An Epidemiological and Multidrug Resistance Study for E. coli Isolated from Urinary Tract Infection (Three Years of Study)

ان الاصابة بجراثيم الايشيريشيا القولونية (E. coli) هي احد المشاكل الرئيسة التي تؤدي الى اصابة الجهاز البولي في العالم. هذه البكتريا بامكانها من تطوير المقاومة ضد مجموعة واسعة من مضادات البكتريا. ان التقصي ونظام المراقبة والاستتراتيجية الفعالة سوف يسهل بشكل كبير من اختيار العلاج المناسب للسيطرة على انتشار البكتريا. تهدف الدراسة الحالية الى الكشف عن وبائية الاصابة والعوامل الخطرة المتعلقة ببكتريا الايشيريشيا القولونية الممرضة للجهاز البولي وانماط المقاومة للمضادات الحيوية.  تم جمع عينات من الادرار (من دفعة الادرار الوسطية) من 1585 مريض لديهم علامات سريرية للاصابة بالجهاز البولي (225 ذكور و 1360 اناث)  دخلوا الى مستشفى زاخو للطوارئ في مدينة زاخو في اقليم كردستان العراق من تاريخ كانون الثاني 2016 ولغاية كانون الاول 2018. تم زرع العينات في اكار الدم والماكونكي وتم حضن اللاطباق المزروعة بدرجة حرارة  37  °م لمدة 24 ساعة. ان تشخيص جراثيم الايشيريشيا القولونية تم بناءا على تفاعل التصبيغ بصبغة كرام والخصائص المستعمرية والفحوصات الكيميائية الحيوية وفقا للمعايير والتوجيهات المتبعة. تم فحص جميع العزلات لنمط المضادات الحيوية باستخدام طريقة نشر القرص بناء على إلارشادات والمعايير المختبرية والسريرية. بينت النتائج انه من بين 1585 عينة كانت 1026 عينة (64.7 %) ايجابية لاصابة جرثومية للجهاز البولي, وكانت باعلى مستوى خلال عام 2016 (83.6 %) (P< 0.0001). كما كان معدل الاصابة في الاناث بالايشيريشيا القولونية  اعلى معنويا من الذكور (P< 0.0001) . وبشكل عام, كانت نسبة الاصابة بالايشيريشيا القولونية بمعدل 21.1% من مجموع الاصابات ونسبتها كانت اعلى خلال عام 2016 (22.9%). كما بينت الدراسة ان نسبة اصابة الاناث كانت اعلى (21.4%) مقارنة بالذكور (18.5%) (P=0.4946). بالاضافة الى ذلك ,خلال ثلاث سنوات من الدراسة (2016, 2017 و 2018), فأن معدل الاصابة بالايشيريشيا القولونية كانت عند اعلى مستوى في الصيف (أيار) وكانت في اعلى مستوى في شهري شباط وايار من العام 2016, كما ان المجموعة العمرية من 20 الى 39 سنة كانت الاكثر اصابة لدى النساء بمعدل (46%)  من مجمل اصابات الاناث, بينما كانت الفئة العمرية من 70 – 74 سنة هي الاقل بمعدل الاصابة (1%) لدى الذكور والاناث. لقد كشفت الدراسة ان نسبة عالية (80.56 %) من الايشيريشيا القولونية المقاومة لمضادات حيوية متعددة وبنسبة عالية لمجاميع المضادات الحيوية البيتا لاكتامز والماكروليدات. كانت نسبة حساسية عالية للمضادين الحيويين اميبنم و ميروبينم. في الختام, ان الاستخدام الخاطئ والمفرط للمضادات الحيوية ستزيد من معدل المقاومة لبكتريا الايشيريشيا القولونية, ولهذا السبب من الضروري الاستخدام الصحيح للمضادات الحيوية المتوفرة. كما أن البرامج التعليمية والمراقبة الدورية لحساسية المضادات الحيوية ضرورية لتقليل نسبة مقاومة المضادات الحيويةUropathogenic E. coli (UPEC) is problematic and still the leading cause of urinary tract infections worldwide. It is developed resistance against most antibiotics. The investigation, surveillance system, and efficient strategy will facilitate selecting an appropriate treatment that could control the bacterial distribution. The present study aims to investigate the epidemiology and associated risk factors of uropathogenic E. coli and to study their antibiotic resistance patterns. 1585 midstream urine specimens were collected from symptomatic urinary tract infections (UTI) patients (225 males and 1360 females) admitted to Zakho emergency hospital, Zakho, Kurdistan Region, Iraq from January 2016 until the end of December 2018. Specimens were inoculated on blood and MacConkey plates and incubated at 37оC for 24 hours. Uropathogenic E. coli was diagnosed based on gram staining, colony characteristics, and standard biochemical tests in accordance with local standards and guidelines. All isolates were screened for their antibiogram pattern using the disk diffusion method based on the Clinical and Laboratory Standards Institute guidelines. The results showed that out of 1585 urine specimens, 1026 (64.7%) were UTIs positive with a statistically higher rate in 2016 (83.6%) (P< 0.0001). The UTIs frequency in females was significantly higher than males (P< 0.0001). Generally, the uropathogenic E. coli represented 21.1% with the highest level in 2016 (22.9%). The uropathogenic E. coli rate was higher, statistically not significant, in females (21.4%) than males (18.5%) (P=0.4946). Additionally, through the three years of study, uropathogenic E. coli (UPEC) was in high frequency in February and May 2016. The female’s age group from 20 to 39 years was the most vulnerable (46%) form total infected females, while those from 70-74 years (1%) were the least susceptible in males and females. A high percentage (80.56 %) of multidrug resistance E. coli isolates was observed with high resistance against -lactamase and macrolides antibiotics. However, higher sensitivity was towards imipenem and meropenem. In conclusion, the wrong and overuse of antibiotics will increase the resistance rate of E. coli. For this reason, proper use of available antibiotics is necessary. Also, the educational programs and periodic monitoring of antimicrobial suscep­tibility are essential for reducing the antibiotic resistance rate

Knowledge, Perception, Attitudes and Behavior on Influenza Immunization and the Determinants of Vaccination

BACKGROUND: We sought to determine the knowledge of, perception, attitudes, and behaviors toward influenza virus and immunization, and the determinants of vaccination among students, patients, and Healthcare Workers (HCWs) at the American University of Beirut and its affiliated Medical Center. METHODS: We conducted a cross-sectional study between October 2016 and January 2017 utilizing a self-administered questionnaire that was provided to 247 randomly selected adult participants. Data collected included socio-demographic characteristics, prior vaccination against influenza, knowledge, perception, attitudes, and behaviors toward influenza and influenza immunization. A multivariable regression model was used to evaluate for independent associations between the different variables and regular or yearly vaccination as a primary outcome. RESULTS: The overall survey response rate was 77%. A substantial proportion of respondents (47.4%) had never received the influenza vaccine. Only 10.2% of students, 19.1% of patients, and 35.6% of HCWs reported regular or yearly influenza vaccine uptake. HCWs had the lowest knowledge score about influenza and its vaccine despite high self-reported levels of knowledge. Barriers to vaccinations included lack of information (31%), fear of adverse effects (29%), and a perception of not being at risk (23%). Several factors were independently associated with regular or yearly vaccination uptake including having children (adjusted OR = 3.8; 95% CI 1.2-12.5), a "very good" self-reported level of knowledge (OR = 16.3; 95% CI 1.4-194.2) and being afraid of the consequences of influenza (OR = 0.2; 95% CI 0.1-0.6). CONCLUSION: Adherence rates with regular or yearly vaccination against influenza remain low across all study groups. We were able to identify predictors as well as barriers to vaccination. Future awareness and vaccination campaigns should specifically aim at correcting misconceptions about vaccination, particularly among HCWs, along with addressing the barriers to vaccination. Predictors of vaccination should be integrated in the design of future campaigns

Removal of phosphate from River water using a new baffle plates electrochemical reactor

During the last 50 years, the human activities have significantly altered the natural cycle of phosphate in this planet, causing phosphate to accumulate in the freshwater ecosystems of some countries to at least 75% greater than preindustrial levels, which indicates an urgent need to develop efficient phosphate treatment methods. Therefore, the current study investigates the removal of phosphate from river water using a new electrochemical cell (PBPR). This new cell utilises perforated baffle plates as a water mixer rather than magnetic stirrers that require power to work. This study investigates the influence of key operational parameters such as initial pH (ipH), current density (Ј), inter-electrode distance (ID), detention time (t) and initial phosphate concentration (IC) on the removal efficiency, and influence of the electrocoagulation process on the morphology of the surface of electrodes. Overall, the results showed that the new reactor was efficient enough to reduce the concentration of phosphate to the permissible limits. Additionally, SEM images showed that the Al anode became rough and nonuniform due to the production of aluminium hydroxides. The main advantages of the electrocoagulation technique are: 1- The EC method does not produce secondary pollutants as it does not required chemical additives, while other traditional treatment methods required either chemical or biological additives [[1], [2], [3], [4]]. 2- It has a large treatment capacity and a relatively short treatment time in comparison with other treatment methods, such as the biological methods [1,[5], [6], [7]]. 3- The EC method produces less sludge than traditional treatment traditional chemical and biological treatment methods [8,9]. EC technology, like any other treatment method, has some drawbacks that could limit its performance. For instance, it still has a clear deficiency in the variety of reactor design, and the electrodes should be periodically replaced as they dissolve into the solution due to the oxidation process [2,10]

Electrocoagulation as a green technology for phosphate removal from River water

The current study investigates the removal of phosphate from water using a new baffle plates aluminium-based electrochemical cell (PBPR) taking consideration the influence of key operating parameters. This new cell utilises perforated baffle plates as a water mixer rather than magnetic stirrers that require extra power to work. As this unit is new, a comprehensive study has been carried to assess it performance. This study also includes preliminary estimates of the reactor’s operating costs, the amount of H2 gas produced and the yieldable energy from it. SEM (scanning electron microscope) was used to investigate the influence of the electrocoagulation process on the morphology of the surface of aluminium electrodes, and an empirical model developed to reproduce the phosphate removal process. The results showed that 99% of phosphate was removed within 60 minutes of electrolysis at an initial pH (ipH) of 6, inter-electrode distance (ID) of 0.5 cm, current density (J) of 6 mA/cm2, initial concentration of phosphate (IC) of 100 mg/L, and minimum operating cost of 0.503 US $/m3. The electrochemical cell produced enough H2 gas to generate 4.34 kWh/m3 of power. Statistically, it was proved that the influence of the operating parameters on phosphate removal could be modelled with an R2 of 0.882, the influence of these operating parameters on phosphate removal following the order: t>J>IC>ipH >ID. Finally, SEM images showed that after several electrolysing runs, the Al anode became rough and nonuniform which could be related to the production of aluminium hydroxides

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Adsorption of aniline from aqueous solutions onto a nanoporous material adsorbent: isotherms, kinetics, and mass transfer mechanisms

MCM-48, which is particulate and nanoporous, was formulated to actively remove aniline (AN) (i.e., benzenamine) from wastewater. MCM-48 was characterized by several methods. It was found that the MCM-48 was highly active in adsorbing aniline from wastewater. The Langmuir, Freundlich, and Temkin isotherms were employed to evaluate the adsorption equilibrium. At 100 and 94 mg g−1, the maximum theoretical and experimental absorption of aniline, respectively, fit with a Type I Langmuir isotherm. The Langmuir model was optimal in comparison to the Freundlich model for the adsorption of AN onto the mesoporous material MCM-48. The results of these kinetics adsorption models were investigated using model kinetics that employed both pseudo-first- and pseudo-second-order models as well as models utilized intraparticle diffusion. The kinetics adsorption models demonstrated that the absorption was rapid and most closely agreed with the pseudo-first-order model. The kinetic studies and the adsorption isotherms revealed the presence of both physical adsorption and chemisorption. The potential adsorption mechanisms include the following: (1) hydrogen bonding, (2) π-π interactions, (3) electrostatic interaction, and (4) hydrophobic interactions. The solution's pH, ionic strength, and ambient temperature also played essential roles in the adsorption. HIGHLIGHTS The mesoporous silica MCM-48 was very successful to remove aniline.; A maximum aniline adsorption 94 mg/g was achieved on MCM48 adsorbent.; MCM-48 was found very active for the removal of aniline compounds from wastewater.; Aniline adsorption mechanism is a chemisorption and physical adsorption process.; The MCM-48 was regenerated and reused efficiently in a batch adsorption.

Brominated flame retardants in children's room : concentration, composition, and health risk assessment

Children spend most of their daily time indoors. Many of the items used indoors, such as furniture, electronics, textile, and children toys, are treated with chemicals to provide longevity and fulfil the safety standards. However, many chemicals added to these products are released into the environment during leaching out from the treated products. Many studies have reported brominated flame retardants (BFRs) in indoor environments; however, few have focused on environments specified for young children. In this study, paired air (PM10) and dust samples were collected from the rooms (n = 30) of Saudi children. These samples were analyzed for different congeners of polybrominated diphenyl ethers (PBDEs) and three important alternative flame retardants using gas chromatography-mass spectrometry. Decabromodiphenyl ether (BDE 209) was the most important analyzed BFR in dust and PM10 samples with a median value of 3150 ng/g of dust and 75 pg/m3. This indicates the wider application of BDE 209 has implications for its occurrence, although its use has been regulated for specified uses since 2014. Among alternative BFRs, 2-Ethylhexyl-2,3,4,5-tetrabromobenzoate (TBB), Bis(2-ethylhexyl)-3,4,5,6-tetrabromophthalate (TBPH), and 1,2-Bis(2,4,6-tribromophenoxy)ethane (BTBPE) were found with a median levels of 10, 15 and 8 ng/g of dust, respectively. However, alternative BFRs were present in 10 samples. The calculated long term and daily exposures via indoor dust and PM10 of Saudi children from their rooms were well below the respective reference dose (RfD) values. Nonetheless, the study highlights BDE 209 at higher levels than previously reported from household dust in Saudi Arabia. The study warrants further extensive research to estimate the different classes of chemical exposure to children from their rooms