International Medical Publisher Journals (iMedPub)
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Early Childhood’s Antibiotic Use and Risk of Allergic Diseases
Get PDFThis review considers the knowledge on the colonization of the infant’s gut with beneficial bacteria starting from early days of life. This colonization drives the developing, but immature, immune system of the infant though the local, intestinal, well-regulated, immune mechanisms, to tolerogenic immune response and “no-disease†state. This response in characterized by TH1 predominance. Any a perturbation of this homeostasis by environmental factors such as antibiotics, “swings back†the immune response towards TH2 response, increasing the propensity to develop allergic inflammation, and clinical allergic diseases. There is emerging evidence to support the role of intestinal microbiota in developing allergic disease. At clinic level, there is vivid research to determine role of antibiotics exposure in developing allergic diseases such as asthma, allergic rhinitis, eczema, and food allergy. The results of studies appear as if they are inconsistent or even conflicting. However, this inconsistency seems to be related to some methodological factors in evaluating the host, exposure, outcome and confounders. Still, the three is clear evidence that antibiotic exposure during prenatal period, infancy, or early childhood is associated with high risk of allergic diseases and asthma during infancy, childhood or early adolescence. This risk is governed by individual’s genetic background & place of residence, type and dose of antibiotics. It is quite important to remember, that antibiotics exposure or use is only one of the risk factors of increased risk of allergy among children and does not exclusively account for this rise
Treatment of combat-related traumatic chronic osteomyelitis with tigecycline: a case series
Get PDFObjective: To evaluate the efficacy of tigecycline treatment in Combat-Related Traumatic Chronic Osteomyelitis (CRTCO). Methods: A retrospective study evaluated tigecycline in the treatment of CRTCO. Cases were reviewed for patients who were treated for the period 2011 - June 2012. During the tigecycline treatment period, orthopedic surgeon taking care of patients started tigecycline treatment upon their discretion, not knowing about the pending study Results: Ten cases were included (one female), mean age 45.5 years. Most common involved bones with CRTCO were femur followed by tibia. Microbiological diagnoses were obtained mostly from bone biopsies and bone swabs. Microorganisms isolated were Acinetobacter spp. (6), Klebsiella pneumoniae (6), Escherichia coli (5), Pseudomonas aeruginosa (4), Enterococcus spp. (3), Staphylococcus aureus (1). Tigecycline mean duration of treatment was 35.7 days (range 21 - 91). Patients were treated with other antimicrobials earlier to tigecycline for a mean duration of 467.37 days (range 2 - 1825). Reasons for switching to tigecycline were: Clinical failure in all patients, in addition to side effects and microbiological failure of previous regimen. Paired difference of the ESR for eight available patients’ pair was not significant (p = 0.055), the same was for CRP (p = 0.9). Clinically improved patients were seven cases (70%). Conclusion: CRTCO is a polymicrobial infection mostly caused by gram-negative bacilli. The outcome of treating these infections with tigecycline is promising
Future Directions for Closed Loop Insulin Delivery Systems
Get PDFClosed loop insulin systems use a glucose sensor and insulin delivery system to maintainthe blood glucose levels in an automated manner. These devices show great promise as apotential treatment option more importantly for Diabetes Mellitus Type 1 but also, DiabetesMellitus Type 2. However these devices face many problems and these need to be solvedbefore a truly clinically applicable form of the device is commercially introduced. Theirefficacy also needs to be improved in certain groups such as children and pregnant women.The literature search was done on two indexes, Google Scholar and PubMed, using meshwords ‘closed loop insulin delivery in diabetes’. All the publications, by various authors,returning to this search, were critically reviewed, assimilated and summarized. This articlepresents this summary of the problems faced by these devices and suggests possiblesolutions for their improvement
Physicians Compliance with Antimicrobials’ De-escalation in Intensive Care Units in Jordan
Get PDFBackground To evaluate physicians’ behavior toward de-escalation of broad-spectrum antimicrobials to narrow-spectrum agents for patients when opportunities loom. Methods A prospective study held in three hospitals. Data were obtained prospectively for ICU patients with the diagnosis of severe infections i.e. severe systemic sepsis, multi-organ dysfunction syndrome and septic shock, and were started on BSA. Failure to de-escalate was considered if culture was available and was susceptible to a narrower antimicrobial agent; hitherto the treating physician did not de-escalate. Excluded from the study patients who were not started on BSA, were on antimicrobial prophylaxis or there was no clear indication for starting BSA, also patients whom their microbiological diagnoses were not available or the pathogen was only susceptible to the initially started BSA.  Results One hundred and nineteen patients’ charts were reviewed. There was 69 (58%) male and 50 (42%) female with mean ages of 59.3 and 68.6 years respectively. Eight (6.7%) patients were de-escalated to narrower spectrum antimicrobials. None of: APACHE 2 score, comorbidities, patients’ outcome while on BSA, sepsis-predisposing clinical diagnosis and microbiological diagnosis significantly encourage physicians for de-escalation. The commonest initial antimicrobials used were Meropenem, Pipracillin/Tazobactam and Imipenem.  Conclusion The majority of physicians are not de-escalating when it ought to be done. The concept of de-escalation has to be stressed upon widely among treating physicians
A novel binary biofilm model for the study of the development of antimicrobial tolerance in Pseudomonas aeruginosa PAO1 and Escherichia coli
Get PDFThe primary aim of this study was to investigate the effect of species interactions on biofilm formation and the investigation of the susceptibility of component species towards BIT in binary biofilms (Ps. aeruginosa PAO1and E. coli ATCC 10000). The Sorbarod biofilm model (Hodgson et al. 1995) was used to establish monospecies and binary species biofilms under conditions of growth rate control by the utilisation of a modified Chemically Defined Medium (MCDM). This MCDM was designed to allow the growth of both species (Ps. aeruginosa PAO1and E. coli ATCC 10000) in the same biofilm, without allowing either to have a growth rate advantage over the other. The results from these experiments suggest that it is possible to use this model to investigate the results of environmental exposure of bacteria to sub-MICs of biocides and develop an understanding of their subsequent tolerance and resistance characteristics. These results indicate that it is possible to establish a binary biofilm in chemically defined media, under growth rate control and to induce tolerance in dual species (binary) biofilms towards BIT. The mechanism of tolerance in binary biofilms towards this biocide was a gradual adaptive process, dependent upon the presence of biocide. This study elucidates a novel technique for the establishment, control and operation of binary biofilms. It has yielded information regarding the use of passage approaches to develop antimicrobials tolerance in both monospecies and binary species biofilms of medically important bacteria
Antimicrobial Resistance of Enteric Pathogens Isolated from Acute Gastroenteritis Patients in Gaza strip, Palestine
Get PDFBackground: Acute gastroenteritis is a severe infection of the gastrointestinal tract (GI). The antibiotic resistance of enteric bacteria has profound clinical implications because it threats the life and worsens the acute gastroenteritis disease. This study is a matched case-control study and aims to determine enteropathogenic bacteria, their antibiotic resistance and associated-risk factors in diarrheal patients in Gaza Strip.   Methods: 132 patients with acute diarrhea were investigated. In addition, data were collected from 132 healthy controls having the same characteristics of patients except the fact they didn’t suffer from diarrhea within the last three months. The age categories of patients are < 5 and > 5 years old. Data were collected through completing a questionnaire form for cases and controls and stool samples were collected from six Primary Health Care Clinics and these samples were inoculated on selective media in Remal clinic- Microbiology laboratory. Results: 12 (9.1%) enteropathogenic bacteria were isolated from 132 stool samples. Salmonella, Campylobacter coli/jejuni, and Aeromonas hydrophilia were isolated in equal numbers from samples 3/12 (25% each), Shigella 2/12 (16.7%), and Yersinia enterocolytica 1/12 (8.3%). The two Shigella spp. are Shigella boydii. The antimicrobial profile of all isolated enteropathogenic bacteria showed high resistance rates for the tested antimicrobials (C. coli/jejuni (52.4%), followed by A. hydrophilia (49.2%), Y. enterocolytica (42.9%), Shigella (26.2%) and Salmonella spp. (22.2%). In addition the antimicrobial profile of the isolated enteropathogenic bacteria showed high resistance rate to rifampin (91.6%), clindamycin (83.3%), erythromycin (75%), cephalexin and tetracycline (66.6%).  Conclusions: The isolated enteropathogenic bacteria showed high resistance rate to several antimicrobials. This study isolated C. coli/jejuni, A. hydrophilia, and Y. enterocolytica, which are not screened for during routine examinations of stool samples in Palestinian health laboratories in Gaza Strip.  Recommendations: We recommend improving of laboratory services in Gaza Strip to extend their ability to isolate all types of enteropathogenic bacteria especially those, which are not isolated routinely. Â
Review study on external-hospital bacteria as a source of infection and antimicrobial resistance in Lebanon
Get PDFMost studies done on bacteria in Lebanon are on hospital isolates. However, someof the sources of hospital isolates might be from contaminated foods and waterthat are imported into hospitals. Studies done in the Department of ExperimentalPathology, Immunology and Microbiology at the American University of Beirut onbacteria isolated from seafood, fruits, vegetables and poultry are reviewed, andattempts made to isolate V. cholerae from various water sources is reported. Theuse of antibacterial agents as food additives for poultry as a contributing factorfor the increase in resistant isolates is demonstrated. Methods to decontaminatefoods prior to getting into the kitchens of hospitals and homes are recommended
Stevens Johnson´s syndrome induced by leflunomide and methotrexate in a young patient with rheumatoid arthritis
Get PDFWe report a case of StevensJohson´s syndrome secondary to the use os leflunomideand methotrexate in a patient dignosed with rheumatoid arthritis. Treatment withcorticosteroids and cyclosporine were successful and mucose and skin lesions relievedin less than a month. A review of the StevensJohnson´s syndrome in terms ofmanagement is also presented
Fresh leafy green vegetables associated with multidrug resistant E.coli
Get PDFBackground: Recent outbreaks of  E. coli diarrheal diseases linked to the consumption of  fresh green produce, has raised a global concern about bacterial pathogens that cause food borne diseases. While little attention have been devoted to contamination of fresh green food with drug resistance bacteria species. Objective: To detect the occurrence of contamination and antibiotic resistance in E. coli isolates from fresh leafy vegetables presented in Jordanian retail markets. Study design: A total 150 fresh leafy green vegetable samples were collected from different markets in Amman and Al-Zarqa in Jordan over the five months; June through October, 2010  . Results: A total of 61 (40.6%) E. coli isolates were found as contaminates of 150 fresh leafy green vegetable samples. The highest contamination with E. coli occurred in parsley and lowest in Lettuce. A range of  3-41% of E. coli isolates were resistant to 7 common antibiotics used often in the treatment of urinary tract infection in Jordan. A total of 17 (27.8%) E. coli isolates were resistant to three or more antimicrobial agents and considered to be multidrug resistant. Of these, 14(82%) isolates were positive for class 1 integron, 17(100%) carry at least one plasmid with a common sizes (7.3 and 54.3 Kb), 12(70.6%),  and  2(11.8%) isolates were positive for Tet A and Tet B genes, respectively. A total of 15 (88.2%) isolates were positive for sul2 and 4 (23.5%) isolates for sul1 gene. Conclusion: This study demonstrates the widespread of antimicrobial resistance in E. coli contaminating fresh green produce and which may increase the reservoir of antimicrobial resistance in the intestinal tract of Jordanian population
Quinolones in Community-Acquired Pneumonia; Are They Born Equal?
Get PDFThere has been debate on the best treatment regimen for CAP, whether to start treatment with β-lactams, β-lactam β-lactamase inhibitor, macrolides, a combination of the earlier or quinolones, among other less commonly used agents. In this review, an attempt to examine some data on the utilization and importance of respiratory quinolones in the treatment of CAP, and to examine whether quinolones are the same in clinical and microbiological efficacy, shall we stick to seven days of treatment versus shorter duration without compromising outcome? Are resistance patterns for respiratory quinolones the same, and are there savings associated with using some respiratory quinolones over others? Moreover, are there any differences in mortality when examined as a treatment end-point, and if there is any differences in speed of recovery for different respiratory quinolones? Do we need to incorporate pharmacokinetics/pharmacodynamics principles in the treatment CAP, and how to dose anti-infective agents in CAP, opposed to leaving treatment-doses for minimum inhibitory concentration alone? Â