Coagulase negative staphylococci in Anti-Cancer Center, Batna, Algeria: antibiotic resistance pattern, biofilm formation, and detection of mecA and icaAD genes

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Klebsiella pneumoniae producing extended spectrum β-lactamase in Regional Military University Hospital of Oran, Algeria: antibiotic resistance, biofilm formation, and detection of blaCTX-M and blaTEM genes

Background: Klebsiella pneumoniae is a bacterial pathogen commonly associated with severe nosocomial and community acquired infections  especially through the acquisition of extended spectrum β-lactamases (ESβL) and biofilm formation capacity. The objectives of this study are to determine the prevalence of K. pneumoniae ESβL (KP-ESβL)-producing isolates in the Regional Military University Hospital of Oran (HMRUO) Algeria,characterize their antibiotic resistance profile, genetically detect blaTEM and blaCTX-M genes, and evaluate their biofilm formation capacity.Methodology: Different clinical specimens including blood, cerebrospinal fluids, urine and catheter, pus, perirectal abscess, and surgical wounds were collected from patients with suspected clinical infections in different units and departments of the hospital. The specimens were cultured on Blood, MacConkey and CLED agar (for urine only) plates and incubated aerobically for 24 hours at 37°C for preliminary identification of bacteria using conventional colony morphology, Gram stain reaction, and disk diffusion test for antibiotic susceptibility testing (AST). Confirmation of isolates, antibiogram, minimum inhibitory concentration (MIC) and detection of resistance phenotypes, were carried out by the automated Vitek 2 (BioMérieux) identification and susceptibility method. ESβL production was confirmed by the synergy and combination disk tests. ESβL genes were detected by conventional simplex PCR and biofilm formation was detected by the tissue culture plate (TCP) method.Results: A total of 630 patients’ clinical samples (one sample per patient) were processed. Klebsiella pneumoniae was isolated in 40 (6.3%) samples, and 15 of these (37.5%) produced ESβL. In the disk diffusion AST assay, all 40 K. pneumoniae isolates were resistant to ampicillin and ticarcillin while all 40 isolates were sensitive to cefoxitin, imipenem and ertapenem. KP-ESβL producing isolates were more frequently recovered from intensive care unit (33.3%) and from urine (46.7%) samples. Group 1 blaCTX-M genes were detected in 13 of the 15 (86.7%) KP-ESβL isolates, and 46.7% of these isolates were moderate biofilm producers.Conclusion: There is need for health departments to put in place preventative measures through regular surveillance of these resistant pathogens and initiating appropriate infection prevention and control strategies to limit their spread in Algerian hospitals and worldwide. Keywords: Klebsiella pneumoniae, ESβL, biofilm, PCR, antibacterial resistance   French title: Klebsiella pneumoniae productrice de-lactamase spectre tendu dans l'hôpital universitaire militaire régional d'Oran, Algérie: résistance aux antibiotiques, formation de biofilm et détection desgènes blaCTX-M et blaTEM Contexte: Klebsiella pneumoniae est un pathogène bactérien communément associé aux infectionsnosocomiales et communautaires sévères, en particulier par l'acquisition de β-lactamases à spectre étendu(ESβL) et la capacité de formation de biofilm. Les objectifs de cette étude sont de déterminer la prévalence desisolats de K. pneumoniae producteurs de βLSE (KP-βLSE) au CHU d'Oran (HMRUO) Algérie, caractériser leurprofil de résistance aux antibiotiques, détecter génétiquement les gènes blaTEM et blaCTX-M, et évaluer leurcapacité de formation de biofilm.Méthodologie: Différents échantillons cliniques, y compris du sang, des liquides céphalo-rachidiens, de l'urinemictionnelle et du cathéter, du pus, des abcès périrectal et des plaies chirurgicales ont été prélevés despatients suspectés d'infections cliniques dans différentes unités et départements de l'hôpital. Les échantillonsont été cultivés sur des milieu de culture: deglose au sang, MacConkey et CLED (pour l'urine uniquement) etincubés en aérobie pendant 24heures à 37°C pour l'identification préliminaire des bactéries en utilisant lamorphologie conventionnelle des colonies, la coloration de Gram et le test de diffusion sur disque pour les testsde sensibilité aux antibiotiques (AST). La confirmation des isolats, l'antibiogramme, la concentration minimaleinhibitrice (CMI) et la détection des phénotypes de résistance ont été réalisés par la méthode automatiséed'identification et de sensibilité sur Vitek 2 (BioMérieux). La production de βLSE a été confirmée par les tests desynergie et de double disques. Les gènes de βLSE ont été détectés par PCR simplex conventionnelle et laformation de biofilm a été détectée par la méthode de la plaque de culture tissulaire (TCP).Résultats: Un total de 630 échantillons cliniques de patients (un échantillon par patient) ont été traités.Klebsiella pneumoniae a été isolé dans 40 échantillons (6,3%) et 15 d'entre eux (37,5%) ont produit des βLSE.Dans le test AST à diffusion sur disque, tous les 40 isolats de K. pneumoniae étaient résistants à l'ampicilline età la ticarcilline, tandis que les 40 isolats étaient sensibles à la céfoxitine, à l'imipénème et à l'ertapénème. Lesisolats producteurs de KP-βLSE ont été plus fréquemment récupérés dans les unités de soins intensifs (33,3%)et dans les échantillons d'urine (46,7%). Les gènes blaCTX-M du groupe 1 ont été détectés dans 13 des 15 isolatsde KP-βLSE (86,7%), et 46,7% de ces isolats étaient des producteurs de biofilm modérés.Conclusion: Il est nécessaire que les services de santé mettent en place des mesures préventives grâce à unesurveillance régulière de ces pathogènes résistants et à la mise en place de stratégies appropriées deprévention et de contrôle des infections pour limiter leur propagation dans les hôpitaux algériens et dans lemonde. Mots clés: Klebsiella pneumoniae, βLSE, biofilm, PCR, résistance antibactérienne &nbsp

Generating indicative-informative summaries with SumUM

We present and evaluate SumUM, a text summarization system that takes a raw technical text as input and produces an indicative informative summary. The indicative part of the summary identifies the topics of the document, and the informative part elaborates on some of these topics according to the reader's interest. SumUM motivates the topics, describes entities, and defines concepts. It is a first step for exploring the issue of dynamic summarization. This is accomplished through a process of shallow syntactic and semantic analysis, concept identification, and text regeneration. Our method was developed through the study of a corpus of abstracts written by professional abstractors. Relying on human judgment, we have evaluated indicativeness, informativeness, and text acceptability of the automatic summaries. The results thus far indicate good performance when compared with other summarization technologies

Complete remission of an advanced hormone receptor positive Her2-negative breast cancer treated by first line palbociclib-letrozole and local treatment

The palbociclib-letrozole combination has revolutionized the treatment of Hormone-receptor-positive Her2-negative advanced breast cancers. The aim of the inclusion of targeted agents in endocrine based therapy is to prolong hormonsensitivity and to delay the initiation of subsequent chemotherapy, especially for patients with low disease burden. However, the interest of locoregional treatment after response to initial therapy in advanced disease still investigational especially in the era of biotherapy. In the present case report, we showed the possible complete response with hormone-therapy associated to targeted therapy and highlighted the role of loco-regional treatment in this situation

Profil épidémiologique et prise en charge des exacerbations d’asthme chez l’enfant à l’hôpital d’enfants de Rabat au Maroc

Introduction: l’exacerbation d’asthme est un phénomène paroxystique qui peut mettre en jeu le pronostic vital. Le but de l’étude est d’évaluer leprofil épidémiologique et les modalités de prise en charge de  l’exacerbation d’asthme chez les enfants âgés de 2 à 15 ans dans l’unité de pneumoallergologie pédiatrique de l’hôpital d’enfants de Rabat au Maroc.Méthodes: il s’agit d’une étude rétrospective qui a concerné 1461 enfants hospitalisés pour exacerbation d’asthme modérée à sévère durant une période d’un an allant de décembre 2011 à novembre 2012, les exacerbations légères étant traitées en ambulatoire.Résultats: les hospitalisations pour exacerbation d’asthme chez les  enfants ont représenté 34 % de l’ensemble des hospitalisations avec trois pics en mai, septembre et décembre. L’âge moyen de survenue était de 3 ans et demi avec une prédominance masculine nette. L’exacerbation  d’asthme était inaugurale dans 22 % des cas. Les infections respiratoires virales dominaient les facteurs déclenchants des exacerbations d’asthme. Le séjour hospitalier était en moyenne de 3 jours. Un transfert en  réanimation a été nécessaire dans 2 % des cas. L’évolution sous  traitement a toujours été favorable et la mortalité a été nulle. Conclusion: la prévalence des hospitalisations pour exacerbation d’asthme suit un profil saisonnier lié aux effets environnementaux. La plupart de ces hospitalisations pourraient cependant être évitées grâce à un meilleur contrôle de l’asthme et à l’amélioration de l’éducation thérapeutique de l’enfant asthmatique et de son entourage

Chemical composition analysis of essential oils of four plants from Aurès region of Algeria and their antibacterial and antibiofilm activities against coagulase-negative staphylococci

Background: The altitudinal and geographical variability of the Aurès mountains of Algeria favored the existence of some endemic and rare varieties of medicinal plants. The aim of the present work is to determine the chemical composition, antimicrobial and antibiofilm properties of the  essential oils (EOs) from aerial parts of four medicinal plants from Aurès region of Algeria; Juniperus thurifera L., Juniperus oxycedrus L., Salvia   officinalis L. and Thymus ciliatus ssp. munbyanus (Boiss. & Reut.) Batt. on coagulase negative staphylococci (CoNS) isolates. Methodology: Extraction of EOs from the four plant materials was carried out by hydro-distillation, and the EO yield expressed in gram of the distillate per 100 grams of dry matter. The chemical composition of the EOs was analyzed by gas chromatography-mass spectrometry (GC-MS) method. In vitro antibacterial and antibiofilm activities of the EOs were evaluated against CoNS previously isolated at the Anti-Cancer Center of Batna, Algeria using the agar disc diffusion assay and biofilm inhibition study, respectively. Minimum inhibitory concentration (MIC) and minimum  bacterial concentration (MBC) of the EOs of S. officinalis L. and T. ciliatus ssp. munbyanus were determined by the dilution method. Results: Twenty-seven and 41 compounds rich in monoterpene hydrocarbons were identified from J. oxycedrus and J. thurifera plants respectively, while 45 and 32 compounds, constituted mainly by oxygenated monoterpenes, were identified from S. officinalis L. and T. ciliatus ssp. munbyanus, respectively. The EOs of T. ciliatus ssp. munbyanus showed the most inhibitory activity of all the four plants on CoNS isolates (n=66) with mean  inhibition zone diameter of 24.99±6.29mm, and mean MIC and MBC values of 2.65±3.77mg/ml and 5.31±7.41mg/ml respectively, followed by S.  officinalis L., with mean inhibition zone diameter of 13.38± 6.52mm, and mean MIC and MBC values of 27.53±28.2 mg/ml and 31.97±33.19 mg/ml  respectively (p<0.0001 by one-way ANOVA). Also, percentage biofilm inhibition of CoNS isolates (n=59) was high for EOs of T. ciliatus ssp. munbyanus  (65.63±10.71%) and S. officinalis L. (53.13±5.83%), although was significantly higher for T. ciliatus ssp. munbyanus compared to S. officinalis L. (p<0.0001, t=7.874). Conclusion: Essential oils from T. ciliatus ssp. munbyanus and S. officinalis L. could represent an alternative to classical antibiotics against planktonic cells and biofilms of CoNS

A stakeholder co-design approach for developing a community pharmacy service to enhance screening and management of atrial fibrillation

The authors would like to thank all participants in this research for their valuable input into the co-design process.Background: Community pharmacies provide a suitable setting to promote self-screening programs aimed at enhancing the early detection of atrial fibrillation (AF). Developing and implementing novel community pharmacy services (CPSs) is a complex and acknowledged challenge, which requires comprehensive planning and the participation of relevant stakeholders. Co-design processes are participatory research approaches that can enhance the development, evaluation and implementation of health services. The aim of this study was to co-design a pharmacist-led CPS aimed at enhancing self-monitoring/screening of AF. Methods: A 3-step co-design process was conducted using qualitative methods: (1) interviews and focus group with potential service users (n = 8) to identify key needs and concerns; (2) focus group with a mixed group of stakeholders (n = 8) to generate a preliminary model of the service; and (3) focus group with community pharmacy owners and managers (n = 4) to explore the feasibility and appropriateness of the model. Data were analysed qualitatively to identify themes and intersections between themes. The JeMa2 model to conceptualize pharmacybased health programs was used to build a theoretical model of the service. Results: Stakeholders delineated: a clear target population (i.e., individuals ≥65 years old, with hypertension, with or without previous AF or stroke); the components of the service (i.e., patient education; self-monitoring at home; results evaluation, referral and follow-up); and a set of circumstances that may influence the implementation of the service (e.g., quality of the service, competency of the pharmacist, inter-professional relationships, etc.). A number of strategies were recommended to enable implementation (e.g.,. endorsement by leading cardiovascular organizations, appropriate communication methods and channels between the pharmacy and the general medical practice settings, etc.). Conclusion: A novel and preliminary model of a CPS aimed at enhancing the management of AF was generated from this participatory process. This model can be used to inform decision making processes aimed at adopting and piloting of the service. It is expected the co-designed service has been adapted to suit existing needs of patients and current care practices, which, in turn, may increase the feasibility and acceptance of the service when it is implemented into a real setting.This work was funded by Covidien Pty Ltd. (Medtronic Australasia Pty Ltd) [UTS Project code: PRO16–0688], which is the company that has the rights to distribute the device Microlife BP A200 AFIB in Australia. Also, funding for this research has been provided by a UTS Chancellor’s postdoctoral fellowship awarded to the first author of this article (ID number: 2013001605)

Intracranial tumors of the central nervous system and air pollution - A nationwide case-control study from Denmark

Background: Inconclusive evidence has suggested a possible link between air pollution and central nervous system (CNS) tumors. We investigated a range of air pollutants in relation to types of CNS tumors. Methods: We identified all (n = 21,057) intracranial tumors in brain, meninges and cranial nerves diagnosed in Denmark between 1989 and 2014 and matched controls on age, sex and year of birth. We established personal 10- year mean residential outdoor exposure to particulate matter < 2.5 μm (PM2.5), nitrous oxides (NOX), primary emitted black carbon (BC) and ozone. We used conditional logistic regression to calculate odds ratios (OR) linearly (per interquartile range (IQR)) and categorically. We accounted for personal income, employment, marital status, use of medication as well as socio-demographic conditions at area level. Results: Malignant tumors of the intracranial CNS was associated with BC (OR: 1.034, 95%CI: 1.005–1.065 per IQR. For NOx the OR per IQR was 1.026 (95%CI: 0.998–1.056). For malignant non-glioma tumors of the brain we found associations with PM2.5 (OR: 1.267, 95%CI: 1.053–1.524 per IQR), BC (OR: 1.049, 95%CI: 0.996–1.106) and NOx (OR: 1.051, 95% CI: 0.996–1.110). Conclusion: Our results suggest that air pollution is associated with malignant intracranial CNS tumors and malignant non-glioma of the brain. However, additional studies are needed