Carbapenemase typing and resistance profile of enteric bacteria isolate with reduced sensitivity to carbapenems in a Lebanese tertiary care center

Objective: nowadays resistant bacteria represent worldwide a public health problem leading in some cases to a stalemate without any possible treatment. Therefore early detection and identification of carbapenemase producing gram-negative bacteria (GNB) is of crucial importance. Consequently we conducted a study in a tertiary care hospital to analyze the resistance phenotype of the carbapenem resistant GNB (CRGNB). Methods: we collected all the CRGNB from September 2014 till January 2016, we took randomly 40/126 strains and performed a sensitivity test in addition to a real time multiplex PCR to detect the exact carbapenemase coding genes (bla SPC , bla IMP1, bla VIM , bla NDM , bla KPC , et bla OXA-48). The studied strains were: Escherichia coli (70%), Klebsiella pneumonia (20%), Enterobacter aerogenes (2,5%), Enterobacter cloacae (2.5%) et Klebsiella oxytoca (2.5%). Results: 100% of the studied strains were intermediate or resistant to ertapenem, 85% intermediate or resistant to imipenem and/or meropenem. 33 / 40 strains (82.5%) are bla OXA-48 positive et one strain (2.5%) is bla NDM positive. the OXA-48 were urinary strains of E coli. 6 / 40 strains (15%) did not express carbapenemase genes in molecular studies. Conclusion: we note a marked emergence of CPGNB especially bla OXA-48 with high resistance pattern leading to narrow therapeutic options. This requires a rapid detection of such strains of GNB so that to initiate quickly the right preventive and therapeutic measures to avoid hospital epidemics with disastrous consequences

Impact of the inpatient infectious disease consultations at a tertiary care university hospital

BACKGROUND: The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting. METHODS: This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit, whenever the antibiotic usage was switched to a mono or bi-therapy. RESULTS: The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6 % of cases and Quinolones discontinuation accounted for 22.7% of cases. CONCLUSION: Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients

Chronic Mercury Intoxication Masquerading as Systemic Disease: A Case Report and Review of the Literature

Background: Mercury is a highly toxic environmental metal that exists in three different forms: elemental, inorganic and organic. Intoxication occurs in either occupational or non-occupational settings, mainly after the inhalation of vapour and fumes in work places, laboratories or homes. Chronic mercury toxicity ranges from mild and insignificant to severe and life-threatening. We describe the case of a young male patient who presented with multiple organ dysfunction after chronic mercury exposure. Case presentation: We report the case of 28-year-old male artisanal gold miner who was admitted to hospital for severe neurological impairment associated with inflammatory bowel disease-like symptoms and a skin rash after mercury exposure. Symptomatic treatment and corticosteroid administration assured rapid clinical improvement. Chronic mercury poisoning can masquerade as an autoimmune or systemic inflammatory disease. Conclusion: Physicians should be aware that low exposure to mercury, even from artisanal gold mining, may be harmful to health. Management can be simple without the need for aggressive or invasive therapeutic measures. Larger case series are required in order to establish a clear management plan

Leptin Reverts Pro-Apoptotic and Antiproliferative Effects of α-Linolenic Acids in BCR-ABL Positive Leukemic Cells: Involvement of PI3K Pathway

It is suspected that bone marrow (BM) microenvironmental factors may influence the evolution of chronic myeloid leukaemia (CML). In this study, we postulated that adipocytes and lipids could be involved in the progression of CML. To test this hypothesis, adipocytes were co-cultured with two BCR-ABL positive cell lines (PCMDS and K562). T cell (Jurkat) and stroma cell (HS-5) lines were used as controls. In the second set of experiments, leukemic cell lines were treated with stearic, oleic, linoleic or α-linolenic acids in presence or absence of leptin. Survival, proliferation, leptin production, OB-R isoforms (OB-Ra and OB-Rb), phosphoinositide 3-kinase (PI3k) and BCL-2 expression have been tested after 24h, 48h and 72h of treatment. Our results showed that adipocytes induced a decrease of CML proliferation and an increase in lipid accumulation in leukemic cells. In addition, CML cell lines induced adipocytes cell death. Chromatography analysis showed that BM microenvironment cells were full of saturated (SFA) and monounsaturated (MUFA) fatty acids, fatty acids that protect tumor cells against external agents. Stearic acid increased Bcl-2 expression in PCMDS, whereas oleic and linoleic acids had no effects. In contrast, α-linolenic acid decreased the proliferation and the survival of CML cell lines as well as BCL-2 and OB-R expression. The effect of α-linolenic acids seemed to be due to PI3K pathway and Bcl-2 inhibition. Leptin production was detected in the co-culture medium. In the presence of leptin, the effect of α-linolenic acid on proliferation, survival, OB-R and BCl-2 expression was reduced

COVID-19 in a Patient Treated for Granulomatosis with Polyangiitis: Persistent Viral Shedding with No Cytokine Storm

Introduction: The coronavirus disease COVID-19 is considered a pandemic disease that has developed rapidly all over the world. As of today, it is unclear whether immunosuppression confers an increased risk for pulmonary complications, or conversely, whether it can be a protective factor with respect to a cytokine storm. Case description: We report the case of a 55-year-old male patient with granulomatosis with polyangiitis treated with rituximab who was infected with COVID-19 pneumonia. To the best of our knowledge, only 1 case has been reported in the literature with similar characteristics. The patient had a non-classic evolution of clinical symptoms with persistent fever and viral shedding, in addition to a negative serology.Conclusion: This case emphasizes the management and immunity response to COVID-19 pneumonia in such patients. Data are still needed regarding patients who have prolonged B-cell depletion, which may put the patient at a higher risk for reinfection

CMV reactivation in COVID-19 patients: pouring fuel on the fire

Severe SARS-CoV-2 infection could promote CMV reactivation, that further worsens disease prognosis. This study included admitted patients with recent COVID-19 for one year period in a tertiary hospital, having clinical criteria of CMV reactivation and positive CMV DNAemia. Fifteen of 559 COVID-19 patients were diagnosed with CMV reactivation (2.7%). 86.6% were male, with a mean age of 63.6 years. Immunodepression was significantly higher in the CMV positive group (p=0.008). Lymphopenia was significantly more important in patients who reactivated CMV (p=<0.001), whereas ferritin level (p=0.019) and IL-6 level (p=0.035) on admission appeared to be significantly lower in this group. There was no significant difference for COVID-19 treatments. ICU admission (p<0 .001) and bacterial infections (p<0.001) appeared to be significant for CMV reactivation. Also, the mortality was significantly higher in the CMV positive group (p=0.042). This study raises the possible incrimination of lymphopenia, immunosuppression, critical illness, and bacterial infections in CMV reactivation

Post-graduation migration intentions of students of Lebanese medical schools: a survey study

<p>Abstract</p> <p>Background</p> <p>The international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans.</p> <p>Methods</p> <p>Our target population consisted of all students of Lebanese medical schools in the pre-final and final years of medical school. We developed the survey questionnaire based on the results of a qualitative study assessing the intentions and motives for students of Lebanese medical schools to train abroad. The questionnaire inquired about student's demographic and educational characteristics, intention to train abroad, the chosen country of abroad training, and post-training intention of returning to Lebanon.</p> <p>Results</p> <p>Of 576 eligible students, 425 participated (73.8% response rate). 406 (95.5%) respondents intended to travel abroad either for specialty training (330 (77.6%)) or subspecialty training (76 (17.9%)). Intention to train abroad was associated with being single compared with being married. The top 4 destination countries were the US (301(74.1%)), France (49 (12.1%)), the United Kingdom (31 (7.6%)) and Canada (17 (4.2%)). One hundred and two (25.1%) respondents intended to return to Lebanon directly after finishing training abroad; 259 (63.8%) intended to return to Lebanon after working abroad temporarily for a varying number or years; 43 (10.6%) intended to never return to Lebanon. The intention to stay indefinitely abroad was associated male sex and having a 2^ndcitizenship. It was inversely associated with being a student of one of the French affiliated medical schools and a plan to train in a surgical specialty.</p> <p>Conclusion</p> <p>An alarming percentage of students of Lebanese medical schools intend to migrate for post graduate training, mainly to the US. A minority intends to return directly to Lebanon after finishing training abroad.</p

Choix de la spécialité en médecine : Quels facteurs influencent la décision des étudiants ?

Objectif : Etablir l'influence des facteurs démographiques et des valeurs attribuées aux spécialités sur le choix de carrière des étudiants en médecine. Méthodes : Un questionnaire composé de trois parties a été distribué à 177 étudiants : la première partie concernait les facteurs démographiques, la seconde partie le choix de spécialité envisagée et la troisième partie correspondait à des caractéristiques attribuées aux spécialités, réparties en six échelles de valeurs, selon l’étude de Murdoch. L’échelle a été validée par une analyse en composantes principales. Après avoir effectué une analyse univariée, l’influence des différents facteurs sur le choix de la spécialité a fait appel à une régression logistique multivariée multinomiale. Résultats : Les échelles de valeur sont corrélées avec les choix de spécialité des étudiants dans les directions prévues, à savoir que les échelles « bioscientific orientation » et « prestige » sont liées au choix de chirurgie et négativement corrélées au choix de psychiatrie, tandis que l’échelle « avoid role strain » est liée aux spécialités de soins primaires, en particulier, à la pédiatrie et à la médecine de famille, ainsi qu’à la psychiatrie et à la radiologie. La chirurgie est un choix en très grande majorité masculin. La pédiatrie est un choix presque exclusivement féminin. Ces différences liées au sexe des étudiants sont aussi retrouvées au niveau du choix des échelles de valeurs. Les autres facteurs démographiques n’ont pas d’influence notable sur le choix de spécialité. Conclusion : Le choix de carrière des étudiants est surtout lié aux caractéristiques qu’ils attribuent à leur future profession, et à la perception qu’ils ont d’eux-mêmes dans le monde du travail. Ces caractéristiques sont différentes entre les sexes, ce qui détermine des choix de spécialité différents pour les hommes et les femmes