the deceased. A high of 59% of designated staff are neither trained nor equipped to deal appropriately with dead bodies and only 39% of dead bodies are disinfected with chlorine solution 2%. Conclusions: The DTC network provides much-needed services over the width of the country. Lives are being saved on  a daily basis despite the ongoing conflict and other humanitarian interventions. However, despite the efforts made so far, there are remaining areas for the quality of the improvement, most importantly availing water and strengthening the infection control measures and preventions of hazardous practices.                        Peer Review History: Received 30 July 2020; Revised 15 August; Accepted 28 August, Available online 15 September 2020 Academic Editor: Essam Mohamed Eissa, Beni-Suef University, Egypt, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 7.0/10 Average Peer review marks at publication stage: 8.0/10 Ali Awadallah Saeed, National University, Sudan, [email protected] Dr. Wadhah Hassan Edrees, Hajjah University, Yemen, [email protected] Similar Articles: EPIDEMICITY OF VIBRIO CHOLERA IN SANA’A CITY, YEMEN: PREVALENCE AND POTENTIAL DETERMINANTS &nbsp

Integrated genome-wide genotyping and gene expression profiling reveals BCL11B as a putative oncogene in acute myeloid leukemia with 14q32 aberrations

Acute myeloid leukemia is a neoplasm characterized by recurrent molecular aberrations traditionally demonstrated by cytogenetic analyses. We used high density genome-wide genotyping and gene expression profiling to reveal acquired cryptic abnormalities in acute myeloid leukemia. By genome-wide genotyping of 137 cases of primary acute myeloid leukemia, we disclosed a recurrent focal amplification on chromosome 14q32, which included the genes BCL11B, CCNK, C14orf177 and SETD3, in two cases. In the affected cases, the BCL11B gene showed consistently high mRNA expression, whereas the expression of the other genes was unperturbed. Flu

Efflux pump inhibitors (EPIs) as new antimicrobial agents against Pseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic human pathogen and one of the leading causes of nosocomial infections worldwide. The difficulty in treatment of pseudomonas infections arises from being multidrug resistant (MDR) and exhibits resistance to most antimicrobial agents due to the expression of different mechanisms overcoming their effects. Of these resistance mechanisms, the active efflux pumps in Pseudomonas aeruginosa that belong to the resistance nodulation division (RND) plays a very important role in extruding the antibiotics outside the bacterial cells providing a protective means against their antibacterial activity. Beside its role against the antimicrobial agents, these pumps can extrude biocides, detergents, and other metabolic inhibitors. It is clear that efflux pumps can be targets for new antimicrobial agents. Peptidomimetic compounds such as phenylalanine arginyl β-naphthylamide (PAβN) have been introduced as efflux pump inhibitors (EPIs); their mechanism of action is through competitive inhibition with antibiotics on the efflux pump resulting in increased intracellular concentration of antibiotic, hence, restoring its antibacterial activity. The advantage of EPIs is the difficulty to develop bacterial resistance against them, but the disadvantage is their toxic property hindering their clinical application. The structure activity relationship of these compounds showed other derivatives from PAβN that are higher in their activity with higher solubility in biological fluids and decreased toxicity level. This raises further questions on how can we compact Pseudomonas infections. Of particular importance, the recent resurgence in the use of older antibiotics such as polymyxins and probably applying stricter control measures in order to prevent their spread in clinical sittings

Thermodynamic Analysis and Optimization of the Micro-CCHP System with a Biomass Heat Source

In this article, new multiple-production systems based on the micro-combined cooling, heating and power (CCHP) cycle with biomass heat sources are presented. In this proposed system, absorption refrigeration cycle subsystems and a water softener system have been used to increase the efficiency of the basic cycle and reduce waste. Comprehensive thermodynamic modeling was carried out on the proposed system. The validation of subsystems and the optimization of the system via the genetic algorithm method was carried out using Engineering Equation Solver (EES) software. The results show that among the components of the system, the dehumidifier has the highest exergy destruction. The effect of the parameters of evaporator temperature 1, ammonia concentration, absorber temperature, heater temperature difference, generator 1 pressure and heat source temperature on the performance of the system was determined. Based on the parametric study, as the temperature of evaporator 1 increases, the energy efficiency of the system increases. The maximum values of the energy efficiency and exergy of the whole system in the range of heat source temperatures between 740 and 750 K are equal to 74.2% and 47.7%. The energy and exergy efficiencies of the system in the basic mode are equal to 70.68% and 44.32%, respectively, and in the optimization mode with the MOOD mode, they are 87.91 and 49.3, respectively

Efflux Pump, the Masked Side of ß-Lactam Resistance in Klebsiella pneumoniae Clinical Isolates

International audienceBACKGROUND: Beta-lactamase production and porin decrease are the well-recognized mechanisms of acquired beta-lactam resistance in Klebsiella pneumoniae isolates. However, such mechanisms proved to be absent in K. pneumoniae isolates that are non susceptible to cefoxitin (FOX) and susceptible to amoxicillin+clavulanic acid in our hospital. Assessing the role of efflux pumps in this beta-lactam phenotype was the aim of this study. METHODOLOGY/FINDINGS: MICs of 9 beta-lactams, including cloxacillin (CLX), and other antibiotic families were tested alone and with an efflux pump inhibitor (EPI), then with both CLX (subinhibitory concentrations) and EPI against 11 unique bacteremia K. pneumoniae isolates displaying the unusual phenotype, and 2 ATCC strains. CLX and EPI-dose dependent effects were studied on 4 representatives strains. CLX MICs significantly decreased when tested with EPI. A similar phenomenon was observed with piperacillin+tazobactam whereas MICs of the other beta-lactams significantly decreased only in the presence of both EPI and CLX. Thus, FOX MICs decreased 128 fold in the K. pneumoniae isolates but also 16 fold in ATCC strain. Restoration of FOX activity was CLX dose-dependent suggesting a competitive relationship between CLX and the other beta-lactams with regard to their efflux. For chloramphenicol, erythromycin and nalidixic acid whose resistance was also due to efflux, adding CLX to EPI did not increase their activity suggesting differences between the efflux process of these molecules and that of beta-lactams. CONCLUSION: This is the first study demonstrating that efflux mechanism plays a key role in the beta-lactam susceptibility of clinical isolates of K. pneumoniae. Such data clearly evidence that the involvement of efflux pumps in beta-lactam resistance is specially underestimated in clinical isolates

The TolC Protein of Legionella pneumophila Plays a Major Role in Multi-Drug Resistance and the Early Steps of Host Invasion

Pneumonia associated with Iegionnaires's disease is initiated in humans after inhalation of contaminated aerosols. In the environment, Legionella pneumophila is thought to survive and multiply as an intracellular parasite within free-living amoeba. In the genome of L. pneumophila Lens, we identified a unique gene, tolC, encoding a protein that is highly homologous to the outer membrane protein TolC of Escherichia coli. Deletion of tolC by allelic exchange in L. pneumophila caused increased sensitivity to various drugs. The complementation of the tolC mutation in trans restored drug resistance, indicating that TolC is involved in multi-drug efflux machinery. In addition, deletion of tolC caused a significant attenuation of virulence towards both amoebae and macrophages. Thus, the TolC protein appears to play a crucial role in virulence which could be mediated by its involvement in efflux pump mechanisms. These findings will be helpful in unraveling the pathogenic mechanisms of L. pneumophila as well as in developing new therapeutic agents affecting the efflux of toxic compounds