Molecular Characterization of Coagulase Positive Staphylococci Isolated From Dogs and Cats

Isolation studies of coagulase-positive staphylococci were conducted on hospitalised and out patient dogs and cats, on three sites: skin, nose and ear, between January and September 1997. Three tests were used to differentiate between coagulase-positive staphylococci, namely: acetoin production, P agar supplemented with acriflavin and B-galactosidase test. Thirty-six Staphylococcus aureus and 90 Staphylococcus intermedius isolates were recovered from these animals. Staphylococcus hyicus was not isolated, the results indicated that the major coagulase-positive Staphylococcus species in dogs was S. intermedius and in cats was S. aureus. The antimicrobial typing of S. aureus and S. intermedius was compared with the molecular typing methods such as: Polyacrylamide-gel Electrophoresis profiles -and of ,protein A concentration-l whole cell proteins, and Polymerase Chain Reaction (PCR)-based methods that include: Random Amplification of Polymorphic DNA (RAPD-PCR), Enterobacterial Repetitive Intergenic Consensus sequences (ERICPCR), Coagulase gene PCR amplification and Restriction Fragment Length Polymorphism (RFLP). The antimicrobial typing differentiated S. aureus and S. intermedius isolates into 14 and 28 profiles respectively. Isolates of S. aureus and S. intermedius containing plasmids were 41.7% and 46% respectively. However, no correlation could be made between plasmid occurrence and antibiotic resistance profiles. The SDS-PAGE profiles of whole cell proteins grouped 24 S. aureus and 48 S. intermedius strains into 19 and 16 profiles respectively. In PCR-based methods the isolates were typed using three primers. The combination of three primers for the RAPD gave 33 and 83 profiles of 36 S. aureus and 90 S. intermedius isolates respectively. ERIC primers grouped 24 S. aureus and 47 S. intermedius isolates into 19 and 43 profiles respectively. The coagulase gene from 24 S. aureus and 47 S. intermedius isolates showed limited discriminatory to the other methods and was least useful for the preliminary epidemiological studies. The restriction enzyme analysis of coagulase gene PCR products was very useful to increase the discriminatory power of coagulase gene PCR but required the use of multiple restriction enzymes. It was concluded that RAPD-PCR and ERIC-PCR are the best methods for typing S. aureus and S. intermedius

Curriculum Development of the Faculties of the Health and Agricultural Sectors University of Gezira 15.12.2011 to 15.6.2012

The University of Gezira adopts nobel goals, community orientation and community development- and it set curricula capable of achieving those goals which are essential for sustainability of its excellence. Periodic development, upgrading and modernization of curricula is a fundamental requirement for all universities; knowledge is growing and changing very fast, also there are rapid changes in community needs and expectations and hence  graduates should be equipped with competencies which enable them to contribute significantly and efficiently in the total development of their societies. The University has a wealth of experience in development of its curricula since its foundation and hence it included it as one of the main four components of the University Development Project. The project is sponsored by the Islamic Bank for Development-Jeddah and the Ministry of Finance Sudan and has been launched in December 2011. The Project aimed to develop the Faculties of agricultural and health sectors- curricula, manpower and infrastructure. Those sectors were chosen to be sectors of excellence for students in the Islamic countries. The Vice Chancellor of the University of Gezira formed a committee to manage the whole task of development of all the curricula of the faculties in the health and agricultural sectors; Medicine, Medical Laboratory Sciences, Animal Production, Veterinary Medicine, Applied Medical Sciences, Dentistry, Pharmacy, Health and Environmental Sciences, Agricultural Sciences. The committee set the justifications, determined its strategies and designed the process of its work. The whole task was accomplished in the stipulated time - 4 months

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc

Long-term (180-Day) outcomes in critically Ill patients with COVID-19 in the REMAP-CAP randomized clinical trial

Importance The longer-term effects of therapies for the treatment of critically ill patients with COVID-19 are unknown. Objective To determine the effect of multiple interventions for critically ill adults with COVID-19 on longer-term outcomes. Design, Setting, and Participants Prespecified secondary analysis of an ongoing adaptive platform trial (REMAP-CAP) testing interventions within multiple therapeutic domains in which 4869 critically ill adult patients with COVID-19 were enrolled between March 9, 2020, and June 22, 2021, from 197 sites in 14 countries. The final 180-day follow-up was completed on March 2, 2022. Interventions Patients were randomized to receive 1 or more interventions within 6 treatment domains: immune modulators (n = 2274), convalescent plasma (n = 2011), antiplatelet therapy (n = 1557), anticoagulation (n = 1033), antivirals (n = 726), and corticosteroids (n = 401). Main Outcomes and Measures The main outcome was survival through day 180, analyzed using a bayesian piecewise exponential model. A hazard ratio (HR) less than 1 represented improved survival (superiority), while an HR greater than 1 represented worsened survival (harm); futility was represented by a relative improvement less than 20% in outcome, shown by an HR greater than 0.83. Results Among 4869 randomized patients (mean age, 59.3 years; 1537 [32.1%] women), 4107 (84.3%) had known vital status and 2590 (63.1%) were alive at day 180. IL-6 receptor antagonists had a greater than 99.9% probability of improving 6-month survival (adjusted HR, 0.74 [95% credible interval {CrI}, 0.61-0.90]) and antiplatelet agents had a 95% probability of improving 6-month survival (adjusted HR, 0.85 [95% CrI, 0.71-1.03]) compared with the control, while the probability of trial-defined statistical futility (HR >0.83) was high for therapeutic anticoagulation (99.9%; HR, 1.13 [95% CrI, 0.93-1.42]), convalescent plasma (99.2%; HR, 0.99 [95% CrI, 0.86-1.14]), and lopinavir-ritonavir (96.6%; HR, 1.06 [95% CrI, 0.82-1.38]) and the probabilities of harm from hydroxychloroquine (96.9%; HR, 1.51 [95% CrI, 0.98-2.29]) and the combination of lopinavir-ritonavir and hydroxychloroquine (96.8%; HR, 1.61 [95% CrI, 0.97-2.67]) were high. The corticosteroid domain was stopped early prior to reaching a predefined statistical trigger; there was a 57.1% to 61.6% probability of improving 6-month survival across varying hydrocortisone dosing strategies. Conclusions and Relevance Among critically ill patients with COVID-19 randomized to receive 1 or more therapeutic interventions, treatment with an IL-6 receptor antagonist had a greater than 99.9% probability of improved 180-day mortality compared with patients randomized to the control, and treatment with an antiplatelet had a 95.0% probability of improved 180-day mortality compared with patients randomized to the control. Overall, when considered with previously reported short-term results, the findings indicate that initial in-hospital treatment effects were consistent for most therapies through 6 months