Prevalence of Metallo-β-Lactamase producing Pseudomonas aeruginosa in wound infections in Duhok city, Iraq

Background: Pseudomonas aeruginosa is common pathogen causing nosocomial infection. Acquired drug resistance and Metallo-β-lactamases (MBL) production have recently emerged as one of the most worrisome resistance mechanism that hydrolyze all beta-lactam antibiotics including penicillins, cephalosporins and carbapenems, with the exception of aztreonam. The aim was to find out the prevalence of multi drug resistant (MDR) and Metallo-β-lactamase (MBL) positive isolates of P. aeruginosa in wounds samples which are a serious concern.Methods: Pseudomonas aeruginosa strains were obtained by standard isolation and identification techniques from 307 wound samples of hospital. Strains were then subjected to susceptibility testing for anti-pseudomonas drugs as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Carbapenems resistant strains were selected for the detection of MBL enzyme production by disc potentiation test. Production of MBL was confirmed by enhancement of inhibition zone around imipenem and meropenem discs impregnated with EDTA, as compared to discs without EDTA.Results: Amongst the 71 isolates of P. aeruginosa, 62(87.3%) isolate were imipenem-sensitive, while 9(12.7%) isolates were found to be imipenem resistant and MBL producers. Very high resistance to antibiotics was recorded amongst MBL producers’ P. aeruginosa compared with non-MBL imipenem-sensitive strains.Conclusion: Study indicates that, surveillance for the detection of MBL is necessary. The rapid dissemination of MBL producers is worrisome and necessitates the implementation of proper and judicious selection of antibiotics especially carbapenem.

Distribution of Extended Spectrum Β-Lactamase Genes among Proteus Mirabilis Isolated From Clinical Specimens in Duhok City, Kurdistan Region, Iraq

Extended Spectrum Beta Lactamase-among Proteus mirabilis strains recorded high incidence leaving few therapeutic options of potential infections. The purpose of current study was to assess the prevalence of antibiotic resistance among Extended Spectrum Beta-Lactamases (ESBL) producing P. mirabilis, in addition to molecular characterization of the ESBL gene-types using PCR. All isolates were fully identified, checked for antibiotic susceptibility and ESBL production using double disk synergy phenotypic method. Positive ESBL-producing isolates were subjected to PCR assay using specific primers for detection of CTX-M, TEM, and SHV genes. The majority of the isolates exhibited absolute susceptibility (100%) to both meropenem and ertapenem and high susceptibility (95%) to imipenem, while co-resistance were expressed toward cefotaxime, ceftazidime, ceftriaxone and other non-lactam antibiotics. Out of 37 isolates, 21(57%) were ESBL-producers and using a double-disc synergy test (DDST). Using molecular-based PCR, CTX-M (81%), TEM (57%) and SHV (24%) were determined among ESBL-positive. CTX-M was predominant and circulating among phenotypic multiple resistant strains. Moreover, the coexistence of CTX-M and TEM gene was a more frequent combination. The study highlighted the increasing levels of low antibiotic susceptibility among P. mirabilis harbored ESBL genes at Duhok city and also confirms that a high level of blaCTX-M-positive ESBL isolates is circulating in this area

Removal of Cr(VI) from Aqueous Solution Using Modified Pomegranate Peel : Equilibrium and Kinetic Studies

The present investigation deals with the utilization of modified pomegrenate peel (MPGP) and formaldehyde modified pomegrenate peel (FMPGP) as adsorbents for the removal of chromium Cr(VI) from aqueous solution. A series of experiments were conducted in a batch system to evaluate the effect of system variables. The effect of pH, initial Cr(VI) concentration, contact time, adsorbent dosage and temperature were considered. The optimal pH values of Cr(VI) removal by MPGP and FMPGP were 2.0 and 3.0 respectively. The time required for equilibrium was found to be about 100 minutes. The initial Cr(VI) concentration and adsorbent dosage was found to have large effect on the adsorption of Cr(VI). The maximum uptake capacities were 13.01 and 22.28 mg of Cr(VI) per gram of MPGP and FMPGP respectively. Adsorption kinetic data were tested using pseudo-first order, pseudo-second order, Elovich and intra-particle diffusion models. Kinetic studies showed that the adsorption followed a pseudo second order reaction due to the high correlation coefficient and the agreement between the experimental and calculated values of qe.The adsorption may follow intraparticle diffusion as well, due to the highest values of rate constants for the surface adsorption and intraparticle diffusion kinetic models, the higher values of rate constants are related to an improved bonding between Cr(VI) ions and adsorbent particle.The Dubinin-radushkevich, Freundlich and Tempkin models were the closest fit for the equilibrium data of MPGP and FMPGP

Removal of Chromium from Aqueous Solution Using Modified Pomegranate Peel:Mechanistic and Thermodynamic Studies

Modified pomegranate peel (MPGP) and formaldehyde modified pomegranate peel (FMPGP) were prepared and used as adsorbent for removal of Cr(VI) ions from aqueous solution using batch process. The temperature variation study of adsorption on both adsorbents revealed that the adsorption process is endothermic, from the positive values of ∆H˚. These values lie in the range of physisorption. The negative values of ∆G˚ show the adsorption is favorable and spontaneous. On the other hand, these negative values increases with increase in temperature on both adsorbents, which indicate that the adsorption is preferable at higher temperatures. ∆S˚ values showed that the process is accompanied by increase in disorder and randomness at the solid solution interface due to the reorientation of water molecules and Cr(VI) ions around the adsorbent surface. The endothermic nature of the adsorption was also confirmed from the positive values of activation energy, Ea, the low values of Ea confirm the physisorption mechanism of adsorption. The sticking probability, S*, of Cr(VI) ion on surface of both adsorbents showed that the adsorption is preferable due to low values of S* (0< S* < 1 ), but S* values are lower for FMPGP indicating that the adsorption on FMPGP is more preferable

Knowledge, attitude and practice of physicians regarding screening of colorectal cancer in qatar: A cross-sectional survey

Purpose: The aim of this study was to evaluate the rate of internal medicine residents’ and faculties’ (specialists and consultants) compliance to colorectal cancer screening in Hamad Medical Corporation (Doha, Qatar) and to identify barriers as well as facilitators that will assist in drawing up changes that would enhance physician-related cancer screening. Methods: A cross-sectional web-based survey was distributed among internal medicine physicians at three component hospitals of Hamad Medical Corporation (HMC); focusing on knowledge and practice of colorectal cancer screening, its barriers and facilitators. Chi-square and t-test statistics were used to draw conclusions where appropriate. Results: The response rate for the survey was 91% and over 75% of the survey respondents were post-graduate trainees. The majority (90.6%) of the physicians (n=144) mentioned that they would recommend colorectal cancer screening for their asymptomatic patients, though trainees tend to choose the correct modality of screening compared to the consultants, 86.21% vs 40.74%. Only 43.4% of the survey participants always to usually recommend screening to their patients in their clinics while only 29.4% do so for their inpatients. Even though there was no statistically significant difference among the frequency of outpatient colorectal cancer screening among trainees, specialists or consultants (p=0.628), there was a clear increase in the reported referrals as the training years or the years of experience increases (p=0.049 for trainees and p=0.009 for faculty). Unclear pathway was reported as the main obstacle to outpatient cancer screening by 30.2% (n= 48) and 54% (n=87) pointed out that an easy and clear pathway for cancer screening would facilitate the same. Conclusion: While the attitude towards colorectal cancer screening is positive, the actual practice of recommendation is sub-optimal. Further initiatives are required to facilitate awareness and compliance to colorectal cancer screening

Prevalence of Venous Thromboembolism in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 25/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, in an exploratory analysis, we compared the odds of VTE in patients on prophylactic compared with therapeutic anticoagulation. Results: The review comprised 24 studies and over 2,500 patients. The pooled proportion of VTE prevalence was 0.31 [95% confidence interval (CI) 0.24, 0.39; I2 94%], of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63; I2 91%), of deep venous thrombosis was 0.23 (95% CI 0.14, 0.32; I2 96%), and of pulmonary embolism was 0.14 (95% CI 0.09, 0.20; I2 90%). Exploratory analysis of few studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared with therapeutic anticoagulation [odds ratio (OR) 5.45; 95% CI 1.90, 15.57; I2 0%]. Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages may reduce VTE burden in this patient's cohort compared with standard prophylactic anticoagulation; however, this is to be ascertained by ongoing randomized controlled trials