A retrospective study of antibiotic resistance patterns of bacterial pathogens isolated from patients in two Lebanese hospitals for two consecutive years (2018 and 2019)

Background: Misuse of antibiotics is the leading factor promoting emergence of bacterial resistance, a situation that has become a serious public health challenge. Among the leading bacteria that have developed resistance to antibiotics are Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, which have caused infections in patients, resulting in considerable mortality. The objective of this retrospective study was to assess antibiotic resistance rates of bacterial pathogens isolated from clinical specimens in two Lebanese hospitals between the years 2018 and 2019. Methodology: Bacteria isolated from routine clinical specimens collected from hospitalized patients in two hospitals, Haroun and Bekaa, in Lebanon for 2018 and 2019, were analyzed. Bacteria isolation and identification were carried out at the laboratory of each hospital using conventional microbiological methods. Antimicrobial susceptibility testings (AST) of each bacterial isolate to antibiotics were performed by the disc diffusion test and interpreted using EUCAST, CLSI or WHO/AST guidelines. Comparisons of the mean resistance rates of each isolate to individual antibiotics by year of isolation were done using the Z-test and p< 0.05 was considered statistically significant. Results: There were a total of 1698 bacteria isolates recovered from hospitalized patients in the two hospitals for 2018 and 2019, of which 87.5% were Gram-negative and 12.5% were Gram-positive bacteria. The most frequent among the Gram-negative isolates was E. coli (66.1%) followed by P. aeruginosa (13.3%), K. pneumoniae (7.7%), Proteus mirabilis (6.7%) and Enterobacter spp (6.3%), while coagulase positive staphylococci CoPS (68.4%) and E. faecalis (31.6%) were the two Gram positive isolates. Of the Gram-negative isolates over the two-year period, 72.2% of E. coli and 76.3% of K. pneumoniae were resistant to ceftazidime, 93% of P. mirabilis to colistin, and 98% of Enterobacter to cefoxitin, but low resistance rates were demonstrated by E. coli to imipenem (1%), K. pneumoniae to tigecycline and amikacin (0.9%), P. mirabilis to imipinem (2%), and Enterobacter to amikacin, ertapenem and tigecycline (3%). Resistance of P. aeruginosa varied between 2% to colistin and 24% to levofloxacin. For the Gram-positive bacteria, 79.1% of E. faecalis were resistant to erythromycin while 70% of CoPS were resistant to cefoxitin, but no isolate was resistant (0%) to linezolid, and only 1% to teicoplanin. Except for Enterobacter spp that showed significant increase in resistance rates (by 250%) to piperacillin/tazobactam in 2019 over 2018, resistance rates of other Gram-negative isolates significantly decreased in 2019 compared to 2018 (p<0.05). For the Gram-positive isolates, resistance rates to many antibiotics tested significantly increased (by a factor of 36.5 - 2569%) in 2019 compared to 2018 among E. faecalis isolates in contrast to the rates for CoPS which significantly decreased by 16.7 - 65.7%, except for penicillin G which increased by a factor of 123%. Conclusion: Overuse and misuse of antibiotics, which is possible because of the easy access of the populace to these drugs, is a leading factor contributing to the high antibiotic resistance rates in this study. There is need to promote awareness of antimicrobial resistance in Lebanon among students especially in non-health related majors and enactment of govermental policy that will limit access to antibiotics. Keywords: antibiotic resistance; changing pattern; hospitalized patients; retrospective   French title: Une étude rétrospective des profils de résistance aux antibiotiques de pathogènes bactériens isolés de patients dans deux hôpitaux libanais pendant deux années consécutives (2018 et 2019) Contexte: La mauvaise utilisation des antibiotiques est le principal facteur favorisant l'émergence de la résistance bactérienne, une situation qui est devenue un sérieux défi de santé publique. Parmi les principales bactéries qui ont développé une résistance aux antibiotiques figurent Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae et Pseudomonas aeruginosa, qui ont provoqué des infections chez les patients, entraînant une mortalité considérable. L'objectif de cette étude rétrospective est d'évaluer les taux de résistance aux antibiotiques des pathogènes bactériens isolés à partir d'échantillons cliniques dans deux hôpitaux Libanais entre les années 2018 et 2019. Méthodologie: Les isolats bactériens prélevés sur des patients hospitalisés dans deux hôpitaux, Haroun et Bekaa, au Liban pour 2018 et 2019, ont été analysés. L'isolement et l'identification des bactéries ont été réalisés au laboratoire de chaque hôpital en utilisant des méthodes microbiologiques conventionnelles. Les tests de sensibilité aux antimicrobiens (AST) de chaque isolat bactérien aux antibiotiques ont été réalisés par le test de diffusion sur disque et interprétés selon les directives EUCAST, CLSI ou WHO/AST. Des comparaisons des taux moyens de résistance de chaque isolat à des antibiotiques individuels par année d'isolement ont été effectuées à l'aide du test Z et p<0,05 a été considéré comme statistiquement significatif. Résultats: Il y a eu un total de 1698 isolats de bactéries récupérés de patients hospitalisés dans les deux hôpitaux durant 2018 et 2019, dont 87,5% étaient à Gram négatif et 12,5% étaient des bactéries à Gram positif. Les isolats à Gram négatif les plus fréquents étaient E. coli (66,1%), suivis de P. aeruginosa (13,3%), K. pneumoniae (7,7%), Proteus mirabilis (6,7%) et Enterobacter spp (6,3%), tandis que les staphylocoques à coagulase positive CoPS (68,4%) et E. faecalis (31,6%) étaient les deux isolats Gram positifs. Parmi les isolats à Gram négatif sur la période de deux ans, 72,2% d'E. coli et 76,3% de K. pneumoniae étaient résistants à la ceftazidime, 93% de P. mirabilis à la colistine et 98% d'Enterobacter à la céfoxitine, mais faible les taux de résistance ont été démontrés par E. coli à l'imipénem (1%), K. pneumoniae à la tigécycline et à l'amikacine (0,9%), P. mirabilis à l'imipinem (2%) et Enterobacter à l'amikacine, à l'ertapénem et à la tigécycline (3%). La résistance de P. aeruginosa variait entre 2% à la colistine et 24% à la lévofloxacine. Pour les bactéries Gram positif, 79,1% des E. faecalis étaient résistantes à l'érythromycine tandis que 70% des CoPS étaient résistantes au céfoxitin, mais aucun isolat n'était résistant (0%) au linézolide et seulement 1% à la teicoplanine. À l'exception d'Enterobacter spp qui ont montré une augmentation significative des taux de résistance (de 250%) à la  pipéracilline/tazobactam en 2019 par rapport à 2018, les taux de résistance des autres isolats à Gram négatif ont considérablement  diminué en 2019 par rapport à 2018 (p<0,05). Pour les isolats Gram-positifs, les taux de résistance à de nombreux antibiotiques testés ont augmenté de manière significative (d'un facteur de 36,5 à 2569%) en 2019 par rapport à 2018 parmi les isolats d'E. faecalis contrairement aux taux de CoPS qui ont significativement diminué de 16,7 à 65,7%, à l'exception de la pénicilline G qui a augmenté d'un facteur de 123%. Conclusion: la surutilisation et la mauvaise utilisation des antibiotiques, ce qui est possible en raison de l'accès facile de la population à ces médicaments, est l'un des principaux facteurs contribuant aux taux élevés de résistance aux antibiotiques dans cette étude. Il est nécessaire de promouvoir la sensibilisation à la résistance aux antimicrobiens au Liban parmi les étudiants, en particulier dans les spécialisations non liées à la santé, et la promulgation d'une politique gouvernementale qui limitera l'accès non contrôlé aux antibiotiques. Mots clés: résistance aux antibiotiques; changement de modèle; patients hospitalisés; rétrospectiv

Design and Implement Machine Learning Tool for Cyber Security Risk Assessment

Cyber-attacks have increased in number and severity, which has negatively affected businesses and their services. As such, cyber security is no longer considered merely a technological problem, but must also be considered as critical to the economy and society. Existing solutions struggle to find indicators of unexpected risks, which limits their ability to make accurate risk assessments. This study presents a risk assessment method based on Machine Learning, an approach used to assess and predict companies' exposure to cybersecurity risks. For this purpose, four algorithm implementations from Machine Learning (Light Gradient Boosting, AdaBoost, CatBoost, Multi-Layer Perceptron) were implemented, trained, and evaluated using generative datasets representing the characteristics of different volumes of data (for example, number of employees, business sector, and known vulnerabilities and externel advisor). The quantitative evaluation conducted on this study shows the high accuracy of Machine Learning models and Especially Multi-Layer Perceptron was the best accuracy when working compared to previous work

Distribution of the superconducting gap in an YNi2B2C film studied by point contact spectroscopy

The differential resistances $R_d=dV/dI(V)$ of point contacts between a normal metal and a c axis oriented YNi2B2C film ($T_c$ = 15.2K) in the superconducting (SC) state have been investigated. $R_d(V)$ contains clear "gap" features connected with processes of Andreev reflection at the boundary between normal metal and superconductor that allow the determination of the SC gap $\Delta$ and its temperature and magnetic field dependence. A distribution of $\Delta$ from $\Delta_min\approx$ 1.5 meV to $\Delta_max\approx$ 2.4 meV is revealed; however the critical temperature $T_c$ in all cases corresponded to that of the film. The value 2$\Delta_max/k_BT_c\approx$3.66 is close to the BCS value of 3.52, and the temperature dependence $\Delta(T)$ is BCS-like, irrespective of the actual $\Delta$ value. It is supposed that the distribution of $\Delta$ can be attributed to a gap anisotropy or to a multiband nature of the SC state in YNi2B2C, rather than to the presence of nodes in the gap.Comment: 6 two-column pages, 7 figs; V2: as published, Fig.4 is modifie

Magnetic field dependence of superconducting energy gaps in YNi2B2C: Evidence of multiband superconductivity

We present results of in field directional point contact spectroscopy (DPCS) study in the quaternary borocarbide superconductor YNi2B2C, which is characterized by a highly anisotropic superconducting gap function. For I||a, the superconducting energy gap (D), decreases linearly with magnetic field and vanishes around 3.25T which is well below the upper critical field (Hc2~6T) measured at the same temperature (2.2K). For I||c, on the other hand, D decreases weakly with magnetic field but the broadening parameter (G) increases rapidly with magnetic field with the absence of any resolvable feature above 3.5T. From an analysis of the field variation of energy gaps and the zero bias density of states we show that the unconventional gap function observed in this material could originate from multiband superconductivity.Comment: 19 pages including figures (final version

Effect of transport-induced charge inhomogeneity on point-contact Andreev reflection spectra at ferromagnet-superconductor interfaces

We investigate the transport properties of a ferromagnet-superconductor interface within the framework of a modified three-dimensional Blonder-Tinkham-Klapwijk formalism. In particular, we propose that charge inhomogeneity forms via two unique transport mechanisms, namely, evanescent Andreev reflection and evanescent quasiparticle transmission. Furthermore, we take into account the influence of charge inhomogeneity on the interfacial barrier potential and calculate the conductance as a function of bias voltage. Point-contact Andreev reflection (PCAR) spectra often show dip structures, large zero-bias conductance enhancement, and additional zero-bias conductance peak. Our results indicate that transport-induced charge inhomogeneity could be a source of all these anomalous characteristics of the PCAR spectra.Comment: 9 pages, 6 figure

Thin Film Growth and Device Fabrication of Iron-Based Superconductors

Iron-based superconductors have received much attention as a new family of high-temperature superconductors owing to their unique properties and distinct differences from cuprates and conventional superconductors. This paper reviews progress in thin film research on iron-based superconductors since their discovery for each of five material systems with an emphasis on growth, physical properties, device fabrication, and relevant bulk material properties.Comment: To appear in J. Phys. Soc. Jp

The influence of different helminth infection phenotypes on immune responses against HIV in co-infected adults in South Africa

<p>Abstract</p> <p>Background</p> <p>The convergent distribution of the Human Immunodeficiency Virus (HIV) and helminth infections has led to the suggestion that infection with helminths exacerbates the HIV epidemic in developing countries. In South Africa, it is estimated that 57% of the population lives in poverty and carries the highest burden of both HIV and helmith infections, however, the disease interactions are under-researched.</p> <p>Methods</p> <p>We employed both coproscopy and <it>Ascaris lumbricoides</it>-specific serum IgE to increase diagnostic sensitivity and to distinguish between different helminth infection phenotypes and their effects on immune responses in HIV co-infected individuals. Coproscopy was done by formol ether and Kato Katz methods. HIV positive and negative adults were stratified according to the presence or absence of <it>A. lumbricoides </it>and/or <it>Trichuris trichuria </it>eggs with or without elevated <it>Ascaris </it>IgE. Lymphocyte subsets were phenotyped by flow cytometry. Viral loads, serum total IgE and eosinophils were also analysed. Lymphocyte activation markers (CCR5, HLA-DR, CD25, CD38 and CD71) were determined. Non parametric statistics were used to describe differences in the variables between the subgroups.</p> <p>Results</p> <p>Helminth prevalence ranged between 40%-60%. Four distinct subgroups of were identified, and this included egg positive/high <it>Ascaris</it>-specific IgE (egg⁺IgE^hi), egg positive/low IgE (egg⁺IgE^lo), egg negative/high IgE (egg^-IgE^hi) and egg negative/low IgE (egg^-IgE^lo) individuals. The egg⁺IgE^hisubgroup displayed lymphocytopenia, eosinophilia, (low CD4⁺counts in HIV^-group), high viral load (in HIV⁺group), and an activated lymphocyte profile. High <it>Ascaris </it>IgE subgroups (egg⁺IgE^hiand egg^-IgE^hi) had eosinophilia, highest viral loads, and lower CD4⁺counts in the HIV^-group). Egg excretion and low IgE (egg⁺IgE^lo) status demonstrated a modified Th₂immune profile with a relatively competent response to HIV.</p> <p>Conclusions</p> <p>People with both helminth egg excretion and high <it>Ascaris</it>-IgE levels had dysregulated immune cells, high viral loads with more immune activation. A modified Th₂helminth response in individuals with egg positive stools and low <it>Ascaris </it>IgE showed a better HIV related immune profile. Future research on helminth-HIV co-infection should include parasite-specific IgE measurements in addition to coproscopy to delineate the different response phenotypes. Helminth infection affects the immune response to HIV in some individuals with high IgE and egg excretion in stool.</p

Smoke and Mirrors: U.K. Newspaper Representations of Intimate Partner Domestic Violence

This is a pre-copyedited, author-produced pdf of an article accepted for publication in Violence Against Women following peer review. The final, definitive version of this paper has been published in Violence Against Women, Vol 23 (1): 114-139, first published April 2016 by SAGE Publishing, and is available on line at doi: 10.1177/1077801216634468. All rights reserved.News media are in a position to project certain perspectives on domestic violence while marginalizing others, which has implications for public understanding and policy development. This study applies discourse analysis to articles on domestic violence in two U.K. national daily newspapers published in 2001-2002 and 2011-2012 to evaluate evidence of change over a 10-year time span. The research examines how discourses of domestic violence are constructed through newspaper representations of victims, predominantly women, and perpetrators, predominantly men. Although one of the newspapers adopts a respectful position toward women, the textual and visual techniques adopted by the other reveal a tendency for blaming the victim and sexualizing violence related to perceptions of “deserving” or “undeserving” women victims.Peer reviewe