Staphylococcus aureus nasal carriage among outpatients attending primary health care centers: a comparative study of two cities in Saudi Arabia and Egypt

AbstractEpidemiological and molecular data on community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) are still scarce in both Egypt and Saudi Arabia. There is almost no data regarding methicillin resistant Staphylococcus aureus (MRSA) prevalence in both countries. This study was conducted to investigate the prevalence and molecular epidemiology of S. aureus and MRSA nasal carriage among outpatients attending primary health care centers in two big cities in both countries. A total of 206 nasal swabs were obtained, 103 swabs from each country. S. aureus isolates were characterized by antibiotic susceptibility, presence of mecA and PVL genes, SCCmec-typing and spa typing, the corresponding Multi locus sequence typing clonal complex was assigned for each spa type based on Ridom StaphType database. MRSA was detected in 32% of the Egyptian outpatients while it was found in 25% of the Saudi Arabian outpatients. All MRSA isolates belonged to SCCmec type V and IVa, where some isolates in Saudi Arabia remained nontypeable. Surprisingly PVL+ isolates were low in frequency: 15% of MRSA Egyptian isolates and 12% of MRSA isolates in Saudi Arabia. Two novel spa types were detected t11839 in Egypt, and t11841 in Saudi Arabia. We found 8 spa types among 20 isolates from Egypt, and 12 spa types out of 15 isolates from Saudi Arabia. Only two spa types t008 and t223 coexisted in both countries. Four clonal complexes (CC5, CC8, CC22, and CC80) were identified in both Egypt and Saudi Arabia. However, the data collected lacked a representation of isolates from different parts of each country as only one health center from each country was included, it still partially illustrates the CA-MRSA situation in both countries. In conclusion a set of control measures is required to prevent further increase in MRSA prevalence

An approach to evaluating the pedagogical value of concordances in Arabic foreign language classrooms: Perspectives from the users

The use of electronic corpora in recent years has been widely spreading among language educators, yet they are still at their initial stages of exploring key issues relating to this approach. One way to integrate corpora in language courses is through concordances, which Baker, Hardie, and McEnery (2006) define as “a list of all the occurrences of a particular search term in a corpus, presented within the context in which they occur, usually a few words to the left and right of search term” (p.42). Despite opposing and supporting arguments on the adaptation, there is a lack of evaluative research examining sufficiency and compliancy of learning through corpus-based activities, especially from intermediate students’ perspectives. In this respect, the study is divided into two parts. The first part is divided into two segments which on the one hand intends to introduce Arabic foreign language (AFL) learners to corpus analysis using arabiCorpus concordancer -this is expected to raise their awareness of how the language functions as well as enhance their spirit of inquiry- while on the other hand, the study also uses a quantitative-oriented approach to measure the effect of utilizing arabiCorpus concordancer on students’ usage and retention of Arabic discourse connectives (ADCs)in comparison to conventional learning techniques. In order to achieve successful results for this study, a repeated-measures design is utilized to collect numeric data using pre and post-writings analysis. The results of these analyses are given via a non-parametric Wilcoxon Signed Ranks Test. The second part of the study aims at inspecting AFL learners’ perceptions and attitudes toward learning through arabiCorpus concordancer, throughout a qualitative-oriented approach that uses two instruments, a focus group and a Likert scale questionnaire. The results of the present study revealed that in a first instance both teaching techniques were successful, yet on another note the concordance surpassed the conventional in both usage and retention, on the short term. Furthermore, on the long term the usage and retention of both conventional and concordance techniques were similar. It was observed that the concordance technique had slightly excelled at that point. Finally, participants’ reported that they would continue to use arabiCorpus concordances, yet under certain restrictions

Repayment determinants for Egyptian microfinance institutions

Finance is one of the core development axes and is the basis for job creation, income, poverty reduction and economic growth. Financial resources in Egypt are both idle and misallocated. Access to finance is a major constraint especially to the poor stratum of the Egyptian society. Microfinance is one of the means through which the poor can gain access to finance. However, Egyptian microfinance institutions (MFIs) are inefficient and are unable to supply 90% of the demand for microcredit. This research focuses on how the supply-demand gap of microcredit in Egypt can be reduced. Hence this paper examines what are the borrowers’ socio-demographic characteristics and loan conditions that affect the microcredit repayment rate in Egypt. These factors are examined so that Egyptian MFIs can be financially and socially efficient and serve as better engines for change. This paper employs the mixed method (qualitative and quantitative) approach in an attempt to answer the research question proposed. The paper estimates the log likelihood of a probit regression model based on data from two MFIs: Misr El Kheir (MEK) and Resala. In addition, interviews were conducted with twelve borrowers of one of Egypt’s MFIs (Tanmeyah). The results show that the repayment determinants are country-specific. Lack of timely repayment is both a supply-sided and demand-sided problem i.e. it is attributed to both the MFI policies and the borrowers’ characteristics. Lack of timely repayment is due to the MFI lending policies, long repayment period, the time the first installment is due, the borrower’s job, income, address and most importantly his/her willingness to pay.Macroeconomic shocks, such as the 25th of January Revolution, have positively contributed to the probability of the borrowers defaulting. Although microfinance is only a tool for poverty alleviation, not the solution, its importance can not be understated. MFIs can reduce the supply-demand gap by mitigating the reasons for lack of timely repayment such as long repayment period, lack of experience, lack of willingness to pay and so on. This will enable MFIs to revive financial resources and promote economic growth

An application of theoretically informed implementation research in pharmacy practice.

This workshope aims to be an introduction to theoretically informed implementation research and enable participants to apply knowledge learned by trying out some case scenarios. Scholars are increasingly interested in closing research-practice gap through the identification and examination of activities and processes that effectively support the dissemination, uptake, and implementation of evidence in real-world practice and policy settings

Theoretically informed implementation research in health sciences.

Implementation research has been used to link the gap between evidence-based research and real practice also known as the practice gap. The use of theory to underpin such research ensures this is systematically carried out making findings more applicable to practice. The main aim of this workshop was to foster the integration of theory into the implementation research journey, leading to strengthening of research methodologies and findings

The Inhibition of First-Pass Metabolism of Beyond Lipinski's Rule of Five Compound by Pharmaceutical Excipient

First pass metabolism in the liver and gut wall metabolism by cytochrome P450 3A (CYP3A) enzymes plays a critical role in limiting the bioavailability of compounds in the beyond Lipinski’s rule of 5 space. This study aims to evaluate the potential inhibitory effects of 4 excipients: PEG 400, lysolecithin, Tween 20, vitamin E d-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) on CYP3A (predominately CYP3A4). Experiments were conducted in-vitro using human liver microsomes using lopinavir as a model compound. Results indicate that PEG 400, lysolecithin and Tween 20 were found to have no inhibitory effects on lopinavir metabolism by CYP3A4. TPGS shows an inhibitory effect at concentrations < 132 µM (200 µg/mL). This makes TPGS an attractive excipient for consideration in a formulation for oral delivery of compounds in the beyond Lipinski’s rule of five space. Further evidence is needed to understand how TPGS exerts its effect

Hospital antimicrobial stewardship program implementation in the Gulf Cooperation Council States: a systematic review of evidence of implementation.

Background and Purpose: Antimicrobial resistance (AMR) has led to the development of initiatives aimed at optimizing antimicrobial use. Co-ordinated interventions for promoting and monitoring safe and effective use of antimicrobials are termed antimicrobial stewardship programs (ASP). While there are several systematic reviews on aspects of ASP, none have focused on the processes and outcomes of implementation in the Gulf Cooperation Council (GCC) States. The aim was to critically appraise, synthesize and present the available evidence on ASP implementation in the GCC States in relation to the interventions, reported outcomes and facilitators and barriers to implementation. Methodology: A systematic review protocol was developed based on PRISMA-P guidelines and registered with PROSPERO (International Prospective Register of Systematic Reviews). Electronic databases (MEDLINE, CINAHL, International Pharmaceutical Abstracts, Cochrane database and Web of Science) were searched using pre-specified terms for peer-reviewed publications in English from 2010 onward. Quality assessment, data extraction and synthesis were independently performed by two reviewers. ASP interventions were compared to the Centre of Disease Control and Prevention (CDC) checklist, a systematic assessment of key ASP interventions. Results and Discussions: ASP interventions implementation in line with CDC checklist were weak, with the majority of studies reporting only one third of the expected CDC criteria. The most commonly reported outcomes were antibiotic consumption, with very little reporting of any microbiological, clinical and economic outcomes. Key facilitators were physician and organisation support. Barriers reported included the lack of dedicated staff and lack of sufficient funding for implementation. Conclusions: There is a lack of robust studies of ASP implementation in the GCC States. Such studies should focus on CDC criteria in developing the ASP intervention and report valid and reliable outcomes including microbiological, clinical and economic outcomes. There is also a need for qualitative research to focus on facilitators, barriers and solutions to implementation

A theoretical exploration of the implementation of antimicrobial stewardship programmes in the United Arab Emirates.

Antimicrobial resistance (AMR) is considered a global health threat and one of the most pressing public health issues. The World Health Organization (WHO) outlined actions to combat the AMR risk including optimising the use of antimicrobials through the introduction of Antimicrobial Stewardship Programmes (ASP). Many collaborative groups have produced bundles of actions that can guide ASP implementation. The Center for Disease Prevention and Control (CDC) have produced a framework of seven core elements driven from key ASP studies demonstrating effectiveness in antimicrobial use. The Gulf Cooperation Council (GCC) states responded to the global health threat of AMR by issuing a five pillars strategic plan. In United Arab Emirates (UAE), local healthcare authorities detected the increased prevalence of resistant microbial strains and responded by issuing mandates demanding hospitals to establish ASP teams and actions tailored to their available resources. The overall aim of the doctoral research was to explore ASP implementation in acute care hospitals in UAE. A number of systematic reviews have been published providing evidence on the effectiveness of ASP interventions and its impact on patient and microbiological outcomes, yet none have explored ASP implementation in relation to international standards. Since it is well recognised that ASP interventions can vary greatly across geographical regions, the need for a systematic review exploring ASP implementation in the GCC region has emerged. The first phase of this doctoral research was a systematic review of 17 studies that aimed to critically appraise and synthesise the evidence of ASP implementation in GCC hospitals in comparison to the CDC framework and identify key facilitators and barriers. The CDC framework was the international standard of choice given its value as a reference point for many GCC hospitals and based on multiple effectiveness studies that used it to identify gaps in ASP implementation in acute care hospitals. Mapping to the CDC framework identified key areas of strengths and weaknesses in reporting implementation where infrastructure elements reporting was heterogeneous and insufficient. It also identified the need for rigorous qualitative in-depth research that utilises implementation frameworks to facilitate identification and understanding of factors that influence the translation of ASP research findings into practice within the healthcare sector in GCC states. The second phase of this doctoral research aimed to explore key stakeholders' perspectives of ASP implementation in UAE hospitals, with a focus on facilitators and barriers. A qualitative study was conducted underpinned by the Consolidated Framework for Implementation Research (CFIR) and involving semi-structured interviews with ASP key stakeholders from UAE hospitals. Data saturation was achieved at the completion of 31 interviews. Multiple CFIR constructs emerged as facilitators (such as stakeholders' engagement and effective communication) or barriers (such as perceived ASP complexity and blame culture) for ASP implementation, which highlighted the value of employing theory as an underpinning in comparison to studies without any theoretical underpinning. Coronavirus Disease 2019 (COVID-19) highly impacted data collection during phase two. Participants' perspectives on the impact of COVID-19 on ASP implementation were separately analysed and presented. The study identified the complexity of ASP implementation which led to initial disruption of the service, yet successful evolvement and restoration of ASP services reflects the high value and adaptability of ASP implementation in UAE hospitals. Future research should focus on obtaining consensus agreement of ASP key stakeholders on recommendations for ASP implementation based on findings of the systematic review and the qualitative study

The Inhibition of First-Pass Metabolism of Beyond Lipinski's Rule of Five Compound by Pharmaceutical Excipient

First pass metabolism in the liver and gut wall metabolism by cytochrome P450 3A (CYP3A) enzymes plays a critical role in limiting the bioavailability of compounds in the beyond Lipinski’s rule of 5 space. This study aims to evaluate the potential inhibitory effects of 4 excipients: PEG 400, lysolecithin, Tween 20, vitamin E d-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) on CYP3A (predominately CYP3A4). Experiments were conducted in-vitro using human liver microsomes using lopinavir as a model compound. Results indicate that PEG 400, lysolecithin and Tween 20 were found to have no inhibitory effects on lopinavir metabolism by CYP3A4. TPGS shows an inhibitory effect at concentrations < 132 µM (200 µg/mL). This makes TPGS an attractive excipient for consideration in a formulation for oral delivery of compounds in the beyond Lipinski’s rule of five space. Further evidence is needed to understand how TPGS exerts its effect