Phenotypic and Genotypic Characterization of Nosocomial Isolates of Staphylococcus aureus with Reference to Methicillin Resistance

Purpose: To investigate the occurrence, species prevalence, antibacterial resistance, and molecular characteristics of S. aureus isolates from different wards located in a university hospital.Methods: A total of one hundred and fifty S. aureus isolates were  recovered from various clinical specimens. The isolates were tested phenotypically by conventional methods and genotypically by polymease chain reaction (PCR) for direct detection of femB and mecA genes.Results: Thirty one isolates (20.7 %) of these were identified as  methicillin-resistant Staphylococcus aureus (MRSA) by oxacillin agar screen test and 124 (82.7 %) of the isolates were β-lactamase producers. The prevalence of MRSA strains among S. aureus isolates was 20.7 %. The overall resistance of MRSA to a variety of antibiotics tested was linezolid, 48.7 %; ciprofloxacin, 15.3 %; sulfamethoxazole/trimethoprim (TMS), 14.0 %; gentamicin, 12.7 %; and rifampicin, 6.7 %. All MRSA isolates were positive for femB and mecA genes; one MSSA carried mecA gene.Conclusion: Since S. aureus isolates are commonly associated with wound infections, skin and soft tissue infections and blood stream infections, glycopeptides, mupirocin, and quinupristin/dalfopristin (Q/D) would be the most effective antibiotics for the treatment of MRSA infections.Keywords: Staphylococcus aureus, mecA, femB, Antibiotics, Staphylococcal infections, Methicillin resistanc

Improvement and enhancement of clavulanic acid production in Streptomyces clavuligerus using vegetable oils

Clavulanic acid (CA) is a potent inhibitor of β-lactamases. Oil can be used as a source of carbon and energy in CA production. To develop a policy for enhanced production of CA, the selection of a production medium and an optimum pH, different vegetable oils as carbon source have been used. The effects of different medium containing vegetable oil on cell growth and CA yield production during the fermentation of Streptomyces clavuligerus ATCC 27064 were demonstrated. In this study, three out of eight tested oils supported CA production. Medium containing olive oil showed two-fold higher CA yield than glycerol containing medium. The highest productivity was obtained at initial pH 7. We concluded that using olive oil as a sole source of carbon and energy for cultivation of S. clavuligerus is a promising strategy for CA production. It has several scientific advantages and economic benefits that lead to increased antibiotic titre and can be considered as a cheaper alternative compared to carbohydrates. The results of this study can be applied for the efficient production of β-lactamase inhibitory antibiotics.Key words: Clavulanic acid, enzymes, β-lactamases, vegetable oils, Streptomyces clavuligerus

Chronic hepatitis C in children: Clinical spectrum and histopathological study

Introduction: Hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease. An estimated 180 million people are infected worldwide. The prevalence of hepatitis C virus (HCV) infection is relatively low in children, with an anti-HCV prevalence rate of 0.2–0.4% in the Western world. Egypt has the highest prevalence of adult HCV infection in the world, averaging 15–25% in rural communities. The main (90%) HCV genotype is type 4. The magnitude of HCV infection in children is not well studied. Asymptomatic HCV infection is detectable in 2.02% of Egyptian children.Aim: To study the clinical presentation and histopathological features of the liver in children with chronic hepatitis C infection.Methods: The study population included 40 children from 2 to 16 years who had been diagnosed with chronic hepatitis C (HCV-RNA positive for 6 months or more by Real-time PCR) in the liver clinic at El-Shatby Children Hospital.Results: Among the 40 patients’ biopsies, 26 (65%) were stage 0, 10 (25%) were stage 1, 4 (10%) were stage 2–3 (HAI). The grades of all 40 children ranged between 0 and 1 (HAI). Developing fibrosis was significantly associated with age (P =0.015).Conclusion: Children with chronicHCV infection are generally asymptomatic. Significant hepatic fibrosis was present in 10%of children with HCV infection. Fibrosis stage was significantly higher in older age children. There was no significant association between fibrosis stage and any biochemical parameter.Keywords: Chronic hepatitis C; Children; Egypt; Clinical profile; Histopathologic change

Chemopreventive and renal protective effects for docosahexaenoic acid (DHA): implications of CRP and lipid peroxides

<p>Abstract</p> <p>Background</p> <p>The fish oil-derived ω-3 fatty acids, like docosahexanoic (DHA), claim a plethora of health benefits. We currently evaluated the antitumor effects of DHA, alone or in combination with cisplatin (CP) in the EAC solid tumor mice model, and monitored concomitant changes in serum levels of C-reactive protein (CRP), lipid peroxidation (measured as malondialdehyde; MDA) and leukocytic count (LC). Further, we verified the capacity of DHA to ameliorate the lethal, CP-induced nephrotoxicity in rats and the molecular mechanisms involved therein.</p> <p>Results</p> <p>EAC-bearing mice exhibited markedly elevated LC (2-fold), CRP (11-fold) and MDA levels (2.7-fold). DHA (125, 250 mg/kg) elicited significant, dose-dependent reductions in tumor size (38%, 79%; respectively), as well as in LC, CRP and MDA levels. These effects for CP were appreciably lower than those of DHA (250 mg/kg). Interestingly, DHA (125 mg/kg) markedly enhanced the chemopreventive effects of CP and boosted its ability to reduce serum CRP and MDA levels. Correlation studies revealed a high degree of positive association between tumor growth and each of CRP (r = 0.85) and leukocytosis (r = 0.89), thus attesting to a diagnostic/prognostic role for CRP.</p> <p>On the other hand, a single CP dose (10 mg/kg) induced nephrotoxicity in rats that was evidenced by proteinuria, deterioration of glomerular filtration rate (GFR, -4-fold), a rise in serum creatinine/urea levels (2–5-fold) after 4 days, and globally-induced animal fatalities after 7 days. Kidney-homogenates from CP-treated rats displayed significantly elevated MDA- and TNF-α-, but reduced GSH-, levels. Rats treated with DHA (250 mg/kg, but not 125 mg/kg) survived the lethal effects of CP, and showed a significant recovery of GFR; while their homogenates had markedly-reduced MDA- and TNF-α-, but -increased GSH-levels. Significant association was detected between creatinine level and those of MDA (r = 0.81), TNF-α ) r = 0.92) and GSH (r = -0.82); implying causal relationships.</p> <p>Conclusion</p> <p>DHA elicited prominent chemopreventive effects on its own, and appreciably augmented those of CP as well. The extent of tumor progression in various mouse groups was highly reflected by CRP levels (thus implying a diagnostic/prognostic role for CRP). Further, this study is the first to reveal that DHA can obliterate the lethal CP-induced nephrotoxicity and renal tissue injury. At the molecular level, DHA appears to act by reducing leukocytosis, systemic inflammation, and oxidative stress.</p

Abnormalities of intestinal rotation and congenital intrinsic duodenal obstruction

Background Congenital duodenal obstruction (CDO) is a unique anomaly with variable presentation depending on the site, type of obstruction, as well as the presence ofassociated anomalies. This is a review of our experience with 51 infants and children with CDO, stressing on the importance of associated rotational abnormalities of the gut.Methods Over a period of 18 years (January 1993– December 2011), 51 infants and children with CDO were treated at our hospital. Their medical records were reviewed retrospectively for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment, and outcome.Results Fifty-one (27 boys and 24 girls) infants and children with intrinsic CDO were treated. Their birth weight ranged from 1.38 to 3.8 kg (mean 2.3 kg). Sixteen (31.4%)were premature. The mean maternal age was 25 years (range 18–40 years). Seven presented at 5 months, 18 days, 3.5 years, 1.8 years, 18 days, 1.5 years, and 2 months of age, respectively. Associated anomalies were observed in 34 (66.7%) of them. Sixteen (31.4%) had Down’s syndrome and 11 (21.6%) had congenital heart disease. Nine (17.6%) had rotational abnormalities of the gut, including two with situs inversus. The site of duodenal obstruction was located in the second part of duodenum in 48 (94%) of them. In two, the site of obstruction was in the fourth part of duodenum, whereas in the third it was located in the third part of duodenum. The causes of obstruction were duodenal atresia in 20 (39.2%), without a gap in eight (15.7%) and with a gap in 12 (23.5%), duodenal stenosis in 11 (21.6%), and duodenal diaphragm in 20 (39.2%). In 14 (27.5%) patients, an annular pancreas was observed. The different operative procedures were as follows: duodenoduodenostomy in 26; excision of the duodenal diaphragm and duodenoplasty in 12; Ladd’s procedure, excision of the duodenal diaphragm, duodenoplasty, and appendectomy in four; Ladd’s procedure, appendectomy, and duodenoduodenostomy in two; and duodenojejunostomy in seven. Two underwent reduction duodenoplasty to decrease the size of the duodenum. Three required reoperations, two because of an anastomotic leak and another because of duodenal dysfunction. Sixteen (31.4%) required total parenteral nutrition. Four died, resulting in an overall survival of 92.2%.Conclusion CDO is classified as intrinsic and extrinsic depending on the cause. Rotational abnormalities including situs inversus are among the rare but interesting anomalies associated with intrinsic CDO. The presence of malrotation or nonrotation with congenital bands does not exclude the presence of an associated intrinsic cause, which should be looked for intraoperatively. This is to obviate the possibility of further subsequent operative treatment. Keywords: congenital duodenal obstruction, duodenal diaphragm, malrotation, situs inversu

Schistosomiasis and Urinary Bladder Cancer in North Western Tanzania: A Retrospective Review of 185 Patients.

Worldwide, cancers of the urinary bladder are well known to be associated with environmental chemical carcinogens such as smoking and occupational exposure to polycyclic aromatic hydrocarbons. These cancers are typically transitional cell carcinoma (urothelial carcinoma). In areas where schistosomiasis is endemic there is a high incidence of squamous cell carcinoma of the urinary bladder. Schistosomiasis causes chronic granulomatous cystitis leading to squamous metaplasia of transitional epithelium, and subsequently development of squamous cell carcinoma. The western part of Tanzania on the shores of Lake Victoria is such an endemic area. This study was done to document the burden of urinary bladder cancer associated with schistosomiasis in this region. This was a descriptive retrospective study of histologically confirmed cases of urinary bladder cancer seen at the Department of Pathology Bugando Medical Centre (BMC) over a period of 10 years. Data were retrieved from the records of the Departments of Pathology, Medical Records and Surgery. Data were analyzed by the use of contingency tables. A total of 185 patients were diagnosed with cancer of the urinary bladder during the study period, where as 90 (48.6%) were males and 95 (51.4) were females. The mean age at diagnosis was 54.3 years. Squamous cell carcinoma was the most frequent histological type (55.1%), followed by conventional transitional cell carcinoma (40.5%). Eighty three of all cancer cases (44.9%) were found to have schistosomal eggs. Schistosomiasis was commonly associated with squamous cancers compared to non squamous cancers. Most of the cancers associated with schistosomiasis had invaded the muscularis propria of the urinary bladder at the time of diagnosis (p<0.001) and such cancers were frequent below 50 years of age with a significant statistical difference (p<0.001). Poorly differentiated tumors were more frequent in females than males with a significant statistical difference (p=0.006). The majority of urinary bladder cancers seen in the Lake Region were squamous cell carcinoma associated with schistosomiasis. These cancers showed an aggressive behavior and were commonly seen in the younger age groups. Effective control of schistosomiasis in this region should significantly reduce the burden of urinary bladder cancer

Intentions to use contraceptives in Pakistan: implications for behavior change campaigns

<p>Abstract</p> <p>Background</p> <p>Since 1990-91, traditional method use has increased at a faster rate in Pakistan than modern method use. The importance of hormonal methods or the IUD has diminished and that of traditional methods has increased in the method mix. There is a need to identify factors motivating and deterring the adoption of specific family planning methods among married men and women in Pakistan.</p> <p>Methods</p> <p>In addition to social and demographic characteristics of respondents, a representative household survey collected information on psychological correlates of family planning behavior from 1,788 non-pregnant wives and 1,805 husbands with not-pregnant wives. Males and females were from separate households. Principal components analysis was conducted to identify the underlying constructs that were important for each gender. Multinomial logistic regression analysis was conducted to determine the correlates of male and female intentions to use contraceptive methods.</p> <p>Results</p> <p>Amongst women, the perception that her in-laws support family planning use was the strongest determinant of her intentions to use contraceptive methods. A woman's belief in the importance of spacing children and her perception that a choice of methods and facilities with competent staff were available were also powerful drivers of her intentions to use contraceptive methods. The strongest obstacle to a woman's forming an intention to use contraceptive methods was her belief that family planning decisions were made by the husband and fertility was determined by God's will. Fears that family planning would harm a woman's womb lowered a woman's intentions to use methods requiring procedures, such as the IUD and female sterilization.</p> <p>The perception that a responsible, caring, husband uses family planning to improve the standard of living of his family and to protect his wife's health was the most important determinant of a man's intention to use condoms. A husband's lack of self-efficacy in being able to discuss family planning with his wife was the strongest driver of the intention to use withdrawal. A man's fear that contraceptives would make a woman sterile and harm her womb lowered his intention to use modern contraceptive methods.</p> <p>Conclusions</p> <p>These findings highlight the importance of having secondary target audiences such as mothers-in-law and husbands in family planning behavior change campaigns implemented in Pakistan. Campaigns that stress the importance of child spacing are likely to have an impact. Client perceptions of the quality of care are important determinants of intentions to use contraceptive methods in Pakistan. Client concerns that the IUD and sterilization procedures might harm a woman's womb and cause sterility should be addressed. The findings suggest that there is a need to assess the actual quality of service delivery in Pakistan.</p