Emerging Carbapenem-Resistant Pseudomonas aeruginosa Isolates Carrying bla_IMP Among Burn Patients in Isfahan, Iran

Background: Metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa is a significant pathogen in burn patients. Objectives: The aim of this study was to determine the prevalence of carbapenem-resistant P. aeruginosa isolates, including those resistant to imipenemase (IMP), in a burn unit in Isfahan, Iran. Patients and Methods: One hundred and fifty P. aeruginosa isolates from burn patients were tested for antibiotic susceptibility by the disc diffusion method in accordance with CLSI guidelines. Production of MBL was identified with the EDTA disk method. DNA was purified from the MBL-positive isolates, and detection of the blaIMP gene was performed with PCR. Results: Fifty-seven out of 150 (38%) isolates were multi-drug resistant (MDR), and 93 (62%) were extensively-drug resistant (XDR). Among all isolates, the resistance rate to ciprofloxacin, tobramycin, imipenem, meropenem, amikacin, ceftazidime, and cefepime was higher than 90%, while the resistance rates to piperacillin/tazobactam and aztreonam were 70.7% and 86%, respectively. Colistin and polymyxin B remained the most effective studied antibiotics. All of the imipenem-resistant P. aeruginosa isolates were MBL-positive, and 107 out of 144 (74.3%) of the MBL isolates were positive for the blaIMP gene. Conclusions: The results of this study show that the rate of P. aeruginosa-caused burn wound infections was very high, and many of the isolates were resistant to three or more classes of antimicrobials. Such extensive resistance to antimicrobial classes is important because few treatment options remain for patients with burn wound infections. blaIMP-producing P. aeruginosa isolates are a rising threat in burn-care units, and should be controlled by conducting infection-control assessments

Potential application of pomegranate seed oil oleogels based on monoglycerides, beeswax and propolis wax as partial substitutes of palm oil in functional chocolate spread

In this research, the effectiveness of pomegranate seed oil oleogel as a partial replacement of fat phase in chocolate spread was studied. Monoglyceride (MG), beeswax (BW) and propolis wax (PW) have been used as structuring agents at 5 g/100 g concentration to gel pomegranate seed oil. The oleogels were then combined with palm oil at 1:1 ratio. Different techniques, including polarized light microscopy, synchrotron XRD, mechanical analyses, and oil binding capacity were used to study the physical and mechanical properties of the palm oil-oleogel systems and chocolate spreads. Results highlighted that MG, BW and PW chemical nature led to the formation of different crystalline network in palm oil-oleogel systems. Chocolate spreads containing palm oil-oleogels showed an increase in the mechanical parameters in the order of PW < BW < MG. This trend might be attributed to the chemical composition of oleogelators and physical bonds formed in the samples. During storage, crystal transformation in MG and structural reorganization in waxes (PW and BW) samples showed a gradual decrease and increase in hardness, respectively. These findings could provide useful information in the application of pomegranate seed oil oleogel for novel confectionery products engineering

Environmental geotechnics: Challenges and opportunities in the post-Covid-19 world

The outbreak of the coronavirus disease 2019 (Covid-19) pandemic not only has created a health crisis across the world but is also expected to impact negatively the global economy and societies at a scale that is maybe larger than that of the 2008 financial crisis. Simultaneously, it has inevitably exerted many negative consequences on the geoenvironment on which human beings depend. The current paper articulates the role of environmental geotechnics in elucidating and mitigating the effects of the current pandemic. It is the belief of all authors that the Covid-19 pandemic presents not only significant challenges but also opportunities for the development of the environmental geotechnics field. This discipline should make full use of geoenvironmental researchers' and engineers' professional skills and expertise to look for development opportunities from this crisis, to highlight the irreplaceable position of the discipline in the global fight against pandemics and to contribute to the health and prosperity of communities, to serve humankind better. In order to reach this goal while taking into account the specificity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the uncertainty of its environmental effects, it is believed that more emphasis should be placed on the following research directions: pathogen-soil interactions; isolation and remediation technologies for pathogen-contaminated sites; new materials for pathogen-contaminated soil; recycling and safe disposal of medical wastes; quantification of uncertainty in geoenvironmental and epidemiological problems; emerging technologies and adaptation strategies in civil, geotechnical and geoenvironmental infrastructures; pandemic-induced environmental risk management; and modelling of pathogen transport and fate in geoenvironment, among others. Moreover, Covid-19 has made it clear to the environmental geotechnics community the importance of urgent international co-operation and of multidisciplinary research actions that must extend to a broad range of scientific fields, including medical and public health disciplines, in order to meet the complexities posed by the Covid-19 pandemic

The Medical Segmentation Decathlon

International challenges have become the de facto standard for comparative assessment of image analysis algorithms given a specific task. Segmentation is so far the most widely investigated medical image processing task, but the various segmentation challenges have typically been organized in isolation, such that algorithm development was driven by the need to tackle a single specific clinical problem. We hypothesized that a method capable of performing well on multiple tasks will generalize well to a previously unseen task and potentially outperform a custom-designed solution. To investigate the hypothesis, we organized the Medical Segmentation Decathlon (MSD) - a biomedical image analysis challenge, in which algorithms compete in a multitude of both tasks and modalities. The underlying data set was designed to explore the axis of difficulties typically encountered when dealing with medical images, such as small data sets, unbalanced labels, multi-site data and small objects. The MSD challenge confirmed that algorithms with a consistent good performance on a set of tasks preserved their good average performance on a different set of previously unseen tasks. Moreover, by monitoring the MSD winner for two years, we found that this algorithm continued generalizing well to a wide range of other clinical problems, further confirming our hypothesis. Three main conclusions can be drawn from this study: (1) state-of-the-art image segmentation algorithms are mature, accurate, and generalize well when retrained on unseen tasks; (2) consistent algorithmic performance across multiple tasks is a strong surrogate of algorithmic generalizability; (3) the training of accurate AI segmentation models is now commoditized to non AI experts

Human physiologically based pharmacokinetic model for ACE inhibitors: ramipril and ramiprilat

BACKGROUND: The angiotensin-converting enzyme (ACE) inhibitors have complicated and poorly characterized pharmacokinetics. There are two binding sites per ACE (high affinity "C", lower affinity "N") that have sub-nanomolar affinities and dissociation rates of hours. Most inhibitors are given orally in a prodrug form that is systemically converted to the active form. This paper describes the first human physiologically based pharmacokinetic (PBPK) model of this drug class. METHODS: The model was applied to the experimental data of van Griensven et. al for the pharmacokinetics of ramiprilat and its prodrug ramipril. It describes the time course of the inhibition of the N and C ACE sites in plasma and the different tissues. The model includes: 1) two independent ACE binding sites; 2) non-equilibrium time dependent binding; 3) liver and kidney ramipril intracellular uptake, conversion to ramiprilat and extrusion from the cell; 4) intestinal ramipril absorption. The experimental in vitro ramiprilat/ACE binding kinetics at 4°C and 300 mM NaCl were assumed for most of the PBPK calculations. The model was incorporated into the freely distributed PBPK program PKQuest. RESULTS: The PBPK model provides an accurate description of the individual variation of the plasma ramipril and ramiprilat and the ramiprilat renal clearance following IV ramiprilat and IV and oral ramipril. Summary of model features: Less than 2% of total body ACE is in plasma; 35% of the oral dose is absorbed; 75% of the ramipril metabolism is hepatic and 25% of this is converted to systemic ramiprilat; 100% of renal ramipril metabolism is converted to systemic ramiprilat. The inhibition was long lasting, with 80% of the C site and 33% of the N site inhibited 24 hours following a 2.5 mg oral ramipril dose. The plasma ACE inhibition determined by the standard assay is significantly less than the true in vivo inhibition because of assay dilution. CONCLUSION: If the in vitro plasma binding kinetics of the ACE inhibitor for the two binding sites are known, a unique PBPK model description of the Griensven et. al. experimental data can be obtained