Nosocomial imipenem-resistant Acinetobacter baumannii infections in intensive care units: incidence and risk factors assessment

Imipenem-resistant Acinetobacter baumannii (A. baumannii) (IRAB) has emerged as a challenging nosocomial pathogen particularly in intensive care units (ICUs). Studying the risk factors associated with IRAB infection is of paramount importance for appropriate control of IRAB spread. The aim of this study was to assess the incidence rate and possible risk factors associated with nosocomial IRAB infections in ICUs. A prospective cohort study was carried out in surgical and emergency ICUs of a tertiary care hospital in Egypt. All patients who developed nosocomial A. baumannii infection from the start of January 2014 to the end of December 2015 were included. Isolates were identified as A. baumannii using API 20NE and E-test was used to define IRAB. Out of 146 A. baumannii isolates, 11 were found to be IRAB (7.5% incidence rate), of them 72.7% (8/11) were found to be multidrug resistant (MDR). Univariate analysis demonstrated that hospital stay before ICU admission [Relative risk (RR) 3.51, 95% confidence interval (CI) 1.0- 12.7, P= 0.04)], longer ICU stay (P= 0.005), exposure to emergent surgery (RR 17.5, CI 7.39-41.4, P= 0.000), the presence of central venous catheter (RR 3.26, CI 1.0-10.6, P= 0.04) and previous carbapenem use (RR 4.05, CI 1.12-14.6, P =0.02) were significant risk factors for IRAB infection. In conclusion, a relatively high IRAB incidence was recorded in ICUs of our hospital. Hospital stay before ICU admission, longer ICU stay, exposure to emergent surgery, the presence of central venous catheter and previous carbapenem use were significant risk factors for IRAB infection. Rationale use of carbapenems in ICUs should be considered.Keywords: Imipenem-resistant, Acinetobacter baumannii, Intensive care unit

Changes in Physico-Chemical Quality and Volatile Compounds of Orange-Carrot Juice Blends During storage

The present study aimed to determine the changes in physico-chemical parameters (pH, total soluble solids “TSS”, total acidity, vitamin C, total carotene, total phenolic and antioxidant activity) as well as sensory evaluation and volatile constituents of the orange juice samples mixed with carrot juice at ratios (1:3, 3:1 and 1:1). While, the polyphenol content was determined using Folin–Ciocalteu, antioxidant activity was measured using two in vitro assays 2,2'-diphenyl-1-picrylhydrazyl (DPPH0) and metal chelating assays. While, the acidity increased, total carotene and pH of the juice decreased during the storage period. There were no significant changes in total phenolics throughout the storage period at the three blending ratios. A slight increase in antioxidant capacity during the storage period had been observed. The headspace volatiles of fresh orange and carrot juices as well as fresh and stored blend juice with ratio (1:3) for 14 days at refrigerator were collected and subjected to Gas chromatography (GC) and Gas chromatography-Mass spectrometery (GC-MS) analysis. A total of 26 volatile compounds were identified in samples of fresh orange and carrot juices as well as fresh and stored blend including 7 alcohols, 4 aldehydes, 9 monoterpene hydrocarbon and 6 esters. Limonene was the one most abundant monoterpene, representing in orange, carrot, fresh and stored blend 47.38, 42.37, 39.24 and 37.25%, respectively. Keywords: Orange- carrot juice, Blend, Antioxidant, Volatile compound

Performance Enhancement of Reverse Osmosis (RO) Membrane Using Nanocomposite Materials

Many attempts were made to enhance the performance of reverse osmosis (RO) membranes in the desalination process. Using ion exchange (IX) bed before RO process and modifying the structure of RO membranes are some of these attempts. Thin film nanocomposite (TFN) membrane is the novel type of RO membranes which is the best in nanofiltration applications. TFN membranes have many new advantages due to the change of their structure in comparison with traditional membranes. In this study the performance of a TFN membrane was compared with that of standard thin film composite (TFC) spiral wound water desalination RO membrane for filtration of IX produced water. The results from the filtration process showed that the flux and water permeability of TFN are 1.55 and 1.56 times that of TFC for feed water with 2050 ppm NaCl concentration with nearly unchanged level of the membrane salt rejection, which will reduce the filtrated water cost

Immunohistochemical Study of Androgen Receptor Expression in Estrogen Receptor-Negative Invasive Breast Carcinoma and its Relation with Clinicopathologic Factors

BACKGROUND: Estrogen receptor (ER)-negative breast carcinomas lack the expression of ER and they have no targeted hormone therapies. The androgen receptor (AR) is a newly emerge biomarker. Detecting AR in these tumors may provide a target for future therapies. AIM: The aim of the study is to examine the immunohistochemical expression profiles of AR protein in ER-negative invasive breast carcinomas and to assess the relation between AR expression and the clinicopathologic factors such as age, tumor size, tumor grade, tumor type, immunohistochemical type, lymph node status, and Ki67 expression. METHODS: Sixty paraffin blocks of ER-negative invasive breast carcinoma cases were stained immunohistochemically by AR. Positive expression was defined as ≥1% nuclear staining. RESULTS: AR positivity was detected in 55% of the studied cases. The positive cases were scored by H-score with a median=117, and a range of 3–285 and by Allred score with a median=7, and a range of 3-8. AR is expressed in 60.9% of triple-negative breast carcinoma cases. AR expression was higher in older age, and there were significant positive correlations between the degree of AR expression (AR%, AR intensity, and H-score) and age (p=0.050, 0.007, 0.033, respectively). There was non-significant negative correlation between Ki67% and the degree of AR expression (AR%, AR intensity, H-score, and Allred score). Regarding different histological types, tumor grade, tumor size, lymph node status, and immunohistochemical types, there was no significant difference between AR positive and AR negative cases. CONCLUSION: AR is frequently expressed in ER-negative invasive breast carcinoma; especially in older age, and in a large number of triple-negative subtypes. This may give chance to benefit from future AR target therapy. We recommend further research work on AR expression in the special histologic subtypes of ER-negative breast carcinoma and in the triple negative group

Control of hyperphosphatemia in regular hemodialysis (HDx) patients by calcium acetate (CA) versus calcium carbonate (CC). A double blind crossover prospective study

This study included fourty chronic renal failure patients aged 37-83 years (mean 51.3±7) on thrice weekly HDx for 4-144 month (Kt/V >1.2). Acetate dialysate with calcium concentration of 3 mEq/L was used. All phosphate binders were discontinued for one month. Patients were divided in two groups. Group I (20 cases) received CA, while group II (20 cases) received CC in equimolar dose (10 mmol, of either t.i.d.) for one month. Crossover of treatment was done for another month while keeping patients on the same diet.Serum levels of total calcium (Ca), ionized Ca (iCa), phosphorus (P), alkaline phosphates (AP), urea (U), creatinine (Cr), ALT, AST, total proteins (TP) and albumin (Alb) were estimated before, and at the end of each month of CA and CC treatment. Serum Ca and iCa were significantly lower in group I after CA compared to values after CC (p<0.01). Similar results in Ca levels were observed in group II (P<0.05). In group II only serurn P was significantly lower after CA compared to its values after CC (P<0.05). There was no significant difference in AP, U, Cr, ALT, AST, TP and Alb before, and at the end of each month of CA and CC treatment (P>0.05 in all). We excluded 12.5% of cases due to CA intolerance while non of cases had similar intolerance to CC.Conclusion: 1) CA is not very superior to CC in control of hyperphosphataemia. 2) CA can be safely increased without the risk of hypercalcemia. 3) Active Vitamin D and high dialysate Ca can be used to suppress parathyroid activity more safely with CA than with CC. 4) Tolerability to CC is superior

Measuring Impact of Air and Agricultural Soil Pollution on Social Development in Saudi Arabia

This research aimed to measure the impact of air and agricultural soil pollution on social development in Saudi Arabia from the period 1995–2019 by using social development indicators, concentrating on the percentages of expenditure on education and health, and the Human Development Index. In addition, this study uses multiple regressions in estimating the model to study the impact of air pollution and agricultural soil on social development. Results of the study showed that a 10% change in the number of chemical fertilizers and pesticides used in Saudi agriculture leads to a change in the total number of inpatients by 0.7% and 0.5%, respectively. It was also found that an increased percentage of health expenditure to total government spending by 10% leads to a decrease in the total number of patients in the hospital by 1.8%. An increase in air pollution, expressed as a 10% increase in CO2 emissions, increases the total number of hospitalized patients by 11.1%.  The increasing total number of patients by 10% leads to a decrease in the total productivity of the worker, as an indicator of 1.8%. Furthermore, a change of 10% in the ratio of education expenditure to total government expenditure leads to a change in the same direction of the Human Development Index by 9.6%. In light of these results, it can be recommended that the country need to reduce air pollution by expanding the use of natural gas in the industrial and transportation sectors, in addition to reducing the use of nitrogenous fertilizers and pesticides in Saudi agriculture through the expansion of clean farming and good agricultural practices

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS‐like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo‐controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS‐specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149751/1/nmo13607.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149751/2/nmo13607_am.pd

Osteogenic Differentiation Potential of Human Bone Marrow and Amniotic Fluid-Derived Mesenchymal Stem Cells in Vitro & in Vivo

BACKGROUND: Cell therapies offer a promising potential in promoting bone regeneration. Stem cell therapy presents attractive care modality in treating degenerative conditions or tissue injuries. The rationale behind this is both the expansion potential of stem cells into a large cell population size and its differentiation abilities into a wide variety of tissue types, when given the proper stimuli. A progenitor stem cell is a promising source of cell therapy in regenerative medicine and bone tissue engineering. AIM: This study aimed to compare the osteogenic differentiation and regenerative potentials of human mesenchymal stem cells derived from human bone marrow (hBM-MSCs) or amniotic fluid (hAF-MSCs), both in vitro and in vivo studies. SUBJECTS AND METHODS: Human MSCs, used in this study, were successfully isolated from two human sources; the bone marrow (BM) and amniotic fluid (AF) collected at the gestational ages of second or third trimesters. RESULTS: The stem cells derived from amniotic fluid seemed to be the most promising type of progenitor cells for clinical applications. In a pre-clinical experiment, attempting to explore the therapeutic application of MSCs in bone regeneration, Rat lumbar spines defects were surgically created and treated with undifferentiated and osteogenically differentiated MSCs, derived from BM and second trimester AF. Cells were loaded on gel-foam scaffolds, inserted and fixed in the area of the surgical defect. X-Ray radiography follows up, and histopathological analysis was done three-four months post- operation. The transplantation of AF-MSCs or BM-MSCs into induced bony defects showed promising results. The AF-MSCs are offering a better healing effect increasing the likelihood of achieving successful spinal fusion. Some bone changes were observed in rats transplanted with osteoblasts differentiated cells but not in rats transplanted with undifferentiated MSCs. Longer observational periods are required to evaluate a true bone formation. The findings of this study suggested that the different sources; hBM-MSCs or hAF-MSCs exhibited remarkably different signature regarding the cell morphology, proliferation capacity and osteogenic differentiation potential CONCLUSIONS: AF-MSCs have a better performance in vivo bone healing than that of BM-MSCs. Hence, AF derived MSCs is highly recommended as an alternative source to BM-MSCs in bone regeneration and spine fusion surgeries. Moreover, the usage of gel-foam as a scaffold proved as an efficient cell carrier that showed bio-compatibility with cells, bio-degradability and osteoinductivity in vivo

Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome

Cannabis is commonly used in cyclic vomiting syndrome (CVS) due to its antiemetic and anxiolytic properties. Paradoxically, chronic cannabis use in the context of cyclic vomiting has led to the recognition of a putative new disorder called cannabinoid hyperemesis syndrome (CHS). Since its first description in 2004, numerous case series and case reports have emerged describing this phenomenon. Although not pathognomonic, a patient behavior called “compulsive hot water bathing” has been associated with CHS. There is considerable controversy about how CHS is defined. Most of the data remain heterogenous with limited follow‐up, making it difficult to ascertain whether chronic cannabis use is causal, merely a clinical association with CVS, or unmasks or triggers symptoms in patients inherently predisposed to develop CVS. This article will discuss the role of cannabis in the regulation of nausea and vomiting, specifically focusing on both CVS and CHS, in order to address controversies in this context. To this objective, we have collated and analyzed published case series and case reports on CHS in order to determine the number of reported cases that meet current Rome IV criteria for CHS. We have also identified limitations in the existing diagnostic framework and propose revised criteria to diagnose CHS. Future research in this area should improve our understanding of the role of cannabis use in cyclic vomiting and help us better understand and manage this disorder.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149684/1/nmo13606_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149684/2/nmo13606.pd

Unifying linguistic annotations and ontologies for the Arabic Quran

The WACL’2 Second Workshop on Arabic Corpus Linguistics was held in conjunction with the Corpus Linguistics 2013 conference. Following on from the successful first WACL in 2011, as well as the related LRE-REL event in 2012, WACL-2 again took place at Lancaster University. The aim of this series of workshops is to create a venue for exploring progress in the field of research into the Arabic language using corpora, from across the many areas of corpus linguistics and computational linguistics where the analysis of Arabic structure and usage is an active issue. The scope of the workshop encompasses both (a) the design, construction and annotation of Arabic corpora, and (b) the use of corpora in research on the Arabic language – in any relevant area, including (but not limited to!) lexis and lexicography, syntax, collocation, NLP systems and analysis tools, contrastive and historical studies, stylistics, and discourse analysis. All varieties of Arabic – including the different Colloquial Arabics as well as Classical/Qur’anic and Modern Standard forms of the language – are within the workshop's purview