Intestinal colonization of infants with multidrug resistant Pseudomonas aeruginos in tertiary care center in Jordan

Background: Pseudomonas.aeruginosa is among the most common opportunistic hospital pathogens, which exhibit an innate resistance and has developed increasing resistance to many useful antimicrobial agents over the last decades. This study investigated the occurrence of important types of ESBLs and MBLs in association with potential important virulence factors among P. aeruginosa isolates from feces of Jordanian infants.   Methods: A total of 302 feces samples were obtained randamely from neonates and infants admitted to Pediatric Clinic and the Neonate Intensive Care Unit (NICU)/Jordan University Hospital (JUH), over a  9-months period(2016- 2017). Fecal samples were cultured for P.aeruginosa and their growth was identified and tested using microbiological and antibiotic susceptibility methods. Additionly,  virulence factors, antimicrobial resistance genes and genotypes were detected using Polymerase Chain Reaction (PCR). Results: A total of 16/302 (5.3%) of P. aeruginosa isolates were recovered from feces samples. Antimicrobial susceptibility of the isolates ranged between the lowest 18.75% to meropenem and highest of 87.5% to azetreonam among 9 tested drugs. The percentage of specific genes of ESBLs and MBLs in 16 P.aeruginosa isolates were the following: blaOXA-50, blaTEM, blaCTX-M , blaVIM ,blaKPC , blaSHV ,blaGES, and blaVEB were detected at the rate of  13(81.2%), 13(81.2%), 12(75%), 12(75%), 11(68.7%), 10(62.5%), 2(12.5),1(6.2%), respectively. The percentage of the potential virulence genes in the same isolates were detected as follow:  lasB, algD , toxA, exo S and exo U at the rate of 100%, 87.5% , 81.2%, 81.2%,31.2, respectively. All P.aeruginosa isolates observed to develop beta-hemolysis on both human and sheep blood agar, and to produce either pyoverdin ((56.3%) or pyocyanin (43.7%).  Conclusions: The present study demonstrates high occurrence of multidrug resistant P.aeruginosa isolates in infant feces which carried high rates of important genes of ESBLs and MBLs and potential virulence factors.   &nbsp

Short Term Outcomes of Neonates Born after Prolonged Premature Rupture of Membranes < 34 Weeks Gestation

Background: Preterm premature rupture of membranes (PPROM) is responsible for one?third of all preterm births worldwide. This aim of this study was to investigate the outcome of neonates born after prolonged PPROM with gestational age below 34 weeks. Materials and methods: This retrospective study included 65 patients who were born to mothers with Prolonged PPROM <34 weeks gestation between January 2011 and December 2015 and admitted to the neonatal intensive care unit (NICU) at Jordan University Hospital. Results: The mean gestational age of included patients was (31.9 ± 2.5 weeks), mean birth weight was (1840 ± 583 g) and 43 (66.2%) were males. The mortality rate in those infants was 12.3 %. Gestational age, birth weight, and Apgar score were significantly lower among mortality cases compared to surviving cases (P < 0.05). Conclusion: Prolonged PPROM before the 34th gestational week is associated with high rate of morbidity and mortality, for which early identification of risk factors for developing PPROM can help in reducing the risk for preterm labors and subsequent burden on healthcare system

Coronavirus disease 2019 (COVID-19): a brief overview of features and current treatment

Since the report of the first cases of pneumonia caused by SARS-CoV-2 in December 2019, COVID-19 has become a pandemic and is globally overwhelming healthcare systems. The symptoms of COVID-19 vary from asymptomatic infection to severe complicated pneumonia with acute respiratory distress syndrome (ARDS) and multiple organ failure leading to death. The estimated case-fatality rate among infected patients in Wuhan, the city where the first case appeared, was 1.4%, with 5.1 times increase in the death rate among those aged above 59 years than those aged 30–59 years. In the absence of a proven effective and licensed treatment, many agents that showed activity against previous coronavirus outbreaks such as SARS and MERS have been used to treat SARS-CoV-2 infection. The SARS-CoV-2 is reported to be 80% homologous with SARS-CoV, and some enzymes are almost 90% homologous. Antiviral drugs are urgently required to reduce case fatality-rate and hospitalizations to relieve the burden on healthcare systems worldwide. Randomized controlled trials are ongoing to assess the efficacy and safety of several treatment regimens

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Decreasing the options’ number in multiple choice questions in the assessment of senior medical students and its effect on exam psychometrics and distractors’ function

Abstract Background Studies that have investigated the effect options’ number in MCQ tests used in the assessments of senior medical students are scarce. This study aims to compare exam psychometrics between three- and five-option MCQ tests in final-year assessments. Methods A cluster randomized study was applied. Participants were classified into three groups, according to their academic levels. Students in each of those levels were randomized into either the three- or five-option test groups. Results Mean time to finish the five-option test was 45 min, versus 32 min for the three-option group. Cronbach’s alpha was 0.89 for the three-option group, versus 0.81 for the five-options, p-value = 0.19. The mean difficulty index for the three-option group was 0.75, compared to 0.73 for the five-option group, p-value = 0.57. The mean discriminating index was 0.53 for the three-option group, and 0.45 for the five-options, p-value = 0.07. The frequency of non-functioning distractors was higher in the five-option test, 111 (56%), versus 39 (39%) in the three-options, with p-value < 0.01. Conclusions This study has shown that three-option MCQs are comparable to five-option MCQs, in terms of exam psychometrics. Three-option MCQs are superior to five-option tests regarding distractors’ effectiveness and saving administrative time

Neonatal Urinary Tract Infection in a Tertiary Care Center in Amman, Jordan

Background: The aim of this study was to describe the prevalence of neonatal urinary tract infection (UTI), demographics, and clinical characteristics in a single referral tertiary neonatal intensive care unit.Methods: The medical records of 118 neonates diagnosed with neonatal UTI were reviewed over a 7-year period.Results: The prevalence of neonatal UTI was 1.5%. The male to female ratio was 1.6:1. In this study, 61% of the neonates were preterm babies. The mean age of diagnosis was 19.55±19.5 days. Pyuria was observed in 20% of the cases, and Escherichia coli was the most common pathogen. Hospital-acquired UTI was observed in 76% of the cases, and community-acquired UTI was noticed in 24% of the subjects. Prolonged jaundice was the most common presenting symptom of UTI followed by sepsis. An abnormal ultrasound was found in 29% of the neonates with hydronephrosis as the most associated anomaly. There was a high rate of extended spectrum-beta lactamase organisms and a high rate of antimicrobial resistance.Conclusion: The occurrence of neonatal UTI was rare in the study population. In addition, hydronephrosis was the most common anomaly. Proper antibiotic stewardship is needed to halt the increasing antimicrobial resistance of uropathogens

Varicella Exposure in Neonatal Intensive Care Unit in a Low Resource Country: Successful Prophylaxis with Intravenous Immunoglobulins

Background: Varicella-zoster infection is a serious and potentially fatal disease, especially among newborns.Several studies have described postnatal varicella zoster exposure among neonates and reported on the efficacy of varicella-zoster immunoglobulins (VZIG) used as post-exposure prophylaxis. Unfortunately, VZIG is not available in Jordan. A limited number of studies have investigated the efficacy of intravenous immunoglobulins (IVIG) as an alternative preventive post-exposure to the varicella virus. Methods: This retrospective descriptive study was conducted to review the outcomes of two separate incidents of varicella-zoster exposure and the prophylactic use of IVIG in the neonatal intensive care unit in Jordan. Results: The sources of exposure in both incidents infected medical health workers. During the exposure, cohort measures were applied to neonates whose mothers did not receive immune prophylaxis against IVIG. Newborns were followed appropriately. Totally, 22 cases were identified representing two exposure incidents without a varicella-zoster infection. Conclusion: The results indicated that IVIG was an effective prophylactic therapy for neonates post varicella virus exposure

Coronavirus Disease 2019 (COVID-19): A Brief Overview of Features and Current Treatment

Since the report of the first cases of pneumonia caused by SARS-CoV-2 in December 2019, COVID-19 has become a pandemic and is globally overwhelming healthcare systems. The symptoms of COVID-19 vary from asymptomatic infection to severe complicated pneumonia with acute respiratory distress syndrome (ARDS) and multiple organ failure leading to death. The estimated case-fatality rate among infected patients in Wuhan, the city where the first case appeared, was 1.4%, with 5.1 times increase in the death rate among those aged above 59 years than those aged 30–59 years. In the absence of a proven effective and licensed treatment, many agents that showed activity against previous coronavirus outbreaks such as SARS and MERS have been used to treat SARS-CoV-2 infection. The SARS-CoV-2 is reported to be 80% homologous with SARS-CoV, and some enzymes are almost 90% homologous. Antiviral drugs are urgently required to reduce case fatality-rate and hospitalizations to relieve the burden on healthcare systems worldwide. Randomized controlled trials are ongoing to assess the efficacy and safety of several treatment regimens