Emergence of Colistin-resistant Pseudomonas aeruginasa in Sohag University Hospitals, Egypt

Background:  Pseudomonas aeruginosa (P. aeruginosa) is a globally recognized cause of healthcare-associated infections (HAIs), the recent increase of the MDR and XDR P.  aeruginosa strains encouraged the use polymyxins as a treatment option, and thus the emergence of colistin-resistant strain is an alarming problem. Objectives: This study aimed to trace the emergence of colistin-resistance in P.  aeruginosa strains associated with HAIs in Sohag University Hospitals, to identify the genetic basis of colistin-resistance in these isolates. Methods: P. aeruginosa strains were isolated and identified phenotypically and genotypically, antibiotic susceptibility of the isolates was tested by disc-diffusion method. The MIC of colistin was measured by E test in colistin resistant isolates. Conventional PCR was used to detect plasmid genes responsible for colistin resistance among the isolates. Results: Seventy-six(76%) of P. aeruginosa isolates were resistant to colistin, the highest percentage of colistin resistant strains were isolated from patients admitted to General Surgery Department that was (50%), no colistin resistant strains were isolated from patients admitted to Vascular Surgery Department. Colistin-resistant isolates exhibited the highest resistance to polymyxin B, norfloxacin, ofloxacin and gatifloxacin by a percentage of (100%). mcr-1gene was detected in (44.4%) of colistin-resistant isolates and mcr-2 gene in (16.6%). Sensitivity of E-test in comparison with PCR was (100%) and specificity was (86.36%). Conclusion: The emergence of colistin resistance in P. aeruginosa in our health care setting is an alarming issue that needs strict adherence to the infection control guidelines specially plasmid mediated resistance as it usually associated with MDR and XDR patterns

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Possible diagnostic role of microRNA-122 in chronic HCV infection and hepatocellular carcinoma

Background:  Infection with hepatitis C virus frequently progresses to cirrhosis and liver cell cancer. Objectives: The objective of this study was testing the usefulness of miR-122 as a marker for diagnosis of cirrhosis in chronic infection with hepatitis C virus (CHC) and as a diagnostic tool for early detection of hepatocellular cancer. Methods: This study included 118 patients; the first group included eighty-eight patients with chronic hepatitis C (CHC) and HCV related cirrhosis, the second group included thirty patients with HCC on to of chronic HCV infection, and the third one included twenty controls. Quantification of the viral RNA by real-time-PCR. MicroRNA-122 expression level was measured by RT-PCR. Results: The mean serum levels of miR‑122 were much higher in CHC, compensated cirrhosis and decompensated cirrhosis patients’ than in controls, while they were less in HCC patients than control group (p = 0.0001). Serum miR-122 revealed gradual decrease in levels with progression of fibrosis stage, with more significant decrease in late fibrosis stages including F3 and F4 (p =0.01). Conclusion: The mean levels of serum miR-122 decreased in patients of HCC thus can differentiate HCC from CHC and liver cirrhosis. MicroRNA -122 had high efficiency compared to other noninvasive indices in prediction of HCV, and progression towards HCC

Protective role of Krill oil against estrogen deficiency induced neurodegeneration in ovariectomized rats

279-285Marine oils are rich in long-chain polyunsaturated omega-3 fatty acids and known to be associated with health promoting effects, particularly on learning memory and prevention of neurodegenerative diseases by decelerating cognitive decline. Krill oil (KO) is novel marine oil rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the antioxidant astaxanthin (ASTA) which play central role in oxidative stress in neuronal metabolism. In the present study, the possible protective role of KO against learning and memory impairment as well as brain oxidative damage induced by ovariectomized (OVX) rats either alone or combined with γ-radiation was investigated. Our data revealed that OVX rats, alone or with γ-radiation, induced a significant decrease in the levels of estrogen (E), serotonin (SER), dopamine (DA), insulin growth factor-1 (IGF-1) and the gene expression of brain-derived neurotrophic factor (BDNF) mRNA, Selective AD Indicator-1 (SELADIN-1) mRNA associated with a significant elevation in malondialdehyde (MDA), amyloid precursor protein (APP) mRNA and glycogen synthase kinase-3beta (GSK-3β) mRNA, acetylcholinesterase (AChE) and norepinephrine (NE). Treatment with KO to OVX rats, alone or with γ-radiation, resulted in significant amelioration of all investigated parameters. This study has confirmed the protective effect of Krill oil against memory impairment and thereby preventing the development of Alzheimer disease

Detection of Virulence and β-lactamase resistance genes of non-typhoidal Salmonella isolates from human and animal origin in Egypt "one health concern"

Abstract Background Non-typhoidal Salmonella (NTS) is a major foodborne zoonotic pathogen worldwide. In the current study, Various NTS strains were isolated from (cows, milk and dairy products in addition to humans) in New Valley and Assiut Governorate, Egypt. NTS were firstly serotyped and tested by antibiotic sensitivity test. Secondly, some virulence genes and Antibiotic resistance genes have been identified by using PCR. Finally, Phylogenesis was performed depending on the invA gene, for two S. typhimurium isolates (one of animal origin and the other of human origin for evaluating zoonotic potential). Results Out of 800 examined samples, the total number of isolates was 87 (10.88%), which were classified into 13 serotypes, with the most prevalent being S. Typhimurium and S. enteritidis. Both bovine and human isolates showed the highest resistance to clindamycin and streptomycin, with 90.80% of the tested isolates exhibiting MDR. The occurrence of the invA gene was 100%, while 72.22%, 30.56%, and 94.44% of the examined strains were positive for stn, spvC, and hilA genes, respectively. Additionally, blaOXA-2 was detected in 16.67% (6/ 36) of the tested isolates, while blaCMY-1 was detected in 30.56% (11of 36) of the tested isolates. Phylogenesis revealed a high degree of similarity between the two isolates. Conclusions The high occurrence of MDR strains of NTS in both human and animal samples with high degree of genetic similarity, shows that cows, milk and milk product may be a valuable source of human infection with NTS and interfere with treatment procedures

Effect of Comprehensive Nursing Interventions on Quality of life among Women with Stress Urinary Incontinence

Stress Urinary Incontinence (SUI) is called a silent epidemic which is not a life threatening condition, but a worldwide problem at the same time which contributes to poor quality of life. Aim: Design, implement comprehensive nursing interventions for adult women with stress urinary incontinence and evaluate the effect of these interventions on improving their quality of life. Quazi experimental research design was utilized to conduct this study. This study was carried out in the Urology and Nephrology Assuit University Hospital and its affiliate Clinic. A sample of 50 adult women, the mean age of studied patients was (42.22±11.84). Two tools were used by the researcher namely: Tool I: A structured interview questionnaire sheet it included two parts, part i: demographic data of patient and part ii: medical&amp; urological data assessment. Tool II: Kings Health Questionnaire (KHQ), it is a standardized questionnaire used to assess the impact of stress urinary incontinence on quality of life. The results showed that the quality of life among adult women with stress urinary incontinence were improved after the implementation of comprehensive nursing interventions with a statistically significance difference (p&gt;0.05) in all quality of life domains. . We conclude that provided comprehensive nursing interventions are effective in improving QOL in adult women with SUI. Given the study results, it is recommended that expand of public education efforts through various methods about importance of health educational interventions for appropriate management of stress urinary incontinence among women

Phenotypical changes of hematopoietic stem and progenitor cells in COVID-19 patients: Correlation with disease status

Hematopoietic stem cells (HSCs) and hematopoietic progenitor cells (HPCs) play a crucial role in the context of viral infections and their associated diseases. The link between HSCs and HPCs and disease status in COVID-19 patients is largely unknown. This study aimed to monitor the kinetics and contributions of HSCs and HPCs in severe and non-severe COVID-19 patients and to evaluate their diagnostic performance in differentiating between healthy and COVID-19 patients as well as severe and non-severe cases. Peripheral blood (PB) samples were collected from 48 COVID-19 patients, 16 recovered, and 27 healthy controls and subjected to deep flow cytometric analysis to determine HSCs and progenitor cells. Their diagnostic value and correlation with C-reactive protein (CRP), D-dimer, and ferritin levels were determined. The percentages of HSCs and common myeloid progenitors (CMPs) declined significantly, while the percentage of multipotent progenitors (MPPs) increased significantly in COVID-19 patients. There were no significant differences in the percentages of megakaryocyte-erythroid progenitors (MEPs) and granulocyte-macrophage progenitors (GMPs) between all groups. Severe COVID-19 patients had a significantly low percentage of HSCs, CMPs, and GMPs compared to non-severe cases. Contrarily, the levels of CRP, D-dimer, and ferritin increased significantly in severe COVID-19 patients. MPPs and CMPs showed excellent diagnostic performance in distinguishing COVID-19 patients from healthy controls and severe from non-severe COVID-19 patients, respectively. Collectively, our study indicated that hematopoietic stem and progenitor cells are significantly altered by COVID-19 and could be used as therapeutic targets and diagnostic biomarkers for severe COVID-19