Exploring quinolone resistance-determining region in Neisseria gonorrhoeae isolates from across India

Background & objectives:

Antimicrobial resistance in Neisseria gonorrhoeae, the causative agent of gonorrhoea, is a subject of worldwide attention. The present study was undertaken to examine the rates of ciprofloxacin resistance, to correlate mutations in gyrA and parC genes with the level of resistance and to look for a variation in mutation pattern, if any, in isolates from across the country.

Methods:

A total of 113 isolates of N. gonorrhoeae collected from sexually transmitted infection patients in six centres during November 2010 to October 2013 were investigated. Minimum inhibitory concentration (MIC) determination was done by E-test and results interpreted as per Calibrated Dichotomous Sensitivity criteria. DNA sequence analysis of gyrA and parC genes was done.

Results:

Of the 113 isolates, only three (2.6%) were susceptible whereas eight (7.07%) were less susceptible, 32 [28.3%, 95% confidence interval (CI): 20.4-37.6%] resistant (MIC 1-3 µg/ml) and 70 (61.9%, 95% CI: 52.2-70.7%) exhibited high-level resistance (HLR) (MIC ≥4 µg/ml) to ciprofloxacin. A S91F substitution in gyrA gene was demonstrated in all ciprofloxacin non-susceptible isolates. All resistant and HLR isolates had a double mutation in gyrA gene. However, only 5.7 per cent of HLR isolates showed double mutations in parC gene. One isolate (MIC 32 µg/ml) had a previously undescribed G85D substitution in the parC gene.

Interpretation & conclusions:

A S91F substitution in gyrA gene was seen in all non-susceptible isolates of N. gonorrhoeae. It may be used as a marker for ciprofloxacin resistance for molecular surveillance approaches to complement the culture-based methods.

Impact of Additional Short Session of Video Training on Performance of Basic Life Support Skills in 2nd-Year Medical Students

CONTEXT

Basic life support (BLS) is a core life-saving skill which everyone should know, but knowledge of BLS is poor even among medical students.

AIMS

The aim of our study was to assess the knowledge regarding BLS among medical students and see impact of training and also to know whether a short session of video training made an impact on their cardiopulmonary resuscitation (CPR) skills.

SETTINGS AND DESIGN

Ninety-two 2^nd-year medical students were included in the study.

MATERIALS AND METHODS

Their baseline knowledge regarding BLS was assessed before workshop with pretest 1. Following workshop posttest 1 and 1 month later, posttest 2 was conducted. A short duration video training on BLS was done after posttest 2 and its impact was assessed 2 months later with performance of CPR skills on a mannequin.

STATISTICAL ANALYSIS USED

Data analysis was done using SPSS version 23.0. Pearson's Chi-square test was used to evaluate the differences between groups for categorized variables. Unpaired and paired t-test was used to calculate the difference of means for quantitative variables.

RESULTS

There was significant improvement in knowledge regarding BLS after the workshop. Even after 1 month, though there was decline in knowledge, still it was significantly higher than the baseline. Short duration video training session did not lead to any improvement in BLS skills.

CONCLUSIONS

BLS training should start early in medical curriculum with reinforcement at regular intervals. Single short duration video training session did not have any impact on improvement of skills.

Synthesis, Photoluminescence Behavior of Green Light Emitting Tb(III) Complexes and Mechanistic Investigation of Energy Transfer Process

A series of five new terbium(III) ion complexes with 4,4-difluoro-1-phenylbutane-1,3-dione (HDPBD) and anciliary ligands was synthesized. The composition and properties of complexes were analyzed by elemental analysis, IR, NMR, powder X-ray diffaraction, TG-DTG and photoluminescence spectroscopy. These complexes exhibited ligand sensitized green emission at 546 nm associated with ⁵D₄ → ⁷F₅ transitions of terbium ion in the emission spectra. The photoluminescence study manifested that the organic ligands act as antenna and facilitate the absorbed energy to emitting levels of Tb(III) ion efficiently. The enhanced luminescence intensity and decay time of ternary C2-C5 complexes observed due to synergistic effect of anciliary ligands. The CIE color coordinates of complexes came under the green region of chromaticity diagram. The mechanistic investigation of intramolecular energy transfer in the complexes was discussed in detail. These terbium(III) complexes can be thrivingly used as one of the green component in light emitting material and in display devices. Graphical Abstract Illustrate the sensitization process of the Tb ion and intramolecular energy transfer process in the Tb³⁺ complex.

Synthesis and photoluminescence properties of europium(III) complexes sensitized with β-diketonato and N, N-donors ancillary ligands

Synthesis of three new europium(III) complexes with 1,3-[bis(4-methoxyphenyl)]propane-1,3-dionato (HBMPD) ligand and ancillary ligands such as 2,2'-biquinoline (biq) or neocuproine (neo) has been reported in this report. The synthesized complexes were characterized by IR (infrared), ¹H and ¹³C NMR (nuclear magnetic resonance) spectroscopy, CHN (carbon, hydrogen and nitrogen) elemental analysis, XRD (X-ray diffraction), TGA (thermogravimetric analysis) and photoluminescence (PL) spectroscopy. The emission spectra of europium(III) complexes displayed both the low intensity ⁵D_1-3→⁷F_0-3 transitions in 410-560nm blue-green region and high intensity characteristic ⁵D₀→⁷F_0-3 transitions in 575-640nm orange-red region correspond to the emission of ancillary ligands and europium ion respectively, which can lead to white luminescence due to integration of blue, green and red color emissions. The photoluminescence investigations indicate that the absorbed energy of the HBMPD ligand transferred to the central europium(III) ion in an efficient manner, which clearly explained by antenna effect. The excellent results of thermal behavior and photophysical properties like luminescence spectra, CIE (Commission Internationale Eclairage) chromaticity coordinates, luminescence decay curves and high quantum efficiency of the complexes make them a promising component of the white light-emitting diodes in display devices.

In vitro efficacy of 21 dual antimicrobial combinations comprising novel and currently recommended combinations for treatment of drug resistant gonorrhoea in future era

BACKGROUND

Recent WHO guidelines recommend dual therapy with ceftriaxone or cefixime plus azithromycin for gonorrhea. Azithromycin in combination with gentamicin or spectinomycin has been recommended in treatment failure cases. Due to emergence of multi-drug resistant (MDR) and extensively-drug resistant (XDR) Neisseria gonorrhoeae strains, it is important to look for efficacy of these combinations and also of others that might be used in future. Therefore, we aimed to evaluate in vitro synergy of 21 dual combinations including current and alternative WHO recommended treatment regimens and other dual combinations.

METHODS AND FINDINGS

The potential utility of in-vitro interactions of 21 combinations was investigated against 95 N. gonorrhoeae strains including 79 MDR and one XDR strain collected during March 2013 to July 2017 and fractional inhibitory concentration index (FICI) was calculated. These 21 combinations comprised of two WHO currently recommended (cefixime+azithromycin, ceftriaxone+azithromycin); two WHO recommended in treatment failure cases (azithromycin+gentamicin, spectinomycin+azithromycin) and other 17 combinations.

RESULTS

FICI of the four WHO recommended antimicrobial combinations were higher (>1.0) than the five novel combinationbreeds (FICI range 0.603-0.951) in the study i.e. gentamicin+ertapenem, moxifloxacin+ertapenem, spectinomycin+ertapenem, azithromycin+ moxifloxacin, cefixime+gentamicin. No antagonistic effect of the above four WHO recommended combinations except spectinomycin+azithromycin (FICI = 4.25) was observed for the XDR strain. Out of above five novel combinations, four combinations produced high synergistic effects in overall 95 strains and also for the XDR strain with FICI of 0.13 to 0.38. Antagonistic effects varying from 3.2 to 12.6% were observed for 10 out of 21 tested combinations (azithromycin in combination with gentamicin and spectinomycin; ceftriaxone with moxifloxacin, gentamicin, spectinomycin and ertapenem; spectinomycin with moxifloxacin and gentamicin; cefixime and gentamicin combination with moxifloxacin).

CONCLUSION

WHO recommended cefixime+azithromycin, ceftriaxone+azithromycin combinations having no antagonism indicates their continuing clinical utility. Highest antagonism without any synergistic effect for the WHO recommended spectinomycin+azithromycin in treatment failure cases suggests that this combination should be evaluated further both in vitro and in vivo. Highest synergistic or additive effect without any antagonistic effect of the above five novel combinations suggests that these may be recommended for treatment in future.

Antibiotic susceptibility pattern of Neisseria gonorrhoeae strains isolated from five cities in India during 2013-2016

PURPOSE

Emergence of multidrug resistance in Neisseria gonorrhoeae, an STI of public health significance is the biggest challenge to gonorrhoea control. Monitoring for antimicrobial resistance is essential for the early detection of emergent drug resistance patterns.

METHODOLOGY

One hundred and twenty four N. gonorrhoeae strains were isolated between September 2013-August 2016 [82-New Delhi, 3-Pune, 3-Mumbai, 20-Secunderabad and 16-Hyderabad] to determine antimicrobial susceptibility and to compare the CLSI disc diffusion method with Etest for these strains. The results of the two methods were compared by using kappa statistics.

RESULTS

Ninety eight percent [CI: 96.2-100] of isolates were resistant to ciprofloxacin, 52 % [CI: 43.2-60.8] to penicillin, 56 % [CI: 47.2-64.7] to tetracycline and 5 % [CI: 1.2-8.8] to azithromycin. All the strains were susceptible to spectinomycin, ceftriaxone and cefixime except for two strains which showed decreased susceptibility to ceftriaxone and cefixime. Kappa scores for penicillin, azithromycin, ciprofloxacin, ceftriaxone and cefixime showed that the CLSI method had high agreement with Etest while tetracycline had substantial agreement.

CONCLUSION

Our data suggest that the disc diffusion method which is both cost effective and more feasible, can effectively be used routinely for monitoring antibiotic susceptibility in N. gonorrhoeae, in limited resource countries like India. We demonstrate the emergence of decreased susceptibility to ceftriaxone and cefixime and threshold levels of resistance to azithromycin in India. This underscores the importance of maintaining continued surveillance for antibiotic resistance in N. gonorrhoeae and a potential requirement for strategic change in guidelines in the not so distant future.

Correlation of HbA1C Levels With Body Mass Index in Newly Diagnosed Polycystic Ovary Syndrome

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a heterogeneous, multisystem endocrinopathy in women of reproductive age manifested with various metabolic disturbances and a wide spectrum of clinical features such as obesity, menstrual abnormalities and hyperandrogenism. Hyperinsulinemia was noted in 50% to 70% of PCOS patients and plays a central role in the development of further complications. The prevalence of obesity in PCOS ranges from 38% to 87%. It has been reported in previous studies that the prevalence of insulin resistance (IR) is higher in obese PCOS women than obesity without PCOS.

OBJECTIVE

To correlate HbA1c levels with body mass index (BMI) in newly diagnosed polycystic ovary syndrom (PCOS) women.

MATERIAL AND METHODS

This case-control study performed at Pt. B. D. Sharma PGIMS, Rohtak includes 30 newly diagnosed PCOS patients and 30 age matched healthy controls of any age. Fasting venous blood samples were obtained for analysis of fasting blood glucose, haemoglobin and HbA1c after obtaining written consent.

RESULTS

HbA1c concentration was higher in cases (6.03±0.19%) than in controls (5.35± 0.08%) with p = 0.002. 33.3% were in pre diabetic range (5.7-6.4%), 36.7% in diabetic range (≥6.5%) and 30% in non diabetic range (<5.7%). BMI of cases (26.09±4.2 kg/m2) was significantly higher than controls (22.9±3.3 kg/m2) with p=0.002. HbA1c showed positive correlation with BMI (p= 0.001).

CONCLUSION

In conclusion, BMI is associated with glycemic control in PCOS.

Multidrug-resistant gonorrhea: A research and development roadmap to discover new medicines

Emilie Alirol and colleagues discuss the development of new treatments for gonorrhea.

Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action

In a Policy Forum, Teodora Wi and colleagues discuss the challenges of antimicrobial resistance in gonococci.

Erratum to: The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

[This corrects the article DOI: 10.1186/s13017-017-0141-6.].

Evolution of nanostructured single-phase CoSb3 thin films by low-energy ion beam induced mixing and their thermoelectric performance

We report that a nanostructured CoSb₃ thin film in a single phase can be synthesized by ion beam processing of Co/Sb bilayer thin films with better thermoelectric properties.

Erratum to: Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

[This corrects the article DOI: 10.1186/s13017-016-0089-y.].

Adaptive Biomedical Innovation: Evolving Our Global System to Sustainably and Safely Bring New Medicines to Patients in Need

The current system of biomedical innovation is unable to keep pace with scientific advancements. We propose to address this gap by reengineering innovation processes to accelerate reliable delivery of products that address unmet medical needs. Adaptive biomedical innovation (ABI) provides an integrative, strategic approach for process innovation. Although the term "ABI" is new, it encompasses fragmented "tools" that have been developed across the global pharmaceutical industry, and could accelerate the evolution of the system through more coordinated application. ABI involves bringing stakeholders together to set shared objectives, foster trust, structure decision-making, and manage expectations through rapid-cycle feedback loops that maximize product knowledge and reduce uncertainty in a continuous, adaptive, and sustainable learning healthcare system. Adaptive decision-making, a core element of ABI, provides a framework for structuring decision-making designed to manage two types of uncertainty - the maturity of scientific and clinical knowledge, and the behaviors of other critical stakeholders.

In-silico Hierarchical Approach for the Identification of Potential Universal Vaccine Candidates (PUVCs) from Neisseria gonorrhoeae

OBJECTIVES

Resistance to the currently recommended extended-spectrum cephalosporins, which is used to treat Gonorrhea, is increasing continuously and leading to a threat of untreatable infection. It is, therefore, becoming extremely essential to search for new therapeutic strategies to control Gonorrhea. Vaccination may be considered as an effective control measure to control this disease, which is caused by Neisseria gonorrhoeae.

METHODS

In-silico hierarchical approach was used to help identify candidate proteins of N. gonorrhoeae that might contribute significantly in vaccine research. In contrast to the conventional vaccine research which requires at least 10-12 years, the present approach would reduce the time period drastically and help to identify Potential Universal Vaccine Candidates (PUVCs). These proteins were further analyzed for the presence of T-cell and linear B-cell epitopes, by using HLAPred and ABCpred servers respectively, in order to facilitate the identification of Multi Epitope Peptide Vaccine Constructs.

RESULTS

We have identified 23 non-host candidate proteins, using the proteomic information of four sequenced strains of N. gonorrhoeae namely FA 1090, TCDC_NG08107, NCCP11945 and MS11 and labeled them as PUVCs. Since all these identified 23 PUVCs contained both T cell and B cell epitopes, these have been further reiterated as PUVCs which could be used as promising leads for vaccine development.

CONCLUSIONS

This hierarchical approach is the first comprehensive study to identify potential vaccine candidates which once utilized for vaccine development would surely serve as promising tools for effective control of Gonorrhea.

Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study

BACKGROUND

The clinical course of advanced adrenocortical carcinoma (ACC) is heterogeneous. Our study aimed primarily to refine and make headway in the prognostic stratification of advanced ACC.

PATIENTS AND METHODS

Patients with advanced ENSAT ACC (stage III or stage IV) at diagnosis registered between 2000 and 2009 in the ENSAT database were enrolled. The primary end point was overall survival (OS). Parameters of potential prognostic relevance were selected. Univariate and multivariate analyses were carried out: model 1 'before surgery'; model 2 'post-surgery'.

RESULTS

Four hundred and forty-four patients with advanced ENSAT ACC (stage III: 210; stage IV: 234) were analyzed. After a median follow-up of 55.2 months, the median OS was 24 months. A modified ENSAT (mENSAT) classification was validated: stage III (invasion of surrounding tissues/organs or the vena renalis/cava) and stage IVa, IVb, IVc (2, 3 or >3 metastatic organs, including N, respectively). Two- or 5-year OS was 73%, 46%, 26% and 15% or 50%, 15%, 14% and 2% for stages III, IVa, IVb and IVc, respectively. In the multivariate analysis, mENSAT stages (stages IVa, IVb, or IVc, respectively) were significantly correlated with OS (P < 0.0001), as well as additional parameters: age ≥ 50 years (P < 0.0001), tumor- or hormone-related symptoms (P = 0.01 and 0.03, respectively) in model 1 but also the R status (P = 0.001) and Grade (Weiss >6 and/or Ki67 ≥ 20%, P = 0.06) in model 2.

CONCLUSION

The mENSAT classification and GRAS parameters (Grade, R status, Age and Symptoms) were found to best stratify the prognosis of patients with advanced ACC.